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1.
Khirurgiia (Mosk) ; (4): 65-69, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32352671

RESUMEN

We report surgical treatment of a 65-year-old patient with recurrent hemangioendothelioma of inferior and middle segment of inferior vena cava with spread to previously established prosthesis. Advanced resection of inferior vena cava and right-sided nephrectomy were not followed by complications and resulted R0 resection. Surgery time was 180 min. Inferior vena cava cross-clamping time was 30 min. Total blood loss was 300 ml. Hemangioendothelioma is a rare tumor with unpredictable potential for malignant transformation and obligatory indications for surgical treatment. Resection and reconstruction of inferior vena cava and renal veins with a synthetic conduit is effective and safe procedure.


Asunto(s)
Hemangioendotelioma/patología , Recurrencia Local de Neoplasia/patología , Neoplasias Vasculares/patología , Vena Cava Inferior/patología , Anciano , Implantación de Prótesis Vascular , Hemangioendotelioma/cirugía , Humanos , Recurrencia Local de Neoplasia/cirugía , Nefrectomía , Venas Renales/patología , Venas Renales/cirugía , Neoplasias Vasculares/cirugía , Vena Cava Inferior/cirugía
3.
Orv Hetil ; 161(15): 588-593, 2020 04 01.
Artículo en Húngaro | MEDLINE | ID: mdl-32323935

RESUMEN

Introduction: The incidence of peripheral arterial diseases and the rate of chronic limb-threatening ischaemia are increasing year by year. Minimally invasive peripheral interventions have gradually replaced traditional operations. Earlier steno-occlusion of the popliteal artery was an indication for femoropopliteal bypass below the knee. Nowadays, endovascular procedures are also used, but the indication of the stent placement into the popliteal artery is controversial. Aim: We have been using Jaguar stent for the treatment of popliteal artery steno-occlusion since January 2016. The aim of our study was to evaluate the efficacy of this treatment. Method: We included patients who underwent popliteal artery angioplasty with Jaguar stent placement between 1 January 2016 and 31 December 2017 in our department. During the one-year follow-up, we examined the popliteal stent patency, amputation-free survival and risk factors that influence stent patency. Statistical analysis: For the comparison of mean values, two-sided t-tests were used. Categorical data were analyzed by using chi-square test. Results: 33 patients underwent popliteal or femoropopliteal endovascular intervention with Jaguar stent placement into the popliteal artery. Postoperative complications that required surgical treatment occurred in 2 patients. At the end of the follow-up, the primary patency of the popliteal stents was 58.1%, the secondary patency was 74.2% and amputation-free survival was 96.8%. Conclusion: Compared with international data, the primary patency of the Jaguar stents in our study is relatively lower, but amputation-free survival is much better, and in most cases there is less operative strain compared with traditional operations. Orv Hetil. 2020; 161(15): 588­593.


Asunto(s)
Angioplastia/instrumentación , Aterosclerosis/cirugía , Implantación de Prótesis Vascular/instrumentación , Arteria Femoral/cirugía , Enfermedad Arterial Periférica/cirugía , Arteria Poplítea/cirugía , Stents , Angioplastia/efectos adversos , Aterosclerosis/diagnóstico por imagen , Aterosclerosis/fisiopatología , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Arteria Femoral/fisiopatología , Humanos , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/fisiopatología , Arteria Poplítea/fisiopatología , Diseño de Prótesis , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Grado de Desobstrucción Vascular
4.
Khirurgiia (Mosk) ; (3): 43-47, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32271736

