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1.
Kyobu Geka ; 74(5): 338-342, 2021 May.
Artículo en Japonés | MEDLINE | ID: mdl-33980791

RESUMEN

An 82-year-old man underwent total aortic arch replacement with a 24 mm Triplex four-branched graft for aortic arch aneurysm. After two years, he was diagnosed with pseudoaneurysms due to bleeding from a non-anastomotic site of the branch graft to the left common carotid artery and minor leakage from a distal anastomotic site of the main graft. A self-expandable Fluency covered stent and cTAG thoracic endograft were used for the aneurysm. After four years, he was referred to our hospital with a complaint of pulsatile swelling of the anterior chest wall. Contrast enhanced computed tomography (CT) revealed a pseudoaneurysm arising from a non-anastomotic site of the branch graft to the left common carotid artery, which extended into the anterior chest wall and the skin through the sternum. He underwent emergency endovascular repair using a Niti-S ComVi covered stent. The postoperative course was uneventful. Postoperative CT showed shrinkage of the pseudoaneurysm. The patient was discharged and required no reintervention during the follow-up.


Asunto(s)
Aneurisma Falso , Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Anciano de 80 o más Años , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Humanos , Masculino , Stents/efectos adversos , Esternón , Resultado del Tratamiento
2.
J Pak Med Assoc ; 71(2(B)): 656-662, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33941954

RESUMEN

OBJECTIVE: To assess the outcome of endovascular treatment of intracranial aneurysm over 15 years. METHODS: The retrospective study was conducted at the at Radiology Department of Aga Khan University Hospital, Karachi, and comprised medical records from April 2003 to April 2018 of patients who received endovascular treatment for intracranial aneurysm. Multiple variables reviewed included demographics, clinical presentation, aneurysm morphology, technique used, technique outcome and clinical outcome. Data was analysed using SPSS 22. RESULTS: Of the 242 patients, 111(45.8%) were males and 131(54.1%) were female. The overall mean age was 46.3+/-13.543 years (range: 9-78years). Aneurysm size was <5mm in 95(40.4%) patients, 5-10mm in 98(41.7%) and >10mm in 42(17.9%) patients. Aneurysms were located in the anterior communicating artery in 93(38.4%) patients, internal carotid artery 48(19.8%) patients and posterior communicating artery 26(10.7%) patients. Patients with higher initial Hess and Hunt grade were more likely to have higher modified Rankin scale score after treatment (p=0.001). Overall, 222(91.7%) patients were treated successfully. Complications were noted in 37(15.2%) patients and 10(4.0%) patients died. CONCLUSIONS: No correlation was found between Hess and Hunt grades and aneurysm severity based on aneurysm size, neck and ruptured/unruptured cases.


Asunto(s)
Aneurisma Roto , Procedimientos Endovasculares , Aneurisma Intracraneal , Adulto , Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/epidemiología , Aneurisma Roto/terapia , Angiografía Cerebral , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Masculino , Persona de Mediana Edad , Pakistán/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento
3.
Ann Palliat Med ; 10(4): 4661-4669, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33966414

