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1.
Rev. colomb. cir ; 35(1): 100-107, 2020. tab, fig
Article in Spanish | LILACS (Americas), COLNAL | ID: biblio-1095479

ABSTRACT

La isquemia arterial aguda de las extremidades se define como la interrupción abrupta del flujo sanguíneo a determinado tejido, lo cual afecta la integridad, la viabilidad de la extremidad, o ambas. Las causas son múltiples y pueden resumirse en dos procesos fisiopatológicos, trombóticos o embólicos, con lo que se puede establecer el pronóstico y el tratamiento según su causa. El cuadro sindrómico es variable, y típicamente, se identifica con las cinco "P" de Pratt (pain, pallor, pulselessness,paralysisand paresthesia); se cuenta con múltiples ayudas diagnósticas, pero la arteriografía sigue siendo el método estándar para el diagnóstico. Con el advenimiento de los avances tecnológicos y los procedimientos vasculares, el salvamento de las extremi-dades ha venido en aumento y ha disminuido la extensión de las amputaciones, lo cual conlleva una mayor tasa de rehabilitación y de reincorporación a la vida social


Acute arterial ischemia of the extremities is defined as the abrupt interruption of blood flow to certain tissue which affects the integrity and/or viability of the limb. The causes are multiple and can be summarized in two pathophysiological processes, thrombotic or embolic, with which the prognosis and management can be established depending on the cause. The syndromic picture is variable, typically identified with the Pratt's five "P" (pain, pallor, pulselessness, paralysis and paresthesia); there is an arsenal of diagnostic tools but arteriography remains the gold standard for diagnosis. With the advent of technological advances and vascular procedures, limb salvage has been increasing with a decrease in the extent of amputations represented by a higher rate of rehabilitation and reincorporation into social life


Subject(s)
Humans , Embolism and Thrombosis , Reperfusion Injury , Endovascular Procedures , Ischemia
3.
Rev. chil. radiol ; 25(2): 71-74, jun. 2019. ilus
Article in Spanish | LILACS (Americas) | ID: biblio-1013852

ABSTRACT

Objetivo: La arteria subclavia aberrante (ASA) o arteria lusoria, es una de las malformaciones más comunes del arco aórtico; en especial su variante derecha. Por otro lado, la arteria subclavia aberrante izquierda es más rara. Presentamos un caso infrecuente de un paciente con síndrome deleción 22q11.2 y ASA izquierda con síntomas en extremidad superior izquierda. La ASA izquierda es una condición muy poco frecuente y hay escasa información sobre su tratamiento quirúrgico. La mayoría de las veces, el ASA es asintomática; especialmente en adultos. Si presenta clínica, sus síntomas son disfagia, tos, disnea, claudicación de la extremidad superior. La presencia de sintomatología es una indicación quirúrgica. El tratamiento quirúrgico de una ASA es discutido. Éste va a depender de la anatomía, comorbilidades y experiencia del cirujano.


Objective: The Aberrant Right Subclavian Artery (ARSA) or Lusoria Artery is one of the most common aortic arch malformations. Aberrant Left Subclavian Artery (ALSA) on the other hand, is a much rarer condition. We present an uncommon case of ALSA in a patient with 22q11.2 deletion syndrome with upper limb symptoms and review the treatment options. ALSA is an exceedingly rare condition and information on its surgical treatment is scarce. In most cases the presence of an ALSA is asymptomatic, especially in adults. Some of the most typical symptoms are dysphagia (dysphagia lusoria), cough, dyspnea, claudication of the upper limb extremity. When symptomatic, the patient has indication of surgery. The treatment of an ALSA is still debatable and it depends on the anatomy, comorbidities and surgeon´s experience.


Subject(s)
Humans , Male , Adult , Subclavian Artery/abnormalities , Subclavian Artery/diagnostic imaging , DiGeorge Syndrome/complications , Subclavian Artery/surgery , Endovascular Procedures/methods
4.
Rev. cir. (Impr.) ; 71(3): 216-224, jun. 2019. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-1058260