RESUMEN

OBJECTIVE: A retrospective analysis of in-hospital results of renal artery stenting in patients with multifocal atherosclerosis. MATERIAL AND METHODS: The study included 19 patients who underwent stenting for renal artery stenosis for the period 2011-2015 in the Kemerovo Cardiology Dispensary. Renal function was assessed considering glomerular filtration rate (GFR). Blood pressure and GFR were evaluated before the stenting procedure and at discharge. RESULTS: Stenting resulted optimal outcomes in all 19 patients. Severity of residual stenosis was 11±3%. In-hospital mortality was absent. Blood pressure in early postoperative period was similar to baseline values. One patient had a normalization of blood pressure up to 115-140/85-90 mm Hg without administration of antihypertensive drugs. Decrease of systolic blood pressure up to 155.3±32.6 mm Hg was noted in other patients at discharge. Blood creatinine levels decreased up to 0.167±0.56 mmol/L. In addition, mean GFR increased from 34.17 ml/min/1.69 m2 up to 37.16 ml/min/1.69 m2. CONCLUSION: Endovascular treatment of renal artery stenosis and secondary hypertension is effective and relatively safe approach.


Asunto(s)
Implantación de Prótesis Vascular , Obstrucción de la Arteria Renal/cirugía , Arteria Renal/cirugía , Stents , Aterosclerosis/complicaciones , Aterosclerosis/cirugía , Humanos , Hipertensión Renovascular/etiología , Hipertensión Renovascular/cirugía , Obstrucción de la Arteria Renal/etiología , Estudios Retrospectivos , Resultado del Tratamiento
6.
Orv Hetil ; 161(11): 437-439, 2020 Mar.
Artículo en Húngaro | MEDLINE | ID: mdl-32148094

RESUMEN

A 79-year-old male patient was operated with Bentall procedure, thoracic aorta-aortic interposition and stent graft implantation for aortic dissection type A. Because of the persistent false lumen a chronic, 60 mm thoraco-abdominal post-dissection aortic aneurysm developed, which we managed with a new endovascular treatment, the so-called "candy-plug" technique. Thoracic endovascular aortic repair (TEVAR) can induce the thrombosis of the false lumen and the aortic remodelling via the covering of the proximal intimal tear. However, the thrombosis of the false lumen is often - in 60% of the cases - incomplete. In these cases we have to prepare for the persistent expansion of the aorta, which can be managed only with high-risk open or endovascular repair. Hence a new solution with lower risk was investigated, which combines TEVAR and the false lumen closure devices. Such a new treatment is the "candy-plug" technique, which was performed in our case. This minimally invasive technique, which excludes the circulation of the false lumen and stops the progression of the aneurysm expansion, can be an effective and safe solution for the treatment of the chronic post-dissection aortic aneurysms. Orv Hetil. 2020; 161(11): 437-439.


Asunto(s)
Aneurisma Disecante/cirugía , Implantación de Prótesis Vascular , Prótesis Vascular , Procedimientos Endovasculares/métodos , Stents , Anciano , Aneurisma Disecante/diagnóstico por imagen , Aortografía , Humanos , Masculino , Estudios Retrospectivos , Resultado del Tratamiento
8.
Medicine (Baltimore) ; 99(11): e19186, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176045

RESUMEN

Obese individuals are apt to develop Stanford A acute aortic dissection (AAD) complicated with acute lung injury (ALI), but the mechanism is still not well defined. We aim to investigate whether oxidative stress and inflammatory are involved in the aortic dissection lung injury caused by obesity.Seventy-nine patients were categorized into AAD with obesity group (n = 17) and AAD without obesity group (n = 62) according to body mass index (BMI). Inflammatory reactions including interleukin 1ß (IL-1ß), tumor necrosis factor-α (TNF-α), IL-6, C-reactive protein (CRP) and white blood cell (WBC) count, and oxidative stress including malondialdehyde (MDA), superoxide dismutase were determined using enzyme-linked immunosorbent assays and chemiluminescence. All the patients received ascending aorta replacement combined with total arch replacement and stented elephant trunk. The postoperative complications were recorded.The incidence of preoperative hypoxemia (94.1% vs 35.5%, P < .01) and postoperative ALI (88.2% vs 40.3%, P < .01) in obese patients was significantly higher than that in non-obese patients. Besides, the ICU stay (119.2 ±â€Š59.2 vs 87.8 ±â€Š31.2 h, P < .01) and hospitalization duration (18.8 ±â€Š8.5 vs 14.3 ±â€Š8.1d, P = .048) were increased in the obese patients with AAD. The expression of IL-1ß, TNF-α, IL-6, CRP, and WBC was remarkably increased (P < .01) in obese group compared with non-obese group.Oxidative stress and inflammatory response may be involved in the process of ALI of aortic dissection caused by obesity, which provides new ideas for the treatment of ALI of the aortic dissection.


