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2.
ABC., imagem cardiovasc ; 34(2)2021. ilus
Article in Portuguese | LILACS | ID: biblio-1291096

ABSTRACT

Adulto jovem de 18 anos que evoluiu após traumatismo craniencefálico leve com fístula carotídea direta. Apresentou zumbido e exoftalmia, ambos de característica pulsátil e à esquerda. Foi submetido a estudo com Doppler das carótidas, que mostrou elevadas velocidades do fluxo sanguíneo e índices de resistência reduzidos nas artérias carótidas comum e interna esquerdas, compatíveis com fístula carotídea direta. A angiotomografia computadorizada cerebral confirmou a fístula carotídea. Foi encaminhado para tratamento endovascular por embolização, com sucesso. O Doppler de carótidas pode ter papel importante no diagnóstico das fístulas carotídeas diretas e acompanhamento de pacientes submetidos à terapêutica endovascular.(AU)


Subject(s)
Humans , Adolescent , Carotid Artery Diseases/physiopathology , Carotid Artery, Internal/pathology , Carotid-Cavernous Sinus Fistula/therapy , Carotid-Cavernous Sinus Fistula/diagnostic imaging , Brain Injuries, Traumatic/diagnostic imaging , Echocardiography, Doppler, Color/methods , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Computed Tomography Angiography/methods
3.
Int. braz. j. urol ; 46(2): 194-202, Mar.-Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090584

ABSTRACT

ABSTRACT Objective To evaluate usage of renal artery embolization (RAE) for renal injuries and discuss the indications for this treatment. Materials and Methods A retrospective study was performed evaluating the electronic medical records of all patients with renal trauma admitted to two major comprehensive hospitals in Shantou city from January 2006 to December 2015. Results There were 264 and 304 renal traumatic patients admitted to hospital A and B, respectively. LGRT was the reason for presentation in the majority of patients (522, 91.9%). A total of 534 (94.0%) patients were treated conservatively. RAE was performed in 9 patients from 2012 to 2015 at hospital A, including in 6 patients (6/9, 66.7%) with LGRT, and 3 patients (3/9, 33.3%) with HGRT. No patient underwent interventional therapy (RAE) at hospital B during the same period. No significant differences in the operative rate of hospital A were observed between the two time periods (2006-2011 and 2012-2015). The operative rate for LGRT between the two hospitals from 2006 to 2011 and 2012 to 2015 was not significantly different. Hospital A showed a significant decrease in the rate of conservative treatment for patients with LGRT. In the univariate and multivariate analyses, the AAST renal grade both were significantly associated with undergoing RAE. Conclusions LGRT was present in the majority of patients, and most cases of renal trauma could be treated with conservative treatment. RAE was well utilized for the treatment of renal trauma. However, some patients with LGRT were treated with unnecessary interventional therapy.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Renal Artery/injuries , Embolization, Therapeutic/methods , Kidney/blood supply , Kidney Diseases/therapy , Trauma Severity Indices , Retrospective Studies , Treatment Outcome , Kidney Diseases/etiology , Kidney Diseases/diagnostic imaging , Middle Aged
4.
Einstein (Säo Paulo) ; 18: eAO5458, 2020. tab
Article in English | LILACS | ID: biblio-1133752

ABSTRACT

ABSTRACT Objective To evaluate improvement in quality of life, reduction of uterine volume, and the correlation between these two variables after uterine fibroid embolization. Methods Data on quality of life before and after uterine fibroid embolization were collected from 60 patients using the Uterine Fibroid Symptom - Quality of Life questionnaire. In 40 of these patients, uterine volume information on magnetic resonance imaging examinations performed before and after uterine fibroid embolization was collected, and compared using the nonparametric Wilcoxon test for paired data. Correlation between quality of life and uterine volume before and after procedure was measured using Spearman's correlation coefficient. Results There was significant improvement in quality of life after uterine fibroid embolization on Uterine Fibroid Symptom - Quality of Life questionnaire, in both subscales scores and the total score. There was a significant median reduction of -37.4% after uterine fibroid embolization, but no correlations between uterine volume and quality of life scores were found before or after embolization. Conclusion Uterine embolization is an alternative to treat uterine fibroids, resulting in relief of symptoms and better quality of life. Although reduction in uterine volume plays an important role in the evaluation of therapeutic success, it does not necessarily have a definitive correlation with relief of symptoms.


