Isquemia mesentérica aguda por disección espontánea y aislada de la arteria mesentérica superior / Mesenteric ischemia caused by a spontaneous and isolated dissection of the superior mesenteric artery

Spontaneous dissection of the superior mesenteric artery is an unusual cause of mesenteric ischemia. Diagnosis can be based on findings of the helicoidal computed tomography or selective angiography of the superior mesenteric artery. We report two male patients, aged 47 and 50 years, who were admitted for abdominal pain. Isolated superior mesenteric artery dissection was confirmed by angiography. Both patients were treated with anticoagulation, conservative measures and recovered uneventfully

Pseudoaneurisma traumático de troncos supra-aórticos: tratamiento endovascular: casos clínicos / Endovascular treatment of traumatic pseudoaneurysms of aortic arch branches: report of3 cases

The traditional treatment of traumatic lesions of the aortic arch branches requires extended surgical exposures, not exempt of morbidity and mortality. Over the last decade, devices that allow a minimally invasive treatment, have been developed. The vessel can be repaired without direct exposure, using an endovascular procedure. We report three patients with traumatic pseudoaneurysms of the left subclavian, brachiocephalic and left common carotid arteries, respectively. All lesions were successfully repaired with the insertion of an endograft. Although long term results of these procedure are unknown, repair of a future stenosis or occlusion is less complicated than the treatment required by the original lesion. Endoluminal repair appears as a safe, efficient and less invasive treatment for these lesions

Aneurisma roto de aorta torácica descendente: tratamiento endovascular / Endovascular treatment of a ruptured thoracic aorta aneurysm

In 1991, a technique to exclude aortic aneurysms from circulation inserting an endoluminal graft through the femoral artery, was described. This procedure, usually used for elective abdominal aneurysms, can also be used in the thoracic aorta. We report a 41 years old male with a Marfan syndrome, presenting with a descending aorta aneurysm that ruptured to the mediastinum and pleural cavity. He was compensated hemodynamically and an endovascular stent-graft was deployed at the ruptured zone, through the femoral artery. The postoperative evolution of the patient was uneventful. This technique will allow a less invasive treatment of ruptured aortic aneurysms

Terapia endovascular en el síndrome de vena cava superior: caso clínico / Endovascular treatment of superior vena cava syndrome: report of 1 case

The treatment of superior vena cava syndrome is usually oriented to the underlying cause, that can be too slow in emergency cases. We report a 49 years old woman with a multiple myeloma that was admitted due to a superior vena cava syndrome caused by a central venous catheter used for chemotherapy for 20 weeks. She was successfully treated with thrombolysis, angioplasty and stent placement. The patient died 7 months later due to the underlying disease. Long term catheters are the responsible for 20 to 30 percent of superior vena cava syndromes. Endovascular treatment of the syndrome is successful in 60 to 100 percent of cases with a symptomatic relapse in 4 to 45 percent of patients

Endarterectomía carotídea bajo anestesia regional: experiencia inicial / Carotid endarterectomy under regional anesthesia: initial experience

Background: Endarterectomy is the treatment of choice for internal carotid artery critical stenosis. Some authors have proposed that the use of regional anesthesia has advantages over general anesthesia. Aim: To report our initial experience with carotid endarterectomy under regional anesthesia. Patients and methods: Between 1998 and 1999, patients with critical carotid artery stenosis, asymptomatic or with transient and recovered symptoms, were selected. A C2, C3, C4 root deep cervical block and superficial block was performed, using a mixture of lidocaine and bupivacaine. A carotid endarterectomy with patch and without routine shunt insertion, with standard and neurological monitoring, was performed. Results: During the study period, 94 carotid endarterectomies were done, 22 under regional anesthesia in 21 patients (12 male, age range 58-90 years old). Ninety five percent had hypertension, 52 percent smoked and 38 percent had renal dysfunction. One patient was converted to general anesthesia. Seventeen patients were discharged within 48 hours of the procedure and the rest, within 72 hours. There was no mortality or complications. Conclusions: Endarterectomy under regional anesthesia is less invasive, has excellent results and is well accepted by patients

Trombosis venosa ilio-femoral: complicación infrecuente del aneurisma aorto-ilíaco en dos casos / Ilio femoral venous thrombosis: an infrequent complication of the aortic-iliac aneurysm in 2 cases

Death due to rupture of and abdominal aortic or iliac aneurysm, is their most frequent complication. We report two male patients, both over seventy years old, who presented with unexplained unilateral ilio-femoral deep vein thrombosis. During diagnostic work up an aortic and iliac aneurysm, compressing the deep venous system with secondary thrombosis, was found. In both patients a prophylactic inferior vena caval filter was inserted and standard elective surgery was then performed. No perioperative complications occurred and both patients remain asymptomatic during follow up. Deep vein thrombosis due to compression by an abdominal aortic and iliac aneurysm is infrequent. It must be ruled out together with intrabdominal cancer, in the elderly patient presenting with unexplained deep vein thrombosis

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

Tratamiento del aneurisma aórtico abdominal por vía endovascular: experiencia inicial / Endovascular treatment of abdominal aortic aneurysm: initial experience

Background: Thirty day mortality of current surgical treatment of abdominal aortic aneurysm is 0.7 to 5 percent. Coronary artery disease is the main risk factor in this elderly population. An alternative procedure based on the transfemoral deployment of self expandable prostheses to exclude the aneurysm, avoids a laparotomy and major surgical trauma, reducing the risks of the conventional operation. Aim: To report our experience on endovascular repair of abdominal aortic aneurysms. Patients and methods: Nine consecutive patients aged 66 to 82 years old, possible candidates for the procedure, were studied. Results: Only four patients fulfilled the requirements for the procedure, which was technically successful in three. One patient was converted to an open surgical repair. Patients were discharged 72-96 hours after graft implantation. The postoperative CAT scan confirmed total exclusion of the aneurysm by the endovascular graft. All nine patients are alive at the time of this report. Conclusions: Given certain anatomical conditions, endovascular treatment of abdominal aortic aneurysms is an attractive alternative for high risk patients

Interrupción de vena cava inferior mediante filtros: indicaciones y resultados en 111 pacientes / Inferior cava vein filters: indications and results in 111 patients

Background: Anticoagulation is the treatment of choice for deep vein thrombosis and pulmonary embolism. Occasionally this treatment is contraindicated or fails to prevent pulmonary embolism. In these patients, inferior cava vein interruption is indicated and filter insertion is the procedure commonly performed. Aim: To report the results of inferior cava vein filter insertions in 111 patients. Patients and methods: A retrospective review of patients in whom inferior cava vein filters were inserted was performed. Results: During the period 1983-1997, filters were inserted in 111 patients (56 female) aged 15 to 93 years old. Indications were pulmonary embolism with contraindication or failure of anticoagulation therapy or poor respiratory function (58 patients), deep vein thrombosis and contraindication for anticoagulation (32 patients) and other indications in 20 patients. In 47 patients, treated before 1993, the insertion required a cut-down. Since then, a percutaneous approach was used in the remaining 64 cases. Three insertion attempts failed, all using cut-down. One of these patients died due to a massive pulmonary embolism. In 88 per cent of the patients the jugular vein was the access site and in 10 patients, the filter was deliberately deployed above the renal veins. There was no mortality or complications. Patients were followed during a maximal period of 147 months and 27 died of unrelated disorders. Survival at 5 and 10 years was 63 and 47 per cent respectively. Symptomatic inferior cava vein obstruction was detected in 5 patients during the follow up period. Conclusions: Inferior cava vein filter insertion is a safe measure to prevent pulmonary embolism and its consequences

Aneurisma aórtico abdominal: tratamiento quirúrgico y tratamiento endovascular: estado actual / Abdominal aortic aneurysms: surgical and endovascular treatment: current state

El tratamiento convencional del aneurisma aórtico abdominal (AAA) es el reemplazo quirúrgico de la aorta dilatada por una prótesis de dacrón. En los últimos años, el control de los factores de riesgo y el progreso en el manejo perioperatorio ha disminuido la mortalidad quirúrgica al 0,7-5 por ciento. La sobrevida alejada alcanza a 70 por ciento a 5 años, con una muy baja incidencia de complicaciones relacionadas con el reemplazo protésico. La introducción en 1990 de una técnica alternativa que evita la laparotomía, reemplazando el AAA por una prótesis instalada por vía endovascular, ha alcanzado un grado de desarrollo que la convierte en una alternativa particularmente atractiva en pacientes que presentan condiciones anatómicas favorables. Los riesgos y complicaciones inicialmente elevados, se han reducido al seleccionar apropiadamente los candidatos y con el uso de las nuevas endoprótesis. Se desconocen los resultados alejados en el tiempo y ciertamente los costos resultan aún elevados. Sin embargo, esta nueva técnica constituye un aporte importante para el tratamiento del AAA

Revascularización infrapoplítea con prótesis de PTFE y fístula arteriovenosa distal / Infrapopliteal revascularization with prosthesis of PTFE and distal arteriovenous fistula

El tratamiento de la isquemia crítica de extremidad inferior es la revascularización. Si el vaso a revascularizar es distal a la arteria poplítea, el conducto ideal para la construcción del puente es la vena safena. Ocasionalmente no se cuenta con vena y debe utilizarse prótesis, obteniendo una permeabilidad alejada inferior. Para mejorar esto, se ha sugerido realizar una fístula arteriovenosa en la anastomosis distal. Durante 2 años hemos intervenido 4 pacientes, todos hombres y edad promedio 67 años. La indicación quirúrgica fue gangrena en 2 pacientes y dolor de reposo en los restantes. Las anastomosis distales se ubicaron en el tercio distal de la pierna, asociándose una fístula arteriovenosa localmente. No hubo complicaciones locales ni mortalidad operatoria. Todos cicatrizaron sus úlceras o resolvieron el dolor de reposo. El seguimiento ha sido completo (promedio 10,2 meses, rango 4-24), todos se rehabilitaron y sus puentes están permeables

Aneurismas micóticos y embolías múltiples en una paciente con endocarditis infecciosa / Mycotic aneurysms and multiple emboli in a patient with infectious endocarditis

Sepsis from an infected cardiac value can lead to bacterial seeding and destruction of the arterial wall with formation of a mycotic aneurysm. The natural history of these lesions is the rupture. We report the case of a 20 year old female who was admitted to our institution with massive mitral regugirtation and emboli of the central nervous system and both lower extremities. She underwent emergency valve replacement and then, staged treatment of her ischmic legs and multiple asymptomatic mycotic aneurysms. Superior mesenteric, right common iliac and left superficial femoral arteries. A splenectomy was required to treat a splenic abscess. An aneurysm of a peripheral branch of the middle cerebral artery was medically treated, demonstrating reduction in size on subsequente angiogram.She recoverd uneventfully and remains asymptomatic after 20 months of follow up. The development of new diagnostic and therapeutic tools had led to a decrease ot these complications during infectious endocarditis. However, in the patient with late diagnosis and symptoms in different territories, the mycotic aneurysm must be kept in mind to provide the patient with appropriate treatment