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Rev. méd. Chile ; 149(8): 1157-1163, ago. 2021. tab, graf, ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1389579


Background: Cervicocranial arterial dissection (CIAD) is an important cause of stroke. Aim: To describe the clinical and imaging characteristics of patients with CIAD. Material and Methods: An anonymous registry was made including all patients admitted to a private hospital with a diagnosis of CIAD. Patients were subdivided as having an anterior or posterior circulation dissection (ACD or PCD, respectively). Results: Fifty-seven patients aged 40 ± 8 years (60% women) were included in the study, 39 with PCD and 18 with ACD. Cervical pain was the most common symptom. CIAD was diagnosed with no clinical or imaging signs of stroke in 49% of patients. Fifty one percent of patients had focal neurological deficits and 72% had a NIH stroke score below five. No significant differences between patients with ACD or PCD were found. Fifty patients received antiplatelet therapy (simple or dual), seven patients were anticoagulated and 13 were subjected to stenting due to progression of stenosis with hemodynamic involvement or bilateral dissection with scarce collaterals. The lesion was located in V3 segment in 27 patients and cervical segment of the internal carotid in 16 cases. A favorable Modified Rankin Scale (0-2) was achieved in 85.9%, with a trend towards achieving better functional prognosis in PCD. Conclusions: Due to the greater availability of non-invasive imaging methods, 50% of these patients with CIAD did not have a stroke. Thus, an earlier and more timely management is feasible.

Humans , Male , Female , Adult , Middle Aged , Stroke/etiology , Aneurysm, Dissecting/complications , Aneurysm, Dissecting/therapy , Prognosis , Stents
In. Verga, Federico; Burghi, Gastón. Encares de paciente crítico. Montevideo, Oficina del Libro FEFMUR, 2020. p.435-457, tab, ilus.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1342676
Rev. bras. cir. cardiovasc ; 34(5): 596-604, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042043


Abstract Aortic dissection (AD) has been recognized to be associated with an inflammatory process. Clinical observations demonstrated that patients with AD had an elevated interleukin (IL)-6 level in comparison to hypertensive or healthy controls. Adverse events such as acute lung injury, postimplantation syndrome, and death are associated with an elevated IL-6 level. Thus, circulating IL-6 could be a reliable biomarker for the diagnosis of AD and for the eveluation of the therapeutic outcomes and the prognosis of AD patients. Therapeutic interventions aiming at attenuating the inflammatory status by IL-6 neutralization could effectively decrease the IL-6 level and thus reverse the progression of the disorder of AD patient. Endovascular aortic repair can effectively control the inflammatory cytokines. Selective antegrade cerebral perfusion with deep hypothermic circulatory arrest during aortic arch replacement shows better neuroprotectve effect with an improved IL-6 level of the cerebrospinal fluid. These results facilitate the understanding of the etiology of AD and guide the directions for the treatment of acute AD in the future. More effective therapeutic agents developed based on the theories of IL-6 signaling involved in the mechasims of AD are anticipated.

Humans , Aortic Aneurysm/metabolism , Interleukin-6/analysis , Aneurysm, Dissecting/metabolism , Aortic Aneurysm/diagnosis , Aortic Aneurysm/therapy , Prognosis , Reference Values , Time Factors , Predictive Value of Tests , Cytokines/analysis , Aneurysm, Dissecting/diagnosis , Aneurysm, Dissecting/therapy
Rev. gastroenterol. Perú ; 37(3): 262-266, jul.-sep. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-991264


Reportamos el caso de un paciente varón de 32 años con dolor abdominal recurrente tipo cólico a causa de disección de arteria mesentérica superior (AMS) y tronco celíaco, el cual se resolvió luego de la colocación de 3 stents en AMS. El paciente presentó una clínica atípica lo cual dificultó el diagnóstico. Discutimos la clínica, métodos diagnósticos y alternativas de tratamiento. Iniciamos con un manejo conservador con analgesia, anticoagulación plena, antihipertensivo y control de imágenes, pero al séptimo día luego de reiniciar la vía oral, presenta angina abdominal, por lo cual procedimos a tratamiento endovascular con resultado exitoso y buena evolución, sin eventos, a un seguimiento de 2 años

We report the case of a 32 year old male with recurrent colic abdominal pain due to superior mesenteric artery (SMA) and celiac trunk dissection, which resolved after placing 3 stents in SMA. The patient presented atypical clinical signs and symptoms, which made the diagnosis difficult. Clinical presentation, diagnostic methods and treatment options are discussed. We started with conservative management with pain medication, anticoagulation, antihypertensive drugs and image control, but on the seventh day, after restarting oral ingestion, he presented with abdominal angina, after which we proceeded to endovascular treatment with successful results and with an uneventfully 2 year follow up

