| 1. |
- Gernhofer, Yan K., et al.
(author)
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Which advanced heart failure therapy strategy is optimal for patients over 60 years old?
- 2019
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In: The Journal of cardiovascular surgery. - 0021-9509. ; 60:2, s. 251-258
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Journal article (peer-reviewed)abstract
- BACKGROUND: The optimal advanced heart failure (HF) therapy strategy for patients aged 60 or older with end-stage HF refractory to optimal medical therapy remains uncertain. This study compares outcomes of three advanced HF therapy strategies in this patient population. METHODS: A single-center retrospective study was conducted in 95 patients aged 60-73 years who had undergone isolated heart transplantation (HTx) or continuous flow left ventricular assist device (LVAD) implantation from 2010 to 2017. Patients were stratified into three cohorts by strategy; HTx-only (N.=25), LVAD-to-HTx (N.=29), and LVAD-only (N.=41). Primary end point was 2-year overall survival. Secondary end points included incidence of post-operative adverse events, freedom from first readmission at 1 year, and percentage of days spent in hospital following advanced HF therapy. RESULTS: Two-year survival was 91% in HTx-only patients, 88% in LVAD-to-HTx patients, and 49% in LVAD-only patients (P=0.0008). No significant difference in post-transplant survival was found between patients with or without LVAD-related adverse events preceding transplantation (P=0.42). One-year freedom from first readmission was 38.3% in HTx-only patients, 17.2% in LVAD-to-HTx patients and 7.3% in LVAD-only patients (P=0.0028). Patients in LVAD-to-HTx cohort had higher incidences of gastrointestinal bleeding (38% vs. 3%; P<0.01), major bleeding (28% vs. 3%; P=0.02), and right heart failure (69% vs. 31%; P<0.01) during post-LVAD period compared with post-HTx period. Their percentage of days spent in hospital during post-LVAD period was significantly higher than post-HTx period (7.9% vs. 1.2%; P<0.001). CONCLUSIONS: Our experience with patients over 60 years old undergoing advanced therapy suggests that HTx-only and LVAD-to-HTx strategies had superior medium-term survival than LVAD-only strategy. LVAD-to-HTx strategy is effective in reducing incidence of adverse events and percentage of hospitalized days in this specific patient population.
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| 2. |
- Budtz-Lilly, Jacob, et al.
(author)
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Outcomes of endovascular aortic repair in the modern era.
- 2018
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In: Journal of Cardiovascular Surgery. - 0021-9509 .- 1827-191X. ; 59:2, s. 180-189
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Research review (peer-reviewed)abstract
- Monitoring outcomes following endovascular aortic repair (EVAR) is critical. Although evidence from randomized controlled trials has solidified the role of EVAR, the analysis of outcomes and "real-world" data has uncovered limitations, improved the selection of appropriate patients, and underscored the importance of instructions for use. Subsequent studies demonstrated the learning curve of EVAR and gradual improvement of outcomes over time. Outcomes analyses will continue to play an important role, particularly as technological growth of endovascular therapy has enabled treatment of more complex aneurysm pathologies and patients. The important analyses are herein reviewed, following the development of EVAR in the treatment of intact abdominal aortic aneurysms (AAA) to ruptured AAAs, and finally to complex aneurysms, including thoracoabdominal aortic aneurysms and mycotic aneurysms. This includes an overview of the more recent results from analyses of branched and fenestrated EVAR, as well as the use of chimney grafts. It is emphasized that the success of endovascular repair has paradoxically been hampered by its rapid growth and early achievements. Even the most advanced engineering developments cannot overcome the long-term effects of the progression of aortic disease. The long-term benefits thus require careful planning and considerations of the natural history of aneurysms and the life expectancy of the patient. Large and international data registry collaborations should continue to play a role in providing outcomes analyses to guide future improvements.
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| 3. |
- Burdess, Anne, et al.
(author)
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Stent-graft induced new entry tears after type B aortic dissection : how to treat and how to prevent?
- 2018
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In: Journal of Cardiovascular Surgery. - : EDIZIONI MINERVA MEDICA. - 0021-9509 .- 1827-191X. ; 59:6, s. 789-796
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Research review (peer-reviewed)abstract
- Progress of aortic disease after stent-graft treatment of aortic dissection includes the risk of stent graft-induced new entry (SINE). In this paper we review the incidence and mechanisms thought to be responsible for retrograde ascending and distal SINE after thoracic endovascular aortic repair (TEVAR) for type B dissection, and examine potential techniques for treatment and prevention. Although the risk of proximal SINE is low, the fatality of this complication requires vigilance in patients who develop new onset symptoms in the early period after TEVAR treatment. Careful technique, minimal oversizing, and use of disease specific stent grafts may reduce the risk for proximal SINE. Distally, SINE is more frequently seen during follow-up in patients treated for chronic dissection. The most important risk factor is oversizing of the stent-graft compared to the true lumen distal landing zone. Development of new disease specific stent grafts with reduced distal radial force may reduce the risk for distal SINE.
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| 4. |
- De La Motte, L., et al.
(author)
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Is EVAR a durable solution? Indications for reinterventions
- 2018
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In: Journal of Cardiovascular Surgery. - 0021-9509. ; 59:2, s. 201-212
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Journal article (peer-reviewed)abstract
- INTRODUCION: Indications for reinterventions after endovascular aneurysm repair (EVAR), as well as their occurrence in number and time, are important to establish in order to optimize patient selection, postprocedure surveillance and also to guide improvements in endograft designs. The aim of this report was to present an overview of current data on reinterventions after elective EVAR. EVIDENCE ACQUISITION: Qualitative review of studies reporting on reinterventions after elective EVAR, identified by a systematic literature search in MEDLINE, EMBASEand the Cochrane Library for publications from 2010 to 13th of November 2017. EVIDENCESYNTHESIS: Twenty-Three studies reporting on 83,307 patients met the inclusion criteria. Index procedures were performed between 1996-2014. There was wide heterogeneity in reporting standards. Type Iendoleaks were reported in 0.6%-13% and type IIIendoleaks in 0.9-2.1% with a significant improvement for newer devices. Migration rates varied between 0-4%. Endoleak type II was the most common indication for re-intervention ranging from 14-25.3% although the majority resolved without intervention. Rupture rates ranged from 0-5.4% and carried a high mortality (60-67%). Ruptures occurred at any time after the index procedure. Limb ischemia rates were reported at 0.4-11.9% with re-intervention rates between 0.06-11.9%. Wound related complications and related re-interventions were the indication in 0.5-14% and 0.3-6.5%, respectively. Endograft infection carried a high risk of mortality and was described in 0.3-3.6%, often related to graft-enteric fistula and the majority had an open explantation of the endograft. CONCLUSIONS: This review showed that the rates of complications and techniques for reintervention developed over time with a tendency towards better outcomes considering the aneurysm related indications. Significant factors that led to subsequent secondary interventions were migration, rupture, infections and type Iand IIendoleaks. Patients treated with earlier generation endografts are still alive and need continued surveillance to detect these severe complications before they lead to rupture. © 2018 Edizioni Minerva Medica.
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| 5. |
- Hellgren, Tina, et al.
