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Ann Vasc Surg ; 49: 39-48, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29454036


BACKGROUND: Combination treatment with percutaneous endovenous intervention (PEVI) and anticoagulation has been proposed for treating lower-extremity proximal deep vein thrombosis (DVT). We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of PEVI plus anticoagulation versus anticoagulation alone in patients with lower-extremity proximal DVT. METHODS: We systematically searched PubMed, Embase, and the Cochrane Library from inception to May 2016. All RCTs comparing clinical outcomes between additional PEVI and anticoagulation alone were included. The main end points were postthrombotic syndrome (PTS) and major bleeding complications. Secondary outcomes included the iliofemoral patency rate, venous obstruction, and recurrent DVT. We assessed pooled data using a random-effects model. RESULTS: Four RCTs were included. PEVI plus standard anticoagulation compared with anticoagulation alone was associated with a lower rate of PTS (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.18-0.63), significantly higher iliofemoral patency rate at 6 months and 12 months (OR 8.49, 95% CI 1.32-54.60), a lower rate of venous obstruction (OR 0.42, 95% CI 0.20-0.924), and a lower rate of recurrent DVT (OR 0.42, 95% CI 0.20-0.92). However, more major bleeding episodes occurred in the group with catheter-directed thrombolysis (Peto OR 5.86, 95% CI 1.76-19.48). CONCLUSIONS: PEVI plus anticoagulation reduced the occurrence of PTS, recurrent DVT, and venous obstruction. Another advantage is an increased patency rate at 6 and 12 months. The disadvantage is an increased occurrence of major bleeding events.

Anticoagulantes/uso terapêutico , Procedimentos Endovasculares/métodos , Trombose Venosa/terapia , Anticoagulantes/efeitos adversos , Coagulação Sanguínea/efeitos dos fármacos , Terapia Combinada , Procedimentos Endovasculares/efeitos adversos , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Síndrome Pós-Trombótica/etiologia , Recidiva , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular/efeitos dos fármacos , Trombose Venosa/sangue , Trombose Venosa/diagnóstico , Trombose Venosa/fisiopatologia
Chin Med Sci J ; 24(3): 182-5, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19848321


OBJECTIVE: To describe a hybrid endovascular procedure for aorta repair with different kinds of bypass followed by concomitant placement of stent graft in the aorta. METHODS: From June 2007 to May 2008, 5 consecutive patients who presented with aortic aneurysm or dissection were treated with a new hybrid aorta repair technique. Complete surgical rerouting of supra-aortic vessels was simultaneously created by endovascular repair of aortic arch aneurysm with stent graft. Hybrid left carotid-subclavian bypass with stent graft deployment covering the ostium of the left subclavian artery was performed in a Debakey type III aortic dissection case. The supra-aortic branch was revascularized in 2 cases from ascending aorta to bilateral common carotid arteries using a 16-8 mm bifurcated graft, then total aortic arch and descending artery was occluded with stent-graft. The left carotid artery to the left subclavian artery bypass was created in 1 case, followed by stent-graft deployment. Two cases of infrarenal abdominal aortic aneurysm underwent left external iliac artery to left internal iliac artery bypass by a retroperineal route, then hybrid procedure was performed with bifurcated stent-graft. All stent grafts were deployed via a retrograde femoral artery approach in 5 patients. RESULTS: Technical success with complete aneurysmal exclusion was achieved in all patients. There was no incidence of endoleak. During a follow-up period of 2 to 10 months, documented perioperative neurologic events did not occur in all patients. One patient suffered from adult respiratory distress syndrome. After received tracheostomy, he recovered later. There was one death resulting from a postoperative myocardial infarction. CONCLUSION: Hybrid arch repair provides an alternative therapy to patients otherwise considered prohibitively high risk for traditional open arch and thoracoabdominal aorta repair.

Aneurisma Aórtico/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Aorta/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Implante de Prótese Vascular/métodos , Humanos , Artéria Ilíaca/cirurgia , Masculino , Tomografia Computadorizada por Raios X