RESUMEN

BACKGROUND: Critical limb artery ischemia is one of common complications after hemodialysis, with endovascular therapy (EVT) having become its first-line treatment. There is no relevant study investigating the relationship between EVT and the prognosis of hemodialysis patients with critical lower limb ischemia, the most common site of vascular dysfunction. METHODS: This was a retrospective, nonrandomized, single-center study. Hemodialysis patients with critical lower limb ischemia between May 2015 and October 2018 were included in this study. Their demographic and clinical data and the results of laboratory test were collected. The outcomes included all-cause mortality, amputation, and revascularization. Kaplan-Meier analysis and log-rank test were used to assess overall survival and amputation-free survival. Univariable and multivariable hazard Cox regression analyses were performed to determine risk factors of amputation and mortality. RESULTS: In all, 67 hemodialysis patients were finally included in this study. The median age of included patients was 69.8±8.7 years, and the median duration of hemodialysis was 44.1±9.2 months. There was no significant difference between patients receiving and not receiving EVT in collected demographic and clinical data except for the duration of hemodialysis (46.1±9.0 vs. 41.7±9.0 months; P=0.048). The level of high-density lipoprotein cholesterol (HDL-C) in patients receiving EVT was 1.4±0.6 mmol/L, which was significantly lower than the 1.9±0.6 mmol/L in patients not receiving EVT (P<0.001). The results from the Kaplan-Meier curves indicated that the incidences of all-cause mortality and amputation were much lower in patients receiving EVT than in those not receiving EVT (P=0.038 and P=0.020). Hazard Cox regression analysis also indicated that EVT played protective role in all-cause mortality and amputation in hemodialysis patients with lower limb ischemia. Age, nutritional risk, stroke, and C-reactive protein (CRP) were also determined as independent risk factors of all-cause mortality according to multivariable analysis. Additionally, duration of hemodialysis and smoking history were identified as independent risk factors of amputation. CONCLUSIONS: EVT could be an efficient treatment for critical lower limb ischemia in hemodialysis patients to reduce all-cause mortality and the incidence of amputation. Moreover, some risk factors, such as malnutritional and stroke, should be avoided to improve the prognosis of hemodialysis patients.


Asunto(s)
Procedimientos Endovasculares , Anciano , Arterias , Enfermedad Crítica , Supervivencia sin Enfermedad , Humanos , Isquemia , Estimación de Kaplan-Meier , Extremidad Inferior , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Diálisis Renal , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
4.
BMJ Case Rep ; 14(5)2021 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-33975838

RESUMEN

Testicular ischaemia after endovascular aortic aneurysm repair (EVAR) is a very uncommon complication. There are only a few cases reported in the literature and the pathogenesis remains unclear. We report a case of unilateral testicular ischaemia in the early postoperative period after EVAR.A 78-year-old man underwent standard EVAR without immediate complications. Twenty-four hours after the procedure, the patient developed sudden onset of right scrotal pain and a low-grade fever. Urgent testicular ultrasound showed ischaemic signs compromising 75% of the testicle. The patient was successfully managed with conservative treatment.Although the pathogenesis is unknown, acute thrombosis of the testicle feeding arteries is postulated as the main hypothesis in the physiopathogenesis.


Asunto(s)
Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Anciano , Aneurisma de la Aorta Abdominal/cirugía , Procedimientos Endovasculares/efectos adversos , Humanos , Isquemia/etiología , Masculino , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Testículo/diagnóstico por imagen , Resultado del Tratamiento
5.
Kyobu Geka ; 74(2): 142-145, 2021 Feb.
Artículo en Japonés | MEDLINE | ID: mdl-33976022

RESUMEN

We report a case of a 65-year-old man, who was transported as an emergency case to our institution because of Stanford type B dissection. He received conservative therapy, but follow-up computed tomography(CT) revealed dilatation of descending aorta and low-enhanced range from abdominal aorta to right common iliac artery due to the expansion of the false lumen on day 11 of hospitalization. So, we attempted to perform debranch thoracic endovascular aortic repair (TEVAR), but we could not delivery the stentgraft through occluded right iliac artery. Four days later, we performed hybrid surgery of TEVAR and Y-graft replacement with reconstruction of the left renal artery. Postoperative CT showed no endoleak of TEVAR and ankle brachial pressure index (ABI) showed normal level. He was discharged on the 13th postoperative day.


Asunto(s)
Aneurisma Disecante , Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Anciano , Aneurisma Disecante/diagnóstico por imagen , Aneurisma Disecante/cirugía , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Prótesis Vascular , Dilatación , Humanos , Isquemia , Masculino , Estudios Retrospectivos , Stents , Resultado del Tratamiento
6.
Medicine (Baltimore) ; 100(18): e25732, 2021 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-33950956

