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1.
BMC Musculoskelet Disord ; 20(1): 380, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31421678

RESUMO

BACKGROUND: At present, bicortical pedicle screws (BPSs) are not used clinically because they carry the potential risk of damaging the prevertebral great vessels (PGVs). The authors observed the anatomical relationship between the PGVs and simulated BPSs at different transverse screw angles (TSAs), exploring the insertion method of the BPS. METHODS: Computed tomography angiography (CTA) images from 65 adults were collected. A total of 4-5 TSAs of the BPSs were simulated on the left and right sides of L1-L5 (L1-L3: 0°, 5°, 10°, 15°; L4-L5: 0°, 5°, 10°, 15°, 20°). There were three types of distances from the anterior vertebral cortex (AVC) to the PGVs (DAVC-PGV); DAVC-PGV < 0.50 cm, DAVC-PGV ≥ 0.50 cm, and DAVC-PGV↑; these distances represented close, distant, and noncontact PGV, respectively. RESULTS: The ratio of every type of PGV was calculated, and the appropriate TSA of the BPS was recommended. In L1, the recommended left TSA of the BPS was 0°, and the ratio of the close PGV was 7.69%, while the recommended right TSA was 0°-10°, and the ratio of the close PGV was 1.54-4.62%. In L2, the recommended left TSA of the BPS was 0° and the ratio of the close PGV was 1.54%, while the recommended right TSA was 0°-15° and the ratio of the close PGV was 3.08-9.23%. In L3, the recommended left TSA was 0°-5°, and the ratio of the close PGV was 1.54-4.62%. In L4, the recommended left TSA was 0°, and the ratio of the close PGV was 4.62%. BPS use was not recommended on the right side of either L3 or L4 or on the either side of L5. CONCLUSIONS: From the anatomical perspective of the PGVs, BPSs were not suitable for insertion into every lumbar vertebra. Furthermore, the recommended methods for inserting BPSs were different in L1-L4.


Assuntos
Vértebras Lombares/irrigação sanguínea , Parafusos Pediculares/efeitos adversos , Fusão Vertebral/métodos , Adulto , Idoso , Aorta Abdominal/anatomia & histologia , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/lesões , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Artéria Ilíaca/anatomia & histologia , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/lesões , Veia Ilíaca/anatomia & histologia , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/lesões , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Veia Cava Inferior/anatomia & histologia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/lesões , Adulto Jovem
4.
Medicine (Baltimore) ; 98(27): e16184, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277124

RESUMO

RATIONALE: Microcoils are a permanent embolic material, and blood vessels that have been embolized by a microcoil remain occluded for a prolonged period of time. The pudendal artery is an important functional vessel for penile erection. Whether simultaneous embolization of the bilateral pudendal artery using microcoils can seriously affect penile erection has not been sufficiently studied. PATIENT CONCERNS: A 47-year-old male patient, after undergoing brain surgery, accidentally pulled out the Foley catheter causing a urethral hemorrhage. The patient was immediately treated using a new larger Foley catheter inserted under urethroscopic guidance and medication. However, massive bleeding occurred on the tenth day after the procedure. DIAGNOSIS: A right internal iliac angiography performed after the bleeding event demonstrated a rupture at the end of the right internal pudendal artery with the contrast agent flowing out directly from the urethra. A super selective internal pudendal angiogram showed a small amount of hemorrhage at the end of the left internal pudendal artery. INTERVENTIONS: The patient underwent interventional treatment. After the bilateral internal iliac angiography was performed, super-selective internal pudendal artery embolization with microcoils was performed. A subsequent bilateral internal pudendal angiogram did not show any abnormality. OUTCOMES: During the follow up period of 2 months, the patient had no complaints of difficulty in urination or sexual dysfunction. LESSONS: Some doctors do not advocate the use of coils as embolic agents in bilateral pudendal artery lesions because of concerns over erectile dysfunction. There is rich vascular circulation in the perineum. Thus, in arterial embolization for the treatment of penile bleeding, regardless of the type of embolic material used, the key is to ensure accurate embolization to maintain good collateral circulation. This principle can help limit the occurrence of sexual dysfunction to the lowest possible levels after such procedures.


