RESUMO
The treatment of acute aortic syndrome has been benefited in recent years from the huge progress in endovascular techniques, compared to classical surgical treatment, by open surgery. Nevertheless, for endovascular treatment to be successful, it is essential for the patient to present adequate vascular access. Those cases with unfavourable vascular anatomy make it necessary to consider open surgery with significant morbidity, or even to reject surgery. A new approach to the abdominal aorta has recently been described as an indication for these patients with impossibility of other vascular access and absolute or relative contraindication to the transthoracic approach. The anesthetic management of the aortic syndrome is well known and, even though there are a variety of options, all of them have proven safety and efficacy. The implementation of new surgical approaches and new possible complications imply a challenge for the anesthesiologist which, for now, has little or none scientific evidence. We present the first case of transcaval aortic endoprosthesis implantation in Spain, its anesthetic implications, and a review of the literature.
RESUMO
Systemic venous pressure is elevated in right heart failure, and this elevation may be reflected in pulsatile venous flow when there is significant tricuspid regurgitation. The presence of this systolic reversed flow in the femoral and popliteal veins may result in major difficulties for diagnosis and treatment. We report the case of a patient with signs and symptoms of acute ischemia of the right lower limb with palpable pulse in the groin and popliteal fossa. Tricuspid regurgitation was suspected by clinical examination, and Doppler ultrasonographic examination of the extremity revealed pulsatile flow in the femoral and popliteal veins while the iliac arterial axis was occluded. A preoperative angiogram revealed an underlying iliac artery thrombosis, which was successfully treated.
Assuntos
Arteriopatias Oclusivas/complicações , Veia Femoral/fisiopatologia , Artéria Ilíaca , Extremidade Inferior/irrigação sanguínea , Veia Poplítea/fisiopatologia , Fluxo Pulsátil , Trombose/complicações , Insuficiência da Valva Tricúspide/complicações , Insuficiência Venosa/etiologia , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular , Feminino , Veia Femoral/diagnóstico por imagem , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Isquemia/etiologia , Pessoa de Meia-Idade , Veia Poplítea/diagnóstico por imagem , Radiografia , Fluxo Sanguíneo Regional , Trombectomia , Trombose/diagnóstico , Trombose/cirurgia , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/fisiopatologia , Ultrassonografia Doppler em Cores , Insuficiência Venosa/diagnóstico , Insuficiência Venosa/fisiopatologia , Pressão VenosaRESUMO
Estimates of the incidence of aortoenteric fistula as a sequela of surgery of the aorta range 1-2%. This complication is less common in patients who have had an aortic endograft implanted for aortoiliac aneurysm. We present three cases of aortoenteric fistula complicating endovascular treatment of abdominal aortic aneurysm (3/423 patients, 0.7% in our series).
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Doenças da Aorta/etiologia , Implante de Prótese Vascular/efeitos adversos , Úlcera Duodenal/etiologia , Fístula Intestinal/etiologia , Fístula Vascular/etiologia , Idoso , Doenças da Aorta/patologia , Doenças da Aorta/cirurgia , Úlcera Duodenal/patologia , Úlcera Duodenal/cirurgia , Evolução Fatal , Humanos , Fístula Intestinal/patologia , Fístula Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/etiologia , Reoperação , Tomografia Computadorizada por Raios X , Fístula Vascular/patologia , Fístula Vascular/cirurgiaRESUMO
Aortoiliac aneurysms are frequent entities that have very important clinical implications, especially in the younger patients. We are asked not only to save lives by preventing the rupture or repairing those that are already ruptured but also to provide an acceptable quality of life in the postoperative period. Endovascular approaches certainly give us such an expectative but are not clearly indicated in our younger patients and cannot be used routinely in those aneurysms with a yuxtarrenal origin. This is the case report of a young man with a yuxtarrenal aortoiliac inflammatory aneurysm that was treated by the interposition of an aortobifemoral bypass with the addition of endovascular devices in the hypogastric vessels to preserve the pelvic blood flow; they contribute to seal the common iliac aneurysms. This approach was useful to avoid complications during a difficult iliac dissection and was permeable within 1 year of the operation. Durability must be assessed.