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Interactive Cardiovascular and Thoracic... Jul 2017Our goal was to evaluate the use of an AFX main body combined with an Endurant proximal aortic cuff to treat selected patients with an abdominal aortic aneurysm (AAA)...
Our goal was to evaluate the use of an AFX main body combined with an Endurant proximal aortic cuff to treat selected patients with an abdominal aortic aneurysm (AAA) associated with anatomical challenges, such as a small distal aortic diameter and a hostile aortic neck. A retrospective analysis of prospectively collected data from 2 vascular institutions identified 14 elective patients with an AAA (all men, 73.5 ± 5.1 years) treated with the AFX main body combined with an Endurant proximal aortic cuff. Patients had a small distal aortic diameter (median 19 mm) and a short or angulated proximal aortic neck (median length 20 mm, range 9-26 mm, median angulation 41.5°, range 23-80°). Six patients (42.9%) had an aortic neck that did not meet the indications for use of the AFX proximal aortic cuff. Primary technical success was achieved in all patients with no 30-day device-related complications or deaths. During a median follow-up period of 13 months (range 6-28 months), no re-intervention was needed. The diameter of the aneurysmal sac decreased from 57.6 ± 5.6 mm preoperatively to 50.4 ± 4.9 mm (P < 0.001) postoperatively. There were no aneurysm-related deaths or ruptures. No migration, disconnection or type I or III endoleak was observed. In 5 of the 6 patients, the initial type II endoleak spontaneously resolved during follow-up, whereas that in the remaining patient persisted without any change in the diameter of the aneurysmal sac. In patients with complex AAA anatomical configurations combining a hostile aortic neck and a narrow aortic bifurcation, the use of an AFX main body combined with an Endurant proximal aortic cuff seems to be feasible with favourable mid-term results.
Topics: Aged; Aortic Aneurysm, Abdominal; Aortography; Blood Vessel Prosthesis; Endovascular Procedures; Female; Follow-Up Studies; Humans; Male; Prosthesis Design; Retrospective Studies; Stents; Suture Techniques; Time Factors; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 28431107
DOI: 10.1093/icvts/ivx087 -
Journal of Vascular Surgery Apr 2017Finite element analysis (FEA) has been suggested to be superior to maximal diameter measurements in predicting rupture of abdominal aortic aneurysms (AAAs). Our...
OBJECTIVE
Finite element analysis (FEA) has been suggested to be superior to maximal diameter measurements in predicting rupture of abdominal aortic aneurysms (AAAs). Our objective was to investigate to what extent previously described rupture risk factors were associated with FEA-estimated rupture risk.
METHODS
One hundred forty-six patients with an asymptomatic AAA of a 40- to 60-mm diameter were retrospectively identified and consecutively included. The patients' computed tomography angiograms were analyzed by FEA without (neutral) and with (specific) input of patient-specific mean arterial pressure (MAP), gender, family history, and age. The maximal wall stress/wall strength ratio was described as a rupture risk equivalent diameter (RRED), which translated this ratio into an average aneurysm diameter of corresponding rupture risk.
RESULTS
In multivariate linear regression, RRED increased with female gender (3.7 mm; 95% confidence interval [CI], 0.13-7.3) and correlated with patient height (0.27 mm/cm; 95% CI, 0.11-0.43) and body surface area (BSA, 16 mm/m; 95% CI, 8.3-24) and inversely with body mass index (BMI, -0.40 mm/kg m; 95% CI, -0.75 to -0.054) in a wall stress-dependent manner. Wall stress-adjusted RRED was raised if the patient was currently smoking (1.1 mm; 95% CI, 0.21-1.9). Age, MAP, family history, and patient weight were unrelated to RRED. In specific FEA, RRED increased with female gender, MAP, family history positive for AAA, height, and BSA, whereas it was inversely related to BMI. All results were independent of aneurysm diameter. Peak wall stress and RRED correlated with aneurysm diameter and lumen volume.
CONCLUSIONS
Female gender, current smoking, increased patient height and BSA, and low BMI were found to increase the mechanical rupture risk of AAAs. Previously described rupture risk factors may in part be explained by patient characteristic-dependent variations in aneurysm biomechanics.
Topics: Aged; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Aortic Rupture; Aortography; Asymptomatic Diseases; Biomechanical Phenomena; Body Mass Index; Body Surface Area; Chi-Square Distribution; Computed Tomography Angiography; Female; Finite Element Analysis; Hemodynamics; Humans; Linear Models; Male; Models, Cardiovascular; Multivariate Analysis; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Sex Factors; Smoking; Stress, Mechanical
PubMed: 28342508
DOI: 10.1016/j.jvs.2016.10.074 -
Cirugia Espanola Oct 2016
Review
Topics: Adult; Humans; Male; Para-Aortic Bodies; Paraganglioma
PubMed: 27166450
DOI: 10.1016/j.ciresp.2016.04.002 -
Cardiovascular Pathology : the Official... May 2024Morphometric information of the structures within the borders of the aortic root is a guide for surgical interventions. It is essential to determine the effects of...
