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2.
Ann Thorac Surg ; 111(1): e1-e3, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32562625

RESUMO

Acute aortic dissection is one of the most common life-threatening diseases that affects the aortic vessel. We present a case of acute Stanford type A aortic dissection in a patient with coronavirus disease 2019 (COVID-19) under treatment with angiotensin-converting enzyme inhibitors. A 68-year-old woman complaining of acute chest pain and dyspnea was admitted to the emergency clinic of our hospital on May 6, 2020. She had history of diabetes and hypertension. This is one of the first acute aortic surgery cases among patients with COVID-19.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Dissecante/virologia , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/virologia , /complicações , Idoso , Aneurisma Dissecante/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , /terapia , Feminino , Humanos
3.
Ann Vasc Surg ; 70: 569.e5-569.e10, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32920025

RESUMO

A 35-year-old man, with a deep pectus excavatum due to a Marfan syndrome treated 9 years before for an acute type A dissection involving only the aortic arch, by a Bentall surgery, was admitted for acute chest pain. Computed tomography (CT) scan showed an acute type non-A non-B dissection extending to the iliac. After 5 days with strict arterial blood pressure management, the patient had recurrent refractory chest pain and a hybrid technique associating full supra-aortic vessels debranching and STABILISE technique during the same procedure was performed. The patient had an uneventful recovery with CT scan showing complete aortic arch aneurysm exclusion.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Síndrome de Marfan/complicações , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etiologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Síndrome de Marfan/diagnóstico , Stents , Resultado do Tratamento
4.
Ann Vasc Surg ; 70: 569.e1-569.e4, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32927034

RESUMO

Ischemic lumbosacral plexopathy secondary to an acute aortic dissection is a rare condition that is usually unilateral and frequently accompanied by a simultaneous spinal cord infarction. The functional prognosis relies on the severity of the nervous system involvement being usually worse when the spinal cord is involved. We present a case of a 46-year-old man who suffered an acute type B aortic dissection presenting as acute paraplegia due to bilateral ischemic lumbosacral plexopathy treated with thoracic endovascular aortic repair. An up-to-date review of the literature on ischemic lumbosacral plexus injury is provided.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Aórtico/complicações , Paraplegia/etiologia , Isquemia do Cordão Espinal/etiologia , Doença Aguda , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/fisiopatologia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/diagnóstico , Paraplegia/fisiopatologia , Isquemia do Cordão Espinal/diagnóstico , Isquemia do Cordão Espinal/fisiopatologia , Resultado do Tratamento
5.
Ann Vasc Surg ; 70: 481-490, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32603844

RESUMO

BACKGROUND: First-generation "off-the-shelf" branched endovascular stent grafts are in development for treatment of thoracoabdominal aortic aneurysms (TAAAs). Prior studies have assessed eligibility rates among highly selected cohorts of patients referred for endovascular treatment, and the broader applicability of these devices to all patients with TAAA is unknown. The aims of this study were to assess the overall suitability of the 3 commercial 4-branched devices with or without adjunct procedure(s) in an unselected cohort of patients with TAAA and to identify areas for improvement in the next generation of devices. METHODS: A retrospective review of three-dimensional centerline reconstructions of contrast-enhanced computed tomography (CT) imaging was performed in consecutive patients with TAAA seen between 2013 and 2017. All patients with contrast-enhanced CT imaging were included, regardless of prior evaluation for suitability for endovascular repair. Eligibility for a device was assessed based on instructions for use (IFU) from the device manufacturer along with prespecified anatomic criteria. Adjunct procedures were defined as carotid-subclavian revascularization, target vessel endovascular intervention, and iliac conduit/revascularization. RESULTS: Of 165 patients with TAAA, 122 had CT scans adequate for study inclusion. Eighteen patients (14.8%) were eligible for at least 1 device by IFU, and 41 (33.6%) could have been made eligible for at least 1 device by an adjunct procedure. Sixty-three (51.6%) were not eligible for any device within IFU even with adjunct procedures, including 31 of 32 patients with TAAA due to dissection. The most common reasons for ineligibility were perivisceral flow channel diameter <20 mm (n = 43) and an inadequate proximal seal zone (n = 29). Women were significantly less likely to be eligible for an off-the-shelf device (P = 0.03) and were more likely to require an iliac procedure to become eligible (P = 0.006). Almost none of the patients with dissection could receive a device even if adjunct procedures were used. CONCLUSIONS: Over half of patients with TAAA could not be made eligible for an off-the-shelf device based on manufacturers' criteria, even with adjunct procedures. Women and patients with TAAA due to dissection had higher rates of ineligibility. These data demonstrate that custom fenestrated devices and low-profile devices are needed to expand eligibility for endovascular repair of TAAA.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Angiografia por Tomografia Computadorizada , Definição da Elegibilidade , Procedimentos Endovasculares/instrumentação , Stents , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Tomada de Decisão Clínica , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Desenho de Prótese , Estudos Retrospectivos
6.
Ann Vasc Surg ; 70: 474-480, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32634557

