RESUMO
The study consists in determining the effect of renal artery stenting in patients with arterial hypertension in combination with renal artery stenosis on the dynamics of clinical and geriatric status in terms of such indicators as the number of drugs taken, cognitive status, determined by the MMSE scale, prevalence of the frequency of falls, psycho-emotional status by the Beck scale, the quality of sleep on the VAS scale, the index of age discrimination according to the E.Palmore ageism questionnaire, the quality of life according to the SF 36 questionnaire. The study involved 72 elderly patients with arterial hypertension in combination with renal artery stenosis. According to the results of the study, as a result of stenting of the renal arteries, there is a decrease in the number of drugs taken, an improvement in the cognitive status on the MMSE scale, a decrease in the frequency of falls, an improvement in the psycho-emotional status on the Beck scale, an improvement in the quality of sleep on the VAS scale, a decrease in the level of age discrimination, an increase in the quality of life according to questionnaire SF-36 on all scales.
Assuntos
Hipertensão , Obstrução da Artéria Renal , Humanos , Idoso , Artéria Renal , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/cirurgia , Qualidade de Vida , Hipertensão/diagnóstico , Hipertensão/epidemiologia , StentsRESUMO
The most common heart valve defect among the elderly and senile is aortic valve stenosis. The traditional method of treating severe aortic valve stenosis is open surgery to replace aortic valve. At the same time, a more modern, minimally invasive method of correcting aortic stenosis is transcatheter aortic valve implantation (TAVI). This intervention is primarily indicated for patients of old age suffering from severe chronic heart failure associated with aortic stenosis, who have a high surgical risk. Currently, TAVI has evolved from a complex and dangerous procedure into an effective and safe method of treatment thanks to the development of a new generation of devices. Currently, there are still topical issues of using TAVI in individual clinical cases (use of TAVI in the elderly (60-75 years), TAVI in centenarians (90 years or more), TAVI in frailty, the feasibility of performing TAVI with low surgical risk, etc.), as well as issues related to longevity valves used for TAVI and prognosis in terms of quality and life expectancy.
Assuntos
Estenose da Valva Aórtica , Insuficiência Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/cirurgia , Humanos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/métodos , Resultado do TratamentoRESUMO
Aortic valve (AV) stenosis is the most common acquired valvular disease with an increasing prevalence due to an aging population, requiring surgical or endovascular intervention. Transcatheter Aortic Valve Implantation (TAVI) represents a real revolution in the field of interventional cardiology for the treatment of elderly or high-risk patients with severe symptomatic AV stenosis. TAVI allows for the correction of aortic defect in the most severe group of patients with chronic heart failure (CHF) with severe comorbidity, who are contraindicated for open surgery to replace AV, in order to interrupt the vicious circle in the progression of CHF, stimulate reverse myocardial remodeling, alleviate symptoms, improve the quality of life, and prognosis of patients, and also as a «bridge¼ to heart transplantation. With the development of next-generation devices, TAVI has evolved from a complex and dangerous procedure to an effective and safe technique. Currently, the greatest scientific interest is the study of valve durability and the possibility of expanding the indications for performing TAVI in categories of patients with low surgical risk, as well as in younger age groups.
Assuntos
Estenose da Valva Aórtica , Insuficiência Cardíaca , Substituição da Valva Aórtica Transcateter , Idoso , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/cirurgia , Humanos , Qualidade de Vida , Fatores de Risco , Resultado do TratamentoRESUMO
A literature review of the publications of foreign authors on the treatment of non-varicose bleeding from the upper gastrointestinal tract of elderly and senile patients is presented. The authors showed a modern view of the possibilities of endovascular hemostasis in comparison with a surgical operation with inefficiency of endoscopic hemostasis and characterized patients in whom it is possible this will be most effective.
Assuntos
Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica , Idoso , Humanos , Resultado do Tratamento , Trato Gastrointestinal SuperiorRESUMO
Hybrid revasculization of myocardium combined the advantages of mammary-coronary bypass surgery and coronary arteries stenting. It presented itself as a perspective direction in treatment of ischemic coronary disease. The article provides the results of comparison of usage of hybrid revasculization of myocardium and aortocoronary bypass in 71 patients with multivessel coronary artery disease. The data obtained indicated, that hybrid approach allowed complete revasculization of the myocardium (as in case of aortocoronary bypass), fast recovery of the patient, shortening a hospital stay due to decrease of intra- and postoperative complications.
Assuntos
Doença da Artéria Coronariana/cirurgia , Vasos Coronários/cirurgia , Revascularização Miocárdica/métodos , Stents , Idoso , HumanosRESUMO
The article provides the results of minimally invasive direct revasculization of myocardium at the period from 2012 to 2014. Given method was used in 49 interventions. There weren't any lethal cases or myocardial infarctions. A mean hospital stay consisted of 8,6±2,7. Computer thomographic coronary bypass angiography was carried out after operation in terms of 6-48 months. The occlusion of mammary coronary shunt was revealed in 3 patients with minimally invasive revasculization of the myocardium in terms up to 48 months. There were noted a decrease' of hospital stay, bleeding during surgery and in early postoperative period, duration of artificial pulmonary ventilation, length of stay in intensive care unit for this group of patients.
