Current role of tever in acute and chronic dissection results in chinauvcd
Current Role of TEVER in Acute and Chronic Dissection: Results in China discusses the increasing rates of acute and chronic type B aortic dissection in China, with over 15,000 new cases annually. While there are no standardized treatment guidelines in China, TEVAR is commonly used to treat over 70% of cases, especially those with complications. The use of TEVAR has grown significantly in China since the first case in 1999, with over 12,000 cases treated in 2012. The summary discusses developments in TEVAR techniques and management strategies used in China for various aortic dissection cases and complications.
Endo vascular treatment of infected aa as is surgıcal draınage and debrıdemen...uvcd
1) Endovascular treatment of infected abdominal aortic aneurysms (AAAs) is an alternative to open surgery that provides less invasive and rapid aneurysm exclusion with prompt bleeding control.
2) Successful endovascular repair requires broad-spectrum antibiotics, adjunct procedures like surgical debridement for eliminating infection sources, and prolonged antibiotic therapy.
3) Endovascular repair alone may be sufficient for well-controlled infections, while unstable patients may require additional drainage; long-term antibiotic therapy is always needed.
Current role of tever in acute and chronic dissection results in chinauvcd
Current Role of TEVER in Acute and Chronic Dissection: Results in China discusses the increasing rates of acute and chronic type B aortic dissection in China, with over 15,000 new cases annually. While there are no standardized treatment guidelines in China, TEVAR is commonly used to treat over 70% of cases, especially those with complications. The use of TEVAR has grown significantly in China since the first case in 1999, with over 12,000 cases treated in 2012. The summary discusses developments in TEVAR techniques and management strategies used in China for various aortic dissection cases and complications.
Endo vascular treatment of infected aa as is surgıcal draınage and debrıdemen...uvcd
1) Endovascular treatment of infected abdominal aortic aneurysms (AAAs) is an alternative to open surgery that provides less invasive and rapid aneurysm exclusion with prompt bleeding control.
2) Successful endovascular repair requires broad-spectrum antibiotics, adjunct procedures like surgical debridement for eliminating infection sources, and prolonged antibiotic therapy.
3) Endovascular repair alone may be sufficient for well-controlled infections, while unstable patients may require additional drainage; long-term antibiotic therapy is always needed.
Endovascular repair for type b aortic dissection with visceruvcd
This document discusses endovascular repair for type B aortic dissection and reports the following key findings:
1. 926 cases of aortic dissection were treated with endovascular repair, with some experiencing ischemia of visceral arteries like the celiac, SMA, and renal arteries.
2. Emergency TEVAR was performed in 74 cases to treat visceral artery ischemia, while 5 others received conservative treatment first before undergoing TEVAR.
3. All cases of visceral artery ischemia were successfully treated with endovascular repair. Follow-up ranged from 7 to 122 months, and mid-term results were successful and durable.
The document discusses options for difficult forearm arteriovenous fistula (AVF) access for hemodialysis. It describes using basilic or cephalic vein transposition in the forearm when wrist AVF is not available or has failed. The author presents case studies and results from 82 patients who underwent basilic or cephalic vein transposition, finding 96% primary patency and 87% secondary patency after a mean follow up of 32.5 months. Complications occurred in 17% of cases and were mostly treated conservatively without loss of the fistula. The conclusions emphasize that autogenous AVF using transposed forearm veins can provide good patency and should be emphasized for long-term hemod
Experience in management of complicated vascular injuryuvcd
1) This study reviewed 850 patients with complex vascular injuries in Yemen between 1999-2012. Most injuries were due to penetrating trauma (87%) rather than blunt trauma (13%) and involved arteries, veins, bones and soft tissues.
2) Vascular reconstruction was commonly needed and included interposition vein grafts (48%), primary artery repair (10%), and synthetic grafts (5%). Skeletal trauma often required external or internal fixation (78% and 7% respectively).
3) Morbidity and mortality rates were significant, including re-operation (4.2%), renal failure (2.7%), graft rupture (2.7%), primary amputation (3.3%), secondary amputation (4%), and
How should recently symptomatic patients be treated urgent cea or casuvcd
Recent symptomatic patients with carotid artery stenosis can be treated with either urgent carotid endarterectomy (CEA) or carotid artery stenting (CAS). While early studies found CEA to have better outcomes, more recent trials like CREST showed comparable rates of stroke and death between CEA and CAS. For recently symptomatic patients specifically, CEA may still be preferred to CAS due to concerns about stabilizing carotid plaque after stenting. Operator experience also impacts outcomes, so treatment should be individualized based on each patient's clinical situation.
