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Sample records for abdominal tratamiento endovascular

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

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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.

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

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    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

  3. Endovascular repair of abdominal aortic aneurysms.

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    Arnaoutakis, Dean J; Zammert, Martin; Karthikesalingam, Alan; Belkin, Michael

    2016-09-01

    Endovascular repair of abdominal aortic aneurysms is an important technique in the vascular surgeon's armamentarium, which has created a seismic shift in the management of aortic pathology over the past two decades. In comparison to traditional open repair, the endovascular approach is associated with significantly improved perioperative morbidity and mortality. The early survival benefit of endovascular abdominal aortic aneurysm repair is sustained up to 3 years postoperatively, but longer-term life expectancy remains poor regardless of operative modality. Nonetheless, most abdominal aortic aneurysms are now repaired using endovascular stent grafts. The technology is not perfect as several postoperative complications, namely endoleak, stent-graft migration, and graft limb thrombosis, can develop and therefore lifelong imaging surveillance is required. In addition, a postoperative inflammatory response has been documented after endovascular repair of aortic aneurysms; the clinical significance of this finding has yet to be determined. Subsequently, the safety and applicability of endovascular stent grafts are likely to improve and expand with the introduction of newer-generation devices and with the simplification of fenestrated systems. PMID:27650343

  4. 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.

  5. [ENDOVASCULAR ABDOMINAL AORTIC ANEURISM REPAIR].

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    Maĭstrenko, D N; Generalov, M I; Tarazov, P G; Zherebtsov, F K; Osovskikh, V V; Ivanov, A S; Oleshchuk, A N; Granov, D A

    2015-01-01

    The authors analyzed the single-center experience of treatment of 72 patients with abdominal aortic aneurisms and severe accompanied pathology. The aneurisms were repaired by stent-grafts. All the patients had abdominal aortic aneurisms with the diameters from 41 to 84 mm against the background of severe somatic pathology. It was a contraindication to planned open surgery. An installation of stent-graft was successful in all 72 follow-ups. It wasn't necessary to use a conversion to open surgery. The follow-up period consisted of 44,6?2,1 months. Control ultrasound and computer tomography studies hadn't revealed an increase of aneurism sack sizes or "eakages". A reduction of abdominal aortic aneurism sizes was noted in 37 patients on 4-5% during first year after operation. The stent-graft implantation extends the possibilities of abdominal aortic aneurism treatment for patients from a high surgical risk group. PMID:26234059

  6. 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

  7. Impact of smoking on endovascular abdominal aortic aneurysm surgery outcome.

    NARCIS (Netherlands)

    Lottman, P.E.M.; Marrewijk, C.J. van; Fransen, G.A.J.; Laheij, R.J.F.; Buth, J.

    2004-01-01

    OBJECTIVE: Smoking plays a major role in deficiencies of the vascular system, and seems to have consequences for the treatment of cardiovascular diseases. We hypothesized that smokers have a higher mortality and more complications after endovascular abdominal aortic aneurysm surgery than non-smokers

  8. Device-specific outcomes after endovascular abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    F.B. Gonçalves (Frederico Bastos); E.V. Rouwet (Ellen); R. Metz (Roderik); J.M. Hendriks (Joke); M.P.F.V. Peeters; B.E. Muhs (Bart); H.J.M. Verhagen (Hence)

    2010-01-01

    textabstractOver the last decade, endovascular aneurysm repair (EVAR) has been used extensively for the elective treatment of infra-renal abdominal aneurysms. However, it remains unclear how specific devices perform and how they compare to others. We provide an overview of currently used endografts,

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

    DEFF Research Database (Denmark)

    Firwana, Belal; Ferwana, Mazen; Hasan, Rim;

    2014-01-01

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

  10. Aneurysm sac enlargement after endovascular Abdominal Aortic Aneurysm repair

    NARCIS (Netherlands)

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

    2015-01-01

    The aim of this study is to give an overview of current knowledge regarding abdominal aortic aneurysm (AAA) growth after endovascular aortic aneurysm repair (EVAR) that could potentially lead to aortic rupture. A search on Pubmed was performed. A total of 705 articles were found after initial search

  11. MRI-based Assessment of Endovascular Abdominal Aortic Aneurysm Repair

    NARCIS (Netherlands)

    Laan, M.J. van der

    2007-01-01

    Imaging techniques play a key role in the Endovascular Abdominal Aortic Aneurysm Repair (EVAR) follow-up. The most important parameters monitored after EVAR are the aneurysm size and the presence of endoleaks. Currently, computed tomographic angiography (CTA) is the most commonly used imaging modali

  12. The treatment of giant abdominal aorta aneurysm with endovascular stent-graf

    OpenAIRE

    Şeref Ulucan; Ahmet Keser; Ahmet Kuzgun; Fatih Aygün; Duran Efe

    2012-01-01

    The usage of endovascular stent-graft in the treatment of abdominal aorta aneurysm has been increasing in the abdominal surgery. This paper presents the case of a patient with right iliac artery aneurysm who was treated with the application of endovascular stent-graft. J Clin Exp Invest 2012; 3 (3): 423-425Key words: Abdominal Aorta Aneurysm, EVAR, Stentgraft

  13. Endovascular abdominal aortic aneurysm repair in the geriatric population

    Institute of Scientific and Technical Information of China (English)

    Athanasios Saratzis; Saif Mohamed

    2012-01-01

    Abdominal aortic aneurysm (AAA) is a relatively common pathology among the elderly. More people above the age of 80 will have to undergo treatment of an AAA in the future. This review aims to summarize the literature focusing on endovascular repair of AAA in the geriatric population. A systematic review of the literature was performed, including results from endovascular abdominal aortic aneurysm repair (EVAR) registries and studies comparing open repair and EVAR in those above the age of 80. A total of 15 studies were identified. EVAR in this population is efficient with a success rate exceeding 90% in all cases, and safe, with early mortality and morbidity being superior among patients undergoing EVAR against open repair. Late survival can be as high as 95% after 5 years. Aneurysm-related death over long-term follow-up was low after EVAR, ranging from 0 to 3.4%. Endovascular repair can be offered safely in the geriatric population and seems to compare favourably with open repair in all studies in the literature to date.

  14. Current endovascular treatment of infrarenal abdominal aortic aneurysms and future directions.

    Science.gov (United States)

    Kokkosis, Angela A; Abramowitz, Steven; Malik, Rajesh K; Ellozy, Sharif H; Faries, Peter L; Marin, Michael L

    2012-12-01

    The paradigm in elective surgical management of infrarenal abdominal aortic aneurysms (AAAs) has quickly shifted from major open surgical repairs to less invasive, endovascular procedures. In the last few years, there have been numerous advancements to commercially available devices making the endovascular approach more attractive and efficacious. This review serves to detail the similarities, differences, advantages, and disadvantages of currently available endovascular stent-grafts as well as preview future and emerging technologies in endovascular aortic therapies.

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

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    Emerson Henrique do Nascimento

    2010-09-01

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

  16. The treatment of giant abdominal aorta aneurysm with endovascular stent-graf

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    Şeref Ulucan

    2012-09-01

    Full Text Available The usage of endovascular stent-graft in the treatment of abdominal aorta aneurysm has been increasing in the abdominal surgery. This paper presents the case of a patient with right iliac artery aneurysm who was treated with the application of endovascular stent-graft. J Clin Exp Invest 2012; 3 (3: 423-425Key words: Abdominal Aorta Aneurysm, EVAR, Stentgraft

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

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

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

  18. Anesthetic considerations for endovascular abdominal aortic aneurysm repair

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    Harikrishnan Kothandan

    2016-01-01

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

  19. Anesthetic considerations for endovascular abdominal aortic aneurysm repair

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

    2016-01-01

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

  20. Intra-Abdominal Hypertension and Abdominal Compartment Syndrome in Association with Ruptured Abdominal Aortic Aneurysm in the Endovascular Era: Vigilance Remains Critical

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    Matthew C. Bozeman

    2012-01-01

    In this review, we describe published experience with IAH and ACS complicating abdominal vascular catastrophes, experience with ACS complicating endovascular repair of rAAAs, and techniques for management of the abdominal wound. Vigilance and appropriate management of IAH and ACS remains critically important in decreasing morbidity and optimizing survival following catastrophic intra-abdominal vascular events.

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

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    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

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

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    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.

  3. Endovascular repair:alternative treatment of ruptured abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    GUO Wei; ZHANG Hong-peng; LIU Xiao-ping; YIN Tai; JIA Xin; LIANG Fa-qi; ZHANG Guo-hua

    2009-01-01

    Background As an alternative to open aneurysm repair,endovascular aortic repair(EVAR)has been applied to ruptured abdominal aortic aneurysm(rAAA).The aim of this study was to evaluate the immediate and long-term outcomes of EVAR for rAAA.Methods From July 1997 to September 2007,20 men and six women with rAAA(median age,68 years)were treated with EVAR.Most patients with suspected rAAA underwent emergency computed tomographic angiography(CTA).The procedure was performed under general or local anesthesia.Endovascular clamping was attempted in hemodynamically unstable patients.Bifurcated endografts and aorto-uni-iliac(AUI)endografts with crossover bypass were used.Patients had CT scan prior to discharge,3,6,12 months after discharge,and annually thereafter.Results Time between diagnosis and EVAR ranged from 1 hour to 5 days.EVAR was performed under general anesthesia in 21 patients,and under local anesthesia in five patients.Endovascular aortic clamping was performed in four patients.There was no conversion to open surgery during EVAR.Stent-graft insertion was successful in all patients.One patient died during EVAR from acute myocardial infarction.Ten patients had systolic blood pressure<80 mm Hg.Eleven patients received a blood transfusion.Mean aneurysm size was(47c12)mm.Mean ICU stay was(8±3)days,mean hospital stay(18±6)days,and mean procedure time(120±32)minutes.The 30-day mortality was 23%(6/26patients),and major morbidity 35%(9/26 patients).Early endoleak occurred in 8/26 patients(31%).The mean follow-up was(18±7)months.No patient demonstrated migration of the stent-graft.Conclusions EVAR is a safe and effective option for treatment of acute rAAA,independent of the patient's general condition.Immediate and mid-term outcomes are favorable,but long-term outcome is unknown.Multi-center studies are necessary to establish the role of EVAR for rAAA.

  4. Perioperative management of endovascular abdominal aortic aneurysm repair

    International Nuclear Information System (INIS)

    Objective: To summarize the clinical experience of perioperative management in performing endovascular abdominal aortic aneurysm repair (EVAR). Methods: EVAR was performed in 22 patients with abdominal aortic aneurysm. The clinical data were retrospectively analyzed. Before treatment the functions of main organs were evaluated and certain measures were adopted in order to protect them. Useful parameters, including the length, diameter, angle and configuration of the proximal and distal aneurysmal neck, the relationship of the aneurysm to aortic branches, the distance from the lowest renal artery to the bifurcation of abdominal aorta, and the quality of access vessels (such as diameter, tortuosity and calcification degree) were determined and assessed with CTA. According to the parameters thus obtained, the suitable stent-graft with ideal diameter and length was selected, and the optimal surgery pattern was employed. Local anesthesia was employed in 20 patients, among them the local anesthesia had to be changed to general anesthesia in one. Epidural anesthesia was carried out in one patient through the surgically-reconstructed iliac artery access,and general anesthesia was employed in one patient who had Stanford type A aortic dissection. The lowest renal artery must be accurately localized before deployment of stent-graft was started. At least one patent internal iliac artery should be reserved when bilateral internal iliac arteries needed to be covered, to be covered by stages or to be reconstructed. After stent-graft placement, angiography must be performed to find out if there was any endoleak and, if any, to determine the type of endoleak and to deal with it properly. Two cases had proximal type I endoleak, so balloon dilation was employed in one and cuff implantation in another one. Distal type I endoleak occurred in one case, but, unfortunately, the iliac artery ruptured when balloon dilation was employed, therefore the patient had to receive vascular repair

  5. 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

  6. Endovascular vs open repair for ruptured abdominal aortic aneurysm

    Science.gov (United States)

    Nedeau, April E.; Pomposelli, Frank B.; Hamdan, Allen D.; Wyers, Mark C.; Hsu, Richard; Sachs, Teviah; Siracuse, Jeffrey J.; Schermerhorn, Mark L.

    2014-01-01

    Objective Endovascular repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) has become first-line therapy at our institution and is performed under a standardized protocol. We compare perioperative mortality, midterm survival, and morbidity after EVAR and open surgical repair (OSR). Methods Records were retrospectively reviewed from May 2000 to September 2010 for repair of infrarenal rAAAs. Primary end points included perioperative mortality and midterm survival. Secondary end points included acute limb ischemia, length of stay, ventilator-dependent respiratory failure, myocardial infarction, renal failure, abdominal compartment syndrome, and secondary intervention. Statistical analysis was performed using the t-test,X2 test, the Fisher exact test, and logistic regression calculations. Midterm survival was assessed with Kaplan-Meier analysis and Cox proportional hazard models. Results Seventy-four infrarenal rAAAs were repaired, 19 by EVAR and 55 by OSR. Despite increased age and comorbidity in the EVAR patients, perioperative mortality was 15.7% for EVAR, which was significantly lower than the 49% for OSR (odds ratio, 0.19; 95% CI, 0.05-0.74; P = .008). Midterm survival also favored EVAR (hazard ratio, 0.40; 95% CI, 0.21-0.77; P = .028, adjusted for age and sex). Mean follow-up was 20 months, and 1-year survival was 60% for EVAR vs 45% for OSR. Mean length of stay for patients surviving >1 day was 10 days for EVAR and 21 days for OSR (P = .004). Ventilator-dependent respiratory failure was 5% in the EVAR group vs 42% for OSR (odds ratio, 0.08; 95% CI, 0.01-0.62; P = .001). Conclusions EVAR of rAAA has a superior perioperative survival advantage and decreased morbidity vs OSR. Although not statistically significant, overall survival favors EVAR. We recommend that EVAR be considered as the first-line treatment of rAAAs and practiced as the standard of care. PMID:22626871

  7. Fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    GUO Wei; ZHANG Hong-peng; LIU Xiao-ping; JIA Xin; XIONG Jiang; MA Xiao-hui

    2013-01-01

    Background Endovascular stent-graft with fenestration can improve proximal sealing in patients with juxtarenal abdominal aortic aneurysm (JAAA).The purpose of this study was to describe our primary experience and evaluate the safety and efficacy of fenestrated device for JAAA in high-risk patients.Methods Between March 2011 and May 2012,nine male patients (mean age,(79.6±8.6) years) with asymptomatic JAAAs underwent elective deployment of the Zenith fenestrated stent-grafts at a single institution.All patients were treated in the hybrid operating room under general anesthesia.Follow-up computed tomography angiography (CTA) was routinely performed before discharge,at 3,6,and 12 months and annually thereafter.Results Procedural success was achieved in all cases.Total sixteen small fenestrations,two large fenestrations and eight scallops were used.Intra-operative complications occurred in four patients,which included one proximal type Ⅰ endoleak,two type Ⅱ endoleaks,and one renal artery dissection.The mean hospital stay was (8.9±1.4) days,mean blood loss was (360.5±46.8) ml,and mean iodinated contrast volume was (230.6±58.3) ml.The mean follow-up time was (7.6±4.2) months.The visceral graft patency was 100% until now.One patient had an increase of serum creatinine of more than 30%,but did not require dialysis.No patients died,no stent fractured,and migration were diagnosed during the follow-up.Conclusions The early results of fenestrated device for high-risk patients with complex JAAAs are satisfactory.However,long-term fenestrated graft durability and branch vessel patency remain to be determined.

  8. A case of acute ischemic colitis after endovascular abdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Grigorios Voulalas

    2016-01-01

    Full Text Available Colonic ischemia is a recognized complication of either open or endovascular abdominal aortic aneurysm repair. The clinical difficulty in establishing the diagnosis, the severity of this complication and the patient's poor physiological status may lead to a fatal outcome. We presented a case of ischemic colitis in a patient with patent hypogastric arteries that occurred after an endovascular abdominal aortic aneurysm repair as well as a review of the available literature. The patient's preoperative, intraoperative and postoperative data were recorded. A thorough search through the Google data and Medline to review similar cases or any analyses that referred to ischemic colitis after endovascular abdominal aneurysm repair was conducted. A 76-year-old male was admitted to our department for an elective endovascular repair of an 8 cm in diameter abdominal aortic aneurysm. A Zenith bifurcation graft was implanted. The whole procedure was uneventful and the final angiogram showed an accurate deployment of the endograft without endoleaks and patency of both hypogastric arteries. During the 1st postoperative day, the patient developed symptoms of acute abdomen in combination with metabolic acidosis and oliguria. He underwent an exploratory laparotomy, which revealed necrosis of the sigmoid. A Hartmann's procedure was performed; the patient was transferred to the intensive care unit where he deceased after 24 h. Postoperative ischemic colitis has been described after open abdominal aneurysm repair. The description of this complication has been reported since the early phase of endovascular abdominal aneurysm repair development with a current incidence of 1.5%–3.0%. Possible mechanisms that may contribute to ischemic colitis in spite of the presence of patent hypogastric arteries include atheroembolization, shock, vasopressive drugs and inferior mesenteric artery occlusion.

  9. A case of acute ischemic colitis after endovascular abdominal aortic aneurysm repair

    Institute of Scientific and Technical Information of China (English)

    Grigorios Voulalas; Chrisostomos Maltezos

    2016-01-01

    Colonic ischemia is a recognized complication of either open or endovascular abdominal aortic aneurysm repair. The clinical difficulty in establishing the diagnosis, the severity of this complication and the patient's poor physiological status may lead to a fatal outcome. We presented a case of ischemic colitis in a patient with patent hypogastric arteries that occurred after an endovascular abdominal aortic aneurysm repair as well as a review of the available literature. The patient's preoperative, intraoperative and postoperative data were recorded. A thorough search through the Google data and Medline to review similar cases or any analyses that referred to ischemic colitis after endovascular abdominal aneurysm repair was conducted. A 76-year-old male was admitted to our department for an elective endovascular repair of an 8 cm in diameter abdominal aortic aneurysm. A Zenith bifurcation graft was implanted. The whole procedure was uneventful and the final angiogram showed an accurate deployment of the endograft without endoleaks and patency of both hypogastric arteries. During the 1st postoperative day, the patient developed symptoms of acute abdomen in combination with metabolic acidosis and oliguria. He underwent an exploratory laparotomy, which revealed necrosis of the sig-moid. A Hartmann's procedure was performed;the patient was transferred to the intensive care unit where he deceased after 24 h. Postoperative ischemic colitis has been described after open abdominal aneurysm repair. The description of this complication has been reported since the early phase of endovascular abdominal aneurysm repair development with a current incidence of 1.5%–3.0%. Possible mechanisms that may contribute to ischemic colitis in spite of the presence of patent hypogastric arteries include athe-roembolization, shock, vasopressive drugs and inferior mesenteric artery occlusion.

  10. Banding for type IA endoleak after endovascular abdominal aortic repair: An underexposed treatment option.

    Science.gov (United States)

    van Lammeren, G W; Ünlü, Ç; De Vries, J P P M

    2016-04-01

    More challenging abdominal aortic aneurysms with unfavorable proximal aortic neck anatomy are treated with endovascular means. As a consequence, proximal inadequate sealing may result in type IA endoleak, which in turn can lead to abdominal aortic aneurysm progression or rupture. The presence of type IA endoleak is an indication for secondary interventions. External aortic banding can be a good option to solve a type IA endoleak, but is underreported in literature; we present two cases and review literature.

  11. Maximal aneurysm diameter follow-up is inadequate after endovascular abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    Wever, JJ; Blankensteijn, JD; Mali, WPTM; Eikelboom, BC

    2000-01-01

    Background: follow-up after endovascular abdominal aortic aneurysm repair (EAR) generally consists of serial diameter measurements. A size change after EAR, however, is the consequence of alterations of the excluded aneurysm sac volume. Objective: to assess the agreement between diameter measurement

  12. Surgical or endovascular therapy of abdominal penetrating aortic ulcers and their natural history: a systematic review.

    Science.gov (United States)

    Georgiadis, George S; Antoniou, George A; Georgakarakos, Efstratios I; Nikolopoulos, Evagelos S; Papanas, Nikolaos; Trellopoulos, George; Iatrou, Christos; Papadopoulou, Maria Z; Lazarides, Miltos K

    2013-10-01

    Little is known regarding the outcomes of endovascular and surgical treatment of penetrating ulcers in the abdominal aorta. The potential benefit of conservative management of asymptomatic disease is also debatable. A systematic review of the literature was undertaken to investigate these issues. PMID:23932417

  13. Emergency abdominal aortic aneurysm repair with a preferential endovascular strategy : Mortality and cost-effectiveness analysis

    NARCIS (Netherlands)

    Kapma, Marten R.; Groen, Henk; Oranen, Bjorn I.; van der Hilst, Christian S.; Tielliu, Ignace F.; Zeebregts, Clark J.; Prins, Ted R.; van den Dungen, Jan J.; Verhoeven, Eric L.

    2007-01-01

    Purpose: To assess mortality and treatment costs of a new management protocol with preferential use of emergency endovascular aneurysm repair (eEVAR) for acute abdominal aortic aneurysm (AAA). Methods: From September 2003 until February 2005, 49 consecutive patients (45 men; mean age 71 years) with

  14. New insights in (acute) endovascular abdominal aneurysm repair : when fenestrated devices fall short

    NARCIS (Netherlands)

    Pol, R. A.; Tielliu, I. F. J.; Zeebregts, C. J.

    2013-01-01

    The suitability for endovascular aneurysm repair (EVAR) is determined primarily by abdominal aortic aneurysm (AAA) anatomy. For patients unsuitable for standard EVAR, due to proximal neck anatomy, fenestrated aortic stent-grafting (FEVAR) is a viable alternative to open repair surgery. Initially FEV

  15. MRI follow-up of abdominal aortic aneurysms after endovascular repair

    NARCIS (Netherlands)

    Cornelissen, S.A.P.

    2012-01-01

    Aneurysm size changes form the basis of the follow-up after endovascular abdominal aortic aneurysm repair, because aneurysm growth increases rupture risk. Aneurysm growth can be caused by endoleak (leakage of blood in the aneurysm sac). Therefore, accurate endoleak detection is important in growing

  16. Mortality of ruptured abdominal aortic aneurysm with selective use of endovascular repair

    NARCIS (Netherlands)

    Verhoeven, E. L. G.; Kapma, M. R.; Bos, W. T. G. J.; Vourliotakis, G.; Bracale, U. M.; Bekkema, F.; Vahl, A. C.; Van den Dungen, J. J. A. M.

    2009-01-01

    The aim of this review was to examine the results over a seven-year period of treatment for ruptured abdominal aortic aneurysm (RAAA). From 2002 on, our tertiary referral centre offered both open and endovascular (EVAR) treatment modalities for RAAA. All patients with a proven RAAA who were admitted

  17. Collected World and Single Center Experience With Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms

    NARCIS (Netherlands)

    Veith, Frank J.; Lachat, Mario; Mayer, Dieter; Malina, Martin; Holst, Jan; Mehta, Manish; Verhoeven, Eric L. G.; Larzon, Thomas; Gennai, Stefano; Coppi, Gioacchino; Lipsitz, Evan C.; Gargiulo, Nicholas J.; van der Vliet, J. Adam; Blankensteijn, Jan; Buth, Jacob; Lee, W. Anthony; Biasi, Giorgio; Deleo, Gaetano; Kasirajan, Karthikeshwar; Moore, Randy; Soong, Chee V.; Cayne, Neal S.; Farber, Mark A.; Raithel, Dieter; Greenberg, Roy K.; van Sambeek, Marc R. H. M.; Brunkwall, Jan S.; Rockman, Caron B.; Hinchliffe, Robert J.

    2009-01-01

    Background: Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial. Objective: To clarify these we examined a c

  18. Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms.

    NARCIS (Netherlands)

    Veith, F.J.; Lachat, M.; Mayer, D.; Malina, M.; Holst, J.; Mehta, M.; Verhoeven, E.L.; Larzon, T.; Gennai, S.; Coppi, G.; Lipsitz, E.C.; Gargiulo, N.J.; Vliet, J.A. van der; Blankensteijn, J.D.; Buth, J.; Lee, W.A.; Biasiol, G.; Deleo, G.; Kasirajan, K.; Moore, R.; Soong, C.V.; Cayne, N.S.; Farber, M.A.; Raithel, D.; Greenberg, R.K.; Sambeek, M.R. van; Brunkwall, J.S.; Rockman, C.B.; Hinchliffe, R.J.

    2009-01-01

    BACKGROUND: Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial. OBJECTIVE: To clarify these we examined a c

  19. Fenestrated stent-grafting after previous endovascular abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    Vourliotakis, G.; Bos, W. T. G. J.; Beck, A. W.; Van den Dungen, J. J. A. M.; Prins, T. R.; Verhoeven, E. L. G.

    2010-01-01

    Aim. The aim of this study was to present their experience and highlight the technical difficulties associated with the use of fenestrated stent-grafts to treat juxta and pararenal abdominal aortic aneurysms (AAA) in patients having undergone a previous infrarenal endovascular aneurysm repair (EVAR)

  20. Surgical or endovascular therapy of abdominal penetrating aortic ulcers and their natural history: a systematic review.

    Science.gov (United States)

    Georgiadis, George S; Antoniou, George A; Georgakarakos, Efstratios I; Nikolopoulos, Evagelos S; Papanas, Nikolaos; Trellopoulos, George; Iatrou, Christos; Papadopoulou, Maria Z; Lazarides, Miltos K

    2013-10-01

    Little is known regarding the outcomes of endovascular and surgical treatment of penetrating ulcers in the abdominal aorta. The potential benefit of conservative management of asymptomatic disease is also debatable. A systematic review of the literature was undertaken to investigate these issues.

  1. Endotension - a cause of failure in endovascular repair of abdominal aortic aneurysms

    International Nuclear Information System (INIS)

    The phenomenon of aortic aneurysm enlargement after endovascular repair without detectable endoleak is called 'endotension'. It is caused by persistent pressurization within the excluded aneurysm sac and may cause subsequent rupture of the aneurysm. We undertake a review of current knowledge about causes, significance and treatment of endotension as a failure in endovascular aortic aneurysm repair. The goal of endovascular abdominal aortic aneurysm repair is to prevent aneurysm ruptures by excluding the aneurysms from the aortic circulation. AAA (Abdominal Aortic Aneurysm) after EVAR (Endovascular Aneurysm Repair) can enlarge even in the absence of detectable endoleak because of persistent pressurization within the excluded aneurysm. There are many theories about the mechanism of pressure transmission into the excluded aneurismal sac. Some laboratory and clinical research shows that endotension can be connected with attachment side failure, graft fabrics or aneurysm sac geometry. Pressure transmission by the thrombus, poor outflow, osmotic effect or ultrafiltration are the other possible mechanisms causing this phenomenon. Maximal diameter measurement by CT is considered to be the best management method in patients after EVAR. However, lack of aneurysm sac shrinkage observed in some cases does not mean the presence of endotension. The role of pulsatility inside the excluded aneurysm sac remains unclear. Several possible concepts of endotension treatment have been discussed, including both open surgical convention and nonoperative approach. The absence of endoleak after endovascular repair not always means that there is no pressurization within the aneurysm. Success of endovascular repair can be evaluated indirectly by observation of changes in the diameter of the aneurysm sac after EVAR. Thus, it is essential to follow up patients after endovascular repair in order to detect any late complications including endotension

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-09-15

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

  4. Endovascular therapy for overcoming challenges presented with blunt abdominal aortic injury.

    Science.gov (United States)

    Gilani, Ramyar; Saucedo-Crespo, Hector; Scott, Bradford G; Tsai, Peter I; Wall, Metthew J; Mattox, Kenneth L

    2012-05-01

    Blunt abdominal aortic injury (BAAI) is a rare and lethal injury requiring surgical management. Injury patterns can be complex and surgical strategy should accommodate specific case circumstances. Endovascular solutions appear appropriate and preferred in certain cases of BAAI, which, however, may not be applicable due to device limitations in regard to patient anatomy and limited operating room capability. However, endovascular therapy can be pursued with limited fluoroscopy capability and consumable availability providing a solution that is expeditious and effective for select cases of BAAI.

  5. Abdominal aortic aneurysms : clinical insights and outcome after endovascular repair

    NARCIS (Netherlands)

    Zandvoort, H.J.A.

    2013-01-01

    Abdominal aortic aneurysm (AAA) is a focal dilatation of the abdominal aorta. The pathophysiology of AAA is a complex multifactorial process and much is still unknown. Histologic and biochemical analysis of AAA wall characteristics can contribute to a better insight in AAA pathophysiology. To make t

  6. Management of multiple type Ⅱ endoleaks detected by duplex ultrasound after endovascular abdominal aneurysm repair

    Institute of Scientific and Technical Information of China (English)

    GUO Da-qiao; LI Wei-miao; JIANG Jun-hao; SHI Zhen-yu; WANG Yu-qi; FU Wei-guo

    2012-01-01

    We reported a case of multiple type Ⅱ endoleaks detected by duplex ultrasound after endovascular abdominal aneurysm repair.The patient was undergoing warfarin therapy.Duplex ultrasound was applied as the sole surveillance method during follow-up and provided the concerned information for reintervention.The endoleaks were successfully repaired by coil embolization of the collaterals from the internal iliac artery feeding the fourth lumbar artery.

  7. Hybrid endografts combinations for the treatment 
of endoleak in endovascular abdominal aortic aneurysm repair.

    Science.gov (United States)

    Georgiadis, George S; Trellopoulos, George; Antoniou, George A; Georgakarakos, Efstratios I; Nikolopoulos, Evagelos S; Iatrou, Christos; Lazarides, Miltos K

    2013-01-01

    Hybrid endografting in endovascular abdominal aortic aneurysm repair (EVAR) is defined as the process of placing a series of two or more different types of covered stents, usually to treat a complex abdominal aortic aneurysm (AAA) or a primary or secondary endoleak. We describe the treatment of a type III, a type Ib, and a type Ia endoleak in three patients respectively, using hybrid solutions, assembling components from different manufacturers. An update of the current clinical and experimental evidence on the application of anatomically compatible, hybrid endograft systems in conventional EVAR is also provided. PMID:23280081

  8. [Endovascular repair of abdominal aortic aneurysm in a patient with transplanted kidney].

    Science.gov (United States)

    Khabazov, R I; Chupin, A V; Kolosov, R V; Deriabin, S V

    2016-01-01

    Endovascular repair of the abdominal aorta is a method of choice in pronounced concomitant pathology and high risk of open surgical treatment. The article deals with a clinical case report of successful surgical management of a patient with an infrarenal aortic aneurysm, transplanted kidney, chronic renal insufficiency, secondary diabetes mellitus, multifocal atherosclerosis with predominant involvement of coronary arteries and lower-limb arteries, in whom open surgical treatment was associated with high risk. Endoprosthetic repair of the abdominal aortic aneurysm was performed with a good postoperative outcome. PMID:27626264

  9. A Case of Endovascular Treatment of Severe Graft Limb Kinking after Endovascular Abdominal Aortic Aneurysm Repair

    Science.gov (United States)

    Shin, Jong-Beom; Park, Mi-Hwa; Jeong, Sang-Ho; Kwon, Sung Woo; Shin, Sung-Hee; Woo, Seong-Ill; Park, Sang-Don

    2016-01-01

    Endovascular aneurysm repair (EVAR) has been recommended as an alternative to open aneurysm repair. The risk of severe perioperative complications is lower than that in open surgical repair; however, late complications are more likely. After EVAR, regular yearly surveillance by duplex ultrasonography or computed tomography is recommended. We report the case of a 67-year-old man with a severely kinked left iliac branch of the stent graft 10 years after EVAR. He had not undergone regular follow-up during the last 4 years. We realigned the endograft kink by percutaneous transluminal angioplasty. PMID:27051658

  10. Aneurysm diameter and proximal aortic neck diameter influence clinical outcome of endovascular abdominal aortic repair : A 4-year EUROSTAR experience

    NARCIS (Netherlands)

    Waasdorp, EJ; de Vries, JPPM; Hobo, R; Leurs, LJ; Buth, J; Moll, FL

    2005-01-01

    Our objective was to evaluate the effect of preoperative aneurysm and aortic neck diameter on clinical outcome after infrarenal abdominal endovascular aneurysm repair (EVAR). Data of patients in the European Collaborators Registry on Stent-Graft Techniques for Abdominal Aortic Aneurysm Repair (EUROS

  11. Tratamiento endovascular de una fuga paraprotésica mitral con dispositivo Amplatzer®

    Directory of Open Access Journals (Sweden)

    Alberto Sciegata

    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.

  12. An Update on the Inflammatory Response after Endovascular Repair for Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Eleni Arnaoutoglou

    2015-01-01

    Full Text Available Postimplantation syndrome (PIS is the clinical and biochemical expression of an inflammatory response following endovascular repair of an aortic aneurysm (EVAR. The goal of this review is to provide an update on the inflammatory response after endovascular repair of abdominal aortic aneurysm, discussing its causes and effects on the clinical outcome of the patient. PIS concerns nearly one-third of patients after EVAR. It is generally a benign condition, although in some patients it may negatively affect outcome. The different definitions and conclusions drawn from several studies reveal that PIS needs to be redefined with standardized diagnostic criteria. The type of the endograft’s material seems to play a role in the inflammatory response. Future studies should focus on a better understanding of the underlying pathophysiology, predictors, and risk factors as well as determining whether effective preventive strategies are necessary.

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

    Energy Technology Data Exchange (ETDEWEB)

    Idoguchi, Koji, E-mail: idoguchi@ares.eonet.ne.jp; Yamaguchi, Masato; Okada, Takuya [Kobe University Hospital, Department of Radiology and Center for Endovascular Therapy (Japan); Nomura, Yoshikatsu [Kobe University Hospital, Department of Cardiovascular Surgery (Japan); Sugimura, Kazuro [Kobe University Hospital, Department of Radiology and Center for Endovascular Therapy (Japan); Okita, Yutaka [Kobe University Hospital, Department of Cardiovascular Surgery (Japan); Sugimoto, Koji [Kobe University Hospital, Department of Radiology and Center for Endovascular Therapy (Japan)

    2012-10-15

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

  14. Acute Testicular Ischemia following Endovascular Abdominal Aortic Aneurysm Repair Identified in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Nathan Finnerty

    2014-01-01

    Full Text Available Endovascular aneurysm repair (EVAR is perhaps the most widely utilized surgical procedure for patients with large abdominal aortic aneurysms. This procedure is minimally invasive and reduces inpatient hospitalization requirements. The case involves a 72-year-old male who presented to the emergency department with right testicular ischemia two days following EVAR. Given the minimal inpatient hospitalization associated with this procedure, emergency physicians are likely to encounter associated complications. Ischemic and thromboembolic events following EVAR are extremely rare but require prompt vascular surgery intervention to minimize morbidity and mortality.

  15. Endovascular Repair of Abdominal Aortic Aneurysms in the Presence of a Transplanted Kidney

    Energy Technology Data Exchange (ETDEWEB)

    Silverberg, Daniel, E-mail: silverberg-d@msn.com; Yalon, Tal; Halak, Moshe [The Chaim Sheba Medical Center, The Department of Vascular Surgery (Israel)

    2015-08-15

    PurposeTo present our experience performing endovascular repair of abdominal aortic aneurysms in kidney transplanted patients.MethodsA retrospective review of all patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) performed at our institution from 2007 to 2014. We identified all patients who had previously undergone a kidney transplant. Data collected included: comorbidities, preoperative imaging modalities, indication for surgery, stent graft configurations, pre- and postoperative renal function, perioperative complications, and survival rates.ResultsA total of 267 EVARs were performed. Six (2 %) had a transplanted kidney. Mean age was 74 (range, 64–82) years; five were males. Mean time from transplantation to EVAR was 7.5 (range, 2–12) years. Five underwent preoperative planning with noncontrast modalities only. Devices used included bifurcated (n = 3), aortouniiliac (n = 2), and tube (n = 1) stent grafts. Technical success was achieved in all patients. None experienced deterioration in renal function. Median follow-up was 39 (range, 6–51) months. Four patients were alive at the time of the study. Two patients expired during the period of follow-up from unrelated causes.ConclusionsEVAR is an effective modality for the management of AAAs in the coexistence of a transplanted kidney. It can be performed with minimal morbidity and mortality without harming the transplanted kidney. Special consideration should be given to device configuration to minimize damage to the renal graft.

  16. Results of Open and Endovascular Abdominal Aortic Aneurysm Repair According to the E-PASS Score

    Directory of Open Access Journals (Sweden)

    Fábio Hüsemann Menezes

    2016-02-01

    Full Text Available Abstract Introduction: Endovascular repair (EVAR of abdominal aortic aneurysm has become the standard of care due to a lower 30-day mortality, a lower morbidity, shorter hospital stay and a quicker recovery. The role of open repair (OR and to whom this type of operation should be offered is subject to discussion. Objective: To present a single center experience on the repair of abdominal aortic aneurysm, comparing the results of open and endovascular repairs. Methods: Retrospective cross-sectional observational study including 286 patients submitted to OR and 91 patients submitted to EVAR. The mean follow-up for the OR group was 66 months and for the EVAR group was 39 months. Results: The overall mortality was 11.89% for OR and 7.69% for EVAR (P=0.263, EVAR presented a death relative risk of 0.647. It was also found a lower intraoperative bleeding for EVAR (OR=1417.48±1180.42 mL versusEVAR=597.80±488.81 mL, P<0.0002 and a shorter operative time for endovascular repair (OR=4.40±1.08 hoursversus EVAR=3.58±1.26 hours,P<0.003. The postoperative complications presented no statistical difference between groups (OR=29.03% versusEVAR=25.27%, P=0.35. Conclusion: EVAR presents a better short term outcome than OR in all classes of physiologic risk. In order to train future vascular surgeons on OR, only young and healthy patients, who carry a very low risk of adverse events, should be selected, aiming at the long term durability of the procedure.

  17. Correção endovascular de aneurisma de aorta abdominal em paciente com rim em ferradura: relato de caso Endovascular repair of an abdominal aortic aneurysm in patient with horseshoe kidney: a case report

    Directory of Open Access Journals (Sweden)

    Eduardo Keller Saadi

    2008-09-01

    Full Text Available O rim em ferradura é uma anomalia congênita rara que pode causar várias dificuldades técnicas durante a correção convencional de aneurisma de aorta abdominal. Relatamos o caso de uma paciente de 68 anos com rim em ferradura, aneurisma de aorta abdominal sintomático e disfunção renal leve. A paciente foi submetida a correção endovascular, sendo utilizada uma endoprótese bifurcada. O pós-operatório foi livre de complicações. O diagnóstico e a técnica endovascular são discutidos, assim como a literatura revisada.Horseshoe kidney is a rare congenital anomaly that may cause various technical problems during conventional repairs of abdominal aortic aneurysms. We report the case of a 68-year-old woman with a horseshoe kidney, symptomatic abdominal aortic aneurysm and mild renal failure. The patient underwent endovascular repair using a bifurcated endoprosthesis. The postoperative was uneventful. We describe the diagnosis and the endovascular technique and literature review.

  18. Tratamento endovascular de aneurisma de aorta abdominal em paciente com rim em ferradura: relato de caso Endovascular treatment of abdominal aortic aneurysm in patient with horseshoe kidney: a case report

    Directory of Open Access Journals (Sweden)

    José Manoel da Silva Silvestre

    2013-03-01

    Full Text Available O rim em ferradura é uma das anomalias urológicas congênitas mais comuns e está presente em cerca de 0,12% dos pacientes com aneurisma de aorta abdominal. O reparo cirúrgico convencional está associado a dificuldades técnicas que provavelmente aumentam a morbidade e a mortalidade, mas que podem ser evitadas com o tratamento endovascular. Relatamos um caso de um paciente de 64 anos com rim em ferradura e aneurisma de aorta abdominal, que foi submetido ao reparo endovascular do aneurisma com sucesso.The horseshoe kidney is one of the most common urologic anomalies and is present in about 0,12% of the patients with abdominal aortic aneurysm. The conventional surgical repair is associated with technical difficulties that probably increase morbidity and mortality, but can be averted by the endovascular treatment. We report a case of a 64-year-old patient with horseshoe kidney and abdominal aortic aneurysm, who underwent endovascular repair with success.

  19. Type II Endoleak Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm: Innovative Transgraft Approach to Contemporary Management

    Directory of Open Access Journals (Sweden)

    M. Fuad Jan

    2015-08-01

    Full Text Available Elective endovascular aneurysm repair (EVAR is the first-line therapeutic option for patients with infrarenal abdominal aortic aneurysm. However, endoleaks –– persistent blood flow outside the lumen of the stent graft (or endograft but within the aneurysm sac or adjacent vascular segment being treated by the graft –– continue to be a persistent problem in the post-EVAR setting. The type II endoleak is the most common of these and can be a demanding challenge to address by standard endovascular techniques. Currently, two prominent endovascular techniques exist for the management of type II endoleaks: direct translumbar embolization and transarterial embolization. Both of these are fraught with their own limitations and complications. In this review, we describe the contemporary trends in management of type II endoleaks and introduce a novel endovascular technique to treat this challenging and common EVAR complication.

  20. Aortocaval Fistula Resulting From Rupture of Abdominal Aortic Dissecting Aneurysm Treated by Delayed Endovascular Repair

    Science.gov (United States)

    Wang, Tiehao; Huang, Bin; Zhao, Jichun; Yang, Yi; Yuan, Ding

    2016-01-01

    Abstract Aortocaval fistula (ACF) after rupture of an abdominal aortic dissecting aneurysm is a rare emergency situation, which has a high mortality. However, the diagnosis is usually delayed, which increases the difficulties of treatment. We describe a case that successfully delayed use of endovascular aneurysm repair (EVAR) for ACF resulting from rupture of abdominal aortic dissecting aneurysm. We describe a special case of a 70-year-old male with an abdominal aortic dissecting aneurysm rupturing into inferior vena cava (IVC). On account of his atypical presentation, the diagnosis had been delayed for half a year. Due to severe metabolic sequelaes of the ACF and preexisting conditions, the traditional open repair was too risky. Minimally invasive EVAR was performed with a successful result. There were no endoleak or fistula at the follow-up of 9th month. EVAR is the most suitable method in patients with ACF from rupture of abdominal aortic dissecting aneurysm. Further educational programs should be developed, which may give rise to earlier diagnosis and treatment with better outcomes. PMID:27149481

  1. 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.

  2. A modified technique for Gore Excluder limb deployment in difficult iliac anatomy during endovascular abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    Vourliotakis, George; Katsargyris, Athanasios; Tielliu, Ignace F. J.; Zeebregts, Clark J.; Verhoeven, Eric L. G.

    2015-01-01

    Complex iliac anatomy including extreme tortuosity constitutes a relative contraindication for endovascular abdominal aortic aneurysm repair with additional risk of limb-graft occlusion. The Gore Excluder limb-graft is a flexible stent-graft, which adapts easily to iliac tortuosity. Nevertheless, th

  3. 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.)

  4. 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.)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-04-15

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

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

    Directory of Open Access Journals (Sweden)

    Sergio Quilici Belczak

    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 (<15 mm juxtarenal abdominal aortic aneurysms. A search for studies published in English and indexed in the PubMed and Medline electronic databases from 2002 to 2012 was performed, 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 <15 mm.

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

    Directory of Open Access Journals (Sweden)

    David Roy

    2012-01-01

    Full Text Available 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 morphology and mechanical properties of calcifications have been investigated, their effects on wall stresses remain controversial. Computational fluid dynamics usually assumes a rigid artery wall, whereas fluid-structure interaction accounts for artery compliance but is still challenging since arteries and blood have similar densities. We discuss alternatives to fluid-structure interaction based on dynamic medical images that address patient-specific hemodynamics and geometries. We describe initial stresses, elastic boundary conditions, and statistical strength for rupture risk assessment. Special emphasis is accorded to workflow development, from the conversion of medical images into finite element models, to the simulation of catheter-aorta interactions and stent-graft deployment. Our purpose is also to elaborate the key ingredients leading to virtual stenting and endovascular repair planning that could improve the procedure and stent-grafts.

  8. Management of endovascular exclusion for abdominal aortic aneurysm with neck bigger than sixty degrees

    International Nuclear Information System (INIS)

    Objective: To study the possibility and the feasibility of endovascular exclusion (EVE) in treating abdominal aortic aneurysm (AAA) and expanding its application extent. Methods: Perform a modified technical procedure for AAA with neck bigger than sixty degree through bundle up or put in Cuff manoeuvre and follow by EVE. Results: AAA with neck bigger than sixty degree are completely excluded after the procedure revealing under color duplex scan, CTA, MRA with confirmations of the stent stability torsionlessness and no endo-leak. Conclusions: It is a safe, feasible method for EVE to treat AAA with neck bigger than sixty degree. Its characteristic mini-trauma is specially suitable for the old and weak patients

  9. Doses to patients and staff from endovascular treatment of abdominal aortic aneurysms - Preliminary results

    International Nuclear Information System (INIS)

    Patient radiation doses received during endovascular treatment of abdominal aortic aneurysms (AAA) can be significant and give rise to both deterministic and stochastic effects. Recording of dose-area product (DAP), fluoroscopy time and number of exposures together with calculations of effective dose, were performed for 8 patients. In addition, the entrance surface dose was measured for 3 of the patients. Typically, DAPs of 340 Gycm2, fluoroscopy times of 30 minutes and 310 exposures were obtained together with maximum entrance surface doses of 1,8 Gy and effective doses of 50 mSv. Finger doses to the staff performing the procedure were in the order of a few hundred μSv. Conversion factors (effective dose/DAP) and (maximum entrance surface does/DAP) of 0,61·10-2 Gy/Gycm2 and 0,15 mSv/Gycm2 were obtained, respectively. (author)

  10. Management of a dislocated endovascular aneurysm repair in a challenging giant abdominal aortic aneurysm.

    Science.gov (United States)

    Geers, Joachim; Daenen, Geert; Stabel, Patrick

    2016-02-01

    Introduction A case report of a contained rupture of an abdominal aneurysm, treated by endovascular technique (EVAR), but complicated by perioperative endoprosthesis limb dislocation. Case report An 81-year old male presented at the emergency department with a contained rupture of an infrarenal aortic aneurysm and bilateral extensive iliac aneurysmatic disease. Open repair was no option, due to the pulmonary condition. The patient was prepped for an emergency EVAR. After placing a bifurcated endoprosthesis, angiography revealed a type IIIa endoleak, due to a dislocation between two left iliac extensions. We converted to a right-sided aorto-uni-iliac endoprosthesis with a femorofemoral bypass. A postoperative CT-scan showed a complete exclusion of the aneurysm, a patent aorto-uni-iliac endoprosthesis and a femorofemoral bypass without an endoleak. Discussion EVAR is feasible with a hostile neck AAA, even in a ruptured AAA. In large AAA, one should consider an overlap larger than suggested in the instructions for use. PMID:27385140

  11. Preoperative Predictors of Long-Term Mortality after Elective Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm

    Science.gov (United States)

    Nagai, Saya; Kudo, Toshifumi; Inoue, Yoshinori; Akaza, Miho; Sasano, Tetsuo

    2016-01-01

    Objective: This study aimed to clarify long-term mortality and its predictors in patients with abdominal aortic aneurysm (AAA) who underwent endovascular aneurysm repair (EVAR). Materials and Methods: Patients with AAA who underwent elective EVAR at Tokyo Medical and Dental University hospital between 2008 and 2011 were reviewed. The patients’ data were retrospectively collected from medical records. Results: Sixty-four patients were identified for this study. In long-term follow-up, the survival rate was significantly lower in patients with high preoperative C-reactive protein (CRP) levels. Patients with obstructive lung disease (FEV1/FVC EVAR for AAA as well as for other diseases. Conclusions: A high preoperative CRP level was a predictor of increased long-term mortality in patients with AAA who underwent EVAR. No specific leading causes of death were identified for this increase in the mortality rate. PMID:27087872

  12. Emergent endovascular vs. open surgery repair for ruptured abdominal aortic aneurysms: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Chuan Qin

    Full Text Available OBJECTIVES: To systematically review studies comparing peri-operative mortality and length of hospital stay in patients with ruptured abdominal aortic aneurysms (rAAAs who underwent endovascular aneurysm repair (EVAR to patients who underwent open surgical repair (OSR. METHODS: The Medline, Cochrane, EMBASE, and Google Scholar databases were searched until Apr 30, 2013 using keywords such as abdominal aortic aneurysm, emergent, emergency, rupture, leaking, acute, endovascular, stent, graft, and endoscopic. The primary outcome was peri-operative mortality and the secondary outcome was length of hospital stay. RESULTS: A total of 18 studies (2 randomized controlled trials, 5 prospective studies, and 11 retrospective studies with a total of 135,734 rAAA patients were included. rAAA patients who underwent EVAR had significantly lower peri-operative mortality compared to those who underwent OSR (overall OR = 0.62, 95% CI = 0.58 to 0.67, P<0.001. rAAA patients with EVAR also had a significantly shorter mean length of hospital stay compared to those with OSR (difference in mean length of stay ranged from -2.00 to -19.10 days, with the overall estimate being -5.25 days (95% CI = -9.23 to -1.26, P = 0.010. There was no publication bias and sensitivity analysis showed good reliability. CONCLUSIONS: EVAR confers significant benefits in terms of peri-operative mortality and length of hospital stay. There is a need for more randomized controlled trials to compare outcomes of EVAR and OSR for rAAA.

  13. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-09-15

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

  15. 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.

  16. Tratamento endovascular dos aneurismas de aorta abdominal: experiência inicial e resultados a curto e médio prazo Endovascular treatment of abdominal aortic aneurysms: initial experience and short and mid-term results

    Directory of Open Access Journals (Sweden)

    Eduardo Keller Saadi

    2006-06-01

    Full Text Available OBJETIVO: O estudo visa a apresentar os resultados a curto e médio prazo do tratamento endovascular dos aneurismas de aorta abdominal (AAA. Trata-se de uma experiência inicial com uma equipe multidisciplinar. MÉTODO: No período entre julho de 2003 e outubro de 2005, 42 pacientes foram submetidos a tratamento endovascular de doenças da aorta, sendo 25 por aneurismas de aorta abdominal (AAA. A idade média foi de 74 ± 10,2 anos e 92% dos pacientes eram do sexo masculino. Os procedimentos foram realizados por uma equipe multidisciplinar, no Hospital de Clínicas de Porto Alegre e Hospital Luterano (ULBRA. Vinte e quatro pacientes foram submetidos à colocação de endoprótese bifurcada e um, reta. Em todos os pacientes, o procedimento foi realizado por dissecção das artérias femorais, em laboratório de hemodinâmica. Em nenhum caso houve necessidade de conversão para cirurgia aberta. RESULTADOS: Não houve óbito nesta série. Até 2 anos e 3 meses de acompanhamento, todos os pacientes estão vivos e 24 (96% livres de reintervenção relacionada ao aneurisma. Um (4% paciente necessitou novo procedimento endovascular por vazamento tipo I, um ano após, sendo colocadas três extensões. Dois outros necessitaram derivação femoro-femoral cruzada, um no momento do procedimento endovascular e o outro, 24 horas após, por apresentar isquemia de membro inferior direito. CONCLUSÃO: O tratamento endovascular dos AAA representa uma nova alternativa à cirurgia convencional, menos invasiva, principalmente para pacientes com alto risco cirúrgico. Como o procedimento é relativamente novo, estudos prospectivos e randomizados são necessários para avaliar resultados a longo prazo. Excelentes resultados a curto e médio prazo podem ser obtidos em nosso meio.OBJECTIVE: The purpose of this study is to present the short and mid-term results of the endovascular treatment of abdominal aortic aneurysms (AAA. This is an initial experience of a

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

    Directory of Open Access Journals (Sweden)

    Rodrigo Gibin Jaldin

    2014-12-01

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

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

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    Bruno Lorenção de Almeida

    2014-12-01

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

  19. Alterations of blood flow pattern after triple stent endovascular treatment of saccular abdominal aortic aneurysm: a porcine model.

    Directory of Open Access Journals (Sweden)

    JAHIR RICHARD DE OLIVEIRA

    2016-06-01

    Full Text Available ABSTRACT Objective: to determine the blood flow pattern changes after endovascular treatment of saccular abdominal aortic aneurysm with triple stent. Methods: we conducted a hemodynamic study of seven Landrace and Large White pigs with saccular aneurysms of the infrarenal abdominal aorta artificially produced according to the technique described. The animals were subjected to triple stenting for endovascular aneurysm. We evaluated the pattern of blood flow by duplex scan before and after stent implantation. We used the non-paired Mann-Whitney test for statistical analysis. Results: there was a significant decrease in the average systolic velocity, from 127.4cm/s in the pre-stent period to 69.81cm/s in the post-stent phase. There was also change in the flow pattern from turbulent in the aneurysmal sac to laminate intra-stent. Conclusion: there were changes in the blood flow pattern of saccular abdominal aortic aneurysm after endovascular treatment with triple stent.

