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At least 1,099 records · Page 61Linked to original sources
PubMed2003

[The first case of one stage endovascular treatment of the stenosis in the celiac trunk, bilateral renal arteries, and right common iliac arteries].

Although not very often diagnosed, the acute and chronic mesenterial ischemia is advancing and life threatening condition. When associated with multivascular pathology compromising the perfusion and causing multiple organ failure the choice of treatment is a challenge. In such cases the radical surgical treatment is associated with high morbidity and mortality. In recent years endovascular methods of treatment (angioplasty and stenting) are gaining popularity in the treatment of these patients. We report a case of chronic mesenteric ischemia that caused abdominal angina and weight loss in a 63-year-old man with renovasal hypertension, renal insufficiency and peripheral vascular disease. Angiographic study revealed multivascular pathology including total occlusion of the superior mesenteric artery, 90% stenosis of the celiac trunk, bilateral high grade renal stenoses and obstructive pathology of both iliac arteries. One stage successful endovascular treatment was performed in the three vascular territories. In the Celiac trunk, left renal artery and right common iliac artery were implanted stents. A double right renal artery was treated successfully with kissing balloon. A clinical follow-up demonstrated success with no recurrence of abdominal pain, body weight gain, better control of the hypertension and improvement of the renal function. This is the first reported case of one stage endovascular treatment of a visceral artery, bilateral renal arteries and iliac artery. This case report illustrates the value of endovascular treatment in a patient with atherosclerotic narrowing of multiple abdominal visceral arteries.

Angiography↗
PubMed2005

Endovascular treatment of a symptomatic aneurysm of the left subclavian artery.

Upper extremity ischemia is a rare entity usually due to emboli of arterial origin. Such thromboemboli produce acute symptoms of sufficient severity as to necessitate early surgical intervention. We report the case of a patient with severe ischemia in his left hand, in whom the embolic source was a mural thrombus localized at the level of a saccular aneurysm of the subclavian artery. After having excluded the presence of a thoracic outlet syndrome, the lesion was successfully treated by means of percutaneous implantation of a stent graft with the exclusion of the aneurysm and the sealing of the thrombus.

Aged↗
PubMed2005

Computerized nailfold video capillaroscopy--a new tool for assessment of Raynaud's phenomenon.

OBJECTIVE: To develop a computer based nailfold video capillaroscopy system with enhanced image quality and to assess its disease-subgroup resolving power in patients with primary and secondary Raynaud's phenomenon (RP). METHODS: Using frame registration software, digitized video images from the microscope were combined to form a panoramic mosaic of the nailfold. Capillary dimensions (apex, arterial, venous, and total width) and density were measured onscreen. Significantly, the new system could guarantee analysis of the same set of capillaries by 2 observers. Forty-eight healthy control subjects, 21 patients with primary RP, 40 patients with limited cutaneous systemic sclerosis (lcSSc), and 11 patients with diffuse cutaneous SSc (dcSSc) were studied. Intra- and interobserver variability were calculated in a subset of 30 subjects. RESULTS: The number of loops/mm was significantly lower, and all 4 capillary dimensions significantly greater, in SSc patients versus controls plus primary RP patients (p < 0.001 for all measures). When comparing control (+ primary RP) patients with SSc patients (lcSSc + dcSSc) the most powerful discriminator was found to be the number of loops/mm. Results for intra- and interobserver reproducibility showed that the limits of agreement were closer when both observers measured the same capillaries. CONCLUSION: The key feature of the newly developed system is that it improves reproducibility of nailfold capillary measurements by allowing reidentification of the same capillaries by different observers. By allowing access to previous measurements, the new system should improve reliability in longitudinal studies, and therefore has the potential of being a valuable outcome measure of microvessel disease/involvement in clinical trials of scleroderma spectrum disorders.

Adult↗
PubMed2005

[Potential of endovascular surgery in children with congenital heart diseases].

Bakulev Scientific Center for Cardiovascular Surgery has very broad experience (3,774 cases) in endovascular operations on patients with different congenital heart diseases. 648 patients have undergone atrioseptostomy, 1,500 patients--balloon valvuloplastic, 546 patients--balloon angioplasty, 565 patients--coil embolization; stents have been used in 86 patients; in 114 cases the surgeons of the Center have used different occluders to close pathological communications, in 315 patients others types of treatment have been applied. In many cases of congenital heart diseases (valvular stenosis of pulmonary artery and aorta, patent ductus arteriosus, atrium and ventricular septal defect, coronary-cardial fistula, coarctation and recoarctation of aorta) endovascular techniques present a good alternative to open surgical procedures. In some cases endovascular techniques are palliative (Rashcind's and Park's procedure, balloon valvuloplasty in stenosis of pulmonary artery and angioplasty in stenosis of peripheral pulmonary artery and aorto-pulmonary anastomosis in patient with cyanotic congenital heart disease, stenting of PDA, coil embolization of collateral artery from aorta to pulmonary artery etc.) Multi-stage endovascular and surgical treatment allows radical or hemodynamic correction in patient with complex congenital heart disease. Nowadays the spectrum of endovascular treatment is wide; it is going to develop in the future, which will allow endovascular techniques to be of wide use in treatment of patient with complex heart diseases.

Angioscopy↗
PubMed2005

[Classification of microangiopathy in systemic sclerosis].

AIM: To classify main types of morphological changes of nailfold capillaries in systemic sclerosis (SSc). MATERIAL AND METHODS: Nailfold videocapillaroscopy (NCS) was performed in 103 patients with SSc (34 patients with dSSc and 69 patients with ISSc) with a median age of 47.9 +/- 13.3 years and mean disease duration of 8.1 +/- 7.1 years. The control group consisted of 35 healthy persons. RESULTS: On the basis of a quantitative estimation of changes the main capillaroscopic patterns of structural changes of capillaries in SSc were distinguished. The first (early) type is characterized by changes mainly of sizes of capillaries and a rather moderate decrease of their amount. In the second (transitive) type simultaneously with change of the sizes of capillaries an appreciable decrease of the amount of capillaries with formation of avascular sites is observed. The third (late) type of changes is characterized by marked reduction of capillaries and plenty of avascular sites in the absence or presence of few dilated capillaries. NCS enables to reveal destruction and new growth of capillaries. The statistical analysis has shown authentic distinctions of NCS parameters between main types of changes and close association of these types with activity of the disease. CONCLUSION: Definition of a type of capillaroscopic changes can serve a reliable and objective criterion of a stage and activity of microangiopathy in SSc which reflects duration of illness as a whole.

Adolescent↗
PubMed2005

[Endoscopic subfascial dissection of venous perforants in treatment of venous trophic ulcers of the legs].

Endoscopic subfascial dissection was performed in patients with chronic venous insufficiency of CEAP class 4-6. 76 surgeries were performed in 68 patients. Mean age of the patients was 56 years. The causes of chronic venous insufficiency were varicose (37) and postthrombotic diseases. Trophic ulcers were in 46 patients. Thirty patients underwent earlier various phlebectomies, including Linton's surgery (6 patients). In 33 patients endoscopic subfascial dissection of venous perforants was combined with various phlebectomy, in 37 patients -- with excision of ulcer with following autodermoplasty few days after surgery. Endoscopic subfascial dissection was carried out with special surgical R.Wolf endoscope with 6 mm instrumental canal, and also standard laparoscopic optical devices "Olympus". Complications during surgery were seen in 2 patients: bleeding in subfascial space (1.3%) and perforation of tissues in ulcer zone (1.3%). In postoperative period long (up to 14 days) lymphorrhea and suppuration of surgical wound were in 2 (2.6%) patients. It is concluded that endoscopic approach is optimal for elimination of pathological reflux through venous perforants in complicated forms of chronic venous insufficiency of the lower extremities, including trophic ulcers resistant to treatment.

Adult↗
PubMed2005

[Capillaroscopy in the diagnosis of systemic sclerosis].

Capillaroscopy is a safe, simple, non-invasive, low-cost analysis of the nailfold circulation. Vascular lesions play a significant role in the pathogenesis of systemic sclerosis. It has been shown that a characteristic microangiopathy, so-called "scleroderma pattern capillary abnormalities", --are present in the majority of patients with systemic sclerosis and already appear in the early stage of the disease. Due to this fact, capillarosopy is considered a practical tool for diagnosing and monitoring patients with systemic sclerosis. Capillaroscopy can help in the selection of patients that need more aggressive therapeutic interventions. Recently, the presence of typical capillaroscopic abnormalities has been suggested as one of the minor criteria for the early diagnosis and classification of systemic sclerosis. The present study presents the role of capillaroscopy in the management of patients with systemic sclerosis.

Diagnosis, Differential↗
PubMed2005

Endografting of thoracic aortic aneurysms and dissections.

3D imaging and endovascular repair have greatly increased the number of interventions in the thoracic aorta. Excellent early results of endovascular repair compensate unproven long term durability. Challenging anatomy is associated with increased risk for late failure of the stent graft (SG) but the option of open repair usually remains and complications from open surgery are also more frequent in these cases. The indications for endovascular repair of the descending aorta include aneurysms larger than 5-6 cm in diameter, pseudoaneurysms and type B dissection complicated by rupture, aortic dilation or distal hypoperfusion. Traumatic transections and certain types of coarctation are also treated endovascularly. Aortic rupture is associated with a high mortality and treatment is attempted liberally. Logistics remain a limitting factor for urgent stent grafting in many centers. Adequate pre and intraoperative imaging is mandatory for correct SG implantation. The mechanical forces of aortic blood flow jeopardize durable fixation of the device. Extended fixation zones of at least 5 cm, generous overlap between SG components and SG positioning along the outer curvature of the sac improve durability. Primary complications include stroke and paraplegia in about 5% of the cases. Late complications are mainly associated with SG dislodgement and inadequate seal. Surveillance is required. Future development focuses on treatment of leasions in the aortic arch. Debranching of the arch and branched SGs are currently being investigated.

Aortic Dissection↗
PubMed2005

Endografting of the abdominal aorta and iliac arteries for occlusive disease.

Angioplasty and stenting of short segment obstructions is highly effective in the treatment of aorto-iliac occlusive disease. However, long-segment, diffuse and calcific aorto-iliac atherosclerosis is most effectively treated with surgical bypass. While aorto-femoral bypass procedures are durable and effective, too often patients are elderly, high risk and poor candidates for open surgery. Endografting of the abdominal aorta and iliac arteries is aimed at improving the short and long-term results of endovascular treatment of extensive, end-stage aorto-iliac disease. Aorto-iliac endografts are widely used in the treatment of aneurysmal disease. Early experiences with endografts in the treatment of occlusive disease are promising. However, evidence that long-term patency of endografts will be substantially better than angioplasty and stenting is not yet available. Prospective clinical trials are needed to determine the role of endografts in the treatment strategy of aorto-iliac occlusive disease.

Angioscopy↗
PubMed2005

Complications of aortic endografting.

Endovascular repair of abdominal aortic aneurysm has been shown to have a significantly lower perioperative mortality rate compared with open repair. It has been a blessing for patients at high risk who were previously denied treatment for their aortic aneurysms. It does, however, have a substantial need for re-intervention for complications. Many of these complications including endoleak, endotension, migration, post implant syndrome and conversion to open repair are unique to endovascular aneurysm repair. Others including injury to the iliac arteries, graft limb thromboses and structural failure of prostheses occur with greater frequency in endovascular repair compared with open repair. It is important, therefore, for vascular surgeons to be aware of these complications including their prevention and appropriate that patients are informed of their incidence. This review discusses the local and vascular complications of endovascular repair of abdominal aortic aneurysm with an emphasis on newer aspects.

Angioscopy↗
PubMed2005

Future perspectives in the treatment of femoro-popliteal arterial occlusions.

Femoro-popliteal occlusive disease represents the most frequent localization of atherosclerosis in the lower extremities. Treatment of this disease has changed remarkably in the last decade. A definite treatment strategy has still to be established. The pathophysiology is described. A general overview of the state-of-the art treatment modalities and the most recent developments is given. This is divided into non-interventional preventive and supportive therapy, endovascular interventional therapy, and surgical interventional therapy. The development of medical therapy has expanded enormously and is progressing still. In the wide range of interventional treatment modalities, there has been a change from invasive bypass surgery to more refined techniques like endarterectomy and percutaneous endovascular therapy. This trend towards restoring the patency of the artery using the vessel wall itself as a conduit, leads to a term encompassing all these treatment modalities, known as restorative intervention. Peri-procedural risks of restorative interventions are of a much lesser degree compared to bypass surgery. Reports of patency rates show a steady increase. It is expected that patency rates will eventually equal or even surpass those of bypass surgery. In conclusion, a treatment strategy for femoro-popliteal occlusions in the future is proposed as follows: the first line of interventional therapy in femoro-popliteal occlusions should be a restorative intervention. With adequate adjuvant medical therapy and sufficient monitoring, this will be the definite treatment for the majority of patients. Bypass surgery should be regarded as the second line of interventional therapy and should be reserved for those patients in whom restorative interventions fail.

Angioscopy↗
PubMed2005

Endovenous laser ablation of varicose veins.

UNLABELLED: Readily available non-invasive diagnostic tests now allow physicians to accurately map out abnormal venous pathways and identify all sources of reflux. Minimally invasive alternatives to surgical removal of incompetent truncal veins have been developed with impressive RESULTS: Endovenous laser treatment can be performed in the office under local anesthesia and is associated with virtually no recovery period. Better understanding of the primary mechanism of energy transfer by direct contact between the laser fiber tip and vein wall has underscored the importance of vein emptying. Improved utilization of tumescent anesthesia has helped facilitate circumferential laser fiber to vein wall contact and virtually eliminated the incidence of heat-related complications. Further refinements in the technique and optimization of laser energy parameters have improved success rates of vein closure from 90% to nearly 100%. Compared to surgery, endovenous laser has also demonstrated lower rates of recurrence largely due to the absence of neovascularity. This review of endovenous laser treatment should validate this exciting technique as a scientifically acceptable option for eliminating truncal vein reflux. If measured by patient acceptance and satisfaction, endovenous laser and other minimally invasive methods have already supplanted traditional surgery as the treatment of choice for superficial venous insufficiency.

Angioscopy↗
PubMed2005

Combining laparoscopic and endovascular techniques to improve the outcome of aortic endografts. Hybrid techniques.

Aortic endografting can be performed with a high initial success rate yet with the need for lifelong surveillance because of numerous long term problems. Among these graft migration, typ II endoleaks and endotension require treatment to prevent abdominal aortic aneurysm (AAA) rupture. We describe our experience with laparoscopic clipping of lumbar arteries and the inferior mesenteric artery (IMA) to prevent Type II leaks as well as with different banding procedures. Several ways to perform active graft fixation are described. Since we believe that active downsizing of the aneurysm reduces some of the intermediate term problems we go a step further and evacuate the thrombus to downsize the aneurysm to prevent longitudinal shrinkage. Laparoscopic techniques can also be used to obtain direct vascular access. This permits insertion of a thoracic endograft directly into the aorta in patients with diseased iliac vessels. Endovascular aneurysm repair (EVAR) insertion under laparoscopic navigation without contrast dye in cases with renal insufficiency is described. We describe our technique of total laparoscopic conversion after failed endografting. Future perspectives and preliminary experience with an aortic stapler are discussed.

Aged↗
PubMed2005

Endovascular brachytherapy for the prevention of restenosis after femoropopliteal angioplasty. Results of the VARA Trial.

AIM: Endovascular brachytherapy (EBT) has been proposed as a method to prevent restenosis. We performed a prospective randomised multicenter study to determine its efficacy for prophylaxis of restenosis after femoropopliteal percutaneous transluminal angioplasty (PTA). METHODS: Patients with symptomatic stenotic or totally occluding lesions in the femoropopliteal artery were randomised to be treated with PTA plus EBT or PTA alone. In case of EBT, 14 Gy was applied by an 192Ir source to the vessel wall. Clinical examination, ankle-brachial pressure index (ABPI) and duplex ultrasound were planned after 6 and 12 months. The primary endpoint was significant restenosis of the treated segment at duplex ultrasound after 12 months. RESULTS: Fifty-three of the 60 patients who eventually met the inclusion criteria could be studied. After 12 months, restenosis rates were 44% (12/27) in the PTA group versus 35% (8/23) in the PTA + EBT group (c2 test, P=0.51). There was no difference in mandatory reintervention between the 2 groups. Overall, EBT resulted in an absolute risk reduction of significant restenosis of 9%, yet in patients with totally occlusive disease this reduction was 32%. CONCLUSIONS: This study suggests an effect of EBT on the occurrence of restenosis only after PTA of occluded femoropopliteal lesions. Due to a too small number of patients analysed this difference is not statistically significant.

Adult↗
PubMed2005

[Possibilities of endoscopic surgery in treatment of chronic venous insufficiency of the lower extremities].

The authors present their experiences with endoscopic dissection of perforating veins in patients with severe forms of chronic venous insufficiency with special reference to the peculiarities of blood supply of the extremity superficial tissue. The generalized morphological description of the perforating arteriovenous structures of the leg is presented as a vascular formation including the arteries and veins put in the general connective-tissue vagina and beginning from the profound or/and muscular veins and arteries. Operations were made on 56 patients aged 25-76 years, 40 of them had postthrombotic disease, 16 - varicose disease. The endoscopic subfascial dissection of the perforating veins was conducted using the standard set of tools for laparoscopic surgery of K. Storz Company. During the surgical procedure the perforating vascular bunch in the subfascial space was isolated, the veins were intersected electrosurgically, the other parts of the vascular bunch were preserved. On the average, the patients were in the hospital for 7+/-2 days. Trophic ulcers healed up during 7-30 days. Long-term results were good in 30%, satisfactory in 64%, unsatisfactory - in 6%. So, the selective endoscopical dissection of perforating veins is thought to be a radical, minimally invasive, anatomically and functionally reasonable method of elimination of the horizontal venous blood regurgitation. This technique resulted in a considerably decreased number of postoperative complications and less time of hospital treatment.

Adult↗