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Will JA, Bindi JM, Crawford JL, West CA, Deitch JS. Chronic abdominal aortic occlusion in a patient with an underdeveloped, irradiated pelvis after childhood treatment of Ewing Sarcoma. J Vasc Surg Cases Innov Tech 2024; 10:101380. [PMID: 38226318 PMCID: PMC10788263 DOI: 10.1016/j.jvscit.2023.101380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/07/2023] [Indexed: 01/17/2024] Open
Abstract
Chronic radiation-induced arterial injury is generally predictable by known tumor types and anatomic location. We present the first case of radiation-induced chronic aortic occlusion associated with a small pelvis secondary to the treatment of childhood Ewing sarcoma. The patient presented with profound claudication and accelerated atherosclerosis obliterans of the aortoiliac system and failed endovascular treatment. Successful aortic reconstruction was performed. This case highlights the long-term effects of chemoradiation to the aortoiliac segment and pelvic bones in a child, and the technical challenges of vascular reconstruction in an underdeveloped irradiated pelvis.
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Affiliation(s)
- Jack A. Will
- Division of Vascular Surgery, TCU Burnett School of Medicine, Texas Health Harris Methodist Hospital, Fort Worth, TX
| | - Jonathan M. Bindi
- Division of Vascular Surgery, TCU Burnett School of Medicine, Texas Health Harris Methodist Hospital, Fort Worth, TX
| | - John L. Crawford
- Division of Vascular Surgery, TCU Burnett School of Medicine, Texas Health Harris Methodist Hospital, Fort Worth, TX
| | - Charles A. West
- Division of Vascular Surgery, TCU Burnett School of Medicine, Texas Health Harris Methodist Hospital, Fort Worth, TX
- Department of Surgery, Texas Health Harris Methodist Hospital, Fort Worth, TX
| | - Johnathan S. Deitch
- Division of Vascular Surgery, TCU Burnett School of Medicine, Texas Health Harris Methodist Hospital, Fort Worth, TX
- Department of Surgery, Texas Health Harris Methodist Hospital, Fort Worth, TX
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Tzirakis K, Kamarianakis Y, Kontopodis N, Ioannou CV. Selection of Bifurcated Grafts' Dimensions during Aorto-Iliac Vascular Reconstruction Based on Their Hemodynamic Performance. Bioengineering (Basel) 2023; 10:776. [PMID: 37508803 PMCID: PMC10376214 DOI: 10.3390/bioengineering10070776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023] Open
Abstract
During the vascular surgical reconstruction of aorto-iliac occlusive/aneurysmal disease, bifurcated grafts are used where vascular surgeons intra-operatively select the size and the relative lengths of the parent and daughter portions of the graft. Currently, clinical practice regarding the selection of the most favorable geometric configuration of the graft is an understudied research subject: decisions are solely based on the clinical experience of the operating surgeon. This manuscript aims to evaluate the hemodynamic performance of various diameters, D, of bifurcated aortic grafts and relate those with proximal/distal part length ratios (the angle φ between the limbs is used as a surrogate marker of the main body-to-limb length ratio) in order to provide insights regarding the effects of different geometries on the hemodynamic environment. To this end, a computationally intensive set of simulations is conducted, and the resulting data are analyzed with modern statistical regression tools. A negative curvilinear relationship of TAWSS with both φ and D is recorded. It is shown that the angle between limbs is a more important predictor for the variability of TAWSS, while the graft's diameter is an important determinant for the variability of OSI. Large percentages of the total graft area with TAWSS < 0.4 Pa, which correspond to thrombogenic stimulating environments, are only observed for large values of φ and D > 20 mm. This variable ranges from 10% (for the smallest values of φ and D) to 55% (for the largest φ and D values). Our findings suggest that grafts with the smallest possible angle between the limbs (i.e., smallest parent-to-daughter length ratio) present the most favorable hemodynamic performance, yielding the smallest percentage of total graft area under thrombogenic simulating environments. Similarly, grafts with the smallest acceptable diameter should be preferred for the same reason. Especially, grafts with diameters greater than 20 mm should be avoided, given the abrupt increase in estimated thrombogenic areas.
