RESUMO
The perfusion territory of the external carotid artery is often underestimated; however, this blood vessel forms abundant "dangerous anastomoses" with the internal carotid and vertebral arteries. An understanding of these vascular anastomoses is crucial to ensure safe cerebrovascular interventions. There are several important aspects of the middle meningeal artery that should be considered, including anastomoses with the anterior(frontal)branch and ophthalmic artery through the sphenoidal artery(recurrent meningeal artery)and meningolacrimal artery. Additionally, the blood supply to the facial nerve via branches of the petrosal branch, such as the superior tympanic artery, and the formation of the facial arcade by the superior tympanic and stylomastoid arteries, which often originate from the posterior auricular artery, is significant. The occipital artery demonstrates rich anastomoses with vessels, such as the ascending pharyngeal and vertebral arteries, forming what is known as the pharyngo-occipital system.
Assuntos
Artéria Carótida Externa , Artérias Meníngeas , Humanos , Artérias Meníngeas/cirurgia , Artéria Carótida Externa/cirurgia , Procedimentos Endovasculares/métodosRESUMO
The ascending pharyngeal, accessory meningeal, and lingual arteries branch from the proximal segment of the external carotid artery. These branches give rise to smaller branches that contribute blood supply to the pharyngeal mucosa, parapharyngeal tissue, middle ear, submandibular tissues, tongue, and dura mater of the middle and posterior fossa. These arteries may also supply the cranial nerves and have potential anastomotic channels that function with the internal carotid and vertebral arteries. M igration of embolic material into the vasa nervorum and potential anastomoses may cause complications. Therefore, knowledge of these functional anatomies is crucial for neuro-interventionalists.
Assuntos
Artérias Meníngeas , Humanos , Artérias Meníngeas/cirurgia , Artérias Meníngeas/diagnóstico por imagem , Faringe/irrigação sanguínea , Faringe/cirurgia , Língua/irrigação sanguínea , Língua/cirurgia , Artéria Carótida Externa/cirurgiaRESUMO
BACKGROUND: The external carotid artery (ECA) is a major artery of the head and neck. Although numerous studies describe the variability of ECA branches, the course variation of the ECA was seemingly overlooked. It was aimed to study the morphological possibilities of the retromandibular segment of the ECA. METHOD: A retrospective study was performed on 60 computed tomography angiograms of 26 male and 31 female adult patients. Three types of retromandibular ECA were defined: type 1 - the ECA has a straight course deep to the anatomical plane of the ramus of the mandible; type 2 - the ECA makes a retromandibular loop directed laterally, extending externally to the anatomical plane of the ramus of the mandible; and type 3 - the retromandibular loop directed laterally reaches just behind the posterior margin of the ramus of the mandible. RESULTS: Type 1 was found in just 43.33%, type 2 in 18.33%, and type 3 in 38.33% of 120 sides cases. On the right, type 1 was significantly associated with the male gender, and type 3 with the female gender (Pearson Chi2=10.9, p=0.004). On the left, there were no statistically significant associations (Pearson Chi2=3.5, p=0.153). In 20 cases, the retromandibular course of the ECA was asymmetrical; in 21 cases, type 1 was recorded bilaterally; in 5 cases, type 2 was bilaterally symmetrical; and in 14 cases, type 3 was found bilaterally. CONCLUSION: These previously undocumented types of ECA are relevant during parotid surgery and should be investigated preoperatively on a case-by-case basis.
