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1.
Vasc Endovascular Surg ; 54(1): 65-68, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31500541

RESUMO

Central venous catheter (CVC) insertion with ultrasound guidance is routine clinical practice in the critically ill patient. Arterial malposition is serious and may lead to severe complications such as hemorrhage, stroke, or death. We describe a bail-out technique for removal of right-sided CVC that was mispositioned into the brachiocephalic trunk (BCT) at the origin of the right common carotid artery (CCA). Covered stenting of the BCT extending into the CCA in combination with plug embolization of the right subclavian artery was utilized.


Assuntos
Tronco Braquiocefálico/diagnóstico por imagem , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres Venosos Centrais , Remoção de Dispositivo/instrumentação , Procedimentos Endovasculares/instrumentação , Stents , Idoso , Remoção de Dispositivo/métodos , Embolização Terapêutica , Humanos , Masculino , Resultado do Tratamento
2.
Vasc Endovascular Surg ; 54(1): 12-16, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31522622

RESUMO

PURPOSE: To investigate the clinical outcomes of endovascular bare stenting in patients with symptomatic isolated superior mesenteric artery (SMA) dissection (ISMAD). METHODS: This study was a retrospective analysis which included a total of 9 patients with symptomatic ISMAD (7 males and 2 females, age range: 48-67 years) who were treated with endovascular bare stenting. Data regarding basic patient clinical characteristics, e-technical success of the operation, and long-term patient outcomes were assessed. RESULTS: Endovascular bare stenting was found to be technically successful in all patients. A total of 9 stents were inserted in these 9 patients. Five patients presented with stable false lumen and 4 patients presented with shrinking of false lumen after stenting. Both the trunk and branches of the SMA remained patent in all patients after stent insertion. There was no incidence of procedure-related complications, with all patients experiencing progressive symptom relief and subsequent symptom abatement within 1 week of the operation. Over a median 24 month follow-up period (range: 12-36 months), abdominal computed tomographic angiography revealed that all patients had obliterated dissections. In addition, there were no instances of stent obstruction, intestinal necrosis, or antiplatelet related bleeding during the follow-up period. CONCLUSIONS: Endovascular bare stenting was found to be a safe and effective treatment for patients with ISMAD.


Assuntos
Aneurisma Dissecante/cirurgia , Procedimentos Endovasculares/instrumentação , Artéria Mesentérica Superior/cirurgia , Stents Metálicos Autoexpansíveis , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Resultado do Tratamento
3.
Vasc Endovascular Surg ; 54(1): 25-35, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31537181

RESUMO

PURPOSE: The aim of this study is to present our personal experience using covered nitinol stent-graft in the treatment of outflow tract stenosis of arteriovenous grafts (AVGs) for hemodialysis access. MATERIALS AND METHODS: Between May 2015 and October 2017, we retrospectively evaluated 36 (24 males, 12 females; mean age: 65.6 years) patients with AVGs on hemodialysis who underwent percutaneous angioplasty followed by endovascular stent-graft deployment for the treatment of stenosis of the venous outflow of the AVG. Indication for treatment included early restenosis (<3 months after previous percutaneous transluminal angioplasty [PTA]), long stenosis (stenoses >50% extending for a length >5 cm), and recoil of the stenosis after PTA performed with a noncompliant high-pressure balloon. Of 36 patients, 27 (75%) required surgical thrombectomy prior to endovascular procedure. Technical success, clinical success, primary and secondary patency, and safety were evaluated. RESULTS: Technical success was 100%, and clinical success was 94.4%. Primary patency was 94.4%, 72.2%, 63%, 45.9%, and 45.9% at 1, 3, 6, 12, and 18 months (average: 215 days, range: 9-653 days); secondary patency was 94.4% and 86.1% at 1 and 3 months; 80.4% at 6, 12, and 18 months; and 53.6% at 24 months (average: 276.8 days, range: 9-744 days). No deaths were registered. CONCLUSIONS: In selected cases, the use of stent-graft represents an effective and safe solution for the treatment of stenotic complications of the venous outflow of AVGs, even in the setting of access thrombosis.


Assuntos
Derivação Arteriovenosa Cirúrgica/instrumentação , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Oclusão de Enxerto Vascular/cirurgia , Diálise Renal , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Ligas , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Politetrafluoretileno , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
4.
Vasc Endovascular Surg ; 54(1): 89-92, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31551026

RESUMO

Endovascular stent placement (ESP) for patient with spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a widely accepted treatment option. However, failed percutaneous ESP is not uncommon and is one of the leading causes for laparotomy. We report a case of 63-year-old man with SIDSMA encountered failed antegrade recanalization via conventional transfemoral approach. We achieved recanalization in a retrograde fashion through middle colic artery using rendezvous technique and successfully placed self-expandable stents inside the dissected superior mesenteric artery. The patient recovered well after percutaneous ESP. We herein describe the transcollateral retrograde approach of percutaneous ESP for SIDSMA as an alternative option when conventional antegrade recanalization fails.


Assuntos
Aneurisma Dissecante/terapia , Circulação Colateral , Procedimentos Endovasculares/métodos , Artéria Mesentérica Superior , Circulação Esplâncnica , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(51): e18412, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861006

RESUMO

RATIONALE: Although implantation of Amplatzer membranous ventricular septal defect occluder (AVSDO) is an alternation to surgical treatment, the interventional therapy is disapproved by FDA due to high incidence of complete atrioventricular block (cAVB) post closure during early and middle term follow-up. However, long-term outcomes of the accumulating numbers of patients who had received AVSDO in the past decades, still remain an issue of concern and late occurrence of potentially catastrophic heart block long after hospital discharge is especially worrying, but rarely documented. We firstly reported a pediatric case with very late-onset cAVB occurring over ten years following transcatheter closure of PmVSD using AVSDO. PATIENT CONCERNS: A 5-year old female received transcatheter closure of PmVSD sized 10-mm on left ventricular angiography with a 14-mm AVSDO owning to a history of recurrent lower respiratory tract infections. Post-procedure echocardiography documented no arrhythmias, residual shunt and aortic regurgitation. All electrocardiogram (ECG) recordings were completely normal and transthoracic echocardiography (TTE) examination showed the device was in the proper position and there was neither residual shunt nor valves regurgitation. Ten years after operation, the patient was re-admitted into our hospital due to recurrent syncope. DIAGNOSES: A 12-lead ECG showed cAVB with a minimal heart rate of 42 bpm. Device flattening was revealed on 2-dimensional TTE and the occluder appeared to return to its original size and shape. Computed tomography and magnetic resonance imaging of brain did not reveal any intracranial hemorrhages, ischemic changes, or space-occupying lesions. Electroencephalogram detected no epileptiform discharge. Other possible etiologies resulting in cAVB such as myocarditis, hypothyroidism and connective tissue diseases were excluded. Therefore, it was ultimately considered the cAVB was mostly likely to be associated with device closure of PmVSD using AVSDO. INTERVENTIONS: The child was empirically treated with prednisone (1-2 mg/Kg daily). OUTCOMES: Unfortunately, no improvement was observed. A permanent pacemaker was implanted. The following course was uneventful. LESSONS: For patients following transcatheter closure of PmVSD using AVSDO, the risk period for developing heart block after device closure appears to be much longer than we speculated. Long-term, perhaps and life-long followed up needs to be considered for this group of patients.


