1,721,256 research outputs found
Clinical use of extra-large self-expanding stents
No full textThe aim of this study is to describe our clinical experience with an extra-large self-expandable stent specifically designed to treat aortic lesions (E-XL, Jotec GmbH, Hechingen, Germany), now commercially available in Europe. The E-XL was used at our Institution in 14 patients (mean age, 56 12 years; 9 males) with the following indications: improve proximal fixation (4 cases), type I endoleak (2 cases), aortic dissection with static malperfusion (1 case) and dynamic malperfusion (7 cases). Early results have been shown to be safe and effective in different clinical settings, including in emergency cases. This peculiar aortic stent could be useful in the armamentarium of the endovascular surgeon. OI tshomba, yamume/0000-0001-8316-4702; Bertoglio, Luca/0000-0001-6871-217
The Bolton Treovance endograft: single center experience
No full textAim. In the last two decades, results of endovascular aortic repair (EVAR) for the treatment of infrarenal abdominal aortic aneurysms (AAAs) have significantly improved thanks to the evolution of stent-grafts and endovascular delivery systems. However, further development is still needed to reduce the incidence of complications and secondary reinterventions. We present our initial experience with the Treovance abdominal aortic stent-graft (Bolton Medical, Barcelona, Spain), a new-generation trimodular endovascular device, developed to increase flexibility, lower profile, improve deployment and sealing mechanisms. Methods. We treated 8 patients with anatomically suitable non-ruptured AAA. Results. Primary technical success was obtained in all patients, and no 30-day device-related complications nor deaths were reported. One patient experienced graft limb occlusion at 3 months, and underwent surgical conversion. At 1-year follow-up (completed in 6 patients), no device-related complications nor type I or III endoleak were observed. Conclusion. Initial personal experience with the Treovance abdominal stent-graft was satisfactory with regard to technical success and short-term clinical results. This new-generation endovascular device performed well even in angulated or heavily calcified anatomies. OI tshomba, yamume/0000-0001-8316-470
Initial clinical experience with a new low-profile thoracic endograft
No full textBackground: The Zenith Alpha thoracic endograft (William Cook Europe, ApS, Bjaeverskov, Denmark) is a new low-profile thoracic endograft that has recently become commercially available in Europe. The reduced profile offers potential benefits and extended applicability, especially in patients with small or diseased iliofemoral vessels. The aim of this study was to evaluate the safety and efficacy of thoracic endovascular aortic repair performed with the new Zenith Alpha thoracic endograft. Methods: From November 2013 to the present, Zenith Alpha thoracic stent grafts have been employed to treat 42 patients (31 men; median age, 71 years; range, 54-83 years) suffering from descending thoracic aortic disease: 34 degenerative aneurysms, 4 aortic ulcers, 2 false aneurysms following prior thoracic open repair, and 2 traumatic blunt injuries. The mean proximal neck length was 25 mm (range, 17-40 mm), with a mean access vessel diameter of 6.7 mm (range, 611 mm). In 11 cases, aortoiliac occlusive disease (TransAtlantic Inter-Society Consensus type B and C lesions) was present. The proximal landing was in zone 1 in 2 cases, in zone 2 in 25 cases, in zone 3 in 11 cases, and in zone 4 in 4 cases. Results: Fifty-one endografts (45 proximal components and 6 distal components) were deployed in 42 patients. The endografts were deployed safely and effectively from one surgical femoral access site in all cases. In patients with associated aortoiliac disease, no adjunctive procedures for device insertion, except for predilation with balloon angioplasty in two cases, were required. No major complications related to the devices were observed in any of the patients during the postoperative course, and there was no perioperative mortality, paraparesis, or paraplegia. At 30 days, morbid events included one case of major stroke, two cases of transient acute renal failure, and one case of postimplantation syndrome. No access-related complications were recorded. Computed tomography performed within 6 months was obtained in 39 patients and confirmed 100% clinical success without device-related complications. No type I endoleaks or bird's beak effects were documented. Conclusions: Our early experience shows that deployment of the new Zenith Alpha endograft from a surgical femoral access is safe and effective in treating thoracic aortic aneurysms, aortic ulcers, and traumatic blunt injuries, even in patients with small or diseased access vessels. Endograft conformance to the aorta and exclusion of the aneurysm were satisfactory. Long-term durability remains to be evaluated. OI tshomba, yamume/0000-0001-8316-470
Delayed Open Conversion after Endovascular Abdominal Aortic Aneurysm: Device-specific Surgical Approach
