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1.
J Cardiothorac Surg ; 16(1): 195, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34243799

RESUMO

BACKGROUND: Intraoperative graft assessment with tools like Transit Time Flow Measurement (TTFM) is imperative for quality control in coronary surgery. We investigated the variation of TTFM parameters before and after protamine administration to identify new benchmark parameters for graft quality assessment. METHODS: The database of the REQUEST ("REgistry for QUality AssESsmenT with Ultrasound Imaging and TTFM in Cardiac Bypass Surgery") study was retrospectively reviewed. A per graft analysis was performed. Only single grafts (i.e., no sequential nor composite grafts) where both pre- and post-protamine TTFM values were recorded with an acoustical coupling index > 30% were included. Grafts with incomplete data and mixed grafts (arterio-venous) were excluded. A second analysis was performed including single grafts only in the same MAP range pre- and post- protamine administration. RESULTS: After adjusting for MAP, we found a small increase in MGF (29 mL/min to 30 mL/min, p = 0.009) and decrease in PI (2.3 to 2.2, p <  0.001) were observed after the administration of protamine. These changes were especially notable for venous conduits and for CABG procedures performed on-pump. CONCLUSION: The small changes in TTFM parameters observed before and after protamine administration seem to be clinically irrelevant, despite being statistically significant in aggregate. Our data do not support a need to perform TTFM measurements both before and after protamine administration. A single TTFM measurement taken either before or after protamine may suffice to achieve reliable data on each graft's performance. Depending on the specific clinical situation and intraoperative changes, more measurements may be informative. TRIAL REGISTRATION: Clinical Trials Number: NCT02385344 , registered February 17th, 2015.


Assuntos
Ponte de Artéria Coronária , Circulação Coronária , Antagonistas de Heparina/uso terapêutico , Protaminas/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Grau de Desobstrução Vascular
2.
Medicine (Baltimore) ; 100(24): e26351, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128887

RESUMO

BACKGROUND: Both coil embolization (CE) and flow-diverting device (FDD) placement are widely used for treatment of intracranial aneurysms (IAs). The aim of this meta-analysis is to compare the relative clinical safety and efficacy of FDD and CE for the treatment of unruptured IAs. METHODS: The PubMed, Embase, and Cochrane Library databases were searched for relevant studies from the date of inception through April 2020. The primary endpoint for this meta-analysis was the 6-month rate of complete occlusion, while secondary endpoints included rates of retreatment, complications, and parental arterial patency. RESULTS: This meta-analysis includes 8 studies, which included 839 total patients that underwent FDD and 2734 that underwent CE. FDD group exhibited a significantly higher pooled 6-month complete occlusion rate (P = .02). The subgroup analysis demonstrated that FDD treatment was associated with significantly higher pooled 6-month complete occlusion rates in patients with large or giant IAs (P < .00001), whereas no differences in 6-month complete occlusion rates were observed between the FDD and CE groups of patients with non-large/giant IAs (P = .83). The pooled retreatment (P = .16) and complication (P = .15) rates were comparable between 2 groups. The CE group exhibited significantly higher pooled parent artery patency rate (P = .01). The funnel plots did not reveal any evidence of publication bias. CONCLUSIONS: FDDs can be used to effectively and safely treat large and giant IAs, achieving higher rates of complete occlusion than CE treatment. For non-large/giant IAs, we observed comparable efficacy between FDD and CE treatments.


Assuntos
Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Humanos , Retratamento , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
3.
BMJ Open ; 11(6): e044356, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108161

RESUMO

INTRODUCTION: Patients with end-stage renal disease may require arteriovenous (AV) access in the form of arteriovenous fistulae (AVFs) or arteriovenous grafts (AVGs) for haemodialysis. AV access dysfunction requires intervention such as plain balloon angioplasty or covered stents to regain patency. AIM: To systematically review and meta-analyse the patency outcomes of covered stents in failing haemodialysis AV access, compared with balloon angioplasty. METHODS: The review was first registered on the International Prospective Register of Systematic Reviews (CRD42018069955) before data collection. We searched six electronic databases to identify relevant randomised controlled trials (RCTs) up until August 2020, without language restriction. Two reviewers assessed the suitability and quality of studies for inclusion using the Consolidated Standards of Reporting Trials guidelines. We meta-analysed data using a random-effects model. RESULTS: We included seven studies including 1147 patients in the systematic review, of which 867 had AVGs and 280 had AVFs. One study was an ongoing RCT. In the meta-analyses, we assessed patients with failing AVGs only. Overall risk of bias was moderate. Covered stents were associated with lower loss of patency versus angioplasty alone at 6, 12 and 24 months (OR 4.48, 95% CI 1.98 to 10.14, p<0.001; OR 4.07, 95% CI 1.74 to 9.54, p=0.001; OR 2.24, 95% CI 1.17 to 4.29, p=0.01, respectively). Covered stents afforded superior access circuit primary patency compared with angioplasty alone at 6 and 12 months (OR 1.91, 95% CI 1.31 to 2.80, p<0.001; OR 1.97, 95% CI 1.14 to 3.41, p=0.02, respectively). This was not significant at 24 months. There was no significant difference in loss of secondary patency between groups at 12 or 24 months (OR 0.74, 95% CI 0.45 to 1.23, p=0.25; OR 0.67, 95% CI 0.29 to 0.154, p=0.34, respectively). CONCLUSION: Our results support use of covered stents over angioplasty alone, at 6, 12 and 24 months in failing AVGs. Further clinical trials are warranted.


Assuntos
Angioplastia com Balão , Derivação Arteriovenosa Cirúrgica , Oclusão de Enxerto Vascular , Humanos , Diálise Renal , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
4.
Angiol Sosud Khir ; 27(2): 99-105, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34166349

RESUMO

Aneurysmatic transformation of a fistulous vein is one of the most frequently encountered complications in patients on programmed dialysis. This complication increases the risk of dysfunction of an arteriovenous fistula. However, there are no common approaches to correction of this complication. This study was aimed at assessing the results of aneurysmorrhaphy for treating aneurysms of fistulous veins in patients on programmed dialysis. For this purpose, we carried out a retrospective analysis of the results of operations in a total of 87 patients with aneurysmatic transformation of an arteriovenous fistula. All patients were subjected to aneurysmorrhaphy supplemented, if necessary, by plasty of stenosis with the use of the tissue of the wall of the resected aneurysm. The vein was placed into a new subcutaneous channel (transposition with transection of the vein) or a pocket formed by the separated subcutaneous tissue (transposition without transection). Secondary patency after 1 year amounted to 95.3%, after 2 years to 91.4%, and after 3 years to 87.6%. At 4.8 years, 69% (95% CI 44.9-84.2) of the arteriovenous fistulas proved patent. CONCLUSION: Aneurysmorrhaphy supplemented with correction of concomitant complications of aneurysms of fistulous veins is an effective and safe operation making it possible to maintain the function of an arteriovenous fistula for a long period of time.


Assuntos
Derivação Arteriovenosa Cirúrgica , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Humanos , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular
5.
Angiol Sosud Khir ; 27(2): 106-113, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34166350

RESUMO

Analyzed herein are the results of surgical treatment of true diffuse aneurysms of the permanent vascular access in 44 patients. Of these, there were 29 men and 15 women, mean age 48.1±2.3 years (19-78 years). The average time having elapsed since the formation of the native access was 109.4±9.5 months (12-276, median - 108 months). The indications for surgical treatment were as follows: haemorrhage including recurrent bleedings (3), thrombosis of the permanent vascular access (26), its dysfunction (5), high flow syndrome (3), large-size aneurysm with disordered function of the limb, pain syndrome or a pronounced cosmetic defect (7). In 14 cases, reconstruction was not performed. We carried out ligating operations, in some instances with partial removal of the aneurysm and establishing a new vascular access. 3 patients underwent resection of the aneurysm with replacement by a graft. In the remote period 1 patient at 46 months developed infection of the prosthesis, resulting in loss of the access. Follow up of the remaining 2 patients demonstrated satisfactory function of the vascular access at 6 and 60 months. 16 patients were subjected to total plasty of the aneurysm using autotissues. On a cylindrical template measuring 6 mm in diameter after dissection of excessive tissues along the posterior wall of the vein, an uninterrupted suture was formed followed by placing the formed transplant into a new bed. 11 patients underwent the operation according to the analogous technique, but the formed autotransplant was reinforced with a thin-wall exoprosthesis made of polytetrafluoroethylene up to 0.2-mm thick and 10 mm in diameter ('Ecoflon'). Two (12.5%) of 16 patients subjected to reconstruction of the aneurysm without reinforcement developed haemorrhage in the early postoperative period, and one developed thrombosis thus resulting in loss of the access. In-hospital patency amounted to 81.3%. In plasty with reinforcement, there were no complications in the early postoperative period. Long-term primary patency after total plasty without reinforcement at 1, 3, and 5 years amounted to 68.2±11.8%, 56.8±14.3%, and 22.7±13.7%, respectively, with secondary patency of 68.2±11.8% at the above-mentioned terms. In the majority of patients aneurysmatic transformation of the transplant occurred again in the remote period. Primary patency at 1, 3 and 4 years after plasty with reinforcement amounted to 80.8±12.2%, 80.8±12-2% and 60.6±19.8%, respectively, with the secondary patency rates of 90.9±8.7% at the above mentioned terms.


