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Complications, Volume 2, Issue 2 (June 2025) – 7 articles

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13 pages, 733 KiB  
Review
Surgical Treatment of Pressure Injures in Spinal Cord Injury Patients: Incidence of Surgical Complications and Tips for Prevention
by Luca Negosanti, Siriana Landi, Micaela Battilana, Ruben Pondrelli and Rossella Sgarzani
Complications 2025, 2(2), 15; https://doi.org/10.3390/complications2020015 - 18 Jun 2025
Viewed by 71
Abstract
Background: People with spinal cord injury/disorder are at a high risk of pressure injury formation, and, in advanced cases, surgery is mandatory. These patients present specific clinical aspects to consider in order to reduce the risk of complications. This paper is a narrative [...] Read more.
Background: People with spinal cord injury/disorder are at a high risk of pressure injury formation, and, in advanced cases, surgery is mandatory. These patients present specific clinical aspects to consider in order to reduce the risk of complications. This paper is a narrative review and expert opinion based on the authors’ institutional experience of over 10 years in a spinal unit. The specific protocols of treatment based on a multidisciplinary approach, protocols of flap selection, and strategies to prevent and manage complications are reviewed. The specific clinical aspects of each patient that should be considered during treatment to optimize the results and to reduce complication rates are reviewed. Conclusions: A multidisciplinary team approach and specific protocols for patient management allow for a reduction in complication rates in the surgical treatment of pressure injuries in spinal cord injury patients and implement an overall success rate. Complications management protocols should be developed and investigated to further improve the overall success rate. Full article
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10 pages, 608 KiB  
Review
Transeptal Puncture Complications: What to Watch for and How to Avoid Them
by Nicolò Azzola Guicciardi, Carlotta De Carlo and Francesco Maisano
Complications 2025, 2(2), 14; https://doi.org/10.3390/complications2020014 - 16 Jun 2025
Viewed by 154
Abstract
Transseptal puncture (TSP) is an essential step for left heart procedures that allows access to the left atrium (LA) through the fossa ovalis (FO) of the interatrial septum (IS). Initially developed for diagnostic purposes, today, it is performed for procedures that require large-bore [...] Read more.
Transseptal puncture (TSP) is an essential step for left heart procedures that allows access to the left atrium (LA) through the fossa ovalis (FO) of the interatrial septum (IS). Initially developed for diagnostic purposes, today, it is performed for procedures that require large-bore device delivery systems and complex three-dimensional navigation in the left atrium. TSP supports various interventions, including atrial fibrillation ablation, left atrial appendage closure, and transcatheter mitral valve repair and replacement. While traditionally performed with Brockenbrough needles under fluoroscopic guidance, the integration of transesophageal and intracardiac echocardiography (TEE/ICE) has significantly improved its safety and precision. Despite its generally high success rate, TSP poses challenges in complex anatomies or for less experienced operators, with complications such as cardiac tamponade, aortic root puncture, and embolic events. Anatomical variations, such as thickened or floppy septa, further complicate the procedure. Technological advancements, including radiofrequency-based systems and specialized guidewires, have enhanced safety in difficult cases. Effective training, including echocardiography and complication management, is vital for operator proficiency. This review outlines the procedural steps for safe TSP, emphasizing proper equipment selection, anatomical considerations, and vascular access techniques. Common complications are discussed alongside management strategies. Advanced tools and techniques for addressing challenging scenarios are highlighted. Full article
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10 pages, 3441 KiB  
Case Report
Managing Bariatric Surgery Complications at a Third Level Public Hospital in Panamá
by Reinaldo Isaacs Beron, Victor Hugo Bruno Cao, Daniel Carreira and Mariela Hurtado
Complications 2025, 2(2), 13; https://doi.org/10.3390/complications2020013 - 15 May 2025
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Abstract
Background: Surgical complications are devastating both for patients and treating surgeons. When complications occur after bariatric procedures, due to specific characteristics of this population, management, although multidisciplinary, should always be led by a surgical team. Methods: We present major complications treated at our [...] Read more.
