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.

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

2018 ◽  
Vol 52 (5) ◽  
pp. 335-343 ◽  
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.

scholarly journals Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

2019 ◽  
Vol 130 (3) ◽  
pp. 895-901 ◽  
Author(s):  
Michael A. Mooney ◽  
Elias D. Simon ◽  
Scott Brigeman ◽  
Peter Nakaji ◽  
Joseph M. Zabramski ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Clinical Outcomes ◽  
Cerebral Artery ◽  
Long Term Results ◽  
Ruptured Aneurysm ◽  
Microsurgical Clipping ◽  
Mca Aneurysm

OBJECTIVEA direct comparison of endovascular versus microsurgical treatment of ruptured middle cerebral artery (MCA) aneurysms in randomized trials is lacking. As endovascular treatment strategies continue to evolve, the number of reports of endovascular treatment of these lesions is increasing. Herein, the authors report a detailed post hoc analysis of ruptured MCA aneurysms treated by microsurgical clipping from the Barrow Ruptured Aneurysm Trial (BRAT).METHODSThe cases of patients enrolled in the BRAT who underwent microsurgical clipping for a ruptured MCA aneurysm were reviewed. Characteristics of patients and their clinical outcomes and long-term angiographic results were analyzed.RESULTSFifty patients underwent microsurgical clipping of a ruptured MCA aneurysm in the BRAT, including 21 who crossed over from the endovascular treatment arm. Four patients with nonsaccular (e.g., dissecting, fusiform, or blister) aneurysms were excluded, leaving 46 patients for analysis. Most (n = 32; 70%) patients presented with a Hunt and Hess grade II or III subarachnoid hemorrhage, with a high prevalence of intraparenchymal blood (n = 23; 50%), intraventricular blood (n = 21; 46%), or both. At the last follow-up (up to 6 years after treatment), clinical outcomes were good (modified Rankin Scale score 0–2) in 70% (n = 19) of 27 Hunt and Hess grades I–III patients and in 36% (n = 4) of 11 Hunt and Hess grade IV or V patients. There were no instances of rebleeding after the surgical clipping of aneurysms in this series at the time of last clinical follow-up.CONCLUSIONSMicrosurgical clipping of ruptured MCA aneurysms has several advantages over endovascular treatment, including durability over time. The authors report detailed outcome data of patients with ruptured MCA aneurysms who underwent microsurgical clipping as part of a prospective, randomized trial. These results should be used for comparison with future endovascular and surgical series to ensure that the best results are being achieved for patients with ruptured MCA aneurysms.

Endovascular treatment of intracranial aneurysms with the Woven EndoBridge device: mid term and long term results

2017 ◽  
Vol 10 (2) ◽  
pp. 127-132 ◽  
Author(s):  
Benjamin Mine ◽  
Alexandra Goutte ◽  
Denis Brisbois ◽  
Boris Lubicz
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Long Term Results ◽  
Results Of Treatment ◽  
Long Term Follow Up ◽  
Device Placement ◽  
Woven Endobridge ◽  
Web Device

PurposeTo evaluate the clinical and anatomical results of treatment of intracranial aneurysms (IA) with the Woven EndoBridge (WEB) device, with emphasis on mid term and long term follow-up.MethodsBetween November 2010 and November 2015, we retrospectively identified, in our prospectively maintained database, all patients treated by WEB device placement for an IA at three institutions. Clinical charts, procedural data, and angiographic results were reviewed.Results48 patients with 49 IAs were identified. There were 35 women and 13 men with a mean age of 57 years (range 35–76 years). All IA were wide necked. Mean aneurysm size was 8.6 mm. There were 44 unruptured IA and 5 ruptured IA. During endovascular treatment (EVT), adjunctive devices were used in 22.4% of procedures. A good clinical outcome (modified Rankin Scale score ≤2) was achieved in 44/48 patients (92%). There was no mortality. Mean follow-up was 25 months (range 3–72 months; median 24 months). Between mid term and long term follow-up, occlusion was stable in 19/23 IA (82.6%), improved in 2/23 IA (8.7%), and worsened in 2/23 IA (8.7%). Retreatment was performed in 8/49 IA (16.3%). At the latest available follow-up, there were 34/47 (72.3%) complete occlusions and 13/47 (27.7%) neck remnants.ConclusionsOur study suggests that EVT of IA with the WEB device provides adequate and stable long term occlusion.

Abstract WP27: Endovascular Treatment in Elderly Patient. Should We Continue Treating Them?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Pedro Cardona ◽  
Blanca Lara ◽  
Helena Quesada ◽  
Nuria Cayuela ◽  
Lucia Aja ◽  
...  
Keyword(s):  
Elderly Patient ◽  
Elderly Patients ◽  
Endovascular Treatment ◽  
Successful Aging ◽  
Functional Independence ◽  
Long Term Results ◽  
Lower Percentage ◽  
Long Term Follow Up

Background: Endovascular treatment has been approved and has demonstrated effective in treating strokes with large vessel occlusion in trials published. A short number of elderly patients were included in these trials of thrombectomy. Current criteria admit patients without limit age but demand good baseline Rankin. However, despite those efforts in subgroup of older patients, we could achieve outcomes and long-term results different after endovascular treatment. Methods: We performed an analysis of consecutives patients treated with stent-retriever from March 2010 to May 2016. We dichotomize between younger (<80 years old) and elderly (>=80y) patients. We assessed good functional outcome in Rankin scale (0-2) at 3 month and long-term follow-up, percentage of successful recanalization (TICI 2b-3), symptomatic intracranial hemorrhage (SICH) and mortality. Moreover we determine percentage of futile recanalization in elderly patients and variables associated to failed thrombectomy. Results: A total of 622 patients were analyzed, mean age 67+/-12, baseline NIH:17, OSTP (onset stroke time to groin puncture): 279 min, baseline Rankin 0-1: 92%. Subgroup of elderly patients represented 21% of patients (131pt): mean age 83 (80-92), NIH:18, OSTP: 272 min, baseline Rankin 0-1:96%. We compare percentage of successful recanalization (TICI 2b-3) between younger and older patient (75% vs 60%; p:0.001). In multivariate analysis functional independence at 3 month (mRs 0-2) was significantly worse in elderly subgroup compared with younger patients (23% vs 51% ) and mortality (25% vs 17%). In a subgroup of long-term follow-up we found in elderly patient an increase of mortality (49%) after 2.5 years and lower percentage mRS 0-2 (18%), due to morbidity and fragility after stroke. Futile recanalization was higher in elderly patients compared with younger (31% vs 17%). Variables associated to futile recanalization in this subgroup of patients were ASPECTS<8 and hostile vascular access to occluded artery. Conclusions: We recommend more restrictive criteria to endovascular treatments in elderly patients. A low percentage of good outcome and high percentage of mortality at long-term follow-up don’t contribute to recent health target of successful aging.

scholarly journals Symptomatic or aneurysmal aberrant subclavian arteries: results of surgical and hybrid repair

2019 ◽  
Vol 29 (3) ◽  
pp. 344-351 ◽  
Author(s):  
Salome Weiss ◽  
Didem Haligür ◽  
Silvan Jungi ◽  
Florian S Schönhoff ◽  
Thierry Carrel ◽  
...  
Keyword(s):  
Symptom Relief ◽  
Long Term Results ◽  
Aneurysmal Dilatation ◽  
Aortic Repair ◽  
Kommerell’S Diverticulum ◽  
Hybrid Repair ◽  
Aberrant Artery ◽  
Hybrid Group

Abstract OBJECTIVES Indications and techniques of repair for symptomatic or aneurysmal aberrant subclavian arteries (ASA) are controversial. This study analyses presentation, treatment and outcome of patients with symptomatic and/or aneurysmal ASA. METHODS Retrospective analysis of consecutive adult patients undergoing symptomatic and/or aneurysmal ASA repair between January 2000 and June 2016. RESULTS Of 12 patients (4 females) with a median age of 66 years (range 24–75), 10 had right ASA and 2 had left ASA originating from a right aortic arch. Six patients (50%) had Kommerell’s diverticulum and 6 patients had aneurysmal dilatation of the ASA itself. Six patients presented with symptoms (dysphagia n = 4, chest pain n = 1, recurrent aspiration n = 1). Nine patients (75%) were treated by open ASA resection/ligation with or without aortic repair. Three patients (25%) underwent hybrid repair using thoracic endovascular aortic repair to exclude the aberrant artery. ASA revascularization was achieved by subclavian–carotid transposition (n = 7), carotid–subclavian bypass (n = 1), aorto-subclavian bypass (n = 3) or reimplantation after aortic graft replacement (n = 1). Thirty-day mortality was 8% (n = 1). The median follow-up duration was 44 months (range 24–151). Symptoms were relieved in 4 and persisted partially in 1, while symptom relief remained unknown in 1 patient who died during follow-up. Imaging after a median of 34 months (range 2–134) after the operation showed patent ASA revascularization in all patients and no endoleaks in the hybrid group. CONCLUSIONS Surgical and hybrid repair allows satisfying results in patients with symptomatic and/or aneurysmal ASA. The optimal procedure has to be defined on an individual patient basis. Further studies, preferably with a multicentre approach, are required to answer more specific questions on the management of these patients and especially to assess long-term results following hybrid repair.

