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1.
J Vasc Surg ; 75(4): 1268-1275.e1, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34655682

RESUMO

BACKGROUND: Isolated iliac artery aneurysms (IAAs), accounting for 2% to 7% of all abdominal aneurysms, are often treated with the use of iliac branched endografts. Although outside the manufacturer's instructions for use, iliac branched devices can be used solely, without the adjunctive placement of an endovascular aneurysm repair device, for the treatment of an isolated IAA. In the present study, we have described the outcomes of the use of the Gore iliac branched endoprosthesis (IBE; W.L. Gore & Associates, Flagstaff, Ariz), without the support of an infrarenal endovascular aneurysm repair device, for the exclusion of an isolated IAA. The present study was an international multicenter retrospective cohort analysis. METHODS: All the patients who had undergone treatment with a solitary IBE for IAA exclusion from January 11, 2013 to December 31, 2018 were retrospectively reviewed. The primary outcome was technical success. The secondary outcomes included mortality, intraoperative and postoperative complications, and reintervention. RESULTS: A total of 18 European and American centers participated, with a total of 51 patients in whom 54 IAAs were excluded. The technical success rate was 94.1%, with an assisted technical success rate of 96.1%. No 30-day mortality occurred, with 98.1% patency of the internal and external iliac artery found at 24 months of follow-up. At 24 months of follow-up, 81.5% of the patients were free of complications and 90% were free of a secondary intervention. CONCLUSIONS: Treatment with a solitary IBE is a safe and, at midterm, an effective treatment strategy for selected patients with a solitary IAA.


Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco , Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/etiologia , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
2.
J Anat ; 229(4): 582-90, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27329696

RESUMO

Over the years, various vascular injection products have been developed to facilitate anatomical dissections. This study aimed to compare the most commonly used vascular injection products in fresh-frozen and formalin-embalmed cadaver specimens. An overview of the properties, advantages and limitations of each substance was given, and a comparison of vascular infusion procedures in both preservation methods was made. A literature search was performed in order to identify the most commonly used vascular injection products. Acrylic paint, latex, gelatin, silicone, Araldite F and Batson's No. 17 were selected for the study. One fresh-frozen and one embalmed cadaver forearm were infused with each injection product according to a uniform protocol. The curing time, skin- and subcutaneous tissue penetration, degree of filling of the arterial tree, extravasations, consistency of the injected vessels during dissection, and the costs of each injection fluid were noted. There was a large variation between the injection fluids in processing- and curing time, colour intensity, flexibility, fragility, elasticity, strength, toxicity and costs. All fluids were suitable for infusion. The penetration of injection fluid into the skin and subcutaneous tissue was significantly better in fresh-frozen specimens (P = 0.002 and P = 0.009, respectively), with significantly smaller branches casted (P = 0.004). Vascular infusion of fresh-frozen cadaver specimens results in a significantly better filled coloured arterial tree, enabling more detail to be achieved and smaller branches casted. The biomechanical properties of fresh-frozen soft tissues are less affected compared with formalin fixation. All the injection fluids studied are suitable for vascular infusion, but their different properties ensure that certain products and procedures are more suitable for specific study purposes.


Assuntos
Anatomia/métodos , Vasos Sanguíneos/anatomia & histologia , Cadáver , Dissecação , Embalsamamento , Resinas Epóxi , Antebraço , Gelatina , Humanos , Látex , Pintura , Plásticos , Silicones
3.
Eur J Vasc Endovasc Surg ; 52(1): 99-104, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27179387

RESUMO

OBJECTIVE: The use of self-expanding stent grafts for treatment of popliteal artery aneurysms (PAA) is a matter of debate, although several studies have shown similar results compared with open surgery. In recent years, a new generation stent graft, with heparin-bonding technology, became available. The aim of this study is to present the results of endovascular PAA repair with heparin-bonded stent grafts. METHODS: Data on all patients with PAA treated with a heparin-bonded polytetrafluoroethylene (ePTFE) stent graft between April 2009 and March 2014 were gathered in a database and retrospectively analyzed. Data were collected from four participating hospitals. Standard follow-up consisted of clinical assessment, and duplex ultrasound at 6 weeks, 6 months, 12 months, and annually thereafter. The primary endpoint of the study was primary patency. Secondary endpoints were primary-assisted and secondary patency and limb salvage rate. RESULTS: A total of 72 PAA was treated in 70 patients. Mean age was 71.2 ± 8.5 years and 93% were male (n = 65). The majority of PAA were asymptomatic (78%). Sixteen cases (22%) had a symptomatic PAA, of which seven (44%) presented with acute ischemia. Early postoperative complications occurred in two patients (3%). Median follow-up was 13 months (range 0-63 months). Primary patency rate at 1 year was 83% and after 3 years 69%; primary assisted patency rate was 87% at 1 year and 74% after 3 years. Secondary patency rate was 88% and 76% at 1 and 3 years, respectively. There were no amputations during follow-up. CONCLUSION: Endovascular treatment of PAA with heparin-bonded stent grafts is a safe treatment option with good early and mid-term patency rates comparable with open repair using the great saphenous vein.


