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1.
Vasc Endovascular Surg ; 54(2): 141-146, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31749415

RESUMO

OBJECTIVES: To compare outcomes in patients randomized to infrapopliteal (IP) plain balloon angioplasty (PBA) for chronic limb-threatening ischemia within the Bypass versus Angioplasty in Severe Ischemia of the Leg (BASIL)-1 trial between 1999 and 2004 with outcomes in consecutive patients undergoing IP PBA at an academic vascular unit a decade later (2009-2013, Contemporary series [CS]). METHODS: Individual patient data were obtained from prospective BASIL-1 (48 patients) and CS databases (73 patients). All had a minimum of 3-years of follow-up. Outcomes studied were amputation-free survival (AFS), overall survival (OS), major (above ankle) limb amputation, arterial reintervention, immediate technical success, and length of hospital stay for the index procedure and during the following 12-month period. Statistical analysis was performed using SAS version 9.4. RESULTS: The BASIL and CS cohorts were well matched for gender, age, diabetes, previous stroke, myocardial infarction and arterial intervention, and presence of tissue loss. More patients in BASIL-1 underwent concomitant treatment of the superficial femoral (60% vs 37%, P = .01) and above knee popliteal (60% vs 34%, P = .005) arteries. Immediate technical success increased from 73% in BASIL-1 to 90% in the CS (P = .01). Between the two cohorts, there were no differences in AFS (hazard ratio [HR] = 1.00, 95% confidence interval [CI]: 0.65-1.54, P = 1.0), OS (HR = 1.04, 95% CI: 0.66-1.62, P = .9), major amputation (HR = 0.86, 95% CI: 0.37-1.97, P = .7), or reintervention (HR = 0.61, 95% CI: 0.29-1.27, P = .2). Contemporary series patients spent significantly fewer days in hospital following the index procedure (P = .02) and also over the following 12 months (P = .002). CONCLUSIONS: Despite improvements in the immediate technical angiographic success of IP PBA between BASIL and the CS, there were no significant improvements in survival outcomes. Results from BASIL-2 and BEST-CLI are required in order to properly define the clinical and cost-effectiveness of endovascular treatment in such patients.


Assuntos
Angioplastia com Balão , Isquemia/terapia , Doença Arterial Periférica/terapia , Artéria Poplítea , Idoso , Idoso de 80 Anos ou mais , Amputação , Angioplastia com Balão/efeitos adversos , Doença Crônica , Bases de Dados Factuais , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Tempo de Internação , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Intervalo Livre de Progressão , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Fatores de Tempo , Grau de Desobstrução Vascular
2.
Vasc Endovascular Surg ; 54(2): 182-190, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31672102

RESUMO

PURPOSE: Neurofibromatosis type 1 (NF1) is an autosomal-dominant disorder found in approximately 1 of every 3000 individuals. Neurofibromatosis type 1 can have vascular manifestations including aneurysms, stenoses, and arteriovenous malformations. The purpose of this article is to describe the clinical manifestations of NF1 vasculopathy, discuss therapeutic options, and highlight endovascular therapies from our institutional experience. MATERIALS AND METHODS: The radiology information system was searched for cases of NF1. Cases with vasculopathy managed with endovascular therapies were included. Demographics, clinical histories, procedural details, and outcomes were recorded. A review of the literature for the management strategies of NF1 vasculopathy was performed. RESULTS: Two pediatric patients with NF1 were identified, both of whom presented with hypertension found to be secondary to renal artery stenosis. One of the patients also had infrarenal aortic narrowing. Both patients were successfully treated with balloon angioplasty, resulting in improved blood pressures. The review of the literature identified case series of pharmacologic, surgical, and endovascular therapies, although, endovascular therapies appear to be preferred due to lower morbidity and mortality. CONCLUSIONS: NF1 vasculopathy is a rare condition that most often presents with hypertension due to renal artery stenosis. In these situations, endovascular management is the preferred approach.


