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Severe Focal Stenosis of the Abdominal Aorta with High Risk of Occlusion. JOURNAL OF INTERDISCIPLINARY MEDICINE 2022. [DOI: 10.2478/jim-2021-0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Whitbeck MG. Treatment of focal distal abdominal aortic stenosis with the GORE VIABAHN VBX balloon expandable covered stent. Catheter Cardiovasc Interv 2019; 95:457-461. [PMID: 31478298 DOI: 10.1002/ccd.28478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/03/2019] [Accepted: 08/20/2019] [Indexed: 11/07/2022]
Abstract
The incidence of focal infrarenal stenosis of the aorta is rare. Endovascular therapy has evolved as a first-line treatment of aortoiliac occlusive disease and has been shown to substantially improve health-related quality of life. The 8 French sheath compatible, GORE VIABAHN VBX (GORE Flagstaff, AZ) balloon expandable covered stent offers the traditional benefits of a balloon expandable covered stent with a design that improves on flexibility. We report three cases with the use of this system for treatment of infrarenal stenosis of the aorta.
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Tatiana B, Peter K, Peter K, Anneliese B, Tina C. Aortic Stenting in Symptomatic Infrarenal Aortic Stenosis and Subtotal Aortic Occlusion. Vasc Endovascular Surg 2019; 53:303-309. [DOI: 10.1177/1538574419830825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The aim of this study was to evaluate the long-term results of aortic stent placement in patients with infrarenal aortic occlusive disease. Methods: Between April 1996 and May 2014, 34 patients with symptomatic infrarenal atherosclerotic aortic stenosis or subtotal aortic occlusion underwent percutaneous angioplasty with primary aortic stent implantation. There were 21 patients with Fontaine stage of the peripheral arterial disease (PAD) II, 5 patients with stage III, and 8 patients with stage IV. One patient withdrew informed consent and was excluded from further analysis. Results: Patients (n = 34, mean age: 62 ± 12 years) were followed for a mean period of 81 months. There were 2 procedure-related access-related complications. Six patients died during follow-up from non-procedure-related causes. Eight patients had late recurrence of symptoms during follow-up. Only in 2 cases, symptomatic recurrences were due to aortic in-stent stenosis (77 and 132 months after the primary stent implantation). Additionally, these 2 patients required therapy for PAD progression distal to the aorta. Five patients required further surgical or endovascular reconstruction for PAD progression distal to the aorta. In another case, clinical treatment failure was due to the progression of atherosclerotic lesion in the perirenal, nonstented part of the abdominal aorta. The mean estimated primary patency rate was 185.6 months (95% confidence interval: 161.3-209.8). Conclusion: Endovascular stent implantation is a safe and long-term effective strategy for the treatment of infrarenal aortic occlusive disease. In our study, the recurrence of symptoms was observed mainly due to atherosclerosis progression by multilevel disease with associated infrainguinal occlusive lesions but not to aortic in-stent restenosis. The prognostic advantage for this relatively young cohort of patients can be the possibility to repeat a percutaneous procedure with less technical difficulties when compared to surgical revision.
