1,721,054 research outputs found
Minimally Invasive Treatment of Portal Hypertension, Abdominal Aortic Aneurysm, and Colon Cancer: A Case Report
No full textSurgical therapy in cirrhotic patients has high morbidity and mortality. Hepatic function and complexity of surgical procedures strongly influence postoperative results. We report the case of a cirrhotic patient with portal hypertension, abdominal aortic aneurysm (AAA), and right colon cancer. After neoadjuvant transjugular intrahepatic portosystemic shunt, we performed 1-stage endovascular aneurysm repair and laparoscopic right colectomy. Minimally invasive surgery allows the effective treatment of high-risk patients with severe comorbidities that some years ago would not have been operated on
A New Bailout Maneuver to Manage Type IIIa Endoleak Due to Displaced Renal Bridging Stent Graft in Narrow Aorta
No full textPurpose: To present endovascular management of an intraoperative type IIIc endoleak (EL) in a patient with migration of the right renal artery (RRA) bridging stent graft (BSG) during branched aortic aneurysm repair.Technique: The technique is demonstrated in an 80-year-old woman who underwent branched endograft repair of a symptomatic 6-cm type II TAAA. The t-Branch thoracoabdominal stent graft was positioned without difficulty. A "partial graft deployment" was performed, with the distal portion of the device remaining inside the delivery system and the right renal and superior mesenteric arteries were stented. When the constraining wires were removed, the RRA BSG migration from the branch was displayed, due to endograft twisting resulting in a horizontal rotation of the t-Branch. The RRA BSG remained oriented upward with the proximal edge positioned above the distal edge of the directional branch, making cannulation very difficult. This bailout technique uses a balloon placed at the level of the RRA BSG through the celiac artery (CA) directional branch; keeping the balloon inflated and in thrust, the edge of the BSG has moved downward making it possible to engage it and relining through the RRA directional branch.Conclusions: This paper describes an endovascular bailout technique for relining a displaced bridging stent graft, oriented upwards with the proximal edge positioned above the distal edge of the directional branch.Clinical Impact This sophisticated technique adds to the spectrum of bailout techniques that can be applied in cases of type IIIa EL with migration and complete separation of BSG
[Primary hepatic actinomycosis: a clinical case report and review of the literature].
No full textPrimitive actinomycotic abscess of the liver is extremely rare: in the world literature are reported twenty cases. The authors report a case of a 73-year-old patient admitted at our hospital in poor general conditions, with twelve kilograms weight loss in the last year, recurrent fever and tenderness in right hypochondrium. CT scan, ultrasonography and angiography showed the presence of a seven-centimeters hypovascularized mass in the fourth segment of the liver. The patient was submitted to surgical segmentectomy of the fourth segment. The histologic examination and the histochemical colorations made on the specimen have given the diagnosis of hepatic actinomycotic abscess. No clinical evidence of other intra-abdominal or extra-abdominal localizations were found. From 1928 to date only twenty similar cases have been reported in the world literature. The mean time between the beginning of the symptoms and the diagnosis was 11.1 months (range: 2-54 months): this to confirm the diagnostic difficulties of the disease. The hepatic lesions are described as single in eight cases and multiple in thirteen. Thirteen patients have been treated only with medical therapy: nine recovered and four died for disease spread. Of the six patients with resectable lesion treated surgically, five recovered and one died for pulmonary recurrence
Surgical Treatment of Symptomatic Aortic Aneurysm in a Patient with Anti-neutrophil Cytoplasmic Antibody-associated Vasculitis: Case Report and Review of the Literature
No full textVasculitis is an heterogeneous group of syndromes, which shares inflammation of blood vessel wall as the main feature. Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a necrotizing vasculitis, with few or no immune deposits, predominantly affecting small vessels (i.e., capillaries, venules, arterioles, and small arteries), associated with ANCAs specific for myeloperoxidase or proteinase 3. Clinical manifestations may be heterogeneous but an involvement of lungs and kidneys frequently occurs. AAV of large vessels is a very rare condition whose standard therapy is medical approach. Surgical revascularization has been described in selected patients after medical failure or in emergent settings. We report the case of a patient affected by symptomatic infrarenal aortic aneurysm related to AAV, who underwent in-situ reconstruction by means of cryopreserved homograft
Geometrical Analysis and Initial Experience With Bentley's BeFlared Bridging Stent for Fenestrated Endovascular Aneurysm Repair
No full textIntroduction: Endovascular treatment of juxtarenal aortic aneurysms is now widely accepted as a safe and effective alternative to open repair. Bridging stent-grafts (BSGs) are used to provide continuity between the main aortic graft and renovisceral target vessels (TVs) in fenestrated endovascular aneurysm repair (FEVAR). The BeFlared (Bentley InnoMed GmbH, Hechingen, Germany) represents the first dedicated BSG specifically designed for FEVAR, incorporating a novel flaring system that enables precise positioning and sealing in a single step. This study aims to evaluate the impact of BeFlared on procedural efficiency, radiation exposure, and deployment accuracy. Methods: A prospective registry of patients who underwent elective FEVAR at 3 Italian centers during February and March 2025 was retrospectively reviewed. Procedural parameters, including mean operative time, mean bridging time, and fluoroscopy duration, were recorded. Technical success was defined as successful stent deployment in all intended TVs. Cone-beam computed tomography (CBCT) was performed intraoperatively, and follow-up computed tomography angiography (CTA) was conducted 1 month