Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.577
Filtrar
1.
J Comput Assist Tomogr ; 44(1): 20-25, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939877

RESUMO

OBJECTIVES: The purpose of this study was to evaluate whether quantitative analysis of lower leg muscle enhancement measured from dynamic computed tomographic angiography (dyn-CTA) could be used for diagnosis of peripheral arterial occlusive disease. METHODS: Patients (N = 35) with known peripheral arterial occlusive disease underwent the dyn-CTA of calves first. Five minutes later, standard CTA of the peripheral runoff from the diaphragm to the toes was performed. A runoff score was assigned by radiologists as a reference standard for each of 4 lower leg artery segments. The lower leg muscle enhancement measured from the dyn-CTA was analyzed by using quantitative kinetic parameters, including initial enhancement (E1), peak enhancement (Epeak), and enhancement ratio (ER) calculated from average time attenuation curves. In addition, histogram of lower leg muscle enhancement was evaluated by using the first enhanced phase images. RESULTS: Lower extremities were diagnosed as a normal group (n = 22) with each vessel segment score equals to 1 or lower and runoff score, 7 or lower, and otherwise as an ischemia group (n = 48). Average ± SD E1 is 91.4% ± 8.5% and 82.3% ± 10.7%, Epeak is 122.7% ± 10.4% and 115.6% ± 11.1%, and ER is 0.75 ± 0.05 and 0.72 ± 0.09 for normal and ischemia group, respectively. Statistical analysis showed that average E1 and Epeak for the ischemia group were significantly lower (P < 0.05) than the normal group. The histogram analysis demonstrated that mean and median of muscle enhancement in the ischemia group were significantly smaller (P < 0.05), and coefficient of variation (CV) was significantly larger (P < 0.05) than the normal group. There were weak negative correlations (r = -0.42, P < 0.05) between runoff scores and E1 and Epeak, and weak positive correlation (r = 0.40, P < 0.05) between runoff scores and CV. The receiver operating characteristics analysis between the 2 groups had area under the curve of 0.77 and 0.76 for E1 and CV, respectively. CONCLUSIONS: Lower leg muscle enhancement measured from the dyn-CTA could be assessed quantitatively to assist diagnosis of ischemia in clinical practice.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Extremidade Inferior/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação
2.
World Neurosurg ; 133: e522-e528, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31550537

RESUMO

OBJECTIVE: We aimed to compare flat detector computed tomography cerebral blood volume (FD-CBV) imaging to single-photon emission computed tomography (SPECT) as an adjunctive technique during balloon test occlusion (BTO) in patients with intracranial aneurysms or tumors. METHODS: Twelve patients who underwent SPECT (99mTc-ethyl cysteinate dimer) and FD-CBV imaging during BTO were enrolled. Color-coded cerebral blood flow (CBF) images and color-coded FD-CBV images were generated and visually inspected whether there were asymmetries between the ipsilateral and contralateral cerebral hemispheres. Region of interest measurements were performed on the color-coded images at the same locations for both modalities. The mean interhemispheric region of interest ratios were calculated, and the ratio between these were estimated using linear regression models. RESULTS: Ten patients had no symptoms during BTO. Two patients developed subtle but inconclusive neurologic changes approximately 10 minutes after balloon inflation; their images showed asymmetric color-coded images with decreased CBF and FD-CBV in the ipsilateral hemisphere. The mean interhemispheric ratio of CBF was significantly smaller in patients with subtle changes than in those without (0.84 vs. 0.98; P < 0.001). Similarly, the mean interhemispheric ratio of FD-CBV was significantly smaller in patients with subtle changes than in those without (0.88 vs. 1.06; P = 0.01). No patient showed increased CBF or FD-CBV in the ipsilateral hemisphere. CONCLUSIONS: The patients with decreased CBF on SPECT also showed decreased FD-CBV in the ipsilateral hemisphere. FD-CBV imaging may be useful as an adjunctive technique for BTO before potential therapeutic carotid artery occlusion.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Oclusão com Balão/métodos , Doenças das Artérias Carótidas/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Arteriopatias Oclusivas/cirurgia , Doenças das Artérias Carótidas/cirurgia , Circulação Cerebrovascular/fisiologia , Feminino , Humanos , Masculino , Neuroimagem/métodos
3.
Vasc Endovascular Surg ; 54(2): 102-110, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31746273

