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1.
J. vasc. bras ; 20: e20200122, 2021. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1250240

ABSTRACT

Abstract External iliac artery endofibrosis is a rare pathology that affects high-level endurance athletes, especially cyclists. Classical symptoms include pain, loss of power, and/or cramp in the affected limb while training at maximal effort. The patient's lack of atherosclerotic risk factors makes clinical suspicion of arteriopathy challenging. Moreover, the best management of such patients is still a subject of discussion. We report the case of a 36-year-old professional female endurance cyclist who presented with lower extremity pain during training. Right external iliac artery endofibrosis was diagnosed and the patient underwent surgical treatment. At two-months follow-up, she reported significant improvement in symptoms. This case highlights the importance of diagnosing peripheral vascular disease in young patients and athletes, who do not fit the ordinary profile of patients with atherosclerotic risk factors.


Resumo A endofibrose da artéria ilíaca externa é uma doença rara que afeta atletas de resistência (endurance) de nível competitivo, principalmente ciclistas. Os sintomas clássicos incluem dor, perda de força e/ou câimbras no membro afetado ao fazer esforço máximo durante o treino. A ausência de fatores de risco ateroscleróticos nesses pacientes torna a suspeita clínica de arteriopatia desafiadora. Além disso, o melhor manejo ainda é motivo de debate. Relatamos o caso de uma ciclista de resistência profissional, de 36 anos, que apresentou dor nos membros inferiores durante o treino. Foi diagnosticada endofibrose da artéria ilíaca externa, e a paciente foi submetida a tratamento cirúrgico. Após seguimento por dois meses, a paciente relatou melhora significativa dos sintomas. Este caso destaca a importância do diagnóstico de doença vascular periférica em pacientes jovens e atletas, os quais não se encaixam no perfil comum do paciente com fatores de risco ateroscleróticos.

2.
J. vasc. bras ; 20: e20210160, 2021. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1356449

ABSTRACT

Abstract Syphilitic aortitis is a rare complication of tertiary syphilis, which can lead to aortic aneurysm formation, aortic valvular insufficiency, and ostial coronary stenosis. Syphilis has re-emerged worldwide over recent decades and vascular surgeons should be aware of its cardiovascular manifestations. Atypical clinical presentation, such as hemoptysis and a computed tomography angiography pattern of a thicker aneurysmal wall with ulcer-like aneurysm projections, should raise suspicion of syphilitic aortic aneurysm. An early diagnosis and appropriate surgical and medical therapies significantly contribute to successful treatment and favorable prognosis. Herein is reported the case of an 82-year-old male patient, positive for syphilis infection, with impending aortic arch aneurysm rupture treated with a hybrid arch repair. After 7 months, the patient was brought to the emergency room in cardiac arrest. Unsuccessful cardiopulmonary resuscitation maneuvers were performed, and an autopsy showed cardiac tamponade due to rupture of the ascending aorta.


Resumo A aortite sifilítica é uma complicação rara da sífilis terciária, que pode levar a formação de aneurisma aórtico, insuficiência valvar aórtica e estenose ostial coronariana. Ao longo das últimas décadas, a sífilis ressurgiu ao redor do mundo, e os cirurgiões vasculares devem estar atentos às suas manifestações cardiovasculares. Apresentações clínicas atípicas, como a hemoptise, e um padrão na angiotomografia computadorizada de parede aneurismática mais grossa com projeções de aneurisma com aparência de úlcera devem levantar a suspeita de aneurisma sifilítico da aorta. O diagnóstico precoce e terapias cirúrgica e clínica adequadas contribuem significativamente para um tratamento bem-sucedido e prognóstico favorável. Relatamos o caso de um paciente do sexo masculino, de 82 anos, que apresentou infecção por sífilis com ruptura iminente de aneurisma do arco aórtico. Ele foi tratado com reparo híbrido do arco. Após 7 meses, o paciente deu entrada na emergência com parada cardiorrespiratória. As manobras de reanimação cardiopulmonar foram realizadas, mas não obtiveram sucesso, e a autópsia mostrou tamponamento cardíaco devido à ruptura da aorta ascendente.

