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1.
Medicine (Baltimore) ; 99(4): e18760, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977867

RESUMO

RATIONALE: Peripheral arterial diseases (PADs) is defined as a systemic arterial disorders involving the lower extremity arteries, iliac, and carotid, which is developed more common in patients with chronic kidney disease (CKD) than individual with normal renal function. Concurrence of mesenteric artery disease and lower extremity artery disease (LEAD) is rare. The presence of PADs in patients receiving hemodialysis leads to a dramatic increase in risk of cardiovascular mortality. However, the early diagnosis of PADs in patient with CKD remains a challenge to nephrologists, which adds an adverse effect on prognosis. PATIENT CONCERNS: A 48-year-old man received regular hemodialysis due to end-stage renal failure caused by type 2 diabetes mellitus (T2DM) for 7 years, who was admitted into hospital for acute, severe rest pain of the right lower extremity at the first time. The computed tomography angiography showed severe, diffuse stenosis of the distal third of femoral artery. After discharged, he was readmitted into hospital for abdominal pain and the recurred right lower limb pain. A diagnostic angiography confirmed the initial occlusion of superior mesenteric artery, severe obstruction of the distal segment of femoral artery and diffuse, irregular stenosis of arteria peronea and arteria tibialis posterior. DIAGNOSIS: The patient was diagnosed as PADs including LEAD and mesenteric artery disease. INTERVENTIONS: The percutaneous transulminal angioplasty (PTA) combined with antiplatelet therapy and beraprost were performed. Moreover, the cinacalcet and lanthanum carbonate were prescribed to control calcium-phosphorus- parathyroid hormone metabolism. OUTCOMES: The patient was free of abdominal pain and partly relieved from the ache of lower limb after PTA. However, he finally succumbed to acute myocardial infarction. LESSONS: The incidence of PADs is higher in dialysis patients due to a unique set of biochemical and endocrine abnormalities. As there is a high uremic status and PADs burden in patients with hemodialysis, the short term risk of cardiovascular disesase mortality markedly increases. There is a need for nephrologists and cardiovascular physicians to identify these patients and then provide early and proper treatment.


Assuntos
Falência Renal Crônica/terapia , Doença Arterial Periférica/etiologia , Diálise Renal/efeitos adversos , Angioplastia , Diabetes Mellitus Tipo 2/complicações , Evolução Fatal , Artéria Femoral/diagnóstico por imagem , Humanos , Falência Renal Crônica/etiologia , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem
2.
Medicine (Baltimore) ; 99(4): e18890, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977898

RESUMO

RATIONALE: Takayasu arteritis (TA) is a systemic large-vessel vasculitis which can be accompanied by the symptoms associated with vascular stenosis. PATIENT CONCERNS: We describe 2 female juveniles with TA who presented with progressive intermittent claudication. DIAGNOSIS: Contrast-enhanced computed tomography (CT) revealed the stenosis of femoral arteries and increased levels of C-reactive protein (CRP), and serum amyloid A (SAA) were noted in both patients. According to European league against rheumatism consensus criteria for the diagnosis of TA was confirmed in both patients. INTERVENTIONS: Both patients had shown resistance to glucocorticoids and treated with tocilizumab (TCZ) (subcutaneous injections, 162 mg/week). OUTCOMES: These treatments improved claudication symptoms. Follow-up imaging by enhanced CT revealed restoration of advanced stenosis of the femoral arteries in both patients. They achieved normalization of levels of the acute-phase reactants CRP and SAA. Serum levels of interleukin-6 were increased transiently after TCZ injection, but declined to within normal ranges at 12 weeks. LESSONS: Juvenile patients with TA presenting with advanced stenosis of the femoral arteries are not rare. The clinical courses of our patients suggested the beneficial effects of TCZ against the progressive vascular stenosis observed in refractory TA.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Arterite de Takayasu/tratamento farmacológico , Adolescente , Constrição Patológica/etiologia , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Interleucina-6/sangue , Claudicação Intermitente/etiologia , Perna (Membro) , Arterite de Takayasu/complicações , Arterite de Takayasu/etiologia , Arterite de Takayasu/fisiopatologia , Resultado do Tratamento
3.
Vasc Endovascular Surg ; 54(2): 102-110, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31746273

RESUMO

OBJECTIVE: Compare technical, clinical, and economic outcomes between endovascular and open approaches in patients with type D aortoiliac occlusive disease according to the TransAtlantic Inter-Society Consensus. METHODS: Patients undergoing revascularization for type D aortoiliac lesions, either endovascular or open surgery approach, from 2 Portuguese institutions between January 2011 and October 2017 were included. The surgical technique was left to the surgeon discretion. Patients with common femoral artery affection, both obstructive and aneurysmatic, were excluded. RESULTS: Twenty-seven patients underwent aortobifemoral bypass and 32 patients were submitted to endovascular repair. The patients undergoing endovascular procedure were more likely to present with chronic heart failure (P = .001) and chronic kidney disease (P = .022) and less likely to have a history of smoking (P = .05). The mean follow-up period was 67.84 (95% confidence interval = 61.85-73.83) months. The open surgery approach resulted in a higher technical success (P = .001); however, limb salvage and patency rates were not different between groups. Endovascular approach was associated with a shorter length-of-stay, both inpatient (6 vs 9 days; P = .041) and patients admitted in the intensive care unit (0 vs 3.81 days; P = .001) as well as lower hospital expenses (US$9281 vs US$23 038; P = .001) with a similar procedure cost (US$2316 vs US$1173; P = .6). No differences were found in the postsurgical quality of life. CONCLUSION: Endovascular approach is, at least, clinically equivalent to open surgery approach and is more cost-efficient. The "endovascular-first" approach should be considered for type D occlusive aortoiliac lesions.


Assuntos
Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Artéria Femoral/cirurgia , Artéria Ilíaca/cirurgia , Idoso , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/economia , Doenças da Aorta/fisiopatologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/economia , Arteriopatias Oclusivas/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/economia , Implante de Prótese Vascular/instrumentação , Redução de Custos , Análise Custo-Benefício , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/economia , Procedimentos Endovasculares/instrumentação , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Custos de Cuidados de Saúde , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Portugal , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Stents , Fatores de Tempo , Resultado do Tratamento
4.
J Surg Oncol ; 121(1): 153-162, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31152457

RESUMO

BACKGROUND: Reported ischemia time of vascularized lymph nodes was 5 hours. This study investigated the effects of arterial ischemia and venous occlusion on vascularized lymph node function in rats. METHODS: Bilateral pedicled groin lymph node flaps were raised in 27 Lewis rats. Femoral artery and vein were separated and clamped for 1, 3, 4, or 5 hour(s). Lymph node flap perfusion and drainage were assessed by laser Doppler flowmetry and indocyanine green lymphography. Histologic changes were assessed using hematoxylin and eosin stain, terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL), and glutathione assays. RESULTS: Perfusion units of 2.84 ± 1.41, 2.46 ± 0.64, 2.42 ± 0.37, and 2.01 ± 0.90 were measured in arterial ischemia groups, and 1.71 ± 0.45, 2.20 ± 0.98, 1.49 ± 0.35, and 0.81 ± 0.20 in venous occlusion groups after 1, 3, 4, and 5 hours of clamping, respectively. Lymphatic drainage showed mean latency periods of 5.33 ± 0.88, 9.00 ± 3.21, 10.00 ± 2.08, and 24.50 ± 11.50 seconds in arterial clamping groups, and 25.00 ± 3.61, 26.00 ± 3.06, 23.33 ± 4.41, and 152.00 ± 0 seconds in venous clamping groups, respectively. Severe medullary and cortical congestion and hemorrhage on histology and cell damage by glutathione levels and TUNEL assay were found after 4 hours of venous clamping. CONCLUSIONS: Arterial ischemia and venous occlusion impact the function and viability of vascularized lymph node flaps differently. The critical venous occlusion time was 4 hours.


Assuntos
Isquemia/fisiopatologia , Linfonodos/irrigação sanguínea , Retalhos Cirúrgicos/irrigação sanguínea , Doenças Vasculares/fisiopatologia , Animais , Drenagem , Artéria Femoral/fisiopatologia , Virilha , Linfonodos/transplante , Masculino , Perfusão , Ratos , Ratos Endogâmicos Lew
5.
Vasc Endovascular Surg ; 54(1): 17-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526118

RESUMO

INTRODUCTION: The aim of this study is to describe our experience in the treatment of femoropopliteal occlusive disease with percutaneous transluminal angioplasty (PTA) followed by stenting with S.M.A.R.T. Flex vascular stent system. MATERIALS AND METHODS: From June 2014 to October 2018, 80 patients were treated at our Institution for intermittent claudication, critical, or acute limb ischemia due to total occlusion or long diffused lesions of the femoropopliteal segment. Main study end points are primary patency, target lesion revascularization, and stent fractures; secondary end points are major amputation rate, procedure-related bleeding, incidence of intrastent restenosis, and primary assisted patency after reintervention. RESULTS: Mean follow-up time was 21 months (range 2-48 months). Primary patency rate was 80% (64 patients of 80), with mean covered lesion length of 8.2 cm. The deployment of a single stent was obtained for 57 (89%) patients, with a mean stent length of 9.86 cm. Of 80 patients, 2 (2.5%) had early stent occlusion within first 48 hours after the procedure, while 4 (5%) of 80 patients experienced stent occlusion within first 6 months. Of 80 patients, 6 (7.5%) had an intrastent restenosis detected at duplex ultrasound with a primary-assisted patency after simple re-PTA procedures of 83.3% at 12 months. DISCUSSION: In the literature, primary patency after PTA and stenting of the femoropopliteal trunk seems to be related to several variables, such as number of stents used, specific stent length, diameters, type and length of lesions, type of pathology (if acute or chronic), and number of preoperatory patent below-the-knee vessels. In this study, we try to analyze each single factor in order to understand their role in predisposing specific stent restenosis. CONCLUSIONS: S.M.A.R.T. Flex vascular stent system has shown good results in terms of primary patency in the treatment of calcified lesions both at SFA and at popliteal level. However, in our experience, stent patency seems to be significantly poorer in patients presenting with acute limb ischemia associated with chronic atherosclerotic disease as well as for lesions located in the mid-distal part of the popliteal artery and both when number of stents increases or number of runoff vessel decreases.


Assuntos
Angioplastia/instrumentação , Artéria Femoral , Claudicação Intermitente/terapia , Isquemia/terapia , Doença Arterial Periférica/terapia , Artéria Poplítea , Stents , Idoso , Idoso de 80 Anos ou mais , Angioplastia/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Claudicação Intermitente/diagnóstico por imagem , Claudicação Intermitente/fisiopatologia , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Itália , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Recidiva , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
6.
Vasc Endovascular Surg ; 54(1): 42-46, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31578127

RESUMO

OBJECTIVE: In clinical practice, the incidence of femoral pseudoaneurysms requiring repair is small, but at a tertiary care center, the repair rate is higher due to referrals. We sought to specifically study patients who suffered postcatheterization pseudoaneurysms requiring thrombin injection or operative repair and compare them to our routine transfemoral endovascular patients to identify predictors of clinically significant pseudoaneurysms. The underlying goal would be to identify what makes these patients that develop pseudoaneurysms different. METHODS: A search of our billing records for Current Procedural Technology (CPT) codes of these 2 procedures between January 2008 and April 2018 was combined with our institution's Peripheral Vascular Intervention Vascular Quality Initiative database spanning from January 2013 to December 2017. A comparison was then performed between patients who had the outcome of operative intervention for a pseudoaneurysm complication and those who did not, with the goal of elucidating patient demographics and periprocedural factors that would predict pseudoaneurysm formation using univariate and multivariate analyses. RESULTS: There were 77 patients who required thrombin injection or open repair for access-related pseudoaneurysms and 324 patients who did not. Complications occurred more often in patients who were older than 75 (40.2% vs 21.9%; P = .0009), female (57.1% vs 38.6%; P = .003), obese (59.7% vs 33.3%; P < .001), hypertensive (96.1% vs 79.3%; P = .0005), who received a sheath >6F (32.4% vs 13%; P < .0001), intraoperative and postoperative anticoagulation (77.3% vs 32.7% and 52.1% vs 24.2%, respectively; P < .0001), and periprocedural P2Y12 inhibitors (48.7% vs 28%; P = .0005). Less complications were observed in patients who had a closure device used (42.9% vs 8.45%; P < .0001) and protamine reversal (26.5% vs 13.3%; P = .0163). CONCLUSIONS: Our findings validate published reports that incriminate a larger sheath size, perioperative anticoagulation, and female gender as increasing the rate of access site complications, with the use of a closure device being protective.


Assuntos
Falso Aneurisma/etiologia , Cateterismo Periférico/efeitos adversos , Artéria Femoral/lesões , Virilha/irrigação sanguínea , Lesões do Sistema Vascular/etiologia , Demandas Administrativas em Assistência à Saúde , Idoso , Falso Aneurisma/diagnóstico , Falso Aneurisma/terapia , Bases de Dados Factuais , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Illinois , Injeções , Masculino , Estudos Retrospectivos , Fatores de Risco , Trombina/administração & dosagem , Fatores de Tempo , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/terapia
7.
Angiol Sosud Khir ; 25(4): 35-39, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855199

