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PURPOSE: To analyse the long-term outcome of open aortic procedures in patients with critical limb threatening ischemia. METHODS: Retrospective analysis of all patients with aortoiliac TransAtlantic Inter-Society Consensus II (TASC II), type D (TASC D) lesions extending to the femoral artery who underwent aortic bypass procedures for critical limb threatening ischemia (CLTI) or intermittent claudication (IC). RESULTS: Over a period of 10 years, 87 patients with IC and 45 patients with CLTI received a total of 56 aortounifemoral and 76 aorto-bi-femoral bypass procedures. After 7 years, overall primary patency (82.2% [CLTI] vs. 80.5% [IC], p = .918) and overall secondary patency (88.9% [CLTI] vs. 88.5% [IC], p = .851) were similar between patients with CLTI and those with IC. Long-term-survival (66.7% vs. 71.3%, p = .356) as well as limb salvage (86.7% vs. 94.3%, p = .104) was considerably lower in the CLTI-group, but the difference was not statistically significant. In the subgroup analysis, patients with CLTI and ischemic lesions (Rutherford class 5-6) had the poorest outcome after 84 months, in terms of secondary patency (92.1% vs. 73.7%, p = .015), limb salvage (97.4% vs. 73.7%, p = .000), and long-term survival (75.0% vs. 26.3%, p = .000) compared to patients with IC. Multivariate analysis revealed significant associations for patients with Rutherford class 5-6 in terms of secondary patency (p = .037) and limb salvage (p = .015). There was a significant difference in primary patency between graft limbs with superficial femoral artery occlusion and graft limbs with patent superficial femoral artery (84.6% vs. 93.0%, p = .017). CONCLUSIONS: Aortic bypass procedures can be used in the treatment of patients with CLTI. Moreover, results are satisfactory in patients with ischemic rest pain. However, less invasive treatments should be considered for patients with ischemic lesions.
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Isquemia/cirugía , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/cirugía , Anciano , Aorta Abdominal/cirugía , Implantación de Prótesis Vascular , Femenino , Arteria Femoral/cirugía , Humanos , Recuperación del Miembro , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica , Estudios RetrospectivosRESUMEN
Human-driven extinctions can affect our understanding of evolution, through the nonrandom loss of certain types of species. Here, we explore how knowledge of a major evolutionary transition-the evolution of flightlessness in birds-is biased by anthropogenic extinctions. Adding data on 581 known anthropogenic extinctions to the extant global avifauna increases the number of species by 5%, but quadruples the number of flightless species. The evolution of flightlessness in birds is a widespread phenomenon, occurring in more than half of bird orders and evolving independently at least 150 times. Thus, we estimate that this evolutionary transition occurred at a rate four times higher than it would appear based solely on extant species. Our analysis of preanthropogenic avian diversity shows how anthropogenic effects can conceal the frequency of major evolutionary transitions in life forms and highlights the fact that macroevolutionary studies with only small amounts of missing data can still be highly biased.
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While the COVID-19 syndrome triggered by the SARS CoV2 was initially seen predominantly as a pulmonary disease, the number of reports of vascular complications has recently increased. The aim of the present review article is to summarize the most relevant vascular complications in COVID-19 patients. These include venous and arterial thromboembolic events as well as local thromboses, which can form directly on the endothelium at the site of cytokine release. A generalized coagulopathy also appears to promote this thrombogenic condition. With a rate of approximately 20%, deep vein thrombosis (DVT) of the leg is one of the most common thromboembolic events in COVID-19 patients requiring intensive care treatment. In addition, arterial events, such as stroke or acute coronary syndrome were also observed in COVID-19 patients with pre-existing vascular disease. Children rarely have vascular complications, but a systemic immune response similar to the Kawasaki syndrome and toxic shock syndrome has been reported. According to current data, the risk of thromboembolic events in hospitalized COVID-19 patients is significantly increased, making thrombosis prophylaxis with low molecular weight or unfractionated heparin necessary. If pharmaceutical thrombosis prophylaxis is contraindicated, intermittent pneumatic compression should be used. In addition, in patients admitted to the hospital with suspected or proven SARS-CoV2 infection, the determination of Ddimers and, in the case of positive results, broad indication for compression sonography of the deep leg veins are recommended. This allows to detect and treat DVT at an early stage. The treatment of thromboses should be carried out according to current guidelines with therapeutic anticoagulation. Further studies and registries are needed to improve the understanding of the relationship between COVID-19 infection and the occurrence of thromboembolic events.
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Anticoagulantes/administración & dosificación , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Materiales Biocompatibles Revestidos , Procedimientos Endovasculares/instrumentación , Arteria Femoral/cirugía , Heparina/administración & dosificación , Enfermedad Arterial Periférica/cirugía , Arteria Poplítea/cirugía , Stents , Anciano , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Femenino , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/fisiopatología , Heparina/efectos adversos , Humanos , Recuperación del Miembro , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/mortalidad , Enfermedad Arterial Periférica/fisiopatología , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/fisiopatología , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/cirugía , Diseño de Prótesis , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
BACKGROUND AND AIMS: To report the experience of a tertiary vascular surgery center using Omniflow II® biosynthetic vascular grafts for treatment of prosthetic aortic graft infection. MATERIALS AND METHODS: Retrospective analysis of all patients with prosthetic graft infections who underwent in situ aortic reconstruction using Omniflow II® grafts or other conduits between March 2015 and May 2017. Early and late mortality, perioperative complications, and reinfection rate were analyzed. RESULTS: Sixteen patients (14 males, median age 68.5, range 57-89) with prosthetic aortic graft infection were treated at our center. Eight patients received an Omniflow II® biosynthetic graft, two patients silver-triclosan coated grafts, three patients bovine pericardial tube grafts, and three patients composite bovine pericardial tube grafts with Omniflow II® graft extensions. Perioperative complications occurred in seven patients (43.8%). Early mortality rate was 18.7% (n = 3). In addition, four patients died during follow-up after a median of 11 months (range 0-34 months). We did not observe any reinfections. Bypass grafts were patent in all patients. No major limb amputations were performed during follow-up. CONCLUSION: Treatment of prosthetic aortic graft infection with Omniflow II® vascular grafts is feasible. Graft material seems to have an excellent resistance to infection and might be a valuable alternative to traditional replacement materials. Especially long-term durability has to be continuously monitored and documented.
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Enfermedades de la Aorta/cirugía , Implantación de Prótesis Vascular/métodos , Prótesis Vascular , Infecciones Relacionadas con Prótesis/cirugía , Anciano , Anciano de 80 o más Años , Animales , Bioprótesis , Bovinos , Materiales Biocompatibles Revestidos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Reoperación , Estudios RetrospectivosRESUMEN
OBJECTIVE/BACKGROUND: Endovascular first is the preferred therapy approach to critical limb ischaemia (CLI). However, in spite of new endovascular techniques, bypass surgery still plays an important role, especially in patients with complex anatomy in whom endovascular therapy is not considered feasible, or has failed. The goal of this study was to analyse the outcomes of prosthetic or autologous vein for femoropopliteal (P3) bypasses performed under the abovementioned conditions. METHODS: A retrospective analysis of patients who underwent a femoropopliteal (P3) bypass for CLI (March 2007-December 2015) was conducted. Endovascular therapy was not possible. Patency rates, limb salvage, major adverse limb event (MALE) free survival, and survival after 5 years were analysed. RESULTS: In total, 151 cases were included in the analysis (rest pain 35.8%, ulcer/gangrene 64.3%). The graft material was autologous vein in 76 cases (vein group) and heparin bonded expanded polytetrafluoroethylene (HePTFE) in 75 cases (HePTFE group). Indications, risk factors, previous revascularisation procedures, and runoff vessels were similar in both groups. Thirty day mortality was 6.6% in the vein group and 5.3% in the HePTFE group (p = .508), early graft occlusion (6.6% vs. 5.3%; p = .508) and 30 day major amputation rate (0% vs. 2.7%; p = .245) were similar between the two groups. Overall primary patency was 51.7% (55.5% [vein group] vs. 51.7% [HePTFE group]; p = .897) and overall secondary patency was 64.2% (74.6% [vein group] vs. 55.6% [HePTFE group]; p = .119), all without significance after 5 years. However, limb salvage (79.1%) was significantly different (90.0% [vein group] vs. 62.9% [HePTFE group]; p = .021). Survival was similar between the groups (47.3% vs. 42.9%; p = .582) as well as MALE free survival (69.4% vs. 55.0%; p = .348). CONCLUSION: Bypasses to the below knee popliteal artery show good results in patients with CLI unsuitable for endovascular therapy. Vein is still the first line graft material.
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Anticoagulantes/administración & dosificación , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Materiales Biocompatibles Revestidos , Arteria Femoral/cirugía , Heparina/administración & dosificación , Isquemia/cirugía , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/cirugía , Politetrafluoroetileno , Arteria Poplítea/cirugía , Venas/trasplante , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica , Anticoagulantes/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Enfermedad Crítica , Supervivencia sin Enfermedad , Femenino , Arteria Femoral/fisiopatología , Heparina/efectos adversos , Humanos , Isquemia/diagnóstico , Isquemia/mortalidad , Isquemia/fisiopatología , Estimación de Kaplan-Meier , Recuperación del Miembro , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/mortalidad , Enfermedad Arterial Periférica/fisiopatología , Arteria Poplítea/fisiopatología , Modelos de Riesgos Proporcionales , Diseño de Prótesis , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Trasplante Autólogo , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
OBJECTIVE: Do asymptomatic restenoses > 70% after carotid endarterectomy (CEA) and carotid stenting (CAS) increase the risk of late ipsilateral stroke? METHODS: Systematic review identified 11 randomised controlled trials (RCTs) reporting rates of restenosis > 70% (and/or occlusion) in patients who had undergone CEA/CAS for the treatment of primary atherosclerotic disease, and nine RCTs reported late ipsilateral stroke rates. Proportional meta-analyses and odds ratios (OR) at end of follow-up were performed. RESULTS: The weighted incidence of restenosis > 70% was 5.8% after "any" CEA, median 47 months (11 RCTs; 4249 patients); 4.1% after patched CEA, median 32 months (5 RCTs; 1078 patients), and 10% after CAS, median 62 months (5 RCTs; 2716 patients). In four RCTs (1964 patients), one of 125 (0.8%) with restenosis > 70% (or occlusion) after CAS suffered late ipsilateral stroke over a median 50 months, compared with 37 of 1839 (2.0%) in CAS patients with no significant restenosis (OR 0.87; 95% CI 0.24-3.21; p = .8339). In seven RCTs (2810 patients), 13 out of 141 (9.2%) with restenosis > 70% (or occlusion) after CEA suffered late ipsilateral stroke over a median 37 months, compared with 33 out of 2669 (1.2%) in patients with no significant restenoses (OR 9.02; 95% CI 4.70-17.28; p < .0001). Following data correction to exclude patients whose surveillance scan showed no evidence of restenosis > 70% before stroke onset, the prevalence of stroke ipsilateral to an untreated asymptomatic > 70% restenosis was seven out of 135 (5.2%) versus 40 out of 2704 (1.5%) in CEA patients with no significant restenosis (OR 4.77; 95% CI 2.29-9.92). CONCLUSIONS: CAS patients with untreated asymptomatic > 70% restenosis had an extremely low rate of late ipsilateral stroke (0.8% over 50 months). CEA patients with untreated, asymptomatic > 70% restenosis had a significantly higher risk of late ipsilateral stroke (compared with patients with no restenosis), but this was only 5% at 37 months. Overall, 97% of all late ipsilateral strokes after CAS and 85% after CEA occurred in patients without evidence of significant restenosis or occlusion.
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Estenosis Carotídea/terapia , Endarterectomía Carotidea , Procedimientos Endovasculares , Accidente Cerebrovascular/epidemiología , Enfermedades Asintomáticas , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/mortalidad , Endarterectomía Carotidea/efectos adversos , Endarterectomía Carotidea/mortalidad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/mortalidad , Humanos , Incidencia , Oportunidad Relativa , Recurrencia , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Stents , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: In this study we analyzed the outcome of tibial and peroneal venous and heparin-bonded expanded polytetrafluoroethylene (HePTFE) bypasses in diabetics with critical limb ischemia (CLI). We aimed to verify our hypothesis that HePTFE grafts will achieve acceptable 1-year patency and limb salvage results in patients who lack an adequate vein. METHODS: We conducted a retrospective analysis for all diabetics who underwent tibial bypass surgery in our department between October 2007 and October 2012. The study includes 97 grafts. All these patients were not suited for an endovascular therapy. We used autologous veins in 56 cases (Vein-Group) and HePTFE grafts in 41 cases (HePTFE-Group). Study endpoints were primary and secondary patency, limb salvage, and survival at 2 years postoperatively. RESULTS: Risk factors and indications were similar in both groups. The comparison between HePTFE- and Vein-Group showed significantly different patency rates. At 2 years, primary patency was 39.3% in HePTFE-Group vs. 78.5% in Vein-Group (P = .003) and secondary patency was 47.4% vs. 81.9% (P = .002). Limb salvage at 2 years was 79.3% vs. 87.4% (P = .073) and survival was 64.6% vs. 62.9% (P = .593) at the 2-year mark, with no significant differences. 30-days mortality, graft occlusion and major amputation rate showed no significant differences, either. CONCLUSIONS: This study shows that HePTFE bypasses are a viable option for diabetics undergoing tibial bypass surgery when no adequate vein is available.
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Anticoagulantes/uso terapéutico , Prótesis Vascular , Angiopatías Diabéticas/cirugía , Heparina/uso terapéutico , Extremidad Inferior/irrigación sanguínea , Politetrafluoroetileno , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: In general, autologous veins are the optimal replacement material for an infected vascular graft in terms of handling, durability and resistance to reinfection. In the absence of suitable autologous material, several options are available, each of which has specific advantages and drawbacks with regard to these characteristics. METHODS: In recent years, xenogeneic materials (in particular pericardial patches from different species and biosynthetic grafts) have been increasingly used as replacement material in the setting of infections. Bovine and equine pericardial patches are applied in particular as self-made tube grafts in the aortic region and also in infections of iliacofemoral prosthetic grafts and shunt infections. RESULTS: The results of small clinical series on durability and resistance to reinfection are promising. CONCLUSION: It is feasible to use biosynthetic materials to replace infected intracavitary and extracavitary vascular grafts with remarkably low reinfection rates; however, the unique mechanical properties of the grafts as well as the initially increased thrombogenicity, need to be taken into consideration.
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AIM: To survey the scope of vascular surgery services in Germany. METHOD: A total of 308 senior German vascular surgeons received a 19-point questionnaire pertaining to department structure and scope of services. Of these surgeons 223 replied between 16 August 2015 and 23 October 2015 (response rate 72 %), with 62.2 % reporting an additional qualification as an endovascular surgeon according to the guidelines of the German Society for Vascular Surgery and Vascular Medicine (Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin, DGG) and 43.5 % as a DGG® endovascular specialist. RESULTS: The number of respondents fully authorized to train in vascular surgery was 71.3 %, while 28.3 % were authorized for limited training. Authorization as a DGG® endovascular surgeon was reported by 24.2 % and authorization as a DGG® endovascular specialist by 17 % of respondents. All respondents performed endovascular interventions on pelvic vessels and 99.1 % also reported carrying out femoral and popliteal endovascular interventions. Endovascular procedures in crural vessels were carried out by 90.1 % and 93.7 % of vascular surgeons performed endovascular procedures in the region of the abdominal aorta (segment V), arteriovenous (AV) fistulas and shunts (85.2 %), upper extremity vessels (80.3 %), the thoracic aorta (segment III, 68.2 %), renal arteries (62.8 %) and visceral aorta (segment IV, 60.5 %). In all 43.5 % of respondents reported experience with endovascular procedures on the carotid bifurcation. Percutaneous arterial procedures formed the focus of endovascular activity, totalling on average 259 interventions per year and department, followed by diagnostic angiography (without intervention) at 166 procedures per year and hybrid arterial interventions at 141 interventions per year. CONCLUSION: This survey revealed a high level of endovascular expertise among vascular surgeons in Germany. This applies not only to the scope of endovascular activities in diagnosis and treatment but also to the number of estimated annual procedures.
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Aortitis is a term which encompasses inflammatory changes to the aortic wall from various pathogenic etiologies. Large vessel vasculitis, such as Takayasu arteritis and giant cell arteritis represent the most common entities; however, there is also an association with other rheumatological diseases. Chronic idiopathic periaortitis represents a distinct disease entity and infectious aortitis is a rare but life-threatening disease. Due to the diverse clinical pictures vascular surgeons often face a significant challenge in terms of making an accurate initial diagnosis. Treatment requires an interdisciplinary approach. This article describes the pathogenesis of the various forms of aortitis as well as the diagnostic methods and treatment approaches.
