RESUMO
INTRODUCTION: Proximal humerus fractures (PHF) are common injuries that can lead to axillary artery injury, which carries the risk of not being identified during initial assessment. The aim of this study was to describe the management of suspected axillary artery injury associated with PHF according to our experience and to describe a new multidisciplinary surgical approach. METHODS: This was a single-center retrospective study. A database was created for patients admitted for PHF to the emergency department of the Hospital of Cannes between October 2017 and October 2019. Patients admitted with PHF associated with suspected ipsilateral upper limb ischemia, and/or massive diaphysis displacement, and/or upper limb ipsilateral neurological deficits were included in this study. RESULTS: In total, 301 patients diagnosed with PHF were admitted within these periods. Among these patients, 12 presented with suspected axillary artery lesions, of whom, 6 were included in the present study and treated according to our new approach. A description of these 6 cases, along with an extensive literature review is presented. CONCLUSION: Based on our experience, the endovascular approach proposed for the management of axillary artery injury associated with proximal humerus fractures is effective, feasible and reproducible.
Assuntos
Fraturas do Úmero , Fraturas do Ombro , Lesões do Sistema Vascular , Humanos , Artéria Axilar/diagnóstico por imagem , Artéria Axilar/cirurgia , Artéria Axilar/lesões , Estudos Retrospectivos , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/cirurgia , Fraturas do Úmero/complicações , Fraturas do Úmero/cirurgia , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Fraturas do Ombro/complicaçõesRESUMO
OBJECTIVE: The objective of this study was to evaluate the results of the off-label use of the Nellix endograft (Endologix, Irvine, Calif) for the treatment of short-neck aneurysms and juxtarenal aortic aneurysms (JAAs) compared with the outcomes of patients with infrarenal abdominal aortic aneurysms treated in accordance with the manufacturer's instructions for use. METHODS: Data available from patients treated with the Nellix endograft from September 2013 to January 2016 were reviewed to create a case-control analysis (1:2). Fourteen elective patients with a short-neck aneurysm or JAA (<10 mm) and mild aortic neck angulation (<35 degrees) were included. As a control group, 28 elective patients who had been treated in accordance with instructions for use were included. Patients were matched for age, sex, aortic diameter, and aortic neck angulation. The final cohort group included 42 patients: 14 in the JAA off-label group (5 with aortic neck length ≤4 mm and 9 with necks of 5 to 10 mm) and 28 in the control group. Technical and clinical success, freedom from any secondary intervention, any type of endoleak, and aneurysm-related death were evaluated. RESULTS: There were no significant differences between the two groups in terms of comorbidity, intraoperative time, radiation time, contrast agent volume, and perioperative mortality and morbidity. Two patients of the JAA group subsequently underwent open repair (14%), both with aortic neck length <4 mm (2/5; 40%), for type Ia endoleak. Two of the control group also subsequently underwent open repair (7%). At a mean follow-up of 22 ± 3.9 months, freedom from any reintervention was 85% for the JAA off-label group vs 92% for the control group (log-rank test, P = .33). CONCLUSIONS: The off-label use of the Nellix endograft for the treatment of JAA showed a higher rate of subsequent conversion to open repair for JAA patients (aortic neck length ≤4 mm), underlining the need for a proximal sealing zone. Longer term data are needed to verify the possible use of the Nellix endograft in selected short-neck aneurysms with aortic neck length >5 mm.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Stents , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Angiografia por Tomografia Computadorizada , Endoleak/etiologia , Endoleak/terapia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Itália , Masculino , Duração da Cirurgia , Rotulagem de Produtos , Desenho de Prótese , Retratamento , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: We compared the outcomes and the durability of endovascular recanalization (EVR) with the Viabahn (W. L. Gore and Associates, Flagstaff, Ariz) covered stent graft vs traditional aortobifemoral or aortofemoral bypass grafting for complex aortoiliac occlusions. METHODS: Between 2008 and 2014, 11 unilateral iliac occlusions and 11 aortobiiliac occlusions were treated by EVR. Also collected were data from the last 21 consecutive patients treated in the same period by aortofemoral (n = 6) or aortobifemoral (n = 15) bypass grafting. In accordance with the TransAtlantic Inter-Society Consensus II (TASC II) document, only patients with type D lesions were considered. Kaplan-Meier estimates for patency were calculated, and Cox proportional hazard modeling was performed. RESULTS: The difference in risk factors between the groups was not significant. General anesthesia was required in 100% of the surgical group, and local or locoregional anesthesia was used for EVR. Suprarenal aortic cross-clamping was required in nine of the open surgical procedures (41%). A brachial percutaneous approach was performed in all patients undergoing EVR, and technical success was 100% in both groups. All of the attempts at EVR were successful. At the 2-year follow-up, primary patency did not differ significantly between the endovascular (91%) and surgical (95%) groups. This was seen in the univariate model (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.02-2.95; P = .28) and in the multivariate model (HR, 0.77; 95% CI, 0.06-10.07; P = .84) for group (HR, 0.58; 95% CI, 0.04-7.72; P = .68), age (HR, 0.89; 95% CI, 0.73-1.08; P = .24), symptoms (HR, 1.98; 95% CI, 0.42-9.46; P = .39), and occlusion (HR, 3.22; 95% CI, 0.51-20.35; P = .21). The average hospital length of stay was shorter for patients treated with ERV than for those treated with open surgery (3.9 ± 2.2 vs 5.8 ± 3.1 days, respectively; P = .03). The complication rate was 4% for EVR vs 18% in the surgical group (P = .32). CONCLUSIONS: At 2 years of follow-up, the results of endoluminal bypass grafting with the Viabahn stent to treat complex aortoiliac disease are promising. Longer-term results are needed to fully evaluate the potential benefits and longer-term patency.
Assuntos
Aorta Abdominal/cirurgia , Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Artéria Ilíaca/cirurgia , Stents , Idoso , Aorta Abdominal/fisiopatologia , Doenças da Aorta/diagnóstico , Doenças da Aorta/fisiopatologia , Aortografia , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Distribuição de Qui-Quadrado , Constrição Patológica , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Artéria Ilíaca/fisiopatologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Modelos de Riscos Proporcionais , Desenho de Prótese , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
We report a case of a metachronous common iliac artery and the internal iliac artery (IIA) aneurysm developed 8 years after an aortobi-femoral bypass for treatment of abdominal aortic aneurysm associated at chronic occlusion of the right iliac axis. To exclude the metachronous aneurysm on the left iliac axis and to maintain the pelvic circulation, an external to IIA endografts were positioned ("U stent-graft technique"). At 6-month follow-up, the computed tomography scan showed patency of the endografts, of the bypass and of the IIA, without endoleak, or other adverse events.
Assuntos
Implante de Prótese Vascular , Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco/diagnóstico , Aneurisma Ilíaco/cirurgia , Stents , Idoso , Humanos , Aneurisma Ilíaco/etiologia , MasculinoRESUMO
The Nellix device (Endologix, Irvine, CA), has been designed with a brand new concept to seal the abdominal aortic aneurysms, minimizing endoleaks and reducing reinterventions. We present the first open conversion of a Nellix endograft due to aortoduodenal fistula of a 74-year-old male patient treated for an abdominal aortic aneurysms of 62-mm diameter.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Remoção de Dispositivo , Duodenopatias/cirurgia , Procedimentos Endovasculares/efeitos adversos , Fístula Intestinal/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Idoso , Aneurisma da Aorta Abdominal/diagnóstico , Aortografia/métodos , Implante de Prótese Vascular/instrumentação , Duodenopatias/diagnóstico , Duodenopatias/microbiologia , Procedimentos Endovasculares/instrumentação , Evolução Fatal , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/microbiologia , Masculino , Desenho de Prótese , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Reoperação , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We report a case of abdominal endograft proximal collapse due to acute type B aortic dissection in a patient previously treated with endovascular repair (EVAR) for an infrarenal abdominal aortic aneurysm. Patient underwent axillobifemoral bypass grafting, in emergency. The postoperative computed tomography scan showed reexpansion of the occluded endograft. The patient died after 2 days with evidence of progression of the thrombosis of the false lumen and with involvement of renal, visceral, and medullar artery. EVAR collapse associated to acute type B aortic dissection is a challenging condition, which requires aggressive approach.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Falha de Prótese , Doença Aguda , Idoso , Dissecção Aórtica/diagnóstico , Aneurisma da Aorta Abdominal/diagnóstico , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Evolução Fatal , Humanos , Masculino , Desenho de Prótese , Reoperação , Estresse Mecânico , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A 59-year-old male, referred to our center with a ruptured aortic aneurysm, underwent urgent endovascular repair and femoro-femoral crossover bypass. An endograft infection because of Aspergillus fumigatus occurred about 20 days after surgery. We removed the endograft and femoral prosthesis and we then performed an aorto-bi-iliac bypass with autogenous reversed superficial femoral veins. Five days after surgery, the patient died. Microbiological examination and postmortem examination showed the presence of A. fumigatus in femoral prosthesis, aortic wall, and periaortic exudate.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Aspergilose/diagnóstico , Aspergillus fumigatus/isolamento & purificação , Prótese Vascular/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Implante de Prótese Vascular/métodos , Remoção de Dispositivo , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The aim of this study was to determine predictors of improved quality of life and claudication in patients undergoing spinal cord stimulation (SCS) for critical lower limb ischemia. METHODS: We retrospectively analyzed 101 consecutive patients with few meter claudication and nonhealing ulcer who underwent definitive SCS. These patients were selected among 274 SCS patients treated at our center from 1995 to 2012. All presented with non-reconstructable critical leg ischemia (NR-CLI) and underwent supervised exercise therapy, best medical care and regular ulcers standard or advanced medications for at least 1 month before SCS implantation. We measured self-perceived quality of life using the SF-36 questionnaire. Patients with an improved walking distance of at least 30 meters after SCS had significant improvement on SF-36 questionnaire scores. We considered 30 meters as the cut-off for clinically significant improvement in pain-free walking distance, and we defined this value as functional success. Logistic regression was applied to assess baseline and other patient variables as possible predictors of functional success. RESULTS: Neither perioperative mortality nor significant complications were found. At a median follow-up of 69 months (range 1-202 months), mortality, major amputation, and minor amputation were 8.9%, 5.9%, and 6.9%, respectively. Functional clinical success was reported in 25.7% of cases. Independent predictors of functional success at univariate analysis included delay between the onset of the ulcer and SCS (P < 0.001) and the pain-free walking distance before SCS (P < 0.002). The only predictive factor of functional success at multivariate analysis was the delay between the onset of ulcer and SCS (median delay in patients with and without functional success was 3 and 15 months, respectively). In particular, comparable to pain-free walking distance before SCS, the success rate decreased by 40% for each month elapsed from onset of ulcer to SCS. CONCLUSIONS: In our series of patients who underwent SCS, reduced delay between the onset of ulcer and SCS was associated with improved quality of life and walking distance. Larger series are required to confirm these data and to assess clinical implications.
Assuntos
Claudicação Intermitente/terapia , Isquemia/terapia , Extremidade Inferior/irrigação sanguínea , Qualidade de Vida , Estimulação da Medula Espinal , Amputação Cirúrgica , Teste de Esforço , Tolerância ao Exercício , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/mortalidade , Claudicação Intermitente/fisiopatologia , Claudicação Intermitente/psicologia , Isquemia/diagnóstico , Isquemia/mortalidade , Isquemia/fisiopatologia , Isquemia/psicologia , Úlcera da Perna/diagnóstico , Úlcera da Perna/terapia , Modelos Logísticos , Análise Multivariada , Razão de Chances , Medição da Dor , Recuperação de Função Fisiológica , Sistema de Registros , Estudos Retrospectivos , Estimulação da Medula Espinal/efeitos adversos , Estimulação da Medula Espinal/mortalidade , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , CicatrizaçãoRESUMO
Blunt aortic injury (BAI) involving an aberrant right subclavian artery (ARSA) is uncommon. The presence of an ARSA entails several treatment issues, in particular regarding the risk of perioperative posterior cerebral stroke. We report the case of a man with an ARSA who suffered from BAI. An initial conservative treatment with delayed open repair was chosen. A review of the published literature with discussion of the case is presented. The presence of an ARSA in patients with BAI can be considered a poor anatomy for endovascular repair, and suitable patients may benefit from delayed open repair.
Assuntos
Acidentes de Trânsito , Aorta/cirurgia , Implante de Prótese Vascular , Motocicletas , Artéria Subclávia/cirurgia , Malformações Vasculares/cirurgia , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/cirurgia , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Aorta/lesões , Aneurisma Aórtico/etiologia , Aneurisma Aórtico/cirurgia , Aortografia/métodos , Humanos , Ligadura , Masculino , Artéria Subclávia/anormalidades , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Malformações Vasculares/complicações , Lesões do Sistema Vascular/etiologia , Ferimentos não Penetrantes/etiologia , Adulto JovemRESUMO
BACKGROUND: Thoracoabdominal aortic aneurysm (TAAA) hybrid repair consists of aortic visceral branch rerouting followed by TAAA endograft exclusion. This technique has been shown to represent a technically feasible strategy in selected patients. METHODS: We analyzed 52 high-risk patients who underwent hybrid TAAA repair between 2001 and 2012 in our centre with a variety of visceral rerouting configurations and of commercially available thoracic endografts. Thirty-seven simultaneous (71.2%) and 15 staged procedures (21.8%) were performed with a four-vessel revascularization in 18 cases (34.6%), a three-vessel revascularization in 11 cases (21.2%) and a two-vessel revascularization in 23 cases (44.2%). RESULTS: No intraoperative deaths were observed. We recorded a perioperative mortality rate of 13.5% (n=7), including deaths from multiorgan failure (n=2), myocardial infarction (n=2), coagulopathy (n=1), pancreatitis (n=1) and bowel infarction (n=1). Perioperative morbidity rate was 28.8% (n=15), including 2 cases of transient paraparesis and 1 case of permanent paraplegia. Renal failure (n=5), pancreatitis (n=3), respiratory failure (n=3) and dysphagia (n=1) were also observed. At median follow-up of 23.9 months procedure-related mortality rate was 9.6%: two patients died from visceral graft occlusion and three from aortic rupture. There were three endoleaks and one endograft migration, none of which resulted in death. Five patients (9.6%) died as a consequence of unrelated events. CONCLUSIONS: Typical complications of conventional TAAA open surgery have not been eliminated by hybrid repair, and significant mortality and morbidity rates have been recorded. Fate of visceral bypasses and incidence of endoleak and other endograft-related complications needs to be carefully assessed. Hybrid TAAA repair should currently be limited to high-risk surgical patients with unfit anatomy for endovascular repair.
RESUMO
Posterior nutcracker syndrome (PNS) is a rare condition due to left renal vein (LRV) hypertension, caused by compression of the LRV between the vertebral column and the abdominal aorta. Diagnosis of PNS is challenging, as symptoms are variable and not specific. Therapeutic options are debated, and either conservative, open, or endovascular approaches have been advocated as both safe and effective. We report our experience with a case of PNS in a 17-year-old woman, who presented with a 2 year history of recurrent hematuria associated to severe left flank and back pain, successfully treated with anterior transposition of the LRV.
Assuntos
Veias Renais/cirurgia , Doenças Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares , Adolescente , Anastomose Cirúrgica , Constrição Patológica , Feminino , Dor no Flanco/etiologia , Hematúria/etiologia , Humanos , Angiografia por Ressonância Magnética , Flebografia/métodos , Veias Renais/diagnóstico por imagem , Veias Renais/patologia , Veias Renais/fisiopatologia , Síndrome , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico , Doenças Vasculares/fisiopatologia , Veia Cava Inferior/cirurgia , Pressão VenosaAssuntos
Doenças Vasculares Periféricas/diagnóstico por imagem , Veias Renais/patologia , Tomografia Computadorizada por Raios X , Aorta Abdominal , Dor nas Costas/etiologia , Constrição Patológica , Feminino , Dor no Flanco/etiologia , Hematúria/etiologia , Humanos , Artéria Mesentérica Superior , Veias Renais/diagnóstico por imagem , Síndrome , Adulto JovemRESUMO
PURPOSE: To describe perforation of a Dacron aortic graft due to a post-thoracotomy dislocated rib fracture in a young Marfan patient. CASE REPORT: Six months after a successful open repair of a type II dissecting thoracoabdominal aortic aneurysm (TAAA), a 40-year-old woman with Marfan syndrome underwent elective repair of a post-thoracotomy dislocated rib fracture. During the procedure, the graft ruptured; 2 TAG stent-grafts were emergently implanted to reline the existing aortic graft. The fractured rib was then resected. The postoperative course was uneventful, without residual leak at computed tomography at 3 days. At 18 months, the patient is well, without need of further operations. CONCLUSION: Early correction of any dislocated rib fracture close to a thoracic aortic graft should be considered, especially if the graft is not wrapped by the aneurysm sac. In these patients, in-graft endovascular relining associated with repair of the rib fracture may be a feasible and effective alternative to redo thoracotomy and surgical graft repair. Prior to attempting rib resection, appropriate thoracic endografts should be on hand in case an endovascular bailout is needed.