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1.
J Cardiothorac Surg ; 16(1): 190, 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233714

RESUMO

OBJECTIVE: Acute aortic dissection is a life-threatening condition. Thoracic endovascular aortic repair (TEVAR), together with optimized medical treatment, is currently the first line treatment for acute Stanford type B aortic dissection. TEVAR can close the entry tear and reduce mortality. Aortic remodeling after TEVAR can directly affect the patient's long-term prognosis. The factors that influence aortic remodeling have, however, received insufficient clinical attention and remain unclear. It is very important to identify these factors. METHODS: A total of 100 patients were continuously enrolled from 2011 to 2018 in 2 centers. Relevant data, including time from hospital admission to surgery, medicine use and aortic computed tomography angiography images obtained before and 6 months after surgery were collected. Patients were divided into favorable and adverse aortic remodeling groups, according to the degree of aortic remodeling. Analysis of variance and the chi-square test were performed using SPSS software to compare differences between groups and to determine the factors that influence postoperative aortic remodeling. RESULTS: The proportion of single-stent implantations was higher in the favorable remodeling group than in the adverse remodeling group (79.5% vs. 53.8% in distal end of stent-graft level and 81.3% vs. 56.4% in diaphragm level, respectively, p < 0.05). The earlier the TEVAR procedure was performed, the better the aortic remodeling (3.4 days vs. 4.8 days in distal stent graft levels, and 3.6 days vs. 4.9 days in diaphragm level, respectively, p < 0.05), the presence of residual distal entry tears in the abdominal aorta also improved aortic remodeling after TEVAR (85.7% vs. 55.1% in the celiac trunk level, and 92.0% vs. 48.9% in the right renal artery level, respectively, p < 0.05). CONCLUSION: Single stent-graft implantation and early surgery were associated with favorable aortic remodeling. Distal entry tears were also conducive to aortic remodeling after surgery for aortic dissection.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Remodelação Vascular/fisiologia , Adulto , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
J Cardiothorac Surg ; 16(1): 185, 2021 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-34174918

RESUMO

BACKGROUND: The Freestyle® bioprosthesis is used for pathologies of the aortic root. Additional resection of the ascending aorta and the proximal arch in dissections or aneurysms might be indicated. The aim was to assess mid-term outcome regarding prosthetic performance, stroke, reoperations, and survival in various pathologies comparing patients with and without additional procedures on the ascending aorta and proximal arch focusing on the standardised technique of unilateral antegrade cerebral perfusion under moderate hypothermia. METHODS: Retrospective data analysis of 278 consecutive patients after Freestyle® root replacement between September 2007 and March 2017. Patients were divided in three categories due to the pathology of the aortic root (re-operation vs endocarditis vs dissection). Two groups based on the aortic anastomosis technique (open arch anastomosis (OA) versus non-open arch anastomosis (non-OA) were compared (119 OA vs 159 non-OA). Cardiovascular risk, previous cardiac events, intra- and postoperative data were evaluated. Inferential statistics were performed with Mann-Whitney U-test. Nominal and categorical variables were tested with Fisher-Freeman-Halton exact test. Kaplan-Meier estimate was used to assess survival. RESULTS: The follow-up rate was 90% (median follow-up: 39.5 months). There were differences in the indication (endocarditis: OA 5 (4.2%) vs non-OA 36 (24%), p < 0.0001; dissection: OA 13 (10.9%) vs non-OA 2 (1.3%); p = 0.0007). OA patients had less perioperative stroke (1 (1%) vs 15 (10%), p = 0.001) and shorter hospital stay (9 vs 12 days, p = 0.0004). There were no differences in the mortality (in-hospital: OA 8 (7%) vs non-OA 8 (5%); p = 0.6; death at follow-up: OA 5 (5%) vs non-OA 15 (11%); p = 0.1). Overall valve performance showed a well-functioning valve in 97.3% at follow-up. CONCLUSION: The valve performance showed excellent results regardless of the initial indication. The incidence of stroke was lower in patients receiving an open arch anastomosis using unilateral antegrade cerebral perfusion without elevated mortality or prolonged hospital stay.


