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1.
Clin Appl Thromb Hemost ; 27: 10760296211002274, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33870763

RESUMO

The purpose of this article is to address several challenging questions in the management of young patients (those age 60 and under) who present with ischemic stroke. Do genetic thrombophilic states, strongly associated with venous thrombosis, independently cause arterial events in adults? Should cases of patent foramen ovale be closed with mechanical devices in patients with cryptogenic stroke? What are the optimal treatments for cerebral vein thrombosis, carotid artery dissection, and antiphospholipid syndrome and are DOACs acceptable treatment for these indications? What is the mechanism underlying large vessel stroke in patients with COVID-19? This is a narrative review. We searched PubMed and Embase and American College of physicians Journal club database for English language articles since 2000 looking mainly at randomized clinical trials, Meta analyses, Cochran reviews as well as some research articles viewed to be cutting edge regarding anticoagulation and cerebrovascular disease. Searches were done entering cerebral vein thrombosis, carotid dissection, anticoagulation therapy and stroke, antiphospholipid antibody and stroke, stroke in young adults, cryptogenic stroke and anticoagulation, patent foramen ovale and cryptogenic stroke, COVID-19 and stroke.


Assuntos
/complicações , /terapia , Adulto , Aneurisma Dissecante/complicações , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/complicações , Vértebras Cervicais/irrigação sanguínea , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/cirurgia , Humanos , Trombose Intracraniana/etiologia , Trombose Intracraniana/terapia , Masculino , Pessoa de Meia-Idade , Pandemias , Prognóstico , Fatores de Risco , Trombofilia/complicações
2.
BMJ Case Rep ; 14(3)2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33722914

RESUMO

Isolated dissection of one of the mesenteric arteries without concurrent involvement of the aorta is a rare clinical entity and an unusual cause of abdominal pain. It usually involves one artery, most commonly the superior mesenteric artery (SMA) followed by the coeliac artery. We are reporting a rare case where both coeliac and SMA were showing dissection. We are reporting a case of 60-year-old hypertensive male who came with worsening abdominal pain for 5 days; CT scan showed coeliac and SMA dissection without any imaging evidence of intestinal ischaemia. He was successfully managed medically with bowel rest and anticoagulation. Two weeks of follow-up CT scan showed no progression or thrombus formation. For complicated cases, percutaneous transluminal angioplasty of a visceral artery or open surgical exploration or hybrid approach is required. However, for stable uncomplicated cases, medical therapy alone is sufficient.


Assuntos
Aneurisma Dissecante , Artéria Mesentérica Superior , Isquemia Mesentérica , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Artéria Celíaca/diagnóstico por imagem , Dissecação , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade
4.
J Cardiothorac Surg ; 16(1): 11, 2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33430862

RESUMO

BACKGROUND: Acute aortic dissection (AAD) is a life-threatening condition which can lead to coronary, brachiocephalic or branch vessel malperfusion, as well as aortic valve insufficiency, or aortic rupture. Mortality of surgical treatment in high-risk or elderly patients with Type A AAD (TAAAD) still remains high, and treatment for such patients remains controversial. We report a successful treatment of TAAAD with a communicating false lumen in a 60-year-old man with acute hemi-cerebral malperfusion. CASE PRESENTATION: The ascending aorta was wrapped with stepwise external wrapping (SEW) procedure, and subsequent thoracic endovascular aortic repair (TEVAR) was successfully performed. The patient was discharged in good physical condition without any complications. CONCLUSIONS: Hybrid therapy with SEW and TEVAR with TAAAD associated with major cerebral malperfusion should be considered, especially in patients for whom open surgery is extremely risky.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Doença Aguda , Aneurisma Dissecante/complicações , Aorta/cirurgia , Aneurisma da Aorta Torácica/complicações , Ruptura Aórtica/complicações , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Procedimentos Endovasculares , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
5.
Kyobu Geka ; 73(11): 936-939, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130718

RESUMO

A 45-year-old male developed Stanford type A acute aortic dissection combined with aortic root dilation and congenital bicuspid aortic valve (BAV). He had a Sieveres type 0 BAV, lateral subtype with right and left cusps. Valve-sparing root reimplantation was performed with decalcification of the cusps. Transthoracic echocardiography(TTE) at discharge revealed no aortic regurgitation, and peak velocity of BAV was 2.15 m/second, mean pressure gradient was 9.6 mmHg and aortic valve area was 2.15 cm2. TTE after 6 months revealed only slight elevation of the peak velocity to 2.78 m/second. To perform successful reimplantation in the case of BAV, anatomic orientation of the cusps should be approximately at 180° and the tissue of the cusps should either be normal or have only minor abnormalities. Valve-sparing root reimplantation for BAV needs a careful follow-up for progression of the aortic valve dysfunction.


Assuntos
Aneurisma Dissecante , Valva Aórtica , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Dilatação , Doenças das Valvas Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Reimplante , Estudos Retrospectivos
6.
Kyobu Geka ; 73(10): 783-788, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130766

RESUMO

Mesenteric malperfusion is reported as a complication associated with acute aortic dissection(AAD) in 3~5% cases, and one of the adverse risk factors for survival. The mortality rate associated with malperfusion due to AAD is higher than that without malperfusion. To improve the clinical outcome, it is important to address the mesenteric malperfusion appropriately. Mesenteric malperfusion remains a diagnostic challenge. Abdominal pain is the most common symptom, but a nonspecific of acute mesenteric ischemia. Computed tomography(CT) including CT angiography is the gold standard in the diagnosis of aortic dissection and the mesenteric malperfusion. No single serum marker, including lactate, is reliable enough to diagnosis mesenteric ischemia. The optimal treatment for mesenteric malperfusion due to AAD is to restore blood flow to the ischemic area as early as possible, while minimizing the risk of thoracic aortic rupture. Those patients with malperfusion but no significant organ ischemia should be treated with immediate surgical repair. Those patients with malperfusion and significant organ ischemia and hemodynamically stable should be treated with mesenteric reperfusion, followed by surgical repair. The management of mesenteric malperfusion associated with AAD requires a tailored approach to improve outcomes. After successful restoration of mesenteric perfusion, patients should be monitored closely, and the bowel should be inspected when there is doubt regarding its viability.


Assuntos
Aneurisma Dissecante , Aneurisma Aórtico , Procedimentos Endovasculares , Isquemia Mesentérica , Doença Aguda , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/cirurgia , Resultado do Tratamento
7.
J Card Surg ; 35(10): 2808-2810, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33043653

RESUMO

Hemorrhagic extension along the pulmonary arteries should be recognized as a complication of Stanford type A aortic dissection. Radiologists and other physicians with an interest in cardiothoracic imaging should be aware of this rare but life-threatening pathology. The anatomical concept of the pathology is outlined in this text, through high-quality electrocardiogram-gated computerized tomography images.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Eletrocardiografia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Artéria Pulmonar , Tomografia Computadorizada por Raios X/métodos , Idoso de 80 Anos ou mais , Evolução Fatal , Feminino , Humanos , Artéria Pulmonar/diagnóstico por imagem , Recusa do Paciente ao Tratamento
8.
Vascular ; 28(6): 705-707, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33045945

RESUMO

OBJECTIVES: Chronic disseminated intravascular coagulation is a rare complication of aortic dissection, and its optimal treatment remains controversial. METHODS: We present a 78-year-old man with repeated hemorrhagic events by disseminated intravascular coagulation due to chronic aortic dissection treated by thoracic endovascular aortic repair. RESULTS: Computed tomography angiography at three months revealed a completely thrombosed false lumen from the distal aortic arch to the descending aorta at the celiac artery level. Platelets and D-dimer levels remained stable, and the patient was doing well without hemorrhagic complications. CONCLUSIONS: Endovascular repair was effective for disseminated intravascular coagulation due to chronic type B aortic dissection.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Coagulação Intravascular Disseminada/etiologia , Procedimentos Endovasculares , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Doença Crônica , Coagulação Intravascular Disseminada/diagnóstico , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Stents , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(36): e22116, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899095

RESUMO

INTRODUCTION: Hemichorea-hemiballismus, which spans a spectrum of involuntary, continuous, nonpatterned movement involving one side of the body, can emerge as the initial manifestation of acute ischemic stroke. However, because of its rarity in the community, the diagnosis and treatment are often delayed. PATIENT CONCERNS: We report a unique case of a 47-year-old female who presented with acute onset hemichorea-hemiballismus. No obvious focal sign apart from involuntary, continuous, nonpatterned movement of her left arm and leg was presented. DIAGNOSIS: Initial diffusion-weighted magnetic resonance imaging (MRI) was negative but significant increase of blood flow velocity in the right middle cerebral artery (MCA) stem was revealed by transcranial doppler sonography. Repeated MRI showed acute infarction in the contralateral globus pallidus. Isolated dissection of the right MCA typified by intimal flap with double lumen was identified by digital subtraction angiography and high-resolution magnetic resonance imaging (HR-MRI). INTERVENTIONS: The patient was initially treated with dual antiplatelet agents but the uncontrollable movement deteriorated during hospitalization. Antithrombotic therapy was then intensified with combination of tirofiban and low-molecular-weight heparin. Other symptomatic treatment included volume expansion with colloidal fluid to improve cerebral perfusion. Her involuntary movement gradually diminished and the patient was discharged with rivaroxaban 15 mg/daily. OUTCOMES: The patient had recovered with significant reduction in her hemichorea-hemiballismus. Three-month follow-up HR-MRI showed complete resolution of the MCA dissection lesions. CONCLUSION: Prompt recognition of acute onset hemichorea-hemiballismus as the manifestation of acute ischemic stroke in appropriate clinical setting may reduce diagnostic delay. Multiple imaging techniques including cerebral digital subtraction angiography and HR-MRI can be applied to diagnosis and further clarify the mechanism of stroke, which facilitate in selection of secondary prevention therapies.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Dissecante/patologia , Coreia/etiologia , Discinesias/etiologia , Artéria Cerebral Média/patologia , Doença Aguda , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/tratamento farmacológico , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Inibidores da Agregação de Plaquetas/uso terapêutico
11.
Ann Ital Chir ; 91: 273-276, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877380

RESUMO

CASE REPORT: A 64-year-old woman presented to our emergency department during the outbreak of the covid-19 emergency in Italy with syncope, anosmia, mild dyspnoea and atypical chest and dorsal pain. A chest CT scan showed an acute type B aortic dissection (ATBAD) and bilateral lung involvement with ground-glass opacity, compatible with interstitial pneumonia. Nasopharyngeal swabs resulted positive for SARS-CoV-2. For the persistence of chest pain, despite the analgesic therapy, we decided to treat her with a TEVAR. Patient's chest and back pain resolved during the first few days after the procedure. No surgical or respiratory complications occurred and the patient was discharged 14 days after surgery. DISCUSSION: By performing the operation under local anesthesia, it was possible to limit both the staff inside the operatory room and droplet/aerosol release. Since we had to perform the operation in a hemodynamics room, thanks to the limited extension of the endoprosthesis and the good caliber of the right vertebral artery we were able to reduce the risk of spinal cord ischemia despite the lack of a revascularization of the left subclavian artery. CONCLUSIONS: A minimally invasive total endovascular approach allows, through local anesthesia and percutaneous access, to avoid surgical cut down and orotracheal intubation. This, combined with a defined management protocol for infected patients, seems to be a reasonable way to perform endovascular aortic procedures in urgent setting, even in a SARSCoV- 2 positive patient. KEY WORDS: COVID-19, Dissection, TEVAR.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Betacoronavirus/isolamento & purificação , Implante de Prótese Vascular/métodos , Infecções por Coronavirus/prevenção & controle , Procedimentos Endovasculares/métodos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Anestesia Local , Aneurisma Dissecante/complicações , Antibioticoprofilaxia , Anticoagulantes/uso terapêutico , Antivirais/uso terapêutico , Aneurisma da Aorta Torácica/complicações , Contraindicações de Procedimentos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/transmissão , Darunavir/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Quimioterapia Combinada , Enoxaparina/uso terapêutico , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Complicações Intraoperatórias/prevenção & controle , Intubação Intratraqueal/efeitos adversos , Pessoa de Meia-Idade , Nasofaringe/virologia , Salas Cirúrgicas , Isolamento de Pacientes , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/transmissão , Ritonavir/uso terapêutico , Isquemia do Cordão Espinal/prevenção & controle , Artéria Vertebral/cirurgia
12.
Ann Vasc Surg ; 69: 451.e5-451.e10, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32615204

RESUMO

BACKGROUND: Acute aortic dissection rarely results in circumferential dissections of the aortic intima that may lead to intimo-intimal intussusception (IIS) with complete separation from the aortic wall. Circumferential dissection may then result in distal embolization of the involved intima and media, adding considerable complexity to the management of such cases. Despite the severity of this complication, the natural history of aortic disease following extensive intimal denuding and IIS is not well documented in the literature. Here we present a case with long-term follow-up of type B aortic dissection (TBAD) complicated by IIS and embolization of the intima into the distal aorta following thoracic endovascular aortic repair. METHODS: Medical records and imaging studies were retrospectively reviewed with the approval of the Institutional Review Board. A single patient underwent repair of a TBAD that was complicated by IIS, with follow-up for 6 years. Aortic recovery was monitored with serial computerized tomography scans. RESULTS: During endovascular stent deployment, the patient's dissection progressed circumferentially, leading to distal embolization of the intima and aortic occlusion. An open transabdominal aortic exploration was performed to extract the embolized intima. Despite this severe aortic structural disruption, the patient recovered well postoperatively and exhibited favorable aortic remodeling over long-term follow-up. The denuded aorta did not rupture or develop progressive worsening aneurysmal dilation and the diameter of the involved aortic segment remained stable during follow-up. CONCLUSIONS: Acute TBADs can progress to circumferential intimal separation and IIS when managed with endovascular stenting and balloon dilation. Continued endovascular management once IIS has occurred may lead to further intimal damage, resulting in distal embolization of the intima and aortic occlusion. Thus, IIS may require conversion to open repair. However, in the event that loss of the aortic intima does occur following IIS, it is possible for the denuded aorta to recover well and remain stable with favorable remodeling over long-term follow-up.


Assuntos
Aneurisma Dissecante/cirurgia , Angioplastia com Balão/efeitos adversos , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/efeitos adversos , Embolia/cirurgia , Lesões do Sistema Vascular/cirurgia , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Angioplastia com Balão/instrumentação , Aorta/diagnóstico por imagem , Aorta/lesões , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Embolia/diagnóstico por imagem , Embolia/etiologia , Humanos , Masculino , Stents , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
13.
Surgery ; 168(1): 185-192, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32507629

RESUMO

BACKGROUND: Acute type A aortic dissection is a cardiovascular emergency requiring operative intervention. Despite advancements in operative technique and increased specialization of cardiovascular care, operative mortality, and morbidity after repair of type A aortic dissection remain high. Our aim was to assess national trends in outcomes of type A aortic dissection repair and the impact of institutional thoracic aortic repair volume on clinical outcomes and resource use in the United States. METHODS: Using the procedural and diagnostic codes of the International Classification of Diseases, Ninth Revision, we identified type A aortic dissection repairs from the 2005 to 2014 database of the National Inpatient Sample. Hospitals were classified into low-, medium- and high-volume tertiles based on annual incidence of thoracic aortic operations. Patient demographics and hospital characteristics, as well as outcomes including mortality, cost, and duration of stay, were evaluated using parametric tests for trends and the volume-outcome relationship. We used a multivariable-adjusted logistic regression model to identify factors associated with mortality. RESULTS: An estimated 25,231 patients received type A aortic dissection repair with an increasing temporal trend in volume and concomitant decrease in mortality. When stratified by hospital volume, 10,115 (40.1%), 8,194 (32.4%), and 6,920 (27.4%) underwent type A aortic dissection at low-volume, medium-volume, and high-volume, respectively. The unadjusted mortality rate in high-volume was the least (21.5% vs 16.8% vs 11.6% for low-volume, medium-volume, and high-volume, respectively; P < .001). Multivariable analysis revealed older age, lesser household incomes and comorbidities, including congestive heart failure (adjusted odds ratio 1.44; P < .001) and coagulopathy (adjusted odds ratio 1.33; P = .01) as statistically significant predictors of mortality; however, the risk-adjusted duration of stay (adjusted odds ratio 0.88; P = .06) was not different between low-volume and high-volume hospitals. After adjusting for patient and hospital characteristics, type A aortic dissection repair at low-volume hospitals was associated with increased likelihood of mortality compared with high-volume hospitals (adjusted odds ratio 2.10; P < .001). Patients undergoing type A aortic dissection repair at low-volume hospitals had increased odds of all complications including stroke, and respiratory complications compared than those at high-volume hospitals (P = .02, P < .001, and P < .001, respectively). CONCLUSION: The volume of open surgical repair for type A aortic dissection in the United States has increased over the past decade, while mortality has decreased. Hospital aortic operative volume is strongly associated with outcomes for type A aortic dissection repair. Protocols for expeditious transfer of patients to high volume aortic centers may serve to further decrease the acute mortality and complications of this procedure.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/patologia , Aorta/patologia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/mortalidade , Aneurisma Aórtico/patologia , Feminino , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia
14.
BMC Neurol ; 20(1): 253, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32576285

RESUMO

BACKGROUND: Aortic dissection (AoD) is a disease with a high mortality rate. Its clinical manifestations are diverse and covert, which makes diagnosis and treatment challenging. Here, we report a very rare case of aortic dissection leading to bilateral cerebral cortex ischaemia and epilepsy. CASE PRESENTATION: A 54-year-old man was admitted to the hospital with acute onset of right limb weakness accompanied by slurred speech. He had a history of hypertension as well as tobacco and alcohol use. The patient was found to have aphasia and right hemiplegia on physical examination. No bleeding was seen on the skull CT. Acute cerebral infarction was considered after admission, and rt-PA was administered for intravenous thrombolysis. During intravenous thrombolysis, the patient suddenly developed epilepsy, and diazepam was given immediately by intravenous injection to control the symptoms. Emergency skull diffusion-weighted imaging (DWI) was performed, and the results showed a small, patchy, high signal that was scattered throughout the left brain hemisphere, right frontal parietal lobe and centrum semiovale. Head and neck CT angiography (CTA) was performed; dissection was found in the ascending aorta, aortic arch, bilateral common carotid artery, proximal part of the internal carotid artery, and initial segment of the left external carotid artery. The laceration was located in the upper part of the ascending aorta. AoD complicated by acute cerebral infarction and epilepsy was considered, and the patient was immediately transferred to the cardiovascular surgery specialist hospital for surgical treatment. CONCLUSIONS: Some aortic dissections have no typical manifestations of chest pain, and the onset is covert. Atypical clinical manifestations of epilepsy secondary to bilateral cerebral hemisphere infarction may appear. AoD with cerebral infarction is a contraindication for intravenous thrombolysis; surgical treatment is the best way to reduce mortality.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Aórtico/complicações , Infarto Cerebral/etiologia , Epilepsia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade
15.
Medicine (Baltimore) ; 99(25): e20580, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569184

RESUMO

INTRODUCTION: Protein-losing enteropathy and spontaneous isolated superior mesenteric artery dissection are both rare clinically. Protein-losing enteropathy due to superior mesenteric artery dissection is extremely rare. PATIENT CONCERNS: A 46-year-old male with acute abdominal pain and hematochezia was diagnosed with a complete occlusion of the superior mesenteric artery because of dissection. He suffered from diarrhea and hypoproteinemia after an emergency thromboendarterectomy. DIAGNOSES: Based on laboratory tests and capsule endoscopy inspection, a diagnosis of protein-losing enteropathy was made. INTERVENTIONS: Endovascular treatment was provided. OUTCOMES: After stent placement, he quickly recovered without a recurrence of symptoms. CONCLUSION: Protein-losing enteropathy is a serious complication of an isolated superior mesenteric artery dissection. Restoring the patency of the superior mesenteric artery is keyed for the treatment of this complication.


Assuntos
Aneurisma Dissecante/etiologia , Enteropatias Perdedoras de Proteínas/etiologia , Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Procedimentos Endovasculares , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/patologia , Pessoa de Meia-Idade , Enteropatias Perdedoras de Proteínas/cirurgia , Tomografia Computadorizada por Raios X
16.
Gan To Kagaku Ryoho ; 47(6): 981-983, 2020 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-32541179

RESUMO

Ramucirumab(RAM)plus nab-paclitaxel(nab-PTX)therapy is a regimen that is recommended for the second round of chemotherapy in recurrent, progressive gastric cancer. We report the first case of a thoracic aortic dissection developed during RAM plus nab-PTX therapy. A 59-year-old male who had undergone a proximal gastrectomy for esophagogastric junction cancer had a recurrence of cancer 6 years later(metastasis to the para-aortic lymph node and left adrenal gland, local recurrence, and multiple bone metastases). He was treated with RAM plus nab-PTX therapy for second-line chemotherapy. On day 9 of the third cycle, he experienced sudden, severe neck pain and visited the outpatient emergency department. Computed tomography detected a Stanford type-A thoracic aortic dissection. However, the patient suffered from a myocardial infarction before the operation, and died. This is the first report of an aortic dissection associated with RAM. Clinicians must be aware of this complication.


Assuntos
Aneurisma Dissecante , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Gástricas , Albuminas , Aneurisma Dissecante/complicações , Anticorpos Monoclonais Humanizados , Gastrectomia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Paclitaxel , Neoplasias Gástricas/complicações
18.
BMC Neurol ; 20(1): 199, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434485

RESUMO

BACKGROUND: Direct evidence of intimal flaps, double lumen and intramural haematomas (IMH) is difficult to detect on conventional angiography in most intracranial vertebrobasilar dissecting aneurysms (VBDAs). Our purpose was to assess the value of three-dimensional high-resolution magnetic resonance vessel wall imaging (3D HRMR VWI) for identifying VBDAs. METHODS: Between August 2013 and January 2016, consecutive patients with suspicious VBDAs were prospectively enrolled to undergo catheter angiography and VWI (pre- and post-contrast). The lesion was diagnosed as definite VBDA when presenting direct signs of dissection; as possible when only presenting indirect signs; and as segmental ectasia when there was local dilation and wall thickness similar to adjacent normal artery's without mural thrombosis. RESULTS: Twenty-one patients with 27 lesions suspicious for VBDAs were finally included. Based on findings of VWI and catheter angiography, definite VBDA was diagnosed in 25 and 7 lesions (92.6%, vs 25.9%, p <  0.001), respectively; possible VBDA in 0 and 20 (0 vs 74.1%), respectively; and segmental ectasia in 2 and 0 (7.4% vs 0%), respectively. On VWI and catheter angiography, intimal flap was detected in 21 and 7 lesions (77.8% vs 25.9%, p = 0.001), respectively; double lumen sign in 18 and 7 (66.7% vs 25.9%, p = 0.003), respectively; and IMH sign in 14 and 0 (51.9% vs 0), respectively. CONCLUSIONS: 3D HRMR VWI could detect direct dissection signs more frequently than catheter angiography. This may help obtain definite diagnosis of intracranial VBDAs, and allow accurate differentiation between dissecting aneurysm and segmental ectasia as well. Further prospective study with larger sample was required to investigate the superiority of HRMR VWI for definite diagnosis of intracranial VBDAs than catheter angiography.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Imageamento Tridimensional/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Adulto , Idoso , Aneurisma Dissecante/complicações , Artéria Basilar/diagnóstico por imagem , Angiografia Cerebral/métodos , Feminino , Hematoma , Humanos , Aneurisma Intracraniano/complicações , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso , Estudos Prospectivos
19.
Ann Vasc Surg ; 68: 572.e9-572.e14, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32439523

RESUMO

BACKGROUND: Free-floating thrombus (FFT) of the cervical carotid artery is a rare but critical condition leading to stroke. The most common underlying pathology is atherosclerotic plaque; nonatherosclerotic pathologies are much rarer. Here we report a case of FFT associated with cervical carotid artery dissection that was successfully treated by surgical thromboendarterectomy. METHODS: A 51-year-old man presented with headache, pain in the left neck, and amaurosis fugax. Magnetic resonance angiography revealed mild stenosis in the bifurcation of the left carotid artery. The stenotic lesion was considered as a possible dissection because of the normal appearance of the vessel 2 years ago and its clinical presentation. Oral aspirin was initiated with the diagnosis of transient ischemic attack. Two weeks later, ultrasound was planned for further examination, which demonstrated a massive FFT with intramural hematoma in the lesion. Because FFT was present despite taking aspirin, surgical thromboendarterectomy was performed to prevent further ischemic events. RESULTS: Intraoperative findings revealed that FFT was the thrombus protruding from the intramural hematoma caused by arterial dissection. After the whole dissected layer was removed, the residual lumen was reinforced by multiple tacking sutures to prevent recurrence of dissection. No further ischemic events and recurrence occurred during the 1-year of follow-up after the surgery. CONCLUSIONS: When managing patients with carotid artery dissection, the formation of FFT should be considered as a possible critical feature. Surgical thromboendarterectomy with intimal tacking sutures might be an option for the treatment, ensuring immediate, preventive effects against the risk of cerebral embolism.


Assuntos
Aneurisma Dissecante/cirurgia , Doenças das Artérias Carótidas/cirurgia , Endarterectomia , Trombose/cirurgia , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Humanos , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Trombose/diagnóstico por imagem , Trombose/etiologia , Resultado do Tratamento
20.
J Cardiothorac Surg ; 15(1): 87, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398043

RESUMO

BACKGROUND: Pulmonary artery aneurysm (PAA), usually associated with congenital heart disease (CHD), is a very rare clinical condition. Pulmonary artery dissection (PAD) is considered the most life-threatening complication of PAA, and patients can progress from being asymptomatic to sudden death. We report the following case of PAA associated with complicated congenital heart disease and simultaneous chronic PAD. To our knowledge, few such complicated cases have ever been reported. CASE PRESENTATION: A 36-year-old male presented to our hospital with a 10-year history of heart fatigue after activities and aggravated for 2 years. Computed tomography angiography (CTA) and echocardiogram showed a giant main pulmonary artery aneurysm (14 cm) with complicated congenital heart disease (a small patent ductus arteriosus, ventricular septal defects, aortic coarctation). Chronic PAD, which was mistaken for a pulmonary valve before operation, was detected during surgery. CONCLUSIONS: PAA associated with complicated CHD and simultaneous PAD is very rare, and its clinical symptoms are varied. Radiologists and surgeons should pay attention to determining whether this patient simultaneously had PAD when PAA was detected on preoperative CTA imaging.


Assuntos
Aneurisma Dissecante/complicações , Cardiopatias Congênitas/complicações , Artéria Pulmonar/cirurgia , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Doença Crônica , Angiografia por Tomografia Computadorizada , Ecocardiografia , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Humanos , Masculino , Artéria Pulmonar/diagnóstico por imagem
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