27 research outputs found
Emergency endovascular management of the common femoral artery rupture due to radiotherapy for scrotal carcinoma
We describe the case of a 72-year-old man with massive hemorrhage and shock resulting from rupture of the left common femoral artery as a complication of radiotherapy in the groin for cancer of the scrotum. This complication is extremely rare, presents dramatically, and is usually fatal. The patient was successfully treated with a stent graft deployment in order to achieve immediate hemostasis maintaining blood flow to the leg. Open surgery is not ideal in those cases especially when there is extensive tumor involvement of the groin causing altered anatomy and increasing the risk of re-bleeding
Successful endovascular treatment of a 13 cm abdominal aortic aneurysm. Case report
There is increasing evidence in the literature that endovascular aneurysm repair is the first-line approach for most of abdominal aortic aneurysms (AAAs). Furthermore aortouniiliac stent graft placement is, in high risk patients or during emergency setting, a safe procedure over the mid- and long-term period and compares well with the results of bifurcated stent grafts. We present a case of a 66 -year-old gentleman, with pneumothorax after therapeutic thoracentesis and a giant AAA, successfully treated with an aortomonoiliac stent grafting and femoro-femoral crossover bypass
Early results of mechanochemical ablation with Flebogrif® in great saphenous vein insufficiency: does polidocanol concentration affect outcome?
Flebogrif® (Balton, Poland) is a novel mechanochemical ablation (MOCA) device for saphenous vein insufficiency. It combines endothelial damage performed by radial retractable cutting hooks together with chemical ablation through sclerosant injection of 3% polidocanol foam according to its IFU. The objective of this study is to evaluate Flebogrif's efficacy in terms of recanalization rate and recurrence by varying polidocanol foam concentrations
Harmonic focus versus conventional electrocautery for femoral artery exposure: a "direct" comparison on the same patients
Surgical access complications during endovascular
aneurysm repair (EVAR) are reported relatively
frequent. HARMONIC FOCUS® (HF; Ethicon EndoSurgery Inc., Cincinnati, Ohio, USA) is a device
developed to improve bleeding control and reduce
heat-related damage stemming from surgical
preparation.
The aim of this study was to evaluate outcomes and
safety of HF versus conventional haemostasis with
electrocautery, both techniques used in the same
patient. Five patients developed bilateral wound’s
thickening (13.9%) demonstrated at the CT scan, two
of whom had no clinical manifestation while in three
cases the thickening was associated with lymphocele
(4.54%), 2 of which were in the side where the EC
was used (5.5%), and 1 case (2.7%), in the HF applied
side. One isolated lymphocele occurred at the left
groin (2.7%) (tables n.2-3). A Fisher’s exact test was
conducted between EC and HF on the occurrence of
wound healing complications (3/36 for EC and 1/36
for HF) that resulted statistically significant at p<0.05.
Focus Harmonic Scalpel has certain advantages than
conventional haemostasis in avoiding surgical access
complications
Standard carotid endarterectomy versus carotid artery stenting with closed-cell stent design and distal embolic protection: does the age matter?
Carotid artery endarterectomy (CEA) is
considered the gold standard for treatment of
symptomatic and asymptomatic carotid disease.
Carotid artery stenting (CAS) is a less invasive
approach and therefore could be considered a viable
alternative to CEA, especially in high-risk patients or
those with relative contraindications to CEA (i.e.
actinic stenosis, post-CEA restenosis, previous neck
or tracheostomy surgery, contralateral laryngeal
nerve paralysis, etc.).
Methods – The aim of this study is to evaluate the
short- and medium-term outcomes of CAS
performed with a single type of closed-cell stent
design and distal filter protection by comparing the
procedure with CEA based upon 3 endpoints: overall
survival rate, stroke free survival rate and restenosis
free survival rate.
The same endpoints were also evaluated in 2
different age groups, more and less than 70 years, to
show possible age-based differences on outcomes.
Among 105 patients (77 males, 28 females), 74 were
submitted to CEA and 31 were subject to CAS.
In all cases the same self-expanding stent with
closed-cell design (XACT Carotid Stent, Abbott
Vascular) and the same distal embolic protection
device (Emboshield NAV, Abbott Vascular) were
employed.
Results – At 12 months, no statistically significant
difference was observed in overall survival rates
(CEA 93.2% vs CAS 93.5%, p=0.967) and restenosis
free survival rates (CEA 94.5% vs CAS 96.8%,
p=0.662).
