RESUMEN
Here we describe a combination of neodymium:yttrium-aluminium-garnet 1064-nm laser emission and injection of 75% dextrose solution to treat lower limb reticular veins. The strategy is known as cryo-laser cryo-sclerotherapy. Preliminary outcomes are reported, showing ecchymosis in up to 30% of cases and intravenous thrombus in 14%. A satisfactory vessel elimination is found in 86% of cases. No improvement or worsening was reported in 14% of patients. The paper provides technical details with the aim of promoting homogeneity in future data collection, so fostering publication of long-term effectiveness and related comparative evaluation with sclerotherapy and laser treatment alone.
Asunto(s)
Criocirugía , Terapia por Láser , Extremidad Inferior/irrigación sanguínea , Escleroterapia , Telangiectasia/cirugía , Venas/cirugía , Criocirugía/efectos adversos , Criocirugía/instrumentación , Estética , Humanos , Terapia por Láser/efectos adversos , Terapia por Láser/instrumentación , Láseres de Estado Sólido/uso terapéutico , Satisfacción del Paciente , Escleroterapia/efectos adversos , Telangiectasia/diagnóstico , Resultado del TratamientoRESUMEN
OBJECTIVE: The objective of this study was to evaluate the feasibility and safety of a polyglycolic acid (PGA) yarn implant for nonthermal ablation of saphenous vein reflux. METHODS: In two consecutive cohort studies (TAHOE I and TAHOE II), the feasibility of abolition of great saphenous vein (GSV) reflux by implantation of a PGA yarn was tested under ultrasound guidance in 51 and 30 patients, respectively. The use of tumescent local anesthesia was not required. Graduated compression stockings and thrombosis prophylaxis with low-molecular-weight heparin were used for 2 weeks after intervention in the first study only. RESULTS: Of 81 enrolled patients, 77 (95%) were available at 6-month follow-up. Complete occlusion of the treated GSV was confirmed by duplex ultrasound in all patients except one patient at day 1. In TAHOE II, closure was preserved in a higher percentage of patients at 6 weeks, with 96.4% vs 82.0% in TAHOE I. The 6-month Kaplan-Meier estimated occlusion rates for TAHOE I and TAHOE II were 68% (95% confidence interval [CI], 54%-79%) and 69% (95% CI, 49%-82%), respectively, with an estimated combined occlusion rate of 69% (95% CI, 57%-76%). Kaplan-Meier analysis yielded a combined reflux-free rate of 85% (95% CI, 75%-91%) at 3 months of follow-up and a rate of 81% (95% CI, 71%-88%) at 6 months of follow-up. Venous Clinical Severity Score (VCSS) improved from a combined mean of 4.6 ± 3.1 at baseline to 2.1 ± 2.2 and 1.6 ± 1.9 at 3 and 6 months, respectively (P < .0001 for 3- and 6-month results). In TAHOE II, four patients with venous ulcers healed at an average of 1.3 months after treatment. CONCLUSIONS: First-in-human use of an endovenous PGA yarn implant for occlusion of refluxing GSVs proved to be feasible, with no serious adverse events. However, recanalization was observed during a period of 6 months in 31% of patients.
Asunto(s)
Implantes Absorbibles , Materiales Biocompatibles , Procedimientos Endovasculares/instrumentación , Ácido Poliglicólico/administración & dosificación , Vena Safena/fisiopatología , Úlcera Varicosa/terapia , Insuficiencia Venosa/terapia , Adulto , Anciano , República Dominicana , Procedimientos Endovasculares/efectos adversos , Europa (Continente) , Estudios de Factibilidad , Femenino , Fibrinolíticos/administración & dosificación , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Ácido Poliglicólico/efectos adversos , Estudios Retrospectivos , Vena Safena/diagnóstico por imagen , Medias de Compresión , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler Dúplex , Ultrasonografía Intervencional , Úlcera Varicosa/diagnóstico por imagen , Úlcera Varicosa/fisiopatología , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/fisiopatología , Cicatrización de HeridasRESUMEN
Molecular characterisation of vulnerable atherosclerosis is necessary for targeting functional imaging and plaque-stabilising therapeutics. Inflammation has been linked to atherogenesis and the development of high-risk plaques. We set to quantify cytokine, chemokine and matrix metalloproteinase (MMP) protein production in cells derived from carotid plaques to map the inflammatory milieu responsible for instability. Carotid endarterectomies from carefully characterised symptomatic (n=35) and asymptomatic (n=32) patients were enzymatically dissociated producing mixed cell type atheroma cell suspensions which were cultured for 24 hours. Supernatants were interrogated for 45 analytes using the Luminex 100 platform. Twenty-nine of the 45 analytes were reproducibly detectable in the majority of donors. The in vitro production of a specific network of mediators was found to be significantly higher in symptomatic than asymptomatic plaques, including: tumour necrosis factor α, interleukin (IL) 1ß, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), macrophage colony-stimulating factor (M-CSF), CCL5, CCL20, CXCL9, matrix metalloproteinase (MMP)-3 and MMP-9. Ingenuity pathway analysis of differentially expressed analytes between symptomatic and asymptomatic patients identified a number of key biological pathways (p< 10(-25)). In conclusion, the carotid artery plaque culprit of ischaemic neurological symptoms is characterised by an inflammatory milieu favouring inflammatory cell recruitment and pro-inflammatory macrophage polarisation.
Asunto(s)
Enfermedades de las Arterias Carótidas/metabolismo , Mediadores de Inflamación/metabolismo , Macrófagos/metabolismo , Anciano , Enfermedades de las Arterias Carótidas/inmunología , Enfermedades de las Arterias Carótidas/cirugía , Estenosis Carotídea/inmunología , Estenosis Carotídea/metabolismo , Estenosis Carotídea/cirugía , Quimiocinas/metabolismo , Factores Estimulantes de Colonias/metabolismo , Citocinas/metabolismo , Endarterectomía Carotidea , Femenino , Humanos , Macrófagos/inmunología , Masculino , Metaloproteinasas de la Matriz/metabolismo , Persona de Mediana Edad , Análisis por Matrices de Proteínas , Inhibidores Tisulares de Metaloproteinasas/metabolismoRESUMEN
OBJECTIVE: A randomized clinical trial assessing the difference in quality of life and clinical outcomes between delayed and simultaneous phlebectomies in the context of endovenous truncal vein ablation. BACKGROUND: Endovenous ablation has replaced open surgery as the treatment of choice for truncal varicose veins. Timing of varicosity treatment is controversial with delayed and simultaneous pathways having studies advocating their benefits. A previous small randomized study has shown improved outcomes for simultaneous treatment. METHODS: Patients undergoing local anesthetic endovenous thermal ablation were randomized to either simultaneous phlebectomy or delayed varicosity treatment. Patients were reviewed at 6 weeks, 6 months, and 1 year with clinical and quality of life scores completed, and were assessed at 6 weeks for need for further varicosity intervention, which was completed with either ultrasound-guided foam sclerotherapy or local anesthetic phlebectomy. Duplex ultrasound assessment of the treated trunk was completed at 6 months. RESULTS: 101 patients were successfully recruited and treated out of 221 suitable patients from a screened population of 393. Patients in the simultaneous group (n = 51) showed a significantly improved Venous Clinical Severity Score at all time points, 36% of the delayed group required further treatment compared with 2% of the simultaneous group (P < 0.001). There were no deep vein thromboses, with 1 superfificial venous thrombosis in each group. CONCLUSIONS: Combined endovenous ablation and phlebectomy delivers improved clinical outcomes and a reduced need for further procedures, as well as early quality of life improvements.
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Procedimientos Quirúrgicos Ambulatorios/métodos , Ablación por Catéter/métodos , Procedimientos Endovasculares/métodos , Calidad de Vida , Várices/psicología , Várices/terapia , Femenino , Estudios de Seguimiento , Humanos , Terapia por Láser/métodos , Masculino , Persona de Mediana Edad , Escleroterapia/métodos , Encuestas y Cuestionarios , Resultado del Tratamiento , Ultrasonografía , Várices/diagnóstico por imagenRESUMEN
OBJECTIVES: Superficial venous thrombosis is common and traditionally considered a benign condition requiring only symptomatic treatment. Recent evidence, however, advocates more aggressive management. Extensive guidance is available but actual practice is unknown. This study aimed to assess the management of superficial venous thrombosis by general practitioners (primary care physicians) and vascular surgeons. METHODS: A 19-question validated electronic survey was created and circulated by e-mail to general practitioners and vascular surgeons in the United Kingdom. The survey evaluated presentation, investigation and treatment of superficial venous thrombosis. RESULTS: Three hundred sixty-nine surveys were returned from 197 vascular surgeons and 172 general practitioners. Most clinicians saw less than 20 cases a year, with 40% of clinicians not performing any investigations. Venous duplex was the investigation of choice in over 55%. Treatment with anti-inflammatory drugs was widespread, but anticoagulation and compression were seldom prescribed. Follow-up and treatment duration were disparate. DISCUSSION: The management of superficial venous thrombosis varies widely despite good levels of evidence and guidance. Investigation and treatment of superficial venous thrombosis show marked differences both between and within groups. Improvements in education are required to optimise the treatment pathway and advance patient care.
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Atención Primaria de Salud , Atención Secundaria de Salud , Encuestas y Cuestionarios , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/epidemiología , Trombosis de la Vena/terapia , Educación Médica Continua , Inglaterra , Femenino , Humanos , MasculinoRESUMEN
Carotid patch infection following carotid patch angioplasty is a rare but serious complication. Accurate diagnosis is vital yet currently ill-defined. We present the use of computed tomography positron emission tomography and leucocyte radioisotope scintigraphy and highlight their potential role in the diagnosis of equivocal carotid patch infection.
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Angioplastia/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Prótesis Vascular/efectos adversos , Imagen Multimodal/métodos , Tomografía de Emisión de Positrones , Infecciones Relacionadas con Prótesis/diagnóstico , Tomografía Computarizada por Rayos X , Angioplastia/instrumentación , Antibacterianos/uso terapéutico , Implantación de Prótesis Vascular/instrumentación , Endarterectomía Carotidea , Humanos , Leucocitos/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tereftalatos Polietilenos , Valor Predictivo de las Pruebas , Diseño de Prótesis , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Reproducibilidad de los Resultados , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: This study assessed patterns of superficial reflux in patients with primary chronic venous disease. METHODS: Retrospective review of all patient venous duplex ultrasonography reports at one institution between 2000 and 2009. Legs with secondary, deep or no superficial reflux were excluded. RESULTS: In total, 8654 limbs were scanned; 2559 legs from 2053 patients (mean age 52.3 years) were included for analysis. Great saphenous vein reflux predominated (68%), followed by combined great saphenous vein/small saphenous vein reflux (20%) and small saphenous vein reflux (7%). The majority of legs with competent saphenofemoral junction had below-knee great saphenous vein reflux (53%); incompetent saphenofemoral junction was associated with combined above and below-knee great saphenous vein reflux (72%). Isolated small saphenous vein reflux was associated with saphenopopliteal junction incompetence (61%), although the majority of all small saphenous vein reflux limbs had a competent saphenopopliteal junction (57%). CONCLUSION: Superficial venous reflux does not necessarily originate from a saphenous junction. Large prospective studies with interval duplex ultrasonography are required to unravel the natural history of primary chronic venous disease.
Asunto(s)
Pierna/irrigación sanguínea , Vena Safena/diagnóstico por imagen , Insuficiencia Venosa/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Humanos , Pierna/diagnóstico por imagen , Pierna/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Vena Safena/fisiopatología , Ultrasonografía , Insuficiencia Venosa/epidemiología , Insuficiencia Venosa/fisiopatologíaRESUMEN
BACKGROUND: Open repair is the gold standard management for juxtarenal aneurysms. Fenestrated endovascular aneurysm repair (FEVAR) is indicated for high-risk patients. The long-term outcomes of FEVAR are largely unknown, and there is no Level I comparative evidence. This systematic review and meta-analysis of case series compares elective juxtarenal aneurysm surgery by open repair and FEVAR. METHODS: A systematic literature search was conducted for all published studies on elective repair of juxtarenal aneurysms by FEVAR and open repair. The MEDLINE, EMBASE, and Cochrane databases were searched from 1947 to April 2013. The exclusion criteria were case series of <10 patients or ruptured aneurysms. The primary outcomes were perioperative mortality and postoperative renal insufficiency. The secondary outcomes were secondary reinterventions and long-term survival. RESULTS: We identified 35 case series with data on 2326 patients. Perioperative mortality was 4.1% in open repair and FEVAR case series (odds ratio for open repair with FEVAR, 1.059; 95% confidence interval, 0.642-1.747; P = .822). Postoperative renal insufficiency was not significantly different (odds ratio for open repair with FEVAR, 1.136; 95% confidence interval, 0.754-1.713; P = .542). FEVAR patients had higher rates of secondary reintervention, renal impairment during follow-up, and a lower long-term survival compared with open repair patients. CONCLUSIONS: FEVAR and open repair have similar short-term outcomes but have diverging long-term outcomes that may be secondary to the selection bias of FEVAR being offered to high-risk patients. FEVAR is a favorable option in high-risk patients, and open repair remains viable as the gold standard.
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Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/mortalidad , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/mortalidad , Distribución de Chi-Cuadrado , Procedimientos Quirúrgicos Electivos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/mortalidad , Humanos , Estimación de Kaplan-Meier , Oportunidad Relativa , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/cirugía , Diseño de Prótesis , Reoperación , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
We present the first case of retrograde ablation of the small saphenous vein to treat active venous ulceration. A 73-year-old gentleman with complicated varicose veins of the left leg and a non-healing venous ulcer despite previous successful endovenous treatment to his left great saphenous vein underwent mechanochemical ablation of his small saphenous vein with the ClariVein® system, under local anaesthetic, using a retrograde cannulation technique. Post-operatively the patient had improved symptomatically and the ulcer size had reduced. This report highlights that patients with small saphenous vein incompetence and active ulceration can be treated successfully with retrograde mechanochemical ablation.
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Técnicas de Ablación/instrumentación , Pierna/irrigación sanguínea , Vena Safena , Úlcera Varicosa/terapia , Anciano , Vendajes , Cateterismo Periférico , Humanos , Masculino , Soluciones Esclerosantes/uso terapéutico , Tetradecil Sulfato de Sodio/uso terapéutico , Ultrasonografía , Úlcera Varicosa/diagnóstico por imagenRESUMEN
Varicose veins are common and cause extensive morbidity; however, the value of treatment is under-appreciated. Many procedures allow the treatment of varicose veins with minimal cost and extensive literature supporting differing minimally invasive approaches. In this article, we investigate the current literature regarding treatment options, clinical outcome and the cost-benefit economics associated with varicose vein treatment. The practice of defining clinical outcome with quality of life (QOL) assessment is explained to provide valid concepts of treatment success beyond occlusion rates.
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Ablación por Catéter/economía , Ablación por Catéter/métodos , Várices/psicología , Várices/cirugía , Ablación por Catéter/psicología , Análisis Costo-Beneficio , Procedimientos Endovasculares/economía , Humanos , Calidad de Vida , Encuestas y Cuestionarios , Resultado del Tratamiento , Insuficiencia Venosa/fisiopatología , Insuficiencia Venosa/psicologíaRESUMEN
The Sapheon Venaseal Closure System (Sapheon Inc, Santa Rosa, Calif), using cyanoacrylate glue, has provided a new modality of treatment, with patients treated without both tumescent anesthesia and postoperative compression. We present the first case of great saphenous vein occlusion performed using glue while the patient was fully anticoagulated with warfarin. This was tolerated well, and the treated vein showed complete early occlusion at 8 weeks; however at 6 months, extensive recanalization was demonstrated on duplex imaging.
