Embolización de un aneurisma micótico de la arteria mesentérica superior: reporte de un caso / Mycotic aneurysm of the superior mesenteric artery coil embolization: case report

Resumen Objetivo: Presentar un caso clínico infrecuente, con una resolución novedosa. Caso Clínico: Paciente con aneurisma micótico de la arteria mesentérica superior manejado satisfactoriamente en forma endovascular. Los aneurismas micóticos viscerales son entidades infrecuentes, con alta morbimortalidad. Es por ello que su manejo debe ser multidisciplinario y considerar diferentes factores al momento de tomar decisiones. En el contexto de la continua mejoría y disponibilidad de las técnicas endovasculares, estas han emergido como una opción terapéutica válida, con posiblemente menos complicaciones. Conclusión: La resolución endovascular del aneurisma micótico visceral es factible, pero su indicación y el manejo completo es aún caso a caso.

Objective: to discuss an infrequent vascular case with a novel resolution. Case Report: Superior mesenteric artery mycotic aneurysm successfully managed with coil embolization. A visceral mycotic aneurysm is an infrequent vascular pathology with high risk of complications and mortality. The endovascular management might offer a treatment option with lower morbimortality rates in selected cases. Conclusion: Endovascular resolution of mycotic visceral aneurysms is both feasible and secure but it must be done in a case to case basis.

Manejo endovascular de las complicaciones agudas de la disección aórtica tipo B / Endovascular management of acute complications of type b aortic dissection

Background: Type B aortic dissection is usually managed by intensive care medical therapy and surgery is reserved for treating the complications that can occur during the evolution of a case. Aim: To assess the endovascular management of acute complications of type B aortic dissection and the closure of the intimal defect and aortic false lumen. Material and Methods: Retrospective analysis of 8 consecutive patients aged 40 to 57 years (seven males) treated for acute complications in the initial episode of a type B aortic dissection between August 2006 and July 2008. Results: Six/eight were known hypertensive patients. The indications for surgery were intractable pain in one, hypertension refractory to treatment in two and distal hypoperfusion in fve. Five patients required covering of the left subclavian artery ostium, without need for surgical repair. One patient was subjected to renal angioplasty and stenting. Technical success was achieved in all cases, with complete closure of the proximal aortic tear and thoracic aortic false lumen, although 7 of patients had a persistent distal aortic false lumen. One case had a transient lower limb paraparesis. No patient died. Conclusions: Endovascular treatment is effective in closing the aortic tear as well as the thoracic aortic false lumen in aortic type B dissections with a low complication rate. Due to the high frequency of distal aortic false lumen persistence, it is not a defnitive treatment for this condition but it is useful for the acute complications of the initial phase of type B aortic dissection.

Atrapamiento de la arteria poplítea: Comunicación de un caso / Popliteal artery entrampment: Report of one case

Popliteal artery entrampment is a rare condition, occurring in young subjects, that causes ischemia of the extremity. The anatomical background is the compression or occlussion of the popliteal artery caused by forced plantar or dorsal flexion. We report a 32 year-old sportsman who presented with gangrene of the right first toe and a history of three months of progressive claudication. The Ankle-Brachial index and pulse volume curve registries showed a severe ischemia below the knee. Angiography showed a medial deviation of the popliteal artery associated to stenosis and aneurysm formation. A CT scan of the contralateral artery was normal. The patient was operated using a posterior approach, performing a reverse saphenous vein bypass graft and excising the popliteal artery. The postoperative period was uneventful.

Calidad de atención evaluada por pacientes operados / Quality of medical attention evaluated by surgery patients

En el presente estudio se encuestaron 279 pacientes operados de patología herniaria y colelitiasis en un período de 5 meses, acerca de satisfacción por la atención recibida durante la hospitalización el grado de información y conocimiento entregado por el médico tratante respecto a su patología. El 92,1 por ciento de los pacientes contestó la encuesta. Del total de pacientes el 79,4 por ciento conocía el nombre de su cirujano y este porcentaje baja a 66,7 por ciento si se trata de cirugía de urgencia. Preguntados acerca de la naturaleza de su enfermedad a los pacientes (benigna o maligna) sólo un 61,5 por ciento de los operados en urgencia sabían la naturaleza de su enfermedad, en compración con un 80 por ciento de aquellos operados en forma electiva. Con respecto a la entrega de licencia médica por el cirujano tratante, ésta sólo ocurrió en el 61 por ciento de quienes la requerían. El porcentaje fue significativamente menor en los pacientes operados de patología herniaria. Por último y a pesar de lo anterior, una gran mayoría de los pacientes evalúan la calidad de la atención global como buena o muy buena. Es necesario mejorar la cercanía del médico con su paciente en especial cuando se trata de atención de urgencia.

Aneurisma de la vena poplítea / Popliteal vein aneurysm: report of one case

The popliteal vein aneurysm is a rare condition that can lead to local symptoms, thrombosis and pulmonary embolism. We report the case of a 67 years old, otherwise healthy white male, who presented to us with localised swelling and pain in the left popliteal fossa. Duplex ultrasound and venography were obtained, confirming the diagnosis of popliteal vein aneurysm. The patient underwent tangential aneurysmectomy and lateral venorrhaphy, recovery was uneventful remaining asymptomatic. The reconstruction was demonstrated patent on a duplex scan. The popliteal vein aneurysm is a potentially fatal condition for which surgical treatment is recommended