Asunto(s)
Lesión Pulmonar Aguda/cirugía , Aneurisma Disecante/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Hipoxia/etiología , Obesidad/complicaciones , Lesión Pulmonar Aguda/diagnóstico por imagen , Adulto , Anciano , Aneurisma Disecante/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Implantación de Prótesis Vascular/métodos , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Hospitales Universitarios , Humanos , Hipoxia/fisiopatología , Modelos Lineales , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/fisiopatología , Cuidados Preoperatorios , Pronóstico , Valores de Referencia , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento
9.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 42(1): 67-72, 2020 Feb 28.
Artículo en Chino | MEDLINE | ID: mdl-32131942

RESUMEN

Objective To evaluate the relationship of volumetric changes and endoleaks after endovascular aneurysm repair(EVAR)for abdominal aortic aneurysms(AAAs). Methods We retrospectively evaluated the clinical and imaging data of 54 patients who had underwent EVAR within 1 month after their aneurysms were detected.All patients received abdominal and pelvic enhanced computed tomography(CTA)for two follow-up visits in Peking Union Medical College Hospital from July 2014 to February 2019.Three-dimensional volumes and maximum diameters on axial CT of the aortic aneurysms were calculated by dedicated semi-automated 3D segmentation software before surgery(V0 and D0),in the 4 th postoperative month(V1and D1),and in the 12 th postoperative month(V2and D2),respectively.The presence or absence of endoleak for each patient with the V1/V0,V2/V0,and V2/V1 were calculated to assess the significance of volume changes with respect to endoleaks and the correlation between volume changes and maximum diameter changes on axial CT images. Results Of the 54 patients,endoleaks were found in 11 patients at the first follow-up visit(4 months after surgery),among whom 8 patients were arranged a second follow-up visit(12 months after surgery),during which endoleaks were found in 5 patients.Fifteen of 43 non-leaked patients underwent a second CTA examination,which revealed endoleak in one case.Patients who did exhibit endoleaks[n =11,V1/V0=1.086(1.033,1.116)]showed significant increases in aneurysm volume when compared with those who did not exhbit endoleaks[n =43,V1/V0=1.019(0.970,1.065)]at the first follow-up visit(Z=-2.695,P=0.007),although no significant difference was found with regard to volume changes between endoleaks(n=6,V2/V0=1.1±0.2,V2/V1=1.0±0.1)and non-endoleaks(n=17,V2/V0=1.0±0.1,V2/V1=1.0±0.1)at the second follow-up visit(t=0.725,P=0.476)as well as between these two follow-up visits(t=-0.021,P=0.984).V0 and D0 were moderately correlated with V1 and D1,respectively(r=0.5,P<0.001)and strongly correlated with V2 and D2,respectively(r=0.8,P<0.001).V1 and D1 were strongly correlated with V2 and D2,respectively(r=0.8,P<0.001). Conclusions The changes of aneurysm volume cannot reliably reflect the occurrence of endoleaks.The change of maximum axial diameter of aneurysm has certain correlation with the changes of aneurysm volume.


