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1.
Ann Vasc Surg ; 77: 348.e13-348.e18, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34437966

RESUMO

Several experiences have shown the benefits of carotid endarterectomy (CEA) to treat symptomatic acute occlusion of common and internal carotid arteries. Instead, surgery for carotid near occlusion remains controversial. We report successful surgical treatment in three patients with near occluded carotid artery. Doppler ultrasound scan was performed and showed common or internal carotid artery (ICA) near occlusion with controlateral carotid stenosis <50% (NASCET) with distal recanalization supported by collateral arteries of the external carotid artery (ECA) documented by preoperative CT-scan or selected angiography. Cases were treated by CEA of bifurcation and common-internal carotid bypass, using a PTFE graft or with longitudinal CEA and direct reconstruction. Perioperative and three months follow-up were free from new neurological events. In conclusion surgery for carotid near occlusion can be safely and successfully performed in selected cases with distal recanalization.


Assuntos
Implante de Prótese Vascular , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Idoso , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Circulação Colateral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Politetrafluoretileno , Desenho de Prótese , Fluxo Sanguíneo Regional , Índice de Gravidade de Doença , Resultado do Tratamento
2.
Ann Vasc Surg ; 68: 83-87, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32673648

RESUMO

BACKGROUND: The liability of patients affected by novel coronavirus disease (COVID-19) to develop venous thromboembolic events is widely acknowledged. However, many particulars of the interactions between the two diseases are still unknown. This study aims to outline the main characteristics of deep venous thrombosis (DVT) and pulmonary embolism (PE) in COVID-19 patients, based on the experience of four high-volume COVID-19 hospitals in Northern Italy. METHODS: All cases of COVID-19 in-hospital patients undergoing duplex ultrasound (DUS) for clinically suspected DVT between March 1st and April 25th, 2020, were reviewed. Demographics and clinical data of all patients with confirmed DVT were recorded. Computed tomography pulmonary angiographies of the same population were also examined looking for signs of PE. RESULTS: Of 101 DUS performed, 42 were positive for DVT, 7 for superficial thrombophlebitis, and 24 for PE, 8 of which associated with a DVT. Most had a moderate (43.9%) or mild (16.9%) pneumonia. All venous districts were involved. Time of onset varied greatly, but diagnosis was more frequent in the first two weeks since in-hospital acceptance (73.8%). Most PEs involved the most distal pulmonary vessels, and two-thirds occurred in absence of a recognizable DVT. CONCLUSIONS: DVT, thrombophlebitis, and PE are different aspects of COVID-19 procoagulant activity and they can arise regardless of severity of respiratory impairment. All venous districts can be involved, including the pulmonary arteries, where the high number and distribution of the thrombotic lesions without signs of DVT could hint a primitive thrombosis rather than embolism.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pandemias , Pneumonia Viral/complicações , Ultrassonografia Doppler Dupla/métodos , Tromboembolia Venosa/diagnóstico , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Fatores de Risco , SARS-CoV-2 , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
3.
Ann Vasc Surg ; 29(5): 1018.e9-1018.e11, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25765638

RESUMO

The multilayer flow modulator (MFM) is a device whose real effectiveness in the treatment of thoracoabdominal aortic aneurysms is not clear yet. A 68-year-old man with a 18-mm blister-like aneurysm of the descending thoracic aorta underwent endovascular exclusion, complicated by the thrombosis of a previous aortobi-iliac prosthesis, treated with embolectomy and femorofemoral bypass. Therefore, an MFM placement was planned. The postoperative course was uneventful and the 6-month computed tomography scan showed a complete thrombosis and remodeling of the aneurysm. The MFM stent could be an alternative treatment for saccular thoracic aortic aneurysm in high-risk patients but should not be used indiscriminately when other modalities of aortic repair are not feasible. Longer follow-up is mandatory to prove the efficacy of this technology.


Assuntos
Aorta Torácica/cirurgia , Prótese Vascular , Procedimentos Endovasculares/métodos , Remodelação Vascular , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/cirurgia , Aortografia , Humanos , Masculino , Período Pós-Operatório , Desenho de Prótese , Tomografia Computadorizada por Raios X
4.
Case Rep Oncol ; 7(1): 23-8, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24575011

RESUMO

INTRODUCTION: Kasabach-Merritt syndrome (KMS) is a life-threatening disease. We describe a combined medical and multistep, endovascular embolization that was successfully performed with surgery. CASE REPORT: A 40-day-old female baby was referred because of an infiltrating pelvic mass. Blood tests showed severe anemia and thrombocytopenia with consumptive coagulopathy. The clinical aspect was pathognomonic for KMS. Administration of steroids and chemotherapy were started and coagulation parameters were normalized with tumor volume regression. Three months later, elective surgical treatment became possible, and dissection and ligature of the left internal iliac artery and sacral artery were performed. The main arterial supply of the mass was embolized with Spongostan®. Two months later, a second hybrid approach was adopted for embolization of the main vascular supply of the tumor occupying the left thigh. Via a third contralateral hybrid femoral approach and under fluoroscopy, selective catheterization of the left profunda femoris artery was performed. The arterial feeder of the tumor, localized at the left gluteus, was seen on a CT scan 2 months later and was embolized with Onyx-18. CONCLUSION: Chemotherapy and a tailored hybrid approach comprising repeated endovascular embolizations seem to be a safe treatment in cases of unresectable and life-threatening tumors in small babies.

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