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2.
Angiol Sosud Khir ; 27(3): 28-32, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528586

RESUMO

Endovascular abdominal aortic aneurysm repair is an operation of choice in rendering hi-tech care for patients with aneurysms of the infrarenal aortic portion. The most frequently performed reoperations account for cases related to removing endoleaks. The article deals with assessing the presence of various types of endoleaks depending on the time elapsed after abdominal aortic aneurysm repair by means of duplex scanning and multislice computed tomography. Duplex scanning proved highly informative in detecting various types of endoleaks, being comparable with the findings of multislice computed tomography (p=0.917). The presence or absence of aneurysmal cavity coloration in the mode of Doppler colour mapping makes it possible to dynamically follow up the process of thrombogenesis. For timely diagnosis of complications after endoprosthetic repair of abdominal aortic aneurysms, the use of ultrasound duplex scanning is considered to be an informative and safe technique, possessing potential possibility of detecting endoleaks and, in our opinion, may be included into the protocol of follow-up of patients in the early postoperative period.


Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Seguimentos , Humanos , Ultrassonografia
3.
Angiol Sosud Khir ; 27(3): 85-93, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528592

RESUMO

Presented herein are the results of treatment of 137 patients with infrarenal aneurysms of the abdominal portion of the aorta in a combination with ischaemic heart disease. Severity of lesions to the coronary bed and the risk of cardiac complications were assessed according to the SYNTAX score. Depending on severity of angina pectoris and the clinical course of infrarenal aortic aneurysms, we used different tactical approaches to operative treatment of patients. In a low risk of coronary complications, we performed isolated prosthetic repair or endoprosthetic reconstruction of the abdominal aorta. In patients with haemodynamically significant lesions of the coronary bed and positive non-invasive tests, the first stage consisted in coronary artery bypass grafting or stenting of coronary arteries taking into account the risk of cardiac complications according to the SYNTAX Score. The second stage consisted in prosthetic repair or endoprosthetic reconstruction of the abdominal aorta. The terms of the second stage differed and were determined by the course of abdominal aortic aneurysms. In symptomatic large aneurysms (more than 8 cm), prosthetic repair of the abdominal aorta was carried out within 2 weeks after previous stenting of coronary arteries. Simultaneous myocardial revascularization and abdominal aortic reconstruction were performed only in patients with severe angina pectoris, lesions of the trunk of the left coronary artery, three-vessel lesions of the coronary bed, high risk of cardiac complications according to the SYNTAX Score and a complicated or symptomatic course of an infrarenal aortic aneurysm. During implantation of stent grafts into the abdominal aorta there were neither lethal outcomes nor cardiac complications. In open operations, the 30-day mortality rate amounted to 2.2%, with the 5-year survival rate of 92%.


Assuntos
Aneurisma da Aorta Abdominal , Aneurisma Aórtico , Isquemia Miocárdica , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Humanos , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
4.
Angiol Sosud Khir ; 27(3): 132-139, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528597

RESUMO

Infection of arterial vascular grafts is a rare but utterly severe complication in vascular surgery. Therapeutic policy in patients with graft infection has not been standardized, to be determined individually. One of the variants of surgical treatment is considered to be repeat aortic repair using a cadaveric graft. Presented in the article is a clinical case report concerning a 60-year-old male patient previously subjected to aortofemoral bifurcation bypass grafting with stage IV ischaemia of lower limbs according to the Pokrovsky-Fontaine classification. In the early postoperative period the events of critical ischaemia were not arrested. Due to the presence of a block of the femoropopliteal segment, as the second stage 3 days after the primary operation, the patient underwent autovenous femoropopliteal bypass grafting with a reversed autovein above the knee-joint fissure. The clinical course of critical ischaemia of the limb was relieved. During subsequent 8 months of follow up his state remained stable. Eight months after the primary operation he developed purulent discharge from the postoperative scar on the left femur. In the setting of the Purulent Surgery Department, the patient was emergently subjected to opening and drainage of the abscess of the postoperative scar. On the bottom of the wound there was a freely lying branch of a synthetic vascular prosthesis. Computed tomography revealed infection of the entire synthetic prosthesis and aneurysms of distal anastomoses. Given extremely high risk for the development of arrosive haemorrhage, a decision was made on operative treatment - repeat prosthetic repair of the abdominal aorta with a cadaveric allograft. At the Vascular Department of the Clinic of Faculty Surgery, laparotomy was performed, with removal of the infected graft, followed by debridement of the retroperitoneal space and repeat aortofemoral bifurcation prosthetic repair of the abdominal aorta with a cadaveric allograft. The wound healed with first intention. There was no evidence of infectious process relapse. The patient was discharged on postoperative day 15 in a satisfactory condition. The duration of follow up amounted to 6 months. The control examination showed that the pain-free walking distance was 500 m. Doppler ultrasonography demonstrated that the graft was functioning, with no signs of either anastomotic aneurysms or suppuration of the retroperitoneal space.