Assuntos
Prótese Vascular , Stents Farmacológicos , Artéria Poplítea/cirurgia , Enxerto Vascular/métodos , Idoso , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Feminino , Heparina/administração & dosagem , Heparina/uso terapêutico , Humanos , Masculino , Resultado do Tratamento , Enxerto Vascular/instrumentação , Grau de Desobstrução Vascular
4.
Eur J Vasc Endovasc Surg ; 51(1): 56-62, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26437914

RESUMO

OBJECTIVE: Endovascular aortic sealing (EVAS) with the Nellix endosystem (Endologix, Irvine, CA, USA) is a new concept to treat infrarenal abdominal aortic aneurysms (AAAs). By sealing the aneurysm, potential endoleaks may be avoided. Early results of EVAS are good, but no data have been published regarding peri-procedural changes in aortoiliac anatomy. In this study, 27 consecutive patients who underwent elective EVAS repair of an AAA were reviewed. METHOD: Specific AAA (diameter, length from renal arteries to aortic bifurcation, supra- and infrarenal neck angulation, AAA volume, thrombus volume, and flow lumen volume), and iliac artery characteristics (length, angulation, location of most severe angulation with reference to the origin of the common iliac artery) were determined from pre- and post-procedural reconstructed computed tomography angiograms. RESULTS: No type I or II endoleaks were seen at 30 day follow up. Total AAA volume, suprarenal and infrarenal angulation, as well as aortic neck diameter did not change significantly post-EVAS. AAA flow lumen increased significantly (mean difference -4.4 mL, 95% CI 2.0 to -8.6 mL) and AAA thrombus volume decreased (mean difference 3.2 mL, 95% CI 2.0 to -1.1 mL). AAA length (125.7 mm vs. 123.1 mm), left common iliac artery length (57.6 mm vs. 55.3 mm), and right and left maximum iliac artery angulation (right 37.4° vs. 32.2°; left: 43.9° vs. 38.4°) were reduced significantly and the location of maximum angulation was further from the iliac artery origin post-EVAS, suggesting slight straightening of the aortoiliac anatomy. CONCLUSION: Most aortoiliac anatomic characteristics remained unchanged post-EVAS. Filling of the endobags to a pressure of 180 mmHg may lead to lost thrombus volume in some patients, probably because liquid is squeezed into lumbar or the inferior mesenteric artery. The absolute differences in pre- and post-EVAS aortoiliac lengths were small, so pre-operative sizing is accurate for determining stent length.


Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Artéria Ilíaca/cirurgia , Stents , Idoso , Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico , Aortografia/métodos , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino , Desenho de Prótese , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Eur J Vasc Endovasc Surg ; 52(1): 64-74, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27162000

RESUMO

OBJECTIVE/BACKGROUND: Aorto-bifemoral bypass remains the gold standard for treatment of aortoiliac occlusive disease (AIOD) in patients with advanced (TASC D) lesions, but has significant associated morbidity and mortality. Treatment with a unibody stent-graft positioned at the aortic bifurcation is a potential endovascular option for the treatment of AIOD. The current study examines the safety, efficacy, and early patency rates of the Endologix AFX unibody stent-graft for treatment of AIOD. METHODS: A multicenter retrospective review was conducted of patients treated exclusively for AIOD with the AFX device. Primary, assisted primary, and secondary patency rates were noted. Clinical improvement was assessed using Rutherford classification and ankle brachial index. Mean duration of follow-up was 22.2 ± 11.2 months. Ninety-one patients (56 males [62%]) were studied. RESULTS: Sixty-seven patients (74%) presented with lifestyle-limiting intermittent claudication and the remaining 24 (26%) had critical limb ischemia. Technical success was 100%. Complications included groin infection (n = 4 [4%]), groin hematoma (n = 4 [4%]), common iliac rupture (n = 4 [4%]), iliac dissection (n = 4 [4%]), and thromboembolic event (n = 3 [3%]; one femoral, one internal iliac artery, and one internal iliac with bilateral popliteal/tibial thromboemboli). Thirty-day mortality was 1% (1/91) resulting from a case of extensive pelvic thromboembolism. At 1 year, 73% of patients experienced improvement in Rutherford stage of -3 or greater compared with baseline. Nine patients (10%) required 16 secondary interventions. At all time points, primary patency rates were > 90%, assisted patency rates were > 98%, and secondary patency rates were 100%. CONCLUSION: This is the largest study to examine the use of the Endologix AFX unibody stent-graft for the treatment of AIOD. Use of the AFX stent-graft appears to be a safe and effective endovascular treatment for complex AIOD.


