Tratamento endovascular de doença oclusiva venosa central com fístula arteriovenosa funcionante / Endovascular treatment of central vein occlusion in patients with functioning arteriovenous fistulas

Resumo Contexto A maior sobrevida dos doentes dialíticos somada à incapacidade de obtenção de órgãos suficientes para atender a demanda, bem como à dificuldade de acesso aos serviços de saúde, levou ao aumento da fila para transplante e ao prolongamento do tempo de utilização do acesso venoso central para hemodiálise. A etiologia mais comum de estenose de veia central é o acesso venoso central prolongado, pelas lesões intimais decorrentes da presença do cateter. Objetivos Avaliar resultados de angioplastia para tratamento de doença oclusiva venosa central com fístula arteriovenosa periférica funcionante. Métodos Estudo tipo coorte retrospectivo com revisão de prontuários de 47 doentes com lesões estenóticas ou oclusivas. A avaliação dos doentes foi realizada em 30 dias, 6 meses e 1 ano após a recanalização ou correção da estenose com ATP ou ATP/aplicação de stent. Resultados Lesões estenóticas foram encontradas em 25 doentes (53%), e oclusões, em 22 (47%) doentes. A angioplastia percutânea transluminal (ATP) com stent foi utilizada em 64% dos doentes, e angioplastia isolada com balão, em 36% deles. A análise de resultados clínicos mostrou elevada taxa de melhora clínica precoce (30 dias) em 82% dos doentes (intervalo de confiança [IC] 71-93%). Após 1 ano de seguimento, a taxa de perviedade primária foi de 57%, e a taxa de perviedade primária assistida foi de 72% (IC 57-84%). Conclusão O tratamento endovascular das estenoses ou oclusões de veia central sugere melhora clínica dos sintomas e taxas adequadas de perviedade no período de 1 ano, apesar da limitação no tamanho amostral.

Abstract Background The increased survival of dialysis patients and the inability to obtain sufficient organs to meet demand for transplantation, compounded by poor access to health services, have caused the transplant waiting lists to grow, extending the time spent using central venous accesses for hemodialysis. The most common etiology of central vein stenosis is prolonged central venous access, due to intimal injuries caused by the presence of the catheter. Objectives To assess the results of angioplasty to treat central vein occlusion in patients with functioning peripheral arteriovenous fistulas. Methods Retrospective cohort study with review of medical records from 47 patients with stenotic or occlusive lesions. Patients were assessed at 30 days, 6 months, and 1 year after recanalization or correction of stenosis with transluminal percutaneous angioplasty (TPA) or TPA/stenting. Results Stenotic lesions were detected in 25 patients (53%) and occlusions were found in 22 (47%) patients. TPA with stenting was used in 64% of patients and balloon angioplasty in isolation was used in 36%. Analysis of clinical results showed a high rate of early clinical improvement (30 days), seen in 82% of patients (confidence interval [CI] 71-93%). After 1 year of follow-up, the primary patency rate was 57% and the assisted primary patency rate was 72% (CI 57-84%). Conclusions Endovascular treatment of central vein stenosis or occlusions suggests clinical improvement of symptoms and adequate rates of patency at 1 year, notwithstanding the limited sample size.

Piometra secundario a estenosis cervical en una adolescente / Pyometra secondary to cervical stenosis in an adolescent

INTRODUCCIÓN: El piometra es una afección infrecuente, pero grave, que en general se diagnostica en mujeres posmenopáusicas. En adolescentes es sumamente raro, y si se acompaña de amenorrea primaria hay que tener en mente las anomalías congénitas. CASO CLÍNICO: Adolescente de 13 años, sin antecedentes personales de interés salvo amenorrea primaria, que acude con abdomen agudo y es intervenida por una peritonitis difusa causada por un piometra secundario a disgenesia (estenosis) cervical congénita. Se realizó dilatación cervical y se dejó una sonda vesical intrauterina para prevenir la reestenosis. CONCLUSIONES: Un diagnóstico precoz y un tratamiento conservador con dilatación cervical y colocación temporal de un catéter urinario son esenciales para un manejo seguro y efectivo de la estenosis cervical en adolescentes.