Assuntos
Angioplastia com Balão , Hipertensão Renovascular/terapia , Neurofibromatose 1/complicações , Obstrução da Artéria Renal/terapia , Artéria Renal/fisiopatologia , Pressão Arterial , Criança , Pré-Escolar , Feminino , Humanos , Hipertensão Renovascular/diagnóstico por imagem , Hipertensão Renovascular/etiologia , Hipertensão Renovascular/fisiopatologia , Neurofibromatose 1/diagnóstico , Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular
3.
Internist (Berl) ; 60(12): 1235-1239, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31667527

RESUMO

BACKGROUND: Peripheral artery disease (PAD) is often diagnosed in an advanced stage. Accordingly, revascularization is also performed late. OBJECTIVES: In this paper, the authors describe the progression to critical limb ischemia and cardiovascular risk. Revascularization for secondary prevention is explained. Revascularization strategies according to lesion location and complexity of the stenosis or occlusion are discussed. MATERIALS AND METHODS: The current guidelines and randomized controlled studies and meta-analyses are analyzed. RESULTS: PAD is associated with a considerable level of suffering and a high cardiovascular risk. Up to 20% of patients with claudicants will progress to critical limb ischemia. Progression and risk of mortality increase during the course of the disease. Improvement of walking ability by revascularization is a major goal of secondary prevention. In the femoropopliteal segment, drug-coated balloon (DCB) angioplasty and bare-metal stent (BMS) implantation are the methods of choice. In long lesions, spot-stenting should be preferred. For treatment of in-stent restenosis, DCB have proven their effectiveness. In severely calcified or dissected lesions, BMS are well suited. Infrapopliteal lesions should be revascularized to provide in-line flow to the foot through the target arterial path. According to current evidence, DCB or drug-eluting stents are more effective than plain old balloon angioplasty or BMS.


Assuntos
Angioplastia com Balão/métodos , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/terapia , Guias de Prática Clínica como Assunto , Fármacos Cardiovasculares , Stents Farmacológicos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
5.
Medicine (Baltimore) ; 98(45): e17877, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702657

RESUMO

RATIONALE: Budd-Chiari syndrome (BCS), which causes congestive hepatopathy and aggravates cirrhosis, is typically treated by interventional angioplasty to ameliorate blood flow. X-ray venography is useful for the evaluation of inferior vena cava (IVC) stenosis and determination of treatment timing, but it is invasive and thus unsuitable for repeated examinations. The development of a simple method for the prediction of IVC stenosis would reduce the burden on patients with BCS. PATIENT CONCERNS: We report here our experience of 2 patients with BCS who underwent percutaneous transluminal angioplasty (PTA). The first patient was a 39-year-old male who underwent PTA to expand his stenotic IVC. The second patient was a 19-year-old male who underwent PTA 3 times due to restenosis of his IVC. DIAGNOSES: Both patients were diagnosed with BCS with severe obstruction of the IVC. INTERVENTIONS: We evaluated the hepatic vein (HV) waveform by Doppler ultrasonography and measured liver stiffness (LS) using transient elastography (TE) before and after PTA. OUTCOMES: In case 1, the phasic oscillation of the HV waveform recovered and the LS value decreased after PTA. Both improvements were maintained for ∼3 years, reflecting the long-term patency of the IVC. In case 2, the HV waveform and the LS value improved temporarily after PTA, but then deteriorated gradually. Monitoring of the HV waveform and LS value allowed retreatment prior to total occlusion of the IVC and abrogated the risk of intravascular needle puncture. LESSONS: Monitoring of the HV waveform and the LS value enables safe management of patients with BCS who may require PTA.


