Asunto(s)
Aneurisma de la Aorta Abdominal , Aneurisma de la Aorta Torácica , Procedimientos de Cirugía Plástica , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/epidemiología , Aneurisma de la Aorta Torácica/cirugía , Humanos , Incidencia , Procedimientos Quirúrgicos VascularesRESUMEN
Purpose: To analyze aortic wall penetration of Heli-FX EndoAnchors after use in seal zones in the aortic arch or descending thoracic aorta during thoracic endovascular aortic repair (TEVAR). Materials and Methods: From May 2014 to May 2019, 25 patients (mean age 70.5±10 years; 16 women) were treated with TEVAR and adjunctive use of the Heli-FX device in 3 academic vascular surgery departments. Computed tomography scans were retrospectively reviewed to determine the location [arch or descending thoracic aorta (DTA)] of the EndoAnchors and the adequacy of aortic wall penetration, defined as adequate (≥2 mm), partial (<2 mm), or inadequate wall penetration (including loss). Endoleaks, reinterventions, and mortality were assessed. Results: A total of 161 EndoAnchors were deployed (median 7 per patient, range 4-9). Twenty-two EndoAnchors were place in the arch (zones 0-2) and 139 in the DTA (zones 3-5). A larger proportion of arch deployments (27%) had suboptimal penetration compared with the DTA (6.5%; p<0.005), resulting in a 91% adequate wall penetration rate for the series overall. Three EndoAnchors were lost (and only 1 retrieved) in 3 different patients, with no additional morbidity; thus, an overall deployment success rate of 88% was achieved. At a mean follow-up of 16.6±14 months, 4 patients required 5 (successful) reinterventions, including one for a type Ia endoleak treated with chimney TEVAR. One patient died 10 months after treatment due to endograft infection, without an opportunity for surgical correction. Conclusion: EndoAnchors have a higher risk of maldeployment in the arch, though this may be attributable to the small learning curve experience in this location. The best aortic wall penetration for this series was in the DTA, where EndoAnchors proved useful for distal endograft fixation during TEVAR.
Asunto(s)
Aneurisma Falso/cirugía , Aorta Torácica/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 Falso/diagnóstico por imagen , Aneurisma Falso/mortalidad , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/mortalidad , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Endofuga/etiología , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Femenino , Migración de Cuerpo Extraño/etiología , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Endovascular treatment of complex aortoiliac disease is seeing a growing popularity despite the Trans-Atlantic Inter-Society Consensus (TASC) II recommendations for open surgery in this cases. However, the available evidence does not focus particularly on patients with complete unilateral iliac axis obstruction (CIAO) (TASC II D4 group). This study reports mid-term results of endovascular therapy with covered stents for CIAO. METHODS: This is single-center retrospective review of patients with CIAO endovascular treatment from January 2015 to December 2017 (3 years). Two types of covered stents were used, alone or combined: the Viabahn self-expandable stent (W. L. Gore, Flagstaff, AZ) and the Advanta V12 balloon-expandable stent (Atrium-Maquet, Hudson, NH). Thirty-day outcomes, long-term patency (assessed with Kaplan-Meier estimates), in-hospital stay, and limb salvage were analyzed. RESULTS: Thirty-nine patients with CIAO were treated in the period (87.2% male, mean age 64.3 ± 9 years). A majority presented with critical limb ischemia (56.4%, n = 22). Recanalization could be accomplished from an ipsilateral or contralateral femoral access in 82.1% of patients (1 case needed the use of a re-entry device), and from a left brachial access in 17.9%. Technical success was 100%. About 66.7% of cases received an aortic kissing stent technique. Common femoral artery/profundoplasty with prosthetic or bovine patch was associated with 74.3% of cases. Thirty-day mortality was 2.6% (1/39). Primary, assisted, and secondary patency rates at 24 months were all 96.8%. Mean in-hospital stay was 5 days; no limb loss was registered during follow-up. CONCLUSIONS: Endovascular treatment of complete iliac axis occlusions can offer comparable midterm patency rates to open surgery aortoiliac femoral bypass, when an adequate combination of balloon and self-expandable covered stents is used and an appropriate outflow through the common femoral artery is warranted.
