Tratamiento quirúrgico del leiomiosarcoma de vena cava inferior

Introducción: La baja incidencia del leiomiosarcoma de la vena cava inferior dificulta tanto la estandarización del diagnóstico como el tratamiento. Objetivo: Presentar el manejo realizado en nuestro centro de un paciente que desarrolló un leiomiosarcoma de vena cava inferior, una patología de baja incidencia y que las posibilidades de realizar un rescate quirúrgico son muy bajas. Resultados: Se presenta el caso de un paciente de 54 años con una tumoración sólida en porción infrarrenal y yuxtarrenal de vena cava inferior de 71 × 76 × 117 mm compatible con leiomiosarcoma de vena cava, con infiltración de uréter derecho que ocasiona uropatía obstructiva derecha grado I-II sin alteración de la función renal, que fue resecada y reconstruida mediante prótesis sin complicaciones. Discusión: Se discute la fisiopatología, el diagnóstico y manejo en relación con el caso presentado. Conclusión: la baja incidencia de estos tumores dificulta tanto la estandarización del diagnóstico como del tratamiento, aunque la cirugía sigue siendo el tratamiento de elección.

Introduction: The low incidence of leiomyosarcoma of the inferior vena cava hinders both the standardization of diagnosis and treatment. Objective: To present the management carried out in our center of a patient who developed an inferior vena cava leiomyosarcoma, a low incidence pathology with uncertain surgical rescue. Results: 54-year-old patient with a solid tumor in the infrarenal and juxtarenal portions of the inferior vena cava of 71 × 76 × 117 mm compatible with leiomyosarcoma of the vena cava, with infiltration of the right ureter that causes right obstructive uropathy grade I-II without kidney function changes; tumour was resected and continuity reconstructed with a prosthesis without complications. Discussion: The pathophysiology, diagnosis and management are commented. Conclusion: the low incidence of these lesions makes it difficult to standardize both diagnosis and treatment, although surgery remains the treatment of choice.

Late Non-Anastomotic Rupture of a Bifurcated Dacron Aortic Graft Treated Using a Gore Excluder Limb Endoprosthesis

Dacron vascular prostheses have been widely used in vascular surgery since the mid-1970s. They have been proven to be the most durable and reliable conduits for arterial replacement in aortic and peripheral surgeries for decades. However, an extremely rare complication, namely late non-anastomotic graft rupture, due to intrinsic structural prosthetic disruption can occur, resulting in acute hemorrhage or false aneurysm formation. We report a case of this rare complication due to non-anastomotic rupture of a bifurcated knitted Dacron aortic vascular graft in a patient who had undergone an aorto-bi-iliac bypass 6 years ago. The patient was successfully treated in an emergency setting with endovascular therapy using an iliac limb of an abdominal aortic endoprosthesis.

Non-Anastomotic Rupture of a Woven Dacron Graft in the Descending Thoracic Aorta Treated with Endovascular Stent Grafting

The intrinsic structural failure of a Dacron graft resulting from the loss of structural integrity of the graft fabric can cause late graft complications. Late non-anastomotic rupture has traditionally been treated surgically via open thoracotomy. We report a case of the successful use of thoracic endovascular repair to treat a Dacron graft rupture in the descending aorta. The rupture occurred 20 years after the graft had been placed. Two stent grafts were placed at the proximal portion of the surgical graft, covering almost its entire length.

Eficacia del destechado del túnel en infección crónica del catéter peritoneal / Tunnel unroofing effectiveness in chronic peritoneal catheter infection

Introducción: la infección crónica del catéter involucra generalmente la colonización del manguito de dacrón (ôcuffõ) externo; sin su remoción el tratamiento antibiótico es inefectivo, la técnica de destechado de catéter ha sido descrita como una alternativa a la extracción del catéter peritoneal. Material y métodos: Se analizaron datos en forma retrospectiva de 13 pacientes. Se evaluó la evolución luego del destechado, considerando como fracaso del tratamiento a la aparición de nueva infección en el orificio, túnel o peritonitis asociada al mismo germen. Resultados: Entre los años 1997-2014, se le practicó destechado a 13 pacientes. Edad promedio 46,23 años (IC 95%: 35,92 años û 56,54 años). Sexo masculino 9, 69,23% (IC 95%: 41,95% û 96,50%).Gérmenes estafilococo 7, pseudomona 2, polimicrobiano 1, cultivo negativo 3. Hubo curación en 9 pacientes, 69,23% (IC 95%: 41,95% û 96,06) no hubo asociación estadística entre sexo, edad, resultado microbiológico, presencia de hemodiálisis previa, tipo de catéter, técnica quirúrgica ni con el cirujano que realizó el procedimiento (p> 0.05). Discusión: La extracción del catéter implica la transferencia transitoria a hemodiálisis y una nueva cirugía de recolocación, si bien existe poca experiencia con la técnica de destechado, puede ser una alternativa válida, permitiendo a un grupo de pacientes continuar con el tratamiento de DP. Conclusión: La cirugía de destechado ha resultado beneficiosa en el 69,23% de los casos (9 pacientes) independientemente del tipo de germen presente, representando un tratamiento aceptable que evita la remoción del catéter permitiendo así la continuidad de la modalidad, disminuyendo la necesidad de emplear terapias más agresivas.

Introduction: chronic catheter infection usually involves external Dacron cuff colonization, without its removal, antibiotic treatment proved ineffective. Catheter unroofing technique has been described as an alternative to peritoneal catheter removal. Material and methods: We analyzed the data from 13 patients retrospectively. Evolution after unroofing was evaluated, considering as treatment failure the appearance of new infection in the hole, tunnel or peritonitis associated to the same germ. Results: Between 1997-2014 years, unroofing was performed on 13 patients. Mean age-rate: 46.2 (IC 95%: 35.9 years û 56.5 years) male sex 9, 69.23%. Germs: staphylococcus 7, pseudomona 2, polymicrobial 1, negative culture 3. Nine patiens healed: 69.2%; there was no statistical association among sex, age, microbiological result, previous hemodialysis use, type of catheter, surgical technique or with the surgeon who performed the procedure (p> 0.05). Discussion: Catheter removal implies transient transference to hemodialysis and new replacement surgery, although there is few experience with this technique, it could be an acceptable alternative, enabling a group of patients to continue with PD treatment. Conclusion: Unroofing technique proved to be beneficial in 69.2% of the cases (9 patients) independently of the type of germ present, representing an acceptable treatment which avoids catheter removal, enabling the procedure to continue, and decreasing the need to employ more aggressive therapies.

A Case of Graft Aneurysm due to Deterioration of a Cooley Double Velour Knitted Dacron Prosthesis / 日本心臓血管外科学会雑誌

A 78-year-old man underwent replacement of a descending thoracic aorta in 1980 using a Cooley double velour knitted Dacron (CDVKD) following a diagnosis of DeBakey type III b aortic dissection. He had back pain and bloody sputum from around January 2012, and so the patient was referred to our department. Upon multi-detector computed tomography (MDCT), we diagnosed a graft aneurysm caused by the prosthetic graft carried out 32 years previously that had expanded to a maximum of greater than 80 mm. An emergency operation was considered due to the continuing back pain and bloody sputum. As a strategy for treatment, low invasive treatment by thoracic endovascular aortic repair (TEVAR) was initially planned. However, due to the large size of the aneurysm relative to the surrounding vessels and severe aortic calcification of the landing zone, complications of endoleak and migration were considered possible upon TEVAR. Instead, we selected total aortic arch replacement with extracorporeal circulation upon median sternotomy, even though this required increased surgical invasion. Postoperative prognosis was good and the patient was discharged from hospital 5 weeks following surgery. There are few reports on the failure of a prosthetic graft causing a graft aneurysm, particularly involving an aging CDVKD graft, but it is possible that deterioration of a prosthetic graft may cause a graft aneurysm. Therefore, postoperative follow-up must be carried out with care.

Disruption of a Dacron Graft Caused by the Vertebral Body of the Lumbar Vertebrae after Reconstruction of the Thoracoabdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

We report an extremely rare case of early disruption of a woven Dacron graft by the mechanical force of the lumbar vertebral body after a thoracoabdominal aortic aneurysm repair. A 75-year-old man with thoracoabdominal aortic aneurysm of Crawford type III underwent replacement of the thoracoabdominal aorta using a Gelweave thoracoabdominal graft (Vascutek) and a Gelweave bifurcate graft (Vascutek). His postoperative course was uneventful and discharged on postoperative day 20. On the 22nd postoperative day, he was re-hospitalized with low back pain. Computed tomography scanning showed a massive hematoma around the region of the graft-to-graft anastomosis. He underwent an emergency operation. At laparotomy, the Gelweave thoracoabdominal graft had a 2-mm hole which had been caused by the mechanical force of lumbar vertebral body, which was not related to the anastomosis. The graft was repaired with a 4-0 polypropylene buttress suture and a new prosthesis graft was used to wrap around the disrupted graft.

