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2.
Vasc Endovascular Surg ; 54(1): 12-16, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31522622

RESUMO

PURPOSE: To investigate the clinical outcomes of endovascular bare stenting in patients with symptomatic isolated superior mesenteric artery (SMA) dissection (ISMAD). METHODS: This study was a retrospective analysis which included a total of 9 patients with symptomatic ISMAD (7 males and 2 females, age range: 48-67 years) who were treated with endovascular bare stenting. Data regarding basic patient clinical characteristics, e-technical success of the operation, and long-term patient outcomes were assessed. RESULTS: Endovascular bare stenting was found to be technically successful in all patients. A total of 9 stents were inserted in these 9 patients. Five patients presented with stable false lumen and 4 patients presented with shrinking of false lumen after stenting. Both the trunk and branches of the SMA remained patent in all patients after stent insertion. There was no incidence of procedure-related complications, with all patients experiencing progressive symptom relief and subsequent symptom abatement within 1 week of the operation. Over a median 24 month follow-up period (range: 12-36 months), abdominal computed tomographic angiography revealed that all patients had obliterated dissections. In addition, there were no instances of stent obstruction, intestinal necrosis, or antiplatelet related bleeding during the follow-up period. CONCLUSIONS: Endovascular bare stenting was found to be a safe and effective treatment for patients with ISMAD.


Assuntos
Aneurisma Dissecante/cirurgia , Procedimentos Endovasculares/instrumentação , Artéria Mesentérica Superior/cirurgia , Stents Metálicos Autoexpansíveis , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Resultado do Tratamento
3.
Vasc Endovascular Surg ; 54(1): 89-92, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31551026

RESUMO

Endovascular stent placement (ESP) for patient with spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a widely accepted treatment option. However, failed percutaneous ESP is not uncommon and is one of the leading causes for laparotomy. We report a case of 63-year-old man with SIDSMA encountered failed antegrade recanalization via conventional transfemoral approach. We achieved recanalization in a retrograde fashion through middle colic artery using rendezvous technique and successfully placed self-expandable stents inside the dissected superior mesenteric artery. The patient recovered well after percutaneous ESP. We herein describe the transcollateral retrograde approach of percutaneous ESP for SIDSMA as an alternative option when conventional antegrade recanalization fails.


Assuntos
Aneurisma Dissecante/terapia , Circulação Colateral , Procedimentos Endovasculares/métodos , Artéria Mesentérica Superior , Circulação Esplâncnica , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
4.
Ann Vasc Surg ; 62: 195-205, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31449941

RESUMO

BACKGROUND: In some cases of complex aortoiliac endovascular repair, the hypogastric landing zone is suboptimal or even insufficient. This study aimed at the technical feasibility and at the outcome of iliac branch device (IBD) deployment with extension of the IBD into the superior gluteal artery (SGA). MATERIALS AND METHODS: This study involves a retrospective analysis of a prospectively maintained single-center cohort of patients with implantation of IBD for aortoiliac and postdissection aneurysms. The IBD cohort with landing zones in the hypogastric main trunk (IIA IBD) was compared with the IBD cohort with landing zones in the SGA (SGA IBD). The main outcome parameters were primary technical success, patency of the hypogastric branch, and freedom from IBD-specific secondary interventions within 30 days. Other outcomes of interest were long-term patency and freedom from buttock claudication, as well as the incidence of endoleaks. Group comparisons were made by univariate significance tests, and freedom from reintervention was analyzed with the Kaplan-Meier-method. RESULTS: From January 2015 to October 2017, a total of 46 IBDs were implanted in 40 patients (39 male; mean age, 71.9 ± 9.1 years). Nineteen of 46 (41.3%) IBDs were extended with at least one bridging stent graft into the SGA because of aneurysmal or short internal iliac artery (IIA). Technical success was achieved in 97.8% (96.3% for IIA IBD vs. 100% for SGA IBD, P = 0.163), and the primary ipsilateral limb patency rate was 100% within 30 days after the procedure. During a mean follow-up period of 19.8 ± 10.0 months (24.7 ± 10.8 for IIA IBD vs. 25.1 ± 9.8 for SGA IBD, P = 0.461), 11.1% IBDs in the IIA IBD group and 15.8% IBDs in the SGA IBD group needed secondary interventions (P = 0.33). Follow-up revealed no patients suffering from persistent buttock claudication or erectile dysfunction. One patient in the SGA IBD group died at late follow-up from a non-aneurysm-related cause. CONCLUSIONS: Extension of IBD into the SGA is a technically feasible and safe maneuver in the treatment of aortoiliac aneurysms with outcomes comparable to those when IBDs extend to the main trunk of the hypogastric artery.