OBJECTIVES
Morphometric information of the structures within the borders of the aortic root is a guide for surgical interventions. It is essential to determine the effects of aortic calcification and atheroma plaque findings on the structures of this region. This study aims to establish the normal values of aortic root structures and to investigate the impact of pathologic findings in order to guide diagnosis and treatment in the clinic.
METHODS
The aortic root structures were morphometrically analyzed in fresh hearts of 110 patients (89 males, 21 females) brought to the forensic medicine institution. The distances between the bases of the aortic sinuses, their widths and heights, and the lengths of the commissures were measured to differentiate between pathologic and non-pathologic aortic classes. Parameters were compared according to gender, age, body mass index, and body surface area.
RESULTS
The mean age was 44.71 ± 15.57 years in 21 female patients and 53.66 ± 15.67 years in 89 male patients. The results of the pathologic aorta group with calcification and atheroma plaque findings were higher than the non-pathologic aorta group in all parameters (P < .05).
CONCLUSIONS
Calcification and the presence of atheroma plaque in the aorta increase the size of the structures at the aortic root. Gender, age, body mass index, and body surface area are among the criteria that will cause changes in the structures of this region. These results will help surgeons to know the normal values of aortic root structures and to consider the effects of pathologic findings in aortic valve repair operations.
PubMed: 38777138
DOI: 10.1016/j.carpath.2024.107655 -
Emergency Radiology Apr 2021Fluoroscopy-guided esophageal disimpaction of ingested food is a safe, effective, and cost-efficient alternative to endoscopically guided disimpaction. Patients with... (Review)
Review
Fluoroscopy-guided esophageal disimpaction of ingested food is a safe, effective, and cost-efficient alternative to endoscopically guided disimpaction. Patients with suspected esophageal impaction usually require fluoroscopy to confirm the diagnosis and determine the level of obstruction, which guides further management. Proximal esophageal food impactions at or near the cricopharyngeus muscle require an ENT intervention. Food impactions from the cervical esophagus to the aortic arch require a GI intervention. Obstructions distal to the aortic arch can usually be managed by the radiologist with a fluoroscopy-guided disimpaction. The use of intravenous glucagon to relax the mid and distal esophageal smooth muscle, combined with an effervescent agent, and water comprises this "combination" therapy to relieve an acute esophageal food impaction. This paper reviews the indications, contraindications, technique, and 32 years of experience with fluoroscopy-guided esophageal disimpaction at our institution. A retrospective chart review of our experience includes 252 patients with a 56% success rate that obviated more expensive and invasive procedures. Only one complication of a minor mucosal tear of no clinical consequence was encountered. Radiologists should be familiar with the presentation and management of this common diagnosis.
Topics: Combined Modality Therapy; Esophagus; Fluoroscopy; Food; Foreign Bodies; Humans; Radiography, Interventional
PubMed: 33108555
DOI: 10.1007/s10140-020-01855-5 -
Surgical Case Reports Sep 2022Aortopulmonary mediastinal paragangliomas are rare. Complete resection of the tumor is desirable regardless of tumor size in view of the risk of sudden death induced by...
BACKGROUND
Aortopulmonary mediastinal paragangliomas are rare. Complete resection of the tumor is desirable regardless of tumor size in view of the risk of sudden death induced by adjacent organ compression and poor prognosis after partial resection or untreated observation. Due to the hypervascularity of the tumor, the risk of intraoperative bleeding is significant, and cardiopulmonary bypass is often required for complete resection.
CASE PRESENTATION
The patient was diagnosed as having bilateral carotid body tumors and supposedly an aortic body tumor at the age of 43 and eventually underwent resections of bilateral carotid body tumors at the age of 52. The pathology of the carotid body tumors was compatible with paraganglioma on both sides. A familial succinate dehydrogenase subunit D mutation was subsequently identified. Five years later, a contrast-enhanced computed tomography scan showed an enlarged tumor of 45 mm in size in the aortopulmonary mediastinum. Based on the previously known genetic mutation, the tumor was thought to be a paraganglioma. After confirming with an endocrinologist that the aortic body tumor was non-functional, radiologists performed preoperative embolization of the feeding vessels. Subsequently, a surgical team consisting of thoracic and cardiovascular surgeons resected the aortic body tumor using a video-assisted small left thoracotomy approach combined with a median sternotomy approach. The procedure was completed without cardiopulmonary bypass or blood transfusion. The patient was discharged home on postoperative day 9 uneventfully.
CONCLUSIONS
After conduction of preceding interventional embolization of multiple feeding vessels, we employed a video-assisted thoracoscopic surgical approach to dissect the aspects of the tumor adjacent to the esophagus, descending thoracic aorta, and left pulmonary artery, followed by a median sternotomy approach to dissect the other aspects of the tumor adjacent to the ascending aorta, aortic arch, right pulmonary artery, and trachea. There have been no reports on scheduled preoperative embolization of feeding vessels to an aortopulmonary mediastinal paraganglioma. Multidisciplinary approach was effective for complete resection of this challenging rare mediastinal tumor.
PubMed: 36138281
DOI: 10.1186/s40792-022-01534-2 -
Journal of Cardiovascular Development... Feb 2021Nutritional status in early life stages has been associated with arterial parameters in childhood. However, it is still controversial whether changes in standardized...
UNLABELLED
Nutritional status in early life stages has been associated with arterial parameters in childhood. However, it is still controversial whether changes in standardized body weight (z-BW), height (z-BH), BW for height (z-BWH) and/or body mass index (z-BMI) in the first three years of life are independently associated with variations in arterial structure, stiffness and hemodynamics in early childhood. In addition, it is unknown if the strength of the associations vary depending on the growth period, nutritional characteristics and/or arterial parameters analyzed.
AIMS
First, to compare the strength of association between body size changes (Δz-BW, Δz-BH, Δz-BWH, Δz-BMI) in different time intervals (growth periods: 0-6, 0-12, 0-24, 0-36, 12-24, 12-36, 24-36 months (m)) and variations in arterial structure, stiffness and hemodynamics at age 6 years. Second, to determine whether the associations depend on exposure to cardiovascular risk factors, body size at birth and/or on body size at the time of the evaluation (cofactors). Anthropometric (at birth, 6, 12, 24, 36 m and at age 6 years), hemodynamic (peripheral and central (aortic)) and arterial (elastic (carotid) and muscular (femoral) arteries; both hemi-bodies) parameters were assessed in a child cohort (6 years; =632). The association between arterial parameters and body size changes (Δz-BW, Δz-BH, Δz-BWH, Δz-BMI) in the different growth periods was compared, before and after adjustment by cofactors.
RESULTS
Δz-BW 0-24 m and Δz-BWH 0-24 m allowed us to explain inter-individual variations in structural arterial properties at age 6 years, with independence of cofactors. When the third year of life was included in the analysis (0-36, 12-36, 24-36 m), Δz-BW explained hemodynamic (peripheral and central) variations at age 6 years. Δz-BH and Δz-BMI showed limited associations with arterial properties.
CONCLUSION
Δz-BW and Δz-BWH are the anthropometric variables with the greatest association with arterial structure and hemodynamics in early childhood, with independence of cofactors.
PubMed: 33671380
DOI: 10.3390/jcdd8020020 -
BMJ Case Reports Dec 2020Here, we report a case of a 70-year-old man referred for an incidentally discovered left renal lesion with peri-aortic lymphadenopathy following a CT scan for back pain....
Here, we report a case of a 70-year-old man referred for an incidentally discovered left renal lesion with peri-aortic lymphadenopathy following a CT scan for back pain. A follow-up MRI scan demonstrated a Bosniak IIF left renal cyst and a T2-hyperintense para-aortic lesion concerning for extra-adrenal paraganglioma (EAP). [I] Metaiodobenzylguanidine scintigraphy of the para-aortic lesion and urine catecholamines were equivocal. The mass was resected via a robotic approach. Histological examination revealed a haemangioma. Haemangiomas are benign vascular tumours frequently identified on imaging of the liver. Intra-abdominal haemangiomas outside of the liver, however, are rare and may have imaging characteristics that mimic EAP.
Topics: Abdomen; Aged; Hemangioma; Humans; Incidental Findings; Magnetic Resonance Imaging; Male; Para-Aortic Bodies; Paraganglioma, Extra-Adrenal; Radionuclide Imaging; Tomography, X-Ray Computed
PubMed: 33310823
DOI: 10.1136/bcr-2020-235431 -
Circulation. Cardiovascular Imaging Nov 2016Current guidelines define severe aortic stenosis in patients with aortic valve area normalized to body surface area (AVA/BSA) <0.6 cm/m; yet, this cutoff has never been... (Comparative Study)
Comparative Study
BACKGROUND
Current guidelines define severe aortic stenosis in patients with aortic valve area normalized to body surface area (AVA/BSA) <0.6 cm/m; yet, this cutoff has never been validated. Moreover, it is not known whether AVA normalization to other body size indexes allows improved outcome prediction. We aim to test the value of AVA normalized to body size for outcome prediction in asymptomatic aortic stenosis.
METHODS AND RESULTS
We included 289 patients with asymptomatic aortic stenosis, preserved ejection fraction, and AVA<1.3 cm at diagnosis. The outcome measure was the occurrence of aortic valve replacement or all-cause death or during follow-up. AVA was normalized to BSA, height, weight, and body mass index. For each normalized index, patients in the lowest tertile were at high risk of events whereas outcome was similar for the other tertiles. High risk of events was observed with AVA/BSA <0.4 cm/m (adjusted hazard ratio [HR], 3.42 [2.09-5.60]), AVA/height <0.45 cm/m (adjusted HR, 3.99 [2.42-6.60]), AVA/weight <0.01 cm/kg (adjusted HR, 3.37 [2.07-5.49]), and AVA/body mass index <0.029 cm/kg per meter square (adjusted HR, 3.23 [1.99-5.24]). Mortality risk was high with AVA/height <0.45 cm/m (adjusted HR, 2.18 [1.28-3.71]), followed by AVA/BSA <0.40 cm/m (adjusted HR, 1.84 [1.09-3.11]), AVA/weight <0.01 cm/kg (adjusted HR, 1.78 [1.07-2.98]), and AVA/body mass index <0.029 cm/kg per meter square (adjusted HR, 1.75 [1.04-2.93]). AVA/height showed better predictive performance than AVA/BSA with improved reclassification and better discrimination (net reclassification improvement: 0.33 versus 0.28; integrated discrimination improvement: 0.10 versus 0.08; C statistic: 0.67 versus 0.65), whereas AVA/weight and AVA/body mass index showed lower predictive capacity.
CONCLUSIONS
Among AVA normalization methods, AVA/height <0.45 cm/m followed by AVA/BSA <0.40 cm/m seem as robust parameters for defining high risk in asymptomatic aortic stenosis. The prognostic value of AVA/height deserves future research.
Topics: Aged; Aged, 80 and over; Aortic Valve; Aortic Valve Stenosis; Asymptomatic Diseases; Body Height; Body Mass Index; Body Surface Area; Body Weight; Disease-Free Survival; Echocardiography, Doppler; Female; France; Heart Valve Prosthesis Implantation; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Predictive Value of Tests; Proportional Hazards Models; Retrospective Studies; Risk Factors; Severity of Illness Index; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Function, Left
PubMed: 27903539
DOI: 10.1161/CIRCIMAGING.116.005121 -
Clinical Research in Cardiology :... Dec 2016Inverse associations between Body Mass Index (BMI) and Body Surface Area (BSA) with mortality in patients after Transcatheter Aortic Valve Implantation (TAVI) have been... (Observational Study)
Observational Study
BACKGROUND
Inverse associations between Body Mass Index (BMI) and Body Surface Area (BSA) with mortality in patients after Transcatheter Aortic Valve Implantation (TAVI) have been reported. This "obesity paradox" is controversial, and it remains unclear which parameter, BMI or BSA, is of greater prognostic value. The aim of this study was to investigate the association of BMI and BSA on short- and mid-term outcomes after TAVI.
METHODS AND RESULTS
This prospective, observational study consisted of 917 consecutive patients undergoing TAVI at our center from 2011 to 2014. The association between BMI/BSA and mortality (at 30 days and 1 year) was assessed using restricted cubic spline functions in propensity-adjusted (by Society of Thoracic Surgeons (STS) risk factors) logistic and Cox proportional models, respectively. The median age of the patients was 82.6 years, with a mean STS Predicted Risk of Mortality (STS-PROM) of 6.6 ± 4.3 %. Throughout the study period (mean follow-up time was 297 days), 150 (16.4 %) patients died; 72 (7.9 %) patients died within 30 days of TAVI. After risk adjustment, the association between body constitution and 30-day mortality was not significant for either measure (BMI p = 0.25; BSA p = 0.32). However, BMI (p = 0.01), but not BSA (p = 0.13), was significantly associated with 1-year survival. There was no association between stroke, vascular complications, or length of stay with BMI or BSA.
CONCLUSIONS
BMI was associated with survival at 1-year after TAVI. Despite the trend towards implementing BSA in risk score calculation, BMI may be more suitable for the assessment of TAVI patients.
Topics: Aged; Aged, 80 and over; Aortic Valve; Aortic Valve Stenosis; Body Mass Index; Body Surface Area; Cardiac Catheterization; Female; Heart Valve Prosthesis Implantation; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Obesity; Propensity Score; Proportional Hazards Models; Prospective Studies; Protective Factors; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 27535139
DOI: 10.1007/s00392-016-1027-4