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1.
Medicine (Baltimore) ; 100(2): e24340, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466221

RESUMO

BACKGROUND: Several randomized clinical trials have demonstrated the safety and efficiency of mechanical thrombectomy in the management of acute ischaemic stroke caused by larger vessel occlusion. According to the trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, acute ischaemic stroke can be divided into cardioembolic stroke and non-cardioembolic stroke. Previous studies have shown that mechanical thrombectomy in cardioembolic stroke with intracranial large artery occlusion has a poor prognosis. The reason may be that the old emboli are hard, making it difficult to remove. However, recent evidence shows that mechanical thrombectomy is also effective and safe in patients with cardioembolic stroke. Therefore, the aim of this study is to evaluate the efficacy and safety of mechanical thrombectomy for cardioembolic stroke. METHODS: The electronic database, including PubMed, Cochrane Library, EMBASE, the China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), VIP database, and Wan-fang database, were thoroughly retrieved from inception to December 1, 2021, without language restrictions. All randomized controlled trials that evaluated the efficacy and safety of mechanical thrombectomy in the treatment of cardioembolic stroke will be included. Primary outcomes will include vascular recanalization rate and score scale. Two authors will independently scan the articles searched, extract the data from articles included, and assess the risk of bias by Cochrane tool of risk of bias. Disagreements will be resolved by discussion among authors. All analysis will be performed based on the Cochrane Handbook for Systematic Reviews of Interventions. Dichotomous variables will be reported as risk ratio or odds ratio with 95% confidence intervals and continuous variables will be summarized as mean difference or standard mean difference with 95% confidence intervals. RESULTS: This review will be to assess the efficacy and safety of mechanical thrombectomy for cardioembolic stroke. CONCLUSIONS: The results of our findings may be helpful for clinicians and health professionals to re-examine the clinical decision-making in the treatment of cardioembolic stroke, promising way for treatment of patients with cardioembolic stroke. SYSTEMATIC REVIEW REGISTRATION NUMBER: INPLASY2020120035.


Assuntos
Arteriopatias Oclusivas/cirurgia , Trombólise Mecânica/métodos , Arteriopatias Oclusivas/complicações , Humanos , Metanálise como Assunto , Razão de Chances , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
2.
Angiol Sosud Khir ; 26(4): 90-96, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33332311

RESUMO

AIM: The present study was aimed at assessing the results of a total of 40 vascular operations carried out using the robotic-assisted da Vinci surgical system. PATIENTS AND METHODS: Between January 2013 and September 2019, a total of 40 robotic-assisted vascular operations were performed at the Department of Vascular Pathology and Hybrid Technologies of the Centre of Vascular and Hybrid Surgery. Of these, 31 interventions were carried out for occlusion of the aortoiliac segment and 9 for removal of an aneurysm of the infrarenal portion of the abdominal aorta. The patients were arbitrarily divided into 2 groups: the first group included those subjected to aortofemoral bypass grafting procedures for atherosclerotic steno-occlusive lesions of the aorta and iliac arteries, whereas the second group comprised the patients who underwent aneurysmoectomies with linear prosthetic repair of the abdominal aorta. RESULTS: Altogether, elective robotic-assisted operations were successfully performed in 38 (95%) cases. Conversion to a laparotomic approach was required in 2 (5%) patients. The mean time of creating an anastomosis with the abdominal aorta amounted to 51 minutes (range 30-90), being 42±4.75 min for aortofemoral bypass grafting and 83±5.00 min for aneurysmoectomies with linear prosthetic repair of the abdominal artery. The average blood loss was 316 (range 50-1000) ml, amounting to 280±209 ml and 438±322 ml for group I and group II, respectively. With the exception of one case, all patients spent 24 hours in the intensive care unit to be then transferred to the specialized ward. The average length of hospital stay amounted to 9.8 days. One patient experienced haemorrhage from the central anastomosis in the early postoperative period and was emergently operated on from a laparotomic approach. Four (10%) patients developed nonlethal complications which were treated conservatively. During the 30-day follow-up period, no lethal outcomes, thromboses, nor infections of the prostheses were observed. CONCLUSION: From a practical point of view, the major advantages of using the robotic-assisted complex include minimal surgical trauma, reduced blood loss, a wide range of high-precision movements of the manipulators, 3-D visualization with a 5-fold magnification, thus making it possible to create a vascular anastomosis sufficiently fast in very tight spaces in the body. Our experience with laparoscopic robotic-assisted surgery demonstrated feasibility of using this technique for treatment of pathology of the aortoiliac segment.


Assuntos
Arteriopatias Oclusivas , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/cirurgia , Humanos , Artéria Ilíaca/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento
3.
Rev Med Liege ; 75(11): 717-723, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33155445

RESUMO

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


Assuntos
Arteriopatias Oclusivas , Procedimentos Endovasculares , Doença Arterial Periférica , Arteriopatias Oclusivas/cirurgia , Artéria Femoral/cirurgia , Humanos , Doença Arterial Periférica/cirurgia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
4.
Zhonghua Wai Ke Za Zhi ; 58(11): 852-857, 2020 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-33120448

RESUMO

Objective: To examine the outcomes of surgical repair for patients with total subclavian artery occlusion. Methods: A retrospective analysis was performed on 67 patients with subclavian artery occlusion disease admitted at Ward 1 of Aortic and Vascular Surgery Center, Fuwai Hospital from January 2016 to July 2019. The age was, and There were 51 male patients and 16 females with an age of (61.7±8.2) years (range: 37 to 79 years). The t-test, Mann-Whitney U-test, χ(2) test, and Fisher's exact test were used to analyze the factors related to the technique success. The Kaplan-Meier curve was used to calculate the cumulative patency rate and plot the corresponding survival curves, and the Log-rank test was used for comparison. The length from the subclavian artery ostial to the occlusion area was used as a variable to plot the receiver operating characteristic curve, and the optimal cut-off value was determined by the Youden index. Results: Eighteen patients received open surgery. Forty-nine patients with subclavian artery occlusion accepted endovascular repair, of which 38 patients succeeded (31 cases on left side and 3 cases on right side). Fifteen patients failed with endovascular therapy, of which 10 cases received elective surgery and 5 cases received conservative therapy. The success rate of endovascular repair was 69.4%(34/49). Among them, the success rate of left subclavian artery occlusion was 81.6%(31/38), while the right side was 3/11. Patients with the length from the subclavian artery ostial to the occlusion area ≥6 mm were more likely to get success (23/34 vs. 4/15, χ(2)=5.506, P=0.019). In the endo-group, one patient had hemorrhage in the left chest. In the open-group, one patient had lymphatic leakage. Follow-up period ranged from 3 to 46 months with a median of 22 months. The patency of endovascular repair group and the open surgery group was 92.6% and 90.8% at 12-month, while 82.9% and 84.3% at 24-month, respectively. The cumulative patency rates of smoking patients and non-smoking patients after endovascular treatment were 70.2% vs. 100% (P=0.048) at 24-month. No independent prognosis factors were identified through the Cox proportional risk model which significantly affected postoperative patency rates for patients with subclavian artery occlusion. Conclusions: Part of patients with subclavian artery occlusion can be treated by endovascular therapy. The success rate of left subclavian artery occlusions is higher than right sides. The length from the subclavian artery ostial to the occlusion area affected the success rate of repair.


Assuntos
Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Doença Arterial Periférica/cirurgia , Artéria Subclávia/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
5.
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
6.
Khirurgiia (Mosk) ; (8): 55-60, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869616

RESUMO

OBJECTIVE: To study the immediate results of therapy and indirect revascularization in patients with critical ischemia of the lower limbs. MATERIAL AND METHODS: The results of medication and surgical treatment were analyzed in 210 patients with critical ischemia of the lower limbs. Atherosclerosis obliterans was diagnosed in 142 patients, thromboangiitis obliterans - in 68 patients. Lesion of femoropopliteal segment was observed in 32 (15.2%) cases, popliteal-tibial segment - 68 (32.8%) patients, tibial and foot segment - 62 (29.5%) cases, foot - 31 (14.8%) cases, multiple-level lesion - 17 (8.1%) cases. Survey consisted of Doppler ultrasound, CT angiography, rheovasography with analysis of rheographic index (RI) and pulse oximetry. Circulatory parameters were compared with identical values in 48 almost healthy persons ("reference group"). The results of medication and surgical treatment were evaluated by using of the scale of Rutherford R.B. et al. (1997). RESULTS: Conservative treatment was performed in 48 patients (control group). The following types of indirect revascularization operations were performed to stimulate regional circulation: bone trepanation in 42 patients, lumbar sympathectomy in 51 patients, bone trepanation + lumbar sympathectomy in 38 patients, bone trepanation with intraosseous irradiation in 31 cases. CONCLUSION: Indirect revascularization improves early postoperative outcomes, ensures maintaining support function of the limb and active lifestyle in patients with critical ischemia of the lower limbs. Technical simplicity of these procedures facilitates widespread introduction of indirect revascularization in multi-field hospitals.


