Subject(s)
Abdomen/diagnostic imaging , Aortic Diseases/pathology , Duodenal Diseases/pathology , Hematemesis/diagnosis , Hemostatic Techniques/instrumentation , Intestinal Fistula/diagnostic imaging , Aged , Aortic Diseases/surgery , Computed Tomography Angiography/methods , Duodenal Diseases/surgery , Hematemesis/etiology , Humans , Intestinal Fistula/pathology , Intestinal Fistula/surgery , Laparotomy , Male , Melena/diagnosis , Melena/etiology , Syncope/diagnosis , Treatment OutcomeABSTRACT
Aortic rupture in the presence of aneurysmal disease is well understood and extensively described in the literature. However, aortic rupture in a non-aneurysmal aorta is far less common. In the few reported cases, perforations are believed to result from a penetrating atheromatous ulcer of the aorta. We describe a rare case of non-aneurysmal aortic rupture in a 68-year-old man with Marfan syndrome and a history of proximal aortic surgery. The urgent need for hemorrhage control precluded any consideration of an endovascular repair.
Subject(s)
Aortic Rupture/etiology , Hemorrhage/etiology , Marfan Syndrome/complications , Aged , Aortic Rupture/diagnostic imaging , Aortic Rupture/surgery , Aortography/methods , Blood Vessel Prosthesis Implantation , Fatal Outcome , Hemorrhage/diagnostic imaging , Hemorrhage/surgery , Hemostatic Techniques , Humans , Male , Marfan Syndrome/diagnosis , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
INTRODUCTION: Aortoiliac arterial occlusive disease is frequently encountered in the management of lower limb vascular insufficiency. We report our experience with covered balloon-expandable stents for treatment of TASC D lesions of the abdominal aorta and common iliac arteries. METHODS: A retrospective study of 30 patients who underwent aortoiliac stenting with the Atrium Advanta V12 from March 2010 to September 2012 was conducted. Patient demographic data, clinical signs and symptoms and procedural details were recorded. Outcomes assessed were primary patency, secondary patency, technical success, complications, limb salvage and survival. RESULTS: Median age was 67 years (range 48-84) and 40% of patients underwent treatment for critical limb ischaemia. Median follow-up was 13 months (range 3-38 months). Stent configuration comprised of long iliac stents in 20 patients, a large diameter aortic stent with iliac stenting in six patients, and aortic stent alone in four patients. Radiological success was achieved in 100% and the complication rate was 6%. Primary patency at 6, 12 and 24 months was 97%, 90% and 79%, respectively. Four cases of in-stent stenosis were reported, with three of these undergoing re-interventions resulting in a secondary patency rate of 97% at the end of follow-up. One patient death occurred within the follow-up period. DISCUSSION: This case series demonstrates that treatment of complex aortoiliac occlusive disease with covered balloon-expandable stents can have acceptable results with good patency and good clinical outcome. Secondary patency rates are comparable to open surgical revascularisation, with lower morbidity.
Subject(s)
Angioplasty, Balloon/instrumentation , Aorta, Abdominal , Aortic Diseases/therapy , Arterial Occlusive Diseases/therapy , Iliac Artery , Stents , Aged , Aged, 80 and over , Angiography, Digital Subtraction , Angioplasty, Balloon/adverse effects , Angioplasty, Balloon/mortality , Aorta, Abdominal/diagnostic imaging , Aorta, Abdominal/physiopathology , Aortic Diseases/diagnosis , Aortic Diseases/mortality , Aortic Diseases/physiopathology , Aortography , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/mortality , Arterial Occlusive Diseases/physiopathology , Constriction, Pathologic , Female , Humans , Iliac Artery/diagnostic imaging , Iliac Artery/physiopathology , Kaplan-Meier Estimate , Limb Salvage , Male , Middle Aged , Prosthesis Design , Recurrence , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , Vascular PatencyABSTRACT
BACKGROUND: Recent data suggest that infrapopliteal percutaneous transluminal angioplasty (PTA) is a reasonable primary therapy for critical limb ischaemia (CLI). Based on the transatlantic intersociety consensus (TASC) classification, this has been found to be true for lesions classified as A, B or C. We report our experience with infrapopliteal PTA stratified by TASC classification. METHODS: A retrospective study of patients who underwent infrapopliteal PTA with or without stenting from October 2007 to July 2011 was conducted, revealing 83 limbs. The primary outcome variables were freedom from reintervention and freedom from index limb amputation. Secondary outcomes were technical success, post-operative complications and survival. TASC classification was assessed for the individual vessel(s) chosen for intervention. RESULTS: Median age was 76 years and radiological success was 86.75%. Average follow-up was 15 months. At 1 and 2 years, freedom from re-intervention, or amputation was 65.1% and 55.6%. Limb salvage was 77.7%. Within 2 years, 2% underwent bypass and 18% repeat infrapopliteal PTA. The 30-day mortality was 5%. Overall survival was 84.5%, 71.8% and 61.6% at 1, 2 and 3 years. Eighty-two per cent were classified as TASC D lesions. Radiological success was achieved in 100% of TASC C lesions in contrast to 86.7% of TASC D lesions. There was not a statistically significant relationship between primary outcomes and TASC D classification. DISCUSSION: Given the encouragingly high rates of radiological success and limb salvage, an attempt at PTA is indicated as an alternative to primary amputation even in patients with radiologically demonstrated severe disease.
