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1.
Circ Cardiovasc Imaging ; 13(6): e009886, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32507018

RESUMO

Background Color-duplex ultrasonography (DUS) could be an alternative to computed tomography-aortography (CTA) in the lifelong surveillance of patients after endovascular aneurysm repair (EVAR), but there is currently no level 1 evidence. The aim of this study was to assess the diagnostic accuracy of DUS as an alternative to CTA for the follow-up of post-EVAR patients. Methods Between December 16, 2010, and June 12, 2015, we conducted a prospective, blinded, diagnostic-accuracy study, in 15 French university hospitals where EVAR was commonly performed. Participants were followed up using both DUS and CTA in a mutually blinded setup until the end of the study or until any major aneurysm-related morphological abnormality requiring reintervention or an amendment to the follow-up policy was revealed by CTA. Database was locked on October 2, 2017. Our main outcome measures were sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios of DUS against reference standard CTA. CIs are binomial 95% CI. Results This study recruited prospectively 659 post-EVAR patients of whom 539 (82%) were eligible for further analysis. Following the baseline inclusion visit, 940 additional follow-up visits were performed in the 539 patients. Major aneurysm-related morphological abnormalities were revealed by CTA in 103 patients (17.2/100 person-years [95% CI, 13.9-20.5]). DUS accurately identified 40 patients where a major aneurysm-related morphological abnormality was present (sensitivity, 39% [95% CI, 29-48]) and 403 of 436 patients with negative CTA (specificity, 92% [95% CI, 90-95]). The negative predictive value and positive predictive value of DUS were 92% (95% CI, 90-95) and 39% (95% CI, 27-50), respectively. The positive likelihood ratio was 4.87 (95% CI, 2.9-9.6). DUS sensitivity reached 73% (95% CI, 51-96) in patients requiring an effective reintervention. Conclusions DUS had an overall low sensitivity in the follow-up of patients after EVAR, but its performance improved meaningfully when the subset of patients requiring effective reinterventions was considered. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01230203.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aortografia/métodos , Implante de Prótese Vascular , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Tomografia Computadorizada Multidetectores , Complicações Pós-Operatórias/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , França , Humanos , Masculino , Complicações Pós-Operatórias/terapia , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Retratamento , Fatores de Tempo , Resultado do Tratamento
2.
Cardiovasc Intervent Radiol ; 43(7): 971-980, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32385611

RESUMO

PURPOSE: Loss of fixation and seal represent a key problem when undertaking endovascular repair of abdominal aortic aneurysms (AAA) with hyperangulated necks (HAN). This study assesses the outcomes following the use of adjunct endostapling to supplement proximal aorto-prosthetic fixation in patients who have AAAs with HAN. METHODS: A retrospective review of a prospective database of 42 patients with HAN (> 60°) who underwent endovascular aneurysm repair (EVAR) with supplementary endostapling was undertaken. Primary outcomes assessed were: change in post-EVAR neck angulation at first post-procedure scan, freedom from type 1 endoleaks, migration and reintervention for proximal seal complications. Secondary parameters included assessment for neck dilatation, sac size changes and EndoAnchor distribution patterns. RESULTS: In total, 42 patients underwent EVAR between 2013 and 2019. There was one 30-day mortality resulting in 41 patients (34 male, 7 females aged 76.8 ± 8.9 years)) being analysed; 251 EndoAnchors were deployed in total, averaging 6 ± 2 per patient; 38 such cases were primary deployments. Neck angulation was 76.9 ± 14 degrees pre-EVAR and 50.2 ± 14.5 degrees post-procedure (p < .001, paired T test). Mean follow-up time was 18.5 (95% CI 13.3-23.9) months. One patient had persistent type Ia endoleak, successfully banded. There was 6.8 ± 10.2 mm sac size reduction (p < .001, paired T test). There were no other neck-related reinterventions, despite continued neck dilatation (3.2 ± 3.7 mm, p < .001, paired T test). CONCLUSION: This study suggests successful EVAR with adjunct endostapling for AAA with hyperangulated necks, with significant sac shrinkage and low rates of endoleaks, migration and reinterventions. More data are needed to consider influencing current instructions for use.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Idoso , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Endoleak/prevenção & controle , Feminino , Humanos , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
3.
J Stroke Cerebrovasc Dis ; 29(7): 104917, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32414582

