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A 75-year-old male, weighing 71 kg, was admitted to our institution with anemia related to a subcapsular hematoma after accidental extraction of a nephrostomy catheter. While the patient exhibited the progression of chronic kidney disease, he was not yet on dialysis. His serum creatinine level increased to 6.8 mg/dL, with an estimated glomerular filtration rate of 7.4 mL/min/1.73 m2. Radiologists planned contrast-enhanced photon-counting detector CT (PCD-CT) with an ultra-low-dose contrast media to mitigate the impact on renal function. The contrast media dosage was set at 7.4 gI, which was 82.6% lower that used in the standard protocol for a male weighing 71 kg. Non-contrast-enhanced PCD-CT identified a low-density nodular area within the renal subcapsular hematoma. Contrast-enhanced PCD-CT revealed contrast enhancement in both the early and late phases corresponding to the nodular area. On virtual monoenergetic images, the renal pseudoaneurysm was most clearly delineated at 40 keV. Following the diagnosis of a pseudoaneurysm, transcatheter arterial coil embolization was performed. No subsequent progression of anemia or the deterioration of renal function was observed, showcasing the potential of ultra-low-dose contrast-enhanced PCD-CT for the detection of small vascular abnormalities while minimizing adverse effects on renal function.
Assuntos
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
RESUMEN Se presenta el caso de un paciente varón de 55 años con antecedente de colecistitis aguda, que durante la hospitalización presentó anemia por hemobilia secundaria a un pseudoaneurima de la arteria cistica. Se realizó, como tratamiento de primera elección, embolización con microparticulas de alcohol polivinílico (PVA) de la arteria cistica, logrando detención del sangrado.
SUMMARY We present the case of a 55-year-old male patient with a history of acute cholecystitis who presented during his hospitalization haemobilia due to a pseudoaneurysm of the cystic artery. Embolectomy of the cystic artery with polyvinyl alcohol microparticles was performed stopping the bleeding.
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A abordagem transradial é indicada para reduzir risco de morte, complicações vasculares ou sangramento. Em pacientes com doença cardíaca isquêmica estável, a abordagem radial é recomendada para diminuir sangramento no local de acesso e complicações vasculares. As complicações são raras, podendo ocorrer hematoma, perfuração e, muito raramente, pseudoaneurisma da artéria radial. Neste relato de caso, é descrito um caso raro de pseudoaneurisma da artéria radial esquerda associada à síndrome compartimental no antebraço esquerdo após realização de cateterismo eletivo. O diagnóstico foi confirmado por ultrassonografia com Doppler, que evidenciou pseudoaneurisma da artéria radial esquerda, medindo 2,1x1,5cm, com colo de 0,3cm. O tratamento cirúrgico do pseudoaneurisma e da síndrome compartimental restaurou a função completa do membro.
The transradial approach is indicated to reduce the risk of death, vascular complications, or bleeding. In patients with stable ischemic heart disease, the radial approach is recommended to reduce vascular complications and bleeding on access site. The complications are rare, and hematoma, perforation, and pseudoaneurysm (very rarely) of the radial artery may occur. This case report describes a rare case of left radial artery pseudoaneurysm associated with compartment syndrome in the left forearm after elective catheterization. The diagnosis was confirmed by Doppler ultrasonography, which showed a left radial artery pseudoaneurysm, measuring 2.1x1.5cm, with a 0.3-cm long/wide neck. Surgical treatment of pseudoaneurysm and compartment syndrome restored full limb function.
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Presentamos el caso de un varón de 64 años quien, tras un primer episodio de pancreatitis aguda necrotizante, reingresa a los 20 días por cuadro de dolor epigástrico intenso y posteriormente episodio de hemorragia digestiva alta en forma de hematemesis y melenas con inestabilización hemodinámica. Se realiza en ese momento gastroscopia urgente objetivándose probable fistula gastrointestinal en bulbo duodenal con coágulo adherido sin sangrado activo en ese momento por lo que se realiza angio-TC urgente que revela colección peripancreática necrótica con presencia de sangrado activo en su interior, procedente de la arteria pancreatoduodenal. La arteriografía urgente identificó imagen compatible con pseudoaneurisma arterial dependiente de la rama de arteria pancreatoduodenal, que fue embolizada con éxito. Desgraciadamente el paciente falleció en las horas posteriores, como consecuencia de un shock séptico secundario a colección pancreática infectada.
