Subject(s)
Aortic Aneurysm, Abdominal , Aortic Aneurysm , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Humans , Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm/surgery , Stents , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Prosthesis Design , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/surgery , Endovascular Procedures/adverse effects , Treatment OutcomeSubject(s)
Humans , Female , Middle Aged , Femoral Artery , Ischemia , Hypertension , Ergotamine , TherapeuticsABSTRACT
BACKGROUND: Endovascular techniques have become an essential tool for treatment of thoracic aortic pathology. The objective of this study was to analyze indications and results of thoracic endovascular aortic repair (TEVAR) in vascular surgery units, through a retrospective and multicentric national registry called Regis-TEVAR. METHODS: From 2012 to 2016, a total of 287 patients from 11 vascular surgery units, treated urgently and electively, were recruited consecutively. The primary variables analyzed are mortality, survival, and reintervention rate. The following indications for TEVAR were also analyzed: aortic dissections, thoracic aneurysms, traumatisms, and intramural hematomas or penetrating ulcers, as well as results and postoperative complications in accordance with each indication. RESULTS: Of the 287 TEVAR performed (239 men, mean age 64.1 ± 14.1 years), 155 were because of aortic aneurysm (54%), 90 because of type B aortic dissection (31.4%), 36 because of traumatic aortic rupture (12.5%), and 6 because of penetrating ulcers or intramural hematomas (2.1%). Overall mortality at 30 days was 11.5% (18.5% in urgent and 5.3% in elective), being higher in dissections (13.3%). The median actuarial survival was 73% at 4 years. The stroke rate was 3.1%, and the rate of spinal cord ischemia was 4.9%. Aortic reoperations were necessary in 23 patients (8.1%). CONCLUSIONS: This registry provides complete and reliable information on real clinical practice of TEVAR in Spain, with results similar to international series of open surgery. In accordance with these data, TEVAR can be performed with acceptable morbidity and mortality and with low rates of postoperative complications.
Subject(s)
Aorta, Thoracic/surgery , Aortic Diseases/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Aged , Aorta, Thoracic/diagnostic imaging , Aortic Diseases/diagnostic imaging , Aortic Diseases/mortality , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/mortality , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Endovascular Procedures/mortality , Female , Humans , Male , Middle Aged , Postoperative Complications/mortality , Postoperative Complications/surgery , Registries , Reoperation , Retrospective Studies , Risk Factors , Spain , Time Factors , Treatment OutcomeABSTRACT
INTRODUCCIÓN: La oclusión aórtica aguda (OAA) es una patología infrecuente con una alta morbimortalidad. El objetivo del estudio fue describir los resultados del tratamiento quirúrgico de la oclusión aórtica aguda y factores de riesgo de mortalidad. MÉTODOS: Se revisaron retrospectivamente las historias clínicas de 29 pacientes diagnosticados e intervenidos por OAA durante 28 años. Se recogieron las variables edad, sexo, tabaco, diabetes, insuficiencia renal crónica, insuficiencia cardiaca, fibrilación auricular, hipertensión arterial, síntomas, diagnóstico y tratamiento, mortalidad a 30 días y supervivencia a largo plazo. Se analizó mediante análisis univariante que factores se relacionaban con la mortalidad. RESULTADOS: Se incluyeron 29 (18 varones), con una media de 66,2 años. La etiología fue: embolia (EM) en 11 casos y trombosis (TR) en 18 casos. Los procedimientos quirúrgicos realizados incluyeron trombectomía transfemoral bilateral (14 casos), by-pass aorto bifemoral (8 casos), by-pass axilo uni/bifemoral (5 casos) y tromboendarterectomía aortoiliaca y renal (2 casos). La morbilidad incluyó: insuficiencia renal (14 casos), isquemia mesentérica (4 casos), complicaciones cardiacas (7 casos), complicaciones respiratorias (5 casos) y pérdida de la extremidad (2 casos). La mortalidad hospitalaria fue del 21% (EM 0%, TR 21%). La supervivencia estimada a 1, 3 y 5 años fue del 60, 50 y 44% respectivamente. La edad (p = 0,032), la hipertensión arterial (p = 0,039) y la etiología de la OAA (p = 0,039) se relacionaron con la mortalidad. CONCLUSIONES: La oclusión aguda de aorta abdominal constituye una urgencia médica con elevada mortalidad. siendo la insuficiencia renal aguda la complicación más frecuente en el postoperatorio