Assuntos
Artéria Carótida Externa , Pescoço , Adulto , Humanos , Masculino , Feminino , Artéria Carótida Externa/diagnóstico por imagem , Artéria Carótida Externa/anatomia & histologia , Artéria Carótida Externa/cirurgia , Estudos Retrospectivos , Glândula Parótida , CabeçaRESUMO
BACKGROUND: Fragmentation, disconnection, or entrapment of an in-use microcatheter during neuro-endovascular procedures is a known risk. Often a benign entity, retained catheters are not infrequently observed, but severe complications including thrombus, thromboembolic events, pseudoaneurysm, and limb ischemia have been described, necessitating retrieval. This technical case report demonstrates the safe use of an external carotid artery (ECA) approach for ligation and removal of a retained microcatheter after middle meningeal artery (MMA) embolization. This article also demonstrates the use of live intraoperative fluoroscopy as a surgical adjunct to ensure that the catheter is fully removed without any injury, shearing, or breakage during removal. METHODS: A 66-year-old male patient presented with bilateral subdural hematomas to an outside hospital. He subsequently underwent evacuation of the hematomas followed by a right-sided MMA embolization, complicated by Onyx (Medtronic, Minneapolis, MN) entrapment of the microcatheter in the MMA. The patient was asymptomatic, but there was significant concern about continuing antiplatelet/anticoagulation therapy in the presence of the subdural hematoma. We proceeded with an open surgical approach for catheter retrieval. As the catheter was withdrawn, intraoperative fluoroscopy demonstrated complete removal without any retained fragments. RESULTS: The patient recovered without event and was discharged on postoperative day 1. On follow-up the patient continued to do well without any complications from the fragment that remained in the external carotid circulation. CONCLUSIONS: This case and accompanying video demonstrates the effective use of open ECA surgical approach to retrieve the retained microcatheter after an MMA embolization. This approach allowed for safe and effective removal of the microcatheter while significantly reducing complication risks.
Assuntos
Artéria Carótida Externa , Embolização Terapêutica , Artérias Meníngeas , Humanos , Masculino , Idoso , Fluoroscopia , Embolização Terapêutica/métodos , Artérias Meníngeas/cirurgia , Artérias Meníngeas/diagnóstico por imagem , Artéria Carótida Externa/cirurgia , Catéteres , Microcirurgia/métodos , Remoção de Dispositivo/métodos , Hematoma Subdural/cirurgia , Hematoma Subdural/etiologiaRESUMO
We report the first case of a juvenile nasal angiofibroma (JNA) fed by multiple arteries from the internal carotid artery (ICA), removed without complications by temporarily blocking the ICA with two balloons. An early adolescent with JNA underwent preoperative embolisation of feeding arteries arising from the external carotid artery (ECA) (University of Pittsburgh Medical Centre classification IV). Endoscopic resection was attempted once but discontinued due to massive bleeding (7000 mL). 17 months later, the JNA had grown to fill both nasal cavities. Repeated preoperative embolisation of the feeders from the ECA was performed, followed by surgery combined with endoscopic and external incision. Intraoperatively, two balloons were inserted into the right ICA, which were inflated at the proximal and distal sites of the feeder vessels to cut-off blood flow to the tumour. The tumour was almost completely resected with 6270 mL of blood loss and no postoperative neurological deterioration.
Assuntos
Angiofibroma , Oclusão com Balão , Embolização Terapêutica , Neoplasias de Cabeça e Pescoço , Neoplasias Nasofaríngeas , Adolescente , Humanos , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Angiofibroma/complicações , Resultado do Tratamento , Neoplasias Nasofaríngeas/complicações , Neoplasias de Cabeça e Pescoço/complicações , Artéria Carótida Externa/cirurgiaRESUMO
BACKGROUND: The aim of this study was to clarify when and from which blood vessels indirect revascularization develops after combined revascularization surgery for moyamoya disease and how the donor vessels that undergo direct revascularization change in the medium to long term. In particular, we focused on the middle temporal artery (MTA), which has not received much attention in indirect revascularization surgery for moyamoya disease until now. METHODS: We targeted 20 sides that were suitable for evaluating the diameter of the external carotid artery system involved in combined revascularization surgery among moyamoya disease patients who underwent a composite revascularization procedure utilizing a 'U'-shaped skin incision encircling the parietal branch of the superficial temporal artery (STA) at our institution from 2018 to 2023. We identified the STA parietal branch, MMA, DTA, and MTA in the TOF source MR images acquired preoperatively and three and six months after surgery; measured the long and short diameters of each blood vessel; approximated the blood vessel shape as an ellipse, and calculated its cross-sectional area. RESULTS: The cross-sectional areas of the MMA, DTA, and MTA involved in indirect revascularization significantly increased compared to presurgery three months after surgery, and this trend continued six months after surgery, but no significant change was observed between three and six months after surgery. There were no cases in which the MTA was clearly confirmed before surgery in the TOF reconstructed images, but the MTA was clearly confirmed in 55% (11/20 cases) of hemispheres three months after surgery and in 85% (17/20 cases) of hemispheres six months after surgery. The crosssectional area of the STA parietal branch, which was the donor for direct revascularization, had increased by more than 150% compared to before surgery in 55% (11/20 cases) of hemispheres three months after surgery. CONCLUSIONS: Indirect revascularization can be expected three months after combined revascularization surgery for moyamoya disease. The MTA, which has not received much attention in terms of indirect revascularization for moyamoya disease patients thus far, was found to be a useful blood flow source for indirect revascularization in combined revascularization surgery for patients with moyamoya disease. Whether or not the cross-sectional area of the superficial temporal artery used as a donor for direct revascularization increased in the medium to long term varied on a case-by-case basis.
Assuntos
Artéria Carótida Externa , Revascularização Cerebral , Doença de Moyamoya , Artérias Temporais , Humanos , Doença de Moyamoya/cirurgia , Doença de Moyamoya/diagnóstico por imagem , Revascularização Cerebral/métodos , Artérias Temporais/cirurgia , Artérias Temporais/diagnóstico por imagem , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Artéria Carótida Externa/cirurgia , Artéria Carótida Externa/diagnóstico por imagem , Adulto Jovem , Adolescente , Criança , Estudos RetrospectivosRESUMO
OBJECTIVE: The objective of this retrospective study was to establish a novel system for evaluating collateralization of the external carotid artery in patients with moyamoya disease (MMD) following direct and indirect revascularization surgeries. METHODS: The authors conducted a retrospective analysis of 456 patients diagnosed with MMD who underwent direct and indirect revascularization procedures at Beijing Tiantan Hospital, Capital Medical University, between January 2015 and May 2023. Using a newly proposed digital subtraction angiography (DSA)-based evaluation system, the authors assessed collateralization angiogenesis objectively and in a standardized manner. RESULTS: The authors' findings indicated that there was no significant difference in collateralization angiogenesis between patients undergoing direct or indirect cerebral revascularization (p = 0.702). However, after cerebral revascularization, patients with ischemic MMD exhibited significantly higher collateralization angiogenesis compared with those with hemorrhagic MMD (p = 0.007). Children with MMD demonstrated higher angiogenesis levels than adults (p < 0.001), but subgroup analysis showed age-specific variations. In adults, collateralization angiogenesis was significantly greater in those with ischemic MMD (p = 0.006), whereas in children, no significant difference was noted between ischemic and hemorrhagic MMD (p = 0.962). Furthermore, regardless of MMD type, direct and indirect revascularization methods yielded similar collateralization angiogenesis (p = 0.962 and p = 0.963, respectively). Importantly, the Matsushima grading system revealed significant differences in angiogenesis in patients with ischemic MMD (p < 0.001). CONCLUSIONS: The newly introduced DSA-based evaluation system offers an objective and standardized method for assessing collateralization angiogenesis in MMD. This study supports the efficacy of both direct and indirect revascularization surgical procedures and highlights distinct pathophysiological processes of ischemic and hemorrhagic disease subtypes. These findings contribute to a better understanding of surgical outcomes and aid in the selection of appropriate treatment strategies for patients with MMD.
Assuntos
Angiografia Digital , Artéria Carótida Externa , Revascularização Cerebral , Circulação Colateral , Doença de Moyamoya , Humanos , Doença de Moyamoya/cirurgia , Doença de Moyamoya/diagnóstico por imagem , Revascularização Cerebral/métodos , Masculino , Feminino , Estudos Retrospectivos , Adulto , Criança , Circulação Colateral/fisiologia , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Artéria Carótida Externa/cirurgia , Artéria Carótida Externa/diagnóstico por imagem , Pré-Escolar , Resultado do Tratamento , Neovascularização FisiológicaRESUMO
The major arterial supply to the thyroid gland is from the superior and inferior thyroid arteries, arising from the external carotid artery and the thyrocervical trunk respectively. The external laryngeal nerve runs in close proximity to the origin of the superior thyroid artery in relation to the thyroid gland. The superior thyroid artery is clinically important in head and neck surgeries. Objectives: To locate the origin of the superior thyroid artery, because wide variability is reported. To provide knowledge of possible variations in its origin, because it is important for surgical procedures in the neck. Methods: The origin of the superior thyroid artery was studied by dissecting sixty adult human hemineck specimens from donated cadavers in a Department of Anatomy. Results: The highest incidence observed was origin of the superior thyroid artery from the external carotid artery (88.33%), whereas origin from the common carotid bifurcation only occurred in 8.33%. However, in 3.33% of cases, the superior thyroid artery originated from the common carotid artery and in a single case, the external laryngeal nerve did not cross the stem of the superior thyroid artery at all, but ran ventral and parallel to the artery. Conclusions: It is important to rule out anomalous origin of superior thyroid artery and verify its relationship to the external laryngeal nerve prior to ligation of the artery in thyroid surgeries, in order to prevent iatrogenic injuries. Moreover, because anomalous origins of the superior thyroid artery are only anatomic variants, thorough knowledge of these is decisive for head and neck surgeries
O suprimento arterial principal para a glândula tireoide provém das artérias tireoideas superior e inferior, que têm origem na artéria carótida externa e no tronco tireocervical, respectivamente. O nervo laríngeo externo faz um percurso bem próximo à origem da artéria tireoidea superior em relação à glândula tireoide. A artéria tireoidea superior é clinicamente importante em cirurgias da cabeça e do pescoço. Objetivos: Localizar a origem da artéria tireoidea superior, considerando a ampla variabilidade descrita na literatura; e oferecer informações sobre possíveis variações em sua origem, devido à importância disso para procedimentos cirúrgicos realizados no pescoço. Métodos: A origem da artéria tireoidea superior foi estudada dissecando-se 60 espécimes de hemipescoço adulto de cadáveres humanos doados ao Departamento de Anatomia. Resultados: A maior incidência observada foi da artéria tireoidea superior com origem na artéria carótida externa (88,33%), enquanto a origem na bifurcação da artéria carótida comum ocorreu em apenas 8,33%. No entanto, em 3,33% dos casos, a artéria tireoidea superior teve origem na artéria carótida comum, e em um único caso, o nervo laríngeo externo não cruzou o tronco da artéria tireoidea superior em nenhum momento, embora tenha cursado ventral e paralelamente a essa artéria. Conclusões: É importante descartar origem anômala da artéria tireoidea superior e confirmar sua relação com o nervo laríngeo externo antes da ligadura da artéria em cirurgias da tireoide, para evitar efeitos iatrogênicos. Além disso, como origens anômalas da artéria tireoidea superior são apenas variantes anatômicas, o conhecimento detalhado dessas variações é decisivo para cirurgias da cabeça e do pescoço
Assuntos
Humanos , Masculino , Feminino , Glândula Tireoide/anatomia & histologia , Artéria Carótida Externa/anatomia & histologia , Artéria Carótida Externa/cirurgia , Variação Anatômica , Nervos Laríngeos/anatomia & histologia , Laringe/anatomia & histologia , Pescoço/cirurgiaRESUMO
The von Willebrand disease (vWD) is a hereditary coagulopathy. There is no gender predilection. Clinically characterized by mucocutaneous bleeding, especially nose bleeding, menorrhagia and bleeding after trauma. This article reports a case of a 52-year-old Caucasian male patient with vWD, who presented with extensive bleeding in the tongue after a lacerating injury caused by accidental biting, and describes some clinical, pathological and treatment aspects of vWD. After repeated attempts to suture the wound and replace clotting factors, a decision was made to perform the ligature of the external carotid artery ipsilateral to the injury. There was favorable resolution of the case, with a good aspect of the scar 2 months after ligation. This case reinforces that it is extremely important to make a thorough review of medical history of all patients, searching for possible bleeding disorders or previous family history.
A doença de von Willebrand (DvW) é uma coagulopatia hereditária. Não há predileção por sexo. Clinicamente caracteriza-se por hemorragias mucocutâneas, sobretudo nasais, menorragias e hemorragias pós-trauma. Este artigo relata um caso clínico de DvW em paciente de 52 anos de idade, leucoderma, do sexo masculino, que apresentou extensa hemorragia em bordo lateral de língua após ferimento lacerante, além de descrever alguns aspectos clínicos, patológicos e terapêuticos da DvW. Após repetidas tentativas de sutura do ferimento e reposição dos fatores de coagulação, optou-se pela ligadura da artéria carótida externa ipsilateral ao ferimento, com resolução favorável do caso, notando-se bom aspecto cicatricial 2 meses após a ligadura. Este caso reforça que é de extrema importância a realização de anamnese criteriosa, buscando-se identificar possíveis distúrbios hemorrágicos prévios ou antecedentes familiares.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Artéria Carótida Externa/cirurgia , Técnicas Hemostáticas , Doenças de von Willebrand/cirurgia , Fator IX/uso terapêutico , Fator VIII/uso terapêutico , Fibrinogênio/uso terapêutico , Ligadura , Lacerações/complicações , Hemorragia Bucal/etiologia , Hemorragia Bucal/cirurgia , Técnicas de Sutura , Língua/lesões , Fator de von Willebrand/uso terapêuticoRESUMO
El objetivo del trabajo es exponer nuestra experiencia en el tratamiento quirúrgico de una fístula arteriovenosa del labio inferior de una paciente de 15 años de edad, producida por una mordida. La paciente fue diagnosticada en su inicio como un Hemangioma traumático, el cual fue tratado con esteroide y exeresis quirúrgica. A los 4 años apareció con una tumoración más voluminosa, se realizó disección de la carótida externa y arteriografía carotídea la cual diagnosticó fístula arteriovenosa, se realizó ligadura de la facial y de los vasos venosos, para aislarla de la circulación. Se inyectaron 4 cc de betametazona en la tumoración, posteriormente se inyectaron 4 inyecciones adicionales con intervalos e 3 semanas, a los tres meses de la ligadura de los vasos sé realizó la exéresis de la fibrosis de la tumoración. En estos momentos la paciente tiene 5 años de la última intervención, no presentando recidiva. Se destaca la importancia del estudio angiográfico para él diagnóstico y tratamiento de esta entidad patológica, que es poco frecuente.
The objetive of this paper is to expose our experience in the surgical treatment of an arteriovenous fistulae of the lower lip in 15 years- old patien, caused for humanbite. The patient was first diagnosed as traumatic hemangioma, treated with steroids and surgical removal. Four years later a voluminous tumor appeared, a dissection of the external carotid and a carotid angiography was performed and an arteriovenous fistulae was diagnosed. A ligament of the facial and venous vasseles was performed to isolete them from circulation. 4cc of Betametaza were inyected inside of tumors, and later 4 additional doses with 3 week of interval. Three months after the ligament a surgical removal of the fibrous tumor was done. At present, after 5 years of the last operation, the patient is getting well, with no recidive. The importance of the angiography study has been put into evidence, to diagnose and treat this athology, which is not so common.
Assuntos
Humanos , Feminino , Fístula Arteriovenosa/cirurgia , Fístula Arteriovenosa/patologia , Hemangioma/cirurgia , Artéria Carótida Externa/cirurgia , Procedimentos Cirúrgicos Bucais/métodosRESUMO
OBJECTIVE: To evaluate the accuracy of subjective visual impression (SVI) of an experienced neuro-radiologist in the measurement of the degree of internal carotid artery (IC) stenosis evaluated by digital angiography (DGA). METHOD: Ten symptomatic patients with internal carotid stenosis greater than 70 percent in a previous duplex scan were submitted to DGA. The degree of stenosis in both sides (symptomatic and asymptomatic) were evaluated by the same neuro-radiologist who gave his SVI and applied the NASCET method immediately after. Both methods were compared using the intraclass correlation coeficient (r) and its 95 percent confidence interval (95 percent ci). For each method, the sample (20 ICs) was also divided in surgical (stenosis between 70 and 99 percent) and non surgical ICs, using kappa concordance coeficient (k) to compare the results. RESULTS: The results comparing the 20 values obtained by each method are: r = 0.90 (95 percent ci: 0.77 -- 0.96). Dividing the sample in surgical and non surgical ICs, k = 0.857, p < 0.0001; sensitivity = 100 percent (39.6 percent - 100 percent); specificity = 93.8 percent (67.7 percent - 99.7 percent); positive predictive value = 80 percent (29.9 percent - 98.9 percent); negative predictive value = 100 percent (74,7 percent - 100 percent). CONCLUSION: The SVI may be used by at least some experienced neuroradiologists as a preliminary tool to evaluate the degree of IC stenosis with DGA, but a standardised and well established method should be routinely performed