RESUMO

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


Assuntos
Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Artéria Femoral/cirurgia , Artéria Ilíaca/cirurgia , Idoso , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/economia , Doenças da Aorta/fisiopatologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/economia , Arteriopatias Oclusivas/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/economia , Implante de Prótese Vascular/instrumentação , Redução de Custos , Análise Custo-Benefício , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/economia , Procedimentos Endovasculares/instrumentação , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Custos de Cuidados de Saúde , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Portugal , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Stents , Fatores de Tempo , Resultado do Tratamento
4.
Ann Vasc Surg ; 62: 232-237, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31075465

RESUMO

BACKGROUND: Open surgery of abdominal aortic aneurysm (AAA) or aortoiliac occlusive disease (AIOD) sometimes requires left renal vein division (LRVD) to gain adequate exposure of the abdominal aorta. The aim of this study is to evaluate the effect of LRVD on the postoperative renal function using propensity score matching (PSM). METHODS: From July 1996 to January 2018, we retrospectively reviewed 698 patients who underwent open aortic surgery, including 543 AAAs and 155 AIODs, at a single institution. 66 patients (9.6%, 47 AAAs, 19 AIODs) needed LRVD during the operation. A 1:3 ratio PSM was used to control the selective bias between the LRVD and non-LRVD groups. We investigated preoperative and postoperative renal function including serum creatinine (sCr) level and estimated glomerular filtration rate (eGFR, mL/min/1.73 m2). Major complications, long-term renal function, and 30-day mortality were also compared. RESULTS: The LRVD group had a significantly higher rate of renal artery reconstruction (15.2% vs. 3.3%, P < 0.001) and suprarenal clamping (54.6% vs. 9.5%, P < 0.001) and higher incidence of juxtarenal AIOD (24.2% vs. 5.4%, P < 0.001). With PSM, 63 patients in the LRVD group and 144 patients in the non-LRVD group were enrolled in this study. The baseline characteristics were well balanced in the groups after PSM. There were no significant differences in preoperative eGFR (72.4 ± 21.3 vs. 76.1 ± 25.0, P = 0.306) and postoperative eGFR on day 3 (69.5 ± 26.6 vs. 77.5 ± 28.5, P = 0.065), day 7 (73.3 ± 24.8 vs. 78.5 ± 27.4, P = 0.264), and in the long-term follow-up period (69.0 ± 22.2 vs. 68.9 ± 27.1, P = 0.986, 50.2 month ± 45.50) in the 2 groups. Only the sCr level (1.40 ± 0.59 vs. 1.21 ± 0.62, P = 0.045) and eGFR (59.5 ± 23.9 vs. 71.4 ± 26.0, P = 0.002) were significantly worse on postoperative day 1 in the LRVD than in the non-LRVD group. There were no significant differences in 30-day mortality (1.6% vs. 1.6%, P = 1.00). CONCLUSIONS: The patients in the LVRD group underwent initial drop in renal function; however, eGFR improved during the follow-up period. There was no difference in renal function and postoperative mortality between LRVD and non-LRVD groups. Therefore, LRVD is a safe and durable procedure during complex abdominal aortic surgery.


Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Arteriopatias Oclusivas/cirurgia , Artéria Ilíaca/cirurgia , Veias Renais/cirurgia , Procedimentos Cirúrgicos Vasculares , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/fisiopatologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/mortalidade , Arteriopatias Oclusivas/fisiopatologia , Feminino , Taxa de Filtração Glomerular , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Recuperação de Função Fisiológica , Veias Renais/diagnóstico por imagem , Veias Renais/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
5.
Ann Vasc Surg ; 62: 21-29, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31201980

