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1.
Rev. cir. (Impr.) ; 72(4): 337-341, ago. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1138719

ABSTRACT

Resumen Introducción: Los aneurismas aislados de arteria ilíaca común son una patología infrecuente y habitualmente el diagnóstico es incidental. Su manejo solía ser por vía abierta, pero con el advenimiento de la cirugía endovascular, se han identificado mejores desenlaces en los pacientes llevados a este tipo de procedimientos, reservando la reparación abierta en los casos agudos y rupturas. La asociación entre estos aneurismas con fístulas ílio-ilíacas son infrecuentes y su manejo endovascular se ha reportado en solo una ocasión. Objetivo: Se presenta un caso de un paciente masculino de 82 años, con esta asociación, en el cual se decidió llevar de manera electiva a manejo endovascular de su patología. Discusión: En la literatura el manejo endovascular es ampliamente recomendado por su perfil de seguridad, sin embargo, no existe suficiente evidencia ante la presencia de una fístula ílio-ilíaca de manera concomitante, por ser una condición infrecuente. Conclusión: En el presente caso, abordamos de manera endovascular esta relación, obteniendo resultados favorables, con adecuado control de la patología, sin presentación de complicaciones.


Introduction: The isolated aneurysms of the common iliac artery correspond to an infrequent pathology; and the diagnosis of this entity is usually incidental. Its management is usually by open route, but with the advent of endovascular surgery, better outcomes have been identified in patients taken to this kind of procedure, reserving open repair for the urgent cases, like ruptures. The association between these aneurysms with ilio-iliac fistula is uncommon and their endovascular management has been reported only in one case in the literature. Aim: A case of an 82-year-old male patient will be presented, with this association, who was taken to an endovascular repair of his pathology, with good postoperative results. Discussion: In the literature, endovascular management is recommended by its safety profile, however there is insufficient evidence in the presence of an ilio-iliac fistula concomitantly, because it is an infrequent condition. Conclusion: In the present case, we address this relationship endovascularly, obtaining favorable results, with adequate control of the pathology, without presenting any complications.


Subject(s)
Humans , Male , Aged, 80 and over , Arteriovenous Fistula/surgery , Iliac Aneurysm/surgery , Endovascular Procedures/methods , Arteriovenous Fistula/diagnostic imaging , Iliac Aneurysm/diagnostic imaging , Computed Tomography Angiography
2.
J. vasc. bras ; 16(1): f:48-l:51, Jan.-Mar. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-841407

ABSTRACT

Resumo Relatamos o caso de uma menina de 12 anos que deu entrada na unidade de emergência com quadro de abdome agudo hemorrágico, massa abdominal pulsátil e instabilidade hemodinâmica. Confirmado o diagnóstico de aneurisma roto de artéria ilíaca direita, foi realizada correção cirúrgica de emergência por reparo aberto com reconstrução extra-anatômica, utilizando enxerto sintético de fino calibre, compatível com a anatomia. O tratamento foi bem-sucedido e a criança apresentou evolução favorável em curto prazo.


Abstract We describe the case of a 12-year-old girl who presented at the emergency department with hemorrhagic acute abdomen, an abdominal pulsating mass and hemodynamic instability. A diagnosis of ruptured right iliac artery aneurysm was confirmed and an emergency open repair procedure was performed with extra-anatomic reconstruction, using a small-caliber synthetic graft, compatible with her anatomy. The treatment was successful and the child was doing well at short-term follow-up.


Subject(s)
Humans , Female , Child , Aneurysm, Ruptured/surgery , Child , Iliac Aneurysm/surgery , Iliac Artery , Abdomen, Acute/complications , Abdomen, Acute/diagnosis , Blood Vessel Prosthesis
3.
Rev. chil. cir ; 68(3): 250-253, jun. 2016. ilus
Article in Spanish | LILACS | ID: lil-787082

ABSTRACT

Objetivo: Presentar un caso infrecuente de aneurisma gigante de arteria iliaca interna roto. Caso clínico: Varón de 68 años de edad con antecedentes de hipertensión arterial crónica, dislipidemia, cardiopatía valvular, cor pulmonale con hipertensión pulmonar moderada, portador de marcapasos definitivo, obesidad y alergia a la plata. Ingresa de urgencia por dolor brusco en fosa iliaca izquierda, irradiado periumbilicalmente sin cortejo vegetativo. En el TC abdominal se objetiva la presencia de un aneurisma gigante de la arteria hipogástrica izquierda con diámetro de 6,8 cm y signos de rotura. Se realiza de forma urgente cirugía endovascular mediante implante de prótesis Endurant® y embolización de arterias glúteas con Coils Interlock®. Control al mes y a los 6 meses sin endofugas ni crecimiento del saco. Discusión: El tratamiento de elección de los aneurismas iliacos sigue siendo la cirugía, de forma electiva cuando el diámetro de la arteria es mayor de 3 cm y urgente cuando debutan con rotura. La terapia endovascular es una alternativa segura y eficaz a la cirugía convencional, con resultados satisfactorios a corto y medio plazo.


Aim: To present an infrequent broken giant Iliac artery aneurysms. Case report: In the current study, we report a case of a 68-year-old male patient with chronic high blood pressure, cholesterol, valvular heart disease, cor pulmonale, pacemaker, obesity and silver allergic. He presented sudden onset of abdominal pain. Computed tomography (CT) revealed a large ruptured left hypogastric aneurysm (diameter of 6.8 cm). Hypogastric aneurysm was repaired by an endovascular graft repair: Endurant® endogratf and coils embolization of gluteal arteries (Interlock®). The patient had a satisfactory clinical progression and recovery. At one and six months after the operation TC revealed not Type II endoleaks. Discussion: Isolated aneurysms of the iliac arteries are rare. Surgical treatment is recommended for iliac artery aneurysms larger than 3 cm. Endovascular repair is an attractive method to repair isolated iliac artery aneurysms with lower morbidity and mortality rates than open surgery.


Subject(s)
Humans , Male , Aged , Iliac Aneurysm/surgery , Iliac Aneurysm/diagnostic imaging , Aneurysm, Ruptured/surgery , Aneurysm, Ruptured/diagnostic imaging , Vascular Surgical Procedures
4.
Rev. bras. cir. cardiovasc ; 31(2): 127-131, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-792660

ABSTRACT

Abstract Objective: Internal iliac artery aneurysms (IIAA) are rare, representing only 0.3% of aortoiliac aneurysms. Its treatment with open surgery is complex and associated with high morbidity and mortality, which led to increasing application of endovascular solutions. In this study, we aimed to evaluate outcomes of endovascular aneurysm repair (EVAR) of IIAA in one institution. Methods: We retrospectively reviewed all cases of IIAA treated with endovascular techniques between 2003 and 2014. Endpoints were morbidity, mortality, freedom from pelvic ischemic symptoms (buttock claudication, ischemic colitis, and spinal cord injury), and need for reintervention. Results: There were 16 patients, 13 males and 3 females, with mean age of 75.1±7 years. A total of 20 IIAA (4 cases were bilateral), with mean diameter of 37.9 mm, were treated. EVAR was performed in 13 (81.3%) patients, with associated internal iliac artery's outflow occlusion in 2. Iliac branch device was used in one patient. Two patients underwent endovascular IIAA embolization alone. One patient underwent percutaneous, transgluteal, IIAA embolization. IIAA flow preservation in at least one internal iliac artery was possible in 9 (56.3%) patients. Early mortality was 7% (1 case). Early morbidity was 18.8%. Pelvic ischemic complications occurred in 1 (7%) patient with buttock claudication. Late reintervention was needed in 3 patients, none of them for IIAA related complications. Conclusion: Endovascular treatment of IIAA is technically feasible and durable. Although overall morbidity is relatively high, major complications are infrequent and perioperative mortality is low. internal iliac artery flow preservation is technically challenging and, in a significant number of cases, not possible at all.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Iliac Aneurysm/surgery , Endovascular Procedures/methods , Portugal , Postoperative Period , Reoperation/statistics & numerical data , Retrospective Studies , Morbidity , Treatment Outcome , Iliac Aneurysm/mortality , Embolization, Therapeutic/methods , Embolization, Therapeutic/mortality , Endovascular Procedures/mortality , Length of Stay
5.
Rev. bras. cir. cardiovasc ; 31(2): 132-139, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-792656

ABSTRACT

Abstract Introduction: Endovascular aneurysm repair (EVAR) is the therapy of choice in high risk patients with abdominal aortic aneurysm. The good results described are leading to the broadening of clinical indications to younger patients. However, reintervention rates seem higher and even with successful treatment sometimes there is growth of the aneurysm sac and rupture, meaning a failure of the therapeutic goal. This study proposes to analyse the impact of age in patients' selection and post-EVAR results. Methods: The clinical records of consecutive patients undergoing endovascular aneurysm repair, between 2001 and 2013, were retrospectively reviewed. Patients were divided according to age groups (<70, 70-80 and >80 years). Gender, body mass index, aneurysm anatomic features, neck characteristics, iliac morphology, surgical indication, endograft type, anesthesic risk classification, length of stay, reinterventions and mortality were analysed and compared. Results: The study included 171 patients, 161 (94.1%) men, and mean age 74.1±8.9 years. The age group under 70 had 32% of the patients. Only three characteristics were found different among age groups: 1) body mass index was higher in younger patients, with a considerable trend toward significance (P=0.06); 2) surgical indication, in the younger group, surgeon's and the patient's option were more proeminent (P<0.05); 3) erectile dysfunction was higher in elderly group (P<0.05). No other clinical and anatomical characteristics or final outcomes were found statisticaly different among age groups. Conclusion: The absence of statistically differences in mortality and reinterventions among age groups suggests that age by itself is not a relevant factor in endovascular aneurysm repair. Indeed, the three characteristics different in younger (obesity, sexual function and patient's choice) favor endovascular aneurysm repair.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Age Factors , Iliac Aneurysm/surgery , Aortic Aneurysm, Abdominal/surgery , Patient Selection , Endovascular Procedures/methods , Postoperative Period , Body Mass Index , Retrospective Studies , Treatment Outcome , Iliac Aneurysm/complications , Iliac Aneurysm/mortality , Aortic Aneurysm, Abdominal/complications , Endovascular Procedures/economics , Erectile Dysfunction/complications
6.
Rev. bras. cir. cardiovasc ; 31(2): 145-150, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-792648