INTRODUCTION: Pyometra is an uncommon but serious condition that is generally diagnosed in postmenopausal women. In adolescents it is extremely rare; if accompanied by primary amenorrhea, consider congenital abnormalities. CASE REPORT: A 13-year-old adolescent, with no relevant personal history except primary amenorrhea, who presented with an acute abdomen and was operated on for diffuse peritonitis caused by pyometra secondary to congenital cervical dysgenesis (stenosis). Cervical dilation was performed and a urinary catheter was temporarily placed inside the uterus to prevent restenosis. CONLUSIONS: An early diagnosis and conservative treatment with cervical dilation and temporary placement of a urinary catheter are essential for the safe and effective management of cervical stenosis in adolescents.

Fatores associados à variação no comprimento e diâmetro vaginal após radioterapia pélvica para câncer do colo uterino / Factors associated with changes in vaginal length and diameter after pelvic radiotherapy for cervical cancer

Introdução: o câncer do colo uterino é o quarto tipo de câncer mais comum entre as mulheres. O tratamento pode incluir a radioterapia e um dos eventos adversos é a estenose vaginal. Objetivos: avaliar a incidência de estenose vaginal através de medidas objetivas e uma escala subjetiva, e identificar os fatores associados à ocorrência desse evento adverso após a radioterapia pélvica. Métodos: estudo longitudinal descritivo realizado de janeiro/2013 a novembro/2015 com 139 mulheres portadoras de neoplasia maligna do colo uterino, estádio I-IIIB, com idades entre 18-75 anos que haviam sido convidadas a participar de um ensaio clínico randomizado para avaliar diversos tratamentos para estenose vaginal após radioterapia. O desfecho foi a estenose vaginal, avaliada através da escala de estenose vaginal Common Terminology Criteria for Adverse Events version 3.0 (CTCAEv3.0) e da diferença entre as medidas do comprimento e do diâmetro da vagina logo após o término da radioterapia. As variáveis independentes foram as características da neoplasia, dados clínicos e sociodemográficos. A análise bivariada foi realizada usando os testes do qui-quadrado, Kruskal-Wallis e Mann-Whitney. A análise multivariada foi realizada através da regressão de Poisson e do modelo linear generalizado. Resultados: a média de idade foi de 47,2 (± 13,4) anos e 40,3% das mulheres estavam na pós-menopausa. Metade delas apresentava câncer do colo do útero estadio IIIB (50,4%). Pela escala CTCAEv3.0, 42 mulheres (30,2%) não apresentaram estenose, 96 mulheres (69,1%) apresentaram estenose grau 1 e uma mulher (0,7%) apresentou estenose grau 2 logo após a radioterapia. Com relação às alterações das medidas vaginais, a variação média de diâmetro foi -0,6 (± 1,7) mm e a variação média do comprimento foi -0,6 (± 1,3) cm. Quinze mulheres apresentaram redução do diâmetro vaginal, sendo que em 93,5% delas a redução foi de 0,5 cm e em 1 mulher a redução foi de 1 cm. Com relação ao comprimento vaginal, 65,7% apresentaram diminuição da medida, sendo que dessas, 62% tiveram diminuição de 0,5-1 cm; 32% tiveram diminuição de 1,5-2,5 cm e 6% tiveram diminuição de 3-4 cm. Por outro lado, 11 mulheres (8%) tiveram aumento do comprimento vaginal, sendo que dessas, 36,3% tiveram aumento de 0,5-1 cm; 36,3% tiveram aumento de 1,5-2,5 cm; 18,3% tiveram aumento de 3-4 cm e 9,1% tiveram aumento de 5 cm. Na análise multivariada, mulheres com invasão vaginal apresentaram menos estenose vaginal pela escala CTCAEv3.0 (coeficiente:-0,51;p<0,01). Quanto à variação do diâmetro, mulheres com estadiamento clínico IIIA/IIIB apresentaram redução da medida mais frequentemente (coeficiente:+1,44;p=0,02). Quanto à variação do comprimento, mulheres que realizaram teleterapia/braquiterapia apresentaram maior redução da medida (coeficiente:-1,17;p<0,01) e mulheres portadoras de diabetes (coeficiente:+1,16; p<0,01) e com invasão vaginal pelo tumor (coeficiente:+0,73;p<0,01) apresentaram aumento da medida. Conclusões: a maioria das mulheres apresentou estenose leve, com redução discreta do comprimento do canal vaginal. Estadiamento clínico avançado e realizar uma associação de braquiterapia e teleterapia se associaram a uma maior frequência de estenose. Mulheres com neoplasias do colo que invadem a vagina apresentam aumento das medidas do comprimento vaginal logo após a radioterapia devido à redução do volume tumoral. (AU)

Introduction: cervical cancer is the fourth most common cancer among women. Treatment may include radiation therapy and one of the adverse events is vaginal stenosis. Objectives: to evaluate the incidence of vaginal stenosis using objective measures and a subjective scale, and to identify factors associated with the occurrence of this adverse event after pelvic radiotherapy for cancer of the cervix. Methods: a longitudinal descriptive study conducted from Jan/2013 to Nov/2015 with 139 women suffering from malignant cervical cancer, stage I-IIIB, aged 18-75 years who had been invited to participate in a randomized clinical trial to evaluate various treatments for vaginal stenosis after radiotherapy. The main outcome was vaginal stenosis assessed using the Common Terminology Criteria for Adverse Events (CTCAEv3.0) and through changes in vaginal diameter and length after the end of radiotherapy. Independent variables were the characteristics of the neoplasm, clinical and sociodemographic data. Bivariate analysis was carried out using chi-squared test, Kruskal-Wallis and Mann-Whitney's test. Multiple analysis was carried out using Poisson regression and a generalized linear model. Results: The mean age was 47.2 (± 13.4) years and 40.3% of women were postmenopausal. Half of them had cervical cancer stage IIIB (50.4%). By CTCAEv3.0 scale, 42 women (30.2%) showed no stenosis, 96 women (69.1%) had grade 1 stenosis and one woman (0.7%) had grade 2 stenosis after radiotherapy. Regarding changes in vaginal measures the average change in diameter was 0.6 (± 1.7) mm and the average length variation was -0.6 (± 1.3) cm. Fifteen women had reduced vaginal diameter, and in 93.5% of them the reduction was 0.5 cm and in one woman the reduction was 1 cm. Regarding vaginal length, 65.7% showed a decrease in extent, and of these, 62% had decreased 0.5-1 cm; 32% had decreased 1.5-2.5 cm and 6% had a reduction of 3-4 cm. On the other hand, 11 women (8%) had an increase in vaginal length, and of these, 36.3% had an increase of 0.5-1 cm; 36.3% had an increase of 1.5-2.5 cm; 18.3% had an increase of 3-4 cm and 9.1% had an increase of 5 cm. In multivariate analysis, women with tumoral invasion of the vaginal walls had fewer vaginal stenosis by CTCAEv3.0 scale (coefficient: -0.51, p <0.01). As to changes in diameter, women with clinical stage IIIA/IIIB had reductions in this measure more frequently (coefficient: +1.44; p=0.02). As to changes in vaginal length, women who underwent teletherapy/brachytherapy showed greater reduction in this measure (coefficient: -1.17; p <0.01) and women with diabetes (coefficient: +1.16; p <0.01) and tumoral invasion of the vaginal walls (coefficient: +0.73; p <0.01) had increases in this measure more frequently. Conclusion: most women had mild stenosis, with a slight reduction of the length of the vagina. Advanced clinical stage and performing a combination of brachytherapy and teletherapy were associated with a higher frequency of stenosis. Women with cervical cancer which invades the vaginal walls have increases in vaginal length after radiotherapy due to reduction in tumoral volume.(AU)

Endoscopic Management of Bile Leakage after Liver Transplantation

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) can be an effective treatment for bile leakage after liver transplantation. We evaluated the efficacy of endoscopic treatment in liver transplantation in patients who developed bile leaks. METHODS: Forty-two patients who developed bile leaks after liver transplantation were included in the study. If a bile leak was observed on ERCP, a sphincterotomy was performed, and a nasobiliary catheter was then inserted. If a bile leak was accompanied by a bile duct stricture, either the stricture was dilated with balloons, followed by nasobiliary catheter insertion across the bile duct stricture, or endoscopic retrograde biliary drainage was performed. RESULTS: In the bile leakage alone group (22 patients), endoscopic treatment was technically successful in 19 (86.4%) and clinically successful in 17 (77.3%) cases. Among the 20 patients with bile leaks with bile duct strictures, endoscopic treatment was technically successful in 13 (65.0%) and clinically successful in 10 (50.0%) cases. Among the 42 patients who underwent ERCP, technical success was achieved in 32 (76.2%) cases and clinical success was achieved in 27 (64.3%) cases. CONCLUSIONS: ERCP is an effective and safe therapeutic modality for bile leaks after liver transplantation. ERCP should be considered as an initial therapeutic modality in post-liver transplantation patients.

