RESUMO
Neurologic events associated to antiphospholipoid syndrome (APLS) are not uncommon, but ischemic stroke due to acute carotid thrombosis, is a rare presentation of this syndrome. We report a case of a 48 years old female patient, without evidence of atherothrombosis or other vascular pathology, who presented an ischemic stroke due to acute thrombosis of the left internal carotid artery. The occlusion was diagnosed by Duplex scan and magnetic resonance angiography (Ds+MRA). The patient was anticoagulated and experienced total regression of her neurologic symptoms after a week. Ds+MRA were performed again and confirmed re-establishment of normal flow of internal carotid artery. A thorough clinical investigation confirmed the diagnosis of APLS (the association of a major thombotic event and high anticardiolipoid IgG antibody titers in three blood samples). The patient has been submitted to oral anticoagulation for three years and has not experienced new neurologic or thrombotic events.
Assuntos
Síndrome Antifosfolipídica/complicações , Trombose das Artérias Carótidas/etiologia , Estenose das Carótidas/etiologia , Acidente Vascular Cerebral/etiologia , Doença Aguda , Administração Oral , Anticoagulantes/administração & dosagem , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/tratamento farmacológico , Trombose das Artérias Carótidas/diagnóstico , Trombose das Artérias Carótidas/tratamento farmacológico , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/tratamento farmacológico , Feminino , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Prevenção Secundária , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/tratamento farmacológico , Resultado do Tratamento , Ultrassonografia Doppler DuplaRESUMO
Chronic severe ischaemia of the upper limb is rare, due to the low incidence of arterial disease and to the presence of an adequate pre-existent collateral network. However, sometimes it occasionally occurs, dictating the need for revascularization. Since 1990, the authors have revascularized five upper extremities with severe ischaemic changes, employing the cephalic and/or basilic veins, used in situ. The aetiology of the arterial disease was autoimmune in one case and late sequelae of trauma in the others. Of the in situ venous bypasses performed, three were brachial-radial, and two sequential grafts (one axillary-radial-ulnar and one axillary-brachial-radial-ulnar). One concomitant sympathectomy was performed. All patients had excellent early and late results which leads the authors to recommend such revascularization of the forearm and hand, especially in the presence of severe ischaemia.
Assuntos
Mãos/irrigação sanguínea , Isquemia/cirurgia , Veias/transplante , Adulto , Angiografia , Feminino , Seguimentos , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , SimpatectomiaRESUMO
From May 1977 to January 1983, 270 patients with traumatic vascular lesions were treated in our Service. Among these, 27 presented associated fractures and/or dislocations. A high index of suspicion, the early recognition of the presence of vascular injury by thorough clinical evaluation, routine use of the Doppler flowmeter and broad indication of preoperative angiography resulted in prompt repair of these lesions in the majority of cases. Early exploration, wide fasciotomies, use of temporary intraluminal shunts during the bone fixation procedures (usually by internal plates), definitive venous and arterial repair after limb stabilization was achieved and frequent use of intraoperative angiography were the predominant factors in the treatment and outcome in these complex injuries. All eight limbs with closed fractures and/or dislocations were preserved, as well as 17 of 19 (89%) of the limbs with open or exposed skeletal injuries, resulting in a limb salvage rate of 92.6%.
Assuntos
Artérias/lesões , Fraturas Ósseas/complicações , Luxações Articulares/complicações , Veias/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artérias/cirurgia , Criança , Feminino , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/cirurgia , Masculino , Métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Veias/cirurgia , Ferimentos não Penetrantes , Ferimentos PenetrantesRESUMO
De maio de 1977 a abril de 1984, 310 pacientes com lesöes vasculares traumáticas foram tratados por nosso grupo. Destes, 37 apresentavam fraturas e/ou lesöes associadas. Um elevado índice de suspeiçäo, o reconhecimento precoce da presença de uma lesäo vascular por exame clínico apurado, o uso rotineiro do Doppler ultra-som e a ampla indicaçäo de angiografia pré-operatória resultaram em reparo precoce destas lesöes, na maioria dos casos. Os fatores predominantes para o êxito do tratamento destas lesöes complexas foram: exploraçäo cirúrgica imediata, fasciotomias extensas, uso de "shunt" temporário intraluminar durante a fixaçäo óssea (geralmente empregando placas e parafusos internos), reparo arterial e venoso definitivo após a estabilizaçäo do membro e o uso freqüente de angiografias peroperatórias. Foram preservados oito membros com fraturas e/ou lesöes fechadas, bem como 26 de 29 dos membros com lesöes ósseas abertas ou expostas, resultando na manutençäo de 91,8% do total das extremidades tratadas
