Sebastián Baldi - Academia.edu (original) (raw)

Papers by Sebastián Baldi

AJNR. American journal of neuroradiology

Two types of balloon are usually employed to perform balloon-assisted coil placement in cerebral ... more Two types of balloon are usually employed to perform balloon-assisted coil placement in cerebral aneurysms: oval, guide-dependent balloons for sidewall aneurysms and round balloons for bifurcation aneurysms. We report on the use of a new, more compliant, guide-dependent oval balloon microcatheter to seal wide-neck bifurcation aneurysms with coils during endovascular occlusion.

Minimally Invasive Therapy & Allied Technologies, 2010

Hemodynamic depression (HD) is a frequent complication related to carotid endartherectomy or caro... more Hemodynamic depression (HD) is a frequent complication related to carotid endartherectomy or carotid artery stenting (CAS), often not well tolerated in patients with coronary artery disease. The purpose of this study is to assess whether CAS without angioplasty is beneficial in patients with severe carotid artery disease before coronary revascularization surgery (CABG) regarding the occurrence of HD. Between October 2002 and August 2006, 39 CAS were performed in 35 patients before cardiac surgery. Outcome measures, including periprocedural and 30-day post stenting and cardiac surgery complications, were assessed. Twenty-seven patients underwent CABG and eight combined CABG and valve replacement. During or immediately after CAS there was no episode of bradycardia or hypotension necessitating medical treatment. In the period between CAS-CABG, there was no case of HD. We also found no myocardial infarction. There were five neurological complications, two of them in the period between CAS-CABG (one transitory ischemic attack (TIA) and one minor stroke) and three after CABG (one TIA and two strokes). Three of them were discharged symptom-free. CAS without angioplasty can be a safe alternative to treat patients with coexistence of carotid and cardiac disease, since does not produce hemodynamic depression, therefore diminishing the cardiac complications.

Journal of Vascular and Interventional Radiology, 2007

Endovascular treatment of aortoiliac aneurysms near or involving the hypogastric artery (HGA) req... more Endovascular treatment of aortoiliac aneurysms near or involving the hypogastric artery (HGA) requires HGA occlusion before endografting to avoid retrograde filling of the aneurysm. The purpose of this study is to evaluate clinical outcomes of bilateral HGA occlusion and determine if benefits gained by endovascular aneurysm repair (EVAR) outweigh the morbidity associated with the procedure. MATERIALS AND METHODS: Between 1999 and 2004, 128 patients with abdominal aortic aneurysm (AAA) were treated with bifurcated endograft placement. Bilateral coverage or embolization of HGAs was performed in 14 patients (10.9%). Embolization was achieved by deployment of coils and coverage was accomplished by extending the endoprosthesis into the external iliac artery. Clinical follow-up and computed tomographic angiography were performed at 1, 3, 6, 9, and 12 months and annually thereafter to detect potential aneurysm growth and endoleaks. RESULTS: During follow-up (range, 1-72 months), buttock claudication was noted in four patients (28.6%), including unilateral claudication in two and bilateral claudication in two. One patient experienced claudication longer than 12 months, which resolved within 18 months. De novo erectile dysfunction was seen in one patient, and pelvic ischemia was not found in any patient. There was no evidence of endoleak, aneurysm enlargement, or death associated with HGA occlusion. CONCLUSIONS: In our series, complications of bilateral HGA occlusion before EVAR were moderate and resolved over time. The benefits gained from EVAR outweigh the clinical problems caused by bilateral HGA occlusion, as there are no technical complications added to the EVAR procedure.

CardioVascular and Interventional Radiology, 2008

Endoleak is a frequent complication after endovascular repair of aortic rupture. We describe the ... more Endoleak is a frequent complication after endovascular repair of aortic rupture. We describe the case of a female patient with traumatic aortic injury, treated with endograft, who developed a type II endoleak through the left subclavian and vertebral arteries. Both arteries originated independently from the aortic arch, and were managed with coil embolization of each vessel. We also report our experience with treating the left vertebral artery by placing a microcatheter through the right vertebral one.

