Endovascular and open surgical options in the treatment of uretero-arterial fistulas

Objective To report and analyze the indications and results of endovascular and open surgical treatment for uretero-arterial fistula. Methods We retrospectively reviewed the clinical data of 25 consecutive patients with uretero-arterial fistulas admitted to our hospital from 2011 to 2020. Endpoints were technical success, freedom from open conversion, stent-graft/graft-related complications, and 30-day and one-year mortality. Results The study included 25 patients (68% female, n = 17) with 27 uretero-arterial fistulas by bilateral pathologies in two patients. The mean age was 61 ± 11 years (range 35–80). The most common predisposing factors for uretero-arterial fistula were history of pelvic operations for malignancy in 21 patients (84%), radiotherapy in 21 patients (84%), previous pelvic vascular bypass in 2 patients (8%), and iliac aneurysms in 2 patients (8%). On average, the period between the primary pelvic surgery and the diagnosis of uretero-arterial fistulas was 46 months (range 7–255). Twenty patients (80%) underwent endovascular treatment of the uretero-arterial fistulas. The primary technical success of the endovascular treatment was 95%, and the freedom from open conversion was 40% at six months and 30% at one year. Thirteen uretero-arterial fistulas (48%) underwent delayed open conversion due to recurrent bleeding in six cases (46%), stent-graft infection in three cases (23%), or pelvic abscess in four cases (31%). Primary open surgery was applied for five (20%) patients. After a mean follow-up of 34 months, early (<30 days) mortality was 8% (2/25), one-year mortality 16% (4/25), and overall mortality was 24% (6/25). Conclusions Uretero-arterial fistula is a late complication of prior pelvic surgery, radiation, and indwelling ureteral stents. Endovascular treatment remains an effective and less invasive modality in controlling the related life-threatening arterial bleeding of the uretero-arterial fistula. Open surgical treatment is still required for patients with local sepsis, previously failed endovascular treatment or infected stent-grafts.

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The Evaluation of Aortic Diameter Changes During Long-Term Follow-Up After Endovascular Treatment of Acute Blunt Traumatic Thoracic Aortic Injuries

Vascular and Endovascular Surgery ◽

10.1177/1538574418765385 ◽

2018 ◽

Vol 52 (5) ◽

pp. 335-343 ◽

Cited By ~ 6

Author(s):

Federico Fontana ◽

Edoardo Macchi ◽

Filippo Piacentino ◽

Larissa Nocchi Cardim ◽

Giuseppe De Marchi ◽

...

Keyword(s):

Endovascular Treatment ◽

Stent Graft ◽

Mean Value ◽

Aortic Diameter ◽

Long Term Results ◽

Technical Success ◽

Long Term Follow Up ◽

Aortic Injuries

Purpose: To evaluate the variations in aortic diameters and long-term results in patients who underwent thoracic endovascular aortic repair (TEVAR) for acute blunt traumatic thoracic aortic injuries (BTTAIs). Materials and Methods: We retrospectively evaluated 23 patients with a mean age of 39 years (range: 17-74 years) who underwent TEVAR for BTTAI between October 2000 and November 2014. All of the patients underwent computed tomography angiography (CTA) before hospital discharge as a baseline imaging for the subsequent follow-up examinations. The technical success, overall survival, and complications were evaluated. Furthermore, the aortic diameters outside of the stent-graft (1 cm proximal and 1 cm distal to the stent-graft) and the aortic diameters within the stent-graft (2 cm distal to the proximal end and 2 cm proximal to the distal end) were assessed. The diameters at baseline on CTA were compared with those of the latest available follow-up examination. Results: Technical success was 100% with a mean follow-up of 65.4 months (range: 12-171 months). No death was registered, and 2 (8.7%) of 23 endograft-related complications (1 stent-graft distal infolding and 1 endoleak 2 and 4 months after the procedure, respectively) were observed. An increase in aortic diameter either proximal or distal to the stent-graft (mean value 0.7 and 0.5 mm, respectively) or within the stent-graft (mean value of 0.5 mm for both proximal and distal diameters) was registered (mean follow-up at 65.4 months, range: 12-171 months). Conclusion: Aortic dilatation following TEVAR for BTTAI is minimal during long-term follow-up. Endovascular treatment represents a durable and safe option in acute BTTAIs.