Assuntos
Arteriopatias Oclusivas/cirurgia , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/tratamento farmacológico , Arteriosclerose Obliterante/diagnóstico por imagem , Arteriosclerose Obliterante/tratamento farmacológico , Arteriosclerose Obliterante/cirurgia , Osso e Ossos/cirurgia , Tratamento Conservador , Humanos , Isquemia/diagnóstico por imagem , Isquemia/tratamento farmacológico , Salvamento de Membro/métodos , Extremidade Inferior/diagnóstico por imagem , Estudos Retrospectivos , Simpatectomia , Tromboangiite Obliterante/diagnóstico por imagem , Tromboangiite Obliterante/tratamento farmacológico , Tromboangiite Obliterante/cirurgia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
7.
Medicine (Baltimore) ; 99(39): e22451, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991482

RESUMO

RATIONALE: Shivering is an important physiological response of the body that causes muscle tremors to maintain temperature homeostasis. Traumatic brain injuries that affect the hypothalamus cause hypothermia, and physical removal of suprasellar tumors causes thermoregulation imbalance. However, no study has reported shivering due to ischemic stroke. PATIENT CONCERNS: A 58-year-old male patient was admitted to our emergency department to evaluate severe stenosis of the basilar artery. While waiting for further examination, he exhibited coarse shivering and severe dysarthria. DIAGNOSIS: Brain computed tomography angiography revealed occlusion of the entire basilar artery, and cerebral hypoperfusion was diagnosed in that area. INTERVENTIONS: Transfemoral cerebral angiography (TFCA) was immediately performed, followed by thrombectomy of the basilar artery. OUTCOMES: Neurological deficits, including shivering, were rapidly reversed. The same symptom reoccurred 5 hours later, and TFCA was performed for thrombectomy and stenting, and neurological symptoms immediately reversed. The patient's neurological symptoms did not worsen during hospitalization. LESSONS: Patients with acute basilar artery occlusion need prompt management because they have a higher mortality rate than those with other intracranial artery occlusions. When a patient exhibits neurological deficits accompanied by abrupt shivering for no specific reason, basilar artery occlusion must be considered.


Assuntos
Arteriopatias Oclusivas/complicações , Artéria Basilar/patologia , Tremor por Sensação de Frio/fisiologia , Arteriopatias Oclusivas/cirurgia , Angiografia Cerebral , Humanos , Masculino , Pessoa de Meia-Idade , Trombectomia
8.
Stroke ; 51(9): 2630-2638, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32772684

RESUMO

BACKGROUND AND PURPOSE: To quantify workflow metrics in patients receiving stroke imaging (noncontrast-enhanced computed tomography [CT] and CT-angiography) in either a computed-tomography scanner suite (CT-Transit [CTT]) or an angio-suite (direct transfer to angio-suite-[DTAS]-using flat-panel CT) before undergoing mechanical thrombectomy. METHODS: Prospective, single-center investigator initiated randomized controlled trial in a comprehensive stroke center focusing on time from imaging to groin puncture (primary end point) and time from hospital admission to final angiographic result (secondary end point) in patients receiving mechanical thrombectomy for anterior circulation large vessel occlusion after randomization to the CTT or DTAS pathway. RESULTS: The trial was stopped early after the enrollment of n=60 patients (CTT: n=34/60 [56.7 %]; DTAS: n=26/60 [43.3%]) of n=110 planned patients because of a preplanned interim analysis. Time from imaging to groin puncture was shorter in DTAS-patients (in minutes, median [interquartile range]: CTT: 26 [23-32]; DTAS: 19 [15-23]; P value: 0.001). Time from hospital admission to stroke imaging was shorter in patients randomized to DTAS (CTT: 12 (7-18); DTAS: 21 (15-25), P value: 0.007). Time from hospital admission to final angiographic reperfusion was comparable between patient groups (CTT: 78 [58-92], DTAS: 80 [66-118]; P value: 0.067). CONCLUSIONS: This trial showed a reduction in time from imaging to groin-puncture when patients are transferred directly to the angiosuite for advanced stroke-imaging compared with imaging in a CT scanner suite. This time saving was outweighed by a longer admission to imaging time and could not translate into a shorter time to final angiographic reperfusion in this trial.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/cirurgia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Angiografia por Tomografia Computadorizada , Determinação de Ponto Final , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transferência de Pacientes , Estudos Prospectivos , Reperfusão , Tempo para o Tratamento , Tomografia Computadorizada por Raios X , Fluxo de Trabalho
9.
Stroke ; 51(9): 2742-2751, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32811382

RESUMO

BACKGROUND AND PURPOSE: We aimed to evaluate the impact of cortical microinfarcts (CMIs) on functional outcome after endovascular treatment in patients with acute ischemic stroke. METHODS: In a multicenter registration study for RESCUE-RE (a registration study for Critical Care of Acute Ischemic Stroke After Recanalization), eligible patients with large vessel occlusion stroke receiving endovascular treatment, who had undergone 3T magnetic resonance imaging on admission or within 24 hours after endovascular treatment were analyzed. We evaluated the presence and numbers of CMIs with assessment of axial T1, T2-weighted images, and fluid-attenuated inversion recovery images. The primary outcome was functional dependence or death defined as modified Rankin Scale scores of 3 to 6 at 90 days. Secondary outcomes included early neurological improvement, any intracranial hemorrhage, symptomatic intracranial hemorrhage, and mortality. We investigated the independent associations of CMIs with the outcomes using multivariable logistic regression in overall patients and in subgroups. RESULTS: Among 414 patients (enrolled from July 2018 to May 2019) included in the analyses, 96 (23.2%) patients had at least one CMI (maximum 6). Patients with CMI(s) were more likely to be functionally dependent or dead at 90 days, compared with those without (55.2% versus 37.4%; P<0.01). In multivariable logistic regression analyses, presence of CMI(s) (adjusted odds ratio, 1.78 [95% CI, 1.04-3.07]; P=0.04) and multiple CMIs (CMIs ≥2; adjusted odds ratio, 7.41 [95% CI, 2.48-22.17]; P<0.001) were independently, significantly associated with the primary outcome. There was no significant difference between subgroups in the associations between CMI presence and the primary outcome. CONCLUSIONS: Acute large vessel occlusion stroke patients receiving endovascular treatment with CMI(s) were more likely to have a poor functional outcome at 90 days, independent of patients' characteristics. Such associations may be dose-dependent. Registration: URL: http://www.chictr.org.cn; Unique identifier: ChiCTR1900022154.


Assuntos
Isquemia Encefálica/complicações , Isquemia Encefálica/cirurgia , Córtex Cerebral , Infarto Cerebral/complicações , Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/cirurgia , Isquemia Encefálica/diagnóstico por imagem , Córtex Cerebral/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/mortalidade , Feminino , Humanos , Hemorragias Intracranianas/etiologia , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Acidente Vascular Cerebral/diagnóstico por imagem , Resultado do Tratamento
12.
Vasc Endovascular Surg ; 54(7): 618-624, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32666893