RESUMO Objetivo Avaliar a melhora na qualidade de vida e a redução do volume uterino, além da correlação entre essas duas variáveis, após a embolização de artérias uterinas. Métodos Foram coletados dados de 60 pacientes sobre qualidade de vida antes e depois da embolização de artérias uterinas com a aplicação do questionário Uterine Fibroid Symptom - Quality of Life. Informações sobre o volume uterino em exames de ressonância magnética realizada antes e depois do procedimento foram coletadas em 40 dessas pacientes e comparadas por meio de teste não paramétrico de Wilcoxon para dados pareados. A correlação entre qualidade de vida e volume uterino antes e depois do procedimento foi determinada pelo coeficiente de Spearman. Resultados Houve melhora significativa na qualidade de vida das pacientes após embolização de artérias uterinas nos escores do questionário Uterine Fibroid Symptom - Quality of Life, tanto das subescalas como do total. Houve redução mediana significativa (-37,4%) no volume uterino após embolização de artérias uterinas, embora não tenha sido estabelecida qualquer correlação entre volume uterino e escores de qualidade de vida antes e depois da embolização. Conclusão A embolização de artérias uterinas é alternativa para o tratamento de fibroide uterina, resultando na melhora dos sintomas e da qualidade de vida. Embora a redução do volume uterino seja fator importante na avaliação do sucesso terapêutico, não está necessariamente correlacionada com melhora de sintomas.


Subject(s)
Quality of Life/psychology , Uterine Neoplasms/therapy , Embolization, Therapeutic/methods , Leiomyoma/therapy , Uterine Neoplasms/psychology , Treatment Outcome , Leiomyoma/psychology
5.
Einstein (Säo Paulo) ; 18: eRC4934, 2020. graf
Article in English | LILACS | ID: biblio-1056036

ABSTRACT

ABSTRACT Varicose gastrointestinal bleeding is one of the major causes of morbidity and mortality in patients with chronic liver disease. Endoscopic treatment is the first therapeutic line for these patients, however, for those whom this therapeutic modality fail, a broad knowledge of alternative treatment options may improve the prognosis. We describe a case of a patient who were successfully embolized from gastroesophageal varices via transsplenic access.


RESUMO O sangramento gastrointestinal varicoso está entre as maiores causas de morbimortalidade nos paciente com doença hepática crônica. O tratamento endoscópico é a primeira linha terapêutica neste pacientes, porém naqueles que apresentam falha nesta modalidade terapêutica, o amplo conhecimento de opções alternativas de tratamento pode melhorar o prognóstico. Descrevemos um caso de paciente submetido à embolização com sucesso de varizes gastresofágicas por acesso transesplênico.


Subject(s)
Humans , Female , Adult , Splenic Vein/surgery , Esophageal and Gastric Varices/surgery , Embolization, Therapeutic/methods , Gastrointestinal Hemorrhage/surgery , Portal Vein/surgery , Splenic Vein/diagnostic imaging , Angiography/methods , Esophageal and Gastric Varices/diagnostic imaging , Tomography, X-Ray Computed/methods , Treatment Outcome , Ultrasonography, Doppler/methods , Venous Thrombosis/surgery , Gastrointestinal Hemorrhage/diagnostic imaging
6.
Rev. cir. (Impr.) ; 71(6): 552-556, dic. 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1058317

ABSTRACT

Resumen Objetivo: Presentar un caso clínico infrecuente, con una resolución novedosa. Caso Clínico: Paciente con aneurisma micótico de la arteria mesentérica superior manejado satisfactoriamente en forma endovascular. Los aneurismas micóticos viscerales son entidades infrecuentes, con alta morbimortalidad. Es por ello que su manejo debe ser multidisciplinario y considerar diferentes factores al momento de tomar decisiones. En el contexto de la continua mejoría y disponibilidad de las técnicas endovasculares, estas han emergido como una opción terapéutica válida, con posiblemente menos complicaciones. Conclusión: La resolución endovascular del aneurisma micótico visceral es factible, pero su indicación y el manejo completo es aún caso a caso.


Objective: to discuss an infrequent vascular case with a novel resolution. Case Report: Superior mesenteric artery mycotic aneurysm successfully managed with coil embolization. A visceral mycotic aneurysm is an infrequent vascular pathology with high risk of complications and mortality. The endovascular management might offer a treatment option with lower morbimortality rates in selected cases. Conclusion: Endovascular resolution of mycotic visceral aneurysms is both feasible and secure but it must be done in a case to case basis.


Subject(s)
Humans , Male , Aged , Aneurysm, Infected/therapy , Mesenteric Artery, Superior/pathology , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Aneurysm, Infected/etiology , Mesenteric Artery, Superior/diagnostic imaging
7.
Arq. bras. cardiol ; 113(5): 1002-1005, Nov. 2019. graf
Article in English | LILACS | ID: biblio-1055043

ABSTRACT

Abstract Fistula from left internal mammary artery (LIMA) to pulmonary artery (PA) is rarely encountered in daily practice. In recent years, endovascular therapy options have emerged for the treatment of fistula formations and replaced with surgery. A 53-year-old man admitted to our outpatient clinic with symptoms of typical angina and shortness of breath despite optimal medical therapy. In his relevant history, he had a coronary artery bypass graft (CABG) operation in 2009 in which his LIMA was anastomosed to left anterior descending (LAD) and ramus artery sequentially. Coronary angiography including selective imaging of LIMA demonstrated a fistula formation originating from the proximal portion of the LIMA and draining to PA. After successful closure of fistula with transcatheter coil embolization, the patient was discharged without any complication and symptom. In conclusion, although LIMA to PA fistula is an infrequent clinical condition, it should be considered as a potential cause of persistent angina after CABG operation. Treatment options include conservative medical therapy, surgical ligation and endovascular interventions. The best therapy should be individualised for each patient in respect to patient's symptoms, surgical compatibility and anatomy of fistula.