Assuntos
Aneurisma , Derivação Arteriovenosa Cirúrgica , Implante de Prótese Vascular , Aneurisma/diagnóstico , Aneurisma/cirurgia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular
6.
Angiol Sosud Khir ; 27(2): 127-134, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34166353

RESUMO

Hydraulic dilatation is used in everyday cardiac surgical practice for assessment of leak-proofness and prevention of spasm of autovenous shunts. The classical technique envisages manual high-pressure solution injection, which exerts a negative effect on venous conduits and is one of the causes of incompetence of shunts in the postoperative period. Limiting pressure during hydraulic dilatation is necessary to minimize morphological changes and preserve functional viability of venous conduits. The purpose of the present study was to develop and assess efficacy of a standardized methodology of controlled hydraulic dilatation of venous conduits. We worked out an original technique of controlled hydraulic dilatation of venous conduits under perfusion pressure of artificial circulation. This was followed by assessing morphological changes and functional viability of venous segments after controlled hydraulic dilatation as compared with veins after conventional uncontrolled hydraulic dilatation and the control intact veins. Uncontrolled hydraulic dilatation was accompanied by endothelial damage (p<0.05), multiple conduit wall tears (p<0.05) according to the findings of light microscopy, leading to a significant decrease in the functional vitality of the venous conduit (a decreased reaction to hyperpotassium solution, phenylephrine, acetylcholine and sodium nitroprusside (p<0.05) according to the findings of biophysical examination. Our original technique of controlled hydraulic dilatation of venous conduits under perfusion pressure of artificial circulation made it possible not only to evaluate leak-proofness of the vessel but also to achieve comparable to the control segments parameters of structural integrity of the venous wall and functional viability of the conduit. Thus, using the developed method of controlled hydraulic dilatation makes it possible to minimize morphofunctional alterations in venous conduits, influencing the function of autovenous shunts.


Assuntos
Ponte de Artéria Coronária , Veias , Dilatação , Humanos , Grau de Desobstrução Vascular
7.
J Card Surg ; 36(7): 2381-2388, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33960508

RESUMO

BACKGROUND AND AIM OF THE STUDY: Many studies support that the no-touch (NT) procedure can improve the patency rate of vein grafts. However, it is not clear that the sequential vein graft early expansion in the NT technique during off-pump coronary artery bypass grafting (CABG). This study will explore this issue. METHODS: This was a prospective single-center randomized controlled clinical trial. A total of 100 patients undergoing off-pump CABG with the sequential saphenous graft were randomly assigned to two groups: the NT and conventional (CON) groups. Perioperative and postoperative data were collected during the hospital stay. The mean diameter of sequential grafts was measured using cardiac computed tomography angiography 3 months after the operation. RESULTS: There was a significant difference in the average diameter of sequential grafts between the two groups (NT: [2.98 ± 0.42], CON: [3.26 ± 0.51], p = .005). There was no difference in occlusion of sequential venous grafts between the two groups (NT: 4/48 [8.3%], CON: 5/49 [10.2%], p = 1.000). There were differences in surgery time between the two groups (NT: 220 [188,240], CON: 190 [175,230], p = .009). CONCLUSIONS: The sequential graft early expansion in the NT technique is not as pronounced as that in the conventional technique, which may have a long-term protective effect on the grafts.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Veia Safena , Angiografia Coronária , Ponte de Artéria Coronária , Humanos , Estudos Prospectivos , Veia Safena/diagnóstico por imagem , Resultado do Tratamento , Grau de Desobstrução Vascular
8.
J Card Surg ; 36(8): 2979-2981, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33974307