Assuntos
Aneurisma Dissecante/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Nádegas/irrigação sanguínea , Procedimentos Endovasculares/instrumentação , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Estudos de Viabilidade , Feminino , Alemanha , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/fisiopatologia , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Claudicação Intermitente/etiologia , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
5.
J Cardiovasc Surg (Torino) ; 60(6): 749-754, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31640318

RESUMO

BACKGROUND: In descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm (TAAA) surgery, though proximal anastomosis using deep hypothermic circulatory arrest (DHCA) is often selected, there are issues surrounding brain and heart protection. In this study, the usefulness of concomitant upper body perfusion via transapical aortic cannulation during deep hypothermic surgery was examined. METHODS: Between October 2014 and May 2019, 5 patients (Crawford extent II chronic dissection, N.=3; extent IV aneurysms, N.=1; DTAA, N.=1) underwent DTAA/TAAA repair under deep hypothermia using transapical aortic perfusion. A proximal anastomosis and artery of Adamkiewicz (AKA) reconstruction were performed under continuous perfusion of the upper and lower body at 20 °C. RESULTS: The time from aortic cross-clamping to proximal anastomosis was 69±33 minutes, and it took 86±47 minutes to AKA reperfusion. There was no spinal cord ischemic injury or brain or heart complications. One patient required tracheostomy, and the average postoperative intubation time for the other patients was 57±52 hours. All patients were discharged, and the average postoperative hospital stay was 25.6±8.1 days. CONCLUSIONS: Concomitant upper body perfusion by the transapical aortic approach contributes to avoidance of brain and heart complications and maintaining spinal cord circulation under deep hypothermic DTAA/TAAA surgery.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Parada Circulatória Induzida por Hipotermia Profunda , Perfusão/métodos , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Doença Crônica , Parada Circulatória Induzida por Hipotermia Profunda/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Perfusão/efeitos adversos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Fluxo Sanguíneo Regional , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
6.
J Stroke Cerebrovasc Dis ; 28(11): 104374, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31530480

RESUMO

Traumatic cerebral aneurysms are histologically dissecting aneurysms or pseudoaneurysms, thus requiring parent artery occlusion for cure. Combination of endovascular parent artery occlusion and extracranial-intracranial bypass is considered optimal to obtain complete obliteration of the aneurysm and to avoid hemodynamic hypoperfusion. However, endovascular parent artery occlusion of the supraclinoid internal carotid artery (ICA) is at risk of ischemic complications due to distal coil protrusion to adjacent perforating arteries or distal embolism of the thrombi generated in the coil mass. A 20-year-old man presented with progressive left optic neuropathy following motor vehicle accident. Radiological examination revealed left supraclinoid ICA aneurysmal formation with dissecting change. We treated this traumatic supraclinoid ICA aneurysm by combination of endovascular parent artery occlusion and high-flow bypass in the hybrid operating room. An aneurysmal clip was applied on the ICA just distal to the aneurysm prior to coil embolization, and worked as a scaffold for subsequent filling coils and as a blockade for the distal emboli. This "clip anchor-assisted coil embolization" technique resulted in optimal parent artery occlusion for the traumatic aneurysm of the supraclinoid ICA with minimal risks of residual blood flow, intraoperative rupture, and thromboembolic complications.


