RESUMO
OBJECTIVE: To determine outcomes of postdissection thoracoabdominal aneurysms by either open or endovascular repair with fenestrated or branched endografts. METHODS: A systematic review was conducted for open or endovascular repair of postdissection thoracoabdominal aneurysms, between January 2009 and February 2020. A meta-analysis was performed for postoperative complications and both early and late mortality and reinterventions. RESULTS: Fifteen noncomparative studies (eight endovascular repair and seven open repair) were suitable for meta-analysis. Overall, 1337 patients were included, 1068 in the open repair group (73% male; mean age 58 years) and 269 in the endovascular repair group (79% male; mean age 65 years). The 30-day mortality was 6% for open repair vs 3% for endovascular repair (P = .35), whereas the 30-day reintervention rate was 3% for open repair vs 1% for endovascular repair (P = .66). The only significant difference was reported for 30-day respiratory complication rate (30% open repair vs 2% endovascular repair; P < .01). The incidence of spinal cord ischemia was 9% for open repair vs 8% for endovascular repair (P = .95). The mean follow-up was 44 months: 48 months (range, 10-72 months) after open repair and 17 months (range, 12-25 months) after endovascular repair (P < .01). Late aortic reinterventions were more frequent after endovascular repair (11% vs 32%; P < .001). The late overall mortality rate was 19% for open repair vs 7% for endovascular repair (P = .08), whereas aortic-related mortality was 7% for open repair vs 3% for endovascular repair (P = .22). CONCLUSIONS: In the absence of comparative studies, this meta-analysis showed that endovascular repair seems to be a viable alternative for patients unfit for open repair.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/mortalidade , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Tomada de Decisão Clínica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Retratamento , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: The purpose of this study was to evaluate the long term results of endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysm (AAA) and ectatic common iliac arteries (CIAs). METHODS: In a retrospective analysis of a prospectively collected database in two high volume centres, patients with AAAs undergoing elective standard EVAR were divided into two groups: those with both CIA diameters <18 mm, and those with at least one ectatic iliac artery (CIA ≥ 18 mm). Patients with an intentional external iliac artery landing zone were excluded. Primary outcomes were survival and freedom from re-intervention. Secondary end points were EVAR failure and iliac related endoleak and iliac re-intervention. RESULTS: From 2000 to 2015, 648 patients were included in the study, 277 (43%) had at least one CIA ≥ 18 mm. Pre-operative risk factors were similar between the two groups, with the exception of chronic renal insufficiency (p = .010) and cerebrovascular events (p = .040), which were higher in the ectatic CIA group. At 30 days from primary procedure, there was a higher rate of type Ib endoleak in patients with ectatic iliacs (p = .020). A statistically significant increase in the incidence of late type Ib endoleak in patients with ectatic iliac arteries was confirmed at a mean follow up of 74.8 months (p = .01). The need for iliac related re-intervention was higher in patients with CIAs ≥18 mm (odds ratio 1.94; 95% confidence interval 1.1-3.2). CONCLUSION: Ectatic iliac arteries are considered suitable landing zones for EVAR, although there is an increased risk of secondary interventions in time mainly due to late CIA dilation and secondary type Ib endoleak. Patients receiving EVAR with flared iliac limbs may benefit a more intensive surveillance to avoid late failures.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Bases de Dados Factuais , Dilatação Patológica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/mortalidade , Artéria Ilíaca/diagnóstico por imagem , Itália , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do TratamentoRESUMO
Serum-derived extracellular vesicles (sEV) from healthy donors display in-vivo pro-angiogenic properties. To identify patients that may benefit from autologous sEV administration for pro-angiogenic purposes, sEV angiogenic capability has been evaluated in type 2 diabetic (T2DM) subjects (D), in obese individuals with (OD) and without (O) T2DM, and in subjects with ischemic disease (IC) (9 patients/group). sEV display different angiogenic properties in such cluster of individuals. miRNomic profile and TGFß content in sEV were evaluated. We found that miR-130a and TGFß content correlates with sEV in-vitro and in-vivo angiogenic properties, particularly in T2DM patients. Ingenuity Pathway Analysis (IPA) identified a number of genes as among the most significant miR-130a interactors. Gain-of-function experiments recognized homeoboxA5 (HOXA5) as a miR-130a specific target. Finally, ROC curve analyses revealed that sEV ineffectiveness could be predicted (Likelihood Ratio+ (LH+) = 3.3 IC 95% from 2.6 to 3.9) by comparing miR-130a and TGFß content 'in Series'. We demonstrate that sEV from high cardiovascular risk patients have different angiogenic properties and that miR-130a and TGFß sEV content predicts 'true ineffective sEVs'. These results provide the rationale for the use of these assays to identify patients that may benefit from autologous sEV administration to boost the angiogenetic process.
