Search Results (286)

Background: Postoperative pulmonary embolism (PPE) is a critical complication that can significantly affect patient outcomes. This study aimed to assess knowledge, attitudes, and practices (KAP) of thoracic healthcare professionals toward PPE. Methods: A cross-sectional study was conducted from September to December 2022. Results: A total of 222 thoracic healthcare professionals participated in the study; the majority were aged 30–40 years (40.54%) and had over 10 years of work experience (47.75%). Participants completed a self-designed questionnaire assessing demographic data and KAP scores: knowledge (0–11), attitudes (11–55), and practices (9–45). The main measures included the mean scores for knowledge, attitudes, and practices, along with correlation analyses and path analysis to assess relationships among the KAP components. Mean scores were 9.03 ± 1.13 for knowledge, 50.09 ± 4.23 for attitudes, and 35.78 ± 7.85 for practices. Participants showed strong awareness of PPE definitions and risk factors, but only 24.77% correctly identified its classic clinical triad. Attitudinally, while most expressed a willingness to engage in PPE training and risk assessment, 55.41% remained cautious about anticoagulation due to bleeding risks. In practice, although 72.52% consistently supported postoperative mobilization, only 30.63% frequently acquired updated PPE knowledge. Significant positive correlations were found between knowledge and attitudes (r = 0.218, p < 0.001) and between attitudes and practices (r = 0.234, p < 0.001). Path analysis showed that knowledge positively influenced attitudes (path coefficient 0.748, p = 0.002), and attitudes positively influenced practices (path coefficient 0.374, p = 0.003). Conclusions: Thoracic healthcare professionals exhibited adequate knowledge, positive attitudes, and proactive practices regarding PPE, indicating a strong foundation for enhancing postoperative care. Full article

Objectives: Residual postoperative pleural space (RPPS) is a common event after pulmonary lobectomy. Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy has been associated with a higher incidence of RPPS. This study aims to evaluate the incidence, the predictors, and potential clinical implications of RPPS following Uniportal VATS lobectomy. Methods: Patients who underwent Uniportal VATS lobectomy, without any previous neoadjuvant treatment, from June 2016 to March 2020, were retrospectively analyzed. RPPS was assessed using the last chest X-Ray prior to discharge and measured by Collins method (%). Results: Among 492 patients who underwent Uniportal VATS lobectomy, 325 (66.1%) developed RPPS. The mean RPPS volume measured by the Collins method was 15.46 ± 8.59% (vs. Collins = 4.2% in no-PRPS). An RPPS > 10.5% of Collins was significantly associated with a higher risk of postoperative air leak (AUC: 0.69, sensitivity: 69%, specificity: 54%, p < 0.001). Multivariable analysis identified the following predictors of RPPS > 10.5%: right-sided surgery (p < 0.001), upper lobectomy (p = 0.01), and prolonged air leak (p = 0.003). Patients with RPPS had a higher risk of only radiologically visible postoperative subcutaneous emphysema on the final chest X-ray (p = 0.041) and were more frequently discharged with a chest tube connected to a Heimlich valve (p < 0.001). Within 90 days post-discharge, 24 (4.9%) patients were readmitted due to increased RPPS (1.4%, requiring drainage in 5 cases [1%]), progression of subcutaneous emphysema (1.6%), and pleural effusion (1.8%, requiring drainage in 6 cases [1.2%]). However, RPPS was not associated with an increased overall risk of postoperative complications (p = 0.31) or 90-day readmission (p = 0.43). Conclusions: RPPS is a common occurrence following Uniportal VATS lobectomy but is not associated with clinically significant complications. The current study findings identified BMI, active smoking, right-sided surgery, and prolonged air leak as significant predictors of RPPS. Full article

