Progress in Diagnosis and Endoscopic Treatment of Stanford B Penetrating Aortic Ulcers

Penetrating aortic ulcers is rare in clinical practice, and it is necessary to intervene in this type of aortic perforating ulcer because it can be accompanied by major arterial dissection and intermural hematoma. With the widespread application and technical advancement of follow-up thoracic aortic endovascular repair (TEVAR), endovascular treatment has become the first choice for symptomatic aortic perforating ulcers. In this review, we will review the diagnosis, diagnosis and endovascular treatment of aortic perforating ulcer.

Download Full-text

Late open conversion after endovascular repair of abdominal aneurysm failure: Better and easier option than complex endovascular treatment

JRSM Cardiovascular Disease ◽

10.1177/2048004017752835 ◽

2018 ◽

Vol 7 ◽

pp. 204800401775283 ◽

Cited By ~ 1

Author(s):

Stefano Bonardelli ◽

Franco Nodari ◽

Maurizio De Lucia ◽

Emanuele Botteri ◽

Alice Benenati ◽

...

Keyword(s):

Endovascular Treatment ◽

Endovascular Repair ◽

Open Repair ◽

Multiple Organ ◽

Type I ◽

Abdominal Aneurysm ◽

Open Conversion ◽

Technical Errors ◽

Report Data

Aim Conversion to open repair becomes the last option in case of endovascular repair of abdominal aneurysm failure, when radiological interventional procedures are unfeasible. While early conversion to open repair generally derives from technical errors, aetiopathogenesis and results of late conversion to open repair often remain unclear. Methods We report data from our Institute’s experience on late conversion to open repair. Twenty-two late conversion to open repairs out of 435 consecutive patients treated during a 18 years period, plus two endovascular repair of abdominal aneurysms performed in other centres, are analysed. The indication for conversion to open repair was aneurysm enlargement because of type I, type III, type II endoleak and endotension. Even if seven cases (23%) had shown an initial aneurysmal shrinkage, in a later phase, the sac began to enlarge again. In 12 patients, conversion to open repair was the last chance after unsuccessful secondary endovascular procedures. Results Three cases (12.5%) were treated in emergency. Aortic cross-clamping was only infrarenal in 10 cases, only or temporarily suprarenal in 14 and temporarily supraceliac in 9 cases, for 19 total and 5 partial endograft excisions. Two patients died for Multiple Organ Failure (MOF), on 42nd (endovascular repair of abdominal aneurysm infection) and 66th postoperative day. No other conversion to open repair-related deaths or major complications were revealed by follow-up post-conversion to open repair (mean: 68 months ranging from 24 to 180 months). Conclusion Late conversion to open repair is often an unpredictable event. It represents a technical challenge: specifically, the most critical point is the proximal aortic clamping that often temporarily excludes the renal circulation. In our series, conversion to open repair can be performed with a low rate of complications. In response to an endovascular repair of abdominal aneurysm failure, before applying complex procedures of endovascular treatment, conversion to open repair should be taken into account.

Download Full-text

Endovascular Treatment of Persistent Sciatic Artery Aneurysms With Primary Stenting: A Systematic Review of the Literature

Vascular and Endovascular Surgery ◽

10.1177/1538574419899034 ◽

2020 ◽

Vol 54 (3) ◽

pp. 264-271 ◽

Cited By ~ 2

Author(s):

Nektarios Charisis ◽

Stefanos Giannopoulos ◽

George Tzavellas ◽

Apostolos Tassiopoulos ◽

George Koullias

Keyword(s):

Systematic Review ◽

Endovascular Treatment ◽

Endovascular Repair ◽

Case Reports ◽

Covered Stent ◽

Acute Limb Ischemia ◽

Imaging Evaluation ◽

Stent Deployment ◽

Persistent Sciatic Artery

Persistent sciatic artery (PSA) is an embryologic remnant of the internal iliac artery, and when is present, it undergoes aneurysmal degeneration in up to 60% of the cases. Endovascular repair is an increasingly utilized treatment strategy for PSA aneurysms (PSAAs). The objective was to demonstrate the safety and efficacy of the endovascular repair in patients with PSAA and to identify potential risk factors for loss of patency or limb loss. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and eligible studies were identified through search of the PubMed, Scopus, and Cochrane Central databases. Fifteen case reports, comprising 15 patients overall, were included. The median age of the patients was 68 years old (mean age 66 ± 13.4 years) with half of the reported patients being women. Most patients presented with progressive limb claudication, complaining about an enlarging palpable pulsatile buttock mass. The onset of symptoms was sudden in 78% of the reported cases. Additionally, the distal pulses on PSAA side were diminished or absent in 91% of the patients. Acute limb ischemia was the primary diagnosis in 75% of the cases. All patients underwent endovascular repair of the PSAA with a covered stent. Procedural outcomes were favorable in all patients demonstrating no symptoms recurrence, aneurysmal regression, or total obliteration evaluated by angiographic studies (computed tomography angiography [CTA] and angiogram). Periprocedural imaging evaluation was determined either with CTA or duplex ultrasound (DUS). Periprocedural complications included only 1 endoleak with distal dissection. This endoleak was identified after stent deployment and dissection distal to the aneurysm. Mean follow-up (with CTA and/or DUS) was 22 months, with all patients being asymptomatic with no recurrence of symptom. The endovascular treatment of PSAA with covered stent is safe and effective. Persistent sciatic artery aneurysms is associated with high procedural success, low periprocedural compilations, and favorable mid-term follow-up.

Download Full-text

Technology developments in endovascular treatment of intracranial aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011475 ◽

2014 ◽

Vol 8 (2) ◽

pp. 135-144 ◽

Cited By ~ 21

Author(s):

Robert M Starke ◽

Aquilla Turk ◽

Dale Ding ◽

Richard W Crowley ◽

Kenneth C Liu ◽

...

Keyword(s):

Clinical Practice ◽

Risk Stratification ◽

Endovascular Treatment ◽

Treatment Planning ◽

Intracranial Aneurysms ◽

Imaging Technology ◽

Novel Devices ◽

Efficacy Of Treatment ◽

New Devices

Advances in the management and endovascular treatment of intracranial aneurysms are progressing at a tremendous rate. Developments in novel imaging technology may improve diagnosis, risk stratification, treatment planning, intraprocedural assessment, and follow-up evaluation. Evolution of devices, including microwires, microcatheters, balloons, stents, and novel scaffolding devices, has greatly expanded the potential to treat difficult aneurysms. Although developments in technology have greatly improved the efficiency and efficacy of treatment of neurovascular disorders, novel devices do not always improve outcomes and may be associated with unique complications. As such, it is paramount to have an in-depth understanding of new devices and the implications of their introduction into clinical practice. This review provides an update on developments in endovascular treatment of intracranial aneurysms.

Download Full-text

61 THE 5-YEAR RESULTS FOR ENDOSCOPIC TREATMENT OF SUPERFICIAL ESOPHAGEAL CANCER AT A NORWEGIAN UNIVERSITY HOSPITAL

Diseases of the Esophagus ◽

10.1093/dote/doaa087.08 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

T Hauge ◽

M Franco-Lie ◽

E Johnson

Keyword(s):

Esophageal Cancer ◽

Treatment Modality ◽

Endoscopic Treatment ◽

University Hospital ◽

Low Grade ◽

Superficial Esophageal Cancer ◽

Radical Esophagectomy ◽

Efficient Treatment ◽

First Choice

Abstract Superficial esophageal cancer (HGD = high grade dysplasia, T1a and T1b with no evidence of spread) accounts for about 20 % of all esophageal cancers. Traditionally, radical esophagectomy, with a significant degree of comorbidity has been the mainstay of treatment. Now most international guidelines, including the ESGE (European Society of Gastrointestinal Endoscopy) recommends endoscopic treatment as the first choice of treatment. The aim of this abstract was to present our data from 2014-2018. Methods From 2014 to 2018 (and ongoing) we have registered all patients endoscopically treated for LGD (low grade dysplasia) and superficial esophageal cancer, including some cases with T1b. The patient material, including treatment modality, histology, time of follow-up, the need for surgery and its outcome were registered. The majority of follow-ups took place at our hospital. Data was also retrieved from cases of late follow-up at other hospitals. Results 86 patients were endoscopically treated. The histology revealed LGD (24%), HGD (50%) and adenocarcinoma (21%). 15% were treated for a T1a tumor, 7% for T1b. 29% underwent endoscopic mucosal resection (EMR), 29% radiofrequency ablation (RFA) and 40% had both. The endoscopic treatment resulted in complete resolution of dysplasia in 64%, downstaging in 11%, whilst progression occurred in 11%. Five patients were operated for initial T1b or progression into T1b. The operation specimen showed no residual tumor in 3/5 patients. There were no serious complications. 90-days mortality was 1%. Conclusion Endoscopic treatment is a safe and efficient treatment option for superficial esophageal cancer. Few patients needed surgery and there was few and exclusively mild complications. This treatment modality will spare many patients for esophageal surgery with its associated high level of comorbidity.

