RESUMEN
Conservative treatment of uncomplicated type B aortic dissection is associated with low short-term mortality. However long-term mortality and complication rates are high, suggesting the need for more aggressive treatment. Studies suggest that combining medical treatment with thoracic endovascular aortic repair (TEVAR) is associated with a better prognosis. TEVAR is not without risk, however, and it is paramount to identify characteristics of risk and benefit as summarised in this review. Further studies are needed in order to implement improved patient selection.
Asunto(s)
Aneurisma de la Aorta Torácica , Disección Aórtica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Humanos , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
We present a case of a 66-year-old woman who developed perigraft seroma after having undergone elective, open abdominal aortic aneurysm repair with a polytetrafluoroethylene graft 5 years previously. One year after graft implantation, she started to suffer from abdominal discomfort and was therefore offered surgical intervention, which she declined owing to the fear of postoperative complications. Instead, an observational strategy was used. Five years later, the patient presented with sudden severe abdominal pain. Subsequent laparotomy revealed that the pseudomembrane lining the perigraft seroma had penetrated through the native aortic wall and into the intraperitoneal cavity, where it had ruptured. The patient was successfully treated by replacing the polytetrafluoroethylene graft with a polyethylene terephthalate (Dacron) graft.
RESUMEN
False aneurysms are formed as a result of bleeding causing a hematoma to compress the surrounding tissue. The majority of false aneurysms presenting to the vascular surgeon are caused by iatrogenic injury to an artery. Although anastomotic failure occurs, a much higher number is caused by bleeding from puncture sites after percutaneous intervention. Anticoagulative medication, low patelet counts and severely calcified vessels increase the risk of forming a false aneurysm. Experienced specialists may make the diagnosis from physical examination, but ultrasound imaging is almost always needed in order to decide for a treatment strategy. Small aneurysms with a diameter of less than 3 cm tend to thrombose spontaneously except in patients in anticoagulative treatment. Treatment options include ultrasound guided compression, which may be effective in a high proportion of patients who are not in anti-coagulative treatment, but may require prolonged compression and cause pain and discomfort. Duplex guided injection of thrombin or glue requires less time of compression and can be effective in patient s on antiocoagulative treatment, but may cause spillage of adhesive material into the crural vessels. Endovascular treatment with coils or covered stent grafts have proven useful in infected ilio-femoral false aneurysms. Open surgical repair may be the best treatment in the setting of imminent rupture, massive hematoma and skin necrosis. We present three patient cases treated with open surgery, endovascular coiling, and thrombin injection.
Asunto(s)
Aneurisma Falso/terapia , Implantación de Prótesis Vascular , Embolización Terapéutica , Procedimientos Endovasculares , Trombina/administración & dosificación , Adhesivos Tisulares/administración & dosificación , Anciano , Aneurisma Falso/diagnóstico por imagen , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Angiografía por Tomografía Computarizada , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/instrumentación , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Stents , Trombina/efectos adversos , Adhesivos Tisulares/efectos adversos , Resultado del TratamientoRESUMEN
Burkholderia pseudomallei is a common cause of serious, difficult to treat infections in South-East Asia and Northern Australia, but is a rare imported pathogen in the USA and Europe. We report a case of a patient with a mycotic aneurysm caused by B. pseudomallei in a previously healthy returning traveller. The patient presented with 4 weeks of abdominal pain and intermittent fever after a brief vacation in Thailand. The aneurysm was excised and replaced by an autologous deep vein graft, and the patient was treated for 6 months with antibiotics adjusted according to postoperative renal impairment. Twenty-four months after surgery the patient is well and without relapse.
Asunto(s)
Aneurisma Infectado/diagnóstico , Burkholderia pseudomallei , Melioidosis/diagnóstico , Aneurisma Infectado/tratamiento farmacológico , Aneurisma Infectado/microbiología , Aneurisma Infectado/cirugía , Antibacterianos/uso terapéutico , Ceftazidima/uso terapéutico , Humanos , Masculino , Melioidosis/tratamiento farmacológico , Melioidosis/microbiología , Melioidosis/cirugía , Persona de Mediana Edad , Tailandia , ViajeRESUMEN
INTRODUCTION: Success with the neoaortoiliac system (NAIS) bypass has previously been reported. Drawbacks to this procedure include prolonged operative times and significant morbidity. The aim of this study was to evaluate whether a 2-team approach in addition to a consistent anastomosis technique reduces the operative time of the NAIS procedure. METHODS: A single-center retrospective review was performed for operations using femoral vein in arterial reconstruction from 2003 to 2012. RESULTS: A total of 40 patients, 25 men and 15 women, were included for analysis. Median operative time for all operations was 300 minutes (interquartile range). Thirty-day mortality was 7.5% (n = 3). Assisted primary patency at 1 year was 100%. CONCLUSION: A 2-surgical team approach can reduce the operative time by up to 50%. This improves the attractiveness of this procedure, particularly when recalling that the treatment is definitive by virtue of its eradication of the source of infection.
Asunto(s)
Arterias/cirugía , Implantación de Prótesis Vascular/efectos adversos , Prótesis Vascular/efectos adversos , Vena Femoral/trasplante , Tempo Operativo , Infecciones Relacionadas con Prótesis/cirugía , Injerto Vascular/métodos , Adulto , Anciano , Anastomosis Quirúrgica , Arterias/microbiología , Arterias/fisiopatología , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/mortalidad , Dinamarca , Remoción de Dispositivos , Femenino , Vena Femoral/fisiopatología , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/mortalidad , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Injerto Vascular/efectos adversos , Injerto Vascular/mortalidad , Grado de Desobstrucción VascularRESUMEN
INTRODUCTION: The hospital costs and benefits of screening older males for abdominal aortic aneurysms (AAA) are unknown. MATERIAL AND METHODS: In 1994, a hospital-based screening trial of 12,658 65-73-year-old males in the County of Viborg, Denmark, was started. AAA > 5 cm were referred for surgery. The remaining AAA were offered annual control scans. Those with aortic ectasia (def.: 2.5-2.9 cm) were rescreened at 5-year intervals. AAA-operations and deaths of AAA at hospital were registered. Finally, costs of screening, surveillance, and treatment were registered. Data on causes of death outside hospitals could not be obtained. RESULTS: The attendance rate was 76%, of whom 191 (4.0%) had AAA. The average observation time was 5.13 years. 60 in the screened and 41 in the control group were operated (P = 0.06), 7 and 27 were operated as an emergency (P < 0.001), and 6 and 19 died at the hospitals due to AAA (p = 0.009). The costs per scan were 83.50 DKK, 81,400 DKK per elective operation (71,485 DKK after screening), and 117,000 DKK for an emergency operation. The costs per prevented hospital death were 67,855 DKK or approx. 7,540 DKK per life year saved (1 GBP = 12 DKK). DISCUSSION: Screening older males for AAA in Denmark seems very cost-effective and reduces hospital mortality of AAA by 68% and probably the overall AAA-specific mortality by 73%.
Asunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/economía , Costos de Hospital , Tamizaje Masivo/economía , Anciano , Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Abdominal/cirugía , Costo de Enfermedad , Análisis Costo-Beneficio , Dinamarca , Urgencias Médicas/economía , Mortalidad Hospitalaria , Humanos , MasculinoRESUMEN
INTRODUCTION: Macrolide treatment has been reported to reduce the risk of recurrent ischaemic heart disease. The influence of a macrolide on the expansion rate of small abdominal aortic aneurysms (AAA) is unknown at present. The aim of this study was to investigate the effect of roxithromycin on the expansion rate of small AAA. MATERIALS AND METHODS: A total of 92 patients with a small AAA were recruited from two populations. One population consisted of 6.339 men aged 65-73 years who were offered participation in a mass screening programme for AAA at the local hospital. From this population 66 subjects were recruited. The remaining 26 were recruited from among 49 subjects diagnosed at interval screening for an initial aortic diameter between 25 mm and 29 mm. The patients were randomized to receive either oral roxithromycin 300 mg once daily for 28 days or matching placebo, and followed for a mean of 1.5 years. RESULTS: During the first year the mean annual expansion rate of AAA was reduced by 44% in the macrolid group (1.56 mm/year) compared to 2.80 mm/year after placebo (p = 0.02). During the second year the difference was only 5%. Multiple linear regression analysis showed that roxithromycin treatment and initial AAA size were significantly related to AAA expansion when adjusted for smoking, diastolic blood pressure, and IgA level > or = 20. The logistic regression analysis confirmed a significant difference in expansion rates above 2 mm annually between the intervention and placebo groups, OR = 0.09 (95% CI: 0.01-0.83). DISCUSSION: In comparison to placebo, roxithromycin 300 mg daily for four weeks reduced the expansion rate of AAA.