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1.
Article | IMSEAR | ID: sea-236284

ABSTRACT

The abdominal aortic aneurysm (AAA), representing 70% to 90% of all aortic aneurysms, is characterized by a widening of the diameter due to an irreversible weakening of the vascular walls. Risk factors include advanced age, male sex, smoking, hypertension, atherosclerosis, and genetic predisposition. From a pathophysiological point of view, AAA involves alterations in connective tissue proteins, chronic inflammation with the release of cytokines and matrix metalloproteinases, as well as changes in the extracellular matrix. MicroRNAs (miRNAs) have emerged as promising biomarkers and therapeutic targets in the regulation of gene expression and different specific signaling pathways in vascular pathologies. Among which some miRNAs have been highlighted such as: miR-29 and miR-27b-3p, involved in the degradation of the extracellular matrix and inflammatory processes during the progression of AAA. Some diagnostic methods such as computed tomography play a fundamental role, while some innovative therapeutic strategies, such as the inhibition of miRNAs, represent a leading role as possible diagnostic and therapeutic targets. A comprehensive approach includes surveillance and surgical treatment strategies to mitigate the progression and risk of AAA rupture, thus highlighting the relevance of miRNAs in the diagnosis and treatment of this pathology.

2.
Rev. colomb. cir ; 39(4): 585-594, Julio 5, 2024. fig
Article in Spanish | LILACS | ID: biblio-1566017

ABSTRACT

Introducción. Las complicaciones posteriores a la reparación endovascular de aneurisma (EVAR) pueden resolverse con técnicas endovasculares. Sin embargo, cuando está indicada, la explantación de una endoprótesis es un procedimiento complejo, que se asocia a lesiones vasculares o viscerales, con alta morbimortalidad, en pacientes con edad avanzada y múltiples comorbilidades, y por lo tanto, alto riesgo quirúrgico. No existen dispositivos producidos por la industria para explantar las endoprótesis aórticas, por lo que el objetivo de este trabajo fue desarrollar un dispositivo para la explantación de endoprótesis aórticas. Métodos. Se llevó a cabo un estudio experimental, en fase preclínica, para desarrollar un dispositivo para la explantación de endoprótesis aórticas, con pruebas en modelos 3D y en un modelo animal porcino cadavérico. Resultados. Es factible desarrollar un modelo experimental de un nuevo dispositivo para explantar endoprótesis aórticas, denominado explantador de Cabrera, y comprobar su funcionamiento en un modelo animal cadavérico. El uso del explantador de Cabrera limitó el daño de la pared aórtica por parte de la endoprótesis en un 100 % al momento de su explantación en un modelo experimental ex vivo. Conclusión. Usando una jeringa septo, el explantador de Cabrera es superior a la técnica estándar de explantación de una endoprótesis al limitar la lesión de la pared aórtica, al colapsar y liberar los ganchos de fijación suprarrenal de forma controlada y segura al interior de la luz aórtica y, posteriormente, extraerla de forma rápida y efectiva, conservando la mayor cantidad de aorta sana para la posterior reconstrucción aorto-ilíaca.


Introduction. Complications after endovascular aneurysm repair (EVAR) can be resolved with endovascular techniques; however, when indicated, stent explantation is a complex procedure, which is associated with vascular or visceral injuries, with high morbidity and mortality in patients, with advanced age and multiple comorbidities, and therefore high surgical risk. There are no devices produced by the industry to explant aortic endoprostheses, so the objective of this work was to develop a device for the explantation of aortic endoprostheses. Methods. An experimental study was carried out, in the preclinical phase, to develop a device for the explantation of aortic endoprostheses, with tests in 3D models and in a cadaveric porcine animal model. Results. It is feasible to develop an experimental model of a new device for explanting aortic endoprostheses, called Cabrera explanter, and verify its operation in a cadaveric animal model. The use of the Cabrera explanter limited damage to the aortic wall by the endoprosthesis by 100% at the time of explantation in an ex vivo experimental model. Conclusions. Using a septum syringe, the Cabrera explanter is superior to the standard stent explantation technique by limiting injury to the aortic wall, collapsing and releasing the adrenal fixation hooks in a controlled and safe manner into the aortic lumen, and subsequently, extract it quickly and effectively, preserving the greatest amount of healthy aorta for the subsequent aorto-iliac reconstruction.


