RESUMO
Hypothenar hammer syndrome affects less than 1% of the population, but if the diagnosis is delayed, digital gangrene and critical ischemia can ensue. The condition is caused by injury to the ulnar artery at the level of the hook of hamate when the palm of the hand is repetitively used as a hammer. Injury includes segmental occlusion of the ulnar artery and aneurysmal formation with or without occlusion. Patients with hypothenar hammer syndrome often present with symptoms of secondary Raynaud syndrome; if Raynaud is unilateral, a vascular origin should be suspected and ruled out. Treatment options for hypothenar hammer syndrome include conservative treatment measures, fibrinolysis, or surgical resection and repair, and depend on the specific injury and timing of diagnosis.
Assuntos
Aneurisma/diagnóstico por imagem , Doença de Raynaud/diagnóstico , Artéria Ulnar/diagnóstico por imagem , Adulto , Aneurisma/complicações , Aneurisma/cirurgia , Humanos , Angiografia por Ressonância Magnética , Masculino , Doença de Raynaud/etiologia , Artéria Ulnar/lesões , Artéria Ulnar/cirurgia , UltrassonografiaRESUMO
We present the case of a patient with a refractory type II endoleak treated with translumbar Onyx with passage of the Onyx material into the endograft and subsequent embolization to the infrainguinal vasculature. This report represents a new complication of Onyx embolization that, to our knowledge, has not previously been described in the literature.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Dimetil Sulfóxido/efeitos adversos , Embolia/etiologia , Embolização Terapêutica/efeitos adversos , Endoleak/terapia , Procedimentos Endovasculares/efeitos adversos , Migração de Corpo Estranho/etiologia , Isquemia/etiologia , Polivinil/efeitos adversos , Doença Aguda , Idoso , Angiografia Digital , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Dimetil Sulfóxido/administração & dosagem , Embolia/diagnóstico por imagem , Embolia/terapia , Embolização Terapêutica/métodos , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Procedimentos Endovasculares/instrumentação , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/terapia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/terapia , Masculino , Polivinil/administração & dosagemAssuntos
Procedimentos Cirúrgicos Ambulatórios , Qualidade da Assistência à Saúde , Procedimentos Cirúrgicos Vasculares , Veias/cirurgia , Anestesia/métodos , Humanos , Terapia a Laser , Procedimentos Cirúrgicos Minimamente Invasivos , Equipe de Assistência ao Paciente , Satisfação do Paciente , Escleroterapia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/organização & administraçãoRESUMO
Endovenous modalities to treat superficial venous reflux of the lower extremities have revolutionized management of patients with varicose veins. Laser and radiofrequency probes have both found their way into the arsenal of physicians treating venous reflux. Although both offer distinct advantages and minor drawbacks, they each offer the convenience of in-office treatment, faster recovery, and improved safety over traditional surgical procedures. This article will briefly discuss the technique, treatment results, and potential complications associated with each procedure.
Assuntos
Ablação por Cateter , Terapia a Laser , Insuficiência Venosa/terapia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Humanos , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Resultado do Tratamento , Varizes/terapiaAssuntos
Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico , Ecocardiografia Transesofagiana/métodos , Embolia/diagnóstico , Próteses Valvulares Cardíacas/efeitos adversos , Falha de Prótese , Aorta Torácica/cirurgia , Doenças da Aorta/complicações , Doenças da Aorta/cirurgia , Broncodilatadores/uso terapêutico , Reanimação Cardiopulmonar/métodos , Dispneia/etiologia , Embolia/etiologia , Embolia/cirurgia , Epinefrina/uso terapêutico , Evolução Fatal , Migração de Corpo Estranho/diagnóstico , Parada Cardíaca/complicações , Parada Cardíaca/terapia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Acidente Vascular Cerebral/complicaçõesRESUMO
OBJECTIVE: Carotid endarterectomy (CEA) is associated with a risk of cerebral ischemia during carotid clamping, particularly in the face of contralateral internal carotid artery (ICA) occlusion. We examined the results of CEA with continuous electroencephalography in patients without and with contralateral ICA occlusion. DESIGN AND SETTING: We reviewed 564 primary CEAs with routine electroencephalography and general anesthesia performed between April 1, 1989, and March 31, 1999, in a community teaching medical center. Main outcome measures were perioperative stroke, temporary lateralizing neurologic deficit, and death. Shunts were placed primarily for significant electroencephalographic changes after carotid clamping but also selectively for contralateral ICA occlusion, prior stroke, or surgeon choice. CEA was performed for asymptomatic disease in 35% of cases. RESULTS: Significant electroencephalographic changes occurred in 16% versus 39% (P <.001) and shunts were placed in 13% versus 55% (P <.001) of patients with patent (n = 507) versus occluded contralateral ICA (n = 57), respectively. The fraction of CEAs with significant electroencephalographic changes during clamping was stable, but shunt use declined slightly over time as our confidence in electroencephalography increased. Patches were placed more often (86% versus 65%; P =.002), but other operative details were similar when the contralateral ICA was occluded. Five early (30 days) strokes (0.9%) and eight early temporary postoperative neurologic events (1.4%) occurred, all ipsilateral to CEA and all after the patient left the operating room with none in patients with contralateral ICA occlusion. Two perioperative deaths occurred, one in a patient without and one in a patient with contralateral ICA occlusion. Neither of these deaths was related to ipsilateral stroke. No increase in stroke rate with decreased shunt use over time was seen. CONCLUSION: Routine use of electroencephalography was associated with apparent complete elimination of intraoperative strokes and less than 1% risk of perioperative strokes. These observations appear to be true even in the face of contralateral ICA occlusion. Electroencephalography is a sensitive detector of cerebral ischemia and a valuable tool for determination of need for shunting during CEA. Surgeons should consider routine use of electroencephalography and selective shunting for significant electroencephalographic changes with clamping.