RESUMEN
OBJECTIVES: Our aim was to assess the feasibility and efficacy of the Cardiatis multilayer flow modulator in the treatment of complex aorta aneurysms. METHODS: This is a single-center prospective registry. Six patients (4 males and 2 females; mean age 74 years) with complex aorta aneurysms (unsuitable for endovascular repair with standard, fenestrated, or branched stent grafts) were treated with the Cardiatis multilayer flow modulator. RESULTS: Clinical success was 100%. Median follow-up was 10 months. One patient died the third postoperative day due to aneurysm rupture. Four aneurysms were completely thrombosed between 1 and 6 months after the procedure. The patency of the covered aortic branches was 100%. At 6 months, the sac volume was decreased in two patients, increased in two patients and remains stable in one patient. There were no stent migrations, retractions, thrombosis, fractures, or reinterventions. CONCLUSIONS: The device preserves flow into the covered aortic branches and completed aneurysm thrombosis occurs gradually; however, the stent did not prevent rupture immediately after the implantation. Longer follow-up is mandatory to prove the efficacy of this technology.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Stents , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Abdominal/fisiopatología , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/mortalidad , Aneurisma de la Aorta Torácica/fisiopatología , Rotura de la Aorta/etiología , Rotura de la Aorta/mortalidad , Aortografía/métodos , Bélgica , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Diseño de Prótesis , Flujo Sanguíneo Regional , Sistema de Registros , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The BRAVISSIMO study is a prospective, non-randomized, multi-center, multi-national, monitored trial, conducted at 12 hospitals in Belgium and 11 hospitals in Italy. This manuscript reports the findings up to the 12-month follow-up time point for both the TASC A&B cohort and the TASC C&D cohort. The primary endpoint of the study is primary patency at 12 months, defined as a target lesion without a hemodynamically significant stenosis on Duplex ultrasound (>50%, systolic velocity ratio no greater than 2.0) and without target lesion revascularization (TLR) within 12 months. Between July 2009 and September 2010, 190 patients with TASC A or TASC B aortoiliac lesions and 135 patients with TASC C or TASC D aortoiliac lesions were included. The demographic data were comparable for the TASC A/B cohort and the TASC C/D cohort. The number of claudicants was significantly higher in the TASC A/B cohort, The TASC C/D cohort contains more CLI patients. The primary patency rate for the total patient population was 93.1%. The primary patency rates at 12 months for the TASC A, B, C and D lesions were 94.0%, 96.5%, 91.3% and 90.2% respectively. No statistical significant difference was shown when comparing these groups. Our findings confirm that endovascular therapy, and more specifically primary stenting, is the preferred treatment for patients with TASC A, B, C and D aortoiliac lesions. We notice similar endovascular results compared to surgery, however without the invasive character of surgery.
Asunto(s)
Arteria Ilíaca , Enfermedad Arterial Periférica/terapia , Stents , Adulto , Anciano , Anciano de 80 o más Años , Aleaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/patología , RecurrenciaRESUMEN
Malignant tumors arising in deep veins of the lower extremities are very uncommon. To our best knowledge, this is the seventh case of a primary venous intravascular synovial sarcoma (SS) reported in literature. A 32-year-old woman was admitted with a second episode of deep venous thrombosis of the right lower limb and pulmonary embolism. Physical and radiological examinations showed besides the thrombosis a tumor arising from the right common femoral vein involving the bifurcation of the common femoral artery. At surgery, en block resection of the tumor including the deep femoral vein and arterial bifurcation was done with an arterial reconstruction using a synthetic graft. Histopathological examination revealed an intravascular SS of the common femoral vein. The mainstay of curative therapy is complete surgical resection of all tumor manifestations with negative histological margins.
