RESUMO
Introduction: Pseudoaneurysms of the subclavian artery are a rare complication. Surgical treatment is necessary to prevent potentially lethal complications. This needs adequate planning in cases that require vertebral artery revascularisation. Report: A 56 year old man with multiple systemic comorbidities underwent endovascular treatment using a balloon expandable bare metal stent for symptomatic subclavian Steal syndrome. During follow up, computed tomography angiography (CTA) revealed a pseudoaneurysm in the proximal segment of the left subclavian artery. The patient had criteria warranting left vertebral artery revascularisation. The patient underwent scheduled hybrid surgical treatment involving transposition of the vertebral artery to the common carotid artery, endarterectomy of the internal carotid artery, and endovascular therapy for pseudoaneurysm exclusion; all were performed on the left side. The post-operative period was without incident. After 12 months the patient remains asymptomatic, with adequate exclusion of the pseudoaneurysm, and patency of the procedures. Discussion: Hybrid surgery could offer a secure, feasible, and less invasive option for treating subclavian artery pseudoaneurysms that require vertebral artery revascularisation.
RESUMO
Introducción: la presencia de riñón pélvico constituye una variante anatómica con escasa incidencia en la población general, y es todavía más infrecuente su asociación con aneurismas de aorta abdominal (AAA). Caso clínico: varón de 69 años con insuficiencia renal estadio 4, remitido por hallazgo ecográfico de AAA. La angioTC muestra un AAA de 56 mm de diámetro máximo con riñón único de localización pélvica, cuya arteria renal única surge de la bifurcación aórtica. El paciente se sometió a tratamiento quirúrgico de forma programada. Se realizó un bypass aortobiiliaco y bypass desde la rama derecha del injerto a la arteria renal con vena safena interna invertida. Como técnica de protección renal se administró manitol intravenoso previamente al clampaje renal y se realizó en primer lugar la anastomosis de la vena safena interna con la arteria renal para así infundir solución salina fría durante el tiempo de isquemia. El posoperatorio transcurrió sin incidencias exceptuando un discreto deterioro de la función renal que se resolvió mediante tratamiento médico. Discusión: el riñón pélvico implica un desafío en el tratamiento de la patología aórtica aneurismática asociada. Por un lado, supone una limitación a la hora de efectuar tratamientos endovasculares y por otro, la necesidad de minimizar el tiempo de isquemia renal durante el clampaje puede aumentar significativamente la complejidad del tratamiento quirúrgico.(AU)
Introduction: pelvic kidney is an anatomical variant with minimal incidence in the general population; its association with abdominal aortic aneurysm (AAA) is even more infrequent. Case report: a 69-year-old man with stage 4 renal failure, was referred due to an ultrasound finding of AAA. CT angiography shows a 56-mm AAA with a single pelvic kidney whose single renal artery arises from the aortic bifurcation. The patient underwent elective surgical treatment. An aorto-biiliac bypass and a bypass from the right branch of the graft to the renal artery with inverted great saphenous vein (GSV) were performed. The renal protection techniques consist on administrating intravenous mannitol prior to renal clamping and to perform the anastomosis of the GSV with the renal artery in first place in order to infuse cold saline solution during the time of ischemia. The postoperative period was uneventful except for a slight deterioration in renal function that was resolved with medical treatment. Discussion: the presence of a pelvic kidney in the treatment of aneurysmal aortic pathology can be challenging. On the one hand, it represents a limitation to endovascular techniques and on the other hand, the need to minimize the time of renal ischemia during clamping can significantly increase the complexity of the surgical treatment.(AU)
