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Biomedical subjects

E Criado

Publications and source records attributed to E Criado.

At least 19 recordsLinked to original sources
PubMed2005

Advantages and indications of transcervical carotid artery stenting with carotid flow reversal.

AIM: The aim of this Italian prospective registry was to evaluate the applicability and efficacy of the Mo.Ma Device (Invatec, Roncadelle, Italy) for the prevention of cerebral embolization during carotid artery stenting (CAS) in a real world population. METHODS: In 4 Italian centers, 416 patients (300 men; mean age 71.6+/-9 years) between October 2001 and March 2005 were enrolled in a prospective registry. Two-hundred and sixty-four symptomatic (63.46%) with >50% diameter stenosis and 152 (36.54%) asymptomatic patients with >70% diameter stenosis were included. The Mo.Ma Proximal Flow Blockage Embolic Protection System was used to perform protected CAS, achieving cerebral protection by endovascular clamping of the common carotid artery (CCA) and of the external carotid artery (ECA). RESULTS: Technical success, defined as the ability to establish protection with the Mo.Ma device and to deploy the stent, was achieved in 412 cases (99.03%). The mean duration of flow blockage was 4.91+/-1.1 min. Transient intolerances to flow blockage were observed in 24 patients (5.76%), but in all cases the procedure was successfully completed. No peri-procedural strokes and deaths were observed. Complications during hospitalization included 16 minor strokes (3.84%), 3 transient ischemic attacks (0.72%), 2 deaths (0.48%) and 1 major stroke (0.24%). This resulted in a cumulative rate at discharge of 4.56% all strokes and deaths, and of 0.72% major strokes and deaths. All the patients underwent thirty-day follow-up. At thirty-day follow-up, there were no deaths and no minor and major strokes, confirming the overall cumulative 4.56% incidence of all strokes and deaths rate, and of 0.72% rate of major strokes and deaths at follow up. In 245 cases (58.89%) there was macroscopic evidence of debris after filtration of the aspirated blood. CONCLUSIONS: This Italian multicenter registry confirms and further supports the efficacy and applicability of the endovascular clamping concept with proximal flow blockage in a broad patient series. Results match favorably with current available studies on carotid stenting with cerebral protection.

Blood Flow Velocity↗
PubMed2004

[Medullar carcinoma of the thyroid gland: surgical treatment of mediastinal metastases].

Metastatic medullary carcinoma is related to very bad prognosis. Surgery, associated or not to radiotherapy, may be effective in controlling metastasis due to local invasion, as in mediastinal extension. We present a case of medullary carcinoma with mediastinal disease that was treated through mediastinal dissection following by complimentary radiotherapy. After three years of follow-up, the patient remains free of recurrence, although calcitonin levels have not become normal yet.

Carcinoma, Medullary↗
PubMed2002

Duplex scanning or arteriography for preoperative planning of lower limb revascularisation.

OBJECTIVE: to compare the accuracy of duplex and angiography for the planning of lower limb revascularisation. PATIENTS AND METHODS: Sixty limbs (82% with critical limb ischaemia) were assessed by means of duplex by one surgeon and by angiography by another in terms of the optimum inflow and outflow sites for arterial bypass. These data were then compared with the final operation performed which was used as the gold standard. Surgeons were blinded to the determinations of the other. RESULTS: surgical plans based on duplex scan and angiography were correct in 77% (40/52) and 79% (41/52), respectively and plans based on the one imaging modality was modified by the other in only 1 and 2 instances. The diagnostic agreement between duplex scanning and arteriography was excellent (Kappa value=0.94, 95% C.I. 0.89-0.98). CONCLUSIONS: the reliability of duplex scanning is comparable to digital angiography in the preoperative planning of lower extremity arterial reconstruction. However neither exam can be considered as the gold standard because intraoperative arteriography needs to be available in a significant number of infrapopliteal procedures.

Adult↗
PubMed1999

Descending thoracic aorta to iliofemoral artery bypass grafting: a role for primary revascularization for aortoiliac occlusive disease?