Assuntos
Acidentes de Trânsito , Aneurisma Dissecante/terapia , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/terapia , Artéria Radial/transplante , Enxerto Vascular , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Velocidade do Fluxo Sanguíneo , Circulação Cerebrovascular , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Masculino , Resultado do Tratamento , Adulto Jovem
7.
J Pak Med Assoc ; 69(9): 1376-1379, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511729

RESUMO

Acute aortic dissection is a frequently fatal condition that rarely involves young individuals. It has an estimated worldwide prevalence of 0.5-2.95 per 100,000 persons per year, with a mean incidence at around age 60. Of all the aortic dissections, less than 10% involve patients younger than 40 years of age. We present the case of a forty-yearold male who presented in the emergency department with non-specific complaints of nausea and lightheadedness. The patient being hemodynamically and clinically stable was discharged after supportive treatment. However after 5 hours the patient presented again in the emergency department with a neck pain, hypotension and sweating. CT angiography revealed a massive aortic dissection involving ascending, arch and descending aorta up to the bifurcation of iliac arteries. The patient was immediately taken for surgery for the replacement of ascending aorta and resuspension of aortic valve. The patient tolerated surgery well and was discharged after being clinically and haemodynamically stable.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Vertigem/diagnóstico , Adulto , Aneurisma Dissecante/complicações , Aneurisma Dissecante/fisiopatologia , Aneurisma Dissecante/cirurgia , Implante de Prótese Vascular , Angiografia por Tomografia Computadorizada , Erros de Diagnóstico , Tontura/etiologia , Serviço Hospitalar de Emergência , Humanos , Hipotensão/etiologia , Imageamento Tridimensional , Masculino , Náusea/etiologia , Near Miss , Cervicalgia/etiologia
8.
Biomed Res Int ; 2019: 3629751, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380418

RESUMO

Thoracic aortic dissection (TAD) is a catastrophic disease worldwide, but the pathogenic genes and pathways are largely unclear. This study aims at integrating two gene expression profile datasets and verifying hub genes and pathways involved in TAD as well as exploring potential molecular mechanisms. We will combine our mRNAs expression profile (6 TAD tissues versus 6 non-TAD tissues) and GSE52093 downloaded from the Gene Expression Omnibus (GEO) database. The two mRNAs expression profiles contained 13 TAD aortic tissues and 11 non-TAD tissues. The two expression profile datasets were integrated and we found out coexpression of differentially expressed genes (DEGs) using bioinformatics methods. The gene ontology and pathway enrichment of DEGs were performed by DAVID and Kyoto Encyclopedia of Genes and Genomes online analyses, respectively. The protein-protein interaction networks of the DEGs were constructed according to the data from the STRING database. Cytohubber calculating result shows the top 10 hub genes with CDC20, AURKA, RFC4, MCM4, TYMS, MCM2, DLGAP5, FANCI, BIRC5, and POLE2. Module analysis revealed that TAD was associated with significant pathways including cell cycle, vascular smooth muscle contraction, and adrenergic signaling in cardiomyocytes. The qRT-PCR result showed that the expression levels of all the hub genes were significantly increased in OA samples (p < 0.05), and these candidate genes could be used as potential diagnostic biomarkers and therapeutic targets of TAD.


Assuntos
Aneurisma Dissecante/genética , Aorta Torácica/metabolismo , Regulação da Expressão Gênica/genética , Contração Muscular/genética , Aneurisma Dissecante/fisiopatologia , Aorta Torácica/fisiopatologia , Ciclo Celular/genética , Ontologia Genética , Humanos , Análise em Microsséries , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/patologia , Mapeamento de Interação de Proteínas , RNA Mensageiro/genética , Transdução de Sinais/genética , Transcriptoma
9.
Biomed Res Int ; 2019: 4919416, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31321237