ABSTRACT

Abstract Objective: Endovascular techniques to treat abdominal aortic aneurysms results in lower morbidity and mortality rates. However, dilation of the common iliac arteries prevents adequate distal sealing, which compromises the procedure success. The aim of this study is report the long-term outcomes of patients with abdominal aortic aneurysms associated with aneurysm of the common iliac artery following endovascular repair using a bifurcated bell-bottom stent graft. Methods: This is a retrospective study that evaluated patients treated with bifurcated bell-bottom extension stent grafts to repair an infrarenal abdominal aortic aneurysm and who had at least one common iliac artery with dilatation > 1.5 cm for at least 12 months after the endovascular intervention. Results: Thirty-eight patients with a mean age of 70.4±8.2 years were included. Stent graft placement was followed by dilation of the common iliac artery aneurysms in 35.3% of cases; endoleak and reoperation rates were 17.6% and 15.7%, respectively. Younger patients showed a higher rate of artery diameter increase following the procedure. The average arterial dilation was 16% in the first year, 29% in the second year, 57% in the third year and 95% from the fourth year until the end of follow-up. Conclusion: Repair of infrarenal abdominal aortic aneurysms with bifurcated bell-bottom type stents when there is common iliac artery dilation is a good therapeutic option to preserve hypogastric flow. The rate of endoleak was 17.6%, and 15.7% of cases required reoperation. Younger patients are more likely to experience dilation of the common iliac artery after the procedure.


Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Postoperative Complications , Iliac Aneurysm/surgery , Aortic Aneurysm, Abdominal/surgery , Endovascular Procedures/instrumentation , Reoperation , Blood Vessel Prosthesis/adverse effects , Retrospective Studies , Follow-Up Studies , Age Factors , Blood Vessel Prosthesis Implantation/methods , Dilatation, Pathologic/etiology , Endoleak/etiology , Endovascular Procedures/methods
7.
J. vasc. bras ; 15(1): 16-20, jan.-mar. 2016. tab
Article in English, Portuguese | LILACS | ID: lil-780905

ABSTRACT

CONTEXTO: Aproximadamente 60% dos pacientes portadores de doença arterial oclusiva crônica periférica têm doença coronariana grave, sendo que a principal causa de morte no pós-operatório de cirurgia vascular de grande porte é o infarto agudo do miocárdio. OBJETIVOS: Determinar a prevalência da doença coronariana em pacientes submetidos a cirurgia vascular eletiva de grande porte e sua relação com as complicações cardiológicas pós-operatórias. MÉTODOS: Foram analisados 200 pacientes submetidos a cirurgia vascular arterial eletiva: doença obstrutiva carotídea, aortoilíaca e femoropoplítea distal e doença aneurismática de aorta abdominal e de artérias ilíacas. Os pacientes constituíram três grupos: grupo I, sem doença coronariana; grupo II, com doença coronariana assintomática; e grupo III, com doença coronariana sintomática. As complicações cardiológicas consideradas foram infarto agudo do miocárdio fatal e não fatal, insuficiência cardíaca congestiva, choque cardiogênico, fibrilação atrial aguda e outras arritmias. RESULTADOS: Complicações cardíacas ocorreram em 11 pacientes (5,5%): três infartos agudos do miocárdio não fatais (1,5%) sempre em pacientes do grupo III. A complicação cardíaca mais frequente foi arritmia (exceto fibrilação atrial) ocorrida em cinco (2,5%) pacientes, sendo três do grupo II. A mortalidade precoce foi de nove pacientes (4,5%). Apenas uma morte foi decorrente de problema cardíaco: choque cardiogênico em paciente do grupo III. CONCLUSÕES: A doença coronariana não foi preditora de óbito nos pacientes submetidos a cirurgia vascular periférica de grande porte. A sobrevida dos pacientes com ou sem doença coronariana não mostrou diferenças estatísticas.


BACKGROUND: Approximately 60% of patients with chronic occlusive peripheral arterial disease have severe coronary disease and the principal cause of death during the postoperative period after major vascular surgery is acute myocardial infarction. OBJECTIVES: To determine the prevalence of coronary disease among patients scheduled for elective major vascular surgery and its relationship with postoperative cardiological complications. METHODS: A total of 200 patients who underwent elective vascular arterial surgery for obstructive carotid disease, aortoiliac and distal femoropopliteal disease and aneurysmal disease of the abdominal aorta and iliac arteries were analyzed. These patients were allocated to three groups: group I, free from coronary disease; group II, asymptomatic coronary disease; and group III, symptomatic coronary disease. The cardiological complications analyzed were fatal and nonfatal acute myocardial infarction, congestive heart failure, cardiogenic shock, acute atrial fibrillation and other arrhythmias. RESULTS: Cardiac complications occurred in 11 patients (5.5%): three nonfatal acute myocardial infarctions (1.5%), all in patients from group III. The most common cardiac complication was arrhythmia (excluding atrial fibrillation) in five (2.5%) patients, three from group II. Early mortality was nine patients (4.5%). Just one death was caused by a cardiac problem: cardiogenic shock in a patient from group III. CONCLUSIONS: Coronary disease was not predictive of death among patients who underwent major peripheral vascular surgery. There were no statistical differences in survival between patients with or without coronary disease.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Aortic Aneurysm/surgery , Vascular Diseases/complications , Vascular Surgical Procedures/history , Peripheral Vascular Diseases , Peripheral Vascular Diseases/complications , Peripheral Vascular Diseases/rehabilitation , Iliac Aneurysm/surgery , Coronary Disease/rehabilitation , Myocardial Infarction/diagnosis , Postoperative Complications , Prevalence
8.
Article in English | WPRIM | ID: wpr-110662

ABSTRACT

Endovascular salvage of the hypogastric artery using iliac branch device (IBD) during endovascular aortic aneurysm repair (EVAR), offers less invasive alternative solution to surgery to prevent pelvic ischemia. We have performed the first Korean surgeon custom-made IBD for this purpose to overcome the limitation of unavailability of the devices in Korea. Four patients with abdominal aortic aneurysm with bilateral common iliac artery aneurysm (CIAA) were treated using custom-made IBDs from October 2013 to December 2013. IBD was created in back table before EVAR operation using TFLE Zenith iliac limb stent graft (Cook Inc.). Three V12 (Atrium, Inc.) one Viabahn (Gore, Inc.) were used for bridging between IBD and target hypogastric artery. With this modification of IBD procedure, exteriorize the guide wire without snare device is possible which offers another benefit in terms of reducing medical costs comparing to commercial IBD. All operations were successful without any device related complications or postoperative endoleaks. During the mean follow up of 3 months, all IBD were patent without clinical complications. Surgeon custom made IBD is feasible and useful to preserve pelvic perfusion especially in the situation of limited commercial IBD availability in many countries. Long-term follow-up is needed to evaluate stent graft patency and IBD-related complications.


Subject(s)
Aged , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis , Endovascular Procedures/instrumentation , Equipment Design , Equipment Failure Analysis , Female , Humans , Iliac Aneurysm/surgery , Iliac Artery/surgery , Male , Salvage Therapy/instrumentation , Stents
9.
Rev. chil. cir ; 65(6): 515-519, dic. 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-698645

ABSTRACT

Background: Endovascular repair of aortic aneurysms is less invasive than the traditional surgical approach. Aim: To evaluate the early and mid-term results of aorto-iliac aneurysm endovascular repair. Material and Methods: Analysis of 28 patients aged 59 to 86 years (22 males), subjected to an endovas-cular repair of aorto-iliac aneurysms between 2007 and 2012. Results: The follow up period of patients ranged from 1 to 65 months. A tri-modular bifurcated prosthesis was installed in 25 patients. A bi-modular bifurcated prosthesis was installed in one patient, an aorto uni iliac prosthesis was installed in one patient; in other patient, a straight endoprosthesis was installed after an abdominal visceral disconnection. In cases of associated iliac aneurysms, unilateral iliac embolization was carried out in seven patients and bilateral embolization in one patient. In one case, the sealing of the hypogastric artery was achieved leaning the prosthetic branch on the hypogastric artery ostium. One patient died 31 days after the operation due to multiple organ failure. One patient died 24 months after surgery due to a gallbladder cancer and other patient died 36 months after surgery due to a rectal cancer. The long-term follow-up showed the presence of type 2 endo-leaks in two patients. The aneurysm decreased in size in 83 percent of patients after 2 years of follow-up. In five patients, a non-progressive laminar parietal thrombosis inside the endoprosthesis, was observed in the immediate postoperative period. It was initially treated with oral anticoagulants. Conclusions: Endovascular repair of aorto-iliac aneurysms is safe and effective in patients with appropriate anatomical conditions, if a skilled surgical team is available...


Objetivo: Evaluar los resultados iniciales y en el mediano plazo de la reparación endovascular de los aneurismas del sector aorto-ilíaco. Material y Método: Revisión de una serie clínica de pacientes operados en forma consecutiva por vía endovascular en el Hospital Dr. Eduardo Pereira de Valparaíso por aneurismas del sector aorto-ilíaco desde 2007 al 2012 con seguimiento actualizado. Resultados: Se trata de 28 pacientes (22 varones), una edad promedio de 72,5 años (rango 59-86) y un seguimiento promedio de 27,4 meses (rango 1-65 meses). Los pacientes fueron seleccionados de acuerdo a la anatomía aorto-ilíaca y su estado general. A 25 pacientes se les instaló una prótesis bifurcada tri-modular, a un paciente una prótesis bifurcada con sólo dos módulos, a otro paciente una prótesis aorto uni ilíaca, y a una paciente una endoprótesis recta luego de una desconexión visceral abdominal. Un paciente fallece a los 31 días después de operado por falla orgánica múltiple y otros dos pacientes fallecen a los 24 meses a causa de un cáncer vesicular y a los 36 meses por un cáncer rectal. El seguimiento alejado evidenció ausencia de endofugas tipo 1, 3 ó 4 y una endofuga tipo 2 en dos pacientes, que no han requerido ninguna intervención. Conclusión: La reparación endovascular de los aneurismas del sector aorto-ilíaco es segura en el corto y mediano plazo, en pacientes con las condiciones anatómicas apropiadas en un centro quirúrgico adecuadamente equipado...


Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Iliac Aneurysm/surgery , Aortic Aneurysm, Abdominal/surgery , Endovascular Procedures/methods , Follow-Up Studies , Postoperative Complications , Treatment Outcome
10.
Rev. chil. cir ; 64(6): 563-566, dic. 2012. ilus
Article in Spanish | LILACS | ID: lil-660016

ABSTRACT

Introduction: Spontaneous dissection of the iliac artery (SDIA) is an extremely rare clinical manifestation, associated to different etiologies, and it usually shows an ischemia of the involved lower extremity. Clinical case: We report a case of a 48-year-old man, with past medical history of chronicle consumption of ergotamine, which presented left lower limb ischemia, while practicing physical exercise. An emergent contrast-enhanced computed tomography scan showed a spontaneous dissection of the common and the external left iliac artery. An endovascular therapy of the lesion was performed with self-expanding stents, achieving the reconstruction of the lesion, the recovery of the blood flow and of the lower limb ischemia. Conclusions: There are no previous descriptions of the association between ergotamine consumption, sport and this very rare pathology. Endovascular treatment represents a less invasive and, such as in our case report, successful management of the SDIA, and it should be considered among the alternative therapies.


Introducción: La disección espontánea de la arteria ilíaca es un cuadro muy poco frecuente asociado a diferentes etiologías que habitualmente se presenta como isquemia de la extremidad comprometida. Caso clínico: Se reporta el caso de un paciente masculino de 48 años con antecedente de consumo crónico de ergotamina, quien mientras practicaba deporte presenta cuadro de isquemia aguda de la extremidad inferior izquierda. Angio tomografía computada demostró disección espontánea de la arteria ilíaca común y externa izquierda. Se realizó terapia endovascular de la lesión con stents auto expandibles, logrando la reparación de la lesión, el restablecimiento del flujo y la recuperación de la isquemia de la extremidad. Discusión y conclusiones: No existen reportes previos de esta patología poco frecuente, en que se asocie en forma conjunta la práctica de deporte y el uso de ergotamina. Dentro de las alternativas terapéuticas, la reparación endovascular representa una opción menos invasiva y, como en este caso, con óptimos resultados.


Subject(s)
Humans , Male , Middle Aged , Aneurysm, Dissecting/surgery , Iliac Aneurysm/surgery , Exercise , Ergotamine/adverse effects , Aneurysm, Dissecting/etiology , Iliac Aneurysm/etiology , Endovascular Procedures/methods , Stents , Treatment Outcome
12.
Rev. argent. cir. cardiovasc. (Impresa) ; 9(3): 149-155, sept.-dic. 2011. ilus, tab
Article in Spanish | LILACS | ID: lil-703262

ABSTRACT

La endoprótesis Nellix es un nuevo dispositivo endoluminal diseñado para tratar los aneurismas aorto-ilíacos, sellando el saco del aneurisma, eliminando así la endofuga mientras se mantiene el flujo normal de las extremidades inferiores. Se compone de dos conductos dilatables por balón,cada uno rodeado por una endobolsa, que se llena in situ con un polímero. Cada conducto soporta la luz del flujo sanguíneo a través del saco del aneurisma hacia las arterias ilíacas. La endobolsa con polímero se mantiene alrededor de la luz y llena el saco del aneurisma, bloqueando el flujoretrógrado de las ramas laterales, anclando el dispositivo en el saco del aneurisma sin necesidad de fijación proximal y distal; además provee estabilidad posicional. Por lo tanto, este dispositivo puede ser utilizado para tratar no sólo los pacientes con cuello aórtico y anatomía ilíaca estándar,sino también en aquellos con anatomías adversas. Se presenta la primera experiencia clínica de Nellix en 34 pacientes durante el período 2008-2010. Los resultados auguran un buen futuro y la pronta aprobación por la Comunidad Europea.


A endoprótese Nellix é um novo dispositivo endoluminal desenhado para tratar os aneurismas aorto-ilíacos, fechando completamente a bolsa de aneurisma, eliminando assim a endofuga,enquanto é mantido o fluxo normal das extremidades inferiores. Compõe-se de dois condutos ampliáveis por um balão, cada um rodeado por uma endobolsa, que se enche “in situ” com umpolímero. Cada conduto suporta a luz do fluxo sanguíneo através da bolsa de aneurisma até as artérias ilíacas. A endobolsa com polímero é mantida ao redor da luz e enche a bolsa de aneurisma, bloqueando o fluxo retrógrado dos ramos laterais, funcionando como dispositivo âncora na bolsa de aneurisma, sem necessidade de fixação proximal e distal, e além disso proporciona estabilidade posicional. Portanto, este dispositivo pode ser utilizado para tratar não somente pacientes com colo aórtico e anatomia ilíaca standard, como também aqueles com anatomias adversas. Apresenta-se a primeira experiência clinica de Nellix em 34 pacientes durante o período 2008-2010. Os resultados auguram um bom futuro e a breve aprovação da Comunidade Européia.


The Nellix endoprosthesis is a new endoluminal device designed to treat aorto-iliac aneurysms by sealing the aneurysm sac, thus eliminating the endoleak space, while maintaining normal flow to the lower extremities. It consists of dual, balloon-expandable endoframes, each surroundedby an endobag, which is filled with an in-situ curing polymer. Each endoframe supports the blood flow lumen through the aneurysm sac to the iliac arteries. The polymer containing endobags surround the flow lumen and fill the aneurysm sac, blocking retrograde flow from side-branches, anchoringthe device within the aneurysm sax without the need for proximal and distal fixation, and further providing it with positional stability. Thus, this device can be used to treat not only patients with standard aortic neck and iliac anatomy but also those with adverse anatomies.We report the first clinical experience with Nellix in 34 patients during 2008-2010. The outcomes augur well and a speedy approval by the European Community.


Subject(s)
Female , Middle Aged , Aged, 80 and over , Iliac Aneurysm/surgery , Iliac Aneurysm/therapy , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Iliac Artery , Treatment Outcome
13.
J. vasc. bras ; 10(3): 217-221, jul.-set. 2011. ilus
Article in Portuguese | LILACS | ID: lil-604465

ABSTRACT

A associação entre a síndrome de veia cava superior e uma dilatação aneurismática das artérias aorta e ilíacas não é comum. A abordagem de cada uma destas patologias pode ser efetuada através do modo convencional, com cirurgia aberta ou pela técnica endovascular. Neste trabalho, relatamos as duas modalidades de intervenção cirúrgica executadas e discutimos suas indicações e os resultados deste caso em particular.


The association between superior vena cava syndrome and an aorto-iliac aneurysm is not common. The approach to each of theses diseases can be either by the conventional way with open surgery or by endovascular techniques. We report the two methods of surgical intervention and discuss their indications and results in this particular case.


Subject(s)
Humans , Iliac Aneurysm/surgery , Vena Cava, Superior , Blood Vessel Prosthesis , Time Factors
14.
Article in English | WPRIM | ID: wpr-100577

ABSTRACT

Suitability rate of endovascular aneurysm repair (EVAR) and the anatomic features causing unsuitability have not been well determined in Asian patients who have abdominal aortic aneurysm (AAA). In a single Korean center, a total of 191 patients with abdominal aortic aneurysm (maximal diameter > or = 4 cm) were identified. Aortoiliac morphologic characteristics in contrast-enhanced computed tomography images were retrospectively reviewed to determine suitability for EVAR with four FDA-approved stent-grafts. AAA was considered ideally suitable for EVAR in 46.6% of patients. The most frequent causes for unsuitability were common iliac artery (CIA) aneurysm (61.8%) and excessive neck angulation (52.9%). Problems such as small and/or short neck and small access were found in minor incidences. If CIA aneurysm is dealt by overstenting with sacrifice of internal iliac artery, suitability rate can increase to 65%. Larger aneurysms were more frequently unsuitable for EVAR and had more chance of having multiple unfavorable features. In conclusion, the overall feasibility rate for EVAR in Korean patients was not different from that in Western patients. However, considering the difference in the major causes of unsuitability, more attention has to be paid to neck angulation and CIA aneurysm to provide EVAR for more Korean patients especially who have large aneurysm.


Subject(s)
Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Female , Humans , Iliac Aneurysm/surgery , Iliac Artery , Male , Middle Aged , Republic of Korea , Retrospective Studies , Stents , Tomography, Spiral Computed
15.
Rev. chil. cir ; 62(3): 279-284, jun. 2010. ilus
Article in Spanish | LILACS | ID: lil-562730

ABSTRACT

A difficult anatomy is the major challenge to overcome with abdominal aortic aneurysm endografting. Bilateral iliac aneurysm preventing an appropriate distal landing zone for an endograft is a common condition and can be managed by: a) Increasing the diameter of the endograft, with limitations in available sizes; b) bilateral hypogastric embolization, accepting an increased morbidity; c) combining a surgical hypogastric revascularization by retroperitonel approach or d) retrograde revascularization from the ipsilateral external iliac artery using an endograft. Recently, branched endografts have been designed to revascularize the hypo gastric artery. Their deployment is complex but allows antegrade and stable flow. We report a 57 year-old male, at high risk for an open procedure, who presented with a small aortic aneurysm, bilateral iliac and left hypogastric aneurysms. A right bifurcated iliac endograft was deployed, associated with left hypogastric aneurysm embolization and aortic endografting. The patient recovered event free, patency of the endograft and absence of endoleak was demonstrated on a CT scan. He presented minor left buttock claudication, sexual function was preserved. This new technique allows safe endovascular treatment of patients with bilateral iliac aneurysm, allowing preservation of pelvic perfusion and avoiding the risk of an open procedure in a high risk patient.


Una anatomía desfavorable es un obstáculo a vencer con el tratamiento endovascular del aneurisma aorto-ilíaco. La presencia de aneurisma ilíaco bilateral es frecuente y amenaza la adecuada fijación distal de una endoprótesis. Esta condición puede ser manejada: a) aumentando el diámetro del dispositivo a nivel ilíaco, con limitaciones en las medidas disponibles; b) embolización hipogástrica bilateral, aceptando una morbimortalidad mayor; c) combinando un abordaje quirúrgico retroperitoneal para revascularizar una arteria hipogástrica, aumentando el impacto del procedimiento; d) mediante revascularización retrógrada unilateral desde la arteria ilíaca externa ipsilateral con otra endoprótesis. Recientemente se ha descrito el uso de endoprótesis ramificadas, que requieren un despliegue complejo, pero permiten revascularizar una o ambas arterias hipogástricas en forma anterógrada y estable. Reportamos el caso de un paciente de sexo masculino y 57 años, de alto riesgo para cirugía convencional, portador de un aneurisma pequeño de aorta abdominal y aneurismas ilíaco común bilateral e hipogástrico izquierdo. Fue tratado mediante despliegue de una endoprótesis bifurcada ilíaca, revascularizando la arteria hipogástrica derecha y embolizando la izquierda aneurismática, asociado a implante de una endoprótesis aórtica convencional, también bifurcada. El paciente evoluciona sin complicaciones, con claudicación glútea izquierda leve en disminución y preservación de su función sexual. Una tomografía axial computada demuestra exclusión efectiva de sus aneurismas. Esta nueva técnica permite tratar de manera segura a pacientes portadores de aneurisma ilíaco bilateral en forma endo-vascular, manteniendo perfusión de la circulación pelviana y disminuyendo el impacto de un procedimiento convencional en pacientes de alto riesgo.


Subject(s)
Humans , Male , Middle Aged , Iliac Aneurysm/therapy , Aortic Aneurysm, Abdominal/therapy , Blood Vessel Prosthesis Implantation/instrumentation , Iliac Aneurysm/surgery , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis , Combined Modality Therapy , Embolization, Therapeutic , Iliac Artery , Pelvis/blood supply , Treatment Outcome
16.
Rev. chil. cir ; 62(2): 150-159, abr. 2010. tab, ilus, graf
Article in Spanish | LILACS | ID: lil-563786

ABSTRACT

Background: Abdominal aorta is the most common site for the formation of degenerative aneurysms. which remain asymptomatic until they rupture. Aim: To review the results of surgical treatment of aorto iliac segment aneurysms. Material and Methods: Retrospective review of medical records of 90 patients aged 48 to 88 years (60 males), operated for aneurysms of the aorto iliac segment, between 1998 and 2008. Patients were followed for a mean of 40 months. Results: Eighty six patients had infrarenal aneurysms with or without iliac extension and four had puré iliac aneurysms. Four patients had inflammatory aneurysms Eighty five were treated with open surgery. Of these, nine had ruptured or fissured aneurysms, two had lower limb ischemia, one had an extrinsic compression and one a complete thrombosis of the aneurysm. Five patients, without complications, were subjected to an endovascular repair. Overall 30 days mortality was 4.4 percent. The figures for ruptured and uncomplicated aneurysms were 11.1 and 2.7 percent respective ly. No patient subjected to endovascular repair died. One, two and three years survival rates were 90, 79 and 78 percent respectively. No patient died due to complications of the prosthetic graft. Three patients required an early re-intervention (an embolectomy in one and for a femoro-femoral bridge in two). Nine patients required a late re-intervention (an intestinal obstruction due to adherences in one and incisional hernias in eight). No patient subjected to endovascular repair required a re-intervention. Conclusions: Surgery for aorto iliac segment aneurysms is safe and avoids deaths caused by their complications.


Objetivo: Analizar la morbimortalidad precoz y alejada en la cirugía de los aneurismas del sector aorto-ilíaco. Material y Método: Revisión retrospectiva en una serie personal de pacientes operados en forma consecutiva por aneurismas del sector aorto-ilíaco desde 1998 a 2008 con seguimiento actualizado. Resultados: Se trata de 90 pacientes (60 varones), promedio de edad 72,7 años; 15,5 por ciento de 80 años o mayores; 86 casos de aneurismas de la aorta abdominal infrarrenal con o sin extensión ilíaca y 4 aneurismas ilíacos puros. Fueron sometidos a una cirugía abierta 85 pacientes y 5 tuvieron una reparación endovascular. De los 85 pacientes operados en forma abierta 13 presentaban alguna complicación: 9 rotos o Asurados, 2 con isquemia de una extremidad, una compresión extrínseca y una trombosis completa aguda del aneurisma. Hubo 4 casos de aneurisma inflamatorio. Los pacientes reparados en forma endovascular no estaban complicados. La mortalidad operatoria global a 30 días fue de 4,4 por ciento (4/90), en aneurismas rotos fue de 11,1 por ciento (1/9), en aneurismas no complicados fue un 2,7 por ciento (2/73), en casos de cirugía abierta un 4,7 por ciento (4/85) y no hubo mortalidad en la cirugía endovascular. El seguimiento medio fue de 39,63 meses (rango 1-131 meses). La supervivencia global fue de 89,7 por ciento, 79,2 por ciento y 77,8 por ciento al primer, tercer y quinto año. En el post-operatorio en relación a la cirugía clásica fueron intervenidos 12 pacientes (12/85: 14,1 por ciento), 3 precozmente (una embolectomía y dos puentes fémoro-femorales) y 9 en forma tardía (8 hernioplastías incisionales y una obstrucción intestinal por bridas). No hemos reintervenido los pacientes operados en forma endovascular. En el seguimiento alejado la mortalidad tuvo como causas principales las enfermedades cardíacas, respiratorias agudas y el cáncer avanzado, sin complicaciones o mortalidad atribuibles al injerto protésico...


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Iliac Aneurysm/surgery , Iliac Aneurysm/mortality , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/mortality , Iliac Aneurysm/complications , Aortic Aneurysm, Abdominal/complications , Cause of Death , Postoperative Complications/epidemiology , Follow-Up Studies , Reoperation , Retrospective Studies , Survival Rate
17.
Journal of Shahrekord University of Medical Sciences. 2009; 10 (4): 117-121
in English, Persian | IMEMR | ID: emr-91896
18.
Maghreb Medical. 2009; 29 (391): 250-251
in French | IMEMR | ID: emr-92071

ABSTRACT

Behcet's disease is a vasculitis more frequent in Japan, in the Middle East and in some Mediterranean countries. It is characterized by a classical triad of recurrent uveitis, oral and genital ulcerations. It is a systemic vasculitis affecting predominantly the venous system. Arterial manifestations in Behcet's disease are less common especially aneurysms who may in some cases quickly involve the vital prognosis. We report two cases of Behcet's disease with arterial internal iliac aneurysms complicated in the two patients by a rupture


