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J Vasc Access ; 21(1): 105-109, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31328635


Non-maturation of arteriovenous fistulas is a frequent problem after dialysis access creation, especially in the forearm. The presence of accessory veins may play an important role in the non-maturing fistula. Several surgical and endovascular techniques are described to deal with this problem. We describe a new surgical technique in which we perform a rejoining of the arm veins to create a single large run-off vessel with greater diameter and flow for haemodialysis.

Braço/irrigação sanguínea , Derivação Arteriovenosa Cirúrgica/métodos , Diálise Renal , Veias/cirurgia , Adulto , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem
EuroIntervention ; 13(2): e177-e184, 2017 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-28512068


AIMS: The aim of this study was to investigate the impact of dual antiplatelet therapy (DAPT) termination on late and very late scaffold thrombosis (ScT) in patients treated with the Absorb bioresorbable vascular scaffold (BVS). METHODS AND RESULTS: Data from the registries of three centres were pooled (808 patients). To investigate the effect of DAPT termination on ScT after a minimum of six months, we selected a subgroup ("DAPT study cohort" with 685 patients) with known DAPT status >6 months and excluded the use of oral anticoagulants and early ScT. In this cohort, definite/probable ScT incidence for the period on DAPT was compared to ScT incidence after DAPT termination. ScT incidence was 0.83 ScT/100 py with 95% confidence interval (CI): 0.34-1.98. After DAPT termination, the incidence was higher (1.77/100 py; 95% CI: 0.66-4.72), compared to the incidence on DAPT (0.26/100 py, 95% CI: 0.04-1.86; p=0.12) and increased within the month after DAPT termination (6.57/100 py, 95% CI: 2.12-20.38; p=0.01). No very late ScT occurred in patients who continued on DAPT for a minimum of 18 months. CONCLUSIONS: The incidence of late and very late definite/probable ScT was acceptable. The incidence was low while on DAPT but potentially higher when DAPT was terminated before 18 months.

Implantes Absorvíveis , Aspirina/administração & dosagem , Fármacos Cardiovasculares/administração & dosagem , Materiais Revestidos Biocompatíveis , Trombose Coronária/prevenção & controle , Intervenção Coronária Percutânea/instrumentação , Inibidores da Agregação de Plaquetas/administração & dosagem , Ticlopidina/análogos & derivados , Idoso , Aspirina/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Clopidogrel , Trombose Coronária/diagnóstico , Trombose Coronária/epidemiologia , Esquema de Medicação , Quimioterapia Combinada , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação de Plaquetas/efeitos adversos , Desenho de Prótese , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Ticlopidina/administração & dosagem , Ticlopidina/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
JACC Cardiovasc Interv ; 9(11): 1178-87, 2016 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-27282601


OBJECTIVES: This is the first-in-human study of a drug-eluting bioresorbable vascular scaffold (BVS) for treatment of peripheral artery disease (PAD) involving the external iliac artery (EIA) and superficial femoral artery (SFA). BACKGROUND: Drug-eluting BVS has shown promise in coronary arteries. METHODS: The ESPRIT BVS system is a device-drug combination consisting of an everolimus-eluting poly-l-lactide scaffold. Safety and performance were evaluated in 35 subjects with symptomatic claudication. RESULTS: Lesions were located in the SFA (88.6%) and EIA (11.4%). Mean lesion length was 35.7 ± 16.0 mm. The study device was successfully deployed in 100% of cases, without recoil. Procedure-related minor complications were observed in 3 patients (groin hematoma, dissection). Within 2 years there was 1 unrelated death, but no patients in this cohort had an amputation. At 1 and 2 years, the binary restenosis rates were 12.1% and 16.1%, respectively, and target lesion revascularization was performed in 3 of 34 patients (8.8%) and 4 of 32 patients (11.8%), respectively. The ankle brachial index 0.75 ± 0.14 improved from pre-procedure to 0.96 ± 0.16 at 2 years' follow-up. At 2 years, 71.0% of the patients were Rutherford-Becker 0, and 93.5% achieved a maximum walking distance of 1,500 feet. CONCLUSIONS: The safety of the ESPRIT BVS was demonstrated with no procedure or device-related deaths or amputations within 2 years. The low occurrence of revascularizations was consistent with duplex-ultrasonography showing sustained patency at 2-years. (A Clinical Evaluation of the Abbott Vascular ESPRIT BVS [Bioresorbable Vascular Scaffold] System [ESPRIT I]; NCT01468974).