Asunto(s)
Vena Femoral/patología , Embolia Pulmonar/etiología , Sarcoma Sinovial/complicaciones , Neoplasias Vasculares/complicaciones , Trombosis de la Vena/etiología , Adulto , Anticoagulantes/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Implantación de Prótesis Vascular , Quimioterapia Adyuvante , Epirrubicina/administración & dosificación , Femenino , Vena Femoral/cirugía , Humanos , Ifosfamida/administración & dosificación , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Sarcoma Sinovial/patología , Sarcoma Sinovial/terapia , Medias de Compresión , Resultado del Tratamiento , Neoplasias Vasculares/patología , Neoplasias Vasculares/terapia , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/terapiaRESUMEN
BACKGROUND: To investigate whether the indication for the first revascularization (diabetic foot, acute ischaemia, aneurysmal disease, chronic occlusive disease) determines the surgical history and survival time in amputated limbs. METHODS: The surgical history of lower extremities amputated between 2002 and 2009 was reviewed for the number of (endo)vascular procedures, minor amputations, wound debridements, complications requiring surgery (acute ischaemia, bleeding, graft infection) and limb survival time (LST). RESULTS: 100 limbs were included in the study. The four groups underwent a similar number of surgical procedures (mean 4.1). Diabetic foot limbs had fewer revascularizations (mean 1.3, p = 0.003) and complications (mean 0.1, p = 0.005), but more minor amputations and wound debridements (mean 1.3, p = 0.002), in a significantly shorter LST (mean 555 days, p = 0.003). Acute ischaemic limbs showed the shortest LST (mean 179 days, p = 0.003) and significantly more complications (mean 0.8, p = 0.005). Limbs initially treated for aneurysmal disease or chronic occlusive disease had the highest number of revascularizations (mean resp. 2.7 and 2.6) and the longest LST (mean resp. 1669 and 1459 days, p = 0.001). Limbs with advanced chronic occlusive disease (rest pain or gangrene) presented with fewer revascularisations (mean resp. 2.5 and 1.8, p = 0.01) and a shorter LST (mean resp. 1284 and 794 days, p = 0.004) compared to claudicants. CONCLUSIONS: Our study suggests that the surgical history and limb survival in amputated limbs is disease and stage specific, and determined by the indication of the first revascularisation.
Asunto(s)
Amputación Quirúrgica , Arteriopatías Oclusivas/cirugía , Pie Diabético/cirugía , Isquemia/cirugía , Pierna/irrigación sanguínea , Pierna/cirugía , Procedimientos Quirúrgicos Vasculares , Enfermedad Aguda , Anciano , Arteriopatías Oclusivas/complicaciones , Enfermedad Crónica , Desbridamiento , Pie Diabético/complicaciones , Femenino , Humanos , Isquemia/complicaciones , Masculino , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
A 68-year-old man underwent carotid endarterectomy for symptomatic carotid artery stenosis. Immediately after surgery the patient suffered dramatic neurological deterioration, due to massive cerebral bleeding. Pathological examination revealed cerebral amyloid angiopathy. This condition is known to predispose to spontaneous, as well as anticoagulation induced, cerebral haemorrhage. Surgical intervention needing anticoagulation in elderly patients at risk for congophilic angiopathy should be performed with extreme caution.
Asunto(s)
Arteria Carótida Interna , Estenosis Carotídea/cirugía , Angiopatía Amiloide Cerebral/complicaciones , Hemorragia Cerebral/etiología , Endarterectomía Carotidea/efectos adversos , Anciano , Estenosis Carotídea/complicaciones , Angiopatía Amiloide Cerebral/diagnóstico , Resultado Fatal , Humanos , MasculinoRESUMEN
The aim of this report is to describe the steps we followed to build up laparoscopic experience progressively towards total laparoscopic aorta surgery. The techniques of retroperitoneoscopic lumbar sympathectomy, hand-assisted laparoscopic aorta surgery and total laparoscopic aorta surgery are discussed and illustrated. Surgical tips and tricks and advice concerning selection of patients and surgical techniques are proposed. The 30-day morbidity and mortality rates of laparoscopic, standard open and endovascular abdominal aorta aneurysm repair were compared.
Asunto(s)
Aorta Abdominal/cirugía , Implantación de Prótesis Vascular , Educación de Postgrado en Medicina , Laparoscopía , Plexo Lumbosacro/cirugía , Espacio Retroperitoneal/cirugía , Simpatectomía , Adulto , Anciano , Anciano de 80 o más Años , Animales , Aneurisma de la Aorta Abdominal/cirugía , Enfermedades de la Aorta/cirugía , Arteriopatías Oclusivas/cirugía , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/educación , Implantación de Prótesis Vascular/métodos , Implantación de Prótesis Vascular/mortalidad , Competencia Clínica , Curriculum , Femenino , Humanos , Laparoscopía/efectos adversos , Laparoscopía/mortalidad , Aprendizaje , Masculino , Persona de Mediana Edad , Modelos Animales , Desarrollo de Programa , Simpatectomía/educación , Simpatectomía/métodosRESUMEN
AIM: There is evidence to suggest an inverse association between serum levels of testosterone and coronary heart disease. The aim of this study was to compare endogenous sex hormone levels of men with severe internal carotid artery (ICA) atherosclerosis with age-matched controls. METHODS: Metabolic parameters and sex hormones were measured or calculated in 124 male patients undergoing carotid endarterectomy for high grade ICA stenosis and in 124 age-matched male controls. The presence or absence of atherosclerotic stenosis of ICA was determined by high resolution B-mode ultrasound. RESULTS: The cases had statistically significant lower levels of total testosterone (TT) (medians: 3.8 microg/L versus 4.3 microg/L, P=0.005) and sex hormone binding globulin (SHBG) (means: 39.8+/-17.2 versus 54.3+/-34.3 nmol/L, P<0.001) compared to controls. Multivariate linear regression analysis, adjusted for all clinical and physiologic parameters, showed a significant inverse association between ICA stenosis and TT (b=-0.158, P=0.013) and SHBG (beta=-0.259, P<0.001). CONCLUSION: This study provides evidence of a positive association between low serum androgen levels and severe ICA atherosclerosis in men. It suggests that higher, but physiological, levels of androgens could have a protective role in the development of atherosclerosis.
Asunto(s)
Enfermedades de las Arterias Carótidas/sangre , Arteria Carótida Interna , Testosterona/sangre , Anciano , Anciano de 80 o más Años , Arteria Carótida Interna/patología , Estudios de Casos y Controles , Humanos , Modelos Lineales , Masculino , Persona de Mediana EdadRESUMEN
AIM: Present knowledge about the epidemiology and the distribution of the cardiovascular risk factors of carotid artery atherosclerosis is limited. The aim of the study was to detect possible gender differences in cardiovascular risk factors in carotid endarterectomy patients. METHODS: Between 1998 and 2003 the cardiovascular risk factors of 804 consecutive isolated carotid endarterectomies were prospectively recorded. The data of 567 men and 237 women were compared and subgroup analysis of young and old male and female subjects was performed. RESULTS: The number of cardiovascular risk factors per patient is higher in men, hypertension is more predominant in women, tobacco use is twice as often present in men. The most frequent risk factors are, in men, tobacco use and hypertension, and, in women, hypertension and hyperlipidemia. The most frequent combination in the male group is tobacco/hypertension/hyperlipidemia and in the female group hypertension/hyperlipidemia. The gender differences were more striking in patients younger than 75 years, after this age the number of cardiovascular risk factor per patient declined in both sexes, the number of smokers decreased but remains higher in men, diabetes is more frequent in women and hypertension and hyperlipidemia become the important risk factors in men as well in women. CONCLUSIONS: There are gender differences in the distribution and in the combinations of cardiovascular risk factors in our selected patients. These findings suggest that screening for carotid artery atherosclerosis should particularly be aimed at people with the combinations of risk factors described above.