  20. Oclusión de la aorta abdominal infrarrenal. Reconstrucción endovascular con stent

    Directory of Open Access Journals (Sweden)

    Carlos Fernández-Pereira

    2008-01-01

    Full Text Available Introducción La oclusión total de la aorta abdominal es de presentación poco frecuente y afecta más a menudo a mujeres de edad mediana con antecedentes de tabaquismo y dislipidemia. El punto de partida de la terapéutica endovascular en la aorta fue la angioplastia en las arterias ilíacas y fue progresando desde el balón hasta la colocación de stents.ObjetivoComunicar nuestros resultados inmediatos y el seguimiento a mediano plazo de pacientes con oclusión de la aorta abdominal tratadas con stents por vía endovascular.Material y métodosDesde octubre de 1998 a mayo de 2005 en nuestro servicio se trataron 5 pacientes de sexo femenino por oclusión total de la aorta abdominal, con síntomas de claudicación grave de ambos miembros inferiores. Los procedimientos se realizaron con anestesia local y sedación. Por vía femoral, se intenta recanalizar con las cuerdas de Whooley o hidrófila Glidewire. Posteriormente se realiza un angiograma abdominal e intercambio por cuerda Amplatz con la cual se avanza el balón para realizar las dilataciones antes de implantar el stent. Las pacientes con lesiones ilíacas también se trataron con stent. El índice tobillo-brazo era de 0,71. El promedio de hospitalización fue de 2 días. Al alta se indicaron clopidogrel y aspirina como medicación antiplaquetaria, excepto la primera paciente (ticlopidina y aspirina. El seguimiento fue clínico y por ecografía Doppler color a la semana, al mes, a los 6 meses y a los 12 meses.ResultadosLas pacientes eran de sexo femenino, con antecedentes de tabaquismo y dislipidemia. Todos los procedimientos fueron técnicamente exitosos, con mejoría del índice tobillo-brazo a 0,98. Una paciente presentó un hematoma inguinal en el sitio de punción, con buena evolución posterior. En el seguimiento alejado clínico y por ultrasonido se observó una permeabilidad de la aorta del 100%, con estenosis en una paciente tratada a nivel de la arteria ilíaca en el segmento no

  1. 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

  2. Antiplatelet treatment and prothrombotic diathesis following endovascular abdominal aortic aneurysm repair.

    Science.gov (United States)

    Trellopoulos, G; Georgiadis, G S; Nikolopoulos, E S; Kapoulas, K C; Georgakarakos, E I; Lazarides, M K

    2014-10-01

    Prothrombotic diathesis expressed by elevated levels of coagulation-specific biomarkers has been reported in patients with abdominal aortic aneurysm (AAA) and after AAA endovascular repair (EVAR). This study investigates the effect of antiplatelet agents (APLs) on the prothrombotic diathesis in the post-EVAR period. Forty elective EVAR patients had thrombin-antithrombin complex, d-dimer, fibrinopeptide A, and high-sensitivity C-reactive protein measured before, at 24 hours, 1 month, and 6 months after EVAR. Patients receiving APLs postoperatively were compared with those not receiving APLs. All biomarkers were above the normal limits preoperatively and increased significantly 24 hours postoperatively followed by a drop at 1 and 6 months. No statistically significant changes were noted among patients receiving APLs in comparison with those not receiving APLs. The preoperative and postoperative prothrombotic diathesis of AAA following EVAR was confirmed in line with other reports. There was however no significant alteration of the examined biomarkers in patients receiving APLs. PMID:24101707

  3. Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Koike, Yuya, E-mail: r06118@hotmail.co.jp; Nishimura, Jun-ichi, E-mail: jun-ichi-n@nifty.com; Hase, Soichiro, E-mail: haseman@hotmail.co.jp; Yamasaki, Motoshige, E-mail: genyamasaki@gmail.com [Kawasaki Saiwai Hospital, Department of Interventional Radiology (Japan)

    2015-04-15

    PurposeThe purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients.MethodsA retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasation of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing.ResultsSac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.ConclusionsEVAR is associated with a potential risk of ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy. Therefore, sac angiography and NBCA embolization during emergency EVAR may represent a possible technical improvement in the treatment of ruptured AAA in hemodynamically unstable patients.

  4. La trapia endovascular: una nueva alternativa en el tratamiento del vasoespasmo cerebral asociado a la hemorragia subaracnoidea espontánea Endovascular therapy: new alternative for treatment of cerebral vasospasm associated with spontaneous subarachnoid hemorrhage

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    Sergio Vargas

    1998-04-01

    Full Text Available EI vaso espasmo cerebral es la principal causa tratable de muerte e incapacidad por hemorragia subaracnoidea espontánea secundaria a la ruptura de un aneurisma cerebral. Sin embargo, su tratamiento ha sido tradicionalmente frustrante, con resultados desalentadores. A pesar de que aún no se han aclarado del todo los mecanismos fisiopatológicos a través de los cuales ocurre este intrigante fenómeno, en los últimos 9 años, paralelamente al desarrollo de las técnicas endovasculares para el tratamiento de las enferm~dades cerebrovasculares, han surgido nuevas alternativas en el manejo del vasoespasmo cerebral. Entre ellas se destacan el uso intraarterial de papaverina y la angioplastia con balón de los vasos cerebrales. Se presenta una revisión del estado actual de estos novedosos instrumentos terapéuticos, así como el reporte de un caso en el cual usamos la papaverina intraarterial en el tratamiento del vasoespasmo quese presentó durante un procedimiento endovascular para excluir un aneurisma de la arteria cerebral media. Cerebral vasospasm is the first treatable cause of death and disability secondary to spontaneous subarachnoid hemorrhage due to ruptured cerebral aneurysms. However, its treatment has been disapointing with poor results. Despite the fact that the physiopathologic mechanisms governing this phenomenon are largely unknown, during the last nine years, simultaneously with the development of endovascular therapy techniques for treatment of cerebrovascular diseases, two new alternatives have emerged in order to alleviate cerebral vasospasm: intraarterial papaverine and cerebral balloon angioplasty. We report the use of intraarterial papaverine in one case to treat cerebral vasospasm presented during the endovascular therapy procedure; a review of literature is included.

  5. Lower Extremity Microembolism in Open vs. Endovascular Abdominal Aortic Aneurysm Repair

    Science.gov (United States)

    Toursavadkohi, Shahab; Kakkos, Stavros K.; Rubinfeld, Ilan; Shepard, Alexander

    2016-01-01

    Although previous studies have documented the occurrence of microembolization during abdominal aortic aneurysm (AAA) repair by both open and endovascular approaches, no study has compared the downstream effects of these two repair techniques on lower extremity hemodynamics. In this prospective cohort study, 20 patients were treated with endovascular aneurysm repair (EVAR) (11 Zenith, 8 Excluder, and 1 Medtronic) and 18 patients with open repair (OR) (16 bifurcated grafts, 2 tube grafts). Pre- and postoperative ankle-brachial indices (ABIs) and toe-brachial indices (TBIs) were measured preoperatively and on postoperative day (POD) 1 and 5. Demographics and preoperative ABIs/TBIs were identical in EVAR (0.97/0.63) and OR (0.96/0.63) patients (p = 0.21). There was a significant decrease in ABIs/TBIs following both EVAR (0.83/0.52, p = 0.01) and OR (0.73/0.39, p = 0.003) on POD #1, although this decrease was greater following OR than EVAR (p = 0.002). This difference largely resolved by POD #5 (p = 0.41). In the OR group, TBIs in the limb in which flow was restored first was significantly reduced compared to the contralateral limb (0.50 vs. 0.61, p = 0.03). In the EVAR group, there was also a difference in TBIs between the main body insertion side and the contralateral side (0.50 vs. 0.59, p = 0.02). Deterioration of lower extremity perfusion pressures occurs commonly after AAA repair regardless of repair technique. Toe perfusion is worse in the limb opened first during OR and on the main body insertion side following EVAR, suggesting that microembolization plays a major role in this deterioration. The derangement following OR is more profound than after EVAR on POD #1, but recovers rapidly. This finding suggests that microembolizarion may be worse with OR or alternatively that other factors associated with OR (e.g., the hemodynamic response to surgery with redistribution of flow to vital organs peri-operatively) may play a role. PMID

  6. Lower Extremity Microembolism in Open vs. Endovascular Abdominal Aortic Aneurysm Repair

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    Shahab eToursavadkohi

    2016-03-01

    Full Text Available Abstract:Although previous studies have documented the occurrence of microembolization during abdominal aortic aneurysm (AAA repair by both open and endovascular approaches, no study has compared the downstream effects of these two repair techniques on lower extremity hemodynamics .In this prospective cohort study, 20 patients were treated with endovascular aneurysm repair (EVAR (11 Zenith, 8 Excluder 1 Medtronic and 18 patients with open repair (OR (16 bifurcated grafts, 2 tube grafts. Pre- and post-operative ankle-brachia! indices (ABls and toe-brachia! indices (TBls were measured pre-operatively and on post­ operative day (POD 1 and 5.Demographics and pre-op ABls/TBls were identical in EVAR (0.97/0.63 and OR (0.96/0.63 patients (p=0.21. There was a significant decrease in ABls/TBls following both EVAR (0.83/0.52, p=0.01 and OR (0.73/0.39, p=0.003 on POD#1, although this decrease was greater following OR than EVAR (p=0.002. This difference largely resolved by POD #5 (p=0.41. In the OR group, TBls in the limb in which flow was restored first was significantly reduced compared to the contralateral limb (0.50 vs 0.61, p=0.03. In the EVAR group there was also a difference in TBls between the main body insertion side and the contralateral side (0.50 vs 0.59, p=0.02.Deterioration of lower extremity perfusion pressures occurs commonly after AAA repair regardless of repair technique. Toe perfusion is worse in the limb opened first during OR and on the main body insertion side following EVAR suggesting that microembolization plays a major role in this deterioration ..The derangement following OR is more profound than after EVAR on POD#1, but recovers rapidly. This finding suggests that microembolizarion may be worse with OR or alternatively that other factors associated with OR (e.g. the hemodynamic response to surgery with redistribution of flow to vital organs peri-operatively may play a role

  7. Comparação entre os tratamentos aberto e endovascular dos aneurismas da aorta abdominal em pacientes de alto risco cirúrgico Comparison between open and endovascular treatment of abdominal aortic aneurysms in high surgical risk patients

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    Célio Teixeira Mendonça

    2005-09-01

    Full Text Available OBJETIVO: Comparar os resultados dos tratamentos aberto e endovascular de aneurismas da aorta abdominal em pacientes de alto risco cirúrgico. MÉTODOS: O tratamento aberto foi realizado em 31 pacientes, e o endovascular, em 18. Sucesso no tratamento endovascular foi definido como perviedade da endoprótese sem endoleaks ou conversão para tratamento aberto. RESULTADOS: Não houve diferença na mortalidade perioperatória entre o tratamento aberto (dois óbitos [6,45%] em 31 e o endovascular (um óbito [5,55%] em 18 (P = 0,899; também não houve diferença entre a mortalidade tardia no tratamento aberto (dois óbitos [6,9%] em 29 e no endovascular (dois óbitos [11,7%] em 17 (P = 0,572. A taxa de sucesso imediato foi de 100% (31/31 no tratamento aberto e de 66,7% (12/18 no endovascular (P = 0,0006; a taxa de sucesso tardio foi de 100% (27/27 no tratamento aberto e de 73,3% (11/15 no endovascular (P = 0,0047. Os valores médios do tempo de internação na UTI, tempo de internação hospitalar e da perda de sangue para os grupos dos tratamentos aberto e endovascular foram: 65,6 versus 34,1 horas*, 9 versus 5,6 dias* e 932 versus 225 ml*, respectivamente (*P OBJECTIVE: To compare the results of open repair and endoluminal repair of abdominal aortic aneurysms in high surgical risk patients. METHODS: Open repair was performed in 31 patients, and endoluminal repair was performed in 18. Success in the endoluminal repair group was defined as continuing graft function without endoleak or conversion to open repair. RESULTS: No significant difference was found between the perioperative mortality rate for open repair (two deaths [6.45%] in 31 patients and endoluminal repair (one death [5.55%] in 18 patients (P = 0.899; similarly, no significant difference was seen in late mortality between open repair (two deaths [6.9%] in 29 patients and endoluminal repair (two deaths [11.7%] in 17 patients (P = 0.572; The rate of immediate success was 100% (31/31 for

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-08-01

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

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

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    R. R. Makar

    2014-01-01

    Full Text Available Introduction. Systemic effects of ruptured abdominal aortic aneurysm (rAAA may be altered by the mode of surgery. This study aimed to determine systemic effects of endovascular aneurysm repair (EVAR compared to open repair (OR. Patients and Methods. Consecutive patients with rAAA were repaired by OR or EVAR according to computerised tomographic (CT findings. Renal function was monitored by estimated glomerular filtration rate (eGFR, serum urea and creatinine, and urinary albumin creatinine ratio (ACR. Hepatic function was assessed postoperatively for 5 days. Intestinal function was determined by the paracetamol absorption test. Intestinal permeability was assessed by urinary lactulose/mannitol ratio. Results. 30 rAAA patients were included. Fourteen had eEVAR and sixteen eOR. Serum urea were higher in eOR, while creatinine was similar between groups. Hepatic function showed no intergroup difference. Paracetamol absorption was increased in eEVAR group at day 3 compared to day 1 (P=0.03, with no similar result in eOR (P=0.24. Peak lactulose/mannitol ratio was higher in eOR (P=0.03, with higher urinary L/M ratio in eOR at day 3 (P=0.02. Clinical intestinal function returned quicker in eEVAR (P=0.02. Conclusion. EVAR attenuated the organ dysfunction compared to open repair. However, a larger comparative trial would be required to validate this. The clinical trial is registered with reference number EUDRACT: 2013-003373-12.

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

    International Nuclear Information System (INIS)

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

  11. Duplex ultrasound and computed tomography angiography in the follow-up of endovascular abdominal aortic aneurysm repair: a comparative study*

    Science.gov (United States)

    Cantador, Alex Aparecido; Siqueira, Daniel Emílio Dalledone; Jacobsen, Octavio Barcellos; Baracat, Jamal; Pereira, Ines Minniti Rodrigues; Menezes, Fábio Hüsemann; Guillaumon, Ana Terezinha

    2016-01-01

    Objective To compare duplex ultrasound and computed tomography (CT) angiography in terms of their performance in detecting endoleaks, as well as in determining the diameter of the aneurysm sac, in the postoperative follow-up of endovascular abdominal aortic aneurysm repair. Materials and Methods This was a prospective study involving 30 patients who had undergone endovascular repair of infrarenal aortoiliac aneurysms. Duplex ultrasound and CT angiography were performed simultaneously by independent radiologists. Measurements of the aneurysm sac diameter were assessed, and the presence or absence of endoleaks was determined. Results The average diameter of the aneurysm sac, as determined by duplex ultrasound and CT angiography was 6.09 ± 1.95 and 6.27 ± 2.16 cm, respectively. Pearson's correlation coefficient showing a statistically significant correlation (R = 0.88; p < 0.01). Comparing the duplex ultrasound and CT angiography results regarding the detection of endoleaks, we found that the former had a negative predictive value of 92.59% and a specificity of 96.15%. Conclusion Our results show that there is little variation between the two methods evaluated, and that the choice between the two would have no significant effect on clinical management. Duplex ultrasound could replace CT angiography in the postoperative follow-up of endovascular aneurysm repair of the infrarenal aorta, because it is a low-cost procedure without the potential clinical complications related to the use of iodinated contrast and exposure to radiation. PMID:27777476

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

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    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.

  13. Technical advances with newer aortic endografts provide additional support to withhold the early endovascular repair of small abdominal aortic aneurysms until it is really needed.

    Science.gov (United States)

    Georgakarakos, Efstratios; Georgiadis, George S; Nikolopoulos, Evagelos; Trellopoulos, George; Kapoulas, Konstantinos; Lazarides, Miltos

    2012-07-01

    The idea of early endovascular aortic repair (EVAR) of "small" abdominal aortic aneurysms (AAAs) has gained attention over "watchful waiting," mostly due to the concern for losing the anatomic suitability for endovascular repair over time. Generally, small AAAs have longer, smaller, less angulated necks, and less tortuous iliac arteries than larger ones. Though the borderline anatomic characteristics were assumed to be contraindications for older generation endografts, the modifications of modern devices seem promising to overcome those limitations, in order to treat the small AAAs when reaching the 5.5 cm threshold. Moreover, early endovascular intervention has been proven neither cost effective nor beneficial for the patients' quality of life. This article evaluates the technical progress that could overcome the difficulties of those small AAAs that present technically demanding anatomies, thus advocating endovascular intervention when they reach the diameter threshold. PMID:22589239

  14. Cost-effectiveness and cost-utility of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Amsterdam Acute Aneurysm Trial

    NARCIS (Netherlands)

    Kapma, M. R.; Dijksman, L. M.; Reimerink, J. J.; de Groof, A. J.; Zeebregts, C. J.; Wisselink, W.; Balm, R.; Dijkgraaf, M. G. W.; Vahl, A. C.

    2014-01-01

    Background: Minimally invasive endovascular aneurysm repair (EVAR) could be a surgical technique that improves outcome of patients with ruptured abdominal aortic aneurysm (rAAA). The aim of this study was to analyse the cost-effectiveness and cost-utility of EVAR compared with standard open repair (

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

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    Fabiana Barroso Thomaz

    2008-08-01

    Full Text Available OBJETIVO: Este estudo tem como objetivo a avaliação pós-operatória do tratamento endovascular de aneurismas da aorta abdominal por angiotomografia com multidetectores. MATERIAIS E MÉTODOS: Foram analisadas, retrospectivamente, angiotomografias de 166 pacientes (137 homens e 29 mulheres com idade média de 73 anos portadores de aneurisma da aorta abdominal submetidos a terapêutica endovascular, no período de junho de 2005 a agosto de 2006. Os exames foram feitos em tomógrafo multidetector de 64 canais e os parâmetros adotados foram: colimação, 0,625 mm; pitch, 0,6-1; mAs, 300-400; kV, 120. Em todos os casos foi utilizado meio de contraste iodado não-iônico (350 mg/ml administrado por meio de bomba infusora, com fluxo de 4 ml/s a 5 ml/s e com volume variável de 70 ml a 100 ml. Os exames foram avaliados quanto à presença de complicações. RESULTADOS: Dos 166 exames realizados, 93 pacientes não apresentaram complicações e 73 apresentaram os seguintes achados: endoleak (n=37, trombose circunferencial da endoprótese (n=29, angulação (n=17, coleção no sítio de punção (n=10, migração da prótese (n=7, dissecção dos vasos de acesso (n=7 e oclusão (n=6. CONCLUSÃO: O endoleak foi a complicação mais prevalente em nosso estudo, sendo o tipo II o mais comum.OBJECTIVE: The present study was aimed at evaluating endovascularly treated abdominal aortic aneurysms by multidetector computed tomography angiography. MATERIALS AND METHODS: Multidetector computed tomography angiography studies of 166 patients were retrospectively analyzed. The sample included 137 men and 29 women with mean age of 73 years who had undergone endovascular treatment for abdominal aortic aneurysm in the period between June 2005 and August 2006. Images were acquired in a 64-channel multidetector tomograph adopting the following parameters: 0.625 mm collimation, pitch 0.6-1, 300-400 mAs, and 120 kV. A nonionic iodinated contrast agent (350 mg/ml was injected

  16. Endovascular treatment of aortic pathologies - State of the art. Part 1 - Aneurysms of abdominal aorta

    International Nuclear Information System (INIS)

    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

  17. Fenestrated and branched endovascular techniques for thoraco-abdominal aneurysm repair

    NARCIS (Netherlands)

    Verhoeven, ELG; Zeebregts, CJ; Kapma, MR; Tielliu, IFJ; Prins, TR; Van Den Dungen, JJAM

    2005-01-01

    Since 1991, endovascular aortic aneurysm repair (EVAR) has been established as an alternative for open surgical repair of aortic aneurysms. one of the main limitations for EVAR is the need for a sufficient scaling zone below or above vital aortic side branches. Recently, efforts have been made to ov

  18. Long-term results of Talent endografts for endovascular abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    Verhoeven, Bart A. N.; Waasdorp, Evert J.; Gorrepati, Madhu L.; van Herwaarden, Joost A.; Vos, Jan Albert; Wille, Jan; Moll, Frans L.; Zarins, Christopher K.; de Vries, Jean Paul P. M.

    2011-01-01

    Background: Since the introduction of endovascular aneurysm repair (EVAR), long-term follow-up studies reporting single-device results are scarce. In this study, we focus on EVAR repair with the Talent stein graft (Medtronic, Santa Rosa, Calif). Methods: Between July 2000 and December 2007, 365 pati

  19. Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair

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    Xiao Yang

    2015-01-01

    Full Text Available Background: Endovascular aneurysm repair (EVAR is one of the first-line therapies of abdominal aortic aneurysms. Postoperative endoleak is the most common complication of EVAR. Computed tomography angiography (CTA, which is routine for follow-up, has side effects (e.g., radiation and also has a certain percentage of missed diagnosis. Preliminary studies on contrast-enhanced ultrasound (CEUS have shown that the sensitivity of CEUS for detecting endoleak is no lower than that of CTA. To investigate the advantages of CEUS, we conducted CEUS examinations of post-EVAR cases in which CTA failed to detect endoleak or could not verify the type of endoleak. Methods: Post-EVAR patients, who were clinically considered to have endoleak and met the inclusion criteria were enrolled between March 2013 and November 2014. All of the patients underwent color Doppler flow imaging (CDFI and a CEUS examination. Size, location, microbubble dispersion, and hemodynamic characteristics of leaks were recorded. Comparison between the diagnosis of CEUS and CDFI was conducted using Fisher′s exact test and clinical outcomes of all patients were followed up. Results: Sixteen patients were enrolled, and 12 (75% had endoleaks with verified types by CEUS. Among 12 cases of endoleaks were positive by CEUS, 10 were CDFI-positive, and the four CEUS-negative cases were all negative by CDFI. The diagnostic values of CEUS and CDFI were statistically different (P = 0.008. Six patients with high-pressure endoleaks received endovascular re-intervention guided by CEUS results. One patient with type III endoleak had open surgery when endovascular repair failed. Conclusions: CEUS is a new, safe, and effective means for detection of endoleaks post-EVAR. This technique can be used as a supplement for routine CTA follow-up to provide more detailed information on endoleak and its category.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-09-15

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

  1. Clinical outcomes of endovascular aneurysm repair of abdominal aortic aneurysm complicated with hypertension: A 5-year experience

    Science.gov (United States)

    Peng, Xi-Tao; Yuan, Qi-Dong; Cui, Ming-Zhe; Fang, Hong-Chao

    2016-01-01

    Objective: To evaluate the therapeutic effects of endovascular aneurysm repair (EVAR) on abdominal aortic aneurysm (AAA) complicated with hypertension. Methods: Fifty-two patients with AAA complicated with hypertension treated in our hospital were retrospectively analyzed. They were divided into an observation group (34 cases) and a control group (18 cases). The control group was treated by incision of AAA and artificial blood vessel replacement, and the observation group was treated by EVAR. Results: All surgeries were performed successfully. However, compared with the control group, the observation group had significantly less surgical time, intraoperative blood loss and blood transfusion, as well as significantly higher total hospitalization expense (PEVAR should be preferentially selected in the treatment of AAA complicated with hypertension due to minimal invasion, safety, stable postoperative vital signs and improved quality of life. PMID:27022336

  2. Seventeen Years’ Experience of Late Open Surgical Conversion after Failed Endovascular Abdominal Aortic Aneurysm Repair with 13 Variant Devices

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Ziheng, E-mail: wuziheng303@hotmail.com [Zhejiang University, Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine (China); Xu, Liang, E-mail: maxalive@163.com [Zhejiang University, Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine (China); Qu, Lefeng, E-mail: qulefeng@gmail.com [The Second Military Medical University, Department of Vascular and Endovascular Surgery, Changzheng Hospital (China); Raithel, Dieter, E-mail: dieter.raithel@rzmail.uni-erlangen.de [Nuremberg Southern Hospital, Department of Vascular and Endovascular Surgery (Germany)

    2015-02-15

    PurposeTo investigate the causes and results of late open surgical conversion (LOSC) after failed abdominal aortic aneurysm repair (EVAR) and to summarize our 17 years’ experience with 13 various endografts.MethodsRetrospective data from August 1994 to January 2011 were analyzed at our center. The various devices’ implant time, the types of devices, the rates and causes of LOSC, and the procedures and results of LOSC were analyzed and evaluated.ResultsA total of 1729 endovascular aneurysm repairs were performed in our single center (Nuremberg South Hospital) with 13 various devices within 17 years. The median follow-up period was 51 months (range 9–119 months). Among them, 77 patients with infrarenal abdominal aortic aneurysms received LOSC. The LOSC rate was 4.5 % (77 of 1729). The LOSC rates were significantly different before and after January 2002 (p < 0.001). The reasons of LOSC were mainly large type I endoleaks (n = 51) that were hard to repair by endovascular techniques. For the LOSC procedure, 71 cases were elective and 6 were emergent. The perioperative mortality was 5.2 % (4 of 77): 1 was elective (due to septic shock) and 3 were urgent (due to hemorrhagic shock).ConclusionLarge type I endoleaks were the main reasons for LOSC. The improvement of devices and operators’ experience may decrease the LOSC rate. Urgent LOSC resulted in a high mortality rate, while selective LOSC was relatively safe with significantly lower mortality rate. Early intervention, full preparation, and timely LOSC are important for patients who require LOSC.

  3. Seventeen Years’ Experience of Late Open Surgical Conversion after Failed Endovascular Abdominal Aortic Aneurysm Repair with 13 Variant Devices

    International Nuclear Information System (INIS)

    PurposeTo investigate the causes and results of late open surgical conversion (LOSC) after failed abdominal aortic aneurysm repair (EVAR) and to summarize our 17 years’ experience with 13 various endografts.MethodsRetrospective data from August 1994 to January 2011 were analyzed at our center. The various devices’ implant time, the types of devices, the rates and causes of LOSC, and the procedures and results of LOSC were analyzed and evaluated.ResultsA total of 1729 endovascular aneurysm repairs were performed in our single center (Nuremberg South Hospital) with 13 various devices within 17 years. The median follow-up period was 51 months (range 9–119 months). Among them, 77 patients with infrarenal abdominal aortic aneurysms received LOSC. The LOSC rate was 4.5 % (77 of 1729). The LOSC rates were significantly different before and after January 2002 (p < 0.001). The reasons of LOSC were mainly large type I endoleaks (n = 51) that were hard to repair by endovascular techniques. For the LOSC procedure, 71 cases were elective and 6 were emergent. The perioperative mortality was 5.2 % (4 of 77): 1 was elective (due to septic shock) and 3 were urgent (due to hemorrhagic shock).ConclusionLarge type I endoleaks were the main reasons for LOSC. The improvement of devices and operators’ experience may decrease the LOSC rate. Urgent LOSC resulted in a high mortality rate, while selective LOSC was relatively safe with significantly lower mortality rate. Early intervention, full preparation, and timely LOSC are important for patients who require LOSC

  4. Medicações referentes às complicações após correção de aneurisma da aorta abdominal endovascular Medication in relation to complications after endovascular abdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Giel G. Koning

    2006-06-01

    Full Text Available OBJETIVO: Este estudo observacional foi desenvolvido para pesquisar a influência dos medicamentos na ocorrência de complicações após correção endovascular de aneurismas da aorta abdominal. MÉTODO: Foram analisados retrospectivamente os dados clínicos referentes a 70 pacientes consecutivos submetidos à correção endovascular de aneurisma da aorta abdominal em dois centros cirúrgicos vasculares num período de 3 anos. As complicações eram classificadas de acordo com as recomendações do Comitê Designado de Padrões de Tratamento. Foi feita uma distinção entre complicações relacionadas ou não ao stent. Uma análise de regressão foi usada para avaliar a associação entre 12 grupos de medicamentos diferentes e o resultado da correção endovascular. RESULTADOS: Durante um acompanhamento de 70 pacientes-anos, foram relatadas 14 complicações leves (20%, 23 moderadas (33% e sete graves (10%. Trinta pacientes (43% que usaram cumarínicos tiveram significantemente menos complicações não relacionadas ao stent (OR. 0,21; 95% CI 0,05-0,90 comparados com os não usuários. Vinte pacientes (29%, tomando medicamentos antieméticos durante internação, mostraram quatro vezes mais complicações relacionadas ao stent (OR. 4,37; 95% CI 1,10-17,3 e o uso de analgésicos no hospital em 25 pacientes foi associado com mais complicações relacionadas ao stent (OR. 3,81; 95% CI 1,32-11,0. CONCLUSÃO: Medicações parecem estar associados com a ocorrência de complicações após terapia endovascular de aneurismas da aorta abdominal. Pacientes que usaram cumarínicos tiveram menos complicações não relacionadas ao stent. Pacientes que usaram agentes antieméticos durante internação mostraram um número quatro vezes maior de complicações não relacionadas ao stent. Pacientes usando analgésicos durante a internação eram associados com maiores complicações relacionadas ao stent.OBJECTIVE: This observational study was undertaken to

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-12-15

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

  6. Spinal Cord Ischemia after Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm: A Rare Complication

    Directory of Open Access Journals (Sweden)

    George N. Kouvelos

    2011-01-01

    Full Text Available Neurologic deficit secondary to spinal cord ischemia after elective infrarenal, endovascular aneurysm repair (EVAR, consists a rare and rather disastrous complication. The etiology of such neurologic complication seems to be multifactorial, making this event unpredictable and foremost unpreventable. We report a case of paraparesis and bladder dysfunction that occurred immediately after the EVAR procedure. Prompt management by conservative or invasive methods seems to be important for the reversal of the neurologic deficit and the optimization of patient's outcome.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-02-15

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

  8. 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.

  9. Lessons learnt from the EUROSTAR registry on endovascular repair of abdominal aortic aneurysm repair

    International Nuclear Information System (INIS)

    Objective: The EUROSTAR project is a multicentred database of the outcome of endovascular repair of infra-renal aortic aneurysms. To date 92 European centres of vascular surgery have contributed. The purpose of the article here is to review the medium term (up to 4 years) results of endovascular aneurysm repair as reported to Eurostar. Patients and methods: Patients intended for endovascular aneurysm repair were notified to the EUROSTAR Data Registry Centre before treatment in order to eliminate bias due to selective reporting. The following data was collected on all patients: (1) their demographic details and the anatomical characteristics of their aneurysms, (2) details of the endovascular device used, (3) procedural complications and the immediate outcome, (4) results of contrast enhanced CT imaging at 3, 6, 12 and 18 months after operation and at yearly intervals thereafter, (5) all adverse events. Life table analysis was performed to determine the cumulative rates of: (1) death from all causes, (2) secondary intervention. Risk factors for rupture and late conversion were identified by regression analysis. Results: By July 2000, 2862 patients had been registered and their median duration of follow-up was 12 mo (range 0-72). Successful deployment was achieved in 2812 patients with a perioperative (30 day) mortality of 2.9%. In 2464 patients enrolled by March 2000 late rupture of the aneurysm occurred in 14 patients for an annual cumulative rate of 1%. The significant factors were proximal type I endoleak (P=0.001), midgraft (type III) endoleak (P=0.001), graft migration (P=0.001) and post-operative kinking of the endograft (P=0.001). Forty-one patients had late conversion to open repair for an annual cumulative rate (risk) of approximately 2.1%. Risk factors (indications) for late conversion were: proximal type I endoleak (P=0.001), midgraft (type III) endoleak (P=0.001), type II endoleak (P=0.003), graft migration (P=0.001), graft kinking (P=0.001) and distal

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

    Directory of Open Access Journals (Sweden)

    Pierre Galvagni Silveira

    2008-01-01

    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.

  11. 腹主动脉瘤腔内治疗现状%Endovascular abdominal aortic aneurysm repair

    Institute of Scientific and Technical Information of China (English)

    符伟国; 邵明哲

    2005-01-01

    @@ 1991年,Parodi等[1]发明人工血管内支架(stent graft,SG)并用于临床成功治愈腹主动脉瘤(abdominal aortic aneurysm,AAA),此后腹主动脉瘤腔内治疗(endovascular abdominal aortic aneurysm repair,EVAR)取得迅速发展.由于EVAR避免了传统开腹手术创伤大和出血多的缺点,使高龄或伴有心、肺、肝、肾功能不全的患者获得积极治疗的机会.一般来讲,腔内治疗主要是指肾下型腹主动脉瘤.目前,EVAR特有并发症,如内漏、移位和SG塌陷等已有大量报道,SG结构破损现象亦有报道.但是,随着SG制造技术的不断进步和手术安全性的逐步提高,SG移植术不再局限于治疗高龄或有严重伴发病的患者,它将取代部分传统开腹术,成为AAA的主要治疗方法.

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

    International Nuclear Information System (INIS)

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

  13. Thromboembolic Complications after Zenith® Low Profile Endovascular Graft for Infrarenal Abdominal Aneurysms

    International Nuclear Information System (INIS)

    PurposeThe purpose of this study was to objectify and evaluate risk factors for thromboembolic complications after treatment with a Zenith® Low Profile Endovascular Graft (Zenith LP). Results were compared with those in the recent literature on endovascular aortic repair (EVAR) and with the thromboembolic complications in the patient group treated with a Zenith Flex Endovascular Graft in our institute in the period before the use of the Zenith LP.Materials and MethodsAll consecutive patients who were suitable for treatment with a Zenith LP endograft between October 2010 and December 2011 were included. The preprocedural computed tomography scan (CT), procedural angiographic images, and the postprocedural CT scans were evaluated for risk factors for and signs of thromboembolic complications. All patients treated between December 2007 and November 2012 with a Zenith Flex endograft were retrospectively evaluated for thromboembolic complications.ResultsIn the study period 17 patients were treated with a LP Zenith endograft. Limb occlusion occurred in 35 % of the patients. Limb occlusions occurred in 24 % of the limbs at risk (one limb occluded twice). In one patient two risk factors for limb occlusion were identified. Between December 2007 and November 2012, a total of 43 patients were treated with a Zenith Flex endograft. No limb occlusion or distal embolization occurred.ConclusionDespite that this was a small retrospective study, the Zenith LP endograft seems to be associated with more frequent thromboembolic complications compared with the known limb occlusion rates in the literature and those of the patients treated with a Zenith Flex endograft in our institute

  14. Thromboembolic Complications after Zenith{sup ®} Low Profile Endovascular Graft for Infrarenal Abdominal Aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Urlings, T. A. J., E-mail: t-urlings@hotmail.com [Medical Center Westeinde, Department of Radiology (Netherlands); Vries, A. C. de, E-mail: a.de.vries@mchaaglanden.nl; Mol van Otterloo, J. C. A. de, E-mail: a.de.molvanotterloo@mchaaglanden.nl; Eefting, D., E-mail: d.eefting@mchaaglanden.nl [Medical Center Westeinde, Department of Vascular Surgery (Netherlands); Linden, E. van der, E-mail: e.van.der.linden@mchaaglanden.nl [Medical Center Westeinde, Department of Radiology (Netherlands)

    2015-06-15

    PurposeThe purpose of this study was to objectify and evaluate risk factors for thromboembolic complications after treatment with a Zenith{sup ®} Low Profile Endovascular Graft (Zenith LP). Results were compared with those in the recent literature on endovascular aortic repair (EVAR) and with the thromboembolic complications in the patient group treated with a Zenith Flex Endovascular Graft in our institute in the period before the use of the Zenith LP.Materials and MethodsAll consecutive patients who were suitable for treatment with a Zenith LP endograft between October 2010 and December 2011 were included. The preprocedural computed tomography scan (CT), procedural angiographic images, and the postprocedural CT scans were evaluated for risk factors for and signs of thromboembolic complications. All patients treated between December 2007 and November 2012 with a Zenith Flex endograft were retrospectively evaluated for thromboembolic complications.ResultsIn the study period 17 patients were treated with a LP Zenith endograft. Limb occlusion occurred in 35 % of the patients. Limb occlusions occurred in 24 % of the limbs at risk (one limb occluded twice). In one patient two risk factors for limb occlusion were identified. Between December 2007 and November 2012, a total of 43 patients were treated with a Zenith Flex endograft. No limb occlusion or distal embolization occurred.ConclusionDespite that this was a small retrospective study, the Zenith LP endograft seems to be associated with more frequent thromboembolic complications compared with the known limb occlusion rates in the literature and those of the patients treated with a Zenith Flex endograft in our institute.

  15. Tratamiento endovascular inmediato con stent graft en laceración de aorta torácica traumática

    Directory of Open Access Journals (Sweden)

    R. Gómes Marques

    2002-12-01

    Full Text Available Paciente de 32 años, que ingresa a la sala de guardia por sufrir politraumatismo secundario a accidente automovilístico. Se le realiza Rx de tórax que evidencia ensanchamiento de mediastino con sospecha clínica y por estudios con TAC y ecotransesofágico de rotura de aorta torácica, confirmada por angiografía de aorta descendente que muestra una imágen compatible con pseudoaneurisma. Debido a que la paciente persiste hipotensa, se decide tratamiento inmediato por vía endovascular, colocando un stent graft expandible con balón, con resultado exitoso y sin complicaciones. En el seguimiento con TAC con contraste al mes, a los 6 meses y al año, no se observaron alteraciones de la prótesis ni leaks peri protésico o re-estenosis.

  16. The increasing role of duplex scanning in the follow-up after endovascular repair of abdominal aortic aneurysms

    Directory of Open Access Journals (Sweden)

    Pulli R

    2014-04-01

    Full Text Available Raffaele Pulli, Walter Dorigo, Leonidas Azas, Stefano Matticari, Aaron Fargion, Carlo PratesiDepartment of Vascular Surgery, University of Florence, Florence, ItalyAim: To analyze the results of a follow-up program after endovascular repair of abdominal aortic aneurysm (EVAR mainly based on duplex ultrasound (DUS examinations.Materials and methods: The postoperative surveillance program changed over the time. In recent years (2007-2012 we are used to performing a DUS and an angio-CT scan within one month after EVAR, a DUS at 6 and 12 months and every 6 months thereafter (Group 2, 498 interventions. Data were compared with our historical series (2000-2006; Group 1, 345 interventions. Perioperative results were recorded. The long-term results were analysed by Kaplan-Meier curves.Results: The rates of perioperative mortality were 1.1% and 1.2% respectively (P=0.9. The cumulative rates of perioperative complications were 16% and 6.5%, respectively (P=0.001. The rate of reinterventions at 60 months was significantly higher in group 2 than in group 1 (29.1% and 20.1% respectively, P=0.03, log rank 4.6. Also the 5-year rate of endoleak was significantly greater in group 2 than group 1 (43.3% and 34.5% respectively, P<0.001, log rank 13.4; however, the rate of endoleaks requiring a redo procedure was lower in group 2 (35/163, 21.5% than in group 1 (51/108, 47%; P<0.001.Conclusion: Data from our study confirm that a DUS-based follow-up program in patients undergoing EVAR is equally sensitive in identifying endoleaks to the CT scan-based program used in past years.Keywords: duplex ultrasound, contrast-enhanced, endovascular aneurysm repair

  17. Correlations of perioperative coagulopathy, fluid infusion and blood transfusions with survival prognosis in endovascular aortic repair for ruptured abdominal aortic aneurysm

    OpenAIRE

    Kawatani, Yohei; Nakamura, Yoshitsugu; Kurobe, Hirotsugu; Suda, Yuji; Hori, Takaki

    2016-01-01

    Background Factors associated with survival prognosis among patients who undergo endovascular aortic repair (EVAR) for ruptured abdominal aortic aneurysms (rAAA) have not been sufficiently investigated. In the present study, we examined correlations between perioperative coagulopathy and 24-h and 30-day postoperative survival. Relationships between coagulopathy and the content of blood transfusions, volumes of crystalloid infusion and survival. Methods This was a retrospective study of the me...

  18. Prospective, intraindividual comparison of MRI versus MDCT for endoleak detection after endovascular repair of abdominal aortic aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Alerci, Mario; Wyttenbach, Rolf [Ospedale San Giovanni Bellinzona (EOC), Department of Radiology, Bellinzona (Switzerland); Oberson, Michel; Gallino, Augusto [Ospedale San Giovanni Bellinzona (EOC), Department of Cardiology, Bellinzona (Switzerland); Fogliata, Antonella [Ospedale San Giovanni Bellinzona (EOC), Department of Medical Physics, Bellinzona (Switzerland); Vock, Peter [Inselspital, University of Berne, Department of Radiology, Berne (Switzerland)

    2009-05-15

    This study compares MRI and MDCT for endoleak detection after endovascular repair of abdominal aortic aneurysms (EVAR). Forty-three patients with previous EVAR underwent both MRI (2D T1-FFE unenhanced and contrast-enhanced; 3D triphasic contrast-enhanced) and 16-slice MDCT (unenhanced and biphasic contrast-enhanced) within 1 week of each other for endoleak detection. MRI was performed by using a high-relaxivity contrast medium (gadobenate dimeglumine, MultiHance registered). Two blinded, independent observers evaluated MRI and MDCT separately. Consensus reading of MRI and MDCT studies was defined as reference standard. Sensitivity, specificity, and accuracy were calculated and Cohen's k statistics were used to estimate agreement between readers. Twenty endoleaks were detected in 18 patients at consensus reading (12 type II and 8 indeterminate endoleaks). Sensitivity, specificity, and accuracy for endoleak detection were 100%, 92%, and 96%, respectively, for reader 1 (95%, 81%, 87% for reader 2) for MRI and 55%, 100%, and 80% for reader 1 (60%, 100%, 82% for reader 2) for MDCT. Interobserver agreement was excellent for MDCT (k = 0.96) and good for MRI (k = 0.81). MRI with the use of a high-relaxivity contrast agent is significantly superior in the detection of endoleaks after EVAR compared with MDCT. MRI may therefore become the preferred technique for patient follow-up after EVAR. (orig.)

  19. Endovascular Treatment of Infrarenal Abdominal Aortic Aneurysm with Short and Angulated Neck in High-Risk Patient

    Directory of Open Access Journals (Sweden)

    Stylianos Koutsias

    2013-01-01

    Full Text Available Endovascular treatment of abdominal aortic aneurysms (AAA is an established alternative to open repair. However lifelong surveillance is still required to monitor endograft function and signal the need for secondary interventions (Hobo and Buth 2006. Aortic morphology, especially related to the proximal neck, often complicates the procedure or increases the risk for late device-related complications (Hobo et al. 2007 and Chisci et al. 2009. The definition of a short and angulated neck is based on length (60° (Hobo et al. 2007 and Chisci et al. 2009. A challenging neck also offers difficulties during open repairs (OR, necessitating extensive dissection with juxta- or suprarenal aortic cross-clamping. Patients with extensive aneurysmal disease typically have more comorbidities and may not tolerate extensive surgical trauma (Sarac et al. 2002. It is, therefore, unclear whether aneurysms with a challenging proximal neck should be offered EVAR or OR (Cox et al. 2006, Choke et al. 2006, Robbins et al. 2005, Sternbergh III et al. 2002, Dillavou et al. 2003, and Greenberg et al. 2003. In our case the insertion of a thoracic endograft followed by the placement of a bifurcated aortic endograft for the treatment of a very short and severely angulated neck proved to be feasible offering acceptable duration of aneurysm exclusion. This adds up to our armamentarium in the treatment of high-risk patients, and it should be considered in emergency cases when the fenestrated and branched endografts are not available.

  20. Can surgeons assess CT suitability for endovascular repair (EVAR) in ruptured abdominal aortic aneurysm? Implications for a ruptured EVAR trial.

    Science.gov (United States)

    Rayt, Harjeet; Lambert, Kelly; Bown, Matthew; Fishwick, Guy; Morgan, Robert; McCarthy, Mark; London, Nick; Sayers, Robert

    2008-01-01

    The purpose of this study was to determine whether surgeons without formal radiological training are able to assess suitability of patients with ruptured abdominal aortic aneurysms (AAA) for EVAR. The CT scans of 20 patients with AAA were reviewed under timed conditions by six vascular surgeons. Twenty minutes was allocated per scan. They were asked to determine if each aneurysm would be treatable by EVAR in the emergency setting and, if so, to measure for device selection. The results were then compared with those of a vascular radiologist. Six surgeons agreed on the suitability of endovascular repair in 45% of cases (95% CI, 23.1-68.5%; 9/20 scans; kappa = 0.41 [p = 0.01]) and concurred with the radiologist in eight of these. Individually, agreement ranged from 13 to 16 of the 20 scans, 65-80% between surgeons. The kappa value for agreement between all the surgeons and the radiologist was 0.47 (p = 0.01, moderate agreement). For the individual surgeons, this ranged from 0.3 to 0.6 (p = 0.01). In conclusion, while overall agreement was moderate between the surgeons and the radiologist, it is clear that if surgeons are to assess patients for ruptured EVAR in the future, focused training of surgical trainees is required.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-06-15

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

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

    Science.gov (United States)

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

    2015-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Gosen Gabriel Konig

    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 aorta 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.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

  4. An Aortoenteric Fistula Arising after Endovascular Management of a Mycotic Abdominal Aortic Aneurysm Complicated with a Psoas Abscess

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    Aytaç Gülcü

    2016-07-01

    Full Text Available Mycotic aortic aneurysms account for 1–3% of all aortic aneurysms. The management of this disease is controversial. Since open surgical repair is associated with high morbidity and mortality rates, endovascular aneurysm repair is an alternative treatment method with promising early and midterm outcomes, although its long-term durability is unknown. Secondary aortoenteric fistulas may occur iatrogenically after either aortic reconstructive surgery or endovascular repair. As the number of aneurysms managed with endovascular aneurysm repair has substantially increased, cases of aortoenteric fistulas referred for endovascular repair are augmented. We report the case of an aortoduodenal fistula manifested with duodenal perforation after staged endovascular and surgical treatment of a mycotic aortic aneurysm.

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

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

    2012-07-15

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

  6. Comparison of clinical curative effect between open surgery and endovascular repair of abdominal aortic aneurysm in China

    Institute of Scientific and Technical Information of China (English)

    WANG Si-wen; LIN Ying; YAO Chen; LIN Pei-liang; WANG Shen-ming

    2012-01-01

    Objective To compare clinical curative effects of open surgery (OS) or endovascular repair (EVAR) for patients with abdominal aortic aneurysm (AAA) in China.Data sources We performed a comprehensive search of both English and Chinese literatures involving case studies on retrograde OS or EVAR of AAA in China from January 1976 to December 2010.Study selection According to the inclusion criteria,76 articles were finally analyzed to compare patient characteristics,clinical success,complications,and prognosis.Results We analyzed a total of 2862 patients with 1757 undergoing OS (OS group) and 1105 undergoing EVAR (EVAR group).There was no significant difference in the success rate of the procedures.Operative time,length of ICU stay,fasting time,duration of total postoperative stay,blood loss,and blood transfusion requirements during the procedure were significantly lower in the EVAR group.A 30-day follow up revealed more cardiac,renal,pulmonary,and visceral complications in the OS group (P<0.01).Low-limb ischemia,however,was more common in the EVAR group (P<0.05).The 30-day mortality rate,including aorta-related and non-aorta related mortality,was significantly lower in the EVAR group (P<0.01).In the follow-up period,there were more patients with occlusions of artificial vessel and late endoleak in the EVAR group (P<0.01).The overall late mortality rate was higher in the OS group (P <0.01),especially non-aorta-related late mortality and mortality during the fourth to the sixth year (P<0.01).Conclusions EVAR was safer and less invasive for AAA patients.Patients suffered fewer complications and recovered sooner.However,complications such as artificial vessel occlusion,low-limb ischemia,and endoleak were common in EVAR.Clinicians should carry out further research to solve these complications and improve the efficacy of EVAR.

  7. Endovascular Aneurysm Repair (EVAR) for Infra-renal Abdominal Aortic Aneurysm (AAA) under Local Anaesthesia - Initial Experience in Hospital Kuala Lumpur.

    Science.gov (United States)

    Syed, A; Zainal, A A; Hanif, H; Naresh, G

    2012-12-01

    This is our initial report on the first 4 cases of infra-renal abdominal aortic aneurysm undergoing Endovascular Aneurysm Repair (EVAR) with local anaesthesia, controlled sedation and monitoring by an anaesthetist. All four patients were males with a mean age of 66.7 years. Only one required ICU stay of two days for cardiac monitoring due to bradycardia and transient hypotension post procedure. No mortality or major post operative morbidity was recorded and the mean hospital stay post procedure was 3.5 days (range 2-5 days).

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

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    Marjanović 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

  9. Treating patients with abdominal aortic aneurysm with endovascular repair and the crossover chimney technique in the internal iliac artery to protect the unilateral internal iliac artery

    Science.gov (United States)

    Guo, Xi; Li, Peng; Liu, Guang-Rui; Huang, Xiao-Yong; Huang, Lian-Jun

    2015-01-01

    This study aims to explore the treatment methods for patients with abdominal aortic aneurysms (AAAs) that required occlusion of the openings of the bilateral internal iliac arteries (IIAs) in endovascular aneurysm repair (EVAR) and to evaluate the efficacy of these treatments. Four patients with AAA were treated with endovascular aneurysm repair (EVAR) and the crossover chimney technique in the bilateral internal iliac arteries (IIAs). We inserted and released the abdominal aortic stent as usual and implanted the bypass stent graft simultaneously. The intraoperative immediate angiography showed complete isolation of the AAA and patency of the bypass. One month after surgery, it showed contrast engorgement in the bypass stent in three patients. The IIA on the bypass side and its branches had good developing. Another case in which we utilized a COOK stent, occlusion started at the opening of the bypass stent, with no occurrence of other complications. For patients in whom AAAs involve bilateral iliac arteries and the openings of the bilateral IIAs need to be occluded, EVAR and a crossover chimney technique can protect the unilateral IIA. PMID:26885136

  10. Medium-Term Outcomes Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms with an Unfavourable Proximal Neck

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    Saha, Prakash, E-mail: prakash.2.saha@kcl.ac.uk; Hughes, John, E-mail: johnhughes387@rocketmail.com; Patel, Ashish S., E-mail: ashish.s.patel@kcl.ac.uk; Donati, Tommaso, E-mail: tommaso.donati@gstt.nhs.uk; Sallam, Morad, E-mail: morad.sallam@gstt.nhs.uk; Patel, Sanjay D., E-mail: sanjay.patel@gstt.nhs.uk; Bell, Rachel E. [King’s Health Partners, Department of Vascular Surgery, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr [King’s Health Partners, Department of Interventional Radiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Modarai, Bijan, E-mail: bijan.modarai@kcl.ac.uk; Zayed, Hany A., E-mail: hany.zayed@gstt.nhs.uk [King’s Health Partners, Department of Vascular Surgery, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom)

    2015-08-15

    PurposeThe purpose of this study was to evaluate medium-term outcomes following endovascular repair of abdominal aortic aneurysms (EVAR) with unfavourable neck anatomy using stent grafts with a 36 mm or larger proximal diameter.Materials and MethodsA retrospective review of 27 patients who underwent elective EVAR between 2006 and 2008 using a stent graft with a 36 mm or larger proximal diameter was carried out. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. Patients were followed up with CTA at 3 and 12 months and annual duplex thereafter.ResultsThe median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Cook Zenith stent grafts were used in all patients, with a proximal diameter of 36 mm (n = 25) and 40 mm (n = 2). Primary and assisted primary technical success rates were 74 and 93 %, respectively. The follow-up period ranged from 62 to 84 months, with a median of 72 months. 15 patients died during follow-up. Two patients died from aortic rupture, and the remaining patients died from cardiac disease (n = 4), chest sepsis (n = 6), cancer (n = 2) and renal failure (n = 1). Complications included type I endoleak (n = 5), limb occlusion (n = 2), limb stenosis (n = 2), limb kinking (n = 1), dissection of an artery (n = 1), occlusion of a femorofemoral cross-over graft (n = 1) and poor attachment of a distal limb (n = 1).ConclusionsEVAR using stent grafts in the presence of an unfavourable neck has a high risk of complications. Medium-term survival in this group is low but mainly due to patient co-morbidities.

  11. 中国腹主动脉瘤腔内治疗十二年回顾与展望%Endovascular treatment of abdominal aortic aneurysms in China: A 12-year retrospective and outlook

    Institute of Scientific and Technical Information of China (English)

    刘昌伟; 陈跃鑫; 叶炜

    2011-01-01

    @@ 腹主动脉瘤腔内修复术(endovascular abdominal aortic aneurysm repair,EVAR) 是近二十年来发展起来的一种通过血管腔内技术修复腹主动脉瘤瘤腔,治疗腹主动脉疾病的新型微创手术.

  12. 腹主动脉瘤腔内治疗的历史与进展%History and progress of endovascular treatment for abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    景在平; 陆清声; 李振江

    2015-01-01

    腹主动脉瘤的传统治疗为开腹手术.20世纪90年代腹主动脉瘤腔内治疗(EVAR)开始兴起,早期EVAR受到患者解剖条件、年龄以及器械的限制,适用范围十分有限,其沿用传统的手术指征也影响了治疗效果.其后腔内技术日趋成熟,腔内器械性能不断改善,使EVAR能应用于更加复杂的病变,治疗效果得以提高.目前EVAR发展仍需面对和解决复杂近端瘤颈、术中术后内漏、累及内脏动脉或髂动脉的腹主动脉瘤以及破裂腹主动脉瘤的完全腔内治疗等难题.在探索这些问题解决办法的过程中,烟囱技术、开窗技术、分支支架技术和“三明治”技术等新技术和新器械得以创造和发展.相信在血管外科医师的努力下,EVAR将更加完善,并得到更加广泛的应用.%The traditional treatment of abdominal aortic aneurysm was open surgery.In the 1990s,endovascular abdominal aortic aneurysm repair (EVAR) began to emerge.In the early stage,this kind of minimally invasive method was applied in highly selected patient cohort due to the limitation of anatomic conditions of patients,age of patients and shortage of available endovascular devices.The indications for open surgery which were used in this new kind of therapeutic modality also influenced the outcomes.As the technique became mature and the properties of endogarft were developed,endovascular treatment can be used to treat more complex pathologies and the results were improved.However,several challenges were rising,including dealing with complex proximal aneurismal neck,intra-and post-operative endoleak,abdominal aortic aneurysm compromising branched arteries and ruptured abdominal aortic aneurysm.To solve these problems,chimney technique,fenestrated stent,branched stent and the sandwich technique had been invented and developed.It is believed that endovascular treatment for abdominal aortic aneurysm could be applied more widely under vascular surgeons' efforts.

  13. Influence of open surgical and endovascular abdominal aortic aneurysm repair on clot quality assessed by ROTEM® test

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    Šarac Momir

    2016-01-01

    Full Text Available Introduction/Aim. The disturbances in hemostasis are often in open surgical repair (OR and endovascular repair (EVAR of an abdominal aortic aneurysm (AAA. These changes may influence the perioperative and early postoperative period inducing serious complications. The aim of this study was to compare the impact of OR and EVAR of AAA on clot quality assessed by rotational thromboelastometry (ROTEM® tests. Methods. The study included 40 patients who underwent elective AAA surgery and were devided into two groups (the OR and the EVAR group - 20 patients in each group. The ROTEM ® test was performed in 4 points: point 1 - 10 min before starting anesthesia in both groups; point 2 - 10 min after aortic clapming in the OR group and 10 min after the stent-graft trunk release in the EVAR group; point 3 - 10 min after the releasing of aortic clamp in the OR group and 10 min after stentgraft placement and releasing the femoral clamp in the EVAR group; point 4 - one hour after the procedure in both groups. Three ROTEM® tests were performed as: extrinsically activated assay with tissue factor (EXTEM, intrinsically activated test using kaolin (INTEM, and extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D (FIBTEM. All tests included the assessment of the maximum clot firmness (MCF and the platelet component of clot strength was presented as maximal clot elasticity (MCE. Results. No significant difference in age, gender and diameter of AAA between groups was found. The time required for the procedure was significantly longer and loss of blood was greater in the OR group than in the EVAR group (p < 0.001. The significant deviation of MCF values in EXTEM test was found mainly in the point 3 (p ≤ 0.004 with significant difference between groups (p < 0.001. A significant difference of MCF values in INTEM test between groups was found in the points 3 and 4 (p < 0.001, which were dose-dependent by heparin sulfate. The MCF

  14. [Thoracic Endovascular Aortic Repair Following Axillo-femoral Bypass in a Patient with Stanford B Acute Aortic Dissection Accompanied by Abdominal Visceral Ischemia;Report of a Case].