PURPOSE: Bypass grafts that originate from the descending thoracic aorta to the iliac or femoral arteries are well described but are not commonly used as primary procedures, and the long-term results remain unknown. A 15-year experience with 50 descending thoracic aorta to iliofemoral artery bypass grafts for aortoiliac occlusive disease is the basis of this report. METHODS: From January 1983 to December 1997, patients who underwent bypass grafting procedures from the descending thoracic aorta to the iliac or femoral arteries were identified. Surgical indications, morbidity and mortality rates, primary and secondary patency rates, limb salvage rates, and survival rates were determined. RESULTS: Fifty descending thoracic aorta to iliofemoral artery bypass grafting procedures were performed 24 (48%) for severe claudication, 22 (44%) for rest pain, and 4 (8%) for ischemic ulceration. A primary procedure was performed in 31 patients (62%) for complete occlusion (21 patients) and severe atherosclerotic disease (10 patients) of the infrarenal aorta. The indications for 19 secondary revascularizations (38%) were prior aortic or extra-anatomic graft failure in 17 cases and aortic graft infection in 2 cases. The follow-up periods ranged from 1 to 150 months (mean, 39 months). The cumulative life-table 5-year primary patency, secondary patency, limb salvage, and survival rates were 79%, 84%, 93%, and 67%, respectively. An improved patency trend was observed for patients who underwent operation for severe claudication as compared with limb-threatening ischemia (92% and 69%; P =.07). However, there was no difference between primary and secondary operations in primary patency rates (81% and 79%; P = NS) or survival rates (72% and 62%; P = NS). CONCLUSION: Descending thoracic aorta to iliofemoral artery bypass grafting has excellent overall long-term results. These results support its more liberal use for primary revascularization, especially for patients with severe atherosclerotic disease or complete occlusion of the infrarenal aorta.

Adult↗
PubMed1998

Efficacy of color flow duplex imaging for proximal upper extremity venous outflow obstruction in hemodialysis patients.

PURPOSE: The efficacy of color flow duplex imaging (CFDI) in detecting proximal upper extremity venous outflow obstruction in hemodialysis patients was compared with that of traditional contrast venography. METHODS: From 1993 through 1997, all hemodialysis patients who were evaluated for upper extremity venous outflow obstruction of the axillary, subclavian, or brachiocephalic veins with both CFDI and venography were identified. Medical history, hemodialysis access procedures, and indications for imaging were reviewed. The diagnostic accuracy of CFDI was compared with that of venography for proximal venous outflow obstruction, including focal stricture, partial obstruction, or complete occlusion. RESULTS: Sixty upper extremities in 42 hemodialysis patients were imaged with both CFDI and venography. Previous ipsilateral intravenous dialysis catheters had been present in 33 (55%) of the extremities imaged; current catheters were present in 16 (27%) of the extremities imaged; and 28 (67%) of the extremities imaged had a current ipsilateral arteriovenous (AV) shunt. Five (8%) of the 60 duplex scans were nondiagnostic because of artifact from intravenous dialysis catheters (3) or incomplete visualization of the subclavian or brachiocephalic veins (2) and were excluded from further analysis. In the remaining 55 duplex scans, proximal venous outflow obstruction was found in 18 (33%), compared with 21 (38%) identified by means of venography (P = not significant [NS]). Overall sensitivity, specificity, positive predictive value, and negative predictive value for CFDI were 81%, 97%, 94%, and 89%, respectively. CONCLUSION: CFDI is a reliable means of detecting proximal upper extremity venous outflow obstruction and should replace contrast venography as the initial imaging study in hemodialysis patients.

Adult↗
PubMed1998

The role of air plethysmography in the diagnosis of chronic venous insufficiency.

