RESUMO
AIM: To review data on the impact of the COVID-19 pandemic on interventional radiology (IR) services. MATERIALS AND METHODS: A systematic review of the available studies was performed according to the PRISMA guidelines. RESULTS: A total of 14 studies met the inclusion criteria. IR caseload reduced between 16.8-80%, with elective activity affected more than emergency work. Trainees also experienced a 11-51.9% reduction in case volumes and many were redeployed to critical care. IR departments re-organised operations and personnel, and many continued to offer 24/7 services and support critical care areas through redeployment of staff. The majority of studies report no significant issues with the availability of personal protective equipment and that local or national governing body or radiology society guidelines were followed. CONCLUSION: The COVID-19 pandemic reduced case volumes and training opportunities. IR departments showed flexibility in service delivery. The lessons learned offer novel insights into how services and training can be reorganised to ensure that IR continues to thrive.
Assuntos
COVID-19/epidemiologia , Pneumonia Viral/epidemiologia , Radiologia Intervencionista , Carga de Trabalho , Saúde Global , Humanos , Pandemias , Pneumonia Viral/virologia , SARS-CoV-2RESUMO
AIM: To describe the authors' experience with prostate artery embolisation (PAE) to treat lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) or refractory haematuria of prostatic origin (RHOPA). MATERIALS AND METHODS: PAE was attempted in 159 patients. Procedural details, pre/post-PAE symptom scores, and pre/post-PAE magnetic resonance imaging (MRI) data were recorded. Statistical analysis was performed to determine clinical outcomes and factors predicting clinical success. RESULTS: Technical success was achieved in 156 patients. In patients with LUTS, the International Prostate Symptom Score (IPSS) improved from a mean of 22 at baseline to 9.5 at 6-months post-PAE, then to 10.7, 10, 11.3, and 11 at 1, 2, 3, and 4 years. The quality of life (QoL) score improved from 4.6 at baseline to 2, 2.2, 2.4, 3.1, and 2.5 at the same time points. The International Index of Erectile Function (IIEF-5) scores remained stable. There was no significant difference in IPSS between bilateral or unilateral embolisation to 2 years, or between BPH alone or BPH with biopsy-proven prostate cancer to 3 years post-PAE. Percentage improvement in IPSS at 1 year correlated with percentage reduction in prostate volume on first post-PAE MRI. Percentage improvement in IPSS at 3 years correlated with initial IPSS. PAE facilitated urinary catheter removal in 13/24 patients in retention. PAE controlled bleeding in 12/12 patients with RHOPA. CONCLUSION: PAE is safe and effective in the management of symptomatic BPH. Patients with the highest baseline IPSS and reduction in prostate volume on first post-PAE MRI are likely to derive most benefit from embolisation.
Assuntos
Embolização Terapêutica/métodos , Hematúria/etiologia , Sintomas do Trato Urinário Inferior/etiologia , Próstata/irrigação sanguínea , Hiperplasia Prostática/complicações , Hiperplasia Prostática/terapia , Retenção Urinária/etiologia , Idoso , Idoso de 80 Anos ou mais , Artérias/diagnóstico por imagem , Seguimentos , Hematúria/terapia , Humanos , Sintomas do Trato Urinário Inferior/terapia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Hiperplasia Prostática/diagnóstico por imagem , Resultado do Tratamento , Retenção Urinária/terapiaRESUMO
OBJECTIVES: To measure the radiation exposure of the operating team during endovascular aortic procedures, and to determine factors that predict high exposures. MATERIALS AND METHODS: Electronic dosimeters placed over and under protective lead garments, were used to prospectively record radiation exposure during endovascular aortic repairs performed in a designated interventional radiology suite. Univariate and multivariate linear regression analyses of predictors of radiation exposure were performed. RESULTS: A total of 26 infra-renal and 10 thoracic endovascular cases were studied. Median (IQR) patient age and body mass index were 76.0 (70.0-81.8) years and 26.2 (23.9-28.9) kg/m(2) respectively. Over-lead exposure to the operator was higher for thoracic than for infra-renal procedures (421.0 [233.8-597.8] µSv vs. 52.5 [27.8-179.8] µSv, p = .0003), reflecting a significant exposure to unprotected parts of the body. Under-lead exposures for operator and assistant were 5.5 (2.0-14.2) µSv and 1.0 (0.0-2.3) µSv respectively, which for an average caseload would comply with total body effective dose limits. Type of case and percentage of digital subtraction angiography (DSA) time in left anterior oblique angulations predicted dose to the operator (p < .0001). CONCLUSIONS: Thoracic procedures, DSA runs and obliquity of the C-arm are strong predictors of radiation exposure during endovascular aortic repairs. Understanding scatter radiation dynamics and instigating measures to minimise radiation exposure should be mandatory.
