RESUMO
BACKGROUND: Rupture of an anastomotic pseudoaneurysm after lower extremity prosthetic bypass is a rare problem, and the traditional mode of treatment has been open surgery. CASE DESCRIPTION: We report the endovascular management of a disrupted distal anastomosis of an above-knee femoro-popliteal Dacron bypass graft. Under local anesthesia and via a femoral cut-down, the Dacron graft was punctured and a 9 x 60 mm stent-graft was implanted resulting in successful pseudoaneurysm exclusion. The patient had an uneventful recovery. CONCLUSIONS: Stent-grafting may offer quick and easy rescue options for such challenging peripheral vascular lesions. Hippokratia 2015; 19 (2):179-181.
RESUMO
It has been postulated that atherosclerosis should be considered as a chronic inflammatory process and peripheral arterial disease (PAD) is a manifestation of such an atherosclerotic vascular disease. Matrix metalloproteinases (MMPs) are significant circulating biomarkers which play a pivotal role in the initiation, progression and clinical manifestations of PAD. This review summarizes the current body of evidence with regard to the association between MMPs and PAD.
Assuntos
Metaloproteinases da Matriz/metabolismo , Doença Arterial Periférica/complicações , Doença Arterial Periférica/enzimologia , Angioplastia com Balão , Animais , Biomarcadores , Comorbidade , Diabetes Mellitus/enzimologia , Progressão da Doença , Matriz Extracelular/metabolismo , Humanos , Hipertensão/enzimologia , Insuficiência Renal Crônica/enzimologiaRESUMO
OBJECTIVES: To compare aortoenteric fistula (AEF) outcome after endovascular (EV-AEFR) or open repair (O-AEFR). DESIGN: Multicentre retrospective comparative study. MATERIALS/METHODS: 25 patients with AEF (24 secondary, 23 males, median age 75 years) after aortic surgery (median four years). Preoperative sepsis was evident in 19 cases. Eight patients were managed with EV-AEFR and 17 with O-AEFR. RESULTS: The two groups were comparable in preoperative characteristics. In-hospital mortality after EV-AEFR was lower compared to O-AEFR (0% and 35%, respectively, p = 0.13). Similarly, morbidity after EV-AEFR was lower compared to O-AEFR (25% and 77%, respectively, p = 0.028). There was a trend for worse recurrence-free, sepsis-free, re-operation-free and AEF-related death-free rates after EV-AEFR, while the early survival advantage of EV-AEFR was lost after two years and the overall long-term survival rates (perioperative mortality included) of the two groups were similar. Preoperative sepsis had no effect on recurrence and sepsis-free rates (p = 0.94 and p = 0.92, respectively), but it was associated with worse two year overall survival (24% vs 50%, p = 0.32). On multivariate analysis, the number of symptoms (two vs one) at presentation was the single predictor of worse re-operation rates, AEF-related and overall survival. CONCLUSIONS: EV-AEFR was associated with no postoperative mortality in this study and can achieve satisfactory short and long-term results, comparable to O-AEFR. Further trials should focus on the role of EV-AEFR in patients at high risk for O-AEFR, due to shock or co-morbidities, or as a bridging procedure.
Assuntos
Aorta Abdominal , Doenças da Aorta/cirurgia , Fístula Intestinal/cirurgia , Stents , Fístula Vascular/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/diagnóstico , Feminino , Seguimentos , Humanos , Fístula Intestinal/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fístula Vascular/diagnósticoRESUMO
The management of superficial femoral artery occlusive disease remains challenging for vascular surgeons. Despite the advances and dramatic changes we have seen in modern practice with the development and introduction of new endovascular techniques, long-term results with these interventions remain disappointing when compared to the "gold standard" of a vein bypass with a good run-off. Furthermore, there is little Level 1 evidence to guide us with regards to the best treatment strategy. In this article, we review some of the currently available open surgical and endovascular options for the management of superficial femoral artery disease.
Assuntos
Arteriopatias Oclusivas/terapia , Artéria Femoral , Angioplastia com Balão , Angioplastia com Balão a Laser , Aterectomia , Humanos , Angiografia por Ressonância Magnética , Artéria Poplítea , Guias de Prática Clínica como Assunto , Stents , Grau de Desobstrução VascularRESUMO
OBJECTIVE: To present the results of the endovascular treatment of popliteal artery aneurysms. METHODS: From April 1999 to January 2002, 11 patients, aged 40-94 years, with 12 popliteal aneurysms were treated. Nine (75%) underwent an endoluminal repair, of whom three were done emergently due to an aneurysm rupture. Aneurysm diameter was 28-105 (mean 69) mm. A Hemobahn stent graft was inserted in six, Wallgraft in two and Passager in one case. RESULTS: During a mean follow-up of 14 (3-31) months, four (44%) thromboses occurred: two in the early postoperative period (30 days) and two during the late postoperative period. Two of the four occluded grafts were successfully reopened, and in the one a stenosis of the distal end of the stent graft was treated with balloon dilatation. Patency rates at 1 and 12 months were 64/47% (primary patency) and 88/75% (secondary patency), respectively. CONCLUSION: Initial experience with endovascular treatment of the popliteal aneurysm in high-risk patients yielded modest results. Larger number of patients and further follow-up time is necessary to evaluate the long-term results.
