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1.
Vasc Specialist Int ; 35(1): 10-15, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30993102

RESUMO

Purpose: There are several commercially approved stent grafts in Korea for the treatment of abdominal aortic aneurysms (AAAs). Each device has its advantages and disadvantages based on the patient's anatomy and the clinical situation. The Zenith device allows accurate and precise endograft placement, whereas the Endurant device has improved flexibility and trackability. We reviewed 5 cases in which a combination of the Zenith main body and the Endurant iliac limb was used. Materials and Methods: From January 2010 to February 2015, 90 patients with AAA underwent endovascular aneurysm repair (EVAR) using the Zenith body at Daegu Catholic University Hospital. Among them, 5 patients who underwent EVAR with the Zenith body and Endurant iliac limb were included in this study. Results: The mean age of the patients was 74.20±3.35 years. All patients were men. The main reason for use of the Endurant iliac limb was aortoiliac angulation. Type III endoleak, stent migration, and stent kinking were not noted. Comparing 85 patients who received a Zenith endograft with 5 patients who received the hybrid endograft, there were no statistical differences in clinical characteristics, intraoperative details and post procedural complications. The mean admission duration was 19.00±13.60 days, and the mean follow-up duration was 1,018.11±925.34 days. In the hybrid endograft group, there was no mortality during the follow-up duration. Conclusion: Although the material, radial force, diameter, and length of the overlap zone differ between the two devices, EVAR with the hybrid endograft is safe and effective.

2.
Sci Rep ; 9(1): 20356, 2019 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-31889152

RESUMO

Recently non-Vitamin K antagonist oral anticoagulants (NOAC) is replacing warfarin for the treatment of deep vein thrombosis (DVT). However, the role of NOAC after thrombolysis of acute iliofeomral DVT (IFDVT) is not yet defined. This randomized clinical trial aimed to compare the safety and efficacy of rivaroxaban versus warfarin after catheter directed thrombolysis of an IFDVT. Patients with acute DVT of both the iliac and the femoral vein (n = 72) were recruited and randomized to either standard anticoagulation (enoxaparin and warfarin, n = 35) or rivaroxaban (n = 37) after successful thrombolysis or mechanical thrombectomy. Primary efficacy outcome was a recurrence of any venous thromboembolism (VTE) within 6 months. Secondary safety outcomes included major bleeding, clinically relevant non-major bleeding (CRNMB), other adverse event, and all-cause mortality. Rate of recurrent VTE were similar in both groups (11.4% versus 12.5%; p = 0.94). Major bleeding or CRNMB was less in rivaroxaban group without significance (2.9% versus 9.4%, HR, 0.31; 95% CI, 0.03-2.96; p = 0.31). Recurrence-free survival and major bleeding-free survival at 6 months were not different in both groups. After thrombolysis of acute IFDVT, rivaroxaban was as safe and effective as warfarin in preventing DVT recurrence.

3.
Vasa ; 47(3): 235-241, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29484958

RESUMO

BACKGROUND: Endovascular treatment is an alternative first-line management for peripheral artery disease (PAD). Hybrid treatment (HT) is defined as a combined treatment for patients with PAD using endovascular and open surgery, simultaneously performed in an operating room. The results of HT are reportedly good for multilevel revascularization (MR) in patients with chronic limb ischaemia, and even in older high-risk patients. The goal of this study was to examine the clinical and haemodynamic outcomes of HT in patients who need MR. PATIENTS AND METHODS: Nine university hospitals in Korea participated in this multicentre study. A total of 134 patients with multilevel PAD underwent HT and MR. Patients were enrolled from July 2014 to June 2015 and were followed for 18 months. RESULTS: The mean age of the patients was 68.8 ± 9.93 years and 88.1 % were men. Patients with Rutherford category 2 to 3 and 4 to 6 comprised 59.0 % and 42.0 % of the group, respectively. The technical success rate was 100 %. The primary patency rates at 12 and 18 months were 77.6 % and 63.9 %, respectively. The primary-assisted patency rates at 12 and 18 months were both 90.0 %. The pre-operative mean ankle brachial index (0.43 ± 0.23) increased to 0.87 ± 0.23 at six months post-operatively (t-test, p < 0.05). The amputation free survival rate was 97.1 %. CONCLUSIONS: Although outcomes of multilevel PAD are reportedly poor when endovascular treatment alone is used, we have shown that HT is a feasible alternative modality for patients with multilevel PAD, with satisfactory amputation-free survival and freedom from re-intervention rates.


