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1.
J Vasc Surg Cases Innov Tech ; 7(4): 645-648, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34693095

RESUMO

We report a vein surgery procedure for popliteal venous aneurysms (PVAs). A 73-year-old woman with a long, irregularly shaped, PVA and thrombus underwent graft replacement using a manually made triple vein panel graft. Simple bypass grafting with a saphenous vein was unsuitable because of long defects and a size mismatch. We harvested the great saphenous vein from the right thigh, divided it into three segments, anastomosed it side-by-side on the long side, and created a venous panel graft. Good graft patency was confirmed at 4 years postoperatively, and the clinical course was stable without pulmonary embolism recurrence.

2.
Cureus ; 13(3): e14016, 2021 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-33777586

RESUMO

Saphenous vein graft (SVG) aneurysm is one of the late unusual complications of coronary artery bypass grafting (CABG). We report a case of a very large SVG aneurysm successfully treated with a vascular plug 4. A 94-year-old man was referred to our hospital for an expanding aortic aneurysm. The patient had undergone CABG 24 years prior, with three SVGs to the left anterior descending (LAD) artery, left circumflex arteries (LCX) artery, and right coronary artery (RCA). A computed tomography scan of the chest demonstrated an 8.8 cm × 6.5 cm aneurysm arising from an ascending aortic wall. Coronary angiography revealed an aneurysm arising from the proximal segment of the SVG to the RCA. The distal graft anastomosis of the SVG to the RCA and LCX was occluded. Another SVG to the LAD was widely patent. From a radial approach, a 5-Fr catheter (Tempo, Cardinal Health, OH) was advanced into its cavity, and a 7-mm Amplatzer vascular plug 4 (AVP-IV, AGA Medical Corporation, MN) was successfully delivered. Contrast CT confirmed a thrombus development in the cavity. The patient was discharged home. However, interventions utilizing vascular plug insertion are limited to cases of graft occlusion. We report a case of the successful treatment of a large SVG aneurysm using the Amplatzer vascular plug 4.

3.
Cureus ; 11(6): e5017, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31497447

RESUMO

Retrograde type A aortic dissection (RTAD) is a severe complication of thoracic endovascular aortic repair (TEVAR). In this regard, we present our unique surgical methods for total arch and descending aorta replacement for RTAD after TEVAR for complicated type B aortic dissection (TBAD). A 52-year-old man with a history of distal arch large aneurysm was diagnosed with TBAD. Because he had sustained chest pain and his aneurysm diameter was 67 mm, TEVAR was urgently performed. After a right axillary-left axillary artery bypass, a stent graft was deployed in the descending aorta via the right femoral artery. Coil embolization was performed in the left subclavian artery. After the condition of the stent graft was checked by angiography, no Type 1 endoleak and backflow from the re-entry was observed. However, seven days after the operation, he experienced chest pain suddenly. Computed tomography (CT) revealed forward blood flow in the descending aorta (type IA endoleak) and thrombosed aortic dissection in the ascending aorta. The distal arch diameter exceeded 70 mm. A decision was taken to immediately perform an operation. Total aortic arch and descending aorta replacement were performed through a median sternotomy with left 5th interspace thoracotomy. The operation was performed under deep hypothermic circulatory arrest, and selective antegrade cerebral perfusion was accomplished. As a result of the exploration of the aortic arch, it was found that the intimal injury by the bare stent caused RTAD. The patient was successfully extubated after the operation and was discharged without any complications. RTAD can present as an early complication after descending stent grafting because of aortic instability or due to the strength of bare stents. Aortic arch and descending aorta replacement after TEVAR via a clamshell incision can be safely performed if RTAD is diagnosed early.

4.
Kyobu Geka ; 66(4): 345-7, 2013 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-23575190

RESUMO

A 51-year-old man of the kidney transplant recipient was admitted to our hospital with acute myocardial infarction. Transthoracic echocardiography revealed a subepicardial left ventricular aneurysm that had increased in its size gradually. The operation was performed at 43rd days after myocardial infarction. Subepicardial aneurysm was seen on the posterior wall of the left ventricle. The orifice of the aneurysm was closed with expanded polytetrafluoroethylene (ePTFE) patch. The postoperative course was uneventful in spite of immunosuppressive therapy with ciclosporin. Surgical repair of a subepicardial aneurysm is recommended because of its high rupture rate.


