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1
Content available remote Endovascular Treatment of Innominate Artery Aneurysms
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EN
In 2004, two patients were operated on due to innominate artery aneurysms in the Department of General and Thoracic Surgery.The first patient was a 53 year old man admitted to the hospital with suspicion of lung neoplasm, haemoptysis and dyspnoea. AngioCT revealed a ruptured aneurysm of the innominate artery. An urgent endovascular procedure was performed with stentgraft implantation. There were no complications during the procedure and recovery. He was discharged in good condition on the twelfth postoperative day. At the three month follow-up visit, he had no complaints.The second patient was a 73 year old man who had been followed for two years because of a slowly growing aneurysm of the innominate artery. Elective operation was performed with stentgraft implantation. He developed arm ischemia during first postoperative day due to subclavian steal syndrome. After thoracic pharmacological sympathectomy, the problem was solved. At the six month follow-up visit, he was asymptomatic.
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Content available remote Traumatic Injuries to Subclavian Arteries Treated with Stentgraft Implantation
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EN
The aim of the study was to present the experience of our centre in endovascular treatment for subclavian artery injuries.Material and methods. In the years 2000-2005, seven patients (five men and two women, aged 28 to 69 years) with traumatic injuries to their subclavian arteries were treated in the Department of General and Vascular Surgery and Department of Radiology. Four patients were diagnosed with post-traumatic aneurysms including one iatrogenic aneurysm following fixation of a fractured clavicle; one patient experienced post-traumatic injury to subclavian artery; one with iatrogenic perforation of subclavian artery with bleeding into pleural cavity; and the last one with another iatrogenic injury resulting from attempts to place a central access line following surgical, restoration of patency within subclavian and axillary arteries. All patients underwent endovascular treatment with the use of self-expanding peripheral stentgrafts (Wallgraft, Boston Scientific, USA).Results. The procedure of stentgraft implantation was successfully performed in all seven patients. In the patient with iatrogenic injury to the subclavian artery, blood extravasation around the stent was observed the next day, which required the stent to be additionally expanded with a balloon catheter. No complications during or immediately after the procedure were detected in any patient. The patient with iatrogenic injury to the subclavian artery following clavicle fracture suffered from thrombosis within the brachial artery during the third week after the procedure.Conclusions. Endovascular treatment of subclavian artery injuries with the use of peripheral stentgrafts is an efficient method that is associated with low complication rates and should be the method of choice in the treatment of subclavian artery injuries.
EN
Thoracic-abdominal aortic aneurysms (TAAA) are still serious medical problem. Classical procedure requires two cavities approach and implantation of vascular prosthetic in the place of aneurysm - Crawford's procedure. Significant progress was made during last years by using endovascular procedures (stentgrafts). Alternative is hybrid procedure - prosthetic appliance of visceral and kidney arteries and then stentgraft implantation in whole thoracic-abdominal aorta.The aim of the study was comparative analysis of classical and hybrid procedures in thoracic-abdominal aneurysms treatment.Material and methods. Between 1989-2011 in Department of Vascular, General and Transplantological Surgery Medical University in Wrocław and Surgical Department of 4th Military Clinical Hospital in Wrocław 53 patients were operated due to thoracic-abdominal aortic aneurysms. Classical Crawford's procedure was performed in 41 patients (group I) and hybrid procedure was performed in 12 patients (group II). Additionally 7 patients required aortic arc branches reconstruction due to achieve optimal conditions to stentgraft amplantation. Procedures were performed at one or two stages.Results. Mortality in patients treated classically (group I) depended on type of aneurysm in Crawford's classification. In type I-II mortality rate was 54% ((7 deaths/12 patients), in type III do V 17% (5 deaths/ 29 patients). In the group after hybrid procedure (group II) mortality rate was 28% (2 deaths/ 7 patients) in type I-II and 20% (1 death/5 patients) in type III to V. Observed serious perioperative complications.Conclusions. 1. Endovascular procedures development enabled introducing of new methods in thoracic-abdominal aortic aneurysms treatment (hybrid procedures) and allowed to get better results. 2. Clear advantage of hybrid procedures above classical Crawford's procedure is observed in type I and II of TAAA. 3. Mortality and morbidity rates recommend hybrid procedure in type I and II of TAAA. 4. Surgical results of classical and hybrid procedures in type III-V TAAA treatment are comparative, with indication on classical approach.
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Content available remote Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms
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EN
Aortic aneurysms, especially when ruputured, constitute a direct life threat. Mortality in emergency surgical procedures has been estimated at 50 to 90%. In the recent years great advances have been achieved in the form of endovascular techniques, which offer effective treatment and are associated with a lower risk of complications and death.The aim of the study was to evaluate endovascular treatment in patients with hypovolaemic shock due to aortic rupture in the infrarenal segment.Material and methods. 19 patients with ruptured aortic aneurysms were treated by stentgraft implantation in our department from 2001 to 2006. Bifurcated stentgrafts were used in 6, while aortouniiliac stentgrafts were used in the remaining 13 with consecutive femoro-femoral by-pass grafting.Results. Good results were obtained in 14 (73.7%) patients operated on while in hypovolaemic shock caused by aortic aneurysm rupture.5 patients died in the perioperative period (26.3%). The deaths were caused by shock and multiple organ failure.Conclusions. 1. Advances in vascular surgery offer an effective treatment for patients in hypovolaemic shock due to abdominal aortic aneurysm rupture. 2. New treatment modalities do not lift the surgeon's responsibility to manage shock, which remains the main cause of death in patients with ruptured aortic aneurysms. 3. If the technical conditions for stentgraft implantation are met, endovascular procedures should be the method of choice in cases of ruptured abdominal aortic aneurysm.
5
Content available remote Own Clinical Observations of Treatment Outcome in Acute Type B Aortic Dissection
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EN
The aim of the study was to analyse early results of treatment of acute type B aortic dissection.Material and methods. 59 patients, treated between 1998 and 2011, were divided into four groups. Group I comprised ten patients in whom hybrid procedures were performed: extra-anatomical by-pass graft from the brachio-cephalic trunk to the left carotid artery in six patients, transposition of the left carotid artery to the right one in two patients, and reversed Y prosthesis from the brachio-cephalic trunk to both carotids in the remaining 2 patients, to facilitate stent-grafting. Group II comprised 13 patientsin whom endovascular procedures were performed (stent-grafting). Group III comprised 21 patients in whom conventional surgery was done. Group IV comprised 15 patients who were treated conservatively.Results. In group I, a very good clinical outcome, without complications, was achieved in six patients (60% of cases). The total mortality rate was 40%. One patient died on the operation table, following stent-grafting, due to the rupture of the aortic arch. Two patients died as a result of brain damage (cerebral aneurysm rupture in one, and ischemic stroke in the other). In one patient, an aorto-oesophageal fistula developed. In group II, one patient died during endovascular procedure. Another patient suffered from type 1 endoleak, requiring repeated endovascular surgery. In group III, 15 patients (72%) died. Moreover, four patients required acorrective cardiac surgery (Bentall procedure)which in three patients resulted in death. Thus, the total mortality rate in this group was as high as 85%. In group IV, the mortality rate was 13%.Conclusions. We noticed a clear superiority of endovascular procedures over conventional surgeries-for acute type B aortic dissection. Hybrid procedures for acute, complicated type B aortic dissection evidently reduce mortality and postoperative morbidity. Uncomplicated acute type B aortic dissections should be treated conservatively at intensivecare units.
PL
Wprowadzenie: Wewnątrznaczyniowa technika zaopatrywania tętniaków aorty brzusznej jest mało inwazyjną metodą, która wykazuje dużą skuteczność leczenia. Wiąże się jednak z narażeniem zarówno pacjenta, jak i personelu medycznego na promieniowanie jonizujące. Cel: A naliza dawek promieniowania p odczas z abiegów implantacji stentgraftów do aorty brzusznej. Materiał i metoda: Analiza retrospektywna danych 50 pacjentów z rozpoznanym tętniakiem aorty brzusznej leczonych z zastosowaniem implantacji stentgraftów. W analizie zostały uwzględnione następujące parametry: wiek, płeć, BMI, wymiar poprzeczny tętniaka, rodzaj tętniaka, a także liczba zużytych elementów stentgraftu. Wyniki: Odnotowano istotność statystyczną wpływu BMI oraz wymiaru poprzecznego tętniaka na wartość Air Kerma (AK) i Dose Area Product (DAP), a także liczby elementów stentgraftu na wartości AK, DAP i czasu fluoroskopii. Nie odnotowano istotnie statystycznego wpływu rodzaju tętniaka na wartości dawek promieniowania. Wnioski: BMI oraz wymiar poprzeczny tętniaka wpływają na wzrost wielkości wartości AK i DAP, a liczba zastosowanych elementów stentgraftu na wzrost wartości AK, DAP i czas fluoroskopii.
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Introduction: The intravascular technique of abdominal aortic aneurysms treatment is a minimally invasive method that demonstrates high efficacy. However, it exposes the patient and staff to ionizing radiation. Aim: A nalysis o f r adiation d oses d uring s tent g raft i mplantations to the abdominal aorta. Material and method: A retrospective analysis of 50 patients with were diagnosed abdominal aortic aneurysm treated with stent graft implantation. The following parameters were included in the analysis: age, sex, BMI, transverse dimension of the aneurysm, type of aneurysm, as well as the number of used elements of the stent graft. Results: Statistical significance of the impact of BMI and transverse aneurysm dimension on the Air Kerma (AK) and Dose Area Product (DAP) values as well as the number of stent grafts on AK, DAP and fluoroscopy time were recorded. There was no significant statistical effect of the type of aneurysm on radiation doses. Conclusions: The BMI and the transverse dimension of the aneurysm influence the increase in the value of AK and DAP, and the number of applied elements of stentgraft increases the AK, DAP and fluoroscopy time.
EN
The aim of the study was to analyze early and distant results following thoracic descending and abdominal aorta stentgraft implantations.Material and methods. During the period between 2000 and 2006, 20 stentgrafts were implanted into the thoracic descending aorta and 114 into the abdominal aorta.Results. The initial technical success was obtained in 85.71% of cases considering the descending aorta and 89.47% in case of the abdominal aorta. The initial clinical success was obtained in 85.71% and 84.21%, respectively. In 5% of descending aortic operations the branching of the left subclavian artery was covered. Early mortality in case of descending aortic operations amounted 4.76%, while that after abdominal aortic operations - 0.88%. After the implantation of abdominal aortic stentgrafts, 2.63% of early conversions were performed because of aneurysmal rupture, and 1.75% of distant conversions, due to prosthesis inflammation. After abdominal aortic operations, 2.63% of patients required reconstructive operations, due to arterial injury at the site of the approach. After the implantation of descending aortic stentgrafts, early type 1 endoleaks were observed in 10% of cases. After the implantation of abdominal aortic stentgrafts, primary endoleaks were observed in 11.4% of cases: type 1 - 7.02%, type 2 - 3.51%, type 3 - 0.88%. Following the implantation of abdominal aortic stentgrafts, 1.75% of patient's demonstrated symptoms of colon ischemia, while 0.88% - kidney ischemia. After abdominal aortic operations secondary endoleaks were observed in 7.01% of cases: type 1 - 2.63%, type 2 - 1.75%, type 3 - 2.63%.Conclusions. 1. The implantation of stentgrafts is a safe and effective method considering the treatment of descending aortic injuries, dissections and ruptures. 2. The implantation of stentgrafts enables to obtain satisfactory results in the treatment of abdominal aortic aneurysms, considering high-risk patients. 3. The significant number of complications and their heterogenity might be responsible for the limited indications towards stentgraft implantations. The above-mentioned method should be performed in case of patients, where classical operations are connected with an increased risk of complications.
EN
A 50-year-old patient after implantation of a Jotec stent graft in the abdominal aorta in 2014, under the constant care of the Outpatient Clinic of Vascular Diseases, Regional Specialised Hospital No. 4 in Bytom, with a stent inserted into the abdominal aorta in 2014, reported to the ward with suspicion of a type IIIA leak. The presence of the leak was confirmed by angio-CT scan. On the basis of the scan the patient was qualified for implantation of the Nellix system into the Jotec stent and was operated on 19th October 2017. The procedure was carried out without any complications. The check-up angio-scan showed no leak whatsoever. Another angio-CT scan was performed a month later and showed no evident leak with the Nellix system stents placed correctly. At present the patient remains at home in good general condition. The date of another check-up including an ultrasound scan has been set.
PL
Chory 50-letni, po implantacji stentgraftu Jotec do aorty brzusznej w 2014 r., pozostający pod stałą opieką Poradni Chorób Naczyń Wojewódzkiego Szpitala Specjalistycznego nr 4 w Bytomiu, zgłosił się na oddział z podejrzeniem przecieku typu IIIA. Obecność przecieku potwierdzono w badaniu angio-TK. Na podstawie wykonanych badań chorego zakwalifikowano do implantacji systemu Nellix do stentgraftu Jotec. Operowany 19.10.2017 r. Przebieg operacji bez powikłań, po implantacji w kontrolnej aortografii bez cech przecieku. W kontrolnym angio-TK miesiąc po leczeniu operacyjnym nie uwidoczniono przecieku, stenty systemu Nellix prawidłowo ułożone. Aktualnie pacjent przebywa w warunkach domowych, w stanie ogólnym dobrym. Ustalono termin kontroli, w tym ultrasonograficznej.
9
Content available remote Retroperitoneal Fibrosis as a Rare Cause of Lower Limb Claudication
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The study presented a case of a 58-year-old male patient treated for retroperitoneal fibrosis, right hydronephrosis, and right common iliac artery stenosis and saccular aneurysm of the above-mentioned vessel. The patient was qualified for endovascular treatment. Stentgraft implantation was performed with good long-term patency during more than 3 years of follow-up. Complete relief of intermittent claudication was observed. However, the endovascular exclusion of the aneurysm did not influence the course of retroperitoneal fibrosis
PL
Autorzy przedstawiają przypadek 46-letniego pacjenta, kierowcy samochodu osobowego uderzonego z dużą siłą w drzwi kierowcy przez rozpędzony tramwaj. Dominującym urazem był uraz klatki piersiowej ze złamaniem wielu żeber, pęknięciem i rozwarstwieniem aorty piersiowej. W postępowaniu ratowniczym wdrożono tylko niezbędne procedury, umożliwiające podtrzymanie czynności życiowych. Jedynie szybki transport do SOR oraz zabieg torakotomii i laparotomii w trybie nagłym z przetoczeniem dużej ilości krwi pozwoliły utrzymać pacjenta przy życiu. Wykonana tomografia (politrauma) pozwoliła na diagnostykę pourazowego uszkodzenia aorty piersiowej, które w trybie pilnym zostało zaopatrzone za pomocą stentgraftu piersiowego. Pozwoliło to na zmniejszenie stanu bezpośredniego zagrożenia życia i leczenie pozostałych urazów i stanów pourazowych. Pacjenta wypisano w 49. dniu leczenia do oddziału rehabilitacyjnego. W niniejszej pracy autorzy opisują mechanizm urazu, w tym konsekwencje uderzenia w drzwi kierowcy i ich wgięcia przez rozpędzony tramwaj. W takiej sytuacji powinno się jak najszybciej przetransportować pacjenta do SOR. Jednakże wykonanie szybkiego drenażu klatki piersiowej z powodu rozpoznanego krwiaka może spowodować nasilenie krwawienia z pourazowego pęknięcia aorty piersiowej.
EN
Limb graft thrombosis (LGT) is one of the most frequent severe complications after endovascular repair of abdominal aortic aneurysms. The aim of the study was to assess the influence of atherosclerosis in ileo-femoral segment on the incidence of LGT as well as to analyze the methods of treatment of LGT. Material and methods. The medical records of 564 consecutive patients operated endovascularly for abdominal aortic aneurysm by means of bifurcated stentgrafts in the Department of General, Vascular and Transplantat Surgery of Medical University of Warsaw were analyzed. The minimal observation time after surgery was one year. Patients with inflammatory, ruptured and falls aneurysms as well as those with the observation period below 12 months were excluded from the study. Patients were divided into two groups: test (B) and control (K) depending on the progression of atherosclerosis in the iliac arteries. Group B included 184 patients (13 women and 171 men), with advanced atherosclerotic lesions of ilio-femoral segment, corresponding to the A - C class in the TASC classification. The remaining 380 patients (25 women and 355 men) without significant blood flow disorders in the iliac arteries, constituted the group K. The computed tomography was done in all patients with acute limb ischemia. Results. During the observation time up to 114 month, the LGT occurred in 43 (7.6%) cases: [group B - 34/184 (18.5%), group K - 9/380 (2.4%)]. The treatment of LGT included an attempt of patency restoring of the prosthesis by means of thrombolysis or thrombectomy combined with stenting. In case of failure the cross-over femoro-femoral bypass was implanted. Thrombectomy was successful in 21 of 40 cases (52.5%), the local thrombolysis was done in 5 patients and it was successful in three cases and in the remaining two patients the thrombectomy was done. In 16 of 24 patients after patency restoring of the prosthesis the angioplastics and stenting was done. In 17 cases the femoro-femoral bypass was implanted. Conclusions. The atherosclerosis in ileo-femoral segment significantly increases the risk of LGT. An attempt of patency restoring (thrombectomia or thrombolysis) combined with stenting and cross-over femoro- femoral bypass implantation in case of failure seems to be the successful method of LGT treatment.
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