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Biomedical subjects

V Riambau

Publications and source records attributed to V Riambau.

At least 19 recordsLinked to original sources
PubMed2004

Endovascular versus open surgical repair of abdominal aortic aneurysm: a comparison of early and intermediate results in patients suitable for both techniques.

PURPOSE: To assess early and intermediate results of endovascular repair of abdominal aortic aneurysms (EVAR), and to compare them with open surgery (OS) in concurrent patients suitable for both types of treatment. METHODS: During 3 years, 180 patients with AAA underwent repair. We excluded patients with ruptured aneurysms (33), juxtarenal aneurysms (11), iliac aneurysms (8), with peripheral embolization (2) and those treated with a cryopreserved homograft (2). From the remaining patients (n=124), we selected those suitable for both techniques (n=83), of which 53 were treated by EVAR and 30 by OS. Analysis was performed using Kaplan-Meier curves and Log Rank tests. RESULTS: Hospital mortality was not significantly higher in the OS group (6.6% OS vs. 3.7% EVAR), p=0.55. The EVAR group had significantly shorter operative time, length of hospital stay and less blood loss. The median follow up time was 2.18 years for OR and 1.58 years for EVAR. There were no conversions from EVAR to OS and no differences in late survival (p=0.255, Cox regression analysis) with a cumulative survival rate at 3 years of 89% for EVAR and 73% for OS. By 3 years 24% (95% CI, 11-47%) of EVAR patients had presented endoleaks with an endovascular re-intervention rate of 27% (95% CI, 13-50%). One patient in the OS group needed a late open intervention. CONCLUSIONS: EVAR compares favourably with OS in terms of reduction of operative time, hospital length of stay and blood loss. This study did not show a difference in early or late mortality. EVAR durability remains the most critical issue to be addressed.

Aged↗
PubMed2003

Indications for myocardial revascularization before endovascular aortic repair.

Due to the strong relationship between abdominal aortic aneurysm (AAA) and coronary morbidity and mortality, it seems mandatory to spend some more time investigating about coronary risk of our endovascular aortic repair (EVAR) patients. Physical examination, basic laboratory testing and ECG will allow us to determine whether the surgical risk for a patient is low, moderate or high. In general a patient who is at low risk will not need any further evaluation. Those at who are at high risk usually will undergo coronary angiography. Patients who are at intermediate risk, probably the largest subgroup of patients candidate to EVAR, will often need additional testing like assessment of resting left ventricular function, exercise stress testing, pharmacological stress testing, ambulatory ECG monitoring, and coronary angiography as well as exercise echocardiography or exercise myocardial perfusion imaging should be considered. Patients undergoing an EVAR procedure, who are found to have prognostic high-risk coronary anatomy and in whom long-term outcome would likely be improved by coronary revascularization, should generally undergo revascularization first. In conclusion, we recommend to evaluate the cardiac status of EVAR's patients in order to reduce the most common serious morbidity related to this new therapeutic modality.

Algorithms↗
PubMed2001

The association between co-morbidity and mortality after abdominal aortic aneurysm endografting in patients ineligible for elective open surgery.

OBJECTIVE: To investigate whether co-morbidity affects mortality after endovascular stenting in patients who are fit and unfit for open surgery. METHODS: Data were obtained from the EUROSTAR registry. The association between co-morbidity and mortality was examined by Cox proportional hazards models. RESULTS: Between 1994 and July 2000, 2862 patients underwent aneurysm stenting; 381 were unfit for open surgery. The early/late mortality rates for patients fit for surgery, patients unfit for surgery and patients unfit for anaesthesia were 2.7/5.2%, 5.1/11.4% (p=0.035/p<0.0001) and 3.7/11.0% (NS/p=0.016), respectively. The survival curves among patients with poor medical condition were significantly worse than in those patients with a good medical condition (p=0.001). The presence or absence of co-existing diseases did not affect the mortality rate in patients unfit for open surgery. The age-adjusted mortality risks of patients fit for open surgery and pulmonary disease or diabetes mellitus were 1.41 (1.02-1.95) and 1.75 (1.12-2.74), respectively. CONCLUSIONS: Patients with co-morbidity had a significantly higher mortality after aortic endografting compared with patients fit for open surgery. Co-morbidity did not increase mortality after endovascular abdominal repair in patients unfit for open surgery. Endovascular repair of abdominal aortic aneurysm seems to have a limited benefit in patients unfit for open surgery.

Adult↗
PubMed2001

[Aortic stent: the vascular surgeon's point of view].