Assuntos
Humanos , Angiografia Digital/normas , Doenças das Artérias Carótidas , Artéria Carótida Interna , Endarterectomia das Carótidas , Doenças das Artérias Carótidas/patologia , Artéria Carótida Externa/cirurgia , Intervalos de Confiança , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
Procedimentos cirúrgicos alternativos para o tratamento de aneurismas "näo clipáveis" da carótida intracavernosa incluem ligadura do vaso ou exclusäo do segmento que origina a lesäo. Essas técnicas estäo associadas a riscos de complicaçöes isquêmicas, mesmo em pacientes com sistema de colaterais funcionante. Portanto, um tratamento adequado requer revascularizaçäo encefálica para manter o fluxo sanguíneo nos territórios envolvidos. Relatamos o caso de uma paciente de 47 anos com sintomas e sinais isquêmicos embólicos e paralisia do III nervo craniano causados por aneurisma gigante, parcialmente trombosado, do segmento cavernoso da carótida interna. A paciente foi submetida a ponte anastomótica entre a carótida externa cervical e a carótida interna supraclinoidea utilizando enxerto de veia safena, seguido de exclusäo do segmento vascular contendo o aneurisma, com bom resultado e sem complicações
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Externa/cirurgia , Artéria Carótida Interna/cirurgia , Aneurisma Intracraniano/cirurgia , Veia Safena/transplante , Anastomose Cirúrgica , Angiografia CerebralRESUMO
Two cases of giant intracavernous aneurysms treated by high flow bypass with saphenous vein graft between the external carotid artery (ECA) and branches of the middle cerebral artery (MCA) are presented. Very often these aneurysms are unclippable because they are fusiform or have a large neck. Occlusion of the internal carotid artery (ICA) is the treatment of choice in many cases. This procedure has however a high risk of brain infarction. Revascularization of the brain by extra-intracranial anastomosis between the superficial temporal artery (STA) and branches of the MCA is frequently performed. This procedure provides however a low flow bypass and brain infarction may occur. We report two cases of giant cavernous sinus aneurysms treated by high flow bypass and endovascular balloon occlusion of the ICA. Immediate high flow revascularization of MCA branches was achieved and the patients showed no ischemic events. Follow-up of 8 and 14 months after operation shows patency of the venous graft and no neurological deficits. Angiographic control examination showed complete aneurysm occlusion in both cases.
Assuntos
Humanos , Masculino , Feminino , Adulto , Artérias/cirurgia , Implante de Prótese Vascular/métodos , Seio Cavernoso/cirurgia , Aneurisma Intracraniano/cirurgia , Veia Safena/transplante , Anastomose Cirúrgica , Angiografia Digital , Artéria Carótida Externa , Artéria Carótida Externa/cirurgia , Artéria Carótida Interna , Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Seio Cavernoso/patologia , Aneurisma Intracraniano/diagnóstico , Imageamento por Ressonância Magnética , Artéria Cerebral Média , Artéria Cerebral Média/cirurgia , Artérias Temporais/cirurgiaRESUMO
Introducción: La estenosis grave de la arteria carótida es una causa importante de accidente vascular encefálico(AVE) y evento isquémico transitorio (TIA) (10-20 por ciento). La endarterectomía carotídea extracraneana (ECE) ha demostrado ser efectiva en reducir este riesgo en pacientes seleccionados, sintomáticos y asintomáticos. Objetivo: Presentar los resultados de una serie de pacientes sometidos a ECE. Métodos: Serie de 135 ECE en 121 sujetos (84 hombres y 37 mujeres), con mediana de 72,2 +/- 7,7 años, tratados con ECE en el Servicio de Cirugía Vascular del Hospital Dipreca entre enero de 1998 y diciembre de 2004. La operación consistió en endarterectomía carotídea (común e interna) luego de realizar arteriotomía longitudinal amplia y endarterectomía carotídea externa por eversión. En la mayoría de los casos se utilizó shunt y bloqueo anestésico cervical profundo y superficial; en todos se fijó la placa distal y arteriorráfia con parche. Se utilizó estadística descriptiva y se calculó porcentajes, medianas, promedios, desviaciones estándar y supervivencia. Resultados: El déficit neurológico central homolateral postoperatorio fue de 1,5 por ciento. La morbilidad general fue de 12,6 por ciento. No hubo mortalidad perioperatoria. Se obtuvo un 94 por ciento de seguimiento. La causa de muerte más frecuente fue la de origen cardíaco (74 por ciento) y hubo un 4,7 por ciento de eventos neurológicos tardíos (TIA o AVE). La supervivencia libre de re estenosis fue de 92 por ciento. Conclusión: La ECE sigue siendo una alternativa de tratamiento en nuestro Hospital con baja morbimortalidad en sujetos seleccionados con estenosis carotídea sintomática y asintomática.
