Biomedical subjects

Y Tshomba

Publications and source records attributed to Y Tshomba.

9 recordsLinked to original sources

PubMed2005

Visceral artery aneurysms.

Visceral artery aneurysms (VAA) frequently present as life-threatening emergencies. The purpose of this study was to review our experience with VAA treatment. Between 1988 and April 2002, 31 VAA were treated in 28 patients (14 males, 14 females) with average age of 55 +/- 15 years. The most common locations were the splenic artery (16) and the hepatic artery (7). Three patients underwent emergency surgery, 22 patients had elective open surgery, and 7 patients underwent endovascular treatment. In the surgical group the perioperative mortality rate was 3.6%. The perioperative morbidity rate was 7.1% (one case of respiratory distress manifested in the immediate postoperative period and one urgent case of bilious fistula). In the endovascular group none of the patients died; the perioperative morbidity rate was of 14.3% (one case of hepatic artery thrombosis after failure of gastroduodenal artery aneurysm embolization). Failure of the procedure was 42.9% (3 cases of aneurysm recanalization). In conclusion, we believe that an aggressive surgical approach is justified, even in the case of asymptomatic VAA, because of the low morbidity and mortality rates. Endovascular treatment should be reserved for selected cases.

Abdomen↗

PubMed2005

Fate of the visceral aortic patch after thoracoabdominal aortic repair.

OBJECTIVE: To analyse the fate of a visceral aortic patch (VAP) in patients that underwent thoracoabdominal aortic aneurysm (TAAA) repair. METHODS: We reviewed 204 consecutive patients (158 M, 46 F) treated for TAAA between 1988 and 2004. We performed VAP in 182 cases. Among the 149 survivors at 6 months, we followed 138 cases, mean follow-up 7 years (range 0.6-16 years). The mean graft diameter we used was 29mm (range 24-34mm) from 1988 to 1999 (83 patients), and 21.7mm (range 16-24mm) from 2000 to 2003 (55 patients). In 23% of cases we performed a separate bypass to the left renal artery. RESULTS: We observed 16 (12%) VAP dilatations (<5cm), 6 (4%) VAP aneurysms (>5cm) and one VAP pseudoaneurysm, at a mean time of 6 years after atherosclerotic TAAA was atherosclerotic repair. There were no VAP dilatations/aneurysms in the group of patients with separate left renal revascularization. Five VAP aneurysms were treated electively. In four cases the operation was performed with thoracophrenolaparotomy, in one case with a bilateral subcostal laparotomy. In all cases the visceral aorta was re-grafted. Reimplantation of a single undersized VAP was performed in one case, separate revascularization of visceral arteries was performed in the other four cases. Selective intraoperative hypothermic perfusion of visceral and renal arteries was used in all the patients. There was 1 perioperative death; 2 patients with preoperative renal failure required dialysis. The last VAP aneurysm has remained asymptomatic and stable at annual CT surveillance. The VAP pseudoaneurysm was successfully treated with an emergency thoracophrenolaparotomy and refashioning the left side suture line. CONCLUSIONS: Aneurysm of VAP is not uncommon in the patients operated on using larger grafts with a single VAP that includes the LRA (7.4%, 5/67 cases). Its treatment carries significant morbidity and mortality.

Aged↗

PubMed2003

Traumatic rupture of the thoracic aorta.

Traumatic rupture of the thoracic aorta is a life threatening situation, and may be secondary to several mechanisms; mainly penetrating or iatrogenic lesions and blunt trauma. Although penetrating mechanisms predominate, the number of patients with aortic disruption due to blunt trauma has continued to increase. This paper shows an overview focusing on the pathogenesis, diagnosis, timing and type of treatment regarding traumatic injuries of the thoracic aorta; it also reports the experience of one single center that deals with these lesions. The major difficulty in the evaluation data on blunt aortic injury is that retrospective reviews often group together patients with all types of aortic lesions, comparing outcomes for injuries in different locations, with diverse methods of repair and different surgeons and/or institutions.

Adolescent↗

PubMed2002

Impact of perioperative haemodynamic monitoring on cardiac morbidity after major vascular surgery in low risk patients. A randomised pilot trial.

OBJECTIVE: to evaluate whether perioperative haemodynamic optimisation influences outcome from infrarenal abdominal aortic aneurysm repair. METHODS: a consecutive series of 100 eligible patients were randomised to either haemodynamic optimisation through the use of a pulmonary artery catheter (CI > 3.0 l/min/sqm, PWP > 10 and <18 mmHg, SVR <1450 dyne/sec/cm(-5), DO(2)> 600 ml/min/sqm) or conventional treatment. RESULTS: there were no differences in terms of in-hospital mortality, cardiovascular morbidity, postoperative renal failure or duration of hospital stay between the groups. CONCLUSIONS: in this study perioperative haemodynamic optimisation was not beneficial.

Aged↗

PubMed2000

Endovascular treatment of a noninfected anastomotic juxtarenal aortic aneurysm.