Resumo A fístula da artéria mamária interna esquerda (AMIE) para a artéria pulmonar (AP) é raramente encontrada na prática diária. Nos últimos anos, opções de terapia endovascular surgiram para o tratamento de formações de fístula e foram substituídas por cirurgia. Um homem de 53 anos de idade, internado em nosso ambulatório com sintomas de angina típica e falta de ar, apesar da terapia clínica ideal. Em seu histórico relevante, ele teve uma cirurgia de revascularização miocárdica (CRM) em 2009, na qual sua AMIE foi anastomosada à descendente anterior esquerda (DAE) e à artéria ramus sequencialmente. A angiografia coronária, incluindo imagens seletivas da AMIE, demonstrou uma formação de fístula proveniente da porção proximal da AMIE e drenando para AP. Após o fechamento bem-sucedido da fístula com embolização transcateter com mola, o paciente recebeu alta sem qualquer complicação e sintoma. Em conclusão, embora fístula entre AMIE e AP seja uma condição clínica pouco frequente, deve ser considerada como uma causa potencial de angina persistente após a operação de revascularização do miocárdio. As opções de tratamento incluem terapia médica conservadora, ligadura cirúrgica e intervenções endovasculares. A melhor terapia deve ser individualizada para cada paciente em relação aos sintomas do paciente, compatibilidade cirúrgica e anatomia da fístula.


Subject(s)
Humans , Male , Middle Aged , Pulmonary Artery , Catheterization, Peripheral/methods , Arterio-Arterial Fistula/therapy , Embolization, Therapeutic/methods , Angina Pectoris/therapy , Mammary Arteries , Postoperative Complications , Blood Vessel Prosthesis , Coronary Artery Bypass/adverse effects , Arterio-Arterial Fistula/complications , Arterio-Arterial Fistula/etiology , Treatment Outcome , Self Expandable Metallic Stents , Angina Pectoris/etiology
8.
Rev. cuba. pediatr ; 91(2): e358, abr.-jun. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1003962

ABSTRACT

Introducción: La malformación aneurismática de la vena de Galeno es una infrecuente variedad de fístula arteriovenosa cerebral de origen embriológico. Se localiza en la línea media de la fisura coroidal y tiene morfología de amplio espectro. Objetivo: Exponer información actualizada acerca del tema. Método: La información se obtuvo de la búsqueda automatizada realizada fundamentalmente en bases de datos MEDLINE, Current Contents y Scielo. Resultados: La malformación aneurismática de la vena Galeno se manifiesta con síntomas y signos derivados de la insuficiencia cardiaca severa refractaria al tratamiento médico y del daño neurológico que provoca. La entidad implica morbilidad grave y mortalidad en el periodo neonatal. La angiorresonancia es la técnica de referencia, pero la ecografía doppler es buen método de valoración. El tratamiento de elección es la embolización endovascular. Consideraciones finales: Debe existir índice elevado de sospecha para no fracasar en el diagnóstico precoz de la enfermedad. Es importante definir la anatomía de la lesión, por las implicaciones clínicas, terapéuticas y pronósticas que ello acarrea. El tratamiento exitoso sigue siendo un reto terapéutico complejo(AU)


Introduction: Vein of Galen aneurysm is a rare and congenital cerebral arteriovenous abnormality with reported incidence of 1:25 000 live births. It represents the 30 percent of the vascular congenital cerebral malformations that harm the pediatric population. Objective: To show updated information about the topic. Method: The information was obtained from the automated search mostly done in MEDLINE, CurrentContents and Scielo databases. Development: Vein of Galen malformation presents with symptoms and signs derived from the severe refractary heart failure to medical treatment and the neurologic damage it causes. That entity implies severe morbidity and mortality on the neonatal period. Angioresonance is the reference technique, but the Doppler ecography is a good valuation method. The election treatment is the endovascular embolization. Final considerations: There must be an elevated rate of suspect to do not fail on the early diagnostic of the disease. It is important to define the lesion's anatomy, because of the clinic, therapeutic and prognostic implications this represent. The successful treatment is still a complex therapeutic challenge(AU)


Subject(s)
Humans , Male , Female , Ultrasonography, Doppler/methods , Embolization, Therapeutic/methods , Vein of Galen Malformations/epidemiology , Vein of Galen Malformations/diagnostic imaging , Magnetic Resonance Angiography/methods
9.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 297-301, May-June 2019. graf
Article in English | LILACS | ID: biblio-1002228

ABSTRACT

Uterine leiomyoma and coronary artery disease are two common diseases in women. However, the association of uterine bleeding caused by leiomyoma with unstable coronary syndrome is not frequent. Here we describe a case of a patient with active vaginal bleeding and unstable angina who underwent a unique approach by performing percutaneous procedures. The report demonstrates that new interventional options can be used to control active bleeding in patients in need of coronary angioplasty


Subject(s)
Humans , Female , Adult , Uterine Hemorrhage/complications , Women , Stents , Angioplasty , Platelet Aggregation Inhibitors/therapeutic use , Angioplasty, Balloon, Coronary/methods , Embolization, Therapeutic/methods , Leiomyoma
10.
Rev. Assoc. Med. Bras. (1992) ; 65(4): 518-523, Apr. 2019. tab
Article in English | LILACS | ID: biblio-1003060

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Female , Pelvis/blood supply , Varicose Veins/therapy , Pelvic Pain/therapy , Embolization, Therapeutic/methods , Syndrome , Brazil , Reproducibility of Results , Treatment Outcome , Chronic Pain , Clinical Decision-Making
11.
J. vasc. bras ; 18: e20180135, 2019. ilus
Article in Portuguese | LILACS | ID: biblio-1012623

ABSTRACT

A dor pélvica crônica é uma doença debilitante, com impacto na qualidade de vida e custos para os serviços de saúde. A síndrome de quebra-nozes é uma importante causa dessa dor, e se refere a um conjunto de sinais secundários à compressão da veia renal esquerda, mais comumente entre a artéria mesentérica superior e a aorta. Seu tratamento ainda permanece controverso e varia de acordo com a gravidade clínica do paciente. Contudo, a técnica endovascular com implante de stent em veia renal tem obtido excelentes resultados. Relatamos um caso de uma paciente de 59 anos submetida a correção endovascular com stent autoexpansível de nitinol. São apresentados dados clínicos, detalhes do procedimento e resultados do acompanhamento dessa paciente. O sucesso técnico foi obtido e não houve relato de complicações pós-operatórias. Pôde-se observar alívio dos sintomas e melhora nos exames de imagem realizados no acompanhamento de curto prazo


Chronic pelvic pain is a debilitating disease that directly impacts on quality of life and generates costs for health services. Nutcracker Syndrome is an important cause of pelvic pain and consists of a set of signs secondary to compression of the left renal vein, most commonly between the superior mesenteric artery and the aorta. Treatment remains controversial and varies depending on the patient's clinical severity. However, endovascular treatment with renal vein stenting has achieved excellent results. We report the case of a 59 year-old female treated by endovascular repair with a self-expanding nitinol stent. Clinical data, details of the procedure, and follow-up results are presented. Technical success was achieved and there patient reported no postoperative complications. Short-term, there was relief from symptoms and follow-up imaging tests showed improvement


Subject(s)
Humans , Female , Middle Aged , Endovascular Procedures/methods , Renal Nutcracker Syndrome/diagnosis , Renal Nutcracker Syndrome/therapy , Pelvis , Renal Veins , Phlebography/methods , Tomography/methods , Stents , Prevalence , Mesenteric Artery, Superior , Constriction, Pathologic , Lower Extremity , Drug Therapy/methods , Embolization, Therapeutic/methods
12.
J. vasc. bras ; 18: e20180134, 2019. tab
Article in Portuguese | LILACS | ID: biblio-1012629

ABSTRACT

A placenta acreta é um importante causa de morbimortalidade materna, sendo responsável por aproximadamente 64% dos casos de histerectomia de urgência e em torno de 2/3 dos casos de sangramento puerperal. Objetivos Descrever uma série de casos de cateterização uterina profilática para evitar sangramento significativo no pós-parto ou durante parto cesárea em gestantes com diagnóstico prévio de acretismo. Métodos Foi realizada uma análise retrospectiva de prontuários dos casos de cateterização da artéria uterina durante cesarianas eletivas ou de urgência em pacientes com alto risco de sangramento puerperal. Resultados O procedimento foi realizado em 14 pacientes. O tempo médio do procedimento cirúrgico e da internação foi de 214,64 minutos (± 42,16) e 7 dias, respectivamente. Todas as pacientes foram submetidas a histerectomia por indicação obstétrica. Nenhuma paciente necessitou de embolização. Não houve sangramento ou necessidade de reabordagem em nenhuma paciente e nenhuma complicação relacionada à punção. Houve apenas um caso de morte fetal e nenhuma morte materna. Conclusões Neste estudo, a cateterização profilática de artérias uterinas com oclusão temporária do fluxo sanguíneo demonstrou ser uma técnica segura, pois apresentou baixa mortalidade fetal, baixa necessidade de hemotransfusão, e nenhuma morte materna. Portanto, pode ser considerada uma estratégia terapêutica importante e eficaz para a diminuição da morbimortalidade materna, especialmente em gestantes com implantação placentária anômala. Além disso, a possibilidade de preservação uterina com o uso do método traz excelente contribuição na terapêutica nesse grupo de pacientes. Entretanto, são necessários ensaios clínicos randomizados para avaliar a eficácia do uso rotineiro da técnica


