RESUMO
BACKGROUND: Frailty predicts adverse perioperative outcomes and increased mortality in patients having vascular surgery. Frailty assessment is a potential tool to inform resource allocation, and shared decision-making about vascular surgery in the resource constrained COVID-19 pandemic environment. This cohort study describes the prevalence of frailty in patients having vascular surgery and the association between frailty, mortality and perioperative outcomes. METHODS: The COVID-19 Vascular Service in Australia (COVER-AU) prospective cohort study evaluates 30-day and six-month outcomes for consecutive patients having vascular surgery in 11 Australian vascular units, March-July 2020. The primary outcome was mortality, with secondary outcomes procedure-related outcomes and hospital utilization. Frailty was assessed using the nine-point visual Clinical Frailty Score, scores of 5 or more considered frail. RESULTS: Of the 917 patients enrolled, 203 were frail (22.1%). The 30 day and 6 month mortality was 2.0% (n = 20) and 5.9% (n = 35) respectively with no significant difference between frail and non-frail patients (OR 1.68, 95%CI 0.79-3.54). However, frail patients stayed longer in hospital, had more perioperative complications, and were more likely to be readmitted or have a reoperation when compared to non-frail patients. At 6 months, frail patients had twice the odds of major amputation compared to non-frail patients, after adjustment (OR 2.01; 95% CI 1.17-3.78), driven by a high rate of amputation during the period of reduced surgical activity. CONCLUSION: Our findings highlight that older, frail patients, experience potentially preventable adverse outcomes and there is a need for targeted interventions to optimize care, especially in times of healthcare stress.
Assuntos
COVID-19 , Fragilidade , Idoso , Amputação Cirúrgica , Austrália/epidemiologia , COVID-19/epidemiologia , Estudos de Coortes , Idoso Fragilizado , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Tempo de Internação , Pandemias , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fatores de Risco , Procedimentos Cirúrgicos Vasculares/efeitos adversosAssuntos
Adenoma Pleomorfo/patologia , Aneurisma/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Neoplasias Faríngeas/diagnóstico por imagem , Neoplasias Faríngeas/cirurgia , Neoplasias das Glândulas Salivares/patologia , Adenoma Pleomorfo/diagnóstico por imagem , Adenoma Pleomorfo/cirurgia , Idoso , Aneurisma/patologia , Aneurisma/cirurgia , Angiografia Digital/métodos , Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Diagnóstico Diferencial , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Feminino , Seguimentos , Humanos , Angiografia por Ressonância Magnética/métodos , Neoplasias Faríngeas/patologia , Medição de Risco , Neoplasias das Glândulas Salivares/diagnóstico por imagem , Neoplasias das Glândulas Salivares/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Endovascular repair of the thoracic aorta after traumatic rupture is an alternative to open repair and its use is becoming increasingly widespread. We aimed to determine the concurrent injuries sustained in patients who underwent thoracic endovascular aortic repair (TEVAR) as well as their Glasgow Coma Score (GCS) and Injury Severity Score (ISS). We also aimed to identify the intraoperative and early complications of TEVAR grafting up to 6 months after procedure and in addition identify the late postoperative complications occurring after 6 months after stent. METHODS: Data were collected retrospectively between January 1998 and January 2012. The Australasian Vascular Audit and hospital trauma registry were used to obtain data related to those patients who underwent TEVAR at our center. Their characteristics were analyzed including associated injuries, delays to diagnosis, ISS scores, and early and long-term complications of endovascular repair. RESULTS: Forty patients (mean age 41.3 ± 20.1) underwent stent graft repair of traumatic thoracic rupture at the aortic isthmus. Motor vehicle and motorbike accidents were responsible for 82.5% of presentations. Average ISS was 37 ± 13 (range 20-75) with an average GCS of 12.5 ± 3.8 at scene. Intraoperative death occurred in 2 cases (ISS score of 75), with 1 further death from severe head injures within 30 days. Average follow-up time was 5.48 ± 2.89 years (maximum 13 years). CONCLUSIONS: Endovascular intervention is a safe and effective treatment, with minimal longer term complications seen after 5-year follow-up.
Assuntos
Aorta Torácica/cirurgia , Ruptura Aórtica/terapia , Implante de Prótese Vascular , Procedimentos Endovasculares , Centros de Traumatologia , Lesões do Sistema Vascular/terapia , Acidentes de Trânsito , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/lesões , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/mortalidade , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Diagnóstico Tardio , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Escala de Coma de Glasgow , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Motocicletas , Valor Preditivo dos Testes , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/mortalidade , Vitória , Adulto JovemRESUMO
Pulmonary hypertension secondary to residual Potts shunt is not an uncommon phenomenon. A 59-year-old male with a history of tetralogy of Fallot was noted, on a full heart study, to have persistent pulmonary hypertension, normal left ventricular function, severe aortic regurgitation, and a residual Potts shunt. A previous surgical attempt at closure of the shunt during definitive repair was unsuccessful. An aortic endoluminal stent graft was deployed to definitively close the shunt. There was a subsequent normalization of pulmonary pressures following Potts shunt closure. The patient will now proceed with surgical aortic root repair and aortic valve replacement.
Assuntos
Aorta Torácica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Artéria Pulmonar/cirurgia , Stents , Anastomose Cirúrgica/efeitos adversos , Insuficiência da Valva Aórtica/etiologia , Implante de Prótese Vascular/instrumentação , Comunicação Interventricular/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Ventrículos do Coração/patologia , Ventrículos do Coração/cirurgia , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reoperação , Tetralogia de Fallot/cirurgiaRESUMO
BACKGROUND: Thoracic aortic transection resulting from blunt trauma is usually fatal. It is almost always associated with multiple, complex, nonaortic injuries that could be adversely affected by standard surgical repair of the aorta. Endovascular stenting techniques offer these patients a less physiologically disruptive treatment option. We studied the feasibility and safety of endovascular stent graft placement for treatment of acute traumatic aortic transection. METHODS: Between 1994 and 2001, 9 patients were treated emergently for aortic transections with stent graft placement. The first patient had a custom-made prototype, and the other 8 patients had the Cook-Zenith thoracic stent graft implanted. All were polyester-covered Z-stent construction and deployed through a femoral 20- to 24-F delivery sheath. RESULTS: Stent graft placement successfully sealed the aorta in all patients. One patient died as a result of a cerebrovascular accident. One patient required a brachial thrombectomy to relieve arm ischemia. The remaining eight patients were alive and without complications during the follow-up period (mean 21 months). CONCLUSIONS: Endovascular repair for acute aortic transection is a safe, effective, and timely treatment option. It may be the treatment of choice in patients with extensive associated injuries.