RESUMO
OBJECTIVE: To demonstrate endovascular management of common iliac artery aneurysms with iliac branch devices and to discuss some technical aspects of these interventions including bilateral procedures. MATERIAL AND METHODS: Endovascular abdominal aortic aneurysm repair with concomitant implantation of iliac branch devices was performed in 9 patients at the Petrovsky National Research Center of Surgery for the period from January 2019 to December 2020. Mean age of patients was 64.8± years (min 52; max 72 years). Preoperative planning and morphometric analysis were based on CT data with a slice thickness of 1 mm. Angiographic reconstruction was made using Osirix 3D software (OsiriX Foundation, Geneva, Switzerland). Abdominal aortic aneurysm was combined with common iliac artery aneurysm in 7 patients (77.7%). Three (33.3%) patients had isolated common iliac artery aneurysm without significant abdominal aorta enlargement (Reber type I). Bilateral common iliac artery aneurysms were detected in 1 (11.1%) patient. All patients had iliac artery aneurysms over 4 cm. Iliac branch device implantation was accompanied by endovascular abdominal aneurysm repair in all patients. RESULTS: Technical success rate was 100%. Six-month results were followed-up in 5 patients (55.5%), annual outcomes - in 2 patients (22.2%). Control examination consisted of a telephone interview, ultrasound of abdominal aorta, pelvic and lower limb arteries and computed tomography. All patients had no endoleaks, stent-graft thrombosis, as well as signs of ischemia of pelvic organs and lower extremities. Incidence of iliac artery aneurysm combined with abdominal aortic aneurysms is about 20%. Until recently, treatment of these patients was performed exclusively with covering of internal iliac artery. Improvement of technologies and development of iliac branch devices made it possible to preserve blood flow in internal iliac artery after endovascular management. This approach allowed avoiding of ischemic complications associated with embolization of internal iliac arteries.
Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco , Aorta Abdominal , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Pessoa de Meia-Idade , Stents , Resultado do TratamentoRESUMO
AIM: To present current treatment modes for DeBakey type I aortic dissection, to compare their early and mid-term postoperative results, to evaluate predictors of negative aortic remodeling after surgery. MATERIAL AND METHODS: Retrospective cohort analysis included 78 patients with DeBakey type I aortic dissection who underwent surgical treatment in 2009-2017. Patients were divided into 3 groups depending on type of intervention: group I (n=22) - Elephant Trunk procedure, group II (n=29) - hybrid interventions, group III (n=27) - proximal aortic replacement alone. Early postoperative results and aortic remodeling in mid-term postoperative period were compared. RESULTS: There were no significant differences in postoperative morbidity, in-hospital mortality and freedom from aortic death. However, 7 patients were lost for follow-up in group III. Analysis of false lumen patency showed results in favor of more aggressive approach (groups I and II) with significantly higher rate of false lumen thrombosis in segments 1 and 2 (p<0,001 and p=0,004 respectively). Freedom from negative aortic remodeling was also significantly higher in groups I and II. Risk factors of patent false lumen were residual fenestration, large volume of false lumen in segment 2, dissection of supra-aortic vessels and connective tissue disorders. Risk factors of negative aortic remodeling were connective tissue disorders, patent false lumen and dissection of supra-aortic vessels. CONCLUSION: Advanced surgical approach (Elephant Trunk procedure or hybrid interventions) should be preferred for DeBakey type I aortic dissection.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Remodelação Vascular , Dissecção Aórtica/fisiopatologia , Aneurisma da Aorta Torácica/fisiopatologia , Implante de Prótese Vascular , Progressão da Doença , Procedimentos Endovasculares , Humanos , Cuidados Pós-Operatórios , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
Abdominal aortic aneurysm is a common vascular disease requiring surgical treatment. Currently, endovascular aortic repair is a good alternative to open surgery. However, high incidence of unfavorable anatomical variants of the proximal landing zone limit the use of endovascular aortic repair in these patients. Additional techniques can increase applicability of endovascular procedure with optimal results. Two patients with unfavorable proximal neck anatomy undergoing endovascular aortic repair with anchor type of proximal fixation devices are reported in the article.
Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Prótese Vascular , Humanos , Desenho de Prótese , Estudos Retrospectivos , Stents , Resultado do TratamentoRESUMO
Presented herein is a clinical case report regarding the use of hybrid technology in surgical treatment of a patient with an aneurysm of the distal portion of the aortic arch and coronary artery disease. The patient underwent a hybrid operation, i.e. debranching of the aortic arch branches, exoprosthetic repair of the ascending aorta, autovenous prosthetic coronary bypass grafting of the branch of the blunt edge of the anterior interventricular artery, stenting of the ascending portion, arch and descending portion of the aorta (stent graft "Medtronic Valiant"). In doing so, we used a non-standard approach to connecting the artificial circulation unit and to choosing the place for establishing proximal anastomoses of autovenous coronary bypass grafts. The early postoperative period was complicated by the development of respiratory insufficiency requiring continuation artificial pulmonary ventilation. The duration of the hospital stay of the patient amounted to 15 days. The check-up multispiral computed tomography showed normal functioning of the reconstruction zones, the stent graft is expanded, with no leak observed. The conclusion was made that hybrid interventions may be considered as an alternative to the classical surgical treatment associated in patients of older age group with a severe course of the postoperative period and high lethality.
Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Ponte de Artéria Coronária , Doença da Artéria Coronariana , Complicações Pós-Operatórias/terapia , Insuficiência Respiratória , Idoso , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/etiologia , Dissecção Aórtica/fisiopatologia , Dissecção Aórtica/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/cirurgia , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Respiração Artificial/métodos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Stents , Tomografia Computadorizada Espiral/métodos , Resultado do TratamentoRESUMO
Analysed herein are immediate and remote results of endoprosthetic repair of the abdominal aorta in patients with unfavourable anatomy of its proximal neck. Group I (Study Group) was composed of 31 patients with unfavourable anatomy of the proximal neck, the control group (Group II) comprised a total of 52 patients with no unfavourable anatomical factors. The criteria of assessment were as follows: technical success, adequate position of the endograft, frequency of the development of various endoleaks, duration of the operation and hospital stay, lethality in the remote period, and necessity of secondary interventions. Technical success of endoprosthetic repair was achieved in 100% of patients in the both groups. An adequate position by the proximal end of the coated portion of the endograft was observed in 27 (87.1%) patients of Group I and in 51 (98.1%) patients of the control group (p=0.08). Secondary postdilatation of the endograft's body in the proximal neck was statistically more often performed in the study group of patients. The duration of the operation and hospital stay in the compared groups had no statistically significant differences. In the remote period, patients with unfavourable morphology of the proximal neck were found to develop type I-A endoleaks into the cavity of the aneurysm. By other evaluated criteria such as the total survival rate, secondary interventions, graft migration, type I-B, II and V endoleaks no statistically significant differences were revealed. It was concluded that endoprosthetic repair of the abdominal aorta in patients with unfavourable anatomy of the proximal neck of the aneurysm is associated with admissible immediate, short- and long-term outcomes. Longer follow up is required in order to more adequately asses the reliability of the obtained findings.
Assuntos
Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Procedimentos Endovasculares/métodos , Idoso , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Desenho de Prótese , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We included into this study 112 patients with ischemic heart disease (IHD) and concomitant type 2 diabetes mellitus (DM) subjected to percutaneous coronary interventions with stenting. Everolimus and sirolimus eluting stents (EES and SES) were implanted in 54 (group 1) and 58 (group 2) patients, respectively. After 12 months in groups 1 and 2 rates of repeat target lesion revascularizations (TLR) were 5.5 and 8.6% (odds ratio - OR - 0.62, 95% confidence interval - CI - 0.14- 2.74, p = 0.72); acute myocardial infarctions (MI) - 3.7 and 5.2% (OR 0.71, 95% CI 0.11- 4.4, p = 0.94); deaths - 1.85 and 1.7% (OR 1.1, 95% CI 0.1- 17.6, p = 1.0), respectively. There was no significant difference between groups by rate of unfavorable cardiac events (composite of cardiac death, nonfatal MI, and clinically indicated TLR) - 11.1 and 15.5% in groups 1 and 2, respectively (OR 0.68, 95% CI 0.225- 2.059, p = 0.69). Rates of stent thrombosis also did not differ (1.85 and 3.4% in groups 1 and 2, respectively; OR 0.53, 95% CI 0.05- 6.0; p = 0.94). Thus the use of EES and SES in patients with IHD and type-2 DM was equally effective.
Assuntos
Reestenose Coronária , Diabetes Mellitus Tipo 2/complicações , Stents Farmacológicos , Isquemia Miocárdica , Intervenção Coronária Percutânea , Complicações Pós-Operatórias , Sirolimo/análogos & derivados , Sirolimo/uso terapêutico , Idoso , Reestenose Coronária/diagnóstico , Reestenose Coronária/etiologia , Reestenose Coronária/mortalidade , Everolimo , Feminino , Seguimentos , Testes de Função Cardíaca/métodos , Humanos , Imunossupressores/uso terapêutico , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Moscou/epidemiologia , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
We have analyzed clinical management of 137 patients with atherosclerotic aneurysms of the abdominal aorta combined with coronary artery disease treated during last 10 years in the First Cardiac Surgery Department (Surgery of the Aorta and its Branches) of the Petrovsky National Research Center of Surgery. All patients were subjected to surgery involving both vascular regions: in 130 patients (94.9%) the procedures were staged while 7 patients underwent myocardial revascularization simultaneously with the reconstruction of the abdominal aorta from the minimal access. According to our results staged procedures are safer for patients with atherosclerotic aneurysms of the abdominal aorta combined with coronary artery disease given the organism's limited capacity due to age and comorbidities. Endovascular repair techniques applied both to the coronary arteries and to the abdominal aorta should be always regarded primarily as a gentle form of intervention. In cases where open surgery is required one should try to avoid blood loss, reduce the duration of the procedure and use minimal access surgery when applicable. The overall mortality rate in patients treated for this disorder over the last 10 years was 2.1%.
Assuntos
Aneurisma da Aorta Abdominal , Aterosclerose , Procedimentos Cirúrgicos Cardiovasculares , Doença da Artéria Coronariana , Complicações Pós-Operatórias , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/etiologia , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/cirurgia , Aterosclerose/complicações , Aterosclerose/fisiopatologia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Procedimentos Cirúrgicos Cardiovasculares/métodos , Procedimentos Cirúrgicos Cardiovasculares/estatística & dados numéricos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/cirurgia , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Federação Russa/epidemiologia , Índice de Gravidade de Doença , Análise de Sobrevida , Resultado do TratamentoRESUMO
Presented herein is a clinical case report concerning successive use of hybrid technology in secondary surgical treatment of a patient with a progressing aortic arch aneurysm and aortic insufficiency, type A chronic aortic dissection after the primary operation of plasty of the aortic valve with prosthetic repair of the ascending aortic portion for type A acute dissection. The patient underwent hybrid operation: prosthetic repair of the aortic valve with mechanical prosthesis "Carbomedics", prosthetic repair of brachiocephalic branches by means of synthetic prostheses "Vascutek" with their switching to the prosthesis of the ascending aorta, stenting of the arch and descending portion of the aorta. The duration of the postoperative hospital stay amounted to 15 days. The control multispiral computed tomography with intravenous contrasting showed that the reconstruction zone was with no deformities, with the stent graft expanded, and no leaks noted. The conclusion was made that further improvement of hybrid technique can make it a true alternative to classical surgical operations in this severely ill cohort of patients. The presented clinical example demonstrates that simultaneous hybrid surgical intervention is the most correct approach in the given situation decreasing lowering the risk of the development of complications in both immediate and remote postoperative period.