Assuntos
Aneurisma Cardíaco/cirurgia , Transplante de Rim , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Pericárdio , Complicações Pós-Operatórias
5.
Ann Thorac Surg ; 94(2): 643-6, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22579896

RESUMO

We report a case of a giant right atrial myxoma mimicking the right ventricular tumor. The 75-year-old patient underwent cardiac surgery, and the tumor was excised along with the stalk. Tricuspid valve annuloplasty was performed before closure of the right atriotomy. The tumor may have caused intraventricular stenosis, hepatic dysfunction, and progressive fatigue as a result of low cardiac output. This case is of special interest because the myxoma was very large compared with those ever reported, and a right atrial myxoma occupying the right ventricular cavity is rare.


Assuntos
Átrios do Coração , Neoplasias Cardíacas/patologia , Ventrículos do Coração/patologia , Mixoma/patologia , Idoso , Feminino , Humanos , Invasividade Neoplásica
7.
Ann Vasc Surg ; 26(4): 571.e11-6, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22321490

RESUMO

The patient, a 55-year-old female Jehovah's Witness who had suffered type B aortic dissection since the age of 53 years, presented with enlargement of the false lumen in the distal aortic arch and was subsequently admitted to our hospital. While hospitalized, her enlarged false lumen ruptured and she underwent replacement of the distal aortic arch and descending thoracic aorta without blood transfusion. Blood conservation strategies for this patient included the following: 1) meticulous hemostasis when incising muscle or soft tissue, 2) minimal use of gauze and discard suckers, 3) exclusive use of a cell salvage device "from skin to skin," 4) low-prime cardiopulmonary bypass, 5) minimal laboratory blood sampling, and 6) preoperative and postoperative erythropoietin treatment. Hemoglobin (Hb) values were 12.5, 15.5, 10.0, and 9.7 g/dL on admission, before rupture, after rupture, and just after the operation, respectively. The patient had an uneventful postoperative course, except for prolonged rehabilitation. The postoperative lowest Hb value was 5.2 g/dL on postoperative day 5, and the Hb value at hospital discharge (postoperative day 55) was 11.0 g/dL. Our experience with blood conservation surgery on this Jehovah's Witness patient suggests that ruptured chronic type B aortic dissection can be safely repaired on bypass through a left thoracotomy with no blood transfusion if the preoperative Hb value is >10.0 g/dL.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Ruptura Aórtica/cirurgia , Transfusão de Sangue/ética , Testemunhas de Jeová , Procedimentos Cirúrgicos Vasculares/métodos , Dissecção Aórtica/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , Ruptura Aórtica/diagnóstico , Doença Crônica , Contraindicações , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos Vasculares/ética
8.
Heart Vessels ; 27(4): 428-31, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22045152

RESUMO

Free-floating left atrial thrombi are rare. Here we report a case of a 75-year-old woman with atrial fibrillation who was admitted for treatment of acute myocardial infarction. A free-floating left atrial thrombus was found incidentally on echocardiography. Ten days after percutaneous coronary intervention, the patient had mild faintness with transient hypotension, and it was found that the left atrial thrombus had developed intermittent entrapment in the mid-ventricle during diastole, with abrupt rebound back to the left atrial cavity during systole. Urgent removal of the thrombus was performed successfully. Although the free-floating thrombus had appeared to be spherical, like a ball thrombus, on echocardiography, the excised thrombus was pedunculated. A cut section revealed a laminated thrombus with an onion-skin-like appearance.