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Affiliation(s)
- Konstantinos Tzirakis
- Department of Mechanical Engineering, Hellenic Mediterranean University, 71410 Heraklion, Crete, Greece
| | - Yiannis Kamarianakis
- Data Science Group, Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, 70013 Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Department, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Department, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
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3
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Hentgen B, Davaine J, Jayet J, Verscheure D, Couture T, Koskas F. Extra anatomic aorto-iliac revascularization using descending thoracic aorta to bifemoral bypass in selected cases. Ann Vasc Surg 2022; 86:210-218. [DOI: 10.1016/j.avsg.2022.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 12/24/2022]
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Osipova OS, Starodubtsev VB, Bugurov SV, Gostev AA, Saaia SB, Cheban AV, Karpenko AA. [Graft-renal bypass surgery during intraoperative dissection of renal artery in a patient with high occlusion of the aorta]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:152-158. [PMID: 34166356 DOI: 10.33529/angio2021216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Despite advances in the development of endovascular techniques of revascularization of renal arteries, in certain clinical cases still remains the need to perform extra-anatomic renal bypass grafting. To such instances belong complicated atherosclerotic aortic lesions, technical difficulties occurring during open revascularization of the aorta and its branches, as well as aneurysms of the juxtarenal portion of the abdominal aorta. Presented herein is a clinical case concerning a patient subjected to non-standard restoration of blood flow in the right renal artery after thromboendarterectomy from the juxtarenal aorta, performed from the left-sided extraperitoneal phrenolumbotomic approach and complicated by secondary dissection of the intima in the right renal artery.
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Affiliation(s)
- O S Osipova
- Department of Vascular Pathology and Hybrid Surgery, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - V B Starodubtsev
- Department of Vascular Pathology and Hybrid Surgery, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - S V Bugurov
- Department of Vascular Pathology and Hybrid Surgery, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - A A Gostev
- Department of Vascular Pathology and Hybrid Surgery, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - Sh B Saaia
- Department of Vascular Pathology and Hybrid Surgery, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - A V Cheban
- Department of Vascular Pathology and Hybrid Surgery, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - A A Karpenko
- Department of Vascular Pathology and Hybrid Surgery, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
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Kato T, Zen K, Kawarada O, Hozawa K, Anzai H, Nakamura H, Funatsu A, Kawasaki D, Tsubakimoto Y, Higashimori A, Kozuki A, Matoba S. Clinical outcomes of endovascular treatment for chronic aortic occlusion: a retrospective multicentre registry: EVT for chronic aortic occlusion. ASIAINTERVENTION 2019; 5:121-127. [PMID: 34912975 DOI: 10.4244/aij-d-18-00050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 04/11/2019] [Indexed: 12/12/2022]
Abstract
AIMS The aim of this study was to evaluate the clinical outcomes of endovascular treatment (EVT) for chronic aortic occlusion (CAO) using multicentre registry data. METHODS AND RESULTS From April 2003 to December 2015, data on 73 consecutive patients (55 men and 18 women; aged 70.7±12.2 years) who underwent EVT for CAO were collected retrospectively from 15 centres in Japan. The primary endpoint was the primary patency at 12 months after EVT. Secondary endpoints were procedural success and periprocedural complication rates. We analysed 67 patients who underwent complete endovascular revascularisation after 2007. Initial procedural success was achieved in 63 cases (94.0%). Complications occurred in three patients (4.5%) (stroke, n=1; distal embolism, n=1; access-site haematoma requiring blood transfusion, n=1). In patients after successful EVT (n=63), the primary and secondary patency rates at 12 months were 90.7% and 97.7%, respectively. During a mean follow-up period of 17.8 months, restenosis/re-occlusion was observed in eight patients (12.7%). CONCLUSIONS EVT for CAO could be performed safely with a high procedural success rate. The short-term clinical outcome was acceptable despite lesion complexity.