ABSTRACT

INTRODUCCIÓN: El trauma vascular es un evento de baja frecuencia, con alta morbimortalidad que afecta la población joven; requiere en general un manejo quirúrgico. Se asocia a complicaciones desde la reintervención quirúrgica hasta la amputación de la extremidad, influenciado por variables tanto asociadas al trauma como a la atención hospitalaria. OBJETIVO: Determinar los factores de riesgo relacionados con amputación, en pacientes con trauma arterial periférico (TAP), atendidos en un Hospital de III nivel Huila- Colombia entre 2014-2017. MATERIALES Y MÉTODOS: Estudio observacional, analítico de corte retrospectiva con pacientes mayores de 13 años con TAP. RESULTADOS: Se incluyeron 79 pacientes, con un 1,56% de las consultas en nuestro Servicio de Urgencia. 89% hombres, promedio de edad 28,5 años. La principal comorbilidad fue la farmacodependencia 8,8%. El MESS (mangled extremity severity) promedio fue de 5,27 puntos y un tiempo critico de isquemia de extremidad > a 6 horas en el 38%. El mayor compromiso fue de miembros superiores, secundario a heridas por arma cortopunzante. La lesión predominante fue la transección arterial. Las principales complicaciones posquirúrgicas fueron la trombosis del vaso (21,5%) y la amputación (13,9%). Factores de riesgo asociados a amputación fueron la edad > 20 años, estancia hospitalaria > 7 días, MESS > 7 puntos, que presentaran como complicación quirúrgica la trombosis arterial y que requirieran reintervención quirúrgica. CONCLUSIONES: El trauma arterial periférico es una patología con gran repercusión socioeconómica y secuelas funcionales. Es necesaria la atención oportuna con tratamiento de las variables relacionadas con mal pronóstico, con el fin de disminuir las tasas de morbimortalidad.


INTRODUCTION: Vascular trauma is a low frequency event, with high morbidity and mortality that affects the young population; In general, it requires surgical management. It is associated with complications from surgical reintervention to amputation of the limb, influenced by trauma associated variables such as hospital care. AIM: Determine risk factors related to amputation, in patients with peripheral arterial trauma (TAP), treated at a Hospital of III level Huila-Colombia between 2014-2017. MATERIALS AND METHOD: Observational, retrospective analytical study with patients older than 13 years with TAP. RESULTS: We included 79 patients with an incidence of 1.56%. 89% men, average age 28.5 years. The main comorbidity was 8.8% drug dependence. The MESS (Mangled extremity severity) average was of 5.27 points and a critical time of limb ischemia > to 6 hours in 38%. The greater commitment was of superior members, secondary to injuries by sharp weapon. The predominant lesion was arterial transection. The main postoperative complications were vessel thrombosis (21.5%) and amputation in 13.9%. Risk factors associated with amputation were determined by age > 20 years, hospital stay > 7 days, MESS > 7 points, and that they presented arterial thrombosis as a surgical complication and finally required surgical reoperation. CONCLUSIONS: Peripheral arterial trauma is a pathology with great socioeconomic impact and functional sequelae. It is necessary the timely attention with treatment of the variables related to poor prognosis, in order to decrease the morbidity and mortality rates.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Wounds, Nonpenetrating/surgery , Extremities/surgery , Vascular System Injuries/surgery , Vascular System Injuries/complications , Endovascular Procedures/statistics & numerical data , Postoperative Complications/epidemiology , Prognosis , Reoperation/statistics & numerical data , Cross-Sectional Studies , Multivariate Analysis , Retrospective Studies , Risk Factors , Follow-Up Studies , Colombia , Limb Salvage/statistics & numerical data , Extremities/injuries , Endovascular Procedures/methods , Amputation/statistics & numerical data
5.
Rev. Fac. Cienc. Méd. Univ. Cuenca ; 37(1): 57-64, Junio 2019. tab, ilus
Article in Spanish | LILACS (Americas) | ID: biblio-1004992

ABSTRACT

La malformación aneurismática de la vena de Galeno (MAVG) es la fístula arteriovenosa menos frecuente dentro de la clasificación de las malforma-ciones arteriovenosas intracraneales, de alta mortalidad que las técnicas endovasculares disminuyen. Se presente el caso de un niño de 2 años 4 meses sometido a tratamiento endovascular por tercera ocasión, quien fue diagnosticado desde la etapa prenatal de MAVG, se programó y ejecutó embolización endovascular en vasos de alimentación que tenían 60% de obliteración, luego del cual permanece estable en la unidad de cuidados intensivos y posteriormente es dado de alta sin complicaciones.


The aneurysmal malformation of the vein of Galen (VOGM) is the arte-riovenous fistula less frequent within the classification of intracranial arte-riovenous malformations, with high mortality that endovascular techniques decrease. A case of a 2-years and 4-months-old boy who were submitted to an endovascular treatment for the third time is presented. The patient was diagnosed from the prenatal stage of VOGM, an endovascular em-bolization was programmed and executed in feeding vessels with 60% of obliterated, after that the patient stays stable in the intensive care unit and finally the patient is discharged without complications.


