Endovascular Treatment of Isolated Atherosclerotic Stenosis of the Infrarenal Abdominal Aorta: Long-term Outcome

Abstract Background Patients with placenta accreta spectrum (PAS) disorders often experience overwhelming hemorrhage during cesarean. Placenta percreta is the most serious subtype. In this paper, we propose a new procedure in order to control intraoperative bleeding. We aimed to evaluate the effect and long-term outcome of Partial Anterior Myometrial Resection and Reconstruction under tourniquet and/or prophylactic abdominal aorta balloon occlusion on patients with placenta percreta. Methods In a retrospective study, data from patients with placenta percreta who delivered by cesarean section between January 1, 2017 and December 31, 2019 were analyzed. Short-term and long-term outcomes were followed up by outpatient clinic and by phone. The quantity of estimated blood loss (EBL), operation time, urine tube time, hospital stay and short-term and long-term complications including fever, thrombosis, hematoma, breast feeding and menstruation problems, lower limb complaints, intrauterine adhesion and so on, were analyzed. Results For all cases, the mean EBL in the surgery was 1399 ± 948 mL, the mean operation time was 107 ± 35minutes, and the mean perioperative hospital stay was 9.6 ± 5.0 days. All the patients had a preserved uterus. Menstrual quantity decreased in 12 patients. Menstrual period prolonged in 11 cases. Uncomfortable abdomen symptoms happened in 9 cases after the surgery. Four cases got thrombosis and 3 got hematoma. Lower extremity discomfort was found in 6 patients. Conclusion Combined with prophylactic abdominal aorta balloon occlusion and/or tourniquet, Partial Anterior Myometrial Resection and Reconstruction is highly effective in reducing the intraoperative blood loss and hysterectomy in placenta percreta. But we should pay great attention to short-term and long-term complications, especially to the complications associated with aorta balloon occlusion.

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Balloon-mounted stenting for ICAS in a multicenter registry study in China: a comparison with the WEAVE/WOVEN trial

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016658 ◽

2020 ◽

pp. neurintsurg-2020-016658

Author(s):

Kaijiang Kang ◽

Yong Zhang ◽

Jie Shuai ◽

Changchun Jiang ◽

Qiyi Zhu ◽

...

Keyword(s):

Registry Study ◽

Term Outcome ◽

Long Term Outcome ◽

Arterial Access ◽

Stent Restenosis ◽

Atherosclerotic Stenosis ◽

Before And After ◽

Intracranial Artery Stenosis ◽

Multicenter Registry

BackgroundThe outcome of deploying balloon-mounted stents for symptomatic intracranial atherosclerotic stenosis (ICAS) has not been fully investigated. In this study we evaluate the safety and long-term outcome of using balloon-mounted stents to treat symptomatic ICAS in comparison with the WEAVE/WOVEN study.MethodsIn a multicenter registry study of stenting for symptomatic intracranial artery stenosis in China, 159 patients treated with an intracranial balloon-mounted stent approved by the China Food and Drug Administration were evaluated. The morphological features of the lesions were categorized by Mori classification. The endpoints, including periprocedural and long-term clinical and radiological outcomes, were the same as those in the WEAVE/WOVEN study.ResultsIn the present study the mean percent stenosis before and after stenting was 84.0% and 6.1%, respectively. The proportions of Mori A, Mori B, and Mori C lesions were 33.3%, 52.2%, and 14.5%, respectively. The 72-hour rates of stroke and mortality after the procedure were 0%. The 1-year rates of any stroke, ischemic stroke, hemorrhagic stroke, and death were 6.3% (10/159), 5.7% (9/159), 0.6% (1/159), and 0.6% (1/159), respectively. The 1-year rate of in-stent restenosis (ISR) was 23.4% (15/64). The rate of ISR in Mori C lesions (53.8%, 7/13) was significantly higher than that in Mori A (15.8%, 3/19) or Mori B lesions (15.6%, 5/32) (p=0.024).ConclusionsThe short-term and long-term outcomes of using a balloon-mounted stent for symptomatic ICAS with focal and non-angular lesions (Mori A and B type) and smooth arterial access were comparable to the results of the WEAVE/WOVEN trial.

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