Behcet s disease new concepts in vascular involvementsuvcd
This document discusses Behcet's disease, a inflammatory disorder characterized by recurrent oral and genital ulcers. It was first described by Dr. Hulusi Behcet in 1937. The document summarizes the epidemiology, pathophysiology, clinical manifestations especially related to vascular involvement, treatment approaches, and the author's experience treating vascular complications through endovascular and open surgical procedures. Key points are that Behcet's disease has higher prevalence along the Silk Road, vascular involvement can include aneurysms and thrombosis, and endovascular repair may be preferable to open surgery for treating aneurysms to avoid complications from anastomoses.
Early cannulation a new model in delivering hemodialysisuvcd
This document summarizes a presentation on early cannulation vascular access grafts. It discusses the guidelines recommending fistulas over catheters and grafts. Several early cannulation graft models are described, including the Vectra, AVflo, Gore Acuseal and Flixene grafts. These grafts aim to allow cannulation within 24 hours through multilayer designs. Studies show fistulas have higher primary and secondary patency rates than grafts at 6 and 18 months, but early cannulation grafts may achieve patency rates closer to fistulas. Early cannulation grafts are indicated when early access is needed to avoid catheters or for interposition when no vessels are available for a fistula.
Drug eluting balloons for critical limb ischaemia (cli)uvcd
- Dr. Steven Kum is a vascular surgeon at Changi General Hospital, where 12.7% of adults are diabetic and they see an average of 1 case of critical limb ischemia (CLI) per day mostly due to diabetes.
- Their vascular team handles revascularization and wound care/reconstruction for CLI patients, often performing simultaneous procedures in a hybrid operating room.
- Their CLI treatment strategy involves revascularization followed by wound cleaning, granulation and skin coverage/reconstruction. They discuss how drug-eluting balloons (DEBs) can help with revascularization and controversies around their use.
- Early results show DEBs may provide prolonged patency for treating CLI, which allows for faster wound healing and reduced risk
Makale Bulgular Her bir makalenin bulgular nelerdir ve sz .pdfabhitravel01
Makale Bulgular
Her bir makalenin bulgular nelerdir ve sz konusu salk sorununu zmek iin bireysel ve toplu olarak
ne gibi karmlar vardr? Cevabnz alannzdan belirli rneklerle destekleyin.
Her bir makaledeki temel biyoistatistiksel hesaplamalarn ve yntemlerin sonular nasl
desteklediini aklayn. Cevabnz destekleyen makalelerden ilgili bilgileri alntlayn.
Bulgular
Transfemoral anjiyografi sonras vcut pozisyonu deitirmenin fizibilite ve gvenliinin deerlendirilmesi:
Randomize bir klinik aratrma makalesi (Valiee, Fathi, Hadizade, Roshani ve Mahmoodi, 2016).
Bulgular
Toplam 86 (erkek, n = 41; kadn, n = 45) denek
almay tamamlad, her grupta ortalama yala 43
63 yl (SD = 9, aralk 3475). Elli alt (%65) kii
ya hi rgn eitim almam ya da
ilkokul seviyesindeydi ve sekizi (%9,3) niversite mezunuydu.
eitim. Deneklerin ounun (%65.1) aylk bir ailesi vard.
gelir <HK$8000 (yaklak 1000$). Yetmi bir
hastalar (%82,6) emekli veya ev hanmyd. tablo 1
asndan iki grubun nemli lde farkl olmadn gstermektedir.
ya, cinsiyet, eitim dzeyi ve aylk hane geliri.
Meslek durumu ikisi arasnda nemli lde farklyd
daha fazla emekli denek ieren gruplar (ki-kare, P = 0009)
Kontrol gruplar, ancak deneyde daha fazla ev hanm
grup.
vaskler adan iki grup arasnda fark yoktu.
komplikasyonlar. Kontrolde bir konu ve hibiri
deney grubunda ponksiyon yerinde kanama geliti
hemostaz yeniden salamak iin manuel basn gerektiren
(Fisher'n kesin testi, P=1). Tekrarlanan lm analizi
boyunca yaanan srt arsn deerlendirmek iin varyans kullanlmtr.
zaman ve gruplar arasnda. nemli bir fark vard
Arkada zaman aralnda iki grup arasnda
kontrol ile ar iddeti (F2,83 = 980, P < 0001)
her zaman aralnda daha fazla ar bildiren grup. Dahas,
iki grup ayn zamanda riner rahatszlkta da nemli lde farkllk gsterdi
(t656 324, P = 0006) kontrol grubu ile
daha yksek idrar rahatszl seviyeleri (Tablo 1).
uygulama iin karmlar
Sonular, erken ambulasyonun bir rol oynayabileceini dndrmektedir.
srt arsn ve idrar rahatszln azaltmada nemli bir rol
post-transfemoral kardiyak kateterizasyonda. Hastalara izin verme
aadaki drt saatlik yatak istirahatinden sonra yataktan kalkmak iin
kardiyak kateterizasyon rutin hale getirilebilir
gvenli olduu ve olabilecei iin Hong Kong'da uygulama
artrmadan hasta konforunu artrmaya yardmc olur.
vaskler komplikasyon insidans. Ayrca, daha ksa
yatak istirahati sresi, bebek iin gerekli hemirelik sresini azaltabilir.
srt arsn hafifletmek iin analjezikler veya srt ovma uygulamak.
Kalp kateterizasyonundan sonra erken ambulasyon da
hastalarn kullanmasna yardmc olmak iin gereken hemirelik sresini azaltmak
ilem sonras yatak istirahati sresince pisuar ve srg.
.
YNTEM
alma, iki klinikte tek kr randomize bir klinik almadr.
Krdistan niversitesi tarafndan onaylanan gruplar
Tp Bilimleri Aratrma Konseyi. almann nerisi u
(www.irct.com) adresinde kayt numaras ile kaytl
IRCT2015091424018N1.
lm aleti
Bu belgede bilgi toplamak ve kaydetmek iin kullanlan ara
gre tasarlanm blmden oluan bir ankettir.
alma.
lk blm demografik ve klinik bilgi form.
10 Nisan, Canlı Donörden Akciğer Nakli Aile Bilgilendirme ToplantısıKifDER
KİFDER tarafından düzenlenen "Canlı Donörden Akciğer Nakli Aile Bilgilendirme Toplantısı"nda Doç. Dr. Ömer Şenbaklavacı, canlı donörden akciger nakli hakkında bilgi verdi.
Similar to Guncel calısmaların isiginda karotis arter darliginda karotis arter stentlemesi (20)
Kardiyopulmoner bypass ve miyokardiyal koruma dr. bilgin emrecan
Guncel calısmaların isiginda karotis arter darliginda karotis arter stentlemesi
1. Güncel Çal malar n I nda Karotis Arter Darl nda Karotis Arter Stentlemesiış ı şığı ığı
Doç. Dr. H. Tankut Akay
Başkent Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Anabilim Dalı
Ulusal Vasküler Cerrahi Derneği Kongresi
27-30 Ekim 2011 Antalya
2. Son 3 yılda endovasküler olarak karotis arter revaskülarizasyonunda belli
başlı gelişmeler olmuştur
1) Primer strok önleme çalışmalarının sonuçları
2) Emboli önleme cihazlarındaki yenilikler
3) Yüksek riskli karotis arter stent hastasının (CAS) detaylı tanımlanması
4) Yüksek riskli karotis arter stent hastasının (CAS) takip sonuçlarının
tamamlanması
5) Ortalama riskteki hastalarda CAS ile CEA yı kıyaslayan 4 büyük
randomize klinik çalışmanın tamamlanması
3. Primer strok önleme çalışmalarının sonuçları
JUPITER (Justification for the Use of statins in Prevention: an
Intervention Trial Evaluating Rosuvastatin)
MRC/BHF Heart Protection Study of cholesterol lowering with
simvastatin in 20,536 high-risk individuals: a randomised
placebocontrolled trial. Lancet 2002;360:7–22.
Amarenco P, Bogousslavsky J, Callahan A III, et al. High-dose
atorvastatin after stroke or transient ischemic attack. N Engl J Med
2006;355:549 –59.
Biller J, Feinberg WM, Castaldo JE, et al. Guidelines for carotid
endarterectomy: a statement for healthcare professionals from a special
writing group of the Stroke Council, American Heart Association.
Stroke 1998;29:554–62.
4.
5.
6. Aortik ark içinde Kateter kılavuz tel manuplasyonunu uzatan herşey CAS
riskini arttırır.
Komplex tip 3 aortik ark
Sirkümferensiyel kalsifik lezyon
ICA da ciddi açılanma
Tortioz CCA
Arkus aortada ciddi kalsifikasyon
multiple lakunar enfarktlar
serebral mikroanjiopatiler
koagulasyon bozuklukarı,
Zor vasküler erişim
Renal sorunlar
9. SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High
risk for Endarterectomy)
CREST (Carotid Revascularization Endarterectomy and Stenting Trial)
EVA-3S [Endarterectomy versus Angioplasty in Patients with
Symptomatic
Severe Carotid Stenosis]
SPACE [Stent-Supported Percutaneous Angioplasty of the Carotid
Artery versus Endarterectomy]
ICSS [International Carotid Stenting Study]
İşlemi yapan kişilerin tecrübezisliği yüzünden çalışmanın sonuçları
etkilendi
10. EPD (emboli protection device)
•Henüz EPD için yapılan randomize kontrollü bir çalışma mevcut değil
•Bir çok kişi faydalı olduğuna inanıyor
•MEDICARE yakın gelecekte FDA onaylı EPD kullanılmazsa ödeme
yapmayacak
Meta analiz
Garg N, Karagiorgos N, Pisimisis GT, et al. Cerebral protection
devices reduce periprocedural strokes during carotid angioplasty and
stenting: a systematic review of the current literature. J Endovasc Ther
2009;16:412–27.