RESUMEN

INTRODUCTION: Although the clinical significance of type II endoleaks remain controversial, management strategies continue to expand. The laparoscopic approach is a minimally invasive method for persistent type II endoleak repair after endovascular aneurysm repair. PATIENT CONCERNS: A 70 - year - old male patient with a history of endovascular aneurysm repair with left internal iliac artery embolization presented with persistent type II endoleak from the lumbar arteries 2 years ago. The aneurysm sac size had increased more than 10 mm during follow up period. DIAGNOSIS: Persistent type II endoleak after endovascular aneurysm repair. INTERVENTIONS: Transarterial embolization was attempted and failed. A minimally invasive laparoscopic lumbar artery ligation was then utilized. OUTCOMES: The patient was discharged without any complications after surgery. Follow-up computed tomography angiography has shown the complete disappearance of the type II endoleaks. CONCLUSIONS: Laparoscopic lumbar artery ligation may be a safe and effective alternative treatment for type II endoleaks, especially in high resource settings.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Endofuga/cirugía , Procedimientos Endovasculares/efectos adversos , Laparoscopía , Anciano , Angiografía por Tomografía Computarizada , Endofuga/diagnóstico , Endofuga/etiología , Humanos , Ligadura/métodos , Masculino , Resultado del Tratamiento
7.
Kyobu Geka ; 74(3): 202-205, 2021 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-33831873

RESUMEN

Idiopathic aortic rupture is a rare but often fatal condition that requires urgent attention and repair. I have performed thoracic endovascular aortic repair ( TEVAR) in two cases of idiopathic aortic rupture and have achieved positive results. It can be difficult to identify the site of rupture in these cases. Therefore, it is necessary to lengthen treatment and to determine the potential for spinal cord ischemia and associated paralysis of the lower extremities. Given its association with a favorable postoperative recovery, TEVAR can be considered as a minimally-invasive option that can be used early to treat this condition, including those associated with hemodynamic instability and in patients who are at high risk for complications.


Asunto(s)
Aneurisma de la Aorta Torácica , Rotura de la Aorta , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Rotura de la Aorta/diagnóstico por imagen , Rotura de la Aorta/cirugía , Humanos , Complicaciones Posoperatorias , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
8.
Kyobu Geka ; 74(3): 228-231, 2021 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-33831880

RESUMEN

An 81-year-old male was referred to our institute. His chief complaint was high fever. Computed tomography (CT) angiography demonstrated newly saccular aortic aneurysms at both thoracic and abdominal aorta. We used intravenous antibiotics( ceftriaxone 4 g/day) for seven days. Positron emission tomography (PET)/CT showed active inflammation sign at both chest and abdominal aneurysms. Open surgery for double aortic aneurysms seemed too invasive because of his past medical history. At eighth day after admission, we performed thoracic endovascular aortic repair( TEVAR) and endovascular aortic repair (EVAR) for preventing rupture of aortic aneurysms. After surgery, we continued intravenous antibiotics (ceftriaxone 4 g/day) for 15 days. We changed intravenous antibiotics to oral antibiotics( levofloxacin 500 mg/day). The postoperative course was uneventful. He was discharged at 19th day after surgery. Since surgery, no symptoms of reinfection have been observed at outpatient clinic. PET/CT was useful to evaluate the control of local infection in this case.


Asunto(s)
Aneurisma de la Aorta Torácica , Aneurisma de la Aorta , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Anciano de 80 o más Años , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Prótesis Vascular , Humanos , Control de Infecciones , Masculino , Tomografía Computarizada por Tomografía de Emisión de Positrones , Estudios Retrospectivos , Resultado del Tratamiento
9.
Kyobu Geka ; 74(4): 258-264, 2021 Apr.
Artículo en Japonés | MEDLINE | ID: mdl-33831885

RESUMEN

BACKGROUNDS: The purpose of this study was to evaluate the short- and mid-term outcomes of open aortic arch surgery and debranching thoracic endovascular aortic repair( TEVAR) in octogenarians. METHODS: Between 2011 and 2019, 26 patients with atherosclerotic aortic arch aneurysms underwent surgery at our institution [open aortic arch surgery( group O):10 patients, debranching TEVAR(group D):16 patients]. RESULTS: There was no operative death in either group. The mean length of hospitalization and intensive care unit stay were 49 and 13 days in group O and 12 and 2 days in group O, respectively. Kaplan-Meier analyses of overall survival (1/6/12/24/36/48 months) showed mortality rates of 100/100/88/88/70/70% in group O and 100/100/87/61/43/26% in group D, respectively. CONCLUSIONS: The acceptable outcomes was demonstrated in octogenarians underwent both open aortic arch surgery and debranching TEVAR. Because of early postoperative recovery, debranching TEVER is considered to be a feasible alternative to conventional open aortic arch surgery in octogenarians.


