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Jefferson Hills, PA, United States

Hynes B.G.,Massachusetts General Hospital | Margey R.,Massachusetts General Hospital | Moran D.,University College Cork | Ruggiero N.J.,Section of Interventional Cardiology | And 3 more authors.
Acta Chirurgica Belgica | Year: 2010

Endovascular renal artery stent therapy for atherosclerotic renal artery stenosis (RAS) is associated with excellent acute technical success, low complication rates and acceptable long-term patency. However, the clinical benefits to patients of renal artery stenting remain uncertain. To facilitate debate regarding the treatment of RAS, we need to understand the epidemiology, basic physiology and clinical consequences of renal artery stenosis. We must attempt to determine which patients are likely to benefit from renal artery stenting, assess the nuances of the percutaneous procedure and review the current literature pertaining to renal artery stenting.

Troisi N.,Section of Vascular Surgery | Bichi S.,Section of Cardiac Surgery | Patrini D.,Section of Cardiac Surgery | Arena V.,Section of Cardiac Surgery | And 3 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2013

Objective: Open surgical replacement of the whole aorta in mega aorta syndrome remains a surgical challenge. We report our experience in the treatment of patients with mega aorta syndrome using a 3-stage hybrid repair. Methods: From January 2006 to December 2011, 12 patients with mega aorta syndrome underwent total replacement of the aorta with a 3-stage hybrid repair, consisting of total replacement of the arch (first stage), retrograde revascularization of the visceral vessels (second stage), and deployment of an endograft (third stage). The intraoperative, early (30-day), and follow-up results were analyzed. Results: No intraoperative mortality occurred in any of the open or endovascular procedures. After the first stage, 1 patient died, resulting in a 30-day mortality of 8.3%. After the second stage, the overall major morbidity was 27.3% (1 surgical revision and 2 temporary dialysis treatments). After the third stage, no conversion or major complication was recorded. The overall mean follow-up period was 31.9 months (range, 1-60 months). One patient died at 10 months postoperatively, and another patient required adjunctive implantation of a stent graft for a type III endoleak. At 3 years, the estimated survival, freedom from any device-related reinterventions, and freedom from type I endoleak was 83.3%, 77.9%, and 100%, respectively. Conclusions: Our hybrid 3-stage approach seems to be effective in the treatment of mega aorta syndrome. The second stage was affected by non-negligible rates of perioperative complications. The overall mid-term results were encouraging, although a larger sample size with longer follow-up is needed to compare this technique with others. Copyright © 2013 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery.

Troisi N.,Section of Vascular Surgery | Peretti E.,Section of Vascular Surgery | Esposito G.,Section of Vascular Surgery | Beretta A.,Section of Vascular Surgery | And 3 more authors.
Annals of Vascular Surgery | Year: 2013

Mycotic aortic aneurysm is a not-so-rare condition and its modalities of treatment are still debated. Graft detachment represents a catastrophic complication after open repair of an abdominal aortic aneurysm. The dehiscence of a graft may have several causes, such as infection, fatigue of materials, and progression of the disease. In recent years, the use of the chimney technique has increased the applicability of endovascular aortic repair for challenging neck anatomies in the abdominal aorta. We report a case involving the use of the bailout chimney technique for graft detachment in a previously treated mycotic infrarenal aortic aneurysm. © 2013 Elsevier Inc. All rights reserved.

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