RESUMEN
INTRODUCTION: Since 2019, Braile Biomédica® introduced a novel custom-made abdominal endograft tailored to the aorta's anatomy, featuring sizing every 3 mm and a diameter change from 50 mm to 8 mm. This design permits uncovered fenestrations around a single Z stent, eliminating the need for bridging stents to visceral vessels. Utilizing triple stent technology, optimal neck fixation is ensured, enabling treatment of necks shorter than 2 mm, with three 360° fenestrations optimizing graft fixation. This paper aims to analyze the initial experience with this custom-made infrarenal graft for abdominal aorta aneurysm (AAA), concerning procedural success and post-procedural short-term outcomes. RESULTS: Among 12 patients treated from May 2022 to January 2024, technical success was achieved in 91.7 %, with only one intra-procedural complication. Follow-up CT scans at 1-3 months revealed resolution of an intraoperative endoleak and two late complications: a late type III endoleak and right renal artery occlusion. CONCLUSIONS: The recent experience with Braile Biomédica® custom-made abdominal endograft demonstrates promising outcomes, particularly in treating AAAs with challenging anatomical features.
Asunto(s)
Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular , Prótesis Vascular , Procedimientos Endovasculares , Diseño de Prótesis , Stents , Humanos , Aneurisma de la Aorta Abdominal/cirugía , Procedimientos Endovasculares/métodos , Implantación de Prótesis Vascular/métodos , Implantación de Prótesis Vascular/instrumentación , Italia , Masculino , Femenino , Anciano , Resultado del Tratamiento , Estudios Retrospectivos , Anciano de 80 o más Años , Factores de Tiempo , Complicaciones PosoperatoriasRESUMEN
Pseudoaneurysm (PA) formation after carotid endarterectomy (CEA) is a very uncommon but dangerous complication, potentially responsible for cerebral embolism or rupture. Therefore, the PA treatment is imperative. Until few years ago, the treatment of choice was represented by open surgical repair, with a higher mortality and morbidity rate than primary operation. Actually, the advancements in endovascular procedures allow the surgeon the possibility to recur to a less invasive approach in the presence of an adequate anatomy, reducing the risk of cranial nerve injuries. We present a case of post-CEA PA successfully treated using the double-layer micromesh stent (Roadsaver®; Terumo, Tokyo, Japan), with almost immediate thrombosis of the aneurysmal sac.
Asunto(s)
Aneurisma Falso/cirugía , Estenosis Carotídea/cirugía , Endarterectomía Carotidea/efectos adversos , Procedimientos Endovasculares/instrumentación , Stents , Anciano , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/fisiopatología , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/fisiopatología , Angiografía por Tomografía Computarizada , Humanos , Masculino , Diseño de Prótesis , Resultado del Tratamiento , Ultrasonografía Doppler en Color , Grado de Desobstrucción VascularRESUMEN
We report the case of a 75-year-old man submitted to traditional endovascular aortic repair (EVAR) for infrarenal abdominal aortic aneurysm. He presented a late type II endoleak 6 months after operation, initially without sac enlargement. One year later, a computed tomography scan control demonstrated a sac expansion >10 mm, also responsible for a secondary proximal type I endoleak. The patient was submitted to transarterial embolization of lumbar arteries through left internal iliac artery, followed by type I endoleak correction with a proximal cuff deployment. Intraoperative angiography revealed no signs of endoleak. Six months later, a sudden enlargement of the sac was detected, with evidence of type III endoleak, probably consequence of the lumbar arteries embolization, promptly corrected through an aortoaortic endograft. In conclusion, even if a conservative approach for type II endoleak without sac enlargement is proposed, sometimes a sudden sac enlargement could be responsible for catastrophic events in the absence of strict follow-up. The sac embolization during EVAR could reduce the incidence of type II endoleak during follow-up, with reoperation and hospital cost reduction.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular , Embolización Terapéutica , Endofuga/cirugía , Procedimientos Endovasculares , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aortografía/métodos , Implantación de Prótesis Vascular/efectos adversos , Angiografía por Tomografía Computarizada , Endofuga/diagnóstico por imagen , Endofuga/etiología , Procedimientos Endovasculares/efectos adversos , Humanos , Masculino , Resultado del Tratamiento , Ultrasonografía Doppler en ColorRESUMEN
While endovascular aortic aneurysm repair (EVAR) has proven to be a safer alternative to open surgical repair for infrarenal abdominal aortic aneurysms (AAA) repair, the development of stent-graft complications mandates follow-up computed tomography imaging to minimize AAA-related mortality. In this single-institution report, adverse EVAR events identified in 150 consecutive patients are detailed. Early morbidity was low (<3%), with only 1 patient death on post-procedure day 2. After discharge (mean follow-up of 24 months), 2 patients died from cancer and one AAA-related mortality occurred after open conversion for stent-graft migration. Although computed tomography imaging detected no EVAR endoleak at 30 days, 19 patients developed an endoleak, including three Type I and four Type III leaks. Our institutional series review confirmed that EVAR of infrarenal AAA is a safe and valid alternative to open surgical repair, but sac embolization at the primary procedure in patients judged to be at high risk for Type II endoleak should be considered.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Prótesis Vascular/efectos adversos , Embolización Terapéutica , Endofuga/terapia , Procedimientos Endovasculares/efectos adversos , Migración de Cuerpo Extraño/terapia , Stents/efectos adversos , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/mortalidad , Aortografía/métodos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/mortalidad , Angiografía por Tomografía Computarizada , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/mortalidad , Endofuga/diagnóstico por imagen , Endofuga/etiología , Endofuga/mortalidad , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/mortalidad , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/mortalidad , Humanos , Italia , Masculino , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
The indication for carotid artery stenosis treatment is based primarily on the severity of internal carotid stenosis. There is increasing evidence that unstable plaques in the extracranial carotid artery can be responsible for ischemic stroke or transient ischemic attacks as the source of emboli, even if in the presence of a moderate stenosis. Physicians should be aware that morphological characteristics of the carotid plaques that indicate recent intra-plaque hemorrhage might require intervention in the absence of severe stenosis. This report details a patient with an unstable plaque in the common carotid artery who met clinical criteria for intervention because of the risk for future stroke.