We present the case of a 64-year-old man who, after a first episode of acute pancreatitis, was readmitted 20 days later due to severe epigastric pain and later an episode of upper gastrointestinal bleeding in the form of hematemesis and melena with hemodynamic instability. An urgent gastroscopy was performed at that time, revealing a probable gastrointestinal fistula in the duodenal bulb with an adherent clot without active bleeding at that time, so an urgent CT angiography was performed that revealed a necrotic peripancreatic collection with the presence of active bleeding inside from the pancreatoduodenal artery. Urgent arteriography identified an image compatible with arterial pseudoaneurysm dependent on the pancreaticoduodenal artery branch, which was successfully embolized. Unfortunately, the patient died a few hours later as a result of septic shock secondary to an infected pancreatic collection.
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Abstract Pseudoaneurysm of the ascending aorta (PAA) is a hazardous and potentially fatal cardiovascular disease. This condition is caused by the rupture of at least one layer of the vessel and contained by the remaining vascular layers or the surrounding mediastinal structures. We presented the surgical treatment of a patient with sepsis and large PAA and brachiocephalic trunk, which was compressing the brachiocephalic trunk leading to syncope.
Assuntos
Humanos , Falso Aneurisma/cirurgia , Falso Aneurisma/diagnóstico por imagem , Sepse/complicações , Aorta/cirurgia , Tronco Braquiocefálico/cirurgia , Tronco Braquiocefálico/diagnóstico por imagemRESUMO
ABSTRACT Purpose: Renal artery pseudoaneurysms (RAPs) and arteriovenous fistulas (AVFs) are rare but potentially life-threatening complications after partial nephrectomy (PN). Selective arterial embolization (SAE) is an effective method for controlling RAPs/AVFs. We assessed the clinical factors affecting the occurrence of RAPs/AVFs after PN and the effects of SAE on postsurgical renal function. Materials and Methods: Four hundred ninety-three patients who underwent PN were retrospectively reviewed. They were placed in either the SAE or the non-SAE group. The effects of clinical factors, including R.E.N.A.L. scores, on the occurrence of RAPs/AVFs were analyzed. The influence of SAE on the estimated glomerular filtration rate (eGFR) during the first postoperative year was evaluated. Results: Thirty-three (6.7%) patients experienced RAPs/AVFs within 8 days of the median interval between PN and SAE. The SAE group had significantly higher R.E.N.A.L. scores, higher N component scores, and higher L component scores (all, p <0.05). In the multivariate analysis, higher N component scores were associated with the occurrence of RAPs/AVFs (Odds ratio: 1.96, p=0.039). In the SAE group, the mean 3-day postembolization eGFR was significantly lower than the mean 3-day postoperative eGFR (p <0.01). This difference in the eGFRs was still present 1 year later. Conclusions: Renal tumors located near the renal sinus and collecting system were associated with a higher risk for RAPs/AVFs after PN. Although SAE was an effective method for controlling symptomatic RAPs/AVFs after PN, a procedure-related impairment of renal function after SAE could occur and still be present at the end of the first postoperative year.
Assuntos
Humanos , Fístula Arteriovenosa/etiologia , Falso Aneurisma/etiologia , Neoplasias Renais/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Taxa de Filtração Glomerular , Nefrectomia/efeitos adversosRESUMO
Abstract Objective: To identify the main hemorrhagic complications after percutaneous nephrolithotomy, as well as the results obtained with transcatheter arterial embolization (TAE) at an interventional radiology center. Materials and Methods: This was a retrospective analysis of patients undergoing TAE for the treatment of hemorrhagic complications after percutaneous nephrolithotomy. All patients underwent computed tomography angiography (CTA). Results: We evaluated a total of nine patients. At emergency department readmission, the most common symptom was macroscopic hematuria, which was seen in five patients. Three patients had an isolated pseudoaneurysm, two had a pseudoaneurysm together with active bleeding (perirenal hematoma), and one had a pseudoaneurysm together with arteriocalyceal fistula. Arteriovenous fistula was diagnosed in three patients and was not seen in combination with other vascular lesions. We did not identify arteriocalyceal fistula in isolation. Five patients underwent TAE with 6 × 15 mm and 6 × 20 mm microcoils. Four patients underwent TAE with n-butyl-2-cyanoacrylate and ethiodized oil. Follow-up CTAs revealed no complications. Conclusion: Because of its high diagnostic accuracy, CTA provides the interventional radiologist with valuable data for individualized therapeutic planning. The TAE procedure is safe and effective. It can therefore be used as a first-line treatment for hemorrhagic complications resulting from percutaneous renal procedures.
Resumo Objetivo: Demonstrar as principais complicações hemorrágicas após nefrolitotripsia percutânea, bem como os resultados após o tratamento por embolização arterial transcateter (EAT) em um centro de radiologia intervencionista. Materiais e Métodos: Coleta e análise de dados retrospectivos de pacientes submetidos a EAT por complicações hemorrágicas após nefrolitotripsia percutânea. Resultados: O sintoma mais comum foi hematúria macroscópica, presente em cinco pacientes no momento da readmissão ao pronto-socorro, e nestes pacientes identificamos três pseudoaneurismas isolados, dois casos de combinação de pseudoaneurisma e sangramento ativo (hematoma perirrenal) e um caso de associação de pseudoaneurisma e fístula arteriocalicinal. Fístula arteriovenosa foi diagnosticada em três pacientes, não sendo observada em associação com outras lesões vasculares. Não identificamos fístula arteriocalicinal isolada, somente associada a pseudoaneurisma. Cinco pacientes foram submetidos a embolização por micromolas 6 × 15 mm e 6 × 20 mm. Quatro pacientes foram submetidos a embolização por Histoacryl e Lipiodol. Não observamos complicações pela angiotomografia computadorizada de controle. Conclusão: A angiotomografia computadorizada apresenta alta acurácia diagnóstica e guarnece o radiologista intervencionista de dados para um planejamento terapêutico individualizado. EAT é um procedimento seguro e eficaz e pode ser utilizado como primeira linha para o tratamento de complicações hemorrágicas resultantes de procedimentos percutâneos renais.
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RESUMEN Se presenta el caso de un varón de 46 años, asintomático y con antecedente de prótesis mecánica aórtica monodisco desde hace 25 años. Mediante el empleo de la ecocardiografía transtorácica, ecocardiografía transesofágica y tomografía cardiaca, se le diagnostica, incidentalmente, un pseudoaneurisma de la fibrosa intervalvular mitroaórtica (región de tejido fibroso localizada entre el velo anterior de la válvula mitral y los velos aórticos izquierdo y no coronariano). Debido al tamaño del pseudoaneurisma, se decide realizar una cirugía. Este artículo muestra la presentación tardía de un pseudoaneurisma en esta localización que aparece como una complicación del reemplazo de la válvula aórtica por endocarditis. Se destaca la evolución asintomática, el tamaño y la cirugía que preserve la válvula cuando no está comprometida. Las diferentes técnicas de imagen son complementarias y ayudan en tomar las decisiones del caso.
ABSTRACT This is the case of a 46-year-old man, asymptomatic, with a history of single-disk mechanical aortic prosthesis implanted 25 years ago, who was incidentally diagnosed with a pseudoaneurysm of the mitral-aortic intervalvular fibrosa (a region of fibrous tissue located between the anterior leaflet of the mitral valve and the left and non-coronary aortic leaflets) discovered by means of a transthoracic echocardiography, transesophageal echocardiography and cardiac computed tomography. Surgery was decided because of the size of the pseudoaneurysm. This article shows the late presentation of a pseudoaneurysm in this location caused by a complication of an aortic valve replacement due to endocarditis. It also highlights the asymptomatic evolution, the size of the pseudoaneurysm and the election of a valve preserving surgery because the valve was not compromised. The different imaging techniques are complementary to the research and help to make the pertinent decisions.