Background: Coronary heart disease (CHD) remains the most prevalent pathology within the circulatory system. Among its chronic complications, ischemic mitral valve regurgitation (IMR) is observed in approximately 15% of patients with sustained myocardial ischemia. The presence of this complex valvular defect significantly increases both overall mortality and the incidence of adverse cardiovascular events. Notably, the presence of moderate to severe mitral regurgitation in patients undergoing surgical revascularization has been shown to double the risk of death. Despite the well-established etiology of IMR, data regarding the efficacy of surgical interventions and the determinants of postoperative outcomes remain inconclusive. Methods: The objective of the present study was to evaluate both early and long-term outcomes of surgical treatment of mitral regurgitation in patients undergoing coronary artery bypass grafting (CABG) due to ischemic heart disease. Particular attention was given to the influence of the severity of regurgitation, left ventricular ejection fraction (LVEF), and the dimensions of the left atrium (LA) and left ventricle (LV) on the postoperative prognosis. An additional aim was to identify preoperative risk factors associated with increased postoperative mortality and morbidity. A retrospective analysis was conducted on 421 patients diagnosed with ischemic mitral regurgitation who underwent concomitant mitral valve surgery and CABG. Exclusion criteria included emergent and urgent procedures as well as non-ischemic etiologies of mitral valve dysfunction. Results: The study cohort comprised 34.9% women and 65.1% men, with the mean age of 65.7 years (±7.57). A substantial proportion (76.7%) of patients were aged over 60 years. More than half (51.5%) presented with severe heart failure symptoms, classified as NYHA class III or IV, while over 70% were categorized as CCS class II or III. Among the surgical procedures performed, 344 patients underwent mitral valve repair, and 77 patients required mitral valve replacement. Additionally, 119 individuals underwent concomitant tricuspid valve repair. Short-term survival was significantly affected by the presence of hypertension, prior cerebrovascular events, and chronic kidney disease. In contrast, hypertension and chronic obstructive pulmonary disease were identified as significant predictors of adverse late-term outcomes. Conclusions: Interestingly, neither the preoperative severity of mitral regurgitation nor the echocardiographic measurements of LA and LV dimensions were found to significantly influence surgical outcomes. The perioperative risk, as assessed by the EuroSCORE II (average score: 10.0%), corresponded closely with observed mortality rates following mitral valve repair (9.9%) and replacement (10.4%). Notably, the need for concomitant tricuspid valve surgery was associated with an elevated mortality rate (12.4%). Furthermore, the preoperative echocardiographic evaluation of LA regurgitation severity, as well as LA and LV dimensions, did not exhibit a statistically significant impact on either early or long-term surgical outcomes. However, a reduced LVEF was correlated with increased long-term mortality. The presence of advanced clinical symptoms and the necessity for tricuspid valve repair were independently associated with a poorer late-term prognosis. Importantly, the annual mortality rate observed in the late-term follow-up of patients who underwent surgical treatment of ischemic mitral regurgitation was lower than rates reported in the literature for patients managed conservatively. The EuroSCORE II scale proved to be a reliable and precise tool in predicting surgical risk and outcomes in this patient population. Full article

Objectives: This study aimed to evaluate the impact of cannulation site preference—femoral versus axillary—on postoperative complications and in-hospital mortality in patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO) due to cardiogenic shock. Methods: In this single-center, retrospective study, 85 patients who received peripheral VA ECMO support between January 2013 and July 2023 were analyzed. Patients were divided into two groups based on arterial cannulation site: femoral cannulation (FC, n = 47) and axillary cannulation (AC, n = 38). Preoperative, intraoperative, and postoperative variables were compared. Cannulation-related complications were categorized as vascular, neurological, or pulmonary. The primary endpoints were postoperative complications and in-hospital mortality. Results: There were no statistically significant differences between the FC and AC groups in terms of demographics, comorbidities, surgical procedures, or ECMO weaning times. Rates of vascular, neurological, and pulmonary complications were similar between groups. Mortality and postoperative dialysis rates did not differ significantly. The low rate of ischemic complications in the FC group may be explained by the use of distal perfusion catheters, which are considered the standard approach to prevent leg ischemia. Both cannulation techniques demonstrated comparable safety and efficacy profiles. Conclusions: Both femoral and axillary cannulation sites can be safely used for peripheral VA ECMO when selected based on individual patient conditions and institutional experience. Cannulation strategy should be tailored according to the urgency of the clinical situation, anatomical feasibility, and anticipated duration of support. Further prospective, randomized studies are required to establish the optimal cannulation approach. Full article