Subject(s)
Humans , Male , Child, Preschool , Vein of Galen Malformations , Endovascular Procedures , Aneurysm , Intracranial Arteriovenous Malformations , Arteriovenous Fistula , Embolization, Therapeutic
6.
Rev. chil. cardiol ; 38(1): 46-53, abr. 2019. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-1003637

ABSTRACT

Resumen En Chile, se han logrado avances importantes en el manejo del Infarto Agudo de Miocardio (IAM) con elevación del segmento ST (IAMCEST). Debido a la mejoría en el diagnóstico precoz y tratamiento, particularmente, con el incremento de la Angioplastía Primaria (APP), hoy están dadas las condiciones para seguir progresando por la vía de la combinación de estrategias de reperfusión y la creación de Redes de Manejo del IAM. El siguiente artículo revisa la evidencia que justifica impulsar dicho avance y se esbozan posibles caminos para lograrlo.


Abstract In Chile, important advances have been made in the management of Acute Myocardial Infarction (MI) with ST segment elevation (STEMI). Due to the progress in early diagnosis and treatment, particularly with the increase in Primary Angioplasty (Primary PCI), nowadays there are conditions to improve early management through the combination of reperfusion strategies and the implementation of MI reperfusion networks. The present article reviews the evidence justifying the promotion of this strategy and outlines possible actions to achieve it.


Subject(s)
Humans , Myocardial Reperfusion/methods , Thrombolytic Therapy/methods , Angioplasty/methods , ST Elevation Myocardial Infarction/therapy , Chile , Endovascular Procedures , Fibrinolytic Agents/therapeutic use , ST Elevation Myocardial Infarction/epidemiology
7.
Article in English | WPRIM (Western Pacific) | ID: wprim-788812

ABSTRACT

OBJECTIVE: Since less invasive endovascular treatment was introduced to South Korea in 1994, a considerable proportion of endovascular treatments have been performed by neuroradiology doctors, and endovascular treatments by vascular neurosurgeons have recently increased. However, few specific statistics are known regarding how many endovascular treatments are performed by neurosurgeons. Thus, authors compared endovascular treatments collaboratively performed by vascular neurosurgeons with all cases throughout South Korea from 2013 to 2017 to elucidate the role of neurosurgeons in the field of endovascular treatment in South Korea.METHODS: The Society of Korean Endovascular Neurosurgeons (SKEN) has issued annual reports every year since 2014. These reports cover statistics on endovascular treatments collaboratively or individually performed by SKEN members from 2013 to 2017. The data was requested and collected from vascular neurosurgeons in various hospitals. The study involved 77 hospitals in its first year, and 100 in its last. National statistics on endovascular treatment from all over South Korea were obtained from the Healthcare Bigdata Hub website of the Health Insurance Review & Assessment Service based on the Electronic Data Interchange (EDI) codes (in the case of intra-arterial (IA) thrombolysis, however, statistics were based on a combination of the EDI and I63 codes, a cerebral infarction disease code) from 2013 to 2017. These two data sets were directly compared and the ratios were obtained.RESULTS: Regionally, during the entire study period, endovascular treatments by SKEN members were most common in Gyeonggi-do, followed by Seoul and Busan. Among the endovascular treatments, conventional cerebral angiography was the most common, followed by cerebral aneurysmal coiling, endovascular treatments for ischemic stroke, and finally endovascular treatments for vascular malformation and tumor embolization. The number of endovascular treatments performed by SKEN members increased every year.CONCLUSION: The SKEN members have been responsible for the major role of endovascular treatments in South Korea for the recent 5 years. This was achieved through the perseverance of senior members who started out in the midst of hardship, the establishment of standards for the training/certification of endovascular neurosurgery, and the enthusiasm of current SKEN members who followed. To provide better treatment to patients, we will have to make further progress in SKEN.


Subject(s)
Cerebral Angiography , Cerebral Infarction , Data Interpretation, Statistical , Dataset , Delivery of Health Care , Endovascular Procedures , Humans , Insurance, Health , Intracranial Aneurysm , Korea , Neurosurgeons , Neurosurgery , Seoul , Stroke , Vascular Malformations
8.
Article in English | WPRIM (Western Pacific) | ID: wprim-739573

ABSTRACT

PURPOSE: A prospective study was conducted to compare radiation exposure to different parts of an endovascular surgeon's body when using a mobile C-arm with that in a hybrid room. METHODS: Exposure during individual procedures performed on 39 patients with a mobile C-arm and 42 patients in a hybrid room, from July 2016 to December 2016, was evaluated. RESULTS: The procedures performed, fluoroscopy time, and dose-area product were not significantly different between groups. The dose-area product per second in the hybrid room group appeared greater than in the C-arm group (4.5 µGym2/sec vs. 3.1 µGym2/sec). In the C-arm group, the peak skin dose on the right neck (1.77 mSv) and shoulder (1.48 mSv) appeared higher than those on their left side (0.32 mSv, 0.53 mSv, respectively) and the counterparts of the hybrid room group (0.88 mSv, 0.20 mSv, respectively). CONCLUSION: The peak skin dose in the hybrid room appeared highest for the lower part of the protective apron. The dose-area product per second seemed to be greater in the hybrid room than when using the C-arm. Thus, attention should be focused on protecting the surgeon's upper body when using the C-arm and the lower body when using the hybrid room.