Assuntos
Procedimentos Endovasculares , Doença Arterial Periférica/terapia , Procedimentos Cirúrgicos Vasculares , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação , Terapia Combinada , Intervalo Livre de Doença , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Hospitais Universitários , Humanos , Estimativa de Kaplan-Meier , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , República da Coreia , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/efeitos adversos
4.
Vasc Specialist Int ; 33(2): 59-64, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28690997

RESUMO

PURPOSE: Cone shape neck is regarded as non-instruction for use (IFU) in most commercial stent graft. However, in real practice, liberal application of endovascular aneurysm repair (EVAR) for outside of IFU happens. We investigate non-adherence to conical neck anatomy in terms of early aneurysmal exclusion results. MATERIALS AND METHODS: From January 2010 to December 2013, 105 patients with abdominal aortic aneurysm (AAA) underwent EVAR in Daegu Catholic University Medical Center. Among them, 38 patients (36.2%) had AAA with conical neck. We investigated the clinical characteristics of patients and the details of conical neck. We also analyzed the clinical results, such as endoleak, migration, procedure failure, perioperative mortality, and admission duration between conical neck and non-conical neck. RESULTS: The maximum diameter of AAA was larger (60.95 mm vs. 52.68 mm, P=0.016) and the infrarenal neck length was shorter (25.07 mm vs. 38.13 mm, P=0.000) in conical neck group. During the procedure, type Ia endoleak occurred more in conical neck group (23.7% vs. 6.0%, P=0.013) and it could be successfully solved with additional adjunctive treatments, such as balloon or Palmaz stent. Although there was no statistical significance, mortality was higher and admission duration was longer in the conical neck (15.8% vs. 6.0%, 16.62±13.12 days vs. 13.03±13.13 days). Mean follow-up duration was 319.2±366.45 days. Successful aneurysmal exclusion was achieved. CONCLUSION: The presence of conical neck may not be a contraindication for EVAR. However, conical neck requires careful observation for additional adjunctive treatments because it increases the risk of type Ia endoleak.

5.
Vasc Specialist Int ; 32(3): 77-104, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27699156

RESUMO

Lower extremity deep vein thrombosis is a serious medical condition that can result in death or major disability due to pulmonary embolism or post-thrombotic syndrome. Appropriate diagnosis and treatment are required to improve symptoms and salvage the affected limb. Early thrombus clearance rapidly resolves symptoms related to venous obstruction, restores valve function and reduces the incidence of post-thrombotic syndrome. Recently, endovascular treatment has been established as a standard method for early thrombus removal. However, there are a variety of views regarding the indications and procedures among medical institutions and operators. Therefore, we intend to provide evidence-based guidelines for diagnosis and treatment of lower extremity deep vein thrombosis by multidisciplinary consensus. These guidelines are the result of a close collaboration between interventional radiologists and vascular surgeons. The goals of these guidelines are to improve treatment, to serve as a guide to the clinician, and consequently to contribute to public health care.

6.
Ann Surg Treat Res ; 91(3): 139-44, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27617255

RESUMO

PURPOSE: Iliac extension of stent-graft during endovascular aneurysm repair (EVAR) increases the incidence of limb occlusion (LO). Hypothetically, adjunctive iliac stent (AIS) could offer some additional protection to overcome this anatomic hostility. But still there is no consensus in terms of effective stent characteristics or configuration. We retrospectively reviewed our center's experience to offer a possible answer to this question. METHODS: Our study included 30 patients (38 limbs) with AIS placed in the external iliac artery (EIA) from January 2010 to December 2013. We classified iliac tortuosity based on anatomic characteristics. AIS's were deployed in EIA with a minimum 5-mm stick-out configuration from the distal edge of the stent-graft. RESULTS: According to the iliac artery tortuosity index, grade 0, grade 1, and grade 2 were 5 (13.2%), 30 (78.9%), and 3 (7.9%), respectively. The diameter of all AIS was 12 mm, which was as large as or larger than the diameter of the stent-graft distal limb. SMART stents were preferred in 34 limbs (89.5%) and stents with 60-mm length were usually used (89.5%). During a mean follow-up of 9.13 ± 10.78 months, ischemic limb pain, which could be the sign of LO, was not noticed in any patients. There was no fracture, kinking, migration, in-stent restenosis, or occlusion of AIS. CONCLUSION: The installation of AIS after extension of stent-graft to EIA reduced the risk of LO without any complications. AIS should be considered as a preventive procedure of LO if stent-graft needs to be extended to EIA during EVAR.

