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1.
Ann R Coll Surg Engl ; 103(3): e94-e97, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645285

RESUMO

Behçet's disease is a rare disease characterised by recurrent oral ulcers, with systemic manifestations including genital ulcers, ocular disease, skin lesions, gastrointestinal disease, neurologic disease, vascular disease and arthritis. Most clinical manifestations of Behçet's disease are believed to be due to vasculitis. The heterogeneous clinical spectrum is influenced by sex, ethnicity and country of residence. Vascular manifestation in the form of isolated large brachial artery aneurysm is rare in children. Treatment involves aneurysmorrhaphy to avoid rupture or ischaemic sequelae in addition to lifelong medical management to control vasculitis.


Assuntos
Aneurisma/diagnóstico por imagem , Síndrome de Behçet/diagnóstico , Artéria Braquial/diagnóstico por imagem , Trombose/diagnóstico por imagem , Aneurisma/etiologia , Aneurisma/patologia , Aneurisma/cirurgia , Anticorpos Antinucleares/imunologia , Síndrome de Behçet/complicações , Síndrome de Behçet/imunologia , Síndrome de Behçet/patologia , Sedimentação Sanguínea , Artéria Braquial/patologia , Artéria Braquial/cirurgia , Proteína C-Reativa/imunologia , Pré-Escolar , Angiografia por Tomografia Computadorizada , Antígeno HLA-B51/imunologia , Humanos , Masculino , Veia Safena/transplante , Trombose/etiologia , Trombose/patologia , Trombose/cirurgia , Enxerto Vascular/métodos
2.
Vasc Endovascular Surg ; 55(1): 5-10, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32869709

RESUMO

BACKGROUND: Distal bypass (DB) is the optimal treatment for patients with critical limb ischemia (CLI). However, effectiveness of DB for patients with intermittent claudication (IC) remains uncertain. This study aimed to analyze long-term results of DB for IC patients (IC-DB) compared with those of DB for CLI patients (CLI-DB). METHODS: Patients undergoing DB from January 2009 to July 2018 at a single institution were retrospectively reviewed. Operative details, primary and secondary patency, amputation free survival rate (AFS), and long-term exercise capacity using Barthel index were analyzed. RESULTS: Out of 302 DB (245 patients), 49 IC-DB were performed in 43 patients: 38 males, mean age 70.3 ± 8.0 years, diabetes mellitus 51%, chronic renal failure with hemodialysis 7%. The Great saphenous vein was used in 47 limbs, the small saphenous vein in 1, and the arm vein in 1. These grafts were bypassed in a non-reversed fashion for 35 limbs, in an in-situ fashion in 9, and in a reversed fashion in 5. The mean operative time was 173 min. The mean follow-up was 25 ± 26 months. Primary and secondary patency of IC-DB was 79% and 94% at 1 year, 71% and 90% at 3 years, 65% and 90% at 5 years, which were significantly higher than those of CLI-DB (primary patency: P = .007, secondary patency: P = .025). AFS of IC-DB and CLI-DB was 100% and 77% at 1 year, 93% and 52% at 3 years, and 90% and 43% at 5 years (IC-DB vs. CLI-DB, p < .0001). Barthel index of IC-DB unchanged at discharge (median 100) and at the last visit (median 100), showing daily activity was maintained adequately. CONCLUSIONS: DB could offer a promising approach for patients with IC because of durable graft patency, acceptable AFS, and maintenance of daily activity.


Assuntos
Claudicação Intermitente/cirurgia , Isquemia/cirurgia , Doença Arterial Periférica/cirurgia , Veia Safena/transplante , Idoso , Idoso de 80 Anos ou mais , Estado Terminal , Tolerância ao Exercício , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Claudicação Intermitente/diagnóstico por imagem , Claudicação Intermitente/fisiopatologia , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
3.
Eur J Vasc Endovasc Surg ; 60(3): 403-409, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32768278

