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1.
Int Angiol ; 29(3): 273-7, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20502416

RESUMO

Four patients suffering from concomitant descending thoracic pathology and abdominal aortic aneurysms were treated with endovascular stent-grafts simultaneously. Graft deployment was successful and uneventful in all patients. Paraplegia was not observed. One patient developed an abdominal type Ib endoleak at 12 months which was repaired endovascularly. One patient died from multiorgan failure 3 days after the deployment of the grafts. After 18, 36 and 42 months follow up all the other patients are well without any graft related complication. Simultaneous endovascular repair for coexisting descending thoracic and abdominal aortic pathologies might be an acceptable alternative to open surgery or hybrid operations, at least for the high risk patients.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Falha de Prótese , Stents , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
J Cardiovasc Surg (Torino) ; 50(3): 373-9, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19455090

RESUMO

The incidence of synchronous abdominal aortic aneurysm (AAA) and colorectal cancer (CRC), although quite rare, still represents an issue of controversy regarding the optimal treatment. This study attempts a historical review of the surgical practice during the past decades by reviewing the existing English literature on this topic. The dilemma between one or two stage treatment has remained as both options offer advantages but also carry some substantial risks. The current practice gives priority to the life threatening disease (AAA>5.5 cm, symptomatic or complicated CRC) (two stage treatment) or suggest simultaneous management (one stage) when both diseases require urgent surgical treatment. The evolution of vascular endografts and the reported efficacy of endovascular aortic repair (EVAR) provide an alternative method for treating these high risk patients, by surpassing some significant obstacles. If the anatomical criteria are satisfied, EVAR could become the optimal solution for the concomitant AAA and CRC patients, especially those who require one stage treatment.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Colectomia , Neoplasias Colorretais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Neoplasias Colorretais/complicações , Neoplasias Colorretais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Int Angiol ; 23(2): 189-91, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15507899

RESUMO

A rare case of a patient with a ruptured abdominal aortic aneurysm (AAA) and an incidentally found left renal artery aneurysm (RAA) is presented. Successful repair of both aneurysms was simultaneously performed. The indications for such a surgical approach are also discussed.


Assuntos
Aneurisma Roto/epidemiologia , Aneurisma/epidemiologia , Aneurisma da Aorta Abdominal/epidemiologia , Achados Incidentais , Artéria Renal , Aneurisma/cirurgia , Aneurisma Roto/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Humanos , Masculino , Pessoa de Meia-Idade
4.
Int Angiol ; 23(4): 305-16, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15767978

RESUMO

The development of low-molecular-weight heparins (LMWHs) was a significant advance in the treatment of venous thromboembolism (VTE). Their better bioavailability and more predictable anticoagulant activity than unfractionated heparin (UFH) allow subcutaneous administration without close laboratory monitoring, and thus make outpatient treatment of deep vein thrombosis (DVT) feasible. The safety and efficacy of outpatient treatment in selected patients were established in randomized clinical trials comparing subcutaneous LMWH administered primarily at home with inpatient intravenous UFH. Furthermore, during the last few years a large number of studies have supported these findings in various clinical settings of every-day practice. It is also important that home treatment has lead to substantial cost reductions along with improvement in patients' satisfaction and quality of life. Thus, outpatient treatment of DVT provides an opportunity, rarely seen in medicine, to improve patient care while reducing the overall VTE health-care cost, and it is likely that will be the preferred regime for the majority of patients in the future. However, the implementation of a home treatment program is not simple, as the risks of insufficient or excessive anticoagulation would be considerable. A structured protocol is necessary to ensure that patient care is optimal, and the keys to a successful outpatient treatment program are patient selection, patient education, patient access to health care team, appropriate follow-up and health care team communication.


Assuntos
Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Trombose Venosa/tratamento farmacológico , Anticoagulantes/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Injeções Subcutâneas , Pacientes Ambulatoriais , Segurança , Resultado do Tratamento
6.
Ann Vasc Surg ; 16(2): 246-58, 2002 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11972262

RESUMO

Peripheral arterial disease (PAD) is associated with platelet hyperaggregability as well as an increase in morbidity and mortality from myocardial infarction and stroke. Enhanced platelet activation in PAD may substantially contribute to these adverse outcomes. A relative resistance to aspirin therapy has been reported in patients with PAD. Therefore, clopidogrel may be superior to aspirin in treatment of PAD. Furthermore, the aspirin + clopidogrel combination could be more effective than monotherapy but its risk-benefit ratio has yet to be evaluated. Clopidogrel is preferable to ticlopidine because of its safer profile and the convenience of once-daily administration. The glycoprotein (Gp) IIb/IIIa inhibitors may also find a place as short-term therapy after peripheral angioplasty. There is a need to consider the use of clopidogrel in patients who cannot tolerate aspirin. Patients who have an event while taking aspirin also present a problem. One possibility here is to substitute aspirin with clopidogrel or to add clopidogrel to the aspirin. Although these options are currently not evidence based in patients with PAD, there is emerging evidence showing that they are realistic choices.


