ABSTRACT
Abstract The presence of malperfusion syndrome in cases of complicated acute type B aortic dissection is a negative predictive factor and urgent intervention is indicated. Anatomic variations, such as the Arc of Buhler, contribute anastomotic channels and can preserve the visceral blood supply. In this case report, we describe the overall management of a 54-year-old man who presented with a type B aortic dissection. Initially, conservative management was chosen, as indicated for an uncomplicated type B dissection, but the dissection deteriorated. Despite the fact that severe occlusion of the celiac artery was detected on Computed Tomography (CT) angiography, the Arc of Buhler anatomical variation was present, contributing adequate visceral blood supply. After considering this finding, the patient was treated effectively with thoracic endovascular aortic repair (TEVAR).
Resumo A presença da síndrome de má perfusão em casos de dissecção aórtica aguda do tipo B complicada é um fator preditor negativo, e uma intervenção urgente é indicada. As variações anatômicas, tais como o arco de Buhler, contribuem como canais anastomóticos e podem preservar o suprimento sanguíneo visceral. Neste relato de caso, descrevemos o manejo geral de um paciente do sexo masculino, de 54 anos, que apresentou uma dissecção aórtica do tipo B. Inicialmente, o manejo conservador foi escolhido, conforme indicado para dissecção do tipo B não complicada, mas a dissecção sofreu deterioração. Apesar de uma oclusão grave da artéria celíaca ter sido detectada na angiotomografia computadorizada, a variação anatômica do arco de Buhler estava presente, contribuindo para o suprimento sanguíneo visceral adequado. Após levar em consideração esse achado, o paciente foi tratado de forma efetiva com reparação endovascular da aorta torácica.
Subject(s)
Humans , Male , Middle Aged , Aorta, Thoracic , Celiac Artery , Anatomic Variation , Aortic Dissection/surgery , Mesenteric Artery, Superior , Endovascular Procedures , Conservative Treatment , Aortic Dissection/diagnosisABSTRACT
The purpose of this study is to compare the perioperative total prostate specific antigen [tPSA] levels among coronary artery bypass grafting [CABG] patients with and without extracorporeal circulation [ECC], to investigate the changes overtime of tPSA in each group separately and to determine the effect of body core temperature on tPSA levels.A prospective study was conducted. Our sample was allocated to: [a] Seven patients who underwent off pump CABG [Group I] and [b] 16 CABG patients with ECC [Group II]. The levels of tPSA were measured preoperatively [baseline], intra-operatively and at the 4[th] postoperative day. We compared the two groups on their tPSA levels and we investigated the changes of tPSA overtime in each group separately. Intra-operative serum samples were obtained in significantly lower body temperature in patients of Group II than in those of Group I [31°C vs. 36.9°C, P < 0.001]. In each group separately, postoperative tPSA levels were increased significantly compared to the baseline values [2.55 ng/ml vs. 0.39 ng/ml for Group I, P= 0.005 and 4.36 ng/ml vs. 0.77 for Group II, P < 0.001]. CABG patients with ECC had significantly lower intra-operative tPSA levels than the baseline values [0.67 ng/ml vs. 0.77 ng/ml, P = 0.008]. We did not observe significant differences of tPSA levels between the two groups.CABG surgery affects similarly the perioperative tPSA independently the involvement of ECC. Although all patients had significantly higher early postoperative tPSA levels, only those who underwent CABG with ECC had exceeded normal values and significantly decreased intra-operative tPSA. Hypothermia seems to be the causal factor of tPSA reduction