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Sample records for abdominal tratamiento endovascular

  1. Aneurisma de la aorta abdominal: Tratamiento endovascular con una endoprótesis fenestrada Abdominal aortic aneurysm: Endovascular treatment with fenestrated endoprothesis

    Directory of Open Access Journals (Sweden)

    Román Rostagno

    2008-12-01

    Full Text Available El tratamiento endovascular de los aneurismas de aorta abdominal es una alternativa a la cirugía abierta para pacientes de alto riesgo. Consiste en la exclusión del saco aneurismático mediante la interposición de una endoprótesis colocada por vía femoral. El tratamiento endovascular no puede ser utilizado en todos los pacientes. Una limitación frecuente la constituye el nacimiento de una arteria visceral desde el saco aneurismático. Para contrarrestar esta limitación recientemente se han desarrollado endoprótesis fenestradas que presentan orificios que se corresponden con el nacimiento de las arterias involucradas en el aneurisma evitando su oclusión, permitiendo de esta manera el tratamiento endovascular. En esta comunicación se presenta un caso de tratamiento endovascular de un aneurisma de aorta abdominal mediante la colocación de una endoprótesis fenestrada en un paciente cuya arteria renal izquierda nacía directamente del saco aneurismático.Endovascular treatment of the abdominal aortic aneurysm is consider an alternative to open surgery for high risk patients. Its goal is to exclude the aneurysm from the circulation by using an endoprothesis introduced from a femoral approach. Patients must be strictly selected to avoid possible complications. The most frequent limitation is related to anatomic contraindications such as visceral arteries involved in the aneurysm. Fenestrated endograft have been recently developed to allow endovascular treatment when anatomic features contraindicate classic endovascular procedures. Fenestrated endograft have holes that match with the origin of the visceral arteries maintaining its potency. In this paper we report the endovascular treatment of an abdominal aortic aneurysm by using a fenestrated endoprothesis in a patient whose left renal artery is originated from the aneurysm.

  2. TRATAMIENTO PERCUTÁNEO CON PRÓTESIS ENDOVASCULAR DE COARTACIÓN DE AORTA ABDOMINAL EN UN ADULTO / Percutaneous treatment with endovascular prosthesis of abdominal aortic coarctation in an adult

    Directory of Open Access Journals (Sweden)

    Luis Felipe Vega Fleites

    2010-12-01

    Full Text Available Resumen: La coartación de la aorta abdominal es una afección vascular no hereditaria poco frecuente, que afecta a hombres y mujeres por igual. Recientemente ha sido nombrada como “Síndrome aórtico medio”, y los hallazgos clínicos son similares a los de la CoAo típica. Para el diagnóstico, se debe recurrir a la resonancia magnética o a la arteriografía, y las opciones terapéuticas incluyen la dilatación percutánea con catéter-globo, el tratamiento quirúrgico y, por último, como opción más novedosa, la implantación de prótesis endovasculares. En este artículo presentamos el caso de una mujer de 45 años de edad, exfumadora, con antecedentes de artritis reumatoidea e hipertensión arterial que presentaba claudicación de miembros inferiores durante la marcha. Existía una disminución bilateral marcada de los pulsos femorales y el Doppler, y mostró un componente amortiguado en ambas arterias femorales y poplíteas. La AngioTAC encontró una estenosis significativa del tercio distal de la aorta abdominal infrarrenal, con hipoplasia marcada de la ilíaca derecha. La aortografía corroboró el diagnóstico (gradiente de 80 mmHg. A través de dos introductores arteriales por las arterias femorales se avanzaron dos catéteres-globo MATCH-35 de 5.0x80 mm que se inflaron simultáneamente y posteriormente, se implantó un stent MEDTRONIC “Bridge Assurant” de 10 x 30 mm en el segmento estenótico, sin complicaciones. El gradiente residual fue de 10 mmHg. La paciente evolucionó favorablemente y fue egresada a las 24 horas del procedimiento. / Abstract: Coarctation of the abdominal aorta is an uncommon, non-inherited vascular condition that affects men and women alike. It has been recently named as "middle aortic syndrome", and the clinical findings are similar to those of typical aortic coarctation. For diagnosis, one must make use of magnetic resonance imaging or arteriography, and therapeutic options include percutaneous balloon catheter dilatation, surgical treatment and, finally, as a more novel option, the implantation of stents. In this paper we present the case of a 45-year-old female, ex-smoker with a history of rheumatoid arthritis and hypertension who presented claudication of lower limbs during gait. There was a marked bilateral decrease of the femoral and Doppler pulses, and showed a damping factor in both femoral and popliteal arteries. The CT angiography found a significant stenosis of the distal third of the infrarenal abdominal aorta with marked hypoplasia of the right iliac. Aortography confirmed the diagnosis (gradient of 80 mmHg. Using two arterial sheaths, two-balloon catheters MATCH-35, 5.0x80 mm were introduced through femoral arteries, simultaneously inflated and subsequently a MEDTRONIC "Bridge Assurant" stent of 10x30 mm was implanted in the stenotic segment; with no complications. The residual gradient was 10 mmHg. The patient improved and was discharged form the hospital 24 hours after the procedure.

  3. Tratamiento endovascular de las patologías de aorta -Estado del arte-: Parte 1 - Aneurismas de aorta abdominal Endovascular treatment of aortic pathologies -State of the art-: Part 1 - Aneurysms of abdominal aorta

    Directory of Open Access Journals (Sweden)

    Carlos E Uribe

    2007-12-01

    Full Text Available En la actualidad, el tratamiento endovascular de las patologías de aorta es una alternativa a la cirugía abierta. Éste ha demostrado ser seguro ya que arroja resultados iguales o superiores que el grupo quirúrgico. En este artículo se presenta el estado actual del tratamiento con endoprótesis de las patologías de aorta, así como las indicaciones, las contraindicaciones y el futuro del tratamiento con este tipo de dispositivos.Endovascular treatment of aortic pathologies is actually an alternative to open surgery. It has proven to be safe, showing similar or better results to those achieved by surgery. In this article, treatment of aortic pathologies by means of endoprosthesis is presented, as well as its indications, contraindications and future treatment with this kind of devices.

  4. Endovascular grafts for abdominal aortic aneurysm.

    Science.gov (United States)

    Steuer, Johnny; Lachat, Mario; Veith, Frank J; Wanhainen, Anders

    2016-01-01

    During the last two decades, endovascular technology has revolutionized the management of patients with abdominal aortic aneurysm (AAA). Today, endovascular aortic repair (EVAR) is the treatment of choice for the majority of patients with an AAA. Randomized controlled trials provide robust evidence for the indication of AAA repair and the rationale for the use of EVAR in selected patients. However, despite that, practice varies and several areas need further elucidation. Important future challenges and areas of research include the role of medical therapy in AAA, whether the indication for repair should be any different in women and in the elderly, and long-term follow-up of patients undergoing complex EVAR with adjuncts, both for elective treatment and for ruptured AAA. Continuous rapid technical and clinical development is to be expected. In this paper, we review the current practice and evidence of stenting in AAA. PMID:26543044

  5. Endovascular treatment of abdominal aortic aneurysms.

    Science.gov (United States)

    Buck, Dominique B; van Herwaarden, Joost A; Schermerhorn, Marc L; Moll, Frans L

    2014-02-01

    Patients with abdominal aortic aneurysms (AAAs) are usually treated with endovascular aneurysm repair (EVAR), which has become the standard of care in many hospitals for patients with suitable anatomy. Clinical evidence indicates that EVAR is associated with superior perioperative outcomes and similar long-term survival compared with open repair. Since the randomized, controlled trials that provided this evidence were conducted, however, the stent graft technology for infrarenal AAA has been further developed. Improvements include profile downsizing, optimization of sealing and fixation, and the use of low porosity fabrics. In addition, imaging techniques have improved, enabling better preoperative planning, stent graft placement, and postoperative surveillance. Also in the past few years, fenestrated and branched stent grafts have increasingly been used to manage anatomically challenging aneurysms, and experiments with off-label use of stent grafts have been performed to treat patients deemed unfit or unsuitable for other treatment strategies. Overall, the indications for endovascular management of AAA are expanding to include increasingly complex and anatomically challenging aneurysms. Ongoing studies and optimization of imaging, in addition to technological refinement of stent grafts, will hopefully continue to broaden the utilization of EVAR. PMID:24343568

  6. Anestesia para intervenção cirúrgica endovascular na aorta abdominal / Anesthesia for endovascular surgery of the abdominal aorta / Anestesia para intervención quirúrgica endovascular en la aorta abdominal

    Scientific Electronic Library Online (English)

    Michelle Nacur, Lorentz; Carlos Leonardo Alves, Boni; Raquel Reis, Soares.

    2008-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O procedimento endovascular para correção de aneurisma de aorta é menos invasivo que o convencional, além de apresentar outras vantagens, como ausência de incisão abdominal, ausência de pinçamento da aorta e menor tempo de recuperação pós-operatória. Por se tratar de proce [...] dimento cirúrgico relativamente novo e apresentar uma série de alterações que devem ser conhecidas pelo anestesiologista foi realizado este trabalho com o objetivo de revisar os aspectos mais relevantes do procedimento endovascular e possibilitar manuseio anestésico mais adequado no perioperatório. CONTEÚDO: Apresentação sucinta da técnica cirúrgica para reparo de aneurismas via endovascular, as possíveis vantagens e desvantagens do procedimento, bem como as complicações potenciais. Além disso, foram abordados os cuidados perioperatórios que o procedimento exige e as técnicas anestésicas que podem ser utilizadas. CONCLUSÕES: O conhecimento das alterações provenientes do procedimento endovascular possibilita conduta anestésica mais adequada e melhora dos resultados perioperatórios nesses pacientes. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El procedimiento endovascular para la corrección del aneurisma de aorta es menos invasivo que el convencional, además de presentar otras ventajas como la ausencia de incisión abdominal, ausencia de pinzamiento de la aorta y un menor tiempo de recuperación postoperatoria. P [...] or tratarse de un procedimiento quirúrgico relativamente nuevo y por presentar una serie de alteraciones que deben ser conocidas por el anestesiólogo, se realizó este trabajo con el objetivo de revisar los aspectos más relevantes del procedimiento endovascular y posibilitar el manejo anestésico más adecuado en el perioperatorio. CONTENIDO: Sencilla presentación de la técnica quirúrgica para la cura de aneurismas vía endovascular, las posibles ventajas y desventajas del procedimiento, como también las complicaciones potenciales. Además de eso, se abordaron los cuidados perioperatorios que el procedimiento exige y las técnicas anestésicas que pueden ser utilizadas. CONCLUSIONES: El conocimiento de las alteraciones provenientes del procedimiento endovascular posibilita una conducta anestésica más adecuada y la mejora de los resultados perioperatorios en esos pacientes. Abstract in english BACKGROUND AND OBJECTIVES: Endovascular surgery for aneurism of the aorta is less invasive than the conventional procedure besides other advantages such as the absence of abdominal incision, absence of ligature of the aorta, and reduced postoperative recovery time. Since it is a relatively new proce [...] dure and to presenting a series of changes that should be known by the anesthesiologist, the objective of this report was to review the most relevant aspects of endovascular surgery, allowing more adequate perioperative anesthetic management. CONTENTS: A brief description of the technique of endovascular aneurism repair, possible vantages and disadvantages of its use, as well as potential complications are discussed. CONCLUSIONS: Knowledge of the changes secondary to the endovascular procedure allows a more adequate anesthetic conduct and improves the postoperative results in those patients.

  7. Neurologic injury after endovascular exclusion of abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To investigate the mechanism of neurologic injury after endovascular graft exclusion of abdominal aortic aneurysms and the methods of prevention and treatment. Materials: Since March 1997 to October 2002, endovascular graft exclusion for abdominal aortic aneurysm have been preformed on 136 patients, with one occurrence of neurologic injury after the operation. The main body-short limb graft was used in this case (Talent) and the operation was successful. The patient complained of bilateral lower extremities pain and disability. Electromusculogram showed bilateral femoral nerve injury. Then the patient was treated with vitamin B12, hyperbaric oxygen and physical therapy for 2 months outcoming with the symptom improvement. Conclusions: Neurologic injury after endovascular graft exclusion for abdominal aortic aneurysms is possible due to the occlusion of the lumbar artery during the operation. Early treatment is important and more effective. Later nerve nutrition and physical treatment can improve some symptoms partly

  8. Ruptured Abdominal Aortic Aneurysm with Antecedent Endovascular Repair of Abdominal Aortic Aneurysm

    OpenAIRE

    Cho, Jae S.

    2014-01-01

    Late aortic rupture following successful endovascular repair of abdominal aortic aneurysm still does occur. It represents the ultimate failure of endovascular aortic repair of abdominal aortic aneurysm (EVAR) and subjects patients to equivalent risk of death as de novo rupture. Unfortunately, it is difficult to identify patients at risk for post-EVAR rupture as many present with aortic rupture in the absence of any endograft-related complications. Continued surveillance and timely interventio...

  9. Open Versus Endovascular Stent Graft Repair of Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Firwana, Belal; Ferwana, Mazen; Hasan, Rim; Alpert, Martin A; Faries, Peter; Dangas, George; Gluud, Christian

    2014-01-01

    We performed an analysis to assess the need for conducting additional randomized controlled trials (RCTs) comparing open and endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Trial sequential analysis (TSA) is a statistical methodology that can calculate the required inform...

  10. [Own experience endovascular prosthetic repair of abdominal aortic aneurysms].

    Science.gov (United States)

    Chupin, A V; Kolosov, R V; Kalinin, A A; Za?tsev, M V; Parshin, P Iu; Orekhov, P Iu; Kemezh, Iu V; Terekhin, S A

    2012-01-01

    Endovascular prosthetic repair has increasingly been used over the last several decades. This type of intervention is indicated for patients running a high surgical and anaesthesiological risk of an open surgical procedure. The experience gained in endovascular prosthetic repair of abdominal aortic aneurysms makes it possible to extend the indications for its practical application. The authors describe herein their experience gained in a total of 20 procedures of endovascular prosthetic repair of abdominal aortic aneurysms using the Gore Excluder endograft device in patients running a high risk of an open surgical intervention. There were neither short -nor long-term lethal outcomes. Three patients after endovascular prosthetic repair were found to have type 1 endoleak and two appeared to have type 2 endoleak. Type 1 endoleaks were coped with intraoperationally. Dynamic follow-up (at 1, 6, 12 months after surgery) of patients including computed tomography showed no complications whatsoever (i. e., no endoleaks, endograft migration, nor increase in the aneurysm's diameter). After endografting of abdominal aortic aneurysms there were neither cardiac nor respiratory complications in the immediate postoperative period. Hence, endografting of an abdominal aortic aneurysm is a method of choice for high-risk patients. PMID:22836333

  11. Endovascular Repair of Abdominal Aortic Aneurysm in a Patient with Renal Transplant

    International Nuclear Information System (INIS)

    Patients with functioning renal transplant who develop abdominal aortic aneurysm can safely be treated with endovascular repair. Endovascular repair of aneurysm avoids renal ischemia associated with cross-clamping of aorta

  12. Ruptured Abdominal Aortic Aneurysm after Endovascular Aortic Aneurysm Repair

    OpenAIRE

    Lee, Chung Won; Chung, Sung Woon; Kim, Jong Won; Kim, Sangpil; Bae, Mi Ju; Kim, Chang Won

    2011-01-01

    In treating uncomplicated abdominal aortic aenurysm, endovascular aortic aneurysm repair (EVAR) has been employed as a good alternative to open repair with low perioperative morbidity and mortality. However, the aneurysm can enlarge or rupture even after EVAR as a result of device failure, endoleak, or graft migration. We experienced two cases of aneurismal rupture after EVAR, which were successfully treated by surgical extra-anatomic bypass.

  13. Endovascular therapy of thoracic and abdominal aortic lesions

    International Nuclear Information System (INIS)

    Objective: To investigate the clinical effects of comprehensive endovascular therapy for thoracic and abdominal aortic lesions. Methods: Five patients with DeBakey III aortic dissection (AD) were treated with endovascular therapy; including endovascular exclusion (EVE) with one-stent-graft (4 cases), fenestration of intimal flap (FIF) (1 case). One pseudoaneurysm after venous prothesis placed in DeBakey IIIAD was treated with one-stent-graft and another one with abdominal aortic aneurysm (AAA) below renal artery with separating stent-graft. Results: Five EVE with one-stent-graft were successfully furnished. Type I endoleakage was found in 2 cases, but disappeared after PTA in 1 case, and persisting after thirty minutes in another case. Both the lower leg's blood flow was recovered with symptom free in the FIF case. After one separating stent-graft placed, DSA showed that AAA disappeared without endoleakage. Conclusions: EVE or FIF is effective and reliable in treating thoracic and abdominal aortic lesions. Separating stent-graft shows more promising future. (authors)

  14. Tratamento endovascular de pseudoaneurisma da aorta abdominal: relato de caso Endovascular treatment of an abdominal aortic pseudoaneurysm: a case report

    Directory of Open Access Journals (Sweden)

    Emerson Henrique do Nascimento

    2010-09-01

    Full Text Available Um estudante de 17 anos, masculino, sofreu ferimentos por arma de fogo e foi submetido a uma laparotomia exploradora. No pós-operatório, queixava-se de dores em membros inferiores e de massa abdominal pulsátil. Realizou tomografia computadorizada (TC de abdome, que evidenciou pseudoaneurisma de aorta abdominal de cerca de 8 cm no maior diâmetro, localizado entre o tronco celíaco e a artéria mesentérica superior. Uma arteriografia confirmou o diagnóstico e procedeu-se, então, a embolização da lesão com fragmentos de fio-guia montados com fios de algodão. Após seis meses, realizou ecoDoppler de aorta abdominal e nova TC de abdome, que evidenciaram fluxo no interior do saco do pseudoaneurisma. Foi, então, submetido a nova embolização endovascular e implante de stent não-revestido de 18 x 58 mm. Após seis meses do último procedimento, realizou-se nova TC de abdome que demonstrou exclusão da lesão.A 17 years old male student has received several gunshots and was submitted to exploratory laparotomy. After surgery, he complained of pain in the lower limbs and a pulsatile abdominal mass. An abdominal computerized tomography (CT scan was carried out and revealed an abdominal aorta pseudoaneurysm of about 8 cm in the larger diameter between the celiac trunk and the superior mesenteric artery. An arteriography confirmed the diagnosis and he was submitted to the lesion embolization with cotton suture wires attached to metallic guide wire fragments. After six months, an abdominal aorta Doppler ultrasonography and a new abdominal CT scan were ordered and depicted flow inside the pseudoaneurysm. The patient was then submitted to a new endovascular embolization, and an 18 x 58 mm uncovered stent was placed. After six months from the last procedure, a new abdominal CT scan showed exclusion of the lesion.

  15. Aneurysm Sac Enlargement after Endovascular Abdominal Aortic Aneurysm Repair.

    Science.gov (United States)

    Dingemans, Siem A; Jonker, Frederik H W; Moll, Frans L; van Herwaarden, Joost A

    2016-02-01

    The aim of this study is to give an overview of current knowledge regarding abdominal aortic aneurysm (AAA) growth after endovascular aortic aneurysm repair (EVAR) that could potentially lead to aortic rupture. A search on Pubmed was performed. A total of 705 articles were found after initial search, of which 49 were included in the final selection. Reports on the incidence of aneurysm enlargement after EVAR vary between 0.2% and 41%. Continuous growth could lead to rupture of the aneurysm sac. There are several supposed risk factors for growth after EVAR. Endoleaks remain a hot topic as these could lead to persistent pressurization of the aneurysm sac causing growth. Various types of endoleak exist, of which each kind requires an individual treatment approach, other risk factors for aneurysm growth include endotension and the use of EVAR outside instructions for use (IFU). Reinterventions after EVAR are common; however, it is unclear how frequently these are required because of aneurysm enlargement. Aneurysm enlargement after EVAR remains a subject of debate, as this could lead to aortic rupture. This emphasizes the need for life-long radiologic surveillance during follow-up. Aortic growth after EVAR is often a result of endoleak; however, in some cases, no endoleak is detectable. Endoleak in combination with aortic growth >5 mm generally requires reintervention. A cause of concern is the liberal use of endovascular devices outside the IFU that may result in increased risk of AAA growth after EVAR. PMID:26627324

  16. Thrombus Volume Change Visualization after Endovascular Abdominal Aortic Aneurysm Repair

    Science.gov (United States)

    Maiora, Josu; García, Guillermo; Macía, Iván; Legarreta, Jon Haitz; Boto, Fernando; Paloc, Céline; Graña, Manuel; Abuín, Javier Sanchez

    A surgical technique currently used in the treatment of Abdominal Aortic Aneurysms (AAA) is the Endovascular Aneurysm Repair (EVAR). This minimally invasive procedure involves inserting a prosthesis in the aortic vessel that excludes the aneurysm from the bloodstream. The stent, once in place acts as a false lumen for the blood current to travel down, and not into the surrounding aneurysm sac. This procedure, therefore, immediately takes the pressure off the aneurysm, which thromboses itself after some time. Nevertheless, in a long term perspective, different complications such as prosthesis displacement or bloodstream leaks into or from the aneurysmatic bulge (endoleaks) could appear causing a pressure elevation and, as a result, increasing the danger of rupture. The purpose of this work is to explore the application of image registration techniques to the visual detection of changes in the thrombus in order to assess the evolution of the aneurysm. Prior to registration, both the lumen and the thrombus are segmented

  17. Anesthetic considerations for endovascular abdominal aortic aneurysm repair.

    Science.gov (United States)

    Kothandan, Harikrishnan; Haw Chieh, Geoffrey Liew; Khan, Shariq Ali; Karthekeyan, Ranjith Baskar; Sharad, Shah Shitalkumar

    2016-01-01

    Aneurysm is defined as a localized and permanent dilatation with an increase in normal diameter by more than 50%. It is more common in males and can affect up to 8% of elderly men. Smoking is the greatest risk factor for abdominal aortic aneurysm (AAA) and other risk factors include hypertension, hyperlipidemia, family history of aneurysms, inflammatory vasculitis, and trauma. Endovascular Aneurysm Repair [EVAR] is a common procedure performed for AAA, because of its minimal invasiveness as compared with open surgical repair. Patients undergoing EVAR have a greater incidence of major co-morbidities and should undergo comprehensive preoperative assessment and optimization within the multidisciplinary settings. In majority of cases, EVAR is extremely well-tolerated. The aim of this article is to outline the Anesthetic considerations related to EVAR. PMID:26750684

  18. Tratamiento endovascular del vasospasmo cerebral inducido por hemorragia subaracnoidea aneurismática Endovascular treatment of cerebral vasospasm due to aneurysmal subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Pedro P. Alcázar

    2008-11-01

    Full Text Available El vasospasmo cerebral es una de las principales causas de morbimortalidad en los pacientes con hemorragia subaracnoidea por rotura de un aneurisma cerebral. Cuando el vasospasmo se hace resistente al tratamiento médico máximo, el tratamiento endovascular es una opción terapéutica para incrementar el flujo sanguíneo cerebral y evitar lesiones isquémicas cerebrales. Los rápidos avances en técnicas endovasculares permiten utilizar la angioplastia transluminal percutánea y la infusión intraarterial de diversos fármacos vasodilatadores para revertir el vasospasmo. En este artículo se revisan las diferentes técnicas endovasculares disponibles y se describen sus mecanismos de acción, técnicas de administración, resultados clínicos y complicaciones.Cerebral vasospasm remains a leading cause of death and disability in patients with aneurysmal subarachnoid hemorrhage. When vasospasm becomes refractory to maximal medical treatment, endovascular therapies may be considered as an option to increase cerebral blood flow to prevent cerebral infarction. Endovascular techniques include transluminal balloon angioplasty and intra-arterial infusion of vasorelaxants. This article reviews the various endovascular techniques for the treatment of cerebral vasospasm and discusses the mechanisms of action, techniques of administration, clinical results, and limitations of these treatment strategies.

  19. Tratamiento endovascular del vasospasmo cerebral inducido por hemorragia subaracnoidea aneurismática / Endovascular treatment of cerebral vasospasm due to aneurysmal subarachnoid hemorrhage

    Scientific Electronic Library Online (English)

    Pedro P., Alcázar; Alejandro, González; Antonio, Romance.

    2008-11-01

    Full Text Available El vasospasmo cerebral es una de las principales causas de morbimortalidad en los pacientes con hemorragia subaracnoidea por rotura de un aneurisma cerebral. Cuando el vasospasmo se hace resistente al tratamiento médico máximo, el tratamiento endovascular es una opción terapéutica para incrementar e [...] l flujo sanguíneo cerebral y evitar lesiones isquémicas cerebrales. Los rápidos avances en técnicas endovasculares permiten utilizar la angioplastia transluminal percutánea y la infusión intraarterial de diversos fármacos vasodilatadores para revertir el vasospasmo. En este artículo se revisan las diferentes técnicas endovasculares disponibles y se describen sus mecanismos de acción, técnicas de administración, resultados clínicos y complicaciones. Abstract in english Cerebral vasospasm remains a leading cause of death and disability in patients with aneurysmal subarachnoid hemorrhage. When vasospasm becomes refractory to maximal medical treatment, endovascular therapies may be considered as an option to increase cerebral blood flow to prevent cerebral infarction [...] . Endovascular techniques include transluminal balloon angioplasty and intra-arterial infusion of vasorelaxants. This article reviews the various endovascular techniques for the treatment of cerebral vasospasm and discusses the mechanisms of action, techniques of administration, clinical results, and limitations of these treatment strategies.

  20. Open abdomen treatment following endovascular repair of ruptured abdominal aortic aneurysms

    OpenAIRE

    Mayer, D; Rancic, Z; Meier, C.; Pfammatter, T; Veith, F J; Lachat, M

    2009-01-01

    BACKGROUND: Open abdomen treatment (OAT) is considered a lifesaving procedure in patients with abdominal compartment syndrome (ACS) after endovascular or open intervention for ruptured abdominal aortic aneurysms (RAAA). Standardized treatment methods and algorithms for its use are still lacking. The high, published mortality rates may reflect difficulties in detecting and treating ACS, especially in patients treated by emergency endovascular aneurysm repair (eEVAR). Presented are standardized...

  1. Long-term safety and efficacy of endovascular abdominal aortic aneurysm repair

    OpenAIRE

    Propper BW; Abularrage CJ

    2013-01-01

    Brandon W Propper, Christopher J Abularrage Division of Vascular Surgery and Endovascular Therapy, John Hopkins Hospital, Baltimore, MD, USA Abstract: Endovascular abdominal aortic aneurysm repair (EVAR) is a safe and efficacious treatment for both unruptured and ruptured abdominal aortic aneurysms. While perioperative mortality is lower with EVAR, long-term outcomes are similar between EVAR and open repair, including quality of life and cost-effectiveness. We review the long-term outcomes fr...

  2. Long-term safety and efficacy of endovascular abdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Propper BW

    2013-04-01

    Full Text Available Brandon W Propper, Christopher J Abularrage Division of Vascular Surgery and Endovascular Therapy, John Hopkins Hospital, Baltimore, MD, USA Abstract: Endovascular abdominal aortic aneurysm repair (EVAR is a safe and efficacious treatment for both unruptured and ruptured abdominal aortic aneurysms. While perioperative mortality is lower with EVAR, long-term outcomes are similar between EVAR and open repair, including quality of life and cost-effectiveness. We review the long-term outcomes from the EUROSTAR registry, and DREAM, EVAR 1, and OVER trials. Keywords: EVAR, endovascular, aneurysm, aortic, outcome, long-term

  3. Modification of an endovascular stent graft for abdominal aortic aneurysm

    Science.gov (United States)

    Moloye, Olajompo Busola

    Endovascular surgery is currently used to treat abdominal aortic aneurysms (AAA). A stent graft is deployed to exclude blood flow from the aneurysm sac. It is an effective procedure used in preventing aneurysm rupture, with reduced patient morbidity and mortality compared to open surgical repair. Migration and leakage around the device ("endoleak") due to poor sealing of the stent graft to the aorta have raised concerns about the long-term durability of endovascular repair. A preliminary study of cell migration and proliferation is presented as a prelude to a more extensive in vivo testing. A method to enhance the biological seal between the stent graft and the aorta is proposed to eliminate this problem. This can be achieved by impregnating the stent graft with 50/50 poly (DL-lactide co glycolic acid) (PLGA) and growth factors such as basic fibroblast growth factor (bFGF) or connective tissue growth factor (CTGF), at the proximal and distal ends. It is hypothesized that as PLGA degrades it will release the growth factors that will promote proliferation and migration of aortic smooth muscle cells to the coated site, leading to a natural seal between the aorta and the stent graft. In addition, growth factor release should promote smooth muscle cell (SMC) contraction that will help keep the stent graft in place at the proximal and distal ends. It is shown that a statistically significant effect of increased cell proliferation and migration is observed for CTGF release. Less of an effect is noted for bFGF or just the PLGA. The effect is estimated to be large enough to be clinically significant in a future animal study. The long term goal of this study is to reduce migration encounter after graft deployment and to reduce secondary interventions of EVAR especially for older patients who are unfit for open surgical treatment.

  4. Perioperative management of endovascular abdominal aortic aneurysm repair

    International Nuclear Information System (INIS)

    Objective: To summarize the clinical experience of perioperative management in performing endovascular abdominal aortic aneurysm repair (EVAR). Methods: EVAR was performed in 22 patients with abdominal aortic aneurysm. The clinical data were retrospectively analyzed. Before treatment the functions of main organs were evaluated and certain measures were adopted in order to protect them. Useful parameters, including the length, diameter, angle and configuration of the proximal and distal aneurysmal neck, the relationship of the aneurysm to aortic branches, the distance from the lowest renal artery to the bifurcation of abdominal aorta, and the quality of access vessels (such as diameter, tortuosity and calcification degree) were determined and assessed with CTA. According to the parameters thus obtained, the suitable stent-graft with ideal diameter and length was selected, and the optimal surgery pattern was employed. Local anesthesia was employed in 20 patients, among them the local anesthesia had to be changed to general anesthesia in one. Epidural anesthesia was carried out in one patient through the surgically-reconstructed iliac artery access,and general anesthesia was employed in one patient who had Stanford type A aortic dissection. The lowest renal artery must be accurately localized before deployment of stent-graft was started. At least one patent internal iliac artery should be reserved when bilateral internal iliac arteries needed to be covered, to be covered by stages or to be reconstructed. After stent-graft placement, angiography must be performed to find out if there was any endoleak and, if any, to determine the type of endoleak and to deal with it properly. Two cases had proximal type I endoleak, so balloon dilation was employed in one and cuff implantation in another one. Distal type I endoleak occurred in one case, but, unfortunately, the iliac artery ruptured when balloon dilation was employed, therefore the patient had to receive vascular repair with prosthesis. Three cases developed type III endoleak. Balloon dilation followed by additional stent-graft placement was adopted in one case. Thoracic endovascular aortic repair with subsequent EVAR was carried out in another patient with Stanford type A aortic dissection. Re-examination with CTA was performed 7-10 days after the treatment, and once a year thereafter. Results: EVAR was successfully completed in all patients. The main complications included thrombosis due to vascular kinking (n=1) and disruption of abdominal incision (n=1). No death due to surgery occurred. During the follow-up period of 6 month to 5 years all patients remained alive. Conclusion: With the advantages of high imaging quality and usefulness for accurate measure of parameters, CTA is the gold standard for preoperative and postoperative evaluation. EVAR is a safe and effective treatment for abdominal aortic aneurysm in aged patients with high-risk. (authors)

  5. Tratamiento endovascular del trauma vascular periférico / Endovascular treatment of peripheral vascular trauma

    Scientific Electronic Library Online (English)

    César Eduardo, Jiménez; Diego, Peña.

    2012-12-01

    Full Text Available El trauma vascular representa un problema de salud pública a nivel nacional e internacional. La epidemia de violencia con mayor uso de armas de alta y baja velocidad en los conflictos militares y a nivel civil urbano, las velocidades más altas en las carreteras y los accidentes laborales, han aument [...] ado la incidencia del trauma vascular. La aparición de procedimientos y tecnologías endovasculares ha ofrecido nuevas alternativas en casos complejos de trauma vascular, como accesos vasculares difíciles, complicaciones tardías y pacientes con enfermedades concomitantes. En este artículo se presenta la experiencia, desde enero de 2010 hasta enero de 2012, con siete pacientes que recibieron tratamiento endovascular y tuvieron seguimiento a seis meses. En 6 (86 %) pacientes fue posible la implantación de endoprótesis (stent) y en uno fue necesario crear un émbolo en la arteria ilio-lumbar mediante espirales de acero (coils). El tiempo promedio de duración del procedimiento quirúrgico fue de 60,7 minutos, con un rango de 40 a 90 minutos. En todos los casos se comprobó éxito angiográfico y permeabilidad del vaso lesionado. Abstract in english Vascular trauma constitutes a public health problem both nationally and internationally. The epidemy of violence with greater use of high and low velocity weapons in the military conflicts as well as at the civil urban level, have increased the incidence of vascular trauma. The advent of endovascula [...] r procedures and technologies offer new alternative approaches in complex vascular trauma, such as those with difficult vascular access, late complications and patients with concomitant complications. Hereby we present our experience with seven patients that were submitted to endovascular treatment in the period January 2010 to January 2012, with six months follow-up. In six patients (86%) it was possible to implant a stent, and in one it became necessary to create an embolus in the ilio-lumbar artery by means of a steel spiral coil. Mean operating time was 60.7 minutes, with a rank of 40 to 90 minutes. Successful result was demonstrated in all cases by angiography and permeability of the affected vessel.

  6. Endovascular Exclusion of an Abdominal Aortic Aneurysm in Patients with Concomitant Abdominal Malignancy: Early Experience

    Energy Technology Data Exchange (ETDEWEB)

    Choi, You Ri; Chang, Nam Kyu [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of); Shin, Hyo Hyun; Oh, Hyun Jun; Kim, Jae Kyu; Choi, Soo Jin Na; Chung, Sang Young [Chonnam National University Hospital, Gwangju (Korea, Republic of); Yim, Nam Yeol [Armed Forces Yangju Hospital, Yangju (Korea, Republic of)

    2010-08-15

    To assess the outcomes of endovascular aortic aneurysm repair (EVAR) for the treatment of an abdominal aortic aneurysm in patients undergoing curative surgical treatment for concomitant abdominal malignancy. The study included 12 patients with abdominal neoplasia and an abdominal aortic aneurysm (AAA), which was treated by surgery and stent EVAR. The neoplasm consisted of the gastric, colorectal, pancreas, prostate, and gall bladder. The follow up period was 3-21 months (mean 11.8 months). All medical records and imaging analyses were reviewed by CTA and/or color Doppler US, retrospectively. Successful endoluminal repair was accomplished in all twelve patients. The mean interval time between EVAR and surgery was 58.6 days. Small amounts of type 2 endoleaks were detected in two patients (17%). One patient developed adult respiratory distress syndrome after Whipple's operation 20 days after surgery, which led to hopeless discharge. No procedure-related mortality, morbidity, or graft-related infection was noted. Exclusion of AAA in patients with accompanying malignancy show with a relatively low procedure morbidity and mortality. Hence, endoluminal AAA repair in patients with synchronous neoplasia may allow greater flexibility in the management of an offending malignancy

  7. Endovascular Exclusion of an Abdominal Aortic Aneurysm in Patients with Concomitant Abdominal Malignancy: Early Experience

    International Nuclear Information System (INIS)

    To assess the outcomes of endovascular aortic aneurysm repair (EVAR) for the treatment of an abdominal aortic aneurysm in patients undergoing curative surgical treatment for concomitant abdominal malignancy. The study included 12 patients with abdominal neoplasia and an abdominal aortic aneurysm (AAA), which was treated by surgery and stent EVAR. The neoplasm consisted of the gastric, colorectal, pancreas, prostate, and gall bladder. The follow up period was 3-21 months (mean 11.8 months). All medical records and imaging analyses were reviewed by CTA and/or color Doppler US, retrospectively. Successful endoluminal repair was accomplished in all twelve patients. The mean interval time between EVAR and surgery was 58.6 days. Small amounts of type 2 endoleaks were detected in two patients (17%). One patient developed adult respiratory distress syndrome after Whipple's operation 20 days after surgery, which led to hopeless discharge. No procedure-related mortality, morbidity, or graft-related infection was noted. Exclusion of AAA in patients with accompanying malignancy show with a relatively low procedure morbidity and mortality. Hence, endoluminal AAA repair in patients with synchronous neoplasia may allow greater flexibility in the management of an offending malignancy

  8. Tratamiento "híbrido" del aneurisma tóraco-abdominal: revascularización visceral extraanatómica e inserción de endoprótesis Extra anatomical revascularization and endovascular stent-grafting for thoracoabdominal aneurysm repair: Report of four cases

    Directory of Open Access Journals (Sweden)

    Renato Mertens M

    2007-02-01

    Full Text Available Surgical treatment of thoracoabdominal aneurysms is a big technical challenge with a high rate of complications and mortality. It requires a large exposure and transient interruption of vital organ perfusion during its repair. Endovascular repair is a less invasive alternative available over the last decade. We report four male patients aged 44 to 76 years, with thoracic aortic aneurysms and involvement of visceral aorta, treated with a two stage procedure. During the first stage, a retrograde revascularization of the superior mesenteric and renal arteries from the infrarenal aorta was done, associated in two cases to a concomitant repair of an infrarenal aortic aneurysm. In the second stage, an endovascular graft was placed through the femoral artery, from the segment proximal to the aneurysm to the infrarenal aorta, above the origin of the visceral artery reconstructions, excluding the aneurysm from circulation. In one patient, both stages were concomitant and in three the second stage was delayed. One patient presented a postoperative bleeding that required reintervention without adverse consequences. No patient died, presented paraplegia or deterioration of renal function. After follow up of 6 to 20 months, there is no evidence of aneurysm growth or complications derived from the procedure

  9. Tratamiento endovascular de lesiones traumáticas de troncos supra aórticos / Endovascular treatment of traumatic supra aortic trunk lesions

    Scientific Electronic Library Online (English)

    MICHEL, BERGOEING R; RENATO, MERTENS M; LEOPOLDO, MARINÉ M; FRANCISCO, VALDÉS E; ALBRECHT, KRÄMER SCH; RICARDO, SONNEBORN G.

    2011-04-01

    Full Text Available Introducción: Las lesiones traumáticas de troncos supra aórticos (TSA) tienen elevada morbimor-talidad, y su tratamiento presenta un desafío técnico. Las técnicas endovasculares se presentan como una alternativa atractiva y de menor riesgo para su solución efectiva. Objetivos: Evaluar los resultados [...] del tratamiento endovascular de las lesiones de TSA. Material y Método: Se revisaron retrospectivamente todos los pacientes sometidos a tratamiento endovascular de lesiones de TSA. Resultados: Entre Marzo de 2000 y Agosto de 2009 se intervinieron 8 pacientes, 6 hombres, edad promedio 33,6 años. El mecanismo traumático fue contuso en 3 y penetrante en 5. Los vasos afectados fueron arteria subclavia en 5, tronco braquiocefálico en 2 y carótida común en uno. De los pacientes con lesión subclavia, tres presentaron compromiso de plexo braquial asociado. Siete pacientes fueron tratados con implante de endoprótesis y uno mediante embolización. Un paciente requirió un stent no cubierto para tratar el colapso parcial precoz de una endoprótesis. No hubo morbilidad neurológica de novo ni mortalidad operatoria. El seguimiento clínico promedio es 24,3 meses. Dos pacientes se perdieron al seguimiento. La permeabilidad primaria asistida es 100% a 21,9 meses. Conclusiones: El tratamiento endovascular de lesiones de TSA es efectivo, con baja morbimortalidad y con buena permeabilidad a mediano plazo. Abstract in english Introduction: Traumatic lesions of supra aortic trunks (SAT) have an elevated morbidity and mortality, and its treatment is technically challenging. Endovascular techniques offer an effective solution with a lower risk, making it an attractive alternative. Objectives: Retrospective review of all the [...] patients with SAT lesions treated with endovascular techniques. Results: Between March 2000 to August 2009, 8 patients were treated, 6 men, mean age 33.6 years. Three patients suffered blunt and 5 a penetrating trauma. The injured vessels were subclavian artery in 5, brachiocephalic trunk in two and common carotid in one. Of the 5 patients with subclavian artery injury, three had associated brachial plexus injury. Six patients were treated with an endo-graft and one with coil-embolization. One patient suffered an early partial collapse of his endograft, requiring an additional bare metal stent to maintain patency. In this series there was neither neurological morbidity nor operative mortality. Follow-up is 24.3 months, and primary assisted patency is 100% at 21.9 months with two patients lost to follow-up. Conclusions: Endovascular treatment of SAT lesions is effective, showing low morbidity and mortality with a good mid-term patency.

  10. Vascular ultrasonography for follow-up of endovascular repair of abdominal aorta aneurysms / Ultrassonografia vascular no seguimento da correção endovascular do aneurisma da aorta abdominal

    Scientific Electronic Library Online (English)

    Domingos, Moraes Filho; Fernando Barbosa, Trevisan; José Manoel da Silva, Silvestre; Wander Eduardo, Sardinha; Eduardo Durante, Ramires; Silfayner Victor Mathias, Dias; Henrique, Matsuda.

    2014-09-01

    Full Text Available Contexto As informações sobre o seguimento de pacientes submetidos à correção endovascular de aneurisma de aorta abdominal com ultrassonografia vascular no Brasil são escassas, bem como sua comparação com os resultados obtidos com a angiotomografia. Na medida em que a ultrassonografia é um exame se [...] m riscos, de baixo custo e de grande disponibilidade, esta se torna um método bastante atraente. Na presente pesquisa, procuramos avaliar a sensibilidade e a especificidade da ultrassonografia vascular (USV) no acompanhamento desses pacientes, comparando este método com a angiotomografia. Materiais e métodos Realizamos estudo prospectivo durante o período de junho de 2012 a maio de 2013. Para tanto, examinamos pacientes acompanhados pelo Ambulatório de Cirurgia Endovascular do Hospital Universitário de Londrina pós-correção endovascular de aneurisma de aorta abdominal. Todos os pacientes haviam sido submetidos à angiotomografia para acompanhamento e foram também avaliados através da radiografia abdominal (raio x simples) e da ultrassonografia vascular. Resultados Foram analisados 30 pacientes, com média de idade de 73 anos, com diâmetro médio do aneurisma de 6 cm, detectando-se quatro vazamentos endovasculares. Na avaliação desses vazamentos endovasculares, a ultrassonografia vascular obteve uma sensibilidade de 75% e uma especificidade de 96%, em relação à angiotomografia. Conclusão A ultrassonografia vascular é um excelente método primário na avaliação e no acompanhamento pós-cirúrgico de pacientes submetidos à correção endovascular do aneurisma da aorta abdominal (AAA). No entanto, em caso de alteração ultrassonográfica ou dificuldade na realização do exame, uma investigação mais específica deve ser realizada para confirmação diagnóstica. Abstract in english Background There is little information available on follow-up of abdominal aortic aneurysm patients treated with endovascular repair using vascular ultrasonography in Brazil or on how it compares with the results of angiotomography. Since ultrasonography is an examination that is risk-free, inexpen [...] sive and widely available, it is a very attractive method. In this study we attempted to evaluate the sensitivity and specificity of vascular ultrasonography for follow-up of these patients by comparing the method with angiotomography. Materials and methods We conducted a prospective study from June 2012 to May 2013. We examined patients followed-up at the endovascular surgery clinic run by the University Hospital of Londrina after endovascular repair of abdominal aortic aneurysms. All patients underwent angiotomography for follow-up and were also examined using simple abdominal X-rays and vascular ultrasonography. Results A total of 30 patients were analyzed, with a mean age of 73 years and a mean aneurysm diameter of 6 cm. Four endoleaks were detected. Vascular ultrasonography achieved sensitivity of 75% and specificity of 96% for classification of these endoleaks, in comparison with angiotomography. Conclusions Vascular ultrasonography is an excellent primary method for evaluation and post-surgical follow-up of patients treated with endovascular repair of abdominal aorta aneurysms. However, when ultrasonography detects problems or is difficult to accomplish, it should be supplemented with a more specific investigation for diagnostic confirmation.

  11. Endovascular Abdominal Aortic Aneurysm Repair in the Presence of a Kidney Transplant: Therapeutic Considerations

    International Nuclear Information System (INIS)

    Abdominal aortic aneurysm (AAA) repair in the presence of a kidney transplant can be extremely challenging, as it carries significant risks of renal ischemia. Endovascular repair is an attractive option, as it can be performed with little or no impairment of renal arterial flow. We describe the endovascular management of a recurrent AAA in a patient with a functioning renal transplant using a custom-made aorto-uni-iliac device. We discuss the planning and the potential problems of the technique

  12. Rupture of an abdominal aortic aneurysm after endovascular graft placement and aneurysm size reduction.

    Science.gov (United States)

    Alimi, Y S; Chakfe, N; Rivoal, E; Slimane, K K; Valerio, N; Riepe, G; Kretz, J G; Juhan, C

    1998-07-01

    Reduction in aneurysm size during the months after an endovascular graft placement generally is considered one of the criteria of success. We report the case of a patient with an abdominal aortic aneurysm rupture occurring 9 months after a bifurcated endovascular graft placement despite a greater than 45% reduction in size noted on contrast-enhanced computed tomography scan performed at 7 months. Biomaterial modifications of the stent and of the Dacron explanted stent-graft are analyzed. PMID:9685144

  13. Quality of life survey after endovascular abdominal aortic aneurysm repair in octogenarians

    OpenAIRE

    Kurz, M; Meier, T.; Pfammatter, T; Amann-Vesti, B R

    2010-01-01

    AIM: The aim of this study was to assess health-related quality of life (HRQOL) after endovascular abdominal aortic aneurysm (AAA) repair in octogenarians compared to younger patients. In addition, a possible association between HRQOL, duration of hospitalisation and preoperative serum C-reactive protein (CRP) was studied. METHODS: 270 consecutive patients (249 men, mean age 73 years, range 52-89 years) with elective endovascular repair of AAA had been retrospectively evaluated. The Nottingha...

  14. Advanced endovascular techniques for thoracic and abdominal aortic dissections.

    Science.gov (United States)

    Kölbel, T; Diener, H; Larena-Avellaneda, A; Debus, S

    2013-02-01

    Endovascular treatment of aortic dissection is still in its infancy and consists usually of implantation of thoracic tubular stent-grafts to cover the proximal entry tear and redirect flow into the true lumen. Large registries comparing endovascular treatment by thoracic endovascular aortic repair (TEVAR) with open surgery for aortic dissection of the descending aorta have demonstrated a clear benefit for endovascular treatment with lower mortality and morbidity rates turning TEVAR into the standard treatment for complicated type B aortic dissection. With this momentum of success endovascular techniques continue to challenge open surgical techniques also in the aortic arch and the ascending aorta. TEVAR for aortic dissection has become more complex requiring an individualized treatment strategy as endovascular techniques have developed with the advent of new devices and increased experience of the operators. In many cases straight implantation of a thoracic tubular stent-graft is sufficient. But as rerouting of the blood flow can also change perfusion of vital side-branches the endovascular operator needs to have a large armamentarium of techniques and adjunctive procedures in order to sufficiently address the individual patient morphology. This chapter reviews a variety of endovascular techniques including access techniques, proximal sealing, the Petticoat-technique, false lumen deployment, fenestration techniques, branch vessel stenting and false lumen obstruction by various techniques. PMID:23443592

  15. Endovascular Stent Graft Repair of Abdominal and Thoracic Aortic Aneurysms

    Science.gov (United States)

    Marin, Michael L.; Hollier, Larry H.; Ellozy, Sharif H.; Spielvogel, David; Mitty, Harold; Griepp, Randall; Lookstein, Robert A.; Carroccio, Alfio; Morrissey, Nicholas J.; Teodorescu, Victoria J.; Jacobs, Tikva S.; Minor, Michael E.; Sheahan, Claudie M.; Chae, Kristina; Oak, Juliana; Cha, Andrew

    2003-01-01

    Objective: On November 23, 1992, the first endovascular stent graft (ESG) repair of an aortic aneurysm was performed in North America. Following the treatment of this patient, we have continued to evaluate ESG over the past 10 years in the treatment of 817 patients. Summary and Background Data: Abdominal (AAA) or thoracic (TAA) aortic aneurysms are a significant health concern traditionally treated by open surgical repair. ESG therapy may offer protection from aneurysm rupture with a reduction in procedure morbidity and mortality. Methods: Over a 10-year period, 817 patients were treated with ESGs for AAA (723) or TAA (94). Patients received 1 of 12 different stent graft devices. Technical and clinical success of ESGs was reviewed, and the incidence of procedure-related complications was analyzed. Results: The mean age was 74.3 years (range, 25–95 years); 678 patients (83%) were men; 86% had 2 or more comorbid medical illnesses, 67% of which included coronary artery disease. Technical success, on an intent-to-treat basis was achieved in 93.8% of patients. Primary clinical success, which included freedom from aneurysm-related death, type I or III endoleak, graft infection or thrombosis, rupture, or conversion to open repair was 65 ± 6% at 8 years. Of great importance, freedom from aneurysm rupture after ESG insertion was 98 ± 1% at 9 years. There was a 2.3% incidence of perioperative mortality. One hundred seventy five patients died of causes not related to their aneurysm during a mean follow-up of 15.4 months. Conclusions: Stent graft therapy for aortic aneurysms is a valuable alternative to open aortic repair, especially in older sicker patients with large aneurysms. Continued device improvements coupled with an enhanced understanding of the important role of aortic pathology in determining therapeutic success will eventually permit ESGs to be a more durable treatment of aortic aneurysms. PMID:14530730

  16. Tratamento Endovascular de Aneurisma de Aorta Abdominal pela Técnica de Chaminé / Endovascular Repair of Abdominal Aortic Aneurism Using the Chimney Graft Technique

    Scientific Electronic Library Online (English)

    Adriano Gonçalves de, Araujo; Fábio Henrique Ribeiro de, Souza; Fernando Henrique, Fernandes; Flávio Passos, Barbosa; José Antônio, Jatene; Paulo Cézar Guimarães, Câmara.

    2014-12-01

    Full Text Available Paciente idoso, portador de insuficiência renal não dialítica e doença pulmonar obstrutiva crônica dependente de oxigênio, foi admitido no pronto-socorro com quadro de dor abdominal lancinante. A angiotomografia de abdome revelou a presença de grande aneurisma aórtico com comprometimento das artéria [...] s viscerais. Devido ao elevado risco cirúrgico, foi proposto o tratamento endovascular pela técnica de chaminé para a preservação dos vasos viscerais. Essa técnica mostra-se promissora por permitir o reparo endovascular desses aneurismas, seja em casos eletivos, em situações de urgência/emergência ou de resgate de uma artéria visceral acidentalmente encoberta por uma endoprótese aórtica. Abstract in english An elderly patient with non-dialysis renal failure and oxygendependent chronic obstructive pulmonary disease was admitted to the emergency room with lancinating abdominal pain. Angiotomography of the abdomen revealed the presence of a large aortic aneurysm with involvement of visceral arteries. Due [...] to the high surgical risk, endovascular repair was proposed, using the chimney graft technique for the preservation of the visceral vessels. This technique is promising because it enables endovascular repair of aneurysms, be it in elective cases, emergencies, or rescue of a visceral artery accidentally covered by an aortic stent graft.

  17. Tratamiento endovascular del trauma de aorta descendente Endovascular treatment of descending aorta trauma

    Directory of Open Access Journals (Sweden)

    Renato Mertens M

    2005-04-01

    Full Text Available Background: Mortality of traumatic aortic lesions is over 80%. A group of those who survive, develop a chronic pseudo aneurism, usually asymptomatic, that is detected during imaging studies. Since conventional surgical treatment of traumatic aortic lesions has a great mortality, endovascular treatment has been used as an alternative treatment in the last decade. Aim: To report our experience with endovascular treatment of traumatic aortic lesions. Patients and methods: Report of seven patients aged 22 to 65 years, with traumatic aortic lesions. Under general anesthesia an endovascular prosthesis was inserted through the femoral artery. Results: No complications were observed in the postoperative period, and after a follow up ranging from 4 to 40 months, no endoleaks or other complications have been detected. Conclusions: Endovascular treatment of traumatic aortic lesions has good immediate and midterm results

  18. Protocol-Based Strategy for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

    OpenAIRE

    Ogino, Hidemitsu; Watanabe, Kazunao; Ikegaya, Yuki; Kawachi, Jun; Shimoyama, Rai; Isogai, Naoko

    2013-01-01

    Objective: Compared with conventional open surgery (COS), endovascular aneurysm repair (EVAR) has been reported to decrease the 30-day mortality rate in patients with ruptured abdominal aortic aneurysms (rAAAs). We developed an EVAR-first strategy for rAAAs that incorporates the Shonan ruptured abdominal aortic aneurysm protocol (SRAP). We describe short-term results with this protocol at our institution and compare them with outcomes in patients who underwent COS.

  19. Reparación endovascular de aneurismas de aorta abdominal (parte I: Epidemiología indicaciones y limitaciones Endovascular repair of abdominal aortic aneurysms (Part I: Epidemiology, indications, and limitations

    Directory of Open Access Journals (Sweden)

    Roberto Carlos Fominaya Pardo

    2007-06-01

    Full Text Available Los aneurismas de la aorta abdominal son una patología frecuente, con alta afinidad hacia la ruptura y muerte. La reparación endovascular es una alternativa al reparo convencional en pacientes de alto riesgo, y el desarrollo tecnológico y el perfeccionamiento de las endoprótesis va a permitir su aplicación en pacientes de buen riesgo para reparo convencional con cirugía abierta. En este artículo se dan las pautas básicas que deben conocer los especialistas en enfermedades cardiovasculares acerca de la epidemiología, indicaciones y limitaciones del reparo endoluminal de los aneurismas de la aorta abdominal.Abdominal aortic aneurysms constitute a frequent pathology, with high propensity to rupture and death; endovascular repair is an alternative to conventional repair in high-risk patients. The technological development and betterment of endoprosthesis will allow the application of this method in patients considered to be of good risk for conventional open repair. This article presents the basic knowledge that should possess the specialists in cardiovascular diseases in regard to epidemiology and indications and limitations of the endoluminal repair of abdominal aortic aneurysms.

  20. Alteraciones neuropsicológicas en pacientes con aneurismas cerebrales: tratamiento quirúrgico versus tratamiento endovascular / Neuropsychological impairment in patients with intracranial aneurysms: surgical versus endovascular treatment

    Scientific Electronic Library Online (English)

    C., Orozco-Giménez; M.J., Katati; R., Vilar; M., Meersmans; M., Pérez-García; J.M., Martín; P., Alcázar; F., Guerrero; F., Escamilla; A., Mínguez; G., Olivares; E., Saura; A., Jorques; V., Arjona.

    2006-02-01

    Full Text Available Objetivos. Describir el rendimiento neuropsicológico de pacientes con aneurismas cerebrales que han sido tratados mediante cirugía o embolización, y determinar la existencia de diferencias en función de la modalidad de tratamiento. Material y métodos. Serie clínica compuesta por 93 pacientes volunta [...] rios, con aneurismas cerebrales, tratados mediante cirugía (n = 56) o embolización (n = 37). A ambos grupos se les realizó una evaluación neuropsicológica retrospectiva, al menos un año después de realizar el tratamiento. Resultados. En ambos grupos se encontraron pacientes con déficit neuropsicológicos. En el grupo de pacientes tratados quirúrgicamente el porcentaje de pacientes sin ninguna afectación neuropsicológica es del 35.7%, mientras que en el grupo de pacientes embolizados este porcentaje asciende al 43.2%. Los análisis muestran una ejecución mejor en el grupo de tratamiento endovascular, respecto al quirúrgico, sólo en memoria visual y en el recuerdo con claves de la memoria verbal. Conclusiones. Años después del tratamiento, un importante porcentaje de pacientes presenta alteraciones neuropsicológicas. El tratamiento endovascular se asocia con un mejor rendimiento en memoria visual y en el recuerdo con claves de la memoria verbal, aunque explica un porcentaje muy escaso de la varianza. Por lo tanto, en la explicación del deterioro neuropsicológico parece más importante el propio efecto de la hemorragia que la modalidad de intervención. Abstract in english Objectives. To describe the neuropsychological status of patients with intracranial aneurysms and to compare the cognitive status of patients with intracranial aneurysm treated by surgical or endovascular mehtods. Material and methods. Ninety-three cases with intracranial aneurysms treated with surg [...] ery (n = 56) or embolization (n = 37) were included. A neuropsychological assessment was applied to both groups retrospectively, at least one year after treatment. Results. Neuropsychological impairment was found in both groups. 35.7% of the patients treated with surgery and 43.2%, of those treated with embolization did not show any cognitive impairment. Visual Memory and Cued Recall of verbal information are better in patients treated by embolization. Conclusions. Our results show that a large proportion of patients with intracranial aneurysms have cognitive impairment after treatment. Endovascular management may cause less impairment in visual and verbal memory. However, bleeding may be the most important factor to explain these cognitive impairments.

  1. Innovative chimney-graft technique for endovascular repair of a pararenal abdominal aortic aneurysm.

    Science.gov (United States)

    Galiñanes, Edgar Luis; Hernandez-Vila, Eduardo A; Krajcer, Zvonimir

    2015-02-01

    After abdominal aortic aneurysm repair, progressive degeneration of the aneurysm can be challenging to treat. Multiple comorbidities and previous operations place such patients at high risk for repeat surgery. Endovascular repair is a possible alternative; however, challenging anatomy can push the limits of available technology. We describe the case of a 71-year-old man who presented with a 5.3-cm pararenal aneurysm 4 years after undergoing open abdominal aortic aneurysm repair. To avoid reoperation, we excluded the aneurysm by endovascular means, using visceral-artery stenting, a chimney-graft technique. Low-profile balloons on a monorail system enabled the rapid exchange of coronary wires via a buddy-wire technique. This novel approach facilitated stenting and simultaneous angioplasty of multiple visceral vessels and the abdominal aorta. PMID:25873796

  2. Perioperative nursing for patients receiving endovascular therapy for ruptured abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To discuss the nursing strategy and practical measures for patients with ruptured abdominal aortic aneurysm during the perioperative period of endovascular intervention. Methods: Endovascular therapy was carried out in 34 patients with ruptured abdominal aortic aneurysm,who were encountered in our department during the period of July 1997 to September 2008. The clinical data were retrospectively analyzed and the nursing points were summarized. Results: The average hospitalization days of the 34 patients were (14 ± 5) days, the mortality rate within 30 days was 23.5% (8/34). No nursing-related complications occurred. Conclusion: A comprehensive understanding of the mechanism, development and clinical evolution of ruptured abdominal aortic aneurysm is very important for nursing care. For nursing staff, well mastering the relevant nursing technique, carefully guarding against any nursing errors and lessening patient's suffering as far as possible, all these are the task of primary importance. (authors)

  3. Hybrid Repair of Suprarenal Abdominal Aortic Aneurysm: Antegrade Debranching with Endovascular Aneurysm Repair

    OpenAIRE

    Kim, Min Hyun; Shin, Hong Kyung; Park, Jae Young; Lee, Taeseung

    2014-01-01

    We report a hybrid repair approach to the treatment of abdominal aortic aneurysm in patients with complex anatomies when typical endovascular aneurysm repair is limited due to juxtarenal involvement. A 63-year-old man presented with a 3-day history of fever and abdominal pain. He was diagnosed with acute cholecystitis along with incidental findings of two separate aneurysms of the abdominal aorta: a 3.7 cm saccular aneurysm at the suprarenal level, and a 6.6 cm fusiform aneurysm above the ili...

  4. Infrarenal abdominal aortic aneurysm. Endovascular repair with stent grafts; Infrarenales Bauchaortenaneurysma. Endovaskulaere Stent-Graft-Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, M.; Voshage, G.; Landwehr, P. [Klinik fuer Diagnostische und Interventionelle Radiologie, Gefaesszentrum Hannover, Diakoniekrankenhaus Henriettenstiftung gGmbH, Hannover (Germany); Busch, T. [Klinik fuer Gefaesschirurgie, Gefaesszentrum Hannover, Diakoniekrankenhaus Henriettenstiftung gGmbH, Hannover (Germany)

    2008-09-15

    As an alternative to surgery, endovascular therapy with stent grafts has become the second main treatment option for infrarenal abdominal aortic aneurysms. Unlike surgery, endovascular treatment with stent grafts is also applicable in patients unfit for open repair. Despite current improvements in endovascular repair devices, significant anatomic barriers still exclude this technique for a large number of patients. Computed tomography, magnetic resonance imaging, and ultrasound are essential for diagnostics, preintervention planning, and postintervention follow-up of abdominal aneurysms treated with stent grafts. This review covers etiology, pathology, and diagnostic aspects. Materials and methods for endovascular treatment of abdominal aortic aneurysms are presented in detail, and clinical results and complications are discussed. (orig.) [German] Die endovaskulaere Therapie des infrarenalen Bauchaortenaneurysmas hat sich als Alternative zur offenen chirurgischen Versorgung etabliert. Im Gegensatz zu Letzterer ist die Aneurysmatherapie mittels Stent-Grafts auch bei schwerkranken, nicht operationsfaehigen Patienten moeglich, wobei der Nutzen kontrovers diskutiert wird. Im Gegensatz zur klassischen transabdominellen Operation ist die Stent-Graft-Technik anatomischen Einschraenkungen unterworfen, die aber kuenftig aufgrund bereits abzusehender technischer Weiterentwicklungen eine geringere Rolle spielen werden. Die Diagnostik, die Entscheidung fuer eine endovaskulaere Therapie, die praeinterventionelle Planung und die Nachsorge erfordern den Einsatz bildgebender Verfahren, v. a. der Computer- und Magnetresonanztomographie sowie der Sonographie. Die fuer die endovaskulaere Aneurysmabehandlung relevanten Aspekte der Diagnostik werden dargestellt. Auf die Technik, die Materialien, die Ergebnisse und die Komplikationen der Stent-Graft-Behandlung wird ausfuehrlich eingegangen. (orig.)

  5. Tratamiento endovascular de urgencia con endoprótesis de aneurisma roto disecado de aorta torácica: A propósito de un caso Emergency endovascular treatment with endoprosthesis of ruptured dissected aneurysm of thoracic aorta: Report of one case

    Directory of Open Access Journals (Sweden)

    José Lugo

    2007-12-01

    Full Text Available Los aneurismas de aorta torácica son menos comunes que los aneurismas de aorta abdominal y pueden encontrarse en aorta ascendente, arco aórtico, aorta descendente o en una combinación de estos segmentos. De estos aneurismas el 30% al 40% se originan en la aorta torácica descendente. En los aneurismas de aorta torácica existe una debilidad estructural de la pared de la aorta, que conlleva una dilatación arterial progresiva con eventual ruptura o disección. Aproximadamente, 50% de los aneurismas de aorta torácica son ateroscleróticos y ocurren como resultado de remodelado arterial y dilatación o a raíz de un metabolismo anormal del colágeno. La mayoría de los aneurismas de aorta torácica se descubren por casualidad durante la evaluación de otros problemas médicos. La meta del tratamiento de los aneurismas de aorta torácica, es prevenir la muerte debido a su ruptura. El riesgo de ruptura de los no tratados oscila entre 46% a 74% y la tasa de mortalidad por su ruptura es extremadamente alta. Los aneurismas de gran tamaño, en especial aquellos mayores de 6 cm, son más susceptibles de rupturas que los aneurismas de menor tamaño. El tratamiento endovascular, inicialmente desarrollado para los aneurismas de aorta abdominal, se introdujo en 1992 como una alternativa menos invasiva al tratamiento de cirugía abierta para los aneurismas de la aorta torácica descendente. En la actualidad, el injerto de stent endovascular en la aorta descendente o endoprótesis, recibe mayor atención como alternativa al reparo quirúrgico de los aneurismas de aorta torácica.Thoracic aortic aneurysms are less common than abdominal aortic aneurysms and can be found in ascending aorta, aortic arch, descending aorta or in a combination of these segments. 30% to 40% of these aneurysms are originated in thoracic descending aorta. In thoracic aortic aneurysms there exists a structural wall weakness that leads to a progressive arterial dilation with eventual rupture or dissection. Approximately 50% of all thoracic aortic aneurysms are atherosclerotic and are the result of arterial restructure and dilation or are due to an abnormal collagen metabolism. Most thoracic aortic aneurysms are only found by chance during other medical problems evaluation. The goal of thoracic aortic aneurysms treatment is the prevention of death due to its rupture. Ruptured risk of untreated aneurysms oscillates between 46% and 74% and mortality rate due to its rupture is extremely high. Large aneurysms, especially when they are greater than 6 cm in diameter are more susceptible of ruptures than smaller aneurysms. Endovascular treatment, initially developed for abdominal aortic aneurysms, was introduced in 1992 as a less invasive alternative to open surgery treatment for descending thoracic aortic aneurysms. Endovascular stent or endoprosthesis is actually getting more attention as an alternative to surgical repair of thoracic aortic aneurysms.

  6. EFFICACY OF THE ENDOVASCULAR TREATMENT OF THE THORACIC AND ABDOMINAL AORTIC ANEURYSMS IN CARTAGENA, COLOMBIA

    Directory of Open Access Journals (Sweden)

    Marzola-Peña Katy

    2015-01-01

    Full Text Available Introduction: The aortic aneurysms (AA are a segmentary and permanent dilatation of the aorta that could end in a catastrophic outcome named acute aortic syndrome (AAS, which could curse with rupture and in most cases in death. The treatment of the AA pretends to prevent its rupture by means of resection and replacement of the aorta by a graft. In the last years, an endovascular management with protesis was done, excluding the circulation aneurysm. Objective: To describe the efficacy, in terms of survival and consequences prevention, of the treatment with stents in thoracic and abdominal AA in older than 50 years. Methods: An observational descriptive study was carried out, of a case series with diagnosis of AA who received endovascular treatment since January, 2012 to June, 2014 in the Clínica Madre Bernarda and Clínica San Juan de Dios in Cartagena, Colombia. Data was collected in a database with Excel™ and were analyzed with the statistical program EPIDAT 3.1. Results: In the period of study 26 patients were identified with diagnosis of thoracic and/or abdominal AA. 76.9% were men. The average age was 71 years with interquartile range between 55-77 years. The age group with highest frequency was 70-79 years with 11 cases (42.3%. The mortality associated to systemic complications after the intervention was 11%. The need of surgical reintervention to endoleak was 13.3% and sequels of paraplegia secondary to the intervention was not described. Conclusions: The endovascular treatment of thoracic and abdominal AA is an important therapeutic alternative. The results observed of the endovascular management of AA were similar to the published ones, as for complications and mortality. Rev.cienc. biomed. 2015;6(1:60-67 KEYWORDS Aortic aneurysm; Endovascular Procedures; Vascular Diseases; Vascular surgical procedures.

  7. Population-Based Outcomes Following Endovascular and Open Repair of Ruptured Abdominal Aortic Aneurysms

    Science.gov (United States)

    Giles, Kristina A.; Hamdan, Allen D.; Pomposelli, Frank B.; Wyers, Mark C.; Dahlberg, Suzanne E.; Schermerhorn, Marc L.

    2009-01-01

    Purpose: To evaluate national outcomes after endovascular and open surgical repair of ruptured abdominal aortic aneurysms (rAAA). Methods: The Nationwide Inpatient Sample was interrogated to identify all repairs between 2000 and 2005 for rAAA based on ICD-9 codes. In the study period, 2323 patients (1794 men; median age 75 years, range 45–98) with rAAAs had endovascular repair, while 26,106 patients (20,311 men; median age 73 years, range 22–99) had an open procedure. Outcomes included in-hospital mortality, length of stay (LOS), complications, and hospitalization charge. A secondary analysis was performed to compare outcomes from low-, medium-, and high-volume institutions based on annual rAAA repair volume. Results: Patients in the endovascular group were significantly older (p<0.05). Mortality was 41% overall: 33% and 41% for endovascular versus open repair, respectively (p<0.001). Mortality after endovascular repair was lower than open surgery for patients ?70 years (36% versus 47%, p<0.001), but not for those <70 years (24% versus 30%, p?=?0.15). LOS was shorter after endovascular repair (7 versus 9 days, p<0.001). Respiratory complications (8% versus 4%, p<0.05) and acute renal failure were more common following open repair (30% versus 23%, p<0.01). Costs were similar (endo $73,590 versus open $67,287, p?=?0.15). Mortality decreased as hospital surgical volume increased (low 44%, medium 39%, high 38%; p<0.001). Over time, endovascular repair utilization increased more rapidly at high-volume centers, and a lower mortality was seen with endovascular repair at high-volume compared to low-volume hospitals (22% versus 44%, p<0.001). Multivariate predictors of mortality were age, female gender, lower hospital surgical volume, open repair, and year of surgery. Conclusion: This population-based study found that mortality associated with rAAAs may be improved by the performance of endovascular repair, especially in older patients. Mortality after rAAA for both endovascular and open repairs was also lower at high-volume institutions. PMID:19842719

  8. Endovascular exclusion for the coexistent lesions of abdominal aortic aneurysm, false-aneurysm and dissection

    International Nuclear Information System (INIS)

    Objective: To evaluate the feasibility of endovascular exclusion for complex abdominal aortic aneurysms. Methods: One case with coexistent lesions of abdominal aortic aneurysm, false-aneurysm and dissection received stent-graft exclusion. The bilateral common femoral arteries were dissected, and the humoral artery was punctured to insert the guidewire. The guidewire stretching technique was applied, and the modular stent-graft was deployed to exclude all the aneurysms and dissection simultaneously. Results: The technique of exclusion achieved a thorough success, and all the three aneurysms were excluded simultaneously with no need of additional extension. No complications such as endoleak, migration, occurred. The lumen of revascularization was patent. Conclusion: Based on the case, the indication of the endovascular exclusion can be further expended

  9. A Literature Review of the Numerical Analysis of Abdominal Aortic Aneurysms Treated with Endovascular Stent Grafts

    OpenAIRE

    Roy, David; Kauffmann, Claude; Delorme, Sébastien; Lerouge, Sophie; Cloutier, Guy; Soulez, Gilles

    2012-01-01

    The purpose of this paper is to present the basic principles and relevant advances in the computational modeling of abdominal aortic aneurysms and endovascular aneurysm repair, providing the community with up-to-date state of the art in terms of numerical analysis and biomechanics. Frameworks describing the mechanical behavior of the aortic wall already exist. However, intraluminal thrombus nonhomogeneous structure and porosity still need to be well characterized. Also, although the morpholog...

  10. The Impact of Endovascular Repair of Ruptured Abdominal Aortic Aneurysm on the Gastrointestinal and Renal Function

    OpenAIRE

    Makar, R.R.; Badger, S.A.; M. E. O’Donnell; Soong, C. V.; Lau, L. L.; Young, I.S.; Hannon, R. J.; Lee, B

    2014-01-01

    Introduction. Systemic effects of ruptured abdominal aortic aneurysm (rAAA) may be altered by the mode of surgery. This study aimed to determine systemic effects of endovascular aneurysm repair (EVAR) compared to open repair (OR). Patients and Methods. Consecutive patients with rAAA were repaired by OR or EVAR according to computerised tomographic (CT) findings. Renal function was monitored by estimated glomerular filtration rate (eGFR), serum urea and creatinine, and urinary albumin creatini...

  11. Open vs. endovascular repair of abdominal aortic aneurysm: a comparative analysis / Análise comparativa entre tratamentos convencional e endovascular de aneurisma de aorta abdominal

    Scientific Electronic Library Online (English)

    Samuel de Paula, Miranda; Paschoal Cunha, Miranda; Marília Granzotto, Volpato; Maria Cláudia, Folino; Antônio Massamitsu, Kambara; Fábio Henrique, Rossi; Nilo Mitsuru, Izukawa.

    2014-12-01

    Full Text Available Contexto: O aneurisma de aorta abdominal (AAA) é uma condição frequentemente assintomática, porém potencialmente fatal, cuja prevalência em homens com 60 anos ou mais está entre 4,3% e 8%. Existem duas modalidades de tratamento disponíveis: cirurgia aberta (TA) e endovascular (TE). Objetivo: Comp [...] arar os resultados dessas duas modalidades de tratamento, entre 2008 e 2013, em um hospital terciário. Métodos: Análise retrospectiva comparando 119 pacientes submetidos ao TA e 219 pacientes submetidos ao TE, para correção de AAA. Resultados: O grupo submetido ao TE apresentou maior idade (71,3 vs. 68,2 anos; p Abstract in english Context: Abdominal aortic aneurysm (AAA) is a condition that is usually asymptomatic, but potentially fatal, and has a prevalence in men over 60 years old ranging from 4.3% to 8%. There are two treatment options available: open surgery (OS) and endovascular treatment (ET). Objective: To compare t [...] he results of repairs conducted using these two treatment methods from 2008 to 2013 in a tertiary hospital. Methods: A retrospective analysis comparing 119 patients treated with OS and 219 patients who underwent ET for AAA repair. Results: The ET group was older (71.3 vs. 68.2 years; p

  12. Tuberculous aneurysm of the abdominal aorta: endovascular repair using stent grafts in two cases

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    Liu, Wei Chiang; Kwak, Byung Kook; Kim, Kyo Nam [Sung Ae General Hospital, Seoul (Korea, Republic of); And Others

    2000-12-01

    Tuberculous aneurysm of the aorta is exceedingly rare. To date, the standard therapy for mycotic aneurysm of the abdominal aorta has been surgery involving in-situ graft placement or extra-anatomic bypass surgery followed by effective anti-tuberculous medication. Only recently has the use of a stent graft in the treatment of tuberculous aortic aneurysm been described in the literature. We report two cases in which a tuberculous aneurysm of the abdominal aorta was successfully repaired using endovascular stent grafts. One case involved is a 42-year-old woman with a large suprarenal abdominal aortic aneurysm and a right psoas abscess, and the other, a 41-year-old man in whom an abdominal aortic aneurysm ruptured during surgical drainage of a psoas abscess. (author)

  13. Tuberculous aneurysm of the abdominal aorta: endovascular repair using stent grafts in two cases

    International Nuclear Information System (INIS)

    Tuberculous aneurysm of the aorta is exceedingly rare. To date, the standard therapy for mycotic aneurysm of the abdominal aorta has been surgery involving in-situ graft placement or extra-anatomic bypass surgery followed by effective anti-tuberculous medication. Only recently has the use of a stent graft in the treatment of tuberculous aortic aneurysm been described in the literature. We report two cases in which a tuberculous aneurysm of the abdominal aorta was successfully repaired using endovascular stent grafts. One case involved is a 42-year-old woman with a large suprarenal abdominal aortic aneurysm and a right psoas abscess, and the other, a 41-year-old man in whom an abdominal aortic aneurysm ruptured during surgical drainage of a psoas abscess. (author)

  14. Tratamiento endovascular del aneurisma de aorta torácica descendente / Endovascular treatment of descending thoracic aorta aneurysms

    Scientific Electronic Library Online (English)

    Renato, Mertens M; Francisco, Valdés E; Albrecht, Krämer Sch; Leopoldo, Mariné M; Manuel, Irarrázaval L; Sergio, Morán V; Ricardo, Zalaquet S; Eitan, Schwartz Y; Jeannette, Vergara G; Magaly, Valdebenito G.

    2003-06-01

    Full Text Available [...] Abstract in english Background: The natural history of aneurysms ends in rupture and death. In 1990 the first endovascular exclusion of an aneurysm, using an endoluminal graft implanted through the femoral arteries was performed. More recently, the same procedure has been used for aneurysms of the thoracic aorta. Aim: [...] To report our experience with endovascular treatment of thoracic aorta aneurysms. Material and methods: Analysis of 14 patients (nine male), aged 30 to 79 years, treated between May 2001 and August 2002. Results: The mean diameter of the aneurysms was 6.9 cm. The etiology was atherosclerotic in nine patients. The Excluder device (Goreâ) was preferentially used. There was no operative mortality or paraplegia. One patient had a transient leg monoparesis that reverted completely. No patient had type I endoleaks. Two patients had type II endoleaks on discharge, that sealed spontaneously. In a follow up, ranging from 2 to 17 months, one patient died of a bronchopneumonia and no aneurysm rupture has been detected. Conclusions: The short term results of endoluminal treatment of thoracic aorta aneurysms are excellent. This treatment is less invasive and has less complications than conventional surgery (Rev Méd Chile 2003; 131: 617-22)

  15. Tratamiento endovascular del aneurisma de aorta torácica descendente Endovascular treatment of descending thoracic aorta aneurysms

    Directory of Open Access Journals (Sweden)

    Renato Mertens M

    2003-06-01

    Full Text Available Background: The natural history of aneurysms ends in rupture and death. In 1990 the first endovascular exclusion of an aneurysm, using an endoluminal graft implanted through the femoral arteries was performed. More recently, the same procedure has been used for aneurysms of the thoracic aorta. Aim: To report our experience with endovascular treatment of thoracic aorta aneurysms. Material and methods: Analysis of 14 patients (nine male, aged 30 to 79 years, treated between May 2001 and August 2002. Results: The mean diameter of the aneurysms was 6.9 cm. The etiology was atherosclerotic in nine patients. The Excluder device (Goreâ was preferentially used. There was no operative mortality or paraplegia. One patient had a transient leg monoparesis that reverted completely. No patient had type I endoleaks. Two patients had type II endoleaks on discharge, that sealed spontaneously. In a follow up, ranging from 2 to 17 months, one patient died of a bronchopneumonia and no aneurysm rupture has been detected. Conclusions: The short term results of endoluminal treatment of thoracic aorta aneurysms are excellent. This treatment is less invasive and has less complications than conventional surgery (Rev Méd Chile 2003; 131: 617-22

  16. [Conventional surgery versus endovascular surgery in a patient who undergoes an abdominal aorta aneurism. Nursing treatment].

    Science.gov (United States)

    Espelosín Azpilicueta, M Dolores; Odériz Baquedano, M Arántzazu

    2006-06-01

    Patients diagnosed with an Abdominal Aorta Aneurism who undergo an operation using either conventional surgery or endovascular surgery require a series of different nursing treatment. The authors comparatively analyze nursing treatment applied to patients who have undergone an abdominal aorta aneurism according to the technique used; their study is retrospective, observational and comparative for all 61 patients who underwent an abdominal aorta aneurism in the Navarre Hospital in 2004. The authors describe both techniques, their advantages and inconveniences, and in a well-developed comparative manner, point out the differences in nursing treatment during post-operative care. Part of this study was presented in a poster format at the XVII National Congress on Vascular Nursing. PMID:16875361

  17. Embolization by micro navigation for treatment of persistent type 2 Endoleaks after endovascular abdominal aortic aneurysm repair / Embolização por micronavegação para tratamento de Endoleak tipo 2 persistente após reparo endovascular do aneurisma de aorta abdominal

    Scientific Electronic Library Online (English)

    Bruno Lorenção de, Almeida; Antônio Massamitsu, Kambara; Fabio Henrique, Rossi; Marcelo Bueno de Oliveira, Colli; Eduardo Silva Jordão de, Oliveira; Patrick Bastos, Metzger; Camila Baumann, Beteli; Sthefanie Fauve Andrade, Cavalcante.

    2014-12-01

    Full Text Available Contexto: O reparo endovascular se estabeleceu como uma modalidade segura e efetiva no tratamento do Aneurisma de Aorta Abdominal. Uma das principais complicações deste tipo de tratamento é o Vazamento ou Endoleak, sendo o do tipo 2 o mais frequente deles. Objetivo: Fazer uma breve revisão de lit [...] eratura e avaliar a segurança e a efetividade da embolização por micronavegação para o tratamento do Vazamento tipo 2. Método: A revisão dos prontuários dos pacientes submetidos ao Reparo Endovascular do Aneurisma de Aorta abdominal identificou cinco pacientes que apresentavam Endoleak tipo 2 persistente. Esses pacientes foram submetidos à embolização por micronavegação. Resultado: Em todos os casos, houve sucesso angiográfico e as tomografias de controle evidenciavam ausência de Vazamento tipo 2 e diminuição do saco aneurismático, após o procedimento. Conclusão: O tratamento do Endoleak tipo II por embolização por micronavegação é um método efetivo e seguro, sendo considerado uma opção para esta complicação após o Reparo Endovascular do Aneurisma de Aorta Abdominal. Abstract in english Background: Endovascular repair has become established as a safe and effective method for treatment of abdominal aortic aneurysms. One major complication of this treatment is leakage, or endoleaks, of which type 2 leaks are the most common. Objective: To conduct a brief review of the literature a [...] nd evaluate the safety and effectiveness of embolization by micronavigation for treatment of type 2 endoleaks. Method: A review of medical records from patients who underwent endovascular repair of abdominal aortic aneurysms identified 5 patients with persistent type 2 endoleaks. These patients were submitted to embolization by micronavigation. Results: In all cases, angiographic success was achieved and control CT scans showed absence of type 2 leaks and aneurysm sacs that had reduced in size after the procedure. Conclusion: Treatment of type 2 endoleaks using embolization by micronavigation is an effective and safe method and should be considered as a treatment option for this complication after endovascular repair of abdominal aortic aneurysms.