RESUMO

Purpose: Imaging artifacts are frequently encountered when performing clinical echocardiography. Based on our review of the literature, two-dimensional linear artifacts are mainly reported in the ascending aorta in patients with suspected aortic dissections. However, pulmonary artery artifacts that mimic pulmonary artery dissection have not been discussed. We herein report our experience with children and adults with preexisting heart conditions and pulmonary artery imaging artifacts. Methods: The study population comprised 10 patients with heart disease who were treated at our hospital from March 2015 to September 2017. Nine patients were children with congenital heart disease, mainly patent ductus arteriosus (n = 8), and one patient was an adult with pulmonary artery hypertension. Transthoracic echocardiography was performed in all patients. Results: We confirmed the diagnosis in six patients during a surgical operation for other indications and in four patients by computed tomographic pulmonary angiography. The most common pulmonary imaging artifact was observed from the left high parasternal view (9/10, 90%). Most of the artifacts were diagonally oriented (8/10, 80%), and a few were horizontally oriented. Half of the artifacts were located in the main pulmonary arteries with mild pulmonary artery dilatation. Pulmonary hypertension was seen only in the adult patient. The thymus gland was clearly seen in young patients. Conclusion: Pulmonary artery imaging artifacts in patients with preexisting heart disease during echocardiographic examination can mimic pulmonary artery dissection. Understanding the types and origins of these ultrasound artifacts is important to avoid a false-positive diagnosis.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Estenose de Artéria Pulmonar/diagnóstico por imagem , Adolescente , Adulto , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/fisiopatologia , Artefatos , Criança , Pré-Escolar , Ecocardiografia/métodos , Feminino , Cardiopatias/diagnóstico , Cardiopatias/fisiopatologia , Cardiopatias/cirurgia , Humanos , Lactente , Masculino , Estenose de Artéria Pulmonar/diagnóstico , Estenose de Artéria Pulmonar/fisiopatologia , Ultrassonografia/efeitos adversos , Ultrassonografia/métodos , Adulto Jovem
10.
Med Sci Monit ; 25: 4933-4940, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269009

RESUMO

BACKGROUND We discuss the presentation and management of extracranial carotid artery aneurysms (ECAAs) and to develop a new type of classification. MATERIAL AND METHODS A retrospective review of 35 ECAAs patients who were admitted in our institution from January 2010 to June 2016 was conducted. The mean follow-up period was 25.58±22.13 months. RESULTS During the study period, 35 aneurysms were diagnosed and treated (mean age, 50.8±15.6 years; 15 men). There were 28 true aneurysms, 5 false aneurysms, and 2 dissecting aneurysms. A total of 16 patients with true aneurysms underwent open surgical treatment (group 1), whereas 15 received endovascular management, including all false and dissecting aneurysms (group 2). The remaining 4 true aneurysms were treated with hybrid operation (group 3). The patency rates of groups 1, 2, and 3 were 100%, 93.3%, and 100%, respectively. According to the Peking Union Medical College Hospital (PUMCH) Classification, all 24 cases of type Ia aneurysms were treated by either open surgery and/or endovascular treatment, whereas all 3 type Ib cases were treated solely by open surgery. All 5 type IIa patients were treated by endovascular treatment, with the exception of 1 failure that was transferred to hybrid operation. All 3 type IIb patients were treated by hybrid operation. CONCLUSIONS Open surgery was more frequently feasible in true aneurysms, and endovascular surgery was the first choice for false and dissecting aneurysms. Hybrid operation was available for complicated cases. The PUMCH classification may be helpful for selection of management strategies for ECAAs.


Assuntos
Aneurisma Dissecante/cirurgia , Artérias Carótidas/cirurgia , Procedimentos Endovasculares/métodos , Adulto , Idoso , Aneurisma Dissecante/classificação , Aneurisma Dissecante/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Artérias Carótidas/fisiopatologia , Doenças das Artérias Carótidas/cirurgia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
11.
Semin Thorac Cardiovasc Surg ; 31(4): 691-696, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31207295