American Journal of Neuroradiology, 2007

BACKGROUND AND PURPOSE: A major concern during carotid artery stent placement is the potential fo... more BACKGROUND AND PURPOSE: A major concern during carotid artery stent placement is the potential for cerebral embolism. Diminishing the number of device manipulations across the lesion might reduce procedural stroke risk. For this purpose, we report our initial experience with carotid stent placement without the use of either balloon angioplasty or distal protection devices. MATERIALS AND METHODS: Eighty-seven consecutive patients with 100 carotid stenoses compose this series. Ninety four of the 100 hundred stented carotid arteries were either symptomatic (58 [58%]) or had a greater than 70% stenosis (36 [36%]). Six percent of them were asymptomatic and had stenosis between 50% and 70%. Patients underwent neurologic evaluation before the procedure and during follow-up at 1, 3, 6, and 12 months and annually thereafter. Carotid sonography and plain films of the neck were performed immediately after the procedure and then at the same time intervals. RESULTS: Primary stent placement was successful in 98 of 100 case subjects. In 2 case subjects, predilation was necessary before stent deployment. Neurologic periprocedural complications included 1 nondisabling and 1 disabling stroke and 5 transient ischemic attacks. The mean duration of follow-up was 23 months (range: 10-36 months). During the follow-up period, there were 5 deaths, all unrelated to the carotid disease, and no major stroke. The degree of stenosis decreased from a mean of 78.85% before the procedure to a mean of 21.23% immediately after. CONCLUSIONS: In this series, carotid stent placement without the use of either balloon angioplasty or distal protection devices was safe and effective with a low incidence of periprocedural complications.

AJNR. American journal of neuroradiology

Platelet-derived thrombi may occur during intracranial aneurysm coiling. We report a series of 13... more Platelet-derived thrombi may occur during intracranial aneurysm coiling. We report a series of 13 patients treated with intraarterial Abciximab for thrombus formation complicating aneurysm coiling. Four patients were treated for acutely ruptured aneurysms. Three procedures consisted of the retreatment of previously coiled aneurysms. Six patients had asymptomatic untreated aneurysms. Abciximab was administered intraarterially through a microcatheter as a bolus of 4-10 mg over a period of 10-20 minutes. All patients underwent postthrombolysis control angiography. They also underwent immediate pre- and postoperative cranial CT. In 10/13 cases, the thrombi developed without coil protrusion into the parent artery. In one case, the thrombus was generated from the guiding catheter and embolized remote from the aneurysm site. In one case, the thrombus developed before any coil placement. In another patient, a coil loop protruded into the parent artery favoring a heightened thrombotic state....

CardioVascular and Interventional Radiology, 2009

Endovascular or surgical treatment of femoropopliteal bypass (FPB) graft occlusion is a safe and ... more Endovascular or surgical treatment of femoropopliteal bypass (FPB) graft occlusion is a safe and effective procedure. However, there are some reports that recommend thrombolysis as an initial therapy [1, 2]. In situ thrombolysis (ITL), with later percutaneous transluminal angioplasty (PTA) of any anastomotic stenoses, is the usual endovascular therapy for this condition [1, 2]. On the other hand, there are cases where ITL, as well as primary stenting, may be contraindicated because of the relative risk of distal embolization [3]. We report a case of acute occlusion of a femoropopliteal prosthetic bypass graft where ITL was contraindicated, which was successfully treated with primary stenting. To our knowledge, this is the first report of primary stenting in acute FPB occlusion.