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Affiliation(s)
- Taku Kato
- Department of Cardiology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osami Kawarada
- Department of Cardiovascular Medicine, Ikuwakai Memorial Hospital, Osaka, Japan
| | - Koji Hozawa
- Department of Cardiology, Interventional Cardiology Unit, New Tokyo Hospital, Matsudo, Japan
| | - Hitoshi Anzai
- Department of Cardiology, Ota Memorial Hospital, Ota, Japan
| | - Hiroaki Nakamura
- Department of Cardiology, Kakogawa Central City Hospital, Kakogawa, Japan
| | | | - Daizo Kawasaki
- Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital, Osaka, Japan
| | | | | | - Amane Kozuki
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Bath J, Rahimi M, Leite JO, Pierre-Louis W, Giglia JS. Laparoscopic aortobifemoral bypass in a USA academic center. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 61:332-339. [PMID: 30417632 DOI: 10.23736/s0021-9509.18.10582-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although aortoiliac occlusive disease (AIOD) is preferentially treated endovascularly, some patients are still better served with an aortobifemoral bypass (ABF). For those patients, surgical treatment options include both standard open operations as well as laparoscopic ABF (LapABF). Several European centers perform LapABF with favorable results instead of open surgery, but this has not been widely embraced in the United States. We reviewed our ten-year experience with LapABF, evolving from a completely laparoscopic to a standardized laparoscopic-assisted approach. METHODS A retrospective review of all laparoscopic aortic operations performed at a single US academic institution from 2005 to 2015 was completed. Demographics, co-morbidities, intraoperative parameters and clinical outcomes were recorded. Patients were excluded from consideration for laparoscopic surgery if they had previous aortic surgery, aneurysmal disease or gastrointestinal pathology (e.g. diverticulitis or an enteric stoma). RESULTS Thirty men and sixteen women were treated, (n=46) with a mean age of 55.7 (range 38-75 years). All operations were performed by a single surgeon. LapABF was successfully completed in 95.6%. A completely laparoscopic approach was undertaken in eight patients and a laparoscopic-assisted approach was used in the remaining 38 patients. Mean follow-up was 46 months (range 1 to 131). The indication for operation was claudication (n=35, 76%), rest pain (n=8, 17%) or tissue loss (n=3, 7%). Twenty-one limbs had a history of a prior failed aortoiliac endovascular intervention (23%). Median length of stay was 6 days (range 2-30). Within 30 days there were two myocardial infarctions (4.3%), one transient ischemic attack (2.2%) and one death (2.2%). Re-intervention was performed in 12 patients over the course of the study period (26.1%). Primary, primary-assisted and secondary patency was 79.4%, 93.9% and 94.9% at 60 months, respectively. Overall mortality was 17% with a mean duration of follow-up of 60 months (range 1-116). Multivariable analysis revealed coronary artery disease (CAD; P=0.03) conferred a sixteen-fold risk for death during long-term follow-up. CONCLUSIONS In this large US series of LapABF, we observed acceptable long-term patency, short length of stay and minimal morbidity. We suggest that this standardized approach for laparoscopic-assisted ABF is a viable option for patients with AIOD not suitable for endovascular therapy. The use of laparoscopic-assisted ABF affords practitioners the benefits of a completely laparoscopic approach while reducing the duration and complexity of the operation. Given the rate of re-interventions in the early era practitioners should be aware of the learning curve with this approach.