Assuntos
Aorta Abdominal/cirurgia , Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Procedimentos Endovasculares/efeitos adversos , Exposição Ocupacional/efeitos adversos , Doses de Radiação , Radiografia Intervencionista/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital/efeitos adversos , Aorta Abdominal/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Aortografia/efeitos adversos , Desenho de Equipamento , Humanos , Modelos Lineares , Análise Multivariada , Exposição Ocupacional/prevenção & controle , Saúde Ocupacional , Estudos Prospectivos , Roupa de Proteção , Lesões por Radiação/etiologia , Lesões por Radiação/prevenção & controle , Monitoramento de Radiação , Proteção Radiológica/instrumentação , Medição de Risco , Fatores de Risco , Espalhamento de RadiaçãoRESUMO
To report the immediate and long-term outcomes following the fluoroscopically guided balloon dilatations performed in our department for the treatment of achalasia. We reviewed retrospectively all patients that underwent a fluoroscopically guided balloon dilatation because of achalasia in our department between April 2007 and September 2010. The follow-up was performed by interviews and/or investigation of the patient's medical and imaging records. The primary endpoints of the study were technical success, clinical success, major complication rates, and repeat dilatation rates because of recurrence of clinical symptomatology. Secondary endpoints were the rate of minor complications and the dilatation-free interval. Various parameters that could affect the clinical outcome were also analyzed. Thirty-nine consecutive patients (20 female) with a mean age 44 ± 17 years underwent 69 dilatations, while 10/39 (25.6%) patients had a history of a previous laparoscopic myotomy. The most common symptom was dysphagia (64/69, 92.7%), while regurgitation and/or retrosternal pain were present in 12/39 (30.7%) and 9/39 (23%) of the cases, respectively. Technical success was achieved in 98.5% (68/69). There were no procedure-related major complications. The mean balloon diameter used was 30 ± 3.9 mm, and the mean period of follow-up was 27.7 ± 16.0 months. Excellent or good initial responses were noted in 54/66 cases (81.8%). A repeated dilatation to deal with recurrence of symptoms was performed in 69.4% of the cases (25/36). In the majority of the cases, two dilatations were needed in order to achieve long-term relief from symptoms. A dilatation-free interval of 4 years was observed in 26.4%. Clinical success was achieved in 30/36 patients (83.3%). Subgroup analysis did not detect significantly different recurrence rates in patients with and without previous laparoscopic myotomy (50% vs. 69% respectively), those of young age (75% < 21 years vs. 68.8% > 21 years), and male gender (71.4% male vs. 55.0% females). The high redilatation rate was attributed to the utilization of smaller balloons by less experienced operators. Fluoroscopically guided balloon dilatation is a safe and effective method for the treatment of achalasia. Young age and prior Heller's laparoscopic myotomy were not associated with increased rates of recurrence rate or clinical failure.