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Infectious aortitis is a rare but life-threatening disease. Due to impending local and systemic complications, prompt diagnosis and initiation of effective causal treatment are essential for patient survival. Differentiating infectious aortitis from other aortic diseases, in particular non-infectious aortitis, is of great importance. This article discusses the various causes, diagnostic tools, and therapeutic strategies for infectious aortitis.
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BACKGROUND: Endovascular recanalization has become the accepted first-line treatment strategy for most lower extremity arterial occlusions, especially in patients with critical limb ischemia (Rutherford 4-6). Prior endovascular interventions have been described as risk factors for the outcome of subsequent lower extremity bypass surgery. The effect on subsequent tibial and peroneal bypasses is controversial. We analyzed the impact of prior endovascular lower extremity revascularization procedures on the short- and mid-term results of femoro-tibial and femoro-peroneal bypasses. METHODS: A retrospective analysis was conducted of all patients who had undergone tibial or peroneal bypass surgery after prior endovascular interventions (PEI-Group, n=40) of the same extremity in our department from October 2007 to October 2012. We compared this group with a group of patients who had received a tibial or peroneal bypass as primary revascularization procedure (BF-Group, n=93) during the same period of time because primary endovascular therapy had been deemed unfeasible in those cases. Indication in all cases was critical limb ischemia; the median age was 78 years (range 50-90 years), 45.1% were diabetics, and 42.9% were female. The graft material was autologous vein in 80 cases and HePTFE in 53 cases. Endpoints of the analysis were primary and secondary patency rates, limb salvage and survival at 2 years postoperatively. RESULTS: At 2 years overall primary patency was 68.4%, secondary patency was 69.5%, limb salvage was 83.6% and survival was 62.6%. Primary patency for the BF-Group was 74.3% vs. 55.1% for the PEI-Group (P=.310) at 2 years; secondary patency was 74.6% vs. 59.1% (P=.268). Prior endovascular intervention did not have any significant effects on limb salvage (83.7% vs. 83.6%; P=.470) or survival rates (61.0% vs. 65.0%; P=.258) at the 2-year mark, either. There were no significant differences in graft occlusion, death and major amputation rates within the first 30 postoperative days. Except for male gender, there were no significant differences in risk factors and indications between the two groups. CONCLUSIONS: Prior endovascular intervention of femoro-tibial vessels does not have a negative impact on the outcome of subsequent tibial or peroneal bypass surgery in patients with critical limb ischemia.
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Arteriopatías Oclusivas/cirugía , Procedimientos Endovasculares/métodos , Isquemia/cirugía , Extremidad Inferior/irrigación sanguínea , Injerto Vascular/métodos , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica , Estudios de Cohortes , Procedimientos Endovasculares/efectos adversos , Femenino , Humanos , Recuperación del Miembro/métodos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Resultado del Tratamiento , Injerto Vascular/efectos adversos , Grado de Desobstrucción VascularRESUMEN
Some herbivores can modify the physiology of plant modules to meet their nutritional requirements. Induction of premature leaf senescence could benefit herbivores since it is associated with the mobilisation of nutrients. We compared the effects of nymphal feeding by Cardiaspina near densitexta on Eucalyptus moluccana with endogenous processes associated with senescence to assess the relative merits of an insect manipulation or plant defence interpretation of responses. Evidence supporting insect manipulation included increased size of fourth and fifth instar nymphs (in the latter the effect was restricted to forewing pad length of females) on leaves supporting high numbers of conspecifics and feeding preventing leaf necrosis. Intra-specific competition negated greater performance at very high densities. High and very high abundances of nymphs were associated with increased concentrations of amino acid N but only very high abundances of nymphs tended to be associated with increased concentrations of six essential amino acids. Contrary to the insect manipulation interpretation, feeding by very high abundances of nymphs was associated with significant reductions in chlorophyll, carotenoids and anthocyanins. Evidence supporting plant defence included the severity of chlorosis increasing with the abundance of nymphs. Leaf reddening did not develop because ambient conditions associated with photoinhibition (high irradiance and low temperature) were not experienced by leaves with chlorotic lesions. Leaf reddening (from anthocyanins) alone is not expected to adversely affect nymphal survival; only leaf necrosis would kill nymphs. For senescence-inducing psyllids, nutritional enhancement does not fit neatly into either an insect manipulation or plant defence interpretation.