Download Full-text

Endovascular repair of subclavian artery aneurysms: results from a single-center experience

Perfusion ◽

10.1177/0267659117720988 ◽

2017 ◽

Vol 32 (8) ◽

pp. 670-674 ◽

Cited By ~ 2

Author(s):

XiXiang Gao ◽

LiQiang Li ◽

YongQuan Gu ◽

LianRui Guo ◽

ShiJun Cui ◽

...

Keyword(s):

Endovascular Treatment ◽

Treatment Outcomes ◽

Stent Graft ◽

Subclavian Artery ◽

Endovascular Repair ◽

Stent Placement ◽

Imaging Findings ◽

Endovascular Stent ◽

Endovascular Stent Placement

Objective: To present our experience of the endovascular treatment of subclavian artery aneurysms (SAAs) and analyze the clinical manifestations, imaging findings and treatment outcomes. Methods: In this retrospective study, nine patients with SAAs underwent endovascular stent placement in our center between July 2011 and June 2016. Clinical features, imaging findings, treatment outcomes and follow-up results of these SAA patients were retrospectively analyzed. Results: Nine patients were diagnosed with SAAs by computer tomography angiography (CTA). Five patients underwent percutaneous endovascular stent placement in the subclavian artery. Three patients underwent endovascular repair of the SAAs with coil embolization and stent graft. One patient underwent stent graft implantation by the simultaneous kissing stent technique. Five patients had their symptoms relieved and thrombosis occurred in one case. The mean follow-up period was 17 months, ranging from 8 to 40 months. Conclusion: For patients with SAAs, endovascular treatment is a feasible choice, with a high success rate, few complications and good clinical outcomes.

Download Full-text

Five to Ten Years Follow-up after Coiling of 241 Patients with Acutely Ruptured Aneurysms

Interventional Neuroradiology ◽

10.1177/159101991201800101 ◽

2012 ◽

Vol 18 (1) ◽

pp. 5-13 ◽

Cited By ~ 5

Author(s):

A. Consoli ◽

L. Renieri ◽

R. Mura ◽

S. Nappini ◽

F. Ricciardi ◽

...

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Critical Issue ◽

Morphological Data ◽

Long Term Stability ◽

Ruptured Aneurysms ◽

First Choice ◽

Second Procedure ◽

Ruptured Intracranial Aneurysms

Endovascular treatment has assumed a role of first choice in the management of ruptured intracranial aneurysms. We describe the clinical and morphological data after the treatment of 258 ruptured intracranial aneurysms in 241 patients, in order to evaluate the safety and the efficacy of the endovascular treatment. Two hundred and forty-one patients with saccular ruptured aneurysms were treated at our institution between 2000 and 2005. After the endovascular treatment a clinical and angiographic follow-up was conducted. The clinical follow-up was carried out with a medical examination and telephonic interviews and mRS was used for evaluation. Two hundred and forty-nine acutely ruptured aneurysms were successfully treated and immediately after the endovascular procedure 81.9% of the aneurysms resulted completely occluded, 12.1% had a residual neck and 6% revealed a residual sac. The evolution of each grade was evaluated at six months and two years. During the follow-up we observed five early and one late re-bleedings. Twenty-four patients underwent a second procedure. After the discharge and up to ten years 73.1% of patients had a good clinical outcome (mRS0–1), 8.9% died and the remainder showed moderate-severe disability (mRS2–3). The long-term stability of the anatomical result is a critical issue of this approach because eventual re-bleedings may occur even after several months or years. A careful clinical and radiological follow-up for up to two years after the embolization may prevent recurrences but may not be sufficient.

