Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 15 de 15
Filtrar
1.
Ann Vasc Surg ; 83: 290-297, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34954032

RESUMO

OBJECTIVES: While endovascular intervention is the recommended first option for management of common iliac artery (CIA) lesions, it lacks durable patency for Trans-Atlantic Inter-Society Consensus (TASC)-II C and D lesions involving the external iliac artery (EIA). Aorto-femoral bypass is a durable option but is unsuitable in patients with significant co-morbidities. Eversion endarterectomy provides an alternative to both endovascular and extensive open aortoiliac reconstruction for occlusive EIA disease. MATERIALS AND METHODS: A single-center, retrospective review (2000-2020) of all patients undergoing eversion endarterectomy for EIA disease was undertaken. Demographic, clinical, operative and follow-up data were recorded. RESULTS: Fifty eversion endarterectomies were performed in 47 patients. The median age was 65.0 years (range 46-82) and 66.6% were male. Sixty-eight percent (n = 34) were ASA grade 3. Indications for intervention were disabling claudication (44%) and critical limb ischaemia (56%). Angiography demonstrated 22 TASC C and 28 TASC D lesions. The median follow-up was 18.5 months (range 0-149). The technical success rate was 100%, and 84% (n = 42) experienced an immediate symptomatic improvement. Primary and primary-assisted patency at one, three and five years was 86%, 82% and 74%, and 100%, 96% and 92%, respectively. The five-year limb salvage rate was 96%. Eight limbs required reintervention to maintain patency, either by open (n = 2), endovascular (n = 3) or hybrid approach (n = 3). Thirty-day mortality was 2% (n = 1) with 10% (n = 5) experiencing a procedure-related morbidity. All-cause mortality was 38% (n = 19) during the follow-up period. CONCLUSIONS: Eversion endarterectomy is a safe, effective alternative treatment for occlusive EIA disease. This study reports durable patency at five years and low perioperative morbidity and mortality.


Assuntos
Arteriopatias Oclusivas , Artéria Ilíaca , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Endarterectomia/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
3.
J Clin Ultrasound ; 43(9): 563-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26178453

RESUMO

PURPOSE: Duplex ultrasound is the first-line mode of investigation for carotid stenosis, whose severity could be graded according to NASCET or St. Mary's ratio criteria. The aim of this study was to compare these two methods and review the literature. METHODS: All patients who had carotid duplex ultrasound in a 1-month period were included. The reports and images were retrospectively reviewed, and the grade of carotid artery stenosis was then recalculated using the St. Mary's Ratio. RESULTS: A total of 245 (160 men) patients with a mean age 70.4 years (±11.5) were assessed, and 469 extracranial carotid systems were analyzed. Pearson's Coefficient revealed strong correlation (r = 0.79, p = 0.05) between the two methods. In 114 (24.3%) internal carotid arteries, results were different. Of these, 26 (22.8%) would have gone for surgery had they been assessed using the St. Mary's Ratio and not the NASCET grading criteria. Conversely, two internal carotid arteries (1.75%) went for surgery using the NASCET grading criteria that would not have had to should the St. Mary's Ratio been used. CONCLUSIONS: Although there is a strong level of correlation between the two criteria, choosing one or the other would have a significant impact on the patient' selection for surgery.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Ultrassonografia Doppler Dupla , Idoso , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença
4.
Surgeon ; 10(4): 206-10, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22818278

RESUMO

BACKGROUND: Management of patients with severe concomitant carotid and coronary disease remains controversial. We report our experience of combined carotid endarterectomy (CEA) and coronary artery bypass surgery (CABG) over a fifteen year period using strict patient selection criteria. METHODS: From 1st January 1995 to December 31st 2009 165 patients underwent combined CABG/CEA procedures at the Mater Hospital. Mean age was 68.2 years (range 43-88) and 127 (77%) were male. Fifty-three (32%) had symptomatic carotid disease. Indications for combined procedures were the presence of symptomatic >70% or asymptomatic >80% internal carotid artery stenosis in a patient requiring urgent CABG because of either unstable angina, recent MI, severe triple vessel disease or severe Left Anterior Descending or Left Main Stem stenosis. RESULTS: Thirty-day stroke and death rate was 3%. All neurological events were in the hemisphere contralateral to the carotid surgery and symptoms had completely resolved prior to discharge from hospital. One patient required evacuation of a cervical haematoma and there were two transient XII nerve palsies. CONCLUSION: Combined CEA/CABG can be performed safely with acceptable morbidity and mortality in patients selected in accordance with strict criteria in a centre with a large experience of both cardiac and carotid surgery.