Subject(s)
Endovascular Procedures , Fluoroscopy , Humans , Neck , Operating Rooms , Prospective Studies , Radiation Exposure , Shoulder , Skin , Surgeons
9.
Article in English | WPRIM (Western Pacific) | ID: wprim-739572

ABSTRACT

PURPOSE: The use of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysms (r-AAA) is steadily increasing. We report early experiences of EVAR for r-AAA performed in two tertiary referral centers in Korea. METHODS: We retrospectively reviewed r-AAA patients treated by EVAR from May 2013 to December 2017. An EVAR-first strategy for r-AAA was adopted whenever feasible. The demographic information, anatomic characteristics, operative details, postoperative complications with special attention to abdominal compartment syndrome (ACS), and 30-day mortality were collected and analyzed. RESULTS: We identified 13 patients who underwent EVAR for r-AAA. Mean age was 74.2 years and mean AAA size was 74.2 mm. Two patients underwent cardiopulmonary resuscitation at initial presentation. Bifurcated stent grafts were used in 12 out of 13 cases and physician-modified endografts with fenestrated/chimney techniques were performed in 2 cases with short neck. Successful stent graft deployment was achieved in all cases. Three patients were suspected of having ACS and 2 of them underwent laparotomy for decompression. The 30-day mortality was 7.7% (1 of 13), the only mortality being a patient that refused decompressive laparotomy for suspected ACS. CONCLUSION: Despite the small numbers, the outcomes of EVAR for treatment of r-AAA were very promising, even in selected cases with unfavorable anatomy. These outcomes were achieved by a dedicated and well-trained team approach, and by use of high-end angiographic technology. Finally, ACS after EVAR is not uncommon, and requires a high index of suspicion as well as liberal use of decompressive surgery.


Subject(s)
Aneurysm , Aortic Aneurysm, Abdominal , Blood Vessel Prosthesis , Cardiopulmonary Resuscitation , Decompression , Endovascular Procedures , Humans , Intra-Abdominal Hypertension , Korea , Laparotomy , Mortality , Neck , Postoperative Complications , Retrospective Studies , Rupture , Tertiary Care Centers
10.
Article in English | WPRIM (Western Pacific) | ID: wprim-739571

ABSTRACT

PURPOSE: Isolated iliac artery aneurysm (IIAA) is uncommon. It is frequently treated by endovascular aneurysm repair (EVAR). This study was to evaluate treatment results of IIAA and survey aortic diameter after EVAR. METHODS: Patients treated for IIAA in Seoul St. Mary's Hospital and Bundang Seoul National University from 2005 to April 2016 were retrospectively enrolled. The inclusion criteria of IIAA was >30 mm of iliac artery aneurysm without abdominal aortic aneurysm, which was treated by open surgical repair (OSR) or EVAR. Patients' clinical characteristics, treatment results, and mortality were obtained from electronic medical records. Diameters of aorta and iliac arteries were measured periodically with scheduled interval based on CT scans. RESULTS: Forty-nine patients (40 males; mean age, 71.9 ± 11.1 years) were enrolled. Five ruptured IIAAs were treated with EVAR (n = 1) or hybrid methods (n = 4). The diameter of ruptured IIAAs was 65 ± 31.4 mm, which was not significantly different from that of elective (44.3 ± 17.0 mm). Forty-four elective IIAA underwent 9 OSR, 31 EVARs, and 3 hybrid treatments (15 bifurcated and 12 straight stent-grafts). Treatment success rate was 93.8% without hospital mortality. There were 4 type I endoleak, 1 type II endoleak, and 1 type III endoleak without aneurysm-related mortality during follow-up. However, the aortic diameter was increased over time though there was no change or decrease in common iliac artery's diameter. CONCLUSION: Treatment of IIAA included various endovascular modalities as well as open surgery. Regular surveillance is still needed due to aortic dilatation after its treatment.