Assuntos
Aneurisma/cirurgia , Implante de Prótese Vascular , Artéria Poplítea/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma/diagnóstico por imagem , Aneurisma Roto/cirurgia , Emergências , Feminino , Oclusão de Enxerto Vascular/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagem , Complicações Pós-Operatórias , Radiografia Intervencionista , Trombose/etiologia , Trombose/terapiaRESUMO
Reperfusion injury of the liver occurs in liver transplantation and in major hepatectomies. It triggers a severe oxidative stress that leads to increased lipid peroxidation. In our study we examined the effect of parenteral supranutritional administration of alpha-tocopherol, a vitamin that plays a key role in the endogenous antioxidant system, to rats subjected to severe ischemia/reperfusion (I/R) injury of the liver. alpha-Tocopherol was administered to the animals at doses of 30 and 300 mg/kg bw, whereas total hepatic ischemia was induced for 60 min followed by 120 min reperfusion. Tissue and blood samples were collected for malonyldialdehyde (MDA) and serum alpha-tocopherol assay, respectively. In the sham operation group, mean MDA level in liver was 1.14 nmole/g wet tissue in the control subgroup, and 1.01 or 0.74 nmole/g wet tissue in the subgroups given 30 or 300 mg/kg alpha-tocopherol. In the I/R group, mean MDA level was 1.57 nmole/g wet tissue in the control subgroup, and 0.97 and 0.77 nmole/g wet tissue in the subgroups given 30 or 300 mg/kg alpha-tocopherol. Mean levels of alpha-tocopherol in serum (mumole/l) were 10.20 and 1.80 in the control subgroups, 25.28 and 11.25 in the subgroups treated with 30 and 300 mg/kg bw of alpha-tocopherol, and 31.00 and 13.02 in the subgroups treated with 30 and 300 mg/kg bw of alpha-tocopherol, within the sham-operation and I/R groups, respectively. A significant decrease of MDA accompanied by a significant increase of serum alpha-tocopherol was documented in the alpha-tocopherol-treated rats within both groups. Ischemia/reperfusion triggered a significant increase of the MDA level in the liver of the rats not treated with alpha-tocopherol as compares with the treated animals.
Assuntos
Peroxidação de Lipídeos/fisiologia , Fígado/metabolismo , Fígado/patologia , Traumatismo por Reperfusão/metabolismo , alfa-Tocoferol/metabolismo , Animais , Fígado/cirurgia , Transplante de Fígado/efeitos adversos , Masculino , Malondialdeído/metabolismo , Estresse Oxidativo , Ratos , Ratos Wistar , alfa-Tocoferol/sangueRESUMO
PURPOSE: To examine the long-term outcome of patients treated with endoluminal grafts (ELGs) for aneurysmal and occlusive disease in the femoropopliteal (FP) segment. METHODS: ELGs of radially expandable polytetrafluoroethylene with terminal Palmaz stents were used to form intimal conduits to revascularize lengthy occlusive disease and exclude aneurysms in the FP segment. Patient records were reviewed retrospectively for outcome. RESULTS: Fifty-five (98%) of 56 ELGs were placed successfully in 51 patients treated from August 1993 to February 1996. Over a mean 36-month follow-up, 28 (50%) ELGs occluded. Half of these failures reflected early technical difficulties. There were 11 (20%) stent stenoses, 6 in the proximal stent and 5 in the distal device. The majority of the graft failures were treated with endovascular techniques; however, FP bypass was required in 7 (25%) patients, while 2 (7%) were not treated. Life-table analysis demonstrated 46% primary and 68% secondary patency rates at 24 months. Among demographic and procedural variables, only previous dilation or stent procedures in the target artery was associated with failure (p < 0.0001). CONCLUSIONS: The prototype ELG used in this series demonstrated durability similar to conventional surgical therapy utilizing synthetic material. Endoluminal grafting of FP lesions may be a more durable alternative to classical bypass once devices and techniques are refined.
