Assuntos
Endarterectomia , Hipertensão Pulmonar/cirurgia , Derivação Peritoneovenosa/efeitos adversos , Artéria Pulmonar/cirurgia , Embolia Pulmonar/cirurgia , Pré-Escolar , Endarterectomia/instrumentação , Endarterectomia/métodos , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/etiologia , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Remote iliac artery endarterectomy (RIAE) is a challenging technique in the treatment of arterial occlusive disease. The impact of proximal transection zone stenting on patency rates is still unclear. METHODS: This is a retrospective analysis of all patients who underwent RIAE in our hospital between March 2007 and October 2017. A stent was used in cases with a dissection flap or a stenosis at the proximal transection zone after RIAE. In all other cases, we did not use a stent. Study end points were patency rates, limb salvage, and survival after 5 years. RESULTS: There were 115 RIAEs performed in 108 patients. All lesions were TransAtlantic Inter-Society Consensus C (61.7%) or D (38.3%) lesions. The median follow-up time was 38.5 months (range, 0-117 months). The indications were claudication in 67.0% and critical limb ischemia in 33.0%. Group 1 (n = 56) included all patients without a stent; group 2 (n = 59) included all patients with stenting of the proximal dissection zone. Risk factors were similar between the groups. The 30-day morbidity and mortality rates between the groups were not significantly different. The primary patency rate was 81.6% (group 1, 76.2%; group 2, 87.6%; P = .286), the primary assisted patency rate was 91.9% (group 1, 94.0%; group 2, 90.0%; P = .512), and the secondary patency rate was 93.8% (group 1, 94.0%; group 2, 91.6%; P = .435) after 5 years. Limb salvage (97.2%; group 1, 100%; group 2, 94.5%; P = .084) and survival time (57.1%; group 1, 66.7%; group 2, 43.5%; P = .170) were also not significantly different between the groups. A restenosis at the transection zone occurred in 14.3% in group 1 and 1.7% in group 2 (P = .013) during follow-up. A newly formed occlusion of the hypogastric artery was seen in 5.2% of patients after RIAE. CONCLUSIONS: RIAE is a safe procedure with excellent patency rates. However, the restenosis rate is higher in cases without stenting.
Assuntos
Arteriopatias Oclusivas/cirurgia , Endarterectomia/instrumentação , Artéria Ilíaca/cirurgia , Claudicação Intermitente/cirurgia , Isquemia/cirurgia , Stents , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/mortalidade , Arteriopatias Oclusivas/fisiopatologia , Estado Terminal , Endarterectomia/efeitos adversos , Endarterectomia/mortalidade , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Claudicação Intermitente/diagnóstico por imagem , Claudicação Intermitente/mortalidade , Claudicação Intermitente/fisiopatologia , Isquemia/diagnóstico por imagem , Isquemia/mortalidade , Isquemia/fisiopatologia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
BACKGROUND: The femoral prosthetic patch is a surgical procedure frequently used to treat atherosclerotic lesions involving femoral artery bifurcation. Even though it is an easy to perform procedure, surgical management of complications, first of all graft infection, may be challenging, with a high morbidity and mortality risk for patients. We report our experience on surgical treatment of femoral patch infections. MATERIALS AND METHODS: Between April 2012 and April 2018, 26 patients (26 limbs) were referred to the emergency department at our institution for the treatment of femoral prosthetic patch infections. None of the patients had been previously treated at our institution. All patients underwent a wide debridement of the infection site. Blood flow was restored through a vein interposition graft anastomosed at least 4-5 cm from the site of infection. End points of the study were death-related events, major or minor limb loss (major loss for above or below the knee amputation and minor for foot or toe), vein interposition graft failures, recurrent graft infections, or surgical wound healing. RESULTS: A total of 26 patients (21 male and 5 female patients) underwent surgical treatment. The mean age of patients was 69 years. The majority of our patients (54%) had been previously treated with an isolated femoral artery prosthetic patch. Three (11%) patients had been treated with a bilateral prosthetic femoral patch, but only one side was infected. After debridement of the infection site, we used the great saphenous vein to revascularize the lower limb in 22 (85%) cases, whereas the cephalic vein was used in only 4 cases (15%). The 5-year survival rate was 81% (standard error [SE] = 0.12). The 5-year primary patency rate was 70% (SE = 0.14). During follow-up, 4 graft occlusions occurred, and in 2 cases, a major amputation was required. The limb salvage rate at 5 years was 81% (SE = 0.13). CONCLUSIONS: An infection can complicate the femoral prosthetic patch carrying a high rate of morbidity, mortality, and limb loss. Surgical indication for a primary procedure must be restricted to critical limb ischemia, and it must be associated to a multilevel correction of the atherosclerotic disease.
