ABSTRACT
BACKGROUND: To describe the occlusion rate and clinical response of a redo ablative procedure in symptomatic patients with recanalization of saphenous vein after endovascular thermal ablation. METHODS: A retrospective cohort study was performed in a prospectively collected data of symptomatic patients with recanalization of the great saphenous vein (GSV) or small saphenous vein (SSV) after endovascular thermal ablation who underwent a secondary ablation (SA) from June 2015 to May 2018. RESULTS: Ten patients (15 limbs) with recanalization of the GSV or SSV were treated with SA. The median age was 67 years and 60% were men. The median time from the first ablation was 7.3 years (interquartile range [IQR] 6.5-9.6). For SA, radiofrequency ablation was performed in 12 limbs (80%) and ultrasound-guided foam sclerotherapy in 3 cases (20%). The GSV was the treated vessel in 14 cases (93.3%). No complications were reported. Median follow-up was 13 months. Preoperative and 1-year follow-up Venous Clinical Severity Score was 9 (IQR 5-10) and 4 (IQR 2-8), respectively. Duplex ultrasound evaluation after 1 year showed an occlusion rate of 93.3% evidencing a partially recanalized vein in 1 treated limb. CONCLUSIONS: In this study, the occlusion rate was 93.3% at 1 year after SA; clinical improvement and no complications were reported. SA appears to be a valid option for the treatment of symptomatic patients with recanalized GSV or SSV.
Subject(s)
Ablation Techniques , Endovascular Procedures , Saphenous Vein/surgery , Varicose Veins/surgery , Venous Insufficiency/surgery , Ablation Techniques/adverse effects , Adult , Aged , Chronic Disease , Databases, Factual , Endovascular Procedures/adverse effects , Female , Humans , Male , Middle Aged , Reoperation , Retrospective Studies , Saphenous Vein/diagnostic imaging , Time Factors , Treatment Outcome , Ultrasonography, Doppler, Duplex , Varicose Veins/diagnostic imaging , Venous Insufficiency/diagnostic imagingABSTRACT
INTRODUCCIÓN: La radiofrecuencia endovascular con los catéteres de primera generación no obtuvo buenos resultados debido a su difícil manipulación y a las restricciones en venas con diámetros mayores de 12 mm. Sin embargo, utilizando los nuevos catéteres no existe evidencia científica suficiente para afirmar que el diámetro represente una limitación técnica. El objetivo del presente estudio fue evaluar y comparar el diámetro pre y postoperatorio de grandes troncos venosos de miembros inferiores para determinar la reducción del calibre que se produce a los 6 meses de la ablación con catéteres de última generación. MÉTODOS: Estudio retrospectivo observacional y descriptivo sobre una cohorte de pacientes con insuficiencia de la vena safena magna, vena safena parva y vena accesoria anterior de la safena magna, operados con catéteres de última generación de radiofrecuencia. Los diámetros fueron evaluados en el pre y en el postoperatorio mediante ecografía. RESULTADOS: Entre el año 2007 y el 2014 se realizaron un total de 365 ablaciones en vasos con un diámetro medio de 9 ± 3,1 mm, observándose una reducción de este a los 6 meses con un valor medio de 5,2 ± 0,8 mm (p < 0,0001). Se observó además oclusión total en el 100% de los casos y complicaciones como trombosis venosa profunda en el 0,5% y trombosis inducida por calor en el 1,1%. CONCLUSIONES: Se comprobó una significativa disminución del diámetro venoso tras el tratamiento endovascular con los nuevos catéteres ClosureFast® incluso en vasos con dilataciones superiores a 12 mm
INTRODUCTION: Endovascular radiofrequency with first generation catheters was not successful due to its technical difficulty and restrictions in veins with diameters larger than 12 mm. However, using the new catheter there is not enough scientific evidence to affirm that the diameter represents a technical limitation. The aim of this study was to evaluate and compare pre and post-operative venous trunks diameter, aiming at the reduction of size after 6 months with last generation catheters. METHODS: Retrospective observational and descriptive study on a cohort of patients with insufficiency of the great saphenous vein, small saphenous vein and anterior accessory vein operated on with last generation radiofrequency catheters. The diameters were evaluated in the pre and post-operative period with ultrasound. RESULTS: Between 2007 and 2014 a total of 365 ablations were performed in veins with an average diameter of 9 ± 3.1 mm showing a reduction of it after 6 months with a mean value of 5.2 ± 0.8 mm (P < .0001). Total occlusion was also observed in 100% of cases and complications such as deep vein thrombosis in 0.5% and heat-induced thrombosis in 1.1%. CONCLUSIONS: A significant reduction in venous diameter after endovascular treatment with the new ClosureFast®catheters was checked, even in veins with diameters greater than 12 mm
Subject(s)
Humans , Male , Female , Catheter Ablation/instrumentation , Catheter Ablation/methods , Catheter Ablation , Endovascular Procedures/methods , Endovascular Procedures/trends , Pulsed Radiofrequency Treatment/methods , Catheter Ablation/statistics & numerical data , Catheter Ablation/standards , Retrospective Studies , Cohort Studies , Saphenous Vein/pathology , Saphenous Vein/surgery , Venous Insufficiency/surgery , Venous InsufficiencyABSTRACT
INTRODUCTION: Endovascular radiofrequency with first generation catheters was not successful due to its technical difficulty and restrictions in veins with diameters larger than 12mm. However, using the new catheter there is not enough scientific evidence to affirm that the diameter represents a technical limitation. The aim of this study was to evaluate and compare pre and post-operative venous trunks diameter, aiming at the reduction of size after 6 months with last generation catheters. METHODS: Retrospective observational and descriptive study on a cohort of patients with insufficiency of the great saphenous vein, small saphenous vein and anterior accessory vein operated on with last generation radiofrequency catheters. The diameters were evaluated in the pre and post-operative period with ultrasound. RESULTS: Between 2007 and 2014 a total of 365 ablations were performed in veins with an average diameter of 9±3.1mm showing a reduction of it after 6 months with a mean value of 5.2±0.8mm (P<.0001). Total occlusion was also observed in 100% of cases and complications such as deep vein thrombosis in 0.5% and heat-induced thrombosis in 1.1%. CONCLUSIONS: A significant reduction in venous diameter after endovascular treatment with the new ClosureFast(®) catheters was checked, even in veins with diameters greater than 12mm.
Subject(s)
Catheter Ablation/instrumentation , Endovascular Procedures/methods , Saphenous Vein/pathology , Saphenous Vein/surgery , Venous Insufficiency/pathology , Venous Insufficiency/surgery , Catheters , Equipment Design , Female , Humans , Male , Middle Aged , Organ Size , Retrospective StudiesABSTRACT
Introducción: Las infecciones severas del periné constituyen un conjunto de infecciones entre las que se destaca la gangrena de Fournier o sinérgica. Es una fascitis necrotizante del periné y área genital, de etiología polimicrobiana. El foco puede estar localizado en el tubo digestivo distal, el tracto genitourinario o la piel. Objetivo: Analizar los hallazgos clínicos, imagenológicos y factores de riesgo y conducta terapéutica en pacientes con infecciones del periné luego de radioterapia por cáncer de recto. Diseño: Análisis retrospectivo. Revisión de la literatura. Métodos: Revisión de bases MEDLINE, LILACS, AMA, AAC y SACP. Pacientes: 3 casos en 15 días. Resultados: Caso 1: masculino, 46 años; cáncer de recto en tratamiento adyuvante. Al finalizar radioterapia presenta celulitis perineal y absceso profundo por perforación adyacente del tumor rectal. Laparotomía, colostomía definitiva por tumor localmente avanzado y drenaje de absceso y celulitis. Egreso. Falleció por progresión de su enfermedad de base. Caso 2: masculino, 40 años. Tumor de recto irresecable por metástasis hepática en tratamiento con radioterapia paliativa por sangrado persistente, presentó gangrena de Fournier por perforación del tumor. Drenaje del foco séptico. Evoluciona con insuficiencia respiratoria progresiva, disfagia y hemorragia digestiva. Óbito. Caso 3: masculino, 33 años. Tumor de recto localizado, de diagnóstico reciente, en tratamiento neoadyuvante con radio y quimioterapia. Durante la radioterapia presentó gangrena de Fournier por perforación de recto retroperitoneal. Evolucionó con sepsis a pesar del tratamiento. Óbito. Discusión y conclusiones: El manejo se basa en el debridamiento quirúrgico, drenaje y curaciones programadas, asociados a antibióticos de amplio espectro y sostén de los parámetros vitales. El diagnóstico precoz es fundamental... (TRUNCADO)
Introduction: Perineal severe infections are unfrequent and the most common presentation is Fournier's Disease. This disease compromise genital and perineal areas with necrosis of the muscular fascia and does not involve the muscle. Primary focus can come from digestive tract, urinary tract of skin. Objective: To analyze clinical, radiological, risk factors and treatment of Founiers Disease in patients with rectal cancer and external radiotherapy. Design: Retrospective serie. Literature review. Patients: 3 cases in last 15 days. Results: Case 1: male, 46y, rectal cancer and adyuvant radiotherapy. During treatment, rectal lateral abscess appeared as consequence of rectal perforation. Laparotomy, definitive colostomy and drainage were performed. He died because of neoplastic disease. Case 2: male, 40y. Rectal tumor with hepatic metastasis was under palliative radiotherapy due to low rectal bleeding. Fournier's Disease was diagnosed due to tumor perforation. In spite of surgical treatment, he developed pulmonary insuficiency, disfagia and digestive bleeding and died. Case 3: male, 33y. Lower rectal tumor in neoadyuvant protocol of radiotherapy. Fournier's Disease was presented during this period due to rectal perforation to retroperitoneum. He presented sepsis and died. Discussion and conclusions: Early surgical debridement, elective and periodic surgical wound care and broad spectrum antibiotics should be applied. Early diagnosis is mandatory. Mortality is nearly 20 per cent. Perforated rectal tumor associated with radiotherapy in males younger than 50y presented as Fournier's Disease is first reported.
Subject(s)
Humans , Male , Adult , Fournier Gangrene/etiology , Bacterial Infections/complications , Rectal Neoplasms/complications , Rectal Neoplasms/radiotherapy , Diagnostic Imaging , Fournier Gangrene/therapy , Bacterial Infections/therapy , Rectal Neoplasms/mortality , Perineum/injuries , Perineum/pathology , Radiotherapy/adverse effectsABSTRACT
Los tumores múltiples colorrectales son de presentación poco frecuente. Según el momento del diagnóstico han sido categorizados históricamente como sincrónicos y metacrónicos. Existen en la literatura, tanto nacional como internacional múltiples reportes y asociaciones de este tipo de tumor colónico. El propósito de esta comunicación es presentar un caso clínico de un tumor doble de colon, idénticos entre si desde el punto de vista histológico y localizados en el colon derecho, correspondiendo en teoría a un tumor sincrónico. Se discuten y ponen a consideración aspectos clínicos, histológicos y terapéuticos al respecto.
Multiple colonic cancers are not frequent. According to its diagnosis they might be metacronous or synchronous. Several reports had have reported this condition, nationally and abroad. The purpose of this report is to communicate a clinical case of an identical and duplicated right colon carcinoma, presumed to be a synchronous tumor. We described objective aspects that ref1ect a complete surgical and oncologic approach.
