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3.
Eur J Vasc Endovasc Surg ; 58(6): 831-838, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31615695

RESUMO

OBJECTIVES: At 12 months follow up of the PLIANT study, clinical success and efficacy of the E-liac Stent Graft System (JOTEC GmbH, Hechingen, Germany) were evaluated. Clinical success was defined as aneurysm exclusion (no type I, III, IV endoleak) with primary patency of the internal iliac artery (IIA) and external iliac artery (EIA) on the E-liac implantation side. METHODS: In this prospective multicentre European observational study, clinical and morphological data of 45 patients (93% male, mean age 72 y) were prospectively collected in 11 European centres between July 2014 and June 2016. Forty patients underwent an aorto-iliac (three patients bilaterally) treatment and five an isolated iliac treatment. RESULTS: At 12 months follow up, data were available for 42 patients. Overall clinical success at 12 months was 90%, with a survival rate of 100%. Four patients (10%) did not achieve clinical success, one with an internal iliac artery (IIA) occlusion on the E-liac implantation side, one with an infrarenal type Ia endoleak, and two with type Ib endoleaks in IIA. At 12 months the primary patency rate in the internal iliac artery on the iliac side branch implantation side was 98%. Two patients (5%) received E-liac related re-interventions: one caused by an edge stenosis at the distal end of the graft limb in the external iliac artery (EIA) and one caused by thrombo-embolism in the external iliac artery. Thus, for the EIA, primary and secondary patency rates were 98% and 100%, respectively. CONCLUSIONS: The low device related re-intervention rate of 5%, the high survival rate of 100%, and the high primary patency rates of 98% for the IIA and EIA at 12 month follow up demonstrate the safety and efficacy of the E-liac Stent Graft System. Long term 36 month results are awaited to confirm the efficacy and durability.


Assuntos
Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Endoleak/epidemiologia , Procedimentos Endovasculares/instrumentação , Oclusão de Enxerto Vascular/epidemiologia , Aneurisma Ilíaco/cirurgia , Stents Metálicos Autoexpansíveis/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Implante de Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Europa (Continente) , Feminino , Seguimentos , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Resultado do Tratamento
4.
Angiol. (Barcelona) ; 71(3): 95-101, mayo-jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-190287

RESUMO

INTRODUCCIÓN Y OBJETIVO: se han descrito diferencias en la prevalencia de la enfermedad arterial periférica (EAP) en distintas áreas geográficas. El objetivo es analizar los pacientes de Europa del este intervenidos en nuestro centro de isquemia crónica de extremidades inferiores y compararlos con los de origen español para describir cómo puede influir la etnia en el desarrollo de la EAP. MATERIALES Y MÉTODOS: se ha escogido una muestra de 337 pacientes intervenidos en nuestro centro desde el 2007 hasta el 2017 diagnosticados de isquemia arterial crónica de extremidades inferiores. Se han analizado los factores de riesgo cardiovascular (FRCV), la clínica al ingreso, las lesiones TASC y la estancia hospitalaria media. RESULTADOS: los pacientes de Europa del este representan el 7,7% de la muestra. La media de edad es de 67,9 años y un 79,8% son varones: el 70% presenta HTA; el 45,4%, DM; el 52,5%, DLP y el 40,7% son fumadores. Respecto a las comorbilidades, el 30,6% presenta cardiopatía isquémica; el 13,6%, EPOC y un 7,4%, accidentes cerebrovasculares. Los pacientes de Europa del este son más jóvenes (53,5 ± 10,53 frente a 69,09 ± 10,77; p = 0,0001), con menor prevalencia del resto de FRCV (HTA 30,7% frente al 73,3%, p = 0,001; DM 23,07% frente a 47,27%; p = 0,017; DLP 30,77% frente al 54,34%; p = 0,021). La prevalencia de fumadores es mayor (80,77% frente a 69,45%; p = 0,002). Presentan una clasificación Rutherford menor y un ITB más alto (3,19 ± 0,85 frente a 3,73 ± 1,19, p = 0,03, y 0,41 ± 0,21 frente a 0,26 ± 0,06, p = 0,028, respectivamente). La mayoría de los pacientes de Europa del este son claudicantes y presentan una estancia media superior que los pacientes claudicantes de origen español (12,31 frente a 6,3 días; p < 0,001). No existen diferencias significativas en el grado TASC. CONCLUSIONES: los pacientes de Europa del este intervenidos de isquemia arterial crónica de extremidades inferiores son más jóvenes, más fumadores y con menor prevalencia del resto de FRCV. La mayoría presenta claudicación intermitente y tiene una estancia hospitalaria media más elevada que los pacientes españoles


