China
Africa
Explore chapters and articles related to this topic
Complications of open aortofemoral bypass
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Preoperative workup traditionally included formal diagnostic angiogram, however that has largely been replaced by noninvasive axial imaging, including CTA or MRA to delineate the extent of the disease. The Trans-Atlantic Intersociety Consensus (TASC II) document has helped dictate first-line therapy depending on extent of disease. Percutaneous balloon therapy is often sought as first-line therapy in patients with TASC A or B lesions (focal, short segment lesions 3–10 cm, unilateral or bilateral). Open revascularization is generally reserved for those with long segment occlusions or diffuse disease.1 With the advancement of endovascular techniques and equipment, aortobifemoral bypass (ABF), which had long been considered the gold standard for aortoiliac occlusive disease, is increasingly now reserved for more complex patients. This impact has been two-fold in consideration of perioperative complications: surgeons are performing a lower volume of open surgery, and those surgeries are reserved for patients with more demanding anatomy, often in the setting of previous percutaneous failure. This trend in the management of aortoiliac occlusive disease makes awareness of the complications of ABF of the utmost importance for any surgeon performing this procedure, to both mitigate the risk and appropriately identify and manage any complication that may occur.
Vascular Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Yiu-Che Chan, John Wang, Julian Wong, Edward Choke, Tjun Tang
CT-A shows severe aortoiliac occlusive disease, near occlusion of the aortic bifurcation and bilateral common iliac arteries, and patent external iliac arteries. How will you counsel this patient for therapy?Lifestyle modification with smoking cessation is imperative for limiting progression of disease, reducing perioperative major adverse cardiovascular events, and durability of revascularisation, be it open surgery or endovascular surgery.Open surgical revascularisation is achieved with aorto-bi-iliac bypass and is appropriate for young patients due to its superior long-term patency. It has notable morbidity (20% that include bleeding, infection, pneumonia, renal failure, peri-operative myocardial infarction, bowel ischaemia) and mortality (1%–3%).13Endovascular revascularisation can be achieved with bilateral iliac stenting (with kissing stents) or covered endovascular reconstructions of aortic bifurcation (CERAB).13,14 Both have good short and intermediate term patency (5 years) but long-term data are scant. The morbidity and mortality for endovascular revascularisation is recognisably lower than open surgery.
Complex lower extremity revascularization
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
There are several treatment options available for iliac artery occlusive disease. The previous gold standard of aortobifemoral bypass is rarely performed. Other open options include a variety of extra-anatomic bypasses, such as axillofemoral bypass and femoral–femoral bypass. A combination of extra-anatomic bypass and some endovascular inflow may also be performed. Previous treatment for unilateral iliac artery occlusion was frequently a femoral–femoral bypass. The vast majority of patients with aortoiliac occlusive disease can be treated with endovascular techniques, including most patients with TASC D lesions. Currently available tools permit recanalization of most iliac artery occlusions. Unilateral iliac artery occlusion is most common and there is often stenosis of the contralateral side. Bilateral iliac artery occlusions may also be treated using a bilateral endovascular approach. If one of the iliac arteries can be reopened and the other one cannot, stenting on one side can be performed followed by a femoral–femoral bypass.
Effect of conservative treatment in aortoiliac occlusive disease
Published in Acta Chirurgica Belgica, 2020
W. Wen, G. H. Ho, E. J. Veen, H. G. W. de Groot, M. G. Buimer, L. van der Laan
Aortoiliac occlusive disease (AIOD) refers to peripheral arterial disease (PAD) that affects the aorta and iliac arteries, often referred to as proximal or inflow disease. AIOD lesions can range from a solitary short-segment stenosis to multiple areas of stenosis and occlusions to complete infrarenal aortic occlusion [1]. The most common and the mildest clinical manifestation of PAD is intermittent claudication (IC). As the population ages, the prevalence of IC will increase about 3% in patients aged 40 and 6% in patients aged 60 years [1]. Newman et al. [2] reported a prevalence of 13.4% in those over 65 years of age, rising to 21.6% in those over 75 years. Risk factors for the development of PAD include age, smoking, male gender, non-white race, diabetes, hypercholesterolemia, hypertension, hypercoagulability, renal insufficiency, and presence of certain inflammatory markers such as C-reactive protein [1,3,4]. More importantly, PAD is a powerful predictor of future cerebrovascular and cardiovascular events such as myocardial infarction and stroke, and is responsible for increased mortality [4,5]. Patients with IC have a twofold increase in age-specific risk of death and a loss of 10 years in life expectancy [6]. The treatment of IC consists of optimal pharmacotherapy with supervised exercise therapy (SET) or/and with revascularization, endovascular or surgical [7]. For femoropopliteal (FP) disease, SET has become the first treatment of choice [8]. When activities of daily life are compromised despite SET, then endovascular revascularization (EVR) is considered. For aortoiliac (AI) disease, SET remains underutilized. Primary EVR is often performed in patients with AIOD [9–12], especially with the upcoming Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) technique for complex AIOD cases [13,14]. However, not every AI lesion is suitable for EVR and an operative revascularization is often too invasive for high-risk patients with numerous comorbidities.
Two cases of vascular complications after urologic robotic surgery
Published in Acta Chirurgica Belgica, 2023
Charles-Edouard Gielen, Yves Pignez, Charles Swaelens
Peripheral arterial disease (PAD) of the lower extremity is common. For example, 8 to 12 million Americans suffer from it [1,3]. In a large series, half of all the patients suffering from PAD have an aortoiliac occlusive disease (AIOD) [2,3].