RESUMO

The decision-making process is crucial for the surgery of acute type A aortic dissection (AAAD). Often surgeons have to face different challenges, taking prompt decisions in emergency setting, during the pre- and intraoperative phase. Choosing if operate or not a patients with AAAD as well as the management of the dissected aortic arch can be challenging. Different factors need to be evaluated as: the patients age, the presence of organ malperfusion, the intimal tear location, and last but not least the surgeon personal experience in aortic surgery. During the last decade, different milestone steps have been achieved in aortic surgery as the antegrade perfusion of the aorta through different cannulation sites, open distal repair, antegrade selective cerebral perfusion, and systematic resection of the proximal intimal tear, allowing complex repair for dedicated team as well as simpler repair for not dedicated surgeons. We reviewed different scenarios and techniques used for the aortic arch replacement in patients with AAAD, taking into consideration that the aim of surgery is to save patients life.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Tomada de Decisão Clínica , Procedimentos Endovasculares/instrumentação , Stents , Doença Aguda , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Humanos , Complicações Pós-Operatórias/mortalidade , Desenho de Prótese , Fatores de Risco , Resultado do Tratamento
12.
Semin Thorac Cardiovasc Surg ; 31(3): 444-450, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150826

RESUMO

To introduce complete thoracic aorta remodeling as a new therapeutic target of thoracic endovascular aortic repair for chronic DeBakey IIIb aneurysms, and analyze the predictors for complete thoracic aorta remodeling. From 2012 to 2017, 75 patients underwent thoracic endovascular aortic repair for chronic DeBakey IIIb aneurysms. Complete thoracic aorta remodeling was defined as thoracic false lumen thrombosis with false lumen diameter <5 mm down to T-10 level. Major adverse aortic events were defined as aortic-related mortality, open conversion, and false lumen recanalization after thoracic false lumen thrombosis. Of the 75 patients included in this study, 60 (80.0%) demonstrated thoracic false lumen thrombosis; among them, overall mortality, open conversion, or false lumen recanalization after thoracic false lumen thrombosis occurred in two (3.3%), one (1.7%), and five (8.3%) patients, respectively. Nineteen (25.3%) of 75 patients who demonstrated complete thoracic aorta remodeling had no major adverse aortic events during follow-up. The number of visceral branches from the false lumen and residual intima tears were significant risk factors for complete thoracic aorta remodeling (HR 0.627, p = 0.041 and HR 0.754, p = 0.042). In chronic DeBakey IIIb aneurysms, complete thoracic aorta remodeling may be the ideal target for endovascular treatment rather than false lumen thrombosis. Additional procedures to eliminate the obstacles to complete thoracic aorta remodeling (number of visceral branches from the false lumen and residual intimal tears) and close follow-up after thoracic false lumen thrombosis may be needed to achieve the optimal outcome.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Remodelação Vascular , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/fisiopatologia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Trombose , Fatores de Tempo , Resultado do Tratamento
13.
Khirurgiia (Mosk) ; (5): 6-17, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31169813

RESUMO

AIM: To present current treatment modes for DeBakey type I aortic dissection, to compare their early and mid-term postoperative results, to evaluate predictors of negative aortic remodeling after surgery. MATERIAL AND METHODS: Retrospective cohort analysis included 78 patients with DeBakey type I aortic dissection who underwent surgical treatment in 2009-2017. Patients were divided into 3 groups depending on type of intervention: group I (n=22) - Elephant Trunk procedure, group II (n=29) - hybrid interventions, group III (n=27) - proximal aortic replacement alone. Early postoperative results and aortic remodeling in mid-term postoperative period were compared. RESULTS: There were no significant differences in postoperative morbidity, in-hospital mortality and freedom from aortic death. However, 7 patients were lost for follow-up in group III. Analysis of false lumen patency showed results in favor of more aggressive approach (groups I and II) with significantly higher rate of false lumen thrombosis in segments 1 and 2 (p<0,001 and p=0,004 respectively). Freedom from negative aortic remodeling was also significantly higher in groups I and II. Risk factors of patent false lumen were residual fenestration, large volume of false lumen in segment 2, dissection of supra-aortic vessels and connective tissue disorders. Risk factors of negative aortic remodeling were connective tissue disorders, patent false lumen and dissection of supra-aortic vessels. CONCLUSION: Advanced surgical approach (Elephant Trunk procedure or hybrid interventions) should be preferred for DeBakey type I aortic dissection.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Remodelação Vascular , Aneurisma Dissecante/fisiopatologia , Aneurisma da Aorta Torácica/fisiopatologia , Implante de Prótese Vascular , Progressão da Doença , Procedimentos Endovasculares , Humanos , Cuidados Pós-Operatórios , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
15.
Biomed Res Int ; 2019: 3247615, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31119164

