ABSTRACT
Stents have been created to prevent vessel recoil after percutaneous transluminal angioplasty (PTA). Despite the evolution in stent design, intimal hyperplasia and stent fractures and the resulting in-stent restenosis (ISR) still occur. Different strategies to treat ISR have been described with variable results in patency rates in the short and the long-term. PTA only in the treatment of ISR showed high procedural success, but the mid and long-term patency rates were very disappointing. Atherectomy devices have showed same insufficient results. If stent fracture is the cause of the ISR, the fracture has to be overstent. The best two options are covered stents and drug eluting stents (DES). Drug eluting devices like DES and drug eluting balloons (DEBs) showed promising results, with patency rates up to over 90% after one year. DEBs have the advantage of leaving nothing behind. Combined treatment of ISR with atherectomy and DEB has a similar good result. Endovascular brachytherapy showed high patency rates after one year but this technique is limited due to the time-consuming nature of the procedure, complex radiation safety measurements, and staffing requirements. Overall drug-eluting devices are emerging as the best treatment of SFA ISR with patency rates over 90% after 2 years.
Subject(s)
Angioplasty, Balloon/instrumentation , Angioplasty, Balloon/methods , Femoral Artery , Peripheral Arterial Disease/therapy , Prosthesis Failure , Stents , Angioplasty, Balloon/adverse effects , Atherectomy/instrumentation , Cardiovascular Agents/administration & dosage , Coated Materials, Biocompatible , Constriction, Pathologic , Drug-Eluting Stents , Femoral Artery/physiopathology , Humans , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/physiopathology , Prosthesis Design , Recurrence , Risk Factors , Time Factors , Treatment Outcome , Vascular Access Devices , Vascular PatencyABSTRACT
The purpose of this article was to obtain a more clear view in the management of popliteal artery aneurysms (PAAs). When do we need to treat it and how is it best treated? After going through multiple review articles and case reports concerning this matter, we came to the following conclusions. Repair of a PAA is indicated when it reaches a postero-anterior diameter of 3 cm (at higher risk for thrombosis) or becomes symptomatic (mild claudication or severe ischemic symptoms). Whether the repair is then performed in an endovascular (Endovascular repair) or open way (Open repair), depends on the personal experience and clinical evaluation of the surgeon.
Subject(s)
Aneurysm/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Patient Selection , Popliteal Artery/surgery , Aneurysm/diagnosis , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Diagnostic Imaging/methods , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Humans , Predictive Value of Tests , Risk Factors , Stents , Treatment OutcomeABSTRACT
We present a case report of a bifurcated aorto-iliac stent graft infection two years after implantation. The initial procedure of implantation as well as the patient's recovery was uneventful. Two years later the patient presented with a growing aneurysmal sac without a detectable endoleak and consequent rupture. Instead of graft explantation, we left the graft in situ and performed thorough debridement and an omentoplasty, because of the poor condition of the patient. A Staphylococcus species grew out of the cultures of the aortic wall. The patient recovered well without persistent infection and is still doing well after 43 months. This conservative approach might be an alternative in patients who are deemed to be at high risk for classic graft explantation and an extra-anatomic bypass or in situ bypass.
Subject(s)
Aorta, Abdominal , Aortic Rupture/etiology , Blood Vessel Prosthesis , Prosthesis-Related Infections/complications , Stents/adverse effects , Aged, 80 and over , Aortic Aneurysm, Abdominal/therapy , Endovascular Procedures , Humans , Male , Postoperative Complications , Psoas Abscess/etiologyABSTRACT
An ileocecal interposition (ICI) between the descending colon and anus was performed in a girl, 14 months old, with congenital aganglionosis up to the sigmoid colon. The left colon could not safely be mobilised because the paracolic arcade had been interupted during a preceding colostomy construction. The functional result, 14 years after reconstruction, is excellent: 1-2 easy defecations per day with normal continence for flatus and stool. An ICI may be an appropriate rescue procedure, saving a maximum length of normally innervated bowel and providing a neorecta1 reservoir.
Subject(s)
Digestive System Surgical Procedures/methods , Hirschsprung Disease/surgery , Colon, Sigmoid/surgery , Colostomy , Enema , Female , Humans , Infant , Rectum/surgeryABSTRACT
In an effort to further improve the hybridisation potential of anhydro-hexitol nucleoside analogues, the 1'-methoxyl and 3'-methoxyl substituents were introduced and evaluated for their antisense potential. In view of the selectivity of pairing with RNA, especially the introduction of a 3'-O-alkyl moiety deserves further study.
Subject(s)
Alcohols , Nucleic Acids/chemical synthesis , Alkylation , Methylation , Nucleosides/chemical synthesisABSTRACT
Hypertension remains a major cause of cardiovascular morbidity in Belgium. Information on the prevalence of hypertension in the working population is desirable. A worksite study of hypertension prevalence was carried out in Belgium where 3472 individuals were screened for 1 week. The result was that high blood pressure (> or = 140/90 mm Hg) was identified in approximately one-third of the men and one-quarter of the women even though the majority of subjects had no recorded history of hypertension. Associations were identified between age and systolic blood pressure and, in men, between systolic blood pressure and alcohol consumption. Most participants in the survey were unaware of their serum cholesterol level. The results of this survey suggest that a large proportion of subjects with high blood pressure in the Belgian working population remain unidentified and indicate a lack of awareness about other cardiovascular risk factors.
