Microcirugía y estrategias adyuvantes en el tratamiento de los aneurismas intracraneales

Introducción: El riesgo del ser humano de padecer un aneurisma intracraneal se calcula entre 1-2 %, en el 80 % de los casos su forma de presentación es una hemorragia subaracnoidea. Objetivo: Evaluar la utilidad de diferentes maniobras adyuvantes para facilitar la micro disección y el presillamiento del cuello de los aneurismas intracraneales. Metodología: Se realizó un estudio descriptivo con todos los pacientes admitidos en el servicio de neurocirugía del Hospital "Roberto Rodríguez", en Morón, Ciego de Ávila, Cuba, que presentaron un diagnóstico de aneurisma intracraneal y que fueran intervenidos con técnica de microcirugía para su exclusión de la circulación, en el periodo comprendido entre enero de 1997 y diciembre del 2020. Resultados: 201 pacientes fueron intervenidos, 198 (98,51 %) con aneurismas de la circulación anterior y solo 3 (1,49 %), de la circulación posterior. En total fueron abordados 252 sacos, se utilizaron estrategias adyuvantes al procedimiento convencional para facilitar el acto del presillamiento aneurismático como lo fueron el drenaje espinal continuo, la ventriculostomìa al exterior para drenaje de LCR y monitorización continua de la PIC y de la presión de retracción cerebral, cierre temporal de la arteria madre, succión retrograda descompresión en los aneurismas gigantes. El 74,62 % de los casos se recuperaron sin ningún tipo de síntomas o secuelas y la mortalidad fue del 1,49 %. Discusión: La microcirugía resulta un procedimiento eficaz, con elevado nivel de eficiencia, para el tratamiento de los aneurismas intracraneales en nuestro medio. Las estrategias adyuvantes facilitan la relajación del parénquima, la disección y el presillamiento del cuello aneurismático.

Introduction: The human risk of suffering from an intracranial aneurysm is estimated between 1-2%, in 80% of cases its presentation is a subarachnoid hemorrhage. Objectives: To evaluate the usefulness of different adjunctive maneuvers to facilitate micro dissection and clamping of the neck of intracranial aneurysms. Method: We have carried out a descriptive study including all the patients admitted in the neurosurgery department of "Roberto Rodríguez" Hospital in Moron, Ciego de Avila, Cuba with the diagnosis of intracranial aneurysms who were operated on through microsurgical cliping techniques in the period between january 1997 and december 2020. Results: 201 patients were operated on, 198 (98.51%) with aneurysms of the anterior circulation and only 3 (1.49%), of the posterior circulation. A total of 252 sacs were approached, adjuvant strategies to the conventional procedure were used to facilitate the act of aneurysmal clamping, such as continuous spinal drainage, ventriculostomy to the outside for CSF drainage and continuous monitoring of ICP and brain retraction pressure, temporary closure of the mother artery, retrograde suction decompression in giant aneurysms. 74.62% of the cases recovered without any type of symptoms or sequelae, and mortality was 1.49%. Discussion: Microsurgery is an effective procedure, with a high efficiency index, for the treatment of intracranial aneurysms in our environment. Adjunctive strategies facilitate parenchymal relaxation, dissection, and clamping of the aneurysmal neck.

Tratamiento endovascular de aneurismas con anatomía aórtica compleja / Endovascular treatment of aneurysms with complex aortic anatomy

RESUMEN Introducción: la anatomía arterial es la principal limitante para el abordaje aórtico endovascular estándar. Presentamos nuestra experiencia para la reparación endovascular de aneurismas aórticos complejos. Material y métodos: estudio observacional retrospectivo en pacientes con aneurismas complejos (yuxta/pararrenales y toracoabdominales) tratados en forma consecutiva mediante: endoprótesis fenestradas (FEVAR), ramificadas (BEVAR), con EndoAnchors (ESAR), o en chimenea (ChEVAR). La decisión de la técnica fue determinada con base en la anatomía arterial. Resultados: se evaluaron los últimos 50 procedimientos (6 mujeres; edad promedio 71,3 años; diámetro 69,6mm; 3 pacientes con aneurismas complicados), de los cuales 22 recibieron FEVAR (2,8 fenestraciones / paciente), 11 BEVAR, 11 ESAR y 6 ChEVAR (1,8 chimeneas /paciente). La tasa de éxito técnico fue del 100% (ausencia de endoleak I o III con permeabilidad adecuada de los vasos viscerales). A 30 días 3 pacientes fallecieron (6%). Durante el seguimiento, 5 pacientes presentaron oclusión de la arteria renal, repermeabilizada en 4. Cuatro pacientes desarrollaron un endoleak tipo IA (3 ESAR secundarios y un ChEVAR), un paciente un endoleak IC y un cuarto uno IIIB (22%, 3 de los 11 ESAR, ninguno de los FEVAR industriales). En el análisis de supervivencia, la supervivencia global fue del 88,6% al año, y libre de reoperación del 86,5%. Conclusiones: se trata de la primera publicación en nuestro medio que muestra un enfoque global del paciente con un aneurisma de aorta complejo, de acuerdo con sus características anatómicas. Estas tecnologías ya desempeñan un papel primario en el tratamiento de estos pacientes.

ABSTRACT Background: Arterial anatomy is the main limiting factor for standard endovascular aortic (EVAR) approach. We present our experience for endovascular repair of complex aortic aneurysms. Material and Methods: This is a retrospective observational study in patients with complex aneurysms (juxta/pararenal and thoracoabdominal) treated consecutively with: fenestrated (FEVAR), branched (BEVAR), EndoAnchors (ESAR), or chimney (ChEVAR) stents. The decision of the technique was determined based on the arterial anatomy. Results: The last 50 procedures were evaluated (6 women; mean age 71.3 years; diameter 69.6 mm; and 3 patients with complicated aneurysms), among whom 22 received FEVAR (2.8 fenestrated stents/patient), 11 BEVAR, 11 ESAR and 6 ChEVAR (1.8 chimney stents/patient). Technical success rate was 100% (absence of type I or III endoleak with adequate patency of the visceral vessels). Three patients died within the first 30 days (6%). During follow-up, 5 patients presented with renal artery occlusion, treated successfully in 4 cases. Four patients developed type IA endoleak (3 secondary ESAR and one ChEVAR), one patient IC endoleak and almost a quarter of cases type IIIB endoleak (22%, 3 out of 11 patients receiving ESAR, none of the industrial FEVAR group). In survival analysis, overall survival analysis was 88.6% at one year, and 86.5% of cases were free from reoperation. Conclusions: This is the first publication in our setting that shows a global approach to the patient with complex aortic aneurysm, according to the anatomical characteristics. These technologies already play a primary role in the treatment of these patients.

Factores predictivos de rotura de aneurismas intracraneales

Introducción: Un aneurisma intracraneal roto provoca una hemorragia subaracnoidea. La enfermedad presenta una alta mortalidad y morbilidad. Sin embargo, no todos se rompen. Mejorar la predicción de rotura permitirá un tratamiento quirúrgico preventivo en un grupo de pacientes y evitará una intervención quirúrgica con riesgos en otro grupo de enfermos. Es necesario identificar factores predictivos para mejorar la estratificación del riesgo de rotura y optimizar el tratamiento de los aneurismas intracraneales incidentales. Objetivo: Identificar factores predictivos de rotura de aneurismas intracraneales. Métodos: En una muestra de 152 pacientes espirituanos con aneurismas intracraneales saculares rotos (n = 138) y no rotos (n = 22) y 160 imágenes de angiografía por tomografía computarizada, se realizaron mensuraciones de los índices o factores morfológicos, los cuales se combinaron mediante análisis de regresión logística con variables demográficas y clínicas. Resultados: El grupo de edad con mayor frecuencia de presentación de aneurismas fue el de mayor de 65 años. La muestra estuvo representada, en su gran mayoría, por el sexo femenino. Se identificaron tres factores clínicos y cuatro factores morfológicos estadísticamente significativos, asociados con la rotura. El índice de no esfericidad (p = 0,002 y el sexo femenino (p = 0,02) fueron los de mayor significación estadística. Conclusiones: Se detectaron siete factores predictivos de rotura de aneurismas intracraneales estadísticamente significativos, de los cuales el índice de no esfericidad resultó el de mayor significación.

Introduction: A ruptured intracranial aneurysm causes a subarachnoid hemorrhage. The disease has high mortality and morbidity. However, not all of them break. Improving the rupture prediction will allow preventive surgical treatment in a group of patients and it will avoid risky surgical intervention in another group of patients. It is necessary to identify predictive factors to improve rupture risk stratification and to optimize treatment of incidental intracranial aneurysms. Objective: To identify rupture predictive factors for intracranial aneurysms. Methods: Measurements of the morphological indices or factors were performed in a sample of 152 patients from Sancti Spiritus with ruptured (n = 138) and unruptured (n = 22) saccular intracranial aneurysms and 160 computed tomography angiography images. They were combined using logistic regression analysis with demographic and clinical variables. Results: The age group with the highest frequency of aneurysm presentation was older than 65. The sample was represented, in its vast majority, by the female sex. Three clinical factors and four statistically significant morphological factors associated with rupture were identified. The non-sphericity index (p = 0.002) and the female sex (p = 0.02) were the most statistically significant. Conclusions: Seven statistically significant predictors of intracranial aneurysm rupture were detected, the non-sphericity index being the most significant.

