Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 62
Filtrar
Mais filtros

Base de dados
País/Região como assunto
Tipo de documento
País de afiliação
Intervalo de ano de publicação
1.
Clin Exp Dermatol ; 47(1): 43-49, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34236712

RESUMO

BACKGROUND: Vascular malformations of the genitalia often go undetected in clinical examination. These vascular malformations can cause a variety of clinical symptoms such as swelling, pain and bleeding. AIM: To characterize the distribution patterns of genital vascular malformations using magnetic resonance imaging (MRI) and to correlate these patterns with clinical findings in order to guide diagnostic decisions. METHODS: A retrospective analysis of MRIs of the pelvis and legs in 370 patients with vascular malformation was performed to determine the involvement of the internal and external genitalia. RESULTS: In 71 patients (19%), genital involvement could be identified by MRI. Of these, 11.3% (8 of 71) presented with internal involvement, 36.6% (26 of 71) with external involvement and 52.1% (37 of 71) with both internal and external involvement. Over half (57.1%) of the 49 patients with visible external genital signs detected during a clinical examination had additional internal genital involvement. CONCLUSIONS: Genital involvement is a common finding in patients with vascular malformation of the legs and/or pelvis. Based on our data, we recommend MRI of the legs and pelvic region in patients with externally visible signs of a vascular malformation of the external genitalia in order to exclude additional internal involvement.


Assuntos
Genitália/irrigação sanguínea , Imageamento por Ressonância Magnética , Malformações Vasculares/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Malformações Vasculares/patologia , Adulto Jovem
2.
Pathologe ; 40(4): 422-430, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31243549

RESUMO

Vascular anomalies are very rare, but can occur in children and adults in almost every region of the body. Due to the complexity of this disease, the path to a definitive diagnosis is often difficult. It requires interdisciplinary teamwork with close exchange of information between the individual treatment partners to reach the correct diagnosis and then to start the best therapy. This article provides an overview of the main types of vascular malformations from a clinical, imaging, and histological point of view, following the current classification of the International Society for the Study of Vascular Anomalies (ISSVA).


Assuntos
Malformações Vasculares , Neoplasias Vasculares , Adulto , Criança , Humanos , Malformações Vasculares/diagnóstico , Neoplasias Vasculares/diagnóstico
3.
Radiologe ; 58(1): 19-24, 2018 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-29242954

RESUMO

BACKGROUND: Abdominal lymphatic malformations (LM) are relatively rare findings in the differential diagnosis of focal abdominal lesions; however, they represent a challenge especially in younger patients. The aim of this review article is to provide up-to-date information about the different kinds of LM manifestations. In addition, related syndromes and typical imaging features to facilitate the diagnosis are discussed. RESULTS: The clinical presentation of abdominal LM is unspecific, whereby most are asymptomatic and comprise incidental findings of thin-walled cystic masses anywhere in the abdomen. The fluid in the cystic masses may be proteinaceous, contain blood, or be infected. Radiological imaging features overlap with other cystic diseases; hallmark in LM is a lack of a solid component and exclusive enhancement of the walls and septae. CONCLUSION: In cystic abdominal masses in early childhood or young adults, abdominal LM must be taken into account by the radiologist. Newly defined entities in this spectrum of diseases are central conducting lymphatic anomaly (CCLA) and generalized lymphatic anomaly (GLA).


Assuntos
Abdome , Doenças Linfáticas , Diagnóstico Diferencial , Humanos , Radiografia
4.
Radiologe ; 58(Suppl 1): 29-33, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29796772

RESUMO

BACKGROUND: Abdominal lymphatic malformations (LM) are relatively rare findings in the differential diagnosis of focal abdominal lesions; however, they represent a challenge especially in younger patients. The aim of this review article is to provide up-to-date information about the different kinds of LM manifestations. In addition, related syndromes and typical imaging features to facilitate the diagnosis are discussed. RESULTS: The clinical presentation of abdominal LM is unspecific, whereby most are asymptomatic and comprise incidental findings of thin-walled cystic masses anywhere in the abdomen. The fluid in the cystic masses may be proteinaceous, contain blood, or be infected. Radiological imaging features overlap with other cystic diseases; hallmark in LM is a lack of a solid component and exclusive enhancement of the walls and septa. CONCLUSION: In cystic abdominal masses in early childhood or young adults, abdominal LM must be taken into account by the radiologist. Newly defined entities in this spectrum of diseases are central conducting lymphatic anomaly (CCLA) and generalized lymphatic anomaly (GLA).


