Predictive value of Pv-aCO 2/Ca-vO 2 combined blood lactate concentration for primary peritonitis-related septic shock in children / 中华危重病急救医学

Objective:To investigate the prognostic value of the ratio of veno-arterial carbon dioxide partial pressure difference to arterio-venous oxygen content difference (Pv-aCO 2/Ca-vO 2) in children with primary peritonitis-related septic shock. Methods:A retrospective study was conducted. Sixty-three children with primary peritonitis-related septic shock admitted to department of intensive care unit of the Children's Hospital Affiliated to Xi'an Jiaotong University from December 2016 to December 2021 were enrolled. The 28-day all-cause mortality was the primary endpoint event. The children were divided into survival group and death group according to the prognosis. The baseline data, blood gas analysis, blood routine, coagulation, inflammatory status, critical score and other related clinical data of the two groups were statistics. The factors affecting the prognosis were analyzed by binary Logistic regression, and the predictability of risk factors were tested by the receiver operator characteristic curve (ROC curve). The risk factors were stratified according to the cut-off, Kaplan-Meier survival curve analysis compared the prognostic differences between the groups.Results:A total of 63 children were enrolled, including 30 males and 33 females, the average age (5.6±4.0) years old, 16 cases died in 28 days, with mortality was 25.4%. There were no significant differences in gender, age, body weight and pathogen distribution between the two groups. The proportion of mechanical ventilation, surgical intervention, vasoactive drug application, and procalcitonin, C-reactive protein, activated partial thromboplastin time, serum lactate (Lac), Pv-aCO 2/Ca-vO 2, pediatric sequential organ failure assessment, pediatric risk of mortality Ⅲ in the death group were higher than those in the survival group. Platelet count, fibrinogen, mean arterial pressure were lower than those in the survival group, and the differences were statistically significant. Binary Logistic regression analysis showed that Lac and Pv-aCO 2/Ca-vO 2 were independent risk factors affecting the prognosis of children [odds ratio ( OR) and 95% confidence interval (95% CI) were 2.01 (1.15-3.21), 2.37 (1.41-3.22), respectively, both P < 0.01]. ROC curve analysis showed that the area under curve (AUC) of Lac, Pv-aCO 2/Ca-vO 2 and their combination were 0.745, 0.876 and 0.923, the sensitivity were 75%, 85% and 88%, and the specificity were 71%, 87% and 91%, respectively. Risk factors were stratified according to cut-off, and Kaplan-Meier survival curve analysis showed that the 28-day cumulative probability of survival of Lac ≥ 4 mmol/L group was lower than that in Lac < 4 mmol/L group [64.29% (18/28) vs. 82.86% (29/35), P < 0.05]. Pv-aCO 2/Ca-vO 2 ≥ 1.6 group 28-day cumulative probability of survival was less than Pv-aCO 2/Ca-vO 2 < 1.6 group [62.07% (18/29) vs. 85.29% (29/34), P < 0.01]. After a hierarchical combination of the two sets of indicator variables, the 28-day cumulative probability of survival of Pv-aCO 2/Ca-vO 2 ≥ 1.6 and Lac ≥ 4 mmol/L group significantly lower than that of the other three groups (Log-rank test, χ2 = 7.910, P = 0.017). Conclusion:Pv-aCO 2/Ca-vO 2 combined with Lac has a good predictive value for the prognosis of children with peritonitis-related septic shock.

Aneurisma venoso yuxta-anastomótico en fístula arterio-venosa para hemodiálisis / Juxtaanastomotic venous aneurysm in arteriovenous fistula for hemodialysis

Introducción: A pesar del gran avance técnico que representan las fístulas arterio-venosas internas para la hemodiálisis, estas no están exentas de complicaciones que comprometen su durabilidad. Entre ellas se encuentran los aneurismas venosos yuxta-anastomóticos. Objetivo: Presentar el tratamiento quirúrgico utilizado para reparar los aneurismas venosos yuxta-anastomóticos. Presentación del caso: Paciente de 54 años, de género femenino y color de piel negra. Presentó antecedentes de padecer insuficiencia renal crónica de 12 años de evolución, con transplante renal fallido, la cual tuvo un aneurisma venoso yuxta-anastomótico, localizado en una fístula arterio-venosa húmero-cefálica en miembro superior izquierdo, que fue confirmado por eco-doppler. Se emplearon como tratamiento quirúrgico la aneurismectomía y el injerto por sustitución con prótesis vascular expandible de poli-tetrafluoretileno. Finalmente, se preservó la fístula arterio-venosa, así como su permeabilidad. Conclusiones: La evolución fue satisfactoria en cuanto a su durabilidad y utilización como vía de acceso para la hemodiálisis(AU)

