Repair of a gigantic ascending aortic pseudoaneurysm - A challenging approach.

Aortic pseudoaneurysms can be a potentially fatal, yet rare, complication of heart surgery. Surgery is indicated but is high risk during sternotomy. Therefore, careful planning is required. We report the case of a 57-year-old patient who underwent heart surgery twice in the past and who presented with an ascending aortic pseudoaneurysm. A successful repair of the pseudoaneurysm was performed under deep hypothermia, left ventricular apical venting, periods of circulatory arrest and endoaortic balloon occlusion.

Manejo conservador de un pseudoaneurisma suprahepático en un paciente pediátrico / Conservative treatment of suprahepatic pseudoaneurysm in a pediatric patient

Introducción: Los pseudoaneurismas suprahepáticos y de la venacava inferior (VCI) son excepcionales en niños. La mayoría de casosen adultos se manejan quirúrgicamente debido al alto riesgo de rotura. Caso clínico: Niña de siete años remitida por traumatismo tóraco-abdominal no presenciado. Hemodinámicamente estable, con hemoglobina de 9,1 g/dL. Se realiza un TC urgente, objetivándose unpseudoaneurisma en la confluencia de la VCI con las suprahepáticasmedia e izquierda, con sangrado activo contenido por la cápsula hepática.Dada la estabilidad hemodinámica y el riesgo quirúrgico, se optó por unmanejo conservador. En el TC a las veinticuatro horas se observó cesedel sangrado. Se realizó un TC de control al mes, tres meses, un año yaño y medio, con desaparición de la lesión. Comentarios: El manejo conservador del pseudoaneurisma de lasvenas suprahepáticas/VCI es factible en caso de estabilidad hemodinámica siempre que se mantenga una vigilancia clínica y radiológicaestrechas.(AU)

Introduction: Suprahepatic and inferior vena cava (IVC) pseudoaneurysms are rare in children. Most cases in adults are treated surgicallydue to the high risk of rupture. Clinical case: Seven-year-old girl referred for a thoracic-abdominaltrauma of unknown origin. Hemodynamically stable, with a hemoglo-bin level of 9.1g/dl. An emergency CT scan was performed, showinga pseudoaneurysm at the confluence of the IVC with the middle andleft suprahepatic veins, with active bleeding contained by the hepatic capsule. Given the hemodynamic stability and surgical risk, conservativetreatment was decided upon. CT-scan at 24 hours showed cessation ofbleeding. A control CT-scan was performed one month, three months,one year, and one and a half years later, showing the lesion had disappeared. Discussion: Conservative treatment of suprahepatic vein pseudoaneurysm/ICV is feasible in the case of hemodynamic stability providedthat strict clinical and radiological surveillance is maintained.(AU)

Median nerve compression at elbow level by a proximal cubital artery pseudoaneurysm: a case report

We describe the case of an 82-year-old man who had recently undergone cardiac surgery (quadruple coronary bypass), who consulted due to the appearance of a necrotic eschar on the thumb of the right index finger, together with paraesthesia and hypoaesthesia in the first 3 fingers of the same hand. An ultrasound scan of the right elbow was performed to rule out involvement of the median nerve and an anechoic, thick-walled mass was found, dependent on the wall of the proximal ulnar artery, compatible with a pseudoaneurysm of the same, compressing the nerve. Electromyography showed an acute lesion of the proximal median nerve and angio-CT confirmed the diagnosis of pseudoaneurysm of the proximal ulnar artery. Pseudoaneurysm is a dilatation by rupture of the arterial wall, which does not involve all three layers of the arterial wall and communicates with the vascular lumen. Its development after vascular manipulation is very rare, and it is uncommon for it to act by compressing a nerve structure. In our case, together with vascular surgery, treatment with intralesional thrombin was decided, with good evolution.

Se describe el caso de un varón de 82 arios intervenido recientemente de cirugía cardíaca (cuádruple bypass coronario), que consulta por aparición de una escara necrótica en el pulpejo del dedo índice derecho, junto a parestesias e hipoestesias en los tres primeros dedos de dicha mano. Se realiza una ecografía del codo derecho para descartar afectación del nervio mediano y se objetiva una masa anecoica, de paredes engrosadas, dependientes de la pared de la arteria cubital proximal, compatible con pseudoaneurisma de esta, que comprime dicho nervio. En la electromiografía se evidencia una lesión aguda del nervio mediano a nivel proximal y en el angio-TC se confirma el diagnóstico de pseudoaneurisma de la arteria cubital proximal. El pseudoaneurisma es una dilatación por rotura de la pared arterial, que no implica a las tres capas de esta y se comunica con la luz vascular. Su desarrollo tras una manipulación vascular es muy infrecuente y que actúe comprimiendo una estructura nerviosa es poco común. En nuestro caso, conjuntamente con cirugía vascular se decidió tratamiento con trombina intralesional, con buena evolución.

