Hybrid treatment of thoracoabdominal aortic aneurysm: Case series and review of the literature

Background/Aim. Open thoracoabdominal aortic aneurysm (ThAAAs) repair is a challenging mission. Total endovascular approach is performed at selected institutions in developing countries, however these are not generalizable. Hybrid procedures offer an alternative approach. The aim of this study was to present our results of the ThAAA hybrid treatment and a literature review. Methods. This is a retrospective study of all patients that underwent the hybrid ThAAA repair at our institution between January 2011 and January 2018. Hybrid ThAAA repair was done as a twostaged procedure ? open visceral debranching followed by stent-graft placement (TEVAR). The following data from eligible studies were extracted and analyzed: first author, publication year, patient sample, 30-day/in-hospital mortality, permanent paraplegia rate, presence of endoleaks and graft patency after the follow-up period, overall survival and mean follow-up period. Results. Seven patients underwent the hybrid ThAAA repair at our institution. Neither intraoperative death nor technical failure due to TEVAR was observed. Mean follow-up rate after discharge was 51.71 months [95% confidence interval (CI): 14.67?88.74 months]. At the time of the follow-up, all bypasses were patent and no prosthesis migration was documented. After one year, a case of type Ib endoleak was identified and treated successfully. Twenty-five studies were eligible for the literature review. Primary technical success was 91.69% (95% CI: 85.34?97.24%). Mean percentage of permanent paraplegia was 5.27% (95% CI: 3.55?7.01%). Visceral graft patency during the mean follow-up of 27.54 months (95% CI: 17.41?37.66 months) was 94.5% (95% CI: 92.5?96.5%). Mean pooled percentage rate of overall endoleaks during the follow-up period was 16.72% (95% CI: 11.15?22.29%). Analysis revealed 15.32% (95% CI: 11.04?19.61%) of 30- day/in-hospital mortality and 65.98% (95% CI: 58.15? 73.81%) of overall survival after the follow-up period. Conclusion. Although thought as less invasive, the hybrid ThAAA repair is still associated with a considerable morbidity and mortality.

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Myasthenia Gravis Exacerbation and Myasthenic Crisis Associated With COVID19: Case Series and Literature Review.

10.21203/rs.3.rs-790941/v1 ◽

2021 ◽

Author(s):

Cleonisio Leite Rodrigues ◽

Hermany Capistrano Freitas ◽

Paulo Reges Oliveira Lima ◽

Pedro Helder de Oliveira Junior ◽

José Marcelino Aragão Fernandes ◽

...

Keyword(s):

Literature Review ◽

Neuromuscular Junction ◽

Hospital Mortality ◽

Myasthenia Gravis ◽

Viral Infections ◽

Case Series ◽

Previous Treatment ◽

Autoimmune Disorder ◽

Myasthenic Crisis

Abstract Myasthenia Gravis (MG) is an autoimmune disorder of the neuromuscular junction that can be exacerbated by many viral infections, including COVID19. Management of MG exacerbations is challenging in this scenario. We report 8 cases of MG exacerbation or myasthenic crisis associated with COVID19 and discuss prognosis and treatment based on a literature review. Most patients were female (7/8), with an average age of 47.1 years. Treatment was immunoglobulin (IVIG) in 3 patients, plasma exchange (PLEX) in 2 patients, and adjustment of baseline drugs in 3. In-hospital mortality was 25% and 37.5% in 2-month follow-up. This is the largest case series of MG exacerbation or myasthenic crisis due to COVID19 to this date. Mortality was considerably higher than in myasthenic crisis of other etiologies. Previous treatment for MG or acute exacerbation treatment did not seem to interfere with prognosis, although sample size was too small to draw definitive conclusions. Further studies are needed to understand the safety and effectiveness of interventions in this setting, particularly of PLEX, IVIG, rituximab and tocilizumab.

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Eight-Year Follow-Up of a High-Risk Patient Treated for Crawford Type II Thoracoabdominal Aortic Aneurysm (TAAA) with a Multistage Hybrid Open-Endovascular Repair

Annals of Thoracic and Cardiovascular Surgery ◽

10.5761/atcs.cr.12.01924 ◽

2013 ◽

Vol 19 (2) ◽

pp. 166-169

Author(s):

Dariusz Janczak ◽

Jerzy Garcarek ◽

Robert Bogdanik ◽

Tomasz Szydelko ◽

Mariusz Chabowski ◽

...

