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2.
J Med Vasc ; 44(5): 311-317, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31474340

RESUMO

INTRODUCTION: Chronic inflammatory diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), are accompanied by high cardiovascular morbidity and mortality secondary to accelerated and premature atherosclerosis. Atherosclerosis is correlated with chronic systemic inflammation independently of the factors for cardiovascular risk. Vasculitis of large arteries such as Takayasu's disease, are characterized both by chronic systemic inflammation and local parietal vascular inflammation. METHODS: We prospectively analyzed in a case-control study, a group of 64 carriers of Takayasu's arteritis patients with a mean age of 41 years [±11.94], a group of 50 RA female patients aged 45 years [±10.27], and a control group with an average age of 44 years [±12.63]. We recorded classic cardiovascular risk factors and used the Framingham equation to calculate the risk. We measured the intima-media thickness (IMT) in the carotids and noted the presence of carotid, aortic and femoral atheroma. RESULTS: The mean calculated cardiovascular risk was 3.5 % in the Takayasu's group. It was 4.4 % in the RA group, and 4.5 % in controls with no significant difference between the three groups (P=0.153). Subclinical atherosclerosis defined by IMT> 0.70mm and/or the presence of atheroma plaque was found in 87 % of Takayasu's patients versus 76 % of RA patients, (P=0.088) and 48 % of controls (P<0.001). Most atherosclerotic plaques were found in the Takayasu group. Compared to the control group the carotid intima-media thickness was significantly higher in the Takayasu group. The average IMT in the Takayasu group was 0.91mm [±0.368], 0.76mm [±0.151] for the PR group, and 0.71mm [±0.141] for controls. DISCUSSION: Atherosclerosis observed in Takayasu's disease was accelerated and premature, occurring in young patients with a low overall cardiovascular risk. Recent data support the central role of inflammation in all stages of atherogenesis from endothelial dysfunction to plaque rupture. Systemic inflammation associated with local parietal inflammation observed in Takayasu's arteritis, appears to be responsible for accelerated and premature atherosclerosis. The results of our study and the literature review favor an active strategy for cardiovascular prevention in Takayasu's disease.


Assuntos
Doenças da Aorta/epidemiologia , Doenças das Artérias Carótidas/epidemiologia , Doença Arterial Periférica/epidemiologia , Arterite de Takayasu/epidemiologia , Adulto , Idade de Início , Doenças da Aorta/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Placa Aterosclerótica , Prevalência , Estudos Prospectivos , Fatores de Risco , Arterite de Takayasu/diagnóstico , Fatores de Tempo
4.
Int J Cardiovasc Imaging ; 35(9): 1745-1753, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31312997

RESUMO

No data exist whether statins have robust anti-inflammatory effects of atherosclerotic plaques primarily during the early treatment period or continuously throughout use. This prospective three time point 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) study of the carotid artery assessed anti-inflammatory effects of statin during the early treatment period (initiation to 3 months) and late treatment period (3 months to 1 year) and their correlation with lipid and inflammatory profile changes during a year of therapy. Nine statin-naïve stable angina patients with inflammatory carotid plaques received 20 mg/day atorvastatin after undergoing initial 18F-FDG PET/CT scanning of carotid arteries and ascending thoracic aorta, and then completed serial 18F-FDG PET/CT imaging at 3 and 12 months whose data were analyzed. The primary outcome was the inter-scan percent change in target-to-background ratio (ΔTBR) within the index vessel. At 3 months of atorvastatin treatment, mean serum low-density lipoprotein cholesterol (LDL-C) level decreased by 36.4% to < 70 mg/dL (p = 0.001) and mean serum high-density lipoprotein cholesterol level increased to > 40 mg/dL (p = 0.041), with both maintained with no further reduction up to 1 year (p = 0.516 and 0.715, respectively) while mean serum high sensitivity C-reactive protein level only numerically decreased (p = 0.093). The index vessel ΔTBR showed continuous plaque inflammation reduction over 1 year, by 4.4% (p = 0.015) from the initiation to 3rd months and 6.2% (p = 0.009) from 3rd months to 1 year, respectively, without correlation with lipid profile changes. The ΔTBR of the bilateral carotid arteries and ascending aorta also continuously decreased from 3 months to 1 year. Three time point 18F-FDG PET/CT imaging demonstrates that statin's anti-inflammatory effect continues throughout its use up to 1 year, even though yielding stable below-target plasma LDL-C levels at 3 months.


