Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.778
Filtrar
1.
Ann Palliat Med ; 10(8): 8762-8771, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488365

RESUMO

BACKGROUND: Thoracoabdominal aortic aneurysms (TAAAs) are one of the most complex aortic aneurysms to treat. Traditional open surgery for TAAAs is highly invasive and total endovascular treatment still has many limitations. Hybrid surgery offers a viable option for TAAA patients, but currently it often alters the original hemodynamics. Therefore, we have developed and applied a hybrid surgery protocol for anatomically suitable TAAA patients. Here we analyzed the short-term outcomes of these patients and evaluated the effectiveness and safety of this procedure. METHODS: A new method was used to perform the required artificial revascularization of the abdominal aorta and its branches. A new visceral debranching and reconstruction approach was used to complete an anatomy-conforming open surgery. Finally, a new vascular access was used for the endovascular operation to complete the implantation of stent-grafts. The clinical data of 10 patients with TAAAs treated at our center with the anatomy-conforming hybrid technique during the period from May 2018 to June 2020 was retrospectively analyzed. The intraoperative and 30-day postoperative key indicators, including survival rates and complications, were analyzed. RESULTS: The hybrid surgery was smoothly performed in all 10 patients. One patient died from non-aortic causes (sepsis/infectious toxic shock) 30 days after surgery, yielding a case-fatality rate of 10.0% (1/10). Two patients (2/10) experienced serious complications within 30 days postoperatively, including multi-organ failure due to infection in one patient and lower limb ischemia in another patient who went on to develop permanent paraplegia. No endoleak after stent implantation was noted and the blood supply of each reconstructed visceral artery was good. CONCLUSIONS: Based on the short-term outcomes, the anatomy-conforming hybrid surgical protocol is safe and effective in treating TAAA patients.


Assuntos
Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Humanos , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
3.
Angiol Sosud Khir ; 27(3): 34-45, 2021.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-34528587

RESUMO

AIM: The study was aimed at assessing the in-hospital results of aortic arch endoprosthetic repair using different variants of endovascular supraaortic debranching. PATIENTS AND METHODS: The analysis included 27 patients subjected within the framework of aortic arch endoprosthetic repair to various types of supraaortic endobranching, including the technique of parallel prostheses and implantation of fenestrated stent grafts. We analysed the clinical and morphological status of patients prior to operation, peculiarities of the intervention (type of debranching and Ishimaru's classification zones in which the reconstruction was performed) and in-hospital results of treatment. RESULTS: The patients' mean age amounted to 66 years. The main nosology (70%) was an aortic aneurysm. Nearly in 30% of cases, the operation was performed emergently for acute aortic syndrome. The main causes of refusal from the traditional prosthetic repair included chronic kidney disease (22.5%), chronic obstructive pulmonary disease (11%), acute cerebral ischaemia within the previous 6 months (15%). The technical success rate of the operation was achieved in 100% of cases. The average duration of the intervention amounted to 226 min, with the mean blood loss equalling 355 ml. The majority of reconstructions were performed in zones 1 and 2 according to Ishimaru (59 and 33%, respectively), in 2 (7%) patients prosthetic repair was performed in zone 0. The total number of the aortic branches involved into reconstruction amounted to 45. Intervention-related complications included 3 (11%) cases of acute cerebral circulation impairment, 2 (7.4%) aortic branch occlusions, and 1 (3.7%) type II endoleak. The in-hospital and 30-day mortality rates amounted to 3.7 and 7.4%, respectively. CONCLUSION: Aortic arch endoprosthetic repair using supraaortic endobranching is considered to be an effective alternative method of treatment for patients with various pathology of the aortic arch and contraindications to traditional prosthetic repair involving artificial blood circulation.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
4.
Angiol Sosud Khir ; 27(3): 140-145, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528598

RESUMO

Total left-sided haemothorax is a rare and severe complication of acute DeBakey type III aortic dissection. The primary aim of treatment is immediate arrest of haemorrhage and stabilization of the haemodynamic status of the patient. Endovascular isolation of the ruptured thoracic portion of the aorta using a stent graft (TEVAR) has recently become the 'gold standard' in treatment of acute, rupture-complicated aortic dissections of this localization. Described in the article is a clinical case report concerning successful endovascular treatment of a seriously ill patient with dissection of the thoracoabdominal portion of the aorta, rupture and massive haemorrhage into the left pleural cavity. The patient underwent endoprosthetic repair of the descending aorta in the setting of a hybrid operating room under local anaesthesia, followed by drainage of the left pleural cavity. The postoperative period was uneventful with no complications. The patient was discharged in a satisfactory condition on day 10 after the emergency surgical intervention. An important advantage of TEVAR for aortic ruptures is a minimally invasive nature of the procedure, consisting in no need to perform either sternothoracotomy or to connect a heart-lung machine, thus decreasing surgical wound, reducing the risk of perioperative life-threatening haemorrhage, and contributing to early activation of the patient.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Hemotórax/diagnóstico , Hemotórax/etiologia , Hemotórax/cirurgia , Humanos , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Stents , Resultado do Tratamento
5.
BMC Surg ; 21(1): 330, 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34407788