INTRODUCTION AND OBJECTIVE: differences in the prevalence of peripheral arterial disease (PAD) have been described in different geographical areas. These differences have been justified by life habits and socio-economic development of a country. The aim of this study is to analyze eastern Europe patients and Spanish patients, who underwent surgical procedures of lower limb chronic ischemia, to describe how can influence ethnicity in the PAD development. MATERIALS AND METHODS: a sample of 337 operated patients of lower extremities chronic ischemia in our center from 2007 to 2017 has been chose. Cardiovascular risk factors (CVRF), clinic at the beginning of admission, TASC lesions in imaging tests and hospitalization days were analyzed. RESULTS: eastern Europe patients represent 7.7% of the sample. The average age is 67.9 years (22-97) and 79.8% are males. 70% have HTA, 45.4% DM, 52.5% DLP and 40.7% are smokers. Regarding comorbidities: 30.6% have ischemic heart disease, 13.6% OCPD and 7.4% cerebrovascular disease. Eastern Europe patients are younger than Spanish patients (53.5 ± 10.53 vs. 69.09 ± 10.77) and with a lower prevalence of the rest of CVRF (HTA 30.7% vs. 73.3%; DM 23.07% vs. 47.27%; DLP 30.77% vs. 54.34%). In addition, the prevalence of smokers is higher (80.77% vs. 69.45%). They also present a lower Rutherford classification and a higher ABI (3.19 ± 0.85 vs. 3.73 ± 1.19 and 0.42 vs. 0.26, respectively). The average stay is higher in claudicants eastern Europe's patients (12.31 vs. 6.3 days). CONCLUSIONS: operated eastern European patients of lower limb chronic ischemia are young patients, smokers, and have a lower prevalence of the rest of CVRF. More than half of eastern Europe patients present intermittent claudication and they have a higher hospital stay than claudicant Spanish patients


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doença Arterial Periférica/etnologia , Doença Arterial Periférica/epidemiologia , Tempo de Internação , Estudos de Casos e Controles , Fatores de Risco , Prevalência , Estudos Retrospectivos , Europa (Continente)/epidemiologia
5.
Ann Vasc Surg ; 58: 232-237, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30731220

RESUMO

BACKGROUND: Horseshoe kidney is a congenital abnormality, with an incidence of 0.25% of the total population. Only 0.12% of patients who undergo an abdominal aortic aneurysm repair might also have a coexisting horseshoe kidney. We present a series of 10 cases auspiciously treated with an endovascular approach along with their respective patient evolutions. A review of the literature is also presented. MATERIALS AND METHODS: A retrospective review of the medical records (January 2004-December 2013) of 10 patients with abdominal aortic aneurysms and horseshoe kidney treated with endovascular repair was done. Patients were treated at 6 different centers in 3 different countries. Demographics, clinical status, medical history, anatomical morphology of the aneurysms and kidneys, as well as surgical outcomes were all analyzed. RESULTS: The median age was 67.5 years (range 47-81), and the median aortic aneurysmal diameter was 57 mm (49-81 mm). A total of 35 arteries provided renal perfusion. There were 13 right renal arteries and 13 left renal arteries, all successfully preserved, with 9 isthmus arteries covered. Median hospital stay consisted of 3.5 days (1-14 days). All aortic aneurysms were successfully excluded with no endoleaks, hematomas, wound infections, or renal failure. During a median follow-up of 7 years, 3 patients died of myocardial infarction 7 years after endovascular aortic repair (EVAR), and the other 7 patients are doing well, with a median aneurysm reduction size sac of 16.5 mm. CONCLUSIONS: Endovascular repair is a safe and efficient endovascular option for the treatment of patients presenting concomitant aortic aneurysm and horseshoe kidney, with excellent short- and medium-term outcomes. To our knowledge, our study represents the largest series of cases with horseshoe kidney successfully treated via EVAR without significant complications.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Rim Fundido/complicações , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , 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 , Feminino , Rim Fundido/diagnóstico por imagem , Rim Fundido/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
6.
J Laparoendosc Adv Surg Tech A ; 29(2): 184-191, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30585754

RESUMO

PURPOSE: Acute appendicitis (AA) is the most frequent surgical entity in the emergency department, but its correct diagnosis remains challenging. To improve diagnosis, clinical prediction rules (CPRs) have been created to establish objective scores for the probability of suffering AA. In this study, we establish scores indicating whether laparoscopy would be superior to clinical observation or repeat diagnostic test. METHODS: A retrospective observational study was conducted with 433 patients submitted to surgery for suspected AA using a laparoscopic approach. The Alvarado, Raja Isteri Pengiran Anak Saleha Appendicitis, appendicitis inflammatory response, and adult appendicitis score scales were applied in each case to establish a high, medium, or low probability of suffering AA. RESULTS: Of the 433 patients analyzed, 381 (88.0%) had AA. Twelve (2.8%) were converted to open surgery, and complications were observed in 54 (12.5%) cases. The CPRs studied showed statistically significant differences between AA and negative appendectomies. However, in patients with intermediate probability scores, the diagnostic accuracy of the CPRs evaluated was not adequate. CONCLUSIONS: Laparoscopic surgery can serve as a diagnostic tool for patients with intermediate AA probability scores because of its low associated morbidity and mortality and because it affords a direct diagnosis of the problem, allowing determination of the appropriate treatment.


