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1.
Article in Spanish | LILACS, CUMED | ID: biblio-1536324

ABSTRACT

Introducción: El síndrome de May-Thurner es una enfermedad cuya prevalencia real es desconocida. Suele ser asintomática y las manifestaciones clínicas aparecen en el contexto de las complicaciones asociadas a la enfermedad. La aproximación diagnóstica se realiza por medio de imágenes, donde se identifican alteraciones patognomónicas que permiten descartar diagnósticos diferenciales. Se ha demostrado que la COVID-19 genera un estado protrombótico, que en contexto del síndrome de May-Thurner puede derivar en complicaciones tromboembólicas. Objetivo: Comparar la clínica y la posible relación de la enfermedad tromboembólica venosa en el curso de la COVID-19 en pacientes con SMT. Caso clínico: Mujer de 24 años, secretaria de profesión y residente en Bucaramanga. Presentó un cuadro clínico de 20 días de evolución que inició con rinorrea hialina, tos ocasional y mialgias; cinco días después manifestó fiebre no cuantificada y tos con expectoración hemoptoica. Conclusiones: Dentro de la fisiopatología de la infección por SARS-CoV-2 se desarrollan mecanismos procoagulantes, lo cual incrementa el riesgo de eventos trombóticos en pacientes con o sin factores de riesgo(AU)


Introduction: May-Thurner syndrome is a disease whose actual prevalence is unknown. It is usually asymptomatic and clinical manifestations appear in the context of complications associated with the disease. The diagnostic approach is performed by imaging, where pathognomonic alterations are identified to rule out differential diagnoses. It has been demonstrated that COVID-19 generates a prothrombotic state, which particularly in patients with May-Thurner syndrome would lead to thromboembolic complications. Objective: To compare the clinical and possible relationship of venous thromboembolic disease in the course of COVID-19 in patients with May-Thurner syndrome. Clinical case: 24-year-old woman, secretary by profession and resident in Bucaramanga, Colombia. She presented a clinical picture of 20 days of evolution that began with hyaline rhinorrhea, occasional cough and myalgias; five days later she manifested unquantified fever and cough with hemoptotic expectoration. Conclusions: Within the pathophysiology of SARS-CoV-2 infection, procoagulant mechanisms develop, which increases the risk of thrombotic events in patients with or without risk factors(AU)


Subject(s)
Humans , Female , Young Adult , Pulmonary Embolism/diagnosis , Risk Factors , Coronavirus Infections/epidemiology , Venous Thrombosis , May-Thurner Syndrome/diagnostic imaging , Iliac Artery
2.
Article in Spanish | LILACS, CUMED | ID: biblio-1408195

ABSTRACT

Los aneurismas de la arteria ilíaca aislados son extremadamente raros y representan solo entre el 2 por ciento y el 7 por ciento de todos los aneurismas intraabdominales. Este artículo tuvo como objetivo asociar los criterios actuales para el tratamiento quirúrgico en los aneurismas aislados y asintomáticos en la arteria ilíaca común. Se presenta un paciente masculino de 62 años, fumador, remitido del departamento de radiología, porque se observó en el ultrasonido abdominal dilatación aneurismática en arteria ilíaca común derecha. En la tomografía computarizada contrastada se confirmó aneurisma aislado con diámetros quirúrgicos. Se decidió operar y se realizó aneurismectomía más injerto por sustitución protésica con dacrón ilio-ilíaco, con una evolución clínica posoperatoria inmediata y tardía satisfactoria. El tratamiento de referencia para el aneurisma de la arteria ilíaca común ha sido la reparación quirúrgica abierta con injertos protésicos. El algoritmo de decisión se basó en el riesgo de ruptura, que depende a su vez del diámetro aneurismático y del ritmo de crecimiento. Actualmente, el umbral para la reparación electiva de la arteria ilíaca aislada puede considerarse con un mínimo de 3,5 cm de diámetro, pero existe nueva evidencia científica de que muchos pacientes pueden someterse a un tratamiento innecesario si se utiliza este diámetro. Esta es una entidad especial, no solo por su infrecuencia sino también por la mayor complejidad de su reparación(AU)


Isolated iliac artery aneurysms are extremely rare and account for only 2 percent to 7 percent of all intra-abdominal aneurysms. This article aimed to associate current criteria for surgical treatment in isolated and asymptomatic aneurysms in the common iliac artery. A 62-year-old male patient, smoker, referred from the radiology department, is presented because aneurysmal dilation was observed in the abdominal ultrasound in the right common iliac artery. The contrasted computed tomography confirmed an isolated aneurysm with surgical diameters. It was decided to operate and aneurysmectomy plus grafting was performed by prosthetic replacement with ilio-iliac dacron, with a satisfactory immediate and late postoperative clinical evolution. The reference treatment for common iliac artery aneurysm has been open surgical repair with prosthetic grafts. The decision algorithm was based on the risk of rupture, which in turn depends on the aneurysmal diameter and the rate of growth. Currently, the threshold for elective repair of the isolated iliac artery can be considered to be a minimum of 3.5 cm in diameter, but there is new scientific evidence that many patients may undergo unnecessary treatment if this diameter is used. This is a special entity, not only because of its infrequency but also because of the higher complexity of its repair(AU)


Subject(s)
Humans , Male , Middle Aged , Tomography, X-Ray Computed/methods , Iliac Artery , Aneurysm
3.
Chinese Journal of Surgery ; (12): 117-121, 2022.
Article in Chinese | WPRIM | ID: wpr-935588

ABSTRACT

Aortoiliac occlusive disease (AIOD) refers to the stenosis and occlusion of the distal abdominal aorta and(or) bifurcation of the aortoiliac artery,which is mainly caused by atherosclerosis,leading to pelvic and lower limb ischemia.Open surgery has always been the main treatment for complex AIOD.However,in recent years,with the development of endovascular surgery technologies and medical instruments,its treatment concept has been greatly changed.More and more clinical evidence has proved that the long-term efficacy of endovascular therapy is not inferior to that of traditional open surgery,so minimally invasive endovascular therapy has become the preferred treatment for AIOD.


Subject(s)
Humans , Aortic Diseases/surgery , Arterial Occlusive Diseases/surgery , Atherosclerosis , Endovascular Procedures , Iliac Artery/surgery , Treatment Outcome , Vascular Patency
4.
Rev. cir. (Impr.) ; 73(4): 461-469, ago. 2021. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-1388855

ABSTRACT

Resumen Introducción: La angioplastia transluminal percutánea (ATP), se ha convertido en una técnica aceptada, en el tratamiento de la enfermedad obstrutiva aortoilíaca, con tasas de éxito del 90-92% y permeabilidad primaria del 55-72% a 5 años. Objetivo: Evaluar los resultados del tratamiento endovascular del sector aortoilíaco. Material y Método: Estudio descriptivo, retrospectivo (revisión de serie de casos unicéntrica), de pacientes, sometidos consecutivamente al tratamiento endovascular (ATP simple y ATP con stent) de la patología obstructiva del sector aortoilíaco, durante un período de 7 años (2002-2019), en el Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Se realizaron 103 procedimientos en 94 pacientes, sexo masculino: 63,83%, femenino: 36,17%, edad promedio: 67,4 años (rango 47-96), distribución de las lesiones según la clasificación TASC II: A (46,24%), B (39,78%), C (8,60%), D (5,38%), remodelando la biburfaccción aórtica (kissing stent) en un 6,80%, procedimientos híbridos (12,62%), seguimiento promedio (47,13 meses), éxito clínico (90,29%), exito técnico (94,17%), permeabilidad primaria, primaria asistida y secundaria a 5 años del 68,09%, 75,53% y 81,91% respectivamente, tasa de salvación de la extremidad a 5 años del 84,04%, mortalidad < 30 días del 1,94%, supervivencia a 5 años del 90,42%. Discusión: Las técnicas endovasculares del sector aortoilíaco son fiables, sus resultados ténicos y permeabilidad, están influenciados por el estadio clínico del paciente y severidad de las lesiones tratadas. Conclusión: En pacientes adecuadamente seleccionados, el tratamiento endovascular del sector aortoilíaco presenta excelentes resultados, permitiendo aumentar la indicación de tratamiento en pacientes considerados de alto riesgo.


Introduction: Percutaneous transluminal angioplasty (PTA) has become an accepted technique in the treatment of aortoiliac occlusive disease, with success rates of 90-92%, and primary patency of 55-72% at 5 years. Aim: To evaluate the results of endovascular treatment (PTA or PTA with stents) of the aortoiliac sector. Material and Method: Descriptive, retrospective study (single-center case series) of patients, consecutively subjected to endovascular treatment (PTA or PTA with stents) of aortoiliac occlusive disease, during a period of 7 years (2002 - 2019), at the Dr. Eduardo Pereira Hospital in Valparaíso, Chile. Results: 103 procedures were performed in 94 patients, male: 63.83%, female: 36.17%, mean age: 67.4 years (range 47-96), distribution of the lesions according to the TASC II classification: A (46.24%), B (39.78%), C (8.60%), D (5.38%), remodeling the aortic bifaction (kissing stent) in 6.80%, hybrid procedures (12.62%), average follow-up (47.13 months), clinical success (90.29%), technical success (94.17%), primary patency, assisted primary and secondary at 5 years of 68.09%, 75, 53% and 81.91% respectively, 5-year limb salvage rate of 84.04%, mortality < 30 days of 1.94%, 5-year survival of 90.42%. Discussion: Endovascular techniques in the aortoiliac sector are reliable, their technical results and patency are influenced by the clinical stage of the patient and the severity of the lesions treated. Conclusion: In appropriately selected patients, endovascular treatment of the aortoiliac sector, presents excellent results, allowing an increase in the indication for treatment in patients considered to be at high risk.


Subject(s)
Male , Female , Middle Aged , Aged , Aged, 80 and over , Arteriosclerosis/surgery , Endovascular Procedures , Iliac Artery/surgery , Aortic Diseases/surgery , Aortic Diseases/therapy , Arteriosclerosis/therapy , Iliac Artery/diagnostic imaging
5.
Int. j. morphol ; 39(3): 688-691, jun. 2021. ilus
Article in English | LILACS | ID: biblio-1385421

ABSTRACT

SUMMARY: The inferior epigastric artery (IEA) is a major blood vessel that supplies the anterior abdominal wall. The aim of the current study was to provide clinicians, surgeons, and obstetricians with sufficient anatomical data on the inferior epigastric artery, such as its origin and branching pattern. The study included 20 embalmed cadavers, these cadavers were dissected, and the inferior epigastric artery and vena comitans/venae comitantes were identified and traced downwards to the external iliac vessels. The origins, caliber, course and pedicle length of both the artery and the vein(s) were studied. The inferior epigastric artery arose independently from the distal external iliac artery deep to the inguinal ligament in 19 (95 %) cadavers. The artery entered the rectus abdominis muscle at its middle third in 13 (65 %) cases and at its lower third in the remaining specimens. In this study, we found that the artery divided into two branches in 18 (90 %) of the cases; in the remaining two cases, it continued as one trunk. The average pedicle length was 7.2 cm. The mean caliber of the IEA was 3.7 mm. In 18 (90 %) dissections, the venous drainage consisted of a pair of venae comitantes that united to form a common vessel at their draining point on the external iliac vein. The average diameter was 3.9 mm. The current study focuses on the anatomical features of the inferior epigastric artery to increase the success rate of abdominal and pelvic operations in clinical practice.


RESUMEN: La arteria epigástrica inferior (AEI) es un vaso sanguíneo principal que irriga la pared abdominal anterior. El objetivo del presente estudio fue proporcionar a los médicos, cirujanos y obstetras suficientes datos anatómicos sobre la arteria epigástrica inferior, como su origen y patrón de ramificación. El estudio incluyó 20 cadáveres embalsamados, los que se disecaron y se identificó la arteria epigástrica inferior y la vena concomitante y se siguieron hasta los vasos ilíacos externos. Se estudiaron los orígenes, calibre, trayecto y longitud del pedículo tanto de la arteria como de la (s) vena (s). La arteria epigástrica inferior surgió independientemente de la arteria ilíaca externa profunda al ligamento inguinal en 19 (95 %) cadáveres. La arteria ingresó al músculo recto del abdomen en su tercio medio en 13 (65 %) casos y en su tercio inferior en las muestras restantes. En este estudio, encontramos que la arteria se dividió en dos ramas en 18 (90 %) de los casos; en los dos casos restantes, continuó como un tronco. La longitud media del pedículo fue de 7,2 cm. El calibre medio del AEI fue de 3,7 mm. En 18 (90 %) disecciones, el drenaje venoso consistió en un par de venas concomitantes las que formaron un vaso común en su punto de drenaje en la vena ilíaca externa. El diámetro medio fue de 3,9 mm. El estudio actual se centra en las características anatómicas de la arteria epigástrica inferior con el propósito de mejorar la tasa de éxito de las cirugías abdominales y pélvicas en la práctica clínica.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Rectus Abdominis/blood supply , Epigastric Arteries/anatomy & histology , Cadaver , Iliac Artery/anatomy & histology
6.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353992

ABSTRACT

El colgajo perforante de la arteria circunfleja ilíaca superficial se utiliza para la reconstrucción de los miembros, sobre todo, en el dorso de las manos y los pies, en la zona de flexión articular y en cirugía maxilofacial, porque es un colgajo fino, flexible y versátil. Presentamos tres pacientes: dos casos pediátricos para la reconstrucción de secuelas traumáticas de la mano y el dorso del pie, y un adulto para la reconstrucción de una quemadura del dorso de la mano. Conclusiones: El colgajo perforante de la arteria circunfleja ilíaca superficial es ideal para el dorso de la mano, el pie y los pliegues articulares. Pese a las variaciones anatómicas en el nacimiento de la arteria circunfleja ilíaca superficial, el dominio de las técnicas microquirúrgicas y de la supermicrocirugía permite tomar, con seguridad, un colgajo de dimensiones moderadas o grandes, fino, con baja morbilidad en la zona dadora. Nivel de Evidencia: V


The superficial circumflex iliac artery perforator (SCIP) flap is a thin, pliable, and versatile flap used mainly for extremities and head and neck reconstruction. We presented 3 cases of SCIP flap reconstructions. Two pediatric cases for the reconstruction of traumatic sequelae of the hand and dorsal foot. One adult case for the reconstruction of a severe burn of the dorsal hand. Conclusion: The SCIP flap is ideal for the reconstruction of the dorsal aspect of the hand, foot, and flexion crease. Despite the anatomical variations in the origin of the superficial circumflex iliac artery, the use of microsurgical techniques and super-microsurgery allows safe harvesting of a thin flap of moderate to large dimensions, with low morbidity in the donor area. Level of Evidence: V


Subject(s)
Child, Preschool , Child , Adult , Surgical Flaps , Soft Tissue Injuries , Hand Injuries , Iliac Artery
7.
Acta Academiae Medicinae Sinicae ; (6): 917-921, 2021.
Article in Chinese | WPRIM | ID: wpr-921560

ABSTRACT

Objective To explore the cause and the treatment strategies of iliac limb occlusion after endovascular abdominal aortic aneurysm repair(EVAR). Methods The patients receiving EVAR in PUMC Hospital from January 2015 to December 2020 were retrospectively analyzed.Sixteen(2.7%)cases of iliac limb occlusion were identified,among which 6,9,and 1 cases underwent surgical bypass,endovascular or hybrid procedure,and conservative treatment,respectively. Results Fifteen cases were successfully treated.During the 10.6-month follow-up,2 cases receiving hybrid treatment underwent femoral-femoral bypass due to re-occlusion of the iliac limb. Conclusions Iliac limb occlusion mostly occurs in the acute phase after EVAR,and endovascular or hybrid treatment can be the first choice for iliac limb occlusion.It is suggested to focus on the risk factors for prevention.


Subject(s)
Humans , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Endovascular Procedures , Iliac Artery/surgery , Retrospective Studies , Risk Factors , Stents , Treatment Outcome
8.
J. vasc. bras ; 20: e20210033, 2021. tab, graf
Article in English | LILACS | ID: biblio-1340175

ABSTRACT

Abstract Background Retroperitoneal open iliac conduits (ROIC) are used in patients with hostile iliac anatomy undergoing endovascular aortic repair (EVAR). Objectives We hereby report our experience of ROIC in patients subjected to EVAR. Methods This was a retrospective evaluation of 8 patients out of a total of 75 patients (11%) who underwent EVAR in the last 10 years. Pre-procedure computed tomography angiography was used to assess the dimensions of iliac and femoral arteries. Patients who had small arterial dimensions (i.e. smaller than the recommended access size for the aortic endograft device) were subjected to ROIC. Results The mean age of the 3 males and 5 females studied was 45.7 ± 15.2 years. The indication for ROIC was the small caliber ilio-femoral access site in 7 patients and atherosclerotic disease in 1 patient. All external grafts were anastomosed to the right common iliac artery except one which was anastomosed to the aortic bifurcation site because of a small common iliac artery. The procedural success rate was 100%. Local access site complications included infection (n=1), retroperitoneal hematoma (n=1), and need for blood transfusion (n=3). The median post-intervention hospital stay was 10 days. All patients had favorable long-term outcomes at a median follow-up of 18 months. Conclusions Female patients require ROIC during EVAR more frequently. Adjunctive use of iliac conduit for EVAR was associated with favorable perioperative and short-term outcomes.


