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1.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(4): 356-361, out.-dez. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1047212

RESUMO

O desenvolvimento das salas cirúrgicas híbridas permitiu que operações de abordagem cirúrgica convencional pudessem ser realizadas e complementadas com a abordagem percutânea e endovascular, criando uma nova forma de tratar os pacientes por meio de cirurgias híbridas. Os procedimentos híbridos permitem que cirurgiões e cardiologistas intervencionistas possam associar suas expertises para tratar, da melhor forma possível, os pacientes com doenças cada vez mais complexas e avançadas, com melhores resultados, reduzindo a morbidade e mortalidade perioperatória e permitindo recuperação mais rápida


The development of hybrid operating rooms allowed that conventional surgical approach operations could be performed and complemented with the percutaneous and endovascular approach, creating a new way of treating patients through hybrid surgeries. Hybrid procedures allow surgeons and interventional cardiologists to combine their expertise to best treat patients with increasingly complex and advanced diseases, with better outcomes, reducing perioperative morbidity and mortality and allowing faster recovery


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Revascularização Miocárdica/métodos , Salas Cirúrgicas , Aorta Torácica , Próteses e Implantes , Aortografia/métodos , Ponte de Artéria Coronária/métodos , Stents Farmacológicos , Intervenção Coronária Percutânea/métodos
3.
Methodist Debakey Cardiovasc J ; 15(2): 152-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384380

RESUMO

Iatrogenic aortocaval fistula is an extremely rare pathologic condition that often results in clinically significant left-to-right extracardiac shunt. In slow-progressing cases, chronic right-sided heart failure can occur and, in some patients, may persist for years. We present a patient with a long-standing aortocaval fistula that was causing high-flow left-to-right shunting, tricuspid regurgitation, severe pulmonary hypertension, and right-side heart failure. After undergoing complete endoscopic isolation of the aortocaval fistula, the patient experienced dramatic clinical improvement and continued to have excellent imaging and clinical resolution after 2 years of follow-up.


Assuntos
Aorta/fisiopatologia , Fístula Arteriovenosa/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Insuficiência Cardíaca/etiologia , Hipertensão Pulmonar/etiologia , Doença Iatrogênica , Veia Cava Inferior/fisiopatologia , Aorta/diagnóstico por imagem , Aortografia/métodos , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/fisiopatologia , Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler em Cores , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Desenho de Prótese , Fluxo Sanguíneo Regional , Dispositivo para Oclusão Septal , Fatores de Tempo , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem
4.
Vasc Endovascular Surg ; 53(7): 563-571, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31362600

RESUMO

OBJECTIVES: Patients referred for fenestrated/branched endovascular aortic repair (F/BEVAR) often present with a previous computed tomography angiogram (CTA), but it is unknown how recent the CTA must be to ensure accurate F/BEVAR planning. We sought to determine whether anatomic planning parameters change significantly between a CTA used for F/BEVAR planning and a CTA obtained 6 to 12 months prior. METHODS: Two blinded observers reviewed preoperative CTAs from 21 patients who underwent F/BEVAR. Each patient had a "recent" scan obtained 0 to 6 months before F/BEVAR planning and a "prior" scan obtained 6 to 12 months before the "recent" CTA. Standard measurements included (1) target vessel separation distances, (2) target vessel origin clock position, and (3) proximal F/BEVAR device diameter. Clinically significant differences for target vessel separation distance, target vessel origin clock position, and proximal F/BEVAR device diameter were predefined as >5 mm, >30 minutes, and >4 mm, respectively. Differences between "recent"/"prior" CTA scans were examined by paired t test. RESULTS: Mean time interval between paired "recent"/"prior" CTAs was 8.0 months (standard deviation: ±1.7). Mean difference in paired "recent"/"prior" target vessel distance (relative to celiac artery [CA]) was 2.6 mm for the superior mesenteric artery (SMA), 2.5 mm for the right renal artery (RRA), and 3.3 mm for the left renal artery (LRA). Of the 21 paired "recent"/"prior" CTAs, clinically significant differences were observed in 2, 4, and 2 patients for SMA, RRA, and LRA target vessel distance, respectively. Target vessel clock position (SMA reference at 12:00) varied by 12 minutes for the CA, 13 minutes for the RRA, and 15 minutes for the LRA. One paired "recent"/"prior" CTA was found to have a clinically significant difference for the LRA. No clinically significant differences were observed for proximal device diameter. CONCLUSIONS: In patients who underwent successful F/BEVAR, measurement comparisons between CTAs obtained up to 1 year prior were minor and unlikely to yield clinically significant changes to F/BEVAR design.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Aortografia/métodos , Implante de Prótese Vascular/métodos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/métodos , Idoso , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Desenho de Prótese , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
5.
Vasc Endovascular Surg ; 53(7): 572-582, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31382837

RESUMO

BACKGROUND-AIM: Limited data exist concerning the fluid dynamic changes induced by endovascular aortic repair with fenestrated and chimney graft modalities in pararenal aneurysms. We aimed to investigate and compare the wall shear stress (WSS) and flow dynamics for the branch vessels before and after endovascular aortic repair with fenestrated and chimney techniques. METHODS: Modeling was done for patient specific pararenal aortic aneurysms employing fenestrated and chimney grafts (Materialise Mimics 10.0) before and after the endovascular procedure, using computed tomography scans of patients. Surface and spatial grids were created using the ANSYS CFD meshing software 2019 R2. Assessment of blood flow, streamlines, and WSS before and after aneurysm repair was performed. RESULTS: The endovascular repair with chimney grafts leaded to a 43% to 53% reduction in perfusion in renal arteries. In fenestrated reconstruction, we observed a 15% reduced perfusion in both renal arteries. In both cases, we observed a decrease in the recirculation phenomena of the aorta after endovascular repair. Concerning the grafts of the renal arteries, we observed in both the transverse and longitudinal axes low WSS regions with simultaneous recirculation of the flow 1 cm distal to the ostium sites in both aortic graft models. High WSS regions appeared in the sites of ostium. CONCLUSIONS: We observed reduced renal perfusion in chimney grafts compared to fenestrated grafts, probably caused by the long and kinked characteristics of these devices.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Tomada de Decisão Clínica , Procedimentos Endovasculares/instrumentação , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Hemodinâmica , Humanos , Hidrodinâmica , Seleção de Pacientes , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Desenho de Prótese , Interpretação de Imagem Radiográfica Assistida por Computador , Circulação Renal , Estresse Mecânico , Resultado do Tratamento
6.
BMJ Case Rep ; 12(7)2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31315846

RESUMO

We report a case of myocarditis that closely mimicked acute aortic dissection in a young woman. The initial presentation was with sudden onset severe back pain and chest discomfort, associated with bilateral arm paraesthesia. The initial ECG demonstrated inferior ST-segment elevation with reciprocal anterior changes. The diagnosis was facilitated by urgent echocardiography, a CT aortogram and invasive coronary angiography to exclude aortic dissection and myocardial infarction, respectively. Acute myocarditis was later confirmed on cardiac MRI. The patient was treated conservatively with no subsequent arrhythmias with preservation of biventricular function.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Miocardite/diagnóstico por imagem , Doença Aguda , Adulto , Aortografia/métodos , Diagnóstico Diferencial , Ecocardiografia/métodos , Eletrocardiografia , Feminino , Humanos , Miocardite/patologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Resultado do Tratamento
7.
Br J Radiol ; 92(1102): 20190127, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31317769

RESUMO

OBJECTIVE: We evaluated the risk factors for massive bleeding based on angiographic findings in patients with placenta previa and accreta who underwent balloon occlusion of the internal iliac artery (BOIA) during cesarean section. METHODS: We performed a retrospective analysis using the clinical records of 42 patients with placenta previa and accreta who underwent BOIA during cesarean section between 2006 and 2017 in Gunma university hospital. We reviewed incidence of collateral arteries to the uterus on the initial aortography. We evaluated the visualization of the ovarian artery arising directly from the abdominal aorta, round ligament artery arising from the external iliac artery/inferior epigastric artery, and the iliolumbar artery. In addition, the clinical characteristics were reviewed. Patients with an estimated blood loss during delivery of >2500 ml, >4 packed red blood cell transfusions, uterine artery embolization after delivery, or hysterectomy were defined as the massive bleeding group. We compared between the massive and non-massive bleeding groups. RESULTS: 20 patients (48%) had a massive bleeding. No procedure-related severe complications were observed. The massive and non-massive bleeding groups differed in terms of operation time (p < 0.001), hysterectomy (p < 0.001), post-operative hospital stay (p < 0.05), and visualization of round ligament arteries to the uterus [15/20 (75%) patients, p < 0.01]. CONCLUSION: The incidence of collateral blood supply from a round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section. ADVANCES IN KNOWLEDGE: Angiographic visualization of collateral circulation from the round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section.


Assuntos
Oclusão com Balão , Cesárea/métodos , Circulação Colateral , Artéria Ilíaca , Ovário/irrigação sanguínea , Placenta Acreta/cirurgia , Placenta Prévia/cirurgia , Hemorragia Pós-Operatória/etiologia , Adulto , Angiografia , Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Artérias/diagnóstico por imagem , Oclusão com Balão/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Hemostasia Cirúrgica/métodos , Humanos , Histerectomia , Artéria Ilíaca/diagnóstico por imagem , Placenta Acreta/diagnóstico por imagem , Placenta Prévia/diagnóstico por imagem , Hemorragia Pós-Operatória/prevenção & controle , Gravidez , Estudos Retrospectivos , Fatores de Risco , Ligamento Redondo do Útero/irrigação sanguínea , Ultrassonografia , Útero/irrigação sanguínea
8.
Vasc Endovascular Surg ; 53(7): 613-616, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31307324

RESUMO

PURPOSE: Endovascular aneurysm repair (EVAR) for an isolated common iliac artery aneurysm (iCIAA) sometimes requires a bifurcated stent graft (SG). In EVAR, it is essential to preserve the renal artery (RA). However, this is challenging in cases of anatomical variation. The double D technique (DDT) can be used in anatomically inadequate cases with a commercially approved bifurcated SG. Here, we report the repair of iCIAA in the presence of a challenging RA anatomy, through EVAR using the DDT. CASE REPORT: An 84-year-old woman was diagnosed with a maximal 35-mm diameter left iCIAA and a nonaneurysmal aorta by computed tomography (CT), which also showed that the right RA arose 50-mm above the aortic bifurcation. The DDT was chosen because commercially approved bifurcated SGs typically require a distance of >70 mm from the proximal position to the aortic bifurcation. Postoperative CT showed excellent results with no endoleaks or SG kinking and occlusion, as well as preservation of robust blood flow to the right RA. CONCLUSION: Endovascular aneurysm repair using the DDT can be an alternative option for treatment of iCIAA with a challenging RA anatomy.


Assuntos
Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Aneurisma Ilíaco/cirurgia , Artéria Renal/anormalidades , Stents , Idoso de 80 Anos ou mais , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/fisiopatologia , Desenho de Prótese , Artéria Renal/diagnóstico por imagem , Artéria Renal/fisiopatologia , Resultado do Tratamento
9.
Vasc Endovascular Surg ; 53(7): 609-612, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31309863

RESUMO

The subclavian steal syndrome (SSS), also called subclavian steal steno-occlusive disease, is defined as reversal of the vertebral artery flow secondary to significant hemodynamically ipsilateral occlusion or stenosis of the proximal subclavian artery. It is usually seen secondary to atherosclerosis and aberrant right subclavian artery (ARSA), resulting in SSS which is even less common. Aberrant right subclavian artery is a kind of vascular anomaly associated with coarctation of the aorta (CoA). It usually originates from the descending aorta distal to the site of CoA. Here, we present a young man who was a case of ARSA and CoA. He developed SSS after transcatheter aortic stenting secondary to unusual origin of ARSA from the site of CoA. Awareness of this rare anomaly helps to overcome this complication in patients undergoing interventional stenting for CoA and ARSA with anomalous origin.


Assuntos
Coartação Aórtica/terapia , Anormalidades Cardiovasculares/complicações , Procedimentos Endovasculares/instrumentação , Stents , Artéria Subclávia/anormalidades , Adulto , Coartação Aórtica/complicações , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/fisiopatologia , Aortografia/métodos , Anormalidades Cardiovasculares/diagnóstico por imagem , Anormalidades Cardiovasculares/fisiopatologia , Anormalidades Cardiovasculares/cirurgia , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Humanos , Masculino , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/fisiopatologia , Artéria Subclávia/cirurgia , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/etiologia , Síndrome do Roubo Subclávio/fisiopatologia , Resultado do Tratamento , Ultrassonografia Doppler em Cores
10.
Int J Cardiovasc Imaging ; 35(11): 2113-2121, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31267264

RESUMO

To investigate the feasibility of aortic computed tomography angiography (CTA) performed at 80 kVp in lean patients using the double region of interest timing bolus (DRTB) technique compared to 100 kVp scanning. This study was approved by the institutional ethics committee, and all patients provided written informed consent. We prospectively included 165 patients from July 2018 to February 2019. We used an 80 kVp protocol when the maximal tube current did not exceed the limit using automatic exposure control; otherwise, 100 kVp was selected. The scan parameters for aortic CTA were determined from the test scan data. Enhancement at six points of the aortoiliac arteries and noise at the bifurcation level were measured. We compared the enhancement and signal to noise ratio (SNR) using Student's t-test. The tube voltage was 80 kVp in 87 patients (53%). The enhancement of the aortoiliac arteries was significantly higher (449.3 ± 77.8 vs 378.7 ± 53.1 HU, p < 0.0001) and the SNR was similar (42.4 ± 11.1 vs 40.0 ± 10.6, p = 0.17), and the amount of contrast medium was lower (33.0 ± 2.5 vs 41.8 ± 3.3 ml, p < 0.001) in the 80 kVp group compared to the 100 kVp group. Reducing the tube current to 80 kVp could decrease the amount of contrast medium used compared to the 100 kVp protocol, while maintaining image quality, for aortic CTA using the DRTB technique.


Assuntos
Doenças da Aorta/diagnóstico por imagem , Aortografia/métodos , Índice de Massa Corporal , Angiografia por Tomografia Computadorizada , Meios de Contraste/administração & dosagem , Iopamidol/administração & dosagem , Tomografia Computadorizada Multidetectores , Magreza/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos
11.
Pediatr Cardiol ; 40(7): 1445-1449, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31332468

RESUMO

A bovine arch is the most common aortic arch variant, characterized by a common origin of the innominate artery and the left common carotid artery. Data have shown that children with bovine arch anatomy and coarctation are at a significantly higher risk of recoarctation following coarctation repair. This study aims to explain the higher coarctation rates, assess the branching of the arch vessels, understand their embryologic origins, and delineate the patterns of displacement of the arch vessels in bovine versus normal anatomy. This retrospective study reviewed the medical records of 178 infants ( < 1-year-old) who had a chest CT Angiogram (58) or CT (120) at our institution between 2007 and 2017. Multiplanar reconstruction software was used to obtain the best image plane to display the sinotubular junction, innominate artery, left common carotid artery, and left subclavian artery. We measured the distances between the branches as HV1, HV2, and HV3. All distances were standardized to body surface area and sinotubular junction diameter, which is a novel method. Bovine arches were found in 32.6% of patients. The total arch length of both arch anatomies was similar. HV3 is longer in bovine arches. HV1 + HV2 and HV2 + HV3 are longer in the normal arches than the bovine arches. The left subclavian artery moves proximally, and the innominate artery moves slightly distally to form the bovine arch and decreasing the clamping distance for coarctation repair. Aortic arch distances were similar when standardized to either sinotubular junction diameter and body surface area.


Assuntos
Aorta Torácica/patologia , Coartação Aórtica/patologia , Artéria Subclávia/patologia , Aorta Torácica/anatomia & histologia , Aortografia/métodos , Artérias Carótidas/anatomia & histologia , Estudos de Casos e Controles , Angiografia por Tomografia Computadorizada , Humanos , Imagem Tridimensional , Lactente , Estudos Retrospectivos , Artéria Subclávia/anatomia & histologia
12.
Vasc Endovascular Surg ; 53(7): 599-601, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31262229

RESUMO

INTRODUCTION: A 90-year-old patient was admitted with a hemorrhagic shock from a huge ruptured abdominal aortic aneurysm with an unfavourable infrarenal aortic neck and a horseshoe kidney (HSK). REPORT: We decided on an open surgical approach: the HSK isthmus was sectioned with an Endo GIA 45 mm, and we performed a suprarenal aortic cross-clamping and an aortic graft reconstruction. Postoperatively, no urinary leakage was detected, and renal function showed no impairment. The patient died on the 10th postoperative day from pneumonia. CONCLUSION: We believe that the sectioning of the HSK isthmus with Endo GIA is a fast and simple maneouvre.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Rim Fundido/complicações , Grampeamento Cirúrgico/métodos , Idoso de 80 Anos ou mais , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Evolução Fatal , Feminino , Rim Fundido/diagnóstico por imagem , Humanos , Pneumonia/etiologia , Choque Hemorrágico/etiologia , Grampeadores Cirúrgicos , Grampeamento Cirúrgico/efeitos adversos , Grampeamento Cirúrgico/instrumentação , Resultado do Tratamento
13.
J Cardiovasc Surg (Torino) ; 60(5): 582-588, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31256581

RESUMO

BACKGROUND: A geometrical understanding of the individual patient's disease morphology is crucial in aortic surgery. The aim of our study was to validate a questionnaire addressing understanding of aortic disease and use this questionnaire to investigate the value of 3D printing as a teaching tool for surgical trainees. METHODS: Anonymized CT-angiography images of six different patients were selected as didactic cases of aortic disease and made into 3D models of transparent rigid resin with the Vat-photopolymerization technique. The 3D aortic models, which could be disassembled and reassembled, were displayed to 37 surgical trainees, immediately after a seminar on aortic disease. A questionnaire was developed to compare the trainees' understanding before (T0) and after (T1) demonstration of the 3D printed models. RESULTS: A panel of 15 experts participated in evaluating face and content validity of the questionnaire. The questionnaire validity was established and therefore the information investigated by the questionnaire could be synthetized using the mean of the items to indicate the understanding. The participants (mean age 28 years, range 26-34, male 59%) showed a significant improvement in understanding from T0 (median=7.25; IQR=1.50) to T1 (median=8.00; IQR=1.50; P=0.002). CONCLUSIONS: Preliminary data suggest that the use of 3D-printed aortic models as a teaching tool was feasible and improved the understanding of aortic disease among surgical trainees.


Assuntos
Aorta/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Educação de Pós-Graduação em Medicina/métodos , Impressão Tridimensional , Cirurgiões/educação , Inquéritos e Questionários , Procedimentos Cirúrgicos Vasculares/educação , Adulto , Aorta/cirurgia , Doenças da Aorta/cirurgia , Compreensão , Escolaridade , Estudos de Viabilidade , Feminino , Humanos , Masculino , Modelos Anatômicos , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Valor Preditivo dos Testes , Dados Preliminares , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes
15.
Int J Cardiovasc Imaging ; 35(10): 1935-1942, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31172392

RESUMO

The aim of this study was to compare the radiation dose and image quality of two CT protocols using a wide-detector computed tomography (WDCT) scanner with single contrast injection for simultaneous evaluation of the aorta and coronary artery. We retrospectively included 104 consecutive patients who underwent coronary and aorta CT angiography. CT Protocols were divided as follows: protocol I, variable helical pitch scan (VHP, n = 31); protocol II, volume scan for coronary artery following helical scan for aorta (VFH, n = 73). Vascular attenuation, noise, signal-to-noise (SNR), and contrast-to-noise ratios (CNR) were compared. Image parameters were measured at coronary artery, thoracic aorta, abdominal aorta, and iliofemoral arteries. Subjective image quality was assessed by two observers. The patient characteristics between groups were similar (P ≥ 0.384). There were no significant differences in any of the quantitative image parameters between the two groups except for the thoracic aorta. Vascular attenuation (469.2 ± 133.6 vs. 605.9 ± 140.2 HU), CNR (24.8 ± 11.4 vs. 37.3 ± 18.5), and SNR (28.4 ± 12.0 vs. 40.6 ± 19.5 ml) were higher in the VHP protocol (P < 0.001 for each) for covering the thoracic aorta. However, all subjective image scores guaranteed diagnostic image quality. The effective radiation dose of the VFH protocol was reduced to 27.2% compared with that of the VHP protocol (443.8 ± 115.8 vs. 706.7 ± 163.7 mGy·cm, P < 0.001). WDCT with single contrast injection allows assessment of both the coronary artery and aorta. The VFH protocol can reduce the radiation dose and preserve the image quality compared with that of the VHP protocol.


Assuntos
Aorta/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Meios de Contraste/administração & dosagem , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Iopamidol/análogos & derivados , Tomografia Computadorizada Espiral , Adulto , Idoso , Feminino , Humanos , Iopamidol/administração & dosagem , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Doses de Radiação , Exposição à Radiação , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Estudos Retrospectivos
16.
Vasc Endovascular Surg ; 53(7): 536-540, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31234730

RESUMO

BACKGROUND: This retrospective case series aims to evaluate the efficacy of the Perclose ProGlide system for postoperative hemostasis following aortic stent-graft insertion. MATERIAL AND METHODS: A prospectively maintained database of patients with a minimum follow-up of 12 months following percutaneous aortic procedures was interrogated. Preprocedural computed tomography (CT) scans were reviewed to assess existing stenosis in the common femoral artery (CFA). Arteries with an estimated stenosis of greater than 25% on visual inspection underwent quantification using multiplanar and curved planar reformation. The preoperative and 1-year follow-up CTs of these patients were assessed for change in stenosis. Analysis was performed by 2 independent reviewers, with senior authors reviewing any discrepancies. RESULTS: One hundred forty-two endovascular aortic aneurysm repairs (EVARs) were performed. The ProGlide system was used in 235 arteries, yielding a high success rate in obtaining postprocedural hemostasis (94%). There were 13 postprocedural access-related complications, including 5 patients requiring surgical closure due to inadequate seal. Two patients required thrombectomy due to distal embolization. One patient required CFA endarterectomy at 6 months for the treatment of preexisting short distance claudication. Vessel analysis was performed in 31 arteries. Mean preoperative stenosis was 32% (range: 20%-57%). Mean postoperative stenosis was 32% (21%-57%). No significant change in degree of stenosis was detected (defined as a 5% change). CONCLUSIONS: The ProGlide system yielded a high success rate in obtaining postoperative hemostasis with low rate of conversion to surgical closure and low complication rates. There was no evidence of worsening vessel stenosis in arteries with preprocedural stenotic disease. LEVEL OF EVIDENCE: Level 4, Case Series.


Assuntos
Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Técnicas Hemostáticas/instrumentação , Hemorragia Pós-Operatória/prevenção & controle , Stents , Centros de Atenção Terciária , Dispositivos de Oclusão Vascular , Aneurisma Aórtico/diagnóstico por imagem , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Feminino , Técnicas Hemostáticas/efeitos adversos , Humanos , Masculino , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Anticancer Res ; 39(6): 3207-3211, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177169

RESUMO

BACKGROUND/AIM: Right aortic arch (RAA) is a rare abnormality of the aortic arch that forms a vascular ring. Oesophageal cancer (EC) accompanied with RAA is even rarer, and in such cases, it is very important to understand the anatomical structure in the upper mediastinum in order to perform a safe and curative operation. PATIENTS AND METHODS: A 67-year-old man who presented with pharyngeal discomfort was admitted to our hospital. Further examinations revealed advanced thoracic EC accompanied with RAA and aortic diverticulum. RESULTS: After neoadjuvant chemotherapy, we successfully and safely performed thoracoscopic oesophagectomy and lymphadenectomy using the prone positioning. CONCLUSION: There exist only a few reports of thoracoscopic oesophagectomy for EC with RAA. Sufficient preoperative preparation and sharing an adequate strategy for the surgical approach with the surgical team are definitely necessary. Although the thoracoscopic approach for EC with RAA is useful, more considerations are needed for some issues.


Assuntos
Aorta Torácica/anormalidades , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Posicionamento do Paciente/métodos , Decúbito Ventral , Toracoscopia , Idoso , Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Quimioterapia Adjuvante , Angiografia por Tomografia Computadorizada , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/patologia , Humanos , Excisão de Linfonodo , Masculino , Terapia Neoadjuvante , Resultado do Tratamento
18.
Ann Vasc Surg ; 60: 407-414, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200051

RESUMO

INTRODUCTION: Contrast medium (CM) use in computed tomography (CT) is limited by nephrotoxicity and possible allergic reactions. The purpose of this study is to introduce a tool for the diagnosis of abdominal aortic aneurysms (AAAs) by avoiding the use of CM. METHODS: With and without CM CTs of patients with AAA were evaluated. A mathematical algorithm was implemented to allow visualization of the inner aortic lumen in the series without CM. The first step of the algorithm consisted in manually highlighting a squared region of interest (ROI) close to the target aortic area. The rest of the algorithm is completely automated and performs the following flow of operations: The "Kantorovich" algorithm is applied to the ROI for image enhancement. Then, a wavelet decomposition method is applied to identify the different frequency components of the image. Exploiting the wavelet decomposition, the system selects the low-frequency components of the image, corresponding to the major structures. Thresholding method, based on the analysis of the gray-level histogram, is then performed to extract the contours of the vessel. At this point, the extraction of the pervious area is completed. Final images were compared with the contrast enhanced scans, valued as gold standard. To validate the algorithm, an analysis of the results has been performed considering the following types of error: En = #m/#ROI ΔA = |1-(#CM/#CEX)| (#m = number of misclassified pixels; #ROI = number of pixels in the ROI; #CM = number of pixels belonging to the CM; #CEX = extracted areas). En provided a measure on the pixels wrongly classified, and ΔA the difference of extracted areas. RESULTS: The algorithm was applied to 233 CT images. Extracted images were compared with the ones with CM. Mean values of the numerical errors ranged from 0.12 to 0.17 for En and 0.11 to 0.35 for ΔA. For all the 233 CT images in the analyzed sequences, the mean error was 0.14 (En) and 0.28 (ΔA). CONCLUSIONS: The developed mathematical algorithm allows to detect the position of the vessel lumen and to extract its contours with a good accuracy. Our experience shows encouraging results and suggests a possible future clinical application to reduce CT CM use.


Assuntos
Algoritmos , Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Meios de Contraste/administração & dosagem , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes
19.
Tex Heart Inst J ; 46(2): 120-123, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31236076

RESUMO

Ascending thoracic aortic aneurysm (ATAA) is typically treated surgically. No commercially available device has been specifically designed for endovascular ATAA repair, and currently, multiple anatomic and technical challenges affect its feasibility. Previously, such repairs have been performed with the patients under general anesthesia. We describe a novel, minimally invasive approach to endovascular repair of ATAA, involving local anesthesia, conscious sedation, and 24-hour hospitalization. Two consecutive male patients (ages, 79 and 54 yr) who had comorbidities underwent percutaneous transfemoral endovascular ATAA repair with use of commercially available endografts. Patient 1 had a saccular aneurysm, and Patient 2 had a pseudoaneurysm consequent to recent surgical ATAA repair. The patients were discharged from the hospital 24 hours after technically successful, uncomplicated procedures. At 2 months, computed tomograms showed no endoleak or stent-graft migration. Our experience shows that minimally invasive endovascular ATAA repair is feasible for selected high-risk patients. We describe the procedure, access and closure devices, and challenges associated with this approach.


Assuntos
Anestesia Local/métodos , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Sedação Consciente/métodos , Procedimentos Endovasculares/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Idoso , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade
20.
Vasc Endovascular Surg ; 53(6): 515-519, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31238816

RESUMO

We present 3 cases of type IIIb endoleak after endovascular aneurysm repair (EVAR) using the Zenith stent graft system. Type III endoleak, like type I endoleak, is a high-pressure, high-risk leak that increases sac pressure up to or even above arterial pressure, and is associated with an increased frequency of open conversions or risk of aneurysm rupture. Type IIIb endoleak is rare but there is much concern that the incidence of type IIIb endoleak is likely to increase hereafter; the mechanism of type IIIb endoleak is deterioration of graft fabric in conjunction with stent sutures. Type IIIb endoleak is difficult to diagnose before rupture. The possibility of type IIIb endoleak should be highly suspected when the continued growth of an excluded aneurysm sac without direct radiologic evidence is observed during follow-up. Type IIIb endoleak can be repaired by relining of the stent graft with additional stent grafts.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Stents , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Endoleak/diagnóstico por imagem , Endoleak/cirurgia , Humanos , Masculino , Desenho de Prótese , Reoperação , Resultado do Tratamento , Ultrassonografia Doppler em Cores
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