Assuntos
Doenças Cardiovasculares/sangue , Diabetes Mellitus Tipo 2/sangue , Proteínas de Homeodomínio/genética , MicroRNAs/genética , Fator de Crescimento Transformador beta/metabolismo , Regiões 3' não Traduzidas , Adulto , Idoso , Doenças Cardiovasculares/genética , Doenças Cardiovasculares/metabolismo , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/metabolismo , Vesículas Extracelulares/genética , Vesículas Extracelulares/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Endovascular repair of thoracoabdominal and juxtarenal aortic aneurysm has recently become a valuable alternative to open surgery especially in high-risk patients. Progressive improvements in graft materials and low-profile devices allow treatment of complex aneurysms even in adverse anatomical settings. However, all published experiences report risks of occlusion and reinterventions due to visceral stent-graft failures in the long term. The purpose of this systematic review is to analyze the results of currently used balloon expandable bridging stent-grafts and to evaluate the newest developments for fenestrated endovascular aortic repair (FEVAR) in juxtarenal endovascular repair. Data were retrieved from retrospective analyses, case series and case reports conducted from 2000 to September 2019. The literature analysis provided a list of the most commonly used balloon-expandable bridging stent-grafts for FEVAR. For each stent-graft a brief summary of structural characteristics and performances have been described. No randomized controlled trials (RCTs) or comparative data between the stent-grafts are available for this specific topic. Several balloon-expandable stent-grafts have been used as bridging stents during FEVAR but the ideal bridging stent-graft is far to be designed. The better understanding of the system FEVAR-native aorta and the strict collaboration and exchange of expertise between physicians and engineers are mandatory in order to increase the performances of these important components and to reduce re-interventions and complications in FEVAR.
Assuntos
Angioplastia com Balão/instrumentação , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Stents , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/mortalidade , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Humanos , Complicações Pós-Operatórias/cirurgia , Desenho de Prótese , Reoperação , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: Today transdermal continuous oxygen therapy (TCOT) is used in wound care to promote healing by improving local hypoxia and preventing infection, and it has been described to reduce local inflammation over 1 month of administration. The present study aims to investigate the effects of this treatment on wound microcirculation through laser speckle contrast analysis (LASCA). METHODS: 20 adult patients (mean age: 76 ± 11.5 years) were prospectively enrolled. Inclusion criteria were presence of venous or mixed lower limb ulcers from three or more months without dimension reduction and without indication to surgery and weekly treatment by our outpatient clinic with silver dressings. Subjects underwent 1 month of TCOT (EPIFLO®) in addition to foam dressing. The primary endpoint was the comparison of ulcer and healthy skin perfusion through LASCA, performed before and after the treatment period. Secondary considered endpoints were wound area, wound area severity index and PUSH Tools 3.0 ulcer severity scales, and pain assessment (Numerical Rating Scale [NRS]). RESULTS: Before treatment, the wound area was significantly more perfused than healthy skin (+45%; P = 0.005). At the end of the study, this difference was not significant anymore (+20.5%; P = 0.11). Ulcer perfusion decreased (-12.5%, P = 0.047), whereas healthy skin perfusion did not vary significantly. A reduction of the wound dimension (median difference: 2 cm; P = 0.009) and pain (median difference: 2 NRS point; P < 0.001) after therapy were assessed. CONCLUSIONS: LASCA shows that 1 month of TCOT can help reduce hyperperfusion of ulcer bed in patients with chronic lower limb ulcers, strengthening the hypothesis that this treatment effectively contrasts inflammation. This could correlate with the area and pain reduction assessed; however, the absence of a control group in this study does not allow a generalization of this hypothesis. Larger, controlled trials are needed to properly assess the relationship between TCOT effects on wound microenvironment and effective healing process.
Assuntos
Fluxometria por Laser-Doppler , Úlcera da Perna/terapia , Oxigênio/administração & dosagem , Imagem de Perfusão , Doença Arterial Periférica/terapia , Pele/irrigação sanguínea , Cicatrização/efeitos dos fármacos , Administração Cutânea , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Doença Crônica , Feminino , Humanos , Úlcera da Perna/diagnóstico , Úlcera da Perna/fisiopatologia , Masculino , Microcirculação , Pessoa de Meia-Idade , Oxigênio/efeitos adversos , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fluxo Sanguíneo Regional , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: Endovascular treatment represents nowadays the preferred therapeutic approach for disabling femoro-popliteal arterial occlusive disease in fit patients. In the latest years, in order to improve short- and long-term outcomes, drug eluting devices have been developed. Drug coated balloons (DCB) and drug eluting stents (DES) are today employed in clinical practice, and several studies has been completed to assess their performance in different clinical scenarios. Objective of the present review and meta-analysis is to compare clinical results of different endovascular treatment modalities in the published literature in the last 10 years. EVIDENCE ACQUISITION: A systematic review and meta-analysis following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement on the literature regarding direct comparisons between DCB, DES, bare metal stents (BMS) and Plain Old Balloon Angioplasty (POBA) has been conducted. Primary outcomes were considered Primary Patency and Target Lesion Revascularization (TLR) at 12 months. Analysis of late survival in different treatment groups was outside the scope of the present study and was therefore not included as main end point. EVIDENCE SYNTHESIS: Meta analysis results confirm that DCB outperforms POBA in both primary patency (estimate OR=3.17, 95% CI: 2.10-4.76) and TLR (POBA estimate OR=3.59, 95% CI= 2.31-5.56). No clear evidences emerged comparing DES and BMS; however, DES were shown to fare better than BMS in terms of TLR when analyzing lesions <15 cm (OR 0.36, 95% CI: 0.35-0.36). Comparison of DCB and DES revealed higher rates of TLR for DES (OR 1.26 95% CI: 1.07-1.49), however no significant differences have been found regarding primary patency analyzing such long lesions (range 14-19.4 cm) as those included in the studies. CONCLUSIONS: While confirming that DCB outperforms POBA in terms of primary patency and TLR at 12 months, only TLR benefits are noted for DES vs. BMS and DCB vs. DES in limited clinical settings. Further RCTs are needed to strongly assess the compared performance of drug eluting devices in relation to lesion length and controlling possible confounders.
Assuntos
Angioplastia/instrumentação , Stents Farmacológicos , Artéria Femoral , Metais , Doença Arterial Periférica/terapia , Artéria Poplítea , Stents , Idoso , Angioplastia/efeitos adversos , Feminino , Artéria Femoral/fisiopatologia , Oclusão de Enxerto Vascular/epidemiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/fisiopatologia , Desenho de Prótese , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
BACKGROUND: One of the most critical phases of carotid endarterectomy (CEA) is the carotid cross-clamping test, which is a concrete evaluation of efficacy of collateral cerebral perfusion. Some studies revealed a strong correlation between tolerance to carotid cross-clamping and postoperative transient ischemic attack (TIA)/stroke complications. The aim of the study is to make a global analysis of supra-aortic trunks (SAT) and circle of Willis (CoW) patency to predict the tolerance to carotid cross-clamping preoperatively. METHODS: We observed retrospectively 503 patients who underwent CEA under local anesthesia between January 2012 and 2017. We analyzed single preoperative risk factors, drug therapy, and vessels patency of the group of patients who did or did not present neurological symptoms at carotid cross-clamping. Afterward, we created a cerebral perfusion score (PTOT) to estimate the efficacy of collateral cerebral perfusion and we compared the results from both groups. The score ranges from 0 (hypothetical total occlusion of the SAT and CoW) to 0.65 in case of patency of all arterial districts. Moreover, we evaluated postoperative complication rates. RESULTS: Patients with previous neurological symptoms, female gender, and diabetes correlate with a lower tolerance to carotid cross-clamping (odds ratio: 2.57, 2.78, and 2.57, respectively; P value < 0.05). The SAT and CoW score revealed that patients with score <0.2 more frequently did not tolerate carotid cross-clamping (P value 0.01). Patients who required an intraoperative shunt presented a higher risk of TIA/stroke within 30 days from surgery than those with a better neurological compensation (P value 0.03). CONCLUSIONS: The efficacy of cerebral mechanisms of compensation during carotid cross-clamping reflects the capability of the brain to adapt to ischemic insults, and this also correlates with the postoperative risk of TIA/stroke. It is possible to identify preoperatively patients with a higher risk of neurological intolerance at carotid cross-clamping. This score could be a useful method to make a further stratification of risk of neurological complications and eventually to prefer a general anesthesia and the use of shunt for those with PTOT < 0.2.
