Editor's Choice - Epidemiology, Diagnostics, and Outcomes of Acute Occlusive Arterial Mesenteric Ischaemia: A Population Based Study.

Objective: The exact incidence and outcomes of acute occlusive arterial mesenteric ischaemia (AMI) are unclear as most studies include only patients diagnosed correctly while alive. The aim of this study was to assess the incidence, mortality, and diagnostics of AMI by also including patients diagnosed post-mortem.

Methods: This retrospective study comprised patients diagnosed with AMI either alive or post-mortem between 2006 and 2015 within a healthcare district serving 1.

Reconstruction of the superficial femoral vessels with muscle flap coverage for soft tissue sarcomas of the proximal thigh.

Background: Surgical resection of soft tissue sarcoma with a margin of healthy tissue may necessitate resection and reconstruction of major blood vessels together with soft tissues of the proximal thigh to preserve the limb. The long-term functional outcomes of these reconstructions remain unestablished. The aim of this report was to assess the vascular and functional outcomes of soft tissue sarcoma patients with femoral vessel reconstructions.

Long Term Results of Pancreatectomy With and Without Venous Resection: A Comparison of Safety and Complications of Spiral Graft, End-to-End and Tangential/Patch Reconstruction Techniques.

Objective: Roughly 10% - 20% of pancreatic cancer patients are candidates for curative intent surgical treatment. In the 2000s, many studies showed similar survival rates comparing pancreatic surgery with or without vein resection and reconstruction. The aim was to identify the best method of venous reconstruction.

Multidisciplinary Oncovascular Surgery is Safe and Effective in the Treatment of Intra-abdominal and Retroperitoneal Sarcomas: A Retrospective Single Centre Cohort Study and a Comprehensive Literature Review.

Objective: Radical excision of retroperitoneal or intra-abdominal soft tissue sarcomas may necessitate vessel resection and reconstruction. The aim of this study was to assess surgical results of retroperitoneal or intra-abdominal sarcomas involving major blood vessels.

Methods: This was a retrospective single centre cohort study and a comprehensive review of literature.

En bloc resection of visceral aorta and right kidney due to aortic sarcoma using temporary extracorporeal bypass grafting.

Aortic sarcomas have not been linked to Lynch syndrome in humans, although other soft tissue malignancies have been. We report the case of a 31-year-old man with Lynch syndrome, who presented with abdominal pain and severe claudication. The clinical and diagnostic workup revealed near occlusion of the infrarenal aorta due to aortic angiosarcoma.

Cryopreserved Venous Allografts in Supra-inguinal Reconstructions: A Single Centre Experience.

Objective: This study introduces a novel technique for supra-inguinal arterial reconstructions with cryopreserved femoral vein and caval allografts with a low re-infection rate and an acceptable graft re-intervention rate on early mid term analysis.

Methods: Patients treated from February 2012 to March 2018 with cryopreserved venous allograft reconstructions owing to infection in the supra-inguinal area were reviewed retrospectively. The primary end points were re-infection and the treatment related mortality rate.

Choice of First Emergency Room Affects the Fate of Patients With Acute Mesenteric Ischaemia: The Importance of Referral Patterns and Triage.

Objectives: Despite modern advances in diagnosis and treatment, acute arterial mesenteric ischaemia (AMI) remains a high mortality disease. One of the key modifiable factors in AMI is the first door to operation time, but the factors attributing to this parameter are largely unknown. The aim of this study was to evaluate the factors affecting delay, with special focus on the pathways to treatment.

Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study.

Background: The treatment of mycotic abdominal aortic aneurysm requires surgery and antimicrobial therapy. Since prosthetic reconstructions carry a considerable risk of reinfection, biological grafts are noteworthy alternatives. The current study evaluated the durability, infection resistance, and midterm outcome of biological grafts in treatment of mycotic abdominal aortic aneurysm.

A Population-Based Study of Abdominal Aortic Aneurysm Treatment in Finland 2000 to 2014.

Background: In the event of rupture of an abdominal aortic aneurysm (AAA), mortality is very high. AAA prevalence and incidence of ruptures have been reported to be decreasing. The treatment of AAA has also undergone a change in recent decades with a shift toward endovascular aneurysm repair (EVAR).

Outcome of surgery for patients with renal cell carcinoma and tumour thrombus in the era of modern targeted therapy.

Objective: This study evaluated the clinical outcome of patients with renal cell carcinoma (RCC) with tumour thrombus (TT) after surgical management.

Materials And Methods: In total, 142 consecutive RCC patients with TT who were operated on in Helsinki University Hospital between 2006 and 2014 were analysed. Eighty-eight (62%) of these patients had been operated on with radical intention and 54 (38%) with cytoreductive intention.

Temporary Axillorenal Bypass in Complex Aorto-Renal Surgery.

Background: Prolonged renal ischemia during vascular surgery carries high morbidity and mortality. We report an alternative technique for maintaining renal circulation during suprarenal aortic or renal artery clamping.

Methods: Between October 2007 and May 2012, 16 patients undergoing aorto-renal surgery (13 men, 3 women) were operated using temporary axillorenal bypass.

[Surgical treatment of soft tissue sarcomas].

Surgical excision of the tumor with a tumor-free margin is always the most important form of treatment of soft tissue sarcoma. Although a local management of the tumor would in many cases be achieved by amputation, the functional and psychological consequences would often be significant. Better knowledge of the biology of different subtypes along with the progress in the forms of treatment has improved the prognosis.

Quality assessment of elective abdominal aortic aneurysm repair from referral to surgery.

Background: The risk of rupture for a large (≥ 55 mm) abdominal aortic aneurysm(AAA) is significant and therefore operative treatment should take place before possible aneurysm rupture. Timing of elective AAA surgery has rarely been investigated previously. The aim of this study is to evaluate success in the elective treatment process of large AAAs from referral to surgery in Helsinki University Central Hospital.

[Emergency problems in vascular surgery].

The most typical emergency patient of vascular surgery is suffering from urgent lower limb ischemia, potentially threatening the viability of the limb. Life-threatening conditions requiring immediate treatment include rupture of the abdominal aorta as well as septicemia associated with necrosis of a neuropathic-ischemic leg of the diabetic patient. Stenosis of the carotid artery requires an emergency operation, if in spite of antithrombotic medication the patient exhibits persistent transient symptoms of paresis or attacks of blindness.

[Challenging treatment of aortic aneurysm is under change].

Abdominal aortic aneurysm is a common and increasing health risk. Indication for therapy in men is an aneurysm over 55 mm and in women, over 50 mm in diameter. Novel endovascular treatment procedures are nowadays suitable for a large proportion of patients and will improve patient safety, shorten the duration of therapy and speed up rehabilitation.

Decrease of mortality of ruptured abdominal aortic aneurysm after centralization and in-hospital quality improvement of vascular service.

Our aim was to determine whether organizational changes could improve the outcome after ruptured abdominal aortic aneurysm (RAAA). Regional centralization and quality improvement in the in-hospital chain of treatment of RAAA included strengthening of the emergency preparedness and better availability of postoperative intensive care. During the reorganization, all patients with RAAA were admitted to Helsinki University Central Hospital (HUCH) from Helsinki and Uusimaa district.

Adjuvant arteriovenous fistula as means of rescue for infrapopliteal venous bypass with poor runoff.

Objective: The aim of this study was to assess the outcome of infrapopliteal bypass when an adjuvant arteriovenous (AV) fistula was reconstructed as means of rescue as a result of poor runoff. The design was a retrospective multicenter case-control study.

Methods: Seventy-seven infrapopliteal vein bypasses required an adjuvant AV fistula among 1813 patients operated on for critical leg ischemia in 3 vascular centers between 1996 and 2003.

Utility of surgery for ruptured abdominal aortic aneurysm.

Our aim was to assess the utility of surgery for ruptured abdominal aortic aneurysm (RAAA) using the number of quality-adjusted life years (QALYs) in a retrospective study with cross-sectional quality-of-life (QoL) evaluation. During a 7-year period up to 2002, 242 of 269 (90%) patients with RAAA underwent surgery. Survivors were sent the EQ-5D self-administered questionnaire to assess their long-term outcome.

Effect of mesenteric ischemia/reperfusion on spinal cord injury following transient aortic occlusion in rabbits.

Purpose: To investigate in a rabbit model if prolonged periods of mesenteric ischemia followed by reperfusion may affect the rate of neurological complications.

Methods: An infrarenal aortic snare, which consisted of a Silastic vessel loop whose ends were passed through plastic tubing, was placed in 50 male New Zealand white rabbits. In 40 of these animals, a similar but smaller device was placed around the superior mesenteric artery (SMA); all devices were exteriorized to allow vessel occlusion in the awake animal.

Infrainguinal endovascular and bypass surgery for critical leg ischemia in patients on long-term dialysis.

Lower limb revascularization has been shown to be worthwhile for treatment of critical leg ischemia in uremic patients, but poor results are expected in patients on long-term dialysis. We have retrospectively evaluated the results of a series of 21 consecutive patients on long-term dialysis who underwent 20 infrainguinal bypass graft and 5 endovascular procedures for critical leg ischemia to identify factors contraindicating any infrainguinal revascularization attempt in this patient population. At 2-year follow-up, the patency rate was 74%, leg salvage rate was 85%, and survival rate was 23%, whereas 23% of patients were alive with salvaged leg.