Introduction: Despite the great technical advance represented by internal arterio-venous fistulas for hemodialysis, these are not exempt from complications that compromise their durability. Among them are juxtaanastomotic venous aneurysms. Objective: Present the surgical treatment used to repair juxtaanastomotic venous aneurysms. Case presentation: 54-year-old patient, female and black skin color. She presented a history of chronic renal failure of 12 years of evolution, with failed kidney transplant, which had a juxtaanastomotic venous aneurysm, located in a humerus-cephalic arterio-venous fistula in the left upper limb, which was confirmed by Doppler echo. Aneurysmectomy and replacement grafting with expandable polytetrafluorethylene vascular prostheses were used as surgical treatment. Finally, the arterio-venous fistula was preserved, as well as its permeability. Conclusions: The evolution was satisfactory in terms of durability and use as an access route for hemodialysis(AU)

Funcionabilidad y durabilidad de fístulas arterio-venosas para hemodiálisis en pacientes no diabéticos / Functionability and durability of arterio-venous fistulas for haemodialysis in non-diabetic patients

Introducción: Existe un incremento anual de pacientes con insuficiencia renal crónica tributarios a hemodiálisis. Para la realización de esta se requiere de la correcta inserción de accesos vasculares que sean duraderos y funcionales. Objetivo: Caracterizar la durabilidad y funcionabilidad de las fístulas arterio-venosas en pacientes no diabéticos con enfermedad renal crónica. Métodos: Se realizó un estudio ambispectivo en 60 pacientes no diabéticos, con enfermedad renal crónica, portadores de una fístula arterio-venosa interna autóloga. Se describieron las variables: edad, sexo, grado de la enfermedad, lugar de confección, durabilidad, funcionabilidad, intentos, superficialización, uso de prótesis de poli-tetra-fluoro-etileno y complicaciones. Resultados: La edad media de los pacientes fue de 55,7 ± 12,7 años y la mitad estuvo entre 40 y 59 años. Los del sexo masculino ocuparon el 71,7 por ciento. Las fístulas duraderas (66,7 por ciento) y las funcionales (71,7 por ciento) se mostraron como las de mayor aparición. Los pacientes con la enfermedad en grado 4 ocuparon el 51,7 por ciento. Las fístulas en zonas radio-cefálica (43,3 por ciento) y húmero-cefálica (45 por ciento) primaron. Solo el 71,7 por ciento tuvo un intento de cirugía. Únicamente en el 20 por ciento se realizó superficialización y cuatro pacientes (6,4 por ciento) recibieron prótesis de poli-tetra-fluoro-etileno. La trombosis representó la complicación más frecuente (25 por ciento). Conclusiones: La durabilidad y la funcionabilidad de las fístulas elaboradas se asociaron con factores como el grado de la enfermedad, el número de intentos, el uso de prótesis vasculares y las complicaciones(AU)

Introduction: There is an annual increase of patients with chronic renal impairment who need haemodialysis. The correct insertion of vascular accesses that are durable and functional is required to perform haemodialysis. Objective: Characterize the durability and functionability of arterio-venous fistulas in non-diabetic patients with chronic kidney disease. Methods: An ambispective study was conducted in 60 non-diabetic patients, with chronic kidney disease carrying an autologous internal arterio-venous fistula. The described variables were: age, sex, stage of the disease, place of manufacture, durability, workability, attempts, superficialization, use of polytetrafluoroethylene prostheses, and complications. Results: The average age of patients was 55.7 ± 12.7 years and half were between 40 and 59 years old. Males were 71.7 percent. Durable (66.7 percent) and functional (71.7 percent) fistulas were shown as the most common ones. Patients with a grade 4 disease represented the 51.7 percent. Fistulas in radio-cephalic zones (43.3 percent) and humerus-cephalic zone (45 percent) prevailed. Only 71.7 percent had an attempt of surgery. Only 20 percent had superficialization and four patients (6.4 percent) received polytetrafluoroethylene prostheses. Thrombosis was the most common complication (25 percent). Conclusions: The durability and functionability of the prepared fistulas were associated with factors such as the stage of the disease, the number of attempts, the use of vascular prostheses, and the complications(AU)