Assuntos
Apendicectomia , Apendicite/diagnóstico , Apendicite/terapia , Técnicas de Apoio para a Decisão , Conduta Expectante , Doença Aguda , Adolescente , Adulto , Apendicectomia/métodos , Técnicas de Diagnóstico por Cirurgia , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Probabilidade , Estudos Retrospectivos , Adulto Jovem
7.
Neuroophthalmology ; 42(5): 299-301, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30258476

RESUMO

Background and Importance We describe a patient with Horner's syndrome caused by an extensive intraparietal hematoma in the wall of the internal carotid artery confused with an arterial dissection. Detection of such pathology instead of dissection or arteritis is important as the management is different. As far as the authors know, it is the first case in which a haematoma within an atherosclerotic plaque is clinically related Horner's syndrome. Clinical Presentation A 81-year-old man presented with acute right hemiplegia and loss of vision of the left eye due to a central retinal artery occlusion. The patient underwent a computerised angiotomography which demonstrated left internal carotid artery occlusion with recanalisation after carotid bifurcation. Clinically, the patient developed a syndrome of Claude-Bernard Horner which replaced the diagnosis on the suspicion that it was a carotid artery dissection. The patient had miosis and ptosis of left eye. In the magnetic resonance angiography, an intramural of a possible hematoma was observed. It was decided to perform surgical treatment of the carotid lesion. Conclusion As this clinical case shows, there are symptomatic courtships that must be studied in detail so as not to confuse the carotid dissection with critical stenosis of the internal carotid artery.

8.
Vascular ; 26(6): 647-656, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30037302

RESUMO

OBJECTIVES: To study the safety and feasibility of the E-liac Stent Graft System® in patients with aorto/iliac aneurysms. METHODS: A prospective multicentric European registry of patients receiving the E-liac Stent Graft System® was conducted. Endpoints of the study included the technical success as well as periprocedural events and 30-day endoleaks, reinterventions, internal and external iliac artery patency and mortality. RESULTS: Between July 2014 and June 2016, a total of 45 patients (93% men, mean age 72 years, range 53-90 years) were enrolled at 11 sites in four European countries. Five patients received an isolated iliac treatment. Thirty-seven patients were treated with a combination of an abdominal stent graft and a unilateral E-liac and three in combination with bilateral E-liac. All E-liac Stent Grafts (48) were implanted in the intended position and the internal iliac arteries were successfully bridged. Two patients did not receive clinical success, due to endoleak type Ia of the aortic stent graft. At 30-day follow-up, clinical success rate was 96%. Three successful endovascular reinterventions were performed within the 30-day follow-up: one due to a type Ia endoleak in the common iliac artery, one due to type Ia endoleak of the aortic stent graft, and one due to bilateral lower limb claudication provoked by stent graft limb stenosis. At 30-day, a 100% survival rate and complete absence of pelvic or buttock ischemia/claudication were reported. Primary patency at 30 days was 100% for the internal iliac artery and 98% for the external iliac artery with an assisted patency of 100% in the latter. CONCLUSIONS: The high clinical success rate, low rates of device-related reinterventions (2%), and excellent patency rate demonstrate the safety and feasibility of the E-liac Stent Graft System. Long-term results are awaited to state efficacy and durability. Clinical Trials.gov. Identifier no. NCT02209194.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Aneurisma Ilíaco/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Desenho de Prótese , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
10.
Ann Vasc Surg ; 50: 253-258, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29501596

