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1.
Medicine (Baltimore) ; 100(32): e26935, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397942

RESUMO

ABSTRACT: Transplant renal artery stenosis (TRAS) is the most common (1%-23%) vascular complication following kidney transplantation. The aim of this study was to review our experience with an endovascular approach to treat TRAS.We retrospectively reviewed kidney transplant recipients who underwent percutaneous transluminal angioplasty (PTA) due to TRAS in our institute from January 2009 to December 2015. We analyzed the patient's baseline characteristics, postoperative renal function, blood pressure evolution, and the number of pre- and post-procedure antihypertensive drugs.A total of 21 patients (15 men, 6 women) were treated with the endovascular technique. The predominant presentation was graft dysfunction (76.2%). Stenosis or hemodynamic kinking was located at the anastomosis in 7 (33.3%) patients, proximal to the anastomosis in 13 (61.9%) patients, and distal the anastomosis in 1 (4.8%) patient. PTA without stent placement was performed in 7 patients (33.3%), and PTA with stent placement was performed in 14 patients (67.7%). Serum creatinine levels demonstrated no difference between the pre-procedure level and that on discharge day (1.61 mg/dl [0.47-3.29 mg/dl] vs 1.46 mg/dl [0.47-3.08 mg/dl]; P = .33). The glomerular filtration rate also showed no difference between the pre-procedure value and that on discharge day (53.6 ml/min [22.4-145.7 ml/min] vs 57.0 ml/min [17.56 -145 ml/min]; P = .084). Systolic blood pressure and diastolic blood pressure (DBP) varied from 137 mm Hg (120-160 mm Hg) and 84 mm Hg (70-100 mm Hg) pre-procedure to 129 mm Hg (90-150 mm Hg) and 79 mm Hg (60-90 mm Hg) at discharge, respectively (P = .124 and P = .07). The number of antihypertensive medications significantly decreased from 1.5 (0-6) pre-procedure to 0.5 (0-2) at discharge (P = .023). In our study, there were no technical failures, procedure-related complications or deaths. During the follow-up period, the free-from-reintervention rate was 100%, and graft failures occurred in 2 patients (9.5%) due to rejection.Endovascular procedures for TRAS show a high technical success rate with a low complication rate and a low reintervention rate. PTA showed a trend toward a positive impact on lowering serum creatinine, systolic blood pressure, and diastolic blood pressure and improving estimated glomerular filtration rate, and the number of antihypertensive medications could be significantly reduced after this procedure.


Assuntos
Angioplastia/métodos , Procedimentos Endovasculares/métodos , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias , Obstrução da Artéria Renal/cirurgia , Stents , Grau de Desobstrução Vascular/fisiologia , Adulto , Idoso , Pressão Sanguínea/fisiologia , Feminino , Seguimentos , Taxa de Filtração Glomerular/fisiologia , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/etiologia , Estudos Retrospectivos , Fatores de Tempo , Transplantados , Resultado do Tratamento
2.
Br J Radiol ; 94(1125): 20210215, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34233490

RESUMO

OBJECTIVES: To emerge hypoperfusion of lower limbs in patients with critical limb ischemia (CLI) using Intravoxel Incoherent Motion microperfusion magnetic resonance imaging (IVIM-MRI). Moreover to examine the ability of IVIM-MRI to differentiate patients with severe peripheral arterial disease (PAD) from normal subjects and evaluate the percutaneous transluminal angioplasty (PTA) results in patients with CLI. METHODS: Eight patients who presented with CLI and six healthy volunteers were examined. The patients underwent IVIM-MRI of lower extremity before and following PTA. The imaging protocol included sagittal diffusion-weighted (DW) sequences. DW images were analyzed and color parametric maps of the micro-circulation of blood inside the capillary network (D*) were constructed. The studies were evaluated by two observers to define interobserver reproducibility. RESULTS: Technical success was achieved in all patients (8/8). The mean ankle-brachial index increased from 0.35 ± 0.2 to 0.76 ± 0.25 (p < 0.05). Successful revascularization improved IVIM microperfusion. Mean D* increased from 279.88 ± 13.47 10-5 mm2/s to 331.51 ± 31 10-5 mm2/s, following PTA, p < 0.05. Moreover, PAD patients presented lower D* values as compared to healthy individuals (279.88 ± 13.47 10-5 mm2/s vs 332.47 ± 22.95 10-5 mm2/s, p < 0.05, respectively). Good interobserver agreement was obtained with an ICC = 0.84 (95% CI 0.64-0.93). CONCLUSIONS: IVIM-MRI can detect differences in microperfusion between patients with PAD and healthy individuals. Moreover, significant restitution of IVIM microperfusion is found following successful PTA. ADVANCES IN KNOWLEDGE: IVIM-MRI is a safe, reproducible and effective modality for evaluation of lower limb hypoperfusion in patients with PAD. It seems also to be a helpful tool to detect changes of tissue perfusion in patients with CLI following revascularization.


