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2.
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
3.
J Cardiovasc Surg (Torino) ; 62(6): 527-534, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1441430

ABSTRACT

INTRODUCTION: Since the outbreak of the 2019 coronavirus (COVID-19), vascular specialists have faced dramatic changes in clinical and surgical practice. Although COVID-19 pulmonary signs and symptoms were the most pertinent problems initially, in the long term, cardiovascular complications became the most fearsome, with poor outcomes in terms of morbidity and mortality. Algorithms and decision-making procedures have been modified, not only to treat new clinical findings in COVID-19 positive patients, but also to avoid complications related to pulmonary and systemic infections. Additionally, COVID-19-negative patients experienced challenging management, due to hospital crowding, the risk of nosocomial COVID-19 transmission, and pandemic emergencies. In this context, aortic interventions were subject to several difficulties. First, in COVID-19-positive patients, there was the onset of new pathological scenarios including thrombotic manifestations and the subsequent complications. Second, in both COVID-19-negative and positive patients, there was a need to deliver optimal treatment with acceptable perioperative risks, forcing a rethinking of decision-making especially in terms of indications for treatments. The aim of this systematic review is to present evidence published on COVID-19 and aortic-related issues, highlighting some challenging aspects regarding management, treatment and outcomes. EVIDENCE ACQUISITION: Data search was performed on PubMed, Scopus and Web of Science, using as time range "January 1st, 2000 - May 1st, 2021." Only articles in English language were included. Key words used for the query were "Aorta" AND "COVID-19" OR "SARS-CoV-2." Furthermore, the NCBI database of "SARS-CoV-2 Resources" was interrogated to find further relevant studies. EVIDENCE SYNTHESIS: The search retrieved 416 papers; among these, 46 studies were eligible and reviewed in depth. The published literature suggests the existence of a hypercoagulable state in patients with COVID-19 disease occurring via direct and indirect mechanisms. COVID-19 infection seems to promote a prothrombotic status that aggravates vascular disease. Regardless of clinical laboratory or status, active COVID-19 infection is considered a risk factor for poor vascular surgery outcomes. Specifically, it is associated with a fourfold increased risk of death and a threefold increased risk of major adverse events. Prognosis of patients hospitalized with COVID-19 disease is often determined by the extent of pulmonary disease, although vascular complications also greatly affect outcomes. Nevertheless, although COVID­19 is highly morbid, in high­risk operations good outcomes can still be achieved even in elderly patients with COVID­19. CONCLUSIONS: In the case of aortic disease during active COVID-19 infection, poor outcomes are associated with COVID-19 vascular and non-vascular complications, while for COVID-19-negative patients not much changed in terms of outcomes, despite the difficulties in management. Endovascular repair, when possible, minimized the impact of treatment, reducing the risk of COVID-related postoperative complications or acquired infection in negative patients.


Subject(s)
Anticoagulants/therapeutic use , Aortic Diseases/surgery , Blood Coagulation/drug effects , COVID-19/therapy , Endovascular Procedures , Thrombophilia/drug therapy , Vascular Surgical Procedures , Anticoagulants/adverse effects , Aortic Diseases/blood , Aortic Diseases/mortality , COVID-19/blood , COVID-19/mortality , Endovascular Procedures/adverse effects , Endovascular Procedures/mortality , Humans , Postoperative Complications/etiology , Risk Assessment , Risk Factors , Thrombophilia/blood , Thrombophilia/mortality , Treatment Outcome , Vascular Surgical Procedures/adverse effects , Vascular Surgical Procedures/mortality
5.
J Stroke Cerebrovasc Dis ; 30(9): 105985, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1294009

ABSTRACT

OBJECTIVES: COVID-19 pandemic has forced important changes in health care worldwide. Stroke care networks have been affected, especially during peak periods. We assessed the impact of the pandemic and lockdowns in stroke admissions and care in Latin America. MATERIALS AND METHODS: A multinational study (7 countries, 18 centers) of patients admitted during the pandemic outbreak (March-June 2020). Comparisons were made with the same period in 2019. Numbers of cases, stroke etiology and severity, acute care and hospitalization outcomes were assessed. RESULTS: Most countries reported mild decreases in stroke admissions compared to the same period of 2019 (1187 vs. 1166, p = 0.03). Among stroke subtypes, there was a reduction in ischemic strokes (IS) admissions (78.3% vs. 73.9%, p = 0.01) compared with 2019, especially in IS with NIHSS 0-5 (50.1% vs. 44.9%, p = 0.03). A substantial increase in the proportion of stroke admissions beyond 48 h from symptoms onset was observed (13.8% vs. 20.5%, p < 0.001). Nevertheless, no differences in total reperfusion treatment rates were observed, with similar door-to-needle, door-to-CT, and door-to-groin times in both periods. Other stroke outcomes, as all-type mortality during hospitalization (4.9% vs. 9.7%, p < 0.001), length of stay (IQR 1-5 days vs. 0-9 days, p < 0.001), and likelihood to be discharged home (91.6% vs. 83.0%, p < 0.001), were compromised during COVID-19 lockdown period. CONCLUSIONS: In this Latin America survey, there was a mild decrease in admissions of IS during the COVID-19 lockdown period, with a significant delay in time to consultations and worse hospitalization outcomes.