RESUMO

BACKGROUND AND PURPOSE: The trajectory of cardiogenic emboli could be affected by anatomical and flow characteristics of the aortic arch. We aimed to study the relation between the different aortic arch patterns and the laterality of cardiogenic emboli. METHODS: 192 cardioembolic strokes were classified into 3 groups according to the type of the aortic arch; type 1 (n = 69), type 2 (n = 49), type 3 (n = 74). The side and site of the cerebral vessels occlusion were divided into anterior and posterior circulation strokes, and anterior strokes were further subdivided into right or left internal carotid, middle or anterior cerebral arteries occlusion. RESULTS: Overall, the anterior circulation embolic occlusions were more common than the posterior, and middle cerebral artery more commonly affected than internal carotid artery. The left side propensity was higher either in the total patients' pool or after segregation into atrial fibrillation (AF) and non AF cardio-embolic cases in all types of aortic arch except for type 1 aortic arch in the non AF cases. This propensity tended to get higher with advancement of the aortic arch types but failed to show statistically significant difference between the 3 arch types, however combination of type 2 and 3 arches into a single group showed statistically significant rise in the left side propensity in the total cardioembolic cases (P = 0.039) and in the non AF cardioembolic cases (P = 0.029). The bovine arch also showed increased left side propensity. CONCLUSION: Cardioemboli tends to have left anterior cerebrovascular predilection especially with AF. Different geometrical patterns of aortic arch branching seem to affect the laterality of cardioemboli and increase its left side predilection.


Assuntos
Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Cardiopatias/complicações , Embolia Intracraniana/etiologia , Acidente Vascular Cerebral/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Cardiopatias/diagnóstico por imagem , Humanos , Embolia Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem
4.
Ann Thorac Surg ; 110(2): 664-669, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32278750

RESUMO

PURPOSE: This report describes first-in-human experiences and early results of gutter-free chimney stent graft implantation for aortic arch pathologies. DESCRIPTION: The gutter-free chimney stent graft consists of an inner stent and an outer skirt fabric to form an integrated structure. The inner and outer layers are nickel-titanium self-expanding skeletal structures with double polytetrafluoroethylene coating. The outer skirt fabric fits the gutter to prevent endoleak, and the proximal inner stent has a larger radial force to ensure the blood flow. All these designs have the advantages to overcome the native defects of current chimney techniques. EVALUATION: We reported 2 patients who were diagnosed as having aortic arch pathologies and received the gutter-free chimney stent graft implantation during thoracic endovascular aortic repair. In all patients, aortic arch lesions were covered, and supraaortic branches were patent without complications after thoracic endovascular aortic repair and during the 17 months of follow-up. CONCLUSIONS: Novel gutter-free chimney stent graft may be safely and effectively utilized for endovascular repair in aortic arch pathologies. Long-term durability should be confirmed by larger studies and ongoing research.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Procedimentos Endovasculares/métodos , Stents , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico , Aortografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Resultado do Tratamento
5.
J Cardiovasc Surg (Torino) ; 61(2): 191-195, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30370756

RESUMO

BACKGROUND: The iliac side branch device (IBD) is a valid method for the treatment of abdominal aorto-iliac aneurysms. However there is still a lack of evidence regarding the optimal length of the bridging stent graft (BSG) since aneurysmal degeneration of the hypogastric artery (HA) is an exclusion criterion. The aim of this study was to analyse the impact of longer BSG compared to the widely used 38mm stent-grafts in terms of reintervention rate and primary patency. METHODS: We retrospectively analyzed our prospectively collected database of all patients who underwent an endovascular aneurysm repair using an IBD in our center between April 2005 and May 2015. The used BSGs were divided into 2 groups. In group A, the BSG was ≤38 mm, and group B>38 mm. The primary endpoint was BSG-related events, including stenosis, occlusion or endoleak. Secondary endpoints were technical success, primary patency and 30-day mortality. RESULTS: Two hundred sixty IBDs were implanted in 215 consecutive patients. Ninetyseven (37%) in group A and 163 (63%) in group B. The technical success rate was 100%. The 30-day mortality was 1% (N.=1) and 1.2% (N.=2) respectively for group A and B (P=0.8). The freedom from BSG-related events amounted to 84% at 60 months for the total cohort. The comparison between the two groups shows no significant difference, while a slight favorable trend for group B (75% vs. 91% at 60 months, P=0.081) was observed. No differences were found as to primary patency (96% and 99% at 60 months respectively for group A and B, P=0.237). CONCLUSIONS: The use of longer stent-grafts (>38 mm) seems not to affect the performance of BSG even in the long run, expanding the indication for IBD also for aneurysms of the hypogastric artery.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/métodos , Desenho de Prótese , Grau de Desobstrução Vascular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Aortografia/métodos , Prótese Vascular , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Artéria Ilíaca/cirurgia , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Prognóstico , Estudos Retrospectivos , Medição de Risco , Stents , Resultado do Tratamento
6.
J Cardiovasc Surg (Torino) ; 61(2): 159-170, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29430886

