RESUMO
Pseudoaneurysm is a rare complication after intertrochanteric fracture fixation. Herein, we present a rare case of late development of a pseudoaneurysm with silent clinical symptoms. The case was a 91-year-old woman treated with proximal femoral nailing and cerclage wiring. Postoperatively, the patient was able to ambulate with a walker without abnormal symptoms. During the follow-ups, the radiographic images showed progressive cortical scalloping on the medial femoral shaft. Ultrasonography revealed a yin-yang sign, and a CT scan confirmed a pseudoaneurysm at the profunda femoris artery (PFA). In this case, many possible causes of pseudoaneurysm were hypothesized. We showed that the excessive displaced, long spiral pattern of an intertrochanteric fracture, which was irreducible by a closed technique, is the risk of a PFA injury. An atherosclerotic vessel was seen in preoperative radiography, indicating poor vessel elasticity which may be a risk of vessel tear during fracture reduction using multiple reduction instruments in excessive displaced fracture. Moreover, over-penetration when drilling should not be overlooked. We also discuss the predisposing factors, surgical techniques which may lead to this type of PFA injury and summarize the literature of pseudoaneurysms related to intertrochanteric fracture fixation.
Assuntos
Falso Aneurisma , Fixação Intramedular de Fraturas , Fraturas do Quadril , Feminino , Humanos , Idoso de 80 Anos ou mais , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Resultado do Tratamento , Fixação Interna de Fraturas/métodos , Fraturas do Quadril/cirurgia , Fraturas do Quadril/complicações , Doença Iatrogênica , Pinos Ortopédicos/efeitos adversosRESUMO
This case discusses an elderly female who presented acutely with compromised profunda femoris pseudoaneurysm and massive haematoma five weeks after dynamic hip screw insertion for a left neck of femur fracture. The only precipitating factor leading to this presentation was ongoing physiotherapy. She was referred from a rehabilitation hospital to the nearest vascular surgical unit for acute and definitive surgical intervention. Post-operatively, she fared incredibly well, regaining her baseline level of functioning. History taking is complex in a patient with dementia. Clinical examination should follow with a focused approach to the site of recent operation and also where complications are likely to manifest when an alteration from baseline cognitive function is noted. This is of course in addition to the complete work up required from a holistic perspective with any acute deterioration. Imaging should be arranged and prompt referral made if a treatable acute cause is identified. It is imperative to involve family and/or next of kin if possible, but this should not impede prompt decision-making in the patient's best interests by the clinical team if delays are likely to occur.
Assuntos
Falso Aneurisma/diagnóstico por imagem , Artéria Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas/reabilitação , Fratura Avulsão/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Hemorragia Pós-Operatória/diagnóstico por imagem , Idoso , Falso Aneurisma/cirurgia , Parafusos Ósseos , Demência Vascular/complicações , Feminino , Artéria Femoral/cirurgia , Fraturas do Colo Femoral/complicações , Fratura Avulsão/cirurgia , Hematoma/complicações , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Humanos , Modalidades de Fisioterapia , Hemorragia Pós-Operatória/complicações , Hemorragia Pós-Operatória/cirurgia , UltrassonografiaRESUMO
Los pseudoaneurismas son una causa infrecuente de masa palpable en cabeza y cuello, habitualmente secundarios a procedimientos intervencionales; trauma e infeccioso son casos aislados. Caso Clínico. Se presenta el caso de un niño de 14 años que luego de haber sufrido un trauma contuso cortante en la región preauricular izquierda intervenido quirúrgicamente, desarrolla al mes un aumento de volumen pulsátil tras un trauma menor en la zona. En la ecografía se aprecia el signo del yin yang, indicador de pseudoaneurisma. Se realiza en pabellón el vaciamiento del pseudoaneurisma y posterior sutura vascular sin incidentes. Discusión. Pese a la baja frecuencia de pseudoaneurisma como causa de masa en cabeza y cuello, se debe considerar como diagnóstico diferencial en el contexto de masas pulsátiles post traumáticas, de horas a días de evolución. El estudio de elección es la ecografía doppler y el Gold Standard del manejo es quirúrgico con sutura vascular.
