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1.
J Endovasc Ther ; 10(3): 453-7, 2003 Jun.
Article in English | MEDLINE | ID: mdl-12932155

ABSTRACT

PURPOSE: To assess the anatomical suitability of ruptured abdominal aortic aneurysms (AAA) for emergency endovascular repair. METHODS: All cases (46 patients [35 men; mean age 74 years, range 54-85]) in which computed tomographic angiography (CTA) confirmed AAA rupture over a 5-year period at our university hospital were reviewed for anatomical suitability for endovascular repair. Measurements were made by a radiologist experienced in anatomical assessment of CT criteria for elective endovascular aneurysm repair (EVAR). RESULTS: The mean aneurysm neck length was 18 mm (range 0-59); 17 were conical, 13 straight, 4 barrel, and 6 reverse conical. Six cases had no proximal neck. Overall, 37 (80%) patients were unsuitable for EVAR according to our criteria. Nearly half the patients (22, 48%) had > or =2 adverse features. Unsuitable neck morphology (35, 76%) was the primary reason for exclusion, but CIA aneurysm (10, 22%) and EIA tortuosity (7, 15%) were secondary adverse features. CONCLUSIONS: With current stent-graft design, the majority of ruptured abdominal aortic aneurysms are anatomically unsuitable for endovascular repair.


Subject(s)
Angioplasty , Aortic Aneurysm, Abdominal/pathology , Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/pathology , Aortic Rupture/surgery , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged
2.
Eur J Gastroenterol Hepatol ; 15(8): 915-9, 2003 Aug.
Article in English | MEDLINE | ID: mdl-12867803

ABSTRACT

BACKGROUND: Most patients with advanced stage malignant obstructive jaundice will be suitable for palliation only. Metallic stents are safe, effective and minimally invasive. DESIGN: A review of case notes of patients who had Wallstents inserted percutaneously from January 1996 to December 2000. RESULTS: Eighty-nine patients with a median age of 72 years underwent percutaneous insertion of biliary metal stents. The diagnoses were cholangiocarcinoma (41.5%), pancreatic carcinoma (40.5%), nodal metastases at the porta hepatis (14.6%) and gall bladder cancer (3.4%). Ninety-six per cent of patients improved their hyperbilirubinaemia to normal levels by 1 month. The median post-procedure hospital stay was 16 days. Early overall complications (within 30 days of stenting) occurred in 30% of patients (70% of these were disease related). The 30 day mortality rate was 20% (n = 18). Fifty (70%) patients were readmitted to hospital, most commonly because of carcinomatosis (16) or stent obstruction (12). The symptom-free period ranged from 2 weeks to 13 months. Median survival for all patients was 3.5 months. Survival correlated inversely with serum bilirubin at presentation (r = -0.34, P = 0.001), but not with other liver function tests. DISCUSSION: Metal wall stenting for malignant obstructive jaundice provides good palliation with low, procedure-related morbidity and mortality, but poor overall survival from disease-related morbidity. Survival significantly correlates with pre-stenting serum bilirubin levels. There is a need to identify the subgroup of patients in whom stenting has no beneficial effect.


Subject(s)
Cholestasis/therapy , Digestive System Neoplasms/therapy , Stents , Aged , Aged, 80 and over , Bile Duct Neoplasms/therapy , Bile Ducts, Intrahepatic , Cholangiocarcinoma/therapy , Cholangiopancreatography, Endoscopic Retrograde , Cholestasis/etiology , Digestive System Neoplasms/complications , Female , Gallbladder Neoplasms/complications , Gallbladder Neoplasms/therapy , Humans , Length of Stay , Liver Neoplasms/secondary , Male , Middle Aged , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/therapy , Patient Readmission , Postoperative Complications/etiology , Treatment Outcome
3.
J Endovasc Ther ; 9(2): 185-93, 2002 Apr.
Article in English | MEDLINE | ID: mdl-12010098

ABSTRACT

PURPOSE: To classify and analyze the volumetric changes seen on spiral computed tomographic angiography (CTA) following endovascular abdominal aortic aneurysm (AAA) repair. METHODS: Fifty patients (46 men; mean age 71 years, range 51-83) with >1 year of imaging follow-up were retrospectively selected. The volume of the aneurysm sac was calculated on standard CT workstations to obtain plots of volume changes over time. For the purpose of this study, a 10% change in sac volume was considered significant. RESULTS: Over a mean 32-month follow-up, 256 CTA scans were performed; initial mean sac volume was 259 mL and initial mean AAA diameter was 6.5 cm. Six distinct patterns of volume change were recognized: group Ia (28 patients, 56%): progressive reduction in aneurysm sac volume; group Ib (3 patients, 6%): transient initial increase then same as Ia; group II (4 patients, 8%): no significant change; group IIIa (5 patients, 10%): late increase in volume; group IIIb (8 patients, 16%): progressive increase in volume; and group IV (2 patients, 4%): late reduction in volume after secondary intervention. Group III changes were associated with endoleak types I and III (p<0.0001). CONCLUSIONS: This classification system of spiral CTA volumetric changes features 6 patterns with recognized clinical significance and predictive value for endoleaks. Group I is the ideal outcome when the aneurysm sac shrinks and often completely disappears, while group III is associated with types I and type III endoleak and should prompt further investigation. Long-term volumetric analysis of all patients is advised.


Subject(s)
Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/therapy , Blood Vessel Prosthesis Implantation , Postoperative Complications/diagnostic imaging , Stents , Tomography, X-Ray Computed , Aged , Angiography , Case-Control Studies , Female , Follow-Up Studies , Humans , Male , Postoperative Complications/epidemiology , Time Factors , Tomography, X-Ray Computed/methods
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