22 research outputs found
Artificial neural network for prediction of in-hospital mortality after open repair of ruptured abdominal aortic aneurysm
Management of internal carotid artery near-occlusion: the need for updated evidence
Near occlusion of internal carotid artery (ICA) is a rare and easily misdiagnosed condition and the decision for revascularisation still remains controversial. We conducted an updated meta-analysis in order to investigate outcomes after carotid endarterectomy (CEA), carotid artery stenting (CAS) or best medical treatment (BMT) in patients with near-occlusion of the ICA. We also aimed to investigate the role of time as a potential moderator of the near-ICA occlusion-stroke rate association. A multiple electronic health database search on articles published up to November 2019 was performed. The pooled stroke rate after CEA, CAS and BMT were calculated. We also investigated transient ischemic attack (TIA), stroke-related death, myocardial infarction (MI), any cause of death and ICA restenosis crude rates (%). A total of 33 articles were finally deemed eligible. The pooled stroke rate was 1.52% [95% confidence interval (CI): 0.09-4.02%] after CEA, 1.80% (95% CI: 0.61-3.40%) after CAS and 8.39% (95% CI: 3.39-14.80%) after BMT. Out of 896 CEA patients, we recorded 22 TIAs (2.5%), 33 all-cause deaths (3.7%), 5 stroke-related deaths (0.6%) and 6 MIs (0.7%). Concerning outcomes after 603 CAS patients, we recorded 7 TIAs (1.2%), 56 all-cause deaths (9.3%), 4 stroke-related deaths (0.7%) and 22 MIs (3.6%). Among 263 patients who were treated with BMT, we found 16 TIAs (6.1%), 10 all-cause deaths (3.8%), no stroke-related death, and no MI. Crude restenosis rate during follow-up was 9.0% (54/601) for CEA and 4.1% (24/592) for CAS patients. No significant effect of publication year upon stroke rate after CEA was recorded. However, there was a significant reversed association between pooled stroke rate after CAS and publication year (P=0.05). A statistically significant reversed association between pooled stroke rate after BMT and publication year was also recorded (P<0.01). The results of this updated meta-analysis revealed high stroke rate for patients with near-occlusion of ICA who treated only with BMT, while intervention seemed to be safe and effective. A downward trend in the stroke rates over time after CAS and BMT was also discovered. These highlight that patients with near-occlusion of ICA should be included and investigated in future studies
Comparison of Two Iliac Branch Devices and Their Midterm Performance in Maintaining Blood Flow to the Internal Iliac Artery
Purpose:To compare and contrast the midterm outcomes of the E-liac and Zenith (ZBIS) iliac branch devices (IBDs) for the preservation of the internal iliac artery (IIA) in aneurysms involving the iliac bifurcation.Materials and Methods:Between January 2014 and December 2018, 84 consecutive patients (median age 74 years; 76 men) were electively treated with the E-liac (n=44) or ZBIS (n=40) IBDs and were retrospectively analyzed to evaluate the technical success, patency, need for reintervention, and mortality associated with these devices.Results:Technical success was achieved in 95 of 99 implantations (95.9%) without any statistically significant difference between the groups (93.7% vs 98.0%, p=0.114). During the first 30 days, 3 occlusions in the ZBIS group and 1 in the E-liac group were identified. There was 1 perioperative death in the ZBIS group. The median follow-up was 37 months for the ZBIS group and 28 months for the E-liac group (p=0.657). Six patients from the ZBIS group and 7 from the E-liac group were lost to follow-up. Among the remaining, there were 2 further deaths recorded, 1 in each group. Four further reinterventions in the E-liac group and 2 in the ZBIS group were performed during follow-up. The Kaplan-Meier estimates of freedom from reintervention were 87.2% (95% CI 82.6% to 90.2%) for the ZBIS group and at 86.0% (95% CI 83.7% to 89.1%) for the E-liac group (p=0.563); the freedom from occlusion estimates were 89.7% (95% CI 85.8% to 94.5%) and 95.3% (95% CI 92% to 98.7%; p=0.317), respectively.Conclusion:The E-liac and the ZBIS IBDs showed equally high technical success, midterm patency, and low reintervention rates
Carotid Artery Stenting-Induced Hemodynamic Instability
Purpose: To present a systematic review and meta-analysis investigating
the incidence of carotid artery stenting (CAS) induced hemodynamic
instability (HI) and to explore differences in periprocedural risk among
patients with and without CAS-associated HI.