Assuntos
Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Endarterectomia/efeitos adversos , Artéria Femoral/cirurgia , Doença Arterial Periférica/cirurgia , Infecções Relacionadas à Prótese/microbiologia , Idoso , Amputação Cirúrgica , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Angiografia por Tomografia Computadorizada , Desbridamento , Endarterectomia/instrumentação , Endarterectomia/mortalidade , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/microbiologia , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/mortalidade , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Veia Safena/transplante , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
The purpose of this study was to analyse the results of hybrid loop endarterectomy from the superficial femoral artery (SFA) in its occlusion, preformed in a total of forty-two patients. Of these, 27 patients had prior to the intervention been diagnosed with stage II B ischaemia and 15 patients had been diagnosed as having critical ischaemia. Technical success of the operation amounted to 88%, with the frequency of early thromboses equalling 2.7%. In the early postoperative period, one patient died of acute myocardial infarction. The 1-, 2- and 3-year remote cumulative primary patency rate amounted to 81, 74 and 74%, respectively. There were no amputations performed within the timeframe of the follow-up period. The technique of hybrid loop endarterectomy with the MultiTASC loop followed by stenting of the proximal portion of the popliteal artery in occlusion of the SFA and stenoses of the common femoral artery has proved to be a highly efficient intervention yielding good immediate and remote results.
Assuntos
Arteriopatias Oclusivas/cirurgia , Endarterectomia , Artéria Femoral/cirurgia , Extremidade Inferior/irrigação sanguínea , Doenças Vasculares Periféricas/cirurgia , Artéria Poplítea/cirurgia , Complicações Pós-Operatórias , Stents , Idoso , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/fisiopatologia , Endarterectomia/efeitos adversos , Endarterectomia/instrumentação , Endarterectomia/métodos , Feminino , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/diagnóstico , Doenças Vasculares Periféricas/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
AIM: The study was aimed at assessing efficacy of using the "MultiTASK" device manufactured by the Le Maitre Company while performing extended endarterectomy from iliac arteries in patients presenting with multilevel atherosclerotic lesions of the arterial bed and chronic ischaemia of lower extremities. PATIENTS AND METHODS: We analysed the outcomes of surgical management of a total of 37 patients presenting with multilevel atherosclerotic lesions of the common and external iliac arteries and arteries below the inguinal ligament over the period from 2012 to 2015 at the Department of Emergency Vascular Surgery of the Scientific Research Institute of Emergency Ambulance Care named after N.V. Sklifosovsky. Twenty one (56.8%) patients presented with haemodynamically significant stenoses of the iliac artery. Eleven (29.7%) patients had occlusion of the external iliac artery and five (13.5%) patients presented with occlusion of the common iliac artery in the distal portion. In all cases there was a second block, i. e. occlusion of the superficial femoral artery. RESULTS: The primary patency rate of the external iliac artery after endarterectomy amounted to 100%. Immediate complications directly associated with endarterectomy from the external iliac artery were encountered in one (2.7%) case - during back traction of the loop there occurred perforation of the wall of the external iliac artery by a calcified plaque, thus requiring external-iliac-common-femoral prosthetic repair. Amputation was performed in two (5.4%) patients (in both cases due to thrombosis and the development of ischaemic gangrene owing to poor condition of the distal arterial bed). One (2.7%) patient died of acute myocardial infarction. CONCLUSION: Extended endarterectomy by means of the "MultiTASC" device turned out efficient, yielding good immediate outcomes in atherosclerotic lesions of femoral arteries both as an independent operation and when combined with reconstruction of arteries beneath the inguinal ligament.
Assuntos
Endarterectomia , Desenho de Equipamento/métodos , Artéria Ilíaca , Isquemia , Doença Arterial Periférica/complicações , Angiografia/métodos , Endarterectomia/instrumentação , Endarterectomia/métodos , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/patologia , Artéria Ilíaca/fisiopatologia , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Doença Arterial Periférica/cirurgia , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia Doppler em Cores/métodos , Grau de Desobstrução VascularRESUMO
An 81-year-old male complained of intermittent claudication of the right leg. Computed tomography (CT) revealed a right external iliac artery (EIA) stenosis with severe calcification extending to the common femoral artery. A hybrid procedure of endarterectomy and stenting was performed. EIA endarterectomy was performed using a novel Cavitron Ultrasonic Surgical Aspirator which ablated the inside of the distal EIA without arterial injury. A stent graft was placed in the proximal EIA covering the margin of endarterectomized distal EIA. Postoperative CT showed no stenosis, and symptoms in the leg disappeared. This could be an alternative procedure for iliofemoral occlusive disease.
Assuntos
Angioplastia com Balão/instrumentação , Arteriopatias Oclusivas/terapia , Endarterectomia/instrumentação , Artéria Femoral/cirurgia , Artéria Ilíaca/cirurgia , Stents , Procedimentos Cirúrgicos Ultrassônicos/instrumentação , Calcificação Vascular/terapia , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/cirurgia , Constrição Patológica , Artéria Femoral/diagnóstico por imagem , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Calcificação Vascular/diagnóstico , Calcificação Vascular/cirurgiaRESUMO
Although coronary endarterectomy is a challenging procedure, its implementation might be mandatory in some cases with diffuse atherosclerotic coronary artery disease. The traditional techniques such as open, semi-closed, eversion, orificial and extraction endarterectomies have been well defined in vascular surgery, however, due to the small size of the coronary arteries, their implementation is not always possible in surgical cardiac revascularization. In this report, we describe a simple method which combines the open and closed techniques of coronary endarterectomy, in which we use the coronary probes at different sizes in order to extract and release the atheromatous plaques from coronary arteries. This technique facilitates the removal of the plaques with easy handling of the coronary probes.
Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/cirurgia , Endarterectomia/métodos , Adulto , Terapia Combinada/instrumentação , Terapia Combinada/métodos , Ponte de Artéria Coronária sem Circulação Extracorpórea/instrumentação , Endarterectomia/instrumentação , Feminino , Humanos , Masculino , Resultado do TratamentoAssuntos
Endarterectomia/efeitos adversos , Hipertensão Pulmonar/etiologia , Complicações Pós-Operatórias , Artéria Pulmonar/cirurgia , Embolia Pulmonar/cirurgia , Idoso , Endarterectomia/instrumentação , Falha de Equipamento , Feminino , Humanos , Hipertensão Pulmonar/fisiopatologia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Recidiva , Ultrassonografia de IntervençãoRESUMO
Stenosis and occlusion of the superficial femoral artery (SFA) are most common in arterial occlusive disease. There are numerous interventional, surgical, and combined approaches to reconstitute maximum blood supply to the lower limb; however, despite intense clinical research, the long-term success rates are still poor. We present the first results with a catheter prototype for laser-based minimal invasive endarterectomy, called laser scoop desobliteration (LSD). The tip of a glass fiber containing a catheter was modified with a spatula head design and connected to an ultraviolet laser. It was tested in cadavers fixed with the Thiel embalming technique preserving tissue consistency, flexibility, and plasticity. After longitudinal arteriotomy of the SFA, a circular dissection between media and adventitia was performed. Then the LSD catheter was inserted and propagated with a progress of 1 mm∕s. Afterward, the atheroma core, which showed a plain surface without substantial attaching tissue debris, was removed. Histological examination of the vessel wall showed that the dissection was performed at the media/adventitia interface. In summary, the constructed LSD catheter allowed a rapid and easy way to perform an endarterectomy, thereby offering an innovative approach in the treatment of chronic occluded SFA.
Assuntos
Endarterectomia/instrumentação , Endarterectomia/métodos , Artéria Femoral/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Doença Arterial Periférica/cirurgia , Desenho de Equipamento , Humanos , Terapia a Laser , Dispositivos de Acesso VascularRESUMO
Endarterectomy and bypass surgery to treat renal artery stenosis are increasingly shunned these days due to high risks of complications during and after the surgery. Striving to find a sound alternative solution, we pioneered the construction of a tissue engineered renovascular graft that could immediately restore the normal blood flow to kidneys and sustain renal functions without suffering restenosis after the surgery. A highly porous scaffold was first constructed by electrospinning polycaprolactone, poliglecaprone, gelatin and elastin, giving the vast majority of non-woven fibers in the scaffold a diameter below 1200 nm. To recapitulate the anatomical and functional signatures of renal arteries, a bi-layer vasculature comprising a smooth muscle layer topped by an endothelial layer was built on the scaffold. The vasculature witnessed a sustained proliferation for up to 10 days in vitro and robustly secreted prostacyclin and endothelin-1, evidencing that the vasculature was functionally comparable to native renal arteries. After 30 days as a renovascular graft in mice, the luminal diameter of the graft remained clear without a restenosis and an increased confluence of the endothelial layer was observed. The tensile test confirmed that the renovascular graft was mechanically superior to native renal arteries and retained this advantage within 30 days in vivo. Also, this renovascular graft sustained renal functions as evidenced by normal levels of serum creatinine, urine creatinine and serum urea nitrogen and the lack of edema in the kidney cortex. These results demonstrate that this renovascular graft holds a great therapeutic promise for renal artery stenosis.