Caracterización de los pacientes con fístulas arterio-venosas para hemodiálisis / Description of patients with arterio-venous fistulas for haemodialysis

Introducción: La fístula arterio-venosa para hemodiálisis es el acceso vascular utilizado con mayor frecuencia. De su adecuada funcionalidad depende la calidad de vida de los pacientes con enfermedad renal crónica. Objetivo: Caracterizar a los pacientes a los que se les confeccionó fístulas arterio-venosas para hemodiálisis. Métodos: Se realizó un estudio descriptivo retrospectivo en 73 pacientes, a los que se les confeccionó una fístula arterio-venosa para hemodiálisis. Las variables de estudio fueron: edad, sexo, tipo de fístula arterio-venosa, localización, complicaciones y tratamiento quirúrgico de las complicaciones. Resultados: Se encontró un predominio del sexo masculino y del grupo etario entre 51 y 60 años. El 94,6 por ciento de las fístulas realizadas fueron autólogas; y, de estas, el 44,1 por ciento, radio-cefálicas. El 27,3 por ciento de las autólogas y el 20 por ciento de las protésicas se presentó trombosis, y el 18,2 por ciento y el 40 por ciento presentaron hipertensión venosa para las autólogas y protésicas, respectivamente. El 43,5 por ciento de los tratamientos realizados frente a las complicaciones resultó la confección de una nueva fístula. Conclusiones: Los pacientes a los que se les confeccionó fístulas arterio-venosas eran predominantemente adultos mayores del sexo masculino y las fístulas más realizadas fueron las autólogas radio-cefálicas. Como principal complicación de las fístulas se encontró la trombosis y se realizaron escasos procederes para el rescate de estas(AU)

Introduction: Arterio-venous fistula for haemodialysis is the most commonly used vascular access. Its proper functionality depends on the quality of life of patients with chronic kidney disease. Objective: Describe patients to whom were made arterio-venous fistulas for haemodialysis. Methods: A retrospective descriptive study was conducted in 73 patients to whom were made an arterio-venous fistula for haemodialysis. The study variables were: age, sex, type of arterio-venous fistula, location, complications and surgical treatment of complications. Results: It was found a predominance of male sex and the age group of 51 to 60 years. 94.6 percent of the fistulas made were autologous; and, of these, 44.1 percent were radio-cephalic. 27.3 percent of the autologous fistulas and 20 percent of the prosthetics ones developed thrombosis, and 18.2 percent and 40 percent showed venous hypertension for autologous and prosthetic fistulas, respectively. 43.5 percent of the treatments performed to face complications resulted in the making of a new fistula. Conclusions: The patients to whom were made arterio-venous fistulas were predominantly older adults of the male sex and the most performed fistulas were the radio-cephalic autologous. As the main complication of fistulas, thrombosis was found and a few practices were performed to rescue them(AU)

Giant complicated glosso-cervical arterio venous malformation managed with external carotid artery ligation and serial injection sclerotherapy: a case report and review of literature

Giant arterio venous malformation (AVM) of the tongue and floor of mouth are rare. They become life threatening when ignored by the patients. Treatment protocols are not well established. This report describes the treatment of a 35 years old female who presented to us with complains of swelling of tongue, floor of mouth and left sub mandibular region since 15 years causing dysphagia, and oral bleed since one day. Magnetic resonance Angiography revealed a giant AVM at the above site with dilated left external carotid artery (ECA) and left lingual artery. Patient underwent ECA ligation under general anaesthesia and serial injection sclerotherapy at the local site. After 3 months and 6 cycles of sclerotherapy, the patient had a satisfactory outcome. A detailed report with review of literature is presented.

