RESUMEN
BACKGROUND: The presence of sac enlargement after abdominal aortic aneurysm (AAA) open repair, a condition usually called perigraft seroma (PGS), nearly always has a benign behavior. Some theories implicated for PGS formation include coagulation abnormalities, fibroblast inhibition, low-grade infection, or improper graft handling. METHODS: This is a retrospective study including patients treated for AAA in 2 academic vascular surgery departments from 2007 to 2014, where 1 center preferably used polytetrafluoroethylene (PTFE) grafts whereas the preference of other center was mostly Dacron graft. The definition of PGS was conceived as a fluid collection around the graft on CT scan imaging with a radiodensity ≤25 Hounsfield units, reaching at least 30 mm in diameter and beyond the third postoperative month. Analysis was performed between patients with and without PGS. RESULTS: Seventy-eight patients met the inclusion criteria: 42 received Dacron and 36 PTFE grafts. Twenty-three (29.5%) patients accomplished the PGS diagnosis. Having a PTFE graft was the strongest factor for PGS formation on multivariate analysis. The medium seroma size was 42 mm (range, 30-90.6 mm) and the mean time from AAA repair to PGS detection was 26 months (range, 4-106 months). Three patients of the 23 with PGS required surgical repair, all of them were successfully treated: 2 by endovascular means and the remaining with explantation and Dacron reconstruction. CONCLUSIONS: PGS formation is not an unusual complication after open reconstructions for AAA treatment. This is especially true for PTFE grafts, and thus, closer follow-up is warranted if using this material. Treatment is clearly needed when symptoms appear; however, preventive strategies with either endovascular relining or reopen reconstructions require an individual approach counterbalancing benefits versus risk of the procedures.
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Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular/efectos adversos , Politetrafluoroetileno/efectos adversos , Seroma/etiología , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tereftalatos Polietilenos/efectos adversos , Diseño de Prótesis , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Seroma/diagnóstico por imagen , España , Factores de Tiempo , Resultado del TratamientoRESUMEN
A 78-year-old man with a 56-mm juxtarenal aneurysm and previous pelvic radiotherapy for prostate cancer (3 years earlier) who was disease free during follow-up received elective aortoaortic bypass suprarenal clamping through a transperitoneal approach. After the patient experienced initial abdominal pain and diarrhea, a computed tomography scan showed mild sigmoid inflammation, and the patient received conservative treatment. One month after discharge, the patient underwent urgent laparotomy and bowel and sigmoid resection for an enterocutaneous fistula. At 6-month follow-up, he has recovered, although a bowel stoma remains.
RESUMEN
BACKGROUND: The use of EndoAnchors is increasing; however, not much about appropriate use in terms of aortic wall penetration (AWP) is described. We aim to evaluate the procedural and anatomical conditions related with borderline (b) or absence (ab) of AWP when checked on first CT-scan after the Endosutured aortic repair (ESAR) for hostile neck anatomies (HNA). METHODS: This study with NCT04100499 is a single center prospective evaluation of patients receiving EndoAnchors for prevention or treatment of a proximal EVAR failure. AWP was evaluated on first CT-scan and findings correlated with neck anatomical features and procedural data. The sum of borderline and absence of AWP was considered as Inadequate - In-AWP (failure). Adjunctive procedures, reinterventions, all-cause mortality, absence of type Ia EL and aneurysm related mortality are also described. RESULTS: Forty-eight patients were treated during the study period and 43 high-surgical risk patients were finally included in the study for analysis with at least one HNA criteria (58%) and associating two in 21% or even three in 21%. A total of 250 EndoAnchors were deployed at a median 6 (range, 4-10) per case. From those, 31 (12.5%) achieved b-AWP and 11 (4.4%) ab-AWP, meaning 42 (16.8%) EndoAnchors with In-AWP. Univariate-analysis showed being an occasional user and a therapeutic case as predictor for at least one and more failures. The only predictor on multivariate analysis for two or more EndoAnchors with In-AWP was being an occasional user. Cumulative-survival and freedom from type-Ia EL at 2-years was 84% and 95%; respectively. CONCLUSIONS: Outcomes of the ESAR therapy should be validated according to their aortic wall penetration checked on first CT-scan. EndoAnchors use in HNA should not be considered an easy approach for the endovascular technique, especially for therapeutic cases. An individual and specific case analysis counterbalancing inadequate use of the device in unexperienced users should be evaluated against the increased risk of proximal failure as in standard EVAR alone during HNA treatment.
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Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Endofuga/etiología , Procedimientos Endovasculares/efectos adversos , Técnicas de Sutura/efectos adversos , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/mortalidad , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/mortalidad , Endofuga/diagnóstico por imagen , Endofuga/mortalidad , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Técnicas de Sutura/instrumentación , Técnicas de Sutura/mortalidad , Suturas , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: The epidemic potential of coronavirus infection is now a reality. Since the first case detected in late 2019 in China, a fast worldwide expansion confirms it. The vascular patient is at a higher risk of developing a severe form of the disease because of its nature associating several comorbid states, and thus, some vascular surgery communities from many countries have tried to stratify patients into those requiring care during these uncertain times. METHODS: This is an observational study describing the current daily vascular surgery practice at one tertiary academic hospital in Madrid region, Spain-one of the most affected regions worldwide due to the COVID-19 outbreak. We analyzed our surgical practice since March 14th when the lockdown was declared up to date, May 14th (2 months). Procedural surgical practice, organizational issues, early outcomes, and all the troubles encountered during this new situation are described. RESULTS: Our department is composed of 10 vascular surgeons and 4 trainees. Surgical practice has been reduced to only urgent care, totaling 50 repairs on 45 patients during the period. Five surgeries were performed on 3 COVID-19-positive patients. Sixty percent were due to critical limb ischemia, 45% of them performed by complete endovascular approach, whereas less than 10% of repairs were aorta related. We were allocated to use a total of 5 surgical rooms in different locations, none our usual, as it was converted into an ICU room while performing 50% of those repairs with unusual nursery staff. CONCLUSIONS: The COVID-19 outbreak has dramatically changed our organization and practice in favor of urgent or semiurgent surgical care alone. The lack of in-hospital/ICU beds and changing nursery staff changed the whole availability organization at our hospital and was a key factor in surgical decision-making in some cases.
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Betacoronavirus , Infecciones por Coronavirus/complicaciones , Pandemias , Neumonía Viral/complicaciones , Especialidades Quirúrgicas/estadística & datos numéricos , Enfermedades Vasculares/cirugía , Procedimientos Quirúrgicos Vasculares/organización & administración , COVID-19 , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/epidemiología , SARS-CoV-2 , España/epidemiología , Enfermedades Vasculares/complicacionesRESUMEN
Purpose: To analyze aortic wall penetration of Heli-FX EndoAnchors after use in seal zones in the aortic arch or descending thoracic aorta during thoracic endovascular aortic repair (TEVAR). Materials and Methods: From May 2014 to May 2019, 25 patients (mean age 70.5±10 years; 16 women) were treated with TEVAR and adjunctive use of the Heli-FX device in 3 academic vascular surgery departments. Computed tomography scans were retrospectively reviewed to determine the location [arch or descending thoracic aorta (DTA)] of the EndoAnchors and the adequacy of aortic wall penetration, defined as adequate (≥2 mm), partial (<2 mm), or inadequate wall penetration (including loss). Endoleaks, reinterventions, and mortality were assessed. Results: A total of 161 EndoAnchors were deployed (median 7 per patient, range 4-9). Twenty-two EndoAnchors were place in the arch (zones 0-2) and 139 in the DTA (zones 3-5). A larger proportion of arch deployments (27%) had suboptimal penetration compared with the DTA (6.5%; p<0.005), resulting in a 91% adequate wall penetration rate for the series overall. Three EndoAnchors were lost (and only 1 retrieved) in 3 different patients, with no additional morbidity; thus, an overall deployment success rate of 88% was achieved. At a mean follow-up of 16.6±14 months, 4 patients required 5 (successful) reinterventions, including one for a type Ia endoleak treated with chimney TEVAR. One patient died 10 months after treatment due to endograft infection, without an opportunity for surgical correction. Conclusion: EndoAnchors have a higher risk of maldeployment in the arch, though this may be attributable to the small learning curve experience in this location. The best aortic wall penetration for this series was in the DTA, where EndoAnchors proved useful for distal endograft fixation during TEVAR.
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Aneurisma Falso/cirugía , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Stents , Anciano , Anciano de 80 o más Años , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/mortalidad , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/mortalidad , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Endofuga/etiología , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Femenino , Migración de Cuerpo Extraño/etiología , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCCIÓN: la enfermedad aterosclerótica en la región femoropoplítea es la principal causa de isquemia crónica de miembros inferiores. Existen diversos tipos de tratamiento quirúrgico -abierto, convencional o endovascular para su tratamiento. El sector poplíteo ha sido una zona conflictiva para el uso de stent debido a su alta carga de estrés mecánico. MÉTODO: estudio retrospectivo observacional monocéntrico en el tratamiento de isquemia crítica con el uso de un stent dual de nitinol y fluoropolímeros en cualquier porción de la arteria poplítea entre enero de 2012 y enero de 2017. La indicación del stent fue fallo del tratamiento endovascular de la angioplastia (disección, reestenosis o recoil). Realizamos seguimiento clínico y ecográfico a 3, 6 y 12 meses. Se evalúa permeabilidad primaria, secundaria, salvamento de miembro y mortalidad. RESULTADOS: se incluyen 19 pacientes -8 hombres (42,1%) y 11 mujeres (57,9%), con una edad media de 77,4 años y características basales habituales. La mediana de seguimiento fue de 8 meses (rango 1-66 meses). Durante el seguimiento, la permeabilidad primaria a 3 meses fue de 94,7% y de 88% a 6 y 12 meses. La permeabilidad secundaria a 3 meses fue del 100% y de 92,9% a 6 y 12 meses. La tasa libre de amputación fue de 92,9% al año de seguimiento. La supervivencia al año fue del 72%. CONCLUSIÓN: el stent dual de nitinolfluoropolímeros impregnado en heparina es una buena opción terapéutica para la isquemia crítica en el sector poplíteo después de fallo con angioplastia, ya que demuestra altas tasas de permeabilidad y supervivencia del miembro en pacientes con isquemia crítica. Es necesario validar los resultados a medio y largo plazo para valorar la posibilidad de stenting primario en este sector
INTRODUCTION: femoropopliteal atheroscletoric disease is the main cause of chronic limb ischemia. There are different types of surgical treatment, open by pass or endovascular. Due to high mechanical stress the popliteal artery has always been considered a no-stent zone. METHOD: observational retrospective one-center study in the treatment of patients with critical limb ischemia (Rutherford-Baker grade 3-5) treated with dual stent along popliteal artery between January 2012 and January 2017. Indication of the stent was primary angioplasty failure (arterial dissection, re-stenosis or recoil). We performed follow-up with ultrasonography at 3, 6 and 12 months. We describe primary patency, secondary patency, limb salvage and mortality. RESULTS: we collected 19 patients, 8 men (42.1%) and 11 women (57.9%), 77.4 years of mean age. The median of follow-up was 8 months (range 1-66 months). Primary patency was 94.7% at 3 months and 88% at 6 and 12 months. Secondary patency was 100% at 3 months and 92.9% at 6 and 12 months. The limb salvage rate was 92.9% at 1 year. Survival rate was 72% for the first year. CONCLUSION: dual stent of nitinol and fluoropolymers impregnated with heparin seems to be a good option in patients with critical limb ischemia associating popliteal artery lesions. It has high patency and limb salvage rates. Despite that, it is necessary to validate these results in medium and long term
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Isquemia/terapia , Arteria Poplítea/patología , Stents Liberadores de Fármacos , Pierna/irrigación sanguínea , Estudios Retrospectivos , Estudios de Seguimiento , Resultado del Tratamiento , Análisis de Supervivencia , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Aortic bare-metal stent rupture is an exceptional complication, associated with high risk of aorta rupture and death. We describe a successful endovascular approach for a symptomatic aortic bare-metal stent fracture after the provisional extension to induce complete attachment (PETTICOAT) technique. METHODS: A 53-year-old man with a complicated type B aortic dissection (visceral malperfusion) was treated with thoracic endovascular aortic repair (TEVAR) and "PETTICOAT" technique. The 1-, 6-, and 12-month follow-up scans showed progressive aortic remodeling. After 15 months from the initial procedure, the patient was admitted to the emergency department with severe thoracic pain and two syncopal episodes. Urgent angio-computed tomography (CT) showed bare-metal stent rupture and aortic dilatation to 45 mm at the site of stent fracture. RESULTS: He was urgently treated with TEVAR to cover the entire length of the bare-metal stent under local anesthesia and motor-evoked potential (MEP) monitoring. If signs of medullary ischemia are observed in the MEP register, a carotid-subclavian bypass was planned. At 12 months of follow-up, the patient remains asymptomatic. CT scan at 1 month and 12 months showed no signs of endoleak and aortic remodeling to 40 mm. CONCLUSIONS: Although unusual, this case demonstrates the possibility of material fatigue/failure and highlights the need of close imaging follow-up after TEVAR for treatment of aortic diseases.
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Aleaciones , Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/métodos , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/métodos , Falla de Prótesis , Stents Metálicos Autoexpandibles , Disección Aórtica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aortografía/métodos , Angiografía por Tomografía Computarizada , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Reoperación , Resultado del TratamientoRESUMEN
PURPOSE: To assess if the suitability of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs) can be expanded by combining the Endurant stent-graft with the Heli-FX EndoAnchors. MATERIALS AND METHODS: Contrast-enhanced computed tomography (CT) scans of 90 patients (mean age 73.2±9 years; 87 men) with RAAA admitted between January 2014 and January 2018 in 2 tertiary care centers were analyzed in a 3-dimensional workstation. Anatomical features of the aneurysms according to the instructions for use (IFU) for the Endurant endograft were evaluated and expansion of treatment with Heli-FX EndoAnchors was assessed. RESULTS: Neck length <10 mm was present in 41 (45.6%) patients; 5 had neck diameters outside the IFU and 45 (50.0%) had conical necks. Thrombus and calcium were absent in 63 (70.0%) and 73 (81.1%), respectively. In the study cohort, 44 (48.9%) patients met all the neck criteria, although overall IFU compliance was found in only 35 (38.9%) patients due to iliac-related issues in 21 patients. The adjunctive use of EndoAnchors in the entire study group would enhance the therapeutic range to an additional 24 patients, 8 of whom would need an associated iliac procedure. This represents an expansion of the total EVAR approach from 48.9% to 75.6% of cases if some iliac issues are overcome and from 38.9% to 56.7% without correcting iliac deficiencies. CONCLUSION: The main reason of being unfit for endovascular treatment in this series was neck length <10 mm. Based on this analysis, nearly 40% of RAAA patients would have been candidates for EVAR based on the IFU neck criteria for the Endurant stent-graft. This suitability could be nearly doubled with the use of EndoAnchors and correction of unsuitable iliac anatomy. The use of EndoAnchors has the potential to offer a significant benefit in the endovascular treatment of RAAA patients.
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Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Stents , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Rotura de la Aorta/diagnóstico por imagen , Implantación de Prótesis Vascular/efectos adversos , Toma de Decisiones Clínicas , Procedimientos Endovasculares/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Diseño de Prótesis , Factores de Riesgo , España , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: To report a case of rupture of the descending aorta after aortic migration during transcatheter aortic valve replacement (TAVR). METHODS: An 85-year-old man with a severe and symptomatic aortic stenosis underwent elective TAVR, which complicated with embolization into the ascending aorta. While repositioning into the descending aorta, the procedure complicated with aortic rupture. RESULTS: The patient required urgent thoracic intravalve stent-graft implantation (thoracic endovascular aortic repair [TEVAR]). Reintervention with other stent graft was required 2 days after initial procedure as proximal rupture was again diagnosed. Patient was discharged 50 days later because of other medical complications. He remains stable at 1 year of follow-up. CONCLUSIONS: TEVAR is a valid and safe option in the treatment of iatrogenic acute aortic rupture due to TAVR.
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Aorta Torácica , Rotura de la Aorta/etiología , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Embolia/etiología , Migración de Cuerpo Extraño/etiología , Prótesis Valvulares Cardíacas/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Anciano de 80 o más Años , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Rotura de la Aorta/diagnóstico por imagen , Rotura de la Aorta/cirugía , Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Aortografía/métodos , Implantación de Prótesis Vascular , Angiografía por Tomografía Computarizada , Ecocardiografía Transesofágica , Embolia/diagnóstico por imagen , Procedimientos Endovasculares , Migración de Cuerpo Extraño/diagnóstico por imagen , Humanos , Masculino , Índice de Severidad de la Enfermedad , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Resultado del TratamientoRESUMEN
Objective Reports on inflammatory aortic abdominal aneurysm treatment are scarce. Traditionally, open surgery has been validated as the gold standard of treatment; however, high technical skills are required. Endovascular aortic repair has been suggested as a less invasive treatment by some authors offering good results. The purpose of our study was to report our experience and outcomes in the treatment of inflammatory aortic abdominal aneurysm using both approaches. Material and methods A retrospective review and data collection of all patients treated for inflammatory aortic abdominal aneurysm between 2000 and 2015 was done in one academic center. Diagnosis of inflammatory aortic abdominal aneurysm was based on preoperative CT-scan imaging. Type of treatment, postoperative and long-term morbidity and mortality are described. Abdominal compressive symptoms (hydronephrosis) severity and relief after treatment are described. Results Thirty-four patients with intact inflammatory aortic abdominal aneurysm were included. Twenty-nine (85.3%) patients were treated by open means and the remaining five (14.7%) with endovascular aortic repair. Nearly 90% were considered high-risk patients. Median follow-up was 46 months (range 24-112). The two groups were comparable, except for the age and preoperative hydronephrosis. There was no statistical significance in blood transfusion requirements, intensive care hospitalization, 30-day and long-term mortality between the two groups. Preoperative hydronephrosis was diagnosed in four (13.8%) patients in the open surgery group and three (60%) patients in the endovascular aortic repair group. Improvement of hydronephrosis was recognized in three out of the four patients in the open repair group and two out of the three in the endovascular aortic repair group. Renal function remained stable in both groups during follow-up. Conclusions Open surgery remains a safe and valid option for the treatment of inflammatory aortic abdominal aneurysm. Although our study included a small number of patients with endovascular aortic repair treatment, results are promising. Further randomized controlled studies may be necessary to assess long-term effectiveness of endovascular aortic repair treatment in this disease.
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Aneurisma de la Aorta Abdominal/cirugía , Aortitis/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/mortalidad , Aortitis/complicaciones , Aortitis/diagnóstico por imagen , Aortografía/métodos , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Angiografía por Tomografía Computarizada , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Femenino , Humanos , Hidronefrosis/etiología , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: To present a case of a patient with possible short (2 years approximately) life expectancy and a 68-mm abdominal aortic aneurysm with a large infrarenal neck and large suprarenal aorta that precluded chimney endovascular aortic repair (Ch-EVAR) treatment. MATERIALS AND METHODS: The technical aspects of a modification of the funnel technique (thoracic endograft as a proximal extension of a main infrarenal device in wide necks) are described. We advocated a migrated bifurcated 36-mm endograft in a 34-mm native aorta, ten mm below the lowest renal artery and added endoanchor (four) fixation to this "intentionally migrated main endograft." Afterward, we extended proximally a large aortic 38-mm-wide/50-mm-long cuff using the remaining 10-mm neck for cuff sealing. This aortic cuff achieved 8.5% oversizing in this 10-mm neck length. We again added additional endoanchoring (four) on this cuff. RESULTS AND CONCLUSIONS: Insights into technical issues for this bailout technique are described. No proximal endoleak or sac enlargement or migration is founded on 6-month follow up.
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Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/métodos , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/métodos , Anciano , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aortografía/métodos , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Humanos , Masculino , Diseño de Prótesis , Resultado del TratamientoRESUMEN
INTRODUCTION: Neck enlargement is well described in patients treated with self-expandable endografts for abdominal aortic aneurysms. Double endografting (ie, overlapping of stent grafts) occurs in patients with proximal cuffs or bifurcated to monoiliacal configuration conversions. When the aortic neck of patients receives 2 suprarenal fixation endografts, it may behave differently in terms of radial force and interaction of additional suprarenal stents extending to the visceral aorta. METHODS: We performed a retrospective study comparing 2 groups. Group 1 included 18 patients treated with 2 proximal self-expandable endografts. Group 2 included 17 patients treated with 1 self-expandable endograft who were consecutively treated during the period of treatment in group 1. Neck measurements were analyzed in both groups preoperatively and in the last computed tomography scan during follow-up. Suprarenal, interrenal, juxtarenal, and infrarenal (at 5 and 10 mm) diameters, as well as interrenal and infrarenal (5 mm) areas, were measured. RESULTS: There was no significant difference in baseline characteristics, initial neck measurements, and aneurysmal sac evolution including endoleaks between the groups. Both groups showed neck enlargement. Group comparisons of all parameters in posttreatment neck measurements showed no statistical change. Univariate analysis showed oversizing to be significant in interrenal diameter and area and infrarenal at 10 mm diameter; however, 2-way analysis of variance analysis showed that the interaction between oversizing and the number of stent grafts was not significant. CONCLUSION: Neck enlargement occurs in patients with self-expandable endografts with a tendency to reach the size of the endograft in the long term. Double endografting seems to interact in the same way as simple endografting in the aortic neck. Although the main limitation of our study lies in the small sample size, the presence of an additional "double" stent graft does not appear to result in any differences in aortic neck dilatation when compared to a single stent graft.
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Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Stents , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aortografía/métodos , Implantación de Prótesis Vascular/efectos adversos , Angiografía por Tomografía Computarizada , Procedimientos Endovasculares/efectos adversos , Femenino , Humanos , Masculino , Diseño de Prótesis , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Perigraft hygromas or seromas are an unusual finding and/or complication after open aortic repair. METHODS AND RESULTS: We present a case of an 82-year-old man with a previous urgent aortic bifurcated graft for abdominal aortic aneurysm rupture. He received several treatments due to abdominal compartment syndrome, requiring a Bogota Bag and colostomy derivation. He was finally discharged home and lost on follow-up. Eight years after this procedure, he presented to the urgency department with an abdominal mass and pain. Urgent computed tomography (CT) scan revealed a giant bilobed aortic sac, corresponding with a huge hygroma. A 3-stage minimally invasive procedure was scheduled due to hostile abdomen. Six months after successful treatment, patient came with fever and abdominal pain. He was diagnosed with graft infection and aortoenteric fistula and was treated with explantation and silver in situ repair. CONCLUSIONS: Aortic hygroma or seromas after open repair should be treated by open means whenever possible. Endovascular techniques could be a valid option in selected patients; however, further evidence is needed.
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Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares , Linfangioma Quístico/cirugía , Neoplasias Vasculares/cirugía , Anciano de 80 o más Años , Aorta Abdominal/diagnóstico por imagen , Aortografía/métodos , Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Angiografía por Tomografía Computarizada , Remoción de Dispositivos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/microbiología , Fístula Intestinal/cirugía , Linfangioma Quístico/diagnóstico por imagen , Masculino , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/cirugía , Factores de Riesgo , Stents , Factores de Tiempo , Insuficiencia del Tratamiento , Fístula Vascular/diagnóstico , Fístula Vascular/microbiología , Fístula Vascular/cirugía , Neoplasias Vasculares/diagnóstico por imagenRESUMEN
BACKGROUND: To report an unsuccessful use of large nitinol stent to prevent proximal endoleak in endograft treatment for juxtarenal aortic aneurysm. CASE REPORT: An 82-year-old male presented coronary disease and severe chronic obstructive pulmonary disease requiring oxygen support. A large 80-mm juxtarenal aneurysm was found on routine urological examination. Neck features were as follows: 7 mm and high anterior-posterior angulation. ASA risk score IV was given. Patient wanted to be treated. We decided a 1-shot intervention based on self-expandable suprarenal fixation endograft with adjunctive extra large self-expandable (high radial force) nitinol stent. Control computed tomography scan demonstrates nitinol stent severe infolding and a possible perforation of the primary endograft. At 6-month follow-up, sac reveals enlargement of 5 mm and 6% volume increase. Patient does not want further treatments due to high risk of procedures. CONCLUSIONS: Extreme caution should be taken when using self-expandable extra large nitinol stents for preventive matters. Oversizing should be carefully considered, not necessarily reaching the endograft chosen size. When short and angulated neck morphology co-exists, other devices or procedures may be a better option.
Asunto(s)
Aleaciones , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Endofuga/terapia , Procedimientos Endovasculares/instrumentación , Falla de Prótesis , Stents Metálicos Autoexpandibles , Aortografía/métodos , Implantación de Prótesis Vascular/efectos adversos , Angiografía por Tomografía Computarizada , Endofuga/diagnóstico por imagen , Endofuga/etiología , Procedimientos Endovasculares/efectos adversos , Humanos , Diseño de Prótesis , Resultado del TratamientoRESUMEN
BACKGROUND: Primary aortic mural thrombus (AMT) is a rare entity. Asymptomatic AMT may be found in imaging studies for other disease studies. Symptomatic AMT as embolic events may localize in the arterial branches of the aorta; limb ischemia is the most usual clinical presentation, though. However, when proximal aorta is compromised, visceral branches occlusion and ischemia may determine morbidity and mortality in these patients. METHODS: We performed a retrospective study with collection of data from January 2011 to September 2016. Medical records of patients were reviewed for: demographic data, cardiovascular risk factors or any known prothrombotic predisposing condition, clinical presentation, vessel of embolism, localization of aortic thrombus, treatment of AMT and symptoms, follow-up, and computed tomography scan imaging findings. RESULTS: A total of 8 patients were included in the study. Mean age was 54.7 ± 11.5 years, with male/female ratio 3:1. Four (50%) patients had AMT at the arch or descending aorta, 3 (37.5%) patients in the infrarenal sector, and the remaining in the visceral aorta. All but one patient received anticoagulation alone for the aortic thrombus. Patient with femoral thromboembolectomy died in the early postoperative time due to severe massive embolism. Median follow-up was 23 months (range, 1-50). Five out of seven patients showed complete aortic thrombus resolution in imaging follow up. None of the patients presented recurrence of embolic events. CONCLUSIONS: An anticoagulation first-approach treatment may be reasonable if mild organ damage is encountered. This strategy may be continued if no recurrences in embolic events are encountered, as high percentage of thrombus resolution is expected. Open or endovascular may be saved for life-threatening visceral or arch branches damage.
Asunto(s)
Anticoagulantes/uso terapéutico , Enfermedades de la Aorta/tratamiento farmacológico , Trombosis/tratamiento farmacológico , Adulto , Anciano , Anticoagulantes/efectos adversos , Enfermedades de la Aorta/complicaciones , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/mortalidad , Aortografía/métodos , Angiografía por Tomografía Computarizada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inducción de Remisión , Estudios Retrospectivos , España , Tromboembolia/etiología , Trombosis/complicaciones , Trombosis/diagnóstico por imagen , Trombosis/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
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