Assuntos
Embolização Terapêutica/instrumentação , Hemorragia/etiologia , Doenças Uretrais/etiologia , Cateteres de Demora/efeitos adversos , Humanos , Artéria Ilíaca/lesões , Masculino , Pessoa de Meia-Idade , Pênis/irrigação sanguínea , Pênis/lesões , Ruptura/etiologia
5.
Am J Forensic Med Pathol ; 40(3): 289-292, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31205056

RESUMO

The bone marrow biopsy is usually a safe procedure; however, it can occasionally present important complications. These complications are not always immediately evident or quickly diagnosed and may include pain at the biopsy site, trauma to neighboring structures, vascular injuries, infection, transient pressure neuropathies, pneumoretroperitoneum, and hemorrhage. Several risk factors are recognized, including thrombocytopenia, concurrent use of anticoagulants, and the presence of an underlying myeloproliferative disorder. While several reports of adverse events have been published, only 2 deaths attributable to this procedure have been reported. We present 2 cases of fatal hemorrhage after bone marrow biopsy.


Assuntos
Biópsia/efeitos adversos , Medula Óssea/patologia , Hemorragia/patologia , Espaço Retroperitoneal/patologia , Choque Hemorrágico/etiologia , Idoso , Evolução Fatal , Feminino , Humanos , Artéria Ilíaca/lesões , Artéria Ilíaca/patologia , Masculino , Pessoa de Meia-Idade
6.
Diagn Interv Radiol ; 25(3): 219-224, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31063141

RESUMO

PURPOSE: We aimed to study the technical and clinical outcome of urgent transcatheter arterial embolization (TAE) for postoperative arterial complications after pelvic or hip surgery, and to accumulate additional experience about the role of embolization for these injuries. METHODS: Patients who received TAE procedure for arterial complications after pelvic or hip surgery between September 1st, 2002 and December 1st, 2014 were screened on medical records and included in the analysis. Angiographic findings included active contrast agent extravasation, pseudoaneurysm formation, arteriovenous fistula, and other suspicious signs such as sighting of coarse margin or distortion of vessels. Embolic agents consisted of coils, gelatin sponge, and polyvinyl alcohol. Technical success was defined as complete occlusion of targeted artery through angiography, and clinical success as sustained resolution of symptoms. RESULTS: A total of 22 patients (15 males, 19-76 years old) were enrolled. Prior to TAE, 12 patients developed hemorrhagic shock and the remaining 10 patients had hemorrhage-related pain, hematoma, or anemia. Contrast agent extravasation occurred in 12 cases, pseudoaneurysm formation in 5 cases, and other suspicious signs in 5 cases. Injury occurred in the internal iliac artery stem in 6 cases, inferior gluteal artery in 6 cases and superior gluteal artery in 6 cases. Multiple vascular lesions appeared in 5 cases. After TAE, technical success occurred in 22 patients and clinical success in 21 patients (95.5%). A 36-year-old woman died of irreversible multiple organ failure; no other severe procedure-related complications were recorded. CONCLUSION: TAE is safe and effective for postoperative arterial complications after pelvic or hip surgery.


Assuntos
Embolização Terapêutica/métodos , Quadril/cirurgia , Pelve/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Angiografia/métodos , Artérias/lesões , Fístula Arteriovenosa/terapia , Nádegas/irrigação sanguínea , Extravasamento de Materiais Terapêuticos e Diagnósticos , Feminino , Hemorragia/terapia , Humanos , Artéria Ilíaca/lesões , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia , Resultado do Tratamento , Adulto Jovem
7.
Ann Transplant ; 24: 199-207, 2019 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-30975974

