RESUMO
A patient who suffered recurrent myocardial ischaemia and cerebrovascular symptoms 56 months after a quadruple coronary bypass is reported. Three coronary arteries had been bypassed using reversed saphenous vein and the other using the left internal mammary artery (IMA). Coronary angiography demonstrated patency of al bypasses but the presence of an obstruction of the left subclavian artery proximal to the origin of the left IMA, with angiographic criteria of the steal syndrome. The patient's symptoms were relieved by bypass from the left common carotid artery to the distal left subclavian artery. The pathophysiology, diagnosis, prevention and treatment of coronary steal syndrome are discussed.
Assuntos
Angina Instável/cirurgia , Ponte de Artéria Coronária , Anastomose de Artéria Torácica Interna-Coronária , Complicações Pós-Operatórias/diagnóstico por imagem , Síndrome do Roubo Subclávio/diagnóstico por imagem , Veias/transplante , Insuficiência Vertebrobasilar/diagnóstico por imagem , Idoso , Angina Instável/diagnóstico por imagem , Angiografia Digital , Prótese Vascular , Artéria Carótida Primitiva/cirurgia , Humanos , Masculino , Reoperação , Artéria Subclávia/cirurgia , Síndrome do Roubo Subclávio/cirurgia , Insuficiência Vertebrobasilar/cirurgiaRESUMO
In our experience intraoperative arteriography in carotid endarterectomy is very effective in detecting residual small lesions after surgery. There were no neurosurgical complications due to arteriography. The interpretation of the surgical results is objective since the criteria are the same as those used to assess preoperative arteriography. Different intraoperative assessment methods to control carotid endarterectomy are also analysed.
Assuntos
Angiografia/métodos , Artérias Carótidas/cirurgia , Endarterectomia , Artérias Carótidas/diagnóstico por imagem , Humanos , Período Intraoperatório , Ataque Isquêmico Transitório/etiologia , Complicações Pós-OperatóriasRESUMO
Three thoraco-abdominal aneurysms treated surgically are presented. They were operated between July 1975 and February 1978. The different surgical-techniques are emphasized, which in turn allow us to comment on the complications that these types of patients may have. All our three patients were operated following the "Retrograde Revascularization Technique" proposed by Dubost. We think that the ischemic time of the visceral arteries is less than following the more simplified, less time consuming and perhaps less traumatic "Graft Inclusion and Direct Vessel Reattachment Crawford-Technique". The incidence of paraplegia can be reduced by maintaining normal blood pressure and reattaching intercostal and lumbar arteries to the graft. Two of our patients survived without presenting any complication in the last four years. The third died in the immediate postoperative period, due to insoluble coagulation problems after massive blood transfusion during surgery.
