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Sample records for abdominal tratamiento endovascular

  1. Tratamiento endovascular del aneurisma de aorta abdominal / Endovascular treatment of the abdominal aorta aneurysm

    Scientific Electronic Library Online (English)

    Fernando, Rodríguez-Ortega; Marco Antonio, Hernández-Mercado; Jesús A, Reyes-Corona; Neyra, Gómez-Ríos; Antonio, Jaymes-Nuñez; Humberto, Alegría-García; Javier, Palma-Mercado.

    2011-03-01

    Full Text Available Objetivo: Reportar nuestra experiencia en el tratamiento endovascular en la resolución de la patología aórtica y evaluar la morbi-mortalidad. Sede: Centro Médico del Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM). Diseño: Estudio descriptivo, observacional, transversal, re [...] trospectivo. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas. Métodos: Se revisaron los expedientes clínicos de los pacientes con aneurisma de aorta abdominal (AAA) a los cuales se les realizó procedimiento endovascular entre junio de 2005 a junio de 2009. Analizando las siguientes variables: género y edad, diámetro del aneurisma aórtico, endoprótesis utilizada, patología concomitante, complicaciones, uso de hemoderivados, días de estancia intra-hospitalaria y morbi-mortalidad. Resultados: 12 pacientes, 10 del género masculino, edad promedio de 57.8 años, diámetro del aneurisma de 66.8 mm, procedimiento anestésico general en todos los pacientes, promedio de unidades de hemoderivados utilizados fue de 0.5, se presentaron tres complicaciones, dos inherentes al procedimiento endovascular. Conclusión: El tratamiento endovascular de la enfermedad aórtica se ha convertido en una opción terapéutica, que ofrece una baja morbi-mortalidad y excelentes resultados a corto plazo, siendo realizado por un grupo multidisciplinario en el área cardiovascular. Abstract in english Objective: To report our experience in the endovascular treatment to resolve aortic pathology and assess the associated morbidity and mortality. Setting: Medical Center of the Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM), Mexico. Design: Descriptive, observational retros [...] pective, transversal study. Statistical analysis: Percentages as summary measure for qualitative variables. Method: We reviewed the clinical records of patients with abdominal aorta aneurysm (AAA) that were subjected to an endovascular procedure between June 2005 and June 2009. We analyzed the following variables: gender and age, diameter of the aortic aneurysm, used endoprosthesis, concomitant pathology, complications, use of hemoderivates, length of in-hospital stay, morbidity, and mortality. Results: We found 12 patients, 10 were men, average age of 57.8 years, aneurysm diameter of 66.8 mm, general anesthesia was used in all patients, the average of hemoderivate units was of 0.5, three complications occurred, two of them were inherent to the endovascular procedure. Conclusion: Endovascular treatment of aortic disease has become a therapeutic alternative that offers a low morbidity and mortality and excellent results in the short term when it is performed by a multidisciplinary team in the cardiovascular area.

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

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    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.

  3. Tratamiento de aorta abdominal e ilíacas con técnica endovascular: Experiencia quirúrgica / Treatment of abdominal aorta and iliac arteries with endovascular technique

    Scientific Electronic Library Online (English)

    Juan G, Barrera; Ligia C, Mateus; Marisol, Carreño; Jorge E, Bayter; José F, Saaibi; Carlos S, Balestrini; Melquisedec, Gutiérrez; Jaime, Calderón; Víctor R, Castillo; Oscar F, Calvo; Jimmy G, Muñoz; Carlos, Santos; Omar F, Gomezese; Freddy, López; Camilo, Pizarro; Carlos A, Luengas; Ángel M, Chávez.

    2007-08-01

    Full Text Available Antecedentes: desde 1991 la técnica endovascular se ha aplicado con éxito en el manejo de los aneurismas de aorta infrarrenal, y se ha perfeccionado de manera tal que rápidamente se ha convertido en una alternativa para pacientes de alto riesgo para la cirugía convencional. Objetivo: describir los r [...] esultados institucionales en el manejo de las patologías de aorta abdominal e ilíacas mediante técnica endovascular desde 2003 a 2005. Diseño-Método: estudio descriptivo, longitudinal, retrospectivo, en el que se analizaron las historias clínicas de los pacientes sometidos a procedimiento endovascular de aorta abdominal e ilíacas. El análisis se realizó en Stata 8,0 S/E. Resultados: a 9 pacientes se les realizó exclusivamente manejo de lesiones en aorta abdominal e ilíacas. Todos los pacientes del estudio fueron hombres con edad media de 68,9 + 8,1 años. Los diagnósticos fueron aneurisma de aorta infrarrenal en 6 pacientes y aneurismas anastomóticos en los 3 restantes. Se evidenció requerimiento de endoprótesis en promedio de 1,9 + 0,8. Se realizó puente femoro-femoral como procedimiento simultáneo en 4 de los 9 pacientes. El 77,8% de los pacientes no tuvo complicaciones. La mortalidad por el procedimiento alcanzó el 22% (2 pacientes), si bien cabe anotar que las complicaciones se presentaron sólo en esos dos pacientes. Conclusiones: la exclusión de aneurismas de aorta y de ilíacas con endoprótesis modulares, se está implementando ampliamente como una opción válida de tratamiento, con resultados excelentes que evitan los riesgos de la intervención convencional y la morbilidad asociada. Abstract in english Antecedents: since 1991 endovascular technique has been successfully used in the management of infra-renal aortic aneurysms and it has been improved in such a way that it has quickly turned into an alternative for patients considered having high risk for conventional surgery. Objective: describe the [...] institutional results in the management of abdominal aortic pathologies through endovascular technique from 2003 to 2005. Design-Method: descriptive, longitudinal, retrospective study in which clinical histories of patients that underwent an endovascular procedure of abdominal aorta and iliac arteries were analyzed. The analysis was performed in Stata 8,0 S/E. Results: 9 patients received exclusively treatment for abdominal aortic and iliac lesions. All were male individuals with mean age 68.9 ± 8.1 years. 6 patients had diagnosis of infra-renal aortic aneurysm and the other 3 had anastomotic aneurysms. Requirement of endoprosthesis was evidenced in an average of 1.9 ± 0.8. Femoro-femoral bypass surgery was performed as simultaneous procedure in 4 of the 9 patients. 77.8% of patients had no complications. Mortality due to the procedure was 22% (2 patients) and it is important to notice that only these 2 patients had complications. Conclusions: exclusion of aortic and iliac aneurysms with modular endoprosthesis is being widely implemented as a valid treatment option, with excellent results that avoid the risks of conventional surgery and its associated morbidity.

  4. Tratamiento de aorta abdominal e ilíacas con técnica endovascular: Experiencia quirúrgica Treatment of abdominal aorta and iliac arteries with endovascular technique

    Directory of Open Access Journals (Sweden)

    Juan G Barrera

    2007-08-01

    Full Text Available Antecedentes: desde 1991 la técnica endovascular se ha aplicado con éxito en el manejo de los aneurismas de aorta infrarrenal, y se ha perfeccionado de manera tal que rápidamente se ha convertido en una alternativa para pacientes de alto riesgo para la cirugía convencional. Objetivo: describir los resultados institucionales en el manejo de las patologías de aorta abdominal e ilíacas mediante técnica endovascular desde 2003 a 2005. Diseño-Método: estudio descriptivo, longitudinal, retrospectivo, en el que se analizaron las historias clínicas de los pacientes sometidos a procedimiento endovascular de aorta abdominal e ilíacas. El análisis se realizó en Stata 8,0 S/E. Resultados: a 9 pacientes se les realizó exclusivamente manejo de lesiones en aorta abdominal e ilíacas. Todos los pacientes del estudio fueron hombres con edad media de 68,9 + 8,1 años. Los diagnósticos fueron aneurisma de aorta infrarrenal en 6 pacientes y aneurismas anastomóticos en los 3 restantes. Se evidenció requerimiento de endoprótesis en promedio de 1,9 + 0,8. Se realizó puente femoro-femoral como procedimiento simultáneo en 4 de los 9 pacientes. El 77,8% de los pacientes no tuvo complicaciones. La mortalidad por el procedimiento alcanzó el 22% (2 pacientes, si bien cabe anotar que las complicaciones se presentaron sólo en esos dos pacientes. Conclusiones: la exclusión de aneurismas de aorta y de ilíacas con endoprótesis modulares, se está implementando ampliamente como una opción válida de tratamiento, con resultados excelentes que evitan los riesgos de la intervención convencional y la morbilidad asociada.Antecedents: since 1991 endovascular technique has been successfully used in the management of infra-renal aortic aneurysms and it has been improved in such a way that it has quickly turned into an alternative for patients considered having high risk for conventional surgery. Objective: describe the institutional results in the management of abdominal aortic pathologies through endovascular technique from 2003 to 2005. Design-Method: descriptive, longitudinal, retrospective study in which clinical histories of patients that underwent an endovascular procedure of abdominal aorta and iliac arteries were analyzed. The analysis was performed in Stata 8,0 S/E. Results: 9 patients received exclusively treatment for abdominal aortic and iliac lesions. All were male individuals with mean age 68.9 ± 8.1 years. 6 patients had diagnosis of infra-renal aortic aneurysm and the other 3 had anastomotic aneurysms. Requirement of endoprosthesis was evidenced in an average of 1.9 ± 0.8. Femoro-femoral bypass surgery was performed as simultaneous procedure in 4 of the 9 patients. 77.8% of patients had no complications. Mortality due to the procedure was 22% (2 patients and it is important to notice that only these 2 patients had complications. Conclusions: exclusion of aortic and iliac aneurysms with modular endoprosthesis is being widely implemented as a valid treatment option, with excellent results that avoid the risks of conventional surgery and its associated morbidity.

  5. 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.

  6. Tratamiento endovascular de aneurisma aórtico abdominal: resultados en 80 pacientes consecutivos / Endovascular repair of abdominal aortic aneurysm: Results in 80 consecutive patients

    Scientific Electronic Library Online (English)

    Francisco, Valdés E; Renato, Mertens M; Albrecht, Krämer Sch; Michel, Bergoeing R; Leopoldo, Mariné M; Roberto, Canessa B; Alvaro, Huete G; Jeanette, Vergara G; Magaly, Valdebenito C; Dixiana, Rivera D.

    2006-10-01

    Full Text Available [...] Abstract in english Background: Endovascular repair of abdominal aortic aneurysms (AAA) avoids laparotomy, shortens hospital stay and reduces morbidity and mortality related to surgical repair, allowing full patient recovery in less time. Aim: To report short and long term results of endovascular repair of AAA in 80 co [...] nsecutive patients treated at our institution. Patients and Methods: Between September 1997 and February 2005, three women and 77 men with a mean age 73.6±7.7 years with AAA 5.8±1.0 cm in diameter, were treated. The surgical risk of 38% of patients was grade III according to the American Society of Anesthesiologists classification. Each procedure was performed in the operating room, under local or regional anesthesia, with the aid of digital substraction angiography. The endograft was deployed through the femoral artery (83.7% bifurcated, 16.3% tubular graft). A femoro-femoral bypass was required in 11.3% of cases. Follow-up included a spiral CT scan at 1, 6 and 12 months postoperatively, and then annually. Results: Endovascular repair was successfully completed in 79/80 patients (98.7% technical success). The procedures lasted 147±71 min. Length of stay in the observation unit was 20.6±13.5 h. Blood transfusion was required in 10%. Sixty two percent of the patients were discharged before 72 h. One patient died 8 days after surgery due to a myocardial infarction (1.3%). During follow-up (3-90 months), 1 patient developed late AAA enlargement due to a type I endoleak, requiring a new endograft. No AAA rupture was observed. Survival at 4 years was 84.2% (SE =9.2). Endovascular re-intervention free survival was 82.7% (SE =9.5). Conclusion: Endovascular surgery allows effective exclusion of AAA avoiding progressive enlargement and/or rupture and is a good alternative to open repair. Close and frequent postoperative follow up is mandatory

  7. 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.

  8. Endovascular repair of ruptured abdominal aortic aneurysm

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    Šarac Momir

    2014-01-01

    Full Text Available Introduction. Rupture of an abdominal aortic aneurysm (AAA is a potentially lethal state. Only half of patients with ruptured AAA reach the hospital alive. The alternative for open reconstruction of this condition is endovascular repair (EVAR. We presented a successful endovascular reapir of ruptured AAA in a patient with a number of comorbidities. Case report. A 60-year-old man was admitted to our institution due to diffuse abdominal pain with flatulence and belching. Initial abdominal ultrasonography showed an AAA that was confirmed on multislice computed tomography scan angiography which revealed a large retroperitoneal haematoma. Because of patient’s comorbidites (previous surgery of laryngeal carcinoma and one-third laryngeal stenosis, arterial hypertension and cardiomyopathy with left ventricle ejection fraction of 30%, stenosis of the right internal carotid artery of 80% it was decided that endovascular repair of ruptured AAA in local anaesthesia and analgosedation would be treatment of choice. Endovascular grafting was achieved with aorto-bi-iliac bifurcated excluder endoprosthesis with complete exclusion of the aneurysmal sac, without further enlargment of haemathoma and no contrast leakage. The postoperative course of the patient was eventless, without complications. On recall examination 3 months after, the state of the patient was well. Conclusion. The alternative for open reconstruction of ruptured AAA in haemodynamically stable patients with suitable anatomy and comorbidities could be emergency EVAR in local anesthesia. This technique could provide greater chances for survival with lower intraoperative and postoperative morbidity and mortality, as shown in the presented patient.

  9. 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.

  10. 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

  11. New Approaches to Computer Assistance for Endovascular Abdominal Aortic Repairs

    OpenAIRE

    Demirci, Stefanie

    2011-01-01

    This work presents new approaches to computer assistance for endovascular abdominal aortic repairs. In the current clinical workflow there is no technical guidance during the intervention except for two dimensional X-Ray images. Here, we introduce interventional registration methods that are able to handle such occlusions and further image dissimilarities. Thereby, contrast removal and disocclusion techniques are integrated within an image registration procedure. Furthermore, we show for the ...

  12. Experiencia en el manejo endovascular para el tratamiento de la aorta torácica Experience in endovascular management for thoracic aorta treatment

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    Juan G Barrera

    2007-12-01

    Full Text Available Antecedentes: el tratamiento endovascular ofrece la posibilidad de cubrir el origen de la disección y evitar que progrese hasta aneurisma de la aorta, y con ello demuestra una reducción en la mortalidad hasta del 16%. Objetivo: evaluar los resultados quirúrgicos en términos de morbi-mortalidad de los pacientes sometidos a manejo endovascular de las lesiones de la aorta torácica en la Fundación Cardiovascular de Colombia desde 2003 hasta 2005. Diseño-método: estudio longitudinal tipo descriptivo retrospectivo, en el que se evaluaron las historias clínicas de todos los pacientes sometidos a manejo endovascular de patología toracoabdominal; en éste sólo se incluyeron los pacientes con procedimientos de la aorta torácica, desde 2003 hasta 2005. El análisis de los datos se realizó en Stata/SE 8,0. Resultados: se realizaron procedimientos de aorta torácica en 16 pacientes. El 75% de los pacientes eran hombres con edad promedio de 55,9 ± 12,6 años. El 87,5% (14 pacientes presentaban disección aórtica tipo A o B; un paciente transección traumática de la aorta y un paciente aneurisma de aorta torácica descendente. Las disecciones agudas se presentaron en 78,6% (11 pacientes y las crónicas en 21,4% (3 pacientes. El promedio de endoprótesis usadas fue de 2,8 ± 1. La estancia en la unidad de cuidados intensivos fue de 3 ± 2,7 días. El 81,3% de los pacientes no presentaron complicaciones mayores. La mortalidad fue del 18,7% (3 pacientes. A todos se les realizó control post-operatorio con tomografía axial computarizada, con evolución satisfactoria. Conclusión: de acuerdo con los reportes de la literatura con mayor casuística, se considera que el manejo endovascular para el tratamiento de la disección, aneurisma o trauma aórtico es un procedimiento confiable que disminuye la morbi-mortalidad.Antecedents: endovascular treatment has the possibility of covering the dissection origin and to avoid its progression to aortic aneurysm, showing a 16% mortality reduction. Objective: evaluate surgical results in terms of morbid-mortality in patients submitted to endovascular management of thoracic aortic lesions in the Colombian Cardiovascular Foundation from 2003 to 2005. Design-Method: longitudinal descriptive retrospective study in which clinical histories of all patients submitted to endovascular treatment of thoracico-abdominal aortic lesions were evaluated. Only patients with thoracic aortic procedures between 2003 and 2005 were included. Data analysis was realized in Stata/SE 8,0. Results: thoracic aortic procedures were performed in 16 patients. 75% were male with mean age 55.9 ± 12.6 years. 87.5% (14 had type A or B aortic dissection; one patient had traumatic aortic transection and one had aneurysm of thoracic descendant aorta. Acute dissections were presented in 78.6% (11 patients and chronic dissections in 21.4% (3 patients. Average of endoprosthesis employed was 2.8 ± 1. Intensive care unit stay was 3 ± 2.7 days. 81.3% had no mayor complications. Mortality was 18.7% (3 patients. All patients had post-operative computerized tomography scan, with satisfactory evolution. Conclusion: according to the largest casuistics literature reports, endovascular management of dissection, aneurysm or aortic trauma is considered a trustworthy procedure that diminishes morbid-mortality.

  13. Experiencia en el manejo endovascular para el tratamiento de la aorta torácica / Experience in endovascular management for thoracic aorta treatment

    Scientific Electronic Library Online (English)

    Juan G, Barrera; Ligia C, Mateus; Marisol, Carreño; Jorge E, Bayter; José F, Saaibi; Carlos S, Balestrini; Melquisedec, Gutiérrez; Jaime, Calderón; Víctor R, Castillo; Óscar F, Calvo; Jimmy G, Muñoz; Carlos, Santos; Jaime, Amarillo; Ómar F, Gomezese; Freddy, López; Camilo, Pizarro; Carlos A, Luengas; Ángel M, Chávez.

    2007-12-01

    Full Text Available Antecedentes: el tratamiento endovascular ofrece la posibilidad de cubrir el origen de la disección y evitar que progrese hasta aneurisma de la aorta, y con ello demuestra una reducción en la mortalidad hasta del 16%. Objetivo: evaluar los resultados quirúrgicos en términos de morbi-mortalidad de lo [...] s pacientes sometidos a manejo endovascular de las lesiones de la aorta torácica en la Fundación Cardiovascular de Colombia desde 2003 hasta 2005. Diseño-método: estudio longitudinal tipo descriptivo retrospectivo, en el que se evaluaron las historias clínicas de todos los pacientes sometidos a manejo endovascular de patología toracoabdominal; en éste sólo se incluyeron los pacientes con procedimientos de la aorta torácica, desde 2003 hasta 2005. El análisis de los datos se realizó en Stata/SE 8,0. Resultados: se realizaron procedimientos de aorta torácica en 16 pacientes. El 75% de los pacientes eran hombres con edad promedio de 55,9 ± 12,6 años. El 87,5% (14 pacientes) presentaban disección aórtica tipo A o B; un paciente transección traumática de la aorta y un paciente aneurisma de aorta torácica descendente. Las disecciones agudas se presentaron en 78,6% (11 pacientes) y las crónicas en 21,4% (3 pacientes). El promedio de endoprótesis usadas fue de 2,8 ± 1. La estancia en la unidad de cuidados intensivos fue de 3 ± 2,7 días. El 81,3% de los pacientes no presentaron complicaciones mayores. La mortalidad fue del 18,7% (3 pacientes). A todos se les realizó control post-operatorio con tomografía axial computarizada, con evolución satisfactoria. Conclusión: de acuerdo con los reportes de la literatura con mayor casuística, se considera que el manejo endovascular para el tratamiento de la disección, aneurisma o trauma aórtico es un procedimiento confiable que disminuye la morbi-mortalidad. Abstract in english Antecedents: endovascular treatment has the possibility of covering the dissection origin and to avoid its progression to aortic aneurysm, showing a 16% mortality reduction. Objective: evaluate surgical results in terms of morbid-mortality in patients submitted to endovascular management of thoracic [...] aortic lesions in the Colombian Cardiovascular Foundation from 2003 to 2005. Design-Method: longitudinal descriptive retrospective study in which clinical histories of all patients submitted to endovascular treatment of thoracico-abdominal aortic lesions were evaluated. Only patients with thoracic aortic procedures between 2003 and 2005 were included. Data analysis was realized in Stata/SE 8,0. Results: thoracic aortic procedures were performed in 16 patients. 75% were male with mean age 55.9 ± 12.6 years. 87.5% (14) had type A or B aortic dissection; one patient had traumatic aortic transection and one had aneurysm of thoracic descendant aorta. Acute dissections were presented in 78.6% (11 patients) and chronic dissections in 21.4% (3 patients). Average of endoprosthesis employed was 2.8 ± 1. Intensive care unit stay was 3 ± 2.7 days. 81.3% had no mayor complications. Mortality was 18.7% (3 patients). All patients had post-operative computerized tomography scan, with satisfactory evolution. Conclusion: according to the largest casuistics literature reports, endovascular management of dissection, aneurysm or aortic trauma is considered a trustworthy procedure that diminishes morbid-mortality.

  14. 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...

  15. 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...

  16. 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

  17. 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.

  18. 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)

  19. 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.

  20. 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.

  1. 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

  2. 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.

  3. 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

  4. 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

  5. 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...

  6. 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

  7. 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

  8. Recognition and treatment of outflow tract stenosis during and after endovascular exclusion for abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To study the cognition and treatment of outflow tract stenosis in and after endovascular exclusion for abdominal aortic aneurysm. Methods: From Mar 1997 to Oct 2002, in 136 patients undergoing abdominal aortic aneurysm endovascular exclusion, 8 patients had outflow tract stenosis during the operation, and 3 patients had outflow tract stenosis after operation. The stenosis of 5 patients occurred at the crotch of the graft-stent. PTA was done in 7 patients and stents were placed in stenotic segment in 2 patients. 2 patients were treated with crossover operation. Results: Following up 1 month to 2 years, all patients have no lower limbs ischemia. Conclusions: The diagnosis of outflow tract stenosis during and after abdominal endovascular exclusion for aortic aneurysm must be in time. The treatment should be according to the different causes of stenosis

  9. 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.

  10. 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.

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    MICHEL BERGOEING R

    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.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.

  13. Innovative Chimney-Graft Technique for Endovascular Repair of a Pararenal Abdominal Aortic Aneurysm

    Science.gov (United States)

    Galiñanes, Edgar Luis; Hernandez-Vila, Eduardo A.

    2015-01-01

    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

  14. 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)

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

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    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

  16. 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...

  17. 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.

  18. 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

  19. 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.

  20. [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

  1. 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.

  2. Manejo actual de la estenosis de carótida: Tratamiento endovascular comparado con endarterectomía / Current management of carotid stenosis: Endovascular treatment versus endarterectomy

    Scientific Electronic Library Online (English)

    Elvira, Jiménez G; Rafael, Oteros F; Fernando, Delgado A; Antonio, Cano S.

    Full Text Available En estenosis carotidea, la única manera de prevenir nuevos eventos cerebrovasculares era mediante antiagregación. Después de los estudios NASCET y ECST se estableció que la endarterectomía conseguía mejores resultados. Ahora se ha establecido la terapia endovascular como alternativa. Nuestro objetiv [...] o es mostrar la evolución de la terapia endovascular en estenosis carotidea, contrastar los resultados entre tratamiento endovascular, médico y quirúrgico y exponer la situación actual de la terapia endovascular. Algunos estudios se realizaron hace décadas y tanto la técnica endovascular como los tratamientos médicos, no son comparables con los de hoy. Varios estudios coinciden en que el stenting beneficia a menores de 70 años y presenta al menos iguales resultados que la endarterectomía a corto plazo, con mayor tasa de reestenosis a largo plazo. Quedan por resolver la indicación de tratamiento en pacientes asintomáticos o la utilización de sistemas de protección. El tratamiento debe ser individualizado en un equipo multidisciplinar. Abstract in english Antiplatelet therapy used to be the only way to prevent further cerebrovascular events in patients with carotid stenosis. After publication of final results of the European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET), endarterectomy was considere [...] d the best treatment option. Currently, endovascular treatment of atherosclerotic carotid artery stenosis has been established as an alternative to surgical endarterectomy. Our aim is to show the evolution of endovascular therapy in carotid stenosis, to compare outcomes between endovascular, medical and surgical treatments, and to analize the current state of endovascular therapy. It is worth underscoring that many of the studies were conducted decades ago and consequently both the endovascular technique and medical treatments used then greatly differ from current practices. Several studies agree stenting benefits patients under 70 years of age and exhibits, at least, same short-term results as endarterectomy, along with higher rate of long-term restenosis. Indication for treatment in asymptomatic patients and the use of protection systems remain an unresolved issue. A multidisciplinary team should implement an individualized treatment plan for each patient.

  3. Manejo actual de la estenosis de carótida: Tratamiento endovascular comparado con endarterectomía Current management of carotid stenosis: Endovascular treatment versus endarterectomy

    Directory of Open Access Journals (Sweden)

    Elvira Jiménez G

    2012-01-01

    Full Text Available En estenosis carotidea, la única manera de prevenir nuevos eventos cerebrovasculares era mediante antiagregación. Después de los estudios NASCET y ECST se estableció que la endarterectomía conseguía mejores resultados. Ahora se ha establecido la terapia endovascular como alternativa. Nuestro objetivo es mostrar la evolución de la terapia endovascular en estenosis carotidea, contrastar los resultados entre tratamiento endovascular, médico y quirúrgico y exponer la situación actual de la terapia endovascular. Algunos estudios se realizaron hace décadas y tanto la técnica endovascular como los tratamientos médicos, no son comparables con los de hoy. Varios estudios coinciden en que el stenting beneficia a menores de 70 años y presenta al menos iguales resultados que la endarterectomía a corto plazo, con mayor tasa de reestenosis a largo plazo. Quedan por resolver la indicación de tratamiento en pacientes asintomáticos o la utilización de sistemas de protección. El tratamiento debe ser individualizado en un equipo multidisciplinar.Antiplatelet therapy used to be the only way to prevent further cerebrovascular events in patients with carotid stenosis. After publication of final results of the European Carotid Surgery Trial (ECST and North American Symptomatic Carotid Endarterectomy Trial (NASCET, endarterectomy was considered the best treatment option. Currently, endovascular treatment of atherosclerotic carotid artery stenosis has been established as an alternative to surgical endarterectomy. Our aim is to show the evolution of endovascular therapy in carotid stenosis, to compare outcomes between endovascular, medical and surgical treatments, and to analize the current state of endovascular therapy. It is worth underscoring that many of the studies were conducted decades ago and consequently both the endovascular technique and medical treatments used then greatly differ from current practices. Several studies agree stenting benefits patients under 70 years of age and exhibits, at least, same short-term results as endarterectomy, along with higher rate of long-term restenosis. Indication for treatment in asymptomatic patients and the use of protection systems remain an unresolved issue. A multidisciplinary team should implement an individualized treatment plan for each patient.

  4. Tratamiento endovascular del síndrome de vena cava superior / Endovascular treatment of superior vena cava syndrome

    Scientific Electronic Library Online (English)

    Michel, Bergoeing R; Renato, Mertens M; Francisco, Valdés E; Albrecht, Krämer Sch; Manuel, Alvarez Z; Pablo, Bertin C; Rodrigo, Sagüés C; Eric, Orellana U; Héctor, Galindo A; Jeannette, Vergara G; Magaly, Valdebenito C.

    2006-07-01

    Full Text Available [...] Abstract in english Background: Superior vena cava syndrome (SVCS) is caused by the obstruction of venous drainage from the upper portion of the body. Common clinical findings are headache and cervical, facial and upper limb edema. Occasionally, clouding of consciousness appears. Aim: to report our experience with endo [...] vascular treatment of SVCS. Material and methods: Retrospective review of all patients with SVCS subjected to endovascular treatment between 1999 and 2005. Results: Eight patients were treated, all of them with malignancies. Six had a benign obstruction due to the presence of a chemotherapy catheter located in the superior vena cava, one had obstruction secondary to radiation therapy and one a tumor compression of the superior vena cava. Two patients underwent thrombolytic therapy. Angioplasty and stenting was performed in all patients. The chemotherapy catheter was removed to all patients and installed again in one. One patient had a hemothorax secondary to a simultaneous needle lung biopsy under video thoracoscopy. No patient died in relation to the procedure. Congestive signs and symptoms subsided in all patients within 24 hours after the procedure. During follow up, only one patient had symptoms related to vena cava obstruction and three died due to their malignant tumor. Conclusions: Endovascular treatment of SVCS has a low rate of complications and provides immediate and mid-term symptom relief

  5. 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)

  6. 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

  7. Open and endovascular repair of juxtarenal abdominal aortic aneurysms: a systematic review

    Scientific Electronic Library Online (English)

    Sergio Quilici, Belczak; Luiz, Lanziotti; Yuri, Botelho; Ricardo, Aun; Erasmo Simão, da Silva; Pedro, Puech-Leão; Nelson, de Luccia.

    2014-09-01

    Full Text Available This systematic review focuses on the 30-day mortality associated with open surgery and fenestrated endografts for short-necked ([...] erformed, using “juxtarenal abdominal aortic aneurysm” and “treatment” as the main keywords. Among the 110 potentially relevant studies that were initially identified, eight were in accordance with the inclusion criteria in the analysis. Similar outcomes for open and endovascular repair were observed for 30-day mortality. No differences were observed regarding the secondary outcomes (duration of surgery, hospital stay, postoperative renal dysfunction and late mortality), except that the late mortality rate was significantly higher for the patients treated with open repair after a median follow-up of 24 months. Fenestrated endografting is a viable alternative to conventional surgery in juxtarenal abdominal aortic aneurysms with a proximal neck

  8. The application of brachial-femoral stretch guidewire in endovascular exclusion of abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To investigate the key technique and application value of brachial-femoral stretch guidewire in endovascular exclusion of abdominal aortic aneurysms. Methods: Since Mach 1997 to October 2002, endovascular exclusion for abdominal aortic aneurysm had been preformed on 136 patients. The main body short limb graft was used in 118 cases. (Vanguard 6, Talent 86, AneuRx 2, Zenith 3, domestic 21). 12 of these patients were undergone brachial-femoral guidewire technique for the procedure. Results: All of the 12 cases with brachial-femoral stretch guidewire technique had the stent-grafts introduced, connected and released successfully. One case suffered brachial artery thrombosis postoperatively. One case had left medial antebrachial cutaneous nerve injured, but no other artery or incision complications occurred. 9 cases with the brachial-femoral stretch guidewire technique showed obviously, shortening of the time for this procedure. Conclusions: For the patients with poor general condition or specific anatomic conditions, such as aneurysm diameter >6 cm and the angle between aneurysm and common iliac artery >45 degree, aneurysm necktwist > 30 degree or iliac artery twist > 45 degree, age over 75 years old and combination with more than one important organ disfunction, the brachial-femoral guidewire technique is the valuable method of choice

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.)

  14. 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.)

  15. 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

  16. 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.

  17. Tratamiento endovascular selectivo de la ateroesclerosis de la bifurcación carotídea / Selective endovascular treatment of atherosclerotic carotid disease

    Scientific Electronic Library Online (English)

    LEOPOLDO, MARINÉ M.

