This document compares outcomes of aortobifemoral bypass grafting (ABF) versus recanalization with percutaneous transluminal angioplasty and stenting (R/PTAS) for treating extensive aortoiliac occlusive disease. Patients who received ABF were younger on average and had higher rates of smoking and hyperlipidemia than the R/PTAS group. Both procedures showed high technical success rates and similar improvements in hemodynamic measures. Early follow-up data indicates ABF may provide better long-term patency rates compared to R/PTAS, though longer-term studies are still needed. The study aims to evaluate whether R/PTAS can provide a less invasive alternative to
Fragility fractures represent a major global health problem. Orthopaedic surgeons have a unique opportunity to improve outcomes for fracture patients by addressing the underlying osteoporosis. Currently, few fracture patients receive evaluation and treatment for osteoporosis despite the condition increasing their risk of future fractures 2-5 times. There is a need for orthopaedic surgeons to play a more active role in optimizing care through evaluating bone mineral density, educating patients on osteoporosis risks, and facilitating referrals to ensure fracture patients receive treatment to prevent future fractures.
Tuberculosis of the spine commonly affects the thoracolumbar region. It presents with back pain and stiffness, cold abscesses, and neurological deficits in advanced cases. On radiographs, it shows vertebral body destruction, disc space narrowing, and paraspinal abscesses. CT and MRI are more sensitive in detecting bone and soft tissue involvement. Management involves anti-tubercular treatment along with surgery to decompress the spinal cord and restore stability if needed. Complications include paraplegia, deformity, and sinus tract formation.
traction on fingers
Surgeon: manipulates distal
fragment into position
Cast immobilization for 6-8
weeks
Follow up X-rays at 2 weeks, 6
weeks
Check for maintenance of
reduction
Gradual mobilization after cast
removal
Physiotherapy
Return to activities in 6-8 weeks
Complications: malunion, non-
union, reflex sympathetic
dystrophy
Indications for surgery:
- Irreducible fracture
- Significant displacement after
reduction
- Open fracture
- Associated injuries of distal
radioulnar joint
Surgical options:
- Percutaneous pinning
- External fixation
- Open reduction and internal
fix
This document discusses the anatomy, pathology, and clinical presentation of proximal biceps brachii tendon injuries. It describes the complex anatomy of the long head of the biceps tendon as it relates to the rotator cuff. Common causes of tendon pathology include overuse injuries in weightlifters and overhead athletes. Clinical evaluation involves tests like Speed's test and Yergason's test to assess for tendon subluxation or instability. Classification systems focus on tendinopathy, subluxation, dislocation, tears and lesions in different anatomic locations. Symptoms typically mirror those of rotator cuff pathology like anterior shoulder pain aggravated by overhead activity.
This document discusses measuring a patient's temporomandibular joint (TMJ) range of motion as part of a new patient exam. It recommends recording three opening movements (comfort, active, passive) which takes 20 seconds, and lateral and protrusive movements, adding another 40 seconds. Normal ranges are provided. The TheraBite range of motion scale is placed on the lower incisors to measure opening, and on the upper incisors for lateral and protrusive movements. Recording baseline TMJ measurements takes under a minute but provides important future reference if jaw issues arise.
supracondylar fracrture of humerus in childrenHardik Pawar
Supracondylar fractures of the humerus are the most common elbow fractures in children. They involve the lower end of the humerus just above the elbow joint. Radiographs are used to classify fractures as non-displaced (Type I), displaced with intact posterior cortex (Type II), or completely displaced (Type III). Treatment depends on the type of fracture and presence of displacement. Undisplaced fractures are treated with splinting while displaced fractures may require closed reduction and casting or pinning. Close monitoring of neurovascular status is important due to risk of injury.
Patient Specific Instrumentation in Total Knee ReplacementVaibhav Bagaria
Use of patient Specific Instruments in Knee replacement has generated tremendous interests, won accolades and also have been showered brick bats. A presentation about its true relevance in modern Knee replacement surgery.
Fragility fractures represent a major global health problem. Orthopaedic surgeons have a unique opportunity to improve outcomes for fracture patients by addressing the underlying osteoporosis. Currently, few fracture patients receive evaluation and treatment for osteoporosis despite the condition increasing their risk of future fractures 2-5 times. There is a need for orthopaedic surgeons to play a more active role in optimizing care through evaluating bone mineral density, educating patients on osteoporosis risks, and facilitating referrals to ensure fracture patients receive treatment to prevent future fractures.
Tuberculosis of the spine commonly affects the thoracolumbar region. It presents with back pain and stiffness, cold abscesses, and neurological deficits in advanced cases. On radiographs, it shows vertebral body destruction, disc space narrowing, and paraspinal abscesses. CT and MRI are more sensitive in detecting bone and soft tissue involvement. Management involves anti-tubercular treatment along with surgery to decompress the spinal cord and restore stability if needed. Complications include paraplegia, deformity, and sinus tract formation.
