Disección espontánea de arteria renal / Spontaneous renal artery dissection

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Complicaciones tras el empleo del dispositivo de cierre arterial StarClose® en punciones femorales / Complications after the use of a StarClose® vascular closure device for femoral punctures

El dispositivo de cierre arterial StarClose® (Abbot Vascular Devices, Abbot Laboratories,Redwood city, CA, EE.UU.) sella de forma rápida una punción arterial femoral mediante la colocación de un clip de nitinol en la adventicia de la arteria. Es un dispositivo seguro y efectivo, con ventajas respecto a la compresión manual, pero que no está exento de complicaciones. Presentamos dos casos con complicaciones tras utilización de StarClose® (AU)

The StarClose® arterial device (Abbot Vascular Devices, Abbot Laboratories, Redwood City, CA, USA) rapidly seals a femoral artery puncture by means of a nitinol clip in the adventitia of the artery. It is a safe and effective device, with advantages as regards manual compression, but is not free of complications. We present two cases with complications after using a StarClose® vascular device (AU)

[Complications after the use of a StarClose® vascular closure device for femoral punctures]. / Complicaciones tras el empleo del dispositivo de cierre arterial StarClose® en punciones femorales.

The StarClose(®) arterial device (Abbot Vascular Devices, Abbot Laboratories, Redwood City, CA, USA) rapidly seals a femoral artery puncture by means of a nitinol clip in the adventitia of the artery. It is a safe and effective device, with advantages as regards manual compression, but is not free of complications. We present two cases with complications after using a StarClose(®) vascular device.

Trombosis arterial secundaria a exostosis de tibia y peroné / Arterial thrombosis secondary to tibia and fibula exostosis

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Tratamiento híbrido de un aneurisma sintomático de un divertículo de Kommerell / Hybrid treatment of a symptomatic aneurysm of a Kommerell's diverticulum

El arco aórtico izquierdo con arteria subclavia derecha aberrante constituye la anomalía vascular congénita más común del arco aórtico. En el 60% de casos se origina de un segmento dilatado, denominado divertículo de Kommerell. El aneurisma de la arteria subclavia derecha aberrante es raro, puede ser clínicamente silente o cursar con síntomas inespecíficos y su rotura se asocia a una elevada mortalidad. No hay criterios precisos para el tratamiento, pero se recomienda su reparación cuando se producen síntomas por compresión o cuando alcanza 30-50mm. La radiografía puede hacer sospechar la malformación, pero la resonancia magnética (RM) o la tomografía computarizada (TC) son las pruebas de elección para realizar el diagnóstico y planificar el tratamiento. Presentamos un caso de una arteria subclavia derecha aberrante con un pequeño aneurisma calcificado en un divertículo de Kommerell que provocó dolor torácico y disfagia y fue tratado mediante un procedimiento combinado endovascular y quirúrgico (AU)

Left aortic arch with aberrant right subclavian artery is the most common congenital vascular anomaly involving the aortic arch. In 60% of cases, the aberrant right subclavian artery arises from a dilated segment of the aortic arch called Kommerell's diverticulum. Aneurysm of the aberrant right subclavian artery is rare; this condition could remain clinically silent or it could originate nonspecific symptoms. Rupture of an aneurysm of the aberrant right subclavian artery is associated with high mortality. Although there are no exact criteria to indicate the treatment of this condition, repair of the aneurysm is recommended when symptoms occur or when it reaches a size of 30mm to 50mm. The malformation can be suspected at plain-film X-ray examination, but magnetic resonance imaging (MRI) or computed tomography (CT) are the imaging tests of choice for the diagnosis and for planning treatment. We present the case of a patient with an aberrant right subclavian artery with a small calcified aneurysm in a Kommerell's diverticulum that caused chest pain and dysphagia; the patient underwent a procedure combining endovascular and surgical treatment (AU)

[Hybrid treatment of a symptomatic aneurysm of a Kommerell's diverticulum]. / Tratamiento híbrido de un aneurisma sintomático de un divertículo de Kommerell.

Left aortic arch with aberrant right subclavian artery is the most common congenital vascular anomaly involving the aortic arch. In 60% of cases, the aberrant right subclavian artery arises from a dilated segment of the aortic arch called Kommerell's diverticulum. Aneurysm of the aberrant right subclavian artery is rare; this condition could remain clinically silent or it could originate nonspecific symptoms. Rupture of an aneurysm of the aberrant right subclavian artery is associated with high mortality. Although there are no exact criteria to indicate the treatment of this condition, repair of the aneurysm is recommended when symptoms occur or when it reaches a size of 30 mm to 50mm. The malformation can be suspected at plain-film X-ray examination, but magnetic resonance imaging (MRI) or computed tomography (CT) are the imaging tests of choice for the diagnosis and for planning treatment. We present the case of a patient with an aberrant right subclavian artery with a small calcified aneurysm in a Kommerell's diverticulum that caused chest pain and dysphagia; the patient underwent a procedure combining endovascular and surgical treatment.

Our experience with Wallstent self-expanding metal prostheses in 65 patients with malignant dysphagia.

OBJECTIVE: to document the usefulness of self-expanding metal stents in patients with malignant dysphagia. METHOD: from January 1992 to January 1997 we implanted 75 Wallstent prostheses (28 uncovered AV, 20 uncovered Unistep, 15 covered Telestep, and 2 covered double-mesh Permalume stents) in 65 patients with malignant dysphagia. RESULTS: mean survival time was 100 days in patients with uncovered stents, and 215 days in patients with covered stents. Oral feeding was possible throughout the post-implantation course in 58 of 65 patients. Only two severe complications occurred: esophageal perforation with mediastinitis, and migration of the stent from the distal esophagus into the stomach. All implantation procedures were done under radiological guidance. For AV and Unistep prostheses we used a nasal approach without sedation, and for Telestep and Permalume stents we used an oral approach with sedation. CONCLUSIONS: Wallstent self-expanding metal stents are useful in palliating malignant dysphagia. The placement and implantation of these stents are straightforward.

[Postbiopsy giant pseudoaneurysm in renal transplant: treatment with embolization]. / Pseudoaneurisma gigante postbiopsia en injerto renal: tratamiento mediante embolización.

Pseudoaneurism in renal grafts is a well known complication of the percutaneous biopsy. Colour Doppler has been shown to be the choice technique for their diagnosis and subsequent control, the most effective treatment being embolization. This paper presents an unusual form of pseudoaneurism in terms of its size (up to 8 cm diameter) in a renal graft, following performance of a percutaneous biopsy with automatic needle. The findings of the colour Doppler study and the angiography are shown and discussed, as well as the treatment by embolization with metal spirals which achieved the stable, complete occlusion of the lesion after six months control.