Assuntos
Estenose das Carótidas/cirurgia , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Endarterectomia das Carótidas/métodos , Seleção de Pacientes , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/complicações , Doença da Artéria Coronariana/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
5.
J Vasc Surg ; 54(1): 240-248.e1, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21636241

RESUMO

OBJECTIVES: Complex endovascular skills are difficult to obtain in the clinical environment. Virtual reality (VR) simulator training is a valuable addition to current training curricula, but is there a benefit in the absence of expert trainers? METHODS: Eighteen endovascular novices performed a renal artery angioplasty/stenting (RAS) on the Vascular Interventional Surgical Trainer simulator. They were randomized into three groups: Group A (n = 6, control), no performance feedback; Group B (n = 6, nonexpert feedback), feedback after every procedure from a nonexpert facilitator; and Group C (n = 6, expert feedback), feedback after every procedure from a consultant vascular surgeon. Each trainee completed RAS six times. Simulator-measured performance metrics included procedural and fluoroscopy time, contrast volume, accuracy of balloon placement, and handling errors. Clinical errors were also measured by blinded video assessment. Data were analyzed using SPSS version 15. RESULTS: A clear learning curve was observed across the six trials. There were no significant differences between the three groups for the general performance metrics, but Group C made fewer errors than Groups A (P = .009) or B (P = .004). Video-based error assessment showed that Groups B and C performed better than Group A (P = .002 and P = .000, respectively). CONCLUSION: VR simulator training for novices can significantly improve general performance in the absence of expert trainers. Procedure-specific qualitative metrics are improved with expert feedback, but nonexpert facilitators can also enhance the quality of training and may represent a valuable alternative to expert clinical faculty.


Assuntos
Angioplastia/educação , Simulação por Computador , Instrução por Computador , Educação de Pós-Graduação em Medicina/métodos , Retroalimentação Psicológica , Obstrução da Artéria Renal/terapia , Adulto , Angioplastia/instrumentação , Competência Clínica , Meios de Contraste , Currículo , Humanos , Irlanda , Curva de Aprendizado , Destreza Motora , Radiografia Intervencionista , Obstrução da Artéria Renal/diagnóstico por imagem , Stents , Análise e Desempenho de Tarefas , Gravação em Vídeo
6.
Acta Biomater ; 48: 110-119, 2017 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-27773752

