P5603Distal stent graft induced new entry: risk factors in acute and chronic type B aortic dissections

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Lortz ◽  
F Leinburger ◽  
K Tsagakis ◽  
C Rammos ◽  
A Lind ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stent Graft ◽  
Rare Complication ◽  
Stent Grafts ◽  
Long Term Outcome ◽  
Acute Dissection ◽  
Predicting Factor ◽  
New Entry

Abstract Background Distal stent graft induced new entry (dSINE) is a rare complication occurring in acute and chronic dissections after thoracic endovascular aortic repair (TEVAR) and is linked to a high reintervention rate. We analyzed potential predicting risk factors for dSINE and analyzed the long-term outcome in patients after reintervention. Methods In this single-center, retrospective study we evaluated patients after TEVAR and investigated possible predictors for dSINE development. Therefore, we used a multivariate analysis to test important interventional parameters such as distal oversizing (dOS), taper ratio (TR), angle between distal stent graft and aorta, acute dissection and stent graft length. Reinterventional characteristics were analyzed and further long-term follow-ups after reintervention evaluated. Results We analyzed 185 patients with acute (n=77) and chronic (n=108) dissections after TEVAR with a follow-up of 68.9±32.5 months. Within the follow-up period, 12 (6.5%) patients developed dSINE after a median time of 22.2±20.7 months. We identified acute dissection as a major predicting factor for dSINE development with a 15.8 times higher odds, followed by an increased dOS and TR. The reintervention rate was higher in the dSINE group (83% vs. 20%, p=0.001), but reinterventional results were mostly satisfying, including further freedom from reintervention and/or new endoleak development up to a mean follow-up of 60.7±54.8 months. No dSINE was seen in association to tapered stent grafts. Conclusion We found acute aortic dissection as a major predicting factor for dSINE development, followed by increased dOS and TR. The use of tapered stent grafts might be beneficial in cases with expected high dOS and TR. In rare cases with dSINE occurrence, reintervention is often required, but has a good prognosis even after years.

Elective and Emergent Endovascular Treatment of Subclavian Artery Aneurysms and Injuries

2003 ◽  
Vol 10 (1) ◽  
pp. 58-65 ◽  
Author(s):  
Maria Schoder ◽  
Manfred Cejna ◽  
Thomas Hölzenbein ◽  
Georg Bischof ◽  
Fritz Lomoschitz ◽  
...  
Keyword(s):  
Stent Graft ◽  
Subclavian Artery ◽  
Artery Aneurysm ◽  
Graft Patency ◽  
Long Term Results ◽  
Stent Grafts ◽  
Central Venous ◽  
Luminal Narrowing

Purpose: To demonstrate our short and long-term results after transbrachial treatment of subclavian artery aneurysms and injuries with stent-grafts in elective and emergency settings. Methods: Ten of 12 consecutive patients (6 men; mean age 63.8 years, range 38–80) were treated electively with commercially prepared endografts delivered via a transbrachial access to repair a subclavian artery aneurysm (n = 3) or an injury from a misplaced central venous catheter (n = 7). Two patients required emergency treatment for a ruptured atherosclerotic aneurysm in one and an unintentional arterial puncture during placement of a central venous access in the other. Stent-graft patency during follow-up was assessed by physical examination with comparison of brachial blood pressures in all patients; computed tomography angiography (CTA) was performed in available patients. Results: Successful deployment of stent-grafts with sealing of the lesion was achieved in all cases. There were 2 (17%) procedural complications. One patient developed an access-site hematoma that required surgical revision. The second patient, who had a right subclavian injury, suffered an embolic cerebral infarction. The primary stent-graft patency during follow-up (mean 11.6 months) was 100%. CTA examinations in 7 patients at a mean 18 months showed strut dislocation at the thoracic outlet without luminal narrowing in 1 patient. A 50% intraluminal narrowing due to compression between the clavicle and the first rib occurred in another patient. Six patients with a mean follow-up of 23 months (range 0.3–4.5 years) are still alive with patent stent-grafts. Conclusions: Endovascular stent-graft treatment of subclavian artery aneurysms and injuries is a less invasive alternative to surgical repair. Long-term results must still be confirmed in further studies.