Pseudoaneurysms are an infrequent cause of palpable mass in the head and neck; usually secondary to invasive procedures; trauma and infectious causes are rare. Clinical Case. We present the case of a 14-year-old boy who, after suffering a blunt contusive trauma in the left preauricular region surgically treated, develops a month later a pulsatile volume increase after a minor trauma in the area. Ultrasound shows the yin yang sign, indicator of pseudoaneurysm. The emptying of the pseudoaneurysm and subsequent vascular suture was performed without incident. Discussion. Despite the low frequency of pseudoaneurysm as a cause of mass in the head and neck, it should be considered as a differential diagnosis in the context of post-traumatic pulsatile masses, from hours to days of evolution. The study of choice is Doppler ultrasound and the Gold Standard treatment is surgery with vascular suture.
Assuntos
Humanos , Masculino , Adolescente , Artérias Temporais/lesões , Falso Aneurisma/diagnóstico por imagem , Artérias Temporais/cirurgia , Artérias Temporais/diagnóstico por imagem , Falso Aneurisma/cirurgia , Falso Aneurisma/etiologia , Ultrassonografia Doppler em Cores , Traumatismo CerebrovascularRESUMO
We present the case of a mixed martial arts (MMA) cage fighter who presented to the emergency department with a right sided common carotid artery pseudoaneurysm as a result of a neck trauma at an MMA event. We discuss the management of blunt force neck trauma, differential diagnosis, imaging findings and review the literature on blunt cerebrovascular injury following blunt force injury to the neck.
Assuntos
Falso Aneurisma/diagnóstico por imagem , Lesões das Artérias Carótidas/diagnóstico por imagem , Artes Marciais/lesões , Cartilagem Tireóidea/diagnóstico por imagem , Cartilagem Tireóidea/lesões , Ferimentos não Penetrantes/diagnóstico por imagem , Adulto , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Lesões das Artérias Carótidas/etiologia , Lesões das Artérias Carótidas/cirurgia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Humanos , Imageamento Tridimensional , Masculino , Radiografia , Cartilagem Tireóidea/cirurgia , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/cirurgiaRESUMO
OBJECTIVE/BACKGROUND: Pseudoaneurysm formation occurs in 2-10% of hemodialysis arteriovenous grafts (AVGs). Surgical repair often requires pseudoaneurysm resection, interposition graft placement, and insertion of a catheter as a bridge. Endovascular stent graft repair is a controversial alternative therapy. This study was performed to examine the effectiveness and mid-term outcomes of stent graft repair for AVG pseudoaneurysms. METHODS: All patients who had undergone stent graft repair for AVG pseudoaneurysms between December 2012 and July 2015 were identified from hospital medical records for retrospective analysis. Outcome measures were technical success, early and late complications, and primary and secondary patency rates. RESULTS: A total of 37 stent graft repairs of AVG pseudoaneurysms were performed in 35 patients (42.9% men; mean age 66.9 years). The mean time from AVG creation to pseudoaneurysm repair was 69 months. The indications of treatment (as per the institutional policy) were large pseudoaneurysm (56.7%), impending rupture (27.1%), and bleeding (16.2%). Mean pseudoaneurysm diameter was 23.0 mm. The most common diameter and length of stent graft used were 7 mm (67.6%) and 50 mm (48.6%), respectively. Technical success was 100%. Only one early complication occurred after stent graft repair, which was due to recurrence of the pseudoaneurysm as a result of a short landing zone. Late complications included infection (17.1%) and thrombosis (37.1%). The 1, 6, and 12 month primary patency rates were 89.2%, 55.5%, and 22.0%, respectively. The 1, 6, and 12 month secondary patency rates were 100%, 88.6%, and 78.6%, respectively. The median follow up was 12.3 months. CONCLUSIONS: The study demonstrates that endovascular stent graft repair is an effective and safe alternative therapy for AVG pseudoaneurysms. However, the rate of thrombosis and infection was high and needs to be balanced against open surgery in future studies.
Assuntos
Falso Aneurisma/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Falência Renal Crônica/terapia , Diálise Renal , Stents , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Flebografia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
The extracranial vertebral artery (VA) is vulnerable to dissection and the V3 segment is the most common location for dissection. Dissection accounts for about 2% of all ischemic strokes and can occur after trauma or chiropractic neck maneuvers. We report an extremely rare case of spontaneous extracranial VA dissection presenting with posterior neck hematoma aggravated after cupping therapy, a treatment in traditional Oriental medicine. We treated the patient successfully by endovascular treatment without any complication.
Assuntos
Embolização Terapêutica/métodos , Hematoma Subdural Espinal/etiologia , Hematoma Subdural Espinal/terapia , Medicina Tradicional Coreana , Dissecação da Artéria Vertebral/etiologia , Dissecação da Artéria Vertebral/terapia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Cateterismo , Angiografia por Tomografia Computadorizada , Hematoma Subdural Espinal/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Resultado do Tratamento , Dissecação da Artéria Vertebral/diagnóstico por imagemRESUMO
Most popliteal arteriovenous fistula and pseudoaneurysm formation are related to trauma. Few cases have previously been reported after acupuncture therapy. Such events are typically observed when the procedure is performed by non-medical acupuncturist. They may present with acute ischemia, recent claudication, distal emboli, or less commonly rupture. Duplex ultrasound should be considered as the 1st method of investigation. Computed tomography scanning is particularly accurate in making the diagnosis. Treatment strategies consist of surgery or endovascular management. The most commonly performed surgical technique for popliteal pseudoaneurysm repair is resection with bypass grafting, whereas popliteal arteriovenous fistula are usually treated surgically with ligation and primary repair. Endovascular procedure using a stent-graft is thought to be a reasonable option for treating popliteal false aneurysm or even arteriovenous fistula. We will describe two cases of an arteriovenous fistula and pseudoaneurysm of the popliteal artery that developed after acupuncture needling in the region of the popliteal artery.
Assuntos
Terapia por Acupuntura/efeitos adversos , Falso Aneurisma/etiologia , Fístula Arteriovenosa/etiologia , Artéria Poplítea , Adulto , Falso Aneurisma/diagnóstico , Falso Aneurisma/cirurgia , Angiografia , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/cirurgia , Humanos , Masculino , Ultrassonografia Doppler , Procedimentos Cirúrgicos VascularesAssuntos
Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Artérias Temporais/diagnóstico por imagem , Artérias Temporais/cirurgia , Adulto , Procedimentos Cirúrgicos Ambulatórios , Anestesia Local , Erros de Diagnóstico , Cisto Epidérmico/diagnóstico , Traumatismos Cranianos Fechados/complicações , Humanos , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler DuplaRESUMO
Acupuncture is a major treatment modality used in Oriental medicine to control chronic pain. However, several complications have been reported, including spinal cord injury, pneumothorax, and subcutaneous pseudoaneurysm, according to the puncture sites. We report the case of a pseudoaneurysm of the abdominal aorta caused by acupuncture.
Assuntos
Terapia por Acupuntura/efeitos adversos , Falso Aneurisma/etiologia , Aneurisma da Aorta Abdominal/etiologia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Acupuncture is an ancient Chinese treatment that has proved effective in relieving pain of various origins. Pseudoaneurysm resulting from acupuncture is an extremely rare event. Only 4 patients treated surgically for such a condition have previously been reported in the world medical literature. We present the case of a patient who had a pseudoaneurysm of the popliteal artery that resulted from acupuncture therapy for osteoarthritis of the knee. The patient was successfully treated by direct repair of the pseudoaneurysm.
Assuntos
Terapia por Acupuntura/efeitos adversos , Falso Aneurisma/etiologia , Artéria Poplítea/lesões , Falso Aneurisma/cirurgia , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Abscesso/etiologia , Terapia por Acupuntura/efeitos adversos , Falso Aneurisma/etiologia , Aneurisma Infectado/etiologia , Aneurisma da Aorta Abdominal/etiologia , Abscesso/diagnóstico , Abscesso/cirurgia , Terapia por Acupuntura/métodos , Idoso , Falso Aneurisma/diagnóstico , Falso Aneurisma/cirurgia , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular , Terapia Combinada , Preparações de Ação Retardada , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
Two young men presented with symptoms following lower extremity injuries sustained in the normal course of participation in sports. One played baseball while the other competed in Tae Kwon Do. One case presented with digital ischemia, the other developed a pulsating hematoma. Each came to angiography, and each proved to have a false aneurysm of a tibial artery. The tibial artery was ligated in each case, without further complications. The patient with digital ischemia was thought to have sustained microemboli, and also underwent lumbar sympathectomy.
Assuntos
Falso Aneurisma/etiologia , Traumatismos em Atletas , Traumatismos da Perna/complicações , Artérias da Tíbia/lesões , Ferimentos não Penetrantes/complicações , Adolescente , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/cirurgia , Beisebol/lesões , Humanos , Masculino , Artes Marciais/lesões , Radiografia , Artérias da Tíbia/diagnóstico por imagem , Artérias da Tíbia/cirurgiaRESUMO
BACKGROUND: Control of hemorrhage in patients with active bleeding from rupture of the aortic arch is difficult, because of the location of the bleeding and the impossibility of cross-clamping the aorta without interfering with cerebral perfusion. A precise and swift plan of management helped us salvage some patients and prompted us to review our experience. METHODS: Six patients with active bleeding of the aortic arch in the mediastinum and pericardial cavity (5 patients) or left pleural cavity (1 patient), treated between 1992 and 1996, were reviewed. Bleeding was reduced by keeping the mediastinum under local tension (3 patients) or by applying compression on the bleeding site (2 patients), or both (1 patient) while circulatory support, retransfusion of aspirated blood, and hypothermia were established. The diseased aortic arch was replaced during deep hypothermic circulatory arrest, which ranged from 25 to 40 minutes. In 3 patients, the brain was further protected by retrograde (2 patients) or antegrade (1 patient) cerebral perfusion. RESULTS: Hemorrhage from the aortic arch was controlled in all patients. Two patients died postoperatively, one of respiratory failure and the other of abdominal sepsis. Recovery of neurologic function was assessed and complete in all patients. The 4 survivors are well 8 to 49 months after operation. CONCLUSIONS: An approach relying on local tamponade to reduce bleeding, rapid establishment of circulatory support and hypothermia, retransfusion of aspirated blood, and swift repair of the aortic arch under circulatory arrest allows salvage of patients with active bleeding from an aortic arch rupture.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Hemorragia/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/cirurgia , Falso Aneurisma/cirurgia , Circulação Assistida , Transfusão de Sangue Autóloga , Ponte Cardiopulmonar , Causas de Morte , Circulação Cerebrovascular , Seguimentos , Parada Cardíaca Induzida , Hemorragia/cirurgia , Hemotórax/prevenção & controle , Hemotórax/cirurgia , Humanos , Hipotermia Induzida , Masculino , Mediastino , Pessoa de Meia-Idade , Exame Neurológico , Derrame Pericárdico/prevenção & controle , Derrame Pericárdico/cirurgia , Derrame Pleural/prevenção & controle , Derrame Pleural/cirurgia , Pressão , Insuficiência Respiratória/etiologia , Estudos Retrospectivos , Sepse/etiologia , Taxa de Sobrevida , Fatores de TempoRESUMO
We report an unusual case of a popliteal aneurysm complicating a distal femoral osteochondroma caused by the repeated massages of a traditional medicine practitioner (sinseh). Management was by excision of the exostosis and reconstruction of the damaged arterial segment by a reversed long saphenous vein graft. We advice against massage over an osteochondroma on the distal medial aspect of the femur and suggest prophylactic removal of such lesions because of this potential complication.