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Abstract Objective: In our clinic, we aimed to investigate the effect of preoperative risk factors and postoperative complications on reoperation and mortality in cases with Behçet's disease which presents very rare coronary artery involvement. Methods: Thirteen patients with Behçet's Disease who had undergone coronary artery bypass grafting in our center between 2003 and 2015 were analyzed. We evaluated the clinical and laboratory findings, complications and mortality rates of our patients in light of the literature. Results: The mean age was 38.5 (30-55; 3 women). The mean time from onset of Behçet's disease to coronary artery disease was 4,7 (3-11) years. Fifty-four percent of the patients were asymptomatic. Coronary artery disease of these was exposed while peripheral vascular surgery was planned due to complications of Behçet's disease. Symptomatic patients presented angina pectoris (31%), acute coronary syndrome (8%) and arrhythmia (8%). In coronary pathology of patients, distal type obstruction (31%), aneurysm and pseudoaneurysm (31%), proximal segment thrombus (15%), chronic type stenosis and occlusions (31%) were present. Early mortality (15%) was due to acute myocardial infarction while the late mortality (15%) was due to cerebral and gastrointestinal bleeding. Reoperation was due to bleeding in one case on the 1st postoperative day and due to acute pulmonary embolism in another case in the 3rdpostoperative year. Conclusion: In Behçet's disease, coronary artery bypass grafting is a procedure with high mortality, especially in the acute period. The on-pump surgery technique in these cases can be safely performed for multiple bypasses and in patients above 40 years old.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doença da Artéria Coronariana/etiologia , Ponte de Artéria Coronária/efeitos adversos , Síndrome de Behçet/complicações , Complicações Pós-Operatórias , Prognóstico , Síndrome de Behçet/cirurgia , Síndrome de Behçet/mortalidade , Fatores de Risco , Falso Aneurisma/etiologia , Vasos Coronários/cirurgia , Doenças Raras , Período Pré-OperatórioRESUMO
Vascular Ehlers-Danlos Syndrome (VEDS) is a rare autosomal dominant disorder caused by mutations in the COL3A1 or COL1A1 genes. Its mortality is secondary to sudden and spontaneous rupture of arteries or hollow organs. The genotype influences the distribution of arterial pathology with aneurysms of intra-abdominal visceral arteries being relatively uncommon. We describe the case of a young man with probable VEDS who died of a spontaneous rupture and dissection of the cystic artery. The patient initially presented with abdominal pain due to an unrecognized spontaneous perforation of the small intestine complicated by sepsis. We postulate that inflammatory mediators may have triggered the arterial rupture due to remodeling and weakening of vessel walls. The phenotype of the patient's vascular damage included bilateral spontaneous carotid-cavernous sinus fistulae and dissection with pseudoaneurysm formation of large- and medium-sized arteries, predominantly the abdominal aorta and its branches. The autopsy uncovered a long history of vascular events that may have been asymptomatic. These findings along with a positive family history supported the VEDS diagnosis. Loeys-Dietz, Marfan, and familial thoracic aortic aneurysm and dissection syndromes were ruled out based on the absence of arterial tortuosity, eye abnormalities, bone overgrowth, and the distribution of vascular damage among other features. Interestingly, microscopic examination of the hippocampus revealed a focus of neuronal heterotopia, commonly associated with epilepsy; however, the patient had no history of seizures. The natural course of VEDS involves the rupture and dissection of arteries that, if unrecognized, can lead to a rapid death after bleeding into free spaces.
Assuntos
Humanos , Masculino , Adulto , Aorta Abdominal , Síndrome de Ehlers-Danlos/patologia , Perfuração Intestinal/complicações , Intestino Delgado/lesões , Aneurisma/complicações , Autopsia , Falso Aneurisma/complicações , Evolução Fatal , Sepse , Dissecção AórticaRESUMO
RESUMEN Introducción: la fístula arteriovenosa autóloga es el acceso vascular óptimo para los pacientes que se realizan hemodiálisis, desde su confección, maduración y utilización esta puede presentar varias complicaciones, siendo los pseudoaneurisma sobre las fístulas arteriovenosas autólogas una de las complicaciones infrecuentes. Reporte de caso: se presenta el caso de un paciente de 40 años, masculino con antecedente de hipertensión arterial, aneurisma cerebral, insuficiencia renal crónica en hemodiálisis utilizando como vía de acceso fístula arteriovenosa autóloga que desarrolló un pseudoaneurisma trombosado. Se exponen aspectos clínicos y quirúrgicos relacionados con este. Conclusiones: se reportó el caso de un paciente con pseudoaneurisma trombosado desarrollado sobre fístula arteriovenosa autóloga, una complicación infrecuente pero que su resolución quirúrgica permitió prolongar la vida útil del acceso vascular.
ABSTRACT Introduction: the arteriovenous-autologous fistula is the optimal vascular access for patients undergoing hemodialysis, since its preparation, maturity stage and use of it can include several complications, being pseudo-aneurysm on arteriovenous-autologous fistulas one of the infrequent complications. Case report: a 40-year-old male patient with a history of hypertension, cerebral aneurysm, and chronic renal failure undergoing hemodialysis is presented, using an arteriovenous-autologous fistula as a pathway that developed a pseudo-aneurysm. Clinical and surgical characteristics related to this case are exposed. Conclusions: the case of a patient with thrombosed pseudo-aneurysm developed on arteriovenous-autologous fistula was reported, an infrequent complication but its surgical resolution allowed prolonging the useful life of the vascular access.
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SUMMARY Hemorrhagic pseudocysts with pseudoaneurysms are a rare and fatal complication of chronic pancreatitis due to the erosion of pancreatic to peripancreatic arteries. The timing of the rupture cannot be accurately predicted, but prompt diagnosis and management are essential to prevent further bleeding. We describe the case of a 68-year-old man who presented acute epigastric pain and anemia and had a history of chronic pancreatitis with a pseudocyst. A biliary and pancreas MRI showed an enlarged size of a known pancreatic pseudocyst with internal high signal intensity material. Color-Doppler ultrasonography showed pulsating signals in the pseudocyst, and our final diagnosis was a pseudoaneurysm in the pancreatic hemorrhagic pseudocyst. The pseudoaneurysm was successfully treated with coil embolization of the feeding artery. We report this case of a rare complication of chronic pancreatitis to show that color-Doppler ultrasound is a non-invasive and effective diagnostic tool for pseudoaneurysm, which enables early detection and prompt treatment without the need for invasive diagnostic modalities.
Assuntos
Humanos , Masculino , Idoso , Pseudocisto Pancreático/diagnóstico por imagem , Falso Aneurisma/diagnóstico por imagem , Ecocardiografia Doppler em Cores , Pancreatite Crônica/complicações , Hemorragia Gastrointestinal/diagnóstico por imagem , Pseudocisto Pancreático/etiologia , Hemorragia Gastrointestinal/etiologiaRESUMO
La perforación concomitante de esófago y aorta se puede presentar después de la ingestión de cuerpos extraños. El reparo aórtico por técnica endovascular, a pesar de ser reciente, es un tratamiento de primera línea por tratarse de un abordaje poco invasivo, rápido y que permite la estabilización hemodinámica, en comparación con la reparación abierta tradicional. Se presentan dos casos de perforación aórtica, en los cuales se llevó a cabo el reparo endovascular con éxito. El primer paciente sufrió una ruptura contenida de la aorta torácica, secundaria a la ingestión de un cuerpo extraño (espina de pescado), y presentó mediastinitis. El segundo paciente sufrió una ruptura aórtica en el arco distal a la arteria subclavia, la cual se corrigió por vía endovascular, pero desarrolló una fístula aorto-esofágica y, finalmente, murió
Concomitant esophageal and aortic perforation has been described in the literature as major complications of foreign body ingestion. Although it has not been widely studied, aortic endovascular repair is the first line of treatment, for it is less invasive, faster and allows early patient stabilization, as compared with the traditional open repair. We present two cases managed successfully with endovascular repair of the aortic perforation. The first case had a contained rupture of the thoracic aorta caused by the ingestion of a foreign body (fish bone) and developed mediastinitis. The second case had an aortic rupture in the arc distal to the subclavian artery, managed with endovascular but he developed an aortoesophageal fistula which was finally lethal.
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Humanos , Ruptura Aórtica , Falso Aneurisma , Perfuração Esofágica , Procedimentos EndovascularesRESUMO
SUMMARY Pseudoaneurysms are rare, but femoral artery false aneurysms have increased in recent decades. They are related to endovascular procedures performed on patients with increased risk for this complication. Pseudoaneurysms generally present with only one neck. This paper describes a femoral artery pseudoaneurysm with two necks that occurred after an endovascular procedure and was successfully treated by duplex-guided fibrin sealant. Pseudoaneurysms are rare, but femoral artery pseudoaneurysms have increased with a discrepant incidence reported from 0.5% to almost 4%, mainly related to the increase of endovascular procedures in recent decades. The double-necked pseudoaneurysm identification was of utmost importance to guide the clinical decision-making and allowed good outcomes for the patient.
RESUMO Os pseudoaneurismas são raros, mas os aneurismas falsos da artéria femoral aumentaram nas últimas décadas. Eles estão relacionados aos procedimentos endovasculares realizados em pacientes com risco aumentado para esta complicação. Os pseudoaneurismas geralmente apresentam apenas um colo. Este artigo descreve um pseudoaneurisma da artéria femoral com dois colos que ocorreu após um procedimento endovascular e foi tratado com sucesso por selante de fibrina guiado por duplex. Os pseudoaneurismas são raros, mas os pseudoaneurismas da artéria femoral aumentaram com uma incidência discrepante relatada de 0,5% a 4%, principalmente relacionada ao aumento dos procedimentos endovasculares nas últimas décadas. A identificação do pseudoaneurisma de colo duplo foi de extrema importância para orientar a tomada de decisão clínica e permitiu bons resultados para o paciente.
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Humanos , Feminino , Adulto , Adesivo Tecidual de Fibrina/uso terapêutico , Falso Aneurisma/terapia , Falso Aneurisma/diagnóstico por imagem , Artéria Femoral/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Ultrassonografia de IntervençãoRESUMO
ABSTRACT Lesions of the axillary artery and consequent compression of the brachial plexus are extremely rare in patients with glenohumeral dislocation and may have greatly varying clinical manifestations. This joint is one of the most affected by dislocation in the human body, accounting for approximately 45% of cases. Less than 1% of patients with shoulder dislocation have vascular complications; however, when there is damage in the axillary artery, the incidence of associated brachial plexus injury is 27% to 44%. The authors report on a case of brachial plexus compression by an axillary artery pseudoaneurysm after a glenohumeral dislocation, aiming to highlight the existence of this association, in order to make an early diagnosis and avoid serious complications, such as neurologic injury.
RESUMO As lesões de artéria axilar e consequente compressão de plexo braquial são extremamente raras em pacientes com luxação de glenoumeral e podem ter manifestações clínicas bastante variadas. Essa articulação é uma das mais acometidas por luxação do corpo humano, representando cerca de 45% dos casos. Menos de 1% dos pacientes com luxação de ombro apresentam complicações vasculares; no entanto, quando há lesão da artéria axilar, a incidência de lesão de plexo braquial associada é de 27% a 44%. Relatamos um caso de compressão do plexo braquial por um pseudoaneurisma de artéria axilar após uma luxação glenoumeral. O objetivo é lembrar a existência dessa associação, a fim de diagnosticá-la precocemente e evitar complicações graves, como a lesão neurológica.
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Humanos , Masculino , Adulto , Falso Aneurisma , Artéria Axilar , Plexo Braquial/lesões , Luxação do OmbroRESUMO
Introducción: El seudoaneurisma es una complicación ocasional (0,05-0,5%) de los procedimientos intervencionistas cuando se utiliza el acceso femoral. El cierre con inyección local de trombina como alternativa al tratamiento quirúrgico luego de compresión manual fallida cuenta con escasos registros. Objetivo: Evaluar la seguridad y eficacia del cierre del seudoaneurisma femoral iatrogénico mediante la inyección local de trombina guiada por ecografía Doppler. Material y métodos: Entre marzo de 2007 y junio de 2016 se incluyeron 32 pacientes para tratamiento con inyección de trombina. Resultados: La edad media fue de 64,3 ± 10,2 años. La mayoría de los seudoaneurismas estuvieron asociados con la realización de cateterismos coronarios diagnósticos o terapéuticos (59,3%). Siete pacientes habían recibido tratamiento anticoagulante y 21 doble antiagregación plaquetaria. En todos los casos se intentó previamente el cierre por compresión manual. La media del diámetro mayor de los seudoaneurismas fue de 38 mm. Luego del tratamiento, la trombosis inmediata del saco ocurrió en 28 pacientes (87,5%), mientras que 4 pacientes requirieron una segunda inyección, lo que determinó un éxito del 96,8%. En un solo paciente este tratamiento no fue efectivo, con posterior conversión a reparación quirúrgica programada. La dosis media de trombina fue de 450 unidades. Un único paciente presentó complicación trombótica venosa que requirió terapia anticoagulante, con buena evolución clínica. Conclusión: El tratamiento del seudoaneurisma con inyección local de trombina guiada con eco-Doppler fue una alternativa terapéutica segura y eficaz para pacientes con seudoaneurisma femoral refractarios a la compresión manual.