Adult , Humans , Male , Abdominal Pain/etiology , Celiac Artery , Mesenteric Artery, Superior , Conservative Treatment , Aneurysm, Dissecting/diagnosis , Combined Modality Therapy , Endovascular Procedures , Aneurysm, Dissecting/complications , Aneurysm, Dissecting/therapy
Rev. chil. cir ; 66(5): 474-477, set. 2014. ilus
Article in Spanish | LILACS | ID: lil-724801


Introduction: Spontaneous dissection of the superior mesenteric artery (AMS) is a infrecuent pathology, representing the main frequency of isolated peripheral artery dissection, it is more common in males and occurs in the fifth decade of life. Materials and Methods: Retrospective cases analysis of patients with spontaneous dissection of AMS that were handled in our hospital, in last two years. Results: Two patients were diagnosed in this period, both active smoking and hypertensive pathology, appearing with severe abdominal and back pain. The diagnosis was made by CT angiogram of the abdomen and pelvis; establishing medical management of hypertension and standard heparin anticoagulation. Both patients had dissections at new imaging controls and one patient required exploratory laparotomy with bowel resection and intestinal anastomosis. Patients recovered satisfactorily and are in control. Conclusions: Spontaneous dissection of the SMA is a rare disease with uncertain evolution, it may occur in middle age of life, associated with smoking and hypertension. The suspected diagnosis is clinical and can be confirmed by CT angiography. Initial management remains conservative and occasionally is surgical.

Introducción: La Disección espontánea de la arteria mesentérica superior (AMS) es una patología infrecuente, representando la primera frecuencia de disección de arteria periférica aislada, ocurre más en varones en la quinta década de la vida. Material y Método: Casos en los últimos 2 años revisados en forma retrospectiva. Resultados: Dos pacientes fueron diagnosticados en este período, presentándose ambos por dolor abdominal y lumbar de gran intensidad al Servicio de Urgencia del hospital; ambos tabáquicos activos y con hipertensión arterial (HTA). El diagnóstico fue realizado por angioTC de abdomen y pelvis, instaurándose manejo médico de HTA y anticoagulación con heparina estándar. Los 2 pacientes presentaron nuevas disecciones en los controles imagenológicos y un paciente requirió laparotomía exploradora con resección intestinal y anastomosis por isquemia intestinal. Los pacientes evolucionaron satisfactoriamente y se encuentran en control. Conclusiones: La disección espontánea de la AMS es una enfermedad poco frecuente de evolución incierta, que ocurre en la edad media de la vida, asociada a tabaquismo e HTA, la sospecha es clínica y el diagnóstico por imágenes. El manejo inicial sigue siendo médico y ocasionalmente es quirúrgico.

Humans , Male , Adult , Female , Middle Aged , Aneurysm, Dissecting , Aneurysm, Dissecting/therapy , Mesenteric Artery, Superior , Angiography , Rupture, Spontaneous , Tomography, X-Ray Computed
Arq. bras. neurocir ; 32(2)jun. 2013. ilus
Article in Portuguese | LILACS | ID: lil-681391


Dissecting aneurysms located in peripheral regions of the cerebellar arteries are rare, and few cases have been described in the literature. Surgical treatment of these lesions may become difficult due to its relatively inaccessible location. Thus, the approach of these aneurysms through endovascular therapy may be an alternative treatment. We described a case of ruptured dissecting aneurysm located in the distal portion of the superior cerebellar artery, which was treated with endovascular embolization. We also discuss the results of endovascular therapy for this type of injury...

Aneurismas dissecantes localizados em regiões periféricas das artérias cerebelares são de ocorrência incomum e poucos casos têm sido descritos na literatura. O tratamento cirúrgico dessas lesões pode se tornar difícil por causa de sua localização relativamente inacessível. Assim, a abordagem desses aneurismas por terapia endovascular pode ser um método alternativo de tratamento. Descrevemos um caso de aneurisma dissecante roto localizado na porção distal da artéria cerebelar superior que foi tratado com embolização endovascular. Discutimos, também, os resultados da terapia endovascular para esse tipo de lesão...

Humans , Female , Adult , Aneurysm, Dissecting/therapy , Embolization, Therapeutic , Posterior Cerebral Artery , Subarachnoid Hemorrhage
Article in English | WPRIM | ID: wpr-218252


We report 2 cases of complicated spontaneous dissection of the celiac artery, which were successfully treated by a stent graft. The first patient was a 47-year-old man who presented with acute abdominal pain. CT scan showed ruptured saccular aneurysm with surrounding retroperitoneal hematoma. The second patient was a 57-year-old man with progressive dissecting aneurysm. Endovascular stent graft was placed in the celiac trunk to control bleeding, and to prevent rupture in each patient. Follow-up CT scans showed complete obliteration of a dissecting aneurysm.

Abdominal Pain/etiology , Aneurysm, Dissecting/therapy , Aneurysm, Ruptured/prevention & control , Celiac Artery/injuries , Hematoma/etiology , Hemorrhage/etiology , Humans , Male , Middle Aged , Retroperitoneal Space , Rupture, Spontaneous/therapy , Stents , Tomography, X-Ray Computed/adverse effects
Rev. argent. cir. cardiovasc. (Impresa) ; 9(2): 108-119, mayo-ago. 2011. tab, graf, ilus
Article in Spanish | LILACS | ID: lil-696158


El tratamiento de endoprótesis endovascular para la disección aórtica aparece con buenos resultados a mediano tiempo. Las posteriores indicaciones, por ejemplo, tanto la disección del arco aórtico como las disecciones aórticas agudas no complicadas se encuentran bajo estudio.

O tratamento de endoprótese endovascular para a dissecção aórtica aparece com bons resultados a médio prazo. As posteriores indicações, por exemplo, tanto a dissecção do arco aórtico quanto as dissecções aórticas agudas não complicadas se encontram sob estudo.

Endovascular stent-graft therapy for aortic dissection is emerging with good midterm results. Further indications, i.e. aortic arch dissection and uncomplicated acute aortic dissections, are under evaluation.

Humans , Aortic Aneurysm, Thoracic/surgery , Aortic Aneurysm, Thoracic/therapy , Blood Vessel Prosthesis Implantation/methods , Stents , Aneurysm, Dissecting/surgery , Aneurysm, Dissecting/therapy , Aortic Rupture/surgery , Treatment Outcome
Arq. neuropsiquiatr ; 65(4a): 1012-1014, dez. 2007. ilus
Article in English | LILACS | ID: lil-470134


Basilar artery (BA) dissecting aneurysms pose difficulties to treatment because both bleeding and thrombosis can happen in the same patient, clinical course is unpredictable and high morbidity is usual. We report the case of a 37-year-old woman with a BA aneurysm probably caused by arterial dissection, presenting embolic and hemorrhagic complications. The aneurysm was submitted to endovascular treatment with stenting and coil embolization. Clinical and radiological results were excellent and no complications were observed, suggesting that BA stenting and coil embolization may be a safe and effective treatment for this condition.

Aneurismas associados a dissecção da artéria basilar (AB) apresentam dificuldades terapêuticas, pois sangramentos e fenômenos trombóticos podem ocorrer no mesmo paciente, seu curso clínico é imprevisível e sua morbidade, alta. Relatamos o caso de uma paciente de 37 anos com aneurisma de artéria basilar provavelmente causado por dissecção arterial, apresentando-se com complicações hemorrágicas e embólicas. O aneurisma foi submetido a tratamento endovascular com colocação de "stent" e embolização com molas. Os resultados clínico e radiológico foram excelentes e nenhuma complicação foi observada, sugerindo que o tratamento dos aneurismas de AB dissecantes com colocação de "stent" e embolização com molas possa ser seguro e eficaz.

Adult , Female , Humans , Aneurysm, Dissecting/therapy , Basilar Artery , Embolization, Therapeutic/methods , Intracranial Aneurysm/therapy , Stents , Aneurysm, Dissecting/diagnosis , Follow-Up Studies , Intracranial Aneurysm/diagnosis , Magnetic Resonance Imaging , Treatment Outcome
Arq. neuropsiquiatr ; 64(4): 1047-1049, dez. 2006. ilus
Article in Portuguese, English | LILACS | ID: lil-439772


A dissecção espontânea da artéria carótida interna é evento raro, acometendo principalmente indivíduos em idade produtiva. Como a abordagem precoce e adequada dessa doença determina quase sempre melhora significativa, torna-se evidente a necessidade de ampliar os conhecimentos sobre seus aspectos clínicos, patogênicos e fisiopatológicos, visando o diagnóstico e tratamento precoces, bem como a redução de suas possíveis seqüelas. Pelos motivos expostos, julgamos pertinente relatar o caso de um homem de 46 anos com dissecção espontânea de artéria carótida interna, com manifestações clínicas atípicas dentre as quais ressaltamos a paralisia de nervos cranianos inferiores.