Assuntos
Aneurisma da Aorta Torácica/complicações , Dissecção Aórtica , Implante de Prótese Vascular , Anuloplastia da Valva Cardíaca , Complicações Pós-Operatórias , Reoperação/métodos , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/etiologia , Dissecção Aórtica/fisiopatologia , Dissecção Aórtica/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Anuloplastia da Valva Cardíaca/efeitos adversos , Anuloplastia da Valva Cardíaca/métodos , Doença Crônica , Progressão da Doença , Ecocardiografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Tomografia Computadorizada Espiral/métodos , Resultado do TratamentoRESUMO
MATERIAL AND METHODS: We followed 619 patients with ischemic heart disease (IHD) and multivessel involvement of coronary arteries: 317 patients subjected to coronary artery bypass grafting (CABG, group 1) and 302 patients subjected to multivessel percutaneous coronary intervention (PCI, group 2) with implantation of drug eluting stents. Both groups had comparable clinical characteristics. During hospitalization we registered deaths and unfavorable cardiological and cerebrovascular events. In remote period after revascularization we assessed survival, angina recurrences and related repeat revascularizations, and rate of severe cardiovascular complications (composite of deaths, acute myocardial infarctions [AMI], stroke, and repeat myocardial revascularizations). RESULTS: During hospitalization there were no significant differences between groups by parameters studied: death rate was 1.7 and 0.9%, that of AMI 2.6 and 1.9%, of stroke 0.9% and 0, of composite of death, AMI, and stroke 5.1 and 1.9% (p = 0.37) in groups 1 and 2, respectively. Survival in remote period was 90.2 (group 1) and 92.7% (group 2). Comparison of Kaplan-Meier survival curves also revealed no significant differences between groups. Angina recurrence/repeat revascularization took place in 54 (17.0%) and in 64 (21.2%) patients in groups 1 and 2, respectively (p = 0.128). Repeat revascularization was carried out in 32 of 54 patients (59.3%) in group 1 and in 58 Of 64 patients (90.6%) in group 2. Rate of severe unfavorable events during whole period of follow up was 33.1% in group 1 and 30.5% in group 2 (p > 0.05). CONCLUSION: In IHD patients with multivessel coronary artery involvement and low Syntax Score immediate and long term (5 year) results of stenting with drug eluting stents are not inferior to results of CABG.
Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Federação Russa/epidemiologia , Índice de Gravidade de Doença , Taxa de Sobrevida/tendências , Resultado do TratamentoRESUMO
UNLABELLED: Aim of the study was to elucidate nosological nature of "idiopathic" arrhythmias by means of right ventricular endomyocardial biopsy (EMB) and to assess effect of etiotropic and pathogenetic treatment. MATERIAL AND METHODS: We included into this study 19 patients (mean age 42.6 +/-11.3 years, 9 women) with atrial fibrillation (AF, n = 16), supraventricular (n = 10) and ventricular (n = 4) extrasystoles (SVE and VE), supraventricular (n = 2) and ventricular (n = 1) tachycardia (SVT and VT), left bundle branch block (LBBB, n = 2), atrioventricular block (n = 2) without structural changes of the heart. In addition to standard examination we performed the following tests: determination of IgG to herpes and Coxsackie B virus, polymerase chain reaction (PCR) for DNA detection of human herpesviruses 1, 2, and 6, Epstein-Barr virus, Varicellae-zoster virus (human herpesvirus 3) and cytomegalovirus in blood; determination of anticardiac antibodies; EMB with subsequent PCR-diagnostics including that of parvovirus B19 and pathomorphological study. DNA diagnostics (n = 4), coronary angiography (n = 6), skin biopsy (n = 1) and some other studies were also performed when indicated. RESULTS AND CONCLUSIONS: Histological picture was abnormal in all cases. Nosological diagnosis was established in all patients: infectious-immune myocarditis (n = 11), parvovirus positive endomyocarditis (n = 1); systemic vasculitis (n = 2); myocardial vasculitis (n = 1), Fabri disease (n = 1), arrhythmogenic right ventricular dysplasia (ARVD, n = 1), undetermined genetic cardiomyopathy (n = 2). Level of various anticardiac antibodies including antinuclear factor with bovine heart antigen was most valuable for diagnosis of myocarditis (sensitivity 78.6%, prognostic value of positive result 91.7%). The following therapy was used in patients with myocarditis/vasculitis: intravenous or oral acyclovir (n = 10), gabreglobine (n = 2), meloxicam (n = 12), hydroxychloroquine (n = 15 for 15 [7.0; 24.] months), glucocorticosteroids (n = 14 for 18 [4.0; 25.5] months), azathioprine (n = 2). Mean duration of follow up was 4 years (48 [31; 62] months). At baseline 62.5% of patients with AF were resistant to all antiarrhythmic drugs. Treatment of myocarditis resulted in significant reduction of mean frequency of attacks of AF from 8 to 3 points, more than in 40% of patients AF emerged less than once a month and 1 patient had no attacks at all. Disappearance of tachycardia dependent LBBB was also noted. Cardioverter defibrillator and cardiac pacemaker were implanted to patients with ARVD and Fabri disease, respectively. EMB helped to establish immunoinflammatory and genetic diseases as causes of idiopathic arrhythmias (in 78.9 and 21.1% of patients, respectively). Antiviral immunosuppressive therapy of myocarditis allowed to increase efficacy of antiarrhythmic therapy in resistant patients and when necessary to optimize their preparedness to interventional treatment.
Assuntos
Arritmias Cardíacas/patologia , Biópsia/métodos , Ventrículos do Coração/patologia , Miocardite/patologia , Miocárdio/patologia , Adulto , Arritmias Cardíacas/etiologia , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/complicações , Adulto JovemRESUMO
AIM: To evaluate the efficiency and safety of outpatient physical exercises (PE), calculated using ergospirometry (ESM) in patients in the early periods after elective percutaneous coronary interventions (PCI) during incomplete coronary bed revascularization. SUBJECTS AND METHODS: Three hundred and eighty-three patients were screened. The trial enrolled the patients after elective PCI in its early periods (3 to 14 days) who had signed an informed consent document to participate in the investigation and who could perform themselves PE at home or visit the medical center. Patients with angioplasty complications (myocardial infarction, severe hematomas, major bleeding, etc.) who had standard contraindications to exercise testing and PE were excluded. The patients included in the trial (n = 50) were divided into 2 groups: (1) 21 patients who had undergone incomplete revascularization; (2) 29 patients who had complete revascularization. The authors estimated exercise endurance by ergospirometry before the investigation, 8 weeks after a course of exercises, and following 6 months and assessed quality of life (QL) using the SF-36 questionnaire. A physical rehabilitation program was elaborated for all the patients according to exercise test results. During the trial, all the patients were allocated to groups of home and clinic exercises using exercise bikes. Medical control of the patients who were exercising at home was made by their telephone conversation, control visits to the medical center at least once monthly, and their concurrently keeping an exercise diary in which each training (duration, intensity), health status, and blood pressure were recorded. The patients could consult their physician at any time if required. RESULTS: In the incomplete and complete revascularization groups, VO2 max increased by 6 and 15%, respectively. Following 6 months, no additional increment in VO2 max was seen in the study groups. According to SF-36 data, QL improved in patients in both groups after 8 weeks and remained at the same level after 6 months. CONCLUSION: An early time course of exercises only in combination with regular medical control has a positive impact on exercise tolerance and QL and preserves its efficiency for at least 6 months regardless of the degree of revascularization.
Assuntos
Terapia por Exercício/normas , Intervenção Coronária Percutânea/reabilitação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Eletivos/reabilitação , Ergometria , Terapia por Exercício/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Período Pós-Operatório , Qualidade de Vida , Espirometria , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
27 patients with thoracic aortic aneurism with dissection type III were operated on and stented. The mean age was 56±11,17 years. Men were 24, women 3. 1 patient developed intraoperative stent-graft leakage type IV, and 1 - type II. Both cases needed no additional manipulations. Minimal invasiveness of the procedure and pain absence allowed early activisation of patients. 2 patients had postoperative paraplegia, which was successfully treated by spinal drainage. There were no lethal cases. The long-term follow-up showed no leakage on CT scans; 11 patients demonstrated complete closure of false canal of the stented segment. The overall survival rate was 92.6% after 60 months of follow-up. Unfavorable results were registered in 29.6%.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Stents , Dissecção Aórtica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A case is reported of a 23-year-old male patient who developed, after severe blunt injury of the lumbar region, massive thrombosis of the vena cava inferior (VCI), both renal veins, bilateral pulmonary artery thromboembolism (PATE), nephrotic syndrome (NS). In spite of anticoagulant therapy, the condition of the patient progressively aggravated for 1.5 year: thrombosis involved the ileac and femoral arteries on the right, thrombus floated in the right atrium with PATE recurrent episodes, pulmonary hypertension reached 120 mm Hg with formation of decompensated cor pulmnonale, proteinuria and hypoalbuminemia deteriorated, anasarca edema developed Multigenic thrombophilia was diagnosed (1 homozygous and 5 heterozygous mutations). A radical one-stage operation was successful: thromboectomy from the VCI, right ileac and left renal veins, thrombendarterectomy from the pulmonary arteries, suture of the interatrial septum defect, installation of cava-filter After the operation pulmonary pressure lowered to 40-45 mm Hg, right heart volume normalized, immunosuppressive therapy with prednisolone and cyclosporine led to nephropathy remission. The discussion covers mechanisms and factors (including genetic) of thrombosis progression, correlations between intravascular thrombosis, NS and chronic glomerulonephritis (possible NS development due to bilateral thrombosis of the renal veins and nephropathy role in thrombosis progression), approaches to conservative and surgical treatment of such patients. Global experience in conduction of pulmonary thrombendarterectomy and thrombectomy from VCI is reviewed (one-stage operations were not described earlier).
Assuntos
Região Lombossacral/lesões , Implantação de Prótese , Embolia Pulmonar , Trombectomia/métodos , Trombofilia , Trombose , Ferimentos não Penetrantes/complicações , Anticoagulantes/administração & dosagem , Progressão da Doença , Artéria Femoral/fisiopatologia , Humanos , Imunossupressores/administração & dosagem , Masculino , Síndrome Nefrótica/etiologia , Síndrome Nefrótica/fisiopatologia , Polimorfismo Genético , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Artéria Pulmonar/fisiopatologia , Embolia Pulmonar/etiologia , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Doença Cardiopulmonar/etiologia , Doença Cardiopulmonar/fisiopatologia , Indução de Remissão , Veias Renais/fisiopatologia , Trombofilia/genética , Trombofilia/fisiopatologia , Trombofilia/terapia , Trombose/etiologia , Trombose/fisiopatologia , Trombose/terapia , Filtros de Veia Cava , Veia Cava Inferior/fisiopatologia , Veia Cava Inferior/cirurgia , Adulto JovemRESUMO
Treatment results of 44 cases of myocardial infarction with ST segment elevation were analyzed. Patients were divided in 2 groups. The first group (n=21) received the transcutaneous coronary intervention with the use of catheters for rheolythic thrombectomy. The second group (n=23) received the intervention with catheters for the manual thrombectomy. Patients from the 1st group demonstrated reliably better results considering adequate reperfusion, registered angio- and electrocardiographically. There were no cases of arterial dissection or vessel perforation in both groups. There were two lethal hospital outcomes among patients of the manual thrombectomy group.
Assuntos
Angioplastia Coronária com Balão , Cateteres Cardíacos , Complicações Intraoperatórias/prevenção & controle , Infarto do Miocárdio/terapia , Trombectomia , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Cateteres Cardíacos/efeitos adversos , Cateteres Cardíacos/normas , Angiografia Coronária , Circulação Coronária , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/fisiopatologia , Análise de Sobrevida , Trombectomia/efeitos adversos , Trombectomia/instrumentação , Trombectomia/métodos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
Analysed in the article are the outcomes of treating a total of 156 patients diagnosed with carotid artery stenosis. Of these, carotid endarterectomy was performed in 82 patients and stenting of carotid arteries was carried out in the remaining 74 patients. The incidence rate of perioperative stroke in the carotid endarterectomy group amounted to 3.6%, being in the stenting group 4.8%, P = 0.57. Multifactorial analysis was used to reveal risk factors for each method. Thus, in the carotid endarterectomy group, the risk factors for cerebrovascular complications appeared to be contralateral occlusion in patients with a history of stroke endured within less than six previous months (P<0.05), as well as the age over 75 years amongst the patients requiring placement of a temporary intraluminal bypass graft (P<0.05). For carotid stenting, risk factors of cerebrovascular complications included a hypoechogenic heterogeneous type of an atherosclerotic plaque (P<0.05) and ulceration of its surface (P<0.05). The presence of the patient's baseline functional class III angina of effort appeared to be a risk factor for the development of cardiovascular complications for carotid endarterectomy (P<0.05). No cardiovascular risk factors for carotid stenting were revealed. Based on the assessment of the risk factors thus detected, the authors worked out an algorithm of choosing an optimal treatment policy for patients presenting with carotid artery stenosis.
Assuntos
Estenose das Carótidas , Endarterectomia das Carótidas , Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Stents/efeitos adversos , Acidente Vascular Cerebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Angina Pectoris/complicações , Angina Pectoris/fisiopatologia , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Artérias Carótidas/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/fisiopatologia , Estenose das Carótidas/cirurgia , Protocolos Clínicos , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Placa Aterosclerótica/complicações , Placa Aterosclerótica/fisiopatologia , Radiografia , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Resultado do TratamentoRESUMO
AIM: To study possibility of nosological diagnosis in patients with dilated cardiomyopathy (DCMP) with use of myocardial biopsy. MATERIAL AND METHODS: The trial enrolled 62 patients (23 females) with DCMP syndrome (end diastolic left ventricular size > 5.5 cm, ejection fraction < 55%). Mean age of the patients was 46.0 +/- 12.8 years. The examination included diagnosis of viral infections (Herpes virus, parvovirus B19), measurement of anticardial antibodies titer, 99Tc-MIBI single photon emission computed tomography of the myocardium, multislice computed tomography, MRT of the heart, coronarography, morphological study of the myocardium (n=20) with application of polymerase chain reaction (PCR) for H.simplex viruses of types 1, 2 and 6, herpes zoster, Epstein-Barr, cytomegalovirus, parvovirus B-19, adenoviruses. The control group (20 operated patients with valvular heart disease and coronary heart disease) was examined for viral genome in the blood and myocardium. RESULTS: Complex examination of DCMP patients showed the following distribution by nosological entuities: myocarditis (n=41, 66.1%) including virus-positive (n=14), primary DCMP (n=16, 25.9%) including with non-compact myocarditis (NCM) in 3, with debute at delivery of the child--in 3. Arrhythmogenic right ventricular dysplasia combined with viral myocarditis (n=2), genetic myopathy (n=1) and Takayasu disease (n=1) combined with NCM, isolated NCM (n=1) were diagnosed in the rest cases. Morphological investigation of the myocardium was made in 20 patients: diagnosis of myocarditis and primary DCMP were made in 70% (including in 2 patients with CHD) and 20%. Detection of viral genome was 20 and 15% in the study and control group, respectively, in the myocardium--in 57.9 (test for parvovirus B19 was not made in 26%) and 65.0% (complete diagnosis). All the virus-positive patients with DCMP were diagnosed to have signs of active/borderline myocarditis. Diagnostic criteria and poor prognosis factors were defined. CONCLUSION: The nosological diagnosis of DCMP was made in all the examinees basing on the complex of clinical, case history and device evidence. The diagnosis was morphologically verified in 33.9% patients. Treatment approaches are developed.
Assuntos
Cardiomiopatia Dilatada/diagnóstico , Miocardite/diagnóstico , Miocárdio/patologia , Viroses/diagnóstico , Adulto , Idoso , Biópsia , Cardiomiopatia Dilatada/tratamento farmacológico , Cardiomiopatia Dilatada/patologia , Cardiomiopatia Dilatada/virologia , Ecocardiografia , Feminino , Coração/virologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Miocardite/tratamento farmacológico , Miocardite/patologia , Miocardite/virologia , Síndrome , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada Espiral , Viroses/tratamento farmacológico , Viroses/patologia , Viroses/virologia , Adulto JovemAssuntos
Aorta Torácica , Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular/métodos , Algoritmos , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Tomada de Decisão Clínica/métodos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Seleção de Pacientes , Prognóstico , Tomografia Computadorizada Espiral/métodosRESUMO
The right-sided aorta is a rare congenital abnormality of the cardiovascular system encountered in 0.05-0.1% of cases during roentgenological examinations and in 0.04-0.1% of cases of autopsy series. Given utterly low prevalence of this pathology, we considered it wise to present herein our own case report dealing with hybrid surgical management of a patient suffering from an aneurysm of both the arch and descending portion of the right-sided aorta combined with type B dissection thereof and decompensated tracheal stenosis. The first stage of the operation consisted in prosthetic repair of the distal third of the arch and the descending portion of the aorta with the "Vascutek" stent graft 20 mm with type 1 haemodynamical correction (i. e., re-establishing the blood flow into the true channel in the zone of the distal anastomosis) in the conditions of extracorporeal circulation (EC) and bihemispheric antegrade cerebral perfusion ACP, followed by replantation of the left subclavian artery ostium into the left common carotid artery. An aneurysmal growth rate of more than 1 cm a year was considered an absolute indication for the second stage of correction of the aortic pathology concerned. The second stage included stenting of the thoracic portion of the aorta. The TF262C150X Valiant thoracic stent graft was implanted into the area of the distal anastomosis with a conduit, followed by positioning the TF 323C150X Valiant thoracic system inserted into the distal end of the first stent. The use of hybrid techniques (a combination of open and endovascular interventions) predetermined the success of surgical management of the patient presenting with dissection of the right-sided aorta.
Assuntos
Anastomose Cirúrgica/métodos , Aorta Torácica , Aneurisma da Aorta Torácica , Anormalidades Cardiovasculares , Stents/normas , Enxerto Vascular , Adulto , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/fisiopatologia , Dissecção Aórtica/cirurgia , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular/normas , Anormalidades Cardiovasculares/patologia , Anormalidades Cardiovasculares/fisiopatologia , Dissecação/métodos , Circulação Extracorpórea , Hemodinâmica , Humanos , Masculino , Radiografia , Artéria Subclávia/cirurgia , Estenose Traqueal/etiologia , Estenose Traqueal/fisiopatologia , Estenose Traqueal/cirurgia , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Enxerto Vascular/instrumentação , Enxerto Vascular/métodosRESUMO
The work was aimed at comparatively studying the outcomes of carotid endarterectomy and carotid stenting for optimal therapeutic decision-making in patients presenting with carotid artery stenoses. We examined and treated a total of one hundred and sixty-seven patients. In the group of endarterectomy, we performed a total of 91 operations in 85 patients, and in the group of carotid stenting, a total of 87 stenting procedures were carried out on the internal carotid artery with cerebral protection in 82 patients. This was followed by analysing both short- and long-term outcomes with a follow-up period ranging from 1 year to 3 years. We examined the following postoperative parameters: «stroke + lethality¼, incidence of transitory ischaemic attacks, as well as the rate of craniocerebral neuropathy and acute myocardial infarction. In the remote period we evaluated the prevalence rate of the parameter «stroke + myocardial infarction + lethality¼, as well as restenosis recurrence. In the carotid-endarterectomy group, the predictors of unfavourable surgical outcomes were contralateral occlusion (p=0.048) and cardial pathology (p=0.0245). In the group of carotid stenting, these predictors turned out to be a heterogeneous atherosclerotic plaque with an uneven or ulcerated contour (p=0.004), and the degree of cerebrovascular insufficiency (p=0.005).
Assuntos
Angioplastia com Balão , Isquemia Encefálica/prevenção & controle , Artérias Carótidas/cirurgia , Endarterectomia das Carótidas , Stents , Acidente Vascular Cerebral/prevenção & controle , Idoso , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/normas , Encéfalo/irrigação sanguínea , Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/complicações , Estenose das Carótidas/patologia , Estenose das Carótidas/fisiopatologia , Estenose das Carótidas/terapia , Circulação Cerebrovascular , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/normas , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/patologia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Risco Ajustado , Fatores de Risco , Prevenção Secundária , Stents/efeitos adversos , Stents/normas , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , UltrassonografiaRESUMO
The paper deals with the topical issues of diagnosis of aortic aneurysms and with the current possibilities of treating this pathology. It presents epidemiological data, assessment of the risk of aortic rupture, a patient management regimen according to screening results, and information on the new miniinvasive aortic aneurysm treatment--endovascular replacement using self-expandable stent-grafts.