Assuntos
Anastomose Cirúrgica/métodos , Aneurisma Dissecante/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Endocardite/cirurgia , Idoso , Anastomose Cirúrgica/efeitos adversos , Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/mortalidade , Implante de Prótese Vascular/efeitos adversos , Feminino , Humanos , Hipotermia Induzida , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Perfusão , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
6.
Heart Surg Forum ; 24(2): E311-E316, 2021 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-33798045

RESUMO

OBJECTIVES: To assess sex differences of clinical presentation and outcomes in propensity-matched patients with acute type A aortic dissection (AAAD). METHODS: We collected the clinical data of patients with AAAD from a single heart center between January 2009 and July 2014. After propensity score matching, we compared differences in clinical presentation and outcomes of patients with AAAD between men and women. RESULTS: There were 590 patients (295 men and 295 women) with AAAD through propensity matching on demographics and patients' history. We found that the presentation and diagnosis of AAAD often were more delayed in women. Severe signs of congestive heart failure (9.8% vs. 5.1%, P = 0.017), cardiac tamponade/shock (9.1% vs. 4.1%, P < 0.001), and periaortic hematoma (26.4% vs. 21.7%, P < 0.001) were more commonly presented in women. Surgery was more commonly performed in men than in women (95.4% (281/295) vs. 91.5% (270/295), P = 0.045), indicating the association of sex with surgical decision. To investigate the association of sex with outcomes after surgery, patients who underwent surgical treatment were re-matched (262 men and 262 women) by propensity score. Women suffered from greater in-hospital mortality than men (8.4% vs. 3.4%, P < 0.001). Postoperative complications of congestive heart failure (9.1% vs. 3.8%, P < 0.001), visceral ischemia (6.8% vs. 1.1%, P < 0.001), and limb ischemia (7.6% vs. 1.5%, P < 0.001) were more frequent in women. For women, prolonged operative time may increase in-hospital mortality, especially after 12 hours from the start of surgery (30.0% vs. 14.3%, P < 0.001). Kaplan-Meier survival analysis indicated worse late outcomes in women in the matched surgery group (log-rank P = 0.012). CONCLUSIONS: Our analysis provides new insights into sex differences in clinical presentation and outcomes of AAAD.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/mortalidade , Aneurisma da Aorta Torácica/mortalidade , China/epidemiologia , Feminino , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento , Adulto Jovem
7.
Eur J Vasc Endovasc Surg ; 61(6): 920-928, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33875325

RESUMO

OBJECTIVE: Age is an independent risk factor for mortality after both elective open surgical repair (OSR) and endovascular aneurysm repair (EVAR). As a result of an ageing population, and the less invasive nature of EVAR, the number of patients over 80 years (octogenarians) being treated is increasing. The mortality and morbidity following aneurysm surgery are increased for octogenarians. However, the mortality for octogenarians who have either low or high peri-operative risks remains unclear. The aim of this study was to provide peri-operative outcomes of octogenarians vs. non-octogenarians after OSR and EVAR for intact aneurysms, including separate subanalyses for elective and urgent intact repair, based on a nationwide cohort. Furthermore, the influence of comorbidities on peri-operative mortality was examined. METHODS: All patients registered in the Dutch Surgical Aneurysm Audit (DSAA) undergoing intact AAA repair between 2013 and 2018, were included. Patient characteristics and peri-operative outcomes (peri-operative mortality, and major complications) of octogenarians vs. non-octogenarians for both OSR and EVAR were compared using descriptive statistics. Multivariable logistic regression analyses were used to examine whether age and the presence of cardiac, pulmonary, or renal comorbidities were associated with mortality. RESULTS: This study included 12 054 EVAR patients (3 015 octogenarians), and 3 815 OSR patients (425 octogenarians). Octogenarians in both the EVAR and OSR treatment groups were more often female and had more comorbidities. In both treatment groups, octogenarians had significantly higher mortality rates following intact repair as well as higher major complication rates. Mortality rates of octogenarians were 1.9% after EVAR and 11.8% after OSR. Age ≥ 80 and presence of cardiac, pulmonary, and renal comorbidities were associated with mortality after EVAR and OSR. CONCLUSION: Because of the high peri-operative mortality rates of octogenarians, awareness of the presence of comorbidities is essential in the decision making process before offering aneurysm repair to this cohort, especially when OSR is considered.


