86,547 research outputs found
AN UNUSUAL COMPLICATION OF OPEN AORTIC SURGERY: HEMORRHAGE DUE TO IATROGENIC RUPTURE OF A RENAL CYST
No full textSecondary Endovascular Repair of Recurring Lesions and Perioperative Complications after Open Aortic Repair: The Complementary Role of Different Technical Solutions
No full textBackground: The aim of our article was to describe the complementary role of different technical solutions for secondary endovascular repair of recurring lesions and perioperative complications after open aortic repair (OAR). Methods: We describe our clinical experience of secondary endovascular repair after OAR. We included in the analysis all consecutive patients who presented recurring lesions and perioperative complications after OAR and underwent secondary endovascular repair between January 1, 2015 and June 31, 2018. Both elective and nonelective cases were captured. Early end points were technical success, 30-day mortality, 30-day major adverse events, and 30-day vascular access complications. Late end points were survival and freedom from secondary interventions. Results: Three different techniques were used in 6 patients: 2 cases of fenestrated–branched endovascular aortic repair (F-BEVAR), 2 cases of parallel-graft EVAR (pg-EVAR), and 2 cases of off-label use of standard devices. Technical success was 100%. One patient died within 30 days from acute pulmonary embolism. One patient developed acute kidney injury not requiring renal replacement therapy, whereas the remaining 4 patients were free from 30-day major adverse events. The cumulative rate of 30-day vascular access complications was 0%. All the 5 patients who survived the index hospitalization had ≥12 months of clinical and imaging follow-up. At the longest individual follow-up, they all were alive and free from secondary interventions. Computed tomography angiography showed in all cases sustained clinical success. Conclusions: Secondary endovascular repair of recurring lesions and perioperative complications after OAR is safe and feasible and offers a minimally invasive effective treatment option when a redo surgical operation would be associated with a considerable risk to the patient. Different solutions are available (including F-BEVAR, pg-EVAR, and off-label use of standard devices) and are complementary rather than competitive. Careful preoperative assessment and familiarity with advanced techniques are essential to achieve satisfactory outcomes
Synthesis of beta-D-ManNAc containing di- and trisaccharide building-blocks for the preparation of immunogenic glycodedrimers
No full textUnassisted in-vitro simulation of superior cavo pulmonary shunt for evaluation of pathophysiological issue
No full textIn this study, a new in-vitro test bench of the bidirectional superior cavo-pulmonary connection (BCPC), which can mimic realistic conditions, was developed to provide the physician with a platform onto which to test surgical procedures outcomes by acquiring local measurements of the relevant hemodynamic quantities. Using values of resistances and compliance from literature data, a simplified lumped parameters model was designed to fit patients from 2 to 5 years. The mock loop circulation developed in this work was validated by using the in-vivo catheterization data from 20 patients.
All the parameters were first set to obtain physiological condition. Then four different dysfunctions were mimicked: diastolic dysfunction, systolic dysfunction, cavo-pulmonary intrinsic failure and a complex mix of these failures.
The measured pressure and flow rate showed an excellent correlation with the clinical catheterization data acquired in BCPC. This new in-vitro test bench can be a handy tool capable of providing better insight on how to treat these patients and which devices to employ in different clinical scenarios
Custom-Made Unibody Conical Endografts for Elective Endovascular Repair of Saccular Infrarenal Abdominal Aortic Aneurysms with Narrow Aortic Bifurcations—Novel Implementation of the Aortoaortic Concept
No full textThe aortoaortic concept for endovascular repair (EVAR) of infrarenal abdominal aortic aneurysms (AAAs) is nearly forgotten but may constitute a valuable option for focal pathologies. Herein, we describe our experience using custom-made (CM) unibody conical endografts for saccular AAAs with narrow (≤20 mm wide) aortic bifurcation (AB) in three patients. Given the narrow AB, the option for a bifurcated stent graft was reputed not optimal. Therefore, we decided to further suggest the construction of a CM unibody conical stent graft with respect to unique anatomical characteristics of the patients. Technical success rate was 100%, and computed tomography angiography at first-month follow-up showed complete sealing proximally and distally with excellent conformability of the endografts in all the cases. All the patients were free from any-type endoleak (EL) and had no evidence of any endograft-related complication (i.e., fracture, thrombosis, or migration) or required any reintervention at their longest follow-up. We conclude that in the proper anatomic setting, the use of CM unibody conical endografts for elective EVAR of saccular AAAs with narrow AB is technically feasible with excellent short-term safety regarding ELs or migration
Clinical evaluation of plaque removal by counterrotational electric toothbrush in orthodontic patients
No full textIn the present crossover clinical trial, the plaque-removing efficacy of a counterrotational toothbrush was compared to that of a normal toothbrush in orthodontic patients. Twenty subjects, aged 11 to 26 years, wh o had orthodontic brackets on all fully erupted teeth of at least one arch were selected. At the first appointment, a prophylaxis was given to bring the plaque score to 0. Ten subjects received counterrotational brushes, and 10 subjects received manual brushes according to a randomized list. At 14 days, plaque scores were recorded and another prophylaxis was given. The subjects who were using the electric brush were assigned to the manual brush and vice versa. A128 days; plaque scores were reassessed. Results showed that the counterrotational brush was significantly more effective in removing supragingivalplaque from bracketed teeth than was the manual brush. The differences in plaque-removing effectiveness were particularly consistent on the proximal surfaces of the teeth. ©..