RESUMO

Objective: To assess the efficacy and short- and mid-term results of endovascular surgery and hybrid surgical procedures in treatment of complex aortic dissection. Methods: Clinical data of 90 patients with complex aortic dissection admitted from June 2012 to June 2018 were retrospectively analyzed. Among the patients, 60 cases were male and 30 cases were female, and their ages were ranged from 32 to 79, with an average age of 55 years old; different endovascular techniques and/or hybrid procedures were performed in these patients. Results: Technical success rate was 100% for the entire group of patients. Type I endoleak occurred in 8 patients immediately after stent-graft placement, which in 2 cases disappeared after a proximal Cuff placement, and the other cases received no special treatment. Follow-up was conducted from 1 month to 72 months, with an average of 36.3 months, and no stent-graft migration or organ ischemia was noted. In the follow-up patients, no type I endoleak occurred but type II endoleak was found in 2 cases, which were cured without treatment; no patient had paraplegia. Conclusion: Endovascular surgery and hybrid procedures have demonstrable mid- and long-term efficacy in treatment of complex aortic diseases. However, this conclusion still requires multicenter, large-sample studies to further confirm.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares/métodos , Adulto , Idoso , Aneurisma Dissecante/fisiopatologia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Stents/efeitos adversos , Resultado do Tratamento
17.
Medicine (Baltimore) ; 98(20): e15453, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096441

RESUMO

Preoperative renal dysfunction is associated with mortality in patients who undergo coronary artery bypass graft and valve surgery. However, the role of preoperative renal dysfunction in type A aortic dissection (TAAD) remains unclear. This study aimed to evaluate the impact of preoperative renal dysfunction on the outcome of surgical intervention in patients with TAAD.We retrospectively studied the outcomes of 159 patients with TAAD who were treated at a tertiary referral hospital between 2005 and 2010. The demographics and surgical details of patients were analyzed according to their renal function. Risk factors for outcomes were analyzed using multivariable logistic regression. Thirty-two of the patients (20.1%) had preoperative serum creatinine of 1.5 mg/dL or more. The multivariable logistic regression model revealed independent risk factors of in-hospital mortality to be renal dysfunction (odds ratio [OR], 3.79; 95% confidence interval [CI], 1.64-8.77), preoperative shock (OR, 8.75; 95% CI, 2.83-27.02), and bypass time (OR, 1.008; 95% CI, 1.003-1.013). In addition, patients with renal dysfunction exhibited a lower 90-day survival rate than did patients without the condition (P of log-rank test = .005).Preoperative renal dysfunction may have a critical role in the surgical outcomes of patients with TAAD. Additional large-scale investigations are warranted.


Assuntos
Aneurisma Dissecante/cirurgia , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Rim/fisiopatologia , Adulto , Idoso , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/fisiopatologia , Ponte de Artéria Coronária/mortalidade , Creatinina/sangue , Feminino , Mortalidade Hospitalar , Humanos , Nefropatias/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
18.
Ann Vasc Surg ; 59: 300-305, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31075476

RESUMO

BACKGROUND: Data from the literature suggest that in patients with acute, complicated type B aortic dissection (cTBAD), initial successful treatment with thoracic endovascular aneurysm repair (TEVAR) is not necessarily associated with favorable remodeling of the dissected aorta during follow-up, and long-term results indicate that TEVAR failed to completely suppress false lumen patency. Sealing of all relevant distal reentries, infrarenal and/or iliac, seems to be the key issue to induce total false lumen thrombosis in abdominal aorta as well as the iliac arteries, especially in complicated patients presenting with malperfusion or complete true lumen collapse. MATERIALS AND METHODS: Of the 34 consecutive patients diagnosed with cTBAD at our hospital from January 2015 to April 2018, 30 had complicated dissections receiving endovascular treatment according to the standard Provisional ExTension To Induce COmplete ATtachment (PETTICOAT) technique and were excluded from this study, whereas 4 patients with radiologic evidence of multiple reentry tears at detached lumbar arteries and iliac bifurcation with complete true lumen collapse and clinical evidence of malperfusion were treated with a modified PETTICOAT technique with distal extension of the aortic stent, balloon expansion of the stented true lumen, and use of the AFX bifurcated endograft system to preserve the natural aortic bifurcation and provide complete distal sealing of reentry tears. RESULTS: Primary technical success was achieved in all patients. No postoperative deaths were observed, but 1 patient experienced an hemorrhagic shock on the second postoperative day. No patient suffered postoperative stroke, paraplegia, paraparesis, or acute renal failure. CONCLUSIONS: Using an abdominal aortic bifurcated endograft with PETTICOAT to treat acute cTBAD seems to be a feasible approach in high-risk patients to improve aortic remodeling. The AFX bifurcated endograft system meets the requirements of anatomical fixation and sealing of distal tears.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Remodelação Vascular , Doença Aguda , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/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 , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Medição de Risco , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
19.
Ann Vasc Surg ; 60: 415-423.e4, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075482

