ABSTRACT
Introducción: La baja incidencia del leiomiosarcoma de la vena cava inferior dificulta tanto la estandarización del diagnóstico como el tratamiento. Objetivo: Presentar el manejo realizado en nuestro centro de un paciente que desarrolló un leiomiosarcoma de vena cava inferior, una patología de baja incidencia y que las posibilidades de realizar un rescate quirúrgico son muy bajas. Resultados: Se presenta el caso de un paciente de 54 años con una tumoración sólida en porción infrarrenal y yuxtarrenal de vena cava inferior de 71 × 76 × 117 mm compatible con leiomiosarcoma de vena cava, con infiltración de uréter derecho que ocasiona uropatía obstructiva derecha grado I-II sin alteración de la función renal, que fue resecada y reconstruida mediante prótesis sin complicaciones. Discusión: Se discute la fisiopatología, el diagnóstico y manejo en relación con el caso presentado. Conclusión: la baja incidencia de estos tumores dificulta tanto la estandarización del diagnóstico como del tratamiento, aunque la cirugía sigue siendo el tratamiento de elección.
Introduction: The low incidence of leiomyosarcoma of the inferior vena cava hinders both the standardization of diagnosis and treatment. Objective: To present the management carried out in our center of a patient who developed an inferior vena cava leiomyosarcoma, a low incidence pathology with uncertain surgical rescue. Results: 54-year-old patient with a solid tumor in the infrarenal and juxtarenal portions of the inferior vena cava of 71 × 76 × 117 mm compatible with leiomyosarcoma of the vena cava, with infiltration of the right ureter that causes right obstructive uropathy grade I-II without kidney function changes; tumour was resected and continuity reconstructed with a prosthesis without complications. Discussion: The pathophysiology, diagnosis and management are commented. Conclusion: the low incidence of these lesions makes it difficult to standardize both diagnosis and treatment, although surgery remains the treatment of choice.
ABSTRACT
Dacron vascular prostheses have been widely used in vascular surgery since the mid-1970s. They have been proven to be the most durable and reliable conduits for arterial replacement in aortic and peripheral surgeries for decades. However, an extremely rare complication, namely late non-anastomotic graft rupture, due to intrinsic structural prosthetic disruption can occur, resulting in acute hemorrhage or false aneurysm formation. We report a case of this rare complication due to non-anastomotic rupture of a bifurcated knitted Dacron aortic vascular graft in a patient who had undergone an aorto-bi-iliac bypass 6 years ago. The patient was successfully treated in an emergency setting with endovascular therapy using an iliac limb of an abdominal aortic endoprosthesis.
Subject(s)
Humans , Aneurysm, False , Blood Vessel Prosthesis , Emergencies , Extremities , Hemorrhage , Polyethylene Terephthalates , Rupture , TransplantsABSTRACT
We report an extremely rare case of early disruption of a woven Dacron graft by the mechanical force of the lumbar vertebral body after a thoracoabdominal aortic aneurysm repair. A 75-year-old man with thoracoabdominal aortic aneurysm of Crawford type III underwent replacement of the thoracoabdominal aorta using a Gelweave thoracoabdominal graft (Vascutek) and a Gelweave bifurcate graft (Vascutek). His postoperative course was uneventful and discharged on postoperative day 20. On the 22nd postoperative day, he was re-hospitalized with low back pain. Computed tomography scanning showed a massive hematoma around the region of the graft-to-graft anastomosis. He underwent an emergency operation. At laparotomy, the Gelweave thoracoabdominal graft had a 2-mm hole which had been caused by the mechanical force of lumbar vertebral body, which was not related to the anastomosis. The graft was repaired with a 4-0 polypropylene buttress suture and a new prosthesis graft was used to wrap around the disrupted graft.
ABSTRACT
A non-anastomotic false aneurysm occurred in a 77-year-old male 11 years after bypass grafting between the left external iliac artery and the right femoral artery using a Cooley double velour knitted Dacron graft. The false aneurysm was caused by rupture of an artificial graft. A partial resection of the graft and its replacement using a Hemashield<sup>®</sup> graft were successfully performed. It was speculated that the mechanical stress by the inguinal band degenerated graft fibers and developed aneurysmal formation.
ABSTRACT
No interstitial bleeding occurred in either type of grafts. By gross observation and under light microscopy, a smooth neointima was noticed on the surface of collagen coated grafts 30 and 90 days after implantation. In a series of 4 patients with Marfan's syndrome undergoing replacement of the aortic root, hemorrhage through the interstices of the graft was virtually eliminated. There was no complication in any patient after a follow up of 3 months. This study reveals that collagen-coated dacron grafts were totally impervious to blood during and after implantation. The collagen coating can promoting cell growth and graft healing and does not interfere with the physical properties of the dacron grafts. As a prosthesis of aorta replacement , it may be applied clinically with safety. If it is used as small diameter vascular prosthesis,the long-term patency may be improved.
ABSTRACT
The aim of this study is to determine whether seeded Dacron with autologous venous tissue fragments shows significant 6-keto-prostglandin F 1? (6 K PGF 1? )production after in vivo implantation.The Dacron grafts seeded with autologous venous fragments were implanted into the inferior vene cava(IVC)of the 13 canines as seeded group;and the control group (8 canines),in which grafts were only preclotted with fresh blood. Plasma 6 K PGF 1? and TXB 2 were assessed at different time.All of the specimens explanted at exsanguination were observed with light microscopy and sanning electron microscopy and the amounts of 6 K PGF 1? from the luminal surface were assessed using ridioimmunoassay. The results showed that the total patency rate of the explanted vessels was higher in seeded group (61.5%) than that in control group ( 25% ),and that endothelial cells lined the whole luminal surface of Dacron at the 14th day after operation in seeded group,but thrombus covered the surface of Dacron at the 14th day in control ones. The level of 6 K PGF 1? from plasma and the luminal surface of Dacron grafts in seeded group was higher,but the level of plasma TXB 2 was lower than that in control group. It can be concluded that seeding Dacron with autologous venous fragments makes a new endothelial lining possible at two weeks,and can release more 6 K PGF 1? and thus lead to an improved patency rate of canine IVC reconstructions,so the graft patency might be determined according to the changes of plasma 6 K PGF 1? and TXB 2 level.