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3.
Ann Vasc Surg ; 66: 104-109, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-1454026

ABSTRACT

BACKGROUND: Type 2 endoleaks (T2Es) are the main cause of reintervention after endovascular repair of abdominal aortic aneurysms (EVAR). The objective of this study is to quantify success rates of T2E treatment. METHODS: This study involves a retrospective analysis of a prospectively maintained database containing data on all consecutive patients treated for a T2E between 2003 and 2017 in a single center. Technical success was defined as absence of endoleak in the final angiographic control after treatment. Clinical success was defined as absence of sac growth over 5 mm in the contrast-enhanced computed tomography performed a year thereafter. Statistics included Kaplan-Meier survival estimates. RESULTS: A total of 528 elective EVARs were performed in the period. Thirty-six of these (6.8%) developed a T2E requiring reintervention, a median of 37.9 months after EVAR. Twenty-five percent of the treatments were performed more than 5 years after intervention. Twenty-eight of the 36 treatments were performed via transarterial embolization. For this technique, technical success was 71.4% and clinical success was 62.5%. A subsequent reintervention was required in 35.7% of patients. In this cohort, the rate of aneurysm rupture was 10.7% (n = 3/28), open surgical conversion was needed in 2 of 28 cases (7.1%), and rate of aneurysm-related death was 14.3% (n = 4/28) over follow-up. CONCLUSIONS: A high percentage of patients are at risk of adverse outcomes after T2E treatment. Strict imaging follow-up is still needed in this population.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Embolization, Therapeutic , Endoleak/therapy , Endovascular Procedures/adverse effects , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/mortality , Blood Vessel Prosthesis Implantation/mortality , Databases, Factual , Embolization, Therapeutic/adverse effects , Embolization, Therapeutic/mortality , Endoleak/diagnostic imaging , Endoleak/etiology , Endoleak/mortality , Endovascular Procedures/mortality , Humans , Retreatment , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
4.
BMJ Case Rep ; 14(8)2021 Aug 25.
Article in English | MEDLINE | ID: covidwho-1373951

ABSTRACT

We present a 54-year-old Caucasian woman, who presented with acute symptomatic type B aortic dissection with deteriorating renal function. She was a known smoker with a 2-year history of dysphagia. CT angiography documented the artery of lusoria arising from the mid-thoracic aorta, aneurysmal dilation of her descending aorta, and kinetic and static flaps around her visceral ostia. The patient was managed by staged hybrid single lumen reconstruction and bilateral subclavian to carotid transpositions. During follow-up, there was no aortic rupture or retrograde type A dissection. There were no renal, visceral, cardiac, pulmonary or spinal complications. The patient went off her antihypertensive medication with a normal estimated glomerular filtration rate and accelerated aortic modulation.


Subject(s)
Aneurysm, Dissecting , Aortic Aneurysm, Abdominal , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Aneurysm, Dissecting/complications , Aneurysm, Dissecting/diagnostic imaging , Aneurysm, Dissecting/surgery , Female , Humans , Middle Aged , Subclavian Artery/diagnostic imaging , Subclavian Artery/surgery
5.
Ann Vasc Surg ; 75: 140-143, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1340555

ABSTRACT

The incidence of venous and arterial thromboembolic complications in COVID-19 patients is significant. The vast majority of COVID-19 patients spend their quarantine at home in a self-isolation condition. The occurrence of Acute limb ischemia (ALI) is a dangerous event that needs prompt diagnosis and management with time-dependent recanalization outcomes. We present a case series of three COVID-19 patients who suffered from ALI that occurred during home self-isolation, and that were diagnosed and treated with a significant time-delay due to COVID-19 social implications.