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Aminoácidos/metabolismo , Senescencia Celular , Resistencia a la Enfermedad/fisiología , Eucalyptus/fisiología , Hemípteros , Herbivoria , Hojas de la Planta/metabolismo , Animales , Antocianinas/metabolismo , Conducta Animal , Carotenoides/metabolismo , Clorofila/metabolismo , Eucalyptus/metabolismo , Femenino , Ninfa , Hojas de la Planta/fisiologíaRESUMEN
BACKGROUND: Demographic development leads to an increase in vascular interventions due to the increase in elderly and multimorbid patients. The aim of this study was to demonstrate the open interventional therapy options and their influence on staff and patients which have become possible due to the introduction of angio-hybrid operations including 3-D imaging Dyna-CT. MATERIAL AND METHODS: The modifications with respect to radiation protection for staff, improvements for patients and the possibilities of operative 3-D imaging Dyna-CT are described based on the current literature. RESULTS: The implementation of angio-hybrid operation theaters has resulted in new open interventional treatment options which can also be employed for high risk elderly patients with aortic and peripheral arterial pathologies. With hybrid operations the radiation exposure and contrast medium exposure can be reduced for patients and an improvement in the results can also be achieved. The implementation of 3-D imaging in the angio-hybrid operation theater could also lead to further improvements, especially for complex aortic procedures. DISCUSSION: Using angio-hybrid operational procedures complex interventions can be carried out with more safety for patients and personnel. The implementation of 3-D imaging Dyna-CT offers additional interesting options for complex aortic procedures.
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Angiografía/instrumentación , Angiografía/tendencias , Conducta Cooperativa , Imagenología Tridimensional/tendencias , Comunicación Interdisciplinaria , Quirófanos/organización & administración , Quirófanos/tendencias , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/tendencias , Cirugía Asistida por Computador/instrumentación , Cirugía Asistida por Computador/tendencias , Equipo Quirúrgico/tendencias , Tomografía Computarizada por Rayos X/instrumentación , Tomografía Computarizada por Rayos X/tendencias , Procedimientos Quirúrgicos Vasculares/instrumentación , Procedimientos Quirúrgicos Vasculares/tendencias , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/tendencias , Predicción , Alemania , Humanos , Seguridad del Paciente , Protección Radiológica , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/cirugíaRESUMEN
The aim of the present study was to review the literature reporting the use of the Hemobahn/Viabahn endograft (W. L. Gore and Assoc Inc., Flagstaff, AZ, USA) for endovascular treatment of popliteal artery aneurysms (PAA). A PubMed database search was performed looking for studies reporting endovascular treatment of PAA with the Hemobahn/Viabahn endograft within the period January 2000-December 2012. All relevant studies were independently assessed and all references were examined for potentially missed relevant reports. Studies were included if they reported experience with five patients or more. Eight studies with 222 patients (mean age 72.4 years, 92.3% male) and 251 PAA (mean diameter 2.9 mm, 14.3% symptomatic) were included. Thirteen cases (5.2%) were treated on an urgent basis, including three cases of ruptured PAA and 10 cases of acute limb ischemia. Initial technical success was 99.2%. The mean number of implanted endografts/PAA was 1.8 (range 1-4). Thirty-day mortality was 1 (0.4%) patient. Perioperative complications occurred in 1.6%, consisting of three access site hematomas and one acute endograft thrombosis. Cumulative mean follow-up duration was 36.9 months. During this period, a total of 46 endograft failures (42 occlusions, 4 stenoses) were observed within a mean postoperative time interval of 10.8 months. Cumulative primary and secondary patency rates were 85.6% and 93.4% at one year, and 78.5% and 90.4% at 2 years, respectively. Limb salvage rate during follow-up was 99.2%. Endoleak was noticed in 15 (6%) cases and endograft migration in 13 (5.2%) cases. Endograft fracture was reported in 14 (5.6%) cases, resulting in occlusion in six patients, and in type III and IV endoleaks in two patients. Secondary intervention during follow-up was required in 47 (18.7%) cases, including 32 reinterventions for endograft occlusion, four for endograft stenosis, and 11 for endoleak repair. Endovascular PAA repair with the Hemobahn/Viabahn endograft is feasible and safe yielding excellent initial technical success rates, minimum perioperative mortality and morbidity, and mid-term patency and limb salvage rates comparable to open surgery. These results suggest that a significant proportion of patients might benefit from endovascular PAA repair.
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Aneurisma/cirugía , Procedimientos Endovasculares/métodos , Arteria Poplítea , Stents , Humanos , Diseño de Prótesis , Resultado del TratamientoRESUMEN
The evolution of endovascular techniques has led to the concept of the "hybrid operating room" (hybrid OR). A hybrid OR combines the sterility of an OR in an operating theatre environment with a high-quality fixed imaging system. On the basis of these advantages it would be desirable that an angio-hybrid OR becomes a standard requirement for endovascular surgery. In Great Britain guidelines have already been published that require a hybrid OR even for normal endovascular management of the infrarenal aorta. However, in Germany there are no guidelines from professional societies or formal rules from the federal joint committee, thus in this article a classification of endovascular procedures according to their complexity and the necessary infrastructures are proposed in order to define particular procedures that should only be performed in an angio-hybrid OR. According to our experience, endovascular procedures can be classified into four categories based on their complexity and the requirements regarding fluoroscopy: level 1: standard EVAR, TEVAR, iliac and popliteal artery procedures; level 2: iliac branched (IBD) and standard (2 fenestrations for the renal arteries and a scallop for the superior mesenteric artery) fenestrated stent-grafting; level 3: more complex fenestrated procedures (three or four fenestrations); and level 4: branched stent-grafting for TAAA. At this moment it is still acceptable to perform level 1 and level 2 procedures outside of a hybrid OR. In our opinion, it is not recommended to perform level 3 and level 4 endovascular procedures without a hybrid OR.
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Diagnóstico por Imagen/instrumentación , Procedimientos Endovasculares/instrumentación , Quirófanos/organización & administración , Conducta Cooperativa , Procedimientos Endovasculares/clasificación , Diseño de Equipo , Alemania , Guías como Asunto , Necesidades y Demandas de Servicios de Salud/organización & administración , Humanos , Comunicación Interdisciplinaria , Programas Nacionales de Salud , Protección Radiológica/instrumentaciónRESUMEN
Inadvertent intraarterial injections in the context of drug abuse can cause damage to the vascular system. The clinical picture depends on the drug properties and ranges from partial ischemia to necrosis of the affected extremity. There are no current evidence-based guidelines regarding the management of intraarterial drug injections. In many cases the concept of solving vasospasm after injection is based on the use of intraarterial application of prostaglandins. We report a case in which a mixture of drugs was injected into the left femoral artery. The patient arrived 24 hours later with ischemia of the left leg at our emergency department. Angiography showed that there was no blood flowing in the leg. Despite intraarterial application of vasodilatators, regional neurolysis and thrombolyis with urokinase major amputation was unavoidable. The outcome after inadvertent injection depends on certain drug properties and the delay between injection and the beginning of therapy.
Asunto(s)
Trastornos Relacionados con Anfetaminas/complicaciones , Dependencia de Heroína/complicaciones , Isquemia/etiología , Extremidad Inferior/irrigación sanguínea , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Amputación Quirúrgica , Benzodiazepinas/administración & dosificación , Arteria Femoral , Humanos , Inyecciones Intraarteriales , Isquemia/diagnóstico por imagen , Isquemia/patología , Isquemia/cirugía , Masculino , Metanfetamina/administración & dosificación , Necrosis , Radiografía , Resultado del TratamientoRESUMEN
This study aims to evaluate the value of VEGF as a surrogate marker for peripheral vascular disease (PVD). Prior to treatment, serum VEGF levels were evaluated by enzyme-linked immunosorbent assay (ELISA) in 293 PVD patients. Risk factors and clinical parameters of PVD were documented. Twenty-six age-matched healthy volunteers served as controls. Serum VEGF values strongly correlated with Fontaine stages (p<0.006, stage IV vs. controls). High VEGF values prior to treatment were associated with poor outcome. Serum VEGF appears to indicate the severity of PVD and might serve as a surrogate indicator of disease severity.