RESUMEN
Smooth muscle cells (SMC) contribute to the development and stability of atherosclerotic lesions. The molecular mechanisms that mediate their properties are incompletely defined. We employed proteomics and in vitro functional assays to identify the unique characteristics of intimal SMC isolated from human carotid endarterectomy specimens and medial SMC from thoracic aortas and carotids. We verified our findings in the Tampere Vascular Study. Human atheroma-derived SMC exhibit decreased expression of mitochondrial proteins ATP Synthase subunit-beta and Aldehyde dehydrogenase 2, and decreased mitochondrial activity when compared to control SMC. Moreover, a comparison between plaque-derived SMC isolated from patients with or without recent acute cerebrovascular symptoms uncovered an increase in Annexin A1, an endogenous anti-inflammatory protein, in the asymptomatic group. The deletion of Annexin A1 or the blockade of its signaling in SMC resulted in increased cytokine production at baseline and after stimulation with the pro-inflammatory cytokine Tumor Necrosis Factor α. In summary, our proteomics and biochemical analysis revealed mitochondrial damage in human plaque-derived SMC as well as a role of Annexin A1 in reducing the production of pro-inflammatory mediators in SMC.
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Anexina A1/metabolismo , Aterosclerosis/patología , Enfermedades de las Arterias Carótidas/metabolismo , Proteínas Mitocondriales/metabolismo , Miocitos del Músculo Liso/metabolismo , Proteoma/metabolismo , Adulto , Aldehído Deshidrogenasa/metabolismo , Aldehído Deshidrogenasa Mitocondrial , Animales , Enfermedades de las Arterias Carótidas/patología , Células Cultivadas , Citocinas/metabolismo , Expresión Génica , Humanos , Ratones , Ratones Noqueados , Mitocondrias Musculares/metabolismo , ATPasas de Translocación de Protón Mitocondriales/metabolismo , Músculo Liso Vascular/patología , Oxidación-Reducción , Peroxirredoxinas/metabolismo , Fenotipo , Análisis de Componente Principal , ProteómicaRESUMEN
Inflammatory abdominal aortic aneurysms (IAAAs) account for 5% to 10% of all abdominal aortic aneurysms, occurring primarily in males. Their true etiology is unknown. Symptoms and signs of IAAA are so variable that they present to a wide range of specialties. There is debate in the literature whether IAAA is a manifestation of systemic autoimmune disease. We describe the case of a young female patient with complicated inflammatory aortoiliac aneurysmal disease, illustrating diagnostic and treatment challenges that remain. Our patient had a positive autoantibody screen, raised erythrocyte sedimentation rate, positive enzyme-linked immunosorbent spot test, and saccular aneurysms, including infective and inflammatory etiologies in her differential diagnosis. Early diagnosis is crucial to limit disease progression, morbidity, and mortality. Medical management is important to address the underlying disease process, but a combination of endovascular and open surgical intervention is often necessary for definitive treatment. Available evidence offers plausibility for benefit of endovascular intervention over open repair.
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Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/terapia , Aortitis/diagnóstico , Aortitis/terapia , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/terapia , Aneurisma Ilíaco/diagnóstico , Aneurisma Ilíaco/terapia , Adulto , Antiinflamatorios/uso terapéutico , Aneurisma de la Aorta Abdominal/sangre , Aneurisma de la Aorta Abdominal/complicaciones , Aortitis/sangre , Aortitis/complicaciones , Aortografía/métodos , Autoanticuerpos/sangre , Enfermedades Autoinmunes/sangre , Enfermedades Autoinmunes/complicaciones , Biomarcadores/sangre , Sedimentación Sanguínea , Implantación de Prótesis Vascular , Embolización Terapéutica , Ensayo de Immunospot Ligado a Enzimas , Femenino , Humanos , Aneurisma Ilíaco/sangre , Aneurisma Ilíaco/complicaciones , Inmunosupresores/uso terapéutico , Valor Predictivo de las Pruebas , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Three cases of blunt trauma to the anterior tibial artery in professional footballers are described. Each case was managed conservatively, allowing the players to promptly return to competitive fixtures. We hope the outcomes of the cases described might be helpful for teams facing the challenge of managing similar injuries.
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Fútbol/lesiones , Arterias Tibiales/lesiones , Lesiones del Sistema Vascular/etiología , Heridas no Penetrantes/etiología , Adulto , Humanos , Masculino , Recuperación de la Función , Factores de Tiempo , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico , Lesiones del Sistema Vascular/fisiopatología , Lesiones del Sistema Vascular/terapia , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/fisiopatología , Heridas no Penetrantes/terapia , Adulto JovenAsunto(s)
Fístula Cutánea/cirugía , Úlcera de la Pierna/cirugía , Suturas , Humanos , Linfedema/cirugíaRESUMEN
INTRODUCTION: No studies as yet have directly evaluated the patients' perspective of carotid endarterectomy (CEA). Here, we determine patient satisfaction, understanding, and perception of CEA. METHODS: Consecutive patients were identified from a prospectively maintained carotid database. A validated 10-point telephone questionnaire was conducted. Questions related to preoperative symptoms, experience of procedure, future interventions, and overall patient satisfaction. RESULTS: Of the 192 patients included, 136 completed the questionnaire (71% response rate). Ninety-two percent were satisfied with the explanation received, however, only 48% understood that CEA aimed to prevent future stroke. Eighty-five percent of patients received local anesthesia (LA) CEA, with 16% reporting severe or unbearable pain. Most patients (83%) would repeat CEA if necessary and 67% stated a future preference for LA CEA. The majority of patients (96%) were satisfied with their treatment overall. CONCLUSIONS: Most patients were satisfied with CEA. Greater emphasis could be placed on improving preoperative information-giving and intraoperative analgesia.
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Estenosis Carotídea/cirugía , Endarterectomía Carotidea , Conocimientos, Actitudes y Práctica en Salud , Educación del Paciente como Asunto , Satisfacción del Paciente , Pacientes/psicología , Analgesia , Anestesia Local , Estenosis Carotídea/complicaciones , Comprensión , Endarterectomía Carotidea/efectos adversos , Endarterectomía Carotidea/psicología , Humanos , Consentimiento Informado , Cuidados Intraoperatorios , Londres , Dimensión del Dolor , Dolor Postoperatorio/etiología , Percepción , Calidad de la Atención de Salud , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
OBJECTIVE: Free-floating thrombus (FFT) of the carotid artery is a rare condition of currently unknown etiology. Less than 150 cases have been described in the published world literature to date. DESIGN AND SETTING: We present 6 consecutive cases of carotid FFT, identified prospectively from 5000 carotid duplex scans over a 34-month period in a single tertiary center for vascular surgery. RESULTS: All 6 cases involved the left carotid bifurcation in neurologically symptomatic individuals. In 5 of the 6 cases, FFT occurred in the absence of a significantly stenosing atheromatous plaque and was not associated with an elevation in velocity on duplex. The patients were all treated with surgical thromboendarterectomy, with good result. CONCLUSIONS: Duplex imaging can underestimate the degree of stenosis. Free-floating thrombus presents a challenge in diagnosis due to its rapidly evolving nature. The management of FFT by acute thromboendarterectomy appears to be safe and effective in limiting further focal neurological sequelae.
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Trombosis de las Arterias Carótidas/diagnóstico por imagen , Trombosis de las Arterias Carótidas/cirugía , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/cirugía , Endarterectomía Carotidea , Ultrasonografía Doppler Dúplex , Adulto , Anciano , Trombosis de las Arterias Carótidas/complicaciones , Estenosis Carotídea/complicaciones , Angiografía Cerebral/métodos , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Infarto de la Arteria Cerebral Media/etiología , Infarto de la Arteria Cerebral Media/patología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía Doppler en Color , Adulto JovenRESUMEN
The treatment of internal iliac artery aneurysms is aimed at the prevention of rupture. Traditionally, this is undertaken surgically; however, endovascular techniques are an acceptable alternative and these techniques are also not without complication. Herein, the authors describe the endovascular treatment of two patients with internal iliac aneurysms. Although the treatments were initially successful, both patients presented with ureteric obstruction and hydronephrosis 2 months later.