RESUMEN
We present a case of a 61 year old man who presented with a 3 week history of easy bruising and ecchymoses in both thighs and right arm without significant trauma. Physical exam was remarkable for oozing gums, diminished second heart sound, a systolic ejection murmur at the aortic position with radiation to carotids, and delayed pulses. Laboratories were remarkable for iron deficiency anemia. Echocardiogram was consistent with severe aortic stenosis. Colonoscopy revealed several arteriovenous malformations throughout the colon. There is an association between severe aortic stenosis and gastrointestinal bleeding. The pathogenesis of Heyde's Syndrome involves iron deficiency anemia due to acquired von Willebrand factor (vWF) deficiency and ultimately gastrointestinal angiodysplasia. Correct diagnosis and management warrants a multidisciplinary approach.
Asunto(s)
Proteínas ADAM/metabolismo , Angiodisplasia/etiología , Estenosis de la Válvula Aórtica/complicaciones , Hemorragia Gastrointestinal/etiología , Enfermedades de von Willebrand/etiología , Proteína ADAMTS13 , Angiodisplasia/diagnóstico , Estenosis de la Válvula Aórtica/fisiopatología , Colonoscopía , Nefropatías Diabéticas/complicaciones , Equimosis/etiología , Activación Enzimática , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Estabilidad Proteica , Estructura Cuaternaria de Proteína , Resistencia al Corte , Síndrome , Negativa del Paciente al Tratamiento , Enfermedades de von Willebrand/diagnóstico , Factor de von Willebrand/químicaRESUMEN
Endovascular therapy has emerged as an essential part of the management we can offer patients suffering from peripheral arterial disease. The AHA/ACCF guidelines deemed ballon angioplasty as a reasonable alternative for patients with limb threatening lower extremity ischemia who are not candidates for an autologus venous graft. Endovascular treatment is most useful for the treatment of critical limb ischemia and should ensure adequate proximal flow before engaging in interventions of distal disease.To increase procedure success rate, a thorough diagnostic evaluation is fundamental. This evaluation must take into account amount of calcium, no flow occlusion, length of occlusion, and presence of collaterals. There are different tools and procedure techniques available. Among these are the medicated ballon angioplasty and atherectomy by laser or high-speed drill, among others. Further studies may consolidate endovascular intervention as a safe and effective management for patients with lower extremity arterial disease and possibly cause a change in the actual practice guidelines.