RESUMO

Polyarteritis nodosa (PAN) affects small- and medium-sized arteries but rarely occurs in coronary artery aneurysms and stenosis. For patients with PAN, coronary artery bypass grafting (CABG) can be challenging, especially with respect to graft selection. We performed CABG using a bilateral internal thoracic artery (ITA) graft for a 21-year-old patient with PAN, with successful postoperative outcomes. Arterial grafts have the risk of stenosis in PAN, but the patient's condition was controlled by steroids and immunosuppressants, and angiography showed no stenosis. We decided to use the ITA graft as a bypass conduit and found that long-term follow-up and continuous treatment are necessary.


Assuntos
Aneurisma Coronário , Artéria Torácica Interna , Poliarterite Nodosa , Adulto , Ponte de Artéria Coronária , Humanos , Artéria Torácica Interna/diagnóstico por imagem , Poliarterite Nodosa/cirurgia , Grau de Desobstrução Vascular , Adulto Jovem
9.
Khirurgiia (Mosk) ; (6): 54-62, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34029036

RESUMO

OBJECTIVE: To evaluate safety and technical efficiency of primary retrograde distal access for endovascular interventions in patients with lower limb ischemia. MATERIAL AND METHODS: A prospective analysis included 25 endovascular procedures via primary retrograde distal access in 23 patients with chronic obliterating diseases of lower limb arteries. Occlusive lesion of femoral-popliteal segment was observed in 68% of cases, occlusion of at least one tibial artery was also found in 68% of cases. In 44% of cases, occlusive lesion was localized at several levels. Percutaneous intervention via anterior tibial artery or dorsalis pedis artery was performed in 68% of cases, posterior tibial artery - 24% of cases, peroneal artery - 8% of cases. We used 2 accesses in 92% of cases (the main one for intervention and additional one for angiography). In 8% of cases, intervention was carried out through a single access. Angiosome artery was punctured in 65% of cases. The only patent tibial vessel was used in 20% of cases. In 24% of cases, we performed antegrade recanalization of 'adjacent' tibial artery via distal access. RESULTS: Primary retrograde distal access was successfully performed in 100% of cases. Retrograde revascularization was not successful in all cases (successful recanalization rate 96%, retrograde intervention rate - 92%). Femoral access was performed in 8% of cases. Antegrade blood flow through at least one tibial artery was restored in all cases. Direct revascularization of the affected angiosome was performed in 15 patients with foot necrosis, indirect revascularization through collaterals - in 5 patients. Local complications of surgical access occurred in 12% of cases. CONCLUSION: Endovascular revascularization via primary retrograde distal access was technically effective in most cases. There were no complications with systemic consequences.


Assuntos
Procedimentos Endovasculares , Doença Arterial Periférica , Procedimentos Endovasculares/efeitos adversos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/cirurgia , Salvamento de Membro , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular
10.
Cochrane Database Syst Rev ; 4: CD013702, 2021 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-33910264

RESUMO

BACKGROUND: Bypass surgery using a large saphenous vein graft, or another autologous venous graft, is a well-recognised treatment option for managing peripheral arterial disease of the lower limb, including chronic limb-threatening ischaemia (CLTI) and intermittent claudication, peripheral limb aneurysms, and major limb arterial trauma. Bypass surgery has good results in terms of limb preservation rates and long-term graft patency but is limited by the possibility of vein graft failure due to stenoses of the graft. Detection of stenoses through clinical and ultrasonographic surveillance, followed by treatment, is used to avoid graft occlusion. The conventional approach to treatment of patients with graft stenosis following infrainguinal bypass consists of open surgical repair, which usually is performed under general anaesthesia. Endoluminal treatment with angioplasty is less invasive and uses local anaesthesia. Both methods aim to improve blood flow to the limb. OBJECTIVES: To assess the effectiveness of endoluminal interventions versus surgical intervention for people with vein graft stenosis following infrainguinal bypass. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov to 25 August 2020. SELECTION CRITERIA: We aimed to include all published and unpublished randomised controlled trials (RCTs) that compared endoluminal interventions versus surgical intervention for people with vein graft stenosis following infrainguinal bypass. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed all identified studies for potential inclusion in the review. We aimed to use standard methodological procedures in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The main outcomes of interest were primary patency, primary assisted patency, and all-cause mortality. MAIN RESULTS: We identified no RCTs that met the inclusion criteria for this review. AUTHORS' CONCLUSIONS: We found no RCTs that compared endoluminal interventions versus surgical intervention for stenosis in vein grafts following infrainguinal bypass. Currently, there is no high-certainty evidence to support the use of one type of intervention over another. High-quality studies are needed to provide evidence on managing vein graft stenosis following infrainguinal bypass.


