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1.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(1): 37-41, 2021 Feb 28.
Artigo em Chinês | MEDLINE | ID: mdl-33663660

RESUMO

Objective To explore the outcomes in patients who receive the endovascular abdominal aortic aneurysm repair(EVAR)and have concomitant intra-abdominal malignancy.Methods Between January 2014 and December 2019,all the patients who underwent surgery for malignancy and/or EVAR were retrospectively reviewed.Results Twenty-eight abdominal aortic aneurysm(AAA)patients with concomitant intra-abdominal malignancy were included.The patients were treated by two-stage operation and the priority was given for EVAR in 21 patients.There was no perioperative death or major complications.In the follow-up,one patient developed graft thrombosis and one had type Ⅱ endoleak.There was no AAA-associated death.Conclusions It is preferred that EVAR should come first followed by operation for malignancy.Details of treatment strategy still need further investigation.


Assuntos
Neoplasias Abdominais , Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Neoplasias Abdominais/complicações , Neoplasias Abdominais/cirurgia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Humanos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
2.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542000

RESUMO

Infected aortic aneurysm is a rare disease and is often overlooked as a source of infection in septic elderly patients. We present a case of a septic elderly man with a ruptured infected aortic aneurysm caused by Salmonella enteritidis This condition was treated non-surgically with percutaneous endovascular aneurysm repair and antibiotics. The postoperative recovery was complicated a month later by spondylodiscitis and psoas abscess. He underwent radiologically guided drainage of the psoas abscess and was placed on lifelong suppressive antibiotics. We discuss the aetiology, treatment options and complications of this condition.


Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal , Discite/etiologia , Procedimentos Endovasculares , Salmonella enteritidis/isolamento & purificação , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Dor nas Costas/etiologia , Ceftriaxona/uso terapêutico , Drenagem/efeitos adversos , Humanos , Masculino , Abscesso do Psoas/etiologia , Sepse , Tomografia Computadorizada por Raios X
3.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542018

RESUMO

We report a case of chronic Q fever presenting with catastrophic bleeding from an infected abdominal aortic aneurysm causing a primary aortoduodenal fistula in an 80-year-old retired farmer. This presentation is rarely reported in literature and only through case reports. Early diagnosis and definitive surgery were critical to a successful outcome. Serological diagnosis of Q fever was initiated on the patient's past exposure to animal reservoirs. Complicating the case was ongoing gastrointestinal bleeding postsurgery, with multiple endoscopies undertaken before a culprit remnant fistula was found. This case highlights the value in considering Coxiella burnetii as an underlying cause in patients with known risk factors presenting with primary aortoduodenal fistulas. Though rare, it represents a readily treatable cause.


Assuntos
Aneurisma da Aorta Abdominal/complicações , Hemorragia Gastrointestinal/etiologia , Fístula Intestinal/cirurgia , Febre Q/diagnóstico , Fístula Vascular/cirurgia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antimaláricos/uso terapêutico , Coxiella burnetii/isolamento & purificação , Doxiciclina/uso terapêutico , Duodenopatias/cirurgia , Humanos , Hidroxicloroquina/uso terapêutico , Masculino , Febre Q/tratamento farmacológico , Tomografia Computadorizada por Raios X
4.
J Psychosom Res ; 142: 110367, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33503514

RESUMO

PURPOSE: Preoperative psychological factors have an impact on postoperative outcomes and there is a paucity of research in vascular surgery. The objective of this study was to examine the impact of preoperative psychological factors on short-term postoperative outcomes in an infrarenal endovascular aneurysm repair (EVAR) cohort. METHODS: A prospective, multi-centre observational study was conducted across three vascular units in England. English-speaking participants who were older than 18 years, able to provide informed consent and awaiting an elective standard infrarenal EVAR were eligible for the study. A total of 46 patients undergoing elective infrarenal AAA repair were assessed preoperatively with the State Trait Anxiety Inventory (STAI), Beck's Depression Inventory (BDI-II) and Life Orientation Test-Revised (LOT-R). Data on five short-term postoperative outcomes was collected and analysed using Spearman's rank correlations. RESULTS: Higher preoperative anxiety levels (ρ = 0.38, p = 0.01), and depression scores (ρ = 0.36, p = 0.02) were moderately correlated with an increased length of postoperative critical care stay. Higher levels of preoperative depression were moderately correlated with greater postoperative opioid analgesia use (ρ = 0.34, p = 0.02). No correlation was witnessed between optimism scores and postoperative outcomes. No correlation was witnessed with respect to total length of stay, number of complications, or time to mobilisation. CONCLUSIONS: There is a potential link between preoperative psychological well-being and short-term postoperative outcomes in an EVAR cohort. Further work is necessary to validate this link and examine the role of preoperative interventions in optimising the psychological well-being of patients undergoing EVAR.