Research advances on risk factors of coronary artery lesion in Kawasaki disease / 中国小儿急救医学

Kawasaki disease is an acute febrile rash disease with systemic vasculitis as the main lesion, which can lead to coronary artery lesion(CAL)in some children.Early diagnosis of Kawasaki disease can effectively prevent CAL.Previous studies on the risk factors of CAL in Kawasaki disease focused on leukocyte, neutrophil percentage, erythrocyte sedimentation rate, C-reactive protein, serum albumin, etc.In recent years, many new biomarkers have been found.This review summarized the newly studied risk factors, aiming to provide reference for timely treatment of Kawasaki disease and prevention of CAL.

Clinical application of Neuroform Atlas stent-assisted coiling in the treatment of unruptured wide-neck intracranial aneurysms / 北京大学学报(医学版)

OBJECTIVE@#To assess the safety and efficacy of Neuroform Atlas stent used in treatment of unruptured wide-neck intracranial aneurysms.@*METHODS@#Clinical data of 62 patients with unruptured wide-neck intracranial aneurysms undergoing Neuroform Atlas stent-assisted coiling from August 2020 to September 2021 were retrospectively analyzed. There were 64 aneurysms in those 62 patients. Among them, 25 aneurysms were located at the bifurcation of M1 segment on middle cerebral artery, 16 at the anterior communicating artery, 10 at the C7 segment of internal carotid artery, 5 at the C6 segment of internal carotid artery, 4 at the apex of basilar artery, 3 at the A3 segment of anterior cerebral artery, and 1 at the M2 segment of middle cerebral artery. All the patients underwent Neuroform Atlas stent-assisted coiling, including 49 patients with single stent assisted coiling and 15 patients with dual stents assisted coiling (14"Y"style and 1"X"style). After the procedure, the immediate DSA was performed to evaluate the status of aneurysm occlusion and the parent artery patency. The clinical follow-up was performed 3 months after the operation and evaluated based on the modified Rankin Scale(mRS).DSA image was reviewed at 6 months after operation and Raymond grading scale was used to assess the status of aneurysm occlusion and the parent artery patency.@*RESULTS@#A total of 62 patients with 64 aneurysms were all achieved technical success(100%).The immediate post-procedural Raymond scale was assessed, including Raymond Ⅰ in 57 aneurysms(89.1%, 57/64), Raymond Ⅱ in 6 aneurysms(9.3%, 6/64) and Raymond Ⅲ in 1 aneurysm(1.6%, 1/64). The peri-procedural complications rate was 4.8%(3/62), 2 patients developed intraoperative thrombosis and 1 patient suffered from local subarachnoid hemorrhage. Among them, 55 patients obtained 3 months clinical follow-up after operation and all the patients had good outcomes (mRS≤2), 50 patients with 52 aneurysms were followed up with DSA 6 months after operation, including Raymond Ⅰ in 45 aneurysms(86.5%, 45/52), Raymond Ⅱ in 4 aneurysms(7.7%, 4/52) and Raymond Ⅲ in 3 aneurysms(5.8%, 3/52).@*CONCLUSION@#Neuroform Atlas stent for the treatment of unruptured wide-neck intracranial aneurysms has high safety and good efficacy, and has its advantages over other traditional stents.

Braided stent-assisted coil embolization versus laser engraved stent-assisted coil embolization in patients with unruptured complex intracranial aneurysms

Abstract Purposes: Braided and laser-cut stents both are efficacious and safe for coiling intracranial aneurysms. The study aimed to compare outcomes following braided stent-assisted coil embolization versus laser engraved stent-assisted coil embolization in 266 patients who were diagnosed with unruptured intracranial aneurysms of different types and locations. Methods: Patients with unruptured complex intracranial aneurysms underwent braided (BSE cohort, n = 125) or laser engraved (LSE cohort, n = 141) stent-assisted embolization. Results: The deployment success rate was higher for patients of the LSE cohort than those of the BSE cohort (140 [99%] vs. 117 [94%], p = 0.0142). Seventy-one (fifty-seven percentages) and 73 (52%) were coil embolization procedure success rates of the BSE and the LSE cohorts. Periprocedural intracranial hemorrhage was higher in patients of the BSE cohort than those of the LSE cohort (8 [6%] vs. 1 [1%], p = 0.0142). Four (three percentages) patients from the LSE cohort and 3 (2%) patients from the BSE cohort had in-stent thrombosis during embolization. Permanent morbidities were higher in patients of the LSE cohort than those of the BSE cohort (8 [6%] vs. 1 [1%], p = 0.0389). Higher successful procedures (76% vs. 68%) and fewer postprocedural intracranial hemorrhage (0% vs. 5%) and mortality (0% vs. 5%) were reported for patients of the BSE cohort in posterior circulation aneurysmal location than those of the LSE cohort. Laser engraved stent has fewer problems with deployment and may have better periprocedural and follow-up outcomes after embolization. Conclusions: Braided stent-assisted embolization should be preferred when the aneurysm is present in the posterior circulation.