RESUMO

BACKGROUND: Aortic stent grafting can cause aortic stiffening and increase pulse wave velocity (PWV), which can potentially affect long-term cardiovascular outcomes. The aim of this study was to clarify the factors contributing to increases in PWV after thoracic endovascular aortic repair (TEVAR). METHODS: We included 64 patients with thoracic aortic pathology (51 men; mean age, 73 years) who underwent elective TEVAR, in this study. TEVAR was performed for degenerative aortic aneurysm (n = 43) or aortic dissection (n = 21), and the treatment length was 175 ± 52 mm. Brachial-ankle PWV (baPWV) was obtained before and 1 week after TEVAR. Univariable and multivariable logistic regression analyses were used to determine the predictors of increases in baPWV of ≥100 cm/sec after TEVAR. RESULTS: baPWV increased from 1,851 ± 392 cm/sec to 2,047 ± 479 cm/sec, and the change in baPWV (ΔbaPWV) was 195 ± 339 cm/sec (95% confidence interval, 111-280). Thirty-seven patients (58%) had ΔbaPWV ≥100 cm/sec after TEVAR. In the multivariable analysis, in addition to Δheart rate and Δsystolic blood pressure, age (odds ratio, 1.21/year; 95% confidence interval, 1.05-1.40) and coronary artery disease (odds ratio, 12.0; 95% confidence interval, 1.20-121) were independent determinants of ΔbaPWV ≥100 cm/sec after TEVAR, whereas ΔbaPWV ≥100 cm/sec was not associated with treatment length or device type. CONCLUSIONS: TEVAR was associated with PWV progression, especially in older patients with coronary artery disease, whereas treatment length or device type was not a predictor of PWV progression after TEVAR.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Rigidez Vascular , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
7.
Ann Vasc Surg ; 70: 152-161, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32634562