  18. Aneurisma de aorta torácica por úlcera aterosclerótica penetrante: tratamiento endovascular, híbrido o cirugía. Revisión / Penetrating atherosclerotic ulcer of the thoracic aorta: endovascular treatment, hybrid or surgery. A review

    Scientific Electronic Library Online (English)

    Magali, Herrera-Gomar; Marco Antonio, Alcántara-Meléndez; Catalina, Lomelí-Estrada; Celso, Mendoza-González; Carlos Alberto, Aguirre-Molina; José Antonio, Lorenzo-Negrete; Eric, Kimura-Hayama; Martín, Rosas-Peralta; Fause, Attie-Cury.

    2009-06-01

    Full Text Available Los aneurismas de aorta pueden acompañarse de síndromes aórticos agudos (SAA) que cursan con debilitamiento de la capa media, lo cual condiciona un riesgo de ruptura aórtica, con alta morbilidad y mortalidad. La úlcera penetrante constituye 5% de los SAA y resulta de una progresiva erosión de una pl [...] aca ateromatosa que penetra la lámina elástica interna y permite la formación de un hematoma en la media de la pared aórtica. El tratamiento endovascular es una alternativa al tratamiento quirúrgico en los SAA que ha demostrado una adecuada tasa de éxito; sin embargo, existe en la actualidad otra modalidad que se conoce como tratamiento híbrido (quirúrgico y endovascular) que parece estar dando adecuados resultados. El caso que analizamos a continuación es el de un paciente que tuvo una úlcera penetrante. El hematoma resultante generó un aneurisma contenido con riesgo de ruptura. Además, en este estudio comentaremos las opciones en el tratamiento de estos pacientes. Abstract in english The aortic aneurysm is part of the acute aortic syndromes (AAS). Aortic aneurysms have a weakened tunica media. Acute aneurysm expansion may herald rupture with high morbility and mortality. Five percent of AAS are diagnosed as pentetrating atherosclerotic ulcer which is an ulceration of an atherosc [...] lerotic lesion of the aorta that penetrates the internal elastic lamina and allows hematoma formation within the tunica media of the aortic wall. Endovascular treatment is an alternative to surgery and has provided an adequate rate of successful repair. There is another type of treatment which combines surgery and endovascular repair (the hybrid open-endovascular repair) which provides adequate results. The afford mention case is about a patient with a penetrating atherosclerotic ulcer. The hematoma that results from this ulcer extends and self-contains the aneurysm, with a high risk of rupture. We will also describe the aneurysm treatment options.

  19. Endovascular Treatment of Blunt Traumatic Abdominal Aortic Occlusion With Kissing Stent Placement

    International Nuclear Information System (INIS)

    Blunt traumatic abdominal aortic dissection is extremely rare and potentially deadly. We present the case of a 62-year-old man involved in a frontal car crash. After emergency undergoing laparotomy for bowel injuries, he was referred to our hospital due to acute ischemia of bilateral lower extremities on day 3 after the trauma. Computed tomography and aortography showed an aortobiiliac dissection with complete occlusion. This injury was successfully treated by endovascular treatment with “kissing”-technique stent placement, which appears to be a safe, effective, and minimally invasive treatment.

  20. Sac Hygroma After Endovascular Abdominal Aortic Aneurysm Repair: Successful Treatment with Endograft Relining

    International Nuclear Information System (INIS)

    Aneurysm sac expansion following endovascular abdominal aortic aneurysm repair (EVAR) is typically associated with endoleaks that can be readily diagnosed on computed tomographic angiography (CTA), ultrasound, or catheter-directed arteriography. Sac hygromas are a cause of sac expansion without apparent endoleak and are presumed to be a result of ultrafiltration of serum manifested by accumulation of fibrinous, gelatinous material within the aneurysm sac following EVAR. Although there are no reported associated ruptures, sac expansion is nevertheless disconcerting and intervention is presumably indicated. We report a case of an expanding aneurysm after EVAR secondary to sac hygroma that was successfully treated with relining of the existing, original endograft

  1. Endovascular Management of Ruptured Abdominal Aortic Aneurysms: An 8-year Single-Centre Experience

    International Nuclear Information System (INIS)

    We aimed to review our experience with the endovascular treatment of ruptured abdominal aortic aneurysm (RAAA). During an 8-year period, 69 patients with a RAAA presented to our department; 67 underwent assessment by computed axial tomography, and 2 died on arrival before any evaluation was possible. A total of 42 patients (63%) were suitable for stent-grafting, and all but 1 (c-arm failure) proceeded to endovascular repair. Of these, 27 underwent surgery with local anaesthesia; 3 did so under general anaesthesia; and a further 11 procedures were commenced with the patient under local anaesthesia and then converted to general anaesthesia. A total of 28 bifurcated and 14 aorto-uni-iliac stent-grafts were implanted. Aortic occlusion balloons were used in 2 (5%) patients. The in-hospital and the 30-day mortality rates were 36% and 41%, respectively. After surgery, 21 complications were encountered in 17 patients. Two patients required reintervention during their hospital stay (1 type I endoleak and 1 limb occlusion). During the follow-up (median 730 days [range 90 to 580 days]), the 1-year and 5-year cumulative survival probabilities were 53% (SE 7.9%) and 50% (SE 8.0%), respectively. Three reinterventions were necessary during follow-up (2 type I endoleaks and 1 graft occlusion). We conclude that endovascular treatment is feasible in the emergency setting, and the early experience is promising. Whether such an approach is superior to open surgery remains to be determined.

  2. Correção endovascular do aneurisma da aorta abdominal: análise dos resultados de único centro

    Directory of Open Access Journals (Sweden)

    Eduardo Rafael Novero

    2012-02-01

    Full Text Available OBJETIVO: Avaliar os resultados clínicos imediatos e em médio prazo do tratamento endovascular em pacientes portadores de aneurisma da aorta abdominal em um centro de referência para doenças cardiovasculares. MATERIAIS E MÉTODOS: Estudo retrospectivo de uma série de pacientes submetidos a tratamento endovascular de aneurisma da aorta abdominal, no período de janeiro de 2009 a julho de 2010. Foram avaliados as características demográficas, o sucesso técnico, o sucesso terapêutico, a morbimortalidade, as complicações e a taxa de reintervenções perioperatórias imediatos, e após um ano de acompanhamento. RESULTADOS: Foram analisados 102 pacientes consecutivos com idade média de 72 ± 9 anos, sendo 79% deles do sexo masculino. Houve sucesso técnico em 97,1% e êxito terapêutico em 81% dos casos. A mortalidade perioperatória foi de 0,9% e a anual, de 7,8%. Foram necessárias reintervenções em 18,8% dos pacientes durante o seguimento. CONCLUSÃO: Em nosso estudo, os resultados obtidos justificam a realização desse procedimento nos pacientes com anatomia adequada.

  3. Exclusión endovascular de un aneurisma de la aorta abdominal con una endoprótesis fenestrada balón expandible / Endovascular Exclusion of an Abdominal Aortic Aneurysm with a Fenestrated Balloon-Expandable Stent-Graft

    Scientific Electronic Library Online (English)

    Hernán G., Bertoni; Germán, Girela; Miguel, Peirano; Jorge H., Leguizamón; Sergio, Ludueña; Héctor, Barone.

    2008-10-01

    Full Text Available La reparación endovascular de los aneurismas de la aorta abdominal (AAA) es una alternativa atractiva a la cirugía convencional. El límite absoluto para el implante de una endoprótesis estándar es la presencia de una o ambas arterias renales emergiendo del saco aneurismático. En estos casos, el empl [...] eo de dispositivos fenestrados con preservación del flujo sanguíneo de dichas arterias puede ser una alternativa terapéutica al tratamiento convencional. El objetivo de esta presentación es comunicar la colocación de una endoprótesis fenestrada balón expandible en un paciente con AAA, monorreno y con un riñón intrapelviano en el que la arteria renal emergía del saco aneurismático. Por vía femoral derecha sobre una guía rígida se ascendió el tronco aórtico de la endoprótesis. A continuación, por la misma vía, se ascendió el módulo de conexión entre el tronco aórtico y la arteria ilíaca común derecha. Un tercer módulo conectó la rama de la fenestración del segundo módulo con la arteria renal. El procedimiento se completó con la oclusión de la arteria ilíaca común izquierda (mediante stent oclusor) y la realización de un bypass femorofemoral. El éxito clínico y de implante alcanzado con este paciente muestra que las endoprótesis fenestradas son una opción en anatomías complejas y nos alienta a continuar trabajando con este tipo de dispositivos. Abstract in english Endovascular repair of abdominal aortic aneurysms (AAA) is an attractive option to conventional surgery. The presence of one or both renal arteries emerging from the aneurysmal sac is the absolute limit for implanting a standard stent-graft. In these cases, the use of fenestrated devices that preser [...] ve blood flow to these arteries might constitute a therapeutic option to conventional treatment. The aim of this case report is to describe the implant of a balloon-expandable stent-graft using a fenestrated device in a patient with an AAA and only one kidney located in the pelvis with a renal artery emerging from the aneurysmal sac. A stiff guide-wire was introduced via the femoral artery and the aortic segment of the stent-graft was advanced. A second segment was introduced to connect the aortic trunk with the right common iliac artery. Finally, a third segment connected the fenestrated branch of the second segment with the renal artery. The procedure ended with the placement of an occluder device in the left common iliac artery and a femorofemoral bypass graft surgery. The clinical success achieved with this patient demonstrates that fenestrated stent-grafts are an option in complex anatomies and encourages us to keep on working with this type of devices.

  4. A Case Report of the Endovascular Treatment of Mycotic Abdominal Aortic Pseudoaneurysms Using a Customized Stent-Graft

    International Nuclear Information System (INIS)

    Abdominal aortic aneurysms located around the major branch of the aorta were treated surgically rather than by endovascular treatment due to the complex anatomy. Recently, the treatment modality evolved towards a customized stent-graft. We report on a case of a mycotic pseudoaneurysm originating in the abdominal aorta at the level of superior mesenteric artery, which was treated with a customized stent-graft.

  5. Unusual perigraft abscess formation associated with stent graft infection after endovascular aortic repair of abdominal aortic aneurysm: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyo Jin; Kim, Song Soo; Ahn, Moon Sang; Lee, Jae Hwan; Shin, Byung Seok; KIm, Jin Hwan [Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon (Korea, Republic of)

    2014-03-15

    Although a stent graft infection after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) is a rare complication, it carries a high mortality and morbidity rate. We report a rare case of stent graft infection that led to an unusual perigraft abscess formation without any associated aortoenteric fistula two years after the EVAR of AAA.

  6. Unusual perigraft abscess formation associated with stent graft infection after endovascular aortic repair of abdominal aortic aneurysm: A case report

    International Nuclear Information System (INIS)

    Although a stent graft infection after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) is a rare complication, it carries a high mortality and morbidity rate. We report a rare case of stent graft infection that led to an unusual perigraft abscess formation without any associated aortoenteric fistula two years after the EVAR of AAA.

  7. Abdominal aortic aneurysm calcification and thrombus volume are not associated with outcome following endovascular abdominal aortic aneurysm repair

    Energy Technology Data Exchange (ETDEWEB)

    Rai, Divyajeet; Velu, Ramesh; Tosenovsky, Patrik; Quigley, Francis [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); The Townsville Hospital, Department of Vascular and Endovascular Surgery, Douglas (Australia); Wisniowski, Brendan; Walker, Philip J. [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); University of Queensland, School of Medicine and Centre for Clinical Research, Department of Vascular Surgery, Royal Brisbane and Women' s Hospital, Herston, QLD (Australia); Bradshaw, Barbara [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); Golledge, Jonathan [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); The Townsville Hospital, Department of Vascular and Endovascular Surgery, Douglas (Australia); University of Queensland, School of Medicine and Centre for Clinical Research, Department of Vascular Surgery, Royal Brisbane and Women' s Hospital, Herston, QLD (Australia)

    2014-08-15

    Aortic calcification and thrombus have been postulated to worsen outcome following endovascular abdominal aortic aneurysm repair (EVAR). The purpose of this study was to assess the association of abdominal aortic aneurysm (AAA) calcification and thrombus volume with outcome following EVAR using a reproducible, quantifiable computed tomography (CT) assessment protocol. Patients with elective EVAR performed between January 2002 and 2012 at the Townsville Hospital, Mater Private Hospital (Townsville) and Royal Brisbane and Women's Hospital (RBWH) were included if preoperative CTAs were available for analysis. AAA calcification and thrombus volume were measured using a semiautomated workstation protocol. Outcomes were assessed in terms of clinical failure, endoleak (type I, type II) and reintervention. Univariate and multivariate analyses were performed. Median follow-up was 1.7 years and the interquartile range 1.0-3.8 years. One hundred thirty-four patients undergoing elective EVAR were included in the study. Rates of primary clinical success and freedom from reintervention were 82.8 % and 88.9 % at the 24-month follow-up. AAA calcification and thrombus volume were not associated with clinical failure, type I endoleak, type II endoleak or reintervention. AAA calcification and thrombus volume were not associated with poorer outcome after EVAR in this study. (orig.)

  8. Abdominal aortic aneurysm calcification and thrombus volume are not associated with outcome following endovascular abdominal aortic aneurysm repair

    International Nuclear Information System (INIS)

    Aortic calcification and thrombus have been postulated to worsen outcome following endovascular abdominal aortic aneurysm repair (EVAR). The purpose of this study was to assess the association of abdominal aortic aneurysm (AAA) calcification and thrombus volume with outcome following EVAR using a reproducible, quantifiable computed tomography (CT) assessment protocol. Patients with elective EVAR performed between January 2002 and 2012 at the Townsville Hospital, Mater Private Hospital (Townsville) and Royal Brisbane and Women's Hospital (RBWH) were included if preoperative CTAs were available for analysis. AAA calcification and thrombus volume were measured using a semiautomated workstation protocol. Outcomes were assessed in terms of clinical failure, endoleak (type I, type II) and reintervention. Univariate and multivariate analyses were performed. Median follow-up was 1.7 years and the interquartile range 1.0-3.8 years. One hundred thirty-four patients undergoing elective EVAR were included in the study. Rates of primary clinical success and freedom from reintervention were 82.8 % and 88.9 % at the 24-month follow-up. AAA calcification and thrombus volume were not associated with clinical failure, type I endoleak, type II endoleak or reintervention. AAA calcification and thrombus volume were not associated with poorer outcome after EVAR in this study. (orig.)

  9. Endovascular stent-graft placement and secondary intervention for abdominal aortic aneurysm in a patient who had a previously inserted iliac stent

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Yong Sun; Cho, Soon Gu; Hong, Kee Chun [Inha University College of Medicine, Incheon (Korea, Republic of)

    2007-04-15

    Endovascular repair of abdominal aortic aneurysm is associated with low morbidity and mortality rates when compared to open surgery, and this can be used in patients who are at a high risk for open surgical repair. Also, secondary intervention is an important for achieving intermediate and long term success of endovascular repair of abdominal aortic aneurysm as this can resolve complications. We report here on endovascular stent-graft placement and a secondary interventional procedure in the abdominal aortic aneurysm of a patient who had a previously inserted iliac stent.

  10. Endovascular repair of abdominal aortic aneurysms: vascular anatomy, device selection, procedure, and procedure-specific complications.

    Science.gov (United States)

    Bryce, Yolanda; Rogoff, Philip; Romanelli, Donald; Reichle, Ralph

    2015-01-01

    Abdominal aortic aneurysm (AAA) is abnormal dilatation of the aorta, carrying a substantial risk of rupture and thereby marked risk of death. Open repair of AAA involves lengthy surgery time, anesthesia, and substantial recovery time. Endovascular aneurysm repair (EVAR) provides a safer option for patients with advanced age and pulmonary, cardiac, and renal dysfunction. Successful endovascular repair of AAA depends on correct selection of patients (on the basis of their vascular anatomy), choice of the correct endoprosthesis, and familiarity with the technique and procedure-specific complications. The type of aneurysm is defined by its location with respect to the renal arteries, whether it is a true or false aneurysm, and whether the common iliac arteries are involved. Vascular anatomy can be divided more technically into aortic neck, aortic aneurysm, pelvic perfusion, and iliac morphology, with grades of difficulty with respect to EVAR, aortic neck morphology being the most common factor to affect EVAR appropriateness. When choosing among the devices available on the market, one must consider the patient's vascular anatomy and choose between devices that provide suprarenal fixation versus those that provide infrarenal fixation. A successful technique can be divided into preprocedural imaging, ancillary procedures before AAA stent-graft placement, the procedure itself, postprocedural medical therapy, and postprocedural imaging surveillance. Imaging surveillance is important in assessing complications such as limb thrombosis, endoleaks, graft migration, enlargement of the aneurysm sac, and rupture. Last, one must consider the issue of radiation safety with regard to EVAR. PMID:25763741

  11. Endovascular stent graft repair of abdominal aortic aneurysms: Current status and future directions

    Directory of Open Access Journals (Sweden)

    Zhonghua Sun

    2009-12-01

    Full Text Available Endovascular stent graft repair of abdominal aortic aneurysm (AAA has undergone rapid developments since it was introduced in the early 1990s. Two main types of aortic stent grafts have been developed and are currently being used in clinical practice to deal with patients with complicated or unsuitable aneurysm necks, namely, suprarenal and fenestrated stent grafts. Helical computed tomography angiography has been widely recognized as the method of choice for both pre-operative planning and post-operative follow-up of endovascular repair (EVAR. In addition to 2D axial images, a number of 2D and 3D reconstructions are generated to provide additional information about imaging of the stent grafts in relation to the aortic aneurysm diameter and extent, encroachment of stent wires to the renal artery ostium and position of the fenestrated vessel stents. The purpose of this article is to provide an overview of applications of EVAR of AAA and diagnostic applications of 2D and 3D image visualizations in the assessment of treatment outcomes of EVAR. Interference of stent wires with renal blood flow from the hemodynamic point of view will also be discussed, and future directions explored.

  12. Management of hypogastric artery in endovascular exclusion for type II C abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To summarize our experiences of management for hypogastric artery in endovascular exclusion (EVE) for type II C abdominal aortic aneurysm (AAA). Methods: From March, 1997 to October, 2002, endovascular exclusions were performed on 42 cases of type II C AAAs. Among them, the unilateral iliac bifurcations of 23 cases and the bilateral iliac bifurcations of 19 cases were involved. Various techniques, including the preservation of contralateral hypogastric artery, reconstruction of unilateral hypogastric artery and extra-artery ligation, were applied according to the different conditions of common iliac artery involved. Results: The procedures were technically successful in 41 patients (97.6%) without presence of obvious type I endoleak. Buttock pain occurred in 3 cases (7.5%), and bloody faeces in 2 cases (5.0%), but without buttock and colorectal necrosis. Conclusions: EVE is an effective method for type II C AAA. It is important to preserve the unilateral hypogastric artery, and avoid to occlude the bilateral hypogastric artery as well as possible

  13. Synchronous colorectal malignancy and abdominal aortic aneurysm treated with endovascular aneurysm repair followed by laparoscopic colectomy.

    Science.gov (United States)

    Kawai, Kazushige; Sunami, Eiji; Tanaka, Junichiro; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Nozawa, Hiroaki; Kazama, Shinsuke; Kanazawa, Takamitsu; Hosaka, Akihiro; Ishihara, Soichiro; Yamaguchi, Hironori; Shigematsu, Kunihiro; Watanabe, Toshiaki

    2015-04-01

    Although the incidence of synchronous abdominal aortic aneurysm (AAA) and malignancies is increasing, there has been no clear consensus in the surgical treatment of such patients. The focus on surgical treatments with minimal invasiveness, such as endovascular aneurysm repair (EVAR) for AAA and laparoscopic colectomy for colorectal cancer, has increased; however, the clinical applicability of combination treatment with EVAR and laparoscopic colectomy has not been established. A 61-year-old man was diagnosed with AAA, advanced sigmoid colon cancer, and coronary artery stenosis. Because the patient also had chronic renal failure with nephrotic syndrome, among several other comorbidities, surgery was considered to be associated with high risks in this patent. Sequential treatments with percutaneous coronary intervention, EVAR, and laparoscopic colectomy were successfully performed. Staged treatment of EVAR followed by laparoscopic colectomy may be a promising strategy for high-risk patients with AAA associated with malignancy. PMID:25875539

  14. Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm: Single Center Experience in 122 Patients

    International Nuclear Information System (INIS)

    To analyze a single center experience of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. Results of 122 patients who underwent EVAR were analyzed, retrospectively. Sex, age, aneurysmal morphology, hostile neck anatomy, preprocedural and postprocedural sac-diameter, technical and clinical success, postprocedural complication and need of additional procedure were analyzed. A total of 111 male and 11 female patients were included. Morphology of the aneurysms was as follows: fusiform (n = 108), saccular (n = 3) and ruptured type (n = 11). Sixty-four patients had hostile neck anatomy. The preprocedural mean sac-diameter was 52.4 mm. Postprocedural sac-diameter was decreased or stable in 110 patients (90.2%) and increased in 8 patients (6.6%). Technical success rate was 100% and clinical success rate was 86.1%. Fifty-one patients showed endoleak (41.8%) and 15 patients (12.3%) underwent secondary intervention due to type I endoleak (n = 4), type II endoleak (n = 4) and stent-graft thrombosis (n = 7). EVAR is a safe and effective therapy for abdominal aortic aneurysm, and it has high technical success and clinical success rate, and low complication rate.

  15. Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm: Single Center Experience in 122 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yun Young; Song, Jang Hyeon; Kim, Yong Tae; Yim, Nam Yeol; Kim, Jae Kyu; Lee, Ho Kyun; Choi, Soo Jin Na; Chung, Sang Young [Dept. of Radiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju (Korea, Republic of); Kim, Soo Hyun; Chang, Nam Kyu [Dept. of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Hwasun (Korea, Republic of)

    2013-02-15

    To analyze a single center experience of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. Results of 122 patients who underwent EVAR were analyzed, retrospectively. Sex, age, aneurysmal morphology, hostile neck anatomy, preprocedural and postprocedural sac-diameter, technical and clinical success, postprocedural complication and need of additional procedure were analyzed. A total of 111 male and 11 female patients were included. Morphology of the aneurysms was as follows: fusiform (n = 108), saccular (n = 3) and ruptured type (n = 11). Sixty-four patients had hostile neck anatomy. The preprocedural mean sac-diameter was 52.4 mm. Postprocedural sac-diameter was decreased or stable in 110 patients (90.2%) and increased in 8 patients (6.6%). Technical success rate was 100% and clinical success rate was 86.1%. Fifty-one patients showed endoleak (41.8%) and 15 patients (12.3%) underwent secondary intervention due to type I endoleak (n = 4), type II endoleak (n = 4) and stent-graft thrombosis (n = 7). EVAR is a safe and effective therapy for abdominal aortic aneurysm, and it has high technical success and clinical success rate, and low complication rate.

  16. Outcomes and Prognostic Factors of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hye Doo; Lee, Yun Young; Lee, Seung Jin; Yim, Nam Yeol; Kim, Jae Kyu; Choi, Soo Jin Na; Jung, Sang Young [Chonnam National University Hospital, Gwangju (Korea, Republic of); Chang, Nam Kyu [Dept. of Radiology, St. Carollo Hospital, Suncheon (Korea, Republic of); Lim, Jae Hoon [Dept. of Radiology, Donggunsan Hospital, Gunsan (Korea, Republic of)

    2012-09-15

    To evaluate the outcomes and find the prognostic factors of endovascular abdominal aortic aneurysm repair (EVAR) in patients with hostile neck anatomy of the abdominal aorta. This study was performed on 100 patients with abdominal aneurysm who were treated with EVAR between March 2006 and December 2010. We divided the patients into two groups: good neck anatomy (GNA), and hostile neck anatomy (HNA) and then compared the primary success rate and the incidence rate of complications with EVAR between the two groups. Our aim was to determine the factors related to the complications of EVAR among HNA types. There were no significant differences of primary success rate and incidence rate of complications between the two groups. Among the types of HNA, the short neck angle [odd ratio (OR), 4.23; 95% confidence interval (CI), 1.21-18.70; p = 0.023] and large neck angle (OR, 2.58; 95% CI, 0.15-11.85; p = 0.031) showed a low primary success rate. The short neck angle (OR, 2.32; 95% CI, 1.18-12.29; p = 0.002) and large neck angle (OR, 4.67; 95% CI, 0.14-19.07; p = 0.032) showed a high incidence rate of early type 1 complication. In the case of the large neck angle (OR, 3.78; 95% CI, 0.96-20.80; p = 0.047), the large neck thrombus (OR, 2.23; 95% CI, 0.24-7.12; p = 0.035) and large neck calcification (OR, 2.50; 95% CI, 0.08-18.37; p 0.043) showed a high incidence rate of complications within a year. The results suggest that patients with hostile neck anatomy can be treated with EVAR successfully, although there was a higher incidence of complications in patients with a short neck length, severe neck angulation, circumferential thrombosis, and calcified proximal neck.

  17. Low-dose multidetector-row CT-angiography of abdominal aortic aneurysm after endovascular repair

    Energy Technology Data Exchange (ETDEWEB)

    Iezzi, R., E-mail: iezzir@virgilio.it [Department of Bioimaging and Radiological Sciences, Institute of Radiology, ' A. Gemelli' Hospital - Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Department of Clinical Science and Bioimaging, Section of Radiology, University ' G. D' Annunzio' , Chieti (Italy); Cotroneo, A.R.; Giammarino, A. [Department of Clinical Science and Bioimaging, Section of Radiology, University ' G. D' Annunzio' , Chieti (Italy); Spigonardo, F. [Department of Vascular Surgery, University ' G. D' Annunzio' , Chieti (Italy); Storto, M.L. [Department of Clinical Science and Bioimaging, Section of Radiology, University ' G. D' Annunzio' , Chieti (Italy)

    2011-07-15

    Purpose: To investigate the possibility of reducing radiation dose exposure while maintaining image quality using multidetector computed tomography angiography (MDCTA) with high-concentration contrast media in patients undergoing follow-up after endovascular aortic repair (EVAR) to treat abdominal aortic aneurysm. Materials and methods: In this prospective, single center, intra-individual study, patients underwent two consecutive MDCTA scans 6 months apart, one with a standard acquisition protocol (130 mAs/120 kV) and 120 mL of iomeprol 300, and one using a low dose protocol (100 mAs/80 kV) and 90 mL of iomeprol 400. Images acquired during the arterial phase of contrast enhancement were evaluated both qualitatively and quantitatively for image noise and intraluminal contrast enhancement. Results: Thirty adult patients were prospectively enrolled. Statistically significantly higher attenuation values were measured in the low-dose acquisition protocol compared to the standard protocol, from the suprarenal abdominal aorta to the common femoral artery (p < 0.0001; all vascular segments). Qualitatively, image quality was judged significantly (p = 0.0002) better with the standard protocol than with the low-dose protocol. However, no significant differences were found between the two protocols in terms of contrast-to-noise ratio (CNR) (13.63 {+-} 6.97 vs. 11.48 {+-} 8.13; p = 0.1058). An overall dose reduction of up to 74% was observed for the low-dose protocol compared with the standard protocol. Conclusion: In repeat follow-up examinations of patients undergoing EVAR for abdominal aortic aneurysm, a low-dose radiation exposure acquisition protocol provides substantially reduced radiation exposure while maintaining a constant CNR and good image quality.

  18. Unfavorable iliac artery anatomy causing access limitations during endovascular abdominal aortic aneurysm repair: application of the endoconduit technique

    Directory of Open Access Journals (Sweden)

    Rodrigo Gibin Jaldin

    2014-12-01

    Full Text Available Endovascular aneurysm repair (EVAR is already considered the first choice treatment for abdominal aortic aneurysms (AAA. Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved.

  19. Simultaneous Endovascular Aneurysm Repair and Distal Gastrectomy in a Patient with Concomitant Abdominal Aortic Aneurysm and Advanced Gastric Cancer

    OpenAIRE

    Matsuno, Yukihiro; Ishida, Narihiro; Fukumoto, Yukiomi; Shimabukuro, Katsuya; Takemura, Hirofumi

    2012-01-01

    The optimal surgical management of patients with concomitant abdominal aortic aneurysm (AAA) and gastrointestinal malignancy remains controversial. A 79?year-old man who presented with hematemesis was found to have advanced gastric cancer concomitant with infrarenal AAA. The patient underwent simultaneous endovascular aneurysm repair (EVAR) and distal gastrectomy. The postoperative course was uneventful. The present case illustrates the clinical utility of EVAR for the high-ris...

  20. Open Repair of Ruptured Abdominal Aortic Aneurysm: The Suitability of Endovascular Aneurysm Repair Does Not Influence Operative Mortality

    OpenAIRE

    Yoon, Hye Young; Cho, Jayun; Song, Incheol; KIM, HYUNG-KEE; Huh, Seung

    2015-01-01

    Purpose: We analyze the outcomes of open repair (OR) in patients with ruptured abdominal aortic aneurysm (RAAA) according to the anatomic suitability for endovascular aneurysm repair (EVAR). Materials and Methods: We reviewed retrospectively all consecutive RAAA patients who underwent OR from January 2005 to March 2014. All suspected patients underwent preoperative computed tomography (CT). Outcomes were major morbidities and mortality. Multivariate analysis was performed by using logistic re...

  1. Anatomical Features and Early Outcomes of Endovascular Repair of Abdominal Aortic Aneurysm from a Korean Multicenter Registry

    OpenAIRE

    Kwon, Hyunwook; Lee, Do Yun; Choi, Soo Jin Na; Park, Ki Hyuk; Min, Seung-Kee; Chang, Jeong-Hwan; Huh, Seung; Jeon, Yong Sun; Won, Jehwan; Byun, Seung Jae; Park, Sang Jun; Jang, Lee Chan; Kwon, Tae-Won

    2015-01-01

    Purpose: To introduce a nation-based endovascular aneurysm repair (EVAR) registry in South Korea and to analyze the anatomical features and early clinical outcomes of abdominal aortic aneurysms (AAA) in patients who underwent EVAR. Materials and methods: The Korean EVAR registry (KER) was a template-based online registry developed and established in 2009. The KER recruited 389 patients who underwent EVAR from 13 medical centers in South Korea from January 2010 to June 2010. We retrospectively...

  2. Embolization by micro navigation for treatment of persistent type 2 Endoleaks after endovascular abdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Bruno Lorenção de Almeida

    2014-12-01

    Full Text Available Background:Endovascular repair has become established as a safe and effective method for treatment of abdominal aortic aneurysms. One major complication of this treatment is leakage, or endoleaks, of which type 2 leaks are the most common.Objective:To conduct a brief review of the literature and evaluate the safety and effectiveness of embolization by micronavigation for treatment of type 2 endoleaks.Method:A review of medical records from patients who underwent endovascular repair of abdominal aortic aneurysms identified 5 patients with persistent type 2 endoleaks. These patients were submitted to embolization by micronavigation.Results:In all cases, angiographic success was achieved and control CT scans showed absence of type 2 leaks and aneurysm sacs that had reduced in size after the procedure.Conclusion:Treatment of type 2 endoleaks using embolization by micronavigation is an effective and safe method and should be considered as a treatment option for this complication after endovascular repair of abdominal aortic aneurysms.

  3. Endovascular coil occlusion of 473 intracranial aneurysms: angiographic and clinical results Tratamiento endovascular de 473 aneurismas intracraneanos: resultados angiográficos y clínicos. Experiencia colombiana, 1996-2008

    Directory of Open Access Journals (Sweden)

    Diego Alberto Herrera

    2011-03-01

    Full Text Available Introduction. Endovascular therapy is a technique accepted throughout the world for the treatment of ruptured and non-ruptured intracranial aneurysms. In Colombia, however, no summary data have been published that validate the method in terms of occlusion grade and morbimortality.
    Objective. The clinical and angiographic outcomes were evaluated for endovascular embolization of 473 intracranial aneurysms treated during a 12 year time interval.
    Materials and methods. Between 1996-2008, 473 intracranial aneurysms treated by an endovascular approach were included in the current retrospective study. Pre and postprocedural angiographic images were analyzed, and clinical outcome was recorded according to the Glasgow coma scale. Immediate angiographic results and morbimortality were evaluated.
    Results. The technical feasibility of the procedure was 96.8%. According to Hunt and Hess scale, 8.7% patients were classified as grade I, 35.7% grade II, 19.2% grade III and 7.8% grades IV/V. Non-ruptured aneurysms had occurred in 28.5% of patients. Immediate procedural angiography demonstrated total occlusion in 69.6%, neck remnant in 17.5% and partial or failed occlusion in 16.1%. Global mortality was 10.4% and procedural mortality was 1.5%. Technique-associated complications presented in 7.6% of treated aneurysms.
    Conclusion. Endovascular treatment of intracranial aneurysms was associated with low morbimortality and high technical feasibility. The results are comparable with other published data summaries and supporting the use of the method in Colombia.
    Introducción. La terapia endovascular es una técnica aceptada mundialmente para el tratamiento de aneurismas cerebrales rotos y no rotos. En nuestro medio no hay grandes series publicadas que permitan comprobar la reproducibilidad del método según el grado de oclusión y la morbimortalidad de la técnica.
    Objetivo. Evaluar los resultados angiográficos y clínicos de la oclusión endovascular de 473 aneurismas intracraneanos tratados durante un período de 12 años.
    Materiales y métodos. Se realizó un estudio retrospectivo en 376 pacientes con 473 aneurismas intracraneanos tratados por terapia endovascular entre los años 1996 y 2008. Se analizaron las imágenes angiográficas antes del procedimiento y después de él y se registró el estado clínico al momento de ser dado de alta, según la escala de coma de Glasgow. Se evalúo la morbimortalidad asociada con la técnica y los resultados angiográficos inmediatos.
    Resultados. La factibilidad técnica del procedimiento fue de 96,8%. Según la escala de Hunt y Hess, al momento de la admisión, 8,7% de los pacientes estaban en el grado I, 35,7% en el grado II, 19,2% en el grado III y 7,8% en los grados IV o V. El 28,5% de los pacientes tenían aneurismas no rotos. Los resultados angiográficos inmediatos demostraron oclusión total en 69,6%, presencia de cuello remanente en 17,5% y oclusión parcial o fallida en 16,1% de los pacientes con "embolización". La mortalidad global fue de 10,4%, con una mortalidad del procedimiento de 1,5%. Se presentaron complicaciones asociadas con la técnica en 7,6% de los aneurismas tratados.
    Conclusión. El tratamiento endovascular de los aneurismas intracraneanos se asoció con una baja morbimortalidad y una gran factibilidad técnica. Los resultados fueron similares a diversas series publicadas en la literatura mundial, respaldando la reproducibilidad del método en nuestro medio.

  4. Manejo del aneurisma de la aorta abdominal: Estado actual, evidencias y perspectivas para el desarrollo de un programa nacional Open and endovascular surgery for the treatment of abdominal aortic aneurism: Review of the available evidence

    Directory of Open Access Journals (Sweden)

    Leopoldo Mariné M

    2009-08-01

    Full Text Available Open and endovascular surgery are therapeutic alternatives for the treatment of abdominal aortic aneurism. The development of guidelines for its treatment requires a thorough analysis of available evidence to recommend the best treatment for each country's reality. Prospective randomized trials have shown best initial results with endovascular surgery, with higher hospital costs than open surgery. The requirement of anatomical suitability for the placement of endovascular prostheses limits the universal use of endovascular surgery. Moreover, this type of surgery needs a strict imaging and clinical follow up due to the high rates of late complications, which range from 20% to 40%. Many of these complications require further surgical interventions, elevating costs of treatment. The initial benefit of endovascular surgery is lost during long follow up as survival curves become similar to those of open surgery. Even for patients with a high surgical risk, the benefits of endovascular surgery are doubtful.

  5. Endovascular therapy of abdominal aortic aneurysm: results of a mid-term follow-up

    International Nuclear Information System (INIS)

    Prospective study to evaluate clinical results and complications of endovascular abdominal aortic aneurysm treatment in a mid-term follow-up. Materials and methods: A total of 122 patients (9 females, 113 males, average age 70.0±7,9 years) with abdominal aortic aneurysms were treated with stent grafts (53 Vanguard or Stentor endografts, 69 Talent endografts). Group I consisted of 40 patients who had all aortic tributaries of the aneurysm sac occluded prior to endovalscular grafting, either spontaneously by parietal thrombosis or by selective coil embolization of the respective ostia preserving collateral circulation distal to the vessel occlusion. Group II consisted of 82 patients and included all cases without or with incomplete coil embolization with at least one patent vessel. Stent grafting was performed in general anesthesia in the first 21 patients, followed by peridural anesthesia in 15 cases, and local anesthesia with conscious sedation in 86 cases. The results were evaluated with Spiral-CT, MRI and radiographs of the endovascular graft, with follow-up examinations obtained at 3, 6, 12 months, and every year - Implantation was successfully completed in all cases without primary conversion surgery, laparotomy or any significant complication. Mean follow-up was 29±21 months (maximum 82 months). The 30-day mortality was 0,8% due to a myocardial infarction 3 days after discharge from the hospital. A total of 47 re-interventions were performed in 29 patients (23.8%), with 35 re-interventions in 18 cases with Vanguard or Stentor endografts and 12 re-interventions in 11 patients with Talent endografts. 23 percutaneous re-interventions included distal graft extension (n=11), Wallstent for kinking and limb stenosis (n=3), and secondary coil embolization of collateral vessels (n=9). 24 surgical re-interventions included proximal graft extension (n=6), new endovascular grafts (n=3), surgical clipping of lumbar and mesenteric artery branches for type-II endoleaks following ineffective secondary coil embolization (n=1), and femorofemoral crossover bypasses (n=4). A total of 10 secondary conversion operations were performed because of damage to the membrane (n=4; 3 Vanguard endografts, 1 Talent endograft), significant caudal migrations (n=5; 4 Vanguard endografts, 1 Talent endograft) associated with type-I endoleaks (n=2), limb occlusion (n=1), disconnection of graft components (n=1), and significant endoluminal thrombus deposits (n=1). One patient, who was followed for 82 months, suffered from a significant endoleak for 10 months with increasing aneurysm diameter but he refused surgery. He was admitted with aneurysm perforation and was successfully operated with aortic graft replacement. Compared to group II, the incidence and size of endoleaks was reduced in group I (incidence 19.2% versus 29.9%, p<0.05). Group I demonstrated significantly better aneurysm shrinkage at 36 months follow-up (? sagittal diameter -11.1±8.4 mm versus -4.9±6.2 mm, p<0.05). (orig.)

  6. Endovascular Treatment of Infrarenal Abdominal Aortic Lesions With or Without Common Iliac Artery Involvement

    Energy Technology Data Exchange (ETDEWEB)

    Oender, Hakan, E-mail: drhakanonder@hotmail.com [Dicle University Medical Faculty, Department of Radiology (Turkey); Oguzkurt, Levent [Baskent University Medical Faculty, Department of Radiology (Turkey); Guer, Serkan [Sifa University Medical Faculty, Department of Radiology (Turkey); Tekbas, Gueven [Dicle University Medical Faculty, Department of Radiology (Turkey); Guerel, Kamil [Abant Izzet Baysal University Medical Faculty, Department of Radiology (Turkey); Coskun, Isa [Baskent University Medical Faculty, Department of Cardiovascular Surgery (Turkey); Oezkan, Ugur [Baskent University Medical Faculty, Department of Radiology (Turkey)

    2013-02-15

    To evaluate the results of stent placement for obstructive atherosclerotic aortic disease with or without involvement of the common iliac artery. Forty patients had self-expanding stents primarily or after balloon dilatation in the abdominal aorta between January 2005 and May 2011. All patients had trouble walking. Follow-up examinations were performed with clinical visits; these included color Doppler ultrasonography and computed tomographic angiography. Technical, clinical, and hemodynamic success was achieved in all patients. None of the patients underwent reintervention during the follow-up period, which ranged from 3 months to 6 years (median 24 months). Nine complications occurred in six patients. Of the nine complications, four were distal thromboembolisms, which were successfully treated with catheter-directed thrombolysis or anticoagulation therapy. Endovascular treatment of the obstructive aortic disease using self-expanding stents was safe and effective, with high technical success and long-term patency. Thromboembolic complications were high even though direct stenting was considered protective for thromboembolism formation. Particularly for infrarenal aortic stenosis, it can be recommended as the first-line treatment option for patients with obstructive atherosclerotic aortic disease.

  7. Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial

    Science.gov (United States)

    Braithwaite, Bruce; Cheshire, Nicholas J.; Greenhalgh, Roger M.; Grieve, Richard; Hassan, Tajek B.; Hinchliffe, Robert; Howell, Simon; Moore, Fionna; Nicholson, Anthony A.; Soong, Chee V.; Thompson, Matt M.; Thompson, Simon G.; Ulug, Pinar; Heatley, Francine; Anjum, Aisha; Kalinowska, Gosia; Sweeting, Michael J.; Thompson, Simon G.; Gomes, Manuel; Grieve, Richard; Powell, Janet T.; Ashleigh, Ray; Gomes, Manuel; Greenhalgh, Roger M.; Grieve, Richard; Hinchliffe, Robert; Sweeting, Michael; Thompson, Matt M.; Thompson, Simon G.; Ulug, Pinar; Roberts, Ian; Bell, Peter R. F.; Cheetham, Anne; Stephany, Jenny; Warlow, Charles; Lamont, Peter; Moss, Jonathan; Tijssen, Jan; Braithwaite, Bruce; Nicholson, Anthony A.; Thompson, Matthew; Ashleigh, Ray; Thompson, Luke; Cheshire, Nicholas J.; Boyle, Jonathan R.; Serracino-Inglott, Ferdinand; Thompson, Matt M.; Hinchliffe, Robert J.; Bell, Rachel; Wilson, Noel; Bown, Matt; Dennis, Martin; Davis, Meryl; Ashleigh, Ray; Howell, Simon; Wyatt, Michael G.; Valenti, Domenico; Bachoo, Paul; Walker, Paul; MacSweeney, Shane; Davies, Jonathan N.; Rittoo, Dynesh; Parvin, Simon D.; Yusuf, Waquar; Nice, Colin; Chetter, Ian; Howard, Adam; Chong, Patrick; Bhat, Raj; McLain, David; Gordon, Andrew; Lane, Ian; Hobbs, Simon; Pillay, Woolagasen; Rowlands, Timothy; El-Tahir, Amin; Asquith, John; Cavanagh, Steve; Dubois, Luc; Forbes, Thomas L.; Ashworth, Emily; Baker, Sara; Barakat, Hashem; Brady, Claire; Brown, Joanne; Bufton, Christine; Chance, Tina; Chrisopoulou, Angela; Cockell, Marie; Croucher, Andrea; Dabee, Leela; Dewhirst, Nikki; Evans, Jo; Gibson, Andy; Gorst, Siobhan; Gough, Moira; Graves, Lynne; Griffin, Michelle; Hatfield, Josie; Hogg, Florence; Howard, Susannah; Hughes, Cían; Metcalfe, David; Lapworth, Michelle; Massey, Ian; Novick, Teresa; Owen, Gareth; Parr, Noala; Pintar, David; Spencer, Sarah; Thomson, Claire; Thunder, Orla; Wallace, Tom; Ward, Sue; Wealleans, Vera; Wilson, Lesley; Woods, Janet; Zheng, Ting

    2015-01-01

    Aims To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. Methods and results This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P effective. Clinical trial registration ISRCTN 48334791. PMID:25855369

  8. Estudo comparativo entre tratamento endovascular e cirurgia convencional na correção eletiva de aneurisma de aorta abdominal: revisão bibliográfica Endovascular elective treatment of the abdominal aortic aneurysm versus conventional open repair: a comparative study

    Directory of Open Access Journals (Sweden)

    Ana Carolina P. Simão

    2009-12-01

    Full Text Available O tratamento eletivo do aneurisma de aorta abdominal é recomendado pela alta morbiletalidade decorrente da eventual ruptura. O objetivo deste trabalho foi comparar o reparo endovascular eletivo com a cirurgia aberta e avaliar as mortalidades hospitalar e perioperatória, em 1 ano, por todas as causas e relacionadas ao aneurisma, a permanência hospitalar, as complicações, as taxas de sobrevida, conversão e reintervenção, a durabilidade do enxerto, o custo-benefício e a relação desses dados com o treinamento da equipe médica responsável pelo tratamento. Realizou-se uma revisão da literatura sobre reparo endovascular versus cirurgia convencional. Foram observados vantagem na sobrevivência perioperatória e menor estresse pós-cirúrgico; no entanto, os benefícios iniciais são perdidos por complicações e reintervenções tardias. Trabalhos baseados nas primeiras gerações de endopróteses superestimam as taxas de mortalidade em curto prazo, complicações e reintervenções. A durabilidade do enxerto, a real vantagem na sobrevida e o custo-benefício são incertos, e outros estudos são necessários para o seguimento em longo prazo.The elective treatment of the abdominal aortic aneurysm is recommended due to the high morbidity and mortality of a possible rupture. The objective of this study was to compare the elective endovascular aneurysm repair with open repair and to analyze the in-hospital and perioperative mortality rate during 1 year related to all causes and to the aneurysm, as well as the postoperative length of hospital stay, complications, survival rates, conversion and reintervention, graft durability, cost-benefit ratio, and relation with the medical team’s experience. A review of the scientific literature about endovascular versus open repair was carried out. We found a higher rate of perioperative survival and less postoperative stress; nevertheless, the initial benefits were lost due to late complications and reinterventions. First-generation endografts overestimated the early results of mortality rates, complications, and reinterventions. Endograft durability, real advantage of survival rates, and cost-benefits are uncertain and further long-term follow-up studies are necessary.

  9. Tratamiento endovascular y trombólisis intraarterial en el ictus isquémico agudo Endovascular treatment and intra-arterial thrombolysis in acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    D. Escudero

    2010-09-01

    Full Text Available Objetivo: Analizar la eficacia y la seguridad de la trombólisis intraarterial y el tratamiento endovascular en pacientes con ictus isquémico agudo. Diseño y ámbito: Estudio prospectivo observacional en una unidad de cuidados intensivos. Pacientes: Dieciséis pacientes recibieron tratamiento endovascular. Se recogieron datos epidemiológicos, localización de la oclusión arterial, tiempo desde el ictus al tratamiento, indicación del tratamiento, National Institutes of Health Stroke Scale al ingreso y al alta hospitalaria, y complicaciones y evolución funcional por escala de Rankin modificada realizada mediante una encuesta telefónica. Resultados: Diez varones, con una edad media de 59 años (29-74 y una estancia media en la unidad de cuidados intensivos de 6 días (1-33. Siete pacientes requirieron ventilación mecánica. Indicación del tratamiento: 4 casos por fracaso de la trombólisis intravenosa, 5 por oclusión de gran vaso, 2 por estar fuera de la ventana terapéutica, 3 por oclusión de la circulación posterior, uno por estar fuera de la ventana terapéutica y tener, además, una oclusión de gran vaso y uno por contraindicación para la trombólisis intravenosa. Localización de la oclusión: 3 en la circulación posterior y 13 en el territorio carotídeo y sus ramas. El fibrinolítico utilizado fue uroquinasa en dosis de 100.000-600.000 UI. Cuatro pacientes requirieron embolectomía mecánica y 10, implantación de stent. Se obtuvo recanalización completa en 11 pacientes (69% y parcial en 4 (25%. Tres pacientes evolucionaron a muerte encefálica. Seis pacientes (46% tuvieron una buena recuperación (escala de Rankin modificada 10 -tiempo de evolución de 3-6h-, y contraindicacio'n para la trombólisis intravenosa y la oclusión arterial proximal.Objective: Analysis of the safety and efficacy of intra-arterial thrombolysis therapy and endovascular treatment in acute ischemic stroke. Design and area: An observational prospective study in the Intensive Care Unit. Patients and methods: 16 patients had endovascular treatment. Epidemiological data, arterial occlusion site, time between stroke onset and treatment, treatment indication, NIHSS scale at admission and discharge from hospital, complications and functional outcome measured by modified Rankin scale (obtained by telephone survey were collected. Results: Ten male patients with a mean age of 59 years (29-74 were included. The mean stay in the ICU was 6 days (1-33. Seven patients required mechanical ventilation. Treatment indications were: intravenous thrombolysis failure in 4 patients, major vessel occlusion in 5, outside of the therapeutic window in 2, posterior circulation occlusion in 3, outside of the therapeutic window plus major vessel occlusion in 1 and intravenous thrombolysis contraindication in 1. The occlusion site was on posterior circulation in 3 and on carotid territories and branches in 13. Thrombolytic treatment used was Urokinase at a dose of 100,000-600,000IU. Four patients required mechanical embolectomy and 10 stent implantation. Complete recanalization was observed in 11 (69% and partial in 4 (25%. Three evolved to brain death. Six patients (46% had a favorable outcome (modified Rankin scale score 10, evolution time between 3-6h, intravenous thrombolysis contraindication and proximal arterial occlusion.

  10. Reparación endovascular de Aneurisma aórtico abdominal: Estudio piloto de endoprótesis Ovation™. Resultados comparativos / Endovascular repair of abdominal aortic aneurysm: comparative results of a pilot study using the Ovation™ prosthesis

    Scientific Electronic Library Online (English)

    Francisco, Valdés; Renato, Mertens; Michel, Bergoeing; Leopoldo, Mariné; Albrecht, Krämer; Francisco, Vargas; Guillermo, Lema; Roberto, Canessa; Jeanette, Vergara.

    Full Text Available Introducción: Las endoprótesis actuales para tratar aneurismas aórticos (AAA) requieren introductores de alto diámetro (18-25F) y se sustentan excluyendo el aneurisma, mediante la fuerza radial de stents metálicos. Objetivo: prótesis Ovation™ (TriVascular, EEUU) con aquellas disponibles en el mercad [...] o. Material y Método: Entre Noviembre 2009 y Agosto 2010 tratamos 47 AAA. En 10 pacientes usamos Ovation™ (Grupo 1). Grupo Control (2): diez pacientes tratados contemporáneamente con endoprótesis comerciales. Ovation™ es tri-modular, de PTFE y nitinol con un stent barbado para fijación supra-renal. Sella bajo las arterias renales mediante 2 anillos llenados con un polímero durante el implante. Usa introductor 13-15F. Usa-Philips-Allura (Best, Holanda). Comparamos: duración del procedimiento, hospitalización y complicaciones. Utilizamos test de Fisher exacto y t de student no pareado. Resultados: Éxito técnico 100%. Sin diferencia entre grupos (edad, sexo, tamaño AAA, riesgo ASA, laboratorio preoperatorio). Tiempo operatorio (hrs): 2,12 ± 0,7 vs. 2,0 ± 0,6 (NS). Estadía postoperatoria (hrs): 44,5 ± 10,7 vs 49,5 ± 32,0 (NS). El cuello del AAA y la permanencia en UTI fueron más cortos en grupo 1 (p= 0,035 y 0,0451). Seguimiento (4,5-12 meses) sin eventos adversos, endofugas tipo I ni III, ni re-intervenciones. Conclusiones: Los resultados con Ovation™ a corto plazo son comparables con los de otras endoprótesis, cumpliendo con estándares de eficacia y seguridad. Ovation ™ navega por vasos pequeños, permite un despliegue preciso y sellado efectivo en cuellos > 7 mm, ampliando el tratamiento endovascular del AAA. Abstract in english Background. Current endografts used in treatment of abdominal aortic aneurysm (AAA), use large (18-25F) delivery systems. Graft fixation and aneurysm sealing is obtained by a proximal stent, requiring an aortic neck >15 mm. Objective. To compare the efficacy and safety of Ovation™ endograft (TriVasc [...] ular, USA) with standard endografts. Methods. Between November 2009 and August 2010 we treated 47 AAA. In 10 patients we used Ovation™ (Group 1). Ten patients treated during the same period with commercially available endografts were used as controls (Group (2). The Ovation™ endo-prosthesis is tri-modular, made of PTFE andnitinol with low profile (13-15F) and has a barbed suprarenal stent for fixation. Sealing is obtained independently through 2 inflatable rings filled with a biocompatible polymer during the procedure. Implantation followed the standard procedure through femoral exposure, using the Philips Allura imaging equipment (Best, Netherlands). Procedure duration, length of stay (LOS) and complications were compared between groups. Fisher exact test and unpaired Student’s t test were used for comparisons. Results. Results. Technical success was 100%. We observed no difference between groups (age, sex, AAA size, ASA risk, preoperative lab work). Procedure time (hrs) was 2,12 ± 0,7 vs. 2,0 ± 0,6 (NS), LOS (hrs) was 44,5 ± 10,7 vs. 49,5 ± 32,0 (NS) in Groups 1 and 2, respectively. Aneurysm neck length and ICU stay were shorter in Group 1 (p= 0,035 and 0,0451 respectively). During a 12 month follow up no adverse events, type I or III endoleak, or secondary interventions have occurred. Conclusion. Results with Ovation™ are comparable to other endografts currently available, achieving the same standards of efficacy and safety. Its highly flexible delivery system allows navigation through small vessels, easy deployment and effective sealing of AAA with necks > 7 mm, broadening the span of patients suitable for endovascular treatment.

  11. Reparación endovascular de Aneurisma aórtico abdominal: Estudio piloto de endoprótesis Ovation™. Resultados comparativos Endovascular repair of abdominal aortic aneurysm: comparative results of a pilot study using the Ovation™ prosthesis

    Directory of Open Access Journals (Sweden)

    Francisco Valdés

    2011-01-01

    Full Text Available Introducción: Las endoprótesis actuales para tratar aneurismas aórticos (AAA requieren introductores de alto diámetro (18-25F y se sustentan excluyendo el aneurisma, mediante la fuerza radial de stents metálicos. Objetivo: prótesis Ovation™ (TriVascular, EEUU con aquellas disponibles en el mercado. Material y Método: Entre Noviembre 2009 y Agosto 2010 tratamos 47 AAA. En 10 pacientes usamos Ovation™ (Grupo 1. Grupo Control (2: diez pacientes tratados contemporáneamente con endoprótesis comerciales. Ovation™ es tri-modular, de PTFE y nitinol con un stent barbado para fijación supra-renal. Sella bajo las arterias renales mediante 2 anillos llenados con un polímero durante el implante. Usa introductor 13-15F. Usa-Philips-Allura (Best, Holanda. Comparamos: duración del procedimiento, hospitalización y complicaciones. Utilizamos test de Fisher exacto y t de student no pareado. Resultados: Éxito técnico 100%. Sin diferencia entre grupos (edad, sexo, tamaño AAA, riesgo ASA, laboratorio preoperatorio. Tiempo operatorio (hrs: 2,12 ± 0,7 vs. 2,0 ± 0,6 (NS. Estadía postoperatoria (hrs: 44,5 ± 10,7 vs 49,5 ± 32,0 (NS. El cuello del AAA y la permanencia en UTI fueron más cortos en grupo 1 (p= 0,035 y 0,0451. Seguimiento (4,5-12 meses sin eventos adversos, endofugas tipo I ni III, ni re-intervenciones. Conclusiones: Los resultados con Ovation™ a corto plazo son comparables con los de otras endoprótesis, cumpliendo con estándares de eficacia y seguridad. Ovation ™ navega por vasos pequeños, permite un despliegue preciso y sellado efectivo en cuellos > 7 mm, ampliando el tratamiento endovascular del AAA.Background. Current endografts used in treatment of abdominal aortic aneurysm (AAA, use large (18-25F delivery systems. Graft fixation and aneurysm sealing is obtained by a proximal stent, requiring an aortic neck >15 mm. Objective. To compare the efficacy and safety of Ovation™ endograft (TriVascular, USA with standard endografts. Methods. Between November 2009 and August 2010 we treated 47 AAA. In 10 patients we used Ovation™ (Group 1. Ten patients treated during the same period with commercially available endografts were used as controls (Group (2. The Ovation™ endo-prosthesis is tri-modular, made of PTFE andnitinol with low profile (13-15F and has a barbed suprarenal stent for fixation. Sealing is obtained independently through 2 inflatable rings filled with a biocompatible polymer during the procedure. Implantation followed the standard procedure through femoral exposure, using the Philips Allura imaging equipment (Best, Netherlands. Procedure duration, length of stay (LOS and complications were compared between groups. Fisher exact test and unpaired Student’s t test were used for comparisons. Results. Results. Technical success was 100%. We observed no difference between groups (age, sex, AAA size, ASA risk, preoperative lab work. Procedure time (hrs was 2,12 ± 0,7 vs. 2,0 ± 0,6 (NS, LOS (hrs was 44,5 ± 10,7 vs. 49,5 ± 32,0 (NS in Groups 1 and 2, respectively. Aneurysm neck length and ICU stay were shorter in Group 1 (p= 0,035 and 0,0451 respectively. During a 12 month follow up no adverse events, type I or III endoleak, or secondary interventions have occurred. Conclusion. Results with Ovation™ are comparable to other endografts currently available, achieving the same standards of efficacy and safety. Its highly flexible delivery system allows navigation through small vessels, easy deployment and effective sealing of AAA with necks > 7 mm, broadening the span of patients suitable for endovascular treatment.

  12. Avaliação pós-operatória do tratamento endovascular de aneurismas da aorta abdominal por angiotomografia com multidetectores Post-operative evaluation of endovascularly treated abdominal aortic aneurysms by multidetector computed tomography angiography

    Directory of Open Access Journals (Sweden)

    Fabiana Barroso Thomaz

    2008-08-01

    Full Text Available OBJETIVO: Este estudo tem como objetivo a avaliação pós-operatória do tratamento endovascular de aneurismas da aorta abdominal por angiotomografia com multidetectores. MATERIAIS E MÉTODOS: Foram analisadas, retrospectivamente, angiotomografias de 166 pacientes (137 homens e 29 mulheres com idade média de 73 anos portadores de aneurisma da aorta abdominal submetidos a terapêutica endovascular, no período de junho de 2005 a agosto de 2006. Os exames foram feitos em tomógrafo multidetector de 64 canais e os parâmetros adotados foram: colimação, 0,625 mm; pitch, 0,6-1; mAs, 300-400; kV, 120. Em todos os casos foi utilizado meio de contraste iodado não-iônico (350 mg/ml administrado por meio de bomba infusora, com fluxo de 4 ml/s a 5 ml/s e com volume variável de 70 ml a 100 ml. Os exames foram avaliados quanto à presença de complicações. RESULTADOS: Dos 166 exames realizados, 93 pacientes não apresentaram complicações e 73 apresentaram os seguintes achados: endoleak (n=37, trombose circunferencial da endoprótese (n=29, angulação (n=17, coleção no sítio de punção (n=10, migração da prótese (n=7, dissecção dos vasos de acesso (n=7 e oclusão (n=6. CONCLUSÃO: O endoleak foi a complicação mais prevalente em nosso estudo, sendo o tipo II o mais comum.OBJECTIVE: The present study was aimed at evaluating endovascularly treated abdominal aortic aneurysms by multidetector computed tomography angiography. MATERIALS AND METHODS: Multidetector computed tomography angiography studies of 166 patients were retrospectively analyzed. The sample included 137 men and 29 women with mean age of 73 years who had undergone endovascular treatment for abdominal aortic aneurysm in the period between June 2005 and August 2006. Images were acquired in a 64-channel multidetector tomograph adopting the following parameters: 0.625 mm collimation, pitch 0.6-1, 300-400 mAs, and 120 kV. A nonionic iodinated contrast agent (350 mg/ml was injected by infusion pump at a rate of 4 ml/s to 5 ml/s and a variable amount of 70 ml to 100 ml. The studies were evaluated for the presence of complications. RESULTS: Among the 166 cases, 93 patients did not present complications and 73 presented the following findings: endoleak (n=37, circumferential thrombosis (n =29, angulation (n=17, presence of collection at the puncture site (n=10, graft migration (n=7, dissection of access vessels (n=7 and occlusion (n=6. CONCLUSION: In summary, endoleak was the most prevalent complication in the present series, with type II endoleak being most frequently found.

  13. Dual-energy CT in the follow-up after endovascular abdominal aortic aneurysm repair

    International Nuclear Information System (INIS)

    This study investigates the dual-energy procedure for postoperative CT follow-up scans after endovascularly treated abdominal aortic aneurysms. The procedure is analyzed with respect to its sensitivity and specificity as well as the associated radiation exposure. 51 examinations were carried out on 47 patients between February 2009 and March 2010. For each patient, a non-enhanced, an arterial and a venous scan were conducted, the latter two using the dual-energy technology. Virtual images for the non-enhanced phase were reconstructed from the data taken in the venous phase. Protocol A, the reference standard, consisted of non-enhanced images and images of the arterial and venous phase. In protocol B, standard non-enhanced images were replaced by the reconstructed virtual non-enhanced images. Protocol C consisted only of virtual non-enhanced and 80 kV images taken during the venous phase. All data was anonymized and evaluated by two independent radiologists. For protocol C, sensitivity, specificity, negative and positive predictive values were computed. The effective radiation dosage was determined for each scan. All endoleaks identified in protocol A were found using protocols B and C. For protocol C, the sensitivity and negative predictive value were 100 %, the specificity was 94.1 %, and the positive predictive value was 89.5 %. Compared to protocol A, protocol C reduces the radiation exposure by 62.45 %. A scan protocol consisting of virtual non-enhanced images as well as 80 kV images taken during the venous phase was found to be a reliable alternative method for diagnosing endoleaks, while reducing the radiation exposure by 62.45 %. (orig.)

  14. Endovascular treatment of abdominal aortic aneurysms--6 years of experience with Ella stent-graft system

    Energy Technology Data Exchange (ETDEWEB)

    Koecher, Martin E-mail: martin.kocher@seznam.cz; Utikal, Petr; Koutna, Jirina; Bachleda, Petr; Buriankova, Eva; Herman, Miroslav; Bucil, Jiri; Benysek, Vladimir; Cerna, Marie; Kojecky, Zdenek

    2004-08-01

    Purpose: Evaluation of 6-year results of abdominal aortic aneurysm (AAA) treatment by Ella stent-grafts with regard to safety and effectivity in relation to morphology of the aneurysm. Methods: From a group of 172 patients with AAA, in whom elective endovascular treatment was considered, 120 of them (69.8%) were found to be suitable for this type of therapy. The bifurcated type of stent-graft was implanted in 97 patients, uniiliacal type in 19 patients and only four patients were found to be suitable for tubular type of stent-graft. Additional necessary procedures (internal iliac artery occlusion or contralateral common iliac artery occlusion in a group of patients with uniiliacal type of stent-graft) were performed surgically during the stent-graft implantation. CT and US controls were performed at 3, 6 and 12 months after implantation, later every 12 months. Results: Primary technical success was achieved in 109 of the 120 patients (91%). Primary endoleak was recorded in 11 patients (primary endoleak type Ia in seven patients, type Ib in three patients and type IIIa in one patient). Assisted technical success after reintervention or spontaneous seal was 98.3%. Surgical conversion was indicated in two patients (1.7%). Perioperative mortality rate was 3.3%. Total average follow-up period was 20.7 months (range from 2 to 60 months). In nine patients (7.5%) secondary endoleak type II was found at control CT or US, in three patients partial thrombosis of the stent-graft was found. There was no aneurysm rupture during follow-up. Conclusion: Treatment of AAA with Ella stent-graft system is effective and safe. Bifurcated stent-graft is the most frequently used type. Uniiliacal type of stent-graft is used by us only in cases of complicated morphology.

  15. Endovascular repair or open repair for ruptured abdominal aortic aneurysm: a Cochrane systematic review

    Science.gov (United States)

    Badger, S A; Harkin, D W; Blair, P H; Ellis, P K; Kee, F; Forster, R

    2016-01-01

    Objectives Emergency endovascular aneurysm repair (eEVAR) may improve outcomes for patients with ruptured abdominal aortic aneurysm (RAAA). The study aim was to compare the outcomes for eEVAR with conventional open surgical repair for the treatment of RAAA. Setting A systematic review of relevant publications was performed. Randomised controlled trials (RCTs) comparing eEVAR with open surgical repair for RAAA were included. Participants 3 RCTs were included, with a total of 761 patients with RAAA. Interventions Meta-analysis was performed with fixed-effects models with ORs and 95% CIs for dichotomous data and mean differences with 95% CIs for continuous data. Primary and secondary outcome measures Primary outcome was short-term mortality. Secondary outcome measures included aneurysm-specific and general complication rates, quality of life and economic analysis. Results Overall risk of bias was low. There was no difference between the 2 interventions on 30-day (or in-hospital) mortality, OR 0.91 (95% CI 0.67 to 1.22; p=0.52). 30-day complications included myocardial infarction, stroke, composite cardiac complications, renal complications, severe bowel ischaemia, spinal cord ischaemia, reoperation, amputation and respiratory failure. Reporting was incomplete, and no robust conclusion was drawn. For complication outcomes that did include at least 2 studies in the meta-analysis, there was no clear evidence to support a difference between eEVAR and open repair. Longer term outcomes and cost per patient were evaluated in only a single study, thus precluding definite conclusions. Conclusions Outcomes between eEVAR and open repair, specifically 30-day mortality, are similar. However, further high-quality trials are required, as the paucity of data currently limits the conclusions. PMID:26873043

  16. TRATAMIENTO ENDOVASCULAR DE LA COARTACIÓN AÓRTICA NATIVA Y RECURRENTE EN PACIENTES MAYORES DE 4 AÑOS: RESULTADOS Y COMPLICACIONES / ENDOVASCULAR REPAIR OF NATIVE AND RECURRENT AORTIC COARCTATION IN PATIENTS OLDER THAN 4 YEARS OF AGE

    Scientific Electronic Library Online (English)

    Martín, Valdebenito; Alejandro, Martínez; Gonzalo, Martínez; Nicolás, Veas; Dante, Lindefjeld; Francisco, Garay; Felipe, Heusser; Daniel, Springmüller; Alejandro, Fajuri; Alejandra, Flores; Francisco, Vergara.

    Full Text Available Objetivos: Reportar nuestra experiencia en el tratamiento endovascular de la Coartación Aórtica (CoAo). Métodos: Se revisaron los registros clínicos de los pacientes mayores de 4 años intervenidos por una CoAo nativa o recoartación en el Hospital Clínico de la Universidad Católica entre los años 200 [...] 7 y 2012. Se realizaron estadísticas descriptivas y se utilizó el test de Wilcoxon signed rank, con una p Abstract in english Aim: There is an increasing interest in the endovascular therapy of both native and recurrent aortic coarcta-tion (Aco). In this article we report the results of endo-vascular treatment of ACo in children and adults at our institution, from 2007 to 2012. Method and Results: The clinical, angiographi [...] c and hemodynamic data of all patients submitted to endovascular repair of ACo at the Endovascular Therapy Center of the Catholic University Hospital were reviewed. Children under 4 years of age were excluded. A total of 27 subjects were included. Mean age was 20.6 years (range 5-64); 30% were females and 30% were under 14 years of age. 15 patients had associated congenital defects: bicuspid aortic valve ( 9), VSD (3), or both VSD and bicuspid aortic valve (3). Hypertension was present in 33% of patients. 74% had endovas-cular repair of a native Aco and 26% of a re-coarctation (2 of them post surgical treatment and 5 post endovas-cular repair). 85% of cases had stent implantation. Repair resulted in a significant (p

  17. The association of patent sac branch vessels with type 2 endoleak of abdominal aortic aneurysm after endovascular exclusion

    International Nuclear Information System (INIS)

    Objective: To determine the association of patent sac branch vessels with early type 2 endoleak rate after endovascular exclusion (EVE). Methods: 8 abdominal aortic aneurysm patients in the presence of type 2 endoleak after EVE were retrospectively reviewed. Results: All the patients with type 2 endoleak had multiple sac branch vessels preoperatively. Conclusions: Patent sac branches play an important role in the pathogenesis of type 2 endoleak. If the excluded sac is increasing in size rapidly, the patent branches must be embolized promptly to avoid aneurysm rupture

  18. Tratamiento endovascular y trombólisis intraarterial en el ictus isquémico agudo / Endovascular treatment and intra-arterial thrombolysis in acute ischemic stroke

    Scientific Electronic Library Online (English)

    D., Escudero; R., Molina; L., Viña; P., Rodríguez; L., Marqués; E., Fernández; L., Forcelledo; J., Otero; F., Taboada; P., Vega; E., Murias; A., Gil.

    2010-09-01

    Full Text Available Objetivo: Analizar la eficacia y la seguridad de la trombólisis intraarterial y el tratamiento endovascular en pacientes con ictus isquémico agudo. Diseño y ámbito: Estudio prospectivo observacional en una unidad de cuidados intensivos. Pacientes: Dieciséis pacientes recibieron tratamiento endovascu [...] lar. Se recogieron datos epidemiológicos, localización de la oclusión arterial, tiempo desde el ictus al tratamiento, indicación del tratamiento, National Institutes of Health Stroke Scale al ingreso y al alta hospitalaria, y complicaciones y evolución funcional por escala de Rankin modificada realizada mediante una encuesta telefónica. Resultados: Diez varones, con una edad media de 59 años (29-74) y una estancia media en la unidad de cuidados intensivos de 6 días (1-33). Siete pacientes requirieron ventilación mecánica. Indicación del tratamiento: 4 casos por fracaso de la trombólisis intravenosa, 5 por oclusión de gran vaso, 2 por estar fuera de la ventana terapéutica, 3 por oclusión de la circulación posterior, uno por estar fuera de la ventana terapéutica y tener, además, una oclusión de gran vaso y uno por contraindicación para la trombólisis intravenosa. Localización de la oclusión: 3 en la circulación posterior y 13 en el territorio carotídeo y sus ramas. El fibrinolítico utilizado fue uroquinasa en dosis de 100.000-600.000 UI. Cuatro pacientes requirieron embolectomía mecánica y 10, implantación de stent. Se obtuvo recanalización completa en 11 pacientes (69%) y parcial en 4 (25%). Tres pacientes evolucionaron a muerte encefálica. Seis pacientes (46%) tuvieron una buena recuperación (escala de Rankin modificada 10) -tiempo de evolución de 3-6h-, y contraindicacio'n para la trombólisis intravenosa y la oclusión arterial proximal. Abstract in english Objective: Analysis of the safety and efficacy of intra-arterial thrombolysis therapy and endovascular treatment in acute ischemic stroke. Design and area: An observational prospective study in the Intensive Care Unit. Patients and methods: 16 patients had endovascular treatment. Epidemiological dat [...] a, arterial occlusion site, time between stroke onset and treatment, treatment indication, NIHSS scale at admission and discharge from hospital, complications and functional outcome measured by modified Rankin scale (obtained by telephone survey) were collected. Results: Ten male patients with a mean age of 59 years (29-74) were included. The mean stay in the ICU was 6 days (1-33). Seven patients required mechanical ventilation. Treatment indications were: intravenous thrombolysis failure in 4 patients, major vessel occlusion in 5, outside of the therapeutic window in 2, posterior circulation occlusion in 3, outside of the therapeutic window plus major vessel occlusion in 1 and intravenous thrombolysis contraindication in 1. The occlusion site was on posterior circulation in 3 and on carotid territories and branches in 13. Thrombolytic treatment used was Urokinase at a dose of 100,000-600,000IU. Four patients required mechanical embolectomy and 10 stent implantation. Complete recanalization was observed in 11 (69%) and partial in 4 (25%). Three evolved to brain death. Six patients (46%) had a favorable outcome (modified Rankin scale score 10), evolution time between 3-6h, intravenous thrombolysis contraindication and proximal arterial occlusion.

  19. Enhancement of ascites during abdominal oncological endovascular intervention without iatrogenic extravasation in patients with chronic liver disease

    International Nuclear Information System (INIS)

    Aim: To evaluate ascites enhancement during abdominal oncological endovascular intervention (IVR) without iatrogenic extravasation and the factors associated with enhancement of ascites. Methods and materials: CT images were obtained using an IVR-CT system for 73 patients with chronic liver disease and ascites. The CT images were obtained at least twice during each IVR. Radiodensity values of ascites at CT were measured for the first and last CT images in each procedure. The factors evaluated for their association with elevated ascitic fluid density were age, interval from the first to the last CT scan, Child–Pugh score, albumin level, total bilirubin level, prothrombin activity, the need for transcatheter arterial chemoembolization (TACE), estimated glomerular filtration rate, total amount of contrast material (CM) per square metre of body surface area (/m2), amount of ascitic fluid, and the amount of CM entering the superior mesenteric artery (SMA) or coeliac artery/m2. Results: The average ascitic radiodensity values for the first and last CT images were 18 and 51 HU, respectively. The percentage of patients with “significantly elevated” ascitic fluid density (?10 HU) was 92%. Multivariate analysis showed that the total amount of CM/m2 and the amount of ascitic fluid were significantly correlated and inversely correlated, respectively, with elevated ascitic fluid density. Conclusions: Ascites enhancement without extravasation frequently occurs during abdominal oncological endovascular intervention in patients with chronic liver disease

  20. Tratamiento endovascular de las patologías de aorta -Estado del arte-: Parte 2 - Patologías de la aorta torácica y otras aplicaciones Endovascular treatment of aortic pathologies -State of the art-: Part 2 - Pathologies of thoracic aorta and other applications

    Directory of Open Access Journals (Sweden)

    Carlos E Uribe

    2007-12-01

    Full Text Available En la actualidad, el tratamiento endovascular de las patologías de aorta es una alternativa a la cirugía abierta. Éste ha demostrado ser seguro ya que arroja resultados iguales o superiores que el grupo quirúrgico. En este artículo se presenta el estado actual del tratamiento con endoprótesis de las patologías de aorta, así como las indicaciones, las contraindicaciones y el futuro del tratamiento con este tipo de dispositivos.Endovascular treatment of aortic pathologies is actually an alternative to open surgery. It has proven to be safe, showing similar or better results to those achieved by surgery. In this article, treatment of aortic pathologies by means of endoprosthesis is presented, as well as its indications, contraindications and future treatment with this kind of devices.

  1. Manejo endovascular de la aorta torácica Endovascular treatment of thoracic aorta

    Directory of Open Access Journals (Sweden)

    Juan G Barrera

    2006-10-01

    Full Text Available En comparación con el tratamiento convencional, la terapia endovascular en aneurisma de aorta torácica, presenta los mejores resultados, por lo que se convierte en el tratamiento de elección para la patología de aorta torácica descendente endovascular, por su baja morbimortalidad perioperatoria. El tratamiento quirúrgico por vía retroperitoneal y/o endovascular para aneurisma de aorta abdominal infrarrenal, resulta ser especialmente seguro en pacientes octogenarios o con alta morbilidad. Esta cohorte institucional presenta resultados perioperatorios y en el seguimiento, similares a los reportados en la literatura mundial.Compared with the conventional treatment, endovascular therapy in thoracic aortic aneurysm shows the best results, being the election treatment for the pathology of the descending thoracic aorta, due to its low peri-operative morbid-mortality. Surgical treatment by retro-peritoneal route and/or endovascular for infra-renal abdominal aortic aneurysm is especially safe in octogenarian patients or in those with a high mortality rate. This institutional cohort show peri-operative and follow-up results similar to those reported in the world literature.

  2. Health Related Quality of Life after Treatment of Abdominal Aortic Aneurysm with Open and Endovascular Techniques—A Two-Year Follow Up

    OpenAIRE

    Monica Pettersson; Ingegerd Bergbom; Erney Mattsson

    2012-01-01

    Background: Patients with Abdominal Aortic Aneurysm can be treated with two different surgical methods: Open repair (OR) or Endovascular Aortic Repair (EVAR). These two different treatments can probably result in different sense of Health related Quality of life, both in a short term and a long term perspective. The purpose of this prospective study was to examine patients’ Health related Quality of life after surgical treatment of Abdominal Aortic Aneurysm over two years using different inst...

  3. Resultados en el corto y mediano plazo de la reparación endovascular de aneurismas de la aorta abdominal y arterias ilíacas: Experience in 28 patients / Endovascular repair of abdominal aortic aneuriysms

    Scientific Electronic Library Online (English)

    JUAN, BOMBIN F; ALEJANDRO, KOTLIK A; JAIME, FERNÁNDEZ V; IVER, ZEGARRA I.

    2013-12-01

    Full Text Available Objetivo: Evaluar los resultados iniciales y en el mediano plazo de la reparación endovascular de los aneurismas del sector aorto-ilíaco. Material y Método: Revisión de una serie clínica de pacientes operados en forma consecutiva por vía endovascular en el Hospital Dr. Eduardo Pereira de Valparaíso [...] por aneurismas del sector aorto-ilíaco desde 2007 al 2012 con seguimiento actualizado. Resultados: Se trata de 28 pacientes (22 varones), una edad promedio de 72,5 años (rango 59-86) y un seguimiento promedio de 27,4 meses (rango 1-65 meses). Los pacientes fueron seleccionados de acuerdo a la anatomía aorto-ilíaca y su estado general. A 25 pacientes se les instaló una prótesis bifurcada tri-modular, a un paciente una prótesis bifurcada con sólo dos módulos, a otro paciente una prótesis aorto uni ilíaca, y a una paciente una endoprótesis recta luego de una desconexión visceral abdominal. Un paciente fallece a los 31 días después de operado por falla orgánica múltiple y otros dos pacientes fallecen a los 24 meses a causa de un cáncer vesicular y a los 36 meses por un cáncer rectal. El seguimiento alejado evidenció ausencia de endofugas tipo 1, 3 ó 4 y una endofuga tipo 2 en dos pacientes, que no han requerido ninguna intervención. Conclusión: La reparación endovascular de los aneurismas del sector aorto-ilíaco es segura en el corto y mediano plazo, en pacientes con las condiciones anatómicas apropiadas en un centro quirúrgico adecuadamente equipado. Abstract in english Background: Endovascular repair of aortic aneurysms is less invasive than the traditional surgical approach. Aim: To evaluate the early and mid-term results of aorto-iliac aneurysm endovascular repair. Material and Methods: Analysis of 28 patients aged 59 to 86 years (22 males), subjected to an endo [...] vas-cular repair of aorto-iliac aneurysms between 2007 and 2012. Results: The follow up period of patients ranged from 1 to 65 months. A tri-modular bifurcated prosthesis was installed in 25 patients. A bi-modular bifurcated prosthesis was installed in one patient, an aorto uni iliac prosthesis was installed in one patient; in other patient, a straight endoprosthesis was installed after an abdominal visceral disconnection. In cases of associated iliac aneurysms, unilateral iliac embolization was carried out in seven patients and bilateral embolization in one patient. In one case, the sealing of the hypogastric artery was achieved leaning the prosthetic branch on the hypogastric artery ostium. One patient died 31 days after the operation due to multiple organ failure. One patient died 24 months after surgery due to a gallbladder cancer and other patient died 36 months after surgery due to a rectal cancer. The long-term follow-up showed the presence of type 2 endo-leaks in two patients. The aneurysm decreased in size in 83% of patients after 2 years of follow-up. In five patients, a non-progressive laminar parietal thrombosis inside the endoprosthesis, was observed in the immediate postoperative period. It was initially treated with oral anticoagulants. Conclusions: Endovascular repair of aorto-iliac aneurysms is safe and effective in patients with appropriate anatomical conditions, if a skilled surgical team is available.

  4. Abdominal Aortic Aneurysm Repair Using Nellix™ EndoVascular Aneurysm Sealing.

    Science.gov (United States)

    van den Ham, Leo H; Zeebregts, Clark J; de Vries, Jean-Paul P M; Reijnen, Michel M P J

    2015-05-01

    Since the dawn of endovascular aortic aneurysm repair (EVAR), starting from its initial report in 1991, there has been a significant evolution in stent graft design and delivery systems. Complications, mostly endoleaks, and re-intervention rates after EVAR remain amongst the most challenging aspects in comparison with traditional open repair. The use of a sac-anchoring endograft changes the approach of aneurysm exclusion. The Nellix™ EndoVascular Aneurysm Sealing system (Endologix Inc., Irvine, CA) consists of balloon expandable stents surrounded by endobags that are filled with a polymer thereby sealing the aneurysm. By sealing the aneurysm sac instead of exclusion with only proximal and distal fixation, the risk of stent migration and endoleaks is theoretically diminished. Current investigational use is aimed to confirm clinical success, decreased complication, and secondary intervention rates compared to conventional endovascular repair. PMID:26055014

  5. Tratamiento endovascular exitoso del síndrome de cascanueces con stent autoexpandible / Successful endovascular treatment of nutcracker's syndrome with self-expanding stent

    Scientific Electronic Library Online (English)

    Marco Antonio, Alcocer-Gamba; Jorge A., Martínez-Chávez; Mónica, Alcántara-Razo; Guering, Eid-Lidt; Leslie M., Lugo-Gavidia; Enrique, García-Hernández; Aquiles, Montalvo-Ramos; Ivonne A., Torres-Quiroz; Arturo, Velázquez-Verduzco.

