RESUMO
BACKGROUND: Isolated iliac artery aneurysm (IIAA) is an uncommon finding. It, accounts for 0.03% of all patients and 2% of all abdominal aneurysm. Endovascular approach represents the treatment of choice for most patients with IIAA. We reported our experience on iliac aneurysm with no proximal landing zone by simultaneous aortoiliac kissing endovascular (S.A.K.E.) covered stenting. METHODS: This is a retrospective analysis of nine consecutive patients with IIAA with no proximal landing zone, who underwent endovascular kissing covered stenting (Gore®Viabahn®VBX) The median aneurysm diameter was 4.1 cm, with a median 3-mm proximal neck length. In 3/9 aneurysms involving the internal iliac arteries the origin of the internal iliac artery was covered after its embolization and a stent graft extending to the external iliac artery (EIA) was placed. All stents were flared with semi-compliant balloon. RESULTS: Iliac aneurysm exclusion was obtained in all cases (100%), no graft migration or endo-leak were recorded. The median operative time was 28 min; the median fluoroscopy time was 9 min and a median 70 mL of contrast was used. At a median 24-month follow-up, all patients are alive, and no endo-leak or migration, infection, distal embolization, limb loss were observed. Moderate buttock claudication was experienced in 1/9 patients with internal iliac artery embolization. In 6/9 patients a shrinkage of the aneurysmal sac was recorded after 1 year. DISCUSSION: Endovascular management of IIAAs cases has been reported in literature and it was confirmed to be safe and successful. The IAA usually progresses into expansion which eventually leads into rupture. Adequate long proximal and distal landing zones were the most important feature related to better outcomes. Short proximal neck (Ë10 mm) represents a real challenge for iliac aneurysm treatment and, nowadays, a classical bifurcated aortoiliac endograft deployment represents the treatment of choice. Endovascular repair of isolated CIA aneurysms with no proximal neck is safe and successful using the SAKE stenting technique with VBX adequately flared and it represents effective and minimally invasive alternative to aortobiliac endograft implantation in the treatment of these aneurysms. To the best of our knowledge, this is the first report which describes this approach in the treatment of IIAA with no adequate proximal landing zone. Our approach overcomes the need to aortic bifurcation graft implantation and reduces procedure time, contrast dose and radiation exposure. It also preserves relevant collaterals vessels thanks to inferior mesenteric artery and lumbar arteries sparing. A proximal aortic bifurcation endograft allows proximal sealing to be regained. Large population study with longer follow-up are needed to establish this approach as a new standard.
RESUMO
The Ovation Abdominal Stent Graft System is a trimodular endoprosthesis planned to overcome the limitations of currently available stent grafts, allowing complex iliac and femoral access and providing a proximal seal in challenge infrarenal neck morphology. The proximal sealing is achieved by means of a network of inflatable rings filled with low-viscosity radiopaque polyethylene glycol-based polymer during stent-graft deployment. The leakage of polymer outside the channel to fill the rings into the vascular system may induce an hypersensitivity reaction and anaphylactic shock. We report a case of anaphylactic reaction during Ovation Abdominal Stent Graft System implantation. The endovascular procedure was successfully concluded.
Assuntos
Anafilaxia/induzido quimicamente , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Polímeros/efeitos adversos , Stents , Idoso , Anafilaxia/diagnóstico , Anafilaxia/terapia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Desenho de Prótese , Índice de Gravidade de DoençaRESUMO
Venous hypertension and outflow stenosis of arteriovenous hemodialysis access managed using endovascular procedures usually present a high technical success rate, with few complications. We reported a rare and fatal complication of superior vena cava perforation with pericardial tamponade 3 months after subclavian vein stenting. Interventional recanalization with stenting for the management of superior vena cava syndrome or central vein stenosis is a safe procedure with a low complication rate. Stent misplacement, reocclusion, migration, or access-related complications appear to occur most frequently.
Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Tamponamento Cardíaco/etiologia , Cateterismo Venoso Central/efeitos adversos , Procedimentos Endovasculares/instrumentação , Doença Iatrogênica , Stents , Doenças Vasculares/terapia , Lesões do Sistema Vascular/etiologia , Veia Cava Superior/lesões , Ferimentos Penetrantes/etiologia , Idoso , Autopsia , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/terapia , Constrição Patológica , Procedimentos Endovasculares/efeitos adversos , Evolução Fatal , Feminino , Humanos , Flebografia , Falha de Prótese , Diálise Renal , Tomografia Computadorizada por Raios X , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/etiologia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/terapia , Veia Cava Superior/diagnóstico por imagem , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/terapiaRESUMO
OBJECTIVES: We prospectively evaluated safety and efficacy from our six-year results of general anesthesia (GA) using remifentanil conscious sedation in carotid endarterectomy (CEA). METHODS: From January 2005 to December 2010, 625 consecutive CEAs were performed on 545 patients (male/female 336/209, age 75 ± 7 years). After a superficial plexus block with ropavacaine, GA was induced with an intravenous infusion of propofol, using local lidocaine during tracheal intubation and a high-dose of remifentanil, in all cases reducing and then stopping the remifentanil infusion at the clamping time so that the patient would be awake and collaborating within a few minutes, as in local anesthesia. Data on postoperative morbidity and mortality, neurological complications, shunt insertions and the responses to one-day and three-month questionnaires on satisfaction were collected for all patients. RESULTS: The 30-day mortality was 0.32% (two patients). Only one major stroke (0.16%) and two minor strokes (0.32%) occurred. A shunt was deployed in 83 cases (13.3%). Eight patients (1.28%) reported cranial nerve injuries, and surgical drainage for postoperative hematoma was performed in 11 patients (1.8%). Thirty-one patients (4.6%) suffered postoperative nausea/vomiting. Almost all patients were satisfied at the 24-h (94.6%) and three-month (>98%) follow-up questionnaire. CONCLUSIONS: The six-year results for GA using remifentanil conscious sedation were very satisfactory and highlighted the advantages of both GA (hemodynamic stability and excellent control of ventilation) and local anesthesia (ease of evaluation of neurological status) in a calm and relaxed environment for both patient and surgeon.
Assuntos
Anestesia Geral , Doenças das Artérias Carótidas/cirurgia , Sedação Consciente , Endarterectomia das Carótidas/métodos , Hipnóticos e Sedativos/administração & dosagem , Piperidinas/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/efeitos adversos , Sedação Consciente/efeitos adversos , Feminino , Humanos , Hipnóticos e Sedativos/efeitos adversos , Intubação Intratraqueal , Itália , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Remifentanil , Inquéritos e Questionários , Fatores de Tempo , Resultado do TratamentoRESUMO
The internal carotid artery (ICA) usually, lies posterolaterally to the external carotid artery (ECA). Sometimes a complete carotid transposition can occur, with the ECA in a lateral position and the ICA on the medial side can occur. Our study evaluated the significance and impact that this anomaly may have on cranial nerve injuries. From January 2008 to November 2010, 296 patients underwent 360 consecutive primary carotid endarterectomy (CEA) procedures. During carotid isolation, we detected an unexpected lateral position of the ECA in 11 cases (3.6%). χ(2) analysis and the Student's t-test were used to compare the incidence of cranial nerve injuries between the 11 patients with the lateral ECA who underwent CEA (group A) and 11 randomized patients with a normal bifurcation (group B). Statistical significance was inferred at χ(2)>3.84 and P<0.05. A statistical difference in the incidence of superior laryngeal nerve paralysis was detected between groups A and B (18.1%, 2/11 in group A vs. 0%, 0/11 in group B; χ(2)>3.84; P<0.05). No differences in incidence of injury were detected for the other cranial nerves. A very meticulous mobilization of the ECA and ICA is needed to perform CEA, but superior laryngeal nerve injury can occur despite the use of a safe and meticulous surgical technique.
Assuntos
Artéria Carótida Externa/cirurgia , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Traumatismos dos Nervos Cranianos/etiologia , Endarterectomia das Carótidas/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Externa/anormalidades , Artéria Carótida Interna/anormalidades , Distribuição de Qui-Quadrado , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
Heparin-induced thrombocytopenia type II is an immune-mediated syndrome that may arise in a time-dependent manner after heparin therapy. Thrombocytopenia and thrombosis in patients exposed to heparin are suggestive of this syndrome.