RESUMO

BACKGROUND: The effect of thoracic endovascular aortic repair (TEVAR) for acute Type B aortic has been confirmed, However, when patients with malignant disease suffer from acute type B aortic dissection (ATBAD), the effect of TEVAR intervention is still unclear. METHODS: ATBAD patients were identified from electronic medical records between 2009 and 2019. The 5 year overall and aortic-disease free survival rates were analyzed and compared between the two groups. RESULTS: Of the 40 enrolled patients, 27 (67.5%) received TEVAR and 13 (32.5%) received OMT. The baseline characteristics of the two groups were not significantly different. Kaplan‒Meier survival curve showed that the 5 year overall survival and 5 year aortic-disease free survival of the TEVAR group were better than those of the OMT group. The Cox proportional hazard model with unadjusted risk showed an 83.0% decrease in 5 year overall mortality (HR, 0.17; 95% CI, 0.05-0.56) and a lower aortic-disease related risk (HR, 0.08; 95% CI, 0.02-0.39) in TEVAR group compared to OMT group. After adjusted for age, gender, smoking, drinking and comorbidities (diabetes mellitus, hypertension and coronary artery diseases), the hazard ratio of 5 year overall mortality was 78.0% lower (HR, 0.22; 95% CI, 0.06.0.81) and the risk of aortic-disease related mortality was 93.0% lower (HR, 0.07; 95% CI, 0.01-0.61) in TEVAR group compared to OMT group. In the cohort stratified by age, sex, the risk of the 5 year overall or aortic-disease related mortality in TEVAR group was relatively reduced compared to OMT group. CONCLUSIONS: Compared to OMT, TEVAR improves the 5 year overall and aortic-disease free survival rates in the cohort of ATBAD patients with a single type of malignant tumors.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Neoplasias , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Estudos de Coortes , Humanos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
6.
Kyobu Geka ; 74(9): 654-659, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34446616

RESUMO

A 31-year-old woman was referred to our institution because of aortoesophageal fistula (AEF) six months after the descending aortic replacement for acute aortic dissection. We operated one-stage repair of the AEF. Thoracoscopic esophagectomy was firstly performed in prone position from right thoracic cavity, and then the esophagus was reconstructed with gastric conduit via posterior mediastinal route with omental flap. Secondly, graft replacement of the descending aorta using lateral oblique straight incision was performed and the graft was covered with omental flap simultaneously. The postoperative course was uneventful, and she started oral intake on the 13th day after surgery. Although the one-stage surgery for the AEF is highly invasive, it could be a good option for selected cases.


Assuntos
Aneurisma da Aorta Torácica , Doenças da Aorta , Implante de Prótese Vascular , Fístula Esofágica , Fístula Vascular , Adulto , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Esofagectomia , Feminino , Humanos , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Fístula Vascular/cirurgia
7.
Ned Tijdschr Geneeskd ; 1652021 07 01.
Artigo em Holandês | MEDLINE | ID: mdl-34346599

RESUMO

BACKGROUND: A thoracic aortic dissection is a rare condition (2.5-3.5 per 100,000 person years) and patients can present with atypical symptoms. However, a missed diagnosis is often fatal. CASE DESCRIPTION: A 66-years-old male presents himself at the GP's office with sharp pain and loss of strength and sensation in the right arm. Pulse and blood pressure are undetectable on the right arm. An immediate thoracoabdominal CT-angiography is ordered in the nearest hospital. It reveals an aortic dissection (Stanford type A) and the patient is swiftly transferred to a tertiary referral hospital. Upon emergency surgery, the aortic valve, -root and ascending aorta are replaced. The patient is discharged home after one month. CONCLUSION: Swift recognition and referral are paramount to survival in aortic dissection. Patients with a low suspicion can be referred to the closed hospital for immediate imaging. When suspicion is high, direct transfer to a thoracic surgery hospital is warranted.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Valva Aórtica , Angiografia por Tomografia Computadorizada , Humanos , Masculino
9.
BMJ Case Rep ; 14(8)2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389588

