Aneurisma de arteria braquial inducido por el uso de muleta / Crutch-induced brachial artery aneurysm

Introducción: el uso de muletas de forma prolongada como desencadenante de aneurisma de arteria braquial es raro pero potencialmente vital. Caso clínico: presentamos a una paciente de 84 años, con historia de poliomielitis y uso prolongado de muleta en brazo derecho. Se diagnostica de isquemia crítica secundaria a oclusión de aneurisma de arteria braquial y lesiones por embolización distal. A pesar de realizarse injerto venoso, la paciente presenta mala evolución con amputación de antebrazo. Discusión: es de vital importancia el reconocimiento y tratamiento de esta patología.(AU)

Introduction: the prolonged use of crutches resulting in a brachial aneurysm is rare but potentially vital. Case report: we present an 84-year-old patient with a history of poliomyelitis and prolonged use of a crutch in her right arm. She was diagnosed with critical ischemia secondary to occlusion of brachial artery aneurysm and distal embolization lesions. Despite having performed a venous graft, the patient presented a poor evolution which resulted in a forearm amputation. Discussion: it's of vital importance to recognize and treat this pathology.(AU)

Giant Symptomatic Aneurysm Secondary to Hereditary Hemorrhagic Telangiectasia of a Main Hepatic Artery with Aberrant Origin in Superior Mesenteric Artery.

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) is a rare disease consistent in vascular dysplasias affecting different organs. Liver involvement includes telangiectases, arteriovenous shunting, and ischemic cholangitis, and its prevalence ranges from 8% to 31%. Spontaneous pseudoaneurysms have never been reported associated to HHT. Several variations in the origin of the main hepatic artery (MHA) have been described in large radiological series and can be found in around 4% of general population. METHODS: A 64-year-old woman with history of HHT was diagnosed of acute symptomatic saccular aneurysm involving the MHA. The associated portovenous fistulae suggested that liver perfusion could be impaired if embolization of the MHA without revascularization was performed. Because of an aberrant origin on the superior mesenteric artery, a hybrid procedure was designed, consistent on endovascular exclusion of the MHA associated with a surgical aortic-hepatic bypass graft. RESULTS: Angio computed tomography (Angio CT) was performed at discharge, 1 month, and 6 months after intervention, revealed complete exclusion of the aneurysm, which reduced 50% in diameter after 6 months. Aneurysms of the MHA can be associated with HHT when intrahepatic arteriovenous fistulae are present. This complication is rare, and the reported cases have been treated by surgical and totally endovascular procedures. The confluence of this very rare condition with an uncommon vascular anatomy makes this a unique case that required the design of a customized intervention. CONCLUSIONS: Hybrid procedures are useful to treat conditions that cannot be solved with standard interventions. Longer series of cases with long-term surveillance are needed to asses the results of these techniques in these complex pathology.

Comparison of Bypass with Endoscopically Harvested Internal Saphenous Vein versus Bypass with Surgically Harvested Internal Saphenous Vein for Lower Limb Arterial Disease.

BACKGROUND: Patients with lower limb arterial disease have a high risk for complications related with surgical wounds. The endoscopic extraction of the great saphenous vein (GSV) is a less invasive alternative to the conventional surgical extraction. METHODS: A clinical and ultrasonographic follow-up was carried out on the lower limb bypass with GSV performed in our institution between years 2007 and 2012. Patients were selected for open or endoscopic harvesting depending on the surgeon assigned (endoscopic or open surgeon). Follow-up was performed at 1, 3, 6, and 12 months after surgery and annually thereafter. All the GSV endoscopic harvestings (GSVEH) were performed by the same surgeon. Data for primary, assisted, and secondary patency and amputation-free survival were analyzed. Anatomopathalogic analysis were performed on pares of samples of the same vein dissected surgically and endoscopically from the same patient. RESULTS: Sixty bypass surgery has been performed on 60 patients (54 men and 6 women), 30 with GSVEH (50%), and 30 with GSV open harvesting (GSVOH). All patients were intervened for critical limb ischemia (Rutherford cathegory 4, 5, and 6). Significant differences were found between both groups for suture dehiscence (GSVEH 0%, GSVOH 20%, P = 0.01) and infection (GSVEH 3%, GSVOH 30% P, 0.006). No significant differences were found between both groups regarding to primary patency, assisted primary patency, or amputation-free survival. An anatomopathologic comparison of segments of veins extracted surgically and endoscopically of the same patients did not show any significant differences. CONCLUSIONS: Although no statistically significant differences were found between GSVOH and GSVEH bypass for lower limb revascularization, there is a trend toward poorer patency rates for the endoscopic technique. GSVEH lowers the risks for infection and dehiscence of surgical wounds.