1,721,059 research outputs found
Current evidence for thoracic aorta type B dissection management
No full textAortic dissection is a devastating cardiovascular condition and represents the most common aortic emergency. Outcome is determined by the type and extent of dissection and the presence of associated complications requiring early diagnosis and treatment. Aortic dissection is defined as acute within 14 days from onset and chronic after that time period. The natural course of type B dissection is determined by 2 elements, early and chronic complications. An uncomplicated acute type B dissection is less frequently lethal but it is not totally benign. Some peculiar issues must be taken into account, such as the high probability of complications development in a dissected aorta and the poor long-term prognosis on medical treatment alone. Then, it would be helpful to identify which patients with uncomplicated type B dissection will have a poorest aortic prognosis over time in order to apply an early intervention.Aortic dissection is a devastating cardiovascular condition and represents the most common aortic emergency. Outcome is determined by the type and extent of dissection and the presence of associated complications requiring early diagnosis and treatment. Aortic dissection is defined as acute within 14 days from onset and chronic after that time period. The natural course of type B dissection is determined by 2 elements, early and chronic complications. An uncomplicated acute type B dissection is less frequently lethal but it is not totally benign. Some peculiar issues must be taken into account, such as the high probability of complications development in a dissected aorta and the poor long-term prognosis on medical treatment alone. Then, it would be helpful to identify which patients with uncomplicated type B dissection will have a poorest aortic prognosis over time in order to apply an early intervention
Endovascular repair versus open repair for inflammatory abdominal aortic aneurysms
No full textBackground
Inflammatory abdominal aortic aneurysm (IAAA) is a rare but potentially life-threatening condition characterised by marked thickening of the aortic wall, peri-aneurysmal and retroperitoneal fibrosis, and dense adhesions of adjacent abdominal organs. The pathogenesis of IAAA remains an enigma. The main aim of invasive or surgical therapy of AAAs is prevention or correction of aortic rupture. Prevention or treatment of AAA rupture by open or endovascular repair is proven by numerous studies published in the literature. Treatment of IAAA poses a different challenge to surgeons compared with traditional atherosclerotic AAA because of the potential for iatrogenic injury in open repair or, alternatively, potential increased inflammatory response to endoprosthesis implantation.
Objectives
To assess the effects of elective endovascular versus open repair for inflammatory abdominal aortic aneurysms.
Search methods
The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (April 2015) and the Cochrane Register of Studies (CRS) (2015, Issue 3). The TSC searched trial databases for details of ongoing and unpublished studies.
Selection criteria
We sought all published and unpublished randomised controlled trials (RCTs), quasi-RCTs and controlled clinical trials comparing results of elective endovascular or open repair of IAAAs without language restriction.
Data collection and analysis
Both review authors independently assessed studies identified for potential inclusion in the review. We planned to conduct data collection and analysis in accordance with the Cochrane Handbook for Systematic Review of Interventions.
Main results
We identified no studies that met the inclusion criteria
Secondary procedures in thoracic aorta
No full textSecondary procedures for thoracic aorta are very demanding to the patient, with significantly high perioperative mortality and morbidity. The aim of this paper was to review the most remarkable secondary procedures following open and endorepairs of thoracic aorta. The PubMed database was searched without any year limits. Search terms used %were “thoracic”, “aorta” and “reintervention”. Two authors independently reviewed abstracts identified by the search and subsequently the reference lists of eligible series were scrutinized in order to detect any additional relevant articles. Different early and late complications following open an endovascular repair of thoracic aorta were described adding their incidence and their potential solutions with secondary interventions. Secondary interventions after open repair (OR) are more related to bleeding and progression of the aortic disease issues and open surgery is again the most common solution. However, in more fragile patients with favorable anatomy, endovascular repair can be offered as a secondary procedure. Reinterventions after endovascular treatment of thoracic aorta diseases (TEVAR) are mostly related to endoleaks and also to the aortic disease progression. Hopefully, the oncoming technological improvements together with the optimized operator expertise can reduce the incidence of secondary procedures following TEVAR for all the aortic pathologies
Current technology for the treatment of infection following abdominal aortic aneurysm (AAA) fixation by endovascular repair (EVAR)
No full textIn recent years, in parallel with the increase of endovascular aortic repair (EVAR) procedures performances, a rise of late open surgical removal of EVAR implants has been observed, due to non-endovascularly correctable graft complications. Among them endograft infection is a rare but devastating occurrence, accounting for an incidence ranging from 0.2% to 0.7% in major series, and almost 1% of all causes of endograft explantations. However, a real estimation of the incidence of the problem respect to the number of EVAR implantations is difficult to obtain. Time to infection is usually defined as the period between EVAR and presentation of symptoms that leads to the infection diagnosis. It can be extremely variable, depending on bacterial virulence and host conditions. The diagnosis of an endograft infection is usually based on a combination of clinical symptoms, imaging studies and microbial cultures whenever possible. If computed tomography (CT) scan is employed in almost 100% of infection diagnosis, a combination of fluorodeoxyglucose-positron emission tomography (FDG-PET) and CT scan is nowadays used with increasing frequency in order to rise the likelihood of detecting a graft infection, since even cultures of blood or samples collected from the infected field can sometimes be negative. Complete graft excision seems the best approach whenever a surgical reconstruction could be attempted. In situ reconstruction can be performed by the interposition of an autologous vein, a cryopreserved allograft or a rifampin-soaked Dacron graft. The so-called conventional treatment contemplates the re-establishment of vascularization through extranatomical routes, thus preserving the new graft material from possible contamination by the surgical field just cleaned. When severe comorbid conditions did not allow graft excision, a conservative treatment should be taken into account. It is mainly based on broad-spectrum or culture-specific antibiotic therapy combined, whenever possible, with percutaneous drainage of the infectious cavity or aneurismal sac followed by irrigation with saline and antibiotic solutions. New techniques of percutaneous drainage under CT scan guidance can allow expedite collection of fluid material for microbial culture or fluid drainage, catheter positioning to collect infectious material from the cavity and perform irrigation of the infected field or injection of iodine contrast when the suspicion of aortoenteric fistula exists
Urgent Mechanical Thrombectomy by Indigo System® in Acute Thrombosed Popliteal Artery Aneurysms: A Report of Two Cases
No full textThe aim of this study is to report the outcome of immediate and direct revascularization by mechanical thrombectomy in acute limb ischemia due to thrombosed popliteal artery aneurysm (PAA). Two patients with acute limb ischemia due to PAA thrombosis were admitted at our hospital, and immediately treated by mechanical thrombectomy (Indigo System). The first patient had a complete recanalization after thrombectomy, while the second one required urokinase infusion (12 hr) due to a suboptimal result. After revascularization, both patients were treated by a polytetrafluoroethylene bypass to definitively exclude PAA. Follow-up showed the patency of the femoropopliteal bypass with good distal outflow. In these 2 reported cases, the Indigo System (R) has proven to be safe and effective, allowing an immediate limb reperfusion, reducing the necessity for thrombolytic drug infusion
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