Assuntos
Abdome/fisiopatologia , Cistos , Anormalidades Linfáticas , Pré-Escolar , Diagnóstico Diferencial , Humanos , Ultrassonografia/métodos , Adulto Jovem
5.
Eur Radiol ; 24(10): 2449-57, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24965507

RESUMO

OBJECTIVES: To assess the diagnostic accuracy of dual-energy computed tomography (DECT) for detection of endoleaks and aneurysm sac calcifications after endovascular aneurysm repair (EVAR) using hard plaque imaging algorithms. MATERIALS AND METHODS: One hundred five patients received 108 triple-phase contrast-enhanced CT (non-contrast, arterial and delayed phase) after EVAR. The delayed phase was acquired in dual-energy and post-processed using the standard (HPI-S) and a modified (HPI-M) hard plaque imaging algorithm. The reference standard was determined using the triple-phase CT and contrast-enhanced ultrasound. All images were analysed separately for the presence of endoleaks and calcifications by two independent readers; sensitivity, specificity and interobserver agreement were calculated. RESULTS: Endoleaks and calcifications were present in 25.9 % (28/108) and 20.4 % (22/108) of images. The HPI-S images had a sensitivity/specificity of 54 %/100 % (reader 1) and 57 %/99 % (reader 2), the HPI-M images of 93 %/92 % (reader 1) and 96 %/92 % (reader 2) for detection of endoleaks. For detection of calcifications HPI-S had a sensitivity/specificity of 91 %/99 % (reader 1) and 95 %/97 % (reader 2), the HPI-M images of 91 %/99 % (reader 1) and 91 %/99 % (reader 2), respectively. CONCLUSION: Using HPI-M, DECT enables an accurate diagnosis of endoleaks after EVAR and allows distinguishing between endoleaks and calcifications with high diagnostic accuracy. KEY POINTS: • Dual-energy computed tomography allows the diagnosis of aortic pathologies after EVAR. • Hard plaque imaging algorithms can distinguish between endoleaks and aneurysm sac calcifications. • The modified hard plaque imaging algorithm detects endoleaks with high diagnostic accuracy.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Calcinose/complicações , Endoleak/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Processamento de Imagem Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Calcinose/diagnóstico por imagem , Endoleak/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes
6.
HNO ; 62(1): 30-4, 2014 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-24357233

RESUMO

Correct clinical and angiographic classification of vascular anomalies, including consideration of their flow pattern (high-flow versus low-flow), is the basis of accurate indications for minimally invasive therapy modalities such as embolization. Technical advancements and miniaturization of catheter materials (including steerable microwires, flow-directed microcatheters and detachable tips) gained access for embolotherapy to lesions anywhere in the body. The aim of embolization, which is mainly indicated for therapy of high-flow arteriovenous malformations, is the complete, permanent occlusion of the lesion nidus. Nowadays, embolotherapy is performed using permanent liquid embolization agents, in multiple staged sessions. This technique reduces complications such as ischemic necrosis and peripheral nerve lesions compared to alcohol embolization. Sole occlusion of the arterial inflow by surgical resection or interventional coil application is considered obsolete. The size of the lesion and the high treatment costs limit the use of embolotherapy.


Assuntos
Embolização Terapêutica/instrumentação , Embolização Terapêutica/métodos , Hemostáticos/uso terapêutico , Malformações Vasculares/terapia , Desenho de Equipamento , Humanos
7.
Radiologe ; 53(6): 531-4, 2013 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-23681513

RESUMO

CLINICAL ISSUE: Infrastructural improvements with a combination of interventional and open surgical procedures. STANDARD TREATMENT: Separate performance of interventional and open surgical procedures. TREATMENT INNOVATIONS: Implementation of hybrid operating rooms. DIAGNOSTIC WORK-UP: Intraoperative high-quality digital subtraction angiography. PERFORMANCE: Best hygienic conditions Intraoperative improved image quality Improved patient management Increased patient safety Broadening of indications ACHIEVEMENTS: Major improvement from a medical standpoint Different implications from a management perspective Economic aspects challenging PRACTICAL RECOMMENDATIONS: Exact planning of all aspects and effects is necessary.