traction on fingers
Surgeon: manipulates distal
fragment into position
Cast immobilization for 6-8
weeks
Follow up X-rays at 2 weeks, 6
weeks
Check for maintenance of
reduction
Gradual mobilization after cast
removal
Physiotherapy
Return to activities in 6-8 weeks
Complications: malunion, non-
union, reflex sympathetic
dystrophy
Indications for surgery:
- Irreducible fracture
- Significant displacement after
reduction
- Open fracture
- Associated injuries of distal
radioulnar joint
Surgical options:
- Percutaneous pinning
- External fixation
- Open reduction and internal
fix
This document discusses the anatomy, pathology, and clinical presentation of proximal biceps brachii tendon injuries. It describes the complex anatomy of the long head of the biceps tendon as it relates to the rotator cuff. Common causes of tendon pathology include overuse injuries in weightlifters and overhead athletes. Clinical evaluation involves tests like Speed's test and Yergason's test to assess for tendon subluxation or instability. Classification systems focus on tendinopathy, subluxation, dislocation, tears and lesions in different anatomic locations. Symptoms typically mirror those of rotator cuff pathology like anterior shoulder pain aggravated by overhead activity.
This document discusses measuring a patient's temporomandibular joint (TMJ) range of motion as part of a new patient exam. It recommends recording three opening movements (comfort, active, passive) which takes 20 seconds, and lateral and protrusive movements, adding another 40 seconds. Normal ranges are provided. The TheraBite range of motion scale is placed on the lower incisors to measure opening, and on the upper incisors for lateral and protrusive movements. Recording baseline TMJ measurements takes under a minute but provides important future reference if jaw issues arise.
supracondylar fracrture of humerus in childrenHardik Pawar
Supracondylar fractures of the humerus are the most common elbow fractures in children. They involve the lower end of the humerus just above the elbow joint. Radiographs are used to classify fractures as non-displaced (Type I), displaced with intact posterior cortex (Type II), or completely displaced (Type III). Treatment depends on the type of fracture and presence of displacement. Undisplaced fractures are treated with splinting while displaced fractures may require closed reduction and casting or pinning. Close monitoring of neurovascular status is important due to risk of injury.
Patient Specific Instrumentation in Total Knee ReplacementVaibhav Bagaria
Use of patient Specific Instruments in Knee replacement has generated tremendous interests, won accolades and also have been showered brick bats. A presentation about its true relevance in modern Knee replacement surgery.
Radiology plays an important role in orthopaedics by providing diagnostic images of bones, joints, and soft tissues. The document discusses various imaging techniques used including conventional radiography, CT, MRI, ultrasound and others. It focuses on conventional radiography, describing the ABCs approach to evaluating x-rays which includes assessing adequacy, alignment, bones, cartilage, and soft tissues. Numerous orthopaedic views are outlined including those for the shoulder, elbow, wrist and their clinical applications. Standard projections and variations that demonstrate specific anatomical structures are presented.
Tuberculosis of the spine, also known as Pott's disease, is caused by Mycobacterium tuberculosis infection that spreads to the vertebrae. It most commonly involves the lower thoracic spine. Symptoms may include back pain, stiffness, deformity, and neurological deficits in 20% of cases. Diagnosis is made through clinical features, imaging such as x-rays showing vertebral destruction, and tests like tuberculin skin test or biopsy. Treatment involves anti-tuberculosis medications and surgery to correct deformities or treat neurological complications. Management aims to diagnose early, begin medical treatment promptly, and use surgery aggressively to prevent deformity and achieve good outcomes.
This document summarizes the history and process of hip resurfacing surgery. It discusses how hip resurfacing procedures aim to mimic the natural hip joint using 2-3 components: an acetabular component and bearing surface, and a femoral component. The document then outlines the design process for the femoral component, including reconstructing the proximal femur through sketches, sweeps, and blend operations in CAD software. Finite element analysis is conducted to test the implant design and ensure stress levels are below yield strengths when subjected to loads up to 2-3 times body weight. The conclusion is that the implant design has low chances of failure based on the FEA results.
This document discusses Cauda Equina Syndrome, a medical condition where the bundle of nerves (cauda equina) in the lower back is compressed, putting pressure on the nerves that control bowel and bladder function. It provides details on a patient case, symptoms like pain, saddle anesthesia, and bladder/bowel dysfunction. Research findings are presented on outcomes depending on surgery timing (better outcomes for patients treated within 48 hours) and severity of bladder/bowel dysfunction. Categories of cauda equina syndrome severity and their relationship to surgery outcomes are described from a 2016 literature review.
T12 fracture with spinal cord compression spinal cord injury treated with posterior spinal fusion and T12 decompression using costotransversectomy approach
The document discusses fractures of the proximal tibia, including:
1. An overview of the history, anatomy, classifications, management, surgical techniques, and latest advances in treating proximal tibia fractures.
2. The anatomy of the proximal tibia, knee joint, and surrounding ligaments are described in detail.
3. Proximal tibia fractures are classified using the Schatzker and AO systems, and treatment depends on the type of fracture, ranging from closed reduction to various surgical fixation techniques.
Differentiate Pronator Teres Syndrome and Carpal Tunnel Syndrome.pptxAde Wijaya
The document discusses differentiating between Pronator Teres Syndrome (PTS) and Carpal Tunnel Syndrome (CTS), which both involve median nerve entrapment. While CTS occurs at the carpal tunnel, PTS occurs at the forearm. Physical examination is important for differentiating the two, and electrodiagnostic studies may be negative or unreliable for PTS but often positive for CTS. It is also possible to have concurrent CTS and PTS.
