1,721,289 research outputs found
Regarding “Endovascular AAA repair with the aortomonoiliac endofit stent-graft: two years’experience”
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Percutaneous transluminal angioplasty of the popliteal artery without the use of stents: a review of 116 consecutive procedures
No full textPURPOSE: To evaluate the safety and efficacy of percutaneous transluminal angioplasty (PTA), without the use of stents, for the treatment of popliteal artery stenosis. METHODS: From March 1997 to December 2003, 116 consecutive PTAs of the popliteal artery were performed in 98 patients. All patients underwent preoperative and postoperative colour duplex scans and preoperative angiography. In all cases, the superficial femoral artery was patent and without significant stenosis. Follow-up patency was assessed by clinical examination and colour duplex scanning in all patients. RESULTS: There was no perioperative mortality. Primary patency after two years was 86% for intermittent claudication (IC) patients and 54% for critical limb ischemia (CLI) patients. Secondary patency rates were 98% for IC patients versus 92% for CLI patients after one year, 94% for IC patients versus 83% for CLI patients after two years and 69% for IC patients versus 7% for CLI patients after five years (P<0.001). CONCLUSION: Popliteal artery PTA is safe and efficient, especially in IC patients with single lesions
The use of virtual reality for carotid artery stenting (CAS) training in type I and type III aortic arches
No full textAIM: Simulation has been proposed to improve learning curves in carotid artery stenting (CAS), but previous studies have only evaluated CAS simulation in a single type of arch usually either type I or type II. The aim of our study is to define the use of virtual reality for CAS training in type I and type III aortic arches for novice operators.
MATERIALS AND METHODS: Fifty experienced interventionalists and fifty novice trainees with no prior experience with endovascular procedures performed a virtual CAS in a type I aortic arch case and one in a type III arch case. They trained on simulator for two hours and then repeated the procedures. Data of the procedures were collected and analysed.
RESULTS: Among novice operators, 38 out of 50 ended the first procedure on type I arch (76%) and 32% (16 out of
50) concluded the first procedure on type III arch (p < .05). After training, 100% of novice ended the easy case and 56% (28 out of 50) concluded the difficult case (p < .05). All experienced operators successfully carried out the simulations.
The simulator induced greater improvement among novice in type I arch rather than in type III arch. Performances of experienced didn’t improve significantly. Among novice, virtual performances of “difficult” cases were significantly worse
than those of “easy” cases, both before and after training.
CONCLUSIONS: Simulator is an effective tool for training of novice operators in type I aortic arch; on the contrary its role has yet to be established in type III aortic arch
Ischemia with endovascular balloon during disarticulations and amputations of limbs
Full text linkObjective Limb disarticulation has been widely performed since the
18th century, especially in war surgery. Actually is infrequently done
in orthopaedic and vascular surgery, and it is associated with a high
mortality rate because of frequent comorbidities. Disarticulation
usually is reserved for patients with malignant tumours or gangrene
from severe artherosclerosis. During disarticulation, hemodynamic
stability can be altered by hemorrhagic events in the femoral or
humeral arteries. We propose an endovascular technique for proximal
control of the artery to reduce blood loss during disarticulation. Our
experience today is limited at hip disarticulation.
Material and methods The vascular access was percutaneous at the
common femoral artery of the healthy limb. A 6 French (Fr) introducer
sheath was placed using the Seldinger technique. Under
fluoroscopic control, with a portable vascular C-arm capable of digitally
subtracter angiogram and roadmap angiography, a 0.035 inch
hydrophilic guide wire was crossed aver into the opposite side iliac
artery through a 5F contra angiographic catheter placed at the aortic
bifurcation. After a diagnostic angiography the guide wire was
replaced with an Amplatz 0.0035 inch, 260 cm long, super stiff guide
wire. Then, a 7 9 20 mm Ultra-thinTM SDS balloon catheter was
placed in the external iliac artery and systemic heparinization with
2500 UI was performed. The balloon catheter was inflated and femoral
pulsation ceased immediately. After proximal, endovascular
occlusion, hip disarticulation was accomplished without any hemorrhagic
complication. At the end of procedure, the balloon was deflated
and removed. Hemostasis of the surgical field completed the procedure.
The femoral access in the healthy common femoral artery was
controlled with a 6 Fr Angio-seal percutaneous hemostatic system.
Results and discussion In hip disarticulation, hemostatic tourniquets
cannot be used of the location of the operating field. Therefore,
control of bleeding is a major issue in this procedure. Various techniques
have been proposed, femoral vessels and nerves were attached before the disarticulation. The use of semi-compliant balloon catheters
for endovascular occlusion avoids injury to the endothelium of
the vessel wall during balloon inflation. However preoperative
assessment, with color-duplex scanning and plain abdominal radiographs,
is mandatory; coexisting atherosclerosis often is present
especially in elderly patients, and severe wall calcification can lead to
vessel rupture and retroperitoneal hematoma, or even balloon catheter
rupture. Moreover, color-duplex scanning and radiographs will help
in choosing the landing-zone for balloon inflation.
Conclusions Endovascular balloon assistance is a simple, safe and
effective technique in preventing major arterial bleeding during
amputation or disarticulation and can be routinely used
Balloon angioplasty or nitinol stents for peripheral-artery disease
No full textSchillinger et al. (May 4 issue)1 demonstrated the superiority of primary stenting with nitinol stents, as compared with balloon angioplasty, in patients with peripheral-artery disease. However, the findings raise an issue with regard to the treatment of restenosis. Endovascular treatment usually represents the second treatment option, after medical therapy and before final surgical revascularization. Restenosis of the target vessel after balloon angioplasty can be treated initially with repeated balloon angioplasty and, in subsequent recurrences, with stenting. In the meantime, the patient has months or years of freedom from symptoms without being treated with stents. In contrast, the reimplantation of a stent to treat restenosis after stenting is much more problematic, and the patient is more likely to require surgical revascularization. Patients with peripheral-artery disease should be offered therapeutic alternatives that will delay irreversible complications as long as possible. Even if balloon angioplasty is a less durable treatment option than nitinol stenting, we believe that it should be considered as the first step in the endovascular management of the disease
Comparison between unibody and two body rectal endograft in patients with abdominal aortic aneurysms: a prospective, multicentric, controlled study
No full textExperience 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
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