RESUMEN
Aneurismas próprios da artéria comunicante posterior são extremamente raros possuindo uma incidência que varia de 0,1 a 2,8 por cento de todos os aneurismas. O surgimento de aneurisma intracraniano em virtude de alterações de fluxo por oclusão arterial é descrito na literatura. Apresentamos o caso de homem de 69 anos, vítima de hemorragia subaracnóidea, com diagnóstico de aneurisma próprio da artéria comunicante posterior direita. Havia também, oclusão da artéria subclávia esquerda com roubo de fluxo da artéria vertebral direita pela vertebral esquerda. Realizou-se tratamento endovascular com angioplastia e colocação de stent na artéria subclávia esquerda com conseqüente oclusão do aneurisma. Discutimos o restabelecimento do fluxo arterial intracraniano como forma de tratamento deste aneurisma.
Asunto(s)
Anciano , Humanos , Masculino , Arteriopatías Oclusivas/complicaciones , Aneurisma Intracraneal/complicaciones , Arteria Subclavia , Hemorragia Subaracnoidea/etiología , Angioplastia , Arteriopatías Oclusivas , Arteriopatías Oclusivas/cirugía , Angiografía Cerebral , Aneurisma Intracraneal , Aneurisma Intracraneal/cirugía , Stents , Hemorragia Subaracnoidea , Hemorragia Subaracnoidea/cirugíaRESUMEN
Apresentamos um caso típico de fístula arteriovenosa dural intracraniana com drenagem para o plexo venoso peribulbar e veias perimedulares. Discutimos seus aspectos etiológicos e fisiopatológicos, bem como os critérios de diagnóstico e tratamento deste tipo de lesäo
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Fístula Arteriovenosa , Duramadre , Malformaciones Arteriovenosas Intracraneales , Médula Espinal , Fístula Arteriovenosa , Angiografía Cerebral , Malformaciones Arteriovenosas Intracraneales , Imagen por Resonancia MagnéticaRESUMEN
Vascular complications after liver transplantation include oclusion or stenosis at the sites of anastomosis in the hepatic artery; portal vein, and vena cava. Balloon angioplasty of these stenosis carries little risk and is a useful procedure for the treatment of these problems. The purpose of this paper was to assess whether percutaneous transluminal angioplasty can help to prolong allograft survival and impruve allograft function in patient with hepatic artery stenosis after liver transplantation. We report a 43-year-old male with stenosis of hepatic artery anastomosis after liver transplantation. An abrupt elevation of liver enzymes and serum bilirrubin levels was noted on the fifth postoperative month. The patient underwent percutaneous liver biopsy, which revealed important ductal depletion due to hypoperfusion, even though Doppler ultrasound examination demonstrated arterial flow. An angiogram confirmed severe stenosis of the arterial anastomosis with poor intraparenchymal arterial perfusion pattern. In an attempt to preserve the graft, a percutaneous transluminal angioplasty was performed using microballoons mounted on a hydrophylic micro guidewire. Intervention proceeded without complication. Liver enzimes and bilirrubin levels decreased within twenty-four hours of angioplasty. Normal levels were achieved after one week. Seven month after angioplasty, the patient is in a optimal clinical condition with no signs of graft impairment. We conclude that percutaneous transluminal angioplasty of hepatic artery stenosis after liver transplantation is relatively safe and may help decrease allograft loss