Endoluminal repair of a pseudoaneurysm in a patient with cryopreserved arterial allograft of the iliac vessel.

Prosthetic infection is one of the most serious complications of vascular surgery, and its treatment remains a surgical challenge. Good results have been reported using in situ replacement with arterial allografts, but late degeneration of the graft itself may necessitate further repair. We report a case of rupture and pseudoaneurysm formation of an iliac artery homograft urgently treated by endoluminal grafting with complete and immediate exclusion of the sac without complications. At 6-month follow-up angio-computed tomography showed patency of the vascular stent graft without leak evidence. Two years and 6 months after the procedure, the patient is well and alive.

Endovascular repair of a ruptured giant popliteal artery aneurysm.

An 88-year-old woman with hypertension, chronic vein insufficiency, and repeated cellulites in the right lower extremity was admitted to our hospital with a new episode of right leg inflammation and edema associated with fever and leukocytosis. Due to unilateral enlargement of the leg and D-simer levels of 1000 microg/mL, a concomitant deep venous thrombosis was suspected and ultrasonography was performed. Color duplex-scanning found normal flow in the right deep leg veins but revealed an 11-cm-diameter popliteal artery aneurysm. A computed tomography scan confirmed the diagnosis and revealed a large perianeurysmal hematoma, and angiography provided evidence of perianeurysmal bleeding. The patient was unfit for open surgery, so an endovascular approach under local anesthesia was elected. The aneurysm was successfully excluded with an endograft, and 15 months after surgery, the patient is alive and had an uneventful postoperative course.

[Revascularization of total renal artery occlusion by angioplasty and stent placement]. / Revascularización eficaz de obstrucción total de arterial renal mediante angioplastia y colocación de Stent.

Revascularization of renal artery stenosis for the treatment of hypertension is an established procedure. In selected clinical scenarios, successful revascularization procedures may preserve or restore renal function. We present a 66-year-old man with secundary hypertension and deteriorating renal function caused by bilateral atherosclerotic renal artery disease (complete obstruction of the left renal artery and subocclusive stenosis of the right) in which blood pressure was successfully controlled and renal function improved and maintained steady after bilateral percutaneus transluminal angioplasty and renal artery stenting.

Revascularización eficaz de obstrucción total de arterial renal mediante angioplastia y colocación de Stent / Revascularization of total renal artery occlusion by angioplasty and stent placement

La revascularización de la estenosis de la arteria renal para el tratamiento de la hipertensión es un procedimiento ya admitido. En escenarios clínicos seleccionados, el éxito del procedimiento de revascularización puede mantener o restaurar la función renal. Presentamos el caso clínico de un paciente varón de 66 años con hipertensión arterial secundaria y deterioro de función renal causada por arteriosclerosis bilateral de las arterias renal (obstrucción completa de la arteria renal izquierda y estenosis suboclusiva de la derecha) en el cual la presión arterial fue controlada con éxito y la función renal mejoró después de una angioplastia transluminal percutánea bilateral y colocación de sendos stents de arterias renales

Revascularization of renal artery stenosis for the treatment of hypertension is an established procedure. In selected clinical scenarios, successful revascularization procedures may preserve or restore renal function. We present a 66-year-old man with secundary hypertension and deteriorating renal function caused by bilateral atherosclerotic renal artery disease (complete obstruction of the left renal artery and subocclusive stenosis of the right) in which blood pressure was successfully controlled and renal function improved and maintained steady after bilateral percutaneus transluminal angioplasty and renal artery stenting

Hipertensión arterial por displasia fibromuscular en dos hermanas / Hypertension for fibromuscular dysplasia in two sisters

Presentamos a dos hermanas con hipertensión arterial descubierta cuando se encontraban embarazadas y producida en ambos casos por displasia fibromuscular de las arterias renales. Comentamos la infrecuente incidencia familiar de la misma y sus posibles causas y revisamos los procedimientos diagnósticos y terapéuticos utilizados (AU)

Transjugular approach to treat portal vein stenosis after liver transplantation--a case report.

The authors present a case of portal vein stenosis that developed shortly after liver transplantation in a 48-year-old woman treated successfully with portal stent implantation by use of a transjugular approach to achieve portal vein access. To their knowledge, there are no other reports in the literature on the use of a transjugular approach with vein stent placement in the treatment of portal stenosis complicating orthotopic liver transplantation.

Transjugular biopsy of the liver with an automated device.

PURPOSE: To evaluate the results of transjugular liver biopsies conducted with an automated device. MATERIAL AND METHODS: Transjugular liver biopsies were conducted on 37 patients. The principal indication was coagulation disorders. The biopsies were performed with a 1.3-mm automated device. Each patient underwent three biopsies: anterior, lateral and posterior. A fourth biopsy was conducted if the first three did not produce at least one core sample that was sufficient for the histologic diagnosis. RESULTS: Transjugular liver biopsy was successful in all 37 patients. We performed a mean of 3.06 punctures per patient (average 2.86 samples). The length of the samples varied from 5 to 23 mm (mean 13.6 mm). Biopsy specimens were useful for histologic diagnosis in 97% of the cases. No serious complications were caused by the procedure. CONCLUSION: The transjugular liver biopsy technique is an efficient way of obtaining tissue samples. The procedure shows a high success ratio and a low complication rate.

[Bronchial embolization in the treatment of hemoptysis]. / Embolización bronquial en el tratamiento de la hemoptisis.

The aim of this retrospective study was to evaluate the efficacy of bronchial artery embolization to treat hemoptysis. Eight hundred sixty-five patients were admitted to our hospital with hemoptysis during the study period. Bronchial arteriographs were obtained for 48, who suffered life-threatening hemoptysis refractory to medical treatment. The likely origin of bleeding was identified in 37: embolization was performed with particles measuring 250 to 1000 micra in size (Contour Emboli, Interventional Therapeutic Corporation, South San Francisco, California, USA) in 35 and with hemostatic collagen sponges in 2. The most common causes of hemoptysis were bronchiectasis (40%), pulmonary tuberculosis (33%), pulmonary aspergilloma (8%) and malignant neoplasm (8%), chronic bronchitis (6%); 4% of the cases were idiopathic. Immediate technical success was achieved in 34 patients (92%) as defined by the absence of hemorrhage for at least 24 hours. All embolized patients were followed until the first recurrence of bleeding or until discharge. Recurrence of hemoptysis (in the first month) was early in 5 patients (13.5%) and late (2 to 96 months) in 9 (24%). The severity of the initial and later episodes of hemoptysis was similar in all early recurrences and most late recurrences. A second embolization was performed six times, and medical and/or surgical treatment was given in all other cases. No significant complications attributable to the technique were observed. The results show that bronchial embolization is valid for the immediate control of life-threatening hemoptysis and has a low rate of severe complication; recurrence is relatively common.

[Traumatic thrombosis of the renal artery]. / Trombósis traumática de la arteria renal.

The authors describe five cases of radiological diagnosis of traumatic thrombosis of the renal artery, paying special attention to the aortography as a positive source of information able to provide on its own a guide to rapid and correct treatment. Special reference is made to the positive errors of filling of the excretory duct in the I.V.U. in the said traumatic thrombosis; a picture which is well produced due to the existence of polar arteries or because the thrombosis is distal to the start of the capsulo-adrenal artery branch which may produce nephrograms due to perforating arteries.

[Massive kidney infarct by occlusion of the main artery]. / Infarto masivo de riñón por oclusión de la arteria principal.

Massive kidney infarct, due to total occlusion of the main artery, is not a frequent process in clinical urology. The most frequent causes are endocarditis, arteritis, atheromatosis and traumatisms. The complete blockage of the renal artery means that the tissue irrigated by the same is bloodless and prone to necrosis and it must be taken into account that although the renal parenchyma cannot withstand for more than 1 to 2 hours the lack of a blood supply, the obstructions or ischemias of shorter duration cause tissue disorders of greater or lesser importance, affecting more quickly and more intensely the cells of the tubules, than those of the glomerules and later the connecting tissue. Clinically, kidney infarcts may sometimes go unobserved and on many other occasions their symptoms are by no means typical although the most characteristic feature is a more intense, sharp, acute pain with macroscopic hematuria, proteinuria and cylindruria and, in the radiological exploration, kidney "silence" but with the excretory duct intact shown by means of retrograde uretero-pyelography. The kidney angiography will reveal the existence of the arterial obstruction, with the resulting avascular image. Extrapremature surgical treatment would be ideal in the cases of massive infarct but this would also require an extrapremature diagnosis, which would enable the embolectomy (where necessary to be carried out, thereby saving the kidney. However, under normal working conditions, taking into account the period of time which inevitably elapses between the patient feeling pain in the kidney and his reaching the Emergency Department and the necessary examinations being carried out which enable the correct diagnosis to be made, the number of hours which have passed make attempts at conservative surgery completely useless. The authors present the case of a 37-year old patient who, 15 days after presenting a picture of right kidney colic, went to the Emergency Department in our Centre where the doctor on duty merely performed a symptomatic treatment and the patient was not admitted to our Department until several days later. In the different radiourographic examinations carried out, right kidney mutism was observed, as well as the permeability of the excretory duct. The aortography revealed the total occlusion of the right renal artery. As more than 20 days had elapsed since the patient first presented the colic pain and before we examined him, there was no other therapeutic solution but the performing of a nephrectomy. The examination of the organ removed confirmed the diagnosis but the origin of the arterial obstruction could not be clarified for sure.