Assuntos
Aspirina/uso terapêutico , Doenças Vasculares Periféricas/tratamento farmacológico , Ativação Plaquetária/fisiologia , Inibidores da Agregação Plaquetária/uso terapêutico , Agregação Plaquetária/fisiologia , Ticlopidina/uso terapêutico , Aspirina/farmacologia , Clopidogrel , Dipiridamol/uso terapêutico , Quimioterapia Combinada , Humanos , Doenças Vasculares Periféricas/fisiopatologia , Ativação Plaquetária/efeitos dos fármacos , Agregação Plaquetária/efeitos dos fármacos , Inibidores da Agregação Plaquetária/farmacologia , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Ticlopidina/análogos & derivados , Ticlopidina/farmacologia
7.
Am Surg ; 67(1): 67-70, 2001 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11206900

RESUMO

Internal carotid artery kinking is frequently accompanied by atheromatous disease at the carotid bifurcation, and in this case both lesions may be treated simultaneously. Various surgical techniques have been used to correct carotid kinking but no particular one has been widely established. We conducted a retrospective review of 18 patients operated upon for internal carotid kinking during the last 5 years, which represents 4.1 per cent of the total carotid procedures performed during the same period. In 13 of the 18 patients carotid endarterectomy was performed before the repair of the kink. In four patients resection of the kinked segment with end-to-end anastomosis was performed combined with longitudinal arteriotomy at the carotid bifurcation. Two patients developed restenosis at the site of anastomosis requiring reoperation with patch angioplasty. Three patients were treated with eversion endarterectomy and end-to-side anastomosis, whereas in six patients we performed resection of the redundant internal carotid artery combined with longitudinal arteriotomy at the bifurcation. The posterior wall was reconstructed with interrupted sutures and the procedure was completed with patch angioplasty of the anterior wall. In four of these cases we used the autogenous resected arterial segment as patch material. None of these patients developed restenosis or symptoms in a follow-up period of 3 to 32 months. In cases in which significant carotid artery stenosis and internal carotid kinking coexist resection of the involved segment with end-to-end anastomosis of the posterior wall and patch angioplasty using the resected autogenous arterial segment constitute a convenient and satisfactory method of reconstruction.


Assuntos
Artérias/transplante , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Endarterectomia das Carótidas/métodos , Idoso , Anastomose Cirúrgica , Doenças das Artérias Carótidas/complicações , Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
Ann Vasc Surg ; 14(2): 130-7, 2000 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10742427

RESUMO

The objective of this study was to determine the relationship between plaque echogenicity as measured by computer and the incidence of cerebrovascular symptoms and cerebral infarction. The correlation between carotid plaque echogenicity and plaque histology was also evaluated. In this prospective nonrandomized study, 38 consecutive patients with 54 atherosclerotic carotid plaques producing 50-99% stenosis were reviewed. The ultrasonic images of the plaques were digitized and transferred to a computer. A histogram for each plaque representing its composition was obtained. The median of the gray scale (GSM) of each histogram was used as measure of plaque echogenicity. All patients had a computed tomography (CT) brain scan performed to determine the presence of cerebral infarction. Twenty-eight plaques were examined histologically to determine the deposition of calcium, hemorrhage, cholesterol, and amorphous granular material. It is possible to identify carotid plaques at high risk for development of cerebrovascular symptoms and cerebral infarction by the computerized measurement of plaque echogenicity. This method may be used to improve the criteria of patients selection for carotid endarterectomy.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Processamento de Imagem Assistida por Computador , Idoso , Idoso de 80 Anos ou mais , Calcinose/diagnóstico por imagem , Artéria Carótida Interna/patologia , Estenose das Carótidas/complicações , Estenose das Carótidas/patologia , Estenose das Carótidas/cirurgia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Endarterectomia das Carótidas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Ultrassonografia
9.
J Cardiovasc Surg (Torino) ; 39(5): 583-5, 1998 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9833716

RESUMO

The coexistence of an abdominal aortic aneurysm and an acute aortic dissection seems to be rare and only a few reports are to be found in the literature. We report a case of a patient with acute aortic dissection of the descending thoracic aorta that caused rupture of a pre-existing abdominal aortic aneurysm. The literature is also thoroughly reviewed.


Assuntos
Aneurisma da Aorta Abdominal/etiologia , Aneurisma da Aorta Torácica/complicações , Dissecção Aórtica/complicações , Ruptura Aórtica/etiologia , Doença Aguda , Dissecção Aórtica/diagnóstico , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , Ruptura Aórtica/diagnóstico , Ecocardiografia Transesofagiana , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
11.
Arch Surg ; 130(2): 143-6, 1995 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-7848082

RESUMO

OBJECTIVES: To elucidate the incidence of Meckel's diverticulum; to determine the correlation between the histologic type of the diverticulum's mucosa and its clinical presentation; and to review our experience with Meckel's diverticulum. DESIGN: Case-control study. SETTING: University hospital in Ioannina, Greece. PATIENTS: A total of 2074 patients undergoing an appendectomy were examined intraoperatively for Meckel's diverticulum (subgroup A1). In addition, Meckel's diverticulum was found incidentally in 15 patients who were undergoing intra-abdominal surgery (subgroup A2). An operation for a complicated Meckel diverticulum was performed in an additional 15 patients (group B). RESULTS: Thirty-three (1.59%) Meckel diverticulae were found incidentally among 2074 patients in subgroup A1. A positive correlation between Meckel's diverticulum and male sex was found (P < .004), but no difference was found in sex distribution between patients in group B and subgroup A1 (P < .6744). The histologic type of the mucosa (gastric) had significant positive correlation with the clinical presentation of the diverticulum (complicated) (P < .001). CONCLUSION: Resection of the unexpected Meckel diverticulum can be performed safely with a low complication rate, regardless of the patient's age.


Assuntos
Divertículo Ileal/epidemiologia , Abdome/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Apendicectomia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Mucosa Gástrica/patologia , Grécia/epidemiologia , Humanos , Incidência , Lactente , Enteropatias/etiologia , Mucosa Intestinal/patologia , Masculino , Divertículo Ileal/complicações , Divertículo Ileal/patologia , Divertículo Ileal/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais
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