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1.
Medicentro (Villa Clara) ; 27(3)sept. 2023.
Article in Spanish | LILACS | ID: biblio-1514500

ABSTRACT

Los aneurismas asociados a las malformaciones arteriovenosas son lesiones vasculares que suelen encontrarse hasta en el 15 % de los pacientes que las presentan, lo que incrementa el riesgo global de hemorragia. Se presenta una paciente de 53 años de edad que sufrió un cuadro agudo de hemorragia subaracnoidea; en el estudio se evidenció la presencia de un aneurisma de comunicante anterior y malformación arteriovenosa distal de la arteria cerebral anterior izquierda, el cual requirió procedimiento quirúrgico debido al sangramiento. La evolución de la paciente fue satisfactoria y sin complicaciones.


Aneurysms associated with arteriovenous malformations are vascular lesions that are usually found in up to 15% of the patients who present them, which increases the overall risk of bleeding. We present a 53-year-old female patient who suffered from an acute subarachnoid hemorrhage; the study revealed the presence of an anterior communicating aneurysm and a distal arteriovenous malformation of the left anterior cerebral artery, which required surgical procedure due to bleeding. The evolution of the patient was satisfactory and without complications.


Subject(s)
Subarachnoid Hemorrhage , Intracranial Aneurysm , Vascular System Injuries
2.
Medicentro (Villa Clara) ; 26(4): 818-834, oct.-dic. 2022. tab, graf
Article in Spanish | LILACS | ID: biblio-1405676

ABSTRACT

RESUMEN Introducción: Los modelos experimentales en animales proporcionan una valiosa información para comprender los procesos fisiopatológicos de las lesiones de los vasos sanguíneos y sus consecuencias. Objetivo: Analizar los cambios histológicos y morfométricos que se observaron en la aorta abdominal de las ratas Wistar sometidas a una dieta hiperglucídica. Métodos: Se formaron aleatoriamente dos grupos experimentales de 10 animales cada uno. El grupo control alimentado con dieta estándar para la especie, y el grupo experimental alimentado con dieta estándar más sacarosa al 35 %, como agua de bebida desde el destete hasta las 20 semanas de vida. El estudio se realizó en muestras de aorta fijadas y procesadas por la técnica clásica de inclusión en parafina y coloreadas con las técnicas de hematoxilina - eosina y Verhoeff. Se realizó la descripción de las capas de la pared arterial y la determinación de variables morfométricas en cada lámina histológica. Resultados: Las ratas Wistar pertenecientes al grupo experimental desarrollaron modificaciones incipientes en la pared arterial de la aorta abdominal, las cuales corresponden con la presencia de tumefacción en la célula endotelial y vacuolización en la célula muscular lisa vascular, así como marcada desorganización de las fibras elásticas y musculares de la capa media. Las variables morfométricas que mostraron diferencias significativas entre los grupos fueron el grosor de la túnica media y el cociente media/ lumen. Conclusiones: La pared media resultó ser la capa más afectada demostrándose el efecto nocivo de la dieta hiperglucídica en la pared arterial.


ABSTRACT Introduction: experimental animal models provide valuable information to understand the physiological and pathological processes of blood vessel injuries and their consequences. Objective: to analyze the histological and morphometric changes observed in the abdominal aorta of Wistar rats subjected to a hyperglycemic diet. Methods: two experimental groups of 10 animals each were randomly formed. The control group was fed with a standard diet for this species, and the experimental group was fed with a standard diet plus 35% sucrose, as drinking water from weaning to 20 weeks of life. The study was performed on aortic samples fixed and processed by the classic paraffin embedding technique and stained with the hematoxylin-eosin and Verhoeff techniques. The description of the layers of the arterial wall and the determination of morphometric variables in each histological slide were made. Results: the Wistar rats belonging to the experimental group developed incipient changes in the arterial wall of the abdominal aorta, which correspond to the presence of endothelial cell swelling and vacuolation in the vascular smooth muscle cell, as well as marked disorganization of the muscle and elastic fibers of the middle layer. The morphometric variables that showed significant differences between the groups were the thickness of the tunica media and the media/lumen ratio. Conclusions: the middle wall turned out to be the most affected layer, demonstrating the harmful effect of the hyperglycemic diet on the arterial wall.


Subject(s)
Cardiovascular Diseases , Rats, Wistar , Diet, Carbohydrate-Restricted , Vascular System Injuries
3.
Rev. cir. (Impr.) ; 74(4): 354-367, ago. 2022. tab, ilus
Article in Spanish | LILACS | ID: biblio-1407937

ABSTRACT

Resumen Introducción: Las lesiones de grandes vasos del tórax por traumatismo torácico (TTLGV) son un grupo heterogéneo de lesiones con alta morbimortalidad que constituyen un 0,3-10% de los hallazgos en el traumatismo torácico (TT). Objetivos: Describir características, tratamientos y variables asociadas a mortalidad en pacientes hospitalizados con TTLGV. Material y Métodos: Estudio analítico-observacional. Período enero-1981 y diciembre-2020. Revisión de protocolos de TT prospectivos y fichas clínicas. Se clasificaron los TTLGV según American Association for the Surgery of Trauma (AAST), se calcularon índices de gravedad del traumatismo: Injury Severity Score (ISS), Revised Trauma Score Triage (RTS-T) y Trauma Injury Severity Score (TRISS). Se realizó análisis univariado y multivariado con cálculo de Odds Ratio (OR) para variables asociadas a mortalidad. Se usó SPSS25®, con pruebas UMann Whitney y chi-cuadrado, según corresponda. Resultados: de un total 4.577 TT, 97 (2,1%) cumplieron criterios de inclusión. Hombres: 81 (91,8%), edad promedio: 32,3 ± 14,8 años. TT penetrante: 65 (67,0%). Lesión de arterias axilo-subclavias en 39 (40,2%) y aorta torácica en 31 (32,0%) fueron las más frecuentes. Fueron AAST 5-6: 39 (40,2%). Tratamiento invasivo: 87 (89,7%), de éstos, en 20 (20,6%) reparación endovascular, 14 (14,4%) de aorta torácica. Cirugía abierta en 67 (69,1%). Mortalidad en 13 (13,4%), fueron variables independientes asociadas a mortalidad el shock al ingreso (OR 6,34) e ISS > 25 (OR 6,03). Conclusión: En nuestra serie, los TTLGV fueron más frecuentemente de vasos axilo-subclavios y aorta torácica. El tratamiento fue principalmente invasivo, siendo la cirugía abierta el más frecuente. Se identificaron variables asociadas a mortalidad.


