共查询到20条相似文献，搜索用时 31 毫秒
1.
Kaichuang Ye Jinbao Qin Minyi Yin Mi’er Jiang Weimin Li Xinwu Lu 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1446-1453.e2
Purpose
To compare midterm outcomes of optimal medical treatment (OMT) alone with OMT and thoracic endovascular aortic repair (TEVAR) of acute type B intramural hematoma (IMHB).Materials and Methods
Retrospective analysis was performed of 65 patients treated with OMT alone (31 patients) or OMT with TEVAR (34 patients) for acute uncomplicated or complicated IMHB from January 2006 to December 2015 in a single institution. Primary outcome was aortic-related mortality during follow-up. Secondary outcomes were aortic-related adverse events, all-cause mortality, and occurrence of complete aortic remodeling.Results
Except for the morphologic nature of the aortic lesion, no significant differences in baseline characteristics between the 2 groups were observed. Mean follow-up time was 32 months ± 19 (range, 1–120 months). Patients in the OMT group had a significantly increased rate of aortic-related mortality (12.9% vs 0% in TEVAR group, P = .046) and aortic-related adverse events (29.0% vs 0% in TEVAR group, P < .001) and an insignificant but higher trending all-cause mortality rate (38.8% vs 19.8% in TEVAR group, P = .15). The occurrence of complete aortic remodeling was significantly lower in the OMT group (15.4% vs 82.1% in TEVAR group, P < .001).Conclusions
TEVAR is likely to protect from progression of IMHB and to be associated with a better prognosis than OMT alone. 相似文献2.
Myung Gyu Song Young Kwon Cho Do Yun Lee Sung Bum Cho Hyun-Ki Yoon Se Hwan Kwon Hyo-Cheol Kim Chang Jin Yoon 《Journal of vascular and interventional radiology : JVIR》2017,28(5):645-654
Purpose
To investigate the midterm outcomes of thoracic endovascular aneurysm repair (TEVAR) with the use of the Seal stent graft for four categories of thoracic aortic disease.Materials and Methods
This retrospective multicenter study evaluated the records of 216 Korean patients who underwent TEVAR with the Seal stent graft during 2007–2010. The study outcomes were (i) perioperative death, (ii) endoleak, (iii) repeat intervention, (iv) aortic-related death, and (v) all sudden unexplained late deaths.Results
The overall technical success rate was 94% (203 cases), and the disease-specific rates were 97% (88 cases) for aneurysms, 96% (71 cases) for dissections, 82% (32 cases) for traumatic aortic disease, and 100% (12 cases) for intramural hematoma and/or penetrating aortic ulcer. There were 6 acute surgical conversions (2 for aneurysms and 4 for dissections). There were 18 endoleaks, 4 retrograde ascending aortic dissections, and 6 stent graft–induced new entries. The 1-, 3-, and 5-year overall survival rates were 93% ± 3, 90% ± 4, and 90% ± 4, respectively.Conclusions
TEVAR with the Seal thoracic stent graft provided a high technical success rate and low mortality and complication rates during midterm follow-up. However, additional long-term studies are needed to evaluate the durability and late complications associated with this device. 相似文献3.
Shen-Yen Lin Sin-Yi Lyu Ta-Wei Su Sung-Yu Chu Chien-Ming Chen Chien-Fu Hung Chee-Jen Chang Po-Jen Ko 《Journal of vascular and interventional radiology : JVIR》2017,28(4):570-575
Purpose
To evaluate outcomes and predictive factors for additional ProGlide device deployment in percutaneous endovascular aortic repair (PEVAR) with the preclose technique.Materials and Methods
Clinical data of patients who underwent PEVAR with the preclose technique from February 2012 to January 2015 were retrospectively reviewed. A total of 268 patients (229 men, 39 women) who underwent PEVAR (thoracic endovascular aortic repair [TEVAR], n = 113; endovascular abdominal aortic repair [EVAR], n = 152; simultaneous TEVAR and EVAR, n = 3) with 418 femoral access sites were enrolled. The mean age of the patients was 69 years ± 14. Univariate and multivariate analyses were performed to identify predictive factors associated with additional ProGlide device deployment.Results
Primary technical success with adequate hemostasis and two ProGlide devices was 87.6%, and 48 femoral arterial access sites (11.5%) required additional ProGlide device deployment. The secondary technical success rate was 99.0%. Four femoral access sites (1.0%) needed surgical repair. Anterior wall calcification near the arteriotomy increased the risk of additional ProGlide device deployment (adjusted odds ratio, 6.19; 95% confidence interval, 2.81–13.64; P < .001), whereas larger sheath size, common femoral artery (CFA) diameter, and depth from the skin to the arteriotomy did not.Conclusions
Additional ProGlide device deployment reduces the rate of surgical repair after primary hemostasis failure in PEVAR. Anterior CFA wall calcification is a significant predictor for additional ProGlide device deployment. 相似文献4.