Successful Off-Label Use of an Iliac Branch Device to Rescue an Occluded Aortofemoral Bypass Graft
No full textPurpose: To report an alternative approach for rescue of an occluded aortofemoral bypass using the Gore Excluder Iliac Branch Endoprosthesis (IBE). Case Report: A 52-year-old man presented with acute right limb ischemia because of displaced and occluded iliac stents and was treated with aortofemoral bypass. On the third postoperative day, there was early bypass failure due to distal embolization from aortic thrombus. After fluoroscopy-guided balloon thrombectomy of the bypass, an endovascular bailout strategy was used. The Gore Excluder IBE was deployed below the renal arteries (with the external iliac limb opening in the surgical prosthesis and the gate opening within the aortic lumen). After antegrade catheterization of the gate, a Gore Viabahn endoprosthesis was inserted as the bridging endograft and deployed so that it landed just above the preimplanted aortoiliac kissing stents without overlapping them. Completion angiography showed technical success without complications; results were sustained at 1-year follow-up. Conclusion: The Gore Excluder IBE may represent a versatile solution for the rescue of complex cases when open surgery would be associated with a considerable risk. This off-label application of a well-recognized endovascular device is safe and feasible and may prove useful as a valuable alternative in properly selected patients
Intraoperative rescue of a dislodged renal stent during fenestrated endovascular aortic repair for treatment of type 1A endoleak
No full textIn the past 15 years, fenestrated-branched endovascular aortic repair (F-BEVAR) has progressively become the first-line option for management of most complex abdominal aortic aneurysms (AAAs); with increasing experience, as well as persistent technological refinements, F-BEVAR indications have been expanded to include rescue of failures after prior EVAR. Despite the feasibility and effectiveness, F-BEVAR procedures in the presence of prior infrarenal endografts may come with higher technical complexity that should be properly anticipated, and several anatomical challenges can be expected. Among these, presence of suprarenal bare stents from prior EVAR device are certainly a frequent scenario and may sometimes make target vessel cannulation more difficult because of encroachment on the target vessel origins. In this manuscript, we report a case intraoperative rescue of a dislodged renal stent during FEVAR for treatment of type 1 endoleak with the aim of showing the culprit of the complication, how to recognize it, and the off-label solution that was devised to solve it
Urgent Use of Gore Excluder Iliac Branch Endoprosthesis with Left Transaxillary Approach for Preservation of the Residual Hypogastric Artery: A Case Series
No full textBackground: Preservation of the residual hypogastric artery (HGA) in patients with previous endovascular aortic aneurysm repair (EVAR) may require complex operative strategies. We report an alternative technique to preserve the residual HGA with the Gore Excluder Iliac Branch endoprosthesis (IBE) in urgent situations. Methods: We report the case of 2 high-risk patients (unfit for open surgery), with previous EVAR and exclusion of 1 HGA, treated in emergency setting. Both patients met the anatomical requirements for Gore IBE use. Due to lack of the native aortic bifurcation, we used a transaxillary approach to deploy a covered stent (Gore Viabahn) in the target HGA. Results: Technical success was 100%. Computed tomography angiography at 30 days, 6 months, and 1 year showed regular placement of all endografts and patency of all residual HGAs without evidence of any endograft-related complication (i.e., stent fracture, stent thrombosis or stent displacement). There was not any detectable type 1, 2, or 3 endoleak at longest follow-up. Conclusions: Our case series shows the technical feasibility and the good results of this approach, which may prove useful when the native aortoiliac carrefour is no longer available. The procedure seems to be safe and effective, with optimal primary patency of the stent grafts, freedom from type 1, 2, and 3 endoleaks, and absence of pelvic ischemic complications
Hybrid Treatment of a True Right Subclavian Artery Aneurysm Involving the Vertebral Artery using a Covered Stent
No full textSubclavian artery aneurysms (SAAs) are rare but potentially life- and limb-threatening. We present the case of a 69-year-old man with a true right SAA; the vertebral artery branched off the aneurysm and was the dominant one. A hybrid (combined open surgical and endovascular) repair was performed; the vertebral artery was anastomosed end to side to the common carotid artery through a right supraclavicular incision, then using a percutaneous high brachial artery access, a covered stent was deployed to exclude the SSA. The procedure was technically successful, and computed tomography angiography at 24 months showed regular placement of the endograft with blood flow within it and absence of any endograft-related complication (i.e., stent fracture/thrombosis/displacement or any-type detectable endoleak). This hybrid treatment is safe and feasible with good midterm results and may represent a valuable, less invasive alternative to conventional open surgical approaches
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