Assuntos
Doenças da Aorta/cirurgia , Prótese Vascular , Artéria Ilíaca/cirurgia , Stents , Enxerto Vascular/métodos , Idoso , Índice Tornozelo-Braço , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Extremidades/irrigação sanguínea , Feminino , Humanos , Claudicação Intermitente/etiologia , Isquemia/etiologia , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Enxerto Vascular/instrumentação , Grau de Desobstrução Vascular
6.
Eur J Vasc Endovasc Surg ; 50(5): 638-47, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26343310

RESUMO

OBJECTIVE: In this study the first results are presented of a new endovascular technique using covered stents to reconstruct the aortic bifurcation in patients with aortoiliac occlusive disease. With the "Covered Endovascular Reconstruction of the Aortic Bifurcation" (CERAB) technique, the anatomy and physiology of the aortic bifurcation is mimicked. MATERIAL AND METHODS: Between 2009 and March 2014, 103 patients (51 male, 52 female) suffering from obstructive lesions at the level of the aortic bifurcation were treated with CERAB in two clinics. The median age was 61 years (range 36-85 years). Lesion morphology was evaluated by CT angiography. Six TASC-II B lesions, nine TASC-II C lesions, and 88 TASC-II D lesions were treated. Follow up was a median 12 months (range 0-49 months) and consisted of clinical examination, ankle brachial indices, and duplex ultrasound examination. RESULTS: Technical success was obtained in 98 procedures (95.1%). In five cases lesions could not be recanalized. Primary patency was 87.3% at 1 year and 82.3% at 2 years, while secondary patency was 95.0% at 1 year and 95.0% at 2 years. Mean ankle brachial indices improved significantly from 0.64 ± 0.21 before to 0.91 ± 014, after the procedure (p < .001). The overall 30 day complication rate was 23.3%, including 22 minor complications and two major complications (1.9%). There was no 30 day mortality. Median hospital stay was 2 days (range 1-16 days). CONCLUSIONS: The CERAB technique appears to be a safe and feasible alternative to open surgical reconstruction of the aortic bifurcation in complex occlusive disease. Comparative studies with the current gold standards are indicated.


Assuntos
Aorta Abdominal/cirurgia , Arteriopatias Oclusivas/cirurgia , Procedimentos Endovasculares/métodos , Artéria Ilíaca/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Eur J Vasc Endovasc Surg ; 48(5): 545-50, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25218651

RESUMO

BACKGROUND: Arterial insufficiency is rarely caused by isolated infrarenal aortic occlusive lesions. Endovascular treatment options include plain balloon angioplasty and bare metal stent placement. In this study the feasibility and efficacy of polytetrafluoroethylene (PTFE) covered balloon expandable stents were evaluated. MATERIAL AND METHODS: Consecutive patients from two centers were prospectively collected in a database and retrospectively analyzed. Results were evaluated by clinical examination, ankle-brachial indices (ABI), duplex ultrasound, and plain abdominal radiography. RESULTS: Thirty-six consecutive patients were treated between November 2008 and June 2013. Indication for treatment was Rutherford 3 (n = 29), 4 (n = 3), and 5 (n = 4). Technical success was always achieved and there were no distal embolizations or vessel wall ruptures. The median follow-up was 22 months (range 0-60). All patients improved clinically and the ABI increased significantly from 0.73 ± 0.18 to 1.01 ± 0.14 (p < .01). One patent covered stent was removed surgically because of infection. Primary patency rates were 100% at 1 and 2 years without stent fractures. CONCLUSION: The use of PTFE covered stents for the treatment of isolated infrarenal aortic occlusive disease is safe and very effective. Patency rates are excellent and complications including distal embolization and vessel wall rupture are extremely rare.