PURPOSE: The role of air plethysmography (APG) in the diagnosis of venous disease is not well defined. We conducted this study to investigate the value of APG in the diagnosis of chronic venous insufficiency and to determine its correlation with the clinical severity of disease and the anatomic distribution of reflux. METHODS: We studied 186 lower extremities with duplex scanning and venography and measured the venous volume, venous filling index (VFI), ejection fraction, and residual volume fraction with APG. Limbs were categorized according to the Society for Vascular Surgery and International Society for Cardiovascular Surgery classification of clinical severity of disease and according to the anatomic distribution of valvular incompetence. RESULTS: Sixty-one limbs had no evidence of disease (class 0), 60 limbs had mild disease (classes 1, 2, and 3), and 65 limbs had severe disease (classes 4, 5, and 6). According to the results of duplex scanning and venography, there was no evidence of reflux in 56 limbs. Isolated superficial venous reflux occurred in 52 limbs, and perforator reflux, alone or in conjunction with superficial reflux, occurred in 30. Deep reflux, with or without superficial reflux, was found in 25 limbs. Deep and perforator reflux, with or without superficial reflux, was found in 19 limbs. The VFI had a sensitivity of 80% and 99% positive predictive value for any type of reflux. The VFI was significantly different between groups of limbs with different clinical severities of disease or different types of reflux. The incidence of deep or perforator reflux in limbs with a normal VFI value was 7%, and it was 82% in limbs with a VFI of more than 5. Among 86 limbs with VFI values not corrected with use of a thigh tourniquet, 28% did not have evidence of deep or perforator reflux, and among 15 limbs with VFI values corrected with the use of a tourniquet, 33% had perforator reflux, deep reflux, or both. All APG parameters had low positive predictive values for severe disease or ulceration. The ejection fraction and residual volume fraction did not influence the clinical severity of disease, did not discriminate between types of reflux, and in combination with the VFI did not improve the predictive value of APG. CONCLUSIONS: The VFI measured by APG is an excellent predictor of venous reflux, provides an estimate of the clinical severity of disease, and at high levels predicts deep reflux, perforator reflux, or both. Correction of an abnormal VFI with a thigh tourniquet is an unreliable predictor of the absence of deep or perforator incompetence. The predictive value of APG for severe disease or ulceration is poor. The ejection fraction and residual volume fraction, individually or in combination with the VFI, add little to the diagnostic value of APG, and their routine performance may not be clinically justified.

Blood Volume↗
PubMed1997

Mechanical characteristics of dilated polytetraflouroethylene used for transluminally placed endovascular grafts.

This study was conducted to assess the mechanical characteristics of dilated polytetraflouroethylene (PTFE) for use in transluminally placed endovascular grafts (TPEGs). Ten-centimeter lengths of 3- and 4-mm thinwalled PTFE were dilated to 8, 10, 12, and 15 mm diameters (3 mm) and 10-, 14-, 16-, and 20-mm diameters (4 mm), respectively (n = 6 for each size). The dilated PTFE segments were evaluated for leakage, further dilation, structural changes (with electron microscopy), and changes in wall thickness occurring after 24 hours of perfusion at pressures of 300-350 mmHg. Both 3- and 4-mm thinwalled PTFE could be dilated to five times their initial diameter before rupture occurred. Three-millimeter grafts dilated to 12- and 4-mm grafts dilated to 14 mm remained resistant to leakage at perfusion pressures up to 350 mmHg. When 3-mm grafts were dilated to 15 mm, the PTFE leaked saline at a rate of 20.3 +/- 9.3 cc per hour at 300 mmHg. pressure. Four-millimeter grafts dilated to 16- and 20-mm diameters leaked saline at 8.4 +/- 7.8 and 52.8 +/- 22 cc per minute, respectively, at the same pressure. No grafts were found to increase in diameter after 24 hours of pressure perfusion. Electron microscopy revealed that PTFE node size was significantly smaller in dilated grafts than in undilated grafts, but there was no significant change in internodal distance. This data suggests that thinwalled PTFE can be dilated to large diameters and retain sufficient strength to resist supraphysiologic pressures. Long-term studies are needed to determine the late structural integrity of dilated PTFE.

Blood Vessel Prosthesis↗
PubMed1997

Endovascular repair of peripheral aneurysms, pseudoaneurysms, and arteriovenous fistulas.

Endovascular repair of peripheral arterial lesions was performed in 10 patients including two iliac aneurysms, two iliac anastomotic pseudoaneurysms, one subclavian pseudoaneurysm, one axillary anastomotic disruption, two prosthetic pseudoaneurysms, and two posttraumatic arteriovenous (AV) fistulas. The indications for repair were aneurysm size in five cases, massive hematoma in one, threatened prosthetic dialysis graft in two, venous hypertension with non-healing ulcer in one, and arm pain in one. Vascular access was obtained through surgical cutdown in all cases, via the femoral artery in five patients, the proximal brachial artery in three and a prosthetic graft in two. Stented prosthetic grafts were used in five cases (1 polyester and polytetrafluoroethylene 4 [PTFE]), and PTFE-covered stents in five cases. Concomitant procedures were done in four patients including two open repairs of a common femoral artery aneurysm, a transluminal dilatation of a proximal aortic anastomotic stenosis, and an iliac artery transluminal angioplasty. Eight of 10 cases were technically successful. Completion arteriography revealed complete exclusion of all lesions, except for one minimal proximal stented graft leak in a pseudoaneurysm, and an incomplete obliteration of an AV fistula. No complications occurred. Operative time ranged from 45 min to 5 hours. Postoperative hospital stay was 1 day in five patients, 2 days in three patients, and 4 days in two patients. Follow-up contrast CT scan, arteriography, or duplex scanning demonstrated complete exclusion of all lesions except an AV fistula, and decrease in size in three aneurysms. The proximal leak initially present in a stented graft resolved. All grafts and covered stents remained patent at 2-19 months of followup. Endovascular exclusion of peripheral arterial aneurysms, pseudoaneurysms, and AV fistulas can be done with a high degree of technical success, low morbidity, and short hospital stay. Short-term follow up is encouraging, however, long term follow up of these procedures is warranted to assess durability of the repair and absence of complications.

Aged↗
PubMed1997

Innominate artery occlusive disease: management with central reconstructive techniques.

BACKGROUND: The purpose of this study was to review our experience with central vascular reconstruction for innominate artery occlusive disease. Eighteen patients underwent central reconstruction for innominate artery (IA) occlusive disease during an 8-year period (1986 to 1994). Mean age was 59 years (range, 36 to 77 years). Women outnumbered men 12 to 6. All patients had symptoms including amaurosis fugax 55%, transient ischemic attacks 44%, vertebrobasilar insufficiency 44%, and arm claudication 33%. The IA was occluded in three patients and stenotic in 15. Three patients underwent previous extrathoracic bypass procedures for IA lesions that failed. METHODS: Operations performed through a median sternotomy included aortocarotid bypass with reimplantation of the subclavian (n = 10) and aortoinnominate bypass (n = 7). Transection and oversewing of the IA was performed in all but one patient, in whom ligation of the IA was performed. One patient with severe chronic obstructive pulmonary disease and previous coronary artery bypass grafting underwent retrograde-transluminal IA angioplasty with endovascular stent placement via a carotid approach. Four patients underwent concomitant carotid endarterectomy). Two patients underwent concomitant coronary artery bypass grafting at the time of IA reconstruction. RESULTS: There was one operative death from myocardial infarction. Perioperative morbidity included dysrrhythmia (three), respiratory insufficiency (three), subendocardial myocardial infarction (two), cerebrovascular accident with complete recovery (two), hemorrhage (one), and acute graft occlusion (one). All grafts remained patient at a mean follow-up of 21 months (range, 8 to 60 months). The only patient who underwent ligation of the IA required a subsequent revision of the IA to transection and oversewing for an embolic event at 4 months status-post aortocarotid bypass. The patient who underwent angioplasty remained asymptomatic with a patient IA at 12 months. Average length of stay for transthoracic repair was 14 days and for transluminal angioplasty 2 days. CONCLUSIONS: Innominate artery bypass based on the ascending aorta is effective in providing relief of symptoms and has a high patency rate. Because of the significant morbidity, these procedures should be reserved for patients with symptoms. The IA should be transected and oversewn to prevent recurrent embolism. Transcarotid, retrograde angioplasty provides an alternative approach to stenotic lesions located in the IA or proximal common carotid artery. An aggressive approach directed at defining coronary artery disease is an invaluable adjunct to the proper treatment of this patient population.

Adult↗
PubMed1997

Predictive value of clinical criteria for the diagnosis of deep vein thrombosis.

BACKGROUND: The widespread use of ultrasonography for the diagnosis of deep vein thrombosis (DVT) has led to the overuse of ultrasonography with low diagnostic yield. We conducted this study to investigate the predictive value of clinical features in the diagnosis of DVT and their potential value as clinical guidelines for the use of ultrasonographic testing in the diagnosis of DVT. METHODS: The results of lower-extremity duplex ultrasonographic studies and clinical surveys prospectively obtained in 1526 patients suspected of having DVT were analyzed. RESULTS: There were 916 inpatients and 610 outpatients. Acute DVT was found in 16% of the inpatient duplex scans, and in 12% of the outpatient studies (p < 0.05). The incidence of acute DVT was not different between men and women in inpatient or outpatient populations. Acute DVT was found in the left leg in 60% of the outpatient studies, significantly more often (p < 0.001) than in the inpatients (35%). Bilateral DVT was more common (p < 0.05) in the inpatient population (35%) compared with the outpatient population (20%). No difference in the anatomic distribution of thrombosis was found between inpatients and outpatients. The presence of leg symptoms was associated with a significantly higher rate (p < 0.05) of positive studies compared with those patients without leg symptoms in both the inpatient and the outpatient populations. Individual symptoms, risk factors, and physical findings had low positive predictive value and sensitivity for the presence of acute DVT on duplex scan. A calf circumference discrepancy of less than 2 cm predicted the absence of DVT in 93% of inpatients and 85% of outpatients. The combination of a calf circumference discrepancy of less than 2 cm with the absence of recent operation, trauma, malignancy, previous history of DVT, or hypercoagulable state predicted the absence of DVT in 92% of the inpatients and 97% of the outpatients. CONCLUSIONS: Clinical symptoms, risk factors, and physical findings are poor predictors of the presence of acute DVT on duplex scan. However, the absence of a combination of objective clinical factors has high predictive value for the absence of acute DVT on duplex scan. These criteria may be used to establish clinical guidelines to reduce the use of duplex scanning for the diagnosis of DVT.

Adult↗
PubMed1997

Prospective randomized comparison of surgical versus endovascular management of thrombosed dialysis access grafts.

PURPOSE: Salvage of thrombosed prosthetic dialysis shunts can be performed using surgical or endovascular techniques. A prospective randomized trial was designed to compare the efficacy of these two methods in restoring dialysis access function. METHODS: One hundred fifteen patients with thrombosed dialysis shunts were randomized prospectively to surgical (n = 56) or endovascular (n = 59) therapy. In the surgical group, salvage was attempted with thrombectomy alone in 22% and with thrombectomy plus graft revision in 78%. In the endovascular group, graft function was restored with mechanical (82%) or thrombolytic (18%) graft thrombectomy followed by percutaneous angioplasty. RESULTS: Stenosis limited to the venous anastomotic area was the cause of shunt thrombosis in 55% of patients, and long-segment venous outflow stenosis or occlusion was the cause in 30%. In 83% of the surgical group and in 72% of the endovascular group, graft function was immediately restored (p = NS). The postoperative graft function rate was significantly better in the surgical group (p < 0.05). Thirty-six percent of grafts managed surgically remained functional at 6 months and 25% at 12 months. In the endovascular group, 11% were functional at 6 months and 9% by 12 months. Patients with long-segment venous outflow stenosis or occlusion had a significantly worse patency rate than those with venous anastomotic stenosis (p < 0.05). CONCLUSIONS: Neither surgical nor endovascular management resulted in long-term function for the majority of shunts after thrombosis. However, surgical management resulted in significantly longer primary patency in this patient population, supporting its use as the primary method of management in most patients in whom shunt thrombosis develops.

Angioplasty, Balloon↗
PubMed1997

Femorofemoral bypass: appropriate application based on factors affecting outcome.

Current surgical options for the treatment of unilateral iliac artery occlusive disease are quite varied and include aortic-based procedures, femorofemoral bypass ileofemoral bypass, and transluminal angioplasty and stenting. Patients with unilateral iliac disease present with a variety of anatomic, physiological and clinical situations. As a result, the surgical options are complementary rather than competitive, and their use needs to be tailored on an individual basis. Femorofemoral bypass, despite its relatively lower patency rate compared with aortic-based inflow procedures, is a useful operation for the treatment of unilateral limb ischemia. It is best suited for patients with limited life-expectancy and/or for those with contraindications for transabdominal or more extensive surgery, or as a remedial procedure for unilateral limb failure of aortofemoral grafts. The purpose of this article is to analyze the results of femorofemoral bypass, and to discuss the factors that may influence its outcome in the treatment of unilateral iliac artery occlusive disease.

Arterial Occlusive Diseases↗
PubMed1996

Reduction of aneurysm pressure and wall stress after endovascular repair of abdominal aortic aneurysm in a canine model.