Assuntos
Implante de Prótese Vascular , Prótese Vascular , Aloenxertos , Aorta Abdominal/cirurgia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Cadáver , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
5.
Pan Afr Med J ; 39: 181, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34584607

RESUMO

Leriche syndrome or aortoiliac occlusive disease is a particular obliterative arterial disease of the lower limbs, consisting of thrombotic occlusion of the aortoiliac junction. We here report the case of a 20-year-old female patient with no particular past medical history, presenting with acute lower limb ischemia. Lower extremity echo Doppler showed overall decrease in arterial blood flow without visualization of endoluminal material. Lower limb angioscaner showed arterial thrombosis of the abdominal aorta extended to bilateral external iliac arteries. The patient subsequently underwent aortic-bi-iliac bypass surgery with good evolution as well as assessments for possible thrombogenic mechanism.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Síndrome de Leriche/diagnóstico por imagem , Trombose/diagnóstico por imagem , Aorta Abdominal/cirurgia , Ecocardiografia Doppler/métodos , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Isquemia/diagnóstico por imagem , Síndrome de Leriche/cirurgia , Extremidade Inferior/irrigação sanguínea , Adulto Jovem
6.
Rozhl Chir ; 100(7): 330-338, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34465109

RESUMO

INTRODUCTION: Vascular graft infection in the aortoiliac territory (abdominal VGI) is undoubtedly one of the most serious complications in vascular surgery. The treatment is burdened with high mortality and morbidity rates. In 2020, the Guidelines on the Management of Vascular Graft and Endograft Infections were published by the European Society for Vascular Surgery (ESVS). In the light of these guidelines, we decided to review retrospectively all patients who presented to our institution with abdominal VGI. METHODS: Retrospective observational study of patients presented with abdominal VGI treated in our institution between 20112019 (9 years). The primary goal was to elucidate the rate of vascular graft infection in aortoiliac reconstructions performed between 20112019 and also the mortality rate in the patient cohort operated for this complication. The secondary goals were to evaluate the success rate and the complication rate in different types of reconstructions. RESULTS: In the defined period between 20112019 we performed 363 open aortoiliac reconstructions. During the same period we treated altogether 15 patients with abdominal VGI, whose primary reconstruction was mostly performed before 2011 (11 patients). In our cohort of patients who underwent reconstruction between 20112019 we observed a graft infection only in 4 cases (1.1%). In the group of 15 patients with abdominal VGI, the male gender prevailed (14 patients). The mean age at the time of primary reconstruction was 61 years. Most of our reconstructions were performed for occlusive disease (14 cases). All infected grafts were aortobifemoral (1 unilateral aortofemoral). They were all late infections with an average presentation time of 61 months since the primary reconstruction (15180 months). Early mortality rate was as high as 27% (4 patients) and overall mortality was 40%. The secondary reinfection rate after primary treatment was 33%. CONCLUSION: Treatment of abdominal VGI is still burdened with high mortality and morbidity rates. The current ESVS guidelines provide valuable guidance for the diagnosis and management of VGI. It nevertheless remains obvious that the treatment needs to be tailored individually in a multidisciplinary team environment.


Assuntos
Prótese Vascular , Procedimentos Cirúrgicos Vasculares , Aorta Abdominal/cirurgia , Prótese Vascular/efeitos adversos , Humanos , Artéria Ilíaca , Masculino , Estudos Retrospectivos , Stents , Resultado do Tratamento
8.
J Cardiothorac Surg ; 16(1): 219, 2021 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-34348745