Assuntos
Síndrome de Budd-Chiari/diagnóstico por imagem , Constrição Patológica/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Veias Hepáticas/diagnóstico por imagem , Adulto , Angioplastia com Balão , Síndrome de Budd-Chiari/complicações , Síndrome de Budd-Chiari/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Veias Hepáticas/cirurgia , Humanos , Masculino , Ultrassonografia Doppler , Adulto Jovem
6.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(10): 814-819, 2019 Oct 24.
Artigo em Chinês | MEDLINE | ID: mdl-31648464

RESUMO

Objective: To evaluate the feasibility and safety percutaneous pulmonary vein intervention in patients with severe pulmonary vein stenosis (PVS) caused by fibrosing mediastinitis(FM). Methods: This retrospective analysis included 5 FM patients (2 male, 3 female, 54-77 years old) confirmed by clinical presentation and chest computed tomography (CT) scan from January to June 2018 who were from Gansu Provincial Hospital and Shanghai Chest Hospital. CT pulmonary angiography (CTPA) further revealed severe PVS caused by fibrotic tissue compression in mediastinum. After selective pulmonary vein angiography, gradually balloon angioplasty was used to expand the pulmonary vein and then stents were implanted in the pre-dilated stenotic pulmonary veins. Evaluation of therapeutic effect was made at 6 months after the procedure. Results: All of 11 serious compression PVS were treated with stent implantation (diameter: 7-10 mm, length: 17-27 mm). After stenting, degree of pulmonary vein stenosis decreased from (83±16)% to (12±4)% (P<0.01). The minimal diameter of the stenotic pulmonary vein was significantly increased from (0.8±0.5)mm to (7.5±0.8)mm (P<0.01). Trans-stenotic gradient decreased from (27.0±15.1)mmHg (1 mmHg=0.133 kPa) to (2.50±0.58)mmHg (P<0.05). Mean pulmonary pressure measured by cardiac catheter decreased from (45.0±9.0)mmHg to (38.7±8.4)mmHg (P<0.05). One patient experienced cardiac arrest due to vagal nerve reflex during big sizing balloon stent dilation and recovered after cardiopulmonary resuscitation. There were no other serious procedure related complications. During the follow-up, severe stenosis at end of proximal stent was evidenced in 1 patient due to fibrotic compression, and another patient developed in-stent thrombosis due to discontinuation of prescribed anticoagulant. Conclusion: Percutaneous intervention for severe pulmonary vein stenosis caused by FM is feasible and safe, and can improve hemodynamic caused by the compression of mediastinal vascular structures in these carefully selected patients.


Assuntos
Angioplastia com Balão , Mediastinite/complicações , Esclerose/complicações , Estenose de Veia Pulmonar/terapia , Stents , Idoso , China , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/patologia , Estudos Retrospectivos , Estenose de Veia Pulmonar/etiologia , Resultado do Tratamento
7.
J Cardiovasc Surg (Torino) ; 60(6): 679-685, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31603295

RESUMO

BACKGROUND: Endovascular treatment of occlusive disease of the superficial femoral artery (SFA) has evolved from plain old balloon angioplasty (POBA) through primary stenting strategy to drug eluting technology-based approach. The RAPID Trial investigates the added value of drug coated balloons (DCB, Legflow) in a primary stenting strategy (Supera stent) for intermediate (5-15 cm) and long segment (>15 cm) SFA lesions. METHODS: In this multicenter, patient-blinded trial, 160 patients with intermittent claudication, ischemic rest pain, or tissue loss due to intermediate or long SFA lesions were randomized (1:1) between Supera + DCB and Supera. Primary endpoint was primary patency at 2 years, defined as freedom from restenosis on duplex ultrasound (peak systolic velocity ratio <2.4). RESULTS: At 2 years, primary patency was 55.1% (95% CI: 43.1-67.1%) in the Supera + DCB group versus 48.3% (95% CI: 35.6-61.0%) in the Supera group (P=0.957). Per protocol analysis showed a primary patency rate of 60.9% (95% CI: 48.6-73.2%) in the Supera + DCB group versus 49.8% (95% CI: 36.9-62.7%) in the Supera group (P=0.469). The overall mortality rate was 5% in both groups (P=0.975). Sustained functional improvement was similar in both groups. CONCLUSIONS: The 2-year results in the current trial of a primary Supera stenting strategy are consistent with other trials reporting on treatment of intermediate and long SFA lesions. A DCB supported Supera stent strategy did not improve patency rate compared to a Supera stent only strategy.