An increased stroke free survival rate was observed
in the CEA group when compared to the CAS group
(CEA 100.0% vs CAS 93.5%, p=0.028).
The age-based endpoints didn’t show any significant
difference.
Conclusion - These results suggest that CEA still
remains the gold standard of treatment for carotid
stenosis given its greater efficacy in the prevention
of stroke CAS. However, CAS could be considered
as an alternative treatment to CEA to be used in
select cases only
Treatment of de novo femoro-popliteal lesions with a new Drug Coated Balloon: early experience of a single Center in the first 50 patients
Angioplasty with drug-coated balloon
(DCB) is an emerging and reliable method for the
treatment of femoro-popliteal lesions. We report
our experience with the Stellarex™ DCB in the
first 50 patients.
Methods - From July 2015 to November 2017, 50
patients (41 M, 9F), medium age (64 ± 7.4 year)
were subject to 33 angioplasties (PTAs) for
femoro-popliteal lesions with a paclitaxel-coated
balloon (Stellarex™). Based upon clinical data
sixteen patients had severe claudication (56% -
Rutherford class 3); ten patients suffered from
ischemic rest pain (34% - Rutherford class 4); and
five presented minor tissue loss (10% -
Rutherford class 5). 42% of patients showed
femoro-popliteal lesion TASC-II B, and 58%
presented lesions pertaining to TASC-II C.
Results - Immediate technical success was 100%
without perioperative complications. Primary
patency rate was 94% at twelve months. In three
cases restenosis (6%) was detected within a year
from procedure, and a further PTA DCB was
performed with primary assisted patency rates of
100% at twelve months. Two patients underwent
major lower limb amputation. Three patients died
during follow-up and one patient was lost at
follow-up.
Conclusion - DCB angioplasty with Stellarex™
is a viable alternative to traditional endovascular
procedures proving satisfactory primary patency
rates at twelve months. Based on our experience,
treatment with DCB is a first choice technique for
non-complex de novo lesions of the femoro –
popliteal tract
Use of the directional atherectomy for the treatment of femoro-popliteal lesions in patients with critical lower limb ischemia
Femoro-popliteal PTA for the treatment
of critical limb ischemia is frequently associated
with unsatisfactory procedural success rates while
directional atherectomy (DCA) has improved
success rate since claudicant patients undergoing
percutaneous treatment of femoro-popliteal
obstructive disease. The aim of this prospective
study is to evaluate the safety, efficacy and
procedural success of DCA, at one year, in the
percutaneous treatment of femoro-popliteal
obstructive disease in patients with critical limb
ischemia.
Methods. From March 2012 to March 2013 18
consecutive patients with critical limb ischemia were
treated with DCA (Turbohawk/Covidien-ev3
Endovascular Inc., North Plymouth, Minnesota,
USA) for the treatment of femoro-popliteal
obstructive disease. Patients were evaluated at 12
months.
Results. Technical and procedural success was
achieved in every patient. No in-hospital major
adverse cardiovascular events occurred. Primary
endpoint: freedom from any amputation was
obtained in all patients. Secondary endpoints:
clinical (Rutherford class improvement) and
hemodynamic success (Ankle-brachial index
improvement) was achieved in all patients.
Conclusion. The use of DCA for the treatment of
femoro-popliteal obstructive disease is a safe and
effective therapeutic strategy for patients with
critical limb ischemia. The data included in our study
should be considered hypothesis-generating in order
to design of a randomized trial comparison with
conventional PTA
A case of symptomatic popliteal vein aneurysm
We describe a case of a 44 year-old man with a subcutaneous swelling in the left popliteal fossa. The patient complained pain posteriorly to the left knee since several months and presented with a saccular aneurysm of the left popliteal vein (PVA) with reflux clearly evidenced at duplex ultrasound scan (DUS), but in absence of thrombus inside and without clinical signs of embolism. The patient was treated surgically by aneurysmectomy with lateral venorrhaphy according to Aldridge technique and a duplex ultrasound scan after six months revealed a complete patency of the left popliteal vein. According to literature evidences and our center experience, the surgical treatment of the popliteal vein aneurysm represents the gold standard in order to prevent the possible complications like development of thrombus inside the aneurysmatic vein and the consequent embolic risk and it is recommended in all case of a symptomatic saccular type of whatever diameter, and in fusiform type >20 mm, with or without thrombus