Herida por arma de fuego y embolismo arterial periférico / Gun-shot wound and peripheral arterial embolism

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Endovascular treatment of iliofemoral chronic post-thrombotic venous flow obstruction.

INTRODUCTION: Patients with deep vein thrombosis affecting the iliac and vena cava veins develop a more severe post-thrombotic syndrome than those with femoropopliteal disease. It has been traditionally treated only with medical therapy. During the last decade, endovascular repair has become the treatment of choice. The aim of this study is to report our midterm results using this technique. METHODS: From 2009 to 2012, 41 limbs in 36 patients with post-thrombotic chronic flow obstruction of iliofemoral vein secondary to stenotic or occlusive lesions and with a clinical CEAP class 3 or higher or venous pain underwent percutaneous treatment. Stent-related outcome (patency and thrombotic events), clinical outcome (improvement of revised Venous Clinical Severity Score [VCSS] and Villalta score) were evaluated after intervention. RESULTS: The procedure was successful in 39 limbs (95%) with no mortality and low morbidity. Thrombotic events occurred in nine limbs (23%) during the follow-up period. At 33 months, primary, assisted-primary, and secondary cumulative patency rates were 74%, 87%, and 89%, respectively. The main risk factor associated with stent occlusion was the severity of thrombotic disease. All postoperative thrombotic events occurred in occluded veins; no previously stenotic veins presented any complication (P = .04). Presence of thrombophilia, stent brand, and stent extension into the common femoral vein were not significantly associated with stent thrombosis. After surgery, the mean revised VCSS and Villalta scores improved substantially (P < .0001). The cumulative rate of revised VCSS improvement was 89% at 33 months. Clinical improvement was observed despite deep venous system reflux remaining uncorrected. CONCLUSIONS: Percutaneous treatment of post-thrombotic venous flow obstruction is an excellent therapeutic option with low morbidity and no mortality. It can be performed with high midterm patency rates and midterm clinical improvement.

Submandibular approach and use of Ligasure(®) system in a complex carotid paraganglioma.

UNLABELLED: Carotid paragangliomas are rare tumors of slow growth, progressive, and highly vascularized; surgery is the chosen treatment, and most surgeons perform an approach with a longitudinal cervicotomy. OBJECTIVE: We present a case of carotid paraganglioma Shamblin III with skull base extension. METHODS: Submandibular approach and vascular sealing device of the Ligasure(®) system were used in the surgery. RESULTS: We achieved complete resection using these adjunctive techniques. CONCLUSIONS: The use of these adjunctive techniques can be useful to manage large carotid body tumors.

Dosis de radiación recibida por el paciente durante el tratamiento endovascular de los aneurismas de aorta abdominal / The radiation dose received by patients during endovascular treatment of abdominal aortic aneurysms

Introducción. Las técnicas endovasculares se utilizan cada vez con mayor frecuencia en el tratamiento de los aneurismas de aorta abdominal (AAA), para lo que es necesario emplear mayores dosis de radiación en los pacientes, tanto en el diagnóstico como en el procedimiento y su seguimiento posterior, que en el tratamiento quirúrgico convencional. Es imprescindible delimitar los niveles de referencia de dosis de radiación necesarios para la ejecución del procedimiento. Objetivo. Cuantificar la dosis total que reciben los pacientes sometidos a esta modalidad de tratamiento. Pacientes y métodos. Se analiza de forma observacional-prospectiva a 46 pacientes con AAA tratados mediante abordaje endovascular en el año 2004, de los cuales 27 reciben un montaje aortomonoilíaco y 19 bifurcado. Resultados. Se obtiene una dosis de radiación total de 48,62 mSv el primer año; esta dosis no difiere entre los pacientes a los que se les coloca una endoprótesis aortomonoilíaca o una bifurcada. Conclusiones. La dosis obtenida no produce un efecto nocivo apreciable el primer año en lo que respecta a efectos deterministas de la dosis empleada. La mayor parte de la dosis recibida se debe a los estudios con tomografía axial computarizada. La resonancia magnética puede jugar un papel muy importante para la reducción de la dosis necesaria en el futuro