RESUMO

Lysolipid-based thermosensitive liposomes (LTSL) embedded in a chitosan-based thermoresponsive hydrogel matrix (denoted Lipogel) represents a novel approach for the spatiotemporal release of therapeutic agents. The entrapment of drug-loaded liposomes in an injectable hydrogel permits local liposome retention, thus providing a prolonged release in target tissues. Moreover, release can be controlled through the use of a minimally invasive external hyperthermic stimulus. Temporal control of release is particularly important for complex multi-step physiological processes, such as angiogenesis, in which different signals are required at different times in order to produce a robust vasculature. In the present work, we demonstrate the ability of Lipogel to provide a flexible, easily modifiable release platform. It is possible to tune the release kinetics of different drugs providing a passive release of one therapeutic agent loaded within the gel and activating the release of a second LTSL encapsulated agent via a hyperthermic stimulus. In addition, it was possible to modify the drug dosage within Lipogel by varying the duration of hyperthermia. This can allow for adaption of drug dosing in real time. As an in vitro proof of concept with this system, we investigated Lipogels ability to recruit stem cells and then elevate their production of vascular endothelial growth factor (VEGF) by controlling the release of a pro-angiogenic drug, desferroxamine (DFO) with an external hyperthermic stimulus. Initial cell recruitment was accomplished by the passive release of hepatocyte growth factor (HGF) from the hydrogel, inducing a migratory response in cells, followed by the delayed release of DFO from thermosensitive liposomes, resulting in a significant increase in VEGF expression. This delayed release could be controlled up to 14days. Moreover, by changing the duration of the hyperthermic pulse, a fine control over the amount of DFO released was achieved. The ability to trigger the release of therapeutic agents at a specific timepoint and control dosing level through changes in duration of hyperthermia enables sequential multi-dose profiles. STATEMENT OF SIGNIFICANCE: This paper details the development of a heat responsive liposome loaded hydrogel for the controlled release of pro-angiogenic therapeutics. Lysolipid-based thermosensitive liposomes (LTSLs) embedded in a chitosan-based thermoresponsive hydrogel matrix represents a novel approach for the spatiotemporal release of therapeutic agents. This hydrogel platform demonstrates remarkable flexibility in terms of drug scheduling and sequencing, enabling the release of multiple agents and the ability to control drug dosing in a minimally invasive fashion. The possibility to tune the release kinetics of different drugs independently represents an innovative platform to utilise for a variety of treatments. This approach allows a significant degree of flexibility in achieving a desired release profile via a minimally invasive stimulus, enabling treatments to be tuned in response to changing symptoms and complications.


Assuntos
Desferroxamina/farmacologia , Liberação Controlada de Fármacos , Hidrogel de Polietilenoglicol-Dimetacrilato/química , Materiais Biocompatíveis/farmacologia , Movimento Celular/efeitos dos fármacos , Quitosana/química , Glicerofosfatos/química , Fator de Crescimento de Hepatócito/farmacologia , Humanos , Hipertermia Induzida , Lipossomos , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/efeitos dos fármacos , Células-Tronco Mesenquimais/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo
7.
Vasc Endovascular Surg ; 50(5): 317-20, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27206744

RESUMO

OBJECTIVES: The initial survival advantage seen with endovascular aneurysm repair (EVAR) over open repair does not persist in the long term. Pulse wave velocity (PWV) is a measure of arterial stiffness, and increased PWV is an independent risk factor for increased cardiovascular morbidity and mortality. This prospective comparative pilot study examined the effect of implantation of an aortic graft on PWV in patients undergoing open or endovascular aortic aneurysm repair. PATIENTS AND METHODS: Thirty-four patients (15 open and 19 EVAR) were recruited. Patient demographics were similar in both the groups. Pulse wave velocity was calculated for all patients preoperatively and postoperatively using a standardized technique on a Philips IU22 Vascular Ultrasound machine and the results compared. RESULTS: An increase in mean PWV following EVAR was demonstrated. The mean postprocedure PWV of 9.7 (± 4.5) cm/sec detected in the open group was significantly lower than the elevated 12.2 (± 4.5) cm/sec detected in the EVAR group. The surgical group also demonstrated a mean decrease of 0.2 (± 4.9) cm/sec in PWV following open repair compared to a mean increase of 3.3 (± 3.7) cm/sec in the EVAR group. CONCLUSION: EVAR patients have a significantly higher postoperative PWV measurement than those undergoing open abdominal aortic aneurysm repair. Patients who have undergone EVAR may be at a higher risk of cardiovascular morbidity in the long term. A larger scale study with a longer prospective follow-up is required.


Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Rigidez Vascular , Idoso , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Projetos Piloto , Estudos Prospectivos , Análise de Onda de Pulso , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler
8.
Angiology ; 67(4): 346-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26056393

RESUMO

Screening for concomitant atherosclerotic disease is important in cardiovascular risk reduction. This study assessed the prevalence of carotid artery disease (CAD) and peripheral arterial disease (PAD) in patients with known abdominal aortic aneurysms (AAAs). All patients with AAA attending the vascular laboratory between the January 1, 2007, and December 31, 2009, were eligible for a carotid ultrasound and measurement of ankle brachial indices. A total of 389 (305 males) patients were identified on the AAA surveillance program with a mean (±standard deviation) age of 76 (±8) years. The mean age of the males was 75.4 (±7.8) years, and the mean age of the females was 77 (±11) years. A total of 332 patients were assessed for CAD, and 101 (30.4%) of those were found to have significant disease. A total of 289 patients were assessed for PAD of which 131 (45.3%) were found to have PAD at rest, and 289 patients were assessed for both and 59 (20.4%) patients had significant CAD + PAD. Patients with AAAs are at high risk of other atherosclerotic disorders, and, therefore, they should receive intensive medical optimization.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico , Doenças das Artérias Carótidas/diagnóstico , Doença Arterial Periférica/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço/métodos , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/epidemiologia , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Doença Arterial Periférica/epidemiologia , Prevalência , Fatores de Risco
9.
J Laparoendosc Adv Surg Tech A ; 25(1): 21-7, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25548964

RESUMO

BACKGROUND: Appendicular stump closure is a crucial step during laparoscopic appendectomy. Recently, endoclips (ECs) have been described for ligation of the appendicular stump. The objective of this review was to compare outcomes with EC versus endoligature (EL) for appendiceal stump closure during laparoscopic appendectomy. MATERIALS AND METHODS: A literature search of Medline, Embase, Cochrane Database, and Google Scholar was performed to identify studies comparing use of EL versus EC in laparoscopic appendectomy between January 1992 and September 2013. Reviews of each study were conducted, and data were extracted. The random-effects model was used to combine data, and between-study heterogeneity was assessed. RESULTS: Seven of the 101 identified studies met the inclusion criteria: four randomized controlled trials and three case controlled series. For the primary outcome of perioperative and postoperative complications, there was no significant difference between the EC versus EL groups. No differences were noted in length of hospital stay. However, a significant reduction in operative time was observed with EC as opposed to EL (standardized mean difference=-0.90, 95% confidence interval=-1.26 to -0.54, P=.001). Moreover, EC procedures were less expensive than EL procedures. CONCLUSIONS: EC application in the management of appendiceal stump during laparoscopic appendectomy appears to be simple, efficacious, safe, and a cost-effective alternative.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/métodos , Técnicas de Sutura/instrumentação , Desenho de Equipamento , Humanos , Ligadura/instrumentação
10.
Vasc Endovascular Surg ; 48(2): 111-5, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24347280

RESUMO

BACKGROUND: Regression of the residual sac is indicative of successful endovascular aortic aneurysm (EVAR) repair. Using color duplex ultrasound (CDU), we monitored the residual aneurysm sac following EVAR and correlated sac behavior with perioperative risk factors. METHODS: Of 145 patients with EVAR, 106 (73.1%) patients between January 01, 2003, and July 01, 2010, had at least 2 consecutive postoperative scans and thus were eligible for inclusion. Mean (± standard deviation [SD]) CDU scans per person was 4.6 (± 1.4). All were conducted by the same technologist using a standard protocol on the same machine. Aneurysm sac change in centimeters and percentage terms was calculated. The presence or absence of an endoleak was also recorded. Change in aneurysm sac size was correlated with preoperative risk factors. FINDINGS: Mean sac size change at 1 month was a decrease of 0.24 cm, equating to a percentage change of 4.3%. At 7 months, the decrease was 0.59 cm (9.8%), at 12 months, 0.73 cm (12.4%), at 18 months 0.92 cm (15.8%), and at 36 months 1.0 cm (16.6%). Both univariate and multivariate analyses demonstrated that statin therapy (P = .002) was the only risk factor variable positively associated with aneurysm regression while the presence of an endoleak was inversely related to sac reduction (P = .01). INTERPRETATION: Maximum aneurysmal sac reduction seems to occur in the first year following endograft implantation. Statin therapy appears to be associated with an increased likelihood of sac regression following EVAR. Further investigation of the role of statins in the biology of abdominal aortic aneurysmal disease is warranted.


Assuntos
Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Aneurisma Aórtico/diagnóstico , Implante de Prótese Vascular/efeitos adversos , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Análise Multivariada , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores
SELEÇÃO DE REFERÊNCIAS
Detalhe da pesquisa