Download Full-text

Abstract TP22: Longer Procedure Time in General Anesthesia versus Conscious Sedation During Mechanical Thrombectomy for Large Vessel Occlusion Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.tp22 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Vasu Saini ◽

Stephanie H Chen ◽

David J McCarthy ◽

Marie C Brunet ◽

Priyank Khandelwal ◽

...

Keyword(s):

Clinical Practice ◽

General Anesthesia ◽

Mechanical Thrombectomy ◽

Conscious Sedation ◽

Routine Clinical Practice ◽

Work Flow ◽

First Choice ◽

Significant Difference ◽

Baseline Characteristics

Introduction: There is no definitive evidence currently to guide the choice between general anesthesia (GA) over conscious sedation (CS) for patients undergoing mechanical thrombectomy (MT). As MT outcomes are highly time-sensitive especially in the early time window, we aim to evaluate work-flow metrics and outcome differences between the two approaches in routine clinical practice at a Comprehensive Stroke Center (CSC). Methods: From 2/2015-9/2018, 329 consecutive MT patients were included from a large retrospective CSC database. In late 2017, we implemented a first-choice GA protocol at our CSC from a first choice CS for MT. Baseline characteristics, work-flow metrics and outcomes measures: mRS at discharge, mRS last follow-up (median, IQR 184 days, 37.25-202.5), radiological hemorrhagic conversion (rHT) and symptomatic intracranial hemorrhage (sICH) defined as rHT with post-MT (4-24 hours) NIHSS worsening ≥4, were examined. Multivariate logistic regression model was used to compare workflow and outcomes in GA vs. CS patients. Results: 82 (25.2%) patients received GA and 246 (74.8%) received CS. Baseline characteristics show significantly higher baseline HTN (p .043) and posterior circulation strokes (p .02) in GA patients. Compared to CS, patients undergoing GA had significantly longer procedure times 54±35 vs. 37±22min (OR .98, 95%CI .97-.996) but no difference in onset- or door-to-puncture times. Both had similar first pass success ~57% vs. 53% (p .59), number of attempts 1(1-2) vs. 1(1-2) (p .94) and rate of TICI 2b-3 ~87% vs. 84% (p .85). On multivariate regression, there was no significant difference in outcome measures between GA and CS: rHT (OR 1.1, 95%CI .64-1.9), sICH (OR 1.15, 95%CI .41-3.2), mRS at discharge (OR .75, 95%CI .176-3.22) and mRS at last follow-up (OR 1.05, 95%CI .53-2.08). Conclusion: In routine clinical practice, compared to CS, patients who underwent GA for MT had no difference in clinical outcomes, despite longer procedure times.

Download Full-text

Clinical Efficacy of Endoscopic Technique in the Treatment of Gastrointestinal Anastomotic Complications: a Retrospective Study

10.21203/rs.3.rs-864798/v1 ◽

2021 ◽

Author(s):

Shenghe Deng ◽

Junnan Gu ◽

Yinghao Cao ◽

Fuwei Mao ◽

Ke Liu ◽

...

Keyword(s):