Assuntos
Cateterismo/métodos , Acalasia Esofágica/terapia , Fluoroscopia/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Cateterismo/efeitos adversos , Transtornos de Deglutição/etiologia , Dilatação/efeitos adversos , Dilatação/métodos , Acalasia Esofágica/cirurgia , Feminino , Fluoroscopia/efeitos adversos , Seguimentos , Refluxo Gastroesofágico/etiologia , Humanos , Entrevistas como Assunto , Laparoscopia/métodos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Recidiva , Retratamento , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Endovascular graft designs incorporating sidebranches, fenestrations and scallops offer a minimally-invasive alternative to open surgery and hybrid approaches for thoracoabdominal aortic aneurysms (TAAA). Our unit has offered total endovascular TAAA repair to selected higher-risk patients since 2008. We report the largest UK series to date of total endovascular TAAA repair. METHODS: Retrospective analysis of a prospectively-maintained operative database. RESULTS: 31 patients (21 male, 10 female) median age 71 years (range 58-84), with TAAA (12 Crawford type I, 13 type III, 6 type IV), median diameter 6.4 (4.3 (mycotic)- 9.9) underwent endovascular TAAA repair (total 48 sidebranches, 26 fenestrations, 13 scallops) between July 2008 and January 2011. Median operating time 225 min (65-540 min), X-ray screening time 58 min (4-212 min), contrast dose 175 ml (70-500 ml), blood loss 325 ml (100-400 ml). Median post-operative length of hospital stay 6 days (2-22 days). Three patients (3/31, 9.7%) died within 30 days of operation: multisystem organ failure (1) acute renal failure and paraplegia (1) and paraplegia (1). There were no other cases of in-hospital organ failure, paraplegia or major complications. The median change in pre-discharge from pre-operative renal function was 3.4% deterioration in eGFR (range: 32.7% deterioration to 73.0% improvement) One patient presented with late-onset paraparesis, a second developed acute renal failure 8 months after repair. One early high-pressure endoleak (type 3) required correction. Three patients had died by median follow-up 12 months (1-36), 2 from heart disease and one from haemopericardium secondary to acute dissection of the ascending aorta (the dissection did not involve, nor extend close to, the endovascular graft). CONCLUSIONS: Total endovascular repair of TAAA offers patients a minimally-invasive alternative to open surgery with early results at least comparable to those seen with open or hybrid surgical approaches.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Procedimentos Endovasculares/métodos , Injúria Renal Aguda/etiologia , Idoso , Idoso de 80 Anos ou mais , Ruptura Aórtica/cirurgia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular , Endoleak/diagnóstico , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Paraparesia/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , StentsRESUMO
OBJECTIVE: Endovascular repair for degenerative aortic aneurysms is well established, but its role in those with infective pathology remains controversial. This study aims to assess the durability of endovascular repair with a review of our midterm results. METHOD: A retrospective analysis of a prospectively maintained endovascular database (1998-2008) was conducted, which identified 673 consecutive patients with aortic aneurysms. RESULTS: Nineteen patients (2.8%) were identified with infected aortic aneurysms, in which there were a total of 23 separate aneurysms (16 thoracic and seven abdominal). Six patients (32%) presented with rupture. Eleven patients (58%) had received antibiotics preoperatively for a median duration of 11 days (1-54 days). Fifteen of the 19 (79%) had positive blood cultures, with Staphylococcus aureus being the most common organism. All 19 patients underwent endovascular repair. There were three Type I endoleaks (one requiring conversion to open repair) and two Type II endoleaks. One patient developed transient paraplegia, resolved by cerebrovascular fluid (CSF) drainage, and one patient had a stroke. The 30-day mortality was 11%, and survival at median follow-up of 20 months (0-83 months) was 73%. All eight deaths in the series were related to aneurysm. CONCLUSION: Endovascular treatment of infective aortic pathology provides an early survival benefit; however, concerns over on-going graft infection remain.
Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Stents , Adulto , Idoso , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma Infectado/mortalidade , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/mortalidade , Ruptura Aórtica/cirurgia , Feminino , Fístula/diagnóstico por imagem , Fístula/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Radiografia , Estudos Retrospectivos , Staphylococcus aureus/isolamento & purificação , Resultado do TratamentoRESUMO
Abdominal aortic aneurysm (AAA) is a common degenerative condition affecting the elderly population. Rupture carries a high overall mortality. Elective endovascular stent graft repair is well described. We describe a patient with ruptured AAA and co-morbid conditions making him unfit for surgery and general or epidural anaesthesia, who was successfully treated by endovascular stent graft under local anaesthesia.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Endarterectomia/métodos , Idoso , Anestesia Local , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Implante de Prótese Vascular/métodos , Humanos , Masculino , Stents , Tomografia Computadorizada por Raios X/métodosRESUMO
Osteoporotic vertebral compression fracture (VCF) is a frequently encountered clinical problem associated with chronic pain and disability. Conservative treatment in the form of bed rest, pain control and bracing may create a vicious circle, in which reduced activity leads to further reduction in bone density and fracture risk. Percutaneous vertebroplasty (PVP) is an accepted treatment modality for osteoporotic vertebral body collapse present for less than 1 year, vertebral myeloma, haemangioma, metastasis and recent traumatic fractures (between 3 and 12 months). We describe an osteoporotic patient in whom successful PVP was performed, under general anaesthesia using CT and fluoroscopic guidance, in a post-traumatic 5-year-old VCF with complete alleviation of debilitating pain. In the light of our experience, we suggest that PVP should be carried out in a series of similar patients to asses its value as a treatment option in patients with chronic osteoporotic vertebral fractures for pain relief and improvement in mobility, independent of fracture age.
Assuntos
Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Dor nas Costas/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
We present a method to register a preoperative MR volume to a sparse set of intraoperative ultrasound slices. Our aim is to allow the transfer of information from preoperative modalities to intraoperative ultrasound images to aid needle placement during thermal ablation of liver metastases. The spatial relationship between ultrasound slices is obtained by tracking the probe using a Polaris optical tracking system. Images are acquired at maximum exhalation and we assume the validity of the rigid body transformation. An initial registration is carried out by picking a single corresponding point in both modalities. Our strategy is to interpret both sets of images in an automated pre-processing step to produce evidence or probabilities of corresponding structure as a pixel or voxel map. The registration algorithm converts the intensity values of the MR and ultrasound images into vessel probability values. The registration is then carried out between the vessel probability images. Results are compared to a "bronze standard" registration which is calculated using a manual point/line picking algorithm and verified using visual inspection. Results show that our starting estimate is within a root mean square target registration error (calculated over the whole liver) of 15.4 mm to the "bronze standard" and this is improved to 3.6 mm after running the intensity-based algorithm.
Assuntos
Algoritmos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Fígado/anatomia & histologia , Fígado/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Técnica de Subtração , Ultrassonografia/métodos , Artefatos , Humanos , Movimento (Física) , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Cirurgia Assistida por Computador/métodosRESUMO
The outcome of teaching the core of knowledge to clinicians and the impact of the POPUMET regulations was assessed using an anonymous questionnaire. 82 of 120 (76%) of non-radiologists responded, of these 37% had attended a radiation protection course. Course attendance improved knowledge of the existence of the POPUMET regulations (p < 0.0001) and the ALARA principle. Course attendance made no difference to knowledge of the relative radiation dose of various radiological procedures. An underestimation of radiation dose was made by all responders (p < 0.001). The majority of responders were not aware that patients have no annual dose limit and the majority did not know the relative radiosensitivity of different organs. We have shown that despite the POPUMET regulations the majority of clinicians have not received adequate radiation protection teaching and that even if a course has been attended overall knowledge is still poor. We propose that formal compulsory teaching at undergraduate level may correct this in the future.
Assuntos
Competência Clínica , Corpo Clínico Hospitalar/educação , Proteção Radiológica , Radiografia , Radiologia/educação , Educação Médica Continuada , Humanos , Doses de Radiação , Inquéritos e Questionários , Reino UnidoRESUMO
PURPOSE: A systematic review was undertaken to provide a meta-analysis of clinical trials comparing thermal ablation with surgical nephrectomy for small renal tumours. METHODS: PubMed (MEDLINE), EMBASE, AMED, and Scopus were searched in August 2013 for eligible prospective or retrospective comparative trials following the PRISMA selection process. Thermal ablation was compared with surgical nephrectomy. Quality of included studies was assessed on the Newcastle-Ottawa Scale (NOS). The primary endpoint was disease-free survival and was analyzed on the log-hazard scale. Secondary outcome measures included complications, local recurrence, and decline of renal function. Hazard ratios (HR) and risk ratios (RR) were calculated with a random effects model, and meta-regression analysis was performed to explore clinical heterogeneity. RESULTS: Six clinical trials (1 randomized and 5 cohort; 6-8 stars on the NOS scale) involving 587 patients with small renal tumors (mean size 2.5 cm) treated with either thermal ablation (percutaneous or laparoscopic application of radiofrequency or microwave) or surgical nephrectomy (open or laparoscopic) were analyzed. Overall complication rate was significantly lower in the ablation group (7.4 vs. 11%; RR: 0.55, 95% confidence interval [CI]: 0.31-0.97, p = 0.04). Postoperative decline of eGFR was higher in case of nephrectomy (mean difference: -14.6 ml/min/1.73 m(2), 95% CI: -27.96 to -1.23, p = 0.03). Local recurrence rate was the same in both groups (3.6 vs. 3.6%; RR: 0.92, 95% CI: 0.4-2.14, p = 0.79) and disease-free survival also was similar up to 5 years (HR: 1.04, 95% CI: 0.48-2.24, p = 0.92). CONCLUSIONS: Thermal ablation of small renal masses produces oncologic outcomes similar to surgical nephrectomy and is associated with significantly lower overall complication rates and a significantly less decline of renal function. More randomized, controlled trials are necessary.