RESUMO

BACKGROUND: Endovascular therapy is first-line treatment for aortoiliac occlusive disease. This shift has altered case volume, patient selection, and risk profile for aortobifemoral bypass (ABF). Given this, we sought to investigate factors influencing morbidity and mortality after ABF in the endovascular era. METHODS: Data for patients undergoing primary ABF from 2000 to 2017 were queried. Primary endpoints included major complication (unplanned return to the operating room, life-or-limb-threatening complications, and 30-day readmission or death) and long-term survival. Logistic regression and Cox proportional hazard models determined predictors of primary endpoints. Kaplan-Meier analysis estimated patency, freedom from reintervention, and long-term survival. RESULTS: During these 17 years, 256 patients underwent primary ABF. Mean age was 67.9 ± 10.6 years and 51.2% were women. Most had claudication (69.5%); 28.9% had critical ischemia. Sixty-five (25.4%) patients had prior aortoiliac endovascular intervention, 106 (41.4%) required aortic cuff endarterectomy, 111 (43.3%) femoral outflow adjunct, 9 (3.5%) simultaneous lower extremity bypass, and 230 (89.8%) had Trans-Atlantic Inter-Society Consensus D lesions. Concomitant renovisceral revascularization was needed in 42 (16.4%) patients. Thirty-day mortality was 2.7%. Major complication occurred in 92 patients (35.9%). Predictors included prior endovascular intervention (odds ratio [OR], 2.2; 95% confidence interval [CI]: 1.2-4.1; P = 0.01), malignancy (OR, 2.6; 95% CI: 1.3-5.3; P = 0.01), intraoperative complication (OR, 3.3; 95% CI: 1.3-9.2; P = 0.03), operative blood loss, (OR, 1.0 per 100 ml; 95% CI: 1.0-1.0; P = 0.03), and cuff endarterectomy (OR, 1.8; 95% CI: 1.0-3.1; P = 0.04). Median follow-up was 5.3 years (interquartile range: 7.2 years). Survival at 1, 3, and 5 years was 94%, 90%, and 82% respectively. Primary patency and freedom from reintervention at 5 years were 76% and 79%, respectively. Predictors of late mortality included malignancy (hazard ratio [HR], 2.3; 95% CI: 1.3-3.9; P < 0.01), chronic obstructive pulmonary disease (HR, 1.8; 95% CI: 1.1-3.1; P = 0.02), congestive heart failure (HR, 2.3; 95% CI: 1.2-4.3; P = 0.01), Rutherford's class (HR, 1.5; 95% CI: 1.1-2.1; P = 0.01), operative blood loss (HR 1.0 per 100 ml; 95% CI: 1.0-1.0; P = 0.04) and chronic kidney disease (HR, 2.3; 95% CI: 1.2-4.2; P = 0.01). CONCLUSIONS: Although late outcomes after ABF in the contemporary era remain acceptable, major complications are frequent. Operative complexity and prior endovascular revascularization predict complications. Long-term survival is driven by degree of limb ischemia and comorbidities. These should be considered in selection for ABF, potentially modifying approach to improve outcomes.


Assuntos
Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Procedimentos Endovasculares/efeitos adversos , Artéria Femoral/cirurgia , Artéria Ilíaca/cirurgia , Enxerto Vascular/métodos , Idoso , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/mortalidade , Doenças da Aorta/fisiopatologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/mortalidade , Arteriopatias Oclusivas/fisiopatologia , Procedimentos Endovasculares/mortalidade , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Intervalo Livre de Progressão , Reoperação , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Enxerto Vascular/efeitos adversos , Enxerto Vascular/mortalidade , Grau de Desobstrução Vascular
6.
Rev Assoc Med Bras (1992) ; 65(11): 1368-1373, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31800899

RESUMO

OBJECTIVE: We aimed to investigate cardiac and extra-cardiac pathologies in patients who were operated for acute arterial occlusion. METHODS: Between March 2010 and March 2018, a total of 120 patients who underwent surgical treatment for acute arterial occlusion were included in this retrospective study. RESULTS: 84 (70%) and 27 (22. 5%) of the patients had cardiac and extra-cardiac pathologies, respectively. In 9 (7. 5%) of the cases, no reason for arterial occlusion could be found. Pure atrial fibrillation was found in 39 (32. 5%) patients. Atrial fibrillation and cardiac valvular pathologies were detected in 45 patients (37. 5%). Among those with a cardiac valvular pathology, 9 patients (7. 5%) had pure mitral stenosis, 21 patients (17. 5%) had moderate to advanced mitral stenosis with tricuspid regurgitation, 9 patients (7. 5%) had 20-30 mitral regurgitation with 30 tricuspid regurgitation, 3 patients (2. 5%) had moderate mitral stenosis, 30-40 tricuspid regurgitation and 20-30 aortic stenosis, and 3 patients (2. 5%) had 30 mitral regurgitation, 10- 20 tricuspid regurgitation, calcific moderate aortic stenosis, and coronary artery disease. Among those 27 patients with an extra-cardiac pathology, 21 patients (22. 5%) had peripheral artery disease, 3 patients (2.5%) had an abdominal aortic aneurysm, and 3 patients (2. 5%) had Behçet's Disease. CONCLUSION: Cardiac and extra-cardiac pathologies should be kept in mind in patients with acute arterial occlusion. Thus, detected pathologies could be treated, and the development of additional peripheral emboli could be prevented.