Asunto(s)
Aneurisma de la Aorta Abdominal/patología , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular , Endofuga/patología , Procedimientos Endovasculares , Endofuga/diagnóstico por imagen , Humanos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
11.
Medicine (Baltimore) ; 99(8): e19119, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080086

RESUMEN

Stent designs with ultrathin struts may further increase the procedural success of challenging lesion subsets. The objective of this study was to assess the safety and efficacy of ultrathin strut, polymer-free sirolimus eluting stent (PF-SES) implantations in a large scale, unselected patient population.Adult patients underwent percutaneous coronary interventions (PCI) with a thin-strut PF-SES. Data from two all-comers observational studies having the same protocol (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were pooled. The accumulated target lesion revascularization (TLR) rate at 9-12 months was the primary endpoint. All dual antiplatelet therapy strategies according to the applicable guidelines were permissible.In total, 7243 patients were prospectively enrolled for PCI with PF-SES in stable coronary artery disease or acute coronary syndrome (ACS). Major risk factors in the overall cohort were diabetes (37.3%), ST elevation myocardial infarction (18.1%) and non-ST myocardial infarction (24.6%). The follow-up rate was 88.6% in the overall population. The TLR rate in the overall cohort was 2.2% whereas definite/probable stent thrombosis (ST) occurred in 0.7%. In patients with in-stent restenosis lesions, the major adverse cardiac events rate was 6.4% whereas the corresponding rate for isolated left main coronary artery (LMCA) disease was highest with 6.7% followed by patients with culprit lesions in vein bypasses (VB, 7.1%). The mortality rate in patients treated in VB lesions was highest with 5.4%, followed by the isolated LMCA subgroup (3.4%) and ACS (2.6%).PCI with PF-SES in an unselected patient population, is associated with low clinical event and ST rates. Furthermore, PF-SES angioplasty in niche indications demonstrated favorable safety and efficacy outcomes with high procedural success rates.


Asunto(s)
Antibacterianos/uso terapéutico , Stents Liberadores de Fármacos/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Sirolimus/uso terapéutico , Implantes Absorbibles/efectos adversos , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/cirugía , Anciano , Implantación de Prótesis Vascular/métodos , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/cirugía , Diabetes Mellitus/epidemiología , Stents Liberadores de Fármacos/tendencias , Oclusión de Injerto Vascular/epidemiología , Humanos , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/complicaciones , Infarto del Miocardio sin Elevación del ST/epidemiología , Polímeros , Pautas de la Práctica en Medicina/normas , Estudios Prospectivos , Diseño de Prótesis , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/epidemiología , Resultado del Tratamiento
12.
Ann Thorac Surg ; 109(3): 959-981, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32000979

RESUMEN

This Society for Vascular Surgery/Society of Thoracic Surgeons (SVS/STS) document illustrates and defines the overall nomenclature associated with type B aortic dissection. The contents describe a new classification system for practical use and reporting that includes the aortic arch. Chronicity of aortic dissection is also defined along with nomenclature in patients with prior aortic repair and other aortic pathologic processes, such as intramural hematoma and penetrating atherosclerotic ulcer. Complicated vs uncomplicated dissections are clearly defined with a new high-risk grouping that will undoubtedly grow in reporting and controversy. Follow-up criteria are also discussed with nomenclature for false lumen status in addition to measurement criteria and definitions of aortic remodeling. Overall, the document provides a facile framework of language that will allow more granular discussions and reporting of aortic dissection in the future.


Asunto(s)
Aneurisma Disecante/cirugía , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/normas , Consenso , Procedimientos Endovasculares/normas , Sociedades Médicas , Cirugía Torácica , Humanos
14.
Chirurg ; 91(2): 169-178, 2020 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-32002560

RESUMEN

Despite the successful establishment of endovascular techniques, colonic ischemia continues to be a serious complication of aortic surgery.The risk factors for colonic ischemia include aortic aneurysm rupture, prolonged aortic clamping, perioperative hypotension, the need for catecholamine therapy, occlusion of the hypogastric arteries and renal insufficiency.The clinical presentation of postoperative colonic ischemia is often unspecific. Classic symptoms include abdominal pain, diarrhea, peranal bleeding and rise of inflammatory parameters. A specific laboratory parameter for colonic ischemia does not exist. The diagnostic gold standard is endoscopy. Imaging methods such as sonography or computer tomography play only a supportive role. Transmural ischemia resulting in bowel wall necrosis is an indication for emergency surgery, predominantly colonic resection with creation of artificial anus.