Assuntos
Aorta/fisiopatologia , Doenças das Artérias Carótidas/cirurgia , Circulação Cerebrovascular , Círculo Arterial do Cérebro , Endarterectomia das Carótidas , Grau de Desobstrução Vascular , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Circulação Colateral , Constrição , Endarterectomia das Carótidas/efeitos adversos , Feminino , Humanos , Ataque Isquêmico Transitório/etiologia , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do TratamentoRESUMO
Endovascular treatment of carotid artery stenosis is a valuable alternative to open surgery, and the evolution of stent materials and cerebral protection devices significantly decreased postoperative neurological complications. Among these, the introduction of nitinol double-layer micromesh stent seems to guarantee a reduced perioperative and postoperative cerebral embolization. Long-term results are however still not available to make a global evaluation of these stents. We present the case of a 66-year-old female patient treated for asymptomatic carotid stenosis complicated by a symptomatic partial stent thrombosis occurred three months after carotid artery stenting.
Assuntos
Ligas , Estenose das Carótidas/terapia , Dispositivos de Proteção Embólica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Stents , Telas Cirúrgicas , Trombose/etiologia , Idoso , Anticoagulantes/administração & dosagem , Doenças Assintomáticas , Estenose das Carótidas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Inibidores da Agregação Plaquetária/administração & dosagem , Desenho de Prótese , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Fatores de Tempo , Resultado do TratamentoRESUMO
Pelvic arteriovenous malformation (AVM) is a rare condition mostly requiring a complex therapeutic strategy. The surgical approach is challenging and burdened by relatively high mortality and morbidity rates. No guidelines are available for the endovascular treatment of AVM because the literature is limited to small case series and case reports. We present a complex case of a pelvic AVM associated with an internal iliac artery aneurysm in a patient previously treated with a common to external prosthetic substitution for aneurysm and proximal ligation of internal iliac artery.
RESUMO
BACKGROUND: Pseudoaneurysm (PA) after carotid endarterectomy (CEA) is a rare and potentially life-threatening complication, with an incidence lower than 1%. Most of the cases described report PAs after carotid patch angioplasty and are associated with infection, often caused by Staphylococci. The management of PAs can be surgical, endovascular, or hybrid. METHODS: We herein present the case of an infected carotid PA 27 days after an eversion CEA. We performed a common to internal carotid bypass with the interposition of great saphenous vein (GSV) associated with specific polyantibiotic therapy for 4 weeks. We searched the PubMed database for reviews and cases reports for patients who developed carotid PA after primary repair CEA in the period between 1969 and 2017. RESULTS: We identified 21 cases of primary closure post-CEA PAs in the literature. In almost 60% of patients, infection was detected. Open surgery was performed in all the cases; in 1 case, an hybrid approach was preferred. In 52% of cases, a vein graft/patch or primary closure was chosen; in 3 cases, ligation was preferred, and in 1 case, a polyester graft was used. CONCLUSION: In our experience and with the evidence observed in the literature, open surgery with GSV interposition is the safest treatment in infected carotid PAs. The endovascular approach must be performed only in proven noninfectious cases. A bridge technique with the insertion of a stent followed by open surgery repair can be an option in emergency cases.