7.
Vasc Specialist Int ; 32(2): 44-50, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27386451

RESUMO

PURPOSE: Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) involving the common iliac artery requires extension of the stent-graft limb into the external iliac artery. For this procedure, internal iliac artery (IIA) embolization is performed to prevent type II endoleak. In this study, we investigated the frequency and risk factor of buttock claudication (BC) in patients having interventional embolization of the IIA. MATERIALS AND METHODS: From January 2010 to December 2013, a total of 110 patients with AAA were treated with EVAR in our institution. This study included 27 patients (24.5%) who had undergone unilateral IIA coil embolization with EVAR. We examined hospital charts retrospectively and interviewed by telephone for the occurrence of BC. RESULTS: Mean age of total patients was 71.9±7.0 years and 88.9% were males. During a mean follow-up of 8.65±9.04 months, the incidence of BC was 40.7% (11 of 27 patients). In 8 patients with claudication, the symptoms had resolved within 1 month of IIA embolization, but the symptoms persisted for more than 6 months in the remaining 3 patients. In univariate and multivariate analysis, risk factors such as age, sex, comorbidity, patency of collateral arteries, and anatomical characteristics of AAA were not significantly related with BC. CONCLUSION: In this study, BC was a frequent complication of IIA embolization during EVAR and there was no associated risk factor. Certain principles such as checking preoperative angiogram, proximal and unilateral IIA embolization may have contributed to reducing the incidence of BC.

8.
Vasc Specialist Int ; 31(3): 87-94, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26509139

RESUMO

PURPOSE: To introduce a nation-based endovascular aneurysm repair (EVAR) registry in South Korea and to analyze the anatomical features and early clinical outcomes of abdominal aortic aneurysms (AAA) in patients who underwent EVAR. MATERIALS AND METHODS: The Korean EVAR registry (KER) was a template-based online registry developed and established in 2009. The KER recruited 389 patients who underwent EVAR from 13 medical centers in South Korea from January 2010 to June 2010. We retrospectively reviewed the anatomic features and 30-day clinical outcomes. RESULTS: Initial deployment without open conversion was achieved in all cases and procedure-related 30-day mortality rate was 1.9%. Anatomic features showed the following variables: proximal aortic neck angle 48.8±25.7° (mean±standard deviation), vertical neck length 35.0±17.2 mm, aneurysmal sac diameter 57.2±14.2 mm, common iliac artery (CIA) involvement in 218 (56.3%) patients, and median right CIA length 34.9 mm. Two hundred and nineteen (56.3%) patients showed neck calcification, 98 patients (25.2%) had neck thrombus, and the inferior mesenteric arteries of 91 patients (23.4%) were occluded. CONCLUSION: Anatomical features of AAA in patients from the KER were characterized as having angulated proximal neck, tortuous iliac artery, and a higher rate of CIA involvement. Long-term follow-up and ongoing studies are required.