Assuntos
Prótese Vascular , Células Endoteliais/citologia , Miócitos de Músculo Liso/citologia , Polímeros/síntese química , Proteínas/química , Obstrução da Artéria Renal/cirurgia , Animais , Células Cultivadas , Creatinina/química , Creatinina/farmacologia , Dioxanos/química , Elastina/química , Elastina/farmacologia , Endarterectomia/instrumentação , Endarterectomia/métodos , Células Endoteliais/fisiologia , Células Endoteliais/transplante , Endotelina-1/química , Endotelina-1/farmacologia , Feminino , Gelatina/química , Gelatina/farmacologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos SCID , Miócitos de Músculo Liso/fisiologia , Miócitos de Músculo Liso/transplante , Poliésteres/química , Poliésteres/farmacologia , Polímeros/química , Artéria Renal/cirurgia , Alicerces Teciduais/químicaRESUMO
BACKGROUND: The Vessel Closure System (VCS) is commercially available since 1997. This clip system has proven to be successful for vascular anastomoses in access surgery. There is little experience with the VCS in peripheral vascular surgery. METHODS: A trial was conducted for patients with peripheral arterial disease, who required either a femoral artery endarterectomy or a peripheral bypass procedure. Patients were randomized into two groups: a VCS group, in which the proximal anastomoses were made using VCS clips; and a control group, in which both proximal and distal anastomoses were performed using Prolene sutures. Outcomes assessed were the speed of anastomosis and patency. Adverse events were monitored. RESULTS: In the VCS group, 12 patients underwent anastomoses using VCS clips. In the control group, 12 patients underwent vascular reconstruction using sutures. In the VCS group, the mean speed of anastomosis was 1.9 mm/min, whereas the mean speed in the control group was 2.5 mm/min; this was not significantly different (P = 0.096). After a follow-up of 12 months, there was no difference in patency. In the VSC group, two serious adverse events occurred, which required emergency surgery. CONCLUSION: Anastomosis in the femoral artery using VCS clips is not faster than that using running Prolene sutures, and in our small sample, two serious adverse events in the VCS group were observed. These results do not support the further use of vascular clips in peripheral vascular surgery.
Assuntos
Endarterectomia/instrumentação , Artéria Femoral/cirurgia , Doença Arterial Periférica/cirurgia , Dispositivos de Fixação Cirúrgica , Técnicas de Sutura/instrumentação , Enxerto Vascular/instrumentação , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Endarterectomia/efeitos adversos , Estudos de Viabilidade , Feminino , Artéria Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Doença Arterial Periférica/fisiopatologia , Técnicas de Sutura/efeitos adversos , Suturas , Fatores de Tempo , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Grau de Desobstrução VascularAssuntos
Aterosclerose/complicações , Endarterectomia , Artéria Femoral/patologia , Artéria Femoral/cirurgia , Claudicação Intermitente/patologia , Claudicação Intermitente/cirurgia , Idoso , Catéteres , Doença Crônica , Cilostazol , Ponte de Artéria Coronária , Doença da Artéria Coronariana/complicações , Endarterectomia/instrumentação , Endarterectomia/métodos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/efeitos dos fármacos , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/etiologia , Humanos , Hipertensão/complicações , Hipertensão/etiologia , Claudicação Intermitente/diagnóstico por imagem , Claudicação Intermitente/tratamento farmacológico , Claudicação Intermitente/etiologia , Masculino , Inibidores da Agregação Plaquetária/uso terapêutico , Radiografia , Fatores de Risco , Tetrazóis/uso terapêutico , Resultado do Tratamento , UltrassonografiaRESUMO
OBJECTIVES: To report our experience of arterial anastomosis with Nakayama's ring pin staplers (titanium staplers) after an endarterectomy in kidney transplantation of diabetic recipients with iliac atherosclerosis. METHODS: In a series of 2126 kidney transplantations carried out between January 1998 and December 2008, 62 recipients received an endarterectomy during transplantation before renal arterial anastomoses as a result of severe iliac atherosclerosis. The renal arteries were anatomosed to hypogastric arteries through titanium staplers in 32 patients (group 1), or to external/common iliac arteries with conventional suturing in 30 patients (group 2). Perioperative outcomes of the two groups have been compared. RESULTS: The mean artery anastomosis time in group 1 was considerably shorter than in the group 2 (6.4 min vs 17.3 min, P < 0.001). Group 1 showed a lower rate of delayed graft function (4.8% vs 27.5%, P = 0.004). No difference in Kaplan-Meier patient survival rate was found between group 1 and group 2 after follow up of 67 ± 28 months (P = 0.58). Graft survival rate (patient deaths included) was higher in group 1 than in group 2 (P = 0.04). CONCLUSIONS: Arterial anastomosis with a titanium stapler is more rapid than conventional suture. It can diminish the rate of delayed graft function and improve the graft survival rate in diabetic recipients with severe iliac atherosclerosis.