Assuntos
Ponte de Artéria Coronária/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Infarto do Miocárdio/cirurgia , Toracotomia/métodos , Angiografia Coronária , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Estudos RetrospectivosRESUMO
Increasingly, there are patients with concomitant coronary artery disease and aortic valve, especially in elderly patients, who often have severe comorbidities and high surgical risk, which is undoubtedly a certain effect on the choice of method and tactics of treatment. Today, there are several approaches to the treatment of patients in this category, and all of them have certain advantages and disadvantages.
Assuntos
Estenose da Valva Aórtica , Procedimentos Cirúrgicos Cardiovasculares , Doença da Artéria Coronariana , Administração dos Cuidados ao Paciente/métodos , Idoso , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/terapia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Procedimentos Cirúrgicos Cardiovasculares/métodos , Comorbidade , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/terapia , Humanos , Risco AjustadoAssuntos
Trombectomia , Tromboembolia/prevenção & controle , Filtros de Veia Cava/efeitos adversos , Trombose Venosa , Humanos , Extremidade Inferior/irrigação sanguínea , Avaliação de Resultados em Cuidados de Saúde , Trombectomia/instrumentação , Trombectomia/métodos , Tromboembolia/etiologia , Veias/cirurgia , Trombose Venosa/complicações , Trombose Venosa/fisiopatologia , Trombose Venosa/cirurgiaRESUMO
Intervention in bifurcation coronary arteries disease is complicated kind of endovascular treatment of coronary heart disease, especially in patients of elderly and senile age. Recently, in the practice of the operating surgeon there is a large choice of bifurcation coronary artery stents. This report contains the views, features and shortcomings of the presented bifurcation structures. Despite the fact that in the Russian Federation bifurcation stents are rarely implanted, their use can greatly simplify and accelerate interventional procedures, along with the decrease of peri- and postoperative complications.
Assuntos
Angioplastia Coronária com Balão/métodos , Doença da Artéria Coronariana/terapia , Stents , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Doença da Artéria Coronariana/patologia , Humanos , Stents/efeitos adversos , Resultado do TratamentoRESUMO
Stenting of coronary artery bifurcation lesions is one of the most difficult types of interventional procedures for coronary heart disease. The frequency of coronary artery bifurcation lesion occurs up to 20%. The article reflects a wide variety of types of classifications of coronary bifurcations compared with the basic classification for A. Medina. Having considered the arts of bifurcations stenting, from a provisional Tstenting to complex procedures culote and crush stenting, we advocate the use of bifurcation structures, especially in elderly and senile.
Assuntos
Angioplastia Coronária com Balão/métodos , Doença da Artéria Coronariana/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/instrumentação , Doença da Artéria Coronariana/classificação , HumanosRESUMO
Hybrid technologies are becoming increasingly strong position in modern cardiac surgery. New standards and expanding the indications for use of these techniques are delivered. The advantages of hybrid interventions are to a substantial reduction in trauma patients during surgery, reducing the risk of both intra- and postoperative complications, death, the most important for the elderly and senile age.
RESUMO
The article describes the clinical case and analyzes the literature concerning endoprosthesis replacement in the case of traumatic thoracic aortic injury in polytrauma. Current strategy of diagnostics and treatment of patient in critical condition with rupture of isthmic aortic part is based on the principle of multistage surgical treatment (damage control orthopedic). The external fixation of multiple pelvis and extremities fractures and on-time implantation of stent-graft in thoracic aortic part were performed at first hours after the admission. A condition of the patient was stabilized. The delayed reconstructive operations on pelvis and extremities bones allowed obtaining the satisfactory functional result. The principles of staged surgical treatment and the use of on-time high-technology methods allowed saving life for the patient even in critical situation in I level traumatologic centre.
Assuntos
Aorta Torácica , Traumatismo Múltiplo , Complicações Pós-Operatórias/terapia , Sepse , Enxerto Vascular , Ferimentos não Penetrantes , Adulto , Aorta Torácica/lesões , Aorta Torácica/fisiopatologia , Aorta Torácica/cirurgia , Prótese Vascular , Humanos , Masculino , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/fisiopatologia , Reoperação , Ruptura/diagnóstico , Ruptura/etiologia , Ruptura/fisiopatologia , Ruptura/cirurgia , Sepse/etiologia , Sepse/terapia , Stents , Tomografia Computadorizada por Raios X , Índices de Gravidade do Trauma , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Enxerto Vascular/métodosRESUMO
The hybrid revascularization of a myocardium combines advantages of mammaro-coronary shunting and stenting of coronary arteries and represents the perspective direction in coronary heart disease treatment. This technique is of most value in patients of advanced and senile age, and also in patients of high surgical risk as it shows small injury, which enables to reduce and facilitate the postoperative period. However today, there is no single standard for the execution of these operations, in particular it is not clear, which scheme of antiagregant and anticoagulant therapy is worth adhering for greater efficiency of the procedures and patient safety.