Assuntos
Angioplastia/métodos , Oclusão de Enxerto Vascular/terapia , Perna (Membro)/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Aneurisma/cirurgia , Constrição Patológica/terapia , Humanos , Claudicação Intermitente/cirurgia , Isquemia/cirurgia , Veia Safena/transplante , Grau de Desobstrução Vascular
11.
Prog Cardiovasc Dis ; 65: 71-75, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33901516

RESUMO

Chronic mesenteric ischemia (CMI) is an uncommon, potentially underdiagnosed clinical condition. Although there is a high prevalence of mesenteric artery stenoses (MAS), an abundant collateral network in the mesenteric circulation mitigates occurrence of ischemia. The most common etiology of CMI is atherosclerosis. CMI is a clinical diagnosis, based upon typical and atypical symptoms and consistent anatomic findings. Typical symptoms of CMI are postprandial abdominal pain, unintended weight loss and food avoidance. The main modalities to diagnose MAS are duplex ultrasound, CT angiography or MR angiography, although high resolution CTA is preferred. Endovascular therapy with balloon expandable stents has become the preferred treatment for MAS.


Assuntos
Angioplastia com Balão , Endarterectomia , Artérias Mesentéricas/cirurgia , Isquemia Mesentérica/terapia , Oclusão Vascular Mesentérica/terapia , Enxerto Vascular , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Doença Crônica , Constrição Patológica , Endarterectomia/efeitos adversos , Humanos , Incidência , Artérias Mesentéricas/diagnóstico por imagem , Artérias Mesentéricas/fisiopatologia , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/epidemiologia , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/epidemiologia , Oclusão Vascular Mesentérica/fisiopatologia , Prevalência , Stents , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Grau de Desobstrução Vascular
12.
J Med Case Rep ; 15(1): 204, 2021 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-33902709

RESUMO

BACKGROUND: Failed aortofemoral and femoropopliteal bypass grafts in the lower extremity artery usually result in acute limb ischemia. Endovascular treatment and surgical revascularization have been reported for limb salvage. CASE PRESENTATION: A 72-year-old Japanese man was admitted with acute limb ischemia due to failed aortofemoral and femoropopliteal bypass grafts. Endovascular treatment with balloon angioplasty, thrombectomy, and stent implantation in the long chronic total occlusion from the right common iliac artery to the superficial femoral artery did not result in efficient flow due to thrombus transfer from a failed aortofemoral bypass graft. However, a rescue femorofemoral bypass (the left femoral to the right deep femoral artery) improved his symptoms, and implanted in-stent flow was gradually recovered. Lower extremity angiography performed 5 months later confirmed the patency of the iliofemoral in-stent flow. However, the femorofemoral bypass graft was unfortunately occluded due to the progression of left external iliac artery stenosis. The patency of the iliofemoral in-stent flow was confirmed at 1 year by ultrasonography. CONCLUSIONS: Improvement of the deep femoral artery flow plays an important role in the treatment of acute limb ischemia due to failed aortofemoral and femoropopliteal bypass grafts. Thus, increased collateral circulation to the periphery through the deep femoral artery dissolved the remaining in-stent thrombus in the iliofemoral artery.


Assuntos
Artéria Ilíaca , Trombose , Idoso , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Masculino , Stents , Trombose/diagnóstico por imagem , Trombose/cirurgia , Resultado do Tratamento , Grau de Desobstrução Vascular
13.
J Cardiothorac Surg ; 16(1): 93, 2021 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-33865411