Orthopedic Aspects Of Metabolic Bone Disease By XiuXiu Srithammasit
This document summarizes various metabolic bone diseases and their orthopedic manifestations and radiographic findings. It covers osteoporosis, rickets and osteomalacia, hyperparathyroidism, hypoparathyroidism, hyperthyroidism, and renal osteodystrophy. For each condition, it describes clinical presentation, pathogenesis, characteristic radiographic findings including areas of bone involvement and patterns of bone changes, and differential diagnoses.
1. The patient is a 75-year-old Thai man who fell off his bicycle 6 hours prior, injuring his left elbow and clavicle.
2. Radiographs show a fracture of the left shaft of the clavicle.
3. Clavicle fractures are commonly classified using the Allman or Neer classifications to determine appropriate treatment. Non-displaced or stable fractures are typically treated non-operatively while displaced or unstable fractures often require surgical fixation.
This document provides a history of orthopedic surgery from ancient times to modern developments. It describes how orthopedic surgery originated from the Greek words "ortho" meaning straight and "paedic" meaning child. Key figures mentioned include Hippocrates who described fracture reduction and clubfoot correction in ancient Greece. Advances in the field included the discoveries of anesthesia, antisepsis, x-rays, and antibiotics. Modern orthopedic surgery was pioneered in the 20th century with the development of techniques like internal fixation, joint replacement, and arthroscopy as well as imaging technologies.
This document provides an overview of common benign bone lesions. It begins with an introduction to bone tumors and their classification as benign or malignant. Several common benign bone tumors are then described in detail, including their clinical features, radiological appearance, diagnosis, treatment, and prognosis. Examples discussed include osteoid osteoma, osteoblastoma, bone islands, chondromas, osteochondromas, chondromyxoid fibroma, chondroblastoma, non-ossifying fibroma, fibrous dysplasia, unicameral bone cyst, aneurysmal bone cyst, and hemangioma. For each lesion, the key presenting symptoms, diagnostic imaging findings, treatment approaches such as surgery or observation, and recurrence risks
1) There are two types of bone healing - primary and secondary. Primary healing requires rigid fixation while secondary involves callus formation.
2) Different fixation methods, such as plates, screws, casts, result in different types of bone healing. Plates and screws typically lead to primary healing while casts usually involve callus formation.
3) Lag screws and plating techniques are methods to achieve compression across fractures, which is important for primary bone healing. A lag screw compresses by engaging only the far cortex while dynamic compression plates apply compression through eccentric screw placement.
This document discusses several types of lytic bone lesions that can be seen on imaging. It describes the imaging appearance and characteristics of lesions such as fibrous dysplasia, adamantinoma, enchondroma, eosinophilic granuloma, giant cell tumor, and nonossifying fibroma. Discriminating features are provided to help differentiate these benign lytic lesions from other entities. The document emphasizes that clinical history including patient age is important when narrowing the differential diagnosis of lytic bone lesions seen on imaging studies.
The document describes the anatomy of the carotid arteries and their branches, evaluation and imaging of carotid artery disease, and treatment strategies including lifestyle modifications to reduce risk factors, carotid endarterectomy to remove plaques from significantly stenotic arteries, and outcomes data from clinical trials on endarterectomy for symptomatic and asymptomatic carotid stenosis. Imaging modalities like carotid duplex ultrasound, CTA, and MRA are described for evaluating the degree of carotid stenosis. The benefits of carotid endarterectomy are greater for symptomatic high-grade stenosis while more moderate for asymptomatic disease.
1) The document discusses various surgical procedures for treating aortic root pathologies. It describes the anatomy of the aortic root and various conditions that can affect it like aneurysms and dissections.
2) Surgical techniques discussed include different types of composite graft replacements, valve sparing procedures, and re-do operations. Specific procedures mentioned are the Bentall procedure and the Ross procedure.
3) Factors that determine whether the aortic valve should be replaced or repaired are discussed. Guidelines for intervention based on aortic root size are also provided.
Radiology plays an important role in orthopaedics by providing diagnostic images of bones, joints, and soft tissues. The document discusses various imaging techniques used including conventional radiography, CT, MRI, ultrasound and others. It focuses on conventional radiography, describing the ABCs approach to evaluating x-rays which includes assessing adequacy, alignment, bones, cartilage, and soft tissues. Numerous orthopaedic views are outlined including those for the shoulder, elbow, wrist and their clinical applications. Standard projections and variations that demonstrate specific anatomical structures are presented.
Tuberculosis of the spine, also known as Pott's disease, is caused by Mycobacterium tuberculosis infection that spreads to the vertebrae. It most commonly involves the lower thoracic spine. Symptoms may include back pain, stiffness, deformity, and neurological deficits in 20% of cases. Diagnosis is made through clinical features, imaging such as x-rays showing vertebral destruction, and tests like tuberculin skin test or biopsy. Treatment involves anti-tuberculosis medications and surgery to correct deformities or treat neurological complications. Management aims to diagnose early, begin medical treatment promptly, and use surgery aggressively to prevent deformity and achieve good outcomes.