RESUMO

INTRODUCTION: The repair of long-term complications of open abdominal aortic repair such as para-anastomotic aneurysm (PAA) and pseudoaneurysm (PSA) is very challenging. The aim of this study was to assess the outcomes of endovascular repair of PAA/PSA after previous open aortic surgery for aneurismal or occlusive disease. EVIDENCE ACQUISITION: A systematic review was undertaken; a search was performed (PRISMA) in MEDLINE, CENTRAL, Cochrane databases and key references of all studies of endovascular treatment of PAA/PSA after open aortic surgery. EVIDENCE SYNTHESIS: Eighteen studies included totally 433 patients (86.3% males) with mean age of 71±2.5 years were identified. Most of the patients were asymptomatic (76%) and diagnosed with PAA (60.5%), while 81.6% had history of open aortic reconstruction for aneurismal disease. The mean diameter of para-anastomotic aneurysms was 59.7 mm (from 23 mm to 110 mm) and the mean duration until their diagnosis was 10±2 years. Standard bifurcated (23.7%), fenestrated (23.4%) and aorto-uni-iliac stent-grafts (16.3%) were mostly used. The technical success rate was 97.8% (391/400) with 1.4% (6/433) 30 day-mortality rate and mean hospital stay of 6±3 days. The mean 1- and 2- year survival rate was 87.8% and 78.8%, respectively. The follow-up ranged from 9 to 43 months, with presenting complications such as endoleak type I (24/378; 6.3%), type II (15/354; 4.3%), type III (3/378;0.8%), migration (4/378; 1%) and limb occlusion (5/310;1.6%). Additionally, 5.7% (19/332) of the patients underwent open conversion, while the total re-intervention rate was 11.4% (39/340; time of reintervention ranged from 7 to 30 months). In cases in which a stent was used for splanchnic vessels (renal artery: 188, superior mesenteric artery: 98, celiac artery: 64), the primary patency rate was 97.4% (341/350). CONCLUSIONS: Endovascular treatment of PAAs and PSAs after previous open aortic surgery is a feasible and efficient option with high technical success rate, low 30-day mortality and good mid-term outcomes.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Endoleak/cirurgia , Procedimentos Endovasculares/métodos , Idoso , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Falso Aneurisma/etiologia , Falso Aneurisma/mortalidade , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Aortografia/métodos , Implante de Prótese Vascular/métodos , Causas de Morte , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Laparotomia/métodos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Prognóstico , Reoperação/métodos , Reoperação/mortalidade , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
7.
Int J Cardiovasc Imaging ; 36(2): 357-366, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31686278

RESUMO

The purpose of this study was to assess by multislice computed tomography (MSCT) imaging geometry of the ascending aorta, the aortic root, the aortic annulus and the left ventricle outflow tract (LVOT) in aortic stenosis (AS) patients, to compare aortic root morphology in patients with AS with healthy controls and to evaluate sex differences. Fifty patients with severe AS and 50 age- and gender-matched controls who underwent MSCT were included in the study. The dimensions of the LVOT, the aortic annulus, the aortic root, the ascending aorta, and the volume of the aortic root were retrospectively assessed and a comparison was made between patients with severe tricuspid AS and controls. Patients with tricuspid AS in comparison with controls had smaller dimensions of the sinus of Valsalva resulting in reduction of the aortic root volume, whereas the dimensions of the other structures were comparable. MSCT revealed larger annular, LVOT and the sinus of Valsalva dimensions and the aortic root volume in men than women. Men with AS differed from healthy men only in regard to the dimensions of the sinus of Valsalva, while women showed significant differences also in the LVOT, and the aortic annulus. MSCT showed accurately aortic root remodeling in tricuspid AS patients and indentified sex-dependent differences. Women with tricuspid AS differ from healthy women more than men did. A high degree of the variability in the aortic root dimensions requires further careful research.


Assuntos
Aorta/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Cardiopatias Congênitas/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Idoso , Idoso de 80 Anos ou mais , Aorta/fisiopatologia , Valva Aórtica/anormalidades , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/fisiopatologia , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/fisiopatologia , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/fisiopatologia
8.
Heart ; 106(2): 126-163, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31874903

RESUMO

Clinical introductionA man in his 60s with no medical history presented with sudden-onset, severe interscapular pain. He was in circulatory shock with a blood pressure of 65/30 mm Hg, heart rate of 115 beats per minute, respiratory rate of 32 breaths per minute and a room air oxygen saturation of 89%. Examination demonstrated weak peripheral pulses, an elevated jugular venous pressure, faint dual heart sounds, no cardiac murmurs and bilateral lung crepitations. An ECG was recorded which showed a broad QRS (figure 1A). There were no previous ECGs to compare this with. In view of his presentation with acute-onset interscapular pain, CT of the aorta was organised by the emergency department clinicians (figure 1B-D). After the CT result was obtained, the on-call cardiologist was contacted and a bedside echocardiogram performed. This demonstrated severe left ventricular systolic dysfunction with akinesia of the apex and lateral walls. The patient was then transferred to the catheter laboratory for an emergency invasive coronary angiogram.heartjnl;106/2/126/F1F1F1Figure 1ECG and CT images at presentation (A) 12 lead ECG. (B) Contrast enhanced CT aorta - coronal view. (C) Contrast enhanced CT aorta - axial view. (D) CT aorta showing 4 chamber view of the heart. WHAT IS THE MOST LIKELY DIAGNOSIS?: Pulmonary embolism.Aortic dissection.Acute myocardial infarction.Cardiac tamponade.


Assuntos
Dor Aguda/etiologia , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Infarto do Miocárdio/diagnóstico por imagem , Dor Aguda/diagnóstico , Angiografia Coronária , Humanos , Masculino , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Valor Preditivo dos Testes , Escápula
9.
Ann Vasc Surg ; 62: 238-247, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394221

RESUMO

BACKGROUND: In previous studies, the growth rate and diameter of infrarenal aorta was paucity of Chinese data. This study aim to evaluate the normal inside diameter and growth rate of the infrarenal aorta and common iliac artery in Chinese adult population and to explore the relationship between related factors and the arterial diameter. METHODS: A retrospective study was performed among 1,340 hospitalized adult patients undergoing contrast-enhanced abdominopelvic computed tomography from April 2017 to March 2018 in our hospital. The inside diameter of infrarenal aorta and common iliac artery was measured. Linear regression was used to analyze the relationship between various factors and arterial diameter. Kruskal-Wallis H test was used to analyze the relationship between the arterial diameter and age. Mann-Whitney U test was used to analyze the relationship between arterial diameter and sex. RESULTS: The inside diameter of the infrarenal aorta was 16.49 ± 2.12 mm in male patients and 14.50 ± 1.73 mm in female patients. In male patients, the right common iliac artery was 9.77 ± 1.75 mm, and the left was 9.65 ± 1.76 mm. In female patients, the right common iliac artery was 8.59 ± 1.31 mm and the left was 8.45 ± 1.28 mm. Comparing the oldest group with the youngest, the infrarenal aortic diameter increased 27.32% in male patients and 30.11% in female patients. Right common iliac artery increased 25.13% in male patients and 30.30% in female patients. Left common iliac artery increased 25.19% in male patients and 34.26% in female patients. The growth rate increased at the beginning, reached its peak at the age of 50-60 years, and then decreased. Multiple linear regression analysis results showed that sex, age, body surface area (BSA), hypertension, and cancer were significantly correlated with the diameter of infrarenal aorta. Sex, age, BSA, and hypertension were correlated with the diameter of right common iliac artery. Sex, age, BSA, and cancer were correlated with the diameter of left common iliac artery. CONCLUSIONS: The diameter of the infrarenal abdominal aorta and common iliac artery of Chinese people is smaller than that of other countries. The abdominal aortic aneurysm (AAA) guideline might be developed based on the basic diameter to suit patients with AAA and a different basic abdominal aortic diameter. Artery diameter was increased by the age, and female patients have smaller diameter and larger arterial growth rate than male patients. Female and young patients with AAA may choose more oversize grafts for endovascular AAA repair.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/crescimento & desenvolvimento , Aortografia/métodos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/crescimento & desenvolvimento , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Superfície Corporal , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Valores de Referência , Estudos Retrospectivos , Fatores Sexuais , Adulto Jovem
10.
Ann Vasc Surg ; 62: 496.e9-496.e13, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394245

RESUMO

Large artery stenosis of the arm or leg arteries or the cervical arteries has been described in giant cell arteritis (GCA); aortic involvement, nevertheless, is less frequent, even if imaging tools such as positron emission tomography (PET) computed tomography have increased the frequency in the observation of aortic involvement. A 56-year-old female with a medical history of GCA presented to our emergency department with an unruptured voluminous thoracoabdominal aortic aneurysm (TAAA). The fluorodeoxyglucose PET demonstrated the presence of high inflammatory activity. The patient underwent endovascular correction using a "sandwich technique." The 3-month control CT scan shows complete aneurysm exclusion. In high risk for surgery patients with GCA, the endovascular treatment with parallel stent graft of TAAA is safe and feasible.


Assuntos
Aneurisma da Aorta Torácica/etiologia , Arterite de Células Gigantes/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Feminino , Arterite de Células Gigantes/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Stents , Resultado do Tratamento
11.
Ann Vasc Surg ; 62: 499.e1-499.e4, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31449957

RESUMO

We report a rare case of 4 cm true aneurysm of left axillary artery in a 3-year-old girl. Computed tomography angiography confirmed the diagnosis. Open surgical repair with resection and primary end-to-end anastomosis was performed. The patient did not have any complication after 1-year follow-up. Axillary artery aneurysm is extremely rare in pediatric population. Previous reports of this rare entity are discussed comprehensively.


Assuntos
Aneurisma/cirurgia , Artéria Axilar/cirurgia , Procedimentos Cirúrgicos Vasculares , Aneurisma/diagnóstico por imagem , Aortografia/métodos , Artéria Axilar/diagnóstico por imagem , Pré-Escolar , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Resultado do Tratamento
14.
Eur J Vasc Endovasc Surg ; 59(2): 237-246, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31865026

RESUMO

OBJECTIVE: The aim was to validate a computational patient specific model of Zenith® fenestrated device deployment in abdominal aortic aneurysms to predict fenestration positions. METHODS: This was a retrospective analysis of the accuracy of numerical simulation for fenestrated stent graft sizing. Finite element computational simulation was performed in 51 consecutive patients that underwent successful endovascular repair with Zenith® fenestrated stent grafts in two vascular surgery units with a high volume of aortic procedures. Longitudinal and rotational clock positions of fenestrations were measured on the simulated models. These measurements were compared with those obtained by (i) an independent observer on the post-operative computed tomography (CT) scan and (ii) by the stent graft manufacturer planning team on the pre-operative CT scan. (iii) Pre- and post-operative positions were also compared. Longitudinal distance and clock face discrepancies >3 mm and 15°, respectively, were considered significant. Reproducibility was assessed using Bland-Altman and linear regression analysis. RESULTS: A total of 195 target arteries were analysed. Both Bland-Altman and linear regression showed good reproducibility between the three measurement techniques performed. The median absolute difference between the simulation and post-operative CT scan was 1.0 ± 1.1 mm for longitudinal distance measurements and 6.9 ± 6.1° for clock positions. The median absolute difference between the planning centre and post-operative CT scan was 0.8 ± 0.8 mm for longitudinal distance measurements and 5.1 ± 5.0° for clock positions. Finally, the median absolute difference between the simulation and the planning centre was 0.96 ± 0.97 mm for longitudinal distance measurements and 4.8 ± 3.6° for clock positions. CONCLUSION: The numerical model of deployed fenestrated stent grafts is accurate for planning position of fenestrations. It has been validated in 51 patients, for whom fenestration locations were similar to the sizing performed by physicians and the planning centre.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Modelagem Computacional Específica para o Paciente , Stents , Aorta/diagnóstico por imagem , Aortografia/métodos , Procedimentos Endovasculares/métodos , Humanos , Período Pós-Operatório , Período Pré-Operatório , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Eur J Vasc Endovasc Surg ; 59(2): 295-300, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31870690

RESUMO

OBJECTIVE: Radiation damage during complex endovascular aortic repair (EVAR) is of major concern to patients and medical staff. This study investigates primarily the influence of different acquisition systems (Allura ClarityIQ vs. Allura Xper, Philips Healthcare, Best, the Netherlands) on radiation dose. Secondly, radiation exposure was analysed for operator positions as well as for procedure and patient specific parameters. METHODS: This was a retrospective study of prospectively collected data. The study prospectively included 62 consecutive patients (mean age 71.2 ± 8.4 years; 63% males) who underwent complex EVAR including fenestrated or branched EVAR of the thoraco-abdominal or the aortic arch from 30 June 2015 to 20 May 2016. In half the patients an advanced dose and real time image noise reduction technology (Allura ClarityIQ) was used, and in the other half the reference acquisition system (Allura Xper) was used. Patient demographics included age, gender, and body mass index. RESULTS: Sixty-two patients with mean age of 71.2 ± 8.4 years (63% males; 39/62) were treated using either Allura ClarityIQ or Allura Xper. Patients treated using Allura ClarityIQ had lower cumulative dose area product (18,948.3 ± 14,648.5 cGy cm2vs. 38,512.4 ± 24,105.4 cGy cm2, p < 0.001) and air kerma (2237.9 ± 1808 mGy vs. 4031 ± 3260.2 mGy, p = .010) in comparison with patients treated using Allura Xper. CONCLUSION: Advanced dose and real time image noise reduction technology, such as Allura ClarityIQ, is a useful tool to lower the amount of radiation for patient and staff during complex endovascular aortic procedures.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Aortografia/instrumentação , Procedimentos Endovasculares/efeitos adversos , Exposição à Radiação/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aortografia/efeitos adversos , Aortografia/métodos , Procedimentos Endovasculares/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doses de Radiação , Intensificação de Imagem Radiográfica/instrumentação , Intensificação de Imagem Radiográfica/métodos , Estudos Retrospectivos
16.
J Invasive Cardiol ; 31(11): E331-E332, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31671062

RESUMO

An 81-year-old Caucasian male with a known abdominal aortic aneurysm (AAA) was referred to the endovascular clinic. One month after successful endovascular repair, surveillance CTA showed endoleak with presence of contrast within the aneurysmal sac. An elective repair was performed.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Cateterismo Periférico/métodos , Endoleak/cirurgia , Procedimentos Endovasculares/efeitos adversos , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Endoleak/diagnóstico , Humanos , Masculino , Artéria Radial , Reoperação
17.
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
19.
Cardiol Young ; 29(10): 1302-1304, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31475651

RESUMO

A new approach was used in the percutaneous treatment of two patients with severe recoarctation involving the origin of the left subclavian artery. A tiny handmade fenestration was created in a NuMED-covered Cheatham-platinum stent before its implantation to avoid left subclavian artery occlusion. The stent placement was performed using a two-guidewire technique in which the different stiffness helped a proper positioning of the stent. After the stent deployment, the fenestration was enlarged performing a balloon angioplasty to improve flow in left subclavian artery.


Assuntos
Aorta Torácica/cirurgia , Coartação Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Materiais Revestidos Biocompatíveis , Platina , Artéria Subclávia/cirurgia , Adulto , Coartação Aórtica/diagnóstico , Aortografia/métodos , Criança , Feminino , Humanos , Masculino , Desenho de Prótese
20.
Saudi J Kidney Dis Transpl ; 30(4): 819-824, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464238

RESUMO

Vascular calcification (VC) is a well-known complication in patients with chronic kidney disease (CKD). Keeping in mind, the end goal to assess the genuine effect of mineral bone disease in the pathogenesis of blood vessel calcification during the pre-dialysis course of CKD, we assessed the prevalence and extent of abdominal aortic calcification (AAC) in nondiabetic CKD patients recently starting hemodialysis (HD). Eighty-one patients with end-stage renal disease beginning HD over a one-month period were selected. They underwent a detailed clinical examination and laboratory evaluation, including serum calcium, phosphorus, parathyroid hormone, fibroblast growth factor (FGF-23), and alkaline phosphatase were measured, and spiral computed tomography was performed to evaluate AAC score. AAC was present in 64 patients (79%). There was a significant correlation between the AAC score and age (r = 0.609, P <0.001) and FGF-23 (r = 0.800, P <0.001). This study suggests that the prevalence and extent of AAC are critical in incident HD patients. Serum FGF-23 level is the sole statistically significant correlate of AAC in these patients.


Assuntos
Aorta Abdominal , Doenças da Aorta/epidemiologia , Falência Renal Crônica/terapia , Diálise Renal , Calcificação Vascular/epidemiologia , Adulto , Idoso , Aorta Abdominal/diagnóstico por imagem , Doenças da Aorta/sangue , Doenças da Aorta/diagnóstico por imagem , Aortografia/métodos , Biomarcadores/sangue , Angiografia por Tomografia Computadorizada , Egito/epidemiologia , Feminino , Fatores de Crescimento de Fibroblastos/sangue , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fósforo/sangue , Prevalência , Diálise Renal/efeitos adversos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada Espiral , Resultado do Tratamento , Calcificação Vascular/sangue , Calcificação Vascular/diagnóstico por imagem , Adulto Jovem
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