Manejo conservador de pseudoaneurisma de vena cava iatrogénico / Conservative management of iatrogenic vena cava pseudoaneurysm

Introducción: los pseudoaneurismas de vena cava infrarrenal (VCI) son una patología infrecuente, sin tratamiento estandarizado; la mayoría, secundarios a traumatismos abdominales. Presentan una mortalidad del 20-57 %. Su manejo debe ser individualizado, con opciones como conservador, quirúrgico o endovascular. Caso clínico: varón de 23 años con cardiopatía congénita compleja que ingresa por síncope extrahospitalario con posterior aleteo auricular e inestabilidad hemodinámica. Durante el procedimiento de ablación presenta shock hemorrágico. Precisa drogas vasoactivas y transfusión masiva. Tras su estabilización, se realiza angio TAC abdominal en el que se visualiza hematoma retroperitoneal dependiente de VCI sin hemorragia activa. Dada la comorbilidad del paciente y la estabilidad hemodinámica, se decide tratamiento conservador y control radiológico. En el angio TAC a los 15 días se visualiza pseudoaneurisma de VCI. Decide mantenerse actitud conservadora, retirar la anticoagulación y realizar revisiones periódicas. Se mantiene estable y se decide el alta, con vigilancia estrecha. En el control a los dos meses se objetiva completa resolución del pseudoaneurisma. Discusión: dada la complejidad de la patología, la estabilidad hemodinámica y las comorbilidades del paciente, se optó por manejo conservador, sin descartar otras opciones terapéuticas si presentaba empeoramiento clínico o radiológico. El tratamiento del pseudoaneurisma de VCI debe individualizarse, priorizando la clínica y la estabilidad del paciente y vigilando la evolución de la lesión con control radiológico estrecho.(AU)

Background: infrarenal cava vein (ICV) pseudoaneurysms are an infrequent pathology, without standardized treatment. Most secondary to abdominal trauma and may associate arterial injuries. Presenting a mortality of 20-57 %, which has not been reduced, despite advances in treatment. Iatrogenic IVC injuries can develop retroperitoneal hematomas and pseudoaneurysms. Its management must be individualized, with options such as conservative, surgical or endovascular. Case report: a 23-year-old male with complex congenital heart disease was admitted due to out-of-hospital syncope with subsequent atrial flutter and hemodynamic instability. During the ablation procedure, he presented hemorrhagic shock requiring doses of vasoactive drugs and massive transfusion. After stabilizing the patient, an abdominal angio-CT was performed, visualizing an IVC-dependent retroperitoneal hematoma with no signs of active bleeding. Given the patient's comorbidity and hemodynamic stability, conservative treatment and radiological control were implemented. CT angiography at 15 days shows IVC pseudoaneurysm. It was decided to maintain a conservative attitude, withdraw anticoagulation and periodic check-ups. Remaining stable, discharge is decided, with close monitoring. At the two months check-up, complete resolution of the pseudoaneurysm is observed. Discussion: given the complexity of the pathology, the patient's hemodynamic stability and comorbidities, conservative management was chosen, without ruling out other therapeutic options if presented with clinical or radiological worsening. The treatment of IVC pseudoaneurysm must be individualized, prioritizing the patient's symptoms and stability and monitoring the evolution of the lesion with close radiological control.(AU)

Pseudoaneurisma de la arteria facial como complicación de un absceso parafaríngeo. Presentación de un caso y revisión de la literatura / Pseudoaneurysm of the facial artery as a complication of parapharyngeal abscess. Presentation of a case and review of the literature

Un pseudoaneurisma constituye una dilatación sacular vascular que implica un defecto a nivel de la íntima y la capa media, manteniendo continuidad de la adventicia. Las dilataciones aneurismáticas de la arteria carótida extracraneal son raras, encontrándose entre sus causas traumatismos, infecciones y complicaciones iatrogénicas. Su tratamiento, recomendado en todos los casos, incluye la cirugía tradicional, la colocación de stent y la embolización. El riesgo de rotura implica una mortalidad de hasta el 30 %. Presentamos el caso de una mujer de 86 años derivada a Urgencias por cuadro de cinco días de odinofagia asociado a tumefacción dolorosa submandibular evidenciándose en el TC una colección parafaríngea compatible con absceso, en cuyo interior se objetivó una estructura vascular aumentada de calibre sugestiva de pseudoaneurisma. Se realizó una arteriografía que confirmó la presencia de una dilatación sacular compatible con pseudoaneurisma a nivel submandibular izquierdo, dependiente de la rama palatina ascendente de la arteria facial. Esta lesión se embolizó mediante coils para posteriormente realizarse drenaje y desbridamiento quirúrgico del absceso submaxilar. La evolución posterior fue satisfactoria. La presencia de una lesión poco frecuente pero con alta mortalidad en un cuadro clínico habitual en la práctica clínica pone de manifiesto la relevancia del estudio mediante TC a cargo de profesionales experimentados. La colaboración en estos casos entre radiólogos y cirujanos de cabeza y cuello resulta imprescindible. (AU)