Assuntos
Arteriopatias Oclusivas/complicações , Doença Aguda , Adulto , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
7.
Clin Nucl Med ; 44(12): 966-968, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31689278

RESUMO

Our patient was a 72-year-old man with absent activity of the right femoral artery and mildly decreased Tc-DPD activity on the right leg as indicated on the blood pool and delayed images, respectively. Subsequent peripheral angiography revealed a total occlusion of the right external iliac artery with good collateral flow. Careful review of blood flow and blood pool images of 3-phase bone scintigraphy could provide additional information about peripheral vascular disease.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Osso e Ossos/diagnóstico por imagem , Artéria Ilíaca/diagnóstico por imagem , Idoso , Angiografia , Arteriopatias Oclusivas/patologia , Humanos , Artéria Ilíaca/patologia , Masculino , Cintilografia
8.
Vasc Med ; 24(5): 455-460, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31543059

RESUMO

Functional popliteal artery entrapment syndrome (FPAES) presents a challenge for clinicians in the field today. The relative rarity of the disease coupled with its affliction primarily in young, athletic individuals makes it a difficult condition to diagnose. Treatment modalities have been limited to surgical intervention, with more novel methods being developed over the last several years. We present a case report and review the diagnostic and management approaches for FPAES, shedding light on proposed future interventions.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/terapia , Artéria Poplítea/diagnóstico por imagem , Arteriopatias Oclusivas/epidemiologia , Arteriopatias Oclusivas/fisiopatologia , Constrição Patológica , Humanos , Artéria Poplítea/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco
9.
BMJ Case Rep ; 12(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31519720

RESUMO

A 56-year-old truck driver with a history of tobacco use presented with acute onset digital ischaemia in the ulnar distribution of his dominant hand, associated with severe pain. Occupational exposures included extensive manual labour and prolonged vibratory stimuli. Workup with Doppler and angiography confirmed the diagnosis of hypothenar hammer syndrome (HHS). After the failure of medical management, he underwent ulnar artery thrombectomy with reconstruction and arterial bypass grafting. His pain improved significantly postsurgically, and he was able to return to a normal routine. This case illustrates the classic presentation, examination, imaging findings and management options of HHS. HHS should be considered in patients with digital ischaemia and associated occupational exposures. Diagnosing the condition appropriately allows for optimal management, aiming at minimising symptoms and maximising quality of life.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Dedos/irrigação sanguínea , Síndrome da Vibração do Segmento Mão-Braço/diagnóstico por imagem , Artéria Ulnar/lesões , Angiografia/métodos , Arteriopatias Oclusivas/etiologia , Diagnóstico Diferencial , Dedos/patologia , Síndrome da Vibração do Segmento Mão-Braço/etiologia , Humanos , Isquemia/diagnóstico , Isquemia/fisiopatologia , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Síndrome , Trombectomia/métodos , Resultado do Tratamento , Artéria Ulnar/patologia , Artéria Ulnar/cirurgia , Ultrassonografia Doppler/métodos , Enxerto Vascular/métodos
11.
J Stroke Cerebrovasc Dis ; 28(11): 104291, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31445856

RESUMO

We report 2 patients with acute occlusion of middle cerebral artery successfully treated by mechanical thrombectomy performed via transbrachial access. Both patients had floating aortic arch thrombi precluding safe transfemoral access due to risk of further iatrogenic embolization. Moreover both patients were diagnosed with hypercoagulopathy secondary to lung malignancy (paraneoplastic etiology, Trousseau's syndrome) as the cause of both aortic thrombi and acute ischemic stroke. Mechanical thrombectomy in the setting of a floating aortic thrombus has been mentioned only once as part of general management of floating aortic thrombi in the whole body. To the best of our knowledge, it has never been described previously in the literature in the context of cerebral mechanical thrombectomy technique. However, the diagnosis of this entity bears clinical importance for it can modify the treatment approach. A modified transbrachial approach allowed us to treat both patients without neurologic complications and resulted in modified Rankin scores of 1 on follow-up. We advise that the cross-sectional imaging of acute stroke patients should include an evaluation of the aortic arch and should be scrutinized in detail especially in patients with possible hypercoagulable state. Flat panel computed tomography technology allowed us to obtain such an imaging study in the angiography suite.


