Ruptured ileocolic artery pseudoaneurysm: case report.

Visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) are rare conditions and are potentially lethal when they rupture. They are usually found as incidental findings on computed tomography (CT) scans of asymptomatic patients. Although conventional open surgery is currently considered the gold standard treatment, the endovascular approach has gained prominence as a minimally invasive procedure with lower surgical risk. In this approach, use of coil embolization in saccular VAAs and VAPAs and implantation of flow-modulating stents constitute alternative treatments for fusiform aneurysms. We present the case of a 51-year-old female patient complaining of acute abdominal pain, tachycardia, and hypotension, with evidence of abdominal bleeding on CT angiography, who was diagnosed with a ruptured ileocolic artery (ICA) pseudoaneurysm. She underwent early endovascular treatment for ICA embolization, which was successful and achieved clinical improvement.

Pseudoaneurisma roto de artéria ileocólica: relato de caso / Ruptured ileocolic artery pseudoaneurysm: case report

Resumo Os aneurismas de artérias viscerais (AAVs) e pseudoaneurismas de artérias viscerais (PAAVs) são condições raras e potencialmente letais quando rotos. Em geral, são encontrados incidentalmente na tomografia computadorizada de pacientes assintomáticos. Embora a cirurgia aberta convencional seja considerada atualmente o tratamento padrão ouro, a abordagem endovascular vem ganhando relevo por ser considerada um procedimento minimamente invasivo e com riscos cirúrgicos menores. Destaca-se, nessa abordagem, o uso de embolização por molas (coils) em AAVs e PAAVs saculares e implante de stent modulador de fluxo como alternativa de tratamento para aneurismas fusiformes. Apresentamos o caso de uma paciente de 51 anos com queixa de dor abdominal aguda, taquicardia e hipotensão, com evidência de sangramento abdominal em angiotomografia e diagnóstico de pseudoaneurisma de artéria ileocólica (AIC) roto. Ela foi submetida a tratamento endovascular precoce de embolização da AIC com sucesso, e houve melhora do quadro clínico.

Abstract Visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) are rare conditions and are potentially lethal when they rupture. They are usually found as incidental findings on computed tomography (CT) scans of asymptomatic patients. Although conventional open surgery is currently considered the gold standard treatment, the endovascular approach has gained prominence as a minimally invasive procedure with lower surgical risk. In this approach, use of coil embolization in saccular VAAs and VAPAs and implantation of flow-modulating stents constitute alternative treatments for fusiform aneurysms. We present the case of a 51-year-old female patient complaining of acute abdominal pain, tachycardia, and hypotension, with evidence of abdominal bleeding on CT angiography, who was diagnosed with a ruptured ileocolic artery (ICA) pseudoaneurysm. She underwent early endovascular treatment for ICA embolization, which was successful and achieved clinical improvement.

Prophylactic catheterization of uterine arteries with temporary blood flow occlusion in patients at high risk of pospartum hemorrhage: is it a safe technique?

BACKGROUND: Placenta accreta is an important factor in maternal morbidity and mortality and is responsible for approximately 64% of emergency hysterectomy cases and about 2/3 of cases of puerperal bleeding. OBJECTIVES: To describe a series of cases of prophylactic uterine catheterization performed to prevent significant postpartum bleeding or during caesarean delivery in pregnant women with a previous diagnosis of accretion. METHODS: A retrospective analysis was conducted of medical records of cases of uterine artery catheterization performed during elective or emergency caesarean sections of patients at high risk of postpartum bleeding. RESULTS: The catheterization of uterine arteries procedure was performed in fourteen patients. Mean duration of surgery and hospital stay were 214.64 minutes (± 42.16) and 7 days, respectively. All patients underwent obstetric hysterectomy. No patient required embolization. There was no bleeding or need to revisit any patient and there were no complications related to puncture. There was one fetal death and no maternal deaths. CONCLUSIONS: In this study, prophylactic uterine artery catheterization with temporary occlusion of blood flow proved to be a safe technique with low fetal mortality, no maternal mortality, and a low rate of blood transfusion and can be considered an important and effective therapeutic strategy for reduction of maternal morbidity and mortality, especially in pregnant women with anomalous placental attachment. Furthermore, the possibility of uterine preservation with the use of this method is an excellent contribution to therapeutic management of this group of patients. However, randomized clinical trials are needed to evaluate the effectiveness of routine use of the technique.

Cateterização profilática de artérias uterinas com oclusão temporária do fluxo sanguíneo em pacientes de alto risco para hemorragia puerperal: é uma técnica segura? / Prophylactic catheterization of uterine arteries with temporary blood flow occlusion in patients at high risk of pospartum hemorrhage: is it a safe technique?

A placenta acreta é um importante causa de morbimortalidade materna, sendo responsável por aproximadamente 64% dos casos de histerectomia de urgência e em torno de 2/3 dos casos de sangramento puerperal. Objetivos Descrever uma série de casos de cateterização uterina profilática para evitar sangramento significativo no pós-parto ou durante parto cesárea em gestantes com diagnóstico prévio de acretismo. Métodos Foi realizada uma análise retrospectiva de prontuários dos casos de cateterização da artéria uterina durante cesarianas eletivas ou de urgência em pacientes com alto risco de sangramento puerperal. Resultados O procedimento foi realizado em 14 pacientes. O tempo médio do procedimento cirúrgico e da internação foi de 214,64 minutos (± 42,16) e 7 dias, respectivamente. Todas as pacientes foram submetidas a histerectomia por indicação obstétrica. Nenhuma paciente necessitou de embolização. Não houve sangramento ou necessidade de reabordagem em nenhuma paciente e nenhuma complicação relacionada à punção. Houve apenas um caso de morte fetal e nenhuma morte materna. Conclusões Neste estudo, a cateterização profilática de artérias uterinas com oclusão temporária do fluxo sanguíneo demonstrou ser uma técnica segura, pois apresentou baixa mortalidade fetal, baixa necessidade de hemotransfusão, e nenhuma morte materna. Portanto, pode ser considerada uma estratégia terapêutica importante e eficaz para a diminuição da morbimortalidade materna, especialmente em gestantes com implantação placentária anômala. Além disso, a possibilidade de preservação uterina com o uso do método traz excelente contribuição na terapêutica nesse grupo de pacientes. Entretanto, são necessários ensaios clínicos randomizados para avaliar a eficácia do uso rotineiro da técnica

Placenta accreta is an important factor in maternal morbidity and mortality and is responsible for approximately 64% of emergency hysterectomy cases and about 2/3 of cases of puerperal bleeding. Objectives To describe a series of cases of prophylactic uterine catheterization performed to prevent significant postpartum bleeding or during caesarean delivery in pregnant women with a previous diagnosis of accretion. Methods A retrospective analysis was conducted of medical records of cases of uterine artery catheterization performed during elective or emergency caesarean sections of patients at high risk of postpartum bleeding. Results The catheterization of uterine arteries procedure was performed in fourteen patients. Mean duration of surgery and hospital stay were 214.64 minutes (± 42.16) and 7 days, respectively. All patients underwent obstetric hysterectomy. No patient required embolization. There was no bleeding or need to revisit any patient and there were no complications related to puncture. There was one fetal death and no maternal deaths. Conclusions In this study, prophylactic uterine artery catheterization with temporary occlusion of blood flow proved to be a safe technique with low fetal mortality, no maternal mortality, and a low rate of blood transfusion and can be considered an important and effective therapeutic strategy for reduction of maternal morbidity and mortality, especially in pregnant women with anomalous placental attachment. Furthermore, the possibility of uterine preservation with the use of this method is an excellent contribution to therapeutic management of this group of patients. However, randomized clinical trials are needed to evaluate the effectiveness of routine use of the technique

Cardiovascular mortality and its relation to socioeconomic levels among inhabitants of São José do Rio Preto, São Paulo state, Brazil.

OBJECTIVE: To analyze cardiovascular mortality indicators in São José do Rio Preto--a city in the State of São Paulo, Brazil--and to evaluate the municipality's mortality rates by socioeconomic levels. METHODS: Data used came from the Mortality Information System and from the Information and Computing Department of the federal governments Unified Health System (SUS). Standardized mortality rates and proportional cardiovascular mortality rates were calculated. A thematic map of the demographic census sectors of the city's urban area--grouped according to socioeconomic levels--was drawn up and is presented with the respective rates. RESULTS: The municipal, state, and national mortality rates decreased in the course of the 1980-2002 period. The municipal mortality rate in 2003 stood at 195.9 deaths per 100,000 inhabitants, with proportional cardiovascular mortality at 31.3%. The three main causes of death were cerebrovascular disease, myocardial infarction, and hypertensive disease. The mortality rate for the population corresponding to the group featuring the lowest socioeconomic levels was 40% higher than that of the group comprising the highest socioeconomic levels. CONCLUSION: The cardiovascular mortality rate decreased in the three geographical areas analyzed. This group of diseases was responsible for approximately one-third of all deaths in São José do Rio Preto in 2003. The area with the lowest socioeconomic level presented the highest mortality rate.

Mortalidade por doenças cardiovasculares e níveis socioeconômicos na população de São José do Rio Preto, estado de São Paulo, Brasil / Cardiovascular mortality and its relation to socioeconomic levels among inhabitants of São José do Rio Preto, São Paulo state, Brazil

OBJETIVO: Analisar os indicadores de mortalidade para doenças cardiovasculares em São José do Rio Preto, no estado de São Paulo e no Brasil e avaliar os coeficientes de mortalidade segundo níveis socioeconômicos da população do município. MÉTODOS: Utilizaram-se informações sobre mortalidade por doenças cardiovasculares e de população do Sistema de Informações de Mortalidade e do Departamento de Informação e Informática do Sistema Unico de Saúde. Calcularam-se coeficientes padronizados de mortalidade e mortalidade proporcional por doenças cardiovasculares. Gerou-se mapa temático dos setores censitários da área urbana do município agrupados segundo níveis socioeconômicos, apresentado com os respectivos coeficientes. RESULTADOS: Os coeficientes de mortalidade para o município, o estado e o país decresceram de 1980 a 2002. Em 2003, o coeficiente do município foi de 195,9 óbitos por 100.000 habitantes, a mortalidade proporcional foi de 31,3 por cento e as três principais causas de morte foram a doença cerebrovascular, o infarto e a doença hipertensiva. O coeficiente de mortalidade da população correspondente ao grupo de setores censitários com o pior nível socioeconômico foi 40 por cento superior ao com o melhor nível. CONCLUSÃO: O coeficiente de mortalidade por doenças cardiovasculares decresceu nas três áreas geográficas analisadas. Do total de óbitos ocorridos em São José do Rio Preto em 2003, aproximadamente um terço foi por este grupo de doenças. A área com nível socioeconômico menos favorecido apresentou o maior coeficiente de mortalidade.

OBJECTIVE: To analyze cardiovascular mortality indicators in São José do Rio Preto - a city in the State of São Paulo, Brazil - and to evaluate the municipalityÆs mortality rates by socioeconomic levels. METHODS: Data used came from the Mortality Information System and from the Information and Computing Department of the federal governmentÆs Unified Health System (SUS). Standardized mortality rates and proportional cardiovascular mortality rates were calculated. A thematic map of the demographic census sectors of the cityÆs urban area - grouped according to socioeconomic levels - was drawn up and is presented with the respective rates. RESULTS: The municipal, state, and national mortality rates decreased in the course of the 1980-2002 period. The municipal mortality rate in 2003 stood at 195.9 deaths per 100,000 inhabitants, with proportional cardiovascular mortality at 31.3 percent. The three main causes of death were cerebrovascular disease, myocardial infarction, and hypertensive disease. The mortality rate for the population corresponding to the group featuring the lowest socioeconomic levels was 40 percent higher than that of the group comprising the highest socioeconomic levels. CONCLUSION: The cardiovascular mortality rate decreased in the three geographical areas analyzed. This group of diseases was responsible for approximately one-third of all deaths in São José do Rio Preto in 2003. The area with the lowest socioeconomic level presented the highest mortality rate.