RESUMEN
BACKGROUND: The aim was to investigate the total prevalence of known and undiagnosed diabetes mellitus (DM), and the association of DM with perioperative complications following elective, infrarenal, open surgical (OSR) or endovascular (EVAR), Abdominal Aortic Aneurysm (AAA) repair. METHODS: In this Norwegian prospective multicentre study, 877 patients underwent preoperative screening for DM by HbA1c measurements from November 2017 to December 2020. Diabetes was defined as screening detected HbA1c ≥ 48 mmol/mol (6.5%) or previously diagnosed diabetes. The association of DM with in-hospital complications, length of stay, and 30-day mortality rate were evaluated using adjusted and unadjusted logistic regression models. RESULTS: The total prevalence of DM was 15% (95% CI 13%,17%), of which 25% of the DM cases (95% CI 18%,33%) were undiagnosed upon admission for AAA surgery. The OSR to EVAR ratio was 52% versus 48%, with similar distribution among DM patients, and no differences in the prevalence of known and undiagnosed DM in the EVAR versus the OSR group. Total 30-day mortality rate was 0.6% (5/877). Sixty-six organ-related complications occurred in 58 (7%) of the patients. DM was not statistically significantly associated with a higher risk of in-hospital organ-related complications (OR 1.23, 95% CI 0.57,2.39, p = 0.57), procedure-related complications (OR 1.48, 95% CI 0.79,2.63, p = 0.20), 30-day mortality (p = 0.09) or length of stay (HR 1.06, 95% CI 0.88,1.28, p = 0.54). According to post-hoc-analyses, organ-related complications were more frequent in patients with newly diagnosed DM (n = 32) than in non-DM patients (OR 4.92; 95% CI 1.53,14.3, p = 0.005). CONCLUSION: Twenty-five percent of all DM cases were undiagnosed at the time of AAA surgery. Based on post-hoc analyses, undiagnosed DM seems to be associated with an increased risk of organ related complications following AAA surgery. This study suggests universal DM screening in AAA patients to reduce the number of DM patients being undiagnosed and to improve proactive diabetes care in this population. The results from post-hoc analyses should be confirmed in future studies.
Asunto(s)
Aneurisma de la Aorta Abdominal , Biomarcadores , Diabetes Mellitus , Procedimientos Endovasculares , Complicaciones Posoperatorias , Humanos , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/epidemiología , Masculino , Femenino , Anciano , Estudios Prospectivos , Prevalencia , Factores de Riesgo , Diabetes Mellitus/epidemiología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Noruega/epidemiología , Medición de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Anciano de 80 o más Años , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Biomarcadores/sangre , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Hemoglobina Glucada/metabolismo , Tiempo de Internación , Persona de Mediana Edad , Enfermedades no Diagnosticadas/epidemiología , Enfermedades no Diagnosticadas/diagnóstico , Mortalidad HospitalariaRESUMEN
BACKGROUND: In an open study the effect of repetitive peripheral magnetic stimulation (RPMS) on the spastic talipes equinus of various origins, degree and duration was evaluated in 53 children and adolescents. STUDY DESIGN AND METHODS: Clinical and electrophysiological investigations were designed to measure the RMPS effect on the spasticity and the functional capabilities of the spastic talipes equines. Moreover, the duration of the effect of one RPMS session should be established. The magnetic stimulation comprising 10 series of 10 s duration was applied over the first sacral radix using a frequency of 20 Hz and a 1.2-fold intensity above the motoric threshold. RESULTS: The RPMS significantly reduced the tonus of the spastic talipes equines and this effect lasted for 1 week. No significant changes of electrophysiological parameters measuring the F-wave, H-reflex und ASR tendon reflex could be observed. CONCLUSION: The RPMS could prove to be an effective option for the treatment of spasticity. However, this method needs further evaluation by evidence-based studies.
Asunto(s)
Pie Equino/etiología , Pie Equino/rehabilitación , Magnetoterapia/métodos , Espasticidad Muscular/complicaciones , Espasticidad Muscular/terapia , Adolescente , Niño , Pie Equino/diagnóstico , Femenino , Humanos , Masculino , Espasticidad Muscular/diagnóstico , Resultado del TratamientoRESUMEN
We report the percutaneous injection of tissue adhesive (Tisseal, Immuno, Vienna, Austria) to ablate a 12-cm internal iliac aneurysm. The complex history of this lesion included previous surgery for a ruptured aortic aneurysm, attempted repair of the internal iliac aneurysm, and several embolization procedures. These factors precluded further open repair or transcatheter techniques and dictated the choice of a more direct approach.
Asunto(s)
Embolización Terapéutica/métodos , Aneurisma Ilíaco/terapia , Adhesivos Tisulares/uso terapéutico , Anciano , Angiografía , Fluoroscopía , Humanos , Aneurisma Ilíaco/diagnóstico por imagen , Masculino , Radiografía Intervencional , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler en Color , Ultrasonografía IntervencionalRESUMEN
PURPOSE: To assess the effectiveness of tissue adhesive and thrombin solution in the percutaneous ablation of peripheral artery pseudoaneurysms. METHODS: Twenty-five pseudoaneurysms were treated over a 33-month period; all had failed ultrasound-guided compression. Tissue adhesive or thrombin solution was injected percutaneously, with needle tip position and changes within the aneurysm confirmed with color Doppler ultrasound. In 19 cases we utilized a protective balloon inflated across the aneurysm neck prior to the injection of tissue adhesive and in six cases used thrombin injection alone. Seven patients were anticoagulated. Patients were followed up after the procedure. RESULTS: All 25 aneurysms were treated successfully; two patients required a return visit and there were no immediate complications or peripheral emboli detected. One patient developed a contralateral pseudoaneurysm. CONCLUSIONS: The percutaneous injection of pseudoaneurysms is a safe, atraumatic, and effective treatment for femoral artery pseudoaneurysms in the peripheral circulation. There are significant advantages over ultrasound-guided compression or surgical repair.
Asunto(s)
Aneurisma Falso/terapia , Embolización Terapéutica/métodos , Arteria Femoral , Hemostáticos/administración & dosificación , Trombina/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/fisiopatología , Angiografía , Velocidad del Flujo Sanguíneo , Arteria Femoral/diagnóstico por imagen , Humanos , Inyecciones Intraarteriales , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Ultrasonografía Doppler en ColorRESUMEN
BACKGROUND: Data from randomised studies are lacking on the value of interventional procedures in the management of atheromatous renal artery stenosis. This randomised prospective trial compared the effects on blood pressure (BP) and renal function of percutaneous transluminal angioplasty vs medical therapy in hypertensive patients with both unilateral and bilateral disease. METHODS: A total of 135 eligible patients were identified, of whom 55 (44%) were randomised. Eligible patients had sustained hypertension, with a minimum diastolic BP of 95 mm Hg on at least two anti-hypertensive drugs. Renal artery stenosis was defined by renal angiography as at least 50% stenosis in the affected vessel. All patients were observed during an initial 4-week run-in period on a fixed drug regimen and subsequent changes measured from this 4-week baseline. RESULTS: Blood pressure fell during the run-in period in all groups. In patients with bilateral renal artery stenosis randomised to angioplasty, a statistically significant (P<0.05) fall in BP was observed at latest follow-up (range 3-54 months). The mean fall in BP at latest follow-up in the angioplasty group, corrected for the medical group response, was 26/10 mm Hg. In patients with unilateral renal artery stenosis, no statistically significant or clinically important differences in outcome were observed between the two groups. No significant differences or trends in serum creatinine were observed between or within any group during follow-up. Major outcome events (death, myocardial infarction, heart failure, stroke, dialysis) were similar in the angioplasty and medical groups during follow-up. In the 40/135 patients undergoing angioplasty, serious or potentially serious complications attributable to the procedure were observed in 11 patients, bleeding at the arterial site (8 patients) being the most frequent. CONCLUSIONS: In hypertensive patients with atheromatous renal artery stenosis, percutaneous renal angioplasty results in a modest improvement in systolic BP compared with medical therapy alone. This benefit was confined to patients with bilateral disease. No patient was 'cured', renal function did not improve, and intervention was accompanied by a significant complication rate.
Asunto(s)
Angioplastia de Balón , Antihipertensivos/administración & dosificación , Arteriosclerosis/terapia , Hipertensión/terapia , Obstrucción de la Arteria Renal/terapia , Adulto , Anciano , Angiografía de Substracción Digital , Angioplastia de Balón/efectos adversos , Arteriosclerosis/complicaciones , Arteriosclerosis/mortalidad , Creatinina/sangre , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/complicaciones , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Análisis de Regresión , Obstrucción de la Arteria Renal/complicaciones , Obstrucción de la Arteria Renal/mortalidad , Tasa de SupervivenciaRESUMEN
Most peripheral arterial aneurysms are pseudoaneurysms and are iatrogenic or related to trauma. They can be treated by several techniques that can be performed by the radiologist, negating the need for surgery. Ultrasound guided compression repair is usually the treatment of choice, but is not always successful. The number of available treatment options reflects the varying site and nature of pseudoaneurysms and perhaps the lack of a consistently reliable method. We have successfully treated 13 patients with peripheral aneurysms (11 femoral, 1 popliteal and 1 posterior tibial aneurysm) using a commercial fibrin tissue adhesive. The method involves percutaneous injection of the adhesive components using ultrasound and screening control, following successful occlusion of the aneurysm neck by angioplasty balloon.
Asunto(s)
Aneurisma Falso/terapia , Adhesivo de Tejido de Fibrina/uso terapéutico , Enfermedades Vasculares Periféricas/terapia , Aneurisma Falso/diagnóstico por imagen , Angioplastia de Balón , Arteria Femoral/diagnóstico por imagen , Humanos , Enfermedades Vasculares Periféricas/diagnóstico por imagen , Arteria Poplítea/diagnóstico por imagen , Radiografía , Ultrasonografía IntervencionalRESUMEN
Seventy-nine patients have been treated by double-balloon percutaneous transluminal angioplasty for aortoiliac atherosclerotic lesions within 0.5 cm of the aortic bifurcation. Seven patients had repeated angioplasties, a total of 86 procedures over an 8 year period up to December 1990. The technique is described and its merits discussed. Technically successful dilatation was achieved in 81 cases (94%) and symptomatic relief was obtained in 75 (87%), including 12 of 14 patients with critical ischaemia. Fourteen of 17 occlusions up to 6 cm long and 67 of 69 stenoses were successfully dilated. After an average follow-up of 49 months (median 51 months, range 7-93), only six patients (7%) developed late recurrence of symptoms requiring further treatment. Six patients have died and 12 have been discharged from follow-up. The cumulative success rate beyond 5 years' follow-up was 80%. Complications requiring surgical intervention occurred in four patients (5%). Double-balloon percutaneous transluminal angioplasty was seen to be an effective procedure which produced lasting improvement and is recommended as the first choice treatment for localised stenotic and occlusive disease at the aortic bifurcation.
Asunto(s)
Angioplastia de Balón/instrumentación , Aorta Abdominal , Enfermedades de la Aorta/terapia , Arteriosclerosis/terapia , Arteria Ilíaca , Adulto , Anciano , Aorta Abdominal/diagnóstico por imagen , Enfermedades de la Aorta/diagnóstico por imagen , Arteriosclerosis/diagnóstico por imagen , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Arteria Ilíaca/diagnóstico por imagen , Isquemia/diagnóstico por imagen , Isquemia/terapia , Pierna/irrigación sanguínea , Masculino , Persona de Mediana Edad , Radiografía , RecurrenciaRESUMEN
The case histories of two patients with combined renal and extra-renal fibromuscular dysplasia are presented. Readers are reminded of this rare but important condition as a cause of obscure abdominal symptoms and abdominal bleeding in the absence of atherosclerotic aortic aneurysm. The aetiology, histology, and management of the condition are discussed.