Subject(s)
Aneurysm , Aorta , Aortic Aneurysm, Abdominal , Dilatation , Electronic Health Records , Endoleak , Endovascular Procedures , Follow-Up Studies , Hospital Mortality , Humans , Iliac Aneurysm , Iliac Artery , Male , Mortality , Retrospective Studies , Seoul , Tomography, X-Ray Computed
11.
Article in English | WPRIM (Western Pacific) | ID: wprim-739570

ABSTRACT

PURPOSE: Since endovascular aneurysm repair (EVAR) was first introduced in 1991, it has undergone rapid technical and quantitative developments. We analyzed the characteristics and trends of EVAR research through bibliometric analysis. METHODS: Comprehensive online searches focused on EVAR were performed from January 1994 to August 2017. The following information was collected: title, year of publication, countries' contribution, authorship, subspecialty, institution, subject category, and top 10 cited articles. RESULTS: A significant increase was demonstrated globally in the number of annual publications on EVAR. The highest number of publications was from the United States (n = 849, 35.08%), followed by England (n = 343, 14.17%), and the institutions with highest number of publications were Stanford University (n = 61, 2.52%) and Skane University Hospital Malmo (n = 45, 1.86%). The Journal of Vascular Surgery published approximately one quarter of the total publications. Vascular surgeons produced the most publications (n = 1871, 78.14%), followed by radiologists (n = 377, 15.58%) and cardiologists (n = 73, 3.02%). The most studied topics on EVAR were complications and procedures. The number of publications on complex EVAR and EVAR in juxtarenal aneurysm has increased more from 2013 to 2017 (5.1%, 9.5%) compared with from 1998 to 2002 (2.1%, 1.8%). CONCLUSION: Our bibliometric analysis showed the characteristics and trends of publications on EVAR over a period of 25 years. The results of the bibliometric analysis revealed the quantitative improvements of publications and the qualitative improvements in challenging EVAR.


Subject(s)
Aneurysm , Authorship , Bibliometrics , Endovascular Procedures , England , Publications , Surgeons , United States
12.
Rev. colomb. cir ; 34(4): 386-393, 20190000. fig
Article in Spanish | LILACS (Americas), COLNAL | ID: biblio-1049206

ABSTRACT

El síndrome de Budd-Chiari consiste en la oclusión de la circulación de salida venosa del hígado, desde las sinusoides hepáticas hasta la unión de la vena cava inferior con la aurícula derecha. Esta entidad es muy rara. Las causas son primarias, obstrucción congénita de la vena cava o trombosis espontánea, o secundarias, compresión extrínseca. Si no se trata la obstrucción esta enfermedad, lleva a cirrosis hepática. Se presenta un caso del síndrome de Budd-Chiari de causa primaria por obstrucción membranosa, tratado por vía endovascular de manera exitosa y con resolución de todos los síntomas. Es el primer reporte en Colombia de este tipo de tratamiento (AU)


Budd-Chiari syndrome refers to the occlusion of the venous outflow of the liver, from the hepatic sinusoids to the junction of the inferior vena cava with the right atrium. This entity is very rare. The causes can be divided in primary (congenital vena cava obstruction or spontaneous thrombosis), and secondary (extrinsic compression). If the obstruction is not treated, leads to liver cirrhosis. In this article, we present a case of Budd-Chiari syndrome, primary due to membranous obstruction, successfully managed by the endovascular route with resolution of all symptoms. To our knowledge, this is the first case reported in Colombia utilizing this type of treatment (AU)


Subject(s)
Humans , Budd-Chiari Syndrome , Vena Cava, Superior , Endovascular Procedures , Liver
13.
J. vasc. bras ; 18: e20180062, 2019. tab, ilus
Article in English | LILACS (Americas) | ID: biblio-1040371

ABSTRACT

The objective of management of superior vena cava syndrome (SVCS) is to promptly alleviate the uncomfortable symptoms. Conventional approaches do not always achieve results as rapidly as endovascular management with stent placement. Objectives To report the experience with endovascular management of SVCS of a Vascular and Endovascular Surgery Service at a Brazilian university hospital. Methods Symptomatic type III SVCS cases were managed with angioplasty and stent placement in 28 patients aged from 37 to 68 years, between 2002 and 2012. The etiology of SVCS was lung or thoracic cancer in 18 patients, while occlusion of the vein for prolonged use of catheters was the cause in the other 10 cases. Results Superior vena cava occlusion repair was not possible in one oligosymptomatic patient with a very severe lesion. Technical success was achieved in 96.4%. There were two deaths, one due to pulmonary embolism, 24 hours after a successful procedure, and the other due to compression of the airways by tumor mass some hours after the procedure. Clinical success was achieved in all cases of technical success, including one patient who died suddenly, after total regression of SVCS symptoms. Symptoms disappeared 24 hours and 48 hours after management in16 and 8 patients respectively; improvement was slower but progressive after 48 hours in the remaining patients. Conclusions Endovascular stent placement was effective for management of SVCS, with good technical and clinical success rates and provided prompt relief from symptoms


O tratamento da síndrome da veia cava superior (SVCS) visa aliviar, rapidamente, os sintomas desconfortáveis. Os resultados das abordagens convencionais nem sempre são tão rápidos quanto os do tratamento endovascular com colocação de stent. Objetivos Relatar a experiência de um Serviço de Cirurgia Vascular e Endovascular de hospital universitário brasileiro com o tratamento endovascular da SVCS. Métodos Vinte e oito pacientes com SVCS sintomática tipo III foram tratados com angioplastia e colocação de stent, entre 2002 e 2012. A idade variou entre 37 e 68 anos. A SVCS resultou de doença neoplásica pulmonar ou torácica em 18 pacientes e de oclusão da veia por uso prolongado de cateteres em 10 pacientes. Resultados Não foi possível reparo da oclusão da veia em um paciente oligossintomático com lesão bastante grave. O sucesso técnico foi de 96,4%. Houve duas mortes, sendo uma por embolia pulmonar 24 horas após procedimento bem-sucedido e outra por compressão das vias aéreas por massa tumoral algumas horas após o procedimento. Houve sucesso clínico em todos os casos de sucesso técnico, incluindo o paciente que faleceu de repente após ter apresentado regressão total dos sintomas. Os sintomas desapareceram em 24 e 48 horas após o tratamento em, respectivamente, 16 e oito pacientes. A melhora foi mais lenta, embora progressiva, após 48 horas nos demais pacientes. Conclusões A colocação de stent endovascular no tratamento da SVCS foi eficaz, com boas taxas de sucesso técnico e clínico e alívio mais rápido dos sintomas


Subject(s)
Vena Cava, Superior , Superior Vena Cava Syndrome , Endovascular Procedures/methods , Vascular Surgical Procedures/methods , Stents , Treatment Outcome
14.
J. vasc. bras ; 18: e20190037, 2019. ilus
Article in Portuguese | LILACS (Americas) | ID: biblio-1040372

ABSTRACT

A síndrome de nutcracker é manifesta na presença de um aprisionamento sintomático da veia renal esquerda entre a aorta abdominal e a artéria mesentérica superior. Uma variação mais efêmera desta desordem é dita síndrome de nutcracker posterior, quando a compressão da veia renal não mais ocorre frontalmente à aorta, mas posteriormente a ela, entre esta e a coluna vertebral. A despeito de variáveis opções terapêuticas, as técnicas presentes visam aliviar os sintomas e diminuir a pressão venosa da veia renal esquerda. Este relato descreve um caso de Síndrome de nutcracker posterior, em que a abordagem de escolha foi a cirurgia aberta, transpondo distalmente a veia gonadal esquerda na veia cava inferior


The Nutcracker Syndrome is manifest in the presence of a symptomatic entrapment of the left renal vein between the abdominal aorta and the superior mesenteric artery. In a more ephemeral variation of this disorder, called the Posterior Nutcracker Syndrome, the renal vein is not compressed anterior to the aorta, but posteriorly, between the artery and the spine. Although there are multiple treatment options, current techniques aim to relieve the symptoms and reduce venous pressure on the left renal vein. This report describes a case of Posterior Nutcracker Syndrome in which the management approach chosen was open surgery, transposing the gonadal vein distally, to the inferior cava vein


Subject(s)
Abdominal Pain , Renal Nutcracker Syndrome/diagnosis , Renal Nutcracker Syndrome/therapy , Aorta, Abdominal , Renal Veins , Vena Cava, Inferior , Tomography, X-Ray Computed/methods , Mesenteric Artery, Superior , Endovascular Procedures/methods
16.
Rev. Col. Bras. Cir ; 46(5): e20192334, 2019. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-1057177

ABSTRACT

RESUMO A oclusão ressuscitativa por balão endovascular da aorta (REBOA) é utilizada para controlar hemorragias não compressíveis do tronco como uma opção menos invasiva e com menos distúrbios fisiológicos quando comparado à toracotomia de emergência com clampeamento da aorta. Isso permite a melhora dos parâmetros hemodinâmicos até que a cirurgia definitiva seja realizada. É utilizada no trauma como uma medida para prevenir o colapso hemodinâmico em pacientes que estão em choque hemorrágico grave, mantendo a perfusão do cérebro e do coração enquanto diminui o sangramento distal até que o controle da hemorragia possa ser realizado. As principais complicações relatadas são insuficiência renal aguda, amputações de membros inferiores e óbitos. O objetivo desse estudo foi avaliar a expansão do uso do REBOA em situações não traumáticas de outras áreas da medicina, assim como, avaliar os resultados obtidos até o momento. Uma pesquisa online do PubMed, Medline e SciELO foi realizada com o termo "REBOA" nos últimos cinco anos, e os artigos incluídos foram os 14 que descrevem especificamente o uso do REBOA para condições não traumáticas. Os resultados sugerem que o uso do REBOA levou a um melhor controle do sangramento e aumento da pressão arterial, reduzindo a necessidade de transfusão de sangue e permitindo que os pacientes sobrevivam ao tratamento definitivo das lesões. Concluindo, o uso expandido do REBOA para emergências não traumáticas parece ser eficaz, mas estudos prospectivos e protocolos bem estabelecidos devem ser desenvolvidos para maximizar os resultados.


ABSTRACT Currently, resuscitative endovascular balloon occlusion of the aorta (REBOA) is used in trauma surgery for controlling non-compressible torso hemorrhages, as a less invasive option and with fewer physiologic disturbances compared with an invasive emergent thoracotomy for aortic cross-clamping. This can allow improvements in hemodynamic parameters until definitive surgery is performed. REBOA is also used in trauma to prevent hemodynamic collapse in patients who are in severe hemorrhagic shock, as a method to maintain perfusion of the brain and heart while decreasing distal bleeding until hemorrhage control can take place. The major complications reported are acute kidney injury, lower leg amputations, and even death. As experience with REBOA in emergency surgery grows, new indications have been described in the literature. The aim of this study was to assess the expansion of the use of REBOA in other areas of medicine, as well as evaluating the current published series. We performed an online search of PubMed, Medline and SciELO with the term "REBOA" in the last five years, and the articles included were the 14 specifically describing the use of REBOA for non-traumatic conditions. The results suggest that the use of REBOA led to improved bleeding control and increased arterial pressure, reducing blood transfusion requirements and allowing patients to survive to definitive treatment of injuries. In conclusion, the expanded use of REBOA for non-traumatic emergencies appears to be effective. However, prospective studies and well-established protocols for specific indications should be developed to maximize patient outcomes.


Subject(s)
Humans , Aorta/surgery , Resuscitation/methods , Balloon Occlusion/methods , Endovascular Procedures/methods , Hemorrhage/prevention & control
17.
J. vasc. bras ; 18: e20180135, 2019. ilus
Article in Portuguese | LILACS (Americas) | 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
18.
J. vasc. bras ; 18: e20160017, 2019. graf
Article in Portuguese | LILACS (Americas) | ID: biblio-1012626

ABSTRACT

A esclerose tuberosa é uma doença genética de transmissão autossômica dominante. Caracteriza-se, na sua apresentação clássica, por epilepsia, deficiência mental e adenomas sebáceos. Aneurismas de aorta podem acometer desde crianças com poucos meses de vida até adultos jovens portadores de esclerose tuberosa. Apresentamos o caso de uma paciente jovem com diagnóstico de aneurisma sacular de aorta torácica e esclerose tuberosa tratada com sucesso por via endovascular


Tuberous sclerosis is a genetic disease with autosomal dominant transmission. Its classic presentation comprises epilepsy, mental deficiencies, and sebaceous adenomas. Aneurysms of the aorta can be detected in people with tuberous sclerosis ranging from children a few months old to young adults. We report the case of a young patient diagnosed with a saccular thoracic aortic aneurysm and tuberous sclerosis who was successfully treated using an endovascular approach


Subject(s)
Humans , Female , Adult , Tuberous Sclerosis , Aortic Aneurysm, Thoracic , Prostheses and Implants , Magnetic Resonance Spectroscopy/methods , Tomography/methods , Ultrasonography/methods , Endovascular Procedures/methods
19.
Int. arch. otorhinolaryngol. (Impr.) ; 23(2): 172-177, 2019. ilus, tab
Article in English | LILACS (Americas) | ID: biblio-1015180

ABSTRACT

Introduction: Acute carotid blowout syndrome (aCBS) is a severe complication of head and neck cancer (HNC). It can be defined as a rupture of the extracranial carotid arteries, or one of their branches, that causes life-threatening hemorrhage, and which nowadays can be treated with urgent endovascular intervention. Objective: We retrospectively evaluate the endovascular management of aCBS and its outcome in years of survival. Methods: Retrospectively, we describe our experience with endovascular control of aCBS in patients treated for HNC. We review the characteristics, pathology, endovascular treatment and morbidity and assess the gain in life years. Results: Nine individuals were included in this study. Four patients had been previously diagnosed with laryngeal squamous cell carcinoma (SCC), one with paranasal SCC, one with nasopharyngeal carcinoma and three with oral or maxillary adenocarcinoma. All subjects underwent radiotherapy and surgical excision to different extents. Twelve endovascular procedures were performed for injuries to the internal carotid artery (n = 3; 25%), external carotid artery (n = 1; 7%) or one of their branches (n = 8; 67%). Deconstructive methods were used in nine procedures, and three procedures were mainly reconstructive with deployment of covered stents. Total control of bleeding was achieved in all individuals with no intraprocedural complications. Conclusion: Endovascular therapy is an effective alternative for the management of exsanguinating CBS. In our series, this palliative therapy increased the overall patient survival by an estimated 9 months (AU)