    Science.gov (United States)

    Nishimoto, Takayuki; Bonkohara, Yukihiro; Azuma, Takashi; Iijima, Masaki; Higashidate, Masafumi

    2016-09-01

    A 60-year-old woman was transfer-red to the emergency department of our medical center with worsening chest and back pain. Computed tomography revealed Stanford type B aortic dissection. There was a false lumen from the distal arch to the abdominal aorta just above the celiac artery. Although she was at 1st treated conservatively, she abruptly developed acute renal failure and lower limb ischemia because of an enlarged false lumen, and emergency axillo-femoral bypass surgery was performed with an 8 mm tube graft. However, renal failure gradually worsened, which necessitated continuous hemodiafiltration was performed. Thoracic endovascular aortic repair was then performed, and her renal function recovered. PMID:27586321

  15. 如何做好腹主动脉瘤腔内修复术%How to do well at endovascular repairing of abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    符伟国; 施德兵

    2007-01-01

    腹主动脉瘤(abdominal aortic aneurysm,AAA)为血管外科临床重要疾病之一,随瘤体增大,其增长速度加快,破裂风险增加,破裂AAA的病死率高。多数AAA患者因高龄或伴有其他严重内科疾病而不适于行开放手术。1991年,阿根廷Parodi等首次报道用支架型人工血管(后简称“支架”)成功治愈AAA,开创了AAA腔内修复治疗(endovascular aneurysm repair,EVAR)的新时代。以下将就如何做好AAA的EVAR的相关问题作一探讨。

  16. Aneurisma de aorta abdominal justa-renal: correção endovascular combinada com derivação ilíaco-renal direita para criar colo proximal adequado Juxtarenal abdominal aortic aneurysm: combined endovascular and open repair with right iliorenal bypass to create adequate proximal neck

    Directory of Open Access Journals (Sweden)

    Matheus Bredarioli

    2007-06-01

    Full Text Available Homem de 78 anos de idade, portador de múltiplas morbidades clínicas deu entrada na emergência com um aneurisma de aorta abdominal justa-renal em condições hemodinâmicas estáveis. A tomografia computadorizada caracterizou aneurisma de 6 cm de diâmetro, e a distância do colo proximal do aneurisma era de 5 mm em relação à artéria renal direita e 28 mm à esquerda. Em virtude das condições clínicas do paciente, optou-se pelo reparo endovascular, mas previamente fez-se uma derivação ilíaco-renal direita com enxerto de politetrafluoretileno, via retroperitoneal para se criar um colo proximal adequado. Após quatro dias, o aneurisma de aorta abdominal foi corrigido colocando-se uma endoprótese Excluder® sem intercorrências. O seguimento pós-operatório evidenciou boa perfusão do rim esquerdo e ausência de migração ou endoleak da endoprótese. Este caso ilustra a combinação de técnicas para tornar possível o reparo de aneurisma de aorta abdominal justa-renal em pacientes de alto risco cirúrgico e anatomia desfavorável.A 78-year-old man with a juxtarenal abdominal aortic aneurysm and several comorbid conditions was admitted at the emergency room in hemodynamically stable conditions. Computed tomography revealed an aneurysm measuring 6 cm in diameter beginning 28 mm below the left renal artery and 5 mm below the right renal artery. Because of the patient's clinical status, a bypass from the right iliac artery to the right renal artery was performed through a retroperitoneal approach using a polytetrafluoroethylene vascular graft. Four days later, an endovascular aneurysm repair was successfully performed using an Excluder® stent-graft. Postoperative follow-up showed good left renal perfusion and no migration or endoleak. This case illustrates the effectiveness of combining open and endovascular techniques to repair juxtarenal abdominal aortic aneurysm in high-risk patients with unfavorable anatomy.

  17. Ligadura videolaparoscópica da artéria mesentérica inferior como tratamento de endoleak persistente após correção endovascular de aneurisma de aorta abdominal Videolaparoscopic ligation of inferior mesenteric artery as a treatment of persistent endoleak after endoluminal abdominal aortic aneurysm repair

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    Gaudencio Espinosa

    2002-04-01

    Full Text Available Videolaparoscopy has been widely used in the treatment of pathologies as cholelithiasis, appendicitis and adrenal tumor. Nowadays, has also been used to treat type II endoleaks after endovascular repair of abdominal aortic aneurysms. The goal of this work is to report one case of inferior mesenteric artery endoleak treated by videolaparoscopy.

  18. Application of endovascular exclusion in treatment of ruptured abdominal aortic aneurysm%腔内隔绝术在破裂性腹主动脉瘤治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    张天华; 姜维良; 张英男; 孙占峰; 马军

    2011-01-01

    [Objective] To summarize clinical practice of endovascular exclusion in patients with ruptured abdominal aortic aneurysms. [Methods] From January 2005 to March 2011, 16 cases of abdominal aortic aneurysm were treated with endovascular exclusion in the Second Affiliated Hospital of Harbin Medical University. Their diagnosis was confirmed by digital subtraction angiography (DSA) and spiral computed tomography angiography. In order to isolate the body of abdominal aortic aneurysm from blood flow, under the guidance of DSA, stent graft was introduced into the abdominal aorta from a small incision of the femoral artery. [ Results] Sixteen cases of abdominal aortic aneurysm were performed endovascular exclusion successfully, including two cases of fenestrations of stent. Two cases died after the procedures, with fatality rate at 12.5% , in whom one died of rupture of abdominal aortic aneurysm and another died of septic shock. Internal fistula was occurred in three patients, but sealed one month after surgery. [Conclusion] Endovascular exclusion of abdominal aortic aneurysm is safe and feasible. The indications of endovascular exclusion of aortic aneurysms and skills of interventional procedure are key factors of successful operation.%[目的]总结腔内隔绝术治疗破裂性腹主动脉瘤的经验.[方法]收集2005年1月-2011年3月采用腔内隔绝术治疗破裂性腹主动脉瘤的16例患者的临床资料.所有患者行数字减影血管造影(DSA)和/或螺旋CT血管成像检查确诊.在DSA指导下,经股动脉小切口将支架移植物导入腹主动脉内,从腔内将瘤体与血流隔绝.[结果] 16例腹主动脉瘤腔内隔绝术获成功.术后死亡2例(病死率为12.5%),分别死于瘤体破裂和感染性休克.3例患者发生内瘘,1个月后自行封闭.[结论]腹主动脉瘤腔内隔绝术是安全有效的方法,其治疗成功的关键主要在于了解动脉瘤的解剖形态以及操作的准确和熟练.

  19. 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

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    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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-12-01

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

  1. Improving Results of Elective Abdominal Aortic Aneurysm Repair at a Low-Volume Hospital by Risk-Adjusted Selection of Treatment in the Endovascular Era

    International Nuclear Information System (INIS)

    Several studies have observed both higher mortality rates and lower utilization of endovascular aneurysm repair (EVAR) at low-volume centers. This article presents the results of elective abdominal aortic aneurysm (AAA) repair at a low-volume center in the endovascular era and investigates whether postprocedural mortality can be improved by extension of EVAR application also in this setting. This is an 11.6-year retrospective cohort study of 132 patients undergoing elective surgical or endovascular AAA repair at a tertiary care academic hospital between 1997 and July 2008, i.e., a median volume of 12 cases per year. The study was divided into two periods of time according to the respective indications and contraindications for EVAR, which substantially changed in 2005. During period 1, only aneurysms with necks ≥20 mm long and not involving the iliac arteries were treated endoluminally. Beginning in 2005, indication for EVAR was expanded to aortoiliac aneurysms with a minimum neck length of 15 mm. Preoperative risk was assessed by the SVS/AAVS comorbidity score. During the first period (1997-2004) 18.4% (16/87) of all patients received EVAR. By extending anatomical confines and indications for EVAR in 2005, the utilization rate of EVAR increased to 40.0% (18/45) during the second period (2005-July 2008; p = 0.007). Prevalence of preoperative risk factors did not change during the two observation periods. In contrast to period 1, high-risk patients were preferentially treated endoluminally during the second period, resulting in a significantly higher median SVS/AAVS score in the EVAR group (p < 0.001). A significant decrease in median length of stay at the intensive/intermediate care unit (5 vs. 2 days; p = 0.006) and length of in-hospital stay (20 vs. 12.5 days; p < 0.001) was observed during period 2. Overall perioperative mortality was reduced from 6.9% during the first period to 2.2% during the second period (p = 0.256). EVAR mortality was 0%, mortality after

  2. Tratamento endovascular do aneurisma da aorta abdominal infrarrenal em pacientes com anatomia favorável para o procedimento: experiência inicial em um serviço universitário Endovascular treatment of infrarenal abdominal aortic aneurysm in patients with favorable anatomy for the repair: initial experience in a university hospital

    Directory of Open Access Journals (Sweden)

    José Manoel da Silva Silvestre

    2011-03-01

    Full Text Available CONTEXTO: Desde sua introdução, em 1991, o reparo endovascular do aneurisma da aorta abdominal infrarrenal tem se tornado uma alternativa atraente para o tratamento dessa doença. Avaliar nossos resultados iniciais quanto à segurança e eficácia dessa técnica nos levou à realização deste estudo. OBJETIVOS: Analisar a mortalidade perioperatória, a sobrevida tardia, as reoperações, as taxas de perviedade e o comportamento do saco aneurismático em pacientes com anatomia favorável para a realização do procedimento. MÉTODOS: Trata-se de um estudo longitudinal, observacional e retrospectivo realizado entre outubro de 2004 e janeiro de 2009 com 41 pacientes que foram submetidos à correção endovascular do aneurisma de aorta abdominal infrarrenal por apresentarem anatomia favorável para o procedimento. Foram analisados os achados dos exames diagnósticos, o tratamento e o seguimento em todos os pacientes. RESULTADOS: Foram implantadas, com sucesso, 31 (75,6% próteses bifurcadas e 10 (24,5% monoilíacas, de 5 diferentes marcas. O diâmetro médio dos aneurismas fusiformes era de 62 mm. A mortalidade perioperatória foi de 4,8% e a sobrevida tardia, 90,2%. Durante o acompanhamento médio de 30 meses, 2 (4,8% pacientes necessitaram de reintervenção, um por migração da endoprótese e outro por vazamento tipo II. Dois (4,8% pacientes apresentaram oclusão de ramo da prótese. Oito (19,5% vazamentos foram diagnosticados e não houve nenhuma rotura dos aneurismas. CONCLUSÃO: Apesar do pequeno número de pacientes, os resultados observados parecem justificar a realização do procedimento endovascular nos pacientes com anatomia favorável.BACKGROUND: Since its introduction in 1991, endovascular repair of infrarenal aortic aneurysms has become an attractive option to treat this disease. The evaluation of our initial results about safety and efficacy of this technique has led us to carry out this study. OBJECTIVES: To analyze

  3. 腹主动脉瘤腔内修复术单中心治疗经验%Endovascular repair of abdominal aortic aneurysm: a single center experience

    Institute of Scientific and Technical Information of China (English)

    陈忠; 贾云峰; 何楠; 吴庆华; 杨耀国; 唐小斌; 吴章敏; 寇镭; 刘晖; 王盛; 李庆; 张征

    2011-01-01

    目的 评价腔内修复术(endovascular aneurysm repair,EVAR)治疗肾下型腹主动脉瘤(abdominal aortic aneurysm,AAA)的围术期和中远期效果.方法 回顾性分析131例AAA行EVAR的临床资料,评价EVAR治疗AAA的安全性和中远期疗效.结果 手术时间(137±29) min,术中出血(142±20) ml、输血(46±26) ml、ICU恢复时间为(17±4)h.围术期主要并发症包括重度心功能不全8例、心肌梗死2例、肺部并发症5例,内漏4例等;随访中发现内漏15例,Ⅰ型8例,Ⅱ型5例,Ⅲ型和Ⅳ型各1例,死亡2例;Kaplan-Meier生存分析无并发症生存率及再次处理率提示60个月后仍有并发症发生,其中40%是需要再次处理的并发症.结论 EVAR是AAA的安全治疗方法,但需要长期严格随访并及时处理并发症.%Objective To evaluate the perioperative and long-term effects of endovascular aneurysm repair(EVAR) of infrarenal abdominal aortic aneurysm (AAA).Methods Clinical data of 131 AAA cases undergoing EVAR were retrospectively evaluated for the safety and long-term efficacy.Results The operative time was (137 ±29) min,blood loss was (142 ±20) ml,blood transfusion was (46 ± 26) ml,ICU staying time was (17 ± 4) h.Major perioperative complications were severe heart failure in 8 cases,myocardial infarction in 2 cases,pulmonary complications in 5 cases,internal leakage in 4 cases.During the period of up to 60 months there were15 cases of endoleak including 8 cases of type Ⅰ,5 cases of type Ⅱ,1 each case of type Ⅲ and Ⅳ and 2 deaths.By Kaplan-Meier survival analysis there were complications developing after 60 months and up to 40% of them needing reintervention.Conclusions Endovascular repair is the safe treatment for AAA,but discharged patients need close long-term follow-up.Complications that ensued need intensive management.

  4. Effects of postimplantation systemic inflammatory response on long-term clinical outcomes after endovascular aneurysm repair of an abdominal aortic aneurysm

    Science.gov (United States)

    Kwon, Hyunwook; Ko, Gi-Young; Kim, Min-Ju; Han, Youngjin; Noh, Minsu; Kwon, Tae-Won; Cho, Yong-Pil

    2016-01-01

    Abstract The aim of this study was to determine the association between postimplantation syndrome (PIS) and long-term clinical outcomes after elective endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm. In this single-center, observational cohort study, a total of 204 consecutive patients undergoing EVAR were included. Primary outcome was long-term mortality from any cause; secondary outcomes included long-term mortality, systemic or implant-related complications, and secondary therapeutic procedures. The diagnosis of PIS was established in 64 patients (31.4%). PIS patients were more likely to receive woven polyester endografts and have a longer postoperative hospital stay and lower incidence of type II endoleaks. In multivariate analysis, PIS was significantly associated with a decreased risk of developing type II endoleaks (P = 0.044). During follow-up period of 44 months, clinical outcomes showed no significant differences in mortality (P = 0.876), systemic (P = 0.668), or implant-related complications (P = 0.847), although rates of secondary therapeutic procedure were significantly higher in non-PIS patients (P = 0.037). The groups had similar rates of overall survival (P = 0.761) and other clinical outcomes (P = 0.562). Patients with and without PIS had similar long-term overall survival rates and other clinical outcomes. PIS was beneficial in preventing type II endoleaks during postoperative period. PMID:27512875

  5. Duplex Ultrasound versus Computed Tomography for the Postoperative Follow-Up of Endovascular Abdominal Aortic Aneurysm Repair. Where Do We Stand Now?

    Science.gov (United States)

    Karanikola, Evridiki; Dalainas, Ilias; Karaolanis, Georgios; Zografos, Georgios; Filis, Konstantinos

    2014-01-01

    In the last decade, endovascular aneurysm repair (EVAR) has rapidly developed to be the preferred method for infrarenal abdominal aortic aneurysm repair in patients with suitable anatomy. EVAR offers the advantage of lower perioperative mortality and morbidity but carries the cost of device-related complications such as endoleak, graft migration, graft thrombosis, and structural graft failure. These complications mandate a lifelong surveillance of EVAR patients and their endografts. The purpose of this study is to review and evaluate the safety of color-duplex ultrasound (CDU) as compared with computed tomography (CT), based on the current literature, for post-EVAR surveillance. The post-EVAR follow-up modalities, CDU versus CT, are evaluated questioning three parameters: (1) accuracy of aneurysm size, (2) detection and classification of endoleaks, and (3) detection of stent-graft deformation. Studies comparing CDU with CT scan for investigation of post-EVAR complications have produced mixed results. Further and long-term research is needed to evaluate the efficacy of CDU versus CT, before CDU can be recommended as the primary imaging modality for EVAR surveillance, in place of CT for stable aneurysms. PMID:25317026

  6. Effects of postimplantation systemic inflammatory response on long-term clinical outcomes after endovascular aneurysm repair of an abdominal aortic aneurysm.

    Science.gov (United States)

    Kwon, Hyunwook; Ko, Gi-Young; Kim, Min-Ju; Han, Youngjin; Noh, Minsu; Kwon, Tae-Won; Cho, Yong-Pil

    2016-08-01

    The aim of this study was to determine the association between postimplantation syndrome (PIS) and long-term clinical outcomes after elective endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm.In this single-center, observational cohort study, a total of 204 consecutive patients undergoing EVAR were included. Primary outcome was long-term mortality from any cause; secondary outcomes included long-term mortality, systemic or implant-related complications, and secondary therapeutic procedures.The diagnosis of PIS was established in 64 patients (31.4%). PIS patients were more likely to receive woven polyester endografts and have a longer postoperative hospital stay and lower incidence of type II endoleaks. In multivariate analysis, PIS was significantly associated with a decreased risk of developing type II endoleaks (P = 0.044). During follow-up period of 44 months, clinical outcomes showed no significant differences in mortality (P = 0.876), systemic (P = 0.668), or implant-related complications (P = 0.847), although rates of secondary therapeutic procedure were significantly higher in non-PIS patients (P = 0.037). The groups had similar rates of overall survival (P = 0.761) and other clinical outcomes (P = 0.562).Patients with and without PIS had similar long-term overall survival rates and other clinical outcomes. PIS was beneficial in preventing type II endoleaks during postoperative period. PMID:27512875

  7. Current technology for the treatment of infection following abdominal aortic aneurysm (AAA) fixation by endovascular repair (EVAR).

    Science.gov (United States)

    Capoccia, L; Mestres, G; Riambau, V

    2014-06-01

    In recent years, in parallel with the increase of endovascular aortic repair (EVAR) procedures performances, a rise of late open surgical removal of EVAR implants has been observed, due to non-endovascularly correctable graft complications. Among them endograft infection is a rare but devastating occurrence, accounting for an incidence ranging from 0.2% to 0.7% in major series, and almost 1% of all causes of endograft explantations. However, a real estimation of the incidence of the problem respect to the number of EVAR implantations is difficult to obtain. Time to infection is usually defined as the period between EVAR and presentation of symptoms that leads to the infection diagnosis. It can be extremely variable, depending on bacterial virulence and host conditions. The diagnosis of an endograft infection is usually based on a combination of clinical symptoms, imaging studies and microbial cultures whenever possible. If computed tomography (CT) scan is employed in almost 100% of infection diagnosis, a combination of fluorodeoxyglucose-positron emission tomography (FDG-PET) and CT scan is nowadays used with increasing frequency in order to rise the likelihood of detecting a graft infection, since even cultures of blood or samples collected from the infected field can sometimes be negative. Complete graft excision seems the best approach whenever a surgical reconstruction could be attempted. In situ reconstruction can be performed by the interposition of an autologous vein, a cryopreserved allograft or a rifampin-soaked Dacron graft. The so-called conventional treatment contemplates the re-establishment of vascularization through extranatomical routes, thus preserving the new graft material from possible contamination by the surgical field just cleaned. When severe comorbid conditions did not allow graft excision, a conservative treatment should be taken into account. It is mainly based on broad-spectrum or culture-specific antibiotic therapy combined, whenever

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-12-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-03-15

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

  10. Aortic Dissection Occurring 18 Months after Successful Endovascular Repair in an Anatomically Difficult Case of Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Satoshi Yamamoto

    2013-01-01

    Full Text Available We report an autopsy case of aneurysm dissection that occurred 18 months after the implantation of a Zenith stent graft. A 94-year-old woman, who had undergone an endovascular repair with postoperative reintervention, died of shock due to retroperitoneal hematoma. An autopsy indicated that the stent graft remained firmly fixed to the native aorta, whereas the dissection occurred near the proximal edge of the stent graft but not at the point of attachment between the suprarenal stent hook and the aorta. The luminal surface of the stent graft was almost completely covered with a transparent film with an endothelial cell lining, which might reflect the tissue regeneration observed on histological examination. This was a rare case of acute aortic dissection that occurred 18 months after EVAR, in which the autopsy indicated interesting microscopic findings and the mechanisms underlying the aortic dissection. We believe that aggressive reintervention at the proximal site in elderly women might cause the dissection of the native aorta.

  11. Construct domain analysis of patient health-related quality of life: physical and mental trajectory profiles following open versus endovascular repair of abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Mouawad NJ

    2012-12-01

    Full Text Available Nicolas J Mouawad, Stefan W Leichtle, Jeffrey V Manchio, Richard M Lampman, Brian G Halloran, Walter M Whitehouse JrMichigan Heart and Vascular Institute, Saint Joseph Mercy Health System, Ann Arbor, MI, USAPurpose: Many clinical trials comparing the outcomes of open surgical repair (OSR versus endovascular aneurysm repair (EVAR for abdominal aortic aneurysms (AAAs have been conducted, with varying results. Surprisingly, few outcomes studies have closely examined perceived physical and mental health-related quality of life (HRQOL factors through a validated survey tool. The purpose of this prospective observational study was to describe the trajectory of HRQOL measures, from baseline to 1 year after surgery, in patients undergoing OSR or EVAR for AAA, and to explore for differences in physical and mental composite scores and their construct domains (subscales using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36® tool.Patients and methods: Over an 18-month period, a small sample of patients undergoing elective AAA repair in a community hospital setting were prospectively enrolled. Fifteen patients undergoing OSR and twenty patients undergoing EVAR were studied. Physical and mental HRQOL parameters were assessed using the SF-36.Results: No significant differences in demographic and clinical variables were found between the OSR and EVAR groups. In the multivariable linear models with repeated measures, both groups showed a significant decline in physical health composite scores 30 days after the surgical procedure (P < 0.01. However, although the OSR group showed a statistically significant decline in three of the four physical health domains, the EVAR group declined in only one physical health domain. Only the OSR group showed a significant decline in three of the four mental health domains at 30 days; however, the decline of these domains was not reflected in the group’s mental health composite scores. By 90 days after

  12. Fisiología, fisiopatología y tratamiento de la distensión abdominal.

    OpenAIRE

    Barba Orozco, Elizabeth

    2015-01-01

    El volumen del contenido de la cavidad abdominal varía en diferentes situaciones de forma fisiológica a lo largo del día. La cavidad abdominal tiene unas paredes que se adaptan a su contenido. Existen dos paredes con escasa movilidad, que se corresponden a nivel posterior, con la columna vertebral y a nivel inferior con la pelvis. Por el contrario, existen dos paredes móviles, el diafragma y la pared antero-lateral del abdomen. Estas paredes tienen un componente muscular imp...

  13. A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms

    Institute of Scientific and Technical Information of China (English)

    HAN Yan-shuo; ZHANG Jian; XIA Qian; LIU Zhi-min; ZHANG Xiao-yu; WU Xiao-yu; LUN Yu

    2013-01-01

    Background Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm (rAAA)obtain the greatest benefit from endovascular repair (EVAR),convincing evidence on the medium-long term effect is lacking.The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair (OSR).Methods A search of publicly published literature was performed.Based on an inclusion and exclusion criteria,a systematic meta-analysis was undertaken to compare patient characteristics,complications,short term mortality and medium-long term outcomes.A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences.A quantitative method was used to analyze the differences between these two methods.Results A search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA (435 EVAR and 778 OSR) would be suitable for this study.Furthermore,13 Chinese studies were included,including 267 patients with rAAA totally,among which 238 patients received operation.The endovascular method was associated with more respiratory diseases before treatment (OR=1.81,P=0.01),while there are more patients with hemodynamic instability before treatment in OSR group (OR=1.53,P=0.031).Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR (weighted mean difference (WMD) 1500 ml,P=0.014).The endovascular method was associated with a shorter stay in intensive care (WMD 2.34 days,P <0.001) and a shorter total postoperative stay (WMD 6.27 days,P <0.001).The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group (OR=0.48,P <0.001 and OR=0.28,P=0.043,respectively).The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR,and the odds ratio was 0.53 (95% confidence interval (CI) 0.41-0.70,P <0.001).There was not,however,any significant reduction in

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

    Directory of Open Access Journals (Sweden)

    Francesca Fratesi

    2015-01-01

    Full Text Available 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-up. The treatment of j-iAAA can be technically challenging. ch-EVAR is a feasible and safe bail-out method for elective j-iAAA with challenging anatomy.

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

    Science.gov (United States)

    Miao, Shun; Lucas, Joseph; Liao, Rui

    2012-02-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-04-15

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

  17. 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.

  18. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-08-01

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

  20. A two-year follow-up for Chinese patients with abdominal aortic aneurysm undergoing open/endovascular repair

    Institute of Scientific and Technical Information of China (English)

    Sun Tao; Zhang Hongju; Cheng Yutong; Wang Su; Tao Ying; Zhang Donghua; Huang Ji

    2014-01-01

    Background A number of studies have demonstrated the rates of overall and aneurysm-related mortality and morbidity in Western populations.The cardiovascular risk factors influencing postoperative outcome have been also reported.Until recently,little has been known about the prognosis in this patient cohort in the Chinese population.We evaluated the independent predictors of mortality and morbidity in abdominal aortic aneurysm (AAA) patients undergoing elective surgical treatment and emphasized whether the coronary artery revascularization could have any effect on the overall mortality and morbidity in patients following the current guideline recommendation.Methods A total of 386 patients (174 women) undergoing surgery in Beijing Anzhen Hospital from January 2008 to June 2010 were enrolled (mean age (70.6±10.5) years).Kaplan-Meier curves were constructed to compare the mortality and morbidity of AAA patients with coronary artery revascularization and those without.A Cox proportional hazards model was constructed to identify clinical factors associated with two-year outcomes.The primary outcomes were death from any cause,the pre-specified morbidity was re-hospitalization for pulmonary conditions,congestive heart failure,angina,ischemic/hemorrhagic stroke.Results During the two-year follow-up,34 patients died and 65 experienced re-hospitalization with pulmonary conditions,congestive heart failure,angina,or ischemic/hemorrhagic stroke.Kaplan-Meier survival analysis showed that the AAA patients with cardiac revascularization had no higher incidence of overall mortality and major morbidity than those without (log-rank test P=0.35 and P=0.40,respectively).Cox proportional hazards regression analysis showed that level of low-density lipoprotein (HR,4.06; 95% CI:1.19-18.7,P=0.027) and AAA size (HR,2.18; 95% CI:1.28-11.65,P=0.036) were independently associated with the incidence of overall mortality.Long-term use of angiotensin converting enzyme inhibitors

  1. Morbidity and mortality in the early postoperative course following elective reconstruction of abdominal aorta aneurysm using endovascular and open surgical techniques

    Directory of Open Access Journals (Sweden)

    Marjanović Ivan

    2010-01-01

    Full Text Available Backgroud/Aim. Surgical treatment is the only method of abdominal aorta aneurysm (AAA treatment. According to data of the available literature, elective open, ie conservative, reconstruction (OR is followed by 3%-5% mortality, as well as by numerous comorbide conditions inside the early postoperative course (the first 30 days after the surgery that occur in 20%-30% of the operated on. The aim of the study was to present preliminar results of a comparative clinical retrospective study of early postoperative morbidity and mortality in AAA reconstruction using endovascular (EVAR and open surgical techniques. Method. This comparative clinical retrospective study included 59 patients, electively operated on for AAA within the period January 2008 - March 2009, divided into two groups. The group I counted 29 (49% of the patients who had been submitted to EVAR by the use of Excluder stent. The group II consisted of 30 (51% of the patients operated on using OR. All of the patients were males, 50-87 years old (mean 67.6 year in the group I, and 54-86 years (mean 68.3 years in the group II. All tha patients had AAA larger than 50 mm, in the group I 50-105 mm (mean 68 mm, and in the group II 50-84 mm (mean 65 mm. Preoperative comorbide conditions of any patients were similar (coronary disease, obstructive lung disease, chronical renal insufficiency. Patients operated on as emergency cases due to rupture or due to symptomatic aneurysm (threthening rupture were excluded. The analysed parameters were the duration of surgical operation, intraoperative and operative blood substitution, postoperative morbidity, the duration of postoperative hospitalization, and hospital mortality. Results. The obtained results showed a statistically significantly shorter time taken by EVAR surgery (average 95 min, ranging 70-180 min as compared to OR surgery (average 167 min, ranging 90-300 min. They also showed statistically significantly less blood loss in the patients operated

  2. Open Surgical Repair After Endovascular Treatment with Endologix Stent Graft: A Case Report

    Directory of Open Access Journals (Sweden)

    Ižsa Coskun

    2016-01-01

    Full Text Available Endovascular treatment of abdominal aortic aneurysm repair is increasingly being used today. We report a 72-year-old male patient who underwent open surgical repair due to separation of IntuTrak Powerlink XL (Endologix endovascular stent graft four months after endovascular intervention for abdominal aortic aneurysm with 9.5 cm diameter.

  3. Techniques in Endovascular Aneurysm Repair

    Directory of Open Access Journals (Sweden)

    Sachin V. Phade

    2011-01-01

    Full Text Available 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-07-01

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

  5. Fatores envolvidos na migração das endopróteses em pacientes submetidos ao tratamento endovascular do aneurisma da aorta abdominal Factors involved in the migration of endoprosthesis in patients undergoing endovascular aneurysm repair

    Directory of Open Access Journals (Sweden)

    Marcelo José de Almeida

    2010-06-01

    Full Text Available A migração da endoprótese é complicação do tratamento endovascular definida como deslocamento da ancoragem inicial. Para avaliação da migração, verifica-se a posição da endoprótese em relação a determinada região anatômica. Considerando o aneurisma da aorta abdominal infrarrenal, a área proximal de referência consiste na origem da artéria renal mais baixa e, na região distal, situa-se nas artérias ilíacas internas. Os pacientes deverão ser monitorizados por longos períodos, a fim de serem identificadas migrações, visto que estas ocorrem normalmente após 2 anos de implante. Para evitar migrações, forças mecânicas que propiciam fixação, determinadas por características dos dispositivos e incorporação da endoprótese, devem predominar sobre forças gravitacionais e hemodinâmicas que tendem a arrastar a prótese no sentido caudal. Angulação, extensão e diâmetro do colo, além da medida transversa do saco aneurismático, são importantes aspectos morfológicos do aneurisma relacionados à migração. Com relação à técnica, não se recomenda implante de endopróteses com sobredimensionamento excessivo (> 30%, por provocar dilatação do colo do aneurisma, além de dobras e vazamentos proximais que também contribuem para a migração. Por outro lado, endopróteses com mecanismos adicionais de fixação (ganchos, farpas e fixação suprarrenal parecem apresentar menos migrações. O processo de incorporação das endopróteses ocorre parcialmente e parece não ser suficiente para impedir migrações tardias. Nesse sentido, estudos experimentais com endopróteses de maior porosidade e uso de substâncias que permitam maior fibroplasia e aderência da prótese à artéria vêm sendo realizados e parecem ser promissores. Esses aspectos serão discutidos nesta revisão.Migration of the endoprosthesis is defined as the misplacement of its initial fixation. To assess the migration, the position of the

  6. Detection of occult endoleaks after endovascular treatment of abdominal aortic aneurysm using magnetic resonance imaging with a blood pool contrast agent: preliminary observations.

    NARCIS (Netherlands)

    Cornelissen, Sandra; Prokop, M.; Verhagen, H.J.; Adriaensen, M.E.; Moll, F.L.; Bartels, L.W.

    2010-01-01

    OBJECTIVE: To determine whether blood pool contrast agent-enhanced magnetic resonance imaging (MRI) can visualize endoleaks that are occult on computed tomography (CT) in patients with nonshrinking aneurysms after endovascular aneurysm repair. MATERIALS AND METHODS: Written informed consent was obta

  7. Resultados del tratamiento endovascular de la patología carotídea en el Hospital San Juan de Dios de Enero 2007 a Febrero 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.

  8. 腹主动脉瘤腔内修复术术前影像学评估与适应证选择%Evaluations of imaging and indications of endovascular abdominal aortic aneurysm repair

    Institute of Scientific and Technical Information of China (English)

    司逸; 符伟国

    2009-01-01

    Endovascular aneurysm repair (EVAR) has gradually replaced the traditional open surgery and become the primary therapy for abdominal aortic aneurysm. Conventional indications of EVAR are extended gradualy with the development of endoluminal instruments and improvement of operating skills. Some latest endovascular devices and techniques are shortly trodueed except for indications of EVAR. In addition, evaluation of imaging before EVAR is indispensable and should be paid adequate attention.%腹主动脉瘤腔内修复术(endovaseular aneurysm repair,EVAR)已逐步取代传统开腹手术而成为腹主动脉瘤的主要治疗方法.随着腔内器械的不断研发改进以及操作技术日益成熟,传统的腔内修复适应证正逐渐得到扩展.尽管新技术的提高和器械的改进更有助于扩大治疗指征和治疗结果.但谨慎细致的术前评估应是EVAR成功的先决条件.

  9. Aortic aneurysm repair - endovascular

    Science.gov (United States)

    EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... Endovascular aortic repair is done because your aneurysm is very large, growing quickly, or is leaking or bleeding. You may have ...

  10. Health-related quality of life outcomes following elective open or endovascular AAA repair: a randomized controlled trial.

    NARCIS (Netherlands)

    Lottman, P.E.M.; Laheij, R.J.F.; Cuypers, P.W.; Bender, M.H.M.; Buth, J.

    2004-01-01

    PURPOSE: To assess health-related quality of life outcomes after endovascular versus open abdominal aortic aneurysm repair. METHODS: Participants were randomly assigned to receive either endovascular or open abdominal aortic aneurysm (AAA) surgery according to a rate of 3 endovascular patients to 1

  11. A Rare Complication of Spinal Cord Ischemia Following Endovascular Aneurysm Repair of an Infrarenal Abdominal Aortic Aneurysm with Arteriosclerosis Obliterans: Report of a Case

    Science.gov (United States)

    Matsumoto, Takuya; Matsubara, Yutaka; Inoue, Kentaro; Aoyagi, Yukihiko; Matsuda, Daisuke; Tanaka, Shinichi; Okadome, Jun; Maehara, Yoshihiko

    2016-01-01

    We herein report a case of a rare complication of spinal cord ischemia (SCI) following endovascular aneurysm repair (EVAR). Computed tomography showed stenosis and calcification of bilateral iliac arteries and a saccular aneurysm of the terminal aorta. Paraplegia occurred soon after balloon angioplasty of iliac arteries and EVAR. Cerebrospinal fluid drainage was not performed because the patient was on dual antiplatelet drugs. The patient was treated with intravenous methylpredonisolone and naloxone; however, this did not improve his paraplegia. SCI after EVAR is extremely rare and unpredictable complication, however, physicians should be aware of SCI after EVAR in patients with atherosclerosis. PMID:27738476

  12. 自制国产化支架-移植物腔内治疗腹主动脉瘤的实验研究%Experimental study of homemade domestic endovascular stent-graft treatment of abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    张云; 张纪蔚; 张柏根

    2001-01-01

    目的探讨自制国产化支架-移植物在治疗犬腹主动脉瘤中的作用。方法以国产镍钛合金丝编织成网状管型支架,外套以国产真丝涤纶交织人造血管,装入导鞘制成支架-移植物系统;用胰蛋白酶灌注犬肾下腹主动脉段形成动脉瘤模型;用血管腔内技术将支架-移植物置入腹主动脉内,隔绝血流分别于第1周、1个月、3个月和6个月末观察通畅度及新生内膜生长。结果 20条模型犬接受手术,成功19条。支架置入后能充分展开并恢复形状,1个月末,支架内表面90%被新生内膜覆盖,3个月末几达100%。6个月末,79%的支架保持通畅,无移位、内漏等并发症。结论自制国产化支架-移植物有良好的生物相容性和较高的通畅率,可用于腹主动脉瘤的治疗。%Objective To evaluate the effect of endovascular repair of abdominal aortic aneurysm (AAA) with homemade domestic stent-graft. Methods Domestic Ni-Ti alloy was knitted tubular mesh stents, wrapped with domestic silk-dacron woven graft. The stent-graft was inserted into introducer sheath. Perfusing the infrarenal abdominal aorta with trypsin developed canine AAA model. Stent-graft was introduced with endovascular technique into the lumen of sac and anchored at the proximal and distal aorta of aneurysm. So the aneurysm was excluded from the blood circulation. The patency of stent-graft and the growth of neointima were observed at intervals of 1 week, 1,3,6 months. Results Twenty canines received endovascular grafting. Nineteen cases were succeeded. After deployed stent unwrapped completely and restored the predermined shape. At 1st month the major part of the stent surface (90%) was covered patency was 79% and the sac was excluded completely. No migration and endoleak was seen. Conclusion Because of good compatibility and high patency, homemade domestic stent-graft can be used in the treatment of AAA by endovascular technique.

  13. Endovascular treatment of complex abdominal aortic aneurysms:Problems and countermeasures%复杂性腹主动脉瘤腔内治疗:问题与对策

    Institute of Scientific and Technical Information of China (English)

    李怀波; 陈德基; 何明基; 练辉; 申刚

    2013-01-01

    Objective To explore the feasibility and safety of artificial stents in the endovascular aneurysm repair (EVAR) for the treatment of complex abdominal aortic aneurysm (AAA). Methods A total of 35 patients with complex AAA who underwent EVAR were reviewed. Results All 35 patients were treated with EVAR. The procedure failed in 2 cases, because the vascular access was too stenosis to release the stent in 1 patient who died 2 days later, and the other one died 1 day after operation since the rupture of aneurysm during procedure. The success rate of EVAR was 94. 29% (33/ 35). In 6 patients with ruptured AAA before operation, 2 died after operation. Conclusion Complex AAA can be treated with improved endovascular technologies.%目的 探讨人工覆膜支架腔内修复术(EVAR)治疗复杂性腹主动脉瘤(AAA)的可行性与安全性.方法 回顾性分析35例接受EVAR治疗的复杂性AAA的患者资料.结果 35例均接受EVAR治疗,2例失败(1例入路血管严重狭窄,支架不能释放,2天后死亡;1例术中瘤体破裂,手术中断,术后1天死亡),手术成功率为94.29% (33/35).6例术前瘤体已破裂,术后死亡2例.结论 对于复杂性AAA,通过改良技术进行腔内治疗,能够取得良好疗效.

  14. Application of occluders in endovascular repair of aortic aneurysms

    Institute of Scientific and Technical Information of China (English)

    SHI Zhen-yu; FU Wei-guo; WANG Yu-qi; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; XU Xin; YANG Jue; ZHU Ting

    2007-01-01

    @@ Since Parodi et al1 reported the first successful case of endovascular treatment for abdominal aortic aneurysm (AAA) in 1991, the endovascular repair has become an important option for the surgical treatment of aortic aneurysms.2-4 The occluder is a newly-developed device introduced intraluminally to block the blood flow in certain arteries.

  15. 腹主动脉瘤腔内修复术中瘤腔内压力监测的意义%The significance of aneurysm sac pressure monitoring during the endovascular repair of abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    杜昕; 郭伟; 刘小平; 张宏鹏; 尹太; 贾鑫

    2008-01-01

    目的 探讨腹主动脉瘤腔内修复术(endovascular aneurysm repair,EVAR)中瘤腔内压力监测的意义.方法 选择2006年4月至2007年3月12例肾下腹主动脉瘤腔内修复术病例,瘤体最大直径(5.83±0.95)cm.术中应用测压导管监测治疗前、后瘤腔内压力的变化,观察内漏类型、部位及随访结果与压力的关系.结果 12例支架型血管(stent-graft,SG)释放前瘤腔内压力约等于体循环压.EVAR后11例瘤腔内收缩压下降>40%,其中7例下降≥50%;1例无明显改变.12例脉压差下降>30%,其中6例下降>75%.术后随访无内漏发生,无动脉瘤相关死亡.5例收缩压下降>50%的病例瘤径出现不同程度的缩小(1.6~3.1 mm),压力未下降的l例瘤径增长3.2 mm,余6例瘤径无明显变化.结论 腹主动脉瘤腔内修复术中瘤腔内压力监测可了解手术前后压力的变化,从而判断腔内治疗效果.%Objective To evaluate aneurysm sac pressure monitoring during endovascular repair (EVAR)of abdominal aortic aneurysm. Methods From April 2006 to May 2007,12 patients with abdominal aorta aneurysm underwent endovascular aneurysm repair.The average max-diameter of the aneurysm WR8(5.83±0.95)cm.The sac pressure was monitored during the whole process of the operation.The correlation between the pressure and endoleaks and long-term outcomes was observed during follow-up.Results Before the stentgraft was delivered.sac pressure was equal to the systemic blood pressure in all the 12 cases.After the EVAR wag finished,the sac systolic pressure dropped by>40% in 11 cases,among which sac blood pressure bropped by ≥50% in 7 cases.sac pressure did not change in 1 case.In all the 12 cases,pulse pressure diminished by>30%,and>75%in 6 cages.During the follow-up,there were no endoleaks and death.In 5 Cases.with sac systolic pressure drop>50%,the max-diameter of the aneurysm decreased by 1.6~3.1 mm,while in one c88e,in which sac pressure had no change the

  16. 腹主动脉瘤腔内修复术后髂支闭塞的治疗%The management of graft limb occlusion following abdominal aortic aneurysm endovascular repair

    Institute of Scientific and Technical Information of China (English)

    马晓辉; 郭伟; 刘小平; 贾鑫; 熊江; 张宏鹏; 张佳; 杜欣; 张敏宏

    2013-01-01

    Objective To review our experience in the limb occlusion after abdominal aortic aneurysm endovascular repair (EVAR).Methods From January 2008 to December 2012,305 abdominal aortic aneurysm (AAA) patients were electively treated with bifurcated stent grafts.From 0 to 36 months after EVAR,iliac branches (1.97%) were found occluded 6 males,including Iliac graft distortions in 4 cases.Thrombosis occurred in three branches with distortions.Presentation included rest pain in 1 case,claudication in 4 cases,and asymptomatic in 1 case.Treatment included femoro-femoral bypass in 1 case,iliac branch plugging plus femoro-femoral bypass in 1 case,thrombectomy and stent in 4 cases.Results Operations were successful in all patients.Symptoms of rest pain and claudication cured.These 6 patients were followed-up for 6 to 18 months (10 ± 8 months).5 patients had not lower limb ischemia.Claudication in 1 patient became serious after treatment,the symptom cured after balloon dilation +stenting.Conclusions Iliac graft is one of the main causes distortion for graft limb occlusions after EVAR.Surgical bypass and endovascular treatment are efficient and safe method to treat graft limb occlusion after EVAR.%目的 总结腹主动脉瘤腔内修复术(abdominal aortic aneurysm endovascular repair,EVAR)后髂支闭塞患者的病因、治疗选择,并评价治疗结果.方法 回顾性分析2008年1月至2012年12月收治的305例患者的临床资料,所有患者使用分叉支架型血管,术后6例男性患者的髂支(1.97%)在EVAR术后0~36个月发生闭塞.其中4例患者出现髂支移植物扭曲,出现扭曲的3个分支中全部发生血栓形成.临床表现为1例患者出现静息痛;4例患者出现跛行;另1例患者无症状.治疗:1例患者采用取栓+股-股旁路;1例采用髂支封堵+股-股旁路;4例患者采用取栓+支架植入.结果 6例患者手术均成功,静息痛和跛行症状消失.6例患者随访时间为6 ~18个月,平均(10±8)

  17. The endovascular repair or open surgery for abdominal aortic aneurysm%高风险患者腹主动脉瘤手术与腔内治疗效果的比较

    Institute of Scientific and Technical Information of China (English)

    王伟; 郭伟; 刘小平; 尹太; 贾鑫; 张宏鹏; 杜昕

    2009-01-01

    Objective To compare the therapeutic effect of endovascular repair (EVAR) and open surgical repair(OSR) of abdominal aortic aneurysm in high-risk patients. Methods The clinical data of 55 patients from 1998 to 2008 with infrarenal abdominal aortic aneurysm who received surgical treatment were analyzed by using the customized probability index. The perioperative and short term advantages and disadvantages of OSR group (n=20) were compared with EVAR group (n=35). Results All patients in OSR group were followed up, 94% patients in EVAR group were followed up, the mean follow up time were 75 and 70 months respectively. (1) Compared to OSR group, the EVAR group had shorter operation time [(3.1±0.6) h vs (4.9±0.9) h, P<0.05], (2) EVAR group had shorter ICU and hospital stay after operation and less blood loss (P<0.01), (3) Compared to OSR group, the EVAR group had lower mortality within 30 d(2.86% vs 15%), (4)the EVAR group had lower peri-operative complications(17% vs 40%), (5) The main complications of EVAR were endoleak (8.57%), (6) The main complications of OSR was cadiovascular incidence(25%). Conclusions Endovascular treatment, indicated for AAA in high-risk patients, can cut down the perioperative incidence of cadiovascular events, mortality and complications. CPI is useful to estimate the perioperative incidence of cadiovascular events, mortality and complications, and can be used to guide the therapeutic method.%目的 比较高风险患者腹主动脉瘤(abdominal aortic aneurysm,AAA)手术治疗(opensurgical repair,OSR)与腔内治疗(endovascular aneurysm repair,EVAR)的效果,探讨高风险患者AAA治疗方式的选择.方法 利用(customized probability index,CPI)危险评分方法[1]筛选出我院1998年至2008年高风险患者55例,比较OSR组(20例)与EVAR组(35例)围手术期及术后近期结果.结果 OSR组随访率100%,平均随访6年3个月.EVAR组随访率94%,平均随访5年10个月.(1)手术时间高风险患者EVAR组(3.1±0.6)h

  18. Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm with Unibody Bifurcated Stent-Grafts%分叉型一体式覆膜支架腔内治疗肾下型腹主动脉瘤的疗效

    Institute of Scientific and Technical Information of China (English)

    史伟浩; 余波; 王巍

    2012-01-01

    目的:探讨应用分叉型一体式覆膜支架腔内治疗腹主动脉瘤和髂动脉瘤的疗效.方法:回顾分析采用分叉型一体式覆膜支架治疗的20例肾下型腹主动脉瘤和髂动脉瘤患者的临床资料.结果:20例患者植入分叉型一体式覆膜支架的手术成功率达100%,无围手术期死亡患者,且所有患者均未出现各类缺血性并发症.8例患者术后存在少量内漏(6例Ⅰ型内漏,2例Ⅲ型内漏),1周后内漏消失;1例患者术后发生急性肝肾功能不全,经内科治疗1周后恢复;2例患者术后出现腹股沟切口淋巴瘘,经换药愈合.平均随访15个月,所有患者未出现新的内漏和支架移位.1例患者术后1年在左侧分支支架内形成血栓,左侧髂动脉局部无血流,经导管接触溶栓治疗1d后实现血管再通.结论:应用分叉型一体式覆膜支架腔内治疗腹主动脉瘤安全有效.%Objective: To summary the clinical experience in applying unibody bifurcated stent-grafts for endovascular treatment of abdominal aortic aneurysm and iliac aneurysm. Methods: From February 2009 to March 2012, unibody bifurcated stent-grafts had been applied in the treatment of 20 patients suffering from infrarenal abdominal aortic aneurysm and iliac aneurysm. Their clinical data were analyzed. Results: A total of 100% success rate of stent implantation has been achieved without periop-erative deaths and any ischemic complications; postoperative endoleak occured in 8 cases(6 cases of type I endoleak, 2 cases of type Ⅲ endoleak) , and endoleak disappeared in all of them within one week; acute liver and kidney dysfunction occurred in one case and it was relieved after medical treatment for one week; groin incision lymphatic fistula occurred in two cases and was healed by dressing change. Patients have been followed up for an average period of 15 months. No endoleak and stent migration occurred. Conclusions: Applying unibody bifurcated stent-graft for endovascular

  19. 复杂型腹主动脉瘤血管腔内介入治疗效果分析及评价%Analysis and evaluation of endovascular interventional treatment of complex abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    李浩诚; 沈永斌; 姜维良

    2016-01-01

    ObjectiveRetrospectively analyse and evaluate the therapeutic effect of endovascular interventional technique in the treatment of complicated abdominal aortic aneurysm according to the patients' condition, preoperative examination, surgical methods, postoperative treatment measures and follow-up data.Methods Collecting the data which including the condition, preoperative examination, surgical methods, and postoperative treatment measures of patients who are treated in the department of vascular surgery, Second Afifliated Hospital of Harbin Medical Universityfrom 2011 January to 2015 June. Divided the patients into two groups: Complex abdominal aortic aneurysm patients group (A group), a total of 63 cases; abdominal aortic aneurysm patients group (B group), a total of 93 cases. Collate and summarize the clinical data of these patients.ResultsThe success rates of the two groups were 100%. During the perioperation period and follow-up period, complicated abdominal aortic aneurysm group appeared 1 cases died. 11 cases of endoleaks was found in perioperative period. After treatment the endoleaks disappeared. 4 cases of endoleaks were found during follow-up period, only 1 case need treatment. The common type of abdominal aortic aneurysm group has no deaths occurred in the perioperative period and 14 cases of endoleaks occurred. Endoleaks disappeared after treatment. 6 cases appeared during the follow-up period. All of the endoleaks disappeared during the observation period. CTA examination showed that there were no signiifcant stent shift occurred in the two groups after the operation and follow-up period.Conclusions There were no signiifcant differences in the length of stay and operation time between the complex abdominal aortic aneurysm group and the common type of abdominal aortic aneurysm. The incidence rate of long-term survival rate and complication of complicated abdominal aortic aneurysm group and common type of abdominal aortic aneurysm group had no signiifcant

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

    Directory of Open Access Journals (Sweden)

    Obinna Obinwa

    2015-01-01

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

  1. Tratamento endovascular de dissecção crônica toracoabdominal complicada com aneurisma torácico, mediante implante de endoprótese vascular Endovascular treatment for chronic toracho-abdominal aortic dissection complicated with thoracic aneurysm, by the placement of an endovascular stent-graft

    Directory of Open Access Journals (Sweden)

    Gaudencio Espinosa

    2000-06-01

    Full Text Available Our objective is to report a case of a patient with a descending thoracic aortic aneurysm and chronic aortic dissection, who was submitted to an endovascular treatment. A 68-year-old male with coronary artery disease and hypertension, with no history of trauma, diabetes or smoking. He had myocardial infarction ten years ago. Under general anesthesia, the left femoral artery was surgically exposed and the left braquial artery was catheterized with a "pigtail" catheter, under Seldinger technique. The proximal 46mm/Æ and distal 34mm/Æ stent-graft was placed just distal to the origen of the left subclavian artery. Control arteriography showed that the lesion was completely excluded. The patient was discharged seven days after the surgery, when a computed tomographic control, was performed showing a sustained aneurysm exclusion and a satisfactory endovascular position.

  2. 腹主动脉瘤腔内修复术不同麻醉方式的比较%Comparison of perioperative outcomes under different anesthetic methods for endovascular abdominal aortic aneurysm repair (EVAR)

    Institute of Scientific and Technical Information of China (English)

    王铁皓; 赵纪春; 黄斌; 马玉奎; 袁丁; 杨轶; 曾国军; 熊飞; 吴洲鹏

    2014-01-01

    Objective To compare perioperative outcomes of endovascular abdominal aortic aneurysm repair (EVAR) by different methods of anesthesia.Method From January 2006 to September 2012,276 abdominal aortic aneurysm (AAA) patients undergoing EVAR in West China Hospital were retrospectively analyzed.Among these patients,105 cases (38.0%) received LA,56 patients (20.3%) received EDA,115 patients (41.7%) received GA.Data of perioperative outcome and AAA among three different anesthesia groups were collected.Result Conversion of anesthetic techniques was not required.Lung complication was significantly lower in the GA group (60/115,52.2%) than the LA group (71/105,67.6%,P =0.02).Compared with EDA and GA groups,patients in LA group had significantly shorter operating time,time of ICU stay,time to ambulation and hospital stay.Logistic regression analysis indicated the anesthesia method was an independent related factor for postoperative complications and LA decreased morbidity of patients with EVAR.Conclusions Local anesthesia has the advantages of shorter operation time and lower incidence of complications.%目的 总结在不同麻醉方式下行腹主动脉瘤腔内治疗(endovascular aneurysm repair,EVAR)的围手术期结果,为EVAR术选择麻醉方式提供参考.方法 回顾性分析四川大学华西医院血管外科从2006年1月至2012年9月收治的择期接受EVAR术的276例腹主动脉瘤(abdominal aortic aneurysm,AAA)患者的临床资料,其中105例(38.0%)采用局部麻醉(local anesthesia,LA),56例(20.3%)采用硬膜外麻醉(epidural anesthesia,EDA),115例(41.7%)采用全身麻醉(generalanesthesia,GA),比较3组基线资料、动脉瘤数据资料、围术期相关资料.结果 术中麻醉或手术方式无改变.LA组的肺部疾病患病率(71/105,67.6%)显著高于GA组(60/115,52.2%,P=0.020).LA组较EDA及GA组显著缩短了手术持续时间、ICU观察时间、术后禁食时间及术后住院时间,其差异具有统计学意

  3. Endovascular stent grafting: a review

    Energy Technology Data Exchange (ETDEWEB)

    Kribs, S. [Univ. of Western Ontario, Dept. of Vascular and Interventional Radiology, London, Ontario (Canada)

    2001-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Sergio Quilici Belczak

    2012-03-01

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

  5. Endovascular Repair Versus Open Surgery in Patients with Abdominal Aortic Aneurysm%腹主动脉瘤开腹手术与腔内治疗的比较

    Institute of Scientific and Technical Information of China (English)

    崔庆丰; 戴向晨; 朱理玮

    2011-01-01

    Objective To compare the therapeutic effect of endovascular aortic repair (EVAR) and open surgical repair (OSR) for treatment of abdominal aortic aneurysm. Methods Thirty-five patients with abdominal aortic aneurysm were treated by EVAR (n=14) and OSR (n=21). The patients' preoperative status, intraoperative variables, perioperative conditions, postoperative complications and survival rate were compared. Results The average age of the patients in EVAR group was older than that in OSR group (P < 0.05). the operating time,the intraoperative blood loss and intrapoerative blood transfusion were less in EVAR group than in OSR group (P < 0.01), And time observation in ICU, time for bedside activities and time to take in food were shorter in EVAR group (P< 0.01). The postoperative morbidity was lower in EVAR group (P < 0.05), but with more complications on long term follow up (P < 0.05). Conclusion EVAR is a safer and less traumatic method than OSR, and patients can recover more rapidly, it is suitable for patients of advanced age and those with more complication. OSR is suitable for younger patients and those with less complications or patients who can not undergo EVAR.%目的:比较腹主动脉瘤腔内修复术与开放手术的疗效.方法:对35例肾下型腹主动脉瘤患者分别进行开放手术( 21例)与腔内修复术(14例)治疗,比较两组术前评估、手术、围手术期及术后随访情况.结果:腔内修复组年龄较高(P<0.05),手术时间、术中出血量、输血量较开腹手术低(P< 0.01),所需营养支持、监护、卧床时间短(P< 0.01),围手术期并发症发生率低(P< 0.05),但远期并发症发生率较高(P< 0.05).结论:腹主动脉瘤腔内支架治疗较为安全,创伤更小,患者恢复速度较快,适合于高龄及合并症较多的患者.传统开放手术适于年轻、合并症少及无法行腔内修复术的患者.

  6. 一体化分叉型支架在肾下型腹主动脉瘤腔内治疗中的应用%Application of unibody bifurcated stent-graft in the endovascular treatment of infrarenal abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    朱豫; 张智勇; 卢绮萍

    2013-01-01

    Objective To investigate the unibody bifurcated stent-graft in the treatment of infra-renal abdominal aortic aneurysm. Methods The clinical data of 15 patients with infrarenal abdominal aortic aneurysm who underwent endovascular treatment with unibody bifurcated stent-graft from March 2010 to February 2013 were retrospectively analyzed. Results All cases were successfully treated by endovascular repair, and patients were followed up for 3 to 36 months to review the CTA. The aneurysms were completely isolated. The stents were in good position without displacement,distortion or endoleak. Conclusion After the preoperative assessment and measurement, the endovascular treatment with unibody bifurcated stent-graft for infrarenal abdominal aortic aneurysm has the advantages of good efficacy, high security, simple operation and few complications.%目的 探讨一体化支架在肾下型腹主动脉瘤治疗中的应用.方法回顾分析 2010 年3 月至 2013 年 2 月采用一体化支架腔内修复术治疗肾下型腹主动脉瘤15例,对其临床资料进行分析总结.结果 所有病例均腔内修复成功,术后随访3~36个月复查CTA,瘤体均被完全隔绝,支架位置良好,无移位、扭曲及内漏现象.结论 术前准确评估、测量后,一体化支架治疗肾下性腹主动脉瘤效果良好,安全性高,操作简单并发症少.

  7. Is emergency endovascular aneurysm repair associated with higher secondary intervention risk at mid-term follow-up?

    NARCIS (Netherlands)

    Oranen, Bjorn I.; Bos, Wendy T. G. J.; Verhoeven, Eric L. G.; Tielliu, Ignace F. J.; Zeebregts, Clark J.; Prins, Ted R.; van den Dungen, Jan J. A. M.

    2006-01-01

    Objective: The study assessed mid-term outcome of emergency endovascular repair for acute infrarenal abdominal aortic aneurysms, with special attention to secondary interventions. Methods. Between May 1998 and August 2005, 56 patients underwent emergent endovascular repair for a ruptured abdominal a

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-01-01

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

  9. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

    Leonhardt, H.; Mellander, S.; Snygg, J.;

    2008-01-01

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed....... All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean...... reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding...

  10. 腹主动脉瘤腔内隔绝术中髂动脉的处理%Management of iliac arteries in endovascular graft exclusion of abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    何玉祥; 种振岳; 王默; 高培显; 韩宗霖; 刘洋; 金星

    2011-01-01

    Objective To summarize our experiences of management for iliac artery in endovascular graft exclusion (EVGE) of abdominal aortic aneurysm (AAA). Methods From July 2004 to November 2010, EVGE were performed in 43 patients with AAAs,including 27 cases involving unilateral and 16 cases of bilateral iliac bifurcations. Various techniques including simple coverage by stent-graft, embolization of the internal iliac artery trunk combined with stent-graft covering,ligation of common iliac artery,reconstruction of the internal iliac artery and combination of the above techniques were applied according to the different conditions of the iliac arterial system involved. Results The procedures were all technically successful in 43 patients without the occurrence of type I endoleakage. Claudication due to gluteus ischemia occurred in 6 cases(14.0%) and bloody stool in 1 case(2.3%); no patient developed buttock, perineal region, and colorectal necrosis; and no patient died. Conclusions It is important to preserve the patency of one of the internal iliac arteries and avoid occlusion of both internal iliac arteries in EVGE of AAA.%目的:总结腹主动脉瘤(AAA)行腔内隔绝术时髂动脉的处理方式.方法:2004年7月至2010年11月共对43例瘤体累及单侧或双侧髂动脉分叉的AAA行腔内隔绝术,其中单侧髂动脉分叉受累27例,双侧髂动脉分叉受累16例.根据髂动脉病变情况,分别采取髂内动脉单纯覆盖、髂内动脉栓塞后覆盖、髂动脉外环结扎、一侧髂内动脉重建等不同的处理方法.结果:所有病例均操作成功,手术结束时无I型内漏存在.术后出现臀部间歇性跛行6例(14.0%),便血1例(2.3%),无病例发生臀部或会阴部皮肤坏死、肠坏死及死亡.结论:术中避免同时封闭双侧髂内动脉,尽量保留一侧髂内动脉是很重要的.

  11. Thoraco-abdominal aortic aneurysm branched repair

    NARCIS (Netherlands)

    Verhoeven, E. L. G.; Tielliu, I. F. J.; Ferreira, M.; Zipfel, B.; Adam, D. J.

    2010-01-01

    Open thoraco-abdominal aortic aneurysm repair is a demanding procedure with high impact on the patient and the operating team. Results from expert centres show mortality rates between 3-21%, with extensive morbidity including renal failure and paraplegia. Endovascular repair of abdominal aortic aneu

  12. Quality of life endovascular and open AAA repair. Results of a randomised trial.

    NARCIS (Netherlands)

    Prinssen, M.; Buskens, E.; Blankensteijn, J.D.

    2004-01-01

    AIM: To compare the quality of life (QoL) in the first postoperative year after elective endovascular abdominal aortic aneurysm repair (EVAR) and open repair (OR) in a randomised study. METHODS: In the Dutch Randomised Endovascular Aneurysm Management (DREAM) trial, patients are randomly allocated t

  13. Sexual Dysfunction After Conventional and Endovascular AAA Repair: Results of the DREAM Trial.

    NARCIS (Netherlands)

    Prinssen, M.; Buskens, E.; Nolthenius, R.P.T.; Sterkenburg, S. van; Teijink, J.A.; Blankensteijn, J.D.

    2004-01-01

    Purpose: To assess sexual function in the first postoperative year after elective endovascular aneurysm repair (EVAR) and open repair (OR) of abdominal aortic aneurysm (AAA).Methods: In the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial, 153 patients (141 men; mean age 71 years, ran

  14. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    International Nuclear Information System (INIS)

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

  15. Evaluation of endovascular abdominal aortic aneurysm repair in nonagenarians%腹主动脉瘤腔内修复技术在90岁以上老年患者中应用的评价

    Institute of Scientific and Technical Information of China (English)

    张宏鹏; 郭伟; 刘小平; 尹太; 贾鑫; 熊江; 马晓辉

    2011-01-01

    目的 探讨年龄逾90岁的腹主动脉瘤(AAA)患者行腔内修复术治疗的安全性和有效性.方法 2003年5月至2011年3月,12例年龄逾90岁的AAA患者接受主动脉腔内修复技术(EVAR)治疗,其中急诊手术2例.平均年龄(91.7±1.5)岁,其中11例为男性(91.7%).统计技术成功率、围手术期并发症、死亡率;术后3,6,9,12个月及每年进行随访,进行CT或超声检查.结果 7例行全身麻醉,5例行局部麻醉,技术成功率为100%,无中转开刀手术患者;2例采用Endurant支架,4例采用Talent支架,6例采用Zenith支架;手术时间(3.4±1.3)h,出血量(220.5±60.5) ml,术后住院时间(8.4±2.3)d;30d死亡率为8.3%,1年死亡率为16.7%,3年死亡率为41.7%,5年死亡率为75%; 11例术后30d仍存活的患者,平均术后生存时间为28.5个月(9~73个月).结论 对于年龄逾90岁的AAA患者,EVAR手术成功率高,围手术期死亡率和并发症发生率低,但从中远期结果来看部分患者的手术获益是有限的,因此术前个体化评估十分重要.%Objective To investigate the safety and efficacy of endovascular abdominal aortic aneurysm repair(EVAR)in nonagenarians. Methods From May 2003 to March 2011, 12 nonagenarian abdominal aortic aneurysm(AAA) patients, including 2 emergency cases, were treated with endovascular repair. Mean age was (91.7 ± 1.5) years, ranging 90-95 years, and there including 2 emergency cases, were 11 males (91.7%). Technical success rate, perioperative complications and mortality were evaluated. Follow-up protocol consisted of computed tomography (CT) or ultrasound examinations performed at 3, 6, 9, 12 months, and annually thereafter. Results Seven patients were operated under general anesthesia and five under local anesthesia. The technical success rate was 100%, with no need for open conversion. Two Endurant endogafts, four Talent endografts and six Zenith endografts were used. Mean operatiion time was (3.4 ± 1.3)h, mean

  16. Tratamiento de la obesidad: necesidad de centrar la atención en los pacientes de alto riesgo caracterizados por la obesidad abdominal Treatment of obesity: the need to target attention on high-risk patients characterized by abdominal obesity

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    Carla Scarsella

    2003-01-01

    Full Text Available La obesidad visceral se asocia a anormalidades metabólicas aumentando el riesgo de diabetes de tipo 2 y de coronariopatía (CP. El Estudio Cardiovascular de Québec demostró que la tríada metabólica aterogénica (TMA presente en hombres visceralmente obesos (VO, incrementa 20 veces el riesgo de CP durante un período de 5 años. Fue desarrollado un algoritmo de detección precoz a fin de identificar individuos que podrían ser portadores de estas anormalidades aterogénicas. Fue descubierto que la presencia simultánea de una circunferencia de la cintura elevada y una hipertrigliceridemia moderada ("cintura hipertrigliceridémica" - CH podrían identificar adecuadamente a una proporción significativa de portadores de la TMA. Es importante dejar claro, que incluso en ausencia de los clásicos factores de riesgo los pacientes VO pueden tener un riesgo elevado de CP si presentan la CH. Finalmente, se ha sugerido que el riesgo de desarrollar un síndrome coronario agudo en pacientes VO no está siempre relacionado al grado de estenosis coronaria y debería considerarse el perfil aterotrombótico/inflamatorio del paciente en la valoración del riesgo. La estabilización de la placa aterosclerótica se convertiría en un objetivo terapéutico legítimo y más factible para la prevención de la CP en los pacientes VO.Abdominal obesity is associated with metabolic abnormalities, increasing the risk of type 2 diabetes and coronary artery disease (CAD. The Quebec Cardiovascular Survey demonstrated that the atherogenic metabolic triad (AMT present in abdominally obese (AO males increases the risk of CAD 20-fold over the course of 5 years. An early detection algorithm was developed to identify individuals presenting these atherogenic abnormalities. It was found that the association of large waist circumference (WC and moderate hypertriglyceridemia (the "hypertriglyceridemic waist", or HW could adequately identify a significant portion of individuals

  17. Preoperative endovascular embolization of a cerebellar hemangioblastoma

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    Almeida-Pérez Rafael

    2013-06-01

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

  18. 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

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    Gaudencio Espinosa

    2002-12-01

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

  19. 腹主动脉瘤患者腔内治疗与开腹修复术的围手术期比较%Perioperative outcomes after endovascular versus open repair of abdominal aortic aneurysms: a single center experience

    Institute of Scientific and Technical Information of China (English)

    赵纪春; 马玉奎; 黄斌; 卢武胜; 杨轶; 袁丁

    2012-01-01

    目的 评估腹主动脉瘤腔内和开腹修复术在治疗腹主动脉瘤患者的安全性和有效性.方法 回顾性分析华西医院血管外科2006年1月至2011年1月期间收治的371例行择期手术的腹主动脉瘤患者,比较腔内修复术治疗患者(EVAR组,n=174)与开腹手术治疗患者(OR组,n=197)的围手术期资料、并发症和死亡率情况.结果 腔内组的平均年龄为(72±8)岁;手术组的平均年龄为(60±14)岁,两组差异有统计学意义(P<0.05).腔内组患者合并COPD的比例为31.0%高于OR组的比例为21.8%(P<0.05).腔内组患者术中失血量为(125±43) ml少于手术组为(858±602) ml (P<0.05).腔内组患者术中无输血,手术组术中有140例患者输血.腔内组术后ICU时间和禁食时间分别为(15±5)h和(7±4)h均低于手术组分别为(31 ±11)h和(90±32)h(P<0.05).腔内组手术时间为(146±39) min短于手术组为(210±24)min,(P<0.05).腔内组术后带呼吸机时间的中位数为(90±23) min短于手术组(220±132) min,(P<0.05).腔内组88例(50.6%)全身麻醉、52例(30.0%)硬膜外阻滞麻醉、34例(19.4%)局麻,手术组全部选择全麻.腔内组术后平均住院时间为(9.1±2.7)d与手术组(9.2±2.6)d相似(P =0.798).围手术期并发症发生率EVAR组为12.6%低于手术组27.0% (P <0.05).EVAR组30 d围手术期死亡率1.15%,手术组30 d围手术期死亡率2.0%.结论 腹主动脉瘤腔内修复术比开腹手术具有创伤小、术中失血少、术后恢复快,围手术期死亡率低等优点,使部分高危不能耐受开腹手术患者能够获得有效治疗,长期生存率有待进一步随访观察.%Objective To evaluate the outcomes of endovascular repair (EVAR) versus open repair (OR) in the patients with abdominal aortic aneurysm (AAA) and compare their perioperative rates of morbidity and mortality.Methods The clinical data of 371 AAA patients from January 2006 to January 2011 were collected and analyzed.Endovascular

  20. Open surgical repair vs endovascular aortic repair for ruptured abdominal aortic aneurysm%破裂腹主动脉瘤开放与腔内修复手术治疗

    Institute of Scientific and Technical Information of China (English)

    罗海龙; 赵纪春; 黄斌; 袁丁; 杨轶; 曾国军; 熊飞; 吴洲鹏; 王铁皓

    2015-01-01

    目的 比较破裂腹主动脉瘤患者行腔内修复术(endovascular aortic repair,EVAR)与开放手术(open surgical repair,OSR)的疗效及安全性. 方法 回顾性分析1999年4月至2013年12月救治的71例破裂腹主动脉瘤患者的围术期及术后早期(术后30 d)资料,对比OSR和EVAR治疗的术后早期死亡率及并发症率.结果 OSR组有59例患者,EVAR组有12例患者.EVAR组年龄高于OSR组[(68±7)岁与(57±11)岁,t=-3.069,P=0.03];EVAR组COPD比率较OSR组高(58.3%与23.7%,x=5.733,P=0.017).EVAR组手术时间较OSR组短[(138±20) min与(258±66) min,t=-11.527,P<0.001];术中出血EVAR组低于OSR组[(130±43) ml与(2 295±425) ml,t=-17.529,P<0.001];EVAR组术中无输血,OSR组术中输血59例,x2=64.058,P<0.001;ICU驻留时间,呼吸机带机时间,术后禁食时间等EVAR组短于OSR组.EVAR组术后早期期死亡3例,OSR组死亡13例,30 d死亡率无明显差异(25.0%与22.0%,x2=0.000,P=1.000),术后严重并发症率EVAR与OSR组差异无统计学意义(33.3%与32.2%.x2=0.111,P=0.739). 结论 早期诊断、紧急的手术治疗和选择合适的治疗方式是提高破裂腹主动脉瘤救治率的关键.%Objective To compare and analyze the perioperative and early postoperative (30 d) outcomes between endovascular aortic repair (EVAR) and open surgical repair (OSR) for ruptured abdominal aortic aneurysm (RAAA).Methods The clinical data of 71 RAAA patients from April 1999 to December 2013 were collected and analyzed.Patients received EVAR (n =12) or OSR (n =59).Results Patients in EVAR group were older than those in OSR group (68 ± 7 vs 57 ± 11 years old,t =-3.069,P =0.03).The comorbidity rate of chronic obstructive pulmonary disease (COPD) in EVAR group was higher than that in OSR group (58.3% vs 23.7%,x2 =5.733,P =0.017).As compared with OSR group,the EVAR group had less blood loss (130 ±43 vs 2 295 ±425 ml,t =-17.529,P <0.001),a lower rate of blood transfusion (0 vs 100.0%,x2 =64.058,P

  1. Therapeutic effects of endovascular repair and open surgical repair in infrarenal abdominal aortic aneurysm%低风险肾下腹主动脉瘤腔内治疗与开腹手术临床分析

    Institute of Scientific and Technical Information of China (English)

    陈岩; 黄俊杰; 罗宇东

    2012-01-01

    目的:比较低风险肾下腹主动脉瘤腔内治疗与开腹手术的治疗效果.方法:回顾性分析42例低风险肾下腹主动脉瘤手术的临床资料.比较腔内治疗组(17例)与开腹手术组(25例)患者手术情况、并发症及治疗费用.结果:腔内治疗组患者在手术时间、ICU时间、术后住院时间、术中出血量上均优于开腹手术组患者(P>0.05),差异具有统计学意义.腔内治疗组患者在30 d围手术期死亡率及手术相关并发症上均少于开腹手术组患者,但差异无统计学意义(P>0.05).住院费用、1年内门诊随诊费用腔内治疗组明显高于开腹手术组(P<0.05),差异具有统计学意义.结论:对低风险肾下腹主动脉瘤患者,腔内治疗具备微创和术后恢复快的优势,但在降低围手术期的死亡率和并发症发生率上没有明显优势且治疗费用昂贵.结合中国国情,建议对于低风险肾下腹主动脉瘤患者采用传统开腹手术方式进行治疗.%Objective: To investigate the therapeutic effect of endovascular repair (EVAR) and open surgical repair (OSR) in patients with low risk infrarenal abdominal aortic aneurysm (AAA). Methods: Retrospective case analysis was made on 42 cases of low risk infrarenal AAA patients underwent wither EVAR or OSR. Therapeutic effect, complication, and cost of treatment were compared between EVAR (n=17) and OSR(n=25). Results: Compared to OSR group, operation time, length of stay in ICU, postoperation hospital stay and intraoperative blood loss significantly decreased(P<0.05) in EVAR group. EVAR had lower perioperative mortality rate and less complications compared to OSR, but there were no significant difference (P>0.05). Cost from hospitalizaiion up to 1 year follow up after EVAR were significantly higher than OSR(P>0.05). Conclusion: EVAR is a safe and minimally invasive operation that gave rise to faster postoperative recovery in low risk infrarenal AAA patients. However, EVAR

  2. 腔内修复术治疗破裂型腹主动脉瘤的效果评价%Effect Evaluation of Endovascular Aortic Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

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    庄晖; 郭平凡; 张金池; 蔡方刚; 刘学强; 吴捷; 戴贻权; 詹腾辉

    2014-01-01

    目的 分析破裂型腹主动脉瘤(ruptured abdominal aneurysm,rAAA)行腔内修复术(endovascular aortic aneurysm repair,EVAR)与开放手术早期结果,评价EVAR治疗的效果. 方法 回顾性收集我院2004年1月~2014年1月收治的48例rAAA患者临床资料,根据其手术与否、手术方式的不同分为术前死亡组(n=20)、EVAR组(n=14)和开放手术组(n=14),三组性别、年龄等一般资料比较无统计学差异(P>0.05),EVAR组和开放手术组在瘤体直径、收缩压、舒张压方面比较差异均无统计学意义(P>0.05). 结果 EVAR组入院至检查时间为(1.2±0.8)h,与开放手术组(7.5±7.1)h比较差异有统计学意义(P =0.006);EVAR组检查至手术时间为(1.8±1.3)h,与开放手术组(16.8±17.7)h比较差异有统计学意义(P=0.007).死亡组入院至死亡时间与EVAR组比较差异有统计学意义(P<0.009).EVAR组手术时间为(2.3±0.7)h,与开放手术组(5.6±2.0)h比较差异有统计学意义(P <0.001);EVAR组的术中出血量为(142.9 ±279.3)ml,与开放手术组的(3 528.6 ±3 252.3)ml间差异有统计学意义(P <0.001);EVAR组的输血量为(985.7±2 148.7)ml,与开放手术组的(3 100.0±2 285.1)ml间差异有统计学意义(P=0.018);EVAR组的住院时间为(7.1±2.7)d,与开放手术组的(13.7±4.9)d间差异有统计学意义(P<0.001);EVAR组的总费用为(20.9±5.8)万元,与开放手术组的(10.1±11.5)万元间差异有统计学意义(P =0.005).两组并发症率比较,差异无统计学意义(P=0.430). 结论 缩短院内抢救准备时间,是rAAA成功救治的要点.EVAR应作为rAAA的一线治疗方案.

  3. ANALYSIS OF ENDOLEAK IN SHORT TERM AFTER ENDOVASCULAR ANEURYSM REPAIR FOR ABDOMINAL AORTIC ANEURYSMS%腹主动脉瘤腔内修复术后短期内漏分析

    Institute of Scientific and Technical Information of China (English)

    黄佃; 周敏; 刘长建; 乔彤; 冉峰

    2013-01-01

    目的 总结腹主动脉瘤(abdominal aorta aneurysm,AAA)患者腔内修复术(endovascular aneurysm repair,EVAR)术后短期内漏发生情况,分析内漏产生原因. 方法 2005年7月-2013年6月,采用EVAR治疗210 例AAA患者.男175例,女35例;年龄42~89岁,平均65.7岁.通过计算机断层扫描动脉造影(computed tomography angiography,CTA)证实为肾下型AAA患者.病程1周~2年,中位病程11.3周.动脉瘤最大直径44~72mm,平均57.3 mm;锚定区长度均>1.5 cm.术后2个月常规行CTA复查,了解造影剂内漏情况;如有较明显内漏,于术后6个月再次复查CTA;如仍有明显内漏,行数字剪影血管造影(digital subtraction angiography,DSA),进一步明确内漏性质及程度,必要时采用EVAR修复. 结果 术中31例患者(14.8%)支架人工血管发生内漏,其中Ⅰ型内漏11例(ⅠA型8例、ⅠB型3例),Ⅱ型内漏18例,Ⅲ型内漏2例(均为Ⅲ B型).患者均获随访,随访时间2~8个月,平均3.1个月.术后2个月复查12例(5.7%)残余动脉瘤腔内有明显造影剂内漏.术后6个月复查仍有10例(4.8%)存在明显内漏,其中8例患者行DSA检查,发现Ⅰ型4例(ⅠA型3例、ⅠB型1例),Ⅱ型3例,Ⅲ型1例.5例Ⅰ、Ⅲ型患者均有不同程度支架人工血管侧突,采用增加延伸移植物支架人工血管方式处理,2~4个月后再次复查CTA显示内漏均消失;Ⅱ型患者未作特殊处理,2个月后再次复查CTA显示内漏仍存在,但动脉瘤最大直径无明显增大. 结论 支架人工血管侧突是AAA患者EVAR术后短期Ⅰ、Ⅲ型内漏产生的重要原因,可通过再次EVAR封堵内漏.

  4. Endovascular repair of aortic aneurysm: Preliminary results

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    Davidović Lazar

    2009-01-01

    Full Text Available Introduction. Endovascular aneurysm repair (EVAR has been introduced into clinical practice at the beginning of the 90's of the last century. Because of economic, political and social problems during the last 25 years, the introduction of this procedure in Serbia was not possible. Objective. The aim of this study was to present preliminary experiences and results of the Clinic for Vascular Surgery of the Serbian Clinical Centre in Belgrade in endovascular treatment of thoracic and abdominal aortic aneurysms. Methods. The procedure was performed in 33 patients (3 female and 30 male, aged from 42 to 83 years. Ten patients had a descending thoracic aorta aneurysm (three atherosclerotic, four traumatic - three chronic and one acute as a part of polytrauma, one dissected, two penetrated atherosclerotic ulcers, while 23 patients had the abdominal aortic aneurysm, one ruptured and two isolated iliac artery aneurysms. The indications for EVAR were isthmic aneurismal localisation, aged over 80 years and associated comorbidity (cardiac, pulmonary and cerebrovasular diseases, previous thoracotomy or multiple laparotomies associated with abdominal infection, idiopatic thrombocitopaenia. All of these patients had three or more risk factors. The diagnosis was established using duplex ultrasonography, angiography and MSCT. In the case of thoracic aneurysm, a Medtronic-Valiant® endovascular stent graft was implanted, while for the abdominal aortic aneurysm Medtronic-Talent® endovascular stent grafts with delivery systems were used. In three patients, following EVAR a surgical repair of the femoral artery aneurysm was performed, and in another three patients femoro-femoral cross over bypass followed implantation of aortouniiliac stent graft. Results. During procedure and follow-up period (mean 1.6 years, there were: one death, one conversion, one endoleak type 1, six patients with endoleak type 2 that disappeared during the follow-up period, one early graft

  5. 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

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    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

  6. 破裂腹主动脉瘤腔内治疗与手术治疗效果比较%Comparing the effects of endovascular and open surgery repair of ruptured abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    韩万里; 戴向晨; 罗宇东; 范海伦; 冯舟; 朱杰昌; 张益伟

    2015-01-01

    Objective:To compare and analyze effects of endovascular repair (EVAR) and open surgery repair (OSR) in patients with ruptured abdominal aortic aneurysm (rAAA). Methods: Clinical data of patients with rAAA were analyzed retrospectively. Outcome parameters included mortality (intraoperation, 30 day, 6 month and 12 month), complications, reinterventions, and length of hospital stay. Results:Thirty-five consecutive patients with rAAAs were presented, 12 of whom underwent EVAR, and 23 underwent OSR. Twenty-eight males and 7 females, age from 37 to 84 years with an mean of(68.37±10.04). At baseline, There was no significant differece in age , gender , comorbidities and preoperative hemodynamic stability between the two groups (P>0.05). The intraoperation, 30 day, 6 month and 12 month mortalities were 0.0%(0 of 12), 0.0%(0 of 12), 0.0%(0 of 12), and 0.0%(0 of 8) after EVAR, compared with 17.4%(4 of 23, P=0.275), 30.4%(7 of 23, P=0.070), 34.8% (8 of 23, P=0.032), and 45.0% (9 of 20, P=0.029) after OSR, respectively. Median length of hospital stay was 11.0 days (interquartile range, 7.0~16.0) after rEVAR and 17.0 days (interquartile range, 14.0~27.0) after OSR (P=0.024). Conclusion:These data suggest that EVAR can be a first-line treatment for rAAA. However, anatomical conditions should be considered with caution. Aortouniiliac is a fast and effective way to control bleeding. Further observation of abdominal compartment syndrome is essential for EVAR.%目的:比较破裂腹主动脉瘤(rAAA)腔内治疗(EVAR)与开放手术(OSR)的治疗情况。方法:回顾性分析分别采取开放手术或腔内治疗的rAAA患者临床资料。比较两组术前一般情况、围手术期死亡率及并发症发生率、术后死亡率、术后住院时间等。结果:rAAA患者共35例,其中男28例,女7例,年龄37~84岁,平均(68.37±10.04)岁。 OSR 23例、EVAR 12例。两组在年龄、性别、合并症及术前血流动力学稳定性

  7. Endovascular repair of abdominal aortic aneurysm: a clinical report of 81 cases%腹主动脉瘤腔内治疗81例临床分析

    Institute of Scientific and Technical Information of China (English)

    常光其; 李梓伦; 李松奇; 叶财盛; 李晓曦; 姚陈; 殷恒讳; 王深明

    2011-01-01

    目的 评估腔内修复术(EVAR)治疗腹主动脉瘤(AAA)的疗效及安全性,并比较不同年龄阶段患者的预后情况.方法 回顾性分析2005年5月到2011年5月接受EVAR的81例AAA 患者的住院和随访资料,将所有患者划分为高龄组(年龄≥75岁)和相对低龄组(年龄<75岁),分别为24例和57例.对两组患者的一般状况、合并症、手术情况、院内并发症和随访等资料进行对比.结果 所有覆膜支架均顺利植入,技术成功率91.4% (74/81).术中无死亡病例,住院病死率1.2%( 1/81).74例获得随访,随访率91.4%,平均随访47.5个月.随访期间死亡12例,1、2、3、4和5年生存率分别为98.6%、92.2%、80.8%、58.7%和44.1%.与相对低龄组比较,高龄组出现腹部疼痛症状比例较低,而合并肾脏疾病和冠状动脉粥样硬化性心脏病比例较高,术后重症监护时间较长,内漏发生率明显增加,而肺部感染和穿刺点血肿发生率也有增高趋势,其余住院及随访情况则无明显差异.结论 EVAR治疗AAA创伤小,安全,短中期疗效满意.高龄患者接受EVAR治疗后部分并发症发生率更高,围手术期应充分准备和密切观察,更好地防治可能的并发症,进一步改善预后.%Objective To evaluate the efficacy and safety of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA),and to compare the prognosis between patients of different ages.Methods The hospitalization and follow-up data of 81 AAA patients treated by EVAR from May 2005 to May 2011 were retrospectively analyzed.All the patients were divided into advanced age group (age≥75 years,24 cases) and relatively young group (age<75 years,57 cases).General conditions,comorbidity,procedure,in-hospital complications,and follow-up were compared between these two groups.Results All covered stents were successfully deployed,a technical success rate of 91.4% (74/81) was achieved.There was no intraoperative death

  8. Adding an endovascular aortic surgery program to a rural regional medical centre

    Science.gov (United States)

    Marelli, Daniel; Woo, Edward; Watson, Michael; Fedalen, Paul; Wang, Grace; Stallings, Megan; Fairman, Ronald; Mannion, John

    2013-01-01

    Background Abdominal aortic aneurysms requiring surgical intervention are generally treated by endovascular means. Such procedures are not always offered in rural hospitals, possibly leaving patients underserved. We reviewed our experience initiating an endoaortic surgery program. Methods A surgeon in a rural centre was credentialed to perform endovascular aortic aneurysm repair through collaboration with a university centre and was proctored locally for the first 5 abdominal aneurysm repairs. Web-based image storage was used to review complex cases as part of an ongoing partnership. Referred patients were screened for multiple aneurysms and underwent long-term monitoring. Results In all, 160 patients were evaluated for 176 aortic pathologies. Twenty-five patients (17 men) aged 55–89 years underwent 26 endovascular abdominal (n = 23) or thoracic (n = 3) aortic procedures. Emergent endovascular procedures were not performed. There were no operative deaths, requirements for dialysis or conversions to open repair. Two endoleaks required early reintervention. The median length of stay in hospital for endovascular procedures was 2.5 days. Chronic endoleaks were observed in 7 patients. An additional 8 patients underwent open abdominal aneurysm repair locally and 15 patients were referred to the university program. Conclusion Creation of an endovascular aortic surgery program in a rural hospital is feasible through collaboration with a high-volume centre. Patient safety is enhanced by obtaining second opinions using web-based image review. Most interventions are for abdominal aortic aneurysms, but planning for a comprehensive aortic clinic is preferable. PMID:24067525

  9. Efficacy analysis of endovascular aneurysm repair and open surgery repair in patients with abdominal aortic aneurysm%腹主动脉瘤腔内修复与开腹手术治疗的疗效分析

    Institute of Scientific and Technical Information of China (English)

    唐佃俊; 张健; 辛世杰; 伦语; 沈世凯; 宋建博; 姜晗; 段志泉

    2015-01-01

    Objective To analyze and compare the clinical efficacies of endovascular aneurysm repair (EVAR) and open surgery repair (OSR) in patients with abdominal aortic aneurysm (AAA).Methods The clinical data of 271 patients with AAA who received surgery at the First Hospital of China Medical University between January 2004 and December 2014 were retrospectively analyzed.Of the 271 patients,153 patients undergoing EVAR were allocated into the EVAR group and 118 patients undergoing OSR into the OSR group,respectively.All the patients underwent a primary screening of preoperative ultrasonography and were diagnosed by three-dimensional computed tomography angiography (CTA),then urgent and severe patients were confirmed by abdominal enhanced CT.The procedures of EVAR:guide wire was inserted into the abdominal arota from femoral artery incision and branched stent was placed.The procedures of OSR:AAA was resected by median abdoninal incision,thrombi and sclerosis plaques in endovascular wall were cleared,and end-to-end abdominal aortic anastomosis and end-to-side iliac aortic anastomosis were performed using Y-shaped blood vessel prosthesis.All the patients were followed up by telephone interview up to December 31,2014.The operation situation,complications at postoperative day 30,short-term complications (between postoperative 3 months and 3 years),medium-and long-term complications (more than postoperative 3 years),mortality and survival rate were observed.Measurement data with normal distribution were presented as x ± s and analyzed using the t test,and count data were analyzed using the chi-square test or Fisher exact probability.Survival curve was drawn by the Kaplan-Meier method,and survival rate was analyzed using the Log-rank test.Results All the patients were confirmed as with AAA by preoperative three-dimensional CTA.The operation time,volume of intraoperative blood loss,volume of intraoperative blood transfusion,time for out-off-bed activity,duration of hospital stay

  10. Reverse crossover chimney technique combined with endovascular aneurysm repair treating abdominal aortic aneurysm%腹主动脉瘤腔内修复术联合腔内反向髂内动脉覆膜支架置入术临床观察

    Institute of Scientific and Technical Information of China (English)

    李彭; 郭曦; 黄小勇; 李铁铮; 韩晓峰; 刘光锐; 薛玉国; 蒲俊舟; 黄连军

    2014-01-01

    目的 探讨腹主动脉瘤腔内修复术联合反向髂内动脉覆膜支架置入术治疗腹主动脉瘤的疗效.方法 自2013年4-6月,于北京安贞医院行腹主动脉瘤腔内修复术联合反向髂内动脉覆膜支架置入术的患者共3例,均为男性,年龄分别为57、66、65岁,采用双侧切开暴露股动脉,对侧送导丝置入转流侧髂内动脉内保留,依次送入腹主动脉支架主体、髂分支及转流支架并分别完全释放.结果 腹主动脉支架选择ENDURANT(Medtronic,美国)或EXCLUDER(GORE,美国)的2例患者转流支架内可见造影剂充盈,转流侧髂内动脉及其分支显影良好,另1例腹主动脉支架选择Zenith(COOK,美国)的患者自转流支架开口处闭塞.术后1个月CT血管造影显示所有患者未出现支架内漏和支架移位等并发症.结论 对于腹主动脉瘤累及双侧髂动脉需行腔内修复术并覆盖双侧髂内动脉患者,同时并行反向髂内动脉腔内覆膜支架置入术能够保护单侧髂内动脉,但还需进一步扩大病例数以分析影响转流支架通畅的因素,并进行长期随访观察远期疗效.%Objective To investigate the curative effect of reverse crossover chimney technique combined with endovascular aneurysm repair treating abdominal aortic aneurysm.Methods Three cases (3 males,average age:57,66,65 years old) received endovascular aneurysm repair(EVAR) and reversed crossover chimney technique in abdominal aortic aneurysm.The vascular stent was sent from contralateral femoral artery.After intervention,digital subtraction angiography showed that abdominal aortic aneurysm was repaired ; bypass-stent and ipsilateral inner iliac artery were unobstructed.Results Contrast medium was fully filled in abdominal aorta and the abdominal aorta was well displayed in 2 cases using bypass-stent,ENDURANT (Medtronic,USA) or EXCLUDER (GORE,USA).The ipsilateral inner iliac artery was also well displayed.Abdominal aorta was obstructed in the opening

  11. Outcome comparison of open versus endovascular techniques in the treatment of abdominal aortic aneurysms%开腹与腔内技术治疗腹主动脉瘤的临床效果比较

    Institute of Scientific and Technical Information of China (English)

    谷涌泉; 郭连瑞; 齐立行; 俞恒锡; 李学锋; 陈兵; 佟铸; 武欣; 郭建明

    2013-01-01

    Objective To compare the efficacy,cost and safety of endovascular aortic repair (EVAR) versus open surgery in the treatment of infrarenal abdominal aortic aneurysms.Methods Retrospective analyses were conducted for the clinical data and follow-up information of 218 cases from January 2002 to December 2011 at our hospital.Open surgery group included 86 patients with an mean age of 65.5 years and a mean aneurysm diameter of 5.4 cm.In EVAR group,there were 132 cases with an average age of 76.8 years and a mean aneurysm diameter of 5.6 cm.Results Among 86 open cases,there were inverted "Y" type artificial graft (n =83) and straight artificial graft (n =3).The surgical success rate was 98.8%,perioperative period mortality rate was 2.3%,a mean volume of blood loss 450 ml and a mean transfusion volume 320 ml.The mean operative duration was 230 rmin,a mean hospitalization time (30 ± 3) days and a mean hospitalization cost RMB yuan 58 000.In EVAR group,the surgical success rate was 100% and perioperative period mortality rate 0.8%.Separating stent graft (n =121,91.7%),straight stent graft (n =4,3%) and one-stent-graft (n =7,5.3%).The mean operative duration was 150 min,a mean volume of blood loss 140 ml,a mean hospitalization time 15.5 days and a mean hospitalization cost RMB yuan 104 800.The operative duration,volume of blood loss and length of hospital stay of EVAR group were superior to those of open surgery group (P < 0.05).But the cost of group EVAR was significantly higher than that of group open surgery (P < 0.05).In group open surgery,80 cases (94.1%) received a mean follow-up period of 46 months.And 79 artificial grafts maintained patency (98.8%) and 8 cases died (10%).There were 125 cases in group EVAR (94.7%) with a mean time of 32.5 months; stent graft patency in 120 cases (96%),10 death; 8 complication cases (5.6%) involved stent migration (n =2)and iliac artery branch occlusion (n =6).Long-term effects had no significant

  12. The treatment strategy of special distal landing zones in endovascular repair of abdominal aortic aneurysm%腹主动脉瘤腔内修复术中特殊远端锚定区的处理策略

    Institute of Scientific and Technical Information of China (English)

    张承磊; 蔡红波; 杨斌; 金辉

    2011-01-01

    Objective To study the assessment and management for abdominal aortic aneurysm (AAA)'s special distal landing zones in endovascular repair (EVAR).Methods The clinic data of66 AAA patients with complicated distal landing zones From January 2007 to December 2010 was retrospectively analyzed.There were 45 male and 21 female patients,aged from 53 to 87 years with a mean of 62 years.All patients underwent the CT angiography examination (1 to 2 mm interval ) to obtain the necessary anatomical data. In this group,there were 20 cases with type Ⅰ and Ⅱ A lesions,including 10 cases with narrow common iliac arteries/external iliac arteries (>50% ),6 cases with seriously distorted common iliac arteries/external iliac arteries,4 cases with the characters of the above,16 cases with bilateral common iliac aneurysms,46 cases with bilateral common iliac aneurysms combined internal iliac aneurysms ( unilateral 32 cases,bilateral 14 cases).The vascular stent-grafts' usage was as follow:Metronic 46 cases,COOK 14 cases,Microport 4 cases,Lifetech 2 cases.Results The mean operative time was 90 min.There were significant stent-graft shortening in 22 cases (33.3%),type Ⅱ endoleak in 18 cases (27.3% ),type Ⅲ endoleak in 5 cases (7.6% ),iliac stents' stenosis ( >50% ) in 2 cases (3.0%),type Ⅱ combined with type Ⅲ endoleak in 5 cases (7.6%),iliac stents' stenosis combined with type Ⅲ endoleak in 4 cases (6.1% ).Patients were followed for a mean of 22 months (range from 3 to 36 months),during the time of follow-up,the following conditions were observed:stent-graft displacement (to the remote < 10 mm) in 2 cases (3.0%),illiac stents restenosis ( >50% ) 2 cases,type Ⅱ endoleak healed in 18 cases ( 18/23,78.3% ),and no type Ⅲ endoleak remained.The fatality rate was 3.0% (2/66).Conclusions Special distal landing zones increased the operative complication rate in EVAR.Being familiar with the features of stent-graft and appropriate use of various

  13. 腹主动脉瘤腔内修复术后支架感染诊治分析%Management of endo-graft infection following endovascular repair of abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    殷恒讳; 王冕; 李梓伦; 姚陈; 胡作军; 王劲松; 常光其; 王深明

    2016-01-01

    目的 总结腹主动脉瘤腔内修复(EVAR)术后支架感染的诊治经验.方法 回顾性总结了 2000年1月至2015年12月中山大学附属第一医院收治的EVAR术后支架感染病例资料,对感染的原因、临床表现、诊断方法、再次干预方式及和预后进行分析.结果 收治的患者共有10例EVAR术后支架感染病例,均为男性,年龄45~ 72岁(平均62.5岁).其中2例初次EVAR手术于我院进行,占我院同期EVAR手术的0.23% (2/885).本次发病与EVAR手术间隔0~27个月(平均6.9个月),主要临床表现为反复发热(100%)及腰背部疼痛(40%).8例患者有明确感染诱因(80.0%),其中腹主动脉瘤肠瘘4例(40%),炎性动脉瘤3例(30%),上呼吸道感染并败血症1例(10%).9例患者接受了二次手术干预,其中局部清创+引流1例,支架切除+双侧腋动脉-股动脉人工血管旁路1例,支架移除+右侧腋动脉-双侧股动脉人工血管旁路7例.随访2~ 60个月(平均24.1个月),1例失访,1例术后死于腹主动脉残端破裂(12.5%),7例迄今存活,其中1例解剖外旁路闭塞(12.5%)但无严重下肢缺血.结论 腹主动脉瘤肠瘘和炎性腹主动脉瘤是本组病例支架感染的主要原因,在充分抗炎治疗的基础上建立解剖外旁路并移除移植物是有效的治疗手段.%Objective To summarize our experience in the management of stent-graft infection after endo-vascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA).Methods Data of patients who were diagnosed as endo-graft infection following EVAR and admitted in our center between January 2000 and December 2015 were reviewed.Clinical records including causes of infection,medical history,re-operative procedures,and prognostic data were analysed.Results A total of 10 male patients,aged 45-72 years (averaged 62.5 years),were enrolled.Two patients received previous EVAR in our center,accounting for 0.23% of all the 885 EVAR procedures we conducted during the

  14. A Meta analysis on endovascular vs open repair for abdominal aortic aneurysm in patients aged 80 and older%高龄腹主动脉瘤患者治疗方式的选择及疗效比较

    Institute of Scientific and Technical Information of China (English)

    韩彦槊; 张健; 姜晗; 沈世凯; 宋健博; 唐佃俊; 辛世杰; 段志泉

    2015-01-01

    Objective To investigate the therapeutic effect between endovascular repair (EVAR) and open surgical repair (OSR) of AAA in patients aged ≥80 years.Methods We searched MEDLINE (1991.1-2014.7), Ovid (1991.1-2014.7), CBM (1998.1-2014.7) and CNKI (1998.1-2014.7) database.Meta-analyses was performed through software STATA 12.0.Results Eight observational studies reporting on 13 490 octogenarian AAAs were included in this analysis.6 763 AAA patients underwent EVAR and 6 727 AAAs underwent OSR.Although EVAR did not reduce cerebrovascular complication (OR =0.156, P =0.172), EVAR was associated with a significantly lower risk of postoperative cardiac complications (OR =0.092, P =0.008), pulmonary complications (OR =0.059, P =0.011) and renal complications (OR =0.097, P =0.007).Pooled analysis showed lower 30-day mortality after EVAR compared with OSR (OR =0.240, 95% CI: 0.197-0.293, P <0.001).As for medium-long term results, four studies found similar overall survival at 3 years after EVAR and open repair (OR =1.14, P =0.208).Sensitivity analysis including four studies (recruiting AAAs more than 100 cases in each study) found similar 30-day mortality.Conclusions EVAR in aged 80 and older AAAs is associated with significantly lower 30-day mortality and morbidity than OSR.%目的 系统评价80岁以上高龄腹主动脉瘤患者的传统手术及腔内治疗的疗效.方法 计算机检索1991年1月至2014年7月MEDLINE、Ovid、CBM和CNKI数据库.根据纳入和排除标准由两名研究者按Cochrane系统评价方法,独立选择文献、提取资料、评价各研究的方法学质量以及提取有效数据,采用STATA 12.0软件进行Meta分析.结果 共纳入8篇相关文献;共统计13 490例高龄腹主动脉瘤(abdominal aortic aneurysm,AAA)患者,其中腔内修复技术(endovascularrepair,EVAR)组6 763例,人工血管移植术(open surgical repair,OSR)组6 727例.术后早期EVAR组的心脏并发症发生率明显低于OSR

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

    DEFF Research Database (Denmark)

    De La Motte, L; Vogt, K; Jensen, Leif Panduro;

    2011-01-01

    AIM: The aim of this study was to estimate the incidence of the post-implantation syndrome/systemic inflammatory response syndrome (SIRS) after endovascular aortic repair. METHODS: All patients, undergoing elective primary endovascular repair of an asymptomatic infrarenal abdominal aortic aneurys...... in the groups (3% in the SIRS group vs. none in the non-SIRS group). CONCLUSION: The high incidence of SIRS after EVAR is unexpected considering the minimally invasive procedure. Further studies on the cause of this response and measures to attenuate the response seem appropriate....

  16. Endovascular Repair of Supra-Celiac and Abdominal Aortic Pseudo Aneurysms Concomitant with a Right Atrial Mass in a Patient with Behçet’s Disease: A Case Report

    Directory of Open Access Journals (Sweden)

    SeyedEbrahim Kassaian

    2015-10-01

    Full Text Available Behcet’s disease is a rare immune mediated systemic vasculitis which besides it’s more frequent involvement of eyes and skin,   sometimes present with aortic pseudo aneurysm and more rarely cardiac inflammatory masses.A 51-year-old patient with Behçet’s Disease presented with two symptomatic aortic pseudoaneurysms concomitant with a right atrial mass. Computed tomography (CT revealed one supra-celiac and another infrarenal aortic pseudoaneurysms. Echocardiography showed a large mobile mass in the right atrium. Both pseudoaneurysms were successfully excluded simultaneously via endovascular approach with Zenith stent-grafts, and the atrial mass was surgically removed 10 days later. Post-implant CT showed successful exclusion of both pseudo-aneurysms, patency of all relevant arteries, and patient is now asymptomatic and has returned to normal lifestyle. Multiple pseudoaneurysms concomitant with a right atrial mass can be an initial manifestation of Behçet’s disease. Endovascular repair can be a good treatment option for the pseudoaneurysms.

  17. [The endovascular correction of aortic coarctation].

    Science.gov (United States)

    Barkov, E D; Silin, V A; Sukhov, V K

    1992-03-01

    The endovascular balloon dilatation of the aorta coarctation performed on indications and at the optimal terms is the radical correction of the defect with a pronounced positive effect in 90% of 43 patients. No aneurysms and restenoses were found. Retained collaterals allow avoidance of the abdominal syndrome and paradoxical hypertension. Contraindications for catheter angioplasty are thought to include agenesia or considerable hypoplasia of the aorta, the absence of the aorta lumen in the zone of coarctation, its considerable length and the presence of prestenotic aneurysms. A short and noncomplicated postoperative period makes the method sufficiently economical.

  18. A canine juxtarenal abdominal aortic aneurysm model applying to endovascular stent-graft's and hemodynamic study%适用于腔内隔绝移植物及血流动力学研究的犬肾周型腹主动脉瘤模型的建立

    Institute of Scientific and Technical Information of China (English)

    黄志军; 陆清声; 景在平; 林晨; 廖明芳

    2012-01-01

    目的 建立一种适用于研究腔内隔绝移植物及血流动力学的犬肾周型腹主动脉瘤模型.方法 通过在犬近肾腹主动脉段移植经0.6%戊二醛浸泡30 min去抗原处理后的牛颈外静脉,制作15例犬肾周型腹主动脉瘤模型.将此动脉瘤模型与患者的肾周型腹主动脉瘤进行形态学的对比,并且检测血流动力学参数外与15例腹主动脉瘤患者对比.结果 15只动物手术过程顺利,术中死亡0只,术后1天腹腔出血死亡1只,术后2天急性肾衰死亡 3只.动物模型与肾周型腹主动脉瘤患者动脉瘤形态相似.直径、壁厚的比例相似.瘤体内收缩压、舒张压、平均动脉压均高于肾上腹主动脉、髂总功脉和动脉瘤入、出口.动脉壁弹性相似.动脉瘤中都出现了涡流或湍流.结论 此模型是适合肾周型腹主动脉瘤腔内隔绝移植物及血流动力学研究的有较大实用价值的动物模型.%Objective To construct an animal juxtarenal abdominal aortic aneurysm model applying to endovascular stent-graft' s and hemodynamic study. Methods The bovine jugular vein segments which had been treated with 0. 6% glutaral were removed to fifteen hybrid canines at juxtarenal abdominal aortic to construct aneurysms. The aneurysm models' hemodynamic data were selected and were contrasted with fifteen patients' juxtarenal abdominal aortic aneurysms. Results The operations of all fifteen canines were-successful. No canine died in the operation but 1 canine died 1 day after operation because of abdominal bleeding and three died in two days because of acute renal failure. The models were similar to the patients in such area as the configuration of aneurysm, the proportion of aneurysm's diameter to wall's thickness, the elasticity of aneurysm's wall and the blood flow in aneurysm. Like the patients, the systolic, diastolic and mean pressures in the aneurysm of the model were higher than the pressures in the suprarenal aorta, the common

  19. Value of imaging in the endovascular repair for abdominal aortic aneurysm%影像技术在腹主动脉瘤腔内治疗中的应用价值

    Institute of Scientific and Technical Information of China (English)

    刘长建

    2012-01-01

    The development of endovascular techniques depends on the concomitant development of imaging techniques. The ideal imaging method for endovascular aortic repair (EVAR) should provide data for diagnosis, for assessment of the vessel diameters, for characterization of the wall of the aorta and iliac arteries and the aneurysm neck, and for guidance on stent graft deployment, so as to assess the plan of treatment and accurate parameters of stent graft. Angiography alone cannot provide all information necessary for EVAR. Advanced methods, which include rotational angiography , CTA, MRA and intravascular ultrasound, have been playing an important role in endovascular treatment of vascular disease. The combined use of new imaging techniques will further improve the treatment of vascular disease in the future.%血管腔内治疗技术的发展有赖于相关影像技术的不断改进.理想的影像学方法应该可为腹主动脉瘤病人和主动脉腔内修复(EVAR)手术提供准确诊断,确定动脉直径,评估主动脉、髂动脉和动脉瘤颈壁的特征,了解支架人工血管置放动脉通路等资料,以便制定治疗方案和选择支架人工血管.单纯血管造影已不能提供EVAR手术必须的完整资料,先进的数字化血管造影、CT血管造影、磁共振血管造影和血管腔内超声技术在血管疾病腔内治疗中已起到十分重要的作用,这些影像技术的联合应用,将进一步提高血管疾病的治疗水平.

  20. Successful endovascular infrarenal aneurysm repair in a patient with situs inversus totalis

    OpenAIRE

    Chan, YC; Cheng, SW; Ting, AC; Qing, KX

    2010-01-01

    Situs inversus totalis is a rare autosomal recessive developmental anomaly. There are very few reports in the published literature of abdominal aortic aneurysm in patient with situs inversus totalis, all of whom underwent open aneurysm repair. This is the first case in the world's literature to describe a patient with situs inversus totalis who had a successful endovascular infrarenal aneurysm repair. Although endovascular infrarenal aneurysm repair should not be more challenging, the endovas...

  1. Endovascular aortal stentgraft implantation - 5-year experience

    International Nuclear Information System (INIS)

    Presentation of own experience in the field of endovascular treatment of aneurysms and aortal wall damage, as well as comparison of the value of angio-CT and dimensioning angiography imaging of aneurysms in the aspect of qualification for aortal stentgraft implantation procedures. 133 patients (11 females and 121 males) aged 23 - 82 years underwent endovascular stentgraft implantation procedures preformed as treatment for aortal aneurysms, delamination and posttraumatic damage of the aortal wall. The treated patients were classified as belonging to groups II (35.5%), III (55%) and IV (9.5%) according to ASA. Qualification for endovascular surgery was based on angio-CT and dimensioning angiography. 21 stentgrafts were implanted into the thoracic and 113 into the abdominal aorta. There was no necessity of perioperative removal of the prosthesis in any case. The overall rate of postoperative complications was 9.7 %. The duration of the surgery ranged from 30 to 120 min. Implantation of aortal stentgrafts is a safe method of treatment for aortal aneurysms, delaminations and ruptures. It as also a life-saving procedure in damage of the aortal wall due to trauma. Computed tomography is an essential imaging modality in the diagnostics of aortal abnormalities. Owing to 3D reconstructions of CT images, the aortal anatomy and the exact site of aortal wall damage can be identified. This is very important for correct selection of the stentgraft parameters and makes it possible to resign from dimensioning angiography. (author)

  2. [Endovascular repair of aortic aneurysm a paradigmatic shift

    DEFF Research Database (Denmark)

    Lönn, Lars Birger

    2008-01-01

    The evolution of endovascular aortic repair (EVAR) is rapid and global. The aim is to replace open surgery as a life-saving treatment. According to randomised controlled studies, abdominal EVAR is a better option than open repair in terms of safety and efficacy in the short run. However......, the overall survival in EVAR patients with severe morbidity is not influenced since mortality in this group is mainly unrelated to the aneurysm. Endovascular repair is also a solid alternative in thoracic pathologies and aortic ruptures. Patient selection and follow-up in EVAR is mainly governed by vascular...... imaging, especially 3-D CT reconstructions. There is a need for an increased number of endovascular specialists in Denmark since an increasing number of patients are suitable for EVAR treatment Udgivelsesdato: 2008/3/10...

  3. Endovascular treatment of thoracic aortic diseases

    Directory of Open Access Journals (Sweden)

    Davidović 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

  4. Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management

    OpenAIRE

    Scaife, Mark; Giannakopoulos, Triantafillos; Al-Khoury, Georges E.; Chaer, Rabih A.; Avgerinos, Efthymios D.

    2016-01-01

    Ultrasound (US) is a well-established screening tool for detection of abdominal aortic aneurysms (AAAs) and is currently recommended not only for those with a relevant family history but also for all men and high-risk women older than 65 years of age. The advent of minimally invasive endovascular techniques in the treatment of AAAs [endovascular aneurysm repair (EVAR)] has increased the need for repeat imaging, especially in the postoperative period. Nevertheless, preoperative planning, intra...

  5. Nursing assistance during endovascular reconstruction using balloon occlusion of the abdominal aorta for patients with severe pelvic trauma and vascular injury%严重骨盆外伤合并血管损伤应用腹主动脉球囊阻断技术的护理配合

    Institute of Scientific and Technical Information of China (English)

    钱维明; 杜丽丽; 项海燕

    2011-01-01

    This paper summarizes the experience of nursing assistance during endovascular reconstruction using balloon occlusion of the abdominal aorta for patients with severe pelvic trauma and vascular injury in traffic accidents. Measures of nursing assistance included preoperative preparation,maintaining vascular access,monitoring urine volume,bilateral dorsalis pedis arterial pulses and the change of blood pressure during the operation. Postoperative nursing focused on effective compression on femoral artery after withdrawal of catheter,observation of urine volume,and local hematoma and skin temperature of lower extremities. The four patients got through the perioperative period safely and were discharged with recovery.%总结了4例因车祸致严重骨盆外伤合并血管损伤的急诊患者应用腹主动脉球囊阻断技术的护理配合经验.护理配合重点包括:完善术前准备,术中确保动静脉通路畅通,准确观察尿量,密切观察双侧足背动脉的搏动,监测血压的变化,穿刺侧肢体拔管后予有效压迫,观察尿量、局部血肿及肢体皮温.4例患者均安全度过围手术期,痊愈出院.

  6. 腹主动脉瘤开放手术和腔内修复术的短期随访研究%Comparison of endovascular versus open repair of abdominal aortic aneurysms: a randomized trial

    Institute of Scientific and Technical Information of China (English)

    张征; 陈忠; 吴章敏; 唐小斌; 刘晖; 寇镭; 吴庆华

    2012-01-01

    Objective:To compare postoperative outcomes up to 6 months after endovascular or open repair of AAA. Methods:A randomized, single center clinical trial of 100 patients with eligible AAA who were candidates for both elective endovascular repair and open repair of AAA. Patients were randomized to receive either EVAR (endovascular aneurysm repair) or OR (open repair) of AAA. All-cause deaths, systemic and surgery- related complication were documented. Intraoperative data was also collected. All patients were followed up to 6 months after surgery. Statistical analysis was applied to process collected data. Results: Fifty patients were assigned to EVAR group and 50 to OR group. Thirty-nine patients underwent OR and 61 underwent EVAR eventually. Perioperative mortality was zero for both groups. When followed up to 6 months, all-cause mortality was lower for EVAR (0 % vs. 2. 6% ) , but there was no significant difference between the 2 groups. Patients in the EVAR group had reduced median procedure time, blood loss, transfusion requirement, hospital stay, but required much more expensive cost ( P < 0. 05 ). There were no significant differences between the 2 groups in major systemic complication, surgery related complication, secondary therapeutic procedures, but EVAR showed a better outcome during perioperative period. Conclusion: In this report of short-term outcomes after elective AAA repair, perioperative mortality and mobility was low for both procedures. Both EVAR-and OR are safe and effective options for AAA. Longer-term outcome data are needed to fully assess the relative merits of the 2 procedures.%目的:比较腹主动脉瘤(AAA)腔内修复术(EVAR)和开放手术(OR),术后6个月内的疗效.方法:选择同时满足OR和EVAR手术条件的AAA患者共100例,随机分配接受OR或EVAR手术,随访至术后6个月,记录分析两组术中情况、病死率、全身并发症及手术相关并发症.结果:至术后6个月,仅OR组死亡1例,两组病死率差

  7. Clinical usefulness of urinary liver-type fatty-acid-binding protein as a perioperative marker of acute kidney injury in patients undergoing endovascular or open-abdominal aortic aneurysm repair

    OpenAIRE

    Obata, Yumi; Kamijo-Ikemori, Atsuko; Ichikawa, Daisuke; Sugaya, Takeshi; Kimura, Kenjiro; Shibagaki, Yugo; Tateda, Takeshi

    2015-01-01

    Purpose Acute kidney injury (AKI) is common after cardiovascular surgery and is usually diagnosed on the basis of the serum creatinine (SCr) level and urinary output. However, SCr is of low sensitivity in patients with poor renal function. Because urinary liver-type fatty-acid-binding protein (L-FABP) reflects renal tubular injury, we evaluated whether perioperative changes in urinary L-FABP predict AKI in the context of abdominal aortic repair. Methods Study participants were 95 patients who...

  8. 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.

  9. Dolor abdominal recurrente .

    Directory of Open Access Journals (Sweden)

    Rodrigo De Vivero

    2009-11-01

    Full Text Available El dolor abdominal recurrente (DAR es un problema frecuente en la consulta médica y en la subespecialidad médica y quirúrgica. El DAR es frecuentemente funcional, es decir, sin una causa orgánica aparente. El diagnóstico diferencial debe incluir pérdida de peso, sangrado gastrointestinal, fiebre persistente, diarrea crónica y vómito importante. En este artículo se revisa el diagnóstico y tratamiento, pruebas diagnósticas y manejo farmacológico y ambiental.

  10. Rat Endovascular Perforation Model

    OpenAIRE

    Sehba, Fatima A.

    2014-01-01

    Experimental animal models of aneurysmal subarachnoid hemorrhage (SAH) have provided a wealth of information on the mechanisms of brain injury. The Rat endovascular perforation model (EVP) replicates the early pathophysiology of SAH and hence is frequently used to study early brain injury following SAH.

  11. 3D-Recon 3D 重建软件在腹主动脉瘤腔内修复术术前评估中的应用%Application of 3D reconstruction software in preoperative assessments of endovascular aneurysm repair for patients with abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    欧阳洋; 黄建华; 李刚; 刘光强; 王宪伟; 王伟; 姜炜

    2014-01-01

    目的:总结评价3D-Recon 3D 重建软件在腹主动脉瘤患者 EVAR 手术术前评估中的应用可行性。方法2013年4~10月腹主动脉瘤患者10例,术前分别使用 CTA 断层二维图像与3D-Recon 3D 重建图像对患者 EVAR 术前的相关参数进行测定,两者间进行对照分析。结果二维图像上测量的血管直径参数均大于3D 重建后软件所测得的参数;二维图像上测量的血管长度参数均小于3D 重建后软件所测得的参数。9例行 EVAR 手术的患者按3D 重建后软件所测得的参数选择支架,EVAR手术均获得成功。结论3D-Recon 3D 重建软件在腹主动脉瘤患者 EVAR 手术术前评估中的作用优于 CTA 断层图像。%Objective To evaluate the application feasibility of 3D-Recon 3D reconstruction soft-ware in preoperative assessments of endovascular aneurysm repairing (EVAR)for patients with ab-dominal aortic aneurysm.Methods Ten patients with abdominal aortic aneurysms underwent two-di-mensional (2D)computed tomographic angiography (CTA)image reconstruction and 3D-Recon 3D imaging preoperatively to measure their relevant parameters and then compare the data.Results The 2D vascular diameters were greater than those of 3D reconstruction software.And 2D vascular lengths were smaller than those of 3D reconstruction.Nine of them selected stents according to their 3D pa-rameters.EVAR operation was all successful.Conclusions For preoperative assessments of EVAR pa-tients with abdominal aortic aneurysm,3D-Recon 3D reconstruction software is superior to CTA im-aging.

  12. 腹主动脉瘤腔内修复术后髂支支架内闭塞的危险因素分析%Analysis of risk factors for iliac limb occlusion after endovascular repair of abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    陈洪胜; 郭媛媛; 彭飞; 魏广源

    2016-01-01

    Objective:To analyze the risk factors for iliac limb occlusion atfer endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm. Methods:hTe clinical data of patients with abdominal aortic aneurysm undergoing EVAR between January 2011 and December 2015 were collected. By a 1:3 matched case-control design, for each case with iliac limb occlusion, 3 patients of the same sex, age (within 3 year), and receiving stent of the same type and same manufacturer were randomly selected as control. hTe risk factors for iliac limb occlusion atfer EVAR were determined by univariate and multivariate Logistic regression analysis.Results:A total of 495 patients with abdominal aortic aneurysm underwent EVAR, among them, 11 cases (2.2%) developed iliac limb occlusion, and the average time to onset was 2-20 weeks atfer surgery. Univariate analysis showed that preoperative iliac artery angulation/tortuosity≥60° (P=0.001), preoperative iliac artery stenosis≥50%(P=0.002) and gratf oversizing of the distal end of the iliac limb>15%(P=0.004) were signiifcantly associated with post-EVAR iliac limb occlusion. Multivariate Logistic regression analysis revealed that all the above variables were independent risk factors for post-EVAR iliac limb occlusion (all P15%(P=0.004)等因素与EVAR后髂支支架内闭塞有关;Logistics回归分析显示,以上述因素均为EVAR后髂支支架内闭塞的独立危险因素(均P<0.05)。结论:术前根据髂动脉解剖特性严格制定计划,选择合适的支架口径是减少术后髂支内闭塞的关键。应识别高危人群,针对可控因素采取预防措施,以避免及减少术后支架内闭塞的发生。

  13. 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.

  14. Endovascular abdominal aortic aneurysm repair: challenges and long-term outcomes%腹主动脉瘤腔内修复面临的挑战和远期疗效研究

    Institute of Scientific and Technical Information of China (English)

    蒋米尔; 刘光

    2011-01-01

    @@ 腹主动脉瘤(abdominal aortic aneurysm,AAA)治疗的目的在于重建主动脉管腔和血流,防止瘤样病变继续发展和破裂发生,改善与疾病自然病程有关的预后.然而传统的开腹手术存在着创伤大、恢复时间长、并发症发生率和死亡率高等诸多不利因素.

  15. Investigation of Clinical Application Using Fusion Imaging Combined CTA with DSA-DYNA-CT in the Endovascular Prosthesis for Abdominal Aortic Aneurysm%CTA与DSA-DYNA-CT融合图像在腹主动脉瘤腔内修复术中的应用

    Institute of Scientific and Technical Information of China (English)

    侯凯; 饶圣祥; 顾君英; 曾蒙苏

    2012-01-01

    目的:评价利用CTA与DSA-DYNA-CT的融合图像作为腹主动脉瘤腔内修复术中的三维血管路径图的可行性.方法:腹主动脉瘤腔内修复术患者15例,术前行胸腹主动脉CTA检查,术中在腹主动脉瘤部位行数字平板DSA结合旋转断层重组技术所获得的CT样图像(DSA-DYNA-CT)的数据采集,在工作站中利用“syngo inspace 3D-fusion”功能进行两者图像融合,作为实时透视过程中的三维血管路径图.结果:CTA与DSA-DYNA-CT在融合过程中,10例骨性错位<2 mm,余5例手动调节后均骨性对位满意;肾动脉融合图像与实时透视的图像的位移较大,其中46.7%(7/15)的患者上下位移>2 mm),66.7%(10/15)的患者左右位移>2 mm.结论:将CTA与DSA-DYNA CT的融合图像作为大血管的DSA三维血管路径图,在不用造影剂的情况下,可以在术中多角度观察导丝及支架与周围血管的位置关系.%Objective:To evaluate the DSA 3D-roadmap in the endovascular prosthesis for abdominal aortic aneurysm with the fusion image of CT angiography(CTA) and DSA-DYNA-CT. Methods: Fifteen patients with abdominal aortic aneurysm were enrolled in the study. Aortic CTA and DSA-DYNA-CT imaging were performed to the fusion imaging in the workstation with the software of syngo inspace 3D fusion for the abdominal aortic aneurysm without contrast medium administration. Then the fusion image was used as the 3D-roadmap in the process of real-time fluoroscopy. Results: In the fusion process of CTA and DYNA-CT, osseous paraposition were 2 mm in 5 cases, but the osseous registration can be satisfied with the manual adjustment ?2mm). Due to the influence of the stent delivery devices, the abdominal aorta has marked displacement. Displacement was more than 2 mm between up and down in 7 cases (7/15,46. 7%), and displacement was greater than 2 mm between left and right in 10 patients (10/15,66. 7%). Conclusions: Without contrast medium administration,the 3D-roadmap, can be

  16. Abdominal Adhesions

    Science.gov (United States)

    ... adhesions? Abdominal adhesions can cause intestinal obstruction and female infertility—the inability to become pregnant after a year of trying. Abdominal adhesions can lead to female infertility by preventing fertilized eggs from reaching the uterus, ...

  17. Endovascular Aneurysm Repair and Sealing (EVARS): A Useful Adjunct in Treating Challenging Morphology.

    Science.gov (United States)

    Harrison, Gareth J; Antoniou, George A; Torella, Francesco; McWilliams, Richard G; Fisher, Robert K

    2016-04-01

    An 81-year-old male with previous open abdominal aortic aneurysm repair presented with asymptomatic large pseudoaneurysms at both ends of an open surgical tube graft. Endovascular aneurysm sealing (EVAS) in combination with the iliac limbs of a standard endovascular aneurysm repair (EVAR) successfully excluded both pseudoaneurysms from circulation. We describe the combination of elements of EVAS and EVAR and have termed this endovascular aneurysm repair and sealing (EVARS). EVARS has the advantage of harnessing the benefits of endobag sealing in aortic necks unsuitable for standard EVAR whilst providing the security of accurate stent placement within short common iliac arteries. In conclusion, EVAS may be combined with standard endovascular iliac limbs and is a possible treatment option for pseudoaneurysm following open aneurysm repair. PMID:26493819

  18. Computed tomography angiography of hybrid thoracic endovascular aortic repair of the aortic arch.

    Science.gov (United States)

    Akhtar, Nila J; Oderich, Gustavo S; Vrtiska, Terri J; Williamson, Eric E; Araoz, Philip A

    2013-05-01

    Endovascular repair of the aorta has traditionally been limited to the abdominal aorta and, more recently, the descending thoracic aorta. However, recently hybrid repairs (a combination of open surgical and endovascular repair) have made endovascular repair of the aortic arch possible. Hybrid repair of the aortic arch typically involves an open surgical debranching procedure that allows for revascularization of the aortic arch vessels and subsequent endovascular stent placement. These approaches avoid the deep hypothermic circulatory arrest required for full, open surgical repair of the aortic arch. In hybrid repairs, the stent landing zone determines which branch vessels will be covered and therefore need revascularization. This article will review the preprocedure assessment with computed tomography angiography, techniques for revascularization and postprocedure complications. PMID:23621141

  19. 无线血压传感器压力遥测腹主动脉瘤覆膜支架腔内修复后内漏的可行性%An invasive telemetric pressure sensor for detecting endoleaks after endovascular abdominal aortic aneurysm stent repair

    Institute of Scientific and Technical Information of China (English)

    翁海滨; 郭旭东; 王文兴

    2012-01-01

    BACKGROUND: To date, the method for detecting endoleaks after endovascular abdominal aortic aneurysm stent repair include spiral computed tomography (CT) scan, artery angiography, magnetic resonance imaging, or duplex ultrasound scanning. But all the results are judged by the image indirectly and cannot examine the endoleaks directly and efficiently. The shortages exist, such as miss diagnosis, complicate to operate, high cost and another disadvantages to patients.OBJECTIVE: To measure the pressure in cavity by using the implantable wireless invasive telemetric pressure sensor in order to diagnose the occurrence of endoleaks after endovascular abdominal aortic aneurysm stent repair METHODS: The implantable wireless pressure detection system consisted of an invasive telemetric pressure sensor, power transmitting coil, data recorder and data processing station. The implantable wireless invasive telemetric pressure sensor could detect the blood pressure in tumor cavity. The implantable wireless invasive telemetric pressure sensor was composed of the wireless energy receiving module, the power management module, the sensor module, the signal conditioning module, the microcontroller and the radio frequency communication module.RESULTS AND CONCLUSION: The prototype has been made and the in vitro blood test experiment has been carried out.Through the simulation test, the feasibility and effectiveness of the pressure telemetry for the wireless pressure sensors has been verified preliminary.%背景 腹主动脉瘤覆膜支架腔内修复后内漏的检查方法主要有螺旋CT、动脉造影、核磁共振、多普勒超声等,但都是通过影像间接判断的,无法实现对内漏的直接有效检查,存在漏诊、操作复杂、检查成本高、对患者有一定创伤等缺点.目的 采用植入式无线血压传感器长期监测腹主动脉瘤修复术后瘤腔内血压,用于诊断是否发生内漏.方法 用于腹主动脉瘤修复后内漏诊断的压力

  20. 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)

  1. Treatment of infrarenal abdominal aortic dissection concomitant with an aneurysm

    Institute of Scientific and Technical Information of China (English)

    WANG Li-xin; ZHU Ting; FU Wei-guo; WANG Yu-qi; XI Xun; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; YANG Ju; SHI Zhen-yu

    2007-01-01

    @@ Aortic dissection occurs when layers of the aortic walls are separated by the blood flow through an intimal tear. Dissection of the aorta most frequently originates in the ascending aorta (70%), followed by the descending aorta (22%), the aortic arch (7%) and the abdominal aorta (1/%).1 The dissection limited to the abdominal aorta is rare.2 An isolated abdominal aortic dissection (IAAD) concomitant with an abdominal aortic aneurysm (AAA) is uncommon. We present here one patient with IAAD and AAA treated by endovascular therapy.

  2. High dose rate endovascular brachytherapy in aorto-iliac lesion for the prevention of restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Yamazaki, Hideya [Toyonaka Municipal Hospital, Osaka (Japan); Tomoda, Kaname; Shiomi, Hiroya [Osaka Univ., Suita (Japan). Graduate School of Medicine] [and others

    2002-02-01

    This study examined the applicability of endovascular brachytherapy to larger del arteries such as the abdominal aorta and iliac artery. Endovascular brachytherapy using an Ir-192 HDR source was administered 11 times to nine patients who had undergone percutaneous transluminal angioplasty (PTA) between 1995 and 1999. The follow-up lasted 13 to 55 months after treatment (median, 24 months). Eight of the 11 lesions have been controlled so far. Although one case developed thrombus inside the stent five months later, recanalization was achieved by means of retreatment. One patient who underwent low-dose irradiation (6 Gy) without stent implantation showed restenosis five months after treatment. We used a centering catheter that did not block the blood stream for exact centering of the radiation source in larger vessels such as the abdominal aorta. Although endovascular brachytherapy is a promising and safe procedure, careful follow-up is needed to detect untoward reactions such as thrombosis. (author)

  3. Endovascular treatment of penetrating ulcers of the paraceliac aorta using fenestrated endografts.

    Science.gov (United States)

    Gargiulo, Mauro; Gallitto, Enrico; Freyrie, Antonio; Stella, Andrea

    2014-04-01

    Penetrating atherosclerotic ulcers (PAUs) are usually focal aortic lesions found in patients with significant comorbidities. They are ideal targets for an endovascular approach if localized in the descending thoracic or infrarenal aorta, but when an origin in the visceral vessels is involved, a standard endovascular approach might not be feasible or effective. We report 2 cases of endovascular treatment of PAUs involving the paraceliac abdominal aorta, using a custom-made tube fenestrated endograft with 4 fenestrations for the abdominal visceral vessels (i.e., celiac-trunk, superior mesenteric artery, and renal arteries). There were no intra- or perioperative complications. At 1 year of follow-up, patients were asymptomatic and computed tomography angiography revealed total lesion exclusion and patency of the visceral vessels. The use of a fenestrated endograft is a safe and effective option to treat paraceliac PAUs.

  4. Aortic dissection. Basic aspects and endovascular management

    International Nuclear Information System (INIS)

    Treatment of thoracic aortic pathology is complicated by the morbidity associated to the surgical procedure and to the frailty of an elderly and difficult population. Surgical operation in this kind of population frequently bears a significant incidence of death and long-term disability. In an effort to reduce the incidence of negative outcomes, minimally invasive techniques in the form of endovascular stenting have been introduced during the past decade. The technology, originally described by Parodi, and initially designed for its use in abdominal aortic aneurysms, has been adapted for the treatment of thoracic aortic aneurysms. Furthermore, an improved understanding of the pathophysiology and the natural history of thoracic aortic disease as well as the analysis of the outcomes have facilitated our treatment decisions in terms of the timing for an appropriate intervention. Treatment of thoracic aortic dissection using endovascular Stent is one of the more recent advances in this condition and is receiving increasing attention, as it is a less invasive alternative to an open surgical repair. Although this technology is still innovative, significant improvements have been made lately in the design and deployment of the endovascular Stent-grafts. These prostheses have been increasingly used to treat aneurysms, dissections and traumatic ruptures, as well as giant penetrating ulcers and intramural hematomas of the descending thoracic aorta with good early and mid-term outcomes. The rareness, complexity and severity of the pathology and the theoretically high risk of complications should render the surgeon extremely cautious especially with young patients. Conceptually, the endo luminal treatment in the acute phase seems to be the solution and will probably become a preferred therapy while technical refinement is under way. Worldwide experience is growing and with this a better understanding of the indications and limitations of this innovative therapy will be

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

    Directory of Open Access Journals (Sweden)

    Carolina Giordani Silva

    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 Sistemática, 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.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 Revisión 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

  6. Meta analysis of outcomes of open surgery versus endovascular aneurysm repair for ruptured abdominal aortic aneurysms%开放手术和腔内修复术治疗腹主动脉瘤破裂的 meta 分析(附2例报告)

    Institute of Scientific and Technical Information of China (English)

    戈小川; 刘建伟

    2013-01-01

      目的比较开放手术和腔内修复术(EVAR)治疗腹主动脉瘤破裂的效果和预后的差异。方法从2例行 EVAR 治疗腹主动脉瘤破裂的经验出发,检索 EVAR 和开放手术治疗该疾病的文献报道并作 meta 分析。结果一共纳入14篇文献,均是单中心研究,大部分都是观察报告,只有1篇是随机对照试验。EVAR 组术后30天死亡率为18%(95%CI:12%~23%),开放手术组为39%(95%CI:34%~44%),两组比较差异有统计学意义(P <0.01)。EVAR 组的平均住院天数及ICU 天数比开放手术组的时间明显缩短,两组比较差异有统计学意义(P <0.05)。EVAR 组平均术中出血量也小于开放手术组(746 ml vs 3435 ml,P <0.01);但在平均术中输液(血)量、手术时间和术后并发症上,两组比较差异无统计学意义(P <0.05)。结论EVAR 治疗腹主动脉瘤破裂和开放手术比较有更低的死亡率、更短的住院时间和更少的出血量,患者术后恢复较快,但术后并发症发生率无显著性差异,而长期生存率仍不明确。%Objective To compare the result of endovascular aneurysm repair(EVAR) and open surgery for ruptured abdominal aortic aneurysms. Method From the experience of 2 patients underwent EVAR treatment of abdominal aortic aneurysm in our hospital, we retrieved the reports on EVAR and surgical treatment of ruptured abdominal aortic aneurysms and made meta-analysis literature. Results Total 14 studies were included in this study. All studies were single-center study, including 13 observational reports and a randomized controlled trial (RCT) report. The 30-day mortality of EVAR group was 18% (95% CI: 12% ~ 23%), while surgery group was 39% (95% CI: 34% ~ 44%), the difference was statistically significant (P < 0.01 ). EVAR group was significantly shorter time than surgery group on the average days in hospital and in ICU (P < 0.05). The average blood loss in EVAR group was

  7. Dynamics of the aorta before and after endovascular aneurysm repair: a systematic review.

    NARCIS (Netherlands)

    Keulen, J.W. van; Prehn, J. van; Prokop, M.; Moll, F.L.; Herwaarden, J.A. van

    2009-01-01

    OBJECTIVE: An overview of the knowledge of thoracic (TAA), and abdominal aortic aneurysm (AAA) dynamics, before and after endovascular repair, is given. METHODS: Medline, EMBASE and the Cochrane database were searched for relevant articles. After inclusion and exclusion, 25 relevant articles reporti

  8. Dynamics of the Aorta Before and After Endovascular Aneurysm Repair : A Systematic Review

    NARCIS (Netherlands)

    van Keulen, J. W.; van Prehn, J.; Prokop, M.; Moll, F. L.; van Herwaarden, J. A.

    2009-01-01

    Objective: An overview of the knowledge of thoracic (TAA), and abdominal aortic aneurysm (AAA) dynamics, before and after endovascular repair, is given. Methods: Medline, EMBASE and the Cochrane database were searched for relevant articles. After inclusion and exclusion, 25 relevant articles reporti

  9. Suprarenal Fixation Resulting in Intestinal Ischemia after Endovascular Aortic Aneurysm Repair

    NARCIS (Netherlands)

    Pol, Robert A.; Keus, Frederick; Prins, Ted R.; Zeebregts, Clark J.

    2014-01-01

    Endovascular aneurysm repair (EVAR) may be associated with specific stent- and procedure-related complications. Hepatic artery anatomic variability may lead to dramatic consequences when unanticipated. A 64-year-old man presented with a 6-cm abdominal aortic aneurysm, suitable for an EVAR procedure.

  10. Dilatation of the proximal neck of infrarenal aortic aneurysms after endovascular AAA repair

    NARCIS (Netherlands)

    Wever, JJ; de Nie, AJ; Blankensteijn, JD; Broeders, IAMJ; Mail, WPTM; Eikelboom, BC

    2000-01-01

    Objectives: to assess size changes of the proximal aortic neck after endograft placement. Methods: since 1994, 54 consecutive patients have undergone abdominal aortic aneurysm (AAA) repair with the Endovascular Technologies (EVT) endograft. The study group comprised the 33 patients who had completed

  11. Endovascular Embolisation of Visceral Artery Pseudoaneurysms

    Directory of Open Access Journals (Sweden)

    Yasir Jamil Khattak

    2014-01-01

    Full Text Available Objective. To evaluate the technical success, safety, and outcome of endovascular embolization procedure in management of visceral artery pseudoaneurysms. Materials and Methods. 46 patients were treated for 53 visceral pseudoaneurysms at our institution. Preliminary diagnostic workup in all cases was performed by contrast enhanced abdominal CT scan and/or duplex ultrasound. In all patients, embolization was performed as per the standard departmental protocol. For data collection, medical records and radiology reports of all patients were retrospectively reviewed. Technical success, safety, and outcome of the procedure were analyzed. Results. Out of 46 patients, 13 were females and 33 were males. Mean patient age was 44.79±13.9 years and mean pseudoaneurysm size was 35±19.5 mm. Technical success rate for endovascular visceral pseudoaneurysm coiling was 93.47% (n=43. Complication rate was 6.52% (n=3. Followup was done for a mean duration of 21±1.6 months (0.5–69 months. Complete resolution of symptoms or improvement in clinical condition was seen in 36 patients (80% out of those 45 in whom procedure was technically successful. Conclusion. Results of embolization of visceral artery pseudoaneurysms with coils at our center showed high success rate and good short term outcome.

  12. Endovascular Embolisation of Visceral Artery Pseudoaneurysms

    International Nuclear Information System (INIS)

    Objective. To evaluate the technical success, safety, and outcome of endovascular embolization procedure in management of visceral artery pseudoaneurysms. Materials and Methods. 46 patients were treated for 53 visceral pseudoaneurysms at our institution. Preliminary diagnostic workup in all cases was performed by contrast enhanced abdominal CT scan and/or duplex ultrasound. In all patients, embolization was performed as per the standard departmental protocol. For data collection, medical records and radiology reports of all patients were retrospectively reviewed. Technical success, safety, and outcome of the procedure were analyzed. Results. Out of 46 patients, 13 were females and 33 were males. Mean patient age was 44.79 ± 13.9 years and mean pseudoaneurysm size was 35 ± 19.5 mm. Technical success rate for endovascular visceral pseudoaneurysm coiling was 93.47% (n = 43). Complication rate was 6.52% (n = 3). Followup was done for a mean duration of 21 ± 1.6 months (0.5–69 months). Complete resolution of symptoms or improvement in clinical condition was seen in 36 patients (80%) out of those 45 in whom procedure was technically successful. Conclusion. Results of embolization of visceral artery pseudoaneurysms with coils at our center showed high success rate and good short term outcome

  13. 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.

  14. Quantification of abdominal aortic deformation after EVAR

    Science.gov (United States)

    Demirci, Stefanie; Manstad-Hulaas, Frode; Navab, Nassir

    2009-02-01

    Quantification of abdominal aortic deformation is an important requirement for the evaluation of endovascular stenting procedures and the further refinement of stent graft design. During endovascular aortic repair (EVAR) treatment, the aortic shape is subject to severe deformation that is imposed by medical instruments such as guide wires, catheters, and, the stent graft. This deformation can affect the flow characteristics and morphology of the aorta which have been shown to be elicitors for stent graft failures and be reason for reappearance of aneurysms. We present a method for quantifying the deformation of an aneurysmatic aorta imposed by an inserted stent graft device. The outline of the procedure includes initial rigid alignment of the two abdominal scans, segmentation of abdominal vessel trees, and automatic reduction of their centerline structures to one specified region of interest around the aorta. This is accomplished by preprocessing and remodeling of the pre- and postoperative aortic shapes before performing a non-rigid registration. We further narrow the resulting displacement fields to only include local non-rigid deformation and therefore, eliminate all remaining global rigid transformations. Finally, deformations for specified locations can be calculated from the resulting displacement fields. In order to evaluate our method, experiments for the extraction of aortic deformation fields are conducted on 15 patient datasets from endovascular aortic repair (EVAR) treatment. A visual assessment of the registration results and evaluation of the usage of deformation quantification were performed by two vascular surgeons and one interventional radiologist who are all experts in EVAR procedures.

  15. 腹主动脉瘤腔内修复术植入物后综合征13例分析%ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR: ANALYSIS OF POST-IMPLANTATION SYNDROME IN 13 CASES

    Institute of Scientific and Technical Information of China (English)

    房涛; 王豪夫; 王曰伟; 李君; 赵宗刚; 戚森

    2012-01-01

    Objective To observe the changes of the temperature, white blood cell count, platelet count, and C-reactive protein in patients who underwent EVAR for abdominal aortic aneurysms ( AAA>. and analyse the factors of EVAR that associated with post-implantation syndrome (PIS). Methods EVAR was performed in 50 patients for AAA. The temperature and white blood cell count, platelet count and C reactive protein were detected in specimens taken from peripheral venous blood, before and on the first day after surgery. Results Of the 50 patients, PIS was recorded in 13 (26%) after EVAR. The differences of postoperative temperature, white blood cell count, platelet count, and C-reactive protein between PIS and non-PIS were significant (t= - 1. 905 - 6.828.P<0. 05). Conclusion PIS is a commonly seen post-EVAR complication, the main manifestation being systemic inflammatory reaction.%目的 观察腹主动脉瘤腔内修复术(EVAR)后病人体温、白细胞、血小板、C反应蛋白的变化,分析EVAR术后与植入物后综合征(PIS)相关的临床因素.方法 行EVAR腹主动脉瘤病人50例,术后第1天采集外周静脉血标本,观察病人体温、白细胞、血小板、C反应蛋白的变化.结果 50例病人中,术后13例(26%)发生PIS.术后PIS组病人体温、白细胞、血小板、C反应蛋白水平与非PIS组比较,差异有显著性(t=-1.905~6.828,P<0.05).结论 PIS为腹主动脉瘤病人EVAR术后一种较常见的并发症,其主要特点表现为系统性炎症反应.

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

    Science.gov (United States)

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

    2009-03-01

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

  17. [Thoracic Endovascular Aortic Repair Via Internal Iliac Artery Conduit].

    Science.gov (United States)

    Hayashi, Taro; Tobe, Satoshi; Sugiyama, Hironobu; Ijyuin, Shinichi; Yamaguchi, Masahiro; Yamaguchi, Masato; Oka, Takanori; Misato, Takuya; Tsunemi, Kotaro; Tanimura, Nobuhiro

    2016-09-01

    A 77-year-old man with a history of stent implantation in the right common iliac artery(CIA) and the left external iliac artery(EIA) was admitted to our hospital for a rapid growth of an aneurysm( max 53 mm) at Th11 level of the descending aorta. Although thoracic endovascular aortic repair (TEVAR) was required, there were many problems about access rout. The infrarenal abdominal aorta and the left EIA were severely calcified, and the lumens of the right CIA stent(5.3 mm) and the left EIA stent( 4.3 mm) were small in size. Besides, the left CIA was short(13 mm). Therefore, TEVAR was performed by retrograde approach from the left internal iliac artery( IIA) with a tube graft conduit in the hybrid operation room. IIA is a useful option for an access rout in endovascular aortic repair. PMID:27586313

  18. The use of fenestrated and branched endovascular aneurysm repair for juxtarenal and thoracoabdominal aneurysms: A systematic review and cost-effectiveness analysis

    NARCIS (Netherlands)

    N. Armstrong (Nigel); L.T. Burgers (Laura); S. Deshpande (Sohan); M.J. Al (Maiwenn); R. Riemsma; S.R. Vallabhaneni; P. Holt (Peter); J.L. Severens (Hans); J. Kleijnen (Jos)

    2015-01-01

    textabstractBackground: Patients with large abdominal aortic aneurysms (AAAs) are usually offered reparative treatment given the high mortality risk. There is uncertainty about how to treat juxtarenal AAAs (JRAAAs) or thoracoabdominal aortic aneurysms (TAAAs). Endovascular repair of an abdominal aor

  19. Anesthetic management in endovascular treatment of aortic pathologies

    Directory of Open Access Journals (Sweden)

    Abdulmenap Güzel

    2014-06-01

    Full Text Available Objective: In this study we aimed to compare the anesthesia methods we used in the endovascular treatment of thoracic and abdominal aorta pathologies and to discuss accompanied by literature. Methods: Our study was carried out be retrospectively assessing a total of 20 patients on whom we had administered endovascular treatment for aortic aneurism and aortic dissection. The demographic features of the patients, their American Anesthesia Association (ASA scores, laboratory findings, accompanying diseases, whether they smoke, their ejection fraction and the place and type of aortic pathology was recorded. Also the surgical procedure, anesthesia method, the amounts of crystalloids, colloids and blood products used during the surgery, the anesthesia and surgery durations, complications and interventions, duration of stays in intensive care and the hospital in general and the mortality rates were recorded. All cases were provided with standard anesthesia monitoring. Results: A total of 20 (M=15, F=5 cases were included in our study. 16 of our cases were in ASA 3 risk group and 4 were in ASA 4 risk group. While patients who had been administered with thoracic endovascular aortic repair (TEVAR were all given general anesthesia, seven patients who had been administered with abdominal endovascular aortic repair (EVAR were given regional and 6 were given general anesthesia and one case was only given sedoanalgesia. While 8 of the patients administered with EVAR had hypertension all of the patients administered with TEVAR had hypertension. No significant differences were found in blood and blood product transfusions, preoperative and postoperative hemoglobin, hematocrit, urea and creatinine values between two groups. Conclusion: In EVAR and TEVAR applications general anesthesia, regional anesthesia, sedoanalgesia accompanied by local anesthesia can be successfully administered depending on the patient’s status and the location of the procedure.

  20. The application of oral enteralnutrition support for senior abdominal aortic aneurysm patients who underwent endovascular aortic repair%口服肠内营养支持在局麻下高龄腹主动脉瘤腔内覆膜支架置入术后的应用

    Institute of Scientific and Technical Information of China (English)

    曾国军; 赵纪春; 马玉奎; 黄斌; 杨轶; 袁丁; 熊飞; 陈熹阳; 吴洲鹏

    2014-01-01

    Objective To investigate the clinical value of oral enteralnutrition support (ENSURE) for senior (> 60 years) abdominal aortic aneurysm (AAA) patients who underwent endovascular aortic repair (EVAR).Methods The data of 30 senior AAA patients who underwent EVAR was restrictively reviewed.The patients were divided into two groups:Group A =15,with postoperative ENSURE,50 g,tid; Group B =15,with postoperative common food.The postoperative data were compared between two groups,including the hospital stay,infection of operative incision rate,and nutritional state in the third and seventh day after operation.Results The postoperative hospital stay and infection rate had no significant difference between two groups.The plasma albumin in group A in the third day and the seventh day were higher (P < 0.05).Conclusions ENSURE improved the nutritional status of AAA patients who underwent EVAR,and shorten postoperative hospital stays.%目的 探讨口服肠内营养支持在局麻下高龄(>60岁)腹主动脉瘤(AAA)腔内覆膜支架置入术后的应用.方法 本院2010年1月至2011年10月经腔内覆膜支架置入术治疗的高龄腹主动脉瘤患者中选取30例,分为2组,每组15例,A组术后8h给予口服肠内营养支持(安素,50 g,3次/d),B组术后8h普食.对比术后切口感染率、血浆白蛋白、术后住院时间.结果 A组患者术后第3、7天白蛋白水平高于B组(P<0.05),两组感染率及术后住院时间比较差异无统计学意义(P>0.05).结论 口服肠内营养支持可促进局麻下经腔内覆膜支架置入术治疗的高龄腹主动脉瘤患者术后恢复,提高营养状态,有利于患者恢复.

  1. 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

  2. Low mortality and morbidity after endovascular repair of ruptured aortic aneurism

    DEFF Research Database (Denmark)

    Duvnjak, Stevo; Balezantis, Tomas; Lindholt, Jes Sanddal

    2015-01-01

    INTRODUCTION: The objective of this study was to describe the implementation and to evaluate the short-term outcome of the first Danish experience with endovascular repair of ruptured abdominal aortic aneurysm (RAAA). METHODS: This was a historical prospective cohort study including all patients ......-operative mortality and morbidity of RAAA can probably be reduced by implementation of RAAA....... shortly after the procedure. In the group with open repair, seven patients (30.7%) died within 30 days. This yields a mortality of all patients treated for rupture at our institution of 19% compared with 32% in Denmark at large. CONCLUSION: Endovascular treatment of RAAA is feasible, and the overall post...

  3. Endovascular Treatment for Proximal Anastomotic Pseudoaneurysm after Total Arch Replacement in Behcet's Disease.

    Science.gov (United States)

    Sakata, Tomoki; Ueda, Hideki; Watanabe, Michiko; Kohno, Hiroki; Tamura, Yusaku; Abe, Shinichiro; Inage, Yuichi; Ikeuchi, Hiroki; Kanda, Tomoyoshi; Fujii, Masahiko; Matsumiya, Goro

    2016-07-01

    A 17-year-old patient underwent total arch replacement for aortic arch aneurysm due to vascular Behcet's disease (BD). Follow-up computed tomography, performed 6 months after the operation, demonstrated pseudoaneurysm formation at the proximal anastomotic site. We performed endovascular treatment and used a short stent graft that was originally designed for abdominal aortic aneurysm. To avoid the occlusion of the coronary or brachiocephalic artery (BCA) due to stent graft migration, we used right ventricular rapid pacing and BCA ballooning. Thus, we believe that endovascular treatment can be used for anastomotic complications in the ascending aorta after open surgery for connective tissue disorders including BD. PMID:27174345

  4. De novo periaortic fibrosis after endovascular aortic repair.

    Science.gov (United States)

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

    2014-02-01

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

  5. Premilinary Observation of Sarpogrelate Hydrochloride on Prevention and Treatment for Gluteal and Limb Ischemia Following Endovascular Repair of Abdominal Aortic Aneurysm%盐酸沙格雷酯在腹主动脉瘤腔内修复术后防治臀肌和下肢缺血的初步观察

    Institute of Scientific and Technical Information of China (English)

    黄斌; 赵纪春; 马玉奎; 卢武胜; 杨轶; 袁丁

    2012-01-01

    Objective To observe the effects of sarpogrelate hydrochloride in prevention and treatment for ischemia of gluteal and limb following endovascular repair of abdominal aortic aneurysm (EVAR) . Methods Clinical data were analyzed in 174 patients with abdominal aortic aneurysm (AAA) who underwent EVAR from January 2006 to January 2011. The patients' mean age was (71. 8 + 8. 2) years old (male: 148 cases, female: 26 cases) . The diameter of abdominal aortic aneurysm was (55. 2+12. 9) mm. AAA involving common iliac artery was in 52 (29.9%) patients. Bifurcated endografts and aorto-uni-iliac (AUI) endografts with crossover bypass were used in 169 patients (97. 1%) and 5 patients (2. 9%) , respectively. Sarpogrelate hydrochloride were used in 39 patients with gluteal and limb ischemia due to exclusion of bilateral and unilateral internal iliac arteries among 174 patients. Sarpogrelate hydrochloride, 100 mg, three times daily, was taken for 2-4 weeks. Symptoms of gluteal and limb ischemia were followed-up. Results All of patients with AAA was repaired by EVAR successfully and no conversion to open repair. General anesthesia (50. 6% (88/174)], epidural anesthesia (30. 0% (52/174)], and local anesthesia (19. 5% (34/174)] were used. Blood loss was (125. 2+43. 1) ml and no blood transfusion during operation. Operative time was (145. 5 + 38. 7) min, ICU stay time was (14. 7+5. 2) h, and postoperative fasting time was (7. 2+4. 3) h. The duration of postoperative hos-pital stay was (9. 1 ±2. 7) d. The perioperative complication rate was 12. 6% (22/174) . The 30-day mortality rate was 1. 1% (2/174) . Gluteal and limb claudication occurred in 2 paients and 5 patients respectively among 29 patients with EVAR due to exclusion of unilateral internal iliac artery, intermittent claudication distance was 100-200 meters. Gluteal muscle pain and limb claudication for less than 200 meters occurred in 4 patients due to exclusion of bilateral internal iliac artery. The symptoms were relieved

  6. Abdominal sounds

    Science.gov (United States)

    ... during sleep. They also occur normally for a short time after the use of certain medicines and after abdominal surgery. Decreased or absent bowel sounds often indicate constipation. Increased ( hyperactive ) bowel sounds ...

  7. Clinical Value of Dual-source CT Angiography in Diagnosis and Following -up Postoperative Endovascular Stent-graft Exclusion of Abdominal Aortic Aneurysm%DSCTA检查在腹主动脉瘤诊断及EVE术后随访中的临床价值

    Institute of Scientific and Technical Information of China (English)

    印隆林; 潘艳霞; 陈加源; 谢欢; 陈晓煜; 李迎春

    2015-01-01

    Objective To investigate the value of dual-source CT angiography ( DSCTA ) in diagnosis and following-up postoperative endovascular stent-graft exclusion(EVE)of abdominal aortic aneurysm(AAA). Methods Eighty-six patients were diagnosed as AAA by dual-source CT angiography. Of these patients,16 patients with aneurysm body under renal artery underwent EVE were following-up observed by DSCTA. Imaging reconstruction that include multi-plane reconstruction( MPR) , maximum in-tensity projection(MIP)and volume rendering technique(VRT), and analysis were finished at workstation. Type, location, size and extension of AAA were focused. Besides, based on correlative measured parameters that satisfied requirement of EVE, AAA located under level of renal artery was classified. The outcomes and complications of 16 patients with AAA underwent EVE were focused. Results ①Eighty-six cases included 4 with aneurysm body located upper level of renal artery and 82 with aneurysm body located under level of renal artery. ②Based on requirement of EVE, 82 cases with aneurysms body located under level of re-nal artery were classified as 9 typeⅠ, 6 typeⅡA, 12 typeⅡB, 42 typeⅡC and 13 typeⅢ.③DSCTA images clearly displayed shape, locality and size of aneurysm, and anatomic relation between aneurysm body and adjacent main branches of aorta, and mu-ral thrombus in all patients. Furthermore, relative data of AAA could also be accurately measured on CTA images. ④The size of aneurysm body reduced to varying degrees or stabilized in all 16 cases underwent EVE, outer area of aneurysm body covered by stent-graft were almost filled with thrombus,and inner surface of stent-graft didn’t observed thrombus in every patient. Shape of stent-graft was normal in 12 cases and slightly abnormal in 4 cases. Stent endoleaking weren’t observed in 16 cases. Conclusion DSCTA examination with handy, effective and non-invasived advantages, is one of important imaging methods in diagnosis and mo

  8. Anesthesia Approach in Endovascular Aortic Reconstruction

    Directory of Open Access Journals (Sweden)

    Ayşin 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.

  9. Hygroma following endovascular femoral aneurysm exclusion

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  10. Tratamento endovascular de aneurisma de ilíaca roto: relato de caso Endovascular treatment of a ruptured iliac aneurysm: case report

    Directory of Open Access Journals (Sweden)

    Adinaldo Adhemar Menezes da Silva

    2007-03-01

    Full Text Available A taxa de mortalidade cirúrgica do aneurisma de ilíaca roto é similar à do aneurisma de aorta abdominal roto, devido à sua localização profunda na pelve, dificuldade de exposição distal da ilíaca decorrente do hematoma, bridas devido a laparotomia prévia e proximidade com ureter e estruturas venosas. O objetivo do presente estudo é enfatizar o procedimento endovascular como mais uma opção na correção dessas lesões. Relata-se o caso de um paciente de 60 anos de idade, submetido a derivação com enxerto aorto-biilíaco prévio com prótese há 5 anos, por aneurisma de aorta abdominal infra-renal, apresentando rotura de aneurisma em segmento remanescente da ilíaca comum esquerda. Estava hemodinamicamente estável após ressuscitação com fluidos e foi submetido ao tratamento endovascular de urgência, com a exclusão do aneurisma e ausência de vazamentos.The surgical mortality rate of ruptured iliac aneurysms is similar to ruptured abdominal aortic aneurysms in terms of their location deep in the pelvis, difficult access to the distal iliac artery due to hematoma, adherences due to prior laparotomy and proximity of the ureter and venous structures. This study aims at highlighting the endovascular procedure as an alternative in the correction of this lesion. We report the case of a patient submitted to aortobiiliac prosthetic graft due to infrarenal abdominal aortic aneurysm 5 years ago, who presented with a ruptured aneurysm in the remaining segment of the left common iliac artery. The patient was hemodynamically stable after fluid replacement therapy and was submitted to urgent endovascular treatment. The treatment resulted in the exclusion of the aneurysm without endoleaks.

  11. Novel endovascular procedures and new developments in aortic surgery.

    Science.gov (United States)

    Cheng, S W K

    2016-09-01

    Endovascular repair has evolved to become a viable mainstream treatment for aortic pathology in both acute and elective settings. As technology advanced, traditional anatomical barriers were progressively tackled using new devices and novel procedures, and there are now multiple options available to the vascular surgeon. In the abdominal aorta, advances in endovascular aneurysm repair have been in the treatment of hostile aortic necks using new sealing concepts and ancillary procedures, and in branch preservation using fenestrations and snorkels. Access challenges have been met with a percutaneous approach and low-profile devices, and standard protocols have improved mortality for ruptured aneurysms. In the thoracic aorta, more invasive hybrid procedures have given way gradually to branched endografts. Particular challenges to the anaesthetist include blood pressure control and the prevention of stroke and paraplegia. Current focus in the thoracic aorta is in treating aortic arch pathology and in optimal management of acute and chronic dissections. This review describes the latest trends in the endovascular treatment of aortic diseases and examines the current evidence for different modalities of management. PMID:27566806

  12. Endovascular Aortic Aneurysm and Dissection Repair (EVAR) in Iran: Descriptive Midterm Follow-up Results

    Science.gov (United States)

    Haji Zeinali, Ali Mohammad; Marzban, Mehrab; Zafarghandi, Mohammadreza; Shirzad, Mahmood; Shirani, Shapour; Mahmoodian, Roshanak; Sheikhvatan, Mehrdad; Lotfi-Tokaldany, Masoumeh

    2016-01-01

    Background: Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain. Objectives: The current study describes for the first time our initial four-year experience of elective endovascular aortic repair (EVAR) at Tehran heart center, the first and a major referral heart center in Iran, as a pioneer of EVAR in Iran. Patients and Methods: A total of 51 patients (46 men) who had the diagnosis of either an abdominal aortic aneurysm (AAA) (n = 36), thoracic aortic aneurysm (TAA) (n = 7), or thoracic aortic dissection (TAD) (n = 8) who had undergone EVAR by Medtronic stent grafts by our team between December 2006 and June 2009 were reviewed. Results: The rate of in-hospital aneurysm-related deaths in the group with AAA stood at 2.8% (one case), while there was no in-hospital mortality in the other groups. All patients were followed up for 13-18 months. The cumulative death rate in follow-up was nine cases from the total 51 cases (18%), out of which six cases were in the AAA group (four patients due to non-cardiac causes and two patients due to aneurysm-related causes), one case in the TAA group (following a severe hemoptysis), and two cases in the TAD group (following an expansion of dissection from re-entrance). The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD. Conclusion: The endovascular stent-graft repair of the abdominal and thoracic aortic aneurysm and aortic dissection had high technical success rates in tandem with low-rate early mortality and morbidity, short hospital stay, and acceptable mid-term free symptom survival among Iranian patients. PMID:27110330

  13. Endovascular Aortic Aneurysm and Dissection Repair (EVAR in Iran: Descriptive Midterm Follow-up Results

    Directory of Open Access Journals (Sweden)

    Haji Zeinali

    2016-01-01

    Full Text Available Background Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain. Objectives The current study describes for the first time our initial four-year experience of elective endovascular aortic repair (EVAR at Tehran heart center, the first and a major referral heart center in Iran, as a pioneer of EVAR in Iran. Patients and Methods A total of 51 patients (46 men who had the diagnosis of either an abdominal aortic aneurysm (AAA (n = 36, thoracic aortic aneurysm (TAA (n = 7, or thoracic aortic dissection (TAD (n = 8 who had undergone EVAR by Medtronic stent grafts by our team between December 2006 and June 2009 were reviewed. Results The rate of in-hospital aneurysm-related deaths in the group with AAA stood at 2.8% (one case, while there was no in-hospital mortality in the other groups. All patients were followed up for 13-18 months. The cumulative death rate in follow-up was nine cases from the total 51 cases (18%, out of which six cases were in the AAA group (four patients due to non-cardiac causes and two patients due to aneurysm-related causes, one case in the TAA group (following a severe hemoptysis, and two cases in the TAD group (following an expansion of dissection from re-entrance. The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD. Conclusion The endovascular stent-graft repair of the abdominal and thoracic aortic aneurysm and aortic dissection had high technical success rates in tandem with low-rate early mortality and morbidity, short hospital stay, and acceptable mid-term free symptom survival among Iranian patients.

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

    Directory of Open Access Journals (Sweden)

    Sinan Demirtaş

    2014-09-01

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

  15. Abdominal Sepsis.

    Science.gov (United States)

    De Waele, Jan J

    2016-08-01

    Abdominal infections are an important challenge for the intensive care physician. In an era of increasing antimicrobial resistance, selecting the appropriate regimen is important and, with new drugs coming to the market, correct use is important more than ever before and abdominal infections are an excellent target for antimicrobial stewardship programs. Biomarkers may be helpful, but their exact role in managing abdominal infections remains incompletely understood. Source control also remains an ongoing conundrum, and evidence is increasing that its importance supersedes the impact of antibiotic therapy. New strategies such as open abdomen management may offer added benefit in severely ill patients, but more data are needed to identify its exact role. The role of fungi and the need for antifungal coverage, on the other hand, have been investigated extensively in recent years, but at this point, it remains unclear who requires empirical as well as directed therapy. PMID:27363829

  16. Endovascular Electrodes for Electrical Stimulation of Blood Vessels for Vasoconstriction - a Finite Element Simulation Study.

    Science.gov (United States)

    Kezurer, Noa; Farah, Nairouz; Mandel, Yossi

    2016-01-01

    Hemorrhagic shock accounts for 30-40 percent of trauma mortality, as bleeding may sometimes be hard to control. Application of short electrical pulses on blood vessels was recently shown to elicit robust vasoconstriction and reduction of blood loss following vascular injury. In this study we present a novel approach for vasoconstriction based on endovascular application of electrical pulses for situations where access to the vessel is limited. In addition to ease of access, we hypothesize that this novel approach will result in a localized and efficient vasoconstriction. Using computer modeling (COMSOL Multiphysics, Electric Currents Module), we studied the effect of endovascular pulsed electrical treatment on abdominal aorta of pigs, and compared the efficiency of different electrodes configurations on the electric field amplitude, homogeneity and locality when applied on a blood vessel wall. Results reveal that the optimal configuration is the endovascular approach where four electrodes are used, spaced 13 mm apart. Furthermore, computer based temperature investigations (bio-heat model, COMSOL Multiphysics) show that the maximum expected temperature rise is of 1.2 degrees; highlighting the safety of the four endovascular electrodes configuration. These results can aid in planning the application of endovascular pulsed electrical treatment as an efficient and safe vasoconstriction approach. PMID:27534438

  17. Endovascular Electrodes for Electrical Stimulation of Blood Vessels for Vasoconstriction – a Finite Element Simulation Study

    Science.gov (United States)

    Kezurer, Noa; Farah, Nairouz; Mandel, Yossi

    2016-01-01

    Hemorrhagic shock accounts for 30–40 percent of trauma mortality, as bleeding may sometimes be hard to control. Application of short electrical pulses on blood vessels was recently shown to elicit robust vasoconstriction and reduction of blood loss following vascular injury. In this study we present a novel approach for vasoconstriction based on endovascular application of electrical pulses for situations where access to the vessel is limited. In addition to ease of access, we hypothesize that this novel approach will result in a localized and efficient vasoconstriction. Using computer modeling (COMSOL Multiphysics, Electric Currents Module), we studied the effect of endovascular pulsed electrical treatment on abdominal aorta of pigs, and compared the efficiency of different electrodes configurations on the electric field amplitude, homogeneity and locality when applied on a blood vessel wall. Results reveal that the optimal configuration is the endovascular approach where four electrodes are used, spaced 13 mm apart. Furthermore, computer based temperature investigations (bio-heat model, COMSOL Multiphysics) show that the maximum expected temperature rise is of 1.2 degrees; highlighting the safety of the four endovascular electrodes configuration. These results can aid in planning the application of endovascular pulsed electrical treatment as an efficient and safe vasoconstriction approach. PMID:27534438

  18. Endovascular Electrodes for Electrical Stimulation of Blood Vessels for Vasoconstriction - a Finite Element Simulation Study.

    Science.gov (United States)

    Kezurer, Noa; Farah, Nairouz; Mandel, Yossi

    2016-08-18

    Hemorrhagic shock accounts for 30-40 percent of trauma mortality, as bleeding may sometimes be hard to control. Application of short electrical pulses on blood vessels was recently shown to elicit robust vasoconstriction and reduction of blood loss following vascular injury. In this study we present a novel approach for vasoconstriction based on endovascular application of electrical pulses for situations where access to the vessel is limited. In addition to ease of access, we hypothesize that this novel approach will result in a localized and efficient vasoconstriction. Using computer modeling (COMSOL Multiphysics, Electric Currents Module), we studied the effect of endovascular pulsed electrical treatment on abdominal aorta of pigs, and compared the efficiency of different electrodes configurations on the electric field amplitude, homogeneity and locality when applied on a blood vessel wall. Results reveal that the optimal configuration is the endovascular approach where four electrodes are used, spaced 13 mm apart. Furthermore, computer based temperature investigations (bio-heat model, COMSOL Multiphysics) show that the maximum expected temperature rise is of 1.2 degrees; highlighting the safety of the four endovascular electrodes configuration. These results can aid in planning the application of endovascular pulsed electrical treatment as an efficient and safe vasoconstriction approach.

  19. Endovascular repair of aortoiliac aneurysm with a hybrid technique to preserve pelvic perfusion

    Institute of Scientific and Technical Information of China (English)

    WU Wei-wei; JIANG Xue-ying; LIU Bao; CHEN Yu; LIU Chang-wei

    2011-01-01

    Endovascular aneurysm repair (EVAR) has been proven to be an effective and safe technique for abdominal or iliac artery aneurysm.However,for aneurysms extending to both iliac bifurcations,routine EVAR will occlude both internal iliac arteries (IIAs),which may increase the risk for pelvic ischemia.New endovascular techniques have been developed to preserve the pelvic perfusion in EVAR for such situation.This article reports an endovascular repair of an aortoiliac aneurysm with an external iliac artery (EIA) to the IIA endograft to preserve the pelvic perfusion.First,an endograft was advanced into the left IIA under the help of an inflated aortic balloon.Coils were deployed to embolize the distal type-1 endoleak from the tunnel around the endograft,and an aortouniiliac endograft and an iliac extension were deployed below the renal arteries extending to the right EIA.Finally,a right-to-left femoro-femoral artery bypass was constructed.Angiography at completion and computed tomography after 6 months demonstrated patency of all grafts and complete exclusion of the aneurysm without any endoleak.Endovascular repair with an EIA-to-IIA endograft to preserve the pelvic inflow is a feasible and effective technique for aortoiliac aneurysms.Coil embolization might be an option to repair the distal type of endoleak.The balloon assisted U-turn technique may help advance the endovascular device over a sharp-angled vessel bifurcation.

  20. Strategies for managing difficulties in withdrawal of delivery system during endovascular aneurysm repair of abdominal aortic aneurysm%腹主动脉瘤腔内修复术中输送器回撤困难的处理对策

    Institute of Scientific and Technical Information of China (English)

    温兴铸; 柏骏; 曲乐丰

    2016-01-01

    目的:探讨腹主动脉瘤(AAA)腔内修复术(EVAR)中输送器回撤困难的原因处理对策。方法:回顾性分析2008年1月—2016年4月305例行EVAR的AAA患者临床资料,分析术中输送器回撤困难发生的原因及相应对策。结果:305例患者中,共21例(6.89%)出现输送器回撤困难,其中复杂AAA18例,非复杂AAA3例;分体式支架修复17例,一体化支架修复4例,差异均有统计学意义(85.7%vs.14.3%;81.0%vs.19.0%,均P<0.05)。18例出现回撤困难复杂AAA患者均存在瘤颈严重扭曲,其中7例存在2个以上连续扭曲瘤颈,2例扭曲同时伴有短瘤颈;在所有存在扭曲瘤颈的患者中,有2个以上连续扭曲瘤颈患者回撤困难的发生率最高(P<0.05)。21例回撤困难情况通过综合运用相关处理对策均成功解决。结论:复杂AAA的EVAR发生输送器回撤困难情况并不少见,尤其是存在2个以上连续扭曲瘤颈的更易发生,通过综合运用相应对策可有效处理。%Objective:To investigate the causes for difficulties in withdrawal of delivery system during endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) and solutions. Methods:The clinical data of 305 AAA patients undergoing EVAR from January 2008 to April 2016 were retrospectively analyzed. The causes for occurrence of the difficulties during delivery system withdrawal and corresponding solving strategies were analyzed. Results:Among the 305 patients, difficulties of delivery system withdrawal occurred in 21cases (6.89%), of whom, 18 cases were complex AAA and 3 cases were non-complex AAA;17 cases were repaired with bifurcated stent grafts and 4 cases with unibody bifurcated stent grafts, and both differences had statisticalsignificance (85.7%vs. 14.3%;81.0%vs. 19.0%, both P<0.05). All the 18 patients with complex AAA who encountered difficulties of delivery system withdrawal had severe aneurysmal neck angulation, of whom

  1. Abdominal Pain

    Science.gov (United States)

    ... relaxation. Guided imagery for abdominal pain About self-hypnosis and kids See YourChild : Pain and Your Child or Teen for more detail ... how to help your baby cope with the pain of medical procedures, circumcision, and teething. ... Helping Kids YourChild : A Look at Biofeedback YourChild : ...

  2. Endovascular Treatment of an Aneurysmal Aberrant Systemic Artery Supplying a Pulmonary Sequestrum

    Energy Technology Data Exchange (ETDEWEB)

    Kristensen, Katrine Lawaetz, E-mail: klk@dadlnet.dk [Odense University Hospital, Department of Thoracic and Vascular Surgery (Denmark); Duus, Louise Aarup, E-mail: louise.brodersen@gmail.com [Sygehus Lillebaelt Vejle, Department of Radiology (Denmark); Elle, Bo, E-mail: Bo.Elle@rsyd.dk [Odense University Hospital, Department of Radiology (Denmark)

    2015-10-15

    An aberrant systemic artery originating from the abdominal aorta supplying a pulmonary sequestration is a rare congenital malformation. This causes a left-to-left shunt. Symptoms include recurrent pneumonias, hemoptysis, and, in the long term, heart failure. Aneurysm of the aberrant vessel is rarely seen. Traditionally, treatment of pulmonary sequestrations includes ligation of the feeding vessel and lobectomy. A new promising treatment is an endovascular approach. Only a few cases describe endovascular treatment of pulmonary sequestration. This is the first published case of a giant aneurysmal branch from the abdominal aorta to the normal basal segments of the lung, successfully occluded with an Amplatzer Vascular Plug II (AVP II, St.Jude Medical, MN, USA) alone.

  3. Endovascular Treatment of an Aneurysmal Aberrant Systemic Artery Supplying a Pulmonary Sequestrum

    International Nuclear Information System (INIS)

    An aberrant systemic artery originating from the abdominal aorta supplying a pulmonary sequestration is a rare congenital malformation. This causes a left-to-left shunt. Symptoms include recurrent pneumonias, hemoptysis, and, in the long term, heart failure. Aneurysm of the aberrant vessel is rarely seen. Traditionally, treatment of pulmonary sequestrations includes ligation of the feeding vessel and lobectomy. A new promising treatment is an endovascular approach. Only a few cases describe endovascular treatment of pulmonary sequestration. This is the first published case of a giant aneurysmal branch from the abdominal aorta to the normal basal segments of the lung, successfully occluded with an Amplatzer Vascular Plug II (AVP II, St.Jude Medical, MN, USA) alone

  4. Endovascular management of the patent inferior mesenteric artery in two cases of uncontrolled type II endoleak after endovascular aneurysm repair

    Directory of Open Access Journals (Sweden)

    Iswanto Sucandy

    2011-01-01

    Full Text Available Context : Endovascular aneurysm repair (EVAR has well documented advantages over traditional open repair and has been widely adopted as the alternative treatment modality for abdominal aortic aneurysm. However, endoleaks specifically type II can be a significant problem with this technique leading to aortic sac expansion and potential rupture. A large number of type II endoleaks are caused by persistent inferior mesenteric artery (IMA retrograde bleeding. Various methods to try to manage this complication have been previously described. IMA embolization via the marginal artery of Drummond, however, has not been adequately popularized as an alternative less invasive approach to the treatment of type II endoleak. Case Report : Two men, ages 77 and 81, underwent uneventful EVAR for 5.5 and 5.0 cm infrarenal abdominal aortic aneurysms, respectively, using Zenith Cook; bifurcated stent grafts. Computed tomography angiography at 1 and 6 months postoperatively demonstrated small type II endoleaks in both cases which were followed clinically. Subsequent follow-up tomography scan at 12 months revealed persistent type II endoleaks related to retrograde filling from the IMA with significant enlargement of the aneurysm sacs. Both patients underwent successful IMA coil embolization via the marginal artery of Drummond. Conclusions : Percutaneous IMA embolization using standard endovascular techniques to access the marginal artery of Drummond is an alternative, and in our opinion, preferred technique for controlling type II endoleaks caused by a persistently patent IMA.

  5. [Endovascular treatment of spinal dorsal intradural arteriovenous fistulas].

    Science.gov (United States)

    Santos-Franco, Jorge Arturo; Collado-Arce, María Griselda Lizbeth; Dávila-Romero, Julio César; Saavedra-Andrade, Rafael; Sandoval-Balanzario, Miguel Antonio

    2015-01-01

    Introducción: las fístulas arteriovenosas intradurales dorsales espinales (FAVIDE) son lesiones poco frecuentes y complejas que son subdiagnósticadas y condicionan discapacidad. El objetivo es presentar nuestra experiencia en el manejo endovascular. Métodos: estudio ambispectivo de pacientes con FAVIDE, tratados mediante terapia endovascular (TEV) con n-butil-cianoacrilato en el periodo de 2007 a 2013. Resultados: se incluyeron 15 pacientes con edad media de 37 años. En 12 casos la presentación fue progresiva e insidiosa en un lapso de entre 6 meses y un año, mientras que 3 presentaron hemorragia. La lesión tuvo localización torácica en 73 % de los casos, lumbar en 20 % y cervical en 7 %. Previo al tratamiento observamos discapacidad de grados 5 y 4 en 73 %, y 67 % tenían alteraciones de la micción de grado 3. Como complicaciones, solo una paciente tuvo deterioro del estado de alerta transitorio 6 horas después del procedimiento. Se encontró una mejoría hacia los grados 1 y 2 de discapacidad, a las 48 horas, 3 y 6 meses, de 53 %, 73 % y 87 %, respectivamente. Conclusiones: con la TEV se tiene un tiempo quirúrgico corto, el volumen de hemorragia es bajo y la estancia hospitalaria es corta, respecto de otras técnicas quirúrgicas. La TEV es un procedimiento seguro y con efectividad significativa en el tratamiento de FAVIDE. Esta es la primera serie de casos tratados con TEV en México.

  6. How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair

    OpenAIRE

    Setacci, Carlo; Chisci, Emiliano; Setacci, Francesco; Ercolini, Leonardo; de Donato, Gianmarco; Troisi, Nicola; Galzerano, Giuseppe; Michelagnoli, Stefano

    2014-01-01

    The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a...

  7. Endovascular Management of Splenic Arteriovenous Fistula with Giant Venous Aneurysmal Dilatation

    OpenAIRE

    Hamed Ibrahim, Wael; M Bassurrah, Hana

    2012-01-01

    Although splenic artery aneurysm is the commonest visceral and third most common intra abdominal aneurysm after aorta and iliac artery, aneurysm of splenic artery along with aneurysm of splenic vein and arteriovenous fistula is a rare entity. Most of them are 10 cm have been reported. We report a case of 11 cm × 8 cm giant splenic vein aneurysm with splenic arteriovenous fistula as the 1st case of giant splenic venous aneurysm with arteriovenous fistula managed by endovascular treatment.

  8. Dynamics of Endovascular Eneurysm Repair

    NARCIS (Netherlands)

    Herwaarden, J.A. van

    2006-01-01

    Endovascular aneurysm repair (EVAR) was in 1996 started at the St. Antonius Hospital, Nieuwegein, The Netherlands, with use of the AneuRx stent-graft system (Medtronic AVE, Santa Rosa, CA, USA). All data were captured prospectively in a vascular database. In Chapter 2 a general overview of recent li

  9. 腔内修复术与开放手术治疗破裂性腹主动脉瘤的围手术期结果比较%Comparative study of perioperative outcome between endovascular repair and open surgical repair for ruptured abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    吴忠隐; 熊江; 贾森皓; 段琛; 李悦; 卫任; 陈峰; 刘杰; 刘小平

    2015-01-01

    目的 比较破裂性腹主动脉瘤行腔内修复术(EVAR)与开放手术围手术期的疗效.方法 回顾性分析2006年1月至2013年1月解放军总医院血管外科符合纳入和排除标准接受手术治疗的66例破裂性腹主动脉瘤患者的临床资料,根据手术方式分为EVAR组(40例)和开放手术组(26例).EVAR组男性30例,女性10例;年龄47 ~ 78岁,平均年龄(71±7)岁.开放手术组男性21例,女性5例;年龄45 ~ 87岁,平均年龄(72±9)岁.采用x2检验和t检验比较2组患者围手术期手术时间、术中输血量、ICU时间、病死率、不良事件发生率及二次干预率的差异.结果 EVAR组手术时间、术中输注悬浮红细胞数量、ICU时间、病死率及不良事件发生率均低于开放手术组,组间差异均有统计学意义[(182 ±44) min比(384±108) min,t=-10.59,P=0.00;(0.4±0.8)单位比(1.1±1.8)单位,t=-2.19,P=0.03;(3.0±1.8)d比(8.5±5.1)d,t=-6.34,P=0.00;20.0% (8/40)比46.2% (12/26),x2 =5.10,P =0.02;25.0% (10/40)比53.8% (14/26),x2=5.67,P =0.02].2组术中输注冰冻血浆数量、二次干预率差异无统计学意义(分别为t=-1.98,P=0.05;x2=0.49,P=0.48).结论 EVAR较开放手术可降低破裂性腹主动脉瘤围手术期病死率和不良事件发生率,但中远期疗效尚需进一步研究.%Objective To compare the perioperative outcome between the endovascular repair (EVAR) and open surgical repair (OSR) for ruptured abdominal aortic aneurysm.Methods From January 2006 to January 2013,totally 66 patients with ruptured abdominal aortic aneurysm (rAAA) treated by surgery were retrospectively analyzed in Department of vascular surgery,People's Liberation Army General Hospital.According to the repair method,all the subjects were divided into EVAR group and OSR group.EVAR group included 40 patients,30 patients were male,10 patients were female,aged from 47 to 78 with a mean of (71 ±7) years.OSR group included 26 patients,21 patients were male,aged from 45 to

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

    Science.gov (United States)

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

    2016-01-01

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

  11. Doxycycline inhibition of proteases and inflammation in abdominal aortic aneurysms

    OpenAIRE

    Khawaja, Hazem Al-

    2011-01-01

    The aim of this thesis is to evaluate the effect of doxycycline on the proteolytic and inflammatory processes in abdominal aneurysms. This data is essential for the development of pharmaceutical strategies for the stabilization of an AAA. Such an approach could reduce the need for elective surgery and endovascular repair. It has repeatedly been shown that AAA progression and rupture is related to the failure of collagen in the aortic wall. Yet the exact mechanism underlying this failure remai...

  12. Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management

    OpenAIRE

    Mark eScaife; Triantafillos eGiannakopoulos; Georges eAlkhoury; Chaer, Rabih A.; Avgerinos, Efthymios D.

    2016-01-01

    Ultrasound (US) is a well-established screening tool for detection of abdominal aortic aneurysms (AAA) and is currently recommended not only for those with a relevant family history but for all men and high-risk women older than 65 years of age. The advent of minimally invasive endovascular techniques in the treatment of AAAs (EVAR) has increased the need for repeat imaging especially in the post-operative period. Nevertheless, preoperative planning, intraoperative execution and postoperative...

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

    OpenAIRE

    Balakrishnan Soundaravalli; Palaniappan, M.; Rajani Sundar; Chandrasekar, P.

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Balakrishnan Soundaravalli

    2012-01-01

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

  15. Ruptured Juxtarenal Abdominal Aortic Aneurysm Treated With a Fenestrated EVAR Graft Intended for a Different Patient.

    Science.gov (United States)

    Al-Jundi, Wissam; Elboushi, Amro; Lees, Tim; Williams, Robin

    2016-08-01

    Treatment of juxtarenal abdominal aortic aneurysms (AAAs) remains challenging. A 79-year-old male who had infrarenal endovascular repair of abdominal aortic aneurysm (EVAR) 13 years previously presented with leaking juxtarenal AAA. Emergency fenestrated EVAR (FEVAR) was performed utilizing a stent graft designed and built for a different patient. Despite the need to embolize the celiac artery prior to covering it with the stent graft in order to achieve adequate proximal seal, the patient had uneventful recovery. PMID:27334480

  16. Long-term outcome of ruptured abdominal aortic aneurysm: Impact of treatment and age

    NARCIS (Netherlands)

    J.W. Raats (Jelle W.); H.C. Flu (Hans C.); G.H. Ho; E.J. Veen (Eelco J.); L.D. Vos (L.); E.W. Steyerberg (Ewout); L. van der Laan (Lyckle)

    2014-01-01

    textabstractBackground: Despite advances in operative repair, ruptured abdominal aortic aneurysm (rAAA) remains associated with high mortality and morbidity rates, especially in elderly patients. The purpose of this study was to evaluate the outcomes of emergency endovascular aneurysm repair (eEVAR)

  17. Endovascular blood flow measurement system

    Science.gov (United States)

    Khe, A. K.; Cherevko, A. A.; Chupakhin, A. P.; Krivoshapkin, A. L.; Orlov, K. Yu

    2016-06-01

    In this paper an endovascular measurement system used for intraoperative cerebral blood flow monitoring is described. The system is based on a Volcano ComboMap Pressure and Flow System extended with analogue-to-digital converter and PC laptop. A series of measurements performed in patients with cerebrovascular pathologies allows us to introduce “velocity-pressure” and “flow rate-energy flow rate” diagrams as important characteristics of the blood flow. The measurement system presented here can be used as an additional instrument in neurosurgery for assessment and monitoring of the operation procedure. Clinical data obtained with the system are used for construction of mathematical models and patient-specific simulations. The monitoring of the blood flow parameters during endovascular interventions was approved by the Ethics Committee at the Meshalkin Novosibirsk Research Institute of Circulation Pathology and included in certain surgical protocols for pre-, intra- and postoperative examinations.

  18. 腔内修复术治疗80岁以上肾下腹主动脉瘤患者的有效性和安全性分析%Efficacy and safety analysis of endovascular aortic repair of abdominal aortic aneurysms in patients over eighty years old

    Institute of Scientific and Technical Information of China (English)

    王志浩; 段琛; 吴忠隐; 张宏鹏; 熊江; 马晓辉; 刘小平; 郭伟; 刘杰; 贾鑫; 贾森皓; 张敏宏; 孙国义; 冯燕; 裴楠楠; 张佳

    2016-01-01

    Objective To evaluate the outcome of the endovascular aortic repair ( EVAR ) of abdominal aortic aneurysms (AAA) in patients over 80 years old and analyze the factors that influence its long-term curative effect.Methods Follow-up visits and analysis were conducted from January 2004 to December 2013 on a total of 96 AAA patients aged over 80 years old who had been treated with EVAR and thus met the inclusion criteria.The primary focus of the study was all-cause mortality and secondary focuses included the rate of intervention-related complications, the rate of secondary interventions and procedural data.The Kaplan-Meier survival curve was used to analyze the long-term survival rate and the cumulative probability of intervention-related complications.The Cox proportional hazards regression model was used to analyze factors that could influence the long-term survival rate.Results Effective follow-up visits were conducted on 76 patients ( 79.2%).The patients were tracked for an average of 3.63 years, with the longest follow-up lasting 10.34 years.During the study, 27 deaths occurred and the all-cause mortality rate was 28.1%.Furthermore, 8 cases of intervention-related complications (8.3%) were observed, including endoleaks and spinal cord ischemia.A total of 6 secondary interventions were conducted on 6 patients, with the rate of secondary interventions being 6.3%.The five-year cumulative survival rate was 64% ( 95%CI:0.53-0.78 ) and the ten-year cumulative survival rate was 35%( 95%CI: 0.15 -0.84 ).The Cox proportional hazards model showed that an ASA classification ofⅢ/Ⅳ(HR=8.45,95%CI:1.26-56.55, P<0.05), smoking (HR=2.08,95%CI:0.70-2.63,P<0.05) and cerebrovascular diseases (HR=2.96,95%CI:1.06 -8.25, P <0.05 ) could significantly increase the risk of the long-term all-cause mortality of an AAA patient treated with EVAR.While hypertension could significantly decrease the risk (HR=0.25,95%CI:0.10-0.66, P<0.05).Conclusion EVAR is safe for senior patients with AAA

  19. The Glasgow Aneurysm Score as a tool to predict 30-day and 2-year mortality in the patients from the Dutch Randomized Endovascular Aneurysm Management trial

    NARCIS (Netherlands)

    Baas, A.F.; Janssen, K.J.M.; Prinssen, M.; Buskens, E.; Blankensteijn, J.D.

    2008-01-01

    Abstract: Objective: Randomized trials have shown that endovascular repair (EVAR) of an abdominal aortic aneurysm (AAA) has a lower perioperative mortality than conventional open repair (OR). However, this initial survival advantage disappears after 1 year. To make EVAR cost-effective, patient selec

  20. The Glasgow Aneurysm Score as a tool to predict 30-day and 2-year mortality in the patients from the Dutch Randomized Endovascular Aneurysm Management trial.

    NARCIS (Netherlands)

    Baas, A.F.; Janssen, K.J.; Prinssen, M.; Buskens, E.; Blankensteijn, J.D.

    2008-01-01

    OBJECTIVE: Randomized trials have shown that endovascular repair (EVAR) of an abdominal aortic aneurysm (AAA) has a lower perioperative mortality than conventional open repair (OR). However, this initial survival advantage disappears after 1 year. To make EVAR cost-effective, patient selection shoul

  1. Preoperative endovascular embolization of a cerebellar hemangioblastoma

    OpenAIRE

    Almeida-Pérez Rafael; Espinosa Héctor; Romero-Ramírez Haroldo; Alcalá-Cerra Gabriel; Orozco-Gómez Fernando; De la Rosa-Manjarréz Ginna

    2013-01-01

    Introduction: hemangioblastomas are benign tumors located in the cerebellum, whichaffect young adults predominantly. These injuries are recognized by its abundant vascularizationwhich makes difficult its resection.Clinical case: The experience in the endovascular treatment of a patient with a cerebellarhemangioblastoma is exposed, emphasizing in the technical considerations andnecessary materials to achieve a successful embolization.Conclusion: Endovascular embolization of tumour vessels faci...

  2. A look into the endovascular crystal ball

    DEFF Research Database (Denmark)

    Schroeder, Torben Veith

    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...

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

    Directory of Open Access Journals (Sweden)

    Alexandre Campos Moraes Amato

    2008-09-01

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

  4. Abdominal Aortic Aneurysms: Treatments

    Science.gov (United States)

    ... access catheters Vertebroplasty Women and vascular disease Women's health Social Media Facebook Twitter ... Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists are vascular ...

  5. Endotension: rupture of abdominal aortic aneurysm Endotensão: ruptura de aneurisma de aorta abdominal

    Directory of Open Access Journals (Sweden)

    Alexandre Campos Moraes Amato

    2012-06-01

    Full Text Available Aortic endovascular exclusion technique called 'chimney' consists of placing stents through abdominal aortic visceral branches and a prosthesis that excludes the thoraco-abdominal aneurysm. Stents and an aortic endoprosthesis are placed in the renal arteries. This method is primarily used when open surgery is too risky. The mechanism that provides aneurysm sac increase without the visible presence of endoleaks has not been fully elucidated. The expansion of the aneurysm sac, due to endotension, is difficult to diagnose, even with the use of advanced imaging tests. Its diagnosis is made by exclusion. We present a case of a late complication in a high-risk patient after a 'chimney' endovascular procedure. Following the surgery, the patient presented a ruptured aneurysm sac without a visible endoleak. A second intervention was not feasible due to the high risk of occluding all of the branches, and complicated by previous 'chimney'. Endotension is a possible cause of aneurysm rupture and death.A técnica de exclusão endovascular conhecida como 'chaminé' consiste na colocação de stent em ramos viscerais e de endoprótese excluindo o aneurisma toracoabdominal. São colocados stents revestidos nas artérias renais e uma endoprótese aórtica, que o método utilizado quando a cirurgia aberta tem risco muito alto. O mecanismo que causa a expansão aneurismática sem a presença detectável de vazamento pelos métodos de imagem não está completamente esclarecido. A expansão do saco aneurismático por endotensão é de difícil diagnóstico, mesmo com o uso de técnicas de imagem avançadas, como tomografia computadorizada e eco-Doppler, sendo o diagnóstico por exclusão. Apresenta-se um caso de complicação tardia após o tratamento endovascular pela técnica da 'chaminé'. Após a cirurgia, o paciente apresentou ruptura sem endoleak visível. Outro procedimento endovascular foi impossibilitado pela técnica da 'chaminé', que dificulta novos

  6. Short-term curative effect of endovascular stent-graft treatment for aortic diseases in China: a systematic review.

    Directory of Open Access Journals (Sweden)

    Siwen Wang

    Full Text Available INTRODUCTION: We analyzed the short-term efficacy of endovascular treatment for aortic diseases by summarizing all available published data on endovascular stent-graft treatment for abdominal aortic aneurysm (AAA, thoracic aortic aneurysm (TAA, type A aortic dissection (type A AD and type B aortic dissection (type B AD in China. METHODS: We performed a systematic analysis of 935 published series on retrograde endovascular treatment for aortic diseases in China from January 1996 to November 2010. Based on the inclusion criteria, 159 studies, involving a total of 5531 patients, were included. RESULTS: There were no significant differences in procedural success among the studies (P>0.05. The rates of overall neurologic complications and stroke were significantly different in all two-group comparisons (P0.05. A significant difference was noted between the 30-day mortality rate of the type A AD patients and the AAA or type B AD patients (P<0.05. CONCLUSION: Endovascular stent-graft is a feasible and safe treatment for aortic diseases, with high procedural success and low incidences of post-procedural complications and short-term mortality. Endovascular treatment for AAA and type B AD is more efficient than for type A AD and TAA.

  7. Contrast Medium Induced Nephropathy after Endovascular Stent Graft Placement: An Examination of Its Prevalence and Risk Factors

    Directory of Open Access Journals (Sweden)

    Yohei Kawatani

    2016-01-01

    Full Text Available Endovascular stent graft placement has become a major treatment for thoracic and abdominal aneurysms. While endovascular therapy is less invasive than open surgery, it involves the use of a contrast medium. Contrast media can cause renal impairment, a condition termed as contrast-induced nephropathy (CIN. This study sought to evaluate the incidence and risk factors of CIN following endovascular stent graft placement for aortic aneurysm repair. The study included 167 consecutive patients who underwent endovascular stent graft placement in our hospital from October 2013 to June 2014. CIN was diagnosed using the European Society of Urogenital Radiology criteria. Patients with and without CIN were compared. Chi-squared tests, t-tests, and multivariate logistic regression analyses were performed. Thirteen patients (7.8% developed CIN. Left ventricular dysfunction and intraoperative blood transfusion were significantly more frequent in the CIN group (P=0.017 and P=0.032, resp.. Multivariate analysis showed that left ventricular dysfunction had the strongest influence on CIN development (odds ratio 9.34, P=0.018, and 95% CI = 1.46–59.7. Patients with CIN also experienced longer ICU and hospital stays. Measures to improve renal perfusion flow should be considered for patients with left ventricular dysfunction who are undergoing endovascular stent graft placement.

  8. Contrast Medium Induced Nephropathy after Endovascular Stent Graft Placement: An Examination of Its Prevalence and Risk Factors

    International Nuclear Information System (INIS)

    Endovascular stent graft placement has become a major treatment for thoracic and abdominal aneurysms. While endovascular therapy is less invasive than open surgery, it involves the use of a contrast medium. Contrast media can cause renal impairment, a condition termed as contrast-induced nephropathy (CIN). This study sought to evaluate the incidence and risk factors of CIN following endovascular stent graft placement for aortic aneurysm repair. The study included 167 consecutive patients who underwent endovascular stent graft placement in our hospital from October 2013 to June 2014. CIN was diagnosed using the European Society of Urogenital Radiology criteria. Patients with and without CIN were compared. Chi-squared tests, t-tests, and multivariate logistic regression analyses were performed. Thirteen patients (7.8%) developed CIN. Left ventricular dysfunction and intraoperative blood transfusion were significantly more frequent in the CIN group (P = 0.017 and P = 0.032, resp.). Multivariate analysis showed that left ventricular dysfunction had the strongest influence on CIN development (odds ratio 9.34, P = 0.018, and 95% CI = 1.46–59.7). Patients with CIN also experienced longer ICU and hospital stays. Measures to improve renal perfusion flow should be considered for patients with left ventricular dysfunction who are undergoing endovascular stent graft placement

  9. Heparin-induced thrombocytopenia with abdominal aortic stent-graft acute thrombosis.

    Science.gov (United States)

    Canaud, Ludovic; Hireche, Kheira; Marty-Ané, Charles; Alric, Pierre

    2013-08-01

    We report a case of heparin-induced thrombocytopenia in a patient on low molecular weight heparin bridge therapy who developed acute abdominal aortic stent-graft thrombosis 1 week after uncomplicated endovascular abdominal aortic aneurysm repair. The diagnosis was confirmed by a computed tomographic scan of the abdomen. The patient was successfully treated by conversion to open repair. The postoperative course was marked by subacute left limb ischemia related to an in vivo cross-reactivity of danaparoid with the heparin immune complex. To our knowledge, this is the first case report of heparin-induced thrombocytopenia with acute abdominal aortic stent-graft thrombosis. PMID:23711968

  10. 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)

  11. Acquisition of endovascular skills for uterine artery embolization using a simulator

    DEFF Research Database (Denmark)

    McLucas, Bruce; Coats, Richard; Lönn, Lars Birger;

    2009-01-01

    This study addresses endovascular training using simulators for uterine artery embolization. A review of endovascular skill training for surgeons using simulators was performed. Surgeons possess varying levels of proficiency in endovascular techniques. A simulator will improve endovascular skills...

  12. Indications for and outcome of open AAA repair in the endovascular era.

    Science.gov (United States)

    Wieker, Carola M; Spazier, Max; Böckler, Dittmar

    2016-04-01

    The benefits, safety and efficacy of endovascular aortic aneurysm repair (EVAR) is well documented and intensively reported in multiple randomized trials and meta-analysis. Therefore, EVAR became the first choice of abdominal aortic aneurysms (AAA) treatment in almost 70-100% of patients. Consecutively, open repair (OR) is performed less frequently in morphologically preselected patients. Anatomical condition remains the most important factor for indication for OR. Especially unfavorable intrarenal landing zone based on difficult neck anatomy like very short neck or excessive neck angulation is still the most predictive factor. Furthermore, patients presenting additional iliac aneurysms, aortoiliac occlusive disease or variations of renal arteries are recommended for OR. Randomized trials like EVAR 1, DREAM and OVER from the year 2004/2005 and 2009 showed lower 30-day mortality rates in EVAR compared to OR. However, the late mortality rates after two years became equal in both treatment options. Furthermore, reinterventions after EVAR occur more frequently than after OR. Analysis from our own data showed a higher 30-day mortality in the patients who underwent OR in the endovascular era (15% vs. 2.5%), however the number of emergency open AAA repair because of ruptured aneurysms was much higher in the endovascular era (32.5% vs. 5%). In conclusion, treatment of AAA has changed in the past decade. Nevertheless OR of AAA still remains as a safe and durable method in experienced surgeons, even in the endovascular era. High volume centres are needed to offer the best patients' treatment providing the best postoperative outcome. Therefore OR must remain a part of fellowship training in the future. To decide the best treatment option many facts like patients' fitness and preference or finally the anatomic suitability for endovascular repair have to be considered. PMID:26822580

  13. Evaluation of patient renal function following endovascular aneurysm repair with suprarenal fixation

    Directory of Open Access Journals (Sweden)

    YingBin Jia

    2011-09-01

    Full Text Available This study aimed to assess the mid-term renal function of abdominal aortic aneurysm patients following suprarenal endovascular repair. From March 2005 to December 2009, 290 abdominal aortic aneurysm patients were included in the study and grouped according to whether they had received infrarenal or suprarenal endovascular aneurysm repair. Suprarenal endovascular aneurysm repair was performed in 173 patients, with a mean age of 72(±8 years (85.0% male. Infrarenal endovascular aneurysm repair was performed in 117 patients, with a mean age of 71(±9 years (90.6% male. Preoperative and one week, 1-, 3-, 6- and 12-month postoperative serum creatinine and cystatin C values were recorded. Estimated glomerular filtration rate was calculated by cystatin-based formula and Cr-based Cockcroft formula. The t-test was used to determine statistical differences between or within groups. All patients received Talent or Zenith endograft. Patients’ characteristics and operative files in the two groups were well matched. Preoperative serum creatinine and cystatin C were 82 (±8 mmol/L and 0.89 (±0.11 mg/L for suprarenal endovascular aneurysm repair, respectively, and 81 (±11 mmol/L and 0.87 (±0.15 mg/L, respectively, for infrarenal endovascular aneurysm repair; no differences were observed between the two groups. Compared to preoperative renal markers within each group, a deterioration in serum creatinine, cystatin C and estimated glomerular filtration rate values was found at one week and 12 months after surgery(P<0.05. A deterioration in cystatin C [SR:(0.93±0.17 mg/L, IR: (0.92±0.31 mg/L] and estimated glomerular filtration rate by cystatin C was also found at six months after surgery(P<0.05. However, no differences in patient serum creatinine, cystatin C and estimated glomerular filtration rate values were observed between groups at each follow-up time interval. There was no greater significant difference in the association of the use of suprarenal

  14. Hybrid procedure for a descending thoracic and subclavian artery aneurysm in a patient with previous abdominal aortic surgery: Case report

    OpenAIRE

    Radak Đorđe; Tanasković Slobodan; Unić-Stojanović Dragana; Jović Miomir; Babić Srđan; Sagić Dragan

    2015-01-01

    Introduction. Hybrid procedures represent staged or simultaneous endovascular and open surgical techniques in the treatment of complex pathologies of the thoracic and abdominal aorta. We are presenting a patient with previous abdominal aortic surgery in whom hybrid vascular procedure for descending aorta and left subclavian artery aneurysm was performed. Case Outline. A 63-year-old female patient was admitted for computed tomography angiography. Descending ...

  15. 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

  16. Resolución endovascular de lesiones por arma de fuego en la región cervical

    Directory of Open Access Journals (Sweden)

    Sebastián Rizzone

    2016-01-01

    Full Text Available Introducción: Las heridas producidas por armas de fuego que comprometen la región cervical son materia de controversia en cuanto a cuál es el mejor método para tratarlas. La resolución endovascular de este tipo de patología ha cobrado gran relevancia en los últimos años debido al desarrollo de nuevos dispositivos y, consecuentemente, a la menor incidencia de complicaciones inherentes al procedimiento. Objetivo: Determinar el rol del tratamiento endovascular en la resolución de las lesiones cervicales por arma de fuego. Material y métodos: Se incluyeron 76 pacientes que sufrieron lesiones cervicales por arma de fuego, a los cuales se les realizó angiografía de los vasos supraaórticos para decidir la conducta a seguir. Resultados: Del total de 76 pacientes, 47 (61,8% presentaron una angiografía patológica; de estos, en 26 se decidió la resolución endovascular de la lesión, implantándose 1,1 stents por paciente. La estadía intrahospitalaria fue en promedio de 10,4 días. A los 30 días de seguimiento, 2 pacientes presentaron secuela neurológica y uno evolucionó con sepsis. En el seguimiento alejado con un promedio de 4 años se registró una muerte a los 117 días de realizado el procedimiento. Conclusiones: La intervención endovascular ha ganado mayor protagonismo con el desarrollo de nuevos dispositivos que permiten el tratamiento de patologías cada vez más complejas y reducir el tiempo de internación intrahospitalaria, como también las complicaciones relacionadas con el procedimiento.

  17. Vascular training and endovascular practice in Europe

    DEFF Research Database (Denmark)

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

    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...

  18. [Abdominal aortic aneurysm: an uncommon presentation].

    Science.gov (United States)

    Taborda, Lúcia; Pereira, Laurinda; Amona, Eurides; Pinto, Erique Guedes; Rodrigues, Joaquim

    2011-01-01

    Most abdominal aortic aneurysms are asymptomatic, being accidentally found on physical examination or in routinely performed imaging studies. They only require surveillance (which is variable according to the aneurism size) and medical therapy in order to achieve risk factor reduction. However, in certain situations, according to the risk of aneurism rupture, elective surgery or endovascular procedure may be necessary. About 80% of the cases of aneurism rupture occur into the retroperitoneal space, with a high mortality rate. There are uncommon presentations of aneurism rupture as the aorto-caval fistula, which also require fast diagnosis and intervention. The authors present the case of a 71-year-old man, with the previous diagnosis of hypertension, acute myocardial infarction 2 months earlier (undergone primary Percutaneous Coronary Intervention) and tabagism, who was admitted at the emergency department with intense 24-hour-evolution epigastric pain. On physical examination, the Blood Pressure values measured at the lower limbs were about half the ones measured at the upper limbs and there was an abdominal pulsatile mass, with a high-intensity murmur. As the authors suspected aortic dissection, aneurysm, coarctation or thrombosis, it was done a Computed Tomography scanning with intravenous contrast, which revealed a ruptured abdominal aorta aneurysm with a mural thrombus. The doppler ultrasound confirmed the presence of a high debit aorto-caval fistula. The patient was immediately transferred to the Vascular Surgery. However he died 2 hours later, during surgery. PMID:22525642

  19. Navigation Technology in Endovascular Aortic Repair

    OpenAIRE

    Manstad-Hulaas, Frode

    2013-01-01

    A number of diseases can affect the aorta, and endovascular (minimally invasive) techniques can be used to treat many of these conditions. During endovascular aortic repair, different instruments, such as catheters (plastic tubes), metal wires and balloons are visualized by X-rays. Intermittent aortic injections of contrast medium improve the depiction of the aorta; however, contrast medium may damage kidney function in some patients, radiation can be harmful and X-ray images are 2- dimension...

  20. 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.

  1. Assessing endovascular skills using the Simulator for Testing and Rating Endovascular Skills (STRESS) machine.

    NARCIS (Netherlands)

    Willems, M.C.M.; Vliet, J.A. van der; Williams, V.A.; Kool, L.J.; Bergqvist, D.; Blankensteijn, J.D.

    2009-01-01

    OBJECTIVES: Endovascular techniques are an integral part of modern-day vascular surgery practice and training. Nevertheless, validated in vitro assessment tools for these skills are scarce. This study describes the development and pilot testing of the Simulator for Testing and Rating Endovascular Sk

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-08-15

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

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

    International Nuclear Information System (INIS)

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

  4. Contemporary management of the demanding infra-renal neck in abdominal aortic aneurysm repair.

    Science.gov (United States)

    Mees, B M; Peppelenbosch, A G; De Haan, M W; Jacobs, M J; Schurink, G W

    2015-04-01

    Proximal infrarenal neck anatomy is a crucial factor in determining outcome of abdominal aortic aneurysm (AAA) repair. Unfavorable or demanding infrarenal neck anatomy significantly increases the complexity of both standard endovascular and open repair resulting in increased rates of morbidity and mortality. While technological improvements and expanding institutional experience have resulted in an increased proportion of patients with an AAA with unfavorable infrarenal neck treated by (fenestrated) endovascular techniques, open repair has also remained a valid technique. The purpose of this manuscript was to describe the wide array of endovascular and open techniques in use to treat patients with an AAA with a demanding infrarenal neck and discuss their results and indications. PMID:25592277

  5. Troubleshooting techniques for the Endurant™ device in endovascular aortic aneurysm repair.

    Science.gov (United States)

    Georgiadis, George S; Antoniou, George A; Trellopoulos, George; Georgakarakos, Efstratios I; Argyriou, Christos; Lazarides, Miltos K

    2014-01-01

    Endovascular aortic aneurysm repair with the Endurant™ stent-graft system has been shown to be safe and effective in high-risk surgical patients with complex suprarenal and/or infrarenal abdominal aortic aneurysm anatomy. The wireformed M-shaped stent architecture and proximal springs with anchoring pins theoretically permit optimal sealing in shorter and more angulated proximal aneurysm necks even under off-label conditions. Nonetheless, extremely difficult anatomical situations and inherent graft system-related limitations must be anticipated. Herein, we describe our techniques to overcome the capture of the tip sleeve within the suprarenal bare-stent anchoring pins, other endograft segments, and native vessels. PMID:25182343

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

    DEFF Research Database (Denmark)

    Vogt, K C; Brunkwall, J; Malina, M;

    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 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...

  7. Unique Technique for Open Surgical Repair after Failed Endovascular Aneurysm Repair with Proximal Anastomoses.

    Science.gov (United States)

    Takebayashi, Satoshi; Hirota, Jun; Mori, Kazuki; Shuto, Takashi; Okamoto, Keitaro; Sato, Aiko; Wada, Tomoyuki; Anai, Hirofumi; Miyamoto, Shinji

    2016-01-01

    Endovascular aortic aneurysm repair (EVAR) has revolutionized the management of abdominal aortic aneurysms (AAAs), with lower perioperative morbidity and mortality compared to conventional surgical repair. However, late secondary re-interventions after EVAR are still needed before aneurysm rupture in many cases. A patient with impending rupture of an AAA associated with a type I endoleak 7 years after EVAR who was successfully treated with a unique technique of fixation of the proximal aortic neck taking into account the structure of the stent graft is reported. This technique offers a safe solution to late open conversion after failed EVAR. PMID:27375808

  8. Suprarenal fixation resulting in intestinal malperfusion after endovascular aortic aneurysm repair.

    Science.gov (United States)

    Siani, Andrea; Accrocca, Federico; De Vivo, Gennaro; Marcucci, Giustino

    2016-05-01

    Superior mesenteric artery (SMA) and coeliac axis (CA) occlusion after endovascular abdominal aneurysm aortic repair (EVAR-AAA), using endograft with suprarenal fixation, are uncommon. However, we are reporting a case of visceral malperfusion, which occurred 7 days after successful EVAR with suprarenal fixation for symptomatic AAA. Endograft metal stent barbs caused severe stenosis of SMA and CA. A successful recovery of SMA was carried out by means of a balloon-expandable stent released through bare metal stent barbs. We believe that an unfavourable anatomy of a proximal aortic neck and visceral aorta may have caused a wrong stent strut deployment with the coverage of CA and SMA. PMID:26826712

  9. Hernia discal lumbar: Tratamiento conservador

    OpenAIRE

    López-Sastre Núñez, Antonio; Candau Pérez, Ernesto

    1999-01-01

    Existe una gran demanda de patología lumbar crónica y aguda que debe de tratarse conjuntamente entre el especialista en Rehabilitación y el Cirujano de columna vertebral. En este trabajo se detallan las posibilidades del tratamiento conservador antes de optar por la cirugía. Se realiza una revisión bibliográfica de los resultados conservadores del tratamiento de la lumbociática de origen discal comparando aquellos estudios publicados con validez estadística. Se detallan las modernas pautas de...

  10. Management of Concomitant Cancer and Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Abdullah Jibawi

    2011-01-01

    Full Text Available Background. The coexistence of neoplasm and abdominal aortic aneurysm (AAA presents a real management challenge. This paper reviews the literature on the prevalence, diagnosis, and management dilemmas of concurrent visceral malignancy and abdominal aortic aneurysm. Method. The MEDLINE and HIGHWIRE databases (1966-present were searched. Papers detailing relevant data were assessed for quality and validity. All case series, review articles, and references of such articles were searched for additional relevant papers. Results. Current challenges in decision making, the effect of major body-cavity surgery on an untreated aneurysm, the effects of major vascular surgery on the treatment of malignancy, the use of EVAR (endovascular aortic aneurysm repair as a fairly low-risk procedure and its role in the management of malignancy, and the effect of other challenging issues such as the use of adjuvant therapy, and patients informed decision-making were reviewed and discussed. Conclusion. In synchronous malignancy and abdominal aortic aneurysm, the most life-threatening lesion should be addressed first. Endovascular aneurysm repair where possible, followed by malignancy resection, is becoming the preferred initial treatment choice in most centres.

  11. Abdominal Pain or Cramping

    Science.gov (United States)

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

  12. Mortality after endovascular repair of ruptured abdominal aortic aneurysms:a systematic review and Meta-analysis%腔内修复破裂的腹主动脉瘤手术死亡率:一个系统评价和Meta分析

    Institute of Scientific and Technical Information of China (English)

    Karkos CD; Harkin DW; Giannakou A; 刘军麟; 殷梅

    2010-01-01

    @@ 尽管现代外科取得了一些进展,但通过开放手术治疗破裂的腹主动脉瘤(ruptured abdominal aortic aneurysms,RAAAs)其死亡率仍高达50%左右.由于来到医院的患者存活率不到一半,由RAAAs所导致的死亡率更高,为80%~90%.

  13. Há espaço para o tratamento endovascular nas dissecções crônicas da aorta descendente? Is the endovascular procedure an option for treatment of cronic type B aortic dissections?

    Directory of Open Access Journals (Sweden)

    Ricardo Ribeiro Dias

    2007-12-01

    Full Text Available OBJETIVO: Questões relativas a quais pacientes/doenças que efetivamente deveriam ser submetidos ao tratamento endovascular ainda geram controvérsias. O objetivo deste trabalho visa a questionar o tratamento endovascular nas dissecções crônicas tipo B de Stanford. MÉTODOS: No período de 2003 a 2006, 11 pacientes portadores de dissecção crônica da aorta tipo B de Stanford com dilatação somente no tórax (diâmetro > 5,5cm, foram submetidos à colocação de prótese endovascular autoexpansível pela artéria femoral. Todos os pacientes foram submetidos à angiotomografia de controle com 6 meses, 1 ano e após, anualmente, com o intuito de avaliar a presença de fluxo na falsa luz e estudar a evolução dos diâmetros da aorta torácica descendente e abdominal no decorrer do tempo. Para esta análise foram utilizados os testes Anova de duas vias para medidas repetidas e o qui-quadrado com o programa SPSS 13. RESULTADOS: Não houve mortalidade hospitalar. Nenhum paciente apresentou endoleak imediatamente após a operação. Durante o período de seguimento médio de 28 meses/paciente, não houve óbitos, um paciente foi submetido à substituição da aorta tóraco-abdominal e dois aguardam esta mesma intervenção. A endoprótese interrompeu o fluxo na falsa luz no tórax em 72,7% dos pacientes e, no abdome, somente em 18,2%, porém isto não implicou na redução dos diâmetros da aorta torácica nem abdominal. CONCLUSÃO: O tratamento endovascular nas dissecções crônicas tipo B de Stanford parece não ser suficiente para tratar esses pacientes no curto/médio prazo, apesar do tamanho reduzido da amostra estudada.OBJECTIVE: Questions regarding the specific patient/disease that should be submitted to the endovascular procedure still remain unclear. The purpose of this report is to evaluate the endovascular treatment in chronic type B aortic dissections. METHODS: Between 2003 and 2006, 11 patients with chronic type B aortic dissection

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

    Institute of Scientific and Technical Information of China (English)

    Zhong-Hua Sun

    2012-01-01

    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,endovaseular 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.

  15. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-12-15

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

  17. Advanced Endovascular Approaches in the Management of Challenging Proximal Aortic Neck Anatomy: Traditional Endografts and the Snorkel Technique

    Science.gov (United States)

    Quatromoni, Jon G.; Orlova, Ksenia; Foley, Paul J.

    2015-01-01

    Advances in endovascular technology, and access to this technology, have significantly changed the field of vascular surgery. Nowhere is this more apparent than in the treatment of abdominal aortic aneurysms (AAAs), in which endovascular aneurysm repair (EVAR) has replaced the traditional open surgical approach in patients with suitable anatomy. However, approximately one-third of patients presenting with AAAs are deemed ineligible for standard EVAR because of anatomic constraints, the majority of which involve the proximal aneurysmal neck. To overcome these challenges, a bevy of endovascular approaches have been developed to either enhance stent graft fixation at the proximal neck or extend the proximal landing zone to allow adequate apposition to the aortic wall and thus aneurysm exclusion. This article is composed of two sections that together address new endovascular approaches for treating aortic aneurysms with difficult proximal neck anatomy. The first section will explore advancements in the traditional EVAR approach for hostile neck anatomy that maximize the use of the native proximal landing zone; the second section will discuss a technique that was developed to extend the native proximal landing zone and maintain perfusion to vital aortic branches using common, off-the-shelf components: the snorkel technique. While the techniques presented differ in terms of approach, the available clinical data, albeit limited, support the notion that they may both have roles in the treatment algorithm for patients with challenging proximal neck anatomy. PMID:26327748

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-07-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Şahin Bozok

    2015-12-01

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

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

    OpenAIRE

    Şahin Bozok; Sedat Ozan Karakişi; Şaban Ergene; Nebiye Tüfekçi; Gökhan İlhan; Hakan Karamustafa

    2015-01-01

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

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

    Science.gov (United States)

    Bozok, Şahin; Ozan Karakişi, Sedat; Ergene, Şaban; Tufekçi, Nebiye; Ilhan, Gökhan; Karamustafa, Hakan

    2015-01-01

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

  3. Case Series of Patients with Ruptured Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Spencer, Taylor

    2015-05-01

    Full Text Available Introduction: Traditionally, patients with suspected ruptured abdominal aortic aneurysm (rAAA are taken immediately for operative repair. Computed tomography (CT has been considered contraindicated. However, with the emergence of endovascular repair, this approach to suspected rAAA could be changing. Methods: We present retrospective data in a case series of 110 patients with rAAA. Patients were managed at a single tertiary medical center over a five-year period. At this site, there was an established multidisciplinary protocol in which patients with suspected rAAA undergo CT with consideration for endovascular aortic repair (EVAR. Results: Our results demonstrated a mortality of 30% with our institutional protocol for CT in suspected rAAA. Comparing patients who ultimately had EVAR with open repair, those able to have endovascular aneurysm repair (EVAR had lower mortality, shorter hospital stays for survivors, and a greater likelihood of being discharged to home than those with open repair. While survivors were more likely to have had EVAR, surviving patients were younger, had a significantly lower creatinine at presentation, and required fewer blood transfusions than those who died. Conclusion: Based on this case series, an institutional approach endorsing CT for presumed rAAA appears to be reasonable. Our results suggest that EVAR may be beneficial in appropriately-selected patients and that CT may potentially facilitate superior management options for patient care. [West J Emerg Med. 2015;16(3:367–371.

  4. Endovascular Management of May-Thurner Syndrome

    Science.gov (United States)

    Al Safran, Zakareya; Hasan, Hosam; Zeid, Wael Abu

    2012-01-01

    May-Thurner syndrome or iliac vein compression syndrome is associated with deep vein thrombosis (DVT) resulting from chronic compression of the left iliac vein against lumbar vertebrae by the overlying right common iliac artery. Historically, May-Thurner syndrome has been treated with anticoagulation therapy. However, this therapy can be problematic when given alone, because it prevents the propagation of the thrombus without eliminating the existing clot. Furthermore, it does not treat the underlying mechanical compression. Consequently, syndrome who was managed by anticoagulation therapy alone, there is a significant chance that the patient will develop recurrent deep vein thrombosis or post thrombotic syndrome or both. Recently, both retrospective and prospective studies have suggested that endovascular management should be front-line treatment; endovascular management actively treats both the mechanical compression with stent placement and the thrombus burden with chemical dissolution. We report our case of 53 years old male patient with May Thurner syndrome who managed by endovascular treatment. PMID:23555515

  5. Tratamiento endovascular de fístula arteriovenosa parotídea

    OpenAIRE

    Santos Gorjón, Pablo; Sánchez Terradillos, Elena; Mingo Sánchez, Eva María; Sánchez-Jara Sánchez, Juan Luis; Martín Hernández, Gonzalo

    2015-01-01

    [ES] Introducción y objetivos: Las fístulas arteriovenosas suelen tener un origen traumático, tras traumatismos faciales o heridas en la región parotídea. Existe poca casuística y el objetivo de esta presentación es remarcar la utilidad del eco-doppler como primer método diagnóstico en todo acufeno pulsátil. Material y métodos: Paciente de 40 años que acude a nuestra consulta para valorar acufeno derecho pulsátil de años de evolución, tras accidente de tráfico. La palpación parotídea revela u...

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

    Directory of Open Access Journals (Sweden)

    Puppala Sapna

    2010-10-01

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

  7. Through-Plane Movement at Multiple Aortic Levels on Dynamic Computed Tomography Angiography Is Limited in Patients With an Abdominal Aortic Aneurysm

    NARCIS (Netherlands)

    de Jonge, Jeroen C; Zandvoort, Herman J A; Vonken, Evert-Jan P A; Moll, Frans L; van Herwaarden, JA

    2015-01-01

    PURPOSE: To analyze the movement of the aorta in the craniocaudal direction (through-plane movement) during the cardiac cycle at several levels to determine any potential impact on endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). METHODS: For this study, 30 patients (median ag

  8. [Hereditary angioedema: strange cause of abdominal pain].

    Science.gov (United States)

    Salas-Lozano, Nereo Guillermo; Meza-Cardona, Javier; González-Fernández, Coty; Pineda-Figueroa, Laura; de Ariño-Suárez, Mauricio

    2014-01-01

    Antecedentes: el angioedema hereditario es un trastorno inflamatorio episódico, que se hereda de manera autosómica dominante y se caracteriza por episodios de edema periférico. Los pacientes pueden tener edema de la pared de cualquier víscera hueca, incluido el intestino. Caso clínico: se comunica el caso de un paciente masculino de 33 años de edad, sin antecedentes de importancia, con dolor abdominal, localizado en el epigastrio, irradiado al cuadrante inferior derecho, acompañado de 5 vómitos. La tomografía abdominal mostró engrosamiento de la pared de la segunda y tercera porción del duodeno, con infiltración de grasa y líquido libre. Los exámenes de laboratorio mostraron: concentraciones bajas del complemento C4 (5.5 mg/dL) y actividad del inhibidor de C1 del complemento de 30%. Conclusiones: el angioedema hereditario es consecuencia de la deficiencia (tipo I) o disfunción (tipo II) del inhibidor C1 del complemento. El dolor abdominal asociado con angioedema es de inicio súbito, como dolor cólico, recurrente y de intensidad moderada. En la actualidad existen dos medicamentos aprobados por la Food and Drug Administration para el tratamiento de pacientes con esta afección.

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

    Science.gov (United States)

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

    2015-11-01

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

  10. Metallic Zinc Exhibits Optimal Biocompatibility for Bioabsorbable Endovascular Stents

    Science.gov (United States)

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

    2015-01-01

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

  11. 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...

  12. Endovascular treatment of symptomatic intracranial atherosclerotic disease

    Directory of Open Access Journals (Sweden)

    Syed I Hussain

    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.

  13. 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.

  14. Endovascular treatment of hemodialysis arteriovenous fistulas

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Hansen, Marc A; Schroeder, Torben V;

    2012-01-01

    Purpose: The purpose of this study was to investigate if the immediate hemodynamic outcome of an endovascular intervention on a dysfunctional hemodialysis arteriovenous fistula is a prognostic factor for primary patency. Methods: This was a prospective observational study including 61 consecutive...

  15. 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

  16. [Abdominal pregnancy, institutional experience].

    Science.gov (United States)

    Bonfante Ramírez, E; Bolaños Ancona, R; Simón Pereyra, L; Juárez García, L; García-Benitez, C Q

    1998-07-01

    Abdominal pregnancy is a rare entity, which has been classified as primary or secondary by Studiford criteria. A retrospective study, between January 1989 and December 1994, realized at Instituto Nacional de Perinatología, found 35,080 pregnancies, from which 149 happened to be ectopic, and 6 of them were abdominal. All patients belonged to a low income society class, age between 24 and 35 years, and average of gestations in 2.6. Gestational age varied from 15 weeks to 32.2 weeks having only one delivery at term with satisfactory postnatal evolution. One patient had a recurrent abdominal pregnancy, with genital Tb as a conditional factor. Time of hospitalization varied from 4 to 5 days, and no further patient complications were reported. Fetal loss was estimated in 83.4%. Abdominal pregnancy is often the sequence of a tubarian ectopic pregnancy an when present, it has a very high maternal mortality reported in world literature, not found in this study. The stated frequency of abdominal pregnancy is from 1 of each 3372, up to 1 in every 10,200 deliveries, reporting in the study 1 abdominal pregnancy in 5846 deliveries. The study had two characteristic entities one, the recurrence and two, the delivery at term of one newborn. Abdominal pregnancy accounts for 4% of all ectopic pregnancies. Clinical findings in abdominal pregnancies are pain, transvaginal bleeding and amenorrea, being the cardinal signs of ectopic pregnancy. PMID:9737070

  17. [Abdominal compartment syndrome].

