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Aneurisma de la Aorta Abdominal , Síndrome de Behçet , Humanos , Síndrome de Behçet/complicaciones , Síndrome de Behçet/diagnóstico , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/complicaciones , Masculino , Angiografía por Tomografía Computarizada , AdultoRESUMEN
Three-dimensional (3D) printing has been used in medicine with applications in many different fields. 3D printing allows patient education, interventionalists training, preprocedural planning, and assists the interventionalist to improve treatment outcomes. 3D printing represents a potential advancement by allowing the printing of flexible vascular models. In this article, the authors report a clinical case using 3D printing to perform a physician-modified fenestrated endograft. An overview of 3D printing in vascular and endovascular surgery is provided, focusing on its potential applications for training, education, preprocedural planning, and current clinical applications.
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Implantación de Prótesis Vascular , Prótesis Vascular , Procedimientos Endovasculares , Impresión Tridimensional , Diseño de Prótesis , Humanos , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/efectos adversos , Modelos Cardiovasculares , Modelos Anatómicos , Modelación Específica para el Paciente , Resultado del Tratamiento , Masculino , Stents , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , AortografíaRESUMEN
Computational surgery (CS) is an interdisciplinary field that uses mathematical models and algorithms to focus specifically on operative planning, simulation, and outcomes analysis to improve surgical care provision. As the digital revolution transforms the surgical work environment through broader adoption of artificial intelligence and machine learning, close collaboration between surgeons and computational scientists is not only unavoidable, but will become essential. In this review, the authors summarize the main advances, as well as ongoing challenges and prospects, that surround the implementation of CS techniques in vascular surgery, with a particular focus on the care of patients affected by abdominal aortic aneurysms (AAAs). Several key areas of AAA care delivery, including patient-specific modelling, virtual surgery simulation, intraoperative imaging-guided surgery, and predictive analytics, as well as biomechanical analysis and machine learning, will be discussed. The overarching goals of these CS applications is to improve the precision and accuracy of AAA repair procedures, while enhancing safety and long-term outcomes. Accordingly, CS has the potential to significantly enhance patient care across the entire surgical journey, from preoperative planning and intraoperative decision making to postoperative surveillance. Moreover, CS-based approaches offer promising opportunities to augment AAA repair quality by enabling precise preoperative simulations, real-time intraoperative navigation, and robust postoperative monitoring. However, integrating these advanced computer-based technologies into medical research and clinical practice presents new challenges. These include addressing technical limitations, ensuring accuracy and reliability, and managing unique ethical considerations associated with their use. Thorough evaluation of these aspects of advanced computation techniques in AAA management is crucial before widespread integration into health care systems can be achieved.
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Aneurisma de la Aorta Abdominal , Modelación Específica para el Paciente , Valor Predictivo de las Pruebas , Cirugía Asistida por Computador , Humanos , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Cirugía Asistida por Computador/efectos adversos , Resultado del Tratamiento , Aprendizaje Automático , Modelos Cardiovasculares , Predicción , Difusión de Innovaciones , Procedimientos Quirúrgicos Vasculares/efectos adversos , Toma de Decisiones Clínicas , Procedimientos Endovasculares/efectos adversosRESUMEN
Fenestrated and branched endovascular aortic aneurysm repair (f-EVAR, b-EVAR, respectively) are technically challenging procedures that have evolved over the last decade for complex aortic aneurysms. They are alternatives to surgical repair for suprarenal and juxtarenal aortic aneurysms. A Pubmed database was reviewed by searching keywords related to f-EVAR, b-EVAR, and juxta renal abdominal aortic aneurysm (AAA) from the last five years to see current indications, contemporary techniques, and results of these techniques for juxtarenal aneurysms. Over the years, f-EVAR and b-EVAR have improved, with high technical success (>95%) and mortality rates of 1-5% for pararenal and 5-10% for thoracoabdominal aortic aneurysms. Key Words: Fenestrated-branched endovascular repair, Fenestrated EVAR, Branched EVAR, Juxtarenal aortic aneurysm.