RESUMO

BACKGROUND: Surgical site infections (SSI) are frequently seen after aortoiliac vascular surgery (2%-14%). Deep SSIs are associated with graft infection, sepsis, and mortality. This study evaluates the difference in incidence and nature of SSI following open aortoiliac surgery for aneurysmal disease compared to occlusive arterial disease. METHODS: A retrospective cohort study was conducted, including all consecutive patients who underwent open aortoiliac vascular surgery between January 2005 and December 2016 in the Amphia Hospital, Breda, the Netherlands. Patients were grouped by disease type, either aneurysmal or occlusive arterial disease. Data were gathered, including patient characteristics, potential risk factors, and development of SSI. Surgical site infections were defined in accordance with the criteria of the Centers for Disease Control. RESULTS: Between January 2005 and December 2016, a total of 756 patients underwent open aortoiliac surgery of which 517 had aortoiliac aneurysms and 225 had aortoiliac occlusive disease. The group with occlusive disease was younger, predominantly male, and had more smokers. After exclusion of 228 patients undergoing acute surgery, the SSI rate after elective surgery was 6.2%, with 10 of 301 SSIs in the aneurysmal group (3.0%) and 22 of 213 SSIs in the group with occlusive disease (10.3%, P < .001). Also, infection-related readmission and reintervention were higher after occlusive surgery, 6.6% versus 0.9% (P < .001) and 4.2% versus 0.9% (P = .003), respectively. Staphylococcus aureus was found as the most common pathogen, causing 64% of SSI in occlusive disease versus 10% in aneurysmal disease (P = .005). Logistic regression showed occlusive arterial disease and chronic renal disease were associated with SSI. CONCLUSION: Our study presents evidence for a higher rate of SSI in patients with aortoiliac occlusive disease compared to aortoiliac aneurysmal disease, in part due to inherent use of inguinal incision in patients with occlusive disease. All precautions to prevent SSI should be taken in patients undergoing vascular surgery for arterial occlusive disease.


Assuntos
Aneurisma Aórtico/cirurgia , Arteriopatias Oclusivas/cirurgia , Aneurisma Ilíaco/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Aneurisma Aórtico/epidemiologia , Aneurisma Aórtico/mortalidade , Arteriopatias Oclusivas/epidemiologia , Arteriopatias Oclusivas/mortalidade , Feminino , Humanos , Aneurisma Ilíaco/etiologia , Aneurisma Ilíaco/mortalidade , Incidência , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Readmissão do Paciente , Retratamento , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/mortalidade , Infecção da Ferida Cirúrgica/terapia , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/mortalidade
13.
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
14.
Ann Vasc Surg ; 69: 452.e1-452.e4, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32634556

RESUMO

INTRODUCTION: A narrow distal aorta (NDA) makes endovascular aortic repair (EVAR) challenging and prone to immediate and late complications. We describe a case of an abdominal aortic false aneurysm (AAFA) with an NDA and iliac occlusive disease that was treated by an iliac branch device (IBD) placed at the aortic bifurcation. CASE REPORT: A 76-year-old male patient suffering from severe bilateral calf claudication presented to our clinic. He had a history of ischemic heart disease, diabetes mellitus, and left colectomy for colon cancer. His workup revealed an AAFA with severe iliac occlusive disease. His aortic lumen and his aortic bifurcation were very narrow (10 mm) precluding a classic bifurcated EVAR. An open repair was not possible because of his multiple comorbidities. We successfully used an IBD by placing its Y configuration at the level of the aortic bifurcation, bridging the branch into one iliac artery with a balloon-expandable covered stent and extending the main component proximally up to the renal arteries with an aortic cuff. CONCLUSIONS: Bifurcated EVAR may not be suitable in patients with an NDA. Using an IBD at the level of the aortic bifurcation is feasible. This technique offers a total endovascular solution in high-risk patients for open repair.


Assuntos
Falso Aneurisma/cirurgia , Angioplastia com Balão/instrumentação , Aneurisma da Aorta Abdominal/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Artéria Ilíaca/cirurgia , Stents , Idoso , Falso Aneurisma/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Arteriopatias Oclusivas/diagnóstico por imagem , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino , Desenho de Prótese , Resultado do Tratamento
16.
Ann Vasc Surg ; 68: 1-7, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32474143

RESUMO

BACKGROUND: The objective of this study was to compared outcomes of patients with aortoiliac occlusive disease (AIOD), limited to the common iliac artery, who underwent either aortoiliac thromboendarterectomy (AIE) or aortobiiliac bypass grafting (ABIB). METHODS: A single-center, retrospective analysis of consecutive patients with AIOD who underwent either AIE or ABIB between 2010 and 2019 from a prospective database. Patients with disease extending to the external iliac or common femoral arteries were excluded. Data collected included demographics, cardiovascular risk factors, indication for surgery, preoperative and postoperative ankle brachial indexes (ABIs), estimated blood loss, major adverse events (MAEs), and long-term patency. The study end point was clinical success, defined as improvement in ABIs with resolution of symptoms. MAEs included return to the operating room for any reason, postoperative myocardial infarction, stroke, pneumonia, or venous thromboembolism. RESULTS: Thirty-three patients, who met inclusion criteria, underwent repair for AIOD (AIE: 13; ABIB: 20) at our institution during this time. In both groups, there were more women than men (AIE: 11, ABIB: 10) with a mean age of 55 ± 7 years and 58 ± 6 years in the AIE and ABIB group, respectively. Indication for surgery included disabling claudication in 19 patients, ischemic rest pain in 13 patients, and tissue loss in one patient. No difference in cardiovascular risk factors or AIOD severity was noted between groups. Patients in the AIE group had slightly higher body mass index (30 ± 5 vs. 26 ± 6, P = 0.06). Two patients in each group required concomitant renal/mesenteric artery endarterectomy. One patient in the AIE group required bilateral femoral artery exposure and external iliac thrombectomy. MAEs (4 vs. 0) were higher in the ABIB group including, pneumonia in one patient, myocardial infarction in another, return to the operating room for evacuation of hematoma in the third and bypass graft thrombectomy with lower extremity angiography in the fourth patient. There were no differences in the intensive care unit or hospital length of stay between groups. Patients in both groups achieved return of normal ABI and complete resolution of their symptoms. At mean follow-up time of 43.4 ± 25.2 and 52.9 ± 35.4 months in the AIE and ABIB group, respectively, there was no symptomatic recurrence or need for reintervention while two patients in the ABIB group died of non-aortic-related issues. CONCLUSIONS: Both procedures were safe, effective, and conferred high long-term primary patency with no need for reintervention in patients with AIOD limited to the common iliac arteries.


Assuntos
Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular , Endarterectomia , Artéria Ilíaca/cirurgia , Adulto , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Endarterectomia/efeitos adversos , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
17.
Ann Vasc Surg ; 69: 450.e1-450.e5, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32534020

RESUMO

The middle aortic syndrome (MAS) is an uncommon clinical expression as a result of isolated stenosis or complete occlusion of the descending thoracic and/or abdominal aorta; Takayasu's arteritis (TA) is a rare vasculitis and a recognized etiology of MAS. We herein present the case of a 52-year-old woman with refractory renovascular hypertension and progressive bilateral lower extremity claudication; she had known history of TA. A computed tomography angiography demonstrated an aortic occlusive lesion compromising the origin of the celiac trunk, superior mesenteric, and bilateral renal arteries. The patient underwent a complex aortic reconstruction with visceral and renal vessels revascularization utilizing a back-table hand-crafted 4-branch Dacron graft through a left thoracoabdominal approach. The patient recovered uneventfully and was discharged on postoperative day 5, and at 36 months from her surgery, she remains symptoms-free and without antihypertensive agents.


Assuntos
Aorta/cirurgia , Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Artéria Celíaca/cirurgia , Artéria Mesentérica Superior/cirurgia , Polietilenotereftalatos , Artéria Renal/cirurgia , Arterite de Takayasu/complicações , Aorta/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/etiologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/etiologia , Artéria Celíaca/diagnóstico por imagem , Feminino , Humanos , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Desenho de Prótese , Artéria Renal/diagnóstico por imagem , Síndrome , Arterite de Takayasu/diagnóstico por imagem , Resultado do Tratamento
18.
Expert Rev Cardiovasc Ther ; 18(7): 395-404, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32544005

RESUMO

INTRODUCTION: Endovascular revascularization has become the preferred treatment for most patients with iliac artery obstructions, with a high rate of clinical and technical success. AREAS COVERED: This review will describe novel developments in the diagnosis and treatment of iliac artery obstructions including the augmentation of preprocedural imaging with advanced flow models, image fusion techniques, and state-of-the-art device-tracking capabilities. EXPERT OPINION: The combination of these developments will change the endovascular field within the next 5 years, allowing targeted iliac treatment without the need for radiographic imaging or iodinated contrast media.


