ObjectiveTo evaluate our experience following the introduction of a percutaneous
program for endovascular treatment of aortic diseases using Perclose
Proglide® assessing efficacy, complications and identification of
potential risk factors that could predict failure or major access site
complications.MethodsA retrospective cohort study during a two-year period was performed. All the
patients submitted to totally percutaneous endovascular repair (PEVAR) of
aortic diseases and transcatheter aortic valve implantation since we started
the total percutaneous approach with the preclosure technique from November
2013 to December 2015 were included in the study. The primary endpoint was
major ipsilateral access complication, defined according to PEVAR trial.
ResultsIn a cohort of 123 patients, immediate technical success was obtained in 121
(98.37%) patients, with only two (0.82%) cases in 242 vascular access sites
that required intervention immediately after the procedure. Pairwise
comparisons revealed increased major access complication among patients with
>50% common femoral artery (CFA) calcification vs. none
(P=0.004) and > 50% CFA calcification
vs. < 50% CFA calcification
(P=0.002). Small artery diameter (<6.5 mm) also
increased major access complication compared to bigger diameters (> 6.5
mm) (P=0.027).ConclusionThe preclosure technique with two Perclose Proglide® for PEVAR is safe
and effective. Complications occur more often in patients with unfavorable
access site anatomy and the success rate can be improved with proper patient
selection.
Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for patients with severe symptomatic aortic stenosis (AS) whose procedural efficacy and safety have been continuously improving. Appropriate preprocedural planning, including aortic valve annulus measurements, transcatheter heart valve choice, and possible procedural complication anticipation is mandatory to a successful procedure. The gold standard for preoperative planning is still to perform a multi-detector computed angiotomography (MDCT), which provides all the information required. Nonetheless, 3D echocardiography and magnet resonance imaging (MRI) are great alternatives for some patients. In this article, we provide an updated comprehensive review, focusing on preoperative TAVR planning and the standard steps required to do it properly.
Urinary incontinence impacts quality of life negatively, and the prevalence of UI is high among obese patients. In the present study, vaginal delivery and menopause were independently associated with UI.
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