Asunto(s)
Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Humanos , Procedimientos Endovasculares/métodos , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/métodos , Resultado del Tratamiento , Prótesis Vascular , Stents , Aneurisma de la Aorta Torácica/cirugíaRESUMEN
CASE: We present a case of a 66-year-old man with lumbar vertebral body erosions after glue embolization of a Type II endoleak secondary to endovascular repair of an infrarenal aortic aneurysm. Multiple biopsies of the affected vertebrae were culture-negative confirming no evidence of infection. He underwent posterior spinal fusion from L2 to L5 with complete resolution of mechanical low back pain and improved functional outcomes. CONCLUSION: Vertebral body osseous erosion is a rare complication of aortic endoleak intervention that can be successfully treated with spinal fusion.
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Embolización Terapéutica , Endofuga , Humanos , Masculino , Anciano , Endofuga/etiología , Endofuga/diagnóstico por imagen , Endofuga/terapia , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Cuerpo Vertebral/diagnóstico por imagen , Cuerpo Vertebral/cirugía , Procedimientos Endovasculares/efectos adversos , Vértebras Lumbares/cirugía , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentaciónRESUMEN
OBJECTIVE: To evaluate the mid-term outcomes of different treatment strategies for the internal iliac artery (IIA) during EVAR. METHODS: This was a retrospective study. All patients undergoing EVAR, who required treatment of at least one side of IIA from January 2013 to July 2022 in a single center, were included. According to the different treatment strategies for IIA, the patients were divided into UP (unilateral preservation), BP (bilateral preservation) and BE (bilateral embolization) groups. The primary outcomes included buttock claudication, bowel ischemia and iliac-related reintervention. Then patients who underwent IIA reconstruction were divided into IPG (iliac parallel stent graft) and IBG (iliac branch stent graft) groups according to the reconstruction technique. The primary outcomes included endoleak, iliac branch occlusion and iliac-related reintervention. RESULTS: A total of 237 patients were included, including 167 in the UP group, 9 in the BP group and 61 in the BE group. The mean follow-up time was 39.0 ± 27.7, 50.0 ± 22.1 and 25.8 ± 18.9 months in UP, BP and BE groups, respectively. Thirty cases (12.7%) of buttock claudication occurred, and it was significantly higher in the BE group than the UP group (26.2% vs. 7.8%, p < 0.001). There were no significant differences in the other follow-up outcomes among three groups. The K-M analysis indicated that the patients in the BE group had a lower survival rate than those in the other two groups (p = 0.024). 24 patients underwent IIA reconstruction, including 8 in the IPG group and 16 in the IBG group. The endoleak in the IBG group was significantly lower than that in the IPG group (0% vs. 25.0%, p = 0.041). The iliac-related reintervention, iliac occlusion and mortality were similar between the two groups. CONCLUSION: Overall it is beneficial for patients to preserve at least one side of IIA during EVAR as much as possible. Compared with IPG, IBG might be more applicable for IIA reconstruction.
Asunto(s)
Procedimientos Endovasculares , Arteria Ilíaca , Humanos , Procedimientos Endovasculares/métodos , Procedimientos Endovasculares/efectos adversos , Masculino , Femenino , Anciano , Arteria Ilíaca/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Stents , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/métodos , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma Ilíaco/cirugía , Endofuga/cirugía , Endofuga/etiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Embolización Terapéutica/métodos , Reparación Endovascular de AneurismasRESUMEN
OBJECTIVE: The prevalence of abdominal aortic aneurysms (AAA) increases with age. Elective intervention for AAA is critical to prevent rupture associated with very high mortality among older males. METHODS: The aim of this study was to address the impact of post-contrast acute kidney-PC-AKI injury among patients treated with endovascular repair of ruptured AAA-EVAR on outcomes such as new onset chronic kidney disease-CKD and mortality among patients within a two-year trial. RESULTS: The same study group (of n = 192 patients) underwent reassessment, two years after EVAR treatment. The overall mortality rate was 16.67%, and it was higher in the AKI group - 38.89%. CKD patients had a mortality rate of 23.88% (n = 16). Among patients with an aneurysm diameter >67 mm mortality rate reached 20% (n = 6), while in the previously reported diabetes mellitus group 37.93% (n = 11). New onset of CKD was diagnosed in 23% of cases. Preexisting CKD patients with PC- AKI contributed to a 33.33% mortality rate (n = 8). CONCLUSION: This study concludes that PC-AKI impacts outcomes and survival in endovascularly treated AAAs. Type 2 diabetes and preexisting chronic kidney disease are associated with higher mortality within a 2-year follow-up, however gender factor was not significant. A larger aneurysm diameter is related with a higher prevalence of PC-AKI. These factors should be taken into account during screening, qualifying patients for the treatment and treating patients with AAA. It may help to identify high-risk individuals and tailor preventive measurements and treatment options accordingly, improving treatment results and reducing mortality.
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Lesión Renal Aguda , Aneurisma de la Aorta Abdominal , Rotura de la Aorta , Procedimientos Endovasculares , Insuficiencia Renal Crónica , Humanos , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Abdominal/complicaciones , Masculino , Procedimientos Endovasculares/efectos adversos , Femenino , Anciano , Factores de Riesgo , Rotura de la Aorta/cirugía , Rotura de la Aorta/mortalidad , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/epidemiología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/mortalidad , Anciano de 80 o más Años , Persona de Mediana Edad , Medios de ContrasteRESUMEN
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.
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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: This study was conducted to evaluate the differences between pre- and postoperative access conditions in percutaneous endovascular aortic repair (PEVAR). METHODS: Between December 2021 and October 2023, PEVAR was performed on 61 patients using the Perclose ProStyle (Abbott Vascular). Enhanced computed tomography and ankle-brachial index tests were performed preoperatively and postoperatively. The inner diameter and area of the iliofemoral artery were automatically measured, and the pre- and postoperative values were compared (114 legs). The same analysis was performed on 12 legs with previous groin operations; open surgical EVAR was performed in 9 legs, an endarterectomy of the femoral artery in 1, and a femoropopliteal bypass in the other leg. RESULTS: All patients were discharged without surgical site infections, lymphatic fistulas, or retroperitoneal haematomas. There were no significant differences between the pre-and postoperative inner diameter and inner area of the external iliac artery and common femoral artery. There were no significant differences between the preoperative and postoperative ankle-brachial index tests. In 12 legs with a previous groin operation, the postoperative ankle-brachial index tests and inner diameter and area of the external iliac artery and common femoral artery were statistically equal to the preoperative values. CONCLUSIONS: This study can support the safety of percutaneous endovascular aortic repair, even in patients with redo groin operations.
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Índice Tobillo Braquial , Procedimientos Endovasculares , Arteria Femoral , Arteria Ilíaca , Humanos , Arteria Femoral/cirugía , Arteria Femoral/diagnóstico por imagen , Masculino , Procedimientos Endovasculares/métodos , Femenino , Anciano , Arteria Ilíaca/cirugía , Arteria Ilíaca/diagnóstico por imagen , Estudios Prospectivos , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/cirugía , Reparación Endovascular de AneurismasRESUMEN
Aneurysms of the coronary arteries and abdominal aorta are extremely rare in infancy. Due to the rarity of the anomaly, there are no existing guidelines on management of these aneurysms. We describe the challenges in diagnosis, evaluation and management of an infantile Marfan with this rare presentation.
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Aneurisma de la Aorta Abdominal , Aneurisma Coronario , Humanos , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Lactante , Aneurisma Coronario/diagnóstico por imagen , Aneurisma Coronario/cirugía , Aneurisma Coronario/diagnóstico , Masculino , Síndrome de Marfan/complicaciones , Aorta Abdominal/diagnóstico por imagenRESUMEN
OBJECTIVES: To analyze how the experience of the surgical team went to impact the outcomes after open surgical repair (OSR) of intact abdominal aortic aneurysms (AAAs). METHODS: This is a single-center, observational cohort study with retrospective analysis of all OR for intact AAA performed between 1 January 2010 and 31 December 2022. The primary outcome was survival at 30 days and in follow-up, and a composite outcome of mortality and major complication. The secondary outcome was freedom from aorta-related reintervention. All outcomes were stratified according to the experience of the operating team (surgeons and anesthesiology). RESULTS: We analyzed 103 (7.2%) patients: 97 (94.2%) males and 6 (5.8%) females. The mean age was 76 ± 8 years (range, 55-93). The best possible team composition was present in 52 (50.5%) interventions. The follow-up index was 0.82 ± 0.18 (range, 0.6-1.0). Mean follow-up duration was 59 ± 43 months (range, 0-158). We observed no differences between teams in major complications (best, 17.3% vs mixed, 21.6%; OR: 0.4, P = 0.622), 30 days mortality (best, 0% vs mixed, 5.9%; OR: 7.6, P = 0.118) and composite outcome (best, 11.5% vs mixed, 17.6%; OR: 0.8, P = 0.416). Cox regression analysis identified the best possible team as a protective factor against the need for reintervention (hazard ratio: 0.2; 95% confidence interval: 0.06-0.88, P = 0.032). CONCLUSIONS: In our experience, OR of AAA yielded satisfactory results in terms of safety and efficacy independently of the team's experience. A more experienced team may protect against aorta-related reintervention.
