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1.
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
2.
Khirurgiia (Mosk) ; (5): 71-76, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169823

RESUMO

Redo arterial reconstructions are followed by advanced surgical risk or impossible in some cases. Active introduction of endovascular surgery complements the capabilities of conventional surgical approach. It is presented case report of restoration of patency of synthetic femoral-popliteal shunt with previous occlusion for a long time. The technique of recanalization and stenting of allograft is described. Immediate results are favorable but further research is needed.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Artéria Femoral/cirurgia , Oclusão de Enxerto Vascular/cirurgia , Artéria Poplítea/cirurgia , Procedimentos Endovasculares , Oclusão de Enxerto Vascular/etiologia , Humanos , Isquemia , Reoperação , Stents , Falha de Tratamento , Resultado do Tratamento , Grau de Desobstrução Vascular
3.
Angiol Sosud Khir ; 25(2): 111-116, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31149997

RESUMO

We analysed the results of surgical treatment of 40 patients with lower limb critical ischaemia induced by atherosclerotic lesion of arteries of the femoropopliteotibial segment with dubious outflow pathways. The patients were divided into two groups of 20 each. Group One patients underwent autovenous femoropopliteal or tibial bypass grafting below the fissure of the knee joint and Group Two patients were subjected to profundoplasty with closure of the arteriotomic opening with an autovenous patch. The outflow pathway index in Group One amounted to 7.5±0.09 and in Group Two to 7.45±0.08. Our findings suggest that the use of profundoplasty as reconstructive operation in patients with dubious outflow pathways is pathogenetically substantiated, because it makes it possible to decrease the rate of early postoperative complications by 20% and that of late bypass thromboses by 25%, as well as to increase the level of the physical component of health by 12.1% and that of mental health by 3.2%. A conclusion drawn is that performing profundoplasty in this cohort of patients is appropriate and effective.


Assuntos
Isquemia , Extremidade Inferior , Procedimentos Cirúrgicos Vasculares , Artéria Femoral/cirurgia , Humanos , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Artéria Poplítea/cirurgia , Grau de Desobstrução Vascular
4.
Angiol Sosud Khir ; 25(2): 118-123, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31149998

RESUMO

Presented herein is an original method of preparing a bypass graft (a non-reversed autovein for femoropopliteal and femorotibial bypass grafting) and assessment of quality of valvulotomy using a thermal imager. The study included a total of 31 patients. All patients subdivided into 2 groups were subjected to bypass grafting operations with the use of a non-reversed autovein. In group 1 (n=16) prior to applying a bypass graft we assessed its patency with the use of an original method by means of a thermal imaging camera. In group 2 (n=15) assessment of graft patency after destruction of valves was not performed. In group 1 there were no bypass graft thromboses in the postoperative period, whereas three (20%) patients in group 2 developed bypass graft thrombosis within the first 24 postoperative hours, requiring repeat operation. Bypass graft thrombosis was caused in all cases by insufficiently destroyed valves of the venous transplant. There were no lethal outcomes within 1 year postoperatively. Control ultrasonographic examination after 1 year revealed bypass graft thrombosis in two (13.3%) patients in group 2, leading to the development of critical ischaemia and gangrene in one (6.6%) of these patients and later on requiring limb amputation at the level of the femur. A conclusion drawn is that thermal imaging makes it possible to intraoperatively assess quality of valvulotomy in using a non-reversed autovein as a bypass graft and to improve the results of surgical treatment.


Assuntos
Isquemia , Trombose , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares , Artéria Femoral/cirurgia , Humanos , Isquemia/cirurgia , Artéria Poplítea/cirurgia
5.
Ann R Coll Surg Engl ; 101(7): e154-e156, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31155912

RESUMO

Infected pseudoaneurysms are a vascular emergency, necessitating urgent surgical management. Owing to the infected field, a synthetic graft may be inappropriate in patients for whom autografting is impossible. Ligation of the artery is the usual management, often leading to amputation. We report a case of cadaveric allografting of the common femoral artery in a patient with a traumatic, infected pseudoaneurysm, who was taking immunosuppressive therapy for a liver transplant. The patient was followed up with ultrasound at 12 months and was found to have a significant graft stenosis, which was treated successfully with angioplasty. At 18 months, the patient remained well. This case describes the successful implantation of a cadaveric allograft into a patient with an infected pseudoaneurysm, negating the for need primary ligation.


Assuntos
Falso Aneurisma/cirurgia , Veia Femoral/transplante , Flebotomia/efeitos adversos , Infecções Estafilocócicas/cirurgia , Enxerto Vascular/métodos , Adulto , Aloenxertos/transplante , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Falso Aneurisma/microbiologia , Cadáver , Angiografia por Tomografia Computadorizada , Artéria Femoral/cirurgia , Veia Femoral/diagnóstico por imagem , Veia Femoral/lesões , Veia Femoral/microbiologia , Virilha , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento
6.
Vasc Endovascular Surg ; 53(6): 452-457, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31170884

RESUMO

BACKGROUND: Metformin is the most commonly used drug for type 2 diabetes. Research has shown that metformin also has a protective effect on endothelium by decreasing endothelial vascular reactivity. We hypothesize that metformin will decrease restenosis/reintervention rates in patients receiving lower extremity non-drug-eluting stents (nDESs) in the superficial femoral artery(SFA) and/or popliteal artery. MATERIALS/METHODS: Retrospective study was performed on 187 patients from October 2012 to December 2015 who received an nDES in the SFA and/or popliteal artery. Patients were divided into 3 groups (Table 1) and compared against for duplex based restenosis (>60%) rates, limb loss rates, and reintervention rates. Each patient's Trans-Atlantic-Inter-Society-Consensus II (TASC-II) class was collected. Postoperative duplex was performed 1 week after the procedure, then every 3 months for the first year, then, every 6 months to check for patency. IBM-SPSS-22 was used for all analyses. RESULTS: Average age of the patients was 64.65 ± 73.4 years. 101 patients had 101 procedures performed on the left lower extremity; 86 patients had 86 procedures performed on the right lower extremity; 123 patients were male and 64 were female. Average length of follow-up was 13.1±9.7 months. Most common indication for intervention was claudication, followed by critical limb threatening ischemia. Restenosis and reintervention by groups can be seen in Table 1. No patients experienced limb loss. There were no statistically significant differences between any of the 3 groups and their limb loss, restenosis, or reintervention rates. CONCLUSIONS: Despite having multiple proven effects in improving certain clinical outcomes and a proven protective effect on endothelium by decreasing endothelial vascular reactivity, metformin does not appear to reduce restenosis or reintervention rates in patients receiving lower extremity nDESs in the SFA and/or popliteal artery.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Procedimentos Endovasculares/instrumentação , Artéria Femoral/cirurgia , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Doença Arterial Periférica/cirurgia , Artéria Poplítea/cirurgia , Stents , Grau de Desobstrução Vascular/efeitos dos fármacos , Idoso , Constrição Patológica , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Procedimentos Endovasculares/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla
7.
Isr Med Assoc J ; 5(21): 322-325, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31140223

RESUMO

BACKGROUND: Access-site bleeding is a common complication of transfemoral transcatheter aortic valve implantation (TAVI). Percutaneous stent-graft implantation within the femoral artery may achieve hemostasis and avert the need for more invasive surgical vascular repair; however, failure to advance a guidewire antegradely via the injured vessel may preclude stent delivery. While retrograde stent-graft delivery from the distal vasculature may potentially enable percutaneous control of bleeding, this approach has not been reported. OBJECTIVES: To assess the feasibility of a retrograde approach for stent-graft implantation in the treatment of access-site bleeding following transfemoral TAVI. METHODS: A prospective TAVI registry was analyzed. Of 349 patients who underwent TAVI, transfemoral access was used in 332 (95%). Access-site injury requiring stent-graft implantation occurred in 56 (17%). In four patients (7%), antegrade wiring across the site of vascular injury was not possible and a retrograde approach for stent delivery was used. RESULTS: Distal vascular access was achieved via the superficial femoral or profunda artery. Retrograde advancement of a polymer-coated 0.035" wire to the abdominal aorta, followed by stent-graft delivery to the common femoral artery, achieved hemostasis in all cases. During a median (interquartile range) follow-up period of 198 (618) days (range 46-2455) there were no deaths and no patient required additional vascular interventions. CONCLUSIONS: A retrograde approach for stent-graft delivery is feasible and allows percutaneous treatment of a common femoral artery injury following TAVI in patients who are not suitable for the conventional antegrade approach.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Cateterismo Periférico , Artéria Femoral/cirurgia , Complicações Intraoperatórias , Hemorragia Pós-Operatória , Substituição da Valva Aórtica Transcateter , Lesões do Sistema Vascular , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/métodos , Estudos de Viabilidade , Feminino , Próteses Valvulares Cardíacas , Hemostasia Cirúrgica/métodos , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Masculino , Avaliação de Processos e Resultados (Cuidados de Saúde) , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/métodos , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/terapia
8.
J Cardiovasc Surg (Torino) ; 60(4): 450-455, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31062570

