Outcome and quality of life after endovascular abdominal aortic aneurysm repair in octogenarians

ObjectiveThis study determined outcome and quality of life (QOL) in octogenarians, compared with patients aged <80 years, 1 year after endovascular aortic aneurysm repair (EVAR).MethodsFrom March 2009 until April 2011, 1263 patients in the Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE) registry with an abdominal aortic aneurysm were treated with EVAR using the Endurant endograft (Medtronic Cardiovascular, Santa Rosa, Calif). The patients were grouped according to those aged ≥80 years (290 [22.9%]) and those aged <80 years (973 [77.1%]) at the time of the procedure. QOL was assessed using composite EuroQoL 5-Dimensions Questionnaire (EQ-5D) index scores. Baseline, perioperative, and follow-up data were analyzed at 1 year.ResultsOctogenarians had poorer anatomic characteristics. The technical success rate was almost 99% for both cohorts, with no deaths. The duration of the implant procedure was significantly longer in the elderly patients (P = .002), with significant differences in overall (P < .001) and postprocedure (P < .001) hospital stays in favor of the younger group. At 1 year, there was a significant difference in all-cause mortality (P = .002) and in the number of major adverse events (P = .003), including secondary rupture (P = .01), to the detriment of octogenarians. There were no significant differences in conversion to open surgery or in overall secondary endovascular procedures. The octogenarians scored lower in their overall health care perception (P < .001) but with no significant difference in the EQ-5D index. Compared with the group aged <80 years, they had still not completely recovered their QOL after 1 year (P = .01).ConclusionsOctogenarians are more difficult to treat by EVAR than younger patients due to poorer anatomic suitability and a higher incidence of complications. Recovery of QOL in octogenarians takes longer (>12 months) than expected

Endovascular Treatment of Thrombosis and Embolism

Deep venous thrombosis (DVT) is a common disorder with a significant mortality rate. Successful endovascular treatment of acute DVT is most likely to be achieved in patients with recently formed thrombus, (< 10-14 days) with acute iliofemoral DVT. Endovascular treatment options include: Catheter-directed thrombolysis (CDT), pharmacomechanical catheter-directed thrombolysis (PCDT), percutaneous aspiration thrombectomy (PAT), vena cava filter protection, venous balloon dilatation and venous stent implantation. Current practice shows strong clinical tendency for the use of PCDT with or without other endovascular methods and an individualized approach for each DVT patient. PMT has not received general acceptance because of the associated risk of PE and damage to venous valves caused by thrombectomy devices. PAT is most commonly used as an adjunctive endovascular technique like balloon maceration to fragment thrombus, balloon angioplasty, stent implantation and vena cava filter placement. Interventional endovascular therapies for DVT have the potential to provide PE protection and prevention of PTS. Patient centered individualized approach for endovascular DVT treatment is recommended to optimize the ideal clinical result. Acute stroke is the leading cause of death for people above the age of 60 and the fifth leading cause in people aged 15-59. Mortality during the first 30 days of ischemic stroke is 20 % and 30 % of survivors will remain permanently disabled

Value of intraplacental villous artery doppler measurements in severe preeclampsia

Blood flow velocity waveforms were recorded by color Doppler ultrasound from intraplacental villous and umbilical arteries in 20 normal and 23 severe preeclamptic pregnancies. The results of the resistance index measurements in intraplacental villous arteries were 0.51 ± 0.037 and 0.55 ± 0.052 in healthy controls and preeclamptics respectively, which was not significantly different. Resistance indices showed a decrease through the umbilical cord from fetus to placenta in both groups. We also noted that Doppler examination of the umbilical cord might be an early indicator of fetal compromise. Detectable intraplacental villous flows were in normal limits even in patients with abnormally high umbilical resistance indices and failure to detect villous artery color Doppler flow signals is probably associated with fetal compromise. We conclude that Doooler measurements from the intraplacental arteries cannot be used in clinical management of patients with severe preeclampsia

Mesenteric Doppler ultrasonography findings of Echinococcus multilocularis infection: an experimental study.