Assuntos
Angioplastia com Balão/instrumentação , Fármacos Cardiovasculares/administração & dosagem , Materiais Revestidos Biocompatíveis , Artéria Femoral , Doença Arterial Periférica/terapia , Stents , Dispositivos de Acesso Vascular , Angioplastia com Balão/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Estudos Prospectivos , Desenho de Prótese , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
8.
Int Heart J ; 60(5): 1137-1141, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484878

RESUMO

Current therapeutic methods for chronic thromboembolic pulmonary hypertension (CTEPH) can improve hemodynamic status and are expected to improve prognoses. However, some patients experience dyspnea during effort and continue supplemental oxygenation despite their hemodynamic status being fully improved. Considering the pathogenesis of CTEPH, the dead space and intrapulmonary shunt are assumed to be responsible for hypoxia in CTEPH, but their contributions are unclear. It is also unclear whether they are improved after treatment. The aim of this study was to investigate the implications of the dead space ratio (DSR) and the intrapulmonary shunt ratio (ISR) for hypoxia in CTEPH and treatment for CTEPH.We retrospectively measured the DSR and ISR of 23 consecutive patients with CTEPH. For 11 of these 23 (10 were treated by balloon pulmonary angioplasty, one with riociguat), we also measured these parameters before and after CTEPH treatments. Overall, the DSR and ISR were abnormally elevated (DSR: 0.63 ± 0.06; ISR: 0.20 ± 0.05). After treatment, mean pulmonary artery pressure was improved (from 40.3 ± 8.1 to 25.5 ± 2.7 mmHg). Although atrial oxygen saturation (SaO2), DSR and ISR were improved (SaO2: from 90.2 ± 3.2 to 93.7 ± 1.8%; DSR: from 0.64 ± 0.06 to 0.58 ± 0.05; ISR: from 0.20 ± 0.04 to 0.18 ± 0.02), these improvements were slight compared with that of mean pulmonary artery pressure.The DSR and ISR were abnormally elevated in patients with CTEPH and their improvement by treatment was limited. Only DSR can be a useful marker for normalization of hypoxia in CTEPH.


Assuntos
Angioplastia com Balão/métodos , Hipertensão Pulmonar/terapia , Embolia Pulmonar/terapia , Pirazóis/uso terapêutico , Pirimidinas/uso terapêutico , Espaço Morto Respiratório/efeitos dos fármacos , Adulto , Idoso , Doença Crônica , Feminino , Hemodinâmica/fisiologia , Hospitais Universitários , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/mortalidade , Japão , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/métodos , Prognóstico , Circulação Pulmonar/fisiologia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/mortalidade , Espaço Morto Respiratório/fisiologia , Testes de Função Respiratória , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Taxa de Sobrevida , Resultado do Tratamento
9.
Surg Technol Int ; 35: 235-242, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31476793

RESUMO

Endovascular treatment of peripheral artery disease has recently become more important due to its minimally invasive nature. Elderly patients as well as fragile patients, like diabetics and those with end-stage renal disease, can benefit from this low-morbidity/-mortality treatment. Very successful results have been achieved with percutaneous balloon angioplasty and stenting in the superficial femoral and iliac arteries. In some areas, however, such as the common femoral artery and the popliteal artery, vascular physicians remain somewhat reluctant to use endovascular strategies. Common femoral endarterectomy, the most often used technique for treatment of common femoral artery lesions, has shown very good long-term results, but is associated with relatively high complication rates, such as superficial and deep wound problems and lymph leakage. This article describes less-invasive endovascular alternatives, such as atherectomy, drug-coated balloons and stenting, and their results. The popliteal artery is also difficult to treat in an endovascular manner due to biomechanical forces during bending and stretching of the knee or leg. Thus, we also describe currently available minimally invasive treatment options for the popliteal artery.


Assuntos
Angioplastia com Balão , Arteriopatias Oclusivas , Doença Arterial Periférica , Stents , Idoso , Arteriopatias Oclusivas/cirurgia , Artéria Femoral , Humanos , Doença Arterial Periférica/cirurgia , Artéria Poplítea , Resultado do Tratamento
10.
Heart Surg Forum ; 22(4): E289-E293, 2019 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-31398094

RESUMO

Phlegmasia cerulea dolens is an acute fulminating form of extensive venous thrombosis. Limb loss, post-thrombotic syndrome and life-threatening conditions can occur without appropriate management. Treatment methods vary; there presently is no consensus on the best form of treatment. Endovascular procedures have been a good option for treating deep vein thrombosis, yet they may be insufficient for patients suffering from phlegmasia cerulea dolens. Venous thrombectomy with the guidance of venography quickly relieves symptoms, hardly causes complications, yields optimal mid-term results, and can be a justifiable treatment for phlegmasia cerulea dolens.


Assuntos
Perna (Membro)/irrigação sanguínea , Trombectomia/métodos , Trombose Venosa/cirurgia , Angioplastia com Balão/métodos , Embolectomia com Balão/instrumentação , Embolectomia com Balão/métodos , Evolução Fatal , Feminino , Veia Femoral , Humanos , Veia Ilíaca/diagnóstico por imagem , Perna (Membro)/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Veia Poplítea , Trombectomia/instrumentação , Trombose Venosa/diagnóstico por imagem
11.
Cardiovasc Intervent Radiol ; 42(11): 1513-1521, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31432220

RESUMO

PURPOSE: The prospective randomized multicenter Freeway study evaluated the possible hemodynamic and clinical benefits of primary stent insertion followed by percutaneous transluminal angioplasty (PTA) with drug-eluting balloons (DEB) over post-stent insertion PTA with standard balloons in the treatment of symptomatic femoropopliteal arteriosclerotic lesions. METHODS: In total, 204 patients in 13 centers in Germany and Austria were enrolled and randomized to primary stenting followed by either FREEWAY™ drug-eluting balloon or standard PTA balloon angioplasty. The primary endpoint was the rate of clinically driven target lesion revascularization (TLR) at 6 months; the secondary endpoints include TLR rate at 12 months and primary patency, shift in Rutherford classification, ankle-brachial index (ABI) and major adverse events (MAE) at 6 and 12 months. Lesion characteristics and vessel patency were analyzed by an independent and blinded corelab. RESULTS: At 6-month and 12-month follow-up, TLR rate was lower in the DEB arm compared to standard PTA but did not reach statistical significance (4.1% vs. 9.0% p = 0.234 and 7.9% vs. 17.7% p = 0.064, respectively). Primary patency was significantly better for patients treated with the DEB at 6 months (90.3% vs. 69.8% p = 0.001) and 12 months (77.4% vs. 61.0% p = 0.027). Improvement in Rutherford classifications was likewise significantly better for patients in the DEB group at 6 (94.9% vs. 84.3% p = 0.027) and 12 months (95.5% vs. 79.9% p = 0.003). The percentage of patients with an improved ABI of 1.0-1.2 was significantly higher in the DEB group compared to the PTA group at 6 months (55.3% vs. 35.3%; p = 0.015) but without significant difference at 12 months (48.2% vs. 32.9%; p = 0.055). At 6 months, rate of major adverse events (MAE) was 1% in both arms, and at 12 months 2.2% for the DEB and 3.8% for the PTA group. CONCLUSION: The Freeway Stent Study shows that the usage of DEB as a restenosis prophylaxis seems to be safe and feasible. The 12-month follow-up results give a clear sign in favor of the DEB group.