Asunto(s)
Arteria Carótida Común/diagnóstico por imagen , Arteria Carótida Común/cirugía , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/cirugía , Angiografía por Tomografía Computarizada , Endarterectomía Carotidea , Placa Aterosclerótica , Ultrasonografía Doppler Dúplex , Anciano , Arteria Carótida Común/patología , Estenosis Carotídea/patología , Toma de Decisiones Clínicas , Humanos , Masculino , Valor Predictivo de las Pruebas , Rotura Espontánea , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
We report a case of traumatic anterior dislocation of the left knee in association with disruption of the soft tissues including knee ligaments, popliteal artery, and common peroneal nerve, resulting in lower limb acute ischemia. All components of this complex trauma were recognized and treated promptly. First, he was submitted to closed reduction of the dislocated knee under general anesthesia; right after he underwent superficial femoro-tibioperoneal trunk bypass using a reversed saphenous contralateral vein recurring to a posterior approach through a popliteal S-shaped incision; rehabilitation program was initiated early; a second and final reconstructive orthopedic operation was carried out in a different center. The present case is important in 2 aspects. First, it reports a very rare occurrence of simultaneous anterior dislocation of the knee associated with vascular insult and common peroneal nerve injury, which was rarely reported in the current literature; second, it highlights that with timely intervention and a team approach, excellent results could be achieved.
Asunto(s)
Isquemia/cirugía , Luxación de la Rodilla/cirugía , Articulación de la Rodilla/cirugía , Recuperación del Miembro , Artes Marciales/lesiones , Arteria Poplítea/cirugía , Vena Safena/cirugía , Injerto Vascular/métodos , Lesiones del Sistema Vascular/cirugía , Adolescente , Angiografía por Tomografía Computarizada , Humanos , Isquemia/diagnóstico por imagen , Isquemia/etiología , Isquemia/fisiopatología , Luxación de la Rodilla/diagnóstico por imagen , Luxación de la Rodilla/etiología , Luxación de la Rodilla/fisiopatología , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiopatología , Masculino , Neuropatías Peroneas/etiología , Neuropatías Peroneas/cirugía , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/lesiones , Arteria Poplítea/fisiopatología , Valor Predictivo de las Pruebas , Vena Safena/diagnóstico por imagen , Vena Safena/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/fisiopatologíaRESUMEN
Endovascular aneurysm repair (EVAR) actually represents the treatment of choice for most patients affected by abdominal aortic aneurysm (AAA). However, the feasibility of EVAR depends on anatomical characteristics of abdominal aorta and iliofemoral axis. We present the case of an 82-year-old man affected by severe left hydronephrosis, kidney tumor, and ureteral tumor requiring nephrectomy, who also presented a very voluminous AAA with a large diameter (96 mm), and a large proximal neck (39 mm) with severe angulation of the proximal neck (>60°). The patient was considered unfit for traditional EVAR and open surgery. Possible alternatives such as fenestrated endovascular abdominal aortic aneurysm repair and chimney technique were excluded; therefore he was treated combining Valiant Captivia endoprosthesis with the AFX unibody, with a good final result. However, this particular alternative adopted for hostile proximal neck needs long-term follow-up.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Diseño de Prótesis , Stents , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aortografía/métodos , Angiografía por Tomografía Computarizada , Humanos , Masculino , Resultado del TratamientoRESUMEN
Abdominal aortic pseudoaneurysm is a rare but life-threatening condition that occurs due to penetrating or blunt trauma. Clinical manifestations are variable, and the time interval from the initial trauma to diagnosis is variable. A prompt diagnosis and an aggressive management approach are required to avoid catastrophic complications. Possible treatment options are open surgical repair, endovascular repair, pseudoanerysmal sac thrombosis induction through direct thrombin injection, and coil embolization. Here, we present the case of a 75-year-old man affected by an infrarenal abdominal aortic pseudoaneurysm presenting with abdominal and lumbar pain for 3 days, who was successfully treated with an endograft.