Assuntos
Cirurgia Geral/organização & administração , Salas Cirúrgicas/organização & administração , Objetivos Organizacionais , Radiologia Intervencionista/organização & administração , Alemanha
8.
Radiologe ; 53(3): 223-9, 2013 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-23435624

RESUMO

CLINICAL/METHODICAL ISSUE: Liquid embolic agents are used for permanent occlusion of capillaries but optimal administration properties are lacking. STANDARD RADIOLOGICAL METHODS: The lack of visualization by fluoroscopy and the risk of serious complications are disadvantages of conventional embolic agents, such as ethanol and Histoacryl. METHODICAL INNOVATIONS: Onyx is a liquid embolic agent consisting of ethylene vinyl alcohol copolymer dissolved in various concentrations of dimethyl sulfoxide (DMSO) and suspended micronized tantalum powder to provide contrast for fluoroscopy. PERFORMANCE: The physicochemical characteristics of Onyx allow controlled application, forming a defined cast and permanent occlusion. Disadvantages are the high costs. Furthermore, the solvent DMSO requires special catheter material and causes pain during Onyx application. ACHIEVEMENTS: Onyx has been primarily used for interventional neuroradiological treatment but peripheral applications are becoming increasingly more common. PRACTICAL RECOMMENDATIONS: Currently, Onyx is mainly used for embolotherapy of endoleaks after endovascular aortic aneurysm repair, for treatment of acute arterial bleeding and for treatment of arteriovenous malformations.


Assuntos
Dimetil Sulfóxido/uso terapêutico , Embolia/diagnóstico por imagem , Embolia/terapia , Embolização Terapêutica/métodos , Hemostáticos/uso terapêutico , Polivinil/uso terapêutico , Radiografia Intervencionista/métodos , Humanos , Soluções
9.
Clin Hemorheol Microcirc ; 83(3): 207-215, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36565106

RESUMO

BACKGROUND: Venous malformations tend to retain their slow-flow behavior, even in progressive disease or regression following therapy. OBJECTIVE: The aim of this study is to analyze the development of acquired hemodynamic relevant arterio-venous fistulae in patients with slow-flow malformations. METHODS: This study is a retrospective analysis based on a consecutive local registry at a tertiary care Interdisciplinary Center for Vascular Anomalies. Patients with venous malformations and development of secondary arterio-venous fistulae were included. Indications for therapy of the vascular malformation were based on patients' symptoms and complications. The following endpoints were of clinical interest and were assessed: origin of development of arteriovenous fistula, development of secondary comorbidities as a result of the vascular malformation. For analysis we focused on descriptive statistics. RESULTS: Out of 1213 consecutive patients with vascular malformations, in 6 patients perfusion changed from slow flow to arterio-venous fast-flow patterns. Four patients developed the fistula after local trauma in the area of the malformation, the other 2 patients developed the fistula due to progression of the disease and recurrent thrombophlebitis. These 2 patients had no trauma or interventions at the time of arterio-venous fistula development. CONCLUSIONS: Acquired arterio-venous fast-flow fistula in patients with slow flow vascular malformation is very rare and might be a result of local trauma or the progression of the disease with recurrent thrombophlebitis. Specific evidence-based treatment options for these patients do not exist.


Assuntos
Fístula Arteriovenosa , Tromboflebite , Malformações Vasculares , Humanos , Estudos Retrospectivos , Malformações Vasculares/complicações , Fístula Arteriovenosa/complicações , Tromboflebite/complicações
10.
Zentralbl Chir ; 137(5): 440-5, 2012 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-21312159

RESUMO

The understanding of hereditary vascular anomalies was hampered for a long time by unclear und unspecific terminology. Today, the classification of the International Society for the Study of Vascular Anomalies (ISSVA) differentiates between vascular tumours (mostly infantile haemangioma) with active endothelial proliferation and regression and vascular malformations (VM), which are defects of the vascular morphogenesis and are distinguished in predominantly venous, arterial, capillary, lymphatic, arteriovenous or combined VM. Symptoms are pain, swelling and restricted movement, accompanied by skin signs like dys-plastic veins and capillary VM (naevus flammeus). Thrombophlebitis and chronic venous insufficiency are related to venous VM. Arteriovenous VM are progressive and can cause ischaemic necroses, in rare cases even a high-output cardiac fail-ure. Lymphatic VM lead to localised swelling, in the long run often to recurrent erysipelas and lymphorroea. Primary imaging is provided by -ul-trasound including flow measurements. Mor-phol-ogy and organ involvement is best delineated by magnetic resonance imaging. Phlebography is used to image deep venous system anomalies and is always accompanied by varicography of the dysplastic parts of the venous VM. Digital subtraction angiography is performed to demon-strate the flow pattern in feeding arteries, the nidus and the drainage veins of arteriovenous VM. Besides size and localisation the prognosis of the patients is determined by the pressure (the high-er the pressure, the poorer the prognosis) and the flow rate (the higher the flow rate, the poorer the prognosis) in the VM. Diagnosis and treatment of these rare diseases are best performed in special-ised, interdisciplinary centres.