RESUMO

The authors analysed oral anticoagulant agents prescribed in the postoperative period to patients after endured reconstructive operative intervention on arteries of the femorotibial segment. The study included a total of 104 patients subjected to femoropopliteal or femorotibial bypass grafting using an autologous vein or a prosthesis. Depending on the prescribed anticoagulation agent, the patients were subdivided into two groups. Group One patients (n=43) in the postoperative period received rivaroxaban, and Group Two patients (n=61) took warfarin. Efficacy of therapy was evaluated by the frequency of haemorrhage and thromboses in the early and remote postoperative periods. The findings of the immediate postoperative period demonstrated comparable rates of haemorrhagic complications, early thromboses and redo interventions in both Groups (p=0.7). The duration of long-term postoperative period varied from 3 months to 5 years. No statistically significant differences in patency of the performed reconstructions were revealed between the groups. The 3-year primary assisted patency rate in the rivaroxaban group and warfarin group amounted to 89 and 80%, respectively. The incidence of haemorrhagic complications in the postoperative period was insignificant in the studied groups. Hence, rivaroxaban may be prescribed in the early and remote postoperative period to patients who underwent open reconstructive operative intervention on arteries of the infrainguinal zone.


Assuntos
Anticoagulantes/uso terapêutico , Rivaroxabana/uso terapêutico , Doenças Vasculares/tratamento farmacológico , Doenças Vasculares/cirurgia , Grau de Desobstrução Vascular/efeitos dos fármacos , Varfarina/uso terapêutico , Anticoagulantes/farmacologia , Artérias/efeitos dos fármacos , Artérias/cirurgia , Implante de Prótese Vascular , Artéria Femoral/efeitos dos fármacos , Artéria Femoral/cirurgia , Humanos , Extremidade Inferior/irrigação sanguínea , Artéria Poplítea/efeitos dos fármacos , Artéria Poplítea/cirurgia , Estudos Retrospectivos , Rivaroxabana/farmacologia , Artérias da Tíbia/efeitos dos fármacos , Artérias da Tíbia/cirurgia , Resultado do Tratamento , Varfarina/farmacologia
8.
Rev. cuba. angiol. cir. vasc ; 20(2): e391, jul.-dic. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1003861

RESUMO

Introducción: Los aneurismas arteriales son poco frecuentes en edad pediátrica, sin embargo; se observa un incremento en la incidencia de pseudoaneurismas a partir de traumatismos vasculares, sobre todo, por la aplicación de procederes invasivos. También se observan en procesos infecciosos y tumorales adyacentes, que acaban por lesionar la pared arterial. La mayoría suelen ser asintomáticos, o se presentan como una masa pulsátil que se asientan sobre la zona de la arteria afectada. Objetivo: Demostrar la importancia del diagnóstico temprano de los pseudoaneurismas para el tratamiento quirúrgico oportuno y evitar complicaciones posteriores. Presentación del caso: se discute un caso de una paciente de dos años de edad con un trauma vascular iatrogénico en la extremidad inferior derecha, que se manifestó como una tumoración pulsátil. Se realizó eco-doppler y angiografía, con lo que se diagnosticó un aneurisma de la arteria femoral derecha. Se realizó una exéresis y reconstrucción vascular con buena evolución. Conclusiones: El diagnóstico rápido de estas entidades vasculares evita que se presenten complicaciones posteriores y aseguran una evolución rápida y satisfactoria de los pacientes que las padecen(AU)


Introduction: Arterial aneurysms are rare in the pediatric ages. However, it is observed an increasement of the incidence of pseudoaneurysms caused by vascular traumas, mainly due to the use of invasive procedures. It is also present in infectious and tumour processes that end up injuring the arterial wall. Most of them are asymptomatic or are presented as a pulsatile mass that sets up over the affected artery's zone. Objective: To show the importance of early diagnosis of pseudo-aneurysms. Case presentation: It is presented the case of a two years old patient with a iatrogenic vascular trauma in the right lower limb that manifested in the way of a pulsatile tumor. Through an eco-Doppler and an angiography, an aneurysm of the right femoral artery was diagnosed, which led to an excision and a vascular reconstruction with good evolution. Conclusions: Early diagnosis of these vascular entities allows its timely surgical treatment, avoids the appearance of further complications and assures a prompt and satisfactorily evolution of the patients(AU)


Assuntos
Humanos , Feminino , Pré-Escolar , Falso Aneurisma/cirurgia , Falso Aneurisma/diagnóstico , Artéria Femoral , Angiografia por Tomografia Computadorizada/métodos
9.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(12): 907-911, 2019 Dec 07.
Artigo em Chinês | MEDLINE | ID: mdl-31887816