Background: Pseudoaneurysm is a rare complication (0.05-0.5%) after interventional procedures using femoral access. There are few registries of local thrombin injection for pseudoaneurysm closure as an alternative treatment to surgery after failed manual compression. Objective: The aim of this study was to evaluate the safety and efficacy of iatrogenic femoral pseudoaneurysm closure with Doppler ultrasound-guided local thrombin injection. Methods: Thirty-two patients were included for thrombin injection treatment between March 2007 and June 2016. Results: Mean age was 64.3±10.2 years. Most pseudoaneurysms were associated with diagnostic or therapeutic cardiac cath-eterizations (59.3%). Seven patients had received anticoagulant treatment and 21, double antiplatelet therapy. In all cases, prior closure was attempted by manual compression. Mean pseudoaneurysm major diameter was 38 mm. Following treatment, immediate pseudoaneurysm sac thrombosis occurred in 28 patients (87.5%), while 4 patients required a second injection, resulting in 96.8% success rate. Treatment was not effective in only one patient, with subsequent conversion to programmed surgical repair. Mean thrombin dose was 450 units. Only one patient presented with venous thrombosis complication requir-ing anticoagulant therapy, with good clinical outcome. Conclusion: Doppler ultrasound-guided local thrombin injection was a safe and effective therapeutic alternative for pseudoa-neurysm treatment in patients with femoral pseudoaneurysm refractory to manual compression.
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Los aneurismas, pseudoaneurismas y divertículos cardiacos son dilataciones o evaginaciones de estructuras de la pared cardiaca: ventrículos, aurículas, septo interauricular, arterias coronarias, entre otros, de distintas causas y de morfología variable. Los avances en las diferentes modalidades diagnósticas han permitido una mayor precisión en la evaluación morfológica y funcional del corazón. Los aneurismas, pseudoaneurismas y divertículos cardiacos son manifestaciones frecuentes de diferentes condiciones, que pueden ser evaluados mediante técnicas como la resonancia magnética (RM) y la tomografía computarizada (TC) que se usan, cada vez con mayor frecuencia, para evaluar la configuración cardiaca. La resonancia magnética cardiovascular (RMC) es la técnica de elección para una mejor valoración anatómica cardiaca. El propósito de este artículo es ilustrar mediante casos clínicos el valor de estas modalidades diagnósticas no invasivas en la evaluación de los aneurismas, pseudoaneurismas y divertículos cardiacos.
Cardiac aneurysms, pseudoaneurysms, and diverticula are dilations or outpouchings of different cardiac structures: ventricles, atria, atrial septum, coronary arteries, among others, due to different causes and of variable morphology. Advances in different diagnostic modalities have allowed greater accuracy in the morphological and functional assessment of the heart. Cardiac aneurysms, pseudoaneurysms, and diverticula are common manifestations of different conditions that can be assessed by magnetic resonance imaging and computed tomography, which are increasingly used to evaluate cardiac configuration. Cardiovascular magnetic resonance (CMR) is the technique of choice for a better cardiac anatomic evaluation. This paper aims to illustrate, through clinical cases based on our experience in CediIMed, the value of these non-invasive diagnostic modalities in the evaluation of cardiac aneurysms, pseudoaneurysms, and diverticula.
Assuntos
Humanos , Aneurisma Cardíaco , Imageamento por Ressonância Magnética , Falso Aneurisma , Tomografia Computadorizada MultidetectoresRESUMO
Objetivo: Determinar la frecuencia de complicaciones vasculares post intervención coronaria percutánea vía radial o femoral.Metodología: Estudio descriptivo prospectivo, se incluyeron 78 pacientes a quienes se les y relacionados con el procedimiento y la frecuenciade las complicaciones a partir de la historia clínica de cada paciente, en caso de presentar hematoma en sitio de punción, se realizará una observación directa para poder realizar Resultados: En 87.2% de pacientes se realizó cateterismo por la arterial radial. Un 10.2% presentó complicaciones vasculares, cuatro hematomas menores, tres hematomas mayores y un pseudoaneurisma. La frecuencia fue mayor en mujeres. Todos los pacientes se encontraban vivos al alta hospitalaria.Conclusiones: La mayoría de las intervenciones coronarias percutáneas se realizaron por vía radial y se presentó una baja tasa de complicaciones
AbstractDetecting the vascular complication rate after percutaneous coronary interventions by radial and femoral access.Methods: observational and prospective study, 78 patients who undergo percutaneous coronary intervention where included. Demographics, clinical and procedure related complications rate where evaluated.Results: in 87.2% patients, catheterizations is perform by the radial artery access. 10.2% had vascular complications, four minor and three major hematoma and one pseudoaneurism. The frequency of complications in patients with radial access was 10.2%. The frequency was higher in women and short size. Al patients were alive at hospital discharge.Conclusion: most of percutaneous coronary interventions were performed by radial approach with a low complication rate showed and no impact on mortality