ABSTRACT
Abstract Background Retroperitoneal open iliac conduits (ROIC) are used in patients with hostile iliac anatomy undergoing endovascular aortic repair (EVAR). Objectives We hereby report our experience of ROIC in patients subjected to EVAR. Methods This was a retrospective evaluation of 8 patients out of a total of 75 patients (11%) who underwent EVAR in the last 10 years. Pre-procedure computed tomography angiography was used to assess the dimensions of iliac and femoral arteries. Patients who had small arterial dimensions (i.e. smaller than the recommended access size for the aortic endograft device) were subjected to ROIC. Results The mean age of the 3 males and 5 females studied was 45.7 ± 15.2 years. The indication for ROIC was the small caliber ilio-femoral access site in 7 patients and atherosclerotic disease in 1 patient. All external grafts were anastomosed to the right common iliac artery except one which was anastomosed to the aortic bifurcation site because of a small common iliac artery. The procedural success rate was 100%. Local access site complications included infection (n=1), retroperitoneal hematoma (n=1), and need for blood transfusion (n=3). The median post-intervention hospital stay was 10 days. All patients had favorable long-term outcomes at a median follow-up of 18 months. Conclusions Female patients require ROIC during EVAR more frequently. Adjunctive use of iliac conduit for EVAR was associated with favorable perioperative and short-term outcomes.
Resumo Contexto Os condutos ilíacos abertos retroperitoneais são utilizados em pacientes submetidos a reparo endovascular de aneurisma (REVA) com anatomia ilíaca hostil. Objetivos Relatamos a nossa experiência com os condutos ilíacos em pacientes submetidos a REVA. Métodos Trata-se de uma avaliação retrospectiva de oito pacientes, de um total de 75 (11%), os quais foram submetidos a REVA nos últimos 10 anos. Foi realizada angiotomografia computadorizada antes do procedimento para avaliar as dimensões das artérias ilíaca e femoral. Os pacientes com dimensões arteriais menores, abaixo do tamanho de acesso recomendado para o dispositivo de endoprótese aórtica, foram submetidos a condutos ilíacos. Resultados A média de idade dos participantes foi de 45,7±15,2 anos, sendo três do sexo masculino e cinco do sexo feminino. As indicações para condutos ilíacos foram local de acesso ilíaco femoral de pequeno calibre, para sete pacientes, e doença aterosclerótica, para um paciente. Todas as próteses externas foram anastomosadas na artéria ilíaca comum direita, com exceção de uma, que foi anastomosada no local da bifurcação aórtica por apresentar artéria ilíaca comum menor. A taxa de sucesso do procedimento foi de 100%. As complicações no local de acesso incluíram infecção (n = 1), hematoma retroperitoneal (n = 1) e necessidade de transfusão de sangue (n = 3). O tempo mediano de internação hospitalar pós-intervenção foi de 10 dias. Todos os pacientes apresentaram desfechos de longo prazo favoráveis no seguimento mediano de 18 meses. Conclusões As pacientes do sexo feminino necessitaram de condutos ilíacos durante REVA com maior frequência. O uso adjuvante de condutos ilíacos com REVA foi associado a desfechos perioperatórios e de curto prazo favoráveis.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aorta/surgery , Aortic Aneurysm/surgery , Femoral Artery/surgery , Endovascular Procedures/methods , Iliac Artery/surgery , Aortic Dissection/surgery , Retroperitoneal Space , Sex Factors , Retrospective Studies , Outcome Assessment, Health Care , Perioperative Care , Vascular Access DevicesABSTRACT
Background: Stroke in young poses a major health problem. Various Indian studies have shown the incidence of stroke to be 10-15%. Cerebral venous thrombosis and rheumatic heart disease are the leading causes of stroke in the young in India. Thrombophilic factors have been implicated in 4-8% of the young strokes worldwide. Protein C deficiency is the most common thrombophilia marker followed by a deficiency of protein S, Factor V Leiden mutation, and antithrombin (AT) deficiency. Aims and objectives was the study of stroke in young is important for various reasons. The etiology and risk factors are more diverse and different as compared to the elderly. Therefore, these may indicate separate therapeutic approaches. The aim is to study the profile of ischemic stroke cases among the young.Methods: The study was carried out at a tertiary care defence hospital between December 2018 to December 2019. All cases of fresh ischemic stroke who were more than 15 and less than 