Assuntos
Aneurisma da Aorta Abdominal , Ruptura Aórtica , Implante de Prótese Vascular , Procedimentos Endovasculares , Complicações Pós-Operatórias , Fatores Etários , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/etiologia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Implante de Prótese Vascular/estatística & dados numéricos , Comorbidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/estatística & dados numéricos , Feminino , Humanos , Masculino , Mortalidade , Países Baixos/epidemiologia , Seleção de Pacientes , Período Perioperatório/mortalidade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Sistema de Registros/estatística & dados numéricos , Risco Ajustado/métodos , Medição de Risco/métodos , Fatores de Risco
10.
Artigo em Inglês | MEDLINE | ID: mdl-33901346

RESUMO

To create an optimal landing zone (zone 2) in the aortic arch for concomitant or subsequent thoracic endovascular aortic repair of aortic diseases (aneurysm, dissection), surgeons frequently need to debranch the supra-aortic vessels. In this video tutorial, we present an alternative to our 2 other video tutorials for surgical debranching of the left subclavian artery (link; link). Depending on patient-specific characteristics, surgical preference and local experience, the surgeon chooses the approach. Here we show how to safely perform a supraclavicular left common carotid artery-to-left subclavian artery bypass.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/métodos , Artéria Carótida Primitiva/cirurgia , Artéria Subclávia/cirurgia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Polietilenotereftalatos
11.
Artigo em Inglês | MEDLINE | ID: mdl-33901349

RESUMO

To create an optimal landing zone (zone 2) in the aortic arch for concomitant or subsequent thoracic endovascular aortic repair of aortic diseases (aneurysm, dissection), surgeons frequently need to debranch the supra-aortic vessels. We present a surgical debranching of the left subclavian artery by performing a centrally located bypass from the left common carotid artery to the left subclavian artery.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Artéria Carótida Primitiva/cirurgia , Procedimentos Endovasculares/métodos , Artéria Subclávia/cirurgia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Polietilenotereftalatos
12.
Artigo em Inglês | MEDLINE | ID: mdl-33901350

RESUMO

To create an optimal landing zone (zone 2) in the aortic arch for concomitant or subsequent thoracic endovascular aortic repair of aortic diseases (aneurysm, dissection), surgeons frequently need to debranch the supra-aortic vessels. We present in this video tutorial an alternative to our video tutorial for surgical debranching of the left subclavian artery in which we used a central approach. When the proximal left subclavian artery is dissected or shows dense adhesions around its proximal, centrally located section, it can be helpful to stretch this bypass to the infraclavicular part of the left subclavian artery.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/métodos , Artéria Carótida Primitiva/cirurgia , Artéria Subclávia/cirurgia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Polietilenotereftalatos
13.
Artigo em Inglês | MEDLINE | ID: mdl-33904265

RESUMO

Therapy for cardiogenic shock using temporary mechanical circulatory support has improved significantly in the last decades, providing patients with new technologies for both acute phase stabilization and bridging to long-term therapies. A combination of a venoarterial extracorporeal life support system and the Impella left ventricular assist device (known as the ECMELLA approach) represents an effective therapy for severe cardiogenic shock that achieves high-flow circulatory support with simultaneous left-ventricular unloading. We present the new ECMELLA 2.0 concept, whereby a single arterial access technique is used to treat severe cardiogenic shock. The goal of this technique is to reduce access-related complications and make a bedside staged weaning from mechanical support possible.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Coração Auxiliar , Implantação de Prótese/métodos , Choque Cardiogênico/cirurgia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Oxigenação por Membrana Extracorpórea/instrumentação , Humanos , Implantação de Prótese/instrumentação
14.
J Cardiothorac Surg ; 16(1): 76, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849597

RESUMO

BACKGROUND: The treatment for extensive aortic arch aneurysms involving the aortic arch and descending aorta is challenging for most cardiovascular surgeons. The surgical treatment is associated with a very high mortality rate. The optimal treatment has not been defined. CASE PRESENTATION: A 49-year-old male was hospitalized due to chest and upper back pain. Computed tomography angiography (CTA) demonstrated there was an extensive aortic arch aneurysm extending to the left common carotid artery and descending aorta. A novel single- stage hybrid surgery was performed on the patient through two steps: treatment of the aortic arch through median sternotomy and thoracic endovascular artery repair. The patient recovered uneventfully. CONCLUSIONS: Our single-stage hybrid repair approach is safe, simple and effective. It provides an alternative treatment for extensive aortic arch aneurysms.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Esternotomia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
15.
J Cardiovasc Surg (Torino) ; 62(4): 369-376, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33829745

RESUMO

BACKGROUND: The aim of this study was to retrospectively analyze early and late outcomes of infrainguinal revascularization performed with the Omniflow-II® (LeMaitre Vascular, Inc., Burlington, MA, USA) biosynthetic vascular graft (BVG) for complex femoro-popliteal obstructive disease. METHODS: Over a 10-year period, this BVG was used in 110 patients who underwent infrainguinal femoro-popliteal or femoro-distal bypass. Early (intraoperative and <30 days) results were analyzed in terms of death, thrombosis, amputations and reinterventions. Follow-up results were analyzed in terms of primary and secondary graft patency, and amputation-free survival. RESULTS: We performed 87 (79.1%) above-the-knee bypass, 20 (18.2%) below-the-knee bypass, and 3 (2.7%) tibial artery bypass. In-hospital mortality was not observed. Mean follow-up was 66±37 months (range, 3-150). Estimated primary patency rate at 1, 2 and 5-years of follow-up was 77%±4 (95%CI: 68-84), 73%±5 (95%CI: 63.5-83), and 59%±6 (95%CI: 47-70.5) respectively. Predictors of primary patency loss were the presence of critical limb ischemia (P=0.048; HR: 2.1; 95%CI: 1.01-4.28), and the necessity of below-the-knee bypass (P=0.012; HR: 2.4; 95%CI: 1.22-4.75). Aneurysmal degeneration of the BVG was detected in 4 (3.6%) patients, an infected BVG occurred in 3 (2.7%) patients. The amputation-free survival was 96%±2 (95%CI: 91-99), 93%±3 (95%CI: 86-96), and 76%±5 (95%CI: 66-84) at 1, 2 and 5-years respectively. CONCLUSIONS: In our experience, Omniflow-II® is a valid first-line alternative for infrainguinal revascularization when the ipsilateral autologous saphenous vein is not available. Aneurysmal degeneration was lower than previously reported with alternative BVGs, and the incidence of BVG infection was acceptably low.


Assuntos
Angiografia/métodos , Bioprótese , Implante de Prótese Vascular/métodos , Prótese Vascular , Artéria Femoral/cirurgia , Artéria Poplítea/cirurgia , Veia Safena/transplante , Idoso , Idoso de 80 Anos ou mais , Feminino , Artéria Femoral/diagnóstico por imagem , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagem , Desenho de Prótese , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia Doppler Dupla/métodos
16.
J Cardiothorac Surg ; 16(1): 89, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33858447

RESUMO

BACKGROUND: Repair of the absence of the whole or major parts of pulmonary arteries is a challenge, and the choice of conduit material to reconstruct the pulmonary arteries is under dispute. We used the autologous innominate vein to construct pulmonary arteries. CASE PRESENTATION L: We present a novel technique using the autologous innominate vein as a free graft in a 6-month-old infant with pulmonary atresia and absence of central pulmonary arteries. Double ductus arteriosus were the only source of perfusion of the lungs. The innominate vein was substituted for the central pulmonary artery between the two lung hila. Total repair by using Contegra graft was performed 9 months later. The patient has been followed for 5 years. CONCLUSIONS: The autologous innominate vein could be used as inter-hilar pulmonary arteries with no calcification and fibrosis in 5-year follow-up.


Assuntos
Implante de Prótese Vascular/métodos , Veias Braquiocefálicas/transplante , Artéria Pulmonar/cirurgia , Atresia Pulmonar/cirurgia , Veias Braquiocefálicas/diagnóstico por imagem , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/fisiopatologia , Seguimentos , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Atresia Pulmonar/complicações , Atresia Pulmonar/diagnóstico por imagem , Reoperação , Transplante Autólogo
17.
Ann Thorac Surg ; 112(2): e143-e145, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33667459

RESUMO

Aortic arch repair with frozen elephant trunk is increasingly offered to patients with extensive thoracic aortic disease. Given the magnitude of such a procedure, reported postoperative mortality and morbidity have to be considered adequate but not negligible. To further improve postoperative outcomes we developed a hybrid approach allowing frozen elephant trunk to be performed without hypothermia and circulatory arrest. After an initial experience in patients with chronic aneurysms, we successfully adopted the same approach in a patient with type 1 acute aortic dissection. Transfemoral stent-graft deployment, balloon clamping, and an always antegrade aortic perfusion are key elements of the approach presented here.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Doença Aguda , Aneurisma Dissecante/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico , Angiografia por Tomografia Computadorizada , Parada Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Stents
19.
Eur J Vasc Endovasc Surg ; 61(6): 988-997, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33762154

RESUMO

OBJECTIVE: To identify factors affecting the outcome after open surgical (OSR) and endovascular (ER) repair of popliteal artery aneurysm (PA) in comparable cohorts. METHODS: A matched comparison in a national, population based cohort of 592 legs treated for PA (2008 - 2012), with long term follow up. Registry data from 899 PA patients treated in 2014 - 2018 were analysed for time trends. The 77 legs treated by ER were matched, by indication, with 154 legs treated with OSR. Medical records and imaging were collected. Analysed risk factors were anatomy, comorbidities, and medication. Elongation and angulations were examined in a core lab. The main outcome was occlusion. RESULTS: Patients in the ER group were older (73 vs. 68 years, p = .001), had more lung disease (p = .012), and were treated with dual antiplatelet therapy or anticoagulants more often (p < .001). The hazard ratio (HR with 95% confidence intervals) for occlusion was 2.69 (1.60 - 4.55, p < .001) for ER, but 3.03 (1.26 - 7.27, p = .013) for poor outflow. For permanent occlusion, the HR after ER was 2.47 (1.35 - 4.50, p = .003), but 4.68 (1.89 - 11.62, p < .001) for poor outflow. In the ER subgroup, occlusion was more common after acute ischaemia (HR 2.94 [1.45 - 5.97], p = .003; and poor outflow HR 14.39 [3.46 - 59.92], p < .001). Larger stent graft diameter reduced the risk (HR 0.71 [0.54 - 0.93], p = .014). In Cox regression analysis adjusted for indication and stent graft diameter, elongation increased the risk (HR 1.020 per degree [1.002 - 1.033], p = .030). PAs treated for acute ischaemia had a median stent graft diameter of 6.5 mm, with those for elective procedures being 8 mm (p < .001). Indications and outcomes were similar during both time periods (2008 - 2012 and 2014 - 2018). CONCLUSION: In comparable groups, ER had a 2.7 fold increased risk of any occlusion, and 2.4 fold increased risk of permanent occlusion, despite more aggressive medical therapy. Risk factors associated with occlusion in ER were poor outflow, smaller stent graft diameter, acute ischaemia, and angulation/elongation. An association between indication, acute ischaemia, and small stent graft diameter was identified.