Background: Tracheal intubation and mechanical ventilation are facilitated by neuromuscular blocking agents. We investigated the effectiveness of subjective clinical evaluation of neuromuscular function on retroglossal area size, since it determines spontaneous ventilation adequacy following tracheal extubation. Secondarily, we correlated changes in retroglossal area and depth of neuromuscular block assessed during both respiratory phases using quantitative neuromuscular monitoring. Methods: Once mechanical ventilation was no longer needed, antagonists were used to reverse the neuromuscular block in 21 consenting patients; adequacy of reversal was assessed subjectively by delivering a sequence of four rapid (2 Hz) electrical stimuli (train-of-four, TOF) to a peripheral nerve and assessing attainment of four equal muscle contractions (TOF ratio = 1.0), signifying normal neuromuscular function. Retroglossal area during both inhalation and exhalation were measured pharyngoscopically at various phases of neuromuscular recovery, including at baseline after anesthesia induction but before neuromuscular block onset and at recovery before tracheal extubation; area changes were correlated with depth of quantitatively measured neuromuscular block. Results: Clinicians’ subjective evaluation of readiness for tracheal extubation failed to identify significant residual block in most patients who required rescue antagonism. Markedly decreased retroglossal areas (inhalation: 39.5% of baseline; exhalation: 20.1% of baseline) were present at extubation, and 11 out of 21 (52.4%) patients needed rescue antagonism. In contrast, in patients with neuromuscular recovery to the currently recommended threshold determined quantitatively (TOF ratio > 0.90), retroglossal areas were only 80% recovered but returned to near baseline values when the TOF ratio ≥ 0.95. Conclusions: Quantitative monitoring should guide the timing of tracheal extubation. Current definitions of the minimal threshold for adequate neuromuscular recovery (TOF ratio > 0.90) after mechanical ventilation in postoperative patients should be re-evaluated. A TOF ratio > 0.95 better correlates with return to normal (baseline) retroglossal area during both inhalation and exhalation. Full article

Background/Objectives: The primary objective of PE repair is to relieve compression exerted on the cardiac and pulmonary structures and enhance the thoracic cavity volume. However, the number of volumetric studies of the thoracic cavity, including the heart and lung volumes, is scarce. This study seeks to systematically evaluate the volumetric changes in these structures to assess the physiological impact obtained by PE repair. Methods: A retrospective analysis was conducted on 63 patients who underwent PE repair using the XI bar technique from April 2023 to February 2024. Volumetric changes were measured preoperatively and postoperatively using SYNAPSE 3D imaging software (Version 4.6, Fujifilm, Tokyo, Japan). Cardiac and pulmonary volumes were quantified, and CT indexes (Haller index, Depression index) were assessed. Complication rates, reoperation rates, and length of hospital stay were also analyzed. Results: The mean cardiac volume increased significantly from 458.25 mL preoperatively to 499.13 mL postoperatively (p = 0.018), showing an 8.9% increase. Pulmonary volumes, however, showed no statistically significant change, remaining stable at approximately 4371.31 mL preoperatively and 4266.87 mL postoperatively (p = 0.57). Conclusions: Repairing PE markedly enhances cardiac volume, emphasizing its importance in relieving mediastinal compression. Pulmonary volumes remain largely unaffected, suggesting that PE primarily impacts cardiac structures. Our approach to the volumetric measurements provides valuable insights into the physiological outcomes of chest wall remodeling and is considered to be a good modality for future studies to enhance our understanding of the functional benefits of PE repair. Full article

Background: The optimal treatment for proximal tibial osteosarcoma (OS) in skeletally immature patients remains controversial. A custom hinged endoprosthesis has been used to preserve the growth potential of the distal femur. This study aims to report (1) the 2-year follow-up outcomes after surgery for pediatric proximal tibial OS; (2) the complications associated with this endoprosthesis; and (3) the extent to which the growth potential of the adjacent open physis can be preserved. Methods: Seven skeletally immature patients (mean age, 11.1 years; range, 9–13 years) with proximal tibial OS were included between November 2020 and December 2022. All underwent tumor resection and reconstruction by this custom endoprosthesis. Postoperative limb function was evaluated by the Musculoskeletal Tumor Society (MSTS) score system and complications were recorded. Overall leg length and femoral length were measured radiographically to determine the growth rate. Results: The mean follow-up time was 34.7 months (standard deviation (SD), 8.9 months). One patient presented with local recurrence 12 months after surgery, and another patient had pulmonary metastasis 3 months postoperatively. The range of flexion of the knee after rehabilitation was between 90° and 125°, with an average of 103.6° (SD, 12.5°). The average MSTS score of the patients after surgery was 27.4 (SD, 1.5). Wound dehiscence took place in three patients after chemotherapy. At the last follow-up, the overall limb length discrepancy was 2.1 cm (SD, 2.4 cm). Growth at the distal femoral physis after surgery was observed in all patients during follow-up, with an average of 81.4% (range, 57.78–100%) of growth of the contralateral distal femoral physis. Conclusions: This custom hinged endoprosthesis can preserve the growth potential of the adjacent distal femur and provide satisfying functional outcomes with lower postoperative complication rate. It could serve as an alternative for proximal tibial OS in skeletally immature children. Full article

Background: Since clazosentan was approved for insurance coverage in Japan, the postoperative management of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) has changed as each facility gains experience. Here, we investigate the prevention, treatment, and management of DCI after SAH throughout Japan in 2023. Methods: In 2024, we conducted an anonymous questionnaire survey—emailed to certified neurosurgeons in hospitals across Japan—regarding management for preventing DCI after aneurysmal SAH. Of them, 78 hospitals responded and were included in this study. These results were compared with the findings of a survey conducted prior to the approval of clazosentan in Japan (2022). Results: The proportion of institutions with a standardized protocol for DCI after aneurysmal SAH at a level of ≥50% was 93.0%. For both craniotomy and endovascular surgery, clazosentan was used most frequently, followed by cilostazol, fasudil, and statins. The most common drug for both direct and endovascular procedures was clazosentan. The predominant reason for discontinuing clazosentan was respiratory complications—such as pulmonary edema—followed by cardiac complications. However, 62.1% of facilities felt that the number of cases wherein clazosentan was discontinued was deceasing. While 77.5% of respondents felt that clazosentan was effective for preventing DCI after aneurysmal SAH, only 49.3% felt that it improved outcomes. Conclusions: Since its approval, clazosentan has been the most common treatment for DCI prevention after aneurysmal SAH. The impression of the effectiveness in preventing DCI and the outcomes of clazosentan have been mixed. As data accumulate, clazosentan use and management protocols will be refined and developed. Full article

Background: Among patients with congenital heart disease, particularly those with a history of undergoing the Fontan operation, pregnancy presents a significant maternal–fetal risk, especially when complicated by severe valvular dysfunction. Lung reperfusion syndrome (LRS) is a rare but life-threatening complication occurring following valve intervention. Multidisciplinary management, including by Cardio-Obstetrics teams, is essential for optimizing outcomes in such high-risk cases. Methods: We present the case of a 37-year-old pregnant patient with previously repaired tetralogy of Fallot (via the Fontan procedure) who presented at 24 weeks gestation with worsening severe pulmonary stenosis and right-ventricular dysfunction. The patient had been lost to cardiac follow-up for over a decade. She experienced recurrent arrhythmias, including supraventricular and non-sustained ventricular tachycardia, prompting hospital admission. A multidisciplinary team recommended transcatheter pulmonic valve replacement (TPVR), performed at 28 weeks’ gestation. Results: Post-TPVR, the patient developed acute hypoxia and hypotension, consistent with Lung Reperfusion Syndrome, necessitating intensive cardiopulmonary support. Despite initial stabilization, progressive maternal respiratory failure and fetal compromise led to an emergent cesarean delivery. The neonate’s neonatal intensive care unit (NICU) course was complicated by spontaneous intestinal perforation, while the mother required intensive care unit (ICU)-level care and a bronchoscopy due to new pulmonary findings. She was extubated and discharged in stable condition on postoperative day five. Conclusions: This case underscores the complexity of managing severe congenital heart disease and valve pathology during pregnancy. Lung reperfusion syndrome should be recognized as a potential complication following TPVR, particularly in pregnant patients with Fontan physiology. Early involvement of a multidisciplinary Cardio-Obstetrics team and structured peripartum planning are critical to improving both maternal and neonatal outcomes. Full article

