1,721,052 research outputs found
Experience with the ovation endograft in abdominal aortic disease
No full textSince Parodi's initial experience in 1990, the need to have appropriate vascular access to deliver the aortic stent graft in endovascular aortic repair has always represented a main issue. The continuous search for an endograft with a smaller profile with no compromise on performance and durability of the device has brought to the production of "ultra-low profile" devices, which however still remain a therapeutic challenge. This latest generation of ultra-low profile endografts currently allows the treatment of abdominal aortic diseases in patients who have previously been excluded because of challenging aortic anatomies and small access vessels. One of these grafts is the TriVascular Ovation system (14 F). After having received the CE Mark on September 17th 2010, this endograft has been used all over the world in well selected patients with relatively challenging necks or smaller iliac vessels. The Authors report their experience with the use of this endograft, with technical tips and tricks
The challenge of gate cannulation during endovascular aortic repair : A hypothesis of simplification
No full textAim One of the technical problems which can be encountered during the endovascular repair (EVAR) of abdominal aortic aneurysms, is represented by the challenge of cannulation of the contralateral gate after the opening of the main body of the endograft, especially in case of tortuous aorta-iliac anatomy. Aim of this work is to propose a hypothesis of simplification, verifying the possibility to maximize the area available for the cannulation of the contralateral gate by simulating an oblique distal end of the leg of the most used devices, without affecting the correct sealing between the main body and the iliac extension. Methods Data about the contralateral gate of the main body of endografts most used for EVAR were analyzed. The elliptical sectional area resulting from the simulation of the oblique cut was calculating with some geometric formulas. Then the gain of “disposable area” for the cannulation of the contralateral gate was calculated as a percentage of the elliptical area resulting in maximum distal oblique cut, with respect to the nominal circular area of the base. Results The only endografts which could undergo an oblique cut without losing the sealing between the main body and the contralateral limb were the Incraft, the Treovance and the Ovation, for which it would be possible to obtain a surface gain up to 84%, 22.8% and 14.4% respectively (being 9.8% in case of Ovation with the main body 29 and 34). A simulation of oblique cut was also performed on the endografts which currently do not allow to do so without a loss of sealing, assuming to lengthen the contralateral gate of an arbitrary measure of 10 mm. In these cases, the percentage of surface gain was greater for endoprostheses which had a smaller diameter of the contralateral leg. Conclusions The oblique cut of the contralateral gate allowed a gain of the surface available for the cannulation, however it was not applicable to all models of currently available endoprostheses, unless of a loss of sealing between the main body and the contralateral iliac limb
Variability of Origin of Splanchnic and Renal Vessels From the Thoracoabdominal Aorta
No full textObjectiveTo analyze the variability of origin of the celiac trunk (CT), the superior mesenteric artery (SMA), the right renal artery (RRA), and the left renal artery (LRA) in terms of mutual distances, angle from the sagittal aortic axis (clock position), and ostial diameters on computed tomography angiographies (CTAs) in three groups of patients.MethodsOne hundred and fifty CTAs of 50 patients with a non-dilated thoracoabdominal aorta (group A), 50 with thoracoabdominal aneurysm (B), and 50 with infrarenal aneurysm (C) were reviewed. The measurements performed on CTAs, as well as the patients' age, sex, and body surface area, were analyzed. p values <.05 were considered statistically significant.ResultsThe clock position of the CT and the SMA, the diameters of all vessels, and the distance of the CT–SMA followed a Gaussian distribution. In contrast, the clock position of the renal vessels did not follow a normal distribution, and nor did the distances of the SMA–RRA, SMA–LRA, RRA–LRA or the distances between the renal arteries and the aortic bifurcation. The same values did not differ significantly among the three groups, with the exception of the distances between the renal arteries and the aortic bifurcation, significantly greater in group C. The clock position of the LRA and the distances of the SMA–LRA, SMA–RRA, RRA–LRA and between both renal arteries and the aortic bifurcation showed a significant correlation with the increase of aortic diameter.ConclusionThe anatomic variability of the origin of both the CT and the SMA in terms of clock position and mutual distances followed a Gaussian distribution, regardless of group. The same applies to the ostial diameters of renal and visceral vessels. In contrast, the origin of the renal vessels had a statistically significant heterogeneity that seemed to be correlated with the increase of aortic diameter in the mesenteric and renal aortic region
Realtà virtuale e stenting carotideo
No full textUn libro medico scientifico che descrive e rappresenta casi clinici relativi alla patologia cardiovascolare
Middle verus long-term results in EVAR: a ten-year follow-up experience
No full textAim. Endovascular repair of abdominal aortic aneurysms is a relatively new technique, with few studies about long-term results. Our aim was to find if endovascular aneurysm repair (EVAR)'s complication rates at long-term were higher than at middle-term and to define a minimal period of follow-up to consider a patient as completely recovered. Methods. From 1998 to 2003, 186 patients underwent EVAR in our center. Patients were followed-up at 1, 6, 12 months and every year. Mean follow-up period was 89 months for long-term result (range 61-121 months). We collected data about cardiac and renal complications, thrombosis, surgical conversions, endoleaks, death and death from aortic rupture. All data were analysed using Sigma Statâ 3.0. Results. We observed a significant increase of mortality rate (50.40% vs. 33.70%, P<0.05); we recorded an increase in the incidence of cardiovascular adverse events (5.80% vs. 1.80%), thrombosis of EVG (2.90% vs. 1.90%), type II (3.90% vs. 3.20%) and type III endoleaks (0.89% vs. 0.53%), but there were not any statistical significant differences. Incidence of renal failure and type I endoleak were significant lower than at middle-term. There weren't any type IV endoleaks or surgical conversion after 60 months. At 120 months 24.58% of patients were alive and free from any major adverse events and 96,87% were free from aortic rupture. Conclusion. EVAR had important complications at long-term follow-up, but their rates weren't significantly higher than those of middle-term; the incidence of late aortic rupture was acceptably low. We could not define a period of follow-up after which a patient could be considered as completely recovered
RR5. Surgical Treatment of Popliteal Aneurysms Using a Posterior Approach: Thirteen Years' Follow-up
No full textOBJECTIVES : Long-term results of posterior approach (PA) for the treatment of popliteal artery aneurysms are lacking in the literature. We compared our results with this access with those from a standard medial approach over a 13-years’ period.
METHODS: Clinical data of all patients treated for a popliteal aneurysm between 2/1998 and 10/2011 were retrospectively reviewed and outcomes analyzed: Kaplan-Meier method with log-rank, chi2 and Wilcoxon test were employed for analysis.
RESULTS : A total of 78 aneurysms were treated in 66 patients (65 men). Mean age was 68 years (range 48-96 years).
Thirty-six aneurysms were asymptomatic (46%). Mean sac diameter was 2.9±1 cm. A PA was used in 43 cases (55%) and a medial approach (MA) in 35. All PA consisted in aneurysmectomy with an interposition graft with end to end anastomoses; among MA 25 interposition grafts and 10 bypass were performed. A PTFE graft was used mostly (57 cases). The two groups differed for age only (median 65.4 for PA vs. 72.9 for MA p=0.01). Five patients had an early thrombosis and required a Fogarty thrombectomy (2 PA and 3 MA, all PTFE grafts). Mortality rate at 30 days was 0%.
One patient suffered a peroneal nerve lesion (permanent) and another one a major wound necrosis with tissue loss (both PA). There were no early amputations. Median follow-up was 58.8 months (range 5 days-166.7 months).
Nine patients died during follow-up for unrelated causes. The 5-year primary and secondary patency rates were 58.9%±8,7% and 96.4%±3.5% respectively for PA, and 67.4%±10,4% and 81.3%±8,9% respectively for MA (p=0.41 for primary patency rate and 0.28 for secondary patency rate). Limb salvage was 100% and 93.3%±6.4% at 5 and 10 years respectively for PA and 91.5%±5.6% at both time points for MA (p=0.3).
CONCLUSIONS : PA in our experience was burdened by a few more early complications compared to MA. However in the long term it provided results which compare favorably to MA.
AUTHOR DISCLOSURES: I. Barbetta, Nothing to disclose; M. Carmo, Nothing to disclose; R. Dallatana, Nothing to disclose; G. Grava, Nothing to disclose; D. Mazzaccaro, Nothing to disclose; A. M. Settembrini, Nothing to disclose; P. Settembrini, Nothing to disclose
New data and clinical results supporting the use of directional atherectomy for infrainguinal peripheral artery disease
No full textEndovascular treatment of atherosclerotic femoropopliteal lesions is increasing, primarily because peripheral artery disease is very common and tends to recur after the first procedure, secondly because new techniques are becoming available. PTA and stenting are no longer the only treatments available and although there is still no agreement on the gold standard for the treatment of infrainguinal lesions, some studies have been conducted in order to give an answer. This review takes into account recent studies and clinical data to support the use of directional atherectomy
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