RESUMO

BACKGROUND: Conservative treatment is feasible in most patients with spontaneous isolated dissection of the superior mesenteric artery (SID-SMA). However, the role of antiplatelet agents and anticoagulants is not well defined in either symptomatic or asymptomatic SID-SMA. This study aimed to conduct a meta-analysis, including a single-arm study, comparing the resolution rate of conservative management with versus without antithrombotics for symptomatic and asymptomatic SID-SMA. METHODS: A systematic search of electronic databases, including PubMed, EMBASE, and Cochrane Library, on August 22nd, 2018, was performed to identify studies concerning SID-SMA. Meta-analyses were conducted to determine the primary resolution rate, long-term aneurysmal change for symptomatic SID-SMA, and any event for asymptomatic SID-SMA. We calculated pooled risk ratios and 95% confidence intervals (CIs) using random-effects model in studies with two arms and in studies with two arms or a single arm. RESULTS: We included data from 35 articles involving 727 patients with SID-SMA (symptomatic 693, asymptomatic 134). No significant differences were observed in the successful resolution rate between conservative management with and without antithrombotics (random-effects model, risk ratio [RR] 0.96; 95% CI, 0.87-1.05]). The pooled resolution rate from combining single-arm studies was 91% (95% CI, 85-95) and 95% (95% CI, 88-100) in conservative management with and without antithrombotic, respectively, which was not statistically significant (RR, 0.97; 95% CI, 0.91-1.02). The pooled morphologic progression rate from combining single-arm studies was 3% (95% CI, 0-8) and 11% (95% CI, 2-26) in conservative management with and without antithrombotics, respectively, which was not statistically significant (RR, 0.44; 95% CI, 0.12-1.64). The adverse event was 0% for both groups for asymptomatic SID-SMA. CONCLUSIONS: Additional antithrombotic therapy for both symptomatic and asymptomatic SID-SMA did not benefit the outcomes. We do not recommend the use of antithrombotics for SID-SMA, unless further evidence shows any beneficial effect.


Assuntos
Aneurisma Dissecante/tratamento farmacológico , Tratamento Conservador/métodos , Fibrinolíticos/uso terapêutico , Artéria Mesentérica Superior/efeitos dos fármacos , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Tratamento Conservador/efeitos adversos , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
Rev Gastroenterol Peru ; 39(1): 88-90, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31042244

RESUMO

Hypoxic hepatitis is an uncommon cause of hepatic damage characterized by a centrolobular necrosis. Its pathophysiology remains unclear. Aortic dissection is a rare but frequently catastrophic event. It is caused by an aortic intimal tear with propagation of a false channel in the media. Depending on the site and extension, it can cause hypoperfusion of any organ leading to cellular ischemia and necrosis. We are presenting a case of hypoxic hepatitis in a patient with an extensive aortic dissection who present to the emergency department.


Assuntos
Aneurisma Dissecante/complicações , Hepatite/etiologia , Isquemia/etiologia , Fígado/irrigação sanguínea , Dor Abdominal/etiologia , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/fisiopatologia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Dispneia/etiologia , Emergências , Evolução Fatal , Hepatite/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
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