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1.
Vasc Endovascular Surg ; 50(5): 317-20, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27206744

RESUMEN

OBJECTIVES: The initial survival advantage seen with endovascular aneurysm repair (EVAR) over open repair does not persist in the long term. Pulse wave velocity (PWV) is a measure of arterial stiffness, and increased PWV is an independent risk factor for increased cardiovascular morbidity and mortality. This prospective comparative pilot study examined the effect of implantation of an aortic graft on PWV in patients undergoing open or endovascular aortic aneurysm repair. PATIENTS AND METHODS: Thirty-four patients (15 open and 19 EVAR) were recruited. Patient demographics were similar in both the groups. Pulse wave velocity was calculated for all patients preoperatively and postoperatively using a standardized technique on a Philips IU22 Vascular Ultrasound machine and the results compared. RESULTS: An increase in mean PWV following EVAR was demonstrated. The mean postprocedure PWV of 9.7 (± 4.5) cm/sec detected in the open group was significantly lower than the elevated 12.2 (± 4.5) cm/sec detected in the EVAR group. The surgical group also demonstrated a mean decrease of 0.2 (± 4.9) cm/sec in PWV following open repair compared to a mean increase of 3.3 (± 3.7) cm/sec in the EVAR group. CONCLUSION: EVAR patients have a significantly higher postoperative PWV measurement than those undergoing open abdominal aortic aneurysm repair. Patients who have undergone EVAR may be at a higher risk of cardiovascular morbidity in the long term. A larger scale study with a longer prospective follow-up is required.


Asunto(s)
Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Procedimientos Endovasculares/efectos adversos , Rigidez Vascular , Anciano , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/fisiopatología , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/fisiopatología , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Masculino , Proyectos Piloto , Estudios Prospectivos , Análisis de la Onda del Pulso , Factores de Riesgo , Stents , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler
2.
Vasc Endovascular Surg ; 48(2): 111-5, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24347280

RESUMEN

BACKGROUND: Regression of the residual sac is indicative of successful endovascular aortic aneurysm (EVAR) repair. Using color duplex ultrasound (CDU), we monitored the residual aneurysm sac following EVAR and correlated sac behavior with perioperative risk factors. METHODS: Of 145 patients with EVAR, 106 (73.1%) patients between January 01, 2003, and July 01, 2010, had at least 2 consecutive postoperative scans and thus were eligible for inclusion. Mean (± standard deviation [SD]) CDU scans per person was 4.6 (± 1.4). All were conducted by the same technologist using a standard protocol on the same machine. Aneurysm sac change in centimeters and percentage terms was calculated. The presence or absence of an endoleak was also recorded. Change in aneurysm sac size was correlated with preoperative risk factors. FINDINGS: Mean sac size change at 1 month was a decrease of 0.24 cm, equating to a percentage change of 4.3%. At 7 months, the decrease was 0.59 cm (9.8%), at 12 months, 0.73 cm (12.4%), at 18 months 0.92 cm (15.8%), and at 36 months 1.0 cm (16.6%). Both univariate and multivariate analyses demonstrated that statin therapy (P = .002) was the only risk factor variable positively associated with aneurysm regression while the presence of an endoleak was inversely related to sac reduction (P = .01). INTERPRETATION: Maximum aneurysmal sac reduction seems to occur in the first year following endograft implantation. Statin therapy appears to be associated with an increased likelihood of sac regression following EVAR. Further investigation of the role of statins in the biology of abdominal aortic aneurysmal disease is warranted.


Asunto(s)
Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta/diagnóstico , Implantación de Prótesis Vascular/efectos adversos , Endofuga/etiología , Procedimientos Endovasculares/efectos adversos , Femenino , Humanos , Masculino , Análisis Multivariante , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler en Color
3.
Surgeon ; 10(4): 206-10, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22818278

RESUMEN

BACKGROUND: Management of patients with severe concomitant carotid and coronary disease remains controversial. We report our experience of combined carotid endarterectomy (CEA) and coronary artery bypass surgery (CABG) over a fifteen year period using strict patient selection criteria. METHODS: From 1st January 1995 to December 31st 2009 165 patients underwent combined CABG/CEA procedures at the Mater Hospital. Mean age was 68.2 years (range 43-88) and 127 (77%) were male. Fifty-three (32%) had symptomatic carotid disease. Indications for combined procedures were the presence of symptomatic >70% or asymptomatic >80% internal carotid artery stenosis in a patient requiring urgent CABG because of either unstable angina, recent MI, severe triple vessel disease or severe Left Anterior Descending or Left Main Stem stenosis. RESULTS: Thirty-day stroke and death rate was 3%. All neurological events were in the hemisphere contralateral to the carotid surgery and symptoms had completely resolved prior to discharge from hospital. One patient required evacuation of a cervical haematoma and there were two transient XII nerve palsies. CONCLUSION: Combined CEA/CABG can be performed safely with acceptable morbidity and mortality in patients selected in accordance with strict criteria in a centre with a large experience of both cardiac and carotid surgery.


Asunto(s)
Estenosis Carotídea/cirugía , Puente de Arteria Coronaria/métodos , Enfermedad de la Arteria Coronaria/cirugía , Endarterectomía Carotidea/métodos , Selección de Paciente , Adulto , Anciano , Anciano de 80 o más Años , Estenosis Carotídea/complicaciones , Enfermedad de la Arteria Coronaria/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
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