Assuntos
Aorta Abdominal/cirurgia , Arteriopatias Oclusivas/cirurgia , Rim/irrigação sanguínea , Politetrafluoretileno/uso terapêutico , Stents , Grau de Desobstrução Vascular/fisiologia , Implante de Prótese Vascular/métodos , Feminino , Humanos , Masculino , Politetrafluoretileno/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
8.
Cardiovasc Intervent Radiol ; 47(5): 533-542, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38565717

RESUMO

PURPOSE: In arterial disease, the presence of two or more serial stenotic lesions is common. For mild lesions, it is difficult to predict whether their combined effect is hemodynamically significant. This study assessed the hemodynamic significance of idealized serial stenotic lesions by simulating their hemodynamic interaction in a computational flow model. MATERIALS AND METHODS: Flow was simulated with SimVascular software in 34 serial lesions, using moderate (15 mL/s) and high (30 mL/s) flow rates. Combinations of one concentric and two eccentric lesions, all 50% area reduction, were designed with variations in interstenotic distance and in relative direction of eccentricity. Fluid and fluid-structure simulations were performed to quantify the combined pressure gradient. RESULTS: At a moderate flow rate, the combined pressure gradient of two lesions ranged from 3.8 to 7.7 mmHg, which increased to a range of 12.5-24.3 mmHg for a high flow rate. Eccentricity caused an up to two-fold increase in pressure gradient relative to concentric lesions. At a high flow rate, the combined pressure gradient for serial eccentric lesions often exceeded the sum of the individual lesions. The relative direction of eccentricity altered the pressure gradient by 15-25%. The impact of flow pulsatility and wall deformability was minor. CONCLUSION: This flow simulation study revealed that lesion eccentricity is an adverse factor in the hemodynamic significance of isolated stenotic lesions and in serial stenotic lesions. Two 50% lesions that are individually non-significant can combine more often than thought to hemodynamic significance in hyperemic conditions.


Assuntos
Simulação por Computador , Hemodinâmica , Humanos , Hemodinâmica/fisiologia , Modelos Cardiovasculares , Velocidade do Fluxo Sanguíneo , Estenose Coronária/fisiopatologia , Estenose Coronária/diagnóstico por imagem
9.
Vasc Endovascular Surg ; 57(7): 816-819, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37518891

RESUMO

We describe a patient with a fistula between small bowel and a polyester patch of the common iliac artery. After emergency treatment with an endograft, the patch was replaced by a venous patch. Within 3-week a symptomatic pseudoaneurysm developed. It was decided to embolize the pseudoaneurysm using autologous subcutaneous fat, followed by a femoro-femoral crossover bypass using an allograft. Using this technique, the pseudoaneurysm was successfully excluded. This case shows that subcutaneous fat tissue can be used as an autologous embolic material, also in larger vessel pathology and in cases of ongoing infection, where regular embolization material cannot be used.


Assuntos
Falso Aneurisma , Implante de Prótese Vascular , Humanos , Artéria Ilíaca/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Resultado do Tratamento , Gordura Subcutânea/diagnóstico por imagem , Gordura Subcutânea/cirurgia
10.
Eur J Vasc Endovasc Surg ; 44(4): 359-67, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22831869

RESUMO

OBJECTIVE: Heparin is used worldwide by vascular surgeons as prophylaxis for arterial thrombo-embolic complications during open and endovascular arterial surgery. Possible harmful effect of heparin use is more perioperative blood loss, resulting in a higher morbidity and mortality. To evaluate the evidence for the use of heparin during aorto-iliac arterial surgery a review was performed. METHODS: A systematic review was performed of literature from MEDLINE, EMBASE and Cochrane databases, last search performed on March 8, 2012. RESULTS: For open surgery for abdominal aortic aneurysm (AAA), only 5 studies were eligible for review and for endovascular aneurysm repair (EVAR) only 1 study. Overall methodological quality of the included studies was poor. One randomised trial could be retrieved. Possible harmful effects of heparin were found of increasing operation time, more blood loss and more transfusion requirements when heparin was used for open AAA surgery in one study. No data were found comparing heparin to no intervention for EVAR. One study compared heparin to a direct thrombin antagonist during EVAR, showing no differences in clinical outcomes. CONCLUSION: Despite limitations this review showed no compelling evidence on the beneficiary effect of the prophylactic perioperative use of heparin during open surgery for (r)AAA. Authors will promote a randomised controlled multi-center trial on this topic for elective open surgical repair of AAA.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Fibrinolíticos/uso terapêutico , Complicações Intraoperatórias/prevenção & controle , Assistência Perioperatória/métodos , Tromboembolia/prevenção & controle , Humanos
11.
Cardiovasc Intervent Radiol ; 45(6): 858-866, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35378613

RESUMO

PURPOSE: The feasibility of using a compressed interwoven Supera stent as a flow diverting device for popliteal aneurysms was recently demonstrated in patients. It is unclear, however, what the optimal flow diverting strategy is, because of the fusiform shape of popliteal aneurysms and their exposure to triphasic flow. To assess this flow diverting strategy for popliteal aneurysms, flow profiles and thrombus formation likelihood were investigated in popliteal aneurysm models. MATERIALS AND METHODS: Six popliteal aneurysm models were created and integrated into a pulsatile flow set-up. These models covered a bent and a straight anatomy in three configurations: control, single-lined and dual-lined Supera stents. Two-dimensional flow velocities were visualized by laser particle image velocimetry. In addition, the efficacy of the stent configurations for promoting aneurysm thrombosis was assessed by simulations of residence time and platelet activation. RESULTS: On average for the two anatomies, the Supera stent led to a twofold reduction of velocities in the aneurysm for single-lined stents, and a fourfold reduction for dual-lined stents. Forward flow was optimally diverted, whereas backward flow was generally deflected into the aneurysm. The dual-lined configuration led to residence times of 15-20 s, compared to 5-15 s for the single stent configurations. Platelet activation potential was not increased by the flow diverting stents. CONCLUSION: A compressed Supera stent was successfully able to divert flow in a popliteal aneurysm phantom. A dual-lined configuration demonstrated superior hemodynamic characteristics compared to its single-lined counterpart.


Assuntos
Aneurisma , Artéria Poplítea , Ligas , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Humanos , Artéria Poplítea/diagnóstico por imagem , Desenho de Prótese , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
12.
Cardiovasc Eng Technol ; 13(2): 265-278, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34585343

RESUMO

PURPOSE: The aim of this study was to investigate if non-invasive central pressure estimations are accurate in patients with an abdominal aortic aneurysm, before and after endovascular repair. Secondary evaluation was if measurement-accuracy was dependent on anatomical characteristics. METHODS: Procedural invasive and non-invasive pressure-measurements were performed simultaneously both before and after endovascular repair in 20 patients with an infrarenal abdominal aortic aneurysm. Invasive catheter measurements were performed in the abdominal aorta. A tonometric device was used to perform non-invasive pressure-wave-analysis at the radial artery. A generalized transfer-function was used to generate an ascending aortic waveform for both measurements, allowing for direct comparison. RESULTS: Pre-treatment the mean differences between methods were - 5.5 mmHg (p = .904), - 11.8 (p < .001), and - 7.2 mmHg (p = .124) for central systolic, diastolic, and mean pressure, respectively. The accuracy was dependent of aneurysm sac volume and intraluminal thrombus volume. Post-treatment limits of agreement were smaller for all pressure parameters compared to pre-treatment. The mean differences were 6.5 mmHg (p = .007), - 6.4 (p < .020), and 1.6 mmHg (p = .370) for central systolic, diastolic, and mean pressure, respectively. CONCLUSION: In untreated AAA's the accuracy of non-invasive central pressure estimation was acceptable (mean difference between 5 and 10 mmHg) when compared to invasive pressures, but dependent of AAA characteristics. After EVAR the accuracy of central pressure estimation improved (reduction of 75% of the mean difference between pre and post measurements) TRIAL REGISTRATION NUMBER: NCT03469388; 3-5-2018.


Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Aorta Abdominal , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Resultado do Tratamento
13.
Surg Endosc ; 25(1): 1-9, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20552372

RESUMO

BACKGROUND: Laparoscopic surgery has been incorporated into common surgical practice. The peritoneum is an organ with various biologic functions that may be affected in different ways by laparoscopic and open techniques. Clinically, these alterations may be important in issues such as peritoneal metastasis and adhesion formation. METHODS: A literature search using the Pubmed and Cochrane databases identified articles focusing on the key issues of laparoscopy, peritoneum, inflammation, morphology, immunology, and fibrinolysis. RESULTS: Laparoscopic surgery induces alterations in the peritoneal integrity and causes local acidosis, probably due to peritoneal hypoxia. The local immune system and inflammation are modulated by a pneumoperitoneum. Additionally, the peritoneal plasmin system is inhibited, leading to peritoneal hypofibrinolysis. CONCLUSION: Similar to open surgery, laparoscopic surgery affects both the integrity and biology of the peritoneum. These observations may have implications for various clinical conditions.