Subject(s)
Humans , Device Removal , Endovascular Procedures , Endovascular Aneurysm Repair , Aorta, Abdominal , Prostheses and Implants , Aortic Aneurysm, Abdominal
3.
Article | IMSEAR | ID: sea-236138

ABSTRACT

Background: Abdominal aortic aneurysm (AAA) is the permanent and irreversible dilation of the lower part of the aorta where the vessel expands, making it susceptible to rupture, which represents a high mortality incident. Methods: A review of clinical records was carried out from September 2021 to March 2023, patients who were diagnosed with aortic aneurysm were included in whom endovascular exclusion of abdominal and thoracic aortic aneurysm was performed at the General Hospital of Mexico by the angiology vascular and endovascular surgery department. Results: 18 endovascular repairs of aortic aneurysms were performed, of which 15.4% were female (n=6) and 84.6% male (n=12). The average proximal neck diameter in the thoracic aorta was 31 mm, average proximal neck diameter in infrarenal AAA 22.2 mm, average aneurysmal diameter in infrarenal segment 63.8 mm, thoracic 31 mm. Regarding the type of endovascular procedure, 11.1% were repaired with the fenestrated endovascular aneurysm repair (FEVAR) technique, and the same proportion with chimney endovascular aneurysm repair (ChEVAR), for a resolution with conventional EVAR of 77.7%. Complications occurred in 3 patients, 2 of which resulted in type 1a and 1b endoleaks that were reoperated and repaired with a proximal cuff, balloon angioplasty, and embolization of the aneurysmal sac with coils. Conclusions: Aortic aneurysm remains a major cause of death in adults because of aortic rupture despite advances over the past two decades that have been made in the endovascular management of large, symptomatic, and ruptured. Timely treatment is essential to prevent rupture and poor patient outcomes.

4.
Article | IMSEAR | ID: sea-236250

ABSTRACT

Abdominal aortic aneurysms are considered as an unusual cause of extraductal biliary obstruction with less than 30 case studies found within the literature. This case report will discuss an 81-year-old female with an incidental initially asymptomatic finding of extrahepatic biliary obstruction and gallbladder distension secondary to an abdominal aortic aneurysm in routine computed tomography staging scan. Extraductal biliary obstructions can require alternative or additional interventions to that of treatment for intraductal obstruction. Subsequently, the aetiology of biliary obstruction is important for clinicians to consider and recognise, to allow for the implementation of appropriate and timely management.

5.
Rev. colomb. cir ; 39(2): 299-307, 20240220. tab
Article in Spanish | LILACS | ID: biblio-1532686

ABSTRACT

Introducción. El aneurisma de la aorta abdominal (AAA) es la dilatación de la aorta abdominal mayor de 1,5 veces el diámetro esperado. Su prevalencia es variable, con tasas reportadas de hasta el 12,5 %. Se considera como causa de muerte de más de 10.000 personas al año en los Estados Unidos. El objetivo de esta revisión de la literatura fue describir los factores de riesgo y las herramientas de tamizaje de AAA. Métodos. Se realizó una búsqueda de la literatura utilizando dos ecuaciones en bases de datos electrónicas, empleando términos seleccionados de "Medical Subject Heading" (MeSH) y "Descriptores en Ciencias de la Salud" (DeCS). Se evaluó la calidad de los estudios con la herramienta STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). Resultados. Se recolectaron 40 artículos y a partir de ellos se construyó el texto de revisión, identificando en estos, los factores de riesgo asociados al desarrollo de AAA, tales como sexo masculino, tabaquismo, hipertensión arterial, antecedente familiar y obesidad, entre otros. La diabetes mellitus parece actuar como factor protector. Dentro de los instrumentos de tamizaje, el ultrasonido abdominal es uno de los más usados. Conclusión. El AAA es una patología multifactorial. En la actualidad la ultrasonografía de aorta es el método de elección para el tamizaje, permitiendo la detección precoz. El tamizaje de AAA con métodos no invasivos, como el ultrasonido, es útil sobre todo en zonas con prevalencia alta de la patología y en pacientes con determinados factores de riesgo.


Introduction. Abdominal aortic aneurysm (AAA) is a dilation of the abdominal aorta greater than 1.5 times the expected diameter. Its prevalence is variable, with reported rates of up to 12.5%. It is considered the cause of death of more than 10,000 people a year in the United States. The objective of this literature review was to describe risk factors and screening tools for AAA. Methods. A literature search was conducted using two equations in electronic databases, using terms selected from "Medical Subject Heading" (MeSH) and "Descriptors in Health Sciences" (DeCS). The quality of the studies was evaluated with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) tool. Results. Forty articles were collected and from them the review text was constructed, identifying the risk factors associated with the development of AAA, such as male sex, smoking, high blood pressure, family history and obesity, among others. Diabetes mellitus seems to act as a protective factor. Among the screening instruments, abdominal ultrasound is one of the most used. Conclusion. AAA is a multifactorial pathology. Currently, aortic ultrasonography is the method of choice for screening, allowing early detection. Screening for AAA with non-invasive methods, such as ultrasound, is useful especially in areas with a high prevalence of this pathology and in patients with certain risk factors.


Subject(s)
Humans , Mass Screening , Aortic Aneurysm, Abdominal , Computed Tomography Angiography , Aortic Diseases , Tobacco Use Disorder , Ultrasonography
6.
Gac. méd. Méx ; Gac. méd. Méx;160(1): 102-109, ene.-feb. 2024. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1557809

ABSTRACT

Resumen Antecedentes: Existe evidencia escasa en México respecto a la mortalidad y patrones del ingreso hospitalario asociados a aneurismas y disecciones aórticos. Objetivo: Analizar las bases de datos nacionales y describir las características epidemiológicas de diferentes patologías aórticas agudas. Material y métodos: Estudio transversal y observacional de una base de datos retrospectiva, en el que se analizó la mortalidad y hospitalización atribuidas a aneurismas y disecciones aórticos. El análisis estadístico se realizó en Stata 16. Resultados: Se documentaron 6049 muertes en la población general, 2367 hospitalizaciones y 476 muertes intrahospitalarias. Adicionalmente, se encontró una diferencia estadísticamente significativa entre las medias de edad de fallecimiento de la población general (65.5 años) y de los pacientes que murieron en el hospital (64.1 años), p < 0.001. En cuanto a las hospitalizaciones secundarias a aneurisma de aorta abdominal roto, 149 casos fueron evidenciados con una media de edad de 65.6 años; 53 (35.5 %) de estos tenía menos de 65 años, con una media de edad de 47.8 años. Conclusiones: Los reportes epidemiológicos de patología aórtica en México son escasos, por ello la implementación de programas de tamizaje y la detección de patologías aórticas son necesarias para mejorar las disparidades encontradas en este análisis.


Abstract Background: In Mexico, there is a paucity of evidence on mortality and hospitalization patterns associated with aortic aneurysms and dissections. Objective: To analyze national databases and describe the epidemiological characteristics of different acute aortic pathologies. Material and methods: Retrospective, cross-sectional, observational study, in which mortality and hospitalization attributed to aortic aneurysms and dissections were analyzed. Statistical analysis was performed on Stata 16. Results: A total of 6,049 deaths were documented in the general population, which included 2,367 hospitalizations and 476 in-hospital deaths. In addition, a statistically significant difference was found between mean age at death in the general population (69.5 years) and the in-hospital death group (64.1 years), p < 0.001. As for hospitalizations secondary to ruptured abdominal aortic aneurysm, 149 cases were identified, with a mean age of 65.6 years, out of whom 53 (35.5 %) were under 65 years of age, with a mean age of 47.8 years. Conclusions: Epidemiological reports of aortic pathology in Mexico are scarce; therefore, implementation of screening and detection programs for aortic pathologies is necessary in order to address the disparities identified in this analysis.

7.
Article in Chinese | WPRIM | ID: wpr-1021153

ABSTRACT

Objective To determine the time point when porcine pancreatic elastase(PPE)induced abdominal aortic aneurysm(AAA)reaches the regression phase in mice and observe the histological characteristics of AAA in regression phase.Methods AAAs were induced by transient intraluminal infusion of PPE in C57BL/6J mice.The diameters of the mouse abdominal aortas were measured before PPE infusion and sacrifice time,day 14 for AAA progression phase or day 56 for regression phase after PPE infusion,respectively.The histological characteristics of the aneurysm lesion site on day 14 and day 56 after surgery were compared and analyzed.Results The diameters of the abdominal aortas were significantly increased in both day 14 and day 56 after PPE infusion groups(diameter growth rate 147%and 155%,respectively)as compared to the baseline diameters.In the day 14 group,the infused aortas showed typical AAA characteristics,such as elastin break/degradation,medial smooth muscle cells depletion,and inflammatory cell diffused infiltration.In the day 56 group after PPE infusion,although the artery diameter did not change significantly as compared to the day 14 group,histology showed that elastin was partially repaired,new smooth muscle cells were added to the damaged aorta media,the infiltrated inflammatory cells were significantly subsided,and the adventitia neovascularization was reduced,showing a significant feature of the disease regression phase.Conclusion In the PPE-induced mouse AAA model,day 56 after surgery is an appropriate time point for observing aneurysm regression,and the histological characteristics of the regression are obvious.

8.
Article in Japanese | WPRIM | ID: wpr-1040101

ABSTRACT

A 70-year-old man with no outpatient history visited the local doctor with complaints of weakness of the limbs and abdominal pain on the following day after vomiting on the previous night. He was suspected to have a ruptured abdominal aortic aneurysm from a simple CT scan of the abdomen, and was transported to our hospital for emergency treatment. After a contrast-enhanced CT scan at our hospital, a thrombosed type B aortic dissection and ruptured abdominal aortic aneurysm were diagnosed, and emergency surgery was performed on the same day. Although the dissection had extended to the abdominal aortic aneurysm, abdominal aortic endovascular repair (EVAR) was performed because it was a thrombosed type B aortic dissection. After admission to the intensive care unit (ICU), the patient showed intra-abdominal hypertension and oliguria. So, we performed an emergency decompressive laparotomy against abdominal compartment syndrome (ACS). He was discharged from the ICU on the 8th day and transferred to rehabilitation on the 38th day. We report a case of a ruptured abdominal aortic aneurysm associated with thrombosed acute type B aortic dissection that was successfully treated.