Assuntos
Fibrilação Atrial/diagnóstico , Diástole , Cardiopatias/diagnóstico , Hipertrofia Ventricular Esquerda/diagnóstico , Infarto do Miocárdio/diagnóstico , Trombose/diagnóstico , Disfunção Ventricular Esquerda/diagnóstico , Função Ventricular Esquerda , Idoso , Angioplastia Coronária com Balão , Anticoagulantes/uso terapêutico , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Ecocardiografia Transesofagiana , Feminino , Cardiopatias/fisiopatologia , Cardiopatias/terapia , Humanos , Hipertrofia Ventricular Esquerda/fisiopatologia , Hipertrofia Ventricular Esquerda/terapia , Achados Incidentais , Infarto do Miocárdio/terapia , Valor Preditivo dos Testes , Trombectomia , Trombose/fisiopatologia , Trombose/terapia , Resultado do Tratamento , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/terapia
9.
Ann Thorac Cardiovasc Surg ; 17(4): 422-7, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21881336

RESUMO

Acute aortic occlusion is a rare but catastrophic pathology with high mortality even after revascularization. We describe four patients who underwent thrombectomy or bypass surgery for acute aortic occlusion with concomitant internal iliac artery occlusion. Two patients (82- and 75-year-old men), who had insufficient reperfusion of bilateral internal iliac arteries after treatment (thrombectomy alone and axillobifemoral bypass, respectively), died on postoperative day three of uncontrollable hyperkalemia and multiple organ failure, respectively (mortality: 50%). The third patient (74-year-old man), in whom the left internal iliac artery was reperfused after an axillobifemoral bypass, underwent right lower limb amputation but survived. The fourth patient (63-year-old man) with sufficient internal iliac artery reperfusion bilaterally after aortobifemoral and right internal iliac artery reconstruction, had an uneventful postoperative course. Elevated creatine phosphokinase and myoglobinuria levels were observed in all four patients but were notably higher in the two patients with no reperfusion in either of the internal iliac arteries. Our results suggest that reperfusion of one or more internal iliac arteries may be a crucial factor in reducing mortality in revascularization treatment of acute aortic occlusion with concomitant internal iliac artery occlusion.


Assuntos
Aorta Abdominal/cirurgia , Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular , Artéria Ilíaca/cirurgia , Trombectomia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/fisiopatologia , Doenças da Aorta/diagnóstico , Doenças da Aorta/fisiopatologia , Aortografia/métodos , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/fisiopatologia , Evolução Fatal , Humanos , Artéria Ilíaca/fisiopatologia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
Ann Vasc Surg ; 25(6): 837.e9-15, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21665425

RESUMO

Persistent sciatic artery (PSA) is a rare congenital vascular malformation. In this article, we have described the case of a 66-year-old woman presenting with a pulsatile mass in the left buttock and bilateral lower limb ischemia, who underwent surgical therapy. Preoperative computed tomography scanning showed a left thrombosed PSA aneurysm (PSAA) with concomitant occlusion of bilateral iliac, bilateral common femoral, and left popliteal arteries. After recanalization of the left common femoral artery occlusion with a systemic heparin treatment, the patient underwent bypass surgery (left femoropopliteal bypass, right iliofemoral bypass) and PSAA exclusion. Postoperative computed tomography scanning 20 months after surgery revealed that the excluded PSAA was thrombosed with no refilling collateral flow, and that the bypass grafts were patent in both legs. In addition to this case report, a literature review of PubMed articles published between 1965 and 2009 that included the treatment and intermediate/long-term management of symptomatic PSAs was conducted. We found 45 articles (67 limbs), of which 24 (29 limbs) described the intermediate/long-term outcomes in patients treated for symptomatic PSA. Regardless of the method of arterial reconstruction or PSAA repair, intermediate/long-term outcomes of different treatments for lower limb ischemia and PSAAs were satisfactory, and the patients were asymptomatic during the follow-up period which ranged from 2 months to 10 years.