Assuntos
Laparoscopia/efeitos adversos , Cavidade Peritoneal/fisiopatologia , Peritônio/fisiopatologia , Pneumoperitônio Artificial/efeitos adversos , Acidose/etiologia , Animais , Dióxido de Carbono/administração & dosagem , Dióxido de Carbono/efeitos adversos , Moléculas de Adesão Celular/metabolismo , Hipóxia Celular , Citocinas/metabolismo , Epitélio/patologia , Fibrinolisina/fisiologia , Fibrinólise , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Macrófagos Peritoneais/fisiologia , Camundongos , Inoculação de Neoplasia , Cavidade Peritoneal/cirurgia , Neoplasias Peritoneais/secundário , Peritônio/imunologia , Peritônio/cirurgia , Peritonite/etiologia , Peritonite/fisiopatologia , Aderências Teciduais/etiologia , Aderências Teciduais/fisiopatologia , Cicatrização/fisiologia
14.
Eur J Vasc Endovasc Surg ; 40(1): 27-34, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20399124

RESUMO

BACKGROUND: Subclavian artery aneurysms (SAAs) are rare and may cause life- and limb-threatening complications. Therapeutic options greatly differ as do access alternatives. The aim of the study was to assess its clinical presentation, diagnostics and therapeutic options as reported in the literature. METHOD: A literature search was performed of the Medline, Cochrane and EMBASE databases. All articles, published until September 2009, describing treatment of an SAA were included. RESULTS: A total of 191 reports, of which 126 met the inclusion criteria, were identified and were published from June 1915 until September 2009. Of these, 394 SAAs were described in 381 patients, with a mean age of 52+/-16 years. The median diameter was 40 mm (range: 10-180 mm). The aetiology appeared to change in time towards more exogenous causes. Fifty-one percent of the SAAs presented with a pulsating mass, shoulder pain and/or non-specific chest pain. Embolisation, rupture and thrombosis were present in 16%, 9% and 6% of patients, respectively, and their incidence was related to the anatomical localisation of the SAA. Open surgery and endovascular repair had a complication rate of 26% and 28%, respectively (p=0.49). Cardiopulmonary complications were restricted to open repair. Mortality rates for open and endovascular techniques were similar (5%). The mortality rates for conventional elective and emergency procedures were 3% and 13%, respectively, and for endovascular repair 4% and 8%, respectively. CONCLUSION: The profiles of diagnostic and treatment options of SAAs are changing. Although guidelines considering timing of intervention may not be conducted from available literature, intervention appears to be indicated, especially in distal SAAs, due to the risk of thrombo-embolic complications. Endovascular repair and hybrid procedures appear to be the preferred treatment modalities, due to a lower rate of cardiopulmonary complications.


Assuntos
Aneurisma/diagnóstico , Aneurisma/cirurgia , Artéria Subclávia/patologia , Artéria Subclávia/cirurgia , Procedimentos Cirúrgicos Vasculares , Aneurisma/etiologia , Aneurisma/mortalidade , Medicina Baseada em Evidências , Humanos , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
15.
Eur J Vasc Endovasc Surg ; 37(5): 585-91, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19231248

RESUMO

BACKGROUND: A persistent sciatic artery (PSA) is a rare vascular anomaly with an estimated incidence of 0.03-0.06%. During early embryonic development, the sciatic artery usually disappears when the superficial femoral artery has developed properly. This study aimed to assess the clinical presentation and outcome of a PSA. METHOD: A systematic review of all cases of PSA published between 1964 and 2007 was performed. RESULTS: In this review, 159 PSAs were described in 122 patients. The mean age at which the PSA was discovered was 57 years, and the incidence was equally distributed with regards to gender. The majority of PSAs was unilateral (70%) and of the complete type (79%). Ninety-one patients (80%) presented with symptoms including intermittent claudication, ischaemia, a pulsating mass or neurological symptoms. An aneurysm was found in 48%, a stenosis in 7%, an occlusion of the PSA in 9% and an occlusion of an artery distal to the PSA in 6% of the subjects. The treatment depended on the symptoms and classification of the PSA. In nine cases (8%), an amputation was required eventually. CONCLUSION: The PSA is a rare anomaly with a high incidence of complications including aneurysm formation and ischaemia that may lead to amputation. Strategies for follow-up could not be deduced from the available literature.


Assuntos
Malformações Arteriovenosas , Perna (Membro)/irrigação sanguínea , Procedimentos Cirúrgicos Vasculares/métodos , Angiografia , Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/epidemiologia , Malformações Arteriovenosas/cirurgia , Diagnóstico Diferencial , Saúde Global , Humanos , Incidência , Prognóstico , Stents , Ultrassonografia Doppler
16.
Emerg Radiol ; 16(5): 387-9, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18982368

RESUMO

A case of right middle lobe torsion occurring after a right upper lobectomy is described. HR-CT angiography was successful in identifying the obstructed right middle lobe bronchus and the avascular nature of the infected and displaced right middle lobe. This detailed information, obtainable from present day multislice HR-CT scanners with the right CT protocols, seems to diminish the need for further confirmation by other methods.


Assuntos
Brônquios , Tomografia Computadorizada por Raios X , Anormalidade Torcional/diagnóstico por imagem , Idoso , Humanos , Masculino , Anormalidade Torcional/diagnóstico
17.
Eur J Vasc Endovasc Surg ; 35(2): 198-204, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17964193

RESUMO

BACKGROUND: During the last decade endovascular therapy has been established as an alternative treatment for a variety of vascular diseases. Neither the classic operating room (OR), nor the conventional angiography suite is optimal for both open surgery and endovascular procedures. Important issues include: quality of the imaging equipment, radiation burden, ease of use of the equipment, need for specially trained personnel, ergonomics, ability to perform both open and percutaneous procedures, sterile environments, as well as quality and efficiency of patient care. METHODS: A literature search identified articles pertinent to the key issues during the decision-making process of creating the optimal endovascular suite. Manual cross-referencing also was performed. RESULTS AND CONCLUSION: The most important feature of working in a dedicated endovascular suite should be the ability to attain best treatment of vascular patients. Whether the interventional radiologist or the vascular surgeon uses the facilities is of less importance. A fixed fluoroscopy unit is preferred, above a portable C-arm. Establishment of an endovascular operating room suite has the benefit of a sterile environment, the possibility of performing hybrid procedures and conversions when necessary. Moreover, angiography immediately before treatment gives contemporary anatomical information, and after treatment provides quality control. As a consequence, better quality and service can be provided to the individual patient.


Assuntos
Salas Cirúrgicas/organização & administração , Avaliação de Processos e Resultados em Cuidados de Saúde , Radiologia Intervencionista/organização & administração , Doenças Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/organização & administração , Eficiência Organizacional , Desenho de Equipamento , Ergonomia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Salas Cirúrgicas/normas , Controle de Qualidade , Radiologia Intervencionista/instrumentação , Radiologia Intervencionista/normas , Procedimentos Cirúrgicos Vasculares/instrumentação , Procedimentos Cirúrgicos Vasculares/normas
18.
Surg Endosc ; 22(5): 1232-6, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-17943363

RESUMO

BACKGROUND: Laparoscopic surgery is evolving rapidly. It involves the creation of a pneumoperitoneum, mostly using carbon dioxide. Cooling of the peritoneum, due to insufflation, might traumatize the peritoneum and disturb peritoneal fibrinolysis, important in peritoneal healing processes. The current study was performed to elucidate the effects of the temperature of insufflation gas on the peritoneal fibrinolytic response to laparoscopic surgery. METHODS: Thirty patients scheduled for laparoscopic cholecystectomy were randomized in two groups: one group in which the pneumoperitoneum was created with carbon dioxide at room temperature, and one wherein carbon dioxide at body temperature was used. Peritoneal biopsies were taken at the start and at the end of surgery. Tissue concentrations of tPA antigen, tPA activity, uPA antigen, and PAI-1 antigen were measured using ELISA techniques. RESULTS: Peritoneal PAI-1 antigen levels were significantly higher at the end of the procedure in patients operated with carbon dioxide at room temperature (p < .05). A slight, but not significant, decrease in tPA antigen and activity was observed in both groups during the procedure. Peritoneal concentrations of uPa antigen did not change during the procedure. CONCLUSIONS: The temperature of carbon dioxide used for insufflation of the abdominal cavity affects peritoneal biology. Cooling of the peritoneum by unheated carbon dioxide causes increased peritoneal PAI-1 levels, important in peritoneal healing processes.


Assuntos
Dióxido de Carbono/administração & dosagem , Colecistectomia Laparoscópica/métodos , Temperatura Alta/uso terapêutico , Insuflação/métodos , Peritônio/efeitos dos fármacos , Adulto , Idoso , Feminino , Fibrinólise , Humanos , Masculino , Pessoa de Meia-Idade , Peritônio/metabolismo , Peritônio/patologia , Inibidor 1 de Ativador de Plasminogênio/metabolismo , Antígeno Polipeptídico Tecidual/efeitos dos fármacos , Antígeno Polipeptídico Tecidual/metabolismo , Resultado do Tratamento , Ativador de Plasminogênio Tipo Uroquinase/efeitos dos fármacos , Ativador de Plasminogênio Tipo Uroquinase/metabolismo
19.
J Cardiovasc Surg (Torino) ; 55(5): 601-12, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25175947

RESUMO

AIM: Current commercially available modular stentgrafts are associated with relevant reintervention rates during follow-up. The Nellix Endovascular Aneurysm Sealing (EVAS) System is a potential device to overcome these limitations of EVAR. Device implantations outside of manufacturer instructions for use due to challenging neck anatomies are very common. This article presents very early experience in the treatment of patients with post EVAR complications and challenging neck anatomies. METHODS: EVAS with the Nellix System consists of bilateral PTFE-covered stentgrafts surrounded by endobags which are filled with biostable polymer which cures after 3-5 minutes. The device and concept is designed to seal the entire aneurysm lumen, to withstand lateral displacement forces and effectively seal lumbar or inferior mesenteric arteries. Potentially, device migration, type II endoleak, and subsequent reinterventions will be reduced in the longterm. Single case experience in four European vascular centers is reported using Nellix off-IFU (instructions for use), addressing technical aspects as well as patient selection criterias. RESULTS: Recent preliminary clinical experience using Nellix outide of the IFU in challenging neck anatomies prooves early feasibility and efficacy in patients being excluded for open repair (OR) and also for EVAR and FEVAR within OR. Short-term results are promising. Migration, renal artery occlusions or type II endoleaks were not observed. One type Ia endoleak was observed but was temporary and resolved. We also found that the chimney technique is feasible with Nellix, where secondary target vessel loss nor gutters were observed. The EVAS concept is a potential tool to treat post EVAR complications such as secondary type I endoleak or type IV material fatigue. Feasibility has been proven in single cases. CONCLUSION: EVAS is an innovative, intriguing concept in the treatment of abdominal aortic aneurysm (AAA). Short-term outcomes of the Nellix system is promising. Early experience of Nellix out of IFU when treating patients with challenging proximal infraenal necks, with post EVAR complications, short necks and chimney techniques show technical feasibility and promising short-term results. Mid- and long-term data are needed to validate device and procedure durability.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Endoleak/cirurgia , Procedimentos Endovasculares/instrumentação , Falha de Prótese , Stents , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Endoleak/diagnóstico , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Europa (Continente) , Estudos de Viabilidade , Feminino , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/prevenção & controle , Humanos , Masculino , Desenho de Prótese , Reoperação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
J Cardiovasc Surg (Torino) ; 54(3): 383-7, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23640357

RESUMO

Endovascular treatment of occlusive disease of the aortic bifurcation is challenging. We developed the Covered Endovascular Reconstruction of Aortic Bifurcation or CERAB-technique, as a new approach for extensive and/or recurrent aortoiliac occlusive disease using three covered balloon expandable stents to reconstruct the aortic bifurcation. This configuration provides the ability to deal with TransAtlantic Inter-Society Consensus (TASC II) C and D lesions, simulating a neo-bifurcation or flow divider in combination with the benefits of covered stents. The intervention can be performed percutaneously or as a hybrid procedure. Initial results are encouraging and further studies are indicated.


Assuntos
Aorta Abdominal/cirurgia , Prótese Vascular , Materiais Revestidos Biocompatíveis , Procedimentos Endovasculares/métodos , Artéria Ilíaca/cirurgia , Síndrome de Leriche/cirurgia , Stents , Angiografia , Aorta Abdominal/diagnóstico por imagem , Humanos , Artéria Ilíaca/diagnóstico por imagem , Síndrome de Leriche/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Desenho de Prótese
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