Endoscopic Treatment ◽

Statistical Significance ◽

Gastrointestinal Surgery ◽

Endoscopic Technique ◽

Anastomotic Stenosis ◽

Endoscopic Intervention ◽

Anastomotic Complications ◽

First Choice ◽

Anastomotic Fistula

Abstract Background: To evaluate the safety and effectiveness of endoscopic technique in treating postoperative anastomotic complications of digestive tract. Methods: Clinical data of patients received endoscopic treatment in our hospital due to anastomotic complications after gastrointestinal surgery from January 2015 to December 2018 were collected for retrospective analysis. Endoscopic intervention was used for postoperative anastomotic complications in all the included cases. The time of the intervention measures, laboratory examination, incidence of complications and postoperative follow-up were observed and analyzed.Results: A total of 88 patients were included in the study, including 43 patients with anastomotic stenosis,22 with anastomotic obstruction,23 with anastomotic fistula. For anastomotic obstruction patients, 36 patients with anastomosis were successfully treated with endoscopy. For anastomotic obstruction patients, 18 cases were successfully treated with endoscopy. For anastomotic fistula patients, 21 cases were successfully treated with endoscopy.During follow-up after the endoscopic procedure, 4 patients with anastomotic stenosis needed endoscopic intervention again, 3 cases undertook surgical intervention and 2 cases maintained acceptable defecation function by intermittent dilation with a plastic dilater. one patients with anastomotic obstruction had stent displacement and was removed. For the anastomotic fistula patients,one case relapsed and then underwent endoscopic intervention again, three cases converted to surgical intervention.Preoperative and postoperative blood biochemical examination had no significant statistical significanceConclusion: Endoscopic treatment of anastomosis complications was effective for some of the patients, especially for those with anastomosis stenosis or stricture, considering its saftey, it might be the first choice for anastomosis complications.

Download Full-text

Symptoms, Vascular Anatomy and Endovascular Treatment of Spinal Cord Arteriovenous Malformations

Interventional Neuroradiology ◽

10.1177/15910199000060s132 ◽

2000 ◽

Vol 6 (1_suppl) ◽

pp. 199-202 ◽

Cited By ~ 5

Author(s):

Y. Niimi ◽

A. Berenstein ◽

A. Setton ◽

J. Pryor

Keyword(s):

Spinal Cord ◽

Endovascular Treatment ◽

Retrospective Analysis ◽

Arteriovenous Malformations ◽

Vascular Anatomy ◽

Provocative Test ◽

First Choice ◽

Complete Obliteration ◽

Choice Of Treatment

The purpose of this study is to evaluate the symptoms, anatomy and efficacy of embolization of spinal cord AVMs (SCAVMs). We performed retrospective analysis of 108 SCAVMs consisting of 38 pediatric and 70 adult cases. They included 81 nidus (26 pediatric) and 27 fistulous (12 pediatric) AVMs. Hemorrhage occurred in 74% of pediatric and 62% of adult cases with multiple hemorrhages in 54% of pediatric and 42% of adult cases. Fistulous AVMs hemorrhaged more frequently in children than adults (75% vs. 13%). 75 cases were treated with embolization alone, 10 with surgery and embolization, 2 with embolization following radiation and 12 with surgery alone. 9 patients received no treatment. In 79 of 87 embolized patients, acrylic was utilized either alone (49) or in combination (30) with other materials. Embolization was attempted 156 times in 93 patients. Complete obliteration by embolization was obtained in 17 cases. If complete obliteration was not possible, partial targeted embolization was performed, aiming at dangerous anatomic structures such as aneurysms. During the follow-up period (mean: 34 months), hemorrhage was observed in only 2 cases. Although technical complications such as dissection or vasospasm occurred on 19 occasions, only 4 resulted in aggravation of neurological symptoms. Of the 21 sessions in which worsening of symptoms occurred after embolization, 10 resulted in permanent deficits and eight of these occurred prior to 1990. SCAVMs have a poor functional prognosis due to frequent hemorrhage if untreated. Embolization with acrylic is feasible as the first choice of treatment. Provocative test and electrophysiological monitoring have improved safety. Partial targeted embolization is effective in preventing hemorrhage.

Download Full-text

Endotension – a late complication successfully treated by open repair

VASA ◽

10.1024/0301-1526.34.1.60 ◽

2005 ◽

Vol 34 (1) ◽

pp. 60-61

Author(s):

Papavasssiliou ◽

Sayers ◽

Fishwick ◽

Vorou ◽

Bell ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Treatment ◽

Endovascular Repair ◽

Open Repair ◽

Late Complication ◽

Maximal Diameter ◽

Abdominal Aortic

Endotension is a late complication following endovascular treatment of abdominal aortic aneurysm (AAA). A 83-year-old male had a successful endovascular repair of a 5.6 cm diameter AAA. During the follow-up period it was marked that the aneurysm continued to increase in size, became 6.6 cm maximal diameter and pulsatile with no evidence of endoleak. On laparotomy no endoleak was identified and the graft was left in situ. Postoperatively and on follow-up the patient remains asymptomatic while the aneurysm continued to appear shrunk.

Download Full-text