Asunto(s)
Arteria Carótida Común/cirugía , Estenosis Carotídea/epidemiología , Estenosis Carotídea/cirugía , Endarterectomía Carotidea , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Estenosis Carotídea/complicaciones , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hiperlipidemias/complicaciones , Hiperlipidemias/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Factores Sexuales , Fumar/epidemiologíaRESUMEN
PURPOSE: The present study was undertaken in order to assess the 30-day complication rate of carotid endarterectomy (CEA) in relation to the patients' cardiovascular risk factors. METHODS: Cardiovascular risk factors, operative details, morbidity and mortality of 1002 carotid endarterectomies in 852 patients were prospectively recorded in a database. The indications for surgery were asymptomatic >or=75% or symptomatic >or=50% internal carotid stenosis when other causes of stroke were excluded. Exclusion criteria were intervention for post-CEA restenosis, post-irradiation lesions, kinking of the internal carotid artery, external carotid artery stenosis, endovascular and simultaneous cardiac procedures. RESULTS: The 30-day combined minor and major stroke and death rate was 2.7% (27/1002). Significant risk factors in logistic regression model were diabetes (stroke and death rate=5.7%, p=0.002, OR=3.31), the simultaneous presence of three cardiovascular risk factors (stroke and death rate=5.3%, p=0.012, OR=3.11) and the combination diabetes, hypertension and hyperlipidemia (stroke and death rate=9.4%, p=0.001, OR=4.22). CONCLUSIONS: Traditional cardiovascular risk factors significantly affect the 30-day stroke and death rate after carotid endarterectomy.
Asunto(s)
Estenosis Carotídea/cirugía , Endarterectomía Carotidea , Complicaciones Posoperatorias , Accidente Cerebrovascular/etiología , Adulto , Anciano , Anciano de 80 o más Años , Bélgica/epidemiología , Estenosis Carotídea/complicaciones , Complicaciones de la Diabetes/complicaciones , Femenino , Humanos , Hiperlipidemias/complicaciones , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Estudios Prospectivos , Factores de Riesgo , Fumar , Accidente Cerebrovascular/mortalidad , Tasa de SupervivenciaRESUMEN
PURPOSE: To describe our technique and one year clinical experience with laparoscopic hand-assisted abdominal aortic surgery for aneurysmal and occlusive disease. PATIENTS AND METHODS: Between June 2001 and May 2002, 13 patients underwent a laparoscopic hand-assisted abdominal aortic operation. RESULTS: The median operating time and aortic cross-clamp time were 230 and 29 minutes respectively. The median intra-operative blood loss was 625cc. There were no peri-operative (30 day) deaths. The conversion to open surgery ratio was 1/13. One major arterial and one systemic complication occurred. Median hospital stay was 6 days (range 4-42 days). CONCLUSION: Laparoscopic hand-assisted abdominal aortic surgery for aneurysmal and occlusive disease is technically feasible and safe. The use of this laparoscopic technique combines the advantage of minimally invasive surgery and the reliability of an established open procedure without the risk of endoleaks in aneurysm surgery.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Arteriopatías Oclusivas/cirugía , Implantación de Prótesis Vascular/métodos , Laparoscopía , Anciano , Estudios de Factibilidad , Femenino , Humanos , Claudicación Intermitente/cirugía , Tiempo de Internación , Masculino , Persona de Mediana EdadRESUMEN
Spontaneous abdominal aortic dissection is a rare entity, often with a clinically unspecific presentation. The cause of the dissection is unclear. Angiography used to be the definitive diagnostic study, but today a correct diagnosis can be achieved with CT scanning and magnetic resonance angiography. The optimal form of management for the individual patient is not clearly established. Chronic dissections may best be managed conservatively, with close follow-up achieved with CT scanning and magnetic resonance. Acute and complicated dissections should be treated surgically with aortic and aortic branch replacement if it can be offered with low morbidity and mortality. In selected cases, resection of the ischemic organs may represent an alternative.
Asunto(s)
Aorta Abdominal/lesiones , Aneurisma de la Aorta Abdominal/diagnóstico , Disección Aórtica/diagnóstico , Rotura Espontánea/diagnóstico , Enfermedad Aguda , Anciano , Disección Aórtica/terapia , Aneurisma de la Aorta Abdominal/terapia , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Rotura Espontánea/terapia , Tomografía Computarizada por Rayos XRESUMEN
After carotid endarterectomy under general anaesthesia, the rapid elimination of desflurane and sevoflurane may allow earlier postoperative neurological assessment than after the use of isoflurane. However, desflurane may be associated with tachycardia and hypertension and may therefore increase cardiovascular risk. We investigated haemodynamic and recovery characteristics in patients scheduled for carotid endarterectomy who were anaesthetised with isoflurane, sevoflurane or desflurane. No significant peri-operative differences were noted in cardiac index or ST segment analysis. The times to extubation, movement on command and consciousness were shorter after desflurane and sevoflurane than after isoflurane anaesthesia. Postoperative pain, nausea, vomiting and shivering were similar in the three study groups.