RESUMO

Objective: To explore the advantages and clinical efficacy of free chimeric perforator flap based on the descending branch of circumflex femoral artery applied to tongue reconstruction after advanced tongue cancer resection. Methods: From October 2013 to December 2018, 57 cases received tongue and oral base reconstruction surgeries using the descending branch of circumflex femoral artery chimeric perforator flap, including 39 males and 18 females, ranged from 20 to 76 years old. And all cases were with stage T3 and T4 tongue cancers, including 35 cases of squamous cell carcinoma, 7 cases of low differentiation cancer, 5 cases of oncosarcoma, and 10 cases of adenoid cystic carcinoma. The tongue was reconstructed by using perforator flap and muscle flap to fill the dead space at the oral floor. The artery anastomoses with the superior thyroid artery or facial artery in the receiving area, and the vein anastomoses with the internal jugular vein in the receiving area. The shape, function and local complications of the reconstructed tongue were observed after operation. Results: Of 57 cases, only one case had partial necrosis of flap, while other 56 cases with chimeric perforator flap survived. Postoperative gastric tube and tracheal cannula were removed in all patients, no cases with oral fistula. All donor sites were sutured in one stage. Postoperative radiotherapy was performed in 41 of the patients. All patients were followed up for 3 to 60 months (average of 20.7 months), with satisfactory esthetic and functional results in reconstructed tongues. Only linear scars were left in the donor areas of the legs, and no lower limb dysfunction was observed. Conclusions: The descending branch of circumflex femoral artery chimeric perforator flap can used for repairing simultaneously the defects of both tongue and oral base. It is helpful to avoid the occurrence of oral fistula and to provide the reconstructed tongue with a good function. It is a good choice to use the descending branch of circumflex femoral artery chimeric perforator flap for tongue reconstruction after resection of advanced tongue cancer resection.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias da Língua , Adulto , Idoso , Feminino , Artéria Femoral , Humanos , Masculino , Pessoa de Meia-Idade , Coxa da Perna , Neoplasias da Língua/cirurgia , Adulto Jovem
11.
Georgian Med News ; (294): 7-10, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687940

RESUMO

Today, the issues of surgical tactics remain unresolved, namely, the choice of volume and area of ​​primary reconstruction with occlusion-stenotic lesions of extracranial arteries and aorto-iliac-femoral segment in conditions of high risk of reperfusion-reoxygenative syndrome. The aim of the study - To improve the results of surgical treatment of combined occlusion-stenotic lesions of extracranial arteries and the aorto-iliac-femoral segment in conditions of high risk of development of reperfusion-reoxygenative complications. The study included 58 patients with combined atherosclerotic lesions of extracranial arteries and aorto-iliac-femoral zone. To diagnose the nature of the lesion of the arterial bed and the features of hemodynamic disorders, ultrasound dopplerography, duplex scanning, X-ray contrast digital angiography were used. The proposed set of measures to prevent the development of reperfusion-reoxygenative complications was introduced to the system of preoperative preparation. The decision of the order of restorative operations on the brachiocephalic arteries and the aorto-iliac-femoral segment was based on the analysis of the localization of the occlusive process in both arterial basins, their hemodynamic characteristics, the degree of ischemia and the tolerance of the brain to ischemia. Due to the spread occlusion-stenotic lesion of extracranial arteries in combination with the stenotic process of the contralateral ICA in the stage of relative compensation of cerebral bloodflow in 7 patients, primarily the surgical intervention on the vessels of the neck was performed. Four to six days after the first surgical intervention, the revascularization of aorta/iliac-femoral segment was performed. In 51 patients, one-time surgical intervention was performed on extracranial arteries and aorto-iliac-femoral basin. Analyzing the results of revascularization operations, it can be argued that a differentiated approach to choosing the tactics of surgical treatment of multifocal atherosclerotic lesions of arterial basins should be used. The revascularization of both arterial basins should be carried out in stages: a reconstructive operation on the extracranial arteries is performed initially, and 4 to 6 days after the first surgical intervention, the aorta/iliac-femoral arterial zone revascularization or revascularization of both arterial basins simultaneously.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Artérias/diagnóstico por imagem , Ultrassonografia Doppler Dupla/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Angiografia Digital , Aorta Abdominal/patologia , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão/prevenção & controle
12.
Int Heart J ; 60(6): 1350-1357, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31735785

RESUMO

Transcatheter aortic valve implantation (TAVI) has been recognized as a standard therapy for severe aortic valve stenosis. However, since some patients who receive TAVI have poor outcomes, the predictors of clinical outcomes after TAVI are important. The aim of this study was to investigate the association between appetite and long-term clinical outcomes.We screened consecutive cases who received TAVI at our medical center between July 2014 and October 2018. A total of 139 patients who received transfemoral TAVI were included as the final study population. They were divided into a good appetite group (n = 105) and a less appetite group (n = 34) according to their dietary intake rate (> 90%: good appetite group, ≤ 90%: less appetite group). We defined the intake rate as the average for breakfast, lunch, and dinner on the day just before discharge. We defined two-year major adverse cardiovascular and cerebrovascular events (MACCE) as a composite of cardiovascular death, myocardial infarction, any coronary revascularization, history of hospitalization due to heart failure, and disabling acute cerebral infarction. Kaplan-Meier analyses and multivariate Cox regression analysis were performed.The median duration of the follow-up period was 372 (189-720) days. Kaplan-Meier curves showed that the less appetite group got MACCE more frequently (event free rate of the less appetite group: 76.5% versus the good appetite group: 94.3%, Log Rank P = 0.01). In multivariate Cox regression analysis, having less appetite was a significant predictor of two-year MACCE (HR 5.26, 95%CI 1.66-16.71, P < 0.01).In conclusion, among the patients who received transfemoral TAVI, appetite status just before discharge was significantly associated with long-term outcome.


Assuntos
Estenose da Valva Aórtica/cirurgia , Apetite , Artéria Femoral , Complicações Pós-Operatórias/epidemiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Próteses Valvulares Cardíacas , Hospitalização , Humanos , Estimativa de Kaplan-Meier , Masculino , Duração da Cirurgia , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento
13.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(11): 882-886, 2019 Nov 24.
Artigo em Chinês | MEDLINE | ID: mdl-31744277

RESUMO

Objective: To investigate the relationship between ultrasound derived ratio of femoral vein to femoral artery diameter and hemodynamics in patients with heart failure. Methods: This was a case-control study. A total of 61 patients with heart failure and 49 patients with non-heart failure hospitalized in the Department of Critical Care Medicine from September 2017 to September 2018 were included in this study. Doppler ultrasound was used to measure the femoral artery and vein diameter. After deep inhalation, the femoral vein diameter was measured again, and the ratio of femoral vein and artery diameter was calculated. The central venous pressure (CVP) and mean pulmonary wedge pressure (mPAWP) were also measured. Pearson correlation analysis was used to explore the correlation between the ratio of femoral vein diameter to femoral artery diameter and CVP and mPAWP, and linear regression equation was established. Results: The overall CVP and mPAWP levels were significantly higher, and the femoral vein diameter after deep inhalation was bigger in heart failure patients than in non-heart failure patients(all P<0.001). The femoral vein diameter/femoral artery diameter ratio was positively correlated with CVP (r=0.76, P<0.001), and positively correlated with mPAWP (r=0.40, P<0.001) in heart failure group. The linear regression equation established by the femoral vein/femoral artery diameter ratio and CVP in the heart failure group showed that the inner diameter of the femoral vein/the inner diameter of the femoral artery ratio≥1.3 corresponded CVP≥15.518 cmH2O(1 cmH2O=0.098 kPa) in heart failure patients. Conclusions: In patients with heart failure, the inner diameter of the femoral vein/femoral artery ratio is positively correlated with CVP and mPAWP. The ratio of inner diameter of the femoral vein/femoral artery can be used to assess the volumetric load of patients with heart failure and to guide the clinical treatment of heart failure patients.


Assuntos
Artéria Femoral , Veia Femoral , Insuficiência Cardíaca , Estudos de Casos e Controles , Pressão Venosa Central , Humanos
14.
J Cardiovasc Surg (Torino) ; 60(5): 567-571, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31778065

RESUMO

Chronic total occlusion (CTO) is a common finding during endovascular treatment of peripheral arterial disease. The treatment of CTOs is a challenging task, which requires good knowledge of the devices and their specific characteristics and skills to different techniques for crossing. As a matter of fact, any dedicated center treating patients with peripheral arterial disease requires an adequate consignment stock regarding wires, catheters, balloons and some specific devices for challenging anatomic scenarios. Herein, the most important steps of a successful recanalization of a femoropopliteal CTO are summarized together with a number of tips regarding utilization of different techniques and specific devices.


Assuntos
Procedimentos Endovasculares/métodos , Artéria Femoral , Doença Arterial Periférica/terapia , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
15.
Medicine (Baltimore) ; 98(45): e17910, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702668

RESUMO

To evaluate the safety and efficacy of total percutaneous closure of the femoral artery access site after veno-arterial extracorporeal membrane oxygenation (VA-ECMO) with the Perclose ProGlide device.This retrospective observational study during an almost 2-year period included 21 patients who underwent VA-ECMO in whom the femoral artery puncture site was closed percutaneously with Perclose ProGlide devices. Technical success was defined as successful arterial closure of the common femoral artery, without the need for additional surgical or endovascular procedures. Access site complications were recorded at 24 hours and 30 days after arterial closure, such as major bleeding requiring transfusion or surgical intervention, minor bleeding, groin infection, pseudoaneurysm, and lymphocele.Technical success was achieved in 20 patients (95.2%). One patient required surgical repair for an access site pseudoaneurysm. Eighteen femoral arteries were closed with 2 devices each, while 3 patients required the use of a third device for femoral artery access site closure to achieve adequate hemostasis. No arterial thrombosis, arterial dissection, arterial stenosis, groin infection, or arteriovenous fistula occurred during the periprocedural period (within 24 hours of arterial closure) or during 30-day follow-up.Percutaneous closure with the Perclose ProGlide device is a feasible procedure for closing femoral arterial access sites after VA-ECMO, with a low incidence of access site complications.


Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Artéria Femoral/cirurgia , Hemostasia Cirúrgica/instrumentação , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Punções/efeitos adversos , Estudos Retrospectivos
16.
Am Surg ; 85(9): 1040-1043, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638521

RESUMO

Although vascular surgery guidelines recommend immediate anticoagulation for acute occlusion of a peripheral artery, it is unclear whether trauma surgeons follow this practice. A survey regarding the use of perioperative anticoagulation was sent to surgeons who perform their own peripheral arterial repairs after traumatic injury to define contemporary practice patterns. This survey demonstrated minimal consensus opinion regarding the management of extremity vascular injuries, strongly suggesting the need for a consensus conference, meta-analysis, and prospective studies to guide further care.


Assuntos
Anticoagulantes/uso terapêutico , Assistência Perioperatória , Padrões de Prática Médica , Lesões do Sistema Vascular/cirurgia , Adulto , Idoso , Arteriopatias Oclusivas/cirurgia , Artéria Axilar/lesões , Artéria Axilar/cirurgia , Artéria Braquial/lesões , Artéria Braquial/cirurgia , Artéria Femoral/lesões , Artéria Femoral/cirurgia , Hemorragia/cirurgia , Humanos , Pessoa de Meia-Idade , Artéria Poplítea/lesões , Artéria Poplítea/cirurgia , Lesões dos Tecidos Moles/cirurgia , Cirurgiões
17.
J Cardiovasc Surg (Torino) ; 60(6): 679-685, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31603295

RESUMO

BACKGROUND: Endovascular treatment of occlusive disease of the superficial femoral artery (SFA) has evolved from plain old balloon angioplasty (POBA) through primary stenting strategy to drug eluting technology-based approach. The RAPID Trial investigates the added value of drug coated balloons (DCB, Legflow) in a primary stenting strategy (Supera stent) for intermediate (5-15 cm) and long segment (>15 cm) SFA lesions. METHODS: In this multicenter, patient-blinded trial, 160 patients with intermittent claudication, ischemic rest pain, or tissue loss due to intermediate or long SFA lesions were randomized (1:1) between Supera + DCB and Supera. Primary endpoint was primary patency at 2 years, defined as freedom from restenosis on duplex ultrasound (peak systolic velocity ratio <2.4). RESULTS: At 2 years, primary patency was 55.1% (95% CI: 43.1-67.1%) in the Supera + DCB group versus 48.3% (95% CI: 35.6-61.0%) in the Supera group (P=0.957). Per protocol analysis showed a primary patency rate of 60.9% (95% CI: 48.6-73.2%) in the Supera + DCB group versus 49.8% (95% CI: 36.9-62.7%) in the Supera group (P=0.469). The overall mortality rate was 5% in both groups (P=0.975). Sustained functional improvement was similar in both groups. CONCLUSIONS: The 2-year results in the current trial of a primary Supera stenting strategy are consistent with other trials reporting on treatment of intermediate and long SFA lesions. A DCB supported Supera stent strategy did not improve patency rate compared to a Supera stent only strategy.


Assuntos
Angioplastia com Balão/instrumentação , Fármacos Cardiovasculares/administração & dosagem , Materiais Revestidos Biocompatíveis , Artéria Femoral , Doença Arterial Periférica/terapia , Stents , Dispositivos de Acesso Vascular , Angioplastia com Balão/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Estudos Prospectivos , Desenho de Prótese , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
18.
Kyobu Geka ; 72(10): 757-761, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31582691

RESUMO

Femoral artery and veins and axillary artery are one of the major vessels in the human body which are easily accessible to circulation. Therefore, these vessels are usually used for cardiac and aortic surgeries to establish extracorporeal circulation through surgical as well as percutaneous technique. Additionally, with increasing a minimally invasive fashion for treatment of cardiac and aortic diseases, these accessible arteries are frequently manipulated, for example transcatheter aortic valve implantation, debranching thoracic endovascular aortic repair and endovascular aneurysm repair. Thus, exposure of the vessels is a basic procedure in this field;cardiac and vascular surgeons need understanding anatomical knowledge of the arteries and the surrounding structures, such as muscles and nerves. Especially, it becomes frequent for surgeons to see a bleeding complication with the increasing endovascular therapy and a calcified and atherosclerotic artery due to peripheral artery disease;these situations increase difficulty of femoral artery exposure. Deep understanding of anatomical knowledge helps to obtain good surgical exposure. We hope that it describes some useful improvements to surgical technique and anatomical understanding of cardiac and vascular surgeons.


Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Artéria Axilar , Artéria Femoral , Humanos , Resultado do Tratamento
19.
Zhonghua Yi Xue Za Zhi ; 99(37): 2912-2915, 2019 Oct 08.
Artigo em Chinês | MEDLINE | ID: mdl-31607020

RESUMO

Objective: To study the effect and safety of vertebral artery stent implantation via femoral artery and radial artery. Methods: Twenty-four patients with vertebral artery stent implantation from December, 2017 to August, 2018 in Beijing Anzhen Hospital were randomized into 2 groups, one was research group with 12 patients, the other was control group with 12 patients. The research group underwent vertebral artery stent implantation via radial artery, the control group underwent vertebral artery stent implantation via femoral artery. The follow-up results of the two groups were analyzed. Results: The success rate of the first puncture in the research group was 100%, significantly higher than 83.33% of the control group, there was no statistical difference (χ(2)=2.528, P>0.05).The implantation time of sheath tube in the research group was (3.2±0.3) min, significantly longer than that in the control group (2.4±0.2) min, the difference was statistically significant (t=7.713, P<0.001). The time from sheath insertion to balloon dilation and bed rest time after operation in the research group were 17.3 (16.2-17.9) min, significantly less than the control group (27.1(26.1-28.3) min), the difference was statistically significant (Z=-4.157, P<0.001). The time of bed rest in the research group was 2.1 (2.0-2.2)h, significantly less than the control group (27.1(25.3- 28.9)h), the difference was statistically significant(Z=-4.167,P<0.001). No cerebrovascular events occurred during the follow-up period. One patient in the control group developed complications of vagal reflex, no patient in the research group developed complications. Conclusions: Vertebral artery stent implantation via radial artery can significantly improve the success rate and safety of the operation. Radial artery approach is a better choice for vertebral artery stent implantation.


Assuntos
Artéria Femoral , Artéria Radial , Stents , Humanos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares , Artéria Vertebral
20.
Medicine (Baltimore) ; 98(40): e17477, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577781

RESUMO

The objective of this study was to compare clinical outcomes in patients who with unfavorable vascular anatomy underwent mechanical thrombectomy (MT) by common carotid artery access versus transfemoral approach.A retrospective review was performed in our hospital database to identify patients with challenging vascular anatomy who underwent MT for anterior circulation large vessel occlusion (LVO) between August 2015 and November 2018. Transcarotid and transfemoral cohorts were compared. Patient characteristics, procedural techniques, clinical outcomes were recorded.A total of 52 patients were included, 16 (31%) underwent MT via transcarotid access. There were no significant differences in patient characteristics, intravenously recombinant tissue plasminogen activator therapy, clot location, or carotid tortuosity and presence of aortic arch type. There were significant differences in clinical outcomes between the 2 cohorts, including mean access-to-reperfusion time (84 vs 44 minutes; P = .000), poor clinical outcome (modified Rankin scale >2) at 90 days follow-up (37.5% vs 63.9%; P = .034). But there were no significant differences in successful revascularization rates (thrombolysis in cerebral infarction score ≥2b 87.5% vs 80.6%; P = .541), post-thrombectomy symptomatic intracranial hemorrhage (12.5% vs 13.9%; P = .892), and mortality (12.5% vs 22.2%; P = .412) were similar between transcarotid and transfemoral cohorts.Our results demonstrate that transcarotid access for MT of anterior circulation LVO in patients with unfavorable vascular anatomy may be considerable. Transcarotid access may be better than transfemoral access in well-selected unfavorable vascular anatomy patients undergoing MT.


Assuntos
Artéria Carótida Primitiva/cirurgia , Procedimentos Endovasculares/métodos , Trombose Intracraniana/cirurgia , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Artéria Femoral , Humanos , Trombose Intracraniana/complicações , Trombose Intracraniana/patologia , Masculino , Punções , Estudos Retrospectivos , Resultado do Tratamento
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