A canine model was designed to evaluate the changes in abdominal aortic aneurysm (AAA) pressure and wall stress after endovascular repair. Eight canines underwent laparotomy and creation of an AAA. The aneurysm was then excluded with a transluminally placed endovascular graft (TPEG) inserted through the right femoral artery and deployed across the AAA to exclude the infrarenal aortic branches from aortic perfusion. Blood pressure and flow data were recorded for 6 hours. The AAA blood pressure decreased from 135 +/- 9.3 mm Hg before exclusion to 45 +/- 17.6 mm Hg at 10 minutes after exclusion (p < 0.001). At 6 hours, AAA blood pressure had declined further to 26 +/- 12.5 mm Hg. Blood flow in the excluded iliac artery decreased from a baseline of 242 +/- 58 ml/min to 41 +/- 29 ml/min 10 minutes after TPEG placement (p < 0.001). At 6 hours, flow was reduced to 12 +/- 3.5 ml/min (p < 0.05 compared with that at 10 minutes). Aortic wall stress was significantly reduced by TPEG placement but was only slightly lower than baseline aortic wall stress before AAA creation. The lumbar arteries were patent with retrograde flow in all cases and were found to be the major contributors to postexclusion aneurysm pressure. Endovascular AAA exclusion results in an immediate decrease in blood pressure and wall stress within the excluded aneurysm, but the aneurysm remains perfused by retrograde flow through the lumbar arteries, which resulted in near-baseline levels of aneurysm wall stress in this canine model. Embolization of patient lumbar vessels at prosthesis placement may further reduce the risk of late rupture.

Animals↗
PubMed1996

Management and outcome of chronic atherosclerotic infrarenal aortic occlusion.

PURPOSE: To evaluate the management and outcome of chronic atherosclerotic infrarenal aortic occlusion (IRAO), a review of 48 patients who were treated for angiographically documented IRAO between January 1980 and December 1994 was undertaken. Mean follow-up was 45 months. Mean age was 57 years (range, 33 to 88 years). Forty-seven patients were heavy smokers. Symptoms included claudication in 81%, rest pain in 25%, and tissue loss in 15%. Impotence was documented in 73% of men. Associated arterial disease included inferior mesenteric artery occlusion in 31 patients, renal artery stenosis or occlusion in 12, superior mesenteric artery stenosis in two, and celiac artery stenosis in one. METHODS: Forty inflow procedures were performed, including 17 thoracobifemoral bypass (TBF) procedures, 15 aortobifemoral/iliac bypass (ABFI) procedures, and eight axillobifemoral bypass (AXBF) procedures. Eight patients were managed without surgery. The thoracic aorta was chosen as the inflow source in 17 patients because of previous abdominal aortic surgery in eight, poor status of the abdominal aorta in eight, and horseshoe kidney in one. RESULTS: The overall operative mortality rate was 5%, and the perioperative morbidity rate was 18%. There was no statistical difference in perioperative mortality and morbidity rates among the operative groups. The five-year survival rate (life-table) for all IRAO patients was 67%. TBF and ABFI revascularization procedures yielded 5-year patency rates of 71% and 79%, respectively (p < 0.05). All eight patients who underwent AXBF died or had occluded grafts at 3 years after surgery. Two-year patency rates (life-table) for TBF, ABFI, and AXBF were 92%, 92%, and 44%, respectively. The AXBF patency rate was significantly inferior to those of TBF and ABFI (p < 0.05). Changes in ankle-brachial indexes after TBF or ABFI were similar, but were significantly greater than changes after AXBF (p < 0.05). Three patients in the nonoperative group died, and two underwent major amputation. Acute renal failure did not occur in our study population. Follow-up creatinine levels > 2.0 mg/dl were documented in three operative patients and in one nonoperative patient, and none required dialysis. CONCLUSIONS: In patients who have IRAO, aorta-based inflow procedures are superior to AXBF both in hemodynamic outcome and in patency rates. Treatment of IRAO with TBF or ABFI yields similar long-term results; the descending thoracic aorta represents an excellent inflow alternative to the abdominal aorta. Clinically significant renal impairment is rarely associated with IRAO. Nonoperative management of IRAO is associated with an increased mortality rate and a high rate of limb loss.

Adult↗