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1.
G Chir ; 39(2): 77-81, 2018.
Article in English | MEDLINE | ID: mdl-29694305

ABSTRACT

Patients with critical limb ischemia are usually compromised, frequently making administration of general or regional anesthesia problematic. We treated 3 fragile patients presenting contraindications to undertake traditional anesthetic techniques for lower limb revascularization, in whom local anesthesia with conscious sedation was used to complete the operation. An axillo-bifemoral, a unilateral axillo-femoral and a femoro-femoral bypass were performed. Procedure was uneventful in all three cases despite the coexistence of specific surgical challenges (distal anastomosis at the profunda in two cases, redo surgery and scarred groin in the third). Surgical revascularization under local anesthesia may be considered in selected high risk patients.


Subject(s)
Anesthesia, Local , Ischemia/surgery , Lower Extremity/blood supply , Vascular Grafting/methods , Aged , Aged, 80 and over , Axillofemoral Bypass Grafting , Comorbidity , Conscious Sedation , Endarterectomy , Female , Femoral Artery/surgery , Frail Elderly , Humans , Ischemia/etiology , Lower Extremity/surgery , Male , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/surgery
5.
Eur J Vasc Endovasc Surg ; 51(6): 815-23, 2016 Jun.
Article in English | MEDLINE | ID: mdl-27026390

ABSTRACT

OBJECTIVE: To compare results of ultrasound based techniques (ultrasound guided compression-(UGC) versus ultrasound guided thrombin injection (UGTI)) to treat iatrogenic post-catheterization femoral pseudoaneurysms. METHODS: The study design involved a systematic review of the literature and meta-analysis of comparative studies. The MEDLINE, CENTRAL, and OpenGray databases were searched up to October 2015. Primary outcome measure was efficacy, while other outcomes examined were safety (complication rate), duration of the procedure, length of hospitalization, and cost of methods. The random effects model was used to calculate combined overall effect sizes of pooled data. Data are presented as the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). RESULTS: Two randomized control trials and 11 observational studies were included in the analysis. Overall, 786 and 318 subjects underwent UGC and UGTI respectively. The latter modality resulted in a significantly higher success rate (97.4% vs. 69.3%, OR 0.06, 95% CI 0.03-0.11) while the complication rate for both techniques was very low (0.69% vs. 0.78%, OR 1.77, 95% CI 0.40-7.88). Data regarding procedural duration and length of hospitalization were very scarce, favoring UGTI (procedural time: MD 35.53 min, 9.11-63.95, length of hospitalization MD 1.99 days, -0.31-4.29). Scarcity of data did not allow proper cost analysis, but two studies suggested that UGTI may offer reduced treatment costs. CONCLUSION: Available evidence suggests that UGTI is superior in terms of efficacy and as safe as UGC and thus should be used as the primary modality for the treatment of post-catheterization femoral pseudoaneurysms.


Subject(s)
Postoperative Complications/drug therapy , Postoperative Complications/surgery , Thrombin/administration & dosage , Ultrasonography , Catheterization/methods , Databases, Factual , Femoral Artery/diagnostic imaging , Humans , Postoperative Complications/diagnostic imaging , Thrombin/therapeutic use
8.
Br J Radiol ; 88(1051): 20140735, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25966288

