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1.
Vasc Endovascular Surg ; 54(2): 147-161, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31736431

RESUMO

INTRODUCTION: Surgical site infection (SSI) presents a ubiquitous concern to surgical specialties, especially in the presence of prosthetic material. Antibiotic-impregnated beads present a novel and evolving means to combat this condition. This review aims to analyze the quality of evidence and methods of antibiotic bead use, particularly for application within vascular surgery. METHODS: A systematic scoping review was conducted within Embase, MEDLINE, and the Cochrane Registry of Randomized Controlled Trials. Articles were evaluated by 2 independent reviewers. Level of evidence was evaluated using the Oxford Center for Evidence-Based Medicine Criteria and the Cochrane Risk of Bias Tool for Randomized Controlled Trials. RESULTS: The search yielded 6951 papers, with 275 included for final analysis. Publications increased in frequency from 1978 to the present. The most common formulation was polymethyl methacrylate; however publications on biodegradable formulations, including calcium sulfate beads, have been published with increasing frequency. Most publications had positive conclusions (94.2%); however, the data was mainly subjective and may be prone to publication bias. Only 11 randomized controlled trials were identified and all but one was evaluated to be at a high risk of bias. The most common indication was for osteomyelitis (52%), orthopedic prosthetic infections (20%), and trauma (9%). Within vascular surgery, beads have been used primarily for the treatment of graft infection, with freedom from recurrence rates being reported from 41% to 87.5%. CONCLUSIONS: Antibiotic-impregnated beads provide a means to deliver high doses of antibiotic directly to a surgical site, without the risks of parenteral therapy. There has yet to be significant high-level quality data published on their use. There is a large body of evidence that suggests antibiotic beads may be used in SSIs in high-risk patients, prosthetic infections, and other complex surgical infections. Important potential areas of application in vascular surgery include graft infection, prevention of wound infection in high-risk patients, and diabetic foot infection.


Assuntos
Antibacterianos/administração & dosagem , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Portadores de Fármacos , Infecções Relacionadas à Prótese/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/efeitos adversos , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Fatores de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia , Resultado do Tratamento
2.
Vasc Endovascular Surg ; 54(2): 191-194, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31578128

RESUMO

Aortic graft infections are uncommon complications after endovascular aortic surgery. In the majority of cases, gram-positive and then gram-negative organisms are the causative agents leading to this condition. Atypical organisms are traditionally not responsible for graft infection unless the patient is immunocompromised. We are reporting a case of culture-confirmed mycobacterium avium complex infection of an aortic graft in a well-controlled patient with HIV who had an undetected viral load and a CD4 count of 324 while on highly active antiretroviral therapy.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Infecções por HIV/tratamento farmacológico , Complexo Mycobacterium avium/patogenicidade , Infecção por Mycobacterium avium-intracellulare/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/terapia , Adulto , Antibacterianos/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular/instrumentação , Remoção de Dispositivo , Infecções por HIV/diagnóstico , Infecções por HIV/imunologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Complexo Mycobacterium avium/imunologia , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Infecção por Mycobacterium avium-intracellulare/imunologia , Infecção por Mycobacterium avium-intracellulare/terapia , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/imunologia , Infecções Relacionadas à Prótese/terapia , Resultado do Tratamento
3.
Zhonghua Wai Ke Za Zhi ; 57(11): 848-852, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31694134

RESUMO

Objective: To examine the results of surgical treatment for endograft infection after thoracic endovascular aortic repair (TEAVR). Methods: Clinical data of 7 patients underwent surgical treatment for endograft infection after TEAVR at Department of Cardiothoracic Surgery, Changhai Hospital, the Navy Medical University between January 2016 and December 2018 were analyzed retrospectively. There were 6 males and 1 female, aging (51.5±16.7) years (range: 25 to 68 years). The origin of the aortic disease was descending aortic aneurysm in 5 cases, and Stanford B aortic dissection in 2 cases. Abdominal aorta below the level of the diaphragm was not involved in all patients. Two patients received "chimney technology" for left subclavian artery procedures. Time to infection was 5(3) months (M(Q(R))) (range: 1 to 24 months). Aortic endograft infection was diagnosed with a combination of microbiology (positive blood cultures, except one with mycotic), radiological evidence and clinical evidence of sepsis. Two patients suffered from aorto-esophageal fistula received emergency surgery, others were treated with elective surgery. Extra-anatomic prosthetic graft bypass was used for reconstruction of aorta, infected endogarft and aorta was removed, sac drainage was performed. Aorto-esophageal fistula was procedured according to the degree of lesions. All patients received antibiotics with specialist advice for 6 to 8 weeks. Results: One patient died due to septic shock. In the follow-time (range: 6 to 24 months), 1 patient suffered from thoracic infection in 3 months after surgery, an other patient got iliac abscess after a month. Conclusions: Endograft infection after TEAVR is high risk but may be curative. Appropriate selection of patients for infected endograft explantation could get a satisfied results.


Assuntos
Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Adulto , Idoso , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/etiologia , Estudos Retrospectivos , Stents , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(48): e17789, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770196

RESUMO

INTRODUCTION: Riolan arch thickening is usually caused by the occlusion of the superior mesenteric artery (SMA), inferior mesenteric artery, or abdominal aortic artery, by colon cancer, or by ulcerative colitis in the active phase. PATIENT CONCERNS: A 61-years-old female was admitted due to left lower abdominal pain, nausea, and vomiting for more than 4 days. She had received an endovascular covered stent-graft exclusion due to abdominal aortic aneurysm 18 months earlier. Computed tomographic angiography (CTA) showed a local rupture of 1 of the branch artery of the SMA, and a pseudoaneurysm was formed around it. It was feared that performing Riolan atrial arch pseudoaneurysm embolization may cause ischemia of the inferior mesenteric artery (IMA) and could lead to avascular necrosis of the descending colon and sigmoid colon, intestinal perforation, and peritonitis. DIAGNOSIS: Riolan arch collateral circulation associated with pseudoaneurysm hemorrhage after endovascular covered stent-graft treatment of an abdominal aortic aneurysm. INTERVENTIONS: Riolan arterial arch pseudoaneurysm embolization was performed near the distal end. OUTCOMES: The symptoms, signs, and biochemistry returned to normal. CONCLUSION: Riolan arch collateral circulation can be caused by pseudoaneurysm hemorrhage after endovascular covered stent-graft treatment of an abdominal aortic aneurysm.


Assuntos
Falso Aneurisma/etiologia , Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/etiologia , Falso Aneurisma/cirurgia , Implante de Prótese Vascular/efeitos adversos , Embolização Terapêutica/métodos , Feminino , Humanos , Artéria Mesentérica Inferior/cirurgia , Artéria Mesentérica Superior/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Hemorragia Pós-Operatória/cirurgia , Stents/efeitos adversos
5.
Eklem Hastalik Cerrahisi ; 30(3): 201-11, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650915

RESUMO

OBJECTIVES: This study aims to evaluate the effects of mesenchymal stem cell (MSC) implantation on vascular graft infections caused by methicillin-resistant Staphylococcus epidermidis (MRSE) and compare with antibiotic treatment. MATERIALS AND METHODS: Healthy adult 56 Wistar rats (age, over 5 months; weighing, 300-350 g) were divided into eight groups. Group 1 was defined as the control group and group 2 was defined as the infected control group. Groups 3 and 4 were defined as Dacron grafted and MRSE infected groups, treated with tigecycline and MSCs, respectively. Groups 5 and 6 were performed polytetrafluoroethylene (PTFE) graft and infected with MRSE. These groups were also administered tigecycline and MSC treatment, respectively. Groups 7 and 8 were infected with MRSE without graft administration and were also performed tigecycline and MSC treatment, respectively. Grafts and soft tissue specimens were collected at 13 days postoperatively. Colony counts of peri-graft tissue were performed. All samples were evaluated by enzyme-linked immunosorbent assay (ELISA) for the markers that determine stem cell activity. RESULTS: The overall success of the treatments was assessed by the number of rats with MRSE recurrence, regardless of graft used. The difference between the untreated group 2, tigecycline groups (3, 5 and 7) and MSCs groups (4, 6 and 8) were statistically significant. Success of MSC and tigecycline treatments was similar in Dacron, PTFE, and non-grafted groups. There was a resistance of MRSE infection in Dacron groups to MSC and tigecycline treatments. This was considered to be indicative of the susceptibility of the Dacron grafts to infection. However, there was no significant difference between group 2 and Dacron groups in terms of bacterial colonization. ELISA results were significant in three cytokines. CONCLUSION: Mesenchymal stem cells can be considered as an alternative treatment option on its own or part of a combination therapy for control of vascular graft infections.


Assuntos
Prótese Vascular/microbiologia , Transplante de Células-Tronco Mesenquimais , Resistência a Meticilina , Infecções Relacionadas à Prótese/terapia , Infecções Estafilocócicas/terapia , Animais , Antibacterianos/farmacologia , Prótese Vascular/efeitos adversos , Células-Tronco Mesenquimais/citologia , Polietilenotereftalatos , Politetrafluoretileno , Infecções Relacionadas à Prótese/microbiologia , Ratos , Ratos Wistar , Staphylococcus epidermidis , Tigeciclina/farmacologia
6.
Semin Vasc Surg ; 32(1-2): 68-72, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540659

RESUMO

The management of infection involving the abdominal aorta requires clinical decisions based on patient factors and the nature of the infectious process. Any infection occurring after endovascular aortic aneurysm repair or open aortic replacement grafting should be treated promptly with appropriate systemic antibiotic therapy. Once a vascular prosthesis becomes infected, surgical treatment is necessary. There should be a low threshold for graft excision and extra-anatomic bypass in the presence of fistula or abscess cavity, when feasible entire graft should be excised. In selected patients, graft excision with in situ aorta reconstruction is an appropriate option using an autogenous femoral vein, cryopreserved allograft, or a prosthetic graft impregnated with antibiotic. The replaced in situ aortic graft should be covered with an omental pedicle. For primary aortic graft infections, endovascular treatment may act as a bridge to more definitive treatment; or, in the absence of gross retroperitoneal infections, endovascular grafting alone with prolonged systemic antibiotic therapy is a viable option, particularly in patients not fit for open surgical procedures.


Assuntos
Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Remoção de Dispositivo/métodos , Procedimentos Endovasculares , Infecções Relacionadas à Prótese/cirurgia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/microbiologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/microbiologia , Implante de Prótese Vascular/instrumentação , Medicina Baseada em Evidências , Humanos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Reoperação , Fatores de Risco , Resultado do Tratamento
7.
Semin Vasc Surg ; 32(1-2): 73-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540660

RESUMO

The use of autologous femoral veins for in situ reconstruction of the aortoiliac segment is an effective technique to treat native aorta or prosthetic graft infections. The indications, technical details, and outcomes of this procedure are detailed. Graft infection involving the aortic segment, while rare, remains one of the most challenging vascular surgery conditions to treat. The original technique of "neo-aortoiliac surgery" with in situ autologous vein grafts has evolved over the past 25 years and remains a worthwhile alternative for the treatment of aortic graft infections, with lower mortality rates compared with other extra-anatomic or in situ surgical options. Acceptance of this surgical option is due to low graft re-infection rates, rare graft disruption, and low long-term aneurysmal degeneration. Excision of the femoral veins is associated with acceptable rates of lower limb edema. The use of an autologous femoral vein graft can be considered the standard of care in selected patients for the management of aortic graft infections. Optimal management of patients with aortic graft infections requires consideration of all potential therapeutic options because no single modality can be used, and individualizing treatment according to the clinical condition will yield the best patient outcomes.


Assuntos
Aneurisma Infectado/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Veia Femoral/transplante , Infecções Relacionadas à Prótese/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aorta/diagnóstico por imagem , Aorta/microbiologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/microbiologia , Implante de Prótese Vascular/instrumentação , Tomada de Decisão Clínica , Remoção de Dispositivo , Humanos , Seleção de Pacientes , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Reoperação , Fatores de Risco , Resultado do Tratamento
8.
Semin Vasc Surg ; 32(1-2): 81-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540661

RESUMO

Aortic graft infection remains one of the most complex clinical challenges faced by vascular specialists, and is often associated with significant patient morbidity and mortality regardless of the approach used for management. The cryopreserved aortic allograft is now a commonly used in situ aortic replacement in the management of graft infection, and is preferred over rifampin-soaked prosthetic grafts. In the review, we summarize the indications for cryopreserved aortic allograft usage, as well as operative technique, clinical results, and alternative treatments. We propose the use of a novel term tertiary aortic fistula, to distinguish aortic fistulae in the setting of aortic endograft infection, a clinical entity whose natural history and best management are currently being characterized.


Assuntos
Aorta/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Vasos Sanguíneos/transplante , Criopreservação , Infecções Relacionadas à Prótese/cirurgia , Aloenxertos , Aorta/diagnóstico por imagem , Aorta/microbiologia , Implante de Prótese Vascular/instrumentação , Remoção de Dispositivo , Humanos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Reoperação , Fatores de Risco , Resultado do Tratamento
10.
Orv Hetil ; 160(31): 1231-1234, 2019 Aug.
Artigo em Húngaro | MEDLINE | ID: mdl-31352805

RESUMO

Creating durable vascular access has become more complicated with the improvement of the management and with the increasing survival of patients with end-stage renal disease. HeRO (Hemodialysis Reliable Outflow) graft allows to maintain vascular access on the upper limb in patients with the presence of bilateral central venous occlusion. Our institute was the first in Hungary to perform a HeRO graft implantation in a patient receiving regular hemodialysis. Our objective was to present our findings with this recent innovation. Case report, medical documentation and imaging studies were reviewed. The patient (73-year-old, female) has been receiving hemodialysis since 12 years with the history of several arteriovenous fistula (AVF) creations, thrombectomies, use of central venous catheter in both sides. Following the occlusion of a left cubital arterio-venous fistula, none of the conventional vascular access types could have been performed due to bilateral subclavian vein occlusion. Successful HeRO graft implantation was performed. The patient underwent graft thrombectomy and endovascular intervention 7 and 12 months after the original procedure. After both reoperations, the graft functioned well for hemodialysis. HeRO graft can be a good alternative to central venous catheters and lower limb arterio-venous grafts in cases of bilateral central venous occlusion. Orv Hetil. 2019; 160(31): 1231-1234.


Assuntos
Implante de Prótese Vascular/métodos , Prótese Vascular/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Falência Renal Crônica/terapia , Diálise Renal/métodos , Idoso , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares , Feminino , Humanos , Hungria , Falência Renal Crônica/diagnóstico , Desenho de Prótese , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
11.
World Neurosurg ; 130: e1116-e1121, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31330338

RESUMO

BACKGROUND: Nearly 20% of individuals with an aneurysm will have multiple aneurysms-these individuals are at increased risk of subarachnoid hemorrhage. Treatment of bilateral aneurysms with flow diverters (FDs), or Pipeline embolization device, has not yet been established as an effective therapy. We evaluated the safety and efficacy of a 2-stage treatment of bilateral aneurysms with Pipeline embolization devices placed 6 months apart. METHODS: We performed a retrospective review to analyze the clinical and angiographic outcomes of 16 individuals with bilateral aneurysms treated with 2-stage flow diversion at a tertiary referral center from January 2010 to July 2018. RESULTS: Of the 16 patients with 33 aneurysms treated with bilateral flow diversion, 1 had 2 aneurysms treated with a single FD on the contralateral side. The aneurysms treated were ophthalmic, superior hypophyseal, posterior communicating, or cavernous segment aneurysms, with an average size of 6.5 mm. No major complications, such as in-stent stenosis, thromboembolic events, distal intraparenchymal hemorrhage, rerupture, stent migration, or neurological death, were recorded. All the patients had good functional outcomes. At the 24-month follow-up examination, 81% of aneurysms showed complete occlusion. No aneurysm required repeat treatment. CONCLUSIONS: The results from the present study have demonstrated that 2-stage treatment of bilateral aneurysms with FDs is both safe and efficacious. The timing of contralateral FD stent placement is critical. We found that 6 months allows for adequate neurological recovery and stent endothelialization.


Assuntos
Prótese Vascular/tendências , Procedimentos Endovasculares/tendências , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Stents Metálicos Autoexpansíveis/tendências , Adulto , Idoso , Prótese Vascular/efeitos adversos , Angiografia Cerebral/métodos , Estudos de Coortes , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Embolização Terapêutica/tendências , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents Metálicos Autoexpansíveis/efeitos adversos , Resultado do Tratamento
12.
Expert Rev Med Devices ; 16(8): 683-695, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31303063

RESUMO

Introduction: Although there is much attention for proper sizing of pre-operative anatomy before (thoracic) endovascular aneurysm repair ([T]EVAR), standardized assessment of endograft position and apposition at postoperative imaging is seldom addressed in the international guidelines. The highly detailed three-dimensional computed tomography angiography (CTA) volumes contain valuable information about the apposition of the endograft with the arterial wall and the position of the device relative to anatomical landmarks in the proximal and distal landing zones, which is currently hardly used. With proper assessment on CTA of the endograft after EVAR, the risk for future endograft-related complications may be determined, allowing patient-tailored, risk-stratified surveillance. Areas covered: This systematic review identified three standardized methods for assessing apposition or position of the endograft in the proximal or distal landing zone on CTA after (T)EVAR. Quantification of apposition and position, validation of measurement precision, and association with endograft-related complications were extracted. Short (<10 mm apposition length) and decreasing (>0 mm) apposition were associated with endograft-associated complications. Expert commentary: Standardized assessment of apposition and position of the endograft in the proximal and distal landing zones on CTA should be incorporated in post-(T)EVAR surveillance. A risk-stratified CTA surveillance protocol is proposed.


Assuntos
Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Complicações Pós-Operatórias/etiologia , Pontos de Referência Anatômicos , Aorta/cirurgia , Procedimentos Endovasculares/instrumentação , Humanos
14.
Semin Thorac Cardiovasc Surg ; 31(4): 674-678, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31271851
15.
J Infect Chemother ; 25(9): 669-680, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31182331

RESUMO

Abdominal aortic graft infections (AGIs) occur in 1-5% of aortic prosthetic placements. It can result in limb amputation, pseudo-aneurysm formation, septic emboli, aorto-enteric fistulae, septic shock and death. The most frequently involved pathogens are methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci, followed by Enterobacteriaceae and uncommon bacteria. In case of gut involvement the presence of fungi has to be considered. Computed tomography angiography is actually the gold standard diagnostic imaging but magnetic resonance is a valid alternative. Nuclear medicine imaging is commonly used to improve sensitivity and specificity. Signs and symptoms are often aspecific and blood cultures can be negative, requiring alternative ways to detect the microorganism responsible for infection, such as 16S rRNA gene sequencing and molecular rapid diagnostic tests. Curative surgical intervention is the first choice approach, with in-situ reconstruction providing by far the best outcome and xenopericardial bovine patch as a promising option. For patients unable to undergo major surgery, the outcome of conservative approach remains uncertain but usually provides for life-long suppressive therapy. However, in selected cases an attempt of stopping antibiotic treatment after 3-6 months can be done. Given the difficulty in their management, we performed a review of AGIs, in order to raise awareness on clinical presentation, current available diagnostic tools, prophylaxis, surgical and anti-infective treatment of AGIs.


Assuntos
Aorta Abdominal/cirurgia , Prótese Vascular/efeitos adversos , Infecções Relacionadas à Prótese , Biofilmes , Prótese Vascular/microbiologia , Contaminação de Equipamentos , Humanos , Pesquisa Interdisciplinar , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Fatores de Risco
16.
World Neurosurg ; 129: 221-224, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31201945

RESUMO

BACKGROUND: The development of flow-diverters such as the Pipeline embolization device (PED) have allowed for safe and effective treatment of challenging and/or previously untreatable intracranial aneurysms. A rare but serious complication during PED deployment involves fracture of single or multiple components, which can lead to retained hardware. To date, there are little data regarding the safety of performing magnetic resonance imaging (MRI) when tip or capture coils remain intracranially. CASE DESCRIPTION: To the best of our knowledge, we present the first case demonstrating the safe completion of MRI after treatment of 2 posterior circulation aneurysms in a woman aged 69 years presenting with subarachnoid hemorrhage whose treatment was complicated by fracture and subsequent retention of the PED tip and capture coils. CONCLUSIONS: MRI (1.5T) appears safe and effective in patients who have retained PED tips and/or capture coils.


Assuntos
Prótese Vascular/efeitos adversos , Embolização Terapêutica/instrumentação , Falha de Equipamento , Aneurisma Intracraniano/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Idoso , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Aneurisma Intracraniano/terapia , Hemorragia Subaracnóidea/terapia
17.
Colloids Surf B Biointerfaces ; 180: 168-176, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31048242

RESUMO

Due to their relatively good biocompatibility and inactivity, titanium oxide films (Ti-O) are used in the coating of coronary stents, which reduces metal corrosion, slows metal ion release, and improves endothelial cell (EC) compatibility. Here, we report further functionalizing Ti-O with biological cues for selective endothelialization. Selenocystine with an l- or a d-enantiomer was first immobilized on the Ti-O film via polydopamine to generate nitric oxide (NO) endogenously, which inhibited smooth muscle cell (SMC) proliferation, followed by the grafting of a functional KREDVC peptide to induce EC adhesion. The synergistic effects of the immobilized KREDVC, surface chirality, and NO generation on selective endothelialization were investigated. The results showed that the surface chirality of the l-enantiomer and KREDVC grafting significantly enhanced the attachment and growth of ECs compared to SMCs. An in vivo study showed von Willebrand factor expression was increased and neointimal hyperplasia was significantly decreased in samples with l-selenocystine immobilization and KREDVC grafting. In summary, these findings provide new insights on the surface modification of cardiovascular implants with selective endothelialization.


Assuntos
Cistina/análogos & derivados , Hiperplasia/prevenção & controle , Indóis/química , Neointima/prevenção & controle , Oligopeptídeos/química , Compostos Organosselênicos/química , Polímeros/química , Titânio/química , Animais , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular , Proliferação de Células/efeitos dos fármacos , Técnicas de Cocultura , Cistina/química , Expressão Gênica , Células Endoteliais da Veia Umbilical Humana/citologia , Células Endoteliais da Veia Umbilical Humana/efeitos dos fármacos , Células Endoteliais da Veia Umbilical Humana/metabolismo , Humanos , Hiperplasia/etiologia , Hiperplasia/metabolismo , Hiperplasia/patologia , Macrófagos/citologia , Macrófagos/efeitos dos fármacos , Macrófagos/metabolismo , Masculino , Miócitos de Músculo Liso/citologia , Miócitos de Músculo Liso/efeitos dos fármacos , Miócitos de Músculo Liso/metabolismo , Neointima/etiologia , Neointima/metabolismo , Neointima/patologia , Óxido Nítrico/biossíntese , Óxido Nítrico/farmacologia , Cultura Primária de Células , Ratos , Ratos Sprague-Dawley , Estereoisomerismo , Titânio/farmacologia , Fator de von Willebrand/genética , Fator de von Willebrand/metabolismo
18.
Ann Vasc Surg ; 59: 307.e13-307.e16, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31075468

RESUMO

We report an unusual case of a 53-year-old male patient, previously undergone an extra-anatomic right-to-left iliofemoral bypass graft, who has developed gross hematuria after 4 months. The cystoscopic examination revealed a wall injury due to the presence of the graft crossing the bladder. Iatrogenic bladder injuries during vascular surgery are extremely rare. In the literature, only 11 cases of transvesical graft are reported. The complication has been resolved with the removal of the misplaced graft and the reconstruction of the bypass with silver-coated Dacron prosthesis. Despite the rarity of this complication, postoperative ultrasound of the bladder is recommended to timely detect any injury and adopt a correct surgical strategy.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Remoção de Dispositivo , Migração de Corpo Estranho/cirurgia , Doença Iatrogênica , Doença Arterial Periférica/cirurgia , Bexiga Urinária/cirurgia , Angiografia por Tomografia Computadorizada , Cistoscopia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Hematúria/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Polietilenotereftalatos , Desenho de Prótese , Resultado do Tratamento , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/lesões
19.
World Neurosurg ; 122: e577-e583, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31108073

RESUMO

BACKGROUND: Flow diverter stents have become a useful tool for treatment of complex intracranial aneurysms. A serious complication is incomplete wall apposition after flow diverter placement. The aim of this study was to present a comprehensive investigation of hemodynamic changes induced by incomplete expansion of a flow diverter. METHODS: A case of a patient treated for an internal carotid artery aneurysm by flow diversion with incomplete wall apposition was virtually investigated. The effect of incomplete flow diverter expansion was studied using image-based blood flow simulations under physiologically relevant flow conditions based on patient-specific clinical data. RESULTS: The numerical results revealed that incomplete expansion at the proximal end of the stent had minimal impact on the intra-aneurysmal blood flow alteration. A region of nonphysiologically high wall shear stress was observed near the contact area between the incompletely expanded proximal end of the flow diverter and the parent artery, which caused an intimal hyperplasia in this region. These simulation results were consistent with the real-life clinical course and outcome. CONCLUSIONS: The results of this study can be considered during treatment planning of complex cases where the risk of incomplete flow diverter expansion exists. Further studies are required before results can also be used to support the decision process about antiplatelet therapy and additional interventions to improve wall apposition.


Assuntos
Doenças das Artérias Carótidas/terapia , Embolização Terapêutica/efeitos adversos , Aneurisma Intracraniano/terapia , Túnica Íntima/patologia , Velocidade do Fluxo Sanguíneo/fisiologia , Prótese Vascular/efeitos adversos , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Interna , Embolização Terapêutica/instrumentação , Hemodinâmica/fisiologia , Humanos , Hiperplasia/etiologia , Hiperplasia/fisiopatologia , Aneurisma Intracraniano/fisiopatologia , Pessoa de Meia-Idade , Modelos Biológicos , Stents/efeitos adversos , Telas Cirúrgicas
20.
Biomed Res Int ; 2019: 3247615, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31119164

RESUMO

Objective: To assess the efficacy and short- and mid-term results of endovascular surgery and hybrid surgical procedures in treatment of complex aortic dissection. Methods: Clinical data of 90 patients with complex aortic dissection admitted from June 2012 to June 2018 were retrospectively analyzed. Among the patients, 60 cases were male and 30 cases were female, and their ages were ranged from 32 to 79, with an average age of 55 years old; different endovascular techniques and/or hybrid procedures were performed in these patients. Results: Technical success rate was 100% for the entire group of patients. Type I endoleak occurred in 8 patients immediately after stent-graft placement, which in 2 cases disappeared after a proximal Cuff placement, and the other cases received no special treatment. Follow-up was conducted from 1 month to 72 months, with an average of 36.3 months, and no stent-graft migration or organ ischemia was noted. In the follow-up patients, no type I endoleak occurred but type II endoleak was found in 2 cases, which were cured without treatment; no patient had paraplegia. Conclusion: Endovascular surgery and hybrid procedures have demonstrable mid- and long-term efficacy in treatment of complex aortic diseases. However, this conclusion still requires multicenter, large-sample studies to further confirm.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares/métodos , Adulto , Idoso , Aneurisma Dissecante/fisiopatologia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Stents/efeitos adversos , Resultado do Tratamento
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