Assuntos
Bloqueio Atrioventricular/etiologia , Procedimentos Endovasculares/instrumentação , Comunicação Interventricular/cirurgia , Complicações Pós-Operatórias/etiologia , Dispositivo para Oclusão Septal/efeitos adversos , Bloqueio Atrioventricular/diagnóstico , Pré-Escolar , Feminino , Humanos , Complicações Pós-Operatórias/diagnóstico
6.
J Med Vasc ; 44(5): 344-349, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31474346

RESUMO

Behçet's disease (BD) is a systemic vasculitis diagnosed on the basis of clinical criteria established by the International Study Group for Behçet's. Vascular involvement is common, affecting both arteries and veins. Aortic localizations are rare and severe and can be life-threatening in case of rupture. Thrombosis is observed but aneurysm or false aneurysm are more common. Computed tomographic angiography is essential for diagnosis and study of the characteristics of aneurysms and false aneurysms. Treatment relies on corticosteroids and immunosuppressive drugs in severe forms supplemented by open or endovascular repair. This latter approach represents a safe and efficient alternative to open surgery, it induces fewer pseudoaneurysms and increases the survival rate especially in association with immunosuppressors. We report a case of Behçet disease revealed by a false aneurysm of the abdominal aorta treated by deployment of a covered stent.


Assuntos
Falso Aneurisma/etiologia , Aneurisma da Aorta Abdominal/etiologia , Síndrome de Behçet/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/terapia , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamento farmacológico , Procedimentos Endovasculares/instrumentação , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
7.
Vasc Health Risk Manag ; 15: 283-290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496717

RESUMO

Angiography remains a widely utilized imaging modality during vascular procedures. Angiography, however, has its limitations by underestimating the true vessel size, plaque morphology, presence of calcium and thrombus, plaque vulnerability, true lesion length, stent expansion and apposition, residual narrowing post intervention and the presence or absence of dissections. Intravascular ultrasound (IVUS) has emerged as an important adjunctive modality to angiography. IVUS offers precise imaging of the vessel size, plaque morphology and the presence of dissections and guides interventional procedures including stent sizing, assessing residual narrowing and stent apposition and expansion. IVUS-guided treatment has shown to yield superior outcomes when compared to angiography-only guided therapy. The cost-effectiveness of the routine use of IVUS during vascular procedures needs to be further studied.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Ultrassonografia de Intervenção , Doença da Artéria Coronariana/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Stents , Resultado do Tratamento
8.
Vasc Endovascular Surg ; 53(7): 572-582, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31382837

RESUMO

BACKGROUND-AIM: Limited data exist concerning the fluid dynamic changes induced by endovascular aortic repair with fenestrated and chimney graft modalities in pararenal aneurysms. We aimed to investigate and compare the wall shear stress (WSS) and flow dynamics for the branch vessels before and after endovascular aortic repair with fenestrated and chimney techniques. METHODS: Modeling was done for patient specific pararenal aortic aneurysms employing fenestrated and chimney grafts (Materialise Mimics 10.0) before and after the endovascular procedure, using computed tomography scans of patients. Surface and spatial grids were created using the ANSYS CFD meshing software 2019 R2. Assessment of blood flow, streamlines, and WSS before and after aneurysm repair was performed. RESULTS: The endovascular repair with chimney grafts leaded to a 43% to 53% reduction in perfusion in renal arteries. In fenestrated reconstruction, we observed a 15% reduced perfusion in both renal arteries. In both cases, we observed a decrease in the recirculation phenomena of the aorta after endovascular repair. Concerning the grafts of the renal arteries, we observed in both the transverse and longitudinal axes low WSS regions with simultaneous recirculation of the flow 1 cm distal to the ostium sites in both aortic graft models. High WSS regions appeared in the sites of ostium. CONCLUSIONS: We observed reduced renal perfusion in chimney grafts compared to fenestrated grafts, probably caused by the long and kinked characteristics of these devices.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Tomada de Decisão Clínica , Procedimentos Endovasculares/instrumentação , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Hemodinâmica , Humanos , Hidrodinâmica , Seleção de Pacientes , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Desenho de Prótese , Interpretação de Imagem Radiográfica Assistida por Computador , Circulação Renal , Estresse Mecânico , Resultado do Tratamento
9.
Methodist Debakey Cardiovasc J ; 15(2): 152-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384380

RESUMO

Iatrogenic aortocaval fistula is an extremely rare pathologic condition that often results in clinically significant left-to-right extracardiac shunt. In slow-progressing cases, chronic right-sided heart failure can occur and, in some patients, may persist for years. We present a patient with a long-standing aortocaval fistula that was causing high-flow left-to-right shunting, tricuspid regurgitation, severe pulmonary hypertension, and right-side heart failure. After undergoing complete endoscopic isolation of the aortocaval fistula, the patient experienced dramatic clinical improvement and continued to have excellent imaging and clinical resolution after 2 years of follow-up.


Assuntos
Aorta/fisiopatologia , Fístula Arteriovenosa/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Insuficiência Cardíaca/etiologia , Hipertensão Pulmonar/etiologia , Doença Iatrogênica , Veia Cava Inferior/fisiopatologia , Aorta/diagnóstico por imagem , Aortografia/métodos , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/fisiopatologia , Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler em Cores , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Desenho de Prótese , Fluxo Sanguíneo Regional , Dispositivo para Oclusão Septal , Fatores de Tempo , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem
10.
Vasc Endovascular Surg ; 53(7): 563-571, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31362600

RESUMO

OBJECTIVES: Patients referred for fenestrated/branched endovascular aortic repair (F/BEVAR) often present with a previous computed tomography angiogram (CTA), but it is unknown how recent the CTA must be to ensure accurate F/BEVAR planning. We sought to determine whether anatomic planning parameters change significantly between a CTA used for F/BEVAR planning and a CTA obtained 6 to 12 months prior. METHODS: Two blinded observers reviewed preoperative CTAs from 21 patients who underwent F/BEVAR. Each patient had a "recent" scan obtained 0 to 6 months before F/BEVAR planning and a "prior" scan obtained 6 to 12 months before the "recent" CTA. Standard measurements included (1) target vessel separation distances, (2) target vessel origin clock position, and (3) proximal F/BEVAR device diameter. Clinically significant differences for target vessel separation distance, target vessel origin clock position, and proximal F/BEVAR device diameter were predefined as >5 mm, >30 minutes, and >4 mm, respectively. Differences between "recent"/"prior" CTA scans were examined by paired t test. RESULTS: Mean time interval between paired "recent"/"prior" CTAs was 8.0 months (standard deviation: ±1.7). Mean difference in paired "recent"/"prior" target vessel distance (relative to celiac artery [CA]) was 2.6 mm for the superior mesenteric artery (SMA), 2.5 mm for the right renal artery (RRA), and 3.3 mm for the left renal artery (LRA). Of the 21 paired "recent"/"prior" CTAs, clinically significant differences were observed in 2, 4, and 2 patients for SMA, RRA, and LRA target vessel distance, respectively. Target vessel clock position (SMA reference at 12:00) varied by 12 minutes for the CA, 13 minutes for the RRA, and 15 minutes for the LRA. One paired "recent"/"prior" CTA was found to have a clinically significant difference for the LRA. No clinically significant differences were observed for proximal device diameter. CONCLUSIONS: In patients who underwent successful F/BEVAR, measurement comparisons between CTAs obtained up to 1 year prior were minor and unlikely to yield clinically significant changes to F/BEVAR design.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Aortografia/métodos , Implante de Prótese Vascular/métodos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/métodos , Idoso , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Desenho de Prótese , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
11.
J Clin Neurosci ; 68: 86-91, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31331751

RESUMO

OBJECTIVE: Clinical data on the new Neuroform Atlas stent for treatment of intracranial aneurysms is limited. We report our experience in stent-assisted coiling procedures of complex, predominantly wide-necked aneurysms. METHODS: This is a retrospective study of consecutive patients treated with the Neuroform Atlas stent between August 2014 and November 2018 at three German tertiary care centers. We evaluated the complication rate, clinical outcome and angiographic result at mid-term follow-up. RESULTS: Thirty-seven aneurysms (elective: 23, previous subarachnoid hemorrhage: 14) were treated in 37 patients (mean age: 59.4 years, 62.2% females). Stent-assisted coiling was successful in all cases, achieving immediate complete aneurysm occlusion by coiling in 83.8% and neck remnants in 16.2%. At 6-month angiographic follow-up, complete aneurysm occlusion was obtained in 80.8% (21/26), neck remnants in 11.5% (3/26) and aneurysm remnants in 7.7% (2/26). Retreatment was necessary in 7.7%. Ischemic stroke occurred in one patient (2.7%). At 6-month clinical follow-up, procedure-related permanent morbidity was 2.7%. CONCLUSIONS: Our results demonstrate that treatment of intracranial aneurysms with the Neuroform Atlas stent is associated with low morbidity and a high aneurysm occlusion rate at mid-term follow-up. Further studies will be necessary to confirm our results.


Assuntos
Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents/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
13.
Vasc Endovascular Surg ; 53(7): 613-616, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31307324

RESUMO

PURPOSE: Endovascular aneurysm repair (EVAR) for an isolated common iliac artery aneurysm (iCIAA) sometimes requires a bifurcated stent graft (SG). In EVAR, it is essential to preserve the renal artery (RA). However, this is challenging in cases of anatomical variation. The double D technique (DDT) can be used in anatomically inadequate cases with a commercially approved bifurcated SG. Here, we report the repair of iCIAA in the presence of a challenging RA anatomy, through EVAR using the DDT. CASE REPORT: An 84-year-old woman was diagnosed with a maximal 35-mm diameter left iCIAA and a nonaneurysmal aorta by computed tomography (CT), which also showed that the right RA arose 50-mm above the aortic bifurcation. The DDT was chosen because commercially approved bifurcated SGs typically require a distance of >70 mm from the proximal position to the aortic bifurcation. Postoperative CT showed excellent results with no endoleaks or SG kinking and occlusion, as well as preservation of robust blood flow to the right RA. CONCLUSION: Endovascular aneurysm repair using the DDT can be an alternative option for treatment of iCIAA with a challenging RA anatomy.


Assuntos
Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Aneurisma Ilíaco/cirurgia , Artéria Renal/anormalidades , Stents , Idoso de 80 Anos ou mais , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/fisiopatologia , Desenho de Prótese , Artéria Renal/diagnóstico por imagem , Artéria Renal/fisiopatologia , Resultado do Tratamento
14.
Vasc Endovascular Surg ; 53(7): 609-612, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31309863

RESUMO

The subclavian steal syndrome (SSS), also called subclavian steal steno-occlusive disease, is defined as reversal of the vertebral artery flow secondary to significant hemodynamically ipsilateral occlusion or stenosis of the proximal subclavian artery. It is usually seen secondary to atherosclerosis and aberrant right subclavian artery (ARSA), resulting in SSS which is even less common. Aberrant right subclavian artery is a kind of vascular anomaly associated with coarctation of the aorta (CoA). It usually originates from the descending aorta distal to the site of CoA. Here, we present a young man who was a case of ARSA and CoA. He developed SSS after transcatheter aortic stenting secondary to unusual origin of ARSA from the site of CoA. Awareness of this rare anomaly helps to overcome this complication in patients undergoing interventional stenting for CoA and ARSA with anomalous origin.


Assuntos
Coartação Aórtica/terapia , Anormalidades Cardiovasculares/complicações , Procedimentos Endovasculares/instrumentação , Stents , Artéria Subclávia/anormalidades , Adulto , Coartação Aórtica/complicações , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/fisiopatologia , Aortografia/métodos , Anormalidades Cardiovasculares/diagnóstico por imagem , Anormalidades Cardiovasculares/fisiopatologia , Anormalidades Cardiovasculares/cirurgia , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Humanos , Masculino , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/fisiopatologia , Artéria Subclávia/cirurgia , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/etiologia , Síndrome do Roubo Subclávio/fisiopatologia , Resultado do Tratamento , Ultrassonografia Doppler em Cores
15.
Int J Cardiovasc Imaging ; 35(10): 1777-1784, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31201589

RESUMO

The aim of this study was to elucidate the vascular responses to paclitaxel-eluting stent (Zilver PTX stent) in superficial femoral artery lesion at different elapsed times using angioscopy. Patients who received Zilver PTX stent implantation from five centers were enrolled. We performed angioscopic examinations at 2, 6, and 12 months after implantation and evaluated neointimal coverage (NIC) grade, intra-stent thrombus (IS-Th) grade, and presence of yellow plaque. NIC grade 0 was defined as stent struts exposed; grade 1, struts transparently visible although covered; grade 2, struts embedded in the neointima, but translucent; and grade 3, struts fully embedded and invisible. IS-Th was graded as follows: grade 0 (none), 1 (focal), and 2 (diffusely spread). Angioscopic follow-up evaluation was performed at 2 months (25 patients, 42 lesions), 6 months (18 patients, 23 stents), and 12 months (14 patients, 24 stents) after stent implantation. Dominant NIC grade significantly increased over time; however, 16.3% of the cases had NIC grade 1 or 2 at 12 months. IS-Th grade decreased; however IS-Th and yellow plaque were persistently observed in 62.5% and 83.3% cases, respectively, at 12 months. An ongoing healing response was observed at 12 months after implantation; however, thrombogenic findings were noted. Prolonged dual antiplatelet therapy could potentially enhance the clinical utility of Zilver PTX.


Assuntos
Ligas , Angioscopia , Fármacos Cardiovasculares/administração & dosagem , Stents Farmacológicos , Procedimentos Endovasculares/instrumentação , Artéria Femoral/diagnóstico por imagem , Paclitaxel/administração & dosagem , Doença Arterial Periférica/terapia , Stents Metálicos Autoexpansíveis , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Fármacos Cardiovasculares/efeitos adversos , Proliferação de Células , Procedimentos Endovasculares/efeitos adversos , Feminino , Artéria Femoral/fisiopatologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Neointima , Paclitaxel/efeitos adversos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Inibidores da Agregação de Plaquetas/administração & dosagem , Valor Preditivo dos Testes , Estudos Prospectivos , Desenho de Prótese , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
16.
Vasc Health Risk Manag ; 15: 115-122, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190849

RESUMO

Iliac vein compression (LIVC) is a prevalent finding in the general population, but a smaller number of patients are symptomatic. ILVC should be considered in symptomatic patients with unexplained unilateral lower leg swelling. Patients typically complain of one or more of the following symptoms: lower leg pain, heaviness, venous claudication, swelling, hyperpigmentation and ulceration. ILVC can be thrombotic, combined with acute or chronic DVT, or non-thrombotic. ILVC is best diagnosed with intravascular ultrasound (IVUS), but computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have emerged as valid screening tests. Venography underestimates the severity of ILVC but may provide insights into the anatomy and the presence of collaterals. Based on current available evidence, endovascular therapy with stenting remains the main treatment strategy for ILVC. Dedicated nitinol venous stents are currently under review by the Food and Drug Administration for potential approval in the United States. These stents have been released outside the US. There is no consensus to the optimal anticoagulation regimen post-ILVC stenting. Oral anticoagulants, however, remain a preferred therapy in patients with history of thrombotic ILVC.