Assuntos
Falso Aneurisma/etiologia , Aneurisma Infectado/etiologia , Doenças das Artérias Carótidas/cirurgia , Lesões das Artérias Carótidas/etiologia , Endarterectomia das Carótidas/efeitos adversos , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/microbiologia , Falso Aneurisma/cirurgia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Implante de Prótese Vascular , Doenças das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/microbiologia , Lesões das Artérias Carótidas/cirurgia , Angiografia por Tomografia Computadorizada , Humanos , Ligadura , Masculino , Veia Safena/transplante , Resultado do TratamentoRESUMO
OBJECTIVES: The traditional surgical approach to the treatment of the superficial venous insufficiency requires at least 12â¯h of post-operative monitoring and this often means the necessity of an overnight hospitalization. The introduction of new, less invasive techniques (i.e endovenous laser ablation) reduces the hospitalization stay in a Day Surgery setting. However, the increasing skills of the operators and the patient's selection, allows to propose endovenous laser ablation in an Outpatient setting. The aim of this study is to evaluate the activity of a single high-volume center. METHOD: We enrolled 112 consecutive patients with great sapehous vein insufficiency and indication to endothermal laser ablation, 57 operations (51%) were performed in Day Surgery setting and 55 (49%) in Outpatient setting according to endovascular laser ablation's criteria. Past medical history, CEAP classification, VCSS score, type of symptoms and intervention's data were collected. Post-operative results (success and complications rates, patient's functional and aesthetic satisfaction) were evaluated at 7 and 30 days after intervention. A QoL questionnaire (CIVIQ) was submitted to the patients 30 days after surgery. RESULTS: We did not observe a statistically significant difference between the two groups concerning treatment results and complications onset. The QoL assessment did not differed significantly, except for over 65-year old patients undergoing outpatient treatment that showed a better QoL compared to those undergoing the same treatment in Day Surgery (p 0.05). CONCLUSIONS: The endothermal laser ablation technique allows a safe, comfortable and faster management of the venous disease in Outpatient setting. This would further reduce the costs of the treatment while preserving the functional and aesthetic results and the low complication rate of the Day Surgery setting.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Terapia a Laser/métodos , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Estudos Prospectivos , Qualidade de Vida , Insuficiência Venosa/psicologiaRESUMO
Serum is an abundant and accessible source of circulating extracellular vesicles (EVs). Serum-EV (sEV) pro-angiogenic capability and mechanisms are herein analyzed using an in vitro assay which predicts sEV angiogenic potential in vivo. Effective sEVs (e-sEVs) also improved vascular remodeling and prevented muscle damage in a mouse model of acute hind limb ischemia. e-sEV angiogenic proteomic and transcriptomic analyses show a positive correlation with matrix-metalloproteinase activation and extracellular matrix organization, cytokine and chemokine signaling pathways, Insulin-like Growth Factor and platelet pathways, and Vascular Endothelial Growth Factor signaling. A discrete gene signature, which highlights differences in e-sEV and ineffective-EV biological activity, was identified using gene ontology (GO) functional analysis. An enrichment of genes associated with the Transforming Growth Factor beta 1 (TGFß1) signaling cascade is associated with e-sEV administration but not with ineffective-EVs. Chromatin immunoprecipitation analysis on the inhibitor of DNA binding I (ID1) promoter region, and the knock-down of small mother against decapentaplegic (SMAD)1-5 proteins confirmed GO functional analyses. This study demonstrates sEV pro-angiogenic activity, validates a simple, sEV pro-angiogenic assay which predicts their biological activity in vivo, and identifies the TGFß1 cascade as a relevant mediator. We propose serum as a readily available source of EVs for therapeutic purposes.