Asunto(s)
Aneurisma de la Aorta Abdominal , Rotura de la Aorta , Implantación de Prótesis Vascular , Colon , Isquemia , Colon/irrigación sanguínea , Humanos , Complicaciones Posoperatorias , Factores de Riesgo
15.
J Cardiovasc Surg (Torino) ; 61(1): 24-36, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32079378

RESUMEN

INTRODUCTION: Open repair (OR), fenestrated endovascular aneurysm repair (fEVAR) and endovascular exclusion using parallel graft (chEVAR) are complementary procedures used for treatment of juxtarenal abdominal aortic aneurysm (jrAAA). The aim of our study was to assess available literature and analyze dispersion of OR, fEVAR and chEVAR procedures among reported papers related to treatment of jrAAA. EVIDENCE ACQUISITION: The PubMed database was systematically searched using predefined strategy and key words related to treatment of jrAAA on September 28th, 2019. Studies were assessed for eligibility using the inclusion and exclusion criteria with at least five patients treated with at least one of the procedures while systematic reviews, meta-analysis, reviews, comments, editorials and letters were excluded as well as studies without clear classification of the location of the aneurysm, studies not specifying the number of patients treated with each of the techniques or not discriminated between aortic pathologies (juxtarenal, paravisceral and thoracoabdominal), hybrid procedures, endoanchors or with branched stent-graft. EVIDENCE SYNTHESIS: Overall, 1533 papers were identified while papers that met inclusion criteria were either representing experience of single institution (87 papers) or from multicenter studies (6 papers), national or international registries (18 papers). In the period between January 1977 and December 2017, treatment of 5664 patients with jrAAA was reported in 87 papers as a single institution report. Out of them 2531 (45%) were treated with OR, 2592 (46%) with fEVAR and 541 (9%) with chEVAR. Out of 29 institutions reporting OR, there were 11 (37.9%) with more than 100 treated patients while 21 (41.1%) out of 51 institutions that reported more than 50 jrAAA treated with fEVAR. Only four institutions reported results of all three treatment modalities. CONCLUSIONS: Based on the results reported in the literature, regardless of its complexity and costs, fEVAR for jrAAA has been accepted in substantial number of hospitals worldwide, while number of reported procedures is reaching OR.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/mortalidad , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Humanos , Complicaciones Posoperatorias/etiología , Diseño de Prótesis , Factores de Riesgo , Resultado del Tratamiento
16.
J Cardiothorac Surg ; 15(1): 13, 2020 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-31924243

RESUMEN

BACKGROUND: We examined the outcome of debranching thoracic endovascular aortic repair (d-TEVAR) without sternotomy for distal aortic arch aneurysm in patients aged ≥75 years. METHODS: Patients who underwent d-TEVAR or TAR for aortic arch aneurysm between 2008 and 2015 at our hospital and aged ≥75 years were included. Age, sex, left ventricular ejection fraction, preoperative creatinine level, diabetes, cerebrovascular disease, and chronic obstructive pulmonary disease were matched using PS. RESULTS: Among 74 patients (d-TEVAR: 51, TAR: 23), 17 patients in each group were matched. No difference in surgical outcome was detected between the d-TEVAR and TAR groups, including 30-day death (0% vs. 0%), hospital death (5.8% vs. 0%: p = 0.31) and incidence of cerebral infarction (5.8% vs. 7.6%: p = 0.27) as well as the long-term outcomes of 5-year survival (92.8% vs. 74.8%: p = 0.30) and 5-year aorta-related event-free rate (88.2% vs. 100%: p = 0.15). Average duration of ICU stay (1.3 ± 1.1 days vs. 5.6 ± 1.3 days: p = 0.025) and hospital stay (16.5 ± 5.2 days vs. 37.7 ± 19.6 days: p = 0.017) were significantly shorter in the d-TEVAR group. CONCLUSION: Our results indicated that d-TEVAR is less invasive without affecting long-term outcome up to 5 years. Although the number of the patients included in the study was small, debranching TEVAR could be one of the treatments of the choice in the elderly, especially with comorbidities.


Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/métodos , Procedimientos Endovasculares/métodos , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Estudios de Casos y Controles , Infarto Cerebral/epidemiología , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Complicaciones Posoperatorias/epidemiología , Supervivencia sin Progresión , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento
17.
Life Sci ; 245: 117349, 2020 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-31981632

RESUMEN

AIMS: To explore whether the combination of atorvastatins and resveratrol is superior to each individual drug alone regarding re-endothelialization after drug-eluting stents (DESs) implantation. MATERIALS AND METHODS: Ninety-four rabbits were randomized into control, atorvastatin, resveratrol, and combined medication groups. Abdominal aorta injury was induced via ballooning, followed by DES implantation. Neointimal formation and re-endothelialization after stent implantation were assessed via optical coherence tomography and scanning electron microscopy. The effects of resveratrol and atorvastatin on bone marrow-derived mesenchymal derived stem cells (BMSCs) were assessed. KEY FINDINGS: Compared with the findings in the resveratrol and atorvastatin groups, the neointimal area and mean neointimal thickness were greater in the combined medication group, which also exhibited improved re-endothelialization. Compared with the effects of monotherapy, combined treatment further protected BMSCs against rapamycin-induced apoptosis and improved cell migration. Combined medication significantly upregulated Akt, p-Akt, eNOS, p-eNOS, and CXCR4 expression in BMSCs compared with the effects of monotherapy, and these effects were abolished by the phosphatidylinositol 3-kinase (PI3K) inhibitor LY294002. SIGNIFICANCE: The combination of atorvastatin and resveratrol has the potential of accelerating re-endothelialization after stent implantation, reducing the risk of thrombosis and improving the safety of DESs.


Asunto(s)
Atorvastatina/uso terapéutico , Implantación de Prótesis Vascular/métodos , Stents Liberadores de Fármacos , Endotelio Vascular/efectos de los fármacos , Resveratrol/uso terapéutico , Animales , Aorta Abdominal/cirugía , Aorta Abdominal/ultraestructura , Atorvastatina/administración & dosificación , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Endotelio Vascular/crecimiento & desarrollo , Endotelio Vascular/ultraestructura , Hylobatidae , Sistema de Señalización de MAP Quinasas/efectos de los fármacos , Masculino , Células Madre Mesenquimatosas/efectos de los fármacos , Microscopía Electrónica de Rastreo , Conejos , Ratas , Ratas Sprague-Dawley , Resveratrol/administración & dosificación , Tomografía de Coherencia Óptica
18.
Eur J Vasc Endovasc Surg ; 59(3): 385-397, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31899100

