46 research outputs found
sj-docx-1-jet-10.1177_15266028231210220 – Supplemental material for Endovascular and Surgical Venous Arterialization for No-Option Patients With Chronic Limb-Threatening Ischemia: A Systematic Review and Meta-Analysis
No full textSupplemental material, sj-docx-1-jet-10.1177_15266028231210220 for Endovascular and Surgical Venous Arterialization for No-Option Patients With Chronic Limb-Threatening Ischemia: A Systematic Review and Meta-Analysis by Alessandro Ucci, Paolo Perini, Antonio Freyrie, Michiel A. Schreve, Çağdaş Ünlü, Eline Huizing, Daniel A. van den Heuvel, Steven Kum, Mehdi H. Shishehbor and Roberto Ferraresi in Journal of Endovascular Therapy</p
Twelve years of experience in carotid endarterectomy with general anesthesia and preserved consciousness
No full textBackground: Carotid endarterectomy (CEA) can be performed both under general anesthesia (GA) or local
anesthesia (LA) with good results. General anesthesia with preserved consciousness (GAPC) using remifentanil
infusion has been already reported in literature and could potentially merge the advantages of GA and LA
overcoming the disadvantages of this last technique. Although the good results of GAPC reported in literature,
this technique is not widespread in clinical practice. The aim of this study was to report the perioperative results
of CEA under GAPC in a large series of consecutive patients.
Methods: This is a retrospective, single center, observational study including all patients treated for CEA
under GAPC in our institution between January 2008 and October 2019. Primary endpoints were neurological
complications rate, mortality rate in the perioperative period, need to GAPC conversion to GA during surgery
and evaluation of the technique with a specific questionnaire regarding patients’ satisfaction. Secondary
endpoints were myocardial infarction (MI) rate, other perioperative complications rate, rate of intraoperative
shunting and need of reintervention in the perioperative period.
Results: In the considered period 1290 CEA under GAPC were performed and included in this study. Neurological
complications rate was 2.01%, mortality rate in the perioperative period was 0.07%, need of GAPC conversion
to GA rate during surgery was 0.46% and patients satisfaction regarding the technique were high with a mean
vote of 9.1 in a 0 to 10 scale. In the perioperative period MI rate was 0.23%, other perioperative complications
rate was 1.39%, intraoperative shunting rate was 7.1% and reintervention rate after surgery was 2.4%.
Conclusions: CEA under GAPC may combine the advantages of LA and GA, with a very low rate of conversion
to GA during surgery and good patients’ satisfaction. Moreover, it does not increase neurological, cardiologic and
systemic complications. For these reasons CEA under GAPC could represents a valid alternative to GA or LA.
(Cite this article as: Ucci A, D’Ospina RM, Perini P, Bianchini Massoni C, De Troia A, Azzarone M, et al.
Twelve years of experience in carotid endarterectomy with general anesthesia and preserved consciousness. Int
Angiol 2020;39:477-84. DOI: 10.23736/S0392-9590.20.04427-2
Surgical treatment of a high-flow femoro-femoral arteriovenous fistula in an intravenous drug abuser
No full textBackground: We report the surgical treatment of a high-flow femoro-femoral arteriovenous fistula (AVF), a rare complication of intravenous drug abuse. Methods: A 36-year-old woman with history of intravenous heroin and cocaine abuse presented with right lower limb edema, inguinal bruit, and heart failure. Duplex ultrasound examination (DUS) and computed tomography angiography showed a large, high-flow AVF involving the common femoral vein and the superficial femoral artery, which is associated with thrombosis of the great saphenous vein and an important inflammation in the right groin, without active bleeding. Under general anesthesia, the patient underwent open surgical repair of the AVF through a right-groin cutdown. The 3-cm-long AVF was repaired with the interposition of a bovine pericardium patch that is sewn from inside the femoral vein through a longitudinal venotomy with a continuous 5–0 polypropylene suture. Results: The venotomy was repaired with a 5–0 polypropylene running suture. No perioperative or postoperative complications were recorded. The inguinal bruit resolved, the arteries recovered good pulsatility, and the lower limb edema promptly reduced. A 6-month DUS confirmed the patency of the femoral arteries and veins and the absence of AVF or infection signs in the right groin. Conclusions: Surgical repair of femoro-femoral AVF in drug abusers by biologic patch interposition is a challenging, but feasible, and effective technique with encouraging midterm results in terms of patency and resistance to infections
Significance and Risk Factors for Intraprosthetic Mural Thrombus in Abdominal Aortic Endografts: a Systematic Review and Meta-Analysis
No full textThe detection of intraprosthetic thrombus (IPT) deposits is a common finding during follow-up for endovascular abdominal aneurysm repair (EVAR); however, its clinical significance is still debated. The aim of this study was to determine if IPT represents a risk factor for thromboembolic events (TE; endograft or limb thrombosis, or distal embolization) after EVAR
TRATTAMENTO CON ENDOPROTESI DI DISSECAZIONE POST-TRAUMATICA DEL DISTRETTO AORTO-ILIACO: CASE REPORT
No full textEndovascular repair of an abdominal aortic aneurysm using bifurcated stent-graft in a patient with bilateral external iliac artery occlusion
No full textAbdominal aortic aneurysm (AAA) in association with external iliac artery (EIA) occlusion is a rare entity which may limit endovascular aortic aneurysm repair (EVAR) feasibility. We describe the case of an 84-year-old man affected by a 64mm infrarenal inflammatory abdominal aortic aneurysm with complete bilateral occlusion of EIA and patency of both common and internal iliac arteries. The common femoral arteries (CFA) were patent, and the patient was asymptomatic for lower limb claudication. The treatment was performed by EVAR using a bifurcated stent-graft after the recanalization of the left EIA, achieving technical success
Surgical and Endovascular Management of Isolated Internal Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis
No full textObjectives:
The purpose of this paper is to report the different modalities for the treatment of isolated internal iliac artery aneurysms (IIIAA), as well as their outcomes.
