RESUMO
AIM: To assess the effectiveness of catheter directed thrombolysis (CDT) in the treatment of acute graft occlusion. METHODS: Tissue prothrombin activator (rt-PA) was the sole agent used for thrombolysis. This was infused through a 4F straight 65 cm catheter placed under ultrasound guidance. Following a pre-CDT angiogram, a catheter was placed just proximal to the distal anastomosis. An infusion of rt-PA was given over 24 h. An assessment of acute clinical success, limb salvage rates, patency rates and complication rates were made over a period of one year. RESULTS: 80% (20/25) of grafts were successfully reopened immediately. 4/5 (80%) of the unsuccessful CDT cases required amputation within a few weeks. 60% (12/20) of successful CDT cases had an underlying stenotic lesion which required angioplasty. Limb salvage rate was 72% (18/25) at 12 months. There was no CDT related mortality. Secondary patency rate at 9 months was 76% (13/17). CONCLUSION: CDT can achieve reasonable results in this group of challenging patients and may be seen as a useful accessory in the vascular toolkit. However, precise indications for its use need further clarification.
Assuntos
Artéria Femoral/cirurgia , Fibrinolíticos/uso terapêutico , Oclusão de Enxerto Vascular/tratamento farmacológico , Artéria Poplítea/cirurgia , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/uso terapêutico , Enxerto Vascular , Idoso , Feminino , Humanos , Salvamento de Membro/instrumentação , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes/uso terapêutico , Estudos Retrospectivos , Terapia Trombolítica/instrumentação , Resultado do TratamentoRESUMO
We present a rare occurrence of a perforated diverticulum of the sigmoid colon found within the contents of a strangulated left inguinal hernia in a 75-year-old man. The hernia was repaired using the Bassini technique. An end colostomy was established after resection of the diseased section of the sigmoid. We review the relevant literature and discuss the choice of repair techniques in such situations.
Assuntos
Colo Sigmoide , Divertículo do Colo/complicações , Hérnia Inguinal/complicações , Obstrução Intestinal/complicações , Perfuração Intestinal/etiologia , Idoso , Colostomia/métodos , Divertículo do Colo/diagnóstico por imagem , Divertículo do Colo/cirurgia , Seguimentos , Hérnia Inguinal/cirurgia , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/cirurgia , Laparotomia/métodos , Masculino , Radiografia Abdominal , Procedimentos de Cirurgia Plástica/métodos , Ruptura EspontâneaRESUMO
This is a case of a 35-year-old who had complained of noisy breathing for 15 years, and had been on treatment for 'chronic asthma'. She presented to the Accident and Emergency department with an acute episode of difficulty with breathing, and on admission was found to have stridor and bilateral abductor vocal fold palsy. Further workup revealed a syringomyelia with an associated Chiari type 1 malformation. It is important to consider the above diagnosis in the differential of young adults with breathing difficulties. A discussion of syringomyelia, Chiai malformations and bilateral vocal fold palsy follows.
