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1.
Kyobu Geka ; 74(9): 654-659, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34446616

RESUMO

A 31-year-old woman was referred to our institution because of aortoesophageal fistula (AEF) six months after the descending aortic replacement for acute aortic dissection. We operated one-stage repair of the AEF. Thoracoscopic esophagectomy was firstly performed in prone position from right thoracic cavity, and then the esophagus was reconstructed with gastric conduit via posterior mediastinal route with omental flap. Secondly, graft replacement of the descending aorta using lateral oblique straight incision was performed and the graft was covered with omental flap simultaneously. The postoperative course was uneventful, and she started oral intake on the 13th day after surgery. Although the one-stage surgery for the AEF is highly invasive, it could be a good option for selected cases.


Assuntos
Aneurisma da Aorta Torácica , Doenças da Aorta , Implante de Prótese Vascular , Fístula Esofágica , Fístula Vascular , Adulto , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Esofagectomia , Feminino , Humanos , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Fístula Vascular/cirurgia
4.
BMJ Case Rep ; 14(8)2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34417238

RESUMO

Aortic mural thrombus (AMT) is an uncommon cause of arterial thromboembolism. It is very rare in patients without significant cardiovascular risk factors. Many aetiologies can cause AMT, but there are no clear guidelines for the evaluation and treatment. We present the case of a 43-year-old woman without arteriosclerotic disease who was admitted to the hospital with peripheral embolisation from the mural thrombus in the distal arch of the aorta. Therapy with systemic anticoagulation resulted in complete resolution without necessitating any surgical or endovascular interventions. There were no reported recurrence or complications of the intra-aortic thrombus within 1-year surveillance imaging study.


Assuntos
Doenças da Aorta , Tromboembolia , Trombose , Adulto , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Feminino , Humanos , Tromboembolia/etiologia , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Resultado do Tratamento
5.
J Thorac Cardiovasc Surg ; 162(3): 781-797, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34304894

RESUMO

This International evidence-based nomenclature and classification consensus on the congenital bicuspid aortic valve and its aortopathy recognizes 3 types of bicuspid aortic valve: 1. Fused type, with 3 phenotypes: right-left cusp fusion, right-non cusp fusion and left-non cusp fusion; 2. 2-sinus type with 2 phenotypes: Latero-lateral and antero-posterior; and 3. Partial-fusion or forme fruste. This consensus recognizes 3 bicuspid-aortopathy types: 1. Ascending phenotype; root phenotype; and 3. extended phenotypes.


Assuntos
Aorta , Doenças da Aorta/classificação , Valva Aórtica/anormalidades , Doença da Válvula Aórtica Bicúspide/classificação , Terminologia como Assunto , Aorta/diagnóstico por imagem , Aorta/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Aortografia , Doença da Válvula Aórtica Bicúspide/diagnóstico por imagem , Doença da Válvula Aórtica Bicúspide/cirurgia , Técnicas de Imagem Cardíaca , Consenso , Humanos , Fenótipo , Valor Preditivo dos Testes , Prognóstico
6.
J Card Surg ; 36(10): 3872-3873, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34309910

RESUMO

Herein, we present a neonatal case of coarctation of the aorta, with aortic arch thrombus confirmed by echocardiography. We performed thrombus removal and aortic arch repair emergently. This critical condition necessitates quick preoperative evaluation with echocardiography. Moreover, postoperative evaluation using computed tomography is reasonable to assess an aortic arch configuration, and exclude the remnant thrombus.


Assuntos
Coartação Aórtica , Doenças da Aorta , Trombose , Aorta , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Humanos , Recém-Nascido , Trombose/diagnóstico por imagem
7.
J Coll Physicians Surg Pak ; 31(Supp. 2): S130-S131, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34271813

RESUMO

Thrombotic complications increase in novel coronavirus disease 2019 (COVID-19) patients. Most of these complications are associated with venous thromboembolism and pulmonary embolism; and arterial thrombosis is rare. Usually, arterial thrombosis affects peripheral arteries. The involvement of large vessels, such as aorta, is rare in the literature. Major artery thrombosis manifests with different additional complications. Contrast-enhanced abdominal computed tomography angiography (CTA) was performed on a patient, who was followed-up with COVID-19 due to gastrointestinal symptoms. Supra-celiac aortic thrombosis and splenic infarction were detected. This case is reported to share experience regarding our treatment approach in the light of the literature data. Key Words: Arterial thrombosis, Acute aortic thrombosis, COVID-19.


Assuntos
Doenças da Aorta , COVID-19 , Embolia Pulmonar , Trombose , Doenças da Aorta/diagnóstico por imagem , Humanos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , SARS-CoV-2 , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Trombose/etiologia
8.
J Thorac Cardiovasc Surg ; 162(3): e383-e414, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34304896

RESUMO

This International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, right-non-coronary cusp fusion and left-non-coronary cusp fusion phenotypes); 2. The 2-sinus type (latero-lateral and antero-posterior phenotypes); and 3. The partial-fusion (forme fruste) type. The presence of raphe and the symmetry of the fused type phenotypes are critical aspects to describe. The International Consensus also recognizes 3 types of bicuspid valve-associated aortopathy: 1. The ascending phenotype; 2. The root phenotype; and 3. Extended phenotypes.


Assuntos
Aorta , Doenças da Aorta/classificação , Valva Aórtica/anormalidades , Doença da Válvula Aórtica Bicúspide/classificação , Terminologia como Assunto , Aorta/diagnóstico por imagem , Aorta/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Aortografia , Doença da Válvula Aórtica Bicúspide/diagnóstico por imagem , Doença da Válvula Aórtica Bicúspide/cirurgia , Técnicas de Imagem Cardíaca , Consenso , Humanos , Fenótipo , Valor Preditivo dos Testes , Prognóstico
9.
J Endovasc Ther ; 28(5): 737-745, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34160321

RESUMO

OBJECTIVE: This UK multicenter study aims to report early- and medium-term results following covered endovascular reconstruction of aortic bifurcation (CERAB) for the treatment of aortoiliac occlusive disease (AIOD) in patients with chronic limb threatening ischemia (CLTI) or intermittent claudication (IC). MATERIALS AND METHODS: Retrospective case analysis was performed of patients who underwent CERAB between November 1, 2012 and March 31, 2020 in 6 centers across the United Kingdom. Anatomical data, including degree of plaque calcification, were assessed using preoperative imaging. Outcome measures included mortality, perioperative complications, target lesion reintervention (TLR), and major limb amputation. Primary, assisted primary, and secondary patencies were calculated at set intervals. RESULTS: A total of 116 patients underwent CERAB over the study period for the following reasons [48% presenting with CLTI (Rutherford 4-6) and 52% with IC (Rutherford 1-3)]; 82% presented had Trans-Atlantic Inter-Society Consensus (TASC) D AIOD disease. Median age was 65 years (range 42-90 years); 76% of the cohort were male. Severely calcified aortic and iliac lesions were noted in 90% and 80% of patients, respectively. Over a median follow-up of 18 months (range 1-91 months), 2 (1.7%) patients were lost to follow up. In total 5, (4.3%) patients died and 2 (1.7%) had a major amputation. Endovascular TLR was required in 14 (12.1%) patients at last follow up. Surgical TLR was performed in 4 (3.4%) patients at last follow-up. Seven (6%) patients developed an aortic/iliac stent occlusion at last follow-up. The Kaplan-Meier (KM) freedom from TLR at 1 year was 94% and KM 1-year primary patency, assisted primary patency, and secondary patency were 88%, 94%, and 98% respectively. Subanalysis found the following features were associated with need for TLR; TASC D disease (OR = 2.45, 95% CI 1.44 to 3.71), severe aortic calcification (OR = 2.01, 95% CI 1.03 to 2.20), and presence of tissue loss at baseline (OR = 1.43, 95% CI 1.01 to 4.63). CONCLUSION: Perioperative (<30 days) and medium-term morbidity, mortality, and patency rates in this pragmatic cohort of patients with severe AIOD lesions show that CERAB is a valid revascularization option. A direct comparison with surgical treatments for AIOD in a randomized controlled trial is justified.


Assuntos
Doenças da Aorta , Arteriopatias Oclusivas , Procedimentos Endovasculares , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Procedimentos Endovasculares/efeitos adversos , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento , Reino Unido , Grau de Desobstrução Vascular
11.
Br J Radiol ; 94(1123): 20210211, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-33989055

RESUMO

Aorto-ostial coronary lesions (AOLs) are important to detect due to the high risk of catastrophic consequences. Unfortunately, due to the complexities of these lesions, they may be missed on invasive coronary angiography. Computed tomography coronary angiogram (CTCA) is highly sensitive and specific in detecting AOLs, and has the additional advantage of demonstrating the surrounding anatomy. CTCA is particularly useful when assessing for AOL aetiologies in addition to atherosclerotic disease, e.g. Congenital anomalies, extrinsic Compression, Iatrogenic, Arteritis and Other, such as Thrombus, Embolism, Dissection and Spasm. This gives rise to "CIAO (TEDS)" as a proposed aide-mémoire and will form the structure of this pictorial review.