Methods:
We performed a systematic review of the literature (database searched: PubMed, Web of Science, Scopus, Cochrane Library; last search: April 2020). We included articles reporting on the outcomes for IIIAA interventions comprising at least 5 patients. Studies were included when presenting extractable outcome data regarding intraoperative and/or early results. We performed meta-analyses of proportions for different outcomes, using random effects model.
Results:
Thirteen non-randomized studies were included (192 patients with 202 IIIAA). IIIAA were symptomatic in the 18.1% (95%CI 9.3-26.9; I-2 54.46%, P = .019). Estimated mean IIIAA diameter was 46.28 mm (95%CI 39.72-52.85; I-2 88.85%, P < .001). Open repair was performed in 21/202 cases. Endovascular treatments were: embolization (81/181), embolization and hypogastric artery coverage (79/181), hypogastric artery coverage by stent-grafting (15/181), stent-grafting in the hypogastric artery (6/181). Overall estimated technical success (TS) rate was 91.6% (95% CI 86.8-95.5; I-2 45.82%, P = .031). TS rate was 94.5% for open surgery (95%CI 85.3-100; I-2 0%, P = .907), and 89.7% for endovascular repair (95%CI 83.8-95.6; I-2 55.43%, P = .006). Estimated overall 30-day mortality was 3.1% (95%CI 0.8-5.4; I-2 0%, P = .969). Mortality rates after open surgery and endovascular repair were 8.2% (95%CI 3.4-19.8; I-2 0%, P = .545) and 2.8% (95%CI 0.5-5.1; I-2 0%, P = .994), respectively. Estimated mean follow-up was 32.63 months (95%CI 21.74-43.53; I-2 94.45%, P < .001). During this timeframe, IIIAA exclusion was preserved in 92.8% of the patients (95%CI 89.3-96.2; I-2 0%, P = .797). Buttock claudication occurred in 13.9% of the patients (95%CI 8.7-19.2; I-2 0%, P = .622).
Conclusions:
IIIAA are frequently large, and symptomatic at presentation. Several treatments are proposed in literature, open and endovascular, both with good results. The endovascular treatment is the preferred method of treatment in literature, since it offers good short- to mid-term results and low early mortality. Buttock claudication after hypogastric artery exclusion is a common complication
Systematic review and meta-analysis of incidence, indications, and outcomes of early open conversions after EVAR for abdominal aortic aneurysms
No full textIntroduction: The purpose of this study is to report incidence, indications, and outcomes of early open conversions (EOC) after endovascular aortic repair (EVAR), defined as surgical conversion performed within 30 days from the initial EVAR. Evidence aquisition: A systematic review of the literature was performed (database searched: PubMed, Web of Science, Scopus, Cochrane Library; last search April 2023). Articles reporting EOC after EVAR comprising at least five patients were included. Meta-analyses of proportions were performed using a random-effects model. Evidence synthesis: Seventeen non-randomized studies, published between 1999 and 2022, were included. A total of 35,970 patients had previously undergone EVAR, of these 438 patients underwent EOC. Estimated incidence of EOC was 1.4% (95% CI 1.1-1.4; I2=81.66%). Specifically, in the works published before 2010 the incidence was 1.8% (95% CI 1.3-2.4; I2=74.25) while for subsequent ones it was 0.9% (95% CI 0.6-1.1; I2=69.82). Weighted mean age was 74.91 years (95% CI 72.42-77.39; I2=83.11%). Estimated rate of cause determining EOC were: access issue in 27.7% of patients (95% CI 13.8-41.6; I2=88.14%), incorrect placement of the endograft in 20.1% (95% CI 10.2-30.0; I2=76,9%), problems with "delivery system" in 9.0% (95% CI 4.9-13.1; I2=0%), aorto-iliac rupture in 8.6% (95% CI 4.5-12.6; I2=0%), endoprosthesis migration in 7.9% of cases (95% CI 3.3-12.4; I2=22.96%), failure in engaging the contralateral gate in 4.8% (95% CI 1.6-8; I2=0%), "kinking" or "twisting" of endoprosthesis in 3.3% (95% CI 0.6-5.9; I2=0%), graft thrombosis in 3.2% (95% CI 0.6-5.7; I2=0%), type Ia endoleak in 2.9% (95% CI 0.4-5.4; I2=0%), type III endoleak in 2.8% (95% CI 0.3-5.3; I2=0%) and endograft infection in 2.7% (95% CI 0.3-5.2; I2=0%). Intraoperative conversion rate was 91.1% (95% CI 85.8-96.4; I2=66.01%). Early mortality rate after EOC was 14.5% (95% CI 9.1-19.9; I2=48.31%). Mean length of stay (LOS) was 11.94 days (95% CI 6.718-17.172; I2=92.34%). Conclusions: The incidence of EOC seems to decrease over time. Causes of EOC were mainly related to access problems and incorrect positioning of the endograft. Most of the EOC were performed intraoperatively carrying a high mortality rate
TRATTAMENTO ENDOVASCOLARE DI FISTOLA AORTO-CAVALE SECONDARIA A CHIRURGIA DELL'AORTA ADDOMINALE: CASE REPORT E REVISIONE DELLA LETTERATURA
No full text
