ABSTRACT
The presence of malperfusion syndrome in cases of complicated acute type B aortic dissection is a negative predictive factor and urgent intervention is indicated. Anatomic variations, such as the Arc of Buhler, contribute anastomotic channels and can preserve the visceral blood supply. In this case report, we describe the overall management of a 54-year-old man who presented with a type B aortic dissection. Initially, conservative management was chosen, as indicated for an uncomplicated type B dissection, but the dissection deteriorated. Despite the fact that severe occlusion of the celiac artery was detected on Computed Tomography (CT) angiography, the Arc of Buhler anatomical variation was present, contributing adequate visceral blood supply. After considering this finding, the patient was treated effectively with thoracic endovascular aortic repair (TEVAR).
A presença da síndrome de má perfusão em casos de dissecção aórtica aguda do tipo B complicada é um fator preditor negativo, e uma intervenção urgente é indicada. As variações anatômicas, tais como o arco de Buhler, contribuem como canais anastomóticos e podem preservar o suprimento sanguíneo visceral. Neste relato de caso, descrevemos o manejo geral de um paciente do sexo masculino, de 54 anos, que apresentou uma dissecção aórtica do tipo B. Inicialmente, o manejo conservador foi escolhido, conforme indicado para dissecção do tipo B não complicada, mas a dissecção sofreu deterioração. Apesar de uma oclusão grave da artéria celíaca ter sido detectada na angiotomografia computadorizada, a variação anatômica do arco de Buhler estava presente, contribuindo para o suprimento sanguíneo visceral adequado. Após levar em consideração esse achado, o paciente foi tratado de forma efetiva com reparação endovascular da aorta torácica.
ABSTRACT
Abstract The presence of malperfusion syndrome in cases of complicated acute type B aortic dissection is a negative predictive factor and urgent intervention is indicated. Anatomic variations, such as the Arc of Buhler, contribute anastomotic channels and can preserve the visceral blood supply. In this case report, we describe the overall management of a 54-year-old man who presented with a type B aortic dissection. Initially, conservative management was chosen, as indicated for an uncomplicated type B dissection, but the dissection deteriorated. Despite the fact that severe occlusion of the celiac artery was detected on Computed Tomography (CT) angiography, the Arc of Buhler anatomical variation was present, contributing adequate visceral blood supply. After considering this finding, the patient was treated effectively with thoracic endovascular aortic repair (TEVAR).
Resumo A presença da síndrome de má perfusão em casos de dissecção aórtica aguda do tipo B complicada é um fator preditor negativo, e uma intervenção urgente é indicada. As variações anatômicas, tais como o arco de Buhler, contribuem como canais anastomóticos e podem preservar o suprimento sanguíneo visceral. Neste relato de caso, descrevemos o manejo geral de um paciente do sexo masculino, de 54 anos, que apresentou uma dissecção aórtica do tipo B. Inicialmente, o manejo conservador foi escolhido, conforme indicado para dissecção do tipo B não complicada, mas a dissecção sofreu deterioração. Apesar de uma oclusão grave da artéria celíaca ter sido detectada na angiotomografia computadorizada, a variação anatômica do arco de Buhler estava presente, contribuindo para o suprimento sanguíneo visceral adequado. Após levar em consideração esse achado, o paciente foi tratado de forma efetiva com reparação endovascular da aorta torácica.
Subject(s)
Humans , Male , Middle Aged , Aorta, Thoracic , Celiac Artery , Anatomic Variation , Aortic Dissection/surgery , Mesenteric Artery, Superior , Endovascular Procedures , Conservative Treatment , Aortic Dissection/diagnosisABSTRACT
PURPOSE: Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has become a crucial method in the management of peritoneal metastasis. This study evaluated the Quality of Life (QoL) post CRS plus HIPEC. METHODS: 80/95 patients underwent CRS plus HIPEC at the Metaxa Cancer Hospital, Piraeus, Greece from 06/2011 to 06/2015 and completed the colorectal version of the Functional Assessment of Cancer Therapy questionnaire (FACTC, version 4) at 1 week pre-operatively and at 1, 3, 6, 12, 18, 24 months post-operatively. The subscales assessed were the physical, social/family, emotional and functional wellbeing. RESULTS: In all subscales, fluctuations in the scores indicated a worsening of QoL in the first 3 post-operative months, followed by improvement back to pre-operative levels and even better scores later on. Statistical improvement was proven for the physical and emotional well-being subscales. CONCLUSIONS: The significant improvement in the physical well-being is attributed to the eradication of symptoms, whereas the relevant improvements in the emotional wellbeing subscale are explained both by the pre-operative desperation of the diagnosis or relapse of malignancy, and the post-operative hopefulness after a successful operation.
Subject(s)
Colorectal Neoplasms/epidemiology , Cytoreduction Surgical Procedures , Neoplasm Recurrence, Local/epidemiology , Peritoneal Neoplasms/epidemiology , Chemotherapy, Cancer, Regional Perfusion , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/surgery , Combined Modality Therapy , Female , Greece , Humans , Hyperthermia, Induced , Length of Stay , Male , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Peritoneal Neoplasms/drug therapy , Peritoneal Neoplasms/pathology , Peritoneal Neoplasms/surgery , Quality of Life , Surveys and QuestionnairesABSTRACT
BACKGROUND: Peritoneal sarcomatosis appears to be responding poorly to systemic chemotherapy. Treatment options traditionally include surgical ressections, chemotherapy and radiation therapy. Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) offers a promising alternative locoregional treatment option. PATIENTS AND METHODS: We examine retrospectively 8 patients (4 females, 4 males) with peritoneal sarcomatosis. The most common histology type was the liposarcoma (4/8). The chemotherapeutic agents that were administered were mitomycin, cisplatin and doxorubicin. We analyse our cases with regard to the PCI, the CC score, the complications that occurred and the overall survival. RESULTS: A complete level of cytoreduction (CC0/1) was feasible in 5/8 of patients. We report post-operative complications such as GI leaks and fistulas in 3 cases and infections in 2 cases. Overall survival was proved to depend on the PCI (better overall survival rate when PCI<20) DISCUSSION: We identify acceptable morbidity, comparable to other series of patients undergoing CRS+HIPEC for other histologies. The specific sarcoma type and the previous treatment received prove to be factors that alter significantly the prognosis and the survival rates: therefore, conclusions cannot be safely excluded in such small patient series. On the whole, we conclude that, given the already positive and promising results from CRS+HIPEC in sarcomatosis, more studies need to be performed, in order to determine the role of all the aforementioned factors. KEY WORDS: Fibrosarcoma, HIPEC, Leiomyosarcoma, Liposarcoma, Rabdomyosarcoma, Sarcomatosis.