Assuntos
Angioplastia/métodos , Pé/irrigação sanguínea , Isquemia/diagnóstico por imagem , Isquemia/terapia , Imageamento por Ressonância Magnética/métodos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Adulto , Idoso , Índice Tornozelo-Braço/métodos , Estudos de Viabilidade , Feminino , Pé/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes
3.
Cochrane Database Syst Rev ; 4: CD013702, 2021 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-33910264

RESUMO

BACKGROUND: Bypass surgery using a large saphenous vein graft, or another autologous venous graft, is a well-recognised treatment option for managing peripheral arterial disease of the lower limb, including chronic limb-threatening ischaemia (CLTI) and intermittent claudication, peripheral limb aneurysms, and major limb arterial trauma. Bypass surgery has good results in terms of limb preservation rates and long-term graft patency but is limited by the possibility of vein graft failure due to stenoses of the graft. Detection of stenoses through clinical and ultrasonographic surveillance, followed by treatment, is used to avoid graft occlusion. The conventional approach to treatment of patients with graft stenosis following infrainguinal bypass consists of open surgical repair, which usually is performed under general anaesthesia. Endoluminal treatment with angioplasty is less invasive and uses local anaesthesia. Both methods aim to improve blood flow to the limb. OBJECTIVES: To assess the effectiveness of endoluminal interventions versus surgical intervention for people with vein graft stenosis following infrainguinal bypass. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov to 25 August 2020. SELECTION CRITERIA: We aimed to include all published and unpublished randomised controlled trials (RCTs) that compared endoluminal interventions versus surgical intervention for people with vein graft stenosis following infrainguinal bypass. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed all identified studies for potential inclusion in the review. We aimed to use standard methodological procedures in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The main outcomes of interest were primary patency, primary assisted patency, and all-cause mortality. MAIN RESULTS: We identified no RCTs that met the inclusion criteria for this review. AUTHORS' CONCLUSIONS: We found no RCTs that compared endoluminal interventions versus surgical intervention for stenosis in vein grafts following infrainguinal bypass. Currently, there is no high-certainty evidence to support the use of one type of intervention over another. High-quality studies are needed to provide evidence on managing vein graft stenosis following infrainguinal bypass.


Assuntos
Angioplastia/métodos , Oclusão de Enxerto Vascular/terapia , Perna (Membro)/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Aneurisma/cirurgia , Constrição Patológica/terapia , Humanos , Claudicação Intermitente/cirurgia , Isquemia/cirurgia , Veia Safena/transplante , Grau de Desobstrução Vascular
4.
Transplant Proc ; 53(4): 1272-1274, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33894988

RESUMO

Transplant renal artery stenosis (TRAS) is a common vascular complication after kidney transplantation, leading to worsening or refractory hypertension, deterioration in renal function, and possible cause of graft loss. Early diagnosis and an appropriate treatment are crucial for organ preservation. Endovascular treatment, including percutaneous transluminal angioplasty and stent implantation, is considered the first-line therapy for TRAS. Here we report the case of a 69-year-old woman with end-stage renal disease for chronic kidney disease not biopsy proven, who underwent a kidney transplant from expanded criteria donors on December 2018. Postoperative course was characterized by delayed graft function. Doppler ultrasonography (US) showed an increase of peak systolic velocity at the origin of the renal artery, and parvus-tardus waveform in periferic graft arteries and an abdominal computed tomography scan confirmed a stenosis at the origin of the main renal artery (TRAS). The patient underwent a percutaneous transluminal angioplasty. It was not possible to place a stent at the particular location of the stenosis at the anastomosis. Despite the improvement of the graft's perfusion, monitored with Doppler US, the patient showed a very poor improvement in renal function and remained on hemodialysis for months. A percutaneous needle biopsy reported a normal renal parenchyma and excluded acute rejection. During this period, the patient received immunosuppressive therapy. About 6 months after the transplant, the patient had an unexpected and slow renal function recovery until she was weaned completely from hemodialysis.


Assuntos
Angioplastia/métodos , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Obstrução da Artéria Renal/cirurgia , Artéria Renal/cirurgia , Idoso , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/cirurgia , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica , Artéria Renal/fisiopatologia , Artéria Renal/transplante , Obstrução da Artéria Renal/etiologia
5.
J Cardiothorac Surg ; 16(1): 66, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789712

RESUMO

BACKGROUND: Brachiocephalic vein aneurysm is a rare vascular malformation, which is often reported in case reports. At present it has attracted much attention due to the serious complications, such as vein aneurysm rupture, pulmonary embolism, venous thrombosis, etc. We report a case of left brachiocephalic vein aneurysm with compression symptoms. CASE PRESENTATION: a 52-year-old male who was admitted to our hospital with irritating cough for more than 1 month. Chest contrast-enhanced CT showed a localized expansion of 5.2 cm in diameter of the left brachiocephalic vein in the anterior mediastinum. The patient received venous angioplasty with brachiocephalic vein aneurysm resection, and the postoperative recovery was well. CONCLUSION: Surgical operation is an effecive treatment method for brachiocephalic vein aneurysm, but it is still necessary to choose the appropriate way according to the type, size, location, lesion scope and complications of the vein aneurysm.


