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1.
Rev Assoc Med Bras (1992) ; 65(9): 1193-1200, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618337

RESUMO

OBJECTIVES: This study was conducted to reveal the possible protective effects of ticagrelor and enoxaparin pretreatment against ischemia-reperfusion (IR)-induced injury on the lung tissue of a rat model. METHODS: Wistar albino rats were randomly divided into 4 groups as follows: group-1 (control-sham), group-2 (control-saline+IR), group-3 (ticagrelor+IR), group-4 (enoxaparin+IR). Before the ischemic period, saline, ticagrelor, and enoxaparin were administered to the 2nd-4th groups, respectively. In these groups, IR injury was induced by clamping the aorta infrarenally for 2 h, followed by 4 h of reperfusion except group-1. After the rats were euthanized, the lungs were processed for histological examinations. Paraffin sections were stained with Haematoxylin&Eosin (H&E) for light microscopic observation. Apoptosis was evaluated by caspase-3 immunoreactivity. Data were statistically analyzed using the SPSS software. RESULTS: In the lung sections stained with H&E, a normal histological structure was observed in group-1, whereas disorganized epithelial cells, hemorrhage, and inflammatory cell infiltration were seen in the alveolar wall in group-2. The histologic structure of the treatment groups was better than that of group-2. Caspase-3(+) apoptotic cells were noticeable in sections of group-2 and were lower in the treatment groups. In group-4, caspase-3 immunostaining was lower than in group-3. In group-2, apoptotic cells were significantly higher than in the other groups (p<0.001). CONCLUSION: Based on the histological results, we suggested that both therapies ameliorated the detrimental effects of IR. Caspase-3 immunohistochemistry results also revealed that pre-treatment with enoxaparin gave better results in an IR-induced rat injury model. In further studies, other parameters such as ROS and inflammatory gene expressions should be evaluated for accurate results.


Assuntos
Aorta Abdominal/cirurgia , Enoxaparina/farmacologia , Pulmão/efeitos dos fármacos , Substâncias Protetoras/farmacologia , Traumatismo por Reperfusão/prevenção & controle , Ticagrelor/farmacologia , Animais , Apoptose/efeitos dos fármacos , Caspase 3/metabolismo , Modelos Animais de Doenças , Pulmão/patologia , Lesão Pulmonar/prevenção & controle , Masculino , Distribuição Aleatória , Ratos Wistar , Traumatismo por Reperfusão/patologia
2.
Semin Vasc Surg ; 32(1-2): 68-72, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540659

RESUMO

The management of infection involving the abdominal aorta requires clinical decisions based on patient factors and the nature of the infectious process. Any infection occurring after endovascular aortic aneurysm repair or open aortic replacement grafting should be treated promptly with appropriate systemic antibiotic therapy. Once a vascular prosthesis becomes infected, surgical treatment is necessary. There should be a low threshold for graft excision and extra-anatomic bypass in the presence of fistula or abscess cavity, when feasible entire graft should be excised. In selected patients, graft excision with in situ aorta reconstruction is an appropriate option using an autogenous femoral vein, cryopreserved allograft, or a prosthetic graft impregnated with antibiotic. The replaced in situ aortic graft should be covered with an omental pedicle. For primary aortic graft infections, endovascular treatment may act as a bridge to more definitive treatment; or, in the absence of gross retroperitoneal infections, endovascular grafting alone with prolonged systemic antibiotic therapy is a viable option, particularly in patients not fit for open surgical procedures.


Assuntos
Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Remoção de Dispositivo/métodos , Procedimentos Endovasculares , Infecções Relacionadas à Prótese/cirurgia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/microbiologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/microbiologia , Implante de Prótese Vascular/instrumentação , Medicina Baseada em Evidências , Humanos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Reoperação , Fatores de Risco , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(29): e16494, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335714