Shuji Ikeda Makiyo Hagihara Akira Kitagawa Yuichiro Izumi Kojiro Suzuki Toyohiro Ota Tsuneo Ishiguchi Hiroyuki Ishibashi 《Japanese journal of radiology》2017,35(10):562-567
Purpose
To determine the incidence and risk factors of renal dysfunction after abdominal endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR).Materials and methods
The study consisted of 227 patients treated with EVAR and 90 with TEVAR for aortic aneurysms. Parameters, including patients’ background factors, preoperative renal function, contrast dose and aortic wall irregularity on CT images were assessed in relation to postoperative renal dysfunction.Results
Deterioration of renal function was observed in 33 of 218 patients (15.1%) after EVAR and in 7 of 79 (8.9%) patients after TEVAR. Hemodialysis was required in one patient after EVAR. In EVAR, renal dysfunction correlated with age (p = 0.034) and occlusion of accessory renal artery (p = 0.0001). In TEVAR, renal dysfunction correlated with age (p = 0.021), contrast dose (p = 0.042) and irregularity of the descending aortic wall (p = 0.023). In a multiple regression analysis, postoperative renal dysfunction was correlated with occlusion of accessory renal artery (p = 0.0003) after EVAR, and age (p = 0.02), contrast dose (p = 0.026) and irregularity of the descending aortic wall (p = 0.042) after TEVAR.Conclusion
Occlusion of accessory renal artery in EVAR, and age, contrast dose and irregularity of the descending aortic wall in TEVAR were considered to be predictors of postoperative renal dysfunction.5.
Chemelli-Steingruber I Chemelli A Strasak A Hugl B Hiemetzberger R Jaschke W Glodny B Czermak BV 《European journal of radiology》2010,73(1):175-180
Introduction
The aim of this retrospective study was to compare the outcome of thoracic endovascular aortic repair (TEVAR) to that of medical therapy in patients with acute type B aortic dissection (TBD).Materials and methods
From July 1996 to April 2008, 88 patients presenting with acute TBD underwent either TEVAR (group A, n = 38) or medical therapy (group B, n = 50). Indications for TEVAR were intractable pain, aortic branch compromise resulting in end-organ ischemia, rapid aortic dilatation and rupture. Follow-up was performed postinterventionally, at 3, 6 and 12 months and yearly thereafter and included clinical examinations and computed tomography (CT), as well as aortic diameter measurements and assessment of thrombosis.Results
Mean follow-up was 33 months in group A and 36 months in group B. The overall mortality rate was 23.7% in group A and 24% in group B, where 4 patients died of late aortic rupture. In group A, complications included 9 endoleaks and 4 retrograde type A dissections, 3 patients were converted to open surgery and 2 needed secondary intervention. None of the patients developed paraplegia. In group B, 4 patients were converted to open surgery and 2 to TEVAR. The maximal aortic diameter increased in both groups. Regarding the extent of thrombosis, our analyses showed slightly better overall results after TEVAR, but they also showed a tendency towards approximation between the two groups during follow-up.Conclusion
TEVAR is a feasible treatment option in acute TBD. However, several serious complications may occur during and after TEVAR and it should therefore be reserved to patients with life-threatening symptoms. 相似文献6.
