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1.
Article in Chinese | WPRIM | ID: wpr-921560

ABSTRACT

Objective To explore the cause and the treatment strategies of iliac limb occlusion after endovascular abdominal aortic aneurysm repair(EVAR). Methods The patients receiving EVAR in PUMC Hospital from January 2015 to December 2020 were retrospectively analyzed.Sixteen(2.7%)cases of iliac limb occlusion were identified,among which 6,9,and 1 cases underwent surgical bypass,endovascular or hybrid procedure,and conservative treatment,respectively. Results Fifteen cases were successfully treated.During the 10.6-month follow-up,2 cases receiving hybrid treatment underwent femoral-femoral bypass due to re-occlusion of the iliac limb. Conclusions Iliac limb occlusion mostly occurs in the acute phase after EVAR,and endovascular or hybrid treatment can be the first choice for iliac limb occlusion.It is suggested to focus on the risk factors for prevention.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Endovascular Procedures , Humans , Iliac Artery/surgery , Retrospective Studies , Risk Factors , Stents , Treatment Outcome
2.
Article in Chinese | WPRIM | ID: wpr-878695

ABSTRACT

Objective To explore the outcomes in patients who receive the endovascular abdominal aortic aneurysm repair(EVAR)and have concomitant intra-abdominal malignancy.Methods Between January 2014 and December 2019,all the patients who underwent surgery for malignancy and/or EVAR were retrospectively reviewed.Results Twenty-eight abdominal aortic aneurysm(AAA)patients with concomitant intra-abdominal malignancy were included.The patients were treated by two-stage operation and the priority was given for EVAR in 21 patients.There was no perioperative death or major complications.In the follow-up,one patient developed graft thrombosis and one had type Ⅱ endoleak.There was no AAA-associated death.Conclusions It is preferred that EVAR should come first followed by operation for malignancy.Details of treatment strategy still need further investigation.


Subject(s)
Abdominal Neoplasms/surgery , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Humans , Retrospective Studies , Risk Factors , Treatment Outcome
3.
Clinics ; 76: e2812, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249575

ABSTRACT

OBJECTIVES: We sought to analyze the hemodynamic effects of the multilayer flow-modulated stent (MFMS) in Thoracoabdominal aortic aneurysms (TAAAs). METHODS: The hemodynamic effects of MFMS were analyzed in aortic thoracoabdominal aneurysms in experimental swine models. We randomly assigned 18 pigs to the stent or control groups and underwent the creation of an artificial bovine pericardium transrenal aneurysm. In the stent group, an MFMS (Cardiatis, Isnes, Belgium) was immediately implanted. After 4 weeks, we evaluated aneurysm sac thrombosis and renal branch patency by angiography, duplex scan, and morphological analysis. RESULTS: All the renal arteries remained patent after re-evaluation in both groups. Aneurysmal sac thrombosis was absent in the control group, whereas in the stent group it was present in 66.7% of aneurysmal sacs (p=0.061). The mean final aneurysm sac diameter was significantly lower in the stent group (mean estimated reduction, 6.90 mm; p=0.021). The proximal neck diameter decreased significantly in the stent group (mean difference, 2.51 mm; p=0.022) and grew significantly in the control group (mean difference, 3.02 mm; p=0.007). The distal neck diameter increased significantly in the control group (mean difference, 3.24 mm; p=0.017). There were no significant findings regarding distal neck measurements in the stent group. CONCLUSION: The MFMSs remained patent and did not obstruct the renal arteries within 4 weeks. In the stent group, the device was also associated with a significant decrease in aneurysmal sac diameter and a large proportion (albeit non-significant) of aneurysmal sac thrombosis.


Subject(s)
Animals , Aortic Aneurysm , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Prosthesis Design , Renal Artery/surgery , Renal Artery/diagnostic imaging , Swine , Blood Vessel Prosthesis , Cattle , Stents , Treatment Outcome , Models, Theoretical
4.
Rev. bras. cir. cardiovasc ; 35(5): 781-788, Sept.-Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137328

ABSTRACT

Abstract We performed a review of the literature (until August 01, 2019) on the occasion of the first transcaval approach for transcatheter aortic valve implantation in our hospital. This review focuses mainly on the indications of this alternative access route to the aorta. It may be useful for vascular surgeons in selected cases, such as the treatment of endoleaks after endovascular aneurysm repair and thoracic endovascular aneurysm repair. We describe historical aspects of transcaval access to the aorta, experimental studies, available case series and outcomes. Finally, we summarize the most significant technical aspects of this little-known access.


Subject(s)
Humans , Male , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Surgeons , Aorta, Abdominal/surgery , Blood Vessel Prosthesis , Stents , Treatment Outcome
5.
Rev. cir. (Impr.) ; 72(1): 59-63, feb. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1092891

ABSTRACT

Resumen Introducción Las fístulas aorto-entéricas (FAE) son una causa infrecuente de hemorragia digestiva. El pronóstico, generalmente ominoso, depende de una alta sospecha clínica y diagnóstico oportuno. Caso clínico Reportamos el caso de una mujer de 66 años intervenida por un aneurisma sacular aórtico abdominal (AAA) yuxtarrenal, con rotura contenida, fistulizado al duodeno. Presentó una hemorragia digestiva en el preoperatorio; sin embargo, el diagnóstico de la fístula se hizo en el intraoperatorio. La paciente fue sometida a reparación quirúrgica urgente con instalación de una prótesis aórtica bifemoral y resección duodenal. En el postoperatorio inmediato presentó una trombosis parcial de las ramas de la prótesis aórtica e isquemia de extremidades, siendo reintervenida exitosamente. Discusión La FAE es una causa potencialmente fatal de hemorragia digestiva. El diagnóstico continúa siendo un desafío debido a su presentación inespecífica y siempre debiese ser considerado frente a una hemorragia digestiva sin causa aparente. Existen varias opciones para el enfrentamiento quirúrgico que deben ser analizadas caso a caso, sin retrasar la reparación de la fístula. Es preferible la resección duodenal ante la simple duodenorrafia.


Introduction Aorto-enteric fistulae (AEF) are a rare cause of gastrointestinal bleeding. The prognosis tends to be ominous, depending greatly in a high level of clinical suspicion and prompt diagnosis. Clinical case We report a case of a 66-year-old female with a saccular juxta-renal abdominal aortic aneurysm (AAA), with a contained rupture. The patient was urgently submitted to surgical repair using an bifemoral aortic prosthesis. A duodenal partial resection was performed. During the immediate postoperative time she presented partial thrombosis of prosthesis and ischemia of lower extremities so she was reoperated successfully. Discussion AEF is a potentially fatal cause of gastrointestinal bleeding. Diagnosis is still troublesome due to its vague presentation and it should always be considered when facing gastrointestinal haemorrhage with no apparent cause. There are several surgical approaches that should be pondered case to case without delaying the repair of the defect.


Subject(s)
Humans , Female , Aged , Aortic Diseases/complications , Intestinal Fistula/surgery , Intestinal Fistula/complications , Duodenal Diseases/complications , Gastrointestinal Hemorrhage/surgery , Intestinal Fistula/diagnosis , Treatment Outcome , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/complications , Blood Vessel Prosthesis Implantation/methods , Perioperative Period , Gastrointestinal Hemorrhage/diagnosis
6.
Rev. cuba. angiol. cir. vasc ; 20(2)jul.-dic. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1003859

ABSTRACT

RESUMEN Introducción: la incorporación de la ecografía a los métodos diagnósticos de los aneurismas aórticos abdominales favorece su detección precoz. Objetivo: Describir las características de los pacientes a quienes se les detectó precozmente un aneurisma aórtico abdominal. Métodos: Estudio descriptivo de corte transversal en 243 pacientes pertenecientes al área de salud del Hospital Clinicoquirúrgico "General Freyre de Andrade", clasificados como población de riesgo (hombres > 50 años y mujeres > 60 años). El periodo de estudio: noviembre de 2016 a octubre de 2017. Resultados: Se realizó el diagnóstico de aneurisma aórtico abdominal en 2,1 % (n= 5); en estos pacientes prevaleció el grupo de edad de 70 a79 años (80 %) y el sexo masculino (60 %). Los factores de riesgo predominantes fueron el tabaquismo, la hipertensión arterial y la enfermedad arterial periférica, todos con igual porcentaje (100 %). El segmento aórtico más afectado fue el infrarrenal (100 %), los diámetros aórticos predominantes fueron: transversal (3-3,9 cm), longitudinal (5-10 cm) y antero-posterior (3-3,9 cm). La proteína C reactiva estuvo incrementada (mayor de 5 mg/L) en el 100 % de los casos. La claudicación intermitente fue la más frecuente. Conclusiones: A pesar de la baja prevalencia porcentual encontrada, destaca en todos los pacientes con aneurisma aórtico abdominal la presencia de factores de riesgo relevantes como es el tabaquismo, la hipertensión arterial y la enfermedad arterial periférica; incremento en la concentración de la proteína C reactiva, afectación en el segmento infrarrenal así como alto porcentaje con edades por encima de 70 años.