This document summarizes the history and process of hip resurfacing surgery. It discusses how hip resurfacing procedures aim to mimic the natural hip joint using 2-3 components: an acetabular component and bearing surface, and a femoral component. The document then outlines the design process for the femoral component, including reconstructing the proximal femur through sketches, sweeps, and blend operations in CAD software. Finite element analysis is conducted to test the implant design and ensure stress levels are below yield strengths when subjected to loads up to 2-3 times body weight. The conclusion is that the implant design has low chances of failure based on the FEA results.
This document discusses Cauda Equina Syndrome, a medical condition where the bundle of nerves (cauda equina) in the lower back is compressed, putting pressure on the nerves that control bowel and bladder function. It provides details on a patient case, symptoms like pain, saddle anesthesia, and bladder/bowel dysfunction. Research findings are presented on outcomes depending on surgery timing (better outcomes for patients treated within 48 hours) and severity of bladder/bowel dysfunction. Categories of cauda equina syndrome severity and their relationship to surgery outcomes are described from a 2016 literature review.
T12 fracture with spinal cord compression spinal cord injury treated with posterior spinal fusion and T12 decompression using costotransversectomy approach
The document discusses fractures of the proximal tibia, including:
1. An overview of the history, anatomy, classifications, management, surgical techniques, and latest advances in treating proximal tibia fractures.
2. The anatomy of the proximal tibia, knee joint, and surrounding ligaments are described in detail.
3. Proximal tibia fractures are classified using the Schatzker and AO systems, and treatment depends on the type of fracture, ranging from closed reduction to various surgical fixation techniques.
Differentiate Pronator Teres Syndrome and Carpal Tunnel Syndrome.pptxAde Wijaya
The document discusses differentiating between Pronator Teres Syndrome (PTS) and Carpal Tunnel Syndrome (CTS), which both involve median nerve entrapment. While CTS occurs at the carpal tunnel, PTS occurs at the forearm. Physical examination is important for differentiating the two, and electrodiagnostic studies may be negative or unreliable for PTS but often positive for CTS. It is also possible to have concurrent CTS and PTS.
Orthopedic Aspects Of Metabolic Bone Disease By XiuXiu Srithammasit
This document summarizes various metabolic bone diseases and their orthopedic manifestations and radiographic findings. It covers osteoporosis, rickets and osteomalacia, hyperparathyroidism, hypoparathyroidism, hyperthyroidism, and renal osteodystrophy. For each condition, it describes clinical presentation, pathogenesis, characteristic radiographic findings including areas of bone involvement and patterns of bone changes, and differential diagnoses.
1. The patient is a 75-year-old Thai man who fell off his bicycle 6 hours prior, injuring his left elbow and clavicle.
2. Radiographs show a fracture of the left shaft of the clavicle.
3. Clavicle fractures are commonly classified using the Allman or Neer classifications to determine appropriate treatment. Non-displaced or stable fractures are typically treated non-operatively while displaced or unstable fractures often require surgical fixation.
This document provides a history of orthopedic surgery from ancient times to modern developments. It describes how orthopedic surgery originated from the Greek words "ortho" meaning straight and "paedic" meaning child. Key figures mentioned include Hippocrates who described fracture reduction and clubfoot correction in ancient Greece. Advances in the field included the discoveries of anesthesia, antisepsis, x-rays, and antibiotics. Modern orthopedic surgery was pioneered in the 20th century with the development of techniques like internal fixation, joint replacement, and arthroscopy as well as imaging technologies.
This document provides an overview of common benign bone lesions. It begins with an introduction to bone tumors and their classification as benign or malignant. Several common benign bone tumors are then described in detail, including their clinical features, radiological appearance, diagnosis, treatment, and prognosis. Examples discussed include osteoid osteoma, osteoblastoma, bone islands, chondromas, osteochondromas, chondromyxoid fibroma, chondroblastoma, non-ossifying fibroma, fibrous dysplasia, unicameral bone cyst, aneurysmal bone cyst, and hemangioma. For each lesion, the key presenting symptoms, diagnostic imaging findings, treatment approaches such as surgery or observation, and recurrence risks
1) There are two types of bone healing - primary and secondary. Primary healing requires rigid fixation while secondary involves callus formation.
2) Different fixation methods, such as plates, screws, casts, result in different types of bone healing. Plates and screws typically lead to primary healing while casts usually involve callus formation.
3) Lag screws and plating techniques are methods to achieve compression across fractures, which is important for primary bone healing. A lag screw compresses by engaging only the far cortex while dynamic compression plates apply compression through eccentric screw placement.
This document discusses several types of lytic bone lesions that can be seen on imaging. It describes the imaging appearance and characteristics of lesions such as fibrous dysplasia, adamantinoma, enchondroma, eosinophilic granuloma, giant cell tumor, and nonossifying fibroma. Discriminating features are provided to help differentiate these benign lytic lesions from other entities. The document emphasizes that clinical history including patient age is important when narrowing the differential diagnosis of lytic bone lesions seen on imaging studies.
The document describes the anatomy of the carotid arteries and their branches, evaluation and imaging of carotid artery disease, and treatment strategies including lifestyle modifications to reduce risk factors, carotid endarterectomy to remove plaques from significantly stenotic arteries, and outcomes data from clinical trials on endarterectomy for symptomatic and asymptomatic carotid stenosis. Imaging modalities like carotid duplex ultrasound, CTA, and MRA are described for evaluating the degree of carotid stenosis. The benefits of carotid endarterectomy are greater for symptomatic high-grade stenosis while more moderate for asymptomatic disease.
