1,720,986 research outputs found
Endovascular repair using parallel grafts to treat a suprarenal pancreatitis‐related abdominal aortic pseudoaneurysm
No full text: Arterial pseudoaneurysms represent an uncommon complication of acute pancreatic inflammation or chronic pancreatitis. We describe a contained rupture of a suprarenal abdominal aortic pseudoaneurysm. An aorto-uni-iliac stent-graft was adopted as the aortic main body and was combined with two chimneys and two periscope stents for celiac/superior mesenteric artery and renal arteries, respectively. The procedure was complicated by the entrapment of the celiac sheath into the barbs of the aortic stent-graft and the attempts to remove the sheath resulted in an upward migration of the stent-grafts. A bail-out endovascular procedure was used to reline the stent-grafts and the pseudoaneurysmal sac was embolized with coils
AAA 23. Different Techniques in Endovascular Treatment of Obstructive Aortoiliac Disease
No full textObjective: Obstructive aortoiliac disease must be considered chal-
lenging treatment lesions for vascular surgeons. The aim of our study
was to evaluate the outcomes of endovascular treatment of these lesions
in terms of early and midterm results, comparing standard iliac stenting
with more complex techniques, including kissing stent, covered recon-
struction of aortic bifurcation, and bifurcated endograft deployment.
Methods: A retrospective review was conducted of 142 patients treated
for aortoiliac disease with endovascular technique from March 2015 to
June 2019 at our institution. We considered in our study 80 patients
with obstructive disease and divided our series into a standard stenting
group (35 patients) and complex technique group (45 patients). In the
complex technique group, 23 kissing stents, 12 bifurcated endografts,
and 10 covered reconstructions of aortic bifurcation were included. For
each group, we analyzed comorbidities and morphologic preoperative
and intraoperative details. Early results were analyzed in terms of 30-
day thrombosis, amputation, and death. Follow-up results were analyzed
by life-table analyses (Kaplan-Meier curves) in terms of primary and sec-
ondary graft patency, assisted primary patency, freedom from reinterven-
tion, amputation-free survival, and overall survival. Univariate Cox
regression analysis was performed to identify risk factors and intraopera-
tive details associated with primary stent graft patency. Median follow-up
was 12 months.
Results: The mean age of patients was 65 6 11 years. At 30 days, we did
not record any cases of amputation and death. The rate of thrombosis
was of 8.9 and 5.0 (
c2 , 1.353;
P 1⁄4 .2) in the standard stenting and complex
technique groups, respectively. In the follow-up, primary patency in both
groups was similar (85.5% vs 95%; log rank, 1.530;
P 1⁄4 .2); secondary
patency and limb salvage for patients with critical limb ischemia,
freedom from reintervention, and overall survival did not differ in the
two groups. Univariate analysis did not find any factors affecting primary
patency.
Conclusions: In our experience, endovascular treatment of obstructive
aortoiliac disease offered satisfactory early and midterm results. Complex
techniques, although they are more technically demanding and time-
consuming strategies, may be performed with results similar to those ob-
tained in standard stenting procedures
Iliac branch device: A possible solution for the preservation of the inferior mesenteric artery in complex aortic endovascular procedure
Full text linkA 76-year-old man was admitted with a bilateral iliac obstructive disease and an abdominal aortic aneurysm. The
right internal iliac artery was patent as well as the inferior mesenteric artery (IMA) that measured 5 mm. Patient
performed TEVAR one year before for a thoracic descending aorta aneurysm. He underwent an endovascular
aneurysm repair with an inner abdominal branch device and an iliac branch device (IBD) was used to preserve
IMA patency. The IBD may be an alternative endovascular device to save IMA in extensive aortic coverage in patients at high risk of spinal cord ischemia
Outcomes of Endovascular Reconstructive Techniques in Trans-Atlantic Inter-Society Consensus II C-D Aortoiliac Lesions
No full textBackground: To describe the outcomes of the endovascular reconstruction of TASC C/D lesions involving the infrarenal aorta and aortic bifurcation with different techniques. Methods: This is an observational, retrospective, single-center study. In a 5-year period, we selected all the patients treated with an endovascular procedure for an aorto-iliac TASC C/D lesion involving the infrarenal aorta and/or the aortic bifurcation. Early (<30 days) outcomes were mortality, major amputation, and thrombosis. Late mid-term (1 and 3 years) outcomes were primary, assisted primary and secondary patency, limb salvage rate, and freedom from reintervention. Results: A total of 87 patients were treated during the index period. Kissing covered stent (cKS), covered reconstruction of aortic bifurcation (CERAB), and unimodular bifurcated AFX Unibody stent-graft (Bif-SG) implantation were performed in 35 (40.4%), 26 (29.8%), and 26 (29.8%) cases, respectively. Bif-SG group included 11 (11/26, 42.3%) patients treated for abdominal aortic aneurysm associated with the obstruction of the aortic bifurcation. Technical success was achieved in all cases and no ruptures or conversions to open surgery were recoded. Median follow-up age was 18 months (interquartile range [IQR], 8-34). Overall primary patency rate was 91.2% (95% confidence interval [CI]: 81.3-95.9) at 1 year and 83.5% (95% CI: 69.6-91.4) at 3 years. Assisted primary patency was 96.9% (95% CI: 87.8-99.2) at 1 and 3 years. Secondary patency was 97.8% (95% CI: 85.5-99.6) at 3 years. Limb salvage rate was 98.6% (95% CI: 90.1-99.7) at 1 and 3 years and, freedom from reintervention was 98.4% (95% CI: 88.9-99.7) at 1 year and 87% (95% CI: 66.1-95.4) at 3 years. Univariate analysis did not identify any factor affecting primary patency rate. Conclusions: Endovascular reconstruction in severe aorto-iliac obstructions using advanced techniques offered promising mid-term patency rates and profiles of safety. The variety of reconstructive configurations allows surgeons to customize on patients' anatomies the type of revascularization
