Aortic endograft and bridging stent-graft remodeling after branched endovascular aortic repair

Objectives The results of branched endovascular repair of thoracoabdominal aneurysms are mainly dependent on durability of the graft used. The purpose of this study was to evaluate postoperative aortic main body and bridging stent-graft remodeling, and their impact on bridging stent-graft instability at one year. Methods Computed tomoangiographies of 43 patients (43 aortic main body mated with 171 bridging stent-grafts) were analyzed before and after branched endovascular repair as well as after a follow-up of 12 months. Primary endpoint was aortic main body remodeling (migration >5 mm, shortening >5 mm, scoliosis >5° or lordosis >5°). Shortening was defined as a reduced length in the long axis, scoliosis as left-right curvature, and lordosis as antero-posterior curvature. Aortic main body remodeling, aneurysm sac changes, and bridging stent-graft tortuosity were evaluated to study their correlations and the impact on the bridging stent-graft instability. Results At 12 months, aortic main body remodeling was observed in 72% of the cases, migration in 39.5% (mean 5.21 mm), shortening in 41.9% (mean 5.79 mm), scoliosis in 58.1%, (mean 10.10°), lordosis in 44.2% (mean 5.78°). Migration, shortening, and scoliosis were more frequent in patients with larger aneurysms ( p = .005), while scoliosis was significantly more frequent in type II thoracoabdominal aneurysm ( p = .019). Aortic main body remodeling was significantly associated to bridging stent-graft remodeling (r: 0.3–0.48). The bridging stent-graft instability rate was 9.3%. Despite a trend toward significance ( p = .07), none of the evaluated aortic main body and bridging stent-graft changes were associated with bridging stent-graft instability at 12 months. Conclusions Aortic main body remodeling is frequent especially in large and extended thoracoabdominal aneurysm aneurysms. Aortic main body and bridging stent-graft remodeling was significantly correlated. While these geometric changes had no significant impact on bridging stent-graft instability at one year, a close long-term follow-up after branched endovascular repair could predict bridging stent-graft failures.

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Adherence to instruction for use after endovascular repair of popliteal artery aneurysm

Vascular ◽

10.1177/17085381211007312 ◽

2021 ◽

pp. 170853812110073

Author(s):

Axel Wrede ◽

Leena Lehti ◽

Jonas Peter Eiberg ◽

Stefan Acosta

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Popliteal Artery ◽

Artery Aneurysm ◽

Primary Patency ◽

Size Difference ◽

Stent Grafts ◽

Popliteal Artery Aneurysm ◽

One Year

Objectives Endovascular repair (ER) of popliteal artery aneurysm (PAA) is an alternative to open repair. However, there is no standardized protocol for when to opt for ER and the decision is therefore at the discretion of the clinician. This study aims to evaluate the adherence to the Instruction For Use (IFU) in patients undergoing ER for PAA and factors associated with stent graft patency at one year. Methods The adherence to IFU provided by the manufacturer in 55 patients treated with Gore Viabahn® Endoprosthesis with Heparin Bioactive Surface for PAA between 2009 and 2019 were retrospectively analyzed. Duplex follow-up was performed at 30 days and one year. Results The two groups of patients treated within ( n = 10) and not within ( n = 45) IFU did not differ in patient demographics, diagnostic assessment, treatment or outcome. Forty-five patients (81.8%) received stent graft placement with at least one deviation according to IFU. Distal oversizing >20% was the most frequent deviation against IFU ( n = 22, 40.0%). Primary patency at one year was 72%. Diameter size difference >1 mm between overlapping stent grafts (6/14 [43%], p = 0.013) and renal insufficiency (5/12 [42%], p = 0.0086) were associated with lower primary patency at one year. Age-adjusted analysis of tortuosity index (HR 1.78/SD, 95% CI 1.17–2.71; p = 0.0071) and maximal PAA angle (HR 1.73/SD, 95% CI 1.018–2.95; p = 0.043) were associated with major amputation/mortality at end of follow-up. Conclusion The majority of patients undergoing ER for PAA were not treated within IFU. Diameter size difference >1 mm between overlapping stent grafts was associated with a higher loss of primary patency at one year. Multi-center studies with larger sample size and long-term follow up of patency are warranted.

