Hybrid endovascular and surgical approach for mycotic pseudoaneurysms of the extracranial internal carotid artery

Objectives: Mycotic pseudoaneurysms of the extracranial internal carotid artery are rare, and their management often represents a challenge, but treatment is necessary due to the high risk of rupture and distal brain embolization. Systemic antibiotics associated with open surgical excision of the infected tissues and carotid reconstruction using autologous grafts are the treatment of choice. The use of endovascular techniques still remains controversial in infective fields; however, it can be an attractive alternative in high-risk patients or more often as a \u201ctemporary\u201d solution to achieve immediate bleeding control for a safe surgical reconstruction. Methods: We discuss the unusual case of an extracranial right internal carotid artery mycotic pseudoaneurysm following methicillin-resistant Staphylococcus aureus infection, in a patient with poor general conditions. Results and Conclusion: The lesion was successfully treated using a hybrid endovascular and surgical procedure

Intestinal and colonic ischaemia in the surgery of subdiaphragmatic aorta

Ischemic colitis resulting in colonic infarction after aortic ream smut ion is a highly lethal corn plication. The etiology and pathogenesis of this condition demonstrate that in many instances it may he prevented. Early recognition, particularly of the transmural ischemic injury, is essential. Numerous techniques used during surgery for assessing the adequacy of colonic perfusion have been evaluated and found to he inaccurate in terms of predicting colonic ischemia. The purpose of this study is to assess the mains monitoring technique for prediction of ischemic colitis during aortic surgery as: colonic mescnterit Doppler signals, inferior mesenteric arteries stump pressure sigmouiil intramiuosal pH and measumnent of mucosal capillary haemoglobin oxy gen saturation by reflectance spectrophotometry A 15-year experience with 1912 patio its undergoing abdominal aortic reconstruction was reviewed to determinated both the incidence of intestinal ischemia and the Clinical anatomic, and technical factors associated with this complication of aortic surgery. Copyrigh

Realtà virtuale e stenting carotideo

Un libro medico scientifico che descrive e rappresenta casi clinici relativi alla patologia cardiovascolare

Il destino dell'ottuagenario operato di aneurisma dell'aorta addominale: Studio retrospettivo = The ­fate of octo­ge­nar­ian ­patients after abdom­i­nal aor­tic aneu­rysm: a ret­ro­spec­tive ­study

Background and aims. Owing to the increased mean life expectancy of the population, there is a rise in the diagnostic incidence of aneurysmatic pathology in ultra-octogenarian patients. Methods. The authors collected data relating to tile incidence of aneurysmatic pathology in ultra-octogenarian patients over a 10-year period in order to evaluate whether the surgical correction of the lesion significantly altered life expectancy compared to the mean level for the over-80-year-old population (5 years). Out of a total of 1298 patients undergoing endoaneurysmectomy, 26% were >80 years old (71 patients), and of these, 56 patients (22%) were operated electively and 15 (4%) underwent emergency surgery. Results. The data obtained from this study confirm the fact that, at a distance of 54 months after traditional endoaneurysmatic surgery, over 82% of ultra-octogenarian patients had died. Death was associated either with fatal complications relating to pre-existing risk factors or the evolution of pathologies unrelated to aneurysmatic disease. Conclusions. In conclusion, this study argues in favour of rethinking the tendency to operate on ultra-octogenarian patients: surgery should be reserved for more favourable cases based on the clinical condition of patients or for contingent situations that call for emergency treatment