9.
Article in Japanese | WPRIM | ID: wpr-1040189

ABSTRACT

A 60-year-old man underwent open surgery for chronic dissecting abdominal aorta accompanied with a horseshoe kidney. Through open laparotomy, the abdominal aortic aneurysm was exposed without revision of the horseshoe kidney. Cold ringer solution was infused to accessory renal arteries for renal protection. After supra-renal clamping, proximal anastomosis was then performed at the level just below the renal arteries. Abdominal cross clamp time at the level of the supra-renal arteries was 23 min. Median and right accessory arteries were reattached with an ischemic time of 73 and 103 min, respectively. Although serum creatine was elevated a preoperative level of 1.17 mg/dl to 3.63 mg/dl at postoperative day 2, that was gradually decreased to nearly preoperative level of 1.25 mg/dl at discharge. Postoperative enhanced CT demonstrated patency of the reattached accessory arteries. The patient was discharged without major complication on postoperative day 21. One year postoperatively, his follow-up course was uneventful without deterioration of renal function.

10.
Article in Japanese | WPRIM | ID: wpr-1040190

ABSTRACT

We report an extremely rare case of an abdominal aortic aneurysm with transient spinal cord ischemia. A 64-year-old male patient presented with a sudden onset of paralysis upon waking up. He was admitted to the emergency department with bilateral lower extremity paralysis. Computed tomography and ultrasonography were performed, and the findings revealed an aneurysmal dilatation. The maximum aneurysm diameter was 65×62 mm. In addition, there was a mural thrombus that was located on the posterior aspect of the wall of the aneurysmal dilatation, and part of the mural thrombus was liquefied. After admission to the hospital, although the symptoms of spinal cord ischemia began to improve, melena was observed the following day. He was subsequently diagnosed with ischemic colitis by an emergency colonoscopy. The mural thrombus had dispersed into the lumbar and internal iliac arteries, and it was postulated that this had been the cause of the spinal cord ischemia and ischemic colitis. Due to an improvement in the spinal cord ischemia and ischemic colitis, he underwent abdominal aortic replacement two weeks later. Spinal cord ischemia and ischemic colitis resolved without recurrence, and he was discharged 13 days post-operatively.

11.
Article in Chinese | WPRIM | ID: wpr-1013592

ABSTRACT

Aim To investigate the effect of long non- coding RNA p21 (LncRNA p21) regulating Hippo- Yes-associated protein (Hippo-YAP) signaling pathway on the formation of abdominal aortic aneurysm (AAA) in mice. Methods C57BL/6 ApoE

12.
Rev. bras. cir. cardiovasc ; Rev. bras. cir. cardiovasc;39(4): e20230350, 2024. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1569619

ABSTRACT

ABSTRACT Mycotic aneurysms of the iliac and other large arteries are rare and are associated with increased morbidity and mortality. Treatment of mycotic aneurysms usually requires modification of the surgical technique done for cases of degenerative or atherosclerotic aneurysms. Degenerative and atherosclerotic fusiform aneurysms are usually managed with aneurysmorrhaphy using a prosthetic graft, which however is not ideal for mycotic aneurysms. Avoidance of prosthetic material at the site of mycotic aneurysm is a better option with higher chances of resolution of infection and favorable patient outcome.

13.
J. Vasc. Bras. (Online) ; J. vasc. bras;23: e20200028, 2024. graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1575138

ABSTRACT

Resumo O aneurisma da aorta abdominal pode representar um desafio terapêutico em várias condições anatômicas, tornando complexo o seu tratamento endovascular. O aneurisma de aorta abdominal justarrenal (AAA-JR) é definido pela ausência de uma zona proximal de fixação no segmento infrarrenal, e, dessa forma, técnicas são utilizadas para obter um colo adequado para a fixação das endopróteses sem promover a oclusão das artérias renais e dos ramos viscerais. As técnicas de stents em paralelo, fenestração em bancada, customização pela indústria e utilização de endoprótese ramificada de prateleira são utilizadas nos aneurismas abdominais com colo proximal inadequado, porém cada técnica apresenta indicação, limitação e riscos. Neste desafio terapêutico, apresenta-se um caso de tratamento endovascular de urgência de um AAA-JR com a técnica de stents em paralelo com boa evolução a médio prazo e discute-se suas opções terapêuticas.


Abstract Abdominal aortic aneurysms can constitute a therapeutic challenge in several anatomical scenarios, making endovascular treatment more complex. A juxtarenal abdominal aortic aneurysm (JR-AAA) is defined by the absence of a proximal landing zone in the infrarenal segment and, therefore, techniques must be used to obtain an adequate neck for fixing the endoprostheses without provoking occlusion of renal arteries and visceral branches. The parallel grafts technique, physician-modified stent-graft, industry customized endoprostheses, and off-the-shelf branched endoprosthesis are techniques used in abdominal aneurysms with inadequate proximal neck, but each technique has its indications, limitations, and risks. In this therapeutic challenge, we present a case of urgent endovascular treatment of a JR-AAA using a parallel grafts technique, with good medium-term results, and discuss the therapeutic options.

14.
J. Vasc. Bras. (Online) ; J. vasc. bras;23: e20240004, 2024. tab
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1582540

ABSTRACT

Resumo Contexto O aneurisma da aorta abdominal (AAA) afeta 4-6 vezes mais frequentemente os homens do que as mulheres, porém nas mulheres o prognóstico costuma ser pior. Objetivo Comparar os procedimentos endovasculares para correção de AAA infrarrenal em homens e mulheres, usando dados de um registro prospectivo. Métodos Esse registro foi feito em cinco hospitais universitários do estado de São Paulo entre 2012 e 2022. Foi realizado um estudo transversal, compilando dados demográficos, anatômicos (diâmetro do aneurisma, colo curto, angulado, calcificado ou com trombo; colo distal < 1,5 cm e artérias ilíacas tortuosas, alteradas), complicações (vazamentos, conversões, perviedade ou estenoses de ramos) e insuficiência renal e mortalidade em 30 dias. Foram utilizados o teste de qui-quadrado e teste t de Student, com significância de 5%. O estudo foi aprovado pelo Comitê de Ética (processo 4040-2011). Resultados Um total de 152 (15,9%) dos pacientes eram mulheres e 799 (84,0%) eram homens (p < 0,05). A maior parte eram brancos (80,2% das mulheres e 87,4% dos homens). Diabetes e hipertensão foram significativamente mais frequentes nas mulheres. O formato foi fusiforme, principalmente nas mulheres (95,39% versus 89,86% nos homens). O diâmetro médio foi menor nas mulheres (5,96 cm versus 6,49 cm; p = 0,0056). As artérias ilíacas foram menos envolvidas nas mulheres (89,40% versus 73,58%; p = 0,00001). A perda sanguínea foi maior nos homens (321,40 ml versus 168,84 ml nas mulheres; p < 0,05). A mortalidade operatória foi similar entre os sexos, mas as obstruções foram mais frequentes nas mulheres (15,2% versus 13,51%; p = 0,017296). Conclusões Nas mulheres, o diâmetro aneurismático foi menor e as complicações obstrutivas foram mais frequentes.


Abstract Background Abdominal aortic aneurysms (AAA) are 4-6 times more frequent among men than among women, but prognosis tends to be worse in women. Objective To compare endovascular procedures to repair infrarenal AAA in men and women, using data from a prospective registry. Methods This registry collected data from five university hospitals in the state of São Paulo (Brazil) from 2012 to 2022. A cross-sectional study was conducted compiling demographic data, anatomic variables (aneurysm diameter, short neck, angulated neck, calcified neck, or thrombosed neck; distal neck < 1.5 cm, and tortuous, abnormal iliac arteries), complications (leaks, conversions, and patency or stenosis of branches) and renal failure and mortality at 30 days. The chi-square test and Student's t test were applied with a 5% significance level. The study was approved by the Ethics Committee (process 4040-2011). Results A total of 152 (15.9%) of the patients were women and 799 (84.0%) were men (p < 0.05). The majority were white (80.2% of the women and 87.4% of the men). Diabetes and hypertension were significantly more frequent among the women. The most prevalent shape was fusiform, particularly among the women (95.39% vs. 89.86% among men). Mean diameter was smaller among the women (5.96 cm vs. 6.49 cm; p = 0.0056). The iliac arteries were less often involved among the women (89.40% vs. 73.58%; p = 0.00001). Blood loss was greater in the men (321.40 ml vs. 168.84 ml among the women; p < 0.05). Operative mortality was similar in both sexes, but obstructions were more frequent among the women (15.2% vs. 13.51%; p = 0.017296). Conclusions Aneurysmal diameter was smaller and obstructive complications were more frequent among women.

15.
Rev. bras. cir. cardiovasc ; Rev. bras. cir. cardiovasc;39(5): e20230434, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1583392

ABSTRACT

ABSTRACT Introduction: Human aortic tissues in vitro are tools to clarify the pathophysiological mechanisms of the cardiovascular system, cell culture, and transplants. Therefore, this study aims to analyze and compare the preservation of human aneurysmatic aortic tissues in three different solutions. Methods: Six human abdominal aortic aneurysms were obtained from patients after surgical ablation. The aorta samples were incubated in different solutions - 0.9% normal physiological saline solution, Ringer's lactate solution, and histidine-tryptophan-ketoglutarate solution (Custodiol®). Segments were collected at 0, 6, 24, and 48 hours. Creatine kinase and nitrate/nitrite were quantified for each incubation time. The tissue's alpha-smooth muscle actin was analyzed by immunofluorescence. Results: There was a significant increase in creatine kinase formation in the normal saline group at 0 and 48 hours and in the Ringer's lactate group at 0 and 48 hours (P=0.018 and P=0.028). The lower levels of creatine kinase and nitrate/nitrite and the aortic tissues' morphological integrity show that histidine-tryptophan-ketoglutarate has better tissue protection. These data suggest that histidine-tryptophan-ketoglutarate induces a protective effect on smooth muscle cells, with less tissue depletion in the aortic aneurysm. Conclusion: This study compared three preservation solutions with the potential for human abdominal aortic aneurysm tissue preservation. The histidine-tryptophan-ketoglutarate solution reduced tissue injury and improved tissue preservation in human abdominal aortic aneurysm tissue samples.

16.
Article in Spanish | LILACS, CUMED | ID: biblio-1565508

ABSTRACT

Introducción: La relación de la presencia de quistes renales y aneurisma de la aorta abdominal es una duda por aclarar, y no se cuenta con literatura al respecto. Objetivo: Estimar la relación entre la presencia de quistes renales y aneurisma de aorta abdominal en pacientes atendidos en el Instituto Nacional de Angiología y Cirugía Vascular. Métodos: Se realizó un estudio descriptivo de corte longitudinal en el período de 2021-2022 en pacientes con diagnóstico clínico y ecográfico de aneurisma de la aorta abdominal. El universo lo conformaron pacientes que asistieron al Departamento de Ultrasonido Doppler con diagnóstico clínico de aneurisma de la aorta abdominal. La muestra estuvo constituida por 152 pacientes; se utilizaron la prueba de Chi cuadrado y el método de estimación del riesgo mediante el cálculo del odds ratio. Resultados: La edad promedio fue de 70,1 ± 5,6 años; el sexo masculino predominó con 27 casos con quiste de un total de 41; el dolor abdominal resultó la manifestación clínica más frecuente (99 casos); y el tabaquismo (97 pacientes) el factor de riesgo cardiovascular que más se presentó. En cuanto a las características ecográficas, predominaron: el aneurisma de la arteria infrarrenal (107 casos), el diámetro muy pequeño con 17 casos y odds ratio de 4,53 se considera de riesgo al igual que toma bilateral de las arterias iliacas con odds ratio de 7,56 (5 casos). Conclusiones: La presencia de aneurisma de la aorta abdominal es independiente de padecer o no quistes renales. Estas dos patologías solo se relacionaron en cuanto a la toma bilateral y diámetro muy pequeño del aneurisma(AU)


Introduction: The relation between the presence of renal cysts and abdominal aortic aneurysm is a question to be clarified, and there is no literature on the subject. Objective: To estimate the relation between the presence of renal cysts and abdominal aortic aneurysm in patients treated at the National Institute of Angiology and Vascular Surgery. Methods: A descriptive longitudinal study was conducted in the period 2021-2022 in patients with a clinical and ultrasound diagnosis of abdominal aortic aneurysm. The universe was made up of patients who attended the Doppler Ultrasound Department with a clinical diagnosis of abdominal aortic aneurysm. The sample consisted of 152 patients. The Chi-square test and the risk estimation method were used to calculate the odds ratio. Results: The mean age was 70.1 ± 5.6 years; males predominated, with 27 cases with cysts out of a total of 41; abdominal pain was the most frequent clinical manifestation (99 cases); and the cardiovascular risk factor that occurred the most was smoking (97 patients). The predominant ultrasound characteristics were: infrarenal artery aneurysm (107 cases) and very small diameter with 17 cases and odds ratio of 4.53; it was considered risky, as it was the bilateral intake of the iliac arteries, with an odds ratio of 7.56 (5 cases). Conclusions: The presence of abdominal aortic aneurysm is independent of whether or not renal cysts are present. These two pathologies were only related in terms of bilateral intake and very small diameter of the aneurysm(AU)


Subject(s)
Humans , Male , Aged
17.
Arch. cardiol. Méx ; Arch. cardiol. Méx;93(4): 422-428, Oct.-Dec. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1527719

ABSTRACT

Abstract Objective: The aim of the study was to compare the immediate and long-term outcomes of endovascular aneurysm repair (EVAR) between patients under and over the age of 80 with abdominal aortic aneurysm (AAA). Methods: From 2011 to 2017, we conducted a retrospective cohort study with AAA patients who received elective EVAR. Primary outcomes included hospital mortality, length of stay, acute kidney injury, and the need for re-interventions. Secondary outcomes included aneurysm-related mortality, acute myocardial infarction, stroke, acute limb ischemia, and prolonged mechanical ventilation. Results: A total of 77 (62.6%) patients under the age of 80 years old and 46 (37.4%) octogenarians were included in the study. The male gender and AAA diameter did not differ among groups (92.2% vs. 82.6%, p = 0.11 and 5.4 cm [4.9-6.2 cm] vs. 5.4 cm [5-6 cm], p = 0.53, respectively). The younger patients had a higher prevalence of tobacco use (72.7% vs. 41.7%, p = 0.01). There were no deaths during the index hospitalization. The incidence of reinterventions (5.3% vs. 15.2%, p = 0.11) and acute kidney injury (14.3% vs. 23.9%, p = 0.18) did not differ between groups, but the length of stay was longer for octogenarian patients (3 days [2-4] vs. 2 days [2-3, p = 0.04]). Endoleaks were the most common cause for re-interventions (81.8%), with a prevalence of 34% across the entire cohort. There were no differences in any of the secondary outcomes between groups. Conclusion: In octogenarian patients with AAA, EVAR represents a safe procedure both during the index hospitalization and during long-term follow-up.


Resumen Objetivo: Comparar los resultados inmediatos y a largo plazo de la reparación endovascular del aneurisma de aorta abdominal (REVA) entre pacientes menores de 80 años y octogenarios. Método: Cohorte retrospectiva que incluyó pacientes con aneurisma de aorta abdominal (AAA) sometidos a REVA electiva desde 2011 hasta 2017. Se evaluaron como punto finales primarios la mortalidad hospitalaria, la duración de la estadía hospitalaria, la incidencia de insuficiencia renal aguda y el requerimiento de reintervenciones. Los puntos finales secundarios incluyeron la mortalidad asociada al aneurisma, infarto agudo de miocardio, accidente cerebrovascular, isquemia arterial aguda de las extremidades y ventilación mecánica prolongada. Resultados: Se incluyeron 77 (62.6%) pacientes menores de 80 años y 46 (37.4%) octogenarios. La prevalencia de sexo masculino y el diámetro del AAA no difirieron entre ambos grupos (92.2% vs. 82.6%, p = 0.11 y 5.4 cm [4.9-6.2 cm] vs. 5.4 cm [5-6 cm], p = 0.53, respectivamente). Los pacientes más jóvenes presentaron una mayor prevalencia de tabaquismo (72.7% vs. 41.7%, p = 0.01). No se registraron muertes durante la hospitalización índice. La incidencia de reintervenciones (5.3% vs. 15.2%, p = 0.11) e insuficiencia renal aguda (14.3% vs. 23.9%, p = 0.18) no difirieron entre ambos grupos, pero la estadía hospitalaria fue más prolongada en pacientes octogenarios (3 días [2-4 días] vs. 2 días [2-3 días], p = 0.04). La causa más frecuente de reintervenciones fue la presencia de endofugas (81.8%), con una prevalencia del 34% en toda la cohorte. No se observaron diferencias en ninguno de los puntos finales secundarios entre ambos grupos. Conclusión: En pacientes octogenarios con AAA, la REVA presentó un buen perfil de seguridad perioperatorio y a largo plazo.

18.
Rev. argent. cardiol ; 91(4): 278-283, nov. 2023. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1535505

ABSTRACT

RESUMEN Introducción: la anatomía arterial es la principal limitante para el abordaje aórtico endovascular estándar. Presentamos nuestra experiencia para la reparación endovascular de aneurismas aórticos complejos. Material y métodos: estudio observacional retrospectivo en pacientes con aneurismas complejos (yuxta/pararrenales y toracoabdominales) tratados en forma consecutiva mediante: endoprótesis fenestradas (FEVAR), ramificadas (BEVAR), con EndoAnchors (ESAR), o en chimenea (ChEVAR). La decisión de la técnica fue determinada con base en la anatomía arterial. Resultados: se evaluaron los últimos 50 procedimientos (6 mujeres; edad promedio 71,3 años; diámetro 69,6mm; 3 pacientes con aneurismas complicados), de los cuales 22 recibieron FEVAR (2,8 fenestraciones / paciente), 11 BEVAR, 11 ESAR y 6 ChEVAR (1,8 chimeneas /paciente). La tasa de éxito técnico fue del 100% (ausencia de endoleak I o III con permeabilidad adecuada de los vasos viscerales). A 30 días 3 pacientes fallecieron (6%). Durante el seguimiento, 5 pacientes presentaron oclusión de la arteria renal, repermeabilizada en 4. Cuatro pacientes desarrollaron un endoleak tipo IA (3 ESAR secundarios y un ChEVAR), un paciente un endoleak IC y un cuarto uno IIIB (22%, 3 de los 11 ESAR, ninguno de los FEVAR industriales). En el análisis de supervivencia, la supervivencia global fue del 88,6% al año, y libre de reoperación del 86,5%. Conclusiones: se trata de la primera publicación en nuestro medio que muestra un enfoque global del paciente con un aneurisma de aorta complejo, de acuerdo con sus características anatómicas. Estas tecnologías ya desempeñan un papel primario en el tratamiento de estos pacientes.