Subject(s)
COVID-19/complications , Delayed Diagnosis , Diagnostic Errors , Ischemia/diagnostic imaging , Peripheral Arterial Disease/diagnostic imaging , Acute Disease , Aged , Aged, 80 and over , Amputation , Anticoagulants/therapeutic use , Blood Vessel Prosthesis Implantation , COVID-19/diagnosis , COVID-19/therapy , Embolectomy , Humans , Ischemia/etiology , Ischemia/surgery , Male , Peripheral Arterial Disease/etiology , Peripheral Arterial Disease/surgery , Predictive Value of Tests , Thrombectomy , Thrombolytic Therapy , Time-to-Treatment , Treatment Outcome
6.
Ann Vasc Surg ; 73: 557-560, 2021 May.
Article in English | MEDLINE | ID: covidwho-1312937

ABSTRACT

Aneurysms and occlusive pathologies of the aorta are frequently associated with atherosclerosis; however, thoracoabdominal aortic aneurysm accompanied by Leriche syndrome is an extremely rare condition with challenging treatment strategy and without established surgical treatment protocols. In this report, we present our treatment strategy in a 64-year-old male patient with ischemic heart disease and type 5 thoracoabdominal aortic aneurysm accompanied by Leriche syndrome.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation , Coronary Artery Bypass , Coronary Artery Disease/surgery , Leriche Syndrome/surgery , Saphenous Vein/transplantation , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnostic imaging , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , COVID-19/complications , COVID-19/diagnosis , Coronary Artery Disease/complications , Coronary Artery Disease/diagnostic imaging , Fatal Outcome , Humans , Leriche Syndrome/complications , Leriche Syndrome/diagnostic imaging , Male , Middle Aged , Polyethylene Terephthalates , Treatment Outcome
7.
Medicina (Kaunas) ; 57(6)2021 Jun 14.
Article in English | MEDLINE | ID: covidwho-1270080

ABSTRACT

The aim of this paper is to share our experience in managing a patient with Klebsiella pneumoniae mycotic abdominal aortic aneurysm who was also infected with COVID-19. A 69-year-old male was transferred to our hospital for the management of an infra-renal mycotic abdominal aortic aneurysm. During his hospital course, the patient contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He was intubated due to respiratory distress. Over a short period, his mycotic aneurysm increased in size from 2.5 cm to 3.9 cm. An emergency repair of his expanding aneurysm was achieved using our previously described protocol of coating endovascular stents with rifampin. The patient was managed with a rifampin-coated endovascular stent graft without any major complications. Postoperatively, the patient did not demonstrate any neurological deficits nor any vascular compromise. He remained afebrile during his postoperative course and was extubated sometime thereafter. He was then transferred to the ward for additional monitoring prior to his discharge to a rehab hospital while being on long-term antibiotics. During his hospital stay, he was monitored with serial ultrasounds to ensure the absence of abscess formation, aortic aneurysm growth or graft endoleak. At 6 weeks after stent graft placement, he underwent a CT scan, which showed a patent stent graft, with a residual sac size of 2.5 cm without any evidence of abscess or endoleak. Over a follow-up period of 180 days, the patient remained asymptomatic while remaining on long-term antibiotics. Thus, in patients whose surgical risk is prohibitive, endovascular stent grafts can be used as a bridge to definitive surgical management.


Subject(s)
Aneurysm, Infected , Aortic Aneurysm, Abdominal , Blood Vessel Prosthesis Implantation , COVID-19 , Endovascular Procedures , Aged , Aneurysm, Infected/surgery , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis , Humans , Male , SARS-CoV-2 , Stents , Treatment Outcome
8.
Ann Vasc Surg ; 75: 140-143, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1245849

ABSTRACT

The incidence of venous and arterial thromboembolic complications in COVID-19 patients is significant. The vast majority of COVID-19 patients spend their quarantine at home in a self-isolation condition. The occurrence of Acute limb ischemia (ALI) is a dangerous event that needs prompt diagnosis and management with time-dependent recanalization outcomes. We present a case series of three COVID-19 patients who suffered from ALI that occurred during home self-isolation, and that were diagnosed and treated with a significant time-delay due to COVID-19 social implications.


