Late surgical outcomes of carotid resection and saphenous vein graft revascularization in patients with advanced head and neck squamous cell carcinoma.

BACKGROUND: In head and neck squamous cell carcinoma, invasion of the carotid artery is a severe mortality predictor. We report an updated experience of 19 patients who underwent head and neck resection for squamous cell carcinoma with concomitant carotid reconstruction. This study aims to analyze overall survival rates, primary patency of the reconstructions, vascular and nonvascular complications, radiotherapy dosing as well as late follow-up and outcomes. METHODS: From September 1997 to 2011, 19 patients with advanced squamous cell carcinoma with carotid artery invasion were submitted to resection and concomitant vascular reconstruction in a single referred oncological institution. Patient follow-up was done by means of periodic outpatient returns, where clinical and duplex scan evaluations were performed to study graft patency. RESULTS: The average length of follow-up was 23.3 (± 34.4) months. Nonvascular complications occurred in 6 patients (31.6%). Only 1 (5.3%) vascular complication was observed, resulting from the immediate occlusion of the carotid graft. All patients were submitted to preoperative, adjuvant, or curative intent radiotherapy during the course of the oncologic treatment, with varying doses. Overall disease-free survival, primary patency, and survival with patent graft rates in 5 years are respectively 12.9%, 93.1%, and 13.0%. Three patients (15.9%) are still alive, all without tumor recurrence, and present a disease-free long-term follow-up with patent grafts 21 months, 68 months, and 151 months after surgery. CONCLUSIONS: Aggressive surgical approach for patients with advanced squamous cell head and neck carcinoma with carotid invasion can lead to cure in a select group of patients. Saphenous vein grafts demonstrated favorable outcomes with low infection and high patency rates, suggesting a valid alternative for arterial reconstruction in these cases.

Comparative study of valved and nonvalved fully implantable catheters inserted via ultrasound-guided puncture for chemotherapy.

BACKGROUND: Fully implantable catheters are important for oncology treatments. They can be functionally categorized as valved or nonvalved. Theoretically, a valve prevents spontaneous blood reflux into the catheter, reducing the incidence of complications. We sought to compare the results from the implantation of valved and nonvalved fully implantable 8-French catheters inserted via ultrasound-guided puncture in cancer patients undergoing chemotherapy treatment. METHODS: A retrospective analysis of 100 patients who underwent long-term catheter implantation guided by ultrasound was performed looking for early (≤30 days) or late (≥90 days) complications. They were evaluated regarding the use of valved or nonvalved catheter and assessed on univariate model. RESULTS: The only early complication (hematoma) was identified in the valved group. Twenty-two late complications were identified (72.72% in the valved group and 27.27% in the nonvalved group; P = 0.009). Blood reflux dysfunction, which occurred in 12 patients in the valved and none in the nonvalved devices group, was the only complication with an incidence that was significantly different between the groups. CONCLUSION: Fully implantable valved catheters with Groshong (Bard Medical Division, Covington, GA) valves have a higher rate of blood reflux dysfunction compared with nonvalved catheters, but this did not interfere with the efficacy of the treatment.

Concomitant aortic and vena caval reconstruction associated with germ-cell tumor resection with creation of a new venous bifurcation.

Aortic and vena caval reconstruction associated with tumor resection is very rare. We describe a 22-year-old man with a retroperitoneal metastasis from a germ-cell tumor previously treated with chemotherapy who presented with a huge mass involving the infrarenal aorta and the inferior vena cava. He underwent retroperitoneal lymph node dissection with concomitant aortic and caval reconstruction that included customization of a new caval bifurcation. His postoperative recovery was uneventful, and he remained well 36 months after the operation. Complementary follow-up imaging examinations demonstrated that the aortic and venous interposition grafts were patent and that there was no local or distant disease recurrence.

Endovascular repair of a traumatic arteriovenous fistula involving the iliac bifurcation using an iliac branch device.

Endovascular techniques have shown to be useful in the management of vascular injuries because they transform a complex and potentially dangerous procedure into a safe one. We present the case of a 39-year-old man with congestive heart failure and abdominal bruit 11 years after an abdominal gunshot wound. Imaging studies revealed an arteriovenous fistula involving the left iliac artery bifurcation, and an iliac branch device was used to treat it. Symptoms resolved, and follow-up imaging showed patency of the graft and closure of the arteriovenous communication. To our knowledge, this is the first report of a nonaneurysmal disease treated with this device.

Tratamento endovascular de aneurismas da aorta em pacientes com doença de Behçet: relato de dois casos / Endovascular treatment of aortic aneurysms in patients with Behcet's disease: report of two cases

A doença de Behçet, uma vasculite sistêmica de causa desconhecida, pode ser causa de doença aneurismática da aorta em alguns portadores dessa patologia. Nós apresentamos nossa experiência com dois casos de aneurismas aórticos em pacientes com doença de Behçet submetidos à terapêutica endovascular, descrevendo seus respectivos seguimentos. A terapêutica atual, a patofisiologia e os critérios diagnósticos vigentes foram revisados. Concluímos que a técnica endovascular é uma excelente opção terapêutica para certos pacientes com doença de Behçet e que esta deve ser acompanhada de tratamento imunossupressivo adequado.

Behcet's disease, a systemic vasculitis of unknown etiology, may be the cause of aortic aneurysmal diseases in some patients. We report our experience with two Behcet's disease patients who presented with aortic aneurysms and were submitted to endovascular therapy, and describe their respective follow-ups. Current pathophysiology, diagnosis, and treatment approaches were reviewed. Our experience suggests that the endovascular approach, combined with adequate immunosuppressive treatment, is an excellent therapeutic option for some patients with Behcet's disease suffering from aneurysms.