Asunto(s)
Anestésicos por Inhalación/farmacología , Endarterectomía Carotidea , Anciano , Periodo de Recuperación de la Anestesia , Cognición/efectos de los fármacos , Desflurano , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Isoflurano/análogos & derivados , Isoflurano/farmacología , Tiempo de Internación , Masculino , Éteres Metílicos/farmacología , Persona de Mediana Edad , Movimiento/efectos de los fármacos , Complicaciones Posoperatorias , SevofluranoRESUMEN
Arterial aneurysms and pseudo-aneurysms are a rare but recognized cause of obstetric hemorrhage. Diagnosis during pregnancy, prior to rupture, is exceptional. We report the first case of diagnosis and treatment of an uterine artery pseudo-aneurysm during pregnancy.
Asunto(s)
Aneurisma Falso/diagnóstico , Aneurisma Falso/terapia , Complicaciones Cardiovasculares del Embarazo , Útero/irrigación sanguínea , Adulto , Angiografía , Arterias , Cesárea , Embolización Terapéutica , Femenino , Fertilización In Vitro , Edad Gestacional , Humanos , Angiografía por Resonancia Magnética , Embarazo , Ultrasonografía Doppler en Color , Hemorragia UterinaAsunto(s)
Quistes/etiología , Claudicación Intermitente/cirugía , Vena Safena/trasplante , Trasplante de Tejidos/efectos adversos , Anciano , Quistes/diagnóstico por imagen , Quistes/cirugía , Estudios de Seguimiento , Rechazo de Injerto , Humanos , Masculino , Resultado del Tratamiento , Ultrasonografía , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/etiología , Enfermedades Vasculares/cirugía , Grado de Desobstrucción VascularRESUMEN
PURPOSE: To describe our technique and clinical experience of retroperitoneoscopic lumbar sympathectomy with balloon dissection. PATIENTS AND METHODS: From 1995 to 1999, 23 procedures were performed. RESULTS: No complications were noted. The median hospital stay was 4 days. Of the 23 attempts, 2 had to be converted to open technique. Histologic examination demonstrated interruption of the sympathetic chain in 22 of the 23 cases and absence of nervous tissue in 1. CONCLUSIONS: Once the technique is mastered, it can be performed fast, and it offers patients the benefits of a minimally invasive approach without the inconsistent therapeutic results of chemical sympathectomy.
Asunto(s)
Laparoscopía/métodos , Plexo Lumbosacro/cirugía , Simpatectomía/métodos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Espacio RetroperitonealRESUMEN
In this case we present a woman with arterial hypertension. Further examination showed an unilateral hydronephrosis caused by extrinsic compression. A tumoral mass, invading the caval inferior vein and the renal vein, is the very origin of the compression. This mass is a recidive of an endometrial stromal sarcoma for which she had a hysterectomy in 1984.
Asunto(s)
Neoplasias Endometriales/complicaciones , Hidronefrosis/etiología , Recurrencia Local de Neoplasia/complicaciones , Sarcoma Estromático Endometrial/complicaciones , Femenino , Humanos , Hipertensión/etiología , Persona de Mediana Edad , Invasividad Neoplásica , Células Neoplásicas Circulantes/patología , Venas Renales/patología , Sarcoma Estromático Endometrial/patología , Neoplasias Vasculares/patología , Vena Cava Inferior/patologíaRESUMEN
Two previously healthy patients were admitted for chest pain, haemoptysis and dyspnoea. Perfusion-ventilation lung scanning demonstrated pulmonary embolism. Lower extremity duplex imaging and contrast venography revealed a thrombosed popliteal vein aneurysm as the source of emboli. After immediate anticoagulant therapy, the thrombo-embolic source was excluded by aneurysmectomy with lateral venography in the first patient. The second patient was treated by anticoagulants and percutaneous vena cava inferior filter placement to prevent recurrent pulmonary embolism. Anatomopathological findings, possible origin, diagnostic modalities and medical and surgical treatment of popliteal vein aneurysm are discussed.