Tratamiento endovascular del aneurisma de la aorta abdominal con endoprótesis percutáneas en pacientes cubanos / Endovascular treatment of abdominal aortic aneurysm with percutaneous endoprosthesis in Cuban patients

Introducción: Los aneurismas de aorta abdominal resultan dilataciones arteriales a dicho nivel. Su ruptura constituye uno de los principales riesgos y provoca la muerte del paciente, de ahí la importancia de tratarlos a tiempo. Las opciones actuales de tratamiento son la cirugía abierta y la reparación aneurismática endovascular; esta última representa la primera línea de tratamiento, por constituir una técnica mínimamente invasiva con bajas tasas de morbilidad y mortalidad. Objetivo: Evaluar el tratamiento endovascular del aneurisma de la aorta abdominal con endoprótesis percutáneas en pacientes cubanos. Métodos: Entre enero y abril de 2018 se realizó un estudio prospectivo, descriptivo y cualitativo en 6 pacientes del sexo masculino con aneurisma de aorta abdominal, seleccionados aleatoriamente, que cumplieron los criterios de uso de endoprótesis vasculares y estuvieron de acuerdo con realizar el proceder. Se colocaron 6 dispositivos en una sala de angiografía, y se utilizó en los pacientes anestesia general y guía fluoroscópica. Resultados: De forma satisfactoria fue posible el tratamiento endovascular por vía percutánea de los 6 pacientes seleccionados; solo 1 presentó una complicación menor y fue dado de alta a las 72 horas y el resto fue egresado en menos de 24 horas. Se logró implementar por vez primera en el país el sistema de cierre percutáneo Proglide sin complicaciones. Conclusiones: El tratamiento endovascular por vía percutánea de aneurismas de aorta abdominal con endoprótesis vasculares es una alternativa eficaz para la cirugía convencional en pacientes que cumplen los criterios de uso del dispositivo(AU)

Introduction: Abdominal aortic aneurysms are arterial dilations in that level. Their rupture is one of the main risks and it causes death in patients; that is why the importance of treating them early. Among the current treatment options are open surgery and endovascular aneurismal reparation, being the last one in the first line of treatment since it is a minimal invasive technique with low rates of morbidity and mortality. Objective: To evaluate the endovascular treatment of abdominal aortic aneurysm with percutaneous endoprosthesis in Cuban patients. Methods: It was conducted from January to April 2018 a retrospective, descriptive and qualitative study in 6 male patients with aneurysm of the abdominal aorta, selected randomly and who met the criteria of vascular endoprosthesis use and agreed with the performance of the procedure. Six devices were placed in an angiography room and it was used general anaesthetic and fluoroscopic guidance. Results: It was possible in a satisfactory way the endovascular treatment by percutaneous way in the six patients selected; just one presented a minor complication and he was discharged after 72 hours; and the rest were discharged in less than 24 hours. It was implemented for the first time in the country without complications the system of percutaneous closure called Proglide. Conclusions: Endovascular treatment by percutaneous way of abdominal aortic aneurysms with vascular endoprosthesis is an efficient alternative for conventional surgery in patients that met the criteria of use of the device(AU)

Initial Experience and Potential Advantages of AFX2 Bifurcated Endograft System: Comparative Case Series

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.

Initial Clinical Experience with the Endologix AFX Unibody Stent Graft System for Treating Patients with Abdominal Aortic Aneurysms: A Case Controlled Comparative Study

PURPOSE: The newly designed unibody AFX endograft system for endovascular aortic aneurysm repair is the only graft with anatomical fixation to the aortic bifurcation in comparison to most other grafts that use the infrarenal neck as the main fixation point. The aim of this study was to assess the preliminary results of the AFX stent-graft system used with infrarenal aortic component and compare them with those obtained in patients treated with a well established endograft of the same material and pure infrarenal fixation as the Gore Excluder. MATERIALS AND METHODS: A retrospective analysis of prospectively collected data from March 2014 to December 2014 identified 10 elective abdominal aortic aneurysm patients treated with the AFX endograft, in comparison to a matched group of 20 patients treated with the Excluder stent-graft. Endpoints included technical and clinical success, freedom from any secondary intervention, any type of endoleak and aneurysm related death. RESULTS: Primary technical success was achieved in all patients and no 30-day device related complications or deaths were occurred. The two groups were similar in terms of radiation burden, contrast media, duration of the procedure, post implantation syndrome and in-hospital stay. During a median follow-up period of 23 months (range, 18–26 months) there were no differences in clinical success, freedom from reintervention and aneurysm related death. No type I endoleak was observed in either group. Five of the 6 type II endoleaks (1 in the AFX and 4 in the Excluder group) spontaneously resolved, while in only one patient (Excluder) the endoleak remained without however any change in aneurysm sac diameter (log rank=0.34). CONCLUSION: The initial experience with the AFX stent graft system is promising, with successful aneurysm exclusion and good short-term results. Further and larger studies are needed to fully evaluate the sort as well as the long-term results.

Cytosolic accumulation of gammaH2AX is associated with tropomyosin-related kinase A-induced cell death in U2OS cells

Tropomyosin-related kinase A (TrkA) plays an important role in cell survival, differentiation, and apoptosis in various neuronal and nonneuronal cell types. Here we show that TrkA overexpression by the Tet-On system mimics NGF-mediated activation pathways in the absence of nerve growth factor (NGF) stimulation in U2OS cells. In addition, p53 upregulation upon DNA damage was inhibited by TrkA, and p21 was upregulated by TrkA in a p53-independent manner. TrkA overexpression caused cell death by interrupting cell cycle progression, and TrkA-induced cell death was diminished in the presence of its specific inhibitor GW441756. Interestingly, TrkA-mediated cell death was strongly related to gammaH2AX production and poly (ADP-ribose) polymerase cleavage in the absence of DNA damage inducer. In this study, we also reveal thatgammagammaH2AX production by TrkA is blocked by TrkA kinase inhibitors K-252a and GW441756, and it is also significantly inhibited by JNK inhibitor SP600125. Moreover, reduction of cell viability by TrkA was strongly suppressed by SP600125 treatment, suggesting a critical role of JNK in TrkA-induced cell death. We also found that gammaH2AX and TrkA were colocalized in cytosol in the absence of DNA damage, and the nuclear localization of gammaH2AX induced by DNA damage was partly altered to cytosol by TrkA overexpression. Our results suggest that the abnormal cytosolic accumulation of gammaH2AX is implicated in TrkA-induced cell death in the absence of DNA damage.

A Case of Atypical Fibroxanthoma

Atypical fibroxanthoma(AFX) is a tumor that occurs as a solitary and ulcerative nodule on actinically damaged or radiation damaged skin of the head and neck in the elderly. AFX is a pleomorphic spindle cell neoplasm of the dermis, which is a clinically benign reactive lesion despite of apparently malignant histologic features. We report a case of AFX which developed on the nasal root area of a 23-year-old man. This case is very unusual in terms of site(less sun-damaged area), overlying skin feature(grossly normal skin) and age(too young). This tumor was completely removed with surgical excision and remained free of recurrence for a period of about 1 year follow-up.