Endoscopic Management of Bile Leakage after Liver Transplantation

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) can be an effective treatment for bile leakage after liver transplantation. We evaluated the efficacy of endoscopic treatment in liver transplantation in patients who developed bile leaks. METHODS: Forty-two patients who developed bile leaks after liver transplantation were included in the study. If a bile leak was observed on ERCP, a sphincterotomy was performed, and a nasobiliary catheter was then inserted. If a bile leak was accompanied by a bile duct stricture, either the stricture was dilated with balloons, followed by nasobiliary catheter insertion across the bile duct stricture, or endoscopic retrograde biliary drainage was performed. RESULTS: In the bile leakage alone group (22 patients), endoscopic treatment was technically successful in 19 (86.4%) and clinically successful in 17 (77.3%) cases. Among the 20 patients with bile leaks with bile duct strictures, endoscopic treatment was technically successful in 13 (65.0%) and clinically successful in 10 (50.0%) cases. Among the 42 patients who underwent ERCP, technical success was achieved in 32 (76.2%) cases and clinical success was achieved in 27 (64.3%) cases. CONCLUSIONS: ERCP is an effective and safe therapeutic modality for bile leaks after liver transplantation. ERCP should be considered as an initial therapeutic modality in post-liver transplantation patients.

Tratamiento de estenosis sintomática de venas pulmonares secundaria a ablación por radiofrecuencia

El aislamiento de las venas pulmonares mediante la aplicación de radiofrecuencia es un tratamiento efectivo de la fibrilación auricular. Una de las complicaciones potenciales y de mayor compromiso clínico de esta técnica invasiva es la estenosis de una o varias venas pulmonares. Esta complicación puede ser tratada mediante angioplastia con o sin colocación de stent, logrando una adecuada mejoría clínica, aunque con un alto índice de recurrencia por re-estenosis.

Isolation of the pulmonary veins by applying radiofrequency is an effective treatment for atrial fibrillation. One of the potential complications with higher clinical compromise utilizing this invasive technique is the occurrence of stenosis of one or more pulmonary veins. This complication can be treated by angioplasty with or without stent implantation, with an adequate clinical improvement, but with a high rate of restenosis.

Two Cases of Electrocautery Incision Therapy Using an Insulated-tip Knife for Treatment of Symptomatic Benign Short-segment Colonic Stenosis Following Colonic Resection / 대한소화기학회지

Anastomotic stenosis of the colon is not an uncommon finding; however, its frequency varies from one study to another. Traditionally, postoperative colonic stenosis is managed surgically. However, endoscopic therapy has recently become the preferred treatment modality over traditional surgery. Good short-term success has been achieved with use of endoscopic balloon dilation; however, restenosis may occur over time in 14% to 25% of patients. The current report showed the effectiveness and usefulness of an insulated-tip knife (IT-knife) for electrocautery therapy of a patient with symptomatic anastomotic colonic stenosis.

Diagnóstico y tratamiento de las complicaciones biliares asociadas al trasplante hepático / Diagnosis and treatment of biliary complications associated with liver transplantation

Las complicaciones biliares se presentan en 10 - 25% de los pacientes que reciben un trasplante hepático y pueden causar una importante morbilidad e incluso la pérdida del injerto. Las complicaciones más comunes son la estenosis biliar (anastomótica y no anastomótica), fuga biliar y litiasis biliar. La gran mayoría de estas complicaciones puede tratarse con éxito mediante colangiopancreatografía retrógrada endoscópica. Esta revisión se centra en el diagnóstico, factores de riego y tratamiento endoscópico de las complicaciones biliares asociadas al trasplante hepático

Biliary complications ocurr in 10 - 25% of liver transplant recipients and are associated to a significant morbidity and the possibility of graft failure. The most common biliary complications are strictures (both anastomotic and non-anastomotic), bile leaks and stones. Most of these complications can be appropriately managed with endoscopic retrograde cholangiopancreatography. This article will review the diagnosis, risk factors, and endoscopic management of biliary complications related to liver transplantation

Guide wire dilatation of anastomotic strictures secondary to surgical repair of esophageal atresia

To evaluate the efficacy of esophageal guide wire dilatation of stricture after surgical treatment of esophageal atresia. This prospective and descriptive study was carried out at Department of Pediatric Surgery, The children's hospital, Pakistan Institute of Medical Sciences [PIMS], Islamabad from January 2008 to December 2011. It included 23 patients, 15 males and 8 females, aged one month to 3 years with esophageal stricture secondary to esophageal atresia who underwent guide wire esophageal dilatation with savary Gilliard Dilators. All procedures were performed under general anesthesia. Associated gastroesophageal reflux [GER]. was noted in 13 patients. Dilatation relieved the stricture in all patients over a follow-up period varying from 3 months to 3 years. Only two patients developed esophageal perforation, which was treated conservatively. Guide wire dilatation is a safe and effective method of treatment in the management of strictures secondary to surgical repair of esophageal atresia

Fully Covered Self Expandable Metal Stent for the Treatment of Benign Biliary Strictures / 대한소화기학회지

No abstract available.

Tratamiento extrauterino intraparto: manejo del recién nacido con síndrome de obstrucción congénita de la vía aérea superior: informe de un caso / Ex utero intrapartum treatment: management of neonatal congenital high airway obstruction syndrome: case report

En años recientes, el tratamiento extrauterino intraparto, que consiste en la intubación fetal extrauterina previa al nacimiento, ha adquirido relevancia en la reducción de la morbimortalidad de neonatos afectados por el síndrome de obstrucción congénita de la vía aérea superior. Caso clínico. Presentamos una madre con un feto de 22 semanas de gestación y diagnóstico de estenosis de la vía aérea, que anticipaba déficit ventilatorio fetal extraparto y derivó en la aplicación del tratamiento extrauterino intraparto para garantizar el intercambio gaseoso fetal en el momento del nacimiento. Conclusiones. La práctica oportuna del procedimiento extrauterino intraparto logró en este caso, mediante el control de los factores maternos y fetales que pudieran afectar la circulación feto-placentaria, el nacimiento de un niño cuya evolución inmediata y a largo plazo fue exitosa con desarrollo deuna vida normal.

In recent years, the ex utero intrapartum treatment (EXIT), that involves extrauterine fetal intubation prior to delivery, has become relevant for the reduction in morbidity and mortality of neonates affected by congenital high airway obstructionsyndrome (CHAOS). Clinical case. We report the case of the mother of an unborn child at pregnancy week 22, who was diagnosed a congenitalpulmonary malformation that precluded intrapartum fetal circulatory deficit and resulted in the conduction of an EXITtechnique, with the aim of ensuring fetal blood gas exchange at the time of delivery. Conclusions. A timely practice of the EXIT technique resulted, by monitoring both maternal and fetal factors that might affect fetoplacental circulation, in the birth of a child whoseimmediate and long-term outcomes were successful allowing the child live a normal life.

La enteroscopia asistida por balón es útil para diagnosticar las estenosis del intestino delgado / Balloon-assisted enteroscopy for small-bowel strictures

Describimos el caso de una mujer de 47 años tratada repetidamente en nuestra unidad de endoscopia por estenosis del intestino delgado por enfermedad de Crohn. El caso ejemplifica la combinación de distintas estrategias para el tratamiento de las estenosis del intestino delgado.

Percutaneous Intervention in Axillary Loop-Configured Arteriovenous Grafts for Chronic Hemodialysis Patients

OBJECTIVE: The purpose of this study was to evaluate the fistulographic features of malfunctioning axillary loop-configured arteriovenous grafts and the efficacy of percutaneous interventions in failed axillary loop-configured arteriovenous grafts. MATERIALS AND METHODS: Ten patients with axillary loop-configured arteriovenous grafts were referred for evaluation of graft patency or upper arm swelling. Fistulography and percutaneous intervention, including thrombolysis, percutaneous transluminal angioplasty and stent placement, were performed. Statistical analysis of the procedure success rate and the primary and secondary patency rates was done. RESULTS: Four patients had graft related and subclavian venous stenosis, two patients had graft related stenosis and another four patients had subclavian venous stenosis only. Sixteen sessions of interventional procedures were performed in eight patients (average: 2 sessions / patient) until the end of follow-up. An interventional procedure was not done in two patients with central venous stenosis. The overall procedure success rate was 69% (11 of 16 sessions). The post-intervention primary and secondary patency rates were 50% and 63% at three months, 38% and 63% at six months and 25% and 63% at one year, respectively. CONCLUSION: Dysfunctional axillary loop-configured arteriovenous grafts almost always had subclavian venous and graft-related stenosis. Interventional treatments are helpful to overcome this and these treatments are expected to play a major role in restoring and maintaining the axillary loop-configured arteriovenous loop grafts.