Methods: Multiple electronic health databases were searched for all
articles published between January 2000 and December 2011 describing
CAS-associated hemodynamic instability. Twenty-seven studies with a
total of 4204 patients were analyzed, placing emphasis on the HI
incidence and its correlation with postprocedure morbidity and
mortality. A meta-regression analysis was conducted to investigate the
role of potential meaningful modifiers upon HI.
Results: The meta-analysis for overall HI rate showed a pooled
proportion of 39.4%. The pooled estimate for hypotension was 12.1%,
12.2% for bradycardia, and 12.5% for both hypotension and bradycardia.
Persistent HI was found to occur in a pooled rate of 19.2%. No
statistically significant differences were found between patients with
and without HI after CAS with respect to death, stroke, transient
ischemic attack (TIA), or major adverse events. The meta-regression
analysis revealed statistically significant associations of mean age
with HI, of <= 10-mm distance between the carotid bifurcation and the
site of minimum lumen diameter with bradycardia, and of prior
ipsilateral CEA with persistent HI.
Conclusion: CAS-induced HI occurs in a considerable percentage of
patients without increasing the perioperative risk. However, applying
the appropriate prophylactic measures and strictly monitoring blood
pressure and heart rate during the procedure and immediately after
should be encouraged for early recognition and correction of these
hemodynannic disturbances. J Endovasc Ther. 2013;20:48-6
Prevalence of Bovine Aortic Arch Variant in Patients with Aortic Dissection and its Implications in the Outcome of Patients with Acute Type B Aortic Dissection
Objective/Background: To investigate the prevalence of bovine arch (BA) among patients with type A and B aortic dissection, and to provide insight into the implication of this variation on the outcome of patients with acute or subacute type B aortic dissection (a/sTBAD). Methods: This retrospective cohort analysis includes patients with a/sTBAD admitted between January 2006 and December 2016. Computed tomographic angiograms (CTAs) of patients referred because of type A aortic dissection were also re-evaluated with regard to the presence of BA. As a control group, 110 oncological patients who had undergone a chest CTA for disease staging during the study period were enrolled. A total of 154 patients with a/sTBAD and 168 with type A aortic dissection were identified during the study period. Results: An overall prevalence of 17.6% for BA variants was revealed. The comparison between patients with aortic dissection and the control group showed no statistically significant difference in BA prevalence (17.7% vs. 17.3%; p = 1.0). No statistically significant difference in BA prevalence was observed when comparing patients with type A aortic dissection with those with type B aortic dissection (16.6% vs. 18.8%; p = .66). During a median follow-up period of 27.8 months, 30 patients died. The mortality rate among patients presenting a BA variant was 34.5%, whereas among patients without, it was 16.0% (p = .04). Multivariate analysis revealed the presence of a BA as an independent predictor of mortality (adjusted odds ratio 3.4, 95% confidence interval 1.2-9.8). Conclusion: The BA should be considered as a predictor of the outcome for patients with type B aortic dissection. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved
A combined approach of a complex aortoiliac aneurysm with distal landing in internal iliac artery branch
Prevalence of Bovine Aortic Arch Variant and its Implication in Outcome of Patients with Acute Type B Aortic Dissection
The chimney graft technique for preserving visceral vessels during endovascular treatment of aortic pathologies
Objective: Patients with juxtarenal, pararenal, or thoracoabdominal
aneurysms require complex surgical open repair, which is associated with
increased mortality and morbidity. The “chimney graft” or
“snorkel” technique has evolved as a potential alternative to
fenestrated and side-branched endografts. The purpose of this study is
to review all published reports on chimney graft (CG) technique
involving visceral vessels and investigate the safety and efficacy of
the technique.
