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Endovascular treatment of pseudoaneurysm of the thoracic aorta from a firearm injury

Petrucci, Orlando; De Oliveira, Pedro Paulo Martins; Martins, Antonio Sérgio; Vieira, Reinaldo Wilson
Fonte: Universidade Estadual Paulista Publicador: Universidade Estadual Paulista
Tipo: Artigo de Revista Científica Formato: 529-530
ENG
Relevância na Pesquisa
27.17%
A 24-year-old male patient was the victim of a firearm wound that penetrated the thorax. He arrived at another hospital hemodynamically unstable and was submitted to exploratory surgery by means of bithoracotomy. A lesion of the left branch of the pulmonary artery was detected and successfully repaired. He was submitted for computer-aided tomography on the fifth postoperative day, and a lesion of the mid-thoracic aorta was detected, which formed a saccular image. Considering that the patient had already been submitted to a bithoracotomy and that a direct approach to repair would involve another thoracotomy within a short period of time, endovascular treatment was chosen in our hospital. The procedure was performed under fluoroscopy. A second computer-aided tomography indicated adequate treatment of the lesion, with no indication of an endoleak. He has undergone ambulatory follow-up for 36 months without any problem related to the procedure. While endovascular treatment of the aorta has developed enormously, multicenter studies are needed to better define the long-term results of this approach. © 2008 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

Ligadura videolaparoscópica da artéria mesentérica inferior como tratamento de endoleak persistente após correção endovascular de aneurisma de aorta abdominal

Espinosa,Gaudencio; Madureira,Delta; Mendes,Warley Dias Siqueira
Fonte: Colégio Brasileiro de Cirurgiões Publicador: Colégio Brasileiro de Cirurgiões
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2002 PT
Relevância na Pesquisa
27.17%
Videolaparoscopy has been widely used in the treatment of pathologies as cholelithiasis, appendicitis and adrenal tumor. Nowadays, has also been used to treat type II endoleaks after endovascular repair of abdominal aortic aneurysms. The goal of this work is to report one case of inferior mesenteric artery endoleak treated by videolaparoscopy.

Nota técnica: avaliação ultrassonográfica de aneurismas da aorta tratados com endopróteses

Cunha,Sergio Xavier Salles
Fonte: Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) Publicador: Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV)
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2012 PT
Relevância na Pesquisa
27.17%
Aneurismas da aorta tratados com endopróteses podem desenvolver endoleaks. Esses endoleaks devem ser classificados com base nos tipos de fluxo, além da localização anatômica. Enfatizamos tipos de fluxo dos endoleaks detectados pela ultrassonografia com Doppler: fluxo entra-e-sai como "pseudoaneurisma", fluxo de canal e fluxo direto. Ao se notar a possibilidade de endoleaks intermitentes, salientamos o conceito de endoseepage detectáveis por crescimento de dimensões sem fluxo entrante aparente. Sugerimos o uso da histologia virtual ultrassonográfica para detecção de infiltrações. Quantidade relativa e localização de sangue ou líquido dentro do saco aneurismático pode ser detectado pela avaliação dos níveis de brilho da ultrassonografia modo B. Essa informação permite um seguimento compreensivo do aneurisma tratado com endoprótese e salienta o risco maior deum endoleak de fluxo direto entrante no aneurisma.

A multidetector tomography protocol for follow-up of endovascular aortic aneurysm repair

