RESUMO
Extracranial carotid artery aneurysm is a rare condition with relatively significant morbidity and mortality. When surgery is not indicated, endovascular techniques are emerging as the preferred treatment. However, even this approach may be contraindicated due to anatomic factors. We present a case of a high-lying extracranial carotid artery aneurysm with challenging anatomy unsuitable for conventional or endovascular repair. After resecting the aneurysm, the carotid artery was revascularized using the new Gore Hybrid Vascular Graft (W. L. Gore & Associates, Flagstaff, Ariz). This straightforward procedure turned out to be safe and further reduced the cerebral ischemic time.
Assuntos
Aneurisma/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/cirurgia , Procedimentos Endovasculares/instrumentação , Stents , Idoso , Aneurisma/diagnóstico , Aneurisma/fisiopatologia , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/fisiopatologia , Feminino , Humanos , Desenho de Prótese , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Grau de Desobstrução VascularRESUMO
We report the first documented case of distal thromboembolism originating from an abdominal aortic aneurysm (AAA) after a blunt trauma. A 72-year-old man with a known 6.2 cm AAA was brought to our emergency department with signs of bilateral acute limb ischemia developing immediately after an accidental fall. The occlusion was confirmed at computed tomographic angiography, and the aneurysm showed a fragmentated/ulcerated mural thrombus, morphologically different as compared to the previous computed tomography (CT). A thromboembolectomy was performed and, after treatment of the ischemic complications, the aneurysm was repaired by open surgery. Embolization from aneurysms in the setting of a trauma is a challenge for the vascular surgeon, also because of its rare occurrence. We describe the management and discuss the operative strategy we opted for in this patient.
Assuntos
Acidentes por Quedas , Aneurisma da Aorta Abdominal/complicações , Isquemia/etiologia , Extremidade Inferior/irrigação sanguínea , Tromboembolia/etiologia , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Aortografia/métodos , Embolectomia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Masculino , Trombectomia , Tromboembolia/diagnóstico por imagem , Tromboembolia/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The aim of this study is to report a new minimally invasive technique of superficial temporal artery (STA) pseudoaneurysm treatment. Several surgical options have been employed to treat STA pseudoaneurysms. To address this rare condition, the employed techniques are ligation and excision of the aneurysm, endovascular coil embolization or percutaneous ultrasound-guided thrombin injection. Between techniques no significant differences are reported in terms of outcomes. The decision to adopt a technique depends on STA pseudoaneurysm morphology and surgeon preference. In the present report, STA pseudoaneurysm afferent and efferent branches were identified by ultrasound in a 92-year-old female. Under local anaesthesia, these branches were ligated through small skin incisions. STA pseudoaneurysm decompression was obtained by an 'over the needle aspiration'. A compressive dressing was left in space for 48 h.