RESUMEN

OBJECTIVE: The objective was to investigate whether endovascular aneurysm repair (EVAR) has better peri-operative and late clinical outcomes than open repair for non-ruptured abdominal aortic aneurysm. METHODS: Electronic bibliographic sources (MEDLINE, EMBASE, and CENTRAL) were searched up to July 2019 using a combination of thesaurus and free text terms to identify randomised controlled trials (RCTs) comparing the outcomes of EVAR and open repair. The systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Pooled estimates of dichotomous outcomes were calculated using odds ratio (OR) or risk difference (RD) and 95% confidence interval (CI). A time to event data meta-analysis was performed using the inverse variance method and the results were reported as summary hazard ratio (HR) and 95% CI. RESULTS: Seven RCTs reporting a total of 2 983 patients were included in quantitative synthesis. Three of the trials reported long term follow up that extended to 15.8 years, 14.2 years, and 12.5 years. Meta-analysis found significantly lower odds of 30 day (OR, 0.36; 95% CI 0.20-0.66) and in hospital mortality with EVAR (RD -0.03; 95% CI -0.04 to -0.02). Meta-analysis of the three trials reporting long term follow up found no significant difference in all cause mortality at any time between EVAR and open repair (HR 1.02; 95% CI 0.93-1.13; p = .62). The hazard of all cause (HR 0.62; 95% CI 0.42-0.91) and aneurysm related death within six months (HR 0.42; 95% CI 0.24-0.75) was significantly lower in patients who underwent EVAR, but with further follow up, the pooled hazard estimate moved in favour of open surgery; in the long term (>8 years) the hazard of aneurysm related mortality was significantly higher after EVAR (HR 5.12; 95% CI 1.59-16.44). The risk of secondary intervention (HR 2.13; 95% CI 1.69-2.68), aneurysm rupture (OR, 5.08; 95% CI 1.11-23.31), and death due to rupture (OR, 3.57; 95% CI 1.87-6.80) was significantly higher after EVAR, but the risk of death due to cancer was not significantly different between EVAR and open repair (OR, 1.03; 95% CI 0.84-1.25). CONCLUSION: Compared with open surgery, EVAR results in a better outcome during the first six months but carries an increased risk of aneurysm related mortality after eight years.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/mortalidad , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Humanos , Complicaciones Posoperatorias/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
19.
Eur J Vasc Endovasc Surg ; 59(3): 428-436, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31911139

RESUMEN

OBJECTIVE: The aim of this study was to evaluate aortic remodelling and associated complications in patients treated by thoracic endovascular aneurysm repair (TEVAR) for blunt traumatic aortic injuries (BTAI). METHODS: This was a retrospective, observational, multicentre study. Remodelling was considered as aortic diameter variations of >2 mm and distal graft and aortic axis angle modification measured by computed tomography angiography (CTA). The predefined levels of measurement were the proximal end of the graft (D1: landing in zone [LZ] 2; D2: LZ 3); distal end (D3); and control measurement (D4) 15 mm beyond D3. Survival, procedure, graft, and/or radiation exposure related complications were registered. CTA was required within three months and at one, six, and 10 years post-operatively. RESULTS: Between 2004 and 2017 52 patients were treated; 47 were included for remodelling analysis (five immediate deaths were excluded); median age was 47 years (range 20-80 years). Mean TEVAR oversizing was 19.6% ± 9.7% (range 5%-35%). Following a median follow up of 67.4 ± 56.1 months (range 14-153 months) survival at one, three, six, and 10 years was 90.4% (standard error [SE] 4.1%), 88.3% (SE 4.5%) 84.8% (SE 5.5%), and 84.8% (SE 5.5%), respectively. There were no procedure/graft related complications except for one late intramural haematoma that required re-intervention. Freedom from aortic remodelling at one, six, and 10 years was 85.1% (SE 5.2%), 30.9% (SE 8.6%), and 24.7% (SE 8.8%), respectively. The increase in D1/D2 and D3 diameters were influenced by time from intervention (both p < .001), age (p < .001 and p = .002, respectively) and sealing in zone 2 (p = .027 and p = .042, respectively). For every 10% increase in oversizing, proximal neck diameter remodelling was 3.4% (p = .05). The distal axis decreased over time (p < .001; significant between three and six years). CONCLUSION: TEVAR is safe for BTAI in the mid to long term. This study reports a correlation between time, oversizing, and remodelling, but the level of adverse events was low.


Asunto(s)
Aorta Torácica/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Traumatismos Torácicos/cirugía , Remodelación Vascular , Lesiones del Sistema Vascular/cirugía , Heridas no Penetrantes/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/lesiones , Aorta Torácica/fisiopatología , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Estudios Retrospectivos , Traumatismos Torácicos/diagnóstico por imagen , Traumatismos Torácicos/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/fisiopatología , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/fisiopatología , Adulto Joven
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