Background/Objectives: Lung-protective ventilation (LPV) reduces postoperative pulmonary complications (PPCs) in obese patients. While the roles of low tidal volume and positive end-expiratory pressure (PEEP) in LPV have been established in patients with healthy lungs, the protective effect of alveolar recruitment strategies (ARSs) remains a subject of debate. This study aims to evaluate the benefit of ARSs in patients with low-to-moderate risk according to the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score undergoing gynecologic cancer surgery with LPV and low tidal volume intraoperatively. Methods: A total of 88 obese patients were evaluated in this study. They were divided into two groups as the non-ARS group (non-ARS) and the ARS group (ARS). Intraoperative hemodynamics, blood gas analyses, respiratory mechanics, mechanical ventilator parameters, and postoperative outcomes were compared in these obese patients. Results: A total of 40 obese patients undergoing major gynecological cancer surgery were included in this study. Although the non-ARS group presented with higher weight (p < 0.05), body mass indexes were similar to the ARS group. Intraoperative blood gas analysis revealed higher end-tidal carbon dioxide (etCO₂) levels in the non-ARS group during the T2 and T3 time intervals (p < 0.05). In the ARS group, peak inspiratory pressure (PIP) at T3 was lower, while drive pressures at T1 and T2 and dynamic compliance at T3 were higher (p < 0.05). Radiologic atelectasis scores were higher in the non-ARS group, indicating more atelectatic lung images (p < 0.05). PPC rates were similar across both groups. Conclusions: Although the ARS demonstrated positive effects on lung mechanics and radiologic atelectasis scores in major open gynecologic cancer surgeries, it did not effectively reduce postoperative pulmonary complications. Full article

Introduction: Among aortic diseases in children, congenital defects such as coarctation of the aorta (CoA), interrupted aortic arch (IAA), hypoplastic aortic arch (HAA), and hypoplastic left heart syndrome (HLHS) predominate. Tissue patches are applied in pediatric cardiovascular surgery for the repair of congenital aortic defects as a filling material to replenish missing tissue or as a substitute material for the complete reconstruction of the vascular wall along the course of the vessel. This retrospective single-center study aimed to present the safety and feasibility of extracellular matrix (ECM) biological scaffolds in pediatric aortic surgery. Patients and methods: There were 26 patients (17 newborns and nine children), who underwent surgical procedures in the Department of Pediatric Cardiac Surgery (Poznań, Poland) between 2023 and 2024. The patients’ population was divided into two subgroups according to the hemodynamic nature of the primary diagnosis of the congenital heart defect and the performed pediatric cardiovascular surgery. The first group included 18 (72%) patients after aortic arch repair for interrupted aortic arch and/or hypoplastic aortic arch, while the second group included seven (28%) patients after aortopulmonary anastomosis. In the first group, patches were used to reconstruct the aortic arch by forming an artificial arch with three separate patches sewn together, primarily addressing the hypoplastic or interrupted segments. In the second group, patches were applied to augment the anastomosis site between the pulmonary trunk and the aortic arch, specifically at the connection points in procedures, such as the Damus–Kaye–Stansel or Norwood procedures. The analysis was based on data acquired from the national cardiac surgery registry. Results: The overall mortality in the presented group was 15%. All procedures were performed using median sternotomy with a cardiopulmonary bypass. The cardiopulmonary bypass (CPB) and aortic cross-clamp (AoX) median times were 144 (107–176) and 53 (33–79) min, respectively. There were two (8%) cases performed in deep hypothermic circulatory arrest (DHCA). The median postoperative stay in the intensive care unit (ICU) was 284 (208–542) h. The median mechanical ventilation time was 226 (103–344) h, including 31% requiring prolonged mechanical ventilation support. Postoperative acute kidney failure requiring hemodiafiltration (HDF) was noticed in 12% of cases. Follow-up data, collected via routine transthoracic echocardiography (TTE) and clinical assessments over a median of 418 (242.3–596.3) days, showed no evidence of patch-related complications such as restenosis, aneurysmal dilation, or calcification in surviving patients. One patient required reintervention on the same day due to a significantly narrow ascending aorta, unrelated to patch failure. No histological data from explanted patches were available, as no patches were removed during the study period. The median (Q1–Q3) hospitalization time was 21 (16–43) days. Conclusions: ProxiCor^® biological patches derived from the extracellular matrix can be safely used in pediatric patients with congenital aortic arch disease. Long-term follow-up is necessary to confirm the durability and growth potential of these patches, particularly regarding their resistance to calcification and dilation. Full article