ABSTRACT Introduction: The incidence of abdominal aortic aneurysms in the population benefits from the incorporation of ultrasound to diagnostic methods due to the importance of their early detection. Objective: To describe the characteristics of patients who are early detected with an abdominal aortic aneurysm. Method: A descriptive, cross-sectional study was conducted in 243 patients belonging to the health area of "General Freyre de Andrade" Clinical- Surgical Hospital that were classified as a risk population (men > 50 years and women > 60 years). The study was conducted from November 2016 to October 2017. Results: The diagnosis of abdominal aortic aneurysm was performed in 2.1 % (n= 5); in these patients predominated the age group of 70 to 79 years (80 %), male sex (60 %) and white skin color (80 %). The predominant risk factors were smoking habit, arterial hypertension and peripheral arterial disease; all with equal percentage (100 %). The most affected aortic segment was the infrarenal (100 %), the predominant aortic diameters were: transversal (3-3.9 cm), longitudinal (5-10 cm) and anterior-posterior (3-3.9 cm). The C-reactive protein increased (greater than 5 mg/L) in 100 % of the cases. Intermittent claudication was the most frequent. Conclusions: Although the percentage prevalence of the disease was low, it was present in all the patients with abdominal aortic aneurysm, risk factors that are favorable to aneurysms, high concentrations of C-reactive protein, affectation in the infrarenal aortic segment, and high percentage of ages of more than 70 years.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , C-Reactive Protein/ultrastructure , Ultrasonography/methods , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/diagnostic imaging , Epidemiology, Descriptive , Cross-Sectional Studies , Risk Factors
7.
Rev. bras. cir. cardiovasc ; 34(3): 279-284, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013475

ABSTRACT

Abstract Objective: The purpose of this study was to compare the operative mortality rate and outcomes of endovascular aneurysm repair (EVAR) between young and geriatric people in a single center. Methods: Eighty-five patients with abdominal aortic aneurysms who underwent EVAR between January 2012 and September 2016 were included. Outcomes were compared between two groups: the young (aged < 65 years) and the geriatric (aged ≥ 65 years). The primary study outcome was technical success; the secondary endpoints were mortality and secondary interventions. The mean follow-up time was 36 months (3-60 months). Results: The study included 72 males and 13 females with a mean age of 71.08±8.6 years (range 49-85 years). Of the 85 patients analyzed, 18 (21.2%) were under 65 years old and 67 patients (78.8%) were over 65 years old. There was no statistically significant correlation between chronic disease and age. We found no statistically significant difference between aneurysm diameter, neck angle, neck length, or right and left iliac angles. The secondary intervention rate was 7% (six patients). The conversion to open surgery was necessary for only one patient and only three deaths were reported (3.5%). There was no statistically significant difference in the mortality and reintervention rates between the age groups. The three deaths occurred only in the geriatric group and two died secondary to rupture. Kidney failure was observed in three patients in the geriatric group (4.5%). Conclusion: Our single-center experience shows that EVAR can be used safely in both young and geriatric patients.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/mortality , Endovascular Procedures/methods , Endovascular Procedures/mortality , Reference Values , Coronary Artery Disease/surgery , Coronary Artery Disease/mortality , Retrospective Studies , Follow-Up Studies , Age Factors , Treatment Outcome , Sex Distribution , Age Distribution , Pulmonary Disease, Chronic Obstructive/surgery , Pulmonary Disease, Chronic Obstructive/mortality , Renal Insufficiency, Chronic/surgery , Renal Insufficiency, Chronic/mortality , Peripheral Arterial Disease/surgery , Peripheral Arterial Disease/mortality
8.
Rev. bras. cir. cardiovasc ; 34(3): 327-334, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013461