Assuntos
Arteriopatias Oclusivas/cirurgia , Procedimentos Endovasculares/métodos , Artéria Ilíaca/cirurgia , Meios de Contraste , Humanos , Resultado do Tratamento
19.
Ann Vasc Surg ; 69: 27-33, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32599112

RESUMO

BACKGROUND: Up to 20% of patients requiring open supra-aortic trunk (SAT) reconstruction have significant carotid artery stenosis. The addition of carotid endarterectomy (CEA) to SAT has been described. Yet, additive risks are not well defined and controversy remains as to whether concomitant CEA increases stroke risk. This study assessed the perioperative effects of adding CEA to SAT. METHODS: Using the National Surgical Quality Improvement Program (NSQIP), patients who underwent SAT from 2005 to 2015 were evaluated. SAT + CEA were identified. An isolated SAT (ISAT) cohort was created by removing patients who underwent concurrent secondary procedures. Nonocclusive indications were excluded. SAT + CEA were compared with ISAT as well as a propensity-matched ISAT cohort. Primary outcomes were 30-day stroke, death, and composite stroke/death/myocardial infarction (SDM). Univariate and logistic regression analyses were performed. RESULTS: After review, 1,515 patients were identified: 1,245 ISAT (82%) and 270 SAT + CEA (18%). Most were women (56%), 86% were Caucasian, and 24% were symptomatic. Average age was 65 ± 12 years and SAT + CEA were older (69 vs. 64 years, P < 0.001). CEA + SAT were more likely to be men (53% vs. 42%, P < 0.001), have hypertension (86% vs. 75%, P < 0.001) and diabetes (26% vs. 20%, P = 0.04). SAT procedures included the following: carotid-subclavian bypass (68%), carotid-carotid bypass (16%), aorta-great vessel bypass (9%), and carotid-subclavian transposition (7%). ISAT were more likely to undergo carotid-subclavian bypass than SAT + CEA (71% vs. 54%, P < 0.001). Overall stroke was 2.3%, death 1.4%, and SDM 4.6%. There were no differences in 30-day stroke (ISAT 2.0% vs. SAT + CEA 3.7%, P = 0.09) or mortality (1.4% vs. 1.5%, P = 0.88). SAT + CEA had higher rates of SDM (7% vs. 4%, P = 0.03). On logistic regression, urgency was a predictor of SDM (operating room [OR] 3.6, 95% confidence interval [CI] 1.5-8.4, P = 0.003); addition of CEA was not predictive of stroke (OR 1.4, 95% CI 0.5-4.2, P = 0.52) or SDM (OR 1.5, 95% CI 0.6-3.6, P = 0.40). After propensity matching, there were no longer differences in demographics or primary end points between the 2 cohorts. CONCLUSIONS: Addition of CEA does not confer increased perioperative stroke or SDM risk over ISAT. Perioperative outcomes appear to be more affected by disseminated disease risk factors than the addition of CEA. In patients undergoing SAT, it is reasonable to consider performing combined CEA in populations with tandem carotid bifurcation disease and appropriate operative risk profile.


Assuntos
Arteriopatias Oclusivas/cirurgia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Procedimentos Cirúrgicos Reconstrutivos , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/mortalidade , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/mortalidade , Bases de Dados Factuais , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
20.
Sanid. mil ; 76(2): 71-73, abr.-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197386

RESUMO

La infección por el nuevo coronavirus SARS-COV-2 (COVID-19) y declarada pandemia mundial por la OMS, ha demostrado en algunos pacientes ser una enfermedad altamente trombogénica, tanto venosa como arterial, generando trombosis venosa profunda, embolismo pulmonar y cuadros de isquemia aguda, tanto en pacientes sin patología previa como con ellas. Se presentan cuatro casos de pacientes atendidos en el Hospital Gómez Ulla de Madrid durante la pandemia. Se compara su presentación clínica y evolución con otras series similares


The infection caused by the novel coronavirus SARS-COV-2 (COVID-19) which was declared global pandemic by the WHO has showed to be a highly thrombotic disease in some patients, presenting with venous and arterial complications such as deep vein thrombosis, pulmonary embolism and acute ischemia affecting patients with and without previous diseases. We describe four cases of COVID-19 patients treated in Gomez Ulla Hospital of Madrid during the pandemic. Clinical manifestations and outcome are compared with other similar series


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Isquemia , Arteriopatias Oclusivas/complicações , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Arteriopatias Oclusivas/cirurgia , Betacoronavirus/isolamento & purificação , Unidades de Terapia Intensiva , Amputação/métodos
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