Background: Critical carotid artery stenosis is an important cause of stroke (CVA) and transient ischemic attack (TIA). Extra cranial endarterectomy (ECE) has proven effective in reducing the risk of these complications in selected patients, both symptomatic and asymptomatic. Aim: To report the results of ECE at Dipreca Hospital in Santiago, Chile. Methods: From January 1998 to December 2004, 135 ECE procedures were performed in 121 patients (84 males and 37 females). Mean age was 72.2 years (SD 7.7). ECE consisted of common and external carotid artery endarterectomy with eversion. In most cases, superficial and deep anesthetic blockade and shunts were utilized. A patch and fixation of distal plaque were performed in all. Results are presented with standard statistics methods. Results: Homolateral postoperative neurologic deficit was observed in 1.5 percent. All cause morbidity was 12.6 percent. There was no perioperative mortality. Follow up data was obtained for 94 percent of patients. Seventy-four percent of late deaths were due to cardiac events and 4.7 percent of patients developed late neurologic events (CVA or TIA). Restenosis free survival was 92 percent. Conclusion: ECE is a safe procedure for patients with both symptomatic and asymptomatic carotid artery stenosis.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Externa/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Estenose das Carótidas/cirurgia , Artéria Carótida Primitiva/cirurgia , Causas de Morte , Chile/epidemiologia , Endarterectomia das Carótidas/mortalidade , Seguimentos , Reestenose Coronária/epidemiologia , Taxa de SobrevidaRESUMO
Se presenta la experiencia en cirugía de los troncos supraaórticos por síntomas vertebrobasilares. desde julio de 1983 a julio de 1987. La serie está constituída por 24 pacientes. El 83,3% ( 20 pacientes ) quedaron libre de síntomas; de los 4 pacientes sintomáticos, 2 de ellos tienen lesiones que deberían ser corregidas. La morbilidad general fué de 20,8%, sin mortallidad operatoria
Assuntos
Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Artéria Vertebral/cirurgia , Insuficiência Vertebrobasilar , Artéria Carótida Externa/cirurgia , Artéria Subclávia/cirurgiaRESUMO
Os aneurismas da artéria carótida extracranial säo raros. O diagnóstico clínico torna-se difícil quando näo há tumor pulsátil em regiäo cervical. No entanto, deve-se pensar nesta possibilidade quando os diagnósticos mais comuns das patologias em regiäo cervical säo afastados. O presente artigo se refere a um paciente no qual a presença de uma massa cervical näo-pulsatil e com sintomatologia de rouquidäo, confundiu o diagnóstico pré-operatório levando a pensar em neoplasia oculta de cabeça e pescoço
Assuntos
Pessoa de Meia-Idade , Humanos , Masculino , Aneurisma/cirurgia , Artéria Carótida Externa/cirurgia , Aneurisma/diagnósticoRESUMO
Antecedentes: los cirujanos se enfrentan a menudo al dilema de resecar las arterias carótidas o subclavia por vecindad o invasión tumoral. El corto intervalo libre de enfermedad y las complicaciones limitan esos intentos. Otras alternativas son la disección subadventicial o la ligadura directa para lograr la exéresis del tumor. Objetivo: analizar frecuencia, necesidad y oportunidad de los reemplazos vasculares en la cirugía oncológica de cabeza y cuello. Lugar de aplicación: Hospital público de atención terciaria de tumores. Diseño: retrospectivo. Población: 13 enfermos; 86,6 por ciento masculinos, edad media 51,9 años (23-73). En el 84,6 por ciento la cirugía fue por tumores malignos. La patología maligna fue metastásica en 8/11 (72,2 por ciento). La histología dominante fue carcinoma epidermoide. Las arterias resecadas fueron la carótida en 12 y la subclavia en 1. En 8/13 se practicó