45 years of age were included. Following clinical evaluation, patients underwent complete haemogram, blood sugar levels, lipid profile and other metabolic parameters. All patients were subjected to chest radiography, 12 lead ECG, and 2D echocardiography, Non-contrast CT head and MRI brain. Prothrombotic work up was also done.Results: A total of 41 patients (12.69%) presented with ischemic stroke before 45 years of age. Out of these 10 (24%) were females and 31 (76%) were male. None of the women smoked or consumed alcohol. Among the males, 19 (47%) smoked more than 10 cigarettes or bidis per day and 9 (22%) were moderate-to-heavy drinkers of alcohol. Hypertension was present in 7 (18%) and diabetes mellitus in 3 (7%) patients. Serum cholesterol was elevated in 7 (18%) patients and triglycerides in 17 (42%). Protein S deficiency was found in 28.8% patients, while protein C deficiency was detected in 21% patients and antithrombin III deficiency in 12% patients.Conclusions: Although traditional risk factors, such as hypertension, diabetes, and smoking, are associated with stroke in both elderly and young, this study shows that other modifiable risk factors such as alcohol consumption were also prevalent. The most common etiological cause was found to be venous infarction followed by cardio embolic cause. Deficiency of Protein S was the most common prothrombotic defect followed by deficiency of Protein C.
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Objective: To study the angiographic profile, treatment andoutcome of Coronary Artery Disease (CAD) in young (< 45years) individuals in India.Methods: Consecutive 132 young adults with CAD reporting totwo tertiary care centres over a period of 1 ½ years wereenrolled as a case control observational study. Subjects whopresented with acute coronary syndrome (ACS), chronic stableangina (CSA), Heart failure or AsymptomaticElectrocardiogram (ECG) abnormalities but confirmed CAD onCoronary Angiogram (CAG) were included. Angiographicprofile, treatment and outcome were analysed with a follow upof one year.Results: Risk factors of abdominal obesity, lipoprotein (a)[Lp(a)] and tobacco consumption were significantly higher instudy group. ST elevation Myocardial Infarction (STEMI) wasthe commonest presentation (71.21%). Single vessel disease(56.06 %) was the commonest angiographic profile with LeftAnterior Descending Artery (LAD) involvement (40.91%).Primary Angioplasty in Myocardial Infarction (PAMI) was donein 42.5% of STEMI and Thrombolysis in 48.9%. Three types ofcoronary involvement were noticed with Type I having discretelesions/thrombus and Type III having multiple segment/arteryinvolvement with differing risk factor profile and outcome.Diffuse and more severe CAD was associated with tobaccouse, abdominal obesity and elevated Lp (a). Late presentation,diffuse disease and persistence of smoking predicted pooreroutcome.Conclusions: CAD in Young commonly presents with AcuteMI and single vessel LAD involvement. Less than half haveaccess to PAMI. Most require stenting although selectedpatients do well with intracoronary thrombolysis. Delayedtreatment and failure to modify risk factors portend badprognosis.
ABSTRACT
Background: Number of markers of inflammation has been associated with coronary artery disease and various studies have shown increased levels during chronic stable angina, acute myocardial infarction, and percutaneous coronary intervention. However, co-relation to final outcomes of percutaneous coronary intervention with these markers has not been studied. Aim of this study was to try and find a correlation between markers of inflammation released during percutaneous coronary intervention and incidence of restenosis on follow up at 06 moths on patients undergoing percutaneous coronary intervention with Bare Metal Stent (BMS).Methods: 36 consecutive only Bare Metal Stent (BMS) angioplasties done at our centre between July 2015 and June 2016 were analysed for markers of inflammation from peripheral venous sample before the procedure and coronary sinus sample after the procedure. Pts were kept on follow up for 6 months and assessed as per their clinical symptoms and Coronary Angiogram was done where indicated and results tabulated.Results: There was increase in the studied markers of inflammation post percutaneous coronary intervention but they did not correlate with or predict possible restenosis.Conclusions: This study showed that markers of inflammation are elevated during percutaneous coronary intervention but none of these markers correlates with subsequent restenosis.