RESUMO
BACKGROUND: The Trans-Atlantic Inter-Society Consensus Document (TASC II) aims to comprehensively describe the case scenarios of aortoiliac and femoropopliteal lesions to suggest an endovascular or a surgical approach. Over time, it has become a guide for describing the gravity of arterial lesions. PURPOSE: To assess the revised TASC II system for classifying arterial lesions in a large database of patients presenting with claudication. MATERIALS AND METHODS: This study was a retrospective review of the arteriograms of patients with intermittent claudication. Aortoiliac and femoropopliteal lesions were classified according to the TASC II. When no consensus was reached, the lesion was rated as unTASCable. RESULTS: In total, 1454 patients were included (male: 62.1%, 66.8±9.3 years). There were 39% aortoiliac lesions (n=960/2462) and 61% femoropopliteal lesions (n=1502/2462); 33.6% of the patients (n=489/1454) were associated with aortoiliac and femoropopliteal lesions. In addition, 20% of the lesions (n=493/2462) were unTASCable, and 26.7% of the patients (n=388/1454) had at least 1 unTASCable lesion. There were 4 categories of unTASCable lesions: (1) association with a common femoral artery lesion in 53.1% (n=262/493); (2) iliac artery lesions in 23.1% (n=114/493); (3) femoropopliteal lesions whose lengths did not fit into any category in 16.6% (n=82/493); and (4) association with an aortic lesion in 7.1% (n=35/493). The interobserver agreement was 0.97 for anatomically describing the infrarenal arterial tree and 0.85 for TASCing, with the lesions lowering to 0.69 for aortoiliac lesions. CONCLUSION: Using the revised TASC II case scenario, 26.7% of the patients had at least 1 unTASCable lesion. Reporting peripheral artery disease using a comprehensive anatomical description of the infrarenal arterial tree showed better interobserver reproducibility.
Assuntos
Arteriopatias Oclusivas , Doença Arterial Periférica , Humanos , Artéria Poplítea/cirurgia , Reprodutibilidade dos Testes , Resultado do Tratamento , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Doença Arterial Periférica/patologia , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Estudos Retrospectivos , Grau de Desobstrução Vascular , Arteriopatias Oclusivas/cirurgia , StentsRESUMO
One of the difficulties of the subintimal arterial flossing with antegrade-retrograde intervention technique (SAFARI) technique is to properly achieve a rendezvous between both antegrade and retrograde accesses. We propose a new technique to overcome this difficulty. It consists of directly percutaneously puncturing 2 loop snares, placed via each access, which are then both used to snare an externally introduced guidewire introduced through the needle. The snares are then moved en bloc, bringing both snares and the wire into the same channel.
Assuntos
Angioplastia com Balão , Artéria Femoral , Doença Arterial Periférica/terapia , Artéria Poplítea , Idoso de 80 Anos ou mais , Angioplastia com Balão/instrumentação , Constrição Patológica , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Punções , Resultado do Tratamento , Dispositivos de Acesso Vascular , Grau de Desobstrução VascularAssuntos
Ligas , Angioplastia com Balão/instrumentação , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Oclusão de Enxerto Vascular/terapia , Falência Renal Crônica/terapia , Diálise Renal , Stents , Extremidade Superior/irrigação sanguínea , Idoso , Circulação Colateral , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Falência Renal Crônica/diagnóstico , Desenho de Prótese , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
Hemorrhagic extension along the pulmonary arteries should be recognized as a complication of Stanford type A aortic dissection. Radiologists and other physicians with an interest in cardiothoracic imaging should be aware of this rare but life-threatening pathology. The anatomical concept of the pathology is outlined in this text, through high-quality electrocardiogram-gated computerized tomography images.
Assuntos
Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Eletrocardiografia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Artéria Pulmonar , Tomografia Computadorizada por Raios X/métodos , Idoso de 80 Anos ou mais , Evolução Fatal , Feminino , Humanos , Artéria Pulmonar/diagnóstico por imagem , Recusa do Paciente ao TratamentoAssuntos
Embolia/etiologia , Artéria Hepática , Necrose Hepática Massiva/etiologia , Transplante de Órgãos/efeitos adversos , Adulto , Embolia/diagnóstico por imagem , Embolia/fisiopatologia , Embolia/terapia , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/fisiopatologia , Encefalopatia Hepática/etiologia , Humanos , Masculino , Necrose Hepática Massiva/diagnóstico por imagem , Necrose Hepática Massiva/fisiopatologia , Trombectomia , Resultado do Tratamento , Grau de Desobstrução VascularAssuntos
Angioplastia com Balão/instrumentação , Isquemia/terapia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/terapia , Stents , Veias , Doença Crônica , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Desenho de Prótese , Fluxo Sanguíneo Regional , Resultado do Tratamento , Veias/diagnóstico por imagem , Veias/fisiopatologia , CicatrizaçãoRESUMO
A 21 year-old male underwent nephrostomy tube insertion for hydronephrosis due to a large para-aortic adenopathy of a testicular tumor. In order to reduce infections during chemotherapy, a ureteral stent was placed. While removing the nephrostomy tube, a pulsatile bleeding was found and a renal angiography was done. A pseudoaneurysm of his first left lumbar (L1) artery communicating with the nephrostomy's access site was found. An embolization was performed with coils in the left L1 artery and one of its subdivisions. Post-embolization controls revealed no bleeding. On the follow-up CT, there were no suspicious retroperitoneal mass.
RESUMO
Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) has always been considered to be a middle-age-onset disease. Diagnosis is confirmed by genetic testing and the finding of the Notch3 mutation or by skin biopsy. Imaging plays a pivotal and crucial role in confirming this diagnosis by identifying white matter changes early in the disease. This can be useful in screening symptomatic patients with a family history of the disease. CADASIL cases have been reported recently in children. We report our experience with CADASIL in a 3-year-old boy.