4.
J. vasc. bras ; 15(4): 322-327, Oct.-Dec. 2016. graf
Article in English | LILACS | ID: biblio-841386

ABSTRACT

Abstract A ruptured descending thoracic aortic aneurysm (rDTAA) is a life-threatening condition associated with high morbidity and mortality. Endovascular treatment for rDTAA promotes effective aneurysm exclusion with a minimally invasive approach. The authors report a case of a 76-year-old man with hemodynamically unstable 9-cm-diameter rDTAA treated with emergency thoracic endovascular aortic repair (TEVAR).


Resumo O aneurisma roto de aorta torácica descendente constitui uma situação ameaçadora associada a alta morbidade e mortalidade. O tratamento endovascular desse tipo de aneurisma promove exclusão eficaz com uma terapêutica minimamente invasiva. Os autores relatam o caso de um paciente do sexo masculino, 76 anos, hemodinamicamente instável, com aneurisma roto de aorta torácica descendente de 9 cm de diâmetro, tratado em caráter emergencial por cirurgia endovascular.


Subject(s)
Humans , Male , Aged , Aneurysm, Ruptured/diagnostic imaging , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Valve Insufficiency/pathology , Endovascular Procedures/rehabilitation , Ambulatory Care/history , Echocardiography , Tomography, X-Ray Computed
5.
Ann Card Anaesth ; 2016 Jan; 19(1): 201-204
Article in English | IMSEAR | ID: sea-172358

ABSTRACT

Many years following transplantation, heart transplant recipients may require noncardiac major surgeries. Anesthesia in such patients may be challenging due to physiological and pharmacological problems regarding allograft denervation and difficult immunosuppressive management. Massive hemorrhage, hypoperfusion, renal, respiratory failure, and infections are some of the most frequent complications related to thoracic aorta aneurysm repair. Understanding how to optimize hemodynamic and infectious risks may have a substantial impact on the outcome. This case report aims at discussing risk stratification and anesthetic management of a 54‑year‑old heart transplant female recipient, affected by Marfan syndrome, undergoing thoracic aorta aneurysm repair.

6.
J. vasc. bras ; 8(3): 277-280, set. 2009. ilus
Article in English | LILACS | ID: lil-535594

ABSTRACT

We report the case of a 72-year-old patient presenting with an isolated common iliac aneurysm with occlusion of contralateral common iliac artery and severe kyphoscoliosis. Because of high risk for open surgery due to chronic obstructive pulmonary disease, this patient was treated with an endovascular approach using an aortomonoiliac stent graft, followed by a femoro-femoral crossover bypass. This report illustrates the usefulness of a minimally invasive approach, and feasibility even for patients with difficult anatomy.


Relatamos o caso de um paciente de 72 anos com aneurisma isolado de ilíaca, oclusão contralateral de artéria ilíaca comum e cifoescoliose grave. Devido ao alto risco para cirurgia convencional em razão de doença pulmonar obstrutiva crônica, o paciente foi tratado com abordagem endovascular, utilizando uma endoprótese aortomonoilíaca, seguida de uma derivação fêmoro-femoral cruzada. Este relato ilustra a utilidade de uma abordagem minimamente invasiva e demonstra que, mesmo para pacientes com anatomia difícil, é factível.


Subject(s)
Humans , Male , Aged , Aneurysm/complications , Aneurysm/diagnosis , Vascular Patency , Iliac Artery , Stents , Tomography/methods
7.
J. vasc. bras ; 7(3): 278-281, set. 2008. ilus
Article in English | LILACS | ID: lil-500249

ABSTRACT

We report a case of a 72-year-old patient considered unfit for open surgery, presenting with paraanastomotic aneurysms of all three anastomoses, 13 years after an open aortobiiliac reconstruction for abdominal aortic aneurysm. This patient was successfully treated with an endovascular approach using a left aortouniiliac endograft and a right iliac tubular endograft, followed by crossover femorofemoral bypass. This report illustrates the usefulness of a minimally invasive approach for solving this complication of aortic open surgery and discusses technical issues related to endovascular devices in this particular setting.