RESUMO

BACKGROUND Vascular failures are serious complications in pancreas transplantation. Open surgery is a reliable and quick intervention method, but it carries a risk of infection and bleeding. Endovascular procedures are rare among patients after a SPK, but are becoming more frequently used. One of the main risks of the endovascular approach is that the renal function impairment caused by contrast agent. MATERIAL AND METHODS We performed a retrospective analysis of 200 transplanted pancreases at our center over the last 14 years. The analyses included those patients after pancreas transplantation who required the most challenging vascular interventions and ones that were non-standard for the procedure. RESULTS Severe vascular conditions requiring endovascular intervention were observed in 3% of SPKs. In one retransplanted patient, there was an acute ischemia of the lower extremity due to the narrowing of the common iliac artery following a previous transplantectomy, above the new pancreas graft anastomoses. In another patient, local inflammation led to the disruption of the external iliac artery on the level of transplantectomy, caused severe bleeding, and we had to implement a stent-graft to reconstruct the iliac artery wall. A third patient had a pseudoaneurysm demanding further treatment with a stent-graft implemented into the femoral artery due to a pseudoaneurysm of the right external iliac artery. CONCLUSIONS Intravenous interventions in patients with a transplanted or retransplanted pancreas are safe and feasible. It is a technically demanding procedure, but the risk of kidney graft function deterioration, as well as of bleeding due to the high dose of heparin used, is lower than with open vascular surgery.


Assuntos
Procedimentos Endovasculares , Transplante de Rim/efeitos adversos , Transplante de Pâncreas/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/cirurgia , Implante de Prótese Vascular , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/lesões , Artéria Femoral/cirurgia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/lesões , Artéria Ilíaca/cirurgia , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Stents , Tomografia Computadorizada por Raios X
8.
J Invasive Cardiol ; 31(5): E97, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31034445

RESUMO

Percutaneous approaches have become routine in transcatheter aortic valve replacement (TAVR). Despite numerous advantages, vascular complications associated with percutaneous access can occur during and after TAVR, and increase morbidity and mortality significantly. Effective management of potentially catastrophic vascular complications often requires prompt recognition, diagnosis, and management by multidisciplinary teams.


Assuntos
Aorta Torácica , Estenose da Valva Aórtica/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Procedimentos Endovasculares/métodos , Complicações Intraoperatórias , Substituição da Valva Aórtica Transcateter , Lesões do Sistema Vascular , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/lesões , Aorta Torácica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Técnicas Hemostáticas , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/lesões , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/fisiopatologia , Complicações Intraoperatórias/cirurgia , Masculino , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/fisiopatologia , Lesões do Sistema Vascular/cirurgia
9.
Clin Anat ; 32(5): 682-688, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30873674

RESUMO

Blood vessels passing through pelvic region come into intimate contact with pelvic bone and can be injured by the sharp edges of the dislocated fracture fragments. The aim of the study was to evaluate the influence of localization, shape, and dislocation of individual pelvic ring bones' fractures on arterial injuries. The study group consisted of 474 patients enrolled in a 1-year prospective multicenter study. The pattern of pelvic fracture lines was characterized and recorded on a planar diagram of the subjected side of the pelvis. The diagram was subdivided into 11 designated areas. Frequency of injury at each 11 areas was recorded. The course of individual arteries in the 11 areas was also recorded in relation to each type of pelvic fractures. Out of the 474 investigated patients, the highest proportion of fractures occurred in the areas of the superior (62%) and inferior (59%) ramus of the pubis as well as in the lateral part of the sacrum (19%). These locations can be associated with injuries of the external iliac, obturator, internal iliac, and aberrant obturator arteries. The highest risk of arterial injuries was associated with vertically displaced fractures in the middle part of the superior and inferior pubic rami, along the ischial ramus, in the apex of the greater sciatic notch and in the vicinity of the ventral part of the sacroiliac joint, where the artery runs at a distance of less than 1 cm from the bone. Clin. Anat. 32:682-688, 2019. © 2019 Wiley Periodicals, Inc.


Assuntos
Fraturas Ósseas/complicações , Artéria Ilíaca/lesões , Ossos Pélvicos/lesões , Fraturas Ósseas/classificação , Fraturas Ósseas/fisiopatologia , Articulação do Quadril/anatomia & histologia , Articulação do Quadril/irrigação sanguínea , Humanos , Ossos Pélvicos/anatomia & histologia , Ossos Pélvicos/irrigação sanguínea , Estudos Prospectivos , Articulação Sacroilíaca/irrigação sanguínea , Articulação Sacroilíaca/lesões
10.
World Neurosurg ; 125: 347-351, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30797924

