Transfemoral endoluminal stented graft repair of a popliteal artery aneurysm

Annals of vascular surgery, 1999

Our objective was to investigate the preliminary use of endovascular stent-grafts for the treatment of femoropopliteal artery aneurysm. Ten patients with an aneurysm of the femoropopliteal artery referred for endovascular treatment were investigated. The series consisted of patients with a true aneurysm of the superficial femoral artery (n = 2); a true aneurysm of the popliteal artery (n = 4); an aneurysmal dilatation of a Biograft bypass (n = 2); a false aneurysm of the superficial femoral aneurysm (n = 1); and a false aneurysm of a composite bypass (n = 1). In 8 of the 10 patients the stent-graft was composed of one or more Palmaz stents sutured to an ePTFE tube graft; in the other 2 patients a venous covering was used in combination with Palmaz stents. The procedure was guided by angiography and intravascular ultrasound. The results of our investigation showed that endovascular stent-grafting of aneurysms of the femoropopliteal artery is a feasible but experimental technique that...

Journal of Vascular Surgery, 2013

European Journal of Vascular and Endovascular Surgery, 2003

Popliteal artery aneurysms are relatively uncommon but potentially limb-threatening lesions that can thrombose or cause distal embolization. Identification of these aneurysms, especially in patients with abdominal aortic aneurysms, is imperative, and prophylactic treatment with either surgical exclusion and bypass or endoluminal stent grafting is critical to prevent these poor outcomes. Endovascular approaches currently using the Viabahn stent graft offer several advantages, including a minimally invasive approach, fewer perioperative complications, and a faster recovery. This must be balanced with a potentially higher failure rate or requirement for reintervention, although contemporary series report comparable short-term outcomes. We present our approach to the evaluation and diagnosis of popliteal aneurysms, the technical aspects of endovascular popliteal aneurysm repair, and a representative case study.

EJVES Extra, 2002

The Cochrane library, 2019

BackgroundPopliteal artery aneurysm (PAA) is a focal dilatation and weakening of the popliteal artery. If left untreated, the aneurysm may thrombose, rupture or the clot within the aneurysm may embolise causing severe morbidity. PAA may be treated surgically by performing a bypass from the arterial segment proximal to the aneurysm to the arterial segment below the aneurysm, which excludes the aneurysm from the circulation. It may also be treated by a stent graft that is inserted percutaneously or through a small cut in the groin. The success of the procedure is gauged by the ability of the graft to stay patent over an extended duration. While surgical treatment is usually preferred in an emergency, the evidence on first line treatment in a non‐emergency setting is unclear. This is an update of a review first published in 2014.ObjectivesTo assess the effectiveness of an endovascular stent graft versus conventional open surgery for the treatment of asymptomatic popliteal artery aneurysms (PAA) on primary and assisted patency rates, hospital stay, length of the procedure and local complications.Search methodsThe Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 29 January 2019.Selection criteriaWe included all randomised controlled trials (RCTs) comparing endovascular stent grafting versus conventional open surgical repair in patients undergoing unilateral or bilateral prophylactic repair of asymptomatic PAAs.Data collection and analysisWe collected data on primary and assisted primary patency rates (primary endpoints) as well as operating time, the length of hospital stay, limb salvage and local wound complications (secondary endpoints). We presented results as risk ratio or mean difference with 95% confidence intervals and assessed the certainty of the evidence using GRADE.Main resultsNo new studies were identified for this update. A single RCT with a total of 30 PAAs met the inclusion criteria. There was a low risk of selection bias and detection bias. However, the risks of performance bias, attrition bias and reporting bias were unclear from the study. Despite being an RCT, the certainty of the evidence was downgraded to moderate due to the small sample size, resulting in wide confidence intervals (CIs); only 30 PAAs were randomised over a period of five years (15 PAAs each in the groups receiving endovascular stent graft and undergoing conventional open surgery). The primary patency rate at one year was 93.3% in the endovascular group and 100% in the surgery group (RR 0.94, 95% CI 0.78 to 1.12; moderate‐certainty evidence). The assisted patency rate at one year was similar in both groups (RR 1.00, 95% CI 0.88 to 1.13; moderate‐certainty evidence). There was no clear evidence of a difference between the two groups in the primary or assisted patency rates at four years (13 grafts were patent from 15 PAA treatments in each group; RR 1.00, 95% CI 0.76 to 1.32; moderate‐certainty evidence); the effects were imprecise and compatible with the benefit of either endovascular stent graft or surgery or no difference. Mean hospital stay was shorter in the endovascular group (4.3 days for the endovascular group versus 7.7 days for the surgical group; mean difference (MD) ‐3.40 days, 95% CI ‐4.42 to ‐2.38; P < 0.001; moderate‐certainty evidence). Mean operating time was also reduced in the endovascular group (75.4 minutes in the endovascular group versus 195.3 minutes in the surgical group; MD ‐119.90 minutes, 95% CI ‐137.71 to ‐102.09; P < 0.001; moderate‐certainty evidence). Limb salvage was 100% in both groups. Data on local wound complications were not published in the trial report.Authors' conclusionsEvidence to determine the effectiveness of endovascular stent graft versus conventional open surgery for the treatment of asymptomatic PAAs is limited to data from one small study. At one year there is moderate‐certainty evidence that primary patency may be improved in the surgery group but assisted primary patency rates were similar between groups. At four years there was no clear benefit from either endovascular stent graft or surgery to primary or assisted primary patency (moderate‐certainty evidence). As both operating time and hospital stay were reduced in the endovascular group (moderate‐certainty evidence), it may represent a viable alternative to open repair of PAA. A large multicenter RCT may provide more information in the future. However, difficulties in recruiting enough patients are likely, unless it is an international collaboration including a number of high volume vascular centres.

Journal of Vascular Surgery, 2010

Journal of Vascular Surgery, 2010

La planeación financiera es una herramienta o técnica que aplica el administrador financiero para la evaluación proyectada, estimada o futura, de un organismo social, público o privado. A partir del análisis de amenazas, oportunidades, fortalezas y debilidades que la empresa debe desarrollar sus operaciones de producción de bienes y servicios y su interacción con el medio ambiente, fija lo que desea hacer para mantenerse como un negocio en marcha dentro del sector al que pertenece. entre los objetivos que puede llegar a fijar una empresa pueden ser: seguir un esquema sólido y constante de ventas y crecimiento en los ingresos; aumentar el número de productos que la empresa fabrica; ampliar el número de clientes a los que se venden productos, y tener presencia en mayor cantidad de lugares donde se venden productos, por mencionar algunos de los objetivos que se establecen en la planeación de la empresa. La planeación necesita una evaluación de estos aspectos. en el caso de las fuerzas de las empresas existen diversas variables concretas que influyen en la solidez de la compañía, entre esos factores se encuentra la relación que mantiene con: • Competidores. • Clientes. • Proveedores. • Bienes o servicios sustitutos. • Requisitos que el gobierno establece a las empresas. • Tecnología en los procesos de las empresas. El análisis de la empresa y su relación con estos elementos permite identificar cuáles son los aspectos en que se encuentra débil y que de acuerdo con los daños que puede ocasionar a la empresa se convierten en amenazas. también pueden presentarse fortalezas en algunos aspectos, y en consecuencia ventajas.

La butée rencontrée par Artaud dans le fantasme de la scène primitive est l'objet de ce mémoire de maitrise en psychologie clinique.