i i 101 Resumen OBJETIVO: El objetivo de este trabajo es evaluar los resultados a largo plazo del... more i i 101 Resumen OBJETIVO: El objetivo de este trabajo es evaluar los resultados a largo plazo del tratamiento endovascular de los aneurismas poplíteos. MATERIAL Y MÉTODOS: Estudio retrospectivo de pacientes tratados por aneurismas poplíteos en el periodo comprendido entre junio de 2002 y agosto de 2009. En todos los casos se utilizo el stent autoexpan-dible de nitinol Hemoban/Viabahn ®. Se trataron 12 aneurismas en 11 pacientes, con una edad media de 65 años. El 17.6 % se encontraban asintomáticos, el 50 % presentaba claudicación intermitente y el 32.4 % restante isquemia critica. El seguimiento se realizo al mes, 3, 6 meses, al año y anualmente. RESULTADOS: El éxito técnico se consiguió en el 100% de los casos sin complicaciones durante los 30 días post tratamiento. La media de seguimiento fue de 34 meses. Se registraron 3 oclusiones, dos de ellas se recanalizaron mediante tra-tamiento fibrinolítico. La permeabilidad primaria durante el seguimiento fue del 75 % y 92 % la secundaria...

CardioVascular and Interventional Radiology, 2009

The aim of this study was to evaluate the effectiveness of endovascular repair in the treatment o... more The aim of this study was to evaluate the effectiveness of endovascular repair in the treatment of isolated iliac artery aneurysm (IAA) using Excluder bifurcated endograft. Eight consecutive patients with IAA were treated during a period of 45 months using Excluder bifurcated endograft. Two patients presented with isolated IAA rupture and were treated emergently, whereas the other six patients underwent elective treatment. All aneurysms lacked sufficient proximal necks and therefore were not suitable for tubular-shaped endograft. Follow-up imaging was performed at 1 week, at every 3 months during the first year, semiannually until 2 years, and annually afterward using angio-computed axial tomography and plain films. Technical success was achieved in all patients. No mortality was seen despite two patients having IAA rupture. Follow-up (12 to 60 months) was done in all but one patient. During this period, complications were observed in three patients. One patient developed sexual impotence at 3-month follow up; one patient presented unilateral gluteal claudication after the procedure, which resolved at 3 months; and one patient developed a graft porosity-related endoleak, which was successfully managed with placement of an additional ipsilateral iliac extension. Endovascular treatment of isolated IAA using bifurcated endograft is safe and can be an alternative to surgical treatment. The benefits from decreased morbidity and mortality of endoluminal treatment of isolated IAA using bifurcated endograft outweigh the minor complications associated with this technique, which are mostly related to occlusion of hypogastric arteries.

Rev Argent Radiol, Mar 1, 1999

Journal of Vascular and Interventional Radiology, 2011

Purpose: To report long-term outcome when using a bifurcated aortic endograft for treatment of ao... more Purpose: To report long-term outcome when using a bifurcated aortic endograft for treatment of aortoiliac occlusive disease (AIOD) in Trans Atlantic Inter Society Consensus (TASC) classification C and D patients. Materials and Methods: Between May 2001 and May 2009, 14 patients (11 men, 3 women) with aortoiliac TASC C and D type lesions and a mean age of 59 years Ϯ 10 (range 41-73 years) were treated using a bifurcated aortic endograft. Although these patients were young, all were considered at high surgical risk. Patients were followed up clinically and by computed tomography (CT) every 3 months for 1 year and yearly thereafter. Results: Endoprosthesis placement was performed in all patients with a technical success rate of 100%. There were no amputations or deaths at 30 days after the procedure. The mean follow-up was 62 months (range 11-96 months). One patient was lost during follow-up at 11 months, and another patient died of a nonrelated cause after 49 months. A single limb occlusion of the prosthesis was seen in two patients at 2 months and 7 months; both were successfully treated by intraarterial fibrinolysis. At a mean follow-up of 62 months, primary patency was 85.7%, and secondary patency was 100%. Conclusions: This series shows promising long-term results following the use of a bifurcated aortic endograft for treatment of AIOD TASC C and D type lesions. Bifurcated aortic endograft is a good minimally invasive alternative to open surgery in high surgical risk patients.