Assuntos
Anticoagulantes/efeitos adversos , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular , Materiais Revestidos Biocompatíveis , Heparina/efeitos adversos , Extremidade Inferior/irrigação sanguínea , Trombocitopenia/induzido quimicamente , Idoso , Anticoagulantes/administração & dosagem , Arginina/análogos & derivados , Implante de Prótese Vascular/instrumentação , Remoção de Dispositivo , Diagnóstico Precoce , Feminino , Heparina/administração & dosagem , Humanos , Ácidos Pipecólicos/administração & dosagem , Politetrafluoretileno , Desenho de Prótese , Reoperação , Sulfonamidas , Trombocitopenia/diagnóstico , Trombocitopenia/terapia , Resultado do TratamentoRESUMO
Arterial percutaneous closure devices (APCD) could lead to severe vascular complications, like acute lower limb ischemia. The aim of this study was to evaluate retrospectively our personal series of acute lower limb ischemia following the use of APCD. From January 2004 to June 2009 the Angio-Seal percutaneous closure devices was deployed in 198 patients. Eight (4%) acute lower limb ischemia required urgent surgical repair. The device was removed in all cases. A thromboembolectomy was performed in five patients (62.5%) and in three (37.5%) an endarterectomy with patch closure was carried out (two saphenous vein and one Dacron). Limb salvage rate was 87.5%. We compared Angio-Seal complications group (A) with the 190 patients in which the Angio-Seal was successfully used without complications (group B) by means of Student's t-test. At 36-month follow-up with color-coded duplex ultrasounds, no chronic limb ischemia or other complications requiring surgical repair occurred. Diabetes, obesity, severe femoral atherosclerotic involvement, use of sheath size >7 Fr and time-consuming procedures were significant risk factors for ischemic APCD complications. Despite vascular injuries being uncommon after APCD deployment, generally a complex surgical repair is necessary. A more careful patient selection would be advisable.
Assuntos
Cateterismo Periférico/efeitos adversos , Hemorragia/prevenção & controle , Técnicas Hemostáticas/efeitos adversos , Isquemia/cirurgia , Procedimentos Cirúrgicos Vasculares , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo , Embolectomia , Endarterectomia , Desenho de Equipamento , Feminino , Artéria Femoral , Hemorragia/etiologia , Técnicas Hemostáticas/instrumentação , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Itália , Salvamento de Membro , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Punções , Radiografia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Trombectomia , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em CoresRESUMO
We report the case of complete transposition of the femoral artery and vein in a 47-year-old woman submitted to high ligation of the left saphenous femoral junction (SFJ) and great saphenous vein (GSV) stripping. During the dissection, we detected that the SFJ and the common, superficial and deep femoral veins were laterally placed to the femoral artery and the GSV crossed the femoral artery bifurcation. Associated variations of the GSV, femoral artery and vein is quite rare and, despite being asymptomatic can lead to technical difficulties increasing the risk of major intraoperative complications. The knowledge of this anomaly seems to be important and its detection is usually intraoperative.
Assuntos
Artéria Femoral/anormalidades , Veia Femoral/anormalidades , Veia Safena/anormalidades , Malformações Vasculares/diagnóstico , Feminino , Veia Femoral/cirurgia , Humanos , Achados Incidentais , Ligadura , Pessoa de Meia-Idade , Veia Safena/cirurgia , Varizes/complicações , Varizes/cirurgia , Malformações Vasculares/complicações , Procedimentos Cirúrgicos VascularesRESUMO
OBJECTIVES: Arterial injury of the lower limb is a rare but catastrophic complication of saphenous vein stripping with a high morbidity rate and severe medico-legal implications. Diagnosis is often delayed and outcome depends on the severity of injury. We report two cases of severe ischemia due to arterial lesion during varicose veins surgery. METHODS: In the first case, a superficial femoral artery ligature after an operation for recurrent varicose veins surgery occurred; in the second case, an intraoperative ligature of the superficial femoral artery and vein was detected. In the first case, an angiography was carried out and a superficial-superficial femoral artery interposition graft with PTFE was performed. In the other case, an interposition graft with a contralateral saphenous vein between the common and superficial femoral artery and an end-to-end anastomosis of the superficial femoral vein was carried out. RESULTS: No amputation occurred, good patency rate of the graft was achieved and no neurologic-muscle complications were revealed. CONCLUSIONS: Femoral artery injury after venous stripping shows a high amputation rate due to delayed diagnosis and severity of arterial involvement. Angiography must be reserved in any case of late ischemia. Prompt diagnosis and aggressive management is mandatory.