RESUMO

BACKGROUND: Vascular injury complications during lumbar discectomy are rare but potentially life-threatening. Therefore, an early diagnosis and effective treatment management is required for these complications. CASE DESCRIPTION: A 50-year-old female patient was admitted to our outpatient clinic with severe back and right leg pain. She underwent surgery for right L4-5 extruded disc herniation with general anesthesia. Sudden arterial hemorrhage occurred during discectomy performed with straight disc forceps and was controlled using hemostatic materials, with no significant decrease in blood pressure. However, the patient became hypotensive near the end of the operation. The incision was quickly closed, and she was turned to supine position. Emergency abdominal ultrasound, computed tomography, and computed tomography angiography revealed an injury of the left main iliac artery, which was repaired by endovascular stenting. Laparotomy and Bogota bag were applied because of increased intrabdominal pressure at 3 hours postoperative. In addition, a retroperitoneal catheter was placed into the area of the right retroperitoneal hematoma on the first postoperative day. Tissue plasminogen activator was administered through the catheter. On postoperative day 3, the Bogota bag was removed, and the abdomen was closed. The patient was discharged without neurodeficit on day 27. Her abdominal fascial defect was closed with a synthetic graft after 5 months. CONCLUSIONS: Although lumbar discectomy is one of the most commonly performed neurosurgical procedures, the routine rules of discectomy should not be neglected. Early detection and a multidisciplinary approach can help prevent mortality in the event of vascular injury.


Assuntos
Discotomia/efeitos adversos , Artéria Ilíaca/lesões , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Perda Sanguínea Cirúrgica , Angiografia por Tomografia Computadorizada , Diagnóstico Precoce , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Artéria Ilíaca/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Pessoa de Meia-Idade , Imagem Multimodal , Stents , Ativador de Plasminogênio Tecidual/administração & dosagem , Ultrassonografia , Lesões do Sistema Vascular/diagnóstico por imagem
11.
Heart Vessels ; 34(7): 1230-1239, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30671641

RESUMO

We established a rabbit iliac artery restenosis model to explore the impact of Telmisartan on the expression of Connexin43 (Cx43) and neointimal hyperplasia. Thirty New Zealand white rabbits were randomly divided into three groups: control group (n = 10), restenosis group (n = 10), and Telmisartan group (n = 10). The restenosis model was established by high-cholesterol diet combined with double-balloon injury of iliac arteries. In addition, Telmisartan at 5 mg/(kg day) was administered to the rabbits of Telmisartan group on the second day after the second balloon injury. All rabbits were killed at the end of the experiment followed by institution policy. Before sacrifice, blood samples were obtained to test serum angiotensinII (AngII). Iliac arteries were isolated for morphological analysis and determining the expression of Cx43 by HE staining, immunohistochemical analysis, reverse transcription-polymerase chain reaction (RT-PCR), and Western Blotting analysis. Then, the local AngII levels of arteries were measured by radioimmunoassay. As compared with controls, the expression of Cx43 mRNA (0.98 ± 0.08) vs. (1.27 ± 0.17), P < 0.01), and Cx43 protein [(0.75 ± 0.08) vs. (0.90 ± 0.08), P < 0.05] of restenosis group were increased, which were significantly higher than those of Telmisartan group [Cx43 mRNA: (1.27 ± 0.17) vs. (1.00 ± 0.20), P < 0.01; Cx43 protein: (0.90 ± 0.08) vs. (0.82 ± 0.05), P < 0.05]. Furthermore, The intima thickness [(266.12 ± 70.27) vs. (2.85 ± 0.19) µm, P < 0.01] and the local AngII [(115.6 ± 15.7) vs. (90.1 ± 7.7), P < 0.05] of restenosis group were raised when compared with controls. Telmisartan group exhibited thinner intima compared with restenosis group [(68.22 ± 24.37) vs. (266.12 ± 70.27), P < 0.01]. However, the local AngII levels between these two groups were approximate. In addition, the plasma concentration of AngII was not significantly different among three groups. In conclusion, Telmisartan can inhibit the expression of connexin43 and neointimal hyperplasia in iliac artery restenosis model.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Conexina 43/metabolismo , Artéria Ilíaca/lesões , Telmisartan/farmacologia , Animais , Cateterismo , Proliferação de Células/efeitos dos fármacos , Conexina 43/genética , Hiperplasia/prevenção & controle , Artéria Ilíaca/patologia , Masculino , Músculo Liso Vascular/metabolismo , Miócitos de Músculo Liso/citologia , Neointima/prevenção & controle , Coelhos
13.
Vasc Endovascular Surg ; 53(2): 160-164, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30301433

