ABSTRACT
AIM: Inferior vena cava (IVC) aneurysm is an infrequent but potentially lethal abnormality. We have seen one such case in our group practice. We have added this case to a review of 53 previously reported cases in order to develop a management algorithm for this entity. METHODS: We conducted a MedLine search of all English-language articles from the first reported case in 1950 through August 2013. Patient demographics, clinical data, management and outcomes were extracted. IVC aneurysms were categorized in 4 types as per Gradman and Steinberg classification. RESULTS: The mean patient age was 27.1 years (range 5-89) and 57.4% were male. A total of 11 (20.3%) had associated vascular anomalies and iliocaval thrombosis was found in 10 (18.5%). There were 23 type I aneurysms, 8 type IIs, 21 type IIIs and 2 type IVs. All but 1 type I was successfully managed conservatively without complications. For type IIs, only 3 patients were managed conservatively with 1 death related to stroke from paradoxical embolus. For type IIIs, resection was the most common management option (14 patients). One patient was treated endovascularly with aneurysm embolization. A total of 6 asymptomatic patients were treated conservatively with 1 death due to thromboembolism. For type IVs, all cases underwent expectant management with 1 death due to aneurysm rupture. CONCLUSION: IVC aneurysms are rare with only 54 cases reported in the literature. Associated vascular anomalies and iliocaval thrombosis should be expected in approximately 20% of cases. Type I aneurysms can be managed expectantly with close surveillance unless symptomatic. For type II-IV, surgical consideration should be given based on high rates of thromboembolic complications and non-negligible risk of rupture.
Subject(s)
Aneurysm/therapy , Endovascular Procedures , Vascular Surgical Procedures , Vena Cava, Inferior/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Aneurysm/classification , Aneurysm/diagnosis , Aneurysm/mortality , Aneurysm/surgery , Child, Preschool , Endovascular Procedures/adverse effects , Endovascular Procedures/mortality , Female , Humans , Male , Middle Aged , Risk Factors , Severity of Illness Index , Treatment Outcome , Vascular Surgical Procedures/adverse effects , Vascular Surgical Procedures/mortality , Young AdultABSTRACT
The present review addresses the pros and cons of the current, wide variety of therapeutic options available for the treatment of acute limb ischemia (ALI). Despite five prospective randomized controlled trials comparing catheter directed thrombolysis and open surgical revascularization, no single treatment strategy can yet be considered optimal for patients with ALI. This report includes 20 years of published data to evaluate the efficacy and safety profile of thrombolytic agents and adjunctive endovascular techniques when compared to open surgical revascularization.
Subject(s)
Endovascular Procedures , Ischemia/therapy , Lower Extremity/blood supply , Vascular Surgical Procedures , Acute Disease , Endovascular Procedures/adverse effects , Humans , Ischemia/diagnosis , Ischemia/physiopathology , Ischemia/surgery , Patient Selection , Postoperative Complications/etiology , Risk Assessment , Risk Factors , Treatment Outcome , Vascular Patency , Vascular Surgical Procedures/adverse effectsABSTRACT
BACKGROUND: The increase in life expectancy results in a higher number of patients with an advanced age over 80 years requiring abdominal aortic aneurysm therapy. The aim of this study was to review the outcome of octogenarians undergoing endovascular treatment for abdominal aortic aneurysms. PATIENTS AND METHODS: Between June 2004 and March 2008 25 patients (24 males, one female), with a mean age of 83 +/- 2.6 years (range: 80-91 years) underwent elective endovascular treatment for abdominal aortic aneurysms. The average preoperative aneurysm diameter was 57 +/- 9.8 mm (range: 40-80 mm). All procedures were carried out in the angiography suite under general anesthesia. RESULTS: Endovascular abdominal aortic aneurysm repair was technically successful in all patients. There was one perioperative death due to an aneurysm-related complication. The perioperative (30 days) mortality rate was 4 %. Intensive care unit admission was required in five patients. The in-hospital morbidity rate was 20 %. Mean follow-up time was 18.7 +/- 14 months (range: 2 to 47 months). Two patients died from unrelated causes. There were no device- or aneurysm-related deaths. A patient with a type I A endoleak underwent correction by additional stent-graft placement four weeks after initial placement. CONCLUSION: Endovascular abdominal aortic aneurysm repair in octogenarians is a valuable alternative to open aortic repair and can be performed safely and successfully. We strongly recommend the endovascular treatment for patients over 80 years of age with an appropriate size of aortic aneurysm.