    2008-12-01

    Full Text Available Resumen: El desarrollo de la cirugía endovascular (CE) ha permitido el tratamiento exitoso de la aterosclerosis carotídea en forma mínimamente invasiva. La endarterectomía sigue siendo la mejor alternativa terapéutica para la estenosis de la bifurcación carotídea, estando la CE reservada para pacien [...] tes considerados de alto riesgo médico o anatómico para la cirugía convencional. Objetivo: Analizar nuestros resultados iniciales con la CE aplicada a lesiones ateroscleróticas de la bifurcación carotídea. Estudio retrospectivo de base de datos prospectiva. Material y Método: Se revisan los antecedentes clínicos e imagenológicos de pacientes tratados con CE mediante angioplastía y stenting entre 2005-2007, por estenosis carotídea mayor de 70%. El seguimiento incluyó evaluación clínica y control periódico por imágenes. Resultados: Se realizó tratamiento en 11 pacientes por estenosis crítica (54,6% hombres, 70,6 años, rango: 61-76). La indicación terapéutica fue: alto riesgo médico (5), o anatómico (6). Alrededor de dos tercios de los pacientes consultaron por síntomas neurológicos. El éxito técnico fue de 100%, sin estenosis residual. En el período postoperatorio precoz una paciente tratada por re-estenosis carotídea sintomática presentó déficit isquémico hemisférico en zona limítrofe ipsilateral sin secuela clínica posterior (Rankin 0). La estada hospitalaria fue de 6 días (mediana, rango 2-25). No hubo isquemia miocárdica clínica ni mortalidad perioperatoria. Durante el seguimiento de 17,4 ± 4,8 meses, no hubo mortalidad, déficit neurológico nuevo ni re-estenosis. Conclusión: La CE es una alternativa eficaz con riesgo razonable en seleccionados pacientes portadores de enfermedad aterosclerótica de la bifurcación carotídea con alto riesgo anatómico o médico para la cirugía convencional. Abstract in english Summary: The development of endovascular surgery (ES) has allowed successful treatment of atherosclerotic carotid stenosis. Carotid endarterectomy continúes to be the option of choice for the treatment of carotid bifurcation atherosclerosis; ES is indicated in patients considered to be of high risk [...] for conventional surgery based on medical or anatomical considerations. Aim: To analyze our early results with ES of atherosclerotic carotid stenosis. A retrospective study based on a prospective datábase. Material ano Method: A prospective datábase of medical records and image studies of all patients with carotid stenosis > 70% treated with angioplasty and stenting between 2005-2007 are reviewed. Follow-up included scheduled clinical visits and appropriate image studies. Results: Eleven patients were treated (54.6 % men, 70.6 years, range: 61-76). Indication for ES was high medical (5) or anatomical (6) risk patients. Two thirds of the patients were symptomatic. Technical success without residual stenosis was achieved in all patients. One minor ipsilateral ischemic hemispheric déficit developed in the early postoperative period in one symptomatic patient treated for recurrent bifurcation stenosis, with full recovery at follow-up (Rankin 0). Median hospital stay was six days (2-25). No early mortality or clinical myocardial ischemia was observed. No mortality, brain ischemia ñor restenosis were recorded during the follow- up period (17.4 ± 4.8 months). Conclusions: ES is an excellent alternative for the treatment of carotid bifurcation disease in selected high risk patients.

  18. Tratamiento endovascular selectivo de la ateroesclerosis de la bifurcación carotídea Selective endovascular treatment of atherosclerotic carotid disease

    Directory of Open Access Journals (Sweden)

    LEOPOLDO MARINÉ M

    2008-12-01

    Full Text Available Resumen: El desarrollo de la cirugía endovascular (CE ha permitido el tratamiento exitoso de la aterosclerosis carotídea en forma mínimamente invasiva. La endarterectomía sigue siendo la mejor alternativa terapéutica para la estenosis de la bifurcación carotídea, estando la CE reservada para pacientes considerados de alto riesgo médico o anatómico para la cirugía convencional. Objetivo: Analizar nuestros resultados iniciales con la CE aplicada a lesiones ateroscleróticas de la bifurcación carotídea. Estudio retrospectivo de base de datos prospectiva. Material y Método: Se revisan los antecedentes clínicos e imagenológicos de pacientes tratados con CE mediante angioplastía y stenting entre 2005-2007, por estenosis carotídea mayor de 70%. El seguimiento incluyó evaluación clínica y control periódico por imágenes. Resultados: Se realizó tratamiento en 11 pacientes por estenosis crítica (54,6% hombres, 70,6 años, rango: 61-76. La indicación terapéutica fue: alto riesgo médico (5, o anatómico (6. Alrededor de dos tercios de los pacientes consultaron por síntomas neurológicos. El éxito técnico fue de 100%, sin estenosis residual. En el período postoperatorio precoz una paciente tratada por re-estenosis carotídea sintomática presentó déficit isquémico hemisférico en zona limítrofe ipsilateral sin secuela clínica posterior (Rankin 0. La estada hospitalaria fue de 6 días (mediana, rango 2-25. No hubo isquemia miocárdica clínica ni mortalidad perioperatoria. Durante el seguimiento de 17,4 ± 4,8 meses, no hubo mortalidad, déficit neurológico nuevo ni re-estenosis. Conclusión: La CE es una alternativa eficaz con riesgo razonable en seleccionados pacientes portadores de enfermedad aterosclerótica de la bifurcación carotídea con alto riesgo anatómico o médico para la cirugía convencional.Summary: The development of endovascular surgery (ES has allowed successful treatment of atherosclerotic carotid stenosis. Carotid endarterectomy continúes to be the option of choice for the treatment of carotid bifurcation atherosclerosis; ES is indicated in patients considered to be of high risk for conventional surgery based on medical or anatomical considerations. Aim: To analyze our early results with ES of atherosclerotic carotid stenosis. A retrospective study based on a prospective datábase. Material ano Method: A prospective datábase of medical records and image studies of all patients with carotid stenosis > 70% treated with angioplasty and stenting between 2005-2007 are reviewed. Follow-up included scheduled clinical visits and appropriate image studies. Results: Eleven patients were treated (54.6 % men, 70.6 years, range: 61-76. Indication for ES was high medical (5 or anatomical (6 risk patients. Two thirds of the patients were symptomatic. Technical success without residual stenosis was achieved in all patients. One minor ipsilateral ischemic hemispheric déficit developed in the early postoperative period in one symptomatic patient treated for recurrent bifurcation stenosis, with full recovery at follow-up (Rankin 0. Median hospital stay was six days (2-25. No early mortality or clinical myocardial ischemia was observed. No mortality, brain ischemia ñor restenosis were recorded during the follow- up period (17.4 ± 4.8 months. Conclusions: ES is an excellent alternative for the treatment of carotid bifurcation disease in selected high risk patients.

  19. 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.

  20. 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.

  1. 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.

  2. 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...

  3. 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.)

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. Cost-effectiveness of the endovascular repair: of Abdominal Aortic Aneurysm in Portugal / Custo-efetividade no tratamento do aneurisma da aorta abdominal: uma abordagem no contexto Português

    Scientific Electronic Library Online (English)

    Paulo, Sousa; Julian, Perelman; Klára, Dimitrovová; António Santos, Simões; Daniel, Brandão; João Albuquerque e, Castro; Luís Mendes, Pedro; Rui, Machado; Sérgio, Sampaio; Paul, Hayes; José, Fernandes e Fernandes.

    2014-06-01

    Full Text Available O tratamento endovascular (EVAR) do aneurisma da aorta abdominal tem sido apontado, nos últimos anos, como uma alternativa bastante atrativa à cirurgia convencional. Não obstante tais benefícios clínicos e percepcionados pelos doentes, os estudos de avaliação económica parecem não ser tão consistent [...] es, o que requer algumas considerações aquando da utilização desta opção terapêutica em larga escala. Objetivos: Avaliar, no contexto Português, o custo-efetividade do EVAR no tratamento do aneurisma da aorta abdominal comparado com o tratamento por cirurgia convencional, usando um modelo desenvolvido previamente no Reino Unido. Metodologia: Os benefícios foram baseados em estudos clínicos internacionais, assumindo que tais resultados podem ser aplicados ao contexto Português. Constituiu-se um painel de peritos para apurar a utilização de recursos associados à intervenção bem como as consequências a curto e médio prazo (valorizados com preços de Portugal). Resultados: A diferença de custos na intervenção primária entre o EVAR e o tratamento por cirurgia convencional, deveu-se ao preço da endoprótese. Não se verificaram diferenças, entre ambos os procedimentos, no que respeita ao custo total associado às complicações e reintervenções. O rácio custo-efetividade incremental (ICER) do EVAR foi de 65,605€/QALY. Conclusões: O tratamento endovascular do aneurisma da aorta abdominal apresenta resultados que parecem comprovar uma elevada efetividade tendo sido utilizada, nos últimos anos, de forma crescente um pouco por todo o mundo. Apesar dos resultados custo-efetividade, aqui apurados, estarem acima do que que é considerado limiar de aceitação em Portugal, o valor económico do EVAR melhoraria se se confirmassem os benefícios a longo prazo que, alguns dos estudos recentes, parecem apontar. Nessas circunstâncias, o tratamento endovascular tornar-se-ia uma intervenção economicamente interessante que, aliada aos bons resultados ao nível da efetividade e da qualidade de vida dos doentes, poderia ser indicada para um maior número de situações clínicas. Abstract in english Endovascular Aneurysm Repair (EVAR) for the treatment of aortic abdominal aneurism has been shown to improve short-term survival and quality of life as compared to Open Repair (OR), while reducing the rate of serious complications and allowing for the treatment of more patients. Objectives: To exami [...] ne the cost-effectiveness of EVAR compared to OR in the treatment of aortic abdominal aneurism in the Portuguese context using a model previously developed in the UK. Methodology: We adapted an international economic evaluation model to the Portuguese situation, assuming that the health benefits of EVAR observed in clinical trials would also apply to Portuguese patients. We carried out an expert panel survey to calculate the resource use associated with the intervention and its short and long-term consequences, valued with Portuguese prices. Results: The major cost difference in the primary intervention (difference of 3,064 € in favor of OR) is related to the cost of the endograft/graft. No major differences are observed in the total cost of complications and re-interventions between the two procedures. EVAR represents a cost of 16,709 € over lifetime compared to 12,130 € for OR. Using data from the literature we show that EVAR allows for 0.17 additional undiscounted years of life and 0.091 additional undiscounted quality-adjusted life years. The incremental cost-effectiveness ratio (ICER) of EVAR is of 65,605 €/QALY. Conclusion: Endovascular repair of aortic abdominal aneurysm represents an effective alternative and has been used increasingly in Portugal and elsewhere. Our study shows that its cost-effectiveness is currently above the commonly accepted threshold in Portugal, but that the economic value of EVAR would greatly improve if benefits were confirmed in the long run after the intervention. Under these circumstances, EVAR would become an economically valuable intervent

  11. Evaluation with Doppler vascular ultrasound in postoperative endovascular treatment of abdominal aortic aneurysm: a prospective comparative study with angiotomography

    Scientific Electronic Library Online (English)

    Graciliano Jose, Franca; Liz Andrea Villela, Baroncini; Aguinaldo de, Oliveira; Enrique Antonio, Vidal; Marcio, Miyamotto; Jeferson Freitas, Toregeani; Luiz Otavio de Mattos, Coelho; Jorge Rufino Ribas, Timi.

    2013-06-01

    Full Text Available BACKGROUND: Diagnosis of abdominal aortic aneurysm (AAA) is usually incidental, and surgical treatment, when indicated, may be open or endovascular. The drawbacks of computed angiotomography (CTA) and the advantages of Doppler ultrasonography have led to the development of alternative follow-up pr [...] otocols, comparing the two methods. OBJECTIVE: To determine validity indices for Doppler ultrasonography and to correlate them with CTA results in a group of patients who had undergone elective endovascular treatment of AAAs. MATERIAL AND METHODS: Thirty-three patients were selected. The following three items were evaluated: 1) presence or absence of endoleak; 2) presence of blood flow in the aortoiliac segment; and 3) maximum AAA diameter. RESULTS: For the detection of endoleak, Doppler ultrasonography showed a sensitivity of 54.5%, a specificity of 92.8%, a positive predictive value of 85.7%, a negative predictive value of 92.8%, and an overall accuracy of 76%. For the evaluation of blood flow in the aortoiliac segment, values were 100, 97.8, 80, 97.8, and 98%, respectively. Maximum AAA diameter was similarly measured by both methods, with statistically significant differences (mean difference: 1.98 mm). Pearson's correlation coefficient was 0.97, showing that Doppler ultrasonography and CTA yielded similar results. CONCLUSION: Doppler ultrasonography showed good validity indices and a moderate correlation with CTA in the postoperative evaluation of patients undergoing endovascular treatment of AAAs.

  12. 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.

  13. 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

  14. 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

  15. 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...

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

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

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    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.

  11. Oclusión intencional de la arteria subclavia izquierda durante el tratamiento endovascular de la aorta torácica descendente / Intentional Occlusion of the Left Subclavian Artery during Endovascular Repair of the Descending Thoracic Aorta

    Scientific Electronic Library Online (English)

    Hernán G, Bertoni; Fabián A, Azzari; Germán A, Girela; Gustavo A, Salvo; Alejandro, de la Vega; Gonzalo A, Romero; Natalia, Bourques; Adrián A, Charask; Jorge H, Leguizamón.

    2011-02-01

    Full Text Available Introducción La seguridad y la eficacia del tratamiento endovascular de la aorta torácica descendente dependen de ciertas condiciones anatómicas, en particular de la presencia de un segmento sano de aorta (cuello proximal). En una proporción importante de pacientes, este cuello proximal es insuficie [...] nte o inexistente. Un bypass o transposición de la arteria subclavia izquierda permitiría mantener una perfusión adecuada del brazo izquierdo luego del implante de la endoprótesis. Sin embargo, este abordaje quirúrgico no siempre es factible en pacientes inestables, tratados de forma urgente o que presentan múltiples comorbilidades. Objetivo Evaluar las consecuencias clínicas y neurológicas de la oclusión intencional de la arteria subclavia izquierda durante el tratamiento endovascular de la aorta torácica descendente. Material y métodos Entre agosto de 1999 y febrero de 2010, 136 pacientes fueron tratados consecutivamente con implante de endoprótesis autoexpandibles. En 29 pacientes (21%) con ausencia de un cuello proximal adecuado (sector sano de aorta ? 15 mm de longitud) se debió cubrir intencionalmente el origen de la arteria subclavia izquierda. En todos los casos, previo al tratamiento se realizó una angiografía selectiva de la arteria vertebral derecha con el objetivo de confirmar la permeabilidad de ésta y la conformación de la circulación vertebrobasilar. Resultados Se trataron 20 hombres y 9 mujeres, cuya edad media fue de 62 (49-72) años. La patología de base fue disección aórtica tipo B aguda (n = 4), disección aórtica tipo B crónica (n = 14), hematoma intramural (n = 1), aneurisma verdadero (n = 7), úlcera aórtica (n = 1) y seudoaneurisma traumático (n = 2). El implante del dispositivo fue exitoso en todos los pacientes. No se registraron complicaciones clínicas ni neurológicas a 29 (13-50) meses de seguimiento medio. Conclusiones La utilización de criterios de selección estrictos permite la oclusión intencional de la arteria subclavia izquierda durante el tratamiento endovascular de la aorta torácica descendente, sin aumentar la incidencia de complicaciones mayores. Así, la revascularización quirúrgica queda reservada para pacientes con síntomas graves de isquemia durante el seguimiento. Abstract in english Background Safety and efficacy of endovascular repair of the descending thoracic aorta depends on certain anatomic conditions, especially on the presence of a suitable proximal neck. This proximal neck is insufficient or absent in many patients. The use of left subclavian-carotid transposition or le [...] ft carotid-tosubclavian artery bypass might allow an adequate perfusion of the left arm after the implantation of the stent-graft. However, this surgical approach is not feasible in unstable patients undergoing emergency surgery or with multiple comorbidities. Objective To evaluate the clinical and neurological outcomes of the intentional occlusion of the left subclavian artery during endovascular repair of the descending thoracic aorta. Material and Methods Between August 1999 and February 2010, 136 patients consecutively underwent implantation of self-expandable stent-grafts. The origin of the left subclavian artery was intentionally covered in 29 patients (21%) with absence of adequate proximal neck (normal aortic segment ?15 mm long). Before the procedure, all patients underwent selective angiography of the right vertebral artery to exclude stenosis and to evaluate vertebrobasilar circulation. Results A total of 20 men and 9 women were treated; mean age was 62 (49-72) years. Stent-graft implantation was indicated due to acute type B aortic dissection (n=4), chronic type B aortic dissection (n=14), intramural hematoma (n=1), true aneurysm (n=7), aortic ulcer (n=1), and traumatic pseudoaneurysm (n=2). The device was successfully implanted in all patients. No clinical or neurological complications were reported after a mean follow-up of 29 months (13-50). Conclusions The use of strict selection criteria allows intentional occlusion of

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

    Scientific Electronic Library Online (English)

    Renato, Mertens M; Francisco, Valdés E; Albrecht, Kramer S; Leopoldo, Mariné M; Jeannette, Vergara G; Magaly, Valdebenito C.

    2002-09-01

    Full Text Available [...] Abstract in english 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, us [...] ing 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. Pseudoaneurisma traumático de troncos supra-aórticos: tratamiento endovascular. Casos clínicos Endovascular treatment of traumatic pseudoaneurysms of aortic arch branches: Report of three cases

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    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

  14. 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

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    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.

  15. 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.

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

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    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.

  17. 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.

  18. ¿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.

  19. ¿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.

  20. Techniques in Endovascular Aneurysm Repair

    OpenAIRE

    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 ar...

  1. Study Design of PROCEDURE Study. A Randomized Comparison of the Dose-Dependent Effects of Pitavastatin in Patients with Abdominal Aortic Aneurysm with Massive Aortic Atheroma: Prevention of Cholesterol Embolization during Endovascular and Open Aneurysm Repair with Pitavastatin (PROCEDURE) Study

    OpenAIRE

    Hoshina, Katsuyuki; Nemoto, Masaru; Hashimoto, Takuya; Miura, Sumio; Urabe, Go; Nakazawa, Tatsu; Hosaka, Akihiro; Kato, Masaaki; Ohkubo, Nobukazu; Miyairi, Takeshi; Okamoto, Hiroyuki; Shigematsu, Kunihiro; Miyata, Tetsuro

    2013-01-01

    Outcomes of abdominal aortic aneurysm (AAA) repair have improved in the 2 decades since the emergence of endovascular aneurysm repair (EVAR). However, EVAR is considered a contraindication for shaggy aorta because of the high risk of shower embolization. Recently, statins have been implicated in preventing embolization in patients with shaggy aorta via its pleiotropic effects, including atheroma reduction and coronary artery stabilization. We selected pitavastatin, a statin with potent effect...

  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

    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...

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

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    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.

  4. 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.

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

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    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.

  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. 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

  8. 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.

  9. Endovascular Repair of Abdominal Aortic Aneurysm does not Improve Early Survival versus Open Repair in Patients Younger than 60 Years?,?? CME

    Science.gov (United States)

    Gupta, P.K.; Ramanan, B.; Lynch, T.G.; Gupta, H.; Fang, X.; Balters, M.; Johanning, J.M.; Longo, G.M.; MacTaggart, J.N.; Pipinos, I.I.

    2013-01-01

    Objectives Multiple randomised trials have demonstrated lower perioperative mortality after endovascular aneurysm repair (EVAR) compared to open surgical repair for infrarenal abdominal aortic aneurysms (AAAs). However, in these trials the mortality advantage for EVAR is being lost within 2 years of repair and the patients evaluated are relatively older with no study specifically comparing EVAR and open repair for patients younger than 60 years of age. Design A retrospective analysis of prospectively collected data. Materials and methods Patients younger than 60 years of age who underwent EVAR and open surgical repair for elective infrarenal AAA were identified from the 2007–09 National Surgical Quality Improvement Program (NSQIP) – a prospective database maintained at 237 centres across the United States. Univariate and multivariate analyses were performed. Results Of the 651 patients, 369 (56.7%) underwent EVAR and 282 (43.3%) underwent open repair. Thirty-day mortality for EVAR and open repair were 1.1% and 0.4%, respectively. This was not significantly different on univariate (P = 0.22) as well as multivariate (P = 0.69) analysis after controlling for other co-morbidities. On multivariate analysis, body mass index, history of stroke and bleeding disorder prior to surgery were associated with a higher 30-day mortality after AAA repair (combined open and EVAR). Conclusions These contemporary results demonstrate that the 30-day mortality rate after open repair is similar to that after EVAR in patients younger than 60 years with infrarenal AAA. PMID:22386386

  10. Chimney-Graft as a Bail-Out Procedure for Endovascular Treatment of an Inflammatory Juxtarenal Abdominal Aortic Aneurysm

    OpenAIRE

    Fratesi, Francesca; Handa, Ashok; Uberoi, Raman; Sideso, Ediri

    2015-01-01

    Inflammatory and juxtarenal Abdominal Aortic Aneurysm (j-iAAA) represents a technical challenge for open repair (OR) due to the peculiar anatomy, extensive perianeurysmal fibrosis, and dense adhesion to the surrounding tissues. A 68-year-old man with an 11?cm asymptomatic j-iAAA was successfully treated with elective EVAR and chimney-graft (ch-EVAR) without postprocedural complications. Target vessel patency and normal renal function are present at 24-month follow-u...

  11. 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

  12. 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.

  13. 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.

  14. 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

  15. [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

  16. 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.

  17. 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.

  18. 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.

  19. Resultados del tratamiento endovascular de la patología carotídea en el Hospital San Juan de Dios de Enero 2007 a Febrero 2010 Results of endovascular management of carotid disease at San Juan de Dios Hospital from January 2007 to February 2010

    Directory of Open Access Journals (Sweden)

    Christian Fonseca-Bolaños

    2012-03-01

    Full Text Available Justificación y objetivo: Determinar la morbi-mortalidad de los pacientes con enfermedad carotídea tratados por medio de stent en el Hospital San Juan de Dios, Costa Rica; de Enero 2007 a Febrero 2010. Métodos: Se realizó un registro retrospectivo observacional de los pacientes con Enfermedad Carotídea durante 13 meses en nuestro instituto. Basado en la información obtenida de los expedientes clínicos, dos subgrupos fueron identificados: pacientes sintomáticos y asintomáticos. Los factores de riesgo, escala ABCD2, territorio cerebral afectado, medidas de severidad de lesión no-invasiva e invasivas, tamaño de stents y finalmente complicaciones peri-operatorias, fueron investigadas y evaluadas. Resultados: 76 pacientes fueron identificados en nuestra serie, 87% (n=66/76 sintomáticos y 13% (n=10/76 asintomáticos. La Hipertensión Arterial fue el factor de riesgo más frecuente, seguido por el tabaquismo. Se evidenció una sub-estimación de la severidad de la lesión en los ultrasonidos diagnósticos en 24% (n=18/76 de los pacientes. Durante el procedimiento, se documentó predilatación de la lesión en 55% (n=42/76 de los pacientes y los stents más frecuentemente utilizados fueron de 7x30mm y 8x30mm representando un 47% (n=36/76 de los casos. La morbilidad neurológica de los pacientes asintomáticos fue del 0% y en el subgrupo de pacientes sintomáticos fue del 3% (2/66. Conclusión: La terapia endovascular demostró ser una técnica segura y efectiva para la revascularización carotídea. Series más numerosas de pacientes deberían ser investigadas para adquirir mayor significancia estadística.Background and aim: To determine the morbi-mortality of patients treated with endovascular stenting for Carotid Artery disease at San Juan de Dios Hospital, Costa Rica; from January 2007 to February 2010. Methods: A retrospective observational registry of patients treated with Carotid Artery endovascular stenting was maintained at our institution over 13 months. Based on the information acquired from medical records, two subgroups were identified: symptomatic and asymptomatic. Some aspects were researched and evaluated such as risk factors, ABCD scale, affected cerebral territory, invasive and non-invasive lesion measurements, stent sizing and finally peri-operatory complications. Results: 76 patients were identified in this series, 87% (n=66/76 symptomatic and 13% (n=10/76 asymptomatic. The most frequent risk factor was hypertension, followed by smoking. Underestimation by ultrasound of lesion severity was found in up to 24% (n=18/76 of patients. Predilatation was done in 55% (n=42/76 and most frequent stent sizes identified were 7x30mm or 8x30mm in 47% (n=36/76 of patients. Neurologic morbidity of asymtomatic patients was 0%, and in the symptomatic group was a 3% (2/66 Conclusion: Endovascular therapy demonstrated to be a safe and effective as a revascularization technique; however larger patient series should be investigated for grater statistical significance.

  20. 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.

  1. 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.

  2. Resultados del tratamiento endovascular de la patología carotídea en el Hospital San Juan de Dios de Enero 2007 a Febrero 2010 / Results of endovascular management of carotid disease at San Juan de Dios Hospital from January 2007 to February 2010

    Scientific Electronic Library Online (English)

    Christian, Fonseca-Bolaños; Miguel, Montero-Baker; Johana, Vásquez-Céspedes; Róger, Jiménez-Juárez; Luis, Morelli-Guillen.

    2012-03-01

    Full Text Available Justificación y objetivo: Determinar la morbi-mortalidad de los pacientes con enfermedad carotídea tratados por medio de stent en el Hospital San Juan de Dios, Costa Rica; de Enero 2007 a Febrero 2010. Métodos: Se realizó un registro retrospectivo observacional de los pacientes con Enfermedad Carotí [...] dea durante 13 meses en nuestro instituto. Basado en la información obtenida de los expedientes clínicos, dos subgrupos fueron identificados: pacientes sintomáticos y asintomáticos. Los factores de riesgo, escala ABCD2, territorio cerebral afectado, medidas de severidad de lesión no-invasiva e invasivas, tamaño de stents y finalmente complicaciones peri-operatorias, fueron investigadas y evaluadas. Resultados: 76 pacientes fueron identificados en nuestra serie, 87% (n=66/76) sintomáticos y 13% (n=10/76) asintomáticos. La Hipertensión Arterial fue el factor de riesgo más frecuente, seguido por el tabaquismo. Se evidenció una sub-estimación de la severidad de la lesión en los ultrasonidos diagnósticos en 24% (n=18/76) de los pacientes. Durante el procedimiento, se documentó predilatación de la lesión en 55% (n=42/76) de los pacientes y los stents más frecuentemente utilizados fueron de 7x30mm y 8x30mm representando un 47% (n=36/76) de los casos. La morbilidad neurológica de los pacientes asintomáticos fue del 0% y en el subgrupo de pacientes sintomáticos fue del 3% (2/66). Conclusión: La terapia endovascular demostró ser una técnica segura y efectiva para la revascularización carotídea. Series más numerosas de pacientes deberían ser investigadas para adquirir mayor significancia estadística. Abstract in english Background and aim: To determine the morbi-mortality of patients treated with endovascular stenting for Carotid Artery disease at San Juan de Dios Hospital, Costa Rica; from January 2007 to February 2010. Methods: A retrospective observational registry of patients treated with Carotid Artery endovas [...] cular stenting was maintained at our institution over 13 months. Based on the information acquired from medical records, two subgroups were identified: symptomatic and asymptomatic. Some aspects were researched and evaluated such as risk factors, ABCD scale, affected cerebral territory, invasive and non-invasive lesion measurements, stent sizing and finally peri-operatory complications. Results: 76 patients were identified in this series, 87% (n=66/76) symptomatic and 13% (n=10/76) asymptomatic. The most frequent risk factor was hypertension, followed by smoking. Underestimation by ultrasound of lesion severity was found in up to 24% (n=18/76) of patients. Predilatation was done in 55% (n=42/76) and most frequent stent sizes identified were 7x30mm or 8x30mm in 47% (n=36/76) of patients. Neurologic morbidity of asymtomatic patients was 0%, and in the symptomatic group was a 3% (2/66) Conclusion: Endovascular therapy demonstrated to be a safe and effective as a revascularization technique; however larger patient series should be investigated for grater statistical significance.

  3. 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.

  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. A look into the endovascular crystal ball

    DEFF Research Database (Denmark)

    Schroeder, T V

    2009-01-01

    This paper summarizes the highlights of the 15th International Workshop of Endovascular Surgery, held in Ajaccio in June 2008. This is an annual event that attracts leading endovascular therapists from both sides of the Atlantic Ocean as well as a contingency from down-under. The layout of this meeting followed the previous events with sessions on carotid artery disease and abdominal and thoracic aortic aneurysms topped up with clinical cases, lower limb ischemia and venous disease. Generally the session takes off by summarising new evidence, followed by questions and discussion. This workshops gives the participants an excellent opportunity to get an updated perspective within these fast developing areas.

  6. 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...

  7. 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

  8. Intestinal infarction: A complication of endovascular therapy

    Energy Technology Data Exchange (ETDEWEB)

    England, Andrew [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom)]. E-mail: andrew.england@smtr.nhs.uk; Butterfield, John S. [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Sukumar, Sathi [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Thompson, David [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Roulson, Jo-An [Department of Histopathology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Pritchard, Susan [Department of Histopathology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Ashleigh, Raymond J. [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom)

    2007-08-15

    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.

  9. Curativos para tratamento de feridas operatórias abdominais: uma revisão sistemática / Dressings for the treatment of abdominal surgical wounds: a systematic review / Los apósitos para el tratamiento quirúrgico de las heridas abdominales: una revisión sistemática

    Scientific Electronic Library Online (English)

    Carolina Giordani, Silva; Maria da Graça Oliveira, Crossetti.

    2012-09-01

    Full Text Available O objetivo deste estudo foi identificar o curativo prevalente para o tratamento das feridas operatórias abdominais com complicações, visando buscar evidências que possam subsidiar o desenvolvimento de um protocolo institucional para o tratamento das mesmas. Metodologia: desenvolveu-se uma Revisão Si [...] stemática, que teve como pergunta norteadora "Qual é o curativo prevalente no tratamento dos pacientes com complicações de feridas operatórias (FOs) abdominais?" Foram utilizados MeSH para buscar o maior número de estudos possíveis em sete base de dados eletrônicas. Resultados: a busca nas bases de dados resultou em 6.107 artigos que, após serem submetidos aos testes de relevância, resultaram em 33 estudos que compuseram a amostra. O curativo a VAC foi o mais indicado para tratar FOs abdominais que tiveram complicações. Conclusão: sugerem-se novas pesquisas para que se possa avaliar a efetividade e viabilidade da terapia VAC na nossa realidade. Abstract in spanish El objetivo de este estudio fue identificar los curativos prevalentes en el tratamiento de heridas quirúrgicas abdominales con complicaciones, con la finalidad de obtener evidencias que puedan subsidiar el desarrollo de protocolo institucional para tratamiento de las mismas. Metodología: una Revisió [...] n Sistemática que tuvo como pregunta orientadora ¿Cuál es el curativo prevalente en el tratamiento de los pacientes con complicaciones de heridas operatorias abdominales? Fueron utilizados MeSH para buscar el mayor número de estudios posibles, en siete bases de datos electrónicas. Resultados: La búsqueda en las bases de datos resultó en 6107 artículos, después se realizaron los Test de Relevancia resultando la muestra final de 33 estudios. El uso del curativo VAC es curativo más indicado para tratar FOs abdominales que tuvieron complicaciones. Conclusión: Se sugieren nuevas investigaciones, para que se pueda evaluar la efectividad y viabilidad de la terapia VAC en nuestra realidad. Abstract in english The aim of this study was to identify the dressings used to treat abdominal surgical wounds with complications, in order to look for evidence that supports the development of an institutional protocol for handling these wounds. Methodology: a Systematic Review was developed, which had as a guiding q [...] uestion: What is the prevalent dressing in the treatment of patients with complications in abdominal surgical wounds? The MeSH database was used to search for the largest possible number of studies in seven electronic databases. Results: The search in the databases resulted in 6,107 articles, after being tested for relevance, the result was 33 studies that comprised the sample. The use of the VAC dressing was the best suited to treat abdominal surgical wounds with complications. Conclusion: Further research is suggested, so that the effectiveness and feasibility of VAC therapy in our reality can be assessed.

  10. 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.

  11. 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.

  12. Cerebral endovascular neurosurgery.

    Science.gov (United States)

    Hopkins, L Nelson; Ecker, Robert D

    2008-06-01

    Cerebral endovascular neurosurgery has evolved rapidly in the past decade through advances in tools and techniques and as a result of the thrust toward evidence-based medicine. More patients with diseases traditionally treated via microsurgical approaches can now be treated with techniques that focus on endoluminal reconstruction. With the introduction of intracranial clot retrievers and appropriately sized stents, stroke care is being slowly revolutionized for those patients with salvageable brain tissue at the time of admission to the hospital. In this article, the recent history, current state, and possible future of cerebral endovascular neurosurgery are reviewed for the following diseases: stroke, intracranial atherosclerotic disease, brachiocephalic occlusive disease, cerebral aneurysms, central nervous system vascular malformations, and brain tumors. New concepts and applications for endovascular treatment of epilepsy and multiple sclerosis are mentioned. The potential for nanotechnology in this field and the future endovascular suite are envisioned. PMID:18695568

  13. 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. [...

  14. Repair of ruptured abdominal aortic aneurysms with bifurcated endografts: a single-center study

    Scientific Electronic Library Online (English)

    André Brito, Queiroz; Karina Paula Domingos Rosa, Schneidwind; Grace Carvajal, Mulatti; Fábio Rodrigues Ferreira Espirito, Santo; Paulo Sassaki, Neto; Inez Ohashi, Torres; Nelson, De Luccia.

    2014-06-01

    Full Text Available OBJECTIVE: The aim of this study was to describe our early experience in the treatment of ruptured abdominal aortic aneurysms with bifurcated endografts. We report on our initial twelve-month experience using this approach. METHODS: Clinical data on patients with ruptured abdominal aortic aneurys [...] ms treated at a single tertiary center in Brazil were prospectively recorded. The eligibility for endovascular treatment was evaluated by computed tomography scanning and anatomical features were determined based on the method of treatment. RESULTS: From February 2012 to January 2013 (12 months), 28 consecutive patients (mean age 67.2 years, range 45-85 years) underwent treatment for ruptured abdominal aortic aneurysms at our hospital. Eighteen patients (64.3%) were suitable for and underwent endovascular treatment with bifurcated endografts (16 patients) or aortouniiliac endografts (two patients). Ten patients who were considered unsuitable for endograft repair underwent open repair. Seven patients were classified as hemodynamically unstable (Endovascular, 5; Open, 2), and 21 were classified as stable (Endovascular, 13; Open, 8). The overall 30-day mortality rate associated with endovascular treatment was 27.8% (stable, 18.7%; unstable, 40%) and the rate associated with open repair was 50% (stable, 37.5%; unstable, 100%). CONCLUSIONS: In this study, the suitability of patients for endovascular repair of ruptured abdominal aortic aneurysms was high and the overall results of endovascular treatment remain encouraging. Indeed, bifurcated endografts are a feasible option for treating anatomically eligible ruptured abdominal aortic aneurysms.

  15. Aneurisma aórtico abdominal en pacientes mayores de 80 años: tratamiento quirúrgico convencional en 80 casos consecutivos / Results of the surgical management of abdominal aortic aneurysms in 80 patients over 80 years of age

    Scientific Electronic Library Online (English)

    Francisco, Valdés E; Michel, Bergoeing R; Albrecht, Krämer Sch; Renato, Mertens M; Roberto, Canessa B; Guillermo, Lema F; Bernardita, Garayar P; Jorge, Urzúa U.

    2003-09-01

    Full Text Available [...] Abstract in english Abdominal aortic aneurysms (AAA) may be lethal unless appropriately and timely treated. Since age is a surgical risk, octogenarians are usually not considered as candidates for surgical intervention. Aim: To asses surgical complications and mortality in octogenarians treated for AAA. Subjects and Me [...] thods: Patients aged 80 years older, treated consecutively between 1984-2001 were retrospectively analyzed. Results: Sixty one patients were male, and their age ranged from 80 to 95 years. All were treated with open surgery. The operation was elective in 58 and as an emergency in 22 patients (symptomatic or ruptured AAA). Aortic diameter was 6.8±1.4 cm in asymptomatic patients and 7.7±1.8 cm in emergency cases (p=0.024). Thirty days postoperative mortality was 5.1% in elective surgery compared to 40.6% in emergency operations (p

  16. 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...

  17. 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.

  18. 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.

  19. 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.

  20. Endovascular Aneurysm Repair Using a Reverse Chimney Technique in a Patient With Marfan Syndrome and Contained Ruptured Chronic Type B Dissection

    International Nuclear Information System (INIS)

    We report endovascular thoracic and abdominal aneurysm repair (EVAR) with reverse chimney technique in a patient with contained ruptured type B dissection. EVAR seems feasible as a bailout option in Marfan patients with acute life-threatening disease.

  1. 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.

  2. 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

  3. 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

  4. 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.

  5. 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...

  6. 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...

  7. [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

  8. 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.

  9. 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)

  10. 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

  11. 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.

  12. 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.

  13. Abdominal tap

    Science.gov (United States)

    Peritoneal tap; Paracentesis ... You then receive a local numbing medicine. The tap needle is inserted 1 to 2 inches into ... not hurt. There are two kinds of abdominal taps: Diagnostic tap -- a small amount of fluid is ...

  14. 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 ...

  15. 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...

  16. 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.

  17. 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.

  18. 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.

  19. Desafios endovasculares aórticos: cirurgia de recurso em patologia aórtica / Challenging aortic procedures: bailout techniques

    Scientific Electronic Library Online (English)

    Gonçalo R., Alves; Leonor, Vasconcelos; Hugo, Rodrigues; Nelson, Oliveira; Frederico, Gonçalves; Mª Emília, Ferreira; João A., Castro; L. Mota, Capitão.

    2013-12-01

    Full Text Available A técnica endovascular é uma reconhecida alternativa à cirurgia convencional, no tratamento da patologia aneurismática aorto-ilíaca. Alguns casos, no entanto, pelas suas especifi cidades anatómicas e/ou clínicas, constituem desafi os técnicos que requerem soluções complexas no seu tratamento. Os aut [...] ores apresentam 3 casos clínicos, tratados na sua Instituição entre Janeiro de 2008 e Dezembro de 2011, onde foram encontradas soluções pouco usuais no tratamento endovascular de aneurismas da aorta torácica e da aorta abdominal. Foram utilizadas alternativas como a técnica de Chimney e de Funnel. Não ocorreu mortalidade relacionada com a doença aneurismática em nenhum dos casos. Os casos clínicos apresentados demonstram a exequibilidade das técnicas assim como os detalhes técnicos inerentes a cada caso. Abstract in english The endovascular technique is now an alternative to conventional surgery in the treatment of aortoiliac aneurysms, especially for patients at high surgical risk. In some cases, however, due to their anatomical and/or clinical features, none of the conventional options are suitable, requiring complex [...] solutions. The authors present 3 cases reports, treated at their institution between January 2008 and December 2011, in which were used unusual solutions for the endovascular treatment of the thoracic and abdominal aortic aneurysms. The alternative techniques used were the Chimney and the Funnel. There was no aneurysm related mortality. This article set forth the techniques details and feasibility.

  20. Direct and indirect measurement of patient radiation exposure during endovascular aortic aneurysm repair.

    Science.gov (United States)

    Weiss, Dustin J; Pipinos, Iraklis I; Longo, G Mathew; Lynch, Thomas G; Rutar, Frank J; Johanning, Jason M

    2008-11-01

    With the increasing complexity of endovascular procedures, concern has grown regarding patient radiation exposure. Abdominal aortic aneurysm (AAA) repair represents the most common complex endovascular procedure currently performed by vascular specialists. Our study evaluates the patient radiation dose received during endovascular AAA repair. Over a 3-month period we prospectively monitored the radiation dose in a series of consecutive patients undergoing endovascular AAA repair. All patients underwent standard endovascular AAA repair with one of two commercially available grafts using the GE OEC 9800 unit. Direct measurement of maximum radiation dose at skin level (peak skin dose, PSD) was recorded using GAFCHROMIC radiographic dosimetry film. Indirect measurements of radiation dose (fluoroscopy time and dose-area-product [DAP]) were recorded with the C-arm dosimeter. A total of 12 consecutive patients undergoing standard endovascular AAA repair were evaluated. Mean PSD was 0.75 Gy (range 0.27-1.25). Mean total fluoroscopy time was 20.6 min (range 12.6-34.2) with an average of 92% spent in standard fluoroscopy and 8% spent in cinefluoroscopy. Regarding total fluoroscopy time, 49% was spent in normal field of view and 51% in magnified view. Mean DAP was 15,166 cGy x cm(2) (range 5,207-24,536). PSD correlated with DAP (r = 0.9, p 0.05). PSD also correlated with body mass index (BMI; r = 0.82, p < 0.05). Obese patients had a mean PSD of 1.1 Gy compared to 0.5 Gy in nonobese patients. PSD of all patients was well below the accepted 2.0 Gy threshold for skin injury. PSD correlated with DAP but not total fluoroscopy time. PSD also correlated with BMI, and the mean PSD was significantly increased in obese compared to nonobese patients. Despite the complexity and duration of endovascular AAA repair, the procedure can be performed safely without excessive radiation exposure. PMID:18992664

  1. 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 ...

  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. 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...

  4. ["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

  5. 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.

  6. 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

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

    Directory of Open Access Journals (Sweden)

    Carlo Zúñiga 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 tomografía 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.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 useful 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.

  8. 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.

  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 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

  11. Endovascular treatment of popliteal aneurysm.

    Science.gov (United States)

    de Donato, G; Setacci, F; Galzerano, G; Borrelli, M P; Mascolo, V; Mazzitelli, G; Ruzzi, U; Setacci, C

    2015-08-01

    Although traditional surgical repair by aneurysm exclusion and bypass is still considered the gold standard in the treatment of popliteal artery aneurysms (PAAs), the endovascular repair (ER) has been gaining great interest in the last decades. ER offers several advantages over open bypass, including lower morbidity and mortality, and faster functional recovery, but some concerns about migration, occlusion, or fracture remain when a stent graft is deployed across a joint that undergo constant flexion. This review summarizes the current evidence on ER for PAAs. Level I evidence is still very limited, while the majority of published data come from retrospective studies. Moreover the heterogeneity of PAA morphology seems to play a major role in the outcomes after popliteal endografts placement, so that many anatomical criteria should be taken into account to determine which patient is best treated endovascularly. In conclusion, while it is unlike that endovascular treatment may displace open surgical bypass in the near future, it indeed does provide a feasible option for selected patients with high surgical risk and good anatomical features. PMID:25742934

  12. Surgical approach of endovascular exclusion for thoracic aortic dissection

    International Nuclear Information System (INIS)

    Objective: To evaluate the surgical approach of endovascular exclusion for thoracic dissection. Methods: Thirty-seven cases of Stanford B type thoracic aortic dissection were undergone endovascular exclusion (EVE) and had been studied retrospectively. Preoperative evaluations for delivery arteries, including common femoral artery, iliac artery, and abdominal aorta, were carried out by using duplex ultrasonography (US), computed tomographic angiography (CTA) and magnetic resonance angiography (MRA). Factors such as arterial calibers, stenosis, tortuosity, sclerotic plaque and media dissection were taken into account. Choices of surgical approach were decided after comprehensive consideration of these factors. If the common femoral artery inner diameter was wider than 8 mm, without severe iliac artery stenosis or tortuosity; the common femoral artery should be selected as the delivery artery. In case of severe arterial stenosis and tortuosities, then the common iliac arteries were exposed by retroperitoneal approach and graft was delivered through this artery. Results: Mural sclerotic plaques were more sensitive to be revealed by US, conversely with CTA and MRA in showing stenosis and tortuosity directly and clearly. Utilizing this preoperative evaluating system, all the grafts passed successfully and favourably through the arteries, without any delivery artery associated complications. Conclusions: Using US, CTA and MRA in combination was necessary for preoperative evaluation of the delivery artery. In those with poor femoral artery condition, exposing common iliac artery decidedly is necessary to ensure the procedure favorably and to avoid delivery artery associated complications

  13. 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.

  14. Endovascular Treatment of Isolated Dissection of Superior Mesenteric Artery.

    Science.gov (United States)

    Sirignano, P; Setacci, F; Galzerano, G; Setacci, C

    2015-01-01

    Isolated spontaneous dissection of the superior mesenteric artery is extremely rare. In December 2012, a 45-year-old man, without significant comorbidities, presented at the emergency room of another hospital with abdominal pain. The patient was treated with medical therapy and discharged on resolution of the pain. Three months later he returned to the emergency room with a new onset of pain. CT-angiography (CTA) showed an isolated SMA dissection associated with aneurysmal dilatation. The patient was referred to our attention. We attempted endovascular exclusion of the dissecting aneurysm in May 2013. We deployed a self-expandable nitinol stent (BostonSC Adapt 4-9 × 32 mm) in order to simultaneously repair the dissection, preserve the branches and exclude the aneurysm. Postoperative course was uneventful and the patient was discharged on postoperative day 2. At 10-month follow-up CTA showed excellent positioning of the stent, patency of the visceral branches and shrinkage of the aneurysm. PMID:26324038

  15. 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

  16. 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

  17. 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)

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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)

  3. Abdominal Pain or Cramping

    Science.gov (United States)

    ... Body & lifestyle changes > Abdominal pain or cramping Abdominal pain or cramping Now playing: E-mail to a ... signs of severe pain. What causes mild belly pain in pregnancy? There are different causes for mild ...

  4. Total abdominal colectomy

    Science.gov (United States)

    Total abdominal colectomy is the removal of the large intestine from the lowest part of the small ... Total abdominal colectomy is most often safe. Your risk depends on your general overall health. Ask your ...

  5. 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.

  6. 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.

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

    Scientific Electronic Library Online (English)

    CARLO, ZÚÑIGA G; RENATO, MERTENS M; FRANCISCO, VALDÉS E; ALBRECHT, KRÄMER SCH; LEOPOLDO, MARINÉ M; MICHEL, BERGOEING R; JEANNETTE, VERGARA G; CLAUDIA, CARVAJAL N.

    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. Abstract in english 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 surgi [...] cal 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.

  8. 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.

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

    Scientific Electronic Library Online (English)

    Leonardo Pessoa, Cavalcante; Marcos Velludo, Bernardes; Ricardo Dias da, Rocha; Marcos Henrique, Parisati; Juliana Lopes, Alfaia; José Emerson dos Santos, Souza; Patrícia de Souza, Lacerda; Raquel Magalhães, Pereira.

    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 car [...] díaca 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. Abstract in english 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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 treated with endovascular embolisation of the SAA with coils. Blood pressure and haemoglobin levels were stabilized and the patient was discharged. In the case of rupture the treatment of choice seems to b...

  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. 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 ...

  16. 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

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. Successful balloon dilation of an abdominal coarctation of the aorta in patient with presumed Takayasu's aortitis.

    Science.gov (United States)

    Kashani, I A; Sklansky, M S; Movahed, H; Lucas, V W; Rothman, A

    1996-08-01

    An 11-year-old male with a severe abdominal aortic coarctation, presumably secondary to aortitis, underwent successful percutaneous balloon dilation that resulted in near-complete relief of the obstruction. Intravascular ultrasound imaging showed a major endovascular tear immediately following dilation and satisfactorily excluded significant branch (superior mesenteric) artery compromise. Arterial remodeling was demonstrated with persistence of the gradient relief over a 12-month follow-up period. PMID:8853153

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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...

  9. 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 ...

  10. Endovascular Tubular Stent-Graft Placement for Isolated Iliac Artery Aneurysms

    International Nuclear Information System (INIS)

    Purpose: To evaluate the safety, efficacy, and mid-term outcomes of endovascular tubular stent-graft placement for repair of isolated iliac artery aneurysms (IAAs). Materials and Methods: Between January 2002 and March 2010, 20 patients (7 women and 13 men; mean age 74 years) underwent endovascular repair of 22 isolated IAAs. Two patients underwent endovascular repair for bilateral aneurysms. Ten para-anastomotic aneurysms (45%) developed after open abdominal aortic aneurysm (AAA) repair with an aorto-iliac graft, and 12 were true aneurysms (55%). Eleven straight and 11 tapered stent-grafts were placed. Contrast-enhanced computed tomography (CT) was performed to detect complications and evaluate aneurysmal shrinkage at week 1, 3, 6, and 12 months and once every year thereafter. Non–contrast-enhanced CT was performed in seven patients with chronic kidney disease. Results: All procedures were successful, without serious complications, during the mean (range) follow-up period of 746 days (47–2651). Type II endoleak not requiring treatment was noted in one patient. The mean (SD) diameters of the true and para-anastomotic aneurysms significantly (p < 0.05) decreased from 42.0 (9.3) to 36.9 (13.6) mm and from 40.1 (13.0) to 33.6 (15.8) mm, respectively; the mean (SD) shrinkage rates were 15.1% (20.2%) and 18.9% (22.4%), respectively. The primary patency rate was 100%, and no secondary interventions were required. Four patients (21%) developed transient buttock claudication, and one patient (5%) developed colorectal ischaemia, which was treated conservatively. Conclusion: Endovascular tubular stent-graft placement for the repair of isolated IAAs is safe and efficacious. Tapered stent-grafts of various sizes are required for accurate placement.

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. 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. ?????

  17. Rotura de aorta torácica descendente: Tratamiento endoprotésico Descending thoracic aortic rupture, endoprosthetic treatment

    Directory of Open Access Journals (Sweden)

    A. Fernández Carmona

    2011-05-01

    Full Text Available La rotura de la aorta, independientemente de su localización y etiología, es una afección extremadamente grave que conduce a la muerte rápidamente. En el momento actual no hay consenso sobre si el tratamiento endovascular de la rotura de la aorta torácica descendente es superior al tratamiento quirúrgico convencional a medio y largo plazo. En esta serie, de 13 casos, describimos nuestra experiencia y evaluamos los resultados en pacientes tratados de forma endoprotésica desde enero de 2005 hasta enero de 2009.Aortic rupture, independently of its location and etiology, is an extremely serious condition that leads to death rapidly. There is currently no consensus on whether endovascular treatment of the descending thoracic aortic rupture is superior to conventional surgical repair in terms of mid-or long-terms outcome. We describe our experience with 13 patients from January 2005 to January 2009 to evaluate the results in patients with descending thoracic aortic rupture undergoing endoprosthetic management.

  18. A 3D model of thrombus formation in a stent-graft after implantation in the abdominal aorta.

    Science.gov (United States)

    Polanczyk, Andrzej; Podyma, Marek; Stefanczyk, Ludomir; Szubert, Wojciech; Zbicinski, Ireneusz

    2015-02-01

    Here we present a 3D kinetic model of thrombus formation in an endovascular prosthesis after implantation in an abdominal aorta with an aneurysm. The computational fluid dynamic technique (CFD) was used to determine the process of thrombus formation and growth in the stent-graft on the basis of the medical data from computed tomography angiography and Doppler ultrasound examination of 10 patients. The Quemada model was used to describe rheological properties of blood. Results of the CFD simulations were validated based on actual data from patients with diagnosed thrombi in aortic implants. The results show that the elaborated CFD model correctly predicted thrombus formation, shape and deposition site in an endovascular prosthesis. The developed CFD model of thrombus growth can be applied to predict the risk of thrombus formation in stent-grafts and assist in selection of geometry of the endovascular prosthesis to reduce possible complications after stent-graft implantation using only basic medical data. PMID:25543277

  19. 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.

  20. 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...

  1. 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

  2. Multi-selective catheter for MR-guided endovascular interventions.

    Science.gov (United States)

    Clogenson, Helene C M; van Lith, Joris Y; Dankelman, Jenny; Melzer, Andreas; van den Dobbelsteen, John J

    2015-07-01

    Selective catheters have predefined distal shapes and need to be exchanged to change tip geometry to facilitate selective catheterization of vascular side branches. These repeated insertions increase the risk of endovascular injury and radiation dose in conventional catheterization laboratories. The aim of this study is to develop a multi-selective catheter that can replace three conventional selective catheters that are commonly used sequentially in a single procedure. By integrating the different shapes in one instrument, it is possible to avoid the required time-consuming exchange. This new instrument is also made compatible with magnetic resonance imaging (MRI) guidance, which, unlike X-ray, presents variable soft tissue contrast without the use of ionizing radiation. A 1.2 m long and 2.15 mm diameter deflectable polymer-based catheter was assembled and three widely used selective catheters could be mimicked. The instrument was visible on the images without producing unwanted artifacts in an abdominal model and in an animal under real-time MRI guidance. Simple navigation tasks were performed together with a 0.035 in. MRI-safe guidewire. In these tasks, the iliac, renal, brachiocephalic, and left subclavian arteries were cannulated only by using the shape setting and without exchange of the instruments. PMID:25937614

  3. 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

  4. [Full term abdominal pregnancy].

    Science.gov (United States)

    Faller, E; Kauffmann, E; Chevrière, S; Heisert, M; Ranjatoelina, H; Boumahni, B; Sitty-Amina, A A; Barau, G

    2006-11-01

    Abdominal pregnancy is a rare localization of ectopic pregnancy, more frequently observed in underdeveloped countries. We report a case of abdominal pregnancy carried to full term delivery, discovered at a time of a cesarean for low site of placenta attachment. Discovery of an abdominal pregnancy at the time of C-section seems exceptional with clinical and ulrasonographic surveillance of pregnancy. The objective of our article is to emphasize the importance of localizing the appendix at the first quarter echography and the utility of the endovaginal ulrasound. PMID:17088777

  5. 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.

  6. 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

  7. Endovascular management of carotid-cavernous fistulas

    International Nuclear Information System (INIS)

    Objective: To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas (CCF) and their complications such as pseudoaneurysms. Methods: Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coil embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stent management of the pseudoaneurysms. Results: All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% (4/22). A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% (8/22). Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion: Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents. (authors)

  8. 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.

  9. 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.

  10. 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

  11. Endovascular treatments for cerebral venous sinus thrombosis.

    Science.gov (United States)

    Qiu, Zhongming; Sang, Hongfei; Dai, Qiliang; Xu, Gelin

    2015-10-01

    Cerebral venous sinus thrombosis (CVST) is an uncommon but potentially fatal condition. CVST usually occurs young adults with a female predominance. The current mainstay for treating CVST is anticoagulation with heparin. However, more aggressive interventions, endovascular treatment as an example, may be indicated in selected patients who are non-responsive to heparin and other anticoagulants. Endovascular approaches include catheter-based local chemical thrombolysis, balloon angioplasty and mechanical thrombectomy, all of which may rapidly recanalize the occluded venous sinus, restore the blood flow, reduce the increased intracranial pressure, and subsequently relieve the corresponding symptoms. However, as an invasive strategy, endovascular procedures per se may cause complications, such as intracranial hemorrhage, vessel dissection and pulmonary embolization, which may substantially decrease the benefit-risk ratio of the treatment. Due to the rareness of the condition and the limited indication of this invasive strategy, safety and efficacy of endovascular procedures in treating CVST are less feasible to be evaluated in large randomized clinical trails. Therefore, the evidences for justifying this treatment strategy are largely derived from case reports, cohort studies and clinical observations. PMID:25771984

  12. 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.

  13. 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 ...

  14. 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 ...

  15. 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

  16. 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.

  17. Abdominal ultrasound (image)

    Science.gov (United States)

    Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X- ... use high frequency sound waves to produce an image and do not expose the individual to radiation. ...

  18. CT of abdominal abscesses

    International Nuclear Information System (INIS)

    The imaging search for a suspected abdominal abscess is common in hospitalized patients, especially after recent abdominal surgery. This paper examines the role of CT in the detection, localization, and treatment of abdominal abscess. The accuracy, limitations, and technical aspects of CT in this clinical setting are discussed. The diagnosis of an abscess is based on the demonstration of a circumscribed abnormal fluid collection. Although percutaneous aspiration with gram stain and culture is usually indicated to differentiate abscess from other fluid collections, the CT-based detection of extraluminal gas bubbles makes the diagnosis of an abscess highly likely. CT is compared with conventional radiographic studies, US, and radio-nuclide imaging. Specific CT and clinical features of abscesses in the following sites are emphasized: subphrenic space, liver, pancreas, kidneys, psoas muscle, appendix, and colonic diverticula. Most abdominal abscesses can be successfully treated with percutaneous drainage techniques. The techniques, results, and limitations of percutaneous abscess drainage are reviewed

  19. Abdominal CT scan

    Science.gov (United States)

    Computed tomography scan - abdomen; CT scan - abdomen; CAT scan - abdomen; CT abdomen and pelvis ... An abdominal CT scan makes detailed pictures of the structures inside your belly (abdomen) very quickly. This test may be used to ...

  20. 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 ...

  1. 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

  2. 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

  3. Intra-abdominal gossypiboma

    OpenAIRE

    Topal, Firdevs; Akbulut, Sabiye; Dinçer, Nazmiye; Topçu, Ça?atay; Y?lmaz, ?eref; Sar?kaya, Hikmet; Yönem, Özlem; Topal, Fatih Esat

    2011-01-01

    AbstractA surgical sponge left in abdominal cavity following completion of the operation (Gossypiboma) is a rare entity. Surgical gauze pad will initiate a granulomatous reaction and it may appear as a large intra-abdominal mass. This condition is referred as gossypiboma. They may not only cause aseptic reactions without significant symptom, but they may also lead to exudative reaction which is manifested in the early phase with non-specific symptoms. Computerized Tomography (CT) is a very va...

  4. ENDOMETRIOSIS DE LA PARED ABDOMINAL

    Scientific Electronic Library Online (English)

    Antonio, Carvajal M; Italo, Braghetto M; Rodrigo, Carvajal G; Cristián, Miranda V.

    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 bordes Abstract in english Background: 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 diagnosi [...] s 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

  5. 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.

  6. Profilaxis antibiótica en histerectomía abdominal y vaginal

    Scientific Electronic Library Online (English)

    Joaquín, Hernández Torres; Gilberto, Pardo Gómez; Isabel C, Acosta Guedes.

    1998-12-01

    Full Text Available Se estudiaron retrospectivamente los expedientes clínicos de 155 pacientes a las que se les realizó histerectomía por vía abdominal o vaginal, en el Servicio de Cirugía General durante un período de 30 meses. Las pacientes se dividieron en 3 grupos según: a) recibieron antibioticoterapia perioperato [...] ria, b) recibieron antibioticoterapia en el posoperatorio inmediato y c) no recibieron tratamiento antibiótico. Se analizó la tasa de infección de la herida quirúrgica, además de la relación de ésta con algunos factores, entre ellos el tiempo quirúrgico y la antisepsia vaginal. Se llevaron los resultados a tratamiento estadístico (chi cuadrado y test de Fisher) y se concluyó en que existe diferencia significativa entre la tasa de infección de la herida cuando se utiliza profilaxis perioperatoria (4,7 %) si se compara con las pacientes que no recibieron tratamiento antibiótico Abstract in english A retrospective study of the medical histories of 155 patients who underwent vaginal of abdominal hysterectomy at the General Surgery Service during 30 months was conducted. Patients were divided into 3 groups: a) patients who received perioperative antibiotic therapy, b) patients that were administ [...] ered antibiotics theraphy in the immediate postoperative and c) those under no antibiotics treatment. The surgical wound infection rate was analyzed as well as its relation with some factors, such as surgical time and vaginal antisepsis. The results were statistically treated (chi square and Fisher’s test) and it was concluded that there is a significant difference between the wound infection rate of patients receiving perioperative prophylaxis (4.7 %) and those without antibiotics treatment

  7. Profilaxis antibiótica en histerectomía abdominal y vaginal

    Directory of Open Access Journals (Sweden)

    Joaquín Hernández Torres

    1998-12-01

    Full Text Available Se estudiaron retrospectivamente los expedientes clínicos de 155 pacientes a las que se les realizó histerectomía por vía abdominal o vaginal, en el Servicio de Cirugía General durante un período de 30 meses. Las pacientes se dividieron en 3 grupos según: a recibieron antibioticoterapia perioperatoria, b recibieron antibioticoterapia en el posoperatorio inmediato y c no recibieron tratamiento antibiótico. Se analizó la tasa de infección de la herida quirúrgica, además de la relación de ésta con algunos factores, entre ellos el tiempo quirúrgico y la antisepsia vaginal. Se llevaron los resultados a tratamiento estadístico (chi cuadrado y test de Fisher y se concluyó en que existe diferencia significativa entre la tasa de infección de la herida cuando se utiliza profilaxis perioperatoria (4,7 % si se compara con las pacientes que no recibieron tratamiento antibióticoA retrospective study of the medical histories of 155 patients who underwent vaginal of abdominal hysterectomy at the General Surgery Service during 30 months was conducted. Patients were divided into 3 groups: a patients who received perioperative antibiotic therapy, b patients that were administered antibiotics theraphy in the immediate postoperative and c those under no antibiotics treatment. The surgical wound infection rate was analyzed as well as its relation with some factors, such as surgical time and vaginal antisepsis. The results were statistically treated (chi square and Fisher’s test and it was concluded that there is a significant difference between the wound infection rate of patients receiving perioperative prophylaxis (4.7 % and those without antibiotics treatment

  8. Stratifying Carotid Diseases for Endovascular Treatments

    OpenAIRE

    Xu, Gelin; Zhu, Juehua; Liu, Xinfeng

    2012-01-01

    Endovascular angioplasty and stenting (CAS) has evolved as an alternative for treating occlusive carotid diseases in recent years. Carotid diseases are characterized by manifold etiologies and miscellaneous clinical manifestations. Although CAS is efficacious in treating patients with occlusive carotid diseases as a whole, the long-term risk-benefit ratio may vary in individual patients. Interventional strategies, such as angioplasty and stenting, should be individualized based on the etiolog...

  9. Control of abdominal muscles.

    Science.gov (United States)

    Iscoe, S

    1998-11-01

    Abdominal muscles serve many roles; in addition to breathing, especially at higher levels of chemical drive or at increased end-expiratory lung volumes, they are responsible for, or contribute to, such protective reflexes as cough, sneeze, and vomiting, generate the high intra-abdominal pressures necessary for defecation and parturition, are active during postural adjustments, and play an essential role in vocalization in many species. Despite this widespread involvement, however, their control has, with rare exceptions, received little attention for two major reasons. First, in most anesthetized or decerebrate preparations, they are relatively inactive at rest, in part because the position of the preparation (supine or prone with abdomen supported), reduces lung volume and, therefore, their activity. Second, unlike phrenic motoneurons innervating the diaphragm, identification of motoneurons to a particular abdominal muscle is difficult. At the lumbar level, a given motoneuron may innervate any one of the four abdominal muscles; at the thoracic level, they are also intermixed with those innervating the intercostals. The two internal muscles, the internal oblique and the transverse abdominis, respond more to increases in chemical or volume-related drive than the two external muscles, the rectus abdominis and external oblique; the basis for this differential sensitivity is unknown. Segmental reflexes at the thoracic and lumbar levels are sufficient to activate abdominal motoneurons in the absence of descending drive but the basis for these reflex effects is also unknown. Neuroanatomical experiments demonstrate many more inputs to, and outputs from, the nucleus retroambigualis, the brainstem region in which the premotor neurons are located, than can be accounted for by their respiratory role alone. These other connections likely subserve activities other than respiration. Studies of the multifunctional roles of the abdominal muscles, on the basis of recent work, hold considerable promise for improving our understanding of their control. PMID:9775401

  10. 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.

  11. 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.)

  12. 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)

  13. 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.

  14. 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

  15. 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.

  16. ACR Appropriateness Criteria® pulsatile abdominal mass, suspected abdominal aortic aneurysm

    OpenAIRE

    Desjardins, Benoit; Dill, Karin E.; Flamm, Scott D.; Francois, Christopher J.; Gerhard-Herman, Marie D; Kalva, Sanjeeva P; Mansour, M. Ashraf; Mohler, Emile R.; Oliva, Isabel B.; Schenker, Matthew P.; Weiss, Clifford; Frank J. Rybicki

    2012-01-01

    Clinical palpation of a pulsating abdominal mass alerts the clinician to the presence of a possible abdominal aortic aneurysm (AAA). Generally an arterial aneurysm is defined as a localized arterial dilatation ?50 % greater than the normal diameter. Imaging studies are important in diagnosing the cause of a pulsatile abdominal mass and, if an AAA is found, in determining its size and involvement of abdominal branches. Ultrasound (US) is the initial imaging modality of choice when a pulsatile ...

  17. 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.

  18. Tratamento endovascular de lesões arteriais traumáticas Endovascular management of traumatic arterial injuries

    Directory of Open Access Journals (Sweden)

    Ruy Fernandes e Fernandes

    2011-03-01

    Full Text Available Introdução: As lesões arteriais traumáticas ocorrem em menos de 10% de politraumatizados e, nos países desenvolvidos, tem-se observado uma preponderância crescente de traumatismos vasculares iatrogénicos. Recentemente vários autores têm descrito a utilização de técnicas endovasculares com sucesso, pelo menor risco cirúrgico, em lesões de difícil acesso cujo tratamento convencional requer grande exposição cirúrgica, dificuldade técnica e mortalidade ou morbilidade apreciáveis. Os procedimentos endovasculares representam ainda uma alternativa terapêutica com menor mortalidade no tratamento de complicações crónicas de traumatismos vasculares, nomeadamente nos aneurismas pós-traumáticos do istmo aórtico (APTIA. Os autores apresentam uma série de doentes com lesões traumáticas arteriais diversas, em fase aguda ou crónica, tratados por via endovascular. Casos Clínicos: Sete doentes (21-77 anos, foram submetidos a tratamento endovascular de traumatismos vasculares na fase aguda ou crónica. Quatro doentes apresentavam lesões traumáticas agudas: 1 caso de rotura traumática do istmo aórtico (RTIA em politraumatismo por acidente de viação; 1 caso de rotura da artéria subclávia (RAS iatrogénica após tentativa de colocação de catéter de hemodiálise; 1 caso rotura de artéria renal (RAR durante angioplastia/stent por doença renovascular; 1 caso de fístula arterio-venosa (FAV da artéria renal intra-parenquimatosa iatrogénica após tumorectomia laparoscópica. Três doentes com complicações crónicas de traumatismos torácicos apresentavam falsos aneurismas do arco aórtico. Os doentes com roturas arteriais foram submetidos a exclusão endovascular com endoprótese e o doente com FAV renal foi submetido a embolização com coils. Os três doentes portadores de APTIA foram submetidos a: tratamento endovascular de aneurisma da aorta torácica (TEVAR-1; “debranching” com bypass carótido-subclávio e TEVAR-2. Todos os procedimentos foram realizados com sucesso. Não se verificou mortalidade. No doente com RAS houve necessidade de cirurgia de descorticação pulmonar esquerda, por hematoma organizado, e o doente com FAV foi submetido com sucesso a nova embolização com coils por recorrência precoce de hematúria. Conclusão: O tratamento endovascular é, em casos seleccionados, uma alternativa válida e menos invasiva de lesões traumáticas complexas em regiões anatómicas de difícil acesso e morbi-mortalidade cirúrgica elevada.Introduction: Traumatic vascular injuries are present in less than 10% of patients with multi-organ trauma and, in western countries, the incidence of iatrogenic vascular lesions has been increasing. Conventional surgery in the approach of these lesions usually requires extended surgical exposure, presents increased technical challenges and has high morbidity and mortality. Recently, several authors have described the successful management of traumatic injuries with endovascular techniques with diminished surgical risk. Endovascular surgery has also been increasingly applied in management of chronic traumatic injuries like chronic post-traumatic thoracic aneurysms with significant improved outcomes. The authors present clinical cases with several acute and chronic traumatic vascular injuries treated with endovascular techniques, Clinical reports: Seven patients (21-77 years with traumatic vascular injuries were treated. Four patients presented acute injuries: 1 case of traumatic aortic injury in a patient with multi-organ trauma after automobile crash; 1 case of iatrogenic subclavian artery rupture after inadvertent subclavian artery catheterization during attempted venous central access ; 1 case of iatrogenic renal artery rupture during renal angioplasty and stenting; 1 case of iatrogenic intra-renal arterio-venous fistula (AVF after laparoscopic resection of a renal tumour. Three patients presented with chronic post-traumatic thoracic aneurysms. In the patients with arterial rupture endovascular exclusion with stentgrafts was perform

  19. Ruptured Petrous Carotid Pseudoaneurysm Due to Tuberculous Otitis: Endovascular Treatment

    OpenAIRE

    Yagci, A.B.; Ardiç, F.N.; Oran, I.; Bir, F; Karabulut, N.

    2006-01-01

    We report the imaging findings and endovascular treatment in an unusual case of petrous internal carotid artery pseudoaneurysm due to primary tuberculous otitis. The aneurysm was recognized and ruptured during a surgical intervention for otitis. Successful endovascular treatment of the aneurysm was performed by occlusion of the parent vessel using detachable balloon and coils.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  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. Tratamento endovascular de lesões arteriais traumáticas / Endovascular management of traumatic arterial injuries

    Scientific Electronic Library Online (English)

    Ruy, Fernandes e Fernandes; Luís Mendes, Pedro; Ana, Evangelista; Jose L., Gimenez; Luís, Silvestre; J. P., Freire; J., Fernandes e Fernandes.

    2011-03-01

    Full Text Available Introdução: As lesões arteriais traumáticas ocorrem em menos de 10% de politraumatizados e, nos países desenvolvidos, tem-se observado uma preponderância crescente de traumatismos vasculares iatrogénicos. Recentemente vários autores têm descrito a utilização de técnicas endovasculares com sucesso, p [...] elo menor risco cirúrgico, em lesões de difícil acesso cujo tratamento convencional requer grande exposição cirúrgica, dificuldade técnica e mortalidade ou morbilidade apreciáveis. Os procedimentos endovasculares representam ainda uma alternativa terapêutica com menor mortalidade no tratamento de complicações crónicas de traumatismos vasculares, nomeadamente nos aneurismas pós-traumáticos do istmo aórtico (APTIA). Os autores apresentam uma série de doentes com lesões traumáticas arteriais diversas, em fase aguda ou crónica, tratados por via endovascular. Casos Clínicos: Sete doentes (21-77 anos), foram submetidos a tratamento endovascular de traumatismos vasculares na fase aguda ou crónica. Quatro doentes apresentavam lesões traumáticas agudas: 1 caso de rotura traumática do istmo aórtico (RTIA) em politraumatismo por acidente de viação; 1 caso de rotura da artéria subclávia (RAS) iatrogénica após tentativa de colocação de catéter de hemodiálise; 1 caso rotura de artéria renal (RAR) durante angioplastia/stent por doença renovascular; 1 caso de fístula arterio-venosa (FAV) da artéria renal intra-parenquimatosa iatrogénica após tumorectomia laparoscópica. Três doentes com complicações crónicas de traumatismos torácicos apresentavam falsos aneurismas do arco aórtico. Os doentes com roturas arteriais foram submetidos a exclusão endovascular com endoprótese e o doente com FAV renal foi submetido a embolização com coils. Os três doentes portadores de APTIA foram submetidos a: tratamento endovascular de aneurisma da aorta torácica (TEVAR)-1; “debranching” com bypass carótido-subclávio e TEVAR-2. Todos os procedimentos foram realizados com sucesso. Não se verificou mortalidade. No doente com RAS houve necessidade de cirurgia de descorticação pulmonar esquerda, por hematoma organizado, e o doente com FAV foi submetido com sucesso a nova embolização com coils por recorrência precoce de hematúria. Conclusão: O tratamento endovascular é, em casos seleccionados, uma alternativa válida e menos invasiva de lesões traumáticas complexas em regiões anatómicas de difícil acesso e morbi-mortalidade cirúrgica elevada. Abstract in english Introduction: Traumatic vascular injuries are present in less than 10% of patients with multi-organ trauma and, in western countries, the incidence of iatrogenic vascular lesions has been increasing. Conventional surgery in the approach of these lesions usually requires extended surgical exposure, p [...] resents increased technical challenges and has high morbidity and mortality. Recently, several authors have described the successful management of traumatic injuries with endovascular techniques with diminished surgical risk. Endovascular surgery has also been increasingly applied in management of chronic traumatic injuries like chronic post-traumatic thoracic aneurysms with significant improved outcomes. The authors present clinical cases with several acute and chronic traumatic vascular injuries treated with endovascular techniques, Clinical reports: Seven patients (21-77 years) with traumatic vascular injuries were treated. Four patients presented acute injuries: 1 case of traumatic aortic injury in a patient with multi-organ trauma after automobile crash; 1 case of iatrogenic subclavian artery rupture after inadvertent subclavian artery catheterization during attempted venous central access ; 1 case of iatrogenic renal artery rupture during renal angioplasty and stenting; 1 case of iatrogenic intra-renal arterio-venous fistula (AVF) after laparoscopic resection of a renal tumour. Three patients presented with chronic post-traumatic thoracic aneurysms. In the patients with arterial rupture endovas

  6. Colorectal cancer associated with abdominal aortic aneurysm: results of EVAR followed by colectomy.

    Science.gov (United States)

    Illuminati, Giulio; Ceccanei, Gianluca; Pacilè, Maria A; Pizzardi, Giulia; Palumbo, Piergaspare; Vietri, Francesco

    2013-01-01

    The association of colorectal cancer and abdominal aortic aneurysm (AAA) is infrequent but poses special problems of priority of treatment under elective circumstances. The purpose of this study was to retrospectively evaluate the outcome of 16 consecutive patients undergoing endovascular aneurysm repair (EVAR) followed by colectomy. Operative mortality was nil. Operative morbidity included two transient rise of serum creatinine level and one extraperitoneal anastomotic leakage which evolved favourably with conservative treatment. EVAR allowed a very short delay of treatment of colorectal cancer after aneurysm repair, minimizing operative complications. PMID:23151840

  7. 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.

  8. 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.

  9. 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

  10. de novo'' aneurysms following endovascular procedures

    International Nuclear Information System (INIS)

    Two personal cases of ''de novo'' aneurysms of the anterior communicating artery (ACoA) occurring 9 and 4 years, respectively, after endovascular carotid occlusion are described. A review of the 30 reported cases (including our own two) of ''de novo'' aneurysms after occlusion of the major cerebral vessels has shown some features, including a rather long time interval after the endovascular procedure of up to 20-25 years (average 9.6 years), a preferential ACoA (36.3%) and internal carotid artery-posterior communicating artery (ICA-PCoA) (33.3%) location of the ''de novo'' aneurysms, and a 10% rate of multiple aneurysms. These data are compared with those of the group of reported spontaneous ''de novo'' aneurysms after SAH or previous aneurysm clipping. We agree that the frequency of ''de novo'' aneurysms after major-vessel occlusion (two among ten procedures in our series, or 20%) is higher than commonly reported (0 to 11%). For this reason, we suggest that patients who have been submitted to endovascular major-vessel occlusion be followed up for up to 20-25 years after the procedure, using non-invasive imaging studies such as MR angiography and high-resolution CT angiography. On the other hand, periodic digital angiography has a questionable risk-benefit ratio; it may be used when a ''de novo'' aneurysm is detected or suspected on non-invasive studies. The progressive enlargement of the ACoA after carotid occlusion, as described in our case 1, must be considered a radiological finding of risk for ''de novo'' aneurysm formation. (orig.)

  11. 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

  12. Minimally Invasive Abdominal Surgery

    OpenAIRE

    Richardson, William S.; Carter, Kristine M.; Fuhrman, George M.; Bolton, John S.; Bowen, John C.

    2000-01-01

    In the last decade, laparoscopy has been the most innovative surgical movement in general surgery. Minimally invasive surgery performed through a few small incisions, laparoscopy is the standard of care for the treatment of gallbladder disease and the gold standard for the treatment of reflux disease. The indications for a laparoscopic approach to abdominal disease continue to increase, and many diseases may be treated with laparoscopic techniques. At Ochsner, laparoscopic techniques have dem...

  13. Endovascular Treatment of the Carotid Stump Syndrome

    International Nuclear Information System (INIS)

    In patients with an occluded internal carotid artery, the carotid stump syndrome is a potential source of microemboli that pass through the ipsilateral external carotid artery and the ophthalmic artery to the territory of the middle cerebral artery. Thus, the syndrome is associated with carotid territory symptoms although the internal carotid artery is occluded. Surgical exclusion of the internal carotid artery associated with endarterectomy of the external carotid artery has been described as the gold standard of treatment by many authors. This report is the second case, to our knowledge, of endovascular treatment of the carotid stump syndrome with the use of a stent-graft

  14. 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

  15. Abdominal aspergillosis: CT findings

    International Nuclear Information System (INIS)

    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.

  16. 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.

  17. Trauma abdominal complejo en una Unidad de Cuidados Intermedios Quirúrgicos / Complex abdominal trauma in an Intermediate Surgical Care Unit

    Scientific Electronic Library Online (English)

    Pablo Raúl, de Posada Jiménez; Ariel, Jordán Alonso; Abel, Antigua Godoy; Lizbet, León Herrera; Ramiro, Guedes Díaz; Yanet, Téstar de Armas.

    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 Q [...] uirúrgicos 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. Abstract in english 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.

  18. 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

  19. 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.)

  20. 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.

  1. Primary Self-Expandable Nitinol Stent Placement in Focal Lesions of Infrarenal Abdominal Aorta: Long Term Results

    International Nuclear Information System (INIS)

    Purpose. To evaluate the technical and clinical success, safety and long term results of percutaneous transluminal angioplasty/self-expandable nitinol stent placement of infrarenal abdominal aorta focal lesions. Materials and Methods. Eighteen patients underwent PTA of focal atherosclerotic occlusive disease of distal abdominal aorta. Two symptomatic occlusions and 16 stenoses in 10 male and 8 female patients (mean age 68.2 years) were treated with primary self-expandable nitinol stent placement. Results. Primary self-expandable nitinol stent placement was technically successful in all 18 procedures; clinical success was achieved in 100% of patients. No complications associated with the procedure occurred. During the 49.4 months of mean follow up (range 3-96, 4 months) all treated aortic segments remained patent. Conclusions. Endovascular treatment (primary self-expandable nitinol stent placement) of focal atherosclerotic lesions of distal abdominal aorta is a safe method with excellent primary technical and clinical success rates and favourable Long term results

  2. Outcomes and costs of endovascular and open repair in patients with a ruptured abdominal aortic aneurysm

    OpenAIRE

    Kapma, Marten Roel,

    2013-01-01

    Vaatchirurgen maken steeds meer gebruik van EVAR, een operatietechniek via de lies die kan worden ingezet bij patiënten met een gesprongen slagader in buik. De behandeling geeft uitstekende overlevingscijfers, maar is niet goedkoper dan een buikoperatie. Dat concludeert Marten Kapma in een onderzoek naar de kosteneffectiviteit van deze twee verschillende operatietechnieken. Mensen met een uitpuiling van de slagader in de buik lopen het risico dat deze verzwakte plek knapt, met een levensg...

  3. 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.

  4. 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.

  5. Beneficio de la ecosonografía abdominal en la evaluación pediátrica de rutina / Routine abdominal ecosonografic scan in children

    Scientific Electronic Library Online (English)

    Enicar, Perla; Dianora, Navarro; Karolina, López; María Ines, Quintero; Ana, Manzano; Creddy, Figuereo; Betzabeth, Quintana; Katiuska, Belandria.

    2012-06-01

    Full Text Available La ecografía abdominal es importante en el diagnóstico y tratamiento de un número elevado de patologías abdominales. El dolor abdominal es la principal indicación de ecografía. Se plan-tea la posibilidad de diagnosticar alteraciones y/o patologías asintomáticas, que pueden requerir intervención temp [...] rana. Objetivo: determinar el beneficio de la ecosonografía abdominal en la evaluación pediátrica de rutina. Pacientes y Método: trabajo prospectivo y transversal. Se incluyen pacientes escogidos al azar, para realizarles ecografía abdominal. Distribuidos en grupo A, los niños con solicitud de evaluación gastrointestinal y grupo B, niños sin patología gastrointestinal. Se solicita consentimiento informado. Resultados: un total de 182 niños, promedio de edad 4,70 años (rango 1m-14 años), 92 varones y 90 hembras. De 131 niños, con enfermedad gastrointestinal, grupo A, 32(24,42%) presentaron alteraciones a la ecografía. De ellos 17/32(53,12%) con hallazgos ecográficos en relación a la enfermedad de base siendo lo más frecuentes hepatopatías (esteatosis, hepatomegalia, fibrosis periportal), litiasis vesicular, cambios en vísceras huecas y reflujo gastroesofágico; 15/32(46,88%) se detectaron alteraciones no relacionados con la enfermedad de base, como: enfermedad renal, tumoración abdominal, esplenomegalia. Grupo B: 16/51 (31,37%) se detectó alteraciones en órganos abdominales: barro biliar, esplenomegalia, hepatopatía, alteraciones renales y otras. Se encontró una diferencia significativa entre los grupos, en relación al hallazgo de alteraciones ecográficas no relacionadas con el motivo de consulta. Los resultados permiten inferir que la ecografía es una herramienta sensible que puede ser utilizada de rutina en la evaluación pediátrica para detectar alteraciones en órganos abdominales para una intervención temprana y tratamiento oportuno. Abstract in english Abdominal ultrasound is important in the diagnosis and treatment of a large number of abdominal pathology. Abdominal pain is the main indication for ultrasound. It raises the possibility of diagnosing disorders and/or asymptomatic pathologies that may require early intervention. Objective: To determ [...] ine the benefit of abdominal sonography in the routine pediatric evaluation. Methods: prospective and cross. Includes patients are randomly selected for abdominal ultrasound and distributed in two groups: Group A, children with gastrointestinal application indication for assessment and group B, children without gastrointestinal pathology. Informed consent is requested. Results: A total of 182 children, mean age 4.70 years (range 1 m-14 years), 92 males and 90 females. Of 131 children with gastrointestinal disease, group A, 32 (24.42%) had alterations to the ultrasound. Of these 17/32 (53.12%) with ultrasound findings in relation to the underlying disease being the most common liver disease (steatosis, hepatomegaly, periportal fibrosis), gallstones, changes in hollow viscera and gastroesophageal reflux; 15/32 (46.88%) were detected abnormalities not related to underlying disease, such as kidney disease, abdominal tumor, splenomegaly. Group B: 16/51 (31.37%) resulted with detected abnormalities in abdominal organs, biliary sludge, spleen, liver, renal and others. We found a significant difference between groups in relation to the discovery of ultrasound abnormalities unrelated to the complaint. The results allow to conclude that ultrasound is a sensitive tool that can be used in routine pediatric evaluation to detect changes in abdominal organs for early intervention and treatment.

  6. Investigación de seromas postliposucción y dermolipectomía abdominal Investigation about seromas in liposuction and abdominal dermolipectomy

    Directory of Open Access Journals (Sweden)

    E. Moretti

    2006-09-01

    Full Text Available El seroma es una de las complicaciones de los procedimientos estéticos de la pared abdominal. Este líquido contenido en el tejido celular subcutáneo y en el espacio supraaponeurótico es frecuente tema de discusión debido a que hay opiniones divergentes y contradictorias con respecto a los factores etiológicos, los elementos que contribuyen a su formación y a su tratamiento. El presente estudio de 2 años de duración, fue diseñado para investigar la incidencia de seromas en liposucciones y dermolipectomías abdominales aisladas, y cuando ambos procedimientos se realizan directamente en el colgajo abdominal. Se estudió esta complicación desde diferentes aspectos: experimental (15 conejos albinos de Nueva Zelanda, histopatológico y mediante análisis restropectivo en 60 casos. Se concluye, desde el punto de vista experimental, que los seromas son exudados. Su origen linfático se demostró por la presencia de linfangiectasias en las biopsias de los animales. El análisis retrospectivo de los casos clínicos y los resultados de laboratorio determinaron que cuando la dermolipectomía y liposucción se realizan en forma aislada el riesgo de desarrollar seromas es menor (13,04% que cuando ambos procedimientos se realizan juntos sobre el colgajo (50%. La aparición de células polimorfomucleares en el líquido indica la contaminación del seroma.Seroma is one of the complications of the aesthetic procedures in the abdominal wall. This fluid collected in the subcutaneous cellular tissue and in the supraaponeurotic space is a frequent subject of discussion since there are many divergent and contradictory opinions with regard to the etiologic factors and the elements that contribute in its formation and or its treatment. A two-year study was conducted to investigate incidence of seromas in liposuction and abdominal dermolipectomy and when both procedures was performed in the abdominal flap. We studied this complication from different aspects: experimental (15 New Zealand albino rabbits, histopathology examinations, as well as retrospective clinical analysis (60 cases. It is concluded, from the laboratorial point of view, that seromas are exudates. Their lymphatic origin was assessed by the presence of lymphagiectasia in the biopsies in animals. The retrospective clinical analysis and the laboratory results determined that when dermolipectomy and liposuctions are performed in isolation, the risk of developing seromas is less (13,04% than in the cases where both techniques are associated in the abdominal flap (50%. The presence of polymorphonuclear cells in the fluid indicates the contamination of the seroma.

  7. Epilepsia abdominal na infância

    Directory of Open Access Journals (Sweden)

    Rubens Moura Ribeiro

    1964-03-01

    Full Text Available São analisados do ponto de vista clínico e eletrencefalográfico, 21 casos relativos a crianças com epilepsia abdominal. Os autores chamam a atenção para as dificuldades que freqüentemente surgem para estabelecer êsse diagnóstico em crianças e, principalmente, para correlacioná-lo à uma patologia cerebral. Representa o EEG um exame subsidiário de valor como auxiliar no diagnóstico, principalmente quando são registradas as disritmias 14 e 6 por segundo. É considerada também a importância das estruturas subcor-ticais e suas ligações com o lobo temporal na regulação da atividade do trato gastrintestinal.

  8. 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 surgery of symptomfree AAA. In order to fulfil all WHO, European, and Danish criteria for screening, a randomised hospitalbased screening trial of 12,639 65-73 year old men in Viborg County (Denmark) was ...

  9. 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.)

  10. 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.

  11. 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?

  12. Embarazo ectópico abdominal: caso clínico

    Scientific Electronic Library Online (English)

    Belkis, Colmenares; José R, López Gómez; Marianela, Rivas; Daicy, Silva.

    2002-12-01

    Full Text Available Se presenta caso de paciente de 29 años de edad con amenorrea de 14 semanas + 4 días y sangrado genital tipo mancha, concomitantemente dolor abdominal. Se diagnostica embarazo ectópico abdominal como hallazgo operatorio. Se realiza revisión de la literatura sobre el manejo obstétrico de esta patolog [...] ía. Abstract in english A case report of a 29 year-old patient presenting 14 week + 4 day amenorrhea and stain-type genital bleeding, with concomitant abdominal pain. An abdominal ectopic pregnancy was diagnosed as a surgical finding. A review of the literature regarding obstetric management of this pathology was made. [...

  13. Embarazo ectópico abdominal: caso clínico

    Directory of Open Access Journals (Sweden)

    Belkis Colmenares

    2002-12-01

    Full Text Available Se presenta caso de paciente de 29 años de edad con amenorrea de 14 semanas + 4 días y sangrado genital tipo mancha, concomitantemente dolor abdominal. Se diagnostica embarazo ectópico abdominal como hallazgo operatorio. Se realiza revisión de la literatura sobre el manejo obstétrico de esta patología.A case report of a 29 year-old patient presenting 14 week + 4 day amenorrhea and stain-type genital bleeding, with concomitant abdominal pain. An abdominal ectopic pregnancy was diagnosed as a surgical finding. A review of the literature regarding obstetric management of this pathology was made.

  14. 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...

  15. Acute endovascular repair of iatrogenic right internal carotid arterial laceration

    OpenAIRE

    Morken, Marit Helene; Cappelen, Johan; Kvistad, Kjell Arne; Søvik, Edmund; Stensæth, Knut Haakon

    2013-01-01

    Carotid arterial bleeding is a feared and possible life-threatening complication of transsphenoidal surgery. We present a case of a meningioma that during resection had a serious complication with laceration of the internal carotid artery (ICA). These patients rarely undergo endovascular treatment, with indications mainly due to the development of pseudoaneurysms or penetrating trauma. However, endovascular treatment with covered stents of carotid arterial bleedings is a feasible alternative ...

  16. Endovascular treatment of traumatic carotid cavernous fistula with trapping technique

    OpenAIRE

    Benny Young; Ahmad Faizal M. Ali

    2013-01-01

    Conventional endovascular treatment for carotid cavernous fistula (CCF) involves a direct delivery of either coils, detachable balloon or both to the fistula with end point of CCF resolution and carotid artery preservation. But in few cases with severe laceration of carotid artery, the feasible endovascular technique applicable is by blocking the filling of fistula from cerebral circulation. This method known as trapping technique which implicates carotid artery occlusion, was performed in ou...

  17. 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

  18. 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...

  19. 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.

  20. 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.

  1. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

    International Nuclear Information System (INIS)

    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.)

  2. 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.)

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. 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.)

  16. Advances in endovascular treatment of acute ischaemic stroke.

    Science.gov (United States)

    Asadi, H; Dowling, R; Yan, B; Wong, S; Mitchell, P

    2015-08-01

    Over the past decade, there have been rapid advancements in ischaemic stroke reperfusion treatments. However, clear clinical benefit is yet to be shown in large clinical trials. In this review, the major studies in different types of endovascular treatments including intra-arterial thrombolysis, aspiration devices, mechanical clot retrievers and the new stent retrievers are discussed. First-generation mechanical thrombectomy devices such as the MERCI Retriever (Stryker, Kalamazoo, MI, USA) and Penumbra aspiration device (Penumbra Inc., Alameda, CA, USA) demonstrated safety and higher rates of recanalisation in the MERCI and Penumbra Pivotal Stroke Trial; however, there was no significant improvement in clinical outcome. Second-generation endovascular stent retrieval devices Solitaire (ev3 Neurovascular, Irvine, CA, USA) and Trevo (Stryker) have shown promising results. In preliminary trials, SOLITAIRE with the Intention for Thrombectomy (SWIFT) and Thrombectomy Revascularization of Large Vessel Occlusions (TREVO), both showed rates of recanalisation close to 90% and significantly improved clinical outcomes compared with the MERCI study, but the recent landmark studies for endovascular treatment (Interventional Management of Stroke (IMS III), Mechanical Retrieval and Recanalisation of Stroke Clots Using Embolectomy (MR-RESCUE) and SYNTHESIS) did not show any clinical benefit from endovascular treatment compared with standard intravenous therapy. However, moving forward, the recent Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischaemic Stroke in the Netherlands (MR-CLEAN) study results have shown marked improvements in recanalisation, reperfusion and functional outcome in patients receiving endovascular treatment (97% using stent retrievers) within 6?h in addition to standard medical care. Overall, although evidence regarding the efficacy of endovascular treatment in acute stroke has been equivocal, recent publications of large multicentre randomised controlled trials indicate benefit of intra-arterial stent retriever reperfusion in patients selected by appropriate imaging and treated early by experienced operators, and it will likely remain an important adjunct to established medical treatment with intravenous tPA. PMID:25443686

  17. 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.

  18. 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.

  19. Updates in abdominal wall management.

    Science.gov (United States)

    Hope, W W; Williams, Z

    2015-10-01

    The field of abdominal wall hernia surgery continues to evolve at a rapid pace. Surgeons dealing with abdominal wall hernias must constantly stay abreast as new biomaterials and surgical techniques evolve. Increasing knowledge related to hernia formation and factors affecting outcomes will help surgeons prevent hernias and individualize hernia repair techniques and biomaterials based on specific clinical situations and patient characteristics. This review outlines some new advances in abdominal wall hernia management focusing on hernia prevention, preoperative strategies to improve outcomes, available biomaterials and mesh products used in hernia repair, new surgical techniques, and improving ways to evaluate outcomes and perform continuous quality improvement in hernia repair. PMID:26149522

  20. 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.

  1. Computational modeling of an endovascular approach to deep brain stimulation

    Science.gov (United States)

    Teplitzky, Benjamin A.; Connolly, Allison T.; Bajwa, Jawad A.; Johnson, Matthew D.

    2014-04-01

    Objective. Deep brain stimulation (DBS) therapy currently relies on a transcranial neurosurgical technique to implant one or more electrode leads into the brain parenchyma. In this study, we used computational modeling to investigate the feasibility of using an endovascular approach to target DBS therapy. Approach. Image-based anatomical reconstructions of the human brain and vasculature were used to identify 17 established and hypothesized anatomical targets of DBS, of which five were found adjacent to a vein or artery with intraluminal diameter ?1 mm. Two of these targets, the fornix and subgenual cingulate white matter (SgCwm) tracts, were further investigated using a computational modeling framework that combined segmented volumes of the vascularized brain, finite element models of the tissue voltage during DBS, and multi-compartment axon models to predict the direct electrophysiological effects of endovascular DBS. Main results. The models showed that: (1) a ring-electrode conforming to the vessel wall was more efficient at neural activation than a guidewire design, (2) increasing the length of a ring-electrode had minimal effect on neural activation thresholds, (3) large variability in neural activation occurred with suboptimal placement of a ring-electrode along the targeted vessel, and (4) activation thresholds for the fornix and SgCwm tracts were comparable for endovascular and stereotactic DBS, though endovascular DBS was able to produce significantly larger contralateral activation for a unilateral implantation. Significance. Together, these results suggest that endovascular DBS can serve as a complementary approach to stereotactic DBS in select cases.

  2. 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.

  3. 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

  4. 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.

  5. Vascular interventional radiology. Current evidence in endovascular surgery. 2. ed.

    International Nuclear Information System (INIS)

    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.

  6. 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

  7. 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)

  8. Aneurisma en la aorta abdominal

    Directory of Open Access Journals (Sweden)

    José Armando González Rodríguez

    2011-01-01

    Full Text Available Se expone el caso clínico de un paciente con antecedentes de aneurisma en la aorta abdominal y con implantación de una endoprótesis en forma de pantalón y cuatro derivaciones coronarias; el paciente ingresó al hospital por dolor abdominal intenso y duradero, por lo cual se le realizó un ecosonograma abdominal y una TAC simple, que no fueron concluyentes para determinar la existencia de un aneurisma en la aorta abdominal; por eso, fue necesario realizar una TAC contrastada con reconstrucción de imágenes, que reveló un aneurisma fusiforme infrarrenal de gran tamaño y alto riesgo de rotura, por lo que se decidió -como única alternativa y en aras de mejorar su expectativa de vida- realizar una reconstrucción quirúrgica, a pesar de que el riesgo quirúrgico aumenta con las afecciones asociadas.

  9. 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.

  10. An Intra-Abdominal Gossypiboma

    OpenAIRE

    Dakubo, J; Clegg-Lamptey, JN; Hodasi, WM; Obaka, HE; Toboh, H; Asempa, W

    2009-01-01

    Inadvertent retention of a foreign body in the abdomen often require another surgery to recover the material. This increases morbidity and mortality. Risk factor that could predispose to a gossypiboma occurring have been reported. A 44-year old female in whom an abdominal sponge was left in the pelvis after a total abdominal hysterectomy is reported. Surgeons must be aware of the risk factors that lead to a gossypiboma and take measures to prevent it.

  11. Atypical abdominal pain and gossypiboma

    OpenAIRE

    Döle?, Ahmet Kenan; Tunal? Döle?, Figen; Kukul Güven, Fatma Mutlu; KORKMAZ, ?lhan; Co?kun, Abuzer; Gören, Erdal; Eren, ?evki Hakan

    2011-01-01

    Abstract The diagnosis of gossypiboma is difficult because of that its radiological finding are not spesific, be seen as rarely and do not come to mind although detailed anamnesis. With this case, we aimed to emhasize the importance of show regard to gossypiboma. In cases of atypical abdominal pain particularly in those with history of undergone operation, even after a long time from operation.Keywords: Emergency, gossypiboma, abdominal pain, radiology, foreign body ÖzetSemptomlar?n...

  12. Surgical management of intracranial aneurysms previously treated with endovascular therapy

    Directory of Open Access Journals (Sweden)

    Kumar Rajiv

    2010-01-01

    Full Text Available Endovascular treatment with coils of cerebral aneurysm is being increasingly used for definitive treatment. An increasing number of patients are coming for surgical intervention either for recurrences, incomplete coil embolization or its complications. Our objective was to assess the surgical management in such patients. This was a retrospective analysis of the patients who were initially treated with endovascular embolization and later managed surgically with clipping either for unsuccessful coiling, recurrence of aneurysm or post-procedural complication, between 2003 and 2007. Anatomical results were excellent in all five patients, and all the aneurysms were totally excluded from the circulation. All patients had good recovery. None of the patients suffered any major intraoperative or postoperative complication. Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy is an emerging challenge, but with proper patient selection and careful planning, this subset of aneurysms can be managed with good results.

  13. Detección y tratamiento del mielomeningocele por un equipo interdisciplinario

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    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.

  14. 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.

  15. Endovascular treatment of traumatic carotid cavernous fistula with trapping technique

    Directory of Open Access Journals (Sweden)

    Benny Young

    2013-08-01

    Full Text Available Conventional endovascular treatment for carotid cavernous fistula (CCF involves a direct delivery of either coils, detachable balloon or both to the fistula with end point of CCF resolution and carotid artery preservation. But in few cases with severe laceration of carotid artery, the feasible endovascular technique applicable is by blocking the filling of fistula from cerebral circulation. This method known as trapping technique which implicates carotid artery occlusion, was performed in our present case with good result. (Med J Indones. 2013;22:178-82. doi: 10.13181/mji.v22i3.588Keywords: Carotid cavernous fistula (CCF, carotid occlusion, trapping technique

  16. 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.

  17. Osteoartritis. Fisiopatología y tratamiento

    Directory of Open Access Journals (Sweden)

    Sarah\\u00ED Mendoza-Casta\\u00F1o

    2011-01-01

    Full Text Available La osteoartritis (OA es un síndrome anatomoclínico caracterizado por dolor mecánico y rigidez asociada que conduce a una pérdida o disminución progresiva de la función articular provocando discapacidad física y afectación de la calidad de vida. Su frecuencia aumenta con la edad y al aumentar la expectativa de vida de la población se prevé un aumento de su incidencia y del consumo de anti-inflamatorios no esteroidales (AINEs para su tratamiento. Muchos factores contribuyen directa o indirectamente a la degeneración de la articulación provocando un aumento del catabolismo de la matriz extracelular, alteración del hueso subcondral y posterior reacción inflamatoria, responsable de la destrucción ósea y del cartílago. Este no se regenera y puede desaparecer, si no en su totalidad, sí en forma importante y extensa. El hueso subcondral responde dando lugar a la producción de osteofitos que se evidencian al exterior, capaces de irritar estructuras vecinas. La OA se considera un estado final de degeneración cuyo inicio puede estar condicionado por numerosos factores. La primera terapia para manejar la OA son los cambios en el estilo de vida. Las medidas ortopédicas son medidas adicionales. En otros casos, el tratamiento anti-inflamatorio y analgésico sintomático es esencial y muchas veces, es la única terapia farmacológica que se prescribe. En casos refractarios o severos, se incluye el tratamiento quirúrgico. Los AINEs, medicamentos inhibidores de la enzima ciclo-oxigenasa, son los más utilizados para el alivio del dolor y la inflamación, si bien no evitan el daño del cartílago. El paracetamol es el tratamiento de elección para el alivio del dolor. Por otro lado, se plantea que el consumo de grandes cantidades de condroitina y glucosamina puede ayudar en el reemplazo del material que se pierde en el proceso catabólico, si bien, los resultados de estos estudios son variables y contradictorios, lo cual sugiere que el beneficio de esta terapia puede tener sus limitaciones. Algunos fitofármacos antioxidantes limitan la degradación de cartílago humano in vitro y mantienen la arquitectura de la articulación en animales de experimentación, pero estas evidencias son aún más limitadas.

  18. Diabetes mellitus: tratamiento dietético

    Scientific Electronic Library Online (English)

    María Matilde, Socarrás Suárez; Miriam, Bolet Astoviza; Manuel, Licea Puig.

    2002-06-01

    Full Text Available Se revisaron los aspectos relacionados con la clasificación, el tratamiento dietético, el cálculo de los requerimientos energéticos y nutrimentales, las especificaciones de la dieta de acuerdo con los diferentes tipos de diabetes, en cuanto a energía, regularidad y composición de la dieta. La dietot [...] erapia es muy importante en el tratamiento de la diabetes mellitus, para lograr una regulación óptima del metabolismo de los hidratos de carbono, grasas y proteínas. Está dirigida a establecer una ingesta nutricional conveniente para lograr o mantener un peso adecuado, prevenir la hiperglucemia y reducir el riesgo de aterosclerosis y de otras complicaciones. Abstract in english Those aspects connected with the classification, diet therapy, calculation of the energetic and nutritional requirements, as well as with the diet specifications according to the different types of diabetes as regards energy, regularity and composition of the diet, were reviewed. The diet therapy is [...] very important in the treatment of diabetes mellitus to attain an optimal regulation of the metabolism of carbohydrates, fats and proteins. It is aimed at establishing a convenient nutritional ingestion that allows to reach or maintain an adequate weight, to prevent hyperglycemia and to reduce the risk of atherosclerosis and of other complications.

  19. 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.

  20. Diabetes mellitus: tratamiento dietético

    Directory of Open Access Journals (Sweden)

    María Matilde Socarrás Suárez

    2002-06-01

    Full Text Available Se revisaron los aspectos relacionados con la clasificación, el tratamiento dietético, el cálculo de los requerimientos energéticos y nutrimentales, las especificaciones de la dieta de acuerdo con los diferentes tipos de diabetes, en cuanto a energía, regularidad y composición de la dieta. La dietoterapia es muy importante en el tratamiento de la diabetes mellitus, para lograr una regulación óptima del metabolismo de los hidratos de carbono, grasas y proteínas. Está dirigida a establecer una ingesta nutricional conveniente para lograr o mantener un peso adecuado, prevenir la hiperglucemia y reducir el riesgo de aterosclerosis y de otras complicaciones.Those aspects connected with the classification, diet therapy, calculation of the energetic and nutritional requirements, as well as with the diet specifications according to the different types of diabetes as regards energy, regularity and composition of the diet, were reviewed. The diet therapy is very important in the treatment of diabetes mellitus to attain an optimal regulation of the metabolism of carbohydrates, fats and proteins. It is aimed at establishing a convenient nutritional ingestion that allows to reach or maintain an adequate weight, to prevent hyperglycemia and to reduce the risk of atherosclerosis and of other complications.

  1. 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

  2. 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.

  3. Tratamento endovascular da estenose da artéria renal em rim único Endovascular treatment of renal stenosis in solitary kidney

    Directory of Open Access Journals (Sweden)

    Ana Terezinha Guillaumon

    2008-06-01

    Full Text Available CONTEXTO: O tratamento endovascular da doença renal hipertensiva, em doentes com rim único, conseqüente à estenose de artéria renal, mostrou ser efetivo na prevenção da falência do órgão, sua função e controle da hipertensão. Quando indicado após avaliação criteriosa, tanto bioquímica como por imagens e sinais do doente, o tratamento endovascular apresenta benefícios clínicos de forma efetiva e pouco invasiva. OBJETIVO: Estudar a doença hipertensiva renovascular e avaliar a eficácia do tratamento endovascular no controle da hipertensão arterial sistêmica e da insuficiência renal secundárias à estenose da artéria renal e como medida de prevenção de falência renal em doentes com rim único funcionante. MÉTODO: Estudo realizado com protocolo de atendimento previamente elaborado, no Centro de Referência de Alta Complexidade em Cirurgia Endovascular do Hospital de Clínicas da Universidade de Campinas, de abril de 1997 a junho de 2005, em 10 doentes com diagnóstico de estenose da artéria renal em rim único funcionante, submetidos ao tratamento endovascular. Foi avaliada a melhora da hipertensão e função renal através de seguimento clínico e laboratorial com medidas de pressão arterial, dosagens séricas de uréia, creatinina e clearance. Exames pelo eco-color-Doppler foram realizados no pós-operatório de 30 dias, 3 meses, 6 meses e anualmente; no caso de haver alguma dúvida na obtenção de imagens ou sinais, foi realizada a aortografia e arteriografia seletiva renal. Nesta casuística, 90% dos doentes apresentavam hipertensão arterial, 70% eram tabagistas, 40%, hiperlipidêmicos, 30% apresentavam doença oclusiva cerebral extracraniana, 60%, obstrução arterial crônica nos membros inferiores, e 20%, diabetes melito. RESULTADOS: O sucesso inicial foi de 100%. O seguimento médio foi de 40 meses. Houve controle da pressão arterial em 90%, diminuição significativa dos níveis de uréia e creatinina após procedimento e piora do quadro de hipertensão em 10%. CONCLUSÃO: O tratamento endovascular da estenose da artéria renal é uma técnica que apresenta benefícios clínicos no controle da hipertensão arterial, preserva a função renal e desacelera a progressão da insuficiência renal crônica de origem renovascular, porém sem melhora desta.BACKGROUND: Endovascular treatment of hypertensive renal disease in patients with a solitary kidney secondary to renal artery stenosis proved to be effective to prevent organ failure and function, as well as hypertension control. When indicated after judicious evaluation using both biochemical methods and the patient's images and signs, endovascular treatment has effective clinical benefits and is little invasive. OBJECTIVE: To study renal artery stenosis with hypertension and evaluate the effectiveness of endovascular treatment in the control of hypertension, renal failure secondary to renal artery stenosis, and in the prevention of renal failure in patients with a solitary kidney. METHODS: This study was performed at the Reference Center of High Complexity in Endovascular Surgery of Hospital de Clínicas da Universidade de Campinas from April 1997 through June 2005 using a previously developed protocol. Ten patients with renal artery stenosis and solitary kidney submitted to endovascular treatment were included. Improvement in hypertension and renal function was assessed through clinical follow-up and laboratory tests using measurements of blood pressure, serum urea levels, creatinine and clearance. Color-flow Doppler ultrasound was performed 30, 90, 180 days after the surgery and yearly thereafter. Aortography and selective renal arteriography were performed in case of doubt as to images or signs. For this population, 90% had hypertension, 70% were smokers, 40% had hyperlipidemia, 30% had carotid artery occlusive disease, 60% had chronic lower limb arterial occlusion, and 20% had diabetes mellitus. RESULTS: Immediate success was 100%. Mean follow-up time was 40 months. Control of blood pressure occurred in 90% of t

  4. Tratamento endovascular da estenose da artéria renal em rim único / Endovascular treatment of renal stenosis in solitary kidney

    Scientific Electronic Library Online (English)

    Ana Terezinha, Guillaumon; Eduardo Faccini, Rocha; Charles Angotti Furtado de, Medeiros.

    2008-06-01

    Full Text Available CONTEXTO: O tratamento endovascular da doença renal hipertensiva, em doentes com rim único, conseqüente à estenose de artéria renal, mostrou ser efetivo na prevenção da falência do órgão, sua função e controle da hipertensão. Quando indicado após avaliação criteriosa, tanto bioquímica como por image [...] ns e sinais do doente, o tratamento endovascular apresenta benefícios clínicos de forma efetiva e pouco invasiva. OBJETIVO: Estudar a doença hipertensiva renovascular e avaliar a eficácia do tratamento endovascular no controle da hipertensão arterial sistêmica e da insuficiência renal secundárias à estenose da artéria renal e como medida de prevenção de falência renal em doentes com rim único funcionante. MÉTODO: Estudo realizado com protocolo de atendimento previamente elaborado, no Centro de Referência de Alta Complexidade em Cirurgia Endovascular do Hospital de Clínicas da Universidade de Campinas, de abril de 1997 a junho de 2005, em 10 doentes com diagnóstico de estenose da artéria renal em rim único funcionante, submetidos ao tratamento endovascular. Foi avaliada a melhora da hipertensão e função renal através de seguimento clínico e laboratorial com medidas de pressão arterial, dosagens séricas de uréia, creatinina e clearance. Exames pelo eco-color-Doppler foram realizados no pós-operatório de 30 dias, 3 meses, 6 meses e anualmente; no caso de haver alguma dúvida na obtenção de imagens ou sinais, foi realizada a aortografia e arteriografia seletiva renal. Nesta casuística, 90% dos doentes apresentavam hipertensão arterial, 70% eram tabagistas, 40%, hiperlipidêmicos, 30% apresentavam doença oclusiva cerebral extracraniana, 60%, obstrução arterial crônica nos membros inferiores, e 20%, diabetes melito. RESULTADOS: O sucesso inicial foi de 100%. O seguimento médio foi de 40 meses. Houve controle da pressão arterial em 90%, diminuição significativa dos níveis de uréia e creatinina após procedimento e piora do quadro de hipertensão em 10%. CONCLUSÃO: O tratamento endovascular da estenose da artéria renal é uma técnica que apresenta benefícios clínicos no controle da hipertensão arterial, preserva a função renal e desacelera a progressão da insuficiência renal crônica de origem renovascular, porém sem melhora desta. Abstract in english BACKGROUND: Endovascular treatment of hypertensive renal disease in patients with a solitary kidney secondary to renal artery stenosis proved to be effective to prevent organ failure and function, as well as hypertension control. When indicated after judicious evaluation using both biochemical metho [...] ds and the patient's images and signs, endovascular treatment has effective clinical benefits and is little invasive. OBJECTIVE: To study renal artery stenosis with hypertension and evaluate the effectiveness of endovascular treatment in the control of hypertension, renal failure secondary to renal artery stenosis, and in the prevention of renal failure in patients with a solitary kidney. METHODS: This study was performed at the Reference Center of High Complexity in Endovascular Surgery of Hospital de Clínicas da Universidade de Campinas from April 1997 through June 2005 using a previously developed protocol. Ten patients with renal artery stenosis and solitary kidney submitted to endovascular treatment were included. Improvement in hypertension and renal function was assessed through clinical follow-up and laboratory tests using measurements of blood pressure, serum urea levels, creatinine and clearance. Color-flow Doppler ultrasound was performed 30, 90, 180 days after the surgery and yearly thereafter. Aortography and selective renal arteriography were performed in case of doubt as to images or signs. For this population, 90% had hypertension, 70% were smokers, 40% had hyperlipidemia, 30% had carotid artery occlusive disease, 60% had chronic lower limb arterial occlusion, and 20% had diabetes mellitus. RESULTS: Immediate success was 100%. Mean follow-up time was 40 months. Control of

  5. Revascularização endovascular infrainguinal: fatores determinantes para a perviedade Endovascular infrainguinal revascularization: predictive factors for patency

    Directory of Open Access Journals (Sweden)

    Felipe Nasser

    2009-03-01

    Full Text Available Contexto: A terapia endovascular tem avançado muito como tratamento para a doença arterial oclusiva infrainguinal, principalmente com o desenvolvimento dos materiais e dos stents autoexpansíveis de nitinol. Objetivo: Avaliar os resultados e os fatores determinantes da angioplastia fêmoro-poplítea em pacientes portadores de isquemia de membros inferiores. Métodos: Foram tratados, através de angioplastia com ou sem stent, 114 pacientes, e acompanhados por um período médio de 12 meses. A média de idade foi de 66 anos; 53% eram do sexo feminino; 23,7% eram portadores de claudicação incapacitante; 8,8%, de dor isquêmica de repouso; e 67,5%, de lesão trófica. As lesões foram classificadas segundo o TransAtlantic Inter-Society Consensus II em A (53%, B (34%, C (5% e D (9%. Resultados: A análise angiográfica do leito distal mostrou uma média de 1,4±1,0 artérias infrapoplíteas pérvias. O sucesso inicial foi de 97%. No seguimento de 1, 6, 12 e 24 meses, a perviedade primária foi de 94, 78, 48 e 31%, e a primária assistida, de 94, 84, 73 e 61%, respectivamente (p = 0,005. O leito distal pobre e a presença de diabetes melito foram associados a uma menor perviedade primária (p = 0,01, enquanto a extensão da lesão não influenciou os resultados. As taxas de salvamento de membro em 6, 12 e 24 meses foram de 95, 90 e 90%, respectivamente. Conclusões: A extensão das lesões tratadas não foi um fator determinante em nossa casuística para o menor sucesso da angioplastia, o que pode sugerir que as indicações para o tratamento endovascular possam ser ampliadas para pacientes com lesões TransAtlantic Inter-Society Consensus II C/D.Background: Endovascular techniques have undergone major advances with regard to the treatment of infrainguinal arterial occlusive disease, mainly as a result of development of new devices and self-expanding nitinol stents. Objective: To evaluate the results and determinant factors of femoropopliteal angioplasty in patients with critical lower limb ischemia. Methods: During the study, 114 patients were submitted to angioplasty or stenting and followed during an average of 12 months. Mean age was 66 years, and 53% were female; 23.7% presented disabling claudication, 8.8% ischemic rest pain and 67.5% tissue loss. Lesions were classified as A (53%, B (34%, C (5% and D (9% according to the TransAtlantic Inter-Society Consensus II. Results: Angiographic run-off analysis showed an average of 1.4±1.0 patent infrapopliteal artery. Initial success rate was 97%. At 1, 6, 12 and 24 months of the follow-up period, primary patencies of 94, 78, 48 and 31%, and assisted primary patencies of 94, 84, 73 and 61% were achieved (p = 0.005. Poor run-off and diabetes mellitus were directly associated with lower primary patency rates (p = 0.01, while angiographic severity of the lesions did not influence results. Limb salvage rates calculated at 6, 12 and 24 months were 95, 90 and 90%, respectively. Conclusions: Lesion length was not a determinant factor of lower success rates for angioplasty or stenting, which may suggest that indications for endovascular treatment can be extended to patients with TransAtlantic Inter-Society Consensus II C/D lesions.

  6. Revascularização endovascular infrainguinal: fatores determinantes para a perviedade / Endovascular infrainguinal revascularization: predictive factors for patency

    Scientific Electronic Library Online (English)

    Felipe, Nasser; Seleno Glauber de Jesus, Silva; Rodrigo Bruno, Biagioni; Roberta Cristina de Almeida, Campos; Marcelo Calil, Burihan; Rhumi, Inoguti; Melissa Andreia de, Moraes; Orlando da Costa, Barros; José Carlos, Ingrund; Adnan, Neser.

    2009-03-01

    Full Text Available Contexto: A terapia endovascular tem avançado muito como tratamento para a doença arterial oclusiva infrainguinal, principalmente com o desenvolvimento dos materiais e dos stents autoexpansíveis de nitinol. Objetivo: Avaliar os resultados e os fatores determinantes da angioplastia fêmoro-poplítea em [...] pacientes portadores de isquemia de membros inferiores. Métodos: Foram tratados, através de angioplastia com ou sem stent, 114 pacientes, e acompanhados por um período médio de 12 meses. A média de idade foi de 66 anos; 53% eram do sexo feminino; 23,7% eram portadores de claudicação incapacitante; 8,8%, de dor isquêmica de repouso; e 67,5%, de lesão trófica. As lesões foram classificadas segundo o TransAtlantic Inter-Society Consensus II em A (53%), B (34%), C (5%) e D (9%). Resultados: A análise angiográfica do leito distal mostrou uma média de 1,4±1,0 artérias infrapoplíteas pérvias. O sucesso inicial foi de 97%. No seguimento de 1, 6, 12 e 24 meses, a perviedade primária foi de 94, 78, 48 e 31%, e a primária assistida, de 94, 84, 73 e 61%, respectivamente (p = 0,005). O leito distal pobre e a presença de diabetes melito foram associados a uma menor perviedade primária (p = 0,01), enquanto a extensão da lesão não influenciou os resultados. As taxas de salvamento de membro em 6, 12 e 24 meses foram de 95, 90 e 90%, respectivamente. Conclusões: A extensão das lesões tratadas não foi um fator determinante em nossa casuística para o menor sucesso da angioplastia, o que pode sugerir que as indicações para o tratamento endovascular possam ser ampliadas para pacientes com lesões TransAtlantic Inter-Society Consensus II C/D. Abstract in english Background: Endovascular techniques have undergone major advances with regard to the treatment of infrainguinal arterial occlusive disease, mainly as a result of development of new devices and self-expanding nitinol stents. Objective: To evaluate the results and determinant factors of femoropoplitea [...] l angioplasty in patients with critical lower limb ischemia. Methods: During the study, 114 patients were submitted to angioplasty or stenting and followed during an average of 12 months. Mean age was 66 years, and 53% were female; 23.7% presented disabling claudication, 8.8% ischemic rest pain and 67.5% tissue loss. Lesions were classified as A (53%), B (34%), C (5%) and D (9%) according to the TransAtlantic Inter-Society Consensus II. Results: Angiographic run-off analysis showed an average of 1.4±1.0 patent infrapopliteal artery. Initial success rate was 97%. At 1, 6, 12 and 24 months of the follow-up period, primary patencies of 94, 78, 48 and 31%, and assisted primary patencies of 94, 84, 73 and 61% were achieved (p = 0.005). Poor run-off and diabetes mellitus were directly associated with lower primary patency rates (p = 0.01), while angiographic severity of the lesions did not influence results. Limb salvage rates calculated at 6, 12 and 24 months were 95, 90 and 90%, respectively. Conclusions: Lesion length was not a determinant factor of lower success rates for angioplasty or stenting, which may suggest that indications for endovascular treatment can be extended to patients with TransAtlantic Inter-Society Consensus II C/D lesions.

  7. 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.

  8. 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.

  9. Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Chang wei; Xie, Xiao dong; You, Chao; Mao, Bo yong; Wang, Chao hua; He, Min; Sun, Hong [Sichuan University West China Hospital, Chengdu (China)

    2010-12-15

    To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudo aneurysms presenting as intractable epistaxis. For 14 consecutive patients with traumatic pseudo aneurysm presenting as refractory epistaxis, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudo aneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (Inca); out of which, two were managed with detachable balloons, two with covered s tents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from Inca pseudo aneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. In patients presenting with a history of cranio cerebral trauma, traumatic pseudo aneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudo aneurysms

  10. Restenosis after Carotid Endarterectomy: Incidence and Endovascular Management

    OpenAIRE

    Oszkinis, G.; Pukacki, F.; Juszkat, R.; Weigele, J.B.; Gabriel, M; Krasinski, Z.; Zielinski, M.; Krejza, J.

    2007-01-01

    Surgical procedures designed to restore vascular patency for a recurrent stenosis following carotid endarterectomy (CEA) are burdened with technical difficulties as well as with the possibility of serious neurological complications. An endovascular approach employing transluminal percutaneous angioplasty and stenting (PTAS) is a promising solution to these problems.

  11. Embolization of a deep orbital varix through endovascular route

    Directory of Open Access Journals (Sweden)

    R Ravi Kumar

    2015-01-01

    Full Text Available We report a case of the primary deep orbital venous varix treated by endovascular coil embolization procedure by transfemoral catheterization. This method of treatment has the advantage of image-guided localization of the pathology, real-time management and confirmation of the success of the procedure in the sitting.

  12. Fine-motor skills testing and prediction of endovascular performance

    DEFF Research Database (Denmark)

    Bech, Bo; Lönn, Lars

    2013-01-01

    Performing endovascular procedures requires good control of fine-motor digital movements and hand-eye coordination. Objective assessment of such skills is difficult. Trainees acquire control of catheter/wire movements at various paces. However, little is known to what extent talent plays for novice candidates at entry to practice.

  13. 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; Léa Mirian Barbosa da, Fonseca.

    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. Abstract in english 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. E [...] ndovascular 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.

  14. Contemporary imaging in abdominal emergencies

    Energy Technology Data Exchange (ETDEWEB)

    Sivit, Carlos J. [Rainbow Babies and Children' s Hospital, Case Western Reserve School of Medicine, Department of Radiology, Cleveland, OH (United States)

    2008-11-15

    Imaging is often a fundamental part in the evaluation of an injured or ill child. A variety of imaging modalities (radiography, angiography/fluoroscopy, sonography, CT, magnetic resonance imaging and scintigraphy) are among the options. CT is worth focused attention because of its usefulness in a variety of emergency department settings, its increasing use, and its potential radiation risks. CT plays an important role in the evaluation of traumatic and nontraumatic abdominal emergencies in children. Therefore, the goal of this paper is to review current imaging approaches and controversies in the evaluation of common acute abdominal emergencies. Through discussion of various modalities, especially CT in evaluation of abdominal pain and trauma, the relative advantages and disadvantages including radiation risk will be reviewed. (orig.)

  15. 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 surgery of symptomfree AAA. In order to fulfil all WHO, European, and Danish criteria for screening, a randomised hospitalbased screening trial of 12,639 65-73 year old men in Viborg County (Denmark) was initiated in 1994. It seemed that US screening is a valid, suitable and acceptable method of screening. The acceptance rate was 77%, and 95% accept control scans. Furthermore, persons at the highest risk of having an AAA attend screening more frequently. We found that 97% of the interval cases developed from aortas that initially measured 2.5-2.9 cm - i.e. approx. only 5% attenders need re-screening at 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 higher in AAA patients without previous hospital discharge diagnoses due to cardiovascular disease than among similar men without AAA. The absolute risk difference after 5 years was 16%. So, they will benefit from general cardiovascular preventive action as smoking cessation, statins and low-dose aspirin, which could inhibit further AAA progression. All 4 existing RCTs point in the same direction, viz. in favour of screening of men aged 65 and above. We found that screening significantly reduced AAA-related mortality by 67% within the first five years (NNT = 352). Restriction of screening to men with previous cardiovascular or pulmonary hospital discharge diagnoses would request only 27% of the relevant male population study to be invited, but would only have prevented 46.7% of the AAA-related deaths. However, the benefit was similar, and low risk screening reduced AAA specific mortality by 78% compared to 52% in the high risk group after 14 years. Despite attractive sustained benefit and improved cost effectiveness was reported by MASS trial after 10 years, cost effectiveness continues to be discussed. We found after 14 years that screening had reduced AAA-specific mortality by 66% (NNT = 135). 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 65-73 years screening for AAA seems acceptable according to criteria from WHO, Council of Europe, and the Danish National Board of Health. In US, UK, and Sweden national programmes are implemented. In Denmark, a flawed HTA from the region of Mid Denmark based upon an economic model, which excluded large AAAs, emergency operations of unruptured cases, and costs for intensive care beyond 48 hours are blocking a qualified decision. Future topics for will be creation and validation of multivariate models predicting need for later repair. We found AAA-size, wall calcification, smoking, tPA and antibodies against C. pneumoniae to be such candidates. Antibiotic treatment for chlamydial infection are disappointing, and we found no sign of C. pneumoniae in AAA walls but rather signs of proteins cross-reacting with chlamydial antibodies indicating "molecular mimicry" as an autoimmune reaction, which calls for further attention. More precise methods for measuring the degree of wall calcification must be developed and validated.

  16. Tratamiento del delincuente habitual.

    Directory of Open Access Journals (Sweden)

    Sanz Morán, Ángel.

    2007-01-01

    Full Text Available Con motivo de un proyecto de reforma al código penal el trabajo plantea el problema de la determinación del tratamiento más adecuado a la criminalidad habitual de carácter medio y grave. Ante ello, luego de revisar la discusión actual sobre los planteamientos monistas y dualistas, se defiende una alternativa que obliga a distinguir conceptualmente entre penas y medidas. Para completar el modelo se invocan además criterios generales como la prevalencia del carácter correctivo de la intervención por sobre lo meramente asegurativo; la imposición de medidas previo pronóstico de peligrosidad individualizado; la opción por la vicariedad de las respuestas sin descartar la acumulación siempre sujeta al principio de proporcionalidad; y finalmente la consideración de la ponderación de riesgo que representa el sujeto y su imputación a él mismo o la sociedad.

  17. 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

  18. Penetrating abdominal injuries: management controversies

    Directory of Open Access Journals (Sweden)

    Velmahos George C

    2009-04-01

    Full Text Available Abstract Penetrating abdominal injuries have been traditionally managed by routine laparotomy. New understanding of trajectories, potential for organ injury, and correlation with advanced radiographic imaging has allowed a shift towards non-operative management of appropriate cases. Although a selective approach has been established for stab wounds, the management of abdominal gunshot wounds remains a matter of controversy. In this chapter we describe the rationale and methodology of selecting patients for non-operative management. We also discuss additional controversial issues, as related to antibiotic prophylaxis, management of asymptomatic thoracoabdominal injuries, and the use of colostomy vs. primary repair for colon injuries.

  19. CT appearances of abdominal tuberculosis

    International Nuclear Information System (INIS)

    The purpose of this article is to review and illustrate the spectrum of computed tomography (CT) appearances of abdominal tuberculosis. Tuberculosis can affect any organ or tissue in the abdomen, and can be mistaken for other inflammatory or neoplastic conditions. The most common sites of tuberculosis in the abdomen include lymph nodes, genitourinary tract, peritoneal cavity and gastrointestinal tract. The liver, spleen, biliary tract, pancreas and adrenals are rarely affected, but are more likely in HIV-seropositive patients and in miliary tuberculosis. This article should alert the radiologist to consider abdominal tuberculosis in the correct clinical setting to ensure timely diagnosis and enable appropriate treatment.

  20. Functional abdominal bloating with distention.

    Science.gov (United States)

    Sullivan, Stephen Norman

    2012-01-01

    Ten to 25% of healthy persons experience bloating. It is particularly common in persons with the irritable bowel syndrome and constipation. While the cause of bloating remains unknown old explanations such as a excessive intestinal gas, exaggerated lumbar lordosis and psychiatric problems have been disproved. New suggestions include recent weight gain, weak or inappropriately relaxed abdominal muscles, an inappropriately contracted diaphragm and retained fluid in loops of distal small bowel. No treatment is of unequivocal benefit but a low FODMAPs diet, probiotics and the non-absorbable antibiotic rifaximin offer some hope. Treatment by weight loss, abdominal exercise, prokinetics and girdles need more study. PMID:22778978

  1. CT appearances of abdominal tuberculosis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, W.-K., E-mail: leewk33@hotmail.com [Department of Medical Imaging, St Vincent' s Hospital, University of Melbourne, Fitzroy, Victoria (Australia); Van Tonder, F.; Tartaglia, C.J.; Dagia, C. [Department of Medical Imaging, St Vincent' s Hospital, University of Melbourne, Fitzroy, Victoria (Australia); Cazzato, R.L. [Department of Radiology, Universita Campus Bio-Medico di Roma, Rome (Italy); Duddalwar, V.A. [Department of Radiology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California (United States); Chang, S.D. [Department of Medical Imaging, Vancouver General Hospital, University of British Columbia, British Columbia (Canada)

    2012-06-15

    The purpose of this article is to review and illustrate the spectrum of computed tomography (CT) appearances of abdominal tuberculosis. Tuberculosis can affect any organ or tissue in the abdomen, and can be mistaken for other inflammatory or neoplastic conditions. The most common sites of tuberculosis in the abdomen include lymph nodes, genitourinary tract, peritoneal cavity and gastrointestinal tract. The liver, spleen, biliary tract, pancreas and adrenals are rarely affected, but are more likely in HIV-seropositive patients and in miliary tuberculosis. This article should alert the radiologist to consider abdominal tuberculosis in the correct clinical setting to ensure timely diagnosis and enable appropriate treatment.

  2. The preparation of teaching simulation system of endovascular intervention

    International Nuclear Information System (INIS)

    Objective: To establish a teaching simulation system of endovascular intervention and to evaluate its application in clinical teaching practice. Methods: The vascular model, which had quite similar diameter and length to that of human arteries, was prepared with glass tubes of different diameters. Stainless steel tubes were cut and welded to manufacture the brackets of an operation bed and a C-arm, and then the above parts together with flat were assembled into the operation bed module. Fixed camera, computer and footswitch were assembled into the image module. The above three modules were integrated into the teaching simulation system of endovascular intervention. With the help of this system, the principal endovascular intervention manipulations were imitatively exercised. Results: The vascular model had the same proportions as in normal human subjects. The operation bed module could be moved in two dimensions. The image module could capture multiple and differently formatted images as well as dynamic images in different sizes. Also, this system carried the image-frozen function, which was just the same as last image hold function of DSA. This simulation system could imitate the basic manipulations of many kinds of endovascular interventions, such as the hepatic artery catheterization, carotid artery catheterization, the performing of looping-technique in uterine artery, etc. Conclusion: The simulation system can imitate many principal endovascular manipulations, and can distinctly display the relationship of the vascular anatomy and interventional instruments with their imaging shadows. Therefore, this simulation system has a promising prospect of being able to be used in the clinical teaching program concerning vascular interventional manipulations. (authors)

  3. Endovascular and surgical treatment of spinal dural arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Andres, Robert H. [University of Berne (Switzerland). Department of Neurosurgery; University of Berne (Switzerland). Department of Diagnostic and Interventional Neuroradiology; Stanford University Medical Center, Department of Neurosurgery, Stanford, CA (United States); University of Berne (Switzerland). Inselspital; Barth, Alain [University of Berne (Switzerland). Department of Neurosurgery; Medical University of Graz, Department of Neurosurgery, Graz (Austria); University of Berne (Switzerland). Inselspital; Guzman, Raphael [University of Berne (Switzerland). Department of Neurosurgery; Stanford University Medical Center, Department of Neurosurgery, Stanford, CA (United States); University of Berne (Switzerland). Inselspital; Remonda, Luca; El-Koussy, Marwan; Schroth, Gerhard [University of Berne (Switzerland). Department of Diagnostic and Interventional Neuroradiology; University of Berne (Switzerland). Inselspital; Seiler, Rolf W.; Widmer, Hans R. [University of Berne (Switzerland). Department of Neurosurgery; University of Berne (Switzerland). Inselspital

    2008-10-15

    The aim of this retrospective study was to evaluate the clinical outcome of patients with spinal dural arteriovenous fistulas (SDAVFs) that were treated with surgery, catheter embolization, or surgery after incomplete embolization. The study included 21 consecutive patients with SDAVFs of the thoracic, lumbar, or sacral spine who were treated in our institution from 1994 to 2007. Thirteen patients were treated with catheter embolization alone. Four patients underwent hemilaminectomy and intradural interruption of the fistula. Four patients were treated by endovascular techniques followed by surgery. The clinical outcome was assessed using the modified Aminoff-Logue scale (ALS) for myelopathy and the modified Rankin scale (MRS) for general quality of life. Patient age ranged from 44 to 77 years (mean 64.7 years). Surgical as well as endovascular treatment resulted in a significant improvement in ALS (-62.5% and -31.4%, respectively, p<0.05) and a tendency toward improved MRS (-50% and -32%, respectively) scores. Patients that underwent surgery after endovascular treatment due to incomplete occlusion of the fistula showed only a tendency for improvement in the ALS score (-16.7%), whereas the MRS score was not affected. We conclude that both endovascular and surgical treatment of SDAVFs resulted in a good and lasting clinical outcome in the majority of cases. In specific situations, when a secondary neurosurgical approach was required after endovascular treatment to achieve complete occlusion of the SDAVF, the clinical outcome was rather poor. The best first line treatment modality for each individual patient should be determined by an interdisciplinary team. (orig.)

  4. Feasibility of endovascular and surface cooling strategies in acute stroke

    DEFF Research Database (Denmark)

    Ovesen, Christian Hjerrild; Brizzi, M

    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 patients and 1 control developed massive infarction. 1 TH patient and 2 control suffered asymptomatic haemorrhagic transformation. Mortality was comparable with 2 (12%) in the TH group and 1 (7%) among controls. Mean (SD) duration of hospital stay was 25.0 days (24, 9) in TH and 22.5 days (20.6) in control patients (P = 0.767). Mean (SD) induction period (cooling onset to target temperature) was 126.3 min (80.6) with endovascular cooling and 196.3 min (76.3) with surface cooling (P = 0.025). CONCLUSIONS: Therapeutic hypothermia with general anaesthesia is feasible in stroke patients. We noticed increased rates of pneumonia, while the length of hospital stay remained comparable. The endovascular cooling strategy provides a faster induction period than surface cooling.

  5. Epilepsia abdominal na infância / Abdominal epilepsy in children

    Scientific Electronic Library Online (English)

    Rubens Moura, Ribeiro; Jorge Armbrust, Figueiredo; Valeriana Moura, Ribeiro.

    1964-03-01

    Full Text Available São analisados do ponto de vista clínico e eletrencefalográfico, 21 casos relativos a crianças com epilepsia abdominal. Os autores chamam a atenção para as dificuldades que freqüentemente surgem para estabelecer êsse diagnóstico em crianças e, principalmente, para correlacioná-lo à uma patologia cer [...] ebral. Representa o EEG um exame subsidiário de valor como auxiliar no diagnóstico, principalmente quando são registradas as disritmias 14 e 6 por segundo. É considerada também a importância das estruturas subcor-ticais e suas ligações com o lobo temporal na regulação da atividade do trato gastrintestinal. Abstract in english The clinical and electroencephalographic finding of 21 children with abdominal epilepsy are analised. There is inquestionably an overlopping between the clinical syndrome of abdominal epilepsy and cerebral pathology. The EEG is usually abnormal and often shows the "14 and 6 per second dysrhythmia" w [...] hich is an indication of abdominal epilepsy. In basis of experimental and clinical evidence it seems probable that the state of activity of the gastro-intestinal tract is under cerebral cortex and lower centers influence.

  6. Reparación de hiperfibrosis abdominal secundaria a liposucción / Repair of hyperfibrosis secondary to abdominal liposuction

    Scientific Electronic Library Online (English)

    I., Fernández Sanza; R., Gómez García.

    2011-12-01

    Full Text Available El desarrollo de hiperfibrosis secundaria a cualquier procedimiento quirúrgico es un problema que afecta al paciente que lo padece y al médico que le trata; puede tener resultados devastadores no solo sobre la estética, sino en casos extremos, también sobre la función. En el ámbito de la Cirugía Plá [...] stica, cuando la hiperfibrosis se desarrolla tras algún procedimiento estético y por ende 100 % electivo, al paciente le es difícil entender y aceptar la génesis de dicho problema y exige al cirujano una reparación rápida y satisfactoria, lo cual no siempre es fácil o incluso factible. En este artículo presentamos el caso de una paciente sometida a liposucción abdominal que, tras la aparición en el postoperatorio y posterior resolución de una seroma, sufrió una hiperfibrosis que deformó la zona; presentamos también nuestra propuesta de tratamiento y los resultados finales conseguidos. Hay que recalcar que cuando estos casos, afortunadamente no muy comunes, aparecen, la evolución suele ser tórpida y en ocasiones resistente a los protocolos de tratamiento habituales, lo que puede llevarnos a desarrollar estrategias poco convencionales y, que en un caso como el que presentamos, resultan bastante efectivas. Abstract in english The development of hyperfibrosis after any surgical procedure is a problem that affects the patient and the doctor who treated, and can have devastating results that affect not only the aesthetic but, in extreme cases, the function. In the field of Plastic Surgery, when hyperfibrosis develops in a c [...] osmetic procedure and therefore 100 % elective, the patient does not understand and accept the genesis of the problem and the surgeon is required to fast repair, but this is not always satisfactory, easy or even feasible. We present the case of a patient undergoing an abdominal liposuction complicated with postoperative seroma; after seromas resolution she developed hyperfibrosis that deformed the area. We also present our proposal for treatment and our final results. It´s important to remark that these cases are usually rresistible to standard treatment protocols, and sometimes leads us to develop unconventional strategies.

  7. Comparison of arterial stiffness and microcirculatory changes following abdominal aortic aneurysm grafting.

    LENUS (Irish Health Repository)

    Moloney, M A

    2012-02-01

    BACKGOUND: Abdominal aortic aneurysm (AAA) surgery provides a unique opportunity to study the impact of arterial stiffness on central haemodynamics, reflected in augmentation index (AI). The aneurysmal aorta is significantly stiffer than undilated age-matched aorta. AIM: We investigated whether replacement of an aneurysmal aorta with a compliant graft would result in a decrease in AI, which would thus decrease myocardial workload parameters. METHODS: Patients undergoing elective open or endovascular AAA repair were assessed with applanation tonometry and laser fluximetry pre-operatively, immediately and long-term post-operatively. RESULTS: Replacement of a small segment of abnormal conduit vessel resulted in improvements in AI, demonstrating that arterial stiffness can be surgically manipulated. CONCLUSIONS: These results reflect a decreased myocardial workload post-aortic grafting. This decrease in AI is important from a risk factor management perspective, and arterial stiffness should become a further recognised and screened for risk factor in patients with known aneurysmal disease.

  8. Comparison of arterial stiffness and microcirculatory changes following abdominal aortic aneurysm grafting.

    LENUS (Irish Health Repository)

    Moloney, M A

    2010-11-11

    BACKGOUND: Abdominal aortic aneurysm (AAA) surgery provides a unique opportunity to study the impact of arterial stiffness on central haemodynamics, reflected in augmentation index (AI). The aneurysmal aorta is significantly stiffer than undilated age-matched aorta. AIM: We investigated whether replacement of an aneurysmal aorta with a compliant graft would result in a decrease in AI, which would thus decrease myocardial workload parameters. METHODS: Patients undergoing elective open or endovascular AAA repair were assessed with applanation tonometry and laser fluximetry pre-operatively, immediately and long-term post-operatively. RESULTS: Replacement of a small segment of abnormal conduit vessel resulted in improvements in AI, demonstrating that arterial stiffness can be surgically manipulated. CONCLUSIONS: These results reflect a decreased myocardial workload post-aortic grafting. This decrease in AI is important from a risk factor management perspective, and arterial stiffness should become a further recognised and screened for risk factor in patients with known aneurysmal disease.

  9. SURGICAL MANAGEMENT OF A RARE CASE OF MARFAN SYNDROME - THE RUPTURE OF AN ABDOMINAL AORTIC ANEURYSM

    Directory of Open Access Journals (Sweden)

    L. Stoica

    2005-10-01

    Full Text Available We present a rare manifestation of the Marfan syndrome. A 33 years old woman with a 10 cm diameter juxta-renal aortic aneurysm ruptured in the retro peritoneum arrived in hemorrhagic shock. Surgery was performed in emergency by thoraco-phreno-laparatomy, the aneurysm was resected and a 20 mm Dacron tube was sutured between the origin of the renal arteries and the aortic bifurcation. Rapid thoracic aortic cross-clamping to stop the hemorrhage and good aneurismal exposure by the division of the left renal vein was the key of this successful management. The patient recovered without any complication. Rupture of the abdominal aortic aneurysm is a life threatening complication which requires a rapid diagnosis and an emergency treatment by open surgery or by endovascular stent grafting. We present the surgical strategy in our case

  10. Abdominal pain - children under age 12

    Science.gov (United States)

    Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children ... When your child complains of abdominal pain, see if they can ... kinds of pain: Generalized pain or pain over more than half ...

  11. Defectos de la pared abdominal

    Directory of Open Access Journals (Sweden)

    Adis L. Peña Cedeño

    2004-03-01

    Full Text Available Se realizó un estudio de los fetos con malformaciones congénitas, dadas por defecto de la pared abdominal (DPA, nacidos en el Hospital Universitario Ginecoobstétrico de Guanabacoa durante los años 1984 al 2000, para determinar la frecuencia de los distintos tipos de defectos de la pared abdominal y las malformaciones asociadas a éstas. Se revisaron los protocolos de necropsias e historias clínicas en este período y se obtuvieron 25 casos con DPA. La malformación más frecuente fue el onfalocele con 14 casos, seguido de la gastrosquisis con 6 casos. Se hallaron malformaciones asociadas en el 68 % de los casos, y se comprobó la efectividad del Programa Nacional de Malformaciones Congénitas, pues en el 80 % de las pacientes se interrumpió precozmente el embarazo.A study of the fetuses with congenital malformations due to defect of the abdominal wall (AWD that were born at the Gynecoobstetric Teaching Hospital of Guanabacoa from 1984 to 2000 was conducted aimed at determining the frequency of the different types of defects of the abdominal wall and the malformations associated with them. The protocosl of necropsies and medical histories corresponding to this period were reviewed and 25 cases with AWD were detected. The most common malformation was omphalocele with 14 cases, followed by gastrosquisis with 6 cases. Associated malformations were found in 68 % of the cases and it was proved the effectiveness of the National Program of Congenital Malformations, since pregnancy was interrupted early in 80 % of the patients.

  12. Recovery of Third Nerve Palsy after Endovascular Packing of Internal Carotid-Posterior Communicating Artery Aneurysms

    OpenAIRE

    Mavilio, N.; Pisani, R.; Rivano, C.; Testa, V.; SPAZIANTE, R.; De Rosa, M.

    2000-01-01

    Endovascular packing of intracranial aneurysm with preservation of the parent vessel has become in many cases a valid alternative to surgical clipping. Regression of oculomotor disorders after clipping of internal carotid-posterior communicating artery (ICA-PCoA) aneurysms has been well assessed. This report focuses on the reversal of third nerve palsy after endovascular packing of ICA-PCoA aneurysms. To this end, clinical appearances, neuroradiological features, and endovascular intervention...

  13. Ten-Year Follow-Up of Endovascular Aneurysm Treatment with Talent Stent-Grafts

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the clinical results, complications, and secondary interventions during long-term follow-up after endovascular aneurysm repair (EVAR) and to investigate the impact of endoleak sizes on aneurysm shrinkage. From 1997 to March 2007, 127 patients (12 female, 115 male; age, 73.0 ± 7.2 years) with abdominal aortic aneurysms were treated with Talent stent-grafts. Follow-up included clinical visits, contrast-enhanced MDCT, and radiographs at 3, 6, and 12 months and then annually. Results were analyzed with respect to clinical outcome, secondary interventions, endoleak rate and management, and change in aneurysm size. There was no need for primary conversion surgery. Thirty-day mortality was 1.6% (two myocardial infarctions). Procedure-related morbidity was 2.4% (paraplegia, partial infarction of one kidney, and inguinal bleeding requiring surgery). Mean follow-up was 47.7 ± 34.2 months (range, 0-123 months). Thirty-nine patients died during follow-up; three of the deaths were related to aneurysm (aneurysm rupture due to endoleak, n = 1; secondary surgical reintervention n = 2). During follow-up, a total of 29 secondary procedures were performed in 19 patients, including 14 percutaneous procedures (10 patients) and 15 surgical procedures (12 patients), including 4 cases with late conversion to open aortic repair (stent-graft infection, n = 1; migration, endoleak, or endotension, n = 3). Overall mean survival was 84.5 ± 4.7 months. Mean survival and freedom from any event was 66.7 ± 4.5 months. MRI depicted significantly more endoleaks compared to MDCT (23.5% vs. 14.3%; P 10% of the aneurysm area were associated with reduced aneurysm shrinkage compared to no endoleaks or <10% endoleaks (? at 3 years, -1.8% vs. -12.0%; P < 0.05). In conclusion, endovascular aneurysm treatment with Talent stent-grafts demonstrated encouraging long-term results with moderate secondary intervention rates. Primary occlusion of all aortic side branches reduced the incidence of large endoleaks. Large endoleaks significantly impaired aneurysm shrinkage, whereas small endoleaks did not.

  14. Emergency diagnostic laparoscopy in abdominal trauma: a study of 41 patients Laparoscopia diagnóstica de urgencia en el traumatismo abdominal: un estudio en 41 pacientes

    Directory of Open Access Journals (Sweden)

    Armando Fermín Álvarez Corcuera del Pera

    2010-07-01

    Full Text Available Background: laparoscopy is a test used in the patients with abdominal trauma with suspicion of intra-abdominal organic damage and an imminent surgical behavior. Objectives: to expose the results of the urgency laparoscopic diagnosis in the traumatic acute abdomen. Methods: an descriptive and retrospective study in patient with diagnosis of abdominal trauma to which were carried out urgency laparoscopy at the Hospital Dr. Gustavo Aldereguía Lima", from january 2001 to december 2008, when not being possible to define injury of intra-abdominal viscera performing other tests. Inclusion and exclusion criterion were applied. Results: we study 41 patients with average of 39, 2 ± 7, 7 years. Most of the studied patients were in the age range from 31 to 40 years with 21 patients (51, 2 % the open abdominal trauma with 26 patients prevailed (63, 4 %. The masculine sex prevailed with 38 patients (92,7 % and as much the open trauma as the closed one were more frequent in this sex with 25 patients (96,2 % and 13 patients (86,7 % respectively. They didn't show visceral damage during the laparoscopy 93, 3 % of the patients with closed abdominal trauma by what the surgical treatment was avoided, the same as in the patients with open abdominal trauma which had a non penetrating damage in abdominal cavity (80, 8 %. Conclusion: laparoscopic diagnosis is a useful test in patients with abdominal trauma and it avoids a considerable number of unnecessary conventional surgical treatment.Fundamento: la laparoscopia es una prueba utilizada en pacientes con trauma abdominal que enfrentan la sospecha de lesión orgánica intra-abdominal para lo cual se requiere una conducta quirúrgica inminente. Objetivo: exponer los resultados de la laparoscopia diagnóstica de urgencia en traumatismos abdominales. Métodos: estudio descriptivo y retrospectivo en pacientes con diagnóstico de trauma abdominal a los cuales se les realizó laparoscopia de urgencia en el Servicio de Gastroenterología del Hospital “Dr. Gustavo Aldereguía Lima” de Cienfuegos, entre los meses de enero del 2001 a diciembre del 2008. Se aplicaron criterios de inclusión y exclusión. Resultados: se estudian a 41 pacientes con una edad promedio de 39,2 ± 7,7 años. La mayor parte de los pacientes estudiados se encontraban en el rango de edad entre los 31 a 40 años, 21 pacientes (51,2 %, predominó el traumatismo abdominal abierto con 26 pacientes (63,4 %. El sexo masculino predominó con 38 pacientes (92,7 %, tanto el trauma abierto como el cerrado fueron más frecuentes en este sexo con 25 (96,2 % y 13 pacientes (86,7 % respectivamente. No mostraron lesión visceral durante la laparoscopia 93,3 % de los pacientes con trauma abdominal cerrado por lo que se evitó el tratamiento quirúrgico al igual que en los pacientes con traumatismos abdominales abiertos que tenían una lesión no penetrante en la cavidad abdominal (80,8 %. Conclusiones: la laparoscopia diagnóstica es una prueba útil en pacientes con trauma abdominal y evita un número considerable de laparotomías exploradoras innecesarias.

  15. Abdominal cocoon secondary to disseminated tuberculosis.

    Science.gov (United States)

    Puppala, Radha; Sripathi, Smiti; Kadavigere, Rajagopal; Koteshwar, Prakashini; Singh, Jyoti

    2014-01-01

    Abdominal cocoon, also known as sclerosing encapsulating peritonitis, represents a rare entity where a variable length of the small bowel is enveloped by a fibrocollagenous membrane giving the appearance of a cocoon. It may be asymptomatic and is often diagnosed incidentally at laparotomy. We present a rare case of abdominal cocoon due to abdominal tuberculosis. PMID:25239980

  16. The value of 3D DSA in endovascular treatment of carotid stenosis

    International Nuclear Information System (INIS)

    Objective: To evaluate three-dimensional digital subtraction angiography (3D DSA) in endovascular treatment of carotid stenosis. Methods: In 138 patient with ischemic stroke, the shape and stenosis of carotid artery, the feasibility of endovascular treatment and the choice of the stent were analyzed by 2D DSA and 3D DSA. Results: Comparing with 2D DSA, 3D DSA could clearly depict the carotid artery in shape and stenosis with correct figuring of the feasibility for endovascular treatment and choice of the stent. Conclusions: 3D DSA shows the major importance in endovascular treatment of carotid stenosis providing more valuable informations than 2D DSA

  17. Virtual reality simulation for the optimization of endovascular procedures: current perspectives

    Directory of Open Access Journals (Sweden)

    Rudarakanchana N

    2015-03-01

    Full Text Available Nung Rudarakanchana,1 Isabelle Van Herzeele,2 Liesbeth Desender,2 Nicholas JW Cheshire1 1Department of Surgery, Imperial College London, London, UK; 2Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, BelgiumOn behalf of EVEREST (European Virtual reality Endovascular RESearch TeamAbstract: Endovascular technologies are rapidly evolving, often requiring coordination and cooperation between clinicians and technicians from diverse specialties. These multidisciplinary interactions lead to challenges that are reflected in the high rate of errors occurring during endovascular procedures. Endovascular virtual reality (VR simulation has evolved from simple benchtop devices to full physic simulators with advanced haptics and dynamic imaging and physiological controls. The latest developments in this field include the use of fully immersive simulated hybrid angiosuites to train whole endovascular teams in crisis resource management and novel technologies that enable practitioners to build VR simulations based on patient-specific anatomy. As our understanding of the skills, both technical and nontechnical, required for optimal endovascular performance improves, the requisite tools for objective assessment of these skills are being developed and will further enable the use of VR simulation in the training and assessment of endovascular interventionalists and their entire teams. Simulation training that allows deliberate practice without danger to patients may be key to bridging the gap between new endovascular technology and improved patient outcomes.Keywords: virtual reality, simulation, endovascular, aneurysm

  18. Endovascular Management of Post-Irradiated Carotid Blowout Syndrome

    Science.gov (United States)

    Chang, Feng-Chi; Luo, Chao-Bao; Lirng, Jiing-Feng; Lin, Chung-Jung; Lee, Han-Jui; Wu, Chih-Chun; Hung, Sheng-Che; Guo, Wan-Yuo

    2015-01-01

    Purpose To retrospectively evaluate the clinical and technical factors related to the outcomes of endovascular management in patients with head-and-neck cancers associated with post-irradiated carotid blowout syndrome (PCBS). Materials and Methods Between 2000 and 2013, 96 patients with PCBS underwent endovascular management. The 40 patients with the pathological lesions located in the external carotid artery were classified as group 1 and were treated with embolization. The other 56 patients with the pathological lesions located in the trunk of the carotid artery were divided into 2 groups as follows: group 2A comprised the 38 patients treated with embolization, and group 2B comprised the 18 patients treated with stent-graft placement. Fisher’s exact test was used to examine endovascular methods, clinical severities, and postprocedural clinical diseases as predictors of outcomes. Results Technical success and immediate hemostasis were achieved in all patients. The results according to endovascular methods (group 1 vs 2A vs 2B) were as follows: technical complication (1/40[2.5%] vs 9/38[23.7%] vs 9/18[50.0%], P = 0.0001); rebleeding (14/40[35.0%] vs 5/38[13.2%] vs 7/18[38.9%]), P = 0.0435). The results according to clinical severity (acute vs ongoing PCBS) were as follows: technical complication (15/47[31.9%] vs 4/49[8.2%], P = 0.0035); rebleeding (18/47[38.3%] vs 8/49[16.3%], P = 0.0155). The results according to post-procedural clinical disease (regressive vs progressive change) were as follows: alive (14/21[66.7%] vs 8/75[10.7%], P<0.0001); survival time (34.1±30.6[0.3–110] vs 3.6±4.0[0.07–22] months, P<0.0001). Conclusion The outcomes of endovascular management of PCBS can be improved by taking embolization as a prior way of treatment, performing endovascular intervention in slight clinical severity and aggressive management of the post-procedural clinical disease. PMID:26439632

  19. Tratamiento de la isquemia crítica de miembros inferiores / Treatment of Critical Lower Limb Ischemia

    Scientific Electronic Library Online (English)

    Samir, Jozami; Mariano, Albertal; Patricio, Zaefferer; Guillermo, Pfund; Alejandro, Fabiani; Gerardo, Nau; Jorge, Thierer; Lucio, Padilla; Jorge, Belardi; Fernando, Cura.

    2010-04-01

    Full Text Available Introducción La isquemia crítica de miembros inferiores representa una manifestación extrema de la enfermedad vascular periférica crónica. La revascularización quirúrgica es el tratamiento de elección para los pacientes con esta patología, ya que pese a ser un procedimiento invasivo reduce la tasa d [...] e amputación y de mortalidad. Sin embargo, tiene una tasa alta de complicaciones. Durante la última década, el perfeccionamiento y la introducción de nuevas tecnologías percutáneas han derivado en un crecimiento importante en la estrategia endovascular. Su baja morbilidad comparada con la de la alternativa quirúrgica ha llevado a un rápido y explosivo incremento en su indicación. Objetivo Evaluar los resultados clínicos en pacientes con lesiones críticas de miembros inferiores tratados de forma endovascular en un centro de alto volumen. Material y métodos Desde enero de 2005 hasta diciembre de 2008 se realizaron 60 procedimientos en 55 pacientes. Resultados La edad de los pacientes fue de 72,5 ± 10,6 años (rango 49-91); el 60,7% eran de sexo masculino, el 57% padecían diabetes y el 48,8%, enfermedad coronaria. El 50% de los pacientes presentaron dolor del miembro en reposo y el resto, lesiones tróficas menores en el 41% y mayores en el 9%. Se trataron en total 74 lesiones: 14 aortoilíacas, 23 femoropoplíteas, 28 infrapoplíteas y 9 bypass vasculares. En el seguimiento a 30 días, la tasa de reintervención de urgencia fue del 10,9%, la de amputación del 5,4%, la de muerte del 3,6% y la de eventos cardíacos mayores (muerte, infarto agudo de miocardio, accidente cerebrovascular, reintervención o amputación) fue del 10,9%. Luego de 30 días, el seguimiento alejado (media 727 ± 442 días) arrojó las siguientes tasas: reintervención 11,7%, amputación 7,4%, infarto agudo de miocardio 2%, accidente cerebrovascular 2%, muerte 11,7% y eventos cardíacos mayores 27,4%. Las tasas de reintervención, amputación y eventos cardíacos mayores durante todo el estudio fueron del 21,4%, 14,3% y 30,3%, respectivamente. Conclusiones El tratamiento endovascular representa una alternativa atractiva para pacientes con isquemia crítica de miembros inferiores al reducir el riesgo de amputación. Sin embargo, esta población presenta un riesgo cardiovascular incrementado en el pronóstico alejado. Abstract in english Background Critical lower limb ischemia is the extreme manifestation of chronic peripheral arterial disease. Surgical revascularization is the treatment of choice for patients with this condition as it reduces amputation and mortality rates despite being an invasive procedure. Yet, the incidence of [...] complications is high. During the last decade, the development and introduction of new percutaneous technologies have enabled significant growth in endovascular strategies. Indications for endovascular treatment have increased due to its low morbidity compared to surgery. Objective To evaluate the clinical outcomes in patients with critical lower limb occlusions undergoing endovascular treatment in a high-volume center. Material and Methods A total of 60 procedures in 55 patients were performed from January 2005 to December 2008. Results Patients' age was 72.5±10.6 years (range 49-91) and 60.7% were men; 57% were diabetics and 48.8% had coronary artery disease. Fifty percent of patients had ischemic rest pain; 41% had minor trophic lesions and 9% presented major throphic lesions. A total of 74 occlusions were treated: 14 aortoiliac, 23 femoropopliteal, 28 infrapopliteal and 9 occlusions of vascular bypass grafts. The following outcomes were evaluated 30 days after the intervention: urgent reintervention, 10.9%; amputation, 5.4%; mortality, 3.6%; major cardiac events (mortality, myocardial infarction, stroke, reintervention or amputation), 10.9%. In the long-term follow-up (median 727±442 days) reintervention rate was 11.7%, amputation 7.4%, myocardial infarction 2%, stroke 2%, mortality 11.7%, and major cardiac events 27.4%. Reintervention, amputation and major cardiac event

  20. Dor visceral abdominal: aspectos clínicos / Abdominal visceral pain: clinical aspects

    Scientific Electronic Library Online (English)

    Telma Mariotto, Zakka; Manoel Jacobsen, Teixeira; Lin Tchia, Yeng.

    2013-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O abdômen é o local mais frequente das síndromes dolorosas agudas ou crônicas, de dor referida de origem em estruturas distantes ou de dor decorrente de lesões sistêmicas. A dor visceral abdominal ocorre por tensão ou estiramento da parede das vísceras ocas ou da cápsula d [...] as vísceras parenquimatosas e pela tração ou estiramento peritoneal. O diagnóstico e o tratamento complexos motivaram este estudo. Os pacientes com dor abdominal crônica usualmente são subtratados e subdiagnosticados. O tratamento interdisciplinar visa minimizar o sofrimento do paciente, aliviar a dor e melhorar sua qualidade de vida. CONTEÚDO: Como as doenças viscerais podem determinar dores de vários tipos e, habitualmente, desafiam os médicos no seu diagnóstico e tratamento, os autores descreveram de forma prática, as características dolorosas e as associações com as doenças mais incidentes. CONCLUSÃO: O tratamento interdisciplinar com a associação das medidas farmacológicas aos procedimentos de medicina física e reabilitação e ao acompanhamento psicológico diminui o sofrimento e as incapacidades e melhora a qualidade de vida. Abstract in english BACKGROUND AND OBJECTIVES: Abdomen is the most frequent site for acute or chronic painful syndromes, for referred pain from distant structures or for pain caused by systemic injuries. Abdominal visceral pain is induced by hollow viscera or parenchymal viscera walls stretching or by peritoneal stretc [...] hing. Complex diagnosis and treatment have motivated this study. Patients with chronic abdominal pain are usually undertreated and underdiagnosed. The interdisciplinary treatment aims at minimizing patients' distress, relieving pain and improving their quality of life. CONTENTS: Since visceral diseases may determine pain of different types and, usually, challenge physicians with regard to their diagnosis and treatment, the authors have described in a practical way painful characteristics and associations with more common diseases. CONCLUSION: The interdisciplinary treatment, with the association of pharmacological measures to physical medicine and rehabilitation procedure and to psychological follow up, decreases distress and inabilities and improves quality of life.

  1. Relationship between Abdominal Strength Measured by a Newly Developed Device and Abdominal Muscle Thickness

    OpenAIRE

    Takanori Noguchi; Shinichi Demura

    2014-01-01

    Although measurement of abdominal strength is important for evaluating trunk myofunction, adequate devices for these measurements have not been developed. As a consequence, the relationships between abdominal strength and abdominal muscle thickness have also not been determined. This study aimed to develop a new device for measuring abdominal strength and to examine the relationship between abdominal muscle strength and thickness. The subjects in the study included 5...

  2. Superselective endo-vascular treatment of renal vascular lesions.

    Science.gov (United States)

    Beaujeux, R; Saussine, C; al-Fakir, A; Boudjema, K; Roy, C; Jacqmin, D; Bourjat, P

    1995-01-01

    Embolization with platinum micro-coils delivered through the Tracker-18 micro-catheter was performed in 6 patients when peripheral selective catheterization with standard angiographic catheters was not possible. The patients had a total of 7 peripheral renal vascular lesions (3 arteriovenous fistulas, 2 false aneurysms, 1 direct vascular trauma and 1 arteriovenous malformation). In all patients we initially used platinum micro-coils as the embolic agent. Two patients required repeat embolization with glue. Endo-vascular treatment was technically successful in all cases and no complications were encountered. There was no renal parenchyma infarction in 3 patients and small peripheral infarctions (10 to 15% of the renal parenchyma) occurred in 3. Super selective endo-vascular treatment with a variable stiffness catheter is safe and useful technique when classical methods of embolization are not possible. PMID:7966749

  3. Endovascular therapy of carotid stenosis with self-expandable stent

    International Nuclear Information System (INIS)

    Objective: To summarize the experience of endovascular treatment of carotid stenosis with expandable stents. Methods: Fifty-two patients with carotid stenosis who experienced repeated transient ischemic attacks or cerebral infarction were admitted to our hospital. The stenosis was pre-expanded with undetachable balloon, and self-expandable stents were implanted across the stenosis. A balloon catheter was used to further expand stents in 29 patients. Results: The stent was accurately implanted, and total disappearance of stenosis was obtained in 34 patients, the degree of stenosis reduced more than 90% in 16 patients, and more than 70% in 2 patients. The patients recovered well and no complications related to the procedure occurred. None experienced TIA or infarction postoperatively in 52 cases and follow-up imaging in 19 patients (6 - 12 months) demonstrated no restenosis. Conclusion: Endovascular stenting may be a safe and valid choice for the treatment of extracranial carotid stenosis

  4. Constructing canine carotid artery stenosis model by endovascular technique

    International Nuclear Information System (INIS)

    Objective: To establish a carotid artery stenosis model by endovascular technique suitable for neuro-interventional therapy. Methods: Twelve dogs were anesthetized, the unilateral segments of the carotid arteries' tunica media and intima were damaged by a corneous guiding wire of home made. Twenty-four carotid artery stenosis models were thus created. DSA examination was performed on postprocedural weeks 2, 4, 8, 10 to estimate the changes of those stenotic carotid arteries. Results: Twenty-four carotid artery stenosis models were successfully created in twelve dogs. Conclusions: Canine carotid artery stenosis models can be created with the endovascular method having variation of pathologic characters and hemodynamic changes similar to human being. It is useful for further research involving the new technique and new material for interventional treatment. (authors)

  5. Unipuncture double-access method in emergent endovascular procedures

    DEFF Research Database (Denmark)

    Hörer, Tal M; Hammo, Sari

    2013-01-01

    We describe a technique to gain an additional endovascular access in acute situations in which a large-bore introducer is already inserted or in situations in which multiple accesses are impaired because of other reasons. Using an existing percutaneous femoral artery access, a second guide wire is inserted into the introducer, which is later withdrawn and applied onto one of the two guide wires. A double-wire access is then achieved. This access can be used, for example, for angiography or embolization catheters. This method might be useful in situations in which a quick and unplanned extra access is needed. It is, for example, applicable in hemodynamically unstable patients in whom percutaneous access can be difficult to obtain or in aortic endovascular procedures when an unplanned access is needed to insert an additional catheter for angiography and embolization.

  6. Endovascular treatment of basilar tip aneurysms associated with moyamoya disease

    International Nuclear Information System (INIS)

    We report the efficacy and safety of endovascular treatment of basilar tip aneurysms (BTA) in five patients with moyamoya disease. The patients underwent intra-aneurysmal embolisation with detachable platinum coils. Three BTA presented with subarachnoid haemorrhage (SAH); the other two were asymptomatic. In four cases, one embolisation procedure produced >95% angiographic obliteration of the aneurysm. In the other patient, 80-90% obliteration was achieved initially, but due to growth of the residual aneurysm, the procedure was repeated 7 months later. Two patients experienced transient oculomotor paresis as a procedure-related complication. Mean follow-up was 43.6±34.0 months (range 8-92 months). One patient died of putaminal haemorrhage unrelated to the aneurysm 15 months after embolisation. The other four had no subsequent SAH and survived without sequelae. Endovascular embolisation using detachable platinum coils proved to be a safe and efficient treatment modality for BTA associated with moyamoya disease. (orig.)

  7. Endovascular treatment of basilar tip aneurysms associated with moyamoya disease

    Energy Technology Data Exchange (ETDEWEB)

    Arita, K.; Kurisu, K.; Ohba, S.; Shibukawa, M.; Kiura, H.; Sakamoto, S. [Department of Neurosurgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, 734-8551, Hiroshima (Japan); Uozumi, T. [Hibino Hospital, Hiroshima (Japan); Nakahara, T. [Division of Neuroendovascular Treatment, Mazda Hospital, Hiroshima (Japan)

    2003-07-01

    We report the efficacy and safety of endovascular treatment of basilar tip aneurysms (BTA) in five patients with moyamoya disease. The patients underwent intra-aneurysmal embolisation with detachable platinum coils. Three BTA presented with subarachnoid haemorrhage (SAH); the other two were asymptomatic. In four cases, one embolisation procedure produced >95% angiographic obliteration of the aneurysm. In the other patient, 80-90% obliteration was achieved initially, but due to growth of the residual aneurysm, the procedure was repeated 7 months later. Two patients experienced transient oculomotor paresis as a procedure-related complication. Mean follow-up was 43.6{+-}34.0 months (range 8-92 months). One patient died of putaminal haemorrhage unrelated to the aneurysm 15 months after embolisation. The other four had no subsequent SAH and survived without sequelae. Endovascular embolisation using detachable platinum coils proved to be a safe and efficient treatment modality for BTA associated with moyamoya disease. (orig.)

  8. Bioresorbable Electronic Stent Integrated with Therapeutic Nanoparticles for Endovascular Diseases.

    Science.gov (United States)

    Son, Donghee; Lee, Jongha; Lee, Dong Jun; Ghaffari, Roozbeh; Yun, Sumin; Kim, Seok Joo; Lee, Ji Eun; Cho, Hye Rim; Yoon, Soonho; Yang, Shixuan; Lee, Seunghyun; Qiao, Shutao; Ling, Daishun; Shin, Sanghun; Song, Jun-Kyul; Kim, Jaemin; Kim, Taeho; Lee, Hakyong; Kim, Jonghoon; Soh, Min; Lee, Nohyun; Hwang, Cheol Seong; Nam, Sangwook; Lu, Nanshu; Hyeon, Taeghwan; Choi, Seung Hong; Kim, Dae-Hyeong

    2015-06-23

    Implantable endovascular devices such as bare metal, drug eluting, and bioresorbable stents have transformed interventional care by providing continuous structural and mechanical support to many peripheral, neural, and coronary arteries affected by blockage. Although effective in achieving immediate restoration of blood flow, the long-term re-endothelialization and inflammation induced by mechanical stents are difficult to diagnose or treat. Here we present nanomaterial designs and integration strategies for the bioresorbable electronic stent with drug-infused functionalized nanoparticles to enable flow sensing, temperature monitoring, data storage, wireless power/data transmission, inflammation suppression, localized drug delivery, and hyperthermia therapy. In vivo and ex vivo animal experiments as well as in vitro cell studies demonstrate the previously unrecognized potential for bioresorbable electronic implants coupled with bioinert therapeutic nanoparticles in the endovascular system. PMID:25905457

  9. Endovascular treatment of an adolescent patient with ruptured intracranial aneurysm

    International Nuclear Information System (INIS)

    The occurrence of intracranial aneurysms in pediatric patients under 18 years of age is between 0,5-2% of all diagnosed aneurysms. We describe our experience with a patient of 10 years old with subarachnoid hemorrhage due to ruptured trilobular aneurysm on the top of the basilar artery, evidenced by CT angiography and DSA. Powered been consistently excluded from the bloodstream of two lobules of the aneurysm through coiling. Changed conditions of hemodynamics in aneurysmal sac fed to subsequent selftrombosing the third lobe of the aneurysm. Made control angiography after 10 months confirmed the good result of endovascular treatment and no neurological deficit. In conclusion it can be noted that in present conditions with a multidisciplinary approach endovascular treatment can be applied in this group of patients. (authors) Key words: SUBARACHNOID HEMORRHAGIA. CEREBRAL VESSEL ANEURYSM. BASILAR CEREBRAL ARTERY. COIL EMBOLIZATION

  10. Idiopathic aneurysms of distal cerebellar arteries: endovascular treatment after rupture

    International Nuclear Information System (INIS)

    Idiopathic ruptured aneurysms of distal cerebellar arteries (DCAAs) are rare, and their endovascular therapy (EVT) has as yet not been extensively reported. They are usually assumed to result from local arterial wall disruption rather than infection, unlike distal supratentorial artery aneurysms. This study was performed to audit their frequency, potential aetiology and results of EVT. Using strict inclusion criteria and a database of 1715 EVT patients, we identified ten idiopathic ruptured DCAAs (0.6%) over a 13-year period (1993-2006). The series comprised six males and four females with mean age of 64 years and solitary aneurysms located on posterior inferior cerebellar artery (five patients), anterior inferior cerebellar artery (three patients) and superior cerebellar artery (two patients). Nine aneurysms were fusiform and were treated by endovascular parent artery occlusion, and one was saccular and treated by endosaccular packing. Endovascular therapy was performed with coils in seven cases, n-butyl-2-cyanoacrylate (NBCA) in two cases and with both in one case. Primary EVT was successful in eight patients. One patient died following a procedure-related re-bleeding and one patient required re-treatment after failed endosaccular packing. Nine patients made good or excellent clinical recoveries (modified Rankin Scale 2 or less). Focal cerebellar infarctions were seen on computed tomography images after EVT in three patients, only one of whom was symptomatic with transient dysmetria, which resolved completely during follow up. No aneurysm recanalisation was detected on late follow-up imaging up to 24 months. Ruptured DCAAs are rare. The majority are fusiform in shape and their aetiology remains uncertain. Endovascular treatment is feasible and effective. It usually requires parent artery occlusion. (orig.)

  11. Carotid Stump Syndrome: Pathophysiology and Endovascular Treatment Options

    International Nuclear Information System (INIS)

    Carotid stump syndrome is one of the recognised causes of recurrent ipsilateral cerebrovascular events after occlusion of the internal carotid artery. It is believed that microemboli arising from the stump of the occluded internal carotid artery or the ipsilateral external carotid artery can pass into the middle cerebral artery circulation as a result of patent external carotid–internal carotid anastomotic channels. Different pathophysiologic causes of this syndrome and endovascular options for treatment are discussed.

  12. Endovascular treatment for arterial injuries of skull base

    International Nuclear Information System (INIS)

    Objective: To explore the role of endovascular techniques in treatment for arterial injuries of skull base. Methods: A total of 53 consecutive cases suffered from skull base arterial injuries were enrolled in our hospital from Oct 2004 to May 2007, including 44 male and 9 female cases with average age of 23.3 years. Thirty-nine cases presented with pulsatile exophthalmos and intracranial vascular murmur, cerchnus and dysphagia in another 9, epistaxis in the remaining 5 cases. Diagnosis of 39 carotid cavernous fistulae (CCF)and 14 carotid pseudoaneurysm were performed by angiography (DSA). Alternative endovascular procedures were performed depending on lesions characteristics and follow-up was done by telephone and outpatient work up. Results: Procedures were performed involving 56 carotid arteries in all 53 cases including 34 CCF with embolization of detachable balloon(33 cases), 3 with balloon and coils, and 3 by stent-graft placement. 8 carotid pseudoaneurysms were cured by parent artery occlusion with balloon, 2 experienced endovascular isolation with balloon and coils, and 4 with stent-graft. Follow-up for mean 9.5 months (range from 2 to 25 months) revealed that the chief symptoms of 45 cases (85%) were relieved within 6 months after the procedure but ocular movement and visual disorder remained in 8 cases (15%)till 12 months. Six pseudoaneurysms and 3 residual leak were found in reexamination, of which 2 cases underwent intervention again 2 and 3 months later due to dural arterial-venous fistula in cavernous sinus, respectively. Conclusions: Endovascular treatment is safe and effective therapeutic option with minimal invasion for skull base arterial injuries. Detachable balloon embolization is the first choice for CCF and carotid pseudoaneurysm. Spring coil packing and stent-graft implantation should be in alternation as combination for special cases. (authors)

  13. Endovascular Treatment of Extracranial Internal Carotid Aneurysms Using Endografts

    International Nuclear Information System (INIS)

    Aneurysms of the extracranial internal carotid artery (EICA) are infrequent. They are difficult to treat with conventional surgery because of their distal extension into the skull base. We report three cases of EICA aneurysms in two symptomatic patients successfully treated with polytetrafluoroethylene self-expanding endografts using an endovascular approach. The aneurysms were located distal to the carotid bifurcation and extended to the subpetrous portion of the internal carotid artery

  14. MBL Interferes with Endovascular Trophoblast Invasion in Pre-Eclampsia

    OpenAIRE

    Francesco Tedesco; Roberta Bulla; Fleur Bossi; Francesco De Seta; Maddalena Tonon; Elisa Masat; Chiara Agostinis; Oriano Radillo

    2011-01-01

    The spiral arteries undergo physiologic changes during pregnancy, and the failure of this process may lead to a spectrum of pregnancy disorders, including pre-eclampsia. Our recent data indicate that decidual endothelial cells (DECs), covering the inner side of the spiral arteries, acquire the ability to synthesize C1q, which acts as a link between endovascular trophoblast and DECs favouring the process of vascular remodelling. In this study, we have shown that sera obtained from pre-eclampti...

  15. An overview of thin film nitinol endovascular devices.

    Science.gov (United States)

    Shayan, Mahdis; Chun, Youngjae

    2015-07-15

    Thin film nitinol has unique mechanical properties (e.g., superelasticity), excellent biocompatibility, and ultra-smooth surface, as well as shape memory behavior. All these features along with its low-profile physical dimension (i.e., a few micrometers thick) make this material an ideal candidate in developing low-profile medical devices (e.g., endovascular devices). Thin film nitinol-based devices can be collapsed and inserted in remarkably smaller diameter catheters for a wide range of catheter-based procedures; therefore, it can be easily delivered through highly tortuous or narrow vascular system. A high-quality thin film nitinol can be fabricated by vacuum sputter deposition technique. Micromachining techniques were used to create micro patterns on the thin film nitinol to provide fenestrations for nutrition and oxygen transport and to increase the device's flexibility for the devices used as thin film nitinol covered stent. In addition, a new surface treatment method has been developed for improving the hemocompatibility of thin film nitinol when it is used as a graft material in endovascular devices. Both in vitro and in vivo test data demonstrated a superior hemocompatibility of the thin film nitinol when compared with commercially available endovascular graft materials such as ePTFE or Dacron polyester. Promising features like these have motivated the development of thin film nitinol as a novel biomaterial for creating endovascular devices such as stent grafts, neurovascular flow diverters, and heart valves. This review focuses on thin film nitinol fabrication processes, mechanical and biological properties of the material, as well as current and potential thin film nitinol medical applications. PMID:25839120

  16. System architecture for a magnetically guided endovascular microcatheter

    OpenAIRE

    Sincic, Ryan S.; Caton, Curtis J.; Lillaney, Prasheel; Goodfriend, Scott; Niemi, Jason; Martin, Alastair J; Losey, Aaron D.; Shah, Neel; Yee, Erin J.; Evans, Lee; Malba, Vincent; Bernhardt, Anthony F.; Settecase, Fabio; Cooke, Daniel L.; Saeed, Maythem

    2014-01-01

    Magnetic resonance imaging (MRI) guided minimally invasive interventions are an emerging technology. We developed a microcatheter that utilizes micro-electromagnets manufactured on the distal tip, in combination with the magnetic field of a MRI scanner, to perform microcatheter steering during endovascular surgery. The aim of this study was to evaluate a user control system for operating, steering and monitoring this magnetically guided microcatheter. The magnetically-assisted remote control ...

  17. The Past, Present and Future of Endovascular Aneurysm Treatment.

    Science.gov (United States)

    Henkes, H; Weber, W

    2015-10-01

    The technology available for the endovascular treatment of intracranial aneurysms is rapidly evolving. Both current and future devices are described. This includes, among others, UNO for parent vessel occlusion, the Medina device for saccular filling, the Comaneci device for remodeling, pCONus for assisted coil occlusion, and WEB and pCANvas for intrasaccular flow disruption. Perspectives of further development such as surface coating for increased radioopacity and decreased thrombogenicity are explained. PMID:26031430

  18. Early experience of endovascular treatment of peripheral vascular disease

    International Nuclear Information System (INIS)

    Atherosclerotic peripheral arterial disease (PAD) is prevalent affecting up to 16% of the population aged 55 years or older. Endovascular intervention for the treatment of limb ischemia has become the first line therapy but in Pakistan it is in embryonic stage due to dearth of trained persons and dedicated centres. This study was conducted to evaluate procedural success and early outcome of endovascular treatment of peripheral vascular disease. Methods: A prospective single arm multicentre study was conducted at the National Institute of Cardiovascular Disease and National Medical Centre, Karachi, Pakistan from January 2013 to June 2014. A total of 25 patients were enrolled in the study that underwent endovascular treatment. Out of 25 patients 23 (92%) had critical limb ischemia (CLI) as per TASC II classification (A to D) and 2 (8%) had carotid lesion with history of TIA. Patients of acute limb ischemia and stroke were excluded. Ankle brachial index (ABI) was classified as normal (0.9-1.3), mild (0.7-0.9), moderate (0.4-0.69), severe (<0.4). Outcome was taken as immediate success and symptoms, amputation of limb among CLI patients and incidence of stroke in patients with carotid artery lesion at end of six months. Results: Among aortoiliac, femoropopliteal and tibioperoneal lesions, tibioperoneal lesions at six months were found to be more symptomatic 6 (86%) and amputation 4 (57%). Two carotid lesions at follow up were asymptomatic without stroke. Conclusion: Endovascular treatment of peripheral vascular lesions, i.e., aortoiliac, femoropopliteal tibioperoneal and carotid lesions were satisfactory in immediate outcome. Tibioperoneal lesions were more symptomatic and limb amputation at six months. (author)

  19. Functional Abdominal Bloating with Distention

    OpenAIRE

    Sullivan, Stephen Norman

    2012-01-01

    Ten to 25% of healthy persons experience bloating. It is particularly common in persons with the irritable bowel syndrome and constipation. While the cause of bloating remains unknown old explanations such as a excessive intestinal gas, exaggerated lumbar lordosis and psychiatric problems have been disproved. New suggestions include recent weight gain, weak or inappropriately relaxed abdominal muscles, an inappropriately contracted diaphragm and retained fluid in loops of distal small bowel. ...

  20. Endovascular Management of Iatrogenic Native Renal Arterial Pseudoaneurysms

    International Nuclear Information System (INIS)

    Purpose: Our purpose was to evaluate iatrogenic renal pseudoaneurysms, endovascular treatment, and outcomes. Methods: This retrospective study (2003–2011) reported the technical and clinical outcomes of endovascular therapy for renal pseudoaneurysms in eight patients (mean age, 46 (range 24–68) years). Renal parenchymal loss evaluation was based on digital subtraction angiography and computed tomography. Results: We identified eight iatrogenic renal pseudoaneurysm patients with symptoms of hematuria, pain, and hematoma after renal biopsy (n = 3), surgery (n = 3), percutaneous nephrolithotomy (n = 1), and endoscopic shock-wave lithotripsy (n = 1). In six patients, the pseudoaneurysms were small-sized (<20 mm) and peripherally located and were treated solely with coil embolization (n = 5). In one patient, coil embolization was preceded by embolization with 500–700 micron embospheres to control active bleeding. The remaining two patients had large-sized (?50 mm), centrally located renal pseudoaneurysms treated with thrombin ± coils. Technical success with immediate bleeding cessation was achieved in all patients. There were no procedure-related deaths or complications (mean follow-up, 23.5 (range, 1–67) months). Conclusions: Treatment of renal pseudoaneurysms using endovascular approach is a relatively safe and viable option regardless of location (central or peripheral) and size of the lesions with minimal renal parenchymal sacrifice.

  1. Endovascular treatment of direct carotid cavernous fistulae: a pictorial review

    International Nuclear Information System (INIS)

    Direct carotid-cavernous fistulae (CCFs) are type A fistulae according to Barrow's classification. Endovascular treatment of these lesions is challenging. The purpose of this review was to evaluate the endovascular treatment of direct CCFs. We also describe the technique, symptomatology and complications associated with the procedure and report on the long-term follow-up in our treated patients. A total of 89 patients with a direct CCF were treated. All patients had baseline brain CT or MR imaging. Treatment comprised transarterial balloon or coil embolizations. The patients were followed up at 1 month and then every 6 months thereafter. Detachable balloons were used in 79 fistulae. In 12 fistulae the balloon could not be negotiated through the fistula and these fistulae were treated with transarterial coil occlusion. Clinical outcomes of the treated patients evaluated at 1 month were: 79 patients (88.8%) cured, 9 (10.1%) significantly improved, 1 (1.1%) remaining static. Endovascular treatment of direct CCFs is safe and effective and results in long-term cure. (orig.)

  2. Endovascular treatment of direct carotid cavernous fistulae: a pictorial review

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, Arun K.; Purkayastha, Sukalyan; Krishnamoorthy, T.; Bodhey, Narendra K.; Kapilamoorthy, T.R.; Kesavadas, C.; Thomas, Bejoy [Sree Chitra Tirunal Institute for Medical Sciences and Technology, Department of Imaging Sciences and Interventional Radiology, Trivandrum (India)

    2006-11-15

    Direct carotid-cavernous fistulae (CCFs) are type A fistulae according to Barrow's classification. Endovascular treatment of these lesions is challenging. The purpose of this review was to evaluate the endovascular treatment of direct CCFs. We also describe the technique, symptomatology and complications associated with the procedure and report on the long-term follow-up in our treated patients. A total of 89 patients with a direct CCF were treated. All patients had baseline brain CT or MR imaging. Treatment comprised transarterial balloon or coil embolizations. The patients were followed up at 1 month and then every 6 months thereafter. Detachable balloons were used in 79 fistulae. In 12 fistulae the balloon could not be negotiated through the fistula and these fistulae were treated with transarterial coil occlusion. Clinical outcomes of the treated patients evaluated at 1 month were: 79 patients (88.8%) cured, 9 (10.1%) significantly improved, 1 (1.1%) remaining static. Endovascular treatment of direct CCFs is safe and effective and results in long-term cure. (orig.)

  3. MBL interferes with endovascular trophoblast invasion in pre-eclampsia.

    Science.gov (United States)

    Agostinis, Chiara; Bossi, Fleur; Masat, Elisa; Radillo, Oriano; Tonon, Maddalena; De Seta, Francesco; Tedesco, Francesco; Bulla, Roberta

    2012-01-01

    The spiral arteries undergo physiologic changes during pregnancy, and the failure of this process may lead to a spectrum of pregnancy disorders, including pre-eclampsia. Our recent data indicate that decidual endothelial cells (DECs), covering the inner side of the spiral arteries, acquire the ability to synthesize C1q, which acts as a link between endovascular trophoblast and DECs favouring the process of vascular remodelling. In this study, we have shown that sera obtained from pre-eclamptic patients strongly inhibit the interaction between extravillous trophoblast (EVT) and DECs, preventing endovascular invasion of trophoblast cells. We further demonstrated that mannose-binding lectin (MBL), one of the factor increased in pre-eclamptic patient sera, strongly inhibits the interaction of EVT with C1q interfering with the process of EVT adhesion to and migration through DECs. These data suggest that the increased level of MBL in pre-eclampsia may contribute to the failure of the endovascular invasion of trophoblast cells. PMID:22203857

  4. Endovascular Treatment for Acute Ischemic Stroke: Updates and Future Implications.

    Science.gov (United States)

    Gao, Jie; Dai, Qiliang; Liu, Xinfeng

    2015-10-01

    Stroke constitutes the primary cause of acquired disability in adults and is a second leading cause of death worldwide. The low recanalization rate after intravenous thrombolysis calls for an alternate therapy for acute ischemic stroke. The methodology for endovascular treatment has evolved greatly over the past two decades. The past 6 months have seen great progress in this area, with several randomized clinical trials all proving the efficacy and safety of endovascular treatment. Three key factors are important for good functional outcome after endovascular treatment: fast imaging to prove proximal occlusion and to exclude large infarct core, using mainly the stent retriever thrombectomy devices and establishing an efficient workflow to achieve fast reperfusion. Although positive results of RCTs are encouraging and bring what is urgently needed in the field, transforming these positive results into clinical practice will be both a challenge and opportunity of the next 5 years. It will need hard work, leadership and cooperation of all members involved in the chain of treating a stroke patient. In the wake of these positive trials, hospitals and professional organizations are working together to save every minute when fighting against this devastating disease. PMID:26600796

  5. Nursing experience in clinical endovascular treatment for renal artery aneurysms

    International Nuclear Information System (INIS)

    Objective: To discuss the standardized clinical nursing measures for patients receiving endovascular treatment of renal artery aneurysms. Methods: The clinical data of 9 patients with renal artery aneurysm, who were admitted to authors' hospital during the period from Jan. 2010 to Aug. 2011 and received endovascular treatment, were retrospectively analyzed. The related nursing points as well as the received endovascular. Results: A total of 9 cases with renal artery aneurysm were treated nursing measures were summarized. Results: A total of 9 cases with renal artery aneurysm were with interventional management, including embolization (n = 6), stent implantation (n = 2) and stent implantation together with coil embolization (n = 1). The mean hospitalization time was (10±2) days. Postoperative retention of urine was observed in one patient and postoperative retroperitoneal hemorrhage occurred in another patient. Neither nursing-related nor operation-related complications occurred. Conclusion: Standardized perioperative nursing care for patients with renal artery aneurysm can surely help enhance the patient's tolerance to the surgery, and effectively prevent the complications. (authors)

  6. Simultaneous Endovascular Treatment of Ruptured Cerebral Aneurysms and Vasospasm

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Dae; Han, Moon Hee; Kang, Hyun Seung; Kim, Jeong Eun [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Ahn, Jun Hyoung [Dept. of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of); Jung, Seung Chai [Dept. of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Chang Hun [Dept. of Neurology, Stroke Center, Myongji Hospital, Goyang (Korea, Republic of); Lim, Jeong Wook [Dept. of Neurosurgery, Sun Hospital, Daejeon (Korea, Republic of)

    2015-02-15

    The management of patients with ruptured cerebral aneurysms and severe vasospasm is subject to considerable controversy. We intended to describe herein an endovascular technique for the simultaneous treatment of aneurysms and vasospasm. A series of 11 patients undergoing simultaneous endovascular treatment of ruptured aneurysms and vasospasm were reviewed. After placement of a guiding catheter within the proximal internal carotid artery for coil embolization, an infusion line of nimodipine was wired to one hub, and of a microcatheter was advanced through another hub (to select and deliver detachable coils). Nimodipine was then infused continuously during the coil embolization. This technique was applied to 11 ruptured aneurysms accompanied by vasospasm (anterior communicating artery, 6 patients; internal carotid artery, 2 patients; posterior communicating and middle cerebral arteries, 1 patient each). Aneurysmal occlusion by coils and nimodipine-induced angioplasty were simultaneously achieved, resulting in excellent outcomes for all patients, and there were no procedure-related complications. Eight patients required repeated nimodipine infusions. Our small series of patients suggests that the simultaneous endovascular management of ruptured cerebral aneurysms and vasospasm is a viable approach in patients presenting with subarachnoid hemorrhage and severe vasospasm.

  7. Developing a complex endovascular fenestrated and branched aortic program.

    Science.gov (United States)

    Schanzer, Andres; Baril, Donald; Robinson, William P; Simons, Jessica P; Aiello, Francesco A; Messina, Louis M

    2015-03-01

    In 2008, the top priority in our division's 5-year strategic plan was "to become an internationally recognized center of excellence for the endovascular treatment of complex aortic pathology extending from the aortic valve to the external iliac artery." Five components were identified as "most critical" to achieve this strategic priority: (1) training at centers of excellence in complex endovascular repair; (2) industry partnership to improve access to developing technologies; (3) a fully integrated team approach with one leader involved in all steps of all cases; (4) prospective data collection; and (5) development and implementation of a physician-sponsored investigational device exemption for juxtarenal, pararenal, and thoracoabdominal aneurysms. We have now performed 49 repairs (16 commercially manufactured devices, 33 physician-modified devices) for 3 common iliac, 20 juxtarenal, 9 pararenal, and 17 thoracoabdominal aneurysms, using 142 fenestrations, branches, and scallops. All patients had complete 30-day follow-up for calculation of 30-day events. Kaplan-Meier analysis was used to calculate 1-year events. In 5 years, we developed a successful complex endovascular aortic program that uses fenestrated/branched repair techniques. A focused team strategic planning approach to program development is an effective way for vascular surgery divisions to gain experience and expertise with new complex technologies while ensuring acceptable patient outcomes. PMID:25595400

  8. The Endovascular Management of Saccular Posterior Inferior Cerebellar Artery Aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Song, Ha Hun [Jeju Halla Hospital, Jeju (Korea, Republic of); Won, Yoo Dong; Kim, Young Joo [Uijongbu St. Mary' s Hospital, The Catholic University of Korea, Uijongbu (Korea, Republic of); Kim, Bum Soo [Kangnam St. Mary' s Hospital, The Catholic University of Korea, Seoul (Korea, Republic of)

    2008-10-15

    The purpose of this retrospective study was to report the outcome of the endovascular treatment of eight patients with eight saccular posterior inferior cerebellar artery (PICA) aneurysms. Over the last seven years (1999-2006), eight consecutive patients with saccular PICA aneurysms were treated by endovascular methods. Five of the aneurysms were presented with subarachnoid hemorrhaging, whereas three were discovered incidentally. Four of the aneurysms (3 ruptured and 1 incidental) were treated by intrasaccular coiling, whereas the remaining four (1 ruptured and 3 incidental) were treated by vertebral artery (VA) occlusion. Of the four aneurysms treated by intrasaccular coiling, three were completely packed with coils and one was partially packed. In three of four patients who underwent vertebral artery occlusions, follow-up digital subtraction angiographies demonstrated thrombosed aneurysms and PICA. No procedurerelated morbidity occurred and no re-bleed was encountered during a follow-up examination (mean; 31 months). As a result of this study, we found that the endovascular management of saccular PICA aneurysms should be considered as safe and effective

  9. Simultaneous Endovascular Treatment of Ruptured Cerebral Aneurysms and Vasospasm

    International Nuclear Information System (INIS)

    The management of patients with ruptured cerebral aneurysms and severe vasospasm is subject to considerable controversy. We intended to describe herein an endovascular technique for the simultaneous treatment of aneurysms and vasospasm. A series of 11 patients undergoing simultaneous endovascular treatment of ruptured aneurysms and vasospasm were reviewed. After placement of a guiding catheter within the proximal internal carotid artery for coil embolization, an infusion line of nimodipine was wired to one hub, and of a microcatheter was advanced through another hub (to select and deliver detachable coils). Nimodipine was then infused continuously during the coil embolization. This technique was applied to 11 ruptured aneurysms accompanied by vasospasm (anterior communicating artery, 6 patients; internal carotid artery, 2 patients; posterior communicating and middle cerebral arteries, 1 patient each). Aneurysmal occlusion by coils and nimodipine-induced angioplasty were simultaneously achieved, resulting in excellent outcomes for all patients, and there were no procedure-related complications. Eight patients required repeated nimodipine infusions. Our small series of patients suggests that the simultaneous endovascular management of ruptured cerebral aneurysms and vasospasm is a viable approach in patients presenting with subarachnoid hemorrhage and severe vasospasm.

  10. Abdominal wound closure: current perspectives

    Directory of Open Access Journals (Sweden)

    Williams ZF

    2015-12-01

    Full Text Available Zachary F Williams, William W Hope Department of Surgery, South East Area Health Education Center, New Hanover Regional Medical Center, Wilmington, NC, USA Abstract: This review examines both early and late wound complications following laparotomy closure, with particular emphasis on technical aspects that reduce hernia formation. Abdominal fascial closure is an area of considerable variation within the field of general surgery. The formation of hernias following abdominal wall incisions continues to be a challenging problem. Ventral hernia repairs are among the most common surgeries performed by general surgeons, and despite many technical advances in the field, incisional hernia rates remain high. Much attention and research has been directed to the surgical management of hernias. Less focus has been placed on prevention of hernia formation despite its obvious importance. This review examines the effects of factors such as the type of incision, suture type and size, closure method, patient risk factors, and the use of prophylactic mesh. Keywords: incisional, abdominal, hernia, prevention, wound closure techniques 

  11. Tratamento endovascular de pseudo-aneurisma de carótida interna em criança / Endovascular treatment of internal carotid pseudoaneurysm in a child

    Scientific Electronic Library Online (English)

    Alexandre Faraco de, Oliveira; Daissuke, Kajita; Rafael Gomes de Almeida, Garzon; Crescêncio Alberto Pereira, Centola; Carla Aparecida Faccio, Bosnardo; Miguel, Francischelli Neto.

