RESUMO
OBJECTIVES: To compare aortoenteric fistula (AEF) outcome after endovascular (EV-AEFR) or open repair (O-AEFR). DESIGN: Multicentre retrospective comparative study. MATERIALS/METHODS: 25 patients with AEF (24 secondary, 23 males, median age 75 years) after aortic surgery (median four years). Preoperative sepsis was evident in 19 cases. Eight patients were managed with EV-AEFR and 17 with O-AEFR. RESULTS: The two groups were comparable in preoperative characteristics. In-hospital mortality after EV-AEFR was lower compared to O-AEFR (0% and 35%, respectively, p = 0.13). Similarly, morbidity after EV-AEFR was lower compared to O-AEFR (25% and 77%, respectively, p = 0.028). There was a trend for worse recurrence-free, sepsis-free, re-operation-free and AEF-related death-free rates after EV-AEFR, while the early survival advantage of EV-AEFR was lost after two years and the overall long-term survival rates (perioperative mortality included) of the two groups were similar. Preoperative sepsis had no effect on recurrence and sepsis-free rates (p = 0.94 and p = 0.92, respectively), but it was associated with worse two year overall survival (24% vs 50%, p = 0.32). On multivariate analysis, the number of symptoms (two vs one) at presentation was the single predictor of worse re-operation rates, AEF-related and overall survival. CONCLUSIONS: EV-AEFR was associated with no postoperative mortality in this study and can achieve satisfactory short and long-term results, comparable to O-AEFR. Further trials should focus on the role of EV-AEFR in patients at high risk for O-AEFR, due to shock or co-morbidities, or as a bridging procedure.
Assuntos
Aorta Abdominal , Doenças da Aorta/cirurgia , Fístula Intestinal/cirurgia , Stents , Fístula Vascular/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/diagnóstico , Feminino , Seguimentos , Humanos , Fístula Intestinal/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fístula Vascular/diagnósticoRESUMO
The management of superficial femoral artery occlusive disease remains challenging for vascular surgeons. Despite the advances and dramatic changes we have seen in modern practice with the development and introduction of new endovascular techniques, long-term results with these interventions remain disappointing when compared to the "gold standard" of a vein bypass with a good run-off. Furthermore, there is little Level 1 evidence to guide us with regards to the best treatment strategy. In this article, we review some of the currently available open surgical and endovascular options for the management of superficial femoral artery disease.
Assuntos
Arteriopatias Oclusivas/terapia , Artéria Femoral , Angioplastia com Balão , Angioplastia com Balão a Laser , Aterectomia , Humanos , Angiografia por Ressonância Magnética , Artéria Poplítea , Guias de Prática Clínica como Assunto , Stents , Grau de Desobstrução VascularRESUMO
BACKGROUND: Rupture of an anastomotic pseudoaneurysm after lower extremity prosthetic bypass is a rare problem, and the traditional mode of treatment has been open surgery. CASE DESCRIPTION: We report the endovascular management of a disrupted distal anastomosis of an above-knee femoro-popliteal Dacron bypass graft. Under local anesthesia and via a femoral cut-down, the Dacron graft was punctured and a 9 x 60 mm stent-graft was implanted resulting in successful pseudoaneurysm exclusion. The patient had an uneventful recovery. CONCLUSIONS: Stent-grafting may offer quick and easy rescue options for such challenging peripheral vascular lesions. Hippokratia 2015; 19 (2):179-181.