The diagnosis of alveolar echinococcosis, caused by the larval stage of Echinococcus multilocularis, is often difficult and almost always possible only in the later stages of the disease. In this study, we aimed to evaluate the findings of Doppler ultrasonography images for the diagnosis of intraabdominal non-visceral alveolar echinococcosis in Meriones unguiculatus. Six infected animals were studied. Abdominal Doppler ultrasonography examinations were performed 20-25 days after the implantation. Then, animals were sacrificed and infected specimens were histopathologically examined. The sonographic examinations of the infected animals revealed lobulated, heterogeneous cystic intraabdominal masses. There were echogenic solid areas with hypoechoic and anechoic cystic areas within the lesions. Doppler ultrasound examination revealed vascular islands within those heterogeneous cystic lesions. Color mode showed multiple vascular coding areas within the solid part of the lesions, most of them were venous structures but there were also arterial vessels showing dominant flow with low resistive indices. Vascular structures were supposed to be the invaded native mesenteric vessels within the infiltrating inflammatory mass lesions. We consider that the Doppler ultrasound finding of irregular mesenteric vascular structures within intraabdominal heterogenous mass lesions may be an important sign for the diagnosis of experimental non-visceral alveolar echinococcosis in Meriones unguiculatus

Looking for the Ideal Particle: An Experimental Embolization Study

This study sought to compare the most frequently used embolic particles in an animal model. In 16 New Zealand white rabbits, right renal arteries were embolized using four different embolic particles (polyvinyl alcohol [PVA] particles, 150-250 mu m; PVA microspheres [PVAMs], 150-300 mu m; Tris-acryl gelatin microspheres [TGMs], 100-300 mu m; expanding microspheres [EXMs], 50-100 mu m). Quantity of embolic material used, embolization time, and angiographic patterns were documented. Fourteen days later, a control angiography was done to document angiographic recanalization and all animals were sacrificed. Histopathological specimens were analyzed for microscopic appearance and granulometric size of the particles, extravasation of the particles, perivascular inflammation, and neocapillarization. The volume of the infarct area in each kidney was calculated. Results revealed a significantly lesser amount of embolic material used in the EXM group (p = 0.020). The angiographic recanalization rate in the EXM group (100%), compared with the PVA (0%) and TGM (0%) groups, was found to be statistically significant (p = 0.014). Although 75% of the renal arteries embolized with PVAMs were recanalized, this was not found to be statistically significant (p = 0.071). Occlusion levels in the PVA group were more proximal than with any of the microspheres. While there was no extravasation in the TGM group, extravasation rates in the PVA, PVAM, and EXM groups were 50%, 25%, and 75%, respectively. A mild degree of inflammation was noted in the PVA, PVAM, and TGM groups. EXMs caused a moderate degree of inflammation in two kidneys (50%). There was neocapillarization in the vessel lumen in all kidneys in the PVA and PVAM groups. The difference was significant (p = 0.014) compared with the TGM and EXM groups, which did not have any neocapillarization. Regarding infarct area volumes, the difference among the groups was significant (p = 0.022). EXMs caused significantly (p = 0.021) less infarction than the other embolic agents. We conclude that EXMs are less efficient due to a high recanalization rate and lesser volume of infarct compared with the other embolic agents in the rabbit kidney model. The most efficient embolization was seen in kidneys embolized with TGMs

Nasal Septal Perforation in a Patient with Takayasu's Arteritis; a Rare Association

Takayasu's arteritis (TA) is a chronic, progressive, granulomatous inflammation of the aorta and its major branches, and is diagnosed often only in the late stage. Tie late phase of disease is characterized by variety of ischemic symptoms due to stenosis or occlusion of the major arteries. Although major neurological events such as stroke, transient ischemic attacks, and seizures due to either progressive arterial stenosis or hypertension, are reported to occur in one-fifth of the patients, nasal septal perforation has not been previously reported. Herein we present a young woman with TA who was hospitalized with left hemiparesis due to occlusion of stented carotid artery. Her clinical course was also complicated with nasal septal perforation. This case suggested that nasal septal perforation could be a rare complication of TA and might be considered as a part of the clinical spectrum of the disease

Improved computerized evaluation of abdominal aortic aneurysm

Accurate measurements of arterial anatomy are emerging as the most important determinants of endovascular abdominal aneurysm repair. It is quite difficult to define and measure arterial anatomy features quantitatively due to the complex structure of the aneurysm and insufficient visual feedback. During decision making, to assist operators in diagnosing abdominal aortic aneurysms, a specialized preprocessing Abdominal Aortic Aneurysm Measurement and Evaluation Tool (AMET) was developed. AMET provides visual interfaces with broad measurement capabilities to generate a 3D model of the aorta for a better diagnosis and accurate stent selection. The accuracy and usability of the tool was tested with a series of measurements that were carried out on a selected patient group. The obtained statistical results were evaluated and compared with the current applied method used by the radiodiagnostic department. Test results showed that the new introduced measurement and evaluation tool, AMET, has higher measurement quality compared to the conventional manual method

Doppler US evaluation of renal biopsy complications in children

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