Abstracts DGG

Conformable stentgraft provides better reintervention free survival in blunt thoracic aortic injury


Background:
According to international guidelines, treatment of truncal insufficiency is widely dominated by thermal endovenous techniques, unless inherent risks and limitations in the face of lymphatic, nerval and thromboembolic complications.In recent years, cyanoacrylate closure (CC) initiated the era of a nonthermal/non-tumescent/non-sclerosant approach.Metaanalyses comparing CC with Laser (EVLA) or radiofrequency ablation (RFA) comprising a number of comparative studies, RCTs and observational studies show that in terms of effectiveness there is no significant difference between thermal and nonthermal modalities.In terms of safety, however, CC devices caused fewer adverse events and less severity at 12 months of follow-up than did EVLA or RFA.

Materials and methods:
Ten-year-experience with the VenaSeal TM closure system and review of the literature.

Results:
Advantages of CC are attributed to better patient comfort along with the intervention.CC devices caused less pain and shorter recovery times compared with RFA or EVLA.Furthermore, tumescent anesthesia and compression bandages are dispensable.Our ten-year-experience with the VenaSeal TM closure system confirms data in the literature and suggests substantially less long-term recurrencies due to neoangiogenesis compared with conventional surgery.

Conclusion:
Pathophysiological preconditions of specific side effects observed among different treatment options, implications for decision making and the need for generating further evidence are discussed.

Materials and methods:
The highest Fowler score and EuroSCORE II were utilized as risk variables for leg wound infection.Risk adjustment (1:1) was performed to compare two groups of patients undergoing surgery with OVH or EVH techniques.Total costs, including costs of facilities, additional hospital stay, and personnel expenses based on Institute for the Hospital Remuneration System (InEK) calculations, were compared with G-DRG reimbursements.

Results:
The baseline characteristics of the two groups did not differ significantly.During the hospital stay, 3 (17.6%)patients in the OVH group had major leg-wound healing disorders.Patients in the OVH group were in the hospital slightly longer, although this was not statistically significant (14.3 vs 11.7 days; p=0.424).The total cost was 23,223€ for the OVH group compared with 18,627€ for the EVH group (p=0.000);thus, the cost of the EVH group exceeded that of the EVH group by 4,596€ based on G-DRG calculations (incl.endoscopic vessel harvesting systems).

Conclusion:
EVH was associated with significant cost savings and fewer leg wound complications in a group of patients with intermediate or high risk.The G-DRG reimbursement system ended with the statement that case-based flat rates are not viable for hospitals treating vulnerable groups of patients.

Background:
Graft-versus-host disease (GVHD) is a significant complication of allogeneic hematopoietic stem cell transplantation, often resulting in severe and debilitating wounds.The only real alternative in case of failure of conservative therapy is the invasive transplantation of skin from the stem cell donor.This work presents the potential of human amniotic membrane (hAM) transplantation as a novel therapeutic approach for wound healing in a patient suffering from GVHD.The amniotic membrane, derived from the placenta, possesses unique properties including anti-inflammatory, anti-microbial, and anti-fibrotic effects, which are conducive to wound repair and regeneration.

Materials and methods:
Amniotic membrane transplantation was performed in three patients suffering from dermal GvHD disease.Human amniotic membrane was transplanted onto the soft tissue defect.We regularly monitored wound size and condition, incidence of infection, extent of local pain, and number of dressing changes.

Results:
In our three cases, complete wound closure was achieved in this patient within a few weeks with a single application of hAM.In addition, there was a local absence of pain and infection over the entire period, as well as no need for bandages after a few weeks.

Conclusion:
By means of transplantation of an amniotic membrane, complete healing of wounds resulting from GvHD reaction can be achieved.It thus offers an alternative to skin transplantation from the stem cell donor.Amnion transplantation as a potential game-changer in the management of GVHD-associated wounds paves the way for future research and clinical applications.

A Cost-Benefit Analysis of Endoscopic versus Conventional Vein Harvesting in Cardiac Surgery Based on the German DRG System
A cost-benefit analysis of open vein harvesting (OVH) versus endoscopic vein harvesting (EVH) for leg wound complications in intermediate-and high-risk cardiac surgical patients was performed based on the German system of Diagnosis-Related Groups (G-DRG) in a retrospective cohort from 2018.