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Affiliation(s)
- Belyavskaya Tatiana
- Department of Vascular Surgery, University Hospital Graz, Medical University Graz, Graz, Austria
- Department of Vascular Surgery, Brandenburg State Hospital, Brandenburg an der Havel, Germany
| | - Kalmar Peter
- Division of Neuroradiology, Vascular and Interventional Radiology, University Hospital of Graz, Medical University Graz, Graz, Austria
| | - Konstantiniuk Peter
- Department of Vascular Surgery, University Hospital Graz, Medical University Graz, Graz, Austria
| | - Baumann Anneliese
- Department of Vascular Surgery, University Hospital Graz, Medical University Graz, Graz, Austria
| | - Cohnert Tina
- Department of Vascular Surgery, University Hospital Graz, Medical University Graz, Graz, Austria
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Mesenchymal Stem Cell Therapy for Ischemic Tissues. Stem Cells Int 2018; 2018:8179075. [PMID: 30402112 PMCID: PMC6196793 DOI: 10.1155/2018/8179075] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 12/13/2022] Open
Abstract
Ischemic diseases such as myocardial infarction, ischemic stroke, and critical limb ischemia are immense public health challenges. Current pharmacotherapy and surgical approaches are insufficient to completely heal ischemic diseases and are associated with a considerable risk of adverse effects. Alternatively, human mesenchymal stem cells (hMSCs) have been shown to exhibit immunomodulation, angiogenesis, and paracrine secretion of bioactive factors that can attenuate inflammation and promote tissue regeneration, making them a promising cell source for ischemic disease therapy. This review summarizes the pathogenesis of ischemic diseases, discusses the potential therapeutic effects and mechanisms of hMSCs for these diseases, and provides an overview of challenges of using hMSCs clinically for treating ischemic diseases.
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Monastiriotis S, Loh S, Tassiopoulos A, Labropoulos N. Clinical characteristics and outcome of isolated infrarenal aortic stenosis in young patients. J Vasc Surg 2018; 67:1143-1149. [DOI: 10.1016/j.jvs.2017.07.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/28/2017] [Indexed: 10/18/2022]
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Müller AM, Langwieser N, Bradaric C, Haller B, Fusaro M, Ott I, von Beckerath N, Kastrati A, Laugwitz KL, Ibrahim T. Endovascular Treatment for Steno-Occlusive Iliac Artery Disease: Safety and Long-Term Outcome. Angiology 2017; 69:308-315. [DOI: 10.1177/0003319717720052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We evaluated safety and long-term outcome of endovascular therapy for steno-occlusive iliac artery disease. All endovascular procedures of iliac artery lesions performed at our institution between 2001 and 2014 (n = 676) were retrospectively analyzed. The overall technical success rate was 99% and yielded 100% for stenoses (n = 596) and 95% for chronic total occlusions (n = 80). Lesion complexity defined by the Trans-Atlantic Inter-Society Consensus (TASC) II classification had no impact on success rates (TASC A + B vs C + D; 99.5% vs 98.6%, P = .359). During a median follow-up of 11 months, the overall rate of restenosis was 9.4%. After 1 and 3 years, the primary patency rates were 94% and 86% and the secondary patency rate was 100%, respectively. The TASC II classification had no impact on long-term patency rates (TASC A + B vs C + D; 86% vs 81%). In a multivariable analysis, stent diameter remained the only significant predictor for restenosis (hazard ratio: 0.58; 95% confidence interval: 0.41%-0.81%; P = .002). In this single-center retrospective study, endovascular therapy for steno-occlusive iliac artery disease was associated with high technical and clinical success rates as well as an excellent long-term patency rate irrespective of lesion complexity.