Keyword(s):

High Risk ◽

Aortic Aneurysm ◽

Endovascular Repair ◽

High Risk Patient ◽

Thoracoabdominal Aortic Aneurysm ◽

Risk Patient ◽

Type Ii

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OTHR-04. Gynecological Malignancies With Metastasis To The Central Nervous System: A Case Series and Systematic Review of the Literature

Neuro-Oncology Advances ◽

10.1093/noajnl/vdab071.059 ◽

2021 ◽

Vol 3 (Supplement_3) ◽

pp. iii15-iii15

Author(s):

Azeem Sajjad ◽

Adeleso Adesina ◽

Penelope Halkiadakis ◽

Kelsey Murphy ◽

Kathleen Mulligan ◽

...

Keyword(s):

Central Nervous System ◽

Overall Survival ◽

Nervous System ◽

Literature Review ◽

Metastatic Disease ◽

Case Series ◽

Progression Free Survival ◽

Gynecologic Malignancies ◽

Free Survival ◽

Cns Metastasis

Abstract Introduction Gynecologic malignancies are an increasingly common proportion of central nervous system metastatic disease. As genetic sequencing technology improves and becomes more accessible, mutations associated with CNS metastasis are easier to elucidate. The aims of this case series and systematic literature review are to describe the patient population with CNS metastatic disease from a gynecologic primary, and to investigate why the proportion of CNS metastasis from gynecologic malignancies is increasing. Ultimately, we hope to improve understanding of this subset of metastatic CNS malignancies and improve management strategies. Methods A literature review of articles describing patients from 1990–2020 who were diagnosed with CNS metastasis from a known gynecologic primary malignancy was performed. Demographics, cancer type, mutation characteristics, management for metastatic disease, progression free survival, number of CNS metastases, and location of metastatic disease were assessed. Inclusion criteria were age>18 years, diagnosis of primary ovarian, uterine, or cervical cancer with confirmed metastatic disease to the CNS, including brain parenchyma, leptomeninges, or intradural spinal cord or dural metastases. Exclusion criteria included pediatric population and bony metastases (e.g., bony spine metastases without evidence of meningeal/parenchymal invasion). Results Our review showed that patients with gynecological metastasis to the CNS generally have worse outcomes regarding overall survival, progression free survival, and quality of life than patients without CNS metastasis. Discussion Our results infer that the reported increase in incidence of CNS metastasis from gynecologic malignancies is a reflection of improvement of detection given advances in technology, improved patient follow up, and increased overall survival of patients with gynecologic malignancies. Further characterization of mutations from gynecologic malignancies associated with brain metastasis could result in development of more treatment options for patients in the future and help determine factors that contribute to developing metastasis to the CNS of various degrees, thus, potentially inform treatment strategies.

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Results of a three-year follow-up after endovascular therapy with multilayer flow modulator in complex thoracoabdominal aortic aneurysm: A case report

Vascular ◽

10.1177/1708538120933516 ◽

2020 ◽

pp. 170853812093351

Author(s):

Nazım Kankılıç ◽

Mehmet S Aydın

Keyword(s):

Case Report ◽

Aortic Aneurysm ◽

Renal Artery ◽

Medical Center ◽

Left Kidney ◽

Thoracoabdominal Aortic Aneurysm ◽

Aortic Aneurysms ◽

Left Renal Artery

Objectives Studies on the short-, medium and long-term effects of flow guiding stents are still limited. In this case report, we present three-year follow-up of the multilayer flow modulator stent in a 55-year-old patient with Crawford Type 2 thoracoabdominal aortic aneurysm. Methods A 55-year-old male patient with Crawford Type 2 thoracoabdominal aortic aneurysm had applied to our medical center. The aneurysm involved coeliac truncus and superior mesenteric artery and extended to the renal artery ostia. Multilayer flow modulator stent was successfully placed, and follow-up CT (Computed tomography) angiographic examination images recorded intermittently (36 months). Results After three years, it was observed that the left renal artery was thrombosed and the left kidney went to atrophy. Other major vascular branches were observed to be open. During this time, the aneurysm was completely closed with thrombus, but the diameter of the aneurysm continued to increase. Conclusions Multilayer flow modulator stents are safe in complex aortic aneurysms. The device increases the thrombus load in the aortic aneurysm and maintains the flow of the main vascular branches. But re-interventions, dilatation of the aneurysm sac and visceral branch obstructions are still challenging for multilayer flow modulator stents.