Asunto(s)
Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Anciano de 80 o más Años , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Humanos , Complicaciones Posoperatorias , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
10.
Kyobu Geka ; 74(4): 271-280, 2021 Apr.
Artículo en Japonés | MEDLINE | ID: mdl-33831887

RESUMEN

OBJECTIVES: We investigated the validity of the surgical strategy for aortic arch aneurysm depending on the patient's condition. METHODS: Between 2014 and 2019, 70 patients underwent total arch replacement (TAR) and 14 patients underwent fenestrated thoracic endovascular aortic repair( fTEVAR) for aortic arch aneurysm. We selected the surgical strategy on the basis of the patient's condition with or without frailty and if surgical risks including cancer or a respiratory condition precluded open surgery. RESULTS: The preoperative average ages were 73.3±7.8 years in the TAR group and 73.9±6.1 years in the fTEVAR group (p=0.93). EuroSCORE Ⅱ was 4.3±3.6 in the TAR group and 6.0±3.3 in the fTEVAR group (p=0.03). Frailty was observed in 11 patients (15.7%) in the TAR group and fivepatients (35.7%) in the fTEVAR group (p=0.08). In the fTEVAR group, there were three patients (21.4%) with cancer and three patients (21.4%) with a respiratory condition that precluded open surgery. The overall 30-day mortality rate was 0% for both groups, and the in-hospital mortality rate was 2.9% in the TAR group and 0% in the fTEVAR group (p=0.52). The incidence of stroke was 2.9% (two patients) in the TAR group and 7.1%( one patient) in the fTEVAR group( p=0.43). However, all stroke patients were able to walk at discharge. The cumulative survival rate was 88.9% and 83.5% in the TAR group and 85.1% and 68.1% in the fTEVAR group at two and five years, respectively (p=0.173). There were both 98.1% of patients in the TAR group and 85.7% and 75.0% of patients in the fTEVAR group who were free from reoperations at two and five years, respectively( p<0.01). CONCLUSIONS: Our surgical strategy and outcomes for aortic arch aneurysm were generally appropriate. It is important to select open surgery or TEVAR depending on the patient's condition.


Asunto(s)
Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Anciano , Anciano de 80 o más Años , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Humanos , Estudios Retrospectivos , Resultado del Tratamiento
11.
Kyobu Geka ; 74(4): 281-290, 2021 Apr.
Artículo en Japonés | MEDLINE | ID: mdl-33831888

RESUMEN

The technologies of endovascular treatment for aortic pathologies have progressed rapidly, and endovascular treatment for thoracic pathologies has gained widespread acceptance, and there has been a significant increase in the number of thoracic pathologies treated by thoracic endovascular aortic repair (TEVAR) over the last decade. The initial results of TEVAR such as operative mortality and morbidities have been good and acceptable. Therefore, indication of TEVAR has expanded along with the improvement of techniques and devices. However, as its mid-term and long-term results became available, complications including stroke, endoleaks and consequent aneurysm rupture have become apparent. Open repair is still the important treatment option because its results are acceptable and durable. This article provides an treatment strategy of aortic arch aneurysms to minimize the complications.


Asunto(s)
Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Aneurisma de la Aorta Torácica/cirugía , Prótesis Vascular , Humanos , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
12.
Medicine (Baltimore) ; 100(14): e25381, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832125

