RESUMO
Venous stenoses are the leading cause of dialysis graft and mature dialysis fistula malfunction. We report a simple, inexpensive technique for treating stenoses that are refractory to conventional balloon angioplasty and present a case in which this technique was successfully applied.
Assuntos
Angioplastia com Balão , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/terapia , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Extremidades/irrigação sanguínea , Feminino , Humanos , Pessoa de Meia-Idade , Veias/patologiaRESUMO
Uterine artery vasospasm can complicate uterine artery embolization (UAE) by prolonging procedure times or even causing treatment failure. Embolization must be delayed until the spasm improves and adequate antegrade flow in the vessel is restored. Vasospasm can also produce a "false endpoint" to the procedure, where stasis of flow in the vessel is falsely attributed to successful embolization but is actually the result of vasospasm, leading to undertreatment or treatment failure. Traditional treatments for uterine artery vasospasm have included transcatheter intra-arterial vasodilators and catheter withdrawal from the vessel, both of which can yield mixed results. We report a case of uterine artery vasospasm during UAE successfully treated with transdermal nitroglycerine ointment.
Assuntos
Embolização Terapêutica , Leiomioma/terapia , Nitroglicerina/uso terapêutico , Espasmo/prevenção & controle , Neoplasias Uterinas/terapia , Vasodilatadores/uso terapêutico , Administração Cutânea , Artérias/fisiopatologia , Embolização Terapêutica/métodos , Feminino , Humanos , Leiomioma/irrigação sanguínea , Pessoa de Meia-Idade , Pomadas , Espasmo/etiologia , Neoplasias Uterinas/irrigação sanguíneaRESUMO
OBJECTIVE: The objective of our study was to evaluate the efficacy and safety of balloon dilatation in the treatment of anastomotic strictures in children with liver transplants. MATERIALS AND METHODS: For a period of 7 years, we treated 20 consecutive biliary-enteric strictures in 19 children (age range, 13 months to 17.9 years, mean, 7.3 years) with balloon dilatation. Dilatation was performed between 30 days and 8.4 years (mean, 2.6 years) following surgical creation of the biliary-enteric anastomosis. Thirteen patients had left lateral segment liver transplant grafts, one patient had a split-liver, left-lobe graft, and five patients had whole liver grafts. RESULTS: Technical success was 100% and there were no procedure-related complications. One patient with a patent anastomosis underwent repeat transplantation 183 days after the procedure for chronic rejection. In 58% (11/19) of the remaining procedures, balloon dilatation resulted in biliary-enteric patency at one year, and continued patency ranges from 1.4 to 5.4 years (mean, 3.6 years). In 40% (8/20) of the procedures, the biliary-enteric stricture persisted after balloon dilatation, and these patients eventually underwent surgical revision, retransplantation, or endobiliary metallic stent placement. CONCLUSION: Balloon dilatation is a safe and effective treatment for biliary-enteric strictures following pediatric liver transplantation.