post-procedure to assess geometric outcomes and complications. These parameters were compared with corresponding measurements obtained from a control cohort of patients who underwent FEVAR procedures, between 2020 and 2024 in the same 3 Italian centers, utilizing the Bentley BeGraft as BSG. Results: Eight FEVAR procedures were performed, with a total of 31 TVs treated using BeFlared stents. The control cohort comprised 60 FEVAR procedures performed using the Bentley BeGraft as the BSG, involving a total of 185 renovisceral TVs. The BeFlared group demonstrated significantly improved intraoperative outcomes compared with the control group. Median operative time was 241 (interquartile range [IQR]=185-295) minutes vs 270.3 (IQR=207-365) minutes (p=0.022), mean bridging stent deployment time was 5 (IQR=4.25-6.15) minutes vs 7.6 (IQR=4.8-9.7) minutes (p<0.001), and median fluoroscopy time was 72.2 (IQR=51-81) minutes vs 82.7 (IQR=49.5-113) minutes (p=0.064). Only 1 patient in the BeFlared cohort required brief intensive care unit admission. The average hospital stay was 5.1 (IQR=4-6) days compared with 5.7 (3-10) days in the control group (p=0.882). In the BeFlared cohort, technical success was achieved in 96.7% of TVs (30/31), no perioperative deaths or TV-related complications were observed. Geometric analysis showed that BeFlared stents had more uniform deployment, with lower variability regarding the landing zone of the BSG in the TV (16.4 mm, IQR=16-17.1 vs 15.4 mm, IQR=14.2-16.6; p<0.001) and BSG aortic protrusion (4.2 mm, IQR=4.1-4.4 vs 5.1 mm, IQR=4.2-5.7; p<0.001) compared with BeGraft. BeFlared also demonstrated a significantly larger proximal stent diameter (10.6 mm, IQR=10.4-11.4 vs 99.5 mm, IQR=8.7-10.2; p<0.001), greater mean flaring angle (51.9 mm, IQR=47.4-55.8 vs 41.4 mm, IQR=37-48.3; p<0.001), and reduced inferior flaring angle (67.8 mm, IQR=61.5-72.4 vs 75.1 mm, IQR=67.4-82; p<0.001). Conclusions: BeFlared demonstrated favorable short-term outcomes, with notable reductions in operative time, radiation exposure, and device manipulation. The geometric consistency and standardized deployment process offer encouraging early evidence of the system's clinical utility. Further studies are required in order to assess long-term safety and cost-effectiveness, as well as durability, across a wider patient population.Clinical ImpactThe BeFlared bridging stent introduces an innovative one-step flaring system that simplifies target vessel stenting during fenestrated endovascular aortic repair (FEVAR). This device enables more precise and reproducible deployment, reducing operative and fluoroscopy times while minimizing radiation exposure. For clinicians, these improvements translate into a safer, more standardized procedure with fewer technical maneuvers and potentially lower complication risks. The enhanced geometric consistency observed with BeFlared may improve long-term branch stability and durability, supporting its role as a next-generation device for complex aortic repair and a valuable advancement in endovascular practice
Videolaparoscopic-Guided Saccography and Direct Sac Embolization After Standard EVAR
No full textIntroduction: The occurrence of type II endoleak (T2EL) presents a significant challenge in standard endovascular aneurysm repair (EVAR), with ongoing debate in the literature regarding its optimal management. Although spontaneous resolution has been observed in many cases, intervention is often required to prevent progressive sac enlargement and rupture. Various approaches have been described, including translumbar, transarterial, and transcaval embolization, as well as direct sac puncture. The aim of this study is to evaluate the role of videolaparoscopic-guided saccography and direct sac embolization (ViSE) in patients with sac enlargement following EVAR. Methods: A prospectively maintained registry of patients undergoing standard EVAR between 2016 and 2022 at our institution was retrospectively reviewed. Exclusion criteria included concomitant computed tomography (CT)-diagnosed type I endoleak or type III endoleak (T1EL or T3EL), less than 6 months of follow-up, or no available imaging study for review. A nidus posterior to the main body of endograft and a hostile abdomen (severe obesity body mass index [BMI] >35 kg/m(2), previous open surgery, or history of peritonitis) were considered contraindications to ViSE. Results: A total of 259 standard EVAR procedures were performed during the study period, with 63 patients (24.3%) identified as having T2EL, 26 underwent endovascular treatment for significant sac growth during follow-up; 14 of these patients received ViSE (5.4%) and were included in the study. The median procedure time and median fluoroscopic time were 140 (interquartile range [IQR]=105-150) and 40.5 (IQR=31-45) minutes, respectively. Technical success was achieved in 12 of 14 patients (87%). In 7 patients (50%), the inferior mesenteric artery (IMA) was ligated. An occult T1EL or T3EL endoleak was revealed in 5 patients (35%), requiring an immediate or staged adjunct procedure. After a median follow-up of 32.4 months (IQR=25.3-51.7), 2 patients presented sac growth and required surgical conversion. None of the patients died due to aortic-related causes. Conclusion: Videolaparoscopic-guided saccography and direct sac embolization may be considered a valid alternative in patients with T2EL and sac growth. In our early experience, it has proven to be safe and effective in treating the nidus and IMA, and identifying hidden T1EL or T3EL. Clinical Impact Videolaparoscopic-guided saccography and direct sac embolization (ViSE) represent a valuable option for managing type II endoleak (T2EL) with sac enlargement after EVAR. This approach allows precise treatment of the nidus and the inferior mesenteric artery while also identifying undetected type I and III endoleaks that may require further intervention. By integrating ViSE into clinical practice, physicians can improve diagnostic accuracy and expand treatment strategies for complex endoleak cases. The technique enhances endovascular options, potentially reducing the need for open conversion and improving long-term outcomes in patients with persistent sac growth
Via biliare principale, pancreatite acuta e chirurgia mini-invasiva.