RESUMO

BACKGROUND: Thoracic endovascular aortic repair (TEVAR) for type B aortic dissections is used to promote false lumen (FL) thrombosis and favorable aortic remodeling, but its impact on occlusion of FL origin branch vessels has not been widely described. We compare FL versus true lumen (TL) branch vessel patency after TEVAR. METHODS: Patients treated by TEVAR for type B aortic dissection in zones 2-5 in the Vascular Quality Initiative from 2009 to 2018 were evaluated. The primary outcome was postoperative branch patency. Secondary outcomes were need for branch vessel intervention, preoperative origin, and postoperative patency of individual branch vessels (celiac, superior mesenteric artery, renal arteries, and iliac arteries). A subset analysis was performed comparing acute and chronic dissections. RESULTS: Of 11,774 patients, 1,484 met criteria for analysis. The left renal was the most common to have FL origin (21.6%), whereas right and left common iliac arteries were the most likely to originate off both lumens (BLs; 22% and 24%). Branch vessels that originated from the TL, FL, BLs, or were obstructed had postoperative patency rates of 99%, 99%, 99%, and 87% (P < 0.0001). Branch vessel treatment was performed in 5% of patients. The right (2.5%) and left (2.8%) renal arteries were the most frequently obstructed branches postoperatively. On multivariate analysis, preoperatively obstructed branches (odds ratio 0.03, P < 0.0001) were negatively associated with postoperative branch patency and branch vessel treatment (odds ratio 3.8, P = 0.004) was positively associated with postoperative patency. FL or BL origin, number of zones covered by TEVAR, urgency, dissection chronicity (acute versus chronic), and demographics were not independently associated with patency. These findings remained unchanged in the subset analysis of only acute dissections. CONCLUSIONS: Branch vessel patency rates after TEVAR for a type B aortic dissection are high and are not significantly different for FL or BL origin vessels compared with TL vessels. Branches that are patent before TEVAR almost always remain patent after TEVAR, but branch vessel stenting may be required in less than 5%.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Grau de Desobstrução Vascular , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
8.
Ann Vasc Surg ; 70: 566.e5-566.e9, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32768549

RESUMO

Isolated superior mesenteric artery (SMA) dissecting aneurysm is frequently symptomatic and potentially catastrophic; thus, it usually requires endovascular treatment. The endovascular management can be challenging in certain cases as catheterization of the collapsed true lumen is often very difficult. This case report is to describe a new approach for catheterization of the true lumen of the SMA in a case of isolated SMA dissecting aneurysm. A 63-year-old male with an SMA dissecting aneurysm underwent stent-graft placement for treatment. Catheterization of the true lumen via the anterograde approach was unsuccessful because of angulation and collapse of the SMA true lumen as a result of the dissecting aneurysm. A guidewire was passed through the collaterals from the celiac artery and retrogradely passed across the collapsed SMA true lumen into the aorta. We then used a snare that had been delivered through the contralateral femoral access to capture and retrieve the guidewire. A delivery system was advanced into the SMA, and a stent graft was successfully deployed to occlude the dissecting aneurysm. This report introduces a new feasible retrograde approach that provides access to the SMA true lumen via celiac collaterals in cases of difficult antegrade catheterization of an SMA dissecting aneurysm.


Assuntos
Aneurisma Dissecante/cirurgia , Implante de Prótese Vascular , Artéria Celíaca/fisiopatologia , Circulação Colateral , Procedimentos Endovasculares , Artéria Mesentérica Superior/cirurgia , Circulação Esplâncnica , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Artéria Celíaca/diagnóstico por imagem , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
9.
Kyobu Geka ; 73(12): 1032-1036, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33268757

RESUMO

We herein report a case of thoracic endovascular aortic repair( TEVAR) for chronic aortic dissection with an aberrant left vertebral artery( LVA) originating from the aortic arch. A 51-year-old man with a medical history of Stanford type B acute aortic dissection 2 years ago was transferred to our institution for the treatment of an aortic expansion. Computed tomography showed a large entry just distal to the takeoff of the left subclavian artery and a dilated dissected thoracic aorta. A left cervical incision over the anterior border of the sternocleidomastoid was made, and the LVA was identified. The proximal LVA was ligated and anastomosed to the left common carotid artery in an end-to-side fashion. After completion of the carotid-subclavian bypass, TEVAR was performed in the usual fashion. The postoperative course was uneventful without stroke or spinal cord injury. At the 1-year follow-up, the false lumen had shrunk and the LVA remained patent.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Humanos , Masculino , Pessoa de Meia-Idade , Stents , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Resultado do Tratamento , Artéria Vertebral
10.
Kyobu Geka ; 73(12): 1037-1040, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33268758