RESUMO

BACKGROUND: Endovascular procedures come with a potential risk of radiation hazards both to patients and to the vascular staff. Classically, most endovascular interventions took place in regular operating rooms (ORs) using a fluoroscopy C-arm unit controlled by a third party. Hybrid operating rooms (HORs) provide an optimal surgical suit with all the qualities of a fixed C-arm device, while allowing the device to be controlled by the surgical team. The latest studies suggest that an operator-controlled system may reduce the radiation dose. The purpose of the present study is to determine the amount of absorbed radiation using an HOR in comparison with a portable C-arm unit and to assess whether the radioprotection awareness of the surgical team influences the radiation exposure. The primary end point was the effective dose in milliSievert (mSv) for the surgical team and the average dose-area product (ADAP) in Gray-meters squared (Gym2) for patients. METHODS: The values of absorbed radiation of the surgical team's dosimeters were collected from January 2015 to May 2016. The HOR was installed in June 2015, and a radioprotection seminar was given in October 2015. The HOR-issued radiation, measured by the maximum dose-area product, ADAP, average dose (AD) per procedure, maximum dose per procedure per month, maximum fluoroscopy time, average fluoroscopic time, peak skin dose, and average skin dose (ASD), was collected monthly from September 2015 to July 2016. The timeline was divided into 3 periods: 5 months pre-HOR (Pre-HOR), 5 months after the HOR installation (PreS-HOR), and 5 months after a radioprotection seminar (PostS-HOR). RESULTS: The average number of procedures per month was 22.55 (±4.9), including endovascular aneurysm repair/thoracic endovascular aneurysm repair, carotid, visceral, and upper and lower limb endovascular revascularization. The average amount of absorbed radiation by the surgeons during PreS-HOR was 1.07 ± 0.4 mSv, which was higher than the other periods (Pre-HOR 0.06 ± 0.03 mSv, P = 0.002; PostS-HOR 0.14 ± 0.09 mSv, P = 0.000, respectively). The ADAP during PreS-HOR was 0.016 ± 0.01 Gym2, which was lower than the PostS-HOR (0.001 ± 0.002 Gym2) (P = 0.034). The AD during PreS-HOR was 0.78 ± 0.3 Gy and 0.39 ± 0.3 Gy during PostS-HOR (P = 0.098). The ASD during PreS-HOR was 0.40 ± 0.2 Gy and 0.20 ± 0.1 Gy during PostS-HOR (P = 0.099). CONCLUSIONS: In our experience, the HOR increases the amount of absorbed radiation for both patients and surgeons. The radioprotection seminars are of utmost importance to provide a continued training and optimize the use of ionizing radiation while using an HOR. Despite the awareness of the surgical team in the radioprotection field, the amount of absorbed radiation using an HOR is higher than the one using a C-Arm unit.


Assuntos
Procedimentos Endovasculares , Curva de Aprendizado , Exposição Ocupacional/prevenção & controle , Saúde do Trabalhador , Salas Cirúrgicas/organização & administração , Segurança do Paciente , Doses de Radiação , Exposição à Radiação/prevenção & controle , Proteção Radiológica/métodos , Radiografia Intervencionista , Lista de Checagem , Competência Clínica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Desenho de Equipamento , Humanos , Exposição Ocupacional/efeitos adversos , Traumatismos Ocupacionais/etiologia , Traumatismos Ocupacionais/prevenção & controle , Equipe de Assistência ao Paciente , Exposição à Radiação/efeitos adversos , Lesões por Radiação/etiologia , Lesões por Radiação/prevenção & controle , Monitoramento de Radiação/métodos , Radiografia Intervencionista/efeitos adversos , Radiografia Intervencionista/instrumentação , Medição de Risco , Fatores de Risco
18.
Surg Technol Int ; 28: 29-35, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27175812

RESUMO

INTRODUCTION: The purpose of our study was to compare the effect, on the inflammatory response and fibrosis formation, of four commercially available sealant products applied on an injured trachea in a Wistar rat population. MATERIALS AND METHODS: We compared four different sealants: cyanoacrylate, fibrin/thrombin, albumin/glutaraldehyde, and polyethylene glycol-based hydrogel (PEG). Rats were organized into six groups of similar size. Four of them were experimental, one was a baseline control group (BCG), and the sixth one was a reference control group (RCG). The RCG and experimental groups underwent the same surgical intervention with tracheal puncture, but no sealant was applied in the RCG. The BCG underwent the same cervical and peritracheal dissection without tracheal puncture. Rats were euthanized after eight weeks. RESULTS: The operation was performed on 54 rats, of which 12 died, leaving a final sample of 42 rats. Macroscopic analysis revealed no superficial tracheal or vascular fistulas, nor signs of local abscess. Although the groups treated with cyanoacrylate, fibrin/thrombin, and albumin/glutaraldehyde showed some degree of fibrosis, the treated area of the PEG group showed neither inflammatory nor scar signs. Microscopic assessment of the BCG and RCG showed no remarkable findings. With the exception of the PEG group, which had a light fibrosis and poor inflammatory response as did the BCG and RCG groups, the other groups showed varying degrees of fibrosis and cicatrization. CONCLUSION: Our study showed that the group treated with PEG had a mild inflammatory and fibrotic response, which is useful in tracheal or tracheobronchial surgical procedures. However, groups treated with cyanoacrylate, fibrin/thrombin, and albumin/glutaraldehyde showed fibrosis and cicatrization.


Assuntos
Adesivos Teciduais/administração & dosagem , Traqueia/lesões , Traqueia/patologia , Doenças da Traqueia/patologia , Doenças da Traqueia/terapia , Animais , Feminino , Masculino , Ratos , Ratos Wistar , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Resultado do Tratamento
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