Middle verus long-term results in EVAR: a ten-year follow-up experience

Aim. Endovascular repair of abdominal aortic aneurysms is a relatively new technique, with few studies about long-term results. Our aim was to find if endovascular aneurysm repair (EVAR)'s complication rates at long-term were higher than at middle-term and to define a minimal period of follow-up to consider a patient as completely recovered. Methods. From 1998 to 2003, 186 patients underwent EVAR in our center. Patients were followed-up at 1, 6, 12 months and every year. Mean follow-up period was 89 months for long-term result (range 61-121 months). We collected data about cardiac and renal complications, thrombosis, surgical conversions, endoleaks, death and death from aortic rupture. All data were analysed using Sigma Stat\ue2 3.0. Results. We observed a significant increase of mortality rate (50.40% vs. 33.70%, P<0.05); we recorded an increase in the incidence of cardiovascular adverse events (5.80% vs. 1.80%), thrombosis of EVG (2.90% vs. 1.90%), type II (3.90% vs. 3.20%) and type III endoleaks (0.89% vs. 0.53%), but there were not any statistical significant differences. Incidence of renal failure and type I endoleak were significant lower than at middle-term. There weren't any type IV endoleaks or surgical conversion after 60 months. At 120 months 24.58% of patients were alive and free from any major adverse events and 96,87% were free from aortic rupture. Conclusion. EVAR had important complications at long-term follow-up, but their rates weren't significantly higher than those of middle-term; the incidence of late aortic rupture was acceptably low. We could not define a period of follow-up after which a patient could be considered as completely recovered

Ischemia intestinale e colite ischemica nella chirurgia dell\u2019aorta sottodiaframmatica

Ischemic colitis resulting in colonic infarction after aortic ream smut ion is a highly lethal corn plication. The etiology and pathogenesis of this condition demonstrate that in many instances it may he prevented. Early recognition, particularly of the transmural ischemic injury, is essential. Numerous techniques used during surgery for assessing the adequacy of colonic perfusion have been evaluated and found to he inaccurate in terms of predicting colonic ischemia. The purpose of this study is to assess the mains monitoring technique for prediction of ischemic colitis during aortic surgery as: colonic mescnterit Doppler signals, inferior mesenteric arteries stump pressure sigmouiil intramiuosal pH and measumnent of mucosal capillary haemoglobin oxy gen saturation by reflectance spectrophotometry A 15-year experience with 1912 patio its undergoing abdominal aortic reconstruction was reviewed to determinated both the incidence of intestinal ischemia and the Clinical anatomic, and technical factors associated with this complication of aortic surgery. Copyrigh

Il trattamento convenzionale e con tecnica chirurgica endovascolare degli aneurismi della arteria iliaca= Conventional and endovascular surgical treatment of iliac artery aneurysms

Background. The paper reports a retrospective study designed to assess the feasibility of an endovascular approach as an adjunct to conventional surgical treatment of iliac aneurysms. Methods. In response to the life-threatening tendency to rupture of iliac aneurysms over 3-3.5 cm in diameter, 58 patients were given traditional surgery in 1979-96 and later (1997 - June 1999) in a second group of 16 patients, half (8) were given conventional and 8 endovascular surgical treatment. Results. Of the total number of 66 conventionally treated patients, no significant differences in surgical technique or results and no hospital deaths were identified. Complications included two occlusions of the treated area which were resolved by thrombectomy, two delayed revascularisations and one case of lymphorrhea from the inguinal incision. Of the 8 patients given endovascular surgery, a keyhole approach was employed in 5 cases and the femoral artery had to be exposed in two other cases: one that demanded simultaneous revascularisation of the peripheral circulation and the other involving the use of a particularly wide endovascular device. A nitinol-covered stent was used on all these patients and follow-up varied from 6 to 24 months. In 7 cases the exclusion of the aneurysm was instantaneous. In the one case of endoleak caused by reflux from the hypogastric artery, a CT scan four months later revealed spontaneous thrombisation of the aneurysmatic sac that had eliminated the leakage. In the one patient requiring isolation of the hypogastric artery, gluteal claudication developed but regressed spontaneously over a 3-month period. There were no postoperative complications of any kind. Conclusions. It was therefore concluded that while conventional surgery remains the treatment of choice for iliac aneurysms, the endovascular approach is a valid alternative in the right clinical and morphological conditions