Saphenous vein ablation with a new cyanoacrylate glue device: a systematic review on 1000 cases.

BACKGROUND: To review published evidence regarding an n-butyl-cyanoacrylate (NBCA) injection device for great (GSV) and small (SSV) saphenous vein incompetence in terms of occlusion rate, postoperative complications and quality of life improvement. MATERIAL AND METHODS: International bibliographic databases (PubMed, EMBASE, Scopus) were searched to identify possible target articles. The only inclusion criterion was the use of the Variclose® system (Biolas, Ankara, Turkey) for superficial vein insufficiency. Exclusion criteria were case reports, review, meta-analysis, article with <6-month follow-up data, abstracts and congress presentations. PRISMA guidelines were used to lead articles selection. RESULTS: Seven studies were included in the final data analysis. A total of 918 patients (1000 limbs) underwent an NBCA procedure for GSV (947 cases) or SSV (53 cases) incompetence. The average procedure duration was 11.7 min. The most common postoperative complications were postoperative pain (4.8%) and superficial vein thrombosis (2.1%). No deep vein thrombosis or pulmonary embolism cases were described. The occlusion rates at six, 12 and 30 months were 97.3%, 96.8% and 94.1%, respectively. CONCLUSION: NBCA injection with the Variclose device seems to be a feasible, effective and safe treatment in GSV incompetence. Long-term follow-up studies and randomized controlled trials are needed to achieve high-quality evidence.

Ten years of endovascular aortic arch repair.

PURPOSE: To evaluate a 10-year single-center experience of arch endovascular aortic repair (AEVAR) using the hybrid approach. METHODS: Between 1999 and 2009, 311 patients were treated with endografts for thoracic aortic pathologies. The aortic arch was involved in 116 (37.3%) patients (97 men; mean age 70.3+/-10.7 years, range 27-84). There were 83 atherosclerotic aneurysms, 21 type B dissections, and 12 other lesions whose proximal landing zones were categorized according to Ishimaru's classification as 24 zone 0, 27 zone 1, and 65 zone 2. A hybrid approach was performed for all zone 0 and zone 1 procedures and in nearly half (47.7%) of zone 2 procedures. Early and midterm outcomes were reviewed retrospectively. RESULTS: The initial clinical success in zone 0 aneurysms was 83.3%, with a 30-day mortality of 12.5% due to intraoperative stroke in all the cases. The respiratory failure rate was 12.5%, and there was 1 type I endoleak that spontaneously resolved at follow-up. Midterm clinical success at a mean 26+/-21 months was 83.3%. In zone 1 aneurysms, the initial clinical success was 82.1% without 30-day mortality or perioperative stroke. The midterm clinical success was 81.5% at a mean 21+/-17 months [2 (7.4%) late aneurysm-related deaths]. Four type I endoleaks spontaneously resolved in 3 patients. In zone 2 cases, the initial clinical success was 90.8%. There was 1 (1.5%) intraoperative death and another (1.5%) within 30 days; 1 (1.5%) patient suffered a stroke, and the respiratory and renal failure rates were 3.0%, respectively. This is the only zone in which paraplegia (2 patients, 3.0%) was encountered. The midterm clinical success was 93.9% at a mean 34+/-20 months. Four type I endoleaks spontaneously resolved in 3 patients at follow-up. CONCLUSION: In selected patients, early and midterm outcomes of AEVAR using the hybrid approach are promising; however, mortality and morbidity, especially for zones 0 and 1, are not negligible. Our results may have practical implications for the ongoing evolution of the hybrid procedure in the aortic arch, as well as for patients fit for traditional surgery.

Endovascular treatment of aortic arch aneurysms / Tratamento endovascular dos aneurismas de arco aórtico

BACKGROUND: Endovascular approach to the aortic arch is an appealing solution for selected patients. OBJECTIVE: To compare the technical and clinical success recorded in the different anatomical settings of endografting for aortic arch disease. METHODS: Between June 1999 and October 2006, among 178 patients treated at our institution for thoracic aorta disease with a stent-graft, the aortic arch was involved in 64 cases. According to the classification proposed by Ishimaru, aortic zone 0 was involved in 14 cases, zone 1 in 12 cases and zone 2 in 38 cases. A hybrid surgical procedure of supra-aortic debranching and revascularization was performed in 37 cases. RESULTS: Zone 0. Proximal neck length: 44±6 mm. Initial clinical success was 78.6 percent: two deaths (stroke), one type Ia endoleak. At a mean follow-up of 16.4±11 months the midterm clinical success was 85.7 percent. Zone 1. Proximal neck length: 28±5 mm. Initial clinical success was 66.7 percent: 0 deaths, four type Ia endoleaks. At a mean follow-up of 16.9±17.2 months the midterm clinical success was 75.0 percent. Zone 2. Proximal neck length: 30±5 mm. Initial clinical success was 84.2 percent: two deaths (one cardiac arrest, one multiorgan embolization), three type Ia endoleaks, one case of open conversion. Two cases of delayed transitory paraparesis/paraplegia were observed. At a mean follow-up of 28.0±17.2 months the midterm clinical success was 89.5 percent. CONCLUSIONS: This study and a literature review demonstrated that hybrid procedure for aortic arch pathology is feasible in selected patients at high risk for conventional surgery. Our experience is still limited by the relatively small sample size. We propose to reserve zone 1 for patients unfit for sternotomy or in cases with aortic neck length > 30 mm following left common carotid artery debranching. We recommend to perform complete aortic rerouting of the aortic arch in cases with lesser comorbidities and shorter aortic neck.

CONTEXTO: O tratamento endovascular dos aneurismas do arco aórtico é uma solução interessante para pacientes selecionados. OBJETIVO: Comparar os sucessos técnico e clínico registrados nas diferentes regiões anatômicas do arco aórtico após a colocação de endoprótese. MÉTODOS: Entre junho de 1999 e outubro de 2006, 178 pacientes foram tratados na nossa instituição devido a doenças da aorta torácica com a colocação de endoprótese, sendo que o arco aórtico estava envolvido em 64 casos. De acordo com a classificação proposta por Ishimaru, a zona aórtica 0 estava envolvida em 14 casos, zona 1 em 12 casos e zona 2 em 38 casos. Procedimentos de debranching do arco aórtico e revascularização extra-anatômica dos troncos supra-aórticos foram realizados em 37 casos para obter um adequado colo aórtico proximal. RESULTADOS: Zona 0. Comprimento do colo proximal: 44±6 mm. Sucesso clínico inicial de 78,6 por cento: dois óbitos (acidente vascular cerebral), um vazamento do tipo Ia. Seguimento médio de 16,4±11 meses com sucesso clínico a médio prazo de 85,7 por cento. Zona 1. Comprimento do colo proximal: 28±5 mm. Sucesso clínico inicial de 66,7 por cento: 0 óbitos, quatro vazamentos do tipo Ia. Seguimento médio de 16,9±17,2 meses com sucesso clínico a médio prazo de 75 por cento. Zona 2. Comprimento do colo proximal: 30±5 mm. Sucesso clínico inicial de 84,2 por cento: dois óbitos (um infarto cardíaco e uma embolização de múltiplos órgãos), três vazamentos do tipo Ia, um caso de conversão para operação aberta. Dois casos de paraparesia/paraplegia transitória tardia foram observados. Seguimento médio de 28,0±17,2 meses com sucesso clínico a médio prazo de 89,5 por cento. CONCLUSÃO: Este estudo e a análise da literatura demonstram que o procedimento híbrido para moléstia do arco aórtico é factível em pacientes selecionados com alto risco para a operação convencional. Nossa experiência ainda é limitada pelo tamanho relativamente pequeno da amostra. Sugerimos...

Aorto-iliac aneurysm associated with congenital pelvic kidney: a short series of successful open repairs under hypothermic selective renal perfusion.

The occurrence of congenital pelvic kidney (cPK) during aorto-iliac aneurysm repair is an extremely unusual finding. We report a series of four patients with aorto-iliac aneurysm and associated cPK who underwent aorto-iliac repair at our institution over the last 10 years. Aorto-iliac aneurysm repair under cPK selective hypothermic perfusion was successfully accomplished in all cases. All the cPK arteries were spared and were selectively reimplanted when required. No major complications or death were reported at long-term follow-up. Open surgical repair of aorto-iliac aneurysm in patients with cPK is safe and effective and, in our short series, we observed no worsening of the renal function; besides, we reported a persistent improvement of the renal function in two out of the four cases.