No full textObjectives: Despite several advances in endoluminal salvage for failed endovascular abdominal aortic repair (EVAR), in our experience an increasing number of cases necessitate delayed open conversion (dOC). Methods: EVAR patients requiring delayed (>30 days) conversion were prospectively collected in a computerized database including demographics, details of aortoiliac anatomy, procedural and clinical success, and postoperative complications. Results: Between 2005 and 2011, 54 patients were treated for aortic stent-graft explantation. Indications included 34 type I and III endoleaks, 13 type II endoleaks with aneurysm growth, 4 cases of material failures, and 3 stent-graft infections. All fit-for-surgery patients with type I/III endoleak underwent directly dOC. Different surgical approaches were used depending on the type of stent-graft. Overall 30-day mortality was 1.9%. Overall morbidity was 31% mainly due to acute renal failure (13 cases). Mean hospitalization was 6 days (range, 5-27 days). Overall survival at mean follow-up of 19 months was 78%. Conclusions: In recent years, the use of EVAR has increased dramatically, including in young patients regardless of their fitness for open repair. dOC after endovascular abdominal aortic aneurysm seems to be a lifesaving procedure with satisfactory initial and mid-term results. (C) 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. OI tshomba, yamume/0000-0001-8316-4702; Bertoglio, Luca/0000-0001-6871-217
Initial clinical experience with a new low-profile thoracic endograft
No full textBackground The Zenith Alpha thoracic endograft (William Cook Europe, ApS, Bjaeverskov, Denmark) is a new low-profile thoracic endograft that has recently become commercially available in Europe. The reduced profile offers potential benefits and extended applicability, especially in patients with small or diseased iliofemoral vessels. The aim of this study was to evaluate the safety and efficacy of thoracic endovascular aortic repair performed with the new Zenith Alpha thoracic endograft. Methods From November 2013 to the present, Zenith Alpha thoracic stent grafts have been employed to treat 42 patients (31 men; median age, 71 years; range, 54-83 years) suffering from descending thoracic aortic disease: 34 degenerative aneurysms, 4 aortic ulcers, 2 false aneurysms following prior thoracic open repair, and 2 traumatic blunt injuries. The mean proximal neck length was 25 mm (range, 17-40 mm), with a mean access vessel diameter of 6.7 mm (range, 6-11 mm). In 11 cases, aortoiliac occlusive disease (TransAtlantic Inter-Society Consensus type B and C lesions) was present. The proximal landing was in zone 1 in 2 cases, in zone 2 in 25 cases, in zone 3 in 11 cases, and in zone 4 in 4 cases. Results Fifty-one endografts (45 proximal components and 6 distal components) were deployed in 42 patients. The endografts were deployed safely and effectively from one surgical femoral access site in all cases. In patients with associated aortoiliac disease, no adjunctive procedures for device insertion, except for predilation with balloon angioplasty in two cases, were required. No major complications related to the devices were observed in any of the patients during the postoperative course, and there was no perioperative mortality, paraparesis, or paraplegia. At 30 days, morbid events included one case of major stroke, two cases of transient acute renal failure, and one case of postimplantation syndrome. No access-related complications were recorded. Computed tomography performed within 6 months was obtained in 39 patients and confirmed 100% clinical success without device-related complications. No type I endoleaks or bird's beak effects were documented. Conclusions Our early experience shows that deployment of the new Zenith Alpha endograft from a surgical femoral access is safe and effective in treating thoracic aortic aneurysms, aortic ulcers, and traumatic blunt injuries, even in patients with small or diseased access vessels. Endograft conformance to the aorta and exclusion of the aneurysm were satisfactory. Long-term durability remains to be evaluated
Priorities of biomedical research
No full textIn their article published in this issue of the IJC, Lee and colleagues report the results of an interesting international survey conducted in order to reveal perceived priorities for research in small aortic
abdominal aneurysm (AAA) among the community of vascular surgeons. Among 10 proposed research topics on AAA, the study cohort of 277 vascular surgeons designated ‘new tests to predict an AAA will be fast growing’ and ‘new medications that will stop an AAA from growing further’ as the two most urgent priorities
Endovascular therapies for aorto-iliac and femoro-popliteal arterial disease: Buridan's ass and the journey towards patient-tailored plaque therapy (PTPT)
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Comparison of Open and Endovascular Surgery for the Treatment of the Infections of the Thoracic Aorta
No full textObjectives: The purpose of the study was to compare the results of open and endovascular treatment for the infections of the thoracic aorta. Materials and Methods: Between 1993 and 2015, 1516