Spontaneous internal carotid artery dissection is a rare event that strikes patients at their productive age. As early intervention frequently determines a significant improvement, it is important to broaden the knowledge of the clinical, pathogenic and pathophysiological aspects of this disease. The objective is making an early diagnosis and treatment to avoid a bad outcome. We report the case of a 46 years-old man with spontaneous carotid artery dissection that had an atypical manifestation characterized by sudden paralysis of lower cranial nerves.

Humans , Male , Middle Aged , Aneurysm, Dissecting/complications , Carotid Artery, Internal , Carotid Artery Diseases/complications , Cranial Nerve Diseases/etiology , Paralysis/etiology , Aneurysm, Dissecting/diagnosis , Aneurysm, Dissecting/therapy , Carotid Artery Diseases/diagnosis , Carotid Artery Diseases/therapy , Cranial Nerve Diseases/therapy , Magnetic Resonance Angiography , Paralysis/therapy , Treatment Outcome
Rev. SOCERJ ; 18(2): 176-178, Mar-Abr. 2005. ilus
Article in Portuguese | LILACS | ID: lil-407496


Relato de caso de paciente idoso com quadro de hemotoráx à direita levando ao diagnóstico de pseudoaneurisma de aorta torácica. O paciente já havia se submetido a tratamento endovascular prévio e à cirurgia de revascularização do miocárdio. Relata-se um caso cujo tratamento foi realizado por via endovascular e que apresentava dificuldades técnicas quanto à abordagem, via de acesso e eficácia do tratamento

Humans , Male , Aged , Aortic Aneurysm/diagnosis , Aortic Aneurysm/physiopathology , Aortic Aneurysm/therapy , Aneurysm, Dissecting/diagnosis , Aneurysm, Dissecting/physiopathology , Aneurysm, Dissecting/therapy , Aorta, Thoracic/abnormalities , Aorta, Thoracic/surgery , Myocardial Revascularization/methods , Myocardial Revascularization , Cardiac Surgical Procedures
Rev. sanid. mil ; 54(4): 214-6, jul.-ago. 2000. ilus, CD-ROM
Article in Spanish | LILACS | ID: lil-292190


Se presenta el primer caso reportado en la República Mexicana, de aneurisma de la aorta tratado mediante la aplicación de un tubo protésico endovascular. Se trata de un paciente del sexo masculino de 77 años de edad, militar retirado, con dilatación aneurismática de la aorta torácica cuya dimensión era de 115 mm de longitud, la cual se determinó mediante angiografía y tomografía computada. Su sintomatología se manifestaba por dolor y sensación de muerte inminente. El paciente se trató mediante la colocación de una prótesis endovascular de 130 mm fabricada en una aleación de níquel y titanio (nitinol) cuya biocompatibilidd ya ha sido comprobada. La correcta colocación del implante se verificó por medio de arteriografía a través de la arteria subclavia derecha. Al momento de la presente publicación y después de un periodo de observación de 7 meses, el paciente no ha tenido complicaciones inherentes a la prótesis, lo cual nos permite continuar utilizándola en lugar de la cirugía abierta, que tiene una mortalidad superior al 50 por ciento.

Humans , Male , Aged , Aortic Aneurysm/diagnosis , Aortic Aneurysm/therapy , Aneurysm, Dissecting/therapy , Blood Vessel Prosthesis
JAMC-Journal of Ayub Medical College-Abbotabad-Pakistan. 1998; 10 (1): 44-45
in English | IMEMR | ID: emr-48177
Rev. méd. Hosp. Säo Vicente de Paulo ; 5(12): 32-4, maio-ago. 1993. ilus, graf
Article in Portuguese | LILACS | ID: lil-138246


Os autores apresentam uma breve revisäo da literatura sobre Dissecçäo Aguda de Aorta, enfatizando patologia, diagnóstico, tratamento clínico e cirúrgico atualmente utilizados no controle da doença. Conclui-se que apresenta alta mortalidade e que imediato diagnóstico é essencial para a evoluçäo adequada

Humans , Aortic Aneurysm/diagnosis , Aneurysm, Dissecting/diagnosis , Acute Disease , Aortic Aneurysm/therapy , Aneurysm, Dissecting/therapy