Aneurisma de arteria coronaria derecha y elevación del segmento ST en cara inferior. Reporte de caso y revisión de la literatura / Right Coronary Artery Aneurysm and inferior ST segment elevation. Case Report and Literature Review / Aneurisma de artéria coronária direita e elevação do segmento ST na cara inferior. Reporte de caso e revisão da literatura

Los aneurismas de las arterias coronarias (AAC) son poco comunes, con una incidencia de 0.3-5.3%. Se definen como una dilatación 1.5 veces mayor al diámetro interno de la arteria normal adyacente. La arteria coronaria derecha es la más comúnmente afectada. Su fisiopatología es poco clara, pero se cree que una de sus principales causas es la aterosclerosis. Los AAC son generalmente asintomáticos o pueden estar asociados a isquemia miocárdica. Su tratamiento aún no está bien establecido, debido al desconocimiento general sobre su historia natural, e incluye desde un manejo conservador hasta el tratamiento quirúrgico. A continuación, se reporta el caso de un paciente con infarto agudo de miocardio y elevación del segmento ST, llevado a coronariografía que evidenció aneurisma de la coronaria derecha, que requirió trombectomía, angioplastia y manejo médico vitalicio ambulatorio.

Coronary artery aneurysms (CAA) are a rare entity with an incidence of 0.3-5.3%. They are dilations of 1.5 times larger than normal adjacent artery, with the right coronary artery as the most affected vessel. Its pathophysiology is unclear but atherosclerosis is believed to be the main cause. CAA are generally asymptomatic but can cause coronary ischemia. Its treatment is yet to be established due to general ignorance about its nature. It ranges from conservative management to surgery. In the following text, we report a case of a patient with acute myocardial infarction presenting ST-segment elevation, who showed a right coronary artery aneurysm in coronary angiography. The patient required thrombectomy, angioplasty and subsequent lifetime outpatient medical management.

Os aneurismas das artérias coronárias (AAC) são pouco comuns, com uma incidência de 0.3-5.3%. Se definem como uma dilatação 1.5 vezes maior ao diâmetro interno da artéria normal adjacente. A artéria coronária direita é a mais comumente afetada. Sua fisiopatologia é pouco clara, mas se crê que uma das suas principais causas é a aterosclerose. Os AAC são geralmente assintomáticos ou podem estar associados a isquemia miocárdica. Seu tratamento ainda não está bem estabelecido, devido ao desconhecimento geral sobre sua história natural, e inclui desde um manejo conservador até o tratamento cirúrgico. A continuação, se reporta o caso de um paciente com infarto agudo de miocárdio e elevação do segmento ST, levado a coronariografia que evidenciou aneurisma da coronária direita, que requereu trombectomia, angioplastia e manejo médico vitalício ambulatório.

Microcirugía mínimamente invasiva para aneurisma de la arteria comunicante anterior: abordaje supraorbitario lateral más angiografía con fluoresceína intraoperatoria / Minimally invasive micro surgery for aneurysm of the anterior communicating artery: supra-orbitary lateral approach with intraoperative Fluorescein Angiography

RESUMEN Los aneurismas de la arteria comunicante anterior son complejos y requieren de tratamiento endovascular o microquirúrgico según sus características. El uso de enfoques mínimamente invasivos en microcirugía continúa evolucionando. Presentamos el caso de un paciente de 34 años con un aneurisma cerebral no roto de AcoA de cuello ancho, con escala de Glasgow de 15 puntos. Se realizó un abordaje supraorbitario lateral más "clipaje" total del aneurisma usando angio fluoresceína intraoperatoria. Se logró el objetivo con seguridad y eficacia; al mismo tiempo se optimizó el tiempo quirúrgico y hospitalario, maximizando la comodidad del paciente, estética y reanudación a sus actividades tempranas. (AU)

SUMMARY Anterior communicating artery aneurisms (ACAA) are complex and require endovascular or microsurgery approaches. The use of minimally invasive microsurgery techniques is evolving. We present the case of a 34-yearold patient with a broad neck, non-broken, ACAA with a Glasgow coma scale of 15 points. A lateral supra-orbitary approach with total clipping of the ACAA using intra-operatory fluorescein angiography was performed. The objective was accomplished successfully and safe, optimizing both intra-operative and hospitalization times, thus,maximizing patient comfort, esthetic and prompt return to normal duties. (AU)

Calcified intrarenal aneurysm simulating urinary lithiasis

ABSTRACT We describe the case of a female patient with calcification in renal topography, initially diagnosed as lithiasis in the left kidney, and later attributed to calcification of intrarenal vascular aneurysm. Next, we discuss the relevance of considering such an entity in the differential diagnoses of intrarenal calcifications before choosing any form of specific interventional treatment.

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.

Perfil clínico de los pacientes con aneurisma cerebral atendidos en el Hospital Carlos Andrade Marín / Clinical profile of patients with cerebral aneurysms treated at Carlos Andrade Marín Hospital

INTRODUCCIÓN. En Ecuador, las enfermedades cerebrovasculares son la tercera causa de muerte en la población general; existen pocos datos en la literatura médica sobre la hemorragia subaracnoidea aneurismática y aneurismas no rotos, por lo que fue fundamental describir un perfil clínico. OBJETIVO. Caracterizar la clínica de los pacientes con diagnóstico de aneurisma cerebral. MATERIALES Y MÉTODOS. Estudio observacional descriptivo. Población de 450 y muestra de 447 pacientes con diagnóstico de aneurisma cerebral atendidos en la Unidad de Neurología del Hospital Carlos Andrade Marín, periodo enero 2010 a diciembre 2018. Los datos clínicos e imagenológicos fueron recolectados a través de la revisión de historias clínicas digitales obtenidas del sistema informático MIS/AS400, y se analizaron en el programa estadístico International Business Machines Statistical Package for the Social Sciences, versión 23. RESULTADOS. Se identificaron 605 aneurismas en 447 pacientes. El 80,5% (360; 447) presentó aneurismas rotos, de éstos el 81,4% (293; 360) tuvo un solo aneurisma. El factor de riesgo más frecuente fue la hipertensión arterial con el 44,3% (198; 447), las manifestaciones observadas fueron: hemorragia subaracnoidea con el 98,9% (356; 360) en aneurismas rotos; y cefalea con el 65,5% (57; 87) en aneurismas no rotos. DISCUSIÓN. Se encontró datos relevantes no coincidentes con la literatura científica mundial, como el bajo número de aneurismas asintomáticos y no rotos, comparados con su contraparte. CONCLUSIÓN. Se evidenció que los aneurismas intracraneales produjeron una amplia gama de manifestaciones clínicas, que fluctuaron desde la hemorragia subaracnoidea como la más frecuente en el grupo de aneurismas rotos, hasta pacientes completamente asintomáticos en el grupo de aneurismas no rotos.

INTRODUCTION. In Ecuador, cerebrovascular diseases are the third leading cause of death in the general population; there are few data in the medical literature on aneurysmal subarachnoid hemorrhage and unruptured aneurysms, so it was essential to describe a clinical profile. OBJECTIVE. To characterize the clinical profile of patients diagnosed with cerebral aneurysm. MATERIALS AND METHODS. Descriptive observational study. Population of 450 and sample of 447 patients with a diagnosis of cerebral aneurysm seen in the Neurology Unit of the Carlos Andrade Marín Hospital, period January 2010 to December 2018. Clinical and imaging data were collected through the review of digital medical records obtained from the MIS/AS400 computer system, and were analyzed in the statistical program International Business Machines Statistical Package for the Social Sciences, version 23. RESULTS. A total of 605 aneurysms were identified in 447 patients. A total of 80,5% (360; 447) had ruptured aneurysms, of which 81,4% (293; 360) had a single aneurysm. The most common risk factor was hypertension with 44,3% (198; 447), the manifestations observed were: subarachnoid hemorrhage with 98,9% (356; 360) in ruptured aneurysms; and headache with 65,5% (57; 87) in unruptured aneurysms. DISCUSSION. We found relevant data not consistent with the world scientific literature, such as the low number of asymptomatic and unruptured aneurysms, compared with its counterpart. CONCLUSION. It was evidenced that intracranial aneurysms produced a wide range of clinical manifestations, ranging from subarachnoid hemorrhage as the most frequent in the group of ruptured aneurysms, to completely asymptomatic patients in the group of unruptured aneurysms.

Síndrome Inflamatória Multissistêmica associada à COVID-19: uma complicação pediátrica da pandemia / COVID-19-associated Multisystem Inflammatory Syndrome: a pediatric complication during the pandemic

Desde o surgimento da pandemia de COVID-19, casos de febre e inflamação sistêmica tardias, similares à Doença de Kawasaki, têm surgido na população pediátrica, sendo denominados Síndrome Inflamatória Multissistêmica associada à COVID-19. Estes quadros podem ir de apenas febre prolongada, até grave envolvimento gastrointestinal e cardíaco, com choque refratário e falência de múltiplos órgãos. Aneurismas de carótida podem surgir na evolução, levando a complicações em longo prazo. O pronto reconhecimento desta entidade com tratamento precoce de suporte geral, uso de imunoglobulina humana endovenosa e outras drogas imunomoduladoras, pode evitar evolução para casos graves e até mesmo fatais, assim como proteger o paciente de complicações crônicas, principalmente cardíacas.

Since the emergence of the COVID-19 pandemic, cases of late fever and systemic inflammation similar to Kawasaki Disease have appeared in the pediatric population, this entity was called Multisystem Inflammatory Syndrome associated with COVID-19. The presentation can range from just prolonged fever to severe gastrointestinal and cardiac involvement with refractory shock and multiple organ failure. Carotid aneurysms can arise in the course leading to long-term complications. The prompt recognition of this syndrome with early treatment with general support, use of Human Intravenous Immunoglobulin and other immunomodulatory drugs, can prevent progression to severe and even fatal cases, as well protect the patient from chronic complications, especially the cardiac ones.

Giant pulmonary artery aneurysms / Aneurismas gigantes de arteria pulmonar

The accompanying images demonstrate giant pulmonary artery aneurysms in a patient with idiopathic pulmonary arterial hypertension (Image 1). In addition to the main pulmonary artery, both the left and right pulmonary arteries are aneurysmal and are compressing the lung parenchyma (Image 2).

Las imágenes adjuntas muestran aneurismas gigantes de la arteria pulmonar en un paciente con hipertensión arterial pulmonar idiopática (Imagen 1). Además de la arteria pulmonar principal, tanto la arteria pulmonar izquierda como la derecha son aneurismáticas y están comprimiendo el parénquima pulmonar (Imagen 2).

Influencia del error diagnóstico en el pronóstico de la hemorragia subaracnoidea aneurismática en uruguay: analisis de una serie de 149 pacientes en un período de tiempo prepandemia y durante la pandemia SARS-Cov2 / Influence of diagnostic error on the prognosis of aneurysmal subarachnoid hemorrhage in Uruguay: analysis of a series of 149 patients in a pre-pandemic period and during the SARS-Cov2 pandemic

Introducción:La hemorragia subaracnoidea espontánea (HSA) presenta aproximadamente el 5% de todos los ACV, siendo una patología de alto impacto en la sociedad por su elevada morbi-mortalidad. La clínica de presentación es variada, lo cual lleva múltiples veces a dificultades en el diagnóstico. El objetivo de este trabajo es analizar el error diagnóstico que existe en esta patología y evaluar si el mismo se vio modificado por la interposición de la Emergencia Sanitaria declarada en el país por la pandemia del SARS-Cov2. Materiales y Métodos: es un estudio prospectivo y multicéntrico, incluyendo a todos los pacientes que presentaron HSA en el Uruguay entre el 1 de noviembre del 2019 y el 31 de julio de 2020. Se analizaron acuerdo con 3 períodos: 1) pre-pandemia, 2) cuarentena general, y 3) nueva normalidad. Se incluyeron todos los pacientes mayores de 18 años que consultaron y se les diagnosticó una HSA espontánea aneurismática. Se definió́ error diagnóstico a la imposibilidad de reconocer esta patología en la consulta médica inicial otorgándole el alta. El análisis se procesó utilizando el software SPSS versión 22. La investigación fue aprobada por todos los Comité de Ética de los diferentes centros que participaron del estudio. Resultados: de un total de 149 pacientes, la edad media fue de 57,23 años, con mayor frecuencia en el sexo femenino. Se constató error diagnóstico en 38 pacientes (25,5%), con mayor porcentaje durante la cuarentena general. El retraso en el diagnóstico por problemas asistenciales fue de un 2,6%. Se evidenció un 22,8% de complicaciones por el tratamiento indicado, y un 71,1% por la HSA, con una mortalidad global del 51,7%. Conclusiones: en el presente trabajo se observó un error diagnóstico elevado, evidenciando una relación directa y significativa con la cefalea y la HSA leve (HyH 1 y 2) como formas de presentación. Hubo un porcentaje mayor de HSA graves en comparación a la literatura, con una relación directa y significativa entre la presencia de vasoespasmo y la mortalidad con el error diagnóstico. También es claro que la crisis sanitaria determinó que ese error diagnóstico aumentara durante los primeros meses de la pandemia en Uruguay.

