RESUMEN
Access from the femoral arteries to the thoracic aorta for intra-aortic balloon pump (IABP) insertion may not be feasible in a substantial number of patients with severe peripheral vascular disease. Since using an alternative access is inevitable in a certain number of patients requiring IABP support, all alternative accesses should be added to the surgical armamentarium. Herein, we present our 27-year experience with different alternative accesses for IABP insertion following failed contraindication to femoral artery cannulation. The alternative techniques described below were: transthoracic insertion with a tube graft, transthoracic insertion - direct, transaxillary/subclavian insertion and transbrachial insertion.
Asunto(s)
Enfermedades Cardiovasculares/cirugía , Arteria Femoral , Contrapulsador Intraaórtico , Adulto , Anciano , Anciano de 80 o más Años , Cateterismo , Femenino , Corazón Auxiliar , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios RetrospectivosRESUMEN
PURPOSE: We sought to determine whether hypothermia provided any benefit in patients undergoing simultaneous coronary artery bypass graft surgery (CABG) and carotid endarterectomy (CEA) using one of two different surgical strategies. METHODS: Group 1 patients (n = 34, 88.2% male, mean age 65.94 ± 6.67 years) underwent CEA under moderate hypothermia before cross clamping the aorta, whereas group 2 patients (n = 23, 69.6% male, mean age 65.78 ± 9.29 years) underwent CEA under normothermic conditions before initiating cardiopulmonary bypass (CPB). Primary outcome of interest was the occurrence of any new neurological event. RESULTS: The two groups were similar in terms of baseline characteristics. Permanent impairment occurred in one patient (2.9%) in group 1. One patient from each group (2.9 and 4.37%) had transient neurological events and they recovered completely on the sixth and 11th postoperative days, respectively. Overall, there was no statistically significant difference between the two groups with regard to occurrence of early neurological outcomes (n = 2, 5.8 % vs n = 1, 4.3 %, p = 0.12). CONCLUSIONS: This study could not provide evidence regarding benefit of hypothermia in simultaneous operations for carotid and coronary artery disease because of the low occurrence rate of adverse outcomes. The single-stage operation is safe and completion of the CEA before CPB may be considered when short duration of CPB is required.
Asunto(s)
Estenosis Carotídea/cirugía , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Endarterectomía Carotidea , Hipotermia Inducida , Anciano , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/mortalidad , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/mortalidad , Endarterectomía Carotidea/efectos adversos , Endarterectomía Carotidea/mortalidad , Femenino , Humanos , Hipotermia Inducida/efectos adversos , Hipotermia Inducida/mortalidad , Ataque Isquémico Transitorio/etiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/etiología , Factores de Tiempo , Resultado del Tratamiento , TurquíaRESUMEN
Traumatic aneurysms of the brachiocephalic artery may cause mostly nonspecific symptoms, which may lead to a misdiagnosis with serious complications. This report describes a 27-year-old woman with a traumatic aneurysm of the brachiocephalic artery,suffering from lung symptoms. Brachiocephalic aneurysm and bronchiectasis were diagnosed by chest CT scan. A bypass from the ascending aorta to the distal brachiocephalic artery with a prosthetic graft and aneurysmectomy were performed without the use of cardiopulmonary bypass. The patient had an uneventful recovery.