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1.
Rev. bras. cir. cardiovasc ; 36(2): 244-252, Mar.-Apr. 2021. graf., tab.
Article in English | SES-SP, LILACS, SES-SP, CONASS, SESSP-IDPCPROD, SES-SP | ID: biblio-1251100

ABSTRACT

Abstract Objective: To investigate whether hybrid repair has supremacy over conventional open repair in aortic arch diseases. Methods: A comprehensive search was undertaken in two major databases (PubMed and MEDLINE) to identify all studies comparing the two surgical techniques in five years, up to December 2018, that met the established criteria in this study. The search returned 310 papers, and 305 were selected after removing duplicates. The abstracts of the remaining articles were assessed, resulting in 15 studies that went to full-text analysis. After application of the inclusion and exclusion criteria, 8 papers remained for the final revision. Results: Eight studies met the criteria, with the inclusion of 1,837 patients. From a short-term perspective, hybrid repair and conventional open repair had similar outcomes in terms of postoperative mortality and acute neurological events. Hybrid repair was associated with less respiratory complications and risk of new intervention, as well as reduced hospital length of stay. Conventional open repair showed better mid- and long-term outcomes. Conclusion: Hybrid repair should be used in selected patients, with a high risk or very high-risk profile for conventional surgery. Finally, since most of the current data were obtained from limited to large samples, with narrow follow-up and had great heterogeneity, the best approach to the aortic arch is still variable. Therefore, the decision of the approach should be individualized and evaluated by the whole Heart Team, considering the expertise of the surgical team.


Subject(s)
Humans , Aorta, Thoracic/surgery , Postoperative Complications , Retrospective Studies , Blood Vessel Prosthesis Implantation , Treatment Outcome
2.
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
3.
Clinics ; 76: e2332, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153976

ABSTRACT

OBJECTIVES: In Brazil, descending thoracic aorta disease (TAD), including aneurysms and dissection, are preferentially managed by endovascular treatment (TEVAR) due to the feasibility and good results of this technique. In this study, we analyzed endovascular treatment of isolated TAD (ITAD) in the public health system over a 10-year period in São Paulo, a municipality in Brazil in which more than 5 million inhabitants depend on the governmental health system. METHODS: Public data from procedures performed between 2008 and 2019 were extracted using web scraping techniques. The following types of data were analyzed: demographic data, operative technique, elective or urgent status, number of surgeries, in-hospital mortality, length of hospital stay, mean length of stay in the intensive care unit, and reimbursement values paid by the government. Trauma cases and congenital diseases were excluded. RESULTS: A total of 1,344 procedures were analyzed; most patients were male and aged ≥65 years. Most individuals had a residential address registered in the city. Approximately one-third of all surgeries were urgent cases. There were 128 in-hospital deaths (9.52%), and in-hospital mortality was lower for elective than for urgent surgeries (7.29% vs. 14.31%, p=0.031). A total of R$ 24.766.008,61 was paid; an average of R$ 17.222,98 per elective procedure and R$ 18.558,68 per urgent procedure. Urgent procedures were significantly more expensive than elective surgeries (p=0.029). CONCLUSION: Over a 10-year period, the total cost of ITAD interventions was R$ 24.766.008,61, which was paid from the governmental system. Elective procedures were associated with lower mortality and lower investment from the health system when compared to those performed in an urgent scenario.


Subject(s)
Humans , Male , Female , Aged , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Aorta, Thoracic/surgery , Postoperative Complications , Time Factors , Brazil/epidemiology , Public Health , Retrospective Studies , Risk Factors , Treatment Outcome
4.
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
5.
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
6.
Article in English | WPRIM | ID: wpr-880673

ABSTRACT

OBJECTIVES@#Thoracoabdominal aortic aneurysm (TAAA) prosthetic vessel replacement is one of the most complex operations in the field of cardiovascular surgery. The key to success of this operation is to prevent and avoid ischemia of important organs while repairing TAAA. This study aims to summarize and analyze the effect of prosthetic vessel replacement under left heart bypass in the treatment of TAAA.@*METHODS@#Data of 15 patients with TAAA who underwent prosthetic vessel replacement under left heart bypass in Xiangya Hospital of Central South University were retrospectively analyzed. According to Crawford classification, there were 2 cases of type I, 8 cases of type II, 3 cases of type III, and 2 cases of type V. There were 14 cases of selective operation and 1 case of emergency operation. All operations were performed under left heart bypass, and cerebrospinal fluid drainage was performed before operation. Left heart bypass was established by intubation of left inferior pulmonary vein and distal abdominal aorta or left femoral artery. The thoracoabdominal aorta was replaced segment by segment. After aortic dissection, the kidneys were perfused with cold crystalloid renal protective solution, and the celiac trunk and superior mesenteric artery were perfused with warm blood.@*RESULTS@#One patient with TAAA after aortic dissection of type A died. During the operation, straight blood vessels were used to repair TAAA, and the celiac artery branches were trimmed into island shape and anastomosed with prosthetic vessels. After the operation, massive bleeding occurred at the anastomotic stoma, then anaphylactic reaction occurred during massive blood transfusion, resulting in death. One patient suffered from paraplegia due to ischemic injury of spinal cord. The other patients recovered well and were discharged. The postoperative ventilation time was (16.5±13.8) h and the postoperative hospital stay was (10±4) d. The amount of red blood cell transfusion was (13±9) U. The patients were followed up for 2 months to 2 years, and the recovery was satisfactory.@*CONCLUSIONS@#The effect of prosthetic vessel replacement under left heart bypass in the treatment of TAAA is good, which is worthy of clinical promotion.


Subject(s)
Aneurysm, Dissecting/surgery , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation , Heart Bypass, Left , Humans , Postoperative Complications , Retrospective Studies , Treatment Outcome
7.
Article in English | WPRIM | ID: wpr-880647

ABSTRACT

Type A aortic dissection (AD) is a critical and severe disease with high mortality. The Sun's operation is a standard surgical method for this kind of disease at present. For the procedure, an elephant trunk stent is inserted into the true lumen of the descending aorta and the aortic arch is replaced. A patient was admitted to the First Hospital of Lanzhou University due to sudden chest and back pain for 6 days. Computed tomography angiography (CTA) showed type A AD. Ascending aorta replacement, Sun's operation, and ascending aorta to right femoral artery bypass grafting were performed. After surgery, the patient's condition was worsened. The digital subtraction angiography (DSA) showed the elephant trunk stent was inserted into the false lumen of AD, leading to the occlusion of the large blood vessel at the distal part of the abdominal aorta and below. Although we performed intima puncture and endovascular aortic repair, the patient was still dead.


Subject(s)
Aneurysm, Dissecting/surgery , Aorta, Abdominal , Aorta, Thoracic/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Humans , Stents/adverse effects , Treatment Outcome
8.
Rev. bras. cir. cardiovasc ; 35(6): 977-985, Nov.-Dec. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1144002

ABSTRACT

Abstract Objective: To review the currently available literature to define the role of thoracic endovascular aortic repair (TEVAR) in patients with connective tissue disorders (CTD). Methods: A comprehensive electronic database search was performed in PubMed, SCOPUS, Embase, Google scholar, and OVID to identify all the articles that reported on outcomes of utilizing TEVAR in patients with CTD during elective and emergency settings. The search was not limited to time or language of the published study. Results: All the relevant studies have been summarized in its correspondence section. The outcomes were analyzed in narrative format. The role of TEVAR has been elaborated as per each study. Currently, there is limited large cohort size studies outlining the use of TEVAR in patients with CTD. The use of endovascular repair in patients with CTD is limited due to progressive aortic dilatations and high possibility of further reinterventions at later stage of life. Conclusion: Open repair remains the gold standard method of intervention in young patients with progressive CTD, especially in the setting of acute type A aortic dissection. However, TEVAR can be sought as a reliable alternative in emergency setting of diseases involving the descending thoracic aorta; yet the long-term data needs to be published to support such practice.


Subject(s)
Humans , Aortic Diseases/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Aorta, Thoracic/surgery , Postoperative Complications/surgery , Retrospective Studies , Risk Factors , Treatment Outcome , Aortic Aneurysm, Thoracic/surgery , Connective Tissue
9.
Rev. bras. cir. cardiovasc ; 35(6): 934-941, Nov.-Dec. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143992

ABSTRACT

Abstract Introduction: The aim of this study is to compare postoperative outcomes and follow-up of two different modifications facilitating surgical technique of frozen elephant trunk (FET) procedure for complex thoracic aortic diseases - zone 0 (fixation with total arch debranching) and zone 3 (fixation with islet-shape arch repair). Methods: From May 2012 to December 2018, data were collected from 139 patients who had been treated with FET procedure for complex thoracic aortic diseases. According to Ishimaru arch map, patients with proximal anastomotic site of hybrid graft at zone 0 and zone 3 were grouped as Group A (n=58, 41.7%) and Group B (n=81, 58.3%), respectively. Mean age of study population was 54.7±11.4 years, and 111 patients were male (79.9%). Results: In-hospital mortality was observed in 20 (14.4%) patients (n=12, acute type A aortic dissection, and n=4, previous aortic dissection surgery). There was no significant difference between both groups in terms of in-hospital mortality. Four patients from Group A and three patients from Group B had permanent neurological deficit (P=0.32). Three patients from both groups had transient spinal cord ischemia (P=0.334). Although mean total perfusion time was longer in Group A, duration of visceral ischemia, when compared with Group B, was shorter (P<0.001). Five-year survival rate was 82.8% in Group A and 81.5% in Group B (P=0.876). Conclusion: FET procedure is a feasible repair technique in the treatment of complex aortic diseases, providing satisfactory early results. Because of its advantageous aspects, zone 0 fixation with debranching is the preferred technique in our clinic.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aortic Aneurysm, Thoracic/surgery , Aortic Aneurysm, Thoracic/diagnostic imaging , Blood Vessel Prosthesis Implantation , Aneurysm, Dissecting/surgery , Aneurysm, Dissecting/diagnostic imaging , Aorta, Thoracic/surgery , Blood Vessel Prosthesis , Stents , Retrospective Studies , Treatment Outcome
10.
Rev. bras. cir. cardiovasc ; 35(5): 834-837, Sept.-Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137354

ABSTRACT

Abstract Giant ascending aortic aneurysm is a rare condition. In this paper, we present an uncommon case of giant ascending aortic aneurysm with a maximal diameter of 14 cm in a 77-year-old woman presenting with unusual symptoms. The patient underwent a successful surgery involving ascending aortic replacement, and was discharged without any complication. After discharge, she was followed regularly and no major problem was observed in her control visits. To the best of our knowledge, our case is the largest ascending aortic aneurysm reported to date in the existing literature.


Subject(s)
Humans , Female , Aged , Aortic Aneurysm/surgery , Aortic Aneurysm/complications , Aortic Aneurysm/diagnostic imaging , Superior Vena Cava Syndrome/etiology , Aorta/surgery , Aorta/diagnostic imaging , Cardiopulmonary Bypass , Tomography, X-Ray Computed , Blood Vessel Prosthesis Implantation
11.
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
12.
Rev. bras. cir. cardiovasc ; 35(4): 427-436, July-Aug. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137284

ABSTRACT

Abstract Objective: To systematically review the rate of morbidity and mortality associated with the use of E-vita hybrid stent graft and ThoraflexTM in patients undergoing complex aortic surgery. Methods: A comprehensive search was undertaken among the four major databases to identify published data about E-vita or Thoraflex™ in patients undergoing repair of thoracic aortic aneurysms. Results: In total, 28 papers were included in the study, encompassing a total of 2,161 patients (1,919 E-vita and 242 Thoraflex™). Patients undergoing surgery with E-vita or Thoraflex™ were of similar age and sex. The number of patients undergoing non-elective repair with Thoraflex™ was higher than with E-vita (35.2% vs. 28.7%, respectively). Cardiopulmonary bypass time was associated with increasing mortality in E-vita patients, however a meta-analysis of proportions showed higher 30-day mortality, permanent neurological deficit, and one-year mortality for Thoraflex™ patients. Direct statistical comparisons between E-vita and Thoraflex™ was not possible due to heterogeneity of studies. Conclusion: Although there are limited studies available, the available data suggests that mortality and morbidity are lower for the E-vita device in thoracic aortic aneurysm surgery than for Thoraflex™. Long-term data of comparative studies do not yet exist to assess viability of these procedures.