Assuntos
Malformações Vasculares/classificação , Malformações Vasculares/genética , Angiografia Digital , Malformações Arteriovenosas/classificação , Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/genética , Hemangioma/classificação , Hemangioma/diagnóstico , Hemangioma/genética , Humanos , Anormalidades Linfáticas/classificação , Anormalidades Linfáticas/diagnóstico , Anormalidades Linfáticas/genética , Angiografia por Ressonância Magnética , Mancha Vinho do Porto/classificação , Mancha Vinho do Porto/diagnóstico , Mancha Vinho do Porto/genética , Prognóstico , Neoplasias Cutâneas/classificação , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/genética , Sociedades Médicas , Neoplasias de Tecidos Moles/classificação , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/genética , Ultrassonografia , Malformações Vasculares/diagnóstico , Veias/anormalidades
11.
Chirurgie (Heidelb) ; 93(9): 892-898, 2022 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-35767078

RESUMO

BACKGROUND: The marginal vein (MV) is a congenital, predominantly venous vascular malformation, which is based on a lack of regression of the embryonic venous system in the lower extremities and is associated with a variety of complications. So far, no uniform treatment regimens have been described in the literature. OBJECTIVE: What are the treatment strategies and outcomes in patients with a MV? MATERIAL AND METHODS: In the period from 1 January 2008 to 31 December 2020, all patients treated at the University Hospital Augsburg with MV were retrospectively reviewed. RESULTS: The median age at the time of diagnosis was 14.8 years (3-42 years). Out of 16 patients 12 had a leg length difference, 75% of patients (12/16) already had chronic venous insufficiency (CVI) at the time of diagnosis of MV. Open surgical removal of MV was performed as first-line treatment in 31.3% (5/16) patients. The MV was primarily closed by endovenous laser therapy (EVLT) in 1/16 patients, 15/16 patients were treated with redo procedures and 2.6 ± 2.4 (mean±SD) redo procedures were performed per patient in follow-up. The mean follow-up was 8.1 years. DISCUSSION: In order to prevent/avoid progression of CVI and thrombosis prophylaxis, the MV should be closed/removed promptly after diagnosis. The use of conventional surgical techniques for the removal of MV seems to have an advantage over treatment with minimally invasive procedures in terms of the number of secondary interventions required.


Assuntos
Varizes , Insuficiência Venosa , Humanos , Estudos Retrospectivos , Veia Safena/cirurgia , Resultado do Tratamento , Varizes/cirurgia , Insuficiência Venosa/cirurgia
12.
CVIR Endovasc ; 4(1): 31, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33740138

RESUMO

BACKGROUND: Intrahepatic arterial pseudoaneurysms are a rare, life-threatening complication after pediatric liver transplantation. Treatment of choice represents interventional radiological management with endovascular embolization of the segmental artery proximal and distal to the aneurysm. However, this technique results in loss of arterial perfusion distal to the aneurysm with subsegment arterial ischemia. CASE PRESENTATION: We report a case of a 1-year-old girl with a pseudoaneurysm in the split-liver graft. Direct percutaneous, transhepatic access to the pseudoaneurysm was performed followed by super selective coil application into the aneurysm. CONCLUSION: Super selective percutaneous, transhepatic coil application is feasible even in pediatric patients after liver transplantation and results in preservation of the entire course of the liver artery.

13.
J Cardiovasc Surg (Torino) ; 51(4): 573-8, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20671642

RESUMO

We present a review of the literature on endovascular brachytherapy (EVBT) after percutaneous transluminal angioplasty (PTA) in the femoropopliteal and tibial arteries. The pathophysiological changes induced by PTA and EVBT within the vessel wall, technical considerations regarding 192Ir and 188Re, the results of clinical trials, and the medication required before, during, and after EVBT are summarized.


