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1.
Vasc Endovascular Surg ; 54(1): 75-79, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31506016

RESUMO

Brachial artery aneurysms and arteriovenous malformations (AVM) are limb-threatening vascular anomalies. This patient presented with a bilobed brachial artery aneurysm in the antecubital fossa proximally to an AVM arising from the dorsal interosseous and ulnar arteries that had been treated with endovascular embolization, leaving the hand solely supplied by the radial artery. The aneurysm continued to increase in size and imaging revealed concomitant thrombus. A femoral vein interposition graft was used to repair the aneurysm, and postoperatively, the patient retained full left arm function.


Assuntos
Aneurisma/cirurgia , Malformações Arteriovenosas/complicações , Artéria Braquial/cirurgia , Veia Femoral/transplante , Artéria Ulnar/anormalidades , Adolescente , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Embolização Terapêutica , Feminino , Humanos , Resultado do Tratamento , Artéria Ulnar/diagnóstico por imagem , Grau de Desobstrução Vascular
2.
Medicine (Baltimore) ; 98(50): e18249, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852092

RESUMO

RATIONALE: Cancer and chemotherapy individually confer hypercoagulability and increased risks of thrombosis. Most thromboembolic complication after breast cancer chemotherapy was venous thrombosis after multiagent chemotherapy. Arterial thrombosis is extremely rare in early breast cancer patients receiving adjuvant chemotherapy. PRESENTING CONCERNS: A 55-year-old woman with right breast cancer presented to the emergency department with sudden pain, numbness, and swelling in her left hand. She underwent breast conserving surgery and sentinel lymph node biopsy 2 months before the visit. She received the second cycle of adjuvant Adriamycin-cyclophosphamide chemotherapy 5 days before. INTERVENTIONS: Computed tomography angiography revealed acute arterial thrombosis in the left brachial, radial, and ulnar arteries. Unfractionated heparin was initiated immediately, followed by brachial and radial-ulnar thrombectomy, restoring perfusion to the extremity. The postoperative course was uncomplicated; she was discharged on warfarin at a daily dose of 4 mg. OUTCOMES: Chemotherapy was discontinued. Anticoagulation with warfarin was continued. She subsequently received adjuvant endocrine therapy with an aromatase inhibitor and adjuvant radiotherapy. MAIN LESSONS: Despite the low risks of arterial thrombosis in breast cancer, it is a devastating complication with significant morbidity and mortality. Thromboprophylaxis should be considered in those at risk. Immediate anticoagulant therapy and surgical intervention should be considered in affected cases.


Assuntos
Artéria Braquial , Neoplasias da Mama/tratamento farmacológico , Ciclofosfamida/efeitos adversos , Doxorrubicina/efeitos adversos , Artéria Radial , Trombose/induzido quimicamente , Artéria Ulnar , Doença Aguda , Neoplasias da Mama/diagnóstico , Quimioterapia Adjuvante/efeitos adversos , Angiografia por Tomografia Computadorizada , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Quimioterapia Combinada/efeitos adversos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Trombectomia/métodos , Trombose/diagnóstico , Trombose/cirurgia , Ultrassonografia Doppler
3.
J Hand Surg Asian Pac Vol ; 24(3): 359-370, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31438795

RESUMO

Background: Chronic hand ischemia refers to progressive, non-acute ischemic symptoms such as cold intolerance, rest pain, ulceration, tissue necrosis, and digit loss and poses a significant challenge in management. Conservative treatment begins with medical optimization and pharmacologic therapy, but when symptoms persist, surgical intervention may be required. Various operations exist to improve circulation including sympathectomy, arterial bypass, or venous arterialization. The purpose of this study is to systematically review published outcomes and present our experience with each surgical technique. Methods: A systematic review of literature regarding surgical treatment of chronic hand ischemia published between 1990 and 2016 was conducted using PRISMA guidelines. A retrospective-review of surgical interventions for chronic hand ischemia from 2010 to 2016 was then conducted. Primary outcomes included improvement in pain, wound-healing, and development of new ulcerations. Results: The review included 38 eight studies, showing all three techniques were effective in treating chronic hand ischemia. Sympathectomy had the lowest rate of new ulcerations (0.8%); bypass had the highest rate of healing existing ulcerations (89%). Arterialization was associated with consistent pain improvement pain (100%) but more complications (30.8%). Our series included 18 patients with 21 affected hands, 18 sympathectomies, 6 ulnar artery bypasses, and 1 arterialization. Most hands had improvement of wounds (89.5%) and pain (78.9%). No patients developed new ulcerations, but one required secondary amputation. Conclusions: When conservative measures fail to improve chronic hand ischemia, surgical intervention is an effective last line treatment. An algorithmic approach can determine the best operation for patients with chronic hand ischemia.


Assuntos
Mãos/irrigação sanguínea , Isquemia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Estudos Retrospectivos , Simpatectomia , Resultado do Tratamento , Artéria Ulnar/cirurgia , Veias/cirurgia , Adulto Jovem
4.
Muscle Nerve ; 60(5): 582-585, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31443126

RESUMO

INTRODUCTION: Our aim in this work was to determine the safety and accuracy of the volar approach to the pronator quadratus (PQ) through cadaver dissection. METHODS: Twenty upper limbs from 10 fresh cadavers were investigated. At the level 3 cm proximal to the ulnar styloid process (USP), a needle was inserted just medial to the palmaris longus (PL) tendon. Distances of the median nerve (MN) and ulnar artery (UA) from the needle insertion point (IP) were measured using ultrasonography and cadaver dissection. RESULTS: The PQ was located at a depth of 10.8-19.9 mm from the skin and had a median thickness of 9.1 mm, measured 3 cm proximal to the USP. The median distances of the MN and UA from the IP were 7.6 and 13.4 mm, respectively. DISCUSSION: A needle insertion for the volar approach to the PQ was safe at 3 cm proximal to the USP, just medial to the PL tendon.


Assuntos
Pontos de Referência Anatômicos , Antebraço/anatomia & histologia , Nervo Mediano/anatomia & histologia , Músculo Esquelético/anatomia & histologia , Artéria Ulnar/anatomia & histologia , Cadáver , Dissecação , Eletromiografia/métodos , Feminino , Antebraço/diagnóstico por imagem , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Tendões , Artéria Ulnar/diagnóstico por imagem , Ultrassonografia
5.
Kyobu Geka ; 72(8): 612-615, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31353355

RESUMO

A 19-year-old man, with a history of hospitalization for infective endocarditis associated with Streptococcus mitis/oralis 2 months before, was admitted to our hospital because of stomach ache and pulsatile mass on the left forearm. Computed tomography(CT) and ultrasonography revealed a thrombus in the superior mesenteric artery and an aneurysm of the left ulnar artery. As vegetation was noted on the anterior leaflet of the mitral valve, mitral valve replacement and ulnar artery aneurysmorrhaphy were performed. He was discharged 24 days after surgery without any complications. Although mycotic aneurysm is one of the complications of infective endocarditis, it is rarely formed in the ulnar artery. Moreover, mycotic aneurysm may develop even after inflammatory reaction has subsided. Thus, longterm observation of patients with infective endocarditis is necessary.


Assuntos
Aneurisma Infectado , Endocardite Bacteriana , Humanos , Masculino , Valva Mitral , Artéria Ulnar , Adulto Jovem
6.
Orthopedics ; 42(5): e415-e422, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31185121

RESUMO

Ulnar artery thrombosis (UAT) occurs most commonly in athletes and manual laborers who repeatedly use their palm in high-impact activities. Anecdotal evidence has shown an increased prevalence of UAT in orthopedic surgeons, especially in joint arthroplasty surgeons, compared with the general population. This study sought to determine the prevalence of UAT among orthopedic surgeons and to identify risk factors for developing UAT. Eighty orthopedic surgeons and residents were included in the study. Participants completed a demographic questionnaire, and a timed Allen test was performed on each hand with the radial artery occluded. A reperfusion result greater than 6 seconds was considered abnormal. Participants with a positive Allen test and UAT-associated symptoms were deemed to have UAT. Statistical analysis was performed using the Fisher exact and Wilcox-on rank-sum tests. The prevalence of UAT was 11% (9 of 80) in the study population compared with 1.6% (21 of 1300) in the general population (P<.0001). For surgeons with 15 years or more of practice, the UAT rate was 24% (8 of 33) compared with 2% (1 of 47) for surgeons with less than 15 years of practice (P=.0030). The prevalence of UAT in adult reconstruction surgeons trended toward significance at 40% (2 of 5) compared with 9% (7 of 75) in the other subspecialties (P=.095). Orthopedic surgeons have an increased risk for developing UAT compared with the general population. The risk of UAT is significantly correlated with advancing years in clinical practice and may be associated with the number of arthroplasty cases performed. [Orthopedics. 2019; 42(5):e415-e422.].


Assuntos
Doenças Profissionais/epidemiologia , Cirurgiões Ortopédicos/estatística & dados numéricos , Trombose/epidemiologia , Artéria Ulnar , Artroplastia/estatística & dados numéricos , Mãos/irrigação sanguínea , Humanos , Prevalência , Inquéritos e Questionários , Fatores de Tempo
7.
Int J Oral Maxillofac Surg ; 48(12): 1509-1515, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31239082

RESUMO

Radial forearm free flap reconstruction for head and neck cancer is very common, and it is widely considered a workhorse flap. Although this flap has a relatively reliable anatomy, surgeons need to be aware of possible anatomical variations and how to deal with them. This paper presents the cases of two patients who underwent oral reconstruction, in whom anomalies of the radial artery were identified while raising a radial forearm free flap. Case 1 demonstrates the dominant branch of the radial artery joining the common interosseous artery approximately 9 cm from the first wrist crease. Case 2 demonstrates abnormal distal branching of the radial artery approximately 4 cm from the first wrist crease. Reconstruction with the flap was successful in both cases. A literature review of reported anomalies of the radial artery is presented, and how to deal with such vascular anomalies is discussed.


Assuntos
Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Artéria Radial , Artéria Ulnar
8.
Ann Vasc Surg ; 59: 306.e7-306.e10, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31075480

RESUMO

Vascular anomaly is a general term that includes all vascular malformations, vascular tumors, and other congenital vascular defects. Vascular malformation is the most common term, and it describes blood vessels that are abnormally formed at birth. Vascular malformations can develop in any part of the body. The most common location is in the lower extremities. Vascular malformations involve arteries, veins, or lymphatic vessels, or a combination of these. Our patient was a 22-year-old man with an arteriovenous malformation in his left forearm. He was admitted due to increased pain and swelling on his left forearm over the previous 9 months. He had 1 arterial feeder derived from the ulnar artery and 2 venous drainage systems at the magnetic resonance angiography. We used indocyanine green fluorescence angiography to assess the arteriovenous malformation during surgery. We found that it was a very useful and unique technique for assessing the anomalies of the vascular anatomy and eradicating the nidus of the arteriovenous malformation. It could prove to be very helpful in avoiding significant blood loss during surgery.


Assuntos
Angiografia/instrumentação , Malformações Arteriovenosas/cirurgia , Corantes Fluorescentes/administração & dosagem , Antebraço/irrigação sanguínea , Verde de Indocianina/administração & dosagem , Artéria Ulnar/cirurgia , Malformações Arteriovenosas/diagnóstico por imagem , Perda Sanguínea Cirúrgica/prevenção & controle , Humanos , Cuidados Intraoperatórios , Angiografia por Ressonância Magnética , Masculino , Valor Preditivo dos Testes , Resultado do Tratamento , Artéria Ulnar/anormalidades , Artéria Ulnar/diagnóstico por imagem , Adulto Jovem
9.
BMC Musculoskelet Disord ; 20(1): 143, 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947704

RESUMO

BACKGROUND: Microvascular problems like increased intraosseous pressure or venous congestion may influence the development of Kienböck's disease. We examined if wrist position modifies the blood flow in the nutrient vessels. METHODS: Retrospective analysis of 17 patients with Kienböck's disease who had a superselective microangiography of the radial, ulnar and interosseous artery in different wrist positions under general anaesthesia. We analysed the data with Fisher's exact and Wilcoxon-test. RESULTS: We found vessels that entered the bone, that ended at the bone edge, and that supplied a vascular plexus. The origins were the anterior interosseous artery in 10 of 17 cases, the radial artery in seven cases, and the ulnar artery in five cases. Movement of the wrist could reduce or stop the blood flow. Type of lunate configuration showed no significant influence on the blood supply in neutral position. CONCLUSION: The radial, ulnar, and anterior interosseous artery contribute to the vascular supply of the lunate bone in different combinations. Wrist movement can reduce blood flow to the lunate bone.


Assuntos
Angiografia/métodos , Osso Semilunar/irrigação sanguínea , Osteonecrose/patologia , Artéria Radial/diagnóstico por imagem , Artéria Ulnar/diagnóstico por imagem , Adulto , Meios de Contraste/administração & dosagem , Feminino , Humanos , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Articulação do Punho/irrigação sanguínea , Articulação do Punho/diagnóstico por imagem , Adulto Jovem
11.
Surg Radiol Anat ; 41(7): 791-799, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30923841

RESUMO

PURPOSE: The purpose of the study is to study and classify the superficial palmar arch and its variation based upon the gross dissection and to check the bilateral symmetry of the arches. Specifically, we checked for the presence of the superficial palmar arch as described in the standard textbooks. METHODS: We dissected 55 hands from 28 cadavers of both sexes that include 18 males and 10 females. The superficial palmar arch was carefully dissected and the arteries contributing its formation were traced. It was classified into complete, incomplete arches. Bilateral symmetry of the arches was also studied. RESULTS: The most common pattern of superficial palmar arch observed is complete. And it is further classified into radio-ulnar and predominantly ulnar types. A consistent proportion of radio-ulnar type arch is completed around first web space. None of the dissected hand meets the definition of the classical superficial palmar arch as described in the standard anatomical textbooks. We also encountered few rare variants of the incomplete superficial palmar arch. CONCLUSIONS: Type 1-4 superficial palmar arch is complete and can be utilized for radial artery or ulnar artery cannulation and radial artery harvesting procedure. In type 5 arch, ulnar artery occlusion could lead to severe hand ischemia and at the same time the radial artery in this type can be harvested without ischemic complication. We suggest that the definition of the complete superficial palmar arch should be rechecked and modified as complete superficial palmar or complete superficial first web space arch.


Assuntos
Variação Anatômica , Mãos/irrigação sanguínea , Artéria Radial/anatomia & histologia , Artéria Ulnar/anatomia & histologia , Adulto , Cadáver , Dissecação , Feminino , Humanos , Masculino
13.
J Hand Surg Asian Pac Vol ; 24(1): 89-92, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30760156

RESUMO

Parkes Weber Syndrome (PWS) is a congenital disorder characterized by the presence of arteriovenous malformations (AVMs) in upper or lower extremities. We herein present a 35 year-old male with PWS with complex AVMs in the right upper extremity; he had been previously treated with multiple sessions of vessel embolization, sclerotherapy and AVM resections. The patient presented to our clinic with two month history of progressive hand ischemia, digit necrosis and infection. Angiography was performed demonstrating numerous AVMs and filiform flow through the ulnar artery with poor opacification of arterial structures in the hand. Because of advanced ischemia, soft tissue infection and osteomyelitis, a distal forearm amputation was indicated. Hand threatening ischemia secondary to steal phenomenon associated to AVMs in PWS is rarely encountered and reported. This case illustrates a complex clinical presentation with advanced disease that required limb amputation.


Assuntos
Malformações Arteriovenosas/diagnóstico por imagem , Mãos/irrigação sanguínea , Isquemia/etiologia , Síndrome de Sturge-Weber/complicações , Síndrome do Roubo Subclávio/diagnóstico por imagem , Adulto , Amputação , Angiografia por Tomografia Computadorizada , Mãos/cirurgia , Humanos , Isquemia/cirurgia , Masculino , Osteomielite/complicações , Infecções dos Tecidos Moles/complicações , Artéria Ulnar/diagnóstico por imagem
14.
Ann Vasc Surg ; 57: 275.e13-275.e15, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30711504

RESUMO

BACKGROUND: Hypothenar hammer syndrome (HHS) is an uncommon vascular syndrome of upper extremity. HHS should be considered in patients who are presented with digital ischemia. Distal ulnar artery compression at the level of Guyon's canal with trauma results in thrombus or aneurysm. It may be observed after repetitive chronic trauma or acute blunt trauma to hypothenar eminence. Middle-aged male laborers, smokers, and dominant hands are affected frequently. Hand pain, discoloration or ulceration of digits, cold intolerance, hypothenar pulsatile mass, hypothenar weakness, and numbness are significant clinical findings. CASE CHARACTERISTICS: In this report, we presented a 37-year-old woman complaining with intermittent hand pain, paleness, and cyanosis at third, fourth, and fifth fingers of the right hand. She had no blunt trauma to her hand but intense amount of needle lace with her hands. Doppler ultrasonography revealed ulnar arterial thrombus at right Guyon's canal level. CONCLUSIONS: She was diagnosed as HHS secondary to intense needlework. A calcium channel blocker and low-dose aspirin were prescribed to her, and avoidance of hand traumas was suggested. These interventions relieved digital ischemia symptoms on her hand.