Assuntos
Ligas/administração & dosagem , Angioplastia com Balão/métodos , Stents Farmacológicos , Artéria Femoral/fisiopatologia , Placa Aterosclerótica/terapia , Artéria Poplítea/fisiopatologia , Índice Tornozelo-Braço , Áustria , Feminino , Seguimentos , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular
12.
J Vasc Surg ; 70(3): 970-979.e3, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31445651

RESUMO

BACKGROUND: Arteriovenous fistulas for patients undergoing hemodialysis (HD) are at high risk of stenosis. Despite conventional balloon angioplasty (CBA), restenosis rates are high. The use of a drug-coated balloon (DCB) may offer an alternative to reduce restenosis. METHODS: This study has been performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic search on MEDLINE, Embase, and the Cochrane Library was performed to identify articles evaluating DCB angioplasty for patients with HD access stenosis. Risk ratios (RRs) of primary patency were pooled, and relevant subgroup and sensitivity analyses were conducted. RESULTS: There were 17 studies (8 randomized controlled trials [RCTs], 9 cohort studies) included, comprising a total of 1113 stenotic dialysis accesses, of which 54.7% underwent DCB angioplasty and 45.3% underwent CBA. There was a significantly superior 6-month (RR, 0.57; 95% confidence interval [CI], 0.44-0.74; P < .00001; I2 = 62%) and 12-month (RR, 0.73; 95% CI, 0.63-0.84; P < .0001; I2 = 53%) primary patency in the DCB angioplasty group in comparison to the CBA group (71.0% vs 49.2% at 6 months; 44.2% vs 20.6% at 12 months). Subgroup analyses of study design (RCTs, cohort studies) showed similar trends. Sensitivity analyses by excluding one poor-quality RCT and those employing the crossover analysis design also showed similar results. Studies investigating central venous stenosis showed significantly better 6-month (RR, 0.57; 95% CI, 0.41-0.79; P = .0009; I2 = 67%) and 12-month (RR, 0.69; 95% CI, 0.56-0.85; P = .0004; I2 = 64%) primary patency in the DCB angioplasty group in comparison to the CBA group. The pooled rate of minor complications was low in both the DCB (1.1%) and CBA (0.9%) groups. CONCLUSIONS: DCB angioplasty appears to be a better and safe alternative to CBA in treating patients with HD stenosis in terms of 6- and 12-month primary patency. However, a larger trial is warranted to establish these findings.


Assuntos
Angioplastia com Balão/instrumentação , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Fármacos Cardiovasculares/administração & dosagem , Materiais Revestidos Biocompatíveis , Oclusão de Enxerto Vascular/terapia , Diálise Renal , Dispositivos de Acesso Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Desenho de Equipamento , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
14.
World Neurosurg ; 131: e425-e432, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376552

RESUMO

BACKGROUND: Near-infrared spectroscopy (NIRS) is an alternative monitoring method during carotid artery stenting (CAS). NIRS has been reported to be effective in emergency care; however, it is unknown whether it can predict intraoperative ischemic intolerance and cerebral hyperperfusion during CAS. Perioperative ischemic intolerance and cerebral hyperperfusion are potential events during CAS for carotid artery stenosis. We evaluated whether perioperative monitoring of the tissue oxygenation index (TOI) using NIRS with the NIRO system can predict the occurrence of ischemic intolerance and cerebral hyperperfusion. METHODS: The TOI of 27 patients was measured during CAS. The relationship between the TOI and ischemic intolerance or cerebral hyperperfusion was analyzed, and the cutoff TOI was calculated to predict their occurrence. RESULTS: Ischemic intolerance occurred in 5 patients during balloon protection. The TOI in the presence of ischemic intolerance was significantly lower than that without ischemic intolerance. The cutoff TOI to detect ischemic intolerance was 50% and that of the TOI change rate before and after balloon protection was 80%. The ischemic symptoms in all patients had resolved immediately after balloon deflation. The cerebral hyperperfusion phenomenon was detected using single-photon emission computed tomography in 4 patients. These patients showed a transient increase in the TOI immediately after CAS; however, none of these patients showed symptomatic cerebral hyperperfusion phenomenon. The cutoff TOI to detect cerebral hyperperfusion was 109% compared with the TOI before CAS. CONCLUSION: Monitoring of the TOI using the NIRO system could be useful for the detection of ischemic intolerance and cerebral hyperperfusion during CAS and to prevent perioperative adverse events.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Estenose das Carótidas/terapia , Complicações Intraoperatórias/diagnóstico por imagem , Monitorização Intraoperatória/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/métodos , Circulação Cerebrovascular , Feminino , Humanos , Hipotensão/epidemiologia , Complicações Intraoperatórias/epidemiologia , Masculino , Complicações Pós-Operatórias/epidemiologia , Stents , Tomografia Computadorizada de Emissão de Fóton Único
15.
Am J Case Rep ; 20: 1089-1093, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31341156

