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1.
Khirurgiia (Mosk) ; (2): 58-66, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570356

RESUMO

OBJECTIVE: To investigate diagnostic role of 18F-fluorodeoxyglucose PET/CT in patients with suspected vascular graft (VG) infection. MATERIAL AND METHODS: A prospective analysis included data of 30 PET/CT examinations for suspected infection of aortic VG (n=27) and bypass grafts (n=3) after surgical treatment (median 48 months). In 77% (23/30) of cases, the diagnosis was initially «possible¼ (n=11) or «rejected¼ (n=12) in accordance with common diagnostic criteria. All PET/CT results were verified by clinical, laboratory and intraoperative («=20) data. VG infection was confirmed in 18 patients and ruled out in 12 cases. RESULTS: PET/CT confirmed VG infection in 94% (17/18) and excluded in 50% (6/12) of cases. False PET/CT results were obtained in 23% (7/30) cases: false positive in 6 cases and false negative in 1 case. Thus, sensitivity, specificity and diagnostic accuracy of PET/CT were 94%, 50% and 77%, respectively; positive and negative predictive value - 74% and 86%. PET/CT results allowed correct reclassifying 33% (10/30) of cases. VG infection was confirmed in 73% (8/11) of patients with initially «possible¼ diagnosis and excluded in 17% (2/12) of patients with initially «rejected¼ infection. Moreover, whole body PET/CT revealed unknown inflammation foci outside VG in 73% (22/30) of cases. These data were applied to correct treatment approach in 80% (24/30) of cases. CONCLUSION: Our results showed high efficacy of 18F-fluorodeoxyglucose PET/CT in the diagnosis of VG infection. Despite low specificity, this technique has high sensitivity and accuracy that allowed reclassifying 33% of cases.


Assuntos
Aorta/diagnóstico por imagem , Prótese Vascular/efeitos adversos , Fluordesoxiglucose F18 , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Enxerto Vascular/efeitos adversos , Aorta/microbiologia , Aorta/cirurgia , Prótese Vascular/microbiologia , Implante de Prótese Vascular/efeitos adversos , Vasos Sanguíneos/diagnóstico por imagem , Vasos Sanguíneos/microbiologia , Humanos , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade
2.
Int J Pharm ; 595: 120243, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33484923

RESUMO

Cardiovascular diseases constitute a number of conditions which are the leading cause of death globally. To combat these diseases and improve the quality and duration of life, several cardiac implants have been developed, including stents, vascular grafts and valvular prostheses. The implantation of these vascular prosthesis has associated risks such as infection or blood clot formation. In order to overcome these limitations medicated vascular prosthesis have been previously used. The present paper describes a 3D printing method to develop medicated vascular prosthesis using fused deposition modelling (FDM) technology. For this purpose, rifampicin (RIF) was selected as a model molecule as it can be used to prevent vascular graft prosthesis infection. Thermoplastic polyurethane (TPU) and RIF were combined using hot melt extrusion (HME) to obtain filaments containing RIF concentrations ranging between 0 and 1% (w/w). These materials are capable of providing RIF release for periods ranging between 30 and 80 days. Moreover, TPU-based materials containing RIF were capable of inhibiting the growth of Staphylococcus aureus. This behaviour was observed even for TPU-based materials containing RIF concentrations of 0.1% (w/w). TPU containing 1% (w/w) of RIF showed antimicrobial properties even after 30 days of RIF release. Alternatively, these methods were used to prepare dipyridamole containing TPU filaments. Finally, using a dual extrusion 3D printer vascular grafts containing both drugs were prepared.


Assuntos
Antibacterianos/farmacocinética , Sistemas de Liberação de Medicamentos/métodos , Poliuretanos/química , Rifampina/farmacocinética , Tecnologia Farmacêutica/métodos , Células Sanguíneas/efeitos dos fármacos , Prótese Vascular/efeitos adversos , Preparações de Ação Retardada/química , Dipiridamol/farmacocinética , Liberação Controlada de Fármacos , Desenho de Equipamento/métodos , Células Endoteliais da Veia Umbilical Humana , Humanos , Inibidores da Agregação de Plaquetas/farmacocinética , Poliuretanos/uso terapêutico , Impressão Tridimensional , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/prevenção & controle , Staphylococcus aureus/efeitos dos fármacos , Trombose/etiologia , Trombose/prevenção & controle
3.
Vasc Endovascular Surg ; 55(1): 95-99, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32875968

RESUMO

Aortoenteric fistula after endovascular aortic repair for an abdominal aortic aneurysm is a rare but severe complication. Particularly, a case of inflammatory abdominal aortic aneurysm is extremely rare and there are only 3 reported cases. A 70-year-old man underwent endovascular aortic repair for impending rupture of an inflammatory abdominal aortic aneurysm and was medicated steroids for approximately 2 years. Four years after endovascular aortic repair, he developed endograft infection with an aortoduodenal fistula and a left psoas abscess. He underwent total endograft excision, debridement, in situ reconstruction of the aorta using prosthetic grafts with omental coverage, and digestive tract reconstruction to prevent leakage. Pseudomonas aeruginosa was detected in the infected aortic sac. The patient has not experienced recurrence of infection in the 35 months since his operation.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Duodenopatias/microbiologia , Procedimentos Endovasculares/efeitos adversos , Fístula Intestinal/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções por Pseudomonas/microbiologia , Abscesso do Psoas/microbiologia , Fístula Vascular/microbiologia , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular/instrumentação , Desbridamento , Remoção de Dispositivo , Duodenopatias/diagnóstico por imagem , Duodenopatias/cirurgia , Procedimentos Endovasculares/instrumentação , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/cirurgia , Masculino , Omento/cirurgia , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/cirurgia , Infecções por Pseudomonas/diagnóstico por imagem , Infecções por Pseudomonas/cirurgia , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/cirurgia , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia
7.
Cochrane Database Syst Rev ; 8: CD013469, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32761821

RESUMO

BACKGROUND: Abdominal aortic graft infections are a major complication following abdominal aortic aneurysm surgery, with high morbidity and mortality rates. They can be treated surgically or conservatively using medical management. The two most common surgical techniques are in situ replacement of the graft and extra-anatomical bypass. Medical management most commonly consists of a course of long-term antibiotics. There is currently no consensus on which intervention (extra-anatomical bypass, in situ replacement, or medical) is the most effective in managing abdominal aortic graft infections. Whilst in emergency or complex situations such as graft rupture surgical management is the only option, in non-emergency situations it is often personal preference that influences the clinician's decision-making. OBJECTIVES: To assess and compare the effects of surgical and medical interventions for abdominal aortic graft infections. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and WHO ICTRP and ClinicalTrials.gov trials registers to 2 December 2019. We also reviewed the bibliographies of the studies identified by the search and contacted specialists in the field and study authors to request information on any possible unpublished data. SELECTION CRITERIA: We aimed to include all randomised controlled trials that used surgical or medical interventions to treat abdominal aortic graft infections. The definitions of abdominal aortic graft infections were accepted as presented in the individual studies, and included secondary infection due to aortoenteric fistula. We excluded studies presenting data on prosthetic graft infections in general, unless data specific to abdominal aortic graft infections could be isolated. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed all studies identified by the search. We planned to independently assess risk of bias of the included trials and to evaluate the quality of the evidence using the GRADE approach. Our main outcomes were overall mortality, amputation, graft re-infection, overall graft-related complications, graft-related mortality, acute limb ischaemia, and re-intervention. MAIN RESULTS: We identified no randomised controlled trials to conduct meta-analysis. AUTHORS' CONCLUSIONS: There is currently insufficient evidence to draw conclusions to support any treatment over the other. Multicentre clinical trials are required to compare different treatments for the condition.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Humanos
9.
Eur J Vasc Endovasc Surg ; 60(5): 671-676, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32807677

RESUMO

OBJECTIVE: The aim of this study was to measure the incidence of post endovascular aneurysm sealing (EVAS) abdominal aortic aneurysm (AAA) growth, and its association with stent migration, in a cohort of patients with differing compliance to old and new Instructions For Use (IFU). METHODS: A retrospective single centre study was conducted to review the computed tomography (CT) and clinical data of elective, infrarenal EVAS cases, performed as a primary intervention, between December 2013 and March 2018. All included patients had a baseline post-operative CT scan at one month and at least one year follow up. The primary outcome measure was the incidence of AAA growth and its association with stent migration. AAA growth was defined as a ≥5% increase in aortic volume between the lowermost renal artery and the aortic bifurcation post EVAS at any time during follow up, in comparison to the baseline CT scan. Migration was defined according to the ESVS guidelines, as > 10 mm downward movement of either Nellix stent frame in the proximal zone. RESULTS: Seventy-six patients were eligible for inclusion in the study (mean age 76 ± 7.4 years; 58 men). AAA growth was identified in 50 of 76 patients (66%); adherence to IFU did not affect its incidence (mean growth within IFU-2016 compliant cohort vs. non-compliant: 16% vs. 13%, p = .33). Over time, the incidence of AAA growth increased, from 32% at one year to 100% at four years. AAA growth by volume was progressive (p < .001), as its extent increased over time. Migration was detected in 16 patients and there was a statistically significant association with AAA growth (13 patients displayed migration and AAA growth, p = .036). CONCLUSION: Patients treated with EVAS are prone to AAA growth, irrespective of whether their aortic anatomy is IFU compliant. AAA growth by volume is associated with stent migration. Clinicians should continue close surveillance post EVAS, regardless of whether patients are treated within IFU.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Falha de Prótese , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/patologia , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/patologia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Progressão da Doença , Procedimentos Cirúrgicos Eletivos/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Seguimentos , Humanos , Incidência , Masculino , Cooperação do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Stents/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
10.
Ann Vasc Surg ; 69: 141-145, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32505682

RESUMO

BACKGROUND: The aim of this study is to compare wound infection, graft infection, and secondary amputation rates in patients who had popliteal artery injury repair with interposition vein versus prosthetic grafts. METHODS: This retrospective comparative study included all adult patients (>18 years) who had interposition grafting for popliteal artery injuries between January 2008 and August 2018 at a university hospital. Patients were divided into 2 groups. Popliteal arteries were repaired with venous graft in Group "A" and with prosthetic graft in Group "B." The outcome measures were wound infection, graft infection, and secondary amputation rates. RESULTS: Forty patients fulfilled the inclusion criteria. Twenty-two patients had arterial repair with venous while 18 with polytetrafluoroethylene grafts. All were male with median age of 32 (interquartile range [IQR] 19.5) years. Both groups were comparable in terms of median age (32.5 [19] vs. 30.5 [23]), Mangled Extremity Severity Score (6 [5] vs. 7 [7]), median hospital stay (7 [5] vs. 7 [9] days), and perioperative complications (2/22 vs. 3/18). In Group "A," no patient had graft infection or secondary amputation while in Group "B," 1 patient had secondary amputation and another had graft infection (P > 0.99). CONCLUSIONS: There is no statistical difference in secondary amputation rate, wound infection, or graft infection in patients undergoing popliteal artery repair with interposition vein versus prosthetic grafts in trauma setting.


Assuntos
Implante de Prótese Vascular , Artéria Poplítea/cirurgia , Lesões do Sistema Vascular/cirurgia , Veias/transplante , Adolescente , Adulto , Amputação , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/lesões , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/cirurgia , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Adulto Jovem
11.
J Med Vasc ; 45(4): 177-183, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32571557

RESUMO

OBJECTIVE: To evaluate the short and long-term results of in situ prosthetic graft treatment using rifampicin-soaked silver polyester graft in patients with aortic infection. MATERIAL AND METHOD: All the patients surgically managed in our center for an aortic infection were retrospectively analyzed. The primary endpoint was the intra-hospital mortality, secondary outcomes were limb salvage, persistent or recurrent infection, prosthetic graft patency, and long-term survival. RESULTS: From January 2004 to December 2015, 18 consecutive patients (12 men and 6 women) were operated on for aortic infection. Six mycotic aneurysms and 12 prosthetic infections, including 8 para-entero-prosthetic fistulas, were treated. In 5 cases, surgery was performed in emergency. During the early postoperative period, we performed one major amputation and two aortic infections were persistent. Intra-hospital mortality was 27.7%. The median follow-up among the 13 surviving patients was 26 months. During follow-up, none of the 13 patients presented reinfection or bypass thrombosis. CONCLUSION: This series shows that in situ revascularization with rifampicin-soaked silver polyester graft for aortic infection have results in agreement with the literature in terms of intra-hospital mortality with a low reinfection rate.


Assuntos
Aneurisma Infectado/cirurgia , Antibacterianos/administração & dosagem , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Poliésteres , Infecções Relacionadas à Prótese/cirurgia , Rifampina/administração & dosagem , Prata , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma Infectado/mortalidade , Antibacterianos/efeitos adversos , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/microbiologia , Aneurisma Aórtico/mortalidade , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Feminino , França , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Poliésteres/efeitos adversos , Desenho de Prótese , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/mortalidade , Estudos Retrospectivos , Rifampina/efeitos adversos , Fatores de Risco , Prata/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
J Card Surg ; 35(7): 1640-1641, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32485059

RESUMO

The migration of sternal wires into vital structures is a rare but potentially life-threatening complication and associated with infection in some cases. While a few cases have been reported the sternal wires were broken in those cases. To our knowledge, this is the first report of multiple, nonbroken, migrated sternal wires stabbing vascular grafts.


Assuntos
Prótese Vascular/efeitos adversos , Fios Ortopédicos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/cirurgia , Hemorragia/etiologia , Hemorragia/cirurgia , Falha de Prótese , Infecções Relacionadas à Prótese/cirurgia , Idoso , Feminino , Humanos , Infecções Relacionadas à Prótese/etiologia , Reoperação , Esternotomia , Esterno , Técnicas de Sutura , Fatores de Tempo
13.
J Surg Res ; 255: 124-129, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32543377

RESUMO

BACKGROUND: There is currently limited data assessing the long-term consequences of thoracic endovascular aortic repair (TEVAR) in otherwise healthy aortic segments remote from the site of endograft coverage. The aim of this study is to retrospectively evaluate aortic remodeling and long-term outcomes of blunt thoracic aortic injury (BTAI) patients treated with TEVAR. Our hypothesis is that significant changes to the aorta proximal to the graft-covered segment are suspected following TEVAR. METHODS: An institutional review board-approved retrospective review of patients who underwent TEVAR for BTAI at a level I trauma center from 2004 to 2018 was performed. Forty-six patients were identified and of these, 32 patients with high-resolution computed tomographic angiography imaging follow-up were included in the study. Computed tomographic angiography measurements of aortic dimensions and branch vessels proximal, distal, and adjacent to the stent grafted segment were recorded preprocedure and postprocedure and analyzed. Primary device-related outcomes such as birdbeaking, mural thrombus, stent migration, and persistent endoleak were assessed. Patient outcomes including mortality, graft-related morbidity, and need for secondary interventions were also analyzed. RESULTS: Mean follow-up of the selected patients in the study was 1.52 y (range, 0.06-8.0 y). Following TEVAR, the ascending aortic length increased significantly (mean 5.7 ± 4.6 mm, P < 0.001). The mean diameters of the ascending aorta (1.5 ± 1.5, P < 0.001 mm), the midaortic arch (1.3 ± 1.7 mm, P < 0.001), and proximal and the distal endograft landing zones (1.9 ± 2.1 mm and 2.2 ± 1.6 mm, respectively, P < 0.001) also increased significantly following TEVAR. Clinically relevant device-related outcomes occurred with the presence of endograft infolding and subsequent development of endograft mural thrombus (P < 0.001). The need for secondary intervention following TEVAR for BTAI was associated with endograft mural thrombus (P < 0.05). CONCLUSIONS: TEVAR for BTAI causes significant geometric changes in the aorta proximal to the stented grafted segment of the aorta. Direct consequences of the graft at the stented segment includes mural thrombus development within the endograft which was associated with the need for secondary intervention. Although clinical significance is yet to be determined, post-TEVAR changes in aortic architecture warrant continued aortic surveillance following BTAI.


Assuntos
Aorta Torácica/lesões , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Remodelação Vascular , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Aorta Torácica/cirurgia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Colonografia Tomográfica Computadorizada , Procedimentos Endovasculares/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Stents/efeitos adversos , Rigidez Vascular , Lesões do Sistema Vascular/patologia , Ferimentos não Penetrantes/patologia , Adulto Jovem
14.
Ann Vasc Surg ; 69: 232-236, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32561242

RESUMO

BACKGROUND: Arteriovenous graft infection is a well-known and frequent complication. The objective of this study was to compare infection rates of primary and secondary indicated arteriovenous grafts (AVGs). SUBJECTS AND METHODS: Retrospectively, we evaluated the indications for AVGs created at our institution which became infected. One hundred forty AVGs were evaluated. Of these AVGs, 33 (23.6%) were primary and 107 (76.4%) secondary indicated. RESULTS: Infection of a primary AVG was detected in 5 patients (15.2 %). Infection of a secondary AVG was detected in 30 patients (28.0%). Primary and secondary patency were significantly lower in patients with infected AVG (P = 0.006; P = 0.0001). The effect of diabetes mellitus and age on development of infection was not confirmed. CONCLUSIONS: Indications for AVG creation clearly influence the future risk of infection. If the indication to use the AVG is to correct a complicated arteriovenous fistula, the risk of infection is 2 times higher.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/instrumentação , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/fisiopatologia , Diálise Renal , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
15.
Ann Vasc Surg ; 68: 549-552, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32416312

RESUMO

BACKGROUND: The residual stump after excision of an infected aortic graft may be subject to acute disruption-blowout-because of recurrence of infection or fatigue due to the mechanical stress. We present an innovative technique in which we used the falciform ligament of the liver to reinforce the aortic stump. METHODS: We excised the falciform ligament by giving attention to avoid any bleeding from the liver. The aortic stump was reinforced with synthetic, monofilament, nonabsorbable polypropylene sutures and the falciform ligament of the liver was plicated inside the stump and further sutured with polypropylene sutures. RESULTS: After 5 months, he is in excellent condition. His laboratory examination is normal, he has stopped taking antibiotics, gained his initial weight, and recovered full activity. CONCLUSIONS: We presented an innovative technique in which we used the falciform ligament of the liver to reinforce the aortic stump after excision of an infected aortobiiliac synthetic graft. This technique can be an alternative option in patients with weak arterial wall or extended bacterial local infection in the retroperitoneal area which renders the aortic wall tissue extremely stiff to be folded and sutured. This technique may enhance the mechanical integrity of the stump.


Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Remoção de Dispositivo , Ligamentos/transplante , Infecções Relacionadas à Prótese/cirurgia , Técnicas de Sutura , Idoso , Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Humanos , Fígado , Masculino , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Resultado do Tratamento
16.
J Cardiothorac Surg ; 15(1): 94, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-32404182

RESUMO

BACKGROUND: Perigraft abscess is a rare condition which constitutes a small proportion of aortic graft infection (AGI). Early diagnosis is very important for timely intervention and improving the survival rate of patients because of its significant morbidity and mortality. CASE PRESENTATION: A 24-year-old young male patient with a history of complicated total arch replacement using elephant trunk technique for acute DeBakey type-1 aortic dissection 6 months before visited our hospital with the chief complaint of persistent fever. Antibiotic treatment in local hospital was ineffective. Echocardiography showed liquid dark area around the aortic graft, and a computerized tomography angiography (CTA) was done for further evaluation of periaortic fluid collection which showed findings to suggest perigraft abscess. The patient underwent surgical debridement of the abscess and was found to have an abscess around the aortic graft which was drained followed by antibiotic treatment. The patient was discharged to his local hospital and recovered well at 2 month follow-up appointment. CONCLUSION: This is a very rare case of aortic abscess around the graft that could successfully be managed by graft-conserving surgery, and it emphasizes the significance of early diagnosis of perigraft abscess in patients with aortic dissection surgery.


Assuntos
Abscesso/etiologia , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular , Prótese Vascular/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , Abscesso/diagnóstico , Humanos , Masculino , Adulto Jovem
17.
Ann Vasc Surg ; 66: 8-10, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32360432

RESUMO

BACKGROUND: COVID-19 infection has been reported to be related with an increased risk of thrombotic complications because of the hypercoagulability state and inflammation. At the moment, no reports are available regarding thrombosis of prosthetic vascular grafts. We present the case of a patient with COVID-19-related pneumonia, who suffered from the acute thrombosis of a previously implanted aortic graft. METHODS AND RESULTS: A 67-year-old male patient, who had undergone open repair of an abdominal aortic aneurysm with a bifurcated graft 6 years before, was admitted to the emergency department with high fever for a week without cough or dyspnea. Thoracic ultrasound showed signs of bilateral interstitial pneumonia, and the Sars-Cov-2 swab was positive. Antiretroviral therapy and prophylactic low molecular weight heparin treatment were initiated. Owing to the progressive impairment of the respiratory function, the patient was intubated after eight days from the admission, the day after he showed signs of bilateral acute limb ischemia. A duplex ultrasound demonstrated the complete thrombosis of the aortic graft without flow at the femoral level. An urgent angio-computed tomography scan for revascularization purpose was requested, but the patient died on the arrival in the radiological suite. CONCLUSIONS: Acute thrombosis of vascular prosthetic grafts is a possible, catastrophic complication of COVID-19 infection. In COVID-19 patients with prosthetic graft, an aggressive antithrombotic treatment could be considered to prevent such an event.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Betacoronavirus , Prótese Vascular/efeitos adversos , Infecções por Coronavirus/complicações , Oclusão de Enxerto Vascular/etiologia , Pneumonia Viral/etiologia , Idoso , Aneurisma da Aorta Abdominal/complicações , Implante de Prótese Vascular/efeitos adversos , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações
18.
Br J Radiol ; 93(1112): 20190279, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32464068

RESUMO

OBJECTIVE: To assess the safety and efficacy of endovascular implantation of a portal vein stent combined with iodine-125 seed-strips followed by transcatheter arterial chemoembolization with sorafenib (PVS-125I-TACE-S) for the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). METHODS: Between January 2015 and July 2017, 18 patients with PVTT caused by HCC that were treated with PVS-125I-TACE-S were reviewed. The technical success, complications, changes in liver function from baseline values due to subsequent endovascular implantation of a portal vein stent combined with iodine-125 seed-strips (PVS-125I), time-to-tumor progression (TTP) and overall survival (OS) were observed. RESULTS: The technical success rate was 100%. Adverse events (AEs) were managed successfully, with no occurrence of procedure-related deaths. Liver function test values after PVS-125I were not significantly different than baseline values (P>0.05). The median TTP was 7.0 months (range: 4.2-9.9 months). In Vp3 PVTT, the TTP was 9.7 months (range: 8.8-10.5 months), and in Vp4 PVTT, the TTP was 4.2 months (range: 2.8-5.6 months). The median OS was 10.0 months (range: 7.0-13.1 months). In Vp3 PVTT, OS was 11.9 months (range: 9.2-14.5 months), and in Vp4 PVTT, OS was 7.2 months (range: 3.8-10.7 months). CONCLUSIONS: PVS-125I-TACE-S is safe for patients with HCC with PVTT and may extend the TTP and survival of patients with Vp4 PVTT. ADVANCES IN KNOWLEDGE: PVS implantation promptly restored flow in the obstructed portal vein, which can reduce the risk of hepatic failure and upper gastrointestinal bleeding. Implantation of iodine-125 seed-strips may directly expose the portal tumor thrombus to radiation and kill cancer cells. Their combined use with TACE-S has a strong scientific rationale.


Assuntos
Antineoplásicos/uso terapêutico , Prótese Vascular , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Radioisótopos do Iodo/uso terapêutico , Neoplasias Hepáticas/terapia , Sorafenibe/uso terapêutico , Stents , Trombose/terapia , Idoso , Antineoplásicos/administração & dosagem , Prótese Vascular/efeitos adversos , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica/instrumentação , Terapia Combinada , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Radioisótopos do Iodo/administração & dosagem , Radioisótopos do Iodo/efeitos adversos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Veia Porta , Sorafenibe/administração & dosagem , Stents/efeitos adversos , Análise de Sobrevida , Trombose/etiologia , Resultado do Tratamento
19.
Vascular ; 28(5): 530-535, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32366177

RESUMO

OBJECTIVE: Inguinal vascular graft infections are high-risk events that cannot be controlled medically but require surgical intervention. This study reviewed the long-term clinical outcomes of obturator bypass using a ringed polytetrafluoroethylene graft for inguinal graft infection. METHODS: A total of eight consecutive patients who underwent obturator bypass using a ringed polytetrafluoroethylene graft for inguinal prosthetic graft infection at a single medical center between January 2006 and October 2017 were retrospectively analyzed. The demographics, clinical characteristics, surgical procedure, and clinical outcomes were evaluated. RESULTS: There was no perioperative death; however, there were three operative complications. On the 1st and 9th postoperative day, two patients underwent hematoma evacuation in the pelvic cavity, and the other patient underwent suture reinforcement for partial dehiscence of the distal anastomosis on the 49th postoperative day. The median length of hospital stay was 14.5 (range, 7-29) days. Only one graft occlusion was observed at postoperative month 40; however, there were no ischemic symptoms. There were no limb amputations and postoperative deaths during the long-term follow-up period. There were no infections of the previous residual and obturator bypass grafts and inguinal infection during the follow-up period of 49 (range, 7-154) months. CONCLUSION: Obturator bypass for inguinal graft infection is feasible and durable with excellent long-term outcomes. However, perioperative bleeding should be taken into consideration.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Extremidade Inferior/irrigação sanguínea , Politetrafluoretileno , Infecções Relacionadas à Prótese/cirurgia , Idoso , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
J Vasc Interv Radiol ; 31(5): 754-758, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32359522

RESUMO

This brief report describes 3 patients with infected extrahepatic splanchnic venous stents or stent grafts. These devices had been placed to treat prehepatic portal hypertension 4 wk, 3 mo, and 31 mo, respectively, before readmission for fever. Blood cultures and fluorine-18 fludeoxyglucose positron emission tomography/CT were positive in all. With systemic antibiotic treatment, 2 patients showed a clinical recovery. In the third patient, antibiotic treatment failed. Therefore, the infected stent graft was surgically removed and a splenorenal shunt was created. No recurrent splanchnic venous infection was observed in these 3 patients.


Assuntos
Antibacterianos/administração & dosagem , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/instrumentação , Hipertensão Portal/cirurgia , Infecções Relacionadas à Prótese/terapia , Stents/efeitos adversos , Resultado do Tratamento , Adolescente , Idoso , Implante de Prótese Vascular/efeitos adversos , Remoção de Dispositivo , Procedimentos Endovasculares/efeitos adversos , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Pressão na Veia Porta , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Circulação Esplâncnica
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