Liver Transplantation After Acute Portal Vein Thrombosis: Case Report.

BACKGROUND: Portal vein thrombosis is a relatively frequent complication in patients with liver cirrhosis. Its detection and management are essential to avoid worsening portal hypertension or liver function complications. This complication can also negatively impact or even preclude liver transplant. CASE PRESENTATION: We report the case of a patient who presented with acute portal vein thrombosis, which allowed the diagnosis of liver cirrhosis and hepatocarcinoma within the Milan criteria. Chemical thrombolysis was performed with a mechanical aspiration of the thrombus, and in a second moment, the patient was submitted to a liver transplant. CONCLUSIONS: Advances in the therapeutic approach to portal vein thrombosis and surgical techniques have allowed the condition to no longer be an absolute contraindication to liver transplantation. Diagnosis in the acute phase is associated with greater therapeutic success, aiming to avoid the extension of thrombosis and achieve portal vein recanalization.

Physician Modified Low Profile Endograft for Endovascular Repair of Juxtarenal Abdominal Aortic Aneurysms in Patients with Small Access Vessels.

INTRODUCTION: Urgent or emergency treatment of patients with abdominal aortic aneurysms that are anatomically unsuitable for conventional repair because of short proximal necks, small diameters and access vessel calcification, and high risk for open repair can be performed with commercially available branched or fenestrated aortic endografts or physician modified stent grafts. REPORT: A technique is described for modification and successful implantation of a commercially available standard aortic stent graft with a low profile main body in two patients at high risk for open repair, with small access vessels and requiring uni- or bilateral renal artery fenestration for juxtarenal aneurysm repair. DISCUSSION: Based on two case experiences, the use of physician modified off the shelf endografts appears to be a feasible and effective alternative to fenestrated endovascular repair in patients with juxtarenal abdominal aortic aneurysms at high risk for open surgical repair. Studies comparing effectiveness of the different options, including chimney/snorkel technique and debranching, are warranted.

Thoracoabdominal branched repositionable device for an urgent complex aortic aneurysm.

The successful use of customized branched or fenestrated devices to treat elective thoracoabdominal aneurysm (TAAA) has already been described. However, the device customization is a lengthy process that necessitates a delay in treatment of more than a month. This case reports an emergency treatment of TAAA, in a 80-year-old patient, refused to open repair, admitted with abdominal pain using a new technique, modifying Gore C3 Excluder (WL Gore & Associates, Flagstaff, AZ) including branches to enable the emergency endovascular treatment of TAAA preserving visceral artery flow and excluding aneurysm.

Aminaphtone for light bleeding in patients under oral anticoagulation.

BACKGROUND: Bleeding is a common complication of oral anticoagulation therapy. OBJECTIVE: The present study evaluated the use of aminaphtone in patients with minor bleeding while taking warfarin. METHODS: Seven patients suffering from bleeding of the nose and gums, who were taking therapeutic doses of warfarin, were included in the study. RESULTS: The patients were prescribed 75 mg aminaphtone twice daily. For 5 of these patients the bleeding was controlled within 48 h, for 1, within 96 h and for the other, a satisfactory reduction was obtained. CONCLUSION: Patients with minor bleeding during treatment using oral anticoagulation, who are free from risk of other complications, can benefit from the use of aminaphtone as an initial therapeutic option.