Assuntos
Aterosclerose/mortalidade , Aterosclerose/cirurgia , Nefropatias Diabéticas/mortalidade , Nefropatias Diabéticas/cirurgia , Endarterectomia/mortalidade , Transplante de Rim/mortalidade , Adulto , Idoso , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/mortalidade , Aterosclerose/patologia , Função Retardada do Enxerto/mortalidade , Diabetes Mellitus Tipo 2/mortalidade , Endarterectomia/instrumentação , Endarterectomia/métodos , Feminino , Sobrevivência de Enxerto , Humanos , Artéria Ilíaca/patologia , Artéria Ilíaca/cirurgia , Falência Renal Crônica/mortalidade , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Artéria Renal/patologia , Artéria Renal/cirurgia , Grampeadores Cirúrgicos , Análise de Sobrevida , Titânio , Adulto JovemRESUMO
OBJECTIVE: Stent-assisted remote iliac endarterectomy (SA-RIEA) is a hybrid minimally invasive technique for treating patients with combined external iliac and common femoral disease, when the only alternative would be conventional open revascularisation. DESIGN: This was a retrospective, single-centre study. MATERIALS AND METHODS: From January 2004 to April 2010, 155 SA-RIEA procedures were performed. The patients' mean age was 62 (range, 43-86) years. Indications for surgery were: severe claudication in 79 (51%), rest pain in 43 (28%) and gangrene in 33 (21%) cases. The mean length of follow-up was 21 months. RESULT: Initial technical success was achieved in 145 (93.5%) procedures. Ten patients required conversion to a conventional iliofemoral reconstructive procedure. The 1-, 3- and 5-year primary, primary-assisted and secondary patency rates were 80.2%, 74.7% and 69.3%; 84.8%, 82.4% and 78.2%; and 86.8%, 84.2% and 79.6%, respectively. Within the first 30 days, there were no early reocclusions, one (0.6%) perioperative death due to myocardial infarction, five (3.4%) minor wound complications and two (1.3%) limb losses. During follow-up, seven patients underwent open reconstruction due to symptomatic reocclusion, and four were re-operated on due to symptomatic restenosis (three percutaneous transluminal angioplasties (PTAs), one reendarterectomy). CONCLUSION: In patients with combined common femoral and external iliac disease, SA-RIEA appears to offer a safe and effective alternative to conventional open surgery.
Assuntos
Arteriopatias Oclusivas/cirurgia , Endarterectomia/instrumentação , Artéria Femoral , Artéria Ilíaca , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução VascularAssuntos
Endarterectomia , Síndrome de Klippel-Trenaunay-Weber/complicações , Artéria Pulmonar/cirurgia , Embolia Pulmonar/cirurgia , Adulto , Anticoagulantes/uso terapêutico , Endarterectomia/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/patologia , Embolia Pulmonar/etiologia , Embolia Pulmonar/patologia , Resultado do Tratamento , Filtros de Veia Cava , Adulto JovemRESUMO
The aim of this paper was to describe a new modification of the remote endarterectomy for the treatment of long superficial femoral artery (SFA) occlusions and to present our preliminary results. Through a subinguinal incision and arteriotomy over the SFA origin, a hydrophilic guidewire was introduced into the subintimal plane of the SFA and advanced distally until reentry into the distal patent popliteal artery. The hydrophilic guidewire is exchanged for an Ablatz wire to provide support for the advancement of the single endarterectomy ring. The MollRing Cutter was introduced in the SFA after the removal of the single endarterectomy ring and it was advanced until the re-entry point. The atherosclerotic core was removed and a nitinol self-expanding stent was placed at the peripheral end of the endarterectomy. Arteriotomy was closed with a patch. Guided subintimally-assisted remote endarterectomy seems to be a successful and safe modification of the traditional technique in the treatment of SFA occlusion, in patients with critical limb ischemia.