Assuntos
Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Malformações Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares , Idoso , Artérias/anormalidades , Artérias/fisiopatologia , Artérias/cirurgia , Circulação Colateral , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Isquemia/fisiopatologia , Fluxo Sanguíneo Regional , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Malformações Vasculares/complicações , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia
11.
Ann Thorac Cardiovasc Surg ; 17(2): 204-7, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21597424

RESUMO

An 84-year-old woman with a history of surgery for cholangiocarcinoma presented to Akita University Hospital with severe right lower abdominal pain, respiratory distress, and hypotension. Computed tomography scanning revealed a ruptured right common iliac artery aneurysm with a massive right retroperitoneal hematoma and a right internal iliac artery aneurysm. Under the bilateral retroperitoneal approach, we preformed an in-situ repair of an aneurysm rupture from the aorta to the left common and right external iliac arteries using a bifurcated knitted Dacron graft, and then we ligated the right internal iliac artery. The postoperative course of the patient was uneventful. The patient was discharged from hospital 52 days after surgery. In conclusion, a bilateral retroperitoneal approach may be a safe and useful strategy for in-situ repair of a right iliac artery aneurysm rupture in patients with peritoneal adhesions after transperitoneal abdominal surgery.


Assuntos
Aneurisma Roto/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar , Implante de Prótese Vascular/métodos , Aneurisma Ilíaco/cirurgia , Idoso de 80 Anos ou mais , Aneurisma Roto/diagnóstico por imagem , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Colangiocarcinoma/cirurgia , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Ligadura , Cavidade Peritoneal/cirurgia , Polietilenotereftalatos , Desenho de Prótese , Espaço Retroperitoneal/cirurgia , Aderências Teciduais , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Ann Vasc Surg ; 25(6): 740-7, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21439774

RESUMO

BACKGROUND: Rupture of an iliac artery aneurysm is rare but could be catastrophic unless it is treated with an appropriate strategy. We reviewed our 10-year institutional experience in treating iliac artery aneurysms to elucidate the effectiveness of open surgical repair strategies for ruptured iliac artery aneurysms in terms of short- and long-term postoperative results. METHODS: A total of 26 patients (men/women = 22/4), with a mean age of 72 years, underwent open repair of iliac artery aneurysm with or without rupture (unruptured/ruptured = 15/11) between January 2001 and April 2010. There was no difference in the distribution of aneurysm morphology between the unruptured and ruptured groups, and 20 (76.9%) of the 26 patients had aneurysms involving unilateral or bilateral internal iliac arteries. Long-term event-free survival rates and freedom from secondary intervention were analyzed using the Kaplan-Meier method (follow-up: 55 ± 39 and 40 ± 25 months in the unruptured and ruptured groups, respectively). RESULTS: There was no difference in the time of surgery between the two groups (351 ± 118 and 348 ± 152 minutes in the unruptured and ruptured groups, respectively), but the ruptured group showed greater blood loss/min (time of surgery) and transfusion volume than the unruptured group. The early postoperative mortality was 6.7% in the unruptured group and 0% in the ruptured group (p = 0.557). There was no difference in the number of postoperative morbidities between the two groups, but the ruptured group showed significantly greater C-reactive protein, lactate dehydrogenase, and total bilirubin levels than the unruptured group. The cardiovascular event-free survival rate at 5 years was 93.3% and 100.0% in the unruptured and ruptured groups, respectively. The secondary intervention-free rate at 5 years was 100.0% and 90.0% in the unruptured and ruptured groups, respectively. CONCLUSIONS: The short- and long-term postoperative mortality rates after open repair for iliac artery aneurysms were satisfactorily low and similar in unruptured and ruptured groups. This suggests that open repair strategies remain as a reliable treatment option to obtain successful postoperative results in patients with rupture of an iliac artery aneurysm.


Assuntos
Aneurisma Roto/cirurgia , Implante de Prótese Vascular , Aneurisma Ilíaco/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Distribuição de Qui-Quadrado , Intervalo Livre de Doença , Feminino , Humanos , Aneurisma Ilíaco/mortalidade , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Reoperação , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
Interact Cardiovasc Thorac Surg ; 12(3): 494-6, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21172948

RESUMO

We describe a 74-year-old male who underwent open stent repair for an infrarenal abdominal aortic aneurysm with a severely calcified aortic neck. The stent graft was constructed by covering a 50-mm long Gianturco Z stent (diameter: 20 mm) with a Dacron prosthesis (diameter: 20 mm). The stented Dacron graft was inserted into the calcified aortic neck, was then sutured to the trimmed aneurysmal wall, and was anastomosed to a bifurcated prosthesis. The distal ends of the bifurcated prosthesis were anastomosed to both common femoral arteries, and the terminal aorta was closed. The patient had an uneventful postoperative course. This procedure may be a feasible and safe way to repair infrarenal abdominal aortic aneurysm with a severely calcified aortic neck.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Calcinose/complicações , Idoso , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Calcinose/diagnóstico por imagem , Humanos , Masculino , Polietilenotereftalatos , Desenho de Prótese , Índice de Gravidade de Doença , Stents , Técnicas de Sutura , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
Ann Vasc Surg ; 24(6): 822.e1-5, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20471208

RESUMO

We describe a rare case of an arteriosclerotic aneurysm in the right-sided descending thoracic aorta with a left-sided aortic arch and concomitant aberrant right subclavian artery. A 76-year-old woman, who was found to have an aneurysm of the right-sided descending thoracic aorta, was referred to our hospital for surgical treatment. Contrast computed tomography scan revealed a left-sided aortic arch with an aberrant right subclavian artery, a descending thoracic aorta passing downward behind the esophagus, and an aneurysm of the right-sided and distal (level between the 8th and 10th vertebral bodies) descending thoracic aorta. With a right posterolateral thoracotomy, the patient underwent descending thoracic aorta replacement using an 18-mm woven Dacron prosthesis. The patient had an uneventful postoperative course and was discharged 24 days after surgery. Histological microscopic examination of the resected aneurysmal wall revealed an arteriosclerotic aneurysm. The postoperative computed tomography scan 18 days after surgery revealed no anastomotic aneurysm or abnormal fluid collection.


Assuntos
Aorta Torácica/anormalidades , Aneurisma da Aorta Torácica/complicações , Artéria Subclávia/anormalidades , Malformações Vasculares/complicações , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Aortografia/métodos , Implante de Prótese Vascular , Feminino , Humanos , Artéria Subclávia/diagnóstico por imagem , Toracotomia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem
15.
Ann Vasc Surg ; 24(6): 824.e1-5, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20471795

RESUMO

We describe a rare case of surgical treatment for a repeated contained rupture of an infected abdominal aortic aneurysm (AAA) with concomitant vertebral erosion. A 59-year-old man presented to a nearby hospital with abdominal pain and fever. On admission, computed tomography (CT) scan revealed a contained rupture of AAA, but the patient declined the offer of surgical therapy. Thereafter, the retroperitoneal hematoma gradually reduced in size. The third and fourth lumbar vertebrae were eroded on the CT scan 12 months after the appearance of the first symptom. However, 21 months after the first symptom, he suffered severe lumbago and was diagnosed with recurrence of contained AAA rupture and vertebral body destruction. He underwent debridement of eroded vertebrae and in situ graft replacement of AAA with omentum flap wrapping. Intraoperative microscopic examination of the hematoma revealed gram-positive Streptococcus. His postoperative course was uneventful, and CT 12 months after surgery did not reveal further deterioration of vertebral erosion or fluid accumulation. Repetitive contained AAA rupture may be another entity in contrast to chronic contained AAA rupture. Vertebral erosion could be associated with infection rather than mass effects of the contained hematoma. Surgical treatment is indicated to prevent life-threatening re-rupture and severe spinal instability.


Assuntos
Aneurisma Infectado/microbiologia , Aneurisma da Aorta Abdominal/microbiologia , Ruptura Aórtica/microbiologia , Vértebras Lombares/microbiologia , Doenças da Coluna Vertebral/microbiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Aortografia/métodos , Implante de Prótese Vascular , Desbridamento , Hematoma/diagnóstico por imagem , Hematoma/microbiologia , Hematoma/cirurgia , Humanos , Dor Lombar/microbiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Omento/cirurgia , Procedimentos Ortopédicos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Retalhos Cirúrgicos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Ann Vasc Surg ; 24(7): 951.e1-6, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20471797

RESUMO

We describe a patient with aortic occlusion due to false-lumen expansion after repair of abdominal aortic rupture in acute type B aortic dissection. A 70-year-old man presented to a nearby hospital with severe lower back pain, and was subsequently referred to our hospital with a diagnosis of abdominal aortic rupture. Computed tomography scanning on admission revealed type B aortic dissection with concomitant false-lumen rupture at the level of pre-existing infrarenal abdominal aortic aneurysm. The patient underwent abdominal aortic replacement with the true lumen reconstructed using a bifurcated knitted Dacron graft. On postoperative day 2, the patient developed severe lower body ischemia. Computed tomography scanning revealed complete true-lumen occlusion at the renal artery level because of false-lumen expansion. The patient underwent open fenestration by opening the bulging flap with a transverse graftotomy distal to the proximal graft anastomosis. After fenestration, the patient developed severe metabolic complications (i.e., myonephropathic-metabolic syndrome) and died a day later of cardiac arrest resulting from hyperkalemia. Abdominal aortic replacement with true-lumen reconstruction in patients with abdominal aortic rupture in type B acute aortic dissection could also lead to acute aortic occlusion due to re-dissection or true-lumen compromise accompanying retrograde propagation of false-lumen thrombosis. This lethal sequela after true-lumen reconstruction might be prevented by an adjuvant procedure such as concomitant fenestration.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Doenças da Aorta/etiologia , Dissecção Aórtica/cirurgia , Ruptura Aórtica/cirurgia , Arteriopatias Oclusivas/etiologia , Implante de Prótese Vascular/efeitos adversos , Acidentes de Trânsito , Doença Aguda , Idoso , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/etiologia , Aortografia/métodos , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Evolução Fatal , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Masculino , Polietilenotereftalatos , Desenho de Prótese , Reoperação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Ann Vasc Surg ; 24(5): 692.e5-9, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20413256

RESUMO

A 78-year-old woman, who had a history of abdominoperineal resection with the associated left-side stoma for rectal cancer, was diagnosed with an infrarenal abdominal aortic aneurysm involving both common and right internal iliac arteries. She underwent in situ graft (bifurcated Dacron) replacement through a right retroperitoneal approach because of limited accessibility to the aorta and iliac arteries due to the left-side stoma. The distal anastomosis of the bifurcated graft was placed to the right external iliac artery and left femoral artery, and the left common iliac artery was excluded by ligating the branching arteries. The patient had an uneventful postoperative course, and the computed tomography scanning at 13 months after surgery revealed thrombosed occlusion of the excluded left common iliac aneurysm. In conclusion, a right retroperitoneal approach may be an option for abdominal aortic aneurysm patients who had a history of transperitoneal abdominal surgery and an associated left-side stoma.


Assuntos
Abdome/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Aneurisma Ilíaco/cirurgia , Neoplasias Retais/cirurgia , Estomas Cirúrgicos , Idoso , Anastomose Cirúrgica , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Feminino , Artéria Femoral/cirurgia , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Ligadura , Polietilenotereftalatos , Desenho de Prótese , Espaço Retroperitoneal/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Ann Vasc Surg ; 24(3): 417.e1-4, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20036502

RESUMO

A 56-year-old man with a painful, progressively enlarging pulsatile mass in the bilateral popliteal fossae was diagnosed with a bilateral popliteal artery aneurysm (PAA) and referred to our hospital to undergo surgical therapy. Computed tomographic scanning demonstrated a large, middle-type PAA with a rich mural thrombus in the bilateral popliteal arteries. Following aneurysm exclusion posteriorly, the patient underwent bypass surgery using a ringed polytetrafluoroethylene graft bilaterally. This procedure was chosen to prevent nerve injury caused by mobilization of the adherent nerves and aneurysmal resection. The patient had a satisfactory postoperative course. This procedure may be recommended for large, middle-type PAAs because (1) the adherent tibial nerve trunk and its branch nerves can be protected by aneurysm exclusion with arterial branch ligation and (2) frequently occurring postexclusion expansion of the aneurysm caused by insufficient branch ligation using the medial approach can be avoided.


Assuntos
Aneurisma/cirurgia , Implante de Prótese Vascular , Artéria Poplítea/cirurgia , Procedimentos Cirúrgicos Vasculares , Aneurisma/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Politetrafluoretileno , Artéria Poplítea/diagnóstico por imagem , Desenho de Prótese , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/instrumentação
19.
Gen Thorac Cardiovasc Surg ; 57(8): 413-7, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19779789

RESUMO

A 74-year-old woman with massive hemoptysis and shock who had been diagnosed with thoracic aortic rupture underwent in situ replacement of the thoracic aorta using an equine pericardial roll graft. The lower lobe of the left lung was resected because of a massive hematoma and adhesion to the wall of the thoracic aorta. Intraoperative microscopic examination of the resected aortic wall revealed Gram-positive bacteria (alpha-streptococcus in bacterial cultivation). Histology of the resected aorta revealed abscess formation in the media and adventitia of the aortic wall associated with disruption of the media (dissection). Postoperative computed tomography revealed no fluid collection around the graft 1 month after surgery, and magnetic resonance imaging showed no significant graft dilation 20 months after operation. The equine pericardium can be an option of alternative graft materials for in situ replacement of the thoracic aorta in patients with an aortobronchial fistula due to aortic rupture.


Assuntos
Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Bioprótese , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Fístula Brônquica/cirurgia , Pericárdio/transplante , Fístula Vascular/cirurgia , Idoso , Animais , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/microbiologia , Ruptura Aórtica/complicações , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/microbiologia , Aortografia/métodos , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/microbiologia , Desbridamento , Feminino , Hemoptise/etiologia , Hemoptise/cirurgia , Cavalos , Humanos , Angiografia por Ressonância Magnética , Choque Hemorrágico/etiologia , Choque Hemorrágico/cirurgia , Streptococcus/isolamento & purificação , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Fístula Vascular/microbiologia
20.
Gen Thorac Cardiovasc Surg ; 57(8): 421-5, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19779791

RESUMO

We describe surgical and adjuvant therapeutic management of a right ventricular (RV) sarcoma and pulmonary artery occlusion. Echocardiographic evaluation of a 39-year-old man with exertional dyspnea revealed a tumor mass in the right ventricle, pulmonary trunk, and bilateral pulmonary arteries. The tumor was resected with concomitant pulmonary valvotomy, but the resection was incomplete. The RV outflow was reconstructed with an allograft patch, and a stentless valve was implanted for pulmonary valvular function. The pulmonary trunk and arteries were enlarged with allograft patches. The tumor was undifferentiated sarcoma and caused postoperative pulmonary artery restenosis. Radiotherapy improved pulmonary perfusion (reduction of RV pressure), but the patient died of brain metastasis. Undifferentiated cardiac sarcomas associated with pulmonary hypoperfusion should be resected even if incompletely, and radiation therapy could alleviate reduced pulmonary perfusion.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Neoplasias Cardíacas/cirurgia , Sarcoma/cirurgia , Adulto , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/patologia , Arteriopatias Oclusivas/cirurgia , Biópsia , Neoplasias Encefálicas/secundário , Constrição Patológica , Dispneia/etiologia , Dispneia/cirurgia , Ecocardiografia Doppler , Evolução Fatal , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/radioterapia , Neoplasias Cardíacas/secundário , Implante de Prótese de Valva Cardíaca , Ventrículos do Coração/cirurgia , Humanos , Masculino , Artéria Pulmonar/patologia , Artéria Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Radioterapia Adjuvante , Sarcoma/complicações , Sarcoma/radioterapia , Sarcoma/secundário , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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