RESUMEN

ABSTRACT: Acute kidney injury (AKI) is a complication that can occur during endovascular aneurysm repair (EVAR), increasing postoperative mortality and disease-related death. We therefore evaluated the incidence of AKI after elective EVAR, as well as related factors affecting AKI occurrence, investigating the volume of contrast medium (CV)/estimated glomerular filtration rate (eGFR) ratio as a predictive factor.We retrospectively reviewed the data of patients who underwent EVAR for infrarenal abdominal aorta aneurysm at a single center between April 2011 and December 2018. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. We evaluated the occurrence of AKI within the first 7 days postoperatively, comparing serum creatinine levels, eGFR, CV, CV/eGFR ratio, fluid input and output, and morbidity between the AKI and no-AKI groups.The data of 147 patients were analyzed, of which 131 (89.1%) were males (mean age: 72.10±7.40 years); the incidence of AKI was 4.1% (6/147 patients). The mean dose of contrast agents used was greater in the AKI group than in the no-AKI group (249.17 ±â€Š83.21 mL vs 179.43 ±â€Š84.32 mL, respectively; P = .05). The baseline eGFR was 42.69 ±â€Š22.08 mL/kg/1.73 m2 in the AKI group and 77.96 ±â€Š18.92 mL/kg/1.73 m2 in the no-AKI group (P = .001). The CV/eGFR ratio was significantly higher in the AKI group (8.21 ±â€Š6.13 vs 2.46 ±â€Š1.44; P = 0.003). Baseline eGFR (odds ratio [OR] = 0.922, P = .001) and the CV/eGFR ratio (OR = 2.049, P = .008) were observed to be factors related to the occurrence of AKI in the logistic regression analysis for patients' characteristics, operation-related factors, and renal outcomes. In the receiver operating characteristic curve analysis, the area under the curve of the CV/eGFR ratio was 0.856, indicating the greatest influence. A CV/eGFR ratio cutoff value of 3.84 was considered the most appropriate, with an 83.3% sensitivity and 83.0% specificity.The CV/eGFR ratio, rather than the absolute amount of contrast agents, was associated with the development of AKI after EVAR. The CV/eGFR ratio could be used as a possible indicator to limit the amount of contrast media required for the procedure.


Asunto(s)
Lesión Renal Aguda/etiología , Aneurisma de la Aorta Abdominal/cirugía , Medios de Contraste/efectos adversos , Procedimientos Endovasculares/efectos adversos , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/fisiopatología , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Procedimientos Endovasculares/métodos , Femenino , Tasa de Filtración Glomerular/efectos de los fármacos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y Especificidad
14.
Am J Case Rep ; 22: e930291, 2021 Apr 12.
Artículo en Inglés | MEDLINE | ID: mdl-33840809

RESUMEN

BACKGROUND National guidelines and consensus statements suggest a 24-hour window for endovascular recanalization in patients presenting with acute ischemic stroke due to large-vessel occlusion. However, the safety and efficacy of extending the window for intervention remains to be definitively established. CASE REPORT A healthy 26-year-old woman presented with headache, left-sided hemiplegia, and rightward gaze palsy 2 days after a minor trauma. Time last known well was approximately 50 hours prior to presentation. Computed tomography angiography revealed dissection of the distal right internal carotid artery and occlusion of the M1 segment of the right middle cerebral artery. Magnetic resonance imaging showed a small area of acute infarct in the right basal ganglia and right insular cortex, but suggested a large ischemic penumbra; this was confirmed with cerebral perfusion analysis. In light of the patient's young age and potential for penumbral salvage, mechanical thrombectomy of an M1 thrombus and stenting of an internal carotid artery dissection were performed nearly 60 hours after the onset of symptoms. The patient demonstrated marked clinical improvement over the following days and was discharged home in excellent condition one week after presentation. Based on our clinical experience and other emerging data, we propose that extension of the 24-hour window for endovascular intervention may improve functional outcomes among select individuals. CONCLUSIONS A 24-hour window for endovascular thrombectomy is appropriate for many patients presenting with acute ischemic stroke. However, in select individuals, extension of the window to 48 hours or beyond may improve functional outcomes.