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Affiliation(s)
- Arne M. Müller
- Klinikum Rechts der Isar, I. Medizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
| | - Nicolas Langwieser
- Klinikum Rechts der Isar, I. Medizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
| | - Christian Bradaric
- Klinikum Rechts der Isar, I. Medizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institut für Medizinische Statistik und Epidemiologie, Technische Universität München, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Ilka Ott
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
| | - Nicolas von Beckerath
- Allgemeines Krankenhaus Viersen, Abteilung Kardiologie und Angiologie, Viersen, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Abteilung für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Klinikum Rechts der Isar, I. Medizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Tareq Ibrahim
- Klinikum Rechts der Isar, I. Medizinische Klinik und Poliklinik, Technische Universität München, Munich, Germany
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Juo YY, Ramirez LR, Ruben G. Innominate Artery Stenosis Presenting With Migratory Digital Ischemia. Vasc Endovascular Surg 2016; 50:411-4. [DOI: 10.1177/1538574416655892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Atherosclerotic lesions of the supra-aortic trunk vessels, including the innominate artery, subclavian artery, or the common carotid artery, tend to present either as low-flow state distal to the lesion or as embolic events. The risk of embolic cerebrovascular event complicates the management of this condition via a pure endovascular approach. A combined operative–endovascular intervention may be a valuable approach in order to reduce the risk of intraoperative stroke and prevent future embolic events. Case Presentation: An 84-year-old female presented at the emergency department (ED) with a 4-month history of migratory digital cyanotic lesions across various fingers on her right hand. The lesion eventually progressed into dry gangrene on her right middle finger. Selective angiography of the aortic arch vessels demonstrated significant atherosclerotic plaque burden throughout her supra-aortic vessels and a segmental stenosis at the proximal innominate artery. A right carotid cut down was performed to allow clamping of the carotid artery so as to minimize the risk of intraoperative stroke from plaque manipulation. Retrograde balloon angioplasty was performed, and stent was placed across the stenotic segment. The patient tolerated the procedure well and had an uneventful postoperative course. She was discharged on postoperative day 3. At 2-week follow-up, she has had no progression of her digital ischemia nor other focal cranial nerve deficits. Conclusion: Migratory digital ischemia is a rare presentation of atherosclerotic disease of the supra-aortic vessels. It represents a challenging situation for endovascular intervention due to concern about plaque dislodgment during the procedure. A retrograde balloon-stent angioplasty following distal carotid control with an open approach may be safe and effective in selected patients.
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Affiliation(s)
- Yen-Yi Juo
- Department of Surgery, George Washington University Medical Center, Washington, DC, USA
| | - Lisbi Rivas Ramirez
- Department of Surgery, George Washington University Medical Center, Washington, DC, USA
| | - Garry Ruben
- Department of Surgery, George Washington University Medical Center, Washington, DC, USA
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Bujak M, Gamberdella J, Mena C. Management of Atherosclerotic Aortoiliac Occlusive Disease. Interv Cardiol Clin 2014; 3:531-543. [PMID: 28582078 DOI: 10.1016/j.iccl.2014.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Development of aortoiliac occlusive disease (AIOD) is associated with classic risk factors for atherosclerotic disease such as hyperlipidemia, hypertension, diabetes, or smoking. Risk factor modification, smoking cessation, and prevention of cardiovascular events remain the cornerstones of AIOD management. Symptom improvement and limb loss prevention are considered secondary goals of therapy. Continuous technological advances, new devices, as well as new revascularization techniques are constantly changing the landscape of AIOD management. Surgical interventions, which were considered a gold standard therapy for nearly 50 years, currently give way to newer and less invasive endovascular techniques.
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Affiliation(s)
- Marcin Bujak
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, DANA3 Cardiology, New Haven, CT 06510, USA
| | - Jacqueline Gamberdella
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, DANA3 Cardiology, New Haven, CT 06510, USA
| | - Carlos Mena
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, DANA3 Cardiology, New Haven, CT 06510, USA.
