21 research outputs found
Endovascular Treatment of Infrarenal Abdominal Aortic Aneurysm with Short and Angulated Neck in High-Risk Patient
Endovascular treatment of abdominal aortic aneurysms (AAA) is an established alternative to open repair. However lifelong surveillance is still required to monitor endograft function and signal the need for secondary interventions (Hobo and Buth 2006). Aortic morphology, especially related to the proximal neck, often complicates the procedure or increases the risk for late device-related complications (Hobo et al. 2007 and Chisci et al. 2009). The definition of a short and angulated neck is based on length (<15 mm), and angulation (>60°) (Hobo et al. 2007 and Chisci et al. 2009). A challenging neck also offers difficulties during open repairs (OR), necessitating extensive dissection with juxta- or suprarenal aortic cross-clamping. Patients with extensive aneurysmal disease typically have more comorbidities and may not tolerate extensive surgical trauma (Sarac et al. 2002). It is, therefore, unclear whether aneurysms with a challenging proximal neck should be offered EVAR or OR (Cox et al. 2006, Choke et al. 2006, Robbins et al. 2005, Sternbergh III et al. 2002, Dillavou et al. 2003, and Greenberg et al. 2003). In our case the insertion of a thoracic endograft followed by the placement of a bifurcated aortic endograft for the treatment of a very short and severely angulated neck proved to be feasible offering acceptable duration of aneurysm exclusion. This adds up to our armamentarium in the treatment of high-risk patients, and it should be considered in emergency cases when the fenestrated and branched endografts are not available
Colonic Ischemia After Endovascular Exclusion of an Aortoiliac Aneurysm Using an Iliac Branch Device
Purpose: To present the first case of colonic ischemia (CI) after
endovascular exclusion of an aortoiliac aneurysm using an iliac branch
device (IBD). Case report: A 69-year-old male patient with an abdominal
aortic and right common iliac artery aneurysm underwent endovascular
repair with an IBD. Completion angiography demonstrated good patency in
2 of the 3 main branches of the right internal iliac artery (IIA)
whereas the left IIA patency was preserved. Preoperatively, the inferior
mesenteric artery (IMA) was patent. Postoperatively, the patient
presented moderate CI. He was treated conservatively and discharged 15
days later with recession of the symptoms. Conclusion: Although
preservation of bilateral iliac artery patency is considered to diminish
the incidence of pelvic ischemia, in case of an exclusion of a patent
IMA, collaterals may not be adequate to ensure blood supply to the left
colon
Peripheral Arterial Disease Is Prevalent But Underdiagnosed and Undertreated in the Primary Care Setting in Central Greece
We investigated the prevalence of peripheral arterial disease (PAD). Primary Care Health Centers (n = 14) in Thessaly (central Greece) recruited 436 participants, mean age 71 (50-79) years. Peripheral arterial disease was considered present if the ankle-brachial index (ABI) was 1.4 in at least 1 leg. Asymptomatic PAD was defined as an abnormal ABI and no symptoms or history of limb revascularization. The prevalence of PAD was 13% (mostly asymptomatic, 11.7%). Only 5 (8.77%) of 57 patients with PAD were aware of their disease and only in these patients were the physicians aware of the presence of PAD. The risk factors associated with PAD were age, smoking, and the combination of diabetes mellitus and coronary artery disease. All symptomatic patients were on antiplatelet therapy but 33% did not take statins. For asymptomatic patients, 74.5% were not on antiplatelet therapy and 57% did not receive statins. In the primary health care setting, PAD is underdiagnosed and undertreated
Hypogastric Preservation Using a Retrograde Endovascular Bypass in a Patient with Ruptured AAA and Concomitant Bilateral Common Iliac Aneurysms: A Feasible Option in the Acute Setting
Preservation of the hypogastric circulation is of major clinical
importance in cases of endovascular aneurysm repair (EVAR) for ruptured
abdominal aortic aneurysm (rAAA). Pelvic ischemia can be detrimental and
significantly increase post-operative morbidity and mortality. However,
the application of a side branch device or a bell-bottom graft is not
possible in ruptured aortoiliac aneurysms (due to off-the-shelf
unavailability and/or prolonged operative time) and in most cases pelvic
circulation may have to be sacrificed. We report a case of a rAAA with
bilateral common iliac artery (CIA) aneurysms that was successfully
repaired with an aorto-uni-iliac (AUI) endograft, a cross-femoral
bypass, and an inverted-U shaped contralateral EIA to IIA endovascular
bypass. The procedure is described in detail and certain technical
points are further discussed. The steps in cases where the aneurysm has
ruptured are different compared to elective repairs and vascular
surgeons need to be aware of certain pitfalls. This strategy may be
feasible in the acute setting and permits preservation of the
hypogastric circulation with the combination of standard techniques and
grafts that are readily available in most institutions
Outcomes of endosutured aneurysm repair with the Heli-FX EndoAnchor implants
Objective
Endovascular aneurysm repair has gained field over open surgery for the
treatment of abdominal aortic aneurysm. However, type Ia endoleak
represents a common complication especially in hostile neck anatomy that
is recently faced using endoanchors. We conducted a systematic review
and meta-analysis to collect and analyse all the available comparative
evidence on the outcomes of the endosuture aneurysm repair in patients
with or without hostile neck in standard endovascular aneurysm repair.
Methods
The current meta-analysis was conducted using the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses guidelines. All the
prospective and retrospective studies reporting primary use of the
Heli-FX EndoAnchor implants were considered eligible for inclusion in
this study. The main study outcomes (technical success of endoanchor
implantation, incidence of type Ia endoleak, aortic stent graft
migration and the percentage of patients who presented regression or
expansion of aneurysm sac throughout the follow-up) were subsequently
expressed as proportions and 95% confidence intervals.
