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1.
Angiol Sosud Khir ; 26(3): 122-126, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063759

RESUMO

Presented in the article are advantages of various methods of treatment of periprosthetic infection which continues to be one of the most challenging problems in modern vascular surgery. We describe herein a clinical case report regarding a patient with late infection of a bifurcated aortofemoral bypass graft. The infectious complication manifested itself by a periprosthetic infiltrate in the area of the distal anastomosis. The stent-graft's limb was resected within the limits of the unaltered tissue. The infectious process then manifested itself as sequestration of the main branch. Staged complete anatomical reconstruction performed later on using a hybrid technique made it possible to achieve an optimal result and resolution of the infection. This case report demonstrated undeniable advantages of using hybrid techniques.


Assuntos
Infecções , Doenças Vasculares , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Stents
2.
Rozhl Chir ; 99(8): 356-360, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33032440

RESUMO

INTRODUCTION: The indications for popliteal artery aneurysm treatment are clear. In aneurysms with patent inflow and outflow arteries, the risk of peripheral embolisation from a mural thrombus is high and the treatment, mostly a vascular intervention, is focused on preventing this extremity-threatening complication. It is unclear, however, how high the risk of peripheral embolisation is and how to proceed with a patent popliteal artery aneurysm fed by the deep femoral artery when the superficial femoral artery is chronically occluded. METHODS: All patients diagnosed with popliteal artery aneurysm between 2015 and 2019 were searched in the database of the Department of Surgery II of University Hospital Olomouc. Patients with a patent popliteal artery aneurysm and chronic superficial femoral artery occlusion in the ipsilateral extremity were selected. RESULTS: We diagnosed 66 patients with 85 popliteal artery aneurysms. Four patients had a patent popliteal artery aneurysm and chronic superficial femoral artery occlusion in the ipsilateral extremity. In these patients, conservative treatment was indicated after the diagnosis was determined. In three patients, no clinically obvious complication of the popliteal artery aneurysm occurred. In one patient, popliteal artery aneurysm thrombosis occurred after a follow-up of 21 months, leading to a shortening of his calf claudication distance and limiting the patient. CONCLUSION: Our experience with this small group of patients shows the possibility of primary conservative treatment in patients with a patent popliteal artery aneurysm below the chronic superficial femoral artery occlusion site. Aneurysm thrombosis can be expected during follow-up. Patients in whom the thrombosis leads to limitations are indicated for surgical intervention. The risk of peripheral embolisation from the mural thrombus cannot be excluded with certainty. Further studies involving large groups of patients are needed to provide a more precise recommendation.


Assuntos
Aneurisma , Arteriopatias Oclusivas , Trombose , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Humanos , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia
3.
Khirurgiia (Mosk) ; (8): 49-54, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869615

RESUMO

OBJECTIVE: To compare various approaches to revascularization of aortoiliac-femoral segment. MATERIAL AND METHODS: Data were collected prospectively for retrospective analysis. There were 192 patients with atherosclerotic lesion of the aortoiliac-femoral segment who underwent reconstructive surgeries. All patients were divided into 3 groups depending on the type of reconstruction: 85 patients underwent open surgical interventions, 63 patients - endovascular interventions, 44 patients - hybrid techniques. Between-group differences were considered significant at p-value <0.05. RESULTS: Hybrid revascularization is characterized by less duration of surgery, blood loss and morbidity. Hybrid interventions ensured favorable primary patency compared to open surgery within the follow-up period. CONCLUSION: Hybrid revascularization of aortoiliac-femoral segment is characterized by less duration of surgery, blood loss and morbidity.


Assuntos
Aorta/cirurgia , Artéria Femoral/cirurgia , Artéria Ilíaca/cirurgia , Doença Arterial Periférica/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Endovasculares , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular
4.
Am J Cardiol ; 128: 181-188, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650917

RESUMO

Endovascular interventions are commonly utilized for treatment of femoropopliteal peripheral artery disease. The relative efficacy of these interventions remains unclear. A Bayesian network meta-analysis was performed comparing 5 endovascular treatment modalities: balloon angioplasty (BA), bare metal stent (BMS), covered stent (CS), drug-coated balloon (DCB), drug-eluting stent (DES) for femoropopliteal peripheral artery disease. The primary efficacy end points were freedom from target lesion revascularization (TLR) and primary patency at 12 months. BA was the reference treatment. Twenty-two trials including 4,381 participants provided data on TLR. Sixteen trials including 3,691 participants provided data on primary patency. Point estimates for DCB suggested that it was the most efficacious treatment for freedom from TLR (odds ratio [OR] 4.23; 95% credible intervals [CrI] 2.43 to 7.66) followed by CS (OR 3.65; 95% CrI 1.11 to 12.55), DES (OR 2.64; 95% CrI 0.72 to 9.77), and BMS (OR 2.3; 95% CrI 1.11 to 4.76). Similarly, point estimates for primary patency were highest with DES (OR 8.93; 95% CrI 3.04, 27.14) followed by CS (OR 3.91; 95% CrI 1.18, 13.84), DCB (OR 3.32; 95% CrI 1.8, 6.25), and BMS (OR 3.5; 95% CrI 1.58, 7.99). In conclusion, DCB has the lowest need for TLR whereas DES has the highest primary patency rate. DCB, CS, and BMS were associated with significant reductions in TLR compared with BA, whereas DCB, DES, CS, and BMS were associated with significantly improved primary patency compared with BA.


Assuntos
Procedimentos Endovasculares/métodos , Artéria Femoral/cirurgia , Doença Arterial Periférica/cirurgia , Artéria Poplítea/cirurgia , Angioplastia com Balão/métodos , Teorema de Bayes , Stents Farmacológicos , Humanos , Cadeias de Markov , Método de Monte Carlo , Metanálise em Rede , Reoperação/estatística & dados numéricos , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
5.
Vasc Endovascular Surg ; 54(7): 646-649, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32638640

RESUMO

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic multisystem inflammatory condition with associated endothelial dysfunction and dysregulated coagulation. Although deep venous thrombosis (DVT) in IBD has been well described, arterial thrombosis and thromboembolism are less commonly appreciated. METHODS: A 63-year-old male with a known history of Crohn disease presented with acute-onset right arm pain. His past vascular history was significant for left lower extremity DVT with an existing inferior vena cava filter and acute ischemia of the right lower extremity requiring a below-knee amputation a year ago. Imaging revealed acute brachial, ulnar, and radial artery thrombosis. RESULTS: Patient underwent an open right brachial, radial, and ulnar thrombectomy to restore vascular flow. He required multiple exploration and thrombectomy for reocclusion of the vessels in the early postoperative period. He later developed a rapidly deteriorating clinical status, flank ecchymosis and swelling concerning for soft tissue ischemia, and compartment syndrome heralding an eventual hemodynamic collapse. On exploration, he was found to have chronic fibrosis of his left femoral vein and femoral artery occlusion. Clinically, the patient deteriorated rapidly, which resulted in his demise. CONCLUSION: The inflammatory reaction in IBD leads to arterial stiffening and hypercoagulability, which should theoretically increase the risk for vascular disease. Although the link between IBD and DVT is well established, arterial thrombosis and thromboembolism remain widely debated, with some implications for therapeutic intervention. The link between vascular thrombosis and IBD must be examined further, as the treatment and prevention of vascular complications in IBD depends on our understanding of this relationship.


Assuntos
Arteriopatias Oclusivas/etiologia , Doença de Crohn/complicações , Artéria Femoral , Veia Femoral , Extremidade Inferior/irrigação sanguínea , Extremidade Superior/irrigação sanguínea , Trombose Venosa/etiologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Arteriopatias Oclusivas/cirurgia , Doença de Crohn/diagnóstico , Evolução Fatal , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Artéria Femoral/cirurgia , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Veia Femoral/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Trombectomia , Resultado do Tratamento , Grau de Desobstrução Vascular , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia , Trombose Venosa/cirurgia
6.
Vasc Endovascular Surg ; 54(7): 650-655, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32666909

RESUMO

Atherosclerotic true aneurysms of the superficial femoral artery (SFA) and profunda femoris artery (PFA) are rare and difficult to detect. The synchronous presence of SFA and PFA aneurysms is even rarer. Herein, we present a case with ipsilateral true SFA and PFA aneurysms diagnosed with rupture. A review of the international literature is made, and the diagnosis and treatment options of this rare condition are discussed. A 75-year-old male was admitted to our hospital with an aneurysm on the distal SFA and the ipsilateral PFA, as well as a hematoma around the PFA. It was difficult to determine the source of the rupture before surgery, even with proper imaging. Successful ligation of the PFA and an aneurysmectomy followed by a bypass grafting for the SFA were performed. An intraoperative examination revealed that the SFA aneurysm had ruptured. In elderly males with a history of ectasia or aneurysm on the aorta or peripheral arteries, a synchronous aneurysm on the SFA or the PFA should be suspected.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Artéria Femoral/diagnóstico por imagem , Idoso , Aneurisma Roto/cirurgia , Artéria Femoral/cirurgia , Oclusão de Enxerto Vascular , Humanos , Ligadura , Masculino , Valor Preditivo dos Testes , Resultado do Tratamento
7.
Expert Rev Med Devices ; 17(6): 533-539, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32525406

RESUMO

INTRODUCTION: The femoropopliteal (FP) segment is a common site of involvement in peripheral arterial disease (PAD) and endovascular therapy has been shown to be safe and effective in the treatment of FP disease. Self-expanding nitinol stents are now frequently used for the treatment of FP disease but in-stent restenosis (ISR) remains a major issue that can lead to recurrence of symptoms requiring repeated revascularizations. Compared to plain old balloon angioplasty (POBA), drug-coated balloons (DCBs) have shown promising results with reduction of ISR rates and target lesion revascularization (TLR). AREAS COVERED: The aim of this review is to describe the mechanisms and classification of ISR and to summarize the available data on outcomes of all DCBs, especially in the treatment of FP ISR. EXPERT OPINION: Currently available data supports the use of DCBs as a first-line therapy in patients with FP ISR, with lower rates of TLR and higher patency rates at 1-year follow-up, when compared to POBA. Further randomized studies are essential to evaluate longer term safety and efficacy of DCBs.


Assuntos
Angioplastia com Balão/efeitos adversos , Reestenose Coronária/tratamento farmacológico , Artéria Femoral/cirurgia , Paclitaxel/uso terapêutico , Artéria Poplítea/cirurgia , Stents/efeitos adversos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
J Cardiothorac Surg ; 15(1): 106, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434594

RESUMO

OBJECTIVE: Aortic arch replacement in acute type A aortic dissection patients remains the most challenging cardiovascular operation. Herein, we described our modified Y-graft technique using the Femoral Artery Bypass (FAB) and the One Minute Systemic Circulatory Arrest (OSCA) technique, and assessed the short-term outcomes of the patients. METHODS: Between February 2015 and November 2017, 51 patients with acute type A aortic dissection underwent aortic arch replacement. Among them, 23 patients underwent FAB while 28 patients underwent both FAB and OSCA. The intraoperative data and postoperative follow-up data were recorded. The follow-up data of patients with traditional Y-graft technique were collected from previously reported studies. RESULTS: In the FAB group, two patients died due to pulmonary infection (30-day survival rate, 91.3%), and two patients were paralyzed from the waist down. Hemodialysis was performed for five patients (21.7%) before hospital discharge. Fifteen patients (65.2%) received respiratory support for more than 2-days and eight patients (34.8%) for more than 5-days. These follow-up results were comparable or better than the patients with traditional Y-graft technique. Furthermore, compared to the FAB group, the morbidity due to neurological dysfunction and acute renal failure was significantly reduced in the FAB+OSCA group. Moreover, the respiratory support, length of postoperative stay and ICU stay were shortened. CONCLUSIONS: This study clarified the feasibility of FAB and OSCA technique in modifying Y-graft technique. The acute type A aortic dissection patients showed less surgical complications and favorable short-term outcomes after this surgery.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Artéria Femoral/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Feminino , Parada Cardíaca Induzida , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos
9.
J Vasc Res ; 57(4): 223-235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32396897

RESUMO

BACKGROUND: There are very few animal models of balloon angioplasty injury in arteriovenous fistula (AVF), hindering insight into the pathophysiologic processes following angioplasty in AVF. The objective of the study was to develop and characterize a rat model of AVF angioplasty injury. METHODS: Balloon angioplasty in 12- to 16-week-old Sprague-Dawley rats was performed at the arteriovenous anastomosis 14 days post-AVF creation with a 2F Fogarty balloon catheter. Morphometry and protein expression of endothelial nitric oxide synthase (eNOS), monocyte-chemoattractant protein-1 (MCP-1), alpha-smooth muscle actin (α-SMA), CD68 (macrophage marker), and collagen expression in AVFs with and without angioplasty were assessed. RESULTS: In AVFs with angioplasty versus without angioplasty: (1) angioplasty increased AVF-vein and artery intimal hyperplasia, (2) angioplasty decreased eNOS protein expression in AVF-vein and artery at 21 days post-AVF creation and remained decreased in the AVF-vein angioplasty group at 35 days, (3) angioplasty increased AVF-vein and artery α-SMA expression within the intimal region at 35 days, (4) angioplasty increased the expression of AVF-vein MCP-1 at 21 days and CD68 at 21 and 35 days, and (5) angioplasty increased AVF-vein and artery collagen expression at 35 days. CONCLUSION: Our findings describe a reproducible rat model to better understand the pathophysiologic mechanisms that ensue following AVF angioplasty.


Assuntos
Angioplastia com Balão , Derivação Arteriovenosa Cirúrgica , Artéria Femoral/lesões , Veia Femoral/lesões , Remodelação Vascular , Lesões do Sistema Vascular/etiologia , Actinas/metabolismo , Animais , Antígenos CD/metabolismo , Antígenos de Diferenciação Mielomonocítica/metabolismo , Quimiocina CCL2/metabolismo , Colágeno/metabolismo , Modelos Animais de Doenças , Artéria Femoral/metabolismo , Artéria Femoral/patologia , Artéria Femoral/cirurgia , Veia Femoral/metabolismo , Veia Femoral/patologia , Veia Femoral/cirurgia , Masculino , Neointima , Óxido Nítrico Sintase Tipo III/metabolismo , Ratos Sprague-Dawley , Fatores de Tempo , Lesões do Sistema Vascular/metabolismo , Lesões do Sistema Vascular/patologia
10.
Eur J Vasc Endovasc Surg ; 59(6): 947-955, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32224037

RESUMO

OBJECTIVE: To assess mid term outcomes of common femoral endarterectomy combined with an inflow and outflow endovascular revascularisation procedure in patients with chronic limb threatening ischaemia (CLTI). METHODS: This was a prospective study. All patients who, for the first time, underwent planned one stage hybrid common femoral artery (CFA) endarterectomy combined with an inflow and/or outflow endovascular revascularisation procedure to achieve limb salvage in patients with CLTI due to multilevel disease were included between January 2015 and May 2017. Demographics, and clinical and lesion characteristics for each patient were reported. The primary outcome was primary patency. Secondary outcomes were technical success, peri-operative morbidity and mortality, assisted primary patency, secondary patency, clinically driven target lesion revascularisation and amputation free survival. RESULTS: Three groups were created according to the endovascular treatment zone: group 1 (inflow, n = 60); group 2 (outflow, n = 46); and group 3 (combined inflow and outflow, n = 53). CFA endarterectomy was a fixed step in all cases. The overall technical success was 98%. The peri-operative complication rate was 14% and the mortality rate was 2%. Patients in group 3 demonstrated a significantly lower primary patency rate (53.9% ± 7.1%; p < .001) at 24 months but improved secondary patency rate of (94.0% ± 3.4%). Based on the outcomes of the Cox regression multivariable analysis, lesion length (hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.06-1.14; p < .001), chronic total occlusion (CTO) (HR 0.50, 95% CI 0.25-0.98; p = .046), peripheral artery calcium scoring system (PACSS) grade 4 (HR 2.44, 95% CI 1.27-4.68; p = .008), incomplete revascularisation (HR 3.32, 95% CI 1.64-6.73; p = .001), and dyslipidaemia (HR 0.50, 95% CI 0.27-0.93; p = .031) were the only significant independent predictors of loss of primary patency. CONCLUSION: Common femoral endarterectomy combined with an inflow and outflow endovascular revascularisation procedure in patients with CLTI is safe, with acceptable patency rates, despite the need for secondary interventions. Dyslipidaemia, lesion length, CTO, PACSS grade 4, and incomplete revascularisation are independent predictors of primary patency loss. The current study analysis supports the recommendation to stage the procedure based on patient risk and degree of limb threat.


Assuntos
Endarterectomia/efeitos adversos , Procedimentos Endovasculares/métodos , Artéria Femoral/cirurgia , Salvamento de Membro/métodos , Doença Arterial Periférica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Amputação/estatística & dados numéricos , Endarterectomia/métodos , Procedimentos Endovasculares/efeitos adversos , Feminino , Artéria Femoral/patologia , Humanos , Salvamento de Membro/efeitos adversos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/patologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Índice de Gravidade de Doença , Resultado do Tratamento , Grau de Desobstrução Vascular
11.
Orv Hetil ; 161(15): 588-593, 2020 04 01.
Artigo em Húngaro | MEDLINE | ID: mdl-32323935

RESUMO

Introduction: The incidence of peripheral arterial diseases and the rate of chronic limb-threatening ischaemia are increasing year by year. Minimally invasive peripheral interventions have gradually replaced traditional operations. Earlier steno-occlusion of the popliteal artery was an indication for femoropopliteal bypass below the knee. Nowadays, endovascular procedures are also used, but the indication of the stent placement into the popliteal artery is controversial. Aim: We have been using Jaguar stent for the treatment of popliteal artery steno-occlusion since January 2016. The aim of our study was to evaluate the efficacy of this treatment. Method: We included patients who underwent popliteal artery angioplasty with Jaguar stent placement between 1 January 2016 and 31 December 2017 in our department. During the one-year follow-up, we examined the popliteal stent patency, amputation-free survival and risk factors that influence stent patency. Statistical analysis: For the comparison of mean values, two-sided t-tests were used. Categorical data were analyzed by using chi-square test. Results: 33 patients underwent popliteal or femoropopliteal endovascular intervention with Jaguar stent placement into the popliteal artery. Postoperative complications that required surgical treatment occurred in 2 patients. At the end of the follow-up, the primary patency of the popliteal stents was 58.1%, the secondary patency was 74.2% and amputation-free survival was 96.8%. Conclusion: Compared with international data, the primary patency of the Jaguar stents in our study is relatively lower, but amputation-free survival is much better, and in most cases there is less operative strain compared with traditional operations. Orv Hetil. 2020; 161(15): 588­593.


Assuntos
Angioplastia/instrumentação , Aterosclerose/cirurgia , Implante de Prótese Vascular/instrumentação , Artéria Femoral/cirurgia , Doença Arterial Periférica/cirurgia , Artéria Poplítea/cirurgia , Stents , Angioplastia/efeitos adversos , Aterosclerose/diagnóstico por imagem , Aterosclerose/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Artéria Femoral/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/fisiopatologia , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
12.
Eur J Vasc Endovasc Surg ; 60(1): 68-75, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32312663

RESUMO

OBJECTIVE: In the presence of long lesions, in patients with chronic limb threatening ischaemia, a femorodistal bypass is often the only option to avoid major amputation. This study investigated whether targeted bypass to the affected angiosome, according to the angiosome concept definition of direct (DR) and indirect revascularisation (IR), has an impact on wound healing, major amputation rate, and mortality. METHODS: A retrospective analysis was performed at Ghent University Hospital of 201 non-healing ischaemic wounds (Rutherford categories 5 and 6) requiring femorodistal bypass surgery in 177 patients (61% male, median age 69 years) with a follow up of 36 months. For every patient, the site of the ulcer, the type of bypass, and material were identified. Based on ulcer location and distal anastomosis, the legs were divided into DR and IR. Kaplan-Meier univariable analysis was used to estimate cumulative ulcer healing, leg salvage, survival, and patency. RESULTS: DR was performed in 103 legs (51%) and IR in 98 legs (49%), with no difference in comorbidity. The mean wound healing time was seven months. DR did not lead to a higher healing rate. The fastest healing rate was obtained when opting for a DR with an autologous greater saphenous vein (GSV; 90% at 12 months). Cryopreserved allografts also yielded good results, especially for wound healing after IR (85% at 12 months). Major amputation was performed in 28.5% after IR vs. 17.3% after DR (p = .071). There was no difference in mortality rate (36.8% [DR] vs. 41.3% [IR]) (p = .088). Autologous GSV had a longer primary patency, primary assisted patency, and secondary patency (26, 34, and 38 months, respectively) than cryopreserved GSV (12.5, 18, and 24 months, respectively) (p = .002, p = .003, and p = .018, respectively), with no difference between DR and IR. CONCLUSION: Direct or indirect revascularisation performed according to the angiosome concept definition yields similar results with regard to healing rates, limb salvage, and mortality.


Assuntos
Artéria Femoral/cirurgia , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Cicatrização , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Femoral/transplante , Humanos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/cirurgia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
Angiology ; 71(7): 602-608, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32319299

RESUMO

Transradial coronary intervention (TRI) lowers bleeding and mortality compared with transfemoral coronary intervention (TFI). There are limited data on outcomes as TFI operators transition to a default TRI practice. The aim of this study was to assess TFI and TRI outcomes before, during, and after the year TRI was first learned by femoral operators. Patients undergoing percutaneous coronary intervention (PCI) at a Veterans Affairs Medical Center from 2006 to 2012 were included. In 2009, TRI was learned by all operators and then used as the default PCI approach from 2010 to 2012. Baseline characteristics and outcomes were collected. Predictors of major bleeding, major adverse cardiovascular events (MACE), and mortality were determined by multivariable analysis; 1192 veterans were included. TRI rates were 9% (2006-2008), 65% (2009), and 90% (2010-2012). Incidence of 1-year MACE and mortality was 5.4% and 3.9%, respectively, in 2009, and 5.6% and 3%, respectively, during 2010 to 2012. Major bleeding remained at <1%. Age, glycoprotein IIb/IIIa inhibitors, and ST-elevation myocardial infarction were independently associated with major bleeding, whereas TRI was protective. Transition to default TRI is feasible over a short time period and associated with low rates of MACE and mortality and very low rate of major bleeding.


Assuntos
Artéria Femoral/cirurgia , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea , Artéria Radial/cirurgia , Idoso , Feminino , Hemorragia/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Intervenção Coronária Percutânea/métodos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
Angiol Sosud Khir ; 26(1): 113-120, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32240145

RESUMO

Described in the article are the results of treating a total of 44 patients who endured repeat operations for infection of aortofemoral bifurcation allografts over the period between 2001 and 2018. These patients had previously undergone reconstructive operations using various synthetic grafts for lower limb ischaemia on the background of lower-limb artery atherosclerosis and infrarenal aortic aneurysms. Infection of synthetic vascular allografts in these patients was observed both in the immediate and remote postoperative periods. The dominating infection in 70% of patients was methicillin-resistant Staphylococcus aureus. The main objective risk factors for infection of bifurcation grafts were found to be as follows: stage III-IV chronic lower limb ischaemia (according to the Fontaine-Pokrovsky classification), diabetes mellitus, and prior operations on lower-limb arteries. Two of the 44 patients were operated on for reinfection after repeat aortofemoral bypass grafting. 30% of patients underwent repeat surgery with symptoms of sepsis. After meticulous additional examination and preoperative preparation the patients were subjected to secondary simultaneous operation, i.e., removal of the synthetic aortofemoral bifurcation prosthesis and aortofemoral bifurcation autovenous repeat reconstruction (repeat bypass grafting) in situ. Aortofemoral bifurcation grafts were formed using superficial femoral veins from both legs. Four patients died in the immediate postoperative period. Other short-term complications included arrosive bleeding with or without sepsis, amputation of one leg due to graft limb thrombosis, and development of peritonitis resulting from perforation of the jejunum. In the remote period, patency of autovenous grafts was confirmed in 37 patients. Of long-term complications, mention should be made of the following: formation of aneurysms of distal anastomoses and thrombosis of one of the limbs of the autovenous graft. The patients were successfully operated on now using synthetic grafts in infection-free conditions. Hence, a method of surgical decision-making in patients with infected aortofemoral bifurcation grafts is the use of the technique of complete removal of the infected synthetic graft with simultaneous in situ replacement using autovenous grafts from superficial femoral veins, active pre- and postoperative antibiotic therapy. Such policy made it possible to decrease the mortality rate to 9%, with a limb-salvage rate of 97.5% and long-term graft patency rate amounting to 92.5%.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Staphylococcus aureus Resistente à Meticilina , Aloenxertos , Aorta Abdominal/cirurgia , Prótese Vascular/efeitos adversos , Artéria Femoral/cirurgia , Humanos
15.
Angiol Sosud Khir ; 26(1): 148-156, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32240151

RESUMO

Analysed herein are the results of treating a total of 17 patients presenting with pathology of the aorta and lower-limb arteries, who from 2010 to 2018 required redo interventions due to infection of a previously implanted synthetic vascular graft. At admission, 3 patients were diagnosed as having an open infected wound, 11 were found to have a fistula, 2 had a false aneurysm in the area of the distal anastomosis of the branch of the bifurcation aortofemoral prosthesis, and 1 had thrombosis of the branch of the prosthesis with evidence of infection. As redo surgery, 4 patients underwent subclavian-femoral bypass grafting, 2 were subjected to crossover iliac-femoral bypass grafting, 8 to unilateral iliac-femoral bypass grafting, 3 to loop endarterectomy. In the majority of cases (14 of the 17) we used bypass grafting with creation of the tunnel through the muscular lacuna. Lethal outcomes were registered in 35% (n=6) of cases in the early postoperative period. Death was caused by acute renal failure in 6% (n=1), by acute mesenteric thrombosis in 12% (n=2), by gastrointestinal haemorrhage in 6% (n=1), and by multiple organ failure in 12% (n=2). Long-term mortality amounted to 33% (n=3) within 12 months. The main causes of death were increasing renal failure in 10% (n=1) and cardiovascular insufficiency on the background of heart diseases in 10% (n=1), as well as respiratory insufficiency in 10% (n=1). Reinfection in the remote period was diagnosed in 1 patient. A conclusion was drawn that bypass grafting is traumatic, however, it may be the only way to save the limb or patient's life in a complicated clinical situation. Using the superficial femoral vein as a shunt demonstrated good long-term results as to patency and resistance to surgical infection. Using a flap of the greater omentum, retroperitoneal fat, as well as wrapping of the prosthesis with a muscular flap ensured good tolerance of the zone of bypass grafting to reinfection.


Assuntos
Bioprótese , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Endarterectomia , Artéria Femoral/cirurgia , Humanos , Resultado do Tratamento , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares
16.
PLoS One ; 15(3): e0230535, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32191751

RESUMO

BACKGROUND: Major vascular complications (VCs) of ilio-femoral arterial access after percutaneous coronary interventions are infrequent, but are associated with increased mortality and morbidity. Routine endovascular repair of VCs is becoming the treatment of choice, especially for patients who cannot tolerate vascular surgery due to advanced cardiovascular disease or are in a bailout situation. Here, we review the different types of vascular access site complications associated with percutaneous coronary interventions (PCIs) and assess the safety and efficacy of endovascular treatment. METHODS: Data were retrospectively analysed from patients who experienced VCs after transfemoral PCIs, from December 2014 to May 2018. During this period, out of 2833 patients who underwent femoral coronary interventions, 53 (1.9%) experienced major VCs. RESULTS: In total, 40/53 (75.5%) cases with major VCs led to unplanned endovascular repair and 13/53 (24.5%) cases required surgical repair. VCs included 17 (32.1%) retroperitoneal bleeding events (BARC-2, 3a,b), 20 (37.7%) intimal dissections, and 16 (30.2%) femoral pseudoaneurysms. Overall, 32 (60.4%) patients received a covered stent, two (3.8%) received a nitinol stent, five (9.4%) patients with dissections were treated with prolonged balloon angioplasty alone, and one patient with femoral pseudoaneurysm underwent thrombin injection with simultaneous balloon occlusion. The mean hospital stay for patients after endovascular treatment was 11.06 ± 5.2 days, while for patients after surgical repair it was 17 ± 8.2 days. Endovascularly treated patients were transfused with red blood cells (13/40 32.5% vs. 2/13 15.4%) significantly more often than patients treated surgically, although surgically treated patients received more red blood cell concentrates per unit than endovascularly treated patients (1 ± 0.47 vs. 2 ± 0.93). During the one-year follow-up, no intermittent claudication was reported, and no patient required secondary endovascular or surgical repair. CONCLUSIONS: For patients who cannot tolerate vascular surgery due to advanced cardiovascular disease or are in a bailout situation, endovascular management of VCs following PCIs seems to be a feasible and safe treatment option, and represents an alternative to surgical repair in life-threatening situations. Endovascular treatment was associated with significantly fewer red blood cell concentrates per patient and fewer days in hospital than surgical treatment.


Assuntos
Procedimentos Endovasculares , Artéria Femoral/cirurgia , Intervenção Coronária Percutânea , Dispositivos de Acesso Vascular , Doenças Vasculares/cirurgia , Idoso , Feminino , Humanos , Masculino , Punções
18.
Arterioscler Thromb Vasc Biol ; 40(5): e126-e137, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32188276

RESUMO

OBJECTIVE: Arteriogenesis, describing the process of collateral artery growth, is activated by fluid shear stress (FSS). Since this vascular mechanotransduction may involve microRNAs (miRNAs), we investigated the FSS-induced expression of vascular cell miRNAs and their functional impact on collateral artery growth during arteriogenesis. Approach and Results: To this end, rats underwent femoral artery ligation and arteriovenous anastomosis to increase collateral blood flow to maximize FSS and trigger collateral vessel remodeling. Five days after surgery, a miRNA expression profile was obtained from collateral tissue, and upregulation of 4 miRNAs (miR-24-3p, miR-143-3p, miR-146a-5p, and miR-195-5p) was verified by quantitative polymerase chain reaction. Knockdown of miRNAs at the same time of the surgery in an in vivo mouse ligation and recovery model demonstrated that inhibition of miR-143-3p only severely impaired blood flow recovery due to decreased arteriogenesis. In situ hybridization revealed distinct localization of miR-143-3p in the vessel wall of growing collateral arteries predominantly in smooth muscle cells. To investigate the mechanotransduction of FSS leading to the increased miR-143-3p expression, cultured endothelial cells were exposed to FSS. This provoked the expression and release of TGF-ß (transforming growth factor-ß), which increased the expression of miR-143-3p in smooth muscle cells in the presence of SRF (serum response factor) and myocardin. COL5A2 (collagen type V-α2)-a target gene of miR-143-3p predicted by in silico analysis-was found to be downregulated in growing collaterals. CONCLUSIONS: These results indicate that the increased miR-143-3p expression in response to FSS might contribute to the reorganization of the extracellular matrix, which is important for vascular remodeling processes, by inhibiting collagen V-α2 biosynthesis.


Assuntos
Colágeno Tipo V/metabolismo , Circulação Colateral , Artéria Femoral/cirurgia , Mecanotransdução Celular , MicroRNAs/metabolismo , Músculo Esquelético/irrigação sanguínea , Neovascularização Fisiológica , Animais , Derivação Arteriovenosa Cirúrgica , Velocidade do Fluxo Sanguíneo , Células Cultivadas , Colágeno Tipo V/genética , Artéria Femoral/metabolismo , Artéria Femoral/fisiopatologia , Células Endoteliais da Veia Umbilical Humana/metabolismo , Humanos , Ligadura , Masculino , Camundongos Endogâmicos C57BL , MicroRNAs/genética , Miócitos de Músculo Liso/metabolismo , Ratos Sprague-Dawley , Fluxo Sanguíneo Regional , Estresse Mecânico
20.
PLoS One ; 15(2): e0227345, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32023258

RESUMO

AIMS: Patients with postoperative delirium (POD) after transcatheter aortic valve replacement (TAVR) are ventilated and hospitalized longer and suffer increased in-hospital mortality. This study hypothesized that a minimalistic approach with conscious sedation during transfemoral aortic valve replacement (TF-AVR) protects against delirium, time of mechanical ventilation, and increased length of stay in intensive care unit (ICU) compared to intubation anaesthesia. METHODS AND RESULTS: 308 patients which underwent TF-AVR in our centre between 01/2013 and 08/2017 were retrospectively evaluated regarding postoperative delirium, time of mechanical ventilation, and days in ICU. TF-AVR was performed with intubation anaesthesia in 245 patients and with conscious sedation in 63. The operative risk estimated by the logEUROScore was similar in both groups (intubation: 13.28 +/-9.06%, conscious sedation: 12.24 +/-6.77%, p = 0.395). In the conscious sedation group procedure duration was shorter (0.61 +/-0.91h vs. 1.75 +/-0.96h, p<0.001). The risk for intraprocedural complications was not influenced by the anaesthesia method (OR conscious sedation instead of intubation 1.66, p = 0.117), but days on ICU (-2.21 days, p<0.0001) and minutes of mechanical ventilation (-531.2 min, p < 0.0001) were reduced. Furthermore, the risk of POD was decreased when TF-AVR was performed under conscious sedation (6.35% vs. 18.18%, OR 0.29, p = 0.021). CONCLUSIONS: Time of mechanical ventilation, risk of POD, and days on ICU were substantially reduced in patients who underwent TF-AVR under conscious sedation. Our data suggest that TF-AVR with conscious sedation is safe with a beneficial postoperative course in clinical practice, and should be considered the favoured approach.


Assuntos
Anestesia , Artéria Femoral/cirurgia , Intubação , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Sedação Consciente , Feminino , Humanos , Unidades de Terapia Intensiva , Modelos Logísticos , Masculino , Marca-Passo Artificial , Complicações Pós-Operatórias/etiologia , Respiração Artificial , Fatores de Risco
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