Evaluation of Morphological and Clinical Factors Related to Failure of Percutaneous Treatment with Thrombin Injection of Femoral Pseudoaneurysms from Cardiac Catheterization.

BACKGROUND: Ultrasound-guided thrombin injection (UGTI) has become the method of choice in the treatment of pseudoaneurysm caused by endovascular procedures because it is minimally invasive, costs less, and effective, with short hospitalization time. The objective was identify the morphological aspects of femoral pseudoaneurysms and clinical aspects of patients that may lead to the failure of UGTI in femoral pseudoaneurysms after cardiac catheterization. POPULATION AND METHOD: From December 2012 to December 2016, 60 patients with pseudoaneurysms caused by cardiac catheterization were referred to the interventional radiology unit to be treated with UGTI. Medical charts were retrospectively reviewed for comorbidities, use of antiplatelet agents, anticoagulation, indication of cardiac catheterization, and so forth. Morphological aspects of the pseudoaneurysms such as volume, diameter (anteroposterior, laterolateral, and longitudinal), length, and diameter of the neck were analyzed. RESULTS: Technical success of UGTI was achieved in 100%. No clinical aspects of the patients were statistically significant for UGTI failure in occlusion of the pseudoaneurysms. For morphological aspects of pseudoaneurysm: anteroposterior (P = 0.029), longitudinal (P = 0.020), and neck diameters (P = 0.004) were statistically significant for UGTI failure. Logistic regression analysis for longitudinal diameter showed that for each centimeter, there was a 2.66 chance of failure of pseudoaneurysm thrombosis in a single thrombin injection session (95% confidence interval: 1.33-5.30). For longitudinal and neck diameters greater than 1.8 cm and 0.55 cm, respectively, there is a greater probability of needing more than one UGTI session for complete thrombosis. CONCLUSIONS: Among variables, the longitudinal dimension was more significant, and in a larger diameter, the treatment with thrombin injection presented greater complexity.

Effect of negative pressure wound therapy for legs in complex wound diabetic patients: Therapeutic challenge and review.

Diabetic foot is one of the main chronic complications caused by diabetes mellitus and can lead to limb amputation. Among the various wound treatment options, negative pressure wound therapy is a treatment modality based on vacuum-sealed drainage and vacuum-assisted closure to create a localized controlled negative pressure environment. In this case report, the patient sought medical attention and underwent surgical debridement of the dorsum of the right foot. Upon worsening of the wound condition, the patient was referred to our hospital for debridement and Renesys Smith Nephew dressing was implanted. After complete coverage of the granulation tissue without infection, elastic suturing was performed in the leg compartment to reduce the size of the dermis and epidermis graft. The patient then underwent a dermal matrix implant procedure, and an epidermis graft was removed from the ipsilateral thigh and placed on the wound. The aim of this study is to report a therapeutic challenge in an extensive wound in diabetic foot using a dressing negative pressure wound therapy and multidisciplinary treatment.

Chemotherapy taste and bronchospasm: a consequence of a fistula between the superior vena cava and the right main bronchi.

A 56-year-old female patient with upper lobe neoplasia of the right lung and superior vena cava syndrome. The patient complained about the taste of the medications during the chemotherapy sessions. Interventional radiology diagnosed cava-bronchial fistula when it injected contrast into the inferior and superior vena cava.

Endovascular management of giant common iliac artery pseudoaneurysm after complications in simultaneous pancreas-kidney transplant: a case report.

