1,721,036 research outputs found
Re “Determination of Optimal and Safest Proximal Sealing Length During Thoracic Endovascular Aortic Repair”
No full textJuxtarenal Aortic Aneurysm: Are We Ready for a Randomised Trial on Open versus Endovascular Repair? Commentary on “Durability of Open Repair of Juxtarenal Abdominal Aortic Aneurysms. A Multicentre Retrospective Study in Five French Academic Centres”
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The Viabahn balloon expandable stent for endovascular reconstruction of the infrarenal aorta and its bifurcation in cases of severe obstructive disease
No full textIntroduction: The covered endovascular reconstruction of the aortic bifurcation (CERAB) represents a promising technique for the treatment obstructive lesions involving the aortic bifurcation. The aim of this report is to describe the use of a new generation balloon-expandable stent-graft (Viabahn VBX, W.L. Gore&Associates, AZ, USA), in the CERAB configuration for the treatment of aorto-iliac obstructive lesions involving the infrarenal aorta and bifurcation. Technical note: This technique was adopted in two patients with severe aorto-iliac obstructive lesions. After bilateral iliac recanalization, an 11 mm diameter VBX stent was deployed in the infrarenal aorta; a post-dilatation up to 16 mm with a non-compliant balloon was performed to adapt the proximal edge of the stent to the aortic diameter. Two 8 mm diameter VBX stents were then deployed at the aortic bifurcation in a kissing conformation, overlapping with the previously positioned aortic stent for 15 mm. A post-ballooning with two kissing 12 × 20 mm compliant balloons (Powerflex Pro PTA, Cordis, CA, USA) was performed to adapt the parallel stents to the aortic cuff. A post-operative angio-CT demonstrated optimal conformability of the aortic cuff to the aortic wall, and apposition of the kissing stents to the aortic cuff. Conclusions: This preliminary experience shows that the VBX stent may allow an effective reconstruction of the aortic bifurcation; the conformability and flaring capability may allow to overcome the diameter mismatch between the aorta and the iliac arteries
Endovascular vs. open treatment of severe aortoiliac occlusive disease – outcomes of a kissing, self-expanding covered stent for reconstruction of the aortic bifurcation
No full text• The kissing stents technique represents the endovascular approach of choice to treat aortoiliac obstructive lesions involving the aortic bifurcation. • Self-expanding covered stents are flexible, conformable and available in long lengths, able to adapt to the often calcific, irregular and long atherosclerotic lesions in this area, and to prevent complications like arterial rupture and distal thromboembolism. • In our experience, the five-year primary patency rate of kissing self-expanding covered stents for the treatment of TASC C-D lesions is 90%, similar to aortobifemoral bypass, although with shorter length of hospitalisation and lower cumulative surgical complication rate. • Clinical presentation, classified as Rutherford category, was the only independent predictor of patency
Geometrical Analysis and Preliminary Results for the Endovascular Reconstruction of Aortic Bifurcation Using New-Generation Balloon-Expandable Covered Stents in the Kissing Conformation
No full textBackground: The purpose of the study is to perform a postimplantation geometrical analysis and to evaluate early and mid-term outcomes of new-generation balloon-expandable covered stents, used in the kissing conformation to treat obstructive lesions involving the aortic bifurcation. Methods: A single-center retrospective review of all patients who underwent endovascular reconstruction of the aortoiliac bifurcation for obstructive disease, with the use of Viabahn balloon expandable stents (VBX; W. L. Gore & Associates, Flagstaff, AZ) deployed in the kissing conformation, from March 2018 to June 2019 was carried out. Two same-size kissing VBXs were simultaneously deployed from the distal aorta (1.5–2 cm above the aortic bifurcation) to the common iliac arteries; a kissing post-ballooning using compliant balloons was routinely performed to flare the proximal part of the VBX, to adapt to the aortic diameter and morphology. A postoperative computed tomography (CT) angiogram was obtained for all patients for the geometrical assessment. “Precision” of deployment was measured as protrusion mismatch, intended as the longitudinal distance between