Annales de Chirurgie Vasculaire, 2009

ABSTRACT La dissection spontanée de l'artère mésentérique supérieure représente une cause... more ABSTRACT La dissection spontanée de l'artère mésentérique supérieure représente une cause rare d'angor intestinal. Son traitement conservateur ou ses traitements plus agressifs tels que la chirurgie ou le traitement endovasculaire dépendent des symptômes. Nous présentons un cas d'ischémie mésentérique aiguë due à la dissection spontanée de l'artère mésentérique supérieure traitée avec succès par la pose d'un stent endovasculaire. Dans la discussion nous passons en revue les différentes autres solutions thérapeutiques présentées dans la littérature.

Annals of vascular surgery

Spontaneous dissection of the superior mesenteric artery represents a rare cause of abdominal ang... more Spontaneous dissection of the superior mesenteric artery represents a rare cause of abdominal angina. Conservative or more aggressive treatments such as surgery or endovascular therapy depend on the symptoms. We present a case report of acute mesenteric ischemia due to spontaneous dissection of the superior mesenteric artery successfully treated by endovascular stent placement. In the discussion we review the different alternatives of treatment presented in the literature.

Minimally Invasive Therapy & Allied Technologies, 2010

Revascularization of infrainguinal vessels is still a challenge. Complications such as flow-limit... more Revascularization of infrainguinal vessels is still a challenge. Complications such as flow-limiting dissections or perforation are responsible for a limited success rate. Failed revascularization attempt leads to amputation in a significant number of patients and increases mortality. We report the use of a novel percutaneous device using the CROSSER catheter system in two patients with peripheral vascular disease. In case # 1 anterior tibial artery patency was restored in a diabetic foot and in case # 2 a chronic traumatic occlusion of the superficial femoral artery was revascularized. In both cases the lesion was recanalized in a short time without any procedure-related complications. The CROSSER catheter system can overcome technical problems and make reentry devices and retrograde distal accesses less relevant. It opens new horizons for the treatment of complex below-the-knee lesions.

Minimally Invasive Therapy & Allied Technologies, 2011

The nutcracker syndrome (NS) is a rare condition characterized by the entrapment of the left rena... more The nutcracker syndrome (NS) is a rare condition characterized by the entrapment of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta. Clinically, it presents with flank pain, hematuria, and symptoms of pelvic venous congestion. Several surgical techniques have been described including left renal vein (LRV) transposition, autotransplantation, LRV bypass, superior mesenteric artery (SMA) transposition, gonadocaval bypass and nephrectomy. More recently, endovascular stenting of the renal vein has been proposed. We present two patients with NS who were successfully managed endovascularly, providing satisfactory mid-term clinical and imaging results.

Minimally Invasive Therapy & Allied Technologies, 2011

We describe a case of a patient with a thoraco-abdominal aortic aneurysm, affecting the origin of... more We describe a case of a patient with a thoraco-abdominal aortic aneurysm, affecting the origin of the celiac trunk, with the particularity of the normal aortic diameter in the segment between superior mesenteric artery and both renal arteries. Endovascular treatment was performed with no fenestrated or branch endoprosthesis. The procedure was divided into two steps. In the first attempt, an aortic prosthesis was deployed at the infrarenal aorta. Then, a thoracic endoprosthesis was deployed in a second procedure. In this case, the celiac trunk was intentionally occluded in order to increase the distal landing zone. At the end, the segment between the superior mesenteric artery above and below the renal arteries was covered by the uncovered struts of both endoprosthesis, with no effects in visceral artery flow. Multislice computed tomographic angiography after six months revealed complete patency of the superior mesenteric artery, both renal arteries and good back-filling of the branches of the celiac axis, with no evidence of aortic endoleak.