(author)
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Outcomes of aortic arch repair using the frozen elephant trunk technique : analysis of a Scandinavian center's results over 14 years
- 2023
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In: Journal of Cardiovascular Surgery. - : EDIZIONI MINERVA MEDICA. - 0021-9509 .- 1827-191X. ; 64:2, s. 215-223
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Journal article (peer-reviewed)abstract
- BACKGROUND: The frozen elephant trunk (FET) technique enables repair of aortic arch pathology, with possibility for endovascular treat-ment of distal thoracic aortic disease. We aimed to study outcomes of FET repair of complex aortic arch disease at a Scandinavian tertiary referral center. METHODS: All patients who underwent FET repair of the aortic arch 2006-2020 were included. Survival, complication and reintervention rate, and aortic remodeling were analyzed. RESULTS: Fifty patients were included: 23 complex thoracic aortic aneurysms involving the aortic arch (TAA), 19 with chronic aortic dis-sections (CAD) (16 Stanford type A, 3 type B) and 8 acute aortic dissections (AAD) (7 Stanford type A, 1 type B). Thirty-day mortality was: TAA=22% (N.=5), CAD=5% (N.=1), AAD=37% (N.=3). Rate of disabling stroke: TAA=22% (N.=5), CAD=5% (N.=1), AAD=25% (N.=2). Rate of permanent spinal cord injury: TAA=9% (N.=2), CAD=5% (N.=1), AAD=0%. 5-year survival: TAA=53%, CAD=83%, AAD=63%. 5-year reintervention-free survival was TAA=83% and CAD=36%. There were no reinterventions in the AAD group. 13/19 (68%) of CAD patients underwent distal stent graft extension during follow-up. On last CT follow-up (median 32 months), 78% of CAD had false lumen thrombosis along the stent graft and 11% in the abdominal aorta. In thoracic aorta there was a mean 64% expansion (P<0.001) of true and 39% reduction (P=0.007) of false lumen diameter. In abdominal aorta, both true and false lumen expanded. CONCLUSIONS: Despite the advantages of the FET technique, repair of extensive aortic arch disease remains associated with high rates of mortality and major neurologic complications. FET repair of CAD induces favorable remodeling in the thoracic aorta.
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| 6. |
- Lilja, Fredrik, et al.
(author)
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Changes in abdominal aortic aneurysm epidemiology
- 2017
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In: Journal of Cardiovascular Surgery. - 0021-9509 .- 1827-191X. ; 58:6, s. 848-853
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Research review (peer-reviewed)abstract
- The epidemiology and treatment of abdominal aortic aneurysms (AAA) has changed over the past 30 years. This review aims to give the reader an overview of these changes and current trends in AAA epidemiology, management and outcome. In the past decades there have been three changes in AAA management and epidemiology: 1) introduction of endovascular aortic repair (EVAR); 2) population screening; and 3) a markedly reduced prevalence of the disease. These developments have resulted in an increased incidence of intact AAA-repair and reduced incidence of ruptured AAA-repair. Overall, survival after both intact and ruptured AAA repair has improved, much thanks to the broad introduction of EVAR. Additionally, both elective and rupture repair in the elderly population has increased, with octogenarians constituting >20% of intact AAA repairs performed in several countries. International analyses of vascular registries indicate that important variations remain in AAA management and results. The changes in AAA epidemiology and management have led to a situation where most AAAs today are treated with EVAR electively. The incidence of ruptured AAA-repair continues to decrease. These changes are accompanied by improvements in both short- and long-term survival.
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| 7. |
- Lindström, David, et al.
(author)
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Bridging stent grafts in fenestrated and branched endovascular aortic repair : current practice and possible complications
- 2019
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In: Journal of Cardiovascular Surgery. - : EDIZIONI MINERVA MEDICA. - 0021-9509 .- 1827-191X. ; 60:4, s. 476-484
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Research review (peer-reviewed)abstract
- Fenestrated and branched endovascular aortic repair (F/B-EVAR) is associated with a high degree of technical and clinical success. Despite this, studies have also reported high reintervention rates, and these are often related to the bridging stent grafts. Often new devices appear on the market before they have been tested in the bridging stent graft position. This review aims to assess the current literature on bridging stent grafts and discuss complications, illustrated by case reports. Complications reported with bridging stem grafts include; endoleak, kink, fracture, migration, occlusion, stenosis and perforation. Some known risk factors for bridging stent occlusions are renal artery stent grafts vs. SMA and celiac artery stent grafts. Some device specific complications have also been reported such as type IIIc endoleak with the Lifestream stent graft (Bard Peripheral Vascular, Tempe, AZ, USA) fractures and type Hid endoleaks with the 1st generation of Begraft (BentleyinnoMed, Hechingen, Germany). In addition, this review also discusses some newer devices with possible relation to complications such as stenosis and target vessel perforation. In conclusion, bridging stent grafts in fenestrated and branched aortic repair have a good midterm patency. Despite this, remaining issues are often related to the bridging stent grafts. Thorough follow-up and attention are needed, especially when new devices are introduced. The endovascular community should work towards a common global feedback system.
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| 8. |
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| 9. |
- Salemans, Pieter B., et al.
(author)
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Up to 10-year follow-up after EVAR with the Endurant stent graft system : a single-center experience
- 2021
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In: Journal of Cardiovascular Surgery. - : EDIZIONI MINERVA MEDICA. - 0021-9509 .- 1827-191X. ; 62:3, s. 242-249
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Journal article (peer-reviewed)abstract
- BACKGROUND: Endovascular aneurysm repair (EVAR) has become the preferred treatment for infrarenal abdominal aortic aneurysms (AAA) over open surgical repair. The Endurant stent graft is widely used, and large registries report low rates of aneurysm-related mortality and reinterventions at midterm follow-up. Reports of long-term follow-up are limited. The aim of this study is to report our experiences and share our results. reintervention rate and mortality at long-term follow-up after using the Endurant stent graft. METHODS: All consecutive patients treated between 2009 and 2013 with the Medtronic Endurant I and II stent graft for an infrarenal AAA in an elective setting were included. Primary outcomes were overall and aneurysm-related survival and reintervention rates. RESULTS: One hundred sixty-five consecutive patients (median age 74; IQR: 68-79) with an aneurysm diameter of 62 mm (IQR: 58-70) and neck length of 29 mm (IQR: 21-40) were electively treated with the Endurant 1 or II stent graft. One hundred thirty-four patients (81.2%) were treated inside IFU (instructions for use) and 31 (18.8%) outside IFU. At median follow-up of 76 months (IQR: 50-97), 60 patients (36.4%) were deceased. Kaplan-Meier estimates at 10 years follow-up of overall survival and freedom from aneurysm-related mortality were respectively 48.5% (CI: 43.7-53.3%) and 973% (CI: 95.7-98.9%). Freedom from reintervention was 86.0% with an CI: 83.1-88.9% at 5 years follow-up and 75.6% with a CI: 70.2-81.0% at 10 years follow-up. A total of 25 (15.2%) patients had an EVAR-related reintervention; indications were endoleak (EL) type 1A (N.=11), EL type 1B (N.=3), EL type 2 (N.=6), EL type 3 (N.=1) and limb occlusion (N.=4). We found no significant differences in outcome between the inside and outside IFU groups. At 5 years follow-up 92.6% of patients had stable or decreased diameter, and 7.4% had an increased diameter. CONCLUSIONS: This large cohort single-center study demonstrates the effectiveness and safety of the Endurant stent graft system at long-term follow-up with low reintervention rates and aneurysm-related mortality.
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| 10. |
- Sörelius, Karl, 1981-, et al.
(author)
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Endovascular treatment of mycotic aortic aneurysms : a paradigm shift
- 2017
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In: Journal of Cardiovascular Surgery. - 0021-9509 .- 1827-191X. ; 58:6, s. 870-874
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Research review (peer-reviewed)abstract
- Treatment of mycotic aortic aneurysms (MAAs) composes a particularly difficult challenge. Open repair has been considered the gold standard, despite lack of evidence supporting its superiority compared with the emerging alternative endovascular aortic repair (EVAR). This review discusses the pros and cons of EVAR for MAAs by dissecting the three largest publications on MAAs, and concludes that there has been a paradigm shift in treatment of MAAs for the benefit of EVAR.
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| 11. |
- Usai, Marco, V, et al.
(author)
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Systematic review of atherectomy of inguinal arteries for atherosclerotic lesions
- 2022
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In: Journal of Cardiovascular Surgery. - : Edizioni Minerva Medica. - 0021-9509 .- 1827-191X. ; 63:1, s. 2-7
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Research review (peer-reviewed)abstract
- INTRODUCTION: Surgical endarterectomy represents the gold standard for the treatment of atherosclerotic lesions of the groin vessels. Endovascular treatment such as atherectomy with or without drug coated angioplasty (DCA) of the so called no stenting zones, i.e. inguinal and popliteal vessels, is gaining growing acceptance as alternative option to open surgery. This systematic review aims to scrutiny the current clinical evidence regarding atherectomy and DCA for the common artery (CFA).EVIDENCE ACQUISITION: We conducted an exhaustive research in multiple platforms (Medline, PubMed, Cochrane, Google Scholar, Em base) on studies over atherectomy and angioplasty for inguinal atherosclerotic lesions published between 2000 and 2021. As search strategy we used a wide list of MeSH items, words, synonyms. Bibliographies of review articles were checked for further relating studies regarding atherectomy of CFA. A qualitative and quantitative data analysis was carried out.EVIDENCE SYNTHESIS: Fifteen studies were included in the qualitative review. Not all studies were focused only on atherectomy of inguinal vessels, despite including such treatment. Hence, data regarding this treatment were not exhaustive. A fairly homogeneous data analysis was possible in 7 of 15 studies. The remaining 8 studies were qualitatively analyzed but not included in the statistical analysis. In all 7 included studies directional atherectomy and DCA under filter protection were carried out. In this subgroup, overall, 497 patients were treated with atherectomy. Sixty-eight percent of the patients were males. Rutherford class from 1-3 dominated against 4-6 (63% vs. 37%). Mean technical success rate was 96%, with a primary and secondary patency rate of 92% and 98% respectively at one year. Procedure related vascular complications ranged from 1% to 6%.CONCLUSIONS: Current literature about atherectomy for inguinal arteries is scant, data are inhomogeneous and so are treatment modalities. Nevertheless, the results of this systematic review suggest that this endovascular strategy is feasible with good short and midterm results. Prospective trials with larger patient cohorts are necessary to confirm these preliminary results.
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| 12. |
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| 13. |
- Wanhainen, Anders, et al.
(author)
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The most important news in the new ESVS 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysm
- 2019
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In: Journal of Cardiovascular Surgery. - : EDIZIONI MINERVA MEDICA. - 0021-9509 .- 1827-191X. ; 60:4, s. 485-489
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Research review (peer-reviewed)abstract
- The "new" and updated European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysm, published in the 2019 January issue of the European Journal of Vascular and Endovascular Surgery, is an extensive document offering 125 recommendations of clinical importance on the management of AAA, accompanied by a comprehensive supporting text that summarizes the literature and motivates the positions made. Several new topics, not addressed in the previous guidelines, are included. Here we summarize the most important news in the new ESVS 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysm.
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| 14. |
- Acosta, Stefan, et al.
(author)
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Update on intra-arterial thrombolysis in patients with lower limb ischemia.
- 2015
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In: Journal of Cardiovascular Surgery. - 0021-9509. ; 56:2, s. 317-324
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Journal article (peer-reviewed)abstract
- Intra--arterial thrombolysis has become the most important minimal--invasive treatment option to treat acute lower limb ischemia. Although hemorrhagic stroke is a dreaded complication, it is considered beneficial to many fragile and elderly patients where vascular surgery is not an option. This review outlines current results after intra--arterial thrombolysis with low dose recombinant tissue plasminogen activator (rtPA) from 2001 to 2012 in two large vascular centers in Sweden. There was an increasing number of thrombolysis of occluded endoprosthesis and decreasing thrombolysis of occluded bypasses during this time period. Technical success rate for thrombolysis of occluded endoprosthesis, bypasses and native artery occlusion was 91%, 89% and 73%, respectively. Amputation--free survival rate at 1 year was 73%. Popliteal arterial aneurysm and anemia were independently associated with dismal amputation--free survival at 30 days. Independent factors associated with dismal amputation--free survival at long--term were foot ulcers, motor deficit, renal insufficiency and anemia. Major hemorrhage occurred in 104 procedures (13.9%); 43 (5.7%) were so severe that thrombolysis was discontinued in advance. All three (0.4%) hemorrhagic strokes were fatal. Preoperative severe limb ischemia with motor deficit was the only independent risk factor for major bleeding. Simultaneous heparin infusion was not associated with increased risk of major bleeding or improved leg salvage or survival. In conclusion, intra--arterial thrombolysis with rtPA for lower limb ischemia was effective, with few major bleeding complications. Simultaneous heparin infusion offered no advantage. Thrombolysis in embolism due to popliteal artery aneurysm is the most important step to improve run--off and a prerequisite to succeed with operative treatment.
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| 15. |
- Avci, M., et al.
(author)
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The use of endoanchors in repair EVAR cases to improve proximal endograft fixation
- 2012
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In: Journal of Cardiovascular Surgery. - 0021-9509. ; 53:4, s. 419-426
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Journal article (peer-reviewed)abstract
- Aim. The aim of this paper was to evaluate short-term outcome of the use of endoanchors to secure the primary migrated endograft and additional extender cuffs to the aortic wall in patients with previous failed endovascular aortic aneurysm repair. Methods. Consecutive patients who needed proximal repair of a primary failed endograft due to migration (with or without type IA endoleaks) were treated with endoanchors, with or without additional extender cuffs. Data of this group were prospectively gathered in vascular referral centers that were early adopters of the endoanchor technique. Preprocedural and periprocedural data were prospectively gathered and retrospectively analyzed. Follow-up after endoanchor placement consisted of regular hospital visits, with computed tomography or duplex scanning at 1, 6, and 12 months. Results. From July 2010 to May 2011, 11 patients (8 men), mean age 77 years (range, 59-88 years), were treated with endoanchors for a failed primary endograft (2 Excluder endografts, 1 AneuRx endograft, and 8 Talent endografts) due to distal migration of the main body, with or without type IA endoleak. Revision consisted of using endoanchors to secure the body of the primary endograft to the aortic wall to avoid persistent migration. Most patients had additional proximal extender cuffs with suprarenal fixation, which were secured with endoanchors to the aortic wall and in some patients also to the primary endograft. A median of 6 endoanchors were implanted. All endoanchors were positioned correctly but one. One endoanchor dislodged but was successfully retrieved using an endovascular snare. During a mean follow-up of 10 months (range, 3-18 months) no endoanchor-related complications or renewed migration of the endografts occurred. Two patients underwent repeat intervention due to persistent type IA endoleak during follow-up. Conclusion. The use of endoanchors to secure migrated endografts to the aortic wall is safe and feasible and might help to overcome persistent migration of primary failed endografts. In combination with the use of sole extender cuffs the majority of proximal EVAR failures can be solved.
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| 16. |
- Bachoo, P., et al.
(author)
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Early outcome of endovascular aneurysm repair in challenging aortic neck morphology based on experience from the GREAT C3 registry
- 2013
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In: Journal of Cardiovascular Surgery. - 0021-9509 .- 1827-191X. ; 54:5, s. 573-580
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Journal article (peer-reviewed)abstract
- Aim. The aim of this paper was to evaluate early outcome of the GORE (R) EXCLUDER (R) AAA Endoprosthesis featuring C3 Delivery System in subjects with aortic neck anatomy outside IFU. Methods. Individual patient data prospectively collected over a 2 year period from the Global Registry for Endovascular Aortic Treatment (GREAT). For each subject a minimum data set was collected containing demographic, pre/intra- and postoperative variables. Main outcome measures were successful exclusion of the AAA and occurrence of any major endoleak at 1 month. In this study, outside IFU was defined as aortic neck length less than 15 mm and/or aortic neck angle greater than 60 degrees. Results. A total of 400 subjects, (86.6% male, mean age 73.9 years). Primary pathology was AAA in 94.2% with 98.2% undergoing EVAR as a primary procedure. Sixty-eight subjects underwent EVAR outside IFU (neck length <15 nun N.=32, neck angle >60 degrees N.=47 and neck length <15 nun and angle >60 degrees N.=11). The graft was successfully deployed within 5 nun of its intended location in 63 (94%) cases utilising a total of 33 repositioning episodes. Eight aortic cuffs were used, 5 to treat a type 1 endoleak. At 30 days we recorded 2 type 2 endoleaks both successfully treated and 1 type 1b also successfully treated. There were 2 deaths, one in each group. Conclusion. GORE (R) EXCLUDER (R) AAA Endoprosthesis featuring C3 Delivery System allows re-positioning to be performed safely in cases outside IFU. Repositioning is an effective operative manoeuvre and facilitates EVAR in challenging anatomy. Longer follow-up is required to evaluate the durability of these results at 30 days.
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| 17. |
- Berger, P., et al.
(author)
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Validation of the Simulator for Testing and Rating Endovascular SkillS (STRESS)-machine in a setting of competence testing
- 2010
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In: Journal of Cardiovascular Surgery. - 0021-9509 .- 1827-191X. ; 51:2, s. 253-256
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Journal article (peer-reviewed)abstract
- AIM: Endovascular skills are an integral part of modern-day vascular surgery. The STRESS machine has been developed to test these skills in vascular surgeons. This study aims to define an optimal pass/fail cutoff value for the STRESS test score. METHODS: The STRESS machine consists of a dry glass model of the abdominal aorta and its tributaries with various stenotic lesions, elongations, and tortuosities. A camera and computer software are used to simulate plain fluoroscopy-mode. The test subjects are given two assignments after which two reviewers use a combination of the ICEPS and MRS to produce the final total score; 43 subjects were tested. According to previous endovascular experience, subjects were classified into four groups: novice-low (no experience, less than 11 performed procedures, less than 50 assisted procedures), novice-high (11-25 performed procedures, more than 50 assisted procedures), intermediate (1-10 performed and >11-25 assisted procedures, 11-25 performed and >1-10 assisted procedures or 25-50 performed procedures) and advanced (more than 50 performed procedures). RESULTS: Test-score and noted experience showed a correlation of 0.794. All intermediate and advanced test subjects scored more than 50 points compared to 4 out of 15 novices. CONCLUSION: We demonstrated that it is possible to determine an optimal cut-off value for competence testing with the STRESS machine.
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| 18. |
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| 19. |
- Bergqvist, David, et al.
(author)
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Invasive treatment for renovascular disease. A twenty year experience from a population based registry
- 2008
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In: Journal of Cardiovascular Surgery. - 0021-9509 .- 1827-191X. ; 49:5, s. 559-563
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Journal article (peer-reviewed)abstract
- AIM: To analyze time trends in invasive treatment of renovascular disease in one country. METHODS: Data have been analyzed from registrations in the Swedish Vascular Registry. RESULTS: Invasive treatment for renovascular disease contributes around 1% of all vascular surgery within the Swedish Vascular Registry. Over the twenty-year period 1987-2006 the population-based frequency of invasive treatment for renovascular disease has increased; 1 597 procedures have been registered with an increase over time. The age of the treated patients has increased over the period (P<0.001). There has been a shift from open to endovascular procedure and from isolated percutaneous transluminal renal angioplasty (PTRA) to PTRA combined with a stent. Complications and mortality are significantly higher in patients undergoing open reconstruction (P<0.01). One year follow-up is incomplete and long-term results are therefore not possible to evaluate through registry-data only. CONCLUSION: Using nation-wide registry data it is possible to analyze time-trends also concerning rare diseases or interventions. The changing pattern toward endovascular treatment of renovascular disease is obvious. Follow-up data at one year are incomplete.
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| 20. |
- Bodelsson, Mikael, et al.
(author)
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Differential effect of hypothermia on the vascular tone and reactivity of the human coronary artery and graft vessels
- 1991
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In: Journal of Cardiovascular Surgery. - 0021-9509. ; 32:3, s. 288-294
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Journal article (peer-reviewed)abstract
- Hypothermia may contribute to vascular spasm during bypass surgery. The effect of cooling on the reactivity of the human coronary artery (CA), saphenous vein (SV) and internal mammary artery (IMA) was studied in vitro. In CA and IMA cooling diminished the resting tension and the contraction to potassium, noradrenaline and 5-hydroxytryptamine. In contrast, in SV the contraction to noradrenaline and 5-hydroxytryptamine was augmented by cooling. The effect of cold was reversible. These results demonstrate different effects of hypothermia in CA and the graft vessels. Thus, hypothermia augments the receptor-mediated contraction in SV but depresses it in IMA which thereby resembles CA. The difference is most marked in the contractile response to 5-hydroxytryptamine, which may accumulate during surgery. This may contribute to spasm in the saphenous vein grafts and may be involved in the mechanisms responsible for the inferior patency of SV compared to IMA as a graft vessel.
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| 21. |
- Breuer, Silke, et al.
(author)
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Introduction of embryonic stem cells into vein grafts reduces intimal hyperplasia in mice.