9.
J Korean Med Sci ; 29(12): 1678-83, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25469069

RESUMO

Endovascular salvage of the hypogastric artery using iliac branch device (IBD) during endovascular aortic aneurysm repair (EVAR), offers less invasive alternative solution to surgery to prevent pelvic ischemia. We have performed the first Korean surgeon custom-made IBD for this purpose to overcome the limitation of unavailability of the devices in Korea. Four patients with abdominal aortic aneurysm with bilateral common iliac artery aneurysm (CIAA) were treated using custom-made IBDs from October 2013 to December 2013. IBD was created in back table before EVAR operation using TFLE Zenith iliac limb stent graft (Cook Inc.). Three V12 (Atrium, Inc.) one Viabahn (Gore, Inc.) were used for bridging between IBD and target hypogastric artery. With this modification of IBD procedure, exteriorize the guide wire without snare device is possible which offers another benefit in terms of reducing medical costs comparing to commercial IBD. All operations were successful without any device related complications or postoperative endoleaks. During the mean follow up of 3 months, all IBD were patent without clinical complications. Surgeon custom made IBD is feasible and useful to preserve pelvic perfusion especially in the situation of limited commercial IBD availability in many countries. Long-term follow-up is needed to evaluate stent graft patency and IBD-related complications.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/cirurgia , Terapia de Salvação/instrumentação , Stents , Idoso , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Masculino , Terapia de Salvação/métodos
10.
Vasc Specialist Int ; 30(1): 38-42, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26217614

RESUMO

This is to report the technique of reversed iliac leg stent-graft in endovascular treatment for isolated internal iliac artery (IIA) aneurysm, which had significant size discrepancy between the common iliac artery (CIA) and external iliac artery (EIA) in 3 patients from different hospitals. Three patients were a 85- and two 82-year-old men. Treated were right IIA aneurysms, sized 6.5×6.2 cm, 5.0×4.0 cm, and 4.1 cm in longest diameter, respectively. The diameters of the right CIA and right EIA measured 21 mm/11 mm, 15 mm/11 mm, and 20 mm/10 mm, respectively. In all cases, reversed iliac leg stent-grafts were prepared on-site; unsheathed and mounted upside-down manually, and deployed in each right CIA. Post-stent-graft angiograms showed complete exclusion of the aneurysms, except for minimal type 1 endoleak in one case. This technique is a useful treatment option in patients with isolated IIA aneurysm.

11.
Vasc Specialist Int ; 30(4): 105-12, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26217628

RESUMO

UNLABELLED: The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. INDICATION: anatomic or pathophysiologic indication includes venous diameter within 2-20 mm, reflux time ≥0.5 seconds and distance from the skin ≥5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis ≥class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles' ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.

12.
Phytother Res ; 26(5): 752-7, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22084059

RESUMO

The antithrombotic activities and bleeding effects of selected fucoidans (source from either Undaria pinnatifida sporophylls or from Fucus vesiculosus) have been compared with heparin in the ferric chloride-induced arterial thrombus mouse model. Thrombosis was induced by applying 5% ferric chloride for 3 min on the carotid artery region of Balb/c mouse. Five minutes prior to thrombus induction, mice were infused through the tail vein with either saline (control) or polysaccharides. Either fucoidan or heparin was dosed at 0.1, 1.25, 2.5, 5.0, 10, 25, or 50 mg/kg intravenously (i.v.) The carotid blood flow was monitored until more than 60 min post-thrombus induction. Mouse tail transection bleeding time was measured up to 60 min after making a cut in the mouse tail. Both antithrombotic and bleeding effects were observed in a dose-dependent manner for both fucoidans and heparin. Thrombus formation was totally (reflected by Doppler flow meter) inhibited at either 5 or 50 mg/kg of unfractionated Undaria fucoidan or a low-molecular-weight Undaria fucoidan fraction, respectively, without prolonging the time-to-stop bleeding compared with the control (p < 0.01). The total inhibition of thrombus formation was observed for unfractionated Fucus fucoidan at 25 mg/kg where the time-to-stop bleeding was still significantly prolonged, by as much as 8 ± 1.7 min (p < 0.02). In contrast the heparin-treated group showed total inhibition of thrombus formation even at a small dose of 0.8 mg/kg (400 IU) at which bleeding continued until 60 min. In conclusion algal fucoidans are highly antithrombotic without potential haemorrhagic effects compared with heparin in the arterial thrombus model, but this property differs from algal species to species, and from the molecular structure of fucoidans.


