Two stage, hybrid endovascular and open surgical approach to treat difficult carotid body tumors.

OBJECTIVE: Present the feasibility, applicability, clinical effectiveness, and results of complicated Shamblin II or III carotid body tumors treated with a two-stage hybrid surgical approach. MATERIALS AND METHODS: Retrospective, observational, cross-sectional, descriptive study of the successful treatment of 16 cases of difficult Shamblin II or III carotid body tumors, consisting of a two-stage surgical approach. We conducted a retrospective, observational, cross-sectional, descriptive study of a series of patients with complicated Shamblin II or III carotid body tumors, which we treated with a two-stage hybrid surgical procedure, in which we first placed a carotid endoprosthesis and 45 days later performed surgical resection of the tumor, following our originally published technique. This study was conducted from February, 2007 to November, 2019, in a third level care centre. RESULTS: We treated 16 patients with a mean age of 50.5 years. All resided at more than 2000 meters above sea level. In all 16 a complete resection was performed. The average duration of surgery was 103.9 min, the average intraoperative bleeding was 69 ml. There were three cases of neuropraxia. The ansa cervicalis nerve had to be sectioned in three cases and there was permanent upper laryngeal nerve injury in two cases. There were no permanent cerebrovascular injuries from placement of the endoprostheses. One patient developed transient cerebral ischaemia (TIA) with no long-term sequelae. There were two cases of asymptomatic late occlusion of the endoprostheses. The average initial volume of the tumors was 54.4 cc. The average tumor volume 35 days after implant of the endoprosthesis was 30.9 cc. SYMPTOMS: Presence of tumors in the neck in all cases and two cases of dysphagia. CONCLUSION: This two-stage hybrid technique allowed for the complete resection of difficult Shamblin II or III carotid body tumors, with one case of TIA and two with permanent upper laryngeal nerve injuries and without mortality.

Nonresectable carotid body tumor: hybrid surgical procedure to achieve complete and safe resection.

BACKGROUND: Carotid body tumors of Shamblin class III without free internal carotid, between the tumor and skull base, are considered nonresectable. The objective of this work is to describe a surgical technique that combines traditional and endovascular strategies to achieve a safe surgical resection of the carotid body tumor of this class. METHODS AND RESULTS: A female patient with a nonresectable carotid body tumor underwent placement of an endoprosthesis going from the common carotid artery to the internal carotid beyond the skull base (to secure cerebral circulation) excluding the external carotid artery. Forty-five days later, the tumor was resected without vascular or cranial nerves injury, and bleeding amounted to 50 cm(3). At 6 months, the patient is tumor free and asymptomatic. CONCLUSION: This is the first known reported case that has been successfully resolved by combining endovascular and traditional strategies. The endoprosthesis maintained cerebral circulation, which otherwise would have been impossible; besides, the vascular supply from the external carotid artery was excluded leading to a decrease in tumor size and a recovery of the sub-adventitial dissection plane, allowing for a successful and safe tumor resection.

Nuevo acceso a la arteria poplítea media e inferior para la interposición de un injerto femoropoplíteo / new access to middle and inferior popliteal artery and interposition of a graft to bypass femora and distal popliteal artery

Introducción: la enfermedad poplítea ateroesclerosa tiene relevancia, porque de una irrigación arterial adecuada de este segmento depende la viabilidad de la pierna y el pie. Las derivaciones laterales o "puentes" presentan un alto índice de fracasos debido al movimiento de flexión de la rodilla que modifica la estructura de la prótesis. Por lo que en esta comunicación se propone una modificación importante en la técnica quirúrgica.Material y método: la realización de esta técnica quirúrgica se llevó a cabo en 28 pacientes: 19 hombres y 9 mujeres con edad promedio de 70 años, quienes fueron atendidos y estudiados en la clínica de Angiología y Cirugía Vascular, ubicada en la sala 15 del Hospital Español. En todos ellos el común denominador fue que manifestaban lesiones isquémicas graves.La técnica consiste en llevar a cabo la interposición de un elemento protésico, mismo que es anastomosado en la "raíz" de la arteria femoral superficial en su porción proximal y en la arteria poplítea media a nivel de la línea articular en el hueco poplíteo, mediante la sección y eversión de la misma y colocación ulterior en sitio anatómico. Resultados: en 20 casos que han sido seguidos hasta por cinco años, 50 por ciento ha mantenido su permeabilidad.Discusión: no se encontraron antecedentes previos en la literatura de esta técnica de revascularización, misma que consideramos muy útil en los casos de lesión de la arteria poplítea proximal y medial, es por ello que ésta puede ser de elección en aquellos casos en los que se cumplan con los preceptos enunciados.