RESUMO

BACKGROUND: There are a lot of reports of the renal failure and heart failure due to coarctation of the aorta. However, there are no case reports in which revascularization dramatically improved left ventricular function in patients with progressive decline in left ventricular function. Herein, we present a rare case in which the left ventricular function was dramatically improved by surgical treatment for progressive left ventricular dysfunction due to atypical coarctation of the aorta. CASE PRESENTATION: A 58-year-old man underwent left axillary artery-bilateral femoral artery bypass at another hospital for atypical coarctation of the aorta due to Takayasu's arteritis. Approximately 10 years later, he was re-hospitalized for heart failure, and the left ventricular ejection fraction gradually decreased to 28%. Computed tomography showed severe calcification and stenosis at the same site from the peripheral thoracic descending aorta to the lower abdominal aorta of the renal artery, and aortography showed delayed bilateral renal artery blood flow. An increase in plasma renin activity was also observed. Despite the administration of multiple antihypertensive drugs, blood pressure control was insufficient. We decided to perform surgical treatment to improve progressive cardiac dysfunction due to increased afterload and activated plasma renin activity. Descending thoracic aorta-abdominal aorta bypass and revascularization of the bilateral renal arteries via the great saphenous vein grafts were performed. Postoperative blood pressure control was improved, and the dose of antihypertensive drugs could be reduced. Plasma renin activity decreased, and transthoracic echocardiography 1.5 years later showed an improvement in contractility with a left ventricular ejection fraction of 58%. CONCLUSION: In atypical coarctation of the aorta in patients with decreased bilateral renal blood flow, heart failure due to renal hypertension, and progressive decrease in left ventricular contractility, descending thoracic aorta-abdominal aortic bypass and bilateral renal artery recirculation can be extremely effective.


Assuntos
Aorta Abdominal , Coartação Aórtica , Insuficiência Cardíaca , Arterite de Takayasu , Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Coartação Aórtica/complicações , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Circulação Renal , Volume Sistólico , Arterite de Takayasu/complicações , Arterite de Takayasu/cirurgia , Função Ventricular Esquerda
9.
J Cardiothorac Surg ; 16(1): 217, 2021 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-34348767

RESUMO

INTRODUCTION: Total thoracic-abdominal aortic aneurysm is a rare disease in cardiovascular surgery, with high surgical risk and high mortality. Surgery is considered the most effective treatment for total aortic aneurysms. CASE PRESENTATION: Our group admitted a 60-year-old female patients with asymptomatic complex total thoracic-abdominal aortic aneurysm, and successfully performed two-staged surgery, namely Bentall + Sun's operation in the first-stage and thoracoabdominal aortic replacement in the second-stage. The results of the surgery were satisfactory. CONCLUSIONS: Patients with total thoracic-abdominal aortic aneurysm may not have typical clinical symptoms and require a careful and comprehensive physical examination and related auxiliary examinations by clinicians. Staged repair of total thoracic-abdominal aortic aneurysms is still a safe and effective treatment.


Assuntos
Aneurisma da Aorta Abdominal , Aneurisma da Aorta Torácica , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Feminino , Humanos , Pessoa de Meia-Idade
10.
J Trauma Acute Care Surg ; 91(2): 318-324, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397953

RESUMO

BACKGROUND: Pelvic angioembolization (AE) is a mainstay in the treatment algorithm for pelvic hemorrhage from pelvic fractures. Nonselective AE refers to embolization of the bilateral internal iliac arteries (IIAs) proximally rather than embolization of their tributaries distally. The aim of this study was to quantify the effect of nonselective pelvic AE on pelvic venous flow in a swine model. We hypothesized that internal iliac vein (IIV) flow following IIA AE is reduced by half. METHODS: Nine Yorkshire swine underwent nonselective right IIA gelfoam AE, followed by left. Pelvic arterial and venous diameter, velocity, and flow were recorded at baseline, after right IIA AE and after left IIA AE. Linear mixed-effect model and signed rank test were used to evaluate significant changes between the three time points. RESULTS: Eight swine (77.8 ± 7.1 kg) underwent successful nonselective IIA AE based on achieving arterial resistive index of 1.0. One case was aborted because of technical difficulties. Compared with baseline, right IIV flow rate dropped by 36% ± 29% (p < 0.05) and 54% ± 29% (p < 0.01) following right and left IIA AE, respectively. Right IIA AE had no initial effect on left IIV flow (0.37% ± 99%, p = 0.95). However, after left IIA AE, left IIV flow reduced by 54% ± 27% (p < 0.01). Internal iliac artery AE had no effect on the external iliac arterial or venous flow rates and no effect on inferior vena cava flow rate. CONCLUSION: The effect of unilateral and bilateral IIA AE on IIV flow appears to be additive. Despite bilateral IIA AE, pelvic venous flow is diminished but not absent. There is abundant collateral circulation between the external and internal iliac vascular systems. Arterial embolization may reduce venous flow and improve on resuscitation efforts in those with unstable pelvic fractures. LEVEL OF EVIDENCE: Prognostic, level IV.


Assuntos
Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Hemorragia/terapia , Artéria Ilíaca/cirurgia , Pelve/irrigação sanguínea , Animais , Aorta Abdominal/cirurgia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Modelos Animais de Doenças , Procedimentos Endovasculares/instrumentação , Feminino , Fraturas Ósseas/complicações , Hemorragia/prevenção & controle , Artéria Ilíaca/fisiopatologia , Masculino , Ossos Pélvicos/lesões , Ossos Pélvicos/patologia , Suínos
11.
J Am Heart Assoc ; 10(16): e020854, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34387124

RESUMO

Background Current right ventricular (RV) volume overload (VO) is established in adult mice. There are no neonatal mouse VO models and how VO affects postnatal RV development is largely unknown. Methods and Results Neonatal VO was induced by the fistula between abdominal aorta and inferior vena cava on postnatal day 7 and confirmed by abdominal ultrasound, echocardiography, and hematoxylin and eosin staining. The RNA-sequencing results showed that the top 5 most enriched gene ontology terms in normal RV development were energy derivation by oxidation of organic compounds, generation of precursor metabolites and energy, cellular respiration, striated muscle tissue development, and muscle organ development. Under the influence of VO, the top 5 most enriched gene ontology terms were angiogenesis, regulation of cytoskeleton organization, regulation of vasculature development, regulation of mitotic cell cycle, and regulation of the actin filament-based process. The top 3 enriched signaling pathways for the normal RV development were PPAR signaling pathway, citrate cycle (Tricarboxylic acid cycle), and fatty acid degradation. VO changed the signaling pathways to focal adhesion, the PI3K-Akt signaling pathway, and pathways in cancer. The RNA sequencing results were confirmed by the examination of the markers of metabolic and cardiac muscle maturation and the markers of cell cycle and angiogenesis. Conclusions A neonatal mouse VO model was successfully established, and the main processes of postnatal RV development were metabolic and cardiac muscle maturation, and VO changed that to angiogenesis and cell cycle regulation.


Assuntos
Transcriptoma , Disfunção Ventricular Direita/genética , Função Ventricular Direita/genética , Animais , Animais Recém-Nascidos , Aorta Abdominal/fisiopatologia , Aorta Abdominal/cirurgia , Derivação Arteriovenosa Cirúrgica , Modelos Animais de Doenças , Perfilação da Expressão Gênica , Regulação da Expressão Gênica no Desenvolvimento , Masculino , Camundongos Endogâmicos C57BL , RNA-Seq , Fatores de Tempo , Veia Cava Inferior/fisiopatologia , Veia Cava Inferior/cirurgia , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia
14.
J Cardiothorac Surg ; 16(1): 190, 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233714

RESUMO

OBJECTIVE: Acute aortic dissection is a life-threatening condition. Thoracic endovascular aortic repair (TEVAR), together with optimized medical treatment, is currently the first line treatment for acute Stanford type B aortic dissection. TEVAR can close the entry tear and reduce mortality. Aortic remodeling after TEVAR can directly affect the patient's long-term prognosis. The factors that influence aortic remodeling have, however, received insufficient clinical attention and remain unclear. It is very important to identify these factors. METHODS: A total of 100 patients were continuously enrolled from 2011 to 2018 in 2 centers. Relevant data, including time from hospital admission to surgery, medicine use and aortic computed tomography angiography images obtained before and 6 months after surgery were collected. Patients were divided into favorable and adverse aortic remodeling groups, according to the degree of aortic remodeling. Analysis of variance and the chi-square test were performed using SPSS software to compare differences between groups and to determine the factors that influence postoperative aortic remodeling. RESULTS: The proportion of single-stent implantations was higher in the favorable remodeling group than in the adverse remodeling group (79.5% vs. 53.8% in distal end of stent-graft level and 81.3% vs. 56.4% in diaphragm level, respectively, p < 0.05). The earlier the TEVAR procedure was performed, the better the aortic remodeling (3.4 days vs. 4.8 days in distal stent graft levels, and 3.6 days vs. 4.9 days in diaphragm level, respectively, p < 0.05), the presence of residual distal entry tears in the abdominal aorta also improved aortic remodeling after TEVAR (85.7% vs. 55.1% in the celiac trunk level, and 92.0% vs. 48.9% in the right renal artery level, respectively, p < 0.05). CONCLUSION: Single stent-graft implantation and early surgery were associated with favorable aortic remodeling. Distal entry tears were also conducive to aortic remodeling after surgery for aortic dissection.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Remodelação Vascular/fisiologia , Adulto , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Angiol Sosud Khir ; 27(2): 152-158, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34166356

RESUMO

Despite advances in the development of endovascular techniques of revascularization of renal arteries, in certain clinical cases still remains the need to perform extra-anatomic renal bypass grafting. To such instances belong complicated atherosclerotic aortic lesions, technical difficulties occurring during open revascularization of the aorta and its branches, as well as aneurysms of the juxtarenal portion of the abdominal aorta. Presented herein is a clinical case concerning a patient subjected to non-standard restoration of blood flow in the right renal artery after thromboendarterectomy from the juxtarenal aorta, performed from the left-sided extraperitoneal phrenolumbotomic approach and complicated by secondary dissection of the intima in the right renal artery.


Assuntos
Implante de Prótese Vascular , Procedimentos Endovasculares , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Prótese Vascular , Dissecação , Endarterectomia , Humanos , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia
17.
Eur J Vasc Endovasc Surg ; 62(1): 46-53, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34088613

RESUMO

OBJECTIVE: Greater population life expectancy and consistent improvement in diagnostic techniques have increased the diagnosis of abdominal aortic aneurysms (AAAs) in the elderly population. The aim was to study the natural history of small (< 55 mm) incidental AAAs in octogenarian and nonagenarian patients to assess the need for follow up and/or invasive treatment. METHODS: This was a retrospective analysis of a prospective registry. Patients ≥ 80 years old at the time of diagnosis of a < 55 mm AAA in 1988-2018 were selected. Clinical and anatomical characteristics were registered. Patients were divided in three groups: 30 - 39 mm, 40 - 49 mm, and 50 - 54 mm AAA. The outcome variables were aorto-iliac rupture, AAA reaching a surgical threshold (≥ 55 mm), and death. A descriptive statistical analysis was performed and life tables, Kaplan-Meier curves, and uni- and multivariable Cox regression were used. RESULTS: Three hundred and ten patients were included, 256 (82.6%) men, with mean index age of 84.5 years (standard deviation [SD] 3.5), and median follow up of 37.9 months (interquartile range [IQR] 18.2 - 65.4). Eighteen (5.8%) AAAs ruptured; four of these patients were operated on and only one survived. Sixty-two (20%) AAA reached a surgical size; eight were repaired electively, with 0% early mortality. The survival rates were 81%, 70%, and 38% at one, two, and five years. The rupture rates were 1%, 2%, and 6% and the AAAs reaching surgical threshold were 1%, 4%, and 19% for the same time periods. AAA size < 40 mm was an independent protective factor from rupture (0.13; 95% confidence interval [CI] 0.03 - 0.48), reaching surgical threshold (0.08; 95% CI 0.04 - 0.16) and death (0.63; 95% CI 0.42 - 0.95). CONCLUSION: The risk of late rupture of small incidental AAA diagnosed in octogenarian and nonagenarian patients is very small, especially when the AAA is < 40 mm in diameter. In contrast, global mortality is high. Conservative management seems sensible, with strict selection of the patients who would benefit from follow up and eventual repair.


Assuntos
Aneurisma da Aorta Abdominal/mortalidade , Ruptura Aórtica/mortalidade , Tratamento Conservador/estatística & dados numéricos , Procedimentos Endovasculares/estatística & dados numéricos , Fatores Etários , Idoso de 80 Anos ou mais , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/terapia , Ruptura Aórtica/etiologia , Ruptura Aórtica/prevenção & controle , Ruptura Aórtica/cirurgia , Progressão da Doença , Seguimentos , Humanos , Achados Incidentais , Masculino , Seleção de Pacientes , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Espanha/epidemiologia , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
18.
Eur J Vasc Endovasc Surg ; 62(1): 26-35, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34090782

RESUMO

OBJECTIVE: Aortic neck dilatation (AND) occurs after endovascular aneurysm repair (EVAR) with self expanding stent grafts (SESs). Whether it continues, ultimately exceeding the endograft diameter leading to abdominal aortic aneurysm (AAA) rupture, remains uncertain. Dynamics, risk factors, and clinical relevance of AND were investigated after EVAR with standard SESs. METHODS: All intact EVAR patients treated from 2000 to 2015 at a tertiary institution were included. Demographic, anatomical, and device related characteristics were investigated as risk factors for AND. Outer to outer diameters were measured at a single standardised aortic level on reconstructed computed tomography (CT) images. RESULTS: A total of 460 patients were included (median follow up 5.2 years, interquartile range [IQR] 3.0, 7.7 years; CT imaging follow up 3.3 years, IQR 1.3, 5.4). Baseline neck diameter was 24 mm (IQR 22, 26) and increased 11.1% (IQR 1.5%, 21.9%) at last CT imaging. Endograft oversizing was 20.0% (IQR 13.6, 28.0). AND was greater during the first year (5.2% [IQR 0, 11.7]) decreasing subsequently (two to four years to 1.4%/year [IQR 0.0, 4.5%], p ≤ .001) and was associated with suprarenal fixation endografts (t value = 7.9, p < .001) and oversizing (t value = 4.4, p < .001). AND exceeding the endograft was 3.5% (95% CI 2.2% - 4.8%) and 14.4% (95% CI 11.0% - 17.8%) at five and eight years, respectively. Excessive AND was associated with baseline neck diameter (OR 1.2/mm, 95% CI 1.05 - 1.41) while the Excluder endograft had a protective effect (OR 0.15, 95% CI 0.04 - 0.58). Excessive AND was associated with type 1A endoleak (HR 3.3, 95% CI 1.1 - 9.7) and endograft migration > 5 mm (HR 3.1, 95% CI 1.4 - 6.9). CONCLUSION: AND after EVAR with SES is associated with endograft oversizing and radial force but decelerates after the first post-operative year. Baseline aortic neck diameter and suprarenal stent bearing endografts were associated with an increased risk of AND beyond nominal stent graft diameter. However, it remains unclear whether patient selection, differences in endograft radial force or the suprarenal stent are accountable for this difference.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/epidemiologia , Dilatação Patológica/epidemiologia , Endoleak/epidemiologia , Procedimentos Endovasculares/efeitos adversos , Migração de Corpo Estranho/epidemiologia , Idoso , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/complicações , Ruptura Aórtica/etiologia , Aortografia , Angiografia por Tomografia Computadorizada , Dilatação Patológica/diagnóstico , Dilatação Patológica/etiologia , Endoleak/diagnóstico , Endoleak/etiologia , Procedimentos Endovasculares/instrumentação , Feminino , Migração de Corpo Estranho/etiologia , Humanos , Masculino , Pescoço , Estudos Retrospectivos , Fatores de Risco , Stents/efeitos adversos , Resultado do Tratamento
20.
Clin Imaging ; 78: 250-255, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34171597

RESUMO

PURPOSE: To assess the efficacy and safety of abdominal aortic (AA) balloon occlusion versus internal iliac arteries (IIA) balloon occlusion in patients with placenta accreta spectrum (PAS) disorders. METHODS: Databases of Embase, PubMed, Web of Science and Cochrane Library were systematically searched from inception to May 2020. The relevant literature was screened and the quality was assessed. RevMan software 5.3 was used to analyze the data. RESULTS: Six studies involving 239 patients in AA occlusion and 281 patients in IIA occlusion were included. The results demonstrated that the intraoperative hemorrhage volume (MD - 410.61 ml, 95% CI -779.74 to -41.47 ml, p < 0.001), balloon dilatation duration (MD -5.34 min, 95% CI -9.91 to -0.77 min, p = 0.02) and fetus radiation dose (MD-20.81 mGy, 95% CI -31.84 to -9.78 mGy, p < 0.001) were significantly less in AA occlusion compared to IIA occlusion. There was no significant difference in the rate of lower extremity thrombosis between AA occlusion and IIA occlusion (OR 0.21, 95% CI 0.02 to 2.21, p = 0.19); similarly, no significant differences were found in blood transfusion volume (MD -344.50 ml, 95% CI -735.74 to 46.74 ml, p = 0.08), the rate of hysterectomy (OR 0.99, 95% CI 0.22 to 4.44, p = 0.99) and other outcome variables. CONCLUSION: The available data demonstrated AA occlusion was more effective in reducing intraoperative hemorrhage volume and fetus radiation dose compared with IIA occlusion in patients with PAS disorders. Larger studies or randomized controlled trials are needed to further assert this evidence.


Assuntos
Oclusão com Balão , Placenta Acreta , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Oclusão com Balão/efeitos adversos , Cesárea , Feminino , Humanos , Histerectomia , Artéria Ilíaca/diagnóstico por imagem , Placenta Acreta/diagnóstico por imagem , Placenta Acreta/terapia , Gravidez , Estudos Retrospectivos
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