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Precise plan of hybrid treatment for thoracoabdominal aortic aneurysm: Hemodynamics of retrograde reconstruction visceral arteries from the iliac artery

PLoS ONE ◽

10.1371/journal.pone.0205679 ◽

2018 ◽

Vol 13 (10) ◽

pp. e0205679

Author(s):

Ding Yuan ◽

Jun Wen ◽

Liqing Peng ◽

Jichun Zhao ◽

Tinghui Zheng

Keyword(s):

Aortic Aneurysm ◽

Iliac Artery ◽

Thoracoabdominal Aortic Aneurysm ◽

Hybrid Treatment ◽

Visceral Arteries

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Long-term outcomes of acromegaly treated with fractionated stereotactic radiation: case series and literature review

Neuro-Oncology Practice ◽

10.1093/nop/npx002 ◽

2017 ◽

Vol 4 (4) ◽

pp. 255-262

Author(s):

Ryan Rhome ◽

Isabelle M Germano ◽

Ren-Dih Sheu ◽

Sheryl Green

Keyword(s):

Systematic Review ◽

Literature Review ◽

Case Series ◽

Tumor Control ◽

Pituitary Neoplasms ◽

Review Of The Literature ◽

Biochemical Control ◽

Low Incidence

Abstract Background Growth hormone (GH)-secreting pituitary adenomas represent an uncommon subset of pituitary neoplasms. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) have been used as primary or adjuvant treatment. The purpose of this study is to report the long-term tumor control and toxicity from our institution and to perform a systematic literature review of acromegaly patients treated with FSRT. Methods We retrospectively reviewed all patients treated with FSRT (median dose 50.4 Gray [Gy], range 50.4–54 Gy) between 2005 and 2012 who had: 1) GH-secreting adenoma with persistently elevated insulin growth factor-1 (IGF-1) despite medical therapy and 2) clinical follow up >3 years after FSRT. Patients were treated with modern FSRT planning techniques. Biochemical control was defined as IGF-1 normalization. Systematic review of the literature was performed for FSRT in acromegaly. Results With a median follow-up of 80 months, radiographic control was achieved in all 11 patients and overall survival was 100%. Long-term biochemical control was achieved in 10 patients (90.9%) with either FSRT alone (36.4%) or FSRT with continued medical management (45.5%). No patient experienced new hypopituitarism, cranial nerve dysfunctions, or visual deficits. Our systematic review found published rates of biochemical control and hypopituitarism vary, with uniformly good radiographic control and low incidence of visual changes. Conclusions Adjuvant FSRT offered effective long-term biochemical control and radiographic control, and there was a lower rate of complications in this current series. Review of the literature shows variations in published rates of biochemical control after FSRT for acromegaly, but low incidence of serious toxicities.

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One-year follow-up after total endovascular repair of a contained-ruptured thoracoabdominal aortic aneurysm with the sandwich technique

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.11.066 ◽

2013 ◽

Vol 58 (2) ◽

pp. 482-485 ◽

Cited By ~ 17

Author(s):

Theodosios Bisdas ◽

Konstantinos P. Donas ◽

Michel Bosiers ◽

Giovanni Torsello ◽

Martin Austermann

Keyword(s):

Aortic Aneurysm ◽

Endovascular Repair ◽

Thoracoabdominal Aortic Aneurysm ◽

Sandwich Technique ◽

One Year

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Case Series Regarding Parastomal Variceal Bleeding: Presentation and Management

Annals of Hepatology ◽

10.5604/01.3001.0012.2228 ◽

2018 ◽

Vol 17 (5) ◽

pp. 0-10

Author(s):

John Romano ◽

Charles V. Welden ◽

Jordan Orr ◽

Brendan McGuire ◽

Mohamed Shoreibah

Keyword(s):

Portal Hypertension ◽

High Risk ◽

Literature Review ◽

Variceal Bleeding ◽

Coil Embolization ◽

Case Series ◽

Treatment Modalities ◽

Post Procedure ◽

Lost To Follow Up

Parastomal variceal bleeding (PVB) is a serious complication occurring in up to 27% of patients with an ostomy and concurrent cirrhosis and portal hypertension. The management of PVB is difficult and there are no clear guidelines on this matter. TIPS, sclerotherapy, and /or coil embolization are all therapies that have been shown to successful manage PVB. We present a case series with five different patients who had a PVB at our institution. The aim of this case series is to report our experience on the management of this infrequently reported but serious condition. We also conducted a systemic literature review focusing on the treatment modalities of 163 patients with parastomal variceal bleeds. In our series, patient 1 had embolization and sclerotherapy without control of bleed and expired on the day of intervention due to hemorrhagic shock. Patient 2 had TIPS in conjunction with embolization and sclerotherapy and had no instance of rebleed 441 days after therapy. Patient 3 did not undergo any intervention due to high risk for morbidity and mortality, the bleed self-resolved and there was no further rebleed, this same patient died of sepsis 73 days later. Patient 4 had embolization and sclerotherapy and had no instance of rebleed 290 days after therapy. Patient 5 had TIPS procedure and was discharged five days post procedure without rebleed, patient has since been lost to follow-up.

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