Introduction: Spontaneous subarachnoid hemorrhage (SAH) represents approximately 5% of all strokes, being a pathology of high impact in society, due to its high morbidity and mortality. The clinical presentation is varied, which leads many times to difficulties in diagnosis. The objective of this work is to analyze the diagnostic error that exists in this pathology, and to assess whether it was modified by the introduction of the Health Emergency declared in the country by the SARS-Cov2 pandemic. Materials and Methods: it is a prospective and multicenter study, including all patients who presented SAH in Uruguay between November 1, 2019 and July 31, 2020. They were analyzed according to 3 periods: 1) pre-pandemic, 2) general quarantine, and 3) new normality. All patients over 18 years of age who consulted and were diagnosed with spontaneous aneurysmal SAH were included. Diagnostic error was defined as the inability to recognize this pathology in the initial medical consultation and discharge. The analysis was processed using SPSS version 22 software. The research was approved by all the Ethics Committees of the different centers that participated in the study. Results: of a total of 149 patients, the mean age was 57.23 years, more frequently in the female sex. Diagnostic error was found in 38 patients (25.5%), with a higher percentage during general quarantine. The delay in diagnosis due to healthcare problems was 2.6%. There were 22.8% complications due to the indicated treatment, and 71.1% due to SAH, with an overall mortality of 51.7%. Conclusions: in the present work, a high diagnostic error was observed, showing a significant direct relationship with headache and mild SAH (HyH 1 and 2) as forms of presentation. There was a higher percentage of severe SAH compared to the literature, with a direct and significant relationship between the presence of vasospasm and mortality with diagnostic error. It is also clear that the health crisis determined that this diagnostic error increased during the first months of the pandemic in Uruguay

Remodelado Histológico en Aneurismas Fusiformes en Ratas Wistar tratadas con Wrapping de Algodón y Politetrafluoroetileno / Histological Remodeling in Fusiform Aneurysms in Wistar Rats Treated with Cotton Wrapping and Polytetrafluoroethylene

Intoducción: El tratamiento microquirúrgico para los aneurismas intracraneales es el clipado, sin embargo, algunos aneurismas deben ser resueltos mediante wrapping. El objetivo del trabajo es analizar los cambios histológicos en aneurismas fusiformes en ratas luego del wrapping con algodón natural y politetrafluoroetileno. Materiales y Método: Se trabajó con 12 Ratas Wistar divididas en 3 grupos. Luego de la anestesia se expusieron ambas arterias carótidas comunes, realizándose un aneurisma fusiforme en cada vaso. Se realizó wrapping a las carótidas derechas, grupo 1 con membrana de politetrafluoroetileno, grupo 2 con algodón natural y grupo 3 empleándo combinación de ambos materiales. Los animales fueron sacrificados a los 45 días postoperatorios, para luego procesar las muestras y análisis histológico vascular. Resultados: En el grupo 1 no se evidenciaron modificaciones estructurales, en el grupo 2 se destacó la presencia de células gigantes multinucleadas, inflamación, con infiltrado linfoplasmocitario. En el grupo 3 fue similar al grupo 2 con el agregado de metaplasia condroide y calcificaciones en capa media. Las arterias carotidas izquierdas (control) no presentaron cambios histológicos y a nivel muscular, aumento del tejido conectivo entre las fibras musculares y fibroblastos en el grupo 2. Discusión: Existen publicaciones sobre la técnica de wrapping con materiales autólogos o heterólogos. Sin embargo, no existen análisis experimentales de los efectos microestructurales producidos en las arterias tras la creación y tratamiento de un aneurisma fusiforme. Conclusiones: La combinación más efectiva para reforzar la pared del aneurisma y evitar la reacción inflamatoria circundante es la utilización de algodón natural y politetrafluoroetileno

Intoduction: The microsurgical treatment for intracranial aneurysms is clipping, however, some aneurysms must be resolved by wrapping. The objective of the work is to analyze the histological changes in fusiforms aneurysms in rats after wrapping with natural cotton and polytetrafluoroethylene. Materials and Method: We worked with 12 Wistar rats divided into 3 groups. After anesthesia, both common carotid arteries were exposed, making a fusiform aneurysm in each vessel. Right carotid wrapping was performed, group 1 with a polytetrafluoroethylene membrane, group 2 with natural cotton, and group 3 using a combination of both materials. The animals were sacrificed 45 days after surgery, to process the specimens and vascular histological analysis. Results: In group 1 there were no structural modifications, in group 2 the presence of multinucleated giant cells, inflammation, with lymphoplasmacytic infiltrate stood out. In group 3 it was similar to group 2 with the addition of chondroid metaplasia and calcifications in the middle layer. The left carotid arteries (control) did not present histological changes and at the muscle level, increased connective tissue between muscle fibers and fibroblasts in group 2. Discussion: There are publications on the wrapping technique with autologous or heterologous materials. However, there are no experimental analyzes of the microstructural effects produced in the arteries after the creation and treatment of a fusiform aneurysm. Conclusions: The most effective combination to reinforce the wall of the aneurysm and avoid the surrounding inflammatory reaction is the use of natural cotton and polytetrafluoroethylene