Assuntos
Aneurisma/cirurgia , Angioplastia/métodos , Veias Braquiocefálicas/cirurgia , Veias Braquiocefálicas/diagnóstico por imagem , Humanos , Masculino , Mediastino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
7.
Eur J Vasc Endovasc Surg ; 61(5): 820-828, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33648846

RESUMO

OBJECTIVE: The aim was to evaluate the short term safety and effectiveness of the Penumbra/Indigo aspiration thrombectomy Systems (Penumbra Inc.) in patients with acute lower limb ischaemia. (ALLI). Recently, endovascular vacuum assisted thrombectomy devices, similar to those used in the management of acute ischaemic stroke, have become available for peripheral arteries, but data are still scarce. METHODS: To assess vessel patency, a modified Thrombolysis in Myocardial Infarction (TIMI) classification, called TIPI (Thrombo-aspiration In Peripheral Ischaemia), is proposed. The TIPI flow is assessed at presentation, immediately after treatment with the study device, and after all adjuvant procedures. The primary outcome is the technical success of the thrombo-aspiration with the investigative system, defined as near complete or complete revascularisation TIPI 2 - 3. Safety and clinical success rate were collected at one month. RESULTS: One hundred and fifty patients were enrolled. The mean age was 72.4 years and 73.3% were male. Rutherford grade on enrolment was I in 16%, IIa in 40.7%, and IIb in 43.3% with a mean ankle brachial index of 0.19. Primary technical success (TIPI 2 - 3 flow) was achieved in 88.7% of patients. Adjunctive procedures included angioplasty/stenting of chronic atherosclerotic lesions (n = 39), thrombolysis (n = 31), covered stenting (n = 15), and supplementary Fogarty embolectomy (n = 6). After all interventions, assisted primary technical success was 95.3% (TIPI 2 - 3 in 143/150). No systemic bleeding complications or device related serious adverse events were reported. At one month follow up, one death, and one below the knee amputation were recorded. Primary patency was 92% (138/150), and the re-intervention rate was 7.33%, resulting in an assisted primary and secondary patency of 94% and 99.33%, respectively. CONCLUSION: Results from the INDIAN registry reveal that mechanical thrombectomy using the Indigo system is safe and effective for revascularisation of ALLI as a primary therapy.


Assuntos
Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Trombectomia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Angioplastia/efeitos adversos , Angioplastia/instrumentação , Angioplastia/métodos , Índice Tornozelo-Braço , Terapia Combinada/efeitos adversos , Terapia Combinada/instrumentação , Terapia Combinada/métodos , Embolectomia/efeitos adversos , Embolectomia/instrumentação , Embolectomia/métodos , Feminino , Seguimentos , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/mortalidade , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Stents/efeitos adversos , Trombectomia/instrumentação , Trombectomia/métodos , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/métodos , Resultado do Tratamento , Grau de Desobstrução Vascular
8.
Sultan Qaboos Univ Med J ; 21(1): e116-e119, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33777432

RESUMO

Objectives: This study aimed to discuss the different challenges faced while managing emergency vascular surgery cases during the COVID-19 pandemic and how these challenges were overcome. Methods: This study details 14 emergency cases that were managed during a period of one month from mid-March to mid-April at Sultan Qaboos University Hospital, Muscat, Oman. The cases included acute limb ischaemia, critical limb ischaemia, type B dissection of the thoracic aorta, thoraco-abdominal aneurysm, critical internal carotid artery stenosis, trauma, infected arteriovenous forearm loop graft and thrombosed arteriovenous fistulas. Results: Only one patient was confirmed to have COVID-19. Five were negative for COVID-19 while the remaining eight were not tested. Various strategies on how the vascular surgical team accommodated changes in hospital protocols and nationwide lockdown are discussed in detail. Conclusions: With the judicious use of personal protective equipment and consumable surgical and endovascular devices, communication with support services and other hospitals and implementation of triage protocols, it was possible to manage vascular surgery emergencies effectively.


Assuntos
COVID-19/diagnóstico , Emergências , Encaminhamento e Consulta , Doenças Vasculares/terapia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/métodos , Aneurisma Dissecante/terapia , Angioplastia/métodos , Aneurisma Aórtico/terapia , Derivação Arteriovenosa Cirúrgica , COVID-19/complicações , Estenose das Carótidas/terapia , Gerenciamento Clínico , Embolectomia/métodos , Feminino , Oclusão de Enxerto Vascular/complicações , Oclusão de Enxerto Vascular/terapia , Humanos , Isquemia/terapia , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Omã , SARS-CoV-2 , Centros de Atenção Terciária , Extremidade Superior
9.
Cochrane Database Syst Rev ; 2: CD000071, 2021 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-33598915