Subject(s)
Middle Aged , Aged , Carotid Artery Injuries/surgery , Endovascular Procedures , Angiography , Reconstructive Surgical Procedures , Carotid Artery Injuries/etiology , Balloon Occlusion , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/radiotherapy
20.
Rev. colomb. cir ; 34(3): 234-244, 20190813. fig, tab
Article in Spanish | LILACS (Americas) | ID: biblio-1016066

ABSTRACT

Introducción. La hemorragia digestiva ocasiona el 2 % de las hospitalizaciones; se clasifica en alta o baja, y la primera se presenta en el 80 % de casos. Después de la estabilización hemodinámica, se determinan la causa y el tratamiento mediante la endoscopia; no obstante, esta falla en 10 a 20 % de los casos, y del 15 al 20 % requieren cirugía mayor, con una mortalidad de más del 40 %. El tratamiento para la hemorragia digestiva mediante la formación de émbolos de los vasos mesentéricos, es una conducta bien establecida, produce buenos resultados, evita la cirugía y disminuye la morbimortalidad. Objetivos. Determinar la indicación y el éxito del tratamiento endovascular para la hemorragia digestiva en nuestra institución. Materiales y métodos. Estudio retrospectivo y descriptivo, se incluyeron 10 pacientes que requirieron la urgente formación de émbolos por falla o imposibilidad del manejo endoscópico, y que presentaban gran riesgo quirúr-gico y anestésico con la técnica abierta. Se evaluaron la causa de la hemorragia, la arteria comprometida, los hallazgos angiográficos, la hemoglobina antes y después de la formación de los émbolos, la reincidencia de la hemorragia, las complicaciones, la necesidad de intervención quirúrgica, la eficacia del procedimiento y la mortalidad a 30 días. Resultados. Todos los pacientes se intervinieron por vía endovascular, para la oclusión selectiva de las arterias comprometidas. La hemorragia se controló en todos ellos. Se presentaron dos muertes tempranas (<30 días) no asociadas con el procedimiento. No hubo complicaciones secundarias a la formación de los émbolos o al acceso percutáneo y, tampoco, necesidad de cirugías mayores posteriores para controlar la hemorragia. Conclusión. Los métodos endovasculares para controlar la hemorragia digestiva son eficaces, no se acompañan de complicaciones, y disminuyen la morbimortalidad y la necesidad de cirugías mayores. Se requieren estudios con mayor número de pacientes para lograr un mayor grado de certeza


Introduction: Gastrointestinal bleeding is a common problem, which represents 2% of hospitalizations. It is classified as high or low depending on their origin; 80% of cases are high bleeders. After hemodynamic stabilization, endoscopy is very important to determine the cause and carry out treatment, which in some cases is unsuccessful or cannot be performed, and 15% -20% will require major surgery with a mortality rate of over 40%. Occlusion of mesenteric vessels, as a treatment for gastrointestinal bleeding is a well defined and successful therapeutic, avoiding major surgery and reducing morbidity and mortality, it is a procedure with very low incidence of complications and repeated bleeding. We studied: the cause of bleeding, the compromised artery, the angiographic findings, the pre and post embolization hemoglobin, re-bleeding complications, need for additional surgery after embolization effectiveness of the procedure to control bleeding, and mortality at 30 days.Objectives: To determine the indication and success of endovascular treatment for the management of gastroin-testinal bleeding in our institutionMaterials and methods: A retrospective and descriptive study.Results: Ten patients (5 females, 5 males) are included, with an average age of 59.8 years; in six cases the bleeding was due to proximal acid-peptic disease, two patients with diverticular disease performed, and two patients bleeding due to gastroduodenal neoplastic disease; all patients required urgent embolization in view of failure or inability to endoscopic management, associated with progressive anemia, active bleeding, schock and requi-rement of more than 3 packed red blood cells; associated with high surgical and anesthetic risk for open surgery. All patients underwent endovascular procedure with selective embolization and the bleeding stop with hemo-dynamic stabilization, two early deaths (<30days) were presented but not associated with the procedure; there were no complications secondary to embolization or percutaneous access, nor was need for further surgery after the procedure to control bleedingConclusion: In our experience the use of endovascular methods to control gastrointestinal bleeding is effective and uncomplicated; reducing morbidity and mortality and the need for major surgery. More studies are needed to determine the number of patients a higher level of evidence


Subject(s)
Humans , Gastrointestinal Hemorrhage , Vascular Diseases , Endovascular Procedures , Vascular Closure Devices
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