1,721,195 research outputs found
Diagnostica avanzata e accessi endovascolari
No full textVolume cartonato di 576 pagine con 667 figure in nero e a colori e 74 tabelle - Questo volume intende offrire un supporto ampio e di rapida consultazione della diagnostica utile e appropriata per affrontare le procedure endoluminali secondo le più attuali conoscenze offerte dalle diverse discipline coinvolte. Per un intervenzionista che sia Chirurgo vascolare, Cardiologo o Radiologo già introdotto alle procedure oppure per chi desidera avvicinarsi a questa importante disciplina, il volume "Diagnostica avanzata e accessi endovascolari" assolve pienamente all'obiettivo di fornire una adeguata diagnostica prima e durante una procedura endoluminale o endovascolare. Il testo accosta alla diagnostica di secondo livello per le procedure endovascolari anche le informazioni necessarie per un buon approccio ai vasi con aghi, guide, cateteri ecc. proprio allo scopo di dimostrare che le procedure devono seguire a una buona diagnostica che, a sua volta, è la base di una buona clinica
Endovascular occlusion of an aortic coarctation after thoracic endovascular aortic repair of an anastomotic aneurysm
Full text linkA 58-year-old man with a history of aortic and mitral mechanical valve replacement was referred to our hospital for symptomatic chronic heart failure. In 1988, he had undergone open surgical correction of an isthmic aortic coarctation (CoA), with the creation of an extra-anatomic bypass from the left subclavian artery to the descending thoracic aorta. The following findings were found: severe mitral valve failure with perivalvular leakage, severe aortic valve stenosis, pulmonary hypertension, distal anastomotic aneurysm with the apparent occlusion of the CoA. A thoracic endovascular aneurysm repair was performed. A postoperative high-pressure leak with no evident signs of ineffective sealing was observed. Computed tomography angiography (CTA) 3D reconstruction demonstrated the recanalization of the CoA. A second procedure was planned. The CoA was anterogradely cannulated. Three coils were deployed into the aneurysmal sac, followed by a vascular plug, positioned on the coarctation conduit, but it failed to anchor and dislocated into the sac. A second plug was deployed, but it also partially dislocated. Finally, a patent foramen ovale occluder device was deployed to occlude the communication. The final angiogram showed the complete occlusion of the coarctation and correction of the leak, which was confirmed by a 6-month post-operative CTA
Controllo dopo endoprotesi dell'aorta toracica
No full textLa Società Italiana di Diagnostica Vascolare (SIDV) è una società scientifico-professionale e come tale promuove la ricerca, e ne divulga i risultati, nel proprio campo di competenza, ma è anche coinvolta ed attiva nelle iniziative didattiche di aggiornamento e nel processo di armonizzazione e accreditamento delle procedure diagnostiche e dei professionisti che le eseguono. In quest’ottica si è ritenuto che fosse un dovere istituzionale l’elaborazione e la pubblicazione di un testo di “Diagnostica Vascolare Ultrasonografica” che contenesse, in forma snella ma non superficiale, tutte le informazioni essenziali in questo campo complesso. In questo testo di “vascolare multidisciplinare” che tratta la diagnostica delle malattie vascolari in un’ottica globale e non secondo prospettive settoriali; i vari capitoli riflettono le linee guida per l’esecuzione e la refertazione degli esami vascolari ultrasonografici già pubblicate nel passato. Questo libro è rivolto agli Specialisti di Discipline Vascolari ed agli Specializzandi, ma anche a tutti coloro che sono interessati e coinvolti nella Diagnostica Vascolare. In altre parole è rivolto e dedicato a tutti i Professionisti che, per coinvolgimento assistenziale quotidiano, per motivi di ricerca, per programmazione socio-sanitaria o per mera curiosità intellettuale, desiderano approfondire queste problematiche servendosi di un libro di facile consultazione
Acute limb ischemia in COVID-19 patients: Could aortic floating thrombus be the source of embolic complications?
No full textBellosta et al1 recently demonstrated a significantly higher incidence of acute limb ischemia (ALI) in COVID-19 patients. In addition, an increased failure rate after revascularization occurred. The colleagues must be complemented for their clinical and scientific com- mitments. The increased thromboembolic complica- tions in COVID-19 patients have been reported even in those receiving anticoagulant therapy and in nonathero- sclerotic patients.1-3 More than 27,000 COVID-19 cases were registered in our region (Emilia-Romagna). Our unit represents the unique vascular surgery service in the province of Modena. As a tertiary COVID center, we did not observe ALI in such patients. It must be taken into account that Bellosta et al1 provide care in an Italian region with a higher incidence of COVID-19 (Lombardia). However, this difference of incidence in northern Italy remains unclear. We observed two COVID-19 patients with concomitant pulmonary embolism (PE) and aortic floating thrombus (AFT; Fig). They were asymptomatic for peripheral embolism and without a source for the PE. Because of the PE, anticoagulant therapy and low- dose antiplatelet therapy were initiated. A significant reduction of the AFT was observed with resolution of the PE in both patients. The AFT is a rare but serious clin- ical condition able to cause dramatic peripheral embo- lism.4 Aortic stent implantation, abnormal coagulation function, and aortic diseases were reported as predictors of AFT.4 Medical therapy was proposed as the treatment of choice in asymptomatic AFT patients.4 Following the plethora of procoagulant modifications described in COVID-19 patients and the above-mentioned trends to intrastent thrombus relapse, we preferred to avoid inva- sive procedures.4,5
Indeed, the AFT may be a more common source of ALI in COVID-19.
The preoperative workup reported by Bellosta et al1 did not include thoracic computed tomography (CT) angiog- raphy. COVID-19 patients are usually diagnosed by
means of CT scans, and our observations were possible thanks to the use of contrast medium.
Finally, thoracoabdominal CT angiography should be considered a routine evaluation in COVID-19 patients presenting with embolic complications.
Clearly, further investigations are required: the throm- botic mechanism; the type, dose, and duration of the anti- coagulant therapy; and the indications for and timing of surgical management of thrombus and emboli.1-3,
Anatomical Feasibility of an Off-the-shelf Single-Renal Scalloped Stent-Graft for Hostile Neck Abdominal Aortic Aneurysm: A Preclinical Study
No full textObjectives: To evaluate the feasibility of a standardized single-renal scallop stent-graft. Design: Preclinical, single-center, real-world, all-comers, retrospective cohort study. Methods: A total of 1347 abdominal aortic aneurysm (AAA) repairs (endovascular and open) performed between 2010 and 2020 were screened for elective treatment and retrievable preoperative high-quality computed tomography angiography (CTA) performed <6 months of the surgical procedure. Six hundred of the included CTAs involved prespecified measurements and a morphological assessment protocol (NCT05150873). The proximal sealing zones suitable for standard stent-graft implantations were further analyzed (N=547). The primary outcome assessed the feasibility of 2 single-renal scallop designs (10×10 mm and 15×10 mm, height × width). The feasibility was the inter-renal length ≥10 mm and ≥15 mm for prototypes #10 and #15, respectively. The secondary outcome quantified hypothetical length and surface improvements comparing those suitable for investigational devices implantation (study group) versus those not (control group). Results: Of the total, 24.7% (n=135) was feasible with prototype #10. The study versus control group sealing zones were shorter (p=0.008), with a smaller surface (p=0.009) and a higher alpha angle (p=0.039). The length and surface area increased by about 25% and 23%, respectively, (both p<0.001) within the study group and became significantly better versus the control group (standard stent-graft; both p<0.001). Of the total, 7.1% (n=39) was suitable for prototype #15. The study versus control group sealing zones were shorter (p=0.148), with a smaller surface (p=0.077) and a higher alpha angle (p=0.027). The length and surface area increased by about 34% and 31%, respectively, (both p<0.001) within the study group and became significantly higher versus the control group (standard stent-graft; both p<0.001). Conclusions: The use of single-renal scalloped stent-graft might be feasible in a considerable number of AAA patients. The breakthrough stands in treating hostile AAAs presenting in mismatched renal arteries, keeping the complexity of the repair as similar as possible to standard endovascular repair with a remarkable improvement in sealing. Clinical Impact: The anatomic feasibility of a single renal stent graft for the treatment of “hostile” abdominal aortic aneurysm (AAA) with mismatched renal arteries was evaluated. The experimental device could be feasible in a considerable number of patients with AAA, approaching 25%, and demonstrate significant improvements in sealing. As far as we know, this is the first paper to report the prevalence of mismatched renal arteries in a large cohort of AAA patients in the real world, while proposing a dedicated device. The breakthrough is to keep the complexity of the repair as close as possible to standard endovascular repair
The anatomical fixation concept
No full textSince the 1990s, when EVAR was born, a continuous technological evolution of the materials has been eitnessed, as well as their improvement, in order to achieve higher performing endografts in terms of precise release, safer deployment and smaller-profile deliveries with the aim to tackle more and more complex iliac accesses. Following the EVAR evolution, the unimodular bifurcated endoprosthesis Endologix Powerlink, was the first to introduce the “anatomical fixation” concept. The latest version of this endograft is called AFX2. This device is simpler to deploy and, in the USA, it has been certified for percutaneous implant. This was possible thanks to the cooperation of the Italian Vascular Surgeons. Those who became familiar with this endograft have improved its indications, even in extreme cases such as the treatment of broken abdominal aortic aneurysms, complex anatomies for less suitable accesses, tight aortic carrefours and hostile proximal necks. This is a reference book written by expert vascular surgeons for fellow surgeons and students interested in extending their knoeledge in EVAR treatment
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