Aneurisma de la vena porta. A propósito de un caso / Portal vein aneurysm. A case presentation

RESUMEN Fundamento: los aneurismas de la vena porta son entidades poco frecuentes, representan aproximadamente el 3% de los aneurismas del sistema venoso. La mayoría de los aneurismas de la vena porta se detectan en pacientes con hígado sano, aunque en algunas ocasiones la hipertensión portal podría favorecer el desarrollo de la patología. Los lugares más comunes son la confluencia venosa esplenomesentérica, la vena porta principal y las ramas de la vena porta intrahepática en los sitios de bifurcación. Objetivo: presentar el caso de un paciente portador de una aneurisma de la vena porta. Presentación del Caso: Paciente femenina, blanca de 49 años de edad con antecedentes de trastornos dispépticos, y en ocasiones, dolor a nivel del hipocondrio derecho. Su examen físico era negativo y la impresión diagnóstica de su médico de asistencia era litiasis vesicular. Durante la realización del examen ultrasonográfico se encuentra como dato positivo una dilatación de tipo aneurismático de la vena porta en el inicio de su trayecto intrahepático de 18 mm de diámetro, y el resto del examen resultó negativo. Conclusiones: Por lo inusual de este caso se decide hacer su presentación.

ABSTRACT: portal vein aneurysms are uncommon, representing approximately the 3% of venous system aneurysms. Most portal vein aneurysms are detected in patients with healthy liver, although on some occasions portal hypertension could favor their development. The most common sites are the splenomesenteric venous confluence, the main portal vein and the branches of the intrahepatic portal vein at bifurcation sites. Objective: to present the case of a patient with a portal vein aneurysm. Case Presentation: A 49-years-old white female patient with a history of dyspeptic disorders, and sometimes pain in the right upper quadrant. Her physical examination was negative and the diagnostic impression from her attending physician was gallstones. During the ultrasound examination, an aneurysmal dilatation of the portal vein at the beginning of its intrahepatic path of 18 mm in diameter was found as a positive finding, being the rest of the examination negative Conclusions: Due to the unusual nature of this case, it was decided to present it.

Anomalía de Ebstein y aneurisma del seno coronario / Ebstein’s anomaly and coronary sinus aneurysm

Resumen La anomalía de Ebstein es una cardiopatía congénita poco común que se asocia a la presencia de vías de conducción anómalas y episodios de taquicardia supraventricular frecuentes, algunos inestables. La asociación con alteraciones anatómicas del seno coronario es rara y no ha sido reportada. Se presenta el caso de una paciente de 58 años con enfermedad coronaria, anomalía de Ebstein, episodios de taquicardia ortodrómica y aneurisma del seno coronario, a quien se realizó ablación.

Abstract Ebstein’s disease is a congenital cardiomyopathy, with a low prevalence in the general population. This abnormality has been associated with abnormal cardiac conduction problems, one of the most important being the accessory pathways. In the presence of an accessory pathway, frequent supraventricular tachycardias may occur, some of which are poorly tolerated. The association with the anomalies of the coronary sinus is not currently reported. The case of a 58-year-old woman with Ebstein’s disease, episodes of supraventricular tachycardia, and coronary sinus aneurysm undergoing ablation therapy is presented.

Edema perianeurismático cerebral. Reporte de dos casos / Cerebral perianeurysmal edema. Report of two cases

La hemorragia subaracnoidea (HSA) secundaria a ruptura aneurismática es una causa importante de morbimortalidad. Hay muchos factores que aumentan la probabilidad de ruptura, como el tamaño, forma, localización, exclusión endovascular incompleta del aneurisma, entre otros. Existen reportes sobre el edema cerebral perianeurismático como factor de riesgo de ruptura aneurismática. Se presentan en el siguiente artículo dos casos, ambos con aneurisma silviano del lado derecho, asociado a edema "perianeurismático".

Subarachnoid hemorrhage (SAH) secondary to aneurysmal rupture is an important cause of morbidity and mortality. There are many factors that increase the probability of rupture, the size, shape, location, incomplete endovascular exclusion of the aneurysm, among others. There are reports on perianeurysmal cerebral edema as a risk factor for aneurysmal rupture. Two cases are presented in the following article, both with right-sided sylvian aneurysm, associated with "perianeursmatic" edema.

Aneurisma venoso postraumático en extremidades superiores. Presentación de dos casos / Post-traumatic venous aneurysm in the upper limbs. Case report on two patients / Aneurisma venoso pós-traumático nos membros superiores. Apresentação de dois casos

RESUMEN Los aneurismas venosos, en especial de la extremidad superior, son malformaciones vasculares de baja frecuencia. Se presentó el manejo de dos pacientes del sexo femenino atendidas en el Servicio de Angiología y Cirugía Vascular del Hospital General Docente "Dr. Agostinho Neto" de la provincia Guantánamo, Cuba, a las que se les diagnosticaron aneurismas en diferentes segmentos del sistema venoso superficial de la extremidad superior, los que se resecaron quirúrgicamente y se les confirmó el diagnóstico mediante biopsia.

ABSTRACT Venous aneurysms, especially the ones located in the upper limbs, are vascular malformations with low incidence in the population. Two cases of venous aneurisms on female patients showed up at the Angiology and Vascular Surgery services at the General Teaching Hospital ¨Dr. Agostinho Neto¨ in Guantanamo, Cuba. Aneurism diagnosis was confirmed through biopsy. They were located in different segments of the superficial venous system of the upper limbs, and were surgically resected.

RESUMO Os aneurismas venosos, principalmente de membro superior, são malformações vasculares de baixa frequência. Foi apresentada a gestão de duas pacientes do sexo feminino atendidas no Serviço de Angiologia e Cirurgia Vascular do Hospital General Docente "Dr. Agostinho Neto" da província de Guantánamo, Cuba, que foram diagnosticados com aneurismas em diferentes segmentos do sistema venoso superficial do membro superior, os quais foram ressecados cirurgicamente e o diagnóstico foi confirmado por biópsia.

Aneurisma verdadeiro isolado de artéria femoral profunda associado a doença arterial periférica: relato de caso / True isolated deep femoral artery aneurysm associated with peripheral artery disease: case report

Resumo Os aneurismas verdadeiros de artéria femoral profunda são extremamente raros, representando cerca de 0,5% do total dos aneurismas periféricos. Neste relato, descrevemos um paciente de 79 anos de idade, sexo masculino, com histórico de abordagem cirúrgica prévia convencional devido a aneurisma de aorta abdominal, que deu entrada no Serviço de Cirurgia Vascular do Hospital das Clínicas com quadro de claudicação intermitente de membros inferiores. Foi realizado eco-Doppler colorido arterial do membro inferior direito, que revelou doença arterial periférica femoro-poplítea e infrapatelar. A angiotomografia computadorizada identificou oclusão aortoilíaca e do enxerto bifurcado desde o segmento infrarrenal da aorta, além de aneurisma de artéria femoral profunda de 3,7 x 3,5 cm de diâmetro com 7 cm de extensão. Procedeu-se com a ressecção do aneurisma e revascularização da artéria femoral profunda por interposição de prótese de Dacron® e reimplante de artéria femoral superficial na prótese. Portanto, nos casos de aneurisma de artéria femoral profunda concomitante a doença arterial periférica, deve-se atentar para revascularização e perfusão adequada do membro inferior.

Abstract True deep femoral artery aneurysms are extremely rare, accounting for about 0.5% of all peripheral aneurysms. In this report, we describe a 79-year-old male patient with a history of prior abdominal aortic aneurysm surgery via a conventional approach who was admitted to the vascular surgery service at the Hospital das Clínicas with intermittent claudication of the lower limbs. Arterial color-Doppler ultrasonography of the right lower limb was performed, revealing peripheral arterial disease of the femoral--popliteal and infrapatellar segments. Computed tomography angiography identified aortoiliac and bifurcated graft occlusion from the infrarenal segment of the aorta, in addition to a deep femoral artery aneurysm with diameters of 3.7 cm x 3.5 cm and length of 7 cm. Resection of the aneurysm was followed by revascularization of the deep femoral artery by interposition of a Dacron® graft and reimplantation of the superficial femoral artery into the graft. In cases of deep femoral artery aneurysms with concomitant peripheral arterial disease, it is important to ensure revascularization and adequate perfusion of the lower limb.

Técnica de remodelamento com uso de stents em T e molas para tratamento de aneurisma renal complexo / Remodeling technique using T-stenting and coils to treat complex renal aneurysm

Resumo O aneurisma da artéria renal é uma condição rara, que vem sendo cada vez mais diagnosticada devido ao uso mais amplo da angiotomografia. Descrevemos um caso de aneurisma da artéria renal tipo II complexo em uma paciente com hipertensão arterial sistêmica e doença renal crônica não dialítica. O tratamento estabelecido foi o reparo endovascular através da combinação da técnica de remodelamento com stents em T e molas, para a preservação dos ramos arteriais renais. Foram obtidos resultados arteriográficos satisfatórios e boa evolução clínica.

Abstract Renal artery aneurysm is a rare condition that is being diagnosed with increasing frequency because of wider use of angiotomography. We describe a case of complex type II renal artery aneurysm in a patient with systemic arterial hypertension and non-dialysis chronic kidney disease. The treatment performed was endovascular repair using the remodeling technique with T-stenting and coils to preserve the renal arterial branches, obtaining satisfactory arteriographic results and good clinical outcomes.

Ex-vivo repair for multiple and intraparenchymal renal artery aneurysms / Reparo Ex Vivo de Aneurismas Intraparenquimatosos Múltiplos da Artéria Renal

Abstract A 45-year-old woman with known hypothyroidism and no other comorbidities was incidentally found to have multiple right renal artery aneurysms. The largest aneurysm measured 5 x 4.5 cm and arose from an inferior segmental branch while two smaller aneurysms arose from an upper segmental branch of the right renal artery. We performed an ex-vivo repair with reverse saphenous vein graft under cold preservation followed by orthotopic kidney auto-transplantation. Her postoperative course was unremarkable and at 1-year follow-up her right kidney is preserved. In this article, we report successful treatment of complex multiple right renal artery aneurysms and describe the surgical technique used for successful repair.

Resumo Uma mulher de 45 anos com hipotireoidismo conhecido e sem outras comorbidades teve achado incidental de múltiplos aneurismas da artéria renal direita. O maior aneurisma media 5 x 4,5 cm e tinha origem no ramo segmentar inferior, juntamente com dois pequenos aneurismas originários do ramo segmentar superior da artéria renal direita. Realizamos o reparo ex vivo com enxerto reverso de veia safena, sob preservação a frio, seguido de autotransplante renal ortotópico. O pós-operatório ocorreu sem intercorrências, e a paciente teve o rim direito preservado no seguimento de 1 ano. Neste artigo, relatamos o tratamento bem-sucedido de múltiplos aneurismas complexos da artéria renal direita e descrevemos a técnica cirúrgica utilizada para o reparo bem-sucedido.

Aneurisma de artéria pancreatoduodenal inferior: tratamento endovascular / Inferior pancreaticoduodenal artery aneurysm: endovascular approach

Resumo Os aneurismas das artérias pancreatoduodenais constituem uma afecção rara. Seu diagnóstico é realizado, na maioria das vezes, em situações de emergência por complicações como a rotura, a qual está associada a altas taxas de mortalidade (21-26%). A embolização do saco aneurismático é o tratamento de escolha, devido à sua alta efetividade e menor mortalidade. Neste artigo, é apresentado e discutido um caso de aneurisma de artéria pancreatoduodenal inferior com diagnóstico obtido durante investigação de sintomas gastrointestinais. O tratamento instituído foi a embolização com micromolas, com completa exclusão do aneurisma e boa evolução clínica.

Abstract Aneurysms of the pancreaticoduodenal arteries are a rare condition. In the majority of cases, diagnosis is made in emergency situations due to complications such as rupture, which is associated with high mortality rates (21-26%). Embolization of the aneurysm sac is the treatment of choice, because of its high efficacy and lower mortality. This article presents and discusses a case of inferior pancreaticoduodenal artery aneurysm that was diagnosed during investigation of gastrointestinal symptoms. The treatment provided was microcoil embolization, with complete exclusion of the aneurysm and a good clinical course.

Endovascular treatment of wide-neck saccular renal artery aneurysm with waffle-cone technique / Tratamento endovascular de aneurisma renal sacular com colo largo com técnica do waffle-cone

Abstract In the past, treatment of visceral artery aneurysms (VAAs) was exclusively surgical. These aneurysms were rarely diagnosed in elective or emergency cases. Development of imaging techniques and endovascular procedures has changed the history of the therapeutic options for this pathology. Endovascular management of VAAs has arisen to advances in endovascular techniques and has achieved high efficacy.

Resumo No passado, o tratamento de aneurismas da artéria visceral (VAAs) era exclusivamente cirúrgico e raramente diagnosticado em casos eletivos ou de emergência. O desenvolvimento de técnicas de imagem e procedimentos endovasculares mudou a história das opções terapêuticas dessa patologia. O manejo endovascular de VAAs surgiu devido ao avanço das técnicas endovasculares, o qual apresentou uma alta eficácia.

Tratamento endovascular com endoprótese aórtica para aneurisma de artéria subclávia secundário à fístula arteriovenosa axilo-axilar traumática tardia / Endovascular treatment with aortic endoprostheses for subclavian artery aneurysm secondary to late traumatic axillary-axillary arteriovenous fistula

Resumo As fístulas arteriovenosas (FAVs) traumáticas envolvendo os vasos axilares e subclávios são incomuns e correspondem de 5 a 10% de todos os traumas arteriais. A anatomia complexa dessa região torna desafiador o tratamento desse segmento. Neste desafio terapêutico, descrevemos o caso de um homem de 73 anos, encaminhado por edema progressivo e úlcera no membro superior direito, com história pregressa de ferimento por arma de fogo na região infraclavicular direita há cerca de 50 anos. Foi realizada angiotomografia e identificou-se FAV axilo-axilar associada à tortuosidade e dilatação aneurismática de artéria subclávia a jusante. O paciente foi submetido à intervenção endovascular com endoprótese cônica (monoilíaca) 26 × 14 × 90 mm Braile® na artéria subclávia aneurismática, posterior à saída da artéria vertebral direita, e endoprótese monoilíaca 16 × 16 × 95 mm Excluder® com sobreposição na primeira prótese, apresentando resultado satisfatório. Portanto, descreve-se a possibilidade de utilização de endoprótese aórtica em situação incomum e de exceção, com sucesso.

Abstract Traumatic arteriovenous fistulas (AVFs) involving the axillary and subclavian vessels are uncommon and account for 5 to 10% of all arterial traumas. The complex anatomy of this region makes treatment of this segment challenging. In this therapeutic challenge, we describe the case of a 73-year-old man, referred for progressive edema and ulceration involving the right upper limb and with a history of gunshot wound to the right infraclavicular region about 50 years previously. Angiotomography was performed and an axillary-axillary AVF was found, associated with tortuosity and aneurysmatic dilation of the subclavian artery downstream. He underwent endovascular intervention and a conical (monoiliac) 26 × 14 × 90 mm Braile® endoprosthesis was used in the aneurysmatic subclavian artery, posterior to the exit of the right vertebral artery and a 16 × 16 × 95mm Excluder® monoiliac endoprosthesis was placed overlapping the first prosthesis, showing a satisfactory result. Therefore, the possibility of successfully using aortic endoprostheses in an unusual and exceptional situation is described.

Tratamento endovascular de aneurisma de artéria hepática assintomático: relato de caso / Endovascular treatment of an asymptomatic hepatic artery aneurism: case report

Resumo Relatamos o caso de um paciente masculino, 77 anos, portador de hipertensão arterial, sem outras comorbidades ou fatores de risco para coronariopatia. Apresentava-se assintomático e, durante exame de ultrassonografia abdominal de rotina, foi diagnosticada uma massa vascular hepática de, aproximadamente, 5 cm de diâmetro. Foi solicitada angiotomografia computadorizada abdominal, que evidenciou aneurisma de artéria hepática de até 5,2 cm de calibre máximo, 7,2 cm de extensão no maior eixo longitudinal e calibre máximo da luz verdadeira de 3,0 cm. Optou-se por realização de correção endovascular do aneurisma com implante de três endopróteses vasculares revestidas Lifestream 7x58 mm, 8x58 mm e 8x37 mm sequenciais, com sucesso, conseguindo-se direcionamento do fluxo pelas próteses, levando à exclusão do aneurisma. O paciente evoluiu assintomático, mesmo 2 anos após o implante, sem intercorrências clínicas. Controle com dúplex arterial, realizados 6 e 12 meses após o procedimento, evidenciaram bom fluxo pelas endopróteses, sem "leak" para o saco aneurismático.

Abstract We report a case of an asymptomatic, 77-year-old, male patient with arterial hypertension and no other comorbidities or risk factors for coronary disease. During a routine abdominal ultrasound examination, he was diagnosed with a hepatic vascular mass with an approximate diameter of 5 cm. Abdominal computed angiotomography was requested, showing an aneurysm of the hepatic artery, with maximum diameter of up to 5.2 cm, longest longitudinal axis of 7.2 cm, and a maximum true lumen caliber of 3.0 cm. We opted for endovascular aneurysm repair with implantation of three sequential Lifestream covered vascular stents (7x58mm, 8x58mm, and 8x37mm), successfully diverting the flow through the stents and excluding the aneurysm. The patient remains asymptomatic and free from clinical complications 2 years after the procedure. Control examinations with arterial duplex ultrasound 6 and 12 months after the procedure showed good flow through the stents with no leakage into the aneurysmal sac.