Journal of the American College of Cardiology, 2010

Diabetes Research and Clinical Practice, 2010

AJNR. American journal of neuroradiology

Two types of balloon are usually employed to perform balloon-assisted coil placement in cerebral ... more Two types of balloon are usually employed to perform balloon-assisted coil placement in cerebral aneurysms: oval, guide-dependent balloons for sidewall aneurysms and round balloons for bifurcation aneurysms. We report on the use of a new, more compliant, guide-dependent oval balloon microcatheter to seal wide-neck bifurcation aneurysms with coils during endovascular occlusion.

Minimally Invasive Therapy & Allied Technologies, 2010

Hemodynamic depression (HD) is a frequent complication related to carotid endartherectomy or caro... more Hemodynamic depression (HD) is a frequent complication related to carotid endartherectomy or carotid artery stenting (CAS), often not well tolerated in patients with coronary artery disease. The purpose of this study is to assess whether CAS without angioplasty is beneficial in patients with severe carotid artery disease before coronary revascularization surgery (CABG) regarding the occurrence of HD. Between October 2002 and August 2006, 39 CAS were performed in 35 patients before cardiac surgery. Outcome measures, including periprocedural and 30-day post stenting and cardiac surgery complications, were assessed. Twenty-seven patients underwent CABG and eight combined CABG and valve replacement. During or immediately after CAS there was no episode of bradycardia or hypotension necessitating medical treatment. In the period between CAS-CABG, there was no case of HD. We also found no myocardial infarction. There were five neurological complications, two of them in the period between CAS-CABG (one transitory ischemic attack (TIA) and one minor stroke) and three after CABG (one TIA and two strokes). Three of them were discharged symptom-free. CAS without angioplasty can be a safe alternative to treat patients with coexistence of carotid and cardiac disease, since does not produce hemodynamic depression, therefore diminishing the cardiac complications.

Journal of Vascular and Interventional Radiology, 2007

Endovascular treatment of aortoiliac aneurysms near or involving the hypogastric artery (HGA) req... more Endovascular treatment of aortoiliac aneurysms near or involving the hypogastric artery (HGA) requires HGA occlusion before endografting to avoid retrograde filling of the aneurysm. The purpose of this study is to evaluate clinical outcomes of bilateral HGA occlusion and determine if benefits gained by endovascular aneurysm repair (EVAR) outweigh the morbidity associated with the procedure. MATERIALS AND METHODS: Between 1999 and 2004, 128 patients with abdominal aortic aneurysm (AAA) were treated with bifurcated endograft placement. Bilateral coverage or embolization of HGAs was performed in 14 patients (10.9%). Embolization was achieved by deployment of coils and coverage was accomplished by extending the endoprosthesis into the external iliac artery. Clinical follow-up and computed tomographic angiography were performed at 1, 3, 6, 9, and 12 months and annually thereafter to detect potential aneurysm growth and endoleaks. RESULTS: During follow-up (range, 1-72 months), buttock claudication was noted in four patients (28.6%), including unilateral claudication in two and bilateral claudication in two. One patient experienced claudication longer than 12 months, which resolved within 18 months. De novo erectile dysfunction was seen in one patient, and pelvic ischemia was not found in any patient. There was no evidence of endoleak, aneurysm enlargement, or death associated with HGA occlusion. CONCLUSIONS: In our series, complications of bilateral HGA occlusion before EVAR were moderate and resolved over time. The benefits gained from EVAR outweigh the clinical problems caused by bilateral HGA occlusion, as there are no technical complications added to the EVAR procedure.

CardioVascular and Interventional Radiology, 2008

Endoleak is a frequent complication after endovascular repair of aortic rupture. We describe the ... more Endoleak is a frequent complication after endovascular repair of aortic rupture. We describe the case of a female patient with traumatic aortic injury, treated with endograft, who developed a type II endoleak through the left subclavian and vertebral arteries. Both arteries originated independently from the aortic arch, and were managed with coil embolization of each vessel. We also report our experience with treating the left vertebral artery by placing a microcatheter through the right vertebral one.