Results
Eight studies with a total of 968 patients were included in a pooled
analysis. The technical success of the primary endoanchor fixation was
97.12% (95%CI: 92.98-99.67). During a mean six months follow-up
period, a pooled rate of 6.23% (95%CI: 0.83-15.25) of the patients
developed a persistent type Ia endoleak despite the primary
implantation. Migration of the main graft was reported in five studies,
in which a 0.26% (95%CI = 0.00-1.54) of the patients required an
additional proximal aortic cuff. Regression of the aneurysm sac was
observed at 68.82% (95%CI: 51.02-84.21). An expansion of the aneurysm
sac was found in 1.93% (95%CI: 0.91-3.24) of the participants. The
overall survival rate was 93.43% (95%CI: 89.97-96.29) at a mean six
months follow-up period.
Conclusions
Endosuture aneurysm repair with the Heli-FX EndoAnchor implants seems to
be technically feasible and safe either for prevention or for repair of
intraoperative type Ia endoleak. Despite the primary implants of
endoanchors, few cases of persistent type Ia endoleak and migration are
still conspicuous. Long-term follow up is needed to determinate the role
of this therapeutic option in the treatment of aortic aneurysms
A systematic review and meta-analysis for the management of Paget-Schroetter syndrome
Objective: There is currently no general agreement on the optimal
treatment of Paget-Schroetter syndrome. Most centers have advocated an
interventional approach that is based on the results of small
institutional series. The purpose of our meta-analysis was to focus on
the safety and efficacy of thrombolysis or anticoagulation with
decompression therapy. A detailed description of the epidemiologic,
etiologic, and clinical characteristics, along with radiologic findings
and treatment option details, was also performed.
Methods: The current meta-analysis was conducted using the PRISMA
guidelines. Studies reporting on spontaneous thrombosis or thrombosis
after strenuous activities of axillary-subclavian vein were considered
eligible. Analyses of all retrospective studies were conducted, and
pooled proportions with 95% confidence intervals of outcome rates were
calculated.
Results: Twenty-five studies with 1511 patients were identified. Among
these patients, 1177 (77.9%) had thrombolysis, 658 (43.5%) had
anticoagulation, and 1293 (85.6%) patients had decompression therapy of
the thoracic outlet. Complete thrombus resolution was estimated at
78.11% of the patients after thrombolysis, and the respective pooled
proportion for partial resolution of thrombus was 23.72%. Despite
thrombolytic therapy, 212 patients underwent additional balloon
angioplasty for residual stenosis, although only 36 stents were
implanted. After anticoagulation, a total of 40.70% of the patients had
complete thrombus resolution, whereas partial resolution was occurred in
29.13% of the patients. During follow-up, a total of 51.75% of the
patients with any initial treatment modality had no remaining thrombus,
and 84.87% of these patients were free of symptoms. We also estimated
that 76.88% of the patients had a Disabilities of the Arm, Shoulder and
Hand score of <20, indicating no or mild symptoms after treatment. A
subgroup meta-analysis with 20 studies and 1309 patients, showed
significantly improved vein patency and symptom resolution in patients
who had first rib resection with or without venoplasty, compared with
those who had only thrombolysis.
Conclusions: Although no randomized controlled data are available, our
analysis strongly suggested higher rates of thrombus and symptoms
resolution with thrombolysis, followed by first rib resection. A
prospective randomized trial comparing anticoagulants with thrombolysis
and decompression of thoracic outlet is required
The Role of TOR1A Polymorphisms in Dystonia: A Systematic Review and Meta-Analysis
<div><p>Importance</p><p>A number of genetic loci were found to be associated with dystonia. Quite a few studies have been contacted to examine possible contribution of TOR1A variants to the risk of dystonia, but their results remain conflicting. The aim of the present study was to systematically evaluate the effect of TOR1A gene SNPs on dystonia and its phenotypic subtypes regarding the body distribution.</p><p>Methods</p><p>We performed a systematic review of Pubmed database to identify all available studies that reported genotype frequencies of TOR1A SNPs in dystonia. In total 16 studies were included in the quantitative analysis. Odds ratios (ORs) were calculated in each study to estimate the influence of TOR1A SNPs genotypes on the risk of dystonia. The fixed-effects model and the random effects model, in case of high heterogeneity, for recessive and dominant mode of inheritance as well as the free generalized odds ratio (OR<sub>G</sub>) model were used to calculate both the pooled point estimate in each study and the overall estimates.</p><p>Results</p><p>Rs1182 was found to be associated with focal dystonia in recessive mode of inheritance [Odds Ratio, OR (95% confidence interval, C.I.): 1.83 (1.14–2.93), Pz = 0.01]. In addition, rs1801968 was associated with writer’s cramp in both recessive and dominant modes [OR (95%C.I.): 5.99 (2.08–17.21), Pz = 0.00009] and [2.48 (1.36–4.51), Pz = 0.003) respectively and in model free-approach [OR<sub>G</sub> (95%C.I.): 2.58 (1.45–4.58)].</p><p>Conclusions</p><p>Our meta-analysis revealed a significant implication of rs1182 and rs1801968 TOR1A variants in the development of focal dystonia and writer’s cramp respectively. TOR1A gene variants seem to be implicated in dystonia phenotype.</p></div
Funnel plot assessing evidence of publication bias in overall studies for TOR1A SNPs included in meta-analysis for entire focal dystonia group and focal dystonia subgroups (cervical dystonia, blepharospasm and writer’s cramp), in dominant and recessive modes of inheritance.
<p>SE, standard error; OR, odds ratio.</p