Subject(s)
Humans , Male , Behcet Syndrome/complications , Iliac Aneurysm/diagnosis , Iliac Aneurysm/surgery
19.
Medicina (B.Aires) ; 68(6): 442-446, nov.-dic. 2008. ilus
Article in Spanish | LILACS | ID: lil-633585

ABSTRACT

El tratamiento endovascular de los aneurismas de aorta abdominal es una alternativa a la cirugía abierta para pacientes de alto riesgo. Consiste en la exclusión del saco aneurismático mediante la interposición de una endoprótesis colocada por vía femoral. El tratamiento endovascular no puede ser utilizado en todos los pacientes. Una limitación frecuente la constituye el nacimiento de una arteria visceral desde el saco aneurismático. Para contrarrestar esta limitación recientemente se han desarrollado endoprótesis fenestradas que presentan orificios que se corresponden con el nacimiento de las arterias involucradas en el aneurisma evitando su oclusión, permitiendo de esta manera el tratamiento endovascular. En esta comunicación se presenta un caso de tratamiento endovascular de un aneurisma de aorta abdominal mediante la colocación de una endoprótesis fenestrada en un paciente cuya arteria renal izquierda nacía directamente del saco aneurismático.


Endovascular treatment of the abdominal aortic aneurysm is consider an alternative to open surgery for high risk patients. Its goal is to exclude the aneurysm from the circulation by using an endoprothesis introduced from a femoral approach. Patients must be strictly selected to avoid possible complications. The most frequent limitation is related to anatomic contraindications such as visceral arteries involved in the aneurysm. Fenestrated endograft have been recently developed to allow endovascular treatment when anatomic features contraindicate classic endovascular procedures. Fenestrated endograft have holes that match with the origin of the visceral arteries maintaining its potency. In this paper we report the endovascular treatment of an abdominal aortic aneurysm by using a fenestrated endoprothesis in a patient whose left renal artery is originated from the aneurysm.


Subject(s)
Aged, 80 and over , Humans , Male , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/methods , Renal Artery/surgery , Iliac Aneurysm/surgery , Prosthesis Design , Postoperative Complications/prevention & control , Stents
20.
Rev. chil. cir ; 60(5): 424-428, oct. 2008. ilus, tab, graf
Article in Spanish | LILACS | ID: lil-549985

ABSTRACT

Introducción: La reparación endovascular de aneurismas abdominales e ilíacos requiere de la introducción de dispositivos de alto calibre (> 16 F) mediante denudación de arterias femorales. Mediante una variación técnica, el sistema de sutura arterial percutanea Prostar-XL® (Abbott, EEUU) permite el acceso arterial percutaneo evitando la denudación. Objetivo: Analizar la experiencia inicial en el tratamiento percutaneo de aneurismas del territorio aorto-ilíaco. Material y Método: Revisión de las historias clínicas y base de datos de pacientes tratados con sutura arterial percutanea, entre octubre de 2003 y abril de 2008. Resultados: Tratamos 22 pacientes con esta técnica (20 hombres y 2 mujeres). Dieciséis portadores de aneurisma aórtico abdominal, 3 aneurismas ilíacos, 2 reparaciones de endofuga y un aneurisma hipogástrico. La edad promedio fue 72,6 años (rango 56-86). Se utilizó el sistema Prostar XL® para sutura percutanea en 37 arterias femorales. La anestesia más utilizada fue peridural en el 50 por ciento de los pacientes. En 7 casos (31,8 por ciento) se efectuó la operación exclusivamente con anestesia local. El diámetro de los dispositivos de endoprótesis fue de 16 a 23 F. Se obtuvo éxito técnico en 34 cierres (92 por ciento). Tres arterias requirieron reparación quirúrgica tradicional. No hubo mortalidad operatoria. Durante el seguimiento (promedio 12,6 meses, rango 1-53) no se registraron falsos aneurismas femorales ni infección. Discusión: El cierre percutaneo en la reparación endovascular de aneurismas aorto-ilíacos es un procedimiento mínimamente invasivo, seguro y efectivo, que permite eventualmente el uso de anestesia local.


Introduction: Endovascular repair of aortic (AAA) and iliac artery aneurysms requires introduction and deployment of large bore devices (> 16 F) through surgical exposure of the femoral artery. The Prostar XL ® arterial suture system allows the introduction of such devices without the need for surgical exposure. Aim: To report our initial experience with percutaneous arterial closure during aneurysm endografting. Methods: We reviewed records and database of patients treated with this technique between October2003 and April 2008. Results: We treated 22 patients with this technique (20 men and 2 women, average age 72 years). Sixteen had AAA, 3 iliac artery aneurysm, 1 hypogastric aneurysm and two for endoleak repair. The percutaneous closure device was used in 37 femoral arteries. In 7 patients (31,8 percent) the operation was completed entirely under local anaesthesia. The diameter of the devices ranged between 16 and 23 F. Technical success was obtained in 34 arteries (92 percent). Three arteries required surgical repair due to inadequate haemostasis (sheaths 18, 21, and 21 F). There was no operative mortality. During follow-up (mean 12,6 months, range 1-53) no false aneurysm or infection at the puncture site has been registered and the patients remain free of complications. Discussion: Percutaneous arterial closure in endovascular aneurysm repair is a safe, minimally invasive and effective procedure which allows resolving theses serious conditions in selected patients.


Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Iliac Aneurysm/surgery , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/methods , Suture Techniques , Femoral Artery/surgery , Follow-Up Studies , Treatment Outcome
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