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1.
Vascular ; 22(1): 51-4, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23512895

RESUMO

Recent improvement in the survival of patients presenting with a ruptured abdominal aortic aneurysm (rAAA) has been credited to endovascular aneurysm repair (EVAR). We present our clinical series in the management of rAAA from 2007 to 2011. A total of 55 consecutive patient charts were reviewed. Thirty-eight patients underwent EVAR, 17 of the 55 patients did not have favorable anatomy for EVAR. Nine of the 17 patients underwent standard open repair. Eight patients underwent a 'hybrid repair' defined as suprarenal aortic endovascular balloon control followed by open repair. Overall 30-day mortality for all 55 patients was 22%. Mortality for the patients managed by endovascular aortic aneurysm repair was 26% compared with 22% with open repair. There were no deaths in the eight patients undergoing the hybrid repair. Endovascular balloon control of the aorta followed by open rAAA repair in patients who are not candidates for rEVAR has produced good results in our experience. Improved results being reported in the management of rAAA may not be on the basis of endovascular repair alone.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Injúria Renal Aguda/etiologia , Idoso , Idoso de 80 Anos ou mais , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
2.
Am Surg ; 77(6): 675-80, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21679631

RESUMO

With an increasing proportion of U.S. individuals 80 years of age or older, the authors examined their surgical experience with octogenarians undergoing major, curative-intent thoracic surgery. Between January 1, 1990, and September 1, 2009, 102 octogenarians underwent curative-intent resection for nonsmall cell carcinoma of the lung (NSCCL), esophageal carcinoma (EC), or related surgery for thoracic esophageal perforation (EP). Analysis and reporting followed the guidelines of the Nationwide Inpatient Sample database study (1994 to 2003). Eighty-six patients underwent curative-intent resection for NSCCL, 12 for EC, and four for surgery for EP. Hospital and 30-day mortalities were 0 per cent. Overall 1-, 2-, and 5-year survival rates were: 78, 58, and 32 per cent. Within the NSCCL cohort, minimally invasive exposures (video-assisted thoracic surgery [VATS] and video thoracoscopy [VT]) were associated with fewer and shorter duration of air leaks, leading to shorter length of stay. Since we began using minimally invasive exposure for NSCCL in 2007, the percentage of octogenarians discharged within 5 days of surgery has increased from 35.5 to 66.7 per cent (P = 0.01), and the percentage of patients discharged within 3 days of surgery has increased from 8.1 to 33.3 per cent (P = 0.006). Of 24 patients undergoing surgery for NSCCL since 2007, 18 (75%) underwent minimally invasive (VATS or VT) exposures, of which 15 patients (83.3%) were discharged home within 5 days and eight (44.4%) within 3 days of their procedure. Excellent, short- and longer-term results can be achieved in elderly patients if risks, exposures, and resections are appropriately matched to patient performance.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Esofágicas/cirurgia , Perfuração Esofágica/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/estatística & dados numéricos , Procedimentos Cirúrgicos Torácicos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Esofagectomia/estatística & dados numéricos , Gastrectomia/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Procedimentos Cirúrgicos Torácicos/tendências , Toracotomia/estatística & dados numéricos
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