Assuntos
Aneurisma , Implante de Prótese Vascular , Procedimentos Endovasculares , Oclusão de Enxerto Vascular , Artéria Poplítea , Idoso , Aneurisma/diagnóstico , Aneurisma/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Feminino , Oclusão de Enxerto Vascular/diagnóstico , Oclusão de Enxerto Vascular/epidemiologia , Oclusão de Enxerto Vascular/etiologia , Humanos , Perna (Membro)/irrigação sanguínea , Perna (Membro)/cirurgia , Salvamento de Membro/estatística & dados numéricos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/patologia , Artéria Poplítea/cirurgia , Sistema de Registros/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Medição de Risco , Fatores de Risco , Suécia/epidemiologia , Grau de Desobstrução Vascular
20.
Eur J Vasc Endovasc Surg ; 61(6): 945-953, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33762153

RESUMO

OBJECTIVE: True aneurysms of the peri-pancreatic arcade (PDAA) have been attributed to increased collateral flow related to coeliac axis (CA) occlusion by a median arcuate ligament (MAL). Although PDAA exclusion is currently recommended, simultaneous CA release and the technique to be used are debated. The aim of this retrospective multicentre study was to compare the results of open surgical repair of true non-ruptured PDAA with release or CA bypass (group A) vs. coil embolisation of PDAA and CA stenting or laparoscopic release (group B). METHODS: From January 1994 to February 2019, 57 consecutive patients (group A: 31 patients; group B: 26 patients), including 35 (61%) men (mean age 56 ± 11 years), were treated at three centres. Twenty-six patients (46%) presented with non-specific abdominal pain: 15 (48%) in group A and 11 (42%) in group B (p = .80). RESULTS: No patient died during the post-operative period. At 30 days, all PDAAs following open repair and embolisation had been treated successfully. In group A, all CAs treated by MAL release or bypass were patent. In group B, 2/12 CA stentings failed at < 48 hours, and all MAL released by laparoscopy were successful. Median length of hospital stay was significantly greater in group A than in group B (5 vs. 3 days; p = .001). In group A, all PDAAs remained excluded. In group B, three PDAA recanalisations following embolisation were treated successfully (two redo embolisations and one open surgical resection). At six years, Kaplan-Meier estimates of freedom for PDAA recanalisation were 100% in group A, and 88% ± 6% in group B (p = .082). No PDAA ruptured during follow up. In group A, all 37 CAs treated by MAL release were patent, and one aortohepatic bypass occluded. In group B, five CAs occluded: four after stenting and the other after laparoscopic MAL release with two redo stenting and three aortohepatic bypasses. Estimates of freedom from CA restenosis/occlusion were 95% ± 3% for MAL release or visceral bypass, and 60% ± 9% for CA stenting (p = .001). Two late restenoses following CA stenting were associated with PDAA recanalisation. CONCLUSION: Current data suggest that open and endovascular treatment of PDAA can be performed with excellent post-operative results in both groups. However, PDAA embolisation was associated with few midterm recanalisations and CA stenting with a significant number of early and midterm failures.


Assuntos
Aneurisma , Síndromes Compartimentais , Artéria Hepática , Complicações Pós-Operatórias , Reoperação , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Artéria Celíaca/patologia , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Duodeno/irrigação sanguínea , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Feminino , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/patologia , Artéria Hepática/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pâncreas/irrigação sanguínea , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Reoperação/estatística & dados numéricos , Stents , Estômago/irrigação sanguínea
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