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High levels of Schistosoma mansoni infections among schoolchildren in central Sudan one year after treatment with praziquantel

Journal of Helminthology ◽

10.1017/s0022149x11000290 ◽

2011 ◽

Vol 86 (2) ◽

pp. 228-232 ◽

Cited By ~ 14

Author(s):

A.M. Ahmed ◽

L.A. El Tash ◽

E.Y. Mohamed ◽

I. Adam

Keyword(s):

Single Dose ◽

Elementary Schools ◽

Longitudinal Study ◽

Schistosoma Mansoni ◽

Intensity Of Infection ◽

Central Sudan ◽

Before And After ◽

One Year ◽

The Impact

AbstractA longitudinal study was conducted to evaluate the impact of praziquantel (PZQ) for the treatment of Schistosoma mansoni infection among schoolchildren in Al Gunaid in Central Sudan. A cohort of schoolchildren (6–15 years of age) was investigated before and 1 year after treatment with a single dose of PZQ 40 mg/kg. Parasitological examinations for S. mansoni were performed before and after treatment, and prevalence and intensity of infection were analysed. Of 2741 schoolchildren recruited from six elementary schools at baseline, 2521 were successfully traced and re-examined at follow-up, with two complete sets of longitudinal parasitological data on S. mansoni. Boys showed significantly higher prevalence of S. mansoni infection than girls. A single dose of PZQ reduced the overall prevalence of S. mansoni infection by 36.7% (from 59.1 to 37.4%) and the intensity of infection by 41.1% (from 116.7 to 68.7 eggs per gram of stool) 1 year after treatment. The reduction in prevalence was significantly higher among the group of children with heavy infections (by 76.1%, from 6.7 to 1.6%) and among girls (by 54.1%, 42.3 to 19.4%) at 1 year after treatment. Thus, in spite of a significant reduction in the prevalence and intensity of S. mansoni infection 1 year after PZQ treatment, the prevalence of the disease was still high and further research is needed on this topic.

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Early- and long-term results of thoracic endovascular aortic repair for blunt traumatic thoracic aortic injury: a single-centre experience†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz023 ◽

2019 ◽

Vol 56 (2) ◽

pp. 307-312

Author(s):

Daisuke Kaneyuki ◽

Toshihisa Asakura ◽

Atsushi Iguchi ◽

Akihiro Yoshitake ◽

Chiho Tokunaga ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Aortic Injury ◽

Long Term Results ◽

Technical Success Rate ◽

Thoracic Aortic Injury ◽

Cord Injury ◽

Long Term Follow Up

Abstract OBJECTIVES Endovascular repair has been proposed as an alternative to classical surgical repair for the management of blunt traumatic thoracic aortic injury. However, the long-term outcomes of endovascular repair and the risks of left subclavian coverage remain unclear. METHODS From April 2001 to August 2018, 33 patients with blunt traumatic thoracic aortic injury underwent endovascular repair in our institution. A follow-up computed tomography and a clinical examination were performed before discharge and at 1 month, and yearly or every 2 years thereafter. RESULTS The mean age was 45 ± 19 years. The technical success rate was 100%. Complete coverage of the left subclavian artery (LSCA) was performed in 20 patients (60.6%). Among 20 patients with coverage of the LSCA, revascularization was performed in 1 patient. No in-hospital deaths occurred. The clinical follow-up rate was 97%, with a mean period of 7 years and a maximum of 18 years. The survival rates were 100% at 1 year, 95% at 5 years and 88.7% at 10 years after the event. Among the 5 patients (20%) who developed neurological complications, 1 who had undergone implantation of a 200-mm long stent graft and LSCA coverage without revascularization developed paraplegia during the long-term follow-up. CONCLUSIONS This study demonstrates that the endovascular treatment of blunt traumatic thoracic aortic injury is a safe and effective therapeutic method over a long-term follow-up period. LSCA coverage and long stent graft placement might be indications for revascularization to prevent spinal cord injury.

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The Introduction of a Crisis Unit in a Mental Hospital

Canadian Psychiatric Association Journal ◽

10.1177/070674377401900501 ◽

1974 ◽

Vol 19 (5) ◽

pp. 445-452 ◽

Cited By ~ 3

Author(s):

George Voineskos ◽

M. F. Morrison ◽

R. C. Jain

Keyword(s):

Mental Hospital ◽

Clinical Service ◽

Treatment Programs ◽

Open Door Policy ◽

Number Of Patients ◽

Before And After ◽

Long Term Follow Up ◽

The Impact

A community oriented Crisis Unit was introduced in a mental hospital as an integral part of a comprehensive Clinical Service. The unit is doing crisis assessment and intervention for patients referred to this Clinical Service and a 72-hour inpatient or day-care crisis oriented therapy. The locale, the organization of the team and the work of the unit are described. Data are given regarding the number of patients seen during the first six months, of those admitted and of those discharged within 72 hours or transferred to another unit of the service. Additional data referring to the patients admitted to the Crisis Unit and during a corresponding six-month period of the previous year when the Unit was not operating are also given. The reduction of the inpatient population of the service and the associated financial savings are outlined. The management of the Unit on an open-door policy is described. The impact of the Unit on the treatment programs of the other units of the service is discussed. It is suggested that crisis therapy oriented units should be considered an essential and integral component of the psychiatric services offered by mental or general hospitals. Comparative studies of patient populations before and after the introduction of such units and long-term follow-up evaluative studies are required.

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Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

European Heart Journal ◽

10.1093/ehjci/ehaa946.2636 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Benito Gonzalez ◽

X Freixa ◽

C Godino ◽

M Taramasso ◽

R Estevez-Loureiro ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Functional Mitral Regurgitation ◽

Valve Repair ◽

One Year ◽

The Impact

Abstract Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results 93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed. Conclusion PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort. Proportion of patients who presented ven Funding Acknowledgement Type of funding source: None

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A prospective, observational clinical trial on the impact of COVID-19-related national lockdown on thyroid hormone in young males

Scientific Reports ◽

10.1038/s41598-021-86670-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Giulia Brigante ◽

Giorgia Spaggiari ◽

Barbara Rossi ◽

Antonio Granata ◽

Manuela Simoni ◽

...

Keyword(s):

Clinical Trial ◽

Serum Levels ◽

Stressful Event ◽

Italian Population ◽

Reference Ranges ◽

Endocrine Regulation ◽

Before And After ◽

Hpt Axis ◽

The Impact

AbstractTrying to manage the dramatic coronavirus disease 2019 (COVID-19) infection spread, many countries imposed national lockdown, radically changing the routinely life of humans worldwide. We hypothesized that both the pandemic per se and the consequent socio-psychological sequelae could constitute stressors for Italian population, potentially affecting the endocrine system. This study was designed to describe the effect of lockdown-related stress on the hypothalamic-pituitary-thyroid (HPT) axis in a cohort of young men. A prospective, observational clinical trial was carried out, including patients attending the male infertility outpatient clinic before and after the national lockdown for COVID-19 pandemic. The study provided a baseline visit performed before and a follow-up visit after the lockdown in 2020. During the follow-up visit, hormonal measurements, lifestyle habits and work management were recorded. Thirty-one male subjects were enrolled (mean age: 31.6 ± 6.0 years). TSH significantly decreased after lockdown (p = 0.015), whereas no significant changes were observed in the testosterone, luteinising hormone, follicle-stimulating hormone, estradiol and prolactin serum levels. No patient showed TSH serum levels above or below reference ranges, neither before nor after lockdown. Interestingly, TSH variation after lockdown was dependent on the working habit change during lockdown (p = 0.042). We described for the first time a TSH reduction after a stressful event in a prospective way, evaluating the HPT axis in the same population, before and after the national lockdown. This result reinforces the possible interconnection between psychological consequences of a stressful event and the endocrine regulation.

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Endovascular repair of de novo post-stenotic aortic coarctation aneurysms with complex collateral supply: two cases with long and medium term follow-up

CVIR Endovascular ◽

10.1186/s42155-020-00193-4 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Omar Abdel-Hadi ◽

John Thomson ◽

Simon J. McPherson

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Aortic Coarctation ◽

De Novo ◽

Aortic Aneurysms ◽

Medium Term ◽

First Case ◽

Case Presentations ◽

Selective Embolisation

Abstract Purpose To report the technical details and outcomes of the endovascular repair of two cases of de novo post-stenotic aortic coarctation aneurysms complicated by complex collateral supply. Case presentations Two patients with thoracic aortic aneurysms complicated by complex aneurysm sac collaterals distal to a previously untreated thoracic aortic coarctation have been treated at our institution. Open surgical intervention was deemed to carry a high risk of haemorrhage due to the degree and complexity of arterial collateralisation. In the first case, selective embolisation of collateral vasculature was performed prior to successful exclusion of the aneurysm with a thoracic endovascular stent-graft and then balloon-expandable stent dilatation of the coarctation stenosis. In the second case, the additional technique of using a jailed sheath within the aneurysm sac allowed for selective embolisation of previously inconspicuous collaterals after deployment of the stent-graft and stent combination. Results Technical success was achieved in both patients with successful occlusion of the aneurysm, with no recorded complications or aneurysm sac perfusion in the long and medium term follow up periods respectively. Conclusion De novo post stenotic aortic coarctation aneurysms are rare. Endovascular repair is a safe and durable technique that provides a less invasive alternative to open surgical repair. The use of a jailed sheath allows for complete selective embolisation of complex collaterals avoiding a type II aneurysm endoleak.

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Impact of Coronary Artery Disease and Diabetes Mellitus on the Long-Term Follow-Up in Patients after Retrograde Recanalization of the Femoropopliteal Arterial Region

Journal of Diabetes Research ◽

10.1155/2019/6036359 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Joanna Wojtasik-Bakalarz ◽

Zoltan Ruzsa ◽

Tomasz Rakowski ◽

Andreas Nyerges ◽

Krzysztof Bartuś ◽

...

Keyword(s):

Diabetes Mellitus ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Risk Of Death ◽

Significant Difference ◽

Long Term Follow Up ◽

Artery Disease ◽

The Impact

The most relevant comorbidities in patients with peripheral artery disease (PAD) are coronary artery disease (CAD) and diabetes mellitus (DM). However, data of long-term follow-up of patients with chronic total occlusion (CTO) are scarce. The aim of the study was to assess the impact of CAD and DM on long-term follow-up patients after superficial femoral artery (SFA) CTO retrograde recanalization. In this study, eighty-six patients with PAD with diagnosed CTO in the femoropopliteal region and at least one unsuccessful attempt of antegrade recanalization were enrolled in 2 clinical centers. Mean time of follow-up in all patients was 47.5 months (±40 months). Patients were divided into two groups depending on the presence of CAD (CAD group: n=45 vs. non-CAD group: n=41) and DM (DM group: n=50 vs. non-DM group: n=36). In long-term follow-up, major adverse peripheral events (MAPE) occurred in 66.6% of patients with CAD vs. 36.5% of patients without CAD and in 50% of patients with DM vs. 55% of non-DM subjects. There were no statistical differences in peripheral endpoints in both groups. However, there was a statistically significant difference in all-cause mortality: in the DM group, there were 6 deaths (12%) (P value = 0.038). To conclude, patients after retrograde recanalization, with coexisting CTO and DM, are at higher risk of death in long-term follow-up.

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Transcatheter closure of defects within the oval fossa using the Amplatzer® Septal Occluder

Cardiology in the Young ◽

10.1017/s1047951102000501 ◽

2002 ◽

Vol 12 (3) ◽

pp. 224-228 ◽

Cited By ~ 1

Author(s):

Haifa Abdul Latiff ◽

Mazeni Alwi ◽

Hasri Samion ◽

Geetha Kandhavel

Keyword(s):

Transcatheter Closure ◽

Standard Procedure ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Term Outcome ◽

Long Term Follow Up ◽

One Year ◽

The Right

This study reviewed the short-term outcome of transcatheter closure of the defects within the oval fossa using an Amplatzer® Septal Occluder. From January 1997 to December 2000, 210 patients with defects within the oval fossa underwent successful transcatheter closure. We reviewed a total of 190 patients with left-to-right shunts, assessing the patients for possible complications and the presence of residual shunts using transthoracic echocardiogram at 24 h, 1 month, 3 months and one year. Their median age was 10 years, with a range from 2 to 64 years, and their median weight was 23.9 kg, with a range from 8.9 to 79 kg. In 5 patients, a patent arterial duct was closed, and in 2 pulmonary balloon valvoplasty performed, at the same sitting. The median size of the Amplatzer® device used was 20 mm, with a range from 9 to 36 mm. The median times for the procedure and fluoroscopy were 95 min, with a range from 30 to 210 min, and 18.4 min, with a range from 5 to 144 min, respectively. Mean follow-up was 20.8 ± 12.4 months. Complete occlusion was obtained in 168 of 190 (88%) patients at 24 h, 128 of 133 (96.2%) at 3 months, and 103 of 104 (99%) at one year. Complications occurred in 4 (2.1%) patients. In one, the device became detached, in the second the device embolized into the right ventricular outflow tract, the lower end of the device straddled in the third, and the final patient had significant bleeding from the site of venupuncture. There were no major complications noted on follow-up. We conclude that transcatheter closure of defects within the oval fossa using the Amplatzer® Septal Occluder is safe and effective. Long-term follow-up is required, nonetheless, before it is recommended as a standard procedure.

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