RESUMO

BACKGROUND: Extracranial carotid artery stenosis is the major cause of stroke, which can lead to disability and mortality. Carotid endarterectomy (CEA) with carotid patch angioplasty is the most popular technique for reducing the risk of stroke. Patch material may be made from an autologous vein, bovine pericardium, or synthetic material including polytetrafluoroethylene (PTFE), Dacron, polyurethane, and polyester. This is an update of a review that was first published in 1996 and was last updated in 2010. OBJECTIVES: To assess the safety and efficacy of different types of patch materials used in carotid patch angioplasty. The primary hypothesis was that a synthetic material was associated with lower risk of patch rupture versus venous patches, but that venous patches were associated with lower risk of perioperative stroke and early or late infection, or both. SEARCH METHODS: We searched the Cochrane Stroke Group trials register (last searched 25 May 2020); the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 4), in the Cochrane Library; MEDLINE (1966 to 25 May 2020); Embase (1980 to 25 May 2020); the Index to Scientific and Technical Proceedings (1980 to 2019); the Web of Science Core Collection; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) portal. We handsearched relevant journals and conference proceedings, checked reference lists, and contacted experts in the field. SELECTION CRITERIA: Randomised and quasi-randomised trials (RCTs) comparing one type of carotid patch with another for CEA. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed eligibility, risk of bias, and trial quality; extracted data; and determined the quality of evidence using the GRADE approach. Outcomes, for example, perioperative ipsilateral stroke and long-term ipsilateral stroke (at least one year), were collected and analysed. MAIN RESULTS: We included 14 trials involving a total of 2278 CEAs with patch closure operations: seven trials compared vein closure with PTFE closure, five compared Dacron grafts with other synthetic materials, and two compared bovine pericardium with other synthetic materials. In most trials, a patient could be randomised twice and could have each carotid artery randomised to different treatment groups. Synthetic patch compared with vein patch angioplasty Vein patch may have little to no difference in effect on perioperative ipsilateral stroke between synthetic versus vein materials, but the evidence is very uncertain (odds ratio (OR) 2.05, 95% confidence interval (CI) 0.66 to 6.38; 5 studies, 797 participants; very low-quality evidence). Vein patch may have little to no difference in effect on long-term ipsilateral stroke between synthetic versus vein materials, but the evidence is very uncertain (OR 1.45, 95% CI 0.69 to 3.07; P = 0.33; 4 studies, 776 participants; very low-quality evidence). Vein patch may increase pseudoaneurysm formation when compared with synthetic patch, but the evidence is very uncertain (OR 0.09, 95% CI 0.02 to 0.49; 4 studies, 776 participants; very low-quality evidence). However, the numbers involved were small. Dacron patch compared with other synthetic patch angioplasty Dacron versus PTFE patch materials  PTFE patch may reduce the risk of perioperative ipsilateral stroke (OR 3.35, 95% CI 0.19 to 59.06; 2 studies, 400 participants; very low-quality evidence). PTFE patch may reduce the risk of long-term ipsilateral stroke (OR 1.52, 95% CI 0.25 to 9.27; 1 study, 200 participants; very low-quality evidence). Dacron may result in an increase in perioperative combined stroke and transient ischaemic attack (TIA) (OR 4.41 95% CI 1.20 to 16.14; 1 study, 200 participants; low-quality evidence) when compared with PTFE. Early arterial re-stenosis or occlusion (within 30 days) was also higher for Dacron patches. During follow-up for longer than one year, more 'any strokes' (OR 10.58, 95% CI 1.34 to 83.43; 2 studies, 304 participants; low-quality evidence) and stroke/death (OR 6.06, 95% CI 1.31 to 28.07; 1 study, 200 participants; low-quality evidence) were reported with Dacron patch closure, although numbers of outcome events were small. Dacron patch may increase the risk of re-stenosis when compared with other synthetic materials (especially with PTFE), but the evidence is very uncertain (OR 3.73, 95% CI 0.71 to 19.65; 3 studies, 490 participants; low-quality evidence). Bovine pericardium patch compared with other synthetic patch angioplasty Bovine pericardium versus PTFE patch materials  Evidence suggests that bovine pericardium patch results in a reduction in long-term ipsilateral stroke (OR 4.17, 95% CI 0.46 to 38.02; 1 study, 195 participants; low-quality evidence). Bovine pericardial patch may reduce the risk of perioperative fatal stroke, death, and infection compared to synthetic material (OR 5.16, 95% CI 0.24 to 108.83; 2 studies, 290 participants; low-quality evidence for PTFE, and low-quality evidence for Dacron; OR 4.39, 95% CI 0.48 to 39.95; 2 studies, 290 participants; low-quality evidence for PTFE, and low-quality evidence for Dacron; OR 7.30, 95% CI 0.37 to 143.16; 1 study, 195 participants; low-quality evidence, respectively), but the numbers of outcomes were small. The evidence is very uncertain about effects of the patch on infection outcomes. AUTHORS' CONCLUSIONS: The number of outcome events is too small to allow conclusions, and more trial data are required to establish whether any differences do exist. Nevertheless, there is little to no difference in effect on perioperative and long-term ipsilateral stroke between vein and any synthetic patch material. Some evidence indicates that other synthetic patches (e.g. PTFE) may be superior to Dacron grafts in terms of perioperative stroke and TIA rates, and both early and late arterial re-stenosis and occlusion. Pseudoaneurysm formation may be more common after use of a vein patch than after use of a synthetic patch. Bovine pericardial patch, which is an acellular xenograft material, may reduce the risk of perioperative fatal stroke, death, and infection compared to other synthetic patches. Further large RCTs are required before definitive conclusions can be reached.