RESUMO

PURPOSE:: To report on the endovascular management of a patient affected by concomitant left common iliac artery and right superficial femoral artery (SFA) pseudoaneurysms after stent positioning. CASE REPORT:: A 77-year-old man affected by severe lower limb atherosclerosis was previously treated with iliac and femoropopliteal Supera stenting procedures; he presented to our emergency department because of bilateral severe claudication recurrence, back pain, and right groin region swelling. Angio-computed tomography (CT) depicted 2 pseudoaneurysms of the left common iliac artery and right SFA, due to stent fracture and stent intussusception, respectively. A 2-step endovascular treatment was planned using bilaterally covered stent-grafts to exclude vascular lesions from blood flow. The devices were successfully deployed without any complication. At 1 month, angio-CT confirmed patency of the implanted stent-grafts showing complete pseudoaneurysm exclusion without leaks. CONCLUSION:: Endovascular approach can be a valid option in the treatment of pseudoaneurysms due to stenting procedure complications.


Assuntos
Falso Aneurisma/cirurgia , Procedimentos Endovasculares/instrumentação , Artéria Femoral/cirurgia , Artéria Ilíaca/cirurgia , Doença Arterial Periférica/cirurgia , Stents , Lesões do Sistema Vascular/cirurgia , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/fisiopatologia , Angiografia Digital , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/lesões , Artéria Femoral/fisiopatologia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/lesões , Artéria Ilíaca/fisiopatologia , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Falha de Prótese , Resultado do Tratamento , Grau de Desobstrução Vascular , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/fisiopatologia
14.
J Vasc Interv Radiol ; 29(12): 1733-1740, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30297312

RESUMO

PURPOSE: To report long-term results of iliofemoral stent placement after transcatheter aortic valve replacement (TAVR). MATERIALS AND METHODS: TAVR access-related complications treated with iliofemoral stent placement were recorded in 56 patients (mean age, 81 years; range; 53-93 years; 48% male) of 648 patients who underwent TAVR at a single center. Fifty-six patients treated with stent placement (40 patients with stent grafts and 16 patients with bare metal stents) underwent clinical and ultrasonographic follow-up after a mean of 676 days (range, 60-1840 days). RESULTS: During follow-up, none of the 56 patients who had stent placement underwent a vascular reintervention of the affected limb, and none suffered from limb claudication. No decrease was observed in ankle-brachial index (ABI) values to an abnormal value, except in 1 patient (mean preprocedural and postprocedural ABI of 1.2 ± 0.14, range, 0.97-1.4 and 1.19 ± 0.24, range, 0.65-1.54, respectively). Arterial duplex assessment showed normal stent flow velocity (mean, 168.7 ± 63.2 cm/sec; range, 80-345 cm/sec) in all but 1 patient. CONCLUSION: Iliofemoral stent implantation is a safe and efficacious treatment for vascular access site and access-related complications during transfemoral TAVR.


Assuntos
Estenose da Valva Aórtica/cirurgia , Cateterismo Periférico/métodos , Procedimentos Endovasculares/instrumentação , Artéria Femoral/cirurgia , Artéria Ilíaca/cirurgia , Stents , Substituição da Valva Aórtica Transcateter/métodos , Lesões do Sistema Vascular/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia , Índice Tornozelo-Braço , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Procedimentos Endovasculares/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/lesões , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/lesões , Masculino , Pessoa de Meia-Idade , Punções , Fatores de Risco , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/fisiopatologia
15.
BMJ Case Rep ; 20182018 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-30131408

RESUMO

Major vascular injury during surgery is life threatening and can be a nightmare for any surgeon.We share our experience of a 42-year-old woman where right common iliac artery and both common iliac veins were accidentally injured during lumbar discectomy leading to haemorrhagic shock. Patient was resuscitated and explored. A 4 cm segment of right common iliac artery was found lacerated along with perforations of both iliac veins. Proximal segment of internal iliac artery was mobilised quickly and vascular continuity was restored by end-to-end anastomosis of this segment to the proximal segment of common iliac artery after excising the damaged segment. Iliac veins were repaired primarily. Patient made an uneventful recovery. We share this technique as it was found expeditious and effective and may benefit surgeons working in this field.