Endovascular Treatment for Iliac Vein Compression Syndrome: a Comparison between the Presence and Absence of Secondary Thrombosis

OBJECTIVE: To evaluate the value of early identification and endovascular treatment of iliac vein compression syndrome (IVCS), with or without deep vein thrombosis (DVT). MATERIALS AND METHODS: Three groups of patients, IVCS without DVT (group 1, n = 39), IVCS with fresh thrombosis (group 2, n = 52) and IVCS with non-fresh thrombosis (group 3, n = 34) were detected by Doppler ultrasonography, magnetic resonance venography, computed tomography or venography. The fresh venous thrombosis were treated by aspiration and thrombectomy, whereas the iliac vein compression per se were treated with a self-expandable stent. In cases with fresh thrombus, the inferior vena cava filter was inserted before the thrombosis suction, mechanical thrombus ablation, percutaneous transluminal angioplasty, stenting or transcatheter thrombolysis. RESULTS: Stenting was performed in 111 patients (38 of 39 group 1 patients and 73 of 86 group 2 or 3 patients). The stenting was tried in one of group 1 and in three of group 2 or 3 patients only to fail. The initial patency rates were 95% (group 1), 89% (group 2) and 65% (group 3), respectively and were significantly different (p = 0.001). Further, the six month patency rates were 93% (group 1), 83% (group 2) and 50% (group 3), respectively, and were similarly significantly different (p = 0.001). Both the initial and six month patency rates in the IVCS patients (without thrombosis or with fresh thrombosis), were significantly greater than the patency rates of IVCS patients with non-fresh thrombosis. CONCLUSION: From the cases examined, the study suggests that endovascular treatment of IVCS, with or without thrombosis, is effective.

Extravesical ureteral reimplantation in stricture lower end ureter

Ureteral stricture is a problem that always has confronted the surgeons. Traditionally, stricture occurs most often in the ureter injured at operation and repair of the stricture has been accomplished by open surgical management. The aim of the work was to evaluate the extravesical ureteral reimplantation in stricture lower end ureter. The study was carried out on 11 patients [8 males and 3 females] with stricture lower end ureter, selected from Al-Azhar University Hospital [New Damietta] between April 2005 to April 2007. All cases were submitted to full history taking, clinical examination and laboratory investigations [urine analysis, blood urea and serum creatinine]. Imaging studies in the form of abdominopelvic ultrasound and excretory urography both pre and postoperatively. In addition to ascending cystography postoperatively at 3, 9 and 18 months. Post operative follow up by Ultrasound revealed improvement in 8 patients out of 10 with pervious moderate hydronephrosis while 2 patients show stabilization. In one patient with severe hydronephrosis shows stabilization without further deterioration. Using excretory urography followup, 6 patients of grade II hydronephrosis and 4 patients of grade III hydronephrosis showed improvement while in one patient with grade IV hydronephrosis remained stabilized. Hospital stay ranged from 5 to 6 days. The results of the present study demonstrated that extravesical ureteral reimplantation is a reliable procedure with a low complication rate, and we have found that this approach is applicable to many different situations but is especially advantageous for ureteral tailoring and the vesical psoas hitch since retrovesical exposure is excellent

Implante de stent em estenose crítica no tronco celíaco: expandindo as fronteiras da intervenção vascular percutânea / Stent implantation in critical stenosis of the celiac trunk: enlarging the frontiers of percutaneous vascular intervention

A isquemia mesentérica sintomática está geralmente associada à aterosclerose grave e difusa das artérias viscerais, tornando-se uma situação clínica infreqüente e de difícil manejo. Descrevemos o caso de uma mulher, de 75 anos, com angina mesentérica incapacitante e estenose de 80% na origem do tronco celíaco, estenose de 50% proximal na artéria mesentérica superior e oclusão da artéria mesentérica inferior. Foi implantado um stent no óstio do tronco celíaco, com sucesso e sem complicações. Os sintomas regrediram já no 1º pós-operatório e a paciente permanece assintomática um ano após o procedimento, que consideramos seguro, eficaz e poderá se tornar o tratamento de escolha nesta doença.