ABSTRACT

Abstract Objective: The main goal of our study was to assess the impact of vascular procedures on the activity of hemostatic and fibrinolytic pathways. Methods: We enrolled 38 patients with ≥ 45 years old undergoing surgery for abdominal aortic aneurysm or peripheral artery disease under general or regional anesthesia and who were hospitalized at least one night after the procedure. Patients undergoing carotid artery surgery and those who had acute bypass graft thrombosis, cancer, renal failure defined as estimated glomerular filtration rate < 30 ml/min/1.73m2, venous thromboembolism three months prior to surgery, or acute infection were excluded from the study. We measured levels of markers of hemostasis (factor VIII, von Willebrand factor:ristocetin cofactor [vWF:CoR], antithrombin), fibrinolysis (D-dimer, tissue plasminogen activator [tPA], plasmin-antiplasmin complexes), and soluble cluster of differentiation 40 ligand (sCD40L) before and 6-12h after vascular procedure. Results: Significant differences between preoperative and postoperative levels of factor VIII (158.0 vs. 103.3, P<0.001), antithrombin (92.1 vs. 74.8, P<0.001), D-dimer (938.0 vs. 2406.0, P=0.005), tPA (10.1 vs. 12.8, P=0.002), and sCD40L (9092.9 vs. 1249.6, P<0.001) were observed. There were no significant differences between pre- and postoperative levels of vWF:CoR (140.6 vs. 162.8, P=0.17) and plasmin-antiplasmin complexes (749.6 vs. 863.7, P=0.21). Conclusion: Vascular surgery leads to significant alterations in hemostatic and fibrinolytic systems. However, the direction of these changes in both pathways remains unclear and seems to be different depending on the type of surgery. A study utilizing dynamic methods of coagulation and fibrinolysis assessment performed on a larger population is warranted.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Vascular Surgical Procedures/adverse effects , Blood Coagulation/physiology , Aortic Aneurysm, Abdominal/surgery , Peripheral Arterial Disease/surgery , Fibrinolysis/physiology , Postoperative Period , Reference Values , Blood Coagulation Factors/analysis , Enzyme-Linked Immunosorbent Assay , Biomarkers/blood , Pilot Projects , Risk Factors , Treatment Outcome , Statistics, Nonparametric , Preoperative Period
9.
Rev. cuba. cir ; 58(1): e608, ene.-mar. 2019. graf
Article in Spanish | LILACS | ID: biblio-1093152

ABSTRACT

RESUMEN La disección aórtica ocurre cuando las capas de la pared aortica se separan como resultado de la entrada de sangre a través de un desgarro en la íntima. El promedio reportado para la disección primaria de la aorta abdominal es menor al 2 por ciento, comparado con el de la aorta ascendente (70 por ciento), aorta descendente (20 por ciento) y el arco aórtico (7 por ciento). Se reporta el caso de un paciente masculino de 74 años de edad que inició su padecimiento con dolor lumbar y abdominal súbito e intenso. Se le realizó una angiotomografía que mostró una disección de la aorta abdominal infrarrenal con extensión a ambas arterias iliacas primitivas hasta antes de su bifurcación. Se le realizó un bypass aortobifemoral con injerto bifurcado de Dacron obteniendo un buen resultado posoperatorio. La disección aórtica abdominal primaria es una rara patología que en pacientes sintomáticos se puede tratar mediante la reparación abierta o endovascular, si se decide realizar la técnica abierta se puede realizar la escisión más bypass aortobifemoral obteniendo buenos resultados como en este caso(AU)


ABSTRACT Aortic dissection occurs when the layers of the aortic wall separate as a result of the entry of blood through a tear in the intima. The average figure reported for primary dissection of the abdominal aorta is less than 2 percent, compared with that of the ascending aorta (70 percent), descending aorta (20 percent), and aortic arch (7 percent). We report the case of a 74-year-old male patient who began his disease with sudden and intense abdominal and back pain. An angiotomography was performed that showed a dissection of the infrarenal abdominal aorta with extension to both primitive iliac arteries until before its bifurcation. An aortobifemoral bypass with a bifurcated Dacron graft was performed, obtaining a good postoperative result. Primary abdominal aortic dissection is a rare pathology that, in symptomatic patients, can be treated by open or endovascular repair. If it is decided to perform the open technique, excision can be performed plus aortobifemoral bypass, obtaining good results as in this case(AU)


Subject(s)
Humans , Male , Aged , Aortic Aneurysm, Abdominal/surgery , Open Abdomen Techniques/methods , Aneurysm, Dissecting/surgery
10.
Einstein (Säo Paulo) ; 17(4): eRC4668, 2019. graf
Article in English | LILACS | ID: biblio-1012008

ABSTRACT

ABSTRACT Endovascular aneurysm repair is an established technique for treating many infrarenal aortic aneurysms. Infection is one of the most serious complications of this technique, and although percutaneous treatment has been well established for intra-abdominal collections, its use to treat peri-prosthetic fluid collections has not been well determined. In this article we describe a small series of three patients who were treated with percutaneous drainage, with good clinical and imaging responses. Percutaneous drainage is a safe, effective and minimally invasive approach for treating this potentially fatal complication.


RESUMO O reparo endovascular de aneurisma é uma técnica para tratamento de diversos aneurismas infrarrenais da aorta. A infecção é uma das complicações mais sérias desse tratamento, e a abordagem percutânea tem sido adotada para coleções intra-abdominais, mas seu uso para tratamento de coleções protéticas vasculares não está bem estabelecido. Descreve-se, neste trabalho, pequena série de três pacientes tratados com drenagem percutânea, que apresentaram boa resposta clínica e de imagem. A drenagem percutânea mostrou-se abordagem segura, efetiva e minimamente invasiva para tratamento desta complicação, que é potencialmente fatal.


