Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 8 de 8
Filtrar
1.
J Cardiovasc Surg (Torino) ; 61(1): 73-77, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29363893

RESUMEN

BACKGROUND: Complex abdominal aortic aneurysm (AAA) is a relatively common presentation to the vascular specialist. Despite this there is little consensus on how to manage the often comorbid group of patients. Recent advances in endovascular technology have led to the availability of multiple devices, many of which could be used to treat the same aneurysm. The aim of this study was to quantify this potential variability across vascular specialists from multiple countries. METHODS: An online survey was emailed to members of the Vascular Society for Great Britain and Ireland (VSGBI), the Canadian Society for Vascular Surgery (CSVS) and the Australian and New Zealand Society for Vascular Surgery (ANZSVS). The survey presented a vignette of a 63-year-old woman with significant respiratory comorbidity and a 54 mm juxtarenal AAA (7 mm neck). There were no other adverse morphological features for endovascular repair. The survey included images and questions related to management of the aneurysm. RESULTS: The survey received 238 responses; 61 from ANZSVS, 65 from CSVS and 112 from VSGBI. VSGBI specialists were significantly more likely to continue surveillance than both ANZSVS (odds ratio [OR] 3.41, 95% confidence interval [CI] 1.61-7.65; P<0.001) and CSVS counterparts (OR 2.61, 95% CI: 1.29-5.47; P<0.01). ANZSVS specialists were significantly more likely to perform an endovascular repair than those from CSVS (OR 3.28, 95% CI: 1.50-7.40; P<0.01) and VSGBI (OR 3.65, 95% CI: 1.81-7.59; P<0.001). CSVS specialists were significantly more likely to manage the aneurysm with open surgery than colleagues from the VSGBI (OR 6.57, 95% CI: 2.58-18.46; P<0.001) and ANZSVS (OR 7.18, 95% CI: 2.22-30.79; P<0.001). CONCLUSIONS: Significant variation in the management of a juxtarenal AAA between countries was observed. The same patient would be more likely to have an endovascular repair in Australia and New Zealand, open surgery in Canada and continuing surveillance in the UK and Ireland. This variation reflects the lack of long-term evidence and international consensus on the optimal management of complex AAA.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/tendencias , Procedimientos Endovasculares/tendencias , Disparidades en Atención de Salud/tendencias , Pautas de la Práctica en Medicina/tendencias , Cirujanos/tendencias , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aortografía/tendencias , Toma de Decisiones Clínicas , Angiografía por Tomografía Computarizada/tendencias , Femenino , Encuestas de Atención de la Salud , Humanos , Persona de Mediana Edad
2.
Thorac Cardiovasc Surg ; 66(4): 287-293, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-28259111

RESUMEN

BACKGROUND: evidence-based medicine (EBM) approaches have reached broad acceptance, both in conservative and surgical disciplines. The aim of this study is to clarify the role of EBM in a rare condition of aortic regurgitation (AR) with surgical indication. METHODS: A purpose-built Internet-based questionnaire was sent to 607 cardiovascular surgeons in Germany, Austria, and Switzerland. A virtual 64-year-old patient's medical history was presented, including two ultrasound images and one computed tomography scan, showing a 58-mm aortic root aneurysm and a severe trileaflet regurgitant aortic valve. Participants had to choose their preferred therapeutic strategy from a list. Additionally, demographics including nationality, the center size, and the frequency of similar types of patients referred to their departments were collected. RESULTS: Of 607 questionnaires, 100 were returned (16%). One participant was excluded due to conflicting answers. Most surgeons (n = 84; 84%) chose a valve-sparing root replacement (VSRR). A Bentall procedure was preferred by 13 surgeons (13%). Two surgeons voted for aortic valve replacement combined with partial root resection. The decision-making process was not significantly influenced by center size, nationality, or frequency of patients. CONCLUSION: Applying the current guidelines to our virtual study patient, 84% of participants acted accordingly choosing VSRR. Remarkably, 14% of these surgeons see less than 10 and 43% see not more than 20 comparable patients per year. Since the guidelines reserve VSRR for competent centers, those numbers as well as the guidelines themselves should be further discussed.


Asunto(s)
Aneurisma de la Aorta/cirugía , Insuficiencia de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Implantación de Prótesis Vascular/tendencias , Medicina Basada en la Evidencia/tendencias , Implantación de Prótesis de Válvulas Cardíacas/tendencias , Pautas de la Práctica en Medicina/tendencias , Cirujanos/tendencias , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/fisiopatología , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/fisiopatología , Aortografía/tendencias , Toma de Decisiones Clínicas , Angiografía por Tomografía Computarizada/tendencias , Ecocardiografía Doppler en Color/tendencias , Europa (Continente) , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Carga de Trabajo
4.
Vascular ; 22(2): 134-41, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23512898

RESUMEN

The purpose of this study was to review the shift in the trend of management and mid-term outcomes of all patients who sustain thoracic aortic injury. A Retrospective analysis was performed of all patients sustaining blunt thoracic aortic trauma admitted to our unit. Forty-seven patients were presented with injury to the thoracic aorta following blunt chest injury. Ten patients underwent open surgical repair of their thoracic aortic injury. The mean age ± SD (range) was 29.4 ± 7.9 years (18-41) with a mean Injury Severity Score (ISS) of 41 ± 14.7 (25-75). Fifteen patients underwent thoracic endovascular repair for blunt aortic transections with a mean age of 35.1 ± 14.5 years (17-65), mean ISS of 40.8 ± 13.9 (20-75) and an average length of hospital stay of 25.6 ± 14.5 days (3-77). The mean aortic diameter proximal to the aortic injury was 23.46 ± 3.02 mm (19-28) with a mean aortic angulation of 58.46° ± 17.73 (44-80°). The mean oversizing was 24.4 ± 5.4% (17-32%). At our institution, there has been a paradigm shift in the emergent repair of blunt thoracic aortic injury from open surgery to endovascular repair. Oversizing of the stent-graft did not translate to a poorer outcome.


Asunto(s)
Aorta Torácica/cirugía , Procedimientos Endovasculares/tendencias , Traumatismos Torácicos/terapia , Centros Traumatológicos/tendencias , Procedimientos Quirúrgicos Vasculares/tendencias , Lesiones del Sistema Vascular/terapia , Adolescente , Adulto , Anciano , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/lesiones , Aortografía/tendencias , Prótesis Vascular/tendencias , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Humanos , Puntaje de Gravedad del Traumatismo , Tiempo de Internación , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Diseño de Prótesis/tendencias , Estudios Retrospectivos , Stents/tendencias , Traumatismos Torácicos/diagnóstico , Factores de Tiempo , Tomografía Computarizada por Rayos X/tendencias , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/instrumentación , Lesiones del Sistema Vascular/diagnóstico , Australia Occidental , Adulto Joven
7.
Rev. esp. cardiol. (Ed. impr.) ; 62(9): 1050-1054, setp. 2009. tab, ilus
Artículo en Español | IBECS | ID: ibc-72702

RESUMEN

Los dispositivos Amplatzer se utilizan en el tratamiento percutáneo de la comunicación interauricular ostium secundum (CIA-OS), el ductus arterioso persistente (PDA) y la comunicación interventricular muscular (CIV-m). Hay muy poca experiencia con estos dispositivos en niños menores de 1 año. Entre enero de 2001 y enero de 2008 se trató a 22 niños menores de 1 año sintomáticos; 3 tenían CIA-OS; 15, PDA y 4, CIV-m. Todos los procedimientos fueron exitosos. No observamos complicaciones inmediatas o a mediano plazo. El cierre percutáneo de estos defectos con dispositivos Amplatzer es una técnica eficaz y segura en niños menores de 1 año sintomáticos que de otro modo requerirían cirugía (AU)


Amplatzer devices are used for the percutaneous closure of ostium secundum atrial septal defects, muscular ventricular septal defects, and patent ductus arteriosus. However, very little experience has been gained in using these devices in infants under 1 year of age. Between January 2001 and January 2008, 22 symptomatic infants aged under 1 year underwent percutaneous treatment: three had an ostium secundum atrial septal defect, 15 had patent ductus arteriosus, and 4 had a muscular ventricular septal defect. All the procedures were completed successfully. No immediate or medium-term complications were observed. Closure of these types of defect using an Amplatzer device in infants under 1 year of age, who would otherwise require surgery, is a safe and effective procedure (AU)


Asunto(s)
Humanos , Masculino , Femenino , Niño , Conducto Arterial , Conducto Arterial/fisiología , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/métodos , Aortografía/métodos , Conducto Arterial/fisiopatología , Conducto Arterial , Estudios Retrospectivos , Aortografía/instrumentación , Aortografía/tendencias , Hemodinámica/fisiología
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA