ABSTRACT
Os aneurismas do tronco tibiofibular são raros e consistem principalmente em pseudoaneurismas. Os autores descrevem um caso incomum de pseudoaneurisma do tronco tibiofibular secundário a endocardite bacteriana diagnosticada e tratada vários anos antes. Após a exclusão de um processo infeccioso ativo, o paciente foi tratado com sucesso através do implante percutâneo de um stent recoberto. O tratamento endovascular, neste contexto, apresentou uma alternativa segura e eficaz
ibioperoneal trunk aneurysms are rare and the majority of them are pseudoaneurysms This report describes an unusual case of a pseudoaneurysm secondary to bacterial endocarditis diagnosed and treated several years previously. After ruling out ongoing infection, the patient was successfully treated by percutaneous covered stent implantation. In this scenario, the use of endovascular techniques offered a safe and effective alternative treatment
Subject(s)
Humans , Male , Aged , Aneurysm, False/complications , Aneurysm, False/physiopathology , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/etiology , Endovascular Procedures/methods , Magnetic Resonance Imaging/methods , Stents , Treatment Outcome , Tibial Arteries , Lower Extremity , Infections/diagnostic imagingABSTRACT
INTRODUÇÃO: A injeção de trombina guiada por ultrassom (IT) é uma opção para o tratamento de pseudoaneurisma da artéria femoral. No entanto, o resultado dessa técnica em pacientes com síndrome coronária aguda (SCA) pode ser comprometido pelo uso de medicações antitrombóticas. Também, o extravasamento de trombina para a circulação sistêmica pode causar aumento de eventos tromboembólicos. MÉTODOS: Foram selecionados todos os pacientes admitidos com SCA que apresentaram pseudoaneurisma da artéria femoral após procedimento percutâneo, tratados com IT, entre janeiro de 2007 e julho de 2011. Características clínicas e laboratoriais, resultado do tratamento e complicações foram avaliados. RESULTADOS: Analisamos 23 pacientes, com idade de 67,1 ± 14,2 anos, 60,9% eram do sexo feminino, com índice de massa corporal de 28,4 ± 4,7 kg/m², e 52,2% eram diabéticos. À apresentação, 87% tinham SCA sem supradesnivelamento do segmento ST e o restante, infarto do miocárdio com supradesnivelamento do segmento ST. Entre os pacientes avaliados, 70% foram submetidos a intervenção coronária percutânea. Todos os pacientes estavam em uso de ácido acetilsalicílico, 78,3% utilizaram inibidores da P2Y12 e 39,1%, inibidores da glicoproteína IIb/IIIa. A IT foi eficaz em ocluir o pseudoaneurisma em 100% dos casos (96,7% após a primeira injeção), sem embolia distal, infecção local ou necessidade de correção cirúrgica em nenhum caso. Não houve infarto, acidente vascular cerebral ou revascularização não-programada. Houve um óbito por choque cardiogênico, 22 dias após a IT, no segundo dia após cirurgia eletiva de revascularização miocárdica. CONCLUSÕES: O tratamento de pseudoaneurisma da artéria femoral com IT é um método seguro e eficaz em pacientes com SCA.
BACKGROUND: Ultrasound-guided thrombin injection (TI) is an option for the treatment of femoral artery pseudoaneurysm. Nevertheless, the result of this technique in patients with acute coronary syndrome (ACS) may be compromised by the use of antithrombotic drugs. In addition, thrombin extravasation to systemic circulation could potentially cause an increase in thromboembolic events. METHODS: Patients admitted with ACS who developed femoral artery pseudoaneurysm after a percutaneous procedure and treated by TI between January 2007 and July 2011 were included. Clinical and laboratory characteristics, treatment results and complications were evaluated. RESULTS: We evaluated 23 patients with mean age of 67.1 ± 14.2 years, 60.9% were women, with body mass index of 28.4 ± 4.7 kg/m² and 52.2% were diabetics. At presentation, 87% had non-ST elevation ACS and the remaining had ST elevation myocardial infarction. Of the evaluated patients, 70% were submitted to percutaneous coronary intervention. All patients were receiving aspirin, 78.3% used P2Y12 inhibitors and 39.1% used glycoprotein IIb/IIIa inhibitors. TI was successful in occluding the pseudoaneurysm in 100% of cases (96.7% after the first injection), without distal embolization, local infection or need of surgical correction. There were no cases of myocardial infarction, stroke or unscheduled revascularization. There was one death due to cardiogenic shock 22 days after TI, on the second post-operative day after an elective coronary artery bypass graft surgery. CONCLUSIONS: Treatment of femoral artery pseudoaneurysm by TI is a safe and effective procedure in patients with ACS.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Femoral Artery/physiopathology , Aneurysm, False/physiopathology , Aneurysm, False/therapy , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/physiopathology , Thrombin/administration & dosage , Cardiac Catheterization , Heparin/administration & dosage , Percutaneous Coronary Intervention/methods , Platelet Aggregation Inhibitors , Ultrasonography, Interventional/methodsABSTRACT
Os autores apresentam caso de paciente do sexo masculino, adulto, com pseudo-aneurisma traumático gigante da artéria temporal superficial, com história de 11 anos de evolução. O diagnóstico definitivo somente ocorreu durante investigação de hemorragia subaracnóidea espontânea, após passar por inúmeros especialistas investigando a tumoração pré-auricular. O tratamento, com ligadura proximal e distal e excisão completa da lesão, foi pela mesma via de abordagem pterional para clipagem de aneurisma intracraniano. Os autores fazem breve revisão da literatura, salientando os aspectos de fisiopatologia, diagnóstico e tratamento.
The authors report a case of an adult male patient with giant traumatic pseudoaneurysm of the superficial temporal artery with eleven years of evolution. The final diagnosis has been defined when the patient presented a subarachnoid hemorrhage. The treatment consisted of excision after trapping in the same pterional approach used for intracranial aneurysm treatment. A brief literature review highlighting the aspects of physiopatholology, diagnosis and treatment is presented.
Subject(s)
Humans , Male , Aged , Temporal Arteries/physiopathology , Temporal Arteries/injuries , Aneurysm, False/diagnosis , Aneurysm, False/physiopathology , Aneurysm, False/therapyABSTRACT
Sepsis from an infected cardiac value can lead to bacterial seeding and destruction of the arterial wall with formation of a mycotic aneurysm. The natural history of these lesions is the rupture. We report the case of a 20 year old female who was admitted to our institution with massive mitral regugirtation and emboli of the central nervous system and both lower extremities. She underwent emergency valve replacement and then, staged treatment of her ischmic legs and multiple asymptomatic mycotic aneurysms. Superior mesenteric, right common iliac and left superficial femoral arteries. A splenectomy was required to treat a splenic abscess. An aneurysm of a peripheral branch of the middle cerebral artery was medically treated, demonstrating reduction in size on subsequente angiogram.She recoverd uneventfully and remains asymptomatic after 20 months of follow up. The development of new diagnostic and therapeutic tools had led to a decrease ot these complications during infectious endocarditis. However, in the patient with late diagnosis and symptoms in different territories, the mycotic aneurysm must be kept in mind to provide the patient with appropriate treatment
Subject(s)
Humans , Female , Adult , Aneurysm, Infected/complications , Embolism/complications , Endocarditis, Bacterial/complications , Aneurysm, Infected/surgery , Embolectomy , Aneurysm, False/physiopathology , Embolism/surgery , Endocarditis, Bacterial/surgery , LigationABSTRACT
Se analizan 81 falsos aneurismas anastomóticos (FAA) en 58 pacientes operados por afecciones vasculares, en el lapso comprendido entre 1966 y 1995. Observamos 60 casos operados originalmente en nuestro hospital y 21 intervenidos en otros servicios. La incidencia de FAA en nuestro hospital fue del 5,46 por ciento. Sobre 502 aneurismas de aorta abdominal, hubo 15 FAA (2,98 por ciento) y sobre 597 aterosclerosis obliterante operados, tuvieron 66 FAA (11,05 por ciento). En la serie global de 81 FAA, 26 por ciento se localizaron a nivel aórtico y, 74 por ciento, a nivel femoral. Se efectuaron estudios bacteriológicos en un 86,4 por ciento de los casos y, sobre el total de cultivados, hubo un 52,9 por ciento de cultivos positivos. El tratamiento quirúrgico realizado en 79 FAA fue el siguiente: reconstrucción anatomótica a nivel aórtico en 55 por ciento (11/20) y, a nivel femoral, en 86,4 por ciento (51/59). Se utilizó técnica extraanatómica en 5 por ciento (8/20) de los FAA aórticos y en 15,3 por ciento (9/59) de los femorales. El índice de amputaciones mayores fue del 24,7 por ciento. De los 79 FAA operados, hubo un 39,2 por ciento de mortalidad postoperatoria. Cuando se comprende la patogénesis de los FAA, los factores involucrados pueden ser considerados en la primera operación previniendo así esta complicación