RESUMEN
Epithelioid hemangioendothelioma is a rare vascular sarcoma that arises from the lining (intima) of blood vessels. We report a case of a 43-year-old male patient, who presented with inferior vena cava (IVC) obstruction and acute bilateral lower extremity deep vein thrombosis. Mechanical thrombectomy was performed with an endovascular thrombectomy device, followed by stent placement in the IVC. The initial pathology on the retrieved specimen obtained from the thrombectomy device revealed an undifferentiated neoplasm, and definitive surgical resection of the retroperitoneal soft-tissue tumor of the IVC documented a rare case of epithelioid hemangioendothelioma.
Asunto(s)
Procedimientos Endovasculares/instrumentación , Hemangioendotelioma Epitelioide/patología , Hemangioendotelioma Epitelioide/cirugía , Neoplasias Retroperitoneales/patología , Neoplasias Retroperitoneales/cirugía , Trombectomía/instrumentación , Vena Cava Inferior/patología , Vena Cava Inferior/cirugía , Trombosis de la Vena/patología , Trombosis de la Vena/cirugía , Adulto , Biopsia , Diferenciación Celular , Diseño de Equipo , Hemangioendotelioma Epitelioide/complicaciones , Humanos , Masculino , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias Retroperitoneales/complicaciones , Stents , Resultado del Tratamiento , Trombosis de la Vena/etiologíaRESUMEN
OBJECTIVE: The effect of socioeconomic status (SES) on the course of many disease states has been documented in the literature but has not been studied in aortic dissection. This study evaluated the effect of SES on 30-day and long-term survival of patients after aortic dissection. METHODS: Hospital discharge records were used to identify patients with acute aortic dissection. Patient demographics, insurance status, comorbidities, and 30-day mortality were collected. Home addresses were used to estimate each patient's median household income, and the neighborhood deprivation index, a measure of SES, was determined. Long-term survival was assessed by review of the Social Security Death Index. Associations between demographics, insurance status, comorbidities, and poverty level were investigated to determine their effect on survival. RESULTS: There were 212 aortic dissections; of which, 118 were type A and 94 were type B. Median follow-up was 7.6 years. The neighborhood deprivation index (hazard ratio, 1.43; 95% confidence interval, 1.16-1.78; P = .001) was associated with reduced long-term survival and was also significantly associated with 30-day mortality (hazard ratio, 1.43; 95% confidence interval, 1.05-1.93; P = .02). The mean neighborhood deprivation index score was higher in patients with type B aortic dissections (0.45 ± 0.93) than in those with type A aortic dissections (0.16 ± 0.96; P = .029). CONCLUSIONS: Patients with a lower SES had reduced short-term and long-term survival after aortic dissection. Patients with type B dissection live in lower socioeconomic neighborhoods than patients with type A dissection.