ABSTRACT
Objetivo: la precisión de la predicción del riesgo de rotura mediante control ultrasonográfico y angiotomografía computarizada está todavía lejos del método de diagnóstico óptimo para el aneurisma de aorta abdominal (AAA). El objetivo de este estudio es realizar un análisis volumétrico del saco aneurismático, comparar sus modificaciones con las del diámetro máximo, estudiar la evolución del volumen del trombo intraluminal (ILT) después de la reparación endovascular del AAA. Métodos: se analizaron un total de 144 AAA reparados por la EVAR electiva. Se realizó una angiotomografía en el periodo preoperatorio, 6-12 meses después de la intervención quirúrgica. Se calculó el diámetro máximo, el volumen del saco aneurismático y el volumen de la ILT en los tres momentos. Se determinó la modificación del diámetro, el volumen total y el volumen del trombo intraluminal (%). Se comparó la modificación del diámetro máximo con el volumen total de los aneurismas y entre el volumen total del aneurisma y el volumen del trombo intraluminal. Resultados: la media de los cambios en el diámetro máximo del AAA y el volumen después de la EVAR fue de -2,16 ± 8,20 mm y 84,4 ± 23,32 cc, respectivamente. Hubo un aumento en el volumen de AAA de 92,22 % y 57,34 % a los 6 y 12 meses en pacientes con endofugas (22.03 ± 19.03 cc a los 12 meses del periodo posoperatorio). La modificación media del ITL y del saco aneurismático fue de 0,59 ± 0,17 y 0,52 ± 1,8 para los pacientes con AAA presurizados y no presurizados, respectivamente (p = 0,308). Conclusión: el análisis volumétrico de los AAA reparados mediante tratamiento endovascular es una medida más preciso que la medición del diámetro máximo para determinar la expansión del saco aneurismático.(AU)
Purpose: the accuracy of risk prediction by ultrasonic control and computerized angiotomography is still far from the optimal diagnostic method for abdominal aortic aneurysm (AAA). The objective of this study is to perform a volumetric analysis of the AAA sac to detect alterations and to follow-up the evolution of the volume of the intraluminal thrombus (ILT) and its influence on the overall evolution after the EVAR. Methods: a total of 144 AAAs repaired by elective EVAR were analyzed. An angiotomography was carried out in the preoperative period, 6-12 months after the operation. The maximum-diameter, aneurysmal sac volume, and ILT volume were calculated each time. We determined the modification of the diameter, total-volume and intraluminal-thrombus volume (%). We made a comparison between the modification of the maximum-diameter and the total-volume of the aneurysms and between the total-volume of the aneurysm and the volume of ILT. Results: the average changes in the maximum diameter of AAA and the volume after EVAR was -2.16 ± 8.20 mm and 84.4 ± 23.32 cc, respectively. There was an increase in AAA-volume of 92.22 % and 57.34 % at 6 and 12 months in patients with endoleaks (22.03 ± 19.03 cc at 12 months of postoperative-period). The means of the ILT and AAA sac ratios were respectively 0.59 ± 0.17 and 0.52 ± 1.8 in AAA in sac growth and in stable or contracted AAA sac groups (p = 0.308). Conclusion: volumetric analysis of AAA repaired by EVAR is a more sensitive measure to determine the expansion of the aneurysm sac than the measurement of the maximum diameter of the aneurysm.(AU)
Subject(s)
Humans , Male , Female , Thrombosis , Titrimetry , Aortic Aneurysm, Abdominal , Angiography , Endoleak , Blood Vessels , Cardiovascular SystemABSTRACT
BACKGROUND: There is a clinical need to identify diagnostic parameters that objectively quantify and monitor the effective visual ability of patients with homonymous visual field defects (HVFDs). Visual processing speed (VPS) is an objective measure of visual ability. It is the reaction time (RT) needed to correctly search and/or reach for a visual stimulus. VPS depends on six main brain processing systems: auditory-cognitive, attentional, working memory, visuocognitive, visuomotor, and executive. We designed a new assessment methodology capable of activating these six systems and measuring RTs to determine the VPS of patients with HVFDs. METHODS: New software was designed for assessing subject visual stimulus search and reach times (S-RT and R-RT respectively), measured in seconds. Thirty-two different everyday visual stimuli were divided in four complexity groups that were presented along 8 radial visual field positions at three different eccentricities (10o, 20o, and 30o). Thus, for each HVFD and control subject, 96 S- and R-RT measures related to VPS were registered. Three additional variables were measured to gather objective data on the validity of the test: eye-hand coordination mistakes (ehcM), eye-hand coordination accuracy (ehcA), and degrees of head movement (dHM, measured by a head-tracker system). HVFD patients and healthy controls (30 each) matched by age and gender were included. Each subject was assessed in a single visit. VPS measurements for HFVD patients and control subjects were compared for the complete test, for each stimulus complexity group, and for each eccentricity. RESULTS: VPS was significantly slower (p < 0.0001) in the HVFD group for the complete test, each stimulus complexity group, and each eccentricity. For the complete test, the VPS of the HVFD patients was 73.0% slower than controls. They also had 335.6% more ehcMs, 41.3% worse ehcA, and 189.0% more dHMs than the controls. CONCLUSIONS: Measurement of VPS by this new assessment methodology could be an effective tool for objectively quantifying the visual ability of HVFD patients. Future research should evaluate the effectiveness of this novel method for measuring the impact that any specific neurovisual rehabilitation program has for these patients.