Assuntos
Arteriopatias Oclusivas/etiologia , Passatempos , Isquemia/etiologia , Doença de Raynaud/etiologia , Trombose/etiologia , Artéria Ulnar , Adulto , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/tratamento farmacológico , Arteriopatias Oclusivas/fisiopatologia , Bloqueadores dos Canais de Cálcio/uso terapêutico , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Isquemia/diagnóstico por imagem , Isquemia/tratamento farmacológico , Isquemia/fisiopatologia , Doença de Raynaud/diagnóstico por imagem , Doença de Raynaud/tratamento farmacológico , Doença de Raynaud/fisiopatologia , Fluxo Sanguíneo Regional , Síndrome , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Artéria Ulnar/diagnóstico por imagem , Artéria Ulnar/efeitos dos fármacos , Artéria Ulnar/fisiopatologia , Ultrassonografia Doppler em Cores
16.
Med Sci Monit ; 25: 32-39, 2019 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-30600313

RESUMO

BACKGROUND Knowledge of the variable relation of the persistent median artery (PMA) to the median nerve and its contribution to the formation of the superficial palmar arch is of great clinical significance. This study presents a proposal of specific variables which might be introduced to characterize the PMA in the wrist region. MATERIAL AND METHODS One hundred and twenty-five randomly selected, isolated upper limbs fixed in 10% formalin solution were subjected to anatomical dissection. RESULTS Of the 125 upper limbs, PMA was found in 5 specimens (4% of the total number of limbs). In the carpal tunnel, the artery occupied the anterolateral position (2 cases), the anterior position (2 cases) or the anteromedial position (1 case) in relation to the median nerve. Two types of superficial palmar arches with significant contributions from the PMA were observed in the studied material: complete medio-ulnar arch and an incomplete arch without a connection between the territories of the ulnar and median arteries. The mean ratio of the diameter of the PMA to the diameter of ulnar artery at the level of the wrist was 0.59 (min.=0.38, max=0.83, SD=0.19). CONCLUSIONS Orthopedic and hand surgeons should be aware of the probability of occurrence of the PMA in both planning and conducting surgeries within the wrist region and within the carpal tunnel, as this anomalous vessel might present significant contributions to the arterial blood supply of the hand and might potentially play an important role in the presence of notable clinical symptoms and presentations.


Assuntos
Nervo Mediano/irrigação sanguínea , Articulação do Punho/anatomia & histologia , Adulto , Cadáver , Síndrome do Túnel Carpal/fisiopatologia , Feminino , Mãos/fisiopatologia , Humanos , Masculino , Nervo Mediano/anatomia & histologia , Artéria Radial , Artéria Ulnar , Punho/anatomia & histologia , Articulação do Punho/fisiopatologia
17.
J Invasive Cardiol ; 31(1): E7, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30611129

RESUMO

To our knowledge, this is the first reported case of a dual-access approach for CTO intervention using transradial and ipsilateral transulnar access. Although retrograde CTO intervention is a challenging procedure, a single arm-double access approach seems to be a feasible alternative that may be useful in patients with limited access-site availability.


Assuntos
Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/cirurgia , Intervenção Coronária Percutânea/métodos , Artéria Radial , Artéria Ulnar , Idoso , Angiografia Coronária/métodos , Humanos , Masculino , Segurança do Paciente , Índice de Gravidade de Doença , Stents , Resultado do Tratamento
18.
Blood Purif ; 47(1-3): 236-239, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30517921

RESUMO

BACKGROUND: Conflicting data continue to surround the optimal dialysis access for the elderly. Many propose that catheters are the best option for this population; others emphasize the creation of an arteriovenous fistula. SUMMARY: While an arteriovenous access is the best available access, it has a high early failure rate, particularly in the elderly. However, significant differences exist in forearm (men ≥65 years ~70%; women ≥65 years ~80%) versus upper arm (men ≥65 years ~40%; women ≥65 years ~38%) fistula failure rates in the elderly, with upper arm having much lower failure rates. Two percutaneous innovative techniques that successfully establish fistulas at the upper arm using proximal radial/ulnar -artery as the inflow have been recently introduced. These procedures have been successfully performed in the elderly. Importantly, these techniques bypass the open surgical exploration and as such avoid the surgical manipulation of the juxta-anastomotic region (a common cause for the development of juxta-anastomotic stenosis and early fistula failure). Key Message: This article discusses the arteriovenous fistula creation in the elderly, highlights the factors necessary for successful fistula creation, and describes the 2 innovative techniques that can be used to provide a robust platform for successful fistula creation in this population.


Assuntos
Serviços de Saúde para Idosos , Artéria Radial/cirurgia , Artéria Ulnar/cirurgia , Dispositivos de Acesso Vascular , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Feminino , Humanos , Masculino
19.
J Vasc Access ; 20(4): 433-437, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30486732

RESUMO

PURPOSE: To report our 13 years of experience with the 'primary extension technique' for the prevention of dialysis-associated steal syndrome. METHODS: All diabetic patients undergoing upper arm autogenous elbow fistula formation using the primary extension technique between September 2001 and September 2014 at a single centre were included. At follow-up all patients were evaluated for patency, adequacy of needling and the presence or absence of steal symptoms. In primary extension technique, the fistula is formed by anastomosing the median cubital vein with the proximal radial or ulnar artery just below the brachial artery bifurcation. RESULTS: In total, 64 operations of the primary extension technique were included in this study. All patients were diabetic. Primary failure was 5%, follow-up 23-84 months. Nine patients (14%) developed cephalic vein thrombosis. In these cases, the basilic vein was successfully transposed to the existing fistula. In eight patients (12.5%), the cephalic vein required superficialisation. In three patients, the flow was preferentially into the basilic vein with poor maturation of cephalic vein. Of these three patients, there was a small proximal cephalic vein in one patient and stenosis in the other two patients. One patient who developed dialysis-associated steal syndrome is included in the results as they were listed for primary extension technique fistula formation but in fact did not have their fistula formed using primary extension technique. Instead, the anastomosis was formed proximal to the bifurcation of the brachial artery. Symptoms improved with revision of the fistula. CONCLUSION: Our 13-year experience demonstrates that the primary extension technique is a safe and effective procedure for fistula formation. Patency rates are comparable to brachio-cephalic and brachio-basilic fistulas and primary extension technique is effective in the prevention of dialysis-associated steal syndrome.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Cotovelo/irrigação sanguínea , Oclusão de Enxerto Vascular/prevenção & controle , Isquemia/prevenção & controle , Artéria Radial/cirurgia , Diálise Renal , Artéria Ulnar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Isquemia/etiologia , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Artéria Radial/fisiopatologia , Fluxo Sanguíneo Regional , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Artéria Ulnar/fisiopatologia , Grau de Desobstrução Vascular , Veias/fisiopatologia , Veias/cirurgia
20.
Sports Health ; 11(3): 238-241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30496025

RESUMO

A 26-year-old, right-handed male professional hockey player presented for a second opinion with dysesthesia of the tips of his right third, fourth, and fifth fingers after 2 previous incidents of hyperextension injuries to his right wrist while holding his hockey stick. Radiographs and computed tomography scans were negative for fracture. After magnetic resonance angiography and Doppler ultrasound imaging, the athlete was diagnosed with hypothenar hammer syndrome (HHS) with ulnar artery aneurysm and thrombosis. He underwent successful surgery with ligation and excision of the aneurysmal, thrombosed ulnar artery and was able to return to hockey 4 weeks after surgery. HHS is thought to be a rare posttraumatic digital ischemia from thrombosis and/or aneurysm of the ulnar artery and was traditionally considered an occupational injury but has been reported more frequently among athletes. There have only been 2 previous case reports of hockey players diagnosed with HHS, and in the previous 2 case reports, both involved repetitive trauma from the hockey stick, which resulted in thrombotic HHS. We present a case of a professional hockey player diagnosed with HHS also due to repetitive trauma from the hockey stick, but this time resulting in aneurysmal HHS with thromboembolism. This case report highlights the importance of keeping HHS in the differential diagnosis in athletes with pain, cold sensitivity, and paresthesia in their fingers with or without a clear history of repetitive trauma to the hypothenar eminence, as HHS is a condition with good outcomes after proper treatment.


Assuntos
Aneurisma/complicações , Arteriopatias Oclusivas/complicações , Dedos/fisiopatologia , Dor/etiologia , Trombose/complicações , Adulto , Traumatismos em Atletas/complicações , Transtornos Traumáticos Cumulativos/complicações , Hóquei/lesões , Humanos , Masculino , Artéria Ulnar/patologia
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