Prevalência de aneurismas viscerais raros em 92.833 angiotomografias (2005-2021) / Prevalence of rare visceral aneurysms on 92,833 CAT scans (2005-2021)

Resumo Contexto Ainda são incomuns os estudos de prevalência de aneurismas viscerais raros, e os poucos estudos que focalizaram esses aneurismas observam taxas de prevalência em grupos de pacientes com aneurismas viscerais, mas pouco se conhece sobre a sua prevalência na população geral. Objetivos Avaliar a prevalência de aneurismas viscerais raros em angiotomografias realizadas para diagnóstico e seguimento de pacientes com diferentes patologias vasculares. Métodos Este estudo transversal partiu do acesso a todos os laudos de angiotomografias realizadas entre janeiro de 2005 e julho de 2021 em hospital privado de excelência situado na cidade de São Paulo. Foi utilizado um programa de mecanismo de busca de laudos pré-indexados, cuja base de dados é o Sistema de Informação Radiológica (RIS), para acesso aos laudos de pacientes com aneurismas intra-abdominais. Resultados Foram acessados laudos de angiotomografias de 92.883 pacientes, dos quais 2.597 (2,795%) apresentavam aneurismas intra-abdominais, sendo 937 (1,063%) viscerais, incluindo 158 (0,171%) aneurismas viscerais raros, mais frequente entre homens e nos seguintes segmentos: tronco celíaco (0,098%), artéria mesentérica superior (0,033%), artéria gástrica esquerda (0,010%), artéria pancreático-duodenal (0,009%), artéria gastroduodenal (0,005%) e arco pancreático (0,004%). Prevalências menores foram encontradas em outros diferentes segmentos. Achados adicionais revelaram taxa de concomitância de aneurismas viscerais raros com outros aneurismas intra-abdominais entre 11,11% e 66,67%. Conclusões A prevalência de aneurismas viscerais raros em ampla população submetida a angiotomografias foi de 0,171%, com maior comprometimento nos pacientes do sexo masculino.

Abstract Background Studies on the prevalence of rare visceral aneurysms are still scarce and the few studies that have focused on these aneurysms present prevalence rates in groups of patients with visceral aneurysms, but little is known about their prevalence in the general population. Objectives To assess the prevalence of rare visceral aneurysms on CAT scans performed for diagnosis and follow-up of patients with other vascular pathologies. Methods This cross-sectional study began by accessing all reports from CAT scans performed between January 2005 and July 2021 at a private hospital of excellence located in the city of São Paulo. A software program for pre-indexed reports was used to search the Radiological Information System (RIS) database to identify reports of patients with intra-abdominal aneurysms. Results CAT scan reports from 92,883 patients were accessed. Of these, 2,597 (2.795%) showed intra-abdominal aneurysms, 937 (1.063%) of which were visceral, including 158 (0.171%) rare visceral aneurysms, which were more frequent among male patients and in the following segments: celiac trunk (0.098%), superior mesenteric (0.033%), left gastric (0.010%), pancreatic-duodenal (0.009%), and gastroduodenal arteries (0.005%) and the pancreatic arch (0.004%). Lower prevalence was found in other segments. Additional findings revealed concomitance of rare visceral aneurysms with other intra-abdominal aneurysms ranging from 11.11% to 66.67%. Conclusions The prevalence of rare visceral aneurysms in a large population undergoing CAT scan was 0.171%, with greater involvement in male patients.

Intracranial aneurysms in Ghanaian adults

Objective: To document the location, size, and multiplicity of intracranial aneurysms in Ghanaians who have undergone digital subtraction angiography (DSA) at a single centre in Accra, Ghana. Design: We conducted a retrospective observational review of the medical records of all patients diagnosed with intracranial aneurysms on DSA Setting: Patients' medical records at Euracare Advanced Diagnostic and Heart Centre were reviewed between March 2018 and March 2020. Participants: Thirty-one patients were identified with various intracranial aneurysms (IAs) within the study period. Patients' ages, sex, and types of IAs were extracted using a checklist and analysed using Microsoft Excel for Windows 2016. Interventions: None Main outcome measures: The prevalence of types and distribution of intracranial aneurysms. Results: The age range of the patients was 26-76 years, with a mean age of 45.5±14.3 years. The mean age of men and women with IA was 45.5 ±15.9 years and 46.7 51.3±12.9 years, respectively. The most common IAs were located in the posterior communicating artery (PCOM) at 54.8% (95%CI: 36.0, 72.7), followed by the anterior communicating (ACOM), which constituted 32.3% (95%CI: 16.7, 51.4). The majority, 89.2% (33/37) of these aneurysms were less than 7mm in diameter. Single aneurysms were present in 25 (80.6%). Conclusion: The most common IAs were found in the PCOM and ACOM, and IAs tend to rupture at a younger age and smaller size among the Ghanaian adults examined. Early detection and treatment of IAs less than 7mm in diameter is recommended.

Risk factors and outcomes of endoleak after endovascular aneurysm repair / 中华普通外科杂志

Objective:To analyze the risk factors and prognosis of endoleak after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm.Methods:The clinical data of patients with infrarenal abdominal aortic aneurysms treated by endovascular repair at the Department of Vascular Surgery,the First Affiliated Hospital of Guangxi Medical University from Jun 2012 to Nov 2021 were retrospectively analyzed.Results:During the first follow-up CTA after surgery,136 out of 299 patients had endoleak.A total of 186 patients had at least one CTA reexamination after discharge. Statistical analysis showed that excessive neck angulation was an independent risk factor for type Ⅰa endoleak ( t=-6.108, P<0.001), wider common iliac artery diameter (left Z=-2.787, P=0.005, Right Z=-2.381, P=0.017) and iliac aneurysm ( χ2=6.398, P=0.011) were risk factors for type Ⅰb endoleak. The survival time of patients in endoleak group was similar to no endoleak group. Conclusions:Excessive neck angulation is an independent risk factor for type Ⅰa endoleak. Most leaks resolve spontaneously ,the prognosis is fair.

Aneurismas de las arterias pulmonares en relación al síndrome de Hughes Stovin / Aenurysms of the pulmonary arteries in relation to Hughes Stovin syndrome

El síndrome de Hughes Stovin es una vasculitis de pequeños y grandes vasos, más frecuente en hombres jóvenes. Se manifiesta con trombosis y aneurismas. Inicia con tromboflebitis que evoluciona a aneurismas con eventual desenlace fatal por ruptura de los mismos. Algunos autores consideran el síndrome de Hughes Stovin como una variante de la enfermedad de Behçet. El diagnóstico es clínico y el tratamiento de primera línea son los corticoides y la ciclofosfamida. Frente a un caso de trombosis, la anticoagulación es controversial por el riesgo de sangrado. Presentamos el caso de un varón joven con cuadro clínico compatible en el cual se descartaron otras patologías con requerimiento de tratamiento quirúrgico por mala evolución clínica.

Hughes Stovin syndrome is characterized by small and big vessels vasculitis, more commonly presented in young men. Initially it manifests with thrombophlebitis and aneurysms which can cause fatal bleed due to rupture. Some authors consider Hughes Stovin syndrome as a variant of Behcet's disease. Diagnosis is made by clinical findings and the first line treatment are corticosteroids and cyclophosphamide. Anticoagulation is controversial due to the increased risk of hemorrhage.

Endothelial Progenitor Cells and NADPH Oxidase Enzyme Activity in the Development of an Aortic Aneurysm

Abstract Introduction: Endothelial progenitor cells (EPCs) and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase enzyme activity may affect the vessel wall and have a role in development of aortic aneurysms. EPCs originate from hematopoietic stem cells and can be enumerated from peripheral blood samples by flow cytometry. In this study, we aimed to evaluate the relation of EPC number and NADPH oxidase enzyme activity in the development of thoracic aortic aneurysm (TAA). Methods: Patients with TAA (n=30) and healthy individuals without TAA (control, n=10) were included in our study. Characterization and enumeration of EPC from peripheral blood samples were performed by flow cytometry with panels including markers of EPCs (CD34/CD133/CD309/CD146/CD144). Additionally, NADPH oxidase enzyme activity (capacity) was also measured by the dihydrorhodamine 123 (DHR 123) test. Results: The enumeration of EPC with CD34+/CD146+ marker showed that the number of mean EPC/106 cells was increased in the patient group (41.5/106 cells), but not in the control group (20.50/105 cells) (P<0.01). Additionally, patients with TAA presented significantly lower NADPH oxidase activity by DHR assay than healthy controls (mean stimulation index: 60.40± 7.86 and 75.10±5.21, respectively) (P<0.01). Conclusion: Our results showed that the number of EPCs is significantly higher in aortic aneurysm patients and may have a role in disease progression. The crosstalk between NADPH oxidase enzyme capacity and EPC number may be useful as a parameter to explain the clinical progression of TAA.

Enfermedad de Kawasaki en pediatría: caso clínico

la enfermedad de Kawasaki (EK) es una vasculitis multisistémica que se presenta en la infancia. Por lo general es una afección aguda, febril, autolimitada, de etiología desconocida y puede desarrollar alteraciones cardiovasculares; su expresión clínica es variable: presenta inflamación de los vasos de mediano calibre y de múltiples tejidos: pulmonar, meníngeo, cardiaco, urinario, gastrointestinal, musculoesquelético, neurológico o linfático. El diagnóstico y el tratamiento buscan disminuir la duración de los síntomas y prevenir la presencia de aneurismas coronarios.

Kawasaki disease (KD) is a multisystemic vasculitis that presents in childhood. It is usually an acute, febrile, self-limited disease of unknown etiology and may develop cardiovascular alterations; its clinical expression is variable as it presents inflammation of medium caliber vessels and multiple tissues: pulmonary, meningeal, cardiac, urinary, gastrointestinal, musculoskeletal, neurological or lymphatic. Diagnosis is clinical, and treatment aims to reduce the duration of clinical symptoms and prevent the presence of coronary aneurysms. Objective: to describe the clinical case of an infant patient with KD, in which clinical criteria characteristic of this pathology were identified. Case report: a 22-month-old male patient was admitted to the emergency room with a 14-day evolutionary clinical picture consisting of fever, emetic episodes, abdominal pain, unresponsive to acetaminophen, and diarrheal episodes. Two days later, he manifested generalized exanthema in the inguinal region that spread to the right testicle, back, and thorax. Subseguently, he presented bilateral nonpurulent conjunctivitis for three days. He received treatment with topical steroids and oral antihistamines; partial improvement with subseguent evolution in right testicularedema and bilateral desquamation in hands and feet. KD was suspected, a transthoracic echocardiogram was sent without coronary aneurysmal dilatations, and treatment with ASA was started without indication, given the evolution of immunoglobulin. Conclusions: KD is infrequent in childhood and should be suspected in patients with prolonged febrile symptoms unresponsive to conventional treatments and in whom the presence of other pathologies is ruled out.

a doença de Kawasaki (DK) é uma vasculite multissistêmica que ocorre na infância. Geralmente é uma doença aguda, febril, autolimitada, de etiologia desconhecida, podendo desenvolver alterações cardiovasculares; sua expressão clínica é variável, apresentando inflamação de vasos de médio porte e de múltiplos tecidos: pulmonar, meníngeo, cardíaco, urinário, gastrointestinal, musculoesquelético, neurológico ou linfático. O diagnóstico é clínico e o tratamento visa reduzir a duração dos sintomas clínicos e prevenir a presença de aneurismas coronábanos. Objetivo: descrever o caso clínico de um paciente infantil com DK, no qual foram identificados critérios clínicos característicos dessa patologia. Caso clínico: paciente do sexo masculino, 22 meses de idade meses de idade, admitido no departamento de emergência com um curso clínico de 14 dias, consistindo em febre, episódios eméticos e dor abdominal, sem resposta ao acetaminofeno, além de episódios diarreicos. Dois dias depois, ele desenvolveu uma erupção cutánea generalizada na região inguinal que se espalhou para o testículo direito, costas e tórax. Posteriormente, ele apresentou conjuntivite bilateral não purulenta por três dias. Ele foi tratado com esferoides tópicos e anti-histamínicos orais; houve melhora parcial com posterior evolução do edema testicular direito, descamação bilateral nas mãos e nos pés. Suspeitou-se de DK, portanto foi realizado ecocardiograma transtorácico sem dilatações aneurismáticas coronarianas e iniciado tratamento com AAS, sem indicação devido ao tempo de evolução da imunoglobulina. Conclusões: a DK não é frequente na infância e deve ser suspeitada em pacientes com sintomas febris prolongados que não respondem aos tratamentos convencionais e nos quais a presença de outras patologias é descartada.

Non Traumatic and Non Hypertensive Intracerebral Bleed: Causes and Imaging Evaluation

Background: Cross-sectional observational study was done in patients with non-traumatic, non-hypertensive intracerebral bleed undergoing cerebral angiography to study its different causes.Material & Methods:Patients with all age groups presenting to the emergency with acute non-traumatic intra-cerebral bleed undergoing cerebral angiography in our institution for a time period of 6 months with a total of 200 patients were included in the study. Data collected were analyzed with respect to causes, distribution of aneurysms. Suspected cases of hypertensive bleed were excluded from the study population.Results:Non-contrast computed tomographic images showed positive findings in the form of either intra-axial/extra-axial bleed or infarct in 95% of patients. However angiographic findings were positive in 52% of patients. Aneurysms were the most common positive angiographic findings (43% cases) with 95% of aneurysms were located in the circle of Willis. Majority of patients had solitary aneurysm while 6% had multiple aneurysms.Conclusions:Among all non-traumatic, non-hpertensive intracerebral bleed aneurysms accounts for majority of the causes. Other causes include intraparenchymal arterio-venous malformations, cerebral venous thrombosis with hemorrhagic infarct and dural arteriovenous malformations (AVM).

Microsurgery versus embolization: different risk factors for short- and long- term outcomes of patients with ruptured aneurysms

Purpose: To evaluate the risk factors for poor outcomes after surgical and endovascular treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods: Patients with ≥ 18-years of age and aSAH were included, while patients who died within 12 h of admission or lost follow-up were excluded. All participants underwent standardized clinical and radiological assessment on admission and were reassessed at discharge and at 6-months follow-up using the Glasgow Outcome Scale (GOS). Results: Death at discharge was associated with female gender, anterior communication artery (ACoA) aneurysm location and presence of atherosclerotic plaque in the surgical group, and with age in the endovascular group. Both groups had clinical condition on follow-up associated with mFisher score on admission and hypertension. GOS on follow-up was also associated with presence of atherosclerotic plaque and multiple aneurysms in surgical group, and with age in endovascular group. Conclusions: Subjects treated surgically are prone to unfavorable outcomes if atherosclerotic plaques and multiple aneurysms are present. In patients with endovascular treatment, age was the main predictor of clinical outcome.

Advances in surgical treatment of internal iliac artery aneurysms / 国际外科学杂志

The internal iliac artery originating from the common iliac artery is an important branch, and communicating with the branches of the abdominal aorta, such as lumbar artery and sacral median artery, forming rich collateral circulation and nourishing the blood supply of gluteal muscle and pelvic floor viscera. Surgical intervention is recommended when the maximum diameter of internal iliac artery aneurysms>2 cm. A variety of treatment modalities are available, particularly, endovascular technique has been successfully applied in the clinical treatment of internal iliac artery aneurysms, which can significantly improve the cure and reduce complications and deaths. This article reviews the previous literature and summarizes the progress of internal iliac artery aneurysms treatment.

A comparative study of pediatric patients with Complete vs. Incomplete Kawasaki Disease in a tertiary Hospital: An eleven year review

Introduction@#Kawasaki disease (KD) is the leading cause of acquired heart disease in childhood, but its diagnosis remains challenging since a significant number of cases do not meet the diagnostic criteria (Incomplete KD). This may delay the diagnosis and initiation of treatment, and increase the risk of morbidity from coronary artery complications.@*Objectives@#This study compared the clinical profile and treatment outcomes of children with complete and incomplete KD. @*Methods@#This is a cross-sectional, retrospective study of pediatric patients diagnosed with KD and admitted in a tertiary hospital from January 1, 2010 to December 31, 2020. Demographics, clinical manifestations, laboratories, 2D echocardiography (2DE) findings and treatment outcomes were obtained by review of medical records and analyzed using descriptive statistics. @*Results@#Among 135 patients studied, 71% were classified as Incomplete Kawasaki Disease. Majority (89%) were children more than 1 year old and predominantly male (55%). Five classic features, other than fever, were more frequent in complete KD – bilateral bulbar conjunctivitis, mucosal changes in the lip and oral cavity, polymorphous exanthem, changes in extremities, and cervical lymphadenopathy. Fever (100%), conjunctivitis (100%), rashes (97%) and oral changes (90%) were the most common findings in complete KD, while fever (100%), rashes (56%), conjunctivitis (46%) and oral changes (35%) were noted in incomplete KD. Higher CRP (167 mg/L vs. 100 mg/L) and lower albumin levels (30 g/L vs. 38 g/L) were seen in complete KD. Coronary artery dilatation (56% vs. 48%) was frequently detected in both complete and incomplete KD. Majority (96%) of cases received only one dose of IVIG and 4% needed additional treatment with methylprednisone. @*Conclusion@#The five principal features of KD other than fever, elevated CRP and lower albumin levels were significantly more common in complete cases. No significant differences in the demographics and 2DE findings of children with complete and incomplete KD were observed.

Tratamento endovascular na doença de Behçet: uma revisão integrativa / Endovascular treatment in Behçet's disease: an integrative review

Resumo A doença de Behçet (DB) é caracterizada por ser uma doença rara, crônica, recidivante, inflamatória e multissistêmica. Quanto ao diagnóstico, não existe nenhum teste universalmente descrito; logo, ele é feito de maneira clínica, por meio da presença da sua tríade clássica de sinais: úlceras orais, úlceras genitais e uveíte (inflamação do trato uveal do olho). O objetivo deste estudo foi avaliar a importância do tratamento endovascular na doença de Behçet, sendo que a revisão de literatura para obter essa resposta foi realizada a partir de 30 artigos publicados entre 2002 e 2021. A DB acomete tanto o sistema venoso quanto o arterial. A ruptura de aneurismas é a principal causa de morte e necessita de tratamento, podendo ser clínico, cirúrgico aberto ou por via endovascular. A cirurgia endovascular vem ganhando espaço no tratamento cirúrgico nos casos de aneurismas arteriais, inclusive nos relacionados com DB, apesar de a terapia de escolha ainda ser controversa.