Bastos,Roberto Moraes; Razuk Filho,Alvaro; Blasbalg,Roberto; Caffaro,Roberto Augusto; Karakhanian,Walter Khegan; Rocha,Antonio José
Fonte: Faculdade de Medicina / USP Publicador: Faculdade de Medicina / USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2011 EN
Relevância na Pesquisa
27.17%
OBJECTIVE: The purpose of this study was to improve the use of 64-channel multidetector computed tomography using lower doses of ionizing radiation during follow-up procedures in a series of patients with endovascular aortic aneurysm repair. METHODS: Thirty patients receiving 5 to 29 months of follow-up after endovascular aortic aneurysm repair were analyzed using a 64-channel multidetector computed tomography device by an exam that included pre-and postcontrast with both arterial and venous phases. Leak presence and type were classified based on the exam phase. RESULTS: Endoleaks were identified in 8/30 of cases; the endoleaks in 3/8 of these cases were not visible in the arterial phases of the exams. CONCLUSION: The authors conclude that multidetector computed tomography with pre-contrast and venous phases should be a part of the ongoing follow-up of patients undergoing endovascular aortic aneurysm repair. The arterial phase can be excluded when the aneurism is stable or regresses. These findings permit a lower radiation dose without jeopardizing the correct diagnosis of an endoleak.

Endoleak Following Endovascular Abdominal Aortic Aneurysm Repair: Implications for Duration of Screening

Corriere, Matthew A.; Feurer, Irene D.; Becker, Stacey Y.; Dattilo, Jeffery B.; Passman, Marc A.; Guzman, Raul J.; Naslund, Thomas C.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/2004 EN
Relevância na Pesquisa
27.48%
Serial computed tomography (CT) scans and/or ultrasounds are required following endovascular abdominal aortic aneurysm repair (EAR) to identify endoleak or aneurysm enlargement. Postoperative CT scan data on 220 patients undergoing EAR are examined to determine the rate, temporal course, and predictors for late endoleak development.

Endoluminal Abdominal Aortic Aneurysm Repair: The Latest Advances in Prevention of Distal Endograft Migration and Type 1 Endoleak

Ghouri, Maaz; Krajcer, Zvonimir
Fonte: Texas Heart Institute Publicador: Texas Heart Institute
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
Relevância na Pesquisa
27.48%
Endovascular abdominal aortic aneurysm repair (EVAR) is an attractive alternative to open surgical repair. Distal endograft migration and type 1 endoleak are recognized to be the 2 main complications of EVAR. First-generation endografts had a stronger propensity for distal migration, modular component separation, thrombosis, and loss of structural integrity. Substantial progress has been made in recent years with 2nd- and 3rd-generation devices to prevent these complications. Some of the most common predictors of endograft failure are angulated and short infrarenal necks, large-diameter necks, and thrombus in the aneurysmal sac. The purpose of this study is to describe and review our experience in using innovative techniques and a newer generation of endografts to prevent distal migration and type 1 endoleak in patients with challenging infrarenal neck anatomy. The use of these innovative EVAR techniques and the new generation of endografts in patients with challenging infrarenal neck anatomy has yielded encouraging procedural and intermediate-term results.

Successful treatment of type I endoleak of common iliac artery with balloon expandable stent (Palmaz XL stent) during endovascular aneurysm repair

Ahn, Jong Hyuk; Kim, Jang Yong; Jeon, Yong Sun; Cho, Soon Gu; Park, Jay K.; Lee, Ki Jong; Hong, Kee Chun
Fonte: The Korean Surgical Society Publicador: The Korean Surgical Society
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
27.89%
Type 1 endoleak of common iliac artery (type Ib endoleak) should be treated during endovascular aneurysm repair (EVAR). An 86-year-old female was diagnosed with abdominal aortic aneurysm measuring 6.6 cm in diameter and right internal iliac artery aneurysm measuring 4.0 cm in diameter. She underwent EVAR after right internal iliac artery embolization. There was type Ib endoleak, which was repaired by balloon-expandable stent, Palmaz XL stent (Cordis). We report successful treatment of type Ib endoleak with Palmaz XL stent, which may be considered as an alternative option for type Ib endoleak after EVAR.

A novel approach to the management of a ruptured Type II endoleak following endovascular repair of an internal iliac artery aneurysm

Patel, S D; Perera, A; Law, N; Mandumula, S
Fonte: The British Institute of Radiology. Publicador: The British Institute of Radiology.
Tipo: Artigo de Revista Científica
Publicado em /12/2011 EN
Relevância na Pesquisa
27.48%
Endovascular repair of isolated iliac artery aneurysms is an established safe and effective management option. Type II endoleak is a potential complication, but rarely results in significant morbidity or mortality. We report a case of a patient who presented with a ruptured internal iliac artery aneurysm secondary to a Type II endoleak. To our knowledge this and the following method of managing this have not been previously reported. Established methods of managing endoleaks, such as intravascular transfemoral embolisation and open or laparoscopic ligation, were not possible. Therefore, we resorted to a novel approach to this type of aneurysm and successfully performed a transcutaneous direct puncture and embolisation of the superior gluteal artery.

Long-Term Results of Aortic Banding for Complex Infrarenal Neck Anatomy and Type I Endoleak after Endovascular Abdominal Aortic Aneurysm Repair

Krajcer, Zvonimir; Dougherty, Kathryn G.; Gregoric, Igor D.
Fonte: Texas Heart Institute Publicador: Texas Heart Institute
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
27.8%
For many patients with abdominal aortic aneurysm, unsuitable anatomy of the infrarenal aortic neck precludes endovascular aortic aneurysm repair or causes type I endoleak after the procedure. In an attempt to overcome these challenges, we retrospectively examined the usefulness of aortic banding as an adjunctive procedure to endovascular repair in 8 patients who had an abdominal aortic aneurysm with a complex infrarenal aortic neck. The procedures were performed with the patients under general anesthesia and involved making an 8-cm upper-midline laparotomy incision to expose the aneurysmal aorta. Three patients underwent aortic banding before endovascular repair; the other 5 underwent banding after the repair because of persistent type I endoleak. After banding, the abdominal aortic aneurysm was successfully excluded in all 8 patients. Long-term follow-up (mean, 38 ± 20 mo) revealed no type I endoleak and no procedure-related complications. In patients who have an abdominal aortic aneurysm with complex infrarenal neck anatomy or a refractory type I endoleak, performing aortic banding as an adjunctive procedure to endovascular aortic repair appears to be a safe strategy with good long-term results.

Type I Endoleak-like Phenomenon Causing Rupture of the Replaced Aneurysm Sac 12 Years after Open Repair of Abdominal Aortic Aneurysm

Matsushita, Masahiro; Ikezawa, Teruo; Banno, Hiroshi
Fonte: The Editorial Committee of Annals of Vascular Diseases Publicador: The Editorial Committee of Annals of Vascular Diseases
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
27.67%
Only a few cases of endoleak following conventional abdominal aortic aneurysm repair have been reported. We treated a patient with a type I endoleak-like phenomenon occuring 12 years after conventional abdominal aortic aneurysm repair. Computed tomography demonstrated dilation of the surgically replaced, once-shrunken aneurysm sac to a diameter of 3.5 cm. Thrombus was identified between the graft and the sac. Four months later the sac ruptured, and emergency repair was performed. Dehiscence of the proximal anastomosis causing dilation and tearing of the sac was found. Dilation of a surgically replaced aneurysm sac after initial shrinkage may suggest an endoleak-like phenomenon requiring second repair.

Ischemic Colitis Following Transarterial Embolization for Type 2 Endoleak of EVAR: Report of a Case

Ito, Toshiro; Kurimoto, Yoshihiko; Kawaharada, Nobuyoshi; Koyanagi, Tetsuya; Maeda, Toshiyuki; Yanase, Yohsuke; Nakazawa, Junji; Hirokawa, Naoki; Higami,, Tetsuya
Fonte: Japanese College of Angiology, The Japanese Society for Vascular Surgery, Japanese Society of Phlebology Publicador: Japanese College of Angiology, The Japanese Society for Vascular Surgery, Japanese Society of Phlebology
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
27.48%
A 71 year old man was diagnosed to have enlargement of abdominal aortic aneurysm due to type 2 endoleak two years after endovascular aneurysm repair (EVAR). 3D-CT demonstrated a type 2 endoleak that originated from the superior mesenteric artery that fed the inferior mesenteric artery and the right iliolumbar artery that flowed into the 4th lumbar artery. Transarterial embolization was performed by means of N-butyl-2-cyanoacrylate (NBCA). After the treatment, he suffered ischemic colitis that extended from the sigmoid colon to the descending colon. Conservative treatment was mainly performed, and clinical improvement was observed over time. He was discharged after 73 postoperative days.

