RESUMO
A postnephrectomy renal acquired arteriovenous fistula (AVF) is a rare clinical entity that may cause high-output heart failure. Most of the cases are identified time along after surgery. We present a case of a postnephrectomy renal AVF treated with aortic customized stent-graft.
Assuntos
Fístula Arteriovenosa/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Nefrectomia/efeitos adversos , Artéria Renal/cirurgia , Veias Renais/cirurgia , Stents , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Desenho de Prótese , Artéria Renal/diagnóstico por imagem , Veias Renais/diagnóstico por imagem , Resultado do TratamentoRESUMO
OBJECTIVES: Non tractable hematuria has a varied etiology. It may be a complication difficult to treat. We report the case treated in our hospital by selective arterial embolization. METHODS: We report the case of an 86-year-old patient who underwent radiotherapy for transitional cell carcinoma. Later on, she presented with hematuria, not responding to usual therapeutic management. Urinary diversion did not solve the problem either. We decided to proceed with selective arterial embolization of the hypogastric arteries using polyvinylalcohol microspheres and metallic coils. RESULTS: Hematuria disappeared after embolization, without the recurrence after nine months of follow-up. Immediate outcome was characterized by a post-embolization syndrome which was treated with antipyretics, antibiotic and morphine derivatives. It diminished progressively and disappeared in 48 hours. CONCLUSIONS: Arterial selective embolization is a useful therapeutic resource for the management of non tractable hematuria, mainly in cancer patients, which present a deteriorated general status.
Assuntos
Embolização Terapêutica , Hematúria/terapia , Lesões por Radiação/terapia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/radioterapia , Carcinoma de Células de Transição/cirurgia , Terapia Combinada , Embolização Terapêutica/instrumentação , Feminino , Hematúria/etiologia , Humanos , Injeções Intra-Arteriais , Microesferas , Recidiva Local de Neoplasia/radioterapia , Nefrectomia , Cuidados Paliativos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Lesões por Radiação/etiologia , Radioterapia/efeitos adversos , Ureter/cirurgia , Ureterostomia , Neoplasias da Bexiga Urinária/radioterapia , Neoplasias da Bexiga Urinária/cirurgia , Derivação UrináriaRESUMO
OBJETIVOS: La hematuria incoercible es uncuadro de etiología diversa. Puede ser una complicacióndifícil de controlar. Nos proponemos presentar un caso tratadoen nuestro hospital con embolización arterial selectiva.MÉTODOS: Comunicamos el caso de una paciente de86 años sometida a tratamiento radioterápico debido aneoplasia urotelial. Presentó posteriormente una hematuriaque no cedió a las medidas terapéuticas habituales.Tampoco la derivación urinaria solucionó el cuadro. Porello optamos por practicar una embolización arterial selectivade arterias hipogástricas, con microesferas de polivinilode alcohol y coils metálicos.RESULTADO: La hematuria desapareció desde el momentode la embolización, sin reaparecer en un tiempo deseguimiento de nueve meses. La evolución inmediata secaracterizó por un síndrome post-embolización, tratadocon antitérmicos, antibiótico y derivados mórficos. Cedióprogresivamente hasta desaparecer a las 48h.CONCLUSIONES: La embolización arterial selectiva esun recurso terapéutico útil para el manejo de hematuriasde difícil control, sobre todo en enfermos neoplásicos, yade por sí muy deteriorados
OBJECTIVES: Non tractable hematuria has ;;a varied etiology. It may be a complication difficult to ;;treat. We report the case treated in our hospital by selective ;;arterial embolization. ;;METHODS: We report the case of an 86-year-old patient ;;who underwent radiotherapy for transitional cell carcinoma. ;;Later on, she presented with hematuria, not responding to ;;usual therapeutic management. Urinary diversion did not ;;solve the problem either. We decided to proceed with ;;selective arterial embolization of the hypogastric arteries ;;using polyvinylalcohol microspheres and metallic coils. ;;RESULTS: Hematuria disappeared after embolization, ;;without the recurrence after nine months of follow-up. ;;Immediate outcome was characterized by a post-embolization ;;syndrome which was treated with antipyretics, antibiotic ;;and morphine derivatives. ;;It diminished progressively and disappeared in 48 hours. ;;CONCLUSIONS: Arterial selective embolization is a useful ;;therapeutic resource for the management of non tractable ;;hematuria, mainly in cancer patients, which present a ;;deteriorated general status