A pseudoaneurysm is a vascular saccular dilatation that involves a defect at the level of the intima and the medial layer, maintaining continuity of the adventitia. Aneurysmal dilatations of the extracranial carotid artery are rare, with trauma, infection and iatrogenic complications among their causes. Their treatment, recommended in all cases, includes traditional surgery, stenting and embolization. The risk of rupture implies a mortality of up to 30 %. We present the case of an 86-year-old woman referred to the Emergency Department with five days of odynophagia associated with painful submandibular swelling, showing in CT a parapharyngeal collection compatible with abscess, inside which an enlarged vascular structure suggestive of pseudoaneurysm was observed. Arteriography confirmed the presence of a saccular dilatation compatible with pseudoaneurysm at the left submandibular region, dependent on the ascending palatine branch of the facial artery. This lesion was embolized by coils and later drainage and surgical debridement of the submaxillary abscess was performed. Subsequent evolution was satisfactory. The presence of an infrequent lesion but with high mortality in a common clinical condition highlights the relevance of CT study by experienced professionals. Collaboration in these cases between radiologists and head and neck surgeons is essential. (AU)

Management of traumatic superficial palmar arch pseudoaneurysm: a therapeutic challenge / Manejo de pseudoaneurisma do arco palmar superficial traumático: desafio terapêutico

Abstract Pseudoaneurysm of the palmar arch is a rare entity. Diagnosis is dependent on high clinical suspicion. We present a case referred to the emergency department, with a history of glass penetrating trauma to the palmar surface with a pulsatile mass and jet bleeding. Doppler ultrasound evidenced a partially thrombosed pseudoaneurysm. A CT angiography examination showed a saccular formation arising from the superficial palmar arch. A conventional surgical approach was indicated. A clinical suspicion must be ventured to arrive at the correct diagnosis. Imaging modalities are needed to identify the pseudoaneurysm and plan the treatment course. Nonetheless, the sequence of diagnosis is individual, because further evaluation with different imaging methods may not change the rationale for the intervention. In our experience, conventional surgical removal is preferable, due to its safety and well-established outcomes.

Resumo O pseudoaneurisma do arco palmar é uma entidade rara, cujo diagnóstico depende de alta suspeição clínica. Apresentamos o caso de um paciente encaminhado ao pronto-socorro com história de traumatismo penetrante por vidro na face palmar, com massa pulsátil e sangramento em jato. A ultrassonografia com Doppler evidenciou pseudoaneurisma parcialmente trombosado, e a angiotomografia demonstrou formação sacular originada do arco palmar superficial. Uma abordagem cirúrgica convencional foi indicada. Para prosseguir com o diagnóstico correto, essa suspeita clínica deve ser aventada. Modalidades de imagem são necessárias para identificar o pseudoaneurisma e planejar o curso do tratamento. No entanto, a sequência diagnóstica é individual, pois uma avaliação mais aprofundada, com diferentes métodos de imagem, pode não alterar o racional da intervenção. Em nossa experiência, a remoção cirúrgica convencional é preferível, visto sua segurança e seus resultados bem estabelecidos.

Prolonged Doppler US-guided pneumatic compression of a radial artery pseudoaneurysm after percutaneous coronary intervention: a simple and effective solution for a rare and challenging problem / Compressão pneumática prolongada e guiada por ultrassom de um pseudoaneurisma da artéria radial após intervenção coronariana percutânea: solução simples e eficaz para um problema raro e desafiador

Abstract Transradial access is associated with fewer access site-related complications, earlier patient mobilization, and greater postprocedural comfort. Pseudoaneurysms are an extremely rare complication after transradial procedures and the radial artery itself is the most atypical arterial site of occurrence. We report a case in which a non-surgical, non-invasive, simple, and effective solution (prolonged pneumatic compression) was used to manage a radial artery pseudoaneurysm, a very rare and challenging complication of transradial procedures.

Resumo O acesso arterial transradial está associado a menos complicações relacionadas ao sítio de punção, com deambulação precoce do paciente e maior conforto pós-procedimento. O pseudoaneurisma é uma complicação extremamente rara após procedimentos transradiais, sendo a artéria radial, por si só, o sítio mais incomum para tal ocorrência. Relata-se um caso de um pseudoaneurisma de artéria radial, uma complicação rara e desafiadora, resolvido com êxito e de maneira simples, não invasiva e não cirúrgica (compressão pneumática prolongada).

Pseudoaneurisma de artéria ulnar superficial / Superficial ulnar artery pseudoaneurysm

Resumo A artéria ulnar é o maior ramo terminal da artéria braquial, ela apresenta origem na fossa cubital e é coberta pelos músculos flexores do antebraço. Reportamos uma variação anatômica, na qual a artéria ulnar situava-se em posição superficial no antebraço. Por falta de conhecimento sobre essa variação, ocorreu a lesão após uma tentativa de punção venosa, a qual levou à formação de um pseudoaneurisma.

Abstract The ulnar artery is the larger terminal branch of the brachial artery. It originates in the cubital fossa and is covered by the flexor muscles of the forearm. We report an anatomic variant in which the ulnar artery was in a superficial position in the forearm. Since this variant was unknown, an attempted venous puncture injured the artery, causing formation of a pseudoaneurysm.

Lesões traumáticas de aorta em zona rural: série de casos com manifestações tardias e revisão dos aspectos terapêuticos / Traumatic aorta injuries in a rural area: late manifestations and review of therapeutic aspects

Resumo As lesões traumáticas da aorta (LTA) torácica estão associadas a altas taxas de morbimortalidade. São classificadas de acordo com a extensão do dano, e a angiotomografia computadorizada tem as maiores sensibilidade e especificidade para identificar o grau de lesão e potenciais lesões associadas. As estratégias terapêuticas para LTA são baseadas no tipo de lesão, na extensão e nas lesões associadas. Pode auxiliar na definição de conduta também o grau de estabilidade do paciente, podendo ser manejo cirúrgico convencional, endovascular (TEVAR) ou conservador em casos selecionados. Entre os pacientes com anatomia vascular adequada, a cirurgia endovascular está associada a melhor sobrevida e a menos riscos. O objetivo deste artigo foi descrever uma série de quatro casos acompanhados em serviço terciário, em um estado com poucos serviços de alta complexidade. A terapêutica endovascular foi empregada como método preferencial. Os pacientes apresentaram evolução favorável sem complicações até a alta e encontram-se em acompanhamento ambulatorial.

Abstract Traumatic thoracic aortic injuries (TTAI) are associated with high rates of morbidity and mortality. They are classified according to the extent of damage and computed tomography angiography has the highest sensitivity and specificity for identifying the degree of injury and potential associated lesions. Treatment strategies for TTAI are based on the type and extent of injury and associated lesions. The patient's degree of stability can also help to define the choice of treatment, which can be conventional or endovascular surgery (EVAR) or even conservative management in selected cases. Among patients with adequate vascular anatomy, endovascular surgery is associated with better survival and fewer risks. The objective of this article is to describe a series of four cases followed up at a tertiary service in a Brazilian state that has few centers that provide high complexity care. Endovascular therapy was employed as the preferred method. All four patients had favorable outcomes, with no complications up to discharge, and are currently in outpatient follow-up.

Ictericia obstructiva secundaria a un pseudoaneurisma de arteria mesentérica superior / Obstructive jaundice secondary to a pseudoaneurysm of the superior mesenteric artery

Los pseudoaneursimas de arteria mesentérica superior son una entidad rara, generalmente asintomáticos pero que pueden debutar con dolor abdominal, masa pulsátil o shock, siendo excepcional la ictericia como forma de presentación. El diagnóstico se realiza mediante pruebas de imagen (TC) y en la actualidad el abordaje endovascular es el más extendido reservándose la cirugía abierta en casos seleccionados. Describimos el caso de una paciente con un pseudoaneurisma de la AMS de 86mm con compresión de la vía biliar extrahepática. (AU)

Upper extremity arterial aneurysms: Etiology, management, and outcome.

BACKGROUND: Upper extremity arterial aneurysms are not common clinical conditions. It may causes ischemic gangrene or limb losses as a result of thromboembolic events due to endothelial damage. In this study, we aimed to investigate the etiology, management, and long-term outcome. METHODS: A total of 55 upper extremity aneurysms between January 2009 and April 2018 were retrospectively investigated. The mean age was 41 ± 13 years, and the women and men were 13 (23.6%) and 42 (76.4%). The mean follow-up was 43 ± 18 months. RESULTS: The incidence of pseudoaneurysm was higher than the true aneurysm (64.5% vs. 35.5%). 30 (84%) patients who had pseudoaneurysm repaired primerely and 6 (16%) patients had patchplasty. About 58% of the true aneurysm caused by blunt trauma. 4 (21%) true brachial aneurysm patients were required emergency intervention due to distal ischemia. 16 (84.2%) patients operated using by saphenous vein graft. The primary and secondary patency was 87.5% and 93.8%. No limb or life loss occurred during follow-up. CONCLUSION: Pseudoaneurysms are more common among upper limb aneurysms and they occur mostly by iatrogenic causes. Blunt trauma can be main cause of the true aneurysm. Surgical resection of the aneurysm and interposition of saphenous vein graft provides excellent results in the long-term.

ANTECEDENTES: los aneurismas arteriales de las extremidades superiores no son condiciones clínicas frecuentes. Puede causar gangrena isquémica o pérdida de extremidades como resultado de eventos tromboembólicos por daño endotelial. En este estudio, nuestro objetivo fue investigar la etiología, el tratamiento y el resultado a largo plazo. MÉTODOS: Se investigaron retrospectivamente un total de 55 aneurismas de las extremidades superiores sometidos a reparación quirúrgica entre enero de 2009 y abril de 2018. La edad media fue de 41 ± 13 años, y las mujeres y los hombres tenían 13 (23.6%) y 42 (76,4%). El seguimiento medio fue de 43 ± 18 meses. RESULTADO: La incidencia de pseudoaneurisma fue mayor que el aneurisma verdadero (64.5% frente a 35.5%) y fue causado por un traumatismo iatrogénico. 30 (84%) de los pseudoaneurismas reparados con cualquier injerto, 6 (16%) pacientes requirieron plastia con parche. 58% del aneurisma verdadero causado por traumatismo cerrado. 4 (21%) pacientes con aneurisma braquial verdadero requirieron intervención de emergencia debido a isquemia distal. 16 (84,2%) pacientes fueron sometidos a operación de reparación de aneurisma mediante injerto de vena safena. La permeabilidad primaria y secundaria fue del 87.5% y 93.8%. No se produjeron pérdidas de miembros ni de la vida durante el seguimiento. CONCLUSIÓN: Los pseudoaneurismas son más comunes entre los aneurismas de miembros superiores y ocurren principalmente por causas iatrogénicas. El traumatismo cerrado es la principal causa del verdadero aneurisma. La resección quirúrgica del aneurisma y la interposición con injerto de vena safena proporciona excelentes resultados a largo plazo.