Background/objectives: This study aimed to investigate the impact of single-inhaler triple therapy on selecting treatment for lung cancer and the perioperative period in lung cancer patients with chronic obstructive pulmonary disease (COPD) and a forced expiratory volume in 1 s (FEV₁) <1.5 L. Methods: All patients had baseline FEV₁ < 1.5 L. The therapeutic drug for COPD, fluticasone furoate/umeclidinium/vilanterol, was initiated 2 weeks preoperatively and continued until 3 months postoperatively. Radical surgery was actively recommended for patients with an FEV₁ ≥ 1.5 L after COPD treatment; otherwise, palliative surgery and postoperative complication risks were discussed. Results: Among 675 lung cancer patients, 214 (31.7%) had COPD, 41 of whom with FEV₁ < 1.5 L were enrolled. After triple-inhaler therapy, FEV₁ improved to ≥1.5 L in 63.4% of patients. Significant differences in the Brinkman index (840 vs. 1120, p = 0.0058) and radical resection (88.5% vs. 40.0%, p = 0.0030) were observed between patients with FEV₁ ≥ 1.5 L and <1.5 L post-treatment. Pneumonia and home oxygen therapy occurred in two cases (4.9%) and one case (2.4%), respectively, all of which were patients with FEV₁ < 1.5 L post-treatment. Among patients undergoing anatomical lung resection, triple-inhaler therapy significantly improved not only post-inhalation FEV₁ (1.26 vs. 1.55 L, p < 0.0001), but also FEV₁ at 3 months postoperatively compared to the value before inhalation (1.31 vs. 1.26 L, p = 0.042). Conclusions: Preoperative triple therapy in lung cancer patients with untreated COPD and FEV₁ < 1.5 L improved respiratory function and increased the feasibility of performing radical resection surgery. Furthermore, it was considered safe and effective, indicating the potential to maintain preoperative respiratory function without increasing perioperative complications. Full article

Background: This study examines the impact of Body Mass Index (BMI) on outcomes after mitral valve surgery via right minithoracotomy, an approach that may reduce wound complications in obese patients. Methods: Between January 2010 and December 2024, 1773 adult patients underwent minimally invasive mitral valve surgery at our institution. They were categorized into three groups: normal weight (BMI < 25, n = 942), overweight (BMI 25–30, n = 661), and obese (BMI > 30, n = 170). Results: The three groups exhibited significant differences, with a higher prevalence of hypertension, dyslipidemia, and diabetes (p < 0.001) in overweight and obese patients. Further-more, they had a greater incidence of preoperative atrial fibrillation (p < 0.001), prior stroke (p = 0.023), chronic obstructive pulmonary disease (p = 0.002), and elevated preoperative creatinine levels (p < 0.001). and their euroscore II was significantly higher (p = 0.040). In-hospital mortality and major complications were similar across groups, except for drainage output in the first 24 h (p = 0.002) and ICU stay (p = 0.022), both resulting higher in the overweight and obese patients. We employed inverse probability of treatment weighting (IPTW) to create three well-matched groups. Following IPTW, postoperative outcomes remained comparable across groups. However, obese patients exhibited a higher incidence of postoperative atrial fibrillation (p = 0.037) and required pacemaker implantation more frequently (p < 0.001). Conclusions: Our findings suggest that obesity does not increase the risk of mortality or major adverse events after minimally in-vasive mitral valve surgery. This approach may offer a less invasive alternative for obese patients, potentially reducing the risk of wound complications associated with conventional surgery. Full article

