RESUMEN
The objective of this article was to give a comprehensive overview over the different etiologies and the current techniques and results of endovascular treatment of aneurysms of the extracranial carotid artery. Extracranial carotid artery aneurysms are characterized by a low incidence but a high stroke rate in case of conservative management. Open surgical treatment has the disadvantage of a high percentage of postoperative cranial nerve injury and morbidity due to the cervical exposure. Endovascular treatment is attractive because of its less invasiveness. Due to the large variety of etiologies and different endovascular treatment approaches no comparative trials or even large retrospective studies do exist to determine the optimal treatment for the disease. This is a non-systematic review of clinical case series and retrospective analysis about endovascular treatment of extracranial carotid artery aneurysms in English literature.
Asunto(s)
Aneurisma/terapia , Implantación de Prótesis Vascular , Enfermedades de las Arterias Carótidas/terapia , Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma/diagnóstico , Aneurisma/epidemiología , Aneurisma/cirugía , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Enfermedades de las Arterias Carótidas/diagnóstico , Enfermedades de las Arterias Carótidas/epidemiología , Enfermedades de las Arterias Carótidas/cirugía , Embolización Terapéutica/efectos adversos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Humanos , Complicaciones Posoperatorias/etiología , Factores de Riesgo , Stents , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
In the femoropopliteal segment, endovascular revascularization techniques have gained the role as a first line treatment strategy. Nitinol stent placement has improved the short- and mid-term primary patency rates in most lesion types and is therefore widely applied. Stenting has several shortcomings as in-stent restenosis, stent fractures and foreign material being left behind in the vessel. The concept of atherectomy is plaque debulking. This results in a potential reduction of inflation pressure requirements in angioplasty. Stent placement and consecutive in-stent restenosis may be avoided. In this non systematic literature review, the performance of different atherectomy techniques, such as direct atherectomy, orbital atherectomy, laser debulking and rotational atherectomy in the treatment of complex femoropopliteal lesions, including long lesions, moderately to heavily calcified lesions as well as occlusions and in-stent restenosis, has been analyzed.
Asunto(s)
Aterectomía/métodos , Arteria Femoral/patología , Arteria Femoral/cirugía , Enfermedades Vasculares Periféricas/cirugía , Arteria Poplítea/patología , Arteria Poplítea/cirugía , Grado de Desobstrucción Vascular , Aleaciones , Constricción Patológica/cirugía , Falla de Equipo , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/prevención & control , Humanos , Conducto Inguinal , Láseres de Excímeros/uso terapéutico , Enfermedades Vasculares Periféricas/patología , Índice de Severidad de la Enfermedad , Stents/efectos adversos , Resultado del Tratamiento , Calcificación Vascular/cirugíaRESUMEN
Endovascular aortic repair (EVAR) necessitates lifelong surveillance for the patient, in order to detect complications timely. Endoleaks (ELs) are among the most common complications of EVAR. Especially type II ELs can have a very unpredictable clinical course and this can range from spontaneous sealing to aortic rupture. Subgroups of this type of EL need to be identified in order to make a proper risk stratification. Aim of this review is to describe the existing imaging techniques, including their advantages and disadvantages in the context of post-EVAR surveillance with a particular emphasis on low-flow ELs. Low flow ELs cause pressurization of the aortic aneurysm sac with a low velocity filling, leading to difficulty of detection by routine imaging protocols for EVAR surveillance, e.g. bi- or triphasic multislice computed tomographic angiography, magnetic resonance imaging and contrast enhanced ultrasound. In this article, we review the imaging possibilities of ELs and discuss the different imaging strategies available for depicting low flow ELs.
Asunto(s)
Aorta/cirugía , Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular/efectos adversos , Diagnóstico por Imagen/métodos , Endofuga/diagnóstico , Procedimientos Endovasculares/efectos adversos , Angiografía de Substracción Digital , Aorta/fisiopatología , Aorta/ultraestructura , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/fisiopatología , Aortografía , Medios de Contraste , Endofuga/etiología , Endofuga/fisiopatología , Hemodinámica , Humanos , Angiografía por Resonancia Magnética , Valor Predictivo de las Pruebas , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler DúplexRESUMEN
The majority of patients with symptomatic carotid artery stenosis will benefit from early intervention with carotid endarterectomy (CEA). Carotid artery stenting (CAS) can be an alternative to CEA in selected cases. This paper will deal with the technical aspects of CAS in the emergency setting, including the use of embolic protection devices and will also discuss the pharmacologic management and treatment of complications. A review of the literature will be presented.
Asunto(s)
Angioplastia/instrumentación , Estenosis Carotídea/terapia , Stents , Angioplastia/efectos adversos , Angioplastia/mortalidad , Anticoagulantes/uso terapéutico , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/mortalidad , Dispositivos de Protección Embólica , Urgencias Médicas , Fibrinolíticos/uso terapéutico , Humanos , Selección de Paciente , Inhibidores de Agregación Plaquetaria/uso terapéutico , Medición de Riesgo , Factores de Riesgo , Resultado del TratamientoRESUMEN
This paper will describe the technique of the treatment of in-stent restenosis of the infrainguinal arteries, using a combined technique of laser debulking followed by drug-eluting balloon angioplasty. The results of this technique from the literature will be discussed, and a comparison with other techniques that are currently used will be made.
Asunto(s)
Angioplastia de Balón Asistida por Láser/instrumentación , Angioplastia de Balón/instrumentación , Enfermedad Arterial Periférica/terapia , Stents , Dispositivos de Acceso Vascular , Angioplastia de Balón/efectos adversos , Angioplastia de Balón Asistida por Láser/efectos adversos , Animales , Constricción Patológica , Diseño de Equipo , Humanos , Enfermedad Arterial Periférica/diagnóstico , Recurrencia , Retratamiento , Resultado del TratamientoRESUMEN
In-stent restenosis after endovascular treatment of stenotic and occlusive disease of the infrainguinal arteries is still a clinical challenge. In this paper an overview of the current status of drug-eluting balloon technology and results of clinical trials with drug-eluting balloon angioplasty is given. Furthermore a case series of 10 patients with in-stent restenosis that were treated with excimer laser angioplasty and drug eluting balloons is described. In this case series the mean lesion length treated was 115 mm, and the mean time to occurrence of restenosis after initial treatment was 7.2 months. At a mean follow-up (of all patients) of 7.6 months no target vessel revascularization was seen. In 7 patients that had Duplex and/or angiographic control (mean follow-up 7 months) no signs of neointimal hyperplasia were demonstrated. These short-term data compare favorable to results obtained with standard balloon angioplasty and cutting-balloon angioplasty. Long-term follow-up is necessary to define the role of combined excimer laser and drug-eluting balloon angioplasty in the treatment of in-stent restenosis further.
Asunto(s)
Angioplastia de Balón/instrumentación , Angioplastia por Láser/métodos , Stents Liberadores de Fármacos , Procedimientos Endovasculares/métodos , Oclusión de Injerto Vascular/terapia , Láseres de Excímeros/uso terapéutico , HumanosRESUMEN
This paper will discuss the potential role of interventional radiologists in teaching of endovascular skills to vascular surgical trainees. Prerequisites and advantages of such a training will be discussed, as well as the secondary effect this kind of training program may have on developing multidisciplinary teams.
