RESUMO
We report a multicenter experience of open conversions (OC) for aortic endograft infections (AEI). We retrospectively analyzed all patients who underwent OC for AEI after endovascular aneurysm repair (EVAR), from 1997 to 2021 in 12 Italian centers. The endpoints were as follows: mortality (30-days, in-hospital), major postoperative complications. Follow-up data included: survival, aortic-related complications, infection persistence or reoccurrence. Fifty-eight patients (mean age: 73.8 ± 6.6 years) were included. Median time from EVAR to OC was 14 months (interquartile range 7-45). Thirty-five patients (60.3%) were symptomatic at presentation. Aortic reconstruction was anatomic in 32 patients (55.2%), extra-anatomic in 26 (44.8%). Thirty-day mortality was 31% (18/58). Six additional patients died after 30 days during the same hospitalization (in-hospital mortality: 41.4%). Most common post-operative complications included respiratory failure (38.6%) and renal insufficiency (35.1%). During 28.1 ± 4 months follow-up, 4 aneurysm-related deaths were recorded. Infection re-occurred in 29.4% of the patients. Estimated survival was 50% at 1 year, and 30% at 5 years, and was significantly lower for patients who underwent extra-anatomic reconstructions (37 vs 61% at 1 year, 16 vs 45% at 5 years; log-rank P = .021). OC for AEI is associated with high early mortality. The poor mid-term survival is influenced by aortic complications and infection re-occurrence.
RESUMO
We report a case of deep femoral artery (DFA) retrograde access for recanalization of an accidental ostial occlusion complicating an antegrade-retrograde superficial femoral artery (SFA) procedure. A 77-year-old man with chronic limb-threatening ischemia of the right lower limb was submitted to a duplex ultrasound that showed a heavy calcified SFA chronic total occlusion. During antegrade and retrograde attempts to cross the SFA obstruction, a control angiogram unexpectedly showed the ostial occlusion of the DFA. Several antegrade attempts to cross the DFA occlusion with various guidewires and catheters were unsuccessfully made. Retrograde access was achieved by direct puncture of the DFA distally to the first perforating artery. With sheathless approach, the occlusion was crossed, the retrograde guidewire was externalized through the femoral sheath, and the balloon angioplasty was then performed antegradely. The SFA recanalization was interrupted because of patient discomfort. The patient had an uncomplicated recovery, with immediate resolution of rest pain probably because of the resolution of the underestimated DFA stenosis. The retrograde DFA access is a useful bailout technique in case of accidental ostial occlusion of the DFA.
Assuntos
Angioplastia com Balão , Procedimentos Endovasculares/efeitos adversos , Artéria Femoral , Isquemia/terapia , Doença Arterial Periférica/terapia , Calcificação Vascular/terapia , Idoso , Doença Crônica , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/fisiopatologia , Grau de Desobstrução VascularRESUMO
During implantation of an Ovation endograft for abdominal aortic aneurysm (AAA) correction, a patient experienced anaphylactic reaction after polymer leakage outside the device circuit. Procedure was completed after hemodynamic stabilization. Since postoperative day 2, patient complained of loss of legs strength. Medullar injury was excluded by electromyography test, and the clinical signs attributed to muscular necrosis and peripheral nerve involvement after arterial embolization. Furthermore, immediately after surgery, a wide erythematous area appeared in the lumbar region. During the next few days, the lesion developed from extensive blisters and necrosis to deep loss of substance. The wound needed to be medicated 2 or 3 times per week. One year after surgery, the patient still needs crutches for deambulation, and the back injury is currently under treatment. In conclusion, surgeons performing aortic endovascular repair with the Ovation endograft, as well as anesthesiologists participating in the procedure, should be aware of the possibility of embolization and ready to promptly treat possible complications.