Assuntos
Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Complicações Pós-Operatórias/etiologia , Angústia Psicológica , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
5.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495175

RESUMO

Horseshoe kidney, representing abnormal fusion of the inferior renal poles, is a rare anatomic anomaly posing challenges in the setting of surgical abdominal aortic aneurysm repair. Historically, open repair has been the favoured surgical approach. However, due to the location of the renal isthmus and wide-ranging variation in anomalous renal vasculature, endovascular aneurysm repair (EVAR) has emerged as a popular, less invasive alternative. We describe one of the first published cases of two-fenestration EVAR in a patient with concomitant horseshoe kidney, followed by a discussion of current trends in surgical management. With the increasing availability to customise fenestrated grafts to patients' unique anatomy, this advanced EVAR technique may emerge as the preferred approach in certain cases.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Prótese Vascular , Procedimentos Endovasculares/métodos , Rim Fundido/complicações , Desenho de Prótese , Artéria Renal/diagnóstico por imagem , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Rim Fundido/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Masculino
7.
Angiol. (Barcelona) ; 72(5): 273-276, sept.-oct. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-195498

RESUMO

El tratamiento endovascular del aneurisma de aorta abdominal (AAA) puede tener complicaciones durante su seguimiento; entre ellas, las endofugas. Presentamos el caso de un paciente de 55 años que fue tratado de manera programada con endoprótesis aórtica bifurcada por un AAA infrarrenal de 84 mm de diámetro. El paciente presentó una reducción progresiva del saco aneurismático hasta un diámetro de 42 mm tras treinta meses de seguimiento. Después de cuatro años de seguimiento y sin signos sugestivos de complicaciones en la ecografía de control, se encuentra un leve crecimiento del saco (46 mm), sin evidencia de endofugas. Ante el hallazgo, se solicita TAC en la que se evidencia crecimiento del saco de hasta 55 mm de diámetro, sin presencia de fugas. En un nuevo estudio a los 3 meses, el saco ha sufrido una rápida expansión, hasta 73 mm de diámetro, sin evidencia de fugas. Ante los hallazgos y el riesgo de rotura, se planifica reparación abierta por endofuga tipo V. Se encuentra una fístula apendicular comunicada con un saco aneurismático de aspecto inflamatorio en la zona de contacto aórtico-apendicular. El paciente evolucionó favorablemente con antibioticoterapia prolongada. A los siete meses no ha presentado complicaciones clínicas ni en las pruebas de imagen


Endovascular aneurysm repair (EVAR) is an important treatment option for abdominal aortic aneurysms. An endoleak is a common complication following EVAR. A 55-year-old man underwent elective EVAR with a bifurcated graft for a 84 mm infrarenal abdominal aortic aneurysm (AAA). Follow-up a showed appropriate reduction of the AAA to 42 mm. A duplex ultrasound at fourth year follow up showed an increase of AAA sac size to 46 mm with no observable endoleaks. A subsequent CTA showed an increase of AAA sac size to 55 mm with no observable endoleaks. A new CTA at 3 months follow up showed a rapid increase of AAA sac size to 73 mm with no observable endoleaks. We decided to perform open surgery. We found appendicular fistula in contact with aneurysmal sac with an inflammatory appearance in the aortic-appendicular contact area. The patient was successfully treated and no severe complications occurred during the 7 months follow-up


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Endovasculares/efeitos adversos , Aneurisma da Aorta Abdominal/cirurgia , Endoleak/etiologia , Apendicite/etiologia , Aneurisma da Aorta Abdominal/complicações , Resultado do Tratamento , Tomografia Computadorizada por Raios X
8.
Rev Med Suisse ; 16(708): 1827-1829, 2020 Sep 30.
Artigo em Francês | MEDLINE | ID: mdl-32997455

RESUMO

Abdominal aneurysm is a common pathology that affects mainly men and for which there are many risk factors. This pathology predominantly stays asymptomatic until rupture and symptoms depend on location. We report the case of a 71-year-old patient. She is presenting herself to the emergency room for a nagging pain, typical of a left cruralgia as she is both febrile and shivering. The abdominal scanner is showing a ruptured infra renal aortic aneurysm. The patient is transferred to universities for an uncomplicated stent. Despite a cruralgia that seemed quite banal, both clinical and anamnestic arguments suggested an abdominal aortic rupture.