Background: Surgical complications are devastating both for patients and treating surgeons. When complications occur after bariatric procedures, due to specific characteristics of this population, management, although multidisciplinary, should always be led by a surgical team. Methods: We present major complications treated at our general surgery service over a seven-year period. Case series: We present five cases that were treated at our service after a bariatric procedure was performed. Two patients were operated on in another country and two more at another service. Three patients showed perforation and leak-related complications. One patient died due to refeeding syndrome complications after revisional surgery. Conclusions: Optimal preoperative evaluations and surgical planning are mandatory for any type of surgery including bariatric procedures, and attempting adequate and well-established surgical techniques extensively described in the medical literature is associated with better outcomes. It is also our understanding that easy channels of communication between patients and treating surgeons could avoid delays in detecting and treating life-threatening conditions. Full article
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17 pages, 3214 KiB  
Case Report
Severe Postoperative Complications Following Bilateral DIEP Flap Breast Reconstruction in a High-Risk Patient: A Case Report
by Francesco Marena, Marco Grosso, Alessia De Col, Franco Bassetto and Tito Brambullo
Complications 2025, 2(2), 12; https://doi.org/10.3390/complications2020012 - 2 May 2025
Viewed by 624
Abstract
Background/Objectives: Deep inferior epigastric perforator (DIEP) flap reconstruction is considered the gold standard for autologous breast reconstruction due to its favorable aesthetic results and low donor site morbidity. Nevertheless, it remains associated with potentially life-threatening complications such as deep vein thrombosis (DVT) [...] Read more.
Background/Objectives: Deep inferior epigastric perforator (DIEP) flap reconstruction is considered the gold standard for autologous breast reconstruction due to its favorable aesthetic results and low donor site morbidity. Nevertheless, it remains associated with potentially life-threatening complications such as deep vein thrombosis (DVT) and pulmonary embolism (PE). This report aims to describe a complex clinical case in which severe thromboembolic and ischemic complications occurred despite adherence to standard prophylactic protocols. Methods: We present the case of a 65-year-old female with multiple thromboembolic risk factors—including obesity, a history of heavy smoking, hormone therapy, and prior COVID-19 infection—who underwent immediate bilateral breast reconstruction with DIEP flaps following mastectomy. Results: Within the first 24 h postoperatively, the patient developed a massive pulmonary embolism requiring intensive care management. Despite appropriate anticoagulation and supportive measures, she subsequently experienced full-thickness necrosis of the central portion of the abdominal flap. Thrombophilia screening and diagnostic imaging did not reveal peripheral venous thrombosis, raising the hypothesis of a hypercoagulable state potentially related to prior SARS-CoV-2 infection. Conclusions: This case underscores the importance of individualized risk stratification and suggests that current prophylaxis protocols may be insufficient for patients with overlapping thrombotic risk factors. The findings advocate for further investigation into the long-term vascular effects of COVID-19 and support reconsidering extended or intensified prophylaxis in high-risk populations undergoing complex microsurgical procedures. Full article
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8 pages, 219 KiB  
Article
Management of Complications in Laparoscopic Sacrocolpopexy: Focus on Urinary Incontinence
by Manuel Saavedra Centeno, Paola Calleja Hermosa, Clara Sánchez Guerrero, Ana Sánchez Ramírez, Clara Velasco Balanza, Lira Pelari Mici, Miguel Rebassa Llul, Miguel Jiménez Cidre, Eduardo Morán Pascual, Salvador Arlandis Guzmán, Esther Martínez-Cuenca, José Miguel Gómez de Vicente, Mercedes Ruiz Hernández, Javier Casado Varela, Luis Alberto San José Manso, Jorge Mora Gurrea, María Pérez Polo, Carlos Errando Smet and Luis López-Fando Lavalle
Complications 2025, 2(2), 11; https://doi.org/10.3390/complications2020011 - 11 Apr 2025
Viewed by 461
Abstract
Pelvic organ prolapse (POP) is a prevalent condition worldwide with detrimental effects on patients’ quality of life. Laparoscopic sacrocolpopexy (LSC) has emerged as the gold standard for managing complex and high-grade POP. While anatomical and subjective outcomes have been extensively documented, the management [...] Read more.
