Annals of vascular surgery
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Meta Analysis
Extracorporeal Shockwave Therapy for Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis.
Diabetes mellitus is one of the most common chronic diseases worldwide. Diabetic foot ulcers (DFUs) occur in over 10% of diabetic patients and are associated with high morbidity. Clinical trials have shown benefit from extracorporeal shockwave therapy (ESWT) in a DFU healing. This systematic review aims to assess the currently available evidence examining the efficacy of ESWT on healing of DFU. ⋯ This systematic review concludes that ESWT has the potential to improve healing in DFUs, although there is, as yet, insufficient evidence to justify its use in routine clinical practice. The meta-analysis has a high risk of bias and is unlikely to reflect true effect size because of problematic risk of bias in included studies. This review highlights the variable quality of methodology of trials and dosing of shockwave therapy and the need for robust adequately powered research into this promising therapy.
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Meta Analysis Comparative Study
Open versus Endovascular Repair of Descending Thoracic Aortic Aneurysm Disease: A Systematic Review and Meta-analysis.
The purpose of this study was to determine whether thoracic endovascular aortic repair reduces death and morbidity compared with open surgical repair for descending thoracic aortic disease. ⋯ The present meta-analysis shows that endovascular repair of thoracic aortic aneurysm gives better perioperative outcomes during inhospital stay although the 1- and 5-year mortality remains the same in both groups; but the long-term outcome is yet to be established. A long-term data and studies are required to give a better understanding of comparing these 2 techniques beyond 5 years of follow-up.
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Review Case Reports
Ruptured Iliac Pseudoaneurysm after Intravesical Bacillus Calmette-Guérin: Urgent Endovascular Treatment. Case Report and Literature Review.
Ruptured mycotic aneurysms are an extremely rare complication of intravesical Bacillus Calmette-Guerin (BCG) immunotherapy. Several cases involving various arterial sites, mostly in the thoracic or abdominal aorta, have been described in the literature. BCG immunotherapy rarely causes false aneurysms and open surgical repair using an in situ prosthetic graft is most commonly performed. Further to this, targeted antituberculous treatment is required for at least one year following surgery. ⋯ Endovascular repair can be considered a valid option in an emergency. A hybrid approach was chosen due to the need for urgent action and the poor condition of the patient who was hemodynamically unstable. In particular, the implantation of an aortouniiliac endoprosthesis at the level of the contralateral iliac axis allowed us to avoid the release of an endoprosthesis at the infected area level. Close patient follow-up with clinical evaluation every 3 months and a computed tomography scan yearly is mandatory following the intervention and during antibiotic therapy. A systematic review of the literature has been subsequently carried out on this specific clinical case, highlighting 47 cases described from 1988.
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Three-dimensional (3D) printing, also known as rapid prototyping or additive manufacturing, is a novel adjunct in the medical field. The aim of this systematic review is to evaluate the role of 3D printing technology in the field of contemporary vascular surgery in terms of its technical aspect, practicability, and clinical outcome. ⋯ 3D printing was recognized and gradually incorporated as a useful adjunct in the field of vascular and endovascular surgery. The production of an accurate anatomic patient-specific replica was shown to bring significant impact in patient management in terms of anatomic understanding, procedural planning, and intraoperative navigation, education, and academic research as well as patient communication. Further analysis on cost-effectiveness was indicated to guide decisions on applicability of such promising technology on a routine basis.
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Catheter-directed thrombolysis (CDT) is a therapeutic option with acceptable results in patients with acute limb ischemia (ALI) but with severe systemic or intracranial bleeding being the most significant clinical complication. The aim of the study is to collect and present direct results of CDT in patients treated for ALI. ⋯ Results confirm the high direct technical success rate of CDT and the high percentage of patients survived without amputation within 30 days, although major complications are a great disadvantage of the method.