Manejo del pseudoaneurisma esplénico y/o hepáticodespués de un traumatismo abdominal en pediatría / Management of splenic and/or hepatic pseudoaneurysm following abdominal trauma in pediatric patients

Introducción: Los pseudoaneurismas (PA) esplénicos y hepáticos son lesiones arteriovenosas raras que se pueden desarrollar tras un tramatismo abdominal. La rotura tardía es su complicación más frecuente que puede conducir a inestabilidad hemodinámica. El objetivo del presente es presentar nuestra experiencia en el manejo de los PA viscerales.Metodología: Estudio retrospectivo en pacientes < 15 años con traumatismo abdominal cerrado con lesión esplénica y/o hepática, entre 2012-2020. Se analizó el desarrollo de PA y el manejo realizado. En todos los pacientes se realizó tomografía computarizada estableciendo el grado del traumatismo, y estudio control en la primera semana postratumatismo mediante ecografía con contraste (CEUS). Si se confirmabaun PA se procedió a angiograma ± embolización percutánea.Resultados: Un total de 32 pacientes con traumatismo cerrado, edad media 8,7 ± 3,2 años (2-15 años), 68,7% (n = 22) hombres y mediana de grado de traumatismo grado III (grado II-IV), 33,3% (n =5/15) desarrollaron un PA esplénico y 5,8% (n = 1/17) desarrollaron un PA hepático con tiempo diagnóstico medio de 3,7 ± 3 (3-8) días. El desarrollo de PA se asoció a mayor puntuación en el índice de severidad con una diferencia de medias de 15,6 ± 5,3 (CI 95% 4,37:26,14 p < 0,008). Todos los PA se trataron mediante embolización un 85,7% (n = 5/6) excepto una esplenectomía urgente.Conclusiones: Los PA viscerales están infradiagnosticados, con una incidencia mayor a la reportada. Consideramos que un estudio de imagen (CEUS) debe ser realizado previo al alta en los traumatismos severos. El tratamiento sigue siendo controversial: sin embargo, recomendamos la embolización percutánea reservando la esplenectomíapara paciente inestables.

Introduction: Splenic and hepatic seudoaneurysm (PA) is a rare arteriovenous injury that may occur following abdominal trauma. The most frequent complication of PA is late rupture, which can lead to hemodynamic instability. The objective of this study was to describe our experience in the management of visceral PA.Materials and methods: A retrospective study of patients under15 years of age with blunt abdominal trauma associated with splenicand/or hepatic injury treated from 2012 to 2020 was carried out. PAformation and management were analyzed. All patients underwent CT-scan, which allowed trauma grade to be established, and also controlcontrast-enhanced ultrasonography (CEUS) in the first week followingtrauma. If PA was confirmed, angiography ± percutaneous embolizationwere performed.Results: A total of 32 patients with blunt trauma were included.Mean age was 8.7 ± 3.2 years (2-15 years). 68.7% (n = 22) of patientswere male. Median trauma grade was grade III (grades II-IV). 33.3%(n = 5/15) of patients developed splenic PA, and 5.8% (n = 1/17) ofpatients developed hepatic PA, with mean diagnostic time being 3.7 ± 3(3-8) days. PA formation was associated with higher severity scores,with a mean difference of 15.6 ± 5.3 (95% CI: 4.37:26.14 p < 0.008). AllPA cases – except for one, which required urgent splenectomy – weretreated with embolization (85.7%) (n = 5/6).Conclusions: Visceral PA is underdiagnosed, with an incidencehigher than reported. Imaging studies (CEUS) are required prior todischarge in the presence of severe trauma. Treatment remains contro-versial, but we recommend percutaneous embolization, with splenectomybeing reserved for unstable patients.

Pseudoaneurisma recidivante a nivel de fístula arteriovenosa en brazo izquierdo / Recurrent pseudoaneurysm at the level of arteriovenous fistula in the left arm

RESUMEN El pseudoaneurisma es un daño de la pared arterial, contenido por el hematoma circundante y estructuras vecinas, con flujo sanguíneo turbulento, que mantiene comunicación con la luz del vaso afecto. El presente estudio describe un paciente masculino de 57 años, que ingresa con diagnóstico de pseudoaneurisma de fístula arteriovenosa humero cefálica izquierda. Se realiza exéresis del falso aneurisma y creación de nueva fístula con prótesis vascular. El paciente reingresa al quinto mes con masa gigante pulsátil en sitio quirúrgico. Se realiza exploración, exéresis del pseudoaneurisma recidivante y nueva fístula humero-basílica izquierda con vena safena. Evoluciona favorablemente, realizándose diálisis dos años posteriores a la última cirugía sin complicaciones.

