ABSTRACT
Introducción y objetivos Las fístulas arteriovenosas piales son malformaciones vasculares infrecuentes. Generalmente son congénitas y su historia natural es ominosa. El objetivo es describir nuestra experiencia en su manejo endovascular y analizar la literatura. Pacientes y métodos Es un estudio retrospectivo descriptivo de pacientes tratados por vía endovascular durante 3 años en 3 instituciones latinoamericanas. Resultados Fueron 6 pacientes con edad media de 22 años. Un caso fue resultado de un traumatismo. El 50% presentó hemorragia intracraneal, el 66% desarrollaron clínica secundaria a efecto de masa y al flujo retrógrado. En los estudios de imagen se observaron varices intracraneales en el 83% de los casos. La angiografía cerebral mostró arterias fistulosas provenientes de la circulación anterior en el (..) (AU)
Subject(s)
Humans , Arteriovenous Fistula/surgery , Endovascular Procedures/methods , Vascular Malformations/surgery , Retrospective Studies , NeuroimagingABSTRACT
INTRODUCTION AND OBJECTIVES: Pial arteriovenous fistulas are infrequent vascular malformations. They are generally congenital and their natural history is ominous. The objective of this work is to describe our experience in their endovascular management and to review the existing literature. PATIENTS AND METHODS: This is a retrospective and descriptive study of patients treated by endovascular approach during 3 years at 3 Latin-American hospitals. RESULTS: The study included 6 patients with a mean age of 22 years. One case was caused by cranial trauma. In total, 50% suffered intracranial haemorrhage and 66% developed symptoms attributable to volume effect or retrograde blood flow. Intracranial varices were identified by CT and MRI scans in 83% of cases. Digital subtraction angiography showed arteriovenous fistulas from anterior circulation in 67% of cases and deep venous drainage in 50%. One endovascular procedure was performed in 5 cases (83%), while 2 procedures were required in one case. A single embolic agent was used to occlude fistulas in 67% of cases; whilst 33% required a combination. Coils were used in 4 cases (67%) and onyx was injected in another 4 (67%). One case required stent and balloon deployment. The fistulas were uneventfully occluded in all cases. The follow-up period was one year in 5 cases and 6 months in one case. All patients remained symptom-free. CONCLUSIONS: Endovascular management can be considered as the treatment of choice. It consists in the embolisation of arterial pedicles with one or more embolic agents and should be performed as close as possible to the drainage vein, avoiding migration of the embolic agent towards the venous side.
Subject(s)
Polyvinyls , Treatment Outcome , Arteriovenous Fistula , Embolization, Therapeutic , Humans , Retrospective StudiesABSTRACT
Debido a su compleja anatomía, las lesiones en la región bucal pueden llevar a múltiples complicaciones. Si bien el nervio facial y el conducto parotídeo pueden ser fácilmente heridos por golpes fuertes o traumatismos penetrantes de la mejilla, la lesión del conducto parotídeo es, en general, pasada por alto (especialmente en entornos de múltiples lesiones) y rara vez es reportada en la literatura. El tratamiento de estas lesiones genera controversias, ya que series cortas y estudios de casos anecdóticos reportan su efectividad desde diversos enfoques (el tratamiento no quirúrgico, la ligadura del conducto proximal con o sin medicamentos antisialorreicos, la reparación primaria con microcirugía, la creación de la fístula sialoplastía usando mucosa oral y la sustitución de injerto venoso). Reportamos un método conservador, ideado por los autores, con el objetivo de drenar y mantener funcional al conducto de Stenon en un paciente masculino que presentó pseudoquiste salival derecho como complicación de un desgarro de la parte distal de este conducto por un trauma maxilofacial causado por accidente automovilístico.
Given the complex anatomy of the mouth, injuries occurring in this region can result in multiple complications. The facial nerve and parotid duct can be easily injured by blows or trauma penetrating the cheek. Parotid duct injury is generally overlooked, especially in settings of multiple injuries. Consequently, they are rarely reported in the literature. The treatment of these injuries is very controversial. Short series and anecdotal case studies claim success with various approaches, such as non-surgical treatment, proximal duct glide with or without antisialogogue medication, primary repair with microsurgery, the creation of the fistula sialoplasty using oral mucosa and vein graft replacement. We present a conservative approach devised by the authors, with the aim of draining and maintaining Stenon's duct functional in a male patient who presented right salivary pseudocyst, as a complication from a tear of the distal part of the duct, following maxillofacial trauma caused by a car accident.