Assuntos
Angioplastia com Balão/efeitos adversos , Arteriopatias Oclusivas/terapia , Braquiterapia/métodos , Radioisótopos de Irídio/uso terapêutico , Extremidade Inferior/irrigação sanguínea , Radioisótopos/uso terapêutico , Rênio/uso terapêutico , Arteriopatias Oclusivas/radioterapia , Constrição Patológica , Humanos , Recidiva , Resultado do Tratamento
14.
Clin Hemorheol Microcirc ; 76(2): 161-170, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925019

RESUMO

INTRODUCTION: Percutaneous sclerotherapy is a well-established treatment option for venous malformations (VM). A recently established sclerosing agent is ethanol-gel. Aim of this study was to identify, if contrast-enhanced ultrasound (CEUS) with an integrated perfusion analysis allows for differentiation between untreated VM, healthy tissue, and with gelified ethanol treated malformation tissue. MATERIAL AND METHODS: In this institutional review board approved prospective study symptomatic VM patients underwent CEUS at exactly the same position before and after sclerotherapy with ethanol-gel. Two experienced sonographers performed all examinations after the bolus injection of microbubbles using a multi-frequency probe with 6 -9 MHz of a high-end ultrasound machine. An integrated perfusion analysis was applied in the center of the VM and in healthy, surrounding tissue. For both regions peak enhancement (peak), time to peak (TTP), area under the curve (AUC), and mean transit time (MTT) were evaluated. Wilcoxon signed rank test was executed; p-values <0.05 were regarded statistically significant. RESULTS: In 23 patients including children (mean age 25.3 years, 19 females) before treatment all identified parameters were significantly higher in the VM center compared to healthy tissue (peak: p < 0.01; TTP: p < 0.01; AUC: p < 0.01; MTT: p < 0.01). Comparing the VM center before and after treatment, TTP (p < 0.02) and MTT (p < 0.01) reduced significantly after sclerotherapy. In surrounding tissue only peak changed after treatment in comparison to pre-treatment results (p = 0.04). Comparing data in the VM center with surrounding tissue after sclerotherapy, results still differed significantly for peak (p < 0.01), TTP (p < 0.01), and AUC (p < 0.01), but assimilated for MTT (p = 0.07). CONCLUSION: All with CEUS identified parameters seem to be excellent tools for differentiating between VM and healthy tissue. TTP and MTT could distinguish between with ethanol-gel sclerotized VM portions and untreated malformation parts and thereby might assist the monitoring of sclerotherapy with ethanol-gel.


Assuntos
Perfusão/métodos , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Ultrassonografia/métodos , Doenças Vasculares/diagnóstico por imagem , Adulto , Meios de Contraste , Feminino , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento
15.
Cardiovasc Intervent Radiol ; 42(2): 213-219, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30374612

RESUMO

PURPOSE: To evaluate radiofrequency ablation (RFA) for closure of marginal veins in pediatric and adult patients with venous malformations. MATERIALS AND METHODS: Medical records, imaging and procedure details were retrospectively reviewed in patients who underwent RFA of the marginal vein in a 17-month period. Additional sclerotherapy (n = 19) and coil embolization of the marginal vein were performed (n = 2). RESULTS: A total of 23 marginal veins were treated in 20 patients. Mean age at treatment was 16 years ± 9.4 (1-37 years). Pre-procedural magnetic resonance imaging revealed thoracoabdominal marginal veins in 3 patients. A type I marginal vein (draining in the great saphenous vein below the popliteal vein) was identified in 1 and type IIa/IIb (draining in a median/lateral accessory saphenous vein) in 2/8 cases. Type III (draining into the profunda femoral vein) was detected in 8, and type IV (draining into gluteal veins) in 1. Mean diameter of the marginal veins was 13.2 mm ± 4 (7-20 mm). Patency was found in 1 during follow-up (22 months ± 9.8). Complete or partial occlusion was achieved in 94.5% of the veins. One patient showed signs of thrombophlebitis after the procedure, and another incomplete paresis of the peroneal nerve. CONCLUSION: RFA is effective as minimally invasive treatment of the marginal venous system. These veins should be treated early in life. Marginal veins with large diameter, residual tributaries and the intrafascial courses usually require adjunct coil embolization and sclerotherapy. LEVEL OF EVIDENCE: Case series, Level IV.


