RESUMO
BACKGROUND: The aim of this study was to explore the effect of patient sex on short-term and long-term outcomes after endovascular treatment for aortoiliac occlusive disease (AIOD). METHODS: A multicenter retrospective analysis was performed on all patients who underwent iliac artery stenting for AIOD across the 3 participating sites from October 1, 2018 to September 21, 2021. Preoperative clinical, operative, and postoperative data were collected on a dedicated database. Demographics and outcomes were compared between male and female patients and the probability of freedom from amputation and freedom from target lesion reintervention were estimated with the Kaplan-Meier method. RESULTS: Of 574 patients, 346 (60%) were male and 228 (40%) were female. Mean follow-up was 12 months. Female patients were significantly older (69.2 ± 10.2 years vs. 67.8 ± 8.9 years, P = 0.025) and more likely to have Trans-Atlantic Inter-Society Consensus II D disease (P = 0.003). The female cohort had significantly less coronary artery disease (40% vs. 50%, P = 0.013), coronary stenting (14% vs. 21%, P = 0.039), and coronary artery bypass grafting (13% vs. 25%, P < 0.001) than the male cohort, as well as less statin use (69% vs. 80%, P = 0.004). There were no differences in stent type, concomitant open surgery, intraoperative events, or hospital length of stay. For 30-day postoperative complications, female patients had a significantly higher rate of thrombotic acute limb ischemia (2% vs. 0%, P = 0.01), while male patients had a higher rate of amputation (4% vs. 9%, P = 0.048). On mid-term outcomes, there was no difference in freedom from amputation or target lesion reintervention between male and female patients (P = 0.14 and P = 0.32, respectively). CONCLUSIONS: Female patients had lower incidence of cardiovascular risk factors but presented with higher Trans-Atlantic Inter-Society Consensus II classification and had higher rates of 30-day thrombotic acute limb ischemia. Male patients were more likely to require amputation within 30 days. Despite no differences in the mid-term, these short-term findings suggest that patient sex may be a relevant consideration in postoperative management and surveillance after endovascular treatment of AIOD.
Assuntos
Doenças da Aorta , Arteriopatias Oclusivas , Aterosclerose , Procedimentos Endovasculares , Síndrome de Leriche , Humanos , Masculino , Feminino , Fatores de Risco , Estudos Retrospectivos , Resultado do Tratamento , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Síndrome de Leriche/etiologia , Procedimentos Endovasculares/efeitos adversos , Aterosclerose/etiologia , Stents , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Grau de Desobstrução VascularRESUMO
OBJECTIVES: The purpose of this study was to evaluate the therapeutic efficacy and safety of endovascular treatment aorto-iliac occlusive disease (AIOD) with TransAtlantic Inter-Society Consensus II (TASC II) C and D lesions. In addition, 10 years of experience with interventional procedures and treatment options in our center were also worthy of further discussion. METHODS: Between January 2011 and December 2020, a total of 26 consecutive AIOD patients with TASC-II C and D lesions treated endovascular approach were enrolled in this study. Patients' demographic and clinical data were collected, and the safety and efficacy of endovascular therapy were evaluated. In addition, operation procedures were also described. RESULTS: The mean age of patients was 62.2 ± 7 years (49-57 years), and the mean body mass index of patients was 24.2 ± 2.6 kg/m2. Fifteen patients (57.7%) were Rutherford 4, 5 each (19.2%) were Rutherford 3 and 5, and 1 (3.8%) was Rutherford 2. No other serious complications occurred except death in 3 patients. Most of the patients (73.1%) had a history of smoking, and hypertension and hyperlipidemia were common comorbidities. Endovascular therapy was successfully performed in 25 patients, and the technical success rate was 96.2%. The patient's ankle-brachial index improved significantly postoperatively compared with preoperatively (preoperative 0.33 ± 0.14 vs 1.0 ± 0.09, P < 0.001). The primary patency rates were 100%, 95.7%, and 91.3% at 1, 3, and 5 years, while the secondary patency rates were 100%. No treatment-related deaths or serious complications occurred. CONCLUSIONS: Endovascular treatment of AIOD patients with TASC-II C and D lesions might be safe and have a high rate of middle-term and long-term primary patency.
Assuntos
Arteriopatias Oclusivas , Procedimentos Endovasculares , Síndrome de Leriche , Humanos , Pessoa de Meia-Idade , Idoso , Consenso , Resultado do Tratamento , Grau de Desobstrução Vascular , Artéria Ilíaca , Procedimentos Endovasculares/efeitos adversos , Síndrome de Leriche/etiologia , Estudos Retrospectivos , StentsRESUMO
AIM: In this research, we aimed to present early follow-up results of the endovascular treatment in patients with Leriche syndrome at our single center. METHODS AND MATERIALS: Between October 2020 and January 2022, 14 patients with Leriche syndrome (12 men, two women) who underwent endovascular treatment at our center retrospectively were evaluated. Before the treatment, the ankle-brachial index (ABI) was found 0.50 ± 0.11 on the right leg and 0.45 ± 0.09 on the left leg. RESULTS: All of the patients with Leriche syndrome applied to our clinic for the first time. In five patients, the fully occluded lesion length was over 3 cm (ranging between 3.5-7.2 cm), hence they were treated with aortic and bilateral iliac bare metallic stents. Although in one patient, the aortic occluding lesion was below 3 cm; it was treated with a bare aortic and bilateral bare iliac stent application because the lesion in the aorta was too calcific. In eight patients, the lesion length was less than 3 cm, bilateral iliac metal bare stents were applied in a kissing stent way. CONCLUSION: Endovascular therapy for chronic aorto-iliac occlusive disease has an early high technical success with primary and secondary patency rates. Especially in patients with high risk factors, it may be considered as a good alternative to conventional surgery.
Assuntos
Implante de Prótese Vascular , Procedimentos Endovasculares , Síndrome de Leriche , Masculino , Humanos , Feminino , Síndrome de Leriche/etiologia , Síndrome de Leriche/patologia , Síndrome de Leriche/cirurgia , Artéria Ilíaca/cirurgia , Implante de Prótese Vascular/métodos , Estudos Retrospectivos , Seguimentos , Procedimentos Endovasculares/métodosRESUMO
BACKGROUND: Leriche syndrome is the triad of symptoms consisting of claudication, erectile dysfunction, and absence of femoral pulses. Inflammatory disease of the heart muscle, myocarditis, may occur because of immune system activation, drug exposure or infections. CASE PRESENTATION: A 31-year-old man with no previous medical history presented to the emergency department with acute back pain that had started suddenly during weightlifting, which was initially misdiagnosed as spinal disc herniation. The patient returned four hours later and a thoracoabdominal computed tomography showed a large thrombus in the aortoiliac region creating a total occlusion. Vascular surgery with embolectomy was immediately performed. Further investigation with echocardiography revealed deteriorated systolic dysfunction with marked hypokinesia and two large thrombi in the left ventricle. Cardiac magnetic resonance imaging showed late contrast enhancement of the inferolateral and septal regions, which indicated a recent myocarditis. CONCLUSION: Myocarditis can result in multiple embolization with diverse organ manifestation including total occlusion of the aortoiliac arteries, which required urgent embolectomy.
Assuntos
Síndrome de Leriche/etiologia , Miocardite/complicações , Tromboembolia/etiologia , Trombose/etiologia , Adulto , Embolectomia , Humanos , Síndrome de Leriche/diagnóstico por imagem , Síndrome de Leriche/cirurgia , Masculino , Miocardite/diagnóstico por imagem , Tromboembolia/diagnóstico por imagem , Tromboembolia/cirurgia , Trombose/diagnóstico por imagem , Resultado do TratamentoRESUMO
Totally occluded aortic aneurysm is a rare pathology. The medical history and the evolution are unknown. We present a case of a regularly followed up 60-year-old man with chronic thrombosed aneurysm, presenting with mycotic acute rupture. As an original treatment, the patient was treated by aortic ligation without distal revascularization. A literature review from 1974 to 2015 enhances the contemporary understanding of the pathology, by exploring the thrombus interaction, pressure, and the wall shear stress. The literature review confirms the poor prognosis and concludes of a necessary closer follow-up for chronic occluded aneurysm.
Assuntos
Aneurisma Infectado/complicações , Aneurisma da Aorta Abdominal/complicações , Ruptura Aórtica/etiologia , Trombose/etiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/fisiopatologia , Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/fisiopatologia , Ruptura Aórtica/cirurgia , Aortografia/métodos , Doença Crônica , Angiografia por Tomografia Computadorizada , Hemodinâmica , Humanos , Síndrome de Leriche/etiologia , Ligadura , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Trombose/diagnóstico por imagem , Trombose/fisiopatologia , Trombose/cirurgia , Resultado do TratamentoRESUMO
STUDY DESIGN: Case report and review of literature. OBJECTIVE: Case report of an acute Leriche-like syndrome as an unusual complication after posterior transpedicular instrumentation of an L1 fracture. SUMMARY OF BACKGROUND DATA: Injuries to the aorta after pedicle screw placement are rare. Reports exist about acute hemorrhage, erosions, and pseudoaneurysm formation. METHODS: A 47-year-old female developed an acute occlusion of the infrarenal aorta after posterior transpedicular instrumentation of an L1 burst-fracture. The patient presented with increasing sensation of hypothermia in both lower extremities and cyanosis of the toes, as well as claudication-like symptoms 15 days after the initial surgery. CT angiography showed bicortical placement of the left pedicle screw at L2 with perforation of the anterior cortex of 2.5âmm and complete obliteration of the infrarenal aorta up to the bifurcation. RESULTS: The patient was treated with resection of the aorta and implantation of a silver graft prosthesis. Preoperative symptoms resolved immediately after surgery without reoccurrence. CONCLUSION: Although rare, the risk of iatrogenic injuries to the aorta during spine surgery exists, several complications have previously been described. However, this is the first report of an acute Leriche-like syndrome after posterior instrumentation of the spine. Whereas bicortical pedicle screw placement in selected cases of posterior spinal instrumentation is intended, one has to be aware of the possible risks, as in our case where an acute aortic obliteration was observed. Preoperative CT-based planning of surgery and profound knowledge of the neurovascular anatomy is mandatory. LEVEL OF EVIDENCE: 5.
Assuntos
Aorta/cirurgia , Síndrome de Leriche/etiologia , Vértebras Lombares/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Feminino , Humanos , Vértebras Lombares/lesões , Pessoa de Meia-Idade , Parafusos Pediculares , Fusão Vertebral/instrumentação , Resultado do TratamentoAssuntos
Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico , Síndrome de Leriche/etiologia , Sarcoma/complicações , Sarcoma/diagnóstico , Adolescente , Ecocardiografia , Ecocardiografia Transesofagiana , Átrios do Coração , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Imageamento Tridimensional , Síndrome de Leriche/diagnóstico , Masculino , Sarcoma/patologia , Sarcoma/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We analyzed long-term results of vascular surgery in 199 patients with diabetes and chronic limb ischemia. At the time of the study mean age of patients was 64.7+1.2 years. They all had severe course of disease. Results showed that in the majority of patients good clinical effect after aorto-femoral reconstructions persisted over a long period of time. Patency of aorto-femoral bypass and limb salvage rate after 9 years equaled 72 and 79%, respectively. This was associated with improved quality of life. Surgery for severe limb ischemia (50 % of patients had critical ischemia) helped to preserve the limb and achieve sustainable increase of pain-free walking distance in 85 % of patients. However 5-year survival rate was 75%. The leading cause of death was myocardial infarction. This was indicative of the lack of prevention of progression of coronary artery disease. Thus, despite the presence of diabetes aorto-femoral reconstructions in most patients reliably and continuously prevented development of critical ischemia and preserved lower limbs. Active prophylaxis of cardiac complications is necessary for improvement of long-term survival of patients after vascular reconstructive surgery.
Assuntos
Aorta Abdominal/cirurgia , Diabetes Mellitus Tipo 2/complicações , Artéria Femoral/cirurgia , Síndrome de Leriche/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Aorta Abdominal/patologia , Aorta Abdominal/fisiopatologia , Feminino , Artéria Femoral/patologia , Artéria Femoral/fisiopatologia , Humanos , Isquemia/etiologia , Isquemia/fisiopatologia , Síndrome de Leriche/etiologia , Síndrome de Leriche/mortalidade , Síndrome de Leriche/patologia , Síndrome de Leriche/fisiopatologia , Salvamento de Membro/métodos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/patologia , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Prevenção Secundária , Índice de Gravidade de Doença , Stents/efeitos adversos , Taxa de Sobrevida , Resultado do Tratamento , Grau de Desobstrução VascularAssuntos
Endocardite/complicações , Síndrome Hipereosinofílica/complicações , Síndrome de Leriche/etiologia , Adulto , Endocardite/fisiopatologia , Humanos , Síndrome Hipereosinofílica/fisiopatologia , Síndrome de Leriche/patologia , Síndrome de Leriche/fisiopatologia , Masculino , Trombose/patologiaAssuntos
Cateterismo Cardíaco/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Complicações Intraoperatórias/diagnóstico , Síndrome de Leriche/diagnóstico , Doença Aguda , Doença da Artéria Coronariana/cirurgia , Feminino , Humanos , Síndrome de Leriche/etiologia , Pessoa de Meia-IdadeAssuntos
Cardiopatias/complicações , Síndrome de Leriche/etiologia , Trombose/complicações , Cardiopatias/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Síndrome de Leriche/diagnóstico por imagem , Pessoa de Meia-Idade , Trombose/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Paradoxical embolism, describing the passage of venous or right-sided cardiac thrombus into the arterial or systemic circulation through patent foramen ovale, is an uncommon cause of acute arterial occlusion. Here, we report acute Leriche syndrome in a young woman attributable to paradoxical embolism. Ischaemia, patent foramen ovale, and venous thrombosis were the triad of evidence for paradoxical embolism.
Assuntos
Embolia Paradoxal/complicações , Síndrome de Leriche/etiologia , Doença Aguda , Adulto , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico , Feminino , Comunicação Interatrial/complicações , Humanos , Síndrome de Leriche/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
Three patients with arterial echinococcosis presented with chronic or acute arterial occlusion. One case diagnosed as Leriche's syndrome was found at surgery to have aortic occlusion caused by hydatid cysts; arterial reconstruction was performed by aortoiliac interposition of a woven Dacron vascular graft. In the other 2 cases presenting with acute femoral or brachial artery occlusion, embolectomy revealed hydatid cysts as the cause of occlusion.
Assuntos
Arteriopatias Oclusivas/etiologia , Artéria Braquial/cirurgia , Equinococose/complicações , Artéria Femoral/cirurgia , Síndrome de Leriche/etiologia , Adulto , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/cirurgia , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/patologia , Equinococose/diagnóstico , Equinococose/cirurgia , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/patologia , Humanos , Síndrome de Leriche/diagnóstico , Síndrome de Leriche/cirurgia , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
A 36-year-old male patient showed a significant decrease of arterial pressure in the lower extremities during coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC). Arterial pressure measured in the femoral artery fell to 10-20 mmHg at the end of ECC, whereas in the upper extremities arterial pressure levels were normal. At the end of the surgery a complete ischemia of both lower extremities was observed. We suspected Leriche's syndrome and performed a successful aortic embolectomy through bilateral femoral arteriotomies immediately. An insufficient anticoagulation could be excluded by prolonged "activated clotting time" (ACT), therefore we presumed that the source of embolus was a small aneurysm of the left ventricle. The shape and superficial structure of the extracted embolus, which was partly covered with endocardium, confirmed our suspicion. No complications occurred throughout the postoperative period. On the 10th postoperative day, the patient left our department for postoperative rehabilitation with a normal perfusion of the lower extremities.
Assuntos
Ponte de Artéria Coronária , Embolia/etiologia , Circulação Extracorpórea , Complicações Intraoperatórias/etiologia , Síndrome de Leriche/etiologia , Adulto , Embolectomia , Embolia/cirurgia , Humanos , MasculinoRESUMO
A 64-year-old man with a history of intermittent claudication presented with chest pain. On admission, he had yellowish papules with a "plucked chicken" appearance on his neck. Histological examination of the biopsy specimen of the lesion revealed degeneration and calcification of elastic fibers in the dermis. His daughter also had similar histological changes in the skin. The diagnosis was pseudoxanthoma elasticum. Fundoscopic examination revealed angioid streaks. Electrocardiography showed inverted T waves in V2-V6, and echocardiography revealed hypokinesis in the anterior wall of the left ventricle. Emergency catheterization showed 90% stenosis in the left anterior descending coronary artery, total occlusion of the abdominal aorta, and severe stenosis in the right subclavian artery. He was treated medically and had no recurrent episodes of chest pain. A careful examination for cardiovascular diseases should be considered in patients with pseudoxanthoma elasticum.
Assuntos
Angina Instável/etiologia , Síndrome de Leriche/etiologia , Pseudoxantoma Elástico/complicações , Estrias Angioides/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pseudoxantoma Elástico/diagnósticoRESUMO
La enfermedad o Síndrome de Leriche (obstrucción aortoilíaca) ha atravesado una serie de cambios en su enfoque diagnóstico y terapeútico desde su descripción original. Se considera el enfoque actual de su fisiopatología y los factores predisponentes, así como los diferentes procedimientos quirúrgicos empleados en nuestro servicio. Se discuten los resultados obtenidos de los diferentes parámetros estudiados acerca de los procedimientos quirúrgicos empleados. Se concluye una vez más que el factor tabáquico es el predisponente más importante y que la cirugía favoreció a un porcentaje elevado de pacientes, no obstante a una mortalidad y morbilidad relativamente elevados, que sin embargo se corrigieron al crear el Servicio de Cirugía Cardiovascular en el hospital