RESUMO
BACKGROUND: This report presents the management of patient with extracranial internal carotid artery pseudoaneurysm due to giant cell arteritis. CASE PRESENTATION: Left internal carotid artery pseudoaneurysm was diagnosed in a 57-year-old Ukrainian woman, which became a direct indication for surgical treatment involving aneurysm resection and internal carotid artery reimplantation. The used reconstruction technique with oblique cutting of internal carotid artery, aneurysm resection, ellipse-form anastomosis formation, and distal intima fixation prevents the dissection, restenosis, and aneurysm of anastomosis in the long-term postoperative period. Histopathological examination revealed the giant cell arteritis of the internal carotid artery. CONCLUSION: This case emphasizes the importance of open surgical treatment of extracranial carotid artery aneurysms, which allows to perform optimal carotid artery reconstruction and also define the rare etiology of disease.
Assuntos
Doenças das Artérias Carótidas , Artéria Carótida Interna , Arterite de Células Gigantes , Humanos , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/cirurgia , Feminino , Pessoa de Meia-Idade , Artéria Carótida Interna/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Falso Aneurisma/cirurgia , Falso Aneurisma/diagnóstico por imagem , Resultado do TratamentoRESUMO
CASE: (1) A 69-year-old man sustained a proximal humeral fracture-dislocation. During emergency surgery, copious bleeding occurred. A pseudoaneurysm was identified 30 days postoperatively. (2) A 69-year-old man sustained a proximal humeral fracture and axillary artery injury. Physical examination demonstrated a cold but pink hand. Hemiarthroplasty and bypass vein grafting were performed. (3) An 86-year-old woman sustained a proximal humeral fracture and axillary artery injury. Her hand had turned cold and pale. Reverse shoulder arthroplasty and bypass vein grafting were performed. CONCLUSION: In cases of proximal humeral fractures with significant displacement, concomitant axillary artery injury must be assessed and if there is a high index of suspicion, prompt advanced imaging is necessary.
Assuntos
Artéria Axilar , Fraturas do Ombro , Humanos , Artéria Axilar/lesões , Artéria Axilar/cirurgia , Artéria Axilar/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/complicações , Idoso , Masculino , Feminino , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Falso Aneurisma/etiologia , Luxação do Ombro/cirurgia , Luxação do Ombro/diagnóstico por imagemRESUMO
CASE: We present a 17-year-old male patient with an initially missed posterior sternoclavicular fracture dislocation who presented with symptoms related to thrombotic emboli arising from a pseudoaneurysm. He was treated 6 weeks after injury with a figure-of-eight tendon allograft repair with good clinical outcomes. CONCLUSION: This is a unique presentation that highlights the significant risk of a missed diagnosis, life-threatening complications that may ensue, and biomechanically superior surgical intervention.
Assuntos
Falso Aneurisma , Humanos , Masculino , Adolescente , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Falso Aneurisma/etiologia , Articulação Esternoclavicular/lesões , Articulação Esternoclavicular/diagnóstico por imagem , Articulação Esternoclavicular/cirurgia , Clavícula/lesões , Clavícula/cirurgia , Clavícula/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Fraturas Ósseas/complicações , Fraturas Ósseas/diagnóstico por imagem , Luxações Articulares/cirurgia , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/complicações , Fratura-Luxação/diagnóstico por imagem , Fratura-Luxação/cirurgia , Fratura-Luxação/complicaçõesRESUMO
We present a compelling case of an elderly male with a complex medical history who presented with sepsis secondary to a urinary tract infection. During admission, changes in his abdominal exam prompted imaging studies, which revealed a grade IV splenic laceration with a giant splenic artery pseudoaneurysm containing a suspected arteriovenous fistula component. Multidisciplinary discussion was had regarding patient management which resulted in the decision to perform an emergent splenectomy. Learning points from this case underscore the crucial role of interdisciplinary collaboration in the treatment of this pathology. Additionally, we discuss the decision-making process to support surgical intervention in the absence of clear guidelines in this exceedingly rare condition.
