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1.
CorSalud ; 13(1): 104-108, 2021. graf
Article in Spanish | LILACS | ID: biblio-1345927

ABSTRACT

RESUMEN El pseudoaneurisma es aquel hematoma pulsátil y encapsulado producido tras la rotura de todas las túnicas del vaso y contenido por tejidos vecinos circundantes. Es considerado una complicación tardía en la cirugía protésica aorto-ilíaca. Se presenta un paciente de 72 años al que se le realizó un baipás aorto-bifemoral 13 años atrás, y que posteriormente se le diagnosticó un pseudoaneurisma para-anastomótico que se dejó evolucionar por presentar varias comorbilidades asociadas. Transcurridos 2 años fue necesario realizarle una intervención quirúrgica por presentar crecimiento excesivo de la tumefacción y complicación isquémica con necrosis cutánea. La aparición de un pseudoaneurisma está relacionada con el sexo, el material protésico y con el tiempo que transcurre desde la cirugía. El seguimiento ultrasonográfico durante el postoperatorio es primordial para identificar tempranamente esta complicación.


ABSTRACT Pseudoaneurysm is that pulsatile and encapsulated hematoma produced after the rupture of all vessel layers and contained by surrounding neighboring tissues. It is considered a late complication in aorto-iliac prosthetic surgery. We present a 72-year-old patient who underwent an aorto-bifemoral bypass grafting 13 years ago, and who was subsequently diagnosed with a para-anastomotic pseudoaneurysm that was allowed to evolve due to presenting several associated comorbidities. After two years, it was necessary to perform a surgical intervention due to the excessive growth of the swelling, and ischemic complication with skin necrosis. The appearance of a pseudoaneurysm is related to sex, prosthetic material as well as the time that elapses since the surgery. Ultrasound follow-up during the postoperative period is essential for an early identification of this complication.


Subject(s)
General Surgery , Blood Vessel Prosthesis , Aneurysm, False , Femoral Artery , Vascular Grafting
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.
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
4.
Rev. Col. Bras. Cir ; 48: e20202587, 2021. graf
Article in English | LILACS | ID: biblio-1155357

ABSTRACT

ABSTRACT Objectives: the aim of this study was to compare the outcomes of a new silicone vascular prostheses with PTFE vascular prostheses, on a rabbit experimental model. Methods: forty rabbits underwent infra-renal aorta replacement with 4 mm diameter prostheses, twenty animals with PDMS and twenty animals with PTFE (control group). Retrograde aortic angiography was performed to assess patency. Histological graft samples were examined by electron microscopy to evaluate prostheses endothelialization. Results: patency rates were 100% for both grafts after 30 days; after 60 days, patency rate for PDMS was 92.3% (±7.4), and 73,8% (±13.1) at 90 days. PTFE grafts had patency rates of 87.5% (±11.7) at 60 and 90 days. No statistically significant difference was found in between groups for patency rates (p=0.62). Postoperative complications (death, paraplegia) rates (p=0.526) and aortic clamping times (p=0.299) were comparable in both groups. No statistically significant difference for stenosis was found on angiographical analysis between groups (p=0.650). Electron microscopy revealed limited anastomotic endothelial ingrowth in both prostheses. Conclusion: in this experimental model, PDMS and PTFE vascular prostheses had comparable outcomes and PDMS prosthesis could be used as a vascular graft.