Assuntos
Carcinoma de Células Renais/cirurgia , Ablação por Cateter/métodos , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Ablação por Cateter/mortalidade , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Nefrectomia/mortalidade , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Sobrevida , Resultado do TratamentoRESUMO
Current endovascular treatments for isolated iliac artery aneurysms (IIAAs) include the use of aortoiliac stent grafts with coverage of the distal aorta or stent grafts confined to the iliac artery without active proximal fixation. We report our experience in the use of custom-made Cook Zenith(TM) iliac limb stent grafts with proximal barb fixation. Patients treated from July 2009 to February 2011 were included. All imaging and patient records were assessed for perioperative and early outcomes. Nine IIAAs (seven patients) were treated. The mean patient age was 80 years (range 58-91 years). The mean aneurysm size was 48 mm (35-80 mm), and the mean length of the proximal landing zone (PLZ) was 29 mm (10-50 mm). The distal landing zone was in the external iliac artery after coil embolization of the internal iliac artery. The Mean diameter of the PLZ was 21 mm (20-24 mm). Technical success was achieved in eight cases. Perioperative complications included reoperation in one patient for groin bleeding and ischemia. On follow-up (mean 12 months, range 1-26), all aneurysms were successfully excluded from the circulation and there was no stent graft migration or thrombosis. Use of custom-made stent grafts with proximal barb fixation in treatment of IIAAs is a feasible option which may reduce the risk of migration when compared with stent grafts with lack of proximal fixation.
Assuntos
Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Aneurisma Ilíaco/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Radiografia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Selective arterial embolisation is increasingly used to arrest intractable postpartum haemorrhage. We report a case of postpartum haemorrhage following a placenta praevia, which had a successful outcome with selective arterial embolisation as the first treatment option. This technique should be more widely available, and in many instances should be considered before and in lieu of any surgical intervention.
Assuntos
Embolização Terapêutica/métodos , Placenta Prévia , Hemorragia Pós-Parto/terapia , Adulto , Angiografia , Feminino , Testes Hematológicos , Humanos , Circulação Placentária , Hemorragia Pós-Parto/etiologia , Gravidez , Radiologia Intervencionista , Resultado do Tratamento , Útero/irrigação sanguíneaRESUMO
Simultaneous involvement and obstruction of the common bile duct and the duodenum presents a difficult and challenging problem to the surgeon, the endoscopist and the interventional radiologist. In the case report we present here, the patient had had duodenal and biliary obstruction secondary to hepatic flexure adenocarcinoma and presented with recurrent obstructive jaundice. As the surgically modified anatomy precluded all conventional endoscopic and percutaneous approaches, it was necessary to use an improvised method of achieving biliary decompression.
Assuntos
Adenocarcinoma/cirurgia , Neoplasias dos Ductos Biliares/cirurgia , Descompressão Cirúrgica/métodos , Obstrução Duodenal/cirurgia , Neoplasias Hepáticas/cirurgia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Ductos Biliares/cirurgia , Colangiografia , Obstrução Duodenal/complicações , Obstrução Duodenal/diagnóstico por imagem , Feminino , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Radiografia Intervencionista/métodos , Resultado do TratamentoRESUMO
Aneurysms of the gluteal arteries are rare and were previously managed with open surgical procedures. Recently percutaneous embolisation techniques have helped reduce morbidity and mortality. A case is presented of a 63-year-old man who presented with haemorrhage and had developed a superior gluteal artery aneurysm following treatment for an invasive squamous cell carcinoma in the sacral area. There was concern that embolisation of the aneurysm might compromise the survival of the myocutaneous buttock rotation flaps that had been used for reconstruction. To overcome this, an endovascular stent was deployed to successfully close off the aneurysm whilst at the same time maintaining blood flow through the superior gluteal artery. Aneurysms in larger peripheral vessels have been managed with stents. However, this is the first reported case of this method of treatment being used in the management of gluteal artery aneurysms.