Sun Young Choi Jong Yun Won Do Yun Lee Donghoon Choi Won-Heum Shim Kwang-Hun Lee 《Korean journal of radiology》2010,11(1):107-114
Objective
The purpose of this study was to evaluate the technical feasibility and clinical efficacy of percutaneous transabdominal treatment of endoleaks after endovascular aneurysm repair.Materials and Methods
Between 2000 and 2007, six patients with type I (n = 4) or II (n = 2) endoleaks were treated by the percutaneous transabdominal approach using embolization with N-butyl cyanoacrylate with or without coils. Five patients underwent a single session and one patient had two sessions of embolization. The median time between aneurysm repair and endoleak treatment was 25.5 months (range: 0-84 months). Follow-up CT images were evaluated for changes in the size and shape of the aneurysm sac and presence or resolution of endoleaks. The median follow-up after endoleak treatment was 16.4 months (range: 0-37 months)Results
Technical success was achieved in all six patients. Clinical success was achieved in four patients with complete resolution of the endoleak confirmed by follow-up CT. Clinical failure was observed in two patients. One eventually underwent surgical conversion, and the other was lost to follow-up. There were no procedure-related complications.Conclusion
The percutaneous transabdominal approach for the treatment of type I or II endoleaks, after endovascular aneurysm repair, is an alternative method when conventional endovascular methods have failed. 相似文献7.
Christopher Bangard Mareike Franke Roman Pfister Antje-Christin Deppe Vladimir Matoussevitch David Maintz De-Hua Chang 《European radiology》2014,24(6):1430-1434
Objectives
To introduce a novel percutaneous technique to stop blood entry at the lesser aortic arch curvature by coil embolisation in type Ia endoleak after TEVAR.Methods
A 61-year-old Marfan patient presented with type Ia endoleak of the aortic arch and a growing aortic arch pseudoaneurysm after TEVAR. Multiple preceding operations and interventions made an endovascular approach unsuccessful. Direct percutaneous puncture of the aneurysmal sac would have cured the sign, but not the cause of blood entry at the lesser curvature of the aortic arch. Direct CT-guided percutaneous puncture of the blood entry site in the aortic arch with fluoroscopically guided coil embolisation using detachable extra-long coils was successfully performed.Results
Three weeks after the intervention, the patient developed fever because of superinfection of the pseudoaneurysm. The blood cultures and CT-guided mediastinal aspirate were sterile. After intravenous administration of antibiotics, the fever disappeared and the patient recovered. Six-month follow-up showed permanent closure of the endoleak and a shrinking aneurysmal sac.Conclusions
Direct percutaneous puncture of the aortic arch at the blood entry site of a thoracic type Ia endoleak after TEVAR and double-chimney stent-grafts with coil embolisation of the wedge-shaped space between the lesser aortic curvature and the stent-graft is possible.Key Points
? Endoleaks after thoracic endovascular aortic repair are common in 15-30 %. ? Most endoleaks can be treated by endovascular means. ? Direct percutaneous endoleak repair is described as a bail-out option. ? Direct percutaneous aortic arch coil embolisation of type 1a endoleak is possible. ? Antibiotic prophylaxis should be administered case by case, considering individual risk factors. 相似文献8.
Mikolaj Wojtaszek Emilia Wnuk Rafal Maciag Krzysztof Lamparski Krzysztof Korzeniowski Olgierd Rowinski 《Journal of vascular and interventional radiology : JVIR》2017,28(2):168-175
Purpose
To evaluate the efficacy and clinical outcomes of ancillary endovascular procedures in promoting false-lumen (FL) thrombosis (FLT) and preventing aortic expansion in patients after thoracic endografting for type B dissections.Materials and Methods
This retrospective review included 15 patients (12 men and 3 women; mean age, 59.6 y). Mean aortic diameter at the time of ancillary treatment was 47.4 mm. Different techniques were used as single procedures or sequentially: covered stent occlusion of detached visceral artery entry tears, occlusion of single entry tears with vascular plugs, or aortic endograft occlusion of multiple FL entry tears. FL embolization with ethylene vinyl alcohol copolymer was performed when selective occlusion was considered insufficient to close distal entry tears. Apart from endovascular aneurysm repair, all procedures were performed percutaneously under local anesthesia. If FL diameter increase persisted after 6-month follow-up computed tomographic (CT) angiography, another intervention was planned; otherwise, yearly follow-up was performed.Results
Mean clinical follow-up duration was 43.8 months (range, 8 d to 86.8 mo), with no in-hospital mortality. Estimated overall survival rates were 93.3%, 86.6%, and 77% at 12, 24, and 48 months, respectively. Three late deaths occurred, one of which was dissection-related at 40 months. Eight surviving patients (53%) had total FLT and 3 had partial FLT with stable aortic diameter on follow-up CT angiography. FL diameter increased in one patient, requiring further intervention.Conclusions
Selective exclusion of new distal entry tears remaining after thoracic endovascular aneurysm repair can stabilize abdominal aortic expansion and promote FLT. 相似文献9.
Graham Roche-Nagle Maureen Hazel Dheeraj K. Rajan 《Journal l'Association canadienne des radiologistes》2018,69(2):215-219
Objectives
The percutaneous endovascular abdominal aortic repair (PEVAR) approach is a minimally invasive technique that has demonstrated clinical benefit over traditional surgical cut down associated with standard endovascular abdominal aortic aneurysm (AAA) repair (EVAR). The objective of our study was to evaluate the budget impact to a Canadian hospital of changing the technique for AAA repair from the EVAR approach to the PEVAR approach.Methods
We examined the budget impact of replacing the EVAR approach with the PEVAR approach in a Canadian hospital that performs 100 endovascular AAA repairs annually. The model incorporates the costs associated with surgery, length of stay, and postoperative complications occurring within 30 days.Results
The use of PEVAR in AAA repair is associated with increased access device costs when compared with the EVAR approach (CAD$1000 vs CAD$400). However, AAA repair completed with the PEVAR approach demonstrates reduced operating time (101 minutes vs 133 minutes), length of stay (2.2 days vs 3.5 days), time in the recovery room (174 minutes vs 193 minutes), and postoperative complications (6% vs 30%), which offset the increased device costs. The model establishes that switching to the PEVAR approach in a Canadian hospital performing 100 AAA repairs annually would result in a potential cost avoidance of CAD$245,120.Conclusions
A change in AAA repair technique from EVAR to PEVAR can be a cost-effective solution for Canadian hospitals. 相似文献10.
Tae Wook Kang Hyunchul Rhim Eun Young Kim Young-sun Kim Dongil Choi Won Jae Lee Hyo K. Lim 《Korean journal of radiology》2009,10(1):34-42
Objective
To assess the safety and therapeutic efficacy of a percutaneous radiofrequency (RF) ablation for the hepatocellular carcinoma (HCC) abutting the diaphragm.Materials and Methods
We retrospectively assessed 80 patients who underwent a percutaneous RF ablation for a single nodular (< 4 cm) HCC over the last four years. Each patient underwent an ultrasound-guided RF ablation using internally cooled electrodes for the first-line treatment. We divided patients into two subgroups based on whether the index tumor was abutting (less than 5 mm) the diaphragm or not: group A (abutting; n = 31) versus group B (non-abutting; n = 49). We compared the two subgroups for complications and therapeutic efficacy using image and the review of medical records. The statistical assessment included an independent t-test, Fisher''s exact test, and chi-square test.Results
The assessment of the diaphragmatic swelling at CT immediately following the procedure was more severe in group A than group B (mean thickness change:1.44 vs. 0.46 mm, p = 0.00). Further, right shoulder pain was more common in group A than B (p = 0.01). Although minor complications (hemothorax 1 case, pleural effusion 1 case) were noted only in group A, no major thoracic complication occurred in either group. The technical success rate was lower in group A than group B (84% vs. 98%, p = 0.03). As well, the primary and secondary technique effectiveness rates in group A and group B were 90% versus 98% (p = 0.29) and 79% versus 91% (p = 0.25), respectively. The local tumor progression rate was higher in group A than in group B (29% vs. 6%, p = 0.02).Conclusion
We found that the percutaneous RF ablation for the HCC abutting the diaphragm is a safe procedure without major complications. However, it is less effective with regard to technical success and local tumor control. 相似文献11.
Woo Chul Kim Yong Sun Jeon Kee Chun Hong Jang Yong Kim Soon Gu Cho Jae Young Park 《Korean journal of radiology》2014,15(5):613-621
Objective
The purpose of this study was to evaluate the effectiveness of detachable interlock microcoils for an embolization of the internal iliac artery during an endovascular aneurysm repair (EVAR).Materials and Methods
A retrospective review was conducted on 40 patients with aortic aneurysms, who had undergone an EVAR between January 2010 and March 2012. Among them, 16 patients were referred for embolization of the internal iliac artery for the prevention of type II endoleaks. Among 16 patients, 13 patients underwent embolization using detachable interlock microcoils during an EVAR. Computed tomographic angiographies and clinical examinations were performed during the follow-up period. Technical success, clinical outcome, and complications were reviewed.Results
Internal iliac artery embolizations using detachable interlock microcoils were technically successful in all 13 patients, with no occurrence of procedure-related complications. Follow-up imaging was accomplished in the 13 cases. In all cases, type II endoleak was not observed with computed tomographic angiography during the median follow-up of 3 months (range, 1-27 months) and the median clinical follow-up of 12 months (range, 1-27 months). Two of 13 (15%) patients had symptoms of buttock pain, and one patient died due to underlying stomach cancer. No significant clinical symptoms such as bowel ischemia were observed.Conclusion
Internal iliac artery embolization during an EVAR using detachable interlock microcoils to prevent type II endoleaks appears safe and effective, although this should be further proven in a larger population. 相似文献12.
Alessandro Gasparetto Kwang Bo Park Saher S. Sabri Auh Whan Park Alan H. Matsumoto John Fritz Angle 《Journal of vascular and interventional radiology : JVIR》2017,28(1):44-49
Purpose
To evaluate significant factors related to delayed aortic false lumen (FL) enlargement in patients who have undergone thoracic stent-graft placement for type B aortic dissection.Materials and Methods
The study included 62 patients (45 male, 17 female) aged 26–80 years (mean age, 58.1 y) who underwent thoracic endovascular aortic repair for type B aortic dissection at a single institution between January 2005 and May 2015. Mean age of aortic dissections was 5.3 months (range, 0.1–73.3 mo). Maximum aortic diameter at presentation was 41.7 mm ± 8.3. The follow-up period ranged from 3 to 104 months (mean, 27.1 mo). Computed tomographic (CT) angiography studies were reviewed to identify FL diameter enlargements > 5 mm at different levels along and distal to the stent graft. Imaging findings and clinical variables were investigated to determine their correlation with FL enlargement.Results
No significant difference was found between the ages of aortic dissections in patients with and without FL enlargement (P = .26). On follow-up CT angiography, 16 patients had 2 or more communication channels between the FL and the systemic circulation, 7 of whom showed FL enlargement > 5 mm (P = .007). Twenty-seven patients showed complete FL thrombosis, none of whom had FL enlargement (P < .001).Conclusions
Two or more communication channels between the FL and the systemic circulation represent a risk factor for FL enlargement regardless of the age of the dissection. Patients with thrombosis of the FL are less likely to experience FL enlargement. 相似文献13.
Miju Bae Chang Ho Jeon Hoon Kwon Jin Hyeok Kim Seon Uoo Choi Seunghwan Song 《Korean journal of radiology》2021,22(4):577
ObjectiveTo report the authors'' experience in performing thoracic endovascular aortic repair (TEVAR) for zone 2 lesions after traumatic aortic injury (TAI).Materials and MethodsThis retrospective review included 10 patients who underwent zone 2 TEVAR after identification of aortic isthmus injury by CT angiography (CTA) upon arrival at the emergency room of a regional trauma center from 2016 to 2019. Patients were classified into two groups: those who underwent left subclavian artery (LSA) embolization concurrently with the main TEVAR procedure, and those in whom LSA embolization was not performed during the main procedure, but was planned as a bailout treatment if type II endoleak was noted on follow-up CTA images. Pre-procedural and procedure-related factors and post-procedure prognosis were compared between the groups.ResultsThere were no differences in pre-procedural factors, occurrence of endoleaks, and post-procedure prognosis (including mortality) between patients in the two groups. The duration of the procedure was shorter in the non-LSA embolization group (61 minutes vs. 27 minutes, p = 0.012). During follow-up, type II endoleak did not occur in either group.ConclusionDelaying preventative LSA embolization until stabilization of the patient would be desirable when performing zone 2 TEVAR for TAI, in the absence of endoleak on the completion aortography image taken after complete deployment of the stent graft. 相似文献
14.
Adel Mohammed Amer Al-kalei Ziheng Wu Hongkun Zhang 《Journal of vascular and interventional radiology : JVIR》2018,29(6):833-840.e2
Purpose
To investigate the effect of a primary intimal tear’s position on the distal convexity as a factor predisposing patients to developing a retrograde type A aortic dissection (RTAAD) after endovascular repair for type B aortic dissections.Materials and Methods
From January 2010 to December 2015, 334 patients with type B aortic dissections identified from a retrospective thoracic endovascular repair database were assigned to 2 groups based on the location of primary intimal tears in the distal aortic arch. Other potential risk factors were analyzed, and Kaplan-Meier survival curves were constructed.Results
The location of the primary intimal tear was identified in 230 patients (68.9%) in the convexity group and in 104 patients (31.1%) in the concavity group. After intervention, 20 patients (convexity: 7.8%, concavity: 1.9%) developed an RTAAD. Univariate analysis identified that the location of the primary intimal tears (P = .053), the areas involved by dissection (P = < .001), and the covering of the brachiocephalic trunk (P = .024) were significantly associated with RTAAD. Multivariate analysis revealed that a primary entry tear at the distal convexity might be a predictor for developing RTAAD (P = .053), with a relative risk of 4.243 (95% confidence interval, 0.984–18.286).Conclusions
Patients with primary intimal tears located in the distal convexity may be more likely to develop RTAAD than patients with primary intimal tears in the distal concavity. 相似文献15.
T. Hofmockel V. Plodeck R. Grützmann N. Weiss M. Laniado Prof. Dr. R.-T. Hoffmann 《Der Radiologe》2013,53(6):513-518
Clinical issue of thoracic aneurysms
Aneurysms are among the most common diseases affecting the thoracic aorta, with a continuous increase in incidence over the recent decades. The main cause of thoracic aneurysms is atherosclerosis, which, due to the frequent lack of major symptoms and the potentially lethal complications such as ruptured aortic aneurysm, remains a challenge in clinical practice.Standard radiological methods
CT angiography remains the imaging method of choice for acute aortic aneurysms, with MR angiography being increasingly used for follow-up imaging.Threshold for treatment
In the ascending aorta a diameter larger than 5–5.5 cm (descending aorta 6.5 cm) is regarded as the threshold for treatment.Thoracic endovascular aortic repair
The continuous evolution of aortic stent grafting (i.e., thoracic endovascular aortic repair [TEVAR]) since Parodi, Palmaz and Dake has led to a steep rise in stent grafting procedures in recent years.Practical recommendations
Particularly in elderly patients with multiple comorbidities, TEVAR is a valuable, less invasive option compared to open surgical repair. 相似文献16.
Yolanda Bryce Wonho Kim Barry Katzen James Benenati Shaun Samuels 《Journal of vascular and interventional radiology : JVIR》2018,29(7):1011-1016
Purpose
To assess differences in outcome in an early and later time period in patients with hostile neck anatomy who underwent endovascular aneurysm repair (EVAR).Materials and Methods
This single-center, institutional review board-approved retrospective study assessed patients who underwent EVAR between 2004 and 2013, divided into 2 time periods: 2004–2008 and 2009–2013. One hundred twenty-five patients had at least 1 hostile neck parameter that met inclusion criteria: 61 of 216 (28%) patients in the early period and 64 of 144 (44%) patients in the late period. Patients in the late group were younger compared to patients in the early group (late group, 74.5 ± 8.8 years vs early group, 77.5 ± 7.5 years; P = .046). No significant differences were observed in hostile neck anatomic factors between the early and late periods.Results
No statistical difference was observed in periprocedural factors or outcome measures, except for abdominal aortic aneurysm (AAA) sac regression in the late period compared to the early period (late period, 73.5% vs early period, 55.7%; P = .038). A statistically significant increase was observed in type 1a endoleaks in patients in the late group with suprarenal fixation compared to patients with infrarenal fixation (suprarenal, 27.0% vs infrarenal, 7.9%; P = .025) and in the overall time studied (suprarenal, 20.3% vs infrarenal, 7.6%; P = .045).Conclusions
Except for AAA sac regression, no changes were observed in periprocedural factors and outcome measures over time in patients with hostile neck who underwent EVAR. 相似文献17.