Background: Thoracic great vessel injuries in thoracic trauma (TTGVI) are a heterogeneous group of injuries with high morbimortality that constituting 0.3-10% of the findings in thoracic trauma (TT). Aim: To describe characteristics, treatments and variables associated with mortality in hospitalized patients with TTGVI. Methods: Observational-analytical study. Period January-1981 and December-2020. Review of prospective TT protocols and clinical records. TTGVI were classified according to American Association for the Surgery of Trauma (AAST), trauma severity index were calculated: Injury Severity Score (ISS), Revised Trauma Score Triage (RTS-T) and Trauma Injury Severity Score (TRISS). Univariate and multi- variate analysis was performed with calculation of Odds Ratio (OR) for variables associated with mortality. SPSS25® was used, with U Mann Whitney and chi-squared tests, as appropriate. Results: From a total of 4.577 TT in the period, 97 (2.1%) met the inclusion criteria. Males: 81 (91.8%), mean age: 32.3 ± 14.8 years. Penetrating TT: 65 (67.0%). Axillary-subclavian artery lesions in 39 (40.2%) and thoracic aorta in 31 (32.0%) were more frequent. AAST 5-6: 39 (40.2%). Invasive treatment: 87 (89.7%), of these, in 20 (20.6%) endovascular repair, 14 (14.4%) of thoracic aorta. Open surgery in 67 (69.1%). Mortality in 13 (13.4%), shock on admission was independently associated with mortality (OR 6.34) and ISS > 25 (OR 6.03). Conclusión: In our series, TTGVI were more frequent in axillary-subclavian vessels and thoracic aorta. Treatment was mainly invasive, with open surgery being the most frequent. Variables associated with mortality were identified.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Thoracic Injuries/diagnosis , Thoracic Injuries/therapy , Thoracic Surgery/methods , Veins/injuries , Radiography, Thoracic/methods , Vascular System Injuries , Endovascular Procedures
4.
Rev. cir. traumatol. buco-maxilo-fac ; 22(2): 42-46, abr.-jun. 2022. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1399294

ABSTRACT

Objetivo: apresentar um caso de lesão vascular em paciente idoso tratado pela técnica da escleroterapia. Relato do caso: paciente masculino, 67 anos, vítima de acidente vascular cerebral, buscou atendimento odontológico por apresentar raízes residuais. Durante o exame físico foi identificada lesão exofítica, de coloração violácea, base séssil, com aproximadamente dois centímetros, localizada em comissura labial esquerda. Para confirmar a origem da alteração foi realizada manobra semiotécnica (diascopia) que revelou tratar-se de lesão vascular. Por ser o paciente idoso, hipertenso, com histórico de acidente vascular cerebral, foi feita a opção por tratamento conservador, sendo realizada a escleroterapia com oleato de monoetanolamina 5%, numa única sessão. No retorno de sete dias, foi observada regressão parcial da lesão e com 30 dias a região se mostrou completamente cicatrizada, sem vestígios da alteração. O oleato de monoetanolamina provoca uma reação inflamatória estéril, aguda, dose-dependente, no endotélio vascular e nos tecidos extravasculares que resulta em fibrose e obliteração dos vasos sanguíneos, induzindo a regressão das lesões. Conclusão: Com base no caso apresentado e nos registros da literatura é possível afirmar que a escleroterapia é uma alternativa terapêutica minimamente invasiva, eficaz, de baixo custo e com resultado estético favorável no tratamento de lesões vasculares orais... (AU)


Objective: to present a case of vascular injury in an elderly patient treated by the sclerotherapy technique. Case report: male patient, 67 years old, victim of a stroke, sought dental care due to residual dental roots. During the physical examination, an exophytic lesion, violet in color, sessile base, approximately two centimeters, located in the left labial commissure, was identified. Diascopy was performed to confirm the origin of the alteration, which revealed that it was a vascular le sion. As the patient was elderly, hypertensive, with a history of stroke, conservative treatment was chosen, with sclerotherapy with 5% mon oethanolamine oleate in a single session. On return after seven days, partial regression of the lesion was observed and, after 30 days, the region was completely healed, with no traces of the alteration. Mon oethanolamine oleate causes a sterile, acute, dose-dependent inflam matory reaction in the vascular endothelium and extravascular tissues that results in fibrosis and obliteration of blood vessels, inducing re gression of the lesions. Conclusion: Based on the case presented and on the literature records, it is possible to affirm that sclerotherapy is a minimally invasive, effective, low-cost therapeutic alternative with a favorable aesthetic result in the treatment of oral vascular lesions... (AU)


Objetivo: presentar un caso de lesión vascular en un paciente de edad avanzada, tratado mediante la técnica de escleroterapia. Reporte de caso: paciente masculino, 67 años, víctima de un derrame cerebral, buscó atención odontológica por raíces dentarias residuales. Durante el examen físico se identificó una lesión exofítica, de color violeta, de base sésil, de aproximadamente dos centímetros, ubicada en la comisura labial izquierda. Se realizó diascopia para confirmar el origen de la alteración, que reveló que se trataba de una lesión vascular. Como el paciente era anciano, hipertenso, con antecedentes de ictus, se optó por tratamiento conservador, con escleroterapia con oleato de monoetanolamina al 5% en una sola sesión. Al regreso a los siete días se observó una regresión parcial de la lesión y, a los 30 días, la región estaba completamente curada, sin rastros de la alteración. El oleato de monoetanolamina provoca una reacción inflamatoria estéril, aguda y dependiente de la dosis en el endotelio vascular y los tejidos extravasculares que produce fibrosis y obliteración de los vasos sanguíneos, lo que induce la regresión de las lesiones. Conclusión: Con base en el caso presentado y en los registros de la literatura, es posible afirmar que la escleroterapia es una alternativa terapéutica mínimamente invasiva, efectiva, de bajo costo y con resultado estético favorable en el tratamiento de las lesiones vasculares orales... (AU)