11. CAS da esas sorun komplex arkusta kateter manuplasyonuna bağlı emboli
oluşması
Bazen kontrlateral hemisferde de
•Faggioli G, Ferri M, Rapezzi C, Tonon C, Manzoli L, Stella A.
Atherosclerotic aortic lesions increase the risk of cerebral embolism
during carotid stenting in patients with complex aortic arch anatomy. J
Vasc Surg 2009;49:80 –5.
•EPD koruyucu
12. Mekanik Koruma
3 şekilde yapılabilir. Distal ve proksimal oklüzyon ve distal filtre teknikleri.
Proximal oklüzyon balonu kullanmak daha da etkili
Kim SJ, Roh HG, Jeon P, et al. Cerebral ischemia detected with
diffusion-weighted MR imaging after protected carotid artery stenting:
comparison of distal balloon and filter device. Korean J Radiol
2007;8:276–85.
Garami ZF, Bismuth J, Charlton-Ouw KM, Davies MG, Peden EK,
Lumsden AB. Feasibility of simultaneous pre- and postfilter transcranial
Doppler monitoring during carotid artery stenting. J Vasc Surg
2009;49:340–4, 345.e1–2, discussion 345.
13. Açık stentler daha flexible ve tortioz
lezyonlarda daha uygun
Kapalı stentler lezyonlu bölgeyi daha iyi
kapsıyor
14. Stent tipi hakkında bazı yayınlarda değişik görüşler olsa da yapılan büyük
çalışmalarda stent tipinin çok etkili olmadığı gösterilmiştir.
Schillinger M, Gschwendtner M, Reimers B, et al. Does carotid stent
cell design matter? Stroke 2008;39:905–9.
15. Yüksek Riskli Hasta Grubu
SAPPHIRE
(Stenting and Angioplasty with Protection in Patients at
High risk for Endarterectomy) çalışması yüksek riskli hastalardaki CEA ve CAS
sonuçlarını kıyaslayan çok merkezli randomize TEK çalışmadır.
Cerrahlar yıllık 30 CEA (15 - 100),
Girişimselciler 64 CAS ( 20 -700).
1 yılın sonunda CEA için primer endpoint 20.1%,ve CAS için 12.2%
3 yılın sonunda ise gruplar arasında fark yok
16. Orta riski hasta grubu
CREST (Carotid Revascularization Endarterectomy and Stenting Trial)
ABD ve Kanada (EPD standart ve tecrübeli girişimciler)
EVA-3S [Endarterectomy versus Angioplasty in Patients with Symptomatic
Severe Carotid Stenosis]
SPACE [Stent-Supported Percutaneous Angioplasty of the Carotid Artery
versus Endarterectomy]
ICSS [International Carotid Stenting Study]
İşlemi yapan kişilerin tecrübezisliği yüzünden çalışmanın sonuçları etkilendi
17. The EVA-3S
Deneyimsiz kişilerin de uyguladığı CAS.
EPD opsiyonel
ÇALIŞMA DURDURULDU
30-günlük strok oranı CAS da çok yüksek (9.6%, p 0.004 CEA da 3.9%)
EPD kullanılmayan hastalarda strok oranı 3 kat fazla
18. SPACE
CAS ve CEA arasında fark yok,
Strok ve ölüm oranı %6.8 ve %6.3
ICSS çalışmasında
Strok ve ölüm oranında(CAS 4.0% vs. CEA 3.2%, p 0.34) fark yok
Minör strokta CAS grubunda daha fazla
19. CREST
2,502 orta cerrahi risk
semptomatik (53%) ve asemptomatik (47%)
Periprosedürel olaylar arasında fark yok (major strok, MI, ölüm).
Takipte CAS grubunda minor strok çok belirgin ( %4.1 e % 2.3)
CEA grubunda MI 2 kat fazla
20.
21.
22.
23.
24.
25.
26.
27. Sonuç
-CAS ta inme oranı hala daha fazla
-İşlemi yapan kişinin tecrübesi anahtar rol oynuyor
- EPD kullanımı son derece önemli
Stentler ilerleyen dönemlerde de kullanımda olacaktır
Teşhis , planlama ve takip kademelerinde
Nörolog, Vasküler cerrah ve girişimsel radyolog kooperasyonu önemli