Assuntos
Falso Aneurisma , Fístula Arteriovenosa , Esplenectomia , Artéria Esplênica , Humanos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Falso Aneurisma/etiologia , Falso Aneurisma/diagnóstico , Falso Aneurisma/cirurgia , Masculino , Artéria Esplênica/diagnóstico por imagem , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/cirurgia , Fístula Arteriovenosa/terapia , Fístula Arteriovenosa/etiologia , Baço/irrigação sanguínea , Baço/diagnóstico por imagem , Baço/lesões , Idoso , Tomografia Computadorizada por Raios XRESUMO
A 66-year-old man developed exertional dyspnea. The patient had undergone total arch replacement for a dissecting aortic arch aneurysm at the age of 53 and conservative treatment for myocardial infarction at the age of 60. Several imaging studies revealed a giant pseudoaneurysm that likely originated from a true ventricular aneurysm. The pseudoaneurysm severely compressed the right ventricle. Surgery was promptly performed. The patient had a history of cardiac surgery and had exclusively dense pericardium adhesion. Therefore, we incised the pseudoaneurysm and sutured the rupture orifice directly from inside the pseudoaneurysm under rapid pacing. This approach may represent an effective surgical alternative in patients with small rupture orifice and dense adhesions.
Assuntos
Falso Aneurisma , Aneurisma Cardíaco , Ventrículos do Coração , Humanos , Masculino , Falso Aneurisma/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/complicações , Idoso , Aneurisma Cardíaco/cirurgia , Aneurisma Cardíaco/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Innominate artery aneurysms (IAAs) are rare and may result in rupture, distal arterial embolization, or local compression without timely treatment. Rupture is the most dangerous of these complications. This article reports a case of innominate artery bifurcation pseudoaneurysm. CASE PRESENTATION: The patient was a 45-year-old man who was admitted to the emergency department due to chest discomfort. The computed tomographic angiography (CTA) imaging indicated the presence of a 3.6*2.4 cm saccular aneurysm in the bifurcation of the innominate artery, involving both the right proximal subclavian and common carotid arteries. The patient's vital signs were normal, there was equal blood pressure in the upper arms and no neurological dysfunction was observed. Gadolinium-enhanced magnetic resonance angiography indicated that the circle of Willis was intact. The treatment involved open surgery combined with endovascular therapy. The external carotid artery was first transposed to the right subclavian artery (RSA) and an 8-mm woven Dacron graft was inserted in the middle. The covered stent graft was then placed in the proximal part of the innominate artery to close the entrance of the aneurysm. Lastly, an occluder was implanted at the origin of the RSA. There were no perioperative or postoperative complications. At 1-year follow-up, no aneurysm was observed on CTA and the right vertebral artery was patent. CONCLUSIONS: This study indicated that the combined use of endovascular therapy and open repair surgery is an effective strategy to treat innominate artery bifurcation pseudoaneurysm.
Assuntos
Falso Aneurisma , Implante de Prótese Vascular , Tronco Braquiocefálico , Procedimentos Endovasculares , Stents , Humanos , Masculino , Pessoa de Meia-Idade , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/cirurgia , Procedimentos Endovasculares/instrumentação , Resultado do Tratamento , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Angiografia por Tomografia Computadorizada , Angiografia por Ressonância MagnéticaRESUMO
Arterio-ureteral fistulas (AUFs), which are relatively rare but potentially life-threatening, require prompt diagnosis and treatment. We reported a case of AUFs following robot-assisted laparoscopic radical cystectomy (RARC) with extended pelvic lymph node dissection and ileal conduit urinary diversion for muscle-invasive bladder cancer, which resulted in massive hemorrhage. Urine leaked from the anastomosis between the ureter, and the end of the ileal conduit was infected, which resulted in an AUF between the pseudoaneurysm of the right common iliac artery and the ureter. The AUF was managed successfully by vascular intervention with an arterial stent graft.
Assuntos
Falso Aneurisma , Cistectomia , Artéria Ilíaca , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Doenças Ureterais , Fístula Urinária , Fístula Vascular , Humanos , Cistectomia/efeitos adversos , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Doenças Ureterais/etiologia , Doenças Ureterais/cirurgia , Artéria Ilíaca/cirurgia , Fístula Vascular/etiologia , Fístula Vascular/cirurgia , Masculino , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/etiologia , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Pessoa de Meia-IdadeRESUMO
CASE: Pseudoaneurysms of the hand are rare among the adult population and even more rare in pediatric patients. We report a case of a 10-month-old boy who presented with a nontraumatic pseudoaneurysm of the deep palmar arch, likely of congenital etiology. Magnetic resonance imaging and angiography identified the growing left hand palmar mass. Surgical excision without the need for vascular reconstruction was performed successfully with no recurrence or complications at 1-year follow-up. CONCLUSION: Surgical excision is an effective treatment for large or symptomatic palmar pseudoaneurysms of likely congenital origin. Vascular reconstruction after excision must be considered on a case-by-case basis to ensure adequate hand perfusion.
Assuntos
Falso Aneurisma , Mãos , Humanos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Falso Aneurisma/etiologia , Masculino , Lactente , Mãos/irrigação sanguínea , Imageamento por Ressonância MagnéticaRESUMO
BACKGROUND: Iatrogenic pseudoaneurysms arising from the internal carotid artery subsequent to carotid endarterectomy are exceptionally infrequent. Herein, we present a case detailing an internal carotid artery pseudoaneurysm that manifested subsequent to a hybrid carotid endarterectomy and endovascular therapy intervention. Our approach to managing this condition involved a novel technique wherein thrombin was directly injected into the luminal cavity of the pseudoaneurysm under the guidance of a C-arm. CASE PRESENTATION: A 66-year-old male patient of Chinese ethnicity exhibited a 4-month history of headache and a 20-day history of gait disturbance. Digital subtraction angiography revealed occlusion in the cervical region of the left carotid artery. Following a hybrid surgical procedure, the patient reported mild pain and bruising surrounding the incision site of the left internal carotid artery endarterectomy. Subsequent angiography identified the presence of a carotid artery pseudoaneurysm. Utilizing C-arm guidance, thrombin was then directly injected into the luminal cavity of the pseudoaneurysm, resulting in complete healing during follow-up. CONCLUSION: For the management of pseudoaneurysms arising post carotid endarterectomy, the direct injection of thrombin into the aneurysm cavity under the guidance of a C-arm is deemed both safe and efficacious.
Assuntos
Lesões das Artérias Carótidas , Artéria Carótida Interna , Endarterectomia das Carótidas , Doença Iatrogênica , Trombina , Humanos , Masculino , Endarterectomia das Carótidas/efeitos adversos , Trombina/administração & dosagem , Trombina/uso terapêutico , Idoso , Lesões das Artérias Carótidas/etiologia , Lesões das Artérias Carótidas/cirurgia , Falso Aneurisma/etiologia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Resultado do Tratamento , Angiografia DigitalRESUMO
BACKGROUND: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (PMAIF) is a rare complication of infective endocarditis or aortic valve surgery. Surgical treatment is suggested, but the long-term follow-up of conservative management remains unclear. CASE PRESENTATION: A 33-year follow-up of a patient who developed PMAIF six years after aortic valve replacement is reported. The patient presented to our center with dyspnea, and the echocardiography revealed an ejection fraction of 20% and a PMAIF measuring 7 × 10 mm. Despite being advised to undergo surgery, the patient declined due to fear of surgical outcomes. Consequently, conservative treatment with close observation but without surgery was initiated. During the 33-year follow-up period, the patient did not experience any adverse health effects. CONCLUSION: Surgical intervention should be considered whenever the PMAIF is diagnosed. However, in any case that the surgery was not applicable, conservative management might lead to long-term survival, based on this and similar case reports in the literature.
Assuntos
Falso Aneurisma , Valva Aórtica , Valva Mitral , Humanos , Falso Aneurisma/cirurgia , Valva Mitral/cirurgia , Valva Aórtica/cirurgia , Masculino , Seguimentos , Aneurisma Cardíaco/cirurgia , Ecocardiografia , Implante de Prótese de Valva Cardíaca , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Pedicle screw instrument surgeries can result in the development of aortic pseudoaneurysm, which is a rare yet potentially severe complication; therefore, the purpose of this work is to describe the case of pseudoaneurysm of the thoracic aorta caused by the severe migration of a pedicle screw after surgery. CASE PRESENTATION: We herein report a patient who underwent endovascular repair for the pseudoaneurysm of the descending thoracic aorta following thoracic vertebral fixation surgery. A 28-80 mm covered stent was initially inserted through the right femoral artery, and intraoperative aortography revealed a minor extravasation of contrast material. Subsequently, an additional 28-140 mm covered stent was implanted. The patient recovered well during the 8-year follow-up period. CONCLUSIONS: Vascular complications resulting from spinal surgery are severe and rare, necessitating early diagnosis and intervention.
