ABSTRACT
Purpose: To analyze the changes in target vessel (TV) anatomy after fenestrated endovascular aneurysm repair (fEVAR) during midterm follow-up. Materials and Methods: A retrospective single-center study analyzed 56 patients (mean age 71±7 years; 49 men) who underwent fEVAR using custom-made stent-grafts (22 Zenith and 34 Anaconda) between June 2010 and July 2016. Advanta V12 (V12; 74, 53%) and BeGraft (BeG; 66, 47%) stent-grafts were used to bridge to the 140 TVs. Measurements of the TV deviation at the aortic origin, the vessel shift distal to the bridging stent-graft (BSG), and the outer and inner BSG curve lengths were performed after 3-dimensional reconstruction of the serial computed tomography angiography scans. The results of the measurements for the main devices, the TVs, and the bridging stent-grafts were compared using univariable and multivariable analysis. Results: Of the 140 BSGs examined (74 V12s and 66 BeGs), 393 measurements (38 celiac trunks, 102 superior mesenteric arteries, 121 left renal arteries, and 132 right renal arteries) were analyzed. The outer/inner BSG curve length ratio was larger after implantation of Zenith devices compared with Anaconda (p<0.001). The vessel shift distal to the BSG was significantly associated with the interaction of the TV and type of BSG only in the univariable analysis (p=0.001). There were no significant changes of the TV deviation at the aortic origin. Only the outer BSG curve length was significantly associated with TV complications (p=0.033). Median follow-up was 24 months (range 2-61). The BSG curve length ratio showed a significant increase over time (p<0.001) but did not differ between the BeG and V12 (p=0.381). Conclusion: No difference was found between the V12 and the BeG stent-grafts regarding anatomical TV changes during midterm follow-up after fEVAR. Both stent-grafts adapt to the TV anatomy over time, and moderate anatomical changes seem to be tolerated without increasing the risk for TV complications. The type of main device also influences the TV anatomy.
Subject(s)
Aortic Aneurysm/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Celiac Artery/surgery , Endovascular Procedures/instrumentation , Mesenteric Artery, Superior/surgery , Renal Artery/surgery , Stents , Vascular Remodeling , Aged , Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm/physiopathology , Blood Vessel Prosthesis Implantation/adverse effects , Celiac Artery/diagnostic imaging , Celiac Artery/physiopathology , Endovascular Procedures/adverse effects , Female , Humans , Male , Mesenteric Artery, Superior/diagnostic imaging , Mesenteric Artery, Superior/physiopathology , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Prosthesis Design , Renal Artery/diagnostic imaging , Renal Artery/physiopathology , Retrospective Studies , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
INTRODUCTION: Idiopathic peripheral facial palsy is the most common and frequent unilateral cranial neurological disorder characterized by an isolated facial nerve paralysis. CASE REPORT: We report a case of an idiopathic facial paralysis (Bell's palsy) in the immediate puerperium in a patient with mild preeclampsia and diagnosed fetal IUGR. Additionally, the presence of Bell's palsy in the puerperium of the mother of our patient suggests a familiar tendency. DISCUSSION: Every gynaecologist and obstetrician should be aware of this quite uncommon complication during pregnancy and the puerperium. This case report illustrates that Bell's palsy can occur in the immediate post-partum after mild preeclamptic symptoms. For these women, a maternal surveillance can be recommended. A fast and accurate diagnosis with a subsequent immediate treatment might be very important in avoiding worsening of the symptoms and therefore improve the recovery prognosis.