Placenta accreta is an important factor in maternal morbidity and mortality and is responsible for approximately 64% of emergency hysterectomy cases and about 2/3 of cases of puerperal bleeding. Objectives To describe a series of cases of prophylactic uterine catheterization performed to prevent significant postpartum bleeding or during caesarean delivery in pregnant women with a previous diagnosis of accretion. Methods A retrospective analysis was conducted of medical records of cases of uterine artery catheterization performed during elective or emergency caesarean sections of patients at high risk of postpartum bleeding. Results The catheterization of uterine arteries procedure was performed in fourteen patients. Mean duration of surgery and hospital stay were 214.64 minutes (± 42.16) and 7 days, respectively. All patients underwent obstetric hysterectomy. No patient required embolization. There was no bleeding or need to revisit any patient and there were no complications related to puncture. There was one fetal death and no maternal deaths. Conclusions In this study, prophylactic uterine artery catheterization with temporary occlusion of blood flow proved to be a safe technique with low fetal mortality, no maternal mortality, and a low rate of blood transfusion and can be considered an important and effective therapeutic strategy for reduction of maternal morbidity and mortality, especially in pregnant women with anomalous placental attachment. Furthermore, the possibility of uterine preservation with the use of this method is an excellent contribution to therapeutic management of this group of patients. However, randomized clinical trials are needed to evaluate the effectiveness of routine use of the technique


Subject(s)
Humans , Female , Adult , Catheterization , Uterine Artery , Postpartum Hemorrhage/therapy , Placenta Accreta , Pregnancy Complications , Uterus , Magnetic Resonance Spectroscopy/methods , Statistical Analysis , Retrospective Studies , Risk Factors , Ultrasonography/methods , Embolization, Therapeutic/methods , Hysterectomy/methods
13.
J. bras. pneumol ; 45(4): e20180137, 2019. tab, graf
Article in English | LILACS | ID: biblio-1012569

ABSTRACT

ABSTRACT Objective: To present a case series of pulmonary arteriovenous malformations (PAVMs), describing the main clinical findings, the number/location of pulmonary vascular abnormalities, the clinical complications, and the treatment administered. Methods: This was a retrospective observational study evaluating patients with PAVM divided into two groups: hereditary hemorrhagic telangiectasia (HHT); and idiopathic PAVM (iPAVM). Results: A total of 41 patients were selected for inclusion, but only 33 had PAVMs. After clinical evaluation, 27 and 6 were diagnosed with HHT and iPAVM, respectively. In the HHT group, the mean age was 49.6 years and 88.9% were female. In that group, 4 patients had an SpO2 of < 90% and the most common clinical finding was epistaxis. In the iPAVM group, the mean age was 48.1 years and 83.3% were female. In that group, 3 patients had an SpO2 of < 90%. Computed tomographic pulmonary angiography showed that most of the PAVMs were in the lower lobes: 56.4% in the HHT group and 85.7% in the iPAVM group. Embolization was performed in 23 patients (in both groups). At this writing, 10 patients are scheduled to undergo the procedure. One of the patients who underwent embolization was subsequently referred for pulmonary resection. Conclusions: In both of the PAVM groups, there was a predominance of women and of fistulas located in the lower lobes. Few of the patients had respiratory symptoms, and most had an SpO2 > 90%. The treatment chosen for all patients was percutaneous transcatheter embolization.


RESUMO Objetivo: Apresentar uma série de casos de malformações arteriovenosas pulmonares (MAVP) e descrever os principais achados clínicos, a quantidade e localização das MAVP, as complicações clínicas e os tratamentos realizados. Métodos: Estudo retrospectivo observacional que avaliou pacientes com MAVP divididos em dois grupos: telangiectasia hemorrágica hereditária (THH) e MAVP idiopática (MAVPi). Resultados: Foram avaliados 41 pacientes, sendo 33 pacientes portadores de MAVP. Após a avaliação clínica, 27 e 6 foram diagnosticados com THH e MAVPi, respectivamente. No grupo THH a média de idade foi de 49,6 anos e 88,9% eram do sexo feminino. Desses pacientes, 4 tinham SpO2 < 90% e o achado clínico mais frequente era epistaxe. No grupo MAVPi a média de idade foi de 48,1 anos, sendo que 83,3% eram do sexo feminino. Desses, 3 tinham SpO2 < 90%. Após a realização de angiotomografia de tórax observou-se que a maior parte das MAVP se situava nos lobos inferiores, totalizando 56,4% e 85,7% nos grupos THH e MAVPi, respectivamente. O tratamento por embolização foi realizado em 23 pacientes nos dois grupos, enquanto 10 aguardavam o procedimento até o momento da escrita deste estudo. Um paciente submetido à embolização foi encaminhado para ressecção pulmonar. Conclusões: Em ambos os grupos de pacientes com MAVP observou-se uma predominância de mulheres e de fístulas localizadas nos lobos inferiores. A maioria era assintomático respiratório com SpO2 > 90%. O tratamento de escolha para todos foi a embolização percutânea por cateter.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Arteriovenous Malformations/etiology , Arteriovenous Malformations/therapy , Arteriovenous Malformations/diagnostic imaging , Pulmonary Artery/abnormalities , Pulmonary Artery/diagnostic imaging , Telangiectasia, Hereditary Hemorrhagic/complications , Catheterization/methods , Angiography/methods , Echocardiography , Radiography, Thoracic/methods , Retrospective Studies , Treatment Outcome , Embolization, Therapeutic/methods , Septal Occluder Device , Computed Tomography Angiography
14.
J. vasc. bras ; 18: e20180112, 2019. graf
Article in Portuguese | LILACS | ID: biblio-1002486

ABSTRACT

Fístulas arteriovenosas (FAVs) renais adquiridas são raras, correspondendo a uma conexão anômala entre o sistema arterial e o sistema venoso. As FAVs renais se dividem em três grandes grupos: idiopáticas, congênitas e adquiridas, sendo as últimas as mais comuns. Atualmente, têm incidência aumentada em decorrência do crescente número de biópsias renais. Apesar de, atualmente, o procedimento de biópsia renal ser relativamente seguro, ele carrega como complicação a formação de FAV no território vascular renal. O tratamento de FAV renal é amplamente discutido na literatura e diversas modalidades terapêuticas podem ser aplicadas. Apresentamos um caso de FAV pós-biópsia renal que foi submetida a tratamento endovascular com sucesso mediante embolização com molas


Acquired renal arteriovenous fistulas (AVF) are rare conditions in which an anomalous connection arises between the arterial and venous systems. Renal AVFs can be classified into three main groups: idiopathic, congenital, and acquired, the last of which are the most common. Incidence has been increasing, due to the growing number of renal biopsies. Although the renal biopsy procedure is relatively safe nowadays, one possible complication is formation of an AVF in the renal vascular territory. Treatment of renal AVF is widely discussed in the literature and a variety of treatment methods can be employed. We report a case of arteriovenous fistula after renal biopsy that was successfully treated with endovascular coil embolization


Subject(s)
Humans , Female , Adult , Arteriovenous Fistula , Nephrotomy , Kidney , Biopsy, Needle/methods , Angiography/methods , Embolization, Therapeutic/methods , Renal Insufficiency , Hematuria/complications
15.
J. vasc. bras ; 18: e20180122, 2019. ilus
Article in Portuguese | LILACS | ID: biblio-984685

ABSTRACT

O tumor glômico é uma neoplasia benigna rara originada de células paraganglionares da crista neural que se desenvolve na camada adventícia do vaso. São tumores não encapsulados e altamente vascularizados. Paciente feminina, 64 anos, foi diagnosticada com tumor glômico hipervascularizado com 5 cm posteriormente à bifurcação carotídea esquerda e oclusão de carótida contralateral. Optou-se por realizar embolização através de acesso endovascular seguida de punção percutânea direta, guiada por angiografia, para preenchimento da área remanescente. Após embolização, realizou-se a exérese cirúrgica do tumor com menor sangramento e maior facilidade para encontrar o plano de clivagem das estruturas adjacentes. Em acompanhamento tardio, a paciente apresenta-se sem recidiva tumoral. O tumor foi classificado como pertencente ao grupo Shamblin II, o qual inclui tumores apresentando de 4 a 6 cm com inserção arterial moderada. Através dessa dupla abordagem, foi possível notar uma redução relativa do sangramento intraoperatório e facilitação de identificação do plano de clivagem, colaborando para sua exérese e evitando o pinçamento cirúrgico


Glomus tumors are rare benign neoplasms originating from paraganglionic cells of the neural crest developing in the adventitious layer of the vessel. They are nonencapsulated and highly vascularized. A 64-year-old female patient was identified with a hypervascularized glomus tumor measuring 5 cm, posterior to the left carotid bifurcation and contralateral carotid occlusion. We performed preoperative embolization via endovascular access followed by direct percutaneous puncture, guided by angiography, to fill the remaining area. After embolization, surgical excision of the tumor was performed with reduced bleeding and it was easier to find the cleavage planes to adjacent structures. At late follow-up, the patient is free from tumor recurrence. The tumor was classified as Shamblin II, measuring 4 to 6 cm with moderate arterial insertion. Through this double approach we observed a relative reduction in intraoperative bleeding and improved identification of the cleavage plane, facilitating excision and avoiding surgical clamping


Subject(s)
Humans , Female , Middle Aged , Carotid Body Tumor/diagnosis , Glomus Jugulare/surgery , Glomus Jugulare/diagnostic imaging , Neoplasms/surgery , Paraganglioma , Diagnostic Imaging/methods , Angiography/methods , Echocardiography, Doppler/methods , Carotid Artery Diseases , Carotid Artery, External , Embolization, Therapeutic/methods
16.
J. vasc. bras ; 18: e20180110, 2019. ilus
Article in Portuguese | LILACS | ID: biblio-976021

ABSTRACT

O sequestro pulmonar refere-se à anomalia congênita definida por massa de parênquima pulmonar não funcionante. É dividido pela existência de envoltório pleural próprio em intralobar, representando cerca de 75% dos casos, ou extralobar, responsável pelos 25% restantes. O diagnóstico é feito através de radiografia e confirmado com tomografia computadorizada, ressonância nuclear magnética e arteriografia. Tradicionalmente, o tratamento proposto é cirúrgico, mas a técnica endovascular tem apresentado bons resultados. É relatado o caso de uma mulher, 29 anos, com quadro clínico de pneumonias de repetição desde os 5 anos. A tomografia de tórax revelou malformação vascular em região inferior de pulmão direito. O tratamento vascular foi realizado através de embolização do ramo anômalo