ABSTRACT Background: Arterial anatomy is the main limiting factor for standard endovascular aortic (EVAR) approach. We present our experience for endovascular repair of complex aortic aneurysms. Material and Methods: This is a retrospective observational study in patients with complex aneurysms (juxta/pararenal and thoracoabdominal) treated consecutively with: fenestrated (FEVAR), branched (BEVAR), EndoAnchors (ESAR), or chimney (ChEVAR) stents. The decision of the technique was determined based on the arterial anatomy. Results: The last 50 procedures were evaluated (6 women; mean age 71.3 years; diameter 69.6 mm; and 3 patients with complicated aneurysms), among whom 22 received FEVAR (2.8 fenestrated stents/patient), 11 BEVAR, 11 ESAR and 6 ChEVAR (1.8 chimney stents/patient). Technical success rate was 100% (absence of type I or III endoleak with adequate patency of the visceral vessels). Three patients died within the first 30 days (6%). During follow-up, 5 patients presented with renal artery occlusion, treated successfully in 4 cases. Four patients developed type IA endoleak (3 secondary ESAR and one ChEVAR), one patient IC endoleak and almost a quarter of cases type IIIB endoleak (22%, 3 out of 11 patients receiving ESAR, none of the industrial FEVAR group). In survival analysis, overall survival analysis was 88.6% at one year, and 86.5% of cases were free from reoperation. Conclusions: This is the first publication in our setting that shows a global approach to the patient with complex aortic aneurysm, according to the anatomical characteristics. These technologies already play a primary role in the treatment of these patients.

19.
Rev. argent. cardiol ; 91(3): 225-230, oct. 2023. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1535487

ABSTRACT

RESUMEN El aneurisma de aorta abdominal (AAA) sintomático no roto es una patología que involucra a aquellos pacientes con AAA intacto, pero que presentan dolor abdominal y/o lumbar atribuido al aneurisma. Esta forma de presentación clínica es po tencialmente mortal dado que su etiopatogenia comprende cambios agudos en la pared aórtica, incluyendo inflamación, lo que incrementa la probabilidad de ruptura inminente. Está claro que estos pacientes deben ser derivados a reparación del AAA. Sin embargo, el momento de la intervención es controvertido. Por lo tanto, el objetivo del presente trabajo fue revisar la información actualizada sobre el abordaje diagnóstico-terapéutico del AAA sintomático no roto.


ABSTRACT Symptomatic unruptured abdominal aortic aneurysm (AAA) refers to a group of patients with intact AAA but who present abdominal and/or lumbar pain attributed to the aneurysm. This form of clinical presentation is potentially fatal since its etiopathogenesis, involving acute changes in the aortic wall, including inflammation, increases the probability of impending rupture. It is clear that these patients should be referred to AAA repair. However, the timing of the intervention is contro versial. Therefore, the aim of the present work was to review updated information on the diagnostic-therapeutic approach of symptomatic unruptured AAA.

20.
Journal of Medical Biomechanics ; (6): E472-E478, 2023.
Article in Chinese | WPRIM | ID: wpr-987973

ABSTRACT

Objective To study the effects of aneurysmal neck angle on stent displacement after endovascular repair of abdominal aortic aneurysm (AAA). Methods The CT images of 28 patients were selected to establish preoperative AAA model, postoperative AAA model and covered stent model respectively, and the models were divided into non-severe angulation group ( n = 14) and severe angulation group ( n = 14) according to the preoperative angle of tumor neck. The geometric shape of each model was measured, and the changes of AAA geometric parameters and postoperative stent displacements before and after surgery were analyzed. The displacement force of the model during the first follow-up was calculated by hemodynamic simulation. Results Significant differences were found in tumor length, maximum diameter, displacement force, tumor neck length and tumor volume between two groups of patients (P 0. 05). For the incidence of internal leakage, there were 2 cases in non-severe angulation group and 4 cases in severe angulation group (P>0. 05).Conclusions Severe neck angulation can lead to a significant increase in support displacement force and decrease in proximal anchorage zone, and thus increase the possibility of support displacement. It is suggested that doctors should strengthen postoperative follow-up for patients with severe neck angulation and be vigilant of the occurrence of long-term internal leakage in clinic.

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