ABSTRACT

OBJECTIVE: To present our experience with the Ovation Abdominal Stent Graft System (TriVascular Inc., Santa Rosa, CA) during endovascular aneurysm repair (EVAR) and compare results according to the type of anaesthesia. METHODS: We conducted a single-centre retrospective study including patients who underwent EVAR using the Ovation endograft between May 2011 and July 2014. Outcome was evaluated regarding pre-, peri- and immediate postoperative and follow-up measures. Overall results are reported, while additional analysis was performed to compare the outcome between groups of patients undertaking either local or regional/general anaesthesia (LA vs RGA). RESULTS: 66 patients were included. Median follow-up was 13 months (range, 1-39 months). Median age was 72 years and median abdominal aortic aneurysm diameter was 58 mm (range, 54-100 mm). Technical success was 63 (95%), while there were 2 (3%) conversions to open surgery. A total percutaneous approach was used in 50/66 (76%) cases. Overall, 9/66 (14%) subjects suffered from any kind of morbidity. Median hospitalization was 3 days (range, 1-16 days). Immediate and midterm mortality rate was 0%. No endoleak Type I, III, IV or stent migration was observed. There were 8 (13%) Type II endoleaks. Overall, additional endovascular procedures were required in 6 (9%), while surgery was performed in 4 (6%) patients. 44 (67%) patients underwent LA and 22 (23%) RGA. Differences between groups were significant for procedural time (85 vs 107 min; p < 0.001), percutaneous access (91% vs 45%; p < 0.001) and systematic complications (2.3% vs 14%; p = 0.05). CONCLUSION: EVAR with the use of the Ovation endograft shows promising short-term and midterm results regarding safety and effectiveness. Completion of the procedures under LA using a total percutaneous approach seems advantageous and may be used in routine practice. ADVANCES IN KNOWLEDGE: The Ovation Abdominal Stent Graft System is an ultra-low profile stent graft system that allows percutaneous deployment for EVAR and offers excellent overall efficacy and safety. Totally percutaneous EVAR under LA seems advantageous and may be used as a routine with this specific endograft.


Subject(s)
Anesthesia, Local , Aortic Aneurysm, Abdominal/surgery , Stents , Aged , Aged, 80 and over , Anesthesia, Conduction , Anesthesia, General , Aortic Aneurysm, Abdominal/pathology , Endoleak/etiology , Equipment Design , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome
11.
Int J Surg ; 11 Suppl 1: S24-9, 2013.
Article in English | MEDLINE | ID: mdl-24380546

ABSTRACT

PURPOSE OF THE STUDY: To evaluate the mid-term safety and effectiveness of a novel stent graft for treatment of abdominal aortic aneurysm (AAA). METHODS: Thirty-three patients with AAA (20 males and 13 females; mean age: 71.3 y) were treated with the Ovation™ Abdominal Stent Graft System (TriVascular, Inc., Santa Rosa, CA, USA). Indications for endovascular aneurysm repair: AAA ≥ 5.5 cm, neck ≥ 7 mm, angulation ≤ 60° and with an inner wall diameter of no less than 16 mm and no greater than 30 mm; the presence of neck calcification and thrombosis is not much of a problem in this device because aortic seal is achieved with 2 polymer-filled sealing rings and the fixation by means of a suprarenal stent with 8 pairs of anchors. Patients were followed through discharge and returned for follow-up visits. The follow-up protocol included a CT-A exam at 1 and 12 months after the intervention; the mid-term follow up was performed at 3 and 6 months with contrast-enhanced ultrasound (CEUS). Mean follow-up duration was 18.6 months (range: 3-25 months). MAIN FINDINGS: Technical success was 100%. Mean implantation procedure time was 31.1 minutes, and median hospital stay was 4.6 days. None of the patients required conversion to open surgery, and no aneurysm enlargement, rupture, fracture, or migration were observed. No type I, III or IV endoleaks were observed. Hospitalization death rate was 0%. Death rate at 30 days was 0%. No major complications were observed. CONCLUSIONS: The first results from this 3-center study with the Ovation stent graft are promising with high technical success and excellent safety and effectiveness.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Polymers/therapeutic use , Aged , Aortic Aneurysm, Abdominal/diagnostic imaging , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/methods , Female , Humans , Male , Polymers/chemistry , Tomography, X-Ray Computed
12.
Int Angiol ; 29(3): 284-5, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20502418

ABSTRACT

Superficial venous aneurysms are rare and usually are uneventful. We present a case in which a 40-year old female presenting with a thrombosed external jugular vein aneurysm which previously caused an undetected pulmonary embolism. The aneurysm was excised and the external jugular vein was ligated under local anesthesia and anticoagulation was initiated. In conclusion aneurysms of the superficial venous system should be considered as a possible source of pulmonary emboli. These sites can safely be excised and ligated under local anesthesia offering long term protection from its possible complications.


Subject(s)
Aneurysm/complications , Aneurysm/surgery , Jugular Veins , Pulmonary Embolism/etiology , Venous Thrombosis/etiology , Adult , Anesthesia, Local , Aneurysm/diagnosis , Anticoagulants/therapeutic use , Female , Humans , Jugular Veins/surgery , Ligation , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/surgery , Radiography , Treatment Outcome , Vascular Surgical Procedures , Venous Thrombosis/diagnosis , Venous Thrombosis/surgery
14.
Eur J Vasc Endovasc Surg ; 39(1): 42-8, 2010 Jan.
Article in English | MEDLINE | ID: mdl-19906549

ABSTRACT

OBJECTIVE: To study the correlation between peak wall stress (PWS) and abdominal aorta aneurysm (AAA) geometric parameters in the presence of intraluminal thrombus (ILT). DESIGN: Computational study using finite element analysis. MATERIAL: AAA models were created by three-dimensional (3D) reconstruction of in vivo acquired computed tomography (CT) images from 19 patients. METHODS: PWS was evaluated in the presence and absence of ILT. DeltaPWS% represents the percentage change in PWS in the presence of ILT. The 3D lumen centrelines were extracted, and the values of torsion, tortuosity and mean curvature were estimated. RESULTS: A positive correlation was observed between DeltaPWS% and relative ILT volume (P=0.03). PWS in the presence of ILT significantly correlated only with the degree of centerline tortuosity (P=0.003) and maximum diameter (P<0.0001). The optimal predictive model for PWS in the presence of ILT was estimated to contain both maximum diameter and centreline tortuosity. CONCLUSIONS: Specific geometric parameters in AAA models in the presence of ILT could serve as potential predictors of elevated PWS. PWS correlated significantly with the maximum diameter and the degree of centreline tortuosity. Centreline tortuosity may become a useful addition to maximum diameter in the decision-making process of AAA treatment.


Subject(s)
Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Rupture/etiology , Aortography/methods , Radiographic Image Interpretation, Computer-Assisted , Thrombosis/diagnostic imaging , Tomography, X-Ray Computed , Aortic Aneurysm, Abdominal/complications , Aortic Rupture/diagnostic imaging , Computer Simulation , Disease Progression , Finite Element Analysis , Humans , Linear Models , Male , Models, Cardiovascular , Risk Assessment , Risk Factors , Stress, Mechanical , Thrombosis/complications
15.
Eur J Vasc Endovasc Surg ; 39(3): 302-4, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20005751

ABSTRACT

UNLABELLED: Using finite element analysis, we evaluated if the site of an aortic bleb, known to be prone to rupture, coincides with the location of peak wall stress (PWS) in a patient-specific abdominal aortic aneurysm (AAA) model. REPORT: PWS was not located at the bleb site, even when stress values were estimated for different bleb wall thicknesses (0.5-2.0 mm) while the rest of the AAA wall was considered constant (2 mm). DISCUSSION: The sites of PWS in AAAs should not always be considered as the sites most prone to rupture since other factors, such as wall strength, may play a role in rupture-risk prediction, depicting the need for further investigation of these parameters.


Subject(s)
Aorta, Abdominal/pathology , Aortic Aneurysm, Abdominal/complications , Aortic Rupture/etiology , Aged , Aorta, Abdominal/surgery , Aortic Aneurysm, Abdominal/pathology , Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/pathology , Finite Element Analysis , Humans , Male , Models, Cardiovascular , Risk Assessment , Risk Factors , Stress, Mechanical , Vascular Surgical Procedures
16.
Eur J Vasc Endovasc Surg ; 39(3): 346-8, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20018531

ABSTRACT

In this report, we present a technique to extend the function of an antecubital arteriovenous fistula in which both the basilic and the brachial veins were simultaneously transposed to create an autologous graft in the arm. This procedure may particularly be applicable for patients in whom, although a brachio-cephalic fistula, anastomosing the brachial artery and the perforating antecubital vein, has been previously performed and has remained patent arterialising the deep arm veins, the cephalic vein has failed to mature or has been thrombosed after multiple punctures. Our preliminary experience in eight patients has shown satisfactory outcome.


Subject(s)
Arteriovenous Shunt, Surgical , Brachial Artery/surgery , Brachiocephalic Veins/surgery , Renal Dialysis , Upper Extremity/blood supply , Aged , Aged, 80 and over , Arteriovenous Shunt, Surgical/adverse effects , Brachial Artery/diagnostic imaging , Brachiocephalic Veins/diagnostic imaging , Female , Humans , Male , Middle Aged , Pilot Projects , Time Factors , Treatment Outcome , Ultrasonography, Doppler, Color , Vascular Patency
17.
Int Angiol ; 28(5): 421-4, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19935599

ABSTRACT

A variety of indications have made the use of double pigtail ureteral catheters routine in urological practice. Although side effects are frequent they are usually mild. We report a case of intravenous stent migration after simultaneous perforation of the left ureter and left common iliac vein during retrograde J-stent placement. To the authors' knowledge such a potentially severe complication of a J-stent has not been previously described. A postprocedural plain abdominal radiograph is a helpful tool which may suggest possible misplacement of the pigtail stent especially if urine fails to return from the distal opening and, if verified, advocate immediate intervention in order to avoid any further devastating complications.


Subject(s)
Foreign-Body Migration/etiology , Iliac Vein/injuries , Pyelonephritis/therapy , Stents , Ureter/injuries , Ureteral Obstruction/therapy , Urinary Catheterization/instrumentation , Vena Cava, Inferior , Wounds, Penetrating/etiology , Device Removal , Female , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/surgery , Humans , Iliac Vein/diagnostic imaging , Iliac Vein/surgery , Middle Aged , Phlebography , Pyelonephritis/complications , Tomography, X-Ray Computed , Ureter/diagnostic imaging , Ureter/surgery , Ureteral Obstruction/etiology , Urinary Catheterization/adverse effects , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/surgery , Wounds, Penetrating/diagnostic imaging , Wounds, Penetrating/surgery
18.
Int Angiol ; 28(4): 325-33, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19648877

ABSTRACT

AIM: The aim of this study was to examine the effect of intraluminal thrombus (ILT) on the peak wall stress (PWS) in abdominal aorta aneurysm models (AAA). METHODS: Anatomically correct patient specific AAA models were created by 3D reconstruction of in vivo acquired computed tomography images from 19 male patients. Patients were divided in two groups according to aneurysm peak transverse diameter, 5-7 cm (10 patients, ''intermediate'' group) and >7 cm (9 patients, ''large'' group), respectively. PWS was evaluated in the presence and absence of ILT. The percentage of PWS reduction (Delta PWS %) was estimated as a percentage of PWS value in the absence of ILT. Finite element analysis was used to numerically compute the wall stress distribution assuming a 2-mm thick hyperelastic AAA wall material model and a 120 mmHg systolic uniform wall loading. The thrombus was modeled as an isotropic, elastic, homogenous and incompressible material. The volume of ILT was estimated as a percentage of the AAA sac volume. RESULTS: The ILT volume was 49.9%+/-10.6% in the ''large'' group and 58.6%+/-13.2% in the ''intermediate'' group (t-test P=0.14). The ''large'' AAAs have higher PWS values than the ''intermediate'' group, both in the presence of ILT (36.9+/-5.8 vs. 23.5+/-6.2 Nt/cm(2), P=0.0001) as well as in the absence of ILT (52.6+/-15.4 vs. 35.0+/-10.5 Nt/cm(2), P=0.01). The presence of ILT resulted in a decrease of PWS (Delta PWS) in all cases. There was no statistical difference between the two groups in the mean PWS reduction, in the presence of ILT (26.9+/-12.5 Nt/cm(2) in the ''large'' group and 31.0+/-11.7 Nt/cm2 in the ''intermediate'' group, t-test P=0.48). However, a strong correlation between the ILT relative volume (ILT%) and the degree of PWS reduction was found only in the ''intermediate'' AAA group (Pearson correlation 0.86, P<0.001), whereas no correlation was observed in the ''large'' AAA group (Pearson correlation 0.05, P=0.9). CONCLUSIONS: The presence of ILT reduced the PWS in all cases. In the ''intermediate'' AAAs our results showed a linear correlation between ILT relative volume and cents PWS. However, in ''large'' aneurysms no such correlation was found. This indicates that the degree of ILT influence on the reduction of PWS in ''large'' AAAs may be related to other factors such as the geometric configurations of the AAA.


Subject(s)
Aorta, Abdominal/physiopathology , Aortic Aneurysm, Abdominal/physiopathology , Thrombosis/physiopathology , Aorta, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortography/methods , Computer Simulation , Elasticity , Finite Element Analysis , Hemodynamics , Humans , Linear Models , Male , Models, Cardiovascular , Stress, Mechanical , Thrombosis/diagnostic imaging , Tomography, X-Ray Computed
19.
Eur J Vasc Endovasc Surg ; 27(3): 275-82, 2004 Mar.
Article in English | MEDLINE | ID: mdl-14760596

ABSTRACT

OBJECTIVE: To assess the true incidence, the reflux patterns and the mechanisms responsible for recurrent varicose vein disease according to current definitions and guidelines. PATIENTS AND METHODS: Ninety-three patients (69 female, 24 male, mean age: 48 years) were prospectively evaluated pre- and postoperatively (1 month and 5 years), using clinical and colour duplex examination of both lower limbs. The CEAP score and its modification for recurrence (REVAS) were used for classification. RESULTS: In 113 operated lower limbs, 28 (25%) were found to have a recurrence, 20 of which were symptomatic (20/28, 72%). However, in this group, the mean severity score decreased significantly from 6.5 (SD 3.1) to 5.2 (SD 2.8) (p<0.001, paired t-test). The correlation between the type and cause of recurrence revealed: (1) true recurrent varices in eight limbs (8/28, 29%), primarily caused by neovascularisation, (2) new varicose veins as a consequence of disease progression in seven limbs (7/28, 25%), (3) residual veins in three limbs (3/28, 11%) mainly due to tactical errors (e.g. failure to strip the GSV), (4) complex patterns in 10 limbs (10/28, 36%). In the limbs with recurrence, 42 sources of venous reflux were identified: (1) 19 new sites of venous reflux were due to disease progression (15% of the operated limbs), (2) 13 were caused by neovascularisation (11.5% of the operated limbs), (3) six resulted from tactical failures (5.3% of the operated limbs) and (4) four were due to technical failures (3.5% of the operated limbs). CONCLUSIONS: This study shows that the recurrence of varicose veins after surgery is not uncommon. However, the clinical condition of most affected limbs remains improved. Progression of the disease and neovascularisation are responsible for more than half of the recurrences. Rigorous evaluation of patients and assiduous surgical technique might reduce recurrence due to technical and tactical failures.


Subject(s)
Varicose Veins/surgery , Vascular Surgical Procedures , Adult , Aged , Disease Progression , Female , Humans , Male , Middle Aged , Prospective Studies , Recurrence , Ultrasonography, Doppler, Duplex , Varicose Veins/diagnostic imaging
20.
Eur J Vasc Endovasc Surg ; 26(2): 195-204, 2003 Aug.
Article in English | MEDLINE | ID: mdl-12917838

ABSTRACT

OBJECTIVE: to investigate the affect of reduced aortic compliance on cardiovascular hemodynamics. MATERIALS AND METHOD: fourteen Yucatan miniature swine were divided into two equal groups, a Sham Operated Group and a Banding Group. A Teflon prosthesis was wrapped around the aortic arc in order to limit proximal aortic compliance (Banding Group). Data were recorded operatively (after implantation of a pressure sensor and a flow probe in the ascending aorta), after banding (only in the Banding Group) and at 2 days postoperatively. RESULTS: after banding, compliance decreased by 52 +/- 13% ((-)X +/- SEM) (p < 0.01) while systolic and pulse pressure increased by 37 +/- 8% (p < 0.05) and 87 +/- 31% (p < 0.01), respectively. Diastolic pressure, mean blood pressure, cardiac output and systemic vascular resistance did not change significantly. Aortic characteristic impedance increased nearly 2.5 times. Amplitudes of forward and reflected pressure waves (derived from the aortic pressure wave) increased by 96 +/- 41% and 174 +/- 46%, respectively (p < 0.05), while the time delay between the two decreased by 36 +/- 7% (p < 0.05). CONCLUSIONS: about half of the total arterial compliance is located in the proximal thoracic aorta. Arterial reconstruction of the proximal aorta with a non-compliant graft results in a significant decrease in systemic arterial compliance, which in turn increases systolic and pulse pressure. The development of more compliant prosthesis, which matches the host artery compliance, is expected to reduce the hemodynamic changes induced after their implantation.


Subject(s)
Aorta, Thoracic/physiology , Hemodynamics/physiology , Animals , Aorta/physiology , Blood Pressure/physiology , Blood Vessel Prosthesis , Cardiac Output/physiology , Compliance , Female , Male , Swine, Miniature , Vascular Resistance/physiology
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