Pelvic organ prolapse (POP) is a prevalent condition worldwide with detrimental effects on patients’ quality of life. Laparoscopic sacrocolpopexy (LSC) has emerged as the gold standard for managing complex and high-grade POP. While anatomical and subjective outcomes have been extensively documented, the management of its associated complications, particularly urinary incontinence, remains challenging. This study evaluates the strategies implemented to address complications arising from LSC, focusing on urinary incontinence. A retrospective multicenter study analyzed 325 patients who underwent LSC using lightweight macroporous Surelift Uplift mesh between 2011 and 2019. Data on perioperative and long-term complications, with emphasis on urinary incontinence management, were extracted from participating centers. Among them, the incidence of new-onset stress urinary incontinence (SUI) postoperatively was 12.9%. A total of 21 patients required further treatment for urinary symptoms, including mid-urethral sling (MUS) procedures in 5.5% and botulinum toxin injections for overactive bladder (OAB) in 0.9%. The findings underscore the importance of proactive and tailored management strategies for urinary incontinence following LSC. While the procedure demonstrates low complication rates and high anatomical success, urinary symptoms require vigilant monitoring and intervention in a two-step procedure for stress incontinence, if needed. Full article
5 pages, 1044 KiB  
Case Report
Severe Aortic Stenosis Treated with Three Self-Expandable Valves: Embolization of the First Two and Successful Implantation of a Larger One
by María-Cruz Ferrer-Gracia, Maria Eugenia Guillén Subirán and José Antonio Diarte de Miguel
Complications 2025, 2(2), 10; https://doi.org/10.3390/complications2020010 - 10 Apr 2025
Viewed by 231
Abstract
Transcatheter aortic valve embolization is a serious complication of transcatheter aortic valve replacement (TAVR). We present the case of a patient who required the implantation of three transcatheter aortic self-expandable valves (SEVs) owing to the embolization of two of them. Full article
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23 pages, 2548 KiB  
Article
The Impact of Periprocedural Prosthetic Valve Leak After Transcatheter Aortic Valve Implantation
by Shafaqat Ali, Sanchit Duhan, Thannon Alsaeed, Lalitsiri Atti, Faryal Farooq, Bijeta Keisham, Ryan Berry, Yasar Sattar, Ahmad Munir, Vijaywant Brar, Tarek A. Helmy, M. Chadi Alraies and James Robert Brašić
Complications 2025, 2(2), 9; https://doi.org/10.3390/complications2020009 - 1 Apr 2025
Viewed by 386
Abstract
A periprocedural prosthetic valve leak (PVL) after transcatheter aortic valve implantation (TAVI), a minimally invasive treatment modality for patients with severe, symptomatic aortic stenosis, may entail serious morbidity. Cohorts hospitalized for TAVI from a national database (2016–2020) were stratified on the presence of [...] Read more.
A periprocedural prosthetic valve leak (PVL) after transcatheter aortic valve implantation (TAVI), a minimally invasive treatment modality for patients with severe, symptomatic aortic stenosis, may entail serious morbidity. Cohorts hospitalized for TAVI from a national database (2016–2020) were stratified on the presence of PVL post-TAVI. TAVI patients with and without PVL were selected for propensity score matching. Pearson’s x2 test was used to compare outcomes. Among 319,448 TAVI patients over five years, 2043 had periprocedural PVL identified at index hospitalization, acute heart failure (49.61% vs. 41.15%, p < 0.001), acute kidney injury (20.40% vs. 11.77%, p < 0.001), cardiac tamponade (1.31% vs. 0.52%, p < 0.05), higher inpatient mortality (3.05% vs. 1.05%, p < 0.001), postprocedural bleeding (3.5% vs. 1.48%, p < 0.001), sudden cardiac arrest (15.34% vs. 8.54%, p < 0.001), and vascular complications (4.10% vs. 1.57%, p < 0.001). TAVI with PVL was associated with a significantly longer length of stay (p < 0.05) and total cost of hospitalization (p < 0.05). The 30-day (15.2% vs. 12%, p = 0.02), 90-day (24.4% vs. 19.9%, p < 0.01), and 180-day (34.7% vs. 24.8%, p < 0.01) readmission rates were significantly higher in the TAVI cohort with PVL. PVL in patients post-TAVI is associated with greater mortality and morbidity during index hospitalization, higher readmission rates, and increased burden on healthcare costs and infrastructure. Full article
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