Asunto(s)
Disección Aórtica/cirugía , Arteria Celíaca/cirugía , Displasia Fibromuscular/cirugía , Obstrucción de la Arteria Renal/cirugía , Adulto , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/patología , Angiografía , Angioplastia de Balón , Arteria Celíaca/diagnóstico por imagen , Arteria Celíaca/patología , Displasia Fibromuscular/diagnóstico por imagen , Displasia Fibromuscular/patología , Humanos , Ligadura , Masculino , Persona de Mediana Edad , Músculo Liso Vascular/patología , Obstrucción de la Arteria Renal/diagnóstico por imagen , Obstrucción de la Arteria Renal/patologíaRESUMEN
Eight catheters from five manufacturers have been subjected to tests which combined bending and tension. Three failure mechanisms have been identified. These included separation of the balloon from its proximal attachment to the shaft, fracture of the shaft at its junction with the balloon, and undue ductility of the shaft. It is concluded that good catheter design should ensure that there is no sudden change in stiffness along the length of the catheter, and that the optimum relationship of ductility to stiffness has not yet been defined for catheters. Recommendations relating to these characteristics could be included in the British Standards relating to angioplasty balloon catheters.
Asunto(s)
Angioplastia de Balón/instrumentación , Cateterismo/instrumentación , Falla de Equipo , Control de Calidad , Estrés MecánicoRESUMEN
Percutaneous balloon angioplasty offers an alternative to surgery for the alleviation of symptoms in upper limb arterial disease. This report documents 28 per-femoral dilatation procedures in 27 patients for 33 subclavian, two innominate, and two axillary lesions. Thirty-four stenoses and three occlusions were treated, with multiple dilatations in five patients. Indications for treatment were: arm ischaemia (15 patients); neurological (steal syndrome) symptoms (8); and combined ischaemia plus steal (5). Angioplasty was technically successful in 27 procedures with symptomatic relief in 25 cases up to a mean follow-up of 24 months (median 20 months, range 2-90 months). One patient had successful repeat angioplasty for recurrent ischaemic symptoms after 30 months. Angioplasty improved pulse deficits in all but two patients and reduced arm blood pressure differential to less than 30 mmHg in all but three patients. There were three complications: a femoral artery occlusion and a groin haematoma required surgical intervention and another patient suffered an extension of a contralateral stroke. Percutaneous balloon angioplasty has proved safe and effective. We recommend angioplasty as the first line treatment for ischaemic or neurological symptoms in upper limb vascular disease.
Asunto(s)
Angioplastia de Balón , Arteriopatías Oclusivas/terapia , Arteria Axilar , Tronco Braquiocefálico , Arteria Subclavia , Brazo/irrigación sanguínea , Constricción Patológica/terapia , Humanos , Isquemia/terapia , Síndrome del Robo de la Subclavia/terapiaRESUMEN
Thrombosis of the vena cava, femoral veins or iliac veins can result in the formation of large collateral veins in the pelvis and retroperitoneum which are often asymptomatic but which may cause severe bleeding and produce major difficulties in urological management. Such abnormalities are a rare cause of urological symptoms but may be difficult to diagnose unless a high index of suspicion is maintained. Three patients are reported who developed significant urological problems as a consequence of acquired venous disease; the use of ultrasound, venography and CT in the diagnosis of this condition is described.
Asunto(s)
Vejiga Urinaria/irrigación sanguínea , Várices/etiología , Adolescente , Adulto , Anciano , Circulación Colateral , Humanos , Vena Ilíaca , Masculino , Tromboflebitis/complicaciones , Trombosis/complicaciones , Venas CavasAsunto(s)
Embolización Terapéutica , Mola Hidatiforme/irrigación sanguínea , Embarazo , Neoplasias Uterinas/irrigación sanguínea , Adulto , Femenino , Humanos , Mola Hidatiforme/diagnóstico por imagen , Mola Hidatiforme/terapia , Recién Nacido , Resultado del Embarazo , Radiografía , Neoplasias Uterinas/diagnóstico por imagen , Neoplasias Uterinas/terapiaRESUMEN
A technique was developed to traverse an occlusion of the common iliac artery when approach from an ipsilateral puncture has been unsuccessful. The technique involves an antegrade approach to the occlusion and allowed successful passage in seven cases. At 2-year follow-up, only one of the seven occlusions had recurred.
Asunto(s)
Angioplastia de Balón/métodos , Arteria Ilíaca , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/terapia , Humanos , Arteria Ilíaca/diagnóstico por imagen , RadiografíaRESUMEN
In a Phase II clinical trial, 14 consecutive, unselected patients with primary hepatocellular carcinoma were treated with a new inhibitor of thymidylate synthase, CB3717. On the basis of previously reported criteria, 6 patients were considered to have a good prognosis (Grade A) and 8 a poor prognosis (Grade B). Three Grade B patients died after only one treatment. Six patients responded (4 Grade A and 2 Grade B) with a decrease in tumour size and greater than 50% fall in serum alphafetoprotein levels; 3 of these had a greater than 1 log fall in alphafetoprotein. A further patient (Grade B) showed static disease during treatment. Thus, of 11 patients receiving two or more treatments 7 showed clinical benefit, with a median survival from start of CB3717 therapy of 46 weeks (2 still alive at 33 and 67 weeks). Our results suggest that CB3717 will be a useful new therapeutic agent in hepatocellular carcinoma. Further controlled trials are indicated to confirm these preliminary findings, using the drug both as a single agent and in combination with inhibitors of thymidine uptake by cells, which may further increase efficacy.
Asunto(s)
Carcinoma Hepatocelular/tratamiento farmacológico , Ácido Fólico/análogos & derivados , Neoplasias Hepáticas/tratamiento farmacológico , Quinazolinas/uso terapéutico , Adulto , Anciano , Carcinoma Hepatocelular/diagnóstico , Evaluación de Medicamentos , Femenino , Ácido Fólico/uso terapéutico , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/diagnóstico , Masculino , Persona de Mediana Edad , Inducción de Remisión , alfa-Fetoproteínas/análisisRESUMEN
We present 2 patients with chronic mesenteric ischemia who were successfully treated by mesenteric bypass grafts which then became stenosed and occluded. Patency was restored by percutaneous transluminal dilatation of the stenoses. Chronic mesenteric ischemia affects a population who are at high risk for surgical procedures, and second operations following occlusion of mesenteric grafts appear to carry an increased risk of both morbidity and mortality. We therefore suggest that transluminal angioplasty may prove a valuable form of treatment in these cases.
Asunto(s)
Angioplastia de Balón , Oclusión de Injerto Vascular/terapia , Arterias Mesentéricas/cirugía , Vena Safena/trasplante , Femenino , Oclusión de Injerto Vascular/etiología , Humanos , Masculino , Persona de Mediana Edad , Grado de Desobstrucción VascularRESUMEN
A prospective study of 57 patients undergoing a total of 85 transluminal angioplasties was undertaken to assess the indications for, and the results of the procedure. We found excellent results with angioplasty in the treatment of isolated iliac artery stenoses, femoral stenoses and short femoral artery occlusions, with a low complication rate. This is the group of patients for whom angioplasty has become a widely used treatment. We feel there is a second group of patients who can benefit from transluminal angioplasty. These are the patients with extensive atherosclerosis in the lower limb vessels where surgery is difficult and the risks of anaesthesia often high due to concomitant coronary artery disease. 66% of these patients in our study obtained significant benefit from limited transluminal angioplasty with a low morbidity and zero mortality. We, therefore, conclude that transluminal angioplasty has an important role to play in the management of these patients.