Assuntos
Anti-Inflamatórios/uso terapêutico , Aorta Torácica/efeitos dos fármacos , Doenças da Aorta/tratamento farmacológico , Aterosclerose/tratamento farmacológico , Artérias Carótidas/efeitos dos fármacos , Doenças das Artérias Carótidas/tratamento farmacológico , Fluordesoxiglucose F18/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/administração & dosagem , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/patologia , Aterosclerose/diagnóstico por imagem , Aterosclerose/patologia , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/patologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/patologia , LDL-Colesterol/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(29): e16486, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335713

RESUMO

RATIONALE: Esophageal foreign body is a commonly seen in China. However, pseudoaneurysm of the aortic arch caused by ingestion of fish bones is a rare, life-threatening condition. PATIENT CONCERNS: A 71-year-old male was admitted to the Ear, Nose, and Throat department with a 4-day history of chest pain after eating fish. DIAGNOSES: After taking out the fish bone by rigid endoscopy, magnetic resonance imaging and computerized tomography angiography (CTA) scans revealed the presence of an aortic arch pseudoaneurysm, which was likely caused by the fish bone. INTERVENTIONS: A successful endovascular graft exclusion surgery was performed to block the aorta ulcer. OUTCOMES: The patient recovered and was discharged 20 days after hospitalization. The patient was healthy and had no fever or chest pain 4 months after discharge from the hospital. LESSONS: Esophageal foreign bodies may lead to life-threatening impairment of the aorta or other big arteries. When esophageal foreign bodies puncture the esophageal wall, especially in the second stenosis of the esophagus, an enhanced-contrast computed tomography scan or a CTA scan may be necessary to exclude any potential impairment of the arteries.


Assuntos
Falso Aneurisma/etiologia , Aorta Torácica , Doenças da Aorta/etiologia , Esôfago/lesões , Corpos Estranhos/complicações , Alimentos Marinhos/efeitos adversos , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Animais , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Osso e Ossos , Esofagoscopia , Esôfago/diagnóstico por imagem , Esôfago/cirurgia , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X
6.
Int J Cardiovasc Imaging ; 35(10): 1903-1911, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31209684

RESUMO

Familial hypercholesterolemia (FH) is an autosomal dominant disorder that affects 1 in 250 people. Aortic stiffness, measured by pulse wave velocity (PWV), is an independent predictor for cardiovascular events. Young FH patients are a unique group with early vessel wall disease that may serve to elucidate the determinants of aortic stiffness. We hypothesized that young FH patients would have early changes in aortic stiffness compared to healthy, age- and sex-matched reference values. Thirty-three FH patients ( ≥ 7 years age; mean age 14.6 ± 3.3 years; 26/33 on statin therapy) underwent cardiac MRI. PWV was determined using propagation of flow waveform from aortic arch phase contrast images. Distensibility and aortic wall thickness (AWT) were measured at the ascending, proximal descending, and diaphragmatic aorta. Ventricular volumes and left ventricular (LV) myocardial mass were measured from 2D cine images. These parameters were compared to age- and sex-matched reference values. FH patients had significantly higher PWV (4.5 ± 0.8 vs. 3.5 ± 0.3 m/s; p < 0.001), aortic distensibility, and ascending aortic wall thickness (1.37 ± 0.18 vs. 1.30 ± 0.02 mm; p < 0.05) compared to reference. There was no difference in aortic area or descending aortic wall thickness between groups. Young FH patients had aortic changes with increased aortic pulse wave velocity in the setting of increased aortic distensibility, accompanied by increased thickness of the ascending aortic wall. Presence of these early findings in young patients despite the majority being on statin therapy support enhanced screening and aggressive treatment of familial hypercholesterolemia to prevent potential future cardiovascular events.