Resumo Contexto Os condutos ilíacos abertos retroperitoneais são utilizados em pacientes submetidos a reparo endovascular de aneurisma (REVA) com anatomia ilíaca hostil. Objetivos Relatamos a nossa experiência com os condutos ilíacos em pacientes submetidos a REVA. Métodos Trata-se de uma avaliação retrospectiva de oito pacientes, de um total de 75 (11%), os quais foram submetidos a REVA nos últimos 10 anos. Foi realizada angiotomografia computadorizada antes do procedimento para avaliar as dimensões das artérias ilíaca e femoral. Os pacientes com dimensões arteriais menores, abaixo do tamanho de acesso recomendado para o dispositivo de endoprótese aórtica, foram submetidos a condutos ilíacos. Resultados A média de idade dos participantes foi de 45,7±15,2 anos, sendo três do sexo masculino e cinco do sexo feminino. As indicações para condutos ilíacos foram local de acesso ilíaco femoral de pequeno calibre, para sete pacientes, e doença aterosclerótica, para um paciente. Todas as próteses externas foram anastomosadas na artéria ilíaca comum direita, com exceção de uma, que foi anastomosada no local da bifurcação aórtica por apresentar artéria ilíaca comum menor. A taxa de sucesso do procedimento foi de 100%. As complicações no local de acesso incluíram infecção (n = 1), hematoma retroperitoneal (n = 1) e necessidade de transfusão de sangue (n = 3). O tempo mediano de internação hospitalar pós-intervenção foi de 10 dias. Todos os pacientes apresentaram desfechos de longo prazo favoráveis no seguimento mediano de 18 meses. Conclusões As pacientes do sexo feminino necessitaram de condutos ilíacos durante REVA com maior frequência. O uso adjuvante de condutos ilíacos com REVA foi associado a desfechos perioperatórios e de curto prazo favoráveis.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aorta/surgery , Aortic Aneurysm/surgery , Femoral Artery/surgery , Endovascular Procedures/methods , Iliac Artery/surgery , Aortic Dissection/surgery , Retroperitoneal Space , Sex Factors , Retrospective Studies , Outcome Assessment, Health Care , Perioperative Care , Vascular Access Devices
9.
J. vasc. bras ; 20: e20210035, 2021. graf
Article in English | LILACS | ID: biblio-1340180

ABSTRACT

Abstract Various vascular complications following renal transplantation include renal artery and vein thrombosis, renal artery stenosis, pseudoaneurysm, and iliac artery dissection. Transplant renal artery stenosis (TRAS) is the most common, while iliac artery dissection is the rarest of these various vascular complications. We describe an elderly male, who had both external iliac artery dissection and TRAS at 2 months following renal transplantation. He underwent successful percutaneous endovascular intervention of both complications. The post-intervention course was uneventful, with improvement in graft renal functions and left lower limb perfusion.


Resumo As diversas complicações vasculares possíveis após um transplante renal incluem trombose da veia e artéria renais, estenose da artéria renal, pseudoaneurisma e dissecção da artéria ilíaca. Entre essas diversas complicações, a estenose da artéria renal transplantada é a mais comum, enquanto a dissecção da artéria ilíaca é a mais rara. Relatamos o caso de um homem idoso que desenvolveu tanto dissecção da artéria ilíaca quanto estenose da artéria renal transplantada 2 meses após transplante renal. As intervenções endovasculares percutâneas foram bem-sucedidas em ambas as complicações. O período pós-intervenção cursou sem complicações, com melhora na função renal do enxerto e na perfusão do membro inferior esquerdo.


Subject(s)
Humans , Male , Middle Aged , Renal Artery/pathology , Kidney Transplantation/adverse effects , Angioplasty , Iliac Artery/pathology , Stents , Constriction, Pathologic , Endovascular Procedures
10.
J. vasc. bras ; 20: e20200082, 2021. graf
Article in Portuguese | LILACS | ID: biblio-1250239

ABSTRACT

Resumo Os aneurismas de aorta abdominal (AAA) são os mais frequentes, mesmo quando comparados a outros segmentos da aorta. A prevalência e a história natural de aneurismas arteriais em receptores de transplante de órgão abdominal permanecem incertas. Relatamos a abordagem de um caso de aneurisma de aorta abdominal em um paciente transplantado renal e com alergia ao contraste. Foi realizado o tratamento convencional do aneurisma de aorta abdominal com um by-pass aorto bi-ilíaco. Para manutenção do enxerto renal, foi confeccionado um by-pass temporário da artéria axilar direita até a artéria ilíaca comum direita. O paciente foi encaminhado para a unidade de terapia intensiva, onde permaneceu estável hemodinamicamente e recebeu alta no 2º pós-operatório. A cirurgia convencional aberta com derivação extra-anatômica temporária é uma alternativa para o tratamento do AAA em pacientes com transplante renal.


Abstract Abdominal aortic aneurysms (AAA) are the most common type, even when compared to those involving other segments of the aorta. The prevalence and natural history of arterial aneurysms in abdominal organ transplant recipients remain uncertain. We report a case of abdominal aortic aneurysm in a kidney transplant patient with contrast allergy. Conventional abdominal aortic aneurysm repair was performed, constructing a bi-iliac aortic bypass. A temporary bypass was constructed from the right axillary artery to the right common iliac artery to maintain the renal graft. The patient was transferred to the intensive care unit, where he remained hemodynamically stable, and he was discharged on the 2nd postoperative day. Conventional open surgery with temporary extra-anatomic bypass is an alternative option for treatment of AAA in patients with transplanted kidneys.


Subject(s)
Humans , Male , Middle Aged , Vascular Surgical Procedures/methods , Kidney Transplantation/adverse effects , Aortic Aneurysm, Abdominal/surgery , Renal Circulation , Anastomosis, Surgical , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnosis , Iliac Artery
11.
J. vasc. bras ; 20: e20200122, 2021. graf
Article in English | LILACS | ID: biblio-1250240

ABSTRACT

Abstract External iliac artery endofibrosis is a rare pathology that affects high-level endurance athletes, especially cyclists. Classical symptoms include pain, loss of power, and/or cramp in the affected limb while training at maximal effort. The patient's lack of atherosclerotic risk factors makes clinical suspicion of arteriopathy challenging. Moreover, the best management of such patients is still a subject of discussion. We report the case of a 36-year-old professional female endurance cyclist who presented with lower extremity pain during training. Right external iliac artery endofibrosis was diagnosed and the patient underwent surgical treatment. At two-months follow-up, she reported significant improvement in symptoms. This case highlights the importance of diagnosing peripheral vascular disease in young patients and athletes, who do not fit the ordinary profile of patients with atherosclerotic risk factors.