Background: Previous studies have shown that ventilation strategies used in general anesthesia influence perioperative outcomes of video-assisted thoracoscopic surgery (VATS). This study investigated the perioperative effects of non-intubated anesthesia (NIA) versus intubated anesthesia (IA) in patients with early-stage non-small cell lung cancer (NSCLC) undergoing VATS. Methods: This retrospective cohort study analyzed patients who underwent elective VATS for early-stage NSCLC between January 2015 and December 2022. Patients were categorized into the NIA and IA groups based on the ventilation strategies during general anesthesia. Comprehensive outcome data, including intraoperative and postoperative variables, were compared between the two groups. Univariate and multivariate logistic regression models were used to assess the odds ratios for conversion from NIA to IA. Results: A total of 372 patients who received NIA and 1560 who received IA for VATS were eligible for analysis. After propensity score matching, 336 patients were included in each group. In the matched analysis, patients who received NIA demonstrated favorable perioperative outcomes, including reduced opioid consumption, lower postoperative complication rates, and shorter hospital stays, compared to those who received IA. Additionally, patients with a lower baseline oxygen saturation and those who experienced intraoperative pulmonary and cardiovascular adverse events had a higher risk of conversion from NIA to IA. Conclusions: NIA during VATS in patients with early-stage NSCLC was associated with superior perioperative outcomes. Prospective studies are warranted to further evaluate the impact of NIA on perioperative outcomes in this patient population. Full article

Background: Popliteal venous aneurysms (PVA) are an uncommon but potentially severe condition due to their association with increased risk of recurrent pulmonary embolisms. Because of their rarity, their aetiology, natural history, and optimal treatment strategies have been poorly defined. The aim of this paper is to report a comprehensive systematic review on the treatment strategies and outcomes in PVA, summarizing current evidence. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science, covering studies published from database inception through February 2025 (protocol registered on PROSPERO CRD420251008927). The primary endpoint was the analysis of outcomes and complications associated with surgical and conservative management. Results: Nine studies, including 173 adult patients with popliteal venous aneurysms, were included. The mean age was 56 years (range 18–86 years, mean aneurysm diameter 25.4 mm). Most of the patients were female (73, 42.2%). Overall, 85 (49.1%) aneurysms were saccular and 74 (42.8%) fusiform, although morphology was not consistently reported across all studies. Intraluminal thrombus was reported in 26 cases (15.0%), and pulmonary embolism upon presentation in 21 (12.1%). Surgical treatment was performed in 119 patients (68.8%), while 54 (31.2%) were managed conservatively. Fifteen patients (13.0%) experienced postoperative complications, including wound infections (4, 3.5%), hematomas (7, 6.0%), and nerve injury (4, 3.5%), but no cases of postoperative pulmonary embolisms were observed. Following surgery, anticoagulation was indicated in most cases for 3–6 months or a long life. During follow-up (mean 35 months, range 1–262), thrombosis of the surgical reconstruction was observed in 1 patient (0.8%). Death occurred in 3 cases (5.5%), all in the non-surgical group: 2 (3.7%) due to malignancy and 1 (1.9%) from myocardial infarction. Conclusions: PVA is a rarely described condition potentially associated with the risk of PE. In their management, surgical strategies in association with oral anticoagulation represent the most commonly described approach, allowing for satisfactory results and a low rate of complications. Full article