Assuntos
Vesículas Extracelulares/metabolismo , Isquemia/sangue , Isquemia/patologia , Músculo Esquelético/metabolismo , Músculo Esquelético/patologia , Remodelação Vascular , Animais , Biomarcadores , Proliferação de Células , Modelos Animais de Doenças , Células Endoteliais/metabolismo , Vesículas Extracelulares/ultraestrutura , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Membro Posterior , Imuno-Histoquímica , Camundongos , Músculo Esquelético/irrigação sanguínea , Neovascularização Fisiológica , Regiões Promotoras Genéticas , Proteômica/métodos , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/patologia , TranscriptomaRESUMO
BACKGROUND: Many studies confirmed the role of early carotid endarterectomy (CEA) to prevent recurrent stroke or transient ischemic attack; however, the mid-long-term neurological benefit is still not completely investigated. The purpose of the study was to evaluate the role of early CEA on the perioperative and postoperative stroke/death complications of patients with a symptomatic carotid stenosis. METHODS: Ninety consecutive patients were referred to our center for a symptomatic carotid stenosis. They were divided into 2 groups according to the time to surgery: G1 within 2 weeks (39 patients) and G2 from 2 weeks to thereafter (51 patients). Neurological assessment was performed with the National Institutes of Health Stroke Scale (NIHSS) at presentation and at follow-up. Echo color Doppler ultrasound was performed at 1-6 months and then yearly. RESULTS: The presentation of neurological symptoms differed significantly between the 2 groups; in fact, minor stroke was more frequent in G1, whereas transient ischemic attack was more frequent in G2 (P value = 0.027). No significant differences emerged between the 2 groups on the surgical intervention or perioperative complications. The study showed a significant improvement of the neurological impairment (evaluated with a reduction of NIHSS score) of patients in G1 compared with G2 (P value = 0.01). CONCLUSIONS: Neurological recovery after a symptomatic carotid stenosis is strictly correlated to the variable "time to surgery." A higher sensitization of the general population on the early recognition of the symptoms and a strict collaboration with neurologists is mandatory to reduce time to CEA and improve clinical outcomes.
Assuntos
Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Ataque Isquêmico Transitório/etiologia , Acidente Vascular Cerebral/etiologia , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/mortalidade , Avaliação da Deficiência , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/mortalidade , Feminino , Humanos , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/mortalidade , Itália , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Recidiva , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em CoresAssuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Artéria Renal/cirurgia , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Desenho de Prótese , Artéria Renal/diagnóstico por imagem , Stents , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of this study was to evaluate the incidence of acute kidney injury (AKI) after open and endovascular abdominal aortic aneurysm repair according to the Aneurysm Renal Injury Score classification. METHODS: We retrospectively evaluated 431 patients undergoing elective open aortic repair (OAR; n = 285) or endovascular repair (n = 146) for infrarenal aortic aneurysm. All data regarding preoperative and postoperative serum creatinine concentrations and postoperative outcomes were assessed. Univariate and multivariate logistic regression models investigated the association between AKI and different risk factors and complications. RESULTS: The incidence of AKI was significantly higher after OAR (26.3% vs 5.5%; P < .001). A significant share of patients who experienced AKI were restored to preoperative renal function at discharge (62.5% vs 77.5% in the endovascular and OAR groups, respectively; P = .37). Preoperative serum creatinine concentration was significantly higher in those patients who further developed AKI (1.25 vs 1.04 mg/dL; P < .001). At the multivariate analysis, AKI was significantly associated with current smoking (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.19-3.52; P = .01), hypertension (OR, 2.46; 95% CI, 1.21-4.3; P = .01), chronic renal disease (OR, 2.53; 95% CI, 1.42-4.53; P < .001), OAR (OR, 7.3; 95% CI, 3.25-16.42; P < .001), and arrhythmias (OR, 3.16; 95% CI, 1.09-9.13; P = .03). AKI stage did not affect postoperative outcomes, except for a longer hospital stay in patients in stage 2 and stage 3 compared with stage 1. CONCLUSIONS: AKI is a common but often reversible complication, especially after OAR. There is an urgent need of a common classification for AKI after aortic surgery. New diagnostic markers for AKI should be evaluated in large-scale studies to assess their reliability.
Assuntos
Injúria Renal Aguda/epidemiologia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Injúria Renal Aguda/sangue , Injúria Renal Aguda/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Creatinina/sangue , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Incidência , Itália/epidemiologia , Tempo de Internação , Modelos Logísticos , Masculino , Análise Multivariada , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Aortic aneurysm repair is a resolutive and effective surgical operation, which can be associated with severe postoperative complications. Procalcitonin (PCT) in clinical practice could play a role in early diagnosis and monitoring of therapy for complications, especially infections, making for timely and more effective interventions. Our aim was to investigate whether PCT could be a predictive marker in early diagnosis of infectious complications after open abdominal aortic surgery. METHODS: Eighty-three consecutive patients who underwent elective open aortic repair at our institution were enrolled. Blood samples were taken before surgery, and each day over the 7-day postoperative period, and measurement of serum PCT, C-reactive protein (CRP), and leukocytes levels were carried out. Data regarding clinical progress, instrumental examinations, and blood chemistry were prospectively collected. RESULTS: Postoperative infectious complications occurred in 24 patients. Within 30 days, 1 death occurred. In the study sample, we found a significant difference in PCT curves of patients with and without infectious complications, especially on third postoperative day (POD; P = 0.004). On analysis of the area under the curve (AUC curve), PCT was shown to be a fair predictor in distinguishing cases with infectious complications (AUC, 0.765 on third POD; CI, 0.638-0.877). Conversely, other inflammatory markers commonly used (leucocytes and CRP) had similar trends in patients with and without postoperative infections. CONCLUSIONS: On the basis of the results collected in this pilot study, despite some limitations, PCT could be considered a better marker of infectious complications after open abdominal aortic repair, when compared with other routinely used parameters.