Resumo A endofibrose da artéria ilíaca externa é uma doença rara que afeta atletas de resistência (endurance) de nível competitivo, principalmente ciclistas. Os sintomas clássicos incluem dor, perda de força e/ou câimbras no membro afetado ao fazer esforço máximo durante o treino. A ausência de fatores de risco ateroscleróticos nesses pacientes torna a suspeita clínica de arteriopatia desafiadora. Além disso, o melhor manejo ainda é motivo de debate. Relatamos o caso de uma ciclista de resistência profissional, de 36 anos, que apresentou dor nos membros inferiores durante o treino. Foi diagnosticada endofibrose da artéria ilíaca externa, e a paciente foi submetida a tratamento cirúrgico. Após seguimento por dois meses, a paciente relatou melhora significativa dos sintomas. Este caso destaca a importância do diagnóstico de doença vascular periférica em pacientes jovens e atletas, os quais não se encaixam no perfil comum do paciente com fatores de risco ateroscleróticos.


Subject(s)
Humans , Female , Adult , Bicycling/physiology , Fibrosis/diagnosis , Iliac Artery , Physical Endurance , Fibrosis/surgery , Endovascular Procedures , Cyclist
12.
Clinics ; 76: e2455, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153982

ABSTRACT

OBJECTIVES: This study aimed to determine the prevalence of signs of impending rupture (SIR) in asymptomatic patients with abdominal aortic and iliac artery aneurysms, and to evaluate whether these signs were associated with rupture in asymptomatic patients. METHODS: This was a retrospective study of patients with abdominal aortic and iliac artery aneurysms identified on computed tomography (CT) over a 10-year period in a single center. The CT scans were reviewed by two reviewers, and patients with SIR were assigned to one of three groups: (1) early symptomatic (ES), (2) late symptomatic (LS), and (3) always asymptomatic (AA). The four main SIR described in the literature were investigated: 1) crescent sign, 2) focal wall discontinuity of circumferential calcifications, 3) aortic bulges or blebs, and 4) aortic draping. RESULTS: From a total of 759 aortic and iliac aneurysm reports on 2226 CT scans, we identified 41 patients with at least one SIR, and a prevalence of 4.14% in asymptomatic patients. Focal wall discontinuity of circumferential calcifications was the most common sign, and it was present in 46.3% of these patients (19/41); among these, 26 were repaired (ES: 9, LS: 2, AA: 15). Eleven asymptomatic patients underwent follow-up CT. The aneurysm increased in size in 6 of the 11 (54.5%) patients, and three ruptured (all with discontinuity of calcifications), one of which had no increase in diameter. CONCLUSIONS: The presence of focal wall discontinuity of circumferential calcifications was the most common SIR. There was a prevalence of all signs in less than 5% of asymptomatic patients. In unrepaired patients, the signs could be observed on follow-up CT scans with an increase in aneurysm size, indicating that the presence of SIR alone in the absence of other clinical factors or aneurysm characteristics is an insufficient indication for surgery.


Subject(s)
Humans , Iliac Aneurysm/epidemiology , Iliac Aneurysm/diagnostic imaging , Aortic Aneurysm, Abdominal/epidemiology , Aortic Aneurysm, Abdominal/diagnostic imaging , Tomography, X-Ray Computed , Retrospective Studies , Iliac Artery/diagnostic imaging
13.
J. vasc. bras ; 20: e20210014, 2021. tab, graf
Article in English | LILACS | ID: biblio-1279391

ABSTRACT

Abstract Background Aneurysms and atheromatous processes are prominent pathological features that are commonly associated with significant morbidity and mortality. Objectives This cadaveric study was conducted to evaluate the morphometric and histological aspects of atheromatous plaque formation in abdominal aortas and their branches and their associated morphological variations, if present, characterized by loops, kinking, or tortuosity. Methods The study was performed using 30 human cadavers (approx. 65-75 years). Frequency of occurrence of calcified plaques in the abdominal aorta and its branches and their morphometric measurements were noted and histological features were observed with the aid of Hematoxylin & Eosin staining. Results Variations in the abdominal aorta and the common iliac artery were observed in 16.6% of specimens. Atheromatous plaque formation was seen in 2 specimens (1 specimen was associated with kinking) while in 3 other specimens only variation in normal structure (kinking/ tortuous artery) was observed. Histological analysis showed foamy macrophages and dense calcification, giving an atheromatous appearance. Conclusions Cadaveric reports of the location, nature, and degree of plaque formation in the abdominal aorta and its branches are extremely important in clinical settings and for choosing treatment options.


Resumo Contexto Aneurismas e processos ateromatosos são características patológicas perceptíveis que costumam estar associadas a morbidade e mortalidade significativas. Objetivos Este estudo em cadáveres teve como objetivo avaliar os aspectos morfométricos e histológicos da formação de placa ateromatosa na aorta abdominal e em seus ramos com suas subsequentes variações morfológicas caracterizadas por enrolamentos, acotovelamentos ou tortuosidades, se presentes. Métodos O estudo foi realizado com 30 cadáveres humanos (aproximadamente 65-75 anos). Foi descrita a frequência de ocorrência de placas calcificadas na aorta abdominal e em seus ramos com as respectivas medidas morfométricas e características histológicas com auxílio da coloração por hematoxilina e eosina. Resultados Variações na aorta abdominal e na artéria ilíaca comum foram observadas em 16,6% dos espécimes. A formação de placa ateromatosa foi observada em dois espécimes (um espécime foi associado a acotovelamento), enquanto em outros três espécimes houve apenas variação na estrutura normal (acotovelamento/artéria tortuosa). A análise histológica mostrou macrófagos espumosos e calcificação densa, o que gerou uma impressão ateromatosa. Conclusões Os estudos em cadáveres sobre localização, natureza e grau de formação de placa na aorta abdominal e em seus ramos são extremamente importantes para os cenários clínicos e as opções de tratamento.


Subject(s)
Humans , Male , Aged , Aorta, Abdominal/anatomy & histology , Plaque, Atherosclerotic/epidemiology , Aorta, Abdominal/pathology , Prevalence , Plaque, Atherosclerotic/pathology , Iliac Artery/anatomy & histology , Iliac Artery/pathology
14.
J. vasc. bras ; 20: e20200188, 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1279384

ABSTRACT

Resumo Contexto A ultrassonografia vascular é o exame de imagem de escolha para rastreamento inicial da compressão na veia ilíaca comum esquerda, cujo achado assintomático pode ser encontrado em até 25% em algumas casuísticas. Objetivo Identificar, pela ultrassonografia vascular, se há diferença na avaliação da compressão na veia ilíaca comum esquerda em mulheres assintomáticas em decúbito dorsal e ao ortostatismo. Métodos Trata-se de um estudo observacional transversal em 50 mulheres voluntárias, sem sintomas de compressão venosa pélvica. Os parâmetros avaliados pela ultrassonografia vascular em decúbito dorsal e ao ortostatismo foram os diâmetros e as velocidades máximas na veia ilíaca comum esquerda no local do cruzamento com a artéria ilíaca comum direita e antes desse cruzamento, além dos índices de velocidade na veia ilíaca comum esquerda no local do cruzamento. Resultados Foram identificados oito casos de compressão significativa na veia ilíaca comum esquerda na avaliação em decúbito dorsal (16%) e somente dois casos (4%) ao ortostatismo. Os diâmetros na veia ilíaca comum esquerda foram estatisticamente maiores (p = 0,002) no local de cruzamento com a artéria ilíaca comum direita ao ortostatismo, e as velocidades e índices de velocidades foram estatisticamente maiores (p < 0,001) em decúbito dorsal. Não houve identificação de compressão significativa na veia ilíaca comum esquerda em ortostatismo quando os índices de velocidades estavam normais em decúbito dorsal. Conclusão Não houve diferença na detecção de compressão significativa da veia ilíaca comum esquerda ao ortostatismo em relação ao decúbito dorsal; no entanto, o estudo mostrou que pode haver menor compressão anatômica da veia ilíaca comum esquerda em posição ortostática.


Abstract Background Vascular ultrasonography is the imaging exam of choice for initial screening for left common iliac vein compression, which is an asymptomatic finding that can be detected in up to 25% of some patient samples. Objective To determine, using vascular ultrasonography, whether findings of left common iliac vein compression in asymptomatic women are different when assessed in the prone and standing positions. Methods This is a cross-sectional observational study of 50 adult female volunteers with no symptoms of pelvic venous compression. The parameters assessed with vascular ultrasonography in the prone and standing positions were diameters and maximum velocities of the left common iliac vein at the point at which it crosses behind the right common iliac artery and before this point, in addition to left common iliac vein velocity indices at the crossing. Results Eight cases of significant compression of the left common iliac vein were identified when assessed in prone position (16%) and just two cases (4%) were identified in the standing position. Left common iliac vein diameters were statistically larger (p = 0.002) at the point where it crosses behind the right common iliac artery in the standing position and velocities and velocity indices were statistically higher (p < 0.001) in the prone position. No significant compression of the left common iliac vein was identified in the standing position when velocity indices were normal in the prone position. Conclusions There was no difference in detection of significant compression of the left common iliac vein when assessed in the standing position in comparison with assessment in the prone position. However, the study showed that anatomic compression of the left common iliac vein may be reduced in the standing position.


Subject(s)
Humans , Female , Adolescent , Adult , Young Adult , Ultrasonography , Supine Position , Standing Position , Iliac Artery/diagnostic imaging , Iliac Vein/diagnostic imaging , Echocardiography, Doppler , Carrier State , Cross-Sectional Studies , Iliac Artery/anatomy & histology , Iliac Vein/anatomy & histology
15.
J. vasc. bras ; 20: e20200195, 2021. graf
Article in Portuguese | LILACS | ID: biblio-1279381

ABSTRACT

Resumo A incidência de aneurismas ilíacos em crianças não é conhecida, havendo apenas alguns relatos de casos na literatura sobre o tema. Neste estudo, é relatado o caso de um paciente masculino, 3 anos, com aneurisma sacular isolado na bifurcação da artéria ilíaca comum direita de origem idiopática, que foi submetido a ressecção, ligadura da artéria ilíaca interna e anastomose vascular término-terminal. Após 1 mês de seguimento, foi diagnosticada oclusão assintomática da anastomose. Devido à presença de circulação colateral, não houve repercussões clínicas da oclusão, e a criança apresentou evolução clínica favorável a médio prazo.


Abstract The incidence of iliac aneurysms in children is unknown and there are only a small number of case reports in the literature on the subject. This article describes the case of a 3-year-old male patient with an isolated saccular aneurysm at the bifurcation of the right common iliac artery, of idiopathic origin, which was repaired by resection, ligature of the internal iliac artery and end-to-end vascular anastomosis. After 1 month of follow-up, he was diagnosed with asymptomatic occlusion of the anastomosis. The occlusion had no clinical repercussions because of collateral circulation and the child has had a favorable clinical course over the medium term.


Subject(s)
Humans , Male , Child, Preschool , Iliac Aneurysm/congenital , Iliac Artery/abnormalities , Anastomosis, Surgical , Iliac Aneurysm/surgery , Iliac Aneurysm/diagnosis , Collateral Circulation
17.
Rev. cuba. angiol. cir. vasc ; 21(3): e84, sept.-dic. 2020. tab, fig
Article in Spanish | LILACS, CUMED | ID: biblio-1156383

ABSTRACT

La enfermedad aorto-ilíaca es una entidad que, por su localización y distribución, plantea un reto para el radiólogo intervencionista. Existen diferentes técnicas endovasculares que ofrecen una buena permeabilidad a mediano y largo plazos, a partir de una selección apropiada de los pacientes. Este artículo tuvo como objetivo caracterizar la técnica de kissing stent como una alternativa terapéutica más, mínimamente invasiva, en los pacientes con enfermedad aorto-ilíaca. En este sentido, se presenta el caso de una mujer de 60 años con claudicación intermitente de 3 meses de evolución, con cambios tróficos de la piel a predominio derecho, en quien se documentó una estenosis aorto-ilíaca bilateral según el Trans-Atlantic Inter-Society Consensus Working Group II tipo A. Se realizó angioplastia con balón y stent autoexpandibles de ambas ilíacas comunes mediante la técnica de kissing stent. En el seguimiento anual, la paciente toleró el ejercicio, y al examen físico, los pulsos periféricos estuvieron presentes. Además, el manejo endovascular de las lesiones estenótica aorto-ilíacas mediante la técnica de kissing stent resulta segura, menos cruenta y con buenos resultados a mediano plazo, que se debe sustentar en una selección apropiada de los pacientes(AU)