RESUMO

BACKGROUND: The clinical use of the radial artery (RA) in coronary artery bypass grafting (CABG) is still limited worldwide, although it has been recommended by several guidelines. Multidetector computed tomography (MDCT) is widely used to evaluate graft patency, as invasive coronary angiography could cause potentially serious risks including bleeding, dissection and stroke. This study aims to report the short-term results of the RA in CABG with MDCT. METHODS: The study population consists of 41 consecutive patients undergoing elective CABG with the RA graft between 2017 to 2018, with MDCT performed to evaluate graft patency during follow-up, and target vessels for the RA were non-left anterior descending coronary arteries with > 70% stenosis. RESULTS: A total of 150 grafts were assessed by MDCT during follow-up (mean, 8.9 ± 5.1 months). MDCT could clearly show the structure and patency of grafts, even for complex coronary artery revascularization. Graft patency of the left internal mammary artery was 92.9% (39/42), with the RA patency of 84.4% (38/45) and the patency of the saphenous vein graft of 81.1% (30/37). And the RA anastomosed to the left coronary artery system might have better patency than the RA anastomosed to the right coronary artery system (25/29, 86.2% vs 13/16, 81.3%, p = 0.686). CONCLUSIONS: The short-term patency rate of RA grafts is good, and the RA might be associated with better patency when anastomosed to the left but not the right coronary artery. MDCT could provide excellent visualization of grafts in CABG.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Ponte de Artéria Coronária/métodos , Tomografia Computadorizada Multidetectores , Artéria Radial/diagnóstico por imagem , Artéria Radial/transplante , Grau de Desobstrução Vascular , Adulto , Idoso , Anastomose Cirúrgica , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Artéria Torácica Interna/diagnóstico por imagem , Artéria Torácica Interna/transplante , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Veia Safena/diagnóstico por imagem , Veia Safena/transplante
14.
Ann Palliat Med ; 10(4): 4047-4054, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33832310

RESUMO

BACKGROUND: Patients in maintenance hemodialysis (MHD) need a patent vascular access for optimal treatment. Autologous arteriovenous fistula (AVF) is the optimal vascular access for patients with MHD. However, AVF dysfunction may limit its use. The aim of this article is to explore the factors associated with primary dysfunction of AVF in patients with MHD. METHODS: This is a retrospective study. A total of 121 patients who underwent anastomosis for AVF in our hospital from January 1st, 2016 through December 31st, 2018 were screened for eligibility. Of these patients, 44 were excluded according to the exclusion criteria. The remaining patients were divided into two groups based on the function of vascular access. The complete blood count and other blood biochemical parameters were compared between two groups. The risk factors associated with AVF dysfunction were analyzed by multivariate Cox proportional hazard regression model for patients with end-stage renal disease (ESRD). RESULTS: There were significant differences in serum phosphorus (P), total cholesterol (TC), low density lipoprotein (LDL) and gender between patency and dysfunction groups of AVFs (P<0.05). Further multivariate COX proportional risk regression showed that hypercholesterolemia and hyperphosphatemia were independent risk factors for AVF dysfunction. CONCLUSIONS: Hypercholesterolemia and hyperphosphatemia are independent risk factors for primary AVF dysfunction in patients with MHD.


Assuntos
Fístula Arteriovenosa , Derivação Arteriovenosa Cirúrgica , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Humanos , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
15.
J Endovasc Ther ; 28(3): 442-451, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33834905

RESUMO

INTRODUCTION: This was a European, multicenter, investigator-initiated and run, single-arm retrospective analysis to assess the safety and the clinical benefit of the use of paclitaxel-coated balloon (PCB) for the treatment of symptomatic central venous stenosis (CVS). MATERIALS AND METHODS: Eleven centers from 7 countries across Europe, submitted 86 cases performed during the period between October 2015 and June 2018. Minimum follow-up was 6 months. Patient baseline demographics and procedural details were collected. Mean age was 62.6 years (SD 15.2 years). Median vascular access age was 3.0 years (IQR 1.2-4.8 years). A total of 55 were arteriovenous fistulas (64%) the rest arteriovenous grafts (31/86, 36%). Vessels treated were 43 subclavian veins, 42 brachiocephalic veins and 1 superior vena cava. Median drug-coated balloon diameter was 10 mm (IQR 8-12 mm). Primary outcome measures were clinically assessed intervention-free period (IFP) of the treated segment at 6 months and procedure-related minor and major complications. Secondary outcome measures included access circuit survival, patient survival, and the investigation of independent factors that influence the IFP. RESULTS: IFP was 62.7% at 6 months. Median patient follow-up time was 1.0 year (IQR 0.5-2.2 years). There was 1 minor complication (1/86; 1.2%) and no major complications. Access circuit survival was 87.7% at 6 months. Patient survival was 79.7% at 2 years according to Kaplan-Meier survival analysis. Higher balloon diameters significantly favored IFP [HR 0.71 (0.55-0.92), p=0.006; 5-7 mm group vs 8-12 mm group, p=0.025]. CONCLUSION: In this analysis, use of PCBs for the treatment of symptomatic CVS was safe. Efficacy was comparable to previous trials. Increased balloon size had a significant effect on patency rates.