Novel Treatment of an Enlarging Internal Iliac Artery Aneurysm in Association with a Type 2 Endoleak via Percutaneous Embolisation of the Superior Gluteal Artery through a Posterior Approach

Werner-Gibbings, Keagan; Rogan, Chris; Robinson, David
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
27.48%
Internal iliac artery (IIA) aneurysms, while rare, carry a significant risk of mortality if they rupture. Endovascular intervention is now the preferred method of treatment for IIAs; however, due to technical considerations, this is not always feasible. We report a case of a patient who developed an enlarging IIA aneurysm in association with a type 2 endoleak supplied by multiple feeding arteries where conventional endovascular treatment was not possible. A novel method of effectively treating the IIA aneurysm with a posterior approach via image-guided puncture of the superior gluteal artery was employed. Five arteries supplying the superior gluteal from the contralateral internal iliac artery were selectively catheterised and coiled before the aneurysmal sac was embolised. The patient made an uneventful recovery, and follow-up imaging demonstrated resolution of the endoleak and decompression of the aneurysmal sac. This case demonstrates that the posterior approach is a safe and viable method of treating internal iliac artery aneurysm when traditional endovascular approaches are technically possible.

CT- and Fluoroscopy-Guided Percutaneous Transabdominal Embolization of Type II Endoleak

Karaman, Kutlay; Dokdok, A. Murat; Karadeniz, Oktay
Fonte: Atatürk University School of Medicine Publicador: Atatürk University School of Medicine
Tipo: Artigo de Revista Científica
Publicado em /06/2013 EN
Relevância na Pesquisa
27.8%
We report a case of a 79-year-old male patient who was treated 3 years previously at another hospital for an abdominal aortic aneurysm with a maximal diameter of 80 mm. After the treatment control period, computed tomography imaging revealed a type II endoleak and no progression in the size of the aneurysm sac. Selective injection of the superior mesenteric artery revealed that the endoleak was filled by the inferior mesenteric artery via the marginal artery. However, it was not possible to access using retrograde catheterization. We decided to treat the type II endoleak percutaneously. Embolization was performed at the tomography table using fluoroscopy with a mobile C-arm, and the puncture was performed transabdominally because there was no access to the sac via a translumbar approach. Under fluoroscopic guidance, various diameter/length coils were deployed. Follow-up computed tomography scans confirmed the collapsed aneurysm sac. When other conventional endovascular methods have failed, percutaneous transabdominal treatment of a type II endoleak with sac enlargement offers an alternative treatment method.

Diagnosis and treatment of a patient with type IV endoleak as a late complication after endovascular aneurysm repair

Wachal, Krzysztof; Szmyt, Krzysztof; Oszkinis, Grzegorz
Fonte: Termedia Publishing House Publicador: Termedia Publishing House
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
27.96%
Type IV endoleak is a very rare complication observed after implantation of aortobiiliac stent grafts. The difficult diagnosis of type IV endoleak leads to the application of many imaging methods in the diagnostic process. We present a case report of a patient who underwent implantation of an aortobiiliac stent graft in 2004. After surgery, the size of the aneurysm sac was monitored continually in the subsequent imaging studies. Progression of the aneurysm sac volume was detected in 2009. In a short period of time, the diameter of the aneurysm increased from 100 to 140 mm. Angio-computed tomography and angiography did not reveal the location of the endoleak. The attempt at localization and endovascular closure of the source of the endoleak failed. It was decided to treat the patient surgically. Intraoperatively, the source of the endoleak was visualized, and the endoleak was closed with surgical sutures.

