In the last several years a stable increase in cardiovascular implantable electronic device (CIED) implantation has been seen, mainly because of the expanded indications for their usage. An important complication of CIED implantation is possible postprocedural infection (pocket or systemic), which is connected with high morbidity and mortality rates and carries a significant financial cost to the health systems. Although this complication is not that frequent (ranging from 1% to over 5% in different studies), it is associated with a significant burden to patients, clinicians, and the healthcare system and because of that attention should be placed on the prevention of the infection. In this article, we collected and summarized the information and data available, directly related to the problem of prevention of CIED infection. The results of different studies and guidelines, regarding prevention with antibiotics, antiseptics, and the usage of antibacterial envelopes are analyzed. Perspective is put on the new technology of using antibacterial envelopes for prevention of infections. The aim of this paper is to review the various infection prevention techniques and to highlight the most beneficial ones according to guidelines and worldwide studies.
Postižení aorty představují významnou součást spektra kardiovaskulárních onemocnění. Mutace ACTA2 je hlavní příčinou familiárního vzniku aneurysmat a disekce hrudní aorty, které se projevují dilatací nebo disekcí hrudní aorty jedinců bez systémové poruchy pojivové tkáně nebo příslušných syndromů. Gen ACTA2 kóduje aktin, konkrétně-aktin hladkého svalu, jenž je izoformou aktinu v hladkých svalech cév. Uvedená mutace vede ke vzniku řady postižení aorty, ale současně i k multisystémové dysfunkci hladkého svalu. Popisujeme případ pacienta s typickými klinickými nálezy odpovídajícími mutaci ACTA2 a výsledek léčby po endovaskulárním a následném chirurgickém výkonu. Projevy a rozvoj klinických symptomů u našeho pacienta přesně odpovídají popisu onemocnění v literatuře.
Background:
We present an analysis that compares aortic morphological
and clinical outcomes of 36 patients, all treated with endovascular uncovered
stents implantation preceded or not by stent-graft implantation, or surgical
treatment in the context of complex treatment of type A or type B aortic
dissection.
Methods:
Between 2014 and 05/2018 our team treated 36
patients with acute aortic dissection and end-organ ischemia due to true lumen
compression. All clinical and periprocedural data were obtained
prospectively, followed by a retrospective analysis. The case series aim is to
show induction of aortic remodeling by depressurization of the false lumen and
increasing the size of the true lumen by non-covered stents implantation in the
aorta and its affected side branches. Secondary endpoints were survival, branch
patency, true lumen and false lumen size evolution.
Results:
Results
from the diameter of both lumens measured by computed tomography angiography
(CTA) before and at least 1 year after the treatment showed statistically
significant differences, patent stents, as well as symptomatic improvement in all
patients. Both aorta-related and general mortality in this complex group of
patients was 0%.
Conclusions:
The concept of redirection of flow in
aortic dissection with non-covered stents was safe, led to positive aorta
remodeling and resulted in excellent survival rate.
Aortic rupture is a dramatic event, which needs a prompt and fast diagnosis and has a high mortality rate. Early and exact diagnosis of impending aortic rupture can be lifesaving. Furthermore, differentiating between impending and complete rupture is important, because it reflects on the management and the prognosis of the patient.
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