RESUMO
Antiplatelet and/or anticoagulant agents (collectively known as antithrombotic agents) are used to reduce the risk of thromboembolic events in patients with conditions such as atrial fibrillation, acute coronary syndrome, recurrent stroke prevention, deep vein thrombosis, hypercoagulable states and endoprostheses. Antithrombotic-associated gastrointestinal (GI) bleeding is an increasing burden due to the growing population of advanced age with multiple comorbidities and the expanding indications for the use of antiplatelet agents and anticoagulants. GI bleeding in antithrombotic users is associated with an increase in short-term and long-term mortality. In addition, in recent decades, there has been an exponential increase in the use of diagnostic and therapeutic GI endoscopic procedures. Since endoscopic procedures hold an inherent risk of bleeding that depends on the type of endoscopy and patients' comorbidities, in patients already on antithrombotic therapies, the risk of procedure-related bleeding is further increased. Interrupting or modifying doses of these agents prior to any invasive procedures put these patients at increased risk of thromboembolic events. Although many international GI societies have published guidelines for the management of antithrombotic agents during an event of GI bleeding and during urgent and elective endoscopic procedures, no Indian guidelines exist that cater to Indian gastroenterologists and their patients. In this regard, the Indian Society of Gastroenterology (ISG), in association with the Cardiological Society of India (CSI), Indian Academy of Neurology (IAN) and Vascular Society of India (VSI), have developed a "Guidance Document" for the management of antithrombotic agents during an event of GI bleeding and during urgent and elective endoscopic procedures.
Assuntos
Gastroenterologia , Neurologia , Humanos , Fibrinolíticos/efeitos adversos , Anticoagulantes/efeitos adversos , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/prevenção & controle , Hemorragia Gastrointestinal/tratamento farmacológico , Endoscopia GastrointestinalAssuntos
Doenças da Aorta/complicações , Transtornos de Deglutição/etiologia , Úlcera/complicações , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Aterosclerose/complicações , Aterosclerose/diagnóstico por imagem , Aterosclerose/cirurgia , Implante de Prótese Vascular/métodos , Transtornos de Deglutição/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Úlcera/diagnóstico por imagem , Úlcera/cirurgiaAssuntos
Artéria Carótida Interna , Endarterectomia das Carótidas , Idoso , Angiografia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/patologia , Artéria Carótida Interna/fisiopatologia , Artéria Carótida Interna/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Acidente Vascular Cerebral/patologiaRESUMO
Rupture of an aortic arch aneurysm is a life-threatening emergency with the risk of mortality escalating by the hour. We describe the successful hybrid repair of a ruptured bovine aortic arch aneurysm in a 75-year-old man, which involved aortic arch debranching by ascending aorta-bicarotid bypass followed by relining of the aortic lumen with a stent-graft. The procedure was not only lifesaving but also resulted in an active gentleman at 2-year follow-up. Considering the morbidity and mortality of open surgery using circulatory arrest, state-of-the-art synchronous hybrid repair seems to be an effective alternative for ruptured aortic arch aneurysms.
Assuntos
Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/complicações , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Stents , Idoso , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/etiologia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Chronic mesenteric ischemia is a life-threatening clinical problem resulting in death from inanition and/or bowel infarction, if left untreated, albeit low disease prevalence. Typical presentation is postprandial abdominal pain, severe weight loss, and altered bowel habit. Surgical revascularization of the superior mesenteric artery provides effective long-term treatment for chronic intestinal ischemia. Eleven patients underwent superior mesenteric artery revascularization, nine of them with open retrograde superior mesenteric artery bypass and two with angioplasty and stenting. All patients except one made a satisfactory recovery in this cohort. Major complication included one graft thrombosis leading to bowel ischemia and death. The rest all recovered weight in 3-6 months with a follow up period of 6 to 28 months. Two patients had recurrence of symptoms due to failing bypass requiring stenting for assisted primary patency. Superior mesenteric artery revascularization can be performed with minimal morbidity and mortality, providing excellent symptom relief and quality of life.