1) The document discusses various surgical procedures for treating aortic root pathologies. It describes the anatomy of the aortic root and various conditions that can affect it like aneurysms and dissections.
2) Surgical techniques discussed include different types of composite graft replacements, valve sparing procedures, and re-do operations. Specific procedures mentioned are the Bentall procedure and the Ross procedure.
3) Factors that determine whether the aortic valve should be replaced or repaired are discussed. Guidelines for intervention based on aortic root size are also provided.
Recurrent ventricular arrhythmia after cardiac surgerysalah_atta
This document discusses the management of post-cardiac surgery ventricular arrhythmias. It begins by outlining the objectives and importance of addressing ventricular arrhythmias after cardiac surgery. Some key points include that ventricular arrhythmias are seen in about 50% of patients after surgery but are generally not related to mortality if left ventricular function is good, while sustained ventricular tachycardia and fibrillation occur less commonly but are life-threatening. The document then covers the epidemiology, etiology, risk factors, diagnosis and treatment of different types of postoperative ventricular arrhythmias.
This document reviews endovascular repair (TEVAR) for ruptured thoracic aortic aneurysms. It provides data on the incidence, mortality rates, and management of ruptured thoracic aneurysms. Open surgical intervention has mortality rates of 18-27% while TEVAR has shown lower 30-day mortality rates of 11-17% in single-institution studies. However, TEVAR is associated with higher mortality risks in older patients (>75 years old) and those with hemodynamic instability. The document recommends TEVAR as a less invasive alternative to open surgery for ruptured thoracic aneurysms, particularly when performed at experienced centers.
Endovascular repair of traumatic aortic transection six years of experienceGeorge Trellopoulos
The document discusses endovascular repair of traumatic aortic transections based on the experiences of treating 12 patients. It finds that endovascular stent grafting securely excluded the traumatic transections with no mortality or paraplegia, though one patient experienced late stent graft collapse requiring reintervention. The results suggest endovascular repair may be superior to open surgery for traumatic aortic transections given its lower mortality, paraplegia, and stroke rates.
Endovascular repair is a safe and effective treatment for traumatic aortic transections with lower mortality and paraplegia rates compared to open surgical repair. However, endovascular repair of transections poses critical issues including appropriate timing, managing small aortic diameters, preventing endograft collapse, and avoiding left subclavian artery occlusion. Newer endografts aim to address some of these issues through features like enhanced control during deployment and ability to treat a broader range of anatomies. Overall endovascular repair shows promise as the preferred treatment but requires close follow-up and further technical improvements to devices.
Valve replacement surgery involves replacing a diseased heart valve with an artificial prosthetic valve. There are two main types of prosthetic valves - mechanical valves made of synthetic materials that last longer but require lifelong blood thinners, and bioprosthetic valves made from animal tissue that do not require blood thinners but only last 10-15 years. Selection of the valve type depends on factors like the patient's age, other medical conditions, and ability to take blood thinners. Valve replacement is usually recommended for severe valve disease causing symptoms or when the risks of continuing valve disease outweigh the risks of surgery.
The document provides an overview of transcatheter aortic valve implantation (TAVI), including a brief history of its development, descriptions of the Edwards Sapien valve and delivery systems, approaches for TAVI, and complications. It also discusses patient screening and risk stratification, as well as newer valve devices that are being developed.
The document summarizes evidence on endovascular management of descending thoracic aorta pathologies, including aneurysms, dissections, and traumatic injuries. It describes outcomes from registries and trials showing technical success over 98% and reduced mortality and paraplegia compared to open surgery. However, no randomized trials have been conducted. It also notes that endografting is superior to open repair for complicated type B dissections but inferior to medical management for uncomplicated dissections. Endovascular treatment of traumatic injuries is feasible but lacks proven benefit.
This document discusses visceral ischemic syndromes and provides details on:
- The vascular anatomy of the celiac axis, SMA, and IMA arteries and their variants
- The main causes of acute mesenteric ischemia including embolism, thrombosis, NOMI, and venous thrombosis
- The clinical presentation and methods for radiographic workup
- Treatment approaches for different causes including embolectomy, thrombectomy, bypass grafting, and endovascular interventions
- Risk factors, symptoms, diagnosis and treatments for chronic mesenteric ischemia
Mitral stenosis surgery is recommended for adolescent or young adult patients with congenital mitral stenosis who have symptoms such as shortness of breath (NYHA class III or IV) and a mean mitral valve gradient over 10 mm Hg on echocardiography. Mitral valve surgery is also reasonable for asymptomatic patients with mild symptoms (NYHA class II) and a mean gradient over 10 mm Hg, or asymptomatic patients with pulmonary artery systolic pressure over 50 mm Hg and a mean gradient over 10 mm Hg. The effectiveness of surgery is uncertain for asymptomatic patients with new onset atrial fibrillation or embolisms while on anticoagulation.
Mitral stenosis surgery is recommended for adolescent or young adult patients with congenital mitral stenosis who have symptoms and a mean mitral valve gradient greater than 10 mm Hg. Mitral valve surgery is also reasonable for asymptomatic patients with mild symptoms and a mean gradient over 10 mm Hg, or asymptomatic patients with pulmonary artery systolic pressure over 50 mm Hg and a mean gradient over 10 mm Hg. The effectiveness of surgery is uncertain for asymptomatic patients with new onset atrial fibrillation or embolisms while on anticoagulation.