Assuntos
Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença das Coronárias/diagnóstico por imagem , Aorta Torácica/anormalidades , Anomalias dos Vasos Coronários/diagnóstico por imagem , Humanos , Sensibilidade e Especificidade
12.
Radiology ; 300(1): 98-107, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33944628

RESUMO

Background Macrophage burden is a major factor in the risk of atherosclerotic plaque rupture, and its evaluation remains challenging with molecular noninvasive imaging approaches. Photon-counting CT (PCCT) with k-edge imaging aims to allow for the specific detection of macrophages using gold nanoparticles. Purpose To perform k-edge imaging in combination with gold nanoparticles to detect and quantify the macrophage burden within the atherosclerotic aortas of rabbits. Materials and Methods Atherosclerotic and control New Zealand white rabbits were imaged before and at several time points up to 2 days after intravenous injection of gold nanoparticles (3.5 mL/kg, 65 mg gold per milliliter). Aortic CT angiography was performed at the end of the follow-up using an intravenous injection of an iodinated contrast material. Gold k-edge and conventional CT images were reconstructed for qualitative and quantitative assessment of the macrophage burden. PCCT imaging results were compared with findings at histologic examination, quantitative histomorphometry, transmission electron microscopy, and quantitative inductively coupled plasma optical emission spectrometry. Pearson correlations between the macrophage area measured in immunostained sections and the concentration of gold and attenuation measured in the corresponding PCCT sections were calculated. Results Seven rabbits with atherosclerosis and four control rabbits without atherosclerosis were analyzed. In atherosclerotic rabbits, calcifications were observed along the aortic wall before injection. At 2 days after injection of gold nanoparticles, only gold k-edge images allowed for the distinction of plaque enhancement within calcifications and for lumen enhancement during angiography. A good correlation was observed between the gold concentration measured within the wall and the macrophage area in 35 plaques (five per rabbit) (r = 0.82; 95% CI: 0.67, 0.91; P < .001), which was higher than that observed on conventional CT images (r = 0.41; 95% CI: 0.09, 0.65; P = .01). Transmission electron microscopy and inductively coupled plasma optical emission spectrometry analyses confirmed the gold k-edge imaging findings. Conclusion Photon-counting CT with gold nanoparticles allowed for the noninvasive evaluation of both molecular and anatomic information in vivo in rabbits with atherosclerotic plaques. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Leiner in this issue.


Assuntos
Doenças da Aorta/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Placa Aterosclerótica/diagnóstico por imagem , Animais , Aorta/diagnóstico por imagem , Modelos Animais de Doenças , Ouro , Macrófagos , Nanopartículas Metálicas , Fótons , Coelhos
13.
Ann Vasc Surg ; 75: 136-139, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33940161

RESUMO

INTRODUCTION: The SARS-CoV-2 infection is associated with significant morbidity and mortality rates. The impact of thrombotic complications has been increasingly recognized as an important component of this disease. CASE REPORTS: We describe four cases of spontaneous acute aortic thrombosis in patients with SARS-CoV-2 infection observed from March to December 2020 at Fondazione Policlinico Universitario Gemelli IRCCS in Rome, Italy.


Assuntos
Doenças da Aorta/etiologia , COVID-19/complicações , Trombose/etiologia , Doença Aguda , Idoso , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , COVID-19/diagnóstico , Embolectomia , Evolução Fatal , Feminino , Humanos , Masculino , Trombectomia , Trombose/diagnóstico por imagem , Trombose/cirurgia , Resultado do Tratamento
14.
J Am Coll Radiol ; 18(5S): S106-S118, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33958105

RESUMO

Nontraumatic aortic disease can be caused by a wide variety of disorders including congenital, inflammatory, infectious, metabolic, neoplastic, and degenerative processes. Imaging examinations such as radiography, ultrasound, echocardiography, catheter-based angiography, CT, MRI, and nuclear medicine examinations are essential for diagnosis, treatment planning, and assessment of therapeutic response. Depending upon the clinical scenario, each of these modalities has strengths and weaknesses. Whenever possible, the selection of a diagnostic imaging examination should be based upon the best available evidence. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. The purpose of this document is to assist physicians select the most appropriate diagnostic imaging examination for nontraumatic aortic diseases.


Assuntos
Doenças da Aorta , Sociedades Médicas , Doenças da Aorta/diagnóstico por imagem , Medicina Baseada em Evidências , Humanos , Imageamento por Ressonância Magnética , Radiografia , Estados Unidos
16.
Vasc Endovascular Surg ; 55(6): 560-570, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33902342

