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2.
Innovations (Phila) ; 14(2): 168-173, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31039681

RESUMO

Thoracic stent graft plus coil embolization is a promising option for management of pulmonary sequestrations. Here we present the case of a 43-year-old male with chronic recurrent chest pain and hemoptysis that was incidentally identified as having a Pryce Type I pulmonary sequestration. The patient had a known history of gastritis, alcohol abuse, chronic leg and back pain, and was incidentally found to have an anomalous artery from the descending thoracic aorta to the left lower lobe. Due to recurrent hemoptysis and refractory back pain with no other identifiable etiology, he was consented for coil embolization and thoracic endovascular aortic repair. In conjunction with interventional radiology, coil embolization of the aberrant thoracic artery was performed under fluoroscopic guidance with good graft coverage of the aberrant artery with an endovascular graft. The patient's postoperative recovery was uneventful and he reported a decrease in his chest pain. Repeat imaging including chest X-ray and CT angiography were performed prior to discharge. CT angiography demonstrated good positioning of the coils as well as the stent graft. The patient was discharged on postoperative day 1. Surgical intervention with ligation of the anomalous vessel has historically been the primary intervention for patients with Pryce Type I sequestrations, and it has yielded satisfactory results. However, thoracic stent graft in addition to coil embolization is a minimally invasive management option that should be considered as the first line of treatment because of the minimal physiologic burden on the patient and quicker recovery as compared to traditional thoracotomy.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Sequestro Broncopulmonar/diagnóstico , Embolização Terapêutica/instrumentação , Hemoptise/etiologia , Adulto , Sequestro Broncopulmonar/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Procedimentos Endovasculares/métodos , Hemoptise/diagnóstico , Humanos , Achados Incidentais , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Stents , Artérias Torácicas/anormalidades , Artérias Torácicas/diagnóstico por imagem , Artérias Torácicas/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
3.
J Neurointerv Surg ; 11(1): 95-98, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30166334

RESUMO

BACKGROUND AND PURPOSE: Thoracolumbar and sacral spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation. The purpose of this study was to perform a systematic review of the demographics, clinical presentation and treatment results of thoracolumbar SEDAVFs. MATERIALS AND METHODS: Pubmed, Scopus and Web of Science databases were searched from January 2000 to January 2018 for articles on treatment of SEDAVFs. Pooled data of individual patients were analyzed for demographic and clinical features of SEDAVFs as well as treatment outcomes. RESULTS: There were 125 patients from 11 studies included. Mean age was 63.5 years. There was a male sex predilection (69.6%). Sensory symptoms including pain or numbness were the most frequently presenting symptoms. Fistula location was the lumbosacral spine in 79.2% and the thoracic spine in 20.8%. Involvement of intradural venous drainage was more common than extradural venous drainage only (89.6% vs 10.4%). Of the 123 treated patients, endovascular therapy was performed in 67.5% of patients, microsurgery in 23.6%, and combined treatment in 8.9%. The overall complete obliteration rate was 83.5% and did not differ between groups. Clinical symptoms improved in 70.7% of patients, were stable in 25%, and worsened in 1.7% with no difference between treatment modalities. CONCLUSIONS: Thoracic and lumbosacral SEDAVFs often present with symptoms secondary to congestive myelopathy or compressive symptoms. Both endovascular and microsurgical treatments were associated with high obliteration rates and good clinical outcomes.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Região Lombossacral/irrigação sanguínea , Região Lombossacral/diagnóstico por imagem , Sacro/irrigação sanguínea , Sacro/diagnóstico por imagem , Artérias Torácicas/diagnóstico por imagem , Idoso , Fístula Arteriovenosa/terapia , Embolização Terapêutica/métodos , Espaço Epidural/irrigação sanguínea , Espaço Epidural/diagnóstico por imagem , Feminino , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/terapia , Resultado do Tratamento
4.
Eur Rev Med Pharmacol Sci ; 22(23): 8098-8103, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30556846

RESUMO

OBJECTIVE: To analyze the application value of high-frequency ultrasound in the muscles, bones and the thoracodorsal artery in the subscapular region and summarize the characteristics of ultrasound. PATIENTS AND METHODS: Subscapularis muscle, bone and thoracodorsal artery of 72 healthy subjects were examined using high-frequency ultrasound, the initial segment diameter of the thoracodorsal artery and peak systolic blood flow velocity were recorded, and the ultrasonographic characteristics of subscapularis muscle, bone and thoracodorsal artery were summarized. RESULTS: The spinous processes of 7th thoracic vertebrae, 9th thoracic vertebrae and 11th thoracic vertebrae all showed strong echoes with posterior acoustic shadow. The vertebral plates of 8th thoracic vertebrae, 10th thoracic vertebrae and 11th thoracic vertebrae showed a strong linear echo on both sides of the spinous process, and the lateral side was connected with the transverse processes of 8th thoracic vertebrae, 10th thoracic vertebrae, and 11th thoracic vertebrae. The inferior scapular artery was launched from the axillary artery, along with the deep side of the inferior scapular muscle, the latissimus dorsi and teres major muscle, and then it went inferior and backward which was then divided into arteriae dorsalis scapulae and thoracodorsal artery, showing a tubular structure with no echo. Color Doppler Flow Imaging (CDFI) showed the endovascular blood flow signal of the inferior scapular artery and its branches. The internal diameter of the initial segment of the thoracodorsal artery of the male subjects was bigger than that of the female subjects, and the difference was statistically significant (p < 0.05). CONCLUSIONS: High-frequency ultrasound can provide a reliable reference for the anatomical structure and adjacent relationship of subscapular muscles, bones and thoracodorsal artery, and is worthy of being promoted as a non-invasive and reliable mean of examination.


Assuntos
Músculo Esquelético/diagnóstico por imagem , Manguito Rotador/diagnóstico por imagem , Escápula/diagnóstico por imagem , Artérias Torácicas/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Adulto , Pontos de Referência Anatômicos , Feminino , Voluntários Saudáveis , Humanos , Músculos Intercostais/diagnóstico por imagem , Masculino , Músculos Paraespinais/diagnóstico por imagem , Valor Preditivo dos Testes , Fatores Sexuais , Músculos Superficiais do Dorso/diagnóstico por imagem , Adulto Jovem
5.
J Med Case Rep ; 12(1): 291, 2018 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-30292243

RESUMO

BACKGROUND: Massive hemothorax resulting from a minor injury mechanism is considered to be rare particularly when the diaphragm is injured. We report a case of massive hemothorax with bleeding from the intercostal artery and diaphragmatic damage caused by minor blunt trauma. CASE PRESENTATION: An 83-year-old Japanese man was transported to our hospital 3 hours after falling out of bed. Computed tomography revealed hemothorax and multiple rib fractures. He underwent fluid resuscitation and a tube thoracostomy, but he became hemodynamically unstable. Contrast-enhanced computed tomography revealed worsening hemothorax with contrast extravasation 4 hours after arrival at the hospital. Emergency angiography indicated hemorrhage in the area supplied by the tenth intercostal artery. Transcatheter arterial embolization stabilized his vital signs for a short period. However, further hemodynamic stabilization required a thoracotomy, which revealed diaphragmatic trauma, which was removed and sutured before fixing his fractured ribs. His postoperative course was uneventful, and he was transferred to another hospital for rehabilitation without complications on hospital day 29. CONCLUSIONS: Minor mechanisms of blunt trauma can cause rib fractures and massive hemothorax. Traumatic diaphragm injury should be considered a differential diagnosis if hemodynamic instability persists after transcatheter arterial embolization in patients with lower level rib fractures.


Assuntos
Diafragma , Embolização Terapêutica/métodos , Hemotórax , Fraturas das Costelas , Toracostomia/métodos , Toracotomia/métodos , Idoso de 80 Anos ou mais , Angiografia/métodos , Diafragma/diagnóstico por imagem , Diafragma/lesões , Diafragma/cirurgia , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico , Fixação de Fratura/métodos , Hemotórax/diagnóstico , Hemotórax/etiologia , Hemotórax/fisiopatologia , Hemotórax/terapia , Humanos , Masculino , Intensificação de Imagem Radiográfica/métodos , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico , Fraturas das Costelas/cirurgia , Artérias Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ferimentos não Penetrantes
6.
Angiol Sosud Khir ; 24(1): 57-65, 2018.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-29688195

RESUMO

The left internal thoracic artery (ITA) is currently an artery of choice for revascularization of coronary arteries. Ultrasonographic duplex scanning (USDS) and ultrasound Doppler flowmetry (UDF) are sequential techniques to control patency of the ITA at stages of rendering care for patients on restoring coronary blood flow. We compared two methods of measuring the volumetric blood flow velocity: by means of USDS and UDF. The obtained results were statistically processed. It was determined that transthoracic USDS and intraoperative UDF in the assessment of the volumetric blood velocity through the ITA in patients with coronary artery disease are comparable methods, provided the patients have similar parameters of central haemodynamics.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana , Assistência Perioperatória/métodos , Artérias Torácicas , Idoso , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/cirurgia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Artérias Torácicas/diagnóstico por imagem , Artérias Torácicas/fisiopatologia , Ultrassonografia Doppler Dupla/métodos , Grau de Desobstrução Vascular
7.
J Thorac Cardiovasc Surg ; 155(4): 1372-1378.e1, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29395204

RESUMO

BACKGROUND: The need for intercostal artery (ICA) reattachment in surgery for descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm (TAAA) remains controversial. We reviewed our experience over a 14-year period to assess the effects of ICA management on neurologic outcome after DTAA/TAAA repair. METHODS: Intraoperative data were reviewed to ascertain the status of T3-12 ICAs and L1-4 ICAs. Arteries were classified as reattached, ligated, occluded, or not exposed. Temporality of reattachment or ligation in response to an intraoperative ischemic event (ie, loss of motor evoked potentials [MEPs]) was noted. Adjustment for other predictors of immediate or delayed paraplegia (DP) was performed by multiple logistic regression. The effects of specific artery level and type of reattachment technique were assessed using stratified contingency tables. RESULTS: A total of 1096 DTAA/TAAAs were performed between 2001 and 2014. The mean patient age was 64 ± 15 years, and 37% were female. Spinal cord ischemia was identified in 10% of patients, including 35 (3%) immediate cases and 77 (7%) DP cases. Overall DP resolution was 47% at discharge. ICA ligation and intraoperative MEP changes were strong predictors of postoperative paraplegia. Multivariable analysis demonstrated that T8-12 ICA ligation significantly increased the risk for paraplegia (odds ratio, 1.3/artery; P < .041) even after adjustment for age >65 years, glomerular filtration rate, extent of II/III aneurysm, increased operative time, and intraoperative MEP loss. CONCLUSIONS: Loss of intraoperative MEPs is serious, and increases the risk of paraplegia in any ICA management strategy. Even with intact MEP, ligation of T8-12 ICAs is associated with increased risk. These findings support reattachment of T8-12 ICAs whenever feasible.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Paraplegia/prevenção & controle , Isquemia do Cordão Espinal/prevenção & controle , Artérias Torácicas/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Potencial Evocado Motor , Feminino , Humanos , Monitorização Neurofisiológica Intraoperatória , Ligadura , Masculino , Pessoa de Meia-Idade , Paraplegia/diagnóstico , Paraplegia/etiologia , Paraplegia/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Isquemia do Cordão Espinal/diagnóstico , Isquemia do Cordão Espinal/etiologia , Isquemia do Cordão Espinal/fisiopatologia , Artérias Torácicas/diagnóstico por imagem , Artérias Torácicas/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/efeitos adversos
9.
J Biomed Mater Res B Appl Biomater ; 106(5): 1842-1850, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-28922543

RESUMO

The degradation of Mirage Bioresorbable Microfiber Scaffold was evaluated in vitro and in vivo. The degradation in polymer molecular weight (MW), strut morphology, and integrity was accessed using gel permeation chromatography (GPC), X-ray micro-computed tomography (micro-CT) evaluation. To simulate the physiological degradation in vitro, scaffolds were deployed in silicone mock vessels connected to a peristaltic pumping system, which pumps 37°C phosphate-buffered saline (PBS, pH 7.4) at a constant rate. At various time points (30D, 60D, 90D, 180D, 270D, and 360D), the MW of microfibers decreased to 57.3, 49.8, 36.9, 13.9, 6.4, and 5.1% against the baseline. The in vivo degradation study was performed by implanting scaffolds in internal thoracic arteries (ITAs) of mini-swine. At the scheduled sacrifice time points (30D, 90D, 180D, 270D, 360D, and 540D), the implanted ITAs were excised for GPC analysis; the MW of the implanted scaffolds dropped to 58.5, 34.7, 24.8, 16.1, 12.9, and 7.1, respectively. Mass loss of scaffolds reached 72.4% at 540D of implantation. Two stages of hydrolysis were observed in in vitro and in vivo degradation kinetics, and the statistical analysis suggested a positive correlation between in vivo and in vitro degradation. After 6 months of incubation in animals, significant strut degradation was seen in the micro-CT evaluation in all sections as strut fragments and separations. The micro-CT results further confirmed that every sample at 720D had X-ray transmission similar to surrounding tissue, thereby indicating full degradation within 2 years. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1842-1850, 2018.


Assuntos
Implantes Absorvíveis , Prótese Vascular , Teste de Materiais , Artérias Torácicas , Microtomografia por Raio-X , Animais , Masculino , Suínos , Porco Miniatura , Artérias Torácicas/diagnóstico por imagem , Artérias Torácicas/cirurgia
10.
Chest ; 153(1): 224-232, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28736305

RESUMO

Procedures designed to drain fluid or air from the pleural spaces can be technically challenging in patients who are critically ill, and are associated with significant complications. Many individual ultrasound techniques have been described, each with the goal of making pleural drainage procedures safer. This article presents a systemic approach for incorporating many of these tools into procedures such as diagnostic thoracentesis, therapeutic drainage, and pleural catheter insertion. A series of illustrative figures and narrated video presentations are included to demonstrate many of the described techniques.


Assuntos
Derrame Pleural/cirurgia , Pontos de Referência Anatômicos , Estado Terminal , Diafragma/diagnóstico por imagem , Drenagem/efeitos adversos , Drenagem/métodos , Humanos , Tratamentos com Preservação do Órgão , Derrame Pleural/diagnóstico por imagem , Cirurgia Assistida por Computador/métodos , Artérias Torácicas/diagnóstico por imagem , Ultrassonografia de Intervenção
11.
Medicine (Baltimore) ; 96(45): e8634, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29137099

RESUMO

The purpose of the study was to evaluate the value of transarterial chemoembolization (TACE) via right internal thoracic artery (RITA) for patients with unresectable hepatocellular carcinoma (HCC).From January 2000 to June 2016, a retrospective study was conducted of all patients with unresectable HCC who underwent TACE via RITA across 3 medical centers. The technical success, serum alpha-fetoprotein (AFP) level changes, major complications, disease control rate, and survival were evaluated and analyzed.During the study peroid, in all, 21 patients (men 21; mean age 57.3 ±â€Š7.1 years) were included in this study. Of the 21 patients, all the tumors were located under the capsule of the liver and adjacent to the diaphragm with median tumor diameter of 8.2 cm in 20 patients, and the tumor was located at the surface of the liver due to incisional site metastasis in 1 remaining patient. Lesions fed by the RITA were demonstrated during initial TACE in 2 patients and during repeat TACE therapy in 19 patients. The technical success rate was 100%. The AFP response 1 month after treatment was complete (n = 4) and partial (n = 9) of 13 patients whose AFP was abnormal before the procedure, and the serum levels of AFP reduced significantly 1 month after treatment (1240.1 ±â€Š347.1 vs 175.2 ±â€Š71.8; P < .01). No major complications occurred. The disease control rate was 100% at 3 months after treatment. The median overall survival from the time of TACE therapy via the RITAs was 18.2 months, and 1-year survival after TACE therapy via the RITAs was 76.2%.Chemoembolization via the RITA can improve the therapeutic efficacy of TACE and reduce the presence of residual HCC.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Neoplasias Hepáticas/terapia , Adulto , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Quimioembolização Terapêutica/efeitos adversos , Seguimentos , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Artérias Torácicas/diagnóstico por imagem , Resultado do Tratamento
13.
J Surg Oncol ; 116(8): 1062-1068, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28782246

RESUMO

BACKGROUND: One promising surgical treatment of lymphedema is the VLNT. Lymph nodes can be harvested from different locations; inguinal, axillary, and supraclavicular ones are used most often. The aim of our study was to assess the surgical anatomy of the lateral thoracic artery lymph node flap. MATERIALS AND METHODS: In total, 16 lymph node flaps from nine cadavers were dissected. Flap markings were made between the anterior and posterior axillary line in dimensions of 10 × 5 cm. Axillary lymph nodes were analyzed using high-resolution ultrasound and morphologically via dissection. The cutaneous vascular territory of the lateral thoracic artery was highlighted via dye injections, the pedicle recorded by length, and diameter and its location in a specific coordinate system. RESULTS: On average, 3.10 ± 1.6 lymph nodes were counted per flap via ultrasound. Macroscopic inspection showed on average 13.40 ± 3.13. Their mean dimensions were 3.76 ± 1.19 mm in width and 7.12 ± 0.98 mm in length by ultrasonography, and 3.83 ± 2.14 mm and 6.30 ± 4.43 mm via dissection. The external diameter of the lateral thoracic artery averaged 2.2 ± 0.40 mm with a mean pedicle length of 3.6 ± 0.82 cm. 87.5% of the specimens had a skin paddle. CONCLUSIONS: The lateral thoracic artery-based lymph node flap proved to be a suitable alternative to other VLNT donor sites.


Assuntos
Linfonodos/anatomia & histologia , Linfedema/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Artérias Torácicas/anatomia & histologia , Cadáver , Dissecação , Humanos , Linfonodos/diagnóstico por imagem , Perfusão , Artérias Torácicas/diagnóstico por imagem
15.
Aesthetic Plast Surg ; 41(3): 524-530, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28233132

RESUMO

BACKGROUND: Current knowledge about the blood supply of the nipple-areola complex (NAC) has largely been derived from studies on cadavers or persons with breasts of normal size. The aim of this study was to identify and classify the NAC blood supply by computed tomographic angiography (CTA) examination in female volunteers with breast hypertrophy. METHODS: CTA examination was performed on hypertrophic breasts of 23 female subjects. The main blood supplies were revealed through image data analyses. The dominant blood supply of the NAC and its vascular sources were identified and sorted. The detectable diameter threshold of blood vessels was set beyond 1.0 mm. RESULTS: A total of 61 dominant blood vessels were identified. The source arteries were traced as the internal thoracic artery (ITA, 50.8%), lateral thoracic artery (LTA, 27.8%), thoracoacromial artery (TA, 14.8%), brachial artery (BA, 3.3%), and axillary artery (AA, 3.3%), and the corresponding reproducibility of these source vessels was 31, 37, 9, 4.3, and 4.3%, in all breasts. The intercostal artery (IA) was not identified as a dominant NAC supplying vessel in any CTA scan image. Twenty-six breasts had only one dominant artery, whereas 17 breasts showed multiple dominant blood supplies. Three breasts showed no dominant blood vessels of the NAC, with diameters greater than the detectable threshold of 1.0 mm, and 52.2% of the breasts demonstrated anatomically symmetrical patterns of blood supply for the NAC. CONCLUSIONS: The ITA, LTA, and TA are likely to be the main vessel sources, whereas the IA is unlikely to be the dominant vessel for NAC perfusion, on the basis of the studied breasts. An asymmetrical pattern of bilateral breast blood supply was demonstrated in a considerable portion of the females with breast hypertrophy in this study. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Mama/anormalidades , Angiografia por Tomografia Computadorizada/métodos , Hipertrofia/diagnóstico por imagem , Hipertrofia/cirurgia , Mamoplastia/métodos , Mamilos/irrigação sanguínea , Artérias Torácicas/diagnóstico por imagem , Adolescente , Adulto , Artéria Axilar/diagnóstico por imagem , Índice de Massa Corporal , Artéria Braquial/diagnóstico por imagem , Mama/diagnóstico por imagem , Mama/cirurgia , China , Estudos de Coortes , Feminino , Seguimentos , Humanos , Artéria Torácica Interna/diagnóstico por imagem , Pessoa de Meia-Idade , Mamilos/diagnóstico por imagem , Mamilos/cirurgia , Estudos Prospectivos , Fluxo Sanguíneo Regional/fisiologia , Resultado do Tratamento , Adulto Jovem
16.
Kyobu Geka ; 69(13): 1059-1063, 2016 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-27909273

RESUMO

A 73-year-old male with diabetes mellitius was referred to our hospital for coronary artery bypass grafting (CABG). Preoperative coronary angiography revealed three-vessel coronary disease. Minimally invasive coronary artery grafting (MICS CABG) via left thoracotomy was selected to decrease surgical site infection due to severe diabetes. In situ bilateral internal thoracic arteries (BITA) were harvested using a long type Harmonic scalpel. In situ right internal thorac artery( RITA)-left anterior descending artery (LAD), in situ left internal thorac artery( LITA)-high lateral branch (HL), and aorta-saphenous vein graft (SVG)-#4 posterior descending artery were performed. BITA, the ascending aorta for proximal anastomosis, and all coronary targets were directly accessed with off-pump technique. There were no major postoperative complications. Postoperative 3D-computed tomography angiography (CTA) revealed all grafts were patent. We believe that use of BITA in MICS CABG is feasible, and can provide satisfactory quality. Further research however, will be needed.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Artérias Torácicas/cirurgia , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Masculino , Artérias Torácicas/diagnóstico por imagem , Toracotomia
18.
Eur J Radiol ; 85(8): 1400-6, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27423679