Assuntos
Prótese Vascular , Endarterectomia das Carótidas/métodos , Polietilenotereftalatos , Politetrafluoretileno , Acidente Vascular Cerebral/prevenção & controle , Falso Aneurisma/epidemiologia , Angioplastia/métodos , Viés , Bioprótese , Prótese Vascular/efeitos adversos , Estenose das Carótidas , Endarterectomia das Carótidas/classificação , Endarterectomia das Carótidas/mortalidade , Humanos , Polietilenotereftalatos/efeitos adversos , Politetrafluoretileno/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Veia Safena , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade
10.
Medicine (Baltimore) ; 100(5): e23976, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592852

RESUMO

ABSTRACT: This pilot study retrospectively assessed the feasible efficacy of TurboHawk plaque rotation system (THPRS) for treatment of arteriosclerosis occlusion in lower extremities (AOLE).A total of 36 eligible patients with AOLE were included in this pilot retrospective study. We divided all those patients into a treatment group and a control group, each group 18 patients. All patients in both groups administered conventional therapy. Additionally, all patients in the treatment group received THPRS, while all patients in the control group received percutaneous transluminal angioplasty (PTA) and percutaneous transluminal stenting (PTS). All outcomes were evaluated and analyzed at 3-month after surgery.At 3-month postsurgery, there were not significant statistical differences in clinical manifestations (intermittent claudication, P = .49; resting pain, P = .28), ankle brachial index change (P = .07), 6-minute walk distance (P = .43), and complications between 2 groups.This pilot study did not show better outcome improvement of THPRS for patients with AOLE. We cautiously draw the present conclusion, because it suffers from several major restrictions. Thus, further studies with larger sample size and longer term follow-up are still needed to warrant the current conclusion.


Assuntos
Técnicas de Ablação/instrumentação , Extremidade Inferior/cirurgia , Doença Arterial Periférica/cirurgia , Placa Aterosclerótica/cirurgia , Procedimentos Cirúrgicos Vasculares/instrumentação , Idoso , Angioplastia/métodos , Estudos de Viabilidade , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Rotação , Resultado do Tratamento
11.
J Orthop Surg Res ; 16(1): 42, 2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33430921

RESUMO

BACKGROUND: The combination of endovascular intervention and microvascular free flap transfer has been effectively used for chronic ischemic wounds of lower limb. The aim of this study was to determine the influence of angioplasty on free flap survival in diabetic foot ulcer reconstruction. METHODS: A retrospective research was conducted for 46 diabetic patients with chronic ulcer of the foot. All patients underwent free flap reconstruction because of their non-healing wound with tendon or bone exposure. Patient's demography, clinical data related to vascular status, vascular intervention, and free flap transfer procedure were collected. Flap survival rate was compared between the group with severe arterial stenosis group and non-severe stenosis group. It was also compared among groups with different revascularization results. RESULTS: The average age of patients was 56.2 ± 10.8 years. There were 14 (30.4%) men and 32 (69.6%) women. Of 46 patients, 23 (50%) had severe infrapopliteal arterial stenosis. All 23 patients underwent endovascular intervention. Their final results of the pedal arch were type 1 in 13 patients, type 2A in 7 patients, type 2B in 2 patients, and type 3 in 1 patient. Total flap necrosis was found in 5 (10.9%) cases, marginal necrosis in 4 (8.7%) cases, and wound dehiscence in 4 (8.7%) cases. There was no significant difference in flap loss between severe arterial stenosis patients and non-severe arterial stenosis patients. In the severe arterial stenosis group, after endovascular intervention, patients with type 1 of pedal arch had a significantly lower rate of total flap necrosis than others. There was no association between the use of revascularized recipient artery and flap survival. CONCLUSIONS: Our study revealed that the quality of pedal arch was crucial for free flap survival. Thus, PTA should aim to re-establish a complete pedal arch to increase wound healing rate and flap success.


Assuntos
Angioplastia/métodos , Arteriopatias Oclusivas/cirurgia , Pé Diabético/cirurgia , Procedimentos Endovasculares/métodos , Retalhos de Tecido Biológico/transplante , Sobrevivência de Enxerto , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Artéria Poplítea/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Arteriopatias Oclusivas/complicações , Pé Diabético/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Cicatrização
12.
J Cardiovasc Surg (Torino) ; 62(2): 153-161, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33480520

RESUMO

BACKGROUND: This study aimed to investigate performance, effectiveness, and safety of excimer laser atherectomy for the treatment of complex lower limb artery disease in a real-world setting. METHODS: In our prospective, multicenter registry, consecutive patients with complex lower limb lesions underwent excimer laser atherectomy with optional standard balloon angioplasty, paclitaxel-coated balloon angioplasty, and bailout stenting. Primary outcome was technical success. Secondary outcomes were device performance of the excimer laser system, freedom from target lesion revascularization (TLR), peri-procedural complications, and amputation-free survival in patients with critical limb ischemia (CLI). RESULTS: A total of 294 patients were enrolled at 14 European centers (mean lesion length 109±103 mm, total occlusions 56.8% [167 of 294 lesions], CLI 47.3% [132 of 279 patients]. Adjuvant balloon angioplasty was conducted in 283 (96.3%), and complementary stent implantation in 98 patients (33.3%). Technical success was achieved in 95.3% of patients. Increasing lesion length was associated with decreased laser atherectomy performance (odds ratio [OR] per 10 mm: 0.94 [95% confidence interval [CI] 0.90 to 0.99], P=0.01). A total of 66 patients (22.4%) completed the 12-month follow-up. Freedom from TLR was 83.5% (95% CI: 74.9 to 92.1) at 12 months. Chronic total occlusions were associated with more TLR (OR 5.03 [95% CI: 1.01 to 25.1], P=0.049). Amputation -free survival in patients with CLI was 93.1% (95% CI: 83.9 to 100). CONCLUSIONS: Excimer laser atherectomy substantially contributed to technical success of endovascular treatment of complex infra-inguinal lesions. Freedom from 12-month TLR was reasonable.


Assuntos
Angioplastia/métodos , Aterectomia/métodos , Lasers de Excimer/uso terapêutico , Perna (Membro)/irrigação sanguínea , Doença Arterial Periférica/terapia , Angiografia , Europa (Continente) , Feminino , Humanos , Masculino , Estudos Prospectivos , Sistema de Registros , Stents
13.
Pediatr Cardiol ; 42(4): 814-820, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33464372

RESUMO

Supravalvular pulmonary stenosis (SVPS) is considered a rare form of pulmonary stenosis (PS) and represents both a diagnostic and therapeutic challenge. There currently exist no reliable echocardiographic criteria to accurately predict the supravalvular form. The aims of the study were to describe the response to treatment of the different PS presentations and to outline the diagnostic capacity of echocardiogram to differentiate the SVPS from valvular PS (VPS). This retrospective study included 106 patients who underwent percutaneous angioplasty between 2006 and 2017. Interventional outcomes of patients with SVPS were compared to those of patients with VPS. Diagnosis of VPS vs. SVPS by echocardiogram was compared to diagnosis obtained by angiogram. Echocardiogram yielded a sensitivity of 56%, a specificity of 82.5%, a positive predictive value of 50%, and a negative predictive value of 85.7%. Patients with SVPS had a significantly smaller pulmonary artery to pulmonary valve (PA:PV) ratio. At 6-12 months of follow-up, the VPS group had a mean right ventricular to pulmonary artery (RV-PA) gradient of 21.68 ± 19.85 mmHg compared to 45.27 ± 24.58 mmHg in the SVPS group. Patients with SVPS had a higher rate of reintervention than patients with VPS (32% vs. 6.2%, p < 0.001). There was no difference in major complications between groups, whereas VPS patients had a higher proportion of pulmonary insufficiency. Percutaneous angioplasty for PS is less effective in patients with a supravalvular component. A better understanding of the underlying histopathology of different PS subtypes could lead to development of different techniques to improve outcomes, with fewer reinterventions, in this population.


Assuntos
Angioplastia com Balão/métodos , Ecocardiografia/métodos , Estenose da Valva Pulmonar/diagnóstico , Estenose da Valva Pulmonar/cirurgia , Angiografia/métodos , Angioplastia/métodos , Criança , Pré-Escolar , Dilatação/métodos , Feminino , Humanos , Lactente , Masculino , Valor Preditivo dos Testes , Artéria Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Insuficiência da Valva Pulmonar/epidemiologia , Estudos Retrospectivos , Sensibilidade e Especificidade
14.
Cardiovasc Intervent Radiol ; 44(5): 784-788, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33388871

RESUMO

PURPOSE: To evaluate the technical success and safety of a steerable coaxial sharp recanalization technique that utilizes routine needles in patients with refractory thoracic central venous occlusions. MATERIALS AND METHODS: This retrospective study was performed on 36-attempted sharp recanalizations in 35 patients (mean age 50 years, 23 male) performed via a supraclavicular approach. In all cases, an 18-gauge trocar needle was custom curved to provide directional control during fluoroscopic triangulation. A 22-gauge Chiba needle was then advanced coaxially across the occlusion. A tractogram was performed to assess for traversal of unintended structures. Procedures were completed by catheter placement, angioplasty, or stenting follow successful recanalizations. RESULTS: Sharp recanalization using this steerable coaxial needle technique demonstrated a technical success rate of 94% (34/36). The mean occlusion length was 30 mm (range 3-53 mm). In 11 patients, success was achieved using this technique after failure of other advanced techniques. In five procedures, stent interstices were traversed. Sharp recanalization was the direct cause of one major complication consisting of pleural transgression causing mild hemothorax treated successfully with a stent graft. CONCLUSION: The proposed technique is effective and safe for patients who have failed traditional blunt recanalization techniques. LEVEL OF EVIDENCE: Level 4, Case Series.


Assuntos
Angioplastia/métodos , Stents , Tórax/irrigação sanguínea , Doenças Vasculares/cirurgia , Adulto , Idoso , Cateterismo Venoso Central , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
15.
Isr Med Assoc J ; 23(1): 28-32, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33443339

RESUMO

BACKGROUND: Patients with critical limb ischemia (CLI) involving the below-the-knee (BTK) arteries are at increased risk of limb loss. Despite improvement in endovascular modalities, it is still unclear whether an aggressive approach results in improved limb salvage. OBJECTIVES: To assess whether an aggressive approach to BTK arterial disease results in improved limb salvage. METHODS: A comparative study of two groups was conducted. Group 1 included patients treated between 2012 and 2014, primarily with transfemoral angioplasty of the tibial arteries. Group 2 included patients treated between 2015-2019 with a wide array of endovascular modalities (stents, multiple tibial artery and pedal angioplasty, retrograde access). Primary endpoint was freedom from amputation at 4 years. RESULTS: A total of 529 BTK interventions were performed. Mean age was 71 ± 10.6 years, 382 (79%) were male. Patients in group 1 were less likely to be taking clopidogrel (66% vs. 83%, P < 0.01) and statins (72 % vs. 87%, P < 0.01). Several therapeutic modalities were used more often in group 2 than in group 1, including pedal angioplasty (24 vs. 43 %, P = 0.01), tibial and pedal retrograde access (0 vs. 10%, P = 0.01), and tibial stenting (3% vs. 25%, P = 0.01). Revascularization of two or more tibial arteries was performed at a higher rate in group 2 (54% vs. 50%, P = 0.45). Estimated freedom from amputation at 40 months follow-up was higher in group 2 (53% vs. 63%, P = 0.05). CONCLUSIONS: An aggressive, multimodality approach in treating BTK arteries results in improved limb salvage.


Assuntos
Amputação , Angioplastia , Procedimentos Endovasculares , Isquemia , Perna (Membro) , Salvamento de Membro , Doença Arterial Periférica , Complicações Pós-Operatórias , Artérias da Tíbia , Idoso , Amputação/métodos , Amputação/estatística & dados numéricos , Angioplastia/efeitos adversos , Angioplastia/métodos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Feminino , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/cirurgia , Israel , Perna (Membro)/irrigação sanguínea , Perna (Membro)/cirurgia , Salvamento de Membro/instrumentação , Salvamento de Membro/métodos , Salvamento de Membro/estatística & dados numéricos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Doença Arterial Periférica/complicações , Doença Arterial Periférica/fisiopatologia , Doença Arterial Periférica/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Stents , Artérias da Tíbia/diagnóstico por imagem , Artérias da Tíbia/fisiopatologia , Artérias da Tíbia/cirurgia , Grau de Desobstrução Vascular
16.
J Vasc Access ; 22(2): 280-287, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32623945

RESUMO

BACKGROUND: Coronavirus disease 2019 is an epidemic disease throughout the world. The management of vascular access during the epidemic is currently unknown. METHODS: In this multicenter cross-sectional study, we collected vascular access data from hemodialysis patients treated at 44 hospitals in Hubei from 22 January to 10 March 2020. We estimated the management of vascular access during the coronavirus disease 2019 outbreak. RESULTS: Of the 9231 hemodialysis patients included, 5387 patients (58.4%) were men and 2959 patients (32.1%) were older than 65 years. Arteriovenous fistula was the predominant type of vascular access, accounting for 76.5%; 496 patients (5.4%) developed vascular access complications; catheter flow reduction was the most common vascular access complication, and stenosis was the predominant complication among those with arteriovenous access. Overall, 280 vascular access sites were placed in patients newly diagnosed with uremia, of whom 260 (92.8%) underwent catheter insertion; 149 rescue procedures were carried out to treat the vascular access complications, which consisted of 132 catheters, 7 percutaneous transluminal angioplasties, 6 arteriovenous fistula repairs, and 4 arteriovenous fistulas. Occlusion of the arteriovenous access had the highest rescue rate (92.7%), while many other vascular access complications remained untreated; 69 and 142 patients were diagnosed with confirmed and suspected coronavirus disease 2019, respectively. A total of 146 patients died, of whom 29 patients (19.9%) died due to vascular access complications. CONCLUSION: Catheter flow reduction and stenosis of arteriovenous access were the major vascular access complications. Most of the vascular access sites established were catheters, and many of the vascular access complications remained untreated.


Assuntos
Angioplastia/métodos , COVID-19/epidemiologia , Oclusão de Enxerto Vascular/terapia , Diálise Renal/métodos , Insuficiência Renal/terapia , Adolescente , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , China/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Insuficiência Renal/epidemiologia , Adulto Jovem
17.
J Neurointerv Surg ; 13(2): 109-113, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32690759

RESUMO

BACKGROUND: Radial access has become popular among neurointerventionalists because it has favorable risk profiles compared with femoral access. Difficulties in accessing or navigating the radial artery have been viewed as a reason to convert to femoral access, but ulnar artery access may prevent complications associated with transfemoral procedures. OBJECTIVE: To evaluate the safety and feasibility of ulnar access for neurointerventions and diagnostic neuroangiographic procedures. METHODS: Consecutive patients who underwent diagnostic angiography or neurointerventional procedures via ulnar access between July 1, 2019 and April 15, 2020 were included. Data recorded were demographics, procedure indication, devices, technique, and complications. Descriptive analysis was performed. RESULTS: Ulnar artery access was obtained for 21 procedures in 18 patients (mean age 70.3±7.8 years; nine men). Procedures included 13 diagnostic angiograms and eight neurointerventions (3 left middle meningeal artery embolization, 1 of which was aborted; 2 carotid artery stenting; 2 angioplasty; 1 mechanical thrombectomy for in-stent thrombosis). A right-sided approach with ultrasound guidance was used for all cases except one. Indications included small caliber radial artery (n=9), radial artery occlusion (n=10), and radial artery preservation for potential bypass (n=2). A 5-French slender sheath was used for diagnostic angiography; a 6-French slender sheath was used for neurointerventions. No case required conversion to femoral access. Two patients had minor hematomas after the procedure; one other had ulnar artery occlusion on 30-day ultrasonography. CONCLUSION: Ulnar access is safe and feasible for diagnostic and interventional neuroangiographic procedures. It provides a useful alternative to radial access, potentially avoiding complications associated with femoral access.


Assuntos
Angioplastia/métodos , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/terapia , Angiografia Cerebral/métodos , Embolização Terapêutica/métodos , Artéria Ulnar/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Angioplastia/efeitos adversos , Angiografia Cerebral/efeitos adversos , Embolização Terapêutica/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents/efeitos adversos
18.
Clin Radiol ; 76(2): 157.e1-157.e10, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32993879

RESUMO

AIM: To evaluate the ultra-lose dose imaging protocol (ULDP), compared to the standard low-dose imaging protocol (LDP), which are used for haemodialysis access, in terms of radiation exposure and image quality. MATERIAL AND METHODS: This was a single-centre, institutional review board-approved, prospective, double-blinded randomised controlled study to compare radiation exposure and image quality of the ULDP and LDP. Ten proceduralists, two radiographers, and 11 nurses were enrolled. Radiation exposure during 80 procedures (40 angioplasties and 40 thrombolysis) was recorded (direct radiation to patients from protocol report and scattered radiation to participants from the RaySafe i2 real-time dosimetry system). Baseline characteristics of procedure were recorded. Image quality was assessed subjectively using questionnaires based on the five-point Likert scale after each procedure. RESULTS: Compared with LDP, the use of ULDP was associated with a significantly lower rate of radiation exposure to proceduralists, patients, and scrub nurses (0.506±0.430 versus 0.847±0.965 µSv/s, p=0.044; 0.571±1.284 versus 1.284±1.007 mGy/s, p<0.001; and 0.052±0.071 versus 0.141±0.185 µSv/s, p=0.005, respectively). No significant difference in image quality or duration of procedure was observed (all p values >0.05). CONCLUSION: Compared with LDP, the use of ULDP was associated with a significantly lower rate of radiation exposure to proceduralists, patients, and scrub nurses without compromising the image quality or duration of procedure.


Assuntos
Angiografia Digital/métodos , Angioplastia/métodos , Oclusão de Enxerto Vascular/cirurgia , Trombólise Mecânica/métodos , Doses de Radiação , Exposição à Radiação/estatística & dados numéricos , Adulto , Protocolos Clínicos , Método Duplo-Cego , Feminino , Fluoroscopia , Humanos , Masculino , Estudos Prospectivos
20.
J Trauma Acute Care Surg ; 90(2): 384-387, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33075025

RESUMO

INTRODUCTION: The optimal management of minimal blunt thoracic aortic injuries (BTAIs) remains controversial, with experienced centers using therapy ranging from medical management (MM) to thoracic endovascular aortic repair (TEVAR). METHODS: The Aortic Trauma Foundation registry was used to examine demographics, injury characteristics, management, and outcomes of patients with BTAI. RESULTS: Two hundred ninety-six patients from 28 international centers were analyzed (mean age, 44.5 years [SD, 18 years]; 76% [225/296] male; mean Injury Severity Score, 34 [SD, 14]). Blunt thoracic aortic injury was classified as Grade I, 22.6% (67/296); Grade II, 17.6% (52/296); Grade III, 47.3% (140/296); and Grade IV, 12.5% (37/296). Overall aortic-related mortality (ARM) was 4.7% (14/296). Among all deaths, 33% (14/42) were ARM. Open repair was required for only 2%, with most undergoing TEVAR (58.4%) or MM (28.0%). Thoracic endovascular repair complications occurred in 3.4% (6/173), most commonly Type 1 endoleak (2.3%; 4/173). Among patients with minimal aortic injury (Grades I and II), 59.7% (71/119) received MM, while 40.3% (48/119) underwent TEVAR. Two patients initially managed with MM required subsequent TEVAR for injury progression during initial hospital stay. No significant difference in ARM between MM and TEVAR was noted for Grades I and II injuries. CONCLUSION: A third of the trauma victims with BTAI succumb to ARM. Thoracic endovascular repair has replaced open repair but remains equivalent in outcomes to MM for minimal injuries. These data support MM of patients with minimal aortic injury. LEVEL OF EVIDENCE: Therapeutic study, level IV.


Assuntos
Angioplastia , Aorta Torácica , Aorta , Tratamento Conservador , Procedimentos Endovasculares , Lesões do Sistema Vascular , Ferimentos não Penetrantes , Adulto , Angioplastia/efeitos adversos , Angioplastia/métodos , Angioplastia/estatística & dados numéricos , Aorta/lesões , Aorta/cirurgia , Aorta Torácica/lesões , Aorta Torácica/cirurgia , Tratamento Conservador/efeitos adversos , Tratamento Conservador/métodos , Tratamento Conservador/mortalidade , Endoleak/epidemiologia , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Mortalidade , Avaliação de Processos e Resultados em Cuidados de Saúde , Sistema de Registros/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos/epidemiologia , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/cirurgia , Lesões do Sistema Vascular/terapia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgia
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