RESUMO

Considerable advances have been made over the last decade in the management of patients with peripheral artery disease. Historically, endovascular treatment has been the accepted approach for short lesions and surgical bypass for long, complex femoropopliteal lesions. However, bypass surgery holds significant risk of mortality and morbidity for the patient. That toll includes prolonged hospitalization, as well as the potential for wound healing and systemic complications, all of which are intensified by the ageing population. Advances in endovascular devices, such as drug eluting stents present an alternative, minimally invasive treatment option which may more suitable for complex lesions in a high-risk population. The aim of this review is to discuss the current literature which addresses surgical bypass and drug eluting stents, particularly for the treatment of long, complex femoropopliteal disease.


Assuntos
Arteriopatias Oclusivas/terapia , Stents Farmacológicos , Artéria Femoral/cirurgia , Doença Arterial Periférica/terapia , Artéria Poplítea/cirurgia , Arteriopatias Oclusivas/cirurgia , Procedimentos Endovasculares , Humanos , Doença Arterial Periférica/cirurgia
9.
J Cardiovasc Surg (Torino) ; 60(4): 439-449, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31062571

RESUMO

Drug-eluting stent (DES) are the mainstay therapy for the treatment of coronary artery disease. Stent design and drug-elution strategies have evolved over the years leading to the last generation DES which shows optimal safety and efficacy outcome. Peripheral arteries have different mechanical and biological features and the lessons learned from the coronary field have been difficult to introduce into the development of peripheral vascular technologies. First, due to its complex biomechanical behavior the use of metallic stents is limited in some vascular segments (i.e., distal superficial fermoral artery [SFA]). Also, peripheral vascular atherosclerosis is different containing higher levels of plaque burden and calcium. Finally, peripheral arterial disease tends to be more aggressive including longer lesions and higher incidence of total chronic occlusion. In general terms, restenosis in the peripheral vascular territory is more aggressive and occurs at a later time (~12 months) requiring a different pharmacokinetic profile compared to coronary technologies. Several strategies have been evaluated in the peripheral arteries raging from the bare metal stent to the drug coated balloon and drug eluting stent with outcome varying depending on the different field of application (i.e. SFA and below-the-knee). Results coming from the clinical trial are encouraging but further studies and direct comparison among the different technologies are demanded to determine the best therapy for peripheral vascular disease.


Assuntos
Paclitaxel/administração & dosagem , Doença Arterial Periférica/terapia , Sirolimo/administração & dosagem , Stents , Sistemas de Liberação de Medicamentos , Stents Farmacológicos , Everolimo/administração & dosagem , Artéria Femoral/cirurgia , Humanos , Doença Arterial Periférica/tratamento farmacológico , Polímeros , Prevenção Secundária/métodos , Serina-Treonina Quinases TOR/antagonistas & inibidores
10.
Int J Exp Pathol ; 100(2): 94-101, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31058412