Methods: Studies were included in the present review if visceral
revascularization during endovascular treatment of aortic pathologies
was achieved via a CG implantation. Reports on the chimney technique for
aortic arch branches revascularization were excluded. A multiple
electronic health database search was performed on all articles
published until April 2011.
Results: The electronic literature search yielded 15 reports that
fulfilled the inclusion criteria. A total of 93 patients (81.3% male;
mean age, 71.9 +/- 0.9 years) were analyzed. In 77.4% of the patients,
the CG procedure was applied for the treatment of abdominal aortic
aneurysms. Out of the 93 patients, 24.7% were operated on in an urgent
setting (symptomatic or ruptured aneurysm). A total of 134 CGs were
implanted: 108 to the renal arteries, 20 to the superior mesenteric
artery, five to the celiac trunk, and one to the inferior mesenteric
artery. In 57 patients, a single CG was deployed; in 32 patients, two
CGs; in three patients, three CGs; and in one patient, four CGs were
deployed. Ninety-four percent of CGs were directed proximally, whereas
6.0% were directed caudally. Primary technical success was achieved in
all patients. A total of 13 patients (14.0%) developed a type I
endoleak. Three were detected and treated intraoperatively.
Postoperatively, 10 type I endoleaks were revealed, four of which
required secondary intervention. During a mean follow-up period of 9.0
+/- 1.0 months, 131 of 134 (97.8%) CGs remained patent. Two CGs to the
renal arteries and one to the superior mesenteric artery occluded.
Postoperatively, 11.8% of patients suffered renal function impairment
and 2.1% a myocardial infarction. Ischemic stroke presented in 3.2% of
patients. The 30-day in-hospital mortality was 4.3%.
Conclusions: The role of the chimney technique in the management of
complex abdominal aortic aneurysms is still unclear. This technique has
relatively good results, considering the anatomic limitations of the
aortic neck. However, long-term endograft durability and proximal
fixation remains a significant concern. Thus, there is a reasonable
hesitation to embrace the method for widespread use in the absence of
long-term data. (J Vasc Surg 2012;55:1497-1503.
Hybrid Open Endovascular Technique for Aortic Thoracoabdominal Pathologies
Background-Many authors using a hybrid debranching strategy for the
treatment of thoracoabdominal pathologies have reported disappointing
results and the initial enthusiasm for the technique has given way to
criticism and ambiguity. The aim of the present meta-analysis study was
to assess the safety and efficacy of the technique in patients with
thoracoabdominal aortic aneurysms or other aortic pathologies.
Methods and Results-A multiple electronic search was performed on all
articles describing hybrid open endovascular repair. Separate
meta-analyses were conducted for technical success, visceral graft
patency, spinal cord ischemia symptoms, renal insufficiency, and other
complications as well as 30-day/in-hospital mortality.
Nineteen publications with a total of 507 patients were analyzed. The
pooled estimates for primary technical success and visceral graft
patency were 96.2% (95% CI, 93.5%-98.2%) and 96.5% (95% CI,
95.2%-97.8%) respectively. A pooled rate of 7.5% (95% CI,
5.0%-11.0%) for overall spinal cord ischemia symptoms was observed;
whereas for irreversible paraplegia the pooled rate was 4.5% (95% CI,
2.5%-7.0%). The pooled estimate for renal failure was 8.8% (95% CI,
3.9%-15.5%). The pooled 30-day/in-hospital mortality rate was 12.8%
(95% CI, 8.6%-17.0%). During the mean follow-up period of 34.5 (95%
CI, 31.5-37.5) months, a total of 119 endoleaks were identified in 111
patients (22.7%).
Conclusions-The repair of thoracoabdominal pathologies by means of
hybrid procedures in patients who are poor surgical candidates is still
associated with significant morbidity and mortality rates. Future
studies may substantiate whether the technique is amenable to
amelioration and improvement. (Circulation. 2011;124:2670-2680.