patients were treated in our institution for diseases of the thoracic and thoraco-abdominal aorta, including 49 for infection at the thoracic level. Twenty-six primitive mycotic aneurysms, 13 cases of infected thoracic aortic grafts and 10 cases of infected thoracic stentgrafts were operated. In this group a fistula with the esophagus and/or the bronchial tree was observed in 24 cases (49%). Results: In the group of the patients treated for mycotic aneurysm, 16 (61%) had an open surgical treatment with the replacement of the thoracic aorta with a silver impregnated prosthesis. In this group five procedures associated an esophageal repair and one pulmonary lobectomy were necessary. Peroperative mortality was 19% (three patients). The other ten patients (39%) were treated with ndovascular treatment (TEVAR) with antibiotic impregnated stentgrafts. In this group technical success was 100% in absence of perioperative deaths. After an average follow-up of 84±20 months, mortality was 25% (four patients) after open treatment (25%) and 10% after TEVAR (one patient). In the group of the prosthetic infections open surgical treatment was carried out in 17 patients with 11 procedures of associated visceral repair. TEVAR was carried out in six cases with a procedure of associated visceral repair. Perioperative mortality after open treatment was 30% (n1⁄45); no perioperative death was observed after TEVAR. After a follow-up of 61±28 months, mortality was 53% and 50% after open surgery and TEVAR, respectively; the rate of reintervention was 6% after open surgery and 33% after TEVAR. Conclusion: The infections of the thoracic aorta present a very high mortality in the event of fistula with the esophagus and/or the bronchial tree requiring an associated surgical treatment. In our series TEVAR gave a higher survival rate for the treatment of primitive mycotic aneurysms than for the infections of surgical grafts or of stentgrafts. In the event of prosthetic infection TEVAR was associated with a higher rate of reintervention
Automated pressure-controlled cerebrospinal fluid drainage during open thoracoabdominal aortic aneurysm repair
No full textObjective Perioperative cerebrospinal fluid (CSF) drainage is a well-established technique for spinal cord protection during thoracoabdominal aortic aneurysm (TAAA) open repair and is usually performed using dripping chamber-based systems. A new automated device for controlled and continuous CSF drainage, designed to maintain CSF pressure around the desired set values, thus avoiding unnecessary drainage, is currently available. The aim of our study was to determine whether the use of the new LiquoGuard automated device (Möller Medical GmbH, Fulda, Germany) during TAAA open repair was safe and effective in maintaining the desired CSF pressure values and whether the incidence of complications was reduced compared with a standard catheter connected to a dripping chamber. Methods Data of patients who underwent surgical TAAA open repair using perioperative CSF drainage at our institution between October 2012 and October 2014 were recorded. The difference in CSF pressure values between patients who underwent CSF drainage with a conventional dripping chamber-based system (manual group) and patients who underwent CSF drainage with the LiquoGuard (automated group) was measured at the beginning of the intervention (T1), 15 minutes after aortic cross-clamping (T2), just before unclamping (T3), at the end of surgery (T4), and 4 hours after the end of surgery (T5). The choice of the draining systems was randomly alternated with one-to-one rate until the last six patients consecutively treated with LiquoGuard were enrolled. Primary outcomes were occurrence of spinal cord ischemia, intracranial hemorrhage, postdural puncture headache, and in-hospital mortality. Results The study included 152 patients who underwent open surgical TAAA repair during the study period: 73 patients underwent CSF drainage with the traditional system and 79 with LiquoGuard. The CSF pressure values at T1 and T5 were not considerably different in the two groups. By repeated-measures analysis of variance, a significant upward trend of perioperative CSF pressure was observed in the automated group at T2, T3, and T4 (group × time interaction = F3,66; P <.001). No difference was reported in the occurrence of spinal cord ischemia, intracranial hemorrhage, or mortality. The LiquoGuard group reported significantly reduced postdural puncture headache (3.3% vs 16.9%; P =.01). Conclusions Perioperative use of LiquoGuard during TAAA open repair was safe and effective. Despite slightly higher intraoperative CSF pressures, the rate of spinal cord ischemia did not increase in the LiquoGuard group, and postdural puncture headache significantly decreased
Late retrograde migration of a left subclavian artery chimney stent-graft into the innominate artery
No full textPurpose: To report an uncommon case of chimney stent-graft migration in the aortic arch. Case Report: A 29-year-old man presented with chronic left arm hyposthenia after late displacement and thrombosis of a left subclavian artery (LSA) chimney graft that migrated retrogradely into the innominate artery 2 years after deployment. The self-expanding LSA chimney was placed during a redo procedure to repair a pseudoaneurysm and type I endoleak after an index emergency thoracic endovascular aortic repair for traumatic aortic rupture 1 year earlier. The patient was successfully treated in an elective procedure via a median sternotomy, with arch aortotomy under circulatory arrest to remove the proximal end of the thrombosed chimney graft from the ostium of the innominate trunk. Three months later, a left carotid-to-subclavian bypass was performed to restore flow to the left arm. Conclusion: Migration of the proximal end of an overly long chimney graft that moved freely in the aortic arch exposed the patient to a high risk of stroke and death. Because of the high-risk situation, open repair under circulatory arrest was elected to remove the proximal end of the chimney graft, with no major complications
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