Assuntos
Aorta/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Aterosclerose/diagnóstico por imagem , Hiperlipoproteinemia Tipo II/complicações , Imagem Cinética por Ressonância Magnética , Análise de Onda de Pulso , Rigidez Vascular , Adolescente , Fatores Etários , Aorta/fisiopatologia , Doenças da Aorta/etiologia , Doenças da Aorta/fisiopatologia , Doenças da Aorta/prevenção & controle , Aterosclerose/etiologia , Aterosclerose/fisiopatologia , Aterosclerose/prevenção & controle , Estudos de Casos e Controles , Criança , Estudos Transversais , Progressão da Doença , Feminino , Predisposição Genética para Doença , Heterozigoto , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Hiperlipoproteinemia Tipo II/genética , Masculino , Fenótipo , Placa Aterosclerótica , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Remodelação Vascular
7.
Ann Vasc Surg ; 59: 307.e7-307.e12, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31075448

RESUMO

Thoracic aortic thrombus is a rare condition that can be a significant source of distal embolic events. This study details experience on the use of an endovascular technique for the management of thoracic aortic thrombus with a stent graft in 5 cases. Four of the cases were diagnosed with aortic arch thrombus, and 1 was diagnosed with distal descending aortic thrombus. All patients were females with age ranging from 44 to 71 years. Arterial embolism was the main clinical finding in most cases, which involved the upper extremities (n = 1) and cerebral embolism (n = 3), while 1 patient was asymptomatic. All 5 surgeries were considered technically successful with 0 perioperative all-cause mortality. Patients were discharged in a stable condition and were prescribed anticoagulant and antiplatelet medications. During follow-up visits, there were no instances of stent-graft failure or collapse, leak, or distal migration. Furthermore, there was complete resolution of the intraluminal thrombus, and all patients were asymptomatic.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Trombose/cirurgia , Adulto , Idoso , Anticoagulantes/administração & dosagem , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Aortografia/métodos , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/administração & dosagem , Estudos Retrospectivos , Stents , Trombose/diagnóstico por imagem , Trombose/fisiopatologia , Resultado do Tratamento
8.
Rev Port Cir Cardiotorac Vasc ; 26(1): 19-26, 2019.
Artigo em Português | MEDLINE | ID: mdl-31104372

RESUMO

Aortic mural thrombus is a rare clinical finding in the absence of aneurysm or atherosclerosis but an important source of noncardiogenic emboli with a difficult diagnosis and a high rate of complications, including high mortality. It appears to occur more frequently in young adults usually with underlying pro-thrombotic disorder. With the increasing use of high resolution imaging, the asymptomatic mural thrombus became an increasingly frequent finding, but its potential for embolization or the best treatment are still a matter of debate. The management of mural thrombus in non-atherosclerotic aorta represents a challenge because no guidelines are available, and should be individualized. The therapeutic approach should include the triple aspects of aortic mural thrombus: primary disease anticoagulation treatment, surgical thrombectomy to solve embolic complications and endovascular/classical surgery to exclude the thrombus from the aorta. Historically therapeutic anticoagulation was proposed as first-line therapy and surgical intervention was reserved for mobile thrombus, recurrent embolism and contraindication for anticoagulation. However, it is associated with a 25-50% embolic recurrence rate, thrombus persistence in 35% and secondary aortic surgery in up to 31% of the cases. Recent data suggest that endovascular coverage of the aortic thrombus, when feasible, appears to be an effective and safe procedure with a low recurrence and re-embolization rates. In this article we review the published literature concerning this topic.