An analysis of early and long-term gender-related outcomes after thoracic endovascular aortic repair
No full textObjectives: To evaluate gender-related outcomes during endovascular treatment of thoracic and thoraco-abdominal aortic diseases (TEVAR). Methods: Multicentre, retrospective, observational cohort study. All TEVARs between January 2005 and April 2023 were identified. Primary outcomes were 30-day mortality, and cumulative survival. Secondary outcomes were vascular access complications, and freedom from TEVAR-related reintervention. Interventions performed in male patients were matched to females on the basis of a one-to-one coarsened exact matching. Results: We identified 151 males who were matched with 151 females. Mortality at 30-day was not statistically different between females and males (11.2% vs 11.2%, P = 1.0). At binary logistic regression analysis, duration of intervention (P = 0.001), and emergency TEVAR (P = 0.001) were associated with mortality at 30 days. Gender did not impact access vessel complication rate [n = 6 (4.0%) vs n = 5 (3.3%), P = 1.0]. The median of follow-up was 46 (IQR, 7-84) months with no difference between males and females [median, 50 (11-95) vs 37.5 (3.5-71.2); P = 0.153]. Estimated survival was not statistically different between females and males (Log-rank χ2 = 0.6, P = 0.442; 95% CI: 110.7-207.3). At Cox's regression analysis, gender did not impact overall survival (HR: 0.8, 95% CI: 0.6-1.3, P = 0.450). Estimated freedom from TEVAR-related reinterventions was not statistically different between females and males (Log-rank χ2 = 0.4, P = 0.837; 95% CI: 187.8-219.3). Conclusions: Female gender itself was not associated with worse 30-day mortality and late survival than males with similar access vessel complication as well as TEVAR-related reintervention rate
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
Cardiac risk after elective endovascular repair for infrarenal abdominal aortic aneurysm, results from the Italian Collaborators for EVAR multicenter registry
No full textObjectives: Major adverse cardiac events (MACEs) were common complications after endovascular aortic repair (EVAR) causing significant post-operative morbidity and mortality. The aim of the study was to evaluate the cardiac risk after elective EVAR for uncomplicated non infected infrarenal abdominal aortic aneurysm (iAAA) in a large multicenter cohort. Materials and methods: This is a multicenter, retrospective, financially unsupported physician-initiated observational cohort study conducted by four academic tertiary referral hospitals from January 2018 to March 2021. Baseline, perioperative, and postoperative information of elective EVARs was evaluated. The primary outcome was the incidence of MACE after EVAR, which was defined as acute coronary syndrome, non-ST-elevation myocardial infarction, unstable angina pectoris, de novo atrial fibrillation, hospitalization for heart failure and revascularization as well as cardiovascular death. Secondary outcomes were one year overall survival (all-cause mortality) and freedom from aorta-related mortality. Comparative analysis was conducted between MACE and overall population and univariate and multivariate logistic regression analyses were used to analyse factors associated with the risk of MACE occurrence and early 1-year mortality. Results: The study has enrolled 497 patients (35 females, 7%) with a mean age of 75.3±7.8 years. MACE rate was 6.4% (32/497, events/patients) and the majority of the events were recorded in the post-operative period (24/32, 75%, overall 24/497, 4.8%). One-year survival from all-cause mortality was 94% (95%CI 91-96) and MACEs population showed a significant lower survival estimation rate (Overall-MACEs, 95.8% [95%CI 93-97] - 67.9% [95%CI 47-82], log-rank 41.950, p= .0001). Freedom from aorta-related mortality was 99.3% (95%CI 98-100). The perioperative needing for red blood cells (RBC) transfusions was strongly related to MACEs occurrence (odds ratio [OR] 2.67, 95%CI 1.52-4.68, p= .001) and one-year mortality (hazard ratio [HR] 2.14, 95%CI 1.48-3.09, p= .0001). Conclusion: MACEs represent a common complication in the post-operative and early period after elective EVAR. Blood loss requiring RBC transfusions is associated with increased post-operative MACEs and early mortality, suggesting that all the efforts should be carried out to reduce the bleeding during and after elective interventions
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Endovascular Bailout Repair After Intraprocedural Thrombosis of a Bifurcated Unimodular Stent-graft During Aorto-iliac Revascularization in a Patient with Sars CoV-2 Infection
No full textTo describe a case of endovascular bailout strategy during stent-graft thrombotic complication in an endovascular procedure for complex TASC II D aortoiliac lesion. A 77-year-old patient was admitted at our institution with bilateral lower limb rest pain due to aortoiliac obstructive disease in a previous aortobifemoral bypass grafting with an asymptomatic Sars-CoV-2 infection. We planned an anatomic reconstruction of the aortoiliac segment with an unimodular bifurcated stent-graft. During the procedure, we observed a preocclusive thrombosis of the aortic portion requiring endovascular thrombectomy with vacuum assisted system followed by a successfully kissing-stent endolining. The post-operative period was uneventful and patient was discharged on the 14th post-operative day. Endovascular thrombectomy may be a helpful strategy during thrombotic complication of complex reconstructions of obstructive aortoiliac disease avoiding surgical conversion to laparotomy
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