1,720,987 research outputs found
The different effect of branches and fenestrations on early and long-term visceral vessel patency in complex aortic endovascular repair
No full textBackground: Aortic endovascular treatment with fenestrated or branched devices (f/bEVAR) requires a connection between the aortic graft and the visceral vessel (VV). However, data on the perioperative and long-term fate of the VVs remain scarce. The aim of our study was to evaluate the VV loss (VVL) according to the type of revascularization performed (fenestrations vs branched) and the necessity for adjunctive visceral procedures (AVPs). Methods: From 2012 to 2017, all f/bEVAR procedures for juxtarenal abdominal aortic aneurysms (JAAAs), pararenal abdominal aortic aneurysms (PAAAs), and thoracoabdominal aortic aneurysms (TAAAs) were considered. The perioperative VVL, AVPs, and graft configuration were considered and evaluated during the follow-up period. Results: In 158 patients, 523 VVs were considered, 140 (26%) in JAAAs, 165 (32%) in PAAAs, and 218 (42%) in TAAAs. Branches were used for 114 vessels (52%) in TAAAs, 8 (5%) in PAAAs, and 0 (0%) in JAAAs. The overall perioperative VVL was 20 (3.8%) and was significantly greater in TAAAs than in PAAAs or JAAAs (6.4% vs 2.4% vs 1.4%; P =.03). The branches resulted in greater perioperative VVL compared with fenestration (9% [11 of 122] vs 2% [9 of 401]; P =.0001). A significant VVL difference between the branches and fenestrations was identified selectively only for the renal arteries: 11 of 52 (21%) vs 6 of 224 (2.5%; P =.001). The results of the multivariate analysis confirmed the independent greater risk of VVL for branches and renal arteries (odds ratio, 4.7; 95% confidence interval, 12.5-1.7; P =.04; odds ratio, 7.1; 95% confidence interval, 52.6-1.05; P =.05, respectively). AVPs were performed in 43 VVs (8.2%) because of dissection (n = 2; 0.4%), stenosis (m = 3; 0.6%), bleeding (n = 3; 0.6%), or kinking between the bridging stent graft and the VV (n = 35; 7%). A significant difference between the branches and fenestrations was seen only for kinking between the bridging stent graft and VV (12% [15 of 112] vs 5% [20 of 401]; P =.005). At 5 years, the incidence of VVL was 2% ± 1%. The fenestrations had significantly greater freedom from VVL compared with the branches (100% vs 87% ± 6%; P =.04), which was confirmed selectively for TAAAs (100% vs 87% ± 6%; P =.04). The use of AVPs did not affect long-term visceral patency. Conclusions: Early and late VVL was infrequent in complex aortic procedures but seemed to occur more frequently in branches than in fenestration, especially for renal arteries. AVPs were often required to correct artery kinking but this did not affect the long-term patency
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Endovascular Treatment of a Ruptured Superficial Femoral Artery Aneurysm in Behcet's Disease: Case Report and Literature Review
No full textPurpose: The aim of the study was to report the endovascular repair of a ruptured superficial femoral artery (SFA) aneurysm in a young patient with Behcet's disease and review the literature. Case Report: A 43-year-old man with a known history of vasculo-Behcet's disease (v-BD) under daily immunosuppressive therapy presented with a ruptured aneurysm of the left SFA. The patient underwent urgent endovascular exclusion of the aneurysm using a self-expanding covered stent. Surgical cut-down followed by direct puncture of the SFA was preferred to percutaneous approach to reduce the risk of postoperative pseudoaneurysm formation. The procedure and postoperative recovery were successful. Doppler ultrasound performed at 3 months and computed tomography angiography performed at 6 months after the procedure confirmed aneurysm exclusion, the endograft patency, and the absence of aneurysm degeneration both at the level of surgical access and endograft landing zone. Conclusions: The endovascular treatment of ruptured lower limb aneurysms has been scarcely reported in the literature despite representing the less invasive option. A rare case of ruptured aneurysm SFA in a patient with v-BD was successfully treated with endovascular therapy (ET) and led to satisfactory midterm outcomes. ET offers encouraging results in terms of reduced vessel trauma and reduced postoperative complication rates
VASCUNET: Novel Rare Vascular Disease Network: Call to Participate in Two Multicentre Pilot Studies
No full textAbstract not available
Current status on aortic endografts
No full textEndovascular treatment has become widespread to treat aneurysmal disease, especially located in the aorta. The modern era of abdominal aortic aneurysm repair started between 1986 and 1991, and in the last 30 years, Endovascular Treatment for abdominal aortic aneurysms evolved both due to the development of new materials and devices and the increasing appeal and effectiveness of the endovascular therapy itself. Vascular surgeons are using nowadays different solutions of Endovascular Treatment to treat all the expressions of aortic pathology (aneurysms, dissections and trauma) both in the acute and elective setting. Despite its use in every location of the aorta (the ascending aorta, the aortic arch, the thoracic aorta, thoraco-abdominal aorta, pararenal, iuxtarenal and infrarenal aortic aneurysms and iliac aneurysms), its safety and efficiency, endovascular treatment for aortic aneurysms presents some drawbacks: despite a lower short-term morbi-mortality, reinterventions and long-term patency are higher compared to open repair. In this review, we detail the most used types of endografts according to location, their performances and durability for each device. We conclude by discussing options to overcome ET limitations. Therefore, an obvious question arises: what we need in the future? What can the technological progress gives to physicians to further improve this new way of treating aorta?
Cystic Adventitial Disease of the Popliteal Artery: Radical Surgical Treatment After Several Failed Approaches. A Case Report and Review of the Literature
No full textAdventitial cystic disease is a rare nonatheromatous cause of popliteal artery disease. We report the case of a 49-year-old male patient who presented with left calf claudication caused by adventitial cystic disease. Popliteal artery resection followed by autologous vein graft interposition and Percutaneous Transluminal Angioplasty (PTA) stenting led to recurrence. The patient was finally successfully treated by bypass with autologous vein. No postoperative complications occurred, and patency was preserved at 33-month follow-up. Several different treatment options are possible; however, a primary radical surgical treatment with extra-anatomical medial bypass with autologous vein seems preferable
Endovascular Repair of a Common Carotid Artery Perforation during Pacemaker Insertion
No full textBackground: We report the percutaneous endovascular management of an iatrogenic perforation of the left common carotid artery (LCCA) during an attempted trans-subclavian pacemaker (PM) placement. Methods: An 87-year-old woman was urgently transferred after an attempted left subclavian vein PM implantation. Computed tomography angiography scan showed the accidental cannulation of LCCA in its most proximal segment. Owing to the significant surgical risks, the mortality rate, and the distal position of the vessel from the skin, we opted for an endovascular strategy with a balloon-expandable stent graft. The Advanta 8 × 38 mm V12 was inserted via a 7 French Flexor Introducer sheath through the right common femoral artery. Results: The patient was discharged on postoperative day 2 without complications. A 6-month follow-up computed tomography angiography demonstrated stent graft and LCCA patency and the patient was in a good stable condition. Conclusions: This case highlights the effectiveness of a minimal invasive endovascular approach to treat this uncommon but potentially lethal injury
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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