Assuntos
Doenças da Aorta/terapia , Trombose/terapia , Anticoagulantes/uso terapêutico , Aorta/diagnóstico por imagem , Aorta/cirurgia , Doenças da Aorta/diagnóstico por imagem , Procedimentos Endovasculares , Humanos , Fatores de Risco , Trombectomia , Trombose/diagnóstico por imagem , Resultado do Tratamento
10.
Ann Vasc Surg ; 59: 313.e11-313.e17, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009719

RESUMO

Percutaneous angioplasty and stenting is nowadays the treatment of choice for atherosclerotic stenotic lesions of the supraaortic trunks. Stent migration is a seldom published complication that can alter the short-term results of these procedures. Herein, we report three cases, from three different institutions, of secondary autoexpandable stent migration, after endovascular treatment of major arch vessel stenosis, and their subsequent endovascular management using three different retrieval techniques. Technical success was achieved in all cases. There were no immediate complications related to the retrieval of the migrated stents. A late complication of iliac thrombosis required complementary surgical intervention. Percutaneous retrieval of migrated self-expanding stents is feasible and can be effectively performed with few complications as a first-line option.


Assuntos
Angioplastia com Balão/efeitos adversos , Aorta Torácica , Doenças da Aorta/terapia , Remoção de Dispositivo/métodos , Migração de Corpo Estranho/terapia , Stents , Idoso , Angioplastia com Balão/instrumentação , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Constrição Patológica , Remoção de Dispositivo/instrumentação , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Dispositivos de Acesso Vascular
11.
J Stroke Cerebrovasc Dis ; 28(6): 1586-1596, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30928215

RESUMO

BACKGROUND: Complex aortic plaque is a potential cause of acute ischemic cerebrovascular disease, which needs timely identification. Also as a marker for systemic atherosclerosis, complex aortic plaque may be indicated by significant (≥50%) cervicocephalic atherosclerotic stenosis. We aimed at examining whether age ranges would influence their association to more accurately estimate the risk of having complex aortic plaque in acute ischemic cerebrovascular disease. METHODS: Aortic arch and cervicocephalic arteries were simultaneously evaluated using computed tomography angiography. Middle-aged (45-64 years) and old-aged (65-85 years) acute ischemic cerebrovascular disease patients were divided into 2 groups according to whether there was an aortic arch plaque with thickness of greater than or equal to 4 mm or associated ulcerations or mural thrombus. RESULTS: Old-aged patients (n = 107) had a higher prevalence of complex aortic plaque (67.3% versus 30.9%, P < .001) than those middle aged (n = 178). Among middle-aged patients, the presence of extracranial significant atherosclerotic stenosis (adjusted odd ratio = 2.89, 95% confidence interval: 1.42-5.86) rather than intracranial ones independently predicted complex aortic plaque. Regarding the extent of significant cervicocephalic atherosclerotic stenosis, the presence of multi-segment, bilateral, simultaneous extracranial and intracranial, and simultaneous anterior and posterior circulation ones were independent indicators for complex aortic plaque in the middle-aged subgroup (adjusted odd ratio = 2.42, 2.05, 2.26, 2.14, respectively). By contrast, no statistical correlation of complex aortic plaque and significant cervicocephalic atherosclerotic stenosis was found among old-aged patients. CONCLUSION: Considering the ranges of age was important to more precisely predict complex aortic plaque with significant cervicocephalic atherosclerotic stenosis in acute ischemic cerebrovascular disease.


Assuntos
Aorta Torácica/patologia , Doenças da Aorta/epidemiologia , Aterosclerose/epidemiologia , Isquemia Encefálica/epidemiologia , Artérias Carótidas/patologia , Doenças das Artérias Carótidas/epidemiologia , Artérias Cerebrais/patologia , Arteriosclerose Intracraniana/epidemiologia , Placa Aterosclerótica , Acidente Vascular Cerebral/epidemiologia , Artéria Vertebral/patologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/patologia , Aortografia/métodos , Aterosclerose/diagnóstico por imagem , Aterosclerose/patologia , Isquemia Encefálica/diagnóstico , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/patologia , Artérias Cerebrais/diagnóstico por imagem , China/epidemiologia , Angiografia por Tomografia Computadorizada , Estudos Transversais , Feminino , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Dados Preliminares , Prevalência , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Artéria Vertebral/diagnóstico por imagem
12.
Ann Vasc Surg ; 59: 143-149, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30954589

RESUMO

BACKGROUND: Perioperative stroke is a major complication after debranching thoracic endovascular aortic repair (TEVAR), with a reported incidence of 7.0-26.9%. Subsequent functional recovery is difficult in most cases. This study was performed to evaluate the efficacy of mini-cardiopulmonary bypass (mini-CPB) support in debranching TEVAR to prevent perioperative stroke. METHODS: From December 2010 to July 2017, 32 patients with a shaggy aorta or intimal irregularity in the aortic arch identified on preoperative computed tomography underwent debranching TEVAR. Nineteen patients underwent debranching TEVAR without mini-CPB, and 13 patients underwent debranching TEVAR with a mini-CPB support. Mini-CPB support had been used in November 2014 to treat perioperative stroke, which had occurred in 8 (42%) patients at that time. The form of the debranching arch vessels was not changed; bypass from the right axillary artery to the left axillary artery was performed for one debranching, and bypass from the right axillary artery to the left common carotid artery and left axillary artery was performed for two debranchings. After establishment of mini-CPB support through this debranching graft and right femoral vein cannulation, all endovascular manipulations were initiated. The left subclavian artery was occluded with a plug at the end of the procedure. RESULTS: The proximal landing zones of the endoprosthesis were as follows: zone 0 in 9 patients, zone 1 in 5 patients, and zone 2 in 5 patients in the no-CPB era and zone 1 in 3 patients and zone 2 in 10 patients in the CPB era. The mean mini-CPB support period was 51 minutes. Postoperative respiratory support and hospitalization were not prolonged with mini-CPB support. The incidence of perioperative stroke was 42% in the no-CPB era and 8% in the CPB era. No operative mortality was observed in the CPB era, although 5 (26%) patients died in the no-CPB era. The cause of operative mortality in the no-CPB era was perioperative stroke in 4 patients and acute myocardial infarction in 1 patient. No significant difference in the cumulative survival rate was found between patients with and without mini-CPB support. CONCLUSIONS: Our mini-CPB system may have the potential to prevent perioperative stroke during debranching TEVAR for treatment of aortic arch pathologies.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/métodos , Ponte Cardiopulmonar/métodos , Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/mortalidade , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/mortalidade , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Fatores de Proteção , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(10): e14489, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855435

RESUMO

We hypothesized that circulating osteoprotegerin (OPG) and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) levels could be associated with vascular calcification, which is predominant in diabetes.The study included 71 Korean participants (36 with diabetes and 35 without diabetes), who were sub-grouped according to the results of the ankle-brachial index (ABI) and/or X-ray computed tomography scan (CT scan). Serum OPG and TRAIL levels were assayed using the respective enzyme-linked immunosorbent assay kits. Statistical significance was analyzed using Student's t test between the 2 groups or analysis of variance (ANOVA) among the 4 groups.Serum OPG was up-regulated in the participants with diabetes, with peripheral arterial disease (PAD), and/or with vascular calcification. TRAIL down-regulation was more strictly controlled than OPG up-regulation; it was significantly downregulated in the participants with PAD and vascular calcification, but not in the participants with diabetes. Serum OPG and TRAIL were regulated in the participants with femoral, popliteal, and peroneal artery calcification but not in the participants with aortic calcification.OPG up-regulation and TRAIL down-regulation were found to be associated with leg lesional vascular calcification; therefore, the average OPG/TRAIL ratio was significantly increased by 3.2-fold in the leg lesional vascular calcification group.


Assuntos
Osteoprotegerina/sangue , Doença Arterial Periférica/sangue , Ligante Indutor de Apoptose Relacionado a TNF/sangue , Calcificação Vascular/sangue , Doenças da Aorta/sangue , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Biomarcadores/sangue , Complicações do Diabetes/sangue , Complicações do Diabetes/diagnóstico por imagem , Humanos , Perna (Membro) , Doença Arterial Periférica/complicações , Doença Arterial Periférica/diagnóstico por imagem , Calcificação Vascular/complicações , Calcificação Vascular/diagnóstico por imagem
15.
Dtsch Med Wochenschr ; 144(7): 484-488, 2019 04.
Artigo em Alemão | MEDLINE | ID: mdl-30925605

RESUMO

HISTORY AND CLINICAL FINDINGS: A 75-year-old woman was admitted to our institution for acute abdominal pain. She had a history of atrial fibrillation, pacemaker implantation and diastolic heart failure. At time of admission, she was under oral anticoagulation therapy with apixaban. EXAMINATIONS AND DIAGNOSIS: The X-ray of the chest showed a reduction in transparency surrounding the calcification of the aortic arch. CT angiography revealed evidence of an intramural hematoma of the aorta ranging from the left subclavian artery to the inferior mesenteric artery with presence of localized ulcer-like projections. THERAPY AND COURSE: Since the IMH was limited to the descending aorta, we first chose a conservative strategy with tight blood pressure control. Unfortunately, the patients' clinical symptoms did not improve. Her pain persisted despite medical treatment. After joint discussion with surgery and radiology, an endovascular aortic repair was successfully performed. The patient recovered well and could be discharged from the hospital. CONCLUSIONS: Acute aortic syndrome describes a life-threatening condition, including acute aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer. Rapid and correct diagnosis is imperative for adequate management. Once the definitive diagnosis of an aortic syndrome is made, prompt and appropriate therapeutic interventions should be undertaken. Urgent surgery for acute aortic syndromes involving the ascending aorta (Stanford Type A) and medical therapy alone for uncomplicated cases involving the descending aorta (Stanford Type B) are typically recommended. In complicated Stanford Type B situations, endovascular aortic repair (TEVAR) should be considered.


Assuntos
Aorta , Doenças da Aorta , Hematoma , Idoso , Aorta/diagnóstico por imagem , Aorta/fisiopatologia , Aorta/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Doenças da Aorta/cirurgia , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Feminino , Hematoma/diagnóstico por imagem , Hematoma/fisiopatologia , Hematoma/cirurgia , Humanos
16.
Ann Vasc Surg ; 59: 309.e11-309.e14, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30825509

RESUMO

Secondary aortobronchial fistula (ABF) is an uncommon clinical entity associated with increased mortality. Most common presentation is hemoptysis, ranging from repetitive self-limiting episodes to massive hematemesis. Mediastinitis (if present) and excessive blood loss burden the unfavorable case of ABF, whereas stent-graft contamination and sepsis are the main concerns regarding endovascular therapy. We are presenting two patients with secondary ABF treated with thoracic endovascular repair who completed long-term follow-up without complications or evidence of infection.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular , Fístula Brônquica/cirurgia , Procedimentos Endovasculares , Fístula Vascular/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Angiografia Digital , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/etiologia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia
17.
Can Assoc Radiol J ; 70(2): 204-209, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30922788

RESUMO

PURPOSE: The purpose of this study is to introduce the aortic bulge sign, a finding observed retrospectively on computed tomography prior to the acute presentation of aortoenteric fistula, and to determine its interobserver reliability. METHODS: Following research ethics board approval, all cases of aortoenteric fistula at our institution occurring from 2011-2015 were identified retrospectively. All previous computed tomography images of patients who eventually developed aortoenteric fistula were reviewed by a single observer for the presence of a potentially predictive finding of fistulization, the aortic bulge sign. These previous images were then combined with age and sex matched controls into a case bank. Eight radiology residents and staff were instructed in observing the aortic bulge sign. These observers then reviewed the case bank in a blinded analysis to determine the interobserver reliability of this finding. RESULTS: Fourteen cases of aortoenteric were identified. The average patient age was 70.71 years with a male-to-female ratio of 11:3. Eleven patients had previous computed tomography images available for review. With blinded analysis by multiple observers, the aortic bulge sign was identified with greater than 80% agreement in six of 11 cases (66.67%). Fleiss' kappa was calculated at k = 0.60 (95% confidence interval 0.50-0.69), corresponding to moderate-to-substantial interobserver agreement. CONCLUSIONS: The aortic bulge sign has been retrospectively identified as a promising computed tomography finding of eventual aortoenteric fistula prior to acute presentation. Further study is required to determine the diagnostic value of this sign.


