RESUMO
The authors report seven cases of abdominal aortic aneurysm rupturing into the inferior vena cava system. Symptoms were protean, but included local clinical manifestations and general findings due to the high-flow arteriovenous fistula. In spite of different types of clinical presentation, the correct preoperative diagnosis was made when a continuous bruit with systolic accentuation was heard over the abdomen. Venous repair consisted of simple closure of the fistula from within the aneurysm in six cases. In one case, treatment required ligation of the right common iliac vein. There were two cases of paraplegia, one before and one after the operation. Two of the seven patients died.
Assuntos
Ruptura Aórtica/cirurgia , Fístula Arteriovenosa/cirurgia , Veia Ilíaca/cirurgia , Veia Cava Inferior/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/cirurgia , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/etiologia , Auscultação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura EspontâneaRESUMO
Operative treatment was applied in 139 patients with hemodynamically significant bilateral stenosis of the carotid arteries due to atherosclerosis. Three groups could be distinguished: group I--stenosis greater than 75% on one side and between 50 and 75% on the other side; group II--stenosis greater than 75% on both sides; group III--obstruction on one side and stenosis greater than 50% on the other side. The risk of clamping did not appear abnormally high, while the peroperative neurologic risk was slightly enhanced due to the possibility of accidents in the region which lies contralateral to that of the operated side, or in the region of the brain stem. The risk in the group III patients did not appear to be increased. Immediate and secondary neurologic prognosis is mainly a function of the presence of multiple peculiar lesions, and also of the presence or absence of parenchymatous ischemic lesions. Preventive surgery on narrowed, stenotic, progressive lesions, detected by ultrasound imaging systematically repeated every 6 months, diminishes the incidence of onset of neurologic complications.
