Modification of protocol with one extra drop of endovascular cyanoacrylate improved closure rates in incompetent great saphenous veins.

Introduction: Great saphenous vein diameter (GSV) of >8 mm was predictor of recanalization following Venaseal cyanoacrylate treatment. The aim of this study was to report our modified protocol with a single extra-drop for treatment for GSV>8 mm, and comparative duplex results in closure rates.

Methods: Patients in our single-centre registry treated with Venaseal were followed up by serial duplex examinations at week 1 and month(s)- 1, 6, 12, 18, 24, and then annually.

Cyanoacrylate glue used to treat great saphenous reflux: Measures of outcome.

Introduction This is a single-center clinical study for the evaluation of safety, efficacy, and performance of endovenous cyanoacrylate (Sapheon Venaseal Closure System, now Medtronic Medical) for the treatment of great saphenous vein (GSV) reflux. Methods Primary outcome measures included the GSV obliteration, with clinical recurrence on follow up as detected by serial clinical and duplex examinations of patients at 1 week, 1 month, 6 months, and 1 year. Venous clinical severity score (VCSS), Aberdeen varicose vein questionnaire (AVVQ), Short Form Health Survey 36 Item (SF-36) questionnaires were used at clinical follow up.

Outcome and risk factor analysis of patients who underwent open infrarenal aortic aneurysm repair.

Introduction: The aim of this study was to evaluate the short- and long-term outcomes in patients who underwent open infrarenal aortic aneurysm repair.

Methods: Consecutive patients who underwent open repair of infrarenal aortic aneurysms at our institution from July 1(st) 1990 to June 30(th) 2012 were reviewed from a prospective collected departmental database. Short-term outcomes included 30-day mortality and peri-operative complications.

Primary stenting of femoropopliteal atherosclerotic lesions using new helical interwoven nitinol stents.

Background: The Supera helical interwoven nitinol stent has enhanced flexibility in counteracting fractures when placed in the femoropopliteal arteries and may improve patency. The aim of this study is to assess the early results of the Supera stent in symptomatic patients with femoropopliteal atherosclerotic lesions.

Methods: From October 2011 to April 2013, patients with symptomatic femoropopliteal lesions were treated with angioplasty and primary stenting using the Supera stent.

Surgeons' static posture and movement repetitions in open and laparoscopic surgery.

Background: There is increasing concern about the surgeon maintaining a static posture during laparoscopic surgery, which can contribute to musculoskeletal disorders. A series of studies are being conducted in Hong Kong examining the surgeons' real-time movements and electromyography in the operating theater during different operations. The present paper examines the postures and movements of surgeons during real-time open and laparoscopic procedures.

Prevalence of abdominal aortic aneurysm in Chinese patients with severe coronary artery disease.

Background: The Asian population is believed to have lower incidence of abdominal aortic aneurysm (AAA), and hence, the benefit of screening is uncertain. The size of native aorta in Asians, which shall affect the definition of AAA, has also never been reported. Our study investigated the prevalence of AAA and the infra-renal aortic diameter (AD) in Chinese patients with severe coronary artery disease.

Successful endovascular infrarenal aneurysm repair in a patient with situs inversus totalis.

Situs inversus totalis is a rare autosomal recessive developmental anomaly. There are very few reports in the published literature of abdominal aortic aneurysm in patient with situs inversus totalis, all of whom underwent open aneurysm repair. This is the first case in the world's literature to describe a patient with situs inversus totalis who had a successful endovascular infrarenal aneurysm repair.

Work-related musculoskeletal symptoms in surgeons.

Introduction: Surgeons are a unique group of healthcare professionals who are at risk for developing work-related musculoskeletal symptoms (WMS). The diversity of operating skills for laparoscopic and endovascular procedures impose different physical demands on surgeons, who also work under time pressure. The present study aims to examine the physical and psychosocial factors and their association with WMS among general surgeons in Hong Kong.

Endovascular repair for thoracic aortic pathologies--early and midterm results.

Objective: To assess the early and midterm results of endovascular stent graft repair in patients with thoracic aortic pathologies.

Methods: Between March 2000 and December 2005, 44 consecutive patients undergoing endovascular repair for 45 thoracic aortic lesions were studied. Follow-up protocol includes regular clinical examination and computed tomographies.

Secondary infection of a pre-existing thoracic aortic aneurysm by iatrogenic oesophageal perforation with aorta-oesophageal fistula formation.

We report a case of iatrogenic perforation of the oesophagus, with subsequent infection of a pre-existing thoracic aortic aneurysm and development of an aorto-oesophageal fistula resulting in life-threatening haemorrhage. This was successfully treated with endovascular aortic stent-graft using a Cook Zenith Tx2 device. Follow-up CT scan 3 months later showed that the aneurysm sac is getting smaller, and patient had no further septic or haemorrhagic complications.

Endovascular repair for abdominal aortic aneurysms: the first hundred cases.

Objective: To evaluate the early and mid-term results of the first 100 elective endovascular repairs for abdominal aortic aneurysms.

Design: Retrospective analysis of prospectively collected data.

Setting: University teaching hospital, Hong Kong.

Supra-aortic hybrid endovascular procedures for complex thoracic aortic disease: single center early to midterm results.

Background: Hybrid technique with open surgical supra-aortic extra-anatomical bypasses (to provide a suitable proximal landing zone) and simultaneous or staged thoracic endovascular stent grafting is less invasive than open surgery in the treatment of complex aortic arch pathology. The aim of this study is to report our hybrid experience.

Methods: Retrospective review of prospectively collected computerized database.

Ionizing radiation absorption of vascular surgeons during endovascular procedures.

Objective: Endovascular procedures have become an integral part of a vascular surgeon's practice. The exposure of surgeons to ionizing radiation and other safety issues have not been well studied. We investigated the radiation exposure of a team of vascular surgeons in an active endovascular unit and compared yearly dosages absorbed by various body parts among different surgeons.

Hybrid endovascular operation for ruptured thoracic aortic aneurysm.

The rupture of a thoracic aortic aneurysm is a life-threatening emergency. Conventional open surgical repair carries a high mortality and morbidity. We report an elderly patient who suffered from rupture of a proximal descending thoracic aortic aneurysm close to the aortic arch.

Endovascular stent graft repair for infected thoracic aortic pseudoaneurysms--a durable option?

Objective: Open surgical repair for infected thoracic aortic pseudoaneurysms carries significant mortality and morbidity. Endovascular stent graft repair has been our preferred approach, although its role remains controversial because persistent infection is always a concern. We aimed to assess the efficacy and durability of endovascular stent graft repair in these patients.

Improvement of mortality of ruptured abdominal aortic aneurysm patients over 12 years and its relationship with tracheostomy.

Cardiopulmonary complication after ruptured abdominal aortic aneurysm (rAAA) repair is an important cause of mortality. Early tracheostomy promotes patient recovery from respiratory morbidities. A policy of routine immediate tracheostomy was adopted in 1999 at our institution.

Reduction in deep vein reflux after concomitant subfascial endoscopic perforating vein surgery and superficial vein ablation in advanced primary chronic venous insufficiency.

Background: Subfascial endoscopic perforating vein surgery (SEPS) and superficial vein surgery (SVS) have been the recommended treatment for advanced chronic venous insufficiency (CVI), despite a high prevalence of deep vein reflux in these patients. The anatomic and hemodynamic results of these procedures, however, remain uncertain. It is hypothesized that concomitant SEPS and SVS would result in a reduction of deep vein reflux in patients with advanced primary CVI.

Surgical treatment of infected aneurysms and pseudoaneurysms of the thoracic and abdominal aorta.

Background: To review the outcome of infected aneurysms and pseudoaneurysms of the thoracic and abdominal aorta treated in a major teaching hospital.

Methods: Between December 1994 and January 2003, 13 infected aortic aneurysms and pseudoaneurysms (5 thoracic, 4 paravisceral, 4 infrarenal) in 10 consecutive patients were treated surgically. Aortic debridement with in situ reconstruction is our standard practice.

Combined endovascular stent grafting and endoscopic injection of fibrin sealant for aortoenteric fistula complicating esophagectomy.

A 67-year-old man with previous total gastrectomy and roux-en-Y esophagojejunostomy had hematemesis 4 weeks after esophagectomy performed because of carcinoma of the esophagus. Investigation showed an aortojejunal fistula with a thoracic aortic pseudoaneurysm. Endovascular stent grafting of the pseudoaneurysm, followed by endoscopic injection of fibrin sealant for the fistula, was performed, and the infection was controlled with broad-spectrum antibiotic agents together with drainage and daily irrigation of the pseudoaneurysm sac.

Aortic aneurysm morphology in Asians: features affecting stent-graft application and design.

Purpose: To determine the morphological features of abdominal aortic aneurysms (AAA) in an Asian cohort in order to identify unique features relevant to stent-graft planning and application.

Methods: Spiral computed tomography (CT) and angiographic assessment of AAA morphology was performed on 65 ethnic Chinese (58 men; mean age 74 years, range 50-87) who underwent endovascular AAA repair. Morphological parameters were compared with published data from American and European patients.

Blood loss and transfusion in elective abdominal aortic aneurysm surgery.

Background: Intraoperative blood loss and transfusion are known determinants of mortality and morbidity of elective abdominal aortic aneurysm (AAA) repair. The present study analysed the pattern of blood loss and transfusion and evaluated the risk factors of blood loss during open repair of infrarenal AAA.

Methods: Blood loss, transfusion and fluid replacement during elective open repair operation for patients with infrarenal AAA were correlated to demographic data, operative findings and procedural information.

Endovascular repair for multiple Salmonella mycotic aneurysms of the thoracic aorta presenting with Cardiovocal syndrome.

Salmonella mycotic thoracic aortic aneurysm is a rare but life-threatening condition. We report a 59-year-old man with two Salmonella mycotic thoracic aortic aneurysms, presented with fever and chills associated with hoarseness due to left vocal cord palsy (Cardiovocal syndrome). Successful endovascular repair was performed using two Talent thoracic stent-graft devices deployed separately to cover the two mycotic aneurysms.

Carotid stenting for radiation-induced extracranial carotid artery occlusive disease: efficacy and midterm outcomes.

Purpose: To investigate the immediate and midterm results of carotid stenting for severe radiation-induced extracranial carotid artery disease.

Methods: Between April 1998 and May 2002, 16 patients (15 men; mean age 64 +/- 8 years, range 48-72) presented with 18 severe radiation-induced carotid stenoses in the internal carotid artery (n=3), common carotid artery (n=7), and both vessels (n=8). Thirteen (76%) patients were symptomatic; the mean degree of carotid stenosis was 85% +/- 10% (range 70%-95%).