Assuntos
Anticoagulantes/administração & dosagem , Diagnóstico por Imagem/métodos , Procedimentos Endovasculares , Veia Ilíaca , Síndrome de May-Thurner , Administração Oral , Anticoagulantes/efeitos adversos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Veia Ilíaca/cirurgia , Angiografia por Ressonância Magnética , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/epidemiologia , Síndrome de May-Thurner/fisiopatologia , Síndrome de May-Thurner/terapia , Flebografia/métodos , Valor Preditivo dos Testes , Prevalência , Stents , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Ultrassonografia de Intervenção
17.
Vasc Endovascular Surg ; 53(6): 512-514, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31230580

RESUMO

Blowout syndrome caused by vascular invasion is a dreadful complication of late stage malignancies that carry high morbidity and poor overall prognosis in a compromised population. Endovascular management can offer minimally invasive and life-saving alternative for such acute conditions. We describe the case of a 62-year-old man with massive fresh bleeding per rectum and shock resulting from rupture of the left external iliac artery secondary to nearby infiltrative recurrent sigmoid cancer. This complication is rare, presents dramatically, and is frequently fatal. The patient was successfully treated with a stent graft deployment in order to achieve hemostasis and reinstituting the arterial integrity.


Assuntos
Adenocarcinoma/complicações , Implante de Prótese Vascular , Procedimentos Endovasculares , Artéria Ilíaca/cirurgia , Recidiva Local de Neoplasia , Doença Arterial Periférica/cirurgia , Neoplasias do Colo Sigmoide/complicações , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/etiologia , Neoplasias do Colo Sigmoide/diagnóstico por imagem , Neoplasias do Colo Sigmoide/patologia , Stents , Resultado do Tratamento
18.
Expert Rev Med Devices ; 16(7): 541-548, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155976

RESUMO

Introduction: Thoracic endovascular aortic repair has been increasingly used to treat type B aortic dissection (TBAD) when it is indicated, offering better outcome in terms of mortality and morbidity compared to open repair. Accepted goals for endovascular treatment of aortic dissections are the closure of the primary intimal entry tear, depressurization, and thrombosis of the false lumen. Areas covered: This is a descriptive review on the Zenith Dissection Endovascular System (Cook Medical Inc., Bloomington, IN) which is a modular system specifically designed to treat TBAD, consisting of a proximal component, the Zenith TX2 TAA Endovascular Graft, and a distal component, the Zenith Dissection Endovascular Stent. The distal stents are uncovered to avoid blockage of dominant spinal cord intercostal arteries and allow for the deployment of the stents across branch vessel origins as needed to treat the dissection. Expert opinion: The Zenith Dissection Endovascular System has already been used for the treatment of TBAD for the last decade mostly in experienced centers. Current evidence suggests that this is a feasible and safe technique with relative low early mortality and morbidity rates. It is important to highlight the potential benefit of Zenith Dissection Endovascular System on the remodeling the dissected aorta during the follow-up period.


Assuntos
Aneurisma Dissecante/cirurgia , Procedimentos Endovasculares/instrumentação , Prótese Vascular , Humanos , Trombose/cirurgia , Resultado do Tratamento
19.
Vasc Endovascular Surg ; 53(6): 452-457, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31170884

RESUMO

BACKGROUND: Metformin is the most commonly used drug for type 2 diabetes. Research has shown that metformin also has a protective effect on endothelium by decreasing endothelial vascular reactivity. We hypothesize that metformin will decrease restenosis/reintervention rates in patients receiving lower extremity non-drug-eluting stents (nDESs) in the superficial femoral artery(SFA) and/or popliteal artery. MATERIALS/METHODS: Retrospective study was performed on 187 patients from October 2012 to December 2015 who received an nDES in the SFA and/or popliteal artery. Patients were divided into 3 groups (Table 1) and compared against for duplex based restenosis (>60%) rates, limb loss rates, and reintervention rates. Each patient's Trans-Atlantic-Inter-Society-Consensus II (TASC-II) class was collected. Postoperative duplex was performed 1 week after the procedure, then every 3 months for the first year, then, every 6 months to check for patency. IBM-SPSS-22 was used for all analyses. RESULTS: Average age of the patients was 64.65 ± 73.4 years. 101 patients had 101 procedures performed on the left lower extremity; 86 patients had 86 procedures performed on the right lower extremity; 123 patients were male and 64 were female. Average length of follow-up was 13.1±9.7 months. Most common indication for intervention was claudication, followed by critical limb threatening ischemia. Restenosis and reintervention by groups can be seen in Table 1. No patients experienced limb loss. There were no statistically significant differences between any of the 3 groups and their limb loss, restenosis, or reintervention rates. CONCLUSIONS: Despite having multiple proven effects in improving certain clinical outcomes and a proven protective effect on endothelium by decreasing endothelial vascular reactivity, metformin does not appear to reduce restenosis or reintervention rates in patients receiving lower extremity nDESs in the SFA and/or popliteal artery.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Procedimentos Endovasculares/instrumentação , Artéria Femoral/cirurgia , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Doença Arterial Periférica/cirurgia , Artéria Poplítea/cirurgia , Stents , Grau de Desobstrução Vascular/efeitos dos fármacos , Idoso , Constrição Patológica , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Procedimentos Endovasculares/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla
20.
J Vasc Surg ; 69(6S): 126S-136S, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31159976

RESUMO

BACKGROUND: The optimal strategy for revascularization in infrainguinal chronic limb-threatening ischemia (CLTI) remains debatable. Comparative trials are scarce, and daily decisions are often made using anecdotal or low-quality evidence. METHODS: We searched multiple databases through May 7, 2017, for prospective studies with at least 1-year follow-up that evaluated patient-relevant outcomes of infrainguinal revascularization procedures in adults with CLTI. Independent pairs of reviewers selected articles and extracted data. Random-effects meta-analysis was used to pool outcomes across studies. RESULTS: We included 44 studies that enrolled 8602 patients. Periprocedural outcomes (mortality, amputation, major adverse cardiac events) were similar across treatment modalities. Overall, patients with infrapopliteal disease had higher patency rates of great saphenous vein graft at 1 and 2 years (primary: 87%, 78%; secondary: 94%, 87%, respectively) compared with all other interventions. Prosthetic bypass outcomes were notably inferior to vein bypass in terms of amputation and patency outcomes, especially for below knee targets at 2 years and beyond. Drug-eluting stents demonstrated improved patency over bare-metal stents in infrapopliteal arteries (primary patency: 73% vs 50% at 1 year), and was at least comparable to balloon angioplasty (66% primary patency). Survival, major amputation, and amputation-free survival at 2 years were broadly similar between endovascular interventions and vein bypass, with prosthetic bypass having higher rates of limb loss. Overall, the included studies were at moderate to high risk of bias and the quality of evidence was low. CONCLUSIONS: There are major limitations in the current state of evidence guiding treatment decisions in CLTI, particularly for severe anatomic patterns of disease treated via endovascular means. Periprocedural (30-day) mortality, amputation, and major adverse cardiac events are broadly similar across modalities. Patency rates are highest for saphenous vein bypass, whereas both patency and limb salvage are markedly inferior for prosthetic grafting to below the knee targets. Among endovascular interventions, percutaneous transluminal angioplasty and drug-eluting stents appear comparable for focal infrapopliteal disease, although no studies included long segment tibial lesions. Heterogeneity in patient risk, severity of limb threat, and anatomy treated renders direct comparison of outcomes from the current literature challenging. Future studies should incorporate both limb severity and anatomic staging to best guide clinical decision making in CLTI.


Assuntos
Implante de Prótese Vascular , Procedimentos Endovasculares , Isquemia/terapia , Doença Arterial Periférica/terapia , Veia Safena/transplante , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Isquemia/diagnóstico , Isquemia/mortalidade , Isquemia/fisiopatologia , Salvamento de Membro , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Intervalo Livre de Progressão , Medição de Risco , Fatores de Risco , Veia Safena/fisiopatologia , Stents , Fatores de Tempo , Grau de Desobstrução Vascular
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