BACKGROUND: Pancreatic transplantation is a definitive treatment for selected patients with insulin-dependent diabetes. It is a technically challenging surgery, and vascular complications are the most common cause of pancreatic graft failure. Although rare, pancreas transplants present higher rates of pseudoaneurysms at the vascular anastomosis than other visceral transplants. We present a case of a simultaneous pancreas-kidney transplant complicated with graft failure and common iliac artery pseudoaneurysm that was successfully treated through endovascular techniques. CASE PRESENTATION: A 34-year-old White woman presented with abdominal pain and a history of type 1 diabetes mellitus, end-stage renal disease, and two previous pancreas transplantation failures. The first was a simultaneous pancreas-kidney transplantation performed 7 months prior that was complicated by pancreas graft thrombosis within 1 month and required graft resection. Five months later, she underwent a second pancreas transplantation with another pancreatic graft thrombosis requiring graft resection. Abdominal angiotomography revealed a pseudoaneurysm in the right common iliac artery at the point of the previous graft anastomosis. The patient was successfully treated endovascularly with a covered stent in the common iliac artery. CONCLUSION: Stent graft implantation for the treatment of common iliac artery pseudoaneurysm as a complication of simultaneous pancreas-kidney transplantation is a safe and feasible procedure.

Superselective transcatheter arterial embolization of iatrogenic inferior epigastric artery after paracentesis: Unusual manifestation of hemoperitoneum.

INTRODUCTION: Paracentesis is a safe procedure and can be performed as a therapy or diagnosis in cancer patients, liver cirrhosis, heart or liver failure. PRESENTATION OF CASE: 59-year-old man with alcoholic liver cirrhosis with ascites and coagulation abnormalities. After diagnostic paracentesis he presented hemodynamic instability with signs of hypovolemic shock and hemoperitoneum. Computed angiotomography with signs of active bleeding and pseudoaneurysm at the site of paracentesis. DISCUSSION: The interventional radiology unit was referred and submitted to arteriography, which demonstrated active bleeding from the left lower epigastric artery. It was successfully treated by transcatheter embolization with 100-300 µm PVA particles. CONCLUSION: Transcatheter embolization with PVA particles is a fast, safe, minimally invasive, reliable method with a high technical success rate for the treatment of active bleeding resulting from injury to the lower epigastric artery.

Ventral incisional hernia case report: A therapeutic challenge.

Incisional hernias are a very common condition and they still are considered to be a surgical challenge due to their recurrence rate. Smoking, obesity and age are risk factors for developing these abdominal wall defects. Despite recent advances in hernia repairs, the recurrence rates of hernias did not significantly diminished, even after the introduction of meshes. The aim of this article is to report a case of a ventral incisional hernia in a 37-year-old man and its successful treatment with a procedure known as the Alcino-Lázaro technique repair. This procedure has been shown to be very effective in incisional hernias, especially in obese patients. Furthermore, it is as cheap as it is reliable, since it can be performed without technological aid or expensive materials (mesh); thus, patients in low-income countries can greatly benefit from this procedure.

Retrievable celect™ filter placement in the superior vena cava: A case report.

INTRODUCTION: Venous thromboembolism is an important cause of morbidity and mortality in the world. Upper Extremity Deep Venous Thrombosis (UEDVT) may be a cause of pulmonary embolism. Anticoagulation is the treatment of choice for venous thromboembolism, which is associated with low hemorrhagic complications. However, there are situations that anticoagulation becomes contraindicated as gastrointestinal tract hemorrhages, stroke, progression of deep venous thrombosis in the presence of adequate anticoagulation, where the vena cava filter is recommended. CASE REPORT: Patient 65 years old, female undergoing neurosurgical treatment of a mass suggestive of schwannoma with asymmetrical edema in the right upper limb, confirming the acute deep venous thrombosis by Doppler ultrassonogarphy. Anticoagulation was contraindicated by neurosurgery and after a multidisciplinary discussion, the superior vena cava filter was chosen. DISCUSSION: The Retrievable Celect™ Filter was implant in superior vena cava and may be considered as an alternative therapeutic method in cases where anticoagulation can not be performed. CONCLUSION: Superior vena cava filter is controversial, but is safe, feasible and effective, in preventing symptomatic pulmonary embolisms in patients in whom anticoagulation is contraindicated.