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1.
J Atheroscler Thromb ; 28(1): 90-95, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32863298

RESUMO

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an acute infectious disease that spreads mainly via the respiratory route. Elderly patients or those with underlying diseases are more seriously affected. We report a case of COVID-19 infection in a geriatric patient with arteriovenous thrombosis of the right lower limb. Despite persistent anticoagulant therapy, the patient's arterial thrombosis continued to progress and presented with ischemic necrosis of the lower extremity. After amputation in this case, the levels of D-dimer and inflammatory cytokine increased progressively, and he presented with acute myocardial infarction, which progressed rapidly to multisystem organ failure. However, whether coronavirus can directly cause the damage of the cardiovascular system and thrombosis needs further investigation.


Assuntos
Amputação , Extremidade Inferior , Insuficiência de Múltiplos Órgãos , Infarto do Miocárdio , Complicações Pós-Operatórias , Trombose , Idoso , Amputação/efeitos adversos , Amputação/métodos , /diagnóstico , /terapia , Evolução Fatal , Artéria Femoral/diagnóstico por imagem , Veia Femoral/diagnóstico por imagem , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Masculino , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/terapia , Necrose/etiologia , Necrose/cirurgia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Trombose/complicações , Trombose/etiologia , Trombose/fisiopatologia , Trombose/terapia , Ultrassonografia/métodos
2.
Ann Vasc Surg ; 70: 370-377, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32603847

RESUMO

BACKGROUND: Arterial access and device delivery in endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) have evolved from open femoral or iliac artery exposure to selective percutaneous arterial access. Although regional application of percutaneous access for these 2 procedures varies widely, the use of this technique continues to increase. Currently, differences in the use of percutaneous access between EVAR and TEVAR have not been well explored. The Gore Global Registry for Endovascular Aortic Treatment (GREAT) registry collected relevant data for evaluation of these issues and the comparative results between open and percutaneous approaches in regard to complication rates and length of stay (LOS). METHODS: This study was performed via a retrospective review of patients from the GREAT registry (Clinicaltrials.gov no. NCT01658787). The primary variable of this study was access site complications including postoperative hematoma, vessel dissection, and pseudoaneurysm. Patients were categorized by abdominal (EVAR) and thoracic (TEVAR) aortic procedures using percutaneous-only, cutdown-only, and combined vascular access techniques for a total of 6 groups. Standard statistical methodology was used to perform single-variable and multivariable analysis of a variety of covariates including LOS, geographical location of procedure, procedural success rate, and access sheath size. RESULTS: Of 4,781 patients from the GREAT registry, 3,837 (80.3%) underwent EVAR and 944 (19.7%) underwent TEVAR with percutaneous-only access techniques being used in 2,017 (42.2%) and cutdown-only in 2,446 (51.2%). There was variable application of percutaneous access by geographic region with Australia and New Zealand using this technique more frequently and Brazil using percutaneous access the least. No significant difference in the rate of access site complications was detected between the 6 groups of patients in the study; however, significantly lower rates of access site complications were associated with percutaneous-only compared with both cutdown-only and combined techniques (P = 0.03). In addition, associated with significantly higher rates of access site complications was longer LOS (P < 0.01). Average LOS was 5.2 days and was higher in the TEVAR group (10.1 days) than that in EVAR (4.0 days, P < 0.05). Increased sheath size does not appear to increase the risk of access site complication. CONCLUSIONS: There was no significant difference found in the complication rate between percutaneous and cutdown access techniques. This analysis demonstrates that percutaneous-only access is safe, has low complication rates, and has lower LOS compared with open access or combined access techniques.


Assuntos
Doenças da Aorta/cirurgia , Implante de Prótese Vascular , Cateterismo Periférico , Procedimentos Endovasculares , Artéria Femoral/cirurgia , Artéria Ilíaca/cirurgia , Idoso , Idoso de 80 Anos ou mais , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Cateterismo Periférico/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Punções , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
3.
Ann Vasc Surg ; 70: 362-369, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32634565

RESUMO

BACKGROUND: Endovascular treatment has become the first-line revascularization technique for femoropopliteal lesions. This technique lacks reliable and accurate morphological control of the arterial segment treated. Intraoperative 2-dimensional angiogram consumes iodinated contrast media and increases X-ray exposure; this subsequently provides no 3-dimensional information on the quality of the revascularization completed, what could explain some of the early and late failures of the technique. We evaluated whether intraoperative optical coherence tomography (OCT) control in addition to standard angiogram could improve the primary patency rate at 12 months in comparison to standard angiogram alone in patients with occlusive femoropopliteal lesions. METHODS: The tomography by optical coherence in femoral artery trial is a multicentric, prospective, randomized, controlled, and single-blind study including patients with long de novo occlusive femoropopliteal lesions. The randomization will be achieved in 2 balanced groups of patients after crossing successfully the lesion: group 1 with intraoperative OCT control in addition to standard angiogram and group 2 with standard angiogram alone. The randomization will be stratified by center. The protocol has been submitted and approved by a French ethic's committee under reference number CPP2019-12-098. The study has been registered under the reference number NCT04434586 on the Web site of clinicaltrials.gov. RESULTS: The primary outcome of the study is the primary patency at 12 months. The number of patients who need to be treated is 166 (83 in each group) considering 5% of no workable data. Symptoms' improvement, target lesion revascularization, target vessel revascularization, quality-of-life questionnaires, cost utility, and cost effectiveness will be analyzed as secondary end-point variables at 12 months. CONCLUSIONS: The present study is to evaluate the potential benefit for patients on the result of endovascular revascularization of long occlusive femoropopliteal lesion at 12 months when using intraoperative OCT control.


Assuntos
Procedimentos Endovasculares , Artéria Femoral/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Artéria Poplítea/diagnóstico por imagem , Tomografia de Coerência Óptica , Angiografia , Constrição Patológica , Procedimentos Endovasculares/efeitos adversos , Artéria Femoral/fisiopatologia , França , Humanos , Estudos Multicêntricos como Assunto , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
4.
Ann Vasc Surg ; 70: 449-458, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32634568

RESUMO

BACKGROUND: The aim of this study is to assess the incidence, clinical manifestations, management, and prognosis of graft infection after bypass surgery with prosthetic conduit for infectious femoral artery pseudoaneurysms (IFAPs) in patients with a history of intravenous drug use (IVDU). METHODS: A single-center retrospective chart review of IVDU presenting with graft infections after previously being treated with extra-anatomic prosthetic conduit bypass surgery for IFAPs between 2009 and 2019 was performed. Relevant clinical data and patient demographics were collected and analyzed. All patients underwent procedures consisting of graft removal with analysis of operative details and complications. RESULTS: Of all 122 patients who underwent IFAP resection with extra-anatomic prosthetic bypass, the incidence of graft infection was 38.5% (47 patients, 48 grafts) with an average age of 35.7 ± 7.3 years. The average interval between bypass surgery and infectious symptoms was 9.2 ± 2.5 months and average time from bypass to graft removal was 13.6 ± 3.4 months. The most common presentation was repeated or unhealable chronic ulcers with sinus formation or purulence either within the bypass area or along the graft conduit route (43, 89.6%). Occlusion of the infected bypass graft occurred in nearly all cases (46, 95.8%). Severe hemorrhage occurred in only 1 case (2.1%). After graft removal, the stumps were ligated in the majority of patients (33, 68.8%) with 15 patients (31.2%) not amenable to ligation due to a difficult dissection. The average time of operation was 35.4 ± 8.7 min with an average blood loss of 35.8 ± 6.7 mL. There were no significant complications such as infection reoccurrence, severe limb ischemia, amputation, or death observed postoperatively. CONCLUSIONS: Patients who receive bypass surgery with prosthetic conduit for IFAPs carry a high incidence of graft infection and subsequent occlusion. However, the presenting symptoms are generally mild, and the incidence of fatal complications is rare. This study suggests that a safe treatment option consists of direct graft removal without reconstruction. Additionally, the procedure proved to be relatively convenient and straightforward, which provides further support toward the strategy of treating IFAPs in IVDUs with pseudoaneurysm resection and prosthetic conduit bypass surgery.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Infectado/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Remoção de Dispositivo , Artéria Femoral/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/microbiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Implante de Prótese Vascular/instrumentação , Remoção de Dispositivo/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/microbiologia , Humanos , Ligadura , Masculino , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
6.
Ann Vasc Surg ; 70: 70-78, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32795647