    2012-12-01

    Full Text Available El síndrome de cascanueces (nutcracker's syndrome) se produce por compresión de la vena renal izquierda a su paso por la horquilla vascular, formada por la aorta y la arteria mesentérica superior, causando una compresión extrínseca que genera estenosis funcional de la misma. Esto produce congestión [...] e hipertensión de la vena renal izquierda que se traduce en insuficiencia y várices de la vena gonadal izquierda, hematuria unilateral y dolor lumbar izquierdo, el diagnóstico pocas veces se realiza, por su baja frecuencia y por la falta de sospecha clínica. El tratamiento del síndrome de cascanueces incluye el autotransplante renal, trasposición de arteria mesentérica superior, revascularización y más recientemente, la colocación de stent en la vena renal. Presentamos el caso de un paciente que fue sometido a tratamiento endovascular exitoso con un stent autoexpandible en la vena renal izquierda, con criterios inmediatos de éxito por angiografía, reducción de la congestión venosa y por desaparición del gradiente cavo/renal. Abstract in english Nutcracker's syndrome is caused by compression of the left renal vein between aorta and superior mesenteric artery, causing extrinsic compression generated functional stenosis. This causes congestion and hypertension of the left renal vein resulting in insufficiency and left gonadal vein varicose, u [...] nilateral hematuria and left flank pain, diagnosis is rarely identified by their low frequency and difficulty of suspecting, treatment of nutcracker's syndrome include renal autotransplantation, transposition of superior mesenteric artery revascularization and recently stenting in renal vein, we present the case of a patient, who showed this pathology by diagnostic support by image studies, was performed successfully implant a self-expanding stent with immediate success criteria by angiography, collateral reduction and by disappearance of cava/renal gradient.

  6. Technical and clinical success of infrarenal endovascular abdominal aortic aneurysm repair: A 10-year single-center experience

    Energy Technology Data Exchange (ETDEWEB)

    Steingruber, I.E. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria)]. E-mail: iris.steingruber@uibk.ac.at; Neuhauser, B. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Seiler, R. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Greiner, A. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Chemelli, A. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Kopf, H. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Walch, C. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Waldenberger, P. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Jaschke, W. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Czermak, B. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria)

    2006-09-15

    Objective: The aim of our retrospective study was to review our single-center experience with aortic abdominal aneurysm (AAA) repair retrospectively. Material and methods: From 1995 to 2005, 70 consecutive patients affected by AAA were treated by endovascular stent-graft repair. Mean follow-up was 23.9 months. Follow-up investigations were performed at 6 and 12 months and yearly thereafter. Five different stent-graft designs were compared to each other. Primary technical success (PTS), assisted primary technical success (APTS), primary clinical success (PCS) and secondary clinical success (SCS) were evaluated. Results: All over PTS was achieved in 94.3%, APTS in 97.1%, PCS in 61.4%, APCS in 64.3% and SCS in 70%. There were 3 type I endoleaks, 25 type II endoleaks, 4 type III endoleaks, 8 limb problems, 5 conversions to open surgery, 10 aneurysm sac expansions and 14 device migrations. Patients with newer generation devices showed better results than patients with first generation prosthesis. In addition results were better for grafts with suprarenal fixation (versus infrarenal fixation) and grafts with barbs and hooks (versus grafts without barbs and hooks). Patients with bad anatomic preconditions showed a higher complication rate. Conclusion: Contrary to first generation products, new stent-graft designs show acceptable technical and clinical results in endovascular AAA aneurysm repair. However, this therapy still should be reserved only for patients with significant comorbities and suitable anatomic conditions.

  7. Risk prediction for perioperative mortality of endovascular versus open repair of abdominal aortic aneurysms using the Medicare population

    Science.gov (United States)

    Giles, Kristina A.; Schermerhorn, Marc L.; O’Malley, A. James; Cotterill, Philip; Jhaveri, Ami; Pomposelli, Frank; Landon, Bruce E.

    2009-01-01

    INTRODUCTION AND OBJECTIVES The impact of risk factors upon perioperative mortality might differ for patients undergoing open versus endovascular repair (EVAR) of abdominal aortic aneurysms (AAA). In order to investigate this, we developed a differential predictive model of perioperative mortality after AAA repair. METHODS A total of 45,660 propensity score matched Medicare beneficiaries undergoing elective open or endovascular AAA repair from 2001–2004 were studied. Using half the dataset we developed a multiple logistic regression model for a matched cohort of open and EVAR patients and used this to derive an easily evaluable risk prediction score. The remainder of the dataset formed a validation cohort used to confirm results. RESULTS The derivation cohort included 11,415 open and 11,415 endovascular repairs. Perioperative mortality was 5.3% and 1.8% respectively. Independent predictors of mortality (RR, 95% CI) were open repair (3.2, 2.7–3.8), age (71–75 years 1.2, 0.9–1.6; 76–80 years 1.9, 1.4–2.5; >80 years 3.1, 2.4–4.2), female sex (1.5, 1.3–1.8), dialysis (2.6, 1.5–4.6), chronic renal insufficiency (2.0, 1.6–2.6), congestive heart failure (1.7, 1.5–2.1), and vascular disease (1.3, 1.2–1.6). There were no differential predictors of mortality across the two procedures. A simple scoring system was developed from a logistic regression model fit to both endovascular and open patients (area under the ROC curve of 72.6) from which low, medium, and high risk groups were developed. The absolute predicted mortality ranged from 0.7% for an EVAR patient ? 70 years of age with no comorbidities to 38% for an open patient > 80 with all the comorbidities considered. Although relative risk was similar among age groups, the absolute difference was greater for older patients (with higher baseline risk). CONCLUSIONS Mortality after AAA repair is predicted by comorbidities, sex, and age and these predictors have similar effects for both methods of AAA repair. This simple scoring system can predict repair mortality for both treatment options and thus may help guide clinical decisions. PMID:19249184

  8. Clinical Results of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Renal Insufficiency without Hemodialysis

    OpenAIRE

    Guntani, Atsushi; Okadome, Jyun; Kawakubo, Eisuke; Kyuragi, Ryoichi; Iwasa, Kazuomi; Fukunaga, Ryota; Kuma, Sosei; Matsumoto, Takuya; Okazaki, Jin; Maehara, Yoshihiko

    2012-01-01

    Objective: Chronic renal insufficiency may be a relative contraindication to endovascular aneurysm repair (EVAR) for the use of contrast enhanced mediums. It is thought that more contrast enhanced media are needed in patients who are not anatomically suitable for EVAR, because of procedural difficulties. We reviewed a 2 year EVAR experience at our institution to determine whether the procedure and use of contrast enhanced mediums has any deleterious effect on renal function in patients with p...

  9. Endoleakage after endovascular treatment of abdominal aortic aneurysms: diagnosis, significance and treatment

    Energy Technology Data Exchange (ETDEWEB)

    Golzarian, Jafar [University of Iowa, University of Iowa Heath Care, IA (United States); Valenti, David [McGill University, Royal Victoria Hospital, McGill University Health Centre, Montreal (Canada)

    2006-12-15

    Endoleak, also called leakage, leak and Perigraft leak, is a major complication and its persistence represents a failure of endovascular aortic aneurysm repair. Its detection and treatment is therefore of primary importance, since endoleak can be associated with pressurization (increase in pressure) of the sac, resulting in expansion and rupture of the aneurysm. The aim of this paper is to discuss the definition, significance, diagnosis and different options to treat endoleak. (orig.)

  10. Percutaneous Transabdominal Approach for the Treatment of Endoleaks after Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Sun Young; Lee, Do Yun; Lee, Kwang Hun [Severance Hospital, University of Yonsei, Seoul (Korea, Republic of); Won, Jong Yun [Gangnam Severance Hospital, University of Yonsei, Seoul (Korea, Republic of); Choi, Dong Hoon; Shim, Won Heum [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    The purpose of this study was to evaluate the technical feasibility and clinical efficacy of percutaneous transabdominal treatment of endoleaks after endovascular aneurysm repair. Between 2000 and 2007, six patients with type I (n = 4) or II (n = 2) endoleaks were treated by the percutaneous transabdominal approach using embolization with N-butyl cyanoacrylate with or without coils. Five patients underwent a single session and one patient had two sessions of embolization. The median time between aneurysm repair and endoleak treatment was 25.5 months (range: 0-84 months). Follow-up CT images were evaluated for changes in the size and shape of the aneurysm sac and presence or resolution of endoleaks. The median follow-up after endoleak treatment was 16.4 months (range: 0-37 months). Technical success was achieved in all six patients. Clinical success was achieved in four patients with complete resolution of the endoleak confirmed by follow-up CT. Clinical failure was observed in two patients. One eventually underwent surgical conversion, and the other was lost to follow-up. There were no procedure-related complications. The percutaneous transabdominal approach for the treatment of type I or II endoleaks, after endovascular aneurysm repair, is an alternative method when conventional endovascular methods have failed.

  11. A prospective clinical, economic, and quality-of-life analysis comparing endovascular aneurysm repair (EVAR), open repair, and best medical treatment in high-risk patients with abdominal aortic aneurysms suitable for EVAR: the Irish patient trial.

    LENUS (Irish Health Repository)

    Hynes, Niamh

    2007-12-01

    To report the results of a trial comparing endovascular aneurysm repair (EVAR) to open repair (OR) and best medical therapy (BMT) involving high-risk patients with abdominal aortic aneurysms (AAA) suitable for EVAR.

  12. Graft Distortion After Endovascular Repair of Abdominal Aortic Aneurysm: Association with Sac Morphology and Mid-Term Complications

    International Nuclear Information System (INIS)

    Purpose: To investigate the incidence, significance, and mechanism of stent-graft distortion after endovascular repair (EVR) of abdominal aortic aneurysm.Methods: EVR of abdominal aortic aneurysm was performed in 51 cases (49 modular, bifurcated; 2 tube). Thirty-two patients were followed for 6 or more months and had equivalent baseline and follow-up images which could be used to determine changes in graft configuration. Sac dimensions were measured using computed tomographic (CT) images and graft-related complications were recorded.Results: Amongst 32 patients evaluated on follow-up, there was graft distortion in 24. Distorted grafts were significantly (p= 0.002) associated with sac diameter reduction (mean 5 mm) and sac length reduction (mean 8.1 mm). All graft-related complications occurred in the limbs of eight distorted grafts, with a mean reduction of sac length in this group of 7.8 mm on reformatted CT images.Conclusion: There was a highly significant association between graft distortion and limb complications, and reduced sac dimensions

  13. Correlation between intrasac pressure measurements of a pressure sensor and an angiographic catheter during endovascular repair of abdominal aortic aneurysm

    Scientific Electronic Library Online (English)

    Pierre Galvagni, Silveira; Christopher William Teixeira, Miller; Rafael Freygang, Mendes; Gilberto Nascimento, Galego.

    Full Text Available PURPOSE: To establish a correlation between intrasac pressure measurements of a pressure sensor and an angiographic catheter placed in the same aneurysm sac before and after its exclusion by an endoprosthesis. METHODS: Patients who underwent endovascular abdominal aortic aneurysm repair and received [...] an EndoSureTM wireless pressure sensor implant between March 19 and December 11, 2004 were enrolled in the study. Simultaneous readings of systolic, diastolic, mean, and pulse pressure within the aneurysm sac were obtained from the catheter and the sensor, both before and after sac exclusion by the endoprosthesis (Readings 1 and 2, respectively). Intrasac pressure measurements were compared using Pearson's correlation and Student's t test. Statistical significance was set at p0.05), mean (p>0.05), and pulse (p0.05) by the sensor. CONCLUSION: The excellent agreement between intrasac pressure readings recorded by the catheter and the sensor justifies use of the latter for detection of post-exclusion abdominal aortic aneurysm pressurization.

  14. Manejo endovascular de la aorta torácica / Endovascular treatment of thoracic aorta

    Scientific Electronic Library Online (English)

    Juan G, Barrera; Ligia C, Mateus; José F, Saaibi; Carlos S, Balestrini; Jaime, Calderón; Marisol, Carreño; VíctorR, Castillo; Camilo, Pizarro; Omar F, Gomezese; Freddy, López; Ángel M, Chaves; Carlos, Luengas; Oscar, Calvo; Rafael, Reyes; Fabio M, Aguilera; Jorge E, Bayter; Leonardo, Salazar; Jimmy, Muñoz.

    2006-10-01

    Full Text Available En comparación con el tratamiento convencional, la terapia endovascular en aneurisma de aorta torácica, presenta los mejores resultados, por lo que se convierte en el tratamiento de elección para la patología de aorta torácica descendente endovascular, por su baja morbimortalidad perioperatoria. El [...] tratamiento quirúrgico por vía retroperitoneal y/o endovascular para aneurisma de aorta abdominal infrarrenal, resulta ser especialmente seguro en pacientes octogenarios o con alta morbilidad. Esta cohorte institucional presenta resultados perioperatorios y en el seguimiento, similares a los reportados en la literatura mundial. Abstract in english Compared with the conventional treatment, endovascular therapy in thoracic aortic aneurysm shows the best results, being the election treatment for the pathology of the descending thoracic aorta, due to its low peri-operative morbid-mortality. Surgical treatment by retro-peritoneal route and/or endo [...] vascular for infra-renal abdominal aortic aneurysm is especially safe in octogenarian patients or in those with a high mortality rate. This institutional cohort show peri-operative and follow-up results similar to those reported in the world literature.

  15. Follow-up of abdominal aortic aneurysm after endovascular aortic repair: Comparison of volumetric and diametric measurement

    International Nuclear Information System (INIS)

    Purpose: To determine the correlation of maximal diameter measurements with volumetric evaluation of size after endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAA) using computed tomography angiography (CTA) and to survey its applicability for clinical follow-up. Materials and methods: 73 consecutive patients (2 females, 71 males; age 38–84 years; mean age, 69.1 ± 8 years) with AAA were treated with percutaneous EVAR in a single institution. For follow-up, CTA was performed periodically after EVAR. Images were evaluated for maximal diameter in consensus by two experienced radiologists. Using OsirixTM, volumetric measurements were done by one radiologist, including the entire infrarenal abdominal aorta. Results: In 73 patients 220 CTA examinations were performed after EVAR with a mean follow-up of 17.3 months (range, 1.8–42.7 months). The mean postinterventional volume of aneurysm was 165.63 ml ± 93.29 ml (range, 47.94–565.67 ml). The mean maximal postinterventional diameter was 5.91 ± 1.52 cm (range, 3.72–13.82 cm). At large over the entire observation period a slight, non-significant decrease of 1.6% (2.58 ml ± 69.05 ml, range 82.82–201.92 ml) in volumes and a 9.3% (mean 0.55 cm ± 1.22 cm, range 2.85–1.93 cm) in diameters were observed. For all examinations a high correlation of volume and diameter was calculated (r = 0.813–0.905; ? < 0.01). Conclusion: For follow-up of abdominal EVAR using CTA there is a high correlation between volumetric and diametric measurements of aneurysm. Based on a daily clinical routine setting, measurements of maximal diameters in cross sectional imaging of AAA after EVAR seems to be sufficient to exclude post interventional enlargement.

  16. Intentional internal iliac artery occlusion in endovascular repair of abdominal aortic aneurysms.

    Science.gov (United States)

    Morrissey, Nicholas J; Faries, Peter L; Carrocio, Alfio; Ellozy, Sharif; Teodorescu, Victoria; Hollier, Larry H; Marin, Michael L

    2002-12-01

    Endoluminal grafting of aortoiliac aneurysms is an evolving technology. Since many lesions involve part of all of the common iliac arteries, it may be necessary to cover the internal iliac (hypogastric) arteries. Since the internal iliac arteries are important for flow to pelvic organs and perhaps the colon, their sacrifice may not be innocuous, especially since reimplantation of the inferior mesenteric artery is not possible during endovascular aneurysm repair. Most series reflect the relative safety of unilateral internal iliac artery sacrifice. Bilateral hypogastric artery sacrifice, especially if not staged temporally, may cause more significant complications. The incidence of claudication and impotence remains significant, prompting some to recommend revascularization of at least one internal iliac artery at the time of aneurysm repair in order to preserve one of these important vessels. Such an internal iliac artery bypass can be simply performed during endovascular aneurysm repair. The development of larger, more precisely deployed iliac limbs as well as the development of branched devices should decrease the need for internal iliac artery sacrifice. PMID:12454341

  17. Comparison of Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysms From the ACS-NSQIP 2005–07

    Science.gov (United States)

    Giles, Kristina A.; Pomposelli, Frank B.; Hamdan, Allen D.; Wyers, Mark C.; Schermerhorn, Marc L.

    2009-01-01

    Purpose: To compare endovascular (EVAR) and open surgical repair (OSR) for ruptured abdominal aortic aneurysms (RAAA) in terms of preoperative hemodynamic status and comorbidities. Methods: The 2005 to 2007 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was interrogated to find all patients undergoing repair for RAAA. Of the 567 RAAA repairs identified, 121 (21%) were endovascular and 446 (79%) were open. Demographics, comorbidities, and preoperative hemodynamic status were compared by repair method. Results: Age, sex, and race were similar between repair cohorts. EVAR patients had greater incidences of recent myocardial infarction (7% versus 2%, p4 units of blood (3% versus 6%, p?=?0.31), intubation (12% versus 17%, p?=?0.18), impaired sensorium (7% versus 11%, p?=?0.25), coma (4% versus 5%, p?=?0.65), acute renal failure (2% versus 2%, p?=?0.60), and ASA class 5 (29% versus 34%, p?=?0.29). Open repair was associated with greater operative time (3.3 versus 2.6 hours, p<0.01) and intraoperative blood transfusions (8 versus 2 units, p<0.001). Overall mortality was 33.5% (EVAR 24% versus OSR 36%; OR 1.8, 95% CI 1.1 to 2.8, p<0.05). After adjusting for preoperative comorbidities and all preoperative hemodynamic variables, mortality after open repair was greater than after EVAR (OR 1.9, 95% CI 1.1 to 3.2, p<0.05). Overall postoperative complications were greater after open repair (62% versus 47%, p<0.01). Graft failure requiring reintervention was higher after EVAR (4% versus 1%, p<0.05), while rates of return to the operating room for a major operation were similar (21% versus 24%, p?=?0.43). Conclusion: For RAAA within NSQIP hospitals in recent years, preoperative hemodynamic status was similar between EVAR and OSR, but EVAR patients had greater comorbidities. Despite this and after accounting for minor differences in hemodynamic status, EVAR mortality was lower than OSR mortality. Institutions with adequate experience and resources should attempt endovascular repair for RAAA when anatomy allows. PMID:19642796

  18. Anatomical Features and Early Outcomes of Endovascular Repair of Abdominal Aortic Aneurysm from a Korean Multicenter Registry

    Science.gov (United States)

    Kwon, Hyunwook; Lee, Do Yun; Choi, Soo Jin Na; Park, Ki Hyuk; Min, Seung-Kee; Chang, Jeong-Hwan; Huh, Seung; Jeon, Yong Sun; Won, Jehwan; Byun, Seung Jae; Park, Sang Jun; Jang, Lee Chan; Kwon, Tae-Won

    2015-01-01

    Purpose: To introduce a nation-based endovascular aneurysm repair (EVAR) registry in South Korea and to analyze the anatomical features and early clinical outcomes of abdominal aortic aneurysms (AAA) in patients who underwent EVAR. Materials and methods: The Korean EVAR registry (KER) was a template-based online registry developed and established in 2009. The KER recruited 389 patients who underwent EVAR from 13 medical centers in South Korea from January 2010 to June 2010. We retrospectively reviewed the anatomic features and 30-day clinical outcomes. Results: Initial deployment without open conversion was achieved in all cases and procedure-related 30-day mortality rate was 1.9%. Anatomic features showed the following variables: proximal aortic neck angle 48.8±25.7° (mean±standard deviation), vertical neck length 35.0±17.2 mm, aneurysmal sac diameter 57.2±14.2 mm, common iliac artery (CIA) involvement in 218 (56.3%) patients, and median right CIA length 34.9 mm. Two hundred and nineteen (56.3%) patients showed neck calcification, 98 patients (25.2%) had neck thrombus, and the inferior mesenteric arteries of 91 patients (23.4%) were occluded. Conclusion: Anatomical features of AAA in patients from the KER were characterized as having angulated proximal neck, tortuous iliac artery, and a higher rate of CIA involvement. Long-term follow-up and ongoing studies are required. PMID:26509139

  19. Outcomes of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy

    International Nuclear Information System (INIS)

    Purpose. The principal anatomic contraindication to endovascular aneurysm repair (EVR) is an unfavorable proximal aortic neck. With increasing experience, a greater proportion of patients with unfavorable neck anatomy are being offered EVR. This study aimed to evaluate outcomes in patients with challenging proximal aortic neck anatomy. Methods. Prospectively collected data from 147 consecutive patients who underwent EVR between December 1997 and April 2005 were supplemented with a retrospective review of medical records and radiological images. Unfavorable anatomic features were defined as neck diameter >28 mm, angulation >60 deg., circumferential thrombus >50%, and length 30 days) (p = 0.57), distal type I endoleak (p = 0.40), type III endoleak (p 0.51), secondary interventions (p = 1.0), aneurysm sac expansion (p = 0.44), or 30 day mortality (p = 0.70). The good neck group had a significantly increased incidence of type II endoleak (p = 0.023). By multivariate analysis, the incidence of intraoperative adjunctive procedures was significantly increased in the presence of severe angulation (p = 0.041, OR 3.08, 95% CI 1.05-9.04). Conclusion. Patients with severely hostile proximal aortic neck anatomy may be treated with EVR, although severely angulated necks require additional intraoperative procedures. Early outcomes are encouraging and suggest that indications for EVR may be expanded to include patients with hostile neck anatomy

  20. Multislice CT Angiography of Fenestrated Endovascular Stent Grafting for Treating Abdominal Aortic Aneurysms: a Pictorial Review of the 2D/3D Visualizations

    International Nuclear Information System (INIS)

    Fenestrated endovascular repair of an abdominal aortic aneurysm has been developed to treat patients with a short or complicated aneurysm neck. Fenestration involves creating an opening in the graft fabric to accommodate the orifice of the vessel that is targeted for preservation. Fixation of the fenestration to the renal arteries and the other visceral arteries can be done by implanting bare or covered stents across the graft-artery ostia interfaces so that a portion of the stent protrudes into the aortic lumen. Accurate alignment of the targeted vessels in a longitudinal aspect is hard to achieve during stent deployment because rotation of the stent graft may take place during delivery from the sheath. Understanding the 3D relationship of the aortic branches and the fenestrated vessel stents following fenestration will aid endovascular specialists to evaluate how the stent graft is situated within the aorta after placement of fenestrations. The aim of this article is to provide the 2D and 3D imaging appearances of the fenestrated endovascular grafts that were implanted in a group of patients with abdominal aortic aneurysms, based on the multislice CT angiography. The potential applications of each visualization technique were explored and compared with the 2D axial images

  1. Multislice CT Angiography of Fenestrated Endovascular Stent Grafting for Treating Abdominal Aortic Aneurysms: a Pictorial Review of the 2D/3D Visualizations

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Zhonghua [Curtin University, Perth (Australia); Mwipatayi, Bibombe P [Royal Perth Hospital, Perth (Australia); Allen, Yvonne B; Hartley, David E [Cook R and D, Perth (Australia); Lawrence-Brown, Michael M [Curtin University of Technology, Perth (Australia)

    2009-06-15

    Fenestrated endovascular repair of an abdominal aortic aneurysm has been developed to treat patients with a short or complicated aneurysm neck. Fenestration involves creating an opening in the graft fabric to accommodate the orifice of the vessel that is targeted for preservation. Fixation of the fenestration to the renal arteries and the other visceral arteries can be done by implanting bare or covered stents across the graft-artery ostia interfaces so that a portion of the stent protrudes into the aortic lumen. Accurate alignment of the targeted vessels in a longitudinal aspect is hard to achieve during stent deployment because rotation of the stent graft may take place during delivery from the sheath. Understanding the 3D relationship of the aortic branches and the fenestrated vessel stents following fenestration will aid endovascular specialists to evaluate how the stent graft is situated within the aorta after placement of fenestrations. The aim of this article is to provide the 2D and 3D imaging appearances of the fenestrated endovascular grafts that were implanted in a group of patients with abdominal aortic aneurysms, based on the multislice CT angiography. The potential applications of each visualization technique were explored and compared with the 2D axial images

  2. Numerical analysis of the hemodynamics of an abdominal aortic aneurysm repaired using the endovascular chimney technique.

    Science.gov (United States)

    Ben Gur, Hila; Kosa, Gabor; Brand, Moshe

    2015-08-01

    This paper presents a numerical analysis of the hemodynamics in an abdominal aorta (AA) with an aneurysm repaired by a stent graft (SG) system using the chimney technique. Computational fluid dynamics (CFD) simulations were conducted in a model of an AA repaired with a chimney stent graft (CSG) inserted into a renal artery parallel to an aortic SG and a model of a healthy AA. Comparing the simulation results of these two cases suggests that the presence of the CSG in the AA causes changes in average wall shear stress (WSS), potentially damaging recirculation zones, and additional changes in flow patterns. PMID:26736427

  3. Mortalidade relacionada ao tratamento endovascular do aneurisma da aorta abdominal com o uso dos modelos revisados / Procedure-related mortality of endovascular abdominal aortic aneurysm repair using revised reporting standards

    Scientific Electronic Library Online (English)

    Gosen Gabriel, Konig; S.R., Vallabhneni; Corinne J. Van, Marrewijk; Lina J., Leurs; Robert J.F., Laheij; Jacob, Buth.

    2007-03-01

    Full Text Available OBJETIVO: O objetivo do estudo foi avaliar a definição da mortalidade relacionada ao procedimento após tratamento endovascular do aneurisma de aorta abdominal (EVAR) como definido pelo Committee for Standardized Reporting Practices in Vascular Surgery. MÉTODO: Dados de pacientes com aneurisma de aor [...] ta abdominal foram analisados do banco de dados EUROSTAR. Os pacientes foram submetidos ao EVAR entre junho de 1996 a fevereiro de 2004 e foram estudados retrospectivamente. A probabilidade explicita da causa de morte foi registrada. O intervalo entre a operação, alta hospitalar ou intervenção secundária até a morte foi registrado. RESULTADOS: De um total de 5612 pacientes, 589 (10,5%) faleceram após o EVAR em acompanhamento total e qualquer causa de morte foi inclusa. Cento e quarenta e um pacientes (12,5%) morreram devido a causa relacionada ao aneurisma, sendo que 28 (4,8%) foram rupturas, 25 (4,2%) infecções do implante e 88 (14,9%) foram pacientes que morreram num prazo de 30 dias após o procedimento inicial (definição atualmente utilizada, também conhecido como resultado clínico a curto prazo). Além disso, 25 pacientes faleceram após 30 dias, mas continuavam ainda hospitalizados (ou transferidos a home-care para reavaliação posterior, ou necessitaram intervenção secundária). Levando em conta a duração da admissão ao hospital e a mortalidade imediata após o procedimento relacionada a intervenções secundárias, 49 mortes tardias também podem ser relacionadas ao EVAR. CONCLUSÃO: Morte tardia compõe uma proporção considerável da mortalidade relacionada ao EVAR dentro do tempo de análise revisado. Abstract in english OBJECTIVE: The aim of this study was to evaluate the definition of Procedure-related mortality after endovascular aneurysm repair (EVAR) as defined by the Committee for Standardized Reporting Practices in Vascular Surgery. METHODS: Data on patients with an AAA were taken from the EUROSTAR database. [...] The patients underwent EVAR between June 1996 and February 2004 and were analyzed retrospectively. Explicit probability of cause of death was recorded. The time interval from operation, hospital discharge or second interventions till death was recorded. RESULTS: A total of 589 out of 5612 patients (10.5%) died after EVAR in total follow up and all causes of death were included. 141 (2.5%) patients died due to aneurysms reported after the EVAR procedure of which 28 (4.8%) were ruptures, 25 (4.2%) graft-infections and 88 (14.9%) patients who died within 30 days after the initial procedure (present definition, also known as short term clinical outcome). In addition 25 patients died after 30 days, but were then (at moment of death) still in the hospital, or were transferred to a nursing home for further re-evaluation, or needed second interventions. Taking into account the duration of hospitalization and mortality immediately after procedure-related second interventions, 49 delayed deaths might also be regarded as being EVAR procedure-related. CONCLUSION: Delayed deaths are a considerable proportion of procedure-related deaths after EVAR within the revised time frame.

  4. Chronic Contained Rupture of an Abdominal Aortic Aneurysm: From Diagnosis to Endovascular Resolution

    International Nuclear Information System (INIS)

    A male patient, 69 years old, presented with fever, leucocytosis, and persistent low back pain; he also had an abdominal aortic aneurysm (AAA), as previously diagnosed by Doppler UltraSound (US), and was admitted to our hospital. On multislice computed tomography (msCT), a large abdominal mass having no definite border and involving the aorta and both of the psoas muscles was seen. This mass involved the forth-lumbar vertebra with lysis, thus simulating AAA rupture into a paraspinal collection; it was initially considered a paraspinal abscess. After magnetic resonance imaging examination and culture of the fluid aspirated from the mass, no infective organisms were found; therefore, a diagnosisof chronically contained AAA rupture was made, and an aortic endoprosthesis was subsequently implanted. The patient was discharged with decreased lumbar pain. At 12-month follow-up, no evidence of leakage was observed. To our knowledge, this is the first case of endoprosthesis implantation in a patient, who was a poor candidate for surgical intervention due to renal failure, leucocytosis and high fever, having a chronically contained AAA ruptured simulatingspodilodiscitis abscess. Appropriate diagnosis and therapy resolved potentially crippling pathology and avoided surgical graft-related complications.

  5. Unfavorable iliac artery anatomy causing access limitations during endovascular abdominal aortic aneurysm repair: application of the endoconduit technique / Tratamento endovascular do aneurisma de aorta abdominal associado à dificuldade no acesso aórtico devido a artérias ilíacas de pequeno calibre: aplicação técnica do Endoconduíte

    Scientific Electronic Library Online (English)

    Rodrigo Gibin, Jaldin; Marcone Lima, Sobreira; Regina, Moura; Matheus, Bertanha; Jamil Víctor de Oliveira, Mariaúba; Rafael Elias Farres, Pimenta; Ricardo de Alvarenga, Yoshida; Winston Bonetti, Yoshida.

    2014-12-01

    Full Text Available O tratamento endovascular para aneurisma de aorta abdominal (AAA) já está bastante difundido, sendo considerado como primeira escolha na maioria dos casos. Limitações no acesso pelas artérias ilíacas tortuosas, com estenoses, calibre pequeno ou doença oclusiva já foram contornadas com o uso de condu [...] tos, dissecção direta aortoilíaca, angioplastias, entre outros procedimentos. O objetivo deste desafio é mostrar as vantagens e limitações de cada alternativa, além de apresentar o resultado e as dificuldades com o endoconduíte. Abstract in english Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for abdominal aortic aneurysms (AAA). Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the adv [...] antages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved.

  6. Endovascular abdominal aortic aneurysm repair: surveillance of endoleak using maximum transverse diameter of aorta on non-enhanced CT

    Energy Technology Data Exchange (ETDEWEB)

    Nagayama, Hiroki; Sueyoshi, Eijun; Sakamoto, Ichiro; Uetani, Masataka [Dept. of Radiology, Nagasaki Univ. School of Medicine, Nagasaki (Japan)], E-mail: sueyo@nagasaki-u.ac.jp

    2012-07-15

    Background. Repeat volumetric analysis of abdominal aortic aneurysm (AAA) after endovascular AAA repair (EVAR) is time-consuming and requires advanced processing, dedicated equipment, and skilled operators. Purpose. To clarify the validity of measuring the maximal short-axis diameter (Dmax) of AAA in follow-up non-enhanced axial CT as a means of detecting substantial endoleaks after EVAR. Material and Methods. CT images were retrospectively reviewed in 47 patients (7 women, 40 men; mean age, 76.2 years) who had no endoleak on initial contrast-enhanced CT after EVAR. Regular follow-up CT studies were performed every 6 months. At each CT study, the Dmax on the CT axial image was measured and compared with that on the last CT (115 data-sets). Contrast-enhanced CT was regarded as the standard of reference to decide the presence or absence of endoleaks. The appearance of endoleak was defined as the end point of this study. Results. Endoleaks were detected in 17 patients during the follow-up period. Mean Dmax changes for 6 months were significant between positive and negative endoleak cases (1.8 {+-} 1.9 vs. -1.1 {+-} 3.0 mm, P < 0.0001). When the Dmax change {<=} 0 mm for 6 months was used as the threshold for negative endoleak, the sensitivity, specificity, positive predictive value, and negative predictive value were 74.5, 82.4, 96.1, and 35.9%, respectively. When Dmax change {<=}-1 mm was used as the threshold, the sensitivity, specificity, PPV, and NPV were 38.8, 100, 100, and 22.1%, respectively. Conclusion. Contrast-enhanced CT is not required for the evaluation of endoleaks when the Dmax decreases by at least 1 mm over 6 months after EVAR.

  7. Endovascular abdominal aortic aneurysm repair: surveillance of endoleak using maximum transverse diameter of aorta on non-enhanced CT

    International Nuclear Information System (INIS)

    Background. Repeat volumetric analysis of abdominal aortic aneurysm (AAA) after endovascular AAA repair (EVAR) is time-consuming and requires advanced processing, dedicated equipment, and skilled operators. Purpose. To clarify the validity of measuring the maximal short-axis diameter (Dmax) of AAA in follow-up non-enhanced axial CT as a means of detecting substantial endoleaks after EVAR. Material and Methods. CT images were retrospectively reviewed in 47 patients (7 women, 40 men; mean age, 76.2 years) who had no endoleak on initial contrast-enhanced CT after EVAR. Regular follow-up CT studies were performed every 6 months. At each CT study, the Dmax on the CT axial image was measured and compared with that on the last CT (115 data-sets). Contrast-enhanced CT was regarded as the standard of reference to decide the presence or absence of endoleaks. The appearance of endoleak was defined as the end point of this study. Results. Endoleaks were detected in 17 patients during the follow-up period. Mean Dmax changes for 6 months were significant between positive and negative endoleak cases (1.8 ± 1.9 vs. -1.1 ± 3.0 mm, P < 0.0001). When the Dmax change ? 0 mm for 6 months was used as the threshold for negative endoleak, the sensitivity, specificity, positive predictive value, and negative predictive value were 74.5, 82.4, 96.1, and 35.9%, respectively. When Dmax change ?-1 mm was used as the threshold, the sensitivity, specificity, PPV, and NPV were 38.8, 100, 100, and 22.1%, respectively. Conclusion. Contrast-enhanced CT is not required for the evaluation of endoleaks when the Dmax decreases by at least 1 mm over 6 months after EVAR

  8. Complete ten-year follow-up after endovascular abdominal aortic aneurysm repair: Survival and causes of death

    International Nuclear Information System (INIS)

    Purpose: To analyze the hazard and causes of death after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms during a complete ten year follow-up. Methods: This is a retrospective clinical study of 130 consecutive patients undergoing EVAR between 1995 and 1998. One-hundred twenty-one patients (93.1%) were treated with first-generation stentgrafts and nine patients (6.9%) received second-generation devices. All patients completed a follow-up of at least 10 years, unless death occurred before then. Time and causes of death were provided by the Austrian central register of deaths. Results: The median follow-up was 7.6 years, and the 130 patients had 968.5 person-years of follow-up. The ten-year mortality rate was 62.3%. Cardiovascular events were the most frequent causes of death, with a 3.9 incidence rate per 100 person-years. Cancer death and death due to other causes occurred in 2.1 and 1.8 cases per 100 person-years, respectively. Lethal late aneurysm rupture happened in 4.6% (n = 6), which corresponds to an annual incidence rate of 0.6 per 100 person-years. All of those patients had been treated with first-generation devices. Conclusions: Cardiovascular events were the most frequent cause of death after EVAR, followed by malignancy and other diseases. The risk of dying from secondary rupture was clearly lower than that of death due to other reasons during ten years after EVAR, even in patients with first-generation stentgrafts.

  9. Transección traumática aguda de la aorta torácica: Tratamiento endovascular Endovascular treatment of acute traumatic rupture of the thoracic aorta: Report of one case

    Directory of Open Access Journals (Sweden)

    Nelson Sepúlveda Sch

    2003-03-01

    Full Text Available Traumatic rupture of the aorta has a near 80% mortality. Most patients die on the site of the accident. Conventional surgical repair of these lesions has a high morbidity and mortality, generally associated to the severity of associated lesions. Over the last decade, endovascular treatment has become an effective therapeutic alternative. We report a 40 years old male, that suffered a traumatic rupture of the descending thoracic aorta in a car accident. A successful endovascular repair was performed, installing an endoprothesis on the site of the lesion, using a femoral artery approach. The patient had a good postoperative evolution and was discharged from the hospital once complete rehabilitation of his associated lesions was obtained (Rev Méd Chile 2003; 131: 309-13.

  10. Comparison of the usefulness 3D CTA with other methods to estimate morphology of abdominal aortic aneurysm before endovascular aneurysm repair

    International Nuclear Information System (INIS)

    The purpose of this study was to examine the accuracy of diagnostic methods in the preoperative evaluation of abdominal aortic aneurysm before endovascular treatment. During the period of January 2002-December 2004, 67 patients with AAA (42 diagnosed in the Department of Radiology of the Central Clinical Hospital of the Ministry of Internal Affairs and Administration and 25 patients diagnosed the in the Department of Radiology of Medical Academy in Bialystok) underwent ultrasonography, spiral CT with 3D reconstructions (3D CTA), and digital subtraction angiography (DSA) following treatment of aortoiliac aneurysms with endoluminal stentgrafts in 36 and 12 patients, respectively. Our experience suggests that spiral computerized tomographic angiography with three-dimensional reconstruction (3D CTA) is a reliable, relatively noninvasive technique to assess the feasibility of endovascular aneurysm repair. DSA allows verification of the measurements from spiral computed scans, but it is a more invasive method than CTA. However, CTA with 3D reconstruction shows a diagnostic effectiveness similar to that of DSA. Thus it may be sufficient as a preoperative imaging technique when evaluating a patient for an endovascular graft procedure. (author)

  11. Early inflammatory response following elective abdominal aortic aneurysm repair: A comparison between endovascular procedure and conventional, open surgery

    Directory of Open Access Journals (Sweden)

    Marjanovi? Ivan

    2011-01-01

    Full Text Available Background/Aim. Abdominal aorta aneurysm (AAA represents a pathological enlargment of infrarenal portion of aorta for over 50% of its lumen. The only treatment of AAA is a surgical reconstruction of the affected segment. Until the late XX century, surgical reconstruction implied explicit, open repair (OR of AAA, which was accompanied by a significant morbidity and mortality of the treated patients. Development of endovascular repair of (EVAR AAA, especially in the last decade, offered another possibility of surgical reconstruction of AAA. The preliminary results of world studies show that complications of such a procedure, as well as morbidity and mortality of patients, are significantly lower than with OR of AAA. The aim of this paper was to present results of comparative clinical prospective study of early inflammatory response after reconstruction of AAA between endovascular and open, conventional surgical technique. Methods. A comparative clinical prospective study included 39 patients, electively operated on for AAA within the period of December 2008 - February 2010, divided into two groups. The group I counted 21 (54% of the patients, 58-87 years old (mean 74.3 years, who had been submited to EVAR by the use of excluder stent graft. The group II consisted of 18 (46% of the patients, 49-82 (mean 66.8 years, operated on using OR technique. All of the treated patients in both groups had AAA larager than 50 mm. The study did not include patients who have been treated as urgent cases, due to the rupture or with simptomatic AAA. Clinical, biochemical and inflamatory parameters in early postoperative period were analyzed, in direct postoperative course (number of leucocytes, thrombocytes, serum circulating levels of cytokine - interleukine (IL-2, IL-4, IL-6 and IL-10. Parameters were monitored on the zero, first, second, third and seventh postoperative days. The study was approved by the Ethics Commitee of the Military Medical Academy. Results. The study showed a statistically significantly shorter time of treatment in the EVAR group (average 90 min compared to the OR group (average 136 min. Also, there was a statistically significantly less blood loss in the patients operated on by the use of EVAR surgery (average 60 mL as compared to the patients treated with OR techinique (average 495 mL, as well as a shorter postoperative hospitalization of patients in the EVAR group (average 4 days compared to the OR group (average 8 days. The OR group was detected with a statistically significant increase of leucocytes and statistically significant fall of the number of thrombocytes in comparison with the EVAR group in all the investigated terms. A significant concentration rise of IL-2 in the OR group and concentration rise of IL-6 in the EVAR group was shown 24 hours after the procedure, whereas on the second postoperative day there was detected a significant fall of IL-6 in the EVAR group. IL-4 concentration in the OR group was significantly higher as of the third postoperative day in comparison to the EVAR group. There was no significant difference in IL-10 concentration between the groups. Conclusion. The EVAR techinique is a safer and less invasive and less traumatic procedure for patients than the OR of AAA. Following the EVAR, there are less inflammatory reactions in the early postoperative periodas compared to the OR and therefore less possibility of the development of systemic inflammatory respons syndrome in patients treated.

  12. Pseudoaneurisma traumático de troncos supra-aórticos: tratamiento endovascular. Casos clínicos Endovascular treatment of traumatic pseudoaneurysms of aortic arch branches: Report of three cases

    Directory of Open Access Journals (Sweden)

    Renato Mertens M

    2002-09-01

    Full Text Available The traditional treatment of traumatic lesions of the aortic arch branches requires extended surgical exposures, not exempt of morbidity and mortality. Over the last decade, devices that allow a minimally invasive treatment, have been developed. The vessel can be repaired without direct exposure, using an endovascular procedure. We report three patients with traumatic pseudoaneurysms of the left subclavian, brachiocephalic and left common carotid arteries, respectively. All lesions were successfully repaired with the insertion of an endograft. Although long term results of these procedure are unknown, repair of a future stenosis or occlusion is less complicated than the treatment required by the original lesion. Endoluminal repair appears as a safe, efficient and less invasive treatment for these lesions. (Rev Méd Chile 2002; 130: 1027-32

  13. ¿Procedimientos endovasculares como tratamiento de la esclerosis múltiple?: La hipótesis de la insuficiencia venosa crónica cerebro medular Endovascular procedures as multiple sclerosis treatment?: The hipothesis of the chronic cerebrospinal venous insufficiency

    Directory of Open Access Journals (Sweden)

    Jorge Nogales-Gaete

    2011-03-01

    Full Text Available En este artículo especial de la modalidad "puntos de vista", se revisan los antecedentes bibliográficos principales relacionados a la entidad denominada "Insuficiencia venosa crónica cerebro medular (IVCCM" cuya formulación ha sido planteada por Zamboni y col, del Centro de Enfermedades Vasculares de la Universidad de Ferrara-Italia quienes le han adjudicado un rol patogénico o de agravación en la Esclerosis Múltiple (EM, que les ha llevado a proponer y realizar procedimientos de angioplastía mediante balón endovascular o stent venoso en pacientes con EM. La revisión de la bibliografía, en esta etapa del conocimiento de la IVCCM, no permite concluir si esta hipotética entidad tiene algún rol en el desarrollo o agravación de la EM. Por otro lado, concordamos con la mayoría de los clínicos e imagenólogos dedicados al estudio y tratamiento de la EM, en la ausencia de argumentos para indicar, alentar o propiciar procedimientos "terapéuticos" endovasculares para la EM. Para avanzar, en el conocimiento de la IVCCM y de eventual relación con la EM, se requieren estudios multicéntricos cuidadosamente conducidos, clínica y metodológicamente rigurosos, aprobados por comités de ética, en pacientes que sean invitados informadamente a participar en protocolos de investigación formales, que cuenten con las protecciones de seguros complementarios pertinentes y responsabilidades del gasto a costas de los investigadores.In this "point of view" or special article, it has been reviewed the main bibliographic antecedents related to the entity denominated as chronic cerebrospinal venous insufficiency (CCSVI, which formulation has been stated by Zamboni et col, from the Vascular Diseases Center of the University of Ferrara-Italy, who have assigned it a pathogenic role or of aggravation one in Multiple Sclerosis (MS, what has led them to propose and carry out endovascular balloon angioplasty or venous stent in MS patients as a treatment. The bibliographic review at this stage of the knowledge of CCSVI does not let us to conclude whether this hypothetical entity has any role in the development or aggravation of MS. On the other hand, we agree with most of the clinicians and neuroimaging MS researchers because of the absence of arguments to indicate, support or propose envovascular "therapeutic" procedures for MS. To advance in the knowledge of CCSVI and the eventual relation with MS it is required some multicentric controlled studies carefully led and clinical and methodological rigorous procedures approved by committee of ethic in very well informed patients invited to participate in protocols of formal investigation who should be protected by complementary pertinent insurances and responsibilities connected to the investigation expenses.

  14. ¿Procedimientos endovasculares como tratamiento de la esclerosis múltiple?: La hipótesis de la insuficiencia venosa crónica cerebro medular / Endovascular procedures as multiple sclerosis treatment?: The hipothesis of the chronic cerebrospinal venous insufficiency

    Scientific Electronic Library Online (English)

    Jorge, Nogales-Gaete.

    2011-03-01

    Full Text Available En este artículo especial de la modalidad "puntos de vista", se revisan los antecedentes bibliográficos principales relacionados a la entidad denominada "Insuficiencia venosa crónica cerebro medular (IVCCM)" cuya formulación ha sido planteada por Zamboni y col, del Centro de Enfermedades Vasculares [...] de la Universidad de Ferrara-Italia quienes le han adjudicado un rol patogénico o de agravación en la Esclerosis Múltiple (EM), que les ha llevado a proponer y realizar procedimientos de angioplastía mediante balón endovascular o stent venoso en pacientes con EM. La revisión de la bibliografía, en esta etapa del conocimiento de la IVCCM, no permite concluir si esta hipotética entidad tiene algún rol en el desarrollo o agravación de la EM. Por otro lado, concordamos con la mayoría de los clínicos e imagenólogos dedicados al estudio y tratamiento de la EM, en la ausencia de argumentos para indicar, alentar o propiciar procedimientos "terapéuticos" endovasculares para la EM. Para avanzar, en el conocimiento de la IVCCM y de eventual relación con la EM, se requieren estudios multicéntricos cuidadosamente conducidos, clínica y metodológicamente rigurosos, aprobados por comités de ética, en pacientes que sean invitados informadamente a participar en protocolos de investigación formales, que cuenten con las protecciones de seguros complementarios pertinentes y responsabilidades del gasto a costas de los investigadores. Abstract in english In this "point of view" or special article, it has been reviewed the main bibliographic antecedents related to the entity denominated as chronic cerebrospinal venous insufficiency (CCSVI), which formulation has been stated by Zamboni et col, from the Vascular Diseases Center of the University of Fer [...] rara-Italy, who have assigned it a pathogenic role or of aggravation one in Multiple Sclerosis (MS), what has led them to propose and carry out endovascular balloon angioplasty or venous stent in MS patients as a treatment. The bibliographic review at this stage of the knowledge of CCSVI does not let us to conclude whether this hypothetical entity has any role in the development or aggravation of MS. On the other hand, we agree with most of the clinicians and neuroimaging MS researchers because of the absence of arguments to indicate, support or propose envovascular "therapeutic" procedures for MS. To advance in the knowledge of CCSVI and the eventual relation with MS it is required some multicentric controlled studies carefully led and clinical and methodological rigorous procedures approved by committee of ethic in very well informed patients invited to participate in protocols of formal investigation who should be protected by complementary pertinent insurances and responsibilities connected to the investigation expenses.

  15. Adherencias abdominales postquirúrgicas en equinos: patofisiología, prevención y tratamiento Post-surgical abdominal adhesions in horses: pathophysiology, prevention and treatment

    Directory of Open Access Journals (Sweden)

    M Werner

    2009-01-01

    Full Text Available A pesar del gran número de investigaciones realizadas tanto en medicina humana como en medicina veterinaria, las adherencias intraabdominales continúan siendo una complicación para los cirujanos en la actualidad. El desarrollo de adherencias intraabdominales es un proceso dinámico y complejo que involucra una serie de eventos que comienzan con un proceso inflamatorio y daño tisular, seguido de desbalances en los procesos de fibrinogénesis y fibrinólisis, terminando con la conversión de fibrina a tejido fibroso. En cirugías de intestino delgado en equinos, la incidencia de adherencias va de 14 a 22%, siendo la causa más común de dolor abdominal recurrente y la segunda causa de celiotomías repetidas. Sin embargo, al incluir todas las causas de cirugías abdominales, en esta especie la incidencia de adherencias es de aproximadamente un 5%. El mayor conocimiento del mecanismo celular de la formación y reformación de adherencias debe llevar a reducir su incidencia. Actualmente, existen una serie de métodos de prevención y tratamientos destinados a disminuir o evitar la aparición de adherencias intraabdominales. El objetivo de esta revisión bibliográfica fue el de recopilar la mayor información disponible e investigaciones que expliquen de mejor manera la fisiopatología, prevención y tratamiento de la formación de adherencias intraabdominales.Despite the great number of human and veterinary medicine research, abdominal adhesions are still a big concern and a frequent complication for surgeons. The development of abdominal adhesions is a complex and dynamic process that involves a series of different mechanisms that start with an inflammatory process and tissue damage, followed by a fibrinogenic and fibrinolytic unbalance and ends with a change from fibrin deposit to fibrous tissue. In horses, after small intestine surgeries, adhesion incidence ranges from 14 to 22%. It is the most frequent cause of recurrent abdominal pain and the second cause for repeat celiotomy. Nevertheless, when all equine abdominal surgeries are included, the incidence of postoperative adhesions approximates 5%. A better understanding of the cellular mechanisms of adhesion formation and reformation should help to develop better prevention methods. Currently, a variety of prevention measures and treatments, most of them aiming to reduce or avoid adhesions formation, are used in veterinary medicine. The aim of this review is to gather most of the available information and the latest research explaining the pathophysiology, prevention and treatment of abdominal adhesions in horses.

  16. Adherencias abdominales postquirúrgicas en equinos: patofisiología, prevención y tratamiento / Post-surgical abdominal adhesions in horses: pathophysiology, prevention and treatment

    Scientific Electronic Library Online (English)

    M, Werner; JS, Galecio; H, Bustamante.

    Full Text Available A pesar del gran número de investigaciones realizadas tanto en medicina humana como en medicina veterinaria, las adherencias intraabdominales continúan siendo una complicación para los cirujanos en la actualidad. El desarrollo de adherencias intraabdominales es un proceso dinámico y complejo que inv [...] olucra una serie de eventos que comienzan con un proceso inflamatorio y daño tisular, seguido de desbalances en los procesos de fibrinogénesis y fibrinólisis, terminando con la conversión de fibrina a tejido fibroso. En cirugías de intestino delgado en equinos, la incidencia de adherencias va de 14 a 22%, siendo la causa más común de dolor abdominal recurrente y la segunda causa de celiotomías repetidas. Sin embargo, al incluir todas las causas de cirugías abdominales, en esta especie la incidencia de adherencias es de aproximadamente un 5%. El mayor conocimiento del mecanismo celular de la formación y reformación de adherencias debe llevar a reducir su incidencia. Actualmente, existen una serie de métodos de prevención y tratamientos destinados a disminuir o evitar la aparición de adherencias intraabdominales. El objetivo de esta revisión bibliográfica fue el de recopilar la mayor información disponible e investigaciones que expliquen de mejor manera la fisiopatología, prevención y tratamiento de la formación de adherencias intraabdominales. Abstract in english Despite the great number of human and veterinary medicine research, abdominal adhesions are still a big concern and a frequent complication for surgeons. The development of abdominal adhesions is a complex and dynamic process that involves a series of different mechanisms that start with an inflamma [...] tory process and tissue damage, followed by a fibrinogenic and fibrinolytic unbalance and ends with a change from fibrin deposit to fibrous tissue. In horses, after small intestine surgeries, adhesion incidence ranges from 14 to 22%. It is the most frequent cause of recurrent abdominal pain and the second cause for repeat celiotomy. Nevertheless, when all equine abdominal surgeries are included, the incidence of postoperative adhesions approximates 5%. A better understanding of the cellular mechanisms of adhesion formation and reformation should help to develop better prevention methods. Currently, a variety of prevention measures and treatments, most of them aiming to reduce or avoid adhesions formation, are used in veterinary medicine. The aim of this review is to gather most of the available information and the latest research explaining the pathophysiology, prevention and treatment of abdominal adhesions in horses.

  17. Correção endovascular de aneurisma de aorta abdominal e artéria ilíaca comum esquerda em paciente com hemofilia C grave Endovascular repair of abdominal aortic aneurysm and left common iliac artery in a patient with severe hemophilia C

    Directory of Open Access Journals (Sweden)

    Sergio Quilici Belczak

    2012-03-01

    Full Text Available A deficiência do fator XI, também conhecida como hemofilia C, é uma doença hematológica hereditária rara, que se manifesta clinicamente com hemorragia persistente após cirurgias, traumas, menorragias e extrações dentárias. Neste artigo, relatou-se a correção endovascular de um paciente com aneurisma de aorta e de artéria ilíaca comum esquerda em um paciente portador de deficiência major do fator XI (atividade do fator XI inferior a 20%. O procedimento foi realizado com sucesso, com o manuseio do distúrbio da coagulação por meio da infusão de plasma fresco no pré-operatório imediato e no pós-operatório, e controle laboratorial da coagulação do paciente.Factor XI deficiency, also known as hemophilia C, is a rare hereditary blood disease that manifests with persistent bleeding after surgery, trauma, menorrhagia, and dental extractions. This article reports an endovascular repair of a patient diagnosed with an aortic and left common iliac aneurysm, with severe factor XI deficiency (factor XI activity below 20%. The procedure was successfully performed with management of the coagulation disorder by preoperative and postoperative infusion of plasma and laboratory control of the coagulation.

  18. Correção endovascular de aneurisma de aorta abdominal e artéria ilíaca comum esquerda em paciente com hemofilia C grave / Endovascular repair of abdominal aortic aneurysm and left common iliac artery in a patient with severe hemophilia C

    Scientific Electronic Library Online (English)

    Sergio Quilici, Belczak; Igor Rafael, Sincos; Ricardo, Aun; Boulanger, Mioto Neto; Manoel, Lobato; Fernando, Saliture; Alex, Ledermain.

    2012-03-01

    Full Text Available A deficiência do fator XI, também conhecida como hemofilia C, é uma doença hematológica hereditária rara, que se manifesta clinicamente com hemorragia persistente após cirurgias, traumas, menorragias e extrações dentárias. Neste artigo, relatou-se a correção endovascular de um paciente com aneurisma [...] de aorta e de artéria ilíaca comum esquerda em um paciente portador de deficiência major do fator XI (atividade do fator XI inferior a 20%). O procedimento foi realizado com sucesso, com o manuseio do distúrbio da coagulação por meio da infusão de plasma fresco no pré-operatório imediato e no pós-operatório, e controle laboratorial da coagulação do paciente. Abstract in english Factor XI deficiency, also known as hemophilia C, is a rare hereditary blood disease that manifests with persistent bleeding after surgery, trauma, menorrhagia, and dental extractions. This article reports an endovascular repair of a patient diagnosed with an aortic and left common iliac aneurysm, w [...] ith severe factor XI deficiency (factor XI activity below 20%). The procedure was successfully performed with management of the coagulation disorder by preoperative and postoperative infusion of plasma and laboratory control of the coagulation.

  19. Tratamiento endovascular de una fuga paraprotésica mitral con dispositivo Amplatzer® / Percutaneous closure of a mitral paraprosthetic leak with an Amplatzer® device

    Scientific Electronic Library Online (English)

    Alberto, Sciegata; José A, Álvarez; Felipe, Deketele; José, Alonso; Jorge G, Allín; Guillermo, Migliaro.

    2012-10-01

    Full Text Available El leak o fuga paraprotésica mitral se presenta entre el 5 y el 17% de los pacientes tratados con cirugía de reemplazo valvular. En general, los defectos son únicos, la mayoría se encuentran localizados en la región postero-medial del anillo valvular y solo la tercera parte produce reflujo de grado [...] grave. El cierre percutáneo por vía endovascular es una alternativa terapéutica válida en pacientes con elevado riesgo para re-operación. La estrategia de abordaje depende de la localización, tamaño, morfología y relaciones adyacentes del o los defectos. El procedimiento debe ser realizado por profesionales con experiencia en el tratamiento de cardiopatías estructurales y en el manejo de estos dispositivos de cierre, y se considera imprescindible la utilización de un ecocardiograma transesofágico tridimensional. Se presenta el caso de un paciente con una fuga paraprotésica valvular mitral que fue cerrada con un dispositivo Amplatzer ® introducido en forma percutánea desde la vena femoral. Abstract in english Mitral paraprosthetic leaks are present in 5 to 17% of patients who receive valve replacement surgery. Overall, the defects are single, most of them are located in the postero-medial region of the annulus, and only one third produce a severe reflux. Percutaneous closure by endovascular surgery is a [...] valid therapeutic alternative in patients at high risk for re-operation. The approach depends on the location, size, morphology and relationships or neighboring defects. The procedure must be performed by professionals with experience in the treatment of structural heart disease and in the management of these closure devices. Guidance with three dimensional transesophageal echocardiography is considered essential. A case of a mitral paraprosthetic leak that was closed with an Amplatzer ® device introduced percutaneously from the femoral vein is here presented.

  20. Techniques in Endovascular Aneurysm Repair

    OpenAIRE

    Phade, Sachin V.; Manuel Garcia-Toca; Kibbe, Melina R

    2011-01-01

    Endovascular repair of infrarenal abdominal aortic aneurysms (EVARs) has revolutionized the treatment of aortic aneurysms, with over half of elective abdominal aortic aneurysm repairs performed endoluminally each year. Since the first endografts were placed two decades ago, many changes have been made in graft design, operative technique, and management of complications. This paper summarizes modern endovascular grafts, considerations in preoperative planning, and EVAR techniques. Specific ar...

  1. Aneurysmal sizing after endovascular repair in patients with abdominal aortic aneurysm: interobserver variability of various measurement protocols and its clinical relevance

    Energy Technology Data Exchange (ETDEWEB)

    Abada, Hicham T.; Sapoval, Marc R.; Mousseaux, Elie; Gaux, Jean-Claude [Department of Cardiovascular and Interventional Radiology, Hopital Europeen Georges Pompidou, 20 rue Leblanc, 75015, Paris (France); Paul, Jean-Francois [Department of Cardiovascular and Interventional Radiology, Hopital Europeen Georges Pompidou, 20 rue Leblanc, 75015, Paris (France); Department of Radiology, Centre Chirugical Marie Lannelongue, 92350, Le Plessis-Robinson (France); De Maertelaer, Viviane [Statistical Unit, Interdisciplinary Research in Human Biology and Nuclear Medicine, University of Brussels, 1070, Brussels (Belgium)

    2003-12-01

    The aim of this study was to determine the variability of various measurement protocols for measurement of abdominal aortic aneurysm (AAA) and the clinical relevance of variability. Three radiologists performed computed tomographic angiography measurements of both the aorta and the largest portion of the aneurysm on selected axial slices. Then measurements of the largest portion of the aneurysm were performed on unselected axial slices, sagittal and coronal reformatted. Finally, aortic volume was calculated. Measurements and volume calculation were performed before and after endovascular repair and assessed: Part 1: interobserver variability for maximum anteroposterior (MAP) and maximum transverse (MTR) diameters on selected slices; part 2: interobserver variability for unselected slices considering MAP and MTR; part 3: interobserver variability considering maximum diameter in any direction (MAD); part 4: interobserver variability for sagittal (SAG) and coronal (COR) free curved multiplanar reformation (MPR); and part 5: volume calculations. We then determined which technique of measurement was the most clinically relevant for detecting changes in aneurysm size or aortic volume. Parts 1 and 2: interobserver variability was 4.1 mm for both MAP and MTR; part 3: interobserver variability was 7 mm for MAD; part 4: interobserver variability was 5.5 mm (COR) and 4.9 mm (SAG); part 5: interobserver variability for volume was 5.5 ml. A combination of MAP and MTR was the most useful for detecting aortic modification. Volume calculation was needed in only a few cases. We recommend avoiding MAD and MPR measurements and suggest instead measuring both maximum anteroposterior and maximum transverse diameters. If aneurysm size remains stable after endovascular repair, aneurysm volume should be measured. (orig.)

  2. Aneurysmal sizing after endovascular repair in patients with abdominal aortic aneurysm: interobserver variability of various measurement protocols and its clinical relevance

    International Nuclear Information System (INIS)

    The aim of this study was to determine the variability of various measurement protocols for measurement of abdominal aortic aneurysm (AAA) and the clinical relevance of variability. Three radiologists performed computed tomographic angiography measurements of both the aorta and the largest portion of the aneurysm on selected axial slices. Then measurements of the largest portion of the aneurysm were performed on unselected axial slices, sagittal and coronal reformatted. Finally, aortic volume was calculated. Measurements and volume calculation were performed before and after endovascular repair and assessed: Part 1: interobserver variability for maximum anteroposterior (MAP) and maximum transverse (MTR) diameters on selected slices; part 2: interobserver variability for unselected slices considering MAP and MTR; part 3: interobserver variability considering maximum diameter in any direction (MAD); part 4: interobserver variability for sagittal (SAG) and coronal (COR) free curved multiplanar reformation (MPR); and part 5: volume calculations. We then determined which technique of measurement was the most clinically relevant for detecting changes in aneurysm size or aortic volume. Parts 1 and 2: interobserver variability was 4.1 mm for both MAP and MTR; part 3: interobserver variability was 7 mm for MAD; part 4: interobserver variability was 5.5 mm (COR) and 4.9 mm (SAG); part 5: interobserver variability for volume was 5.5 ml. A combination of MAP and MTR was the most useful for detecting aortic modification. Volume calculation was needed in only a few cases. We recommend avoiding MAD and MPR measurements and suggest instead measuring both maximum anteroposterior and maximum transverse diameters. If aneurysm size remains stable after endovascular repair, aneurysm volume should be measured. (orig.)

  3. Successful staged management of simultaneous abdominal aortic aneurysm and renal tumor: the novel minimally invasive treatment with endovascular aneurysm repair and retroperitoneal laparoscopic radical nephrectomy in an elderly and high-risk case

    OpenAIRE

    Masayuki Takeda; Masahiko Matsumoto; Shigeaki Kaga; Hidenori Zakoji; Shouji Kudou; Norifumi Sawada; Satoru Kira

    2012-01-01

    The association between abdominal aortic aneurysm (AAA) and renal tumor is becoming more frequent, and the increasing incidence of this synchronous diseases raised questions about the procedures of treatment. In most of the previous cases, open nephrectomy and AAA surgery have been reported, however in high risk and elderly patients, the procedure is life threatening. We present a successful staged treatment of AAA and renal tumor using novel minimally invasive treatment with endovascular ane...

  4. Tratamento endoluminal de aneurismas anastomóticos na aorta abdominal: relato de dois casos Endovascular treatment of abdominal aortic anastomotic aneurysms: report of two cases

    Directory of Open Access Journals (Sweden)

    Ricardo Aun

    2006-03-01

    Full Text Available Os aneurismas anastomóticos que envolvem a anastomose proximal de reconstruções do território aorto-ilíaco são graves, e as operações convencionais para sua correção são complexas e passíveis de graves complicações. Apresentamos dois casos de aneurismas de anastomoses proximais de enxerto aorto-bifemoral que ocorreram após 15 e 18 anos, respectivamente, de evolução dos enxertos e que foram corrigidos pela técnica endoluminal. Ambos os pacientes evoluíram bem e foram submetidos a controle pela tomografia computadorizada com 12 e 6 meses de evolução, respectivamente, com exclusão do aneurisma.Proximal anastomosis aneurysm is a rare and severe complication in aortofemoral bypass surgery. Surgical treatment is complex and has a high morbidity and mortality rate. We report two cases of proximal anastomosis aneurysm in late follow up of aortobifemoral bypass surgery, which occurred 15 and 18 years, respectively, after the bypasses and were repaired by the endovascular technique. Both patients progressed well and were submitted to 6- and 12-month follow-up CT scans showing aneurysm exclusion.

  5. Tratamento endoluminal de aneurismas anastomóticos na aorta abdominal: relato de dois casos / Endovascular treatment of abdominal aortic anastomotic aneurysms: report of two cases

    Scientific Electronic Library Online (English)

    Ricardo, Aun; Fernando Tavares, Saliture Neto; Alex, Lederman; Hilton, Waksman.

    2006-03-01

    Full Text Available Os aneurismas anastomóticos que envolvem a anastomose proximal de reconstruções do território aorto-ilíaco são graves, e as operações convencionais para sua correção são complexas e passíveis de graves complicações. Apresentamos dois casos de aneurismas de anastomoses proximais de enxerto aorto-bife [...] moral que ocorreram após 15 e 18 anos, respectivamente, de evolução dos enxertos e que foram corrigidos pela técnica endoluminal. Ambos os pacientes evoluíram bem e foram submetidos a controle pela tomografia computadorizada com 12 e 6 meses de evolução, respectivamente, com exclusão do aneurisma. Abstract in english Proximal anastomosis aneurysm is a rare and severe complication in aortofemoral bypass surgery. Surgical treatment is complex and has a high morbidity and mortality rate. We report two cases of proximal anastomosis aneurysm in late follow up of aortobifemoral bypass surgery, which occurred 15 and 18 [...] years, respectively, after the bypasses and were repaired by the endovascular technique. Both patients progressed well and were submitted to 6- and 12-month follow-up CT scans showing aneurysm exclusion.

  6. Abdominal aorta morphometric study for endovascular treatment of aortic aneurysms: comparison between spiral CT and angiography / Estudo morfométrico da aorta abdominal para tratamento endovascular dos aneurismas aórticos: comparação entre tomografia helicoidal e angiografia

    Scientific Electronic Library Online (English)

    Gaudencio, Espinosa; Edson, Marchiori; Adalberto Pereira de, Araújo; Mônica Ferreira, Caramalho; Pedro, Barzola.

    2002-12-01

    Full Text Available OBJETIVOS: Este trabalho visa comparar a acurácia da tomografia computadorizada e da angiografia para avaliar os aneurismas de aorta abdominal (AAA) para posterior implante de endoprótese vascular. MÉTODO: De junho de 1997 até março de 2001, foram atendidos 113 pacientes portadores de AAA, tendo sid [...] o submetidos a estudo por tomografia helicoidal computadorizada de abdome e pelve e angiografia com cateter centimetrado do eixo arterial aorto-ilíaco. A idade dos pacientes variou entre 51 e 88 anos (S:69a.), sendo 104 do sexo masculino e nove do feminino. RESULTADOS: Quando comparadas as médias dos diâmetros aferidas pela tomografia computadorizada e pela angiografia, notou-se que a diferença do diâmetro foi significativa para o colo aórtico infra-renal (r 0,05). Quando comparadas as médias das extensões aferidas pela tomografia computadorizada e pela angiografia, notou-se que a diferença das extensões foi significativa para o colo aórtico infra-renal (r Abstract in english PURPOSE: To compare the computed tomography and angiography study of abdominal aortic aneurysms for posterior endograft implant. METHOD: From June 1997 to March 2001, 113 patients with abdominal aortic aneurysm were submitted to study of the aorto-iliac axis with abdominal spiral computed tomography [...] and angiography with calibrated catheter. The patient's ages ranged from 51 and 88 years (mean: 69). There were 104 males and nine females. RESULTS: When comparing the mean computed tomography and angiography diameters, we observed that there was a statistical difference for the infra-renal neck (p0.05). When comparing the mean lengths, we observed that there was a statistical difference for the aortic infra-renal neck (p

  7. Cide-A Gene Expression in Patients with Obesity Qualified for Endovascular Treatment of Abdominal Aorta Aneurysm

    Directory of Open Access Journals (Sweden)

    Feldo Marcin

    2015-02-01

    Full Text Available CIDE-A gene and the genes of LRP group play a key role in the regulation of the body weight and lipid metabolism in mammals. CIDE-A is defined as a potential human obesity gene and the LRP1 gene is associated with the development of abdominal aortic aneurysm (AAA.

  8. Bilateral prevascular herniae – A rare complication of aorto-uniiliac endovascular abdominal aortic aneurysm repair and femoro-femoral bypass

    Directory of Open Access Journals (Sweden)

    Obinna Obinwa

    2015-01-01

    Full Text Available A case of a 78-year-old female with bilateral groin prevascular herniae following an emergency aorto-uniiliac EVAR and femoro-femoral bypass for a ruptured abdominal aortic aneurysm is presented. Primary repair of the herniae was achieved using a preperitoneal approach. The case emphasises a safe approach to dealing with this rare complication.

  9. Endovascular therapy of abdominal aortic aneurysm: results of a mid-term follow-up; Endovaskulaere Therapie von abdominellen Aortenaneurysmen: Klinisch-radiologishe Ergebnisse im mittelfristigen Verlauf

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, M.B.; Schweitzer, H.; Herber, S.; Thelen, M. [Universitaetsklinik Mainz (Germany). Klinik fuer Radiologie; Schmiedt, W.; Neufang, A. [Universitaetsklinik Mainz (Germany). Klinik fuer Herz-, Thorax-, und Gefaesschirurgie; Dueber, C. [Universitaetsklinikum Mannheim (Germany). Inst. fuer Diagnostische Radiologie

    2003-10-01

    Prospective study to evaluate clinical results and complications of endovascular abdominal aortic aneurysm treatment in a mid-term follow-up. Materials and methods: A total of 122 patients (9 females, 113 males, average age 70.0{+-}7,9 years) with abdominal aortic aneurysms were treated with stent grafts (53 Vanguard or Stentor endografts, 69 Talent endografts). Group I consisted of 40 patients who had all aortic tributaries of the aneurysm sac occluded prior to endovalscular grafting, either spontaneously by parietal thrombosis or by selective coil embolization of the respective ostia preserving collateral circulation distal to the vessel occlusion. Group II consisted of 82 patients and included all cases without or with incomplete coil embolization with at least one patent vessel. Stent grafting was performed in general anesthesia in the first 21 patients, followed by peridural anesthesia in 15 cases, and local anesthesia with conscious sedation in 86 cases. The results were evaluated with Spiral-CT, MRI and radiographs of the endovascular graft, with follow-up examinations obtained at 3, 6, 12 months, and every year - Implantation was successfully completed in all cases without primary conversion surgery, laparotomy or any significant complication. Mean follow-up was 29{+-}21 months (maximum 82 months). The 30-day mortality was 0,8% due to a myocardial infarction 3 days after discharge from the hospital. A total of 47 re-interventions were performed in 29 patients (23.8%), with 35 re-interventions in 18 cases with Vanguard or Stentor endografts and 12 re-interventions in 11 patients with Talent endografts. 23 percutaneous re-interventions included distal graft extension (n=11), Wallstent for kinking and limb stenosis (n=3), and secondary coil embolization of collateral vessels (n=9). 24 surgical re-interventions included proximal graft extension (n=6), new endovascular grafts (n=3), surgical clipping of lumbar and mesenteric artery branches for type-II endoleaks following ineffective secondary coil embolization (n=1), and femorofemoral crossover bypasses (n=4). A total of 10 secondary conversion operations were performed because of damage to the membrane (n=4; 3 Vanguard endografts, 1 Talent endograft), significant caudal migrations (n=5; 4 Vanguard endografts, 1 Talent endograft) associated with type-I endoleaks (n=2), limb occlusion (n=1), disconnection of graft components (n=1), and significant endoluminal thrombus deposits (n=1). One patient, who was followed for 82 months, suffered from a significant endoleak for 10 months with increasing aneurysm diameter but he refused surgery. He was admitted with aneurysm perforation and was successfully operated with aortic graft replacement. Compared to group II, the incidence and size of endoleaks was reduced in group I (incidence 19.2% versus 29.9%, p<0.05). Group I demonstrated significantly better aneurysm shrinkage at 36 months follow-up ({delta} sagittal diameter -11.1{+-}8.4 mm versus -4.9{+-}6.2 mm, p<0.05). (orig.) [German] Zielsetzung: Prospektive Studie zur Erfassung der klinisch-radiologischen Ergebnisse und Komplikationen im mittelfristigen Verlauf nach endovaskulaerer Aneurysmatherapie. Material und Methoden: 122 Patienten (9 Frauen, 113 Maenner, Alter 70,9{+-}7,9 Jahre) mit abdominellen Aortenaneurysmen wurden mittels Stentprothesen endovaskulaer behandelt (Vanguard/Stentor n=53, Talent n=69). Patienten mit verschlossenen aortalen Seitenaesten im Aneurysmabereich (spontan oder, nach Embolisationsbehandlung) wurden in Gruppe I (n=40) zusammengefasst, Patienten mit mindestens einem perfundierten Seitenast in Gruppe II (n=82). Die Implantationen erfolgten zunaechst in Allgemeinnarkose (n=21), spaeter in Periduralanaesthesie (n=15) und schliesslich in Lokalanaestesie (n=86). Die Ergebniskontrollen erfolgten mittels Spiral-CT, MRT und Stent-Radiographie postinterventionell, nach 3, 6 und 12 Monaten, dann jaehrlich. Ergebnisse: Die Implantationen wurden in allen Faellen erfolgreich durchgefuehrt, ohne primaere Konversionsoperationen, Laparotomien oder sonstig

  10. Surveillance of patients post-endovascular abdominal aortic aneurysm repair (EVAR). A web-based survey of practice in the UK

    International Nuclear Information System (INIS)

    Aim: To evaluate the current practice of endovascular abdominal aortic aneurysm repair (EVAR) surveillance amongst British Society of Interventional Radiologists (BSIR) members. Materials and methods: A web-based survey ( (Surveymonkey.com)) of BSIR members was performed from June 2011 to September 2011. Questions included who was responsible for organizing follow-up, techniques used in follow-up, and timing of follow-up imaging. Results: The majority (46%) of follow-up is organized by radiologists. In the first year, 74% of imaging interactions involves the use of computed tomography (CT), with 40% of respondents using multiple phases. After the first year, ultrasound is utilized more frequently, usually with plain films. Most patients receive imaging at 1, 6, and 12 months, and thereafter most respondents plan on indefinite yearly follow-up. Conclusion: EVAR follow-up protocols in the past have been empirical rather than evidence based. The present survey shows the current range of protocols used in the UK. Despite the frequent use of CT in the first year post-EVAR, there does appear to be a trend towards using ultrasound after the first year of follow-up

  11. Vascular surgical society of great britain and ireland: changes in proximal aortic neck dimensions following endovascular repair of abdominal aortic aneurysm

    Science.gov (United States)

    Walker; MacIerewicz; Whitaker; Gregson; Hopkinson

    1999-05-01

    BACKGROUND: Dilatation of the proximal neck following conventional open repair of abdominal aortic aneurysm (AAA) has been reported. Such continued dilatation following endovascular repair (EVR) could potentially be a disaster resulting in graft slippage, endoleak and aneurysm rupture. The aim of this study was to detect any change in proximal neck diameter following EVR of AAAs. METHODS: One hundred patients had undergone EVR of an AAA over a 4-year period in whom contrast-enhanced spiral computed tomography was performed both before and after EVR (1 week, 3, 6 and 12 months and annually thereafter). Change in aortic proximal neck diameter, change in maximum aortic diameter, presence of endoleaks, and change in length from the lowest renal artery to the aortic bifurcation was sought. RESULTS: The median anteroposterior and transverse diameter decreased from 64 mm before operation to 56 and 54 mm respectively after operation. This trend in reduction in maximum diameter was not seen in patients with endoleaks. There was no significant change in proximal neck diameter when measured at 5-mm intervals following EVR. There was also no significant change in the aortic length following EVR. CONCLUSION: There was no evidence of proximal neck dilatation or aneurysm length reduction following EVR of AAAs. PMID:10361203

  12. Abdominal aorta morphometric study for endovascular treatment of aortic aneurysms: comparison between spiral CT and angiography; Estudo morfometrico da aorta abdominal para tratamento endovascular dos aneurismas aorticos: comparacao entre tomografia helicoidal e angiografia

    Energy Technology Data Exchange (ETDEWEB)

    Espinosa, Gaudencio [Universidade Federal, Rio de Janeiro, RJ (Brazil). Hospital Universitario Clementino Fraga Filho. Dept. de Cirurgia Vascular; Marchiori, Edson [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia]. E-mail: edmarchiori@zipmail.com.br; Caramalho, Monica Ferreira [Hospital Miguel Couto, Rio de Janeiro (Brazil); Barzola, Pedro [Medtronic-AVE do Brasil, Sao Paulo, SP (Brazil); Araujo, Adalberto Pereira de

    2002-12-01

    Purpose: To compare the computed tomography and angiography study of abdominal aortic aneurysms for posterior endograft implant. Method: From June 1997 to March 2001, 113 patients with abdominal aortic aneurysm were submitted to study of the aorto-iliac axis with abdominal spiral computed tomography and angiography with calibrated catheter. The patient's ages ranged from 51 and 88 years (mean: 69). There were 104 males and nine females. Results: When comparing the mean computed tomography and angiography diameters, we observed that there was a statistical difference for the infra-renal neck (p<0.05) and for the aortic aneurysm diameters (p<0.001). There was no statistical difference for the iliac artery diameters (p>0.05). When comparing the mean lengths, we observed that there was a statistical difference for the aortic infra-renal neck (p<0.05), for the distance between the renal artery and the aortic bifurcation (p<0.05) and for the common iliac artery lengths (p<0.05). There was also a statistical difference for the length between the renal artery and the internal iliac artery (p<0.05). Conclusions: In the AAA pre-procedure imaging study there were statistical differences between the computed tomography and angiographic measurement studies. We believe that computed tomography is a superior method for the evaluation of diameters and the angiography with a calibrated catheter for the length evaluation. We conclude, that both methods are complementary and must be undertaken for accurate evaluation of all candidates for aortic endograft implant. (author)

  13. Abdominal aorta morphometric study for endovascular treatment of aortic aneurysms: comparison between spiral CT and angiography Estudo morfométrico da aorta abdominal para tratamento endovascular dos aneurismas aórticos: comparação entre tomografia helicoidal e angiografia

    Directory of Open Access Journals (Sweden)

    Gaudencio Espinosa

    2002-12-01

    Full Text Available PURPOSE: To compare the computed tomography and angiography study of abdominal aortic aneurysms for posterior endograft implant. METHOD: From June 1997 to March 2001, 113 patients with abdominal aortic aneurysm were submitted to study of the aorto-iliac axis with abdominal spiral computed tomography and angiography with calibrated catheter. The patient's ages ranged from 51 and 88 years (mean: 69. There were 104 males and nine females. RESULTS: When comparing the mean computed tomography and angiography diameters, we observed that there was a statistical difference for the infra-renal neck (p0.05. When comparing the mean lengths, we observed that there was a statistical difference for the aortic infra-renal neck (pOBJETIVOS: Este trabalho visa comparar a acurácia da tomografia computadorizada e da angiografia para avaliar os aneurismas de aorta abdominal (AAA para posterior implante de endoprótese vascular. MÉTODO: De junho de 1997 até março de 2001, foram atendidos 113 pacientes portadores de AAA, tendo sido submetidos a estudo por tomografia helicoidal computadorizada de abdome e pelve e angiografia com cateter centimetrado do eixo arterial aorto-ilíaco. A idade dos pacientes variou entre 51 e 88 anos (S:69a., sendo 104 do sexo masculino e nove do feminino. RESULTADOS: Quando comparadas as médias dos diâmetros aferidas pela tomografia computadorizada e pela angiografia, notou-se que a diferença do diâmetro foi significativa para o colo aórtico infra-renal (r 0,05. Quando comparadas as médias das extensões aferidas pela tomografia computadorizada e pela angiografia, notou-se que a diferença das extensões foi significativa para o colo aórtico infra-renal (r < 0,05, para a distância entre a artéria renal e a bifurcação aórtica (r < 0,05 e para as artérias ilíacas comuns (r < 0,05. A comparação entre as médias também foi significativa para a extensão entre a artéria renal e a artéria ilíaca interna (r < 0,05. CONCLUSÕES: Na avaliação por imagem dos AAA houve diferenças estatísticas significativas entre os dois métodos diagnósticos. A tomografia computadorizada aparentou ser o melhor método pré-operatório para a medida dos diâmetros, e a angiografia por cateter centimetrado para a avaliação das extensões (comprimentos. Portanto, os dois métodos se complementam, devendo ser realizados na avaliação de todos os pacientes candidatos ao implante de uma endoprótese aórtica.

  14. Endovascular therapy for abdominal aortic aneurysm and iliac artery aneurysm using SEAL aortic stent-graft: A single center experience

    International Nuclear Information System (INIS)

    The aim of this study was to evaluate the safety and efficacy of SEAL aortic stent-graft for abdominal aortoiliac aneurysms. Between October 2007 and January 2014, 33 patients with abdominal aortoiliac aneurysms were treated with SEAL aortic stent-graft. We evaluated the technical success rate, clinical and CT follow-up periods, major complications, need for additional interventional treatment, aneurysm-related mortality and clinical success rate. SEAL bifurcated aortic stent-graft was successfully placed in 32 patients (97%). Clinical and CT follow-up periods were 24 and 14 months, respectively. Endoleak developed in 13 patients (41%): spontaneous regression or decrease in 6, need for additional treatment in 4 and follow-up loss in 3. Significant stenosis of stent-graft occurred in 4 patients (12%) and was treated with stenting in 3. Migration of stent-graft was noted in 3 patients (9%) and treated with additional stent-grafting. Aneurysm-related mortality was 9% (3 of 33). The placement of SEAL stent-graft was effective in 26 patients (79%). The placement of SEAL aortic stent-graft was safe and effective in patients with aneurysms of abdominal aorta and iliac arteries. However, complicating endoleaks, stenosis and migration of the stent-graft developed during the follow-up. Therefore, regular CT follow-up seems to be mandatory.

  15. Endovascular therapy for abdominal aortic aneurysm and iliac artery aneurysm using SEAL aortic stent-graft: A single center experience

    Energy Technology Data Exchange (ETDEWEB)

    Park, Su Young; Kim, Jeong Ho; Byun, Sung Su; Kang, Jin Mo; Choi, Sang Tae; Park, Jae Hyung [Gachon University Gil Hospital, Incheon (Korea, Republic of)

    2015-03-15

    The aim of this study was to evaluate the safety and efficacy of SEAL aortic stent-graft for abdominal aortoiliac aneurysms. Between October 2007 and January 2014, 33 patients with abdominal aortoiliac aneurysms were treated with SEAL aortic stent-graft. We evaluated the technical success rate, clinical and CT follow-up periods, major complications, need for additional interventional treatment, aneurysm-related mortality and clinical success rate. SEAL bifurcated aortic stent-graft was successfully placed in 32 patients (97%). Clinical and CT follow-up periods were 24 and 14 months, respectively. Endoleak developed in 13 patients (41%): spontaneous regression or decrease in 6, need for additional treatment in 4 and follow-up loss in 3. Significant stenosis of stent-graft occurred in 4 patients (12%) and was treated with stenting in 3. Migration of stent-graft was noted in 3 patients (9%) and treated with additional stent-grafting. Aneurysm-related mortality was 9% (3 of 33). The placement of SEAL stent-graft was effective in 26 patients (79%). The placement of SEAL aortic stent-graft was safe and effective in patients with aneurysms of abdominal aorta and iliac arteries. However, complicating endoleaks, stenosis and migration of the stent-graft developed during the follow-up. Therefore, regular CT follow-up seems to be mandatory.

  16. Endovascular abdominal aortic repair for AAA. Anatomical suitability and limitation in Japanese population according to the inclusion criteria of Zenith AAA stent graft

    International Nuclear Information System (INIS)

    Since 2007, the EVAR (endovascular abdominal aortic repair) grafts, Zenith, Excluder and Powerlink had been commercially available in Japan. However, a small iliac artery, typical of Japanese population especially in women, was a limiting factor to indicate EVAR. We analyzed the suitability of EVAR in Japanese population according to the inclusion criteria of Zenith AAA stent graft in the current study. From January 2006 to December 2007, 106 AAA (abdominal aortic aneurysm) patients (88 men, 18 women) with a mean age of 73 years were investigated in our institution by multi-slice CT scan in terms of suitability of EVAR, then we measured their abdominal aorta and iliac artery parameters as follows; proximal neck diameter (PND) and length (PNL), common iliac artery diameter (CIAD) and length (CIAL), suprarenal (SNA) and infrarenal neck angulation (INA), external iliac artery diameter (EIAD) and aortic length from the lowest renal artery to the aortic bifurcation (AOL). The inclusion criteria for Zenith AAA stent graft treatment were; PND: 18-28 mm, PNL more than 15 mm, unilateral CIAD less than 20 mm, CIAL at least 10 mm, SNA less than 45 degree and INA less than 60 degree, unilateral EIAD more than 7.5 mm. The indication of EVAR was 25.5% (27/106 patients), and was especially very low in women (5.6%) strictly according to the inclusion criteria of the Zenith AAA stent graft. The main reason of exclusion of EVAR was proximal short neck (40.5%), small iliac artery (30.4%) and infrarenal aortic neck angulation (29.1%). In our analysis, female AAA patients had small PNL and EIAD with angulated neck compared with male AAA ones. Anatomical suitability of EVAR in Japanese population strictly following by the inclusion criteria of Zenith AAA stent graft was low due to their characteristic differences from the European Union (EU) and the United States (US) patients, such as short proximal neck, steep neck angulation and small iliac artery, especially in women. More flexible or branched/fenestrated grafts with a low profile sheath may be essential to be indicated EVAR in more Japanese AAA patients. (author)

  17. Automatic pose initialization for accurate 2D/3D registration applied to abdominal aortic aneurysm endovascular repair

    Science.gov (United States)

    Miao, Shun; Lucas, Joseph; Liao, Rui

    2012-02-01

    Minimally invasive abdominal aortic aneurysm (AAA) stenting can be greatly facilitated by overlaying the preoperative 3-D model of the abdominal aorta onto the intra-operative 2-D X-ray images. Accurate 2-D/3-D registration in 3-D space makes the 2-D/3-D overlay robust to the change of C-Arm angulations. By far, the 2-D/3-D registration methods based on simulated X-ray projection images using multiple image planes have been shown to be able to provide satisfactory 3-D registration accuracy. However, one drawback of the intensity-based 2-D/3-D registration methods is that the similarity measure is usually highly non-convex and hence the optimizer can easily be trapped into local minima. User interaction therefore is often needed in the initialization of the position of the 3-D model in order to get a successful 2-D/3-D registration. In this paper, a novel 3-D pose initialization technique is proposed, as an extension of our previously proposed bi-plane 2-D/3-D registration method for AAA intervention [4]. The proposed method detects vessel bifurcation points and spine centerline in both 2-D and 3-D images, and utilizes landmark information to bring the 3-D volume into a 15mm capture range. The proposed landmark detection method was validated on real dataset, and is shown to be able to provide a good initialization for 2-D/3-D registration in [4], thus making the workflow fully automatic.

  18. Disección de aorta: Aspectos básicos y manejo endovascular / Aortic dissection: Basic aspects and endovascular management

    Scientific Electronic Library Online (English)

    Nicolás I, Jaramillo; Carlos L, Alviar.

    2005-08-01

    Full Text Available El tratamiento de la patología aórtica torácica se complica por la asociación con una alta mortalidad en la reparación quirúrgica, y al mismo tiempo fragilidad y gran comorbilidad en los adultos de edad avanzada. En la búsqueda por reducir la incidencia de resultados negativos, en la década pasada s [...] e introdujo la técnica de intervención por la vía de la mínima invasión, con la colocación de dispositivos del tipo stent vía endovascular. La técnica, originalmente descrita por Parodi e inicialmente diseñada para uso en la corrección de aneurismas de aorta abdominal, ha sido adoptada para el uso en la patología aórtica torácica. El mejoramiento en el entendimiento de la fisiopatología y la historia natural de la enfermedad de la aorta torácica y el análisis de los resultados, han facilitado la toma de decisiones en cuanto al tratamiento en términos del tiempo de la intervención apropiada. El tratamiento de la disección de la aorta torácica con el uso de stent endovascular, es uno de los más recientes avances en el tratamiento y hoy recibe una atención especial, al punto que es una alternativa menos invasiva; incluso la tecnología está apenas en sus primeras etapas y en los últimos años se han mejorado significativamente el diseño y el sistema de liberación de estos dispositivos endovasculares conocidos como stent-grafts. Estas prótesis se utilizan de forma creciente en el tratamiento de aneurismas, disecciones, rupturas traumáticas, úlceras penetradas gigantes y hematomas intramurales de la aorta torácica descendente, con buenos resultados tanto tempranos como a mediano plazo. La poca frecuencia, la alta complejidad y la severidad de la patología, y al mismo tiempo el alto riesgo teórico de las complicaciones que se pueden generar, deben mantener cauto al operador, especialmente cuando esta técnica se aplica en pacientes jóvenes. De manera conceptual la solución por la vía endoluminal en las fases agudas, probablemente llegue a ser la terapia preferida, aunque la técnica todavía está en proceso de refinamiento. A nivel mundial la experiencia viene en crecimiento y hoy se entienden mejor las indicaciones y las limitaciones de esta terapia innovadora. En este artículo se hace una revisión general sobre el diagnóstico clínico y el manejo de la disección aórtica y sus variantes: el hematoma intramural y la úlcera aórtica aterosclerótica. Abstract in english Treatment of thoracic aortic pathology is complicated by the morbidity associated to the surgical procedure and to the frailty of an elderly and difficult population. Surgical operation in this kind of population frequently bears a significant incidence of death and long term disability. In an effor [...] t to reduce the incidence of negative outcomes, minimally invasive techniques in the form of endovascular stenting have been introduced during the past decade. The technology, originally described by Parodi, and initially designed for its use in abdominal aortic aneurysms, has been adapted for the treatment of thoracic aortic aneurysms. Furthermore, an improved understanding of the pathophysiology and the natural history of thoracic aortic disease as well as the analysis of the outcomes has facilitated our treatment decisions in terms of the timing for an appropriate intervention. Treatment of thoracic aortic dissection using endovascular stent is one of the more recent advances in this condition and is receiving increasing attention as it is a less invasive alternative to an open surgical repair. Although this technology is still innovative, significant improvements have been made lately in the design and deployment of the endovascular stent-grafts. These prostheses have been increasingly used to treat aneurysms, dissections and traumatic ruptures, as well as giant penetrating ulcers and intramural hematomas of the descending thoracic aorta with good early and mid-term outcomes. The rareness, complexity and severity of the pathology and the theoretically high risk of complications should re

  19. Disección de aorta: Aspectos básicos y manejo endovascular Aortic dissection: Basic aspects and endovascular management

    Directory of Open Access Journals (Sweden)

    Nicolás I Jaramillo

    2005-08-01

    Full Text Available El tratamiento de la patología aórtica torácica se complica por la asociación con una alta mortalidad en la reparación quirúrgica, y al mismo tiempo fragilidad y gran comorbilidad en los adultos de edad avanzada. En la búsqueda por reducir la incidencia de resultados negativos, en la década pasada se introdujo la técnica de intervención por la vía de la mínima invasión, con la colocación de dispositivos del tipo stent vía endovascular. La técnica, originalmente descrita por Parodi e inicialmente diseñada para uso en la corrección de aneurismas de aorta abdominal, ha sido adoptada para el uso en la patología aórtica torácica. El mejoramiento en el entendimiento de la fisiopatología y la historia natural de la enfermedad de la aorta torácica y el análisis de los resultados, han facilitado la toma de decisiones en cuanto al tratamiento en términos del tiempo de la intervención apropiada. El tratamiento de la disección de la aorta torácica con el uso de stent endovascular, es uno de los más recientes avances en el tratamiento y hoy recibe una atención especial, al punto que es una alternativa menos invasiva; incluso la tecnología está apenas en sus primeras etapas y en los últimos años se han mejorado significativamente el diseño y el sistema de liberación de estos dispositivos endovasculares conocidos como stent-grafts. Estas prótesis se utilizan de forma creciente en el tratamiento de aneurismas, disecciones, rupturas traumáticas, úlceras penetradas gigantes y hematomas intramurales de la aorta torácica descendente, con buenos resultados tanto tempranos como a mediano plazo. La poca frecuencia, la alta complejidad y la severidad de la patología, y al mismo tiempo el alto riesgo teórico de las complicaciones que se pueden generar, deben mantener cauto al operador, especialmente cuando esta técnica se aplica en pacientes jóvenes. De manera conceptual la solución por la vía endoluminal en las fases agudas, probablemente llegue a ser la terapia preferida, aunque la técnica todavía está en proceso de refinamiento. A nivel mundial la experiencia viene en crecimiento y hoy se entienden mejor las indicaciones y las limitaciones de esta terapia innovadora. En este artículo se hace una revisión general sobre el diagnóstico clínico y el manejo de la disección aórtica y sus variantes: el hematoma intramural y la úlcera aórtica aterosclerótica.Treatment of thoracic aortic pathology is complicated by the morbidity associated to the surgical procedure and to the frailty of an elderly and difficult population. Surgical operation in this kind of population frequently bears a significant incidence of death and long term disability. In an effort to reduce the incidence of negative outcomes, minimally invasive techniques in the form of endovascular stenting have been introduced during the past decade. The technology, originally described by Parodi, and initially designed for its use in abdominal aortic aneurysms, has been adapted for the treatment of thoracic aortic aneurysms. Furthermore, an improved understanding of the pathophysiology and the natural history of thoracic aortic disease as well as the analysis of the outcomes has facilitated our treatment decisions in terms of the timing for an appropriate intervention. Treatment of thoracic aortic dissection using endovascular stent is one of the more recent advances in this condition and is receiving increasing attention as it is a less invasive alternative to an open surgical repair. Although this technology is still innovative, significant improvements have been made lately in the design and deployment of the endovascular stent-grafts. These prostheses have been increasingly used to treat aneurysms, dissections and traumatic ruptures, as well as giant penetrating ulcers and intramural hematomas of the descending thoracic aorta with good early and mid-term outcomes. The rareness, complexity and severity of the pathology and the theoretically high risk of complications should render the surgeon extremely cautious

  20. Dual-energy CT in the follow-up after endovascular abdominal aortic aneurysm repair; Dual-Energy CT zur postoperativen Langzeitkontrolle nach endovaskulaer therapierten abdominellen Aortenaneurysmen

    Energy Technology Data Exchange (ETDEWEB)

    Braegelmann, A.; Heindel, W.; Seifarth, H. [Universitaetsklinikum Muenster (Germany). Inst. fuer Klinische Radiologie; Bunck, A.; Maintz, D. [Universitaetsklinikum Muenster (Germany). Inst. fuer Klinische Radiologie; Universitaetsklinikum Koeln (Germany). Inst. und Poliklinik fuer Radiologische Diagnostik; Donas, K.; Kasprzak, B. [Universitaetsklinikum Muenster (Germany). Klinik fuer Vaskulaere und Endovaskulaere Chirurgie

    2013-04-15

    This study investigates the dual-energy procedure for postoperative CT follow-up scans after endovascularly treated abdominal aortic aneurysms. The procedure is analyzed with respect to its sensitivity and specificity as well as the associated radiation exposure. 51 examinations were carried out on 47 patients between February 2009 and March 2010. For each patient, a non-enhanced, an arterial and a venous scan were conducted, the latter two using the dual-energy technology. Virtual images for the non-enhanced phase were reconstructed from the data taken in the venous phase. Protocol A, the reference standard, consisted of non-enhanced images and images of the arterial and venous phase. In protocol B, standard non-enhanced images were replaced by the reconstructed virtual non-enhanced images. Protocol C consisted only of virtual non-enhanced and 80 kV images taken during the venous phase. All data was anonymized and evaluated by two independent radiologists. For protocol C, sensitivity, specificity, negative and positive predictive values were computed. The effective radiation dosage was determined for each scan. All endoleaks identified in protocol A were found using protocols B and C. For protocol C, the sensitivity and negative predictive value were 100 %, the specificity was 94.1 %, and the positive predictive value was 89.5 %. Compared to protocol A, protocol C reduces the radiation exposure by 62.45 %. A scan protocol consisting of virtual non-enhanced images as well as 80 kV images taken during the venous phase was found to be a reliable alternative method for diagnosing endoleaks, while reducing the radiation exposure by 62.45 %. (orig.)

  1. Comparison of Efficacy of Endovascular Aneurysm Repair Versus Open Surgical Repair in Middle/High-Risk Patients With Abdominal Aortic Aneurysm.

    Science.gov (United States)

    Zhang, Chang-Lie; Song, Zhi-Hong; Wang, Fan

    2016-01-01

    To explore the efficacy of endovascular aneurysm repair (EVAR) compared with traditional open surgical repair (OSR) in the treatment of middle/high-risk patients with abdominal aortic aneurysm (AAA). With a retrospective method, we analyzed the clinical data of 57 patients with middle/high-risk AAA admitted to Linyi People's Hospital Affiliated to Shandong University from January 2010 to January 2014. Twenty-eight of the 57 patients received EVAR and 29 others received OSR. Statistical analysis was conducted by the design of spreadsheet according to preoperative, intraoperative, perioperative, and postoperative follow-up relevant information. Our study showed that the difference in baseline characteristics of different therapies in middle/high-risk AAA patients was not statistically significant in preoperative period (P > 0.05). In intraoperative period, the efficacy of middle/high-risk AAA patients in EVAR group was significantly superior to OSR group in terms of blood loss, blood transfusion, and general anesthesia rate (all P < 0.01). In perioperative period, the ICU observation time and the average fasting time of middle/high-risk AAA patients in EVAR group were remarkably lower than OSR group (all P < 0.01), but the average hospital stay and the operation cost of middle/high-risk AAA patients in EVAR group were notably higher than OSR group. In postoperative follow-up period, OSR group was identified with a lower incidence of surgery-related complications than EVAR group (P < 0.05), but EVAR group was demonstrated with a higher survival rate than OSR group (P < 0.05); after 12 months of follow-up, SF-36 scale scores in OSR group were higher than EVAR group (P < 0.05). In conclusion, EVAR may have a better short-term effect, whereas OSR may have a better long-term effect in the treatment of middle/high-risk AAA patients. PMID:26295612

  2. Successful staged management of simultaneous abdominal aortic aneurysm and renal tumor: the novel minimally invasive treatment with endovascular aneurysm repair and retroperitoneal laparoscopic radical nephrectomy in an elderly and high-risk case

    Science.gov (United States)

    Kira, Satoru; Sawada, Norifumi; Kudou, Shouji; Zakoji, Hidenori; Kaga, Shigeaki; Matsumoto, Masahiko; Takeda, Masayuki

    2012-01-01

    The association between abdominal aortic aneurysm (AAA) and renal tumor is becoming more frequent, and the increasing incidence of this synchronous diseases raised questions about the procedures of treatment. In most of the previous cases, open nephrectomy and AAA surgery have been reported, however in high risk and elderly patients, the procedure is life threatening. We present a successful staged treatment of AAA and renal tumor using novel minimally invasive treatment with endovascular aneurysm repair and retroperitoneal laparoscopic radical nephrectomy in an elderly and high-risk case. PMID:24765444

  3. Successful staged management of simultaneous abdominal aortic aneurysm and renal tumor: the novel minimally invasive treatment with endovascular aneurysm repair and retroperitoneal laparoscopic radical nephrectomy in an elderly and high-risk case

    Directory of Open Access Journals (Sweden)

    Satoru Kira

    2012-04-01

    Full Text Available The association between abdominal aortic aneurysm (AAA and renal tumor is becoming more frequent, and the increasing incidence of this synchronous diseases raised questions about the procedures of treatment. In most of the previous cases, open nephrectomy and AAA surgery have been reported, however in high risk and elderly patients, the procedure is life threatening. We present a successful staged treatment of AAA and renal tumor using novel minimally invasive treatment with endovascular aneurysm repair and retroperitoneal laparoscopic radical nephrectomy in an elderly and high-risk case.

  4. Evaluation of the proximal aortic neck enlargement following endovascular repair of abdominal aortic aneurysm: 3-years experience

    Energy Technology Data Exchange (ETDEWEB)

    Napoli, Vinicio; Bargellini, Irene; Petruzzi, Pasquale; Cioni, Roberto; Vignali, Claudio; Bartolozzi, Carlo [Division of Diagnostic and Interventional Radiology, Department of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa, Via Roma 67, 56126, Pisa (Italy); Sardella, Savino G.; Ferrari, Mauro [Division of Vascular Surgery, Cisanello Hospital, Pisa (Italy)

    2003-08-01

    The aim of this study was to evaluate incidence, potential risk factors and effects on stent-graft migration of proximal neck dilatation after endoluminal repair of abdominal aortic aneurysm (EVAR), and the role of ultrasound (US) in detecting neck enlargement. From November 1998 to October 2001, 90 patients underwent EVAR. On follow-up, US and CT angiography (CTA) were performed, and diameters of the suprarenal and infrarenal aortic necks were monitored. Incidence of significant neck enlargement ({>=}2.5 mm) and distal stent-graft migration (>10 mm) was calculated. Several factors were evaluated as predictive of neck enlargement. Ultrasound and CTA measurements were compared. The US and CTA examinations were available in 68, 39, and 11 patients at 1, 2, and 3 years follow-up (mean follow-up 15 months). Incidence of significant neck dilatation was 21.8% at the infrarenal level (13, 33, and 36% at 1, 2, and 3 years follow-up) and 13.8% at the suprarenal level (9, 18, and 27% at 1, 2, and 3 years follow-up). Significant stent-graft migration occurred in 14 of 87 patients (16%) and was associated with neck dilatation in 8 (2 suprarenal and 6 infrarenal). No risk factors were identified. Ultrasound was less accurate than CT in measuring neck diameter, in particular at the suprarenal level. Proximal aortic neck enlargement occurs in up to 30% of patients after EVAR and represents the main risk factor for stent-graft migration. The risk of infrarenal neck dilatation is higher at 2 years follow-up, whereas the suprarenal neck enlarges later. Ultrasound is not useful in monitoring neck diameter. (orig.)

  5. Evaluation of the proximal aortic neck enlargement following endovascular repair of abdominal aortic aneurysm: 3-years experience

    International Nuclear Information System (INIS)

    The aim of this study was to evaluate incidence, potential risk factors and effects on stent-graft migration of proximal neck dilatation after endoluminal repair of abdominal aortic aneurysm (EVAR), and the role of ultrasound (US) in detecting neck enlargement. From November 1998 to October 2001, 90 patients underwent EVAR. On follow-up, US and CT angiography (CTA) were performed, and diameters of the suprarenal and infrarenal aortic necks were monitored. Incidence of significant neck enlargement (?2.5 mm) and distal stent-graft migration (>10 mm) was calculated. Several factors were evaluated as predictive of neck enlargement. Ultrasound and CTA measurements were compared. The US and CTA examinations were available in 68, 39, and 11 patients at 1, 2, and 3 years follow-up (mean follow-up 15 months). Incidence of significant neck dilatation was 21.8% at the infrarenal level (13, 33, and 36% at 1, 2, and 3 years follow-up) and 13.8% at the suprarenal level (9, 18, and 27% at 1, 2, and 3 years follow-up). Significant stent-graft migration occurred in 14 of 87 patients (16%) and was associated with neck dilatation in 8 (2 suprarenal and 6 infrarenal). No risk factors were identified. Ultrasound was less accurate than CT in measuring neck diameter, in particular at the suprarenal level. Proximal aortic neck enlargement occurs in up to 30% of patients after EVAR and represents the main risk factor for stent-graft migration. The risk of infrarenal neck dilatation is higher at 2 years follow-up, whereas the suprarenal neck enlarges later. Ultrasound is not useful in monitoring neck diameter. (orig.)

  6. Fluid-structure interaction of a patient-specific abdominal aortic aneurysm treated with an endovascular stent-graft.

    LENUS (Irish Health Repository)

    Molony, David S

    2009-01-01

    BACKGROUND: Abdominal aortic aneurysms (AAA) are local dilatations of the infrarenal aorta. If left untreated they may rupture and lead to death. One form of treatment is the minimally invasive insertion of a stent-graft into the aneurysm. Despite this effective treatment aneurysms may occasionally continue to expand and this may eventually result in post-operative rupture of the aneurysm. Fluid-structure interaction (FSI) is a particularly useful tool for investigating aneurysm biomechanics as both the wall stresses and fluid forces can be examined. METHODS: Pre-op, Post-op and Follow-up models were reconstructed from CT scans of a single patient and FSI simulations were performed on each model. The FSI approach involved coupling Abaqus and Fluent via a third-party software - MpCCI. Aneurysm wall stress and compliance were investigated as well as the drag force acting on the stent-graft. RESULTS: Aneurysm wall stress was reduced from 0.38 MPa before surgery to a value of 0.03 MPa after insertion of the stent-graft. Higher stresses were seen in the aneurysm neck and iliac legs post-operatively. The compliance of the aneurysm was also reduced post-operatively. The peak Post-op axial drag force was found to be 4.85 N. This increased to 6.37 N in the Follow-up model. CONCLUSION: In a patient-specific case peak aneurysm wall stress was reduced by 92%. Such a reduction in aneurysm wall stress may lead to shrinkage of the aneurysm over time. Hence, post-operative stress patterns may help in determining the likelihood of aneurysm shrinkage post EVAR. Post-operative remodelling of the aneurysm may lead to increased drag forces.

  7. Fluid-structure interaction of a patient-specific abdominal aortic aneurysm treated with an endovascular stent-graft

    Directory of Open Access Journals (Sweden)

    McGloughlin Tim M

    2009-10-01

    Full Text Available Abstract Background Abdominal aortic aneurysms (AAA are local dilatations of the infrarenal aorta. If left untreated they may rupture and lead to death. One form of treatment is the minimally invasive insertion of a stent-graft into the aneurysm. Despite this effective treatment aneurysms may occasionally continue to expand and this may eventually result in post-operative rupture of the aneurysm. Fluid-structure interaction (FSI is a particularly useful tool for investigating aneurysm biomechanics as both the wall stresses and fluid forces can be examined. Methods Pre-op, Post-op and Follow-up models were reconstructed from CT scans of a single patient and FSI simulations were performed on each model. The FSI approach involved coupling Abaqus and Fluent via a third-party software - MpCCI. Aneurysm wall stress and compliance were investigated as well as the drag force acting on the stent-graft. Results Aneurysm wall stress was reduced from 0.38 MPa before surgery to a value of 0.03 MPa after insertion of the stent-graft. Higher stresses were seen in the aneurysm neck and iliac legs post-operatively. The compliance of the aneurysm was also reduced post-operatively. The peak Post-op axial drag force was found to be 4.85 N. This increased to 6.37 N in the Follow-up model. Conclusion In a patient-specific case peak aneurysm wall stress was reduced by 92%. Such a reduction in aneurysm wall stress may lead to shrinkage of the aneurysm over time. Hence, post-operative stress patterns may help in determining the likelihood of aneurysm shrinkage post EVAR. Post-operative remodelling of the aneurysm may lead to increased drag forces.

  8. Techniques in Endovascular Aneurysm Repair

    Science.gov (United States)

    Phade, Sachin V.; Garcia-Toca, Manuel; Kibbe, Melina R.

    2011-01-01

    Endovascular repair of infrarenal abdominal aortic aneurysms (EVARs) has revolutionized the treatment of aortic aneurysms, with over half of elective abdominal aortic aneurysm repairs performed endoluminally each year. Since the first endografts were placed two decades ago, many changes have been made in graft design, operative technique, and management of complications. This paper summarizes modern endovascular grafts, considerations in preoperative planning, and EVAR techniques. Specific areas that are addressed include endograft selection, arterial access, sheath delivery, aortic branch management, graft deployment, intravascular ultrasonography, pressure sensors, management of endoleaks and compressed limbs, and exit strategies. PMID:22121487

  9. The Impact of Body Mass Index on Perioperative Outcomes of Open and Endovascular Abdominal Aortic Aneurysm Repair from the National Surgical Quality Improvement Program 2005–2007

    Science.gov (United States)

    Giles, Kristina A; Wyers, Mark C; Pomposelli, Frank B; Hamdan, Allen D; Ching, Y Avery; Schermerhorn, Marc L

    2010-01-01

    OBJECTIVES Obesity and morbid obesity have been shown to increase wound infections and occasionally mortality after many surgical procedures. Little is known about the relative impact of body mass index on these outcomes after open (OAR) and endovascular abdominal aortic aneurysm repair (EVAR). METHODS The 2005–2007 National Surgical Quality Improvement Program (NSQIP), a multi-institutional risk-adjusted database, was retrospectively queried to compare perioperative mortality (in-hospital or 30-day) and postoperative wound infections after OAR and EVAR. Patient demographics, comorbidities, and operative details were analyzed. Body mass index (BMI) was calculated from height and weight variables and definitions of obesity and morbid obesity were defined as BMI > 30kg/m2 and BMI > 40kg/m2 respectively. Student's T-test, Wilcoxon Rank Sum, Chi-square, and multivariate logistic regression were used to compare outcomes. RESULTS There were 2,097 OAR and 3,358 EVAR. Compared to EVAR, OAR patients were younger, more likely to be female (26% vs. 17%, P < .001), and less obese (27% vs. 32%, P < .001). Mortality was 3.7% vs. 1.2% after OAR vs. EVAR respectively (RR 3.1, P < .001) and overall morbidity was 28% vs. 12% (RR 2.3, P < .001). Morbidly obese patients had a higher mortality for both OAR (7.3%) and EVAR (2.4%) than obese patients (3.9% OAR; 1.5% EVAR) or non-obese patients (3.7% OAR; 1.1% EVAR). Obese patients had a higher rate of wound infection vs. non-obese after open repair (6.3% vs. 2.4%, P < .001) and EVAR (3.3% vs. 1.5%, P < .001). Morbid obesity predicted mortality after OAR but not EVAR and obesity was an independent predictor of wound infection after OAR and EVAR. CONCLUSIONS Morbid obesity confers a worse outcome for mortality after AAA repair. Obesity is also a risk factor for infectious complications after OAR and EVAR. Obese patients and particularly morbidly obese patients should be treated with EVAR when anatomically feasible. PMID:20843627

  10. Abdominal aortic aneurysm

    OpenAIRE

    SakalihasanN, Natzi; Limet, Raymond; Defawe, O. D.

    2000-01-01

    Abdominal aortic aneurysms cause 1.3% of all deaths among men aged 65-85 years in developed countries. These aneurysms are typically asymptomatic until the catastrophic event of rupture. Repair of large or symptomatic aneurysms by open surgery or endovascular repair is recommended, whereas repair of small abdominal aortic aneurysms does not provide a significant benefit. Abdominal aortic aneurysm is linked to the degradation of the elastic media of the atheromatous aorta. An inflammatory cell...

  11. Uso del pericardio porcino tratado con gluteraldehido en el tratamiento de los defectos de la pared abdominal: estudio experimental en ratas / Using porcine pericardio gluteraldehyde treated in the treatment of abdominal wall defects: an experimental study in rats

    Scientific Electronic Library Online (English)

    Mario Marcelino, More Flores; Edith, Paz Carrillo; Flor Ángel, Cruz Chávez.

    2013-10-01

    Full Text Available Introducción: El tratamiento quirúrgico del onfalocele y gastrosquísis gigante, plantea un tratamiento complementario con parches protésicos sintéticos que son eliminados a los siete a doce días de haberse aplicado Objetivos: El objetivo del presente trabajo fue determinar la utilidad de un parche d [...] e pericardio porcino tratada con glutaraldehido 1%, aplicado quirúrgicamente sobre un defecto de la pared abdominal. Material y Métodos: El estudio de tipo experimental se llevó a cabo en el Servicio de Cirugía Experimental del Instituto Nacional de Salud del El pericardio porcino obtenido en forma estéril y fue tratado con gluteraldehido al 1 %. Los animales fueron anestesiados con una combinación de ketamina 50mg /kilo y Xilascina a razón de 12 mgs /kilo IM Atropina 0.2 mgs / Kilo IM. Usando una técnica quirúrgica aséptica. Se les resecó, de 1x 3 cms de pared, en la zona media del abdomen, aplicándoles luego un parche de pericardio 1,5 cm. por 3 cm. la cual, se fijó a los bordes del defecto. Resultados: Cuatro animales murieron y 26 sobrevivieron hasta los 30 días. Se observó Cierre de la herida en primera intención en 22 ratas (84,65 % ), integración del parche a la pared abdominal. Hubieron 4 evisceraciones (13,3 %) y 2 eventraciones (6,6 %) Conclusiones: El parche de porcino tratado con glutaraldehido al 1 %, ha tenido un efecto curativo de los efectos de la pared abdominal en ratas, caracterizado por cierre de la herida en primera intención, integración del parche a la pared abdominal y escasas complicaciones. Abstract in english Introduction: In the Surgical treatment of giant omphalocele and gastroschisis and recommended the complementary treatment with prosthetic synthetic patch in order to prevent the compartmental syndrome. But this prosthetic materials are get out seven a twelve days post surgery. Objectives: This stud [...] y has the goal to determinate the usefulness of a porcine pericardium treated with 1 % glutaraldehyde , surgically applied on a defect in the abdominal wall. Matrial and method: The study was carry on in Experimental Surgery Unit at the National Child Hospital , we've had 30 rats Holtzmann with weights between 200 and 300 grams. The porcine pericardium sterile obtained was treated with 1% glutaraldehyde. The animals were anesthesied with ketamine 50 mg/ kg and Xilascina 12 mgs/kg IM Atropine 0.2 mgs/Kilo IM. Using sterile surgical technical a rectangular area of 3 x 1 centimeter of the abdominal wall was resected. A similar patch of the porcine pericardium was fixed on the defect with vycril5 (0). Later the skin was sutured on the pericardium..The rats remain lives during 30 days. Results: We had 4 animals death for due evisceration 26 rats survived. In 22 animals, the chirurgical wound was close in first intention 100 % of live animals was observed permanence of the pericardium and the integration of the patch to the abdominal wall. Conclusion: The porcine pericardical patch was curative effect on the abdominal wall defect of the experimental animals. With some mild complications.

  12. Tratamiento endovascular del aneurisma de aorta descendente en el adolescente con síndrome de Marfan: Reporte de un caso / Endovascular treatment of an aneurysm of the descending aorta in an adolescent with Marfan syndrome

    Scientific Electronic Library Online (English)

    Juan G, Barrera; Camilo, Espinel; Jaime, Amarillo; Víctor R, Castillo; Antonio, Figueredo; Javier, Gentile; Walter, Mosquera; Sebastián, Balestrini; Leonardo, Salazar; Adriana S, Murcia.

    2012-01-01

    Full Text Available Se expone el caso de un adolescente de 14 años de edad, con síndrome de Marfan y antecedente de tres cirugías cardiovasculares previas: valvuloplastia aórtica y mitral a los cinco años y valvuloplastia aórtica y reconstrucción de la aorta torácica con tubo de pericardio bovino a sus diez años. En pr [...] imer tiempo quirúrgico se realizó reemplazo valvular aórtico por válvula mecánica y valvuloplastia mitral y tricuspidea, y en segundo tiempo quirúrgico, durante la misma hospitalización, exclusión endovascular de aneurisma de aorta descendente asintomático sin complicaciones. Antes del egreso se diagnosticó una endofuga tipo II que se manejó con observación clínica. Luego de un año del procedimiento, los controles clínico y tomográfico son satisfactorios. Abstract in english We describe the case of a 14-year-old adolescent with Marfan syndrome and a history of three previous cardiovascular surgeries: aortic and mitral valve replacement at the age of 5 and aortic valve replacement and reconstruction of the thoracic aorta with a tube of bovine pericardium at the age of te [...] n. In the first surgical procedure the aortic valve was replaced by a mechanical valve, and mitral and tricuspid valvuloplasty was performed. In a second surgical procedure during the same hospitalization, endovascular exclusion of the asymptomatic descending aortic aneurysm was realized without complications. Before discharge, a type II endoleak was diagnosed and managed through clinical observation. After a year of the procedure, clinical and tomographic controls are satisfactory.

  13. Tratamiento endovascular del aneurisma de aorta descendente en el adolescente con síndrome de Marfan: Reporte de un caso Endovascular treatment of an aneurysm of the descending aorta in an adolescent with Marfan syndrome

    Directory of Open Access Journals (Sweden)

    Juan G Barrera

    2012-01-01

    Full Text Available Se expone el caso de un adolescente de 14 años de edad, con síndrome de Marfan y antecedente de tres cirugías cardiovasculares previas: valvuloplastia aórtica y mitral a los cinco años y valvuloplastia aórtica y reconstrucción de la aorta torácica con tubo de pericardio bovino a sus diez años. En primer tiempo quirúrgico se realizó reemplazo valvular aórtico por válvula mecánica y valvuloplastia mitral y tricuspidea, y en segundo tiempo quirúrgico, durante la misma hospitalización, exclusión endovascular de aneurisma de aorta descendente asintomático sin complicaciones. Antes del egreso se diagnosticó una endofuga tipo II que se manejó con observación clínica. Luego de un año del procedimiento, los controles clínico y tomográfico son satisfactorios.We describe the case of a 14-year-old adolescent with Marfan syndrome and a history of three previous cardiovascular surgeries: aortic and mitral valve replacement at the age of 5 and aortic valve replacement and reconstruction of the thoracic aorta with a tube of bovine pericardium at the age of ten. In the first surgical procedure the aortic valve was replaced by a mechanical valve, and mitral and tricuspid valvuloplasty was performed. In a second surgical procedure during the same hospitalization, endovascular exclusion of the asymptomatic descending aortic aneurysm was realized without complications. Before discharge, a type II endoleak was diagnosed and managed through clinical observation. After a year of the procedure, clinical and tomographic controls are satisfactory.

  14. Changes in abdominal aortic aneurysm size after endovascular repair with Zenith, AneuRx, and custom-made stent-grafts.

    Science.gov (United States)

    Neuhauser, Beate; Oldenburg, W Andrew; Hakaim, Albert G

    2004-07-01

    The aim of this study was to determine the maximal aneurysm diameter (MAD), the total aneurysm volume (TAV), the intra-aneurysm vascular channel (IAVC), and total thrombus volume (TTV) and compare changes in those parameters during a 12-month time period. In addition, these parameters for three different endovascular grafts were compared. A retrospective review of 42 patients who had undergone endovascular aneurysm repair (EVAR) between July 1999 and March 2001, and without evidence of an endoleak or migration, was performed. The minimum follow-up in this group was 12 months. The three grafts deployed were Dacron-stainless steel bifurcated grafts with suprarenal fixation [Zenith; Cook, Inc. (n = 14)], Dacron stainless steel aorto uni-iliac grafts with suprarenal fixation [custom-made (n = 10)], and externally supported Dacron nitinol bifurcated grafts [AneuRx; Medtronic, Inc. (n = 18)]. Volumetric measurements were obtained from CT images performed preoperatively, at 1 month and 12 months thereafter, using a 3-D Magicview 1000 workstation (Siemens, Inc.). Regardless of the type of endograft, a significant change in MAD and TAV (P = 0.008), IAVC (P = 0.031), and TTV (P = 0.001) was observed over the 12-month postoperative period. Both maximum diameter and total aneurysm volume appear to reflect accurately successful aneurysm exclusion. We conclude that both two-dimensional, maximal aneurysm diameter and three-dimensional, total aneurysm volume accurately reflect changes in morphology after endovascular aneurysm repair. PMID:15279189

  15. Innovador tratamiento de heridas abdominales complejas mediante terapia de presión negativa con instilación intermitente / Novel treatment of complex abdominal wounds with negative pressure therapy with intermittent instillation

    Scientific Electronic Library Online (English)

    A., García-Ruano; S., García-Fernández; S., Mahedero-Navarrete; J. M., Lasso-Vázquez; R., Pérez-Cano.

    2013-09-01

    Full Text Available Describimos nuestra experiencia en el tratamiento de heridas abdominales postquirúrgicas dehiscentes y contaminadas con exposición de material protésico, mediante terapia de presión negativa con instilación intermitente de soluciones tópicas. Este dispositivo nos permitió el rescate de pacientes plu [...] ripatológicos evitando una reintervención compleja de alta morbi-mortalidad y facilitando el cierre de la herida, además con conservación de la malla en la mayor parte de los casos. Abstract in english The present data reports our experience in the treatment of postsurgical dehiscent and infected abdominal wounds with exposure of prosthetic material with negative pressure therapy with intermittent instillation of topical solutions. This device allowed the rescue of pluripatological patients avoidi [...] ng a complex resurgery of high morbi-mortality and facilitating wound closure, besides with conservation of the mesh in most of the cases.

  16. [Endovascular prostheses and extra-anatomical bypasses to mesenteric and renal vessels in a patient with a thoraco-abdominal aortic aneurysm: a possible alternative to the standard operation].

    Science.gov (United States)

    van Engeland, M I A; Visser, M J T; de Vries, C; Vahl, A C

    2007-03-24

    A 57-year-old male had a thoraco-abdominal aortic aneurysm that was increasing in diameter, accompanied by pain in the right lower abdomen and groin. Ten years earlier he had had a dissecting thoraco-abdominal aneurysm that extended from the left subclavian artery to the aortic bifurcation. A CT-scan revealed further growth of the aneurysm. He was treated by an open and an endovascular operation. The distal aorta was replaced by a bifurcation prosthesis via a laparotomy, with 2 other bifurcation prostheses to 2 mesenteric and 2 renal arteries. In a second session, a carotid-subclavian bypass was constructed and the aorta was reinforced by an endograft from the left subclavian artery to the bifurcation prosthesis. Postoperatively he suffered a transient ischaemic attack, hypertension, pneumonia, and vocal cord paresis. At follow-up 1.5 years later, the patient was free of symptoms, with the exception of slight hoarseness during forced speech, and the aneurysm was totally under control. This procedure may be an alternative to the classical thoracophrenicolaparotomy. PMID:17447598

  17. Existen ventajas en el abordaje extraperitoneal para el tratamiento del aneurisma de aorta abdominal? Are there advantages in the extraperitoneal approach for the treatment of abdominal aortic aneurysm?

    Directory of Open Access Journals (Sweden)

    Heinz Hiller

    2010-02-01

    Full Text Available Existen controversias acerca de las posibles ventajas del abordaje transperitoneal vs. extraperitoneal en la cirugía de aneurisma de aorta abdominal; con este último, algunos estudios reportan menor morbilidad y complicaciones operatorias. Este estudio describe los resultados que se obtuvieron con los dos abordajes en un solo centro de referencia. Es un estudio retrospectivo, descriptivo, de doce años, en un grupo de 299 pacientes con diagnóstico de aneurisma de aorta abdominal que fueron intervenidos de manera electiva y distribuidos en dos grupos según el abordaje (transperitoneal = grupo 1, extraperitoneal = grupo 2. En total se operaron 93 pacientes en el grupo 1 y 206 pacientes en el 2. En ambos predominaron pacientes del sexo masculino. La edad media fue de 68 años. Las frecuencias de co-morbilidades fueron similares en los dos grupos. Se registró una tendencia a menor número de reoperaciones en el grupo 2 (12,9% vs. 5,8%, De otra parte, se observó una tendencia de mayores complicaciones post-operatorias en el grupo 1 con una frecuencia de 30,1% vs. 12,6% en el grupo 2; sin embargo, el tipo de complicaciones fue similar. Los resultados mostraron una estancia hospitalaria media de 13,3 días (DE ± 10,4 vs. 7,19 días (DE ± 4,20 p= 0,00001, estancia post-operatoria media de 9,16 días (DE ± 8,1 vs. 5,62 días (DE ± 3,46 p= 0,001 y estancia en la unidad de cuidados intensivos media de 2,76 días (DE ± 4,19 vs. 1,56 días (DE ± 1,86 p= 0,00001 en los grupos 1 y 2 respectivamente. La mortalidad inmediata total fue de 3,3%. La frecuencia de mortalidad para los grupos fue de 6,5% (n= 6 vs. 1,9% (n= 4 respectivamente. En nuestra experiencia el abordaje por la vía extraperitoneal presenta una tendencia favorable para los pacientes en cuanto a la estancia hospitalaria, la estancia en la unidad de cuidados intensivos, la frecuencia de complicaciones post-operatorias y la frecuencia de re-intervenciones en el post-operatorio inmediato. Debido al tamaño de la muestra no puede concluirse que hubo una diferencia estadísticamente significativa en cuanto a la mortalidad; sin embargo se observó una tendencia a la reducción de la misma con el abordaje extraperitoneal.There are current controversies over the benefits of the extraperitoneal vs the transperitoneal approach for repairing an infrarenal abdominal aortic aneurysm. Several studies report a reduction in morbidity and mortality with the former approach. This study reports the short term results using both approaches at one reference center. This is a 12 year, retrospective descriptive study of 299 patients who underwent an elective open repair of an abdominal aortic aneurysm, distributed in two groups: transperitoneal approach group=1, extraperitoneal approach group=2. A total of 93 patients in group 1 and 206 in group 2 were intervened, mainly male patients with an median age of 68 years. The frequencies of co-morbidities were similar in both groups. There was a reduced tendency of reoperations in group 2 (12.9%vs 5.8%, and a greater tendency of postoperative complications in group 1 (30.1% vs 12.6%. However, the types complications were similar. The results show a median hospital stay of 13.3 days (SD+- 10,4 vs. 7.19 days (SD+- 4.20 p=0.00001, median post-operative stay of 9.16 days (SD-+ 8,1 vs. 5.62 days (SD+- 3,46 p= 0.001 and median intensive unit stay of 2.76 days (SD+-4.19 vs 1.56 days (SD+-1.86 p=0.00001 in group 1 y 2 respectively. Early global mortality was 3.3% with a distribution frequency of 6.5% (n=6 in group 1 and 1.9% (n=4 in group 2. In our experience, the extraperitoneal approach offers better results regarding hospital, postoperative and intensive care unit stay, as well as post-operative re-operation rates and complications. Because of the small sample size, the mortality difference was not statistically significant; however, we found an important tendency towards improved mortality rates with this approach.

  18. Existen ventajas en el abordaje extraperitoneal para el tratamiento del aneurisma de aorta abdominal? / Are there advantages in the extraperitoneal approach for the treatment of abdominal aortic aneurysm?

    Scientific Electronic Library Online (English)

    Heinz, Hiller; Jaime, Camacho; Julián, Moreno.

    2010-02-01

    Full Text Available Existen controversias acerca de las posibles ventajas del abordaje transperitoneal vs. extraperitoneal en la cirugía de aneurisma de aorta abdominal; con este último, algunos estudios reportan menor morbilidad y complicaciones operatorias. Este estudio describe los resultados que se obtuvieron con l [...] os dos abordajes en un solo centro de referencia. Es un estudio retrospectivo, descriptivo, de doce años, en un grupo de 299 pacientes con diagnóstico de aneurisma de aorta abdominal que fueron intervenidos de manera electiva y distribuidos en dos grupos según el abordaje (transperitoneal = grupo 1, extraperitoneal = grupo 2). En total se operaron 93 pacientes en el grupo 1 y 206 pacientes en el 2. En ambos predominaron pacientes del sexo masculino. La edad media fue de 68 años. Las frecuencias de co-morbilidades fueron similares en los dos grupos. Se registró una tendencia a menor número de reoperaciones en el grupo 2 (12,9% vs. 5,8%), De otra parte, se observó una tendencia de mayores complicaciones post-operatorias en el grupo 1 con una frecuencia de 30,1% vs. 12,6% en el grupo 2; sin embargo, el tipo de complicaciones fue similar. Los resultados mostraron una estancia hospitalaria media de 13,3 días (DE ± 10,4) vs. 7,19 días (DE ± 4,20) p= 0,00001, estancia post-operatoria media de 9,16 días (DE ± 8,1) vs. 5,62 días (DE ± 3,46) p= 0,001 y estancia en la unidad de cuidados intensivos media de 2,76 días (DE ± 4,19) vs. 1,56 días (DE ± 1,86) p= 0,00001 en los grupos 1 y 2 respectivamente. La mortalidad inmediata total fue de 3,3%. La frecuencia de mortalidad para los grupos fue de 6,5% (n= 6) vs. 1,9% (n= 4) respectivamente. En nuestra experiencia el abordaje por la vía extraperitoneal presenta una tendencia favorable para los pacientes en cuanto a la estancia hospitalaria, la estancia en la unidad de cuidados intensivos, la frecuencia de complicaciones post-operatorias y la frecuencia de re-intervenciones en el post-operatorio inmediato. Debido al tamaño de la muestra no puede concluirse que hubo una diferencia estadísticamente significativa en cuanto a la mortalidad; sin embargo se observó una tendencia a la reducción de la misma con el abordaje extraperitoneal. Abstract in english There are current controversies over the benefits of the extraperitoneal vs the transperitoneal approach for repairing an infrarenal abdominal aortic aneurysm. Several studies report a reduction in morbidity and mortality with the former approach. This study reports the short term results using both [...] approaches at one reference center. This is a 12 year, retrospective descriptive study of 299 patients who underwent an elective open repair of an abdominal aortic aneurysm, distributed in two groups: transperitoneal approach group=1, extraperitoneal approach group=2. A total of 93 patients in group 1 and 206 in group 2 were intervened, mainly male patients with an median age of 68 years. The frequencies of co-morbidities were similar in both groups. There was a reduced tendency of reoperations in group 2 (12.9%vs 5.8%), and a greater tendency of postoperative complications in group 1 (30.1% vs 12.6%). However, the types complications were similar. The results show a median hospital stay of 13.3 days (SD+- 10,4) vs. 7.19 days (SD+- 4.20) p=0.00001, median post-operative stay of 9.16 days (SD-+ 8,1) vs. 5.62 days (SD+- 3,46) p= 0.001 and median intensive unit stay of 2.76 days (SD+-4.19) vs 1.56 days (SD+-1.86) p=0.00001 in group 1 y 2 respectively. Early global mortality was 3.3% with a distribution frequency of 6.5% (n=6) in group 1 and 1.9% (n=4) in group 2. In our experience, the extraperitoneal approach offers better results regarding hospital, postoperative and intensive care unit stay, as well as post-operative re-operation rates and complications. Because of the small sample size, the mortality difference was not statistically significant; however, we found an important tendency towards improved mortality rates with this approach.

  19. Tratamiento de los defectos congénitos de la pared abdominal (gastrosquisis y onfalocele en el Hospital Universitario San Vicente de Paúl, 1998-2006

    Directory of Open Access Journals (Sweden)

    Paula Jaramillo Gómez

    2008-11-01

    Full Text Available INTRODUCCIÓN: la gastrosquisis y el onfalocele son malformaciones neonatales de la pared abdominal que, a pesar de sus grandes diferencias, comparten el manifestarse por herniación de las vísceras intraabdominales a través de un defecto de la pared abdominal. Los niños con estas enfermedades se presentan como emergencias quirúrgicas que plantean un reto al cirujano tratante. Tienen una tasa de mortalidad que oscila entre 40 y 60% aun con el tratamiento apropiado y se asocian a un amplio rango de malformaciones, principalmente en los que tienen diagnóstico de onfalocele. El objetivo de la presente revisión retrospectiva fue describir el tratamiento y los resultados obtenidos en estos pacientes, entre 1998 y 2006, en el Servicio de Cirugía infantil del Hospital Universitario San Vicente de Paúl, de Medellín, Colombia. PACIENTES Y MÉTODOS: se evaluaron todos los pacientes que ingresaron al Servicio de Cirugía infantil del HUSVP con diagnóstico de gastrosquisis u onfalocele, entre el 1 de enero de 1998 y el 31 de diciembre de 2006. Se definió el tipo de tratamiento que se les realizó y, de acuerdo con este, se revisaron los resultados; las complicaciones posquirúrgicas, tales como la infección del sitio operatorio, evisceración, sepsis, íleus e hipertensión intraabdominal; el tiempo de inicio de la vía oral y de la nutrición parenteral total (NPT; la duración de la estancia en la unidad de cuidados intensivos y en el hospital. RESULTADOS: se identificaron 55 pacientes, 32 con gastrosquisis y 23 con onfalocele, todos ellos tratados quirúrgicamente. El tipo más frecuente de cirugía fue el cierre primario (56,4%; en cuanto al cierre por etapas, el procedimiento más utilizado fue el silo en 21,8% de los niños. En el 75,9% de los pacientes se presentó alguna complicación, más frecuentemente la sepsis, y cuando se evaluaron las complicaciones asociadas al procedimiento quirúrgico, el porcentaje fue similar para el cierre primario y el cierre por etapas. El inicio de la vía oral fue más temprano en los pacientes con cierre primario. Los pacientes con gastrosquisis requirieron mayor tiempo en la UCI y en el hospital. La tasa global de mortalidad fue del 29%, mayor en los pacientes con onfalocele.

  20. Endovascular treatment of hemoptysis: influence of the type of pathology on the post embolization prognosis; Tratamiento endovascular de la hemoptisis: influencia del tipo de patologia en el pronostico postembolizacion

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, J.; Fernandez, M.; Fernandez, A.; Duran, D.; Dominguez, L.; Boullosa, E. [Hospital Xeral de Vigo (Spain)

    2000-07-01

    To describe the course of patients with hemoptysis following embolization of the arteries involved, assessing the incidence of re bleeding in patients grouped according to type of pathology. Over the past five years, we have carried out 77 embolization in bronchial and other systemic arteries in 64 patients (46 men and 18 women) ranging in age from 18 to 83 years (mean: 54{+-}15 years). The underlying diseases were active tuberculosis (n=11), latent tuberculosis (n=15), bronchiectasis (n=14), aspergilloma (n=3), pulmonary neoplasm (n=10), lung abscess (n=10) and miscellaneous conditions (n=10). Rebleeding occurred in 25 patients (32%). Of these, 13 had to undergo repeat embolization, 7 were treated surgically and 3 died during the recurrence of hemoptysis. In two cases, no diseased arteries could be found and embolization was not performed. The overall hemostatic efficacy was 86% after 7 days, 78% after one month and 61% after one year. In the patients with tuberculosis, the rates were 96% at one week and 91% at one month and one year, while among the remaining groups (with neoplasm, abscess, etc.), the incidences were 80% at day 7,70% at one month and 42% at one year. According to our experience, rebleeding occurs most frequently among patients with diseases other than tuberculosis. In these cases, follow-up should be closer and other therapeutic alternatives (surgery, radiotherapy, endobronchial laser) should be considered as a complement to percutaneous endovascular treatment. (Author) 22 refs.

  1. Incidence of systemic inflammatory response syndrome after endovascular aortic repair

    DEFF Research Database (Denmark)

    De La Motte, L; Vogt, K; Jensen, Leif Panduro; Rasmussen, John Bøje Grønvall; Kehlet, H; Veith Schroeder, T; Lönn, L

    2011-01-01

    AIM: The aim of this study was to estimate the incidence of the post-implantation syndrome/systemic inflammatory response syndrome (SIRS) after endovascular aortic repair. METHODS: All patients, undergoing elective primary endovascular repair of an asymptomatic infrarenal abdominal aortic aneurysm...

  2. Aortic aneurysm repair - endovascular

    Science.gov (United States)

    EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... graft up into your aorta, to where the aneurysm is located. The doctor will open the stent ...

  3. To intervene or not? A man with multidrug-resistant hypertension, endovascular abdominal aneurysm repair, bilateral renal artery stenosis and end-stage renal disease salvaged with renal artery stenting.

    Science.gov (United States)

    Sarafidis, Pantelis A; Stavridis, Kyriakos C; Loutradis, Charalampos N; Saratzis, Athanasios N; Pateinakis, Panagiotis; Papagianni, Aikaterini; Efstratiadis, Georgios; Saratzis, Nicolaos

    2016-04-01

    We report the case of a 69-year-old man with uncontrolled multidrug-resistant secondary hypertension following a 10 year history of endovascular abdominal aortic aneurysm repair, with suprarenal fixation and concurrent angioplasty with stenting of the left renal artery for atherosclerotic renal disease, and progressive chronic kidney disease. Renal scintigraphy revealed complete loss of the right kidney's and severe reduction of the left kidney's perfusion and function. Following recent evidence and consultation with vascular surgeons regarding the technical difficulties of any procedure, escalation of antihypertensive treatment was initially chosen. Careful drug adjustments significantly improved but did not fully control blood pressure (BP); further, the patient experienced an acute ischaemic stroke and renal function deterioration towards end-stage renal disease within a few months. At this point, revascularization of the left renal artery coupled with three haemodialysis sessions to remove contrast media was justified as rescue therapy against permanent renal replacement therapy. Successful intervention achieved an immediate BP reduction, with BP fully controlled, despite a??>?70% decrease in antihypertensive treatment, while renal function improved at 6 months from 11.5 to 22 ml/min/1.73 m(2). Renal angioplasty confers undisputed benefits in BP control and nephroprotection, and should be offered without delay to patients with renovascular hypertension and/or ischaemic nephropathy. PMID:26581234

  4. Síndrome compartimental abdominal / Abdominal compartment syndrome

    Scientific Electronic Library Online (English)

    Misael, Guzmán Nápoles; Martha Esther, Larrea Fabra.

    2013-06-01

    Full Text Available Desde el siglo XIX se conocen los efectos negativos del aumento de la presión intraabdominal, pero no se le prestó la debida atención a este trastorno hasta la última década del pasado siglo y la primera del actual. En este artículo exponemos las definiciones de los términos presión intrabdominal, h [...] ipertensión intrabdominal y síndrome compartimental abdominal, que fueron tomadas por consenso y aprobadas por la World Society of the Abdominal Compartment Syndrome. En nuestro medio, para el diagnóstico de la hipertensión intrabdominal y del síndrome compartimental abdominal se requiere medir la presión intrabdominal, secundariamente la presión de perfusión abdominal y se deben correlacionar estos datos con signos de deterioro clínico en el paciente. Las medidas terapéuticas médicas en relación con el síndrome compartimental abdominal son limitadas; cuando este es sintomático la descompresión abdominal es el tratamiento ya establecido. Enfatizamos en que el diagnóstico temprano de la hipertensión intrabdominal y del síndrome compartimental abdominal contribuyen a disminuir el desarrollo de un síndrome de disfunción múltiple de órganos y por tanto a reducir la mortalidad en estos pacientes. Con el objetivo de actualizar los conocimientos sobre hipertensión intrabdominal y síndrome compartimental abdominal, su diagnóstico y tratamiento, realizamos una minuciosa revisión actualizada de diversos artículos referentes al síndrome compartimental abdominal, tanto en el ámbito nacional como internacional. Abstract in english The negative effects of increased intra-abdominal pressure are known since the XIX Century, but attention was not paid to this disorder until the last decade of the last century and the first decade of the present one. In this article, we state the definitions of the terms intra-abdominal pressure, [...] intra-abdominal hypertension, and abdominal compartment syndrome which were taken with consent and approved by the World Society of the Abdominal Compartment Syndrome. In our field, to get to a diagnosis of intra-abdominal hypertension and abdominal compartment syndrome, it is required to measure the intra-abdominal pressure and secondarily, the abdominal perfusion pressure; then, these data should be correlated with the signs of clinical deterioration of the patient. The medical therapeutic measures related to the abdominal compartment syndrome are limited, and when it is symptomatic, abdominal decompression is the established treatment. We want to make emphasis on the fact that the early diagnosis of intra-abdominal hypertension and abdominal compartment syndrome contribute to diminish the development of a multiple organ dysfunction syndrome, hence reducing mortality in these patients. With the aim of updating knowledge about intra-abdominal hypertension and abdominal compartment syndrome as well as their diagnosis and treatment, we carried out a detailed updated review of different articles regarding the abdominal compartment syndrome from both national and international scopes.

  5. Cirugía abierta versus cirugía endovascular en el tratamiento de la patología de la aorta torácica descendente

    Directory of Open Access Journals (Sweden)

    Mauricio Peláez

    2012-01-01

    Full Text Available Introducción: El reparo endovascular de la aorta torácica (REVAT se ha incrementado en el mundo en los últimos años con relación al abierto. Objetivo: Comparar los resultados clínicos del REVAT frente al reparo abierto en la Fundación Cardio Infantil (Bogotá, Colombia entre 2002 y 2011. Metodología: Análisis retrospectivo de la cohorte de pacientes sometidos a reparo abierto (grupo 1 en comparación de REVAT (grupo 2. En cada uno de los grupos se evaluó tiempo quirúrgico, tasa de morbilidad, mortalidad, reintervención y estancia hospitalaria. Resultados: Se incluyeron 57 pacientes en el análisis (26 % reparo abierto; 74 % REVAT. Se reintervinieron dos pacientes por endofugas tipo 1 en el grupo 2 y un caso por sangrado en el grupo 1. La mortalidad operatoria fue para el grupo 1 de 20 %, y para el grupo 2, de 2,3 %. El tiempo quirúrgico fue de 398 ± 180 min (grupo 1 versus 85,5 ± 35 min (grupo 2 (p = 0,0001 y el tiempo de estancia hospitalaria promedio fue de 9,8 días (grupo 1 y 5,3 días (grupo 2 [p = 0,01]. El tiempo promedio de seguimiento fue 4,8 ± 3,1 años. Conclusiones: El REVAT parece ofrecer menor morbilidad, mortalidad, tiempo quirúrgico y estancia hospitalaria respecto al reparo abierto, aunque las poblaciones de pacientes incluidos no fueron estrictamente comparables. Se requieren nuevos análisis en un diseño prospectivo, idealmente aleatorizado para documentar los beneficios a largo plazo de este tipo de reparo.

  6. Endovascular stent grafting: a review

    International Nuclear Information System (INIS)

    Endovascular stent grafts are intravascular devices composed of surgical graft material and a metallic frame, (Fig. 1). Their main application has been to treat aneurysms, but they have been used in vascular trauma and are being investigated for use in occlusive disease. Their advantage in treating aneurysms over conventional surgical treatment is that they are loaded into relatively small delivery systems (Fig. 2) and can be introduced to the area of interest from a remote site - usually the femoral artery. This avoids the morbidity of surgical exposure in difficult sites, such as the thoracic aorta, and lessens the cardiovascular stress to patients by eliminating the need to surgically cross-clamp the vessel being treated. The first description of abdominal aortic aneurysm exclusion by an endovascular stent graft was provided by Parodi and colleagues in 1991. Much of the early clinical experience in endovascular stent grafting was obtained from centres in Australia and Europe, and they are now reporting midterm follow-up data. There are now many centres in Canada and the United States involved in endovascular research and practice. (author)

  7. Ruptured abdominal aortic aneurysm.

    Science.gov (United States)

    Sachs, T; Schermerhorn, M

    2010-06-01

    Ruptured abdominal aortic aneurysm (AAA) continues to be one of the most lethal vascular pathologies we encounter. Its management demands prompt and efficient evaluation and repair. Open repair has traditionally been the mainstay of treatment. However, the introduction of endovascular techniques has altered the treatment algorithm for ruptured AAA in most major medical centers. We present recent literature and techniques for ruptured AAA and its surgical management. PMID:20668419

  8. Non-invasiv, Multi Detector Row (MDR) based Computational Fluid Dynamics (CFD) analysis of hemodynamics in infrarenal Abdominal Aortic Aneurysm (AAA) before and after endovascular repair; Blutflusssimulation mittels Computational-Fluid-Dynamics an aus CT-Daten rekonstruierten Aortenaneurysmata vor und nach Stent-Graft Implantation

    Energy Technology Data Exchange (ETDEWEB)

    Juchems, M.S.; Pless, D.; Fleiter, T.R.; Gabelmann, A.; Brambs, H.J.; Aschpoff, A J. [Ulm Univ. (Germany). Abt. fuer diagnostische Radiologie; Liewald, F. [Ulm Univ. (Germany). Abt. fuer Thorax-und Gefaesschirurgie

    2004-01-01

    Purpose: Simulation, description and analysis of dynamic pressure in infrarenal abdominal aortic aneurysms (AAA) before and after endovascular repair. Materials and Methods: During March 1996 and May 2001, 13 patients with AAA underwent endovascular treatment. The MDR-CT scans of these patients were used for the non-invasive analysis of the hemodynamics in the aorta with CFD software before and after endovascular repair. One pre-interventional and three post-interventional CT scans were analyzed for each patient. Results: Compared to the pre-interventional simulation, endovascular treatment led to an average dynamic pressure decrease of 1057 Pa in 10 of 13 patients. During the subsequent course, the median of the dynamic pressure decreased in 8 of 13 patients. Vulnerable regions initially identified as high-pressure regions, like the docking area or the second stent limb, adapted to the pressure in the surrounding tissue in the course of time. (orig.) [German] Ziel: Simulation, Beschreibung und Entwicklung dynamischer Druckverhaeltnisse auf die Aorten- bzw. Stentgraftwand im zeitlichen Verlauf vor und nach stentgestuetzter Ausschaltung infrarenaler Bauchaortenaneurysmata. Patienten und Methode: Zwischen Maerz 1996 und Mai 2001 wurden 13 Patienten mit einem infrarenalen Bauchaortenaneurysma einer transfemoralen Stent-Graft-Implantation unterzogen. Basierend auf Multi Detector Row (MDR) -CT Datensaetzen dieser 13 Patienten wurde mithilfe einer ''Computational Fluid Dynamics'' (CFD) Software eine Blutflusssimulation der abdominellen Aorta vor und nach Stentimplantation durchgefuehrt. Von jedem Patienten wurden Simulationen von einer prae- und drei postoperativen Follow-up CT-Serien erstellt. Ergebnisse: Die Stentimplantation fuehrte bei 10/13 Patienten zu einer Senkung des dynamischen Spitzendrucks um durchschnittlich 1057 Pa von der prae- zur postoperativen Untersuchung. Im weiteren Verlauf sank auch der Median des dynamischen Druckes bei 8/13 Patienten. Regionen mit erhoehten Druckwerten (sog. vulnerable Regionen), wie beispielsweise die des angedockten Stentschenkels, glichen sich im Verlauf der Zeit den Umgebungsdruecken an. (orig.)

  9. Endovascular Repair of Aortic Disease: A Venture Capital Perspective

    OpenAIRE

    Buchanan, Lucas W.; Stavropoulos, S. William; Resnick, Joshua B.; Solomon, Jeffrey

    2009-01-01

    Endovascular devices for the treatment of abdominal and thoracic aortic disease are poised to become the next $1 billion medical device market. A shift from open repair to endovascular repair, advances in technology, screening initiatives, and new indications are driving this growth. Although billion-dollar medical device markets are rare, this field is fraught with risk and uncertainty for startups and their venture capital investors. Technological hurdles, daunting clinical and regulatory t...

  10. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    International Nuclear Information System (INIS)

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula. All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered. Patients with cancer may only need treatment for the acute bleeding episode, and an endovascular approach has the advantage of low morbidity

  11. Intestinal infarction: A complication of endovascular therapy

    International Nuclear Information System (INIS)

    This report presents a rare case of intestinal infarction following endovascular therapy. A female patient who had undergone an internal carotid artery stenting procedure presented suddenly with abdominal pain. Radiological and clinical examinations at the time suggested a picture of intestinal ischaemia, in view of the patient's general conditions and co-existing morbidities surgical intervention was not considered to be an option. The patient died 4 days after the carotid stenting procedure, post-mortem examination revealed infarction of the ileum and caecum. The learning outcomes are if performing endovascular therapy in a patient with diffuse atherosclerotic disease early consideration of intestinal ischaemia should be given to any patient who presents with acute post-procedural abdominal pain

  12. Endovascular Management of Delayed Complete Graft Thrombosis After Endovascular Aneurysm Repair

    International Nuclear Information System (INIS)

    Graft thrombosis rates after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms vary widely in published series. When thrombosis does occur, it usually involves a single limb and occurs within 3 months of stent-graft insertion. If the entire endoprosthesis is thrombosed, treatment may be challenging because femoro-femoral crossover graft insertion is not an option and a greater volume of thrombus is present, thus making thrombolysis more difficult. We present two cases of delayed thrombosis after EVAR involving the entire stent-graft. These were successfully treated by a combined surgical and endovascular technique, and patency has been maintained in both cases to date.

  13. Abdominal Pain

    Science.gov (United States)

    ... and Recurrent or Functional Abdominal Pain (RAP or FAP) What is abdominal pain? Abdominal pain , or stomachache, ... recurrent abdominal pain (RAP) or functional abdominal pain (FAP)? If your health care provider has ruled out ...

  14. Preoperative endovascular embolization of a cerebellar hemangioblastoma

    Directory of Open Access Journals (Sweden)

    Almeida-Pérez Rafael

    2013-06-01

    Full Text Available Introduction: hemangioblastomas are benign tumors located in the cerebellum, whichaffect young adults predominantly. These injuries are recognized by its abundant vascularizationwhich makes difficult its resection.Clinical case: The experience in the endovascular treatment of a patient with a cerebellarhemangioblastoma is exposed, emphasizing in the technical considerations andnecessary materials to achieve a successful embolization.Conclusion: Endovascular embolization of tumour vessels facilitates its surgical resectiondue to it decreases the intraoperative hemorrhage and the possibilities of neurovascularinjuries, although its security profile has been questioned due to the risk ofunleashing intratumoral hemorrhage. Rev.cienc.biomed. 2013; 4(1: 170-173RESUMEN:Introducción: los hemangioblastomas son tumores benignos localizados con mayorfrecuencia en el cerebelo, que afectan predominantemente a los adultos jóvenes. Estaslesiones son reconocidas por su abundante vascularización, lo cual dificulta su resección.Caso clínico: se expone la experiencia en el tratamiento endovascular de una pacientecon un hemangioblastoma cerebeloso, destacando las consideraciones técnicas y losmateriales necesarios para lograr una embolización exitosa.Conclusión: la embolización endovascular de los vasos tumorales facilita su resecciónquirúrgica, debido a que disminuye el sangrado intraoperatorio y las probabilidades delesiones neurovasculares, aunque su perfil de seguridad ha sido cuestionado debidoal riesgo de desencadenar hemorragias intratumorales. Rev.cienc.biomed. 2013;4(1: 170-173

  15. Endovascular Management of Thoracic Aortic Aneurysms

    International Nuclear Information System (INIS)

    The overall survival of patients with thoracic aortic aneurysm (TAA) has improved significantly in the past few years. Endovascular treatment, proposed as an alternative to surgery, has been considered a therapeutic innovation because of its low degree of invasiveness, which allows the treatment of even high-surgical risk patients with limited complications and mortality. A major limitation is the lack of adequate evidence regarding long-term benefit and durability because follow-up has been limited to just a few years even in the largest series. The combination of endovascular exclusion with visceral branch revascularization for the treatment of thoraco-abdominal aortic aneurysms involving the visceral aorta has also been attempted. As an alternative, endografts with branches represent a technological evolution that allows treatment of complex anatomy. Even if only small numbers of patients and short follow-up are available, this technical approach, which has with limited mortality (<10%) and paraplegia rates, to expand endovascular treatment to TAA seems feasible. With improved capability to recognize proper anatomy and select clinical candidates, the choice of endovascular stent-graft placement may offer a strategy to optimize management and improve prognosis.

  16. Exclusión percutánea de seudoaneurisma aórtico abdominal traumático desde acceso braquial / Percutaneous exclusion of traumatic abdominal aortic pseudoaneurysm from a brachial approach

    Scientific Electronic Library Online (English)

    Ricardo, Gamboa; Raúl E, Ríos-Méndez; Raúl, Solernó; Federico, Giachello; Ángeles, Videla-Lynch; Ricardo A, Sarmiento.

    2012-03-01

    Full Text Available El seudoaneurisma aórtico abdominal (SAA) es una lesión infrecuente, se describe a la injuria traumática aórtica, como una de sus principales causas, tanto su ruptura como el tratamiento quirúrgico tienen alta morbimortalidad. Por ello, el tratamiento endovascular mediante embolización química o exc [...] lusión con dispositivos, ha surgido como tratamiento alternativo. Sin embargo, existen riesgos como la oclusión de vasos viscerales cercanos al cuello del defecto, embolización del material o ruptura aórtica. Por lo tanto, la elección del material y vía de abordaje, debe ser planeada cuidadosamente en cada caso. Comunicamos un paciente, a quien 10 años después de una herida abdominal por arma de fuego, se le diagnosticó un SAA de 17 x 13 cm, con cuello corto, originado cercanamente al ostium del tronco celíaco, formando un ángulo agudo con el eje aórtico. Realizamos la exclusión del mismo, con un dispositivo diseñado para el cierre de comunicación interauricular (CIA), utilizando el acceso braquial izquierdo, debido a la angulación del cuello del defecto. No hubo complicaciones, a las 72 horas se otorgó alta hospitalaria. El control tomográfico al mes, mostró el falso aneurisma de igual tamaño y sin flujo residual. A los cinco meses de seguimiento, la paciente permanece asintomática. Abstract in english Abdominal aortic pseudoaneurysm (AAP) is a rare lesion, although traumatic aortic injury is described as one of the main causes; both the rupture as the surgical treatment of the defect has high morbidity and mortality. Therefore, endovascular treatment either by chemical embolization or exclusion o [...] f defect with devices has emerged as an alternative treatment. However, there are risks such as occlusion of visceral vessels near the neck of the defect, embolization material or aortic rupture. Therefore, the choice of material and method of approach should be planned carefully in each case. We report a patient who ten years after abdominal wound frearm was diagnosed with AAP 17x13 cm, with short neck originated close to the ostium of the celiac trunk at an acute angle with the aortic axis. We perform the exclusion of the defect with a device designed for closing atrial septal defect from the left brachial access due to the angulation of the neck defect. There were no complications. At 72 hours was granted discharge. A month later, CT scan control showed the false aneurysm of equal size and no residual flow. The monitoring to date is five months and the patient remained asymptomatic.

  17. Percutaneous endovascular reconstruction with endovascular placement for isolated spontaneous dissection of the superior mesenteric artery

    International Nuclear Information System (INIS)

    Objective: To evaluate the safety and efficacy of percutaneous endovascular reconstruction with endovascular stent placement for isolated spontaneous dissection of the superior mesenteric artery. Methods: Five patients with isolated spontaneous dissection of the superior mesenteric artery were enrolled in this study. The diagnosis was confirmed by abdominal computed tomography angiography (CTA) and percutaneous transcatheter digital subtraction angiography (DSA) in all the five patients. One asymptomatic case was discovered by medical examination, which was classified to type ? (Sakamoto angiographic categorization). The other four cases were admitted to hospital with acute abdominal pain and diarrhea, which were classified to type ? (1 case) and type ? (3 cases). Fasting together with antiplatelet and anticoagulation therapy was initially employed. Then, percutaneous endovascular reconstruction with stenting was carried out and the patients were kept on antiplatelet therapy. Follow-up checkups with CTA or DSA were conducted at 1, 3 and 6 months after the treatment. Results: Technical success was achieved in all five patients without any complications. Combination of the coil embolization and endovascular stent placement were preformed in 2 cases. The other 3 cases were successfully treated with simple double-stent placement. The clinical symptoms in the four symptomatic patients disappeared within 3 weeks. Follow-up CTA or DSA was adopted in 5 patients. Repeated angiography performed at 3 months after the procedure showed that complete resolution of the dissection and successful restoration of the true lumen with sufficient distal flow of the SMA were obtained in five patients. Conclusion: Percutaneous endovascular reconstruction with stent placement is a feasible and effective treatment for isolated spontaneous dissection of the superior mesenteric artery. (authors)

  18. Bilateral paramedian thalamic and mesencephalic infarcts after basilar tip aneurysm coiling: role of the artery of Percheron / Infarto talámico paramedial bilateral y mesencefálico después del tratamiento endovascular de un aneurisma de la punta de la arteria basilar: rol de la arteria de Percheron

    Scientific Electronic Library Online (English)

    L., Rangel-Castilla; J., Gasco; B., Thompson; P., Salinas.

    2009-06-01

    Full Text Available La técnica endovascular para el manejo de aneurismas está ganando auge como una alternativa a la cirugía abierta. Sin embargo, se han descrito diferentes complicaciones tromboembólicas relacionadas con esta modalidad. El flujo sanguíneo al tálamo y al mesencéfalo puede surgir de variaciones anatómic [...] as complejas. La variación infrecuente: "arteria de Percheron", es una rama arterial solitaria que se origina del segmento proximal de una de la arterias cerebrales posteriores. Presentamos un paciente que tuvo un procedimiento endovascular electivo para el tratamiento de un aneurisma de la punta de la arteria basilar; 12 horas después del procedimiento, el paciente estaba clínicamente en coma profundo. La resonancia magnética (RM) cerebral mostró infartos talámicos paramediales bilaterales y mesencefálicos, compatible con la oclusión de la arteria de Percheron. Los eventos tromboembólicos relacionados con el uso de embolización con coil y stents es una rara pero catastrófica secuela. El uso de agentes antiplaquetarios se debe de recomendar en este tipo de situaciones. Cuando existen infartos talámicos paramediales bilaterales y mesencefálicos, la oclusión de la arteria de Percheron se debe de tener en mente. La angiografía puede no ser de mucha utilidad y la falta de visualización de la arteria no excluye su presencia. En este caso los hallazgos en la RM cerebral confirman la presencia de un infarto basado en la distribución anatómica de la arteria de Percheron. Abstract in english Aneurysm embolization using Guglielmi detachable coils (GDC) is gaining acceptance as a viable alternative for surgery in the treatment of aneurysms. Recent reports describe a significant rate of thromboembolic complications. Thalamic and midbrain blood supply can arise from complex anatomical varia [...] tions. The rare variation: "artery of Percheron", is a solitary arterial trunk arising from one of the proximal segments of a posterior cerebral artery and supplies the paramedian thalami and rostral midbrain bilaterally. We describe a patient that underwent elective endovascular treatment for a basilar tip aneurysm using GDC and stents in each PCA; 12 hours later patient was comatose and not following commands. Sequential magnetic resonance imaging (MRI) of brain showed bilateral paramedian thalamic and mesencephalic infarcts presumably secondary to artery of Percheron occlusion. Thromboembolic event related to the use of the GDC embolization and stents is a rare clinical sequelae, but catastrophic. The use of antiplatelets agents should be reinforced in the scenario. When bilateral medial thalamic and midbrain infarcts are found, occlusion of the artery of Percheron should be considered. Angiography may not b helpful and lack of visualization of the artery does not exclude its presence. In this case the MRI findings confirmed the presence of the infarction based on the anatomical distribution.

  19. Tuberculosis abdominal Abdominal tuberculosis

    Directory of Open Access Journals (Sweden)

    T. Rubio

    2005-08-01

    Full Text Available La tuberculosis abdominal cursa con un cuadro inespecífico, con difícil diagnóstico diferencial respecto a otras entidades de similar semiología. Presentamos el caso de un varón que ingresa por presentar dolor abdominal, pérdida progresiva y notoria de peso corporal y fiebre de dos meses de evolución. El cultivo de la biopsia de colon mostró presencia de bacilo de Koch.Abdominal tuberculosis develops according to a non-specific clinical picture, with a difficult differential diagnosis with respect to other entities of similar semiology. We present the case of a male who was admitted because of abdominal pain, progressive and notable loss of body weight and a fever of two months evolution. The culture from the colon biopsy showed the presence of Koch bacilli.

  20. Abdominal splenosis / Esplenosis abdominal

    Scientific Electronic Library Online (English)

    Dorota, Ksiadzyna; Amado Salvador, Peña.

    2011-08-01

    Full Text Available Splenosis is a benign condition caused by an ectopic autotransplantation of splenic tissues after splenic trauma or surgery. It usually occurs within the abdominal and pelvic cavity. Patients are generally asymptomatic and this entity is diagnosed accidentally. However, occasionally extensive abdomi [...] nal splenosis poses a significant diagnostic dilemma for gastroenterologists, especially when this condition manifests as a disseminated metastatic malignant disease on abdominal imaging. This paper presents a concise review of the literature on this often misleading disorder. The crucial role of taking a thorough patient's medical history concerning splenic trauma in the past, the need for differential diagnosis of tumor-like lesions disclosed on abdominal imaging and novel diagnostics modalities that allow avoiding unnecessary laparotomy in case of abdominal splenosis are stressed. The increased prevalence of abdominal trauma due to road accidents and the growing armamentarium of available imaging modalities suggest that abdominal splenosis may be expected more often than ever. In order to prevent any possible diagnostic doubts and unnecessary future invasive examinations, confirmed splenosis should be recorded in the medical documentation of the patient.

  1. Endovascular stent graft repair of multiple tuberculous thoracoabdominal aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Jung; Won, Je Hwan [Dept. of Radiology, Ajou University School of Medicine, Suwon (Korea, Republic of)

    2014-05-15

    We describe a case of multiple tuberculous aneurysms of the descending thoracic aorta and abdominal aorta repaired with endovascular stent graft. The case was a 47-year-old man who presented with three saccular pseudoaneurysms of aortoiliac bifurcation at computed tomography (CT) scan. Despite of antimycobacterial treatment, these aneurysms grew rapidly and saccular pseudoaneurysm of the descending thoracic aorta was newly seen. A bifurcated stent graft was successfully implanted in the aortoiliac bifurcation. Subsequently, endovascular stent graft was placed well in the descending thoracic aorta. Fourteen months after the procedure, the patient was stable and serial CT images showed regression of aneurysms with ongoing antimycobacterial treatment. Therefore, endovascular stent graft repair with antimycobacterial therapy may be a treatment option in patients with multiple tuberculous aneurysms.

  2. Successful selective angiographic embolisation of a gastroduodenal pseudoaneurysm following penetrating abdominal trauma

    Scientific Electronic Library Online (English)

    S, Adam; J L, Bruce; G L, Laing; D L, Clarke.