the stents’ proximal ends. “Conformability” was measured as radial mismatch (area and volume of the “dead space” between the stented lumen and the aortic wall) and D-ratio (ratio of the major and minor axes in the axial view). Symmetry was measured as the ratio between the minor diameter of the 2 kissing stents at the same level. Results: Twenty-eight patients (56 limbs) underwent endovascular treatment with kissing VBXs for Trans-Atlantic Inter-Society Consensus II C (n = 10, 36%) or D (n = 18, 64%) lesions involving the aortic bifurcation. Two 8-mm diameter (“8L”) VBX stents were used in most cases (n = 32, 57%). At the postoperative CT, the mean protrusion mismatch was 0.8 ± 1.7 mm and was <5 mm in all cases. The mean radial mismatch area was 20.4 ± 10.6 mm2, and the mean radial mismatch volume was 2442 ± 182 mm3. The mean D-ratio was 1.4 ± 0.2. Early procedural and postprocedural complication rates were 4% and 0%, respectively. After 9.7 ± 4.2 months of follow-up, no cases of limb occlusion or restenosis occurred. Conclusions: The use of kissing VBX stents may represent a valid option for the treatment of obstructive lesions involving the aortic bifurcation, with excellent early and mid-term outcomes and achievement of optimal stents geometry
Endovascular TAAArepair: Current status and future challenges
Full text linkOpen surgical repair has been the gold standard for treatment of thoracoabdominal aortic aneurysms (TAAAs). Currently open surgical repair has been reserved mostly for young and fit patients with connective tissue disorders, using separate branch vessel reconstructions instead of 'island' patches, and distal perfusion instead of "clamp-and-go" technique. Endovascular repair has been gaining widespread acceptance because of its potential to significantly decrease morbidity and mortality. Several large aortic centers have developed dedicated clinical programs to advance techniques of fenestrated-branched endovascular repair (FBEVAR) using patient-specific and off-the-shelf devices, offering a minimally invasive alternative to open repair allowing treatment of increasingly older and sicker TAAA patients. In this article, we review the current technical aspects of endovascular TAAArepair and the literature of open versus endovascular outcomes of TAAArepair
Cell growth modulation of human cells irradiated in vitro with low-level laser therapy.
No full textOBJECTIVE: The aim of this study was to investigate the effects of different wavelengths and doses of laser radiation on in vitro cell proliferation. We evaluated the biological effects of low-level laser therapy (LLLT) on two human cancer cell lines: HeLa (epithelial adenocarcinoma) and TK6 (lymphoblast). Our attention was focused on the combination of the two laser emissions as it could have a synergic effect greater than the single emission applied separately.
BACKGROUND DATA: The effects of LLLT on human cells are still poorly understood and unexplained. Several cell types were found non responsive to laser bio stimulation; in other cases, only a partial activation was observed.
METHODS: A laser device was used for cell irradiation with a continuous wave diode (lambda = 808 nm), a pulsed wave diode (lambda = 905 nm), and a combined wave diodes (lambda = 808 nm + 905 nm), in the dose range of 1-60 J/cm(2).
RESULTS: The effect of the combined low-level 808-905-nm diode laser irradiation were slightly superior to those achieved with either laser alone in HeLa cells. TK6 cellular proliferation was not found to be significantly affected by any of the energy levels and varying exposure doses investigated.
CONCLUSIONS: Our results are a confirmation of previous observations carried out on human cells, where only the proliferation of slowly growing cell populations appeared to be stimulated by laser light
The Chimney/Periscope Technique as Total Endovascular Treatment of Kommerell's Diverticulum
Full text linkWe report a case of Kommerell's diverticulum (KD) treated with a total endovascular approach, maintaining supra-aortic trunk (SAT) patency. A 75 year-old female with aneurysmal KD was deemed unsuitable for open surgery. Landing zone 2 was unfeasible; therefore, we planned an endovascular approach with landing in zone 1, chimney to left subclavian artery and periscope to right subclavian artery. Postoperatively she was free from complications, with complete exclusion of KD and SAT patency at 3-year follow-up
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