RESUMO
We describe a case of heparin-induced thrombocytopenia (HIT) in association with heparin-bonded stent grafts. A 61-year-old man with claudication secondary to a left superficial femoral artery (SFA) occlusion was treated with 2 heparin-bonded polytetrafluorethylene (hep-PTFE) grafts. Despite the use of antiplatelet medication, he presented with thrombosed hep-PTFE grafts 1 week after initial treatment. An additional hep-PTFE graft was placed at the SFA origin because of migration of the first graft. He was discharged on anticoagulation; however, he presented again 2 weeks later with recurrent SFA thrombosis and a platelet count of 60,000, raising suspicion for HIT. All exogenous forms of heparin were discontinued, and he was started on an alternative anticoagulant. The patient returned again 5 days after being discharged with recurrent symptoms of acute limb ischemia. He underwent a left femoropopliteal artery bypass with autogenous conduit and removal of the grafts. He has since had an uneventful recovery. We believe HIT should be considered as a potential cause of hep-PTFE graft thrombosis. Diagnosis and management of these patients is complex and may require explantation of the graft.
Assuntos
Anticoagulantes/efeitos adversos , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Materiais Revestidos Biocompatíveis/efeitos adversos , Artéria Femoral/cirurgia , Oclusão de Enxerto Vascular/induzido quimicamente , Heparina/efeitos adversos , Trombocitopenia/induzido quimicamente , Trombose/induzido quimicamente , Anticoagulantes/administração & dosagem , Implante de Prótese Vascular/instrumentação , Remoção de Dispositivo , Substituição de Medicamentos , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/terapia , Heparina/administração & dosagem , Humanos , Claudicação Intermitente/cirurgia , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Desenho de Prótese , Recidiva , Reoperação , Trombocitopenia/diagnóstico por imagem , Trombocitopenia/terapia , Trombose/diagnóstico por imagem , Trombose/terapia , Resultado do TratamentoAssuntos
Dor Abdominal/etiologia , Artérias , Dor Crônica/etiologia , Displasia Fibromuscular/complicações , Vísceras/irrigação sanguínea , Anticoagulantes/uso terapêutico , Artérias/diagnóstico por imagem , Biópsia , Angiografia por Tomografia Computadorizada , Feminino , Displasia Fibromuscular/diagnóstico por imagem , Displasia Fibromuscular/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Resultado do TratamentoRESUMO
A 63-year-old man was referred to our office with an enlarging left adrenal mass found on work-up for prostate cancer. Imaging performed over the course of 6 months demonstrated an increasing left adrenal mass from 2.8 to 3.6 cm. Functional testing of the adrenal lesion was performed. The adrenal mass was non-functional. Owing to the enlarging size, the patient underwent a laparoscopic left adrenalectomy without complication and was discharged home the following day. Gross pathological evaluation demonstrated a 3.2 cm, well-encapsulated, partially cystic mass. Histological evaluation demonstrated a small round blue cell tumour suspicious of sarcoma. Immunohistochemical testing revealed strong CD99 positivity consistent with Ewing family of tumours. Reverse transcriptase PCR demonstrated the presence of the Ewing sarcoma fusion transcript. The patient is currently enrolled in an ongoing research chemotherapy protocol at our institution using vincristine, doxorubicin, cyclophosphamide, ifosfamide and etoposide.