Changes in Polytetrafluoroethylene and Dacron GraftDiameters after Arterial Bypass Surgery

PURPOSE: We compared postoperative diameter changes between polytetrafluoroethylene (PTFE) and Dacron grafts after aortic reconstruction and femoropopliteal bypass. METHOD: We analyzed 173 PTFE grafts and 73 Dacron grafts (165 aortic grafts, 81 peripheral grafts). The mean follow-up period was 28.4 months. RESULT: The mean diameter change in the Dacron grafts (6.6+/-3.0 SD mm) was larger than that in the PTFE grafts (3.7+/-1.8 SD mm). There was a statistically significant difference in the diameter change of PTFE and Dacron aortic grafts (p<0.001). The diameter changes in PTFE peripheral grafts were not significant (p=0.065). There was a significant linear correlation between diameter changes in the Dacron aortic grafts and follow-up duration (correlation coefficient=0.238, p=0.043). Diameter changes in the PTFE grafts showed no linear correlation with follow-up duration, irrespective of grafting range (aortic grafting correlation coefficient=0.048, p=0.646; peripheral grafting correlation coefficient=0.011, p=0.925). CONCLUSION: This study suggests that PTFE has superior durability compared to Dacron, and the change in graft diameter should be taken into consideration when the diameter of the graft needed for aortic reconstruction is selected.

Giant Fusiform Aneurysm by Circumferential Wrapping with Sutures-Reinforcement

Adirect intracranial operative approach with clipping the neck of the aneurysm is generally considered to be the ideal treatment for the intracranial arterial aneurysms. Several strategies exist for treating unclippable aneurysms. Intravascular techniques, proximal occlusion of the parent artery or trapping of the aneurysm, microsurgical bypass of the involved arterial segment, and reinforcement or wrapping of the aneurysmal wall are frequently used. The authors report a case with long term(6 years) follow-up results of the circumferential wrapping with sutures-reinforcement for giant fusiform aneurysm of the internal carotid artery. The giant fusiform aneurysm and ideal wrapping materials were discussed with review of literature.

Non-anastomotic False Aneurysm after the Replacement Using a Double Velour Knitted Dacron Graft: A Case Report / 日本心臓血管外科学会雑誌

A non-anastomotic false aneurysm occurred in a 77-year-old male 11 years after bypass grafting between the left external iliac artery and the right femoral artery using a Cooley double velour knitted Dacron graft. The false aneurysm was caused by rupture of an artificial graft. A partial resection of the graft and its replacement using a Hemashield^® graft were successfully performed. It was speculated that the mechanical stress by the inguinal band degenerated graft fibers and developed aneurysmal formation.

Unusual Dilatation of Gelatin-Impregnated Knitted Dacron Prostheses after Abdominal Aortic Aneurysm Surgery / 日本心臓血管外科学会雑誌

We experienced unusual dilatation of gelatin-impregnated knitted Dacron prostheses after abdominal aortic aneurysm surgery. Therefore, we investigated dilatation of gelatin impregnated knitted Dacron grafts compared with other types of Dacron grafts after abdominal aortic aneurysm surgery. Eighteen grafts inserted after abdominal aortic aneurysm surgery were studied for to evaluate dilatation. Enhance CT was used to determine the external diameter of the most dilated portion of the abdominal aortic grafts and high speed plain CT was used to determine the most dilated internal diameter. The gelatin-impregnated knitted Dacron grafts dilated from 25% to 43.8% (mean 31.8±7.2%), significantly more than collagen impregnated woven Dacron grafts (<i>p</i>=0.0003). Moreover, high fever was frequently noticed after these grafts implantation (66.7%). Therefore, caution must be used concerning these implantation in aortic lesions and careful follow-up study should be performed after implantation.

Aneurysms Arising from a Knitted Dacron Velour Graft Which Caused Acute Arterial Embolization / 日本心臓血管外科学会雑誌

A 67-year-old man suffered acute arterial occlusion caused by emboli from aneurysms in a right axillo-bifemoral graft using Cooley double velour knitted Dacron, which was inplanted 10 years and 10 months before the admission. The patient underwent urgent redo surgery; left axillobifemoral bypass with 6mm ringed PTFE graft and right femoropopliteal bypass with <i>in situ</i> saphenous vein were performed successfully. Several clinical experiences by others demonstrated that Cooley double velour knitted Dacron graft, manufactured before June, 1981, might have possible aneurysmogenic factors, therefore cases in which it has been employed should be followed up carefully.

Experimental and Clinical Research for a Collagen-Coated Dacron Graft / 中华胸心血管外科杂志

No interstitial bleeding occurred in either type of grafts. By gross observation and under light microscopy, a smooth neointima was noticed on the surface of collagen coated grafts 30 and 90 days after implantation. In a series of 4 patients with Marfan's syndrome undergoing replacement of the aortic root, hemorrhage through the interstices of the graft was virtually eliminated. There was no complication in any patient after a follow up of 3 months. This study reveals that collagen-coated dacron grafts were totally impervious to blood during and after implantation. The collagen coating can promoting cell growth and graft healing and does not interfere with the physical properties of the dacron grafts. As a prosthesis of aorta replacement , it may be applied clinically with safety. If it is used as small diameter vascular prosthesis,the long-term patency may be improved.

Treatment of Fusiform Intracranial Aneurysm by Wrapping with Suture-Reinforcement: Technical Note

Several strategies exit for treating unclippable aneurysm, including intravascular techniques, proximal occlusion of the parent artery or trapping of the aneurysm, microsurgical bypass of the involved arterial segment and reinforcement of the aneurysmal wall. Reinforcement or wrapping is frequently used when the other techniques are thought to be unsafe. We report a technical modification of the traditional wrapping technique for treatment of the fusiform aneurysm of the internal carotid artery, which includes reinforced Daron-patch with traction sutures to the adjacent to prevent aneurysmal rupture and further expansion.

A study on changes of 6 K PGF 1? from plasma and the luminal surface of the Dacron grafts implanted into the canine inferior vene cava / 中国普通外科杂志

The aim of this study is to determine whether seeded Dacron with autologous venous tissue fragments shows significant 6-keto-prostglandin F 1? (6 K PGF 1? )production after in vivo implantation.The Dacron grafts seeded with autologous venous fragments were implanted into the inferior vene cava(IVC)of the 13 canines as seeded group;and the control group (8 canines),in which grafts were only preclotted with fresh blood. Plasma 6 K PGF 1? and TXB 2 were assessed at different time.All of the specimens explanted at exsanguination were observed with light microscopy and sanning electron microscopy and the amounts of 6 K PGF 1? from the luminal surface were assessed using ridioimmunoassay. The results showed that the total patency rate of the explanted vessels was higher in seeded group (61.5%) than that in control group ( 25% ),and that endothelial cells lined the whole luminal surface of Dacron at the 14th day after operation in seeded group,but thrombus covered the surface of Dacron at the 14th day in control ones. The level of 6 K PGF 1? from plasma and the luminal surface of Dacron grafts in seeded group was higher,but the level of plasma TXB 2 was lower than that in control group. It can be concluded that seeding Dacron with autologous venous fragments makes a new endothelial lining possible at two weeks,and can release more 6 K PGF 1? and thus lead to an improved patency rate of canine IVC reconstructions,so the graft patency might be determined according to the changes of plasma 6 K PGF 1? and TXB 2 level.

Histopathologic study of Dacron Graft following Experimental Fun-thickness Scleral Resection in Rabbits

To evaluate the possibility of Dacron patch for artificial sclera. Dacron(polyethylene terephthalate) which is readily available, biocompatable, safe, and inert synthetic material was implanted in the area of full-thickness scleral defect in rabbits. The histopathologic examinations showed that fibrovascular tissue invested into all interstices of Dacron filaments and fibroconnective tissue encapsulation around Dacron patch had strong connection with collagen fibers of recipient sclera at 4 weeks after graft There were no adverse reactions such as retinal detachment and fibrous proliferation into the vitreous cavity except mild inflammatory response of surrounding tissue at the early postoperative stage. As a result, Dacron graft showed successful firm adhesion to the recipient sclera without serious complications. Thus, We think that Dacron could possibly be used, instead of donor sclera, as artificial scleral graft material for the surgical treatment of perforating scleral diseases.

Histopathologic Findings after Experimental Penetrating Keratoplasty using Dacron-Gore-Tex(R) Combined Graft in Rabbits: Treatment of Corneal Perforation using Synthetic Materials. Report II

The purpose of this study is to evaluate the histopathologic findings after experimental penetrating keratoplasty using Dacron-Gore-Tex(R) combined graft in rabbits and the clinical efficacy of the treatment of corneal perforation using synthetic materials. Type A which used end to end fixation showed better results than that of type B which used intralamellar fixation and, however, complications and instability of graft occured in most eyes of both types. Type C which modified type B and reduced the thickness of intralamellar portion of graft showed relatively good results compared with type A and B, but there was still instability. Leakage from anterior chamber in early postoperative period prior to fiibrovascular invasion into graft was considered as the main cause of instability of graft. Therefore we performed type D which emphasized on preventing leakage, and well-maintained anterior chamber without extrusion of graft, that is, the best result among all 4 types was observed until 6 weeks postoperatively. Although further study is needed, we think that Dacron-Gore-Tex(R) combined graft can be a good substitute for the management of corneal perforation.

Histopathologic Comparison of Vascularization between Dacron and Donor Sclera as Wrapping Material in Hydroxyapatite Implantation

Recently, a hydroxyapatite sphere has been increasingly used as a buried integrated orbital implant for the great improved motility of the prosthesis after enucleation. To allow more rapid ascess of vasculature into the hydroxyapatite implant, Dacron as a new synthetic wrapping material of the implant for anophthalmic sockets had been used and compared histologically with donor sclera in rabbits. At 4 weeks after implantation, fibrovascular ingrowth was found mainly near the scleral windows, where fibrosis extended 2 mm centrally in scleral-wrapped implants. In Contrast, in Dacron-wrapped implants, there was extensive fibrovascular infiltration through Dacron filaments and windows as well, making the hydroxyapatite sphere completely invested with fibrovascular tissue to the center within 4 weeks of implantation. Thus, Dacron as a new wrapping material appears to allow a more rapid vascularization into the hydroxyapatite implant than other collagen material without any serious complications, resulting in early rehabilitation with an artificial eye.

Ruptured Dacron Prosthesis by Blunt Trauma 8 Years after Implantation for Axillo-femoral Bypass / 日本心臓血管外科学会雑誌

A case of a 77-year-old man is reported, who developed late rupture of the knitted Darcon velour graft by blunt trauma 8 years after implantation for axillo-femoral bypass. Dacron fiber deterioration, which led the graft to fragility, might have played a main role in the clinical setting. This case clearly emphasizes that with its possibility to be deteriorated life-long care and follow up should be taken for the patients who undergo arterial reconstructive surgery using Dacron prostheses.

Experimental Scleral Grafting with Dacron Patch

We conducted experimental studies to evaluate the possibility of Dacron patch for artificial sclera and to gain basic data for practical approach. Forty eyes of twenty rabbits were randomly assigned to experimental or control eye in both eyes. The lamellar-thickness scleral resection was performed and followed by implantation of Dacron and homologous scleral patch respectively. We examined them after one, two, four and 12 weeks. Grossly adhesion of Dacron patch was stable after four weeks. Histologically Dacron graft evoked an outer capsule and a well-vascularized granulomatous foreign body reaction. There were fibrous and vascular ingrowth securety anchored graft to bed and adhesion was uniform and firm throughout the tissue. Attachment of homolgous graft to bed was poor after 1 week but stable after two weeks. Dacron patch appears to be a good alternative to homologous sclera for scleral reinforcement.

An experimental study on prevention of postlaminectomy scar formation

In repeat lumbar surgery for failed back syndrome, well organized fibrous scar tissue is often noted, binding together the dura, nerve roots, and paraspinal muscles. An animal experimental study was done to investigate the prevention of scar formation after lumbar laminectomy by using dacron and sodium hyaluronate. The experimental animals consisted of three groups: 1) control group, 2) D group (covering the laminectomy defect with dacron sheet), and 3) H group (covering the laminectomy defect with sodium hyaluronate gel). Animals were sacrificed at varying intervals (3-12 weeks) and the lumbar spines were evaluated with histologic preparations. Scar adhesion to the dura was most significantly suppressed in the D group, followed by the H group and the control group.