INTRODUCTION: Acute aortic occlusion (AAO) is a rare disease with high morbidity and mortality. The aim of this study was to describe the results of surgical treatment of acute aortic occlusion and risk factors for mortality. METHODS: Retrospective review of the clinical history of 29 patients diagnosed and operated on for AAO during 28 years. The following variables were analysed: age, sex, tabaco use, diabetes, chronic renal insufficiency, chronic heart failure, atrial fibrillation, arterial hypertension, symptoms, diagnosis and treatment, 30-day mortality and long-term survival. A univariant analysis was performed of variables related to mortality. RESULTS: Twenty-nine patients were included (18 male) with a mean age of 66,2 years. The aetiology was: embolism (EM) in 11 cases and Thrombosis (TR) in 18 cases. The surgical procedures performed included bilateral transfemoral thrombectomy (14 cases), aortobifemoral by-pass (8 cases), axilo uni/bifemoral by-pass (5 cases) and aortoiliac and renal tromboendarterectomy (2 cases). Morbidity included: renal failure (14 cases), mesenteric ischemia (4 cases), cardiac complications (7 cases), respiratory complications (5 cases) and loss of extremity (2 cases). The in-hospital mortality was 21% (EM 0%, TR 21%). The estimated survival at 1.3 and 5 years was 60, 50 and 44% respectively. Age (p = 0.032), arterial hypertension (p = 0.039) and aetiology of the AAO (p = 0.039) were related to mortality. CONCLUSIONS: Acute aortic occlusion is a medical emergency with high mortality rates. Acute renal failure is the most common postoperative complication
Subject(s)
Humans , Aortic Valve Stenosis/surgery , Aorta, Abdominal/surgery , Treatment Outcome , Thrombosis/surgery , Embolism/surgery , Thrombectomy/methods , Endarterectomy/methodsABSTRACT
INTRODUCTION: Acute aortic occlusion (AAO) is a rare disease with high morbidity and mortality. The aim of this study was to describe the results of surgical treatment of acute aortic occlusion and risk factors for mortality. METHODS: Retrospective review of the clinical history of 29 patients diagnosed and operated on for AAO during 28 years. The following variables were analysed: age, sex, tabaco use, diabetes, chronic renal insufficiency, chronic heart failure, atrial fibrillation, arterial hypertension, symptoms, diagnosis and treatment, 30-day mortality and long-term survival. A univariant analysis was performed of variables related to mortality. RESULTS: Twenty-nine patients were included (18 male) with a mean age of 66,2 years. The aetiology was: embolism (EM) in 11 cases and Thrombosis (TR) in 18 cases. The surgical procedures performed included bilateral transfemoral thrombectomy (14 cases), aorto-bifemoral by-pass (8 cases), axilo uni/bifemoral by-pass (5 cases) and aortoiliac and renal tromboendarterectomy (2 cases). Morbidity included: renal failure (14 cases), mesenteric ischemia (4 cases), cardiac complications (7 cases), respiratory complications (5 cases) and loss of extremity (2 cases). The in-hospital mortality was 21% (EM 0%, TR 21%). The estimated survival at 1.3 and 5 years was 60, 50 and 44% respectively. Age (p=0.032), arterial hypertension (p=0.039) and aetiology of the AAO (p=0.039) were related to mortality. CONCLUSIONS: Acute aortic occlusion is a medical emergency with high mortality rates. Acute renal failure is the most common postoperative complication.
Subject(s)
Aortic Diseases/diagnosis , Aged , Female , Humans , Male , Postoperative Complications , Retrospective Studies , Risk Factors , Thrombosis , Treatment OutcomeABSTRACT
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