RESUMO

OBJECTIVE: Vein is regarded superior to artificial graft in peripheral arterial bypass surgery. However, this option is often limited owing to previous use or removal of the ipsilateral greater saphenous vein (iGSV). In this case, the contralateral great saphenous vein (cGSV), the small saphenous vein (SSV), or arm veins (AV) are possible alternatives. Experience with all three grafts for below knee vein bypass is reported. METHODS: Consecutive patients treated at an academic tertiary referral centre between January 1998 and July 2018 using the cGSV, SSV, or AV as the main peripheral bypass graft were analysed. Study end points were primary patency, secondary patency, limb salvage, and survival. RESULTS: Over the observed time period, 2642 bypass operations for treatment of peripheral artery disease with below knee target arteries were performed at the authors' institution: 1937 procedures using the iGSV; 644 bypass procedures using the cGSV (n = 186; 28.9%), SSV (n = 101; 15.7%), or AV (n = 357; 55.4%); and 61 procedures using a prosthetic graft. The median follow up period was 2.3 years (range 9 days-18.5 years). Thirty day mortality was 1.9% for the whole group and similar between the three groups. After five years, primary and secondary patency rates were comparable between the three groups. Secondary patency was 75% (95% confidence interval [CI] 66-83) in the cGSV and SSV groups, and 65% (95% CI 57-73) in the AV group (p = .47). Limb salvage and survival after five years were, respectively, 73% (95% CI 65-81) and 89% (95% CI 82-95) in the cGSV group, 79% (95% CI 69-89) and 87% (95% CI 79-95) in the SSV group, and 74% (95% CI 68-80) and 83% (77-89) in the AV group (p = .46). CONCLUSION: All three types of alternative autologous vein graft are equal regarding outcome parameters. Vascular surgeons should consider all autologous options if their preferred choice is not available.


Assuntos
Braço/irrigação sanguínea , Implante de Prótese Vascular , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Veia Safena/transplante , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação , Implante de Prótese Vascular/efeitos adversos , Bases de Dados Factuais , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/cirurgia , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
4.
Asian Cardiovasc Thorac Ann ; 28(6): 316-321, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32615773

RESUMO

BACKGROUND: The method of coronary-coronary bypass grafting was described in 1987 but has not been widely used, and there are only a few studies that report good short-term and mid-term results as well as some individual cases of long-term follow-up. In our medical institution, we carried out an analysis of the long-term results of coronary-coronary bypass grafting, which are presented in this study. METHODS: This was a retrospective single-center study on 95 patients who underwent coronary-coronary bypass grafting as a supplement to the standard coronary bypass grafting procedure. All patients underwent angiographic assessment of the coronary bypass grafts during the long-term follow-up period. The observation period was up to 123 months. Angiographic assessment of 109 coronary-coronary grafts was carried out. RESULTS: Twelve (7.6%) arterial and 11 (19.3%) venous conduits were found to be occluded, and 8 (10.3%) arterial and 10 (31.3%) venous coronary-coronary grafts were occluded during the observation period. CONCLUSION: Arterial coronary-coronary artery bypass grafting represents an alternative technique that allows complete myocardial revascularization.


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Anastomose de Artéria Torácica Interna-Coronária , Artéria Torácica Interna/cirurgia , Veia Safena/transplante , Angiografia Coronária , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Masculino , Artéria Torácica Interna/diagnóstico por imagem , Artéria Torácica Interna/fisiopatologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
6.
Medicine (Baltimore) ; 99(28): e20850, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664079

RESUMO

RATIONALE: With the development and standardization of modern chronic total occlusions (CTOs) recanalization technique, percutaneous coronary intervention has become a promising treatment alternative to surgery after bypass graft failure. Treatment of a native coronary CTO lesion is preferable to treatment of a saphenous vein graft (SVG) CTO supplying the same territory; however, technical expertise is required. PATIENT CONCERNS: This is a 69-year-old male with prior history of coronary artery bypass grafting presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration. DIAGNOSIS: The patient was diagnosed as heart failure caused by ischemia after SVG failure (SVG to right coronary artery) according to electrocardiogram, plasma N-terminal pro-B-type natriuretic peptide levels, and coronary angiogram. INTERVENTIONS: We recanalized native right coronary artery CTO by retrograde approach using septal collaterals by surfing technique after recanalization of totally occluded left coronary artery. OUTCOMES: Dyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea. LESSONS: In case of SVG failure, percutaneous coronary intervention of native vessel should be considered as a treatment option. Retrograde approach through native vessel is safe but has requirements for operators' volume, skill, and experience.


