RESUMEN
We report the case of a 70-year-old man with an asymptomatic, fast-growing, paraceliac penetrating aortic ulcer (PAU). Guidelines recommend endovascular repair if an asymptomatic PAU shows a mean growth rate ≥5 mm per year: this patient's maximum aortic diameter was 47 mm but had increased 10 mm in the previous year. The very short sealing zones required a custom-made stent graft. A custom-made relay stent graft comprises a single celiac trunk fenestration, a superior mesenteric artery (SMA) scallop measured according to SMA ostium size, an uncovered distal stent, and 6-mm tapering was used with technical and clinical success.
Asunto(s)
Enfermedades de la Aorta/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Arteria Celíaca/cirugía , Procedimientos Endovasculares/instrumentación , Arteria Mesentérica Superior/cirugía , Stents , Úlcera/cirugía , Anciano , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/fisiopatología , Aortografía/métodos , Enfermedades Asintomáticas , Arteria Celíaca/diagnóstico por imagen , Arteria Celíaca/fisiopatología , Angiografía por Tomografía Computarizada , Humanos , Masculino , Arteria Mesentérica Superior/diagnóstico por imagen , Arteria Mesentérica Superior/fisiopatología , Diseño de Prótesis , Resultado del Tratamiento , Úlcera/diagnóstico por imagen , Úlcera/fisiopatologíaRESUMEN
BACKGROUND: Pre-operative embolization prior to surgical resection of carotid body tumors was meant to decrease intraoperative blood loss and operative time. Yet, potential confounders such as different Shamblin classes have never been analyzed. Aim of our meta-analysis was to investigate effectiveness of a pre-operative embolization according to different Shamblin classes. METHODS: Five studies comprising 245 patients were included. A random effects model meta-analysis was conducted, and the I2 statistic was used to assessment for heterogeneity. RESULTS: Pre-operative embolization was associated with a significant reduction in blood loss (WM: 276.4 mL; 95% CI, 201.9-378.3, p < 0.01); an absolute mean reduction, though not statistically significant, was observed in both Shamblin 2 and 3 classes. No difference in operative time was found between the two strategies (WM: 192.0 min; 95% CI, 157.7-234.1, p = 1.0). CONCLUSIONS: Embolization proved an overall significant reduction in perioperative bleeding, which did not reach threshold for statistical significance when Shamblin classes were singularly considered.