RESUMO

BACKGROUND Endovascular procedures for renal artery stenosis induced by Takayasu arteritis include renal angioplasty (RA); sometimes renal artery bypass surgery may be required. Recently, there have been several reports about the use of drug-coated balloon (DCB) for renal artery stenosis in patients with Takayasu arteritis. CASE REPORT A 19-year-old female was diagnosed with ulcerative colitis in 2012 and was on oral therapy. In 2015, she developed type V Takayasu arteritis, with 90% stenosis of the bilateral common carotid arteries, 90% stenosis of the right renal artery, and 75% stenosis of the infrarenal abdominal aorta. Her abdominal aortic stenosis reduced blood flow to the lower extremities and revascularization was required, so balloon dilatation of the abdominal aorta and renal angioplasty for right renal artery were performed at another hospital in March 2016. However, in-stent restenosis occurred 2 times, we performed renal angioplasty again with DCB. The patient has subsequently shown a stable course without recurrence of hypertension. At 2 years after renal angioplasty with the DCB, her serum renin and aldosterone levels were normal, there was no change of the right renal artery blood flow rate, and the blood pressure was normal. CONCLUSIONS This case suggests that dilation of in-stent restenosis with a DCB is an effective strategy for renal artery stenosis in patients with Takayasu arteritis. It seems desirable to consider expanding the indications for use of DCB to include renal artery stenosis.


Assuntos
Angioplastia com Balão , Materiais Revestidos Biocompatíveis , Paclitaxel , Obstrução da Artéria Renal/terapia , Stents , Arterite de Takayasu/complicações , Feminino , Humanos , Recidiva , Obstrução da Artéria Renal/complicações , Adulto Jovem
16.
Cardiovasc Intervent Radiol ; 42(10): 1398-1404, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31342098

RESUMO

OBJECTIVE: Percutaneous transluminal balloon angioplasty (PTA) is the main treatment option for Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) obstruction. However, IVC rupture caused by PTA has never been reported. MATERIALS AND METHODS: Between August 2004 and December 2016, a consecutive cohort of 617 BCS patients with obstructed IVC who underwent PTA with or without stent placement were reviewed retrospectively to identify IVC rupture. Pre- and post-procedural imaging data, clinical and procedural technical data were analyzed. RESULTS: Of the 617 BCS patients, five patients had IVC rupture caused by PTA (0.81%). Four of these patients had retroperitoneal, intra-hepatic IVC rupture without extravasation into abdominal cavity which was successfully managed conservatively. One patient had supra-hepatic IVC rupture into the pericardial cavity which was surgically treated. CONCLUSION: IVC rupture is a rare complication of PTA treatment of BCS and most commonly located at the intra-hepatic IVC caused by oversized balloons which does not require additional treatment.


Assuntos
Angioplastia com Balão/efeitos adversos , Arteriopatias Oclusivas/complicações , Síndrome de Budd-Chiari/complicações , Síndrome de Budd-Chiari/terapia , Ruptura/etiologia , Veia Cava Inferior/lesões , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
17.
Rev Esp Cardiol (Engl Ed) ; 72(8): 599, 2019 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31345532
18.
World Neurosurg ; 131: e211-e217, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31349074