Endovascular repair has been suggested as an attractive, revolutionary and less invasive technique for treating abdominal aorta aneurysms (AAA).The vascular surgeon plays a role in an interdisciplinary approach to treatment, given that several professionals are involved in the success of this new technique. Preoperative imaging techniques, patient screening, endoprosthetic selection, anesthetic management, endovascular skill and preoperative and postoperative monitoring are the elements that determine clinical and technical success. The surgeon must coordinate all members of the treatment team and assumes final responsibility for each of the sub-processes of the procedure. Our team's 3-year experience encompasses 110 AAA, 38 isolated aorta aneurysms and 8 isolated iliac aneurisms. It has been possible to implant stents without complications in 98.2% of the AAA cases. Perioperative mortality was 4.5% for AAA cases. Primary leaks were recorded in 14.8% of AAA, most of which were resolved through additional endovascular procedures. Migrations of 5.4% of the stents occurred, and branch dislocations were seen in 1.8% during follow-up. Hospital mortality was 1.8% for AAA. To date, no conversion has occurred, either immediately after surgery or during follow-up. In conclusion, an interdisciplinary approach provides the best formula for introducing and applying this new therapeutic technique. The vascular surgeon should coordinate the team and take final clinical responsibility. The long-term results show that endovascular repair of AAA deserves a place in our therapeutic arsenal.

Adult↗
PubMed2000

Metal-induced generalized pruriginous dermatitis and endovascular surgery.

Metal contact allergy is a common problem in the general population. Diagnostic and therapeutic medical-surgical procedures in which metals can be responsible for eczema are diverse. Endovascular aortic surgery is still an experimental but less invasive technique. A generalized eczematous dermatitis elicited by metal of an endovascular prosthesis is presented. An abdominal aortic aneurysm was diagnosed in a 79-year-old woman. Endoluminal repair with a straight Vanguard endograft was successful. 3 weeks later, she suffered a severe episode of erythema and eczema on the legs. Since then, she complained of continuous pruritus with eczema and excoriated papules. The dermatitis and also the patch test pathology showed eczema. Patch testing was positive to nickel sulfate and cobalt chloride. An endograft semi-quantitative metal analysis was performed with plasma-induction joint mass-spectrometry. The self-expanding metal stent was mainly composed of nickel (approximately 55%) and titanium (21%) with reinforcing thread of platinum. Antimony was detected only in the polyester textile. These results are consistent with Nitinol composition. The need for preoperative patch testing for metals is controversial. Enquiry about metal allergy is recommended before endoluminal surgical procedures. In the near future, the design of endografts must take into account the possibility of this sort of reaction.

Aged↗
PubMed1999

Radicular acute pain after epidural anaesthesia with the technique of loss of resistance with normal saline solution.

Epidural anaesthesia using the loss of resistance to saline technique, without air, was successfully performed in a 65-year-old man scheduled for elective vascular surgery of the right leg. Epidural catheterisation was uneventful. Fifteen minutes after the initial dose of plain 0.5% bupivacaine, the patient experienced severe pain in his lower abdomen and legs which coincided with a supplementary injection of 2 ml bupivacaine and 50 microgram fentanyl, and a change from the lateral to the supine position. General anaesthesia was induced and CT and MRI scans were performed showing trapped air in the epidural space at the L4 level causing compression of the thecal sac. After excluding other causes, the spontaneous entry of air through the Tuohy needle was thought to be the most likely explanation for this complication. The patient recovered uneventfully.

Acute Disease↗
PubMed1993

Polyclonal 111In-IgG, 125I-LDL and 125I-endothelin-1 accumulation in experimental arterial wall injury.

To test iodine-125 labelled low-density lipoprotein (125I-LDL), polyclonal indium-111 labelled immunoglobulin G (111In-IgG) and iodine-125 labelled endothelin-1 uptake in metabolically active atheromatous plaques after arterial wall injury, we performed balloon de-endothelialization of carotid arteries or abdominal aortas in 24 New Zealand male rabbits which were fed with a normal diet (n = 14) or a hypercholesterolaemic diet (n = 10) after surgery. Six weeks later the animals were injected with 200 microCi of 125I-LDL and/or with 100 microCi of 111In-IgG or with 9 microCi of 125I-endothelin-1. Forty-eight hours later the animals were sacrificed. Carotid arteries and aortas were removed, counted and fixed for autoradiography and light microscopy examination. Contralateral carotid arteries and thoracic aortas served as controls. Significant 111In-IgG uptake was observed in the injured arteries at autoradiography, with localization mainly in the healing edges, and at well counting. The percentage of the injected dose per gram (%D.inj/g) was 0.0188 +/- 0.06 versus 0.0059 +/- 0.003 in controls (P < 0.05). There was no difference in 111In-IgG uptake between arteries with injury alone and those with active atheroma formation at the site of the injury. Significant 125I-LDL uptake was observed only when lipid deposition was present at light microscopy (%D.inj/g of 0.0024 +/- 0.0005 vs. 0.0010 +/- 0.0003 in controls, P < 0.05). 125I-endothelin-1 accumulation was observed in four of five injured aortas both at autoradiography, with diffuse localization, and at well counting (%D.inj/g of 0.0012 +/- 0.0004 in the abdominal aortas vs 0.0008 +/- 0.0003 in the thoracic aortas).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Renal duplex scanning: correlation with angiography and isotopic renography.