Relatamos um caso de um paciente de 72 anos não considerado elegível para cirurgia aberta, apresentando aneurismas para-anastomóticos das três anastomoses, 13 anos após uma reconstrução aberta aorto-biilíaca para aneurisma aórtico abdominal. Este paciente foi tratado com sucesso através de abordagem endovascular usando uma endoprótese aorto-uniilíaca esquerda e uma endoprótese tubular ilíaca direita, seguida por derivação cruzada fêmoro-femoral. Este relato ilustra a utilidade de uma abordagem minimamente invasiva para o tratamento desta complicação da cirurgia aórtica aberta e discute questões técnicas relacionadas a dispositivos endovasculares neste contexto em especial.


Subject(s)
Humans , Male , Aged , Aortic Aneurysm/surgery , Aortic Aneurysm/complications , Iliac Aneurysm/surgery , Iliac Aneurysm/complications , Aneurysm, False/surgery , Aneurysm, False/diagnosis
8.
J. vasc. bras ; 7(2): 90-98, jun. 2008. tab
Article in English, Portuguese | LILACS | ID: lil-488563

ABSTRACT

BACKGROUND: Endovascular approach to the aortic arch is an appealing solution for selected patients. OBJECTIVE: To compare the technical and clinical success recorded in the different anatomical settings of endografting for aortic arch disease. METHODS: Between June 1999 and October 2006, among 178 patients treated at our institution for thoracic aorta disease with a stent-graft, the aortic arch was involved in 64 cases. According to the classification proposed by Ishimaru, aortic zone 0 was involved in 14 cases, zone 1 in 12 cases and zone 2 in 38 cases. A hybrid surgical procedure of supra-aortic debranching and revascularization was performed in 37 cases. RESULTS: Zone 0. Proximal neck length: 44±6 mm. Initial clinical success was 78.6 percent: two deaths (stroke), one type Ia endoleak. At a mean follow-up of 16.4±11 months the midterm clinical success was 85.7 percent. Zone 1. Proximal neck length: 28±5 mm. Initial clinical success was 66.7 percent: 0 deaths, four type Ia endoleaks. At a mean follow-up of 16.9±17.2 months the midterm clinical success was 75.0 percent. Zone 2. Proximal neck length: 30±5 mm. Initial clinical success was 84.2 percent: two deaths (one cardiac arrest, one multiorgan embolization), three type Ia endoleaks, one case of open conversion. Two cases of delayed transitory paraparesis/paraplegia were observed. At a mean follow-up of 28.0±17.2 months the midterm clinical success was 89.5 percent. CONCLUSIONS: This study and a literature review demonstrated that hybrid procedure for aortic arch pathology is feasible in selected patients at high risk for conventional surgery. Our experience is still limited by the relatively small sample size. We propose to reserve zone 1 for patients unfit for sternotomy or in cases with aortic neck length > 30 mm following left common carotid artery debranching. We recommend to perform complete aortic rerouting of the aortic arch in cases with lesser comorbidities and shorter aortic neck.


CONTEXTO: O tratamento endovascular dos aneurismas do arco aórtico é uma solução interessante para pacientes selecionados. OBJETIVO: Comparar os sucessos técnico e clínico registrados nas diferentes regiões anatômicas do arco aórtico após a colocação de endoprótese. MÉTODOS: Entre junho de 1999 e outubro de 2006, 178 pacientes foram tratados na nossa instituição devido a doenças da aorta torácica com a colocação de endoprótese, sendo que o arco aórtico estava envolvido em 64 casos. De acordo com a classificação proposta por Ishimaru, a zona aórtica 0 estava envolvida em 14 casos, zona 1 em 12 casos e zona 2 em 38 casos. Procedimentos de debranching do arco aórtico e revascularização extra-anatômica dos troncos supra-aórticos foram realizados em 37 casos para obter um adequado colo aórtico proximal. RESULTADOS: Zona 0. Comprimento do colo proximal: 44±6 mm. Sucesso clínico inicial de 78,6 por cento: dois óbitos (acidente vascular cerebral), um vazamento do tipo Ia. Seguimento médio de 16,4±11 meses com sucesso clínico a médio prazo de 85,7 por cento. Zona 1. Comprimento do colo proximal: 28±5 mm. Sucesso clínico inicial de 66,7 por cento: 0 óbitos, quatro vazamentos do tipo Ia. Seguimento médio de 16,9±17,2 meses com sucesso clínico a médio prazo de 75 por cento. Zona 2. Comprimento do colo proximal: 30±5 mm. Sucesso clínico inicial de 84,2 por cento: dois óbitos (um infarto cardíaco e uma embolização de múltiplos órgãos), três vazamentos do tipo Ia, um caso de conversão para operação aberta. Dois casos de paraparesia/paraplegia transitória tardia foram observados. Seguimento médio de 28,0±17,2 meses com sucesso clínico a médio prazo de 89,5 por cento. CONCLUSÃO: Este estudo e a análise da literatura demonstram que o procedimento híbrido para moléstia do arco aórtico é factível em pacientes selecionados com alto risco para a operação convencional. Nossa experiência ainda é limitada pelo tamanho relativamente pequeno da amostra. Sugerimos...


Subject(s)
Humans , Male , Female , Aged , Aneurysm/surgery , Aorta, Thoracic/surgery
9.
J. vasc. bras ; 4(1): 27-34, 2005. ilus, tab
Article in English | LILACS | ID: lil-421698

ABSTRACT

Objective: Visceral artery aneurysms, despite being uncommon, are important vascular diseases, since they frequently are life threatening, and often fatal emergencies. The purpose of this study is to review our experience with treatment of visceral artery aneurysms. Method: Between 1988 and June, 2004, 37 visceral artery aneurysms were treated in 35 patients (17 male and 18 female) with average age of 56 mais ou menos 14 years. The most common locations were the splenic artery (18), the hepatic artery (10) and the superior mesenteric artery (four), 22 patients were asymptomatic, 13 patients were symptomatic. Emergency surgery was performed on three patients, elective open surgery on 20 patients, and endovascular treatment onseven patients. Results: Perioperative mortality rate was 3,1 por cento in the surgical group. The perioperative mobidity rate was 5,7 por cento: one case of respiratory distress and one case of bilious fistula were...


Subject(s)
Male , Female , Humans , Splenic Artery/surgery , Hepatic Artery/surgery , Mesenteric Artery, Superior/surgery , Splanchnic Circulation/physiology , Aneurysm/complications , Aneurysm/diagnosis , Celiac Artery/surgery
10.
J. vasc. bras ; 3(4): 323-330, dez. 2004. graf
Article in English | LILACS | ID: lil-404922

ABSTRACT

Objective: To evaluate the perioperative and long-term outcomese of combined coronary artery bypass grafting and carotid endartectomy performed in our Institute.Methods: From January 1992 to Apri1 2004, 158 patients with a mean age of 66.3 years (range 42-81) underwent combined carotid endartectomy and coronary artery bypass grafting. Selection criteria were symptomatic ot asymptomatic 70-99 por cento carotid stenosis and unstable coronary symptoms or coronary anatomy judged to preclude safe endarterectomy. Carotid duplex scanning was introduced as a routine screening test from 1996 for patients candidate to coronary artery bypass grafting. Patients presenting fop carotid endartectomy were subjected to further cardiological study only if deemed to be at high cardiac risk. Results: Perioperative mortality was 5.7 por cento. Causes of death were: myocardial infarction with multiorgan failure (four patients),irreversible left ventricular fibrillation (three patients) and low ejection syndrome complicated by stroke and ventricular fibrillation (two patients). The perioperative stroke cate was 1.3 por cento. Mean follow-up was 49 months (range 1-138): 22 patients were lost at follow-up and of remaining 136 patients 21 (15.4 por cento) died. Causes of late mortality were: eight myocardial infarctions, tive cancers, six congestive heartfailure and two abdominal aortic aneurysm rupture. Late stroke rate was 2.2 por cento (two patients with contralateral stroke and one with ipsilateral stroke). One asymptomatic carotid occlusion and three [ carotid restenosis were also observed. Discussion: The low stroke cate observed in our series suggest the use of combined carotid endartectomy and coronary artery bypassgrafting in patients with significant symptomatic and asymptomatic carotid artery stenosis that need myocardial revascularization. Poor len-ventricular function, unstable angina and bilateral carotid artery stenosis, account for the high perioperative mortality associated with this approach.