Assuntos
Aneurisma da Aorta Abdominal/complicações , Ruptura Aórtica/complicações , Ciática/complicações , Idoso , Feminino , Humanos , Fatores de Risco
9.
Eur J Vasc Endovasc Surg ; 60(5): 739-746, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32778487

RESUMO

OBJECTIVE: Abdominal aortic aneurysm (AAA) is associated with morphological and functional changes in both aneurysmal and non-aneurysmal arteries. However, it remains uncertain whether similar changes also exist in the venous vasculature. The aim of this study was to evaluate global venous function in patients with AAA and controls. METHODS: This experimental study comprised 31 men with AAA (mean ± standard deviation age 70.0 ± 2.8 years) and 29 male controls (aged 70.6 ± 3.4 years). Venous occlusion plethysmography (VOP) was used to evaluate arm venous compliance at venous pressures between 10 and 60 mmHg in steps of 5 mmHg. Compensatory mobilisation of venous capacitance blood (capacitance response) was measured with a volumetric technique during experimental hypovolaemia induced by lower body negative pressure (LBNP). RESULTS: The VOP induced pressure-volume curve was significantly less steep in patients with AAA (interaction, p < .001), indicating lower venous compliance. Accordingly, the corresponding pressure-compliance curves displayed reduced venous compliance at lower venous pressures in patients with AAA vs. controls (interaction, p < .001; AAA vs. control, p = .018). After adjusting for arterial hypertension, diabetes mellitus, hyperlipidaemia, chronic obstructive pulmonary disease, and smoking, VOP detected differences in venous compliance remained significant at low venous pressures, that is, at 10 mmHg (p = .008), 15 mmHg (p = .013), and 20 mmHg (p = .026). Mean venous compliance was negatively correlated with aortic diameter (r = -.332, p = .010). Mobilisation of venous capacitance response during LBNP was reduced by approximately 25% in patients with AAA (p = .030), and the redistribution of venous blood during LBNP was negatively correlated with aortic diameter (r = -.417, p = .007). CONCLUSION: Men with AAA demonstrated reduced venous compliance and, as a result, a lesser capacity to mobilise peripheral venous blood to the central circulation during hypovolaemic stress. These findings imply that the AAA disease may be accompanied by functional changes in the venous vascular wall.


Assuntos
Aneurisma da Aorta Abdominal/complicações , Hipovolemia/fisiopatologia , Veias/fisiopatologia , Idoso , Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/fisiopatologia , Braço/irrigação sanguínea , Estudos de Casos e Controles , Complacência (Medida de Distensibilidade) , Feminino , Humanos , Masculino , Pletismografia , Ultrassonografia , Pressão Venosa/fisiologia
10.
Eur J Vasc Endovasc Surg ; 60(4): 539-547, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32741677

RESUMO

OBJECTIVE: The rupture of abdominal aortic aneurysms (AAAs) is associated with high mortality despite surgical developments. The determination of aneurysm diameter allows for follow up of aneurysm growth but fails in precisely predicting aneurysm rupture. In this study, time resolved three dimensional ultrasound (4D ultrasound) based wall motion indices (WMIs) are investigated to see if they are capable of distinguishing between uneven affected regions of the aneurysm wall. METHODS: In a prospective study, 56 patients with an AAA were examined using 4D ultrasound. Local longitudinal, circumferential, and shear strains were computed using custom methods. The deformation of the neck and sac of each aneurysm was characterised by statistical indices of the obtained distributions of local wall strains (WMIs): mean and peak strain, heterogeneity index, and local strain ratio. The locations of regions with highest local peak strain were determined. RESULTS: Compared with the aneurysm neck, the sac is characterised by low mean strain, but highly heterogeneous deformation, described by high local strain ratio and heterogeneity index. Differences were highly significant (p < .001) for all strain components. The regions with the highest circumferential peak strain were found more often in the posterior part of the aneurysm neck (p < .050) and sac (p < .001) regions, compared with other wall regions. No statistically significant correlation was found between the WMIs and maximum AAA diameter, except for longitudinal mean strain, which decreased with the increasing diameter (rho = -.42, p < .010). CONCLUSION: Characterisation of wall kinematics by 4D ultrasound based WMIs provides a new and independent criterion for the distinction of diseased tissue in the AAA sac and the less affected neck region. This is a promising step towards the establishment of new biomarkers to differentiate between the mechanical instability of the AAA and rupture risk.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Ultrassonografia , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/fisiopatologia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/etiologia , Ruptura Aórtica/fisiopatologia , Fenômenos Biomecânicos , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Estresse Mecânico
11.
Ann Vasc Surg ; 69: 454.e7-454.e11, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32768550

RESUMO

Small-sized vessels can represent a contraindication to standard endovascular aortic repair (EVAR), and more specifically, aortoiliac deformities resulting from poliomyelitis may add an adjunctive challenge for total endovascular repair. Herein we report a case of a 62-year-old man with a 55 mm abdominal aortic aneurysm (AAA) and a history of poliomyelitis. More specifically, a computed tomography angiogram (CTA) showed a very narrow infrarenal aortic neck, measuring 13 mm in maximum diameter, and severely atrophic external iliac and common femoral arteries. A total endovascular repair was planned and realized with a single aortic JOTEC iliac branch and contralateral VBX placement. All prosthetic materials were delivered from the nonatrophic side. At the 1-year CTA, the aneurysm was successfully excluded and both iliofemoral axes were patent.


Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Artéria Ilíaca/cirurgia , Poliomielite/complicações , Stents , Idoso , Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Atrofia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/patologia , Masculino , Poliomielite/diagnóstico , Poliomielite/virologia , Resultado do Tratamento
13.
Ned Tijdschr Geneeskd ; 1642020 05 04.
Artigo em Holandês | MEDLINE | ID: mdl-32395969

RESUMO

Aneurysm of the abdominal aorta is common and can be treated with endovascular repair, open surgical repair or conservative treatment. Risk-stratification and treatment decision-making can be complex in frail patients and depends largely on anatomy, life-expectancy and functional capacity. Currently, risk-stratification in the Netherlands is primarily based on comorbidities and age. Insight in a patient's resilience could provide important additional information. For this reason, St. Antonius hospital has implemented an Anaesthesia Geriatric Evaluation (AGE) to screen for frailty in high risk vascular surgery patients. Results of frailty-screening are discussed in a multi-disciplinary team (MDT) to assess perioperative risk and compose a personal treatment plan. This paper presents a case-series of three patients to illustrate the additional value of MDT care and frailty-screening in a high-risk vascular surgery population.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Fragilidade/diagnóstico , Avaliação Geriátrica , Idoso , Aneurisma da Aorta Abdominal/complicações , Fragilidade/complicações , Humanos , Equipe de Assistência ao Paciente , Cuidados Pré-Operatórios , Medição de Risco , Fatores de Risco , Procedimentos Cirúrgicos Vasculares
15.
Ann Vasc Surg ; 66: 8-10, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32360432

RESUMO

BACKGROUND: COVID-19 infection has been reported to be related with an increased risk of thrombotic complications because of the hypercoagulability state and inflammation. At the moment, no reports are available regarding thrombosis of prosthetic vascular grafts. We present the case of a patient with COVID-19-related pneumonia, who suffered from the acute thrombosis of a previously implanted aortic graft. METHODS AND RESULTS: A 67-year-old male patient, who had undergone open repair of an abdominal aortic aneurysm with a bifurcated graft 6 years before, was admitted to the emergency department with high fever for a week without cough or dyspnea. Thoracic ultrasound showed signs of bilateral interstitial pneumonia, and the Sars-Cov-2 swab was positive. Antiretroviral therapy and prophylactic low molecular weight heparin treatment were initiated. Owing to the progressive impairment of the respiratory function, the patient was intubated after eight days from the admission, the day after he showed signs of bilateral acute limb ischemia. A duplex ultrasound demonstrated the complete thrombosis of the aortic graft without flow at the femoral level. An urgent angio-computed tomography scan for revascularization purpose was requested, but the patient died on the arrival in the radiological suite. CONCLUSIONS: Acute thrombosis of vascular prosthetic grafts is a possible, catastrophic complication of COVID-19 infection. In COVID-19 patients with prosthetic graft, an aggressive antithrombotic treatment could be considered to prevent such an event.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Betacoronavirus , Prótese Vascular/efeitos adversos , Infecções por Coronavirus/complicações , Oclusão de Enxerto Vascular/etiologia , Pneumonia Viral/etiologia , Idoso , Aneurisma da Aorta Abdominal/complicações , Implante de Prótese Vascular/efeitos adversos , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações
16.
Vasc Endovascular Surg ; 54(6): 544-548, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32458751

RESUMO

The prevalence of concomitant abdominal aortic aneurysm (AAA) and severe aortic stenosis (AS) has been increasing in the elderly population. Both conditions have adverse outcomes, if not adequately managed. No clear recommendations are available in the literature until today, in regards of the management sequence making thus the decision-making challenging. We report 2 cases of AAA and significant AS treated with endovascular aortic repair (EVAR) and transcatheter aortic valve implantation (TAVI) during the same procedure and a review of the literature on this topic. Based on our experience, the combined procedure with TAVI followed by EVAR seems to be feasible, safe, and effective while detailed preoperative planning and a carefully tailored management strategy by a multidisciplinary team are essential.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Estenose da Valva Aórtica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Humanos , Masculino , Índice de Gravidade de Doença , Resultado do Tratamento
17.
Eur J Vasc Endovasc Surg ; 60(1): 36-42, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32253164

RESUMO

OBJECTIVE: Numerous studies have shown a paradoxical protective effect of diabetes on the development and progression of abdominal aortic aneurysm (AAA). The aim of this study was to investigate whether the protective role of diabetes on AAA extends to rupture, given the presence of an AAA. METHODS: This was a register based case control study. Patients with ruptured AAA (RAAA) were matched 1:1 with patients undergoing elective surgery for AAA by sex, age, and year of diagnosis. Multiple conditional logistic regression was performed to estimate the odds ratio (OR) associating a diagnosis of diabetes with RAAA. No protocol was registered. RESULTS: From 1996 to 2016, there were 6293 potential people with RAAA. A total of 898 people with a RAAA were excluded since no matching controls existed. This left 5 395 cases in the study. The cases had a median age of 75, and 85.4% were men. Diabetes was defined by hospital diagnosis or the redemption of antidiabetic prescriptions within one year. Comparing cases with controls and the presence of diabetes, a significant crude OR of 0.82 (95% confidence interval [CI] 0.71-0.95) was found. When adjusting for confounders OR increased to 0.97 (CI 0.83-1.14). Stratifying by age and year of diagnosis did not change the results markedly. OR associating RAAA with diabetes was significantly elevated in women (adjusted OR 1.82 [CI 1.17-2.81]). Of the 5395 cases, the overall 30 days mortality was 58% (n = 3145). Using Cox regression, a crude hazard ratio (HR) of 1.06 (CI 0.93-1.22) was found for the 30 day mortality and having diabetes compared with not having diabetes. Adjusting for index year, male sex, and age had little effect on this estimate (HR 1.11 [CI 0.97-1.28]). CONCLUSION: Diabetes was not found to protect against RAAA, given the presence of an AAA. Furthermore, diabetes did not increase the risk of dying within 30 days of RAAA.


Assuntos
Aneurisma da Aorta Abdominal/complicações , Ruptura Aórtica/etiologia , Angiopatias Diabéticas/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Ruptura Aórtica/epidemiologia , Estudos de Casos e Controles , Dinamarca/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Fatores de Risco
18.
Eur J Vasc Endovasc Surg ; 60(3): 365-373, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32253165

RESUMO

OBJECTIVE: To test whether aneurysm biomechanical ratio (ABR; a dimensionless ratio of wall stress and wall strength) can predict aneurysm related events. METHODS: In a prospective multicentre clinical study of 295 patients with an abdominal aortic aneurysm (AAA; diameter ≥ 40 mm), three dimensional reconstruction and computational biomechanical analyses were used to compute ABR at baseline. Participants were followed for at least two years and the primary end point was the composite of aneurysm rupture or repair. RESULTS: The majority were male (87%), current or former smokers (86%), most (72%) had hypertension (mean ± standard deviation [SD] systolic blood pressure 140 ± 22 mmHg), and mean ± SD baseline diameter was 49.0 ± 6.9 mm. Mean ± SD ABR was 0.49 ± 0.27. Participants were followed up for a mean ± SD of 848 ± 379 days and rupture (n = 13) or repair (n = 102) occurred in 115 (39%) cases. The number of repairs increased across tertiles of ABR: low (n = 24), medium (n = 34), and high ABR (n = 44) (p = .010). Rupture or repair occurred more frequently in those with higher ABR (log rank p = .009) and ABR was independently predictive of this outcome after adjusting for diameter and other clinical risk factors, including sex and smoking (hazard ratio 1.41; 95% confidence interval 1.09-1.83 [p = .010]). CONCLUSION: It has been shown that biomechanical ABR is a strong independent predictor of AAA rupture or repair in a model incorporating known risk factors, including diameter. Determining ABR at baseline could help guide the management of patients with AAA.


Assuntos
Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/fisiopatologia , Ruptura Aórtica/etiologia , Hemodinâmica , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/fisiopatologia , Ruptura Aórtica/cirurgia , Aortografia , Fenômenos Biomecânicos , Angiografia por Tomografia Computadorizada , Progressão da Doença , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Estresse Mecânico , Fatores de Tempo , Procedimentos Cirúrgicos Vasculares
19.
Clin Nucl Med ; 45(6): e288-e289, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32332315

RESUMO

We present a case of inflammatory abdominal arterial aneurysms, which demonstrates the potential usefulness of PET/CT with F-FDG in long-term monitoring of this disease, but also demonstrates potential pitfalls in abdominal arterial aneurysm imaging with PET/CT. Imaging may be challenged as the initial presentation prior to therapy may mimic an infected aneurysm. Follow-up images may be mistaken for vascular graft infection or persistent disease.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Aneurisma da Aorta Abdominal/complicações , Diagnóstico Diferencial , Feminino , Fluordesoxiglucose F18 , Humanos , Inflamação/complicações , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
20.
Vascular ; 28(5): 557-567, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32338154

RESUMO

BACKGROUND: Elective abdominal aortic aneurysm (AAA) repair is advocated in patients where risk of rupture exceeds the risks of peri-procedural morbidity and mortality. Chronic obstructive pulmonary disease (COPD) is a known risk factor for AAA and increased operative morbidity in general. Since literature on the correlation between the clinical classification of COPD and morbidity following endovascular infrarenal AAA repair (EVAR) is scarce, assessment per individual remains a challenge. OBJECTIVE: To analyse the pulmonary and all-cause morbidity and mortality in patients with documented COPD and relate this to their GOLD classification. METHODS: Sixty-eight patients with COPD, documented by a lung function test, who underwent elective EVAR between July 2002 and July 2018 were retrospectively reviewed. The primary endpoint was the incidence of 30-day pulmonary adverse events. Procedural characteristics, length of hospital stay, pulmonary and all-cause morbidity including major adverse events (MAEs) during follow-up and five-year survival divided per GOLD classification were the secondary endpoints. RESULTS: There was no statistically significant difference in the incidence of pulmonary adverse events between GOLD I/II and GOLD III/IV patients. There was neither procedural nor 30-day mortality in either group. Through 30 days and 1 year, there was no difference in pulmonary and all-cause morbidity between groups. Three MAEs occurred in the GOLD I/II group versus 2 MAE in the GOLD III/IV group during the first postoperative year. The five-year survival was 66.0%, 60.9% and 61.9% for patients with GOLD I, GOLD II and GOLD III, respectively. Three of four GOLD IV died within the first year after EVAR. CONCLUSION: EVAR can be safely performed in patients with COPD, with low 30-day morbidity and mortality rates. Although severe co-morbidity should be taken into account, EVAR seems to be justified in patients with COPD with a GOLD classification I, II or III. Further research should focus on optimising the pulmonary condition in patients selected for EVAR.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Pneumopatias/etiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Idoso , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Implante de Prótese Vascular/mortalidade , Comorbidade , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Pneumopatias/diagnóstico , Pneumopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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