Assuntos
Doenças da Aorta/complicações , Arteriopatias Oclusivas/complicações , Isquemia Encefálica/terapia , Trombose Intracraniana/terapia , Acidente Vascular Cerebral/terapia , Trombectomia/métodos , Doenças da Aorta/diagnóstico por imagem , Arteriopatias Oclusivas/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
12.
J Vasc Res ; 56(5): 217-229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31272099

RESUMO

Reduced lower-limb blood flow has been shown to lead to asymmetrical abdominal aortic aneurysms (AAAs) but the mechanism of action is not fully understood. Therefore, small animal ultrasound (Vevo2100, FUJIFILM VisualSonics) was used to longitudinally study mice that underwent standard porcine pancreatic elastase (PPE) infusion (n = 5), and PPE infusion with modified 20% iliac artery stenosis in the left (n = 4) and right (n = 5) iliac arteries. Human AAA computed tomography images were obtained from patients with normal (n = 9) or stenosed left (n = 2), right (n = 1), and bilateral (n = 1) iliac arteries. We observed rapid early growth and rightward expansion (8/9 mice) in the modified PPE groups (p < 0.05), leading to slightly larger and asymmetric AAAs compared to the standard PPE group. Further examination showed a significant increase in TGFß1 (p < 0.05) and cellular infiltration (p < 0.05) in the modified PPE group versus standard PPE mice. Congruent, yet variable, observations were made in human AAA patients with reduced iliac outflow compared to those with normal iliac outflow. Our results suggest that arterial stenosis at the time of aneurysm induction leads to faster AAA growth with aneurysm asymmetry and increased vascular inflammation after 8 weeks, indicating that moderate iliac stenosis may have upstream effects on AAA progression.


Assuntos
Aneurisma da Aorta Abdominal/etiologia , Arteriopatias Oclusivas/complicações , Artéria Ilíaca , Animais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/metabolismo , Aneurisma da Aorta Abdominal/fisiopatologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Constrição Patológica , Modelos Animais de Doenças , Progressão da Doença , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Interleucina-6/metabolismo , Masculino , Camundongos Endogâmicos C57BL , Elastase Pancreática , Fluxo Sanguíneo Regional , Fatores de Risco , Fatores de Tempo , Fator de Crescimento Transformador beta1/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo
13.
Medicine (Baltimore) ; 98(29): e16503, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335720

RESUMO

RATIONALE: Total knee arthroplasty (TKA) is a globally well-accepted surgery because of its good outcome and safety. Although TKA-associated arterial injuries occur, postoperative anterior tibial artery (ATA) occlusion has not been reported yet. Herein, we present a case of ATA occlusion after TKA. PATIENT CONCERNS: A 42-year-old man with a 6-year history of right knee pain after right patella fracture treated with open reduction was referred to our clinic. Valgus and contracture deformities were detected in the right knee. Severe osteoarthritis (OA) in the right knee and multiple osteochondromas were observed on radiography. DIAGNOSIS: On the basis of clinical and imaging findings, the patient was diagnosed with OA and multiple osteochondromas. INTERVENTIONS: TKA was performed in the right knee and the osteochondromas were resected. ATA occlusion was found postoperatively and was treated conservatively. OUTCOMES: Although the right ATA occlusion did not resolve, the patient recovered well postoperatively, with pain relief and recovery of right knee range of motion. LESSONS: The clinical outcome in a case of ATA occlusion after TKA demonstrates that conservative treatment could be appropriate in this context.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Artroplastia do Joelho/efeitos adversos , Artérias da Tíbia/diagnóstico por imagem , Adulto , Anticoagulantes/uso terapêutico , Arteriopatias Oclusivas/tratamento farmacológico , Humanos , Masculino , Osteoartrite do Joelho/cirurgia , Osteocondrose/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem
15.
Turk Kardiyol Dern Ars ; 47(5): 399-405, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31311900

RESUMO

Transaxillary access is an alternative to femoral access in patients with iliofemoral occlusion for transcatheter aortic valve implantation (TAVI). A Multilayer Flow Modulator (MLFM) stent is frequently used in patients with a complex thoracic and abdominal aortic aneurysm. The MLFM stent is particularly used in cases where large arteries, such as the renal or celiac artery, feed from the aneurysmal sac. To the best of our knowledge, there is no prior report in the literature of a TAVI case with a pre-existing MLFM stent. Presently described are 2 TAVI cases, one with thoracoabdominal MLFM stents, and the second with occluded bilateral carotid and iliac arteries.