The purpose of this study was to assess the accuracy of Duplex scanning in detecting renovascular disease and to compare it with angiography, renal scintigraphy and captopril test for plasma renin activity and isotopic renography. A Duplex scan was performed in 92 renal arteries (46 patients) and compared to angiography. Three degrees of stenoses were established: 0-60%, 61-99% and occlusion. The peak systolic velocity (PSV) in the renal artery and its ratio to the peak velocity in the aorta (RAR) were used to discriminate stenoses > 60%. PSV in the interlobar arteries was used to assess the relative perfusion of both parenchyma. Angiography demonstrated a stenoses > 60% in 23 hypertensive patients. In all of the patients, plasma renin activity was measured and isotopic renograms (pre- and post-captopril) obtained in order to discriminate hypertension of vascular origin. A PSV in the renal artery > 210 cm/s and a RAR > 3.5 were found to be the diagnostic criteria with the best sensitivity and specificity in detecting stenoses > 60%. Based on these data, Duplex correctly identified 49/54 stenoses > 60%; 28/33 stenoses < 60%; and 5/5 occlusions (kappa 0.79). Sensitivity and specificity in detecting stenoses > 60% were 89.5 and 90.7%, respectively. The ratio between PSV in the interlobar arteries of both parenchyma accurately predicted the relative perfusion (ratio between DTPA uptake in both kidneys) in the isotopic test (n = 23, r = 0.91, p = 0.001). The captopril test (for plasma renin activity and isotopic renography) was positive in only five patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Two-year follow-up after laser thermal balloon angioplasty (LTBA) in lower extremities: initial experience.

We describe the results obtained with the use of laser thermal balloon angioplasty (LTBA) in the treatment of atherosclerosis obliterans of the lower limbs in 37 patients (34 males, 3 females, mean age 58 +/- 9 years) with occlusive arterial disease (Fontaine stages II-IV) presenting 39 significant lesions. Immediate results and two years of clinical follow-up are analyzed. Initial ankle/brachial Doppler index was 0.51 +/- 0.17. Eighteen lesions were located in the iliac area (13 stenoses 2.3 +/- 1 cm and 5 occlusions 4.2 +/- 3 cm) and 21 lesions in the femoropopliteal area (5 stenoses 2.6 +/- 2 cm and 16 occlusions 5.7 +/- 3 cm). A percutaneous procedure was used in 38 cases. In only one case was femoral dissection needed. The laser source was argon in 26 cases and Nd-YAG in 13. Initial success was 85% (89% in iliac lesions and 81% in femoropopliteal lesions; 100% in stenoses and 70% in occlusions). The presence of occlusion (p less than 0.01) and/or calcium (p less than 0.05) negatively influenced the immediate results. No major complications were observed; seven (17%) minor complications occurred. Ankle/brachial Doppler index after treatment was 0.82 +/- 0.21. Cumulative clinical patency for successfully treated patients after two-year follow-up was 91%. LTBA thus represents an effective and less aggressive way of treating peripheral atherosclerosis obliterans. In spite of some limitations, it is useful in selected patients. The results of this study are very much like those in the literature for similar series and early experience.

Adult↗
PubMedDate not supplied

Noninvasive localization of human atherosclerotic lesions with indium 111-labeled monoclonal Z2D3 antibody specific for proliferating smooth muscle cells.

BACKGROUND: Targeting exclusive antigens in atherosclerotic plaques with antibodies may provide a noninvasive means to detect rapidly proliferative atherosclerotic lesions. 111In-labeled negative charge-modified Z2D3 F(ab')2 (Z2D3) specific for an antigen expressed exclusively by proliferating smooth muscle cells has been shown to accumulate in rabbit atherosclerotic plaques. METHODS: The safety, biodistribution, accumulation, and elimination of Z2D3 were assessed in 11 patients who were candidates for carotid endarterectomy. The presence of atheromas in these patients was confirmed by angiography and Doppler ultrasound. Z2D3 (250 microg) labeled with 5 mCi of 111In was administered by slow intravenous injection. Planar and single photon emission computed tomography (SPECT) images were obtained 4, 24, 48, and 72 hours later. Carotid endarterectomy was performed and the surgical specimens were imaged, weighed, gamma-counted, and analyzed by immunostaining. RESULTS: Uptake of Z2D3 at the site of the carotid plaques was observed in the planar and SPECT views at 4 hours in all subjects. In addition, antibody uptake was noted in the contralateral vessel in 5 subjects. SPECT images identified the atherosclerotic plaques with focal uptake. The antibody uptake corresponded with the angiographic location of the disease. Immunohistochemical studies of the endarterectomy specimens confirmed the localization of Z2D3 into the plaque areas containing smooth muscle cells. Adverse drug reactions were not observed. CONCLUSION: This study demonstrates the feasibility of targeting atherosclerotic lesions with negative charge-modified antibody. It also proposes the possibility of selective identification of various components of atherosclerotic plaque, which may contribute to determining strategies of intervention in future.

Aged↗
PubMedDate not supplied

[Aortobifemoral prostheses with "0" porosity. Results after 2 years' experience].

During the last years diverse types of Dacron prosthesis without porosity (because to be impregnated by different materials) have appeared. In the presented study, outcomes from three different types of prosthesis (differentiated by the impregnated material) were evaluated and a comparison with classical prosthesis was made.

Aorta, Abdominal↗