RESUMO

Vascular surgical interventions are often burdened with late complications, including thrombosis or restenosis. The latter is generally caused by neointimal hyperplasia. Although extracellular matrix (ECM) remodelling is an important part of neointima formation, this process is not clearly understood. The aim of the study was to assess the content and activity of membrane-type 1 matrix metalloproteinase in human neointima in the late stages of its development. Matrix metalloproteinase-2 and tissue inhibitor of matrix metalloproteinase-2 were also evaluated. The research was performed on neointima samples collected during secondary vascular interventions from patients with chronic limb ischaemia who developed vascular occlusion at 6-18 months after aorto/ilio-femoral bypass grafting. The control material consisted of segments of femoral arteries collected from organ donors. Western blot and/or ELISA were used for the determination of MT1-MMP and TIMP-2 expression. The activity of MT1-MMP was measured by fluorometric assay and that of MMP-2 by zymography. We demonstrated significantly increased MT1-MMP protein content in neointima when compared to normal arteries. However, the activity of MT1-MMP was significantly lower in neointima than in control samples. The decreased MT1-MMP activity was concomitant with reduced activity of MMP-2. The TIMP-2 protein levels in neointima and normal arteries were not significantly different. The results of our study suggest that the reduced activity of MT1-MMP and consequently MMP-2 in human neointima may play a role in decreased degradation of ECM components and thus promote neointimal overgrowth.


Assuntos
Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular/efeitos adversos , Metaloproteinase 14 da Matriz/metabolismo , Metaloproteinase 2 da Matriz/metabolismo , Neointima/enzimologia , Neointima/patologia , Aorta/cirurgia , Artéria Femoral/enzimologia , Artéria Femoral/cirurgia , Oclusão de Enxerto Vascular/enzimologia , Oclusão de Enxerto Vascular/cirurgia , Humanos , Hiperplasia/enzimologia , Artéria Ilíaca/cirurgia , Perna (Membro)/irrigação sanguínea , Reoperação , Inibidor Tecidual de Metaloproteinase-2/metabolismo
11.
Ann Vasc Surg ; 59: 285-292, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009734

RESUMO

Femoropopliteal atherosclerosis affects a significant percentage of the world population, leading to intermittent claudication and critical limb ischemia. The femoropopliteal segment has a unique set of biomechanical challenges that must be considered and overcome for treatment. The use of stents is a reality and a necessity in peripheral interventions. The success of first-generation femoropopliteal stents was limited by their rigidity and deformability. The standard nitinol stents overcame certain biomechanical challenges because of their superelasticity and thermal shape memory, although stent fracture is still an issue. Therefore, interwoven nitinol stents with helical structure have been developed, borrowing the concept from biliary stents, aiming to provide good flexibility while still maintaining a uniform cell size and significant radial strength. This unique interwoven structure gains it advantage in the femoropopliteal region. The purpose of this review article is to investigate the current published evidence of the use of self-expandable interwoven nitinol stents in femoropopliteal arterial disease and compare them with other endovascular treatment options.


Assuntos
Ligas , Procedimentos Endovasculares/instrumentação , Artéria Femoral/cirurgia , Doença Arterial Periférica/cirurgia , Artéria Poplítea/cirurgia , Stents Metálicos Autoexpansíveis , Procedimentos Endovasculares/efeitos adversos , Artéria Femoral/fisiopatologia , Hemodinâmica , Humanos , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/fisiopatologia , Desenho de Prótese , Falha de Prótese , Medição de Risco , Fatores de Risco , Estresse Mecânico , Resultado do Tratamento
12.
Ann Transplant ; 24: 199-207, 2019 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-30975974

RESUMO

BACKGROUND Vascular failures are serious complications in pancreas transplantation. Open surgery is a reliable and quick intervention method, but it carries a risk of infection and bleeding. Endovascular procedures are rare among patients after a SPK, but are becoming more frequently used. One of the main risks of the endovascular approach is that the renal function impairment caused by contrast agent. MATERIAL AND METHODS We performed a retrospective analysis of 200 transplanted pancreases at our center over the last 14 years. The analyses included those patients after pancreas transplantation who required the most challenging vascular interventions and ones that were non-standard for the procedure. RESULTS Severe vascular conditions requiring endovascular intervention were observed in 3% of SPKs. In one retransplanted patient, there was an acute ischemia of the lower extremity due to the narrowing of the common iliac artery following a previous transplantectomy, above the new pancreas graft anastomoses. In another patient, local inflammation led to the disruption of the external iliac artery on the level of transplantectomy, caused severe bleeding, and we had to implement a stent-graft to reconstruct the iliac artery wall. A third patient had a pseudoaneurysm demanding further treatment with a stent-graft implemented into the femoral artery due to a pseudoaneurysm of the right external iliac artery. CONCLUSIONS Intravenous interventions in patients with a transplanted or retransplanted pancreas are safe and feasible. It is a technically demanding procedure, but the risk of kidney graft function deterioration, as well as of bleeding due to the high dose of heparin used, is lower than with open vascular surgery.


Assuntos
Procedimentos Endovasculares , Transplante de Rim/efeitos adversos , Transplante de Pâncreas/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/cirurgia , Implante de Prótese Vascular , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/lesões , Artéria Femoral/cirurgia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/lesões , Artéria Ilíaca/cirurgia , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Stents , Tomografia Computadorizada por Raios X
14.
J Cardiovasc Surg (Torino) ; 60(4): 456-459, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30994309

RESUMO

Superficial femoral and popliteal artery disease are commonly involved in the development of symptomatic PAD. As time has gone on drug coated stents and drug coated balloons have supplanted the plain balloon angioplasty corner stone of therapy with superiority proven in randomized trials. Device approval trials are typically characterized by simple lesions that are less common than the longer complex disease. Registry data has demonstrated benefit of both technologies though drug coated balloons typically require a significant amount of adjunctive stenting in more complex disease. Recently published randomized data is starting to help proceduralists define when each therapy may be more optimal.


Assuntos
Angioplastia com Balão , Arteriopatias Oclusivas/terapia , Stents Farmacológicos , Artéria Femoral/cirurgia , Doença Arterial Periférica/terapia , Artéria Poplítea/cirurgia , Arteriopatias Oclusivas/cirurgia , Aterosclerose/terapia , Procedimentos Endovasculares , Humanos , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/cirurgia , Polímeros , Desenho de Prótese , Resultado do Tratamento , Grau de Desobstrução Vascular
16.
Eur J Vasc Endovasc Surg ; 57(5): 650-657, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30910498

RESUMO

OBJECTIVES: The effect of superficial femoral artery (SFA) occlusion on long-term patency of aortofemoral bypasses (AFBs) for aortoiliac occlusive disease (AIOD) was examined. METHODS: The AIOD database was reviewed to identify risk factors for AFB failure. The status of the SFA at AFB procedure was categorised as patent; diseased treated (DT), if the SFA occlusion was intervened on concomitant to AFB; or diseased untreated (DU), if the SFA was occluded but not revascularised. Censoring hierarchies for primary patency and patent graft survival time were constructed. Data were analysed by contingency table, Kaplan-Meier, and Cox regression analysis. RESULTS: Between 2004 and 2015, 122 AFB (9 unifemoral, 113 bifemoral) for AIOD were performed. Seventy-five (61%) were female and the mean age was 60 ± 10 years. At the time of AFB, 50 (41%) had occluded SFAs (DT/DU). Of these, 15 had concomitant SFA revascularisation (i.e., DT) at the time of AFB. Patients with occluded SFAs had greater history of prior aortoiliac/infrainguinal procedures (aortoiliac 54% vs. 22%, infrainguinal 58% vs. 25%, both p < 0.001), Trans-Atlantic Inter-Society Consensus II classification of femoropopliteal type D lesions (78 vs. 10%, p < 0.001), Rutherford 4-6 categories (80% vs. 57%, p = 0.011), and longer hospital stay (median 11 vs. 7 days, p < 0.004). SFA status did not affect 30 day mortality (overall 9%); however, sub-analysis showed DT had significantly higher mortality than DU (p < 0.03). Over a median follow up of 7.7 (IQR 4.3-11.4) years, primary patency at one and five years was 98.3% and 91.2% in patients with patent SFAs, 87.9% and 82.7% in DU, and 72.7% and 43.6% in DT (p < 0.001), respectively. On multivariable analysis, low baseline glomerular filtration rate (HR 1.01, p = 0.022), DT (HR 3.7, p = 0.020), Rutherford 4-6 (HR 9.1, p = 0.048), and occluded SFA (HR 3.9, p = 0.009) adversely affected primary patency of AFBs. Long-term mortality was not different between the SFA status groups (p = 0.279). CONCLUSION: Baseline SFA occlusion predicted a fourfold increased hazard of primary AFB failure. Concomitant SFA revascularisation did not improve AFB durability and was associated with increased in hospital mortality.


Assuntos
Aorta Abdominal/cirurgia , Arteriopatias Oclusivas/cirurgia , Artéria Femoral/cirurgia , Oclusão de Enxerto Vascular/etiologia , Artéria Ilíaca/cirurgia , Enxerto Vascular , Grau de Desobstrução Vascular , Idoso , Feminino , Seguimentos , Taxa de Filtração Glomerular , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Fatores de Risco , Trombose/etiologia , Enxerto Vascular/efeitos adversos
17.
J Med Case Rep ; 13(1): 90, 2019 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-30894201

RESUMO

BACKGROUND: Vascular closure devices have been widely used to achieve rapid hemostasis after percutaneous catheterization procedures via the common femoral artery. The EXOSEAL vascular closure device is a device that can deliver a bioabsorbable polyglycolic acid plug to fill the subcutaneous puncture route at the groin for rapid hemostasis, and this device has a lower risk of arterial occlusion than other vascular closure devices. CASE PRESENTATION: An 83-year-old Japanese man underwent percutaneous coronary intervention for a proximal stenosis in his left circumflex artery through a 7-Fr sheath from his right common femoral artery. We encountered acute popliteal artery occlusion associated with EXOSEAL vascular closure device. We detected the plug material of this device at the occluded lesion by intravascular ultrasound, and performed successful bailout stenting after pulling the embolus with an inflated balloon catheter up to the superficial femoral artery from the popliteal artery. CONCLUSION: Acute limb ischemia caused by an EXOSEAL vascular closure device is a very rare complication. Balloon angioplasty and stenting are considered to be effective options to deal with the plug dislodgement of an EXOSEAL vascular closure device. We must be prepared for every rare complication during endovascular treatment.


Assuntos
Arteriopatias Oclusivas/etiologia , Artéria Femoral/lesões , Dispositivos de Oclusão Vascular/efeitos adversos , Idoso de 80 Anos ou mais , Angiografia , Angioplastia com Balão , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Procedimentos Endovasculares , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Humanos , Masculino , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/lesões , Artéria Poplítea/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem
18.
Eur J Vasc Endovasc Surg ; 57(6): 832-841, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30910497

RESUMO

OBJECTIVE: The incidence of diabetes is rapidly increasing and diabetes is associated with an increased risk of peripheral artery disease. Recent studies have shown a time dependent decline in vulnerable plaque features and secondary cardiovascular events in iliofemoral endarterectomy (IFE) patients. IFE patients with diabetes have a high risk of cardiovascular events. It is not known, however, whether vulnerable plaque features and cardiovascular events reduce over time in IFE patients with diabetes. METHODS: Between 2003 and 2014, 691 atherosclerotic plaques were obtained by IFE, from 212 patients with and 479 patients without diabetes. Plaques were immunohistochemically stained and analysed for the presence of intraplaque haemorrhage, lipid core, calcification, collagen, smooth muscle cells, and macrophages. Patients were stratified according to their diabetic status and year of inclusion. All patients had a follow up of three years in which cardiovascular adverse events were recorded. RESULTS: A time dependent decrease was observed in intraplaque haemorrhage, plaque lipid core, and percentage of macrophages in IFE patients with diabetes. After multivariable correction for changes in risk factors over time, intraplaque haemorrhage (64.2% [2002-2005] vs. 39.6% [2012-2014], p = .01) became significantly less prevalent. Interestingly, the percentage of severely calcified plaques remained high over time. The number of secondary events decreased over time in patients without diabetes (HR 1.80, 95% CI 1.15-2.81 (p = .010) for 2002-2005 vs. 2012-2014), but remained high and unchanged in patients with diabetes. CONCLUSION: In patients with diabetes undergoing IFE, a time dependent stabilisation of atherosclerotic plaque features was found in line with previous observations in patients with severe atherosclerosis. The presence of severely calcified lesions remained high and unchanged. The secondary event rate remained high in patients with diabetes in contrast to a significant decrease in patients without diabetes. These findings stress the need for improvement of care in IFE patients with diabetes.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Endarterectomia , Artéria Femoral/cirurgia , Artéria Ilíaca/cirurgia , Doença Arterial Periférica/cirurgia , Placa Aterosclerótica , Idoso , Bancos de Espécimes Biológicos , Doenças Cardiovasculares/diagnóstico , Diabetes Mellitus/diagnóstico , Endarterectomia/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/patologia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/patologia , Incidência , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/epidemiologia , Doença Arterial Periférica/patologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
19.
J Craniofac Surg ; 30(3): e213-e216, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30845093