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Affiliation(s)
- Jonathan Bath
- Division of Vascular Surgery, Department of Surgery, University of Missouri Hospitals and Clinics, Columbia, MO, USA
| | - Maham Rahimi
- Division of Vascular Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Jose O Leite
- Division of Vascular Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | - Joseph S Giglia
- Division of Vascular Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA -
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7
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Pooshpas P, Lehman E, Aziz F. Factors Associated with Increased Risk of Unplanned Hospital Readmission after Endovascular Aortoiliac Interventions. Cureus 2018; 10:e3558. [PMID: 30648090 PMCID: PMC6324857 DOI: 10.7759/cureus.3558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/07/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives Readmissions to hospital after surgical procedures are considered as reflective of poor quality of healthcare provided during the index hospitalization and are associated with increased costs of healthcare. Aortoiliac occlusive disease represents an aggressive form of atherosclerotic disease and has been traditionally treated with open surgical bypasses. Endovascular interventions for aortoiliac occlusive disease are associated with comparable outcomes to open surgical procedures. The purpose of this study is to review the factors associated with hospital readmission after aortoiliac endovascular interventions. Methods The 2015 procedure targeted American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database and general and vascular surgery NSQIP participant user file (PUF) were used for this analysis. Patient, diagnosis and procedure characteristics of patients undergoing aortoiliac endovascular interventions were reviewed. Bivariate analysis was used to identify the relationship between the independent variables and 30-day readmission. The significant variables from the bivariate analysis were used to generate a multivariable logistic regression model. The predicted probability of readmission was calculated. Results Out of 823 patients, 86 were readmitted. Readmission was related to the principal procedure in 48 (73.9%) patients. A total of 61 (7%) patients underwent an unplanned operation within 30 days after the index procedure. A multivariable logistic regression model identified the following variables to be significantly associated with 30-day risk of readmission: the use of pre-procedural beta blocker (OR = 2.06, 95% CI = 1.23 - 3.45, P < 0.01), external/internal iliac intervention (OR = 1.95, 95% CI = 1.18 - 3.20, P <0.01), critical limb ischemia (OR = 1.80, 95% CI = 1.10 - 2.94, P <0.05), and unplanned return to the operating room (OR = 11.65, 95% CI = 6.35 - 21.35, P <0.01). The predicted probability of readmission was as follows: 5.5% for critical limb ischemia, 5.9% for external iliac artery angioplasty/stenting, 6.2% for preoperative beta blockers, 17.7% for patients with cardiac arrest, 27% for unplanned return to the operating room, and 94.7% for patients with all of these risk factors. Conclusion Readmissions after endovascular interventions for severe atherosclerotic disease can be used as a quality metric. Several factors place a patient at a high risk for readmission. Unplanned return to the operating room, cardiac arrest, preoperative beta blockers, location of disease, and preoperative symptoms are independent risk factors for hospital readmission. Unplanned return to the operating room is associated with 11.65-fold increase in the risk of hospital readmission.
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Affiliation(s)
- Pardis Pooshpas
- Miscellaneous, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, USA
| | - Erik Lehman
- Surgery, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, USA
| | - Faisal Aziz
- Cardiac/thoracic/vascular Surgery, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, USA
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Argyriou C, Georgakarakos E, Georgiadis GS, Schoretsanitis N, Lazarides MK. The Effect of Revascularization on the Hemodynamic Profile of Patients with Infrarenal Aortic Occlusion. Ann Vasc Surg 2017; 43:210-217. [DOI: 10.1016/j.avsg.2016.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/30/2016] [Accepted: 11/28/2016] [Indexed: 10/19/2022]
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9
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Jehangir W, Sanabria F, Singh Z, Enakuaa S, Bedran KH, Raoof N, Yousif A. Enteric Fistulous Communication with an Aortobifemoral Graft Permitting for Eggerthella Lenta Colonization. J Glob Infect Dis 2016; 7:170-2. [PMID: 26752872 PMCID: PMC4693309 DOI: 10.4103/0974-777x.170506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The presence of an aortoenteric fistula following aortobifemoral graft repair of an abdominal aortic aneurysm is associated with a high probability of infection leading to clinically significant bacteremia. We report a case of an aortoenteric fistula that developed two years after initial aortic grafting resulting in colonization with the anaerobe, Eggerthella lenta. This dangerous bacterium is difficult to culture, associated with high mortality and the patient may have mild symptoms on presentation.