    2014-08-01

    Full Text Available New endoscopic and endovascular therapies have revolutionised the management of complex traumatic visceral aneurysms. A pseudoaneurysm of the gastroduodenal artery following penetrating abdominal trauma was successfully managed by selective angiographic embolisation. [...

  3. Endovascular treatment of thoracic aortic diseases

    Directory of Open Access Journals (Sweden)

    Davidovi? Lazar

    2013-01-01

    Full Text Available Bacground/Aim. Endovascular treatment of thoracic aortic diseases is an adequate alternative to open surgery. This method was firstly performed in Serbia in 2004, while routine usage started in 2007. Aim of this study was to analyse initial experience in endovacular treatment of thoracic aortic diseses of three main vascular hospitals in Belgrade - Clinic for Vascular and Endovascular Surgery of the Clinical Center of Serbia, Clinic for Vascular Surgery of the Military Medical Academy, and Clinic for Vascular Surgery of the Institute for Cardiovascular Diseases “Dedinje”. Methods. Between March 2004. and November 2010. 41 patients were treated in these three hospitals due to different diseases of the thoracic aorta. A total of 21 patients had degenerative atherosclerotic aneurysm, 6 patients had penetrating aortic ulcer, 6 had posttraumatic aneurysm, 4 patients had ruptured thoracic aortic aneurysm, 1 had false anastomotic aneurysm after open repair, and 3 patients had dissected thoracic aneurysm of the thoracoabdominal aorta. In 15 cases the endovascular procedure was performed as a part of the hybrid procedure, after carotidsubclavian bypass in 4 patients and subclavian artery transposition in 1 patient due to the short aneurysmatic neck; in 2 patients iliac conduit was used due to hypoplastic or stenotic iliac artery; in 5 patients previous reconstruction of abdominal aorta was performed; in 1 patient complete debranching of the aortic arch, and in 2 patients visceral abdominal debranching were performed. Results. The intrahospital mortality rate (30 days was 7.26% (3 patients with ruptured thoracic aneurysms died. Endoleak type II in the first control exam was revealed in 3 patients (7. 26%. The patients were followed up in a period of 1-72 months, on average 29 months. The most devastating complication during a followup period was aortoesofageal fistula in 1 patient a year after the treatment of posttraumatic aneurysm. Conversion was performed with explantation of stent-graft and open aortic in situ recontruction, followed by esophagectomy and the creation of cervical and gastrical stoma. Conclusion. Having in mind initial results of the 3 main vascular clinics in Belgrade, Serbia, economical situation in our country, as well as the published international results, endovascular treatment of thoracic aortic diseases is indicated in hemodinamicaly unstable patients with acute traumatic aneurysm, or in stabile patients older than 65, as well as in case of chronic diseases of the thoracic aorta in patients with significant comorbid conditions or in patients older than 65 years. Endovascular procedures on the thoracic aorta could be performed, hower, only in high-volume centers with experience in routine open surgery of thoracic aorta.

  4. Renal autotransplantation in open surgical repair of suprarenal abdominal aortic aneurysm

    OpenAIRE

    Min, Eun-Ki; Kim, Young Hoon; Han, Duck Jong; Han, Youngjin; Kwon, Hyunwook; Choi, Byung Hyun; Park, Hojong; Choi, Ji Yoon; Kwon, Tae-Won; Cho, Yong-Pil

    2015-01-01

    Although the standard treatment of abdominal aortic aneurysm has shifted from open surgery to endovascular repair, open surgery has remained the standard of care for complex aneurysms involving the visceral arteries and in patients unsuitable for endovascular aneurysm repair. Postoperative renal insufficiency may occur after open surgical repair of suprarenal abdominal aortic aneurysm. Methods of minimizing renal ischemic injury include aortic cross-clamping and renal reconstruction technique...

  5. Endovascular Treatment Strategies in Aortoiliac Occlusion

    International Nuclear Information System (INIS)

    The aim of this study was to report our experience in endovascular treatment of total aortoiliac occlusion. Five patients who underwent endovascular recanalization procedures including manual aspiration thrombectomy, balloon angioplasty, and stent placement for total aortoiliac occlusion in a 4-year period were reviewed retrospectively. The mean age of patients was 51 years (range, 43 to 58 years). All patients had abdominal aorta and bilateral common iliac artery occlusion with or without external iliac artery occlusion. All patients either had a contraindication to surgery or refused it. Initial technical success was obtained in four of five (80%) patients. Endovascular techniques were successful in four patients who had good distal runoff and short-segment aortoiliac occlusion, but failed in a patient who had the worst distal runoff and long-segment aortoiliac occlusion. We observed two major complications, one of which was bilateral rupture of the common iliac arteries treated with covered stent placement. Another patient had extension of intra-aortic thrombus into the iliac stent after primary stenting. This was successfully treated with manual aspiration thrombectomy. Aortic and iliac stents remained patent during the follow-up period (median, 18 months; range, 3 to 26 months) in four patients. Primary patency rates at 6, 12, and 24 months were all 80%. In conclusion, endovascular treatment can be an alternative for aortoiliac occlusion in selected patients. Short- to midterm follow-up so far is satisfactory. Removal of intra-aortic thrombus with manual aspiration thrombectomy before balloon angioplasty and/or stenting is possible and a good alternative to thrombolysis.

  6. Tratamiento de los defectos de la pared abdominal (gastrosquisis y onfalocele) en el Hospital Universitario San Vicente de Paúl, Medellín, 1998-2006 / Management of abdominal wall defects (gastroschisis and omphalocele) at Hospital Universitario San Vicente de Paúl, in Medellín, Colombia, 1998-2006

    Scientific Electronic Library Online (English)

    Míriam Natalia, Herrera Toro; María Elena, Arango Rave; Paula María, Jaramillo Gómez.

    2010-09-01

    Full Text Available Introducción:la gastrosquisis y el onfalocele son malformaciones de la pared abdominal en neonatos que, a pesar de sus grandes diferencias, tienen en común el hecho de ser enfermedades graves caracterizadas por la herniación de las vísceras intrabdominales a través de un defecto de la pared abdomina [...] l. Los niños con estas enfermedades se presentan como emergencias quirúrgicas que plantean un reto difícil para el cirujano tratante. Tienen una tasa de mortalidad que oscila entre 20- 40%, aun con el tratamiento apropiado y se asocian a un amplio rango de malformaciones, principalmente en los niños con onfalocele. Objetivo: el objetivo de la presente revisión retrospectiva es describir el tratamientode los pacientes con gastrosquisis y onfalocele, y los resultados con él obtenidos, entre 1998 y 2006, en la Sección de Cirugía Pediátrica del Hospital Universitario San Vicente de Paúl (HUSVP), de Medellín. Pacientes y métodos: se evaluaron todos los pacientes que ingresaron al Servicio de Cirugía Pediátrica del HUSVP con diagnóstico de gastrosquisis u onfalocele, entre el 1 de enero de 1998 y el 31 de diciembre de 2006. Se definió el tipo de tratamiento llevado a cabo y, de acuerdo con este, se revisaron los resultados: las complicaciones posquirúrgicas, tales como infección del sitio operatorio, evisceración, sepsis, íleo e hipertensión intrabdominal; el tiempo de inicio de la vía oral y de la nutrición parenteral total (NPT); la permanencia en la unidad de cuidados intensivos (UCI) y la duración de la estancia hospitalaria. Resultados: se identificaron 55 pacientes, 32 con gastrosquisis y 23 con onfalocele; en todos se hizo tratamiento quirúrgico. En 31 pacientes (56,4%) se hizo cierre primario y en 24 (43,6%), cierre por etapas; en esta última modalidad el procedimiento más utilizado fue el silo (12 niños; (50%). En 42 pacientes (76,4%) se presentaron complicaciones la más frecuente de las cuales fue la sepsis. La frecuencia de complicaciones asociadas al procedimiento quirúrgico fue similar para el cierre primario y el cierre por etapas (49,9% y 49,7%, respectivamente). El inicio de la vía oral fue más temprano para los pacientes tratados con cierre primario. Los pacientes con gastrosquisis requirieron mayor tiempo de estancia en la UCI y en el hospital. Murieron 16 pacientes (29,1%); la mortalidad fue más alta en los que tenían onfalocele (10/23; 43,5%) que en los con gastrosquisis (6/32; 18,8%). Abstract in english Introduction: Gastroschisis and omphalocele are neonatal malformations of the abdominal wall. Despite their great differences, both are severe diseases characterized by herniation of viscera through the defect in the abdominal wall. Children with these defects present as surgical emergencies that po [...] se a difficult challenge to the attending surgeon. Even with appropriate management, the mortality rate is between 20-40%. Omphalocele and, to a lesser degree gastroschisis, are associated with a wide range of malformations. Objective: The aim of this retrospective review was to describe the management of children with gastroschisis or omphalocele, and the results obtained with it, at the Pediatric Surgery Section, Hospital Universitario San Vicente de Paúl, in Medellin, Colombia. Patients and methods: We evaluated the charts of all patients admitted to the Pediatric Surgery Section, between January 1, 1998 and December 31, 2006, with a diagnosis of gastroschisis or omphalocele. The type of treatment was defined as either primary closure or closure by stages; accordingly, we reviewed the results of the operation, the surgical complications (surgical site infection, evisceration, sepsis, ileus and intraabdominal hypertension), the time of onset of oral and total parenteral nutrition (TPN), and the duration of hospital and UCI stay. Results: 55 patients were identified, 32 with gastroschisis and 23 with omphalocele, all of whom were surgically treated. In 31 patients (56.4%) primary closure was carried out, while in 24 ( 43.6%) the closure was

  7. Hydrogels in endovascular embolization.

    Czech Academy of Sciences Publication Activity Database

    Horák, Daniel; Gumargalieva, K. Z.; Zaikov, G. E.

    vol. 19. New York : Nova Science Publishers, Inc., 2006 - (Pethrick, R.; Zaikov, G.), s. 35-57 ISBN 1-59454-899-4 Institutional research plan: CEZ:AV0Z40500505 Keywords : hydrogels * endovascular * embolisation Subject RIV: CD - Macromolecular Chemistry

  8. Heparin-induced thrombocytopenia and endovascular procedures: report of two cases Trombocitopenia induzida por heparina e tratamento endovascular: relato de dois casos

    Directory of Open Access Journals (Sweden)

    Christiane Campolina Furquim Werneck

    2009-09-01

    Full Text Available Heparin-induced thrombocytopenia (HIT is a transient disorder caused by platelet-activating antibodies against platelet factor 4 (PF4-heparin complexes. Clinically it translates into arterial or venous thrombosis and carries high morbidity and mortality. The use of large doses of heparin during endovascular repair of abdominal aortic aneurysm could increase the incidence of HIT. We report two cases associating the use of heparin during endovascular repair of abdominal aortic aneurysm with the development of HIT.Trombocitopenia induzida por heparina (TIH é um distúrbio transitório causado pela ativação de anticorpos anti-plaquetários contra o fator plaquetário 4 (FP4 combinado com a molécula de heparina, formando complexos que clinicamente se traduzem em tromboses arteriais ou venosas com alta morbimortalidade. O uso de altas doses de heparina durante procedimentos endovasculares para o tratamento de aneurisma de aorta abdominal pode aumentar a incidência de TIH. Relatamos dois casos em que o uso de heparina durante tratamento endovascular de aneurisma de aorta abdominal estava associado ao aparecimento de TIH.

  9. Endovascular repair as a sole treatment in multiple aneurysms in patient with SLE

    International Nuclear Information System (INIS)

    Full text: Introduction: Most aneurysms are local manifestations of systemic disease. For patients over 65 years the incidence of aneurysm of the abdominal aorta (AAA) is approximately 5-6% in men and 1-2 % for women. The presence of both the AAA and aneurysms in other location is even rarer, and this percentage is likely increase further in patients with systemic lupus erythematosus (SLE). What you will learn: We present a rare clinical case of endovascular treatment of multifocal aneurysm including post catheterization pseudoaneurysm. The patient is a 73 years old woman with a history of SLE and age-related comorbidity. Originally an endovascular treatment of aneurysms of the abdominal aorta and right common iliac artery was used. Two years later a successfully endovascular treatment of aneurysm of the right renal artery was conducted, which however is complicated by the formation of a pseudoaneurysm in access through the left femoral artery. The late one is again treated endovascular by placement of a covered stent after failure of percutaneous injection of 1000 UI thrombin. Discussion: Adult patients with a long history of SLE are unsuitable candidates for surgical treatment of aneurysmal disease, especially in its multifocal form. In our case we have taken multistep successful endovascular procedures, including technically hard placing of the stent at the site of the right renal aneurysms, and post catheterization pseudoaneurysm. Conclusion: Multifocal aneurysmal vascular changes due to macroangiopathia in SLE can be treated alone by endovascular means in multi-stages procedures

  10. Endovascular aortic graft infection resulting in retroperitoneal abscess: report of a case

    Directory of Open Access Journals (Sweden)

    Salvatore Di Somma

    2010-06-01

    Full Text Available Infection is a rare complication of aortoiliac endovascular procedures, with an incidence inferior to 0.5%, and it may result in a retroperitoneal abscess potentially evolving to sepsis and gastrointestinal bleeding. In more than 50% of cases endovascular aortoiliac prosthetic grafts infection occur months or years after the procedure. The growing number of endovascular procedures, and as the actually midterm follow up in most cases, septic sequelae will no doubt continue to occur with increased frequency and may represent an emerging problem in the ED for the emergency physician. Endovascular graft infection begins with unspecific clinical manifestations. An high index of suspicion in any patient with an aortic stent graft presenting prolonged or recurrent fever and or abdominal or back pain and a low threshold for obtaining CT scan should increase the clinician’s ability to make a timely diagnosis in the ED setting.

  11. Endovascular stroke treatment today.

    OpenAIRE

    Grunwald, IQ; Wakhloo, AK; Walter, S.; Molyneux, AJ; Byrne, JV; S. Nagel; Kühn, AL; Papadakis, M.; Fassbender, K; Balami, JS; Roffi, M; Sievert, H; Buchan, A.

    2011-01-01

    The purpose of this study was to review current treatment options in acute ischemic stroke, focusing on the latest advances in the field of mechanical recanalization. These devices recently made available for endovascular intracranial thrombectomy show great potential in acute stroke treatments. Compelling evidence of their recanalization efficacy comes from current mechanical embolectomy trials. In addition to allowing an extension of the therapeutic time window, mechanical recanalization de...

  12. [Endovascular surgery in the war].

    Science.gov (United States)

    Reva, V A; Samokhvalov, I M

    2015-01-01

    Rapid growth of medical technologies has led to implementation of endovascular methods of diagnosis and treatment into rapidly developing battlefield surgery. This work based on analysing all available current publications generalizes the data on using endovascular surgery in combat vascular injury. During the Korean war (1950-1953) American surgeons for the first time performed endovascular balloon occlusion of the aorta - the first intravascular intervention carried out in a zone of combat operations. Half a century thereafter, with the beginning of the war in Afghanistan (2001) and in Iraq (2003) surgeons of central hospitals of the USA Armed Forces began performing delayed endovascular operations to the wounded. The development of technologies, advent of mobile angiographs made it possible to later on implement high-tech endovascular interventions in a zone of combat operations. At first, more often they performed implantation of cava filters, somewhat afterward - angioembolization of damaged accessory vessels, stenting and endovascular repair of major arteries. The first in the theatre of war endovascular prosthetic repair of the thoracic aorta for severe closed injury was performed in 2008. Russian experience of using endovascular surgery in combat injuries is limited to diagnostic angiography and regional intraarterial perfusion. Despite the advent of stationary angiographs in large hospitals of the RF Ministry of Defence in the early 1990s, endovascular operations for combat vascular injury are casuistic. Foreign experience in active implementation of endovascular technologies to treatment of war-time injuries has substantiated feasibility of using intravascular interventions in tertiary care military hospitals. Carrying out basic training courses on endovascular surgery should become an organic part of preparing multimodality general battlefield surgeons rendering care on the theatre of combat operations. PMID:26035580

  13. Endovascular treatment in pregnancy

    International Nuclear Information System (INIS)

    There is an increased risk of stroke during pregnancy and the puerperium. Decisions should be made immediately upon transfer to each institution, particularly with respect to when and how to treat the patient. This review highlights the feasibility of endovascular treatment in pregnancy. Most of the pharmaceutical agents and therapeutic devices used in clinical practice can be utilized in pregnant patients. Comprehensive information on the benefits and risks of treatment should be explained to the patient and her family, with particular attention to the safety of the mother and fetus. Radiation exposure to the fetus is also a concern; the hazard can be minimized with optimal protection. Several studies have demonstrated that conventional procedures do not cause serious radiation exposure exceeding the threshold of safety to the fetus. Endovascular therapy can be safely performed for the treatment of acute stroke as in non-pregnant patients with adequate attention to pharmaceutical agents and shielding from radiation. In contrast to therapy for acute stroke, preventive endovascular treatment for asymptomatic lesions remains controversial. Several conditions, such as cerebral aneurysms and arteriovenous malformations, are known to bleed more frequently in pregnancy, but whether the benefits of preventive treatment outweigh the associated risks is unknown. The decision for preventive treatment should be carefully made on a case-by-case basis after extensive discussion with the patient. (author)

  14. Vascular access complications in endovascular procedures with large sheaths.

    Science.gov (United States)

    Lejay, Anne; Caspar, Thibault; Ohana, Mickaël; Delay, Charline; Girsowicz, Elie; Ohlmann, P; Thaveau, Fabien; Geny, Bernard; Georg, Yannick; Chakfe, Nabil

    2016-04-01

    Endovascular procedures, such as transcatheter aortic valve implantation (TAVI), thoracic endovascular aortic repair (TEVAR), and endovascular abdominal aortic repair (EVAR) have been established as promising less invasive therapeutic options. However, despite continuous advances and device improvements, the use of large-sheaths still remains an important challenge, since significant coexisting arterial disease may be encountered in patients undergoing such procedures. Identification of coexisting arterial diseases by optimal preoperative imaging assessment is essential to anticipate these difficulties and avoid the complications by using adequate access options. Should a vascular complication such as iliac rupture occur, vascular interventionists must be aware of salvage procedures to control and treat major complications, such as maintaining wire access across the rupture for occlusion balloon placement and vessel control, while disruption is addressed either through an endovascular or an open approach. The aims of this review are to describe how to prevent vascular complications by optimal preoperative imaging assessment, to detail intraoperative options available for addressing difficult access issues and to discuss how to manage intraoperative major vascular complications. PMID:26603161

  15. Endovascular repair of para-anastomotic aortoiliac aneurysms.

    LENUS (Irish Health Repository)

    Tsang, Julian S

    2009-11-01

    The purpose of this study is to evaluate the use of endovascular stent grafts in the treatment of para-anastomotic aneurysms (PAAs) as an alternative to high-risk open surgical repair. We identified all patients with previous open aortic aneurysm repair who underwent infrarenal endovascular aneurysm repair (EVAR) at our institution from June 1998 to April 2007. Patient demographics, previous surgery, and operative complications were recorded. One hundred forty-eight patients underwent EVAR during the study period and 11 patients had previous aortic surgery. Of these 11 redo patients, the mean age was 62 years at initial surgery and 71 years at EVAR. All patients were male. Initial open repair was for rupture in five (45%) patients. The average time between initial and subsequent reintervention was 9 years. All patients were ASA Grade III or IV. Fifty-five percent of the PAAs involved the iliac arteries, 36% the abdominal aorta, and 9% were aortoiliac. Ten patients had endovascular stent-grafts inserted electively, and one patient presented with a contained leak. Aorto-uni-iliac stent-grafts were deployed in seven patients, and bifurcated stent-grafts in four patients. A 100% successful deployment rate was achieved. Perioperative mortality was not seen and one patient needed surgical reintervention to correct an endoleak. Endovascular repair of PAAs is safe and feasible. It is a suitable alternative and has probably now become the treatment of choice in the management of PAAs.

  16. Abdominal Pain

    DEFF Research Database (Denmark)

    Faaborg, Pia Møller; Finnerup, Nanna Brix; Christensen, Peter; Krogh, Klaus

    2013-01-01

    Introduction. Most spinal-cord-injured patients have constipation. One-third develop chronic abdominal pain 10 years or more after injury. Nevertheless, very little is known about the nature of abdominal pain after spinal cord injury (SCI). It may be neuropathic or caused by constipation. Aim. To compare characteristics of abdominal pain in SCI with able-bodied with chronic idiopathic constipation (CIC). Subjects and Methods. 21 SCI and 15 CIC patients were referred for treatment of bowel sympto...

  17. Abdominal CT

    International Nuclear Information System (INIS)

    Computed tomography (CT) has proven useful in the evaluation of anatomy and a variety of lesions in the abdomen. Although abdominal CT has a lot of merits, it has several demerits as well. One of the demerits is difficulty to determine origin of large abdominal tumors. One of the merits is improvement of the ability to evaluate abdominal vascular anatomy and pathology, using short time scans following a bolus injection of intravascular contrast medium. (author)

  18. Abdominal Pain

    DEFF Research Database (Denmark)

    Faaborg, Pia Møller; Finnerup, Nanna Brix; Christensen, Peter; Krogh, Klaus

    2013-01-01

    Introduction. Most spinal-cord-injured patients have constipation. One-third develop chronic abdominal pain 10 years or more after injury. Nevertheless, very little is known about the nature of abdominal pain after spinal cord injury (SCI). It may be neuropathic or caused by constipation. Aim. To...... compare characteristics of abdominal pain in SCI with able-bodied with chronic idiopathic constipation (CIC). Subjects and Methods. 21 SCI and 15 CIC patients were referred for treatment of bowel symptoms. Constipation-related symptoms were assessed with the Cleveland Constipation Scoring System and the...... International Spinal Cord Injury Basic Bowel Function Data Set. Characteristics of abdominal pain were described using the Brief Danish Pain Questionnaire. Total gastrointestinal transit times (GITT) were measured by radiopaque markers. Results. Seventeen (81%) SCI and 14 (93%) CIC patients reported abdominal...

  19. Endovascular repair of aortic disease: a venture capital perspective.

    Science.gov (United States)

    Buchanan, Lucas W; Stavropoulos, S William; Resnick, Joshua B; Solomon, Jeffrey

    2009-03-01

    Endovascular devices for the treatment of abdominal and thoracic aortic disease are poised to become the next $1 billion medical device market. A shift from open repair to endovascular repair, advances in technology, screening initiatives, and new indications are driving this growth. Although billion-dollar medical device markets are rare, this field is fraught with risk and uncertainty for startups and their venture capital investors. Technological hurdles, daunting clinical and regulatory timelines, market adoption issues, and entrenched competitors pose significant barriers to successful new venture creation. In fact, the number of aortic endografts that have failed to reach commercialization or have been pulled from the market exceeds the number of Food and Drug Administration-approved endografts in the United States. This article will shed some light on the venture capital mind-set and decision-making paradigm in the context of aortic disease. PMID:21326532

  20. Tratamento endovascular da persistência do canal arterial em adulto / Patent ductus arteriosus: endovascular treatment in adult patient

    Scientific Electronic Library Online (English)

    Diego Felipe, Gaia; José Honório, Palma; Hyung Chun, Kim; José Augusto Marcondes de, Souza; Cláudia Rodrigues, Alves; Enio, Buffolo.

    2008-08-01

    Full Text Available A persistência do canal arterial (PCA) é uma anomalia relativamente freqüente e de simples correção. A correção envolve a ligadura do ducto com ou sem a sua secção. A anomalia em adultos pode provocar hipertensão pulmonar persistente e disfunção ventricular. A correção em adultos é controversa e de [...] maior risco. Um caso de correção endovascular com acesso intra-abdominal da PCA em adulto é descrito. Abstract in english The patent ductus arteriosus (PDA) is a common type of congenital heart defect and its correction is simple when performed early in life. Surgery is performed using stitches or clips. In adults, the anomaly can lead to pulmonary hypertension and ventricular dysfunction. Surgery in adults is controve [...] rsial and high-risk. This report describes an alternative endovascular approach in an adult patient.

  1. Tratamento endovascular da persistência do canal arterial em adulto Patent ductus arteriosus: endovascular treatment in adult patient

    Directory of Open Access Journals (Sweden)

    Diego Felipe Gaia

    2008-08-01

    Full Text Available A persistência do canal arterial (PCA é uma anomalia relativamente freqüente e de simples correção. A correção envolve a ligadura do ducto com ou sem a sua secção. A anomalia em adultos pode provocar hipertensão pulmonar persistente e disfunção ventricular. A correção em adultos é controversa e de maior risco. Um caso de correção endovascular com acesso intra-abdominal da PCA em adulto é descrito.The patent ductus arteriosus (PDA is a common type of congenital heart defect and its correction is simple when performed early in life. Surgery is performed using stitches or clips. In adults, the anomaly can lead to pulmonary hypertension and ventricular dysfunction. Surgery in adults is controversial and high-risk. This report describes an alternative endovascular approach in an adult patient.

  2. Abdominal trauma

    International Nuclear Information System (INIS)

    Abdominal injury is an important cause of morbidity and mortality in childhood. Ten percent of trauma-related deaths are due to abdominal injury. Thousands of children are involved in auto accidents annually; many suffer severe internal injury. Child abuse is a second less frequent but equally serious cause of internal abdominal injury. The descriptions of McCort and Eisenstein and their associates in the 1960s first brought to attention the frequency and severity of visceral injury as important manifestations of the child abuse syndrome. Blunt abdominal trauma often causes multiple injuries; in the past, many children have been subjected to exploratory surgery to evaluate the extent of possible hidden injury. Since the advent of noninvasive radiologic imaging techniques including radionuclide scans and ultrasound and, especially, computed tomography (CT), the radiologist has been better able to assess (accurately) the extent of abdominal injury and thus allow conservative therapy in many cases. Penetrating abdominal trauma occurs following gunshot wounds, stabbing, and other similar injury. This is fortunately, a relatively uncommon occurrence in most pediatric centers and will not be discussed specifically here, although many principles of blunt trauma diagnosis are valid for evaluation of penetrating abdominal trauma. If there is any question that a wound has extended intraperitonelly, a sinogram with water-soluble contrast material allows quick, accurate diagnosis. The presence of large amounts of free intraperitoneal gas suggests penetrating injury to the colon or other gas-containing viscus and is generally considered an indication for surgery

  3. Successful treatment of endotension and aneurysm sac enlargement with endovascular stent graft reinforcement.

    Science.gov (United States)

    Kougias, Panagiotis; Lin, Peter H; Dardik, Alan; Lee, W Anthony; El Sayed, Hosam F; Zhou, Wei

    2007-07-01

    Abdominal aortic aneurysm (AAA) enlarges after successful endovascular repair because of endoleak, which is persistent blood flow within the aneurysm sac. In the absence of detectable endoleak, AAA may still expand, in part because of endotension, which is persistent pressurization within the excluded aneurysm. We report three patients who underwent successful endovascular AAA repair using the Excluder device (W. L. Gore & Associates, Flagstaff, Ariz). Although their postoperative surveillance showed an initial aneurysm regression, delayed aneurysm enlargement developed in all three, apparently due to endotension. Endovascular treatment was performed in which endograft reinforcement with a combination of aortic cuff and iliac endograft extenders were inserted in the previously implanted stent grafts. The endograft reinforcement procedure successfully resulted in aneurysm sac regression in all three patients. Our study underscores the significance of increased graft permeability as a mechanism of endotension and delayed aneurysm enlargement after successful endovascular AAA repair. In addition, our cases illustrate the feasibility and efficacy of an endovascular treatment strategy when endotension and aneurysm sac enlargement develops after endovascular AAA repair. PMID:17606128

  4. Hybrid Treatment of Coexisting Renal Artery Aneurysm and Abdominal Aortic Aneurysm in a Gallbladder Cancer Patient

    OpenAIRE

    Jung, Hyuk Jae; Lee, Sang Su

    2014-01-01

    Renal artery aneurysm (RAA) is uncommon, and the coexistence of an abdominal aortic aneurysm (AAA) is an extremely rare condition with potentially high life-threatening mortality in case of rupture. Aneurysms can be treated by endovascular intervention or open surgery. Although most of aneurysms are treated by endovascular intervention, open surgery is often necessary for RAAs associated with the proximal renal bifurcation or the branches in the distal renal arteries. We report a rare case of...

  5. Abdominal Adhesions

    Science.gov (United States)

    ... abdominal adhesions include using starch- and latex-free gloves handling tissues and organs gently shortening surgery time using moistened drapes and swabs occasionally applying saline solution [ Top ] Eating, Diet, and Nutrition Researchers have not found ...

  6. Use of the IntuiTrak® Stent-Graft Delivery System for Percutaneous Abdominal Aortic Aneurysm Exclusion: Initial Single-Center Experience

    OpenAIRE

    Tom, Cindy W.; Krajcer, Zvonimir

    2010-01-01

    The exclusion of abdominal aortic aneurysms by endovascular techniques has enabled the treatment of patients who have high-risk comorbidities that preclude safe surgical repair. Since the development of the unibody bifurcated endovascular stent-graft for abdominal aortic aneurysm exclusion, remarkable technological improvements have facilitated stent-graft delivery and reduced the required size of the access site. Our initial institutional experience with the use of the Endologix IntuiTrak® E...

  7. Endovascular treatment of a triple paraanastomotic aneurysm after aortobiiliac reconstruction Tratamento endovascular de triplo aneurisma para-anastomótico após derivação aorto-biilíaca

    Directory of Open Access Journals (Sweden)

    Alexandre Campos Moraes Amato

    2008-09-01

    Full Text Available We report a case of a 72-year-old patient considered unfit for open surgery, presenting with paraanastomotic aneurysms of all three anastomoses, 13 years after an open aortobiiliac reconstruction for abdominal aortic aneurysm. This patient was successfully treated with an endovascular approach using a left aortouniiliac endograft and a right iliac tubular endograft, followed by crossover femorofemoral bypass. This report illustrates the usefulness of a minimally invasive approach for solving this complication of aortic open surgery and discusses technical issues related to endovascular devices in this particular setting.Relatamos um caso de um paciente de 72 anos não considerado elegível para cirurgia aberta, apresentando aneurismas para-anastomóticos das três anastomoses, 13 anos após uma reconstrução aberta aorto-biilíaca para aneurisma aórtico abdominal. Este paciente foi tratado com sucesso através de abordagem endovascular usando uma endoprótese aorto-uniilíaca esquerda e uma endoprótese tubular ilíaca direita, seguida por derivação cruzada fêmoro-femoral. Este relato ilustra a utilidade de uma abordagem minimamente invasiva para o tratamento desta complicação da cirurgia aórtica aberta e discute questões técnicas relacionadas a dispositivos endovasculares neste contexto em especial.

  8. De novo periaortic fibrosis after endovascular aortic repair.

    Science.gov (United States)

    Alomran, Faris; de Blic, Romain; Mallios, Alexandros; Costanzo, Alessandro; Boura, Benoit; Combes, Myriam

    2014-02-01

    We report a case of a 63-year-old man presenting with abdominal pain and hydronephrosis secondary to periaortic fibrosis (PAF) 8 months after an endovascular aortic repair (EVAR) using a woven polyester bifurcated graft. De novo delayed PAF after open repair is rare and even more infrequent after EVAR. All 3 previously reported cases occurred after woven polyester grafts and no reported cases after polytetrafluorethylene grafts. Management included steroidal anti-inflammatory treatment and bilateral double J tube placement. Satisfactory results were obtained. PMID:24275428

  9. Hygroma following endovascular femoral aneurysm exclusion

    DEFF Research Database (Denmark)

    Wad, Morten; Pedersen, Brian Lindegaard; Lönn, Lars; Sillesen, Henrik

    2013-01-01

    Endovascular treatment of aneurysms in the superficial femoral artery (SFA) and popliteal segments is a suggested alternative to open surgical repair. Careful selection of patients for endovascular treatment of SFA aneurysms is mandatory.

  10. Utility of aortic cuffs in converting initially ineligible patients due to unfavorable neck anatomy into successful candidates for endovascular aortic aneurysm repair: A Case Series

    OpenAIRE

    Awan, Omer; Garcia, Mark; Awan, Yousaf; Gakhal, Mandip; Kim, Moonjohn; Iliescu, Bogdan; Siegel, Eliot

    2010-01-01

    Endovascular repair of the abdominal aortic aneurysm has been established as a successful alternative to open surgical repair, provided that the criteria necessary for such an approach are fulfilled. Anatomic criteria include suitable diameter, length, and angle of the aneurysm proximal neck. We present three cases in which patients were initially ineligible for endovascular repair because of unfavorable neck anatomy but in whom the use of aortic cuffs allowed for successful endograft placeme...

  11. Anesthesia Approach in Endovascular Aortic Reconstruction

    Directory of Open Access Journals (Sweden)

    Ay?in Alagöl

    2013-03-01

    Full Text Available Introduction: We have analyzed our initial results of our anesthesia techniques in our new-onset endovascular aortic reconstruction cases.Patients and Methods: The perioperative data of 15 elective and emergent endovascular aortic reconstruction cases that were operated in 2010-2011 were collected in a database. The choice of anesthesia was made by the risk factors, surgical team’s preferences, type and location of the aortic pathology and by the predicted operation duration. The data of local and general anesthesia cases were compared.Results: Thirteen (86.7% cases were male and 2 (13.3% female. Eleven patients were in ASA Class III. The demographic parameters, ASA classifications, concurrent diseases were similar in both groups. Thirteen (86.7% cases had infrarenal abdominal aortic aneurysm and 2 (13.3% had Type III aortic dissection. The diastolic arterial pressures were lower in general anesthesia group in 20th and 40th minutes’ measurements just like the mean arterial pressure measurements at the 40th, 100th minutes and during the deployment of the graft. Postoperative mortality occurred in 3 (20.0% patients and they all had general anesthesia and they were operated on emergency basis. Postoperative morbidity occurred in four patients that had general anesthesia (acute renal failure, multi-organ failure and pneumonia. The other patient had atrial fibrillation on the 1st postoperative day and was converted to sinus rhythm with amiodarone infusion.Conclusion: Edovascular aortic reconstruction procedures can safely be performed with both general and local anesthesia less invasively compared to open surgery. General anesthesia may be preferred for the better hemodynamic control.

  12. Hygroma following endovascular femoral aneurysm exclusion

    DEFF Research Database (Denmark)

    Wad, Morten; Pedersen, Brian Lindegaard; Lönn, Lars; Sillesen, Henrik

    2013-01-01

    Endovascular treatment of aneurysms in the superficial femoral artery (SFA) and popliteal segments is a suggested alternative to open surgical repair. Careful selection of patients for endovascular treatment of SFA aneurysms is mandatory.......Endovascular treatment of aneurysms in the superficial femoral artery (SFA) and popliteal segments is a suggested alternative to open surgical repair. Careful selection of patients for endovascular treatment of SFA aneurysms is mandatory....

  13. Single center experience in endovascular aortic repair: review of technical and clinical aspects

    Directory of Open Access Journals (Sweden)

    Sinan Demirta?

    2014-09-01

    Full Text Available Objective: The aim of this study is sharing of our endovascular aortic repair experiments in patients with high risk for surgery and contributing to literature with comparing previous report according to mortality complicationsand additional operations. Methods:Patients with endovascular aortic repair application were evaluated retrospectively. Perioperative one month mortality, additional applications during procedure, occurred complications, endoleak types, approaching anesthetical technique, diagnosis of disease, comorbid factors and demographical data registered. Results were compared with data in the literature Results: Abdominal endovascular aortic repair (EVAR applicated into 19 patients. Thoracic endovascular aor tic repair (TEVAR applicated into 11 patients. EVAR patients were operated with diagnosis of abdominal aortic aneurysm. Nine of these patients were emergely operated due to rupture. TEVAR applicated 8 patients were operated due to Type 3 Aortic Dissection and 1 patient was operated due to transsection. One month mortality of all patients were found as 10% (three atients. Endoleaks were occurred 6 patients: Three of them were Type 1a, two of them were Type1b and one of them was Type2. Balloon angioplasty applicated in two patients due to Type 1a endoleak and, in one patient due to Type 1b endoleak. Chronic renal failure was developed in one patient (3.3% due to contrast nephropathy. Reexploration was applicated in two patients (6.7% due to hematoma. Conclusion: Endovascular techniques are become frequently preferred treatment modality with the developing technology. We believed that endovascular approaches are safely preferable alternative in patients with high surgical risk as our series.

  14. Abdominal emergencies

    International Nuclear Information System (INIS)

    Full text: There are numerous conditions that affect mainly or exclusively the pediatric population. These constitute true emergencies, related to patient's health. Delay in diagnosis and treatment of abdominal non-traumatic emergencies may result in rapid deterioration, peritonitis, sepsis, even death or in severe complications with subsequent morbidity. Abdominal emergencies in children mostly present with pain, tenderness, occasionally coupled by vomiting, fever, abdominal distension, and failure to pass meconium or stools. Diarrhea, blood per rectum, abnormal laboratory tests and lethargy may also be manifestations of acute abdominal conditions. Abdominal emergencies have a different aetiology, depending on age and whether the pain is acute or chronic. Symptoms have to be matched with age and gender. Newborns up to 1 months of age may have congenital diseases: atresia, low obstruction including Hirschsprung's disease, meconium ileus. Meconium plug is one of the commonest cause of low obstruction in newborns that may also develop necrotizing enterocolitis, incarcerated inguinal hernia and mid-gut volvulus. Past the immediate postnatal period, any duodenal obstruction should be considered midgut volvulus until proven otherwise and patients should undergo ultrasonography and/or properly performed upper GI contrast study that records the exact position of the deduno-jejunal junction. Infants 6 months-2 years carry the risk of intussusception, mid-gut volvulus, perforation, acute pyelonephritis. Preschool and school-aged children 2-12 years carry the risk of appendicitis, genito-urinary abnormalities including torsion, urachal abnormalities, haemolytic uremic syndrome and Henoch-Schonlein purpura. Children above 12 years suffer from the same conditions as in adults. Most conditions may affect any age despite age predilection. Abdominal solid organ ultrasonography (US) coupled with gastrointestinal ultrasonography is the principle imaging modality in radiosensitive children and young individuals with abdominal pain. Sensitivity and specificity for US in diagnosing intussusception, midgut volvulus, urinary tract abnormalities and appendicitis is over 90%. US, occasionally with x-rays, usually suffice for an accurate diagnosis. Upper GI contrast studies are indicated in suspected malrotation, volvulus and atypical high obstruction cases. Lower GI contrast studies are indicated in low/colonic obstruction. CT and/or MRI should be reserved for atypical, complex cases when US and conventional radiography are equivocal or inconclusive. The radiologist should engage oneself to act immediately, consider and actively exclude those diagnoses that could be a threat to the child's health or life. The appropriate modality should be chosen and proper technique should be applied. Radiologists should function as clinicians, take initiative and discuss options and alternative diagnoses. Lack of experience should not delay performance of tests. Our job is finished when a diagnostic test has a written report provided that we make sure the child is managed properly.

  15. Tratamiento quirúrgico de la isquemia mesentérica crónica, revisión de la literatura y presentación de un caso / Surgical treatment of chronic mesenteric ischemia: Literature review and case presentation

    Scientific Electronic Library Online (English)

    César E, Jiménez; Álex, Valencia; Juan Rafael, Correa.

    2012-01-01

    Full Text Available Los problemas vasculares mesentéricos son infrecuentes pero, cuando se presentan, pueden ser catastróficos. La isquemia mesentérica crónica es una entidad caracterizada por la obstrucción de los vasos mesentéricos; se manifiesta por dolor abdominal después de las comidas, desnutrición y miedo a come [...] r. La mortalidad de la isquemia aguda es de 50 a 70 %. El manejo quirúrgico es la terapia de elección con excelentes resultados. El objetivo del tratamiento de la isquemia mesentérica crónica es solucionar los síntomas con un procedimiento efectivo y duradero, disminuyendo el riesgo de isquemia aguda. El tratamiento óptimo aun es discutido aunque la cirugía abierta se considera el método de referencia del manejo; no obstante, se asocia a una morbimortalidad importante. Presentamos el caso de un paciente con una isquemia mesentérica crónica, que se manejó con cirugía abierta y excelente resultado clínico y nutricional. Se hace una revisión extensa de la literatura científica actual. Abstract in english Mesenteric vascular problems are infrequent, but may be catastrophic. Chronic mesenteric ischemia (CMI) is a morbid disease that results from progressive stenotic disease of the mesenteric vessels. CMI presents with postprandial abdominal pain, inanition, fear of food And weight loss. Untreated,The [...] mortality in acute intestinal ischemia is high (50%-70%). Vascular reconstruction is remarkably successful in relieving the symptoms of chronic intestinal ischemia . The goal of treatment for CMI is a safe and effective revascularization that provides the patient with immediate and durable relief of symptoms, minimal procedural risk, and protection from morbidity and mortality associated with intestinal ischemia. Optimal treatment for patients with CMI remains controversial and challenging. Open surgical revascularization is still considered the standard of care, but may be associated with significant morbidity and mortality. We presented a patient with severe abdominal pain after meals, repeatedly. Angiography revealed severe stenosis and occlusion of the super mesenteric artery (SMA). Endovascular treatment was initially unsuccessful, after that we did a open bypass with full clinical and nutritional recovery.

  16. Endovascular treatment of PICA aneurysms

    International Nuclear Information System (INIS)

    Endovascular treatment of aneurysms of the posterior inferior cerebellar artery (PICA) avoids manipulation of the brainstem or lower cranial nerves and should therefore carry a lower risk of neurological morbidity than surgical clipping. We reviewed our experience of 23 patients with PICA aneurysms treated by endovascular occlusion with Guglielmi detachable coils and documented their long-term outcome on follow-up. We observed a 28 day procedure-related neurological morbidity of 13% (3/23 patients). One patient suffered permanent neurological complications. There were no procedure-related deaths. None of our patients suffered a re-bleed from their treated aneurysms. Our series shows endovascular treatment of ruptured PICA aneurysms to be safe and effective. (orig.)

  17. Signal quality of endovascular electroencephalography

    Science.gov (United States)

    He, Bryan D.; Ebrahimi, Mosalam; Palafox, Leon; Srinivasan, Lakshminarayan

    2016-02-01

    Objective, Approach. A growing number of prototypes for diagnosing and treating neurological and psychiatric diseases are predicated on access to high-quality brain signals, which typically requires surgically opening the skull. Where endovascular navigation previously transformed the treatment of cerebral vascular malformations, we now show that it can provide access to brain signals with substantially higher signal quality than scalp recordings. Main results. While endovascular signals were known to be larger in amplitude than scalp signals, our analysis in rabbits borrows a standard technique from communication theory to show endovascular signals also have up to 100× better signal-to-noise ratio. Significance. With a viable minimally-invasive path to high-quality brain signals, patients with brain diseases could one day receive potent electroceuticals through the bloodstream, in the course of a brief outpatient procedure.

  18. Intraoperative endovascular ultrasonography

    Science.gov (United States)

    Eton, Darwin; Ahn, Samuel S.; Baker, J. D.; Pensabene, Joseph; Yeatman, Lawrence S.; Moore, Wesley S.

    1991-05-01

    The early experience using intra-operative endovascular ultrasonography (EU) is reported in eight patients undergoing lower extremity revasularization. In four patients, intra-operative EU successfully characterized inflow stenoses that were inadequately imaged with pre- operative arteriography. Two patients were found to have hemodynamically significant inflow stenoses, and were treated with intra-operative balloon angioplasty followed by repeat EU. The other two patients were found to have non-hemodynamically significant inflow stenoses requiring no treatment. Additional outflow procedures were required in all four patients. In the remaining four patients, EU was used to evaluate the completeness of TEC rotary atherectomy, of Hall oscillatory endarterectomy, of thrombectomy of the superficial femoral and popliteal arteries, and of valve lysis during in situ saphenous vein grafting, respectively. In the latter case, the valve leaflets were not clearly seen. In the other cases, EU assisted the surgeon. Angioscopy and angiography were available for comparison. In one case, angioscopy failed because of inability to clear the field while inspecting retrograde the limb of an aorto-bi-femoral graft. EU however was possible. No complications of EU occurred. EU is a safe procedure indicated when characterization of a lesion is needed prior to an intervention or when evaluation of the intervention's success is desired. We did not find it useful in valve lysis for in-site grafting.

  19. Abdominal tuberculosis.

    OpenAIRE

    Vickers, D.

    1985-01-01

    Tuberculosis has staged a global comeback and forms a dangerous combination with AIDS. The abdomen is one of the common sites of extrapulmonary involvement. Patients with abdominal tuberculosis have a wide range and spectrum of symptoms and signs; the disease is therefore a great mimic. Diagnosis, mainly radiological and supported by endoscopy, is difficult to make and laparotomy is required in a large number of patient. Management involves judicious combination of antitubercular therapy and ...

  20. The ovation abdominal stent graft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives.

    Science.gov (United States)

    Georgakarakos, Efstratios; Ioannou, Christos V; Georgiadis, George S; Storck, Martin; Trellopoulos, George; Koutsias, Stylianos; Lazarides, Miltos K

    2016-03-01

    The Ovation Abdominal Stent Graft System is a trimodular endoprosthesis recently introduced for the endovascular repair of abdominal aortic aneurysm (AAA). It uncouples the stages of stent-graft fixation and sealing with the suprarenal fixation achieved with a long, rigid anchored stent while the sealing onto the neck is accomplished via a pair of polymer-filled inflatable rings that accommodate to each patient's individual anatomy. Moreover, the lack of Nitinol support enables lower profiles of the endograft's delivery system, thus facilitating the navigation through angulated and stenosed iliac vessels. Ovation's novel design expands further the AAA eligibility to endovascular repair. This article discusses the clinical and hemodynamic consequences of the Ovation design and contributes to better understanding of current and future implications. PMID:26822951

  1. Abdominal Aortic Aneurysm : Epidemiological and Health Economic Aspects

    OpenAIRE

    Mani, Kevin

    2010-01-01

    Abdominal aortic aneurysm (AAA) is a common disease that is life threatening when rupture occurs. The aims of this thesis were to study (I) the long-term survival after AAA repair, (II) the cost of repair with open (OR) and endovascular (EVAR) technique, (III) the effect of different statistical methods on interpretation of cost data, (IV) the prevalence of the disease among patients with suspected arterial disease referred to the vascular laboratory, and (V) the cost-effectiveness of selecti...

  2. Renal autotransplantation in open surgical repair of suprarenal abdominal aortic aneurysm

    Science.gov (United States)

    Min, Eun-Ki; Kim, Young Hoon; Han, Duck Jong; Han, Youngjin; Kwon, Hyunwook; Choi, Byung Hyun; Park, Hojong; Choi, Ji Yoon; Kwon, Tae-Won

    2015-01-01

    Although the standard treatment of abdominal aortic aneurysm has shifted from open surgery to endovascular repair, open surgery has remained the standard of care for complex aneurysms involving the visceral arteries and in patients unsuitable for endovascular aneurysm repair. Postoperative renal insufficiency may occur after open surgical repair of suprarenal abdominal aortic aneurysm. Methods of minimizing renal ischemic injury include aortic cross-clamping and renal reconstruction techniques. This report describes the use of renal autotransplantation for renal reconstruction during open surgical repair of a suprarenal abdominal aortic aneurysm. This technique was successful, suggesting its feasibility for open suprarenal abdominal aortic aneurysm repair, minimizing renal ischemic injury and optimizing postoperative renal function. PMID:26131445

  3. ["Arteriosclerotic" aneurysm of the abdominal aorta].

    Science.gov (United States)

    Stein, S D; Baldi, T; Uthoff, H; Jäger, K A

    2010-09-01

    We present a patient with an aortic aneurysm and the epidemiology, etiology, screening, symptoms and therapeutic options of abdominal aortic aneurysms are discussed. A widening of the abdominal aorta >3 cm is termed aortic aneurysm. As patients with aortic aneurysm are mostly oligosymptomatic until rupture occurs and an estimated 30,000 patients annually die from ruptured aortic aneurysm in the US a screening of the population at greatest risk (smokers, familial predisposition) is recommended. Screening is best done by ultrasound. Noninvasive therapy is limited to antiplatelet therapy and optimal adjustment of risk factors. For definitive treatment endovascular aortic repair (EVAR) is considered an established alternative to open surgery with lower 30 days mortality but higher reintervention rate. PMID:20824610

  4. Open surgical repair of abdominal aortic aneurysm: Proximal aortic control by endoaortic balloon - A novel approach

    Directory of Open Access Journals (Sweden)

    Balakrishnan Soundaravalli

    2012-01-01

    Full Text Available Patients with infrarenal abdominal aortic aneurysm with unfavorable anatomy for endovascular aneurysm repair have to undergo open surgical repair. Open surgery has its own morbidity in terms of proximal clamping and declamping, bleeding and prolonged hospital stay and mortality. We present two such patients with juxtarenal abdominal aortic aneurysm who underwent open surgical repair. The proximal aortic control during open surgical repair of the aneurysm was achieved by endoaortic balloon occlusion technique.

  5. Endovascular Treatment of a Carotid Dissecting Pseudoaneurysm in a Patient with Ehlers-Danlos Syndrome Type IV with Fatal Outcome

    International Nuclear Information System (INIS)

    We present a patient with Ehlers-Danlos syndrome type IV (EDS IV) with a carotid dissecting pseudoaneurysm causing severe carotid stenosis. This lesion was treated endovascularly. Unfortunately, the patient died of remote vascular catastrophes (intracranial hemorrhage and abdominal aortic rupture). This unique case illustrates the perils of endovascular treatment of EDS IV patients and the need for preoperative screening for concomitant lesions. It also shows that a dissecting pseudoaneurysm can feasibly be treated with a covered stent and that closure is effective using Angioseal in patients with EDS IV

  6. Fístula aortocava como complicación de aneurisma aórtico abdominal / Aortocaval fistula as a complication of abdominal aortic aneurysm

    Scientific Electronic Library Online (English)

    Carlo, Zúñiga G; José Ramón, Rodríguez A; Patricio, Cáceres G.

    2011-12-01

    Full Text Available La fístula aortocava (FAC) es una complicación infrecuente del aneurisma aórtico abdominal (AAA). El diagnóstico se sospecha por la detección de un soplo continuo en el hemiabdomen inferior, asociado a masa abdominal pulsátil y signos variables de congestión venosa e insuficiencia cardíaca. La tomog [...] rafía computada multicorte (TCM) permite confirmar el diagnóstico, evidenciando contraste de la vena cava inferior en fase arterial e identificando la zona anatómica de la comunicación arteriovenosa, en algunos casos. La reparación quirúrgica suele ser compleja, reportándose una alta morbi-mortalidad asociada. El uso de técnicas endovasculares pareciera mejorar el pronóstico de esta entidad. Reportamos un caso de FAC tratado mediante cirugía abierta. Se incluye una revisión de la literatura respecto a esta rara condición. Abstract in english Aortocaval fistula (ACF) is an infrequent complication of abdominal aortic aneurysm (AAA). Diagnosis is suspected by the presence of a continuous abdominal bruit and pulsatile abdominal mass, with variable signs of venous congestion and acute heart failure. Multislice computed tomography (MSCT) is u [...] seful in establishing the diagnosis, showing early enhancement of inferior vena cava and, in some cases, identifying the arteriovenous comunication. Surgical treatment is usually complex, with high morbidity and mortality rates. Endovascular treatment seems to be a promising alternative for the management of these patients. We report a case of ACF treated with open surgery and a literature review of this rare condition.

  7. Tratamiento Antimicrobiano

    Scientific Electronic Library Online (English)

    Amando, Martín Peña; Lisbeth, Aurenty; Ángela, Troncone Azocar; José Vicente, Franco Soto.

    2010-12-01

    Full Text Available Las Meningitis Bacterianas Agudas (MBA) siguen constituyendo un capítulo de extraordinario interés dentro de los procesos infecciosos. El conocimiento de la epidemiología local es fundamental. La terapia específica con antibióticos debe ser aplicada en forma precoz, con drogas bactericidas de buena [...] concentración en líquido cefalorraquídeo. El conocimiento de la resistencia de los gérmenes causales de las MBA es capital para el logro de un tratamiento eficaz, buscando la menor morbi-mortalidad posible. Cada paciente debe individualizarse en función de la edad, factores asociados y evolución del caso. Abstract in english Acute bacterial meningitis (ABM) remains a chapter of extraordinary interest in infectious processes. Knowledge of local epidemiology is essential. Specific therapy with the use of antibiotics must be used early, using antibacterial drugs with good concentration in cerebrospinal fluid. Knowledge of [...] the resistance of the causative organisms of the MBA is valuable in achieving an effective treatment, seeking the lowest possible morbidity and mortality. Each patient should be individualized for each patient age, associated factors and its evolution. Treatment should be individualized for each patient age, associated factors and clinical course.

  8. Complications after Endovascular Aneurysm Repair

    OpenAIRE

    Maleux, Geert; Koolen, Marcel; Heye, Sam

    2009-01-01

    Endovascular aneurysm repair (EVAR) has become an established technique for the treatment of many infrarenal aortic aneurysms. Although EVAR is obviously less invasive than open surgical repair, it is not free of complications. These can potentially result in severe morbidity or even mortality, stressing the need for an early detection and subsequent treatment. In this review article, the pathophysiology, diagnosis, and treatment of the most common complications of EVAR, with the exception of...

  9. Contemporary Endovascular Embolotherapy for Meningioma

    OpenAIRE

    Dubel, Gregory J.; Ahn, Sun Ho; Soares, Gregory M.

    2013-01-01

    Preoperative endovascular tumor embolization has been used for 40 years. Meningiomas are the most common benign intracranial tumor in which preoperative embolization has been most extensively described in the literature. Advocates of embolization report that it reduces operative blood-loss, and softens the tumor, thus making surgery safer and easier. Opponents suggest that it adds additional risk and cost for patients without controlled studies showing conclusive benefit. The literature sugge...

  10. Abdominal wall surgery

    Science.gov (United States)

    Abdominal wall surgery is a procedure that improves the appearance of flabby, stretched-out abdominal (belly) muscles and skin. ... mini-tummy tuck to more extensive surgery. Abdominal wall surgery is not the same as liposuction, which ...

  11. [Endovascular treatment for cerebral aneurysms].

    Science.gov (United States)

    Hoya, Katsumi; Hyodo, Akio

    2009-09-01

    Endovascular therapy for cerebral aneurysms has been possible since the advent of Guglielmi detachable coils. The International Subarachnoid Aneurysm Trial (ISAT) showed that the 1-year outcome of endovascular coiling for ruptured aneurysms was significantly better than that of neurosurgical clipping. After the ISAT study, remarkably high numbers of aneurysms have been treated using coils across the world. Digital subtraction angiography (DSA) system and its road map function are also essential for endovascular therapy. Three-dimensional DSA is helpful in understanding the anatomy of an aneurysm that has to be treated and determining the working angle for coiling. The biplane system is also useful for embolization. Many kinds of coils such as three-dimensional shaped coils and stretch-resistant coils have been invented. These coils, in combination with balloon-or stent-assisted techniques, enable the treatment of difficult aneurysms such as those with wide necks. Bioactive coils allow the healing of aneurysm by promoting tissue reaction. However, it is difficult to cure very large and giant aneurysms even with the new coils. Hence flow-diverting stents and Onyx are being clinically tested for the treatment of such cases. PMID:19803402

  12. Endovascular treatment of thoracic aortic aneurysms: a review

    International Nuclear Information System (INIS)

    Open surgical repair is considered the traditional treatment for patients with thoracic aortic aneurysms (TAA). In view of the persistent perioperative mobidity and mortality, endovascular stent-graft placement as a minimally invasive and potentially safer treatment for aneurysm of the descending aorta was introduced in 1992. Since then, progress has been made and several institutions have substantiated the safety and effectiveness of stent grafts in the repair of descending TAAs or type-B aortic dissections. Currently, both custom-designed, home-made, and commercially available stent grafts are used. Prior to placement of the endoprosthesis, three major prerequisites must be considered: the localization and morphology of the aneurysm; the distal vascular access of sufficient size; and a limited tortuosity of the abdominal and thoracic aorta. Although short-term results are encouraging, severe complications, including paraplegia, cerebral strokes, and aortic rupture, have been encountered. The long-term durability of currently available stent-graft systems is nonexistent and material fatigue are of major concern to both surgeons and radiologists. Nevertheless, endovascular stent-graft placement could become the procedure of choice in a substantial number of patients with descending TAA. (orig.)

  13. Endovascular treatment of thoracic aortic aneurysms: a review

    Energy Technology Data Exchange (ETDEWEB)

    Thurnher, Siegfried A. [Department of Radiology, University Hospital, Wien (Austria); Grabenwoeger, Martin [Department of Cardio-Thoracic Surgery, University of Vienna (Austria)

    2002-06-01

    Open surgical repair is considered the traditional treatment for patients with thoracic aortic aneurysms (TAA). In view of the persistent perioperative mobidity and mortality, endovascular stent-graft placement as a minimally invasive and potentially safer treatment for aneurysm of the descending aorta was introduced in 1992. Since then, progress has been made and several institutions have substantiated the safety and effectiveness of stent grafts in the repair of descending TAAs or type-B aortic dissections. Currently, both custom-designed, home-made, and commercially available stent grafts are used. Prior to placement of the endoprosthesis, three major prerequisites must be considered: the localization and morphology of the aneurysm; the distal vascular access of sufficient size; and a limited tortuosity of the abdominal and thoracic aorta. Although short-term results are encouraging, severe complications, including paraplegia, cerebral strokes, and aortic rupture, have been encountered. The long-term durability of currently available stent-graft systems is nonexistent and material fatigue are of major concern to both surgeons and radiologists. Nevertheless, endovascular stent-graft placement could become the procedure of choice in a substantial number of patients with descending TAA. (orig.)

  14. Emergent Endovascular Stent Grafts for Ruptured Aortic Aneurysms.

    Science.gov (United States)

    Montgomery, Jennifer P; Kolbeck, Kenneth J; Kaufman, John A

    2015-09-01

    Ruptured aortic aneurysms uniformly require emergent attention. Historically, urgent surgical repair or medical management was the only treatment options. The development of covered stent grafts has introduced a third approach in the care of these critical patients. The clinical status of the patient and local physician expertise drive the treatment modalities in the majority of cases. The goal of therapy in these patients is to stabilize the patient as quickly as possible, establish maximum survival with minimum morbidity, and provide a long lasting result. The endovascular approach has become an acceptable treatment option in an increasing number of patients presenting with ruptured aneurysmal disease of both the descending thoracic and abdominal aorta. Major factors influencing treatment include patient clinical status, characteristics of the aorta, physician preference, institutional experience, and availability of appropriate equipment. Planning, experience, and the ability to improvise effective solutions are keys to the success of the procedure when endovascular techniques are utilized. Three separate cases, requiring intraprocedural improvisation, are presented followed by a review of the literature. PMID:26327743

  15. Endovascular Stent-Graft Treatment of Giant Celiac Artery Pseudoaneurysm

    Science.gov (United States)

    Tuncel, Sedat Alpaslan; Gülcü, Aytaç; Y?lmaz, Erdem; Çiftçi, Taner; Göktay, Ahmet Yi?it

    2015-01-01

    Summary Background Visceral artery aneurysms (VAAs) comprise an uncommon but life-threatening vascular disease. When rupture is the first clinical presentation, mortality rate reaches 70%. Increased use of cross-sectional imaging has led to a greater rate of diagnosis (40–80%) of asymptomatic VAAs. In the past, surgery was the treatment of choice for VAAs carrying high risk of mortality and morbidity. Case Report A 22-year-old man, who had undergone gastric, pancreatic and aortic surgery 2.5 years earlier, presented with progressive abdominal pain. Multidetector computed tomography scan revealed an 8-cm celiac pseudoaneurysm. We report a giant celiac pseudoaneurysm treated with stent-graft implantation. Conclusions Endovascular treatment of VAA is a safe and effective method alternative to surgery. PMID:26236417

  16. Abdominal trauma

    International Nuclear Information System (INIS)

    Radiologic evaluation of abdominal trauma must provide a quick and accurate assessment of the lesions in order to improve the management of the patient. The technique used varies depending on the mechanism of the trauma (blunt trauma or stab wounds) and the hemodynamic status. Radiologic evaluation is usually performed in blunt trauma whereas stab wound trauma is usually explored surgically. The various techniques available are standard radiographs, ultrasonography, computed tomography and arteriography. The role of magnetic resonance imaging in the immediate evaluation is still not well defined. It appears to be useful method in the delayed evaluation of diaphragmatic trauma. Computed tomography is the method most commonly performed in trauma patients. This technique is accurate and allows correct assessment of the lesions. The disadvantages are the radiation induced and the need for a hemo-dynamically stable patient. The aim of the radiologic evaluation is to provide the clinicians with an accurate description of the lesions. It can help in the management of the patient usually in association with clinical and laboratory data. It can also guide interventional procedures (drainage, embolization...). Finally, it allows radiographic follow-up when conservative treatment is performed. (authors). 26 refs., 11 figs., 1 tab

  17. Vascular training and endovascular practice in Europe

    DEFF Research Database (Denmark)

    Liapis, C.D.; Avgerinos, E.D.

    2009-01-01

    OBJECTIVE: To evaluate the influence of the status of vascular surgery (VS) training paradigms on the actual practice of endovascular therapy among the European countries. METHODS: An email-based survey concerning vascular surgery training models and endovascular practices of different clinical specialties was distributed to a VS educator within 14 European countries. European Vascular and Endovascular Monitor (EVEM) data also were processed to correlate endovascular practice with training models. RESULTS: Fourteen questionnaires were gathered. Vascular training in Europe appears in 3 models: 1. Mono-specialty (independence): 7 countries, 2. Subspecialty: 5 countries, 3. An existing specialty within general surgery: 2 countries. Independent compared to non-independent certification shortens overall training length (5.9 vs 7.9 years, p=0.006), while increasing overall training devoted specifically to VS (3.9 vs 2.7 years, p=0.008). Among countries with independent certification an average of 76% of aortic and 50% of peripheral endovascular procedures are performed by vascular surgeons, while the corresponding values, for countries with a non-independent certification, are 69% and 36% respectively. Countries with independent vascular certification, despite their lower average endovascular index (procedures per 100,000 population), reported a higher growth rate of aortic endovascular procedures (VS independent 132% vs VS non-independent 87%), within a four-year period (2003-2007). Peripheral endovascular procedures, though, have similar growth rates in both country groups (VS independent 62% vs VS non-independent 60%). CONCLUSIONS: In European countries with VS as an independent specialty, vascular surgeons have a shorter total training period but spend more time in VS training, although they may not undertake a greater proportion of the endovascular procedures their countries appear to have adopted endovascular technologies more rapidly compared to the ones with non-independent VS curricula. Whether such differences influence patient outcomes requires investigation in future studies Udgivelsesdato: 2009/1

  18. Abdominal aortic aneurysm: Treatment options, image visualizations and follow-up procedures

    Directory of Open Access Journals (Sweden)

    Zhong-Hua Sun

    2012-03-01

    Full Text Available Abdominal aortic aneurysm is a common vascular disease that affects elderly population. Open surgical repair is regarded as the gold standard technique for treatment of abdominal aortic aneurysm, however, endovascular aneurysm repair has rapidly expanded since its first introduction in 1990s. As a less invasive technique, endovascular aneurysm repair has been confirmed to be an effective alternative to open surgical repair, especially in patients with co-morbid conditions. Computed tomography (CT angiography is currently the preferred imaging modality for both preoperative planning and post-operative follow-up. 2D CT images are complemented by a number of 3D reconstructions which enhance the diagnostic applications of CT angiography in both planning and follow-up of endovascular repair. CT has the disadvantage of high cummulative radiation dose, of particular concern in younger patients, since patients require regular imaging follow-ups after endovascular repair, thus, exposing patients to repeated radiation exposure for life. There is a trend to change from CT to ultrasound surveillance of endovascular aneurysm repair. Medical image visualizations demonstrate excellent morphological assessment of aneurysm and stent-grafts, but fail to provide hemodynamic changes caused by the complex stent-graft device that is implanted into the aorta. This article reviews the treatment options of abdominal aortic aneurysm, various image visualization tools, and follow-up procedures with use of different modalities including both imaging and computational fluid dynamics methods. Future directions to improve treatment outcomes in the follow-up of endovascular aneurysm repair are outlined.

  19. Endovascular Repair of Complex Aortic Aneurysms: Intravascular Ultrasound Guidance with an Intracardiac Probe

    International Nuclear Information System (INIS)

    To assess the accuracy and efficacy of intravascular ultrasound guidance obtained by an intracardiac ultrasound probe during complex aortic endografting. Between November 1999 and July 2002, 19 patients (5 female, 14 male; mean age 73.5 ± 2.1 years) underwent endovascular repair of thoracic (n = 10), complex abdominal (n = 6) and concomitant thoraco-abdominal (n = 3) aortic aneurysm. The most suitable size and configuration of the stent-graft were chosen on the basis of preoperative computed tomographic angiography (CTA) or magnetic resonance angiography (MRA). Intraoperative intravascular ultrasound imaging was obtained using a 9 Fr, 9 MHz intracardiac echocardiography (ICE) probe, 110 cm in length, inserted through a 10 Fr precurved long sheath. The endografts were deployed as planned by CTA or MRA. Before stent-graft deployment, the ICE probe allowed us to view the posterior aortic arch and descending thoraco-abdominal aorta without position-related artifacts, and to identify both sites of stent-graft positioning. After stent-graft deployment, the ICE probe allowed us to detect the need for additional modular components to internally reline the aorta in 11 patients, and to discover 2 incomplete graft expansions subsequently treated with adjunctive balloon angioplasty. In 1 patient, the ICE probe supported the decision that the patient was ineligible for the endovascular exclusion procedure. The ICE probe provides accurate information on the anatomy of the posterior aortic arch and thoracic and abdominal aortic aneurysms and a rapid identification of attachment sites and stent-graft pathology, allowing refinement and improvement of the endovascular strategy

  20. Tratamiento percutaneo de aneurismas aorto-ilíacos Percutaneous treatment of aorto-iliac aneurysm

    Directory of Open Access Journals (Sweden)

    CARLO ZÚÑIGA G

    2008-10-01

    Full Text Available Introducción: La reparación endovascular de aneurismas abdominales e ilíacos requiere de la introducción de dispositivos de alto calibre (> 16 F mediante denudación de arterias femorales. Mediante una variación técnica, el sistema de sutura arterial percutanea Prostar-XL® (Abbott, EEUU permite el acceso arterial percutaneo evitando la denudación. Objetivo: Analizar la experiencia inicial en el tratamiento percutaneo de aneurismas del territorio aorto-ilíaco. Material y Método: Revisión de las historias clínicas y base de datos de pacientes tratados con sutura arterial percutanea, entre octubre de 2003 y abril de 2008. Resultados: Tratamos 22 pacientes con esta técnica (20 hombres y 2 mujeres. Dieciséis portadores de aneurisma aórtico abdominal, 3 aneurismas ilíacos, 2 reparaciones de endofuga y un aneurisma hipogástrico. La edad promedio fue 72,6 años (rango 56-86. Se utilizó el sistema Prostar XL® para sutura percutanea en 37 arterias femorales. La anestesia más utilizada fue peridural en el 50% de los pacientes. En 7 casos (31,8% se efectuó la operación exclusivamente con anestesia local. El diámetro de los dispositivos de endoprótesis fue de 16 a 23 F. Se obtuvo éxito técnico en 34 cierres (92%. Tres arterias requirieron reparación quirúrgica tradicional. No hubo mortalidad operatoria. Durante el seguimiento (promedio 12,6 meses, rango 1-53 no se registraron falsos aneurismas femorales ni infección. Discusión: El cierre percutaneo en la reparación endovascular de aneurismas aorto-ilíacos es un procedimiento mínimamente invasivo, seguro y efectivo, que permite eventualmente el uso de anestesia local.Introduction: Endovascular repair of aortic (AAA and iliac artery aneurysms requires introduction and deployment of large bore devices (> 16 F through surgical exposure of the femoral artery. The Prostar XL ® arterial suture system allows the introduction of such devices without the need for surgical exposure. Aim: To report our initial experience with percutaneous arterial closure during aneurysm endografting. Methods: We reviewed records and datábase of patients treated with this technique between October2003 and April 2008. Results: We treated 22 patients with this technique (20 men and 2 women, average age 72 years. Sixteen had AAA, 3 iliac artery aneurysm, 1 hypogastric aneurysm and two for endoleak repair. The percutaneous closure device was used in 37 femoral arteries. In 7 patients (31,8% the operation was completed entirely under local anaesthesia. The diameter of the devices ranged between 16 and 23 F. Technical success was obtained in 34 arteries (92%. Three arteries required surgical repair due to inadequate haemostasis (sheaths 18, 21, and 21 F. There was no operative mortality. During follow-up (mean 12,6 months, range 1-53 no false aneurysm or infection at the puncture site has been registered and the patients remain free of complications. Discussion: Percutaneous arterial closure in endovascular aneurysm repair is a safe, minimally invasive and effective procedure which allows resolving theses serious conditions in selected patients.

  1. Cervical mycotic aneurysm in an infant. MRI findings and endovascular treatment

    International Nuclear Information System (INIS)

    A case of cervical mycotic aneurysm in a 6-month-old infant is presented. Eight days after birth the preterm newborn had a perforated necrotizing enterocolitis. Treatment included abdominal percutaneous drainage and surgery. Hemo cultures grew staphylococcus aureus methicillin resistant. Antibiotic therapy was indicated with a favorable evolution. Five months later the infant showed a lateral cervical mass nad hemorrhagic fluid in her right external auditory canal. Ultrasound and MRI were performed. MRI demonstrated a heterogeneous fluid-containing neck mass, similar in appearance to a parapharyngeal hematoma, with flow void sign. Digital substraction angiography (DSA) was performed to highlight the vascular anatomy demonstrating a mycotic aneurysm adjacent to the ascendent pharyngeal artery. The endovascular treatment with Histoacryl-Lipiodol was successful without any technical or neurological complications. Mycotic aneurysm is a very rare, but potentially fatal complication in infants. In our case report, MRI and DSA provided an accurate diagnosis leading to a rapid endovascular therapy. (author)

  2. Effects of electrocautery to provoke endovascular thermal injury / Efeitos do eletrocautério para provocar lesão térmica endovascular

    Scientific Electronic Library Online (English)

    Fabio Henrique, Rossi; Nilo Mitsuru, Izukawa; Domingos Guerino, Silva; Juliana, Chen; Akash Kuzhiparambil, Prakasan; Mabel Moura Barros, Zamorano; Lílian Mary, Silva.

    2011-10-01

    Full Text Available OBJETIVO: Investigar os efeitos de um modelo experimental de eletrocautério em provocar lesão venosa térmica endovascular. MÉTODOS: O eletrocautério endovascular foi colocado dentro de oito modelos experimentais de veia safena bovina. Cada uma foi dividida em oito segmentos e intensidades progressiv [...] as de energia elétrica liberada. Os efeitos macroscópicos e microscópicos foram analisados. RESULTADOS: Foram estudados quarenta segmentos de veia safena bovina. Quanto maior a energia elétrica aplicada pelo eletrocauterizador endovascular maiores foram as alteraçoes de picnose nuclear e mais intensa a retração citoplasmática observada. CONCLUSÃO: O eletrocautério endovascular experimental demonstrou ser capaz de induzir a destruição da camada íntima e provocar lesão térmica endovascular. Abstract in english PURPOSE: To investigate the effects of a new electrocautery device to provoke endovascular venous thermal injury. METHODS: An experimental endovascular electrocautery was placed inside eight ex-vivo bovine saphenous veins models. Each one was divided in eight segments and progressive intensities of [...] electric energy liberated. The macroscopic and microscopic effects were analyzed. RESULTS: Forty bovine saphenous veins segments were studied. The higher the electric energy applied the greater the nuclear picnosis and more intense the cytoplasmatic shrinkage and electrocoagulation effects. CONCLUSION: The experimental endovascular electrocautery device demonstrated to be both capable of inducing the destruction of the intimal layers of the studied vein model and provoke endovascular thermal injury.

  3. Effects of electrocautery to provoke endovascular thermal injury Efeitos do eletrocautério para provocar lesão térmica endovascular

    Directory of Open Access Journals (Sweden)

    Fabio Henrique Rossi

    2011-10-01

    Full Text Available PURPOSE: To investigate the effects of a new electrocautery device to provoke endovascular venous thermal injury. METHODS: An experimental endovascular electrocautery was placed inside eight ex-vivo bovine saphenous veins models. Each one was divided in eight segments and progressive intensities of electric energy liberated. The macroscopic and microscopic effects were analyzed. RESULTS: Forty bovine saphenous veins segments were studied. The higher the electric energy applied the greater the nuclear picnosis and more intense the cytoplasmatic shrinkage and electrocoagulation effects. CONCLUSION: The experimental endovascular electrocautery device demonstrated to be both capable of inducing the destruction of the intimal layers of the studied vein model and provoke endovascular thermal injury.OBJETIVO: Investigar os efeitos de um modelo experimental de eletrocautério em provocar lesão venosa térmica endovascular. MÉTODOS: O eletrocautério endovascular foi colocado dentro de oito modelos experimentais de veia safena bovina. Cada uma foi dividida em oito segmentos e intensidades progressivas de energia elétrica liberada. Os efeitos macroscópicos e microscópicos foram analisados. RESULTADOS: Foram estudados quarenta segmentos de veia safena bovina. Quanto maior a energia elétrica aplicada pelo eletrocauterizador endovascular maiores foram as alteraçoes de picnose nuclear e mais intensa a retração citoplasmática observada. CONCLUSÃO: O eletrocautério endovascular experimental demonstrou ser capaz de induzir a destruição da camada íntima e provocar lesão térmica endovascular.

  4. Endovascular interventional therapy for acute limb ischemia

    International Nuclear Information System (INIS)

    Acute limb ischemia is an urgent and common clinical condition which occurs when the blood flow to a certain extremity is suddenly blocked b either embolic agent or thrombotic vascular lesion. Prompt restoration of perfusion through early intervention can significantly decrease the incidence of amputation and mortality. The main therapeutic methods include surgical operation and endovascular interventional technique. For recent years, considerable progress in treating acute limb ischemia with endovascular interventional technique has been achieved. This article aims to make a comprehensive review in respect of the endovascular intervention therapy for acute limb ischemia. (authors)

  5. Endovascular repair of an aorto-iliac aneurysm succeeded by kidney transplantation Tratamento endovascular de aneurisma aorto-ilíaco sucedido por transplante renal

    Directory of Open Access Journals (Sweden)

    Marcelo Bellini Dalio

    2010-09-01

    Full Text Available We present the case of aorto-iliac aneurysm in a patient with chronic renal failure requiring dialysis who were treated with an endovascular stent graft and, later on, submitted to kidney transplantation. A 53-year-old male with renal failure requiring dialysis presented with an asymptomatic abdominal aorto-iliac aneurysm measuring 5.0cm of diameter. He was treated with endovascular repair technique, being used an endoprosthesis Excluder®. After four months, he was successfully submitted to kidney transplantation (dead donor, with anastomosis of the graft renal artery in the external iliac artery distal to the endoprosthesis. The magnetic resonance imaging, carried out 30 days after the procedure, showed a good positioning of the endoprosthesis and adequate perfusion of the renal graft. In the follow-up, the patient presented improvement of nitrogenous waste, good positioning of the endoprosthesis without migration or endoleak. The endovascular repair of aorto-iliac aneurysm in a patient with end-stage renal failure under hemodialysis treatment showed to be feasible, safe and efficient, as it did not prevent the success of the posterior kidney transplantation.Apresentamos o caso de aneurisma aortoilíaco em um paciente com insuficiência renal crônica dialítica tratado com uma endoprótese vascular, sendo, após, submetido a transplante renal. Um homem de 53 anos com insuficiência renal dialítica apresentava um aneurisma abdominal aortoilíaco assintomático com 5,0cm de diâmetro. Foi tratado com técnica endovascular com uma endoprótese Excluderâ. Após quatro meses, foi submetido a transplante renal (doador cadáver com sucesso, com anastomose da artéria renal do enxerto na artéria ilíaca externa distal à endoprótese. A ressonância magnética 30 dias após o procedimento mostrou a endoprótese bem posicionada e o enxerto renal bem perfundido. No seguimento, o paciente evoluiu com melhora das escórias nitrogenadas, bom posicionamento da endoprótese, sem migração ou endoleak. O reparo endovascular do aneurisma aortoilíaco em paciente com insuficiência renal terminal em hemodiálise mostrou-se exequível, seguro e eficaz, e não comprometeu o sucesso do transplante renal posterior.

  6. Videolaparoscopia en el trauma abdominal / Videolaparoscopy in abdominal trauma

    Scientific Electronic Library Online (English)

    Justo, Escalona Cartaya; Zenén, Rodríguez Fernández; Modesto, Matos Tamayo.

    2012-03-01

    Full Text Available Introducción: la videolaparoscopia realizada de urgencia es uno de los avances tecnológicos más importantes para el diagnóstico precoz y el tratamiento oportuno de las afecciones abdominales agudas que incluyen las de causa traumática. Objetivo: caracterizar a pacientes con trauma abdominal sometido [...] s a videolaparoscopia de urgencia, según variables seleccionadas, e identificar algunos aspectos concernientes a la aplicación de esta técnica en nuestro medio. Métodos: se realizó un estudio observacional descriptivo de 18 pacientes ingresados por trauma abdominal en el servicio de Cirugía General del Hospital Universitario "Saturnino Lora", de Santiago de Cuba, durante los años 2006-2007, a los que se les realizó videolaparoscopia de urgencia. Resultados: predominaron los hombres jóvenes y los traumas abiertos. La ecografía y la punción abdominales fueron los métodos diagnósticos más utilizados. En los dos tercios de la serie la videolaparoscopia fue negativa o diagnosticó violación peritoneal simple. El hígado fue la víscera más frecuentemente lesionada. Para el acceso videolaparoscópico se necesitaron dos puertos en la mayoría de la serie. Dos pacientes requirieron laparotomía convencional, para un índice de conversión de 11,1 %, por lo que se evitaron 16 laparotomías innecesarias. El tiempo quirúrgico y la estadía hospitalaria posoperatoria fueron menores en la cirugía videolaparoscópica que en la laparotomía convencional. Conclusiones: la videolaparoscopia realizada con urgencia puede considerarse una herramienta de probada utilidad para el diagnóstico y tratamiento de los pacientes con traumatismos abdominales, porque evita un número considerable de laparotomías innecesarias y permite un aceptable margen de seguridad en la medida en que el cirujano perfeccione y domine esta tecnología. Abstract in english Introduction: the video-laparoscopy carried out with emergency is one of the more important technological advances for an early diagnosis and the timely treatment of acute abdominal affections including those of traumatic cause. Objective: to characterize patients with abdominal trauma submitted to [...] videolaparoscopia of urgency according to the selected variables and to identify some features related to the implementation of this technique in our context. Methods: a descriptive and observational study was conducted in 18 patients admitted due to abdominal trauma in the service of general surgery of the "Saturnino Lora" University Hospital of Santiago de Cuba province from 2006 to 2007, who underwent emergency video-laparoscopy. Results: there was predominance of young men and of open traumata. The echography and the abdominal puncture were the more used diagnostic methods. In the two third of the series, the video-laparoscopy was negative or diagnosed a simple peritoneal violation. The liver was the more frequent injured viscus. For the videolaparoscopy access are necessary two ports in most of series. Two patients required conventional laparotomy for a conversion rate of 11.1 % avoinding 16 unnecessary laparotomies. The surgical time and the postoperative hospital stay were less in the videolaparoscopy surgery than in the conventional laparotomy. Conclusions: the videolaparoscopy carried out with emergency may be considered a tool of usefulness demonstrated for diagnosis and treatment of patients presenting with abdominal traumata because of it avoids many unnecessary laparotomies and allows an acceptable degree of certainty insofar as the surgeon improve and dominate this technology.

  7. Linfangioma abdominal: Caso clínico Abdominal lymphangioma

    Directory of Open Access Journals (Sweden)

    Ignacia Torrealba A

    2012-02-01

    Full Text Available El linfangioma abdominal es una patología poco frecuente, benigna que corresponde a una malformación congénita del desarrollo linfático mesentérico y/o retroperitoneal. Es más frecuente en población infantil. Objetivo: Reportar un caso con presentación atípica de linfangioma. Caso clínico: Paciente de 2 años varón, previamente sano, que se presenta con dolor abdominal, luego lipotimia y palidez generalizada tras recibir un masaje abdominal. Al examen físico se encontró una masa abdominal, sin hepatomegalia, esplenomegalia ni adenopatías palpables. Presentaba un hematocrito de 17,3%. La Ecografía mostró una gran masa retrope-ritoneal con áreas anecogénicas y septos vascularizados. La TAC mostró hallazgos similares: masa quísti-ca, lobulada probablemente determinada por linfangioma abdominal. Se realizó extirpación quirúrgica y la biopsia confirma el diagnóstico. Discusión: El linfangioma abdominal es una patología infrecuente en niños. La presentación clínica es variable, puede ser desde asintomático hasta presentarse con abdomen agudo. Se requiere estudio imagenológico para su evaluación preoperatoria. La ecografía y TAC tienen un importante rol diagnóstico, en localización, tamaño, anatomía circundante y posibles complicaciones.Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics, more frequent in pediatrics. Objective: To report a case with unusual clinical presentation of lymphangioma. Clinical Case: A two-year old boy previously health who presented with abdominal pain, lipothymia, and generalized pallor ensuing an abdominal massage. Abnormal findings included an abdominal mass and Ht of 17.3%. Sonogram showed a large retroperitoneal mass with anechogenic areas and vasculari-zed septi. CT scans showed similar results. Surgical removal and biopsy confirmed the diagnosis. Discusion: Abdominal lymphangioma is uncommon in children, presentation varies from asymptomatic to acute abdomen. Images are essential in diagnosis and pre-op studies.

  8. Helical CT of abdominal aorta; Angioscanner helicoidal de l'aorte abdominale

    Energy Technology Data Exchange (ETDEWEB)

    Bourlet, P.; Garnier, J.M.; Alfidja, A.; Lipiecka, E.; Chahid, T.; Privat, C.; Ravel, A.; Boyer, L. [Centre Hospitalier Universitaire Montpied, Service de Radiologie B Viscerale et Vasculaire, 63 - Clermont Ferrand (France)

    2005-01-15

    The purpose was to illustrate that single or multi-row spiral CT angiography has become the main modality for the examination of the abdominal aorta. Our multidisciplinary group investigates weekly 15 abdominal aortas, with a single slice spiral CT since 1995, and a 4 row detector spiral CT since 1999. CT scans protocols and parameters optimization for the 2 CT systems are described. Indications and results of CT to investigate the various abdominal aortic diseases are illustrated and discussed: aneurysms (pre-therapeutic staging, selection of indications of endovascular stent-grafting); obstructive aorto-arterio-pathies (pre-therapeutic staging, follow up after endovascular revascularization); dissection (diagnosis, pre-therapeutic staging, follow up); inflammatory diseases; normal patterns and principal complications after surgery. Situations where multislice CT is superior to single slice CT and compared advantages of MRI are discussed. CT is at the present time the main technique to image abdominal aorta. Multislice CT is especially interesting to explore the whole aorta, poly traumatisms, and to plan and follow up endovascular treatments. (author)

  9. Renal Vascular Lesions: Diagnosis and Endovascular Management

    OpenAIRE

    Chimpiri, A. Rao; Natarajan, Balasubramani

    2009-01-01

    Renal vascular abnormalities included in this review are renal artery aneurysms (RAA) and renal arteriovenous malformations (AVM). The clinical presentation, diagnosis, and principles of management with emphasis on endovascular techniques are discussed.

  10. Imaging and management of complications of open surgical repair of abdominal aortic aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Nayeemuddin, M. [Department of Interventional Radiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent (United Kingdom); Pherwani, A.D. [Department of Vascular Surgery, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent (United Kingdom); Asquith, J.R., E-mail: john.asquith@uhns.nhs.uk [Department of Interventional Radiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent (United Kingdom)

    2012-08-15

    Open repair is still considered the reference standard for long-term repair of abdominal aortic aneurysms (AAA). In contrast to endovascular aneurysm repair (EVAR), patients with open surgical repair of AAA are not routinely followed up with imaging. Although complications following EVAR are widely recognized and routinely identified on follow-up imaging, complications also do occur following open surgical repair. With frequent use of multi-slice computed tomography (CT) angiography (CTA) in vascular patients, there is now improved recognition of the potential complications following open surgical repair. Many of these complications are increasingly being managed using endovascular techniques. The aim of this review is to illustrate a variety of potential complications that may occur following open surgical repair and to demonstrate their management using both surgical and endovascular techniques.

  11. Tratamento endovascular de fístula aortocaval pós-traumática tardia: relato de caso Endovascular treatment of late post-traumatic aorto-caval fistula: case report

    Directory of Open Access Journals (Sweden)

    Leonardo Pessoa Cavalcante

    2013-03-01

    Full Text Available As fístulas aortocavais são entidades raras e de etiologia variada. Uma minoria é consequente a eventos pós-traumáticos. As manifestações clínicas, nesses casos, podem ser agudas ou tardias. As tardias manifestam-se dias, semanas ou anos após o trauma, principalmente como quadro de insuficiência cardíaca congestiva. O tratamento de tais fístulas pode ser realizado através do reparo direto por cirurgia aberta ou através da abordagem endovascular. Relatamos o caso de um paciente do sexo masculino, de 53 anos que apresentou, 27 anos após um ferimento por arma branca abdominal, sinais importantes de insuficiência cardíaca congestiva, manifestada como palpitações e dispneia, fibrilação atrial paroxística, além de pressão arterial divergente e sopro em epigástrio. A angiotomografia confirmou o diagnóstico de fístula aortocaval e procedeu-se ao tratamento endovascular para o selamento da fístula. O paciente, segundo acompanhamento após três meses, apresentou evolução satisfatória, com melhora significante do quadro e controle adequado da insuficiência cardíaca congestiva.Aortocaval fistulas are rare entities with different etiologies. A minority of them are consequent to post-traumatic events. The clinic in these cases may be acute or delayed. The later manifest themselves days, weeks or years after the trauma mainly as congestive heart failure. Its treatment can be done by open surgery or endovascular approach. The present case it is a 53 year old man who presented, 27 years after a stab wound in the abdomen, important signs of congestive heart failure, manifested as palpitations and dyspnea, paroxysmal atrial fibrillation, besides of dissenting blood pressure and bruit in the epigastrium. Angiotomography confirmed the diagnosis of aorto-caval fistula and proceeded to endovascular treatment for fistula repair. The patient, according with control after three months, showed a satisfactory outcome, with significant improvement of the condition and appropriate control of heart failure.

  12. Aortic Branch Artery Pseudoaneurysms Associated with Intramural Hematoma: When and How to Do Endovascular Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Ferro, Carlo; Rossi, Umberto G., E-mail: urossi76@hotmail.com; Seitun, Sara [IRCCS San Martino University Hospital, IST, National Institute for Cancer Research, Department of Radiology and Interventional Radiology (Italy); Scarano, Flavio; Passerone, Giancarlo [IRCCS San Martino University Hospital, IST, National Institute for Cancer Research, Department of Cardiac Surgery (Italy); Williams, David M. [University of Michigan Medical Center, Department of Radiology, Division of Vascular and Interventional Radiology (United States)

    2013-04-15

    To describe when and how to perform endovascular embolization of aortic branch artery pseudoaneurysms associated with type A and type B intramural hematoma (IMH) involving the descending thoracic and abdominal aorta (DeBakey I and III) that increased significantly in size during follow-up. Sixty-one patients (39 men; mean {+-} standard deviation age 66.1 {+-} 11.2 years) with acute IMH undergoing at least two multidetector computed tomographic examinations during follow-up for 12 months or longer were enrolled. Overall, 48 patients (31 men, age 65.9 {+-} 11.5) had type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III). Among the 48 patients, 26 (54 %; 17 men, aged 64.3 {+-} 11.4 years) had 71 aortic branch artery pseudoaneurysms. Overall, during a mean follow-up of 22.1 {+-} 9.5 months (range 12-42 months), 31 (44 %) pseudoaneurysms disappeared; 22 (31 %) decreased in size; two (3 %) remained stable; and 16 (22 %) increased in size. Among the 16 pseudoaneurysms with increasing size, five of these (three intercostal arteries, one combined intercostobronchial/intercostal arteries, one renal artery), present in five symptomatic patients, had a significant increase in size (thickness >10 mm; width and length >20 mm). These five patients underwent endovascular embolization with coils and/or Amplatzer Vascular Plug. In all patients, complete thrombosis and exclusion of aortic pseudoaneurysm and relief of back pain were achieved. Aortic branch artery pseudoaneurysms associated with type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III) may be considered relatively benign lesions. However, a small number may grow in size or extend longitudinally with clinical symptoms during follow-up, and in these cases, endovascular embolization can be an effective and safe procedure.

  13. Endovascular Treatment of Symptomatic Intracranial Atherosclerotic Disease

    OpenAIRE

    Short, Jody L.; Majid, Arshad; Hussain, Syed I

    2011-01-01

    Symptomatic intracranial atherosclerotic disease (ICAD) is responsible for approximately 10% of all ischemic strokes in the United States. The risk of recurrent stroke may be as high as 35% in patient with critical stenosis >70% in diameter narrowing. Recent advances in medical and endovascular therapy have placed ICAD at the forefront of clinical stroke research to optimize the best medical and endovascular approach to treat this important underlying stroke etiology. Analysis of symptomatic ...

  14. Endovascular Management of Acute Limb Ischemia.

    LENUS (Irish Health Repository)

    Hynes, Brian G

    2011-09-14

    Despite major advances in pharmacologic and endovascular therapies, acute limb ischemia (ALI) continues to result in significant morbidity and mortality. The incidence of ALI may be as high as 13-17 cases per 100,000 people per year, with mortality rates approaching 18% in some series. This review will address the contemporary endovascular management of ALI encompassing pharmacologic and percutaneous interventional treatment strategies.

  15. Acute vasculitis after endovascular brachytherapy

    International Nuclear Information System (INIS)

    Purpose: Angioplasty effectively relieves coronary artery stenosis but is often followed by restenosis. Endovascular radiation (? or ?) at the time of angioplasty prevents restenosis in a large proportion of vessels in swine (short term) and humans (short and long term). Little information is available about the effects of this radiation exposure beyond the wall of the coronary arteries. Methods and Materials: Samples were obtained from 76 minipigs in the course of several experiments designed to evaluate endovascular brachytherapy: 76 of 114 coronary arteries and 6 of 12 iliac arteries were exposed to endovascular radiation from 32P sources (35 Gy at 0.5 mm from the intima). Two-thirds of the vessels had angioplasty or stenting. The vessels were systematically examined either at 28 days or at 6 months after radiation. Results: We found an unexpected lesion: acute necrotizing vasculitis in arterioles located ?2.05 mm from the target artery. It was characterized by fibrinoid necrosis of the wall, often associated with lymphocytic exudates or thrombosis. Based on the review of perpendicular sections of tissue samples, the arterioles had received between 6 and 40 Gy. This arteriolar vasculitis occurred at 28 days in samples from 51% of irradiated coronary arteries and 100% of irradiated iliac arteries. By 6 months, the incidence of acute vasculitis decreased to 24% around the coronary arteries. However, at that time, healing vasculitis was evident, often with luminal narrowing, in 46% of samples. Vasculitis was not seen in any of 44 samples from unirradiated vessels (0%) and had no relation to angioplasty, stenting, or their sequelae. This radiation-associated vasculitis in the swine resembles the localized lymphocytic vasculitis that we have reported in tissues of humans exposed to external radiation. On the other hand, it is quite different from the various types of systemic vasculitis that occur in nonirradiated humans. Conclusion: Endoarterial brachytherapy using 32P results in vascular effects beyond the adventitia of the target vessel. This necrotizing vasculitis is causally related to radiation, but its mechanism is unclear and a dose effect is not evident. Quite possibly, local upregulation of inflammatory cytokines contributes to this radiation-associated vasculitis, which only involved some of the arterioles in each sample. It is likely that radiation-associated vasculitis also occurs around human coronary arteries and may result in foci of ischemia. To our knowledge, this lesion has not been previously recognized, either in experimental models or in human specimens examined after angioplasty/brachytherapy

  16. Management of recurrent aneurysms following endovascular therapy.

    Science.gov (United States)

    Chen, Kevin S; Wilson, Thomas J; Stetler, William R; Davis, Matthew C; Giles, David A; Kahn, Elyne N; Chaudhary, Neeraj; Gemmete, Joseph J; Thompson, B Gregory; Pandey, Aditya S

    2015-12-01

    The aim of the current study is to describe the complication rates and clinical outcomes in patients who either underwent repeat intervention or conservative management with radiographic surveillance when presenting with aneurysmal recurrence after endovascular treatment. Since publication of the international subarachnoid aneurysm trial (ISAT), an increasing number of patients are treated with endovascular therapy. However, recurrence after endovascular therapy continues to pose a challenge, and there is minimal evidence to guide its management. We performed a retrospective review of all patients who underwent endovascular treatment of an intracranial aneurysm from January 2005 to February 2013. The patients who had an aneurysmal recurrence following the initial endovascular treatment were identified and divided into two groups: those followed with conservative management (n=24), and those who underwent reintervention (n=65). The groups were compared for complications and clinical outcomes. When a reintervention was undertaken, microsurgical clip ligation was associated with a higher rate of occlusion than additional endovascular therapy (psubarachnoid hemorrhage, or had a greater degree of recurrence. We conclude that clinical outcomes and repeat subarachnoid hemorrhage are similar in patients who underwent retreatment versus those who had conservative management for their recurrent cerebral aneurysms. PMID:26256068

  17. Linfangioma abdominal: Caso clínico / Abdominal lymphangioma

    Scientific Electronic Library Online (English)

    Ignacia, Torrealba A; Florencia, De Barbieri M.

    2012-02-01

    Full Text Available El linfangioma abdominal es una patología poco frecuente, benigna que corresponde a una malformación congénita del desarrollo linfático mesentérico y/o retroperitoneal. Es más frecuente en población infantil. Objetivo: Reportar un caso con presentación atípica de linfangioma. Caso clínico: Paciente [...] de 2 años varón, previamente sano, que se presenta con dolor abdominal, luego lipotimia y palidez generalizada tras recibir un masaje abdominal. Al examen físico se encontró una masa abdominal, sin hepatomegalia, esplenomegalia ni adenopatías palpables. Presentaba un hematocrito de 17,3%. La Ecografía mostró una gran masa retrope-ritoneal con áreas anecogénicas y septos vascularizados. La TAC mostró hallazgos similares: masa quísti-ca, lobulada probablemente determinada por linfangioma abdominal. Se realizó extirpación quirúrgica y la biopsia confirma el diagnóstico. Discusión: El linfangioma abdominal es una patología infrecuente en niños. La presentación clínica es variable, puede ser desde asintomático hasta presentarse con abdomen agudo. Se requiere estudio imagenológico para su evaluación preoperatoria. La ecografía y TAC tienen un importante rol diagnóstico, en localización, tamaño, anatomía circundante y posibles complicaciones. Abstract in english Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics, more frequent in pediatrics. Objective: To report a case with unusual clinical presentation of lymphangioma. Clinical Case: A two-year old boy previously health who presented with abd [...] ominal pain, lipothymia, and generalized pallor ensuing an abdominal massage. Abnormal findings included an abdominal mass and Ht of 17.3%. Sonogram showed a large retroperitoneal mass with anechogenic areas and vasculari-zed septi. CT scans showed similar results. Surgical removal and biopsy confirmed the diagnosis. Discusion: Abdominal lymphangioma is uncommon in children, presentation varies from asymptomatic to acute abdomen. Images are essential in diagnosis and pre-op studies.

  18. The use of intravascular ultrasound as control procedure for the deployment of endovascular stented grafts

    DEFF Research Database (Denmark)

    Vogt, K C; Brunkwall, J; Malina, M; Ivancev, K; Lindblad, B; Risberg, B; Schroeder, T V

    1997-01-01

    OBJECTIVE: To assess whether intravascular ultrasound (IVUS), used systematically in a series of patients with abdominal aortic aneurysms (AAA), is a feasible control procedure to ensure correct transfemoral placement of endovascular stent grafts (TPEG). DESIGN: Descriptive study. MATERIALS AND...... interference from guidewires or the introducer system. Imaging during stent deployment was abandoned after IVUS catheter damage in two of three cases. Postprocedural IVUS was able to evaluate the expansion of the stents and the adaptation to the aortic wall in all instances. In four (29%) cases a leak was...

  19. Endovascular stent graft for treatment of complicated spontaneous dissection of celiac artery: Report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Ung Rae; Lee, Young Hwan [Dept. of Diagnostic Radiology, Catholic University of Daegu School of Medicine, Daegu (Korea, Republic of); Kim, Young Hwan [Dept. of Diagnostic Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2013-06-15

    We report 2 cases of complicated spontaneous dissection of the celiac artery, which were successfully treated by a stent graft. The first patient was a 47-year-old man who presented with acute abdominal pain. CT scan showed ruptured saccular aneurysm with surrounding retroperitoneal hematoma. The second patient was a 57-year-old man with progressive dissecting aneurysm. Endovascular stent graft was placed in the celiac trunk to control bleeding, and to prevent rupture in each patient. Follow-up CT scans showed complete obliteration of a dissecting aneurysm.

  20. Vestibulopatia por lesão endovascular em cateterismo de urgência / Vestibular system paresis due to emergency endovascular catheterization

    Scientific Electronic Library Online (English)

    Lucinda, Simoceli; Danilo Anunciatto, Sguillar; Henrique Mendes Paiva, Santos; Camilla, Caputti.

    2012-06-01

    Full Text Available OBJETIVO: O objetivo deste relato de caso é descrever uma causa incomum de vestibulopatia periférica associada à perda auditiva unilateral em paciente idoso pós- cateterismo de urgência. RELATO DE CASO: Paciente do gênero masculino, 82 anos, submetido à correção de aneurisma roto de aorta abdominal, [...] no intra-operatório sofreu infarto agudo do miocárdio necessitando de angioplastia primária. Após alta hospitalar refere queixa de hipoacusia acentuada à direita e vertigem incapacitante, sem sinais neurológicos focais. Ao exame clínico otorrinolaringológico apresentava: Teste de Weber lateralizado para a esquerda, nistagmo espontâneo para a esquerda , marcha oscilante, leve disbasia e ataxia, índexnariz e diadococinesia normais, Teste de Romberg com oscilação sem queda e Fukuda com desvio lateral para a direita. O exame audiométrico evidenciava anacusia à direita e perda neurossensorial à esquerda em agudos, arreflexia vestibular à direita na prova calórica e, na tomografia computadorizada dos ossos temporais e tronco-encefálico, presença de haste metálica atravessando o osso temporal direito, a partir da veia jugular interna e bulbo jugular, atravessando os canais semicirculares posterior, superior e vestíbulo, projetando-se em lobo temporal. O diagnóstico radiológico foi lesão traumática por guia endovascular metálico durante cateterismo de urgência e a conduta, considerando que o paciente não havia compensado o equilíbrio, foi reabilitação vestibular. CONCLUSÃO: Queixas de tontura no paciente idoso devem ser criteriosamente avaliadas diante do seu histórico clínico patológico pois os antecedentes de doenças e tratamentos prévios, em geral, direcionam as hipóteses diagnósticas porém podem trazer alterações inesperadas. Abstract in english OBJECTIVE: The objective of this story of case is to describe an uncommon cause of associated peripheral Vestibulopathy to the unilateral auditory loss in aged patient after catheterization of urgency. STORY OF CASE: Patient of the masculine sort, 82 years, submitted to the correction of abdominal r [...] agged aneurism of aorta, in the intra-operative suffered heart attack acute from the myocardium needing primary angioplasty. High after hospital it relates to complaint of accented hearing loss to the right and crippling vertigo, without focal neurological signals. To the otorhinolaryngological clinical examination it presented: Test of Weber lateralized for the left, spontaneous nystagmus for the left, marches rocking, has taken normal disbasia and ataxia, index-nose and diadochokinesia, Test of Romberg with oscillation without fall and Fukuda with lateral shunting line for the right. The audiometric examination evidenced deafness to the right and sensorineural loss to the left in sharps, areflexia initial to the right in caloric test e, the computerized tomography of the secular bones and brainstem, presence of metallic connecting rod crossing the right secular bone, from the vein internal jugular vein and bulb jugular vein, crossing the posterior, superior and vestibule semicircular canals, projecting itself in temporal lobe. The radiological diagnoses was traumatic injury for guide to endovascular metallic during catheterization of urgency and the behavior, considering that the patient had not compensated the balance, it was vestibular rehabilitation. CONCLUSION: Complaints of giddiness in the aged patient must be closely evaluated of its pathological clinical description because the antecedents of illnesses and previous treatments, in general, direct the diagnostic hypotheses however they can bring unexpected alterations.

  1. Hygroma following endovascular femoral aneurysm exclusion : A case report

    DEFF Research Database (Denmark)

    Wad, Morten; Pedersen, Brian Lindegaard

    2013-01-01

    Endovascular treatment of aneurysms in the superficial femoral artery (SFA) and popliteal segments is a suggested alternative to open surgical repair. Careful selection of patients for endovascular treatment of SFA aneurysms is mandatory.

  2. Tratamento endovascular de aneurismas cirsoideos do couro cabeludo Endovascular treatment of scalp cirsoid aneurysms

    Directory of Open Access Journals (Sweden)

    Eduardo Wajnberg

    2010-08-01

    Full Text Available OBJETIVO: Relatar os resultados da aplicação de técnicas endovasculares no tratamento de aneurismas cirsoideos do couro cabeludo. MATERIAIS E MÉTODOS: Quatro pacientes com diagnóstico de aneurismas cirsoideos foram submetidos ao tratamento por via endovascular. Todos os quatro pacientes incluídos nesta série tinham malformações arteriovenosas e foram tratados apenas com embolização. RESULTADOS: Três pacientes foram submetidos a tratamento endovascular mediante embolização transarterial e um foi tratado por punção direta da porção venosa. Os resultados clínicos e cosméticos foram satisfatórios em todos os pacientes. Não houve recidiva clínica durante o período de acompanhamento. CONCLUSÃO: A via endovascular é uma alternativa segura e eficaz no tratamento dos aneurismas cirsoideos. Embora possa ser efetivamente utilizado como uma alternativa adjuvante ou complementar à cirurgia, especialmente quando é necessário lidar com aferências profundas, a maioria dos casos pode ser totalmente curada apenas com a terapêutica endovascular. A escolha do método de tratamento deve ser baseada em uma variedade de características próprias da lesão, incluindo sua angioarquitetura, tamanho e apresentação clínica.OBJECTIVE: To report results of the application of endovascular techniques in the management of scalp cirsoid aneurysms. MATERIALS AND METHODS: Four patients diagnosed with cirsoid aneurysms were submitted to treatment by endovascular approach. All the four patients included in the present series had arteriovenous malformations and were treated solely by embolization. RESULTS: Three of the patients underwent endovascular treatment by transarterial embolization and one was treated by direct puncture of the venous segment. Both clinical and cosmetic outcomes were satisfactory in all of the patients. Clinical relapse was not observed along the follow-up period. CONCLUSION: The endovascular approach is safe and effective in the management of crisoid aneurysms. Although this technique can be used as an adjuvant or complement to surgery, particularly in cases where deep afferents are involved, complete resolution can be achieved only with endovascular treatment. The choice of treatment method should be based on a range of typical characteristics of the lesion, including angioarchitecture, size and clinical presentation.

  3. Management of abdominal wall defects (gastroschisis and omphalocele at Hospital Universitario San Vicente de Paúl, in Medellín, Colombia, 1998-2006 Tratamiento de los defectos de la pared abdominal (gastrosquisis y onfalocele en el Hospital Universitario San Vicente de Paúl, Medellín, 1998-2006

    Directory of Open Access Journals (Sweden)

    Mirian Natalia Herrera Toro

    2010-08-01

    Full Text Available

    Introduction: Gastroschisis and omphalocele are neonatal malformations of the abdominal wall. Despite their great differences, both are severe diseases characterized by herniation of viscera through the defect in the abdominal wall. Children with these defects present as surgical emergencies that pose a difficult challenge to the attending surgeon. Even with appropriate management, the mortality rate is between 20-40%. Omphalocele and, to a lesser degree gastroschisis, are associated with a wide range of malformations.

    Objective: The aim of this retrospective review was to describe the management of children with gastroschisis or omphalocele, and the results obtained with it, at the

    Pediatric Surgery Section, Hospital Universitario San Vicente de Paúl, in Medellin, Colombia.

    Patients and methods: We evaluated the charts of all patients admitted to the Pediatric Surgery Section, between January 1, 1998 and December 31, 2006, with a diagnosis of gastroschisis or omphalocele. The type of treatment was defined as either primary closure or closure by stages; accordingly, we reviewed the results of the operation, the surgical complications (surgical site infection, evisceration, sepsis, ileus and intraabdominal hypertension, the time of onset of oral and total parenteral nutrition (TPN, and the duration of hospital and UCI stay.

    Results: 55 patients were identified, 32 with gastroschisis and 23 with omphalocele, all of whom were surgically treated. In 31 patients (56.4% primary closure was carried

    out, while in 24 (43.6% the closure was done by stages; in the latter modality silo was most frequently used (12 cases. Complications, mostl

  4. Endovascular repair of early rupture of Dacron aortic graft--two case reports.

    LENUS (Irish Health Repository)

    Sultan, Sherif

    2005-01-01

    Complications after open aortic surgery pose a challenge both to the vascular surgeon and the patient because of aging population, widespread use of cardiac revascularization, and improved survival after aortic surgery. The perioperative mortality rate for redo elective aortic surgery ranges from 5% to 29% and increases to 70-100% in emergency situation. Endovascular treatment of the postaortic open surgery (PAOS) patient has fewer complications and a lower mortality rate in comparison with redo open surgical repair. Two cases of ruptured abdominal aortic aneurysm (AAA) were managed with the conventional open surgical repair. Subsequently, spiral contrast computer tomography scans showed reperfusion of the AAA sac remnant mimicking a type III endoleak. These graft-related complications presented as vascular emergencies, and in both cases endovascular aneurysm repair (EVAR) procedure was performed successfully by aortouniiliac (AUI) stent graft and femorofemoral crossover bypass. These 2 patients add further merit to the cases reported in the English literature. This highlights the crucial importance of endovascular grafts in the management of such complex vascular problems.

  5. Failure of aneurysm sac shrinkage after endovascular repair; the effect of mural calcification

    Energy Technology Data Exchange (ETDEWEB)

    Love, M. [Department of Radiology, Royal Victoria Hospital, Belfast (United Kingdom)]. E-mail: mark.love@royalhospitals.n-i.nhs.uk; Wray, A. [Department of Radiology, Royal Victoria Hospital, Belfast (United Kingdom); Worthington, M. [Department of Radiology, Royal Victoria Hospital, Belfast (United Kingdom); Ellis, P. [Department of Radiology, Royal Victoria Hospital, Belfast (United Kingdom)

    2005-12-15

    AIM: To evaluate the effect of abdominal aortic aneurysm wall calcification on subsequent sac shrinkage after endovascular repair. MATERIALS AND METHODS: Seventy-three patients underwent endovascular aneurysm repair. The degree of sac wall calcification on pre-procedural computed tomography (CT) examination was graded from 1 to 4 according to the degree of circumferential involvement. On follow-up CT imaging, the maximum transverse diameter (MTD) of the sac was recorded, as well as the presence or absence of endoleak. In those patients with a non-shrinking aneurysm, but no CT evidence of endoleak, contrast-enhanced ultrasound (USS) was performed. Any patient with an endoleak, however diagnosed, was excluded from the study. Kruskal-Wallis and Spearman's rank correlation coefficient testing was applied to compare the degree of calcification and change in MTD. RESULTS: Sixty-three pre-procedural CT images were available for calcification grading. Six of this group had endoleaks resulting in 57 sets of data being available for the study. A reduction in MTD occurred in 68.25% of these patients by 1 year post-procedure. Our figures show aortic calcification is inversely associated with MTD reduction at 6 months (p=0.01), 1 year (p=0.05) and 2 years (p=0.05). CONCLUSION: This study indicates that the degree of aortic wall calcification is significant in predicting MTD reduction post-endovascular repair. The possible mechanisms and implications of this are discussed.

  6. Evaluation of robotic catheter technology in complex endovascular intervention

    OpenAIRE

    Theodoreli-Riga, C.V.

    2013-01-01

    The past four decades have witnessed tremendous strides in the evolution of endovascular devices and techniques. Catheter-based intervention has revolutionized the management of arterial disease allowing treatment of aortic and peripheral pathologies via a minimally invasive approach. Despite the exponential advances in endovascular equipment, devices and techniques, catheter-based endovascular intervention has certain morphological and technological constraints. Complex patien...

  7. Radiological Findings and Endovascular Management of Three Cases with Segmental Arterial Mediolysis

    International Nuclear Information System (INIS)

    Segmental arterial mediolysis (SAM) is an uncommon self-limited disorder that can cause abdominal catastrophes through massive bleeding or bowel infarction. The former arise from arterial aneurysms, and the latter from arterial stenosis or occlusions. Although this is an acute self-limiting disease, the catastrophic consequence, originating from intra-abdominal hemorrhage (arterial dilatation, aneurysms, dissecting hematomas) or bowel infarction (arterial stenosis, arterial occlusions), is not rare. The identification of these lesions is very important in the differential diagnosis of suspected patients with complaints of abdominal pain with hemorrhage. We report computerized tomography angiography and digital subtraction angiography findings of three cases with abdominal SAM, who were treated with endovascular management due to abdominal bleeding. Angiography showed arterial dilatations, aneurysms, and occlusions of visceral arteries in all three cases, The string-of-beads appearance was present in only one case. Bleeding stopped immediately after embolization of three cases and follow-up revealed no evidence of recurrences at 23, 18, and 15 months, respectively, Arterial coil embolization is an effective treatment modality for bleeding complications of SAM. Close follow-up is recommended, primarily to ascertain the fate of the nontreated arterial lesions.

  8. The role of gadolinium-enhanced MR imaging in the preoperative evaluation of inflammatory abdominal aortic aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Anbarasu, A.; McWilliams, R.G. [Department of Radiology, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP (United Kingdom); Harris, P.L. [Department of Vascular Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP (United Kingdom)

    2002-07-01

    Inflammatory abdominal aortic aneurysm is an uncommon variant of abdominal aortic aneurysms. Thorough preoperative imaging of the extent of the aneurysm and inflammation and the associated complications are crucial in the management of this condition. We report a case of inflammatory abdominal aortic aneurysm where, after the initial contrast-enhanced CT, gadolinium-enhanced MR imaging was used to define the true extent of the inflammation and differentiate inflammation from mural thrombus at the iliac extension of the aneurysm. The imaging appearances are presented and the impact of MR imaging on further surgical management options including endovascular repair are discussed. (orig.)

  9. Hybrid treatment of bullet embolism at the abdominal aortic bifurcation, complicated with thoracoabdominal aorta pseudoaneurysm and common iliac artery occlusion: case report / Tratamento híbrido de embolia por projétil de arma de fogo em bifurcação aórtica abdominal complicada com pseudoaneurisma de aorta tóraco-abdominal e oclusão de artéria ilíaca comum: relato de caso

    Scientific Electronic Library Online (English)

    Patrick Bastos, Metzger; Rafael Borges, Monteiro; Maria Luiza Leite de, Medeiros; Willian Guidini, Lima; Vinicius, Bertoldi; Fabio Henrique, Rossi; Nilo Mitssuru, Izukawa; Antônio Massamitsu, Kambara.

    2014-03-01

    Full Text Available A embolização por projétil de arma de fogo na circulação sanguínea é rara e de difícil suspeição no atendimento inicial ao trauma. Relatamos e discutimos um caso de embolia em bifurcação aórtica abdominal complicada com pesudoaneurisma de aorta tóraco-abdominal e oclusão de artéria ilíaca comum dire [...] ita, tratada de forma efetiva pelos métodos endovascular e cirúrgico convencional. Abstract in english Embolization due to a firearm projectile entering the bloodstream is a rare event that is unlikely to be suspected during initial treatment of trauma patients. We describe and discuss a case of bullet embolism of the abdominal aortic bifurcation, complicated by a pseudoaneurysm of the thoracoabdomin [...] al aorta and occlusion of the right common iliac artery, but successfully treated using a combination of endovascular methods and conventional surgery.

  10. Redo-EVAR After Surgical Repair in Ruptured Abdominal Aortic Aneurysm

    Science.gov (United States)

    Bozok, ?ahin; Ozan Karaki?i, Sedat; Ergene, ?aban; Tufekçi, Nebiye; Ilhan, Gökhan; Karamustafa, Hakan

    2015-01-01

    Endovascular aneurysm repair (EVAR) is an adequate means for treating infrarenal abdominal aortic aneurysms (AAA). However, secondary interventions are required in approximately 15% to 20% of patients. The aim of this paper was to report our knowledge with stent grafts in secondary interventions after EVAR in a 73-year-old patient. One of the exceptional complications of EVAR are endoleaks which may lead to expansion of aneurysm and rupture if not repaired. PMID:26702349

  11. Preservação das artérias hipogástricas com endoprótese ramificada no tratamento endovascular de aneurismas aorto-ilíacos / The Zenith iliac bifurcation Device (IBD) for preservation of the internal iliac arteries during endovascular repair of aortic-iliac aneurysms

    Scientific Electronic Library Online (English)

    Emanuel, Dias; Gonçalo, Alves; Leonor, Vasconcelos; Aragão de, Morais; João Albuquerque, Castro; Luís Mota, Capitão.

    2010-12-01

    Full Text Available Introdução: Os doentes com indicação para tratamento endovascular de aneurismas da aorta abdominal (EVAR) apresentam frequentemente artérias ilíacas comuns ectasiadas ou aneurismáticas, o que impossibilita a sua utilização como zona de encoragem distal da endoprótese. Em cerca de 15 a 30% dos casos [...] pode existir necessidade de oclusão/embolização de uma ou de ambas as hipogástricas, com extensão da endoprótese para a artéria ilíaca externa. Isto tem sido associado a casos de claudicação glútea, isquémia intestinal, deficits neurológicos, e de disfunção vesical, intestinal e eréctil. O uso de endopróteses com ramo para a artéria hipogástrica apresenta-se como uma recente inovação que permite a preservação desta artéria e evitar estas complicações. Caso clínico: Homem de 63 anos, com antecedentes de cirurgia aórtica com interposição protésica aorto-aórtica em 2008 por aneurisma da aorta abdominal (AAA) infra-renal, admitido para tratamento endovascular de aneurisma das artérias ilíaca comum e hipogástrica direitas, com 3,3 cm de maior diâmetro. O doente foi submetido a colocação por via femoral de endoprótese Zenith® ramificada para bifurcação ilíaca com preservação da artéria hipogástrica. Conclusões: A utilização de endopróteses ramificadas para a bifurcação ilíaca durante a correcção endovascular de aneurismas aorto-ilíacos para ser uma forma segura e pouco complexa de garantir a preservação das artérias hipogástricas e minimizar as complicações associadas à sua oclusão. Abstract in english Introduction: A significant portion of patients presenting for endovascular aneurysm repair of the abdominal aorta (EVAR) have aneurysmatic or ectasied common iliac arteries, raising distal anchorage issues. In these cases, it may be necessary occlusion / embolization of one or both hipo gastric art [...] eries with extension of the endoprothesis to the external iliac artery. This procedure has been associated to gluteal claudication, intestinal ischemia, vesical and intestinal disfunction, neurologic deficits and impotence. The use of branched endoprothesis with preservation of the hypgastric artery is a recente innovation to reduce such complications. Clinical case: A 63 year-old male, previously submitted to an open repair of an abdominal aortic aneurysm with an aorto-aortic prothesis, was admitted for endovascular treatment of an aneurysm of the right common and internal iliac arteries with 3,3cm. A Zenith® branched endoprothesis with a branch to the iliac bifurcation was deployed via right femoral access, thus assuring preservation of the hypogastric artery. Conclusion: Hypogastric preservation necessity during EVAR in aorto-iliac aneurysms may be achieved in a secure and simple way through the placement of endoprothesis to the iliac bifurcation.

  12. Preservação das artérias hipogástricas com endoprótese ramificada no tratamento endovascular de aneurismas aorto-ilíacos The Zenith iliac bifurcation Device (IBD for preservation of the internal iliac arteries during endovascular repair of aortic-iliac aneurysms

    Directory of Open Access Journals (Sweden)

    Emanuel Dias

    2010-12-01

    Full Text Available Introdução: Os doentes com indicação para tratamento endovascular de aneurismas da aorta abdominal (EVAR apresentam frequentemente artérias ilíacas comuns ectasiadas ou aneurismáticas, o que impossibilita a sua utilização como zona de encoragem distal da endoprótese. Em cerca de 15 a 30% dos casos pode existir necessidade de oclusão/embolização de uma ou de ambas as hipogástricas, com extensão da endoprótese para a artéria ilíaca externa. Isto tem sido associado a casos de claudicação glútea, isquémia intestinal, deficits neurológicos, e de disfunção vesical, intestinal e eréctil. O uso de endopróteses com ramo para a artéria hipogástrica apresenta-se como uma recente inovação que permite a preservação desta artéria e evitar estas complicações. Caso clínico: Homem de 63 anos, com antecedentes de cirurgia aórtica com interposição protésica aorto-aórtica em 2008 por aneurisma da aorta abdominal (AAA infra-renal, admitido para tratamento endovascular de aneurisma das artérias ilíaca comum e hipogástrica direitas, com 3,3 cm de maior diâmetro. O doente foi submetido a colocação por via femoral de endoprótese Zenith® ramificada para bifurcação ilíaca com preservação da artéria hipogástrica. Conclusões: A utilização de endopróteses ramificadas para a bifurcação ilíaca durante a correcção endovascular de aneurismas aorto-ilíacos para ser uma forma segura e pouco complexa de garantir a preservação das artérias hipogástricas e minimizar as complicações associadas à sua oclusão.Introduction: A significant portion of patients presenting for endovascular aneurysm repair of the abdominal aorta (EVAR have aneurysmatic or ectasied common iliac arteries, raising distal anchorage issues. In these cases, it may be necessary occlusion / embolization of one or both hipo gastric arteries with extension of the endoprothesis to the external iliac artery. This procedure has been associated to gluteal claudication, intestinal ischemia, vesical and intestinal disfunction, neurologic deficits and impotence. The use of branched endoprothesis with preservation of the hypgastric artery is a recente innovation to reduce such complications. Clinical case: A 63 year-old male, previously submitted to an open repair of an abdominal aortic aneurysm with an aorto-aortic prothesis, was admitted for endovascular treatment of an aneurysm of the right common and internal iliac arteries with 3,3cm. A Zenith® branched endoprothesis with a branch to the iliac bifurcation was deployed via right femoral access, thus assuring preservation of the hypogastric artery. Conclusion: Hypogastric preservation necessity during EVAR in aorto-iliac aneurysms may be achieved in a secure and simple way through the placement of endoprothesis to the iliac bifurcation.

  13. Towards individualized follow-up protocols after endovascular aortic aneurysm repair.

    Science.gov (United States)

    Laturnus, Johanna; Oliveira, Nelson; Basto Gonçalves, Frederico; Schurink, Geert W; Verhagen, Hence; Jacobs, Michael J; Mees, Barend M

    2016-04-01

    Endovascular aneurysm repair (EVAR) has become the primary treatment option for elective abdominal aortic aneurysms. However, a significant number of patients require secondary interventions to maintain adequate aneurysm exclusion and ultimately prevent death from abdominal aortic aneurysm (AAA) rupture. To maintain success and offer timely secondary intervention, intensive image surveillance has been recommended. These rigorous surveillance regimens are costly and may have deleterious effects from radiation and contrast exposure. Improvements in patient selection, operative technique and devices have caused a decline in complications after EVAR. Therefore, there is a need to reduce surveillance after EVAR for patients at lower risk of complications and install individualized follow-up protocols. This review describes the current strategies for surveillance and clarification of risk factors and predictors for late complications and discusses proposed risk-adapted strategies for postoperative surveillance after EVAR. PMID:26745264

  14. Emergency endovascular aortic repair of a ruptured mycotic aorto-iliac aneurysm presenting with lumbar radiculopathy.

    Science.gov (United States)

    Lee, Ting-Ying; Tsai, Chien-Sung; Tsai, Yi-Ting; Lin, Chih-Yuan; Lin, Yi-Chanag; Hsu, Po-Shun

    2014-01-01

    Ruptured abdominal aortic aneurysm is life-threatening without immediate management. The initial clinical presentation is non-specific and impending rupture is easily missed, especially without a CT scan. We present a case of a 56-year-old man with low-back pain and left lower-extremity numbness, which was diagnosed as a herniated intervertebral disc (HIVD) with left acute sciatica syndrome. He also complained of persistent fever and abdominal discomfort. Routine blood work-up revealed leukocytosis and decreasing haemoglobin levels. CT angiography (CTA) showed impending rupture of the left aorto-iliac aneurysm. We therefore performed endovascular aneurysm repair (EVAR). Blood culture revealed Salmonella enterica, for which he received antibiotics. No acute sciatica syndrome was present immediately after the EVAR. No EVAR-related complications were noted in the one-year CTA follow up. PMID:25000523

  15. Abdominal epilepsy in chronic recurrent abdominal pain

    Directory of Open Access Journals (Sweden)

    V Y Kshirsagar

    2012-01-01

    Full Text Available Background: Abdominal epilepsy (AE is an uncommon cause for chronic recurrent abdominal pain in children and adults. It is characterized by paroxysmal episode of abdominal pain, diverse abdominal complaints, definite electroencephalogram (EEG abnormalities and favorable response to the introduction of anti-epileptic drugs (AED. We studied 150 children with chronic recurrent abdominal pain and after exclusion of more common etiologies for the presenting complaints; workup proceeded with an EEG. We found 111 (74% children with an abnormal EEG and 39 (26% children with normal EEG. All children were subjected to AED (Oxcarbazepine and 139 (92% children responded to AED out of which 111 (74% children had an abnormal EEG and 27 (18% had a normal EEG. On further follow-up the patients were symptom free, which helped us to confirm the clinical diagnosis. Context: Recurrent chronic abdominal pain is a common problem encountered by pediatricians. Variety of investigations are done to come to a diagnosis but a cause is rarely found. In such children diagnosis of AE should be considered and an EEG will confirm the diagnosis and treated with AED. Aims: To find the incidence of AE in children presenting with chronic recurrent abdominal pain and to correlate EEG findings and their clinical response to empirical AEDs in both cases and control. Settings and Design: Krishna Institute of Medical Sciences University, Karad, Maharashtra, India. Prospective analytical study. Materials and Methods: A total of 150 children with chronic recurrent abdominal pain were studied by investigations to rule out common causes of abdominal pain and an EEG. All children were then started with AED oxycarbamezepine and their response to the treatment was noted. Results: 111 (74% of the total 150 children showed a positive EEG change suggestive of epileptogenic activity and of which 75 (67.56% were females and 36 (32.43% were male, majority of children were in the age of group of 9-12 years. Temporal wave discharges were 39 (35.13% of the total abnormal EEG?s. All the children were started on AEDs and those with abnormal EEG showed 100% response to treatment while 27 (18% children with normal EEG also responded to treatment. Twelve (8% children did not have any improvement in symptoms. Conclusions: A diagnosis of AE must be considered in children with chronic recurrent abdominal pain, especially in those with suggestive history, and an EEG can save a child from lot of unnecessary investigations and suffering.

  16. Pneumatic compression for embolic protection during upper extremity endovascular intervention.

    Science.gov (United States)

    Cassar, Andrew; Barsness, Gregory W; Wysokinski, Waldemar E; Gifford, Shaun M; Bower, Thomas C; Edwards, William D; Gulati, Rajiv

    2014-01-01

    Embolic protection devices are occasionally employed during endovascular interventions to prevent complications caused by embolic debris. However, these devices have imperfect efficacy, confer risk of endovascular trauma, and are expensive. We report a patient with giant cell arteritis and symptomatic axillary artery stenosis, with a perceived elevated risk of distal embolization during endovascular intervention. We describe a straightforward embolic protection technique of brachial pressure cuff inflation during endovascular intervention and aspiration of displaced thrombotic material from the static column of blood. This novel, effective, and cost-free technique could also be employed in other vascular beds during endovascular intervention. PMID:24178727

  17. Endovascular treatment of very small intracranial aneurysms

    DEFF Research Database (Denmark)

    Iskandar, A; Nepper-Rasmussen, J

    2011-01-01

    The endovascular treatment of intracranial aneurysms 3 mm or less is considered controversial. The purpose of this study is to report angiographic and clinical results following coiling of such aneurysms and compare them to those of larger aneurysms (> 3 mm).Between November 1999 and November 2009...... endovascular treatment was attempted in 956 consecutive intracranial aneurysms. Of 956 aneurysms, 111 aneurysms were very small aneurysms with a maximal diameter of 3 mm or less. We conducted a retrospective analysis of angiographic and clinical outcome following coiling of very small aneurysms and...... subsequently comparing it to the results of larger aneurysms.Coiling initially failed in eight aneurysms. In the remaining 103 aneurysms endovascular treatment was accomplished and immediate angiographic results showed complete aneurysm occlusion in 43 aneurysms, nearly complete aneurysm occlusion in 54...

  18. Endovascular Aneurysm Repair: Current and Future Status

    International Nuclear Information System (INIS)

    Endovascular aneurysm repair has rapidly expanded since its introduction in the early 1990s. Early experiences were associated with high rates of complications including conversion to open repair. Perioperative morbidity and mortality results have improved but these concerns have been replaced by questions about long-term durability. Gradually, too, these problems have been addressed. Challenges of today include the ability to roll out the endovascular technique to patients with adverse aneurysm morphology. Fenestrated and branch stent-graft technology is in its infancy. Only now are we beginning to fully understand the advantages, limitations, and complications of such technology. This paper outlines some of the concepts and discusses the controversies and challenges facing clinicians involved in endovascular aneurysm surgery today and in the future

  19. Endovascular treatment of thoracic aortic fistulas.

    Science.gov (United States)

    Léobon, Bertrand; Roux, Daniel; Mugniot, Antoine; Rousseau, Hervé; Cérene, Alain; Glock, Yves; Fournial, Gérard

    2002-07-01

    Aortoesophageal and aortobronchial fistulas constitute a problem in therapy because of the high rates of morbidity and mortality associated with operation. From May 1996 to March 2000, we treated by an endovascular procedure one aortoesophageal and three aortobronchial fistulas. There was no postoperative death. We noted one peripheral vascular complication that required a surgical procedure, one postoperative confusion, and one inflammatory syndrome. In one case, because of a persistent leakage after 21 months, we had to implant a second endovascular stent graft. A few weeks later the reopening of this patient's esophageal fistula led to his death by mediastinitis 25 months after the first procedure. The few cases published seem to bear out the interest, observed in our 4 patients, of an endovascular approach to treat complex lesions such as fistulas of the thoracic aorta especially in emergency or palliative cases. PMID:12118773

  20. Magnetic resonance imaging-guided endovascular interventions

    International Nuclear Information System (INIS)

    Historically, the combination of relatively long imaging times and restricted patient access has made MRI-guided intervention an impractical technique. Recent developments in MR hardware, pulse sequence improvements that have allowed the development of rapid imaging, and the availability of instruments that can be used under MR guidance have helped to overcome many of the disadvantages of MRI. Parallel to the development of MRI, image-guided percutaneous and endovascular interventions are becoming increasingly complex and require progressively more sophisticated imaging techniques to guide and control such interventions. These initially parallel trends have converged in the last couple of years. The ability of MRI to provide both unprecedented morphology and functional information has created a growing interest in both percutaneous and endovascular MRI-guided interventions. The goal of this review is to describe the technical prerequisites for MR-guided endovascular interventions, to discuss experimental and clinical applications, and to explain safety aspects of this technique

  1. Endovascular treatment for intracranial venous sinus thrombosis

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy and risk of endovascular treatment for intracranial venous sinus thrombosis. Methods: Twenty seven patients with intracranial venous sinus thrombosis confirmed by CT, MRI, MRV and/or DSA, from 2004 September to 2006 September, were treated with anticoagulant therapy but without response and then followed by multiple modalities including endovascular treatment. Nineteen of them accepted intravenous thrombolysis and mechanical thrombus maceration, another 5 accepted intravenous thrombolysis, mechanical thrombus maceration and intraarterial thrombolysis and the last 3 with stenting. Results: After thrombolysis, symptoms and signs of 23 patients improved obviously and headache disappeared in 18 of them, but with only mild degree in other 5 and no improvement in 3. Twenty one patients among them achieved recanalization of sinuses completely as confirmed on postprocedural angiography, MRI and MRV studies taken prior to hospital discharge and other 3 achieved recanalization of sinuses partly. Conclusion: Endovascular treatment is an effective and safe measure for potentially catastrophic intracranial dural sinus thrombosis. (authors)

  2. Abdominal MRI in childhood

    International Nuclear Information System (INIS)

    MRI provides diagnostic information in multiple abdominal diseases in childhood. Additional information to sonographic findings can be achieved in the diagnosis of abdominal malformation as well as in several inflammatory processes. In childhood cancer imaging MRI is essential at the beginning as well as during therapy to assess response to therapy. Because of radiation protection MRI has to replace CT in abdominal imaging in children. Some technical details have to be considered when children are examined. (orig.)

  3. Emergency Endovascular Treatment of Sac Rupture for Type IIIa Endoleak in Thoracic Aortic Aneurysm Previously Excluded with Endovascular Repair

    International Nuclear Information System (INIS)

    Elective endovascular treatment of thoracic aortic pathology has been applied in a variety of conditions. The complications of thoracic aortic stenting are also well recognized. Endoleak after endovascular repair of thoracic aortic aneurysms is the most frequent complication; among them, type III is the least frequent. Endovascular treatment of type III endoleak is generally performed under elective conditions; less frequently, in emergency. We report a successful emergency endovascular management of post-thoracic endovascular repair for thoracic aortic aneurysm rupture due to type IIIa endoleak.

  4. Lower respiratory tract infection and rapid expansion of an abdominal aortic aneurysm: a case report

    Directory of Open Access Journals (Sweden)

    Puppala Sapna

    2010-10-01

    Full Text Available Abstract Introduction The rate of abdominal aortic aneurysm expansion is related to multiple factors. There is some evidence that inflammation can accelerate aneurysm expansion. However, the association between pulmonary sepsis and rapid abdominal aortic aneurysm expansion is rarely reported. Case presentation Here we present a case of a rapidly expanding abdominal aortic aneurysm in a 68-year-old Caucasian man with a concomitant lower respiratory tract infection and systemic sepsis requiring intensive monitoring and urgent endovascular intervention. Our patient had an uncomplicated post-operative recovery and a follow-up computed tomography scan at one month demonstrated no evidence of an endoleak. Conclusion This case highlights the potential association between pulmonary sepsis and rapid abdominal aortic aneurysm expansion. In such cases, a policy of frequent monitoring should be adopted to identify those patients requiring definitive management.

  5. Abdominal Aortic Aneurysms: Treatments

    Science.gov (United States)

    ... renal disease Infertility Liver disease Needle biopsy Osteoporosis Pediatrics Pelvic pain ... Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists ...

  6. Unconventional Applications of Endovascular Devices in Acquired Structural Cardiomyopathies / Aplicaciones no convencionales de dispositivos endovasculares en cardiopatías estructurales adquiridas

    Scientific Electronic Library Online (English)

    José A. G, Álvarez; José L, Alonso; Gustavo A, Leiva; Pablo, Baglioni; María L, Fernández Recalde; Carlos, Rivas; Osvaldo D, Manuale; Guillermo, Migliaro; Alejandra Morales, Lezica; Alberto, Sciegata.

    2013-04-01

    Full Text Available En los últimos años se han diseñado e introducido en la práctica clínica habitual diversos dispositivos para el tratamiento de cardiopatías estructurales congenitas y adquiridas. Pero más allá de sus indicaciones formales, la utilización off-label de estos dispositivos en situaciones en las que el t [...] ratamiento quirúrgico convencional tiene un riesgo elevado se ha comunicado cada vez con más frecuencia con resultados alentadores. En esta comunicación se presentan cuatro casos de pacientes con patologías de baja preva-lencia que fueron tratados por vía endovascular con dispositivos Amplatzer® por fuera de las indicaciones para las que fueron diseñados. Una fuga paravalvular aórtica, un defecto de Gerbode adquirido, una fístula de la aorta hacia la aurícula derecha y una fuga paraprotesica mitral se cerraron con dispositivos para oclusión vascular, para el cierre de comunicación interauricular, para el cierre de conducto arterioso y para el tratamiento de comunicaciones interventriculares musculares, respectivamente. En todos los casos los tratamientos fueron efectivos y los pacientes evolucionaron favorablemente sin requerir nuevas intervenciones. Se concluye que la utilización de dispositivos Amplatzer® en patologías seleccionadas más allá de las indicaciones para las que fueron diseñados es una alternativa terapeutica válida en manos de equipos experimentados en este tipo de tratamiento. Abstract in english In recent years, several devices for the treatment of congenital or acquired structural cardiomyopathies have been designed and introduced in clinical practice. But beyond their formal indications, in situations where conventional surgical treatment has a high risk, off-label use of these devices ha [...] s been reported with increasing frequency and encouraging results. This work presents four cases of patients with low prevalence disorders who were treated with percutaneous Amplatzer® devices for indications other than those for which they were designed. An aortic paravalvular leak, an acquired Gerbode defect, an aorta to right atrium fistula and a mitral paraprosthetic leak were respectively closed with devices for vascular occlusion, atrial septal defect closure, ductus arteriosus closure and treatment of muscular interventricular communication. In all cases the treatments were effective and patients had a favourable outcome without requiring new surgical interventions. We conclude that, irrespective of the indications for which they were designed, the use of Amplatzer® devices in selected pathologies is a good therapeutic alternative in the hands of experienced teams in this type of treatment.

  7. Effects of electrocautery to provoke endovascular thermal injury Efeitos do eletrocautério para provocar lesão térmica endovascular

    OpenAIRE

    Fabio Henrique Rossi; Nilo Mitsuru Izukawa; Domingos Guerino Silva; Juliana Chen; Akash Kuzhiparambil Prakasan; Mabel Moura Barros Zamorano; Lílian Mary Silva

    2011-01-01

    PURPOSE: To investigate the effects of a new electrocautery device to provoke endovascular venous thermal injury. METHODS: An experimental endovascular electrocautery was placed inside eight ex-vivo bovine saphenous veins models. Each one was divided in eight segments and progressive intensities of electric energy liberated. The macroscopic and microscopic effects were analyzed. RESULTS: Forty bovine saphenous veins segments were studied. The higher the electric energy applied the greater the...

  8. Embarazo ectópico abdominal / Abdominal ectopic pregnancy

    Scientific Electronic Library Online (English)

    Pedro Antonio, Chirino Acosta; Ángel Miguel, Sarmiento Vitón; Miguel Alexis, González Linares; Amnerys, Cabrera Rumayor; Nuvia, Soto Paez.

    2015-06-01

    Full Text Available El embarazo ectópico abdominal ocurre con escasa frecuencia. Se refiere al implante del embarazo en algunas de las estructuras de la cavidad abdominal, generalmente se asocia a una alta incidencia en la mortalidad materna y fetal; la mortalidad materna es siete veces mayor que en el embarazo tubáric [...] o y hasta 90 veces más que en el embarazo normal. El caso que a continuación se presenta es una paciente con antecedentes de salud previa, que asistió al Hospital Provincial de Bengo, municipio de Dande de la República Popular de Angola, en septiembre de 2013. Se le diagnosticó un embarazo a término con una deficiente atención prenatal. Se detectó perdida genital y ausencia de latidos cardiacos fetales. Se le comenzó la inducción del parto, y al no tener progreso, se realizó la cesaría hallándose un embarazo ectópico abdominal. Se realizó la extracción de un recién nacido a término muerto y gran parte de la placenta. Abstract in english Abdominal ectopic pregnancy is not frequent. It refers to the extrauterine implantation of pregnancy in some of the abdominal cavity structures, generally associated with a high incidence of maternal and fetal mortality; rates of maternal mortality have been reported as high as sevenfold higher than [...] in tubal pregnancy, and up to ninetyfold higher than normal pregnancy. This case report (September 2013) presents a patient with previous history, she attended to Bengo Provincial Hospital, Dandede municipality, People’s Angola Republic. The pregnancy was detected at term with poor prenatal care. Genital loss and absence of fetal heartbeats were observed. The Induction of labor was initiated, having not progress; a cesarean section was performed, finding an abdominal ectopic pregnancy. The removal of a stillborn at term and great part of the placenta was performed.

  9. Development of Delirium in the Intensive Care Unit in Patients after Endovascular Aortic Repair: A Retrospective Evaluation of the Prevalence and Risk Factors

    OpenAIRE

    Yohei Kawatani; Yoshitsugu Nakamura; Yujiro Hayashi; Tetsuyoshi Taneichi; Yujiro Ito; Hirotsugu Kurobe; Yuji Suda; Takaki Hori

    2015-01-01

    Delirium is an acute form of nervous system dysfunction often observed in patients in the intensive care unit. Endovascular aortic repair (EVAR) is considered a minimally invasive surgical treatment for abdominal aortic aneurysm. Although the operation method is widely used, there are few investigations of the rate and risk factors of delirium development after the operation. In this study, we retrospectively examined the rate of delirium development in the intensive care unit (ICU) after EVA...

  10. Endometrioma de parede abdominal / Abdominal wall endometrioma

    Scientific Electronic Library Online (English)

    Italo, Accetta; Pietro, Accetta; André Figueiredo, Accetta; Francisco José Santos, Maia; Ana Paula Félix de Andrade, Oliveira.

    2011-03-01

    Full Text Available RACIONAL: A incidência exata da endometriose na população geral é desconhecida. A confirmação desta doença só é possível através da análise histopatológica de um fragmento obtido por algum procedimento invasivo, pois não existe até o momento, nenhum marcador clínico seguro. OBJETIVO: Relatar a exper [...] iência com as manifestações clínicas e o tratamento cirúrgico em pacientes com endometrioma de parede abdominal. MÉTODO: Análise retrospectiva das pacientes operadas por endometrioma de parede abdominal, dando ênfase aos dados relativos à idade, sintomas, cesariana prévia, relação dos sintomas com o ciclo menstrual, exames físicos e complementares, tratamento cirúrgico, evolução pósoperatória e resultado histopatológico dos espécimes. RESULTADOS: Foram operadas 14 pacientes no período estudado, com idade entre 28 e 40 anos. A presença de massa e dor local que piorava durante a menstruação foram as queixas principais. Ultrassonografia e tomografia computadorizada foram exames importantes em localizar precisamente a doença. O tratamento cirúrgico foi exérese ampla da tumoração e dos tecidos comprometidos. As pacientes evoluíram satisfatoriamente e o histopatológico confirmou a suspeita de endometrioma de parede abdominal em todos os casos. CONCLUSÂO: Foi nítida a relação entre cesariana prévia e endometrioma de parede abdominal e estudos ultrassonográficos e tomográficos auxiliaram a planejar a abordagem cirúrgica permitindo a exérese da tumoração e de todos os tecidos adjacentes comprometidos. Abstract in english BACKGROND: The exact incidence of endometriosis in the general population is unknown. Confirmation of this disease is only possible by histopathological analysis of a fragment obtained by some invasive procedure, because there is so far, no clinical secure marker. AIM: To report the experience with [...] the clinical manifestations and surgical treatment in patients with abdominal wall endometrioma. METHODS: Retrospective analysis of patients operated for abdominal wall endometrioma with emphasis on data relating to age, symptoms, previous cesarean, relation of symptoms with the menstrual cycle, physical examinations and additional surgical treatment, postoperative course and histopathological results of specimens. RESULTS: Forteen patients were operated during the study period, aged between 28 and 40 years. The presence of local mass and pain that worsened during menstruation were the main complaints. Ultrasound and CT examinations were important to precisely localize the disease. Surgical excision was a wide excision of the tumor and affected tissues. The patient progressed satisfactorily and histopathology confirmed the diagnosis of abdominal wall endometrioma in all cases. CONCLUSION: Exists a clear relationship between cesarean operation and abdominal wall endometrioma; ultrasound studies and CT scans help to plan the surgical resection allowing resection of tumor and all affected adjacent tissues.

  11. Endometrioma de parede abdominal / Abdominal wall endometrioma

    Scientific Electronic Library Online (English)

    Italo, Accetta; Pietro, Accetta; André Figueiredo, Accetta; Francisco José Santos, Maia; Ana Paula Félix de Andrade, Oliveira.

    2011-02-01

    Full Text Available OBJETIVO: Relatar a experiência dos autores com as manifestações clínicas e o tratamento cirúrgico em pacientes com endometrioma de parede abdominal. MÉTODOS: Análise retrospectiva das pacientes operadas por endometrioma de parede abdominal, dando ênfase aos dados relativos à idade, sintomas, cesari [...] ana prévia, relação dos sintomas com o ciclo menstrual, exames físicos e complementares, tratamento cirúrgico, evolução pós-operatória e resultado histopatológico dos espécimes. RESULTADOS: Foram operadas 14 pacientes no período estudado, com idade entre 28 e 40 anos. A presença de massa e dor local que piorava durante a menstruação foram as queixas principais. Ultrassonografia e tomografia computadorizada foram exames importantes em localizar precisamente a doença. O tratamento cirúrgico foi exérese ampla da tumoração e dos tecidos comprometidos. As pacientes evoluíram satisfatoriamente e o histopatológico confirmou a suspeita de endometrioma de parede abdominal em todos os casos. CONCLUSÃO: Foi nítida a relação entre cesariana prévia e endometrioma de parede abdominal e estudos ultrassonográficos e tomográficos auxiliaram a planejar a abordagem cirúrgica permitindo a exérese da tumoração e de todos os tecidos adjacentes comprometidos. Abstract in english OBJECTIVE: To report the authors' experience with the clinical manifestations and surgical treatment of abdominal wall endometriomas. METHODS: A retrospective analysis of patients operated for abdominal wall endometrioma was carried out, with emphasis on age, symptoms, previous cesarean, relation of [...] symptoms with the menstrual cycle, physical examinations and additional surgical treatment, postoperative course and histopathological results of specimens. RESULTS: Fourteen patients were operated during the study period, aged between 28 and 40 years. The presence of a local mass and pain that worsened during menstruation were the main complaints. Ultrasound and Computerized Tomography examinations were important in the precise location of the disease. Surgical excision was wide, invooving the tumor and affected tissues. The patients progressed satisfactorily and histopathology confirmed the diagnosis of abdominal wall endometrioma in all cases. CONCLUSION: There was a clear relationship between cesarean section and abdominal wall endometrioma. Ultrasound studies and CT scans helped to plan the surgical approach, allowing resection of the tumor and all adjacent affected tissues.

  12. Abdominal Compartment Syndrome

    Directory of Open Access Journals (Sweden)

    Ovchinnikov V.?.

    2013-03-01

    Full Text Available We considered one of the most complicated problems of surgery and intensive care — abdominal compartment syndrome. It is a severe, and in some cases lethal complication developing in major injuries and pathology of abdominal cavity and retroperitoneal space, as well as in extra-abdominal pathology. In addition, compartment syndrome can be the complication of a number of surgical procedures accompanied primarily by laparotomy wound closure with tissue tension. We demonstrated the classification of the complication taking into consideration the etiology, pathogenesis of intra-abdominal hypertension development, the significance of intra-abdominal pressure level, as well as its role in multi-organ failure development. We considered the methods of intra-abdominal pressure measurement, and the urinary pressure measurement using Unometer™Abdo-Pressure™ device turned out to be the most accurate, simple and safe. The preventive and treatment modalities of abdominal compartment syndrome were described. The monitoring of intra-abdominal pressure level in risk group patients, adequate infusion therapy, timely decompression (nasogastrointestinal intubation, decompressive laparotomy, and optimal respiratory support conditions are of primary importance.

  13. Abdominal injuries and sport

    OpenAIRE

    Ryan, J. M.

    1999-01-01

    Serious abdominal injuries resulting from sport are rare. The potential for misdiagnosis is significant and the consequences may be serious. Patients with abdominal pain should be taken very seriously and investigated with appropriate diagnostic equipment. Sporting bodies have a responsibility to address safety within a particular sport and to change the rules where necessary as injury patterns are identified. ?????

  14. Technology penetration of endovascular aortic aneurysm repair in southern California.

    Science.gov (United States)

    Shah, Haimesh; Kumar, S Ram; Major, Kevin; Hood, Douglas; Rowe, Vincent; Weaver, Fred A

    2006-11-01

    Our objective was to investigate the penetration of endovascular abdominal aortic aneurysm repair (EVAR) in the large, diverse health-care market of southern California over 3 years and to study variability in the pattern of distribution of EVAR in southern California counties by analyzing available demographic, geographic, and socioeconomic data from California state health-care databases. Information abstracted from the inpatient hospital discharge data for patients undergoing AAA repair for the years 2001, 2002, and 2003, derived from the Office of Statewide Health Planning and Development, included age, gender, race, hospitals performing EVAR, and payors for the service. Per-capita income (PCI) for the year 1999 and the population size of each county for the respective years were obtained from the U.S. Census Bureau. Data pertaining to members of the Southern California Vascular Surgical Society (SCVSS) serving the southern California region were obtained from the SCVSS membership directory. Data were categorized based on 10 counties in southern California. All the above variables were analyzed using the chi-squared test, with p or =65 years (p 21,000 US$ (p health maintenance organization, preferred provider organization, and private insurance holders (p penetration of the procedure varied among counties. County affluence, payor mix, and the number of vascular surgeons/county influenced the variability. These observations suggest that economic barriers may limit access to new biomedical technology. This has implications for health-care public policy directed toward providing equal access to medical care without regard to economic status. PMID:17136631

  15. Endovascular Embolization of Spontaneous Retroperitoneal Hemorrhage Secondary to Anticoagulant Treatment

    International Nuclear Information System (INIS)

    The purpose of this study was to report a single hospital's experience of endovascular treatment of patients with retroperitoneal hemorrhage (RPH) secondary to anticoagulant treatment. Ten consecutive patients treated in an intensive care unit and needing blood transfusions due to RPH secondary to anticoagulation were referred for digital subtraction angiography (DSA) to detect the bleeding site(s) and to evaluate the possibilities of treating them by transcatheter embolization. DSA revealed bleeding site(s) in all 10 patients: 1 lumbar artery in 4 patients, 1 branch of internal iliac artery in 3 patients and multiple bleeding sites in 3 patients. Embolization could be performed in 9 of them. Coils, gelatin and/or polyvinyl alcohol were used as embolic agents. Bleeding stopped or markedly decreased after embolization in 8 of the 9 (89%) patients. Four patients were operated on prior to embolization, but surgery failed to control the bleeding in any of these cases. Abdominal compartment syndrome requiring surgical or radiological intervention after embolization developed in 5 patients. One patient died, and 2 had sequelae due to RPH. All 7 patients whose bleeding stopped after embolization had a good clinical outcome. Embolization seems to be an effective and safe method to control the bleeding in patients with RPH secondary to anticoagulant treatment when conservative treatment is insufficient

  16. Endovascular Treatment of Chronic Mesenteric Ischemia: Results in 14 Patients

    International Nuclear Information System (INIS)

    We evaluated immediate and long-term results of percutaneous transluminal angioplasty (PTA) and stent placement to treat stenotic and occluded arteries in patients with chronic mesenteric ischemia. Fourteen patients were treated by 3 exclusive celiac artery (CA) PTAs (2 stentings), 3 cases with both Superior Mesenteric Artery (SMA) and CA angioplasties, and 8 exclusive SMA angioplasties (3 stentings). Eleven patients had atheromatous stenoses with one case of an early onset atheroma in an HIV patient with antiphospholipid syndrome. The other etiologies of mesenteric arterial lesions were Takayashu arteritis (2 cases) and a postradiation stenoses (1 case). Technical success was achieved in all cases. Two major complications were observed: one hematoma and one false aneurysm occurring at the brachial puncture site (14.3%). An immediate clinical success was obtained in all patients. During a follow-up of 1-83 months (mean: 29 months), 11 patients were symptom free; 3 patients had recurrent pain; in one patient with inflammatory syndrome, pain relief was obtained with medical treatment; in 2 patients abdominal pain was due to restenosis 36 and 6 months after PTA, respectively. Restenosis was treated by PTA (postirradiation stenosis), and by surgical bypass (atheromatous stenosis). Percutaneous endovascular techniques are safe and accurate. They are an alternative to surgery in patients with chronic mesenteric ischemia due to short and proximal occlusive lesions of SMA and CA

  17. Metallic zinc exhibits optimal biocompatibility for bioabsorbable endovascular stents.

    Science.gov (United States)

    Bowen, Patrick K; Guillory, Roger J; Shearier, Emily R; Seitz, Jan-Marten; Drelich, Jaroslaw; Bocks, Martin; Zhao, Feng; Goldman, Jeremy

    2015-11-01

    Although corrosion resistant bare metal stents are considered generally effective, their permanent presence in a diseased artery is an increasingly recognized limitation due to the potential for long-term complications. We previously reported that metallic zinc exhibited an ideal biocorrosion rate within murine aortas, thus raising the possibility of zinc as a candidate base material for endovascular stenting applications. This study was undertaken to further assess the arterial biocompatibility of metallic zinc. Metallic zinc wires were punctured and advanced into the rat abdominal aorta lumen for up to 6.5months. This study demonstrated that metallic zinc did not provoke responses that often contribute to restenosis. Low cell densities and neointimal tissue thickness, along with tissue regeneration within the corroding implant, point to optimal biocompatibility of corroding zinc. Furthermore, the lack of progression in neointimal tissue thickness over 6.5months or the presence of smooth muscle cells near the zinc implant suggest that the products of zinc corrosion may suppress the activities of inflammatory and smooth muscle cells. PMID:26249616

  18. Endovascular treatment of ruptured splenic artery aneurysm

    DEFF Research Database (Denmark)

    Bjerring, Ole Steen

    2008-01-01

    Splenic artery aneurysms (SAA) are traditionally treated surgically, but endovascular techniques are becoming increasingly popular. A 64 year-old male with chest pain and low blood pressure was admitted under suspicion of AMI. A CT scan showed a 56 mm SAA with signs of rupture. The patient was...

  19. Endovascular treatment of symptomatic intracranial atherosclerotic disease

    Directory of Open Access Journals (Sweden)

    SyedIHussain

    2011-02-01

    Full Text Available Abstract: Symptomatic intracranial atherosclerotic disease (ICAD is responsible for approximately 10% of all ischemic strokes in the United States. The risk of recurrent stroke may be as high as 35% in patient with critical stenosis greater than 70% in diameter narrowing. Recent advances in medical and endovascular therapy have placed ICAD at the forefront of clinical stroke research to optimize the best medical and endovascular approach to treat this important underlying stroke etiology. Analysis of symptomatic ICAD studies lead to the question that whether angioplasty and or stenting is a safe, suitable and efficacious therapeutic strategy in patients with critical stenoses that are deemed refractory to medical management. Most of the currently available data in support of angioplasty and or stenting in high risk patients with severe symptomatic ICAD is in the form of case series and randomized trial results of endovascular therapy versus medical treatment are awaited. This is a comprehensive review of the state of the art in the endovascular approach with angioplasty and or stenting of symptomatic intracranial atherosclerotic disease.

  20. Endovascular Treatment of AVF after Hair Transplantation

    International Nuclear Information System (INIS)

    Arteriovenous fistula (AVF) of the scalp is a very rare complication of hair transplantation. Only 9 cases have been reported in nearly half a century. The diagnosis is clinical but angiography is necessary for defining the angioarchitecture of the lesion. Due to technical developments, endovascular embolization has become the primary treatment for AVF of the scalp.

  1. Endovascular Treatment of Symptomatic Intracranial Atherosclerotic Disease

    Science.gov (United States)

    Short, Jody L.; Majid, Arshad; Hussain, Syed I.

    2011-01-01

    Symptomatic intracranial atherosclerotic disease (ICAD) is responsible for approximately 10% of all ischemic strokes in the United States. The risk of recurrent stroke may be as high as 35% in patient with critical stenosis >70% in diameter narrowing. Recent advances in medical and endovascular therapy have placed ICAD at the forefront of clinical stroke research to optimize the best medical and endovascular approach to treat this important underlying stroke etiology. Analysis of symptomatic ICAD studies lead to the question that whether angioplasty and/or stenting is a safe, suitable, and efficacious therapeutic strategy in patients with critical stenoses that are deemed refractory to medical management. Most of the currently available data in support of angioplasty and/or stenting in high risk patients with severe symptomatic ICAD is in the form of case series and randomized trial results of endovascular therapy versus medical treatment are awaited. This is a comprehensive review of the state of the art in the endovascular approach with angioplasty and/or stenting of symptomatic ICAD. PMID:21359195

  2. Hernia abdominal traumáti / Traumatic abdominal hernia

    Scientific Electronic Library Online (English)

    Carlos Hernando, Morales; Jaime Andrés, Montoya; Óscar, Henao.

    2011-12-01

    Full Text Available Las hernias abdominales traumáticas son un tipo de hernias adquiridas, secundarias a traumatismo cerrado. Se reportan dos casos de este tipo de lesiones, uno de ellos con lesión abdominal significativa asociada. En uno de los casos, se corrigió el defecto por planos y fijación de malla de polipropil [...] eno por encima de la fascia; el otro fue corregido con malla por abordaje laparoscópico. En ambos casos, el periodo posoperatorio transcurrió sin complicaciones. Se presenta una revisión de la literatura. Abstract in english Traumatic abdominal wall hernias are a type of acquired hernias secondary to blunt trauma. We report two cases of such hernias, one of them with significant intra-abdominal injury. One wall defect was repaired in layers and fixation of polypropylene mesh over the fascia. The other case was repaired [...] by laparoscopy. Postoperative course was uneventful. The latest literature is reviewed. With this literature review and case report we hope to augment the knowledge on traumatic abdominal wall hernias, hopefully leading to early diagnosis and treatment.

  3. Obesidad mórbida: caso excepcional de reconstrucción de pared abdominal / Morbid obesity: an exceptional patient. Apronectomy and new abdominal wall reconstruction

    Scientific Electronic Library Online (English)

    F.J., Gabilondo Zubizarreta; V., Torrero López,; N., Madariaga Romero; J., Ayestarán Soto; M., Uceda Carmona; J., Caramés Estefanía.

    2006-09-01

    Full Text Available Presentamos una nueva técnica para la reconstrucción de la pared abdominal, con material sintético en una paciente que padeciendo un cuadro de obesidad mórbida sin cirugía ni traumatismo previo, sufre una diástasis de músculos rectos de su pared abdominal por la que se produce una evisceración intes [...] tinal que al alojarse en el faldón abdominal y añadirse un proceso de acumulación de líquidos en el intersticio semejante al linfedema, supuso como tratamiento una resección superior a los 60 Kg. entre sólidos y líquidos y una estrategia y técnica nuevas de reconstrucción del defecto de la pared abdominal. Abstract in english The aim of this work is to show a new technique for reconstruction of the abdominal wall with synthetic matherial in a patient with morbid obesity. The disease has no relation with antecedents of previous surgery or trauma and is asociated with a dyasthasis of the rectus abdomini muscles which has c [...] onditionated a intestinal evisceration.This evisceration is accommodated in the abdominal apron and is associated with a great accumulation of fluid (liquid) in the interstitium, which seems a linphedema. Taking account the combination of liquid and soft tissues the resection is larger than 60 Kg. and this has forced us to develop new strategies for the menagement of the patient and techniques for the reconstruction of the abdominal wall defect.

  4. Chronic contained abdominal aortic aneurysm rupture after suprarenal fixation fatigue fracture.

    Science.gov (United States)

    Pitoulias, Georgios A; Mavros, Dimitrios M; Pappas, Evaggelos A; Atmatzidis, Stefanos K; Papadimitriou, Dimitrios K

    2012-10-01

    Chronic contained rupture (CCR) of an abdominal aortic aneurysm is a rare condition, and differential diagnosis might be difficult. We present a clinical case of a hemodynamically stable octogenarian who presented with intermittent pain in the left lower abdomen. The patient had a history of diverticulitis, and 6 years ago, he had undergone endovascular abdominal aortic aneurysm repair (EVAR) with a Talent bifurcated prosthesis. Additionally, 20 days before his admission to our hospital, he had undergone a secondary iliac limb extension for treatment of post-EVAR rupture. On admission, abdominal plain radiography identified suprarenal fixation fracture as a possible reason for CCR, but computed tomographic angiography failed to confirm any endoleak or "active" bleeding and rupture. The patient received medication treatment for possible diverticulitis and was kept under close monitoring for suspected failure of recently performed secondary endovascular procedure and CCR. A day later, the abdominal pain symptoms worsened, and a new computed tomographic angiography confirmed the suspected CCR. The patient was treated successfully by "open" repair using a Y prosthesis. To our knowledge, this is the first reported case of post-EVAR CCR due to suprarenal fixation fatigue fracture. Lifelong post-EVAR follow-up with high level of both clinical and imaging diagnostic accuracy is essential for the early recognition and proper treatment of EVAR pitfalls. PMID:22944573

  5. ENDOMETRIOSIS DE LA PARED ABDOMINAL

    Directory of Open Access Journals (Sweden)

    Antonio Carvajal M

    2007-01-01

    Full Text Available Antecedentes: La presencia de endometriosis de la pared abdominal (EPA suele confundirse con otras patologías médico-quirúrgicas que aparecen en la misma zona. Objetivo: Evaluar las características clínicas de la EPA. Método: Se realizó un estudio retrospectivo de todas las pacientes hospitalizadas con el diagnóstico histopatológico de EPA entre enero de 1997 y diciembre de 2005. Resultados: Se encontraron 14 pacientes, con edad promedio de 33,2 años. Los principales síntomas fueron: dolor cíclico (71,4%, masa abdominal (100%, dispareunia (21,4% y dismenorrea (42,8%. Todas la pacientes tuvieron al menos una cirugía ginecológica (2 con procedimientos laparoscópicos u obstétrica (85,7% cesárea. Sólo una paciente se había diagnosticado previamente de endometriosis. Los síntomas comenzaron en promedio 3,5 años posteriores a la última cirugía. Las EPA tenían un tamaño promedio de 3,2 cm. El diagnóstico pre-operatorio fue correcto en el 64,3% de las pacientes. Los diagnósticos incorrectos correspondieron a 3 granulomas, una hernia inguinal y un lipoma. Todas las pacientes requirieron cirugía y en el 64,3% fue necesario la utilización de mallas polytetrafluoethyleno. Cuatro pacientes (28,5% presentaron recurrencias. 60% de los diagnósticos iniciales incorrectos v/s 11,1% de los acertados recurrieron. Conclusiones: La EPA puede encontrarse en cicatrices tanto ginecológicas como obstétricas. Los síntomas comunes son masas con dolor cíclico. La ecografía de pared abdominal fue suficiente para enfrentar el diagnóstico diferencial. El diagnóstico pre-operatorio es importante para planificar la cirugía porque redujo las recurrencias. El tratamiento de elección es la cirugía con resección amplia de los bordesBackground: The presence of abdominal wall endometriosis (AWE used to be confused with other surgical pathologies that may appear in these zones. Objective: To evaluate the AWE clinical characteristics. Method: Retrospective study of all the patients hospitalized with the histopathologycal diagnosis of AWE, between January 1997 and December 2005. Results: There was found AWE only in 14 patients. Their mean age was 33.2 years old. The symptoms were: cyclic pain (71.4%, abdominal wall mass (100%, dyspareunia (21.4% and dysmenorrhea (42.8%. All patients had at least one gynecologic (2 patients with laparoscopic procedures or obstetric surgery (85.7% had previous cesarean section. Only one patient had previously been diagnosed with pelvic endometriosis. Their symptoms started after an average of 3.5 years after surgery. The AWE had a mean size of 3.2 cm. The preoperative diagnosis was correct in 64.3%. The incorrect preoperative diagnoses were 3 granuloma, 1 inguinal hernia and 1 lipoma. All patients required surgery. 64.3% of the patients it was necessary a polytetrafluoethylene mesh. Four patients (28.5% had AWE recurrences. 60% of the wrong initial diagnosis recurred versus 11.1% of the correct ones. Conclusion: AWE may be present in gynecologic or obstetric scars. Their common symptoms are masses with cyclic pain. Ultrasonography is enough to approach the differential diagnosis. The correct preoperative diagnosis is important to plan surgery and reduce recurrences. The surgical wide excision is the preferable treatment. Establishing clear endometriosis limits reduce the recurrences

  6. Endovascular treatment of the carotid-cavernous vascular lesions / Tratamento endovascular das lesões vasculares carotidocavernosas

    Scientific Electronic Library Online (English)

    Guilherme Brasileiro de, Aguiar.

    2014-07-01

    Full Text Available Introduction: The treatment of lesions which compromise the cavernous sinus has always constituted a challenge. The endovascular treatment of these lesions has presented diverse alterations over the last years. This study aims to evaluate the endovascular treatment of vascular lesions in the inter [...] nal carotid artery (ICA), cavernous segment, performed at our service. Method: This is a descriptive study, retrospective and prospective. Patients with aneurysm in the cavernous ICA or direct carotid-cavernous fistula (dCCF) submitted to endovascular treatment were evaluated. Results: Included were 26 patients with intracavernous aneurysms and 10 with dCCF. All aneurysms were treated with ICA occlusion. The dCCF were treated with occlusion of the ICA in seven cases and with selective fistula occlusion in the remaining three. There was an improvement in pain and ocular proptosis in all patients with dCCF. In the patients with intracavernous aneurysms, the incidence of retroorbitary pain went from 84.6% to a mere 30.8%, following the treatment. Following endovascular treatment, there was an important improvement in the dysfunction of cranial nerves, compromised in both patient groups, mainly in the oculomotor nerve. Conclusion: The endovascular treatment provided an improvement in the patients of this study, especially in the criteria pain and oculomotor nerve dysfunction.