ABSTRACT Pseudoaneurysm is damage to the arterial wall, contained by the surrounding hematoma and neighboring structures, with turbulent blood flow, which maintains communication with the lumen of the affected vessel. The present study describes a 57-year-old male patient who was admitted with a diagnosis of left cephalic humeral arteriovenous fistula pseudoaneurysm. The false aneurysm wasexcised, and a new fistula was created with a vascular prosthesis. The patient was readmitted in the fifth month with a giant pulsatile mass at the surgical site. Surgical exploration was performed, excision of the recurrent pseudoaneurysm and a new left humerus-basilic fistula with saphenous vein. He is progressing favorably, performing dialysis two years after the last surgery without complications.

Manejo anestésico durante la cirugía para pseudoaneurisma ventricular izquierdo / Anesthetic management during surgery for left ventricular pseudoaneurysm

Resumen: Se informa la conducta anestésica de un caso de pseudoaneurisma ventricular izquierdo crónico secundario a complicación de infarto de miocardio transmural, complicación rara y casi siempre mortal. En este informe se describe el caso de una mujer de 60 años con insuficiencia cardíaca aguda a consecuencia de un infarto cardíaco ocurrido cinco meses atrás, que generó la complicación de la cual damos referencia. El manejo anestésico perioperatorio se logró al enfocarse en mantener una presión arterial estable para garantizar la perfusión cerebral y reducir el riesgo de ruptura completa del aneurisma hacia el espacio mediastinal.

Abstract: The anesthetic behavior of a case of chronic left ventricular pseudoaneurysm secondary to a complication of transmural myocardial infarction, a rare and almost always fatal complication, is reported. This report describes the case of a 60-year-old woman with acute heart failure, this is a consequence of a heart attack that occurred 5 months ago, which generated the complication of which we refer. Perioperative anesthetic management was achieved by focusing on maintaining a stable blood pressure to ensure cerebral perfusion and reduce the risk of complete rupture of the aneurysm into the mediastinal space.

Resolución endovascular de pseudoaneurisma poplíteo gigante / Endovascular resolution of giant popliteal pseudoaneurysm

Introducción: el pseudoaneurisma poplíteo es una entidad infrecuente y suele ser secundario a un trauma. Se presenta el caso de pseudoaneurisma poplíteo traumático. Caso clínico:hombre de 74 años con fractura de fémur hace 4 meses, manejada con implantes externos antes de la resolución definitiva. Presentó sangrado local y aumento del volumen de la extremidad inferior izquierda. El angio TAC evidenció un gran pseudoaneurisma de la arteria poplítea izquierda que se resolvió de manera endovascular con stent cubierto. Discusión: el tratamiento endovascular es una opción para la resolución del pseudoaneurisma poplíteo. El tratamiento quirúrgico abierto debe considerarse en casos de inestabilidad hemodinámica y la posible coexistencia de otras lesiones que requieran manejo inmediato.(AU)

Introduction: popliteal pseudoaneurysm is a rare entity and is usually secondary to trauma. A case of traumatic popliteal pseudoaneurysm is presented.Case report:a 74-year-old man with a femur fracture 4 months ago, managed with external tutors prior to final resolution. He presented local bleeding and increased volume of the left lower limb. AngioTC showed a large pseudoaneurysm of the left popliteal artery. We resolve it with endovascular treatment with a covered stent. Discussion: endovascular treatment is an option for the resolution of popliteal pseudoaneurysm. Open surgical treatment should be considered in cases of hemodynamic instability and the possible coexistence of other injuries that require immediate management.(AU)

Cross clamping of the supraceliac aorta is effective for bleeding control in ruptured giant splenic artery pseudoaneurysm when proximal and distal control of the splenic artery is not possible: a case report / O clampeamento da aorta supracelíaca é eficaz no controle de sangramento em pseudoaneurisma gigante roto de artéria esplênica quando o controle proximal e distal da artéria esplênica não é possível - relato de caso

Abstract Splenic artery pseudoaneurysm is the most common of all the visceral artery pseudoaneurysms. Presentation is often variable and the condition demands immediate diagnosis and management because pseudoaneurysm rupture increases morbidity and mortality. It is associated with pancreatitis and other conditions like abdominal trauma, chronic pancreatitis, pseudocyst of the pancreas, liver transplantation, and, rarely, peptic ulcer disease. We present a case of a giant splenic artery pseudoaneurysm measuring 14x8 cm. Proximal and distal control of the vessels could not be achieved during the procedure because of local adhesions and inflammation and it was necessary to cross clamp the supraceliac aorta to control bleeding.