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Mujtaba M, Chhabra L, Abdulbaki AM, Sadiq I. Balloon angioplasty with secondary stenting for chronically occluded abdominal aorta in a high-risk patient. BMJ Case Rep 2014; 2014:bcr-2014-204959. [PMID: 25056303 DOI: 10.1136/bcr-2014-204959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mohmmadtokir Mujtaba
- Department of Cardiology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut, USA
| | - Lovely Chhabra
- Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut, USA
| | | | - Immad Sadiq
- Department of Cardiology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut, USA
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Sixt S, Krankenberg H, Möhrle C, Kaspar M, Tübler T, Rastan A, Brechtel K, Macharzina R, Neumann FJ, Zeller T. Endovascular treatment for extensive aortoiliac artery reconstruction: a single-center experience based on 1712 interventions. J Endovasc Ther 2013; 20:64-73. [PMID: 23391085 DOI: 10.1583/12-4014.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the clinical and technical outcomes following endovascular therapy for aortoiliac occlusive disease, including complex reconstruction of the aortic bifurcation. METHODS A retrospective database search identified 1184 consecutive patients (864 men; mean age 64±10 years) who underwent 1712 procedures to treat target lesions in the distal aorta and iliac arteries from September 1996 to December 2006. The intended strategy was to open only one femoral access site primarily, so a second puncture was needed only for the kissing balloon technique at the aortic bifurcation. The primary endpoint was a 1-year duplex-based primary patency; secondary endpoints included acute technical success (residual stenosis <30%), secondary patency, and target lesion revascularization (TLR). Results were stratified by lesion morphology, which was classified according to the TransAtlantic Inter-Society Consensus (TASC II) document. RESULTS Most of the interventions were done in the iliac arteries (n=1337); 292 cases involved the aortic bifurcation, and 83 cases were in the distal aorta/aortic bifurcation. The mean follow-up was 3.24 years (range 0-12.7). In the entire study cohort, the 12- and 24-month restenosis, TLR, and primary/secondary patency rates did not differ among TASC II A-D subgroups. The symptom-driven TLR in the entire cohort was 8% and 9% at the 12- and 24-month follow-up, leading to secondary patency rates of 96% and 91% in the entire cohort. Outcomes for complex interventions in the distal aorta or aortic bifurcation did not differ significantly compared to the total cohort. The overall survival without restenosis, amputation, or surgery in TASC II subgroups A+B was higher (69.6%±1.5%) compared to TASC II C+D lesions (62.8%±1.9%, p=0.001). CONCLUSION The indication for percutaneous intervention in aortoiliac occlusive disease can be extended to complex TASC C and D lesions in experienced endovascular centers, even if complex reconstruction of the distal aorta or the aortic bifurcation is indicated.
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Affiliation(s)
- Sebastian Sixt
- Department of Angiology, Heart Center Bad Krozingen, Germany.
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Moszura T, Goreczny S, Dryzek P, Niwald M. Three-year-old child with middle aortic syndrome treated by endovascular stent implantation. Pediatr Cardiol 2013; 34:1027-30. [PMID: 22638999 DOI: 10.1007/s00246-012-0354-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 04/27/2012] [Indexed: 11/28/2022]
Abstract
Middle aortic syndrome (MAS) is an extremely rare anomaly and represents both a diagnostic and therapeutic challenge, particularly in young children. A case of a 3.5 year-old child with MAS and arterial hypertension is reported, where owing to the patient's young age and the length of the hypoplastic aortic segment, surgical correction with end-to-end anastomosis was not feasible. Instead of palliative bypass grafting between the thoracic and abdominal aorta, successful percutaneous balloon angioplasty and stenting of the lesion was performed with the assistance of three-dimensional rotational angiography.
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Affiliation(s)
- Tomasz Moszura
- Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, 93347, Lodz, Poland
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Tapping CR, Ahmed M, Scott PM, Lakshminarayan R, Robinson GJ, Ettles DF, Shrivastava V. Primary infrarenal aortic stenting with or without iliac stenting for isolated and aortoiliac stenoses: single-centre experience with long-term follow-up. Cardiovasc Intervent Radiol 2012; 36:62-8. [PMID: 22456847 DOI: 10.1007/s00270-012-0372-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the technical success, complications, long-term clinical outcome, and patency after primary infrarenal aortic stenting for aortic and aortoiliac stenosis. Between January 1999 and January 2006, 22 consecutive patients underwent endovascular treatment because of infrarenal aortic stenosis with and without common iliac stenosis (10 men; mean age 64 ± 14 years). Eleven (11 of 22) patients had an isolated aortic stenosis, whereas 11 of 22 had aortic stenosis that extended into the common iliac arteries (CIAs). Thirteen patients were Rutherford classification type 3, and 9 patients were type 4. Statistical analysis included paired Student t test and Kaplan-Meier life table analysis; p < 0.05 was considered significant. Technical and initial clinical success was achieved in all patients. There were three (14 %) procedure-related complications, which included two access-point pseudoaneurysms and one non-flow-limiting left external iliac dissection. Patients were followed-up for a mean period of 88 months (range 60-132). Mean preprocedure ankle brachial pressure indexes (ABPI) were 0.60 ± -0.15 (right) and 0.61 ± -0.16 (left). After the procedure they were 0.86 ± -0.07 (right) and 0.90 ± -0.09 (left). The increase in ABPI was significant (p < 0.05), and this continued throughout follow-up. Four (18 %) patients had recurrence of symptoms during follow-up. These occurred at 36, 48, 48, and 50 months after the original procedure. All four patients were successfully treated with repeat angioplasty procedures. There was a significant difference in primary patency between isolated aortic stenosis (100 %) and aortoiliac stenosis (60 %) (p = 0.031). Cumulative follow-up was 1920 months yielding a reintervention rate of 0.025/events/year. CONCLUSION Primary stenting of infrarenal stenosis is safe and successful with a low reintervention rate. It should be considered as first-line treatment for patients with infrarenal aortic stenotic disease.
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Affiliation(s)
- C R Tapping
- Department of Radiology, Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Road, Hull, HU3 2JZ, UK
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Puech-Leão P, Wolosker N, Zerati AE, Nascimento LD. Impact of endovascular technique in vascular surgery training at a large university hospital in Brazil. JOURNAL OF SURGICAL EDUCATION 2011; 68:19-23. [PMID: 21292210 DOI: 10.1016/j.jsurg.2010.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 07/11/2010] [Accepted: 08/24/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The aim of this study was to determine the impact of endovascular surgery versus open vascular technique training in a Brazilian teaching service. DESIGN Cross-sectional study. SETTING Hospital das Clinicas-Faculty of Medicine-University of Sao Paulo, a tertiary institutional hospital-Brazil. PARTICIPANTS We reviewed 1,040 arterial operations performed during 2 distinct time periods: January 1995 to December 1996, and January 2006 to December 2007. Based on the disease treated, the procedures were classified into the following 5 groups: abdominal aortic aneurysms (AAA), aorto-iliac obstructive disease (AI), obstructive disease of the femoropopliteal-tibial segment (FP), carotid disease (C), and others (O). The operations were also divided into an endovascular surgery (ES) group and an open surgery (OS) group. We compared the number of open and endovascular procedures for each arterial disease group during both periods. RESULTS During the 2006-2007 period, 654 patients were treated surgically, whereas over the 1995-1996 period, 386 arterial operations were performed. A significant increase in endovascular procedures (p < 0.001) was found from the 1995-1996 period to the 2006-2007 period (35 vs 351, respectively) in all groups, whereas open surgery showed a slight increase in the number of procedures in the AAA and O groups only. In the 1995-1996 period, OS was the primary surgical method for all groups, but in the 2006-2007 time frame, OS was performed more frequently than ES only in the AAA and O groups. Considering all vascular disease groups, OS was the technique used in 90.9% (351 of 386) of the operations during 1995-1996, whereas in 2006-2007, OS was performed in only 46.3% (303 of 654) of the procedures. CONCLUSIONS The increase in the number of ES observed over the past decade has had little impact on OS procedures performed at our medical center, not bringing harm to open surgical training.