Subject(s)
Humans , Male , Aged , Sclerotherapy , Dental Care , Vascular Malformations , Hemangioma , Mouth/pathology , Blood Vessels , Vascular System Injuries , Conservative Treatment
5.
Chinese Journal of Surgery ; (12): 63-68, 2022.
Article in Chinese | WPRIM | ID: wpr-935581

ABSTRACT

Objective: To analyze the treatment and clinical prognosis of lower extremity arterial injury caused by trauma. Methods: The clinical data of 77 patients with traumatic lower extremity arterial injury admitted to Department of Vascular Surgery,Yichang Central People's Hospital from January 2013 to June 2021 were collected retrospectively. There were 65 males and 12 females, with an average age of 47.4 years (range: 7 to 75 years). Among the 77 patients, 56 cases (72.7%) had open injury and 21 cases (27.3%) had closed injury. Iliac artery was injured in 9 cases (11.7%), common femoral artery in 7 cases (9.1%), superficial femoral artery in 1 case (1.3%), popliteal artery in 11 cases (14.3%) and inferior knee artery in 49 cases (63.6%). The treatment methods and clinical effects were analyzed. Results: One case with pelvic fracture combined the internal iliac artery injury and 1 case with multiple injuries involving the common femoral artery died of circulatory failure before surgery. Seventy-five cases received vascular-related operations, including arterial ligation in 24 cases, arterial reconstruction in 40 cases, stent graft implantation in 1 case, primary amputation in 2 cases, and arterial embolization in 8 cases. The overall mortality rate was 6.5% (5/77), all of which were closed injuries. Except for 2 cases who died before surgery, 3 cases with pelvic fracture combined the internal iliac artery injury died of multiple organ failure after internal iliac artery embolization. There were 8 cases received amputation (10.4%, 8/77), 5 cases with closed injury and 3 cases with open injury. In addition to 2 cases with primary amputation, 6 cases underwent secondary amputation due to ischemia-reperfusion injury after revascularization (4 cases with popliteal artery injury and 2 cases with subpatellar artery injury). The average followed-up time was 17 months (range: 2 months to 8 years). One patient with femoral artery injury underwent autologous great saphenous vein bypass, and lower limb artery CT angiography was re-examined 6 months after the operation, and 30% distal anastomotic stenosis was found. Ankle brachial index<0.8 was found in two patients 1 year after popliteal artery repair, but none of the patients had intermittent claudication symptoms, and no further intervention was performed. Five patients suffered delayed healing due to severe lower limb injury, fracture and skin injury. Among them, 2 cases had poor wound healing at the stump of amputation, which gradually healed 3 to 5 months after several debridements. The other 3 vascular injury combined with tibial fracture patients had delayed tibial healing after surgery, but no symptoms of vascular ischemia occurred. All the other patients recovered well and no other serious complications occurred. Conclusions: The proportion of death and disability in patients with lower limb artery injury caused by trauma is high. Active and orderly surgical repair according to the site and type of injury can reduce the mortality, save the function of the affected limb, and promote the healing of injury.


Subject(s)
Female , Humans , Male , Middle Aged , Amputation, Surgical , Femoral Artery , Lower Extremity , Popliteal Artery/surgery , Retrospective Studies , Treatment Outcome , Vascular System Injuries/surgery
6.
J. vasc. bras ; 21: e20210081, 2022. graf
Article in Portuguese | LILACS | ID: biblio-1360565

ABSTRACT

Resumo O tamanduá-bandeira é um mamífero encontrado na América Central e na América do Sul. Esse animal possui garras que podem chegar a 6,5 cm de comprimento, utilizadas para escavar formigueiros e obter alimento, além de servir para sua defesa. Relatamos o caso de paciente masculino de 52 anos, com histórico de epilepsia, que foi levado desacordado ao pronto-socorro, devido a lesões no seu braço direito causadas por um tamanduá. Frente à suspeita de trauma vascular, o paciente foi submetido a exploração cirúrgica, que evidenciou uma lesão combinada de vasos braquiais, submetida a reparo. Apresentou boa evolução do quadro, recebendo alta hospitalar no segundo dia de pós-operatório e, no seguimento ambulatorial, evoluiu sem sequelas neurológicas ou vasculares.


Abstract The giant anteater is a mammal found in Central and South America. These animals have claws that can reach 6.5 centimeters in length, which they use to dig anthills to obtain food and for defense. We report the case of a 52-year-old male patient with a history of epilepsy who was taken unconscious to the emergency room due to injuries to his right arm caused by an anteater. He underwent surgical exploration to investigate suspected vascular trauma, revealing a combined (arterial and venous) injury of the brachial vessels, which were repaired. He recovered well and was discharged on the second postoperative day. During outpatient follow-up he continued to improve, with no neurological or vascular sequelae.


Subject(s)
Humans , Male , Middle Aged , Brachial Artery/injuries , Ulnar Artery/injuries , Radial Artery/injuries , Vascular System Injuries/surgery , Vermilingua , Embolectomy , Vascular System Injuries/drug therapy , Accidental Injuries , Hoof and Claw
7.
Rev. cir. (Impr.) ; 73(4): 445-453, ago. 2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1388853

ABSTRACT

Resumen Introducción: La reparación convencional de la arteria subclavia es desafiante, con una morbilidad del 24% y mortalidad del 5% al 25%; las técnicas endovasculares permiten la reparación arterial subclavia desde un acceso distal, reduciendo la elevada morbimortalidad asociada. Objetivo: Evaluar los resultados a largo plazo del tratamiento endovascular de las lesiones traumáticas de la arteria subclavia. Materiales y Método: Estudio descriptivo, observacional (revisión de serie de casos unicéntrica) de pacientes sometidos a la reparación endovascular de la arteria subclavia, debido a lesiones traumáticas, utilizando dos técnicas (stent balón expandible y oclusión endovascular con balón) durante un período de 12 años (2007-2019) en el Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Se realizaron 15 procedimientos consecutivos, electivos (86,67%), urgencias (13,33%), sexo masculino (66,67%), femenino (33,33%), edad promedio de 55,8 años (rango 26-69), abordaje utilizado: arteria femoral común (93,33%) y arteria braquial (6,67%), etiología de las lesiones: iatrogenia (66,67%) y trauma (33,33%), reparación mediante stent balón expandible (66,67%), oclusión endovascular con balón (33,33%), tasa de éxito técnico (100%), tasa de permeabilidad primaria a 1, 5, 10 años del 100%, 93,33% y 86,66% respectivamente, seguimiento medio (61,4 meses), estancia hospitalaria promedio (3,3 días), tiempo quirúrgico promedio (75 min), no hubo morbilidad cardiovascular, neurológica central o mortalidad relacionada al procedimiento. Discusión: La técnica endovascular elimina la necesidad de disección quirúrgica, disminuyendo el riesgo de lesión de estructuras adyacentes, especialmente en pacientes politraumatizados. Conclusión: En pacientes adecuadamente seleccionados, la técnica endovascular representa una excelente estrategia terapéutica de reparación de las lesiones subclavias.


Introduction: Conventional subclavian artery repair is challenging, with 24% morbidity and 5% to 25% mortality. Endovascular techniques allow subclavian repair from a distal artery, reducing the associated high morbidity and mortality. Aim: To evaluate the long-term results of endovascular treatment of traumatic lesions of the subclavian artery. Materials and Method: Descriptive, observational study (single-center case series review) of patients undergoing endovascular repair of the subclavian artery due to traumatic injuries, using two techniques (expandable balloon stent and endovascular balloon occlusion), during a period of 12 years (2007-2019), at the Dr. Eduardo Pereira Hospital in Valparaíso, Chile. Results: 15 consecutive procedures were performed, elective (86.67%), emergencies (13.33%), male sex (66.67%), female (33.33%), average age of 55.8 years (range 26-69), approach used: common femoral artery (93.33%) and brachial artery (6.67%), etiology of the lesions: iatrogenesis (66.67%) and trauma (33.33%), repair by expandable balloon stent (66.67%), balloon occlusion (33.33%), technical success rate (100%), primary patency rate at 1, 5, 10 years of 100%, 93.33% and 86.66% respectively, mean follow-up (61.4 months), average hospital stay (3.3 days), average surgical time (75 min), there was no cardiovascular, central neurological morbidity or mortality related to the procedure. Discussion: Endovascular techniques eliminate the need for surgical dissection, reducing the risk of injury to adjacent structures, especially in multiple trauma patients. Conclusion: In properly selected patients, the endovascular technique represents an excellent therapeutic strategy for the repair of subclavian artery lesions.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Subclavian Artery/surgery , Subclavian Artery/injuries , Endovascular Procedures/methods , Retrospective Studies , Treatment Outcome , Vascular System Injuries/surgery , Endovascular Procedures/adverse effects
8.
Rev. med. Risaralda ; 27(1): 92-95, ene.-jun. 2021. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1280498

ABSTRACT

Resumen Las malformaciones venosas son lesiones vasculares benignas infrecuentes que se presentan en el útero. Están conformadas por venas anormales, de diferentes tamaños y proporciones, con configuración espongiforme y disposición al azar. En la literatura, han sido previamente reportados algunos casos, usando el término "hemangioma cavernoso", pero según los cambios recientes en la terminología, aprobados por Sociedad Internacional para el Estudio de las Anormalidades Vasculares (ISSVA), se desaconseja el uso de este término y se sugiere el de "Malformación venosa", si se cumplen los hallazgos histopatológicos al momento de hacer el diagnóstico. Presentamos el caso de una mujer de 44 años, con cuadro de hemorragia vaginal anormal y diagnóstico clínico de miomatosis y mioma abortado por el orificio cervical interno, el estudio histopatológico reveló la presencia de una malformación venosa que comprometía el miometrio y endometrio, con formación subsecuente de un pólipo.


Abstract Venous malformations are benign vascular lesions that rarely appear in the uterus. They are made up of abnormal veins, of different sizes and proportions, with spongiform configuration and random disposition. In the literature, some cases have been previously reported, using the term "cavernous hemangioma", but according to recent changes in terminology, approved by the International Society for the Study of Vascular Abnormalities (ISSVA), the use of this term is discouraged, and the diagnosis of Venous malformation is suggested, if the histopathological findings are met. We present the case of a 44-year-old woman, with abnormal vaginal bleeding and a clinical diagnosis of myomatosis and myoma aborted by the internal cervical orifice, in whom the histopathological study revealed the presence of a venous malformation that compromised the myometrium and endometrium, with subsequent formation of a polyp.


Subject(s)
Humans , Female , Adult , Uterus , Vascular Malformations , Hemangioma, Cavernous , Uterus/pathology , Vascular System Injuries , Hemangioma , Morphogenesis
9.
Rev. cuba. angiol. cir. vasc ; 22(1): e281, ene.-abr. 2021. fig
Article in Spanish | LILACS, CUMED | ID: biblio-1251684

ABSTRACT

Los traumas vasculares periféricos poseen una frecuencia elevada en relación con las lesiones vasculares y conllevan a una incapacidad significativa a pacientes relativamente jóvenes. La identificación oportuna y el manejo inicial adecuado de este tipo de lesión son muy importantes para su posterior evolución. Este artículo tuvo como objetivo exponer la importancia del tratamiento oportuno del trauma vascular en dos pacientes llegados el mismo día al servicio de urgencias del Hospital Militar Central "Dr. Luis Díaz Soto". Se presenta como primer caso a un paciente masculino de 44 años de edad, con antecedentes de salud aparente. Sufrió una herida de aproximadamente 12 cm en el brazo izquierdo, que se acompañó de sangramiento e hipotensión arterial. Se le colocó injerto protésico y se le realizó anastomosis término-terminal en la arteria humeral porque presentaba sección completa de esta; su evolución fue favorable. El segundo caso se trata de un paciente masculino de 60 años de edad, con antecedentes de salud aparente. Sufrió un trauma en el antebrazo izquierdo que le provocó una herida de alrededor de 8 cm, con sangramiento, palidez y frialdad del tercio distal del antebrazo, cianosis reversible de la mano, impotencia funcional, ausencia de pulso radial e hipotensión arterial. Se le realizó anastomosis término-terminal de arteria radial porque presentaba sección completa de esta y su evolución resultó favorable. El tratamiento oportuno y acertado del trauma vascular evitó la pérdida de la vida de los pacientes, disminuyó la presencia de complicaciones, aseguró una evolución rápida y redujo incapacidades en estos(AU)


Peripheral vascular traumas have a high frequency in relation to vascular lesions, and lead to significant disability in relatively young patients. Timely identification and adequate initial management of this type of lesion are very important for its subsequent evolution. This article aimed to show the importance of timely treatment of vascular trauma in two patients who arrived on the same day at the emergency service of Dr. Luis Díaz Soto Central Military Hospital. The first case presented corresponds to a 44-year-old male patient apparently without previous heath conditions. He had a wound of approximately twelve centimeters on the left arm, which was accompanied by bleeding and arterial hypotension. The patient was placed a prosthetic graft and performed an end-to-end anastomosis in the brachial artery because it was completely sectioned. The patient's evolution was favorable. The second case corresponds to a 60-year-old male patient with an apparent health history. He suffered a trauma to his left forearm that caused a wound of about 8 cm, with bleeding, paleness and coldness of the distal third of the forearm, reversible cyanosis of the hand, functional impotence, absence of radial pulse and arterial hypotension. End-to-end anastomosis of the radial artery was performed because the patient presented complete section of the artery and his evolution was favorable. Timely and correct treatment of vascular trauma prevented the loss of life in both patients, reduced the presence of complications, ensured a rapid evolution, and reduced their disabilities(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Pulse , Brachial Artery , Radial Artery , Transplants , Emergencies , Vascular System Injuries
10.
J. vasc. bras ; 20: e20190117, 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1279397

ABSTRACT

Resumo Contexto A veia safena magna é usada como material de remendo em vários tipos de reconstrução arterial, incluindo no trauma e endarterectomias de carótida e femoral. Houve relatos de ruptura do remendo de safena, particularmente de veias colhidas na região do tornozelo. Há uma necessidade de medição objetiva da resistência tecidual da safena magna. Objetivos Mensurar a força tensional suportada pela veia safena magna e analisar a correlação entre resistência e diâmetro da veia. Métodos As veias foram coletadas durante operações de safenectomia por varizes dos membros inferiores. Foram analisados apenas segmentos sem refluxo. Foram analisados 10 membros de oito pacientes, com um total de 20 espécimes. Os espécimes foram submetidos a ensaio de tração em equipamento eletrônico, obtendo-se os valores de tensão máxima do material em quilogramas-força por centímetro quadrado (kgf/cm2; força máxima dividida pela área de secção transversa do segmento submetido à tração). Resultados A tensão máxima suportada pela veia safena do tornozelo variou de 74,02 a 190,10 kgf/cm2, e a tensão máxima da veia safena da crossa variou de 13,53 a 69,45 kgf/cm2 (p < 0,0001). O coeficiente de correlação de Pearson entre o diâmetro da veia distendida e a tensão máxima suportada foram iguais a -0,852 (correlação inversa moderada a forte). Conclusões A resistência tecidual da veia safena magna do tornozelo é maior do que a da crossa em mulheres submetidas a operação de varizes; há correlação negativa entre o diâmetro da veia e sua resistência tecidual nessa mesma população.


Abstract Background The great saphenous vein is used as patch material in several types of arterial reconstruction, including trauma and carotid and femoral endarterectomy. There have been reports of saphenous patch blowout, particularly of patches constructed with veins harvested from the ankle. There is a need for objective measurement of the resistance of saphenous vein tissues. Objectives To measure the tensile strength of the great saphenous vein harvested at the ankle and groin and analyze the correlation between diameter and tissue strength. Methods Venous samples were harvested during elective saphenous stripping in patients with symptomatic varicose veins. Only segments without reflux were included. Ten limbs from eight patients were studied, providing 20 samples in total. Venous segments were opened along their longitudinal axis and fitted to electronic traction assay equipment to obtain values for material maximum tension in kilograms-force per square centimeter (kgf/cm2; the maximum force resisted by the segment, divided by its cross-sectional area). Results The average maximum tension in the ankle saphenous vein group ranged from 74.02 to 190.10 kgf/cm2 and from 13.53 to 69.45 kgf/cm2 in the groin saphenous vein group (p < 0.0001). The Pearson coefficient for the correlation between vein diameter and maximum tension was -0.852 (moderate to strong inverse correlation). Conclusions Ankle saphenous vein tissue from female patients operated for varicose veins has significantly higher resistance than saphenous vein tissue from the groin and there is an inverse relation between vein diameter and resistance of tissue from the same population.


Subject(s)
Humans , Female , Adult , Middle Aged , Saphenous Vein/anatomy & histology , Tensile Strength , Saphenous Vein/injuries , Varicose Veins , Intervention Studies , Vascular System Injuries , Inguinal Canal/anatomy & histology , Ankle/anatomy & histology
11.
J. vasc. bras ; 20: e20200189, 2021. graf
Article in Portuguese | LILACS | ID: biblio-1279392

ABSTRACT

Resumo As alterações vasculares ocorrem frequentemente em região de cabeça e pescoço, sendo o hemangioma a mais comum. Paciente do sexo feminino, 61 anos, queixou-se de dor intensa em palato duro. Notou-se lesão arroxeada, de 1,5 cm, sensível à palpação e com histórico de hemorragia. A paciente era edêntula total, e a prótese total superior comprimia o local da lesão. Foi realizada a vitropressão, confirmando a origem vascular. A hipótese diagnóstica foi de hemangioma. Na primeira sessão, aplicou-se o laser vermelho (660 nm) em quatro pontos ao redor da lesão, sendo 0,5 J em cada ponto afim de se obter analgesia e iniciar o processo de reparo, além do reembasamento da prótese total superior. Na segunda sessão, foi feita aplicação de 2 mL de oleato de monoetanolamina 5%. Após 14 dias, observou-se regressão total da lesão. Os cirurgiões-dentistas devem estar aptos a reconhecer, diagnosticar e tratar as lesões vasculares em cavidade oral.


Abstract Vascular changes frequently involve the head and neck region and hemagioma is the most common. A 61-year-old female patient complained of severe pain in the hard palate. A purple lesion was found, measuring 1.5 cm, sensitive to palpation, and with a history of hemorrhage. The patient was fully edentulous and her upper denture compressed the lesion site. Diascopy confirmed the lesion's vascular origin. A diagnostic hypothesis of hemangioma was raised. In the first session, red laser light (660nm) was applied at 4 points around the lesion, with 0.5 J at each point, in order to obtain analgesia and trigger the repair process. The upper denture was also relined. In the second session, 2 mL of 5% monoethanolamine oleate was applied. After 14 days, total regression of the lesion was observed. Dental surgeons must be able to recognize, diagnose and treat vascular lesions in the oral cavity.


Subject(s)
Humans , Female , Middle Aged , Sclerotherapy/methods , Palate, Hard/injuries , Low-Level Light Therapy , Vascular System Injuries/therapy , Hemangioma/therapy , Mouth, Edentulous , Oral Medicine , Palate, Hard/blood supply , Denture, Complete, Upper , Hemangioma/diagnosis
12.
Chinese Journal of Traumatology ; (6): 401-403, 2021.
Article in English | WPRIM | ID: wpr-922352

ABSTRACT

Shark attacks are rare unique pathological processes. Some of them represent devastating injuries with a high morbidity and significant mortality. Related published articles are limited. The increased human interaction within the environment of sharks is the cause of rising incidence of such attacks. This study reported a case of level 4 shark injuries (shark-induced trauma scale) in a 33-year-old male patient, who presented with an extensive injury of the right lower limb with the characteristic features of shark bite. At admission the patient was in a state of shock with profuse bleeding that was controlled by tourniquet. The patient was resuscitated according to the advanced trauma life support. Clinical examination showed hard signs of vascular injury with absent pedal pulse, associated neurological deficits and severance at the knee joint. Prompt vascular intervention after resuscitation was performed to manage the major vascular injuries, together with proper washout and debridement of all the necrotic tissues under strong antibiotic coverage to prevent infection. After that, the patient underwent sequenced plastic, orthopedic, and neurological interventions. Strict follow-up was conducted, which showed that the patient was saved and achieved a functioning limb. This study aims to highlight the management of level 4 shark injuries, which are considered serious and challenging with a high fatality rate and a great risk of amputation due to the associated major vascular injuries. Immediate well organized management plan is crucial. Prompt resuscitation and surgical intervention by a highly-skilled medical team are required to improve the chance of patient survival and limb salvage.


Subject(s)
Adult , Animals , Humans , Male , Bites and Stings/complications , Limb Salvage , Retrospective Studies , Sharks , Vascular System Injuries/surgery
13.
J. vasc. bras ; 20: e20210016, 2021. graf
Article in Portuguese | LILACS | ID: biblio-1356448

ABSTRACT

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


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


Subject(s)
Humans , Male , Aged , Arteriovenous Fistula/complications , Aneurysm/complications , Prostheses and Implants , Subclavian Artery/injuries , Axillary Artery/injuries , Wounds, Gunshot/complications , Upper Extremity , Vascular System Injuries , Endovascular Procedures
14.
Rev. Col. Bras. Cir ; 48: e20202783, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155358

ABSTRACT

ABSTRACT Introduction: extremity tourniquet (TQ) use has increased in the civilian setting; the beneficial results observed in the military has influenced acceptance by EMS and bystanders. This review aimed to analyze extremity TQ types used in the civilian setting, injury site, indications, and complications. Methods: a systematic review was conducted based on original articles published in PubMed, Embase, and Cochrane following PRISMA guidelines from 2010 to 2019. Data extraction focused on extremity TQ use for hemorrhage control in the civilian setting, demographic data, study type and duration, mechanism of injury, indications for use, injury site, TQ type, TQ time, and complications. Results: of the 1384 articles identified, 14 were selected for review with a total of 3912 civilian victims with extremity hemorrhage and 3522 extremity TQ placements analyzed. The majority of TQs were applied to male (79%) patients, with blunt or penetrating trauma. Among the indications for TQ use were hemorrhagic shock, suspicion of vascular injuries, continued bleeding, and partial or complete traumatic amputations. Upper extremity application was the most common TQ application site (56%), nearly all applied to a single extremity (99%), and only 0,6% required both upper and lower extremity applications. 80% of the applied TQs were commercial devices, and 20% improvised. Conclusions: TQ use in the civilian setting is associated with trauma-related injuries. Most are single-site TQs applied for the most part to male adults with upper extremity injury. Commercial TQs are more commonly employed, time in an urban setting is under 1 hour, with few complications described.


RESUMO Introdução: o uso de torniquete em extremidades (TQ) aumentou no ambiente civil; os resultados benéficos observados nas forças armadas influenciaram a aceitação por equipes de pré-hospitalar (PH) assim como pela população leiga. Esta revisão teve como objetivo analisar os tipos de TQ de extremidades usados em ambiente civil, local da lesão, indicações e complicações. Métodos: revisão sistemática foi conduzida com base em artigos originais publicados no PubMed, Embase e Cochrane seguindo as diretrizes do PRISMA de 2010 a 2019. Extração de dados focada no uso de TQ de extremidade para controle de hemorragia em ambiente civil, dados demográficos, tipo de estudo e duração, mecanismo de lesão, indicações de uso, local da lesão, tipo de TQ, tempo de TQ e complicações. Resultados: dos 1.384 artigos identificados, 14 foram selecionados para revisão com total de 3.912 vítimas civis com hemorragia nas extremidades e 3.522 colocações de extremidades TQ analisadas. A maioria foi aplicado em pacientes do sexo masculino (79%), com trauma contuso ou penetrante. Entre as indicações estavam choque hemorrágico, suspeita de lesões vasculares, sangramento contínuo e amputações traumáticas parciais ou completas. A aplicação na extremidade superior foi o local de aplicação mais comum (56%), quase todos aplicados a uma única extremidade (99%), e apenas 0,6% requereram aplicações nas extremidades superior e inferior. 80% dos TQs aplicados eram dispositivos comerciais e 20% improvisados. Conclusões: o uso de TQ em ambientes civis está associado a traumas. Os TQs comerciais são mais utilizados, com tempo menor que uma hora de uso e poucas complicações.


Subject(s)
Humans , Male , Adult , Tourniquets/statistics & numerical data , Vascular System Injuries/therapy , Exsanguination/prevention & control , Hemorrhage/prevention & control , Emergency Medical Services , Emergency Treatment , Extremities/injuries , Vascular System Injuries/complications , Vascular System Injuries/mortality , Exsanguination/etiology , Exsanguination/mortality , Hemorrhage/etiology , Hemorrhage/mortality
15.
Rev. bras. anal. clin ; 52(4): 303-309, 20201230. ilus
Article in Portuguese | LILACS | ID: biblio-1223466

ABSTRACT

A Doença de Behçet (DB) é uma afecção entendida por ser inflamatória, multissistêmica,de causa ainda desconhecida, apresentando sintomas como úlceras orais, genitais, uveíte, lesões cutâneas e vasculites recorrentes, sendo mais frequente nos países que se estendem desde o Mediterrâneo até o extremo Oriente. Reconhecida atualmente como uma doença autoimune, a DB parece agregar elementos genéticos do portador e fatores ambientais desencadeantes. Para o estabelecimento de critérios internacionais para um diagnóstico, protocolos clínicos foram desenvolvidos para auxiliar a atividade da doença assim permitindo a padronização das pesquisas na área, ainda que não existam alterações laboratoriais ou histopatológicas definidas da doença. O diagnóstico depende de uma avaliação clínica criteriosa que, quando precoce, é determinante para o prognóstico.Neste artigo são revistos dados clínicos para o diagnóstico da Doença de Behçet.


Behçet's disease (DB) is an affection understood to be multisystemic inflammation of an as yet unknown cause, presenting symptoms such as oral ulcers, genitalia, uveitis, cutaneous lesions and recurrent vasculitis. It is more frequent in countries stretching from the Mediterranean to the Far East. Currently recognized as an autoimmune disease, DB appears to aggregate carrier genetic elements and environmental triggering factors. The establishment of international criteria for a diagnosis, clinical protocols were developed to aid the activity of the disease thus allowing the standardization of research in the area, although there are no laboratory or histopathological changes defined disease, the diagnosis dependent on a careful clinical evaluation that when are determinants for the prognosis. In this article we review clinical data for the diagnosis of Behçet's Disease.


Subject(s)
Autoimmune Diseases , Behcet Syndrome/diagnosis , Vascular System Injuries
16.
Int. braz. j. urol ; 46(6): 1021-1028, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134271

ABSTRACT

ABSTRACT Objective To study the arterial segments of ovine kidney, present a proportional volume analysis of each kidney arterial segment, and analyze arterial injuries caused by simulated partial nephrectomy of cranial pole. Materials and Methods Forty-eight ovine kidneys injected with polyester resin into the renal arteries and collecting system were used in this study. Eighteen kidneys were used to study the arterial segments and the proportional volume of each renal segment. Other 30 kidneys were submitted to superior pole resection at a distance of 1.0cm, 0.5cm, or exactly at the cranial hilar edge, just before the resin hardening. These endocasts were used to evaluate the arterial injuries caused by these different resection planes. Results Ovine renal artery divided into two (ventral and dorsal) or three segmental arteries. Dorsal segment presented higher proportional volume than ventral segment. For kidneys with three segments, the third segment was on the caudal region (caudo-ventral or caudo-dorsal segment) and presented the lowest proportional volume. None of the resected kidneys (at 1.0, 0.5 or at the cranial hilar edge) presented injury of arterial branches that irrigate non-resected region. Conclusion The segmental distribution of renal artery, the proportional volume of each segment and arterial injuries after cranial pole resection in ovine kidneys are different from what is observed in human kidneys. Meanwhile, ovine kidneys show a primary segmental division on anterior and posterior, as in humans, but different from swine. These anatomical characteristics should be considered when using ovine as animal models for renal experimental and/or training procedures.


Subject(s)
Animals , Vascular System Injuries , Nephrectomy/adverse effects , Renal Artery , Swine , Sheep , Models, Animal , Kidney/surgery
17.
Rev. colomb. cardiol ; 27(2): 117-121, mar.-abr. 2020. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1138764

ABSTRACT

Resumen La ruptura de la vena cava inferior durante los procedimientos de intervencionismo percutáneo es una complicación infrecuente que se asocia con alta tasa de mortalidad aunque sea detectada a tiempo y se realice reparo quirúrgico, el cual es hoy el estándar de manejo. No existen hasta el momento casos reportados de manejo percutáneo de perforación de la vena cava durante procedimientos de electrofisiología. Se describe el caso de una paciente llevada a aislamiento eléctrico de venas pulmonares para el manejo de fibrilación auricular paroxística, en quien, durante el procedimiento, se produjo perforación accidental de la vena cava inferior con la sonda de ecocardiografía intracardiaca, la cual fue tratada exitosamente mediante el uso de un balón de alta distensibilidad con lo que se logró adecuada hemostasia sin necesidad de intervención quirúrgica. Se considera que el uso de un balón de alta distensibilidad puede ser una herramienta útil en el control del sangrado asociado a lesiones vasculares iatrogénicas, y que por consiguiente todo intervencionista debería tener presente.


Abstract Rupture of the inferior vena cava during percutaneous intervention procedures is an uncommon complication. It is associated with a high rate of mortality, even when it is detected at the time and the current standard management, surgical repair is performed. At present there are no cases reported of the percutaneous management of a vena cava perforation during electrophysiology procedures. The case is described of a patient subjected to electric ablation of pulmonary veins for the management of paroxysmal atrial fibrillation. During the procedure there was an accidental rupture of the inferior vena cava with the echocardiography cardiac catheter. She was successfully treated using a high-compliance balloon, with adequate haemostasis being achieved without surgical intervention. The use of a high-compliance balloon is considered as a useful tool in the control of bleeding associated with iatrogenic vascular injuries, and for this reason all interventionist should be aware of it.


