RESUMO
BACKGROUND: The study aims to describe midterm outcomes following treatment of infrarenal abdominal aortic aneurysms (AAAs) with short necks by endosutured aneurysm repair using the Heli-FX EndoAnchor system. METHODS: This is a retrospective study of prospectively collected data from 9 vascular surgery departments between June 2010 and December 2019, including treated AAAs with neck lengths ≤10 mm. The decision for the use of EndoAnchors was made by the treating surgeon or multidisciplinary aortic committee according to each center's practice. There were 2 Groups further assessed according to neck length, A (≥4 and <7 mm) and B (≥7 and ≤10 mm). The main outcomes analyzed were technical success, freedom from type Ia endoleaks (TIaELs), sac size increase, all-cause and aneurysm-related mortality. RESULTS: Seventy-six patients were included in the study, 17 fell into Group A and 59 into Group B. Median follow-up for the cohort was 40.5 (interquartile range 12-61) months. A median of 6 (interquartile range 3) EndoAnchors were deployed in each subject. Technical success was 86.8% for the total group, 82.4% and 88.1% (P = 0.534) for Groups A and B respectively. Six out of 10 (60%) of TIaELs at the completion angiographies showed spontaneous resolution. Cumulative freedom from TIaEL at 3 and 5 years for the total group was 89% and 84% respectively; this was 93% and 74% for Group A and 88% at both intervals in Group B (P = 0.545). In total, there were 7 (9.2%) patients presenting with TIaELs over the entire study period. Two (11.8%) in Group A and 5 (8.5%) in Group B (P = 0.679). There were more patients with sac regression in Group B (Group A = 6-35.3% vs. Group B = 34-57.6%, P = 0.230) with no statistical significance. All-cause mortality was 19 (25%) patients, with no difference (4-23.5% vs. 15-25.4%, P = 0.874) between groups; whereas aneurysm-related mortality occurred in 1 patient from Group A and 3 from Group B. CONCLUSIONS: This study demonstrates reasonable outcomes for patients with short-necked AAAs treated by endosutured aneurysm repair in terms of TIaELs up to 5-year follow-up. EndoAnchor use should be judiciously evaluated in short necks and may be a reasonable option when anatomical constraints are encountered, mainly for those with 7-10 mm neck lengths. Shorter neck length aspects, as indicated by the results from Group A, may be an alternative when no other options are available or feasible.
Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Prótese Vascular , Endoleak , Procedimentos Endovasculares , Desenho de Prótese , Sistema de Registros , Humanos , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Estudos Retrospectivos , Masculino , Feminino , Idoso , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Fatores de Tempo , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Resultado do Tratamento , Idoso de 80 Anos ou mais , Endoleak/etiologia , Fatores de Risco , Técnicas de Sutura/efeitos adversos , Técnicas de Sutura/mortalidade , Pessoa de Meia-IdadeRESUMO
The most frequent complications of any aneurysm is rupture. Consequently there is a general rull that aneurysms should be treated when diagnosed because the odds of survival after rupture are poor... The authors describe the immediate repair using the intraluminal approach, with special reference to indications and results using this procedure. An illustrative and well documented case is presented.
Assuntos
Humanos , Masculino , Idoso , Aneurisma da Aorta Abdominal/cirurgia , Endarterectomia , Ruptura Aórtica/cirurgia , Doença Pulmonar Obstrutiva Crônica , Fatores de Risco , TabagismoRESUMO
We report our experience with one patient with recurrent coarctation and aneurysm degeneration treated endoluminally. A novel technique was used combining balloon-expandable with self-expandable endografts. The balloon-expandable component expanded the area of stenosis and also created a neck to allow the implantation of the self-expandable endograft to exclude the aneurysm. Mismatch of diameters was solved with the creation of a new proximal neck, in which the distal end was progressively expanded to reach the appropriate diameter to implant the self-expandable endograft inside. Expansion of the narrow stenosis and complete exclusion of the aneurysm was achieved without a residual pressure gradient.
Assuntos
Angioplastia com Balão , Aneurisma da Aorta Torácica/terapia , Coartação Aórtica/terapia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Stents , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/patologia , Aneurisma da Aorta Torácica/cirurgia , Coartação Aórtica/complicações , Coartação Aórtica/patologia , Coartação Aórtica/cirurgia , Aortografia/métodos , Humanos , Masculino , Politetrafluoretileno , Desenho de Prótese , Recidiva , Reoperação , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Cilostazol is a potent selective inhibitor of phosphodiesterase-3 of proven efficacy in intermittent claudication. It has antiplatelet effect and produces vasodilatation in several vascular territories. This drug has been approved in some countries for the prevention of recurrence of cerebral infarction. Limited data in patients with cerebral infarcts suggest improvement in cerebral blood flow. Dilatation of cerebral vessels with carbon-dioxide challenge can be assessed by transcranial Doppler technique. The percentage increase in blood flow velocity is called cerebral vasomotor reactivity (CVR). OBJECTIVE: In this investigation we sought to measure CVR before and after oral administration of cilostazol. METHODS: We studied patients with risk factors for atherosclerosis before they received cilostazol (100 mg twice daily) for intermittent claudication. CVR was assessed by measuring bilateral middle cerebral artery blood flow velocity during normoventilation and after 3 minutes of breathing 8% carbon dioxide. One average value was obtained from each patient. CVR was measured the day before cilostazol first dose, at 1 month, and 3 to 6 months later. RESULTS: We examined 9 patients (8 men and 1 woman) aged 67.6 +/- 8.4 years. All patients had hypertension, 5 had diabetes, 4 were smokers, 5 had high cholesterol levels, and 4 had coronary artery disease. CVR was 54.4 +/- 14.4% at baseline, and increased to 64.2 +/- 18.6% after 1 month (P < .05) and to 67.1 +/- 13.3% at 3 to 6 months later (P < .01). CONCLUSION: Our findings suggest that cilostazol increases CVR in patients with atherosclerotic disease.
RESUMO
The endoluminal approach of the diffusely atheromatous aorta (DAA) is an emerging tool to prevent further embolization. We treated one symptomatic patient with DAA. We designed a catheter with a balloon at the tip for occlusion of both common iliac arteries through which the antegrade flow was allowed by an iliac to femoral arterio-arterial shunt connected to an in-line filter. Filter wires were also placed in the superior mesenteric and both renal arteries' take-off, keeping their antegrade flow. The endograft was then introduced through these tubes. Endoluminal treatment of the primary source of atheromatous embolization is feasible, representing a new approach to be considered.