RESUMO

A 53-year-old man was presented with Stanford type A acute aortic dissection. We first performed emergency ascending aortic replacement under selective cerebral perfusion with moderate hypothermia. He developed abdominal pain after the surgery. Six days after the 1st surgery, computed tomography revealed that the new entries were located in the distal anastomosis site and the distal aortic arch, and the true lumen of the aorta was obstructed by the false lumen and stenosis. Visceral malperfusion was diagnosed and emergent total debranching thoracic endovascular aortic repair (TEVAR) was planned. One proximal covered stentgraft and 2 distal bare stents were deployed.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Humanos , Masculino , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(45): e23008, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157946

RESUMO

Type A acute aortic dissection (TAAAD) carries a high mortality rate in the absence of surgical treatment. This study sought to determine whether combining the assessment of clinical and computed tomography (CT) findings can be used to predict the long-term all-cause mortality rate of patients with TAAAD.Eighty-five consecutive patients with TAAAD who had undergone CT imaging and surgery were retrospectively reviewed. For the clinical and CT findings, univariate testing followed by multivariate logistic regression analysis was conducted to identify independent predictors of death. Then, the area under the receiver operating characteristic curve of the combined prediction model was calculated.The long-term mortality rate was 34.1% in our cohort (a median follow-up period of 60 months). Multivariate logistic regression analysis identified the following presenting variables as predictors of death: male sex (odds ratio [OR]: 6.67; 95% confidence interval [CI]: 1.67-25.0; P = .007), kidney malperfusion (OR: 2.18; 95% CI: 1.16-4.1; P = .02), and descending aorta size (OR: 1.12; 95% CI: 1.00-1.25; P = .05). Receiver operating characteristic curve analysis revealed an area under the receiver operating characteristic curve of 0.84 when using the combined model for prediction of long-term all-cause mortality (P ≤ .01).The combined assessment of clinical and CT findings can reasonably predict the long-term prognosis of TAAAD with surgery.


Assuntos
Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/mortalidade , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta Torácica/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Feminino , Seguimentos , Humanos , Rim/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores Sexuais , Tomografia Computadorizada por Raios X
12.
Interact Cardiovasc Thorac Surg ; 31(6): 834-840, 2020 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-33150432

RESUMO

OBJECTIVES: Our goal was to compare the short-term outcomes of Stanford type A aortic dissection (TAAD), during the coronavirus disease 2019 (COVID-19) pandemic with those during normal times and summarize our perioperative management experience of patients with TAAD in the context of COVID-19. METHODS: From 17 January 2020 to 8 March 2020, a total of 27 patients with TAAD were operated on in 8 cardiovascular surgery centres in Hubei Province (COVID-19 group). The data from 91 patients with TAAD from the same centres during the same period last year were extracted from the Hubei Cardiac Surgery Registration System (control group). A propensity score matched subgroup of 26 pairs (1:2) was identified. Perioperative data and short-term outcomes were assessed. RESULTS: Nine patients in the COVID-19 group were categorized as suspicious for the disease (9/27, 33.3%), and others were excluded (18/27, 66.7%). No one was laboratory confirmed preoperatively. The average waiting, cross-clamp and circulatory arrest times were longer in the COVID-19 group (22.9 ± 8.3 vs 9.7 ± 4.0 h, P < 0.001; 135 ± 36 vs 103 ± 45 min, P = 0.003; 24 ± 9 vs 17 ± 8 min, P < 0.001, respectively). The 30-day or in-hospital deaths were 3.8% in both groups (P = 1.0). The COVID-19 group was associated with longer ventilation and intensive care unit times (81 ± 71 vs 45 ± 19 h, P < 0.001; 7.4 ± 3.8 vs 4.5 ± 2.7 days; P < 0.001, respectively). There were no statistical differences between the 2 groups in the incidence of complications such as stroke, neurological deficit, acute kidney injury, pulmonary infection and reoperation. Serum antibody tests for those patients showed 7 out of 9 suspected cases were Immunoglobulin G positive. No cross-infection occurred in other patients or associated medical staff. CONCLUSIONS: With adequate preparation and appropriate protection, satisfactory early outcomes can be achieved after emergency operations for patients with TAAD during the COVID-19 pandemic.


Assuntos
Aneurisma Dissecante/cirurgia , Pandemias , Pontuação de Propensão , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma Dissecante/epidemiologia , China/epidemiologia , Comorbidade , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento
13.
BMC Surg ; 20(1): 266, 2020 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-33143659

RESUMO

BACKGROUND: The long-term complication rates of open repair and thoracic endovascular aortic repair (TEVAR) have not yet been determined. Therefore, this study aimed to compare the long-term outcomes and aortic reintervention rates between open repair and TEVAR in patients with descending thoracic aortic pathologies. METHODS: Between January 2002 and December 2017, 230 patients with descending thoracic aortic pathologies underwent surgery. Of these, 136 patients were included in this retrospective study: 45 patients (10, 2, and 33 with dissection, penetrating atherosclerotic ulcer, and pseudoaneurysm, respectively) underwent open repair and 91 patients (27, 1, and 63 with dissection, penetrating atherosclerotic ulcer, and pseudoaneurysm, respectively) underwent TEVAR. The primary end points were in-hospital mortality, and short-term complications. The secondary end points were long-term mortality and reintervention rates. Based on the propensity score matching (PSM), 35 patients who underwent open repair were matched to 35 patients who underwent TEVAR (ratio = 1:1). RESULTS: The mean follow-up period was 70.2 ± 51.9 months. Shorter intensive care unit and hospital stay were seen in the TEVAR group than in the open repair group before and after PSM (p < 0.001 and p < 0.001, respectively). However, in-hospital mortality, and spinal cord ischemia were not significantly different among the two groups (before PSM: p = 0.068 and p = 0.211, respectively; after PSM: p = 0.303 and p = 0.314, respectively). The cumulative all-cause death and aorta-related death showed no significant differences between the two groups (before PSM: p = 0.709 and p = 0.734, respectively; after PSM: p = 0.888 and p = 0.731, respectively). However, aortic reintervention rates were higher in the TEVAR group than in the open repair group before and after PSM (p = 0.006 and p = 0.013, respectively). CONCLUSION: The TEVAR group was superior in short-term recovery outcomes but had higher reintervention rates compared to the open repair group. However, there were no significant differences in long-term survival between the two groups.


Assuntos
Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Adulto , Idoso , Aneurisma Dissecante/cirurgia , Falso Aneurisma/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/cirurgia , Aterosclerose/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Implante de Prótese Vascular/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Úlcera/cirurgia
14.
Am Surg ; 86(11): 1482-1484, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33155825

RESUMO

Evaluating a high-risk patient for a high-risk operation is complicated. Discussing the benefits and burdens with your patient is only a part of the process. Should the decision be not to operate, explaining and planning the nonoperative path forward with all of its inherent challenges is crucial. Because the inevitable is likely to happen, the patient as well as their family must be prepared. If they are not, then the result may be exactly what the patient was hoping to avoid in the first place by declining the operation. Critical to this conversation is understanding the nuances of "doing everything" when dealing with a patient facing a life-limiting condition.


Assuntos
Cuidados Paliativos , Planejamento de Assistência ao Paciente , Procedimentos Cirúrgicos Operatórios , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Tomada de Decisão Compartilhada , Família , Evolução Fatal , Humanos , Masculino , Cuidados Paliativos/ética , Cuidados Paliativos/métodos , Medição de Risco , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/ética , Procedimentos Cirúrgicos Operatórios/métodos
15.
J Vasc Interv Radiol ; 31(12): 1984-1992.e1, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33153865

RESUMO

PURPOSE: To report early and midterm outcomes of treating thoracic aortic aneurysm (TAA) and aortic dissection (AD) involving zone 1 and zone 0 with multiple parallel stent grafts (PSGs). MATERIALS AND METHODS: From February 2011 to August 2018, 31 of 1,806 patients (1.7%) who underwent thoracic endovascular aortic repair (TEVAR) with double PSGs (DPSGs) (n = 20) or triple PSGs (TPSGs) (n = 11) were retrospectively reviewed. Procedures were performed in high-risk patients who had TAA or AD involving zone 1 or zone 0. RESULTS: Fifteen patients (48.4%) who presented with symptomatic or impending rupture underwent urgent or emergent TEVAR with DPSGs or TPSGs. Nineteen patients (61.3%) were treated for zone 0 disease. Technical and clinical success rates were 70.0% for DPSG cohort and 45.5% for TPSG cohort. Intraoperative type Ia endoleak was observed in 30% of DPSG cohort and 45.5% of TPSG cohort. One patient in the DPSG cohort died of aortic sinus rupture intraoperatively. Minor stroke during the 30-day postoperative period was more frequent in the TPSG cohort (P = .042). Mean duration of follow-up was 28.9 months ± 17.7. The TPSG cohort had a higher incidence of major adverse events (72.7% vs 25.0%, P = .021). The most common adverse events were endoleaks (12.9%), endograft migration (9.7%), PSG stenosis or occlusion (6.5%), retrograde dissection (6.5%), and stroke (3.2%). Endograft migrations were more common in TPSG cohort (27.3%, P = .037). Overall mortality rate was 16.1% (5/31) perioperatively and during follow-up. There were no statistical differences in overall survival and reintervention-free survival. CONCLUSIONS: In the context of TEVAR with multiple PSGs for aortic arch repair, TPSGs may have a high risk of major complications.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Stents , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
16.
BMC Surg ; 20(1): 286, 2020 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-33208110

RESUMO

BACKGROUND: Antegrade cerebral perfusion (ACP), including unilateral and bilateral, is most commonly used for cerebral protection in aortic surgery. There is still no consensus on the superiority of the two methods. Our research aimed to investigate the clinical effects of u-ACP and b-ACP. METHODS: 321 of 356 patients with type A aortic dissection were studied retrospectively. 124 patients (38.6%) received u-ACP, and 197 patients (61.4%) received b-ACP. We compared the incidence of postoperative neurological complications and other collected data between two groups. Besides, we also analyzed perioperative variables to find the potential associated factors for neurological dysfunction (ND). RESULTS: For u-ACP group, 54 patients (43.5%) had postoperative neurological complications, including 22 patients (17.7%) with permanent neurologic dysfunction (PND) and 32 patients (25.8%) with temporary neurologic dysfunction (TND). For b-ACP group, 47 patients (23.8%) experienced postoperative neurological complications, including 16 patients (8.1%) of PND and 31 patients (15.7%) of TND. The incidence of PND and TND were significantly different between two groups along with shorter CPB time (p = 0.016), higher nasopharyngeal temperature (p≦0.000), shorter ventilation time (p = 0.018), and lower incidence of hypoxia (p = 0.022). Furthermore, multivariate stepwise logistic regression analysis confirmed that preoperative neurological dysfunction (OR = 1.20, p = 0.028), CPB duration (OR = 3.21, p = 0.002), and type of cerebral perfusion (OR = 1.48, p = 0.017) were strongly associated with postoperative ND. CONCLUSIONS: In our study, it was observed that b-ACP procedure exhibited shorter CPB time, milder hypothermia, shorter ventilation time, lower incidence of postoperative hypoxia, and neurological dysfunction compared to u-ACP. Meanwhile, the incidence of ND was independently associated with three factors: preoperative neurological dysfunction, CPB time, and type of cerebral perfusion.


Assuntos
Aneurisma Dissecante , Aneurisma Aórtico , Circulação Cerebrovascular , Circulação Extracorpórea/métodos , Doenças do Sistema Nervoso/prevenção & controle , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/cirurgia , Encéfalo/irrigação sanguínea , Ponte Cardiopulmonar/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Perfusão/métodos , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
17.
Kyobu Geka ; 73(10): 783-788, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130766

RESUMO

Mesenteric malperfusion is reported as a complication associated with acute aortic dissection(AAD) in 3~5% cases, and one of the adverse risk factors for survival. The mortality rate associated with malperfusion due to AAD is higher than that without malperfusion. To improve the clinical outcome, it is important to address the mesenteric malperfusion appropriately. Mesenteric malperfusion remains a diagnostic challenge. Abdominal pain is the most common symptom, but a nonspecific of acute mesenteric ischemia. Computed tomography(CT) including CT angiography is the gold standard in the diagnosis of aortic dissection and the mesenteric malperfusion. No single serum marker, including lactate, is reliable enough to diagnosis mesenteric ischemia. The optimal treatment for mesenteric malperfusion due to AAD is to restore blood flow to the ischemic area as early as possible, while minimizing the risk of thoracic aortic rupture. Those patients with malperfusion but no significant organ ischemia should be treated with immediate surgical repair. Those patients with malperfusion and significant organ ischemia and hemodynamically stable should be treated with mesenteric reperfusion, followed by surgical repair. The management of mesenteric malperfusion associated with AAD requires a tailored approach to improve outcomes. After successful restoration of mesenteric perfusion, patients should be monitored closely, and the bowel should be inspected when there is doubt regarding its viability.


Assuntos
Aneurisma Dissecante , Aneurisma Aórtico , Procedimentos Endovasculares , Isquemia Mesentérica , Doença Aguda , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/cirurgia , Resultado do Tratamento
18.
Kyobu Geka ; 73(11): 936-939, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130718

RESUMO

A 45-year-old male developed Stanford type A acute aortic dissection combined with aortic root dilation and congenital bicuspid aortic valve (BAV). He had a Sieveres type 0 BAV, lateral subtype with right and left cusps. Valve-sparing root reimplantation was performed with decalcification of the cusps. Transthoracic echocardiography(TTE) at discharge revealed no aortic regurgitation, and peak velocity of BAV was 2.15 m/second, mean pressure gradient was 9.6 mmHg and aortic valve area was 2.15 cm2. TTE after 6 months revealed only slight elevation of the peak velocity to 2.78 m/second. To perform successful reimplantation in the case of BAV, anatomic orientation of the cusps should be approximately at 180° and the tissue of the cusps should either be normal or have only minor abnormalities. Valve-sparing root reimplantation for BAV needs a careful follow-up for progression of the aortic valve dysfunction.


Assuntos
Aneurisma Dissecante , Valva Aórtica , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Dilatação , Doenças das Valvas Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Reimplante , Estudos Retrospectivos
20.
Pan Afr Med J ; 36: 247, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33014243

RESUMO

Aortic dissection in the most common fatal disease affecting the aorta. Ascending aortic dissection can lead to coronary malperfusion causing myocardial infarction with ST elevation. The distinction between aortic dissection and a primary myocardial infarction can be difficult because both conditions can have similar presentations. Making the right diagnosis is essential because the therapies used to treat myocardial infarction can be fatal for patients with aortic dissection. Emergency transthoracic echography presents a rapid imaging procedure that provides strong hints of the coexistence of these two diseases, leading to further imaging examination and prevent inappropriate administration of treatments that could cause catastrophic outcome. We report a case of a 62-year-old man admitted to our hospital with chest pain, who was diagnosed as inferior wall myocardial infarction based on electrocardiographic findings. The diagnosis was reassessed due to a significant aortic regurgitation and an intimal tear in the ascending aorta on transthoracic echocardiography. Computed tomography angiogram of the chest and transesophageal echography fully confirmed the presence of ascending aortic dissection. Emergency surgery was successfully performed and the patient recovered well.


Assuntos
Aneurisma Dissecante/diagnóstico , Insuficiência da Valva Aórtica/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Aneurisma Dissecante/cirurgia , Dor no Peito/etiologia , Angiografia por Tomografia Computadorizada , Ecocardiografia , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade
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