RESUMO

BACKGROUND: Reports have emerged describing the successful endovascular recanalization of the chronically occluded internal carotid artery (COICA). The impact this restoration of flow has on the sensitive carotid sinus baroreceptors has not been previously described. In this manuscript, we present the largest COICA surgical series to date, with a specific focus on perioperative heart rate abnormalities. METHODS: Patient demographics were obtained, and the COICAs were radiographically classified based on the anatomic distribution of the stenosis and collateral flow. Thirty-six patients had a total of 37 COICA revascularization procedures. RESULTS: A total of 23 patients had intraprocedural bradycardia during balloon angioplasty. Three patients went into transient asystole during the procedure, and 2 of these patients had symptomatic bradycardia with ischemic cerebral changes, 1 of which required permanent pacemaking. All other patients had immediate resolution of their bradycardia, asystole, and neurologic symptoms immediately following balloon deflation and pharmaceutical management. There was a statistically significant difference in the observed proportion of bradycardic patients among COICA classifications (P = 0.014). There was no statistically significant difference in mean age between patients with bradycardia and those without (aged 63.36 vs. 67.71 years, P = 0.2265). CONCLUSIONS: Bradycardia associated with angioplasty of the carotid bulb was observed in the majority of patients receiving COICA revascularization. A small percentage of these patients were symptomatic. Our results suggest that carotid sinus baroreceptors remain active while residing in a complete arterial occlusion, and close monitoring is necessary during balloon angioplasty of the proximal COICA.


Assuntos
Angioplastia com Balão , Bradicardia/epidemiologia , Estenose das Carótidas/terapia , Parada Cardíaca/epidemiologia , Complicações Intraoperatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Seio Carotídeo , Estenose das Carótidas/classificação , Estenose das Carótidas/diagnóstico por imagem , Doença Crônica , Circulação Colateral , Procedimentos Endovasculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressorreceptores
19.
Khirurgiia (Mosk) ; (6): 11-19, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317936

RESUMO

AIM: To analyze various methods for treatment of TIPS dysfunction. MATERIAL AND METHODS: There were 45 patients (29 men, 16 women, aged 52.2±2.03 years) with TIPS dysfunction. Dysfunction of bare-metal stent was noted in 29 cases, stent-graft - in 16 cases. TIPS thrombosis occurred in 24 patients, hyperplasia of hepatic vein intima - in 7, pseudointimal hyperplasia of the shunt - in 7, liver tissue prolapse - in 5, migration of stent - in 2 patients. Redo surgery included rheolytic thrombectomy, balloon angioplasty, stent-in-stent technique, u-shaped and parallel stenting. RESULTS: Patients were hospitalized in 3, 6 and 12 months after surgery for evaluation of the results of redo interventions. Balloon angioplasty and rheolytic thrombectomy (5 patients) were followed by TIPS dysfunction after 1 week in 2 patients, after 12 months - in 2. Normal function of stent over 1 year was noted in 1 patient. Isolated balloon angioplasty (n=23) was followed by TIPS dysfunction within 1 week in 13 patients, within 3 months in 3 patients, up to 6 months in 1 patient, within 6-12 months in 1 patient. Normal function of TIPS over 1 year was observed in 4 patients. Stent-in-stent stenting (n=18) was followed by early thrombosis in 5 patients, normal function of TIPS up to 3 months was noted in 3 patients, within 3-6 months - in 2 patients, up to 1 year - in 1 patient. Normal function of TIPS over 1 year was observed in 7 patients. TIPS thrombosis occurred in 1 patient on the 2nd day after U-shaped stenting. Normal function of TIPS over 1 year was observed in another patient after the same procedure. Early TIPS dysfunction occurred in 2 patients after parallel stenting, dysfunction within 3 months was revealed in 2 patients. Normal function of TIPS over 1 year was observed in 2 patients. CONCLUSION: Rheolytic thrombectomy combined with balloon angioplasty is preferred for early TIPS dysfunction. Parallel stenting is advisable in long-term period. The use of stent grafts as a shunt can reduce the incidence of TIPS dysfunction.


Assuntos
Hipertensão Portal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Angioplastia com Balão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Stents/efeitos adversos , Trombectomia
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