Diagnóstico y tratamiento histeroscópico de una paciente posmenopáusica con fístula arteriovenosa uterina / Hysteroscopy diagnosis and management of uterine arterio-venous fistula in a postmenopausal woman

Resumen ANTECEDENTES: La fístula arteriovenosa uterina es una de las malformaciones vasculares más frecuentes. El sangrado vaginal abundante es un signo sugerente de este tipo de alteración. CASO CLÍNICO: Paciente de 51 años, acudió al servicio de Urgencias debido a un sangrado vaginal abundante de un mes de evolución. En la exploración física se objetivaron los genitales externos y la vagina normales, y el útero ligeramente aumentado de tamaño. La ecografía transvaginal con Doppler color solo reportó aumento de la vascularización uterina. La histeroscopia diagnóstica confirmó la coexistencia de una fístula arteriovenosa uterina. La histeroscopia quirúrgica se practicó con espéculo, pinza de Pozzi, dilatación con tallos de Hegar (9'5), coagulación con histeroscopio Storz, asa de Collins, con energía bipolar a 45 watt y suero fisiológico como medio de distensión. La malformación arteriovenosa se coaguló en diversas zonas anatómicas, hasta conseguir la obstrucción completa de la fístula. El posoperatorio trascurrió sin contratiempos. El seguimiento de la paciente fue satisfactorio, hasta la fecha no manifiesta síntomas adicionales de la alteración. CONCLUSIONES: La histeroscopia es un método efectivo, de mínima invasión y con escasa morbilidad para establecer el diagnóstico y tratamiento de las malformaciones vasculares uterinas.

Abstract BACKGROUND: Uterine arterio-venous fistula is one of the most frequent vascular malformations. A heavy vaginal bleeding should make us suspect the presence of this type of vascular malformation. CLINICAL CASE: A 51-years-old patient was admitted in Emergency Service for heavy vaginal bleeding of one month of evolution. On physical examination, external genitalia and vagina were normal but uterus had slightly increased in size. A transvaginal ultrasound with color Doppler was performed where an increase in uterine vascularization was shown. Subsequently, an office hysteroscopy was carried out confirming the diagnosis of uterine arterio-venous fistula. After a correct anesthetic evaluation, a surgical hysteroscopy was performed, using speculum, Pozzi clamp, dilation with Hegar stems up to number 9.5, coagulation resectoscope Storz Gyrus with Collins loop handle with bipolar energy at 45 watt of coagulation and physiological saline, as a means of relaxation. The arterio-venous malformation was coagulated at several levels until the obliteration of the fistula was completed. The postoperative period was favorable. In the subsequent follow-up in consultation, the patient continues asymptomatic. CONCLUSION: Hysteroscopy is an effective, minimally invasive method with low morbidity to establish the diagnosis and treatment of vascular malformations.

Percutaneous intervention for symptomatic central vein stenosis in patients with upper limb arteriovenous dialysis access

Central venous stenosis is an important hindrance to long-term maintenance of arteriovenous access in the upper extremities in dialysis patients. Aim The present study was done to determine feasibility and clinical success of endovascular approach for the treatment of symptomatic central venous stenosis associated with significant ipsilateral limb edema in dialysis patients with vascular access in the upper limb. Methods A database of hemodialysis patients who underwent endovascular treatment for central venous stenosis from January 2014 to January 2017 at our institute was retrospectively reviewed. Follow-up was variable. Results The study included ten patients (6 men and 4 women) with a mean age of 45.2 years, who underwent thirteen interventions during a period of 3 years. The technical success rate for endovascular treatment was 100%. One patient underwent primary PTA (percutaneous transluminal angioplasty). Seven patients underwent primary PTA and stenting. Three patients underwent secondary PTA. One among these patients underwent secondary PTA twice along with fistuloplasty. One patient underwent secondary PTA with stenting. No immediate complications were encountered during the procedure. Our study shows a primary patency rate of 67% and 33% at 6 months and 12 months for PTA with stenting. Our study also shows secondary or assisted primary patency of 75% at 6 months of follow-up. Conclusions Endovascular therapy (PTA) with or without stenting for central venous stenosis is safe, with low rates of technical failure. Multiple additional interventions are the rule and long-term patency rate is not very good.