Experience of direct percutaneous sac injection in type II endoleak using cone beam computed tomography

Park, Yoong-Seok; Do, Young Soo; Park, Hong Suk; Park, Kwang Bo; Kim, Dong-Ik
Fonte: The Korean Surgical Society Publicador: The Korean Surgical Society
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
27.67%
Cone beam CT, usually used in dental area, could easily obtain 3-dimensional images using cone beam shaped ionized radiation. Cone beam CT is very useful for direct percutaneous sac injection (DPSI) which needs very precise measurement to avoid puncture of inferior vena cava or vessel around sac or stent graft. Here we describe two cases of DPSI using cone beam CT. In case 1, a 79-year-old male had widening of preexisted type II endoleak after endovascular aneurysm repair (EVAR). However, transarterial embolization failed due to tortuous collateral branches of lumbar arteries. In case 2, a 72-year-old female had symptomatic sac enlargement by type II endoleak after EVAR. However, there was no route to approach the lumbar arteries. Therefore, we performed DPSI assisted by cone beam CT in cases 1, 2. Six-month CT follow-up revealed no sign of sac enlargement by type II endoleak.

Nova técnica para correção do aneurisma da aorta toracoabdominal, com avaliação em um modelo experimental "in vitro" com fluxo pulsátil e avaliação das conexões por método tomográfico

Franklin, Rafael Narciso
Fonte: Universidade Federal do Paraná Publicador: Universidade Federal do Paraná
Tipo: Dissertação Formato: application/pdf
PORTUGUêS
Relevância na Pesquisa
27.48%
Resumo: O aneurisma da aorta toracoabdominal (AATA) é uma doença degenerativa crônica, cuja história natural geralmente envolve a deterioração estrutural progressiva da parede do vaso, com gradual expansão e eventual ruptura. A ruptura, com suas desastrosas repercussões, é a sua mais importante complicação, com taxa de mortalidade global de aproximadamente 90%. A história desta doença tem refletido o notável progresso da cirurgia ao longo das gerações. A cirurgia aberta foi sendo progressivamente refinada e melhorada com advento de novas tecnologias. Porém, mesmo nos melhores centros, a morbimortalidade ainda é considerada elevada. Semelhante ao que ocorreu no tratamento do aneurisma da aorta abdominal, a técnica endovascular surgiu como uma forma menos invasiva e promissora para correção do AATA. A real possibilidade de transformar uma cirurgia de grande porte em um procedimento minimamente invasivo seduziu os especialistas e produziu profundas mudanças conceituais, com uma busca constante na melhoria da técnica, dos materiais e, consequentemente, dos resultados. Esta dissertação tem como objetivo descrever uma nova técnica de intervenção endovascular para correção do AATA intitulada como "Polvo”...

Abdominal aortic aneurysm follow-up after endovascular repair in a canine model with non-invasive vascular elastography

Salloum, Elie
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
EN
Relevância na Pesquisa
28.1%
Le traitement chirurgical des anévrismes de l'aorte abdominale est de plus en plus remplacé par la réparation endovasculaire de l’anévrisme (« endovascular aneurysm repair », EVAR) en utilisant des endoprothèses (« stent-grafts », SGs). Cependant, l'efficacité de cette approche moins invasive est compromise par l'incidence de l'écoulement persistant dans l'anévrisme, appelé endofuites menant à une rupture d'anévrisme si elle n'est pas détectée. Par conséquent, une surveillance de longue durée par tomodensitométrie sur une base annuelle est nécessaire ce qui augmente le coût de la procédure EVAR, exposant le patient à un rayonnement ionisants et un agent de contraste néphrotoxique. Le mécanisme de rupture d'anévrisme secondaire à l'endofuite est lié à une pression du sac de l'anévrisme proche de la pression systémique. Il existe une relation entre la contraction ou l'expansion du sac et la pressurisation du sac. La pressurisation résiduelle de l'anévrisme aortique abdominale va induire une pulsation et une circulation sanguine à l'intérieur du sac empêchant ainsi la thrombose du sac et la guérison de l'anévrisme. L'élastographie vasculaire non-invasive (« non-invasive vascular elastography »...

Adequate Seal and No Endoleak on the First Postoperative Computed Tomography Angiography as Criteria for No Additional Imaging Up to 5 Years after Endovascular Aneurysm Repair

Bastos Gonçalves, F; Luijtgaarden, K; Hoeks, S; Hendriks, J; Raa, S; Rouwet, E; Stolker, R; Verhagen, H
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica
Publicado em //2013 ENG
Relevância na Pesquisa
37.8%
OBJECTIVE: Intensive image surveillance after endovascular aneurysm repair is generally recommended due to continued risk of complications. However, patients at lower risk may not benefit from this strategy. We evaluated the predictive value of the first postoperative computed tomography angiography (CTA) characteristics for aneurysm-related adverse events as a means of patient selection for risk-adapted surveillance. METHODS: All patients treated with the Low-Permeability Excluder Endoprosthesis (W. L. Gore & Assoc, Flagstaff, Ariz) at a tertiary institution from 2004 to 2011 were included. First postoperative CTAs were analyzed for the presence of endoleaks, endograft kinking, distance from the lowermost renal artery to the start of the endograft, and for proximal and distal sealing length using center lumen line reconstructions. The primary end point was freedom from aneurysm-related adverse events. Multivariable Cox regression was used to test postoperative CTA characteristics as independent risk factors, which were subsequently used as selection criteria for low-risk and high-risk groups. Estimates for freedom from adverse events were obtained using Kaplan-Meier survival curves. RESULTS: Included were 131 patients. The median follow-up was 4.1 years (interquartile range...

Hemoptysis as a first symptom of endoleak after thoracic endovascular aortic repair, which caused aortic rupture and required complex management

Synowiec, Tomasz; Warot, Marcin; Burchard, Paweł; Paschke, Łukasz; Łysiak, Zuzanna; Chęciński, Paweł
Fonte: Termedia Publishing House Publicador: Termedia Publishing House
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
27.48%
Thoracic endovascular aortic repair (TEVAR) has become the most common procedure in the treatment of thoracic aorta aneurysms. However, potential long-term complications of this technique could be life-threatening. Hemoptysis is a common symptom of lung tumor, especially cancer. On the other hand, hemoptysis can also be caused by bronchitis, tuberculosis, mycosis, and trauma. In this case report, we present a patient with hemoptysis and lung tumor suggesting lung cancer, which was a unique symptom of type IA endoleak after TEVAR and led to rupture of the thoracic aneurysm. It was decided to perform next an endovascular procedure due to the severe state of the patient. Next the thoracotomy was performed because drainage of the left pleural cavity was unsuccessful. In the last stage bronchoscopy was needed to remove the thrombus, which occluded the left main bronchi. Successful management has led to the patient's full recovery. Despite justified popularity of endovascular procedures in the treatment of thoracic aorta aneurysms, we should remember about potential long-term complications. Hemoptysis could be a unique symptom of the endoleak after TEVAR and treatment of such complications could be complex and demanding.

Successful treatment of endoleak Type I with uncovered EX-L stent after thoracic endovascular aneurysm repair†

Buz, Semih; Zipfel, Burkhart; D'Ancona, Guiseppe; Hetzer, Roland
Fonte: Oxford University Press Publicador: Oxford University Press
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
27.48%
Treatment of endoleaks after thoracic endovascular repair remains challenging, particularly when the proximal landing zone is small and partly includes the origin of the neck vessels. We report a Type Ia endoleak, occurring after thoracic endovascular aneurysm repair, which was successfully treated with a novel uncovered nitinol stent. With this success, we were able to avoid a conventional surgery to treat the endoleak.