Assuntos
Anticoagulantes/farmacologia , Fibrinolíticos/farmacologia , Fucus/química , Polissacarídeos/farmacologia , Trombose/tratamento farmacológico , Undaria/química , Animais , Anticoagulantes/isolamento & purificação , Anticoagulantes/uso terapêutico , Tempo de Sangramento , Cloretos/farmacologia , Modelos Animais de Doenças , Compostos Férricos/farmacologia , Fibrinolíticos/isolamento & purificação , Fibrinolíticos/uso terapêutico , Heparina/farmacologia , Injeções Intravenosas , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Polissacarídeos/isolamento & purificação , Polissacarídeos/uso terapêutico , Trombose/induzido quimicamente
13.
J Vasc Surg ; 54(3): 660-7; discussion 667-8, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21788114

RESUMO

OBJECTIVE: The purpose of this study was to compare the branch morphology and short-term outcome of endovascular aneurysm repair using multibranched thoracoabdominal custom-made stent grafts (CSGs) vs standard stent grafts (SSGs). METHODS: Data on patient demographics, aortic morphology, component use, and outcome were collected prospectively. Final branch length (cuff to target artery orifice) and branch angle (cuff orientation to target artery orientation) were determined using 3-D reconstruction of computed tomographic angiograms (CTAs). RESULTS: Between January 2008 and March 2010, 28 patients underwent endovascular aneurysm repair using 14 CSGs and 14 SSGs. Two patients were excluded from analysis: one patient in the CSG group had yet to undergo CTA, and one patient in the SSG group had crossed renal branches due to problems traversing a previously reconstructed aortic arch. All the stent grafts were implanted successfully. There were no perioperative deaths. There were no statistically significant differences between the CSG (n = 13) and SSG (n = 13) groups in terms of patient age (74.4 ± 7.9 years vs 73.5 ± 6.0 years), aneurysm diameter (66.1 ± 9.0 mm vs 71.2 ± 9.0 mm), operative time (311 ± 94 minutes vs 286 ± 57 minutes), fluoroscopy time (108 ± 43 minutes vs 101 ± 30 minutes), contrast volume (98 ± 39 minutes vs 91 ± 27 minutes), blood loss (458 ± 205 mL vs 433 ± 193 mL), mean branch angle (22.8 ± 19.0 degrees vs 22.0 ± 17.6 degrees), or branch length (25.3 ± 12.1 mm vs 23.4 ± 10.2 mm). CONCLUSION: The substitution of SSG for CSG had no effect on the complexity of the procedure, the branch morphology, or the perioperative outcome. The availability of an off-the-shelf SSG will broaden the application of endovascular thoracoabdominal aortic aneurysm repair by eliminating manufacturing delays.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/normas , Prótese Vascular/normas , Procedimentos Endovasculares/normas , Stents/normas , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Distribuição de Qui-Quadrado , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Estudos Prospectivos , Desenho de Prótese , Medição de Risco , Fatores de Risco , São Francisco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
J Vasc Surg ; 51(3): 572-6, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20045625

RESUMO

PURPOSE: To describe variations in the shape, orientation, and length of the branches of multi-branched thoracoabdominal stent grafts. METHOD: The branches were constructed in situ by attaching a covered stent (Fluency Plus Tracheobronchial Stent Graft; Bard Peripheral Vascular, Tempe, Ariz) to each of four caudally-oriented cuffs on custom-made stent grafts. Pre- and postoperative computed tomography (CT) scans of 38 consecutively treated patients were analyzed using a three-dimensional work station to give the orientation of celiac, superior mesenteric, and right renal and left renal orifices relative to the centerline of the aorta (planned cuff orientation [PCO]) and relative to the centerline of the stent graft (actual vessel orientation [AVO]). The orientation of each cuff (actual cuff orientation [ACO]) was also measured relative to the centerline of the stent graft. These values were used to assess the degree of stent graft malorientation (ACO-PCO), or cuff-to-artery misalignment (ACO-AVO), and combined with measurements of branch length to calculate the resulting lateral displacement (arc distance [AD]) between each cuff and its corresponding arterial orifice and the angle (longitudinal branch angulation [LBA]) between the long axis of the branch and the long axis of the aorta, all in the plane of the aortic surface. RESULTS: All 136 branches were inserted as intended. None has since migrated, disconnected, or kinked. In most cases, stent graft orientation was accurate, with a mean ACO-PCO of 18.4 + 12.1 degrees. Cuff-to-artery misalignment was correspondingly low, with a mean ACO-AVO of 19.8 + 14.0 degrees. More than 30 degrees of misalignment was present in 23.2% of branches, yet only 9% (n = 12) had an LBA of >30 degrees. CONCLUSION: Moderate degrees of cuff-to-artery misalignment had no effect on the feasibility of multi-branched stent graft insertion.