Assuntos
Falso Aneurisma , Aorta Torácica , Procedimentos Endovasculares , Parafusos Pediculares , Humanos , Falso Aneurisma/cirurgia , Falso Aneurisma/etiologia , Procedimentos Endovasculares/métodos , Parafusos Pediculares/efeitos adversos , Masculino , Aorta Torácica/cirurgia , Stents/efeitos adversos , Seguimentos , Aneurisma da Aorta Torácica/cirurgia , Vértebras Torácicas/cirurgia , Complicações Pós-Operatórias/cirurgia , Pessoa de Meia-IdadeRESUMO
While partial nephrectomy offers oncologic efficacy and preserves renal function for T1 renal tumors, renal artery pseudoaneurysm (RAP) remains a rare but potentially life-threatening complication. This study compared RAP incidence across robotic-assisted (RAPN), laparoscopic (LPN), and open (OPN) partial nephrectomies in a large tertiary oncological center. This retrospective study analyzed 785 patients undergoing partial nephrectomy between 2012 and 2022 (398 RAPN, 122 LPN, 265 OPN). Data included demographics, tumor size/location, surgical type, clinical presentation, treatment, and post-operative outcomes. The primary outcome was RAP incidence, with secondary outcomes including presentation, treatment efficacy, and renal function. Seventeen patients (2.1%) developed RAP, presenting with massive hematuria (100%), hemorrhagic shock (5.8%), and clot retention (23%). The median onset was 12 days postoperatively. RAP occurred in 4 (1%), 4 (3.3%), and 9 (3.4%) patients following RAPN, LPN, and OPN, respectively (p = 0.04). Only operative length and surgical approach were independently associated with RAP. Selective embolization achieved immediate bleeding control in 94%, with one patient requiring a second embolization. No additional surgery or nephrectomy was needed. Estimated GFR at one year was similar across both groups (p = 0.53). RAPN demonstrated a significantly lower RAP incidence compared to LPN and OPN (p = 0.04). Emergency angiographic embolization proved effective, with no long-term renal function impact. This retrospective study lacked randomization and long-term follow-up. Further research with larger datasets and longer follow-ups is warranted. This study suggests that robotic-assisted partial nephrectomy is associated with a significantly lower risk of RAP compared to traditional approaches. Emergency embolization effectively treats RAP without compromising long-term renal function.
Assuntos
Falso Aneurisma , Neoplasias Renais , Laparoscopia , Nefrectomia , Complicações Pós-Operatórias , Artéria Renal , Procedimentos Cirúrgicos Robóticos , Humanos , Nefrectomia/métodos , Nefrectomia/efeitos adversos , Falso Aneurisma/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Masculino , Feminino , Pessoa de Meia-Idade , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Idoso , Artéria Renal/cirurgia , Neoplasias Renais/cirurgia , Incidência , Resultado do Tratamento , Embolização Terapêutica/métodosAssuntos
Falso Aneurisma , Aneurisma Cardíaco , Septo Interventricular , Humanos , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/diagnóstico , Septo Interventricular/diagnóstico por imagem , Septo Interventricular/cirurgia , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/cirurgia , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/diagnóstico , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Masculino , Idoso , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico , Resultado do Tratamento , FemininoRESUMO
A female underwent arthroscopic anterior cruciate ligament reconstruction (ACLR) via an outside-in drilling technique. At 4 weeks after surgery, she presented with a pulsatile painful mass on the lateral femoral condyle. Imaging confirmed a superolateral genicular artery pseudoaneurysm. Thrombin injections were administered twice, resulting in reduced size and minimal pain. This case emphasises the rare occurrence of pseudoaneurysms post-ACLR and highlights the importance of early detection and intervention for vascular complications. Although debated, we suggest tourniquet deflation before closure to facilitate identification and management of vascular issues. This report contributes valuable insights into managing pseudoaneurysms following ACLR.
Assuntos
Falso Aneurisma , Reconstrução do Ligamento Cruzado Anterior , Humanos , Falso Aneurisma/etiologia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Feminino , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/métodos , Adulto , Artroscopia/efeitos adversos , Artroscopia/métodos , Complicações Pós-Operatórias , Trombina/administração & dosagem , Lesões do Ligamento Cruzado Anterior/cirurgiaRESUMO
A 59-year-old man was admitted to our hospital with left hemiplegia. A computed tomography( CT) scan and echocardiography revealed a cerebral infarction in the right middle cerebral artery's territory, as well as a large pseudoaneurysm (4×3 cm) of the lateral left ventricular wall. The patient agreed to undergo cardiac surgery because of the high risk of rupture and recurrent cerebral infarctions. Owing to the high probability of damaging the posterior papillary muscle and coronary arteries, an extracardiac approach was used, and the pseudoaneurysm cavity was closed using double-patch repair. The patient was discharged from the hospital on the 12th postoperative day without any complications. Both postoperative CT and echocardiography showed closure of the cavity.