    Science.gov (United States)

    Pottecher, T; Segura, P; Launoy, A

    2001-04-01

    French physicians dealing with abdominal emergencies are not very familiar with the abdominal compartment syndrome (ACS). Increased abdominal pressure has deleterious consequences on local (intestine, liver, kidney) circulation, leading to death in the absence of correct treatment. Abdominal trauma and ruptured aortic aneurism are the main causes of ACS. Clinical presentation may be misleading: respiratory failure, oliguria or circulatory symptoms are often predominant. Abdominal palpation is inefficient for evaluating intra-abdominal pressure (IAP); only measurement of cystic pressure allows precise evaluation of IAP. Abdominal decompression is the treatment of choice. It must be performed as soon as IAP exceeds 25 mmHg. The procedure may be risky with a high incidence of severe complications when ischaemic territories are reperfused. Recent data underline the importance of compensation of hypovolemia before decompression. Abdominal closure may necessitate various techniques (aponevrotomy, Bogota bags, etc.). At any rate, IAP must remain low at the end of the procedure. In case of suspicion of ACS, early measurement of IAP is mandatory. If pressure is over 25 mmHg, a decompressive procedure must be initiated. PMID:11340703

  18. El tratamiento fiscal del crowdfunding

    OpenAIRE

    Martínez Muñoz, Yolanda

    2015-01-01

    Este trabajo aborda el estudio del crowdfunding y su tratamiento fiscal en el sistema español. El notable protagonismo adquirido por este modo de financiación alternativa para proyectos innovadores exige la creación de un marco jurídico adecuado y el establecimiento de un sistema de incentivos fiscales que impulsen su desarrollo. En este sentido, la Ley de fomento de la financiación empresarial establece el régimen jurídico del crowdfunding financiero, dando cobertura legal a esta nueva forma...

  19. Tratamiento de la litiasis urinaria

    OpenAIRE

    Martínez Dubarbie, Francisco

    2015-01-01

    Introducción:La litiasis urinaria es una patología muy frecuente tanto en los servicios de urología como en las urgencias hospitalarias y en atención primaria, por lo tanto, es esencial conocer su manejo y las distintas opciones terapéuticas de las que se disponen. Objetivo:El objetivo de este trabajo es exponer los tratamientos disponibles con el fin de elaborar unos protocolos de actuación tomando como referencia la actividad en el HUMV. Material y métodos: Para ello se ha hecho una r...

  20. Angioedema hereditario: Tratamiento del ataque agudo en la Argentina

    Directory of Open Access Journals (Sweden)

    Alejandro Malbrán

    2014-06-01

    Full Text Available En el mundo, el angioedema hereditario (HAE afecta a 1 de cada 50 000 personas. Produce episodios de angioedema cutáneo, abdominal y laríngeos que generan gran incapacidad. La mortalidad por la enfermedad oscila entre 15 y 50%. Aunque en Argentina un concentrado plasmático de C1 inhibidor (pdC1INH ha estado aprobado y disponible por décadas para el tratamiento del ataque agudo, solo 15 (26% de 58 pacientes había recibido pdC1INH alguna vez hasta el año 2008, y solo 2(3.4% lo usaban regularmente. Luego de la aprobación de los nuevos medicamentos para HAE, incluido el icatibant en Argentina y de la publicación de las guías terapéuticas, 42 (82% de 51 pacientes del grupo original tienen pdC1INH para tratar el próximo ataque. Sin embargo, 16 (18% de estos pacientes continúan sin acceso a la medicación y otros 15 (35.7% acceden a través de otro enfermo en forma espuria. Solo 12 (28.6% de los pacientes con el medicamento puede auto tratarse en su domicilio. La mejora en el acceso a la medicación es importante pero debe extenderse a todos los afectados y facilitarse el auto-tratamiento.

  1. tratamiento

    Directory of Open Access Journals (Sweden)

    Oscar Vázquez Tsuji

    2006-01-01

    Full Text Available La Gnatostomiasis en México es causada por helmintos del género Gnathostoma. Durante mucho tiempo se pensó que esta enfermedad era rara y esporádica en México. La gnatostomiasis es una infección sistémica causada por la migración de larvas del nemátodo Gnathostoma. Esta parasitosis se considera como una zoonosis que involucra una gran variedad de animales que funcionan como huésped intermediario y definitivo del parásito. El consumo de pescado crudo es el factor de riesgo más importante.

  2. Tratamiento del paciente con artrosis

    Directory of Open Access Journals (Sweden)

    Francisco Vargas Negrín

    2014-01-01

    Full Text Available El manejo terapéutico del paciente con artrosis tiene como objetivo disminuir la sintomatología dolorosa e inflamatoria, mejorar la capacidad funcional del paciente y la aplicación de intervenciones terapéuticas eficaces y lo más seguras posibles. Un enfoque centrado en el paciente implica su participación activa en el diseño del plan terapéutico y en la toma de decisiones informadas oportunas en todas las etapas de la enfermedad. La educación terapéutica, la actividad física y el ejercicio terapéutico junto con el control de peso, en caso de sobrepeso u obesidad, constituyen el núcleo central del tratamiento. Los autocuidados individuales y por los familiares son fundamentales en el control del día a día del paciente. El uso de terapias físicas, ayudas técnicas (bastón, etc. y de fármacos tipo analgésicos simples, opioides y antiinflamatorios tiene evidencias demostradas en el control del dolor, mejora la funcionalidad y la calidad de vida del paciente y una clara recomendación de uso en el tratamiento de la artrosis. La cirugía conservadora y la de reemplazo articular se indican en los casos en los que no se logran los objetivos terapéuticos en casos concretos.

  3. Doble tratamiento de conducto para Nahuel

    OpenAIRE

    Amat, Adalberto

    2010-01-01

    ResumenJaguar joven con fractura en ambos caninos inferiores con exposición de la pulpa. Presentaba al momento del tratamiento necrosis y gangrena pul la American Se realizó endodoncia (Tratamiento del conducto radicular) bajo anestesia general inhalatoria, y posterior obturación.

  4. Doble tratamiento de conducto para Nahuel

    Directory of Open Access Journals (Sweden)

    Amat, Adalberto

    2010-05-01

    Full Text Available ResumenJaguar joven con fractura en ambos caninos inferiores con exposición de la pulpa. Presentaba al momento del tratamiento necrosis y gangrena pul la American Se realizó endodoncia (Tratamiento del conducto radicular bajo anestesia general inhalatoria, y posterior obturación.

  5. [Inflammatory abdominal aortic aneurysm].

    Science.gov (United States)

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T

    2000-01-01

    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  6. Endovascular treatment of spine and spinal cord lesions

    Energy Technology Data Exchange (ETDEWEB)

    Berenstein, A. (New York Univ. - Bellevue Medical Center, NY (United States). Dept. of Neurosurgery); Lasjaunias, P. (New York Univ., NY (United States) Hopital de Bicetre, 94 - Le Kremlin-Bicetre (France))

    1992-01-01

    Completing this comprehensive series on endovascular interventional angiography, Volume 5 focuses on the vascular abnormalities of the spine and spinal cord. It is based on the detailed functional vascular anatomy described in Volume 3 and the principles and function of endovascular treatment described in Volumes 1-4. As in the companion volumes, the unique approach gives view of the disease itself, its anatomical features and its clinical presentation. The technical aspects of the interventional or endovascular neuroradiology are built upon the solid analysis of the disease and its angioarchitecture. The recent developments in endovascular procedures, such as aneurysm treatment, angioplasty, and vascular recanalizations, are reviewed. (orig.). 118 figs. in 442 separate illustrations

  7. 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.

  8. Abdominal Pain Syndrome

    Science.gov (United States)

    ... inspection of a drop of urine), and urine culture for bacterial infection. Stools can be analyzed for ... Hepatitis C Inflammatory Bowel Disease Irritable Bowel Syndrome Obesity Digestive Health Topics Abdominal Pain Syndrome Belching, Bloating, ...

  9. Abdominal ultrasound (image)

    Science.gov (United States)

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

  10. 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

  11. Techniques for aortic arch endovascular repair.

    Science.gov (United States)

    kHONGKU, Kiattisak; Dias, Nuno; Sonesson, Bjorn; Resch, Timothy

    2016-06-01

    This article reviews endovascular strategies for aortic arch repair. Open repair remains the gold standard particularly for good risk patients. Endovascular treatment potentially offers a less invasive repair. Principles, technical considerations, devices and outcomes of each technique are discussed and summarized. Hybrid repair combines less invasive revascularization options, instead of arch replacement while extending stent-graft into the arch. Outcomes vary with regard to extent of repair and aortic arch pathologies treated. Results of arch chimney and other parallel graft techniques perhaps make it a less preferable choice for elective cases. However, they are very appealing options for urgent or bailout situations. Fenestrated stent-grafting is subjected to many technical challenges in aortic arch due to difficulties in stent-graft orientation and fenestration positioning. In situ fenestration techniques emerge to avoid these problems, but durability of stent-grafts after fenestration and ischemic consequences of temporary carotid arteries coverage raises some concern total arch repair using this technique. Arch branched graft is a new technology. Early outcomes did not meet the expectation; however the results have been improving after its learning curve period. Refining stent-graft technologies and implantation techniques positively impact outcomes of endovascular approaches. PMID:26940011

  12. 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.

  13. necesidad de un tratamiento multidireccional

    Directory of Open Access Journals (Sweden)

    M Cardona

    2005-01-01

    Full Text Available Una mujer de 89 años fue hallada en su domicilio en coma, bradicárdica e hipotensa, tras la ingesta de bisoprolol y lorazepam en una tentativa de suicidio. Al administrar flumazenilo se obtuvo una mejoría en el estado de conciencia, pero la persistencia de la bradicardia, hipotensión y oligoanuria, motivaron una terapéutica intravenosa con fluidos y expansores del plasma y la administración sucesiva de glucagón, dopamina y adrenalina, hasta que la situación cardiocirculatoria se estabilizó a las 52 horas del ingreso. La evolución posterior fue favorable y la paciente fue dada de alta sin secuelas. Se discute el papel antidótico de estos fármacos en el tratamiento de la intoxicación por beta-bloqueantes

  14. Impact of graft composition on the systemic inflammatory response after an elective repair of an abdominal aortic aneurysm

    OpenAIRE

    Baek, Jong Kwan; Kwon, Hyunwook; Ko, Gi-Young; Kim, Min Joo; Han, Youngjin; Chung, Young Soo; Park, Hojong; Kwon, Tae-Won; Cho, Yong-Pil

    2014-01-01

    Purpose The present study aimed to evaluate the risk factors and the role of graft material in the development of an acute phase systemic inflammatory response, and the clinical outcome in patients who undergo endovascular aneurysm repair (EVAR) or open surgical repair (OSR) of an abdominal aortic aneurysm (AAA). Methods We retrospectively evaluated the risk factors and the role of graft material in an increased risk of developing systemic inflammatory response syndrome (SIRS), and the clinic...

  15. Hybrid procedure for a descending thoracic and subclavian artery aneurysm in a patient with previous abdominal aortic surgery: Case report

    Directory of Open Access Journals (Sweden)

    Radak Đorđe

    2015-01-01

    Full Text Available Introduction. Hybrid procedures represent staged or simultaneous endovascular and open surgical techniques in the treatment of complex pathologies of the thoracic and abdominal aorta. We are presenting a patient with previous abdominal aortic surgery in whom hybrid vascular procedure for descending aorta and left subclavian artery aneurysm was performed. Case Outline. A 63-year-old female patient was admitted for computed tomography angiography. Descending aorta aneurysm (7.6 cm as well as aneurysm of the left subclavian artery (LSA was noted. Eight years ago she underwent abdominal aortic aneurysm resection and aortoiliac bypass. Standard TEVAR (thoracic endovascular aortic repair procedure couldn’t be done due to small dimensions of previous “Y” graft (12.6 mm, so first we did LSA transposition and after three days hybrid procedure. After “Y” graft exposure, anastomosis between the corps of “Y” graft and tubular graft 10 mm was created and through this conduit thoracic stent-graft was placed followed by complete “Y” graft replacement. After 6 months angiography showed regular postoperative findings. Conclusion. Combined surgical and endovascular procedures in thoracic aorta pathology treatment could be useful solutions with favorable outcome. [Projekat Ministarstva nauke Republike Srbije, br. 41002

  16. Effect of radioactivity on stent-graft incorporation after endovascular treatment of aneurysms: An animal study.

    Science.gov (United States)

    Lerouge, Sophie; Raymond, Jean; Schloesser, Klaus; Gaboury, Louis; Soulez, Gilles

    2006-12-01

    Poor stent-graft (SG) incorporation into the vessel wall, following endovascular repair of abdominal aortic aneurysms (EVAR), can lead to endoleaks and SG migration. Low-dose radiation can prevent aneurysm recurrence after coil embolization, and has been associated with a "paradoxical" increase in neointima formation after stenting in a few studies. It was hypothesized that in situ beta radiation emitted from SG could improve its incorporation by preventing the persistence of circulating channels between the implant and the vessel wall and increasing neointima formation around the SG. Phosphorus 32 ((32)P, 200 or 400 kBq per SG (n = 6 each)) was ion implanted on the external surface of balloon-expandable SGs. Twelve radioactive and six non-radioactive SGs were deployed in iliac arteries of nine Mongrel dogs. Neointima formation inside the graft and the persistence of circulating flow through an artificial groove created during the endovascular procedure were assessed by follow-up imaging and by blinded, computerized histomorphometric analysis after animal sacrifice at 3 months. Occlusion occurred in four radioactive SGs. A lesser number of patent grooves was observed along high-activity SGs than along control SGs (1/3 versus 4/4). No difference in neointima formation was observed in radioactive and non-radioactive SGs. Alteration of external graft surface was observed after ion implantation. Ion implantation of (32)P on SGs does not seem to be a viable strategy to improve incorporation and prevent type-I endoleak after EVAR.

  17. Quantified Aortic Luminal Irregularity as a Predictor of Complications and Prognosis After Endovascular Aneurysm Repair

    Science.gov (United States)

    Hosaka, Akihiro; Kato, Masaaki; Motoki, Manabu; Sugai, Hiroko; Okubo, Nobukazu

    2016-01-01

    Abstract Atheromatous degeneration of the aorta is considered to be a risk factor for postoperative embolic complications after endovascular treatment, and is associated with a high incidence of vascular events in the long term. We devised a method to quantify the shagginess of the aorta using contrast-enhanced computed tomography (CT) images. This study examined the method's validity and prognostic usefulness in patients undergoing elective endovascular abdominal aortic aneurysm repair (EVAR). We retrospectively investigated 427 patients who underwent elective EVAR between 2007 and 2013. Preoperative contrast-enhanced CT images with a slice thickness of 1 mm were analyzed using a workstation, and the degree of aortic luminal irregularity from the level of the left subclavian artery ostium to that of the celiac artery ostium was quantified by computing a shagginess score. We compared the computed scores with subjective visual assessments of aortic shagginess. Subsequently, we evaluated the relationship between the computed scores and postoperative prognosis. The shagginess scores were significantly correlated with the visual assessments of the aortic lumen, which were performed by 5 experienced vascular surgeons (rho ranged from 0.564–0.654, all P EVAR (odds ratio, 2.78; 95% confidence interval [CI], 1.83–4.22, P EVAR. PMID:26945368

  18. Endovascular treatment of post-laparoscopic pancreatectomy splenic arteriovenous fistula with splenic vein aneurysm.

    Science.gov (United States)

    Ueda, Tatsuo; Murata, Satoru; Yamamoto, Akira; Tamai, Jin; Kobayashi, Yuko; Hiranuma, Chiaki; Yoshida, Hiroshi; Kumita, Shin-Ichiro

    2015-07-01

    Splenic arteriovenous fistulas (SAVFs) with splenic vein aneurysms are extremely rare entities. There have been no prior reports of SAVFs developing after laparoscopic pancreatectomy. Here, we report the first case. A 40-year-old man underwent a laparoscopic, spleen-preserving, distal pancreatectomy for an endocrine neoplasm of the pancreatic tail. Three months after surgery, a computed tomography (CT) scan demonstrated an SAVF with a dilated splenic vein. The SAVF, together with the splenic vein aneurysm, was successfully treated using percutaneous transarterial coil embolization of the splenic artery, including the SAVF and drainage vein. After the endovascular treatment, the patient's recovery was uneventful. He was discharged on postoperative day 6 and continues to be well 3 mo after discharge. An abdominal CT scan performed at his 3-mo follow-up demonstrated complete thrombosis of the splenic vein aneurysm, which had decreased to a 40 mm diameter. This is the first reported case of SAVF following a laparoscopic pancreatectomy and demonstrates the usefulness of endovascular treatment for this type of complication.

  19. Endovascular exclusion of a large external iliac vein aneurysm.

    Science.gov (United States)

    Todorov, Mina; Hernandez, Diego

    2013-07-01

    Iliac vein aneurysms are uncommon, and there is no consensus on optimal treatment. We present a case of venous exclusion using an endovascular approach. To our knowledge, this is the first reported case of a large external iliac vein aneurysm treated endovascularly. We have demonstrated the feasibility of this approach with satisfactory 1-year follow-up.

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

    DEFF Research Database (Denmark)

    De La Motte, L; Vogt, K; Jensen, Leif Panduro;

    2011-01-01

    The aim of this study was to estimate the incidence of the post-implantation syndrome/systemic inflammatory response syndrome (SIRS) after endovascular aortic repair.......The aim of this study was to estimate the incidence of the post-implantation syndrome/systemic inflammatory response syndrome (SIRS) after endovascular aortic repair....

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-08-15

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

  3. Complex Regional Pain Syndrome Type II Secondary to Endovascular Aneurysm Repair

    Directory of Open Access Journals (Sweden)

    Hamilton Chen

    2015-01-01

    Full Text Available Complex regional pain syndrome (CRPS is a chronic pain disorder characterized by severe pain and vasomotor and pseudomotor changes. Endovascular aneurysm repair (EVAR of abdominal aortic aneurysms is a recent advance in vascular surgery that has allowed repair of AAA while offering reduced intensive care unit and hospital lengths of stay, reduced blood loss, fewer major complications, and more rapid recovery. Pseudoaneurysms are a rare complication of an EVAR procedure that may result in a wide range of complications. The present report examines CRPS type II as a novel consequence of pseudoaneurysm formation from brachial artery access in the EVAR procedure. To our knowledge, this is the first reported case of CRPS type II presentation as sequelae of an EVAR procedure.

  4. 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. PMID:26673398

  5. Vestibular system paresis due to emergency endovascular catheterization

    Directory of Open Access Journals (Sweden)

    Simoceli, Lucinda

    2012-01-01

    Full Text Available 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 ragged 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.

  6. Abdominal emergencies in pediatrics.

    Science.gov (United States)

    Coca Robinot, D; Liébana de Rojas, C; Aguirre Pascual, E

    2016-05-01

    Abdominal symptoms are among the most common reasons for pediatric emergency department visits, and abdominal pain is the most frequently reported symptom. Thorough history taking and physical examination can often reach the correct diagnosis. Knowing the abdominal conditions that are most common in each age group can help radiologists narrow the differential diagnosis. When imaging tests are indicated, ultrasonography is usually the first-line technique, enabling the diagnosis or adding relevant information with the well-known advantages of this technique. Nowadays, plain-film X-ray studies are reserved for cases in which perforation, bowel obstruction, or foreign body ingestion is suspected. It is also important to remember that abdominal pain can also occur secondary to basal pneumonia. CT is reserved for specific indications and in individual cases, for example, in patients with high clinical suspicion of abdominal disease and inconclusive findings at ultrasonography. We review some of the most common conditions in pediatric emergencies, the different imaging tests indicated in each case, and the imaging signs in each condition.

  7. Endovascular treatment for intracranial infectious aneurysms Tratamento endovascular de aneurismas infecciosos intracranianos

    Directory of Open Access Journals (Sweden)

    Eduardo Wajnberg

    2008-12-01

    Full Text Available OBJETIVE: To re-enforce an alternative, less aggressive treatment modality in the management of intracranial infectious aneurysms. METHOD: We present a series of five patients with infectious endocarditis and intracranial infectious aneurysms (mycotic aneurysms managed by means of endovascular treatment. RESULTS: Endovascular treatment was executed technically uneventfully in all patients. Three patients had favorable clinical outcome: two were classified as Glasgow Outcome Scale 4/5, and one had total neurological recovery (GOS 5/5. Two patients died (GOS 1/5, one in consequence of the initial intracranial bleeding and the other after cardiac complications from endocarditis and open-heart surgery. CONCLUSION: Endovascular techniques are an expanding option for the treatment of IIAs. It has been especially useful for infectious endocarditis patients with IIA, who will be submitted to cardiac surgery with cardiopulmonary bypass and anticoagulation, with the risk of intracranial bleeding.OBJETIVO: Enfatizar o método endovascular como uma opção de tratamento alternativa e menos agressiva no tratamento de aneurismas infecciosos intracranianos. MÉTODO: Apresentamos uma série de cinco pacientes com endocardite infecciosa e aneurismas infecciosos intra-cranianos (aneurismas micóticos tratados através da via endovascular. RESULTADOS: O tratamento endovascular teve sucesso técnico e sem intercorrências relacionadas ao cateterismo em todos os casos. Três pacientes tiveram desfecho clínico favorável: dois com escala de regeneração de Glasgow 4/5 e um com recuperação neurológica completa (GOS 5/5. Dois pacientes tiveram desfecho desfavorável (GOS 1/5, um devido às conseqüências do sangramento intracraniano inicial e outro devido a complicações cardíacas da endocardite e cirurgia de troca valvar. CONCLUSÃO: As técnicas endovasculares são uma nova opção de tratamento dos aneurismas infecciosos intracranianos. Ela é especialmente

  8. Tratamiento conservador en pacientes con retinoblastoma bilateral

    OpenAIRE

    Juan C. Suárez; Mabel C. Ospina; Sandra A. Arias; González, María E

    2008-01-01

    OBJETIVO: comparar el tratamiento convencional del retinoblastoma bilateral, usado hasta hace algunos años, consistente en radioterapia o enucleación bilateral, con el tratamiento conservador actual que incluye termoterapia transpupilar (TTT) o TTT/quimioterapia al menos en un ojo, en niños con diagnóstico de retinoblastoma bilateral. DISEÑO: estudio retrospectivo descriptivo. MUESTRA: 20 pacientes con diagnóstico de retinoblastoma bilateral que consultaron al Hospital Universitario San Vicen...

  9. Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management

    Science.gov (United States)

    Scaife, Mark; Giannakopoulos, Triantafillos; Al-Khoury, Georges E.; Chaer, Rabih A.; Avgerinos, Efthymios D.

    2016-01-01

    Ultrasound (US) is a well-established screening tool for detection of abdominal aortic aneurysms (AAAs) and is currently recommended not only for those with a relevant family history but also for all men and high-risk women older than 65 years of age. The advent of minimally invasive endovascular techniques in the treatment of AAAs [endovascular aneurysm repair (EVAR)] has increased the need for repeat imaging, especially in the postoperative period. Nevertheless, preoperative planning, intraoperative execution, and postoperative surveillance all mandate accurate imaging. While computed tomographic angiography and angiography have dominated the field, repeatedly exposing patients to the deleterious effects of cumulative radiation and intravenous nephrotoxic contrast, US technology has significantly evolved over the past decade. In addition to standard color duplex US, 2D, 3D, or 4D contrast-enhanced US modalities are revolutionizing AAA management and postoperative surveillance. This technology can accurately measure AAA diameter and volume, and most importantly, it can detect endoleaks post-EVAR with high sensitivity and specificity. 4D contrast-enhanced US can even provide hemodynamic information about the branch vessels following fenestrated EVARs. The need for experienced US operators and accredited vascular labs is mandatory to guarantee the reliability of the results. This review article presents a comprehensive overview of the literature on the state-of-art US imaging in AAA management, including post-EVAR follow-up, techniques, and diagnostic accuracy. PMID:27303669

  10. Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management.

    Science.gov (United States)

    Scaife, Mark; Giannakopoulos, Triantafillos; Al-Khoury, Georges E; Chaer, Rabih A; Avgerinos, Efthymios D

    2016-01-01

    Ultrasound (US) is a well-established screening tool for detection of abdominal aortic aneurysms (AAAs) and is currently recommended not only for those with a relevant family history but also for all men and high-risk women older than 65 years of age. The advent of minimally invasive endovascular techniques in the treatment of AAAs [endovascular aneurysm repair (EVAR)] has increased the need for repeat imaging, especially in the postoperative period. Nevertheless, preoperative planning, intraoperative execution, and postoperative surveillance all mandate accurate imaging. While computed tomographic angiography and angiography have dominated the field, repeatedly exposing patients to the deleterious effects of cumulative radiation and intravenous nephrotoxic contrast, US technology has significantly evolved over the past decade. In addition to standard color duplex US, 2D, 3D, or 4D contrast-enhanced US modalities are revolutionizing AAA management and postoperative surveillance. This technology can accurately measure AAA diameter and volume, and most importantly, it can detect endoleaks post-EVAR with high sensitivity and specificity. 4D contrast-enhanced US can even provide hemodynamic information about the branch vessels following fenestrated EVARs. The need for experienced US operators and accredited vascular labs is mandatory to guarantee the reliability of the results. This review article presents a comprehensive overview of the literature on the state-of-art US imaging in AAA management, including post-EVAR follow-up, techniques, and diagnostic accuracy. PMID:27303669

  11. Childhood abdominal cystic lymphangioma

    International Nuclear Information System (INIS)

    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

  12. Abdominal Dual Energy Imaging

    Science.gov (United States)

    Sommer, F. Graham; Brody, William R.; Cassel, Douglas M.; Macovski, Albert

    1981-11-01

    Dual energy scanned projection radiography of the abdomen has been performed using an experimental line-scanned radiographic system. Digital images simultaneously obtained at 85 and 135 kVp are combined, using photoelectric/Compton decomposition algorithms to create images from which selected materials are cancelled. Soft tissue cancellation images have proved most useful in various abdominal imaging applications, largely due to the elimination of obscuring high-contrast bowel gas shadows. These techniques have been successfully applied to intravenous pyelography, oral cholecystography, intravenous abdominal arteriog-raphy and the imaging of renal calculi.

  13. 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

  14. 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.

  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. Endovascular revascularization for aortoiliac atherosclerotic disease

    Science.gov (United States)

    Aggarwal, Vikas; Waldo, Stephen W; Armstrong, Ehrin J

    2016-01-01

    Atherosclerotic iliac artery disease is increasingly being treated with endovascular techniques. A number of new stent technologies can be utilized with high long-term patency, including self-expanding stents, balloon-expandable stents, and covered stents, but comparative data on these stent types and in more complex lesions are lacking. This article provides a review of currently available iliac stent technologies, as well as complex procedural aspects of iliac artery interventions, including approaches to the treatment of iliac bifurcation disease, long segment occlusions, choice of stent type, and treatment of iliac artery in-stent restenosis. PMID:27099509

  17. Carotid artery revascularization : Surgical and endovascular developments

    OpenAIRE

    de Borst, G. J.

    2007-01-01

    Carotid artery revascularization. Surgical and endovascular developments. Stroke is among the most disabling chronic diseases and the third major cause of death in the Western world. In the Netherlands around 12 per 1000 inhabitants suffers a stroke, and in 2005 over 10.000 people died as a result of stroke representing 7.6% of all deaths. In 10-20% of patients stroke is heralded by transient cerebral deficit. These harbingers of stroke allow a certain amount of time to search for the cause o...

  18. CEREBRAL ARTERIOVENOUS MALFORMATIONS IN CHILDREN. ENDOVASCULAR TREATMENT

    OpenAIRE

    Scheglov, D.; Zagorodniy, V.

    2013-01-01

    The objective — to learn the features of the cerebral arteriovenous malformations (АVМ) endovascular treatment in children. Materials and methods. Totally 39 children with cerebral AVMs were treated at the center from 2005 to 2012. The average age of the patients (12.6 ± 1.2) years. It was found that the most of AVMs were occurred in temporoparietal subcortical area — 46.2 % cases. Results. Small size of AVMs were detected in 15.4 % of patients, the middle — in 33.3 %, the large — in 38.5 %, ...

  19. Dolor abdominal agudo: Enfoque para el médico de atención primaria

    Directory of Open Access Journals (Sweden)

    Camilo Eduardo Lozano Bretón

    2012-08-01

    Full Text Available El dolor abdominal es una causa frecuente de consulta en cualquier servicio de urgencias, y por esto, los médicos de atención primaria deben conocer las patologías que puedan poner en peligro la vida de sus pacientes. Se hace una revisión de las patologías mas frecuentemente asociadas a dolor abdominal en el ámbito de urgencias, y se hace énfasis en los medios por los que se puede llegar al diagnóstico adecuado y los conceptos generales del tratamiento de cada una de estas condiciones.

  20. 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.

  1. Physicians' Abdominal Auscultation

    DEFF Research Database (Denmark)

    John, Gade; Peter, Kruse; Andersen, Ole Trier;

    1998-01-01

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

  2. Children's (Pediatric) Abdominal Ultrasound Imaging

    Medline Plus

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

  3. Endovascular repair of a tuberculous aneurysm of descending thoracic aorta

    Institute of Scientific and Technical Information of China (English)

    WANG Yong; ZHANG Jian; YIN Ming-di; WANG Shao-ye; DUAN Zhi-quan; XIN Shi-jie

    2011-01-01

    Tuberculous aortic aneurysm (TBAA) is an extremely rare clinical event with life-threatening implication. Management for this condition is challenging and its therapeutic option has not been yet established. A few recent reports described endovascular repair rather than open surgery as the method for treatment. Although this remains controversial,endovascular exclusion has been gaining acceptance for some surgeons. We present a case of TBAA who was treated by endovascular stent grafting for a descending thoracic aortic aneurysm with simultaneous anti-tuberculous medication.The outcome was favorable.

  4. [Endovascular repair for coarctation of the aorta in an adult].

    Science.gov (United States)

    Hayashi, Jun; Abe, Kazuo; Hata, Masaki; Nagano, Naoko; Hamasaki, Azumi; Suzuki, Kenji

    2013-09-01

    A 27-year-old woman with Turner's syndrome who underwent successful endovascular treatment for coarctation of the aorta is presented. She was admitted to our hospital complaining of upper extremity hypertension. Computed tomography revealed discrete stenosis of the proximal descending aorta and developed collateral circulation. After endovascular repair with a balloon expandable stent, her transcoarctation gradient fell from 44 mmHg preoperatively to less than 10 mmHg. She was discharged with no complications on the 7th postoperative day. Coarctation of the aorta in an adult patient could be safely and effectively managed by endovascular treatment.

  5. Endovascular aortic repair: First twenty years

    Directory of Open Access Journals (Sweden)

    Končar Igor

    2012-01-01

    Full Text Available Endovascular aortic/aneurysm repair (EVAR was introduced into clinical practice at the beginning of the nineties. Its fast development had a great influence on clinicians, vascular surgeons and interventional radiologists, educational curriculums, patients, industry and medical insurance. The aim of this paper is to present the contribution of clinicians and industry to the development and advancement of endovascular aortic repair over the last 20 years. This review article presents the development of EVAR by focusing on the contribution of physicians, surgeons and interventional radiologists in the creation of the new field of vascular surgery termed hybrid vascular surgery, and also the contribution of technological advancement by a significant help of industrial representatives – engineers and their counselors. This article also analyzes studies conducted in order to compare the successfulness of EVAR with up-to-now applied open surgical repair of aortic aneurysms, and some treatment techniques of other aortic diseases. During the first two decades of its development the EVAR method was rapidly progressing and was adopted concurrently with the expansion of technology. Owing to large randomized studies, early and long-term results indicate specific complications of this method, thus influencing further technological improvement and defining risk patients groups in whom the use of the technique should be avoided. Good results are insured only in centers, specialized in vascular surgery, which have on their disposal adequate conditions for solving all complications associated with this method.

  6. Endovascular treatment of iliac vein compression syndrome

    Institute of Scientific and Technical Information of China (English)

    MENG Qing-you; LI Xiao-qiang; QIAN Ai-min; SANG Hong-fei; RONG Jian-jie; ZHU Li-wei

    2011-01-01

    Background Iliac vein compression syndrome (IVCS),the symptomatic compression of the left common iliac vein between the right common iliac artery and the vertebrae,is not an uncommon condition.The aim of this research was to retrospectively evaluate long-term outcome and the significance of endovascular treatment in patients with left IVCS.Methods Between January 1997 and September 2008,296 patients received interventional therapy in the left common iliac vein.In the second stage,170 cases underwent saphenous vein high ligation and stripping.Two hundred and thirty-one cases were followed up over a period of 6 to 120 months (average 46 months) and evaluated for symptom improvement with color ultrasound and ascending venography.Results The stenotic or occlusive segments of the left iliac vein were successfully dilated in 285 cases,of whom 272 received stent implantation therapy.Most of the patients achieved satisfactory results on discharge.During the follow-up period,varicose veins were alleviated in 98.7% of the patients,and leg swelling disappeared or was obviously relieved in 84% of cases.About 85% of leg ulcers completely healed.The total patency rate was 91.7% as evaluated with color ultrasound and 91.5% with ascending venography.Conclusions Endovascular treatment of IVCS provides effective symptomatic improvement and good long-term patency in most patients.

  7. 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

  8. 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.

  9. Endovascular treatment of vasculogenic erectile dysfunction

    Institute of Scientific and Technical Information of China (English)

    Edward D Kim; Ryan C Owen; Gregory S White; Osama O Elkelany; Cyrus D Rahnema

    2015-01-01

    The treatment of erectile dysfunction (ED) has been a fascination involving multiple medical specialities over the past century with urologic, cardiac and surgical experts all contributing knowledge toward this multifactorial disease. With the well‑described association between ED and cardiovascular disease, angiography has been utilized to identify vasculogenic impotence. Given the success of endovascular drug‑eluting stent (DES) placement for the treatment of coronary artery disease, there has been interest in using this same technology for the treatment of vasculogenic ED. For men with inflow stenosis, DES placement to bypass arterial lesions has recently been reported with a high technical success rate. Comparatively, endovascular embolization as an approach to correct veno‑occlusive dysfunction has produced astonishing procedural success rates as well. However, after a thorough literature review, arterial intervention is only recommended for younger patients with isolated vascular injuries, typically from previous traumatic experiences. Short‑term functional outcomes are less than optimal with long‑term results yet to be determined. In conclusion, the hope for a minimally invasive approach to ED persists but additional investigation is required prior to universal endorsement.

  10. Endovascular treatment of acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Paramdeep Singh

    2013-01-01

    Full Text Available Early recanalization of the occluded artery leads to better clinical outcomes in patients with acute ischemic stroke (AIS through protection of the time-sensitive penumbra. Intravenous administration of pharmacologic thrombolytic agents has been a standard treatment for AIS. To get better rates of recanalization, enhance the time window, and diminish the possibility of intracranial hemorrhage, endovascular thrombectomy was launched, with first authorization of the Merci clot retriever, a corkscrew-like apparatus, followed by approval of the Penumbra thromboaspiration system. Both devices lead to a high rate of recanalization. On the other hand, time to recanalization was on an average of 45 minutes, with most of the patients attaining only partial recanalization. More lately, retrievable stents have shown promise in decreasing the time to recanalization, and attaining a superior rate of complete clot resolution. The retrievable stent can be released within the clot to engage it within the struts of the stent, and afterwards it is taken back by pulling it under flow arrest. Neurointerventional techniques have a persistently ever-increasing and stimulating role in the management of AIS, as indicated by the advent of several important techniques. Stent retrievers have the capability to be ascertained as the most important approach to endovascular stroke treatment.

  11. Endovascular therapeutic strategies in ruptured intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Machi, Paolo, E-mail: paolo.machi@gmail.com [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Lobotesis, Kyriakos, E-mail: kyriakos@lobotesis.co.uk [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Vendrell, Jean Francoise, E-mail: jfvendrell@yahoo.fr [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Riquelme, Carlos, E-mail: riquelme.carlos@neuf.fr [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Eker, Omer, E-mail: eker_omer@yahoo.fr [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Costalat, Vincent, E-mail: vincentcost@hotmail.com [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France); Bonafe, Alain, E-mail: bonafeh@aol.com [CHRU Montpellier, Service de Neurorradiologie, Hopital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5 (France)

    2013-10-01

    The aim of the present study was to evaluate endovascular techniques used currently which were not available at the time of ISAT inclusion period, such as balloon remodelling and flow-divertion, in order to assess whether these new technologies have improved the endovascular approach outcomes. We present a review of articles, published in major journals, with the aim to evaluate the efficacy and the safety of coiling with balloon remodelling for the treatment of ruptured aneurysms in comparison to coiling performed without such coadjutant techniques. Furthermore, we reviewed publications reporting on the treatment of ruptured aneurysms in the acute phase with the one of the most recent technologies available nowadays: the flow diverting stent. Looking at the recent literature the results regarding ruptured aneurysms treated with balloon assisted coiling (BAC) have shown an improvement in terms of anatomical results and morbi-mortality rates. Case series of ruptured middle cerebral artery (MCA) aneurysms treated by EVT report results similar to those obtained by surgical clipping. Several articles recently report encouraging results in treating ruptured dissecting and blister aneurysms with flow diverters. Questions regarding the best treatment available for ruptured aneurysms are yet to be answered. Hence there is a need for a subsequent trial aiming to answer these unresolved issues.

  12. Abdominal aorta coarctation: The first three case reports in our literature

    Directory of Open Access Journals (Sweden)

    Gajin Predrag

    2010-01-01

    Full Text Available Introduction. Congenital coarctation of the thoracic aorta at the ligamentum arteriosum or the aortic arch is well recognized. But a much less common variety (0.5-2.0% of aortic coarctation is located in the distal thoracic aorta or abdominal aorta or both and is often called 'middle aortic syndrome' or 'midaortic dysplastic syndrome'. This represents serious pathological condition and indicates multidisciplinary therapy approach. Outline of Cases. From 1996 to 2007, at the Vascular Surgery Clinic of the Institute for Cardiovascular Diseases 'Dedinje', Belgrade, three patients were treated due to abdominal aorta coarctation, two females aged 55 and 50 and a 4-year-old child. The patients were treated surgically (by-pass with a prosthetic graft and patch angioplasty and endovascular-percutaneous transluminal angioplasty (PTA with and without a stent. The follow-up period was 3-70 months. In the 50-year-old patient, angiography showed severe narrowing of the suprarenal segment of the abdominal aorta. Thoraco-abdominal bypass with a 16 mm dacronic tubular graft was performed. In the 4-year-old patient angiography also showed a suprarenal aorta narrowing. In the first act patch angioplasty was performed and after PTA of the visceral arteries was done on several occasions. In the 55-year-old patient, after diagnostic angiography, infrarenal aorta coarctation was registered. PTA was performed with stent placement. All patients were asymptomatic on control check-ups. Conclusion. Abdominal coarctation is a pathological disease which is seldom found in vascular surgery. Angiography is of major importance for setting the diagnosis and for the control of the results of surgical and nonsurgical treatment. The combination of surgical and endovascular treatment in our patients showed very good results in the studied period.

  13. Expanding current EVAR indications to include small abdominal aortic aneurysms: a glimpse of the future.

    Science.gov (United States)

    Georgakarakos, Efstratios; Ioannou, Christos V; Georgiadis, George S; Kapoulas, Konstantinos; Schoretsanitis, Nikolaos; Lazarides, Miltos

    2011-08-01

    The traditional criterion of maximum transverse diameter is not sufficient to differentiate the small abdominal aortic aneurysms (AAAs) that are either prone to rupture or prone to enlarge rapidly. Wall stress may be a more reliable indicator with respect to these tasks. We review the importance of geometric features in rupture- or growth-predictive models and stress the need for further evaluation and validation of geometric indices. This study may lead to identifying those small AAAs that could justify early endovascular intervention. PMID:21422056

  14. 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

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

    International Nuclear Information System (INIS)

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

  16. 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

  17. 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.

  18. Radiation Exposure of Abdominal Cone Beam Computed Tomography

    Energy Technology Data Exchange (ETDEWEB)

    Sailer, Anna M., E-mail: anni.sailer@mumc.nl [Maastricht University Medical Centre (MUMC), Department of Radiology (Netherlands); Schurink, Geert Willem H., E-mail: gwh.schurink@mumc.nl [Maastricht University Medical Centre, Department of Surgery (Netherlands); Wildberger, Joachim E., E-mail: j.wildberger@mumc.nl; Graaf, Rick de, E-mail: r.de.graaf@mumc.nl; Zwam, Willem H. van, E-mail: w.van.zwam@mumc.nl; Haan, Michiel W. de, E-mail: m.de.haan@mumc.nl; Kemerink, Gerrit J., E-mail: gerrit.kemerink@mumc.nl; Jeukens, Cécile R. L. P. N., E-mail: cecile.jeukens@mumc.nl [Maastricht University Medical Centre (MUMC), Department of Radiology (Netherlands)

    2015-02-15

    PurposeTo evaluate patients radiation exposure of abdominal C-arm cone beam computed tomography (CBCT).MethodsThis prospective study was approved by the institutional review board; written, informed consent was waived. Radiation exposure of abdominal CBCT was evaluated in 40 patients who underwent CBCT during endovascular interventions. Dose area product (DAP) of CBCT was documented and effective dose (ED) was estimated based on organ doses using dedicated Monte Carlo simulation software with consideration of X-ray field location and patients’ individual body weight and height. Weight-dependent ED per DAP conversion factors were calculated. CBCT radiation dose was compared to radiation dose of procedural fluoroscopy. CBCT dose-related risk for cancer was assessed.ResultsMean ED of abdominal CBCT was 4.3 mSv (95 % confidence interval [CI] 3.9; 4.8 mSv, range 1.1–7.4 mSv). ED was significantly higher in the upper than in the lower abdomen (p = 0.003) and increased with patients’ weight (r = 0.55, slope = 0.045 mSv/kg, p < 0.001). Radiation exposure of CBCT corresponded to the radiation exposure of on average 7.2 fluoroscopy minutes (95 % CI 5.5; 8.8 min) in the same region of interest. Lifetime risk of exposure related cancer death was 0.033 % or less depending on age and weight.ConclusionsMean ED of abdominal CBCT was 4.3 mSv depending on X-ray field location and body weight.

  19. Component separation in abdominal trauma.

    Science.gov (United States)

    Rawstorne, Edward; Smart, Christopher J; Fallis, Simon A; Suggett, Nigel

    2014-01-01

    Component separation is established for complex hernia repairs. This case presents early component separation and release of the anterior and posterior sheath to facilitate closure of the abdominal wall following emergency laparotomy, reinforcing the repair with a biological mesh. On Day 11 following an emergency laparotomy for penetrating trauma, this patient underwent component separation and release of the anterior and posterior sheath. An intra-abdominal biological mesh was secured, and the fascia and skin closed successfully. Primary abdominal closure can be achieved in patients with penetrating abdominal trauma with the use of component separation and insertion of intra-abdominal biological mesh, where standard closure is not possible. PMID:24876334

  20. 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?

  1. Enhancing brain lesions after endovascular treatment of aneurysms

    DEFF Research Database (Denmark)

    Cruz, J P; Marotta, T; O'Kelly, C;

    2014-01-01

    Complications of endovascular therapy of aneurysms mainly include aneurysm rupture and thromboembolic events. The widespread use of MR imaging for follow-up of these patients revealed various nonvascular complications such as aseptic meningitis, hydrocephalus, and perianeurysmal brain edema. We...

  2. Thoracic endovascular aortic repair for complicated chronic type B aortic dissection in a patient on hemodialysis with recurrent ischemic colitis.

    Science.gov (United States)

    Miyazaki, Yuko; Furuyama, Tadashi; Matsubara, Yutaka; Yoshiya, Keiji; Yoshiga, Ryosuke; Inoue, Kentaro; Matsuda, Daisuke; Aoyagi, Yukihiko; Kato, Masaaki; Matsumoto, Takuya; Maehara, Yoshihiko

    2016-12-01

    We present a successful case of thoracic endovascular aortic repair (TEVAR) for chronic Stanford type B aortic dissection (B-AD) with recurrent ischemic colitis. The patient was a 56-year-old woman with abdominal pain as the main complaint who had two operations previously: the total arch replacement 8 years ago and the Bentall 7 years ago for acute Stanford type A aortic dissection. Her abdominal pain worsened as her blood pressure became low during her hemodialysis treatment. An enhanced computed tomography scan was performed on the patient and showed chronic B-AD that occurred from the distal anastomotic part of the total arch graft to the bilateral common iliac arteries. The celiac artery and superior mesenteric artery (SMA) arose from the true lumen, and these were compressed by the expanded false lumen. Her complicated chronic B-AD was treated with the Zenith Dissection Endovascular System, and its procedure was performed as her proximal entry tear was covered by a proximal tapered Zenith TX2 stent graft, supplemented by a noncovered aortic stent extending across both renal arteries, the SMA, and the celiac artery. Seven days after this operation, enhanced computed tomography showed that the patient's true lumen was expanded and her blood flow to the true lumen and SMA was improved. On the other hand, her false lumen tended to be thrombosed. Consequently, she was discharged 10 days after the operation without any postoperative complications as she had no abdominal complaints even though she underwent hemodialysis three times per week after the operation. We believe that TEVAR supplemented by a noncovered aortic stent is an effective treatment, even for highly chronic B-AD in dialysis patients. PMID:27090121

  3. Tratamiento de la osteoporosis grave con teriparatide

    Directory of Open Access Journals (Sweden)

    Marcelo A. Sarli

    2013-10-01

    Full Text Available El objetivo de este trabajo retrospectivo fue evaluar el tratamiento de la osteoporosis grave con teriparatide (PTH y comparar nuestros resultados con los publicados en la literatura médica. Se incluyeron cuarenta y seis pacientes, cuarenta y dos mujeres y cuatro varones, edad: 69.15 ± 9.43 años. Seis eran vírgenes de tratamiento y cuarenta tratados previamente con bisfosfonatos. Treinta y dos pacientes habían tenido 93 fracturas de las cuales 86 vertebrales. Cuarenta y seis recibieron PTH 6 meses, 29 pacientes durante 12 meses y 20 completaron los 18 meses sugeridos. La densidad mineral ósea (DMO de columna lumbar aumentó significativamente desde el primer control a los 6 meses (p < 0.0001. La DMO de cuello de fémur alcanzó un incremento significativo al final del tratamiento (p = 0.002. La osteocalcina aumentó significativamente al mes, seguido por el ß crosslaps (beta-CTx, prueba en suero al tercer mes y la fosfatasa alcalina ósea, regresando los marcadores de recambio óseo a niveles basales a los 18 meses. Las calcemias y las calciurias no se modificaron significativamente, pero 8 pacientes tuvieron hipercalcemias leves y tres hipercalciurias asintomáticas. El tratamiento fue bien tolerado y no se registraron efectos adversos graves que requirieran suspender el tratamiento. En conclusión, la PTH es una alternativa útil y segura para el tratamiento de la osteoporosis grave. Nuestros resultados concuerdan con los previamente publicados en la literatura médica.

  4. Advances in Abdominal Aortic Aneurysm Care - Towards personalized, centralized and endovascular care

    NARCIS (Netherlands)

    S.C. van Beek

    2014-01-01

    Dit proefschrift gaat over patiënten met een verwijde buikslagader; een aneurysma van de abdominale aorta (AAA). Een AAA moet worden geopereerd ter voorkoming van ruptuur indien de verwijding groter is dan 5,5 cm. Een ruptuur is een spontane lekkage uit het aneurysma waarbij een patiënt vaak binnen

  5. Advances in Abdominal Aortic Aneurysm Care - Towards personalized, centralized and endovascular care

    OpenAIRE

    van Beek

    2014-01-01

    Dit proefschrift gaat over patiënten met een verwijde buikslagader; een aneurysma van de abdominale aorta (AAA). Een AAA moet worden geopereerd ter voorkoming van ruptuur indien de verwijding groter is dan 5,5 cm. Een ruptuur is een spontane lekkage uit het aneurysma waarbij een patiënt vaak binnen 24 uur overlijdt door verbloeding. Dit proefschrift bevat drie onderdelen. In het eerste onderdeel is de toegevoegde waarde van predictiemodellen onderzocht. Een predictiemodel berekent voor indivi...

  6. Should Endovascular Repair Be Reimbursed for Low Risk Abdominal Aortic Aneurysm Patients? Evidence from Ontario, Canada

    Directory of Open Access Journals (Sweden)

    Jean-Eric Tarride

    2011-01-01

    Full Text Available Background. This paper presents unpublished clinical and economic data associated with open surgical repair (OSR in low risk (LR patients and how it compares with EVAR and OSR in high risk (HR patients with an AAA > 5.5 cm. Design. Data from a 1-year prospective observational study was used to compare EVAR in HR patients versus OSR in HR and LR patients. Results. Between 2003 and 2005, 140 patients were treated with EVAR and 195 with OSR (HR: 52; LR: 143. The 1-year mortality rate with EVAR was statistically lower than HR OSR patients and comparable to LR OSR patients. One-year health-related quality of life was lower in the EVAR patients compared to OSR patients. EVAR was cost-effective compared to OSR HR but not when compared to OSR LR patients. Conclusions. Despite a similar clinical effectiveness, these results suggest that, at the current price, EVAR is more expensive than open repair for low risk patients.

  7. Obesity-Associated Abdominal Elephantiasis

    Directory of Open Access Journals (Sweden)

    Ritesh Kohli

    2013-01-01

    Full Text Available Abdominal elephantiasis is a rare entity. Abdominal elephantiasis is an uncommon, but deformative and progressive cutaneous disease caused by chronic lymphedema and recurrent streptococcal or Staphylococcus infections of the abdominal wall. We present 3 cases of patients with morbid obesity who presented to our hospital with abdominal wall swelling, thickening, erythema, and pain. The abdominal wall and legs were edematous, with cobblestone-like, thickened, hyperpigmented, and fissured plaques on the abdomen. Two patients had localised areas of skin erythema, tenderness, and increased warmth. There was purulent drainage from the abdominal wall in one patient. They were managed with antibiotics with some initial improvement. Meticulous skin care and local keratolytic treatment for the lesions were initiated with limited success due to their late presentation. All three patients refused surgical therapy. Conclusion. Early diagnosis is important for the treatment of abdominal elephantiasis and prevention of complications.

  8. The abdominal circulatory pump.

    Directory of Open Access Journals (Sweden)

    Andrea Aliverti

    Full Text Available Blood in the splanchnic vasculature can be transferred to the extremities. We quantified such blood shifts in normal subjects by measuring trunk volume by optoelectronic plethysmography, simultaneously with changes in body volume by whole body plethysmography during contractions of the diaphragm and abdominal muscles. Trunk volume changes with blood shifts, but body volume does not so that the blood volume shifted between trunk and extremities (Vbs is the difference between changes in trunk and body volume. This is so because both trunk and body volume change identically with breathing and gas expansion or compression. During tidal breathing Vbs was 50-75 ml with an ejection fraction of 4-6% and an output of 750-1500 ml/min. Step increases in abdominal pressure resulted in rapid emptying presumably from the liver with a time constant of 0.61+/-0.1SE sec. followed by slower flow from non-hepatic viscera. The filling time constant was 0.57+/-0.09SE sec. Splanchnic emptying shifted up to 650 ml blood. With emptying, the increased hepatic vein flow increases the blood pressure at its entry into the inferior vena cava (IVC and abolishes the pressure gradient producing flow between the femoral vein and the IVC inducing blood pooling in the legs. The findings are important for exercise because the larger the Vbs the greater the perfusion of locomotor muscles. During asystolic cardiac arrest we calculate that appropriate timing of abdominal compression could produce an output of 6 L/min. so that the abdominal circulatory pump might act as an auxiliary heart.

  9. The Abdominal Circulatory Pump

    OpenAIRE

    Andrea Aliverti; Dario Bovio; Irene Fullin; Dellacà, Raffaele L.; Antonella Lo Mauro; Antonio Pedotti; Macklem, Peter T.

    2009-01-01

    Blood in the splanchnic vasculature can be transferred to the extremities. We quantified such blood shifts in normal subjects by measuring trunk volume by optoelectronic plethysmography, simultaneously with changes in body volume by whole body plethysmography during contractions of the diaphragm and abdominal muscles. Trunk volume changes with blood shifts, but body volume does not so that the blood volume shifted between trunk and extremities (Vbs) is the difference between changes in trunk ...

  10. Abdominal Radical Trachelectomy

    OpenAIRE

    Căpîlna, Mihai Emil; Ioanid, Nicolae; Scripcariu, Viorel; Gavrilescu, Madalina Mihaela; Szabo, Bela

    2014-01-01

    Objective Abdominal radical trachelectomy (ART) is one of the fertility-sparing procedures in women with early-stage cervical cancer. The published results of ART, in comparison with vaginal radical trachelectomy, so far are limited. Materials and Methods This retrospective study comprises all cases of female patients referred to ART with early-stage cervical cancer from 2 gynecologic oncology centers in Romania. Results A total of 29 women were referred for ART, but subsequently, fertility c...

  11. 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...

  12. Facial necrosis after endovascular Onyx-18 embolization for epistaxis

    OpenAIRE

    Grandhi, Ramesh; Panczykowski, David; Zwagerman, Nathan T.; Gehris, Robin; Villasenor-Park, Jennifer; Ho, Jonhan; Grandinetti, Lisa; Horowitz, Michael; Lanzino, Giuseppe; Burrows, Anthony M.

    2013-01-01

    Background: Evolution in techniques and equipment has expanded the role, effectiveness, and safety of endovascular transarterial embolization for the treatment of severe epistaxis. Risks from this treatment approach include major ischemic complications. To date, there have been only a few reports of soft tissue necrosis following endovascular embolization for severe epistaxis; none involve the use of Onyx-18. Case Description: We report the case of a 52-year-old woman who presented with epist...

  13. Evolving Role of Endovascular Treatment of Acute Ischemic Stroke

    OpenAIRE

    Ciccone, Alfonso; del Zoppo, Gregory J.

    2014-01-01

    The perceived advantages of endovascular treatment for acute ischemic stroke in terms of recanalization, the multimodal and targeted approaches, and perhaps the more permissive rules on devices than on medications for their licensing favored the assumption that endovascular treatment is superior to intravenous thrombolysis for acute treatment of ischemic stroke, and its adoption in more advanced stroke centers. However, this assumption has been questioned by recent clinical trial experience s...

  14. Endovascular embolization of pulmonary arteriovenous malformations

    Institute of Scientific and Technical Information of China (English)

    LIU Feng-yong; WANG Mao-qiang; FAN Qing-sheng; DUAN Feng; WANG Zhi-jun; SONG Peng

    2010-01-01

    Background The major consequence of pulmonary arteriovenous malformations (PAVMs) is the direct inflow of blood from the pulmonary artery to the pulmonary vein which induces hypoxemia. Severe complications include transient ischemic attacks, paradoxical embolization in the central nervous system, massive hemoptysis or hemothorax, etc. The conventional treatment is surgical intervention. However, this can be very traumatic and dangerous. Endovascular embolization has advantages over surgery such as a faithful therapeutic effect, a low complication rate, repeatability, etc. Methods Patients (n=23) with symptomatic PAVMs underwent endovascular embolization; 11 were males and 12 were females, with ages ranging from 6 months to 58 years. During the embolization, microcoils were applied in 6 cases and standard steel coils were used in 17 cases.Results Multiple PAVMs lesions were found in 16 cases and single PAVMs lesion was found in 7 cases. Embolotherapy was carried out 28 times for 23 patients. The success rate was 100%. The results of pulmonary arteriography after treatment showed that single lesion disappeared completely while the main abnormal vessels in multiple lesions also disappeared. The mean blood oxygen saturation increased from (78.04±8.22)% to (95.13±3.67)% after the procedure. A correlated groups t test showed changes in blood oxygen saturation before and after embolization (fe=9.101, P <0.001). Symptoms of cardiac insufficiency disappeared in 5 cases and vascular murmur in the chest disappeared in 13 cases. After embolization, mild chest pain occurred in 11 cases, small amounts of pleural effusion occurred in 5 cases, and 1 patient died 2 months later because of a pyogenic infection secondary to the pulmonary infarction. Among the 22 remaining cases, with overall follow-up ranging from 18 months to 12 years, general conditions were fine, daily lives were normal and there were no neurologic symptoms or signs, except for 3 patients with diffused PAVMs who

  15. 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.

  16. 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.

  17. [Endovascular intervention in Takayasu Arteritis. Case report].

    Science.gov (United States)

    Di Santo, Marisa; Stelmaszewski, Érica V; Villa, Alejandra

    2016-06-01

    A four year old patient with no medical history was admitted to our hospital's Emergency Department, suffering from edema and hypertension. During physical examination a low pulse was detected in the left arm and a lack of pulses in lower limbs, with a blood pressure difference greater than 10 mm Hg between both arms. An echocardiogram demonstrated severe aortic abdominal coarctation and ventricular dysfunction. Takayasu arteritis was diagnosed and cardiac angiography was performed. Disconnection of left subclavian artery and severe tightness at the abdominal aorta were confirmed. The definitive diagnosis was Takayasu arteritis. Angioplasty with stent was performed in abdominal aorta, with good subsequent results. The pulses improved in the lower limbs, and normal blood pressure values without gradient between all members were registered. The echocardiogram improved ventricular function and the gradient in the coarctation area was significantly reduced.

  18. Hybrid treatment of bullet embolism at the abdominal aortic bifurcation, complicated with thoracoabdominal aorta pseudoaneurysm and common iliac artery occlusion: case report

    Directory of Open Access Journals (Sweden)

    Patrick Bastos Metzger

    2014-03-01

    Full Text Available Embolization due to a firearm projectile entering the bloodstream is a rare event that is unlikely to be suspected during initial treatment of trauma patients. We describe and discuss a case of bullet embolism of the abdominal aortic bifurcation, complicated by a pseudoaneurysm of the thoracoabdominal aorta and occlusion of the right common iliac artery, but successfully treated using a combination of endovascular methods and conventional surgery.

  19. Endovascular therapy for acute stroke: Quo vadis?

    Directory of Open Access Journals (Sweden)

    Venkatesh S Madhugiri

    2013-01-01

    Full Text Available Endovascular therapy (EVT has gained vogue in the management of patients with acute stroke. Newer stent-retriever devices have led to better recanalization rates. In many centers, EVT is slowly being used as an add on to or in some instances, even as an alternative to intravenous tissue plasminogen activator (IV tPA. The publication of the results of the SYNTHESIS expansion, Interventional Management of Stroke III and Mechanical Retrieval Recanalization of Stroke Clots Using Embolectomy trials in 2013 has questioned the enthusiastic use of EVT in acute stroke. They demonstrate that EVT (using a variety of devices is no superior to IV tPA in the management of acute stroke. In the light of these controversial findings, we review the current status of EVT in the management of acute stroke.

  20. 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.

  1. Endovascular Management of Sigmoid Sinus Diverticulum.

    Science.gov (United States)

    Paramasivam, Srinivasan; Furtado, Sunil; Shigamatsu, Tomoyoshi; Smouha, Eric

    2016-06-01

    Sigmoid sinus diverticulum (SSD) is a rare vascular disorder due to dehiscence of the sigmoid plate. It may be associated with prediverticular venous sinus stenosis (SS) and usually presents as pulsatile tinnitus. The mechanism of development of the SSD and tinnitus from a sinus diverticulum and associated SS is unclear. Previous case reports have suggested that remodeling of the venous system targeting the stenosis, elimination of the diverticulum, or both, have resulted in symptom relief. We present a case of SSD with SS, treated by stenting of the stenosis along with coil embolization of the diverticulum, resulting in complete relief of symptoms. We have also reviewed the literature and discussed the evolution of management from open surgical treatment to endovascular treatment. PMID:27610124

  2. Tratamiento acortado estrictamente supervisado para tuberculosis pulmonar

    Directory of Open Access Journals (Sweden)

    Alvarez-Gordillo Guadalupe del Carmen

    1998-01-01

    Full Text Available Objetivo. Evaluar la posibilidad de aplicar el tratamiento acortado estrictamente supervisado (TAES en el Programa de Control de la Tuberculosis en Chiapas, México. Material y métodos. Se evaluó la eficacia y la eficiencia del tratamiento en una cohorte de pacientes con tuberculosis pulmonar confirmada por baciloscopía, que ingresaron a tratamiento con esquemas de autoadministración semisupervisión y estricta supervisión, de enero a junio de 1996. Resultados. La eficacia fue de 90.9. 97.7 y 100% para los esquemas de tratamiento autoadministrado, semisupervisado y TAES, respectivamente, mientras que la eficiencia fue de 68.1. 77.6 y 88.5% en el mismo orden. Conclusiones. Para la salud pública el TAES demostró ser la actividad más importante en el control de la tuberculosis, al elevar las tasas de curación y disminuir, por lo tanto, las fuentes de transmisión de la enfermedad.

  3. Halitosis: diagnóstico y tratamiento

    Directory of Open Access Journals (Sweden)

    M. Monfort Codinach

    2014-06-01

    Full Text Available Introducción: Debido a los múltiples factores que pueden causar o agravar la halitosis, y que el tratamiento depende de eso, es imprescindible hacer un diagnóstico detallado para identificar todos y cada uno de ellos. Diagnóstico: En la halitosis es esencial hacer un diagnóstico etiológico. Por ello hay que prestar atención a la anamnesis para poder descartar las pocas probabilidades de una causa sistémica, preguntar al paciente sobre diferentes aspectos de la halitosis, fijándose en los aspectos psicológicos de la patología, realizar una minuciosa exploración oral y las pruebas complementarias. Tratamiento: Debemos enfocarlo según la etiología y los objetivos perseguidos son reducir el número de bacterias, el número de sustratos proteicos y neutralizar los compuestos volátiles sulfurados. Conclusiones: Es básico el correcto diagnóstico etiológico para realizar un tratamiento exitoso. Para esto el control mecánico de la placa es necesario pero no suficiente, considerando los posibles efectos adversos de los agentes químicos por la larga duración de los tratamientos.

  4. Tratamiento conservador en pacientes con retinoblastoma bilateral

    Directory of Open Access Journals (Sweden)

    Juan C. Suárez

    2008-11-01

    Full Text Available OBJETIVO: comparar el tratamiento convencional del retinoblastoma bilateral, usado hasta hace algunos años, consistente en radioterapia o enucleación bilateral, con el tratamiento conservador actual que incluye termoterapia transpupilar (TTT o TTT/quimioterapia al menos en un ojo, en niños con diagnóstico de retinoblastoma bilateral. DISEÑO: estudio retrospectivo descriptivo. MUESTRA: 20 pacientes con diagnóstico de retinoblastoma bilateral que consultaron al Hospital Universitario San Vicente de Paúl, de Medellín, Colombia, entre 1997 y 2007. MÉTODO: se hizo enucleación del ojo con el tumor de mayor tamaño. En el otro ojo se hizo tratamiento con TTT, con el láser diodo (810 nm, spot amplio, solo o combinado con otras terapias. RESULTADOS: se dividió a los pacientes en dos grupos: 16 pacientes (32 ojos en el grupo 1 tratados conservadoramente y 4 pacientes (8 ojos en el grupo 2 con tratamiento convencional. El rango de edad fue de 1-72 meses en el grupo 1 y de 1-12 meses en el grupo 2. El tiempo de seguimiento fue de 7-67 meses para el grupo 1 y de 13-73 meses para el grupo 2. En el grupo 1 se hizo enucleación de 16 ojos (50%, radioterapia externa de uno (3,1%, quimioterapia más termoterapia de 5 (15,6% y quimioterapia más termoterapia más crioterapia de 10 (31,3%. En todos los pacientes se logró preservar al menos un ojo. En el grupo 2, se enuclearon 7 ojos (87,5% y se hizo radioterapia externa más enucleación en un paciente (12.5%. Además, todos los pacientes recibieron quimioterapia. CONCLUSIÓN: la terapia conservadora actual consistente en tratamiento local (termoterapia, crioterapia o braquiterapia y quimiorreducción permite preservar al menos un ojo y en algunos casos de los dos, muchas veces con buena agudeza visual, en niños con retinoblastoma bilateral; se evitan así la enucleación bilateral y la radioterapia externa usada en el tratamiento convencional con todos sus efectos secundarios. La enucleación contin

  5. [Differential diagnosis of abdominal pain].

    Science.gov (United States)

    Frei, Pascal

    2015-09-01

    Despite the frequency of functional abdominal pain, potentially dangerous causes of abdominal pain need to be excluded. Medical history and clinical examination must focus on red flags and signs for imflammatory or malignant diseases. See the patient twice in the case of severe and acute abdominal pain if lab parameters or radiological examinations are normal. Avoid repeated and useless X-ray exposure whenever possible. In the case of subacute or chronic abdominal pain, lab tests such as fecal calprotectin, helicobacter stool antigen and serological tests for celiac disease are very useful. Elderly patients may show atypical or missing clinical signs. Take care of red herrings and be skeptical whether your initial diagnosis is really correct. Abdominal pain can frequently be an abdominal wall pain. PMID:26331201

  6. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B;

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....

  7. Open conversion after endovascular aortic aneurysm repair with the Ovation Prime™ endograft.

    Science.gov (United States)

    Georgiadis, George S; Charalampidis, Dimitrios; Georgakarakos, Efstratios I; Antoniou, George A; Trellopoulos, George; Vogiatzaki, Theodosia; Lazarides, Miltos K

    2014-02-01

    Advances in abdominal aortic aneurysm (AAA) endograft device technology have contributed to improved outcomes and durability of endovascular aortic aneurysm repair (EVAR), even in complex infrarenal aortic anatomies. However, stent graft failure secondary to endoleaks, migration, endotension and sac enlargement are persistent problems that can result in aneurysm rupture following EVAR.A symptomatic infrarenal AAA (4mm proximal neck) was treated initially with an Ovation Prime™ device (TriVascular, Inc., Santa Rosa, CA) in an off-label fashion, leading to type Ia endoleak moderately reduced by additional proximal neck ballooning. A failed Chimney technique to the single patent, but severely stenosed, right renal artery preceded the use of this device. A large type Ia endoleak was evident at 6-month follow-up, but following a failed supplementary endovascular intervention with coils to seal the endoleak, the patient presented with hemorrhagic shock from AAA rupture, requiring urgent open conversion. Intraoperatively it was impossible to explant this new type of endograft. Circumferential tying of the infrarenal aorta with a Teflon band was unable to stop the bleeding. However, after dividing the body of the stent-graft below the two proximal polymer rings, the endoleak was successfully treated by suturing the graft with the proximal aortic neck. The procedure was completed with extension of the stump to the common femoral arteries using a bifurcated Dacron prosthesis.The body of an Ovation Prime™ endograft may be impossible to explant in open conversion conditions. Large prospective studies with longer follow-up are required to adequately reflect the behavior of this particular device. PMID:24619891

  8. Hybrid Endovascular Aorta Repair with Simultaneous Supra-aortic Branch or Iliac Branch Revascularization

    Institute of Scientific and Technical Information of China (English)

    Yue-hong Zheng; Nim Choi; Hong-ru Deng; CU Kouk; Kun Yu; Furtado Rui

    2009-01-01

    Objective To describe a hybrid endovascular procedure for aorta repair with different kinds of bypass followed by concomitant placement of stent graft in the aorta.Methods From June 2007 to May 2008,5 consecutive patients who presented with aortic aneurysm or dissection were treated with a new hybrid aorta repair technique.Complete surgical rerouting of supra-aortic vessels was simultaneously created by endovascular repair of aortic arch aneurysm with stent graft.Hybrid left carotid-subclavian bypass with stent graft deployment covering the ostium of the left subclavian artery was performed in a Debakey type Ⅲ aortic dissection case.The supra-aortic branch was revascularized in 2 cases from ascending aorta to bilateral common carotid arteries using a 16-8 mm bifurcated graft,then total aortic arch and descending artery was occluded with stent-graft.The left carotid artery to the left subclavian artery bypass was created in 1 case,followed by stent-graft deployment.Two cases of infrarenal abdominal aortic aneurysm underwent left external iliac artery to left internal iliac artery bypass by a retroperineal route,then hybrid procedure was performed with bifurcated stent-graft.All stent grafts were deployed via a retrograde femoral artery approach in 5 patients.Results Technical success with complete aneurysmal exclusion was achieved in all patients.There was no incidence of endoleak.During a follow-up period of 2 to 10 months,documented perioperative neurologic events did not occur in all patients.One patient suffered from adult respiratory distress syndrome.After received tracheostomy,he recovered later.There was one death resulting from a postoperative myocardial infarction.Conclusion Hybrid arch repair provides an alternative therapy to patients otherwise considered prohibitively high risk for traditional open arch and thoracoabdominal aorta repair.

  9. Combined Endovascular and Microsurgical Management of Complex Cerebral Aneurysms

    Directory of Open Access Journals (Sweden)

    Omar eChoudhri

    2013-08-01

    Full Text Available Cerebral aneurysms are associated with a 50% mortality rate after rupture and patients can suffer significant morbidity during subsequent treatment. Neurosurgical management of both ruptured and unruptured aneurysms has evolved over the years. The historical practice of using microsurgical clipping to treat aneurysms has benefitted in the last two decades from tremendous improvement in endovascular technology. Microsurgery and endovascular therapies are often viewed as competing treatments but it is important to recognize their individual limitations. Some aneurysms are considered complex, due to several factors such as aneurysm anatomy and a patient’s clinical condition. A complex aneurysm often cannot be completely excluded with a single approach and its successful treatment requires a combination of microsurgical and endovascular techniques. Planning such an approach relies on understanding aneurysm anatomy and thus should routinely include 3D angiographic imaging. In patients with ruptured aneurysms, endovascular coiling is a well-tolerated early treatment and residual aneurysms can be treated with intervals of definitive clipping. Microsurgical clipping also can be used to reconstruct the neck of a complex aneurysm, allowing successful placement of coils across a narrow neck. Endovascular techniques are assisted by balloons, which can be used in coiling and testing parent vessel occlusion before sacrifice. In some cases microsurgical bypasses can provide alternate flow for planned vessel sacrifice. We present current paradigms for combining endovascular and microsurgical approaches to treat complex aneurysms and share our experience in 67 such cases. A dual microsurgical–endovascular approach addresses the challenge of intracranial aneurysms. This combination can be performed safely and produces excellent rates of aneurysm obliteration. Hybrid angiographic operating-room suites can foster seamless and efficient complementary application

  10. Hypnosis for functional abdominal pain.

    Science.gov (United States)

    Gottsegen, David

    2011-07-01

    Chronic abdominal pain is a common pediatric condition affecting 20% of the pediatric population worldwide. Most children with this disorder are found to have no specific organic etiology and are given the diagnosis of functional abdominal pain. Well-designed clinical trials have found hypnotherapy and guided imagery to be the most efficacious treatments for this condition. Hypnotic techniques used for other somatic symptoms are easily adaptable for use with functional abdominal pain. The author discusses 2 contrasting hypnotic approaches to functional abdominal pain and provides implications for further research. These approaches may provide new insights into this common and complex disorder. PMID:21922712

  11. Children's (Pediatric) Abdominal Ultrasound Imaging

    Medline Plus

    Full Text Available ... through blood vessels. Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Children's (pediatric) abdominal ultrasound imaging produces pictures ...

  12. Abdominal aortic aneurysms: virtual imaging and analysis through a remote web server

    Energy Technology Data Exchange (ETDEWEB)

    Neri, Emanuele; Bargellini, Irene; Vignali, Claudio; Bartolozzi, Carlo [University of Pisa, Diagnostic and Interventional Radiology, Pisa (Italy); Rieger, Michael; Jaschke, Werner [University of Innsbruck, Diagnostic and Interventional Radiology, Innsbruck (Austria); Giachetti, Andrea; Tuveri, Massimiliano [Center for Research and Study, Sardinia (Italy)

    2005-02-01

    The study describes the application of a web-based software in the planning of the endovascular treatment of abdominal aortic aneurysms (AAA). The software has been developed in the framework of a 2-year research project called Aneurysm QUAntification Through an Internet Collaborative System (AQUATICS); it allows to manage remotely Virtual Reality Modeling Language (VRML) models of the abdominal aorta, derived from multirow computed tomography angiography (CTA) data sets, and to obtain measurements of diameters, angles and centerline lengths. To test the reliability of measurements, two radiologists performed a detailed analysis of multiple 3D models generated from a synthetic phantom, mimicking an AAA. The system was tested on 30 patients with AAA; CTA data sets were mailed and the time required for segmentation and measurement were collected for each case. The Bland-Altman plot analysis showed that the mean intra- and inter-observer differences in measures on phantoms were clinically acceptable. The mean time required for segmentation was 1 h (range 45-120 min). The mean time required for measurements on the web was 7 min (range 4-11 min). The AQUATICS web server may provide a rapid, standardized and accurate tool for the evaluation of AAA prior to the endovascular treatment. (orig.)

  13. [Stagewise treatment of a giant false paraanastomotic aneurysm of the abdominal aorta].

    Science.gov (United States)

    Ignatyev, I M; Volodyukhin, M Yu; Zanochkin, A V; Rafikov, A Yu; Khairullin, R N

    2016-01-01

    The article deals with a case report concerning successful stagewise treatment of a patient presenting with a giant false abdominal aortic paraanastomotic aneurysm having developed 2 months after an operation of linear prosthetic repair for a juxtarenal aneurysm with reimplantation of the left renal artery. The secondary operation was carried out 3 months after aortic reconstruction. The first stage consisted in performing endovascular prosthetic repair of the abdominal aortic paraanastomotic pseudoaneurysm by means of a bifurcated stent graft Endurant II (Medtronic), with the second stage being laparotomy with the removal of the retroperitoneal haematoma. The postoperative period turned out uneventful. The patient was discharged from hospital on the 8th day after the second operation. The patient was examined 2 months later, presenting no complaints and returning to his previous work. According to the findings of the check-up duplex scanning, the graft was patient, with no evidence of a paraanastomotic aneurysm. This is followed by discussion of the problems regarding the use of surgical and endovascular technologies in treatment of paraanastomotic aortic aneurysms. PMID:27336337

  14. Practical pediatric abdominal CT

    International Nuclear Information System (INIS)

    This course is designed to help the radiologist in a hospital setting successfully approach abdominal CT in the infant and child. Emphasis is placed on techniques necessary for a high-quality examination of the upper abdomen, as applied to common pediatric problems such as trauma, tumor, and infection. Material is presented on technical considerations, including patient sedation, preparation, and potential pitfalls and helpful hints for imaging. An emphasis is placed on dynamic scanning with table incrementation. The section on trauma focuses on an approach to imaging the abdomen in the injured child, typical injuries, patterns of injury in the upper abdomen, and why CT is the best imaging modality for blunt upper abdominal trauma. The discussion of tumor imaging reviews the appearance of typical childhood neoplasia including Wilms tumor, neuroblastoma, non-Hodgkin and Burkitt lymphoma, and disseminated solid tumors such as rhabdomyosarcoma. The authors emphasize what to look for and where, both on initial and on later (for recurrences) examinations. The discussion of infection addresses detection of abscesses and occult infections in children, as well as imaging of abscesses prior to intervention

  15. 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.)

  16. Detecting endoleaks after endovascular AAA repair with a minimally invasive, implantable, telemetric pressure sensor: an in vitro study

    Energy Technology Data Exchange (ETDEWEB)

    Springer, Fabian; Pfeffer, Joachim-Georg; Schmitz-Rode, Thomas [RWTH Aachen University, Helmholtz-Institute for Biomedical Engineering, Applied Medical Engineering, Aachen (Germany); Schlierf, Roland; Schnakenberg, Uwe [RWTH Aachen University, Institute of Materials in Electrical Engineering I, Aachen (Germany); Mahnken, Andreas H. [RWTH Aachen University, Helmholtz-Institute for Biomedical Engineering, Applied Medical Engineering, Aachen (Germany); RWTH Aachen University, Department of Diagnostic Radiology, University Hospital, Aachen (Germany)

    2007-10-15

    A feasibility study on a completely digital telemetric pressure sensor (TPS) to detect endoleaks was performed in an in vitro model of an abdominal aortic aneurysm (AAA). An endovascular-stented AAA silicone model with different types (I-III) and sizes (3-11 French) of endoleaks was created and pulsatile pressure was applied with physiological flow and pressure rates [mean intraaortic pressure (IAP): 95-130 mmHg] and different degrees of thrombosis of the aneurysm sac. Aneurysm sac pressure (ASP) was measured with the TPS and with wired pressure sensors (WPS) as a reference. Statistical analysis included paired t-test, Pearson's correlation analysis and Bland-Altman plots. After opening an endoleak, the mean ASP increased significantly (P < 0.0001) from 15 to almost 95% of the mean IAP depending on endoleak type and size. ASP could be measured accurately with the TPS and the WPS. The telemetric and wired ASP increase showed a high Pearson's correlation coefficient (r) for a non-thrombosed (r = 0.97) and a thrombosed (r = 0.96) aneurysm sac. In an in vitro silicone model, the newly designed telemetric pressure sensor was able to detect the occurrence of an endoleak in a non-invasive way and might be a valuable device for follow-up of endovascular AAA repair. (orig.)

  17. 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.

  18. Endovascular Intervention for Acute Ischemic Stroke in Light of Recent Trials

    Directory of Open Access Journals (Sweden)

    Kenan Alkhalili

    2014-01-01

    Full Text Available Three recently published trials, MR RESCUE, IMS III, and SYNTHESIS Expansion, evaluating the efficacy and safety of endovascular treatment of acute ischemic stroke have generated concerns about the future of endovascular approach. However, the tremendous evolution that imaging and endovascular treatment modalities have undergone over the past several years has raised doubts about the validity of these trials. In this paper, we review the role of endovascular treatment strategies in acute ischemic stroke and discuss the limitations and shortcomings that prevent generalization of the findings of recent trials. We also provide our experience in endovascular treatment of acute ischemic stroke.

  19. Endovascular treatment of coarctation and related aneurysms.

    Science.gov (United States)

    Galiñanes, E L; Krajcer, Z

    2014-06-11

    Today,surgical repair has almost doubled the 30year survival rate in patients with coarctation of the aorta (CoA), and 72% to 98% of patients now reach adulthood. Possible late complications include malignant hypertension, left ventricular dysfunction, aortic valve dysfunction, recurrent CoA, and aneurysm formation with risk of rupture. Treating postoperative CoA-related aneurysms with observation alone is associated with a mortality rate of 36%, compared with 9% for surgical repair. Even in the best surgeons' hands, aortic surgery has associated complications, and the complexity of reoperative surgery makes the risks substantially greater. For patients with CoA-related aneurysm, endovascular treatment constitutes a good alternative to reoperative surgery because it poses a lower risk of morbidity and mortality. Implanting an endograft has been shown to be successful in treating CoA and related aneurysms, producing excellent intermediate outcomes and minimal morbidity and mortality. Despite evidence that using covered stents improves outcomes, the superiority of any particular stent type has yet to be established. With a variety of endografts available, the decision of which stent to use depends on anatomy, availability, and operator preference.

  20. 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.

  1. 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

  2. éste durante el tratamiento

    Directory of Open Access Journals (Sweden)

    José Miguel Martínez González

    2005-01-01

    Full Text Available El objetivo de esta investigación fue estudiar si las creencias relacionadas con la vivencia del acompañamiento de un familiar en el tratamiento de un drogodependiente, y las del mismo paciente, varían en función de aspectos como el tiempo de abstinencia, el tiempo dedicado al tratamiento, la presencia de patología dual en el drogodependiente, la gravedad de ajuste psicológico del acompañante, los años de evolución de la drogodependencia y el tiempo transcurrido desde que se conoce el problema. La muestra estuvo compuesta por 130 personas, 65 familiares y 65 drogodependientes en tratamiento en centros ambulatorios. Para el análisis de los datos, obtenidos éstos, mediante distintos diseños cuasi-experimentales de grupos no aleatorios, se aplicó la prueba “t-Student” para un nivel de significación del 0,05. Se analizaron las relaciones bivariadas entre las variables descritas y las diferentes creencias tanto en los pacientes como en los familiares de éstos. Los resultados mostraron que las creencias evaluadas están presentes en la experiencia del adicto y del familiar, cambiando éstas a través de los valores de las variables manipuladas ya mencionadas.

  3. 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.

  4. Aneurysm growth after late conversion of thoracic endovascular aortic repair

    Directory of Open Access Journals (Sweden)

    Hirofumi Kasahara

    2015-01-01

    Full Text Available A 69-year-old man underwent thoracic endovascular aortic repair of a descending aortic aneurysm. Three years later, he developed impending rupture due to aneurysmal expansion that included the proximal landing zone. Urgent open surgery was performed via lateral thoracotomy, and a Dacron graft was sewn to the previous stent graft distally with Teflon felt reinforcement. Postoperatively, four sequential computed tomography scans demonstrated that the aneurysm was additionally increasing in size probably due to continuous hematoma production, suggesting a possibility of endoleaks. This case demonstrates the importance of careful radiologic surveillance after endovascular repair, and also after partial open conversion.

  5. Endovascular treatment of axillary artery dissection following anterior shoulder dislocation.

    Science.gov (United States)

    Fass, G; Barchiche, M Reda; Lemaitre, J; De Quin, I; Goffin, C; Bricart, R; Bellens, B

    2008-01-01

    Injury to the axillary artery is a rare complication of anterior shoulder dislocation. Open surgical repair is technically demanding because of the anatomical position of the vessel and the propensity for concomitant injuries. Standard surgical exposure techniques involve extensive dissection, including a combination of supraclavicular or infraclavicular incision, median sternotomy, and thoracotomy causing significant morbidity and mortality rates. Endovascular techniques may offer an alternative to these surgically demanding procedures. We present a patient with a traumatic dissection of the axillary artery following anterior shoulder dislocation who was successfully managed with an endovascular stent. PMID:18411587

  6. Endovascular treatment of complex traumatic lesions of the infrapopliteal segment Tratamento endovascular de lesões traumáticas complexas do segmento infrapoplíteo

    Directory of Open Access Journals (Sweden)

    Roberta C. A. Campos

    2009-06-01

    Full Text Available The occurrence of vascular trauma due to a range of causes has increased considerably. In this setting, endovascular repair has arisen as a new and less invasive approach. We report the case of three patients with lesions of below-knee vessels that were treated by endovascular procedures.A ocorrência de trauma vascular decorrente de diversas causas aumentou consideravelmente. Nesse contexto, o tratamento endovascular surge como um método novo e menos invasivo. Relatamos o caso de três pacientes com lesões abaixo do joelho que foram tratadas por procedimentos endovasculares.

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

    Directory of Open Access Journals (Sweden)

    F.J. Gabilondo Zubizarreta

    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 intestinal 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.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 conditionated 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.

  8. Delayed type Ⅲb endoleak using AnacondaTM stent graft in abdominal aortic aneurysm repair

    Institute of Scientific and Technical Information of China (English)

    WU Zi-heng; Dieter Raithel; QU Le-feng

    2010-01-01

    @@ Endoleaks are defined as the persistence of blood flow outside the lumen of the endoluminal graft but within an aneurysm sac or the adjacent vascular segment being treated by the graft and classified into 5 categories.1,2 Although type Ⅲb endoleaks (fabric defect) have been reported to occur in some divices,3-6 it has never been previously reported with the AnacondaTM endograft (Vascutek, Terumo, Scotland) after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Here we report a delayed type Ⅲb endoleak of AnacondaTM endograft after EVAR for AAA.

  9. Penetrating abdominal trauma.

    Science.gov (United States)

    Henneman, P L

    1989-08-01

    The management of patients with penetrating abdominal trauma is outlined in Figure 1. Patients with hemodynamic instability, evisceration, significant gastrointestinal bleeding, peritoneal signs, gunshot wounds with peritoneal violation, and type 2 and 3 shotgun wounds should undergo emergency laparotomy. The initial ED management of these patients includes airway management, monitoring of cardiac rhythm and vital signs, history, physical examination, and placement of intravenous lines. Blood should be obtained for initial hematocrit, type and cross-matching, electrolytes, and an alcohol level or drug screen as needed. Initial resuscitation should utilize crystalloid fluid replacement. If more than 2 liters of crystalloid are needed to stabilize an adult (less in a child), blood should be given. Group O Rh-negative packed red blood cells should be immediately available for a patient in impending arrest or massive hemorrhage. Type-specific blood should be available within 15 minutes. A patient with penetrating thoracic and high abdominal trauma should receive a portable chest x-ray, and a hemo- or pneumothorax should be treated with tube thoracostomy. An unstable patient with clinical signs consistent with a pneumothorax, however, should receive a tube thoracostomy prior to obtaining roentgenographic confirmation. If time permits, a nasogastric tube and Foley catheter should be placed, and the urine evaluated for blood (these procedures can be performed in the operating room). If kidney involvement is suspected because of hematuria or penetrating trauma in the area of a kidney or ureter in a patient requiring surgery, a single-shot IVP should be performed either in the ED or the operating room. An ECG is important in patients with possible cardiac involvement and in patients over the age of 40 going to the operating room. Tetanus status should be updated, and appropriate antibiotics covering bowel flora should be given. Operative management should rarely be delayed

  10. La equinoterapia en el tratamiento de la discapacidad infantil

    OpenAIRE

    Pérez Álvarez, Luis; Rodríguez Meso, Juan; Rodríguez Castellano, Niurka

    2008-01-01

    La equinoterapia ha sido un procedimiento empleado a lo largo de la historia de la Medicina en el tratamiento de diversas enfermedades. A partir de 1990 su empleo en el tratamiento de la discapacidad infantil se ha incrementado. La evidencia científica documentada hasta el presente no permite establecer conclusiones definitivas en cuanto a su valor en el tratamiento de la discapacidad infantil, aunque las experiencias referidas por diferentes autores, demuestran ...

  11. Economics of abdominal wall reconstruction.

    Science.gov (United States)

    Bower, Curtis; Roth, J Scott

    2013-10-01

    The economic aspects of abdominal wall reconstruction are frequently overlooked, although understandings of the financial implications are essential in providing cost-efficient health care. Ventral hernia repairs are frequently performed surgical procedures with significant economic ramifications for employers, insurers, providers, and patients because of the volume of procedures, complication rates, the significant rate of recurrence, and escalating costs. Because biological mesh materials add significant expense to the costs of treating complex abdominal wall hernias, the role of such costly materials needs to be better defined to ensure the most cost-efficient and effective treatments for ventral abdominal wall hernias. PMID:24035086

  12. Endovascular Treatment of Aortic Aneurysms and Blood Transfusion. What do We Need?

    Science.gov (United States)

    Machado, Rui; Loureiro, Luís; Antunes, Inês; Coutinho, Jorge; Almeida, Rui

    2016-05-01

    ções da British Society of Haematology baseiam-se numa relação unidades crossmatched/transfundidas de 2:1. Na nossa instituição, a relação unidades crossmatched/transfundidas foi de 10,1 até 2010 e 7,3 de 2011 a 2012. Conclusões: Os resultados mudaram o nosso Maximum Surgical Blood Orders Schedule para o tratamento endovascular dosaneurismas da aorta. Atualmente procedemos ao teste 'type and screen' para próteses aorto-bi-iliaca e aorto-uni-iliaca e a testes de crossmatch de duas unidades de glóbulos vermelhos para torácica, três para híbrida-torácica e quatro para híbrida-abdominal. Isto pode levar a menos gastos, aumento de eficácia e reduzir a sobrecarga no departamento de hematologia.

  13. El tratamiento farmacológico de las depresiones resistentes.

    OpenAIRE

    Laura Gótor Martínez

    2002-01-01

    La reciente aparición de nuevos antidepresivos y otros psicofármacos ha ampliado las posibilidades de tratamiento de las depresiones resistentes. Pero cuál es el verdadero significado de depresión resistente al tratamiento. Este artículo realiza una revisión de la definición de éste término y otros como respuesta al tratamiento, falta de respuesta, remisión, respuesta parcial; así como de las estrategias de tratamiento de potenciación, combinación y las posibles ventajas del cambio de antidep...

  14. Micromanaging Abdominal Aortic Aneurysms

    Directory of Open Access Journals (Sweden)

    Lars Maegdefessel

    2013-07-01

    Full Text Available The contribution of abdominal aortic aneurysm (AAA disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to “fine tune” the translational output of their target messenger RNAs (mRNAs by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility.

  15. Abdominal aortic feminism.

    Science.gov (United States)

    Mortimer, Alice Emily

    2014-01-01

    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer.

  16. Cateteres intravenosos fraturados: retirada por técnicas endovasculares Intravenous catheter fragments: endovascular retrieval

    Directory of Open Access Journals (Sweden)

    Gustavo Andrade

    2006-06-01

    Full Text Available OBJETIVO: A colocação de cateter para acesso venoso central é uma prática médica cada vez mais comum, sendo a fratura e embolização de fragmentos do cateter raras, porém correspondem aos corpos estranhos intravasculares mais comuns. O objetivo é demonstrar nossa experiência na retirada desses corpos estranhos intravasculares utilizando técnicas endovasculares. MATERIAIS E MÉTODOS: Análise retrospectiva dos últimos cinco anos permitiu a avaliação de dez casos consecutivos, com a idade variando entre nove meses e 67 anos. RESULTADOS: O procedimento foi realizado com sucesso em todos os casos, por diferentes técnicas, sem complicações. Os locais mais comuns de alojamento dos fragmentos foram átrio direito, veia cava superior e artéria pulmonar esquerda. A retirada desses corpos estranhos por técnicas endovasculares é procedimento relativamente simples quando comparado à alternativa cirúrgica, tendo sido utilizada com segurança e sucesso em inúmeros pacientes. Os dispositivos disponíveis mostraram-se bastante eficazes, sendo o laço o mais versátil. CONCLUSÃO: A alta taxa de sucesso com poucas complicações relatadas, mesmo em crianças, permite a afirmação que os corpos estranhos intravenosos devem ser extraídos por técnicas percutâneas sempre que possível. Contudo, a familiarização com as diversas técnicas é fundamental, permitindo combinações e modificações, adaptando-as à situação do caso.OBJECTIVE: Central venous access is an increasingly frequent procedure and intravenous catheter fractures and fragments embolization, although being rare, correspond to the most common intravascular foreign bodies. This study purpose is to show our experience in the removal of these foreign bodies, employing endovascular techniques. MATERIALS AND METHODS: Retrospective analysis of ten consecutive cases in the last five years, including patients with ages ranging from 9 months to 67 years. RESULTS: The procedure

  17. Intra-abdominal tuberculous peritonitis

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, G.; Ahlhelm, F.; Altmeyer, K.; Kramann, B. [Dept. of Diagnostic Radiology, University Hospital, Homburg (Germany); Hennes, P. [Dept. of Pediatrics, University Hospital, Homburg (Germany); Pueschel, W. [Dept. of Pathology, University Hospital, Homburg (Germany); Karadiakos, N. [Dept. of Pediatric Surgery, University Hospital, Homburg (Germany)

    2001-07-01

    We report the case of a 15-year-old boy suffering from progressive dyspnea on exertion and painful abdominal protrusion. Final diagnosis of intra-abdominal tuberculosis (TB), including lymphadenopathy and abdominal abscess formation, was made following elective laparotomy. This type of disease is a rare manifestation of extrapulmonary tuberculosis. The imaging findings in unenhanced and contrast-enhanced MRI and laparoscopic images are presented. Differential diagnosis of abdominal abscess formation and other fungal or bacteriological infections, as well as the imaging findings of this type of lesion, are discussed. This case demonstrates that atypical manifestation of TB may remain unrecognized; thus, awareness of this kind of manifestation of tuberculosis may prevent patients from being subjected to inappropriate therapies. (orig.)

  18. JAMA Patient Page: Abdominal Hernia

    Science.gov (United States)

    ... an operation. Umbilical hernia Abdominal wall Intestinal loop Peritoneum Skin Peritoneum Umbilical annulus SYMPTOMS The first symptom of a ... vomiting, or constipation. Inguinal hernia Indirect inguinal hernia Peritoneum Deep inguinal ring Inguinal canal Superficial inguinal ring ...

  19. Children's (Pediatric) Abdominal Ultrasound Imaging

    Medline Plus

    Full Text Available ... located within a child's abdomen. A Doppler ultrasound study may be part of a child's abdominal ultrasound ... pain from the procedure. If a Doppler ultrasound study is performed, your child may actually hear pulse- ...

  20. Children's (Pediatric) Abdominal Ultrasound Imaging

    Medline Plus

    Full Text Available ... technique that allows the physician to see and evaluate blood flow through arteries and veins in the ... the procedure? Abdominal ultrasound imaging is performed to evaluate the: appendix stomach/ pylorus liver gallbladder spleen pancreas ...

  1. How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair

    Science.gov (United States)

    Setacci, Carlo; Chisci, Emiliano; Setacci, Francesco; Ercolini, Leonardo; de Donato, Gianmarco; Troisi, Nicola; Galzerano, Giuseppe; Michelagnoli, Stefano

    2014-01-01

    The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis. There is no good evidence to guide management so far. In the case of active gastrointestinal bleeding, pseudoaneurysm, or extensive perigraft purulence involving adjacent organs, an invasive treatment should always be attempted. In the other cases (the majority), when there is not an immediate danger to the patient's life, a conservative management is started with a proper antimicrobial therapy. Any infectious cavity can be percutaneously drained. Management depends on the patient's condition and a tailored approach should always be offered. In the case of a patient who is young, has a good life expectancy, or in whom there is absence of significant comorbidities, a surgical attempt can be proposed. Surgical techniques favor, in terms of mortality, patency, and reinfection rate, the in situ reconstruction. Choice of technique relies on the center and the operator's experience. Long-term antibiotic therapy is always required in all cases, with close monitoring of the C-reactive protein. PMID:26798744

  2. ENDOVASCULAR TREATMENT OF INTRACRANIAL DURAL ARTERIOVENOUS FISTULAS OF LATERAL SINUS

    Institute of Scientific and Technical Information of China (English)

    胡锦清; 沈建康; 林东; 赵卫国; 成侃; 王健; 凌华威

    2002-01-01

    Objective To evaluate use of transarterial endovascular embolization in 10 consecutive patients with DAVFs of lateral sinus. Methods A six-vessel cerebral diagnostic angiography was performed in each of the patients. All the patients underwent superselective angiography and transarterial endovascular embolization with N-butyl cyanoacrylate ( NBCA ) or polyvinyl alcohol ( PVA ) particle. Six patients received 3 to 6 months angiographic follow-up. Results Ten patients undergone 16 procedures and 23 supplying arteries were embolized with NBCA glue ( in 8) and PVA particle ( in 2 ). Eight patients experienced anatomic and clinical cure. Two patients achieved clinical cure despite the presence of a small residual lesion on angiography.All the 4 patients with pulsatile tinnitus and vascular bruit were ceased immediately after endovascular procedures. Pulsatile tinnitus recurred in one patient 2 months after partial embolization and disappeared after a second therapy. There was no complication. Conclusion Transarterial endovascular embolization is a safe, effective and minimally invasive method for treatment of lateral sinus DA VFs.

  3. 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

  4. Salmonella aortitis treated with endovascular aortic repair: a case report

    Directory of Open Access Journals (Sweden)

    Strahm Carol

    2012-08-01

    Full Text Available Abstract Introduction Salmonella is a typical cause of aortitis, which is associated with high morbidity and mortality. In infrarenal disease, besides open surgery, endovascular aortic repair as an alternative treatment has been reported. To the best of our knowledge, we report the first successful endovascular aortic repair documented by necropsy to date. Case presentation A 67-year-old Caucasian man presented with low back pain, fever and positive blood cultures for Salmonella Enteritidis. A computed tomography scan showed an enlargement and intramural hematoma of the infrarenal aortic wall; a Salmonella aortitis was suspected and antimicrobial therapy initiated. Because of substantial comorbidities, endovascular aortic repair was favored over open surgery; postoperatively the antibiotic treatment was continued for 12 months. Post-mortem there were neither macroscopic nor microscopic signs of aortitis or graft infection. Conclusions We could demonstrate by necropsy that endovascular aortic repair of infrarenal aortitis with prolonged pre- and postinterventional antibiotic therapy for 12 months was a minimally invasive alternative and should be considered in selected clinically stable patients with substantial co-morbidities.

  5. Aneurysm Formation After Endovascular Treatment of Acute Type A Dissection.

    Science.gov (United States)

    Yang, Lai; Wang, Jiaping

    2016-08-01

    Recently, reports have described successful endovascular stent graft (ESG) treatment of patients with acute type A aortic dissection. We report 1 ESG treatment for this condition and the complication of a new aneurysm formation during a 6-month follow-up. PMID:27630269

  6. 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.

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

    DEFF Research Database (Denmark)

    Bech, Bo; Lönn, Lars; Schroeder, Torben V;

    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...

  8. Tratamientos psicologicos en la hipertension arterial

    Directory of Open Access Journals (Sweden)

    Lilia Mabel Labiano

    2002-01-01

    Full Text Available En vista que las evidencias obtenidas acerca del beneticio percibido por los sujetos hipertensos leves con los tratamientos farmacológicos resultan conflictivas, se ha considerado importante para estos pacientes, la aplicación de intervenciones psicológicas y comportamentales. Se presentan en este trabajo, distintos tipos de tratamientos psicológicos que en los últimos años han demostrado su efectividad en la reducción de la presión arterial esencial. Se consideraron importantes para individuos hipertensos leves, la implementación de procedimientos tales como: la relajación, el entrenamiento autógeno, la retroalimentación biológica, la meditación, el Hatha -Yoga, la reestructuración cognitiva y el entrenamiento en habilidades sociales, porque contribuyeron a la reducción, no solo de los niveles hipertensivos sino también de los efectos adversos de la medicación farmacológica que afectan la calidad de vida. Es necesario evidentemente que el individuo generalice las estrategias aprendidas en el contexto clínico-experimental, a los diferentes contextos vitales. La técnica empleada, las características del terapeuta y el tipo de personalidad del paciente son componentes principales en la determinación del éxito del tratamiento. La práctica diaria sostenida fuera del contexto clínico, es un elemento de crucial importancia para el mantenimiento de la mejoría lograda.

  9. Updates on abdominal desmoid tumors

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Desmoid tumor is a monoclonal, fibroblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia infiltrates locally, recurs frequentiy after resection but does not metastasize. Abdominal desmoid occurs sporadically, in association with some familial syndromes and often represents a clinical dilemma for surgeons. The enigmatic biology and anatomical location of abdominal desmoids make treatment recommendations difficult. This distinct pathological entity is reviewed with a specific focus on aetiology and management.

  10. Component separation in abdominal trauma

    OpenAIRE

    Rawstorne, Edward; Smart, Christopher J.; Fallis, Simon A.; Suggett, Nigel

    2014-01-01

    Component separation is established for complex hernia repairs. This case presents early component separation and release of the anterior and posterior sheath to facilitate closure of the abdominal wall following emergency laparotomy, reinforcing the repair with a biological mesh. On Day 11 following an emergency laparotomy for penetrating trauma, this patient underwent component separation and release of the anterior and posterior sheath. An intra-abdominal biological mesh was secured, and t...

  11. Tratamiento no quirúrgico en el tratamiento de periimplantitis: revisión narrativa

    Directory of Open Access Journals (Sweden)

    M. Zurlohe

    2014-12-01

    Full Text Available Existen una gran variedad de protocolos terapéuticos a la hora de tratar la periimplantitis, desde tratamientos desinfectantes, desbridación mecánica hasta procedimientos quirúrgicos. Estudios han demostrado discordancias en sus resultados con respecto a cual es el método ideal para tratar una periimplantitis. El uso de instrumentos de desbridamiento mecánico, el método láser, antibioterapia, enfoques quirúrgicos ya sean resectivas o regenerativas muestran resultados heterogéneos. Al presente, no existe suficiente evidencia científica para poder valer un tratamiento específico no quirúrgico a la hora de enfrentarnos a una periimplantitis. El objetivo de esta revisión narrativa será analizar la literatura actual sobre el tratamiento no quirúrgico de la periimplantitis y sus indicaciones y eficacia como tratamiento. No se ha visto que tratando una la lesión periimplantaria mediante un enfoque terapéutico no quirúrgico haya dado resultados efectivos y el uso de antisépticos locales como auxiliar sólo ha mostrado efectos limitados sobre las variables clínicas y microbiológicas. Se necesitan más estudios randomizados y controlados con resultados a largo plazo para poder validar el protocolo de terapia no quirúrgico de la periimplantitis.

  12. Endovascular treatment of thoracic aorta aneurysm and dissection

    International Nuclear Information System (INIS)

    Full text: The aim is to give up to date information about modern endovascular treatment of aortic pathology Dissection and aneurysms of the aorta are life threatening condition requiring in most of the cases prompt surgical or endovascular treatment because of the poor natural evolution. Purpose: to assess the immediate and 1-year outcome of endovascular treatment in broad spectrum of acute and subacute aortic syndrome during the last 3 years (November 2012 - August 2015) in City Clinic (Sofia, Bulgaria). We performed endovascular treatment of 47 patients (43 men, 4 women) at average age 54 y. with dissection (24) and aneurysms (23) of the aortic arch and thoracic aorta (in 5 emergent treatment was performed for aortic rupture). All patients were treated with minimal surgical femoral approach. In 4 (9%) of them initial carotid to carotid bypass was performed in order to provide a sufficient landing zone for the endograft implantation.the last 9 patients (19%) were treated without general anesthesia with either deep sedation or epidural anesthesia. Results: In all patients successful endograft implantation was achieved. Additional stent-graft or open cell stent was implanted in 4 cases in order to centralize the flow in the compressed true lumen. In 5 cases additional vascular plug or large coil was delivered in the left subclavian arteryostium in order to interrupt retrograde aneurysm or false lumen filling. Complications: 30 days mortality-2.2%, neurologic disorders (4.4%). one year survival- 45 (90.5%). 3 and 6 mo control CT scan showed no migration of the graft in 100%, full false lumen isolation in 19 out of 24 dissections (80%) and aneurysm free of expansion in 20 out of 23 (86%), patent carotid bay-pass graft in 4 of 4 (100%). This one center study showed excellent immediate and 1 year clinical and device results from endovascular repair of potentially fatal disease. Endovascular treatment is a method of choice for broad spectrum of aortic pathology

  13. Hiperalgesia asociada al tratamiento con opioides

    Directory of Open Access Journals (Sweden)

    A. Gil Martín

    2014-10-01

    Full Text Available La hiperalgesia inducida por opioides es una reacción paradójica caracterizada por una percepción intensificada de dolor relacionada con el uso de estos medicamentos en ausencia de progresión de la enfermedad o de síndrome de retirada. A diferencia de los casos de tolerancia, definida como pérdida de potencia analgésica durante el uso prolongado de opioides, no se produce mejoría con el escalado de dosis. La hiperalgesia inducida por opioides se ha manifestado en pacientes con dosis de mantenimiento y retirada, pacientes con dosis elevadas o escalado de dosis y pacientes con dosis ultra bajas. Para establecer un diagnóstico diferencial es importante tener en cuenta que un incremento de dosis puede producir una mejoría temporal en pacientes con tolerancia pero no en los que han desarrollado hiperalgesia. La prevalencia de dicho fenómeno es desconocida, pero puede ser más frecuente de lo esperado y muchas veces no reconocido. El mecanismo subyacente no está bien definido, pero existen diversos estudios experimentales tanto en modelos animales como en humanos en los que se observa que la hiperalgesia no está desencadenada por un único factor, sino que son muchos los implicados. Entre los mecanismos propuestos destacan: la mediación del receptor NMDA (N-metil-D-aspartato activado por la liberación presináptica de glutamato, la modulación por la proteína-kinasa de calcio/calmodulina, el aumento en el número de nociceptores o la liberación de neurotransmisores excitadores. Se han realizado diversos estudios para describir la expresión y la relevancia de la hiperalgesia inducida por opioides en distintos grupos de pacientes: ex-adictos a opioides en tratamiento de mantenimiento con metadona, en exposición perioperatoria, en voluntarios sanos o en dolor crónico. Existen diferentes estrategias de tratamiento disponibles; entre las más aceptadas se encuentra la reducción en la dosis del opioide utilizado, la rotación del

  14. Halitosis: diagnóstico y tratamiento

    OpenAIRE

    M. Monfort Codinach; E. Jané Salas

    2014-01-01

    Introducción: Debido a los múltiples factores que pueden causar o agravar la halitosis, y que el tratamiento depende de eso, es imprescindible hacer un diagnóstico detallado para identificar todos y cada uno de ellos. Diagnóstico: En la halitosis es esencial hacer un diagnóstico etiológico. Por ello hay que prestar atención a la anamnesis para poder descartar las pocas probabilidades de una causa sistémica, preguntar al paciente sobre diferentes aspectos de la halitosis, fijándose en los aspe...

  15. Imaging of gastrointestinal and abdominal tuberculosis

    NARCIS (Netherlands)

    Vanhoenacker, FM; De Backer, AI; Op de Beeck, B; Maes, M; Van Altena, R; Van Beckevoort, D; Kersemans, P; De Schepper, AM

    2004-01-01

    This article discusses the range of manifestations of tuberculosis (TB) of the abdomen, including involvement of the gastrointestinal tract, the peritoneum, mesentery, omentum, abdominal lymph nodes, solid abdominal organs, the genital system and the abdominal aorta. Abdominal TB is a diagnostic cha

  16. 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)

  17. 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

    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.

  18. Occupational Radiation Exposure During Endovascular Aortic Repair

    Energy Technology Data Exchange (ETDEWEB)

    Sailer, Anna M., E-mail: anni.sailer@mumc.nl [Maastricht University Medical Centre (MUMC), Department of Radiology (Netherlands); Schurink, Geert Willem H., E-mail: gwh.schurink@mumc.nl [Maastricht University Medical Centre (MUMC), Department of Surgery (Netherlands); Bol, Martine E., E-mail: m.bol@maastrichtuniversity.nl; Haan, Michiel W. de, E-mail: m.de.haan@mumc.nl; Zwam, Willem H. van, E-mail: w.van.zwam@mumc.nl; Wildberger, Joachim E., E-mail: j.wildberger@mumc.nl; Jeukens, Cécile R. L. P. N., E-mail: cecile.jeukens@mumc.nl [Maastricht University Medical Centre (MUMC), Department of Radiology (Netherlands)

    2015-08-15

    PurposeThe aim of the study was to evaluate the radiation exposure to operating room personnel and to assess determinants for high personal doses during endovascular aortic repair.Materials and MethodsOccupational radiation exposure was prospectively evaluated during 22 infra-renal aortic repair procedures (EVAR), 11 thoracic aortic repair procedures (TEVAR), and 11 fenestrated or branched aortic repair procedures (FEVAR). Real-time over-lead dosimeters attached to the left breast pocket measured personal doses for the first operators (FO) and second operators (SO), radiology technicians (RT), scrub nurses (SN), anesthesiologists (AN), and non-sterile nurses (NSN). Besides protective apron and thyroid collar, no additional radiation shielding was used. Procedural dose area product (DAP), iodinated contrast volume, fluoroscopy time, patient’s body weight, and C-arm angulation were documented.ResultsAverage procedural FO dose was significantly higher during FEVAR (0.34 ± 0.28 mSv) compared to EVAR (0.11 ± 0.21 mSv) and TEVAR (0.06 ± 0.05 mSv; p = 0.003). Average personnel doses were 0.17 ± 0.21 mSv (FO), 0.042 ± 0.045 mSv (SO), 0.019 ± 0.042 mSv (RT), 0.017 ± 0.031 mSv (SN), 0.006 ± 0.007 mSv (AN), and 0.004 ± 0.009 mSv (NSN). SO and AN doses were strongly correlated with FO dose (p = 0.003 and p < 0.001). There was a significant correlation between FO dose and procedural DAP (R = 0.69, p < 0.001), iodinated contrast volume (R = 0.67, p < 0.001) and left-anterior C-arm projections >60° (p = 0.02), and a weak correlation with fluoroscopy time (R = 0.40, p = 0.049).ConclusionAverage FO dose was a factor four higher than SO dose. Predictors for high personal doses are procedural DAP, iodinated contrast volume, and left-anterior C-arm projections greater than 60°.

  19. Y PROCEDIMIENTOS QUIRÚRGICOS DE TRATAMIENTO

    Directory of Open Access Journals (Sweden)

    FBE Guevara

    2005-01-01

    Full Text Available La hemiplejía laríngea idiopática es la causa más común de insuficiencia de las vías respiratorias altas en equinos. La enfermedad está clasificada como una axonopatía distal que afecta el nervio laríngeo recurrente y que produce atrofia neurogénica de la musculatura intrínseca de la laringe. La enfermedad se manifiesta por la paresa o parálisis de los músculos abductores laríngeos (cricoaritenoides dorsal, lo que termina en la obstrucción de la vía aérea y en el colapso dinámico del cartílago aritenoideo afectado, durante el ejercicio. Su diagnóstico es realizado por medio de un examen endoscópico, en reposo o durante el ejercicio. Las técnicas quirúrgicas de tratamiento para caballos con grados III o IV de hemiplejía laríngea son principalmente la laringoplastia prostética, la aritenoidectomía, la ventriculectomía/cordectomía y los procedimientos de reinervación del músculo cricoaritenoideo dorsal. De las anteriores técnicas, la laringoplastia continúa siendo el tratamiento quirúrgico de primera elección.

  20. Tratamiento quirúrgico de los hemangiomas

    Directory of Open Access Journals (Sweden)

    M Waner

    2004-01-01

    Full Text Available El planteamiento terapéutico ante los hemangiomas ha cambiado ligeramente estos últimos años, pasando de mantener una actitud general conservadora a ser más agresivos en algunos casos. Las alteraciones inestéticas crónicas que pueden originar los hemangiomas, el trauma psicosocial que pueden desencadenar en la niñez, junto con un mejor conocimiento del comportamiento de este tipo de lesiones y el avance en técnicas quirúrgicas más seguras y eficaces, han sido los factores fundamentales de este cambio de actitud. El presente trabajo se centra en el tratamiento quirúrgico de los hemangiomas, explicando las indicaciones que tienen según la etapa de evolución en que se encuentren y las técnicas quirúrgicas empleadas para resecar la lesión con la mínima morbilidad. Así mismo, se tratan de forma detallada aquellas lesiones que, por presentar una localización anatómica facial concreta, requieren un tratamiento quirúrgico especial.