Assuntos
Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Stents , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Humanos , Imagem Tridimensional , Desenho de Prótese , Interpretação de Imagem Radiográfica Assistida por Computador , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
J Endovasc Ther ; 16(3): 359-64, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19642795

RESUMO

PURPOSE: To assess the feasibility of endovascular thoracoabdominal aortic aneurysm (TAAA) repair using a standard off-the-shelf multi-branched stent-graft. METHODS: The aortic anatomy of 66 patients (45 men; mean age 74 years, range 57-87) referred for endovascular repair of TAAA was measured using 3-dimensional reconstructed images from computed tomographic angiograms. In particular, the orientation and longitudinal position of the orifice of each celiac artery, right renal artery, and left renal artery were measured relative to the location of the superior mesenteric artery (SMA) orifice. Based on prior experience, branch insertion with a standard endograft was considered feasible under the following conditions: (1) no more than 4 indispensable (target) arteries to the abdominal viscera, (2) the celiac artery and SMA were 6 to 10 mm in diameter, (3) the renal arteries were 4 to 8 mm in diameter, (4) all target arteries were accessible from a transbrachial approach, (5) the distance between each cuff and the corresponding arterial orifice was 4 indispensable visceral or renal branches, and 3 patients had inaccessible upward directed renal artery branches. Three of the remaining 59 patients had renal arteries outside the boundaries defined by conditions 5 and 6 when the hypothetical stent-graft was positioned with its SMA cuff 25 mm proximal to the corresponding SMA orifice. However, if the stent-graft were deployed in a more caudal location, only 1 of these 3 renal arteries would have been out of range. Therefore, 58 (88%) of 66 patients met all the eligibility criteria for repair using the off-the-shelf stent-graft. CONCLUSION: A standardized, off-the-shelf, multi-branched stent-graft is applicable in 88% of cases of TAAA that would otherwise have been treated using customized stent-grafts. The use of a pre-made stent-graft has the potential to eliminate long manufacturing delays and expand the scope of endovascular repair of TAAA.


Assuntos
Angioplastia com Balão , Aneurisma da Aorta Torácica/patologia , Aneurisma da Aorta Torácica/terapia , Prótese Vascular , Desenho de Prótese , Stents , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Torácica/diagnóstico por imagem , Estudos de Coortes , Estudos de Viabilidade , Feminino , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
16.
Korean J Anesthesiol ; 56(1): 25-30, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30625691

RESUMO

BACKGROUND: This study was designed to test the hypothesis that a combined femoral and politeal sciatic nerve blocks (FPSNB) would have excellent clinical properties and better patient satisfaction than epidural anesthesia for the great saphenous veins stripping (GSVS) surgery with multiple stab avulsion (MSA). METHODS: Sixty patients were allocated into two groups. The epidural group received epidural anesthesia with 15 ml of 0.75% ropivacaine (n = 30), and the FPSNB group received a combined FPSNB with 25 ml of 1.5% mepivacaine with a nerve stimulator (n = 30). We assessed the anesthetic and postoperative records. A questionnaire-based study including patient satisfaction for anesthetic techniques (100 point scale) was conducted 3 days postoperatively by a blinded observer. RESULTS: The time from initial injection to the start of surgery and the duration of sensory blockade were not different between groups (P > 0.05). The percentage of patients with anesthesia-related complications in epidural anesthesia was 33.3%, 46.6%, 23.3% and 20% for shivering, hypotension, bradycardia and postoperative voiding difficulty, respectively. FPSNB did not produce these complications. Additional analgesia with 50-100 microgram of fentanyl was more frequently used in FPSNB (60% vs 6.7%, FPSNB vs Epidural group, P < 0.01), but patient satisfaction of FPSNB was higher than epidural anesthesia (88.1 +/- 13.2 vs 76.5 +/- 15.8, FPSNB vs Epidural group, P < 0.01). CONCLUSIONS: A combined FPSNB with a small amount of narcotics is an adequate anesthetic technique for unilateral GSVS surgery with MSA.

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