Assuntos
Falso Aneurisma/terapia , Nádegas/irrigação sanguínea , Complicações Pós-Operatórias/terapia , Stents , Falso Aneurisma/etiologia , Angioplastia com Balão/métodos , Artérias , Carcinoma de Células Escamosas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Articulação Sacroilíaca , Retalhos Cirúrgicos/irrigação sanguínea , Tomografia Computadorizada por Raios XRESUMO
Open surgery for thoracic aortic disease is associated with significant morbidity and the reported rates for paraplegia and stroke are 3%-19% and 6%-11%, respectively. Spinal cord ischemia and stroke have also been reported following endoluminal repair. This study reviews the incidence of paraplegia and stroke in a series of 186 patients treated with thoracic stent grafts. From July 1997 to September 2006, 186 patients (125 men) underwent endoluminal repair of thoracic aortic pathology. Mean age was 71 years (range, 17-90 years). One hundred twenty-eight patients were treated electively and 58 patients had urgent procedures. Anesthesia was epidural in 131, general in 50, and local in 5 patients. Seven patients developed paraplegia (3.8%; two urgent and five elective). All occurred in-hospital apart from one associated with severe hypotension after a myocardial infarction at 3 weeks. Four of these recovered with cerebrospinal fluid (CSF) drainage. One patient with paraplegia died and two had permanent neurological deficit. The rate of permanent paraplegia and death was 1.6%. There were seven strokes (3.8%; four urgent and three elective). Three patients made a complete recovery, one had permanent expressive dysphasia, and three died. The rate of permanent stroke and death was 2.1%. Endoluminal treatment of thoracic aortic disease is an attractive alternative to open surgery; however, there is still a risk of paraplegia and stroke. Permanent neurological deficits and death occurred in 3.7% of the patients in this series. We conclude that prompt recognition of paraplegia and immediate insertion of a CSF drain can be an effective way of recovering spinal cord function and improving the prognosis.
Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/efeitos adversos , Paraplegia/etiologia , Isquemia do Cordão Espinal/etiologia , Acidente Vascular Cerebral/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/epidemiologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Drenagem/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Paraplegia/mortalidade , Paraplegia/patologia , Paraplegia/fisiopatologia , Paraplegia/cirurgia , Recuperação de Função Fisiológica , Isquemia do Cordão Espinal/mortalidade , Isquemia do Cordão Espinal/patologia , Isquemia do Cordão Espinal/fisiopatologia , Isquemia do Cordão Espinal/cirurgia , Stents , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Endovascular aneurysm repair (EVAR) has become an established alternative to open repair (OR). We present a consecutive series of 486 elective patients with large infra-renal aortic abdominal aneurysm, comparing OR with EVAR. Prospective data collected during an 8-year period from January 1997 to October 2005 was reviewed. Statistical analysis performed using SPSS data editor with chi(2) tests and Mann-Whitney U-tests. There were 486 patients with 329 OR (293 males, 36 females) with median age of 72 years with median diameter 6.3 cm and 157 EVAR (148 males, 9 females) with median age 75 years with median diameter 6.1 cm. Mortality was 13 (4%) for OR and 5 (3.2%) for EVAR (three of whom were in the UK EVAR 2 trial). Blood loss was significantly less for EVAR 500 ml vs. 1500 ml for OR. Sixty-five (19.8%) patients with OR had significantly more peri-operative complications compared with 14 (8.9%) with EVAR. The length of stay in hospital was significantly less for EVAR. This non-randomised study shows that although EVAR does not have a statistically significantly lower mortality, it does have statistically significantly lower complication rates compared with OR. EVAR can be achieved with good primary success, but long-term follow-up is essential to assess durability.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Complicações Intraoperatórias/etiologia , Artéria Renal/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Aneurisma da Aorta Abdominal/mortalidade , Implante de Prótese Vascular , Estudos de Coortes , Feminino , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/mortalidadeRESUMO
BACKGROUND: Carotid endarterectomy reduces the risk of stroke and death in patients with severe carotid artery stenosis. This study examined whether the technique used to close the arteriotomy influenced the rate of perioperative transient ischaemic attack (TIA), stroke or death. METHODS: A cohort of 236 patients undergoing carotid endarterectomy at a single centre was studied; 117 patients had primary closure of the arteriotomy and 119 patients in a sequential series had closure with a Dacron patch. A standard endarterectomy with completion intraoperative duplex imaging and digital subtraction angiography was used throughout. RESULTS: Patch closure was associated with a significant reduction in the 30-day combined death, stroke and TIA rate: 10.3 per cent for primary closure versus 2.5 per cent for patch closure (P = 0.017). The risk of any cerebral event (stroke or TIA) was also significantly reduced (7.7 versus 1.7 per cent; P = 0.033). Residual stenosis on completion angiography was more common after primary closure (24.6 versus 7.4 per cent; P = 0.003). CONCLUSION: Dacron patch closure had a higher technical success rate on completion imaging and was associated with a significant reduction in the risk of perioperative stroke, TIA and death.