Abstract Behçet's Disease (BD) is a rare, chronic, relapsing, inflammatory, and multisystemic disease. There is no universally described test for confirming diagnosis, so it is made clinically, on the basis of its classic triad of signs: oral ulcers, genital ulcers, and uveitis (inflammation of the uveal tract of the eye). The aim of this study is to evaluate the importance of endovascular treatment in Behçet's disease. The literature review conducted to achieve this objective covered 30 articles published between 2002 and 2021. Behçet's Disease affects both the venous and arterial systems. Rupture of aneurysms is the main cause of death and thus requires treatment, which can be clinical, open surgical, or endovascular. Endovascular surgery has been gaining ground for surgical treatment of arterial aneurysms, including those related to BD, although the therapy of choice is still controversial.

Analysis of risk factors for duration of small or medium-sized coronary artery aneurysms in children with Kawasaki disease / 中华实用儿科临床杂志

Objective:To analyze risk factors for duration of small or medium-sized coronary artery aneurysms (CAA) in children with Kawasaki disease (KD) so as to provide clinical guidance for early and full course treatment.Methods:The clinical data of 68 children diagnosed with KD in the Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University from January 2018 to January 2021 were retrospectively analyzed.According to duration of CAA, all cases were divided into 2 groups, duration of CAA ≥ 8 weeks group and duration of CAA <8 weeks group.Risk factors associated with CAA duration were screened using univariate analysis, and then independent risk factors for CAA duration in children with KD were analysed using multiple Logistic regression analysis. Results:A total of 68 cases were enrolled in this study.Among these cases, 45 cases (66.18%) were male and 23 cases (33.82%) were female.The onset age was from 3 months to 10 years old, and the median onset age was 1.59 (1.02-3.19). There were 31 cases in the group with CAA duration ≥8 weeks and 37 cases in the group with CAA duration <8 weeks.Univariate analysis showed that patients with the total fever course >10 days[45.16%(14/31 cases) vs.21.62%(8/37 cases)], time of treatment with intravenous immunoglobulin (IVIG)>10 days[54.84%(17/31 cases) vs.16.22%(6/37 cases)], platelet (PLT)>600×10 9/L[32.26%(10/31 cases) vs.10.81%(4/37 cases)], hypersensitive C-reactive protein (HsCRP) >100 mg/L[38.71%(12/31 cases) vs.13.51%(5/37 cases)] (all P<0.05 ) in the group with CAA duration ≥8 weeks were significantly more than those in the group with CAA duration <8 weeks.However, there were no significant differences in gender, age, type of KD, etiology evidence, hormone application, duration of fever before IVIG application, IVIG sensitivity, IVIG application way, urine leukocytes, white blood cells, hemoglobin, percent of neutrophilic granulocyte, erythrocyte sedimentation rate, glutamic-pyruvic transaminase between the 2 groups (all P>0.05). Multivariate Logistic regression analysis showed that the course of IVIG before application >10 days ( OR=6.589, 95% CI: 1.678-25.867, P=0.007)and HsCRP >100 mg/L ( OR=7.949, 95% CI: 1.947-32.461, P=0.004)were independent risk factors for predicting the duration of KD complicated with small and medium-sized CAA ≥8 weeks. Conclusions:The course of IVIG before application >10 days and HsCRP>100 mg/L are independent risk factors for KD complicated with small and medium-sized CAA lasting ≥8 weeks.

Aneurismas por Estreptococo Pneumoniae / Aneurysms by Streptococcal Pneumoniae

El Estreptococo Pneumoniae es un microorganismo patógeno capaz de causar en humanos diversas infecciones y procesos invasivos severos, siempre graves y potencialmente letales. El objetivo de este trabajo fue mostrar la infrecuente presencia del Estreptococo Pneumoniae en la aparición de los aneurismas micóticos aórticos y de arterias periféricas, una asociación muy particular que coloca al cirujano vascular ante una especial conducta terapéutica encaminada a erradicar la infección, evitar la ruptura y sustituir la arteria, para mantener la continuidad de la luz del vaso y prevenir situaciones graves de isquemia(AU)

Streptococcal Pneumoniae is a pathogenic microorganism capable of causing in humans various infections and severe, always serious and potentially lethal invasive processes. The objective of this work was to show the rare presence of Streptococcal Pneumoniae in the onset of aortic mycotic aneurysms and peripheral arteries, a very particular association that places the vascular surgeon in an special therapeutic behavior aimed at eradicating the infection, preventing ruptures and replacing the artery, to maintain the continuity of vessel's light and prevent serious ischemia's situations(AU)