No full textVia biliare principale, pancreatite acuta e chirurgia mini-invasiva
Distal Endovascular Extension After FET: Short and Mid-Term Outcome in a High-Volume Single-Center Experience
Full text linkBackground: This study aims to investigate results and outcomes of distal endovascular extensions after frozen elephant trunk (FET) procedure. Methods: Between September 2018 and December 2022, all consecutive patients who underwent thoracic endovascular aortic repair (TEVAR) or complex thoraco-abdominal repair (TAA-EVAR) after FET were included in the study. Patients were assigned to "Aneurysm" group or to "Dissection" group according to underlying patology before FET repair. The primary end points were overall technical success and early reintervention rate. Secondary end points included 30-day and mid-term overall survival. Results: A total of 29 patients were included in the study and divided as follows: n = 12 in the aneurysm group and n = 17 in the dissection group. The mean age of the population was 64.6 ± 10.2 years, and 69% were male. All patients received TEVAR as primary extension while 9 of them underwent further extension to a subsequent TAA-EVAR in a second stage. Among the dissection group, 7 patients experienced a distal stent-graft-induced new entries caused by the stent-graft portion of the FET. Technical success of the first stage (TEVAR) was fully achieved as well as for the second stage (TAA-EVAR). Within the first 30 days, no patient expired or required early reinterventions. Freedom-from-reintervention at 36 months was 72% and 64% in the aneurysm and dissection group, respectively. Overall, 1 major adverse event (3.4%) and 3 access-related complication (10.3%) occurred among the entire cohort. The Kaplan-Meier survival estimation showed a nonsignificant log-rank value (P = 0.248) with a survival rate of 91.7% and 100% at 12, 24, and 36 months each for aneurysm and dissection group, respectively. Conclusions: Distal endovascular extensions after FET repair are feasible with low perioperative morbidity and mortality regardless of the underlying pathology. Technical success rate of endovascular extension is high, but aortic-related reintervention rate remains quite consistent over time. Thus, a close surveillance is advocated for such patients
Treatment of popliteal artery aneurysms by means of cryopreserved homograft
No full textAutologous saphenous vein is considered the gold standard conduit in the femoral-popliteal revascularization for popliteal artery aneurysms (PAAs). In several cases, it may be absent or unsuitable for length or diameter and so it may be considered unfit for a conduit. In such patients, a synthetic graft or the endovascular correction can be useful, but results are controversial. In this retrospective case series, we have analyzed the safety and efficacy of the cryopreserved homograft (CHg) as a conduit in the PAA revascularization
Sheath-Anchoring for Rail Guidewire Technique to Advance and Deploy Thoracic Endograft in Hostile Anatomy
No full textBackground: To describe a bailout technique to advance and precisely deploy thoracic endograft in the ascending aorta in case of difficulty crossing the aortic arch.Case Reports: A 73-year-old man presented with a large ruptured aneurysms in the descending aorta. During the TEVAR, stent-graft passage through the aortic arch was impossible due to the severe tor tuosity of the aor ta. The problem has been resolved using the sheath-anchoring rail guidewire (SARG) technique.Results: Through an axillary access, a snare was used to capture the stiff wire from the femoral access. A sheath was advanced over the stiff wire to the ascending aorta and placed there. By exploiting the grip of the sheath on the stiff in the ascending aorta, it was possible to handle the tension, move the delivery system through the arch and carefully deploy the graft.Conclusion: The SARG is a simple and quick learning technique which can be useful for Physicians dealing with complex aortic arch anatomy
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