biopsia por congelación de la adventicia. El material de reemplazo fue heterólogo en 6 y autólogo en 7. Resultados: se produjo un óbito perioperatorio. Los restantes evolucionaron bien, produciéndose la obliteración espontánea sin secuelas en 2. Cuatro enfermos experimentaron disfonía como secuela de la inclusión del vago en la resección. Conclusiones: los reemplazos vasculares en cirugía oncológica de cabeza y cuello son infrecuentes, seguros y necesarios cuando el tumor invade el plano adventicial de los grandes vasos del cuello. Su frecuencia podría ser mayor si se realizara congelación de la adventicia en forma rutinaria
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Implante de Prótese Vascular , Neoplasias de Cabeça e Pescoço , Artéria Carótida Externa/cirurgia , Artéria Carótida Externa/patologia , Artéria Carótida Interna/cirurgia , Artéria Carótida Interna/patologia , Complicações Pós-Operatórias , Estudos Retrospectivos , Artéria Subclávia , Procedimentos Cirúrgicos VascularesRESUMO
Se presenta un paciente masculino de 72 años con 6 meses de evolución de un carcinoma espinocelular en labio superior. La finalidad es presentar una variante del colgajo de Abbé-Estlander, sugerir su uso en caso de estar frente a una lesión similar.
Assuntos
Humanos , Masculino , Idoso , Artéria Carótida Externa/cirurgia , Carcinoma de Células Escamosas/cirurgia , Retalhos Cirúrgicos/métodos , Neoplasias Labiais/patologia , Biópsia , Procedimentos Cirúrgicos OperatóriosRESUMO
Se presenta una experiencia sobre 16 pacientes portadores de grandes malformaciones vasculares en el territorio de la cara y el cuello. Se comenta el estudio mediante angiografía retrógrada y digital para determinar el diagnóstico lo más exacto posible y se relata la técnica y el material utilizado para la embolización de los vasos nutricios del tumor sanguíneo. El tratamiento puede ser único si la resección del tumor ocasionase secuelas o trastornos prácticamente incompatibles con la vida de relación, o previo a una resección quirúrgica que debe realizarse en un período no mayor a 7 días. Se detallan las complicaciones que el método ha tenido y la forma de obviar las mismas
Assuntos
Adulto , Humanos , Masculino , Feminino , Artéria Carótida Externa/cirurgia , Malformações Arteriovenosas/terapia , Embolização Terapêutica/métodos , Neoplasias de Cabeça e Pescoço/etiologia , Malformações Arteriovenosas/complicaçõesRESUMO
Entre enero de 1992 y junio de 1995 se analizan, sobre 125 cirugías en 99 pacientes, 7 aneurismas carotídeos extracraneales, 5 unilaterales y 2 bilaterales. De la serie sólo hubo una mujer y la edad osciló entre los 51 y 72 años. Presentaron síntomas cerebrovasculares 4 de los pacientes y uno solo fue un hallazgo. Los exámenes complementarios realizados fueron tomografía cerebral, ecocardiograma, ecodoppler de los 4 vasos del cuello y arteriografía cérvico-cerebral. Las cirugías se efectuaron bajo anestesia general y tratamiento farmacológico de protección cerebral pre y postoperatorio; el 71,4 por ciento bajo shunt. Las intervenciones consistieron el 28,6 por ciento en resección y reemplazo protético término-terminal de la carótida interna; 57,1 por ciento resección parcial y angioplastia con prótesis; y en el caso restante resección y reemplazo protéico + ligadura de la carótida externa (14,3 por ciento). La mortalidad del total de las 125 cirugías fue del 2,4 por ciento y la morbilidad del 3,2 por ciento. La cirugía de los aneurismas carotídeos extracraneales no presentó morbimortalidad. El protocolo sistematizado de diagnóstico en insuficientes cerebrovasculares incrementó nuestra casuística en esta patología en los últimos 3 años y la normatización de la cirugía carotídea permitió obtener buenos resultados