[Complex supraclavicular false aneurysm. Case report]. / Falso aneurisma supraclavicular complexo. Caso clínico.

The authors report the clinical case of a 29 year-old caucasian male, previously healthy, victim of traffic accident with head and chest trauma, resulting in a prolonged stay (around 60 days) in an intensive care unit. After hospital discharge, the patient noticed a slow growing of a left supraclavicular pulsatile mass, associated with pain, both local and irradiating to the left arm. The diagnostic investigation revealed a complex false aneurysm with associated arterio-venous fistulae, dissecting cervical muscle planes and involving the braquial plexus. He was submitted to surgical intervention consisting in the ligation of a scapular afferent artery and ligation of communication to the internal jugular vein, with significant decrease in the intra-luminal blood flow velocity. He was subsequently submitted to percutaneous eco-guided thrombin injection under Valsalva manouver, with complete thrombosis of the false aneurysm. There was a quick resolution of the clinical complaints and a progressive reduction of the mass volume (6 month follow-up). A discussion is made on the main features of this entity, normally its etiopathogeny, surgical management and false aneurysm exclusion by means of eco-guided injection of thrombin.

[Hybrid infrainguinal revascularization for critical limb ischemia]. / Revascularização infrainguinal híbrida em isquémia crítica.

The introduction of endovascular procedures in the routine of vascular surgery allowed for the expansion of therapeutic options in the diverse areas of vascular disease. Endoluminal revascularization can be regarded as a usefull complement of conventional surgical techniques. An above-knee femoro-popliteal bypass surgery ePTFE graft has been performed, followed by a sheath introduction on the graft body. This allows a simplified access to crural vessels, while providing efficient revascularization of the femoro-popliteal sector. Distal revascularization was performed using angioplasty and stenting when appropriate, as to insure continuous flux in at least one of the tibial or the peroneal arteries. The aim of this kind of procedure is to insure efficient femoro-popliteal revascularization and to achieve a run-off to the foot in at least one vessel. This type of intervention may be particularly attractive in Leriche-Fontaine's grade IV patients with no available autologous venous graft.