RESUMO

We present a case of a persistent false lumen after ascending aorta replacement due to Stanford Type A dissection treated by endovascular means. The main entry tear was occluded with an atrial septal defect closure device, sealing the false lumen. A total of five additional stents were implanted to centralise and secure the flow in the true lumen. CT scan at 6-month follow-up showed excellent results with a decreased total aortic diameter and thrombosed false lumen.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta/diagnóstico por imagem , Aorta/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Dissecação , Humanos , Stents , Resultado do Tratamento
11.
Kyobu Geka ; 74(8): 623-626, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34334607

RESUMO

This is the case of 50s female with Stanford type A acute aortic dissection who underwent emergent total arch replacement. The aortic arch was transected just distal to the left subclavian artery, followed by the insertion of J Graft Frozenix into the descending aorta. No blood pressure gradient was observed between the radial and femoral arteries immediately after the operation. Nevertheless, intermittent claudication was observed after a week. Ankle-brachial index( ABI) measurement was calculated at 0.7 in both legs. Computed tomography (CT) revealed a kinking of the non-stented part of the endograft. Subsequently, thoracic endovascular aortic repair( TEVAR) was performed. As a result, ABI measurement normalized and lower limb pain disappeared. Three years after, CT showed that the endograft expanded satisfactorily. In deployment of J Graft Frozenix, the non-stented part should be kept as short as possible. For kinking, TEVAR should be considered the initial treatment option.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento
12.
J Card Surg ; 36(10): 3963-3967, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34338352

RESUMO

We report first in man implantations of the newly designed Evita-open-NEO hybrid prosthesis for complex aortic arch disease from three different countries in Asia-Pacific including instructions on how to proceed with perioperative coagulation management.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Humanos , Implantação de Prótese
13.
J Card Surg ; 36(10): 3854-3856, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34338372

RESUMO

Staged repair of the aortic arch and downstream aorta using the elephant trunk technique is widely accepted for extensive aortic disease. However, elephant trunk retrieval is challenging in patients with unclampable descending aorta caused by extreme aneurysmal dilation or surrounding tissue adhesion. Here, we introduce a new elephant trunk retrieval technique using the step-by-step aortic clamping in descending aortic replacement of dissecting aortic aneurysm. This technique is a safe and feasible method of elephant trunk retrieval that consists of staged clamping and intraoperative ultrasound assessment of blood flow in the aorta.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Constrição , Humanos
15.
Orv Hetil ; 162(31): 1260-1264, 2021 08 01.
Artigo em Húngaro | MEDLINE | ID: mdl-34333459

RESUMO

Összefoglaló. Az aortadissectio krónikus stádiumában kialakuló thoracoabdominalis tágulatok megoldása multidiszciplináris megközelítést, nagy felkészültséget és fejlett technológiát igényel. A jellemzoen többlépcsos mutétsorozat mortalitása és morbiditása az endovascularis technológia fejlodésével csökkent, de még mindig jelentos. A fenesztrált endovascularis aortamutét a thoracoabdominalis nyitott mutét alternatívája, mely kisebb mortalitással és morbiditással, rövidebb kórházi tartózkodással jár. Aortadissectio esetén történo alkalmazása az aorta lumenében lévo membrán miatt kihívást jelent. Esetbemutatásunkban egy 56 éves nobeteget demonstrálunk, aki tíz évvel korábban A-típusú dissectio miatt aorta ascendens rekonstrukción esett át. A követés során csaknem a teljes aorta tágulata alakult ki, melynek megoldása három lépésben történt. Az elso lépésben a disszekált aortaív nyitott mutétjét végeztük 'frozen elephant trunk' technikával, majd az aorta descendens tágulatának endovascularis kezelése történt sztentgraft-implantációval. A mutétsorozat záró lépése egy fenesztrált endovascularis aortamutét volt, mely egyben ezen technikának az aortadissectio esetében történt elso hazai alkalmazását jelenti. Orv Hetil. 2021; 162(31): 1260-1264. Summary. Thoracoabdominal aortic aneurysms developing in the chronic phase of an aortic dissection require multidisciplinary approach, experienced operators and advanced technology. The mortality and morbidity rate of these multistage operations were reduced with the latest technical achievements in endovascular repair, but they are still significant. Fenestrated endovascular aortic repair, an alternative of thoracoabdominal open repair, is associated with less mortality and morbidity, shorter hospital stay. Using fenestrated devices in aortic dissection is usually technically demanding due to the dissection membrane. We report the case of a 56-year-old woman, who underwent ascending aortic repair due to type A aortic dissection. During the follow-up, a large thoracoabdominal aneurysm developed involving also the arch. We performed a three-stage operation starting with the open repair of the aortic arch using a 'frozen elephant trunk' device followed by a thoracic endovascular aortic repair of the descending aorta. The final stage was a fenestrated endovascular aortic repair, which is the first use of this technique in aortic dissection in Hungary. Orv Hetil. 2021; 162(31): 1260-1264.


Assuntos
Aneurisma da Aorta Torácica , Procedimentos Endovasculares , Procedimentos Cirúrgicos Reconstrutivos , Aneurisma da Aorta Torácica/cirurgia , Dissecação , Feminino , Humanos , Hungria , Pessoa de Meia-Idade
16.
Zhonghua Yi Xue Za Zhi ; 101(29): 2328-2332, 2021 Aug 03.
Artigo em Chinês | MEDLINE | ID: mdl-34333950

RESUMO

Objective: To investigate the feasibility, efficacy and safety of semiconductor laser in situ fenestration of type A aortic dissection during thoracic endovascular aortic repair. Methods: The clinical data of 68 patients with type A aortic dissection treated by semiconductor laser in situ fenestration from June 2016 to January 2020 in Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University were analyzed retrospectively. Of the patients, 45 were male, 23 were female, the mean age was (52±14) years. The technical success rate and complication rates were assessed. Results: The technical success rate of 68 patients was 92.6% (63/68), only 5 patients failed due to the complex aortic arch type, 3 patients underwent chimney stent implantation, 2 patients underwent artificial vessel bypass. During the perioperative period, 1 patient died due to severe pulmonary infection, 4 patients developed neurological symptoms such as cerebral infarction after surgery, and the remaining patients had no related complications. Postoperative CTA follow-up indicated that the primary intercalation rupture was completely closed, and the main and branch stents were patency, 8 (8.8%) type Ⅰ leakage were occurred. Conclusion: It showed that in situ semiconductor laser fenestration is a feasible, effective and safe method to treat type A aortic dissection.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Adulto , Idoso , Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , China , Feminino , Humanos , Lasers Semicondutores , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento
17.
Kyobu Geka ; 74(8): 583-586, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34334598

RESUMO

A 26-year-old man with relapsing polychondritis was admitted for the treatment of multiple thoracic aortic aneurysms in the ascending and descending aorta. Descending thoracic aortic aneurysm showed rapid expansion, therefore, the patient underwent an extended thoracic aortic repair from the ascending aorta to the descending aorta via anterolateral thoracotomy and partial sternotomy. Although postoperative course was uneventful, aortic root enlargement and severe aortic insufficiency progressed over the next two years. He and his family refused redo surgical intervention and the patient died of heart failure. Careful perioperative follow-up may be mandatory in a patient with relapsing polychondritis complicated by cardiovascular disease.


Assuntos
Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Policondrite Recidivante , Adulto , Aorta/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Humanos , Masculino , Policondrite Recidivante/complicações , Toracotomia
18.
Kyobu Geka ; 74(8): 615-619, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34334605

RESUMO

The case was a 65-year-old woman. She underwent graft replacement of ascending aorta because she developed Stanford type A acute aortic dissection in November 2016. After six months she had a fever, so she underwent contrast-enhanced computed tomography and echocardiography at the previous hospital. An abnormal shadow was found in the artificial blood vessel, and the blood culture test was positive. The abnormal shadow was suspected to be a vegetation and was referred to our department. Vegetation was highly mobile and emergency surgery was performed considering the risk of embolism. Intraoperative findings showed that vegetation was attached to the anastomotic site of the artificial blood vessel. She was transferred to a rehabilitation hospital 57 days after the operation and is currently rehabilitating.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Embolia , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Feminino , Humanos
19.
Kyobu Geka ; 74(8): 627-630, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34334608

RESUMO

Bronchial artery aneurysm (BAA) is a rare disease, for which early treatment is recommended due to the risk of rupture often resulting in severe consequences. We report a case of successful treatment of an asymptomatic BAA by selective branch embolization combined with thoracic endovascular aortic repair (TEVAR). A 68-year-old man was accidentally found to have a bronchial artery aneurysm by computed tomography. The distance from the origin of the bronchial artery to the aneurysm was only 6 mm, at which branches were found. The BAA was completely excluded by selective branch coil embolization and deployment of a thoracic stent graft to cover the orifice of the BAA. Angiography confirmed that there was no endoleak. Selective branch embolization of BAA combined with TEVAR is effective to completely occlude the blood stream to BAA.


Assuntos
Aneurisma , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Embolização Terapêutica , Procedimentos Endovasculares , Idoso , Aneurisma/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Artérias Brônquicas/diagnóstico por imagem , Humanos , Masculino , Stents , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...