Implantes Absorvíveis , Angioplastia com Balão/instrumentação , Fármacos Cardiovasculares/administração & dosagem , Materiais Revestidos Biocompatíveis , Everolimo/administração & dosagem , Artéria Femoral , Artéria Ilíaca , Claudicação Intermitente/terapia , Doença Arterial Periférica/terapia , Idoso , Angiografia , Angioplastia com Balão/efeitos adversos , Índice Tornozelo-Braço , Fármacos Cardiovasculares/efeitos adversos , Everolimo/efeitos adversos , Tolerância ao Exercício , Estudos de Viabilidade , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Claudicação Intermitente/diagnóstico por imagem , Claudicação Intermitente/fisiopatologia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Estudos Prospectivos , Desenho de Prótese , Recuperação de Função Fisiológica , Recidiva , Retratamento , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Grau de Desobstrução Vascular
J Endovasc Ther ; 22(1): 1-10, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25775672


PURPOSE: To evaluate the short- and midterm outcomes of the Viabahn endoprosthesis with Propaten Bioactive Surface vs. standard balloon angioplasty for treatment of in-stent restenosis in the superficial femoral artery. METHODS: Between June 2010 and February 2012, 83 patients with superficial femoral artery in-stent and Rutherford category 2 to 5 ischemia were enrolled at 7 sites participating in this prospective randomized controlled study (RELINE;; identifier NCT01108861). The patients were randomized to treatment with either the heparin-bonded Viabahn endoprosthesis (n = 39: 29 men; mean age 67.7 ± 9.8 years) or a standard angioplasty balloon (n = 44: 32 men; mean age 69.0 ± 9.7 years). The primary effectiveness outcome was primary patency at 12 months, defined as no restenosis/occlusion within the target lesion based on duplex ultrasound and no target lesion revascularization. The primary safety endpoint was the incidence of serious device-related adverse events within 30 days of the procedure. RESULTS: All patients randomized to receive dilation or the Viabahn stent-graft were treated according to their assignment. The technical success was 100% for the Viabahn group and 81.8% for the angioplasty group (p = 0.002) owing to 9 patients requiring a bailout procedure after unsuccessful angioplasty. The 12-month primary patency rates were 74.8% for the Viabahn group and 28.0% for the angioplasty group (p < 0.001). Excluding the 9 angioplasty patients who received bailout stenting, the primary patency for optimal balloon angioplasty was 37.0% (p < 0.001). Three patients experienced device-related adverse events within 30 days: occlusion of the target lesion (Viabahn group), peripheral embolization (angioplasty group), and reocclusion of the target lesion (angioplasty group). CONCLUSION: In this study, the treatment of femoropopliteal in-stent restenosis with a Viabahn endoprosthesis showed significantly better results than treatment with a standard balloon at 1 year.

Angioplastia com Balão , Stents Farmacológicos , Artéria Femoral , Doença Arterial Periférica/terapia , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/métodos , Bélgica , Materiais Revestidos Biocompatíveis , Constrição Patológica , Feminino , Seguimentos , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/patologia , Estudos Prospectivos , Recidiva , Método Simples-Cego , Stents/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
J Vasc Surg ; 43(2): 313-8; discussion 318-9, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16476607


OBJECTIVE: Several prosthetic materials have been used for femoropopliteal bypass grafting in patients with peripheral vascular disease in whom a venous bypass is not possible. Expanded polytetrafluoroethylene (ePTFE) is the most commonly used, but patency results have not always equaled those achieved with vein, especially in below-knee reconstructions. This study assessed the performance of a new heparin-bonded ePTFE vascular graft that was designed to provide resistance to thrombosis and thereby decrease early graft failures and possibly prolong patency. METHOD: From June 2002 to June 2003, 86 patients (62 men and 24 women; mean age, 70 years; 99 diseased limbs) were enrolled prospectively in a nonrandomized, multicenter study of the heparin-bonded ePTFE graft. Fifty-five above-knee and 44 below-knee (including 21 femorocrural) procedures were performed. Follow-up evaluations consisted of clinical examinations, ultrasonographic studies, and distal pulse assessments. Patency and limb salvage rates were assessed by using life-table analyses. RESULTS: All grafts were patent immediately after implantation. There were no graft infections or episodes of prolonged anastomotic bleeding. During the 1-year follow-up, 10 patients died, 15 grafts occluded, and 5 major amputations were performed. The overall primary and secondary 1-year patency rates were 82% and 97%, respectively. The limb salvage rate in patients with critical limb ischemia (n = 41) was 87%. Primary patency rates according to bypass type were 84%, 81%, and 74% for above-knee femoropopliteal, below-knee femoropopliteal, and femorocrural bypasses, respectively; the corresponding secondary patency rates were 96%, 100%, and 100%. CONCLUSIONS: In this study, the heparin-bonded ePTFE graft provided promising early patency and limb salvage results, with no device-related complications, in patients with occlusive vascular disease. Longer-term and randomized studies are warranted to determine whether this graft provides results superior to those achieved with other prostheses, especially in patients at increased risk of early graft failure, such as those undergoing below-knee bypass and those with poor run-off or advanced vascular disease.

Anticoagulantes/administração & dosagem , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Artéria Femoral/cirurgia , Heparina/administração & dosagem , Doenças Vasculares Periféricas/cirurgia , Politetrafluoretileno , Artéria Poplítea/cirurgia , Idoso , Idoso de 80 Anos ou mais , Amputação , Bélgica/epidemiologia , Implante de Prótese Vascular/efeitos adversos , Feminino , Artéria Femoral/fisiopatologia , Seguimentos , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/prevenção & controle , Humanos , Tábuas de Vida , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/mortalidade , Doenças Vasculares Periféricas/fisiopatologia , Artéria Poplítea/fisiopatologia , Estudos Prospectivos , Desenho de Prótese , Índice de Gravidade de Doença , Trombose/etiologia , Trombose/fisiopatologia , Trombose/prevenção & controle , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular