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1.
Vasc Health Risk Manag ; 17: 111-121, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33854321

RESUMO

Autogenous radial-cephalic direct wrist arteriovenous fistula (RC-AVF) in the non-dominant arm is the gold standard for dialysis vascular access. However, the RC-AVF non-maturation rate is significant (≃ 40%) due to an increasingly elderly and comorbid population incidence. A detailed identification of the biological cascade underlying arteriovenous fistula (AVF) maturation could be the key to clinical research aimed at identify the group of patients at risk of primary AVF failure. Currently, careful post-operative monitoring remains the most crucial aspect to overcome the problem of impaired maturation. Up to 80% of patients with immature RC-AVF have problems potentially solvable with early endovascular or surgical correction. Physical examination by experienced practitioners in conjunction with duplex ultrasound examination (DUS) can identify physical signs of non-maturation, understand the underlying cause, and drive for a tailored early planning to treat the complication. New approaches for the early assessment of AVF maturation are under study. Techniques to promote RC-AVF maturation performed through the administration of pre-or peri-operative drugs have missed up to now to prove an efficacy in improving fistula success. The new techniques tested after surgery appear to hold future promise for improving fistula maturation.


Assuntos
Derivação Arteriovenosa Cirúrgica , Oclusão de Enxerto Vascular/diagnóstico , Exame Físico , Artéria Radial/cirurgia , Ultrassonografia Doppler Dupla , Grau de Desobstrução Vascular , Veias/cirurgia , Punho/irrigação sanguínea , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Diagnóstico Precoce , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Valor Preditivo dos Testes , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Diálise Renal , Fatores de Risco , Fatores de Tempo , Falha de Tratamento , Veias/diagnóstico por imagem , Veias/fisiopatologia
2.
Sensors (Basel) ; 21(5)2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33800280

RESUMO

Finger vein (FV) biometrics is one of the most promising individual recognition traits, which has the capabilities of uniqueness, anti-forgery, and bio-assay, etc. However, due to the restricts of imaging environments, the acquired FV images are easily degraded to low-contrast, blur, as well as serious noise disturbance. Therefore, how to extract more efficient and robust features from these low-quality FV images, remains to be addressed. In this paper, a novel feature extraction method of FV images is presented, which combines curvature and radon-like features (RLF). First, an enhanced vein pattern image is obtained by calculating the mean curvature of each pixel in the original FV image. Then, a specific implementation of RLF is developed and performed on the previously obtained vein pattern image, which can effectively aggregate the dispersed spatial information around the vein structures, thus highlight vein patterns and suppress spurious non-boundary responses and noises. Finally, a smoother vein structure image is obtained for subsequent matching and verification. Compared with the existing curvature-based recognition methods, the proposed method can not only preserve the inherent vein patterns, but also eliminate most of the pseudo vein information, so as to restore more smoothing and genuine vein structure information. In order to assess the performance of our proposed RLF-based method, we conducted comprehensive experiments on three public FV databases and a self-built FV database (which contains 37,080 samples that derived from 1030 individuals). The experimental results denoted that RLF-based feature extraction method can obtain more complete and continuous vein patterns, as well as better recognition accuracy.


Assuntos
Radônio , Algoritmos , Biometria , Dedos , Humanos , Veias/diagnóstico por imagem
4.
Vasc Endovascular Surg ; 55(4): 348-354, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33478360

RESUMO

INTRODUCTION: Despite advances of endovascular interventions, bypass surgery remains the gold standard for treatment of long and complex arterial occlusions in the lower limb. Autologous vein is regarded superior to other options. As the graft of first choice, the great saphenous vein (GSV) is often not available due to previous bypass, stripping or poor quality. Other options like arm veins (AV) are important alternatives. As forearm portions of AVs are often unusable, a graft created from the upper arm basilic and cephalic veins provides a valuable alternative. PATIENTS AND METHODS: We analyzed consecutive patients treated at an academic tertiary referral center between 01/1998 and 07/2018 using arm veins as the main peripheral bypass graft. Study endpoints were primary patency, secondary patency, limb salvage and survival. RESULTS: In the observed time period 2702 bypass procedures were performed at our institution for below-knee arterial reconstructions. Vein grafts used included the ipsilateral GSV (iGSV; n = 1937/71.7%), contralateral GSV (cGSV; 192/7.1%), small saphenous vein (SSV; 133/4.9%), prosthetic conduits (61/2.3%) and different configurations of AV (379/14%). In the majority of patients receiving AV grafts a complete continuous cephalic or basilic vein (CAV) was used (n = 292/77%). If it was not possible to use major parts of these 2 veins, either spliced arm vein grafts (SAV) (42/11%) or an upper arm basilic-cephalic loop graft (45/12%) were used. Median follow-up was 27 (interquartile range: 8-50) months. After 3 years secondary patency (CAV: 85%; SAV: 62%; loop: 66%; p = 0.125) and limb salvage rates (CAV: 79%, SAV: 68%; loop: 79%; p = 0.346) were similar between the 3 bypass options. CONCLUSION: The encouraging results of alternative AV configurations highlight their value in case the basilic or cephalic veins are not useable in continuity. Especially for infragenual redo-bypass procedures, these techniques should be considered to offer patients durable revascularization options.


Assuntos
Braço/irrigação sanguínea , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Enxerto Vascular , Veias/transplante , Idoso , Bases de Dados Factuais , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
8.
Vasc Endovascular Surg ; 55(3): 228-233, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33308082

RESUMO

BACKGROUND: Thoracic central venous obstruction (TCVO) is a common condition which can impact the ability to achieve central venous access (CVA) in patients on hemodialysis. The Surfacer® Inside-Out® Catheter Access System is designed to enable repeated right-side central venous access in patients with TCVO. METHODS: We retrospectively analyzed medical records of 10 dialysis patients who presented with TCVO and underwent the Inside-Out procedure with the Surfacer System to obtain CVA between 2017 and 2020. Patient demographics, hemodialysis vascular access history, and procedural data were identified and analyzed. The mean patient age was 62.4 ± 19.6 years (25.9-89.1 years) with 7 of the 10 patients being male. Eight patients (80.0%) were diagnosed with chronic kidney disease with time on hemodialysis ranging from 3 to 13 years. The remaining 2 required CVA to treat acute-on-chronic kidney injury due to septic shock. Patients in our series had a mean of 2.8 ± 1.6 previous catheters placed prior to the Surfacer procedure. RESULTS: CVA was achieved in all 10 patients with 1 patient requiring a second attempt to achieve access due to the inability to initially traverse the iliac vein with the device, possibly due to a history of kidney transplantation. One multimorbid patient died shortly after the successful procedure, possibly due to cardiac decompensation. Mean total procedure time for the 7 patients having only dialysis catheter placement using the Surfacer device was 67.2 ± 19.1 minutes (49-103 minutes). The remaining 3 patients received a Hemodialysis Reliable Outflow (HeRO) graft in conjunction with the Inside-Out procedure. All vascular accesses functioned properly during the immediate time period following placement. No adverse events associated with the use of Surfacer device were encountered. CONCLUSIONS: Data presented from our patient series confirms the effectiveness of the Surfacer System to safely achieve CVA in dialysis patients with TCVOs with a history of multiple catheter placements.


Assuntos
Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Nefropatias/terapia , Diálise Renal , Tórax/irrigação sanguínea , Doenças Vasculares/complicações , Veias , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Venoso Central/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Nefropatias/complicações , Nefropatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Doenças Vasculares/diagnóstico por imagem , Veias/diagnóstico por imagem
9.
Vasc Endovascular Surg ; 55(1): 58-63, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33256561

RESUMO

PURPOSE: To report our clinical experience with IVUS-guided percutaneous deep vein arterialization (pDVA) to treat chronic critical limb ischemia (cCLI) patients with no-endovascular or surgical options approach due to creation of an arteriovenous fistula (AVF). MATERIALS AND METHODS: In a 2 years period, 14 no-option cCLI patients were treated with percutaneous deep vein arterialization (pDVA) by creating an AVF with a IVUS-guided system between posterior tibial artery and its satellite deep vein. Technical success was defined as successful AVF creation and venous perfusion of the wound site. Patients' characteristics, procedure details, mortality and wound outcomes were assessed prospectively. RESULTS: Successful pDVA was successfully performed in all patients (mean age 82 years) without any procedural complications. Clinical improvement was achieved in all patients with resolution of rest pain, tissue formation of granulation tissue or both; only 3 major amputations were performed within the study period with a limb salvage rate of 78%. Median wound healing time was 4.8 months. CONCLUSION: pDVA is a safe and feasible revascularization technique alternative in no-option cCLI patients.


Assuntos
Derivação Arteriovenosa Cirúrgica , Diabetes Mellitus , Pé/irrigação sanguínea , Isquemia/cirurgia , Doença Arterial Periférica/cirurgia , Artérias da Tíbia/cirurgia , Ultrassonografia de Intervenção , Veias/cirurgia , Idoso , Idoso de 80 Anos ou mais , Amputação , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Estado Terminal , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Estudos Prospectivos , Fluxo Sanguíneo Regional , Artérias da Tíbia/diagnóstico por imagem , Artérias da Tíbia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Veias/diagnóstico por imagem , Veias/fisiopatologia , Cicatrização
11.
Sensors (Basel) ; 21(1)2020 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-33379213

RESUMO

In the fingertip blood automatic sampling process, when the blood sampling point in the fingertip venous area, it will greatly increase the amount of bleeding without being squeezed. In order to accurately locate the blood sampling point in the venous area, we propose a new finger vein image segmentation approach basing on Gabor transform and Gaussian mixed model (GMM). Firstly, Gabor filter parameter can be set adaptively according to the differential excitation of image and we use the local binary pattern (LBP) to fuse the same-scale and multi-orientation Gabor features of the image. Then, finger vein image segmentation is achieved by Gabor-GMM system and optimized by the max flow min cut method which is based on the relative entropy of the foreground and the background. Finally, the blood sampling point can be localized with corner detection. The experimental results show that the proposed approach has significant performance in segmenting finger vein images which the average accuracy of segmentation images reach 91.6%.


Assuntos
Algoritmos , Testes Hematológicos , Processamento de Imagem Assistida por Computador , Entropia , Distribuição Normal , Veias/diagnóstico por imagem
12.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370935

RESUMO

We report the case of a 35-year-old woman who presented with recurrent macroscopic haematuria and known diagnosis of Klippel-Trenaunay syndrome. Imaging and cystoscopy identified an extensive venous malformation involving a large area of the bladder wall. Holmium laser therapy was ineffective at obtaining symptom control. Following a multidisciplinary team meeting, transvenous sclerotherapy with sodium tetradecyl sulphate was performed under image guidance. A reduction in venous density was observed on cystoscopy and the patient has had complete resolution of symptoms within 6 weeks and continued to be asymptomatic up to 24-month follow-up. We propose that transvenous sclerotherapy is considered first-line treatment in this clinical setting.


Assuntos
Hematúria/terapia , Síndrome de Klippel-Trenaunay-Weber/complicações , Escleroterapia/métodos , Malformações Vasculares/terapia , Veias/patologia , Administração Intravenosa , Adulto , Cistoscopia , Feminino , Hematúria/etiologia , Humanos , Síndrome de Klippel-Trenaunay-Weber/terapia , Lasers de Estado Sólido/uso terapêutico , Angiografia por Ressonância Magnética , Soluções Esclerosantes/administração & dosagem , Tetradecilsulfato de Sódio/administração & dosagem , Resultado do Tratamento , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologia , Malformações Vasculares/diagnóstico , Malformações Vasculares/etiologia , Malformações Vasculares/patologia , Veias/diagnóstico por imagem , Veias/efeitos dos fármacos
13.
Vasc Health Risk Manag ; 16: 419-427, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33116552

RESUMO

Purpose: Central venous lesions (CVLs) can adversely affect hemodialysis access maturation and maintenance, which in turn worsen patient morbidity and access circuit patency. In this study, we assessed several clinical variables, patient characteristics, and clinical consequences of symptomatic central vein stenosis and obstruction in patients who underwent renal replacement therapy in the form of hemodialysis. Patients and Methods: The medical records of all hemodialysis patients with clinically symptomatic CVLs who underwent digital subtraction angiography treatment at King Abdullah University Hospital between January 2017 and December 2019 were retrieved. Patient characteristics and the clinical and anatomical features of CVLs were analyzed retrospectively. Pearson's chi-square tests of association were used to identify and assess relationships between patient characteristics and CVLs. Results: The study cohort comprised 66 patients with end-stage renal disease who developed symptomatic central vein stenosis. Of the 66 patients, 56.1% were men, and their mean age was approximately 52 years. Most (62.1%) of the patients were determined to have a history of central catheter insertion into the jugular vein. Hypertension was the most common comorbidity (78.8%, p<0.001), followed by type 2 diabetes mellitus (47.0 %, p<0.01). The incidence of stenosis was found to be significantly higher in the brachiocephalic vein than in other central veins (43.9%, p<0.001). A repeated central catheter insertion in a patient was predictive of central venous occlusion (p<0.05). Stenotic lesions were found to be associated with a significantly higher success rate than occlusive lesions (91.2%, p<0.01). Conclusion: Multiple central venous catheters (CVCs) are found to be associated with occlusive CVLs and unfavorable recanalization outcomes. Multiple CVC should be avoided by creating a permanent vascular access in a timely fashion for patients with chronic kidney disease and by avoiding the ipsilateral insertion of CVC and AVF.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Procedimentos Endovasculares , Falência Renal Crônica/terapia , Diálise Renal , Doenças Vasculares/terapia , Veias , Adulto , Idoso , Comorbidade , Constrição Patológica , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Incidência , Jordânia/epidemiologia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/epidemiologia , Doenças Vasculares/fisiopatologia , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
15.
J Vasc Interv Radiol ; 31(10): 1560-1569, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32855049

RESUMO

PURPOSE: The purpose of this study was to determine the efficacy and safety of embolization treatment in pelvic venous disorders in women refluxing in the ovarian and or internal iliac veins in women with chronic pelvic pain. MATERIALS AND METHODS: A retrospective study conducted from January 2000 to June 2017 in 617 patients diagnosed with pelvic venous disorders (PeVDs) with a mean age of 43.2 ± 7.2 years were treated using an embolization procedure. A total of 520 were included, and 97 patients were excluded. The main inclusion criteria were PeVD symptoms for more than 6 months and transvaginal Doppler ultrasonography (TV-DUS) diagnosis of varicose veins in the pelvis with a diameter greater than 6 mm. The main objective was to embolize the 4 main pelvic venous plexi (ovarian and internal iliac veins) whenever possible. Follow-up was performed using clinical symptoms (visual analog scale) and TV-DUS at 1, 3, 6, and 12 months and then every year up to 5 years. RESULTS: The technical success (embolization of the 4 main pelvic veins) was achieved in 84.4% of the patients. The average follow-up was 58.7 ± 5.7 months. The visual analog scale was improved from 7.63 ± 0.9 points pretreatment to 0.91 ± 1.5 at 5 years. A total of 26 patients (5%) presented with symptom recurrence and pelvic varicose veins. There were 57 minor complications (10.9%) and 11 major complications (2.1%), with 7 cases (1.34%) of device migration to the lung. CONCLUSIONS: The embolization of pelvic varicose veins is a safe and effective procedure. The selection of the embolic agents and the number of veins needed to be treated.


Assuntos
Dor Crônica/prevenção & controle , Embolização Terapêutica , Ovário/irrigação sanguínea , Dor Pélvica/prevenção & controle , Pelve/irrigação sanguínea , Varizes/terapia , Veias , Adulto , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Varizes/diagnóstico por imagem , Veias/diagnóstico por imagem
16.
Niger J Clin Pract ; 23(7): 1004-1007, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620732

RESUMO

Background: Scrotal ultrasonography has high sensitivity in the detection of intra-scrotal abnormalities. Various ultrasonographic parameters such as the spermatic cord diameter, venous diameter, and venous retrograde flow in either supine or upright positions with or without Valsalva maneuver have been investigated to assess patients suspected of having varicocele. Aims: This study aimed at comparing testicular vein diameter in supine and upright positions using ultrasonography. Methodology: This is a prospective multicenter study conducted between September 2018 and June 2019. Eighty-two consenting suspected cases of varicocele, 20 years and above, referred for scrotal ultrasonography were included in this study. Results: The study population had a mean age of 42.9 + 14.89 (SD) with a range of 20-96 years. The highest number of participants fell within the age range of 30-39 years 23 (28%). Varicocele was demonstrated in 96.3% of the patients. More patients showed sonographic evidence of varicocele in the upright position, on the right 50 (61%) as well as left 50 (61%). Bilateral varicocele had a higher frequency in the upright position 45 (54.9%), while supine was 23 (28%). Upright position had the widest diameter in 72% of participants on the right and 82% on the left. The upright position also showed higher average vein diameter of 2.6 mm and 2.9 mm on the right and left, respectively, while it was 2.2 mm and 2.3 mm for right and left in the supine position. Conclusion: The upright position is more predictive of varicocele in scrotal ultrasound examination for suspected cases of varicocele. We recommend an upright position where one position is to be used.


Assuntos
Cordão Espermático/diagnóstico por imagem , Posição Ortostática , Decúbito Dorsal , Testículo/diagnóstico por imagem , Ultrassonografia/métodos , Varicocele/diagnóstico por imagem , Veias/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Cordão Espermático/irrigação sanguínea , Testículo/irrigação sanguínea , Manobra de Valsalva
17.
Ann Vasc Surg ; 69: 43-51, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32479883

RESUMO

BACKGROUND: Up to 30% of autogenous cephalic vein arteriovenous fistulas (AVFs) are too deep for reliable cannulation. Techniques to superficialize these AVFs have been described previously. This study describes a new surgical technique for AVF superficialization and provides a review of the alternative techniques. METHODS: The path of the fistula is marked using ultrasound, and transverse incisions are made along this path. The underlying tissue is separated from the dermis over this area to expose the fistula outflow vein. The mobilized vein is then elevated and "trapped" directly under the dermis by closing the superficial fascia and adipose tissue beneath it. RESULTS: Between March 2016 and February 2019, 23 patients underwent superficialization using this technique at two centers. The mean time between AVF creation and superficialization was 6.3 months, and the time to first use for hemodialysis after superficialization was 38.8 ± 27.9 days. The average presuperficialization depth was 7.1 ± 2.4 mm and average postsuperficialization depth was 3.7 ± 2.7 mm (P = 0.002). Sixteen fistulas were successfully accessed for a cannulation rate of 89%. 94.7% of fistulas remained patent at last visit, with only one thrombosed 8-10 weeks after superficialization. CONCLUSIONS: This technique appears to be both safe and effective, and results in a vein that is immediately subdermal without major contour deformity. Early outcomes are comparable to those alternative methods described in the literature.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Braquial/cirurgia , Dissecação , Artéria Radial/cirurgia , Extremidade Superior/irrigação sanguínea , Veias/cirurgia , Artéria Braquial/diagnóstico por imagem , Cateterismo , Dissecação/efeitos adversos , Feminino , Humanos , Masculino , Artéria Radial/diagnóstico por imagem , Diálise Renal , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem
18.
Vascular ; 28(6): 775-783, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32522136

RESUMO

OBJECTIVES: Dialysis fistula aneurysms are common complications which in selective cases require surgical revision. It is recommended to detect and treat outflow stenosis concurrent with a dialysis fistula aneurysm, but usually, the treatment is divided into two stages - the open and endovascular stages are performed separately. We describe the results of hybrid procedures composed of aneurysm resection and endovascular correction for outflow veins performed for a dialysis fistula aneurysm treatment. METHODS: From March 2012, we performed hybrid procedures in 28 patients to correct dialysis fistula aneurysms. Patients, dialysis access, operative data, and the results obtained during a median follow-up of 28.5 months were analyzed. RESULTS: For dialysis fistula aneurysm correction, we performed 27 bypasses and 1 aneurysmorraphy. For outflow vein stenosis correction, we performed standard balloon angioplasty, no stents or stentgraft were used. The average increase in minimal diameter after angioplasty was 135.5% (range 57-275%). The 12- and 24-month primary patency rates of corrected fistulas in the observed group were 92.3% and 80%, respectively. A significant difference in the one-year patency rates between the urgent and planned procedures was observed (81.2% vs. 100%, respectively). No early complications related to endovascular or open procedures were observed. Late complications were observed in seven patients (25%) - mainly thrombosis caused by the recurrence of outflow vein stenosis (six patients, 21.5%), infection, lymphocele, and hematoma (one case of each complication). CONCLUSIONS: A hybrid procedure for the surgical correction of dialysis fistula aneurysms with the simultaneous correction of outflow pathologies enables effective long-term treatment. The obtained data showed the efficiency and good results of this procedure. Procedures performed for urgent indications significantly increase the risk for later complications, especially fistula thrombosis and loss of dialysis access.


Assuntos
Aneurisma/terapia , Angioplastia com Balão , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular , Diálise Renal , Veias/cirurgia , Idoso , Aneurisma/diagnóstico por imagem , Aneurisma/etiologia , Aneurisma/fisiopatologia , Angioplastia com Balão/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
20.
Ann Vasc Surg ; 69: 450.e23-450.e28, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32561240

RESUMO

In recent decades, the increasing complexity of arterial bypasses in the management of chronic limb-threatening ischemia has spurred the development of alternative techniques, such as revascularization of genicular arteries. Few publications on this technique can be found in the literature, and its use has been restricted to specialized vascular groups. This article describes the case of a patient with extensive femorotibial occlusive disease who received a collateral artery bypass, using the deep femoral artery as a donor, the cephalic vein as an alternative autogenous substitute, and the descending genicular artery as a recipient. Bypass to the descending genicular artery, although underutilized, is an effective option and increases the possibility of limb salvage in the management of chronic limb-threatening ischemia.


Assuntos
Artéria Femoral/cirurgia , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Enxerto Vascular , Veias/cirurgia , Idoso , Doença Crônica , Circulação Colateral , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Fluxo Sanguíneo Regional , Resultado do Tratamento , Veias/diagnóstico por imagem , Veias/fisiopatologia
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