Assuntos
Aneurisma/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular/instrumentação , Artéria Femoral , Stents , Idoso , Idoso de 80 Anos ou mais , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Angiografia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Materiais Biocompatíveis , Velocidade do Fluxo Sanguíneo , Feminino , Artéria Femoral/diagnóstico por imagem , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Politetrafluoretileno , Desenho de Prótese , Falha de Prótese , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia Doppler DuplaRESUMO
OBJECTIVE: To examine interleukin-6 (IL-6) and C-reactive protein (CRP) release in children with head injury (HI) and investigate if there is a correlation between the levels of these two proteins and the severity of HI. DESIGN: Prospective clinical investigation. SETTING: Eight-bed paediatric intensive care unit in a university hospital. PATIENTS: Forty-five children were followed up for 4 days after HI and their serum IL-6 and CRP levels were measured. MEASUREMENTS AND RESULTS: Peak serum IL-6 levels occurred 4 h postinjury, decreasing over time. CRP was normal 4 h after injury, then increased reaching peak levels in 48 h. Children with admission Glasgow Coma Scale (GCS) scores of 8 or less had higher IL-6 levels compared to children with GCS scores higher than 8, 4 and 12 h post-injury (p<0.01 and p<0.05, respectively). IL-6 was higher in children with admission PRISM scores of 10 or more than in those with PRISM scores lower than 10 at 4 and 12 h (p<0.05). CRP levels were higher in patients with GCS scores of 8 or less compared to patients with GCS scores higher than 8 at 24, 48 and 72 h (p<0.05, p<0.02 and p<0.02, respectively) . Patients with PRISM scores of 10 or more had higher CRP levels compared to those with PRISM scores lower than 10 at 24, 48 and 72 h (p<0.05). Peak CRP levels correlated well with peak IL-6 levels (r = 0.49, p<0.001). No correlation between IL-6 or CRP levels and mortality or clinical outcome was found. CONCLUSIONS: Serum IL-6 and CRP levels are elevated in children with HI and there is a relation between the severity of HI and the levels of these proteins. There was no correlation between IL-6, CRP and outcomes of the patients.
Assuntos
Proteína C-Reativa/metabolismo , Traumatismos Craniocerebrais/imunologia , Interleucina-6/sangue , Adolescente , Criança , Pré-Escolar , Traumatismos Craniocerebrais/sangue , Feminino , Escala de Coma de Glasgow , Humanos , Lactente , Masculino , Estudos Prospectivos , Fatores de TempoRESUMO
BACKGROUND: Modification of endografts are required to simplify and improve the safety of the endovascular management of abdominal aortic aneurysms (AAA). OBJECTIVES: The aim of this study is to evaluate the efficacy of a new custom-made, tubular and bifurcated device. MATERIALS AND METHODS: The graft consisted of a continuous, self-expanding, stainless steel, Z-stent structure, covered with a thin wall PTFE tube. Bifurcated grafts were constructed in vivo from three PTFE tubes with a continuous Z-stent structure. Twenty-seven high risk patients with a mean age of 74 (62-86) years and AAA, mean diameter 5.9 cm, were treated in the last 26 months. Tube grafts were deployed in 13 aortic and one iliac cases, bifurcated grafts in nine cases and aorto-uni-iliac grafts with femorofemoral bypass in four cases. Grafts were deployed percutaneously under local anaesthesia. Patients were followed with contrast CT periodically. RESULTS: All grafts were deployed. There were no open conversions or other major complications. There were nine proximal and one distal postoperative endoleak. Four sealed spontaneously, three were treated successfully with endovascular techniques and three are under surveillance. In the 7 (2-23) months follow-up, one patient died due to heart failure 3 months post-procedure. CONCLUSIONS: Local anaesthesia and percutaneous graft introduction simplify and improve the efficacy of the procedure. Continuous aortic graft support provides stability and reduces the risk of migration. PTFE is a flexible, low-profile material for use in endovascular stent-grafts. The bifurcation concept used offers a simple technique for bifurcated grafts.
Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Idoso , Idoso de 80 Anos ou mais , Anestesia Local , Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Stents , Tomografia Computadorizada por Raios XRESUMO
During a 12-month period 239 children who presented with a burn injury at the Emergency Department of a teaching children's hospital in Athens, with city-wide coverage, and 239 gender- and age-matched controls with minor non-injury ailments were interviewed. The questionnaire covered sociodemographic characteristics of the children and their families, information allowing the construction of a burn avoidance index in their homes and items from the Achenback scale that were synthesized into a child activity score. The data were analyzed through conditional logistic regression. In general, socio-demographic variables were not of overwhelming importance, although some of the findings indicate that supervision lapses and barefoot walking of gypsy children increase the risk of burn injuries. The kitchen in an inherently high risk place for injuries and the powerful inverse association of the burn avoidance index with burn injury risk points towards steps that could be easily taken and impart substantial protection. There was no evidence in this study of burn injury proneness or that hyperactivity of the child increased the risk of burn injury; indeed, the results point in the opposite direction. Our results strongly support the view that childhood burn injuries are largely environmentally conditioned and, accordingly, easily preventable.
