RESUMO
Percutaneous transluminal angioplasty and stenting is being employed with increasing frequency for stenosis involving the brachiocephalic circulation. However, the efficacy of these procedures is limited by intimal hyperplasia and subsequent re-stenosis. Long-term results for treating lesions of the subclavian or innominate artery have shown significant re-stenotic rate. Accordingly, carotid-subclavian bypass remains as an important procedure. Alternative methods may still be required, particularly after failure of open re-vascularization and percutaneous techniques. This report describes an underused technique that enables upper extremity revascularization following prior attempts at endovascular and standard open techniques.
Assuntos
Anastomose Cirúrgica/métodos , Angioplastia , Arteriopatias Oclusivas , Artéria Axilar , Artéria Carótida Primitiva , Oclusão de Enxerto Vascular , Angiografia/métodos , Angioplastia/efeitos adversos , Angioplastia/métodos , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/fisiopatologia , Arteriopatias Oclusivas/cirurgia , Artéria Axilar/diagnóstico por imagem , Artéria Axilar/cirurgia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/cirurgia , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/cirurgia , Feminino , Oclusão de Enxerto Vascular/diagnóstico , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/cirurgia , Humanos , Pessoa de Meia-Idade , Reoperação , Stents , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Resultado do Tratamento , Extremidade Superior/irrigação sanguínea , Grau de Desobstrução VascularRESUMO
Carotid endarterectomy continues to be an operation that is widely employed and associated with excellent outcomes. Challenges to attain adequate field visualization do occur. A new retracting device is described that vastly improves operative field visualization, particularly in the upper area where high lesions and limited cervical mobility can restrict or hamper technical maneuvers. Complex maneuvers such as mandibular subluxation or osteotomy may be obviated.
Assuntos
Endarterectomia das Carótidas/instrumentação , Dissecação/instrumentação , Desenho de Equipamento , HumanosAssuntos
Oclusão Vascular Mesentérica/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Abdome Agudo , Humanos , Masculino , Oclusão Vascular Mesentérica/diagnóstico por imagem , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler Dupla , Grau de Desobstrução VascularRESUMO
The components-separation technique was originally described and has been popularised for the treatment of large midline hernias. In this report, we indicate that components separation can also be applied for the closure of transverse non-midline hernias, provided the largest diameter of the defect (i.e., the transverse axis) corresponds to a size typically amenable to be closed by this technique. This idea will help surgeons in considering technical options available when facing patients with transverse incisional hernias and not willing to add prosthetic materials to a complicated abdominal wall.