RESUMO

BACKGROUND: Paclitaxel-coated devices have been shown to decrease restenosis when used in the femoropopliteal artery. Recent reports have suggested a possible risk of increased late mortality in patients treated with paclitaxel. It has been suggested that younger patients and those with limited comorbidities may be at higher risk. Our objective was to analyze long-term mortality based on patient age comparing treatment with paclitaxel to uncoated devices. METHODS: We performed a retrospective review of 1,170 consecutive patients who underwent femoropopliteal percutaneous intervention by angioplasty, atherectomy, stent placement, or combination between 2011 and 2018. Patients were grouped by age at the time of procedure: <60 years old (n = 244, 20.9%), 60-80 years old (n = 635, 54.3%), and >80 years old (n = 291, 24.9%). Within each group, patients were further divided by use of paclitaxel. The primary outcome measure was survival assessed by Kaplan-Meier analysis. Differences between the groups were analyzed with analysis of variance. Multivariable analysis was performed using Cox proportional hazard models. RESULTS: Of the 1,170 patients who underwent femoropopliteal percutaneous intervention, 654 (55.9%) received a paclitaxel-coated device during treatment and 516 (44.1%) did not. Mean age of the overall patient cohort was 70.4 ± 12.6 years and 663 (56.7%) were male. When comparing the groups by age we found an increase in age but a decrease in the proportion of patients who smoke. The use of paclitaxel-coated devices was similar across the groups (<60 years old, 56.2%; 60-80 years old, 57.0%; >80 years old, 52.6%; P = 0.45). Demographics and comorbidities were similar between the patients treated with and without paclitaxel within each age group except more males in the <60-year-old group treated without paclitaxel and more patients with chronic limb threatening ischemia in the >80-year-old group treated with paclitaxel. In patients <60 and 60-80 years old paclitaxel use was associated with increased survival at 4 years: <60 (80.7% vs. 64.4%; P = 0.04); 60-80 (63.2% vs. 55.1%; P = 0.04). Survival was similar in the >80-year-old group (46.6% vs. 32.8%; P = 0.65). CONCLUSIONS: Our data suggest that the use of paclitaxel-coated arterial devices is not associated with increased mortality. On the contrary, our data show that younger patients treated with paclitaxel show improved survival compared with those treated without paclitaxel. Paclitaxel-coated devices may be used with continued caution especially in patients at high risk for restenosis.


Assuntos
Angioplastia com Balão/instrumentação , Fármacos Cardiovasculares/administração & dosagem , Stents Farmacológicos , Artéria Femoral , Paclitaxel/administração & dosagem , Doença Arterial Periférica/terapia , Artéria Poplítea , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/mortalidade , Aterectomia , Fármacos Cardiovasculares/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Paclitaxel/efeitos adversos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/mortalidade , Artéria Poplítea/diagnóstico por imagem , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
Ann Vasc Surg ; 70: 555-558, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32800886

RESUMO

One of the difficulties of the subintimal arterial flossing with antegrade-retrograde intervention technique (SAFARI) technique is to properly achieve a rendezvous between both antegrade and retrograde accesses. We propose a new technique to overcome this difficulty. It consists of directly percutaneously puncturing 2 loop snares, placed via each access, which are then both used to snare an externally introduced guidewire introduced through the needle. The snares are then moved en bloc, bringing both snares and the wire into the same channel.


Assuntos
Angioplastia com Balão , Artéria Femoral , Doença Arterial Periférica/terapia , Artéria Poplítea , Idoso de 80 Anos ou mais , Angioplastia com Balão/instrumentação , Constrição Patológica , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Punções , Resultado do Tratamento , Dispositivos de Acesso Vascular , Grau de Desobstrução Vascular
8.
Ann Vasc Surg ; 70: 197-201, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32335254

RESUMO

We describe a novel endovascular technique in which three 0.014″ guidewires are placed in parallel through a 0.035″ lumen catheter, in order to create a stiff platform to allow for delivery of 0.035″ profile devices through challenging anatomy. Three illustrative cases are presented: a difficult aortic bifurcation during lower extremity intervention, a tortuous internal iliac artery during placement of an iliac branch device, and salvage of a renal artery after inadvertent coverage during proximal cuff deployment for type 1a endoleak. We also quantify the relative stiffness of the triple 0.014″ wire configuration, using several well-known 0.035″ wires for comparison. The "triple wire technique" is an effective method for tracking endovascular devices through difficult tortuous anatomy, and can be used in a variety of clinical settings. The technique is especially useful when a traditional, stiff 0.035″ wire will not track without "kicking out." Each 0.014″ wire is reasonably soft and traverses the tortuous vessel easily, but when the 3 wires are used together as a rail it provides a stiff enough platform for delivery.


Assuntos
Implante de Prótese Vascular/instrumentação , Endoleak/cirurgia , Procedimentos Endovasculares/instrumentação , Artéria Femoral/cirurgia , Aneurisma Ilíaco/cirurgia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Dispositivos de Acesso Vascular , Idoso , Idoso de 80 Anos ou mais , Prótese Vascular , Endoleak/tratamento farmacológico , Desenho de Equipamento , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Maleabilidade , Stents
9.
Cardiovasc Pathol ; 50: 107268, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32858206

RESUMO

We report the sudden unexpected death from exsanguination of a 60-year-old white female who underwent balloon angioplasty of her right popliteal artery via a right common femoral arteriotomy 3 weeks before death. This resulted in a mycotic pseudoaneurysm of the right femoral artery that ruptured, causing fatal exsanguination. A pseudoaneurysm is an arterial wall defect in which part of the wall consists of fibrin and fibrous tissue, lacking components of the normal arterial wall, that is intima, media, and adventitia. Pseudoaneurysms result from traumatic arterial injury, infection, rupture of a true aneurysm, or surgery. A literature search revealed no reports with the patient dying unexpectedly outside the hospital. Immediate surgical intervention and antibiotic therapy are preferred treatments.


Assuntos
Falso Aneurisma/etiologia , Aneurisma Infectado/etiologia , Aneurisma Roto/etiologia , Angioplastia com Balão/efeitos adversos , Artéria Femoral/lesões , Lesões do Sistema Vascular/etiologia , Falso Aneurisma/patologia , Aneurisma Infectado/patologia , Aneurisma Roto/patologia , Autopsia , Evolução Fatal , Feminino , Artéria Femoral/patologia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Lesões do Sistema Vascular/patologia
10.
Medicine (Baltimore) ; 99(52): e23731, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350755

RESUMO

BACKGROUND: Access site hemostasis after percutaneous procedures done in the catheterization laboratory still needs to be better studied in relation to such aspects as the different results achieved with different hemostasis strategies, the impact of different introducer sheath sizes, and arterial versus venous access. The objective of this review is to synthesize the available scientific evidence regarding different techniques for hemostasis of femoral access sites after percutaneous diagnostic and therapeutic procedures. METHODS: This review is being reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The primary outcomes will include the following vascular complications: hematoma, pseudoaneurysm, bleeding, minor, and major vascular complications. The secondary outcomes will include the following: time to hemostasis, repetition of manual compression, and device failure. A structured strategy will be used to search the PubMed/ MEDLINE, Embase, CINAHL, and CENTRAL databases. In addition, a handsearch of the reference lists of selected studies will be conducted. The ERIC research database will be queried for the gray literature and ClinicalTrials.gov, for potential results not yet published in indexed journals. Two reviewers will independently screen citations and abstracts, identify full-text articles for inclusion, extract data, and appraise the quality and risk of bias of included studies. If possible, a meta-analysis will be carried out. All estimations will be made using Review Manager 5.3. Statistical heterogeneity will be assessed by considering the I2 proxy, accompanied with qualitative indicators such as differences in procedures, interventions, and outcomes among the studies. If synthesis proves inappropriate, a narrative review will be undertaken. RESULTS: This protocol adheres to the PRISMA-P guideline to ensure clarity and completeness of reporting at all phases of the systematic review. CONCLUSION: This study will provide synthesized information on different methods used to achieve hemostasis after femoral access. ETHICS AND DISSEMINATION: Ethical approval number CAAE 19713219700005327. The results of the systematic review will be disseminated via publication in a peer-reviewed journal and through conference presentations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019140794.


Assuntos
Doença da Artéria Coronariana/cirurgia , Artéria Femoral , Hemostasia , Intervenção Coronária Percutânea , Humanos
11.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(12): 1053-1059, 2020 Dec 24.
Artigo em Chinês | MEDLINE | ID: mdl-33355750

RESUMO

Objective: To investigate the effects of femoral approach versus radial approach on the incidence of contrast-induced acute kidney injury (CI-AKI) in patients with coronary heart disease, who received twice contrast agents within a short interval. Methods: A total of 322 patients with coronary heart disease, who admitted to the General Hospital of Northern Theater Command from January 2010 to January 2015, were included in this retrospective analysis. All patients exposed to contrast agents twice within 30 days. The patients were divided into two groups according to the approach of interventional operation: radial artery group (n=235) and femoral artery group (n=87). Serum creatinine (SCr) values were detected at 48 and 72 hours post procedure. Endpoint events were CI-AKI, which was defined as SCr increased>0.5 mg/dl (44.2 µmol/L) or relative ratio ((postoperative SCr-preoperative SCr)/preoperative SCr×100%>25%) within 72 hours after contrast agent use after excluding other causes. Clinical characteristics and the incidence of CI-AKI were compared between the two groups, multivariate logistic regression analysis was used to detect the risk factors of postoperative CI-AKI in these patients. Results: The proportion of smoking, PCI history, STEMI patients and levels of fibrinogen, fasting blood glucose, troponin T was significantly higher in femoral artery group than in radial artery group (all P<0.05). The interval between two procedure sessions was significantly longer in the femoral artery group than in the radial artery group (P=0.001). The incidence of CI-AKI tended to be higher in femoral artery group than in radial artery group after the first operation (18.6% (16/87) vs. 11.9% (28/235), P=0.133). CI-AKI incidence after the second operation was similar between the two groups (P>0.05). Multivariate logistic regression analysis showed that interventional approach was not an independent risk factor for postoperative CI-AKI in patients with coronary heart disease undergoing interventional procedures twice within 30 days (P>0.05);STEMI (OR=2.854, 95%CI 1.100-7.404, P=0.031) and diuretics use (OR=4.002, 95%CI 1.470-10.893, P=0.007) were independent risk factors for CI-AKI after the first operation. Conclusion: There is no correlation between the risk of CI-AKI and interventional approaches in patients with coronary heart disease who undergo interventional surgery twice within 30 days.


Assuntos
Lesão Renal Aguda , Doença das Coronárias , Intervenção Coronária Percutânea , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/epidemiologia , Meios de Contraste/efeitos adversos , Artéria Femoral/cirurgia , Humanos , Incidência , Intervenção Coronária Percutânea/efeitos adversos , Artéria Radial , Estudos Retrospectivos , Fatores de Risco
12.
J Vis Exp ; (165)2020 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-33283790

RESUMO

Percutaneous coronary intervention (PCI), combined with the deployment of a coronary stent, represents the gold standard in interventional treatment of coronary artery disease. In-stent restenosis (ISR) is determined by an excessive proliferation of neointimal tissue within the stent and limits the long-term success of stents. A variety of animal models have been used to elucidate pathophysiological processes underlying in-stent restenosis (ISR), with the porcine coronary and the rabbit iliac artery models being the most frequently used. Murine models provide the advantages of high throughput, ease of handling and housing, reproducibility, and a broad availability of molecular markers. The apolipoprotein E deficient (apoE-/- ) mouse model has been widely used to study cardiovascular diseases. However, stents must be miniaturized to be implanted into mice, involving important changes of their mechanical and (potentially) biological properties. The use of apoE-/- rats can overcome these shortcomings as apoE-/- rats allow for the evaluation of human-sized coronary stents while at the same time providing an atherogenic phenotype. This makes them an excellent and reliable model to investigate ISR after stent implantation. Here, we describe, in detail, the implantation of commercially available human coronary stents into the abdominal aorta of rats with an apoE-/- background using a trans-femoral access.


Assuntos
Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Vasos Coronários/cirurgia , Artéria Femoral/cirurgia , Stents , Animais , Aorta Abdominal/patologia , Feminino , Humanos , Masculino , Ratos , Reprodutibilidade dos Testes , Resultado do Tratamento
13.
Rev Med Suisse ; 16(718): 2372-2375, 2020 Dec 09.
Artigo em Francês | MEDLINE | ID: mdl-33300696

RESUMO

Arteriopathy of the lower limbs is a frequent pathology. In the face of persistent invalidating claudication or critical ischemia, surgical or endovascular revascularization treatment is necessary. The aim of this article is to review the evolution of the endovascular therapeutic arsenal of the femoropopliteal segment, to present the new endovascular devices available and to give current recommendations for post-interventional antithrombotic treatment.


Assuntos
Procedimentos Endovasculares , Extremidade Inferior/cirurgia , Doenças Vasculares/cirurgia , Artéria Femoral/cirurgia , Humanos , Claudicação Intermitente , Isquemia/complicações , Doenças Vasculares/complicações
14.
Georgian Med News ; (307): 85-91, 2020 Oct.
Artigo em Russo | MEDLINE | ID: mdl-33270583

RESUMO

Objective - to determine the effectiveness of modern methods of radiological diagnostics for improving the results of treatment of patients with distal occlusive-stenotic diseases of the femoral-popliteal-tibial segment of atherosclerotic genesis. The analysis of examinations and treatment of 150 patients with distal atherosclerosis, who were in the Department of Vascular Surgery of the Regional Clinical Hospita A. Novaka. On ultrasound examination of the arteries of the femoral-popliteal-tibial segment, false negative and false positive results were observed in 11 and 3 patients, respectively. On duplex scanning, a false negative was observed in 5 patients, a false positive in two patients. On X-ray contrast angiography, respectively, in 14 and 5 patients, with MDCT - in 3 and 2 patients. To study of the deep femoral artery, the largest number of false positive and false negative results were observed during ultrasound examination of 12 and 5 patients and X-ray contrast angiography in 18 and 12 patients, respectively. Have compared the radiological methods for diagnosing the arteries of the femoral-popliteal-tibial segment and the deep femoral artery, the most effective were MDCT (89.1% and 90%, respectively) and ultrasound duplex scanning (88.7% 82%, respectively). The predictability of the research method for diagnosing the arteries of the femoral-popliteal-tibial segment for ultrasound was 97.7%, for ultrasound - 97.1%, for RCAH - 91.1%, for MSCT - 98% with an accuracy of 90.7%, 95 , 3%, 78.2%, 95.5%. For the deep femoral artery, the predictability of ultrasound was 95.9%, ultrasound - 96.9%, RCAH - 58.6%, MSCT - 99% with an accuracy of 88.7%, 93.3%, 66.5%, 97.3%, respectively.


Assuntos
Arteriopatias Oclusivas , Artéria Poplítea , Artéria Femoral/diagnóstico por imagem , Humanos , Artéria Poplítea/diagnóstico por imagem , Ultrassonografia , Procedimentos Cirúrgicos Vasculares
15.
Angiol Sosud Khir ; 26(4): 98-107, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33332312

RESUMO

Atherosclerosis obliterans is managed by various reconstructions of lower-limb arteries, but despite this, in the immediate and remote postoperative period there appears the necessity to carry out repeat reconstructions, which might be caused by shunt thrombosis, progression of atherosclerosis, etc. One of the methods of solving this problem is revascularization of lower-limb arteries through the deep femoral vein with plasty thereof. In occlusive lesions of the superficial femoral artery, the deep femoral artery plays the key role in blood supply of the entire extremity. The article deals with the principles of repeat surgical treatment of lower-limb arteries with the use of the deep femoral artery, also discussing the problems concerning the frequency of occurrence of thromboses in various positions, and the role of the deep femoral artery in blood supply of the lower extremity. The problem of efficacy of redo operations on lower-limb arteries using the deep femoral artery is still important. Despite the possibility of revascularization of lower extremities through the deep femoral vein, a high percentage of amputations remains. The terms of patency of the reconstructed deep femoral artery has proved to be several times longer than those of femoropopliteal and femorotibial shunts in the remote postoperative period. Besides, there are no clear-cut criteria for prognosis of efficacy of reconstructive interventions on the deep femoral artery in patients with multi-segment lesions of arteries of lower extremities after primary interventions, therefore, no common surgical policy exists. The use of the deep femoral artery in patients with ischaemia of lower extremities is explained by the minimally traumatic nature and confirmed efficacy after a series of previously performed multilevel operations, severe lesions of the distal bed, as well as in patients with severe concomitant diseases.


Assuntos
Artéria Femoral , Extremidade Inferior , Amputação , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Humanos , Isquemia , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares
16.
Acta Cir Bras ; 35(10): e202001004, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33237176

RESUMO

PURPOSE: To modify a surgical catheterization method using the bent needle introducer in small animals. METHODS: Eight-week-old male Lewis rats were used in the study. A needle introducer was created by bending a 21G injection needle at 45°. The bent needle introducer was used for catheter insertion into the left femoral artery of the rats under anesthesia. As a control, a catheter was directly inserted into the blood vessel without the introducer. The insertion time of each method was measured. Blood pressure and heart rate were measured 24 h after catheter insertion using the telemetry system. RESULTS: Using the introducer, the catheter was successfully inserted within a short time in all rats. Without the introducer, a longer duration was required for catheter insertion. The frequency of the insertion with no catheter-based errors with the introducer tended to be higher than that without the introducer. The mean arterial pressure and heart rate 24 h after catheter insertion in each group were almost the same. CONCLUSIONS: We developed a surgical catheterization method using the introducer in small animals. This could potentially reduce the frequency of the insertion with catheter-based errors and insertion time.


Assuntos
Cateterismo , Artéria Femoral , Animais , Artéria Femoral/cirurgia , Masculino , Agulhas , Ratos , Ratos Endogâmicos Lew
17.
Semin Vasc Surg ; 33(1-2): 16-23, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33218612

RESUMO

Both transfemoral carotid artery stenting (TF-CAS) and transcarotid artery revascularization (TCAR) are competing endovascular alternatives to carotid endarterectomy for the treatment of atherosclerotic carotid artery stenosis. TF-CAS is an endovascular procedure associated with a long learning curve and higher periprocedural stroke and death rates during an operator's early experience. Estimates suggest that more than 50 cases are required to achieve outcomes similar to carotid endarterectomy. TCAR is a novel hybrid procedure combining direct common carotid artery access and cerebral blood flow reversal with carotid stent placement. In distinction from TF-CAS, TCAR has a rather short learning curve. A multi-institutional analysis showed that operators achieved technical proficiency after approximately 10 to 15 cases. This was reinforced by a large Society for Vascular Surgery, Vascular Quality Initiative Transcarotid Artery Revascularization Surveillance Project analysis that demonstrated that expertise peaked after approximately 20 cases. Both studies found that TCAR was not associated with an increased rate of stroke or death during operator's early experience. These data suggest that TCAR is readily learned and patients are not at increased risk during a surgeon's early experience.


Assuntos
Angioplastia com Balão , Estenose das Carótidas/terapia , Cateterismo Periférico , Competência Clínica , Artéria Femoral , Curva de Aprendizado , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Cateterismo Periférico/efeitos adversos , Dispositivos de Proteção Embólica , Humanos , Punções , Fatores de Risco , Stents , Resultado do Tratamento
18.
J Cardiovasc Surg (Torino) ; 61(5): 617-625, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33231029

RESUMO

BACKGROUND: This clinical trial aims to evaluate the outcome (up to 24-months) of the treatment of in-stent restenotic or reoccluded lesions in the femoropopliteal arteries, by comparing the treatment of the GORE® VIABAHN® Endoprosthesis with PROPATEN Bioactive Surface (W. L. Gore & Associates, Flagstaff, AZ, USA) with a standard PTA treatment. The primary effectiveness endpoint of the study is the primary patency at 12 months, defined as no evidence of restenosis or occlusion within the originally treated lesion based on color-flow duplex ultrasound (PSVR≤2.5) and without target lesion revascularization (TLR) within 12 months. The primary safety endpoint is the proportion of subjects who experience serious device-related adverse events within 30 days postprocedure. METHODS: A total of 83 patients meeting inclusion and exclusion criteria have been enrolled in this prospective, randomized, multicenter, controlled study in 7 sites between June 2010 and February 2012. Patients with an in-stent restenosis lesion in the femoropopliteal region and a Rutherford classification from 2 to 5 could be enrolled. After screening, the patient was randomized to either treatment with the GORE® VIABAHN® Endoprosthesis with PROPATEN Bioactive Surface or treatment with a standard PTA balloon. After the index procedure, follow-up visits at 1 month, 6 months, 12 months and 24 months were required. A color flow Doppler ultrasound was performed on all follow-up visits and a quantitative vascular angiography at the 12-month follow-up visit. RESULTS: In the VIABAHN® group, 39 patients (74.4% male; mean age 67.69±9.77 years) were enrolled and in the PTA group, 44 patients (72.7% male; mean age 68.98±9.71 years) were enrolled, which is comparable for both treatment groups. In the VIABAHN® group, 34 (87.2%) patients presented with claudication (Rutherford 2 and 3) and 5 (12.8%) patients had critical limb ischemia (Rutherford 4 and 5). In the PTA group, 36 (81.8%) patients were claudicants (Rutherford 2 and 3) and 8 (18.2%) presented with critical limb ischemia (Rutherford 4 and 5). The 12-month primary patency rates were 74.8% for the VIABAHN® group and 28.0% for the PTA group (P<0.001). No patients were reported to have device-related serious adverse events within 30 days postprocedure. The primary patency rate for the 24-month follow-up was 58.40% in the Viabahn group and 11.60% in the PTA group (P<0.001). CONCLUSIONS: The treatment of femoropopliteal in-stent restenosis with a VIABAHN® Endoprosthesis shows significantly better results than the treatment with a standard PTA balloon. This demonstrates that the use of the VIABAHN® Endoprosthesis is a very promising tool for the treatment of complex in-stent restenosis.


Assuntos
Angioplastia com Balão/instrumentação , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Artéria Femoral/cirurgia , Doença Arterial Periférica/terapia , Stents , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Bélgica , Implante de Prótese Vascular/efeitos adversos , Constrição Patológica , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Estudos Prospectivos , Recidiva , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
19.
Am J Gastroenterol ; 115(11): 1915-1917, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33156112

RESUMO

INTRODUCTION: We aim to discuss the utility of self-expandable esophageal metal stent (SEMS) in variceal bleeding in challenging cases. METHODS: Case description, discussion on patient management and decision-making process in an uncommon situation, from a multidisciplinary point of view. RESULTS: We report a case of a cirrhotic patient with refractory variceal bleeding who underwent a SEMS placement, which remained in situ for 9 months. This decision was based on the initial poor status and short life expectancy, limiting the consideration of other options for lowering portal hypertension, along with an underlying prothrombotic predisposition. However, the patient's general and hepatic improvement and the development of dysphagia led to the SEMS removal, exposing a large esophageal-tracheal fistula. DISCUSSION: Early patient evaluation, risks of long-term SEMS, and life expectancy should be taken in consideration before SEMS placement.


Assuntos
Transtornos de Deglutição , Estenose Esofágica , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Hepatite B Crônica/complicações , Cirrose Hepática Alcoólica/complicações , Complicações Pós-Operatórias , Stents Metálicos Autoexpansíveis , Fístula Traqueoesofágica , Idoso , Anticoagulantes/uso terapêutico , Carcinoma Hepatocelular/etiologia , Doenças do Esôfago/etiologia , Doenças do Esôfago/terapia , Varizes Esofágicas e Gástricas/etiologia , Artéria Femoral , Hemorragia Gastrointestinal/etiologia , Hemostase Endoscópica , Humanos , Expectativa de Vida , Cirrose Hepática/complicações , Neoplasias Hepáticas/etiologia , Masculino , Nutrição Parenteral , Doença Arterial Periférica/complicações , Doença Arterial Periférica/tratamento farmacológico , Inibidores da Agregação de Plaquetas/uso terapêutico , Artéria Poplítea , Fatores de Tempo
20.
Rev Med Liege ; 75(11): 717-723, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33155445

RESUMO

Endovascular treatment established itself last years as the first choice to treat femoropopliteal arterial occlusive disease. It is less invasive than the surgical approach. Endovascular techniques and devices evolution made it efficient. Use of retrograde puncture or re-entry catheters allows to recanalize more complex lesions. Vessel preparation of stenotic or occluded target lesion becomes an integral part of the therapy. Thanks to a lot of multicenter randomized controlled trials, drug eluting balloons took major place in the armamentarium we have, despite strong controversies last months about their safety. Conventional self-expandable stents with or without eluting drug, and vasculo-mimetic stents allow to treat very calcified lesions or dissected lesions through the recanalization procedure. This paper aims to review endovascular technical developments achieved last years to treat femoropopliteal arterial occlusive disease.


Assuntos
Arteriopatias Oclusivas , Procedimentos Endovasculares , Doença Arterial Periférica , Arteriopatias Oclusivas/cirurgia , Artéria Femoral/cirurgia , Humanos , Doença Arterial Periférica/cirurgia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
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