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Endovascular Treatment of Spontaneous and Isolated Infrarenal Acute Aortic Syndrome with Unibody Aortic Stent-Grafts

World Journal of Surgery ◽

10.1007/s00268-020-05754-1 ◽

2020 ◽

Vol 44 (12) ◽

pp. 4267-4274

Author(s):

Felice Pecoraro ◽

Ettore Dinoto ◽

Domenico Mirabella ◽

Francesca Ferlito ◽

Arduino Farina ◽

...

Keyword(s):

Endovascular Treatment ◽

Stent Graft ◽

Abdominal Aorta ◽

Infrarenal Aorta ◽

Acute Aortic Syndrome ◽

Technical Success ◽

Stent Grafts ◽

Femoral Access ◽

Persistent Symptoms

Abstract Introduction Spontaneous acute aortic syndrome (IAAS) is rarely localized in the infrarenal aorta. The endovascular approach is preferred over conventional open surgery with fewer complications. However, dedicated endovascular devices for IAAS treatment are unavailable. The aim was to report a large single-center experience using unibody stent-grafts to address IAAS. Methods From April 2016 to March 2019, a retrospective analysis of patients presenting spontaneous and isolated IAAS was performed. Patients addressed with the unibody stent-graft (AFX endovascular AAA system; Endologix Inc., Irvine, CA) were included in the study. Indications to IAAS treatment were persistent symptoms and/or dilated abdominal aorta (>3 cm). The measured outcomes were technical success; early outcomes (<30 days) including mortality, morbidity, symptoms recurrence, and endoleak occurrence; and late outcomes (>30 days) including mortality, symptoms recurrence, endoleak occurrence, stent-graft patency, and survival. Median follow-up was 23.77 ± 10 months. Results Twenty-one patients with IAAS were included. Indications to treatment were symptoms in 14 (67%) patients and dilated abdominal aorta in 7 (33%). Technical success was achieved in all cases. No perioperative mortality and 1 (4.8%) early femoral access complication was encountered. During the follow-up were registered 1 (4.8%) aortic unrelated death and 1 (4.8%) stent-graft limb stenosis. The 36 months estimated survival and freedom from reintervention were 92% (CI: 37–43; SE: 1.7) and 94% (CI: 37–44; SE: 1.7), respectively. Conclusions The endovascular treatment of IAAS with unibody stent-graft (AFX endovascular AAA system; Endologix Inc.) is safe and effective with promising mid-term outcomes. The use of unibody stent-grafts expands the endovascular indication, despite the usual anatomic IAAS features. Larger studies with longer follow-up are required to validate the outcomes of the reported technique.

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Operative Treatment of a Superior Cerebellar Artery Perforator Dissecting Aneurysm

Operative Neurosurgery ◽

10.1093/ons/opz407 ◽

2020 ◽

Vol 19 (2) ◽

pp. E203-E208

Author(s):

Jonathan J Lee ◽

Meng Huang ◽

Jaime Guerrero ◽

Virendra R Desai ◽

Amanda Jenson ◽

...

Keyword(s):

Surgical Treatment ◽

Endovascular Treatment ◽

Therapeutic Strategy ◽

Dissecting Aneurysm ◽

Superior Cerebellar Artery ◽

Cerebral Angiogram ◽

Suboccipital Craniotomy ◽

Cerebellar Artery ◽

Open Surgical Treatment ◽

Artery Perforator

Abstract BACKGROUND AND IMPORTANCE Superior cerebellar artery (SCA) perforator aneurysms are extremely rare, with only one other case published in the literature. There is no conclusive management strategy for these aneurysms, although endovascular treatment, open surgical treatment with clipping, and antifibrinolytic administration with spontaneous thrombosis have all been discussed. CLINICAL PRESENTATION A 61-yr-old male presented with intraventricular hemorrhage (IVH) primarily in the posterior fossa. He was found to have a dissecting left SCA perforator aneurysm lying on the floor of the fourth ventricle. The aneurysm was not amenable to endovascular treatment, and antifibrinolytic therapy failed to spontaneously thrombose the aneurysm. We performed a suboccipital craniotomy and used a supracerebellar transvermian approach to resect the aneurysm. There was total obliteration of the aneurysm on postoperative cerebral angiogram. CONCLUSION SCA perforator aneurysms represent an extremely uncommon subset of intracranial aneurysms. The best therapeutic strategy has yet to be definitively proven. When pursuing surgical treatment, the supracerebellar transvermian navigated approach can be a useful and safe option, as described and illustrated in this video.

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Surgical and Endovascular Treatment in a One-year Serie of Patients with Aneurysmatic Lesions - Lugano 2013

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0034-1383808 ◽

2014 ◽

Vol 75 (S 02) ◽

Author(s):

D. Valsecchi ◽

M. Reinert

Keyword(s):

Endovascular Treatment ◽

One Year

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Epicardial cryoablation as surgical treatment for atrial fibrillation: One year follow up in 84 patients

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2008-1037863 ◽

2008 ◽

Vol 56 (S 1) ◽

Author(s):

R Uhl ◽

I Marcolino ◽

E Zimmer ◽

F Beyersdorf ◽

E Eschenbruch

Keyword(s):

Atrial Fibrillation ◽

Surgical Treatment ◽

One Year

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Endovascular Treatment of Arteriovenous Fistula with Pseudoaneurysm at Popliteal Fossa Using a PTFE Stent-graft: A Case Report

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2005.52.2.107 ◽

2005 ◽

Vol 52 (2) ◽

pp. 107

Author(s):

Jeong Yeol Choi ◽

Dong Hyun Kim ◽

Hyung Woo Oh ◽

Jeong Hwan Jang ◽

Jae Hee Oh ◽

...

Keyword(s):

Case Report ◽

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Stent Graft ◽

Popliteal Fossa

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Osteosynthesis at pelvic injuries in toy-breed dogs

Veterinaria Kubani ◽

10.33861/2071-8020-2020-3-32-33 ◽

2020 ◽

pp. 32-33

Author(s):

Nikolay I. Antonov ◽

Keyword(s):

Surgical Treatment ◽

Urban Environment ◽

Pelvic Trauma ◽

X Rays ◽

Skeletal Trauma ◽

Companion Dogs ◽

Pelvic Injuries ◽

Behavioral Features ◽

Osteosynthesis Techniques ◽

One Year

Pelvic injuries account for 16 to 25% of all skeletal trauma in small pets. Small dogs as companion dogs are now widespread. Unusual exterior and behavioral features have made them popular and at the same time vulnerable in the modern urban environment. The author defined the nature of injuries and adapted technique of transosseous osteosynthesis for the treatment of toy-breed dogs with pelvic trauma. The study of the X-rays in 226 dogs with pelvic injuries demonstrated that toy-breed dogs accounted for 16% of the total. Multiple pelvic trauma was revealed in 95% of them. Surgical treatment was performed in 24 dogs, conservative one - in 13, that amounted to 65% and 35%, respectively. Surgical treatment consisted in open juxtaposing of fragments and focal transosseous and/or internal osteosynthesis with subsequent external fixation using devices of various designs. The external structures were of three types: half-ring support or U-shaped staple, pair of parallel curved plates connected by two threaded rods with each other, and pair of curved plates located bilaterally on both sides of the pelvis and connected by two threaded rods with the help of threaded ends. The terms of fixation for pelvic injuries in toy-breed dogs at the age under one year were 42 days on the average, and in the dogs at the age above one year - 60 days. Surgical treatment in toy-breed dogs with pelvic injuries was performed more often in comparison with conservative one. Pelvic trauma was accompanied by pronounced pain shock. The osteosynthesis techniques used in toy-breed dogs are little traumatic and not limiting functions thereby contributing to recovery of all the structures of pelvis and pelvic limbs.

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