RESUMO
BACKGROUND: Significant morbidity and mortality are related to conventional aortic replacement surgery. Endovascular debranching techniques, fenestrated or branched endografts are time consuming and costly. OBJECTIVE: We alternatively propose to use endovascular approach with parallel grafts for debranching of aortic arch. METHODS: Under general anesthesia, 12 F sheaths were inserted in the femoral, axillary and common carotid arteries for vascular accesses. ViaBahn grafts 10 - 15 cm in length were placed into the aortic arch from right common carotid, left common carotid and left axillary arteries, until the tip of each graft reached into the ascending aorta. Through one femoral artery, the aortic stent -graft was positioned and delivered. Soon after, the parallel grafts were sequentially delivered. Self-spanding Wallstents(R) were used for parallel grafts reinforcement. Ballooning was routinely used for parallel grafts and rarely for aortic graft. RESULTS: This technique was used in 2 cases. The first one was a lady with 72 years old, with an aortic retrograde dissection from left subclavian artery and involving remaining arch branches. Through right common carotid artery a stent-graft was placed in the ascending aorta and through the left common carotid artery a ViaBahn was inserted parallel to the former. A thoracic endograft then covered all the aortic arch dissection extending into the ascending aorta close to the sinu -tubular junction. The second case was a 82 year old male patient with a 7 cm aortic arch aneurysm. Through both common carotid arteries ViaBahn grafts were introduced and positioned into the ascending aorta. Soon after, the deployment of the thoracic stent graft covered all parallel grafts of the aortic arch, excluding the aneurysm. Both cases did not have neurologic or cardiac complications and were discharged 10 days after the procedure. CONCLUSIONS: This technique may be a good minimal invasive off-the-shelf technical option for aortic arch ''debranching''. More data and further improvements are required before this promising technique can be widely advocated.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/patologia , Feminino , Humanos , MasculinoRESUMO
The goal of this study was to determine the prevalence, epidemiology and clinical-therapeutical evolution of hepatolithiasis (HL) in Argentina. With this purpose a survey was conducted sending a questionnaire to ten referencial and interventional radiology centers in the country. Seven centers answered on time. In the last five years a total of 8,736 consecutive patients were examined for cholangiography (endoscopic retrograde cholangiography, PTC). A total of 5,920 (68%) were biliary lithiasis and 53 (0.9%, range 0.5-2.6%) of these were HL. In case of HL the diagnostic procedure was the ERCP in 68% of the cases, and the PTC in the remainder 32%. The patients with HL (53% females, mean age 52, range 23-85) clinically presented cholangitis (79%); pancreatitis (6%) and five (9.4%) showed evolution to a biliary cirrhosis. Associated diseases or abnormalities of the biliary tree were: biliary postsurgical strictures (BPS), 28%; Caroli's Syndrome, 20%; and choledocholithiasis, 28%. While a 9.4% presented a "biliary history" (that was defined as two or more episodes of biliary surgery) and a 5.7% lacked associated or predisposing diseases. Follow-up was lost in 23% of the cases and in 77% a follow up of 38 months (range 8-60) was observed with 4.8% mortality rate. The treatment was hepatobiliary surgery in 58% of the cases; endoscopic papillotomy in 17% and combined treatments that included extracorporeal shock wave lithotripsy and ursodeoxycholic acid (UDCA) in 15%. Four out of 53 cases (7.5%) received UDCA as the only successful therapy. HL is an entity with high biliary morbidity in 85% of the cases and development in to cirrhosis in 9.4%. When the diagnosis is made in the western world both BPS and Caroli must be discarded first. Combined treatments or only UDCA are new therapeutical alternative in the western world.
Assuntos
Doença de Caroli/complicações , Litíase/complicações , Litíase/epidemiologia , Hepatopatias/complicações , Hepatopatias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina , Doença de Caroli/diagnóstico , Doença de Caroli/epidemiologia , Diagnóstico Diferencial , Feminino , Humanos , Litíase/diagnóstico , Litíase/terapia , Hepatopatias/diagnóstico , Hepatopatias/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e QuestionáriosRESUMO
The goal of this study was to determine the prevalence, epidemiology and clinical-therapeutical evolution of hepatolithiasis (HL) in Argentina. With this purpose a survey was conducted sending a questionnaire to ten referencial and interventional radiology centers in the country. Seven centers answered on time. In the last five years a total of 8,736 consecutive patients were examined for cholangiography (endoscopic retrograde cholangiography, PTC). A total of 5,920 (68
) were biliary lithiasis and 53 (0.9
, range 0.5-2.6
) of these were HL. In case of HL the diagnostic procedure was the ERCP in 68
of the cases, and the PTC in the remainder 32
. The patients with HL (53
females, mean age 52, range 23-85) clinically presented cholangitis (79
); pancreatitis (6
) and five (9.4
) showed evolution to a biliary cirrhosis. Associated diseases or abnormalities of the biliary tree were: biliary postsurgical strictures (BPS), 28
; Carolis Syndrome, 20
; and choledocholithiasis, 28
. While a 9.4
presented a [quot ]biliary history[quot ] (that was defined as two or more episodes of biliary surgery) and a 5.7
lacked associated or predisposing diseases. Follow-up was lost in 23
of the cases and in 77
a follow up of 38 months (range 8-60) was observed with 4.8
mortality rate. The treatment was hepatobiliary surgery in 58
of the cases; endoscopic papillotomy in 17
and combined treatments that included extracorporeal shock wave lithotripsy and ursodeoxycholic acid (UDCA) in 15
. Four out of 53 cases (7.5
) received UDCA as the only successful therapy. HL is an entity with high biliary morbidity in 85
of the cases and development in to cirrhosis in 9.4
. When the diagnosis is made in the western world both BPS and Caroli must be discarded first. Combined treatments or only UDCA are new therapeutical alternative in the western world.
RESUMO
A fin de determinar la prevalencia epidemiología y comportamiento clínico-terapÛutico de la hepatolitiasis (HL) en el país se envió un cuestionario a 10 centros de referencia, en Radiología invasiva de vía biliar. De 10 centros encuestados, 7 (70 por ciento) contestaron en tiempo y forma. Reuniéndose un total de 8.736 colangiografías (C) en los últimos 5 años: 5.920 (68 por ciento) fueron litiasis biliares y 53 de estas resultaron HL (0.9 por ciento, rango 0,5-2.6 por ciento). El método diagnóstico fue la C. retrógrada en el 36 (68 por ciento) y en el 17 (32 por ciento) la C. transhepática. De 53 pacientes con HL (53 por ciento, x de edad 52, rango 23-85); el 79 por ciento (42/53) se presentó clínicamente con una colangitis; un 6 por ciento 3/53) padeció una pancreatitis aguda y un 9.4 por ciento (5/53), evolucionó a una cirrosis biliar. Las enfermedades predisponentes a HL fueron: en el 28 por ciento (15/53) estenosis postquirúrgica de la via biliar (EPQ); en el 20 por ciento (11/53) Enfermedad de Carolí en otro 28 por ciento (15/53) panlitiasiscoledociana. Mientras que un 9,4 por ciento (5/53) presentó una "historia biliar" (dos o más intervenciones sobre la via biliar) y en un 5,7 por ciento (3/53) no se hallaron factores predisponentes. En un 77 por ciento se observó un follow-up de 38 meses (rango 8-60), con una mortalidad de 4,8 por ciento (2/41): siendo tratados con cirurgía en el 58 por ciento de los casos (31/53); papilotomía en el 17 por ciento (9/53) y tratamiento combinados en el 15 por ciento (8/53) que incluían a litotripsia extracorpórea y Ac. Ursodesoxicólico(AUDC). Cuatro de 53 (7.5 por ciento) recibieron AUDC como única terapéutica. Se concluye que la HL es una entidad con alta morbilidad biliar (85 por ciento) y heoática (cirrosis en el 9.4 por ciento). Cuando se diagnostica en Occidente, debe buscarse EPQ o un Carolí. Siendo los tratamientos combinados o el AUDC como única alternativa, una nueva modalidad terapéutica del mundo occidental. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Litíase/epidemiologia , Litíase/complicações , Hepatopatias/epidemiologia , Hepatopatias/complicações , Doença de Caroli/complicações , Litíase/diagnóstico , Litíase/terapia , Hepatopatias/diagnóstico , Hepatopatias/terapia , Doença de Caroli/epidemiologia , Doença de Caroli/diagnóstico , Argentina , Prevalência , Inquéritos e Questionários , Diagnóstico Diferencial , Idoso de 80 Anos ou maisRESUMO
A fin de determinar la prevalencia epidemiología y comportamiento clínico-terapêutico de la hepatolitiasis (HL) en el país se envió un cuestionario a 10 centros de referencia, en Radiología invasiva de vía biliar. De 10 centros encuestados, 7 (70 por ciento) contestaron en tiempo y forma. Reuniéndose un total de 8.736 colangiografías (C) en los últimos 5 años: 5.920 (68 por ciento) fueron litiasis biliares y 53 de estas resultaron HL (0.9 por ciento, rango 0,5-2.6 por ciento). El método diagnóstico fue la C. retrógrada en el 36 (68 por ciento) y en el 17 (32 por ciento) la C. transhepática. De 53 pacientes con HL (53 por ciento, x de edad 52, rango 23-85); el 79 por ciento (42/53) se presentó clínicamente con una colangitis; un 6 por ciento 3/53) padeció una pancreatitis aguda y un 9.4 por ciento (5/53), evolucionó a una cirrosis biliar. Las enfermedades predisponentes a HL fueron: en el 28 por ciento (15/53) estenosis postquirúrgica de la via biliar (EPQ); en el 20 por ciento (11/53) Enfermedad de Carolí en otro 28 por ciento (15/53) panlitiasiscoledociana. Mientras que un 9,4 por ciento (5/53) presentó una "historia biliar" (dos o más intervenciones sobre la via biliar) y en un 5,7 por ciento (3/53) no se hallaron factores predisponentes. En un 77 por ciento se observó un follow-up de 38 meses (rango 8-60), con una mortalidad de 4,8 por ciento (2/41): siendo tratados con cirurgía en el 58 por ciento de los casos (31/53); papilotomía en el 17 por ciento (9/53) y tratamiento combinados en el 15 por ciento (8/53) que incluían a litotripsia extracorpórea y Ac. Ursodesoxicólico(AUDC). Cuatro de 53 (7.5 por ciento) recibieron AUDC como única terapéutica. Se concluye que la HL es una entidad con alta morbilidad biliar (85 por ciento) y heoática (cirrosis en el 9.4 por ciento). Cuando se diagnostica en Occidente, debe buscarse EPQ o un Carolí. Siendo los tratamientos combinados o el AUDC como única alternativa, una nueva modalidad terapéutica del mundo occidental.