Estenose arterial nos transplantes renais / Arterial stenosis after renal transplantation

OBJETIVO: Relacionar a influência dos dois tipos de anastomoses arteriais empregadas (término-terminal e término-lateral), da idade do receptor, do rim de doador vivo ou cadáver e do uso de remendo aórtico ("patch") quanto à presença ou não de estenose da artéria renal e, avaliar o tratamento destas estenoses. MÉTODO: Estudo retrospectivo de 278 pacientes submetidos a transplante renal no Hospital Universitário Clementino Fraga Filho (HUCFF), de maio de 1989 a maio de 2001. RESULTADOS: Não se mostrou relação entre as variáveis estudadas com a presença ou não de estenose da artéria renal. A estenose da artéria renal foi detectada em oito casos, que foram tratados, com sucesso, mediante angioplastia transluminal percutânea (ATP), com implante primário de "stent" (n = 7) ou sem implante de "stent" (n = 1). CONCLUSÕES: As variáveis estudadas não influenciaram no aparecimento da estenose da artéria renal e o tratamento endovascular foi efetivo na correção destas lesões estenóticas.

Estudo comparativo da reação inflamatória renal entre álcool de polivinil - flocular e álcool de polivinil + acetato de polivinil - esférico: estudo experimental / Comparative study of renal inflammatory reaction between irregular - polyvinyl alcohol and spherical - polyvinyl alcohol + polyvinyl acetate: experimental study

OBJETIVO: Avaliar as características e os efeitos de um agente embólico, disponível comercialmente, consistindo de Polivinil Alcool (PVA) de morfologia flocular, e comparar com um agente esférico, de tecnologia nacional, consistindo de Polivinil Alcool e Polivinil Acetato (PVA + PVAc). MÉTODO: Foram utilizadas fêmeas de coelho albino "New Zealand", submetidas à embolização arterial renal. PVA-flocular foi usado em 24 animais, assim como PVA+PVAc-esférico. Seis animais foram utilizados como controle. Todos foram mantidos em cativeiro até a morte, por períodos pós-operatórios de 48 horas, cinco dias, 10 dias e 30 dias. RESULTADOS: Ambos os agentes promoveram oclusão do vaso e infarto do órgão. O estudo microscópico inicial das artérias embolizadas com PVA-flocular, mostra oclusão com trombo e PVA. Os vasos embolizados com PVA+PVAc-esférico, mostram os agentes ocupando praticamente todo o lúmen. No estudo de 30 dias, observa-se absorção do trombo e retração dos agentes de PVAflocular, criando espaços. E com PVA+PVAc-esférico, pode-se observar os agentes circundados por intensa fibrose. CONCLUSÕES: Ambas as partículas foram efetivas para causar isquemia tecidual. A reação inflamatória foi mais intensa com PVA+PVAc-esférico que também apresentou grau de penetração maior no sistema vascular.

BACKGROUND: To evaluate the characteristics and the effects of an embolic agent, available commercially, consisting of irregular - Polyvinyl Alcohol (PVA), and to compare with a spherical agent, of brazilian technology, consisting of Polyvinyl Alcohol and Polyvinyl Acetate (PVA + PVAc). METHODS: Renal arterial embolization was performed in females of New Zealand White rabbits. Irregular - PVA was used in 24 animals. Spherical - PVA+PVAc was used in 24 animals. Six animals were used as control. All animals were maintained in captivity until the euthanasia, after 48 hours, 5 days, 10 days and 30 days. RESULTS: Both agents resulted in vessel occlusion and organ infarction. The initial macroscopic study of the arteries embolized with irregular-PVA, the occluding plug consisted of thrombus and PVA. In vessels embolized with spherical-PVA+PVAc, the occluding plug consisted mostly of the embolic agent. After 30 days, there is absorption of the thrombus and retraction of the agents of PVA-irregular, creating spaces. With spherical-PVA+PVAc, it can be observed the agents surrounded by intense fibrosis. CONCLUSION: Both particles were effective to cause tissue ischemia. The inflammatory reaction was more intense with spherical-PVA+PVAc, besides presenting larger degree of penetration in the vascular system.

Six-year experience with talent stent-graft repair of abdominal aortic aneurysms.

PURPOSE: To report a long-term experience with the Talent Endoprosthesis for the treatment of abdominal aortic aneurysm (AAA). METHODS: In the period between June 1997 and June 2003, 193 patients (171 men; mean age 71.0+/-7.8 years, range 52-89) with AAA were treated with a Talent Endoprosthesis. Patients were clinically and radiologically followed in the postoperative period, at 30 days, and then annually up to 72 months. In addition to computed tomographic scans, a plain abdominal radiogram was also performed annually for structural assessment of the stent-graft. RESULTS: Implantation success was 99.0% (191/193). Delivery system introduction was the cause of 1 failure, and the other patient was converted to surgery for intraprocedural device migration. There were 10 (5.2%) endoleaks (3 type I, 7 type II) at 30 days; all type I and 3/7 type II endoleaks were treated (93.3% secondary clinical success). Seven (3.7%) patients died in the perioperative period, including the conversion. During follow-up, 18 (9.3%) additional deaths occurred, and 4 new endoleaks (1 type I, 2 type II, 1 type III) were encountered. In up to 6 years' follow-up, the Talent Endoprosthesis did not present signs of material fatigue, but 1 component disconnection at 42 months led to death. There was no aneurysm rupture. After an initial increase in the aortic neck (1.2+/-1.1 mm) in the postoperative period, the neck diameters continued to increase until after the third year. An average reduction of 5.6+/-4.1 mm in the aneurysm diameter at 1 year was noted; the reduction gradually reached 14.1+/-10.7 mm after 60 months. CONCLUSIONS: The Talent Endoprosthesis was an efficient alternative for managing AAAs, achieving low morbidity and mortality rates and a good long-term clinical outcome in this study. The Talent Endoprosthesis did not present signs of material fatigue over a 6-year follow-up.

Correção de aneurisma de aorta abdominal em paciente com dois rins pélvicos / Abdominal aortic aneurysm repair in patient with two pelvic kidneys

Abdominal aortic aneurysm reconstruction is usually performed in vascular surgical practice. However, the repair of an abdominal aortic aneurysm associated with a pelvic kidney is rare. Our goal is to present a case report of an abdominal aortic aneurysm associated with two congenital pelvic kidneys wich was treated successfully by aneurysmectomy and inclusion of an aortoaortic graft.

Angioplastia com implante de "stent" na artéria mesentérica superior / Superior mesenteric artery stent following percutaneous transluminal angioplasty

Endovascular techniques have been used to treat arterial stenosis throughout the vascular system. The goal of this work is to report one case of percutaneous transluminal angioplasty with primary stenting of the ostial segment of the superior mesenteric artery for treatment of chronic mesenteric ischemia.

Ligadura videolaparoscópica da artéria mesentérica inferior como tratamento de endoleak persistente após correção endovascular de aneurisma de aorta abdominal / Videolaparoscopic ligation of inferior mesenteric artery as a treatment of persistent endoleak after endoluminal abdominal aortic aneurysm repair

Videolaparoscopy has been widely used in the treatment of pathologies as cholelithiasis, appendicitis and adrenal tumor. Nowadays, has also been used to treat type II endoleaks after endovascular repair of abdominal aortic aneurysms. The goal of this work is to report one case of inferior mesenteric artery endoleak treated by videolaparoscopy.