ABSTRACT
Nonspecific aortoarteritis (NAA) is an autoimmune disease characterized by the development of an inflammatory process in large arteries such as the aorta and its branches and pulmonary arteries. Operative interventions for lesions of the aortic arch branches may be divided into extra- and transthoracic. Involvement of all branches of the aortic arch requires transthoracic interventions to be performed. According to the findings of various authors, bicarotid bypass grafting is accompanied by a high incidence rate of complications and lethal outcomes. The most serious complication is haemorrhagic stroke developing in 40% of patients. That is why commencing from 1991 the practice of simultaneous restoration of the two carotid basins was discontinued. A clinical case report presented herein demonstrates the authors' therapeutic policy in patients with NAA and multiple involvement of brachiocephalic arteries and first of all with bicarotid occlusion.
Subject(s)
Blood Vessel Prosthesis Implantation/methods , Carotid Stenosis , Cerebral Hemorrhage , Postoperative Complications/prevention & control , Takayasu Arteritis , Adult , Aorta/diagnostic imaging , Aorta/surgery , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Brachiocephalic Trunk/diagnostic imaging , Carotid Arteries/diagnostic imaging , Carotid Arteries/surgery , Carotid Stenosis/diagnosis , Carotid Stenosis/etiology , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/prevention & control , Echocardiography/methods , Female , Humans , Risk Adjustment/methods , Takayasu Arteritis/complications , Takayasu Arteritis/diagnosis , Takayasu Arteritis/physiopathology , Takayasu Arteritis/surgery , Tomography, X-Ray Computed/methods , Treatment Outcome , Ultrasonography, Doppler, Duplex/methodsABSTRACT
Described in the article is a clinical case report concerning staged management of a patient presenting with a thoracoabdominal aortic aneurysm. The first stage consisted in complete lower debranching with prosthetic repair of all visceral arteries and the right renal artery. The second stage was endovascular repair of the aortic aneurysm. The chosen approach made it possible to avoid clamping of the thoracic portion of the aorta, which favourably contributed to a decrease in the traumatic nature of the operative procedure, simultaneously preserving the radicality of treatment after the two-stage intervention.
Subject(s)
Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation/methods , Endovascular Procedures/methods , Postoperative Complications/prevention & control , Renal Artery/surgery , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/physiopathology , Aortic Aneurysm, Thoracic/surgery , Aortography/methods , Blood Vessel Prosthesis , Humans , Male , Middle Aged , Postoperative Complications/etiology , Risk Adjustment/methods , Tomography, X-Ray Computed/methods , Treatment Outcome , Viscera/blood supplyABSTRACT
Renal arteriovenous malformation is a rarely encountered disease characterized by the presence of a direct arteriovenous shunt between the renal artery and vein. This nosology was first described by Varela in 1928, and by 1997 the number of such cases amounted to slightly more than 200. Endovascular closure of a fistula seems to be an attractive method of treatment in view of low traumaticity and a short period of rehabilitation. However, as shown by our case report, this type of intervention in large-diameter fistulas may be associated with the development of life-threatening complications. In case of rupture of the renal capsule and/or arteriovenous aneurysm, radical nephrectomy, unfortunately, remains to be a method of choice. Described below is a case concerning treatment of a female patient presenting with bilateral arteriovenous malformations and the world's first emergency operation for a ruptured intraparenchymatous arteriovenous aneurysm using an extracorporeal technique.
