Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 426
Filtrar
1.
Br J Radiol ; 93(1108): 20190751, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32017608

RESUMO

OBJECTIVE: To determine the utility of low-dose gelatin sponge particles and 5% ethanolamine oleate iopamidol (EOI) mixture in retrograde transvenous obliteration (GERTO) for gastric varices (GV). METHODS: 57 consecutive patients who underwent balloon-occluded retrograde transvenous obliteration (B-RTO) for GV were divided into three groups with Hirota's grade by balloon-occluded retrograde transvenous venography. Hirota's Grade 1 patients were assigned to G1 group and underwent treatment with 5% EOI. Grade ≥ 2 patients prior to August 2015 were G ≥ 2 group treated with 5% EOI, and those treated thereafter were GERTO group. The amount of EOI used per unit GV volume (EOI/GV ratio), the times to embolization and recurrence rate of GV were evaluated. RESULTS: The EOI/GV ratio was 0.66 ± 0.19 in G1, 1.5 ± 0.8 in G ≥ 2, and 0.58 ± 0.23 in GERTO (G ≥ 2 vs GERTO, p < 0.0001). The times to embolization were 26.5 ± 10.5 min for G1, 39.2 ± 26.8 for G ≥ 2, and 21.4 ± 9.4 for GERTO (G ≥ 2 vs GERTO, p = 0.005). The recurrence rate was not significantly different in any of the groups. CONCLUSION: GERTO was performed in lower amount of sclerosants and in less time compared to conventional B-RTO in Hirota's grade ≥2. ADVANCES IN KNOWLEDGE: Feasibility of low-dose gelatin sponge particles and 5% EOI mixture as sclerosants for GV.


Assuntos
Oclusão com Balão/métodos , Varizes Esofágicas e Gástricas/terapia , Gelatina/administração & dosagem , Iopamidol/administração & dosagem , Ácidos Oleicos/administração & dosagem , Soluções Esclerosantes/administração & dosagem , Idoso , Oclusão com Balão/efeitos adversos , Combinação de Medicamentos , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Flebografia/métodos
2.
J Trauma Acute Care Surg ; 88(2): 298-304, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31996655

RESUMO

BACKGROUND: Partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) and intermittent REBOA (iREBOA) are techniques to extend the therapeutic duration of REBOA by balloon titration for distal flow or cyclical balloon inflation/deflation to allow transient distal flow, respectively. We hypothesized that manually titrated pREBOA would reduce blood losses and ischemic burden when compared with iREBOA. METHODS: Following 20% blood volume controlled hemorrhage, 10 anesthetized pigs underwent uncontrolled hemorrhage from the right iliac artery and vein. Once in hemorrhagic shock, animals underwent 15 minutes of complete zone 1 REBOA followed by 75 minutes of either pREBOA or iREBOA (n = 5/group). After 90 minutes, definitive hemorrhage control was obtained, animals were resuscitated with the remaining collected blood, and then received 2 hours of critical care. RESULTS: There were no differences in mortality. Animals randomized to iREBOA spent a larger portion of the time at full occlusion when compared with pREBOA (median, 70 minutes; interquartile range [IQR], 70-80 vs. median, 20 minutes; IQR, 20-40, respectively; p = 0.008). While the average blood pressure during the intervention period was equivalent between groups, this was offset by large fluctuations in blood pressure and significantly more rescue occlusions for hypotension with iREBOA. Despite lower maximum aortic flow rates, the pREBOA group tolerated a greater total amount of distal aortic flow during the intervention period (median, 20.9 L; IQR, 20.1-23.0 vs. median, 9.8 L; IQR, 6.8-10.3; p = 0.03) with equivalent abdominal blood losses. Final plasma lactate and creatinine concentrations were equivalent, although iREBOA animals had increased duodenal edema on histology. CONCLUSION: Compared with iREBOA, pREBOA reduced the time spent at full occlusion and the number of precipitous drops in proximal mean arterial pressure while delivering more distal aortic flow but not increasing total blood loss in this highly lethal injury model. Neither technique demonstrated a survival benefit. Further refinement of these techniques is necessary before clinical guidelines are issued.


Assuntos
Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Ressuscitação/métodos , Choque Hemorrágico/terapia , Ferimentos e Lesões/terapia , Animais , Aorta/cirurgia , Oclusão com Balão/efeitos adversos , Oclusão com Balão/instrumentação , Modelos Animais de Doenças , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Ressuscitação/efeitos adversos , Ressuscitação/instrumentação , Choque Hemorrágico/etiologia , Choque Hemorrágico/mortalidade , Análise de Sobrevida , Sus scrofa , Fatores de Tempo , Índices de Gravidade do Trauma , Resultado do Tratamento , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico
3.
J Trauma Acute Care Surg ; 88(2): 305-309, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31804421

RESUMO

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a viable resuscitation approach for a subdiaphragmatic injury that can regulate arterial blood flow. On the other hand, the evaluation of venous or portal venous blood flow during REBOA remains insufficient because invasive cannulation or exposure of the vessel may affect the blood flow, and Doppler echography is highly operator-dependent. However, phase contrast magnetic resonance imaging has enabled accurate evaluation and noninvasive measurement. This study aimed to investigate the change of venous and portal venous blood flow during REBOA in a porcine model. METHODS: Seven pigs were anesthetized, and a REBOA catheter was placed. The blood flows of the inferior vena cava (IVC), hepatic vein (HV), portal vein (PV), and superior vena cava (SVC) were measured using phase contrast magnetic resonance imaging, in both the balloon deflated (no-REBOA) and fully balloon inflated (REBOA) states. Mean arterial pressure (MAP), central venous pressure, cardiac index, and systemic vascular resistance index were measured. RESULTS: The blood flows of the suprahepatic, infrahepatic, and distal IVC, HV, and PV in the no-REBOA state were 1.40 ± 0.36 L·min, 0.94 ± 0.16 L·min, 0.50 ± 0.19 L·min, 0.060 ± 0.018 L·min, and 0.32 ± 0.091 L·min, respectively. The blood flow of each section in the REBOA condition was significantly decreased at 0.41 ± 0.078 (33% of baseline), 0.15 ± 0.13 (15%), 0.043 ± 0.034 (9%), 0.029 ± 0.017 (37%), and 0.070 ± 0.034 L·min (21%), respectively. The blood flow of the SVC increased significantly in the REBOA condition (1.4 ± 0.63 L·min vs. 0.53 ± 0.14 L·min [257%]). Mean arterial pressure, central venous pressure, cardiac index, and systemic vascular resistance index were significantly increased after REBOA inflation. CONCLUSION: Resuscitative endovascular balloon occlusion of the aorta decreased blood flows of the IVC, HV, and PV and increased blood flow of the SVC. This result could be explained by the collateral flow from the lower body to the SVC. A better understanding of the effect of REBOA on the venous and portal venous systems may help control liver injury.


Assuntos
Oclusão com Balão/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Sistema Porta/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Ressuscitação/efeitos adversos , Animais , Aorta/cirurgia , Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Fígado/lesões , Imagem por Ressonância Magnética , Masculino , Modelos Animais , Sistema Porta/diagnóstico por imagem , Ressuscitação/métodos , Choque Hemorrágico/etiologia , Choque Hemorrágico/terapia , Suínos , Porco Miniatura
4.
Vasc Endovascular Surg ; 54(3): 214-219, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31878841

RESUMO

OBJECTIVES: This study aimed to assess the feasibility and results of double-lumen balloon-assisted embolization of visceral artery aneurysms (VAAs). METHODS: Nine patients (mean age, 55.3 ± 10.8 years) diagnosed with VAA (superior mesenteric, n = 5; splenic, n = 2; renal, n = 2) and undergoing double-lumen balloon-assisted embolization were included in this study. Magnetic resonance angiogram (MRA) was used in the 6-month follow-up to assess the aneurysms and patency of the parent arteries. RESULTS: All patients were successfully treated with no reports of morbidity or mortality. Residual filling of the aneurysm neck was detected in 2 patients at the end of the procedure, but those parts were found to be stable in the sixth-month MRA. In 1 patient with renal aneurysm, a stent had to be deployed using a double-lumen balloon catheter because of the prolapse of the coil into the main artery. In another patient with a very large-necked superior mesenteric artery aneurysm, additional coils could be used at the same time thanks to the double-lumen balloon as the coils were not stabilized enough during embolization with the microcatheter coils. Liquid embolic agent was also used in this patient from the same lumen because of the large diameter of the aneurysm. CONCLUSIONS: Double-lumen balloons, which are mostly used in neurointerventional procedures, can be efficiently used as in the treatment of VAAs due to their ability to deploy stent and perform coil-liquid embolization through 1 lumen.


Assuntos
Aneurisma/terapia , Oclusão com Balão/instrumentação , Dispositivos de Acesso Vascular , Vísceras/irrigação sanguínea , Idoso , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Oclusão com Balão/efeitos adversos , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(51): e18446, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861017

RESUMO

Thrombosis is one of the serious complications related to prophylactic balloon occlusion of the abdominal aorta (PBOAA). This study aims to retrospectively analyze the efficacy and safety of continuous low-flow infusion of diluted heparin saline to prevent this complication related to PBOAA and further to provide the theory and evidences for using PBOAA.A study was carried out at our hospital from March 2016 to December 2018. Women with pernicious placenta previa (PPP) were treated PBOAA to prevent massive bleeding during CS. According to whether continuous low-flow infusion of diluted heparin saline was used to prevent catheter-related thrombosis or not, they were divided into 2 groups, the test group and the control group. The incidence of thrombosis between the 2 groups was compared and the effective treatment of thrombosis was also discussed. The comparison of nonparametric values was accomplished by using Fisher exact test. Statistical significance was set at P < .05.There were 31 women with PPP who received PBOAA during CS who were included in our study. Six of 19 women in control group (31.6%) developed thrombotic complications, while none of 12 women in test group. There were statistically significant differences in the incidence of thrombosis between the 2 groups (P = .037). There was no statistically significant difference in the amount of estimated blood loss and blood transfusion during CS between the 2 groups, nor was there statistically significant difference in the hospital days after CS (P > .05). All 6 women with thrombotic complications had no positive symptoms and thrombotic sequelae. The managements of thrombus included systemic anticoagulation, catheter-directed thrombolysis, and catheter-directed anticoagulation. One of the 6 women was lost to follow-up, and the thrombus of the other 5 women were completely dissolved. No other adverse outcomes or complications related to PBOAA were observed in all women in this study.Continuous low-flow infusion of diluted heparin saline is a safe procedure when PBOAA is performed for patients with PPP. It can effectively reduce or even avoid thrombosis without increasing intraoperative blood loss during CS for PPP patients.


Assuntos
Anticoagulantes/administração & dosagem , Aorta Abdominal , Oclusão com Balão/efeitos adversos , Heparina/administração & dosagem , Trombose/prevenção & controle , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Placenta Prévia/etiologia , Gravidez , Estudos Retrospectivos , Trombose/etiologia , Hemorragia Uterina/etiologia , Hemorragia Uterina/prevenção & controle
6.
Biomed Res Int ; 2019: 2674758, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31073523

RESUMO

Aims: To evaluate the safety and effectiveness of percutaneous transhepatic antegrade embolization (PTAE) with 2-octyl cyanoacrylate assisted with balloon occlusion of the left renal vein or gastrorenal shunts (GRSs) for the treatment of isolated gastric varices (IGVs) with large GRSs. Methods: Thirty patients with IGVs associated with large GRSs who had underwent PTAE assisted with a balloon to block the opening of the GRS in the left renal vein were retrospectively evaluated and followed up. Clinical and laboratory data were collected to evaluate the technical success of the procedure, complications, changes in the liver function using Child-Pugh scores, worsening of the esophageal varices, the rebleeding rate, and survival. Laboratory data obtained before and after PTAE were compared (paired-sample t-test). Results: PTAE was technically successful in all 30 patients. No serious complications were observed except for one nonsymptomatic pulmonary embolism. During a mean follow-up of 30 months, rebleeding was observed in 4/30 (13.3%) patients, worsening of esophageal varices was observed in 4/30 (13.3%) patients, and newly developed or aggravated ascites were observed on CT in 3/30 (10%) patients. Significant improvement was observed in Child-Pugh scores (p=0.009) and the international normalized ratio (INR) (p=0.004) at 3 months after PTAE. The cumulative survival rates at 1, 2, 3, and 5 years were 96.3%, 96.3%, 79.9%, and 79.9%, respectively. Conclusion: Balloon-assisted PTAE with 2-octyl cyanoacrylate is technically feasible, safe, and effective for the treatment of IGV associated with a large GRS.


Assuntos
Oclusão com Balão/métodos , Embolização Terapêutica/métodos , Varizes Esofágicas e Gástricas/terapia , Cirrose Hepática/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Oclusão com Balão/efeitos adversos , Cianoacrilatos/administração & dosagem , Varizes Esofágicas e Gástricas/fisiopatologia , Feminino , Fístula/fisiopatologia , Fístula/terapia , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/patologia , Hemorragia/complicações , Hemorragia/patologia , Humanos , Estimativa de Kaplan-Meier , Fígado/fisiopatologia , Cirrose Hepática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Veias Renais/efeitos dos fármacos , Veias Renais/cirurgia , Adesivos Teciduais/administração & dosagem , Resultado do Tratamento
7.
J Trauma Acute Care Surg ; 87(3): 590-598, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31145381

RESUMO

BACKGROUND: The cardiac effects of resuscitative endovascular balloon occlusion of the aorta (REBOA) are largely unknown. We hypothesized that increased afterload from REBOA would lead to cardiac injury, and that partial flow using endovascular variable aortic control (EVAC) would mitigate this injury. METHODS: Eighteen anesthetized swine underwent controlled 25% blood volume hemorrhage. Animals were randomized to either Zone 1 REBOA, Zone 1 EVAC, or no intervention (control) for 45 minutes. Animals were then resuscitated with shed blood, observed during critical care, and euthanized after a 6-hour total experimental time. Left ventricular function was measured with a pressure-volume catheter, and blood samples were drawn at routine intervals. RESULTS: The average cardiac output during the intervention period was higher in the REBOA group (9.3 [8.6-15.4] L/min) compared with the EVAC group (7.2 [5.8-8.0] L/min, p = 0.01) and the control group (6.8 [5.8-7.7] L/min, p < 0.01). At the end of the intervention, the preload recruitable stroke work was significantly higher in both the REBOA and EVAC groups compared with the control group (111.2 [102.5-148.6] and 116.7 [116.6-141.4] vs. 67.1 [62.7-87.9], p = 0.02 and p < 0.01, respectively). The higher preload recruitable stroke work was maintained throughout the experiment in the EVAC group, but not in the REBOA group. Serum troponin concentrations after 6 hours were higher in the REBOA group compared with both the EVAC and control groups (6.26 ± 5.35 ng/mL vs 0.92 ± 0.61 ng/mL and 0.65 ± 0.38 ng/mL, p = 0.05 and p = 0.03, respectively). Cardiac intramural hemorrhage was higher in the REBOA group compared with the control group (1.67 ± 0.46 vs. 0.17 ± 0.18, p = 0.03), but not between the EVAC and control groups. CONCLUSION: In a swine model of hemorrhagic shock, complete aortic occlusion resulted in cardiac injury, although there was no direct decrease in cardiac function. EVAC mitigated the cardiac injury and improved cardiac performance during resuscitation and critical care.


Assuntos
Aorta , Oclusão com Balão , Procedimentos Endovasculares/métodos , Isquemia Miocárdica/prevenção & controle , Ressuscitação/métodos , Animais , Aorta/fisiopatologia , Aorta/cirurgia , Oclusão com Balão/efeitos adversos , Oclusão com Balão/métodos , Modelos Animais de Doenças , Feminino , Masculino , Isquemia Miocárdica/etiologia , Choque Hemorrágico/terapia , Suínos , Função Ventricular Esquerda
8.
BMJ Case Rep ; 12(5)2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31092493

RESUMO

Oesophageal balloon tamponade tubes are a rare cause of ST-segment elevation (STE), thought to result from extrinsic compression of coronary arteries. This case describes STE following the use of a Sengstaken-Blakemore tube (SBT) under traction for management of bleeding oesophageal varices during orthotopic liver transplantation. This case is the first to report a significant troponin rise with STE indicative of myocardial injury following the use of SBT. Interestingly, we found that releasing traction from the SBT resulted in resolution of STE within minutes, suggesting that SBT traction may reversibly impede coronary perfusion. We recommend vigilant monitoring of patients following SBT insertion and for clinicians to consider that SBT traction may impair coronary perfusion and result in myocardial injury in patients without pre-existing coronary artery disease.


Assuntos
Oclusão com Balão/efeitos adversos , Varizes Esofágicas e Gástricas/terapia , Transplante de Fígado/efeitos adversos , Isquemia Miocárdica/etiologia , Drenagem , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade
9.
Heart Surg Forum ; 22(2): E063-E069, 2019 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-31013213

RESUMO

BACKGROUND: Great saphenous vein (GSV) graft failure is one of the major reasons for repeat bypass grafting. A comparison of the effects of simultaneous, short-duration, externally squeezing and internally distending forces on the same segment of ex-vivo human GSV has not yet been published, although similar studies have compared the experimental injury of different ex-vivo human veins. METHODS: Approximately 8-cm-long segments of GSV were harvested from each of the 15 patients. For each specimen, one end of the vein piece was occluded at a distance of 1 cm with an external cross-clamp for 5 min and the other end was similarly occluded at a distance of 1 cm by an endoluminal balloon. The middle sections of the veins, which were not occluded by any means, were taken as the control group. Two histologists, who were blinded to the groups, graded the hematoxylin and eosin (H&E) and Weigert-Van Gieson (WVG) stained sections semi-quantitatively and performed the histomorphometric measurements. RESULTS: The result of the histopathological evaluation of the intima layer showed that the microscopic scoring of lesions in the balloon group was significantly higher than that in the clamp and control groups (5.16 ± 1.32, 3.83 ± 0.75, and 1.00 ± 1.09, respectively; P < .001). In the adventitia layer, this level of scoring increased more in the clamp group than in the balloon and control groups (5.16 ± 1.16, 3.00 ± 0.89, and 0.16 ± 0.40, respectively, P < .001). CONCLUSION: Both the endoluminal balloon and external clamp techniques have harmful effects on the vein wall. Studying different kind of forces on different veins cannot provide us with reliable comparisons.


Assuntos
Oclusão com Balão/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte de Artéria Coronária , Veia Safena/lesões , Veia Safena/transplante , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Feminino , Humanos , Técnicas In Vitro , Masculino , Pessoa de Meia-Idade
10.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(2): 87-93, mar.-abr. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-182007

RESUMO

Microsurgical clipping is still regarded as the gold-standard treatment for broad-neck intracranial aneurysms. New endovascular techniques like balloon or stent assisted coiling are quickly rising to the challenge and showing promising outcomes. As a result, broad-neck aneurysms are increasingly addressed by these techniques despite they have not been tested against clipping in a randomized controlled trial and long-term complications might be unknown yet. Intraprocedural coil migration has been well documented in the literature, but the same complication in a delayed fashion is scarcely reported. We present a case of delayed coil migration occurring after a balloon-assisted embolization of a wide-necked intracranial aneurysm and we perform a literature review for similar cases. We discuss how, despite seeming an extremely rare complication, with new endovascular techniques increasingly perceived as the safer option in any aneurysm, potential adverse events may become more frequent. Strategies proposed to address this developing scenario are also reviewed


El clipaje microquirúrgico todavía se considera el tratamiento de elección para los aneurismas intracraneales de cuello ancho. Técnicas de embolización asistida por balón o stent se han desarrollado para estas lesiones y muestran resultados prometedores. Como consecuencia, los aneurismas de cuello ancho se abordan cada vez más mediante estas técnicas, a pesar de que no existen ensayos controlados aleatorizados al respecto, y las complicaciones a largo plazo podrían ser desconocidas. La migración intraprocedimiento de un coil está bien documentada, pero la misma complicación de forma tardía apenas está descrita. Presentamos un caso de migración tardía de un coil tras embolización asistida con balón de un aneurisma intracraneal de cuello ancho y revisamos la literatura para casos similares. Argumentamos que, a pesar de parecer una complicación extremadamente rara, con la creciente percepción de que las nuevas técnicas endovasculares son la opción más segura en cualquier aneurisma, los potenciales eventos adversos pueden aumentar. También revisamos las estrategias propuestas para abordar este nuevo escenario


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Embolização Terapêutica/efeitos adversos , Aneurisma Intracraniano/diagnóstico por imagem , Oclusão com Balão/efeitos adversos , Migração de Corpo Estranho/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Stents , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/cirurgia
11.
Biomed Res Int ; 2019: 3793840, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30863777

RESUMO

Background: The safety of cervical rotatory manipulation (CRM) is still controversial, especially in patients with carotid artery atherosclerosis (CAS). The study aimed to investigate the effects of CRM on carotid plaques in vulnerability. Methods: 50 rabbits were randomly divided into four groups: model rabbits with CRM [CAS-CRM (n=15)]; model rabbits without CRM [CAS (n=15)]; normal rabbits with CRM [Normal-CRM (n=10)]; and Blank-control group (n=10). CAS disease models were induced by carotid artery balloon injury combined with a high-fat diet for 12 weeks. Then, CRM technique was performed in CAS-CRM and Normal-CRM groups for 3 weeks. In the end, determination of serum level of hs-CRP and Lp-PLA2, histological analysis under HE and Masson trichromic staining, and immunohistochemical analysis with CD34 and CD68 antibody were completed in order. Results: Carotid stenosis rates on successful model rabbits ranged from 70% to 98%. The CAS-CRM group had an increased level of hs-CRP (P<0.05), in comparison with the CAS group, whereas effects were not significant between the Normal-CRM group and Blank-control group. In comparison with the CAS group, the positive expression of CD34 and CD68 in the CAS-CRM group increased significantly (P<0.05). Conclusion: CRM therapy may increase the vulnerability of carotid plaque in rabbits with severe CAS.


Assuntos
Oclusão com Balão/efeitos adversos , Proteína C-Reativa/genética , Doenças das Artérias Carótidas/cirurgia , Manipulação da Coluna/efeitos adversos , Placa Aterosclerótica/cirurgia , Animais , Antígenos CD34/genética , Proteína C-Reativa/metabolismo , Artérias Carótidas/metabolismo , Artérias Carótidas/fisiopatologia , Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/sangue , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/fisiopatologia , Lesões das Artérias Carótidas/metabolismo , Lesões das Artérias Carótidas/fisiopatologia , Lesões das Artérias Carótidas/cirurgia , Dieta Hiperlipídica , Modelos Animais de Doenças , Regulação da Expressão Gênica/genética , Humanos , Placa Aterosclerótica/sangue , Placa Aterosclerótica/etiologia , Placa Aterosclerótica/fisiopatologia , Coelhos
12.
J Vasc Interv Radiol ; 30(3): 342-346, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30819475

RESUMO

This report describes a single-center experience with balloon-occluded transarterial chemoembolization for liver-directed therapy. A total of 26 patients (11 male, 4 female; mean age, 65 y ± 7) with 28 tumors (mean diameter, 2.7 cm; range, 1.1-5.9 cm) were treated. Technical success rate was 100% (28 of 28 cases), with 1 minor complication of left portal vein thrombosis and small liver infarct. Of the 15 tumors analyzed for response, 60% (9 of 15) exhibited complete response, 33.3% (5 of 15) exhibited partial response, and 6.6% (1 of 15) had stable disease on follow-up. Eight patients exhibited overall progression with a new hepatic lesion and a median time to progression of 7.9 months (range, 5-11 mo).


Assuntos
Oclusão com Balão , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Idoso , Angiografia Digital , Oclusão com Balão/efeitos adversos , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/efeitos adversos , Progressão da Doença , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Cidade de Nova Iorque , Dados Preliminares , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Curr Opin Anaesthesiol ; 32(2): 213-226, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30817398

RESUMO

PURPOSE OF REVIEW: Hemorrhage is the major cause of early death in severely injured patients. In civilian emergency medical services, the majority of life-threatening bleedings are found in noncompressible body regions (e.g. abdomen and pelvis). Resuscitative endovascular balloon occlusion of the aorta (REBOA) has therefore been discussed in recent years as a possible lifesaving procedure and numerous studies, meta-analyses and guidelines have been published. In this review, the data situation of REBOA in the management of bleeding trauma patients is discussed and practical implementation is depicted. RECENT FINDINGS: The typical indication for REBOA is a traumatic life-threatening hemorrhage below the diaphragm in patients unresponsive or only transiently responsive to the usual conservative therapeutic measures. REBOA appears to be a safe and effective procedure to reduce blood loss and stabilize the patient's hemodynamic status. However, surgical hemostasis has to be achieved within 30-60 min after occlusion of the aorta. Data on clear advantages of REBOA over resuscitative thoracostomy are inconclusive. SUMMARY: REBOA could play an important role in the management of the severely bleeding patient in the future. Together with transfusion and therapy of coagulation disorders, REBOA may be an additional tool in the anesthetist's hands for trauma management in interprofessional care concepts.


Assuntos
Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Hemorragia/terapia , Ressuscitação/métodos , Toracostomia/métodos , Ferimentos e Lesões/complicações , Aorta/cirurgia , Oclusão com Balão/efeitos adversos , Procedimentos Endovasculares/instrumentação , Hemorragia/diagnóstico , Hemorragia/etiologia , Humanos , Escala de Gravidade do Ferimento , Índice de Gravidade de Doença , Toracostomia/efeitos adversos , Fatores de Tempo , Tronco , Resultado do Tratamento , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
14.
Semin Liver Dis ; 39(2): 178-194, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30912098

RESUMO

Failure to control variceal bleeding with current recommendations occurs in 10 to 20% of cases. This systematic review and meta-analysis analyzes the experience, results, and complications of "bridge" therapies for failure to control acute variceal bleeding: balloon tamponade and esophageal stents. The main outcomes assessed were failure to control bleeding and mortality in the short-term and medium-term follow-up, and adverse events. Balloon tamponade studies had a pooled rate of short-term failure to control bleeding of 35.5%, and adverse events in over 20% of cases; 9.7% resulting in death. Stenting failed to control bleeding in the short term and medium term in 12.7 and 21.5% of cases of severe or refractory variceal bleeding, respectively, despite stent migration in 23.8% of cases. Medium-term mortality rates were similar in both therapies. Although only one trial compared these treatments, the available evidence consistently supports that stents serve as a better and safer bridge therapy in refractory acute variceal bleeding.


Assuntos
Oclusão com Balão/métodos , Hemorragia Gastrointestinal/terapia , Cirrose Hepática/complicações , Stents , Adulto , Idoso , Oclusão com Balão/efeitos adversos , Oclusão com Balão/mortalidade , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/mortalidade , Varizes Esofágicas e Gástricas/terapia , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Stents/efeitos adversos , Falha de Tratamento
15.
J Vasc Interv Radiol ; 30(2): 187-194, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30717949

RESUMO

PURPOSE: To assess short- and long-term mortality and rebleeding with endoscopic cyanoacrylate (EC) versus balloon-occluded retrograde transvenous obliteration (BRTO). MATERIALS AND METHODS: A retrospective cohort comparison was conducted of 90 EC patients and 71 BRTO patients from 1997 through 2015 with portal hypertension who presented due to endoscopically confirmed bleeding cardiofundal gastric varices. Patients underwent either endoscopic intra-varix injection of 4-carbon-n-butyl-2-cyanoacrylate or sclerosis with sodium tetradecyl sulfate with balloon occlusion for primary variceal treatment. RESULTS: Seventy-one BRTO patients and 90 EC patients, of whom 89% had cirrhosis and 35% were women, were included, with a respective average Model for End-Stage Liver Disease (MELD) score of 13.4 and 14.4, respectively. Mortality at 6 weeks was 14.4% for EC patients and 13.1% for BRTO patients (Kaplan-Meier/Wilcoxon, P = .85). No long-term mortality difference was observed (Cox hazard ratio [HR] = 0.89, P = .64). Also, 5.1% of EC patients and 3.5% of BRTO patients (Kaplan-Meier/Wilcoxon, P = .62) rebled at 6 weeks, but at 1 year, 22.0% of EC patients and 3.5% of BRTO patients had rebled (Kaplan-Meier/Wilcoxon, P < .01). Lower rates of long-term rebleeding were found with BRTO (Cox HR = 0.25, P = .03). No difference was seen in the rate of new portal hypertensive complications (Cox HR = 1.21, P = .464). However, 16/71 patients who underwent BRTO had simultaneous transjugular intrahepatic portosystemic shunt. Age, sex, MELD score, and presence of cirrhosis were the primary predictors of mortality. One death in the EC group and 5 deaths in the BRTO group were deemed to be procedurally related (chi-square, P = .088). CONCLUSIONS: BRTO is associated with a lower rate of rebleeding but no change in mortality.


Assuntos
Oclusão com Balão , Embucrilato/administração & dosagem , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/métodos , Adulto , Idoso , Oclusão com Balão/efeitos adversos , Oclusão com Balão/mortalidade , Embucrilato/efeitos adversos , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/mortalidade , Feminino , Seguimentos , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemostase Endoscópica/efeitos adversos , Hemostase Endoscópica/mortalidade , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
16.
Gynecol Obstet Invest ; 84(4): 343-349, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30625467

RESUMO

BACKGROUND: We aimed to compare the hemostatic effect and perioperative outcomes between internal iliac artery (IIA) and abdominal aorta (AA) balloon occlusions in pernicious placenta previa patients complicated with placenta accrete and underwent cesarean delivery. METHODS: One hundred and twenty-three pernicious placenta previa patients complicated with placenta accrete were retrospectively reviewed. Patients who received IIA or AA occlusions were subsequently divided into the IIA group (n = 71) and AA group (n = 52). Estimated blood loss (EBL) and blood transferring volume were evaluated. RESULTS: No difference was observed in EBL during cesarean delivery, EBL within 24 h or blood transferring volume between IIA and AA groups. Subgroup analysis disclosed that AA occlusion presented lower EBL during cesarean delivery and EBL within 24 h compared to IIA occlusion in placenta percreta subgroup. For secondary outcomes, IIA occlusion caused better Apgar score at 1 min but higher rates of IIA ligation and iodoform gauze packing of the uterine cavity compared to AA occlusion. Multivariate linear analysis revealed that invasion depth independently predicted worse EBL. CONCLUSION: IIA and AA occlusions have similar hemostatic effects in pernicious placenta previa patients with placenta accrete underwent cesarean delivery, while AA occlusion is more effective in reducing EBL in placenta percreta subgroup.


Assuntos
Aorta Abdominal/cirurgia , Oclusão com Balão/métodos , Artéria Ilíaca/cirurgia , Placenta Acreta/cirurgia , Placenta Prévia/cirurgia , Adulto , Oclusão com Balão/efeitos adversos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Feminino , Humanos , Ligadura/efeitos adversos , Ligadura/métodos , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Útero/cirurgia
17.
J Surg Res ; 236: 247-258, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30694763

RESUMO

BACKGROUND: The aim of this study was to review and summarize the large animal data on resuscitative endovascular balloon occlusion of the aorta (REBOA) for traumatic hemorrhage and identify knowledge gaps pertinent to the proposed broader use of the technique in prehospital situations. METHODS: A review of published large animal models of traumatic hemorrhage incorporating REBOA with a primary outcome of the effect of aortic occlusion was performed. Data were collected on experimental protocols, hemodynamic effects, resuscitation requirements, mortality, metabolic and tissue consequences of induced ischemia-reperfusion, and effects on hemorrhage volume and other injuries. RESULTS: A limited number of REBOA studies exist, and there is variability in the species and size of animals used. Various controlled and uncontrolled hemorrhage protocols have been studied, and a number of balloon devices used. Hemodynamic effects of occlusion were consistent as were basic systemic physiological effects. Minimal study of the effects of partial aortic occlusion and hemodynamic and metabolic physiology distal to the balloon has been performed, and partial or complete occlusion times >90 min have not been studied. CONCLUSIONS: Significant knowledge gaps exist, which are potentially relevant to the expanded use of REBOA. Investigation into the physiology of partial occlusion and the metabolic effects and potential mitigation strategies for large-scale ischemia and reperfusion are particularly needed.


Assuntos
Oclusão com Balão/métodos , Modelos Animais de Doenças , Ressuscitação/métodos , Choque Hemorrágico/terapia , Ferimentos e Lesões/complicações , Animais , Aorta Torácica , Oclusão com Balão/efeitos adversos , Humanos , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/prevenção & controle , Ressuscitação/efeitos adversos , Choque Hemorrágico/etiologia
18.
Ann Vasc Surg ; 55: 307.e1-307.e4, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30059759

RESUMO

Gastric varices are a common manifestation of portal hypertension and are associated with a high rate of mortality and rebleeding. Balloon-occluded retrograde transvenous obliteration (BRTO) is a commonly used method to sclerose gastric varices and has a high clinical success. Common complications following BRTO include portal or splenic vein thrombosis, systemic sclerosant extravasation, pulmonary emboli, and inferior vena cava thrombosis. This report describes a patient with vascular plug migration into the left pulmonary artery with subsequent endovascular retrieval.


Assuntos
Oclusão com Balão/efeitos adversos , Remoção de Dispositivo/métodos , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares , Varizes Esofágicas e Gástricas/cirurgia , Migração de Corpo Estranho/cirurgia , Hemorragia Gastrointestinal/terapia , Artéria Pulmonar/cirurgia , Dispositivos de Oclusão Vascular , Angiografia Digital , Angiografia por Tomografia Computadorizada , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/fisiopatologia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/fisiopatologia , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/diagnóstico , Hipertensão Portal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pressão na Veia Porta , Artéria Pulmonar/diagnóstico por imagem , Resultado do Tratamento
20.
Artigo em Inglês | MEDLINE | ID: mdl-30453089

RESUMO

Restenosis is a major problem after percutaneous coronary intervention (PCI) treatment. Inflammation is one of the major core mechanisms involved in the occurrence of restenosis, and plays an important role in intimal hyperplasia. Detoxification and activating blood circulation decoction (DABCD) is a traditional Chinese medicine that is used in the treatment and prevention of atherosclerotic and inflammatory diseases. Our previous studies demonstrated that DABCD-mediated cardioprotection involves anti-inflammatory mechanisms and could be developed as a novel drug for the treatment of vascular smooth muscle cell (VSMC) proliferation and aortic restenosis. A rat model of postoperative restenosis after PCI was generated by balloon injury to determine the protective effects and potential mechanisms of DABCD. The injured segments of aortae were collected on days 14 and 28 after the operation to observe the morphological changes in the vascular structure and measure the proportion of inflammatory factors in plasma and vascular tissues, as well as test the proliferative activity of VSMCs. The expression of related proteins, namely, Toll-like receptor (TLR) 4 and nuclear factor (NF)-κB, in the mechanistic study was clarified by western blot analysis. We tested the hypothesis that the cardioprotective effects of DABCD on aortic restenosis are associated with the inhibition of aortic intimal hyperplasia in this model. Our results showed that DABCD has protective effect on rat aortic restenosis and the anti-inflammatory mechanism of DABCD on balloon-induced restenosis in rat may be due to its ability to inhibit TLR4-mediated NF-κB signaling pathways. DABCD may be a potential therapeutic agent against restenosis.


Assuntos
Oclusão com Balão/efeitos adversos , Circulação Sanguínea/efeitos dos fármacos , Reestenose Coronária/fisiopatologia , Medicamentos de Ervas Chinesas/farmacologia , NF-kappa B/metabolismo , Transdução de Sinais/efeitos dos fármacos , Receptor 4 Toll-Like/metabolismo , Animais , Proliferação de Células/efeitos dos fármacos , Reestenose Coronária/etiologia , Reestenose Coronária/metabolismo , Reestenose Coronária/patologia , Citocinas/metabolismo , Medicamentos de Ervas Chinesas/uso terapêutico , Regulação da Expressão Gênica/efeitos dos fármacos , Masculino , Músculo Liso Vascular/patologia , Ratos , Ratos Sprague-Dawley
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA