Aortic Stenting in Symptomatic Infrarenal Aortic Stenosis and Subtotal Aortic Occlusion

2019 ◽  
Vol 53 (4) ◽  
pp. 303-309 ◽  
Author(s):  
Belyavskaya Tatiana ◽  
Kalmar Peter ◽  
Konstantiniuk Peter ◽  
Baumann Anneliese ◽  
Cohnert Tina
Keyword(s):  
Aortic Stenosis ◽  
Stent Implantation ◽  
Atherosclerotic Lesion ◽  
Primary Patency ◽  
Occlusive Disease ◽  
Aortic Occlusion ◽  
Long Term Results ◽  
Young Cohort

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.

Periprocedural and Long-Term Outcomes of Stent Implantation for De Novo Subclavian Artery Disease

2019 ◽  
Vol 53 (4) ◽  
pp. 284-291
Author(s):  
Hirokazu Onishi ◽  
Toru Naganuma ◽  
Koji Hozawa ◽  
Tomohiko Sato ◽  
Hisaaki Ishiguro ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Stent Implantation ◽  
De Novo ◽  
Clinical Success ◽  
Primary Patency ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Procedural Success

Introduction: The purpose of the current study was to investigate the periprocedural and long-term outcomes of stent implantation for de novo subclavian artery (SCA) disease. Material and Methods: We retrospectively investigated consecutive patients with de novo SCA lesions undergoing elective endovascular therapy procedures at our center between April 2004 and September 2015. All patients were included in the analyses of periprocedural outcomes, including procedural and clinical success. Subsequently, patients who completed the clinical follow-up and were assessed with brachial systolic pressure differences between the diseased and the contralateral arms, or angiographic stenosis, after stent implantation with procedural success were included in the analyses of long-term outcomes, including primary patency. Results: There were 62 patients (median 71.0 years, interquartile range 65.3-76.0 years; 45 men) with 62 de novo SCA lesions included in the analyses of periprocedural outcomes. There were 46 stenoses (74.2%) and 16 occlusions (25.8%). Our results indicated high procedural success rates for overall (95.2%), stenotic (97.8%), and occlusive (87.5%) lesions. Similarly, high clinical success rates were observed for overall (91.9%), stenotic (93.5%), and occlusive (87.5%) lesions. The median follow-up time was 6.0 years (interquartile range, 2.6-8.3 years). There were 48 patients with 48 de novo SCA lesions included in the analyses of long-term outcomes. Primary patency estimates were 97.7% (1 year), 97.7% (3 years), 93.1% (5 years), and 87.6% (7 years). Also, we observed a high estimate for freedom from reintervention for the target vessel (93.8%). Conclusion: Stent implantation for de novo SCA disease can be performed successfully and safely with favorable periprocedural and long-term outcomes.

Langzeitergebnisse der systemischen Thrombolysetherapie bei aorto-iliakaler Verschlusskrankheit

VASA ◽  
2001 ◽  
Vol 30 (3) ◽  
pp. 212-218
Author(s):  
Robert A. Bucek ◽  
G. Schnürer ◽  
M. Haumer ◽  
M. Reiter ◽  
A. Ahmadi ◽  
...  
Keyword(s):  
Patency Rate ◽  
Clinical Success ◽  
Prospective Trial ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Occlusive Disease ◽  
Long Term Results ◽  
Primary Patency Rate ◽  
Lysis Therapy

Background: Long term results of systemic lysis therapy with ultrahigh-dose urokinase (UHUK) in reopening aorto-iliac occlusive disease have not yet been evaluated. This prospective trial investigates the long-term primary patency rate, the rate of complications and assesses the role of different expected influence parameters on the primary patency rate. Patients and methods: 72 patients with aorto-iliac occlusive disease received daily intravenous infusions of UHUK either until reperfusion or – after at least 3 cycles – no progress in recanalization could be stated on two consecutive days by duplex scanning. Results: Systemic lysis therapy was morphological at least partially successful in 44 patients (61.1%). Concomitant percutaneous transluminal angioplasty was performed in 41 patients (56.9%), surgery in 7 patients (9.7%) and both in further 5 patients (6.9%). In patients without surgery hemodynamical success could be achieved in 39 patients (54.2%) and even more important clinical success in 51 patients (70.8%). Compared to baseline results patients improved significantly in ankle/brachial pressure index and in Fontaine stages (p < 0,001), the same results could be seen after a mean follow-up period of 62 months. Thrombolysis was complicated in 4 patients (5.6%) by macroembolizations but no major bleedings or deaths occurred. Primary patency was 76%, 64%, and 43% after 1, 5 and 10 years. Male sex and distal localization were significantly correlated with lower primary clinical patency. Conclusion: Systemic lysis therapy is an alternative to surgical intervention in acute and subacute aorto-iliac occlusive disease, because it offers acceptable long-term results with a low rate of complications.

scholarly journals Carotid endarterectomy with extended lesion: formation of a new bifurcation according to A.V.Pokrovsky or autoarterial reconstruction according to A.A.Karpenko?

2020 ◽  
Vol 7 (3) ◽  
pp. 33-42
Author(s):  
A. N. Kazantsev ◽  
K. P. Chernykh ◽  
N. E. Zarkua ◽  
R. Yu. Leader ◽  
K. G. Kubachev ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cardiovascular Events ◽  
Atherosclerotic Lesion ◽  
Long Term Results ◽  
External Carotid ◽  
Long Term Follow Up ◽  
Group 2 ◽  
Group 1

Purpose of the study. Comparison of hospital and long-term results of autoarterial reconstruction of carotid artery bifurcation and the formation of a new bifurcation with an extended atherosclerotic lesion of the internal carotid artery (ICA). Materials and methods. In the period from January 2018 to May 2020, this cohort, comparative, prospective, open-label study included 279 patients with an extended atherosclerotic lesion of the ICA operated on in the Alexandr Hospital. Depending on the implemented strategy of surgical correction, all patients were divided into two groups: group 1 (n=132) — autoarterial reconstruction of bifurcation of the carotid arteries; Group 2 (n=147) — the formation of a new bifurcation. Complications were recorded in the hospital and long-term postoperative periods. The total follow-up period was 16.4±9.3 months. The endpoints of the study were such adverse cardiovascular events as death, myocardial infarction (MI), stroke, thrombosis / restenosis of the anastomosis zone, combined endpoint (death from stroke / IM + IM + stroke). Results. The ICA clamping time in group 1 was 32.6±3.3 minutes, in group 2 – 31.7±3.5 minutes, which did not receive statistically significant differences (р=0.81). In the hospital postoperative period, adverse cardiovascular events were not recorded. In the long-term follow-up, the groups were comparable in the frequency of all complications. Identified lethal outcomes developed as a result of the formation of MI in patients with multiple lesions of the coronary arteries and a history of myocardial revascularization. The likely cause was shunt / stent thrombosis with subsequent coronary insufficiency and an increase in ischemic heart damage. The causes of stroke, recorded in each group in isolated cases, were the presence of atrial fibrillation. Patients did not comply with the recommended regimen of anticoagulant therapy, which provoked the development of cerebral catastrophe. In turn, the identified restenoses of the reconstruction zone were asymptomatic and were also observed in isolated cases in each group in the period 12 months after CEE. Conclusion. Autoarterial reconstruction of carotid bifurcation and the formation of a new bifurcation are comparable in safety and effectiveness methods of surgical treatment of an extended atherosclerotic lesion of the ICA. Operation techniques differ in the choice of an artery that is cut off from bifurcation — the external carotid artery or ICA. Further, the reconstruction progress is absolutely identical. Hospital and long-term follow-up results showed minimal indicators of the development of cardiovascular and hemodynamic changes due to the type of operation. Thus, both reconstruction techniques can be the operation of choice for an extended ICA lesion.

Midterm Outcomes on Primary Endovascular Treatment of 395 Aortoiliac Occlusive Disease Patients: A Single-Center Experience

Angiology ◽  
2021 ◽  
pp. 000331972199137
Author(s):  
Ender Özgün Çakmak ◽  
Emrah Bayam ◽  
Fatih Yilmaz ◽  
Muzaffer Kahyaoğlu ◽  
Mehmet Çelik ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Primary Patency ◽  
Occlusive Disease ◽  
Secondary Patency ◽  
Aortoiliac Occlusive Disease ◽  
Single Center Experience ◽  
Observational Cohort ◽  
Vascular Center

We report the results of endovascular treatment of Trans-Atlantic Inter-Society Consensus II (TASC) A&B, TASC C, and TASC D aortoiliac lesions in a single vascular center. In this retrospective, observational cohort study, we analyzed 395 patients (mean age 61.2 ± 9.0; 359 men) between January 2015 and December 2017. Technical success was achieved in 96.5%; in-hospital mortality was 1.2% (n = 5). Median follow-up was 36 months (range 24-49 months). After 1 and 5 years, the primary patency rates were 99% and 85% for TASC A&B, 90%, and 78% for TASC C, and 90% and 74% for TASC D. Secondary patency rates were 99% and 90% for TASC A&B, 98% and 65% for TASC C, and 97% and 65% for TASC D. Previous peripheral revascularization (hazard ratio: 1.76, 95% CI: 1.01-3.08, P = .04) was associated with decreased primary patency along with lower age, TASC C, and TASC D class. This analysis reported the acceptable effectiveness and safety of stenting for all types of aortoiliac occlusive disease in a modern setting, with few complications and excellent long-term primary and secondary patency rates.

scholarly journals Long-term results of open aorto-femoral reconstructions

2021 ◽  
Vol 180 (1) ◽  
pp. 54-59
Author(s):  
T. B. Rakhmatillaev ◽  
A. V. Gusinskiy ◽  
V. V. Shlomin ◽  
O. V. Fionik ◽  
A. V. Shatravka ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Supervision ◽  
Primary Patency ◽  
Long Term Results ◽  
Secondary Patency ◽  
Femoral Arteries ◽  
Reconstructive Operations

The objective was to analyze the long-term results of open aorto-femoral reconstructions in order to optimize the approach to surgical treatment.Methods and materials. The study included 548 patients with reconstructions of the aorto-femoral segment performed between 1999 and 2007. Of these, 293 patients underwent loop endarterectomy of the iliac arteries, 255 – after aorto-femoral bypass with a synthetic prosthesis. All interventions were performed against the critical lower limb ischemia. The superficial femoral arteries remained occluded in all cases. Outflow was carried out only in the deep femoral arteries and collateral vessels. Patients were under clinical supervision for 5 to 20 years. In the long-term period, most patients underwent interventions on the coronary, brachiocephalic arteries, as well as surgery for cancer.Results. Timely correction of concomitant pathology made it possible to increase the survival rate of patients by the 10-year follow-up period to 72 %, and after 20 years this figure reached 63 %. The primary patency of the reconstructed segment after loop endarterectomy was significantly higher than after aorto-femoral bypass surgery. Secondary patency in the groups did not significantly differ and by 20 years of follow-up reached 76 %. A high level of patency of the operated segment was also provided by a large percentage of preserved limbs (80 % after 20 years). A study of the quality of life showed that, despite the persistence of intermittent claudication at the level of 400–800 meters, the vast majority of patients were satisfied with their life. Suppurations in the transplant area and the formation of false aneurysms in the area of anastomoses were found only in the group of aorto-femoral bypass grafts.Conclusion. Open reconstructive operations on the aorto-femoral segment, such as loop endarterectomy and aorto-femoral bypass with adequate postoperative medical examination have good long-term results of survival, patency of the reconstructed segment, percentage of saved limbs and quality of life of patients. Complications in the form of suppuration in the transplant area and the formation of false aneurysms occur only after bypass.

Long-term follow-up of treated critical aortic stenosis

1995 ◽  
Vol 5 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Denise Kitchiner ◽  
Narayanswami Sreeram ◽  
Nilima Malaiya ◽  
Mark Jackson ◽  
Kevin Walsh ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Systemic Circulation ◽  
Long Term Results ◽  
Cross Sectional ◽  
Critical Aortic Stenosis ◽  
Initial Intervention ◽  
Long Term Follow Up ◽  
Long Term Prognosis

SummaryTo determine the long-term results in patients with critical aortic stenosis who survive initial intervention, and to identify factors which predict prognosis, we studied patients who underwent intervention between 1979 and 1992 for critical aortic stenosis treated within the first three months of life. Patients with a hypoplastic left ventricle or mitral stenosis who were not considered for a biventricular repair were excluded. Follow-up examination included cross-sectional and Doppler echocardiography. All initial and subsequent patient data were reviewed. Of the 64 patients with critical aortic stenosis, 41 (64%) survived more than one month after initial intervention (surgical valvotomy in 39, balloon valvoplasty in two). These survivors constitute the study group. Mild or moderate residual aortic stenosis or regurgitation without further intervention was found in 28 patients at a median duration of 3.1 years (range 0.2–15.0 years). A poor result with re-intervention (n=6) or death (n=7) occurred in 13 patients. The diameter of the aortic valve at presentation was smaller (p<0.02) in patients with a poor result (median 5.5; range 5–15 mm), than in those with a satisfactory result (median 8.0; range 5–10 mm). Significant residual aortic stenosis was present from the time of initial intervention in nine of the 13 patients (69%) with a poor result. No difference was found in the incidence of a duct-dependent systemic circulation, associated cardiac lesions, mechanical ventilation, acidosis or the use of inotropes preoperatively between patients with a satisfactory or a poor late outcome. Of patients with critical aortic stenosis, 64% survived for more than a month after initial intervention. A small aortic valvar diameter at presentation ( 6 mm) and residual stenosis after initial intervention were important determinants of long-term prognosis.

scholarly journals 397 Long-term follow-up after balloon expandable covered stents implantation for management of TAVI-related vascular access complications

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Matteo Maurina ◽  
Damiano Regazzoli ◽  
Francesco Condello ◽  
Antonio Mangieri ◽  
Giulio Giuseppe Stefanini ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Vascular Complications ◽  
Vascular Complication ◽  
Long Term Results ◽  
Stent Fracture ◽  
Covered Stents ◽  
Stent Deformation ◽  
Starting Point

Abstract Aims Despite increasing experience and device innovation with transcatheter aortic valve implantation (TAVI), vascular complications are still a major problem and endovascular management is generally the first option. When stent implantation is required, self expandable (SE) stents are generally preferred over balloon expandable (BE) stents as they are more elastic and less compressible. However, BE stents support higher radial outward force, adhere to the vase lumen with greater precision and are less expensive. As no large registry reported data about stents BE alone in this setting, we report our experience with BE stents implantation to manage a vascular complication after TAVI. We believe that our work could be useful and possibly serves as a starting point for future research. Methods and results We retrospectively collected baseline, procedural and follow-up data about 78 patients who were implanted with a BE stent to manage a vascular complication after TAVI. At a median clinical follow-up of 410 days (IQR: 66–1016 days), no percutaneous or surgical interventions were reported after discharge. No cases of symptomatic leg-ischaemia were reported and only one patient was symptomatic for claudication. Doppler follow-up (available for 25 patients; 32%) showed no cases of stent fracture or displacement. Conclusions Our experience showed good acute and long-term results of BE covered stent implantation to manage a vascular complication after TAVI. It is possible that a greater radial outward force is a good choice in terms of hemostasis without necessarily being associated with stent deformation/fracture resulting in restenosis or further interventions. While present data may not be generalized, they may be useful to critically re-evaluate (and eventually reduce) the need of SE stents when treating femoral arteries bleedings.

scholarly journals Excellent long-term results with iliac stenting in local anesthesia for post-thrombotic syndrome

2015 ◽  
Vol 4 (9) ◽  
pp. 205846011559216 ◽  
Author(s):  
Lotte Klitfod ◽  
Sven Just ◽  
Pia Foegh ◽  
Niels Baekgaard
Keyword(s):  
Endovascular Treatment ◽  
Local Anesthesia ◽  
Symptom Relief ◽  
Iliac Vein ◽  
Primary Patency ◽  
Long Term Results ◽  
Compression Stocking ◽  
Post Thrombotic Syndrome

Background Only 20% of iliac veins will recanalize on anticoagulation (AC) treatment alone and may, therefore, develop venous obstruction after iliofemoral deep venous thrombosis (DVT). A considerable number of these patients will suffer from post-thrombotic syndrome (PTS) leading to impaired quality of life in more than 50%. Endovascular treatment for iliac vein obstruction using stents is known to alleviate PTS symptoms in selected patients. Purpose To report the Danish long-term results of endovascular treatment with iliac stenting. Material and Methods From 2000 to 2013 consecutive patients were evaluated and 19 patients with severe venous claudication were identified and subsequently underwent angioplasty and stenting. AC treatment was prescribed for 6 months, and knee-high class II compression stocking recommended for 1 year. Scheduled follow-up was done in the outpatient clinic at 6 weeks, 3 months, and annually thereafter. Results Nineteen patients, all women, all with left-sided iliac vein obstruction, and all with severe PTS symptoms were included. The median follow-up time was 81 months (range, 1–146 months; mean, 69 months). Primary patency rate of the inserted iliac stent was 89% (17/19) and 16 patients (84 %) had almost or total symptom relief at follow-up. Conclusion Endovascular stenting of iliac obstruction in local anesthesia is minimally invasive and shows excellent long-term outcomes for patients suffering from PTS.

Present Status of Infrainguinal Arterial Bypass Procedures Following an All Autogenous Policy - Long-Term Results of a Single Center

Swiss Surgery ◽  
2002 ◽  
Vol 8 (4) ◽  
pp. 171-175 ◽  
Author(s):  
Eugster ◽  
Stierli ◽  
Guerke ◽  
Obeid ◽  
Hess
Keyword(s):  
Primary Patency ◽  
Long Term Results ◽  
Single Center ◽  
Arterial Reconstruction ◽  
Size Mismatch ◽  
Vein Grafts ◽  
Vein Disease

Objectives: The direction of vein grafts for infrainguinal arterial reconstruction is controversial. Long-term results of a single center following an all autogenous tissue policy in infrainguinal arterial reconstruction are reported with special attention to possible advantages for the in situ and non-reversed bypass using angioscopy. Methods: From 10/88 until 12/00 540 bypasses with autogenous veins were performed on 497 patients. Veins were used in a non-reversed or in-situ direction, valve disruption was performed under angioscopic control. All grafts were prospectively included in our data base and follow-up was scheduled in our vascular lab before discharge and after 3, 6, 9, 12, 24 etc. months. Results: Primary patency of all bypasses after 108 months was 55.2%, primary assisted 76.9% (SE +/- 9.87), survival 58.4% (SE +/- 8.88) and limb salvage 81.3% (SE +/- 9.75). Perioperative mortality was 0.9% (5 pat.). Patency rates (primary assisted patency) after 72 months were 81.7% (98.2%) for supragenicular, 61.5% (79.4%) for infragenicular and 56.6% (78.1%) for tibial anastomoses and for pedal reconstructions after 48 months 49.3% (68.6%). Conclusion: Reviewing the literature neither the in situ and non-reversed nor the reversed grafts yielded better long-term results. Absence of size mismatch may be an advantage in smaller veins. Angioscopy may detect unsuspected vein disease.

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