Subject(s)
Humans , Male , Aged , Aged, 80 and over , Aorta, Abdominal/surgery , Prosthesis-Related Infections/surgery , Endovascular Procedures/adverse effects , Aorta, Abdominal/anatomy & histology , Tomography, X-Ray Computed , Drainage/methods , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/diagnostic imaging , Endovascular Procedures/methods
11.
Rev. bras. cir. cardiovasc ; 33(5): 522-524, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-977446

ABSTRACT

Abstract This paper presents a case study of a patient that underwent surgery for a ruptured abdominal aneurysm. The postoperative course was complicated by resistant hypertension and tachycardia. A suprarenal mass was detected in the computed tomography scan with radiological suspicion of pheochromocytoma. Few cases of pheochromocytoma coexisting with aneurysms have been reported. Management of cardiovascular stability is crucial in such cases. Despite the lack of evidence, pheochromocytomas might have a role in the etiology of aortic aneurysms.


Subject(s)
Humans , Male , Middle Aged , Pheochromocytoma/surgery , Aortic Aneurysm, Abdominal/surgery , Adrenal Gland Neoplasms/surgery , Hypertension/etiology , Pheochromocytoma/complications , Pheochromocytoma/diagnostic imaging , Tomography, X-Ray Computed , Aortic Aneurysm, Abdominal/complications , Adrenal Gland Neoplasms/complications , Adrenal Gland Neoplasms/diagnostic imaging
12.
J. vasc. bras ; 17(3)jul.-set. 2018. tab
Article in Portuguese | LILACS | ID: biblio-916138

ABSTRACT

Contexto: Os aneurismas de aorta abdominal (AAA) infrarrenal apresentam alta morbimortalidade associada à ruptura e podem ser tratados por cirurgia aberta ou endovascular. Objetivos: Analisar os fatores de risco e a sobrevida associados aos métodos cirúrgico e endovascular no tratamento do AAA. Métodos: Estudo retrospectivo e longitudinal envolvendo 41 pacientes submetidos à correção endovascular ou aberta do AAA, de forma eletiva ou emergencial, no período de 48 meses. Foi realizada análise de comorbidades pré-operatórias, sobrevida em 30 dias e 1 ano, mortalidade hospitalar, tempo de internação, hemotransfusões, duração da cirurgia e ocorrência de insuficiência renal aguda. A estatística inferencial e a análise de sobrevida foram realizadas considerando intervalo de confiança de 95% e p < 0,05 como significante. Resultados: Dos 41 pacientes, 12 foram submetidos à correção aberta e 29, à endovascular. A maioria eram homens (75%), com média de idade de 71 anos (mín. 56, máx. 90 anos). Não houve diferenças de fatores de risco entre os grupos. A sobrevida global dos pacientes foi diferente para os tratamentos aberto e endovascular, tanto em 30 dias (37 vs. 72%; p = 0,01) quanto em 360 dias (37 vs. 67%; p = 0,01), respectivamente. A sobrevida dos casos eletivos em 30 dias (71 vs. 76%; p = 0,44) e 360 dias (ambas 71%; p = 0,34) foram semelhantes. O reparo endovascular apresentou menor tempo de internação (3,0 vs. 4,4 dias; p = 0,02) e duração da cirurgia (111 vs. 163 min; p = 0,005) quando comparado à cirurgia aberta. Conclusões: Não houve diferença na sobrevida em curto e médio prazo dos pacientes com AAA tratados de forma eletiva pelas técnicas endovascular e cirúrgica. Menor tempo de internação e duração da cirurgia foram observados no tratamento minimamente invasivo


Background: Infrarenal abdominal aortic aneurysms (AAA) are responsible for high rates of rupture-associated morbidity and mortality and can be treated by open or endovascular surgery. Objectives: To analyze risk factors and survival associated with surgical and endovascular AAA treatment methods. Methods: A retrospective, longitudinal study involving 41 patients who underwent endovascular or open AAA repair, whether elective or emergency, over a 48-month period, with analysis of preoperative comorbidities, 30-day and 1-year survival, in-hospital mortality, length of hospital stay, transfusion of blood products, duration of surgery, and development of acute kidney failure. Inferential statistics and survival analysis considered a 95% CI and p < 0.05 as significant. Results: Twelve of the 41 patients were treated with open surgery and 29 with endovascular techniques. The majority were male (75%), with an average age of 71 (range: 56 ­ 90 years). There were no differences in demographic or risk factors between the groups. Overall survival rates for open and endovascular repair were different for both 30 days (37 vs. 72%, p = 0.01) and 360 days (37 vs. 67%, p = 0.01). However, survival rates in elective cases were similar at 30 days (71 vs. 76%, p = 0.44) and 360 days (both 71%, p = 0.34). Endovascular repair showed shorter length of hospital stay (3.0 vs. 4.4 days; p = 0.02) and duration of surgery (111 vs. 163 min; p < 0.01) compared to open repair. Conclusions: There was no difference in short- or medium-term survival of AAA patients treated electively with endovascular or open surgery. Hospital stays and duration of surgery were both shorter with minimally invasive treatment


