RESUMO
Despite recent publications indicating billowing (aneurysmal degeneration of the outer fabric material manifesting as a bulging sac of contained contrast due to weakening of the fabric material between the metal struts) as a benign finding, we present a unique case of billowing that resulted in aneurysmal rupture with the AFX2® stent graft (Endologix, Inc., Irvine, CA). AFX2® consists of an inner metallic endoskeleton with multiple metallic struts covered by a polytetrafluoroethylene graft fabric. It allows the flow of blood or contrast beyond the border of the metallic endoskeleton without evidence of endoleak or rupture secondary to the outer cover being anchored to the endoskeleton with polypropylene sutures only at the proximal and distal ends. Our report raises the concern that although billowing may be a relatively common manifestation with Endologix stent grafts, clinicians have to be diligent as the phenomenon may progress to abdominal aortic aneurysm rupture.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular/efeitos adversos , Falha de Prótese , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/etiologia , Implante de Prótese Vascular , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Humanos , Imageamento Tridimensional , Masculino , Desenho de Prótese , StentsAssuntos
Aneurisma Infectado/diagnóstico , Aneurisma Aórtico/microbiologia , Infecções por Clostridium/diagnóstico , Adenoma Viloso/complicações , Idoso , Aneurisma Infectado/complicações , Aneurisma Infectado/microbiologia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico , Neoplasias do Ceco/complicações , Infecções por Clostridium/complicações , Evolução Fatal , Humanos , MasculinoRESUMO
OBJECTIVE: Arteriovenous fistulae traditionally have been placed in the upper extremity. Experience with groin hemodialysis access has been discouraging because of high infection rates and associated limb amputation. We reviewed our experience with angioaccess grafts in the groin to assess safety and viability in our hemodialysis patient population. METHODS: A retrospective review was performed of all groin hemodialysis access grafts placed at a single tertiary care center between June 1990 and February 1998. Demographics, complications, and subsequent treatment were recorded. Graft patency and infection rates were analyzed with life-table analysis. RESULTS: Data were collected on 73 graft insertions. A total of 52 episodes of thrombosis occurred in 26 grafts. Primary patency rate was 71% at 1 year. Secondary patency rate was 83% at 1 year. There was a 22% incidence rate of infection. CONCLUSION: We conclude that the incidence rate of infection and thrombosis in our series of femoral-based hemodialysis grafts is comparable with rates reported in the literature for upper extremity polytetrafluoroethylene angioaccess grafts. Although not considered a first choice, femoral artery-based hemodialysis access is a viable option when arteriovenous fistulae in the upper extremity cannot be constructed.