RESUMO

RATIONALE: It is difficult to discriminate malignant pheochromocytoma (PCC) from benign PCC. The requirement of abdominal aortic and inferior vena cava reconstruction is extremely rare. PATIENT CONCERNS: We here report a case of a large pheochromocytoma in a 56-year-old woman who complained of only hand trembling and had no hypertension or other symptoms. The operation was difficult because of a tight adhesion to the circumference of great vessels. A replacement of the aortocaval vessels with grafts was necessary to remove the tumor completely. DIAGNOSES: Ultrasonography, computed tomography (CT), and catecholamine assay revealed suspecting the retroperitoneal PCC. INTERVENTIONS: Tumor excision and reconstruction of the abdominal aorta and inferior vena cava by externally supported polytetrafluoroethylene (ePTFE) vessels were successfully performed. OUTCOMES: A follow-up CT angiography showed no recurrence and graft vessels presented good patency after 7years. Catecholamine in urine and serum assay was normal. LESSONS: The complete resection of the tumor and infiltrated great vessels were necessary for the long-term survival of patients with a large PCC. The ePTFE graft is a good substitute for vessel reconstruction.


Assuntos
Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Feocromocitoma/cirurgia , Neoplasias Retroperitoneais/cirurgia , Veia Cava Inferior/cirurgia , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/patologia , Angiografia por Tomografia Computadorizada , Epinefrina/análise , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Norepinefrina/análise , Feocromocitoma/diagnóstico , Feocromocitoma/patologia , Politetrafluoretileno , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/patologia , Resultado do Tratamento , Ultrassonografia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia
4.
Medicine (Baltimore) ; 98(28): e16397, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305448

RESUMO

RATIONALE: Vasculitis is one of the common pathological hallmarks of systemic lupus erythematosus (SLE). Vascular lesions in SLE commonly involve medium- and small-sized vessels. Rarely, vasculitis in SLE may involve large vessels such as the aorta leading to life-threatening complications. Reported cases of large vessel lesions in SLE included aortic aneurysm and aortic dissection. PATIENT CONCERNS: Here, we report a 52-year-old Chinese woman with SLE, who was stable on oral glucocorticoid, but showed sudden intractable hypertension and heavy proteinuria before we found aorta coarctation in her computed tomography (CT) scan of the aorta. DIAGNOSES: This patient's large vascular lesions were likely secondary and not a primary manifestation of lupus activity. INTERVENTIONS AND OUTCOMES: After endovascular stent graft repair of the abdominal aorta, her hypertension and proteinuria were controlled. LESSONS: In the context of reported cases of large vessel lesions in SLE, our case further supports the significance of having a wide differential for vascular lesions in SLE, especially when an SLE patient presents sudden hypertension and heavy proteinuria. This case also demonstrates that vascular lesions in SLE may lead to serious, potentially fatal consequences.


Assuntos
Coartação Aórtica/etiologia , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Pessoa de Meia-Idade
5.
Einstein (Sao Paulo) ; 17(4): eRC4668, 2019 Jul 10.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31291387

RESUMO

Endovascular aneurysm repair is an established technique for treating many infrarenal aortic aneurysms. Infection is one of the most serious complications of this technique, and although percutaneous treatment has been well established for intra-abdominal collections, its use to treat peri-prosthetic fluid collections has not been well determined. In this article we describe a small series of three patients who were treated with percutaneous drainage, with good clinical and imaging responses. Percutaneous drainage is a safe, effective and minimally invasive approach for treating this potentially fatal complication.


Assuntos
Aorta Abdominal/cirurgia , Procedimentos Endovasculares/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Drenagem/métodos , Procedimentos Endovasculares/métodos , Humanos , Masculino , Tomografia Computadorizada por Raios X
6.
N Engl J Med ; 380(22): 2126-2135, 2019 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-31141634

RESUMO

BACKGROUND: Elective endovascular repair of an abdominal aortic aneurysm results in lower perioperative mortality than traditional open repair, but after 4 years this survival advantage is not seen; in addition, results of two European trials have shown worse long-term outcomes with endovascular repair than with open repair. Long-term results of a study we conducted more than a decade ago to compare endovascular repair with open repair are unknown. METHODS: We randomly assigned patients with asymptomatic abdominal aortic aneurysms to either endovascular repair or open repair of the aneurysm. All the patients were candidates for either procedure. Patients were followed for up to 14 years. RESULTS: A total of 881 patients underwent randomization: 444 were assigned to endovascular repair and 437 to open repair. The primary outcome was all-cause mortality. A total of 302 patients (68.0%) in the endovascular-repair group and 306 (70.0%) in the open-repair group died (hazard ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.13). During the first 4 years of follow-up, overall survival appeared to be higher with endovascular repair than with open repair; from year 4 through year 8, overall survival was higher in the open-repair group; and after 8 years, overall survival was once again higher in the endovascular-repair group (hazard ratio for death, 0.94; 95% CI, 0.74 to 1.18). None of these trends were significant. There were 12 aneurysm-related deaths (2.7%) in the endovascular-repair group and 16 (3.7%) in the open-repair group (between-group difference, -1.0 percentage point; 95% CI, -3.3 to 1.4); most deaths occurred during the perioperative period. Aneurysm rupture occurred in 7 patients (1.6%) in the endovascular-repair group, and rupture of a thoracic aneurysm occurred in 1 patient (0.2%) in the open-repair group (between-group difference, 1.3 percentage points; 95% CI, 0.1 to 2.6). Death from chronic obstructive lung disease was just over 50% more common with open repair (5.4% of patients in the endovascular-repair group and 8.2% in the open-repair group died from chronic obstructive lung disease; between-group difference, -2.8 percentage points; 95% CI, -6.2 to 0.5). More patients in the endovascular-repair group underwent secondary procedures. CONCLUSIONS: Long-term overall survival was similar among patients who underwent endovascular repair and those who underwent open repair. A difference between groups was noted in the number of patients who underwent secondary therapeutic procedures. Our results were not consistent with the findings of worse performance of endovascular repair with respect to long-term survival that was seen in the two European trials. (Funded by the Department of Veteran Affairs Office of Research and Development; OVER ClinicalTrials.gov number, NCT00094575.).


Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Endovasculares , Idoso , Aneurisma da Aorta Abdominal/mortalidade , Causas de Morte , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Endovasculares/métodos , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Complicações Pós-Operatórias , Resultado do Tratamento
8.
Ann Biomed Eng ; 47(7): 1611-1625, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30963384

RESUMO

Abdominal aortic aneurysm (AAA) is a vascular disease characterized by the enlargement of the infrarenal segment of the aorta. A ruptured AAA can cause internal bleeding and carries a high mortality rate, which is why the clinical management of the disease is focused on preventing aneurysm rupture. AAA rupture risk is estimated by the change in maximum diameter over time (i.e., growth rate) or if the diameter reaches a prescribed threshold. The latter is typically 5.5 cm in most clinical centers, at which time surgical intervention is recommended. While a size-based criterion is suitable for most patients who are diagnosed at an early stage of the disease, it is well known that some small AAA rupture or patients become symptomatic prior to a maximum diameter of 5.5 cm. Consequently, the mechanical stress in the aortic wall can also be used as an integral component of a biomechanics-based rupture risk assessment strategy. In this work, we seek to identify geometric characteristics that correlate strongly with wall stress using a sample space of 100 asymptomatic, unruptured, electively repaired AAA models. The segmentation of the clinical images, volume meshing, and quantification of up to 45 geometric measures of each AAA were done using in-house Matlab scripts. Finite element analysis was performed to compute the first principal stress distributions from which three global biomechanical parameters were calculated: peak wall stress, 99th percentile wall stress and spatially averaged wall stress. Following a feature reduction approach consisting of Pearson's correlation matrices with Bonferroni correction and linear regressions, a multivariate stepwise regression analysis was conducted to find the geometric measures most highly correlated with each of the biomechanical parameters. Our findings indicate that wall stress can be predicted by geometric indices with an accuracy of up to 94% when AAA models are generated with uniform wall thickness and up to 67% for patient specific, non-uniform wall thickness AAA. These geometric predictors of wall stress could be used in lieu of complex finite element models as part of a geometry-based protocol for rupture risk assessment.


Assuntos
Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/fisiopatologia , Modelos Cardiovasculares , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Cirúrgicos Eletivos , Humanos , Estresse Mecânico
9.
Eur J Pharm Biopharm ; 139: 272-278, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31004790

RESUMO

OBJECTIVE: Vascular prostheses for small caliber bypass grafts in cardiac and vascular diseases or for access surgery are still missing. Poly (Ɛ-caprolactone) (PCL) has been previously investigated by our group and showed good biocompatibility and mechanical properties in vitro and rapid endothelialisation, cellular infiltration and vascularisation in vivo yielding optimal patency in the abdominal aortic position. The aim of the present study is to evaluate our PCL graft in the carotid position and to compare its outcome to the grafts implanted in the abdominal aortic position. METHODS: PCL grafts (1 mm ID/10 mm long) were implanted into the left common carotid artery in 20 Sprague-Dawley rats and compared to our previously published series of abdominal aortic implants. The animals were followed up to 3, 6, 12 and 24 weeks. At each time point, in vivo compliance, angiography and histological examination with morphology were performed. RESULTS: PCL grafts showed good mechanical properties and ease of handling. The average graft compliance was 14.5 ±â€¯1.7%/ mmHg compared to 7.8 ±â€¯0.9% for the abdominal position and 45.1 ±â€¯3.2%/ mmHg for the native carotid artery. The overall patency for the carotid position was 65% as compared to 100% in the abdominal position. Complete endothelialisation was achieved at 3 weeks and cell invasion was more rapid than in the aortic position. In contrast, intimal hyperplasia (IH) and vascular density were less pronounced than in the aortic position. CONCLUSION: Our PCL grafts in the carotid position were well endothelialised with early cellular infiltration, higher compliance, lower IH and calcification compared to the similar grafts implanted in the aortic position. However, there was a higher occlusion rate compared to our abdominal aorta series. Anatomical position, compliance mismatch, flow conditions may answer the difference in patency seen.


Assuntos
Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular/efeitos adversos , Artérias Carótidas/cirurgia , Animais , Aorta Abdominal/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Caproatos/química , Artérias Carótidas/fisiopatologia , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Lactonas/química , Modelos Animais , Poliésteres/química , Ratos , Ratos Sprague-Dawley , Grau de Desobstrução Vascular
10.
J Cardiovasc Surg (Torino) ; 60(4): 485-489, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30947488

RESUMO

The "new" and updated European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysm, published in the 2019 January issue of the European Journal of Vascular and Endovascular Surgery, is an extensive document offering 125 recommendations of clinical importance on the management of AAA, accompanied by a comprehensive supporting text that summarizes the literature and motivates the positions made. Several new topics, not addressed in the previous guidelines, are included. Here we summarize the most important news in the new ESVS 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysm.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma Ilíaco/cirurgia , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Vasculares/normas , Aorta Abdominal/cirurgia , Humanos , Artéria Ilíaca/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos
11.
Eur J Vasc Endovasc Surg ; 57(5): 650-657, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30910498

RESUMO

OBJECTIVES: The effect of superficial femoral artery (SFA) occlusion on long-term patency of aortofemoral bypasses (AFBs) for aortoiliac occlusive disease (AIOD) was examined. METHODS: The AIOD database was reviewed to identify risk factors for AFB failure. The status of the SFA at AFB procedure was categorised as patent; diseased treated (DT), if the SFA occlusion was intervened on concomitant to AFB; or diseased untreated (DU), if the SFA was occluded but not revascularised. Censoring hierarchies for primary patency and patent graft survival time were constructed. Data were analysed by contingency table, Kaplan-Meier, and Cox regression analysis. RESULTS: Between 2004 and 2015, 122 AFB (9 unifemoral, 113 bifemoral) for AIOD were performed. Seventy-five (61%) were female and the mean age was 60 ± 10 years. At the time of AFB, 50 (41%) had occluded SFAs (DT/DU). Of these, 15 had concomitant SFA revascularisation (i.e., DT) at the time of AFB. Patients with occluded SFAs had greater history of prior aortoiliac/infrainguinal procedures (aortoiliac 54% vs. 22%, infrainguinal 58% vs. 25%, both p < 0.001), Trans-Atlantic Inter-Society Consensus II classification of femoropopliteal type D lesions (78 vs. 10%, p < 0.001), Rutherford 4-6 categories (80% vs. 57%, p = 0.011), and longer hospital stay (median 11 vs. 7 days, p < 0.004). SFA status did not affect 30 day mortality (overall 9%); however, sub-analysis showed DT had significantly higher mortality than DU (p < 0.03). Over a median follow up of 7.7 (IQR 4.3-11.4) years, primary patency at one and five years was 98.3% and 91.2% in patients with patent SFAs, 87.9% and 82.7% in DU, and 72.7% and 43.6% in DT (p < 0.001), respectively. On multivariable analysis, low baseline glomerular filtration rate (HR 1.01, p = 0.022), DT (HR 3.7, p = 0.020), Rutherford 4-6 (HR 9.1, p = 0.048), and occluded SFA (HR 3.9, p = 0.009) adversely affected primary patency of AFBs. Long-term mortality was not different between the SFA status groups (p = 0.279). CONCLUSION: Baseline SFA occlusion predicted a fourfold increased hazard of primary AFB failure. Concomitant SFA revascularisation did not improve AFB durability and was associated with increased in hospital mortality.


Assuntos
Aorta Abdominal/cirurgia , Arteriopatias Oclusivas/cirurgia , Artéria Femoral/cirurgia , Oclusão de Enxerto Vascular/etiologia , Artéria Ilíaca/cirurgia , Enxerto Vascular , Grau de Desobstrução Vascular , Idoso , Feminino , Seguimentos , Taxa de Filtração Glomerular , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Fatores de Risco , Trombose/etiologia , Enxerto Vascular/efeitos adversos
12.
Tex Heart Inst J ; 46(1): 36-40, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30833836

RESUMO

Infrarenal abdominal aortic aneurysm with aortocaval fistula, a rare condition, can be fatal without prompt intervention. The clinical symptoms are complex and varied, so diagnosis is typically confirmed by use of contrast-enhanced multidetector computed tomography. We report our surgical repair of a 13-cm-diameter infrarenal abdominal aortic aneurysm and aortocaval fistula in a 63-year-old orchestral tuba player who had 2 classic symptoms of the condition. The unruptured aneurysm and fistula were complicated by acutely angled vessels, so we performed surgery rather than endovascular repair. The patient recovered fully and was discharged from the hospital. This infrarenal aneurysm with aortocaval fistula is perhaps the largest to have been treated successfully by means of open surgery. In addition to our patient's case, we discuss the history and treatment considerations of this rare combined condition.


Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Fístula Arteriovenosa/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Veia Cava Inferior/cirurgia , Aorta Abdominal/anormalidades , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico , Aortografia , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Música , Flebografia , Veia Cava Inferior/anormalidades
14.
Minim Invasive Ther Allied Technol ; 28(2): 127-133, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30810444

RESUMO

BACKGROUND: Combining electromagnetic tracking of instruments with preoperatively acquired images can provide detailed visualization for intraoperative guidance and reduce the need for fluoroscopy and contrast. In this study, we investigated the accuracy of a vessel-based registration method designed for matching preoperative image and electromagnetically tracked positions for endovascular therapy. MATERIAL AND METHODS: An open-source registration method was used to match the centerline extracted from computed tomography (CT) to electromagnetically tracked positions within a vascular phantom representing the abdominal aorta with bifurcations. The target registration error (TRE) was calculated for 11 fiducials distributed over the phantom. Median and intra-quartile range (IQR) for 30 registrations was reported. TRE < 5 mm was claimed sufficient for endovascular navigation, evaluated using the Wilcoxon signed-rank test. TRE was also compared to a 3D-3D registration method based on intraoperative cone-beam CT, using the Mann-Whitney U-test. RESULTS: The TRE was 3.75 (IQR: 3.48-3.99) mm for the centerline registration algorithm and 3.21 (IQR: 1.50-3.57) mm for the 3D-3D method (p < .001). For both methods, the TRE was significantly < 5 mm (p < .001). CONCLUSION: The centerline registration method was feasible, with an accuracy sufficient for navigation in endovascular therapy. The centerline method avoids additional image acquisition for registration purpose only.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Procedimentos Endovasculares/métodos , Imagem Tridimensional/métodos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Inteligência Artificial , Tomografia Computadorizada de Feixe Cônico , Fenômenos Eletromagnéticos , Fluoroscopia , Humanos , Imagens de Fantasmas
15.
Tech Vasc Interv Radiol ; 22(1): 14-20, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30765070

RESUMO

With the advances in affordable three-dimensional (3D) printing technology, 3D reconstruction and patient-specific 3D printed models are establishing a crucial role in the field of medicine for both educational purposes and procedural planning. 3D printed models provide physicians with increased 3D perception and tactile feedback, and enable a team-based approach to operational planning. However, performing an effective 3D reconstruction requires an in-depth understanding of the software features to accurately segment and reconstruct the human anatomy of interest from preacquired image data from multiple modalities such as computer tomography, 3D angiography and magnetic resonance imaging, and the different 3D printers/materials available in the market today. Increased understanding of this technology may benefit radiologists by developing techniques and tricks specific to interventional radiology and establishing a criterion to determine when to use these. Thus, the purpose of this manuscript is to provide physicians with an update on currently available 3D reconstruction software as well as printers and materials. Our initial experience using this technology is introduced based on a specific case of developing a 3D printed aorta for a patient with severe stenosis of the abdominal aorta.


Assuntos
Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Impressão Tridimensional , Radiografia Intervencionista/métodos , Radiologia Intervencionista/métodos , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Aortografia/métodos , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Angiografia por Tomografia Computadorizada , Constrição Patológica , Humanos , Angiografia por Ressonância Magnética , Modelos Anatômicos , Interpretação de Imagem Radiográfica Assistida por Computador
16.
Kyobu Geka ; 72(2): 104-107, 2019 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-30772874

RESUMO

Extraperitoneal approach is commonly employed for thoracoabdominal aortic repair via Stoney incision. It is supposedly rare to encounter abdominal visceral bleeding during that procedure. However, the spleen may spontaneously adhere to the adjacent peritoneum, which could induce incidental injury to the spleen by its anterior mobilization during extraperitoneal approach. Unless we bare its potential risk in mind, bleeding from the spleen may be overlooked, which results in hemodynamic deterioration. We have experienced 3 cases of splenic injury that necessitated hemostatic maneuvers for bleeding during and just after the thoracoabdominal aortic repair.


Assuntos
Aorta Abdominal/cirurgia , Aorta Torácica/cirurgia , Hemostasia Cirúrgica/métodos , Complicações Intraoperatórias/etiologia , Baço/lesões , Hemorragia/terapia , Humanos , Complicações Intraoperatórias/terapia , Esplenopatias/terapia , Procedimentos Cirúrgicos Vasculares/efeitos adversos
17.
Ann Vasc Surg ; 58: 381.e5-381.e9, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30731218

RESUMO

Neoplasias affecting the aorta are usually due to a variety of thoracic and abdominal tumors, which are more common than primary tumors of the aortic wall. Those tumors that can invade the abdominal aorta are usually sarcomas, which are able to mimic, both clinically and radiologically, an aortic disease such as an aneurysm or a dissection. There are few clinical scenarios where surgical resection and aortic repair needs to be performed, and indications have not still been clearly established in the literature. We describe the case of a patient with a periaortic lymphoma who presented an aortic rupture and was successfully treated with an urgent endovascular repair.


Assuntos
Falso Aneurisma/etiologia , Aorta Abdominal/patologia , Aneurisma da Aorta Abdominal/etiologia , Ruptura Aórtica/etiologia , Linfoma Difuso de Grandes Células B/patologia , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/patologia , Falso Aneurisma/cirurgia , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/patologia , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/patologia , Ruptura Aórtica/cirurgia , Aortografia/métodos , Implante de Prótese Vascular , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Humanos , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/terapia , Masculino , Invasividade Neoplásica , Recidiva , Resultado do Tratamento
18.
Ann Vasc Surg ; 58: 381.e1-381.e4, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30731223

RESUMO

BACKGROUND: A man in very poor general condition was admitted for acute thrombosis of the infrarenal aorta associated to a penetrating aortic ulcer (PAU) of the distal thoracic aorta. METHODS: We planned a two-stage procedure: an axillobifemoral revascularization to be followed by thoracic endovascular aortic repair (TEVAR) after rehabilitation. Before the second stage, the patient presented with acute respiratory failure secondary to an abrupt PAU evolution. RESULTS: A properly selected stent graft was successfully deployed in an antegrade manner through a left axillary artery access with the nose of the delivery system pushed over a guidewire deep into the aortic thrombosis. CONCLUSIONS: Inadequate access and paraplegia are the major challenges hampering clinical success of TEVAR. Off-the-shelf stent graft can be used outside its primary use in an unconventional setting. Careful planning, consideration of all comorbidities and vascular anatomy, as well as correct choice of the device are crucial for the successful treatment.


Assuntos
Aorta Abdominal/cirurgia , Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Artéria Axilar/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Artéria Femoral/cirurgia , Trombose/cirurgia , Úlcera/cirurgia , Idoso , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/fisiopatologia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Aortografia/métodos , Artéria Axilar/diagnóstico por imagem , Artéria Axilar/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Masculino , Desenho de Prótese , Stents , Trombose/diagnóstico por imagem , Trombose/fisiopatologia , Resultado do Tratamento , Úlcera/diagnóstico por imagem , Úlcera/fisiopatologia
19.
Ann Vasc Surg ; 58: 385.e7-385.e9, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30763702

RESUMO

An 87-year-old man with severe intermittent claudication and lower limb pain at rest was referred to our hospital for examination. Computed tomography (CT) angiography imaging showed a severe stenosis in the infrarenal abdominal aorta. The ankle brachial indices (ABIs) were 0.62 (right) and 0.60 (left). Endovascular aortic repair was performed with distal protection. The postoperative course was uneventful, and postoperative CT showed no stenosis or distal embolization. The ABI improved to the normal values of 1.02 (right) and 1.13 (left). The patient was followed up as an outpatient without a cane. Long-term follow-up and randomized controlled trials are necessary to clarify the durability and efficacy of the endovascular approach for this aortic pathology.


Assuntos
Aorta Abdominal/cirurgia , Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/fisiopatologia , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Aortografia/métodos , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Angiografia por Tomografia Computadorizada , Constrição Patológica , Humanos , Claudicação Intermitente/etiologia , Masculino , Resultado do Tratamento , Grau de Desobstrução Vascular
20.
J Cardiovasc Surg (Torino) ; 60(2): 186-190, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30698372

RESUMO

Anatomical changes after endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs) are thoroughly studied as they could affect the long-term postoperative outcome. The aim of the present study was to review the literature and summarize the recent data regarding the aortic remodeling and its clinical significance. A continuous aortic neck expansion is observed after EVAR and is more rapid at the first month and during the third postoperative year. This aortic neck dilation is not influenced by the type of proximal stent-graft fixation, is comparable to open surgical aneurysm repair and is most probably related with the natural progression of aneurismal disease. Aortic neck angulation reduces significantly immediately after EVAR and then continues to reduce slowly and gradually. Neck angulations ≥60° have a greater reduction compared to neck angulations <60°. An expansion of the common iliac arteries at the distal landing zone is also observed after EVAR and is more prominent in the first six postoperative months. A postoperative increase of the distance between superior mesenteric artery and iliac bifurcations (aortoiliac elongation) is described and is associated with increased type I endoleaks and reinterventions. The aneurysm sac diameter most frequently reduces after EVAR in absence of an endoleak and this aneurysm sac regression has been associated with the stent-graft type.


Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Remodelação Vascular , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Endoleak/etiologia , Endoleak/cirurgia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Reoperação , Fatores de Risco , Stents , Resultado do Tratamento
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