American Journal of Neuroradiology, 2007

BACKGROUND AND PURPOSE: A major concern during carotid artery stent placement is the potential fo... more BACKGROUND AND PURPOSE: A major concern during carotid artery stent placement is the potential for cerebral embolism. Diminishing the number of device manipulations across the lesion might reduce procedural stroke risk. For this purpose, we report our initial experience with carotid stent placement without the use of either balloon angioplasty or distal protection devices. MATERIALS AND METHODS: Eighty-seven consecutive patients with 100 carotid stenoses compose this series. Ninety four of the 100 hundred stented carotid arteries were either symptomatic (58 [58%]) or had a greater than 70% stenosis (36 [36%]). Six percent of them were asymptomatic and had stenosis between 50% and 70%. Patients underwent neurologic evaluation before the procedure and during follow-up at 1, 3, 6, and 12 months and annually thereafter. Carotid sonography and plain films of the neck were performed immediately after the procedure and then at the same time intervals. RESULTS: Primary stent placement was successful in 98 of 100 case subjects. In 2 case subjects, predilation was necessary before stent deployment. Neurologic periprocedural complications included 1 nondisabling and 1 disabling stroke and 5 transient ischemic attacks. The mean duration of follow-up was 23 months (range: 10-36 months). During the follow-up period, there were 5 deaths, all unrelated to the carotid disease, and no major stroke. The degree of stenosis decreased from a mean of 78.85% before the procedure to a mean of 21.23% immediately after. CONCLUSIONS: In this series, carotid stent placement without the use of either balloon angioplasty or distal protection devices was safe and effective with a low incidence of periprocedural complications.

AJNR. American journal of neuroradiology

Platelet-derived thrombi may occur during intracranial aneurysm coiling. We report a series of 13... more Platelet-derived thrombi may occur during intracranial aneurysm coiling. We report a series of 13 patients treated with intraarterial Abciximab for thrombus formation complicating aneurysm coiling. Four patients were treated for acutely ruptured aneurysms. Three procedures consisted of the retreatment of previously coiled aneurysms. Six patients had asymptomatic untreated aneurysms. Abciximab was administered intraarterially through a microcatheter as a bolus of 4-10 mg over a period of 10-20 minutes. All patients underwent postthrombolysis control angiography. They also underwent immediate pre- and postoperative cranial CT. In 10/13 cases, the thrombi developed without coil protrusion into the parent artery. In one case, the thrombus was generated from the guiding catheter and embolized remote from the aneurysm site. In one case, the thrombus developed before any coil placement. In another patient, a coil loop protruded into the parent artery favoring a heightened thrombotic state....

CardioVascular and Interventional Radiology, 2009

Endovascular or surgical treatment of femoropopliteal bypass (FPB) graft occlusion is a safe and ... more Endovascular or surgical treatment of femoropopliteal bypass (FPB) graft occlusion is a safe and effective procedure. However, there are some reports that recommend thrombolysis as an initial therapy [1, 2]. In situ thrombolysis (ITL), with later percutaneous transluminal angioplasty (PTA) of any anastomotic stenoses, is the usual endovascular therapy for this condition [1, 2]. On the other hand, there are cases where ITL, as well as primary stenting, may be contraindicated because of the relative risk of distal embolization [3]. We report a case of acute occlusion of a femoropopliteal prosthetic bypass graft where ITL was contraindicated, which was successfully treated with primary stenting. To our knowledge, this is the first report of primary stenting in acute FPB occlusion.

i i 101 Resumen OBJETIVO: El objetivo de este trabajo es evaluar los resultados a largo plazo del... more i i 101 Resumen OBJETIVO: El objetivo de este trabajo es evaluar los resultados a largo plazo del tratamiento endovascular de los aneurismas poplíteos. MATERIAL Y MÉTODOS: Estudio retrospectivo de pacientes tratados por aneurismas poplíteos en el periodo comprendido entre junio de 2002 y agosto de 2009. En todos los casos se utilizo el stent autoexpan-dible de nitinol Hemoban/Viabahn ®. Se trataron 12 aneurismas en 11 pacientes, con una edad media de 65 años. El 17.6 % se encontraban asintomáticos, el 50 % presentaba claudicación intermitente y el 32.4 % restante isquemia critica. El seguimiento se realizo al mes, 3, 6 meses, al año y anualmente. RESULTADOS: El éxito técnico se consiguió en el 100% de los casos sin complicaciones durante los 30 días post tratamiento. La media de seguimiento fue de 34 meses. Se registraron 3 oclusiones, dos de ellas se recanalizaron mediante tra-tamiento fibrinolítico. La permeabilidad primaria durante el seguimiento fue del 75 % y 92 % la secundaria...

CardioVascular and Interventional Radiology, 2009

The aim of this study was to evaluate the effectiveness of endovascular repair in the treatment o... more The aim of this study was to evaluate the effectiveness of endovascular repair in the treatment of isolated iliac artery aneurysm (IAA) using Excluder bifurcated endograft. Eight consecutive patients with IAA were treated during a period of 45 months using Excluder bifurcated endograft. Two patients presented with isolated IAA rupture and were treated emergently, whereas the other six patients underwent elective treatment. All aneurysms lacked sufficient proximal necks and therefore were not suitable for tubular-shaped endograft. Follow-up imaging was performed at 1 week, at every 3 months during the first year, semiannually until 2 years, and annually afterward using angio-computed axial tomography and plain films. Technical success was achieved in all patients. No mortality was seen despite two patients having IAA rupture. Follow-up (12 to 60 months) was done in all but one patient. During this period, complications were observed in three patients. One patient developed sexual impotence at 3-month follow up; one patient presented unilateral gluteal claudication after the procedure, which resolved at 3 months; and one patient developed a graft porosity-related endoleak, which was successfully managed with placement of an additional ipsilateral iliac extension. Endovascular treatment of isolated IAA using bifurcated endograft is safe and can be an alternative to surgical treatment. The benefits from decreased morbidity and mortality of endoluminal treatment of isolated IAA using bifurcated endograft outweigh the minor complications associated with this technique, which are mostly related to occlusion of hypogastric arteries.

Rev Argent Radiol, Mar 1, 1999

Journal of Vascular and Interventional Radiology, 2011

Purpose: To report long-term outcome when using a bifurcated aortic endograft for treatment of ao... more Purpose: To report long-term outcome when using a bifurcated aortic endograft for treatment of aortoiliac occlusive disease (AIOD) in Trans Atlantic Inter Society Consensus (TASC) classification C and D patients. Materials and Methods: Between May 2001 and May 2009, 14 patients (11 men, 3 women) with aortoiliac TASC C and D type lesions and a mean age of 59 years Ϯ 10 (range 41-73 years) were treated using a bifurcated aortic endograft. Although these patients were young, all were considered at high surgical risk. Patients were followed up clinically and by computed tomography (CT) every 3 months for 1 year and yearly thereafter. Results: Endoprosthesis placement was performed in all patients with a technical success rate of 100%. There were no amputations or deaths at 30 days after the procedure. The mean follow-up was 62 months (range 11-96 months). One patient was lost during follow-up at 11 months, and another patient died of a nonrelated cause after 49 months. A single limb occlusion of the prosthesis was seen in two patients at 2 months and 7 months; both were successfully treated by intraarterial fibrinolysis. At a mean follow-up of 62 months, primary patency was 85.7%, and secondary patency was 100%. Conclusions: This series shows promising long-term results following the use of a bifurcated aortic endograft for treatment of AIOD TASC C and D type lesions. Bifurcated aortic endograft is a good minimally invasive alternative to open surgery in high surgical risk patients.