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Affiliation(s)
- Waqas Jehangir
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Federico Sanabria
- Ross University School of Medicine, Portsmouth, Dominica, United States
| | - Zorawar Singh
- Ross University School of Medicine, Portsmouth, Dominica, United States
| | - Souad Enakuaa
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Kebir Hammed Bedran
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Nazar Raoof
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Abdalla Yousif
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
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10
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Georgakarakos E, Argyriou C, Georgiadis GS, Ioannou CV, Lazarides MK. Immediate hemodynamic changes after revascularization of complete infrarenal aortic occlusion: A classic issue revisited. Med Hypotheses 2015; 87:22-7. [PMID: 26826635 DOI: 10.1016/j.mehy.2015.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 12/07/2015] [Accepted: 12/15/2015] [Indexed: 11/19/2022]
Abstract
Chronic total occlusion of the infrarenal aorta (CTOA) is a rare disease, characterized by severe impairment of limb perfusion. It is advocated that revascularization may improve survival rates, presumably due to improved cardiovascular performance; however no experimental or clinical data exist to identify a clear causative correlation and provide a relevant pathophysiologic background. Therefore we conducted a pilot study based on pulse wave analysis to detect the hemodynamic changes immediately after revascularization, in a group of six consecutive patients with CTOA. All patients were subjected to non-invasive measurements 1 day before surgery and at the end of the 1st postoperative month. Pulse wave analysis was performed noninvasively with a novel validated brachial cuff-based automatic oscillometric device. All patients had markedly preoperative high Augmentation Index (adjusted at heart rate 75 beats/min, AI@75). The AI@75 decreased from 46 ± 6.6 preoperatively to 24 ± 5.7 (p 0.0002). Wave reflection magnitude decreased from 72.3 ± 5.2% to 63 ± 6.7% (p 0.02). Cardiax index increased from 2.8 ± 1.2 to 3.4 ± 1.2l/min × 1/m(2) (p 0.41). Pulse wave velocity remained practically unchanged post-interventionally. These findings show that central aorta hemodynamics can be improved immediately following revascularization procedures in patients with complete occlusion of the entire length of the infrarenal aorta and can constitute the background of improved postoperative life-expectancy.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece.
| | - Christos Argyriou
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Christos V Ioannou
- Vascular Surgery Department, University of Crete Medical School, Heraklion, Crete, Greece
| | - Miltos K Lazarides
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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11
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Recovery of Renal Function after Prolonged Anuria in Acute Suprarenal Aortic Occlusion. Ann Vasc Surg 2015; 30:307.e11-4. [PMID: 26520421 DOI: 10.1016/j.avsg.2015.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 11/21/2022]
Abstract
Acute suprarenal aortic occlusion is a rare but often catastrophic event. Despite immediate treatment, mortality and morbidity are high. We present a case of acute suprarenal aortic occlusion presenting with renal failure and dyspnea but without lower limb ischemia. Diagnosis was initially not taken in consideration. The patient required hemodialysis and temporary mechanical ventilation. After 13 days, an abdominal ultrasound was performed which revealed thrombosis of the suprarenal abdominal aorta. Suprarenal aortic thrombectomy was performed followed by aortobi-iliac bypass grafting. Diuresis returned 4 hr after surgery, and the patient fully recovered. Thorough review of the literature revealed only 8 cases of acute suprarenal aortic occlusion. Only 3 patients survived. To our knowledge, this is the first reported case of acute suprarenal occlusion, in which renal function could be restored after a 14-day period of anuria. The case illustrates that in select cases with prolonged acute renal failure aortorenal revascularization can be performed successfully.
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12
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Abstract
Treatment of severe aortoiliac disease has dramatically evolved from a dependence on open aortobifemoral grafting to hybrid and endovascular only approaches. Open surgery has been the gold standard treatment of severe aortoiliac disease with excellent patency rates, but with increased length of stay and major complications. In contrast, endovascular interventions can successfully treat almost any lesion with decreased risk, compared to open surgery. Although primary patency rates remain inferior, secondary endovascular interventions are often minor procedures resulting in comparable long-term outcomes. The risks of renal insufficiency, embolization and access complications are not insignificant; however, most can be prevented or managed without significant clinical consequence. Endovascular therapies should be considered a first-line treatment option for all patients with aortoiliac disease, especially those with high-risk cardiovascular comorbidities.