Pulmonary sequestration is a congenital anomaly defined as a nonfunctioning mass of lung parenchyma. Presence of an independent pleural envelope classifies it as intralobar, accounting for approximately 75% of the cases, while absence classifies cases as extralobar, accounting for the remaining 25%. Diagnosis is made through radiography and confirmed by computed tomography, magnetic resonance, or angiography. The traditional treatment is open surgical repair, but endovascular techniques have been used, with good results. We report the case of a 29-year-old-woman presenting with recurrent pneumonia for 5 years. A CT scan of the chest revealed poor vascular formation in the lower region of the right lung. The pulmonary sequestration was treated by embolization of the anomalous branch


Subject(s)
Humans , Female , Adult , Congenital Abnormalities/surgery , Congenital Abnormalities/therapy , Endovascular Procedures/methods , Aorta, Thoracic , Angiography/methods , Magnetic Resonance Spectroscopy/methods , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methods , Pulmonary Circulation , Embolization, Therapeutic/methods
17.
Rev. méd. Chile ; 147(1): 41-46, 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-991371

ABSTRACT

Background: Pelvic venous insufficiency may cause pelvic congestion syndrome that is characterized by chronic pelvic pain exacerbated by prolonged standing, sexual activity or menstrual cycle. It may be treated by embolizing the dysfunctional pelvic venous drainage and sometimes resecting vulvar, perineal and thigh varices. Aim: To assess the results of embolization of insufficient pelvic or ovarian veins on pelvic congestion syndrome. Material and Methods: Analysis of 17 female patients aged 32 to 53 years, who underwent subjected to a selective coil embolization of insufficient pelvic and/or ovarian veins through the jugular, basilic or cephalic veins. In the preoperative period, all patients had a lower extremity venous duplex pelvic ultrasound examination and some had an abdominal and pelvic CT angiogram. Results: The technical success of the procedure was 100% and no complications were registered. During a 32 month follow up, no patient had symptoms of pelvic venous insufficiency or relapse of vulvar or thigh varices. Conclusions: Embolization of insufficient pelvic and ovarian veins is a safe and successful procedure for the treatment of pelvic venous insufficiency or vulvar varices.


Subject(s)
Humans , Female , Adult , Middle Aged , Ovary/blood supply , Pelvis/blood supply , Varicose Veins/therapy , Pelvic Pain/therapy , Embolization, Therapeutic/methods , Ovary/diagnostic imaging , Pelvis/diagnostic imaging , Syndrome , Varicose Veins/diagnostic imaging , Phlebography/methods , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Pelvic Pain/diagnostic imaging , Chronic Pain
18.
Int. j. odontostomatol. (Print) ; 12(4): 343-347, dic. 2018. graf
Article in English | LILACS | ID: biblio-975755

ABSTRACT

ABSTRACT: Nasal hemorrhage or epistaxis is a common finding in the emergency department. The causes of epistaxis are varied and can be classified as local, systemic or a combination of both. The aim of this study was to report a case of embolization of branches of the maxillary artery for treatment of epistaxis secondary to facial trauma. A 43-year-old man suffered blunt trauma in the frontonasal area as a result of a bicycle accident. It presented with amnesia, severe epistaxis, panfacial edema and nasal deformity. The patient was hypotensive and hypothermic, with evidence of hemorrhagic intracranial. Orotracheal intubation was performed immediately to protect the airways and prevent aspiration of blood to the lower respiratory tract. The occlusion of the artery was successful and was immediately followed by cessation of oronasal bleeding. The patient was discharged after ten days. Arterial embolization should be the gold-standard treatment, which provides a safe and effective alternative for the control of epistaxis.


RESUMEN: La hemorragia nasal o epistaxis es un hallazgo común en el servicio de urgencias. Las causas de la epistaxis son variadas y pueden clasificarse como locales, sistémicas o una combinación. El objetivo de este estudio fuerelatar un caso de embolización de ramas de la arteria maxilar para el tratamiento de epistaxis secundaria a trauma facial. Um hombre de 43 años de edad sufrió traumatismo contuso en la zona frontonasal como consecuencia de un accidente de bicicleta. Se presentaba con amnesia, epistaxis grave, edema panfacial y deformidad nasal. El paciente fue hipotenso y hipotermático, con evidencia de hemorragia intracraneal. La intubación orotraqueal fue realizada inmediatamente para proteger las vías aéreas y evitar la aspiración de sangre para el tracto respiratorio inferior. La oclusión de la arteria fue exitosa y fue seguida inmediatamente por cesación de sangramiento oronasal. El paciente fue dado de alta después de diez días. La embolización arterial debe ser el tratamiento de elección, que proporciona una alternativa segura y eficaz para el control de la epistaxis.


Subject(s)
Humans , Male , Adult , Epistaxis/etiology , Epistaxis/therapy , Embolization, Therapeutic/methods , Brazil , Angiography , Fluoroscopy , Tomography, X-Ray Computed , Hemorrhage , Nasal Cavity
19.
J. vasc. bras ; 17(4): 353-357, out.-dez. 2018. ilus
Article in Portuguese | LILACS | ID: biblio-969248

ABSTRACT

Pseudoaneurysms of gluteal arteries are rare, especially involving the inferior gluteal artery. They are mainly associated with penetrating trauma, infections, or pelvic fractures. A minority of cases are caused by blunt traumas, with only six cases reported in English. We present a case of pseudoaneurysm of the right inferior gluteal artery after a bicycle fall, presenting with a large hematoma in the gluteal region, observed during clinical examination, and significantly reduced hemoglobin. CT angiography revealed a large hematoma, with contrast extravasation and pseudoaneurysm formation. Angiography revealed that the origin of the lesion was in the right inferior gluteal artery. This artery was embolized with coils. After the procedure, the patient was referred to an intensive care unit, from where he was later transferred to a different hospital, with bleeding controlled. Endovascular treatment of these cases is a safe, fast and an effective option


Pseudoaneurismas de artérias glúteas são raros, especialmente os que envolvem a artéria glútea inferior. Eles estão associados principalmente a traumas penetrantes, infecções ou fraturas de pelve. Em uma minoria de casos, são causados por traumas fechados, havendo somente seis casos relatados na literatura. Apresenta-se aqui um caso de pseudoaneurisma da artéria glútea inferior direita após queda de bicicleta, evoluindo com grande hematoma na região glútea ao exame clínico e queda hematimétrica significativa. A angiotomografia revelou um grande hematoma na região glútea, com extravasamento de contraste e formação de pseudoaneurisma no local. A angiografia revelou que a origem da lesão era na artéria glútea inferior direita. Foi realizada embolização dessa artéria com molas. Após esse procedimento, o paciente foi encaminhado para a unidade de terapia intensiva, de onde foi posteriormente transferido para outro hospital, com o sangramento controlado. Para esses casos, o tratamento endovascular é uma opção segura, rápida e efetiva


Subject(s)
Humans , Male , Middle Aged , Buttocks/blood supply , Aneurysm, False/complications , Aneurysm, False/diagnosis , Angiography/methods , Accidents, Traffic , Ultrasonography, Doppler/methods , Diagnosis, Differential , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Hematoma
20.
J. vasc. bras ; 17(3)jul.-set. 2018. ilus
Article in Portuguese | LILACS | ID: biblio-915990

ABSTRACT

O pseudoaneurisma da artéria esplênica é uma entidade rara, com pouco mais de 150 casos descritos na literatura. A pancreatite é a etiologia mais comum, seguida do trauma. Em contraposição ao aneurisma verdadeiro, esse pseudoaneurisma é frequentemente sintomático, com risco de ruptura de 47% e mortalidade de 90%, quando não tratado. Descrevemos o caso de uma paciente de 48 anos que apresentou hemorragia gastrointestinal associada a pancreatite crônica agudizada. Durante investigação, a endoscopia evidenciou sinais de sangramento recente, e a angiorressonância de abdome observou volumoso pseudoaneurisma da artéria esplênica. Foi submetida a tratamento endovascular com embolização com micromolas, não apresentando novos episódios de sangramento. Atualmente, o tratamento endovascular é efetivo com baixa morbimortalidade e taxas de sucesso de 79-100%, sendo uma técnica viável para pacientes com processo inflamatório abdominal em franca atividade. Realizamos uma revisão das técnicas endovasculares e agentes embolizantes usados para o tratamento dessa patologia


Pseudoaneurysm of the splenic artery is a rare entity, with little more than 150 cases described in the literature. Pancreatitis is the most common etiology, followed by trauma. In contrast with true aneurysms, pseudoaneurysms are frequently symptomatic, with a 47% risk of rupture and 90% mortality if left untreated. We describe the case of a 48-year-old female patient who suffered a gastrointestinal hemorrhage associated with acute-on-chronic pancreatitis. During workup, endoscopy revealed signs of recent bleeding and magnetic resonance angiography of the abdomen showed a large pseudoaneurysm of the splenic artery. The patient underwent endovascular treatment with microcoil embolization and no further bleeding episodes occurred. Endovascular treatment is now an effective option with low morbidity and mortality and success rates in the range of 79-100%, making it a viable technique for patients with active abdominal inflammation. We conducted a review of endovascular techniques and embolization agents used to treat this pathology


Subject(s)
Humans , Female , Middle Aged , Aneurysm, False/surgery , Endovascular Procedures/methods , Hemorrhage , Splenic Artery/surgery , Abdomen , Angiography/methods , Arteriovenous Fistula/surgery , Diagnostic Imaging/methods , Echocardiography/methods , Embolization, Therapeutic/methods , Endoscopy/methods , Magnetic Resonance Spectroscopy/methods , Pancreas/surgery , Pancreatitis/etiology
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