Asunto(s)
Isquemia Encefálica , Procedimientos Endovasculares , Accidente Cerebrovascular , Adulto , Isquemia Encefálica/etiología , Arteria Carótida Interna , Femenino , Humanos , Accidente Cerebrovascular/etiología , Trombectomía , Resultado del Tratamiento
15.
J Int Med Res ; 49(4): 300060520984933, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33845651

RESUMEN

OBJECTIVE: This study was performed to evaluate the safety and efficacy of endovascular stenting and embolization for the management of radiation-induced peripheral arterial pseudoaneurysms. METHODS: Twelve consecutive patients with radiation-induced peripheral arterial pseudoaneurysms (diameter of 10-30 mm and mean size of 20.42 mm) were admitted to our hospital from 1 January 2015 to 31 October 2019. The patients' baseline characteristics, perioperative parameters, device characteristics, and curative effects were systematically recorded and analyzed. RESULTS: The 12 patients comprised 3 men and 9 women with a mean age of 62.90 ± 13.97 years. The iliac artery was the most commonly involved artery, followed by the subclavian artery. In all patients, the pseudoaneurysms were detected by enhanced computed tomography. Twelve covered stents were deployed (7 or 8 mm in diameter and 50 mm in length). Additional coil embolization was performed in three patients (Patients 8, 9, and 10). The primary and secondary technical success rate was 91.7% and 100%, respectively. Apart from one death caused by rebleeding, no patients developed rebleeding during follow-up. CONCLUSION: Endovascular stenting and coil embolization are feasible and effective for the management of radiation-induced peripheral arterial pseudoaneurysms in highly selected patients.


Asunto(s)
Aneurisma Falso , Embolización Terapéutica , Procedimientos Endovasculares , Anciano , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/terapia , Arterias , Prótesis Vascular , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Stents , Resultado del Tratamiento
16.
Am J Case Rep ; 22: e929538, 2021 Apr 13.
Artículo en Inglés | MEDLINE | ID: mdl-33848284

RESUMEN

BACKGROUND Spontaneous isolated dissection of the superior mesenteric artery (SID-SMA) is a rare but potentially fatal condition. Although many cases of SID-SMA have been reported in the literature in recent years because of the increased use of contrast-enhanced computed tomography (CT) scanning, optimal management has not yet been firmly established. CASE REPORT We report 2 cases of SID-SMA that were managed with stenting and angioplasty via transfemoral access. In case 1 a 54-year-old man presented with diffuse abdominal pain without Blumberg sign. Laboratory data were unremarkable. Abdominal CT scanning revealed SID-SMA and initial bowel ischemia. The angiogram revealed a dissected true lumen of SMA with a narrowing of the ileo-colic artery managed, respectively, with self-expandable stent placement and angioplasty. In case 2, a 45-year-old man presented with severe abdominal cramping and pain of 3 days' duration. Physical examination revealed abdominal tenderness with positive Blumberg sign. Laboratory tests showed leukocytosis and increased lactate dehydrogenase. Abdominal CT scan revealed SID-SMA and initial bowel ischemia. After an SMA angiogram, 2 self-expandable stents were placed and an angioplasty was performed. Although a postprocedural angiogram showed good patency of the SMA in both patients, the first patient had a recurrence of abdominal pain after 5 days with a new narrowing tract of the SMA and more inferiorly a dissection with aneurysm of a false lumen, detected on CT scan, treated respectively with stenting and coils. CT follow-up showed successful morphological results in both patients. CONCLUSIONS In our experience, endovascular treatment of SID-SMA is safe and effective, including in cases of recurrence and postprocedural evolution.


Asunto(s)
Aneurisma Disecante , Procedimientos Endovasculares , Disección , Humanos , Masculino , Arteria Mesentérica Superior/diagnóstico por imagen , Persona de Mediana Edad , Stents , Factores de Tiempo , Resultado del Tratamiento
17.
J Med Case Rep ; 15(1): 168, 2021 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-33853688

RESUMEN

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) is the gold standard for surgical management of descending thoracic aortic pathology. Depending on the anatomy, TEVAR often requires deployment across the origin of the left subclavian artery (LSA) to obtain a proximal seal, thus potentially compromising perfusion to the left upper extremity (LUE). However, in most patients this is generally well tolerated without revascularization due to collateralization from the left vertebral artery (LVA). CASE PRESENTATION: We present a complex 59-year-old Caucasian patient case of TEVAR with a history of prior arch debranching and intraoperative LSA coverage requiring subsequent LSA embolization and emergency take-back for left carotid-subclavian bypass. CONCLUSION: The purpose of this case report is to highlight an often overlooked anatomic LVA variant and an atypical, delayed presentation of acute LUE limb ischemia.


Asunto(s)
Aneurisma Disecante , Aneurisma de la Aorta Torácica , Enfermedades de la Aorta , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Aneurisma Disecante/diagnóstico por imagen , Aneurisma Disecante/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Enfermedades de la Aorta/cirugía , Brazo , Humanos , Isquemia , Persona de Mediana Edad , Estudios Retrospectivos , Stents , Arteria Subclavia/diagnóstico por imagen , Arteria Subclavia/cirugía , Resultado del Tratamiento
18.
BMJ Case Rep ; 14(4): 1-2, 2021 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-33875517

RESUMEN

Delayed rupture of an aneurysm following WEB embolization has not yet been reported. We present a case of a multiply ruptured anterior communicating artery aneurysm treated via WEB embolization. A post-treatment CT scan confirmed no evidence of rebleeding during treatment. Four hours after treatment, the patient developed an acute, significant increase in intracranial pressure with bloody ventriculostomy output, with CT scan demonstrating new parenchymal and intraventricular hemorrhage. The aneurysm was subsequently treated via microsurgical clipping that did not identify an "uncovered" bleb or rupture source.


Asunto(s)
Aneurisma Roto , Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma Intracraneal , Hemorragia Subaracnoidea , Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/terapia , Embolización Terapéutica/efectos adversos , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Hemorragia Subaracnoidea/terapia , Resultado del Tratamiento
19.
BMJ Case Rep ; 14(4)2021 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-33879462

RESUMEN

Persistent sciatic artery (PSA) is a rare vascular anomaly that can cause acute limb ischaemia (ALI) due to peripheral thromboembolism following aneurysm formation, and surgical repair or exclusion with or without femoropopliteal bypass is the standard treatment for these symptomatic cases of PSA. Here, we report a case of a 70-year-old man with right PSA aneurysm who suffered from recurrent ALI despite the history of right femoropopliteal bypass at the age of 58 for occlusion of right PSA and graft (femoropopliteal bypass graft)-to-tibial bypass at the age of 68 for occlusion of right posterior tibial artery. We performed a catheter angiographic examination using an intravascular ultrasound and performed an endovascular therapy (EVT) for the purpose of jailing the internal iliac artery. This is a rare case of PSA aneurysm presenting with recurrent ALI after femoropopliteal bypass successfully treated with EVT.


Asunto(s)
Aneurisma , Arteriopatías Oclusivas , Procedimientos Endovasculares , Anciano , Aneurisma/complicaciones , Aneurisma/diagnóstico por imagen , Aneurisma/cirugía , Arterias , Humanos , Isquemia/etiología , Isquemia/cirugía , Masculino
20.
Medicina (Kaunas) ; 57(3)2021 Mar 17.
Artículo en Inglés | MEDLINE | ID: mdl-33802895

RESUMEN

Interventional radiology of the male urogenital system includes percutaneous and endovascular procedures, and these last consist mostly of transcatheter arterial embolizations. At the kidney level, arterial embolizations are performed mainly for palliative treatment of parenchymal tumors, for renal traumas and, less frequently, for arteriovenous fistulas and renal aneurysms and pseudoaneurysms. These latter may often require emergency intervention as they can cause renal or peri-renal hematomas or significant hematuria. Transcatheter arterial embolization is also an effective therapy for intractable severe bladder hematuria secondary to a number of neoplastic and inflammatory conditions in the pelvis, including unresectable bladder cancer and radiation-induced or cyclophosphamide-induced hemorrhagic cystitis. Endovascular interventional procedures for the penis are indicated for the treatment of post-traumatic priapism. In this article, we review the main endovascular radiological interventions of the male urogenital system, describing the technical aspects, results, and complications of each procedure at the various anatomical districts.


Asunto(s)
Aneurisma Falso , Fístula Arteriovenosa , Embolización Terapéutica , Procedimientos Endovasculares , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/terapia , Humanos , Masculino , Radiología Intervencional , Resultado del Tratamiento
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