RESUMO
Atherosclerosis is a systemic disease affecting the coronary, carotid, intracerebral, renal and peripherial arteries. The early morphological and functional impairments could be detected in the second or third decades of life and their progression depend on the number and severity of risk factors and individual susceptility. Although the vascular risk factors (smoking, overweight, age, unhealthy diet, lack of physical exercise, hypertension, diabetes mellitus, chronic kidney disease and dyslipidemia) are the same and common in the different vascular diseases, the present clinical routine artificially classifies the diagnosis and therapy of different vascular diseases into different subfields of medicine with the negative impact of possible polypragmasia. Recently, worldwide health surveys (e.g. REACH registry) have proven the usefulness of a holistic approach in the diagnosis and therapy of multiorgan-affected vascular patients. This review summarizes the multidisciplinary advances and future perspective of vascular diseases.
Assuntos
Doenças Autoimunes/complicações , Diabetes Mellitus Tipo 2/complicações , Dislipidemias/complicações , Nefropatias/complicações , Doenças Vasculares/diagnóstico , Doenças Vasculares/terapia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/terapia , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/terapia , Doença Crônica , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/terapia , Dislipidemias/diagnóstico , Dislipidemias/terapia , Humanos , Hipertensão/diagnóstico , Hipertensão/terapia , Comunicação Interdisciplinar , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Nefropatias/terapia , Fatores de Risco , Doenças Vasculares/complicações , Doenças Vasculares/etiologia , Doenças Vasculares/imunologia , Doenças Vasculares/patologia , Doenças Vasculares/prevenção & controleRESUMO
The management of the abdominal aortic aneurysm is associated with several risk factors, especially in patients after renal transplantation. Endovascular aneurysm repair (EVAR) can be the proper treatment in feasible cases. The authors present a patient's case who underwent renal transplantation and developed an infrarenal aortic aneurysm some years later. A 50-year-old male patient was operated with EVAR. During the starting period of the procedure bilateral iliac dissection developed, and the endovascular approach was converted into traditional open operation. At the time when the aorta was clamped, an extraanatomic shunt was applied to ensure the blood supply of the transplanted organ. In the early postoperative period, a transient renal function impairment was observed. Later on, the renal function returned to normal values. In this article, alternative methods used to prevent ischaemic damage of the transplanted organ during the procedure are presented as well. Finally, the authors report the international trends and experiences in the field of preserving the viability of a transplanted organ during abdominal aneurysm repairs. Orv Hetil. 2019; 160(37): 1471-1475.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares/métodos , Aneurisma Ilíaco/cirurgia , Transplante de Rim , Humanos , Artéria Ilíaca/cirurgia , Transplante de Rim/efeitos adversos , Masculino , Resultado do TratamentoRESUMO
UNLABELLED: Currently, peripheral arterial disease is an underdiagnosed disorder. Several modifiable and non-modifiable risk factors have role in its development and progression. As system disorder it might be a part and an important predictor of fatal cardio- and cerebrovascular events. CASE REPORT: The authors describe the case of a 73-year-old male with multilocational vascular disorder, with simultaneously occurring carotid disease, critical limb ischaemia with aorto-bifemoral bypass, multiple infarction with mechanical complication, inoperable coronary disease and with implantable cardioverter defibrillator for ventricular arrhythmia. CONCLUSION: Peripheral arterial disease affects the whole vascular system and can progress into serious cardiac and cerebral manifestations causing the patient's death inspite of comprehensive treatment.
Assuntos
Doenças Vasculares Periféricas/diagnóstico , Doenças Vasculares Periféricas/terapia , Idoso , Angiografia Digital , Aorta/cirurgia , Estenose das Carótidas/complicações , Angiografia Coronária , Doença das Coronárias/complicações , Desfibriladores Implantáveis , Eletrocardiografia , Evolução Fatal , Artéria Femoral/cirurgia , Humanos , Isquemia/complicações , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Masculino , Doenças Vasculares Periféricas/complicações , Choque Cardiogênico/complicações , Taquicardia Ventricular/complicações , Taquicardia Ventricular/terapia , Procedimentos Cirúrgicos VascularesRESUMO
The infiltration of red blood cells into atheromatous plaques is implicated in atherogenesis. Inside the lesion, hemoglobin (Hb) is oxidized to ferri- and ferrylHb which exhibit prooxidant and proinflammatory activities. Cystathione gamma-lyase- (CSE-) derived H2S has been suggested to possess various antiatherogenic actions. Expression of CSE was upregulated predominantly in macrophages, foam cells, and myofibroblasts of human atherosclerotic lesions derived from carotid artery specimens of patients. A similar pattern was observed in aortic lesions of apolipoprotein E-deficient mice on high-fat diet. We identified several triggers for inducing CSE expression in macrophages and vascular smooth muscle cells including heme, ferrylHb, plaque lipids, oxidized low-density lipoprotein, tumor necrosis factor-α, and interleukin-1ß. In the interplay between hemoglobin and atheroma lipids, H2S significantly mitigated oxidation of Hb preventing the formation of ferrylHb derivatives, therefore providing a novel function as a heme-redox-intermediate-scavenging antioxidant. By inhibiting Hb-lipid interactions, sulfide lowered oxidized Hb-mediated induction of adhesion molecules in endothelium and disruption of endothelial integrity. Exogenous H2S inhibited heme and Hb-mediated lipid oxidation of human atheroma-derived lipid and human complicated lesion. Our study suggests that the CSE/H2S system represents an atheroprotective pathway for removing or limiting the formation of oxidized Hb and lipid derivatives in the atherosclerotic plaque.
Assuntos
Aterosclerose/sangue , Aterosclerose/tratamento farmacológico , Hemoglobinas/metabolismo , Sulfeto de Hidrogênio/farmacologia , Lipídeos/sangue , Placa Aterosclerótica/sangue , Placa Aterosclerótica/tratamento farmacológico , Animais , Aterosclerose/patologia , Células Cultivadas , Células Endoteliais , Humanos , Sulfeto de Hidrogênio/química , Camundongos , Camundongos Endogâmicos C57BL , Morfolinas/química , Morfolinas/farmacologia , Compostos Organofosforados/química , Compostos Organofosforados/farmacologia , Compostos Organotiofosforados/química , Compostos Organotiofosforados/farmacologia , Piperidinas/química , Piperidinas/farmacologia , Placa Aterosclerótica/patologia , Pirrolidinas/química , Pirrolidinas/farmacologiaRESUMO
We report a unique case of a cured Hodgkin's disease patient who developed several complications decades after mantle and neck radiation therapy. First on the right, then years later on the left side of the neck a pharyngocutaneous fistula developed complicated by rupture of the carotid arteries on both sides necessitating their ligation. The fistula on the right side was successfully closed by plastic surgery, but the one on the left side is still a problem as severe hypoperfusion of the brain limits therapeutic possibilities. We discuss the relationships between the treatment for Hodgkin's disease and subsequent complications as well as treatment of these complications.