Assuntos
Falso Aneurisma , Infarto Cerebral , Ventrículos do Coração , Humanos , Masculino , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Falso Aneurisma/etiologia , Pessoa de Meia-Idade , Infarto Cerebral/etiologia , Infarto Cerebral/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/cirurgia , Aneurisma Cardíaco/etiologiaRESUMO
BACKGROUND: Hepatic artery pseudoaneurysm after liver transplantation is a rare condition that can lead to spontaneous bleeding, depending on its extent and location. Treatment involves endovascular and surgical approaches in addition to liver retransplantation in cases of graft failure. CASE REPORT: A 42-year-old female underwent deceased donor liver transplantation due to cryptogenic cirrhosis and schistosomiasis with an uneventful postoperative course. However, 18 days after the operation, she presented to the emergency department with abdominal pain, hypotension, and lipothymia. A computed tomography scan revealed a hepatic artery anastomotic pseudoaneurysm, and due to hemodynamic instability, emergency laparotomy was indicated. During the operation, the pseudoaneurysm was found to be ruptured, and the recipient's hepatic artery was ligated due to life-threatening bleeding. She later developed ischemic cholangiopathy and biliary complications, eventually undergoing retransplantation 7 months after the emergency operation. The patient remains well 11 months after the retransplantation. CONCLUSION: We report a rare case of life-threatening rupture of hepatic artery pseudoaneurysm, which required emergency ligation of the recipient's hepatic artery and subsequent liver retransplantation due to biliary complications.
Assuntos
Falso Aneurisma , Aneurisma Roto , Artéria Hepática , Transplante de Fígado , Humanos , Transplante de Fígado/efeitos adversos , Falso Aneurisma/cirurgia , Falso Aneurisma/etiologia , Feminino , Artéria Hepática/cirurgia , Artéria Hepática/diagnóstico por imagem , Adulto , Aneurisma Roto/cirurgia , Aneurisma Roto/etiologia , Reoperação , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Arteriovenous fistula stenosis can directly lead to the formation of autologous arteriovenous fistula aneurysms (AVFAs), but the coexistence of true and pseudoaneurysms is relatively rare. The coexistence of true and pseudoaneurysms increases the risk of rupture of the arteriovenous fistula and complicates subsequent surgical intervention, potentially posing a threat to the patient's life, and thus requires significant attention. CASE PRESENTATION: The patient presented with arteriovenous fistula (AVF) after hemodialysis 6 years ago. 2 years ago, the patient presented with a mass that had formed near the left forearm arteriovenous fistula and gradually increased in size. Preoperatively, the AVF stenosis was identified as the cause of the mass formation, and the patient was operated on. First, the blood flow was controlled to reduce the pressure at the aneurysm, and then the incision was enlarged to separate the AVF anastomosis from the mass area. The stenotic segment of the true and pseudo aneurysms and cephalic vein was removed and the over-dilated proximal cephalic vein was locally narrowed and subsequently anastomosed with the proximal radial artery to create AVF. The patient was dialyzed with an internal fistula the next day and showed no clinical manifestations related to end-limb ischemia. CONCLUSION: We removed a true pseudoaneurysm in AVF and secured the patient's vascular access. This report provides an effective strategy to manage this condition.
Assuntos
Falso Aneurisma , Derivação Arteriovenosa Cirúrgica , Diálise Renal , Humanos , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Constrição Patológica , Masculino , Pessoa de Meia-Idade , Falência Renal Crônica/terapia , Falência Renal Crônica/complicações , Antebraço/irrigação sanguíneaRESUMO
Vascular graft infection (VGI) is one of the most serious complications following arterial reconstructive surgery. VGI has received increasing attention over the past decade, but many questions remain regarding its diagnosis and management. In this review, we describe our approach to VGI through multidisciplinary collaboration and discuss decision making for challenging presentations. This review will concentrate on VGI that impacts both aneurysms and pseudoaneurysms excluding the ascending thoracic aorta.