Assuntos
Aorta/diagnóstico por imagem , Aorta/patologia , Doenças da Aorta/diagnóstico por imagem , Fístula do Sistema Digestório/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Fístula Vascular/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos
18.
J Cardiovasc Surg (Torino) ; 60(3): 275-280, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30827086

RESUMO

Endovascular repair of descending thoracic aorta (DTA) is considered as first interventional option for most part of the aortic disorders. However, many unmet needs and issues are still limiting its applicability. One of the major limitations is related to the existing gaps in evidence. Clear and robust evidence is still needed in many aspects of the management of DTA pathologies. In numerous clinical scenarios, adequate trials are lacking. Besides those gaps in evidence, it is well recognized that thoracic endografting (TEVAR) is technically evolving in order to overcome technical and device-related complications and limitations. We can deploy endografts in any aortic segment: in the descending, in the ascending, in the arch, even preserving aortic branches. Nevertheless, from the pure technical point of view, current generations of endografts still need more development and improvement. Durability remains the major concern for any endovascular treatment, and thoracic endografting is not an exception. As Galenus said, the physician is only nature's assistant, thoracic endograft should also follow the natural anatomy instead of fighting against it. We will focus the following pages on the graft conformability and compliance, both related to durability and safety of thoracic endografting. We will review the current knowledge and concerns associated with the anatomical and hemodynamic modifications induced by the thoracic endograft strength, stiffness and straightness and their implications for the future thoracic endograft designs.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Migração de Corpo Estranho/etiologia , Hemodinâmica , Humanos , Desenho de Prótese , Falha de Prótese , Fatores de Risco , Resultado do Tratamento
20.
BMJ Case Rep ; 12(2)2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30733248

RESUMO

Cushing's syndrome is known to present with a characteristic set of clinical manifestations and complications, well described in literature. However, hypercoagulability remains an under recognised entity in Cushing's syndrome. A 31-year-old woman from Southern India presented with history of fever, left upper quadrant pain and progressive breathing difficulty for 3 weeks. Clinical examination revealed discriminatory features of Cushing's syndrome. Laboratory investigations showed biochemical features of endogenous ACTH-dependent Cushing's syndrome. Imaging of the abdomen revealed splenic collection, left-sided empyema and extensive arterial thrombosis. Gadolinium enhanced dynamic MRI of the pituitary gland revealed no evidence of an adenoma while a Ga-68 DOTATATE positron emission tomography CT scan ruled out an ectopic Cushing's. A diagnosis of endogenous Cushing's syndrome causing a prothrombotic state with extensive arterial thrombosis was made. She was initiated on oral anticoagulation and oral ketoconazole for medical adrenal suppression. She subsequently underwent bilateral adrenalectomy and was well at follow-up.


Assuntos
Doenças da Aorta/diagnóstico por imagem , Síndrome de Cushing/diagnóstico , Trombofilia/diagnóstico , Trombose/diagnóstico por imagem , Hormônio Adrenocorticotrópico/sangue , Adulto , Anticoagulantes/uso terapêutico , Doenças da Aorta/etiologia , Artéria Celíaca/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Síndrome de Cushing/complicações , Síndrome de Cushing/tratamento farmacológico , Feminino , Artéria Hepática/diagnóstico por imagem , Humanos , Hidrocortisona/sangue , Hidrocortisona/urina , Infarto/diagnóstico por imagem , Infarto/etiologia , Cetoconazol/uso terapêutico , Nefropatias/diagnóstico por imagem , Nefropatias/etiologia , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Esplênica/diagnóstico por imagem , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/etiologia , Trombofilia/tratamento farmacológico , Trombofilia/etiologia , Trombose/tratamento farmacológico , Trombose/etiologia
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