RESUMEN
PURPOSE: This study aimed to evaluate midterm outcomes of conventional percutaneous transluminal angioplasty (PTA) in the treatment of femoropopliteal steno-obstructive disease and assess the effect of risk factors on patency rates. MATERIALS AND METHODS: One hundred consecutive patients with femoropopliteal steno-obstructive disease underwent PTA, for a total of 104 procedures. Presence of cardiovascular risk factors, TransAtlantic Inter-Society Consensus (TASC) classification, runoff status, pre-and postprocedural clinical data and procedure outcome were recorded. Follow-up consisted of clinical assessment and colour Doppler ultrasonography at 1, 6 and 12 months. RESULTS: Technical success was 96% (96/100). Seven lesions required stent placement. Primary and secondary patency rates were 82.7% and 88.8% at 6 months and 74.3% and 81.5% at 12 months, respectively. Primary patency rates at 12 months were significantly higher for TASC A-B-C lesions than for TASC D lesions (p < 0.05). Primary patency rates at 12 months were 61.6% and 78.8% (p<0.05) for poor or adequate runoff status, respectively. CONCLUSIONS: Conventional PTA is a minimally invasive alternative to bypass surgery for treating TASC A-C atherosclerotic lesions in the presence of adequate runoff.
Asunto(s)
Angioplastia de Balón , Arteriopatías Oclusivas/terapia , Arteria Femoral , Arteria Poplítea , Stents , Anciano , Anciano de 80 o más Años , Arteriopatías Oclusivas/clasificación , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler en Color , Grado de Desobstrucción VascularRESUMEN
PURPOSE: This study was performed to compare the rate of morphological (renal infarction and/or ischaemic lesions) and functional renal complications after the suprarenal and infrarenal fixation of aortic stent-grafts for endovascular abdominal aortic aneurysm repair (EVAR). MATERIALS AND METHODS: We retrospectively reviewed all followup computed tomography (CT) angiograms (obtained at 1, 6 and 12 months and yearly thereafter) and laboratory data pertaining to 102 patients who underwent suprarenal (60 patients, group A) or infrarenal (42 patients, group B) placement of aortic stent-grafts. The groups were compared in terms of complications affecting kidney function (creatinine clearance) and morphology (renal artery steno-occlusions, morphological and structural parenchymal changes), and pre- and postprocedural arterial pressure (AP). RESULTS: Analysis of patient demographics revealed no statistically significant difference between the two groups. The proximal neck was shorter in group A (2.14 cm+/-0.84 cm) than in group B (3.41 cm+/-1.21 cm). Creatinine clearance (CrCl) decreased in both groups (group A: from 64.24 ml/min to 60.66 ml/min; group B: from 72.41 ml/min to 68.73 ml/min) without any significant difference in terms of changes in renal function (CrCl variation: -8.75% vs. -6.4%) or morphology (post-EVAR stenosis: 2.6% vs. 0%; progression of existing steno-occlusive lesions: 1% vs. 0%; ischaemic lesions: 3.2% vs. 0%), or in AP. CONCLUSIONS: In our experience, the use of abdominal endografts with suprarenal fixation did not lead to any significant increase in morphological and/or functional renal complications compared with those with infrarenal fixation.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/métodos , Creatinina/orina , Enfermedades Renales/etiología , Stents/efectos adversos , Anciano , Angiografía , Presión Sanguínea , Implantación de Prótesis Vascular/efectos adversos , Femenino , Humanos , Enfermedades Renales/orina , Masculino , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: The purpose of this study was to determine how many patients with abdominal aortic aneurysm (AAA) are eligible for endovascular abdominal aortic aneurysm repair (EVAR). MATERIALS AND METHODS: We retrospectively reviewed computed tomography (CT) angiograms obtained between January 2002 and June 2003 in 182 patients with suspected AAA. Indication for surgical or endovascular treatment was based on clinical and radiological criteria. The percentage of patients eligible for EVAR was evaluated. RESULTS: Out of a total of 182 patients with suspected AAA studied by CT angiography, after combined radiological-surgical assessment, 130 were considered eligible for surgical or endovascular treatment (71.4%). EVAR was indicated in 51 patients (39.3%, group A) and surgical repair was indicated in 79 patients (60.7%, group B). The reasons for ineligibility for EVAR were the following: unfavourable anatomy of the proximal neck in 41 patients (51.9%), diameter of the aneurysm sac >7 cm in 13 patients (16.4%), markedly tortuous/dilated iliac axis in six patients (7.6%), age <65 years in 17 patients (21.5%) and patient refusal in two cases (2.5%). There were no statistically significant differences in aneurysm diameter (52.7+/-0.8 versus 49.8+/-1.2 mm, p=ns), patients' age (73.2+/-1.2 versus 70.6+/-2.02 years, p=ns) or proximal neck length (2.95+/-1 versus 3.03+/-1.2 cm, p=ns) between groups A and B. CONCLUSIONS: Endovascular repair of abdominal aortic aneurysms through the placement of aortic stent-grafts has now become a viable alternative to open surgery. In recent years, the number of patients treated with EVAR has steadily risen as a result of increased physician experience, availability of new and more versatile devices and improvements in noninvasive imaging techniques. Unfavourable neck anatomy is the primary factor for exclusion from endovascular repair.