Endovascular treatment for chronic atherosclerotic occlusive mesenteric disease: Is stenting superior to balloon angioplasty?

VASA ◽  
2010 ◽  
Vol 39 (4) ◽  
pp. 319-324 ◽  
Author(s):  
Daliri ◽  
Grunwald ◽  
Jobst ◽  
Szucs-Farkas ◽  
Diehm ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Patency Rate ◽  
Celiac Artery ◽  
Primary Patency ◽  
Secondary Patency ◽  
Chronic Mesenteric Ischemia ◽  
Primary Patency Rate ◽  
Secondary Patency Rate

Background: Endovascular treatment is an increasingly used therapeutic option in patients with chronic atherosclerotic occlusive mesenteric disease. Purpose of this study was evaluation of patency and mortality in patients treated with visceral artery percutaneous transluminal angioplasty (PTA) or stenting including follow-up. Patients and methods: A retrospective review of 17 consecutive patients (4 women, 13 men) with endovascular treatment for symptomatic chronic mesenteric ischemia from 1998 to 2004 was performed. Mean follow-up period was 42 months. Patient demographics, interventional details, primary and/or secondary patency and mortality were recorded. Cumulative mortality and patency rates were determined using Kaplan-Meier life table analysis. Results: Twenty-six interventions (PTA alone n = 13, PTA and stenting n = 13) were performed in 17 patients. Interventions were performed in the superior mesenteric artery (n = 13) and celiac artery (n = 13). The re-intervention rate was 30 % (6/26). Re-interventions were performed for the superior mesenteric artery (n = 4) and celiac artery (n = 2). Cumulative overall 1-year results were primary patency rate 81 %, secondary patency rate 94 %, and survival rate 82 %. Cumulative 10-year results were primary patency rate 73 %, secondary patency rate 94 %, and survival rate 65 %. The 10-year secondary patency rate was 100 % in patients post initial stenting and 86 % in patients post initial PTA. Conclusions: Long-term follow-up post endovascular treatment for chronic mesenteric ischemia demonstrated a considerable overall secondary patency rate of 94 %. However, the long-term secondary patency rate was higher in patients post initial stenting compared to PTA alone.

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 Percutaneous Alcohol Sclerotherapy of Simple Hepatic Cysts. Results From a Multicentre Survey in Italy

HPB Surgery ◽  
1994 ◽  
Vol 8 (2) ◽  
pp. 89-94 ◽  
Author(s):  
Marco Montorsi ◽  
Guido Torzilli ◽  
Uberto Fumagalli ◽  
Stefano Bona ◽  
Riccardo Rosati ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Local Anesthesia ◽  
Long Term Results ◽  
Hepatic Cysts ◽  
Number Of Patients ◽  
Mean Diameter ◽  
The Mean

The increased use of Ultrasonography (US) has led to increased detection of simple hepatic cysts. For symptomatic cysts treatment is necessary. Until some years ago surgery was the only therapy. We have treated a large number of patients with Percutaneous Alcohol Sclerotherapy (PAS) and evaluated retrospectively the efficacy of this approach.Data on 21 patients with symptomatic simple hepatic cysts were reviewed retrospectively. Cysts had a mean diameter of 9 cm (range: 7–15 cm). PAS was always performed under local anesthesia and US guidance. 25% of the volume was replaced with 95% ethanol and then completely aspirated after 20–30 minutes.No complications or deaths occurred. In all patients symptoms disappeared after treatment. In 15 out of 21 cases there was no evidence of residual cyst on US, computed tomography (CT) or magnetic resonance (MRI). In 6 patients with shorter follow-up, cysts showed a mean reduction in diameter of 50%. The mean follow-up was 18 months (range 6–60 months).We conclude that PAS is easy with low risk for the patients and with good long-term results; it should therefore become the procedure of choice for simple hepatic cysts.

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