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1.
BMC Infect Dis ; 20(1): 97, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005105

RESUMO

BACKGROUND: Salmonella species commonly causes infection in humans and on occasion leads to serious complications, such as mycotic aneurysms. Here, we present the first case reported of a patient with a mycotic aneurysm likely secondary to Salmonella Rissen infection. CASE PRESENTATION: The patient presented with 4 weeks of lower back pain, chills and a single episode of diarrhoea 2 months prior during a 14-day trip to Hong Kong and Taiwan. Magnetic resonance imaging revealed an aneurysmal left internal iliac artery with adjacent left iliacus rim-enhancing collection. A stool culture was positive for Salmonella Rissen ST 469 EBG 66 on whole genome sequencing. The patient underwent an emergency bifurcated graft of his internal iliac aneurysm and was successfully treated with appropriate antibiotics. CONCLUSIONS: This case highlights the importance of considering the diagnosis of a mycotic aneurysm in an unusual presentation of back pain with features of infection.


Assuntos
Aneurisma Infectado/cirurgia , Aneurisma Ilíaco/cirurgia , Infecções por Salmonella/cirurgia , Idoso , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/tratamento farmacológico , Antibacterianos/uso terapêutico , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/tratamento farmacológico , Aneurisma Ilíaco/microbiologia , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/microbiologia , Masculino , Salmonella/efeitos dos fármacos , Salmonella/isolamento & purificação , Salmonella/patogenicidade , Infecções por Salmonella/diagnóstico por imagem , Infecções por Salmonella/tratamento farmacológico
3.
Vasc Endovascular Surg ; 54(3): 292-296, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31896316

RESUMO

Common iliac artery (CIA) aneurysms present across a spectrum of anatomic variants that can pose unique operative challenges. A wide variety of procedural approaches have been described in the literature with current therapeutic options including both open and endovascular repair. These techniques may involve either ligation or embolization of the internal iliac artery (IIA) with reliance on collateralized blood flow to the pelvis to mitigate postoperative complications. However, preservation of the IIA is often preferred. This case report describes a hybrid surgical approach for treating CIA aneurysms while preserving IIA perfusion. Our technique mitigates the risks of hypogastric artery dissection (including hypogastric vein injury) in the presence of a large CIA aneurysm.


Assuntos
Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/cirurgia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Artéria Ilíaca/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
4.
Ann Vasc Surg ; 62: 499.e9-499.e14, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31536789

RESUMO

Ectopic renal artery (RA), a rare congenital anomaly, presents a challenge in open surgery and endovascular repair for abdominal aortic lesions. To preserve the abnormal main blood supply and renal function complicates the procedures requiring careful imaging measurement and well-designed therapeutic strategy. We report on a 68-year-old man with abdominal aortic atherosclerotic ulcers, bilateral common iliac artery aneurysms, and right ectopic RA stenosis that was successfully managed with antegrade chimney technique, resulting in well-excluded lesions and well-reconstructed renal blood supply without any complication. This endovascular procedure may be useful for repair of abdominal aortic lesions with ectopic RA in high-risk surgical patients.


Assuntos
Aorta Abdominal/cirurgia , Doenças da Aorta/cirurgia , Aterosclerose/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco/cirurgia , Obstrução da Artéria Renal/cirurgia , Artéria Renal/cirurgia , Úlcera/cirurgia , Malformações Vasculares/cirurgia , Idoso , Aorta Abdominal/diagnóstico por imagem , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Aterosclerose/complicações , Aterosclerose/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Humanos , Aneurisma Ilíaco/complicações , Aneurisma Ilíaco/diagnóstico por imagem , Masculino , Artéria Renal/anormalidades , Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico por imagem , Stents , Resultado do Tratamento , Úlcera/complicações , Úlcera/diagnóstico por imagem , Malformações Vasculares/complicações , Malformações Vasculares/diagnóstico por imagem
5.
Ann Vasc Surg ; 62: 35-44, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31201971

RESUMO

BACKGROUND: Iliac branch devices (IBDs) can treat iliac and aortoiliac aneurysms (AIAs) less invasively than open surgery (OS) and preserve pelvic perfusion. Our hypothesis was that the rates of perioperative complications after treatment for AIAs are similar between IBDs and hypogastric occlusion with coil and cover (C&C), and lower than OS. METHODS: We identified patients undergoing elective AIA repair by IBD, C&C, and OS (all with infrarenal clamps) within the National Surgical Quality Improvement Program (NSQIP) vascular aneurysm specific Participant User Files (2012-2016). Baseline characteristics, procedural variables, and 30-day outcomes were compared. The primary outcomes were any major complication or death. Secondary outcomes included minor complications, total operative time, total and intensive care unit length of stay (LOS), and reinterventions. Multivariable logistic regression assessed differences in major complications between IBD and C&C/OS after adjusting for patient and procedural variables. RESULTS: We identified 593 patients (83% men, mean age 71.6 ± 9 years) undergoing elective AIA repair (IBD = 283, C&C = 118, and OS = 192). Patient age and American Society of Anesthesiology (ASA) classification varied significantly between groups. Mean aneurysm diameter was higher for OS and similar between IBD and C&C (5.9 cm vs. 5.5 cm and 5.2 cm, respectively, P < 0.001). OS was associated with higher rate of major complications (65.5% vs. IBD: 8.8% and C&C: 13.6%, P=<0.001) and higher mortality (3.6% vs. IBD: 0.7% and C&C: 0%, P = 0.017). Minor complications and reinterventions were similar. IBD patients had significantly shorter total operative time and total and intensive care unit LOS. After adjustment, OS was associated with higher major complications compared with IBD (Odds ratio [OR]: 11.3, 95% confidence interval [CI]: 5.8-21.9, P < 0.001), primarily because of the use of transfusions (major complications excluding transfusions OR: 1.3, 95% CI: 0.6-2.8, P = 0.52). Major complications between IBD and C&C were similar (OR: 1.6, 95% CI: 0.8-3.4, P = 0.23). CONCLUSIONS: The use of IBDs for elective treatment of AIAs is associated with favorable perioperative outcomes and a lower rate of major complications compared with OS, primarily because of fewer transfusions. IBDs use has perioperative outcomes similar to C&C with the associated benefit of preserving pelvic perfusion. Pending long-term durability results for this technique, IBDs appear to be associated with several perioperative advantages in patients with AIAs compared with OS and C&C.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Aneurisma Ilíaco/cirurgia , Pelve/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Embolização Terapêutica/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/mortalidade , Aneurisma Ilíaco/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
6.
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
8.
Orv Hetil ; 160(37): 1471-1475, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31495189

RESUMO

The management of the abdominal aortic aneurysm is associated with several risk factors, especially in patients after renal transplantation. Endovascular aneurysm repair (EVAR) can be the proper treatment in feasible cases. The authors present a patient's case who underwent renal transplantation and developed an infrarenal aortic aneurysm some years later. A 50-year-old male patient was operated with EVAR. During the starting period of the procedure bilateral iliac dissection developed, and the endovascular approach was converted into traditional open operation. At the time when the aorta was clamped, an extraanatomic shunt was applied to ensure the blood supply of the transplanted organ. In the early postoperative period, a transient renal function impairment was observed. Later on, the renal function returned to normal values. In this article, alternative methods used to prevent ischaemic damage of the transplanted organ during the procedure are presented as well. Finally, the authors report the international trends and experiences in the field of preserving the viability of a transplanted organ during abdominal aneurysm repairs. Orv Hetil. 2019; 160(37): 1471-1475.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares/métodos , Aneurisma Ilíaco/cirurgia , Transplante de Rim , Humanos , Artéria Ilíaca/cirurgia , Transplante de Rim/efeitos adversos , Masculino , Resultado do Tratamento
9.
Vasc Endovascular Surg ; 53(7): 613-616, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31307324

RESUMO

PURPOSE: Endovascular aneurysm repair (EVAR) for an isolated common iliac artery aneurysm (iCIAA) sometimes requires a bifurcated stent graft (SG). In EVAR, it is essential to preserve the renal artery (RA). However, this is challenging in cases of anatomical variation. The double D technique (DDT) can be used in anatomically inadequate cases with a commercially approved bifurcated SG. Here, we report the repair of iCIAA in the presence of a challenging RA anatomy, through EVAR using the DDT. CASE REPORT: An 84-year-old woman was diagnosed with a maximal 35-mm diameter left iCIAA and a nonaneurysmal aorta by computed tomography (CT), which also showed that the right RA arose 50-mm above the aortic bifurcation. The DDT was chosen because commercially approved bifurcated SGs typically require a distance of >70 mm from the proximal position to the aortic bifurcation. Postoperative CT showed excellent results with no endoleaks or SG kinking and occlusion, as well as preservation of robust blood flow to the right RA. CONCLUSION: Endovascular aneurysm repair using the DDT can be an alternative option for treatment of iCIAA with a challenging RA anatomy.


Assuntos
Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Aneurisma Ilíaco/cirurgia , Artéria Renal/anormalidades , Stents , Idoso de 80 Anos ou mais , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/fisiopatologia , Desenho de Prótese , Artéria Renal/diagnóstico por imagem , Artéria Renal/fisiopatologia , Resultado do Tratamento
10.
Vasc Endovascular Surg ; 53(7): 617-622, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31339471

RESUMO

OBJECTIVE: Spontaneous multiple artery dissection is a relatively rare phenomenon. Early clinical signs are often nonspecific, making it difficult to diagnose. CASE REPORT: This is a case of a 51-year-old female who presented with spontaneous dissection of 4 visceral arteries, both iliac arteries, and of the right internal carotid artery. The patient underwent urgent successful endovascular repair. Later complications included acute respiratory distress syndrome and pneumonia after massive blood transfusion. She recovered gradually and was discharged after 21 days. Due to this rare presentation, genetic investigation was performed in search of a connective tissue disorder. Results revealed a new COL3A1 subtype mutation. The pathogenicity of this variant remains unclear. CONCLUSION: We recommend a high index of suspicion for visceral artery dissection in the differential diagnosis for abdominal pain with concurrent uncontrolled hypertension. Early diagnosis and intervention are crucial to reducing the mortality rate.


Assuntos
Aneurisma Dissecante , Artéria Carótida Interna , Aneurisma Ilíaco , Vísceras/irrigação sanguínea , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/genética , Aneurisma Dissecante/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Colágeno Tipo III/genética , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Feminino , Predisposição Genética para Doença , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/genética , Aneurisma Ilíaco/cirurgia , Pessoa de Meia-Idade , Mutação , Fenótipo , Fatores de Risco , Resultado do Tratamento
11.
Ann Vasc Surg ; 60: 76-84.e1, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31220590

RESUMO

BACKGROUND: Treatment of common and internal iliac aneurysms is usually done by open surgery. A novel iliac branch endoprosthesis (IBE) is commercially available with encouraging initial results. Our objective is to compare perioperative outcomes of patients with iliac aneurysms treated by open surgery (OS) versus endovascular repair with IBE. METHODS: The study was a retrospective, single-center review of patients who were treated for aortoiliac or isolated common and/or internal iliac artery aneurysms from 2014 to 2017. Patients with connective tissue disorders, infected grafts, or thoracoabdominal aneurysms were excluded. Primary outcomes were perioperative mortality, length of hospital (LOS) and intensive care unit (ICU) stay, estimated blood loss, need for red blood cell transfusion (RBC), and perioperative reinterventions. RESULTS: Sixty-seven patients (96% male) were treated with OS (n = 25, mean age 68 ± 8 years) or IBE (n = 42, mean age 73 ± 8 years; P = 0.02) with 1 symptomatic patient in each group. Perioperative mortality occurred in 1 patient in the OS group (4%), with no mortality in the IBE group (P = 0.37) Total LOS and ICU stay was higher for OS compared to IBE (total stay 7.5 ± 3.4 vs. 1.7 ± 1.4 days for IBE, P < 0.0001 and ICU LOS 3.3 ± 2.1 vs. 0.1 ± 0.4 days, P < 0.0001). Estimated blood loss was higher for patients undergoing OS (4,732 ± 2,540 mL) compared to patients treated with IBE (263 ± 451 mL, P < 0.0001), resulting in higher RBC transfusion requirements (1.5 ± 2.4 vs. 0.2 ± 0.8 units, P = 0.001). Five patients in the OS group had early procedure-related reinterventions, while 2 patients in the IBE group required reintervention for access site complications (20% vs. 4.7%, P = 0.09). CONCLUSIONS: Endovascular repair of iliac aneurysms with IBE is feasible and is associated with lower blood loss, LOS and ICU stay, and had lower RBC transfusion requirements. Cost analysis and long-term follow-up will be needed to define the value of this modality for iliac artery aneurysm repair.


Assuntos
Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Aneurisma Ilíaco/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
Ann Vasc Surg ; 60: 476.e1-476.e6, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075450

RESUMO

We report the use of manufacturer-customized fenestrated iliac stent grafts to treat common iliac artery aneurysms (CIAAs) in patients with challenging iliac anatomy, unsuitable for iliac branched devices (IBDs). A 71-year-old woman presented with bilateral CIAAs measuring 44 mm and 29 mm and a perivisceral abdominal aortic aneurysm (AAA). The second patient, a 72-year-old male, had a 42-mm CIAA and an AAA, which expanded to 50 mm during the short-term follow-up. The contralateral internal iliac was occluded. Both patients were deemed high risk for open repair, and endovascular repair was recommended. The aneurysm anatomies were unsuitable for isolated CIAA repair. Suitable sealing zones for endovascular repair were the visceral segment proximally and the external iliac arteries. Preservation of both internal iliac arteries (IIAs) was important to reduce the risk of spinal cord ischemia, but due to distal CIA narrowing, neither patient had sufficient "space" for the branches used in conventional IBD deployment. Three fenestrated Vascutek Anaconda™ iliac limbs were successfully deployed. All three IIAs were preserved with no endoleak, and the patients were discharged after an uneventful postprocedural course. To our knowledge, this is the first successful report of iliac aneurysm repair with manufacturer-customized fenestrated iliac limbs.


Assuntos
Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Aneurisma Ilíaco/cirurgia , Stents , Idoso , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/fisiopatologia , Masculino , Desenho de Prótese , Resultado do Tratamento
14.
BMJ Case Rep ; 12(5)2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31088810

RESUMO

Vascular intrapelvic complications due to total hip arthroplasty failure are uncommon, with less than 30 cases reported in the literature. Herein, we report a case of unusual asymptomatic delayed vascular complication after 10 years from right total hip arthroplasty. A man in mid-50s, with multiple comorbidities including end-stage renal disease. The patient was admitted for the renal transplant surgery. Intraoperatively, right external iliac artery pseudoaneurysm was discovered, which required the transplantation to be done on the left side. After recovery from the renal transplant surgery, the patient underwent resection of the right external iliac artery pseudoaneurysm with primary anastomosis by vascular surgery, with resection of the migrated screw by orthopaedic surgery.


Assuntos
Falso Aneurisma/etiologia , Artroplastia de Quadril/efeitos adversos , Parafusos Ósseos/efeitos adversos , Aneurisma Ilíaco/etiologia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia
15.
J Cardiovasc Med (Hagerstown) ; 20(8): 557-563, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30950984

RESUMO

AIM: To report our experience about hypogastric artery coverage during endovascular aneurysm repair (EVAR) for aortoiliac aneurysms in patients younger than 80 years (group A) compared with octogenarian patients (group B). METHODS: Data of consecutive EVAR with hypogastric artery coverage from 01/1998 to 12/2016 were retrospectively analyzed. Primary outcomes were the occurrence of ischemic colitis, type II endoleak and buttock claudication both at 30 days and in the long term. P values less than 0.05 were considered statistically significant. RESULTS: The hypogastric artery was covered in 107 patients. Twenty-three (21.5%) were octogenarian (group B). At 30 days, one type II endoleak occurred in group B, whereas 16 patients of group A experienced buttock claudication. There were no cases of ischemic colitis. During follow-up (median 63.5 months), no cases of ischemic colitis occurred. Six new type II endoleaks were recorded (five in group B and one in group A, P = 0.0001). Buttock claudication persisted in four patients of group A. No new cases of buttock claudication were observed. CONCLUSION: Unilateral hypogastric artery coverage during EVAR for aortoiliac aneurysms can be performed with an acceptable rate of postoperative complication. Postoperative buttock claudication was more frequent in younger patients, whereas a type II endoleak occurred mostly in octogenarian patients during follow-up.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco/cirurgia , Pelve/irrigação sanguínea , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Circulação Colateral , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/fisiopatologia , Claudicação Intermitente/etiologia , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
J Cardiovasc Surg (Torino) ; 60(4): 485-489, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30947488

RESUMO

The "new" and updated European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysm, published in the 2019 January issue of the European Journal of Vascular and Endovascular Surgery, is an extensive document offering 125 recommendations of clinical importance on the management of AAA, accompanied by a comprehensive supporting text that summarizes the literature and motivates the positions made. Several new topics, not addressed in the previous guidelines, are included. Here we summarize the most important news in the new ESVS 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysm.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma Ilíaco/cirurgia , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Vasculares/normas , Aorta Abdominal/cirurgia , Humanos , Artéria Ilíaca/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos
19.
Orphanet J Rare Dis ; 14(1): 81, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987653

RESUMO

BACKGROUND: This study was conducted to evaluate our local experiences of adjunctive mechanical prosthetic wrapping for aortoiliac vascular anastomoses as a prophylactic measure following surgical repair of Behçet's aortoiliac aneurysms. The goal of prosthetic wrapping to reinforce the vascular anastomoses by mechanical protection to reduce the bleeding complications, and consequently pseudoaneurysm formation. This was aided by the administration of pre- and postoperative immunosuppressive therapy as an adjuvant treatment. METHODS: A seven-year retrospective study was conducted between January 2006 and December 2012, retrieving data of patients with Behçet's aortoiliac aneurysms. All patients underwent open surgical repair using a heparin-bonded synthetic Dacron® graft. Data for all patients were retrieved and analyzed for diagnostic procedures, graft selection, as well as, different methods of surgical repair. Graft-related complications such as anastomotic pseudoaneurysms, occlusion, and thrombosis were also reported. RESULTS: Sixteen patients were recruited in this study. There were  11 (69%) males and 5 (31%) females with the male to female ratio 2:1. The patients' age ranged between 25 and 47 years with the mean of 36.4 ± 7.3. All Behçet's aortic/aortoiliac aneurysms were repaired by the application of heparin-bonded Dacron® tube and bifurcated grafts. The anastomotic wrapping technique was performed for both the proximal and the distal vascular anastomoses. The technical success of aortoiliac aneurysm and wrapping techniques was achieved in 100% of patients. All patients were given pre- and postoperative systemic immunosuppressive therapy. No graft-related complications were reported except for only one anastomotic pseudoaneurysm that developed at one of the right iliac anastomoses, that developed within 24 months after follow up. CONCLUSIONS: Mechanical prosthetic wrapping for vascular anastomoses in patients with Behçet's aortic/aortoiliac aneurysms is a feasible, simple, and reliable technique with low morbidity and mortality. It was performed as a prophylactic measure to avoid the development of postoperative anastomotic pseudoaneurysms. It must be performed for all patients with Behçet's arterial aneurysms whenever possible. Furthermore, the supplemental administration of pre- and postoperative systemic immunosuppressive therapy should be considered as an important factor for the prophylaxis and prevention of anastomotic pseudoaneurysms and other graft-related complications.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/cirurgia , Adulto , Anastomose Cirúrgica , Falso Aneurisma/cirurgia , Anastomose Arteriovenosa/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
Heart Surg Forum ; 22(2): E088-E091, 2019 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-31013215

RESUMO

OBJECTIVES: Isolated iliac artery aneurysms (IAAs) are rare, but nonetheless life-threatening when ruptured. The endovascular approach has taken over open repairs in time. The reported data is constituted of a retrospective series. We reviewed our 10-year-long experience with elective endovascular treatment of iliac aneurysms. METHODS: Data regarding 22 patients with 24 IAAs treated with endovascular stent grafting between 2005 and 2015 were reviewed. RESULTS: Twenty-two patients (aged 68.4 ± 9.6 years, range 50-82) with 24 unilateral or bilateral iliac aneurysms were treated. Twenty patients (91%) were male. Two patients with unilateral IAA had prior abdominal aortic aneurysm (AAA) surgical repair. The mean aneurysm diameter was 4.8 ± 2.1 (3.8 to 7.1) mm. Procedural success rate was 100%, only one patient with an iliovenous fistula had periprocedural type II endoleak. Internal iliac artery coil occlusion was applied in 16 of 24 procedures (66%). Thirty-day mortality included one patient (4%). CONCLUSION: Endovascular repair is the preferred approach for isolated IAAs. Because of the retrospective nature of data sets, larger cohorts are necessary for better definition of morbidity and mortality rates.


Assuntos
Implante de Prótese Vascular/métodos , Prótese Vascular , Procedimentos Endovasculares/métodos , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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