1. Arterial aneurysms are a permanent localized dilatation of an artery over its normal diameter. They are caused by degenerative diseases like atherosclerosis that damage the artery wall.
2. Abdominal aortic aneurysms (AAA) specifically are 4 times more common in males. They are usually asymptomatic but can cause pain or rupture. Elective repair is recommended when AAA exceeds 5.5cm in diameter.
3. Ruptured AAA has a high mortality rate of 50% even with emergency surgery, so preventative repair of larger aneurysms is important to avoid rupture.
Endovascular repair of traumatic aortic transection six years of experienceGeorge Trellopoulos
This document discusses endovascular repair as an alternative treatment for ruptured abdominal aortic aneurysms compared to open repair. Endovascular repair has the benefits of avoiding general anesthesia, clamping, and blood loss. Several studies show endovascular repair results in lower mortality and morbidity rates compared to open repair. However, patient hemodynamic status and anatomy must meet certain criteria for endovascular repair to be feasible. Key considerations for successful endovascular repair include the patient's clinical condition, CT imaging of anatomy, type of anesthesia used, stent graft configuration, and potential use of an occlusion balloon. Long-term data is still needed but endovascular repair shows promise as an additional treatment option for ruptured abdominal aortic aneurys
Posterior approach aortic root enlargement in redo aorticescts2012
This document discusses aortic root enlargement using a posterior approach for redo aortic valve replacement. It provides details on the surgical technique used, which involves extending the aortotomy incision along the commissure between the left coronary and noncoronary sinuses across the anterior mitral leaflet and using a Dacron patch to enlarge the annulus. Results from a study of 25 patients found a hospital mortality rate of 8% due to low cardiac output, with 3 patients requiring reexploration for bleeding. The conclusion is that aortic root enlargement using this posterior approach can be done safely and does not increase surgical risk. However, the main limitation is the small number of patients and lack of long-term follow-
Coronary Ostial stenting techniques:Current statusPawan Ola
Ostial lesions, located within 3 mm of a vessel origin, pose unique challenges for percutaneous coronary intervention (PCI). Precise stent placement is required to avoid geographic miss and ensure optimal coverage of the lesion. Several techniques have been developed to aid accurate stent placement for ostial lesions, including aorto-free floating wire, stent pull-back, and Szabo/anchor wire methods. The use of these targeted approaches can reduce the risk of additional stenting and reintervention compared to conventional PCI for ostial lesions.
Hybrid tevar for the treatment of aortic dissectionuvcd
- Hybrid TEVAR involves using open surgery and endovascular stent grafting to treat aortic dissection.
- It can be used for acute type A dissection to allow total arch repair followed by TEVAR for the descending thoracic aorta. It is also indicated for chronic type B dissection when there is no suitable proximal landing zone by creating one through open surgery.
- The author presents results from their hospital demonstrating the safety and effectiveness of hybrid TEVAR for both acute type A and chronic type B dissection, with favorable outcomes including high rates of false lumen thrombosis and regression.
This document discusses the debate around whether endovascular or surgical interventions should be the first option for treating critical limb ischemia in the lower extremities. It presents data on patency rates from studies comparing percutaneous angioplasty and stenting to femoral-popliteal bypass. It also summarizes studies reporting outcomes of endovascular and surgical procedures for various levels of the leg vasculature. The overall conclusion is that an endovascular-first approach is reasonable for appropriately selected patients, as it is not associated with worse outcomes compared to initial surgery.
Similar to Doença oclusiva em terrritório aorto ilíaco (20)
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. INTRODUÇÃOINTRODUÇÃO
1/3 PACIENTES COM ATEROSCLEROSE1/3 PACIENTES COM ATEROSCLEROSE
OBLITERANTEOBLITERANTE
POPULAÇÃO – 39-65 ANOS 1-2%POPULAÇÃO – 39-65 ANOS 1-2%
ACIMA DOS 70 ANOS 6%ACIMA DOS 70 ANOS 6%
SUCESSO INICIAL DE 96%SUCESSO INICIAL DE 96%
PERVIEDADE - 5 ANOS – 91%PERVIEDADE - 5 ANOS – 91%
MORBIDADE – 8,3%MORBIDADE – 8,3%
MORTALIDADE – 3,3%MORTALIDADE – 3,3%
17. TASC II Classification of Aortoiliac‐TASC II Classification of Aortoiliac‐
DiseaseDisease
Tipo ATipo A
Estenose unilateral ou bilateral da artéria ilíacaEstenose unilateral ou bilateral da artéria ilíaca
comumcomum
Estenose curta unilateral ou bilateral da artériaEstenose curta unilateral ou bilateral da artéria
ilíaca externa (<3cm)ilíaca externa (<3cm)
18.
19. TASC II Classification of Aortoiliac‐TASC II Classification of Aortoiliac‐
DiseaseDisease
Tipo BTipo B
Estenose curta aorta da infra-renal (<3cm)Estenose curta aorta da infra-renal (<3cm)
Oclusão unilateral da artéria ilíaca comumOclusão unilateral da artéria ilíaca comum
Uma ou várias estenoses - 3 10cm envolvendo‐Uma ou várias estenoses - 3 10cm envolvendo‐
a artéria ilíaca externa sem se extender para aa artéria ilíaca externa sem se extender para a
femoral comum.femoral comum.