Resumo O pseudoaneurisma de artéria esplênica é o mais comum entre os pseudoaneurismas de artérias viscerais. A apresentação geralmente varia e requer diagnóstico e tratamento imediatos, pois a ruptura do pseudoaneurisma aumenta a morbimortalidade. Esse tipo de pseudoaneurisma está associado à pancreatite e a outras condições, como trauma abdominal, pancreatite crônica, pseudocisto de pâncreas, transplante de fígado e, raramente, úlcera péptica. Apresentamos um caso de pseudoaneurisma gigante de artéria esplênica, com tamanho de 14x8 cm. Durante o procedimento, não foi possível alcançar controle proximal e distal dos vasos devido a aderências locais e inflamação, sendo necessário o clampeamento da aorta supracelíaca para controle do sangramento.

Pseudoaneurisma de la arteria femoral derecha posterior a cateterismo cardíaco / Right femoral artery pseudoaneurysm following cardiac catheterization

El pseudoaneurisma se puede definir como un hematoma pulsátil repermeabilizado y encapsulado, en comunicación con la luz de un vaso dañado. Los pseudoaneurismas de las extremidades son los más frecuentes; entre ellos se destacan los iatrogénicos de la arteria femoral. Su incidencia es del 2 por ciento-8 por ciento cuando se realizan angioplastia/stent coronarios y del 0,2 por ciento-0,5 por ciento cuando únicamente se hace angiografía diagnóstica. Se presenta un paciente con diagnóstico de pseudoaneurisma femoral derecho posterior a un cateterismo cardíaco, con el objetivo de demostrar la importancia del diagnóstico temprano de las pseudaeurismas para el tratamiento quirúrgico oportuno y evitar complicaciones posteriores. Al mes del procedimiento, el paciente comenzó con aumento de volumen en la región inguinal derecha y a la auscultación se apreció un soplo a ese nivel. Se le realizó exérisis del pseudoaneurisma y reparación quirúrgica de la arteria femoral. En las consultas de evaluación posoperatoria se mostró una evolución clínica y radiológica satisfactoria. El diagnóstico rápido de estas entidades vasculares evita que se presenten complicaciones posteriores y aseguran una evolución rápida y satisfactoria de los pacientes que la padecen(AU)

Pseudoaneurysm can be defined as a repermeabilized and encapsulated pulsatile hematoma, in communication with the light of a damaged vessel. Pseudoaneurysms of the limbs are the most frequent; among them are the iatrogenic of the femoral artery. Its incidence is 2 percent -8 percent when coronary angioplasty/stent is performed and 0.2 percent-0.5 percent when only diagnostic angiography is performed. A patient with a diagnosis of right femoral pseudoaneurysm after cardiac catheterization is presented, with the aim of demonstrating the importance of early diagnosis of pseudoaneurysms for timely surgical treatment and avoiding subsequent complications. A month after the procedure, the patient began with an increase in volume in the right inguinal region and auscultation showed a murmur at that level. Pseudoaneurysm exeresis and surgical repair of the femoral artery were performed. In the postoperative evaluation consultations, a satisfactory clinical and radiological evolution was shown. The rapid diagnosis of these vascular entities prevents subsequent complications from occurring and ensures a rapid and satisfactory evolution of patients who suffer from it(AU)

Aneurisma tuberculoso de aorta abdominal / Tuberculous Abdominal Aortic Aneurysm

El aneurisma micótico surge de la destrucción infecciosa de la pared arterial y se diagnostica cuando hay un aneurisma en el contexto de inflamación y hemocultivos o biopsia positivos, aunque esto no es un requisito excluyente. Los agentes etiológicos de mayor frecuencia son bacterias (Staphylococcus, Salmonella)2 pero también se han notificado hongos (Aspergillus niger). La tuberculosis puede afectar cualquier órgano de la economía, el compromiso arterial es una complicación rara y potencialmente mortal, puede ocurrir por extensión directa de un foco adyacente o por diseminación hematógena o linfangítica de lesiones primarias. El compromiso en los grandes vasos puede presentarse de diversas formas, incluyendo pólipos, aortoarteritis estenosante y formación de aneurismas o pseudoaneurismas, siendo esta última la más común. Presentamos el diagnóstico de aneurisma de aorta abdominal infrarrenal con trombo intramural y pseudoaneurisma de aorta renal izquierda como hallazgo incidental en una paciente con tuberculosis ganglionar.

The mycotic aneurysm arises from the infectious destruction of the arterial wall and is diagnosed when there is an aneurysm within the context of inflammation and positive blood cultures or biopsies, though this is not an essential requirement. The most common etiologic agents are bacteria (Staphylococcus, Salmonella)2, but fungi have also been reported (Aspergillus niger). Tuberculosis may affect any organ of the body; arterial compromise is a rare and potentially mortal complication that may occur by direct extension of an adjacent infected site or by bloodstream or lymphangitic dissemination of primary lesions. The great vessels may be compromised in different ways, including polyps, stenotic aortoarteritis and formation of aneurysms or pseudoaneurysms, being the latter the most common one. We present the diagnosis of infrarenal abdominal aortic aneurysm with intramural thrombus and left renal aortic pseudoaneurysm as incidental finding in a patient with nodal tuberculosis.