Assuntos
Angioplastia com Balão , Derivação Arteriovenosa Cirúrgica , Angioplastia com Balão/efeitos adversos , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Pré-Escolar , Constrição Patológica , Europa (Continente) , Humanos , Lactente , Pessoa de Meia-Idade , Paclitaxel/efeitos adversos , Diálise Renal , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veia Cava Superior
16.
J Cardiothorac Surg ; 16(1): 74, 2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33845865

RESUMO

BACKGROUND: previous studies evaluating external stents for saphenous vein grafts (SVG) in CABG were limited to on-pump isolated CABG and single grafting technique with one external stent per patient. The objective of this prospective study was to evaluate the safety and the short-term performance of external stents in a heterogeneous group of patients who underwent on- and off-pump CABG, single and sequential grafting. METHODS: 102 patients undergoing CABG were enrolled in two centers. All patients received internal mammary artery to the left anterior descending artery and additional arterial and/or venous grafts. In each patient, at least one SVG was supported with an external stent. Grafts' patency and SVG lumen uniformity were assessed using CT angiography at a pre-defined time window of 6-12 months post procedure. All patients were prospectively followed-up via phone call and/or visit every 6 months for Major Adverse Cardiac and Cerebrovascular Events. RESULTS: 51 patients (50%) underwent off-pump CABG and 23 patients (23%) were grafted with bilateral internal mammary arteries. Each patient received one or more SVG grafted in a sequential technique (44%) or as a single graft (56%). All SVG were externally stented in 84% of patients and in 16% (n = 16) one SVG was stented and one remained unsupported. At 6-12 months, patency rates of LIMA, RIMA, externally stented SVG and none-stented SVG were 100, 100, 98 and 87.5% respectively. 90% of the externally stented SVG had uniform lumen compared to 37% of the non-stented SVG. Clinical follow-up was completed for all patients with a mean duration of 20 months (range 6-54 months). During follow up period, one patient experienced myocardial infarction due to occlusion of the LIMA-LAD graft and one patient experienced a transient ischemic attack. CONCLUSIONS: External stenting of SVG is feasible and safe in CABG setting which includes off pump CABG and sequential SVG grafting and associated with acceptable early patency rates. TRIAL REGISTRATION: Study was registered at ClinicalTrials.gov. NCT01860274 (initial release 20.05.2013).


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Anastomose de Artéria Torácica Interna-Coronária , Veia Safena/transplante , Stents , Grau de Desobstrução Vascular , Idoso , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Feminino , Humanos , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veia Safena/diagnóstico por imagem , Resultado do Tratamento
17.
Biomed Res Int ; 2021: 5528006, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33928147

RESUMO

We used the radial artery as a second target conduit for coronary artery bypass grafting since 1971. However, randomized clinical studies have demonstrated differences in clinical outcomes between the radial artery and other grafts because these trials are underpowered. As we proceed toward 50 years of experience with radial artery grafting, we examined the literature to define the best second-best target vessel for coronary artery bypass grafting. The literature was reviewed with emphasis, and a large number of randomized controlled trials, propensity-matched observational series, and meta-analyses were identified with a large patient population who received arterial conduit and saphenous vein grafts. The radial artery has been shown to be effective and safe when used as a second target conduit for coronary artery bypass grafting. Results and patency rates were superior to those for saphenous vein grafting. It has also been shown that the radial artery is a safe and effective graft as a third conduit into the territory of the artery right coronary artery. However, there is little evidence based on a few comparable series limiting the use of the gastroepiploic artery. In its fifth decade of use, we can finally deduced that the aorto-to-coronary radial bypass graft is the conduit of choice for coronary operations after the left internal thoracic artery to the left anterior descending artery.