  7. Abdominal aortic aneurysm

    Science.gov (United States)

    Aneurysm - aortic; AAA ... pressure Male gender Genetic factors An abdominal aortic aneurysm is most often seen in males over age ... one or more risk factors. The larger the aneurysm, the more likely it is to break open. ...

  8. Abdominal tuberculosis: Imaging features

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Jose M. [Department of Radiology, Hospital de S. Joao, Porto (Portugal)]. E-mail: jmpjesus@yahoo.com; Madureira, Antonio J. [Department of Radiology, Hospital de S. Joao, Porto (Portugal); Vieira, Alberto [Department of Radiology, Hospital de S. Joao, Porto (Portugal); Ramos, Isabel [Department of Radiology, Hospital de S. Joao, Porto (Portugal)

    2005-08-01

    Radiological findings of abdominal tuberculosis can mimic those of many different diseases. A high level of suspicion is required, especially in high-risk population. In this article, we will describe barium studies, ultrasound (US) and computed tomography (CT) findings of abdominal tuberculosis (TB), with emphasis in the latest. We will illustrate CT findings that can help in the diagnosis of abdominal tuberculosis and describe imaging features that differentiate it from other inflammatory and neoplastic diseases, particularly lymphoma and Crohn's disease. As tuberculosis can affect any organ in the abdomen, emphasis is placed to ileocecal involvement, lymphadenopathy, peritonitis and solid organ disease (liver, spleen and pancreas). A positive culture or hystologic analysis of biopsy is still required in many patients for definitive diagnosis. Learning objectives:1.To review the relevant pathophysiology of abdominal tuberculosis. 2.Illustrate CT findings that can help in the diagnosis.

  9. Abdominal tuberculosis: Imaging features

    International Nuclear Information System (INIS)

    Radiological findings of abdominal tuberculosis can mimic those of many different diseases. A high level of suspicion is required, especially in high-risk population. In this article, we will describe barium studies, ultrasound (US) and computed tomography (CT) findings of abdominal tuberculosis (TB), with emphasis in the latest. We will illustrate CT findings that can help in the diagnosis of abdominal tuberculosis and describe imaging features that differentiate it from other inflammatory and neoplastic diseases, particularly lymphoma and Crohn's disease. As tuberculosis can affect any organ in the abdomen, emphasis is placed to ileocecal involvement, lymphadenopathy, peritonitis and solid organ disease (liver, spleen and pancreas). A positive culture or hystologic analysis of biopsy is still required in many patients for definitive diagnosis. Learning objectives:1.To review the relevant pathophysiology of abdominal tuberculosis. 2.Illustrate CT findings that can help in the diagnosis

  10. Complex Abdominal Wall Repair

    Medline Plus

    Full Text Available ... some not so great tissue on the right lateral aspect of her abdominal wall, but we do ... can actually use Veritas either to repair our lateral defects used in the component separation to allow ...

  11. Complex Abdominal Wall Repair

    Medline Plus

    Full Text Available ... up with her, she's actually pregnant now and plans on delivering her first child. She does have ... patients that are ill and in the intensive care unit, have significant abdominal problems, and mesh is ...

  12. Complex Abdominal Wall Repair

    Medline Plus

    Full Text Available ... screen and open the door to informed medical care. 00:00:59 Hello, I'm Dr. Jonathan ... patients that are ill and in the intensive care unit, have significant abdominal problems, and mesh is ...

  13. Abdominal ultrasound (image)

    Science.gov (United States)

    Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X-ray, MRI, ... it has its place as a diagnostic tool. Ultrasound scans use high frequency sound waves to produce ...

  14. Abdominal cerebrospinal fluid pseudocyst

    International Nuclear Information System (INIS)

    A case of an abdominal cerebrospinal fluid (CSF) pseudocyst in a patient with a ventriculoperitoneal shunt is reported to illustrate this known but rare complication. In the setting of a VP shunt, the frequency of abdominal CSF pseudocyst formation is approximately 3.2%, often being precipitated by a recent inflammatory or infective process or recent surgery. Larger pseudocysts tend to be sterile, whereas smaller pseudocysts are more often infected. Ultrasound and CTeach have characteristic findings Copyright (2004) Blackwell Publishing Asia Pty Ltd

  15. Imaging in Tuberculosis abdominal

    International Nuclear Information System (INIS)

    In this article we illustrate and discuss imaging features resulting from Tuberculosis abdominal affectation. We present patients evaluated with several imaging modalities who had abdominal symptoms and findings suggestive of granulomatous disease. Diagnosis was confirm including hystopatology and clinical outgoing. Cases involved presented many affected organs such as lymphatic system, peritoneum, liver, spleen, pancreas, kidneys, ureters, adrenal glands and pelvic organs Tuberculosis, Tuberculosis renal, Tuberculosis hepatic, Tuberculosis splenic Tomography, x-ray, computed

  16. Impairment of erectile function after elective repair of abdominal aortic aneurysm.

    Science.gov (United States)

    Majd, P; Ahmad, W; Luebke, Th; Gawenda, M; Brunkwall, J

    2016-02-01

    The purpose of the present study was to compare the functional change of erectile dysfunction after endovascular repair (EVAR) and open repair (OR) of abdominal aortic aneurysm.Between April 2009 and December 2011, male patients admitted for elective treatment of an asymptomatic infrarenal abdominal aortic aneurysm were included. The erectile function was evaluated by using a validated KEED questionnaire. All patients filled out the questionnaire preoperatively and postoperatively after one year.The number of patients with an increase of erectile dysfunction was 8 (26.6%) to 16 (53.3%) in open repair group vs. 30 (42.6%) to 40 (58.8%) in endovascular aneurysm repair. There was no statistically significant difference between open repair and endovascular aneurysm repair groups in order of new incidence of erectile dysfunction (p?=?0.412). The study showed an increase in the mean value of Erectile Dysfunction -Score postoperatively in both the groups as well.The present study showed an increase of erectile dysfunction postoperatively, but the difference between the two groups was not statistically significant. PMID:25761855

  17. The endovascular treatment of brain arteriovenous malformations.

    Science.gov (United States)

    Valavanis, A; Ya?argil, M G

    1998-01-01

    Advances in superselective microcatheterization techniques, which took place in the past decade, established superselective endovascular exploration as an integral and indispensable tool in the pretherapeutic evaluation of brain AVMs. The strict and routine application of superselective angiography furthered our knowledge on the angioarchitecture of brain AVMs, including vascular composition of the nidus, types of feeding arteries and types and patterns of venous drainage. In addition, various types of weak angioarchitectural elements, such as flow-related aneurysms, intranidal vascular cavities and varix formation proximal to high-grade stenosis of draining veins, could be identified as factors predisposing for AVM rupture. A wide spectrum of secondary angiomorphological changes induced by the arteriovenous shunt of the nidus and occurring up- and downstream of the nidus have been identified as manifestations of high-flow angiopathy. These data help to better predict the natural history, understand the widely variable clinical presentation and to define therapeutic targets of brain AVMs. Correlation of the topography of the AVM as demonstrated by MR with the angioarchitecture as demonstrated by superselective angiography provided a system for topographic-vascular classification of brain AVMs, which proved very useful for patient selection and definition of therapeutic goals. This study showed, that 40% of patients with brain AVMs can be cured by embolization alone with a severe morbidity of 1.3% and a mortality of 1.3%. Part of theses patients can, however, be cured equally effective by microsurgery or radiosurgery. Which modality will be chosen for a particular patient will mainly depend on the locally available expertise and experience, but also on the preference of the patient following its comprehensive information about the chances for cure and the risks associated with each of these therapeutic modalities. Embolization has a significant role in the multimodality treatment of brain AVMs, by either enabling or facilitating subsequent microsurgical or radiosurgical treatment. Appropriately targeted embolization in otherwise untreatable AVMs represents a reasonable form of palliative treatment of either ameliorating the clinical condition of the patient or reducing the potential risk of hemorrhage. Regarding the practical aspects of the endovascular treatment the following conclusions could be drawn from the experience obtained with this series of 387 patients with a brain AVM: (1) The goal of endovascular treatment should be defined prior to the procedure. This does not preclude a change in the goal, if additional information obtained during the procedure make this necessary. (2) The result of endovascular treatment of a brain AVM in terms of the degree of obliteration achieved and complication rate depends mainly on the endovascular strategy developed and the technique applied. These depend on the specific angioarchitecture and topography of the individual AVM, on the past history and clinical presentation of the patient and on the predefined goal of embolization. The strategy should include the definition of embolization targets, the selection of the most appropriate approach for endovascular navigation, the determination of the sequence of catheterization of individual feeding arteries, the selection of the type of catheters and microcatheters, the selection of the appropriate embolic materials as well as the site and mode of their delivery. Thereafter, every endovascular move should be, as in a chess game, the result of a logical plan. (3) Atraumatic superselective microcatheterization is a key point in the endovascular treatment of brain AVMs. It requires manual skills, knowledge of anatomy and respect for the vascular wall. (4) All locations of brain AVMs should be regarded as eloquent, and no distinction should be made between eloquent and non-eloquent areas of the brain when deciding on the execution of embolizatio PMID:10050213

  18. Uso de endoprótesis bifurcada ilíaca para revascularización hipogástrica durante tratamiento de aneurisma aorto-ilíaco Bifurcated iliac endograft in a patient with aortic-iliac aneurysm

    Directory of Open Access Journals (Sweden)

    RENATO MERTENS M

    2010-06-01

    Full Text Available Una anatomía desfavorable es un obstáculo a vencer con el tratamiento endovascular del aneurisma aorto-ilíaco. La presencia de aneurisma ilíaco bilateral es frecuente y amenaza la adecuada fijación distal de una endoprótesis. Esta condición puede ser manejada: a aumentando el diámetro del dispositivo a nivel ilíaco, con limitaciones en las medidas disponibles; b embolización hipogástrica bilateral, aceptando una morbimortalidad mayor; c combinando un abordaje quirúrgico retroperitoneal para revascularizar una arteria hipogástrica, aumentando el impacto del procedimiento; d mediante revascularización retrógrada unilateral desde la arteria ilíaca externa ipsilateral con otra endoprótesis. Recientemente se ha descrito el uso de endoprótesis ramificadas, que requieren un despliegue complejo, pero permiten revascularizar una o ambas arterias hipogástricas en forma anterógrada y estable. Reportamos el caso de un paciente de sexo masculino y 57 años, de alto riesgo para cirugía convencional, portador de un aneurisma pequeño de aorta abdominal y aneurismas ilíaco común bilateral e hipogástrico izquierdo. Fue tratado mediante despliegue de una endoprótesis bifurcada ilíaca, revascularizando la arteria hipogástrica derecha y embolizando la izquierda aneurismática, asociado a implante de una endoprótesis aórtica convencional, también bifurcada. El paciente evoluciona sin complicaciones, con claudicación glútea izquierda leve en disminución y preservación de su función sexual. Una tomografía axial computada demuestra exclusión efectiva de sus aneurismas. Esta nueva técnica permite tratar de manera segura a pacientes portadores de aneurisma ilíaco bilateral en forma endo-vascular, manteniendo perfusión de la circulación pelviana y disminuyendo el impacto de un procedimiento convencional en pacientes de alto riesgo.A difficult anatomy is the major challenge to overcome with abdominal aortic aneurysm endografting. Bilateral iliac aneurysm preventing an appropriate distal landing zone for an endograft is a common condition and can be managed by: a Increasing the diameter of the endograft, with limitations in available sizes; b bilateral hypogastric embolization, accepting an increased morbidity; c combining a surgical hypogastric revascularization by retroperitonel approach or d retrograde revascularization from the ipsilateral external iliac artery using an endograft. Recently, branched endografts have been designed to revascularize the hypo gastric artery. Their deployment is complex but allows antegrade and stable fl ow. We report a 57 year-old male, at high risk for an open procedure, who presented with a small aortic aneurysm, bilateral iliac and left hypogastric aneurysms. A right bifurcated iliac endograft was deployed, associated with left hypogastric aneurysm embolization and aortic endografting. The patient recovered event free, patency of the endograft and absence of endoleak was demonstrated on a CT scan. He presented minor left buttock claudication, sexual function was preserved. This new technique allows safe endovascular treatment of patients with bilateral iliac aneurysm, allowing preservation of pelvic perfusion and avoiding the risk of an open procedure in a high risk patient.

  19. Biomechanical Issues in Endovascular Device Design

    OpenAIRE

    James E. Moore

    2009-01-01

    The biomechanical nature of the arterial system and its major disease states provides a series of challenges to treatment strategies. Endovascular device design objectives have mostly centered on short-term challenges, such as deployability and immediate restoration of reliable flow channels. The resulting design features may be at odds with long-term clinical success. In-stent restenosis, endoleaks, and loss of device structural integrity (e.g., strut fractures) are all manifestations of a l...

  20. Endovascular Embolization of Head and Neck Tumors

    OpenAIRE

    MarcALazzaro

    2011-01-01

    Endovascular tumor embolization as adjunctive therapy for head and neck cancers is evolving and has become an important part of the tools available for their treatment. Careful study of tumor vascular anatomy and adhering to general principles of intra-arterial therapy can prove this approach to be effective and safe. Various embolic materials are available and can be suited for a given tumor and its vascular supply. This article aims to summarize current methods and agents used in endovas...

  1. Endovascular treatment of intracranial venous sinus thrombosis

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical efficacy and safety of endovascular treatment for intracranial venous sinus thrombosis. Methods: Ten patients with intracranial venous sinus thrombosis, confirmed by CT, MRI, MRV and / or DSA and encountered during the period of Aug. 2005-Aug. 2007, were treated with endovascular management after they failed to respond to anticoagulant therapy. Of ten patients, intravenous thrombolysis and mechanical thrombus maceration were carried out in 6, while intravenous thrombolysis, mechanical thrombus maceration together with intra-arterial thrombolysis were employed in 4. After the treatment, the anticoagulant therapy continued for 6 months. The patients were followed up for 12-29 months (mean 21 months). Results: After the treatment, the clinical symptoms and signs were completely or partially relieved in eight patients, including disappearance of headache (n=6) and relive of headache (n=2). No obvious improvement was found in one patient and linguistic function disturbance was seen in the remaining one. Lumbar puncture showed that the cerebrospinal fluid pressure returned to normal in all patients. Neither recurrence of thrombosis nor new symptom of neuralgic dysfunction was observed. No procedure-related intracranial or systemic hemorrhagic complications occurred both during and after the operation. Conclusion: Endovascular treatment is an effective and safe procedure for the potentially catastrophic intracranial venous thrombosis. (authors)

  2. Complications of endovascular treatment of cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Orrù, Emanuele, E-mail: surgeon.ema@gmail.com [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Roccatagliata, Luca, E-mail: lroccatagliata@neurologia.unige.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy); Department of Health Sciences (DISSAL), University of Genoa (Italy); Cester, Giacomo, E-mail: giacomo.cester@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Causin, Francesco, E-mail: francesco.causin@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Castellan, Lucio, E-mail: lucio.castellan@hsanmartino.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy)

    2013-10-01

    The number of neuroendovascular treatments of both ruptured and unruptured aneurysms has increased substantially in the last two decades. Complications of endovascular treatments of cerebral aneurysms are rare but can potentially lead to acute worsening of the neurological status, to new neurological deficits or death. Some of the possible complications, such as vascular access site complications or systemic side effects associated with contrast medium (e.g. contrast medium allergy, contrast induced nephropathy) can also be encountered in diagnostic angiography. The most common complications of endovascular treatment of cerebral aneurysms are related to acute thromboembolic events and perforation of the aneurysm. Overall, the reported rate of thromboembolic complications ranges between 4.7% and 12.5% while the rate of intraprocedural rupture of cerebral aneurysms is about 0.7% in patients with unruptured aneurysms and about 4.1% in patients with previously ruptured aneurysms. Thromboembolic and hemorrhagic complications may occur during different phases of endovascular procedures and are related to different technical, clinical and anatomic reasons. A thorough knowledge of the different aspects of these complications can reduce the risk of their occurrence and minimize their clinical sequelae. A deep understanding of complications and of their management is thus part of the best standard of care.

  3. The effect of endoleak on intra-aneurysmal pressure after EVE for abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To investigate the intra-aneurysmal pressure curve in the presence of endoleak after endovascular exclusion (EVE) for abdominal aortic aneurysm (AAA). Methods: Infrarenal aortic aneurysms were created with bovine jugular vein segments or patches. Then they were underwent incomplete endovascular exclusion of the aneurysm and formation of endoleaks. The pressures of blood flow outside the graft into the sac were measured. Results: The intrasac pressure was higher than systemic pressure in the presence of endoleak. After sealing the endoleak, pressure decreased significantly, and the pressure cure showed approximately linear. Conclusion: The change of intra-aneurysmal pressure curve reflected the load on aneurysmal wall after EVE, and can also help to determine the endoleak existence

  4. Endovascular treatment of acute ischemic stroke: current indications

    DEFF Research Database (Denmark)

    Yoo, Albert J; Chaudhry, Zeshan A; Leslie-Mazwi, Thabele M; Chandra, Ronil V; Hirsch, Joshua A; González, Ramon Gilberto; Simonsen, Claus Z

    2012-01-01

    Endovascular stroke therapy is an effective means of achieving reperfusion in stroke patients with proximal cerebral artery occlusions. However, current guideline recommendations express uncertainty regarding the clinical efficacy of catheter-based treatments, given the lack of supportive trial...... outcomes, and which may be used to guide endovascular treatment decisions. Anterior circulation strokes represent the primary focus of this review....

  5. Vascular Rupture Caused by a Molding Balloon during Endovascular Aneurysm Repair: Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hee Young; Do, Young Soo; Park, Hong Suk; Park, Kwang Bo [Dept. of Radiology, Samsugn Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Young Wook; Kim, Dong Ik [Dept. of Surgery, Samsugn Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2011-08-15

    Endovascular aneurysm repair (EVAR) has been accepted as an alternative to traditional open surgery in selected patients. Despite the minimally invasiveness of this treatment, several complications may occur during or after EVAR. Complications include endoleak, aortic dissection, distal embolism, or iatrogenic injury to the access artery. However, there are few reports on the vascular rupture caused by a molding balloon during EVAR. We report two cases of infrarenal abdominal aortic aneurysms complicated by procedure-related aortic or iliac artery rupture by the molding balloon during EVAR. In our cases, we observed suddenly abrupt increase of the diameter of the endograft during balloon inflation, because we inflated the balloon rapidly. In conclusion, careful attention must be paid during inflation of the molding balloon to prevent vascular rupture.

  6. Contrast-enhanced ultrasound after endovascular aortic repair—current status and future perspectives

    Science.gov (United States)

    Partovi, Sasan; Kaspar, Mathias; Aschwanden, Markus; Lopresti, Charles; Madan, Shivanshu; Uthoff, Heiko; Imfeld, Stephan

    2015-01-01

    An increasing number of patients with abdominal aortic aneurysms (AAAs) are undergoing endovascular aortic repair (EVAR) instead of open surgery. These patients require lifelong surveillance, and the follow-up imaging modality of choice has been traditionally computed tomography angiography (CTA). Repetitive CTA imaging is associated with cumulative radiation exposure and requires the administration of multiple doses of nephrotoxic contrast agents. Contrast-enhanced ultrasound (CEUS) has emerged as an alternative strategy in the follow-up of patients with EVAR and demonstrates high sensitivity and specificity for detection of endoleaks. In fact, a series of studies have shown that CEUS is at least performing equal to computed tomography for the detection and classification of endoleaks. This article summarizes current evidence of CEUS after EVAR and demonstrates its usefulness via various patient cases.

  7. Embarazo ectópico abdominal

    Directory of Open Access Journals (Sweden)

    Pedro Antonio Chirino Acosta

    2015-06-01

    Full Text Available El embarazo ectópico abdominal ocurre con escasa frecuencia. Se refiere al implante del embarazo en algunas de las estructuras de la cavidad abdominal, generalmente se asocia a una alta incidencia en la mortalidad materna y fetal; la mortalidad materna es siete veces mayor que en el embarazo tubárico y hasta 90 veces más que en el embarazo normal. El caso que a continuación se presenta es una paciente con antecedentes de salud previa, que asistió al Hospital Provincial de Bengo, municipio de Dande de la República Popular de Angola, en septiembre de 2013. Se le diagnosticó un embarazo a término con una deficiente atención prenatal. Se detectó perdida genital y ausencia de latidos cardiacos fetales. Se le comenzó la inducción del parto, y al no tener progreso, se realizó la cesaría hallándose un embarazo ectópico abdominal. Se realizó la extracción de un recién nacido a término muerto y gran parte de la placenta.

  8. Abdominal ultrasound in AIDS

    International Nuclear Information System (INIS)

    To present the abdominal abnormalities disclosed by ultrasound studies performed in AIDS patients, discussing the importance of these findings in the diagnosis of diseases associated with this syndrome. Over the course of four years, we examined 250 AIDS patients (175 males and 75 females with a mean age of 30 years). We have evaluated the signs that are nonspecific as well as those that are related to AIDS. The nonspecific signs consisted of hepatomegaly (79,2%), fatty infiltration (16%), gallbladder wall thickening (12%), splenomegaly (54,4%), ascites (9.2%), lymph node enlargement 1.5 cm (12.5%), liver nodules (3.6%), visceral microcalcifications (0.8%) and renal masses (0.8%). Ultrasound is useful in the initial study of abdominal pathology associated or not associated with AIDS. In some patients with treatable diseases (tuberculosis, abdominal lymphoma), this techniques was also of value in the assessment of the response to treatment. (Author) 15 refs

  9. Endovascular and surgical management of carotid artery restenosis

    Directory of Open Access Journals (Sweden)

    Radak ?.J.

    2007-01-01

    Full Text Available Background. The incidence of recurrent carotid stenosis after primary endarterectomy ranges from 10-34%. We presented our four year experience and comparing reoperation versus endovascular treatment. Methods. In period from 2001 to 2005, 50 patients, 37 men and 13 women, were treated surgically and endovascular due to restenosis. Results. There were no minor or major stroke, death and myocardial infarction periprocedural and in first 30 days in either group. In endovascular group one patients 3,17% had transient ischemic attack and two patients 11,76% in surgical group. One patient died from myocardial infraction in follow up in surgical group. There were no restenosis >50% in endovascular group, two patients have restenosis >50% in surgical group. Conclusions. Endovascular treatment of carotid artery restenosis represents a safe and efficient way of treatment, connected with minor number of serious complications than redo operation.

  10. Endoluminal repair of abdominal aortic aneurysms -- state of the art

    International Nuclear Information System (INIS)

    This paper considers the historical aspects of endovascular aneursym repair; the major findings of our Departments experience over an 8((1)/(2))-year period and reviews recent developments in endovascular prostheses. Analysis of 400 patients undergoing primary repair of abdominal aortic aneurysm between 1992 and 2000 revealed a perioperative mortality rate of 2.7% and primary conversion rate of 5%. With sequential studies it was shown that the outcome was better with bifurcated/aorto uni iliac grafts than tube grafts; better with second generation prostheses than first generation protheses and that survival in consecutive patients treated concurrently by open repair and endoluminal repair was superior in the endoluminal group. Endoluminal AAA repair is at a critical point of its development. It is unquestioned that it can dramatically reduce the need for intensive care and length of hospital stay and more recently it has been reported that survival is improved compared with open repair. The need for lifetime surveillance, the probability of graft failure and need for re-intervention, however, negate some of the advantages. The small incidence of unpredictable rupture following endoluminal AAA repair is a timely reminder of the need for continued careful follow-up

  11. Dolor abdominal recurrente

    Directory of Open Access Journals (Sweden)

    Rodrigo De Vivero

    2005-06-01

    Full Text Available Recurrent abdominal pain, is a common pediatric problem encountered by primary care physicians, medical subspecialists and surgical specialists. Chronic abdominal pain in children is usually functional-that is, without objective evidence of an underlying organic disorder. The presence of weight loss, gastrointestinal bleeding, persistent fever, chronic severe diarrhea and significant vomiting is associated with a higher prevalence of organic disease. In this article, it examined the diagnostic and therapeutic value of a medical and psychologic history, diagnostic tests, and pharmacological and behavioral therapy.

  12. Childhood abdominal cystic lymphangioma

    Energy Technology Data Exchange (ETDEWEB)

    Konen, Osnat; Rathaus, Valeria; Shapiro, Myra [Department of Diagnostic Imaging, Meir General Hospital, Sapir Medical Centre, Kfar Saba (Israel); Dlugy, Elena [Department of Paediatric Surgery, Schneider Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Freud, Enrique [Department of Paediatric Surgery, Sapir Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Kessler, Ada [Department of Diagnostic Imaging, Sourasky Medical Centre, Tel-Aviv (Israel); Horev, Gadi [Department of Diagnostic Imaging, Schneider Medical Centre, Tel-Aviv (Israel)

    2002-02-01

    Background: Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics. Clinical presentation is variable and may be misleading; therefore, complex imaging studies are necessary in the evaluation of this condition. US and CT have a major role in the correct preoperative diagnosis and provide important information regarding location, size, adjacent organ involvement, and expected complications. Objective: To evaluate the clinical and imaging findings of seven children with proven abdominal cystic lymphangioma. Materials and methods: Clinical and imaging files of seven children with pathologically proven abdominal lymphangioma, from three university hospitals, were retrospectively evaluated. Patient's ages ranged from 1 day to 6 years (mean, 2.2 years). Symptoms and signs included evidence of inflammation, abnormal prenatal US findings, chronic abdominal pain, haemorrhage following trauma, clinical signs of intestinal obstruction, and abdominal distension with lower extremities lymphoedema. Plain films of five patients, US of six patients and CT of five patients were reviewed. Sequential imaging examinations were available in two cases. Results: Abdominal plain films showed displacement of bowel loops by a soft tissue mass in five of six patients, two of them with dilatation of small bowel loops. US revealed an abdominal multiloculated septated cystic mass in five of six cases and a single pelvic cyst in one which changed in appearance over 2 months. Ascites was present in three cases. CT demonstrated a septated cystic mass of variable sizes in all available five cases. Sequential US and CT examinations in two patients showed progressive enlargement of the masses, increase of fluid echogenicity, and thickening of walls or septa in both cases, with multiplication of septa in one case. At surgery, mesenteric lymphangioma was found in five patients and retroperitoneal lymphangioma in the other two. Conclusions: US and CT are highly sensitive in the diagnosis of abdominal lymphangioma. Our limited experience with follow-up examinations in two patients suggests that progressive enlargement, multiplication and thickening of septa and increased echogenicity of the cystic fluid are signs indicating complications demanding urgent treatment. (orig.)

  13. Lateral abdominal wall hematoma as a rare complication after carotid artery stenting: a case report

    Directory of Open Access Journals (Sweden)

    Satomi Jyunichiro

    2009-11-01

    Full Text Available Abstract Abdominal wall hematoma is a rare and life-threatening complication after carotid artery stenting (CAS, but it can occur when activated clotting time is prolonged. We report a right lateral abdominal wall hematoma caused by rupture of the superficial circumflex iliac artery after CAS in a 72-year-old man with severe stenosis of the origin of the right internal carotid artery. We performed CAS for the targeted lesion while activated clotting time exceeded 300 seconds. After 2 hours, he complained of right lateral abdominal pain. Abdominal computed tomography revealed an extensive hematoma in the right lateral abdominal wall. Activated clotting time was 180 seconds at this point. Seven hours later, he developed hypotension and hemoglobin level dropped to 11.3 g/dl. Subsequent computed tomography showed enlargement of the hematoma. Emergent selective angiography of the external iliac artery revealed active bleeding from the right superficial circumflex iliac artery. Transcatheter arterial embolization with Gelfoam and microcoils was performed successfully. With more CAS procedures being performed, it is important for endovascular surgeons and radiologists to consider the possibility of abdominal wall hematoma in this situation.

  14. Hemorragia subaracnoidea no traumática: diagnóstico, tratamiento y resultados considerando los recursos del hospital público

    Scientific Electronic Library Online (English)

    Cynthia, Purves; Jorge, Bolzani; Hugo, Koatz; Pablo, Cartolano; Jorge, Fiol; Salvador, Selles.

    2007-03-01

    Full Text Available Objetivo. Evaluamos la evolución de una población de 74 pacientes con diagnóstico de hemorragia subaracnoidea no traumática, en relación con la metodología de trabajo de un hospital público y la influencia de ciertos efectos operativos inherentes al sistema. Método. Los pacientes fueron internados e [...] n la Unidad de Terapia Intensiva (UTI) estudiados mediante tomografía axial computada (TC) y angiografía digital de 4 vasos, analizándose los tiempos de demora en la realización de los mismos. Consideramos la terapéutica al ingreso y el tratamiento quirúrgico (microcirugía o tratamiento endovascular). Evaluamos la morbimortalidad específica en función de la terapéutica implementada y la global de la población estudiada Resultados. De los pacientes sometidos a microcirugía (36) fallecieron 8 (22%) y de los casos que recibieron tratamiento endovascular (12) falleció un caso (8.33%). La mortalidad global de la población estudiada fue de 24 pacientes (32%) Conclusión. Consideramos que el diagnóstico y tratamiento de la HSA no traumática en el hospital público enfrenta dificultades operativas para la adecuada implementación de una atención neuroquirúrgica de excelencia en tiempo oportuno. Abstract in english Objective. We evaluated 74 patients with diagnosisnon traumatic subarachnoid hemorrhage in relation with the working methodology of a public hospital and its influence in certain operative effects inherent to the system. Method. Patients were treated in a neurosurgical intensive care unit, head CT s [...] canning and cerebral angiography were performed; we analyzed the delay in their execution. We considered the initial therapy and the surgical treatment (microsurgery/ endovascular). We evaluated the specific morbimortality in relation to the implemented therapeutics and the global morbi- mortality of the population studied. Results. Of the patients that underwent microsurgical treatment (36) 8 died (22%) and 1 patient (8.33%) died of the 12 patients that underwent endovascular treatment. The overall mortality of the population studied was 24 patients (32%). Conclusion. We consider that the diagnosis and treatment of aneurysmal subarachnoid hemorrhage in a public hospital faces operative difficulties for the proper implementation of neurosurgical treatment of excellence in the appropriate time.

  15. Endometrioma de parede abdominal

    Directory of Open Access Journals (Sweden)

    Italo Accetta

    2011-02-01

    Full Text Available OBJETIVO: Relatar a experiência dos autores com as manifestações clínicas e o tratamento cirúrgico em pacientes com endometrioma de parede abdominal. MÉTODOS: Análise retrospectiva das pacientes operadas por endometrioma de parede abdominal, dando ênfase aos dados relativos à idade, sintomas, cesariana prévia, relação dos sintomas com o ciclo menstrual, exames físicos e complementares, tratamento cirúrgico, evolução pós-operatória e resultado histopatológico dos espécimes. RESULTADOS: Foram operadas 14 pacientes no período estudado, com idade entre 28 e 40 anos. A presença de massa e dor local que piorava durante a menstruação foram as queixas principais. Ultrassonografia e tomografia computadorizada foram exames importantes em localizar precisamente a doença. O tratamento cirúrgico foi exérese ampla da tumoração e dos tecidos comprometidos. As pacientes evoluíram satisfatoriamente e o histopatológico confirmou a suspeita de endometrioma de parede abdominal em todos os casos. CONCLUSÃO: Foi nítida a relação entre cesariana prévia e endometrioma de parede abdominal e estudos ultrassonográficos e tomográficos auxiliaram a planejar a abordagem cirúrgica permitindo a exérese da tumoração e de todos os tecidos adjacentes comprometidos.

  16. Abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal

    2010-01-01

    Although the number of elective operations for abdominal aortic aneurysms (AAA) is increasing, the sex- and age-standardised mortality rate of AAAs continues to rise, especially among men aged 65 years or more. The lethality of ruptured AAA continues to be 80-95%, compared with 5-7% by elective...

  17. Physicians' Abdominal Auscultation

    DEFF Research Database (Denmark)

    John, Gade; Peter, Kruse; Andersen, Ole Trier; Boel, Pedersen Simon; Steen, Boesby

    1998-01-01

    Background: Abdominal auscultation has an important position in the physical examination of the abdomen. Little is known about rater agreement. The aim of this study was to describe rater agreement and thus, indirectly, the value of the examination. Methods: In a semi-virtual setup 12 recordings ...

  18. Adult abdominal hernias.

    LENUS (Irish Health Repository)

    Murphy, Kevin P

    2014-06-01

    Educational Objectives and Key Points. 1. Given that abdominal hernias are a frequent imaging finding, radiologists not only are required to interpret the appearances of abdominal hernias but also should be comfortable with identifying associated complications and postrepair findings. 2. CT is the imaging modality of choice for the assessment of a known adult abdominal hernia in both elective and acute circumstances because of rapid acquisition, capability of multiplanar reconstruction, good spatial resolution, and anatomic depiction with excellent sensitivity for most complications. 3. Ultrasound is useful for adult groin assessment and is the imaging modality of choice for pediatric abdominal wall hernia assessment, whereas MRI is beneficial when there is reasonable concern that a patient\\'s symptoms could be attributable to a hernia or a musculoskeletal source. 4. Fluoroscopic herniography is a sensitive radiologic investigation for patients with groin pain in whom a hernia is suspected but in whom a hernia cannot be identified at physical examination. 5. The diagnosis of an internal hernia not only is a challenging clinical diagnosis but also can be difficult to diagnose with imaging: Closed-loop small-bowel obstruction and abnormally located bowel loops relative to normally located small bowel or colon should prompt assessment for an internal hernia.

  19. Linfoma de Burkitt abdominal / Abdominal Burkitt lymphoma

    Scientific Electronic Library Online (English)

    José Ridal, González Álvarez; Miguel Ángel, Rodríguez Hernández; Alfredo, Cruz Cordero; Zenia, Rodríguez Hernández; Emilio Andrés, Rodríguez Ramirez.

    2014-04-01

    Full Text Available El linfoma de Burkitt es un tipo de linfoma no Hodgkin, infrecuente, que afecta principalmente a niños y adolescentes. Se presenta un adolescente masculino, blanco, de 12 años de edad y antecedentes de salud anterior, con un dolor en epigastrio, tipo cólico de pocos días de evolución, que fue increm [...] entándose, sin modificaciones con la tos, estornudos o cambios de posición ni preferencia de horario, irradiado a fosa ilíaca derecha, sin vómitos, fiebre u otra sintomatología. Se realizan estudios imagenológicos, endoscópicos e histológicos, diagnosticándole un tumor de colon, es intervenido quirúrgicamente. El linfoma de Burkitt es una rara entidad que necesita de la clínica y la combinación de varios métodos de imagen para aproximarse a la sospecha diagnóstica y representa un gran desafío, por lo que alertamos a los pediatras a sospecharlo ante los dolores abdominales y tumoraciones de abdomen. Abstract in english Burkitt's lymphoma is a type of uncommon non-Hodgkin lymphoma, affecting mainly children and adolescents. A white male teen, 12 years of age, presents with previous health record, epigastric pain, cramping of some days of length, which was increasing, unchanged coughing, sneezing or changes in posit [...] ion, irradiated to the right iliac fossa, without vomiting, fever or other symptoms. Imaging, endoscopic and histological studies were performed. He was diagnosed with a colon tumor, removed later on. Burkitt lymphoma is a rare entity that requires clinical observation and combining several imaging methods to come close to the suspected diagnosis, and represents a big challenge, so we alert pediatricians to suspect of abdominal pain and abdominal tumors.

  20. Aneurismas de la aorta torácica: Historia natural, diagnóstico y tratamiento / Thoracic aortic aneurysm: Natural history, diagnosis and management

    Scientific Electronic Library Online (English)

    Javier, Vega; Daniela, Gonzalez; Willy, Yankovic; Javier, Oroz; Rodrigo, Guaman; Nicolás, Castro.

    Full Text Available Los aneurismas corresponden a una dilatación arterial localizada que es producida por una debilidad de la pared; se clasifican en verdaderos y falsos. La incidencia es de aproximadamente 6 - 10 casos por 100.000 habitantes al año y los aneurismas de la aorta ascendente son los más frecuentes dentro [...] del grupo de los aneurismas de la aorta torácica (AAT). Habitualmente se generan como resultado de una necrosis quística de la media que suele estar asociada a otras patologías. Los aneurismas suelen pesquisarse de manera incidental mediante exámenes imagenológicos solicitados por diferentes motivos. Su historia natural no está completamente clarificada, pero en términos generales los AAT tienen un crecimiento promedio de 0,1 cm por año. La angiografía por tomografía computada o por resonancia magnética, son los exámenes de elección para el diagnóstico. Para aquellos pacientes con aneurismas pequeños que no requieren cirugía, las medidas orientadas a la reducción del riesgo de ateroesclerosis son el pilar del tratamiento. Para los aneurismas de la aorta ascendente que cumplan con los requisitos, requieran de revascularización coronaria o reemplazo valvular, se recomienda el tratamiento quirúrgico. En relación a los aneurismas del cayado aórtico las opciones terapéuticas son tres: cirugía, terapia endovascular y terapia combinada. Para los aneurismas de la aorta descendente la terapia endovascular se perfila como la más eficiente. Los pacientes sin indicación de tratamiento quirúrgico o endovascular deben ser controlados de manera seriada con estudios imagenológicos. Abstract in english Aneurysms are defined as a localized dilatation caused by a weakness in the arterial wall. and may be classified as true or false aneurysm. The incidence is estimated to be 6-10 cases per 100,000 patient years. Aneurysms of the ascending aorta are the most common within the group of thoracic aortic [...] aneurysms (TAA). These often result from cystic medial degeneration, which tends to be associated with other pathologic entities. Aneurysms are diagnosed most commonly on imaging studies performed for an unrelated indication. Although its natural history remains unclear, it is known that current average growth is about 0.1 cm per year. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are the preferred imaging tests to detect aortic aneurysms. Measures aimed to reduce atherosclerosis risk are the main treatment objective for patients with smaller aneurysms that do not require surgery. When ascending aortic aneurysms meet the size criteria or coronary revascularization and aortic valvular replacement are necessary, surgical treatment it's recommended. For aortic arch aneurysms, there are three therapeutic alternatives: surgery, endovascular therapy and combined therapy. For descending aortic aneurysms, endovascular therapy is the preferred procedure. Patients with no indication for surgical or endovascular therapy, should be followed up with serial imaging studies.

  1. Screening for Abdominal Aortic Aneurysm

    Science.gov (United States)

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) ... final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final recommendation statement applies to adults ages ...

  2. Children's (Pediatric) Abdominal Ultrasound Imaging

    Science.gov (United States)

    ... Resources Professions Site Index A-Z Children's (Pediatric) Ultrasound - Abdomen Children’s (pediatric) ultrasound imaging of the abdomen ... limitations of Abdominal Ultrasound Imaging? What is Abdominal Ultrasound Imaging? Ultrasound is safe and painless, and produces ...

  3. Endovascular Treatment of Ruptured Pericallosal Artery Aneurysms

    Science.gov (United States)

    Ko, Jun Kyeung; Kim, Hwan Soo; Choi, Hyuk Jin; Lee, Tae Hong; Yun, Eun Young

    2015-01-01

    Objective Aneurysms arising from the pericallosal artery (PA) are uncommon and challenging to treat. The aim of this study was to report our experiences of the endovascular treatment of ruptured PA aneurysms. Methods From September 2003 to December 2013, 30 ruptured PA aneurysms in 30 patients were treated at our institution via an endovascular approach. Procedural data, clinical and angiographic results were retrospectively reviewed. Results Regarding immediate angiographic control, complete occlusion was achieved in 21 (70.0%) patients and near-complete occlusion in 9 (30.0%). Eight procedure-related complications occurred, including intraprocedural rupture and early rebleeding in three each, and thromboembolic event in two. At last follow-up, 18 patients were independent with a modified Rankin Scale (mRS) score of 0-2, and the other 12 were either dependent or had expired (mRS score, 3-6). Adjacent hematoma was found to be associated with an increased risk of poor clinical outcome. Seventeen of 23 surviving patients underwent follow-up conventional angiography (mean, 16.5 months). Results showed stable occlusion in 14 (82.4%), minor recanalization in two (11.8%), and major recanalization, which required recoiling, in one (5.9%). Conclusion Our experiences demonstrate that endovascular treatment for a ruptured PA aneurysms is both feasible and effective. However, periprocedural rebleedings were found to occur far more often (20.0%) than is generally suspected and to be associated with preoperative contrast retention. Analysis showed existing adjacent hematoma is predictive of a poor clinical outcome. PMID:26539261

  4. Abdominal obesity and fatty liver

    DEFF Research Database (Denmark)

    Jakobsen, M U; Berentzen, T; Sørensen, T I A; Overvad, K

    2007-01-01

    It has been hypothesized that visceral fat releases free fatty acids and adipokines and thereby exposes the liver to fat accumulation. The authors aimed to evaluate current epidemiologic evidence for an association between abdominal fat and liver fat content. Clinical and epidemiologic studies with data on abdominal fat and liver fat content were reviewed. Studies using waist circumference to estimate abdominal fat mass suggested a direct association between abdominal fat and liver fat content. ...

  5. Endovascular treatment of stroke. When and How?

    International Nuclear Information System (INIS)

    Full text: It is well known that stroke is the third leading cause of death and the most common cause of permanent disability in the Western countries. Ischemic stroke is the commonest between the causes and atheroembolic events is principally involved. Intravenous thrombolysis (IVT) has dramatically changed the treatment mentality which previously was mostly supportive and didn't change significantly the prognosis. IVT is now considered the standard of care, having however certain limitations that have paved the way for the development of endovascular treatment. The main disadvantage of IVT is the relatively limited available time window, leading very few patients to receive the treatment. Intra-arterial options for treatment are not confined to delivery of a thrombolytic drug into the thrombus, but extended to quite variable mechanical options. The use of thrombolytic agents regionally or locally (Intra-arterial Thrombolysis - IAT), although may be allowed for an extended time window comparatively to IVT, has more or less the same disadvantages and the complications that related to the administrated drug. Moreover and despite the good results of several randomized trials, IAT has never granted an FDA approval. Nevertheless its use is included in the AHA/ASA guidelines under recommended in certain situations. IAT can be used as a standalone treatment or may be combined (bridging therapy) with IVT. Endovascular treatment has been boosted however, after the advent of mechanical devices for clot removal in acute stroke. These devices have become more sophisticated nowadays and this treatment is more and more is preferred when endovascular means are considered. Initially, mechanical devices were used for the clot disruption in combination with IAT (augmented thrombolysis). Other devices have been developed aiming to directly remove a clot rather than disrupt or macerate it, and the procedure turned to be a thrombectomy. Many different devices had been used with different success rates, until the recently published 'SWIFT' trial render the stent retrievers as the best option until now and establish the use of these devices as the preferred method for the mechanical thrombectomy. The effectiveness of endovascular techniques in acute ischemic stroke has been established in many trials. Clinicians however continue to face many challenges in the selection of the most appropriate approach. In conclusion, while IVT remains the standard of care for the few patients presenting early, interventional techniques can play a significant role in a larger population who present much later, fail to improve with IVT, or who do not meet the inclusion criteria for IVT

  6. A multimodality vascular imaging phantom of an abdominal aortic aneurysm with a visible thrombus

    Energy Technology Data Exchange (ETDEWEB)

    Allard, Louise; Chayer, Boris; Qin Zhao [Laboratory of Biorheology and Medical Ultrasonics, Research Center, University of Montreal Hospital (CRCHUM), Quebec H2L 2W5 (Canada); Soulez, Gilles [Department of Radiology, University of Montreal Hospital (CHUM), Quebec H2L 2M1 (Canada); Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Quebec H3T 1J4 (Canada); Institute of Biomedical Engineering, University of Montreal, Quebec H3T 1J4 (Canada); Roy, David [Institute of Biomedical Engineering, University of Montreal, Quebec H3T 1J4 (Canada); Cloutier, Guy [Laboratory of Biorheology and Medical Ultrasonics, Research Center, University of Montreal Hospital (CRCHUM), Quebec H2L 2W5 (Canada); Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Quebec H3T 1J4 (Canada); Institute of Biomedical Engineering, University of Montreal, Quebec H3T 1J4 (Canada)

    2013-06-15

    Purpose: With the continuous development of new stent grafts and implantation techniques, it has now become technically feasible to treat abdominal aortic aneurysms (AAA) with challenging anatomy using endovascular repair with standard, fenestrated, or branched stent-grafts. In vitro experimentations are very useful to improve stent-graft design and conformability or imaging guidance for stent-graft delivery or follow-up. Vascular replicas also help to better understand the limitation of endovascular approaches in challenging anatomy and possibly improve surgical planning or training by practicing high risk clinical procedures in the laboratory to improve outcomes in the operating room. Most AAA phantoms available have a very basic anatomy, which is not representative of the clinical reality. This paper presents a method of fabrication of a realistic AAA phantom with a visible thrombus, as well as some mechanical properties characterizing such phantom. Methods: A realistic AAA geometry replica of a real patient anatomy taken from a multidetector computed tomography (CT) scan was manufactured. To demonstrate the multimodality imaging capability of this new phantom with a thrombus visible in magnetic resonance (MR) angiography, CT angiography (CTA), digital subtraction angiography (DSA), and ultrasound, image acquisitions with all these modalities were performed by using standard clinical protocols. Potential use of this phantom for stent deployment was also tested. A rheometer allowed defining hyperelastic and viscoelastic properties of phantom materials. Results: MR imaging measurements of SNR and CNR values on T1 and T2-weighted sequences and MR angiography indicated reasonable agreement with published values of AAA thrombus and abdominal components in vivo. X-ray absorption also lay within normal ranges of AAA patients and was representative of findings observed on CTA, fluoroscopy, and DSA. Ultrasound propagation speeds for developed materials were also in concordance with the literature for vascular and abdominal tissues. Conclusions: The mimicked abdominal tissues, AAA wall, and surrounding thrombus were developed to match imaging features of in vivo MR, CT, and ultrasound examinations. This phantom should be of value for image calibration, segmentation, and testing of endovascular devices for AAA endovascular repair.

  7. A multimodality vascular imaging phantom of an abdominal aortic aneurysm with a visible thrombus

    International Nuclear Information System (INIS)

    Purpose: With the continuous development of new stent grafts and implantation techniques, it has now become technically feasible to treat abdominal aortic aneurysms (AAA) with challenging anatomy using endovascular repair with standard, fenestrated, or branched stent-grafts. In vitro experimentations are very useful to improve stent-graft design and conformability or imaging guidance for stent-graft delivery or follow-up. Vascular replicas also help to better understand the limitation of endovascular approaches in challenging anatomy and possibly improve surgical planning or training by practicing high risk clinical procedures in the laboratory to improve outcomes in the operating room. Most AAA phantoms available have a very basic anatomy, which is not representative of the clinical reality. This paper presents a method of fabrication of a realistic AAA phantom with a visible thrombus, as well as some mechanical properties characterizing such phantom. Methods: A realistic AAA geometry replica of a real patient anatomy taken from a multidetector computed tomography (CT) scan was manufactured. To demonstrate the multimodality imaging capability of this new phantom with a thrombus visible in magnetic resonance (MR) angiography, CT angiography (CTA), digital subtraction angiography (DSA), and ultrasound, image acquisitions with all these modalities were performed by using standard clinical protocols. Potential use of this phantom for stent deployment was also tested. A rheometer allowed defining hyperelastic and viscoelastic properties of phantom materials. Results: MR imaging measurements of SNR and CNR values on T1 and T2-weighted sequences and MR angiography indicated reasonable agreement with published values of AAA thrombus and abdominal components in vivo. X-ray absorption also lay within normal ranges of AAA patients and was representative of findings observed on CTA, fluoroscopy, and DSA. Ultrasound propagation speeds for developed materials were also in concordance with the literature for vascular and abdominal tissues. Conclusions: The mimicked abdominal tissues, AAA wall, and surrounding thrombus were developed to match imaging features of in vivo MR, CT, and ultrasound examinations. This phantom should be of value for image calibration, segmentation, and testing of endovascular devices for AAA endovascular repair.

  8. The Endovascular Management of Iliac Artery Aneurysms

    International Nuclear Information System (INIS)

    Background: Isolated aneurysms of the iliac arteries are uncommon. Previously treated by conventional surgery, there is increasing use of endografts to treat these lesions. Purpose: The purpose of this study was to assess the efficacy, safety, and durability of the stent-grafts for treatment of iliac artery aneurysms (IAAs). The results of endografting for isolated IAAs over a 10-year period were analyzed retrospectively. The treatment methods differed depending on the anatomic location of the aneurysms. Twenty-one patients (1 woman, 20 men) underwent endovascular stent-graft repair, with one procedure carried out under emergency conditions after acute rupture. The mean aneurysm diameter was 4.6 cm.Results:The procedural technical success was 100%. There was zero 30-day mortality. Follow-up was by interval CT scans. At a mean follow-up of 51.2 months, the stent-graft patency rate was 100%. Reintervention was performed in four patients (19%): one patient (4.7%) with a type I endoleak and three patients (14.3%) with type II endoleaks.Conclusion:We conclude that endovascular repair of isolated IAAs is a safe, minimally invasive technique with low morbidity rates. Follow-up results up to 10 years suggest that this approach is durable and should be regarded as a first treatment option for appropriate candidates

  9. Endovascular brachytherapy to prevent restenosis after angioplasty

    International Nuclear Information System (INIS)

    Endovascular radiotherapy is the first effective prophylaxis of restenosis after percutaneous transluminal angioplasty (PTA) and stenting. The FDA recently approved two devices for the delivery of intracoronary radiation following coronary artery stenting. Published multicenter, double-blind, randomized trials of intracoronary radiation therapy report good results for preventing in-stent restenosis, while the data for the peripheral circulation are still inconclusive. Beta-emitters are easier applicable and probably also safer, whereas gamma-emitters have been more extensively evaluated clinically so far. Primary indication for endovascular brachytherapy are patients at high risk for restenosis, such as previous restenoses, in-stent hyperplasia, long stented segment, long PTA lesion, narrow residual vascular lumen and diabetes. Data from coronary circulation suggest a safety margin of at least 4 to 10 mm at both ends of the angioplastic segment to avoid edge restenosis. To prevent late thrombosis of the treated coronary segment, antiplatelet therapy with clopidogrel and aspirin are recommended for at least 6 months after PTA and for 12 months after a newly implanted stent. An established medication regimen after radiotherapy of peripheral arteries is still lacking. (orig.)

  10. Endovascular strategy for unruptured cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Mangiafico, S., E-mail: mangiax@libero.it [Interventional Neuroradiology Unit, Careggi University Hospital, Florence (Italy); Guarnieri, G., E-mail: gianluigiguarnieri@hotmail.it [Neuroradiology Service, Cardarelli Hospital, Naples (Italy); Consoli, A., E-mail: onemed21@gmail.com [Interventional Neuroradiology Unit, Careggi University Hospital, Florence (Italy); Ambrosanio, G., E-mail: gambros@libero.it [Neuroradiology Service, Cardarelli Hospital, Naples (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Service, Cardarelli Hospital, Naples (Italy)

    2013-10-01

    The treatment of unruptured intracranial aneurysms (UIAs) remains complex and not clearly defined. While for ruptured intracranial aneurysms the management and the treatment option (surgery or endovascular treatment) are well defined by several trials, for asymptomatic UIAs the best management is still currently uncertain. The rationale to treat an UIA is to prevent the rupture and its consequent SAH and all complications derived from hemorrhage or reduce/eliminate neurological palsy. Although this statement is correct, the indication to treat an UIA should be based on a correct balance between the natural history of UIA and treatment risk. Patient's clinical history, aneurysm characteristics, and strategy management influence the natural history of UIAs and treatment outcomes. In the last 10 years and more, two important large multicenter studies were performed in order to analysis of all these factors and to evaluate the best treatment option for UIAs. The aim of this paper is to try to synthesize the possible indications to the endovascular treatment (EVT), when and how to treat an UIA.

  11. Endovascular therapeutic strategies in ruptured intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Machi, Paolo, E-mail: paolo.machi@gmail.com [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Lobotesis, Kyriakos, E-mail: kyriakos@lobotesis.co.uk [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Vendrell, Jean Francoise, E-mail: jfvendrell@yahoo.fr [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Riquelme, Carlos, E-mail: riquelme.carlos@neuf.fr [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Eker, Omer, E-mail: eker_omer@yahoo.fr [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Costalat, Vincent, E-mail: vincentcost@hotmail.com [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Bonafe, Alain, E-mail: bonafeh@aol.com [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France)

    2013-10-01

    The aim of the present study was to evaluate endovascular techniques used currently which were not available at the time of ISAT inclusion period, such as balloon remodelling and flow-divertion, in order to assess whether these new technologies have improved the endovascular approach outcomes. We present a review of articles, published in major journals, with the aim to evaluate the efficacy and the safety of coiling with balloon remodelling for the treatment of ruptured aneurysms in comparison to coiling performed without such coadjutant techniques. Furthermore, we reviewed publications reporting on the treatment of ruptured aneurysms in the acute phase with the one of the most recent technologies available nowadays: the flow diverting stent. Looking at the recent literature the results regarding ruptured aneurysms treated with balloon assisted coiling (BAC) have shown an improvement in terms of anatomical results and morbi-mortality rates. Case series of ruptured middle cerebral artery (MCA) aneurysms treated by EVT report results similar to those obtained by surgical clipping. Several articles recently report encouraging results in treating ruptured dissecting and blister aneurysms with flow diverters. Questions regarding the best treatment available for ruptured aneurysms are yet to be answered. Hence there is a need for a subsequent trial aiming to answer these unresolved issues.

  12. Endovascular therapeutic strategies in ruptured intracranial aneurysms

    International Nuclear Information System (INIS)

    The aim of the present study was to evaluate endovascular techniques used currently which were not available at the time of ISAT inclusion period, such as balloon remodelling and flow-divertion, in order to assess whether these new technologies have improved the endovascular approach outcomes. We present a review of articles, published in major journals, with the aim to evaluate the efficacy and the safety of coiling with balloon remodelling for the treatment of ruptured aneurysms in comparison to coiling performed without such coadjutant techniques. Furthermore, we reviewed publications reporting on the treatment of ruptured aneurysms in the acute phase with the one of the most recent technologies available nowadays: the flow diverting stent. Looking at the recent literature the results regarding ruptured aneurysms treated with balloon assisted coiling (BAC) have shown an improvement in terms of anatomical results and morbi-mortality rates. Case series of ruptured middle cerebral artery (MCA) aneurysms treated by EVT report results similar to those obtained by surgical clipping. Several articles recently report encouraging results in treating ruptured dissecting and blister aneurysms with flow diverters. Questions regarding the best treatment available for ruptured aneurysms are yet to be answered. Hence there is a need for a subsequent trial aiming to answer these unresolved issues

  13. Endovascular strategy for unruptured cerebral aneurysms

    International Nuclear Information System (INIS)

    The treatment of unruptured intracranial aneurysms (UIAs) remains complex and not clearly defined. While for ruptured intracranial aneurysms the management and the treatment option (surgery or endovascular treatment) are well defined by several trials, for asymptomatic UIAs the best management is still currently uncertain. The rationale to treat an UIA is to prevent the rupture and its consequent SAH and all complications derived from hemorrhage or reduce/eliminate neurological palsy. Although this statement is correct, the indication to treat an UIA should be based on a correct balance between the natural history of UIA and treatment risk. Patient's clinical history, aneurysm characteristics, and strategy management influence the natural history of UIAs and treatment outcomes. In the last 10 years and more, two important large multicenter studies were performed in order to analysis of all these factors and to evaluate the best treatment option for UIAs. The aim of this paper is to try to synthesize the possible indications to the endovascular treatment (EVT), when and how to treat an UIA

  14. Endograft-preserving therapy of a patient with Coxiella burnetii-infected abdominal aortic aneurysm: a case report

    Directory of Open Access Journals (Sweden)

    Kloppenburg Geoffrey TL

    2011-12-01

    Full Text Available Abstract Introduction Coxiella burnetii, the causative agent of Q fever, may cause endocarditis and vascular infections that result in severe morbidity and mortality. We report a case of a C. burnetii-infected abdominal aorta and its management in a patient with a previous endovascular aortic aneurysm repair. Case presentation A 62-year-old Caucasian man was admitted to our hospital three months after endovascular aortic aneurysm repair with a bifurcated stent graft. He had increasing abdominal complaints and general malaise. A computed tomography scan of his abdomen revealed several para-aneurysmal abscesses. Surgery was performed via midline laparotomy. The entire abdominal wall of his aneurysmal sac, including the abscesses, was removed. The vascular endoprosthesis showed no macroscopic signs of infection. The decision was made to leave the endograft in place because of the severe cardiopulmonary comorbidities, thereby avoiding suprarenal clamping and explantation of this device with venous reconstruction. The proximal and distal parts of the endograft were secured to the aortic wall and common iliac artery walls, respectively, to avoid future migration. Polymerase chain reaction for C. burnetii was positive in all specimens of aortic tissue. Specific antibiotic therapy was initiated. Our patient was discharged in good clinical condition after six days. Conclusions In our patient, the infection was limited to the abdominal aneurysm wall, which was removed, leaving the endograft in place. Vascular surgeons should be familiar with this bailout procedure in high-risk patients.

  15. Superinfecção e rotura de aneurisma da aorta abdominal por Salmonella dublin: relato de caso Superinfection and rupture of abdominal aortic aneurysm after Salmonella dublin septicemia: a case report

    Directory of Open Access Journals (Sweden)

    Anibal Basile Filho

    1988-12-01

    Full Text Available Os autores relatam o caso de paciente de 66 anos, que apresentou superinfecção e rotura de aneurisma da aorta abdominal, após septicemia por Salmonella dublin. As infecções endovasculares associadas à rotura de aneurisma pré-existentes são um rico potencial nos pacientes com mais de 50 anos de idade, que apresentam bacteremia ou septicemia por Salmonella sp. A alta mortalidade da aortite por salmonelose é devida à septicemia grave ou à rotura desses aneurismas. Qualquer tecido orgânico pode ser a sede de infecções metastáticas, porém os locais mais susceptíveis são os tecidos necróticos e as lesões crônicas degenerativas. Os autores discutem a importância do diagnóstico precoce para reduzir a mortalidade dessa entidade.The authors present a case of a 66 year-old woman with a dissection and rupture of abdominal aortic aneurysm after Salmonella dublin septicemia. Endovascular infection and rupture of atherosclerotic aneurysm is a substantial risk in patients older than 50 years of age who have bacteremia or sepsis due to Salmonella sp. The high mortality is the resultant of Salmonella aortitis due either to septicemia or rupture. Tissue anywhere may be seeded, but damage tissues appear to be particularly susceptible to abscess and chronic destructive lesions. The significance of early diagnosis to decrease the fatal outcome is discussed.

  16. The blunt abdominal trauma

    International Nuclear Information System (INIS)

    Up to 1970 the number of patients suffering from blunt abdominal trauma showed a substantial increase. In more than 50% of all cases there are additional injuries. The most important factor influencing the prognosis of these patients is the early and correct indication for operation and the avoidance of unnecessary laparotomies. As a primary aim in diagnosis one should consider the recognition of an intraperitoneal bleeding without risk for the patient. Peritoneal lavage as an invasive method with low complication rates has proved good. First reports also show good results using the sonography of the abdomen. The recognition of the injured organ allows a carefully directed operation. Concerning the prognosis it is of minor importance. The diagnosis in patients with blunt abdominal trauma at the university clinic of Freiburg consists of: sonography, followed in positive cases by laparotomy or angiography and laparotomy. In cases with questionable results a lavage is done. (orig.)

  17. Anterior abdominal wall anomalies

    Directory of Open Access Journals (Sweden)

    Mehmet Eliçevik

    2010-05-01

    Full Text Available Anterior abdominal wall defects consists of omphalocele, gastroschisis, umblical hernia and exstrophy-epispadias complex. This section is written for the diagnosis and treatment of those anomalies which are summarized by figures. Managment of abdominal wall defects requires collaboration between the Pediatricians and Pediatric Surgeons. The pitfalls of preoperative and postoperative care from the respect of Pediatrics and intensive care unit are established. Especially the exstrophy-epispadias complex is a life long diasease, special attention for the diagnosis and treatment of mainly the urogenital and associated malformations must be given on the long term follow-up. Patient transfer to specialized centers of Pediatric Urology, in the field of exstrophy-epispadias-complex is recommended. (Turk Arch Ped 2010; 45 Suppl: 29-34

  18. Current status of endovascular stroke treatment.

    Science.gov (United States)

    Meyers, Philip M; Schumacher, H Christian; Connolly, E Sander; Heyer, Eric J; Gray, William A; Higashida, Randall T

    2011-06-01

    The management of acute ischemic stroke is rapidly developing.Although acute ischemic stroke is a major cause of adult disability and death, the number of patients requiring emergency endovascular intervention remains unknown, but is a fraction of the overall stroke population. Public health initiatives endeavor to raise public awareness about acute stroke to improve triage for emergency treatment, and the medical community is working to develop stroke services at community and academic medical centers throughout the United States. There is an Accreditation Council for Graduate Medical Education–approved pathway for training in endovascular surgical neuroradiology, the specialty designed to train physicians specifically to treat cerebrovascular diseases. Primary and comprehensive stroke center designations have been defined, yet questions remain about the best delivery model. Telemedicine is available to help community medical centers cope with the complexity of stroke triage and treatment. Should comprehensive care be provided at every community center, or should patients with complex medical needs be triaged to major stroke centers with high-level surgical,intensive care, and endovascular capabilities? Although the answers to these and other questions about stroke care delivery remain unanswered owing to the paucity of empirical data, we are convinced that stroke care regionalization is crucial for delivery of high-quality comprehensive ischemic stroke treatment. A stroke team available 24 hours per day, 7 days per week requires specialty skills in stroke neurology, endovascular surgical neuroradiology, neurosurgery, neurointensive care, anesthesiology, nursing, and technical support for optimal success. Several physician groups with divergent training backgrounds (i.e., interventional neuroradiology, neurosurgery,neurology, peripheral interventional radiology, and cardiology) lay claim to the treatment of stroke patients,particularly the endovascular or interventional methods. Few would challenge neurologists over the responsibility for emergency evaluation and triage of stroke victims for intra intravenous fibrinolysis, even though emergency physicians are most commonly the first to evaluate these patients. There are many unanswered questions about the role of imaging in defining best treatment. Perfusion imaging with CT or MRI appears to have relevance even though its role remains undefined and is the subject of ongoing research. Meanwhile, investigators are exploring new, and perhaps more specific,imaging methods with cerebral metabolic rate of oxygen and cellular acid-base imbalance. There are currently 6 ongoing trials of stroke intervention, many with proprietary technologies and private funding, competing for the same patient population as multicenter trials funded by the NIH. At the same time, much of the interventional stroke treatment currently occurs outside of trials in the community and academic settings without the collection of much-needed data. Market forces will certainly shape future stroke therapy, but it is unclear whether the current combination of private and public funding for these endeavors is the best method of development. PMID:21646506

  19. The abdominal circulatory pump.

    Science.gov (United States)

    Aliverti, Andrea; Bovio, Dario; Fullin, Irene; Dellacà, Raffaele L; Lo Mauro, Antonella; Pedotti, Antonio; Macklem, Peter T

    2009-01-01

    Blood in the splanchnic vasculature can be transferred to the extremities. We quantified such blood shifts in normal subjects by measuring trunk volume by optoelectronic plethysmography, simultaneously with changes in body volume by whole body plethysmography during contractions of the diaphragm and abdominal muscles. Trunk volume changes with blood shifts, but body volume does not so that the blood volume shifted between trunk and extremities (Vbs) is the difference between changes in trunk and body volume. This is so because both trunk and body volume change identically with breathing and gas expansion or compression. During tidal breathing Vbs was 50-75 ml with an ejection fraction of 4-6% and an output of 750-1500 ml/min. Step increases in abdominal pressure resulted in rapid emptying presumably from the liver with a time constant of 0.61+/-0.1SE sec. followed by slower flow from non-hepatic viscera. The filling time constant was 0.57+/-0.09SE sec. Splanchnic emptying shifted up to 650 ml blood. With emptying, the increased hepatic vein flow increases the blood pressure at its entry into the inferior vena cava (IVC) and abolishes the pressure gradient producing flow between the femoral vein and the IVC inducing blood pooling in the legs. The findings are important for exercise because the larger the Vbs the greater the perfusion of locomotor muscles. During asystolic cardiac arrest we calculate that appropriate timing of abdominal compression could produce an output of 6 L/min. so that the abdominal circulatory pump might act as an auxiliary heart. PMID:19440240

  20. The Abdominal Circulatory Pump

    OpenAIRE

    Aliverti, Andrea; Bovio, Dario; Fullin, Irene; Dellacà, Raffaele L.; Lo Mauro, Antonella; Pedotti, Antonio; Macklem, Peter T

    2009-01-01

    Blood in the splanchnic vasculature can be transferred to the extremities. We quantified such blood shifts in normal subjects by measuring trunk volume by optoelectronic plethysmography, simultaneously with changes in body volume by whole body plethysmography during contractions of the diaphragm and abdominal muscles. Trunk volume changes with blood shifts, but body volume does not so that the blood volume shifted between trunk and extremities (Vbs) is the difference between changes in trunk ...

  1. Trauma abdominal complejo en una Unidad de Cuidados Intermedios Quirúrgicos Complex abdominal trauma in an Intermediate Surgical Care Unit

    Directory of Open Access Journals (Sweden)

    Pablo Raúl de Posada Jiménez

    2009-06-01

    Full Text Available El traumatismo abdominal representa del 15-20 % del total de las lesiones traumáticas. Nuestro objetivo fue conocer el comportamiento del traumatismo abdominal predominante en el lesionado complejo. Se revisaron las historias clínicas de 24 pacientes ingresados en la Unidad de Cuidados Intermedios Quirúrgicos del Hospital Militar Central “Dr. Luis Díaz Soto” durante el año 2002, con el diagnóstico de trauma abdominal predominante. Hubo una mayor incidencia del traumatismo cerrado (70.8%, predominando en el sexo masculino (75%. El lavado peritoneal diagnóstico y la punción abdominal fueron los procedimientos más utilizados. Las lesiones más frecuentes fueron del hígado, el intestino delgado y el hematoma retroperitoneal. La hepatorrafia (30% fue la técnica quirúrgica más empleada. Las complicaciones (29.2% más frecuentes fueron la sepsis intraabdominal, de la herida quirúrgica y los trastornos hidroelectrolíticos. La mortalidad fue del 8.3%. La tendencia del comportamiento del traumatismo abdominal no ha logrado variarse en los últimos años, su frecuencia se mantiene estable y el tratamiento quirúrgico continúa siendo el más empleado.The abdominal traumatism represents the 15-20 % of the total of the traumatic lesions. Our objective was to know the behavior of the abdominal traumatism, predominant in the patients with complex lesions. We went through the clinical records of 24 patients who entered the Surgical Intermediate Care Unit of the Central Military Hospital Luis Díaz Soto during 2002, with diagnosis of predominant abdominal trauma. There was a higher incidence of the closed traumatism (70.8 %, predominating the male sex (75 %. The peritoneal diagnostic lavage and the abdominal punction were the most used procedures. The most frequent lesions were those in the liver, the small intestine and the retroperitoneal hematoma. Hepatorraphy (30 % was the most used surgical technique. The most frequent complications (29.2 % intra-abdominal sepsis, complications of the surgical injury and electrolytic disturbs. There was 8.3 % of mortality. There was not any variation of the abdominal traumatism behavior tendency achieved in the last years, its frequency is steady and the surgical treatment is still the most used.

  2. Tratamiento endovascular de fístula aorto esofágica secundaria a cáncer de esófago: Caso clínico

    Directory of Open Access Journals (Sweden)

    Michel Bergoeing R

    2013-02-01

    Full Text Available Background: Esophageal squamous cell carcinoma can spread locally to neighboring organs in the mediastinum. When it invades the aorta, the patient may develop an aorto esophageal fistula (AEF, complication that carries a high mortality rate. We report a 62-year-old male with stage IV esophageal carcinoma who, after chemo radiation treatment, developed an AEF. He was successfully treated with the use of an aortic endograft. The patient died 13 months later due to progression of his cancer, without evidence of sepsis or new bleeding episodes.

  3. Abdominal emergencies during pregnancy.

    Science.gov (United States)

    Bouyou, J; Gaujoux, S; Marcellin, L; Leconte, M; Goffinet, F; Chapron, C; Dousset, B

    2015-12-01

    Abdominal emergencies during pregnancy (excluding obstetrical emergencies) occur in one out of 500-700 pregnancies and may involve gastrointestinal, gynecologic, urologic, vascular and traumatic etiologies; surgery is necessary in 0.2-2% of cases. Since these emergencies are relatively rare, patients should be referred to specialized centers where surgical, obstetrical and neonatal cares are available, particularly because surgical intervention increases the risk of premature labor. Clinical presentations may be atypical and misleading because of pregnancy-associated anatomical and physiologic alterations, which often result in diagnostic uncertainty and therapeutic delay with increased risks of maternal and infant morbidity. The most common abdominal emergencies are acute appendicitis (best treated by laparoscopic appendectomy), acute calculous cholecystitis (best treated by laparoscopic cholecystectomy from the first trimester through the early part of the third trimester) and intestinal obstruction (where medical treatment is the first-line approach, just as in the non-pregnant patient). Acute pancreatitis is rare, usually resulting from trans-ampullary passage of gallstones; it usually resolves with medical treatment but an elevated risk of recurrent episodes justifies laparoscopic cholecystectomy in the 2nd trimester and endoscopic sphincterotomy in the 3rd trimester. The aim of the present work is to review pregnancy-induced anatomical and physiological modifications, to describe the main abdominal emergencies during pregnancy, their specific features and their diagnostic and therapeutic management. PMID:26527261

  4. Abdominal aspergillosis: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Yeom, Suk Keu, E-mail: pagoda20@hanmail.net [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Hye Jin, E-mail: kimhyejin@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Byun, Jae Ho, E-mail: jhbyun@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Ah Young, E-mail: aykim@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Lee, Moon-Gyu, E-mail: mglee@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Ha, Hyun Kwon, E-mail: hkha@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of)

    2011-03-15

    Objective: In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients. Materials and methods: CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients (5 women, 1 man; mean age, 43.4 years; range, 23-59 years) with pathologically proved abdominal aspergillosis by two gastrointestinal radiologists in consensus. Medical records were also reviewed to determine each patient's clinical status and outcome. Results: All patients were immunocompromised state: 4 patients received immunosuppressive therapy for solid organ transplantation and 2 patients received chemotherapy for acute myeloid leukemia. Aspergillosis involved blood vessels (n = 3), liver (n = 2), spleen (n = 2), gastrointestinal tract (n = 2), native kidney (n = 1), transplanted kidney (n = 1), peritoneum (n = 1), and retroperitoneum (n = 1). CT demonstrated solid organ or bowel infarction or perforation secondary to vascular thrombosis or pseudoaneurysm, multiple low-attenuating lesions of solid organs presenting as abscesses, concentric bowel wall thickening mimicking typhlitis, or diffuse or nodular infiltration of the peritoneum and retroperitoneum. Conclusion: Familiarity with findings commonly presenting as angioinvasive features or abscesses on CT, may facilitate the diagnosis of rare and fatal abdominal aspergillosis.

  5. Acromegalia: diagnóstico y tratamiento

    Directory of Open Access Journals (Sweden)

    Olga Lidia Pereira Despaigne

    2015-03-01

    Full Text Available La acromegalia es una enfermedad crónica multisistémica, de baja prevalencia, cuyo diagnóstico y tratamiento deben adecuarse a las realidades actuales. No obstante, continúa siendo una enfermedad subdiagnosticada, que evoluciona con una elevada tasa de mortalidad, generalmente por causas cardiovasculares y cerebrovasculares, lo cual reduce la esperanza de vida de la persona que la padece. En el presente artículo se describen las formas de presentación del hipersomatotropismo, los métodos de diagnóstico y las modalidades terapéuticas, que incluyen la quirúrgica, la farmacológica y la radioterapia

  6. Correção endovascular de dissecção de aorta ascendente / Endovascular repair of ascending aortic dissection

    Scientific Electronic Library Online (English)

    José Carlos Dorsa Vieira, Pontes; Amaury Mont' Serrat Ávila Souza, Dias; João Jackson, Duarte; Ricardo Adala, Benfatti; Neimar, Gardenal.

    2013-03-01

    Full Text Available Paciente de 84 anos com dissecção de aorta torácica tipo A de Stanford comprometendo todo o arco aórtico e aorta descendente. Proposto e aceito o tratamento endovascular em função da gravidade do quadro clínico. Procedeu-se à dissecção das artérias femorais comum bilateralmente. A aortografia confir [...] mou a exclusão da falsa luz e a patência dos óstios coronarianos. Abstract in english Woman, 84 years-old, with Stanford type A thoracic aortic dissection committing aortic arch and descending aorta. Proposed and accepted endovascular treatment according to the severity of the clinical picture. Common femoral artery dissection bilaterally was done. Aortography confirmed the exclusion [...] of the false lumen and patency of the coronary ostia.

  7. Correção endovascular de dissecção de aorta ascendente Endovascular repair of ascending aortic dissection

    Directory of Open Access Journals (Sweden)

    José Carlos Dorsa Vieira Pontes

    2013-03-01

    Full Text Available Paciente de 84 anos com dissecção de aorta torácica tipo A de Stanford comprometendo todo o arco aórtico e aorta descendente. Proposto e aceito o tratamento endovascular em função da gravidade do quadro clínico. Procedeu-se à dissecção das artérias femorais comum bilateralmente. A aortografia confirmou a exclusão da falsa luz e a patência dos óstios coronarianos.Woman, 84 years-old, with Stanford type A thoracic aortic dissection committing aortic arch and descending aorta. Proposed and accepted endovascular treatment according to the severity of the clinical picture. Common femoral artery dissection bilaterally was done. Aortography confirmed the exclusion of the false lumen and patency of the coronary ostia.

  8. Endovascular Management of an Infected Superficial Femoral Artery Pseudoaneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Damodharan, Karthik, E-mail: drdkarthik@hotmail.com; Beckett, David [Royal Bournemouth Hospital (United Kingdom)

    2013-10-15

    This article describes an endovascular technique of treating an infected pseudoaneurysm by direct thrombin injection via a catheter placed inside the aneurysm sac while maintaining temporary balloon occlusion of the neck of the false aneurysm.

  9. The importance of expert feedback during endovascular simulator training.

    LENUS (Irish Health Repository)

    Boyle, Emily

    2011-07-01

    Complex endovascular skills are difficult to obtain in the clinical environment. Virtual reality (VR) simulator training is a valuable addition to current training curricula, but is there a benefit in the absence of expert trainers?

  10. Computer-supported diagnosis for endotension cases in endovascular aortic aneurysm repair evolution.

    Science.gov (United States)

    García, G; Tapia, A; De Blas, M

    2014-06-01

    An abdominal aortic aneurysm (AAA) is a localized abnormal enlargement of the abdominal aorta with fatal consequences if not treated on time. The endovascular aneurysm repair (EVAR) is a minimal invasive therapy that reduces recovery times and improves survival rates in AAA cases. Nevertheless, post-operation difficulties can appear influencing the evolution of treatment. The objective of this work is to develop a pilot computer-supported diagnosis system for an automated characterization of EVAR progression from CTA images. The system is based on the extraction of texture features from post-EVAR thrombus aneurysm samples and on posterior classification. Three conventional texture-analysis methods, namely the gray level co-occurrence matrix (GLCM), the gray level run length matrix (GLRLM), the gray level difference method (GLDM), and a new method proposed by the authors, the run length matrix of local co-occurrence matrices (RLMLCM), were applied to each sample. Several classification schemes were experimentally evaluated. The ensembles of a k-nearest neighbor (k-NN), a multilayer perceptron neural network (MLP-NN), and a support vector machine (SVM) classifier fed with a reduced version of texture features resulted in a better performance (Az=94.35±0.30), as compared to the classification performance of the other alternatives. PMID:24721658

  11. Hybrid treatment of bullet embolism at the abdominal aortic bifurcation, complicated with thoracoabdominal aorta pseudoaneurysm and common iliac artery occlusion: case report

    Directory of Open Access Journals (Sweden)

    Patrick Bastos Metzger

    2014-03-01

    Full Text Available Embolization due to a firearm projectile entering the bloodstream is a rare event that is unlikely to be suspected during initial treatment of trauma patients. We describe and discuss a case of bullet embolism of the abdominal aortic bifurcation, complicated by a pseudoaneurysm of the thoracoabdominal aorta and occlusion of the right common iliac artery, but successfully treated using a combination of endovascular methods and conventional surgery.

  12. Tratamiento farmacológico del TOC

    Directory of Open Access Journals (Sweden)

    Cristina Lóyzaga

    2000-01-01

    Full Text Available El abordaje farmacológico del TOC se basa en los inhibidores selectivos de la recaptura de serotonina (ISRS, medicamentos que han resultado ser efectivos y seguros. Como grupo, los ISRS son igual de eficaces que la clorimipramina, pero producen menos efectos secundarios y, por lo tanto, mejor tolerancia y mejor apego al tratamiento. La efectividad antiobsesiva parece ser independiente de su actividad antidepresiva. Entre los factores predictores de respuesta al tratameinto, se ha propuesto que los altos puntajes en las compulsiones predicen una mala respuesta al tratamiento. Para los casos refractarios y resistentes o cuando hay síntomas de comorbilidad, se han utilizado, con relativo éxito, combinaciones con diferentes IRS, con benzodiacepinas, o bien, con potenciadores como el litio, o antipsicóticos, como la risperidona y el haloperidol. El uso del carbonato de litio es controvertido, aunque parece ser útil como potenciador a largo plazo entre 15 y 30% de los pacientes. La combinación de ISRS con antipsicóticos comenzó a utilizarse en los pacientes con síntomas psicóticos, aunque ahora se combinan también en los pacientes resistentes. El manejo farmacológico de los niños con TOC se ha basado en la utilización de ISRS, que han resultado ser seguros, eficaces y bien tolerados en este grupo de edad. A lo largo del presente trabajo describiremos las características farmacológicas y la respuesta clínica de los medicamentos utilizados en el manejo de este trastorno.

  13. Current endovascular management of the ischaemic diabetic foot.

    Science.gov (United States)

    Gerassimidis, T; Karkos, C D; Karamanos, D; Kamparoudis, A

    2008-04-01

    Ischaemic diabetic foot ulcers pose a significant problem which is associated with a high likelihood of amputation. With the advent of endovascular surgery, the management of lower limb arterial lesions in the diabetic population has become more appealing. Coronary 0.014 monorail guide wires, appropriate sized angioplasty balloons and stents, and subintimal recanalisation, are all useful adjuncts and techniques to achieve revascularization. This article reviews the modern endovascular management of the diabetic foot. PMID:18923656

  14. Current endovascular management of the ischaemic diabetic foot

    OpenAIRE

    Gerassimidis, T; Karkos, CD; Karamanos, D; Kamparoudis, A

    2008-01-01

    Ischaemic diabetic foot ulcers pose a significant problem which is associated with a high likelihood of amputation. With the advent of endovascular surgery, the management of lower limb arterial lesions in the diabetic population has become more appealing. Coronary 0.014 monorail guide wires, appropriate sized angioplasty balloons and stents, and subintimal recanalisation, are all useful adjuncts and techniques to achieve revascularization. This article reviews the modern endovascular mana...

  15. Evolution of Endovascular Treatment for Complex Thoracic Aortic Disease

    OpenAIRE

    Roselli, Eric E

    2008-01-01

    In a relatively short period of time, transcatheter and endovascular approaches to treat thoracic aortic and structural heart disease have exploded onto the scene. New device frontiers already being forged in the experimental stages include expanded indications and variations of fenestrated and branch stentgrafting to treat thoracoabdominal and arch disease, endovascular ascending and aortic root repair, and all of the cardiac valves. A fundamental concept to optimize durability of endovascul...

  16. [Endovascular repair of aortic aneurysm a paradigmatic shift

    DEFF Research Database (Denmark)

    Lönn, Lars Birger

    2008-01-01

    overall survival in EVAR patients with severe morbidity is not influenced since mortality in this group is mainly unrelated to the aneurysm. Endovascular repair is also a solid alternative in thoracic pathologies and aortic ruptures. Patient selection and follow-up in EVAR is mainly governed by vascular...... imaging, especially 3-D CT reconstructions. There is a need for an increased number of endovascular specialists in Denmark since an increasing number of patients are suitable for EVAR treatment Udgivelsesdato: 2008/3/10...