Subject(s)
COVID-19/prevention & control , Endovascular Procedures/trends , Hospitalization/trends , Practice Patterns, Physicians'/trends , Stroke/therapy , Time-to-Treatment/trends , COVID-19/transmission , Cause of Death/trends , Endovascular Procedures/adverse effects , Endovascular Procedures/mortality , Female , Health Care Surveys , Hospital Mortality/trends , Humans , Latin America , Length of Stay/trends , Male , Patient Admission/trends , Patient Discharge/trends , Stroke/diagnosis , Stroke/mortality , Time Factors , Treatment Outcome
6.
J Neurointerv Surg ; 14(3): 274-279, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1255620

ABSTRACT

BACKGROUND: The COVID-19 pandemic has disrupted acute stroke care logistics, including delays in hyperacute management and decreased monitoring following endovascular therapy (EVT). We aimed to assess the impact of the pandemic on 90-day functional outcome among patients treated with EVT. METHODS: This is an observational cohort study including all patients evaluated for an acute stroke between March 30, 2020 and September 30, 2020 (pandemic cohort) and 2019 (reference cohort) in a high-volume Canadian academic stroke center. We collected baseline characteristics, acute reperfusion treatment and management metrics. For EVT-treated patients, we assessed the modified Rankin score (mRS) at 90 days. We evaluated the impact of the pandemic on a 90-day favourable functional status (defined as mRS 0-2) and death using multivariable logistic regressions. RESULTS: Among 383 and 339 patients included in the pandemic and reference cohorts, baseline characteristics were similar. Delays from symptom onset to evaluation and in-house treatment were longer during the early first wave, but returned to reference values in the subsequent months. Among the 127 and 136 EVT-treated patients in each respective cohort, favourable 90-day outcome occurred in 53/99 (53%) vs 52/109 (48%, p=0.40), whereas 22/99 (22%) and 28/109 (26%, p=0.56) patients died. In multivariable regressions, the pandemic period was not associated with 90-day favourable functional status (aOR 1.27, 95% CI 0.60 to 2.56) or death (aOR 0.74, 95% CI 0.33 to 1.63). CONCLUSION: In this single-center cohort study conducted in a Canadian pandemic epicenter, the first 6 months of the COVID-19 pandemic did not impact 90-day functional outcomes or death among EVT-treated patients.


Subject(s)
Brain Ischemia , COVID-19 , Endovascular Procedures , Stroke , Brain Ischemia/therapy , Canada/epidemiology , Cohort Studies , Endovascular Procedures/adverse effects , Humans , Pandemics , SARS-CoV-2 , Stroke/diagnostic imaging , Stroke/epidemiology , Stroke/surgery , Thrombectomy/adverse effects , Treatment Outcome
7.
Curr Opin Anaesthesiol ; 34(4): 476-481, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1254865

ABSTRACT

PURPOSE OF REVIEW: This review discusses the general anesthetic approach of endovascular stroke therapy and highlights recent advances and considerations for optimal intraoperative management of acute ischemic stroke. RECENT FINDINGS: Recent randomized controlled trials have shown no differences in clinical outcomes between monitored anesthesia care with sedation compared with general anesthesia for endovascular stroke therapy. The COVID-19 pandemic has complicated decision-making in the neurointerventional setting. Advances in imaging techniques have extended the window of treatment for endovascular therapy. SUMMARY: Optimal time to intervention, hemodynamic stability, novel imaging techniques, and careful consideration of anesthetic plan can impact patient outcomes in reperfusion stroke therapy.


Subject(s)
Anesthetics , Brain Ischemia , COVID-19 , Endovascular Procedures , Ischemic Stroke , Stroke , Brain Ischemia/therapy , Conscious Sedation , Endovascular Procedures/adverse effects , Humans , Pandemics , Radiology, Interventional , SARS-CoV-2 , Stroke/therapy , Treatment Outcome
8.
J Stroke Cerebrovasc Dis ; 29(8): 104980, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-343178

ABSTRACT

BACKGROUND: The COVID-19 pandemic has presented unprecedented challenges to healthcare organizations worldwide. A steadily rising number of patients requiring intensive care, a large proportion from racial and ethnic minorities, demands creative solutions to provide high-quality care while ensuring healthcare worker safety in the face of limited resources. Boston Medical Center has been particularly affected due to the underserved patient population we care for and the increased risk of ischemic stroke in patients with COVID-19 infection. METHODS: We present protocol modifications developed to manage patients with acute ischemic stroke in a safe and effective manner while prioritizing judicious use of personal protective equipment and intensive care unit resources. CONCLUSION: We feel this information will benefit other organizations facing similar obstacles in caring for the most vulnerable patient populations during this ongoing public health crisis.


Subject(s)
Betacoronavirus/pathogenicity , Brain Ischemia/virology , Coronavirus Infections/therapy , Endovascular Procedures , Health Services Needs and Demand/organization & administration , Needs Assessment/organization & administration , Pneumonia, Viral/therapy , Radiography, Interventional , Stroke/therapy , Thrombolytic Therapy , Boston , Brain Ischemia/diagnosis , Brain Ischemia/epidemiology , COVID-19 , Clinical Decision-Making , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Critical Pathways/organization & administration , Endovascular Procedures/adverse effects , Host Microbial Interactions , Humans , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Radiography, Interventional/adverse effects , Risk Assessment , Risk Factors , SARS-CoV-2 , Stroke/diagnosis , Stroke/epidemiology , Thrombolytic Therapy/adverse effects , Treatment Outcome , Triage/organization & administration
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