INTRODUCTION: Common iliac aneurysms are present in up to 40% of abdominal aortic aneurysms and frequently impair distal landing zones for endovascular aneurysm repair. Several techniques have been developed in order to overcome these issues, with different applications and conflicting results. Although long-term outcomes of hypogastric exclusion are favorable, the risks of pelvic ischemia and morbidity rates are high. We aim to review current hypogastric preservation strategies used in the endovascular treatment of aortoiliac aneurysms. EVIDENCE ACQUISITION: A thorough non-systematic review of the literature was conducted using PubMed/Medline. Forty-five articles were included, according to their scientific relevance and relation with the subject. EVIDENCE SYNTHESIS: The bell-bottom technique can be used in common iliac arteries with up to 24mm of diameter. Although apparently effective in the short-term, long-term durability is questionable with reported type 1b endoleak rates varying from 3,4-7,8% and high re-intervention rates reported. Iliac branches have better long-term outcomes, with 90,4% patency rates and 91,8% freedom from re-intervention at 10 years' follow-up. Nonetheless, its widespread application is limited by complex anatomies and increased costs. Finally, parallel-graft techniques are an effective option for hostile anatomies unsuitable for other techniques. Endoleak due to gutter development remains the biggest limitation for its long-term durability and solid evidence regarding its application is still lacking. CONCLUSIONS: When determining the appropriate hypogastric preservation strategy, several factors should be considered. Anatomic criteria, life-expectancy as well as physical and sexual activity are the most important criteria. Procedure complexity and cost should also be accounted for.
The coronavirus disease 2019 pandemic has brought about significant changes in the medical field. While primarily characterized as a respiratory syndrome, COVID-19 is also associated with vascular events, particularly thrombotic complications. These events can manifest as initial presentations or develop as complications during the course of the disease, predominantly driven by immune-mediated mechanisms. MethodsPatients with thrombotic complications followed in the post-COVID-19 thrombosis consult of 2021 were retrospectively analyzed and assessed for predisposing factors for pulmonary embolism (PE), including thrombophilias. Patients underwent reassessments over a minimum six-month period following diagnosis to evaluate vascular reperfusion and the potential discontinuation of anticoagulant therapy. ResultsAll patients with PE exhibited segmental or subsegmental PE. Pulmonary CT angiography revealed that only one patient did not show complete reperfusion after six months of anticoagulant therapy alone. There were no instances of recurrent thrombotic events observed during this observation period. Among the studied patients, hypertension, diabetes, and obesity were identified as the most prevalent predisposing factors. No patients were diagnosed with thrombophilias or other relevant factors. Despite extensive research on the predisposing mechanisms of this complication in recent years, limited data exist regarding patients with this specific complication. Discussion and conclusionContinued research into COVID-19 patients and their complications is crucial for understanding the pathophysiological mechanisms and risk factors associated with these complications. The findings of this study support the existence of a multifactorial mechanism, with a significant pro-inflammatory component exacerbated by pre-existing risk factors, rather than a purely prothrombotic mechanism.
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