RESUMEN
PURPOSE: To evaluate the late events and mid-term results after endovascular aneurysm repair (EVAR). METHODS: Between December 2006 and May 2012, 175 abdominal aortic aneurysms were treated by EVAR. Aneurysm-related events were analyzed. RESULTS: The complications that occurred during the EVAR procedure were renal artery occlusion in two patients, access artery injury in two, delivery failure in one, retrograde aortic dissection in one, and death from hepatic failure in one patient. Five adverse endoleaks (four type I, one type III) remained at discharge, and the technical success rate was 97 %. On follow-up, limb occlusion had occurred in five patients. Unilateral renal atrophy was found in three patients, but none of the patients required new hemodialysis. Sac enlargement (≥5 mm) developed in ten patients. Their culprit endoleaks were type Ia in one, II in eight, and V in one patient. Transarterial embolization was performed for three out of the eight type II endoleaks. The rate of freedom from secondary re-intervention was 93 % at 3 and 5 years, respectively. The survival and freedom from aneurysm-related events rates were 74 % at 3 years and 47 % at 5 years. CONCLUSIONS: The mid-term results of EVAR were excellent with a low rate of aneurysm-related deaths, although there were relatively high aneurysm-related event rates. Sac re-enlargement from type II endoleaks was the most common major issue at the mid-term follow-up.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Procedimientos Endovasculares , Complicaciones Posoperatorias/epidemiología , Anciano , Anciano de 80 o más Años , Fuga Anastomótica/epidemiología , Disección Aórtica/epidemiología , Aneurisma de la Aorta Abdominal/mortalidad , Arterias/lesiones , Atrofia/epidemiología , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Hígado/patología , Fallo Hepático/epidemiología , Masculino , Obstrucción de la Arteria Renal/epidemiología , Factores de TiempoRESUMEN
AIM: The effect of pharmacotherapy or supervised exercise training on patients with intermittent claudication was assessed. METHODS: One hundred patients with stable intermittent claudication due to arteriosclerosis obliterans were analyzed. We divided the patients into 2 groups: patients treated by pharmacotherapy alone (Group A: 39 claudicants) and patients treated by supervised exercise training and pharmacotherapy (Group B: 61 claudicants). The changes in ankle-brachial pressure index (ABI) and recovery time of ABI after a 40-m walk (RT(40)) and absolute claudication distance (ACD) on a treadmill before and after each treatment were assessed. RESULTS: In Group A, RT(40) decreased from 9.5 +/- 5.8 min at the baseline to 6.4 +/- 3.5 min after 6 months (P=0.0002). In Group B, it decreased from 9.7+/-5.2 min at the baseline to 6.3+/-4.2 min after 3 weeks (P<0.0001). In Group A, ACD increased from 249+/-177 m at the baseline to 317+/-168 m after 6 months (P=0.0003). In Group B, it increased from 143+/-90 m at the baseline to 257+/-161 m after 3 weeks (P<0.0001). CONCLUSION: Hemodynamics and walking ability were improved by either short-term supervised exercise training or midterm pharmacotherapy. RT(40) may be useful for predicting the effect of conservative treatment on intermittent claudication. Greater increases in ACD after treatment can be achieved in claudicants with a shorter RT(40) before conservative treatment.
Asunto(s)
Arteriosclerosis Obliterante/terapia , Fármacos Cardiovasculares/uso terapéutico , Terapia por Ejercicio , Claudicación Intermitente/terapia , Anciano , Anciano de 80 o más Años , Índice Tobillo Braquial , Arteriosclerosis Obliterante/complicaciones , Arteriosclerosis Obliterante/tratamiento farmacológico , Arteriosclerosis Obliterante/fisiopatología , Presión Sanguínea/efectos de los fármacos , Terapia Combinada , Prueba de Esfuerzo , Tolerancia al Ejercicio/efectos de los fármacos , Femenino , Humanos , Claudicación Intermitente/tratamiento farmacológico , Claudicación Intermitente/etiología , Claudicación Intermitente/fisiopatología , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del TratamientoRESUMEN
An 82-year-old female was admitted with a diagnosis of infectious spondylitis.The culturing of vertebral body biopsy specimens yielded a non-tuberculous acid-fast bacterium (Mycobacterium intracellulare). CT disclosed a saccular mass in the abdominal aorta in contact with the collapsed vertebral bodies (L2-3), and a diagnosis of infected abdominal aortic aneurysm was made. Axillofemoral bypass, resection of the infected abdominal aortic aneurysm, vertebrectomy (L2-3) and reconstruction with a fibular graft, and packing with the greater omentum were performed. An acid fast bacterium was detected from the thrombus in the aneurysm. The clinical course suggested that this patient developed an infected abdominal aortic aneurysm due to Mycobacterium intracellulare transmitted from infectious spondylitis.