Assuntos
Queimaduras/epidemiologia , Queimaduras/etiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Demografia , Seguimentos , Grécia/epidemiologia , Humanos , Estudos Retrospectivos , Fatores de Risco , Classe Social , Inquéritos e QuestionáriosRESUMO
PURPOSE: To examine whether endoluminal grafts (ELGs) of radically expandable polytetrafluoroethylene (PTFE) can successfully form durable internal conduits to revascularize lengthy occlusive disease and exclude aneurysms in the femoropopliteal (FP) arteries. METHODS: Under protocol, implantation of an unpredilated PTFE tube ELG anchored with Palmaz stents using a low-profile percutaneous delivery system was attempted in 50 symptomatic patients for a variety of pathologies: (1) restenosis; (2) complex lesions unlikely to be treated successfully with other endoluminal therapies; (3) acute angioplasty failure; and (4) aneurysms. There were 37 occlusions, 14 stenoses, and 2 long, combined stenotic-aneurysmal lesions in 47 native arteries, 5 FP grafts, and 1 femorotibial (FT) vein graft. Thirty-two percent of the patients had < or = vessel runoff. The average lesion length was 20.4 +/- 11.4 cm (range 1.5 to 40), and the mean preoperative ankle-brachial index (ABI) at rest was 0.53 +/- 0.14. RESULTS: In a 20-month period through April 1995, 50 patients (34 males, 16 females; mean age 69.5 years, range 45 to 87) underwent 54 procedures in 53 limbs; 55 ELGs were successfully deployed in 51 limbs; 2 patients were converted to FP bypass owing to technical problems (96% procedural success). There were 18 inhospital complications: 1 distal wire dissection repaired with an additional ELG; 2 hematomas requiring surgical repair; 1 graft collapse; 1 pseudoaneurysm at the site of a mid-ELG leak; 7 minor access sequelae; and 6 acute ELG thromboses, 4 treated with lytic therapy and balloon dilation, 1 with open thrombectomy, and 1 with bypass grafting. The mean postoperative ABI was 1.01 +/- 0.10. During the 30-day postprocedure period, 2 ELGs rethrombosed and 2 other limbs (3 ELGs) occluded; 1 thrombosis and 1 rethrombosis were lysed successfully, but the other 2 patients had an FP bypass. Over the mean 8.3 +/- 5.5 month follow-up, 6 additional ELGs occluded and 1 reoccluded; 4 were successfully treated by endovascular techniques for a primary patency of 72% and secondary patency of 84% by life-table analysis. CONCLUSIONS: Endovascular grafting is a conceptually attractive technique that has the potential to expand the current boundaries of interventional treatment. This preliminary experience attests to the feasibility and safety of ELG deployment in the superficial femoral arteries. Whether such a device can match the durability of classical revascularization techniques remains to be determined in clinical trials when device configurations and deployment techniques have been standardized.
Assuntos
Aneurisma/cirurgia , Arteriopatias Oclusivas/cirurgia , Prótese Vascular , Artéria Femoral , Politetrafluoretileno , Idoso , Idoso de 80 Anos ou mais , Constrição Patológica , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Poplítea , Stents , Grau de Desobstrução VascularRESUMO
A fatal case of diphtheria occurred in a nonimmunized child. The child died because of the late diagnosis of the disease, which is now extremely rare.
Assuntos
Difteria/patologia , Pré-Escolar , Corynebacterium diphtheriae/isolamento & purificação , Difteria/microbiologia , Evolução Fatal , Feminino , Humanos , Laringe/patologia , Pulmão/patologia , Miocárdio/patologia , Traqueia/patologiaRESUMO
The relationship between oxygenation and lung volume during high frequency oscillatory ventilation (HFOV) was studied. We ventilated anesthetized, tracheostomized adult rabbits that were rendered surfactant-deficient by lung lavage. Lung volume was measured by the 'disconnection technique'. In the first experiment, HFOV was commenced after conventional mechanical ventilation (CMV) for 1 hr. In the absence of sustained inflation (SI), oxygenation improved with time during HFOV. In the second experiment, HFOV was instituted after CMV for 4 hr. In the absence of SI, all animals expired during the experimental period. In the third experiment we ventilated rabbits for 4 hr and then switched to HFOV. We applied SI first and increased mean airway pressure (MAP) by increments of 2 cmH2O every 15 min. However, there was little improvement in PaO2 despite the use of repeated SI and the increase in MAP. We conclude that oxygenation has a linear relationship to lung volume during HFOV, and that secondary lung injury due to long-term CMV impairs the response to HFOV. Therefore, it is important to minimize the risk of such secondary injuries before instituting HFOV.