    2006-03-01

    Full Text Available Relato de um caso de paciente feminina, com 6 anos de idade, que apresentou uma massa cervical, dolorosa e com características de processo infeccioso, que revelou ser um pseudo-aneurisma de carótida interna. Foi realizado o tratamento endovascular, com o uso de um balão destacável que determinou a o [...] clusão e conseqüente trombose do pseudo-aneurisma, com excelente resultado. Abstract in english This report is about a 6-year-old female patient who presented a painful cervical mass with characteristics of an infectious process, which was, in fact, an internal carotid pseudoaneurysm. The treatment consisted of the pseudoaneurysm occlusion with an endovascular detachable balloon and its conseq [...] uent thrombosis, with excellent results.

  12. Tratamento endovascular de pseudo-aneurisma de carótida interna em criança Endovascular treatment of internal carotid pseudoaneurysm in a child

    Directory of Open Access Journals (Sweden)

    Alexandre Faraco de Oliveira

    2006-03-01

    Full Text Available Relato de um caso de paciente feminina, com 6 anos de idade, que apresentou uma massa cervical, dolorosa e com características de processo infeccioso, que revelou ser um pseudo-aneurisma de carótida interna. Foi realizado o tratamento endovascular, com o uso de um balão destacável que determinou a oclusão e conseqüente trombose do pseudo-aneurisma, com excelente resultado.This report is about a 6-year-old female patient who presented a painful cervical mass with characteristics of an infectious process, which was, in fact, an internal carotid pseudoaneurysm. The treatment consisted of the pseudoaneurysm occlusion with an endovascular detachable balloon and its consequent thrombosis, with excellent results.

  13. Drenaje percutáneo de colecciones abdominales Percutaneous drainage od abdominal collections

    Directory of Open Access Journals (Sweden)

    Nancy Toro

    1995-03-01

    Full Text Available Gracias a los grandes adelantos en las imágenes diagnósticas la radiología intervencionista ha tenido grandes avances en los últimos años; el drenaje percutáneo de colecciones abdominales es hoy en día un procedimiento ampliamente utilizado para el tratamiento definitivo de patologías tan variadas como abscesos abdominales, complicaciones de pancreatitis y apendicitis, drenaje de hematomas, linfoceles, bilomas, quistes y tumores necróticos; también se han demostrado su seguridad y efectividad para el drenaje de colecciones en el tórax, el bazo y el retroperitoneo. En los pacientes críticamente enfermos el DPC permite una rápida mejoría del cuadro clínico para ser llevados a cirugía en mejores condiciones y simplificar los procedimientos quirúrgicos. Para el radiólogo estos procedimientos representan la oportunidad de reforzar su papel como clínico en el seguimiento estrecho de estos pacientes.

    Interventional radiology has greatly progressed in recent years due to the great advances of diagnostic imaging. Percutaneous drainage (PCD of abdominal collections is presently a widely employed procedure for definitive treatment of diverse entitles such as abdominal abscesses, complications of pancreatitis and appendicitis, evacuation of hematomas, Iymphoceles, bilomas, necrotic cysts and tumors. It has also shown safety and effectiveness for draining collections in the thorax, spleen and retroperitoneum. In critically III patients PCD allows a quick improvement of the clinical situation so that surgery, If needed, can be performed In better conditions and this procedure becomes simpler. For radiologists this Interventions represent the opportunity to Improve their clinical evaluation of patients.

  14. Tratamento endovascular da reestenose carotídea: resultados em curto prazo / Endovascular treatment of carotid artery restenosis: short term results

    Scientific Electronic Library Online (English)

    Ricardo Augusto Carvalho, Lujan; Leonardo Aguiar, Lucas; Andréia de Fátima, Gracio; Giovana Maria Lopes, Carvalho; Armando de Carvalho, Lobato.

    2011-03-01

    Full Text Available CONTEXTO: O tratamento cirúrgico da reestenose carotídea apresenta alta taxa de lesão neurológica. Contrariamente, o tratamento endovascular da doença obstrutiva carotídea extracraniana tem se tornado mais factível e gradualmente menores taxas de risco cirúrgico vêm sendo reportadas, tornando-se uma [...] opção em situações especiais, e provavelmente poderá ser considerado o tratamento padrão para reestenose carotídea. OBJETIVOS: Avaliar a aplicabilidade, a segurança e a eficácia da angioplastia com o uso do stent (ACS) no tratamento da reestenose carotídea (REC) no intraoperatório e no pós-operatório recente (80%, enquanto quatro (21%) eram sintomáticos com estenose >70%. Apenas em um paciente não foi utilizado sistema de proteção cerebral. O sucesso técnico foi obtido em todos os casos. Não houve morte ou acidente vascular encefálico no intra ou no pós-operatório recente (30 dias). CONCLUSÃO: O tratamento endovascular da reestenose carotídea mostrou-se uma abordagem factível e segura em curto prazo Abstract in english CONTEXT: The surgical treatment of carotid artery restenosis presents a high risk of nerve injury. On the contrary, endovascular treatment for extracranial carotid artery obstructive disease has become more feasible. Gradually, lower rates of surgical risk have been reported, which makes the treatme [...] nt a good option in special situations. It may be considered as the standard treatment for carotid artery restenosis. OBJECTIVE: To evaluate the applicability, safety, and efficacy of the angioplasty with the use of a stent (Carotid Artery Stenting - CAS) for the treatment of carotid artery restenosis, in the intraoperative and early (80%, whereas 4 (21%) were symptomatic with stenosis >70%. In only one patient a cerebral protection system was not used. Technical success was achieved in all cases. There was no death or stroke in the intraoperative or the early postoperative period (30 days). CONCLUSION: Endovascular treatment of carotid artery restenosis seems to be a feasible and safe approach in the short term

  15. Tratamento endovascular da reestenose carotídea: resultados em curto prazo Endovascular treatment of carotid artery restenosis: short term results

    Directory of Open Access Journals (Sweden)

    Ricardo Augusto Carvalho Lujan

    2011-03-01

    Full Text Available CONTEXTO: O tratamento cirúrgico da reestenose carotídea apresenta alta taxa de lesão neurológica. Contrariamente, o tratamento endovascular da doença obstrutiva carotídea extracraniana tem se tornado mais factível e gradualmente menores taxas de risco cirúrgico vêm sendo reportadas, tornando-se uma opção em situações especiais, e provavelmente poderá ser considerado o tratamento padrão para reestenose carotídea. OBJETIVOS: Avaliar a aplicabilidade, a segurança e a eficácia da angioplastia com o uso do stent (ACS no tratamento da reestenose carotídea (REC no intraoperatório e no pós-operatório recente (80%, enquanto quatro (21% eram sintomáticos com estenose >70%. Apenas em um paciente não foi utilizado sistema de proteção cerebral. O sucesso técnico foi obtido em todos os casos. Não houve morte ou acidente vascular encefálico no intra ou no pós-operatório recente (30 dias. CONCLUSÃO: O tratamento endovascular da reestenose carotídea mostrou-se uma abordagem factível e segura em curto prazoCONTEXT: The surgical treatment of carotid artery restenosis presents a high risk of nerve injury. On the contrary, endovascular treatment for extracranial carotid artery obstructive disease has become more feasible. Gradually, lower rates of surgical risk have been reported, which makes the treatment a good option in special situations. It may be considered as the standard treatment for carotid artery restenosis. OBJECTIVE: To evaluate the applicability, safety, and efficacy of the angioplasty with the use of a stent (Carotid Artery Stenting - CAS for the treatment of carotid artery restenosis, in the intraoperative and early (80%, whereas 4 (21% were symptomatic with stenosis >70%. In only one patient a cerebral protection system was not used. Technical success was achieved in all cases. There was no death or stroke in the intraoperative or the early postoperative period (30 days. CONCLUSION: Endovascular treatment of carotid artery restenosis seems to be a feasible and safe approach in the short term

  16. Tórax inestable: Fisiopatología, tratamiento

    Scientific Electronic Library Online (English)

    Gerardo, Llera Domínguez; Sergio, Rabell Hernández; Arnaldo, Valls Martín; Aurelio, Menéndez Guerrero.

    1996-06-01

    Full Text Available Se reporta que el traumatismo de tórax tiene una alta mortalidad y el tórax inestable que es una modalidad, mostró en Cuba, en una serie de 1985 a 1988, el 25 %. Se indica que el tratamiento del tórax batiente ha ido cambiando de acuerdo con la fisiopatología que ha sido aceptada en cada momento. Se [...] refiere que cuando se pensó que el problema principal era la inestabilidad torácica, los métodos usados fueron para inmovilizar. Posteriormente se utilizó la estabilización neumática interna, pero a largo plazo producía mortalidad por infección respiratoria y estenosis traqueales. Se destaca que con el concepto actual de que lo principal es la contusión pulmonar subyacente se seleccionan los pacientes y se ventilan sólo los que tienen función respiratoria comprometida, y los otros se tratan con fisioterapia y bloqueos o anestesia peridural para combatir el dolor. Se concluye en que a los pacientes que se ventilan es importante desacoplarlos tempranamente del respirador mecánico, para lo que son útiles los fijadores externos como el de Valls. En los pacientes que tienen que ser sometidos a una toracotomía se puede aprovechar para hacer una osteosíntesis Abstract in english It is reported that thoracic traumas have a high mortality, and the flail chest, a modality, showed in Cuba, in a series from 1985 to 1988, the 25 %. The management of flail chest has been changing with the physiopathology accepted at each moment. When it was thought that the main problem was the th [...] oracic instability, the methods were used just to immobilize. Later, the internal pneumatic stabilization was used, but at a long term it produced mortality due to respiratory infections and tracheal stenosis. It is highlighted that with today's concept, the main objective is the underlying lung contusion; the patients are selected and ventilation is indicated only for those who have a compromised respiratory function; the others are treated with physical therapy and blockade, or peridural anesthesia to fight pain. It is concluded that it is important to disconect early the ventilated patients from the mechanical respirator, and external fixators like Valls' are useful for this purpose. In patients submitted to thoracotomy, an osteosynthesis may be performed if necessary

  17. Tórax inestable: Fisiopatología, tratamiento

    Scientific Electronic Library Online (English)

    Gerardo, Llera Domínguez; Sergio, Rabell Hernández; Arnaldo, Valls Martín; Aurelio, Menéndez Guerrero.

    1996-12-01

    Full Text Available Se reporta que el traumatismo de tórax tiene una alta mortalidad y el tórax inestable que es una modalidad, mostró en Cuba, en una serie de 1985 a 1988, el 25 %. Se indica que el tratamiento del tórax batiente ha ido cambiando de acuerdo con la fisiopatología que ha sido aceptada en cada momento. Se [...] refiere que cuando se pensó que el problema principal era la inestabilidad torácica, los métodos usados fueron para inmovilizar. Posteriormente se utilizó la estabilización neumática interna, pero a largo plazo producía mortalidad por infección respiratoria y estenosis traqueales. Se destaca que con el concepto actual de que lo principal es la contusión pulmonar subyacente se seleccionan los pacientes y se ventilan sólo los que tienen función respiratoria comprometida, y los otros se tratan con fisioterapia y bloqueos o anestesia peridural para combatir el dolor. Se concluye en que a los pacientes que se ventilan es importante desacoplarlos tempranamente del respirador mecánico, para lo que son útiles los fijadores externos como el de Valls. En los pacientes que tienen que ser sometidos a una toracotomía se puede aprovechar para hacer una osteosíntesis Abstract in english It is reported that thoracic traumas have a high mortality, and the flail chest, a modality, showed in Cuba, in a series from 1985 to 1988, the 25 %. The management of flail chest has been changing with the physiopathology accepted at each moment. When it was thought that the main problem was the th [...] oracic instability, the methods were used just to immobilize. Later, the internal pneumatic stabilization was used, but at a long term it produced mortality due to respiratory infections and tracheal stenosis. It is highlighted that with today's concept, the main objective is the underlying lung contusion; the patients are selected and ventilation is indicated only for those who have a compromised respiratory function; the others are treated with physical therapy and blockade, or peridural anesthesia to fight pain. It is concluded that it is important to disconect early the ventilated patients from the mechanical respirator, and external fixators like Valls' are useful for this purpose. In patients submitted to thoracotomy, an osteosynthesis may be performed if necessary

  18. Retained and Fractured Microcatheter: a Cause of Transient Ischaemic Attacks: Endovascular Management Using Carotid Stents

    OpenAIRE

    Mortimer, A.M.; Nelson, R. J.; Clifton, A.; Renowden, S.A.

    2012-01-01

    A retained microcatheter is a rare complication of endovascular treatment of cerebral aneurysms. We describe such a case that was complicated by delayed microcatheter fracture within the internal carotid artery and subsequent thrombo-embolism resulting in transient ischaemic attacks. We also describe endovascular management of this complication through the use of several carotid stents.

  19. Leo Stent for Endovascular Treatment of Broad-Necked and Fusiform Intracranial Aneurysms

    OpenAIRE

    Juszkat, R.; S. Nowak; Smól, S.; Kociemba, W.; Blok, T.; Zarzecka, A.

    2007-01-01

    The advent of intracranial stents has widened the indications for endovascular treatment of broad-necked and fusiform aneurysms. Leo stent is a self-expandable, nitinol, braided stent dedicated to intracranial vessels. The aim of this study is to present our experience in endovascular treatment of broad-necked and fusiform intracranial aneurysms using self-expanding, nitinol Leo stents.

  20. Trauma abdominal em grávidas Abdominal trauma in pregnant women

    Directory of Open Access Journals (Sweden)

    Gustavo Pereira Fraga

    2005-09-01

    Full Text Available OBJETIVOS: avaliar os fatores indicativos (parâmetros clínicos e índices de gravidade fisiológicos e anatômicos da evolução materna e fetal entre gestantes vítimas de trauma abdominal submetidas à laparotomia e discutir as particularidades do atendimento nesta situação. MÉTODOS: análise retrospectiva dos prontuários de 245 mulheres com trauma abdominal e tratamento operatório, atendidas entre 1990 e 2002. Foram identificadas 13 gestantes com lesão abdominal submetidas à laparotomia. Para registro e análise estatística dos dados foram utilizados o protocolo Epi-Info 6.04 e o teste exato de Fisher, com intervalo de confiança de 95%. Foram relacionados com a mortalidade fetal: escore na escala de coma de Glasgow, pressão arterial sistólica, índices de trauma (RTS, ATI, ISS e lesão uterina. RESULTADOS: a idade variou de 13 a 34 anos (média de 22,5. Seis mulheres (46,2% estavam no terceiro trimestre de gestação. O trauma penetrante correspondeu a 53,8% das lesões e em seis dessas pacientes o mecanismo de trauma foi ferimento por projétil de arma de fogo. Três pacientes tiveram lesões uterinas, associadas com óbito fetal. Não houve óbito materno e a mortalidade fetal foi de 30,7%. Não houve associação entre os índices de trauma e a mortalidade materna e fetal. A lesão uterina foi o único fator preditivo de risco para perda fetal (p=0,014. CONCLUSÕES: apesar da casuística pequena e de se tratar de estudo retrospectivo de gestantes com trauma grave, os achados deste estudo mostram que não há indicadores com boa acurácia para indicação da evolução materna e fetal.PURPOSE: to evaluate the predictors (clinical findings and physiological and anatomical scores of the maternal and fetal outcomes among pregnant women victims of abdominal trauma who were submitted to laparotomy and to discuss particularities of assessment in this situation. METHODS: retrospective analysis of the medical records of 245 women with abdominal trauma and surgical treatment, from 1990 to 2002. Thirteen pregnant women with abdominal injury were identified. All cases were registered in the Epi-Info 6.04 protocol and data were analyzed statistically by the Fisher exact test, with confidence interval of 95%. RESULTS: ages ranged from 13 to 34 years (mean of 22.5. Six women (46.2% were in the third trimester of pregnancy. Penetrating trauma accounted for 53.8% of injuries and in six of these patients the mechanism of trauma was gunshot wounds. Three patients had uterine injuries associated with fetal death. There were no maternal deaths and fetal mortality was 30.7%. The use of trauma scores was not associated with maternal and fetal mortality. Uterine injury was the only predictive risk factor for fetal loss (p=0.014. CONCLUSIONS: this is a retrospective study analyzing a small number of pregnant women victims of severe trauma. However, the results show that there are no predictive accuracy scores to evaluate maternal and fetal outcomes.

  1. Percutaneous endovascular stent-graft treatment of aortic aneurysms and dissections: new techniques and initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Do Yun; Choi, Dong Hoon; Kang, Sung Gwon; Lee, Kwang Hoon; Won, Jong Yun [Yonsei University College of Medicine, Seoul (Korea, Republic of); Kang, Sung Gwon [Chosun University College of Medicine, Gwangju (Korea, Republic of); Won, Je Whan [Aju University College of Medicine, Suwon (Korea, Republic of); Song, Ho Young [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2003-01-01

    To evaluate the feasibility, safety and effectiveness of a newly designed percutaneously implanted separate stent-graft (SSG) for the treatment of aortic aneurysms and dissections. Using a percutaneous technique, SSG placement (in the descending thoracic aorta in 26 cases and infrarenal abdominal aorta in 24) was attempted in 50 patients with aortic aneurysms (n=27) or dissection (n=23). All SSGs were individually constructed using self-expandable nitinol stents and a Dacron graft, and were introduced through a 12 F sheath and expanded to a diameter of 20-34 mm. In all cases, vascular access was through the femoral artery. The clinical status of each patient was monitored, and postoperative CT was performed within one week of the procedure and at 3-6 month intervals afterwards. Endovascular stent-graft deployment was technically successful in 49 of 50 patients (98%). The one failure was due to torsion of the unsupported graft during deployment. Successful exclusion of aneurysms and the primary entry tears of dissections was achieved in all but three patients with aortic dissection. All patients in whom technical success was achieved showed complete thrombosis of the thoracic false lumen or aneurysmal sac, and the overall technique success rate was 92%. In addition, sixteen patients demonstrated complete resolution of the dissected thoracic false lumen (n=9) or aneurysmal sac (n=7). Immediate post-operative complications occurred at the femoral puncture site in one patient with an arteriovenous fistula, and in two, a new saccular aneurysm developed at the distal margin of the stent. No patients died, and there was no instance of paraplegia, stroke, side-branch occlusion or infection during the subsequent mean follow-up period of 9.4 (range, 2 to 26) months. In patients with aortic aneurysm and dissection, treatment with a separate percutaneously inserted stent-graft is technically feasible, safe, and effective.

  2. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts.

    Science.gov (United States)

    Svensson, Lars G; Kouchoukos, Nicholas T; Miller, D Craig; Bavaria, Joseph E; Coselli, Joseph S; Curi, Michael A; Eggebrecht, Holger; Elefteriades, John A; Erbel, Raimund; Gleason, Thomas G; Lytle, Bruce W; Mitchell, R Scott; Nienaber, Christoph A; Roselli, Eric E; Safi, Hazim J; Shemin, Richard J; Sicard, Gregorio A; Sundt, Thoralf M; Szeto, Wilson Y; Wheatley, Grayson H

    2008-01-01

    Between 43,000 and 47,000 people die annually in the United States from diseases of the aorta and its branches and continues to increase. For the thoracic aorta, these diseases are increasingly treated by stent-grafting. No prospective randomized study exists comparing stent-grafting and open surgical treatment, including for disease subgroups. Currently, one stent-graft device is approved by the Food and Drug Administration for descending thoracic aortic aneurysms although two new devices are expected to obtain FDA approval in 2008. Stent-graft devices are used "off label" or under physician Investigational Device Exemption studies for other indications such as traumatic rupture of the aorta and aortic dissection. Early first-generation devices suffered from problems such as stroke with insertion, ascending aortic dissection or aortic penetration from struts, vascular injury, graft collapse, endovascular leaks, graft material failure, continued aneurysm expansion or rupture, and migration or kinking; however, the newer iterations coming to market have been considerably improved. Although the devices have been tested in pulse duplicators out to 10 years, long-term durability is not known, particularly in young patients. The long-term consequences of repeated computed tomography scans for checking device integrity and positioning on the risk of irradiation-induced cancer remains of concern in young patients. This document (1) reviews the natural history of aortic disease, indications for repair, outcomes after conventional open surgery, currently available devices, and insights from outcomes of randomized studies using stent-grafts for abdominal aortic aneurysm surgery, the latter having been treated for a longer time by stent-grafts; and (2) offers suggestions for treatment. PMID:18083364

  3. Observer variation in vascular CT measurements of the abdominal aorta

    International Nuclear Information System (INIS)

    Aim: To assess the inter-observer variation between a radiographer and radiologist when performing CT measurement of the abdominal aorta before endovascular aortic aneurysm repair (EVAR). Methods: A total of 30 consecutive patients who were considered anatomically suitable for EVAR had aortic measurements performed independently by a vascular radioogist and then by a radiographer training vascular and CT imaging. All measurements were performed on a computer workstation using electronic callipers, each patient had 12 anatomical sites evaluated (eight diameters, four vessel lengths). Statistical analysis was performed by the computer package SPSS for Windows 11.01. Results: Of the 30 patients, mean difference in measurements between observers was 2.3 mm ± 1.2 mm and 6.0 mm ± 6.4 mm for diameter and vessel length measurements, respectively. Two hundred and seven (86%) diameter measurements were ?2 mm of each other and 233 (97%) were within ?5 mm. Eighty-two (57%) length measurements were within ?5 mm, and 100 (83%) within 10 mm or less. Widest variation existed for measurements of common iliac diameter and aortic neck length, where coefficients of variance were 38.2 (95% CI 35.7-41.0) and 40.0 (95% CI 36.2-44.6), respectively. Conclusion: A good level of agreement exists between a trained radiographer and radiologist when comparing vascular CT measurements of the aorta. It is technically feasible for a radiographer to perform these measurements, and improvements in variability may be achieved from a more standardised technique and automated vessel analysis software. Further research is required to establish the overall variability between different observer types when undertaking vascular CT measurements

  4. Estudio dosimétrico de la embolización endovascular de varicocele en pacientes pediátricos / Paediatric varicocele embolization dosimetric study

    Scientific Electronic Library Online (English)

    J.A., Calama Santiago; J.M., Penedo Cobos; M.Y., Molina López; C., González Ruiz; R., García Mollá; F., Sierra Díaz.

    2008-09-01

    Full Text Available Introducción y objetivos: El varicocele es una anomalía benigna que se detecta generalmente en pacientes jóvenes, y para cuyo tratamiento existen técnicas quirúrgicas. La embolización endovascular es un procedimiento terapéutico alternativo mínimamente invasivo, pero con un riesgo radiológico asocia [...] do que resulta esencial conocer para valorar el método de tratamiento más adecuado. El objetivo del trabajo es determinar niveles locales de dosis recibidas en embolizaciones de varicocele en pacientes pediátricos y minimizarlas, estimando el riesgo radiológico. Material y métodos: El estudio se ha realizado en dos fases; una retrospectiva para 15 embolizaciones en pacientes con edades comprendidas entre 10 y 18 años, sin intervención previa en el método de trabajo, y otra prospectiva para 10 pacientes de 10 a 16 años de edad, utilizando algunas técnicas de reducción de dosis implementadas en el equipo. Se conocía el tiempo de escopia y el valor del producto dosis-área de cada intervención. Además, en la fase prospectiva, se han utilizado dosímetros termoluminescentes para la evaluación de la dosis máxima de entrada en piel, y películas radiográficas para verificar la zona irradiada. Resultados: La dosis efectiva media estimada en el estudio retrospectivo fue de 8.8 mSv. El riesgo total medio de inducción de cáncer fatal en cualquier localización fue un 0.16%, siendo un 0.0007% para los efectos hereditarios. La dosis máxima de entrada en piel fue de 250 mGy, siendo 2 Gy el umbral de dosis para la aparición de efectos deterministas en piel. Para los pacientes del estudio prospectivo, las dosis y el riesgo radiológico se redujeron en más de un 70%. Conclusiones: La estimación de riesgo radiológico estocástico es relativamente elevada comparada con el riesgo de complicaciones severas en las intervenciones quirúrgicas de varicocele, excepto para el caso de efectos hereditarios. Son descartables los efectos de tipo determinista, salvo en complicaciones del procedimiento. La exposición a la radiación debe ser optimizada. Es necesario que los clínicos prescriptores e intervencionistas conozcan los riesgos radiológicos asociados a la intervención e informen a sus pacientes. Abstract in english Introduction and objectives: Varicocele is a benign condition, often asymptomatic, that appears among young men with a normal life expectancy. The endovascular embolization is a minimally invasive therapeutic procedure indicated for varicocele treatment, although there are safe surgical alternatives [...] . It is essential to know the radiological risk associated with the procedure. The aim of this work is to determine local dose levels in paediatric varicocele embolization, in order to minimize and to estimate the radiological risk. Material and methods: In the retrospective study, 15 cases were analyzed, all of which were paediatric patients (10-18 years). The screening time and the dose-area product were known, as provided by the X-ray equipment. In the prospective study, dose optimization techniques were implemented, and in addition, radiographic films were used in order to verify the radiated zone and termoluminiscense dosimeters in order to evaluate gonad dose and maximum skin dose for 10 paediatric patients (10-16 years). Results: In the retrospective group, the average effective dose was 8.8 mSv. The total average risk of a fatal cancer induction in any location was 0.16%, and 0.0007% for hereditary effects. The maximum skin dose was 250 mGy, which is far from the threshold for deterministic effects (2 Gy). In the prospective group, dose and radiological risk decreased by more than 70%. Conclusions: Hereditary effects were very low in contrast to the fatal cancer risk estimation. According to the results we can discard deterministic effects, unless complications appear in the procedure. Radiation exposure must be optimized. It is necessary that medical staff know the radiological risks associated with the intervention, and inform the patients about them.

  5. Layer-dependent wall properties of abdominal aortic aneurysms: Experimental study and material characterization.

    Science.gov (United States)

    Sassani, Sophia G; Kakisis, John; Tsangaris, Sokrates; Sokolis, Dimitrios P

    2015-09-01

    Mechanical testing and in-depth characterization of the abdominal aortic aneurysm wall from fifteen patients undergoing open surgery was performed to establish the layer-dependent tissue properties that are non-available in the literature. Quantitative microscopic evaluation was performed to identify the spatial organization of collagen-fiber network. Among a number of candidate models, the four-fiber family (microstructure-motivated) model, especially that including dispersions of fiber angles about the main directions, was superior to the Fung- and Gasser-type models in the fitting quality allowed, though it presented a practical difficulty in parameter estimation, so that an analysis was conducted aiding the identification of a more specific diagonal- and circumferential-fiber family model for all three layers. The adventitia was stiffer and stronger than the other layers, owing to its increased collagen content, and its contribution to the response of the intact wall was augmented being under greater residual tension than the media, whereas the intima was under residual compression. All layers were stiffer circumferentially than longitudinally, due to preferential collagen arrangement along that axis. The histologically-guided material characterization of layered wall presented herein is expected to assist clinical decision, by developing reliable criteria to predict the rupture risk of abdominal aortic aneurysms, and optimize endovascular interventions. PMID:26011656

  6. Abdominal Compartment Syndrome Due to OHSS

    Directory of Open Access Journals (Sweden)

    Shohreh Malekkhosravi

    2012-02-01

    Full Text Available Abdominal compartment syndrome is a dangerous clinical situation, usually following abdominal injuries&operations. It is seldom observed in patients with gynecologic and obstetric problems. Abdominalcompartment syndrome may be consequence ovarian hyperstimulation syndrome. A 28-year-old womanpresented as a sever ovarian hyperstimulation.The increased IAP indicated that OHSS may beconsidered a compartment syndrome. Abdominal compartment syndrome needs laparotomy orparacentesis for reduction of pressure.

  7. Abdominal pregnancy: Methods of hemorrhage control

    OpenAIRE

    Kunwar, Shipra; Khan, Tamkin; Srivastava, Kumkumrani

    2015-01-01

    Abdominal pregnancy is an extremely rare form of ectopic pregnancy, mostly occurring secondarily after tubal rupture or abortion with secondary implantation anywhere in the peritoneal cavity. Massive intra-abdominal hemorrhage is a life threatening complication associated with secondary abdominal pregnancy. Various methods and techniques have been reported in the literature for controlling hemorrhage. Here, we report a case of massive intraperitoneal haemorrhage following placental removal co...

  8. Ruptura de aneurismas de aorta abdominal. Herramienta informática para su predicción / Rupture of abdominal aortic aneurysm. Software for its prediction

    Scientific Electronic Library Online (English)

    Guillermo, Vilalta-Alonso; Félix, Nieto; José A., Vilalta-Alonso; Carlos, Vaquero; Laurentiu M., Lipsa; Melchor, Rodríguez-Madrigal.

    2011-04-01

    Full Text Available La ruptura de los aneurismas de aorta abdominal representa un evento clínico muy importante debido a su alta tasa de mortalidad. Los indicadores empleados actualmente para decidir el tratamiento a pacientes con aneurismas son el diámetro máximo transversal y la tasa de crecimiento, los que pueden se [...] r considerados insuficientes, pues no tienen una base teórica físicamente fundamentada. En el presente artículo se definen los fundamentos para el diseño de una herramienta informática para PC que permita predecir, con suficiente precisión para ser clínicamente relevante, el riesgo de ruptura de aneurismas de aorta abdominal sobre bases personalizadas del paciente. La herramienta consta de 3 módulos, que están diseñados para procesar toda la información del paciente e integrarla mediante un modelo que incorpora la interrelación de los factores biomecánicos de diferentes naturalezas (biológicos, estructurales y geométrico) y escalas (temporal y dimensional), con el objetivo de calcular un indicador numérico y personalizado del riesgo de ruptura. Esta herramienta debe constituir un elemento auxiliar del facultativo médico en la toma de decisiones respecto del tratamiento adecuado a pacientes con aneurisma. Abstract in english The rupture of abdominal aortic aneurysm (AAA) represents an important clinical event due to its high mortality rate. Currently the criteria to decide on the treatment of AAA patients are the peak transverse diameter and the growth rate which can be considered insufficient because they have not a re [...] asonable physical base. The foundations for the design of PC software to predict, with sufficient accuracy to be clinically relevant, the risk of AAA rupture on patient-specific basis are defined in this paper. The software consists of 3 modules which are designed for processing all patient-specific information and integrate them through a model that interrelates the different nature (biological, structural and geometric) and scales (temporal and dimensional) biomechanical factors, in order to calculate a numerical and patient-specific indicator of the rupture risk. This tool should be an auxiliary element to physician in making decision on appropriate treatment decisions for patients with aneurysm.

  9. Dolor abdominal recurrente psicológico o anatómico secundario a síndrome de Wilkie / Recurrent psychological or anatomical abdominal pain secondary to Wilkie's syndrome

    Scientific Electronic Library Online (English)

    Mario Andrés, Castillo Wisman; María del Carmen, Alvarez Galán; Raimundo, Rodríguez-Bobada Aguirre; Julián, Arenas Mosqueda.

    2014-06-01

    Full Text Available El síndrome de la arteria mesentérica superior (SAMS) o de Wilkie es una causa inusual de dolor y obstrucción abdominal alta, debido a la compresión de la tercera porción del duodeno, entre la aorta y arteria mesentérica superior. El paciente presenta síntomas como náuseas, vómitos, dolor epigástric [...] o, retraso ponderal o saciedad precoz. Por ser el dolor abdominal un motivo frecuente de consulta en atención primaria y en los servicios de urgencias, presentamos este caso poco frecuente, a tener en cuenta dentro del diagnostico diferencial de un dolor abdominal con síntomas recurrentes y sin respuesta al manejo médico. A pesar de su rareza, el SAMS es una patología cada vez más vista en nuestra población, debido al aumento de la cirugía traumatológica vertebral, cirugías mayores, alteraciones de la conducta alimentaria, drogas de abuso, quemados, paraplejías e inmovilizados. Puede diagnosticarse desde atención primaria, ya que se trata de pacientes muy demandantes por la poca respuesta al tratamiento medico inicial, si se desconoce la importancia nutricional en el manejo de estos pacientes. Presentamos su sintomatología, grupos de riesgo, diagnósticos diferenciales y tratamiento. Abstract in english Superior mesenteric artery (SMA) (or Wilkie's) syndrome is a rare cause for upper abdominal pain and obstruction, due to compression of the third portion of the duodenum, between the aort