Subject(s)
Humans , Male , Female , Aortic Aneurysm, Abdominal/mortality , Aortic Aneurysm, Abdominal/surgery , Endovascular Procedures/methods , Risk Factors , Survival Analysis , Age Factors , Blood Vessel Prosthesis Implantation , Comorbidity , Elective Surgical Procedures , Mortality , Retrospective Studies , Sex Factors , Statistical Analysis , Treatment Outcome
13.
Rev. bras. cir. cardiovasc ; 33(3): 265-270, May-June 2018. tab, graf
Article in English | LILACS | ID: biblio-958405

ABSTRACT

Abstract Objective: This study aims to compare open surgical and endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms in terms of their effects on quality of life, using Short Form-36 (SF-36). Methods: A total of 133 consecutive patients who underwent EVAR or open surgical repair for infra-renal abdominal aorta aneurysm between January 2009 and June 2014 were included in the study. Twenty-six (19.5%) patients died during follow-up and were excluded from the analysis. Overall, 107 patients, 39 (36.4%) in the open repair group, and 68 (63.6%) in the EVAR group, completed all follow-up visits and study assessments. Quality of life assessments using SF-36 were performed before surgery and at post-operative months 1, 6, and 12. Results: The mean duration of follow-up was 29.55±19.95 months. At one month, both physical and mental domains of the quality of life assessments favored EVAR, while the two surgical approaches did not differ significantly at or after six months postoperatively. Conclusion: Despite anatomical advantages and acceptable mid-phase mortality in patients with high- or medium-risk for open surgery, EVAR did not exhibit a quality of life superiority over open surgery in terms of physical function and patient comfort at or after postoperative six months.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Quality of Life , Aortic Aneurysm, Abdominal/surgery , Endovascular Procedures/methods , Postoperative Period , Time Factors , Prospective Studies , Surveys and Questionnaires , Follow-Up Studies , Treatment Outcome , Aortic Aneurysm, Abdominal/mortality , Statistics, Nonparametric , Preoperative Period , Endovascular Procedures/mortality
14.
Rev. bras. cir. cardiovasc ; 32(6): 545-547, Nov.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-897963

ABSTRACT

Abstract Stent-graft migration and type I endoleaks are associated with a higher rate of reintervention and increased mortality and morbidity. This article describes a patient presented with an infrarenal aortic stent-graft which had migrated into the aortic sac with loss of all aortic neck attachment. The acutely expanding abdominal aortic aneurysm was treated by placing a second modular endograft within and above the migrated stentgraft. The patient returned 36 months later, with features of an acute myocardial infarction, severe bilateral lower limb ischemia, and renal failure. He was too ill for intervention and demised within 48 hours.


Subject(s)
Humans , Male , Aged , Stents/adverse effects , Foreign-Body Migration/diagnostic imaging , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Aorta, Abdominal/surgery , Postoperative Complications , Tomography, X-Ray Computed , Foreign-Body Migration/surgery , Fatal Outcome , Endovascular Procedures
15.
Brasília; CONITEC; mar. 2017.
Non-conventional in Portuguese | LILACS, BRISA | ID: biblio-906986

ABSTRACT

INTRODUÇÃO: O diâmetro máximo normal da aorta abdominal é de 2,0 cm. A dilatação da aorta abdominal quando atinge um diâmetro 50% maior do que o esperado, ou 3,0 cm nos adultos, é chamada de aneurisma. Aneurismas de aorta abdominal (AAA) são encontrados incidentalmente com frequência, sobretudo na população idosa, sendo responsáveis por 90 a 95% de todos os casos de aneurismas de aorta. Estima-se que a prevalência dos AAA é de 2% na população com faixa etária de 60 anos, e em cerca de 5% após os 70 anos, sendo 2 a 3 vezes mais comum no sexo masculino. TECNOLOGIAS: Tratamento clínico: Não consideramos nesta diretriz a avaliação crítica do tratamento clínico. Portadores de AAA devem ser aconselhados a cessar o hábito de fumar e encorajados a procurar tratamento apropriado para hipertensão arterial sistêmica, dislipidemia, diabetes mellitus e outros fatores de risco cardiovasculares. Tratamento cirúrgico: O reparo cirúrgico aberto consiste em uma incisão abdominal e a substituição de parte da aorta, lesionada pelo aneurisma, por um tubo sintético ou enxerto aórtico, que é suturado no local. Nesta diretriz, os termos cirurgia, cirurgia aberta e tratamento cirúrgico são sinônimos. Tratamento endovascular :O tratamento endovascular do AAA (Endovascular Abdominal Aortic Aneurysm Repair - EVAR) é uma forma de tratamento para o aneurisma de aorta abdominal que é menos invasiva do que a cirurgia aberta. O tratamento endovascular usa uma endoprótese para reforçar a parede da aorta e para ajudar a impedir que a área lesionada se rompa. O procedimento consiste na punção da artéria femoral em região inguinal, acesso ao aneurisma através de um fio guia e liberação da endoprótese no interior da aorta, no local do aneurisma. ESCOPO: O escopo desta diretriz é definir qual o melhor tratamento (clínico, cirúrgico ou endovascular (EVAR)) para o AAA em relação a desfechos importantes para os pacientes (mortalidade cirúrgica, mortalidade global, reintervenções, infarto do miocárdio e acidente vascular cerebral). Não foram incluídos neste protocolo os aneurismas torácicos, aneurismas infecciosos e os casos de dissecção de aorta. IMPLEMENTAÇÃO: A incorporação das recomendações da diretriz na prática clínica é uma etapa de grande importância. Devemos contar com a participação das organizações médicas e dos pacientes, que podem desempenhar um papel fundamental no apoio à disseminação da informação e facilitar a implementação da diretriz. Algumas estratégias serão utilizadas para que essa informação alcance a todos os interessados de forma clara e compreensível. RECOMENDAÇÕES: As recomendações desta diretriz foram estruturadas após a avaliação da qualidade do corpo de evidências para cada desfecho e comparação entre intervenções. Consideramos a direção e a força da recomendação segundo o método GRADE (The Grading of Recommendations Assessment, Development and Evaluation). O equilíbrio entre os resultados desejáveis e indesejáveis (possíveis danos e benefícios) e a aplicação de valores e preferências do paciente determinou a direção da recomendação (contra ou a favor). Tais fatores, juntamente com a qualidade das evidências, determinaram a força da recomendação (forte ou fraca).


Subject(s)
Aortic Aneurysm, Abdominal/drug therapy , Aortic Aneurysm, Abdominal/surgery , Clinical Protocols/standards , Endovascular Procedures/methods , Practice Guidelines as Topic , Brazil , Technology Assessment, Biomedical , Unified Health System
16.
Brasília; CONITEC; mar. 2017. tab, ilus.
Monography in Portuguese | LILACS, BRISA | ID: biblio-837217

ABSTRACT

A presente proposta de Diretriz Nacional para o Tratamento do Aneurisma de Aorta Abdominal é fruto de uma parceria entre o Ministério da Saúde e o Instituto Nacional de Cardiologia. A proposta foi avaliada pela Subcomissão Técnica de Avaliação de PCDT da CONITEC e apresentada aos membros do Plenário da CONITEC, em sua 47ª Reunião Ordinária, que recomendaram favoravelmente ao texto. A Diretriz Brasileira para o Tratamento do Aneurisma de Aorta Abdominal segue agora para consulta pública a fim de que se considere a visão da sociedade e se possa receber as suas valiosas contribuições, que poderão ser tanto de conteúdo científico quanto um relato de experiência. Gostaríamos de saber a sua opinião sobre a proposta como um todo, assim como se há recomendações que poderiam ser diferentes ou mesmo se algum aspecto importante deixou de ser considerado. Aos 10 (dez) dias do mês de novembro de 2016, reuniu-se a Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde ­ CONITEC, regulamentada pelo Decreto nº 7.646, de 21 de dezembro de 2011, e os membros presentes deliberaram por unanimidade recomendar a aprovação da Diretriz Brasileira para o Tratamento Percutâneo do Aneurisma de Aorta Abdominal. Foi assinado o Registro de Deliberação n ̊ 222/2016. A Portaria Nº 488, de 6 de março de 2017 - prova as Diretrizes Brasileiras para o tratamento de Aneurisma da Aorta Abdominal.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/therapy , Endovascular Procedures/methods , Health Planning Guidelines , Brazil , Technology Assessment, Biomedical , Unified Health System
17.
Rev. bras. cir. cardiovasc ; 32(1): 43-48, Jan.-Feb. 2017. tab
Article in English | LILACS | ID: biblio-843462

ABSTRACT

Abstract Objective: To evaluate our experience following the introduction of a percutaneous program for endovascular treatment of aortic diseases using Perclose Proglide® assessing efficacy, complications and identification of potential risk factors that could predict failure or major access site complications. Methods: A retrospective cohort study during a two-year period was performed. All the patients submitted to totally percutaneous endovascular repair (PEVAR) of aortic diseases and transcatheter aortic valve implantation since we started the total percutaneous approach with the preclosure technique from November 2013 to December 2015 were included in the study. The primary endpoint was major ipsilateral access complication, defined according to PEVAR trial. Results: In a cohort of 123 patients, immediate technical success was obtained in 121 (98.37%) patients, with only two (0.82%) cases in 242 vascular access sites that required intervention immediately after the procedure. Pairwise comparisons revealed increased major access complication among patients with >50% common femoral artery (CFA) calcification vs. none (P=0.004) and > 50% CFA calcification vs. < 50% CFA calcification (P=0.002). Small artery diameter (<6.5 mm) also increased major access complication compared to bigger diameters (> 6.5 mm) (P=0.027). Conclusion: The preclosure technique with two Perclose Proglide® for PEVAR is safe and effective. Complications occur more often in patients with unfavorable access site anatomy and the success rate can be improved with proper patient selection.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Suture Techniques/instrumentation , Aortic Aneurysm, Thoracic/surgery , Aortic Aneurysm, Abdominal/surgery , Endovascular Procedures/methods , Retrospective Studies , Risk Factors , Treatment Outcome , Femoral Artery
18.
Rev. bras. cir. cardiovasc ; 32(1): 53-56, Jan.-Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-843459

ABSTRACT

Abstract Advent of antiretroviral therapy has increased survival of patients with human immunodeficiency virus (HIV) infections, with the result that some of these patients now develop degenerative diseases, such as atherosclerotic aneurysms. Degenerative thoracoabdominal aortic aneurysm is rare in HIV patients. In this report, a 63-year-old male patient with HIV submitted to open repair of thoracoabdominal aortic aneurysm. The patient did not suffer any type of complication in the perioperative period and remained well in a 28-month follow-up period. In summary, open repair still remains a good alternative for aortic complex aneurysms even in HIV patients.


Subject(s)
Humans , Male , Middle Aged , HIV Infections/complications , Aortic Aneurysm, Thoracic/surgery , Aortic Aneurysm, Abdominal/surgery , Angiography , Tomography, X-Ray Computed , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Abdominal/diagnostic imaging , Blood Vessel Prosthesis Implantation/methods , Endovascular Procedures
19.
In. Vieira, Joaquim Edson; Rios, Isabel Cristina; Takaoka, Flávio. Anestesia e bioética / Anesthesia and bioethics. São Paulo, Atheneu, 8; 2017. p.2731-2739.
Monography in Portuguese | LILACS | ID: biblio-848019
20.
Rev. bras. cir. cardiovasc ; 31(6): 415-421, Nov.-Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-843453

ABSTRACT

Abstract Objective: The endovascular repair of aortic abdominal aneurysms exposes the patients and surgical team to ionizing radiation with risk of direct tissue damage and induction of gene mutation. This study aims to describe our standard of radiation exposure in endovascular aortic aneurysm repair and the factors that influence it. Methods: Retrospective analysis of a prospective database of patients with abdominal infra-renal aortic aneurysms submitted to endovascular repair. This study evaluated the radiation doses (dose area product (DAP)), fluoroscopy durations and their relationships to the patients, aneurysms, and stent-graft characteristics. Results: This study included 127 patients with a mean age of 73 years. The mean DAP was 4.8 mGy.m2, and the fluoroscopy time was 21.8 minutes. Aortic bilateral iliac aneurysms, higher body mass index, aneurysms with diameters larger than 60 mm, necks with diameters larger than 28 mm, common iliac arteries with diameters larger than 20 mm, and neck angulations superior to 50 degrees were associated with an increased radiation dose. The number of anatomic risk factors present was associated with increased radiation exposure and fluoroscopy time, regardless of the anatomical risk factors. Conclusion: The radiation exposure during endovascular aortic aneurysm repair is significant (mean DAP 4.8 mGy.m2) with potential hazards to the surgical team and the patients. The anatomical characteristics of the aneurysm, patient characteristics, and the procedure's technical difficulty were all related to increased radiation exposure during endovascular aortic aneurysm repair procedures. Approximately 40% of radiation exposure can be explained by body mass index, neck angulation, aneurysm diameter, neck diameter, and aneurysm type.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Radiation Dosage , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/diagnostic imaging , Radiation Exposure , Endovascular Procedures/methods , Fluoroscopy , Retrospective Studies , Risk Factors , Occupational Exposure , Endovascular Procedures/adverse effects
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