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Aneurisma de la Aorta Abdominal , Complicaciones Posoperatorias , Humanos , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/mortalidad , Femenino , Masculino , Anciano , Estudios Retrospectivos , Anciano de 80 o más Años , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Grupo de Atención al Paciente/organización & administración , Resultado del Tratamiento , Implantación de Prótesis Vascular/métodos , Implantación de Prótesis Vascular/mortalidadRESUMEN
Endovascular aneurysm repair (EVAR) has emerged as the preferred treatment for abdominal aortic aneurysm (AAA), offering advantages such as reduced mortality, faster recovery, and fewer complications compared to open repair (OR). However, concerns persist regarding long-term durability, and the need for reinterventions. Among all reported EVAR complications, endograft collapse poses a significant challenge, particularly when presenting with acute lower limb ischemia (ALI). The aim of this report is to describe two cases of non-dissection-related abdominal endograft collapse manifesting as ALI, requiring urgent intervention, emergent conversion to OR and complete endograft removal.
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Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Humanos , Aneurisma de la Aorta Abdominal/cirugía , Procedimientos Endovasculares/métodos , Masculino , Implantación de Prótesis Vascular/métodos , Anciano , Falla de Prótesis , Prótesis Vascular , Anciano de 80 o más Años , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiología , Remoción de Dispositivos , Isquemia/etiología , Isquemia/cirugía , Reparación Endovascular de AneurismasRESUMEN
The presence of an intraperitoneal source of infection, e.g., a liver abscess, can be an obstacle to performing an abdominal aortic surgery with a midline laparotomy because graft infection is one of the most critical complications of aortic surgery. We report the successful Y-grafting of a pararenal abdominal aortic aneurysm through a retroperitoneal approach in a 67-year-old male undergoing liver abscess drainage. The retroperitoneal approach to the abdominal aorta may be useful for abdominal aortic surgery in patients with a localized intraperitoneal infection.
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Aneurisma de la Aorta Abdominal , Absceso Hepático , Humanos , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/complicaciones , Masculino , Anciano , Absceso Hepático/cirugía , Absceso Hepático/etiología , Absceso Hepático/diagnóstico por imagen , Implantación de Prótesis Vascular/métodosRESUMEN
BACKGROUND: Treatment of asymptomatic Abdominal Aortic Aneurysms (AAA) presents a clinical challenge, requiring a delicate balance between rupture risk, patient comorbidities, and intervention-related complications. International guidelines recommend intervention for specific AAA size thresholds, but these are based on historical trials with limited female representation. We aimed to analyse disease characteristics, AAA size at rupture, and intervention outcomes in patients with ruptured AAA from 2009 to 2023 to investigate the gap between guidelines and local realities. METHODS: This single-centre retrospective cohort study analysed electronic health records of patients treated for a ruptured AAA, excluding those who were managed palliatively. The study assessed patients' demographics, risk factors, comorbidities, clinical presentation, radiological characteristics, and outcomes. RESULTS: Of 164 patients (41 females, 123 males, median age 73.5), 93.3% presented with abdominal or back pain. The median AAA size at rupture was 8.0 cm in males and 7.6 cm in females. No significant correlations were found between demographic characteristics, risk factors, AAA size, repair modality, and outcomes. Trends show a decline in AAA prevalence and rupture rates, aligning with global health initiatives. Post-intervention survival rates at 30 days were 70.7% (67.5% in males and 80.0% in females), and at 2 years were 65.85% (61.7% in males and 70.0% in females). CONCLUSION: Evolving AAA trends and improved post-intervention survival rates warrant a critical reassessment of existing intervention recommendations. Adjusting intervention thresholds to larger sizes may be justified to optimise the risk-benefit ratio.
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Aneurisma de la Aorta Abdominal , Rotura de la Aorta , Guías de Práctica Clínica como Asunto , Humanos , Masculino , Femenino , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Estudios Retrospectivos , Persona de Mediana Edad , Anciano de 80 o más Años , Factores de Riesgo , Estudios de Cohortes , Tasa de SupervivenciaRESUMEN
BACKGROUND: Our aim was to analyse abdominal aneurysm sac thrombus density and volume on computed tomography (CT) after endovascular aneurysm repair (EVAR). METHODS: Patients who underwent EVAR between January 2005 and December 2010 and had at least four follow-up CT exams available over the first five years of follow-up were included in this retrospective single-centre study. Thrombus density and aneurysm sac volume were calculated on unenhanced CT scans. Linear mixed models were used for data analysis. RESULTS: Out of 82 patients, 44 (54%) had an endoleak on post-EVAR contrast-enhanced CT. Thrombus density significantly increased over time in both the endoleak and non-endoleak groups, with a slope of 0.159 UH/month (95% confidence interval [CI] 0.115-0.202), p < 0.0001) and 0.052 UH/month (95% CI 0.002-0.102, p = 0.041). In patients without endoleak, a significant decrease in aneurysm sac volume was identified over time (slope -0.891 cc/month, 95% CI -1.200 to -0.581); p < 0.001) compared to patients with endoleak (slope 0.284 cc/month, 95% CI -0.031 to 0.523, p = 0.082). The association between thrombus density and aneurysm sac volume was positive in the endoleak group (slope 1.543 UH/cc, 95% CI 0.948-2.138, p < 0.001) and negative in the non-endoleak group (slope -1.450 UH/cc, 95% CI -2.326 to -0.574, p = 0.001). CONCLUSION: We observed a progressive increase in thrombus density of the aneurysm sac after EVAR in patients with and without endoleak, more pronounced in patients with endoleak. The association between aneurysm volume and thrombus density was positive in patients with and negative in those without endoleak. RELEVANCE STATEMENT: A progressive increase in thrombus density and volume of abdominal aortic aneurysm sac on unenhanced CT might suggest underlying endoleak lately after EVAR. KEY POINTS: Thrombus density of the aneurysm sac after EVAR increased over time. Progressive increase in thrombus density was significantly associated to the underlying endoleak. The association between aneurysm volume and thrombus density was positive in patients with and negative in those without endoleak.
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Aneurisma de la Aorta Abdominal , Endofuga , Procedimientos Endovasculares , Trombosis , Tomografía Computarizada por Rayos X , Humanos , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Endofuga/diagnóstico por imagen , Endofuga/etiología , Femenino , Masculino , Estudios Retrospectivos , Anciano , Procedimientos Endovasculares/métodos , Trombosis/diagnóstico por imagen , Trombosis/etiología , Tomografía Computarizada por Rayos X/métodos , Anciano de 80 o más AñosAsunto(s)
Lesión Renal Aguda , Medios de Contraste , Procedimientos Endovasculares , Humanos , Lesión Renal Aguda/etiología , Medios de Contraste/efectos adversos , Procedimientos Endovasculares/efectos adversos , Factores de Riesgo , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Aneurisma de la Aorta Abdominal/cirugía , Reparación Endovascular de AneurismasRESUMEN
Fenestrated and branched endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms is increasingly replacing open repair as the primary modality of treatment. Mid- and long-term results are encouraging and support its use in the correct settings. Nevertheless, appropriateness of indication for treatment, patient selection, and surgeon and hospital performance has not been clearly evaluated and reviewed. The objective of this review article was to identify areas in which appropriateness of care is relevant and can be optimized when considering treatment of patients with fenestrated and branched endovascular repair for complex abdominal and thoracoabdominal aortic aneurysms.
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Aneurisma de la Aorta Abdominal , Aneurisma de la Aorta Torácica , Implantación de Prótesis Vascular , Prótesis Vascular , Procedimientos Endovasculares , Selección de Paciente , Diseño de Prótesis , Humanos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Resultado del Tratamiento , Factores de Riesgo , Toma de Decisiones Clínicas , Stents , Medición de Riesgo , Complicaciones Posoperatorias/etiologíaRESUMEN
Infective native arterial aneurysms and inflammatory aortic aneurysms are rare but morbid pathologies seen by vascular surgeons in the emergency setting. Presentation is not always clear, and a full workup must be obtained before adopting a management strategy. Treatment is multidisciplinary and is tailored to every case based on workup findings. Imaging with computed tomography, magnetic resonance, or with fluorodeoxyglucose-positron emission tomography aids in diagnosis and in monitoring response to treatment. Open surgery is traditionally performed for definitive management. Endovascular surgery may offer an alternative treatment in select cases with acceptable outcomes. Neither technique has been proven to be superior to the other. Physicians should consider patient's anatomy, comorbidities, life expectancy, and goals of care before selecting an approach. Long-term pharmacological treatment, with antibiotics in case of infective aneurysms and immunosuppressants in case of inflammatory aneurysms, is usually required and should be managed in collaboration with infectious disease specialists and rheumatologists.
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Aneurisma Infectado , Antibacterianos , Aneurisma de la Aorta Abdominal , Aortitis , Procedimientos Endovasculares , Humanos , Aneurisma Infectado/microbiología , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/cirugía , Aneurisma Infectado/terapia , Aneurisma Infectado/diagnóstico , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Resultado del Tratamiento , Antibacterianos/uso terapéutico , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Aortitis/terapia , Aortitis/diagnóstico por imagen , Aortitis/diagnóstico , Factores de Riesgo , Valor Predictivo de las Pruebas , Urgencias Médicas , Aortografía , Inmunosupresores/uso terapéutico , Procedimientos Quirúrgicos Vasculares , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/efectos adversos , Servicio de Urgencia en HospitalRESUMEN
There is variation in the management of small aneurysms in the United States today, with some surgeons moving forward with elective repair and others practice ongoing surveillance. Literature exists to suggest that small aneurysms are repaired at a higher rate than should be considered acceptable, and this represents a deviation from current standards of care. To best understand the optimal care of this patient population, this article aims to evaluate the current management of small aneurysms, review contemporary guidelines and the literature behind them, and assess the appropriateness of surgical management of small aneurysms.
Asunto(s)
Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Selección de Paciente , Humanos , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Resultado del Tratamiento , Factores de Riesgo , Implantación de Prótesis Vascular/efectos adversos , Procedimientos Endovasculares/efectos adversos , Guías de Práctica Clínica como Asunto , Toma de Decisiones Clínicas , Medición de Riesgo , Procedimientos Quirúrgicos Vasculares/normas , Procedimientos Quirúrgicos Vasculares/efectos adversosRESUMEN
OBJECTIVES: To develop and validate a deep learning model for detecting post-endovascular aortic repair (EVAR) endoleak from non-contrast CT. METHODS: This retrospective study involved 245 patients who underwent EVAR between September 2016 and December 2022. All patients underwent both non-enhanced and enhanced follow-up CT. The presence of endoleak was evaluated based on computed tomography angiography (CTA) and radiology reports. First, the aneurysm sac was segmented, and radiomic features were extracted on non-contrast CT. Statistical analysis was conducted to investigate differences in shape and density characteristics between aneurysm sacs with and without endoleak. Subsequently, a deep learning model was trained to generate predicted segmentation of the endoleak. A binary decision was made based on whether the model produced a segmentation to detect the presence of endoleak. The absence of a predicted segmentation indicated no endoleak, while the presence of a predicted segmentation indicated endoleak. Finally, the performance of the model was evaluated by comparing the predicted segmentation with the reference segmentation obtained from CTA. Model performance was assessed using metrics such as dice similarity coefficient, sensitivity, specificity, and the area under the curve (AUC). RESULTS: This study finally included 85 patients with endoleak and 82 patients without endoleak. Compared to patients without endoleak, patients with endoleak had higher CT values and greater dispersion. The AUC in validation group was 0.951, dice similarity coefficient was 0.814, sensitivity was 0.877, and specificity was 0.884. CONCLUSION: This deep learning model based on non-contrast CT can detect endoleak after EVAR with high sensitivity.