Telangiectasia hemorrágica hereditaria: a propósito de un caso clínico / Hereditary hemorrhagic telangiectasia: on the subject of a clinical case

La epistaxis, es un síntoma frecuente en la consulta de otorrinolaringología. Dentro de las causas posibles encontramos la telangiectasia hemorrágica hereditaria (síndrome de Rendu Osler Weber), que corresponde a un desorden autosómico dominante caracterizado por sangrados nasales y gastrointestinales asociados a malformaciones arteriovenosas sistémicas. Su manifestación más frecuente es la epistaxis, presentándose más frecuentemente en personas mayores de 40 años, sin predilección por género. Se presenta el caso de un paciente de sexo masculino de 46 años quien consulta por epistaxis a repetición y severa. Durante la hospitalización se efectúa el tratamiento convencional de la epistaxis, diagnóstico retroactivo del síndrome de Rendu Osler Weber y manejo multidisciplinario de la patología. Se realiza revisión de la literatura y discusión del manejo del paciente que cursa con esta enfermedad.

Epistaxis is a common symptom in the otorhinolaryngology consultation. Among the possible causes are hereditary hemorrhagic telangiectasia (Rendu Osler Weber syndrome), which corresponds to an autosomal dominant disorder characterized by nasal and gastrointestinal bleeding associated with systemic arteriovenous malformations. Its most frequent manifestation is epistaxis, presenting more frequently in people over 40 years of age, without gender preference. We present the case of a male patient of 46 years old who consults for recurrence and severe epistaxis. During hospitalization, conventional treatment of epistaxis, retroactive diagnosis of Rendu Osler Weber syndrome and multidisciplinary management of pathology are performed. We review the literature and discuss the management of patients with this disease.

Fístulas arterio-venosas trombosadas para hemodiálisis y su tratamiento / Thrombosed hemodyalisis arteriovenous fistulae and their treatment

Introducción: La trombosis constituye la principal causa de disfunción y pérdida de las fístulas arterio-venosas para hemodiálisis. Objetivo: actualizar los aspectos relacionados con los principales tratamientos de las fístulas arterio-venosas trombosadas. Fuente de los datos: Se realizó la búsqueda de artículos sobre el tema en la base de dato Medline, artículos publicados en páginas web y revistas líderes en la publicación de estudios sobre fístulas arterio-venosas para hemodiálisis. Síntesis de los datos: La trombosis es la complicación más frecuente de las fístulas arterio-venosas, su principal causa lo constituyen los errores técnicos en la trombosis precoz y las estenosis en las tardías. Conclusiones: La repermeabilización precoz de las fístulas arterio-venosas y tratar las estenosis en el mismo acto quirúrgico, es lo que se recomienda. Para tales fines se cuenta con las técnicas quirúrgicas identificadas como el gold standard y las endovasculares, con resultados alentadores(AU)

Introduction: Thrombosis is the most frequent cause of dysfunction and loss of hemodyalisis arteriovenous fistula. Objective: To update knowledge on the epidemiology, the characteristics and the main treatments of the thrombosed hemodyalisis arteriovenous fistulae. Data source: A literature research about the topic was made in Medline, in articles published in different web pages and in leading journals in the publication of studies about hemodialysis arteriovenous fistula. Data synthesis: Thrombosis is the most frequent complication of the arteriovenous fistula, being the technical errors the main cause of premature thrombosis and the stenosis in the late thrombosis. Conclusions: It is recommended to use early repermeabilization of the arteriovenuos fistulae and to treat stenosis in the same surgical act; for that purpose the surgical treatment identified as the "standard gold" and the endovascular technique achieve encouraging results(AU)

Congenital Lymphatic Malformation

Lymphatic malformation is one of common benign disease in head and neck lesion. It frequently arises from oral cavity, pharynx, skin, and mediastinum. Huge lymphatic malformation may result in dysfunction of vital structure. Lymphatic malformation, which has commonly ill-defined margin, would affect surrounding structures which include upper aero-digestive tract with unresectable margin. Lymphatic malformation is mainly treated with conservative methods. Recently, various treatment modalities have been introduced. So, we intended to describe this disease entity with the review of recent literature.

Monochorionic diamniotic twin pregnancy with selective IUGR type 2: fetoscopic and sonographic findings of ominous prognosis / Gestación gemelar monocorial complicada con RCIU selectiva tipo 2: hallazgos ecográficos y fetoscópicos de mal pronóstico

A woman with a monochorionic diamniotic twin pregnancy was referred to our Centre due to a discrepancy in size between the foetuses. She was 17 weeks' pregnant when the diagnosis of selective IUGR type 2 was made and the laser ablation of the placental anastomoses was performed. During the fetoscopy, we identified an arterio-venous anastomosis with bidirectional flow, which is atypical in this type of anastomoses (unidirectionals) and could represent a sign of ominous prognosis for the restricted twin.

Presentamos el caso de una gestante de 17 semanas con una gestación gemelar monocoriónica biamniótica complicada con RCIU selectivo tipo 2 que requirió, de acuerdo a criterios ecográficos, ablación quirúrgica láser de las anastomosis placentarias. Se identificó durante la fetoscopia una anastomosis arterio-venosa que mostraba flujo bidireccional lo cual es sumamente inusual en este tipo de anastomosis, no reportado antes en la literatura, constituyendo así un signo de mal pronóstico para el gemelo pequeño.

Posterior Knee Pain: An Unusual Cause.

The pain around the posterior knee called ‘popliteal fossa’ has been known to be caused by a variety of disease entities. Whatever the causes, the challenge remains in diagnosis. Proper history and clinical examination followed by uses of appropriate diagnostic tools are secrets to success. Venous malformation is a very rare cause of pain in popliteal area and its diagnosis is frequently delayed, missed or given incorrectly. Here, we report a case of a 24-year-old patient who presented with posterior knee pain for 2 years and was diagnosed as a case of intramuscular arterio-venous malformation by lower limb angiography. This patient was treated successfully by surgical resection. His follow-up was satisfactory with no evidence of recurrence.

Telangiectasia hemorrágica hereditaria Síndrome de Osler Weber Rendú y manejo con bevacizumab / Hereditary hemorrhagic telangiectasia Osler Weber Rendu syndrome and management with bevacizumab

Presentamos un caso clínico de una paciente con diagnóstico de telangiectasia hemorrágica hereditaria con múltiples manifestaciones sistémicas debidas a sangrados profusos, anemia severa y malformaciones arteriovenosas pulmonares, hepáticas y falla cardiaca de alto débito, con adecuada respuesta al uso de bevacizumab. (Acta Med Colomb 2015; 40: 66-68).

The case of a patient diagnosed with hereditary hemorrhagic telangiectasia with multiple systemic manifestations due to profuse bleeding, severe anemia and pulmonary arteriovenous malformations, liver and heart failure high debit adequate response to the use of bevacizumab, is presented. (Acta Med Colomb 2015; 40: 66-68).

Association of Blood Group O with Gastrointestinal Bleeding in Continuous-Flow LVAD Patients.

Background: Increasing use of mechanical circulatory devices for advanced heart failure therapy has led to challenges in managing complications that arise from device implantation for long term support either as a bridge to transplant or as destination therapy. Patients with continuous flow left ventricular assist devices (CF-LVADS) show increasing incidence of gastrointestinal (GI) bleeds. Lack of pulsatality and narrow pulse pressure result in initiation and progression of arteriovenous malformations. High shear forces generated lead to destruction of von Willebrand factor (vWF) making it functionally inactive predisposing patients to increasing bleeding. Literature suggests that patients with blood type O have lower baseline levels of von Willebrand factor. It therefore seemed relevant to study the role of blood groups in this population. Methodology: Retrospective data analysis of 119 CF-LVADS patients discharged between 01/2005 and 07/2014. This study was approved by the Institutional Review Board on 08/01/2014. Results: Blood type (p=0.23), gender (p=0.16) and the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile (p=0.86) were not associated with significant incidence of GI bleeding. Blood group O was not associated with a higher incidence of GI bleeding (correlation coefficient =0.07) Patients supported on the HeartMate II (HMII) LVAD experienced more GI bleeding than patients supported on the HeartWare LVAD (HVAD) (p=0.009). HMII LVAD patients who experienced GI bleeding had a mean age of 59.8 years vs. 55.7 years for HMII LVAD patients in the Non-GI bleed group. Age was a significant factor for GI bleeding (p=0.016). Conclusion: Blood group and GI bleeding did not show any significant association in our study. Patients with blood group O did not show increased incidence of GI bleeding despite reported lower baseline levels of von Willebrand factor suggesting contribution of additional factors leading to this complication. The HVAD had a decreased incidence of GI bleeding as compared to Heartmate II. This study is limited by the fact that it was a retrospective analysis in a small population.

Malformaciones arteriovenosas. Revisión y análisis estadístico de 52 MAVs tratadas durante el período de 2000-2010. Tercera parte / Arteriovenous malformations. Review and statistical analysis of 52 MAVs treated during the period 2000-2010. Third part

INTRODUCCIÓN: describir nuestra experiencia en el tratamiento de las MAVs analizando: procedimientos endovasculares utilizados, resultados postoperatorios y complicaciones asociadas, estadificación según escalas de Barthel y Rankin modificadas. MATERIAL Y MÉTODOS: la población de estudio se constituyó por 52 pacientes con MAVs la cual fue analizada y estudiada mediante examen neurológico pre y postoperatorio, TC cerebral, RM cerebral y arteriografía de 4 vasos de cuello, la totalidad fue tratada mediante cirugía convencional en nuestro Servicio durante el período comprendido entre los años 2000 a 2010. RESULTADOS: recibieron tratamiento endovascular previo a la cirugía 16 MAVs (30,76 %). Todas fueron operadas. Doce pacientes mejoraron en el postoperatorio (23,07 %), 30 pacientes (57,69%) no sufrieron modificaciones y 10 de ellos (19,23%) empeoraron durante el postoperatorio. La mortalidad fue de 7 casos (13,46 %). CONCLUSIÓN: consideramos a los procedimientos endovasculares y la radiocirugía una herramienta de indudable valor terapéutico. Creemos que el subgrupo de MAVs grados III, IV y V representa una entidad singular que las distingue del resto, como una subtipo que requiere más aun de una compleja toma de decisiones. Tuvimos las mayores complicaciones postoperatorias en MAVs grados III y IV. Nuestra mortalidad postoperatoria coincide con la bibliografía consultada

INTRODUCTION: to describe our experience in treating AVMs based on the endovascular procedures used, postoperative results and associated complications, staging according to Barthel Index and modified Rankin Scale. PATIENTS AND METHOD: we present 52 patients with AVMs which were analysed and studied by Pre and Post-Surgery Neurological exam, brain CT, Brain IRM and four Neck vessels arteriography. All the patients were treated by conventional Surgery at our Department of Neurosurgery for the 2000­2010 period. RESULTS: Sixteen patients with AVMs (30.76%) underwent endovascular treatment prior to surgery. 100% were operated. 12 patients (23.07%) improved their clinical condition in the postoperative period, 30 patients (57.69%) showed no changes, and 10 of them (19.23%) experienced deterioration during the postoperative period. There were 7 mortal cases (13.46%). CONCLUSION: we believe that endovascular procedures and radiosurgery are tools of immense therapeutic value. We also consider that the subgroup of AVMs grade III, IV and V have unique features that distinguish them among the rest as a subtype, thus requiring extreme care when making decisions. Most postoperative complications occurred with AVMs grade III and IV. The mortal cases in the postoperative period coincided with those mentioned in the bibliography consulted

Choroidal Venous Pulsations at an Arterio-venous Crossing in Polypoidal Choroidal Vasculopathy

It has been reported that pulsations in abnormal vessels are observed on indocyanine green (ICG) angiography in half of patients with polypoidal choroidal vasculopathy (PCV), although the mechanism of the pulsation is unknown. In this study, we report a case of PCV showing venous pulsations at an arterio-venous (A-V) crossing, and discuss a possible mechanism of polypoidal vessel formation and pulsations in PCV. A 66-year-old female presented with a reddish-orange elevated lesion and serous retinal detachment in the macula of her left eye, and was diagnosed as PCV. She was treated with photodynamic therapy (PDT), and followed-up through routine examinations, including ICG angiography. ICG angiography at presentation showed a branching vascular network and choroidal venules with dye leakage (polypoidal vessels) in the left eye. Pulsations, supposedly of venous origin, were observed at an A-V crossing in the abnormal vessels. Within 3 months after PDT, the polypoidal vessel ceased to leak and the pulsations vanished. The reddish-orange lesion gradually decreased in size with complete disappearance of retinal detachment. This study suggests that an unusual compression at an A-V crossing may make a venule polypoidal, and fluctuations of blood flow and pressure in the venule may cause pulsatile movements of the vessel wall.

Are Brain Natriuretic Peptide Levels Related To Flow Through Autologous Ateriovenous Fistulae For Chronic Haemodialysis

Formation of arterio-venous-fistulae (AVF) may exacerbate cardiac failure in the ever increasing, elderly population on haemodialysis. Brain Natriuretic Peptide (BNP) may prove a useful marker of cardiac failure in this population. We aimed to determine effect of creation of an AVF and flow in AVF on BNP levels. Ten patients undergoing primary formation of an upper limb autologous AVF (pre-dialysis), were recruited. Serum BNP (pg/ml) and flow in AVF (cm3/s) were documented pre-operatively, and then 2, 6 and 12 weeks post-operatively. The relationship between flow and BNP levels was assessed. Ten patients (6 male), mean age of 66yrs were recruited. Five patients had a radio-cephalic and 5 had a brachio-cephalic AVF formed. There was no correlation between BNP levels and flow within the AVF (r=0.34, p=0.28) at any time point. There was a general trend towards increased flow in the AVF over time, with only the change between flow at 2-weeks and 3-months postoperatively reaching significance, p=0.043. There was a general trend for BNP to fall over time in the postoperative period, with no significant change between the postoperative sampling time points. BNP levels do not correlate with flow across an AVF.

Malformaciones Vasculares / Vascular malformation

Las malformaciones vasculares son anomalías presentes siempre desde el nacimiento que, al contrario de los hemangiomas, nunca desaparecen; pueden crecer durante toda la vida por hipertrofia. Según la clasificación de la ISSVA, las malformaciones vasculares se dividen en función del vaso afectado en capilares o venulares, venosas, linfáticas, arterio-venosas y combinadas o complejas. Cada una de ellas, con unas peculiaridades clínicas y hemodinámicas definitorias.

Vascular malformations are anomalies always present at birth that, contrary to hemangiomas, never regress; and may hypertrophy during lifetime. According to the ISSVA classification, vascular malformations are divided, depending on the affected vessel, into capillary or venular, venous, lymphatic, arteriovenous and combined or complex; each with certain defining clinical and haemodynamic peculiarities.

New Operative Treatment of Hyperfunctioning Arteriovenous Fistula for Hemodialysis: A Case Report

Hyperfunctioning fistulas are rare complications of hemodialysis access. They give rise to devastating complications, including a steal syndrome with reduced perfusion to the dependent limb and cardiac insufficiency caused by the high shunt volume. Numerous techniques such as fistula ligation, banding, plication, T-banding and distal revascularization with interval ligation have been developed. However, each technique bears the potential for its own complications, such as failure to resolve symptoms, recurrence and technical difficulty. Herein, we report a new technique that remedies the shortcomings of the other procedures. All the patients first underwent partial aneurysmal resection and lateral aneurysmorrhaphy of the enlarged vein from just distal to the anastomosis using a 6-0 prolene running sutures and then external wrapping with an 8 mm expanded polytetrafluoroethylene graft was done for a length of approximately 5 cm. Two patients with hyperfunctioning brachiocephalic arteriovenous fistula were treated this way. Doppler measurement of the fistula flow showed a mean flow reduction of about 60%. The procedure was effective and safe, with a mean follow up of 2 months.

Persistent Trigeminal Artery with a Cerebellar Branch and Trigeminal-Cavernous Fistula from Ruptured Aneurysm: Transarterial Coil Embolization / 신경중재치료의학

We report a case of persistent trigeminal artery (PTA) with a cerebellar branch supplying the posterior inferior cerebellar arterial territory, combined with a trigeminal-cavernous fistula resulting from rupture of an aneurysm at proximal trunk of the PTA. The fistula was successfully treated by transarterial coil embolization with preservation of PTA.