Asunto(s)
Angioplastia de Balón/instrumentación , Arteria Ilíaca , Isquemia/terapia , Enfermedad Arterial Periférica/terapia , Stents , Anciano , Angioplastia de Balón/efectos adversos , Constricción Patológica , Enfermedad Crítica , Bases de Datos Factuales , Femenino , Humanos , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/fisiopatología , Isquemia/diagnóstico por imagen , Isquemia/fisiopatología , Recuperación del Miembro , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Diseño de Prótesis , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano , Aneurisma/etiología , Vena Safena/trasplante , Injerto Vascular/efectos adversos , Aneurisma/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Ultrasonografía DopplerRESUMEN
PURPOSE:: Endograft infection is an infrequent but one of the most serious and challenging complications after endovascular aortic repair. The aim of this study was to assess the management of this complication in a tertiary center. CASE SERIES:: A retrospective analysis of a prospective database was performed including all patients who underwent elective endovascular abdominal aortic repair (EVAR) from 2003 to 2016 in a tertiary center. Seven cases of endograft infection were identified during the follow-up period from a total of 473 (1.48%) EVAR. Most frequent symptoms at presentation were fever (71.4%) and lumbar pain (57.1%). One case developed an early infection, while 6 cases were diagnosed as late infections. Mean time from endograft placement to symptom presentation was 28.3 months (2-91.5 months). Gram-positive cocci were the microorganisms most commonly isolated in blood cultures (66%). Two cases were managed with endograft removal and aortic reconstruction with a cryopreserved allograft, 2 cases with surgical drainage, and 2 cases exclusively with antibiotic therapy. In 1 case, the diagnosis was performed postoperatively based on intraoperative findings associated with positive graft cultures; and graft explantation was performed with "in situ" reconstruction using a Dacron graft. Perioperative mortality was 42.9%. One-year mortality was 57.1%. Mean follow-up was 21.5 months. CONCLUSION:: Endograft explantation is the gold standard of treatment; however, given the overall high morbi-mortality rates of this pathology, a tailored approach should always be offered depending on the patient's overall condition. Conservative management can be an acceptable option in those patients with short life expectancy and high surgical risk.
Asunto(s)
Antibacterianos/uso terapéutico , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Prótesis Vascular/efectos adversos , Tratamiento Conservador/métodos , Remoción de Dispositivos , Procedimientos Endovasculares/efectos adversos , Infecciones Relacionadas con Prótesis/terapia , Anciano , Anciano de 80 o más Años , Antibacterianos/efectos adversos , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/mortalidad , Aortografía/métodos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/mortalidad , Toma de Decisiones Clínicas , Angiografía por Tomografía Computarizada , Tratamiento Conservador/efectos adversos , Tratamiento Conservador/mortalidad , Bases de Datos Factuales , Remoción de Dispositivos/efectos adversos , Remoción de Dispositivos/mortalidad , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/mortalidad , Humanos , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/mortalidad , Reoperación , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , España , Factores de Tiempo , Resultado del TratamientoRESUMEN
No disponible
Asunto(s)
Humanos , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/complicaciones , Arteria Ilíaca/diagnóstico por imagen , Claudicación Intermitente/etiología , Trasplante de Riñón/efectos adversos , Hipertensión/etiología , Angiografía por Tomografía ComputarizadaRESUMEN
PURPOSE: To describe the uses and advantages of hybrid vascular grafts (HVGs) for complex iliofemoral revascularization procedures. CASE REPORT: We report 3 cases of iliofemoral occlusions repaired with the Gore HVG, used as an alternative technique to standardized common femoral artery (CFA) endarterectomy associated with iliac stenting or open repair. The indication in each of the 3 cases was different: In the first case, there was an absent CFA secondary to a mycotic pseudoaneurysm, in the second case, an iatrogenic lesion of the posterior wall of the CFA during the intervention was performed, and in the third case, the indication was because of thrombosis of a previous iliofemoral revascularization procedure. CONCLUSION: Although we only present 3 cases, the Gore HVG can be useful for complex iliofemoral revascularizations, serving as an alternative to standardized CFA endarterectomy plus iliac stenting in cases where there is a damaged or absent CFA, especially in high-surgical risk patients.
Asunto(s)
Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Arteria Femoral/cirugía , Arteria Ilíaca/cirugía , Enfermedad Arterial Periférica/cirugía , Stents , Anciano , Anticoagulantes/administración & dosificación , Materiales Biocompatibles Revestidos , Angiografía por Tomografía Computarizada , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/fisiopatología , Heparina/administración & dosificación , Humanos , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/fisiopatología , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Politetrafluoroetileno , Diseño de Prótesis , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
OBJECTIVE: Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) has gained widespread use through a solid reputation of safety and effectiveness. However, some issues, such as endoleaks and sac growth over time, still arise as important concerns. Antiplatelet therapy, mandatory as secondary prevention of cardiovascular disease, may play a role in both phenomena by interfering with blood clotting properties and the inflammatory process associated with AAA. We analyzed whether different antiplatelet therapies were independent risk factors for type II endoleak (T2E) persistence and midterm sac growth after EVAR. METHODS: All patients with T2E detected in the first post-EVAR control were included, except those without at least 1 year of complete follow-up. Data for demographics, clinical comorbidities, EVAR devices, and antiplatelet therapies were recorded. All patients underwent routine follow-up with contrast-enhanced tomography at 1 month, 6 months, 12 months, and annually thereafter. A three-dimensional rendering of each endoleak was performed for detailed volumetry. Main outcomes were endoleak persistence at 6 months and sac growth >5 mm at end of follow-up. RESULTS: During a 9-year period, 87 patients with initial T2E were monitored for a mean of 41.5 months. On discharge, salicylates were prescribed to 50, clopidogrel to 16, and multiagent therapy or anticoagulation to 9; no therapy was given to 12. No significant differences in comorbidities or baseline AAA characteristics were found between groups. At 6 months thereafter, 59% (n = 51) of the initial T2Es persisted. At end of follow-up, 32 patients had sac growth >5 mm (37%). Sac growth was significantly less frequent in the group treated with salicylates (26% vs 60%; P = .004). Cox proportional hazards model reinforced the role of salicylates as protectors for sac growth over time (hazard ratio, 0.34; 95% confidence interval, 0.13-0.87; P = .024), whereas T2E nidus volume and endoleak complexity behaved like independent risk factors. CONCLUSIONS: Antiplatelet therapy with salicylates appears to be linked to a decreased risk of sac growth >5 mm over time in patients with T2Es detected right after EVAR. Population-based cohort studies are mandatory to confirm this finding and to guide a potential recommendation.
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Aneurisma de la Aorta Abdominal/cirugía , Aspirina/uso terapéutico , Implantación de Prótesis Vascular/efectos adversos , Endofuga/terapia , Procedimientos Endovasculares/efectos adversos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Ticlopidina/análogos & derivados , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aortografía/métodos , Aspirina/efectos adversos , Distribución de Chi-Cuadrado , Clopidogrel , Angiografía por Tomografía Computarizada , Medios de Contraste/administración & dosificación , Bases de Datos Factuales , Quimioterapia Combinada , Endofuga/diagnóstico por imagen , Endofuga/etiología , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Inhibidores de Agregación Plaquetaria/efectos adversos , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , España , Ticlopidina/efectos adversos , Ticlopidina/uso terapéutico , Factores de Tiempo , Resultado del TratamientoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Aneurisma/etiología , Trasplante de Riñón , Anastomosis Quirúrgica/efectos adversos , Dispositivos de Acceso Vascular/efectos adversos , Complicaciones Posoperatorias/diagnósticoAsunto(s)
Aneurisma/etiología , Derivación Arteriovenosa Quirúrgica/efectos adversos , Arteria Braquial/patología , Trasplante de Riñón , Complicaciones Posoperatorias/patología , Diálisis Renal , Dispositivos de Acceso Vascular/efectos adversos , Adulto , Aneurisma/diagnóstico por imagen , Aneurisma/cirugía , Implantación de Prótesis Vascular , Arteria Braquial/diagnóstico por imagen , Arteria Braquial/cirugía , Angiografía por Tomografía Computarizada , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagenRESUMEN
BACKGROUND: Intentional hypogastric artery covering during endovascular repair of abdominal aortic aneurysms (EVAR) can carry a non-negligible rate of complications; to preserve pelvic blood flow, several approaches are in use, such as sandwich techniques, branched iliac devices, or the use of aortic extender cuffs in a bell-bottom configuration. We assess the performance of the latter for treatment of common iliac artery aneurysms during EVAR. METHODS: Prospective gathering of data in 21 dilated common iliac arteries (18-25 mm) with coexisting abdominal aorta aneurysm, which were treated from 2005 to 2010 and received a GORE(®) Excluder endograft and one (n = 14) or several aortic extenders in a bell-bottom configuration. Control group consisted of 136 EVARs performed with the same device in the same time frame. Median follow-up was of 47 months, with contrast-enhanced computed tomography assessment 1 month after the procedure and yearly thereafter. RESULTS: Age and comorbidities were homogeneously distributed among groups, although the aortic aneurysm diameter was lower in the bell-bottom group (50 mm vs. 58.2 mm, P < 0.001). There was no 30-day mortality registered in this group, and only one patient died during follow-up (5.3%), without relation with the aneurysmal disease. No significant differences were found in reintervention (15.8% vs. 14.7%, P = 0.707) or endoleak rates (36.8% vs. 38.9%, Fisher P = 1). There were no type I and four type II endoleaks, two of which precised treatment for sac growth. Endoleak-free survival (P = 0.994) and reintervention-free survival (P = 0.563) did not show differences either. CONCLUSION: Bell-bottom technique is a feasible and safe alternative for preserving hypogastric blood flow, and does not imply a higher risk of reintervention or endoleak at 3-year follow-up.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Aneurisma Ilíaco/cirugía , Pelvis/irrigación sanguínea , Stents , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/fisiopatología , Aortografía/métodos , Implantación de Prótesis Vascular/efectos adversos , Estudios de Casos y Controles , Supervivencia sin Enfermedad , Procedimientos Endovasculares/efectos adversos , Estudios de Factibilidad , Femenino , Humanos , Aneurisma Ilíaco/diagnóstico por imagen , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Estudios Prospectivos , Diseño de Prótesis , Cintigrafía , Flujo Sanguíneo Regional , Reoperación , Factores de Riesgo , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Introducción. Estudios multicéntricos recientes sugieren un dudoso beneficio de la endarterectomía carotídea (EC) en pacientes con pseudooclusión carotídea (POC). Objetivo. Evaluar el resultado clínico y hemodinámico de la EC en las POC sintomáticas. Pacientes y métodos. Entre 1999 y 2005 se intervinieron 13 pacientes con POC interna (3,96% de la cirugía carotídea) sintomáticas: siete con infarto cerebral (53,8%), tres con accidente isquémico transitorio (23,1%), dos con amaurosis fugaz (15,4%) y uno con síncopes de repetición (7,7%). En todos se realizó eco-Doppler y angiografía. Criterios diagnósticos del eco-Doppler: oclusión origen carótida interna, flujo en goteo o señal distal amortiguada. Criterios diagnósticos de la angiografía: obstrucción origen carótida interna con relleno filiforme distal. Se indicó la revascularización quirúrgica en todos ellos. Resultados. En 12 pacientes se pudo revascularizar la carótida interna (92,3%) y en uno se hizo su ligadura (7,7%). Técnica de revascularización: 11 EC y un bypass a carótida interna distal. Morbimortalidad quirúrgica del 0%. Control clínico: 3-69 meses (media: 31,6 meses) mediante eco-Doppler de troncos supraaórticos y transcraneal, encontrándose todos vivos, asintomáticos y con permeabilidad de la carótida interna. La reserva hemodinámica homolateral postoperatoria se ha encontrado normalizada en la mayoría de los pacientes. Conclusiones. Se considera indicada la intervención quirúrgica en casos sintomáticos de POC, ya que logra la repermeabilización de la carótida y la normalización de la reserva hemodinámica en un alto porcentaje, previniendo además la aparición de nueva sintomatología a largo plazo
Introduction. Recent multicentre studies suggest dubious benefits for carotid endarterectomy (CE) in patients with pseudo-occlusion of the carotid artery (POC). Aim. To evaluate the clinical and haemodynamic outcomes of CE in cases of symptomatic POC. Patients and methods. Between 1999 and 2005 interventions were carried out on 13 patients with symptomatic pseudo-occlusion of the internal carotid artery (3.96% of the carotid surgery conducted): seven with cerebral infarction (53.8%), three with transient ischemic attack (23.1%), two with amaurosis fugax (15.4%) and one with recurring syncopes (7.7%). Doppler ultrasonography and angiography recordings were performed in all cases. Diagnostic criteria for Doppler ultrasonography were occlusion with its origin in the internal carotid artery, a drip flow or attenuated distal signals. Diagnostic criteria for angiography were occlusion with its origin in the internal carotid artery with filiform distal filling. Surgical revascularisation was indicated in all cases. Results. The internal carotid artery was revascularised in 12 patients (92.3%) and ligation was performed in one of them (7.7%). Revascularisation technique: 11 CE and one distal internal carotid artery bypass. Surgical morbidity and mortality rates of 0%. Clinical monitoring: 3-69 months (mean: 31.6 months) using transcranial and supra-aortic trunk Doppler ultrasonography; all patients were alive, asymptomatic and with patency of the internal carotid artery. The post-operative homolateral haemodynamic reserve was found to be at normal levels in most of the patients. Conclusions. Surgical intervention is considered to be indicated in symptomatic cases of POC, as it achieves repatency of the carotid artery and normalises the haemodynamic reserve in a high percentage of cases; it also prevents the appearance of new symptoms in the long term