Assuntos
Vasos Coronários/cirurgia , Dispneia/etiologia , Insuficiência Cardíaca/diagnóstico , Veia Safena/transplante , Assistência ao Convalescente , Idoso , Angiografia Coronária/métodos , Ponte de Artéria Coronária/efeitos adversos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Eletrocardiografia/métodos , Oclusão de Enxerto Vascular/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Intervenção Coronária Percutânea/métodos , Resultado do Tratamento
7.
Ann Vasc Surg ; 69: 453.e5-453.e10, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32653615

RESUMO

To report a case of acute arm ischemia and prosthetic shoulder infection treated by extra-anatomical great saphenous vein graft with external vascular scaffolding. A 65 year-old man with multiple surgical interventions for soft tissue sarcoma of the right shoulder, local radiotherapy with residual brachial plexus neuropraxia, was referred to our attention for signs of arm ischemia. Two weeks before, the patient was submitted to prosthetic shoulder replacement complicated with prosthetic infection. Considering the mechanism of vascular injury, an open surgical revascularization was planned with a deliberate avoidance of the natural anatomic pathway to reduce the risk of graft infection. Consequently, after the complete removal of infected shoulder prosthesis and placement of antibiotic spacer, an axillarbrachial artery bypass using great saphenous vein was performed using a new braided cobalt chrome kink resistant external vascular support to prevent compression, also considering the extra-anatomical position of the graft. At 12 months' follow-up, patient was in good clinical condition with complete resolution of arm ischemia; computed tomographic angiography and duplex scan revealed patency of the graft with excellent distal perfusion. The new external vascular support seems to be useful and feasible for preventing compression of extra-anatomical venous bypass.


Assuntos
Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/instrumentação , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Remoção de Dispositivo , Isquemia/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Veia Safena/transplante , Prótese de Ombro/efeitos adversos , Extremidade Superior/irrigação sanguínea , Idoso , Ligas de Cromo , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Isquemia/fisiopatologia , Masculino , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Fluxo Sanguíneo Regional , Resultado do Tratamento , Grau de Desobstrução Vascular
8.
Int J Cardiovasc Imaging ; 36(11): 2105-2106, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32686029

RESUMO

A patient with Takayasu arteritis who underwent CABG using a saphenous vein graft (SVG) experienced ventricular fibrillation due to total SVG occlusion. A drug-eluting stent was implanted; however, follow-up CAG demonstrated an advanced expansion of peri-stent contrast staining. Coronary computed tomography angiography revealed contrast media extending around the SVG. An intravascular ultrasound indicated a worsening stent malapposition and a significant positive remodeling.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Coronário/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Stents Farmacológicos , Oclusão de Enxerto Vascular/terapia , Imagem Multimodal , Intervenção Coronária Percutânea/instrumentação , Veia Safena/transplante , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Angiografia por Tomografia Computadorizada , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/etiologia , Angiografia Coronária , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Humanos , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Valor Preditivo dos Testes , Veia Safena/diagnóstico por imagem , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico , Resultado do Tratamento , Ultrassonografia de Intervenção , Remodelação Vascular
9.
J Postgrad Med ; 66(3): 165-168, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32675454

RESUMO

Hemoptysis due to saphenous venous graft (SVG) aneurysm is an extremely rare condition and published literature has described the role of conservative management, surgical resection, and covered stent. Here, we report a successful placement of a covered stent for SVG aneurysm in a 56-year-old male who presented with hemoptysis. He was a known diabetic and had undergone a coronary artery bypass grafting 5 years ago. Computed tomography (CT) chest and fiberoptic bronchoscopy performed in another local hospital had revealed blood in the left lingula with spillover into the left lung parenchyma. Hence, he had received empirical anti-tuberculosis medication for 2 months without any improvement. He was referred to our hospital for further management of hemoptysis. Multidetector CT (MDCT) angiography of the chest covering coronaries performed at our hospital revealed SVG aneurysm that was managed with covered stent placement.


Assuntos
Aneurisma/etiologia , Ponte de Artéria Coronária/efeitos adversos , Hemoptise/etiologia , Veia Safena/transplante , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores
10.
JAMA ; 324(2): 179-187, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32662861

RESUMO

Importance: Observational studies have suggested that the use of radial artery grafts for coronary artery bypass grafting may improve clinical outcomes compared with the use of saphenous vein grafts, but this has not been confirmed in randomized trials. Objective: To compare clinical outcomes between patients receiving radial artery vs saphenous vein grafts for coronary artery bypass grafting after long-term follow-up. Design, Setting, and Participants: Patient-level pooled analysis comparing radial artery vs saphenous vein graft in adult patients undergoing isolated coronary artery bypass grafting from 5 countries (Australia, Italy, Serbia, South Korea, and the United Kingdom), with enrollment from 1997 to 2009 and follow-up completed in 2019. Interventions: Patients were randomized to undergo either radial artery (n = 534) or saphenous vein (n = 502) grafts for coronary artery bypass grafting. Main Outcomes and Measures: The primary outcome was a composite of death, myocardial infarction, or repeat revascularization and the secondary outcome was a composite of death or myocardial infarction. Results: A total of 1036 patients were randomized (mean age, 66.6 years in the radial artery group vs 67.1 years in the saphenous vein group; 376 [70.4%] men in the radial artery group vs 351 [69.9%] in the saphenous vein group); 942 (90.9%) of the originally randomized patients completed 10 years of follow-up (510 in the radial artery group). At a median (interquartile range) follow-up of 10 (10-11) years, the use of the radial artery, compared with the saphenous vein, in coronary artery bypass grafting was associated with a statistically significant reduction in the incidence of the composite outcome of death, myocardial infarction, or repeat revascularization (220 vs 237 total events; 41 vs 47 events per 1000 patient-years; hazard ratio, 0.73 [95% CI, 0.61-0.88]; P < .001) and of the composite of death or myocardial infarction (188 vs 193 total events; 35 vs 38 events per 1000 patient-years; hazard ratio, 0.77 [95% CI, 0.63-0.94]; P = .01). Conclusions and Relevance: In this individual participant data meta-analysis with a median follow-up of 10 years, among patients undergoing coronary artery bypass grafting, the use of the radial artery compared with the saphenous vein was associated with a lower risk of a composite of cardiovascular outcomes.


Assuntos
Ponte de Artéria Coronária/métodos , Artéria Radial/transplante , Veia Safena/transplante , Idoso , Ponte de Artéria Coronária/mortalidade , Feminino , Seguimentos , Humanos , Incidência , Masculino , Infarto do Miocárdio/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento
11.
Artigo em Inglês | MEDLINE | ID: mdl-32520449

RESUMO

Left ventricular aneurysm is a late mechanical complication of untreated acute myocardial infarction. It has become relatively rare since the development of percutaneous cardiac intervention.  Most aneurysms are located at the anterior ventricular wall, and are caused by total occlusion of the left anterior descending artery. Usually, the anterior and apical walls initially become akinetic; this can sometimes evolve into dyskinesia. Thrombus formation is a common finding, since the apical contractility is impaired. This tutorial illustrates the challenging technical aspects of a large thrombus removal, along with the geometric reconstruction of the left ventricular aneurysm and coronary bypass surgery.


Assuntos
Ponte de Artéria Coronária , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração/cirurgia , Idoso , Humanos , Masculino , Veia Safena/transplante
12.
Vasc Endovascular Surg ; 54(5): 430-435, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32489155

RESUMO

OBJECTIVE: Cadaveric saphenous vein (CV) conduits are used in rare instances for limb salvage in patients without autogenous veins although long-term outcome data are scarce. This study was designed to evaluate the outcomes of CV bypass in patients with threatened limbs. METHODS: We retrospectively reviewed the charts from 2010 to 2017 of 25 patients who underwent 30 CV allografts for critical limb ischemia and acute limb ischemia. Patient charts were reviewed for demographics, comorbidities, smoking status, indications for bypass, and outcomes. Primary outcomes included graft patency, major amputation rates, and mortality. Secondary outcomes measured included infection rates, 30-day major adverse cardiac events (MACE) and major adverse limb events (MALE). Statistical analysis was performed using time series and Kaplan-Meier survival curves. RESULTS: A total of 30 limbs received CV lower extremity bypasses (20 males, 10 female), and the average age was 68 ± 4 years. Primary patency rates were 71%, 42%, and 28% at 3, 6, and 12 months, respectively. Assisted primary patency rates were 78%, 56%, and 37% at 3, 6, and 12 months, respectively. Secondary patency rates were 77%, 59%, and 28% at 3, 6, and 12 months, respectively. Minor amputations, defined as amputations below the transmetatarsal level occurred in 5 (20%) patients. Wound infection occurred in 8 (32%) patients which was managed with local wound care and no patients required an extraanatomic bypass for limb salvage. Thirty-day MALE occurred in 7 (23.3%) patients. We had no 30-day mortality or MACE. The average graft length was 64.2 ± 8 cm with an average graft diameter of 3.9 ± 2 mm. Amputation-free survival and overall survival at 12 months were 20 (68%) and 21 (84%), respectively. CONCLUSIONS: Cadaveric saphenous vein allograft may be used as a bypass conduit as a viable surgical option before limb amputation. Despite the poor patency rates, the limb salvage rates of cadaveric vein grafts demonstrate that this alternate conduit may be considered when no autogenous vein is available.


Assuntos
Salvamento de Membro , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Veia Safena/transplante , Enxerto Vascular , Idoso , Amputação , Cadáver , Feminino , Humanos , Salvamento de Membro/efeitos adversos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Intervalo Livre de Progressão , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Enxerto Vascular/efeitos adversos , Grau de Desobstrução Vascular
14.
J Card Surg ; 35(7): 1717-1720, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32598498

RESUMO

We present a 57-year-old man with recent Streptococcus viridans endocarditis on mitral and aortic valves who had a mycotic aneurysm of the left anterior descending (LAD) coronary artery and associated superior mesenteric and cerebral artery aneurysms. The patient had preoperative renal failure and the infection was controlled with ceftriaxone. Mitral and aortic valve replacement were performed using tissue valves and the LAD aortic aneurysm was ligated and the patient had saphenous venous graft to the LAD. The postoperative course was complicated by pleural effusion and the patient had antibiotic therapy for 6 weeks postoperatively.


Assuntos
Antibacterianos/administração & dosagem , Valva Aórtica/cirurgia , Aneurisma Coronário/etiologia , Aneurisma Coronário/cirurgia , Ponte de Artéria Coronária/métodos , Vasos Coronários/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/cirurgia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Endocardite Bacteriana/microbiologia , Doenças das Valvas Cardíacas/microbiologia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Veia Safena/transplante , Infecções Estreptocócicas , Resultado do Tratamento , Estreptococos Viridans
15.
Ann Thorac Surg ; 110(5): e449-e450, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32504604

RESUMO

The COVID-19 pandemic has necessitated that operating room procedures be modified to ensure the safety of staff and patients. Specifically, procedures that have the potential to create aerosolization must be reassessed, given the risk of viral transmission via aerosolization. We present the use of a nonsealed endoscopic vessel harvesting approach during coronary surgery that does not necessitate the use of CO2 insufflation and utilizes suction through an ultra low particulate filter, thus mitigating the risk of possible viral transmission via aerosolization or surgical smoke production. This approach is technically feasible and can minimize the risk of viral transmission during endoscopic vessel harvesting.


Assuntos
Betacoronavirus , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Infecções por Coronavirus/epidemiologia , Endoscopia/métodos , Pneumonia Viral/epidemiologia , Veia Safena/transplante , Coleta de Tecidos e Órgãos/métodos , Idoso , Comorbidade , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Masculino , Pandemias
16.
Ann Vasc Surg ; 69: 146-157, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32502675

RESUMO

BACKGROUND: Brachial artery injuries are rare. The objectives of the study are to report our experience and identify predictors of outcome. The hypothesis of the study is that maintaining ischemic times less than six hours results in improved outcomes. METHODS: This is a retrospective 118-month study. The outcome measure is total operative time from admission to restoration of blood flow, and outcomes are survival and limb salvage. Statistical analyses used in the study are univariate and multivariate stepwise logistic regression. RESULTS: There were 124 patients with 131 brachial artery injuries. Mechanism of injury (MOI) included the following: penetrating: 108 (87%) and blunt: 16 (13%). Operative management included the following: 77 (62%) reverse saphenous vein interposition grafts, 37 (29.8%) end-to-end anastomosis, and 4 (3.2%) ligation. Fasciotomies were performed in 23 (19.2%) patients. Outcomes of the study were as follows: 120 patients survived and the overall survival rate was 96.8%, adjusted survival rate excluding intraoperative deaths was 100%, overall limb salvage/amputation rate was 95.1%/4.9%, and adjusted limb salvage/amputation rates excluding intraoperative deaths were 98.3%/1.67%. Univariate analysis showed the mean ischemic times for survivors as 5 ± 3.1 hrs (300 ± 186 min) versus ischemic times for non survivors as 3 ± 2.2 hrs (180 ± 132 min) (P = 0.017); Injury Severity Score (ISS) (P = 0.002); and estimated blood loss (EBL) (P = 0.024). Logistic regression identified independent predictors of outcome for survival: MOI: penetrating [P = 0.015, RR - 4.29, 95% CI: 1.49-12.36]; Glasgow Coma Score < 7 [P < 0.001, RR - 21.71, 95% CI: 9.37-50.32]; ISS > 15 [P < 0.005, RR - 4.98, 95% CI: 1.68-14.73]; and patients not requiring ED thoracotomy [P = 0.009, RR - 7.48, 95% CI: 2.58-21.69]. CONCLUSIONS: Brachial artery injuries are rare. For patients not requiring ED thoracotomy, Glasgow Coma Score, ISS, and EBL predicted survival. The adjusted limb salvage rate was 98.3%. Patients with brachial artery injuries die from associated injuries, experiencing less ischemic times than survivors who are able to undergo repairs.


Assuntos
Artéria Braquial/cirurgia , Veia Safena/transplante , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/cirurgia , Adolescente , Adulto , Amputação , Anastomose Cirúrgica , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/lesões , Feminino , Humanos , Ligadura , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/diagnóstico por imagem , Adulto Jovem
17.
Ann Vasc Surg ; 69: 174-181, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32502678

RESUMO

BACKGROUND: The purpose of this study is to record our institution's experience in the management of extracranial carotid artery aneurysms (ECCAs) over the past 15 years. METHODS: A retrospective chart review was performed on consecutive patients with ECCAs from April 2003 to December 2017. Outpatient and inpatient clinic charts were reviewed. All the patients were treated by open surgery between 2003 and 2008. For other patients, the treatment methods included open surgery, endovascular surgery, and hybrid operations which were dependent on the aneurysm anatomy, as well as conservative management. In open series, a carotid shunt was applied and transcranial color Doppler was selectively used for intraoperative monitoring of cerebral blood flow. The resected aneurysm sacs were tested with hematoxylin and eosin stains. Each case was reexamined one month after the patients were discharged from the hospital. A questionnaire survey, a clinical examination, and duplex ultrasonography or computed tomography angiography imaging were carried out. The patients were then reexamined three and six months after surgery and then annually. RESULTS: Thirty ECCAs were treated in 30 patients-14 men and 16 women, with a mean age of 54 ± 13 years. Four types of carotid aneurysms were identified: type I, II, III, and V, with 17, 3, 1, and 9 patients, respectively. From 2003 to 2008, there were eight patients (type I: seven; type II: one), and all were treated by open surgery and one suffered transient cranial nerve palsy. From 2009 to 2017, two patients were treated with conservative management, ten were treated with open surgery, nine were treated with endovascular surgery, and one was treated with hybrid operation. Among the patients who were treated with open surgery, two suffered neck hematoma. All patients recovered well without complications in the endovascular surgery group. Twenty-seven patients presented for follow-up and without contralateral aneurysms or other complications. CONCLUSIONS: The optimal treatment of ECCAs is dependent on the morphology of the carotid artery and properties of aneurysms. Open surgical repair is a suitable and safe procedure for type I ECCAs when the aneurysms are concomitant with kinking in the internal carotid artery. Endovascular treatment is an effective alternative to open surgery for false ECCA repair.