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Affiliation(s)
- Pedro Puech-Leão
- Division of Vascular and Endovascular Surgery, University of Sao Paulo, Sao Paulo, Brazil
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Alhan C, Karabulut H, Senay S, Cagil H, Toraman F. Endovascular treatment of occlusive abdominal aortic thrombosis. Heart Vessels 2010; 25:70-2. [PMID: 20091402 DOI: 10.1007/s00380-009-1169-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 04/08/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Cem Alhan
- Department of Cardiovascular Surgery, School of Medicine, Acibadem University, Acibadem Kadikoy Hospital, Ozlem Sitesi B Blok D: 25, Kosuyolu-Uskudar, 81100 Istanbul, Turkey
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Beard JD. Which is the best revascularization for critical limb ischemia: Endovascular or open surgery? J Vasc Surg 2008; 48:11S-16S. [DOI: 10.1016/j.jvs.2008.08.036] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 08/06/2008] [Accepted: 08/12/2008] [Indexed: 11/25/2022]
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Hara M, Nishino M. Impact of intravascular ultrasound for the treatment of calcified infrarenal aortic stenosis: a case report study. Catheter Cardiovasc Interv 2008; 72:867-70. [PMID: 19006256 DOI: 10.1002/ccd.21691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We report two cases of heavily calcified infrarenal aortic stenosis that were successfully treated by intravascular ultrasound- (IVUS)-guided stenting. Two middle-aged women visited our hospital due to intermittent claudication. Diagnostic arteriography revealed possible infrarenal aortic stenosis even though the findings were equivocal. IVUS demonstrated heavily calcified atherosclerotic lesions and allowed the accurate assessment of the types and extents of the lesions to be treated in both cases. The patients successfully underwent stent implantation according to the findings of IVUS. IVUS significantly contributed to the interventional successes.
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Affiliation(s)
- Masahiko Hara
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan.
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Schaefer PJ, Mueller-Huelsbeck S, Lukas R, Schaefer FK, Huemme TH, Heller M, Jahnke T. Low-profile primary stent placement for the treatment of focal calcified ulcerated stenosis in the infrarenal aorta. J Vasc Interv Radiol 2008; 19:182-8. [PMID: 18341946 DOI: 10.1016/j.jvir.2007.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 09/01/2007] [Accepted: 09/09/2007] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To analyze the immediate and midterm success of low-profile stent placement in calcified ulcerated lesions of the infrarenal aorta in patients with arterial occlusive disease. MATERIALS AND METHODS In this prospective case series, 13 symptomatic patients (eight men, five women; mean age, 64.8 years +/- 12.1; age range, 44-84 years) with focal calcified ulcerated stenoses of the infrarenal aorta were treated with stent placement by using a low-profile technique in a radiology intervention center during a 4-year period. Clinical examinations and duplex ultrasonography were used to evaluate the stents? patency and clinical success. Kaplan-Meier graphs were calculated to analyze the freedom-of-symptom rate. RESULTS The initial technical success rate was 92% (12 of 13 patients). Due to extended calcifications, a residual stenosis of 50%-60% remained in one patient. No peri-interventional complications occurred. The mean follow-up was 26 months (range, 5-53 months). During follow-up, one patient had a restenosis after 7 months and presented clinically with Fontaine stage IIb. Two patients had iliac and/or femoral stenoses, and both presented with Fontaine stage IIb. One patient's symptoms originated from the lumbar spine. Primary patency and primary clinical success rates were 85% and 69%, respectively. According to Kaplan-Meier tables, the freedom-from-symptom rates were 92%, 84%, 73%, and 63% at 0, 7, 12, and 21 months, respectively. CONCLUSIONS Low-profile stent placement in calcified, ulcerated lesions of the infrarenal aorta is an effective and safe treatment for symptomatic stenoses in patients with arterial occlusive disease after a mean follow-up of 26 months.
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Affiliation(s)
- Philipp J Schaefer
- Department of Diagnostic Radiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Strasse 9, 24105 Kiel, Germany.
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Primary stenting for aortic lesions: From single stenoses to total aortoiliac occlusions. J Vasc Surg 2008; 47:310-7. [DOI: 10.1016/j.jvs.2007.10.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 10/09/2007] [Accepted: 10/11/2007] [Indexed: 11/24/2022]
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Vega-de Céniga M, Estallo-Laliena L, Barba-Vélez A. Tratamiento combinado de enfermedad aórtica femoral con ateroembolismo distal: a propósito de un caso. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)02008-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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