Assuntos
Ablação por Radiofrequência/métodos , Malformações Vasculares/terapia , Insuficiência Venosa/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Veia Femoral/fisiopatologia , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Veia Safena/fisiopatologia , Resultado do Tratamento , Malformações Vasculares/complicações , Malformações Vasculares/fisiopatologia , Grau de Desobstrução Vascular/fisiologia , Insuficiência Venosa/fisiopatologia , Adulto Jovem
17.
Cardiovasc Intervent Radiol ; 42(12): 1687-1694, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31531691

RESUMO

PURPOSE: To evaluate the incidence of acute renal failure and chronic kidney disease due to occlusion of accessory renal arteries during endovascular aneurysm repair of infrarenal abdominal aortic aneurysm. MATERIAL AND METHODS: We retrospectively reviewed the course of 181 patients (mean age, 71, SD ± 9  years) who underwent EVAR of infrarenal abdominal aortic aneurysm. The renal vessel anatomy was analyzed in all pre- and postoperative CT scans. Diameter and origin of accessory renal arteries were evaluated. Renal function was determined by pre- and postoperative serum creatinine and eGFR levels. Long-term follow-up (>3 months) of patients was available in 121 cases (66.9%). Acute kidney injury and chronic kidney failure were defined according to guidelines of "Kidney Disease: Improving Global Outcomes" (KDIGO). RESULTS: In 65 of 181 patients (33.9%), 82 accessory renal arteries were identified preoperatively. In 19 of 181 patients (10.5%), one or more accessory renal arteries were covered and subsequently occluded by the implanted stent-graft device. Neither acute kidney injury (10.3% vs 12.5%; p = .785) nor chronic kidney disease (10.7% vs 15.38%; p = .452) was detected significantly more often in patients with covered accessory renal artery. The only significant predictor of acute kidney injury was the preoperative serum creatinine level (1.12 mg/dl vs. 0.98 mg/dl; p = .03). Significant predictors for chronic kidney disease were preoperative serum creatinine, eGFR, and impaired renal function (p < .001). CONCLUSION: Coverage of accessory renal artery due to stent-graft does not lead either to temporary acute kidney injury after endovascular aneurysm repair or to chronic kidney disease. LEVEL OF EVIDENCE: Level II b.


Assuntos
Injúria Renal Aguda/epidemiologia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Complicações Pós-Operatórias/epidemiologia , Artéria Renal/cirurgia , Insuficiência Renal Crônica/epidemiologia , Idoso , Aneurisma da Aorta Abdominal/epidemiologia , Procedimentos Endovasculares/métodos , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
18.
Eur J Vasc Endovasc Surg ; 36(1): 63-70, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18356087

RESUMO

OBJECTIVES: To assess health-related quality of life (HRQoL) up to 24 months after successful infrageniculate bypass surgery for limb-threatening ischaemia. METHODS: 89 patients with infrageniculate bypass surgery for limb-salvage were studied. HRQoL was assessed using the Short Form (SF)-36v1 questionnaire before, 6, 12, and 24 months after revascularisation. RESULTS: 47 patients (53%) with intact limb and functioning graft were assessed after 24 months, 27 patients (30%) died, further 7 required secondary amputation, 3 suffered irremediable graft occlusion, and 4 were lost to follow-up. The 24-months HRQoL-values were significantly improved in 4 domains: physical functioning (p<0.01), bodily pain (p<0.01), mental health (p=0.04), and social functioning (p=0.01). Except for baseline-values, HRQoL remained inferior in diabetics compared to non-diabetics throughout follow-up. Maximum improvement of HRQoL was delayed in diabetics (12 months vs. 6 months) and less pronounced. After 24 months non-diabetic patients maintained improvement in 5 domains and diabetic patients only in bodily pain. CONCLUSIONS: Improvement in HRQoL is sustained for more than 12 months after successful infrageniculate bypass surgery. Therefore, an aggressive approach towards revascularisation seems to be justified from the patient's perspective. However, this benefit in quality of life is less in diabetic patients, despite similar limb-salvage rates.


Assuntos
Implante de Prótese Vascular , Complicações do Diabetes/cirurgia , Isquemia/cirurgia , Salvamento de Membro , Doenças Vasculares Periféricas/cirurgia , Qualidade de Vida , Grau de Desobstrução Vascular , Idoso , Amputação Cirúrgica , Complicações do Diabetes/fisiopatologia , Feminino , Seguimentos , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/cirurgia , Indicadores Básicos de Saúde , Humanos , Isquemia/etiologia , Isquemia/fisiopatologia , Masculino , Satisfação do Paciente , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Reoperação , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
19.
Vasa ; 37(4): 338-44, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19003744

RESUMO

BACKGROUND: To test whether quality of life depends on the psyche of patients after successful bypass surgery for peripheral arterial disease (PAD). PATIENTS AND METHODS: A total of 74 consecutive patients aged 36-69 years (57.7 +/- 8.8 years) with symptomatic PAD in the stages Fontaine IIb-IV were enrolled in a prospective study after successful bypass surgery. Because of bypass failure and one death during the study period, 11 of these patients were excluded from evaluation. Prior to surgery, Doppler sonography and digital subtraction angiography were carried out in all patients. Before and after revascularization, the ankle / brachial index (ABI) was determined in all study objects and the pain free walking distance (PFWD) in those with PAD stage Fontaine IIb. Health-related quality of life was measured by using the "Medical Outcomes Study Group Short Form 36" (SF-36), and personality was determined by employing the Psycho-Diagnostic-Test (PDT). RESULTS: After surgery, there was an increase in ABI from 0.32 +/- 0.13 to 0.79 +/- 0.19 (p < .01), in PFWD from 42.6 m +/- 38.6 m to 419.7 m +/- 152.3 m (p < .01), and in the SF-36 scales "Physical functioning", "Bodily pain", "General health perceptions", and "Role-functioning physical" (p < .05). ABI correlated positively with "Bodily pain" (p < .01), "General health perceptions" (p < .01) and "Mental health" (p < .05). Among SF-36 and PDT-scales, "Role-functioning physical" correlated negatively with "Moodiness" / "Neuroticism" (p < .05), and "Social functioning" correlated positively with "General activity" (p < .01). CONCLUSIONS: Whether objective clinical improvement increases quality of life mainly depends on the psyche of patients: A high level of general activity favors an improved quality of life and neurotic characteristics are more likely to be a hindrance.


Assuntos
Doenças Vasculares Periféricas/cirurgia , Personalidade , Qualidade de Vida , Procedimentos Cirúrgicos Vasculares , Adulto , Afeto , Idoso , Humanos , Pessoa de Meia-Idade , Transtornos Neuróticos/psicologia , Doenças Vasculares Periféricas/fisiopatologia , Doenças Vasculares Periféricas/psicologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Perfil de Impacto da Doença , Inquéritos e Questionários , Resultado do Tratamento , Caminhada
20.
Clin Hemorheol Microcirc ; 69(1-2): 45-57, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29630543

RESUMO

The aim of this follow-up study was to demonstrate the effect of percutaneous interventional treatment on local microcirculation of peripheral vascular malformations using CEUS and TIC analysis. MATERIAL AND METHODS: Retrospective analysis of 197 patients (136 female; 61 male; 3-86 years) with 135 venous (VM), 39 arterio-venous (AVM), 8 lymphatic and 15 veno-lymphatic peripheral vascular malformations before and after the first percutaneous treatment.CEUS was performed after i.v. injection of 1-2.4 ml of sulfur hexafluoride microbubbles (SonoVue®) using a 6-9 MHz linear probe. Digitally stored cine loops (starting in the early arterial phase for 60 sec) were read by independent readers in consensus. Regions of interest (ROI) were defined in the center and at the margins of the malformation, as well as in the healthy surrounding tissue. TIC analyses with Time to Peak (TTP) and Area under the Curve (AUC) were calculated using integrated perfusion software. RESULTS: After the treatment there was a significant decrease for median AUC in VM in the center from 297.8 (14.5-2167.6) rU down to 243.3 (0.1-1678.8) rU (p = 0.043) and in the surrounding tissue down to 107.7 (20.2-660.2) rU (p = 0.018). For the other malformations AUC decreased in the center and the margins as well. TTP rose, however these changes did not reach the level of significance. CONCLUSION: Analyzing the capillary microcirculation TICs offer a possibility of monitoring therapy-induced capillary changes of vascular malformations.


Assuntos
Meios de Contraste/uso terapêutico , Microcirculação/fisiologia , Ultrassonografia/métodos , Malformações Vasculares/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA