Infección de injerto carótido-carotídeo para debranching aórtico: tratamiento con injerto autológo de vena / Infection of a carotid-carotid graft for aortic debranching: treatment with an autologous venous graft

Resumen El uso de prótesis vasculares y dispositivos endovasculares ha permitido tratar muchas patologías que antes no se intervenían dado el gran riesgo quirúrgico, como es el caso de los aneurismas de aorta torácica. Los materiales usados para estas reconstrucciones son muy resistentes y de larga duración, pero son muy sensibles a ser colonizados y presentar infección, lo que genera morbimortalidad considerable. Se presenta el caso de un paciente de 64 años con antecedente de aneurisma del arco aórtico y aorta descendente, tratado en forma extra institucional con prótesis de aorta torácica endovascular y debranchig de las ramas del arco aórtico, con injerto carótido-carotídeo y carótido-subclavio izquierdo en dacrón, por vía pretraqueal, con antecedente de intento de cubrimiento del injerto expuesto con un flap miocutáneo el cual fue fallido por necrosis; ingresó al Hospital Universitario Clínica de San Rafael, con exposición del injerto carótido-carotídeo a nivel cervical, signos locales de infección y sepsis secundaria.

Abstract The use of vascular replacements and endovascular devices has led to the treatment of many conditions that could not be operated on due to a high surgical risk, such as aortic aneurysms. The materials used for these reconstructions are very resistant and durable, but are very susceptible to being colonised and infected, which leads to a considerable morbidity and mortality. The case is presented of a 64 year-old patient with a history of an aortic arch and descending aortic aneurysm. This had been treated in another hospital with a thoracic aortic endovascular repair and debranching of the aortic arch, with carotid-carotid and left carotid-subclavian Dacron graft. The pretracheal route was used, after attempting to cover the exposed graft with a myocutaneous flap that failed due to necrosis. The patient was admitted to the Hospital Universitario Clínica de San Rafael, presenting with a carotid-carotid graft at cervical level, with local signs of infection and secondary sepsis.

Treatment of Giant Intracranial Aneurysms: a Review Based on Experience from 286 Cases / Tratamento dos aneurismas gigantes intracranianos: uma revisão baseada na experiência de 286 casos

Aneurysms are classified as giant when their largest diameter is equal to or greater than 25 mm, which represents approximately 5­7% of intracranial aneurysms. Severe disease with poor natural history presents with 68% mortality in two years and 85% in five years for untreated cases. Thus, in the majority of cases, the patients require treatment, despite the risks of therapeutic options. We discuss the epidemiology, natural history, diagnosis, and treatment of giant aneurysms based on the experience of 286 operations and literature data.

Os Aneurismas são classificados como gigantes quando seu maior diâmetro é igual ou superior a 25 mm e representam aproximadamente de 5 a 7% dos aneurismas intracranianos. Trata-se de patologia grave com história natural ruim apresentando mortalidade de 68% em 2 anos e 85% em 5 anos para casos não tratados. Desta forma, na maioria dos casos, estes pacientes devem ser tratados apesar do alto risco das opções terapêuticas. Neste estudo, discutimos a epidemiologia, a história natural, o diagnóstico e o tratamento desta grave patologia baseado na experiência de 286 pacientes tratados e dados da literatura.

Arteritis de Takayasu y aneurisma gigante en escolar: Reporte de caso / Takayasu arteritis and giant aneurysm in a school student: A case report

La arteritis de Takayasu es una vasculitis de grandes vasos que afecta a la aorta y sus ramas principales, llevando a estenosis y trombosis, así como a la formación de aneurismas. Se reporta una incidencia global de 2,6 casos por millón por año, siendo baja en niños. La terapia de elección son los corticoides, seguidos de inmunosupresores en casos de resistencia. Se reporta el caso clínico de un paciente con arteritis de Takayasu con formación de aneurisma gigante de la aorta.

Takayasu's arteritis is a vasculitis of large vessels that affects the aorta and its major branches, leading to stenosis and thrombosis, as well as aneurysm formation. An overall incidence of 2.6 cases per million per year has been reported, being lower in children. Corticosteroids are the therapy of choice, followed by immunosuppressants in cases of resistance. We report the case of a patient with Takayasu's arteritis with formation of giant aneurysm of the aorta.