Ovarian hyperstimulation syndrome as a rare cause of acute bilateral limb and renal ischemia.

Ovarian hyperstimulation syndrome (OHS) is a rare and potentially fatal condition, particularly when it is associated with arterial thromboembolic events. We present a case of acute ischemia of both lower limbs and left kidney due to OHS. The clinical presentation included voluminous ascites, pleural effusion, and significant ovarian enlargement. Subsequently, bilateral severe acute limb ischemia and left kidney segmental infarction were established. Surgical thromboembolectomy and muscle débridement of the lower limbs were necessary, and the patient recovered with partial limitations. A high index of suspicion and timely treatment are essential to minimize consequences of arterial thrombosis associated with OHS.

A mycotic forearm pseudoaneurym as an unusual complication of infective endocarditis.

INTRODUCTION: Mycotic pseudoaneurysms are an infrequent complication of infective endocarditis; most cases are secondary to arterial trauma. The commonest site involved are the intracranial arteries, followed by the abdominal aorta and then the peripheral vessels. CASE PRESENTATION: We report a case of a 36-year-old man, admitted in our institution for a subarachnoid haemorrhage, who presented with fever of unknown origin during his stay in the neurocritical care unit and whom was diagnosed infective endocarditis due to Meticilin Sensible Staphylococcus Aureus. Almost two weeks after antibiotic therapy was instituted, he presented a large, growing, pulsatile mass of the left forearm. A giant pseudoaneurysm arising from the radial artery was detected with ultrasound and surgical intervention was carried out. A large laceration of the radial artery was detected and an interposition of a vein graft was performed. DISCUSSION: Forearm mycotic pseudoaneurysms are rare. A high index of suspicion is needed and they should always be borne in mind in the differential diagnosis of an extremity pain, swelling or motor-sensorial deficit after infective endocarditis.

[Hybrid repair of the aortic arch. Santa Marta Hospital initial experience]. / Reparação híbrida do arco aórtico: experiência inicial do Hospital de Santa Marta.

OBJECTIVES: To retrospectively review the hybrid treatment of the aortic arch with supra-aortic debranching and endo- vascular stent-graft repair in a single institution. METHODS: From 2007 to 2010, all patients submitted to aortic debranching procedures were entered into a prospective database analysis. For the present study, only patients with sealing zones 0 and 1, according to the Ishimaru classification, were included. Procedure-related morbimortality was analysed for the open and endovascular procedures. RESULTS: During the study period, we electively performed 6 total aortic debranching and 4 partial aortic debranching procedures in 10 patients. According to the etiology the indications were: 6 aortic arch aneurysms, 2 post-dissection aneurysms, 1 false aneurysm and 1 type I endoleak following TEVAR. The proximal sealing zone was Ishimaru zone 0 in six patients and zone 1 in four patients. The TEVAR procedure was delayed in all patients with a completion success of 80% (1 patient died from ruptured aortic aneurysm; 1 patient denied the second procedure and was lost to follow-up). The 30d mortality rate was 10% (patient mentioned above). The main morbidity was: 1 axillar venous thrombosis, 1 case of subclinical myocardial infarction, 1 case of terminal renal insufficiency and 1 case of prolonged ventilation. No permanent cerebral or peripheral neurologic deficit was noted. CONCLUSIONS: The hybrid repair of the aortic arch is a feasible and reproducible procedure, and our results are similar to the previously published series. Medium and long-term results are necessary to confirm whether the technique can be regarded as a safe alternative to open surgery in high-risk patients.

[Visceral artery aneurysms: alternative therapeutic approach]. / Aneurismas das artérias viscerais: alternativa terapêutica.

The authors report two cases in which stent grafts were used to treat visceral artery aneurysms. Case number 1 was a 42-year old woman with a history of renal colic who was found to have a right renal artery aneurysm. Two 6-mm x 20-mm Wallgraft endoprosthesis (Boston Scientific, Watertown, Mass) were placed across the aneurysm neck. Case number 2 was a 72 year-old woman with a past medical history significant for hepatic angioma and hypothyroidism. She was found to have a superior mesenteric artery aneurysm that was treated with a 6-mm x 17-mm Jostent stent graft (Jomed, GmbH, Ra). In both cases the aneurysm was completely excluded and distal end-organ flow preserved. Stent graft placement is a safe and effective treatment for visceral artery aneurysms. If this approach proves durable and reproducible, it can become the method of choice for the management of visceral artery aneurysms in selected patients.

[The implementation of a Vascular Pain Unit]. / Implementação de uma Unidade de Dor Vascular.

The concern towards the adequate pain treatment of vascular surgical patients in the Department of Angiology and Vascular Surgery at Hospital de Santa Marta took to the development of an organized structure, intended to optimize perioperative analgesia. In this paper we intend to describe the implementation process of the Vascular Pain Unit, which started in 2003 and was concluded in January 2005.