Assuntos
Procedimentos de Cirurgia Plástica , Infecções Relacionadas à Prótese , Humanos , Procedimentos de Cirurgia Plástica/métodos , Procedimentos de Cirurgia Plástica/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Prótese Vascular/efeitos adversos , Equipe de Assistência ao Paciente , Falso Aneurisma/cirurgia , Falso Aneurisma/etiologia , Artérias/cirurgiaRESUMO
OBJECTIVE: Report on a case of pseudoaneurysm which was caused by injury of the internal carotid artery (ICA) during endoscopic endonasal surgery (EES), which was followed by rebleeding after treatment with a Willis covered stent. METHODS: A woman, aged 68, underwent EES for the treatment of a pituitary adenoma. During the surgery, the right ICA was injured, and successfully hemostasis by packed with cottonoid and gelatin sponge. Besides, cerebral angiography was performed in the interventional operating room for the purpose of discovering the formation of a pseudoaneurysm in the cavernous sinus segment of ICA, which was treated with a covered stent. After successfully placing the covered stent, the patient was promptly transferred to the general operating room for the removal of the cottonoid and to address the bleeding once again. The authors employ crushed muscles and cottonoid to locally compress and stop bleeding. Owing to concerns about the risk of rebleeding in the patient, after stent implantation, the patient did not utilize antiplatelet drugs. After the surgery, the patient developed occlusion of the right ICA and massive cerebral infarction in the right hemisphere. Dehydration, anti-infection, rehabilitation, hyperbaric oxygen, as well as related treatments, were given. The cottonoid was removed in EES 2 months postsurgery, and no instances of bleeding were observed. Six months after surgery, the patient had clear consciousness and hemiplegia in the left limb, with a Glasgow Outcome Scale score of 4. RESULTS: The ICA was injured during EES, which resulted in the formation of a pseudoaneurysm, the Willis stent was adopted for treatment, and there was a risk of rebleeding after the nasal packing (cottonoid, crushed muscles) was removed immediately. CONCLUSIONS: The ICA was injured during EES after bleeding was controlled by packing with cottonoid, crushed muscles, etc, subsequently, the patient was given intravascular treatment, it is advised to make thorough preparations and, after a suitable period, remove nasal packing in the hybrid operating room to address unexpected situations and unforeseen circumstances.
Assuntos
Lesões das Artérias Carótidas , Artéria Carótida Interna , Neoplasias Hipofisárias , Stents , Humanos , Feminino , Lesões das Artérias Carótidas/etiologia , Lesões das Artérias Carótidas/cirurgia , Lesões das Artérias Carótidas/terapia , Neoplasias Hipofisárias/cirurgia , Idoso , Artéria Carótida Interna/cirurgia , Adenoma/cirurgia , Endoscopia/métodos , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Falso Aneurisma/terapia , Falso Aneurisma/diagnóstico por imagem , Angiografia Cerebral , Recidiva , Complicações Intraoperatórias/etiologiaRESUMO
OBJECTIVES: Heparin-induced thrombocytopenia is a known complication of heparin exposure with potentially life-threatening sequelae. Direct thrombin inhibitors can be substituted for heparin in patients with heparin-induced thrombocytopenia that require anticoagulation. However, the use of direct thrombin inhibitors as a substitute for heparin has not been widely reported in the neuroendovascular literature. MATERIALS AND METHODS: Here we report the first use of the direct thrombin inhibitor bivalirudin in a neuroendovascular procedure as a substitute for heparin in a patient with a ruptured pseudoaneurysm and heparin-induced thrombocytopenia, and review the literature on the use of bivalirudin and argatroban for such patients. RESULTS: Bivalirudin was safely and effectively used in the case reported, with no thrombotic or hemorrhagic complications. Our literature review revealed a paucity of studies on the use of heparin alternatives, including bivalirudin, in neuroendovascular procedures in patients with heparin-induced thrombocytopenia. CONCLUSIONS: Heparin-induced thrombocytopenia is an important iatrogenic disease process in patients undergoing neuroendovascular procedures, and developing protocols to diagnose and manage heparin-induced thrombocytopenia is important for healthcare systems. While further research needs to be done to establish the full range of anticoagulation options to substitute for heparin, our case indicates bivalirudin as a potential candidate.