Asunto(s)
Educación de Postgrado en Medicina , Procedimientos Endovasculares/educación , Internado y Residencia , Relaciones Interprofesionales , Radiología Intervencionista/educación , Procedimientos Quirúrgicos Vasculares/educación , Competencia Clínica , Conducta Cooperativa , Curriculum , Humanos , Modelos Educacionales , Grupo de Atención al PacienteRESUMEN
In all fields of surgery there is a trend towards less invasive procedures reducing hospital stay, complications and mortality. Open surgery in the treatment of aortic diseases is gradually less applied, and instead endovascular aortic repair - EVAR - is a widely accepted treatment modality of today. The traditional approach in EVAR involves surgical exposure of the femoral arteries with bilateral groin incisions. Through the groin access, and under fluoroscopy, a special insertion sheath introducer is used to position a stent graft in the desired location with the patient in general or epidural anesthesia. The evolving stent-technology with smaller sheath sizes has broadened the scenario for alternative approaches for access and closure of the common femoral arteries. The following review presents an introduction on technical aspects of puncture of the femoral artery and closure of the arterial wall using percutaneous closure devices. We also aim to discuss three important approaches to expose and close the femoral arteries during endovascular aortic repair: The cut down approach, the true percutaneous technique, and the femoral fascial closure. Finally, factors important in the choice of techniques will be discussed in relation to early and late complications. We suggest that a percutaneous femoral approach should initially be considered for all endovascular aortic procedures, but with a low threshold to convert to traditional cut-down technique when complications such as bleeding, stenosis, ischemia, or femoral artery injury occur. The choice of the optimal femoral approach depends on the unique anatomy of each patient.
Asunto(s)
Enfermedades de la Aorta/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Arteria Femoral , Hemorragia/prevención & control , Técnicas Hemostáticas , Enfermedades de la Aorta/diagnóstico por imagen , Aortografía/métodos , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Arteria Femoral/diagnóstico por imagen , Hemorragia/etiología , Humanos , Imagen por Resonancia Magnética , Selección de Paciente , Diseño de Prótesis , Punciones , Stents , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
This paper will discuss the clinical sequelae of deep venous thrombosis of the lower extremity and will deal briefly with conservative therapy. The (endo)vascular modalities that are currently used will be described more in detail, and includes systemic thrombolysis, surgical thrombectomy, catheter directed thrombolysis and other catheter based therapies like ultrasound assisted thrombolysis, pharmacomechanical thrombolysis and percutaneous mechanical thrombectomy. Results, advantages and disadvantages of each technique will be dealt with.
Asunto(s)
Extremidad Inferior/irrigación sanguínea , Trombectomía , Terapia Trombolítica , Trombosis de la Vena/terapia , Medicina Basada en la Evidencia , Humanos , Trombectomía/efectos adversos , Terapia Trombolítica/efectos adversos , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/cirugíaRESUMEN
This paper will deal with the role of vena cava filters in the management of venous thromboembolism. The role of medical therapy, indications and contraindications for the placement of caval filters will be discussed. An overview of the currently available filters will be given, and technical aspects, as well as complications related to the procedure will be discussed. Finally the management of patients with a filter in situ and indications for caval filter removal shall be dealt with.
Asunto(s)
Embolia Pulmonar/prevención & control , Filtros de Vena Cava , Tromboembolia Venosa/terapia , Remoción de Dispositivos , Medicina Basada en la Evidencia , Humanos , Diseño de Prótesis , Embolia Pulmonar/etiología , Resultado del Tratamiento , Filtros de Vena Cava/efectos adversos , Tromboembolia Venosa/complicaciones , Tromboembolia Venosa/diagnósticoRESUMEN
BACKGROUND: Vascular access patency is of vital importance for patients requiring haemodialysis. This analysis validates potential risk factors and benefits in patients undergoing vascular access procedures. PATIENTS AND METHODS: Vascular access procedures performed over a two-year period were retrospectively analysed. Clinical data and concomitant medication were retrieved from files as were surgical data following a standardized data capture sheet. Outcome parameters were primary (PP) and secondary patency (SP) as well as freedom from repeated revascularization. Minimal follow-up with functioning access was 679 days. RESULTS: During the observation period, 244 patients (mean age 62.2 +/- 0.9 years, 60.7 % male patients, 36.1 % pre-emptive, 31.1 % late referral) underwent vascular accesses procedures. PP and SP were 35.6 % and 45.6 %, respectively, at 540 days. Presence of diabetes mellitus was associated with decreased PP (OR: 0.6, 95 %-CI: 0.3 - 1.0) and SP (OR: 0.4, 95 %-CI: 0.2 - 0.7), whereas female gender was associated with lower SP (OR: 0.6, 95 %-CI: 0.3 - 0.9) and freedom from repeated revascularization rates (OR: 0.6, 95 %-CI: 0.3 - 1.0). In contrast, presence of hyperparathyreoidism was associated with higher SP (OR: 1.7, 95 %-CI: 1.0 - 3.0) and freedom from repeated revascularization (OR: 1.7, 95 %-CI: 1.0 - 3.0) rates. CONCLUSIONS: Haemodialysis access performs worst in patients with diabetes mellitus and in women. The benefit of hyperparathyroidism should be interpreted as hypothesis generating.
Asunto(s)
Derivación Arteriovenosa Quirúrgica , Oclusión de Injerto Vascular/etiología , Fallo Renal Crónico/terapia , Diálisis Renal , Grado de Desobstrucción Vascular , Derivación Arteriovenosa Quirúrgica/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Distribución de Chi-Cuadrado , Complicaciones de la Diabetes/etiología , Femenino , Oclusión de Injerto Vascular/cirugía , Humanos , Hiperparatiroidismo/complicaciones , Estimación de Kaplan-Meier , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Modelos de Riesgos Proporcionales , Reoperación , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Resultado del TratamientoRESUMEN
The purpose of this study was to prospectively evaluate the incidence of retinal emboli during carotid angioplasty and stenting (CAS) and to correlate emboli with clinical findings and transcranial Doppler (TCD)-detected cerebral embolic load. Between 2001 and 2005, 33 CAS procedures in 32 patients (23 [72%] male, 19 [58%] symptomatic, mean age 72.5 years [range 54.6 to 83.9]) scheduled for CAS were included in this study. Bilateral fundoscopy with retinal photography was performed by an experienced ophthalmologist immediately before, immediately after (fundoscopy only), and 1 day after the procedure and again at long-term follow-up (mean 37 months). Visual field testing was performed before CAS and again at long-term follow-up. TCD-detected cerebral emboli were stratified to five procedural phases: wiring, predilatation, stent placement, postdilatation, and cerebral protection device (CPD) use (if applicable). To establish correlation between TCD data and retinal embolization, Mann-Whitney test was used, and P < 0.05 was considered statistically significant. All procedures were performed successfully. In five of 33 procedures (15%), new retinal emboli were found. Two of the procedures with emboli had small retinal infarcts. Three of five were performed using CPDs versus seven of 28 that had no retinal emboli (P = not significant). Two of four patients (50%) with previous radiation therapy to the neck had new retinal emboli versus three of 29 patients (10%) who had no previous radiation therapy (P = 0.038). None of the other patient characteristics was associated with retinal embolization. In 30 (91%) of patients with an adequate acoustic temporal window for TCD monitoring, there was no statistically significant correlation between TCD data and the incidence of retinal emboli. No visual field defects were found. On long-term follow-up, all retinal emboli and retinal infarcts had resolved. Retinal embolization during CAS is not uncommon, and it occurs in both protected and unprotected procedures. Most retinal emboli are clinically silent.
Asunto(s)
Angioplastia de Balón/estadística & datos numéricos , Enfermedades de las Arterias Carótidas/epidemiología , Enfermedades de las Arterias Carótidas/terapia , Embolia/epidemiología , Arteria Retiniana/diagnóstico por imagen , Enfermedades de la Retina/epidemiología , Stents , Anciano , Anciano de 80 o más Años , Comorbilidad , Embolia/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Remisión Espontánea , Enfermedades de la Retina/diagnóstico por imagen , Ultrasonografía Doppler Transcraneal/métodosAsunto(s)
Implantación de Prótesis Vascular/normas , Estenosis Carotídea/cirugía , Stents , Angiografía de Substracción Digital , Implantación de Prótesis Vascular/métodos , Estenosis Carotídea/diagnóstico , Competencia Clínica , Diagnóstico Diferencial , Humanos , Angiografía por Resonancia Magnética , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler DúplexRESUMEN
Endovascular aneurysm repair (EVAR) represents one of the greatest advances in vascular surgery over the past 50 years. In contrast to conventional aneurysm repair, EVAR requires accurate preoperative imaging and stringent postoperative surveillance. Duplex ultrasound (DUS), transesophageal echocardiography, intravascular ultrasound, computed tomography (CT) and magnetic resonance (MR), each provide useful information for patient selection, choice of endograft type and surveillance. Today most interventionists and surgeons will rely on CT or MR to assess aortic morphology, evaluate access artery patency and locate side branch orifices. However, recent developments in cross-sectional imaging, including advanced image postprocessing, multi-modality image fusion and new contrast agents have resulted in improved spatial resolution for preoperative planning. Advanced reconstruction algorithms, like dynamic CTA and MRA, provide valuable information on dynamic changes in aneurysm morphology that might have an important impact on endograft selection. During follow-up, imaging of the graft and aneurysm is of utmost importance to identify patients in need of secondary intervention. This has led to rigorous follow-up protocols including duplex ultrasound and regular CT examinations. The use of these intense follow-up protocols has recently been questioned because of high radiation dose and the frequent use of nephrotoxic contrast agents. New imaging modalities like contrast enhanced DUS, dynamic MR and dual-source CT could reduce radiation dose and obviate the need for nephrotoxic contrast. Up-to-date knowledge of non-invasive vascular imaging and image processing is crucial for EVAR planning and is essential for the development of follow-up programs involving reduced risk of harmful side effects.
Asunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico , Implantación de Prótesis Vascular , Diagnóstico por Imagen , Selección de Paciente , Angiografía de Substracción Digital , Aneurisma de la Aorta Abdominal/cirugía , Aortografía , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Diagnóstico por Imagen/efectos adversos , Diagnóstico por Imagen/métodos , Ecocardiografía Transesofágica , Humanos , Angiografía por Resonancia Magnética , Valor Predictivo de las Pruebas , Diseño de Prótesis , Radiografía Intervencional , Reoperación , Medición de Riesgo , Stents , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía Doppler Dúplex , Ultrasonografía IntervencionalRESUMEN
This paper deals with the treatment of acute neurological complications that may occur during carotid angioplasty with stenting. Endovascular 'neurorescue' techniques include mechanical thrombus removal (using retrieval devices, aspiration catheters, and wire or balloon fragmentation) and local and intra-arterial thrombolysis. The treatment of acute thrombosis and dissection during carotid artery and stenting will also be discussed. Knowledge of these additional skills is essential to increasing the safety of carotid stenting procedures.
Asunto(s)
Angioplastia/efectos adversos , Angioplastia/métodos , Encefalopatías/etiología , Encefalopatías/cirugía , Enfermedades de las Arterias Carótidas/cirugía , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/cirugía , Stents , Embolectomía/instrumentación , Embolectomía/métodos , Embolización Terapéutica/instrumentación , Embolización Terapéutica/métodos , Diseño de Equipo , HumanosRESUMEN
INTRODUCTION: Surgical treatment of renal artery aneurysms is inevitably associated with temporary renal artery occlusion and risk of ischemic injury. We present a technique for renal artery grafting and aneurysm exclusion without interrupting renal blood flow. REPORT: A symptomatic renal artery aneurysm was bypassed with a venous graft between the abdominal aorta and the very distal renal artery utilizing a distal anastomotic device without interruption of renal blood flow. The aneurysm was then excluded by means of hemostatic clips. CONCLUSION: The presented surgical technique offers the major advantage of avoiding organ ischemia and accelerating the surgical procedure.
Asunto(s)
Aneurisma/cirugía , Isquemia/prevención & control , Arteria Renal/cirugía , Vena Safena/trasplante , Procedimientos Quirúrgicos Vasculares , Adulto , Anastomosis Quirúrgica , Aneurisma/patología , Aneurisma/fisiopatología , Aorta/cirugía , Diseño de Equipo , Femenino , Humanos , Isquemia/etiología , Isquemia/fisiopatología , Angiografía por Resonancia Magnética , Arteria Renal/patología , Arteria Renal/fisiopatología , Circulación Renal , Engrapadoras Quirúrgicas , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/instrumentaciónRESUMEN
This paper will describe the complications that can occur during and after carotid artery angioplasty and stenting. Etiology, prevention and treatment of procedure related complications will be dealt with.