Introduction. It is becoming increasingly more frequent to treat abdominal aortic aneurysms (AAA) using endovascular techniques and as a result the doses of radiation patients receive, both in the diagnosis and intervention as well as in the ensuing follow-up, are higher than in conventional surgical treatment. It is essential to define the reference radiation dosage levels that are needed to perform the operation. Aim. To quantify the total dose received by patients submitted to this kind of treatment. Patients and methods. An observational-prospective study was conducted to analyse 46 patients with AAA who were treated using an endovascular approach in the year 2004; aortomonoiliac devices were utilised in 27 cases and 19 received bifurcated stents. Results. A total radiation dose of 48.62 mSv was obtained in the first year; patients received the same dose regardless of whether an aortomonoiliac or a bifurcated stent had been placed. Conclusions. The dose obtained does not give rise to any appreciable adverse effects in the first year as far as dosage-determined effects are concerned. The greater part of the dose received by patients is due to the computerised axial tomography scans that are carried out. Magnetic resonance imaging can play an important role in reducing the doses that are required in the future

Tratamiento endovascular de fístula arteriovenosa y falso aneurisma poplíteos postraumáticos. Presentación de un caso / Endovascular treatment of post-traumatic popliteal arteriovenous fistula and false aneurysm. A case report

Introducción. La fístula arteriovenosa (FAV) postraumática que afecta a los vasos poplíteos es una patología de incidencia escasa cuyo tratamiento hasta ahora ha sido quirúrgico; no obstante, también se puede lograr la oclusión de la fístula mediante la implantación de un stent recubierto intraarterial, con reducción extraordinaria tanto del tiempo quirúrgico como de la estancia hospitalaria del paciente. Caso clínico. Varón de 29 años con una FAV en la segunda porción de poplítea derecha, así como falso aneurisma de dos años de evolución provocados por traumatismo por arma blanca. Tras el estudio preoperatorio correspondiente que incluía eco-Doppler y arteriografía, se decidió tratamiento mediante técnica endovascular, que consistió en la implantación de un stent recubierto en la arteria poplítea, con lo que se consiguió al mismo tiempo la oclusión de la fístula y de la comunicación con el falso aneurisma. El tiempo quirúrgico fue de 60 minutos, no se requirió transfusión sanguínea y se dio de alta al paciente en el quinto día de postoperatorio. El eco-Doppler realizado a los 90 días de la intervención muestra la arteria y la vena poplíteas permeables con ausencia de comunicación entre ellas, así como trombosis del falso aneurisma. Conclusión. Las técnicas endovasculares constituyen una alternativa a la cirugía en casos de FAV postraumáticas que afectan a vasos de calibre grande y mediano

Introduction. Post-traumatic arteriovenous fistula (AVF) involving the popliteal vessels is a pathology with a poor incidence being open surgery its treatment of choice. Nowadays however the total occlusion of the fistula can also be achieved by means of the implantation of a covered stent-graft, which implies an important reduction of both surgical time and hospital stay. Case report. A 29-year old man who had a stab wound in the right popliteal fossa two years earlier was admitted with a popliteal AVF involving the middle popliteal segment along with a false aneurysm. After echo-Doppler examination and arteriography the patient was assessed for endovascular treatment that consisted in the implantation of a covered stent-graft thus achieving the occlusion of both the fistula and the false aneurysm. The procedure lasted 60 minutes, blood transfusion was not required and the patient was discharged on the 5th postoperative day. 90 days after operation an echo-Doppler examination was performed that showed patency of both artery and vein, absence of fistula and thrombosis of the false aneurysm. Conclusion. Endovascular techniques are an alternative to open surgery in the treatment of post-traumatic AVF involving large or middle size vessels