scholarly journals Long-term Outcome of Incidental Cystic Liver Tumors in the General Population

2021 ◽  
Author(s):  
Sophia Freya Ulrike Blum ◽  
Till Ittermann ◽  
Marie-Luise Kromrey ◽  
Corinna Dreyer ◽  
Danilo Seppelt ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Liver Tumors ◽  
Liver Cyst ◽  
Lesion Size ◽  
Term Outcome ◽  
Long Term Outcome ◽  
The Mean

Abstract Aim of this study was to investigate frequency, incidence and risk factors of liver cysts in the general population in a longitudinal survey. Cyst frequency was investigated in 607 adult volunteers (288 women, 319 men, mean age 55 years) using strong T2-weighted magnetic resonance imaging. Risk factors were investigated for occurrence, frequency and size of cystic lesions at baseline. Incidence and physiological growing of the lesions were observed in a 5-years follow-up. At baseline, 431 volunteers had 1,479 cysts (71.0%). The mean number of cysts per person was 3.4 ± 9.0. The mean size of cysts was 13.1 ± 11.7 mm. Women had a higher number of cysts than men (p = 0.026). Older and male volunteers demonstrated a higher cyst frequency (p = 0.002 and p = 0.025). Per one-year increase in age the chance for a liver cyst increased by 2%. Four-hundred seventeen volunteers had cysts in the follow-up, in 24.6% new lesions had occurred. Lesion size significantly increased in follow-up (p < 0.001). Age and male sex were associated with the occurrence of at least one liver cyst. Women had a higher average number of cysts. Cystic lesion progression is a physiological phenomenon in the long-term follow-up.

scholarly journals Sex and age difference in risk factor distribution, trend, and long-term outcome of patients undergoing isolated coronary artery bypass graft surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Babak Sattartabar ◽  
Ali Ajam ◽  
Mina Pashang ◽  
Arash Jalali ◽  
Saeed Sadeghian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Family History ◽  
Positive Family History ◽  
Probability Weighting ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Inverse Probability

Abstract Background Preoperative coronary artery disease risk factors (CADRFs) distribution and pattern may also have an important role in determining major adverse cardiovascular events (MACEs). In this study, we aimed to evaluate the CADRFs distribution and trend over 10 years and also the long-term outcome of CABG in different age-sex categories. Method In this registry-based serial cross-sectional study, we enrolled 24,328 patients who underwent isolated CABG and evaluated the prevalence of CADRFs according to sex and age. We used inverse probability weighting (IPW) to compare survival and MACE between the sexes. We also used Cox regression to determine each CADRFs effect on survival and MACEs. Results In general, DLP (56.00%), HTN (53.10%), DM (38.40%), and positive family history (38.30%) were the most frequent risk factors in all patients. Prevalence of HTN, DLP, DM, obesity, and positive family history were all higher in women, all statistically significant. The median follow-up duration was 78.1 months (76.31–79.87 months). After inverse probability weighting (to balance risk factors and comorbidities), men had lower MACEs during follow-up (HR 0.72; 95% CI 0.57–0.91; P value 0.006) and there was no significant difference in survival between sexes. DM and HTN were associated with higher mortality and MACEs in both sexes. Conclusion Although DLP is still the most frequent CADRF among the CABG population, the level of LDL and TG is decreasing. Women experience higher MACE post CABG. Therefore, health care providers and legislators must pay greater attention to female population CADRFs and ways to prevent them at different levels.

scholarly journals Long-term outcome of closed reduction in late-detected hip dislocation: 60 patients aged six to 36 months at diagnosis followed to a mean age of 58 years

2018 ◽  
Vol 12 (4) ◽  
pp. 369-374 ◽  
Author(s):  
T. Terjesen
Keyword(s):  
Risk Factors ◽  
Closed Reduction ◽  
Hip Dislocation ◽  
Harris Hip Score ◽  
Patient Age ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Patient Âgé

PurposeThe aims of this study on late-detected developmental dislocation of the hip (DDH) were to assess the outcome in patients aged 55 to 60 years and to define prognostic factors.MethodsThe study included 60 patients (74 hips). Primary treatment was skin traction to obtain closed reduction, followed by hip spica plaster cast. There were 52 girls and eight boys with a mean age at reduction of 19.6 months (8 to 37). Criteria for good long-term outcome were no osteoarthritis (OA) or total hip arthroplasty (THA) and modified Harris Hip Score ≥ 80 points.ResultsThe mean patient age at follow-up was 57.7 years (55 to 60). Good long-term clinical and radiographic outcome occurred in 39 of 73 hips (53%). In all, 24 hips (32%) had undergone THA at a mean patient age of 48.1 years (31 to 58). Survival analysis with conversion to THA as endpoint showed a reduction in survival from 100% at patient age 30 years to 62% at 58 years. Risk factors for poor outcome were age at reduction ≥ 1.5 years and residual dysplasia (Severin grades III/IV) at skeletal maturity.ConclusionWith a mean follow-up of patient age 58 years, the outcome of late-detected DDH, treated with traction and closed reduction, was satisfactory in more than half the hips. This indicates that the hip will probably last more than 50 years if risk factors like age at reduction ≥ 1.5 years, residual dysplasia and avascular necrosis are avoided.

A Proposed Grading System of Brain and Spinal Cavernomas

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. 807-814 ◽  
Author(s):  
Juri Kivelev ◽  
Aki Laakso ◽  
Mika Niemelä ◽  
Juha Hernesniemi
Keyword(s):  
Risk Factors ◽  
Glasgow Outcome Scale ◽  
Outcome Measure ◽  
Postoperative Outcome ◽  
Unfavorable Outcome ◽  
Surgical Removal ◽  
Grading System ◽  
Long Term Outcome

Abstract BACKGROUND: Most cavernomas in the central nervous system are characterized by a benign natural course. Progressive symptoms warrant surgical removal. In the literature, the factors affecting long-term postoperative outcome are not statistically well confirmed. OBJECTIVE: To perform a multifactorial analysis of risk factors on a large patient series and to use the results to propose a simple grading scale to predict outcome. METHODS: We studied 303 consecutive patients with cavernomas treated surgically at our department from 1980 to 2009. Follow-up assessment was performed on average 5.7 years postoperatively (range, 0.2-36 years). The main outcome measure was the patients' condition at the last follow-up on Glasgow Outcome Scale. For statistical analysis, the outcome measure was dichotomized to favorable (Glasgow Outcome Scale 5) and unfavorable (Glasgow Outcome Scale 1–4). Binary logistic regression analysis was used to estimate the effect of age, sex, seizures, preexisting neurological deficits, hemorrhage, and size and location of cavernoma on long-term outcome. RESULTS: Infratentorial, basal ganglia, or spinal location and preexisting neurological deficit were the only independent risk factors for unfavorable outcome, with relative risks of 2.7 (P = .008) and 3.2 (P = .002), respectively. We formulated a grading system based on a score of 1 to 3. When applied to our series, the proposed grading system strongly correlated with outcome (P &lt; .001, Pearson χ2 test). The risk for long-term unfavorable outcome was 13%, 22%, and 55% for grades 1 through 3, respectively. CONCLUSION: The proposed grading system showed a convincing correlation with postoperative outcome in surgically treated cavernoma patients.

Clinical assessment of a shaft screw for stabilization of the humeral condyle in dogs

2014 ◽  
Vol 27 (03) ◽  
pp. 179-185 ◽  
Author(s):  
M. S. Tivers ◽  
J. Grierson ◽  
A. P. Moores
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Major Complication ◽  
Lateral Approach ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Follow Up ◽  
Humeral Condyle

SummaryObjective: To report the use of a 4.5 mm shaft screw for the management of humeral condylar fractures (HCF) and incomplete ossification of the humeral condyle (IOHC) in dogs, and to assess risk factors for complications.Methods: Dogs with HCF or IOHC that were managed with a 4.5 mm shaft screw with a minimum follow-up of six months from surgery were included. Data from the case records were used to identify risk factors for complications. Long-term follow-up was provided by an owner questionnaire and veterinary re-examination.Results: Forty-three elbows were treated in 40 dogs (14 IOHC, 29 HCF). Minor complications were seen in four cases (9%) and major complications in 10 cases (23%). There were no statistically significant risk factors for major complication. Infection resulted in shaft screw removal from three IOHC cases. Four of eight IOHC cases that had a lateral approach had a major complication compared with zero out of six dogs that had a medial approach, but this difference was not significant (p = 0.085). Nine of 12 IOHC cases and 20/23 HCF cases had excellent or good limb use at the time of long-term follow- up (median of 106 weeks, range 26–227 weeks). All fractures healed but IOHC fissure healing was inconsistent. Fatigue failure of shaft screws was not seen.Clinical significance: The use of shaft screws for the management of IOHC and HCF is associated with a relatively low rate of complications (compared to previous reports) and a good long-term outcome.

scholarly journals Long-Term Efficacy of Variable-Thread Tapered Implants—A Retrospective, Clinical and Radiological Evaluation

Medicina ◽  
2020 ◽  
Vol 56 (11) ◽  
pp. 564
Author(s):  
Oliver Blume ◽  
Eva Maria Schnödt ◽  
Michael Back ◽  
Jan IR Wildenhof ◽  
Florian A. Probst ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Stability ◽  
Common Reason ◽  
Long Term Results ◽  
Control Group ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Potential Risk Factors

Background and Objective: There is multifaceted evidence that variable-thread tapered implants (VTTIs) offer high primary stability but few regarding the long-term success. This retrospective clinical and radiological cohort study assessed the long-term outcome of VTTIs. Material and Methods: All patients treated in an OMFS practice with NobelActive Internal® VTTI between October 2007 and September 2011 were invited for clinical examination. The outcome variables were (i) survival rate, (ii) implant success according to the “Health Scale for Dental Implants” and (iii) prevalence of peri-implantitis. Furthermore, the effect of local and systemic risk factors was investigated. Results: In 81 subjects (46 females and 35 males, mean age 65.6 years) 270 implants (157 VTTIs and 113 others as a control group) were analyzed. In 7 out of 81 patients (8.6%), 8 out of 157 VTTIs (5.1%) and 5 out of 113 other implants (4.4%) were lost. Peri-implantitis, defined as (i) presence of bleeding on gentle probing (0.25 N) or exudation and (ii) radiographic bone loss exceeding 0.5 mm since implant insertion to last follow-up, was the most common reason for implant loss (11 out of 13, 84.6%). Sixty-six out of 87 VTTIs (75.9%) were successful. Seventeen out of 42 patients (40.5%) developed peri-implantitis on 29 out of 79 VTTI sites (36.7%). Plaque and missing keratinized peri-implant mucosa were identified as potential risk factors for the development of peri-implantitis. Conclusion: Variable-thread tapered implants showed good long-term results, even in low bone quality. Peri-implantitis was the most common reason for implant failure and may be connected to certain risk factors.

scholarly journals Re-TEVAR in treatment of stent graft-induced new entry between two non-overlapping stent-grafts: a case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yiwei He ◽  
Shoujun Tang ◽  
Yongheng Zhang ◽  
Jianping Liu ◽  
Haining Zhou
Keyword(s):  
Stent Graft ◽  
Early Period ◽  
Aortic Disease ◽  
Sudden Onset ◽  
Stent Grafts ◽  
Short Term ◽  
Case Presentation ◽  
Potential Risks ◽  
New Entry

Abstract Background Progress of the aortic disease after the stent graft treatment of aortic dissection implicates the potential risks of stent graft-induced new entry (SINE). Although rarely reported, it should be vigilant in patients who might incur serious complication in early period after the thoracic endovascular aortic repair (TEVAR). Thus, the development of aortic disease-specific stent grafts would assist in achieving positive patient outcomes when suffering SINE. However, it is an extremely rare for SINE between two non-overlapping stent-grafts. Case presentation We here reported a 59-year-old male patient with sudden onset of chest pain for 4 h. Multi-detector computed tomography (MDCT) revealed a huge SINE formed between two non-overlapping stent-grafts. The re-TEVAR surgery was performed and the patient experienced a good recovery. Conclusion The SINE between two non-overlapping stent-grafts treated by re-TEVAR operation was alternative and feasible. The short-term and medium-term follow-up results were satisfactory.

scholarly journals Long-term outcome of incidental cystic liver tumors in the general population

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
S. F. U. Blum ◽  
T. Ittermann ◽  
M. L. Kromrey ◽  
C. M. Dreyer ◽  
D. Seppelt ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Liver Tumors ◽  
Liver Cyst ◽  
Lesion Size ◽  
Term Outcome ◽  
Long Term Outcome ◽  
The Mean

AbstractAim of this study was to investigate frequency, incidence and risk factors of liver cysts in the general population in a longitudinal survey. Cyst frequency was investigated in 607 adult volunteers (288 women, 319 men, mean age 55 years) using strong T2-weighted magnetic resonance imaging. Risk factors were investigated for occurrence, frequency and size of cystic lesions at baseline. Incidence and physiological growing of the lesions were observed in a 5-years follow-up. At baseline, 431 volunteers had 1,479 cysts (71.0%). The mean number of cysts per person was 3.4 ± 9.0. The mean size of cysts was 13.1 ± 11.7 mm. Women had a higher number of cysts than men (p = 0.026). Older and male volunteers demonstrated a higher cyst frequency (p = 0.002 and p = 0.025). Per one-year increase in age the chance for a liver cyst increased by 2%. Four-hundred seventeen volunteers had cysts in the follow-up, in 24.6% new lesions had occurred. Lesion size significantly increased in follow-up (p < 0.001). Age and male sex were associated with the occurrence of at least one liver cyst. Women had a higher average number of cysts. Cystic lesion progression is a physiological phenomenon in the long-term follow-up.

scholarly journals 6-Month Follow Up of 8679 Hospitalized COVID-19 Patients in Germany: A Nationwide Cohort Study

2021 ◽  
Author(s):  
Christian Guenster ◽  
Reinhard Busse ◽  
Melissa Spoden ◽  
Tanja Rombey ◽  
Gerhard Schillinger ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Protective Factor ◽  
German Population ◽  
Local Health ◽  
Multivariable Logistic Regression Model ◽  
Long Term Outcome ◽  
Long Term Mortality

Background: Data on long-term outcomes of hospitalized COVID-19 patients are scarce. Objective: To provide a detailed account of hospitalized COVID-19 patients until 180 days after their initial hospitalization. Design: Nationwide cohort study using claims data from the German Local Health Care Funds, the health insurer of one-third of the German population. Setting: Germany. Patients: Adult patients hospitalized in Germany between Feb 1 and April 30, 2020 with PCR-confirmed COVID-19 and a related principal diagnosis. Measurements: Patient characteristics and ventilation status, in-hospital, 30-, 90- and 180-day mortality measured from admission, and 180-day readmission measured from discharge. Multivariable logistic regression model of independent risk factors for 180-day mortality. Results: Of 8679 patients (median age, 72 years), 2161 (24.9%) died during the index hospitalization. 30-day mortality was 23.9% (2073/8679), 90-day mortality 27.9% (2425/8679), and 180-day mortality 29.6% (2566/8679). The latter was 52.3% (1472/2817) for patients aged ≥ 80 years, and 53.0% for patients who had been ventilated invasively (853/1608). Risk factors for 180-day mortality included coagulopathy, BMI ≥ 40, and age. Female sex was a protective factor. Of 6235 patients discharged alive, 1668 patients were readmitted a total of 2551 times within 180 days, resulting in an overall readmission rate of 26.8%. Limitations: We could not stratify patients by ICU treatment as it is not coded separately. Furthermore, we cannot exclude residual confounding in our analysis of risk factors nor determine causality between risk factors and long-term mortality given the observational nature of this study. Conclusion: This nationwide cohort study of hospitalized COVID-19 patients in Germany found considerable long-term mortality and readmission rates, especially among patients with coagulopathy. Close follow-up after hospital discharge may improve long-term outcome.

Sign in / Sign up

Export Citation Format

Share Document