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Titolo:
PRELIMINARY CLINICAL OUTCOME AND IMAGING CRITERION FOR ENDOVASCULAR PROSTHESIS DEVELOPMENT IN HIGH-RISK PATIENTS WHO HAVE AORTOILIAC AND TRAUMATIC ARTERIAL LESIONS
Autore:
WHITE RA; DONAYRE CE; WALOT I; KOPCHOK GE; WILSON EP; BUWALDA R; DEVIRGILIO C; AYRES B; ZALEWSKI M; MEHRINGER CM;
Indirizzi:
HARBOR UCLA MED CTR,DEPT SURG,1000 W CARSON ST TORRANCE CA 90509 HARBOR UCLA MED CTR,DEPT RADIOL TORRANCE CA 90509 VET ADM WADSWORTH MED CTR,DEPT SURG LOS ANGELES CA 00000
Titolo Testata:
Journal of vascular surgery
fascicolo: 4, volume: 24, anno: 1996,
pagine: 556 - 569
SICI:
0741-5214(1996)24:4<556:PCOAIC>2.0.ZU;2-8
Fonte:
ISI
Lingua:
ENG
Soggetto:
ABDOMINAL AORTIC-ANEURYSMS; GRAFTS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
9
Recensione:
Indirizzi per estratti:
Citazione:
R.A. White et al., "PRELIMINARY CLINICAL OUTCOME AND IMAGING CRITERION FOR ENDOVASCULAR PROSTHESIS DEVELOPMENT IN HIGH-RISK PATIENTS WHO HAVE AORTOILIAC AND TRAUMATIC ARTERIAL LESIONS", Journal of vascular surgery, 24(4), 1996, pp. 556-569

Abstract

Purpose: This report reviews our preliminary experience of prospective treatment of arterial lesions with endoluminal grafts in a Food and Drug Administration (FDA)-approved, investigator-sponsored Investigation Device Exemptions study. The utility and accuracy of various imaging methods, including angiography, cinefluoroscopy computed tomography (CT), intravascular ultrasonography (IVUS), and duplex scanning, in performing the procedures was also assessed. Methods: Thirty-one patients were evaluated; 17 patients were treated, including 11 with abdominal aortic aneurysms, one with an aortic occlusive lesion, two with iliac artery aneurysms, and three with traumatic arteriovenous fistulas. Twelve of the 14 patients who had aorta and iliac artery lesions were high-risk. The mean follow-up of patients treated was 9 months (range, 6 to 15 months). Results. Aortoaortic endoluminal interposition procedures were not successful for treating abdominal aortic aneurysms earlyin the study (n = 3). Aortoiliac endoluminal bypass, contralateral iliac artery occlusion, and femorofemoral bypass procedures were successful in seven of eight subsequent cases (88%), with no incidence of endoleaks at either the proximal or distal fixation sites using the deployment methods described in this report. The 30-day operative mortalityrate on follow-up evaluations for patients who underwent aortoiliac procedures was 14% (two of 14). Other major complications included transient renal failure in three patients that required short-term (two toeight times) dialysis, one arterial perforation and one dissection, and one prolonged intubation. No myocardial. infarctions or strokes occurred. After major complications or identification of limitations in the study, the protocol was modified with the approval of the FDA to help avoid tile recurrence of the same problems. There were no deaths orcomplications in the trauma cases. Conclusions: Contrast-enhanced CT (axial images and spiral reconstructions) was the most-accurate methodto determine candidacy for aortoiliac procedures and to choose the site for deployment of the devices. Angiographic scans were misleading in several patients regarding the critical determinants of patient candidacy and device deployment, particularly regarding the presence of a distal aortic neck. Cinefluoroscopy wets used in all patients and was particularly useful for determining the continuity of vascular structures and the anatomy of branch arteries and for enabling precise positioning of stent devices. Determination of fixation sites and assessing dimensional information by cinefluoroscopy and angiography were limited by inaccuracies produced by image magnification, parallax, and uniplanar views. IVUS was used to determine the morphologic features of vascular structures (i.e., calcium, thrombus), to perform real-time observation of the expansion of devices, and to assure firm fixation of balloon-expanded stents before the procedures were completed, Duplex scanning was very helpful in assessing and identifying precisely the location of arteriovenous fistulas before intervention and provided assessment at follow-up intervals. Three-dimensional reconstruction imaging technologies such as spiral CT were particularly helpful for assessing the morphologic features of vascular anatomy before the intervention and at follow-up intervals, whereas 3-D IVUS provided a similar real-time perspective during the procedure.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 19/09/20 alle ore 08:13:56