RESUMO
OBJECTIVE: To describe a single institutional experience with minimally invasive limited ligation endoluminal-assisted revision (MILLER) for treatment of dialysis access steal syndrome (DASS). MATERIALS AND METHODS: Twenty patients were retrospectively identified that underwent 30 MILLER band procedures for DASS at our institution from March 2010 to December 2014. Technical success was defined by successful creation of MILLER band with preservation of flow for hemodialysis. Clinical success was defined as complete resolution of signs and symptoms with preservation of dialysis access in a 1-month postprocedural period. Primary MILLER band patency, postintervention-assisted primary access patency, and postprocedure secondary access patency are reported. RESULTS: Technical success was achieved in all patients. Clinical success was achieved in 75% of patients after one banding procedure and in 95% of patients after two banding procedures. One patient experienced access thrombosis following the initial banding procedure which was subsequently treated and did not lead to loss of access. MILLER band patency was 83% at 1 month and 77% at 6 months. Postintervention-assisted primary patency was 95%, 93%, and 92% at 3 months, 6 months, and 1 year, respectively. Postintervention secondary patency was 86%, 68%, and 59% at 3 months, 6 months, and 1 year, respectively. CONCLUSIONS: MILLER banding offers a less-invasive alternative to surgical therapy that appears to be safe and permits preservation of dialysis access.
Assuntos
Derivação Arteriovenosa Cirúrgica , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias/cirurgia , Diálise Renal , Artéria Subclávia/cirurgia , Síndrome do Roubo Subclávio/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Ligadura/instrumentação , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Complicações Pós-Operatórias/diagnóstico por imagem , Reoperação , Estudos Retrospectivos , Artéria Subclávia/diagnóstico por imagem , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/etiologia , Resultado do TratamentoRESUMO
A 67-year-old dialysis-dependent man presented to the cardiology service with worsening high output cardiac failure and was found to have a harsh, right-sided abdominal bruit on examination. Of significance, he had undergone several laparotomies related to a stab wound experienced 7 years earlier. A computed tomography scan revealed right renal artery pseudoaneurysms with fistulous communication to the vena cava. Successful percutaneous coil embolization and cyanoacrylate gluing enabled fistula closure without renal infarction. Symptoms of cardiac failure ultimately resolved following treatment. Catheter-based therapies provide minimally invasive and effective strategies for treating complicated fistulas involving the renal vasculature.
Assuntos
Falso Aneurisma/terapia , Fístula Arteriovenosa/terapia , Débito Cardíaco Elevado/etiologia , Embolização Terapêutica , Insuficiência Cardíaca/etiologia , Artéria Renal , Veia Cava Inferior , Ferimentos Perfurantes/complicações , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Débito Cardíaco Elevado/diagnóstico por imagem , Débito Cardíaco Elevado/terapia , Cianoacrilatos/uso terapêutico , Embolização Terapêutica/instrumentação , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/terapia , Humanos , Masculino , Artéria Renal/diagnóstico por imagem , Adesivos Teciduais/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Ferimentos Perfurantes/cirurgiaRESUMO
The inferior epigastric artery represents a potentially overlooked source of pelvic arterial hemorrhage. The authors describe 3 patients with massive inferior epigastric artery bleeding following cesarean section, paracentesis, and blunt trauma that were successfully treated with transarterial embolization. The inferior epigastric artery should be considered as a possible source of arterial hemorrhage if arteriography of internal iliac artery branches does not yield a bleeding source.
Assuntos
Embolização Terapêutica , Artérias Epigástricas/lesões , Hemorragia/terapia , Adulto , Idoso , Cesárea/efeitos adversos , Artérias Epigástricas/diagnóstico por imagem , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Masculino , Paracentese/efeitos adversos , Gravidez , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos não Penetrantes/complicaçõesRESUMO
Massive gastrointestinal hemorrhage secondary to metastatic renal cell carcinoma involving the jejunum is rare but has been previously described in the medical literature. Treatment options for metastatic renal cell carcinoma are limited, but transcatheter arterial embolization can be performed to control gastrointestinal hemorrhage either alone or prior to surgical resection. We describe a case of successful transcatheter arterial embolization for control of massive gastrointestinal hemorrhage secondary to locally recurrent renal cell carcinoma invading the jejunum and review the literature. Arteriography provided both the diagnosis of recurrent disease and the means of therapy.