Oclusão unilateral da artéria ilíaca externa semOclusão unilateral da artéria ilíaca externa sem
envolver a origem da ilíaca interna ou femoralenvolver a origem da ilíaca interna ou femoral
comumcomum
20.
21.
22. TASC II Classification of Aortoiliac‐TASC II Classification of Aortoiliac‐
DiseaseDisease
Tipo CTipo C
Oclusão da artéria ilíaca comum - bilateralOclusão da artéria ilíaca comum - bilateral
Artéria Ilíaca Externa – bilateral - estenose - 3 10cm sem‐Artéria Ilíaca Externa – bilateral - estenose - 3 10cm sem‐
envolver a artéria femoral comumenvolver a artéria femoral comum
Estenose unilateral da artéria ilíaca externa envolvendo a artériaEstenose unilateral da artéria ilíaca externa envolvendo a artéria
femoral comumfemoral comum
Estenose unilateral da artéria ilíaca externa envolvendo a artériaEstenose unilateral da artéria ilíaca externa envolvendo a artéria
femoral comum e a origem da artéria ilíaca internafemoral comum e a origem da artéria ilíaca interna
Oclusão unilateral da artéria ilíaca externa (calcificada) semOclusão unilateral da artéria ilíaca externa (calcificada) sem
envolver a artéria femoral comum e a origem da artéria ilíacaenvolver a artéria femoral comum e a origem da artéria ilíaca
internainterna
23.
24.
25. TASC II Classification of Aortoiliac‐TASC II Classification of Aortoiliac‐
DiseaseDisease
Tipo DTipo D
Oclusão aórtica infra-renalOclusão aórtica infra-renal
Doença difusa da aorta envolvendo ambas as ilíacasDoença difusa da aorta envolvendo ambas as ilíacas
Múltiplas estenoses das artérias artéria ilíaca comum,Múltiplas estenoses das artérias artéria ilíaca comum,
interna e femoral comuminterna e femoral comum
Oclusão unilateral da artéria da artéria ilíaca comum eOclusão unilateral da artéria da artéria ilíaca comum e
ilíaca externailíaca externa
Oclusão bilateral da artéria ilíaca externaOclusão bilateral da artéria ilíaca externa
Estenose ilíaca associada AAAEstenose ilíaca associada AAA
37. EndarterectomiaEndarterectomia
Reservado para o Tipo IReservado para o Tipo I
Não pode ser realizada em pacientes comNão pode ser realizada em pacientes com
AneurismaAneurisma
PerviedadePerviedade
Cirurgião DependenteCirurgião Dependente
60 94% em 5 anos‐60 94% em 5 anos‐
38.
39. Bypass AnatômicoBypass Anatômico
AortofemoralAortofemoral
Transabdominal ou RetroperitonealTransabdominal ou Retroperitoneal
Anastomoses : Termino-terminal ou Termino-Anastomoses : Termino-terminal ou Termino-
laterallateral
PTFE ou DacronPTFE ou Dacron
45. INDICAÇÕES PARA OINDICAÇÕES PARA O
PROCEDIMENTO CIRÚRGICOPROCEDIMENTO CIRÚRGICO
Recommendation 36Recommendation 36. Treatment of aortoiliac lesions. Treatment of aortoiliac lesions
· TASC A and D lesions: Endovascular therapy is the treatment of· TASC A and D lesions: Endovascular therapy is the treatment of
choice for type A lesions and surgery is the treatment of choicechoice for type A lesions and surgery is the treatment of choice
for type D lesions [C].for type D lesions [C].
· TASC B and C lesions: Endovascular treatment is the preferred· TASC B and C lesions: Endovascular treatment is the preferred
treatment for type B lesions and surgery is the preferredtreatment for type B lesions and surgery is the preferred
treatment for good-risk patients with type C lesions. Thetreatment for good-risk patients with type C lesions. The
patient’s co-morbidities, fully informed patient preference andpatient’s co-morbidities, fully informed patient preference and
the local operator’s long-term success rates must be consideredthe local operator’s long-term success rates must be considered
when making treatment recommendations for type B and type Cwhen making treatment recommendations for type B and type C
lesions [C].lesions [C].
49. Objective:Objective: Aortobifemoral bypass (ABF) grafting has been the traditional treatment for extensive aortoiliac occlusiveAortobifemoral bypass (ABF) grafting has been the traditional treatment for extensive aortoiliac occlusive
disease (AIOD). This retrospective study compared the outcomes and durability of recanalization, percutaneousdisease (AIOD). This retrospective study compared the outcomes and durability of recanalization, percutaneous
transluminal angioplasty, and stenting (R/PTAS) vs ABF for severe AIOD.transluminal angioplasty, and stenting (R/PTAS) vs ABF for severe AIOD.