- 2014
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In: The Journal of cardiovascular surgery. - 0021-9509. ; 55:2, s. 235-46
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Journal article (peer-reviewed)abstract
- Aim: Atherosclerosis with its cardiovascular events including cardiac and peripheral ischemia represents the main cause of death in the developed countries. Although interventional treatments like percutaneous transluminal angioplasty (PTA) or stents are increasingly applied for the treatment of peripheral arterial disease, they are not always technically applicable or durable and bypass surgery is needed. Compared to synthetic grafts, vein grafts show a better patency especially when used for the lower leg as well as a lower risk for infection compared to synthetic grafts. Still the long-term patency rates are unsatisfactory due to accelerated intimal hyperplasia, a thickening of the vessel wall. The aim of this study was to elucidate, if the implantation of embryonic stem cells into vein grafts can reduce the development of intimal hyperplasia in a mouse in vivo model. Methods: In this study we implanted LacZ-tagged (ROSA26) murine embryonic stem cells into decellularized vein grafts. Control groups were: 1) untreated veins; 2) decellularized veins; 3) decellularized veins with gel and plastic film; and 4) decellularized veins with smooth muscle cells in gel surrounded by plastic film. Six weeks after insertion into the carotid artery of mice, the grafts were excised and analyzed immunohistochemically, morphologically, and by x-gal staining and compared to the control groups. The Mann-Whitney-U test was used to compare groups. Statistical significance was indicated by a value of P<0.05. Results: Decellularized veins with implanted stem cells showed significantly less intimal thickening compared to all control groups (intimal hyperplasia vs. luminal circumference mean±SD 7.3±3.5 µm, median 8 µm). The control groups: 1) untreated veins (60.3±25.5 µm, median 58.5 µm); 2) decellularized veins (53.9±22.4 µm, median 48.4 µm); 3) decellularized veins with gel and plastic film (70.6±22.4 µm, median 72.6 µm); and 4) decellularized veins with smooth muscle cells in gel surrounded by plastic film (73.5±18.1 µm, median 73.6 µm) all showed the same high degree of intimal hyperplasia. Conclusion: This study demonstrates that embryonic stem cells have a therapeutic competence to favourably modulate intimal hyperplasia in vivo.
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| 22. |
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| 23. |
- Dias, Nuno, et al.
(author)
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Revascularization options for left subclavian salvage during TEVAR.
- 2014
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In: Journal of Cardiovascular Surgery. - 0021-9509. ; 55:4, s. 497-503
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Journal article (peer-reviewed)abstract
- This article reviews the solutions for the revascularization of the left subclavian artery during thoracic endovascular aortic repair (TEVAR). Open surgical revascularization has been the predominant technique used but recent developments may lead to an increasing role of the endovascular revascularization. The different open and endovascular technical options are discussed and the results summarized.
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| 24. |
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| 25. |
- Hellberg, Anders, et al.
(author)
-
Influence of low proximal aortic pressure on spinal cord oxygenation in experimental thoracic aortic occlusion
- 2001
-
In: Journal of Cardiovascular Surgery. - 0021-9509 .- 1827-191X. ; 42:2, s. 227-231
-
Journal article (peer-reviewed)abstract
- BACKGROUND: To evaluate the effect of low proximal aortic pressure on cerebrospinal fluid (CSF) oxygenation in an experimental thoracic occlusion model. METHODS: In nine pigs, continuous intrathecal pO(2), pCO(2) and pH monitoring was used during double descending thoracic aortic clamping following insertion of an aorto-aortic shunt. In five pigs, the shunt was connected to a citrated bag adjusted at approximately 40-45 cm above the heart for partial exsanguination in order to decrease mean proximal aortic pressure (MPAP) to below 50 mmHg. In four animals, sodium nitroprusside infusion was used for this purpose. RESULTS: Intrathecal pO(2) demonstrated a significant decrease from 4.9+/-2.1 to 2.9+/-2.4 kPa after 10 minutes of aortic cross-clamping. Lowering proximal aortic pressure caused a further significant decrease to 1.2+/-1.7 kPa (p<0.05). In seven pigs (5 in the exsanguination and 2 in the vasodilator group), restoration of mean proximal aortic pressure to 94.0+/-27.7 caused a recovery of CSF pO(2) from 1.2+/-1.9 to 2.8+/-3.0 (p<0.05). CONCLUSIONS: The results of this study demonstrate that MPAP which provides spinal cord perfusion through subclavian-vertebral arteries are crucial for maintenance of spinal cord oxygenation during thoracic aortic occlusion in this pig model.
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| 26. |
- Herlitz, Johan, et al.
(author)
-
Physical activity, symptoms of chest pain and dyspnea in patients with ischemic heart disease in relation to age before and two years after coronary artery bypass grafting
- 2001
-
In: Journal of Cardiovascular Surgery. - : Edizioni Minerva Medica. - 0021-9509 .- 1827-191X. ; 42:2, s. 165-173
-
Journal article (peer-reviewed)abstract
- BACKGROUND: To describe limitation of physical activity, cause of limitation of physical activity and symptoms of dyspnea and chest pain in relation to age before and 2 years after coronary artery bypass grafting (CABG). METHODS: All patients from Western Sweden who underwent CABG without concomitant procedures during 3 years in 1989-1991 answered questionnaires before, and 2 years after the operation. Patients were divided into 3 age groups of equal size i.e. 32-59 years, 60-67 years and > or = 68 years. RESULTS: In total, 2121 patients participated in the evaluation. The overall 2 year mortality in the 3 age groups was 3.8%, 6.8% and 12.2% (p<0.001). Limitation of physical activity was significantly associated with age prior to surgery but not thereafter. Improvement in physical activity, following CABG, was significant in all age groups. The proportion of patients being free of dyspnea increased markedly regardless of age. The number of chest pain attacks was associated with age after CABG, i.e. fewer attacks in the elderly, but such an association was not found prior to surgery. Improvement in number of chest pain attacks was more marked in the elderly. CONCLUSIONS: Physical activity improved similarly in all age groups after CABG. Attacks of chest pain, although significantly reduced in all age groups, seemed more effectively reduced in the elderly.
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| 27. |
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| 28. |
- Hongku, Kiattisak, et al.
(author)
-
Techniques for aortic arch endovascular repair.
- 2016
-
In: Journal of Cardiovascular Surgery. - 0021-9509. ; 57:3, s. 421-436
-
Research review (peer-reviewed)abstract
- This article reviews endovascular strategies for aortic arch repair. Open repair remains the gold standard particularly for good risk patients. Endovascular treatment potentially offers a less invasive repair. Principles, technical considerations, devices and outcomes of each technique are discussed and summarized. Hybrid repair combines less invasive revascularization options, instead of arch replacement while extending stent graft into the arch. Outcomes vary with regard to extent of repair and aortic arch pathologies treated. Results of arch chimney and other parallel graft techniques perhaps make it a less preferable choice for elective cases. However, they are very appealing options for urgent or bailout situations. Fenestrated stent grafting is subjected to many technical challenges in aortic arch due to difficulties in stent graft orientation and fenestration positioning. In situ fenestration techniques emerge to avoid these problems, but durability of stent grafts after fenestration and ischemic consequences of temporary carotid arteries coverage raises some concern total arch repair using this technique. Arch branched graft is a new technology. Early outcomes did not meet the expectation; however the results have been improving after its learning curve period. Refining stent graft technologies and implantation techniques positively impact outcomes of endovascular approaches.
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| 29. |
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| 30. |
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| 31. |
- Larzon, Thomas, 1950-, et al.
(author)
-
One hundred percent of ruptured aortic abdominal aneurysms can be treated endovascularly if adjunct techniques are used such as chimneys, periscopes and embolization
- 2014
-
In: Journal of Cardiovascular Surgery. - : Edizioni Minerva Medica. - 0021-9509 .- 1827-191X. ; 55:2, s. 169-178
-
Journal article (peer-reviewed)abstract
- Observational studies comparing endovascular aneurysm repair (EVAR) with open repair (OR) in ruptured abdominal aortic aneurysms (AAA) have suggested a benefit for EVAR but have been questioned recently by randomized controlled trials (RCT). A low eligibility for endovascular repair is a main limitation of these RCTs. In contrast, data from 473 patients from 1998 to 2011 in the Orebro/Zurich series show that nearly all AAA patients presenting with rupture can in fact be treated with EVAR with a low 30-day mortality rate (24%) and a minimal exclusion rate (4%). By using different adjunct techniques, such as chimneys and periscopes, also juxtarenal aneurysms can be treated even if simultaneous aortic balloon occlusion is necessary. Onyx (TM) embolization of the internal iliac artery in patients with aortoiliac aneurysms prevents back flow, thus avoiding an endoleak type. From May 2009 until December 2013, 70 patients arrived at Orebro University Hospital with a ruptured AAA diagnose. Nine percent were considered unfit for any intervention (including OR) and were treated medically. All of the 64 patients that underwent surgery were treated with EVAR and 30-day mortality in this group was 17 of 64 patients (27%). The mortality for patients treated with adjunct techniques was not significantly increased compared with patients treated with standard EVAR. In conclusion, our data support that open repair of ruptured AAA can be replaced by EVAR with appropriate management of existing adjunct techniques.
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| 32. |
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| 33. |
- Larzon, Thomas, 1950-, et al.
(author)
-
Type II endoleak : a problem to be solved
- 2014
-
In: Journal of Cardiovascular Surgery. - : Edizioni Minerva Medica. - 0021-9509 .- 1827-191X. ; 55:1, s. 109-118
-
Journal article (peer-reviewed)abstract
- Type II endoleak is a common phenomenon after endovascular aortic aneurysm repair (EVAR). The majority of type II endoleaks are considered benign, since approximately one third of them resolve spontaneously and they have no influence on mortality and rupture rate after EVAR. Thus, type H endoleak without sac expansion is recommended to be observed conservatively. Treatment for type II endoleak with sac expansion is still controversial. It has been reported that a certain type II endoleak causes sac expansion and late aneurysm rupture. Type II endoleak is often treated with solid agents as coils and vascular plugs or with liquid agents as different glues and thrombin. Onyx (TM) is a relatively new liquid embolic agents and it seems promising due to its capability to be injected in controlled manner with good visualization. Perisac embolization is another novel technique and it deals with all patent arterial branches, yet it requires further long-term studies. There are several access routes in treatment for type II endoleak. Trans lumbar approach seems more successful and safe than transarterial approach, and transcaval approach reduces the risk for infection compared to translumbar embolization. However, success rate of intervention for type II endoleak is unsatisfactory and recurrence rate is high. Endovascular treatment for type II endoleak is dependent on its nature and sometimes it can be challenging. Therefore, treatment for type II endoleak, including preventive embolization should be considered carefully and development of embolization methods is essential.
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| 34. |
- Lonn, L, et al.
(author)
-
Is EVAR the treatment of choice for aortoenteric fistula?
- 2010
-
In: Journal of Cardiovascular Surgery. - 0021-9509. ; 51:3, s. 319-327
-
Journal article (peer-reviewed)abstract
- Aortoenteric fistula formation is a devastating condition regardless of whether it is primary or secondary (i.e. after previous aneurysm repair) in nature. Patients present with signs and symptoms of gastrointestinal bleeding with or without signs of systemic infection and are often in a very poor clinical condition. Conventional treatment consists of extensive open surgery (extra-anatomical bypass or aortic ligation), closure of fistula tract and complete removal of any prosthetic material. This treatment is associated with high morbidity and mortality and therefore more minimally invasive options with endovascular repair have been attempted. Endovascular repair is often successful in the short-term achieving favorable immediate outcome. In the presence of systemic infection, however, EVAR alone as an ultimate solution is often followed by repeat infection and bleeding. A staged combination of EVAR treatment for acute bleeding and aggressive infection treatment with systemic and local antibiotics, surgical abscess revision and fistula tract closure might be an option in fragile patients. For patients fit for open repair, EVAR can be used as a bridging procedure to definitive repair particularly in the setting of systemic infection.
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| 35. |
- Lonn, L., et al.
(author)
-
TEVAR and covering the celiac artery. Is it safe or not?
- 2010
-
In: Journal of Cardiovascular Surgery. - 0021-9509. ; 51:2, s. 177-182
-
Journal article (peer-reviewed)abstract
- Thoracic endovascular aortic repair (TEVAR) is the treatment of choice for descending thoracic aortic aneurysms (TAA). However, not all patients with TAA can be treated with the endovascular technique. Insufficient proximal and/or distal sealing zone is the most common reason for open surgery in these patients. If the distal sealing zone above the celiac axis is too short, several endovascular alternatives are possible; hybrid procedures with TEVAR and open by-pass to the celiac artery, custom made stent-grafts with scallop or fenestration for the celiac artery, or intentional coverage of the celiac artery. In the latter case, adequate collateral supply to the upper gastrointestinal tract is crucial. Collateral arteries joining the celiac and the superior mesenteric arteries are well characterized in patients with chronic celiac stenosis or occlusion. Are these collateral pathways sufficient also for sudden iatrogenic closure of the celiac artery? By performing a preoperative angiography of the superior mesenteric artery with temporary balloon occlusion of the celiac artery, collateral capacity between the two vessels can be tested in advance. Exact positioning of the distal end of a large thoracic stent-graft can be challenging and require special considerations and techniques. Most case series in the literature support the efficacy and the safety of intentional celiac covering. However, there are also reports of ischemic foregut complications that could be associated to the procedure. Taken together, in the large majority of patients, it appears that intentional celiac coverage can be done safely provided that sufficient collateral function have been demonstrated in advance.
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| 36. |
- Malina, Martin, et al.
(author)
-
Balloon control for ruptured AAAs: when and when not to use?
- 2014
-
In: Journal of Cardiovascular Surgery. - 0021-9509. ; 55:2, s. 161-167
-
Journal article (peer-reviewed)abstract
- Emergency endovascular aneurysm repair (eEVAR) for ruptured abdominal aortic aneurysm (rAAA) must be carried out instantly. This requires firm logistics that include the ability to cross-clamp the aorta without delay. The present article focuses on the technique of balloon control of the aorta in eEVAR with aspects on indications as well as the organization of this type of vascular service. Transfemoral insertion of the occlusion balloon under local anesthesia is advocated and described. The use of dual balloons shortens the time of visceral ischemia without necessitating repeat declamping until the aneurysm has been completely excluded. Staged declamping upon completion is necessary just as in open repair. A "balloon test" is suggested to better identify those high risk patients with a rAAA who may benefit from endovascular rAAA repair.
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| 37. |
- Malina, Martin, et al.
(author)
-
Chimney grafts in aortic occlusive disease.
- 2014
-
In: Journal of Cardiovascular Surgery. - 0021-9509. ; 55:2, s. 69-74
-
Journal article (peer-reviewed)abstract
- The aim of this article was to present juxtavisceral aortic occlusive disease with particular reference to a novel therapeutic approach, namely protected stenting by means of so called chimney grafts. The juxta renal aortic occlusion is the last aortoiliac occlusive lesion not to be stented routinely because of the risk for trash and/or need for overstenting of vital aortic side branches. The risk for trash also exists in open repair which makes it particularly challenging in this setting. The patients have advanced atherosclerosis and are poor risks for major surgery. A safe endovascular approach is therefore desirable. These lesions are either predominantly thrombotic or heavily calcified plaques. The thrombotic lesions can be stented under protection of the visceral branches by temporary occlusion balloons. The calcified lesions, on the other hand, require overstenting of the visceral vessels that then need to be preserved by chimney grafts. These endovascular procedures are complex and time consuming but they are associated with less surgical trauma and hence improved morbidity, mortality and recovery. The median term results of chimney grafts are encouraging, although more patients and longer follow-up are still needed.
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| 38. |
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| 39. |
- Malina, Martin, et al.
(author)
-
In Situ Fenestration - A novel option for endovascular aortic arch repair.
- 2015
-
In: Journal of Cardiovascular Surgery. - 0021-9509. ; 56:3, s. 355-362
-
Journal article (peer-reviewed)abstract
- Aortic arch repair, is a surgical challenge irrespective of which technique is applied. While open surgical repair is a major trauma and a technically difficult procedure that many elderly patients tolerate poorly, the branched and fenestrated stentgrafts remain complex to implant safely. Hybrid procedures combine some of the advantages of both open and endovascular techniques but also many disadvantages. The possibility of total arch replacement with a standard off--the--shelf thoracic stentgraft and preservation of precerebral vessels by in situ fenestration has recently been reported. Some technical issues remain but recent technical adjuncts seem to facilitate temporary cerebral shunting during implantation as well as piercing of the stentgraft fabric. The positioning of fenestrations is inherently accurate by this technique which may be associated with less material fatigue and improve durability. Preliminarily, this technology holds the promise of simpler implantation, less risk for stroke and improved durability of the devices.
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| 40. |
- Malina, Martin
(author)
-
Reinterventions after open and endovascular AAA repair.
- 2015
-
In: Journal of Cardiovascular Surgery. - 0021-9509. ; 56:2, s. 257-268
-
Journal article (peer-reviewed)abstract
- Reinterventions seem to occur more frequently after endovascular aneurysm repair than after open surgical repair and are encountered in about 20% versus 10% of the cases, respectively. However, reinterventions following endovascular repair are predominantly endoluminal and early reinterventions are more frequent after open repair. The indications for reintervention after EVAR have changed over time. The incidence and type of reintervention depends on the complexity of the primary procedure, irrespective of whether it was open or endovascular. The use of a device outside instructions for use is associated with a higher complication rate but it may nevertheless be fully justified. Advanced stent-grafts such as fenestrated and branched devices require secondary procedures more often than a standard stent-graft. Similarly, more complex open repair, e.g. a bifurcated bypass, reimplantation of visceral arteries or a redo procedure, is also associated with more reinterventions than a simple tube graft. This manuscript presents some of the most common complications of open and endovascular aortic aneurysm repair and the reinterventions they require. Many of the complications are similar with both open and endovascular techniques. Limb thrombosis, infections and endoleaks are the most frequent indications for reintervention.
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| 41. |
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| 42. |
- Ohrlander, T, et al.
(author)
-
Emergency intervention for thrombosed popliteal artery aneurysm: can the limb be salvaged?
- 2007
-
In: Journal of Cardiovascular Surgery. - 0021-9509. ; 48:3, s. 289-297
-
Journal article (peer-reviewed)abstract
- We present a review and our own experience of the demographic aspects of popliteal artery aneurysms (PAAs), their clinical presentation, the treatment alternatives and associated outcome. The incidence of PAAs varies between 0,1-1%. 95% of the patients are male. 50% are asymptomatic at the time of diagnosis. Annually, 5-24% of PAAs develop symptoms. The clinical presentation varies widely with an amputation rate of up to 78% in acute ischemic cases. The main indication for PAA repair is prevention of embolisation but acute revascularisation is the primary task in die emergency setting. Open surgery and endovascular techniques are described and can be combined with intraarterial thrombolysis as pre- or intraoperative treatment. The literature proves often inconclusive due to small numbers of heterogenous cases. Each case, therefore, needs to be assessed individually and offered the most suitable treatment.
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| 43. |
- Pedersen, G., et al.
(author)
-
Improved patency and reduced intimal hyperplasia in PTFE grafts with luminal immobilized heparin compared with standard PTFE grafts at six months in a sheep model
- 2010
-
In: Journal of Cardiovascular Surgery. - 0021-9509. ; 51:3, s. 443-448
-
Journal article (peer-reviewed)abstract
- AIM: The aim of this study was to compare the performance of polytetrafluoroethylene (PTFE) grafts with luminal coating of immobilized heparin to that of standard PTFE grafts at six months. METHODS: Twenty-eight common carotid arteries in fourteen sheep were bypassed with heparin-coated PTFE grafts (6 mm diameter, 6 cm length) on one side and standard PTFE grafts on the other. The grafts were explanted after six months. The thickness of intimal hyperplasia (IH) in open grafts was measured with histomorphometrical methods. RESULTS: Two of 14 heparinized PTFE grafts and nine of 14 grafts in the control PTFE-group were occluded at explantation (P=0.006). Six-month patency rates for heparinized PTFE grafts and for standard PTFE grafts were 86% and 36%, respectively. Mean graft anastomotic IH thickness in open grafts were 0.074 mm for heparinized PTFE grafts and 0.259 mm for PTFE-grafts (P=0.006). CONCLUSION: PTFE grafts with luminal coating containing immobilized heparin had significantly better patency and recruited less intimal hyperplasia than standard PTFE grafts at six months.
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| 44. |
- Perrotta, S., et al.
(author)
-
Body mass index and outcome after coronary artery bypass surgery
- 2007
-
In: J Cardiovasc Surg (Torino). - 0021-9509. ; 48:2, s. 239-45
-
Journal article (peer-reviewed)abstract
- AIM: Morbidity and mortality after surgical interventions are influenced by different preoperative factors. We investigated the impact of body mass index (BMI) on outcome after coronary artery bypass grafting (CABG). METHODS: A total of 4 749 CABG patients were divided into 4 groups: low BMI (or=35 kg/m(2), n=146). The incidence of severe perioperative complications (heart failure, renal failure or perioperative stroke), 30-day mortality, length of stay (LOS) and long-term survival were compared. A multivariate analysis with BMI, age, gender and Cleveland Clinic risk score as independent variables and 30-day mortality as dependent variable was performed. RESULTS: Compared to patients with normal BMI, low BMI patients had higher incidence of severe complications (12.5 vs 7.0%, P=0.039), higher 30-day mortality (6.2 vs 1.7 %, P=0.001) and inferior cumulative long-term survival (P=0.04). Patients with moderately increased BMI had longer LOS (10.8 vs 9.0 days, P=0.003) but no difference in incidence of severe complications or mortality. Patients with severely increased BMI had a higher incidence of severe complications (12.3 vs 7.0%, P=0.015, longer LOS (13.0 vs 9.0 days, P<0.001), but no significant difference in early or long-term mortality. Low but not high BMI was an independent predictor for 30-day mortality. CONCLUSIONS: The results suggest that low BMI is associated with increased morbidity and mortality after CABG. Overweight is associated with more postoperative complications and longer hospitalisation but not with an increased early or long-term mortality.
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| 45. |
- Resch, Timothy A., et al.
(author)
-
Remodeling of the thoracic aorta after stent grafting of type B dissection : a Swedish multicenter study
- 2006
-
In: Journal of Cardiovascular Surgery. - 0021-9509 .- 1827-191X. ; 47:5, s. 503-508
-
Journal article (peer-reviewed)abstract
- AIM: Endovascular repair of complicated type B dissections has evolved as a promising alternative to open repair. Previous studies have indicated that continued false lumen flow is a predictor of continued aortic dilatation and risk of rupture during follow-up. This multicenter study was conducted to analyze the postoperative changes of the false lumen after endografting of complicated type B dissections. METHODS: All patients treated with endovascular stent grafts for thoracic type B dissections at 5 major Vascular Centers in Sweden were identified through local databases. Review of charts and all available pre- and postoperative CT scans were performed to identify demographics, indications for repair as well as postoperative changes of the aorta and false lumen. RESULTS: A total of 129 patients treated for type B dissections between 1994 and December 2005 were identified. Median radiological follow-up was 14 months. Fourteen patients died perioperatively leaving 115 patients available for analysis. Seventy-four of these had CT imaging of sufficient quality for morphological analysis. The vast majority of acute patients were treated for rupture or end-organ ischemia whereas most chronic patients were treated for asymptomatic aneurysms. In 80% of patients, the false lumen thrombosed along the stent graft but it remained perfused distal to the stent graft fixation in 50% of patients. Only 5% of patients presented with aortic enlargement of the stent grafted area when adequate proximal sealing was achieved. The distal, uncovered aorta displayed expansion in 16% of patients. CONCLUSIONS: The stent grafted thoracic aorta after type B dissection appears to be stabilized by covering the primary entry site with a stent graft in the majority of both acute and chronic dissections. The uncovered portion of the aorta distal to the stent graft, however, remains at risk of continuous dilatation. Stent grafting for complicated type B thoracic dissections seems to be a treatment option with reasonable morbidity and mortality even though the incidence of severe complications is still significant.
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| 46. |
- Resch, Tim, et al.
(author)
-
Incidence and management of complications after branched and fenestrated endografting.
- 2010
-
In: Journal of Cardiovascular Surgery. - 0021-9509. ; 51:1, s. 105-113
-
Journal article (peer-reviewed)abstract
- Endovascular treatment of complex aortic aneurysms with fenestrated and branched stentgrafts is in rapid development. Early and midterm results from centers of excellence are very promising but the technique is still in its infancy. With the introduction of EVAR for complex aneurysms a new set of failure modes have also been introduced. These relate both to the specific deployment techniques of the devices and to their intrinsic design characteristics. Procedural planning is of utmost importance for success. Failure to accomplish this may result in disastrous and uncorrectable perioperative failure. The endograft must be correctly tailored to the patient with regards to branch and fenestration positioning and design. Migration of stent-graft components, target vessel occlusions due to branch compression or dislocation and fenestration malpositioning must be recognized during follow up and treated accordingly. The clinical consequences of complex aneurysm repair include spinal cord ischemia and peripheral embolisation and strategies to handle this must be present.
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| 47. |
- Resch, Tim
(author)
-
Latest developments in TEVAR.
- 2014
-
In: Journal of Cardiovascular Surgery. - 0021-9509. ; 55:4, s. 489-490
-
Journal article (peer-reviewed)
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| 48. |
- Resch, Tim
(author)
-
Pararenal aneurysms: currently available fenestrated endografts.
- 2013
-
In: Journal of Cardiovascular Surgery. - 0021-9509. ; 54:1, s. 27-33
-
Journal article (peer-reviewed)abstract
- Endovascular aneurysm repair (EVAR) is a valid treatment option for abdominal aortic aneurysm (AAA). The outcome of infrarenal EVAR is dependent on choosing patients with appropriate anatomy to allow for good proximal and distal seal. In the absence of an infrarenal neck of adequate length and quality, fenestrated stent-graft repair has emerged as an alternative treatment option. For the past decade there has only been one type of fenestrated endograft on the market. This has shown good short- and midterm outcome in many centers. This graft is custom designed for each individual patient. Over the past few years further development has led to the introduction of new, off-the-shelf stent-graft for fenestrated repair and some new companies have entered the marketplace. Most of these new devices are still in their infancy and currently undergoing clinical trials but add promise to the development of pararenal aortic repair.
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| 49. |
- Resch, Tim, et al.
(author)
-
Techniques to reduce radiation for patients and operators during aortic endografting.
- 2016
-
In: Journal of Cardiovascular Surgery. - 0021-9509. ; 57:2, s. 178-184
-
Journal article (peer-reviewed)abstract
- Endovascular aortic repair of aortic pathologies has become widely spread among vascular surgeons. Much focus has been directed at perfecting and developing endovascular procedures to treat evermore-complex issues. Much less focus has been directed at the radiation hazards to patients as well as operators and staff when such procedures are performed. Radiation exposure must be used according to the ALARA (As low As Reasonably Achievable) principle to avoid short- and long-term negative side effects. Modern imaging technology offers many technological developments to reduce radiation such as low dose programs, pulsed imaging, flat-panel technology and advanced intraoperative imaging techniques. But beside this, simple measures, based on the understanding of radiation exposure, can easily be implemented in everyday standard practice. Appropriate shielding of patients and staff, using adjuncts to be able to keep a safe distance to the radiation source and avoiding to work with inappropriate C- arm angulations should be used routinely. Continued education of vascular surgeons is imperative to implement changes in practice to reduce radiation exposure.
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| 50. |
- Resch, Tim, et al.
(author)
-
Treatment of endoleaks: techniques and outcome.
- 2012
-
In: Journal of Cardiovascular Surgery. - 0021-9509. ; 53:1, s. 91-99
-
Journal article (peer-reviewed)abstract
- Endoleaks are one of the most common reasons for reinterventions and failure after endovascular aneurysm repair (EVAR). Current classifications divide endoleaks into type I-V but a more pragmatic definition is of direct and indirect endoleaks. Direct endoleaks (type I and III) transmit direct systemic pressure to the aneurysm sac and carry a high risk of aneurysm growth and rupture if left untreated. Immediate intervention is generally warranted. Indirect endoleaks (type II, IV, V) may have a more benign course and should be treated only under the presence of aneurysm growth. Appropriate procedural planning and device selection is critical to avoid endoleaks and most direct endoleaks can be identified and treated periprocedurally by use of high quality intraoperative imaging techniques. Late endoleaks can be treated predominately by endovascular means and the need for conversion to open surgery is rare.
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