Reparación endovascular de fístula arteriovenosa femoral bilateral tras cateterismo / Endovascular repair of bilateral arteriovenous femoral fistula following catheterization

Introducción. El aumento del número de cateterismos cardíacos para el diagnóstico y el tratamiento de la patología cardíaca se ha acompañado de un incremento en la incidencia de complicaciones vasculares. Las fístulas arteriovenosas tras cateterismo tienen una incidencia escasa (1%). Caso clínico. Varón de 64 años con antecedentes de tabaquismo, dislipemia, hipertensión arterial, broncopatía crónica y cardiopatía isquémica crónica que precisó revascularización quirúrgica hace 18 años y angioplastia con implantación de dos stents hace un año. Fue remitido a nuestro servicio por claudicación intermitente a cortas distancias en el miembro inferior izquierdo de aparición brusca tras realización de cateterismo de control. El estudio arteriográfico demostró la presencia de una oclusión segmentaria de la arteria ilíaca externa izquierda y sendas fístulas arteriovenosas en ambos sectores femorales. El paciente fue intervenido de dichos hallazgos mediante técnica endovascular sin complicaciones perioperatorias. Conclusiones. Se distinguen tres tipos de factores de riesgo en el desarrollo de las fístulas arteriovenosas tras cateterismo: relacionados con el paciente, con el procedimiento y la anticoagulación en relación con éste. La reparación endovascular supone un procedimiento menos agresivo que la cirugía convencional en pacientes seleccionados, que ofrece excelentes resultados a corto y medio plazo

INTRODUCTION. The increasing number of cardiac catheterizations for diagnosis and/or treatment of coronary disease has raised the incidence of vascular complications. This incidence is not high in case of postcatheterization arteriovenous fistulae (1%). CASE REPORT. A 64 year-old man with the following clinical backgrounds: cigarette-smoker, dyslipemia, arterial hypertension, chronic bronchopathy and chronic ischemic cardiopathy, underwent coronary revascularisation 18 years ago; two coronary stent grafts were placed one year ago. He was referred to our department because of sudden onset of short distance intermittent claudication immediately after a diagnostic cardiac catheterization. Arteriography showed a left external iliac artery short occlusion and a bilateral femoral arteriovenous fistula. The patient underwent repair of these lesions by using endovascular techniques without complications. CONCLUSIONS. There are three risk factors for the development of postcatheterization arteriovenous fistulae: those related to the patient, the procedure and the anticoagulation. In selected patients, endovascular repair is less aggressive than open surgery and offers excellent short- and medium-term results

Aneurisma idiopático de aorta abdominal en una paciente de 8 años de edad / Idiopathic abdominal aortic aneurysm in an 8-year-old female patient

Introducción. Los aneurismas aórticos son una entidad excepcional en la edad pediátrica y, habitualmente, se presentan asociados a otras enfermedades. Caso clínico. Paciente de sexo femenino, de 8 años de edad, que acudió al hospital con una historia de dolor abdominal y la presencia de una masa hipogástrica pulsátil que correspondía a un aneurisma aórtico gigante. Conclusión. Ante la excepcionalidad de la patología, tanto el diagnóstico como un tratamiento quirúrgico precoz fueron las claves para la completa recuperación de la paciente. La elección correcta de la técnica quirúrgica y los materiales usados probablemente permitieron el crecimiento sin la aparición de problemas derivados de la prótesis (AU)

INTRODUCTION. Abdominal aortic aneurysms are very rare in children. They are usually associated with well-known medical conditions but some are idiopathic. CASE REPORT. An 8-year-old girl who was admitted to hospital with abdominal pain and a large abdominal pulsatile mass corresponding to a large aortic aneurysm. CONCLUSION. An accurate diagnosis and a prompt surgical treatment led to a quick and successful recovery. A right choice of both, surgical technique and prosthetic material, probably let a free-complication growth-up of this patient (AU)