Annales de Chirurgie Vasculaire, 2009

ABSTRACT La dissection spontanée de l'artère mésentérique supérieure représente une cause... more ABSTRACT La dissection spontanée de l'artère mésentérique supérieure représente une cause rare d'angor intestinal. Son traitement conservateur ou ses traitements plus agressifs tels que la chirurgie ou le traitement endovasculaire dépendent des symptômes. Nous présentons un cas d'ischémie mésentérique aiguë due à la dissection spontanée de l'artère mésentérique supérieure traitée avec succès par la pose d'un stent endovasculaire. Dans la discussion nous passons en revue les différentes autres solutions thérapeutiques présentées dans la littérature.

Annals of vascular surgery

Spontaneous dissection of the superior mesenteric artery represents a rare cause of abdominal ang... more Spontaneous dissection of the superior mesenteric artery represents a rare cause of abdominal angina. Conservative or more aggressive treatments such as surgery or endovascular therapy depend on the symptoms. We present a case report of acute mesenteric ischemia due to spontaneous dissection of the superior mesenteric artery successfully treated by endovascular stent placement. In the discussion we review the different alternatives of treatment presented in the literature.

Minimally Invasive Therapy & Allied Technologies, 2010

Revascularization of infrainguinal vessels is still a challenge. Complications such as flow-limit... more Revascularization of infrainguinal vessels is still a challenge. Complications such as flow-limiting dissections or perforation are responsible for a limited success rate. Failed revascularization attempt leads to amputation in a significant number of patients and increases mortality. We report the use of a novel percutaneous device using the CROSSER catheter system in two patients with peripheral vascular disease. In case # 1 anterior tibial artery patency was restored in a diabetic foot and in case # 2 a chronic traumatic occlusion of the superficial femoral artery was revascularized. In both cases the lesion was recanalized in a short time without any procedure-related complications. The CROSSER catheter system can overcome technical problems and make reentry devices and retrograde distal accesses less relevant. It opens new horizons for the treatment of complex below-the-knee lesions.

Minimally Invasive Therapy & Allied Technologies, 2011

The nutcracker syndrome (NS) is a rare condition characterized by the entrapment of the left rena... more The nutcracker syndrome (NS) is a rare condition characterized by the entrapment of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta. Clinically, it presents with flank pain, hematuria, and symptoms of pelvic venous congestion. Several surgical techniques have been described including left renal vein (LRV) transposition, autotransplantation, LRV bypass, superior mesenteric artery (SMA) transposition, gonadocaval bypass and nephrectomy. More recently, endovascular stenting of the renal vein has been proposed. We present two patients with NS who were successfully managed endovascularly, providing satisfactory mid-term clinical and imaging results.

Minimally Invasive Therapy & Allied Technologies, 2011

We describe a case of a patient with a thoraco-abdominal aortic aneurysm, affecting the origin of... more We describe a case of a patient with a thoraco-abdominal aortic aneurysm, affecting the origin of the celiac trunk, with the particularity of the normal aortic diameter in the segment between superior mesenteric artery and both renal arteries. Endovascular treatment was performed with no fenestrated or branch endoprosthesis. The procedure was divided into two steps. In the first attempt, an aortic prosthesis was deployed at the infrarenal aorta. Then, a thoracic endoprosthesis was deployed in a second procedure. In this case, the celiac trunk was intentionally occluded in order to increase the distal landing zone. At the end, the segment between the superior mesenteric artery above and below the renal arteries was covered by the uncovered struts of both endoprosthesis, with no effects in visceral artery flow. Multislice computed tomographic angiography after six months revealed complete patency of the superior mesenteric artery, both renal arteries and good back-filling of the branches of the celiac axis, with no evidence of aortic endoleak.

Journal of the American College of Cardiology, 2010

Diabetes Research and Clinical Practice, 2010