Subject(s)
COVID-19/complications , Delayed Diagnosis , Diagnostic Errors , Ischemia/diagnostic imaging , Peripheral Arterial Disease/diagnostic imaging , Acute Disease , Aged , Aged, 80 and over , Amputation , Anticoagulants/therapeutic use , Blood Vessel Prosthesis Implantation , COVID-19/diagnosis , COVID-19/therapy , Embolectomy , Humans , Ischemia/etiology , Ischemia/surgery , Male , Peripheral Arterial Disease/etiology , Peripheral Arterial Disease/surgery , Predictive Value of Tests , Thrombectomy , Thrombolytic Therapy , Time-to-Treatment , Treatment Outcome
9.
J Card Surg ; 36(5): 1659-1664, 2021 May.
Article in English | MEDLINE | ID: covidwho-1112268

ABSTRACT

OBJECTIVES: We seek to report our management protocol and early outcomes of acute type A aortic dissection (ATAAD) repair during the early phase of coronavirus disease 2019 (COVID-19). METHODS: From January 23 to April 30, 2020, we performed ATAAD repair for 33 patients, including three with pregnancy-related TAADs. Confirmation of COVID-19 depended on the results of two nucleic acid tests and pulmonary computed tomography scan. Based on testing results and hemodynamic stability, patients were triaged to an isolated intensive care unit or negative pressure operating room for emergency surgery. RESULTS: Mean age 50.2 ± 13.3 years and 20 were male (60.1%) and 8 patients were febrile (>37.3°C; 24.2%) and 17 were lymphopenic (51.5%). No patient was excluded from COVID-19 infection preoperatively. Extensive aortic repair with total arch replacement (TAR) was performed in 24 (72.7%), and limited proximal repair in 9 patients (27.3%). Cardiopulmonary bypass and cross-clamp times averaged 177 ± 34 and 88 ± 20 min for TAR, and 150 ± 30 and 83 ± 18 min for hemiarch, respectively. The mean operation time was 410 ± 68.3 min. Operative mortality was 6.1% (2/33). Complications included reintubation in four (12.1%), acute kidney failure in two (6.1%), and cerebral infarction in one (3.0%). No paraplegia nor re-exploration for bleeding occurred. COVID-19 was excluded in 100% eventually. No nosocomial infection occurred. Nor did any patient/surgical staff develop fever or test positive during the study period. CONCLUSIONS: The results of this study show that our management protocol based on testing results and hemodynamic stability in patients with ATAAD during the COVID-19 pandemic was effective and achieved favorable early surgical outcomes.


Subject(s)
Aneurysm, Dissecting , Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation , COVID-19 , Acute Disease , Adult , Aneurysm, Dissecting/epidemiology , Aneurysm, Dissecting/surgery , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/epidemiology , Aortic Aneurysm, Thoracic/surgery , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Time Factors , Treatment Outcome
10.
J Neurointerv Surg ; 13(2): e1, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-883391

ABSTRACT

This is a report of the first three cases of endovascular aneurysm treatment that were proctored by a remote interventionalist using a novel high-resolution low-latency streaming technology. The proctor was located in a neurovascular centre and supported the treating interventional teams in two distant cities (up to 800 km/500 miles apart). All aneurysms were treated using the Woven EndoBridge (WEB) embolisation system, either electively or following subarachnoid haemorrhage. On-site proctoring was not possible due to travel restrictions during the COVID-19 pandemic. WEB placement was feasible in all cases. Good rapport between proctors and treating physicians was reported, enabled by the high-resolution image transmission and uninterrupted feedback/discussion via audiostream. No clinical complications were encountered. Short-term follow-up revealed adequate occlusion of all treated aneurysms. The employed streaming technology provided effective remote proctoring during complex aneurysm cases, including the management of technical complications.


Subject(s)
COVID-19 , Endovascular Procedures/methods , Intracranial Aneurysm/surgery , Neurosurgical Procedures/methods , Pandemics , Telemedicine/methods , Blood Vessel Prosthesis Implantation , Communication , Embolization, Therapeutic , Feedback , Humans , Treatment Outcome , Videoconferencing
11.
Ann Ital Chir ; 91: 273-276, 2020.
Article in English | MEDLINE | ID: covidwho-739593

ABSTRACT

CASE REPORT: A 64-year-old woman presented to our emergency department during the outbreak of the covid-19 emergency in Italy with syncope, anosmia, mild dyspnoea and atypical chest and dorsal pain. A chest CT scan showed an acute type B aortic dissection (ATBAD) and bilateral lung involvement with ground-glass opacity, compatible with interstitial pneumonia. Nasopharyngeal swabs resulted positive for SARS-CoV-2. For the persistence of chest pain, despite the analgesic therapy, we decided to treat her with a TEVAR. Patient's chest and back pain resolved during the first few days after the procedure. No surgical or respiratory complications occurred and the patient was discharged 14 days after surgery. DISCUSSION: By performing the operation under local anesthesia, it was possible to limit both the staff inside the operatory room and droplet/aerosol release. Since we had to perform the operation in a hemodynamics room, thanks to the limited extension of the endoprosthesis and the good caliber of the right vertebral artery we were able to reduce the risk of spinal cord ischemia despite the lack of a revascularization of the left subclavian artery. CONCLUSIONS: A minimally invasive total endovascular approach allows, through local anesthesia and percutaneous access, to avoid surgical cut down and orotracheal intubation. This, combined with a defined management protocol for infected patients, seems to be a reasonable way to perform endovascular aortic procedures in urgent setting, even in a SARSCoV- 2 positive patient. KEY WORDS: COVID-19, Dissection, TEVAR.


Subject(s)
Aneurysm, Dissecting/surgery , Aortic Aneurysm, Thoracic/surgery , Betacoronavirus/isolation & purification , Blood Vessel Prosthesis Implantation/methods , Coronavirus Infections/prevention & control , Endovascular Procedures/methods , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Anesthesia, Local , Aneurysm, Dissecting/complications , Antibiotic Prophylaxis , Anticoagulants/therapeutic use , Antiviral Agents/therapeutic use , Aortic Aneurysm, Thoracic/complications , COVID-19 , Contraindications, Procedure , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Coronavirus Infections/transmission , Darunavir/therapeutic use , Diabetes Mellitus, Type 2/complications , Drug Therapy, Combination , Enoxaparin/therapeutic use , Female , Humans , Hydroxychloroquine/therapeutic use , Intraoperative Complications/prevention & control , Intubation, Intratracheal/adverse effects , Middle Aged , Nasopharynx/virology , Operating Rooms , Patient Isolation , Pneumonia, Viral/complications , Pneumonia, Viral/drug therapy , Pneumonia, Viral/transmission , Ritonavir/therapeutic use , SARS-CoV-2 , Spinal Cord Ischemia/prevention & control , Vertebral Artery/surgery
12.
Adv Chronic Kidney Dis ; 27(5): 390-396, 2020 09.
Article in English | MEDLINE | ID: covidwho-729001

ABSTRACT

The coronavirus (coronavirus disease-2019) pandemic has changed care delivery for patients with end-stage kidney disease. We explore the US healthcare system as it pertains to dialysis care, including existing policies, modifications implemented in response to the coronavirus disease-2019 crisis, and possible next steps for policy makers and nephrologists. This includes policies related to resource management, use of telemedicine, prioritization of dialysis access procedures, expansion of home dialysis modalities, administrative duties, and quality assessment. The government has already established policies that have instated some flexibilities to help providers focus their response to the crisis. However, future policy during and after the coronavirus disease-2019 pandemic can bolster our ability to optimize care for patients with end-stage kidney disease. Key themes in this perspective are the importance of policy flexibility, clear strategies for emergency preparedness, and robust health systems that maximize accessibility and patient autonomy.


Subject(s)
COVID-19 , Health Policy , Kidney Failure, Chronic/therapy , Nephrology , Renal Dialysis/methods , Telemedicine/methods , Ambulatory Care Facilities , Anastomosis, Surgical , Arteries/surgery , Blood Vessel Prosthesis Implantation , Centers for Medicare and Medicaid Services, U.S. , Computer Security , Delivery of Health Care/methods , Delivery of Health Care/standards , Disaster Planning , Health Services Accessibility , Hemodialysis Solutions/supply & distribution , Hemodialysis, Home/methods , Hemodialysis, Home/standards , Humans , Organization and Administration/standards , Personal Autonomy , Personal Protective Equipment , Quality Assurance, Health Care , Reimbursement Mechanisms , Renal Dialysis/instrumentation , Renal Dialysis/standards , SARS-CoV-2 , Telemedicine/standards , United States , Veins/surgery
14.
J Card Surg ; 35(7): 1736-1739, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-526929

ABSTRACT

The impact of the coronavirus disease 2019 (COVID-19) pandemic in New York City (NYC) is dramatic. COVID-19 cases surged, hospitals expanded to meet capacity, and NYC remains the global epicenter of this pandemic. During this unprecedented time, a young woman with known Marfan syndrome presented with an acute complicated type B aortic dissection to our Aortic Center. Using the provisional extension to induce a complete attachment technique, we treated this patient and quickly discharged her the next day to decrease the risk of COVID-19 infection. Her progress was monitored using frequent phone calls and one office visit at two weeks.


Subject(s)
Aneurysm, Dissecting/surgery , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/methods , Coronavirus Infections/epidemiology , Endovascular Procedures/methods , Pneumonia, Viral/epidemiology , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Acute Disease , Adult , Aneurysm, Dissecting/diagnostic imaging , Aneurysm, Dissecting/etiology , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/etiology , COVID-19 , Chest Pain/diagnosis , Chest Pain/etiology , Coronavirus Infections/diagnosis , Cross Infection/prevention & control , Female , Follow-Up Studies , Humans , Length of Stay , Magnetic Resonance Angiography/methods , Marfan Syndrome/complications , Marfan Syndrome/diagnosis , New York City , Pandemics , Pneumonia, Viral/diagnosis , Severity of Illness Index , Treatment Outcome
15.
Ann Vasc Surg ; 66: 14-17, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-347639

ABSTRACT

We report a patient who presented with acute abdominal pain during the COVID-19 pandemic. His work-up revealed rupture of a 5.8 cm abdominal aortic aneurysm. He also had fever, cough, and shortness of breath and radiologic evidence of COVID-19 infection. After careful consideration, he underwent successful endovascular repair under local anesthesia with good short-term results.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/surgery , Betacoronavirus , Blood Vessel Prosthesis Implantation , Coronavirus Infections/complications , Endovascular Procedures , Pneumonia, Viral/complications , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/virology , Aortic Rupture/diagnostic imaging , COVID-19 , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
16.
Ann Vasc Surg ; 66: 8-10, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-133306

ABSTRACT

BACKGROUND: COVID-19 infection has been reported to be related with an increased risk of thrombotic complications because of the hypercoagulability state and inflammation. At the moment, no reports are available regarding thrombosis of prosthetic vascular grafts. We present the case of a patient with COVID-19-related pneumonia, who suffered from the acute thrombosis of a previously implanted aortic graft. METHODS AND RESULTS: A 67-year-old male patient, who had undergone open repair of an abdominal aortic aneurysm with a bifurcated graft 6 years before, was admitted to the emergency department with high fever for a week without cough or dyspnea. Thoracic ultrasound showed signs of bilateral interstitial pneumonia, and the Sars-Cov-2 swab was positive. Antiretroviral therapy and prophylactic low molecular weight heparin treatment were initiated. Owing to the progressive impairment of the respiratory function, the patient was intubated after eight days from the admission, the day after he showed signs of bilateral acute limb ischemia. A duplex ultrasound demonstrated the complete thrombosis of the aortic graft without flow at the femoral level. An urgent angio-computed tomography scan for revascularization purpose was requested, but the patient died on the arrival in the radiological suite. CONCLUSIONS: Acute thrombosis of vascular prosthetic grafts is a possible, catastrophic complication of COVID-19 infection. In COVID-19 patients with prosthetic graft, an aggressive antithrombotic treatment could be considered to prevent such an event.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Betacoronavirus , Blood Vessel Prosthesis/adverse effects , Coronavirus Infections/complications , Graft Occlusion, Vascular/etiology , Pneumonia, Viral/etiology , Aged , Aortic Aneurysm, Abdominal/complications , Blood Vessel Prosthesis Implantation/adverse effects , COVID-19 , Humans , Male , Pandemics , Pneumonia, Viral/complications , SARS-CoV-2
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