Assuntos
Ponte de Artéria Coronária , Artéria Radial/cirurgia , Angiografia Coronária , Humanos , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Tomografia Computadorizada por Raios X , Falha de Tratamento , Grau de Desobstrução Vascular
18.
Angiol Sosud Khir ; 27(1): 48-51, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33825728

RESUMO

Analysed in the article are the results of ultrasonographic examination of patency of venous stents implanted in 86 patients with obstructive lesions of the iliofemoral segment of deep veins. The authors proposed an algorithm of triplex scanning, making it possible to optimize ultrasonographic examination, as well as increasing the accuracy of assessing the state of the stent and patency of the stented segments of veins. The first stage was to examine the state of the stented venous segment in the mode of grey-scale scanning (B-mode), for which purpose the study was performed in the longitudinal and transverse projections. This made it possible to determine the qualitative state of the stent as either presence or absence of its migration and deformation, completeness of expansion, extravasal compression. The second stage was to locate the venous stent in the mode of colour Doppler mapping (CD-mode), thus making it possible to assess stent patency. The third stage was examination in the spectral Doppler mode with the use of the distal compression test. Ultrasonographically detected phasic, respiration-synchronized blood flow with an increase of its linear velocity proximal to the stent in distal compression (positive compression test) is suggestive of no obstructive alterations in the stent's lumen. Determination of the blood flow velocity makes it possible to evaluate the stent patency or stenotic alterations. Monophasic low-velocity blood flow in the ipsilateral common femoral artery may also be indirectly indicative of impaired stent patency (pronounced stenosis, thrombosis, occlusion). The proposed algorithm of ultrasonographic triplex study of patency of venous stents may be used in out-patient conditions repeatedly and safely for the patient.


Assuntos
Veia Ilíaca , Trombose Venosa , Algoritmos , Veia Femoral , Humanos , Veia Ilíaca/diagnóstico por imagem , Flebografia , Estudos Retrospectivos , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
19.
Angiol Sosud Khir ; 27(1): 107-112, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33825736

RESUMO

AIM: The aim of our investigation was to analyse the results of treatment of patients with atherosclerotic lesions of the femoropopliteal segment by means of femoropopliteal bypass grafting or loop endarterectomy within the framework of a single-centre retrospective study. PATIENTS AND METHODS: The study included a total of 177 patients who were divided into two groups. Group One was composed of 108 patients subjected to loop endarterectomy from the arteries of the femoropopliteal segment, and Group Two comprised 69 patients who endured femoropopliteal bypass surgery using a synthetic graft. RESULTS: Thoroughly analysed were the clinical, demographic, anatomical and perioperative data, as well as intra- and perioperative complications, followed by assessment of primary and secondary patency, with no statistically significant differences in these parameters revealed. Secondary patency was somewhat better in the group of loop endarterectomy. Also determined and examined were specific complications such as insufficient extraction of the plaque, perforation of the artery with the loop, thinning of the wall, detachment of the calcified plaque. This is followed by discussing variants of correction of similar events. In the group of loop endarterectomy, there were no severe complications, such as myocardial infarction, stroke, amputation in the early postoperative period. CONCLUSION: Loop endarterectomy is an acceptable alternative to femoropopliteal bypass grafting with a synthetic prosthesis. Taking into account all specific complications, it is possible to achieve minimization of unsuccessful outcomes.


Assuntos
Endarterectomia , Artéria Poplítea , Endarterectomia/efeitos adversos , Artéria Femoral/cirurgia , Humanos , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular
20.
Angiol Sosud Khir ; 27(1): 113-119, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33825737

RESUMO

Our study was aimed at determining advantages of profundoplasty in patients with critical ischaemia of lower limbs in repeat arterial reconstructions. It included a total of 56 patients subjected to redo operations for thrombosis of a femoropopliteal bypass graft. Of these, 29 underwent profundoplasty (group I) and 27 repeat femoropopliteal bypass grafting (group II). Critical ischaemia was relieved in the early postoperative period in 28 (97%) and 24 (89%) patients of group I and II, respectively. The 3-year patency rate after profundoplasty amounted to 100% and after femoropopliteal bypass grafting to 47% (p<0.05). The lower-limb amputation rates over the 3-year period of follow up amounted to 3 (10%) and 11 (41%), p<0.05, respectively. Over the 3-year period of follow up, there was no statistically significant difference in the values of the ankle-brachial index (p>0.05).


Assuntos
Artéria Femoral , Isquemia , Artéria Femoral/cirurgia , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/cirurgia , Extremidade Inferior/cirurgia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/efeitos adversos
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