A new instrument for transiridectomy clip closure.
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Humans↗
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Results for “clip closure”
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Prophylactic Surgical Left Atrial Appendage Closure in Bioprosthetic Aortic Valve Replacement: Short-Term Outcomes of Randomized Controlled LAA-CLOSURE Trial.
BACKGROUND: Surgical closure of the left atrial appendage (LAA) reduces stroke risk in patients with atrial fibrillation (AF) undergoing cardiac surgery. We evaluated the safety and efficacy of prophylactic LAA closure during bioprosthetic surgical aortic valve replacement in patients without prior AF. METHODS: In this investigator-initiated, academic, randomized, open-label, multicenter LAA-CLOSURE (Left Atrial Appendage CLOSURE for the Prevention of Thromboembolisms in Patients Undergoing Aortic Bioprosthesis Surgery) trial, 921 patients without prior AF undergoing bioprosthetic surgical aortic valve replacement with or without concomitant surgery were randomized and 904 patients included in the modified intention-to-treat analysis (prophylactic LAA closure, n=445; or usual care, n=459). Median age was 73 years (interquartile range, 69-76), 34.8% were women, and 49% had concomitant coronary artery disease. The primary end point was a composite of cardiovascular death, stroke, or systemic embolism at 30 days. RESULTS: The primary end point occurred in 10 of 434 (2.2%) patients in the LAA closure group and 14 of 452 (3.1%) patients in the control group; however, the treatment effect changed direction at ≈7 days. In the time-split Cox regression model, hazard ratios were 2.4 (95% CI, 0.62-9.4; P=0.20) between 0 and 7 days and 0.29 (95% CI, 0.080-1.0; P=0.056) between 7 and 30 days. No closure-related serious complications or differences in bleeding were observed. Postoperative AF occurred in 205 of 445 (46.1%) versus 184 of 459 (40.1%) patients (relative risk, 1.1 [95% CI, 0.99-1.3]; P=0.07), and AF at discharge in 40 of 445 (9.2%) versus 34 of 459 (7.7%) patients (relative risk, 1.2 [95% CI, 0.77-1.8]; P=0.44), in the closure and control groups, respectively. CONCLUSIONS: Prophylactic LAA closure during bioprosthetic surgical aortic valve replacement was safe and did not increase bleeding. REGISTRATION: URL: clinicaltrials.gov; Unique Identifier: NCT02321137.
Aged↗
The effects of timolol on cataract extraction and intraocular pressure.
We studied the effect of timolol on post-operative intraocular pressures (IOPs) in a control and experimental group of 30 eyes, each in patients who had uncomplicated intracapsular cataract extractions, most with iris clip lenses. Closure of the eye in each case was with three 6-0 silk sutures preplaced in a morticed incision. Six control eyes had IOP increases of 6 mm Hg or more within 24 hours of surgery. One patient treated with timolol had an IOP increase of 6 mm Hg or more. The differences in IOP between the control and experimental groups were statistically significant at the .01 level. The pressure lowering ability of timolol appears to be prophylactic as well as therapeutic. It is well suited for pseudophakic eyes as pressure reduction is not associated with pupillary alterations.
Cataract Extraction↗
Rapid closure of defects in serosal membranes.
The use of surgical clips (Hemoclips) for closure of defects in omentum and mesentery is an efficient and safe alternative to sutures. It avoids the problem of hematoma formation from inadvertent injury of vessels by the needle.
Humans↗
[Large aneurysm of the middle cerebral artery].
Seven surgical cases of large aneurysms (over 10 mm in diameter) are described. In 5 cases the neck of the aneurysm was closed, in 2 the aneurysmal sac was excised. Large aneurysms of the middle cerebral artery cause great difficulties in surgical closure of their necks with routinely used clips. Late results of treatment were very good in 5 cases.
Adult↗
[Spontaneous right primary iliac arteriovenous fistula and an unrecognized aorto-caval fistula located above an aneurysm].
A patient admitted for treatment of an aorto-iliac aneurism presented himself with swelling of the lower extremities and a low grade bruit over the abdomen continuous throughout systole and diastole. Aortography demonstrated the presence of a suspected ilio-caval fistula. Surgical treatment consisted of closure of the fistula and vascular replacement with an appropriate aorto-bifemoral prosthesis. Large statistics report an incidence of aortocaval fistula up to 4% in association with rupturing aortic aneurisms. The grave clinical signs and aortography confirm the diagnosis. Some of those may obstruct themselves spontaneously only to reopen at the time of operation as in the case reported. The greatest peroperatory problems with closure of those fistulae are pulmonary emboli by air and aneurismal contents. In our first case a temporary caval clip was placed as a part in the management of the lesion.
Aged↗
Avlox--a new atraumatic method of skin closure: a preliminary report.
The Avlox system, a recently introduced atraumatic method of closing skin, can be used on any surface in which skin edges can be approximated without undue pressure. Although the method has many advantages over conventional suture methods, the authors do not recommend use of the clips on weight-bearing surfaces or above bony prominences.
Dermatologic Surgical Procedures↗
[Closure of traumatic internal carotid-cavernous fistula with an improved type of captive embolus (author's transl)].
A 29-year-old male was treated for a traumatic internal carotid-cavernous fistula by embolization with an improved type of captive polyurethane foam embolus which was inserted through the common carotid artery. Neither the intracranial nor cervical carotid artery was ligated. The angiogram of right carotid taken one month after the surgery revealed satisfactory closure of the fistula and a perfect blood flow from the carotid artery involved. Soon after the operation, the chemosis, exophthalmos and disturbance of the right ocular movements began to diminish. The intracranial noise and bruit disappeared completely. There have been several opinions concerning the best kind of embolizing material and operative procedure. In our case, we devised an improved type of captive mooring embolus. A cylindrical piece of polyurethane foam was used because of its elasticity, plasticity and unabsorbability. To make our embolus we tied one end of a cylindrical embolus with a mooring suture of Nylon mono-filament so that its tip would be small enough to pass easily into the fistula, threaded discoid piece under the other end of the embolus for hook holding action, and fixed a silver clip marker at the tip of the embolus for locating with X-ray. We kept the mooring Nylon thread straignt without curling till operative use. The incised common carotid artery was closed by Iwabuchi's interlacing vascular suture method with excellent results.
Adult↗