Assuntos
Discotomia/efeitos adversos , Artéria Ilíaca/lesões , Complicações Intraoperatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões do Sistema Vascular/cirurgia , Adulto , Feminino , Humanos , Artéria Ilíaca/cirurgia , Complicações Intraoperatórias/etiologia , Vértebras Lombares/cirurgia , Choque Hemorrágico/etiologia , Choque Hemorrágico/cirurgia
16.
Adv Clin Exp Med ; 27(10): 1371-1375, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30058782

RESUMO

BACKGROUND: Iatrogenic vascular injuries, due to the particular nature of such pathology, are associated with high morbidity and mortality in the postoperative period. OBJECTIVES: The objective of this study was to present a case of non-classic approach to the therapy of iatrogenic arteriovenous fistula. MATERIAL AND METHODS: We present a case of a 17-year old female patient admitted to the Department of Vascular, General and Oncologic Surgery (Copernicus Memorial Hospital, Lódz, Poland) due to an iatrogenic injury to the common iliac vein and artery, following neurosurgical intervention on the spine. Two weeks prior to admission, the patient underwent surgery in the Neurosurgery Clinic for herniated nucleus pulposus and lumbar spine scoliosis. The imaging diagnostic revealed the presence of a pseudoaneurysm of the right common iliac artery and arteriovenous fistula between the right common iliac vessels. The patient was qualified for endovascular treatment. Two self-expanding covered stents were successfully deployed. The clinical and radiological outcome of the procedure was good. The postoperative period was uneventful. The patient was discharged home on the 3rd postoperative day. RESULTS: The control examinations (directly after the procedure and 6, 12, 24 and 32 months thereafter) revealed full patency of the iliac vessels, as well as no recurrence of arteriovenous fistula, nor a pseudoaneurysm of the right common iliac artery. No symptoms of either chronic limb ischaemia or venous insufficiency were observed. CONCLUSIONS: Iatrogenic vessel injury, being a complication of neurosurgical and orthopedic surgeries, may be overlooked and remain undetected both in intraand postoperative period. Modern imaging techniques allow for an adequate diagnosis of the injury and planning the treatment of arteriovenous fistula. The endovascular procedures are the method of choice in patients with arteriovenous fistulas of iliac vessels, alternative to open surgery.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Procedimentos Endovasculares/métodos , Doença Iatrogênica , Aneurisma Ilíaco/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Veia Ilíaca/cirurgia , Stents , Adolescente , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Constrição Patológica/congênito , Constrição Patológica/cirurgia , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/lesões , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/lesões , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/anormalidades , Vértebras Lombares/cirurgia , Polônia , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Acta Biomater ; 75: 235-252, 2018 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-29859367

RESUMO

Peripheral vascular trauma due to injuries of the upper and lower limbs are life-threatening, and their treatment require rapid diagnosis and highly-qualified surgical procedures. Experienced surgeons have recognized that subclavian arteries, affected by injuries of the upper limbs, require a more careful handling due to fragility than common iliac arteries, which are may be affected by injures of the lower limbs. We investigated these two artery types with comparable diameter to evaluate the differences in the biomechanical properties between subclavian and iliac arteries. Human subclavian and common iliac arteries of 14 donors either from the right or the left side (age: 63 yrs, SD: 19,9 female and 5 male) were investigated. Extension-inflation-torsion experiments at different axial strains (0-20%), transmural pressures (0-200 mmHg) and torsion (±25°) on preconditioned arterial tubes were performed. Residual stresses in both circumferential and axial direction were determined. Additionally, the microstructure of the tissues was determined via second-harmonic generation imaging and by histological investigations. At physiological conditions (pi=13.3 kPa, λz=1.1) common iliac arteries revealed higher Cauchy stresses in circumferential and axial directions but a more compliant response in the circumferential direction than subclavian arteries. Both arteries showed distinct stiffer behavior in circumferential than in axial direction. Circumferential stiffness of common iliac arteries at physiological conditions increased significantly with aging (r=-0.67,p=0.02). The median inversion stretches, where the axial force is basically independent of the transmural pressure, were determined to be 1.05 for subclavian arteries and 1.11 for common iliac arteries. Both arteries exhibited increased torsional stiffness, when either axial prestretch or inflation pressure was increased. Residual stresses in the circumferential direction were significantly lower for subclavian arteries than for common iliac arteries at measurements after 30 min (p=0.05) and 16hrs (p=0.01). Investigations of the collagen microstructure revealed different collagen fiber orientations and dispersions in subclavian and iliac arteries. The difference in the collagen microstructure revealed further that the adventitia seems to contribute significantly to the passive mechanical response of the tested arteries at physiological loadings. Histological investigations indicated pronounced thickened intimal layers in subclavian and common iliac arteries, with a thickness comparable to the adventitial layer. In conclusion, we obtained biomechanical differences between subclavian and common iliac arteries, which possibly resulted from their different mechanical loadings/environments and respective in vivo movements caused by their anatomical locations. The biomechanical differences explored in this study are well reflected by the microstructure of the collagen and the histology of the investigated arteries, and the results can improve trauma patient care and endovascular implant design. STATEMENT OF SIGNIFICANCE: During surgical interventions surgeons experienced that subclavian arteries (SAs) supplying the upper extremities, appear more fragile and prone to damage during surgical repair than common iliac arteries (CIAs), supplying the lower extremities. To investigate this difference in a systematic way the aim of this study was to compare the biomechanical properties of these two arteries from the same donors in terms of geometry, extension-inflation-torsion behavior, residual stresses, microstructure, and histology. In regard to cardiovascular medicine the material behavior of aged human arteries is of crucial interest. Moreover, the investigation of SA is important as it can help to improve surgical procedures at this challenging location. Over the long-term it might well be of value in the construction of artificial arteries for substituting native arteries. In addition, the analysis of mechanical stresses can improve design and material choice for endovascular implants to optimize long-term implant function.


Assuntos
Artéria Ilíaca/química , Artéria Ilíaca/fisiopatologia , Estresse Mecânico , Artéria Subclávia/química , Artéria Subclávia/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Artéria Ilíaca/lesões , Masculino , Pessoa de Meia-Idade , Artéria Subclávia/lesões
19.
J Neonatal Perinatal Med ; 11(1): 105-108, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29689742

RESUMO

Two neonates with congenital heart disease, one and thirty-one days old respectively, suffered inadvertent arterial injury from cardiac catheterization. Both insults resulted in unrecognized avulsion of the external iliac artery from its origin. The patients quickly decompensated, with their right lower extremities becoming critically ischemic. In both cases, segments of reversed greater saphenous vein were used as interposition grafts from the common iliac artery to the common femoral artery. Reperfusion of the right foot was immediate for the one-day-old. She is now three years old and able to run, but is followed for a mild limb length discrepancy. The 31-day-old had restoration of flow to the right limb; however, the foot remained ischemic and eventually required transmetatarsal amputation. She is now 16 months old and able to crawl; she also is followed for limb length discrepancy. Without vein grafting, both infants would likely have lost their affected limbs, and possibly lost their lives. These cases advocate for microsurgical repair of arterial injuries in even the youngest patients, and promote the use of vein grafts when direct anastomosis is not feasible.


Assuntos
Pé/irrigação sanguínea , Artéria Ilíaca/lesões , Artéria Ilíaca/cirurgia , Isquemia/cirurgia , Lesões do Sistema Vascular/cirurgia , Assistência ao Convalescente , Cateterismo Cardíaco/efeitos adversos , Feminino , Artéria Femoral/cirurgia , Humanos , Lactente , Recém-Nascido , Isquemia/etiologia , Microcirurgia , Veia Safena/transplante , Enxerto Vascular , Lesões do Sistema Vascular/etiologia
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