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Affiliation(s)
- Daniel G Clair
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jocelyn M Beach
- Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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13
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Lucas ML, Deibler L, Erling Jr. N, Lichtenfels E, Aerts N. Surgical treatment of chronic aortoiliac occlusion. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.20140041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Chronic aortoiliac occlusion (CAIO) is a significant cause of lower limb ischemia and is often found in young patients who smoke. OBJECTIVE: To review recent results achieved treating CAIO patients with open surgery. METHODS: From November 2011 to April 2014, 21 patients with CAIO were treated at the Santa Casa de Misericórdia, Porto Alegre, Brazil. Demographic data, comorbidities, clinical presentation and surgical results were analyzed. RESULTS: Eleven women and ten men were treated with direct aortic bypass (DAB; n=18) or with extra-anatomic bypass (EAD; n=3). Mean age was 53.7 ± 7.3 years (range: 43-79 years) and all patients smoked. Thirteen patients (62%) had critical ischemia. Six of the patients treated with DAB (33.4%) also required additional revascularization (3 renal and 3 femoropopliteal procedures). Perioperative mortality was zero. Four patients (22.2%) suffered transitory renal dysfunction, but only one patient (5.6%) required hemodialysis. Median follow-up time was 17 months (range: 2-29 months) and there was just one late death, from ischemic heart disease, 7 months after the surgery on the abdominal aorta. CONCLUSIONS: Aortic reconstruction is a safe method for treating patients with CAIO, with low perioperative morbidity and mortality rates.
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Affiliation(s)
| | - Lúcia Deibler
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Nilon Erling Jr.
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | | | - Newton Aerts
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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14
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Yoshihara T, Hasebe H, Shimasaki M, Uyama S, Takanohashi S, Togawa A, Takanohashi A, Shirota K, Nakamura H. Acute heart failure due to chronic juxtarenal aortic occlusion in a patient with antiphospholipid antibody syndrome. J Cardiol Cases 2014; 10:69-72. [PMID: 30546509 DOI: 10.1016/j.jccase.2014.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/20/2014] [Accepted: 05/08/2014] [Indexed: 11/25/2022] Open
Abstract
Abdominal aortic occlusions are rare, but occasionally life threatening. A 48-year-old man was hospitalized due to acute heart failure accompanied by acute kidney injury (AKI). Abdominal ultrasound revealed deteriorating blood flow in the bilateral renal arteries. Subsequent abdominal aortography showed abdominal aortic occlusion just below the right renal artery and an occluded left renal artery. Dilated superior and inferior mesenteric arteries functioning as collateral feeding arteries suggested chronic occlusion. A hypercoagulation workup led to a diagnosis of antiphospholipid antibody syndrome (APS). This case report describes rare chronic juxtarenal abdominal occlusion in a patient with APS. <Leaning objective: Abdominal aortic occlusions are rare, but occasionally life threatening. The proximal propagation of aortic thrombosis might cause prerenal AKI. In our case, the renal arteries' involvement of chronic juxtarenal arteries in a patient with APS gave rise to the onset of acute heart failure associated with prerenal AKI.>.
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Affiliation(s)
- Tsutomu Yoshihara
- Division of Arrhythmology and Cardiology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Hideyuki Hasebe
- Division of Arrhythmology and Cardiology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Megumi Shimasaki
- Division of Nephrology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Satoko Uyama
- Division of Nephrology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Seiko Takanohashi
- Division of Nephrology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Akashi Togawa
- Division of Nephrology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Akira Takanohashi
- Division of Thoracic and Cardiovascular Surgery, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Kazuaki Shirota
- Division of Thoracic and Cardiovascular Surgery, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Hajime Nakamura
- Division of Thoracic and Cardiovascular Surgery, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
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Friedell ML, Stark KR, Kujath SW, Carter RR. Current status of lower-extremity revascularization. Curr Probl Surg 2014; 51:254-90. [DOI: 10.1067/j.cpsurg.2014.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 02/25/2014] [Indexed: 11/22/2022]
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16
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Novel Approach for Juxtarenal Aortic Occlusion Treatment: The Y-Guidewire Configuration for Aortic Bifurcation Reconstruction. Cardiovasc Intervent Radiol 2013; 37:1122-5. [DOI: 10.1007/s00270-013-0730-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 08/20/2013] [Indexed: 11/27/2022]
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17
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Dohi T, Iida O, Okamoto S, Nanto K, Nanto S, Uematsu M. Mid-term clinical outcome following endovascular therapy in patients with chronic aortic occlusion. Cardiovasc Interv Ther 2013; 28:327-32. [DOI: 10.1007/s12928-013-0173-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 03/19/2013] [Indexed: 10/27/2022]
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