Assuntos
Arteriopatias Oclusivas/cirurgia , Endarterectomia/métodos , Artéria Femoral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Arteriopatias Oclusivas/diagnóstico por imagem , Constrição Patológica , Endarterectomia/instrumentação , Desenho de Equipamento , Feminino , Artéria Femoral/diagnóstico por imagem , Grécia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Prospectivos , Radiografia Intervencionista , Stents , Resultado do TratamentoRESUMO
Remote superficial femoral artery endarterectomy (RSFAE) is an effective minimal invasive treatment modality of TransAtlantic Inter-Society Consensus (TASC) C and D atherosclerotic lesions of the superficial femoral artery (SFA) with at least equal patency rates as supragenicular synthetic bypass grafts. This procedure is performed through a single femoral arteriotomy and the intima core in the SFA is dissected using the Vollmar ring and the Mollring cutter devices, respectively. The intimal core distally of the transaction zone is secured by an expandable polytetrafluoroethylene-covered nitinol stent. By its minimal invasive character, RSFAE will lead to lower rate of postoperative complications and shorter hospital stay compared to supragenicular bypass graft surgery. Additional advantage in comparison with percutaneous procedures is the opportunity of open endarterectomy of the common femoral and/or profunda artery. Synthetic material will be avoided and vein will be preserved for possible future cardiovascular surgery. Reobstruction of the SFA tends to have, in contrast to bypass grafts, less severe symptoms due to preservation of collaterals and thereby lower amputation rate. Achilles heel of RSFAE is the relatively high percentage of first year restenosis due to neointimal hyperplasia. Strict follow-up at 3, 6 and 12 months is advised including duplex ultrasound. In case of symptomatic or asymptomatic hemodynamic restenosis (>50%) percutaneous transluminal angioplasty must be performed to improve long-term patency. The majority of reobstructions can be treated by endovascular means. New endovascular techniques, like balloon cryoplasty or drug eluting stents have to be studied in combination with RSFAE to optimize its technique and improve patency rates.
Assuntos
Aterosclerose/cirurgia , Endarterectomia/métodos , Artéria Femoral/cirurgia , Endarterectomia/instrumentação , Humanos , Stents , Grau de Desobstrução VascularRESUMO
OBJECTIVE: To report the long term results of ultrasonic superficial femoral artery endarterectomy (USFAE). DESIGN: Retrospective study. PATIENTS AND METHODS: From January 1998 to June 2004 218 USFAE were performed in 202 selected patients (178 males, 192 procedures) with a median age of 65 years (46-87 years). Indications for operation were disabling intermittent claudication in 137 procedures (68%), rest pain in 24 procedures (12%), and limb salvage in 41 procedures (20%). The new medical technology of ultrasonic endarterectomy is based on the application of the mechanical vibrations in the range of low frequency ultrasound. The ultrasonic device consists of the ultrasonic generator, acoustic unit and the flexible wave concentrators with special working tips in the shape of a ring. Follow up consisted of clinical evaluation, ankle-brachial index measurements and duplex scanning. RESULTS: The mean follow-up time was 30.1 months. The mean length of the endarterectomised SFAs was 29 cm (range, 15-43 cm). The five year cumulative primary patency rate by means of life table analysis was 45.8 +/- 4.4% (SE). Percutaneous transluminal balloon angioplasty and surgical re-interventions were performed in thirty three and five patients respectively resulting in a primary assisted patency rate of 57.5 +/- 4.1%. The five year secondary patency rate was 65.6 +/- 3.8%. Limb salvage was achieved in 35 of the 41 patients with gangrene. CONCLUSIONS: The long term results of ultrasonic SFA endarterectomy suggest this is an effective technique.