Assuntos
Aorta Abdominal/cirurgia , Calcitonina/sangue , Infecções Respiratórias/sangue , Infecção da Ferida Cirúrgica/sangue , Infecções Urinárias/sangue , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Área Sob a Curva , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Diagnóstico Precoce , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Itália , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidade , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/mortalidade , Fatores de Tempo , Resultado do Tratamento , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologia , Infecções Urinárias/mortalidade , Procedimentos Cirúrgicos Vasculares/mortalidadeRESUMO
In this case series, we selected 4 patients with asymptomatic severe carotid stenosis due to unstable plaques, which were identified with contrast-enhanced ultrasound. These patients underwent carotid stenting with a new generation double mesh stent. Diffusion-weighted magnetic resonance imaging (DW-MRI) was executed before and after the procedure to detect early cerebral microembolizations. No early neurological complications occurred nor cerebral microembolizations were detected at DW-MRI. New double mesh carotid stents appear to be a safe option also in asymptomatic patients with unstable plaques at high risk for surgery.
Assuntos
Angioplastia/instrumentação , Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/terapia , Meios de Contraste , Imagem de Difusão por Ressonância Magnética , Fosfolipídeos , Stents , Hexafluoreto de Enxofre , Telas Cirúrgicas , Ultrassonografia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Placa Aterosclerótica , Valor Preditivo dos Testes , Desenho de Prótese , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia Doppler em CoresRESUMO
Growing evidence suggests that small vesicles actively released from cells may encapsulate transcriptional regulators and RNA molecules. Their ability to interact with neighbouring cells and/or with distant cells through biological fluids, makes them a medium through which intercellular exchange of information can happen. Recently, membrane vesicles, which include exosomes and microvesicles, gained a place amongst the vast group of angiogenic mediators. In the present review we discuss the potential relevance of these vesicles in physiological and pathological situations of angiogenesis as well as their mechanism of action.
Assuntos
Vesículas Extracelulares/metabolismo , Neovascularização Patológica/fisiopatologia , Neovascularização Fisiológica/fisiologia , Animais , Exossomos/metabolismo , Humanos , RNA/metabolismoRESUMO
We report 2 cases of exclusion of visceral artery aneurysms. The first was a common hepatic artery aneurysm treated with a multilayer stent; the second was a celiac trunk aneurysm excluded by a covered stent. Computed tomographic angiography was performed at regular intervals after each procedure, together with echo color Doppler imaging and contrast-enhanced sonography. Computed tomographic angiography and contrast-enhanced sonography were able to detect endoleaks in both patients and the related inflow vessel; moreover, diameter measurements of the sacs were identical. In our preliminary experience, contrast-enhanced sonography appeared to be as accurate as computed tomographic angiography after endovascular visceral artery aneurysm exclusion.
Assuntos
Aneurisma/diagnóstico , Aneurisma/cirurgia , Artéria Celíaca/diagnóstico por imagem , Artéria Hepática/diagnóstico por imagem , Stents , Ultrassonografia/métodos , Idoso de 80 Anos ou mais , Artéria Celíaca/cirurgia , Meios de Contraste , Artéria Hepática/cirurgia , Humanos , Aumento da Imagem/métodos , Masculino , Resultado do TratamentoRESUMO
Aberrant right subclavian artery (ARSA) is a rare congenital anomaly characterized by the origin of the right subclavian artery from the aortic arch distally to the left subclavian artery. We describe the case of a young patient with symptomatic ARSA treated by mediastinoscopy-assisted ligation at its origin and subclavian-carotid transposition.