Surgery Blog for Surgeons

Can we ligate the celiac trunk?

Branches of the aorta used to be considered vital for the circulation as they often supply a large amount of other vessels. Ligating intercostal or lumbar branches is commonly accepted to be safe if needed. However, the major ventral branches of the aorta were generally thought to be more important. Occlusion of the inferior mesenteric artery (IMA) is being practices routinely ever since the introduction of the endovascular aortic aneurysm repair (EVAR) with often only transient mucosal ischemia of the sigmoid colon observed in about 10% of the cases.

While the occlusion of the superior mesenteric artery (SMA) is widely accepted not to be compatible with life, ligating the celiac axis may be an interesting approach to explore.

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Abdominal aortic aneurysms in women - are 50mm still actual?

The title of a paper, recently published in the British Journal of Surgery, is "Influence of sex on expansion rate of abdominal aortic aneurysms".

This paper describes a trial with a very interesting conclusion:

The growth rate of AAA was significantly greater in women than in men. This may have implications for the frequency of follow-up and timing of repair of AAA in women.

The cutoff size for AAA in Germany is 50mm. I know that the NHS in the UK makes possible the treatment of such aneurysms until they reach 55mm. Since years the head of our Vascular Surgery Division considers treating of female aneurysms at 45mm. I have to tell him about this nice paper.

Thanks, Dr. Mofidi et al.!

Carotid-Artery Endarterectomy or Stenting

First results of the EVA-3S trials were recently published in the NEJM. The conclusion is clear:

In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting.

OK, I am a surgeon and have the thinking of a surgeon. I always had a bad feeling regarding the carotid stents. The idea of an uncovered stent, pressed against the plaques on the carotid bifurcation, made me feel uncomfortable.

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