Assuntos
Arteriopatias Oclusivas , Artéria Axilar/cirurgia , Cateterismo Cardíaco/métodos , Stents , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Aneurisma da Aorta Abdominal/cirurgia , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino
18.
Diagn Interv Radiol ; 25(4): 320-327, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31231068

RESUMO

PURPOSE: We aimed to assess the technical success of the combined percutaneous direct puncture of occluded artery - antegrade intervention technique, as well as the clinical effectiveness of treatment, on the basis of changes in the Rutherford classification. METHODS: Between June 2015 and July 2018, 441 patients underwent endovascular recanalization due to lower limb peripheral arterial disease at our center. Of these, 18 patients (4%; 15 males, 3 females; mean age, 63.2 years) had failed antegrade recanalization and percutaneous retrograde access because of long segment occlusion, arterial rupture or dissection. Combined percutaneous direct puncture of occluded artery and antegrade approach was applied to these patients. Clinical follow-up examinations were performed at 1 month, 3 months, 6 months, and annually thereafter. RESULTS: The mean follow-up period was 22.8±10.9 months. The mean procedure time was 93.6±28.2 min. Technical success was achieved in 14 patients (78%). Complete restoration of arterial flow in the punctured vessel could not be achieved in 4 patients (22%). Minor complications occurred in 4 of 18 procedures (22%). Amputation-free survival and limb salvage rates (83.3% and 100%, respectively) were the same for 12 and 24 months. CONCLUSION: Technical success in lower limb peripheral arterial disease may be improved with the use of a combined percutaneous direct puncture of occluded artery - antegrade intervention, particularly for patients in whom other techniques are not a viable option.


Assuntos
Procedimentos Endovasculares/métodos , Doença Arterial Periférica/terapia , Punções/instrumentação , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/terapia , Terapia Combinada/métodos , Feminino , Fluoroscopia/métodos , Seguimentos , Humanos , Salvamento de Membro/estatística & dados numéricos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Punções/tendências , Estudos Retrospectivos , Artérias da Tíbia/patologia , Resultado do Tratamento , Ultrassonografia Doppler em Cores/métodos , Grau de Desobstrução Vascular
19.
J Stroke Cerebrovasc Dis ; 28(9): e135-e138, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31253482

RESUMO

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by chronic thrombi in the pulmonary arteries, causing pulmonary hypertension and right heart failure. Early and accurate diagnosis are essential for successful treatment but are often difficult because clinical signs and symptoms can be nonspecific and risk factors, such as history of venous thromboembolism, may not always be present. Here, we report a case involving a 76-year-old woman who demonstrated paradoxical cerebral embolism as the initial manifestation of CTEPH. She developed right hemiplegia without dyspnea or edema. Brain magnetic resonance imaging revealed multiple fresh infarctions, while transesophageal echocardiography revealed a patent foramen ovale. Based on these findings, she was diagnosed as having paradoxical cerebral embolism. During the search for the embolic source, right heart catheterization showed significant pulmonary hypertension and pulmonary angiography revealed chronic thrombi in the peripheral pulmonary arteries, consistent with a diagnosis of CTEPH. To our knowledge, this is the first case of CTEPH to be diagnosed with the onset of paradoxical cerebral embolism. Because CTEPH is the only potentially curable form of pulmonary hypertension, clinicians should consider paradoxical cerebral embolism as a possible initial manifestation of CTEPH.


Assuntos
Arteriopatias Oclusivas/complicações , Embolia Paradoxal/etiologia , Hipertensão Pulmonar/etiologia , Embolia Intracraniana/etiologia , Trombose/complicações , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Doença Crônica , Angiografia por Tomografia Computadorizada , Imagem de Difusão por Ressonância Magnética , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico por imagem , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Embolia Intracraniana/diagnóstico por imagem , Trombose/diagnóstico por imagem
20.
Ann Vasc Surg ; 60: 477.e15-477.e19, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200033

RESUMO

Acute aortic occlusion is a rare but potentially devastating clinical event, which requires a prompt diagnosis and emergency treatment. Only 5 cases of native thoracic aorta acute occlusion have so far been reported with different pathologic causes. The clinical features depend on the level of occlusion. Sometimes the diagnosis could be misinterpreted as a stroke or other diseases of the central nervous system. This could lead to a delay in the diagnosis and revascularization procedure, followed by a morbidity or mortality increase. Open surgery has been considered the first-line approach. This study is of a female patient suffering from acute descending thoracic aorta occlusion undergoing, for the first time to our knowledge, endovascular surgical treatment.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Trombose/cirurgia , Doença Aguda , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , Stents , Trombose/diagnóstico por imagem , Trombose/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA