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1.
J Am Heart Assoc ; 11(12): e023858, 2022 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-35699179

RESUMO

Background Fibromuscular dysplasia (FMD) is a disease of unknown etiology that causes stenosis, aneurysmal dilatation, and dissection of vascular beds. Known to affect medium-sized arteries, FMD is not typically considered to affect the aorta. We tested the hypothesis that aortic size in FMD is abnormal compared with age- and sex-matched controls. Methods and Results Medical records and computed tomography angiography images were reviewed in female patients with a diagnosis of FMD who were seen in the vascular medicine clinic at Emory Healthcare. Aortic dimensions were measured at 6 different landmarks. Using 2 sample t tests, the aortic measurements and height-indexed measurements were compared with published normal values in healthy women of a similar age. A total of 94 female patients were included in the study. The median age was 57 (interquartile range, 50-65). FMD involvement was present most commonly in the extracranial carotid (77.7%) and renal (43.6%) arteries. All 6 aortic segments were found to be larger in both absolute measures and height-indexed measures in the FMD population (P<0.001). The largest differences were observed within the absolute measures of the sinotubular junction with mean±SD (mm) (29.9±4.1) versus (27±2.5), ascending aorta (32.7±4.4) versus (30.0±3.5), and descending aorta (24.7±3.0) versus (22.0±2.0) (P<0.001). Conclusions Aortic diameters in female patients with FMD are larger when compared with published age- and sex-matched normal values. These findings suggest that FMD may also affect the large-sized arteries.


Assuntos
Aneurisma , Displasia Fibromuscular , Aorta/diagnóstico por imagem , Artérias Carótidas , Angiografia por Tomografia Computadorizada/efeitos adversos , Feminino , Displasia Fibromuscular/complicações , Humanos , Pessoa de Meia-Idade
2.
J Cardiothorac Surg ; 17(1): 163, 2022 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-35725603

RESUMO

BACKGROUND: Azygos vein aneurysm (AVA) is a rare thoracic pathological entity that mimics a posterior mediastinal mass. However, the pathogenesis of primary azygos vein aneurysms is not clear and its pathology is still being discussed. Some of the AVA are asymptomatic and usually discovered accidentally by routine physical examination. CASE PRESENTATION: We report the case of a 37-year-old woman who had an azygos vein arch aneurysm with no obvious clinical symptoms. With the analysis of clinical features of the case and AVA morphological characteristics, the AVA was found by a chest computed tomography. Then, enhanced chest computed tomography showed a soft-tissue mass (4.9 × 3.7 × 3.2 cm) in the right posterior mediastinum, which was connected to the superior vena cava and significantly enhanced with contrast agent stratification. The density of the tumor in the delayed stage was the same as that in the azygos vein. The patient underwent video-assisted thoracoscopic surgery. Histopathological evaluation of the surgical biopsy specimen proved to be a completely thrombosed aneurism of the azygos vein arch. CONCLUSIONS: AVA is a rare pathology that must be taken into consideration during the differential diagnosis of right posterior mediastinal masses. Thoracoscopic surgery is one of the most preferred treatment options for azygos vein aneurysm.


Assuntos
Aneurisma , Doenças do Mediastino , Adulto , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Veia Ázigos/diagnóstico por imagem , Veia Ázigos/cirurgia , Feminino , Humanos , Doenças do Mediastino/diagnóstico , Cirurgia Torácica Vídeoassistida/métodos , Tomografia Computadorizada por Raios X , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/cirurgia
5.
Medicine (Baltimore) ; 101(24): e29539, 2022 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-35713464

RESUMO

ABSTRACT: Gastroduodenal artery aneurysms (GDAA) and pancreaticoduodenal artery aneurysms (PDAA) are rare, have high rupture risks, and are located in the arcade between the celiac artery and the superior mesenteric artery. Pancreaticoduodenal artery aneurysms are associated with celiac artery stenosis, and it is hypothesized that these celiac lesions might contribute to the formation of aneurysms. In contrast, a few studies have reported an association between a gastroduodenal artery aneurysm and celiac lesions. This study aimed to investigate the potential differences between patients with gastroduodenal and pancreaticoduodenal artery aneurysms and better understand their pathogenesis.We selected patients with GDAA and PDAA who were admitted to our department between January 2010 and December 2020. Aortic wall volume, aortic wall calcification, and pancreaticoduodenal arcade volume of computed tomography images were calculated semi-manually using Horos 3.3.5.Eight GDAAs and 11 PDAAs were analyzed. Celiac lesions were found in all PDAA patients, with none in GDAA cases. Volumetry demonstrated that aortic wall volume and calcification were more prominent in the GDAA group than in the PDAA group (P = .026 and P = .049, respectively). The pancreaticoduodenal arcade volume was larger in the PDAA group (P = .002).In our study, celiac artery lesions were strongly correlated with PDAA. The volume of the pancreaticoduodenal arcade was larger in the PDAA group, and aortic wall volume and calcification were larger in the GDAA group.


Assuntos
Aneurisma , Embolização Terapêutica , Aneurisma/etiologia , Artéria Celíaca/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Duodeno/irrigação sanguínea , Duodeno/diagnóstico por imagem , Embolização Terapêutica/métodos , Humanos , Pâncreas/irrigação sanguínea , Pâncreas/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento
7.
Vasc Endovascular Surg ; 56(5): 501-504, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35651321

RESUMO

Popliteal arteriovenous fistulae (PAF) are anomalous communications between the arterial and venous systems of the lower extremity. They are usually secondary to trauma and are rarely associated with additional vascular defects. The coexistence of a PAF and a venous aneurysm is rare and usually occurs in patients with connective tissue disorders. Evidence regarding the management of this type of anomaly is scarce. However, both open and endovascular approaches seem feasible alternatives for treating this condition. Here, we describe a spontaneous popliteal arteriovenous fistula associated with a venous aneurysm in a 42-year-old male patient who presented with a popliteal mass. Satisfactory endovascular closure of the fistula and exclusion of the venous aneurysm were achieved using an Amplatzer™ Vascular Plug II.


Assuntos
Aneurisma , Fístula Arteriovenosa , Procedimentos Endovasculares , Adulto , Aneurisma/diagnóstico por imagem , Aneurisma/etiologia , Aneurisma/cirurgia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/cirurgia , Humanos , Masculino , Resultado do Tratamento
8.
Br J Hosp Med (Lond) ; 83(5): 1-7, 2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35653317

RESUMO

Aneurysms are associated with significant complications if not diagnosed and managed appropriately. Popliteal arterial aneurysms are the most common peripheral aneurysm, and can cause pain, nerve compression, ischaemia and limb loss. Vascular surgery is an emerging specialty under the remit of general surgery, with the primary objectives of preventing death and limb loss. This article summarises the epidemiology, investigation and management of popliteal arterial aneurysms for vascular and non-vascular trainees.


Assuntos
Aneurisma , Artéria Poplítea , Aneurisma/cirurgia , Humanos , Isquemia/etiologia , Artéria Poplítea/cirurgia
9.
Acta Neurochir (Wien) ; 164(7): 1861-1871, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35524810

RESUMO

BACKGROUND: The excimer laser-assisted non-occlusive anastomosis (ELANA) bypass technique may have the advantage of its non-occlusive design in the treatment of last-resort cases where endovascular treatment or direct clipping is considered to be unsafe. However, the technique remains technically challenging. Therefore, a sutureless ELANA Clip device (SEcl) was developed to simplify the technique avoiding tedious anastomosis stitching in depth. The present study investigates the clinical feasibility and safety of the SEcl technique. METHODS: Three patients with complex and large aneurysms in the anterior circulation were selected after multidisciplinary consensus that the aneurysms were too complex for endovascular or direct clipping treatment options. Bypass surgery was considered as a last-resort treatment option, and after preoperative evaluation and informed consent, SEcl bypass surgery was performed. Applicability, technical aspects and patient outcomes are assessed. RESULTS: All aneurysms were excluded from the circulation. The creation of the intracranial anastomosis was easier and faster. No device-related serious adverse events were encountered, and all outcomes were favorable (one patient stable Modified Rankin Scale, two patients improved). CONCLUSION: The SEcl anastomosis technique is feasible and, considering the severity of the disease, relatively safe. It can be considered a treatment option in very difficult-to treat last-resort aneurysm cases. From this study, further developments in minimizing clip size and application in cardiac surgery are initiated.


Assuntos
Aneurisma , Revascularização Cerebral , Aneurisma Intracraniano , Anastomose Cirúrgica/métodos , Revascularização Cerebral/métodos , Estudos de Viabilidade , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Lasers de Excimer/uso terapêutico , Projetos Piloto , Instrumentos Cirúrgicos , Resultado do Tratamento
11.
Genes (Basel) ; 13(5)2022 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-35627118

RESUMO

OBJECTIVES: Protein C (PC) deficiency is an inherited thrombophilia with a prevalence of 0.5% in the general population and 3% in subjects with a first-time deep vein thrombosis (DVT). Here we report a series of 14 PC-deficient Polish patients with comprehensive clinical and molecular characteristics, including long-term follow-up data and a deep mutational analysis of the PROC gene. PATIENTS AND METHODS: Fourteen unrelated probands (mean ± SD age 43.8 ± 13.0 years) with suspicion of PC deficiency, who experienced thromboembolic events and a majority of whom received anticoagulants (92.8%), were screened for PROC mutations by sequencing the nine PROC exons and their flanking intron regions. RESULTS: Ten probands (71.4%) had missense mutations, two patients (14.3%) carried nonsense variants, and the other two subjects (14.3%) had splice-site mutations, the latter including the c.401-1G>A variant, reported here for the very first time. The proband carrying the c.401-1A allele had a hepatic artery aneurysm with a highly positive family history of aneurysms and the absence of any mutations known to predispose to this vascular anomaly. CONCLUSION: A novel detrimental PROC mutation was identified in a family with aneurysms, which might suggest yet unclear links of thrombophilia to vascular anomalies, including aneurysms at atypical locations in women. The present case series also supports data indicating that novel oral anticoagulants (NOACs) are effective in PC deficient patients.


Assuntos
Aneurisma , Deficiência de Proteína C , Trombofilia , Trombose , Administração Oral , Adulto , Aneurisma/tratamento farmacológico , Anticoagulantes/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Mutação , Polônia , Proteína C/genética , Proteína C/metabolismo , Proteína C/uso terapêutico , Deficiência de Proteína C/tratamento farmacológico , Deficiência de Proteína C/genética , Trombose/genética
12.
BMC Nephrol ; 23(1): 185, 2022 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-35568810

RESUMO

OBJECTIVE: To explore the technical specifications and clinical outcomes of thrombosed aneurysmal haemodialysis arteriovenous fistula (AVF) treated with ultrasound-guided percutaneous transluminal angioplasty combined with minimal aneurysmotomy. METHODS: This case series study included 11 patients who had thrombosed aneurysmal AVF and underwent salvage procedures over a 13-month period. All procedures were performed under duplex guidance. Minimal aneurysmotomy was performed, along with manual thrombectomy and thrombolytic agent infusion, followed by angioplasty to macerate the thrombus and sufficiently dilate potential stenoses. A successful procedure was defined as immediate restoration of flow through the AVF. RESULTS: The 11 patients (four males and seven females) had a mean age of 49.6 years ± 11.9 years. Six patients (54.5%) had two or more aneurysms. The mean aneurysm maximal diameter was 21.5 mm (standard deviation: ± 5.0 mm), and the mean thrombus length was 12.9 cm (8-22 cm). Ten (83.3%) of the 12 procedures were technically successful. The mean duration of operation was 150.9 minutes (standard deviation: ± 34.2 minutes), and mean postoperative AVF blood flow was 728.6 ml/min (standard deviation: ± 53.7 mi/min). The resumption of hemodialysis was successful in all 11 cases, with a clinical success rate of 100%. The primary patency rates were 90.0% and 75.0% at three and four months over a mean follow-up time of 6.3 months (3-12 months). The secondary patency rates were 90.4% at three and four months. CONCLUSION: A hybrid approach combining ultrasound-guided percutaneous transluminal angioplasty and minimal aneurysmotomy might be a safe and effective method for thrombosed aneurysmal AVF salvage.


Assuntos
Aneurisma , Fístula Arteriovenosa , Derivação Arteriovenosa Cirúrgica , Trombose , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal , Estudos Retrospectivos , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/cirurgia , Resultado do Tratamento , Grau de Desobstrução Vascular
13.
Medicine (Baltimore) ; 101(19): e29327, 2022 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-35583543

RESUMO

ABSTRACT: This single-center, retrospective study aimed to describe the anatomic and clinical characteristics of extracranial carotid artery aneurysms (ECAAs) and to compare various ECAA management strategies in terms of outcomes.A total of 41 consecutive patients, who underwent treatment for ECAAs between November 1996 and May 2020, were included in this study. The ECAAs were anatomically categorized using the Attigah and Peking Union Medical College Hospital (PUMCH) classifications. The possible study outcomes were restenosis or occlusion of the ipsilateral carotid artery after treatment and treatment-associated morbidity or mortality.The 41 patients were stratified into three groups according to the management strategies employed: surgical (n = 25, 61.0%), endovascular (n = 10, 24.4%), and conservative treatment (n = 6, 14.6%). A palpable, pulsatile mass was the most common clinical manifestation (n = 16, 39.0%), and degenerative aneurysms (n = 29, 65.9%) represented the most common pathogenetic or etiological mechanism. According to the Attigah classification, type I ECAAs (n = 24, 58.5%) were the most common. Using the PUMCH classification, type I ECAAs (n = 26, 63.4%) were the most common. There was a higher prevalence of Attigah type I ECAAs among patients who underwent surgical treatment compared with those who underwent endovascular treatment (64.0% vs 40.0%, P = .09), whereas patients with PUMCH type IIa aneurysms were more likely to receive endovascular treatment (12.0% vs 30.0%). False aneurysms were more likely to be treated using endovascular techniques (20% vs 70%, P = 0.02). Except for two early internal carotid artery occlusions (one each among patients who underwent surgical and endovascular treatments, respectively), there were no early or late restenoses or occlusions during follow-up. Cranial nerve injuries were noted in three patients after surgical treatment, and late ipsilateral strokes occurred in two patients (one each among patients who underwent endovascular and conservative treatment, respectively). There were no other treatment-associated complications or deaths during the study period. CONCLUSIONS: Both surgical and endovascular treatments could be performed safely for ECAAs with good long-term results according to anatomic location and morphology.


Assuntos
Aneurisma , Doenças das Artérias Carótidas , Procedimentos Endovasculares , Aneurisma/etiologia , Aneurisma/cirurgia , Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna , Procedimentos Endovasculares/métodos , Humanos , Estudos Retrospectivos , Resultado do Tratamento
14.
Turk J Pediatr ; 64(2): 408-411, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35611433

RESUMO

BACKGROUND: As an extremely rare entity reported in children, Rasmussen`s aneurysm is an inflammatory pseudo-aneurysmal dilatation of a branch of the pulmonary artery adjacent to or within a tuberculous cavity. CASE: Here, we reported a 9-year-old child with Down syndrome who presented with massive hemoptysis. Endovascular coil embolization was performed for Rasmussen`s aneurysm. During the 2-year follow-up period, she had no further episodes of bleeding. CONCLUSIONS: In case of the development of massive hemoptysis in the follow-up of a patient with pulmonary tuberculosis and Down syndrome, this lethal complication should be considered.


Assuntos
Aneurisma , Síndrome de Down , Embolização Terapêutica , Tuberculose Pulmonar , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/terapia , Criança , Síndrome de Down/complicações , Feminino , Hemoptise/etiologia , Humanos , Tuberculose Pulmonar/complicações
15.
Sci Rep ; 12(1): 9051, 2022 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-35641535

RESUMO

To describe the peripheral angiographic features of vasculopathy in idiopathic inflammatory myopathies (IIM) and systemic sclerosis (SSc) in comparison to polyarteritis nodosa (PAN). Angiograms of 47 extremities (24 upper and 23 lower) of 11 patients with IIM (n = 5) and SSc (n = 6), and 12 patients with PAN who presented with critical limb ischemia were retrospectively analyzed with regards to the presence of stenosis, occlusion, aneurysms and delayed distal flow, and degree of neovascularization. Diffuse narrowing was more frequent (66.1 vs. 38.0%, p = 0.001), whereas multifocal stenosis (6.5% vs. 26.8%, p = 0.002), abrupt occlusion (11.3% vs. 29.6%, p = 0.010) and aneurysm formation (1.6% vs. 11.3%, p = 0.037) were less frequent in IIM/SSc than PAN. In distal arteries, tapered occlusion (95.5% vs. 76.0%, p = ns) and delayed flow (77.3% vs. 48.0%, p = 0.039) were more common in IIM/SSc than PAN. After 1 year, auto- or surgical amputation tended to be more frequent in IIM/SSc than PAN (36.4% vs. 16.7%, p = ns). In conclusion, diffuse narrowing, tapered occlusion and delayed distal flow on conventional angiograms tend to be more frequent in IIM/SSc than PAN. Further studies are needed to verify these findings in a larger prospective cohort.


Assuntos
Aneurisma , Miosite , Poliarterite Nodosa , Escleroderma Sistêmico , Angiografia , Constrição Patológica , Humanos , Miosite/diagnóstico por imagem , Estudos Prospectivos , Estudos Retrospectivos , Escleroderma Sistêmico/diagnóstico por imagem
16.
J Vis Exp ; (183)2022 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-35575528

RESUMO

Apolipoprotein E (Apoe)- or low density lipoprotein receptor (Ldlr)-deficient hyperlipidemic mice are the two most commonly used models for atherosclerosis research. They are used to study the impact of a various genetic factors and different cell types on atherosclerotic lesion formation and as well as test the development of new therapies. Isolation, excision of the whole aorta, and quantification of Oil Red O-stained atherosclerotic lesions are basic morphometric methods used to evaluate atherosclerotic burden. The goal of this protocol is to describe an optimized, step-by-step surgical method to dissect, perfuse-fix, isolate, stain, image and analyze atherosclerotic lesions in mouse aortas with Oil Red O. Because atherosclerotic lesions can form anywhere in the entire aortic tree, this whole aorta Oil Red O staining method has the advantage of evaluating lipid-laden plaques in the entire aorta and all branches in a single mouse. In addition to Oil Red O staining, fresh isolated whole aortas can be used for variety of in vitro and in vivo experiments and cell isolations.


Assuntos
Aterosclerose , Hiperlipidemias , Placa Aterosclerótica , Aneurisma , Animais , Aorta/patologia , Apolipoproteínas E , Aterosclerose/metabolismo , Aterosclerose/patologia , Compostos Azo , Modelos Animais de Doenças , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Microscopia de Fluorescência/métodos , Placa Aterosclerótica/patologia , Coloração e Rotulagem/métodos
17.
Acta Neurochir (Wien) ; 164(6): 1645-1651, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35477815

RESUMO

PURPOSE: The aim of this study is to investigate the clinical and radiological features related to the symptomatic ischemic complications of vertebral artery dissecting aneurysm (VADA) following endovascular treatment (EVT). METHODS: The clinical and radiological features of 127 VADAs, which were treated in a single tertiary institute between September 2008 and December 2020, were retrospectively reviewed. We defined a thrombosed aneurysm as being one which the thrombus was in the aneurysm in magnetic resonance imaging (MRI). Symptomatic ischemic complication was defined as a case in which acute infarction was confirmed on diffusion weighted image after EVT with associated clinical symptoms. Univariate and multivariate analyses were executed to demonstrate the associations between symptomatic ischemic complication and characteristics of VADA. RESULTS: The rate of symptomatic ischemic complication was 13.4% (17 of 127). The thrombosed aneurysms were observed in 24.4% (31 of 127) and posterior inferior cerebellar artery (PICA) involvement was shown in 38.6% (49 of 127). Multivariate logistic regression analysis demonstrated that thrombosed aneurysms (odds ratio [OR] = 8.54, 95% confidence interval [CI] 1.98-36.87, p = 0.004) and PICA involvement (OR = 4.26, 95% CI 1.03-17.68, p = 0.046) were significantly associated with symptomatic ischemic complications following EVT. CONCLUSION: This study showed that the VADAs with intra-aneurysmal thrombose and PICA involvement may be independent risk factors for symptomatic ischemic complications following EVT. Therefore, when the thrombosed VADAs with PICA involvement are observed, practitioners may consider close postoperative monitoring for early detection of ischemic complications.


Assuntos
Aneurisma , Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Dissecação da Artéria Vertebral , Aneurisma/complicações , Embolização Terapêutica/métodos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Humanos , Aneurisma Intracraniano/complicações , Estudos Retrospectivos , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/cirurgia
18.
J Vis Exp ; (181)2022 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-35404358

RESUMO

Large animal models, specifically swine, are widely used to research cardiovascular diseases and therapies, as well as for training purposes. This paper describes two different aneurysmal swine models that may help researchers to study new therapies for aneurysmal diseases. These aneurysmal models are created by surgically adding a pouch of tissue to carotid arteries in swine. When the model is used for research, the pouch must be autologous; for training purposes, a synthetic pouch suffices. First, the right external jugular vein (EJV) and right common carotid artery (CCA) must be surgically exposed. The EJV is ligated and a vein pouch fashioned from a short segment. This pouch is then sutured to an elliptical arteriotomy performed in the CCA. Animals must be kept heparinized during model creation, and local vasodilators may be used to decrease vasospasms. Once the suture is completed, correct blood flow should be inspected, checking for bleeding from the suture line and vessel patency. Finally, the surgical incision is closed by layers and an angiography performed to image the aneurysmal model. A simplification of this aneurysmal carotid model that decreases invasiveness and surgical time is the use of a synthetic, rather than venous, pouch. For this purpose, a pouch is tailored in advance with a segment of a polytetrafluoroethylene (PTFE) prosthesis, one end of which is sutured close using polypropylene vascular suture and sterilized prior to surgery. This "sac" is then attached to an arteriotomy performed in the CCA as described. Although these models do not reproduce many of the physiopathological events related to aneurysm formation, they are hemodynamically similar to the situation found in the clinical setting. Therefore, they can be used for research or training purposes, allowing physicians to learn and practice different endovascular techniques in animal models that are close to the human system.


Assuntos
Aneurisma , Procedimentos Endovasculares , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Animais , Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/cirurgia , Modelos Animais de Doenças , Suínos
19.
Cir. pediátr ; 35(2): 1-5, Abril, 2022. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-203576

RESUMO

Introducción: Los pseudoaneurismas (PA) esplénicos y hepáticos son lesiones arteriovenosas raras que se pueden desarrollar tras un tramatismo abdominal. La rotura tardía es su complicación más frecuente que puede conducir a inestabilidad hemodinámica. El objetivo del presente es presentar nuestra experiencia en el manejo de los PA viscerales.Metodología: Estudio retrospectivo en pacientes < 15 años con traumatismo abdominal cerrado con lesión esplénica y/o hepática, entre 2012-2020. Se analizó el desarrollo de PA y el manejo realizado. En todos los pacientes se realizó tomografía computarizada estableciendo el grado del traumatismo, y estudio control en la primera semana postratumatismo mediante ecografía con contraste (CEUS). Si se confirmabaun PA se procedió a angiograma ± embolización percutánea.Resultados: Un total de 32 pacientes con traumatismo cerrado, edad media 8,7 ± 3,2 años (2-15 años), 68,7% (n = 22) hombres y mediana de grado de traumatismo grado III (grado II-IV), 33,3% (n =5/15) desarrollaron un PA esplénico y 5,8% (n = 1/17) desarrollaron un PA hepático con tiempo diagnóstico medio de 3,7 ± 3 (3-8) días. El desarrollo de PA se asoció a mayor puntuación en el índice de severidad con una diferencia de medias de 15,6 ± 5,3 (CI 95% 4,37:26,14 p < 0,008). Todos los PA se trataron mediante embolización un 85,7% (n = 5/6) excepto una esplenectomía urgente.Conclusiones: Los PA viscerales están infradiagnosticados, con una incidencia mayor a la reportada. Consideramos que un estudio de imagen (CEUS) debe ser realizado previo al alta en los traumatismos severos. El tratamiento sigue siendo controversial: sin embargo, recomendamos la embolización percutánea reservando la esplenectomíapara paciente inestables.


Introduction: Splenic and hepatic seudoaneurysm (PA) is a rare arteriovenous injury that may occur following abdominal trauma. The most frequent complication of PA is late rupture, which can lead to hemodynamic instability. The objective of this study was to describe our experience in the management of visceral PA.Materials and methods: A retrospective study of patients under15 years of age with blunt abdominal trauma associated with splenicand/or hepatic injury treated from 2012 to 2020 was carried out. PAformation and management were analyzed. All patients underwent CT-scan, which allowed trauma grade to be established, and also controlcontrast-enhanced ultrasonography (CEUS) in the first week followingtrauma. If PA was confirmed, angiography ± percutaneous embolizationwere performed.Results: A total of 32 patients with blunt trauma were included.Mean age was 8.7 ± 3.2 years (2-15 years). 68.7% (n = 22) of patientswere male. Median trauma grade was grade III (grades II-IV). 33.3%(n = 5/15) of patients developed splenic PA, and 5.8% (n = 1/17) ofpatients developed hepatic PA, with mean diagnostic time being 3.7 ± 3(3-8) days. PA formation was associated with higher severity scores,with a mean difference of 15.6 ± 5.3 (95% CI: 4.37:26.14 p < 0.008). AllPA cases – except for one, which required urgent splenectomy – weretreated with embolization (85.7%) (n = 5/6).Conclusions: Visceral PA is underdiagnosed, with an incidencehigher than reported. Imaging studies (CEUS) are required prior todischarge in the presence of severe trauma. Treatment remains contro-versial, but we recommend percutaneous embolization, with splenectomybeing reserved for unstable patients.


Assuntos
Humanos , Criança , Falso Aneurisma , Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/terapia , Aneurisma/diagnóstico por imagem , Pediatria , Estudos Retrospectivos , Cirurgia Geral , Criança , Pré-Escolar
20.
In Vivo ; 36(3): 1503-1507, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35478107

RESUMO

BACKGROUND/AIM: Celiac artery aneurysms represent rare eventualities which remain symptomatic for a long period of time; however, once diagnosed, it should be carefully monitored due to the high risk of developing life-threatening complications. When it comes to the types of therapeutic strategies, both endovascular and surgical therapies can be taken in consideration. CASE REPORT: Depending on the patency of the collateral network, simple ligation or graft placement should be performed. The aim of the current paper is to report the case of a patient diagnosed with a celiac trunk aneurysm who was successfully submitted to resection in association with iliac graft placement between the abdominal aorta and the common hepatic artery. CONCLUSION: Whenever celiac artery aneurysm is diagnosed, it should be closely monitored and treated, resection and reconstruction being a feasible method in order to avoid the development of a life-threatening complication.


Assuntos
Aneurisma , Artéria Celíaca , Aneurisma/diagnóstico , Aneurisma/etiologia , Aneurisma/cirurgia , Aorta Abdominal , Cadáver , Artéria Celíaca/cirurgia , Artéria Hepática/cirurgia , Humanos
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