Subject(s)
Humans , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation , Aorta, Thoracic/surgery , Blood Vessel Prosthesis , Stents , Treatment Outcome
13.
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
14.
Article in Chinese | WPRIM | ID: wpr-826388

ABSTRACT

To investigate the risk factors associated with acute renal failure (ARF) after thoracoabdominal aortic aneurysm (TAAA) surgery. A total of 156 patients underwent TAAA repair between January 2009 and December 2017. Renal failure was defined based on the Kidney Disease Improving Global Outcomes criteria. The patients were divided into ARF group and non-ARF group based on the presence/absence of postoperative ARF. The risk factors of ARF were analyzed by univariate analysis and multivariate logistic analysis. The subjects included 111 males and 45 females aged (40.4±10.9) years (range:19-65 years). The surgical reasons included aortic dissection (=130,83.3%),aneurysm (=22,14.1%),and pseudoaneurysm (=4,2.6%). The degrees of repair included Crawford extent I in 6 patients (3.8%),extent Ⅱ in 128 patients (82.1%),extent Ⅲ in 20 patients (12.8%),and extent Ⅳ in 2 patients(1.3%). There were 3 patients presented with aortic rupture and 6 patients received emergent operations. Nine patients (5.8%) died within 30 days after surgery,and 8 patients (5.1%) suffered from permanent paraplegia. Thirty-six patients (23.1%) had ARF after surgery,and 18 of them needed dialysis. Multivariate logistic analysis showed that smoking ( =2.637,95%=1.113-6.250,=0.028),packed red blood cell usage in operation (≥6 U) ( =5.508,95%=2.144-11.930,=0.000),reoperation for bleeding (=3.529,95%=1.298-9.590,=0.013) were independent risk factors for ARF after TAAA repair. Smoking,packed red blood cell usage in operation (≥6 U),reoperation for bleeding are the independent risk factors of ARF after TAAA surgery.


Subject(s)
Acute Kidney Injury , Adult , Aged , Aortic Aneurysm, Thoracic , General Surgery , Blood Transfusion , Blood Vessel Prosthesis Implantation , Female , Humans , Male , Middle Aged , Postoperative Complications , Reoperation , Retrospective Studies , Risk Factors , Smoking , Treatment Outcome , Young Adult
15.
Article in Chinese | WPRIM | ID: wpr-826362

ABSTRACT

To evaluate the early and mid-term results after surgical repair of thoracoabdominal aortic aneurysm(TAAA)in patients with DeBakey typeⅠor Ⅲ aortic dissection. The clinical data of 130 patients who underwent TAAA repair for chronic DeBakey typeⅠ(groupⅠ, =47)or type Ⅲ(group Ⅲ, =83)aortic dissections in our center between January 2009 and December 2017 were retrospectively analyzed.Early postoperative results,midterm survival,and re-interventions were compared between these two groups. The 30-day mortality rate was 6.9%(=9)in the overall cohort,with no statistic difference between groupⅠand group Ⅲ(10.6% 4.8%;=0.803, =0.370).The incidence of major adverse events(38.3% 51.8%;=2.199, =0.138),5-year actuarial survival rate [(81.7±5.9)% (87.2±4.2)%;=0.483, =0.487],and 5-year actuarial freedom from all reinterventions [(84.5±6.7)% (85.5±4.8)%;=0.010, =0.920] showed no significant differences between these two groups. The early and mid-term outcomes after surgical repair of TAAA are similar for DeBakey typeⅠ and type Ⅲ patients.However,studies with larger sample sizes are still required.


Subject(s)
Aneurysm, Dissecting , Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation , Hospital Mortality , Humans , Postoperative Complications , Retrospective Studies , Treatment Outcome
16.
Article in Chinese | WPRIM | ID: wpr-879227

ABSTRACT

Numerical simulation of stent deployment is very important to the surgical planning and risk assess of the interventional treatment for the cardio-cerebrovascular diseases. Our group developed a framework to deploy the braided stent and the stent graft virtually by finite element simulation. By using the framework, the whole process of the deployment of the flow diverter to treat a cerebral aneurysm was simulated, and the deformation of the parent artery and the distributions of the stress in the parent artery wall were investigated. The results provided some information to improve the intervention of cerebral aneurysm and optimize the design of the flow diverter. Furthermore, the whole process of the deployment of the stent graft to treat an aortic dissection was simulated, and the distributions of the stress in the aortic wall were investigated when the different oversize ratio of the stent graft was selected. The simulation results proved that the maximum stress located at the position where the bare metal ring touched the artery wall. The results also can be applied to improve the intervention of the aortic dissection and the design of the stent graft.


Subject(s)
Arteries , Blood Vessel Prosthesis Implantation , Cardiovascular Diseases , Computer Simulation , Finite Element Analysis , Humans , Prosthesis Design , Stents
17.
Rev. bras. cir. cardiovasc ; 34(6): 759-764, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057495

ABSTRACT

Abstract Regardless the successful treatment of the descending aorta with endovascular prosthesis, for the ascending aorta segment, because of several anatomic and physiologic issues, this technique has been considered an alternative only for high-risk or inoperable patients. Despite restricted indications, hundreds of treatments have been performed worldwide, demonstrating its safety and reproducibility if it is done in high-quality centers. Therefore, understanding patients' selection criteria and technique limitations are critical to its application.


Subject(s)
Humans , Aortic Diseases/surgery , Endovascular Procedures/methods , Aorta, Thoracic/surgery , Aortic Diseases/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/methods , Computed Tomography Angiography
18.
Article in Chinese | WPRIM | ID: wpr-776009

ABSTRACT

Objective To evaluate the early and midterm results of surgical repair of thoracoabdominal aortic aneurysm(TAAA)in patients with Marfan syndrome(MFS). Methods The clinical data of patients with MFS undergoing TAAA repair in Fuwai Hospital between January 2009 and December 2017 were retrospectively analyzed.These patients were divided into two groups:MFS group(=58)and non-MFS group(=98).The baseline data,early postoperative results,and midterm follow-up outcomes were compared between these two groups. Results MFS patients were significantly younger(32 years old 45 years old,=9.603,=0.000)and more frequently had a history of aortic aneurysm or dissection(19% 0,=19.996,=0.000)than non-MFS patients.However,the proportions of males and smokers were significantly lower when compared with non-MFS patients(55.2% 80.6%,=11.489,=0.001;13.8% 46.9%,=17.686,=0.001).There was no significant difference in proportion of emergency operation,prophylactic cerebrospinal fluid drainage,operation time,intra-operative circulation management,and intra-operative blood transfusion(all >0.05).The 30-day mortality rate was significantly lower in MFS group than in non-MFS group(0 9.2%, [Formula: see text]=5.034,=0.025). Conclusions For patients with MFS,TAAA repair provides lower 30-day mortality and comparative middle-term survival.However,the re-intervention rate is higher among MFS patients,highlighting the importance of close follow-up.


Subject(s)
Adult , Aneurysm, Dissecting , Aortic Aneurysm, Thoracic , General Surgery , Blood Vessel Prosthesis Implantation , Female , Humans , Male , Marfan Syndrome , Middle Aged , Retrospective Studies , Treatment Outcome
19.
Article in Chinese | WPRIM | ID: wpr-819048

ABSTRACT

OBJECTIVE@#To analyze risk factors of pelvic ischemia after occlusion of the internal iliac artery during endovascular aneurysm repair (EVAR) surgery.@*METHODS@#The clinical data, preoperative CT angiography (CTA) findings and follow-up results of 82 patients with unilateral embolization of internal iliac artery undergoing EVAR were analyzed retrospectively. Among 82 patients, pelvic ischemic symptoms were developed in 20 patients (ischemia group) and the remaining patients served as control group. The risk factors for pelvic ischemia after occlusion of internal iliac artery during EVAR surgery were explored using univariate and multivariate analysis, and the clinical value was evaluated using ROC curves.@*RESULTS@#The univariate analysis showed that the numbers of the contralateral internal iliac artery and the ipsilateral deep femoral artery stenosis in the pelvic ischemia group were less than those in the control group (both <0.05). Multivariate Logistic regression analysis showed that the decreased number of internal iliac artery branches (=8.383, 95%:1.469-47.841, <0.05) was an independent risk of pelvic ischemia. The ROC curve analysis showed that of the decreased number of contralateral internal iliac artery branches for predicting the incidence of pelvic ischemia was 0.816; when the number of 3.5 was taken as cut-off value, the corresponding sensitivity was 0.861 and the specificity was 0.167.@*CONCLUSIONS@#The decrease in number of the contralateral internal iliac artery branches on preoperative CTA is an independent risk factor for pelvic ischemia after occlusion of the internal iliac artery during EVAR surgery, but it does not show enough clinical value.


Subject(s)
Aortic Aneurysm, Abdominal , General Surgery , Blood Vessel Prosthesis Implantation , Case-Control Studies , Embolization, Therapeutic , Endovascular Procedures , Humans , Iliac Aneurysm , Iliac Artery , General Surgery , Retrospective Studies , Risk Factors , Treatment Outcome
20.
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
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