Subject(s)
Humans , Female , Aged , Pulmonary Veins/abnormalities , Rupture , Vena Cava, Inferior , Wounds and Injuries , Venae Cavae , Echocardiography , Electrophysiology , Vascular System Injuries
18.
J. vasc. bras ; 19: e20200007, 2020. graf
Article in Portuguese | LILACS | ID: biblio-1279359

ABSTRACT

Resumo Os traumas penetrantes de vasos subclávios atingem mortalidade de até 60% em um cenário pré-hospitalar. A mortalidade no intraoperatório varia de 5-30%. Apresenta-se um caso de estratégia de controle de danos para um paciente com lesão na origem da artéria subclávia esquerda, através de ligadura, sem necessidade de outra intervenção, mantendo a viabilidade do membro superior esquerdo por meio de circulação colateral. Os autores fazem uma revisão sobre vias de acesso e estratégias de tratamento com ênfase em controle de danos para lesões de vasos subclávios.


Abstract Mortality from penetrating traumas involving the subclavian vessels can be as high as 60% in pre-hospital settings. Operating room mortality is in the range of 5-30%. This paper presents a case in which a strategy for damage control was employed for a patient with an injury to the origin of the left subclavian artery, using subclavian ligation, with no need for any other intervention, and maintaining viability of the left upper limb via collateral circulation. The authors also review surgical approaches and treatment strategies with a focus on damage control in subclavian vessel injuries.


Subject(s)
Humans , Male , Adult , Young Adult , Subclavian Artery/injuries , Subclavian Vein/injuries , Thoracic Injuries/surgery , Vascular System Injuries , Subclavian Steal Syndrome , Thoracotomy/methods , Collateral Circulation , Upper Extremity , Hemostasis, Surgical/methods , Ligation/methods
19.
China Journal of Orthopaedics and Traumatology ; (12): 1142-1147, 2020.
Article in Chinese | WPRIM | ID: wpr-879369

ABSTRACT

OBJECTIVE@#To analyze the causes of vascular injury occurred in oblique lateral interbody fusion for treating lumbar degenerative diseases, and put forward preventive measures.@*METHODS@#There were 235 patients analyzed from October 2014 to May 2017 in five hospitals, who were treated with oblique lateral interbody fusion with or without posterior pedicle screw fixation. There were 79 males and 156 females with an average age of (61.9±13.5) years old (ranged from 32 to 83 years). There were 7 cases of vascular injury, including 4 cases of segmental vessel injury, 1 case of left common iliac artery injury, 1 case of left common iliac veininjury and 1 case of ovarian vein injury.@*RESULTS@#The follow up time ranged from 6 to 36 months, averagely (15.6±7.5) months. There was no pedicle screw loosen or fracture. The low back pain VAS decreased from preoperative 6.7±2.3 to 1.4±0.8 at the latest follow-up, which was statistically difference(@*CONCLUSION@#Oblique lateral interbody fusion technique provides a new method for minimally invasive fusion of lumbar internal fixation. However, it has a risk of vascular injury. In order to effectively prevent the occurrence of vascular injury, the operative indications and careful and meticulous operation should be strictly grasped.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Lumbar Vertebrae/surgery , Lumbosacral Region , Pedicle Screws , Retrospective Studies , Spinal Fusion/adverse effects , Treatment Outcome , Vascular System Injuries/surgery
20.
Rev. colomb. cir ; 35(3): 514-519, 2020. fig
Article in Spanish | LILACS | ID: biblio-1123239

ABSTRACT

Introducción. La embolia pulmonar por herida con arma de fuego es potencialmente fatal y una complicación rara que puede presentarse en los servicios de urgencias. En los últimos años, se ha presentado una mayor inci-dencia por la violencia social civil (85 %) que por las guerras (15 %). Los principales síntomas de los pacientes son dolor torácico, disnea y hemoptisis por la erosión vascular y el infarto pulmonar asociado.Caso clínico. Se presenta el caso de un paciente de 18 años de edad que ingresó por múltiples heridas por proyec-tiles de arma de fuego, una de ellas con un proyectil alojado en la arteria pulmonar del lóbulo inferior derecho y embolia pulmonar aguda en las ramas arteriales distales al proyectil. Se optó por un tratamiento conservador y la evolución fue adecuada. Discusión. La sintomatología de esta condición depende de la localización, la trombosis asociada, los fenóme-nos de isquemia y las complicaciones hemorrágicas. Entre las complicaciones de un proyectil de fuego alojado en una arteria pulmonar, están la isquemia, la trombosis, los pseudoaneurismas, la hemorragia, el derrame pleural, la insuficiencia vascular y la endocarditis. La mayoría de los pacientes deben someterse a una intervención quirúrgica cuando el proyectil se aloja en las arterias pulmonares principales o lobares y las compromete; cuando se localiza en las arterias segmentarias y subsegmentarias, tienden a presentar fístulas con el bronquio y vasoespasmo compensatorio, lo que permitiría el manejo conservador


Introduction: Gunshot wound pulmonary embolism is potentially fatal and a rare complication that can occur in emergency departments. In recent years, there has been a higher incidence of civil social violence (85%) than for wars (15%). The main symptoms of patients are chest pain, dyspnoea and hemoptisis from vascular erosion and associated pulmonary infarction. Clinical case: We present a case of an 18-year-old patient who was admitted for multiple projectile wounds by firearm, one of them with a projectile lodged in the pulmonary artery of the right lower lobe and acute pulmonary embolism in the arterial branches distal to the projectile. Conservative management was decided, with adequate evolution.Discussion: The symptomatology of this condition depends on the location, associated thrombosis, ischemia phenomena and hemorrhagic complications. Complications of a fire projectile lodged in a pulmonary artery include ischemia, thrombosis, pseudoaneurysms, bleeding, pleural effusion, vascular insufficiency, and endocarditis. Most patients must undergo surgery when the projectile is housed in the main pulmonary arteries or lobar, when located in the segmental and subsegmental arteries tend to have fistulas with bronchi and compensatory vasospasm, which would allow conservative management


Subject(s)
Humans , Vascular System Injuries , Pulmonary Embolism , Wounds, Gunshot , Conservative Treatment
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