Pseudoaneurisma humeral secundario a punción arterial inadvertida / Brachial artery pseudoaneurysm secondary to inadvertent arterial puncture

RESUMEN Los pseudoaneurismas de la arteria humeral son infrecuentes, pero pueden asociarse a complicaciones de alta morbilidad como la isquemia de miembro superior. Comunicamos un caso de pseudoaneurisma humeral en el pliegue del codo, que se presentó como tumor pulsátil con leve disminución de la temperatura y parestesias en la mano homolateral de un año de evolución, debido a una punción arterial inadvertida durante la venopunción para extracción de sangre. Se trató con éxito mediante resección quirúrgica más reconstrucción vascular con bypass húmero-cubital y bypass húmero-radial ambos con vena safena. Se discuten las diversas opciones terapéuticas disponibles para los pseudoaneurismas humerales considerando las características anatómicas y la sintomatología del paciente.

ABSTRACT Brachial artery pseudoaneurysms are rare but can be associated with severe complications as ischemia of the upper extremity. We report a case of a brachial artery pseudoaneurysm in the crease of the elbow presenting as a pulsating mass with progressive growth over the past year. The ipsilateral hand was sightly cold and presented paresthesia. The lesion was due to inadvertent arterial puncture during venipuncture. The pseudoaneurysm was successfully treated with surgical resection and vascular reconstruction with a brachial to ulnar artery bypass and brachial to radial artery bypass with saphenous vein graft. The different therapeutic options available for brachial artery pseudoaneurysms are discussed, considering the anatomic characteristics and patients' symptoms.

Reparación endovascular de las lesiones traumáticas de la arteria subclavia / Endovascular repair of traumatic subclavian artery injuries

Resumen Introducción: La reparación convencional de la arteria subclavia es desafiante, con una morbilidad del 24% y mortalidad del 5% al 25%; las técnicas endovasculares permiten la reparación arterial subclavia desde un acceso distal, reduciendo la elevada morbimortalidad asociada. Objetivo: Evaluar los resultados a largo plazo del tratamiento endovascular de las lesiones traumáticas de la arteria subclavia. Materiales y Método: Estudio descriptivo, observacional (revisión de serie de casos unicéntrica) de pacientes sometidos a la reparación endovascular de la arteria subclavia, debido a lesiones traumáticas, utilizando dos técnicas (stent balón expandible y oclusión endovascular con balón) durante un período de 12 años (2007-2019) en el Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Se realizaron 15 procedimientos consecutivos, electivos (86,67%), urgencias (13,33%), sexo masculino (66,67%), femenino (33,33%), edad promedio de 55,8 años (rango 26-69), abordaje utilizado: arteria femoral común (93,33%) y arteria braquial (6,67%), etiología de las lesiones: iatrogenia (66,67%) y trauma (33,33%), reparación mediante stent balón expandible (66,67%), oclusión endovascular con balón (33,33%), tasa de éxito técnico (100%), tasa de permeabilidad primaria a 1, 5, 10 años del 100%, 93,33% y 86,66% respectivamente, seguimiento medio (61,4 meses), estancia hospitalaria promedio (3,3 días), tiempo quirúrgico promedio (75 min), no hubo morbilidad cardiovascular, neurológica central o mortalidad relacionada al procedimiento. Discusión: La técnica endovascular elimina la necesidad de disección quirúrgica, disminuyendo el riesgo de lesión de estructuras adyacentes, especialmente en pacientes politraumatizados. Conclusión: En pacientes adecuadamente seleccionados, la técnica endovascular representa una excelente estrategia terapéutica de reparación de las lesiones subclavias.

Introduction: Conventional subclavian artery repair is challenging, with 24% morbidity and 5% to 25% mortality. Endovascular techniques allow subclavian repair from a distal artery, reducing the associated high morbidity and mortality. Aim: To evaluate the long-term results of endovascular treatment of traumatic lesions of the subclavian artery. Materials and Method: Descriptive, observational study (single-center case series review) of patients undergoing endovascular repair of the subclavian artery due to traumatic injuries, using two techniques (expandable balloon stent and endovascular balloon occlusion), during a period of 12 years (2007-2019), at the Dr. Eduardo Pereira Hospital in Valparaíso, Chile. Results: 15 consecutive procedures were performed, elective (86.67%), emergencies (13.33%), male sex (66.67%), female (33.33%), average age of 55.8 years (range 26-69), approach used: common femoral artery (93.33%) and brachial artery (6.67%), etiology of the lesions: iatrogenesis (66.67%) and trauma (33.33%), repair by expandable balloon stent (66.67%), balloon occlusion (33.33%), technical success rate (100%), primary patency rate at 1, 5, 10 years of 100%, 93.33% and 86.66% respectively, mean follow-up (61.4 months), average hospital stay (3.3 days), average surgical time (75 min), there was no cardiovascular, central neurological morbidity or mortality related to the procedure. Discussion: Endovascular techniques eliminate the need for surgical dissection, reducing the risk of injury to adjacent structures, especially in multiple trauma patients. Conclusion: In properly selected patients, the endovascular technique represents an excellent therapeutic strategy for the repair of subclavian artery lesions.