RESUMO

PURPOSE: The treatment of aortoiliac occlusive disease (AIOD) has largely shifted to endovascular techniques, with primary stenting constituting the preferred treatment approach. The goal of the current study was to summarize available literature and to determine whether covered stents are superior to bare metal stents for the treatment of AIOD, in terms of both periprocedural and long-term outcomes. METHODS: A meta-analysis of 47 studies was conducted with the use of random effects modeling. The incidence of adverse events during follow up among the individual included studies was synthesized. RESULTS: Most of the lesions were located at the common iliac arteries and were chronic total occlusions. The procedure was technically successful in almost all cases in both groups, with a low rate of periprocedural complications observed in both groups. The reported primary patency rates for the non-covered and covered stent group during an average follow up of 24.3 months among the individual studies, were 84% and 92% respectively, while surgical or endovascular re-intervention was required in 10% of non-covered stent cases and in 6% of covered stent cases. Eight studies comparing covered vs non-covered stents in terms of patency demonstrated superiority of covered stents (OR: 2.47; 95% CI: 1.01-6.01; p = 0.047 Combining TASC C/D lesions together 12 studies reported 92% (95%CI:89%-95%) primary patency in the covered stent group, while 7 studies reported 75% (95%CI: 60%-88%) primary patency for cases treated with non-covered stents. CONCLUSION: This study demonstrated that covered stents are safe and effective when utilized for the treatment of AIOD. Covered stents were associated with a statistically significant higher odds of primary patency in both the overall cohort and in more complex TASC C/D lesions. However, additional high-quality comparative analyses between covered vs bare metal stents and between several types of covered stents are needed to determine the most optimal treatment modality for AIOD.


Assuntos
Doenças da Aorta/terapia , Arteriopatias Oclusivas/terapia , Procedimentos Endovasculares/instrumentação , Artéria Ilíaca , Stents , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Constrição Patológica , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
18.
Ann Vasc Surg ; 75: 120-127, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33905848

RESUMO

OBJECTIVE: The COVID-19 pandemic has forced the cancellation of planned surgery and led to significant surgical service reductions. Early intervention in aortovascular disease is often critical and cannot be deferred despite these reductions. There is urgent need to evaluate the provision and outcomes of thoracic aortovascular intervention during the peak of the pandemic. METHODS: Prospective data was collected for patients receiving open and endovascular thoracic aortovascular intervention over two-time points; January-May 2020 and January-May 2019 at three tertiary cardiovascular centres. Baseline demographics, cardiovascular risk and COVID-19 screening results were noted. Primary outcomes were median length of intensive care unit and hospital stay, intra-operative mortality, 30-day mortality, post-operative stroke, and spinal cord injury. RESULTS: Patients operated in 2020 (41) had significantly higher median EuroSCORE II than 2019 (53) (7.44 vs. 5.86, P = 0.032) and rates of previous cardiac (19.5% vs. 3.8%, P = 0.019), aortic (14.6% vs. 1.9%, P = 0.041), and endovascular (22.0% vs. 3.8%, P = 0.009) intervention. There was an increase in proportion of urgent cases in 2020 (31.7% vs. 18.9%). There were no intra-operative deaths in 2020 and 1 in 2019 (P = 1.00). There were no significant differences (P ≥ 0.05) in 30-day mortality (4.9% vs. 13.2%), median intensive care unit length of stay (72 vs. 70 hr), median hospital length of stay (8 vs. 9 days), post-operative stroke (3 vs. 6), or spinal cord injury (2 vs. 1) between 2020 and 2019 respectively. CONCLUSIONS: Despite the increased mortality risk of patients and urgency of cases during COVID-19, complicated by the introduction of cohorting and screening regimens, thoracic aortovascular intervention remained safe with comparable in outcomes to pre-COVID-19.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , COVID-19 , Procedimentos Cirúrgicos Vasculares , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/mortalidade , COVID-19/diagnóstico , COVID-19/mortalidade , COVID-19/prevenção & controle , COVID-19/transmissão , Teste para COVID-19 , Bases de Dados Factuais , Inglaterra , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
20.
Heart Surg Forum ; 24(2): E372-E374, 2021 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-33891542

RESUMO

The world has suffered over the past year under COVID-19. Unfortunately, people still are getting sick from other, also severe, diseases. Although the COVID-19 infection is present, patients need treatment for other life-threatening conditions. We present the case of a 36-year-old patient with severe infective endocarditis with a large abscess of the aortic root, who also is COVID-19 positive. Definitive diagnostics and treatment were avoided due to COVID-19 infection. In the end, emergent surgery was indicated due to acute cardiac decompensation and the development of heart failure symptoms, and the patient recovered uneventfully after surgery.


Assuntos
Abscesso/microbiologia , Abscesso/cirurgia , Doenças da Aorta/microbiologia , Doenças da Aorta/cirurgia , COVID-19/complicações , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Abscesso/diagnóstico por imagem , Adulto , Doenças da Aorta/diagnóstico por imagem , Endocardite Bacteriana/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Masculino , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/microbiologia , Derrame Pleural/cirurgia , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Respiração Artificial , SARS-CoV-2
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