  17. Detection of thrombosis and restenosis in an endovascular stent

    Science.gov (United States)

    Wu, Junru; Weissman, Eric

    2002-05-01

    Endovascular stents that are implanted in an artery are often used in the interventional treatment of coronary artery disease. Its widespread applications are, however, limited by the development of subacute thrombosis (clot forming inside of the stent). Ex vivo experiments with pigs have shown that the broadband A-mode ultrasound is quite effective in detection thrombosis and restenosis in an endovascular stent. [Work supported by BFGoodrich and Noveon, Inc.

  18. Advances in angiography and their impact on endovascular therapy.

    Science.gov (United States)

    Mitty, Harold A

    2003-11-01

    Transvascular therapy has progressed rapidly due to improvements in imaging equipment and endovascular devices. Interventional fluoroscopic equipment and portable machines are able to produce high-resolution digital images in well-lighted procedure rooms. Catheters and guidewires are now available in a variety of shapes, diameters and lengths, allowing entry into distal, small, and tortuous vessels. This in turn permits targeted local therapy of tumors and bleeding sites, as well as endovascular treatment of diseased vessels. PMID:14647869

  19. Hybrid Endovascular Repair in Aortic Arch Pathologies: A Retrospective Study

    OpenAIRE

    Lijun Wang,; Hongpeng Zhang; Xin Jia; Jiang Xiong; Xiaoping Liu; Tai Yin; Wei Guo; Xiaohui Ma

    2010-01-01

    The aortic arch presents specific challenges to endovascular repair. Hybrid repair is increasingly evolving as an alternative option for selected patients, and promising initial results have been reported. The aim of this study was to introduce our experiences and evaluate mid-term results of supra aortic transpositions for extended endovascular repair of aortic arch pathologies. From December 2002 to January 2008, 25 patients with thoracic aortic aneurysms and dissections involving the aorti...

  20. Advances in the endovascular treatment of intracranial arteriovenous malformations

    OpenAIRE

    Tournade, Alain; Riquelme, Carlos

    2000-01-01

    The three treatment options for intracranial arteriovenous malformation are resection, endovascular embolization, and stereotactic radioneurosurgery, in rare cases, the malformation can be eradicated using only one of these options; most cases require a combination of the options, even all three. The most recent advances have been in interventional neuroradiology with the introduction of highdefinition 3D imaging and hyperselective intranidal endovascular embolization using rnicrocatheters an...

  1. Endovascular treatment of splenic artery aneurysms

    International Nuclear Information System (INIS)

    Purpose. To assess the feasibility and effectiveness of endovascular treatment of splenic artery aneurysm (SAAs). Materials and methods. Between May 2000 and June 2003 we treated 11 true SAAs in 9 patients (7 females and 2 males; mean age 58 years), 8 saccular and 3 fusiform, 4 located at the middle tract of the splenic artery, 5 at the distal tract and 2 intra-parenchymal. The diagnosis was performed with colour-Doppler ultrasound and/or CT-angiography; 7 patients were symptomless, 1 had left hypochondriac pain, and 1 had acute abdomen caused by a ruptured SAA. Four SAAs were treated by micro coil embolisation of the aneurysmal sac with preservation of splenic artery patency; in 2 cases this was associated with transcatheter injection of N-butyl-2-cyanoacrylate. Four cases were treated by endovascular ligature, with sectoral spleen ischaemia. One ruptured SAA received emergency treatment with splenic artery cyanoacrylate embolisation. Two intra-parenchymal SAAs were excluded, one by cyanoacrylate embolisation of the afferent artery and the other by transcatheter thrombin injection in the aneurysmal sac. Results. Technical success was observed in all cases (in 10/11 at the end of the procedure; in 1/11 at CT performed 3 days after the procedure). The follow-up (mean 18 months; range 6-36) was performed by colour-Doppler ultrasound and/or CT-angiography 3, 6 and 12 months after the procedure and subsequently once a year; the complete exclusion of the aneurysms was confirmed in 11/11 cases. The complications were: 4 cases of mild pleuritis; fever and left hypochondriac pain 1 day after the procedure (in the same 4 patients and in one other case); 5 cases of sectorial spleen ischaemia and 1 case of diffuse spleen infarction with partial revascularization by collateral vessels. No alteration of the levels of pancreatic enzymes was found; a transitory increase in platelet count occurred only in the patient with diffuse spleen infarction. Conclusions. Using different techniques, endovascular treatment is feasible in nearly all SAAs. It ensures good immediate and long term results, and no doubt presents some advantages in comparison to surgical treatment, as it less invasive and allows the preservation of splenic function

  2. Detección y tratamiento del mielomeningocele por un equipo interdisciplinario

    Directory of Open Access Journals (Sweden)

    Jorgelina Iglesias

    2000-01-01

    Full Text Available El objetivo de este trabajo es presentar la experiencia y los resultados obtenidos por un equipo multidisciplinario en la detección y tratamiento del mielomeningocele, en un período comprendido entre 1995- 1998 y comparar los resultados con los datos de un período igual entre 1991-1994. En estos ocho años se produjeron en el Hospital Sardá 54.650 nacimientos; se detectaron 69 mielomeningoceles, con una prevalencia de 1,26?. En el primer período se realizó diagnóstico prenatal en el 41% de los casos, en el segundo período, el diagnóstico fue realizado en el 83% de los pacientes. Con la creación del equipo interdisciplinario se unificaron criterios para el diagnóstico, seguimiento, finalización del embarazo y derivación del recién nacido para su tratamiento quirúrgico ulterior. La cesárea abdominal programada permitiría un menor daño sobre la placa neural y evitaría infección. El retraso quirúrgico en el cierre del disrafismo no modificó la evaluación neurológica inicial ni creó factores de riesgo adicionales.

  3. Gore excluder device with the C3 delivery system for management of abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Morasch MD

    2012-02-01

    Full Text Available Cheong J Lee, Mark L Keldahl, Mark D MoraschDivision of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USAAbstract: The GORE Excluder stent-graft is one of the currently available devices approved by the US Food and Drug Administration for use in endovascular aortic repair. Recently, a new delivery system modification has been applied to the Excluder device which allows repositioning of the stent-graft to adjust for accurate proximal landing and facilitate gate cannulation. In this review, we examine the Excluder device with the new C3 delivery system and its potential benefit in the management of abdominal aortic aneurysms.Keywords: gore excluder, abdominal aortic aneurysm, repair, C3 delivery system

  4. Endovascular treatment of extracranial vertebral artery stenosis

    Science.gov (United States)

    Kocak, Burak; Korkmazer, Bora; Islak, Civan; Kocer, Naci; Kizilkilic, Osman

    2012-01-01

    Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery (VA) stenosis seems a safe, effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation, with a low complication rate and good long-term results. In patients with severe tortuosity of the vessel, stent placement is a real challenge. The new coronary balloon-expandable stents may be preferred. A large variability of restenosis rates has been reported. Drug-eluting stents may be the solution. After a comprehensive review of the literature, it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible, but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management. PMID:23024840

  5. Endovascular treatment of extracranial vertebral artery stenosis

    Directory of Open Access Journals (Sweden)

    Burak Kocak

    2012-01-01

    Full Text Available Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery (VA stenosis seems a safe, effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation, with a low complication rate and good long-term results. In patients with severe tortuosity of the vessel, stent placement is a real challenge. The new coronary balloon-expandable stents may be preferred. A large variability of restenosis rates has been reported. Drug-eluting stents may be the solution. After a comprehensive review of the literature, it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible, but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.

  6. Endovascular Aneurysm Repair Treatment of Aortoiliac Aneurysms

    DEFF Research Database (Denmark)

    Taudorf, Mikkel; Rasmussen, John Bøje Grønvall; Schroeder, Torben V; Lönn, Lars

    2016-01-01

    PURPOSE: To compare the risk of gluteal claudication after endovascular aneurysm repair (EVAR) of aortoiliac aneurysms by interventional exclusion of the internal iliac artery (IIA) with plugs or coils versus a branch iliac device to maintain pelvic blood supply and to identify risk factors for...... postoperative gluteal claudication. MATERIALS AND METHODS: A retrospective analysis of a prospectively collected data set included patients with aortoiliac aneurysms treated with EVAR from January 2007 to December 2013 at a tertiary referral vascular unit. Descriptive and procedural data were obtained from a....... The incidence of gluteal claudication was higher when coils rather than plugs were used for embolization of the IIA before EVAR (P = .002). CONCLUSIONS: The findings suggest that the use of a branch iliac device significantly reduces the risk of gluteal claudication after EVAR of aortoiliac aneurysm....

  7. Endovascular Perforation Murine Model of Subarachnoid Hemorrhage.

    Science.gov (United States)

    Du, Guo Jia; Lu, Gang; Zheng, Zhi Yuan; Poon, Wai Sang; Wong, Kwok Chu George

    2016-01-01

    Subarachnoid hemorrhage (SAH) is a subtype of stroke with disastrous outcomes of high disability and mortality. A variety of endeavors have been developed to explore a SAH animal model for investigation of the disease. Among these models, the endovascular perforation SAH model was considered to be the most simulative to the clinical human SAH because it reproduces several pathophysiology procedures and presents some of the most important post-hemorrhage features. An applicable SAH animal model should have the characteristics of low mortality rate, limited surgical manipulation, and adaptation to many species, which permits reproducibility and standardization. An intensive discussion of how to improve the techniques and refine the procedure has taken place in the last decade. This report describes our experiences with a murine model of SAH. We aim to standardize and optimize the procedures to establish a relatively stable animal model for SAH research. PMID:26463927

  8. Acute iliac artery rupture: endovascular treatment.

    Science.gov (United States)

    Chatziioannou, A; Mourikis, D; Katsimilis, J; Skiadas, V; Koutoulidis, V; Katsenis, K; Vlahos, L

    2007-01-01

    The authors present 7 patients who suffered iliac artery rupture over a 2 year period. In 5 patients, the rupture was iatrogenic: 4 cases were secondary to balloon angioplasty for iliac artery stenosis and 1 occurred during coronary angioplasty. In the last 2 patients, the rupture was secondary to iliac artery mycotic aneurysm. Direct placement of a stent-graft was performed in all cases, which was dilated until extravasation was controlled. Placement of the stent-graft was successful in all the cases, without any complications. The techniques used, results, and mid-term follow-up are presented. In conclusion, endovascular placement of a stent-graft is a quick, minimally invasive, efficient, and safe method for emergency treatment of acute iliac artery rupture, with satisfactory short- and mid-term results. PMID:16897264

  9. Acute Iliac Artery Rupture: Endovascular Treatment

    International Nuclear Information System (INIS)

    The authors present 7 patients who suffered iliac artery rupture over a 2 year period. In 5 patients, the rupture was iatrogenic: 4 cases were secondary to balloon angioplasty for iliac artery stenosis and 1 occurred during coronary angioplasty. In the last 2 patients, the rupture was secondary to iliac artery mycotic aneurysm. Direct placement of a stent-graft was performed in all cases, which was dilated until extravasation was controlled. Placement of the stent-graft was successful in all the cases, without any complications. The techniques used, results, and mid-term follow-up are presented. In conclusion, endovascular placement of a stent-graft is a quick, minimally invasive, efficient, and safe method for emergency treatment of acute iliac artery rupture, with satisfactory short- and mid-term results

  10. Endovascular Treatment of an Aortoiliac Tuberculous Pseudoaneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Villegas, Miguel O.; Mereles, Alberto Perez; Tamashiro, Gustavo A.; Dini, Andres E.; Mollon, Ana P.; De Candido, Laura V.; Zelaya, Denis A.; Soledispa-Suarez, Carlos I.; Denato, Sergio; Tamashiro, Alberto; Diaz, Jose A., E-mail: joseantoniodiaz@hotmail.com [Hospital Nacional Prof. Alejandro Posadas, Department of Cardiology, Section of Hemodinamia (Argentina)

    2013-04-15

    We report a rare case of a tuberculous mycotic aortoiliac pseudoaneurysm treated with an endovascular procedure and follow-up of 36 months. The patient was a white 72-year-old man with pulmonary tuberculosis and a former smoker with hypertension, chronic renal failure, and dyslipidemia. A computed tomographic scan of the abdomen and pelvis revealed a left paravertebral cavity with fluid content and involvement of vertebrae L2-L4. After a surgical repair attempt, the patient was treated with the implant of a bifurcated endoprosthesis. Because it is unlikely that any center has extensive experience in the management of this rare manifestation of the disease, we reviewed the literature for similar cases.

  11. Evolution of endovascular stroke therapies and devices.

    Science.gov (United States)

    Wallace, Adam N; Kansagra, Akash P; McEachern, James; Moran, Christopher J; Cross Iii, Dewitte T; Derdeyn, Colin P

    2016-03-01

    Acute ischemic stroke is caused by occlusion of a cerebral artery, resulting in loss of brain tissue and neurologic deficits. However, a portion of the ischemic brain can be salvaged if blood flow is restored within an appropriate time frame. The past year has seen the publication of five positive randomized controlled trials demonstrating substantial benefit of mechanical thrombectomy in select patients with large vessel cerebrovascular occlusion. This progress is related to several factors, but most importantly, dramatic improvements in speed and rates of recanalization with the latest generation devices. In this article, we review the evolution of endovascular acute ischemic stroke therapies and key design features of the most widely used devices. PMID:26781520

  12. Abetalipoproteinemia: monitoreo del tratamiento

    Scientific Electronic Library Online (English)

    Alejandro M., O´Donnell; Pablo E., Levatte; Raúl, Uicich.

    2004-12-01

    Full Text Available La abetalipoproteinemia es causada por un defecto en la síntesis de beta-lipoproteínas plasmáticas, VLDL y quilomicrones. Cursa con desnutrición grave, diarrea crónica malabsortiva, polineuritis, ataxia, retinitis pigmentaria y acantocitosis. Se presenta un niño de cinco años de edad que consultó po [...] r un cuadro compatible con esta enfermedad. El diagnóstico se hizo por biopsia de intestino delgado y laboratorio. Se inició tratamiento con dieta hipograsa y triglicéridos de cadena mediana, formas hidrosolubles de vitaminas A y D, altas dosis de vitaminas E y K intramuscular y lípidos endovenosos en forma periódica para la provisión de ácidos grasos esenciales ante evidencias de deficiencia. Recibió lípidos endovenosos quincenalmente durante cinco años hasta que comenzó con reacciones de intolerancia durante las infusiones, que hubo que espaciar. La recuperación fue excelente. Hoy, a los catorce años, es un adolescente normal, con desarrollo y tamaño corporal normales para su edad. Ante la imposibilidad de monitorear el estado nutricional (deficiencia o exceso) en ácidos grasos esenciales y vitaminas, eventualidad posible por lo atípico de la dieta, el síndrome malabsortivo y debido a los valores no dosables en plasma se obtuvieron tres biopsias de tejido adiposo. Los resultados demostraron la dependencia de las infusiones y una composición diferente del tejido adiposo, según los distintos momentos del tratamiento y en comparación con la de los adultos normales de nuestro país. Consideramos que la determinación de ácidos grasos en el tejido adiposo es una herramienta útil en el monitoreo del tratamiento de esta grave enfermedad. Abstract in english Abetalipoproteinemia is a disease caused by a defect in the synthesis of beta-lipoproteins, VLDL and chilomicrons. The clinical picture is characterized by chronic malabsorptive diarrhea, malnutrition, polyneuritis, ataxia, retinitis pigmentosa and acanthocytes in blood smears. We present a child wi [...] th the typical manifestations of the disease. The response to the classical treatment was very good. The child also received periodic IV lipid infusions to provide essential fatty acids to improve his nutritional status, which we presumed as marginal given his fat malabsorption and a very low fat diet plus MCT. The sequence of infusions was every 15 days for the first five years, monthly later, and finally, every six months. Chromatographic analysis of subcutaneous adipose tissue samples showed a decrease in the concentration of EFA depending on the periodicity of IV lipid infusions, becoming progressively different from the composition of adipose tissue of normal subjects. It is concluded that adipose subcutaneous tissue biopsies are a useful tool for monitoring the nutritional status of patients with this rare disease, given the important functional consequences of EFA deficiency.

  13. Posttraumatic abdominal aortic dissection

    International Nuclear Information System (INIS)

    Dissections due to deceleration trauma are rarely limited to the infradiaphragmal aorta (only 2-3%) and are usually lethal. Here we report the unusual course of an abdominal aortic dissection with aneurysmatic enlargement of the false lumen. Based on diagnostic imaging, a therapeutic stent application was planed in order to close the entry and to prevent rupture. During the intervention sondation of the false lumen revealed that the left renal artery had a reentry. Due to the complexity of the entry - reentry situation of the left renal artery the intervention was not possible, and the patient had to undergo vascular surgery. (orig.)

  14. [Abdominal penetrating trauma].

    Science.gov (United States)

    Kring, Søren; Helligsøe, Per; Kåg, Lise

    2009-06-22

    A 19-year-old female was brought to the Emergency Room as a trauma patient. During a tilting contest she fell off the horse and was penetrated by a spear used for tilting the ring. She was respiratorically as well as haemodynamically stable. The spear was supported but not removed by the paramedics. The spear penetrated the patient near the left iliac crest pointing at the heart. Further investigation at the Emergency Room is described briefly and guidelines for penetrating, impaled foreign bodies in the (thoraco)abdominal region are outlined. PMID:19671404

  15. Abdominal Tuberculosis in Surgical Practise

    Directory of Open Access Journals (Sweden)

    D.Rthapa,Meena Sidhu, H.L.Goswamy,Nasib C.Dirray

    2000-01-01

    Full Text Available Thirty patients of abdominal tuberculosis in the age grClip of20-40 years were analyzed. Majorityofthe cases had abdominal pain as the leading clinical presentation. A significant number ofpatientsalso had abdominal lump. Intestinal obstruction! perforation was present in 10 patients requiringsurgical intervention. Barium studies (done on 27 occasions had a positive rate of70%. All patients,where diagnosis of tuberculosis was confirmed, received three-drug anti-tubercular regimen Therewas no post-operative mortality.

  16. Abdominal tuberculosis. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Arslan, A.; Ciftci, E.; Ceylan, N.; Metin, K.; Demirci, A. [Dept. of Radiology, Kocaeli Univ. (Turkey)

    1998-11-01

    Tuberculous involvement of the abdominal parenchymatous organs is usually a diffuse process. The macronodular form of hepatosplenic tuberculosis and focal involvement of the pancreas ar extremely rare. This report describes CT findings of abdominal parenchymatous organ involvement in a patient with pulmonary and vertebral tuberculosis. Although CT does not confirm a diagnosis of abdominal tuberculosis, it is a valuable examination that can support the diagnosis and define the extent of disease. (orig.)

  17. Chronical abdominal pain in children: management in the Communitary Medical Consultation Dolor abdominal crónico en niños: conducta en la consulta médica comunitaria

    Directory of Open Access Journals (Sweden)

    Lorenzo Pérez Romano

    Full Text Available The term recurrent abdominal pain is characterized by the presence of three or more episodes of abdominal pain in a three-months period although in clincal practice, this term is applied to intermittent episodes of pain in a period of more than one month. This definition is arbitrary causing debates and errors in diagnosing the patient. The term chronic abdominal pain is accepted nowadays which is the one that comprises the constant or intermittent abdominal pain of long duration, functional or organic. In this paper a bibliographical review on chronic abdominal pain in children is carried out. A critical analysis of the evaluation of the patient with this disorders is done as well as the management to follow with them in the primary attention and, the pharmachlogical and non pharmachlogical treatment of the patient with functional pain.
    El término dolor abdominal recurrente se caracteriza por la presencia de tres o más episodios de dolor abdominal, durante un período de tres meses, aunque en la práctica clínica, el término se aplica también a episodios intermitentes de dolor de más de un mes de duración. La definición es arbitraria y ha originado controversias y errores en el diagnóstico; la que se acepta actualmente es dolor abdominal crónico, que comprende específicamente el dolor abdominal constante o intermitente, de larga duración, funcional u orgánico. En el presente trabajo se realiza una revisión bibliográfica sobre el dolor abdominal crónico en edad pediátrica, su etiología, clasificación actual y diagnóstico; se realiza un análisis crítico de la evaluación de los pacientes con estos trastornos, de la conducta a seguir con ellos en la atención comunitaria, y del tratamiento no farmacológico y farmacológico de los pacientes con dolor funcional.

  18. Tratamiento oncológico / Chemotherapy

    Scientific Electronic Library Online (English)

    Luis Gonzalo, Guevara Casallas; Jaime, Holguín Rojas; Rolando, Ortega Quiroz.

    2013-09-30

    Full Text Available Los esquemas de quimioterapia convencionales no han demostrado ningún beneficio en el tratamiento del paciente con carcinoma hepatocelular (CHC), las tasas de respuesta han sido muy bajas y no se ha observado ningún beneficio en la sobrevida cuando se usan agentes únicos o en combinación de quimiote [...] rapia. El advenimiento de nuevas moléculas de acción en sitios más específicos ha brindado una mejor esperanza en la sobrevida con menores efectos adversos Abstract in english Conventional chemotherapy has shown no benefit for the treatment of patients with hepatocellular carcinoma (HCC). Response rates have been very low and no survival benefits have been observed for any single agent or combination chemotherapy regime. Nevertheless, the advent of new molecules which act [...] on specific sites has given more hope for better survival with fewer adverse effects from chemotherapy

  19. Complications after endovascular stent-grafting of thoracic aortic diseases

    Directory of Open Access Journals (Sweden)

    Rivolta Nicola

    2006-09-01

    Full Text Available Abstract Background To update our experience with thoracic aortic stent-graft treatment over a 5-year period, with special consideration for the occurrence and management of complications. Methods From December 2000 to June 2006, 52 patients with thoracic aortic pathologies underwent endovascular repair; there were 43 males (83% and 9 females, mean age 63 ± 19 years (range 17–87. Fourteen patients (27% were treated for degenerative thoracic aortic aneurysm, 12 patients (24% for penetrating aortic ulcer, 8 patients (15% for blunt traumatic injury, 7 patients (13% for acute type B dissection, 6 patients (11% for a type B dissecting aneurysm; 5 patients (10% with thoraco-abdominal aortic aneurysms were excluded from the analyses. Fifteen patients (32% underwent emergency treatment. Overall, mean EuroSCORE was 9 ± 3 (median 15, range 3–19. All procedures were performed in the theatre under general anesthesia. All complications occurring during hospitalisation were recorded. Follow-up protocol featured CT-A, and chest X-rays 1, 4 and 12 months after intervention, and annually thereafter. Results Primary technical success was achieved in all patients; procedures never aborted because of access difficulty. Conversion to standard open repair was never required. Mean duration of the procedure was 119 ± 75 minutes (median 90, range 45–285. Mean blood loss was 254 mL (range 50–1200 mL. The mean length of the aorta covered by the SGs was 192 ± 21 mm (range 100–360. The LSA was over-stented in 17 cases (17/47, 36%. Overall 30-day operative mortality was 6.4% (3/47. Major complications included pneumonia (n = 9, cerebrovascular accidents (n = 4, arrhythmia (n = 4, acute renal failure (n = 3, and colic ischemia (n = 1. Overall, endoleak rate was 14%. Conclusion Although this report is a retrospective and not comparative analysis of thoracic aortic repair, the combined minor and major morbidity rate was lower than previous reported to results of either electively and emergency performed conventional repair.

  20. Long-term Follow-up Study of Endovascularly Treated Intracranial Aneurysms

    OpenAIRE

    Pyysalo, L.M.; Keski-Nisula, L.H.; Niskakangas, T.T.; Kähärä, V.J.; Öhman, J.E.

    2010-01-01

    Long-term follow-up studies after endovascular treatment for intracranial aneurysm are still rare and inconclusive. The aim of this study was to assess long-term clinical and angiographic outcome of patients with endovascularly treated aneurysms.

  1. Abdominal aortic aneurysms: virtual imaging and analysis through a remote web server

    International Nuclear Information System (INIS)

    The study describes the application of a web-based software in the planning of the endovascular treatment of abdominal aortic aneurysms (AAA). The software has been developed in the framework of a 2-year research project called Aneurysm QUAntification Through an Internet Collaborative System (AQUATICS); it allows to manage remotely Virtual Reality Modeling Language (VRML) models of the abdominal aorta, derived from multirow computed tomography angiography (CTA) data sets, and to obtain measurements of diameters, angles and centerline lengths. To test the reliability of measurements, two radiologists performed a detailed analysis of multiple 3D models generated from a synthetic phantom, mimicking an AAA. The system was tested on 30 patients with AAA; CTA data sets were mailed and the time required for segmentation and measurement were collected for each case. The Bland-Altman plot analysis showed that the mean intra- and inter-observer differences in measures on phantoms were clinically acceptable. The mean time required for segmentation was 1 h (range 45-120 min). The mean time required for measurements on the web was 7 min (range 4-11 min). The AQUATICS web server may provide a rapid, standardized and accurate tool for the evaluation of AAA prior to the endovascular treatment. (orig.)

  2. Abdominal aortic aneurysms: virtual imaging and analysis through a remote web server

    Energy Technology Data Exchange (ETDEWEB)

    Neri, Emanuele; Bargellini, Irene; Vignali, Claudio; Bartolozzi, Carlo [University of Pisa, Diagnostic and Interventional Radiology, Pisa (Italy); Rieger, Michael; Jaschke, Werner [University of Innsbruck, Diagnostic and Interventional Radiology, Innsbruck (Austria); Giachetti, Andrea; Tuveri, Massimiliano [Center for Research and Study, Sardinia (Italy)

    2005-02-01

    The study describes the application of a web-based software in the planning of the endovascular treatment of abdominal aortic aneurysms (AAA). The software has been developed in the framework of a 2-year research project called Aneurysm QUAntification Through an Internet Collaborative System (AQUATICS); it allows to manage remotely Virtual Reality Modeling Language (VRML) models of the abdominal aorta, derived from multirow computed tomography angiography (CTA) data sets, and to obtain measurements of diameters, angles and centerline lengths. To test the reliability of measurements, two radiologists performed a detailed analysis of multiple 3D models generated from a synthetic phantom, mimicking an AAA. The system was tested on 30 patients with AAA; CTA data sets were mailed and the time required for segmentation and measurement were collected for each case. The Bland-Altman plot analysis showed that the mean intra- and inter-observer differences in measures on phantoms were clinically acceptable. The mean time required for segmentation was 1 h (range 45-120 min). The mean time required for measurements on the web was 7 min (range 4-11 min). The AQUATICS web server may provide a rapid, standardized and accurate tool for the evaluation of AAA prior to the endovascular treatment. (orig.)

  3. Long-Term Follow-Up Study of Endovascularly Treated Intracranial Aneurysms

    OpenAIRE

    Pyysalo, L.M.; Keski-Nisula, L.H.; Niskakangas, T.T.; Kähärä, V.J.; Öhman, J.E.

    2010-01-01

    Long-term follow-up studies after endovascular treatment for intracranial aneurysm are still rare and inconclusive. The aim of this study was to assess the long-term clinical and angiographic outcome of patients with endovascularly treated aneurysms. The clinical outcome of all 185 patients with endovascularly treated aneurysms were analyzed and 77 out of 122 surviving patients were examined with MRI and MRA nine to 16 years (mean 11 years) after the initial endovascular treatment.

  4. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

    Energy Technology Data Exchange (ETDEWEB)

    Marincek, B. [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland)

    2002-09-01

    Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films - bowel obstruction, pneumoperitoneum, and the search of ureteral calculi - are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain. (orig.)

  5. Endovascular treatment of head and neck arteriovenous malformations

    International Nuclear Information System (INIS)

    Head and neck arteriovenous malformations (H and N AVM) are associated with considerable clinical and psychosocial burden and present a significant treatment challenge. We evaluated the presentation, response to treatment, and outcome of patients with H and N AVMs treated by endovascular means at our institution. Patients with H and N AVMs treated by endovascular means from 1984 to 2012 were evaluated retrospectively. These included AVMs involving the scalp, orbit, maxillofacial, and upper neck localizations. Patient's clinical files, radiological images, catheter angiograms, and surgical reports were reviewed. Eighty-nine patients with H and N AVMs (46 females, 43 males; 48 small, 41 large) received endovascular therapy. The goals of treatment were curative (n = 30), palliative (n = 34), or presurgical (n = 25). The total number of endovascular treatment sessions was 244 (average of 1.5 per patient). The goal of treatment was met in 92.1 % of cases. Eventual cure was achieved in 42 patients accounting for 58.4 % (52/89) of all patients who underwent treatment for any goal. Twenty-eight of these patients were cured by embolization alone (28/89, 31.4 %) of which 18 were single-hole AVFs. Twenty-four were cured by planned surgical excision after presurgical embolization (24/89, 27 %). Seven patients (7/89, 7.2 %) suffered transient and two (2/89, 2.2 %) permanent endovascular treatment complications. Endovascular treatment is effective for H and N AVMs and relatively safe. It is particularly effective for symptom palliation and presurgical aid. Embolization is curative mostly in small lesions and single-hole fistulas. In patients with large non-curable H and N AVMs, endovascular therapy is often the only palliative option. (orig.)

  6. Endovascular treatment of head and neck arteriovenous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Dmytriw, A.A. [University Health Network, Joint Department of Medical Imaging, Toronto, Ontario (Canada); Ter Brugge, K.G.; Krings, T.; Agid, R. [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario (Canada)

    2014-03-15

    Head and neck arteriovenous malformations (H and N AVM) are associated with considerable clinical and psychosocial burden and present a significant treatment challenge. We evaluated the presentation, response to treatment, and outcome of patients with H and N AVMs treated by endovascular means at our institution. Patients with H and N AVMs treated by endovascular means from 1984 to 2012 were evaluated retrospectively. These included AVMs involving the scalp, orbit, maxillofacial, and upper neck localizations. Patient's clinical files, radiological images, catheter angiograms, and surgical reports were reviewed. Eighty-nine patients with H and N AVMs (46 females, 43 males; 48 small, 41 large) received endovascular therapy. The goals of treatment were curative (n = 30), palliative (n = 34), or presurgical (n = 25). The total number of endovascular treatment sessions was 244 (average of 1.5 per patient). The goal of treatment was met in 92.1 % of cases. Eventual cure was achieved in 42 patients accounting for 58.4 % (52/89) of all patients who underwent treatment for any goal. Twenty-eight of these patients were cured by embolization alone (28/89, 31.4 %) of which 18 were single-hole AVFs. Twenty-four were cured by planned surgical excision after presurgical embolization (24/89, 27 %). Seven patients (7/89, 7.2 %) suffered transient and two (2/89, 2.2 %) permanent endovascular treatment complications. Endovascular treatment is effective for H and N AVMs and relatively safe. It is particularly effective for symptom palliation and presurgical aid. Embolization is curative mostly in small lesions and single-hole fistulas. In patients with large non-curable H and N AVMs, endovascular therapy is often the only palliative option. (orig.)

  7. Combined Endovascular and Microsurgical Management of Complex Cerebral Aneurysms

    Directory of Open Access Journals (Sweden)

    GaryKSteinberg, MD, PhD

    2013-08-01

    Full Text Available Cerebral aneurysms are associated with a 50% mortality rate after rupture and patients can suffer significant morbidity during subsequent treatment. Neurosurgical management of both ruptured and unruptured aneurysms has evolved over the years. The historical practice of using microsurgical clipping to treat aneurysms has benefitted in the last two decades from tremendous improvement in endovascular technology. Microsurgery and endovascular therapies are often viewed as competing treatments but it is important to recognize their individual limitations. Some aneurysms are considered complex, due to several factors such as aneurysm anatomy and a patient’s clinical condition. A complex aneurysm often cannot be completely excluded with a single approach and its successful treatment requires a combination of microsurgical and endovascular techniques. Planning such an approach relies on understanding aneurysm anatomy and thus should routinely include 3D angiographic imaging. In patients with ruptured aneurysms, endovascular coiling is a well-tolerated early treatment and residual aneurysms can be treated with intervals of definitive clipping. Microsurgical clipping also can be used to reconstruct the neck of a complex aneurysm, allowing successful placement of coils across a narrow neck. Endovascular techniques are assisted by balloons, which can be used in coiling and testing parent vessel occlusion before sacrifice. In some cases microsurgical bypasses can provide alternate flow for planned vessel sacrifice. We present current paradigms for combining endovascular and microsurgical approaches to treat complex aneurysms and share our experience in 67 such cases. A dual microsurgical–endovascular approach addresses the challenge of intracranial aneurysms. This combination can be performed safely and produces excellent rates of aneurysm obliteration. Hybrid angiographic operating-room suites can foster seamless and efficient complementary application of these two modalities.

  8. Manejo y enfoque inicial del dolor abdominal en un paciente inmunosuprimido Management and initial work up of abdominal pain in an immunodepressed patient

    Directory of Open Access Journals (Sweden)

    Héctor René Hazbón Nieto

    2007-06-01

    Full Text Available En este artículo describimos el caso de una paciente con abdomen agudo y antecedente de púrpura trombocitopénica idiopática, trasplante hepático y tratamiento inmunosupresor. Ante la duda diagnóstica, la paciente fue llevada a laparoscopia exploratoria encontrándose una apendicitis aguda. Presentamos el enfoque y manejo de la patología abdominal quirúrgica en pacientes con enfermedad autoinmune y tratamiento inmunosupresor exponeniendo las ventajas de la invasión mínima frente al procedimiento convencional.In this article we described the case of a patient with acute abdomen and previous history of idi-opathic thrombocytopenic purple, liver transplant and immunosuppressor treatment. Because of the doubt in the diagnosis, an exploratory laparoscopic was done and an acute appendicitis was found. We presented the initial surgical approach of abdominal pathology in patients with autoimmune disease and immunosuppressor treatment and also explain the advantages of the minimum invasion compared with conventional procedure.

  9. Actinomicosis primaria de la pared abdominal: Descripción de dos casos y revisión de la literatura / Primary actinomycosis of abdominal wall: Report of 2 cases and literature review

    Scientific Electronic Library Online (English)

    J. C., García García; M. J., Núñez Fernández; J. M., Cerqueiro González; C., García Martín; J. C., Rodríguez García; L., Anibarro García; J. M. de, Lis Muñoz; L., Piñeiro Gómez-Durán.

    2001-02-01

    Full Text Available Presentamos dos casos de actinomicosis aislada de la pared abdominal y revisamos 18 casos publicados previamente para describir las características clínicas y el manejo terapéutico de este síndrome. Su diagnóstico debe plantearse en pacientes con una masa abdominal palpable, de aparición subaguda, c [...] on una historia previa de enfermedad digestiva, diabetes, cirugía abdominal o uso prolongado de DIU. Contrastan con otras formas de actinomicosis, la edad media más alta de los pacientes, el predominio del sexo femenino, la localización prevalente de la lesión en el cuadrante inferior izquierdo del abdomen y la menor duración de la sintomatología previa al diagnóstico. La TAC es la técnica de imagen de primera elección y se debe recomendar la aspiración percutánea con aguja para un diagnóstico definitivo. La administración prolongada de antibióticos, con o sin drenaje percutáneo, es el tratamiento de elección ya que es muy efectivo y hace innecesario el manejo quirúrgico más agresivo. El pronóstico es excelente con un tratamiento adecuado. Abstract in english We report two cases of isolated abdominal wall actinomycosis and review 18 previously reported cases to further characterize the clinical findings and the therapeutic management of this syndrome. This diagnosis would be advocated in patients with a palpable abdominal mass of subacute appearance with [...] a previous history of digestive medical illness, diabetes, abdominal surgery, or prolonged IUD use. In contrast with other actynomicosis locations, remarkable data were a more elevated mean age of patients; a female predominance; a prevalent location of mass in abdominal lower left quadrant; and a shorter duration of symptomatology before to diagnosis. The CT is the first choice for imaging study and percutaneos needle aspiration would be recommended for definite diagnosis. The long-term antibiotic therapy, with or without percutaneous drainage, is the first treatment choice because is very effective and made unnecessary a more invasive surgical management. The prognosis is excellent with adecuated treatment.

  10. Tratamento endovascular da oclusão das artérias ilíacas Endovascular treatment of iliac arteries occlusion

    Directory of Open Access Journals (Sweden)

    Cleoni Pedron

    2001-10-01

    Full Text Available A oclusão das artérias ilíacas é uma patologia freqüente. Várias opções cirúrgicas existem para o seu tratamento, como a ponte aorto-bifemoral, a ponte femoro-femoral cruzada, o implante de endoprótese e outros. A ponte aorto-bifemoral é considerada o tratamento com melhores resultados. O tratamento endovascular da oclusão das artérias apresenta alta taxa de sucesso e baixo índice de complicações. Realizamos este tratamento em 24 pacientes, com idade média de 61 anos, variando de 39 a 82 anos. A indicação foi claudicação intermitente em 19 pacientes e isquemia crítica em cinco. O fator de risco mais freqüente foi tabagismo em 19 pacientes. A taxa de sucesso técnico na ultrapassagem da lesão foi de 91,7% e a taxa de patência foi de 71% em um ano. Os bons resultados com o tratamento endovascular nas oclusões das artérias ilíacas, com baixas taxas de morbidade e mortalidade, sugerem a inclusão deste procedimento no arsenal terapêutico.Occlusion of the iliac arteries is a common disease. Several surgical options are available to treat them, such as aorto-bifemoral bypass graft, cross femoro-femoral bypass, endoprosthesis implants and others. Aorto-bifemoral bypass graft is considered the treatment that provides the best results. Endovascular treatment for occlusion of the iliac arteries provides high success rates and low incidence of complications. Twenty-four patients, aged between 39 and 82 years (mean 61 years, were submitted to this treatment. Intermittent claudication and critical ischemia were the indications in 19 and 5 patients, respectively. The most common risk factor was smoking (19 patients. The technical success rate of iliac artery recanalization was 91.7% and the patency rate after one year was 71%. The good results achieved with percutaneous recanalization and stenting of occluded iliac arteries, which presents low morbidity and mortality rates, suggest that this procedure should be included among the therapeutic options for the treatment of iliac arteries occlusion.

  11. Endo-luminal grafting for treatment of abdominal aortic aneurysms

    International Nuclear Information System (INIS)

    Objective: To evaluate the preliminary clinical results of endovascular procedures for abdominal aortic aneurysms (AAA) in a prospective study. Methods: Six patients (average age 70 years, range 56 to 78) with infrarenal AAA were enrolled in Shanghai Zhongshan hospital from February 1998 to February 1999. Computed tomography and angiography were done in every patient for measurement of the length, diameter, and angulation of the proximal and distal AAA necks, aneurysm sac, and common and external iliac arteries. The average diameter of the aneurysm was 6.3 cm (range 4.6 cm to 8.0 cm). The mean proximal neck diameter was 2.0 cm (range 1.8 cm to 2.2 cm) and proximal neck length was 3.0 cm (range 2.5 cm to 3.5 cm). All patients were treated with the endo-luminal grafting for exclusion of AAA. Results: Two tubular and 4 bifurcated endo-grafts were used. All endo-graft procedures were completed successfully. One patient died of renal failure 72 hours after the procedure because of the prolonged operative time and excessive contrast medium. Aortography after the procedure showed the AAA were excluded by endo-graft and no endo-leak in the proximal or distal connections was detected. The patients could take meal and were ambulatory on the first and second postoperative day, respectively. Clinical success (aneurysm exclusion with no death or endo-leak) at 30 days was 83.3%. In the 24 months follow-up in 5 cases, no migration, endo-leak, and increasing aneurysm size were detected with spiral CT or color Duplex ultrasound. Conclusion: Based on initial results and a short term mean follow-up period of 24 months, the endovascular treatment of AAA with stent-graft system is feasible and safe. Further study will be required to observe the long term result in the exclusion of AAA

  12. Manual de tratamiento de agua

    OpenAIRE

    Pérez Parra, Jorge Arturo

    1981-01-01

    Este Manual de Tratamiento de Agua se ha hecho con la intención de ofrecer en forma conjunta una serie de principios y conocimientos sobre los diferentes procesos de tratamiento del agua, cuya descripción se hace no como operaciones unitarias sino siguiendo un orden práctico encaminado hacia el aspecto teórico y al diseño de las diferentes unidades que componen una planta de tratamiento para el acondicionamiento de las aguas utilizadas como fuente de abastecimiento

  13. Abdominal Burkitt lymphoma

    International Nuclear Information System (INIS)

    Purpose: As scarce information is available, in this research we have tried to describe the imaging findings of the Burkitt's lymphoma. Retrospective analysis of the clinical and imaging presentation of a 4 years old boy, is given. Biopsy confirmed the BL. Different imaging techniques were combined. The X-rays were negative. The US revealed a moderate hepatomegaly with multiple hypoechoic nodules and free fluid in the abdominal cavity. The CT showed the hepatomegaly as well as solid nodules in great number and different sizes(due to the densitometric behaviour and to post contrast enhancement), a scarce amount of ascites and a density increase of the mesentery fat. The MRI characterized and revealed in detail the US and the CT findings. The Burkitt's lymphoma is a rare entity; several methods are needed to approach the diagnosis. It represents a great clinical and imaging challenge. (author)

  14. Abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Lindholt, Jes S.

    2010-01-01

    ). The cost per life year gained was 157 euro [1,170 DKK] and the cost per QALY at 178 euro [1,326 DKK]. In all, the ethical dilemma of the prophylactic operation, and the limited psychological side effects seem not to outweigh the benefits of screening. Conclusively, we found that offering men aged 65......Although the number of elective operations for abdominal aortic aneurysms (AAA) is increasing, the sex- and age-standardised mortality rate of AAAs continues to rise, especially among men aged 65 years or more. The lethality of ruptured AAA continues to be 80-95%, compared with 5-7% by elective...... 5-year intervals. Two large RCTs have given clear indications of operation. Survivors of surgery enjoy the same quality of life as the background population, and only 2-5% of patients refuse an offer of surgery. Early detection seems relevant since the cardiovascular mortality is more than 4 times...

  15. Abdominal manifestations of sarcoidosis

    International Nuclear Information System (INIS)

    Lymphadenopathy due to sarcoidosis may resemble that seen in lymphoproliferative disorders. The authors retrospectively compared abdominal/pelvic CT findings in 36 patients (16 with sarcoidosis, 20 with non-Hodgkin lymphoma (NHL) to determine if nodal distribution and morphology would be useful in distinguishing between them. Eleven of 16 patients with sarcoidosis showed adenopathy. Retrocrural, retroperitoneal, and pelvic adenopathy were significantly less frequent (P<.05) in sarcoidosis than in NHL. Large confluent nodes were more frequent (P<05) in NHL (11 of 20) than in sarcoidosis (one of 11). There were significant differences (P<05) in mean nodal size (NHL, 8 cm; sarcoidosis, 2.6 cm). Larger confluent nodal masses are significantly more frequent (P<05) in NHL. Sarcoidosis infrequently involves retrocrural and pelvic nodes. However, the distribution of nodal involvement at other sites is unreliable in separating the two diseases

  16. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B; Olsen, P S; Perko, M J; Agerskov, Kim; Røder, O; Lorentzen, Jørgen Ewald

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553...... patients, 51 (9%) of whom died within the first 48 hours. Of the 502 patients who survived for more than 48 hours, 109 required ICU therapy for more than 48 hours, whereas 393 patients were in the ICU for less than 48 hours. The incidence of preoperative risk factors was similar for the two groups. The...... combined failed to permit identification of patients in whom the perioperative survival rate was 0%. Even 20% of patients with multiorgan failure survived for 6 months. Of those patients who needed ICU therapy for more than 48 hours, 41 (38%) were alive at the end of 1988. In response to a questionnaire...

  17. Cateteres intravenosos fraturados: retirada por técnicas endovasculares Intravenous catheter fragments: endovascular retrieval

    Directory of Open Access Journals (Sweden)

    Gustavo Andrade

    2006-06-01

    Full Text Available OBJETIVO: A colocação de cateter para acesso venoso central é uma prática médica cada vez mais comum, sendo a fratura e embolização de fragmentos do cateter raras, porém correspondem aos corpos estranhos intravasculares mais comuns. O objetivo é demonstrar nossa experiência na retirada desses corpos estranhos intravasculares utilizando técnicas endovasculares. MATERIAIS E MÉTODOS: Análise retrospectiva dos últimos cinco anos permitiu a avaliação de dez casos consecutivos, com a idade variando entre nove meses e 67 anos. RESULTADOS: O procedimento foi realizado com sucesso em todos os casos, por diferentes técnicas, sem complicações. Os locais mais comuns de alojamento dos fragmentos foram átrio direito, veia cava superior e artéria pulmonar esquerda. A retirada desses corpos estranhos por técnicas endovasculares é procedimento relativamente simples quando comparado à alternativa cirúrgica, tendo sido utilizada com segurança e sucesso em inúmeros pacientes. Os dispositivos disponíveis mostraram-se bastante eficazes, sendo o laço o mais versátil. CONCLUSÃO: A alta taxa de sucesso com poucas complicações relatadas, mesmo em crianças, permite a afirmação que os corpos estranhos intravenosos devem ser extraídos por técnicas percutâneas sempre que possível. Contudo, a familiarização com as diversas técnicas é fundamental, permitindo combinações e modificações, adaptando-as à situação do caso.OBJECTIVE: Central venous access is an increasingly frequent procedure and intravenous catheter fractures and fragments embolization, although being rare, correspond to the most common intravascular foreign bodies. This study purpose is to show our experience in the removal of these foreign bodies, employing endovascular techniques. MATERIALS AND METHODS: Retrospective analysis of ten consecutive cases in the last five years, including patients with ages ranging from 9 months to 67 years. RESULTS: The procedure was successfully performed in all the cases by means of different techniques and with no complication. Most common fragments lodgement sites were: right atrium, superior vena cava and left pulmonary artery. The retrieval of these foreign bodies by means of endovascular techniques is a relatively simple procedure when compared to the surgical alternative, and has been safely and successfully performed in countless patients. The available devices have proven quite effective and, among them, the loop snare is the most versatile. CONCLUSION: The high success rate with few complications reported, even in children, allows us to say that, whenever possible, percutaneous extraction of intravascular foreign objects should be performed. Notwithstanding, familiarization with the several techniques available is essential, allowing combinations and modifications according to each situation.

  18. Endovascular Repair of a Type III Thoracoabdominal Aortic Aneurysm in a Patient with Occlusion of Visceral Arteries

    International Nuclear Information System (INIS)

    The successful endovascular repair of a type III thoracoabdominal aortic aneurysm (TAAA) with the use of a tube endograft is reported. A 56-year-old male with a 6.4-cm type III TAAA, a 4.2-cm infrarenal abdominal aortic aneurysm, and chronic renal insufficiency presented with flank pain, nausea, acute anuria, and serum creatinine of 6.1 mg/dl. Acute occlusion of the left solitary renal artery was diagnosed and emergent recanalization with percutaneus transluminal angioplasty and stenting was performed successfully, with reversal of the serum creatinine level at 1.6 mg/dl. Further imaging studies for TAAA management revealed ostial occlusion of both the celiac artery (CA) and the superior mesenteric artery (SMA) but a hypertrophic inferior mesenteric artery (IMA) providing retrograde flow to the aforementioned vessels. This rare anatomic serendipity allowed us to repair the TAAA simply by using a two-component tube endograft without fenestrations (Zenith; William Cook, Bjaeverskov, Denmark) that covered the entire length of the aneurysm, including the CA and SMA origins, since a natural arterial bypass from the IMA to the CA and SMA already existed, affording protection from gastrointestinal ischemic complications. The patient had a fast and uneventful recovery and is currently doing well 6 months after the procedure. To our knowledge, this is the first report in the English literature of successful endovascular repair of a TAAA involving visceral arteries with the simple use of a tube endograft

  19. Detecting endoleaks after endovascular AAA repair with a minimally invasive, implantable, telemetric pressure sensor: an in vitro study

    Energy Technology Data Exchange (ETDEWEB)

    Springer, Fabian; Pfeffer, Joachim-Georg; Schmitz-Rode, Thomas [RWTH Aachen University, Helmholtz-Institute for Biomedical Engineering, Applied Medical Engineering, Aachen (Germany); Schlierf, Roland; Schnakenberg, Uwe [RWTH Aachen University, Institute of Materials in Electrical Engineering I, Aachen (Germany); Mahnken, Andreas H. [RWTH Aachen University, Helmholtz-Institute for Biomedical Engineering, Applied Medical Engineering, Aachen (Germany); RWTH Aachen University, Department of Diagnostic Radiology, University Hospital, Aachen (Germany)

    2007-10-15

    A feasibility study on a completely digital telemetric pressure sensor (TPS) to detect endoleaks was performed in an in vitro model of an abdominal aortic aneurysm (AAA). An endovascular-stented AAA silicone model with different types (I-III) and sizes (3-11 French) of endoleaks was created and pulsatile pressure was applied with physiological flow and pressure rates [mean intraaortic pressure (IAP): 95-130 mmHg] and different degrees of thrombosis of the aneurysm sac. Aneurysm sac pressure (ASP) was measured with the TPS and with wired pressure sensors (WPS) as a reference. Statistical analysis included paired t-test, Pearson's correlation analysis and Bland-Altman plots. After opening an endoleak, the mean ASP increased significantly (P < 0.0001) from 15 to almost 95% of the mean IAP depending on endoleak type and size. ASP could be measured accurately with the TPS and the WPS. The telemetric and wired ASP increase showed a high Pearson's correlation coefficient (r) for a non-thrombosed (r = 0.97) and a thrombosed (r = 0.96) aneurysm sac. In an in vitro silicone model, the newly designed telemetric pressure sensor was able to detect the occurrence of an endoleak in a non-invasive way and might be a valuable device for follow-up of endovascular AAA repair. (orig.)

  20. Detecting endoleaks after endovascular AAA repair with a minimally invasive, implantable, telemetric pressure sensor: an in vitro study

    International Nuclear Information System (INIS)

    A feasibility study on a completely digital telemetric pressure sensor (TPS) to detect endoleaks was performed in an in vitro model of an abdominal aortic aneurysm (AAA). An endovascular-stented AAA silicone model with different types (I-III) and sizes (3-11 French) of endoleaks was created and pulsatile pressure was applied with physiological flow and pressure rates [mean intraaortic pressure (IAP): 95-130 mmHg] and different degrees of thrombosis of the aneurysm sac. Aneurysm sac pressure (ASP) was measured with the TPS and with wired pressure sensors (WPS) as a reference. Statistical analysis included paired t-test, Pearson's correlation analysis and Bland-Altman plots. After opening an endoleak, the mean ASP increased significantly (P < 0.0001) from 15 to almost 95% of the mean IAP depending on endoleak type and size. ASP could be measured accurately with the TPS and the WPS. The telemetric and wired ASP increase showed a high Pearson's correlation coefficient (r) for a non-thrombosed (r 0.97) and a thrombosed (r = 0.96) aneurysm sac. In an in vitro silicone model, the newly designed telemetric pressure sensor was able to detect the occurrence of an endoleak in a non-invasive way and might be a valuable device for follow-up of endovascular AAA repair. (orig.)

  1. Abdominal wall hernia and pregnancy

    DEFF Research Database (Denmark)

    Jensen, K K; Henriksen, N A; Jorgensen, L N

    2015-01-01

    PURPOSE: There is no consensus as to the treatment strategy for abdominal wall hernias in fertile women. This study was undertaken to review the current literature on treatment of abdominal wall hernias in fertile women before or during pregnancy. METHODS: A literature search was undertaken in Pub...... incarcerated hernias in pregnant women, as well as combined hernia repair and cesarean section appears as safe procedures. No major complications were reported following hernia repair before or during pregnancy. The combined procedure of elective cesarean section and abdominal wall hernia repair was reported...... in 102 patients without major complications. CONCLUSIONS: The literature on abdominal wall hernia and pregnancy is sparse. Abdominal wall hernia repair with suture or mesh may cause pain in the last trimester of a subsequent pregnancy. Hernia repair in conjunction with cesarean section appear as the...

  2. Endovascular treatment of cerebral venous thrombosis: Contemporary multicenter experience.

    Science.gov (United States)

    Mokin, Maxim; Lopes, Demetrius K; Binning, Mandy J; Veznedaroglu, Erol; Liebman, Kenneth M; Arthur, Adam S; Doss, Vinodh T; Levy, Elad I; Siddiqui, Adnan H

    2015-08-01

    Endovascular therapy of cerebral venous thrombosis using modern approaches to intracranial recanalization, such as stent retrievers and aspiration thrombectomy, is not well described. We performed a retrospective review of data for consecutive patients with venous sinus thrombosis who underwent endovascular treatment between 1 January 2010 and 31 December 2013 at participating institutions. We identified a total of 13 patients with a diagnosis of cerebral venous thrombosis. The most frequently utilized type of endovascular intervention was the Penumbra aspiration system (Penumbra Inc., Alameda, California, USA) (nine cases), followed by local infusion of tissue plasminogen activator (bolus and/or drip in six cases) and stent retrievers (Solitaire FR (Covidien, Irvine, California, USA) in three cases and Trevo (Stryker, Kalamazoo, Michigan, USA) in one case). Overall, multimodality treatment (two or more different types of devices or approaches) was performed in 62% of cases. Follow-up data were available for 11 patients; of those, five had a favorable clinical outcome (defined as modified Rankin Scale score of 0-2) and three patients died. Various endovascular approaches are utilized in current clinical practice. A multimodal approach to endovascular therapy for the treatment of cerebral venous thrombosis resulted in partial or complete restoration of flow in all cases, yet the mortality rate of 27% indicates the need for improvement in recanalization strategies for this disorder. PMID:26055685

  3. Endovascular treatment of cerebral arteriovenous malformations and Dural arteriovenous malformations

    International Nuclear Information System (INIS)

    Objective: To report our experience with the endovascular management of cerebral arteriovenous malformations and dural arteriovenous fistulas. Methods: Fifty patients (66% males and 34% females) with cerebral arteriovenous malformations and dural arteriovenous fistulas were treated in our department between September 2007 and April of 2010 using endovascular therapy. A total of 84 endovascular procedures were performed. N-butyl cyanoacrylate Histoacryl was the embolic material used in 76% of the cases; Onyx alone was used in 20%, Onyx and coils combined in 3.6%. Results: The most common symptoms were headache, epileptic seizures and intracranial hemorrhage. Thirty-two percent of the patients were cured using embolization as the only therapeutic technique, meaning that a higher number of patients were cured in just one session. Thirty-eight percent of all patients underwent a surgical resection or radiosurgical treatment after nodal size reduction through endovascular treatment. The overall reported complications were 5.9%. Conclusion: Cerebral arteriovenous malformations and dural arteriovenous fistulas are complex lesions with a potential risk for intracranial hemorrhages. Endovascular therapy is safe and effective, and together with surgery and radiosurgery, is an essential component of the multimodal approach to this problem.

  4. Vascular interventional radiology. Current evidence in endovascular surgery. 2. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Cowling, Mark G. (ed.) [Univ. Hospital North Staffordshire, Stoke-on-Trent (United Kingdom). Dept. of Radiology

    2012-11-01

    Succinct chapters that will allow readers to identify quickly the information that they need. Ideally sized book for storage and use in the interventional suite. Contains sufficient detail for trainees in endovascular therapy/interventional radiology to gain a thorough grasp of the relevant issues. Fully updated to reflect recent advances. This new edition of Vascular Interventional Radiology: Current Evidence in Endovascular Surgery provides a thorough yet succinct and accessible review of the latest knowledge in the field of endovascular surgery. All chapters have been updated to reflect the advances that have occurred during the past five years, and new chapters are included on carotid artery stenting and day case intervention. The chapter on lower limb veno-occlusive disease has been expanded to include management of deep venous thrombosis. Among the other topics considered are the endovascular treatment options in different arterial territories, aneurysm repair techniques, and the management of venous stenosis and venous insufficiency. The aim throughout is to tackle issues of evidence-based practice in order to assist trainees and experienced practitioners in making and implementing treatment decisions. This book will be an invaluable source of information for both interventional radiologists and vascular surgeons with an interest in endovascular techniques.

  5. Endovascular treatment of the carotid-cavernous vascular lesions

    Directory of Open Access Journals (Sweden)

    Guilherme Brasileiro de Aguiar

    2014-07-01

    Full Text Available Introduction: The treatment of lesions which compromise the cavernous sinus has always constituted a challenge. The endovascular treatment of these lesions has presented diverse alterations over the last years. This study aims to evaluate the endovascular treatment of vascular lesions in the internal carotid artery (ICA, cavernous segment, performed at our service. Method: This is a descriptive study, retrospective and prospective. Patients with aneurysm in the cavernous ICA or direct carotid-cavernous fistula (dCCF submitted to endovascular treatment were evaluated. Results: Included were 26 patients with intracavernous aneurysms and 10 with dCCF. All aneurysms were treated with ICA occlusion. The dCCF were treated with occlusion of the ICA in seven cases and with selective fistula occlusion in the remaining three. There was an improvement in pain and ocular proptosis in all patients with dCCF. In the patients with intracavernous aneurysms, the incidence of retroorbitary pain went from 84.6% to a mere 30.8%, following the treatment. Following endovascular treatment, there was an important improvement in the dysfunction of cranial nerves, compromised in both patient groups, mainly in the oculomotor nerve. Conclusion: The endovascular treatment provided an improvement in the patients of this study, especially in the criteria pain and oculomotor nerve dysfunction.

  6. Asthma May Raise Risk for Abdominal Aneurysm

    Science.gov (United States)

    ... 157202.html Asthma May Raise Risk for Abdominal Aneurysm Airway disease also linked to greater rupture risk ... be at an increased risk of abdominal aortic aneurysm, a new study suggests. An abdominal aortic aneurysm ...

  7. Multimodal endovascular treatment for traumatic carotidcavernous fistula

    Directory of Open Access Journals (Sweden)

    ZENG Tao

    2013-12-01

    Full Text Available ?Abstract?Objective: To present our experience in treating traumatic carotid-cavernous fistula (TCCF by multimodal endovascular treatment. Methods: The management of 28 patients with TCCF between January 2004 and October 2012 in our hospital was retrospectively analyzed. According to imaging charateristics, 24 cases were categorized into Type I, 3 Type II and 1 Type III. Totally 30 endovascular treatments were performed: Type I TCCFs were obliterated via transvenous approach (7/25, or transarterial approach (18/25 including 6 by detachable balloon occlusion, 6 by microcoil embolization, 3 by Hyperglide balloon-assisted coil embo- lization and 3 by a combination of detachable balloon and coil embolization. Two patients were treated with closure of internal carotid artery (ICA. Type II TCCFs were treated with transvenous embolotherapy (2/3 or carotid artery com- pression therapy (1/3. The Type III patient underwent de- tachable balloon embolization. Results: Immediate postoperative angiography showed recovery in 26 cases. One recurrent TCCF was found 2 weeks after detachable balloon embolization, and then re- Chin J Traumatol 2013;16(6:334-338 obliterated by transarterial coils. Reexamination found bal- loon deflation and fistula recanalization in 1 patient one month after combination of detachable balloons and coil embolization, which was cured by a second treatment via transvenous approach. The immediate angiography revealed residual blood flow in 4 patients. Among them, 2 patients with delayed symptoms at follow-up needed a second treatment, 1 patient recovered after carotid artery compres- sion therapy, and the remaining patient’s symptoms disap- peared on digital subtraction angiography at five-month follow-up. CT angiography revealed anterior communicat- ing artery aneurysm in the patient who was treated with closure of ICA 4 years later. Conclusion: According to results of images, characteristics of the fistula and type of drainage, proper treatment approach and embolic material can maximally heal pathological changes, retain the ipsilateral ICA patency and reduce long-term complications. Key words: Carotid-cavernous sinus fistula; Embolization, therapeutic; Balloon occlusion

  8. Endovascular treatment of renal artery stenoses

    International Nuclear Information System (INIS)

    To evaluate the procedure success and effect on hypertension after stenting of incidentally diagnosed atherosclerotic renal artery stenoses. Study Design: An experimental study. Place and Duration of Study: A multicentric study was conducted at the Plastic Surgery and General Hospital, National Medical Center and Ziauddin University Hospital, Karachi, Pakistan from January 2009 to March 2013. Methodology: Hypertension (systolic blood pressure > 160 and diastolic > 90 mmHg with two or more than two medications) with coronary artery disease were initially evaluated for coronary angiography, Renal artery angiography was also endovascular performed and stent was deployed for atherosclerotic renal artery stenosis when found. Blood pressure readings, reduction in need of antihypertensive medication and serum creatinine levels were taken as outcome measures. Patients having renal artery stenoses secondary to connective tissue disorders and fibromuscular dysplasia were excluded. Results: There were 25 patients, 14 (56%) male and 11 (44%) female, with mean age of 49 +- 6 years. Diabetes mellitus, dyslipidemia and smoking were seen in 11 (44%), 10 (40%) and 4 (16%) patients respectively. Renal insufficiency (serum creatinine > 1.5 mg/dl) was seen in one (04%) patient. Bilateral, and isolated right and left renal artery stenoses was seen in 5 (20%), 9 (36%) and 11(44%) patients respectively. Mean percentage of renal artery stenoses was 89%, ranged from 70% to 99% while ostial lesion was found in 20 (80%) patients. A significant decrease in systolic (168.20 +- 9.987 vs. 140.60 +- 5.649 mmHg, p < 0.001) and diastolic blood pressure (88.60 +- 5.50 vs. 77.20 +- 5.017 mmHg, p < 0.001) and reduction of medication (2.72 +- 0.458 vs. 1.5 +- 0.510, p < 0.01) were noted without a change in renal function (p= 0.061) after renal artery stenting. Conclusion: Endovascular stenting of renal artery stenoses in patients with poorly controlled hypertension is a safe and effective treatment. (author)

  9. Percutaneous fenestration of intimal flap and endovascular stent placement for aortic dissection: 1 case report and reference review

    International Nuclear Information System (INIS)

    Objective: To evaluate the safety and effect of percutaneous fenestration of intimal flap (FIF) ad endovascular stent (ES) placement for aortic dissection. Methods: Male patient, 54 years old. DeBakey IIIb aortic dissection, tear of intimal flap situated at the beginning of descending aorta, developed to abdominal aorta and right iliac artery. The true lumen was 3 mm at narrowest location. Through femoral artery approach, percutaneous fenestration of intimal flap and ES placement are operated and four ES were placed. Results: The blood flow of aortic true lumen and branches were resumed. The true lumen raised to 12.3 mm at the narrowest location. The clinical symptoms vanished. Conclusion: Percutaneous fenestration and ES placement for aortic dissection feature little injure, high safety and efficacy. So, It is the first choice for certain aortic dissection

  10. Feasibility of endovascular and surface cooling strategies in acute stroke

    DEFF Research Database (Denmark)

    Ovesen, Christian Hjerrild; Brizzi, M; Pott, F C; Thorsen-Meyer, H C; Karlsson, T; Ersson, A; Christensen, H; Norrlin, A; Meden, Per; Krieger, D W; Petersson, Jane

    2012-01-01

    BACKGROUND: Therapeutic hypothermia (TH) is a promising treatment of stroke, but limited data are available regarding the safety and effectiveness of cooling methodology. We investigated the safety of TH and compared the cooling capacity of two widely used cooling strategies - endovascular and...... surface cooling. METHODS: COOLAID Oresund is a bicentre randomized trial in Copenhagen (Denmark) and Malmö (Sweden). Patients were randomized to either TH (33°C for 24 h) in a general intensive care unit (ICU) or standardized stroke unit care (control). Cooling was induced by a surface or endovascular......-based strategy. RESULTS: Thirty-one patients were randomized. Seven were cooled using endovascular and 10 using surface-based cooling methods and 14 patients received standard care (controls). 14 (45%) patients received thrombolysis. Pneumonia was recorded in 6 (35%) TH patients and in 1 (7%) control. 4 TH...

  11. [Responding to Arterial Perforation during Endovascular Neurosurgery].

    Science.gov (United States)

    Muraoka, Kenichiro; Tomita, Yosuke; Kuwahara, Ken; Takahashi, Yu; Okuma, Yu; Tanabe, Tomoyuki; Meguro, Toshinari; Hirotsune, Nobuyuki; Nishino, Shigeki

    2015-11-01

    During endovascular neurosurgery, various devices, such as catheters, are passed through the intracranial arteries to access target vessels;the arteries can thereby be perforated. Even though such incidents are serious and should be dealt with appropriately, few case reports or standard procedures have been published. Herein, we report two cases of arterial perforation that occurred recently in our hospital. In the first case, the patient had been treated preoperatively using feeder occlusion of an arteriovenous malformation;the microcatheter perforated the feeder, which branched from the middle cerebral artery. The feeder and perforation site were occluded by injection of n-butyl 2-cyanoacrylate(NBCA)through the same microcatheter, and complete hemostasis was thereby achieved. The second case occurred during an embolization of the middle meningeal artery(MMA)to treat a refractory chronic subdural hematoma;the microcatheter perforated a branch of the MMA. Both the perforation and the artery were embolized using platinum coils and by injecting NBCA, and hemostasis was achieved. Considering the anatomical and pathological properties of the injured vessels, favorable results were achieved with appropriate intervention. PMID:26549717

  12. Endovascular treatment of scalp cirsoid aneurysms

    Directory of Open Access Journals (Sweden)

    Gupta A

    2008-01-01

    Full Text Available Background: Scalp is the most common site of soft tissue arteriovenous fistulae and surgical excision has been the primary mode of treatment. Endovascular treatment has evolved as an alternative to the surgery. Aims: To evaluate the effectiveness of percutaneous direct-puncture embolization of cirsoid aneurysms. Materials and Methods: From January 1995 to December 2004, 15 patients underwent percutaneous direct-puncture embolization of cirsoid aneurysms. Plain X-ray, computerized tomography scan and complete selective cerebral angiogram were done in all. Seven patients had forehead lesions, four had temporal and the remaining four patients had occipital region cirsoid aneurysms. Lesions were punctured with 21-gauge needle and embolized with 20-50% cyanoacrylate-lipiodol mixture. Circumferential compression was applied during injection. Results: Post-embolization angiogram showed complete obliteration in 11 patients. The remaining four patients required adjunctive transarterial embolization with polyvinyl alcohol particles for complete lesion devascularization. Two patients had post procedure surgery for removal of disfiguring and hard glue cast. There were no major procedure-related complications. No patients had any recurrence in the follow-up. Conclusion: Percutaneous direct puncture embolization of cirsoid aneurysms is a safe and effective procedure. It can be effectively used as an alternative to surgery. Sometimes adjunctive transarterial embolization is also required to deal with deeper feeders.

  13. Endovascular Treatment of an Aortic Traumatic Double Rupture

    Science.gov (United States)

    Attinà, Domenico; Buia, Francesco; Russo, Vincenzo; Pilato, Emanuele; Lovato, Luigi; Bartolomeo, Roberto Di; Zompatori, Maurizio

    2015-01-01

    Traumatic thoracic aortic rupture is a life-threatening condition; aortic isthmus is the most common site of rupture, but in rare cases traumatic injury can localize elsewhere, such as at aortic arch or at the level of the diaphragm. In the past few years, endovascular treatment of traumatic aortic injury became a safe procedure, with lower mortality and complication, if compared with open surgery. We report a case of a 40-year-old-man admitted to emergency department after a violent car crash in which an aortic traumatic double rupture was successfully treated with two endovascular stent-grafts coverage. PMID:25859315

  14. Advances in endovascular treatment of critical limb ischemia.

    LENUS (Irish Health Repository)

    Yan, Bryan P

    2011-04-01

    Critical limb ischemia (CLI) represents the most severe clinical manifestation of peripheral arterial disease. In the absence of timely revascularization, CLI carries high risk of mortality and amputation. Over the past decade, endovascular revascularization has rapidly become the preferred primary treatment strategy for CLI, especially for the treatment of below-the-knee disease. Advances in percutaneous devices and techniques have expanded the spectrum of patients with CLI who are deemed candidates for revascularization. This review will focus on advances in endovascular options for the treatment of CLI, in particular for below-the-knee disease.

  15. Abdominal aortic feminism.

    Science.gov (United States)

    Mortimer, Alice Emily

    2014-01-01

    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer. PMID:25398912

  16. Intra-abdominal tuberculous peritonitis

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, G.; Ahlhelm, F.; Altmeyer, K.; Kramann, B. [Dept. of Diagnostic Radiology, University Hospital, Homburg (Germany); Hennes, P. [Dept. of Pediatrics, University Hospital, Homburg (Germany); Pueschel, W. [Dept. of Pathology, University Hospital, Homburg (Germany); Karadiakos, N. [Dept. of Pediatric Surgery, University Hospital, Homburg (Germany)

    2001-07-01

    We report the case of a 15-year-old boy suffering from progressive dyspnea on exertion and painful abdominal protrusion. Final diagnosis of intra-abdominal tuberculosis (TB), including lymphadenopathy and abdominal abscess formation, was made following elective laparotomy. This type of disease is a rare manifestation of extrapulmonary tuberculosis. The imaging findings in unenhanced and contrast-enhanced MRI and laparoscopic images are presented. Differential diagnosis of abdominal abscess formation and other fungal or bacteriological infections, as well as the imaging findings of this type of lesion, are discussed. This case demonstrates that atypical manifestation of TB may remain unrecognized; thus, awareness of this kind of manifestation of tuberculosis may prevent patients from being subjected to inappropriate therapies. (orig.)

  17. Functional Abdominal Pain in Children

    Science.gov (United States)

    ... pain. The doctor will also ask about the effects of foods and beverages upon the pain, and relationship to stools, sleep, physical activities, and emotional stress. The diagnosis of functional abdominal pain is ...

  18. Abdominal Actinomycetoma With Lymphnode Involvement

    Directory of Open Access Journals (Sweden)

    Damisetty Rajetha

    2004-01-01

    Full Text Available Actinomycotic mycetoma of the anterior abdominal wall with inguinal lymphnode involvement, an exceedingly rare entity is described here with mycological histological features. Remarkable therapeutic response was noted with Welsh regimen.

  19. Role of endovascular treatment in vascular injuries

    International Nuclear Information System (INIS)

    Objective: To evaluate retrospectively the results, complications and follow-up of patients after endovascular treatment of vascular injuries. Methods: Fifty transcatheter embolisation procedures (TCE) were performed in 46 patients between 1999 and 2008 at the Aga Khan University Hospital, Karachi. Injuries in 14 (30.4%) patients were due to road traffic accident; iatrogenic in 13 (28%); accidental in 6 (13%). Firearms, bomb blasts and earthquake contributed to injuries in 8(17%), 4(8.8%) and 1(2.2%) patients respectively. All patients underwent angiography and had evidence of either active haemorrhage, pseudo-aneurysm, abnormal vascularity or arteriovenous fistula. Follow-up ranged from 1 day to 6 years with mean of 10.5 months. Medical record files, lab results and imaging reports were utilised for the study. Procedure was declared as technically successful when there was cessation of extravasation, occlusion of fistula or exclusion of pseudo-aneurysm in the post-embolisation angiograms. Treatment was deemed clinically successful if there was resolution of the indication for which the procedure was done. Results: Transcatheter embolisation was technically successful in occluding vascular lesions in all 46 (100%) patients. Lesions recurred in 4 (9%) patients who underwent initially successful TCE. These patients were treated effectively with repeated TCE. Three patients died during the same hospital stay and 3 patients died after being discharged from the hospital. All these patients were treated successfully with TCE and had factors other then TCE contributing to their mortality. Conclusion: Transcatheter embolisation for vascular injuries was found to be a satisfactory procedure, with low morbidity and mortality rates. (author)

  20. Subarachnoid hemorrhage with blister aneurysms: Endovascular management

    Directory of Open Access Journals (Sweden)

    Swati Dayanand Chinchure

    2014-01-01

    Full Text Available Blister aneurysms of are rare lesions representing a real challenge for diagnosis and management. They typically show small size, hemispherical shape, fragile wall, broad neck, and are arising from non-branching sites of intracranial arteries. Materials and Methods: We retrospectively reviewed all aneurysms treated at our institution. Seventeen patients (6 male, 11 female with 17 blister aneurysms were identified (mean age 53.3, range 41-63 years. Clinical, procedural, angiographic data as well as follow up data were evaluated. Results: All patients presented with aneurysmal subarachnoid hemorrhage. Majority of the blister aneurysms were located in ICA while 1 was located at posterior cerebral artery, 1 at vertebral and 1 involving basilar artery. All patients were treated using single or overlapping stents and if possible additional coiling. There was no intra-operative rupture. Good outcome (mrs 0-2 was seen in 14 patients. Poor clinical outcome (mrs 3-5 was seen in 2 patients due to vasospasm induced ischemic deficits at discharge, both of them improved on follow up (mrs 1 on follow up. There were 3 mortalities, One patient died of rebleeding while other 2 died due to SAH induced complications. Follow-up angiography was available in 16 patients (one patient died before follow up angiogram and revealed complete or near complete aneurysm occlusion in 11, incomplete obliteration in 1 and no change in 2 cases. Two cases showed post-treatment angiographic aneurysm recurrence. Both cases were managed with repeat coiling and overlapping stent placement. Conclusion: Endovascular management using single/overlapping stent and if possible coil placement is technically safe and feasible in blister aneurysms. Overlapping stents lead to better aneurysm occlusion than a single stent. Blister aneurysm in dorso-medial ICA showed higher tendency of continued growth/recurrence, higher incidence of clinical vasospasm and in these cases early angiographic follow-up is advisable. Repeat treatment should be considered promptly if necessary.

  1. Tratamento Endovascular dos Aneurismas de Artéria Poplítea / Endovascular Treatment of Popliteal Artery Aneurysms

    Scientific Electronic Library Online (English)

    Marilia G., Volpato; Patrick Bastos, Metzger; Maria Claudia, Folino; Fabio Henrique, Rossi; Samuel Martins, Moreira; Mohamed Hassan, Saleh; Nilo Mitsuru, Izukawa; Antonio Massamitsu, Kambara.

    2014-12-01

    Full Text Available Introdução: Com os recentes avanços nas técnicas endovasculares e com o surgimento de endopróteses mais flexíveis, o tratamento das lesões aneurismáticas da artéria poplítea tem se tornado mais frequente. O objetivo desse estudo foi avaliar os desfechos clínicos a curto e médio prazos do tratamento [...] de lesões aneurismáticas da artéria poplítea com o uso de endopróteses flexíveis. Métodos: Estudo retrospectivo, longitudinal, realizado em dois centros, no período de janeiro de 2011 a fevereiro de 2014. Foram avaliados características populacionais, dados do procedimento e imagens radiológicas no seguimento médio de 1 ano, sendo obtidas as taxas de morbimortalidade, complicações e perviedade da endoprótese. Resultados: Treze pacientes do sexo masculino, com idade de 66 ± 9 anos, foram submetidos ao tratamento de aneurismas de artéria poplítea em 15 membros. Na avaliação do leito de deságue, a maior parte dos pacientes possuía pelo menos duas artérias da perna pérvias (92,3%). O implante do stent ocorreu no segmento médio em 57,1% e, no segmento distal da artéria poplítea, em 42,9% dos procedimentos. Foi possível realizar a revascularização da lesão-alvo em todos os casos, sendo que, em quatro membros, foi necessário o uso de dois stents. Foram utilizados 17 stents Viabahn® e 2 stents Multilayer®. Durante o seguimento de 12 meses, não ocorreram fraturas de stents. A taxa de perviedade primária foi de 53,3% e a de salvamento de membro de 100%. Conclusões: O tratamento endovascular do aneurisma de artéria poplítea demonstrou ser eficaz no seguimento de médio prazo. Abstract in english Background: With the recent advances in endovascular techniques and the emergence of more flexible endoprosthesis, the treatment of popliteal artery aneurysms has become more frequent. The objective of this study was to evaluate the short and mid-term clinical outcomes of the treatment of popliteal [...] artery aneurysms with the use of a flexible endoprosthesis. Methods: Retrospective longitudinal study conducted in two sites from January of 2011 to February of 2014. Populational characteristics, procedure-related data, and radiologic imaging were evaluated at a mean follow-up of 1 year. Morbidity and mortality rates, complication rates, and stent patency rates were obtained. Results: A total of 13 male patients, mean age 66 ± 9 years, were submitted to popliteal artery aneurysm treatment in 15 limbs. Run-off vessel evaluation showed that most patients had at least two patent arteries in the legs (92.3%). Stents were implanted in the middle segment in 57.1% and in the distal segment of the popliteal artery in 42.9% of the procedures. Target lesion revascularization was achieved in all of the cases and two stents were required in four limbs. Seventeen ViabahnTM and two MultilayerTM stents were used. During the 12-month follow-up there were no stent fractures. The primary patency rate was 53.3% and limb salvage rate was 100%. Conclusions: Endovascular treatment of popliteal artery aneurysm was shown to be effective in the mid-term follow-up.

  2. Emergency endovascular treatment of emergent or ruptured aortic aneurysms: A single centre experience

    International Nuclear Information System (INIS)

    Objective: To report our experience with emergency endovascular repair (eEVAR) in patients with ruptured or acutely symptomatic AA. Methods: From August 1998 to June 2004, 22 high-risk patients (21 men, median age 74 years, range 15-84 years) with ruptured or acutely symptomatic aneurysms underwent eEVAR using Talent endoprostheses. All procedures were performed in the operating theatre by a surgical/radiology team. Indications for repair, co-morbidities and outcomes were recorded with follow-up by US and CT scanning. Results: Of 22 eEVARs, 13 patients had abdominal AA and nine patients had thoracic AA. Nineteen (86.4%) repairs were technically successful, there was one patient with a type I proximal endoleak treated conservatively and two patients died during their inpatient period (myocardial infarction and broncho-pneumonia). On follow-up of the 20 survivors (median 7 months, range 0-48 months), there were three further deaths, and two further endoleaks. The 1-year survival by life-table analysis is 75 ± 9.8% and 13 patients are free from reintervention at last follow-up. Conclusion: eEVAR had encouraging initial results in selected high-risk patients

  3. Endovascular repair of direct carotid-cavernous fistula in Ehlers-Danlos type IV.

    Science.gov (United States)

    Linfante, Italo; Lin, Eugene; Knott, Eric; Katzen, Barry; Dabus, Guilherme

    2015-01-01

    Ehlers-Danlos syndrome (EDS) type IV is a collagen vascular disease with an autosomal dominant inheritance caused by COL3A1 mutation. Patients with EDS type IV can present with organ rupture, spontaneous arterial dissections and ruptured aneurysms. Because of their propensity to form arterial dissections, aneurysms and rupture, they can develop carotid-cavernous fistula (CCF) after minor trauma or spontaneously. In EDS, it has been reported that even conventional catheter diagnostic angiography may result in large artery dissections and vessel rupture. In addition, the treatment of CCF in EDS type IV can result in up to 59% mortality after initial treatment, of which 23% is attributed to direct complications of treatment. We present the case of a patient with EDS type IV who previously had spontaneous dissection and multiple pseudoaneurysms of both the iliac and femoral arteries and the distal abdominal aorta. Several years later the patient developed a direct type A CCF which was successfully treated with endovascular embolization using a transvenous approach with detachable coils. The literature pertaining to CCF in EDS type IV and its treatment is reviewed. PMID:24401479

  4. The use of intravascular ultrasound as control procedure for the deployment of endovascular stented grafts

    DEFF Research Database (Denmark)

    Vogt, K C; Brunkwall, J

    1997-01-01

    OBJECTIVE: To assess whether intravascular ultrasound (IVUS), used systematically in a series of patients with abdominal aortic aneurysms (AAA), is a feasible control procedure to ensure correct transfemoral placement of endovascular stent grafts (TPEG). DESIGN: Descriptive study. MATERIALS AND METHODS: Fourteen patients with infrarenal aortic aneurysms were treated by the placement of one tube graft, 10 aorto-uni-iliac and three aorto-bi-iliac grafts. Arteriography and IVUS were performed before, during and after deployment of the graft to ensure correct placement in relation to side branches, and proper adaptation of the stents to the aortic wall. Postoperative CT-scan and arteriography served as control procedures. RESULTS: IVUS identified both renal arteries before graft deployment in eight of 13 (62%) patients. In the remaining patients only one renal artery was visualised due to interference from guidewires or the introducer system. Imaging during stent deployment was abandoned after IVUS catheter damage in two of three cases. Postprocedural IVUS was able to evaluate the expansion of the stents and the adaptation to the aortic wall in all instances. In four (29%) cases a leak was identified. Additional intervention included deployment of a further stent (n = 2) or redilation (n = 2). Covering of the renal arteries could only be indirectly determined by IVUS. CONCLUSION: IVUS can provide important decisive information before and after stented graft deployment, with the limitations that guidewires, introducer system and stents may cause interference. Contemporary IVUS designs are unsuitable for monitoring stent deployment.

  5. Tratamento endovascular da oclusão das artérias ilíacas / Endovascular treatment of iliac arteries occlusion

    Scientific Electronic Library Online (English)

    Cleoni, Pedron; Arno von, Ristow; José Mussa, Cury Filho; Henrique Sallas, Martin; Carlos Clementino, Peixoto;