Subject(s)
Humans , Male , Female , Adult , Endarterectomy, Carotid/methods , Endarterectomy, Carotid/mortality , Carotid Stenosis/surgery , Carotid Stenosis/diagnosis , Carotid Stenosis/mortality , Ventricular Function, Left/physiology , Myocardial Revascularization
11.
J. vasc. bras ; 2(3): 197-210, set. 2003. ilus
Article in English | LILACS | ID: lil-358717

ABSTRACT

Traumatic rupture of the thoracic aorta is a life threatening situation, and may be secondary to several mechanisms; mainly penetrating or iatrogenic lesions and blunt trauma. Although penetrating mechanisms predominate, the number of patients with aortic disruption due to blunt trauma has continued to increase.This paper shows an overview focusing on the pathogenesis, diagnosis, timing and type of treatment regarding traumatic injuries of the thoracic aorta; it also reports the experience of one single center that deals with these lesions.The major difficulty in the evaluation data on blunt aortic injury is that retrospective reviews often group together patients with all types of aortic lesions, comparing outcomes for injuries in different locations, with diverse methods of repair and different surgeons and/or institutions.


Subject(s)
Humans , Male , Adult , Aorta, Thoracic/injuries , Aorta, Thoracic/pathology , Wounds and Injuries/diagnosis , Aortic Rupture/surgery , Aortic Rupture/diagnosis , Aortic Rupture/therapy , Retrospective Studies , Tomography
12.
J. vasc. bras ; 1(3): 207-218, dez. 2002. ilus, tab, graf
Article in Portuguese | LILACS | ID: lil-414434

ABSTRACT

Objetivos: O objetivo deste estudo foi ode analisar morbidade e mortalidade p6s-cirúrgicas em pacientes submetidos à cirurgia de aneurisma da aorta torácica e aneurisma toracoabdominal no Departamento de Cirurgia Vascular do IRCCS San RatTaele, Milão.Métodos: O estudo incluiu 332 pacientes (256 homens e 76 mulheres) com idade média de 65 anos (variação de 34 a 82 anos) que foram submetidos a 333 operações para aneurismectomia de aneurisma da aorta torácica e aneurisma toracoabdominal entre janeiro de 1988 e outubro de 2002. A drenagem do líquido cefalorraquidiano foi utilizada em 212 casos (75 por cento dos aneurismas toracoabdominais, 53 por cento dos aneurismas da aorta torácica); 215 pacientes (110 aneurismas toracoabdominais e 105 aneurismas da aorta torácica) foram submetidos à cirurgia de bypass coronário esquerdo através do uso de bomba Biomedicus.Resultados: A taxa total de mortalidade aos 30 dias foi de 40/332 (12 por cento); um total de 32 mortes (10,5 por cento) foram registradas durante as cirurgias eletivas e oito (29,6 por cento) em pacientes submetidos a reparos emergenciais. As seguintes complicações p6s-cirúrgicas foram relatadas: paraplegia/paraparesia em 21 casos (6,3 por cento), insuficiência respiratoria com necessidade de entubação prolongada em 79 casos (24 por cento), complicações cardíacas (arritmia grave, enfarte do miocárdio) em 29 casos (9 por cento), insuficiência renal em 23 casos (7 por cento), hemorragia pos-cirúrgica com necessidade de revisão cirúrgica em 17 casos (5 por cento), infecção do enxerto em seis casos (1,8 por cento). Conclusões: As taxas de morbidade e mortalidade ocorridas apos a cirurgia de aneurisma toracoabdominal e aneurisma da aorta torácica ainda são altas. Contudo, de acordo com nossa experiência, o uso de suporte circulat6rio distal ativo, clampeamento seqüericial e drenagem de líquido cerebrorraquidiano faz com que resultados aceitáveis sejam alcançados e reduz complicações secundárias à isquemia visceral e isquemia da medula espinhal, sem a necessidade de tempo de clampeamento rápido...


Subject(s)
Aortic Aneurysm , Aortic Aneurysm, Abdominal , Paraparesis , Paraplegia , Renal Insufficiency
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