Aortoiliac disease is an entity that, due to its location and distribution, poses a challenge for the interventional radiologist. There are different endovascular techniques offering good permeability in the mid- and long terms, based on appropriate selection of patients. This article aimed at characterizing the kissing stent technique as another minimally-invasive therapeutic alternative in patients with aortoiliac disease. In this respect, the case is presented of a 60-year-old woman with intermittent claudication of three months of evolution, with trophic changes of the skin, predominantly on the right side, and in whom a bilateral aortoiliac disease was documented as type A according to the Trans-Atlantic Inter-Society Consensus Working Group II. Balloon angioplasty and self-expanding stenting of both common iliac arteries were performed using the kissing stent technique. At annual follow-up, the patient tolerated exercise; and, on physical examination, peripheral pulses were present. In addition, endovascular management of aortoiliac disease stenotic lesions using the kissing stent technique is safe, less invasive and present good outcomes in the midterm, which must be based on appropriate selection of patients(AU)


Subject(s)
Humans , Male , Female , Constriction, Pathologic , Endovascular Procedures , Radiologists , Iliac Artery , Exercise
18.
MedUNAB ; 23(2): 301-306, 22-07-2020.
Article in Spanish | LILACS | ID: biblio-1118424

ABSTRACT

Introducción. El síndrome de Leriche fue definido en 1940 por René Leriche como una enfermedad oclusiva aorto-ilíaca. Su importancia radica en que ocupa el segundo lugar en incidencia dentro de las enfermedades oclusivas arteriales, después de la enfermedad de la arteria femoral superficial. Objetivo. Presentar el caso clínico de un paciente con Síndrome de Leriche cuyo diagnóstico trombótico fue confirmado por una angiotomografía computarizada con su respectiva reestructuración en 3D. Adicionalmente, se informa al lector sobre los datos propios de la patología a través de una breve revisión de la literatura. Caso clínico. Paciente masculino con síntomas clínicos agudos de enfermedad oclusiva aorto-ilíaca o síndrome de Leriche en una extremidad. Se realiza el respectivo procesamiento de imagen asistida por computador (reconstrucción tridimensional) que evidencia la patología a pesar de que la ecografía Doppler no determinó trombosis inicial. Discusión. En procesos oclusivos arteriales se emplean técnicas no invasivas como la ecografía y la angiotomografía. Sin embargo, esta última es la técnica por excelencia, sobre todo para procesos trombóticos, pues agiliza la anticoagulación, así como el abordaje terapéutico. Conclusiones. La angiotomografía es una técnica no invasiva con alta sensibilidad y especificidad para detectar estenosis aorto-ilíaca. Se ha convertido en una gran herramienta diagnostica por sus alcances imagenológicos, como la obtención de imágenes iso volumétricas, que permiten evaluar todo el trayecto arterial en los diferentes planos, por medio del uso de medios de contraste, superando en resultados a la ecografía. Cómo citar: Picón-Jaimes YA, Díaz-Jurado JJ, Orozco-Chinome JE, Ramírez-Rodríguez PA, Arciniegas-Torres NA, Hernández-Sarmiento MA, Villabona-Rosales SA. Angiotomografía en sospecha de enfermedad oclusiva aorto-ilíaca (o síndrome de Leriche). MedUNAB. 2020;23(2): 301-306. doi: 10.29375/01237047.3732.


Introduction. Leriche syndrome was defined in 1940 by René Leriche as an aortoiliac occlusive disease. Its importance lies in it occupying second place in the incidence of occlusive arterial diseases, after superficial femoral artery disease. Objective. Present the clinical case of a patient with Leriche syndrome whose diagnosis of thrombosis was confirmed by a computed tomography angiography with its respective 3D reconstruction. Additionally, the reader is given information about the pathology through a brief summary of the literature. Clinical case. Male patient with acute clinical symptoms of aortoiliac occlusive disease or Leriche syndrome in one limb. The respective computer-assisted image processing (three-dimensional reconstruction) is carried out, which shows the pathology, despite the Doppler ultrasound not initially establishing thrombosis. Discussion. Non-invasive techniques are used in procedures for occlusive arteries, such as ultrasound and CT angiography. However, the latter is a technique par excellence, above all for thrombosis procedures, as well as the therapeutic approach. Conclusions. CT angiography is a non-invasive technique with high sensitivity and specificity in the detection of aortoiliac stenosis. It has become a great diagnostic tool because of its imagery scope, such as obtaining isovolumic images, which enable the assessment of the entire arterial route in different planes, through the use of contrast media, producing more results than the ultrasound. Cómo citar: Picón-Jaimes YA, Díaz-Jurado JJ, Orozco-Chinome JE, Ramírez-Rodríguez PA, Arciniegas-Torres NA, Hernández-Sarmiento MA, Villabona-Rosales SA. Angiotomografía en sospecha de enfermedad oclusiva aorto-ilíaca (o síndrome de Leriche). MedUNAB. 2020;23(2): 301-306. doi: 10.29375/01237047.3732.


Introdução. A síndrome de Leriche foi definida em 1940 por René Leriche como uma doença oclusiva aorto-ilíaca. Sua importância reside no fato de ocupar o segundo lugar em incidência dentro das doenças arteriais obstrutivas, após a doença na artéria femoral superficial. Objetivo. Apresentar o caso clínico de um paciente com síndrome de Leriche cujo diagnóstico trombótico foi confirmado por uma angiotomografia computadorizada (angio-TC) com reestruturação em 3D. Adicionalmente, o leitor é informado sobre os dados próprios da patologia através de uma breve revisão de literatura. Caso clínico. Paciente de sexo masculino com sintomas clínicos agudos da doença oclusiva aorto-ilíaca ou síndrome de Leriche em uma extremidade. Foi realizado o processamento da imagem assistida por computador (reconstrução tridimensional), evidenciando a patologia, ainda que a ultrassonografia Doppler não determinou trombose inicial. Discussão. Em processos oclusivos arteriais são utilizadas técnicas não invasivas como a ultrassonografia e a angiotomografia. No entanto, a angiotomografia é a técnica padrão ouro, principalmente para processos trombóticos, pois acelera a anticoagulação e a abordagem terapêutica. Conclusão. A angiotomografia é uma técnica não invasiva com alta sensibilidade e especificidade para detectar estenose aorto-ilíaca. Tornou-se uma ótima ferramenta de diagnóstico por suas características imagenológicas, como a obtenção de imagens isovolumétricas que permitem avaliar todo o trajeto arterial nos diferentes planos, através do uso de meios de contraste, superando os resultados da ultrassonografia. Cómo citar: Picón-Jaimes YA, Díaz-Jurado JJ, Orozco-Chinome JE, Ramírez-Rodríguez PA, Arciniegas-Torres NA, Hernández-Sarmiento MA, Villabona-Rosales SA. Angiotomografía en sospecha de enfermedad oclusiva aorto-ilíaca (o síndrome de Leriche). MedUNAB. 2020;23(2): 301-306. doi: 10.29375/01237047.3732.


Subject(s)
Leriche Syndrome , Aorta, Abdominal , Aortic Diseases , Iliac Artery , Intermittent Claudication
19.
Endocrinology and Metabolism ; : 122-131, 2020.
Article in English | WPRIM | ID: wpr-816621

ABSTRACT

BACKGROUND: We investigated associations between perirenal fat thickness and atherosclerotic calcification in six different vascular beds.METHODS: Using a community-based cohort (n=3,919), perirenal fat thickness was estimated from computed tomography scans. It was classified as Q1 (the lowest quartile) to Q4 (the highest quartile) in each sex. Calcification in the carotid arteries, coronary arteries, thoracic aorta, abdominal aorta, iliac arteries, and renal arteries was evaluated.RESULTS: Perirenal fat thickness was associated with older age (P<0.01) and a higher prevalence of obesity, hypertension, and dyslipidemia (P<0.01 for all). Perirenal fat thickness was independently associated with renal arterial calcification even after adjustment for age, sex, body mass index, hypertension, dyslipidemia, smoking history, and family history of heart diseases in first-degree relatives (odds ratio [OR] per quartile of perirenal fat thickness, 1.25; 95% confidence interval [CI], 1.09 to 1.44). Compared to Q1, the odds of renal arterial calcification in Q4 was about two times higher (OR, 2.05; 95% CI, 1.29 to 3.25). After adjustment for renal arterial calcification and atherosclerotic risk factors, the only other vascular bed where perirenal fat thickness showed a significant association with calcification was the abdominal aorta (OR, 1.11; 95% CI, 1.00 to 1.23; P=0.045).CONCLUSION: Perirenal fat thickness was independently associated with vascular calcification in the renal artery and abdominal aorta.


Subject(s)
Humans , Aorta, Abdominal , Aorta, Thoracic , Atherosclerosis , Body Mass Index , Carotid Arteries , Cohort Studies , Coronary Vessels , Dyslipidemias , Heart Diseases , Hypertension , Iliac Artery , Obesity , Prevalence , Renal Artery , Risk Factors , Smoke , Smoking , Vascular Calcification
20.
Chinese Medical Journal ; (24): 913-919, 2020.
Article in English | WPRIM | ID: wpr-877989

ABSTRACT

BACKGROUND@#Although endovascular therapy has been widely used for focal aortoiliac occlusive disease (AIOD), its performance for extensive AIOD (EAIOD) is not fully evaluated. We aimed to demonstrate the long-term results of EAIOD treated by endovascular therapy and to identify the potential risk factors for the loss of primary patency.@*METHODS@#Between January 2008 and June 2018, patients with a clinical diagnosis of the 2007 TransAtlantic Inter-Society Consensus II (TASC II) C and D AIOD lesions who underwent endovascular treatment in our institution were enrolled. Demographic, diagnosis, procedure characteristics, and follow-up information were reviewed. Univariate analysis was used to identify the correlation between the variables and the primary patency. A multivariate logistic regression model was used to identify the independent risk factors associated with primary patency. Five- and 10-year primary and secondary patency, as well as survival rates, were calculated by Kaplan-Meier analysis.@*RESULTS@#A total of 148 patients underwent endovascular treatment in our center. Of these, 39.2% were classified as having TASC II C lesions and 60.8% as having TASC II D lesions. The technical success rate was 88.5%. The mean follow-up time was 79.2 ± 29.2 months. Primary and secondary patency was 82.1% and 89.4% at 5 years, and 74.8% and 83.1% at 10 years, respectively. The 5-year survival rate was 84.2%. Compared with patients without loss of primary patency, patients with this condition showed significant differences in age, TASC II classification, infrainguinal lesions, critical limb ischemia (CLI), and smoking. Multivariate logistic regression analysis showed age <61 years (adjusted odds ratio [aOR]: 6.47; 95% CI: 1.47-28.36; P = 0.01), CLI (aOR: 7.81; 95% CI: 1.92-31.89; P = 0.04), and smoking (aOR: 10.15; 95% CI: 2.79-36.90; P < 0.01) were independent risk factors for the loss of primary patency.@*CONCLUSION@#Endovascular therapy was an effective treatment for EAIOD with encouraging patency and survival rate. Age <61 years, CLI, and smoking were independent risk factors for the loss of primary patency.


Subject(s)
Female , Humans , Male , Middle Aged , Arterial Occlusive Diseases/surgery , Endovascular Procedures/methods , Iliac Artery/surgery , Kaplan-Meier Estimate , Retrospective Studies , Risk Factors , Stents , Survival Rate , Treatment Outcome , Vascular Patency
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