Assuntos
Aneurisma/terapia , Implante de Prótese Vascular , Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Veia Safena/transplante , Técnicas de Sutura , Adulto , Idoso , Aneurisma/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , China , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Stents , Técnicas de Sutura/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
J Cardiothorac Surg ; 15(1): 126, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503570

RESUMO

BACKGROUND: Owing to the high patency, the use of the left internal mammary artery (LIMA) for left anterior descending artery (LAD) grafting has been a cornerstone of coronary artery bypass grafting surgery (CABG). However, for some patients whose LIMA cannot be used, surgeons have to choose other conduit materials to revascularize the LAD. The purpose of this study was to explore the differences in different conduit materials used for LAD in terms of parameters measured by transit-time flow measurement (TTFM) and the early graft patency detected by computed tomography angiography. METHODS: We retrospectively collected the data of 410 patients who underwent isolated primary OPCAB with intraoperative TTFM data. According to the strategy of the LAD revascularization, 410 patients were assigned to three groups: a left internal mammal artery (LIMA) group (n = 333), a right IMA (RIMA) group (n = 34) and a great saphenous vein (SVG) group (n = 43). The baseline and perioperative blood parameters were compared for the three groups, as well as the early graft patency rates. RESULTS: Compared with the LIMA-LAD group, the SVG-LAD group had a significantly higher mean graft flow volume (MGF) (37.15 ± 23.29 vs 29.71 ± 20.94 ml/min, P = 0.036), however, had a lower value of pulse index (PI) (2.07 ± 0.62 vs 2.65 ± 1.01, P<0.001). There was no significant difference between the two groups in terms of DF (P>0.05). Compared with the RIMA-LAD group, the SVG-LAD group just had a lower value of PI (2.07 ± 0.62 vs 2.56 ± 0.96, P = 0.029). However, there was no significant difference between the two groups in terms of MGF and DF (P>0.05). Compared with the LIMA-LAD group, the RIMA-LAD group had a slightly lower value of DF (70.76 ± 11.87 vs 74.06 ± 7.09, P = 0.018), while there was no difference in terms of MGF and PI between the two groups (P>0.05). The patency rate of the LIMA-LAD group was 98.72% (309/313), that of RIMA-LAD group was 97.06% (33/34), and that of SVG-LAD group was 100%. There was no difference among the three groups in patency rate (P = 0.405). CONCLUSIONS: SVG-LAD has a higher intraoperative MGF and a lower value of the PI than both LIMA-LAD and RIMA-LAD. RIMA has a higher preoperative blood flow and a lower value of the PI than LIMA; however, there were no significant difference between RIMA grafted to LAD and LIMA grafted to LAD in terms of MGF, PI and DF. In situ skeletonized RIMA did not increase blood flow compared to pedicled LIMA.


Assuntos
Ponte de Artéria Coronária/métodos , Artéria Torácica Interna/transplante , Análise de Onda de Pulso/métodos , Veia Safena/transplante , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Vasos Coronários/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
19.
J Surg Res ; 253: 280-287, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32402853

RESUMO

BACKGROUND: The autologous vein remains the standard conduit for lower extremity and coronary artery bypass grafting despite a 30%-50% 5-y failure rate, primarily attributable to intimal hyperplasia (IH) that develops in the midterm period (3-24 mo) of graft maturation. Our group discovered that externally strengthening vein grafts by cross-linking the adventitial collagen with photochemical tissue passivation (PTP) mitigates IH in an arteriovenous model at 4 wk. We now investigate whether this effect is retained in the midterm period follow-up. METHODS: Six Hanford miniature pigs received bilateral carotid artery interposition vein grafts. In each animal, the external surface of one graft was treated with PTP before grafting, whereas the opposite side served as the untreated control. The grafts were harvested after 3 mo. Ultrasound evaluation of all vein grafts was performed at the time of grafting and harvest. The grafts were also evaluated histomorphometrically and immunohistologically for markers of IH. RESULTS: All vein grafts were patent at 3 mo except one graft in the PTP-treated group because of early technical failure. The control vein grafts had significantly greater IH than PTP-treated grafts at 3 mo, as evidenced by the intimal area (2.6 ± 1.0 mm2versus 1.4 ± 1.5 mm2, respectively, P = 0.045) and medial area (5.1 ± 1.9 mm2versus 2.7 ± 2.4 mm2, respectively, P = 0.048). The control grafts had an increased presence and proliferation of mural myofibroblasts with greater smooth muscle actin and proliferating cell nuclear antigen staining. CONCLUSIONS: PTP treatment to the external surface of the vein grafts decreases IH at 3 mo after arteriovenous grafting and may prevent future graft failure.


Assuntos
Artérias Carótidas/cirurgia , Neointima/prevenção & controle , Fotoquimioterapia/métodos , Veia Safena/transplante , Enxerto Vascular/métodos , Túnica Adventícia/efeitos dos fármacos , Túnica Adventícia/efeitos da radiação , Animais , Colágeno/química , Colágeno/efeitos dos fármacos , Colágeno/efeitos da radiação , Feminino , Corantes Fluorescentes/administração & dosagem , Luz , Neointima/diagnóstico , Neointima/etiologia , Neointima/patologia , Rosa Bengala/administração & dosagem , Veia Safena/diagnóstico por imagem , Veia Safena/patologia , Suínos , Porco Miniatura , Transplante Autólogo/efeitos adversos , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/patologia , Enxerto Vascular/efeitos adversos , Grau de Desobstrução Vascular
20.
J Card Surg ; 35(6): 1314-1321, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32353909

RESUMO

BACKGROUND: The saphenous vein remains the most frequently used conduit for coronary artery bypass grafting, despite reported unsatisfactory long-term patency rates. Understanding the pathophysiology of vein graft failure and attempting to improve its longevity has been a significant area of research for more than three decades. This article aims to review the current understanding of the pathophysiology and potential new intervention strategies. METHODS: A search of three databases: MEDLINE, Web of Science, and Cochrane Library, was undertaken for the terms "pathophysiology," "prevention," and "treatment" plus the term "vein graft failure." RESULTS: Saphenous graft failure is commonly the consequence of four different pathophysiological mechanisms, early acute thrombosis, vascular inflammation, intimal hyperplasia, and late accelerated atherosclerosis. Different methods have been proposed to inhibit or attenuate these pathological processes including modified surgical technique, topical pretreatment, external graft support, and postoperative pharmacological interventions. Once graft failure occurs, the available treatments are either surgical reintervention, angioplasty, or conservative medical management reserved for patients not eligible for either procedure. CONCLUSION: Despite the extensive amount of research performed, the pathophysiology of saphenous vein graft is still not completely understood. Surgical and pharmacological interventions have improved early patency and different strategies for prevention seem to offer some hope in improving long-term patency.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Oclusão de Enxerto Vascular/prevenção & controle , Oclusão de Enxerto Vascular/terapia , Disfunção Primária do Enxerto/prevenção & controle , Disfunção Primária do Enxerto/terapia , Veia Safena/transplante , Enxerto Vascular/métodos , Oclusão de Enxerto Vascular/etiologia , Humanos , Disfunção Primária do Enxerto/etiologia , Resultado do Tratamento , Grau de Desobstrução Vascular
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