1,721,030 research outputs found
The effect of manufacturer's instructions for use compliance on Cook ZBIS iliac-branched endograft long term outcomes
No full textCurrent guidelines indicate iliac branched endografts as the ideal means to preserve pelvic perfusion during endovascular aortic repair. Since patient vascular anatomy represents the main limitation to extensive use of these devices, off-label application may be considered to expand the number of patients being treated. Aim of this study is to evaluate long-term outcomes obtained using the Cook ZBIS endograft in the treatment of aorto-iliac aneurysms according to or outside manufacturer's instruction for use
Results of aberrant right subclavian artery aneurysm repair
No full textObjective: The objective of this multicenter registry was to review current treatments and late results of repair of aneurysm of aberrant right subclavian artery (AARSA).Methods: All consecutive AARSA repairs from 2006 to 2013 in seven centers were reviewed. End points were 30-day and late mortality, reintervention rate, and AARSA-related death.Results: Twenty-one AARSA repairs were included (57% men; mean age, 67 years); 3 ruptures (14%) required emergent treatment; 12 (57%) were symptomatic for dysphagia (33%), dysphonia (24%), or pain (19%). Eight cases (38%) presented with thoracic aortic aneurysm, two with intramural hematoma, and one with acute type B aortic dissection. Mean AARSA diameter was 4.2 cm; a single bicarotid common trunk was present in 38% of cases. The majority of patients underwent hybrid intervention (n=15; 71%) consisting of single (n=2) or bilateral (n=12) subclavian to carotid transposition or bypass or ascending aorta to subclavian bypass (n=1) plus thoracic endovascular aortic repair (TEVAR); 19% of cases underwent open repair and 9% simple TEVAR with AARSA overstenting. Perioperative death occurred in two patients (9%): in one case after TEVAR in ruptured AARSA, requiring secondary sternotomy and aortic banding; and in an elective case due to multiorgan failure after a hybrid procedure. Median follow-up was 30 (interquartile range, 15-46) months. The Kaplan-Meier estimate of survival at 36 months was 90% (standard error, 0.64). Late AARSA-related death in one case was due to AARSA-esophageal fistula presenting with continuing backflow from distal AARSA and previous TEVAR. At computed tomography controls, one type I endoleak and one type II endoleak were detected; the latter required reintervention by aneurysm wrapping and ligature of collaterals. AARSA-related death was more frequent after TEVAR, a procedure reserved for ruptures, compared with elective open or hybrid repair.Conclusions: Hybrid repair is the preferred therapeutic option for patients presenting with AARSA. Midterm results show high rates of clinical success with low risk of reintervention. Simple endografting presents high risk of related death; these findings underline the importance of achieving complete sealing to avoid treatment failures
Results From the Pararenal Aneurysm Chimney Endovascular Repair (PACE), an Italian Multicenter Study
No full textObjectives
This study evaluated the safety and efficacy of endovascular aortic repair (EVAR) plus adjunctive chimney technique in the treatment of pararenal abdominal aortic aneurysm using a single model of abdominal device in a real-world experience.Methods
Data on all consecutive patients treated in 14 different Italian centers over a 7-year period (2007-2014) were collected. To ensure homogeneity, only procedures performed with one single model of graft, the Gore Excluder AAA Endoprosthesis (W. L. Gore, Flagstaff, Ariz) bifurcated endograft were included. Preoperative and postoperative CT scans of all patients were evaluated by a dedicated core laboratory blinded to clinical data.
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Results
During the study period, 52 patients underwent EVAR with chimney technique. In 40.3% of cases, surgery was conducted in an urgent setting (19 symptomatic patients and 2 ruptured aortic aneurysms). Mean aneurysm diameter at the time of intervention was 60.4 ± 12.8 mm. Procedures were performed under local anesthesia in 23 cases (44.2%). Total number of chimney stents was 75 (1.4/patient), and mean contrast media use was 178 ± 90 mL. Technical success was achieved in 88.5%, the remaining cases accounting for 2 intraoperative renal artery occlusions and 4 type I proximal endoleaks; 3 of these disappeared at 30-day CT control. Six reinterventions were performed within 30 days, 2 surgical corrections of groin hematoma, 2 type II endoleak embolizations, 1 type I endoleak correction (coiling and glue embolization), and 1 bilateral renal artery fibrinolysis. Furthermore, 1 patient underwent bowel resection for infarction. Two patients died perioperatively, 1 of myocardial infarction and 1 of multiorgan failure, both deaths on postoperative day 11. At a mean follow-up of 18.2 months 3 late reintervention were needed, 1 for a late renal occlusion and the other 2 for correction of type II endoleak. No late conversions or late aneurysm-related deaths were recorded.