S. Lotfi R. E. Clough T. Ali R. Salter C. P. Young R. Bell B. Modarai P. Taylor 《Cardiovascular and interventional radiology》2013,36(1):46-55
Purpose
Hybrid repair constitutes supra-aortic debranching before thoracic endovascular aortic repair (TEVAR). It offers improved short-term outcome compared with open surgery; however, longer-term studies are required to assess patient outcomes and patency of the extra-anatomic bypass grafts.Methods
A prospectively maintained database of 380 elective and urgent patients who had undergone TEVAR (1997–2011) was analyzed retrospectively. Fifty-one patients (34 males; 17 females) underwent hybrid repair. Median age was 71 (range, 18–90) years with mean follow-up of 15 (range, 0–61) months.Results
Perioperative complications included death: 10 % (5/51), stroke: 12 % (6/51), paraplegia: 6 % (3/51), endoleak: 16 % (8/51), rupture: 4 % (2/51), upper-limb ischemia: 2 % (1/51), bypass graft occlusion: 4 % (2/51), and cardiopulmonary complications in 14 % (7/51). Three patients (6 %) required emergency intervention for retrograde dissection: (2 aortic root repairs; 2 innominate stents). Early reintervention was performed for type 1 endoleak in two patients (2 proximal cuff extensions). One patient underwent innominate stenting and revision of their bypass for symptomatic restenosis. At 48 months, survival was 73 %. Endoleak was detected in three (6 %) patients (type 1 = 2; type 2 = 1) requiring debranching with proximal stent graft (n = 2) and proximal extension cuff (n = 1). One patient had a fatal rupture of a mycotic aneurysm and two arch aneurysms expanded. No bypass graft occluded after the perioperative period.Conclusions
Hybrid operations to treat aortic arch disease can be performed with results comparable to open surgery. The longer-term outcomes demonstrate low rates of reintervention and high rates of graft patency. 相似文献18.
Wonho Kim Ripal T. Gandhi Constantino S. Peña Raul E. Herrera Melanie B. Schernthaner Juan M. Acuña Victor N. Becerra Barry T. Katzen 《Journal of vascular and interventional radiology : JVIR》2017,28(1):35-43
Purpose
To determine whether statin therapy is associated with abdominal aortic aneurysm (AAA) sac regression after endovascular aneurysm repair (EVAR).Materials and Methods
A total of 109 patients treated with EVAR were retrospectively analyzed (no-statin group, n = 45; statin group, n = 64). The primary endpoint was the incidence of AAA sac regression. To investigate independent predictors of AAA sac regression, regression analysis was performed. The mean age was 74 years (range, 55–90 y), and 87.2% of patients were men.Results
The no-statin group had higher rates of AAA sac regression than the statin group at 1 year (no-statin group, 66.7%; statin group, 45.3%; P = .028). The incidence of AAA sac regression increased over time in the statin group, and no statistical difference was seen between the two groups at 2 years (no-statin group, 66.7%; statin group, 57.8%; P = .350). The difference between the changes in maximum AAA diameter was significant between groups at 1 year (no-statin group vs statin group, ?4.9 mm ± 5.9; P = .041), but the difference did not reach statistical significance at 2 years (no-statin group, ?10.0 mm ± 10.1; statin group, ?8.0 mm ± 9.6; P = .306). Statin therapy was not associated with AAA sac regression on univariate (odds ratio [OR], 0.685; 95% confidence interval [CI], 0.310–1.516; P = .351) and multivariate analyses (OR, 0.617; 95% CI, 0.215–1.772; P = .369).Conclusions
Statin therapy had no effect on AAA sac regression at 2 years. There is insufficient evidence to recommend statin therapy for AAA sac regression. 相似文献19.
Objective
The aim of the study was to compare the diagnostic performances of F-18 sodium fluoride positron emission tomography/computed tomography (bone PET/CT) and bone scintigraphy (BS) for the detection of thyroid cancer bone metastasis.Materials and Methods
We retrospectively enrolled 6 thyroid cancer patients (age = 44.7 ± 9.8 years, M:F = 1:5, papillary:follicular = 2:4) with suspected bone metastatic lesions in the whole body iodine scintigraphy or BS, who subsequently underwent bone PET/CT. Pathologic diagnosis was conducted for 4 lesions of 4 patients.Results
Of the 17 suspected bone lesions, 10 were metastatic and 7 benign. Compared to BS, bone PET/CT exhibited superior sensitivity (10/10 = 100% vs. 2/10 = 20%, p = 0.008), and accuracy (14/17 = 82.4% vs. 7/17 = 41.2%, p < 0.025). The specificity (4/7 = 57.1%) of bone PET/CT was not significantly different from that of BS (5/7 = 71.4%, p > 0.05).Conclusion
Bone PET/CT may be more sensitive and accurate than BS for the detection of thyroid cancer bone metastasis. 相似文献20.
Marco Midulla Ramiro Moreno Anne Negre-Salvayre Franc Nicoud Jean Pierre Pruvo Stephan Haulon Hervé Rousseau 《Cardiovascular and interventional radiology》2014,37(1):69-76