An 82-year-old man underwent an endovascular procedure with a commercially available endovascular graft for an anastomotic juxtarenal abdominal aortic aneurysm. The anastomotic aneurysm, which showed no sign of infection, developed 4 years after implantation of an aortic end-to-end graft for an infrarenal aortic aneurysm. The aneurysm was diagnosed during routine ultrasonographic follow-up; there was no apparent infection of the graft. Aortography confirmed the diagnosis and also revealed a small pseudoaneurysm at the level of the distal aortic anastomosis. Endovascular surgery was performed in the operating room with the guidance of C-arm fluoroscopy and intravascular ultrasound. Two Vanguard Straight Endovascular Aortic Graft Cuffs (26 x 50 mm and 24 x 50 mm) were implanted, successfully excluding both the anastomotic juxtarenal aortic aneurysm and the distal pseudoaneurysm. The renal arteries were preserved and no early or late endoleaks were observed. The patient was discharged 2 days after the procedure. Sixteen months later, he was alive and well, with no endovascular leakage, no enlargement of the aortic aneurysms, and no sign of infection. In our opinion, this experience shows that commercially available endovascular grafts may be used successfully to treat anastomotic aortic aneurysms and pseudoaneurysms.

Aged↗

PubMed1999

Chlamydia pneumoniae eradication from carotid plaques. Results of an open, randomised treatment study.

OBJECTIVE: to determine the effect of specific antibiotic treatment with roxithromycin in the eradication of Chlamydia pneumoniae from carotid artery plaques. DESIGN: prospective open randomised treatment study. PATIENTS AND METHODS: we analysed 32 patients (16 females, mean age 70.1+/-14.7 years) who underwent surgery for the removal of atherosclerotic plaques from carotid arteries. During surgery samples of lingual vein and superior thyroid artery were also taken. Before surgery, patients were randomised to receive either roxithromycin 150 mg twice daily or no treatment. Sixteen patients were treated with antibiotic for a mean of 26 days (range 17-35 days). The two groups of patients were comparable in terms of age, sex, risk factors, and seroprevalence for C. pneumoniae. We applied a semi-nested polymerase chain reaction (PCR) technique to the carotid plaques, lingual vein, and thyroid artery samples. Blood samples were obtained from the patients for the determination of C. pneumoniae IgG, IgA, and IgM antibody titres by a microimmunofluorescence technique. RESULTS: in twelve out of sixteen non-treated patients we found evidence of C. pneumoniae DNA in the carotid plaques. Conversely, C. pneumoniae DNA was detected in only five out of sixteen treated patients (p=0.034, Chi-squared test). In all cases PCR was negative for the lingual vein and thyroid artery samples. CONCLUSIONS: Roxithromycin seems effective in reducing the bacterial burden of C. pneumoniae within atherosclerotic plaques, although extended follow-up is needed to determine whether antibiotic treatment benefits long-term patient outcome.

Aged↗

PubMed1999

Chlamydia pneumoniae DNA detection in peripheral blood mononuclear cells is predictive of vascular infection.

Abdominal aortic aneurysm tissue and peripheral blood mononuclear cells (PBMC) of 41 consecutive subjects undergoing abdominal aortic aneurysm surgery were analyzed by polymerase chain reaction (PCR) for the presence of Chlamydia pneumoniae, Mycoplasma pneumoniae, and Helicobacter pylori DNA. Twenty patients (49%) were positive for C. pneumoniae DNA-16 (39%) in both PBMC and aneurysm tissue, 3 (7.3%) in PBMC only, and 1 (2.4%) in the artery specimen only. Previous exposure to C. pneumoniae was confirmed in 19 (95%) of the 20 PCR positive subjects by C. pneumoniae-specific serology, using the microimmunofluorescence test. None was positive for H. pylori or M. pneumoniae DNA, either in the PBMC or in the artery specimens. In conclusion, carriage of C. pneumoniae DNA is common both in PBMC and in abdominal aortic tissue from patients undergoing abdominal aneurysm surgery. Blood PCR may be a useful tool for identifying subjects carrying C. pneumoniae in the vascular wall.

Aged↗

PubMedDate not supplied

Ruptured abdominal aortic aneurysm in the elderly patient.

The authors discuss several aspects of the management of ruptured abdominal aortic aneurysm in elderly patients. The cost-effectiveness and indications of repair of rAAA in elderly patients are analysed. A literature survey of risk-factors and results of open treatment of rAAA in elderly patients is made. The challenge of endovascular repair of rAAA in the elderly patient is discussed. Finally, the authors report their personnal experience with AAA repair in 163 patients aged 75 years and older, operated on between January 2003 and September 2005(89 endoaneurysmal stentgrafts and 74 open repairs, 42 rAAA,23 symptomatic AAA and 98 selective asymptomatic AAA).

Aged↗

PubMedDate not supplied

Celiac artery compression syndrome: successful laparoscopic treatment-a case report.

Several authors believe the crus of the diaphragm or the arcuate ligament is largely implicated in the etiology of the celiac artery compression syndrome (CACS). An unusual case of CACS successfully treated with laparoscopic decompression is reported. While under general anesthesia, the patient underwent laparoscopic division of the hypertrophic median arcuate ligament and dissection free of the celiac trunk. Postoperative angiography demonstrated improved flow in the celiac artery. The patient was discharged on the second postoperative day. At 6 months, Doppler ultrasound scanning and magnetic resonance angiography revealed good patency of the celiac trunk. The patient reported complete resolution of symptoms and increased weight. A laparoscopic approach allows the surgeon to sufficiently dissect the celiac axis. An excellent clinical result at short-term follow-up was attained. This is the second reported experience with this new procedure and the first successfully performed with only four port sites.

Arterial Occlusive Diseases↗