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Conclusions
The chimney technique may represent a safe and effective technique in the treatment of pararenal aneurysms when used in a suitable anatomy, even in urgent settings. Low risk of visceral occlusion may be achieved with a fully covered abdominal endograft and single or double chimney stents
Plaque debulking for femoro-popliteal occlusions: techniques and results
No full textAlthough currently there is a trend of using percutaneous transluminal angioplasty (PTA) and stenting for the treatment of long occlusions of superficial femoral artery, many studies reported comparable results in terms of mid- and long-term patency between PTA and stenting and plaque debulking techniques such as remote endarterectomy, directional atherectomy catheter atherectomy and laser guided atherectomy. A successful debulking procedure is strongly associated with patients comorbidities, length of lesions and clinical presentation. In the last decade many new devices have been proposed to improve debulking results. Despite encouraging data about technical feasibility and limb salvage rate, debulking is still associated with a low rate of long-term primary and secondary patency. However, randomized clinical trials are expected and can hopefully provide conclusions on the effective durability of these procedures
A technical review of bail-out procedures to place Najuta stent-graft into the ascending aorta
Full text linkBackgroundThe Najuta stent-graft (Kawasumi Laboratories Inc., Tokyo, Japan) is usually easily advanced to the correct deployment position in the ascending aorta thanks to the pre-curved delivery J-sheath with all fenestrations automatically oriented towards the supra-aortic vessels. Aortic arch anatomy and delivery system stiffness could however represent limitations for proper endograft advancement, especially when the aortic arch bends sharply. The aim of this technical note is to report a series of bail-out procedures that could be useful to overcome the difficulties encountered during the Najuta stent-graft advancement up to the ascending aorta.Main bodyThe insertion, positioning and deployment of a Najuta stent-graft requires a through-and-through guidewire technique using a .035 '' 400 cm hydrophilic nitinol guidewire (Radifocus (TM) Guidewire M Non-Vascular, Terumo Corporation, Tokyo, Japan) with right brachial and both femoral accesses. When standard maneuver to put the endograft tip into the aortic arch, some bail-out procedures can be applied to obtain proper positioning. Five techniques are described into the text: positioning of a coaxial extra-stiff guidewire; positioning of a long introducer sheath down to the aortic root from the right brachial access; inflation of a balloon inside the ostia of the supra-aortic vessels; inflation of a balloon inside the aortic arch (coaxial to the device); and transapical access technique. This is a troubleshooting guide for allowing physicians to overcome various difficulties with the Najuta endograft as well as for other similar devices.Short conclusionTechnical issues in advancing the delivery system of Najuta stent-graft could occur. Therefore, the rescue procedures described in this technical note could be useful to guarantee the correct positioning and deployment of the stent-graft
Bilateral Staged Computed Tomography-Guided Gluteal Artery Puncture for Internal Iliac Embolization in a Patient with Type II Endoleak
No full textRepair of isolated iliac aneurysm with stent-graft implantation and internal iliac coverage may induce significant type II endoleak from patent internal iliac refilling leading to ongoing aneurysm growth. Subsequent treatment of such complication can be challenging especially in case of bilateral iliac involvement. Open repair is technically demanding and often a high risk procedure, while embolization via transfemoral approach is unviable due to the stent-graft coverage precluding direct antegrade access between the common and the internal iliac lumen. Percutaneous retrograde embolization from superior gluteal artery is a feasible technique in case of impossible access through the origin of internal iliac artery
Complications after endovascular treatment of extensive iliac artery disease
No full textThe main topic of the 2011 EVC textbook focuses on the prevention of complications and, when occurring, on their best management.
The Authors extensively discuss carotid artery interventions, prevention and treatment of cerebral ischemia during carotid endarterectomy and stenting, as well as management of post-procedural infection, arterial occlusion and restenosis. In open and endovascular aortic repair the Authors highlight practical issues including groin complications, difficult vascular access, case-planning, neurological complications, surveillance protocols, hybrid interventions, graft infection and burdensome anatomical issues in aortic access. The chapters dealing with peripheral arterial disease focus on prevention and treatment of problems after extensive iliac, superficial femoral and popliteal artery disease interventions. New exciting developments in extreme distal recanalization, drug-eluting stents and balloons, microsurgical extremity reconstruction and wound management are discussed and described in detail. Finally, the Authors present the new and modern technique of e-learning for the vascular specialist.
Contents
Prevention and treatment of cerebral ischemia during carotid endarterectomy
Prevention and treatment of cerebral ischemia during carotid artery stenting
Management of restenosis after carotid artery stenting and carotid endarterectomy
Complications after carotid revascularization
How to avoid and manage groin complications after endovascular repair
Difficult access for endovascular aortic aneurysm repair
Case planning for endovascular aortic repair with 3D workstations
Prevention and management of neurological complications of thoracic endografting
Late complications following EVAR: surveillance protocols and management
Retrograde visceral bypass for hybrid treatment of thoraco-abdominal aortic aneurysms
Dealing with vascular graft infection, including aortic enteric fistulas
Dealing with complications of open aortic surgery: access to the suprarenal aorta
Customized aortic repair: a novel endovascular treatment concept for aortic aneurysms
Complications after endovascular treatment of extensive iliac artery disease
Prevention and management of superficial femoral artery restenosis
Complications after open treatment of extensive femoropopliteal disease
Drug-coated balloons: clinical data and new developments
Below-the-knee endovascular procedures and strategies to improve early and late outcome
Differential indications for autologous bypasses in microsurgical extremity reconstruction
The modern role of primary and secondary amputation
Management of the diabetic angiopathic wound
Organization of modern wound management
e-Learning for the vascular specialis
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
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