RESUMO Objetivo: analisar novo tubo de silicone como material para prótese vascular e compará-lo a prótese de PTFE, em modelo experimental com coelhos. Métodos: quarenta coelhos foram submetidos a interposição, na aorta infrarrenal, de próteses de 4mm de diâmetro, sendo 20 animais com PDMS e 20 com PTFE (grupo controle). Foi realizada arteriografia retrógrada da aorta para avaliar a patência das próteses. Para avaliar a endotelização das próteses foi realizada microscopia eletrônica de maneira amostral pareada. Resultados: a patência em 30 dias foi de 100% para as duas próteses. Aos 60 dias, a taxa de patência do PDMS foi de 92,3% (± 7,4), e de 73,8% (±13,1) em 90 dias; as próteses de PTFE tiveram taxas de patência de 87,5% (± 11,7) aos 60 e 90 dias. Não foi observada diferença significativa entre as taxas de patência dos grupos (p=0,62). Não foi observada diferença entre os grupos quanto à evolução com complicações pós-operatórias (p=0,526) e quanto ao tempo de clampeamento da aorta (p=0,299). Não houve diferença significativa entre os grupos quanto ao grau de estenose das próteses (p=0,650) à avaliação angiográfica. A microscopia eletrônica mostrou crescimento endotelial limitado às regiões próximas às anastomoses nos dois tipos de próteses. Conclusões: o PDMS mostrou-se passível de utilização como prótese vascular, com resultados comparáveis aos do PTFE no modelo utilizado.


Subject(s)
Animals , Aorta/surgery , Polytetrafluoroethylene/therapeutic use , Silicones/therapeutic use , Blood Vessel Prosthesis , Polyesters , Rabbits
5.
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
6.
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
7.
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
8.
Rev. colomb. cir ; 35(4): 647-658, 2020. tab, fig
Article in Spanish | LILACS | ID: biblio-1147911

ABSTRACT

Introducción. Las malformaciones vasculares son anomalías que están presentes desde el nacimiento, no desaparecen y pueden crecer a lo largo de la vida. Se ha demostrado en estudios retrospectivos que la terminología para clasificar las anomalías vasculares es inexacta en un 69 % de casos, por lo que se hace un diagnostico inadecuado y en un 53 % de casos se brinda al paciente y su familia una información incorrecta del tratamiento y el curso clínico. Métodos. Estudio prospectivo longitudinal, realizado entre 2016 y 2019, donde se incluyeron pacientes con anomalías vasculares, que consultaron a nuestra institución, fueron valorados por el servicio de cirugía vascular, se hizo un plan diagnóstico y manejo integral, vía endovascular, quirúrgica o mixta, de acuerdo con cada caso. Resultados. La malformación más común fue la de tipo venoso, en el 40,3 % de los casos. Se realizó manejo endovascular en el 93,1 % de casos de malformaciones vasculares y quirúrgico en el 6,9 %. La mejoría de los síntomas que motivaron la consulta fue del 100 % para los tumores vasculares y del 70,8 % para las malformaciones. Sin embargo, los resultados son heterogéneos. Discusión. Es necesario realizar un adecuado diagnóstico de las anomalías vasculares, para alcanzar un trata-miento eficaz, con mejoría de los síntomas


Introduction. Vascular malformations are abnormalities that are present from birth, do not disappear and can grow throughout life. It has been shown in retrospective studies that the terminology to classify vascular anomalies is inaccurate in 69% of cases, an inappropriate diagnosis is made and in 53% of cases the patient and their family are given incorrect information on the treatment and the clinical course.Methods. Longitudinal prospective study conducted between 2016 and 2019. Patients with vascular anomalies and consulted to our institution were included. They were evaluated by the vascular surgery service, and a comprehensive diagnosis and management plan was made, including endovascular, surgical or mixed, according to each case. Results. The most common malformation was the venous type in 40.3% of the cases. Endovascular management was performed in 93.1% of cases and surgery in 6.9%. The improvement in the symptoms that led to the con-sultation was 100% for vascular tumors and 70.8% for malformations. However, the results are heterogeneous.Conclusions. It is necessary to obtain an adequate diagnosis of vascular anomalies, to achieve an effective treatment, with improvement of the symptoms


Subject(s)
Humans , Vascular Malformations , Vascular Surgical Procedures , Blood Vessel Prosthesis , Neoplasms, Vascular Tissue
9.
Arq. bras. cardiol ; 113(5): 1002-1005, Nov. 2019. graf
Article in English | LILACS | ID: biblio-1055043

ABSTRACT

Abstract Fistula from left internal mammary artery (LIMA) to pulmonary artery (PA) is rarely encountered in daily practice. In recent years, endovascular therapy options have emerged for the treatment of fistula formations and replaced with surgery. A 53-year-old man admitted to our outpatient clinic with symptoms of typical angina and shortness of breath despite optimal medical therapy. In his relevant history, he had a coronary artery bypass graft (CABG) operation in 2009 in which his LIMA was anastomosed to left anterior descending (LAD) and ramus artery sequentially. Coronary angiography including selective imaging of LIMA demonstrated a fistula formation originating from the proximal portion of the LIMA and draining to PA. After successful closure of fistula with transcatheter coil embolization, the patient was discharged without any complication and symptom. In conclusion, although LIMA to PA fistula is an infrequent clinical condition, it should be considered as a potential cause of persistent angina after CABG operation. Treatment options include conservative medical therapy, surgical ligation and endovascular interventions. The best therapy should be individualised for each patient in respect to patient's symptoms, surgical compatibility and anatomy of fistula.


Resumo A fístula da artéria mamária interna esquerda (AMIE) para a artéria pulmonar (AP) é raramente encontrada na prática diária. Nos últimos anos, opções de terapia endovascular surgiram para o tratamento de formações de fístula e foram substituídas por cirurgia. Um homem de 53 anos de idade, internado em nosso ambulatório com sintomas de angina típica e falta de ar, apesar da terapia clínica ideal. Em seu histórico relevante, ele teve uma cirurgia de revascularização miocárdica (CRM) em 2009, na qual sua AMIE foi anastomosada à descendente anterior esquerda (DAE) e à artéria ramus sequencialmente. A angiografia coronária, incluindo imagens seletivas da AMIE, demonstrou uma formação de fístula proveniente da porção proximal da AMIE e drenando para AP. Após o fechamento bem-sucedido da fístula com embolização transcateter com mola, o paciente recebeu alta sem qualquer complicação e sintoma. Em conclusão, embora fístula entre AMIE e AP seja uma condição clínica pouco frequente, deve ser considerada como uma causa potencial de angina persistente após a operação de revascularização do miocárdio. As opções de tratamento incluem terapia médica conservadora, ligadura cirúrgica e intervenções endovasculares. A melhor terapia deve ser individualizada para cada paciente em relação aos sintomas do paciente, compatibilidade cirúrgica e anatomia da fístula.


Subject(s)
Humans , Male , Middle Aged , Pulmonary Artery , Catheterization, Peripheral/methods , Arterio-Arterial Fistula/therapy , Embolization, Therapeutic/methods , Angina Pectoris/therapy , Mammary Arteries , Postoperative Complications , Blood Vessel Prosthesis , Coronary Artery Bypass/adverse effects , Arterio-Arterial Fistula/complications , Arterio-Arterial Fistula/etiology , Treatment Outcome , Self Expandable Metallic Stents , Angina Pectoris/etiology
10.
Braz. j. med. biol. res ; 52(8): e8318, 2019. tab, graf
Article in English | LILACS | ID: biblio-1011603

ABSTRACT

Currently, there is great clinical need for suitable synthetic grafts that can be used in vascular diseases. Synthetic grafts have been successfully used in medium and large arteries, however, their use in small diameter vessels is limited and presents a high failure rate. In this context, the aim of this study was to develop tissue engineering scaffolds, using poly(trimethylene carbonate-co-L-lactide) (PTMCLLA), for application as small diameter vascular grafts. For this, copolymers with varying trimethylene carbonate/lactide ratios - 20/80, 30/70, and 40/60 - were submitted to electrospinning and the resulting scaffolds were evaluated in terms of their physicochemical and biological properties. The scaffolds produced with PTMCLLA 20/80, 30/70, and 40/60 showed smooth fibers with an average diameter of 771±273, 606±242, and 697±232 nm, respectively. When the degradation ratio was evaluated, the three scaffold groups had a similar molecular weight (Mw) on the final day of analysis. PTMCLLA 30/70 and 40/60 scaffolds exhibited greater flexibility than the PTMCLLA 20/80. However, the PTMCLLA 40/60 scaffolds showed a large wrinkling and their biological properties were not evaluated. The PTMCLLA 30/70 scaffolds supported the adhesion and growth of mesenchymal stem cells (MSCs), endothelial progenitor cells, and smooth muscle cells (SMCs). In addition, they provided a spreading of MSCs and SMCs. Given the results, the electrospun scaffolds produced with PTMCLLA 30/70 copolymer can be considered promising candidates for future applications in vascular tissue engineering.


Subject(s)
Humans , Polyesters/chemistry , Blood Vessel Prosthesis , Dioxanes/chemistry , Tissue Scaffolds/chemistry , Materials Testing , Cells, Cultured/cytology , Myocytes, Smooth Muscle/cytology , Cell Proliferation , Mesenchymal Stem Cells/cytology , Endothelial Progenitor Cells/cytology
11.
Chinese Journal of Biotechnology ; (12): 1750-1760, 2019.
Article in Chinese | WPRIM | ID: wpr-771756

ABSTRACT

Due to limited availability of autologous blood vessels (blood vessels from the same recipient used for vascular transplantation materials) and inadequate growth ability of non-autologous blood vessels (artificial blood vessel transplantation materials), more and more attention has been paid to tissue engineering blood vessels. In this study, we constructed an ammonium phosphate zwitterion modified acellular vascular scaffold with highly biocompatible bone marrow-derived endothelial progenitor cells as the inner layer of a new vascular transplantation material. The vascular acellular scaffolds were modified by a simple method-co-precipitation method. The platelet adhesion test, hemolysis test, recalcification test and cytotoxicity of acellular vascular scaffolds in vitro were evaluated. Ammonium phosphate zwitterions modified endothelial progenitor cells on the surface of acellular scaffolds with concave and convex structure on the surface of natural vascular lumen can be effectively promoted by improving anticoagulant activity. Modified acellular scaffolds have similar mechanical properties to natural blood vessels and can effectively construct endothelialization in vitro. The results of this study provide a preliminary exploration for the modification of vascular acellular scaffolds to achieve anti-thrombosis and endothelialization in vitro.


Subject(s)
Blood Vessel Prosthesis , Humans , Phosphates , Thrombosis , Tissue Engineering , Tissue Scaffolds
12.
Article in English | WPRIM | ID: wpr-762013

ABSTRACT

A 68-year-old male patient with a history of femoro-femoral bypass following unsuccessful intervention for chronic total iliac occlusion was found to have a saccular pseudoaneurysm of the right common iliac artery (CIA) due to interventional device-related injuries associated with the past endovascular intervention. An iatrogenic pseudoaneurysm in the CIA is generally asymptomatic, but it has a high risk of rupture, regardless of its size or symptoms. Endovascular therapy may be the best treatment option; however, ineffective sealing with a stent graft may lead to a type I endoleak. Under such conditions, use of the liquid embolic agent, Onyx, as a bailout solution for the type 1 endoleak is promising.


Subject(s)
Aged , Aneurysm , Aneurysm, False , Blood Vessel Prosthesis , Endoleak , Humans , Iliac Artery , Male , Rupture , Stents
13.
Article in English | WPRIM | ID: wpr-762007

ABSTRACT

PURPOSE: There are several commercially approved stent grafts in Korea for the treatment of abdominal aortic aneurysms (AAAs). Each device has its advantages and disadvantages based on the patient’s anatomy and the clinical situation. The Zenith device allows accurate and precise endograft placement, whereas the Endurant device has improved flexibility and trackability. We reviewed 5 cases in which a combination of the Zenith main body and the Endurant iliac limb was used. MATERIALS AND METHODS: From January 2010 to February 2015, 90 patients with AAA underwent endovascular aneurysm repair (EVAR) using the Zenith body at Daegu Catholic University Hospital. Among them, 5 patients who underwent EVAR with the Zenith body and Endurant iliac limb were included in this study. RESULTS: The mean age of the patients was 74.20±3.35 years. All patients were men. The main reason for use of the Endurant iliac limb was aortoiliac angulation. Type III endoleak, stent migration, and stent kinking were not noted. Comparing 85 patients who received a Zenith endograft with 5 patients who received the hybrid endograft, there were no statistical differences in clinical characteristics, intraoperative details and post procedural complications. The mean admission duration was 19.00±13.60 days, and the mean follow-up duration was 1,018.11±925.34 days. In the hybrid endograft group, there was no mortality during the follow-up duration. CONCLUSION: Although the material, radial force, diameter, and length of the overlap zone differ between the two devices, EVAR with the hybrid endograft is safe and effective.


Subject(s)
Aneurysm , Aortic Aneurysm, Abdominal , Blood Vessel Prosthesis , Endoleak , Endovascular Procedures , Extremities , Follow-Up Studies , Humans , Korea , Male , Mortality , Pliability , Postoperative Complications , Stents
14.
Article in English | WPRIM | ID: wpr-761876

ABSTRACT

BACKGROUND: The endovascular approach to aortic disease treatment has been increasingly utilized in the past 2 decades. This study aimed to determine the long-term results of using the Seal thoracic stent graft. METHODS: We retrospectively reviewed the outcomes of patients who underwent thoracic endovascular aortic repair or a hybrid procedure using the Seal thoracic stent graft (S&G Biotech, Seongnam, Korea) from January 2008 to July 2018 at a single institution. We investigated in-hospital mortality and the incidence of postoperative complications. We also investigated the mid-term survival rate and incidence of aorta-related complications. RESULTS: Among 72 patients with stent grafts, 15 patients underwent the hybrid procedure and 21 underwent emergency surgery. The mean follow-up period was 37.86±30.73 months (range, 0–124 months). Five patients (6.9%) died within 30 days. Two patients developed cerebrovascular accidents. Spinal cord injury occurred in 2 patients. Postoperative renal failure, postoperative extracorporeal membrane oxygenation support, and pneumonia were reported in 3, 1, and 6 patients, respectively. Stent-related aortic complications were observed in 5 patients (6.8%). The 1- and 5-year survival and freedom from stent-induced aortic event rates were 81.5% and 58.7%, and 97.0% and 89.1%, respectively. CONCLUSION: The use of the Seal thoracic stent graft yielded good mid-term results. Further studies are needed to examine the long-term outcomes of this device.


Subject(s)
Aorta, Thoracic , Aortic Diseases , Aortic Rupture , Blood Vessel Prosthesis , Emergencies , Endoleak , Extracorporeal Membrane Oxygenation , Follow-Up Studies , Freedom , Hospital Mortality , Humans , Incidence , Pneumonia , Postoperative Complications , Renal Insufficiency , Retrospective Studies , Spinal Cord Injuries , Stents , Stroke , Survival Rate
15.
Article in English | WPRIM | ID: wpr-786694

ABSTRACT

PURPOSE: The outcomes of endovascular aneurysmal repair (EVAR) for infrarenal abdominal aortic aneurysms (AAAs) in the Middle East have rarely been reported. We analyzed the outcomes of EVAR in a Jordanian population.MATERIALS AND METHODS: We conducted a retrospective review of the medical records of patients with infrarenal AAA who were treated with elective EVAR between January 2004 and January 2017 at a single center in Jordan. Patient characteristics, anatomical characteristics, procedural details, and early and late postoperative outcomes were analyzed.RESULTS: A total of 288 patients (mean age, 70 years; 77.8% males) underwent EVAR for infrarenal AAA (median aneurysm size, 64 mm). Bifurcated endografts were used in 265 patients, and aorto-uni-iliac devices were used in 22 patients. Successful endograft deployment was achieved in all patients with no open conversion. Early complications included localized groin hematoma in 15, femoral artery dissection in 4, wound infection in 3, and seroma in 3 patients. With a mean follow-up of 60 months, 50 endoleaks were detected, including 9 type I, 38 type II, and 3 type III. Seven patients had unilateral graft limb occlusion. The 30-day mortality was 1.7%, and long-term mortality was 7.0%, mostly due to non-AAA-related causes.CONCLUSION: EVAR was safely performed in Jordanian patients with minimal complications. However, long-term surveillance is important due to the risk of endoleaks and consequent intervention.


Subject(s)
Aneurysm , Aortic Aneurysm, Abdominal , Blood Vessel Prosthesis , Endoleak , Extremities , Femoral Artery , Follow-Up Studies , Groin , Hematoma , Humans , Jordan , Medical Records , Middle East , Mortality , Retrospective Studies , Seroma , Transplants , Wound Infection
16.
Article in English | WPRIM | ID: wpr-786693

ABSTRACT

PURPOSE: The AFX2 endograft is a unibody, bifurcated stent graft that can be used to lower complications in certain patients. In this study, we retrospectively reviewed consecutive cases in which the AFX2 system was used to overcome the challenges of narrow distal aorta, as well as to reduce procedure time and contrast medium dose. Furthermore, we compared the results with matched patients treated using the Endurant II endograft system.MATERIALS AND METHODS: This was a retrospective observational study of nine patients with abdominal aortic aneurysm (AAA) who underwent endovascular aneurysm repair (EVAR) using the AFX2 device between June 2017 and April 2018 at Seoul National University Hospital. The patients had narrow distal aorta (n=3), reversed tapered neck (n=1), iliac artery aneurysm (n=2), chronic kidney disease patients (n=2), and impending rupture (n=1). Seven matched patients were treated using the Endurant II graft.RESULTS: In the AFX2 group, the mean procedure time was 87.2 minutes, mean blood loss volume was 157.7 mL, and mean volume of contrast medium used was 48.3 mL. In the Endurant II group, the mean procedure time was 140.0 minutes, mean blood loss volume was 175.0 mL, and mean volume of contrast medium used was 119.3 mL.CONCLUSION: Our preliminary experiences with selected AAA patients treated using the AFX2 endovascular repair system showed good outcomes compared with similar patients treated using the Endurant II system. Therefore, the AFX2 may be a good option to perform EVAR in patients of advanced age who have chronic kidney failure or narrow distal aorta.


Subject(s)
Aneurysm , Aorta , Aortic Aneurysm , Aortic Aneurysm, Abdominal , Blood Vessel Prosthesis , Humans , Iliac Artery , Kidney Failure, Chronic , Neck , Observational Study , Renal Insufficiency, Chronic , Retrospective Studies , Rupture , Seoul , Transplants
17.
Article in English | WPRIM | ID: wpr-786688

ABSTRACT

Dacron vascular prostheses have been widely used in vascular surgery since the mid-1970s. They have been proven to be the most durable and reliable conduits for arterial replacement in aortic and peripheral surgeries for decades. However, an extremely rare complication, namely late non-anastomotic graft rupture, due to intrinsic structural prosthetic disruption can occur, resulting in acute hemorrhage or false aneurysm formation. We report a case of this rare complication due to non-anastomotic rupture of a bifurcated knitted Dacron aortic vascular graft in a patient who had undergone an aorto-bi-iliac bypass 6 years ago. The patient was successfully treated in an emergency setting with endovascular therapy using an iliac limb of an abdominal aortic endoprosthesis.


Subject(s)
Aneurysm, False , Blood Vessel Prosthesis , Emergencies , Extremities , Hemorrhage , Humans , Polyethylene Terephthalates , Rupture , Transplants
18.
Kosin Medical Journal ; : 168-172, 2019.
Article in English | WPRIM | ID: wpr-786384

ABSTRACT

Aortoiliac occlusive disease (AIOD), especially proximal to the transplant artery, in kidney transplant patient activates the renin-angiotensin-aldosterone system by limiting graft renal perfusion and causes symptoms that can occur with transplant renal artery stenosis (TRAS) such as refractory hypertension, water retention, and graft renal dysfunction. Immediate clinical suspicion is difficult due to the nature of the progressive disease unlike TRAS. Herein, we present an interesting case of bilateral common iliac artery occlusion (AIOD, TASC II, type C) that manifested as uncontrolled blood pressure and decreased allograft function in a patient who had kidney transplant 17 years ago. The patient was successfully diagnosed with duplex scan, ankle-brachial index (ABI) and computed tomography angiography and treated with percutaneous luminal angioplasty and stent graft insertion.


Subject(s)
Allografts , Angiography , Angioplasty , Ankle Brachial Index , Arteries , Blood Pressure , Blood Vessel Prosthesis , Humans , Hypertension , Iliac Artery , Kidney Transplantation , Kidney , Perfusion , Phenobarbital , Renal Artery Obstruction , Renin-Angiotensin System , Transplants , Water
19.
Article in English | WPRIM | ID: wpr-739588

ABSTRACT

PURPOSE: Recent studies have analyzed the short-term clinical outcomes of ndovascular management. However, the long-term outcomes are unknown. This study aimed to investigate clinical outcomes after endovascular management for ruptured pseudoaneurysm in patients after pancreaticoduodenectomy (PD). METHODS: The medical records of 2,783 patients who underwent PD were retrospectively reviewed at a single center. Of 62 patients who received intervention after pseudonaeurysm rupture, 57 patients (91.9%) experienced eventual success of hemostasis. The patients were composed as follows: (embolization only [EMB], n = 30), (stent-graft placement only [STENT], n = 19) and (both embolization and stent-graft placement simultaneously or different times [EMB + STENT], n = 8). Long-term complications were defined as events that occur more than 30 days after the last successful endovascular treatment. RESULTS: Among 57 patients, short-term stent-graft related complications developed in 3 patients (5.3%) and clinical complication developed in 18 patients (31.5%). Nine (15.8%) had long-term stent-graft related complications, which involved partial thrombosis in 5 cases, occlusion in 3 cases and migration in 1 case. Except for 1 death, the remaining 8 cases did not experience clinical complications. The stent graft primary patency rate was 88.9% after 1 month, 84.2% after 1 year, and 63.2% after 2 years. Of 57 patients, 30 days mortality occurred in 8 patients (14.0%). CONCLUSION: After recovery from initial complication, most of patients did not experience fatal clinical complication during long-term follow-up. Endovascular management is an effective and safe management of pseudoaneurysm rupture after PD in terms of long-term safety.


Subject(s)
Aneurysm, False , Blood Vessel Prosthesis , Embolization, Therapeutic , Follow-Up Studies , Hemostasis , Humans , Medical Records , Mortality , Pancreaticoduodenectomy , Retrospective Studies , Rupture , Stents , Thrombosis
20.
Article in English | WPRIM | ID: wpr-739572

ABSTRACT

PURPOSE: The use of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysms (r-AAA) is steadily increasing. We report early experiences of EVAR for r-AAA performed in two tertiary referral centers in Korea. METHODS: We retrospectively reviewed r-AAA patients treated by EVAR from May 2013 to December 2017. An EVAR-first strategy for r-AAA was adopted whenever feasible. The demographic information, anatomic characteristics, operative details, postoperative complications with special attention to abdominal compartment syndrome (ACS), and 30-day mortality were collected and analyzed. RESULTS: We identified 13 patients who underwent EVAR for r-AAA. Mean age was 74.2 years and mean AAA size was 74.2 mm. Two patients underwent cardiopulmonary resuscitation at initial presentation. Bifurcated stent grafts were used in 12 out of 13 cases and physician-modified endografts with fenestrated/chimney techniques were performed in 2 cases with short neck. Successful stent graft deployment was achieved in all cases. Three patients were suspected of having ACS and 2 of them underwent laparotomy for decompression. The 30-day mortality was 7.7% (1 of 13), the only mortality being a patient that refused decompressive laparotomy for suspected ACS. CONCLUSION: Despite the small numbers, the outcomes of EVAR for treatment of r-AAA were very promising, even in selected cases with unfavorable anatomy. These outcomes were achieved by a dedicated and well-trained team approach, and by use of high-end angiographic technology. Finally, ACS after EVAR is not uncommon, and requires a high index of suspicion as well as liberal use of decompressive surgery.


Subject(s)
Aneurysm , Aortic Aneurysm, Abdominal , Blood Vessel Prosthesis , Cardiopulmonary Resuscitation , Decompression , Endovascular Procedures , Humans , Intra-Abdominal Hypertension , Korea , Laparotomy , Mortality , Neck , Postoperative Complications , Retrospective Studies , Rupture , Tertiary Care Centers
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