RESUMO

INTRODUCTION: Microsurgical interposition of vein grafts is an extraordinarily filigree surgical technique, which requires both sound theoretical knowledge and solid manual skills. Although there are a large number of training models, the majority of these are either relatively expensive, technically complex, or employ synthetic materials with poor resemblance to human tissue. The authors' model allows training of ex vivo vein graft interposition on gradually thawed cryopreserved vessels and it, therefore, is cost-efficient and readily available when needed. Furthermore, it respects the 3R-principle (Reduce-Refine-Replace), as it is based on rat cadaveric vessels. METHODS: Three trainees with basic microsurgical experience, but without prior performance of vein graft interpositioning, were chosen to perform 20 femoral vein graft (5 mm) interpositions into femoral artery defects. The patency and leakage rate served as qualitative variable and operation time as a quantitative variable for efficiency control. RESULTS: For the first half of trials, the trainees had a patency failure rate of 50% and for the second half a rate of 13.3%. The leakage rate noticeably decreased from 44.4% in the first half of trials to 10% in the second half. Although the trainees needed 60 minutes on average for their first 10 trials, they improved to 51 minutes for their last 10 anastomoses. CONCLUSION: The authors' microsurgical model offers a simple, low-cost simulation training, specifically designed for learning of vein graft interposition into arterial defects. The model is associated with a high learning curve, based on an objective control of the anastomoses by assessment of the patency, leakage, and operation time.


Assuntos
Criopreservação , Microcirurgia/educação , Enxerto Vascular/educação , Animais , Artéria Femoral/fisiologia , Artéria Femoral/cirurgia , Veia Femoral/fisiologia , Veia Femoral/transplante , Humanos , Modelos Educacionais , Ratos
20.
Medicine (Baltimore) ; 98(5): e14268, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30702588

RESUMO

RATIONALE: As survival prospects improve for long-term patients with hemodialysis, it is common for patients to exhaust all upper extremity access options before other avenues need exploration. The purpose of this case report was to describe our experience in creating a prosthetic graft between left femoral artery and right femoral vein in a patient with history of central venous occlusion and bilateral femoral neck fracture. PATIENT CONCERNS: A female patient with hemodialysis exhausted all upper extremity access options along with bilateral femoral neck fracture. DIAGNOSES: Patients with end-stage renal disease exhausted all upper extremity access options. INTERVENTIONS: We performed a left femoral artery to right femoral vein dialysis access utilizing a prosthetic graft and autologous cephalic vein. OUTCOME: The graft was used for hemodialysis 3 weeks after the operation. There was no edema of the lower extremity through the immediate postoperative period as well as at follow up. The patient has been using the access for 9 months with no complication of thrombosis, infection, or bleeding. LESSONS: Prosthetic graft between the left femoral artery and right femoral vein is a simple, safe and novel approach to creating lower extremity access. This method could be a viable means of hemodialysis access in selected patients.


Assuntos
Implante de Prótese Vascular/métodos , Artéria Femoral/cirurgia , Veia Femoral/cirurgia , Falência Renal Crônica/cirurgia , Diálise Renal/métodos , Adulto , Feminino , Humanos
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