Methods:Methods: Between 1998 and 2004, 86 patients (161 limbs) underwent ABF (nBetween 1998 and 2004, 86 patients (161 limbs) underwent ABF (n __ 75) or iliofemoral bypass (n75) or iliofemoral bypass (n __ 11), and11), and
83 patients (127 limbs) underwent R/PTAS. All patients had severe symptomatic AIOD (claudication, 53%; rest pain,83 patients (127 limbs) underwent R/PTAS. All patients had severe symptomatic AIOD (claudication, 53%; rest pain,
28%; tissue loss, 12%; acute limb ischemia, 7%). The analyses excluded patients treated for aneurysms, extra-anatomic28%; tissue loss, 12%; acute limb ischemia, 7%). The analyses excluded patients treated for aneurysms, extra-anatomic
procedures, and endovascular treatment of iliac stenoses. Original angiographic imaging, medical records, andprocedures, and endovascular treatment of iliac stenoses. Original angiographic imaging, medical records, and
noninvasive testing were reviewed. Kaplan-Meier estimates for patency and survival were calculated and univariatenoninvasive testing were reviewed. Kaplan-Meier estimates for patency and survival were calculated and univariate
analyses performed. Mortality was verified by the Social Security database.analyses performed. Mortality was verified by the Social Security database.
Results:Results: The ABF patients were younger than the R/PTAS patients (60 vs 65 years;The ABF patients were younger than the R/PTAS patients (60 vs 65 years; PP __ .003) and had higher rates of.003) and had higher rates of
hyperlipidemia (hyperlipidemia (PP __ .009) and smoking (.009) and smoking (PP < .001). All other clinical variables, including cardiac status, diabetes,< .001). All other clinical variables, including cardiac status, diabetes,
symptoms at presentation, TransAtlantic Inter-Society Consensus stratification, and presence of poor outflow weresymptoms at presentation, TransAtlantic Inter-Society Consensus stratification, and presence of poor outflow were
similar between the two groups. Patients underwent ABF with general anesthesia (96%), often with concomitantsimilar between the two groups. Patients underwent ABF with general anesthesia (96%), often with concomitant
treatment of femoral or infrainguinal disease (61% endarterectomy, profundaplasty, or distal bypass). Technical successtreatment of femoral or infrainguinal disease (61% endarterectomy, profundaplasty, or distal bypass). Technical success
was universal, with marked improvement in ankle-brachial indices (0.48 to 0.84,was universal, with marked improvement in ankle-brachial indices (0.48 to 0.84, PP<.001). Patients underwent R/PTAS<.001). Patients underwent R/PTAS
with local anesthesia/sedation (78%), with a 96% technical success rate and similar hemodynamic improvement (0.36 towith local anesthesia/sedation (78%), with a 96% technical success rate and similar hemodynamic improvement (0.36 to
0.82,0.82, PP < .001). At the time of R/PTAS, 21% of patients underwent femoral endarterectomy/profundaplasty or bypass< .001). At the time of R/PTAS, 21% of patients underwent femoral endarterectomy/profundaplasty or bypass
(n(n __ 5) for concomitant infrainguinal disease.5) for concomitant infrainguinal disease. Limb-based primary patency at 3 years was significantly higher forLimb-based primary patency at 3 years was significantly higher for ABFABF
than for R/PTAS (93% vs 74%,than for R/PTAS (93% vs 74%, PP __ .002). Secondary patency rates (97% vs 95%), limb salvage (98% vs. 98%), and long-.002). Secondary patency rates (97% vs 95%), limb salvage (98% vs. 98%), and long-
term survival (80% vs 80%) were similar.term survival (80% vs 80%) were similar. Diabetes mellitus and the requirement of distal bypass were associatedDiabetes mellitus and the requirement of distal bypass were associated
with decreased patency (with decreased patency (PP < .001). Critical limb ischemia at presentation (tissue loss, hazard ratio [HR], 8.1;< .001). Critical limb ischemia at presentation (tissue loss, hazard ratio [HR], 8.1; PP < .< .
001), poor outflow (HR, 2;001), poor outflow (HR, 2; PP __ .023), and renal failure (HR, 2.5;.023), and renal failure (HR, 2.5; PP __ .02) were associated with decreased survival..02) were associated with decreased survival.
Conclusion:Conclusion: R/PTAS is a suitable, less invasive alternative to ABF for the treatment of severe AIOD. Repair of theR/PTAS is a suitable, less invasive alternative to ABF for the treatment of severe AIOD. Repair of the
concomitant femoral occlusive disease is often needed regardless of open or endovascular treatment. Infrainguinalconcomitant femoral occlusive disease is often needed regardless of open or endovascular treatment. Infrainguinal
disease negatively affects the durability of the procedure and patient survival. ( J Vasc Surg 2008;48:1451-57.)disease negatively affects the durability of the procedure and patient survival. ( J Vasc Surg 2008;48:1451-57.)
50. CONCLUSÃOCONCLUSÃO
OPÇÃO DO TRATAMENTO CIRÚRGICOOPÇÃO DO TRATAMENTO CIRÚRGICO
CONDIÇÕES ANATÔMICASCONDIÇÕES ANATÔMICAS
CONDIÇÕES CLÍNICAS DO PACIENTECONDIÇÕES CLÍNICAS DO PACIENTE
RISCO DO PROCEDIMENTORISCO DO PROCEDIMENTO
INTERVENÇÕES PRÉVIASINTERVENÇÕES PRÉVIAS
EXPECTATIVA DE VIDAEXPECTATIVA DE VIDA