RESUMO

OBJECTIVES: We investigated the frequencies and factors associated with the presence of extra-hepatic feeding arteries (EHFAs) of hepatocellular carcinoma (HCC) using intra-arterial CT aortography images. METHODS: A total of 173 patients with HCC who underwent transarterial chemoembolization (TACE) in our institution between January 2013 and March 2015 were enrolled. The types of EHFAs were evaluated by CT aortography images using an apparatus that combines multidetector-row computed tomography and angiography system. In addition, factors associated with the presence of EHFAs were determined. RESULTS: EHFAs were present in 22 (12.7%) patients with HCC. EHFAs most frequently branched from the right inferior phrenic artery (n=19), while others branched from the right adrenal artery (n=2), right renal artery (n=2), right internal thoracic artery (n=2), branches of the superior mesenteric artery (n=1), and an unknown artery from the aorta (n=1). Factors significantly associated with the presence of EHFAs in multivariate analysis were tumor size≥30mm (odds ratio (OR), 5.233 [95% confidence interval (CI), 1.507-17.413]; p=0.009) and number of prior TACE treatments≥3 (OR, 6.847 [95% CI, 1.928-24.311]; p=0.003). CONCLUSIONS: EHFAs of HCC were assessed with CT aortography images. Repeat TACE treatments and large tumor size were risk factors for the presence of EHFAs.


Assuntos
Aortografia/métodos , Carcinoma Hepatocelular/irrigação sanguínea , Angiografia por Tomografia Computadorizada/métodos , Neoplasias Hepáticas/irrigação sanguínea , Tomografia Computadorizada Multidetectores/métodos , Neovascularização Patológica/diagnóstico por imagem , Glândulas Suprarrenais/irrigação sanguínea , Glândulas Suprarrenais/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico por imagem , Quimioembolização Terapêutica/métodos , Meios de Contraste , Diafragma/irrigação sanguínea , Diafragma/diagnóstico por imagem , Feminino , Artéria Hepática/diagnóstico por imagem , Humanos , Imageamento Tridimensional/métodos , Iopamidol , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem , Artérias Torácicas/diagnóstico por imagem , Carga Tumoral
19.
Ann Vasc Surg ; 34: 62-7, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27177704

RESUMO

BACKGROUND: To retrospectively analyze the role of intercostal artery reconstruction in the spinal cord protection for patients undergoing extensive thoracoabdominal aortic aneurysm repair. METHODS: From August 2007 to 2014, thoracoabdominal aortas (Crawford II) of 81 consecutive patients with mean age 39.4 ± 10.32 years were repaired. Seventy-three of these patients (90.12%) were diagnosed with aortic dissection in our group, 25 (30.86%) with Stanford type A dissection and 48 (59.26%) with Stanford B aortic dissection. All 25 patients with type A dissection have previously undergone surgical procedures which include Bentall's procedures in 11 cases, ascending aortic replacement in 6 cases, and total aortic arch replacement in 8 cases. All procedures were performed under profound hypothermia with interval cardiac arrest after making a thoracoabdominal incision. Extracorporeal circulation was instituted with 2 arterial cannulae and a single venous cannula in the right atrium. T6-T12 intercostal arteries and L1 and L2 lumbar arteries were formed to a neo-intercostal artery in place and were connected to an 8 mm branch for maintaining spinal cord blood perfusion. Visceral arteries were joined into a patch and anastomosed to the end of the main graft. The left renal artery was anastomosed to an 8 mm branch or joined to the patch. The other 10 mm branches were anastomosed to iliac arteries. RESULTS: With 100% follow-up, early mortality was 7.4%. Six deaths were recorded; 1 patient died of cerebral hemorrhage, 3 of renal failure, 1 of heart failure because of myocardial infarction, and the last one died from the rupture of celiac artery dissection. The rate of postoperative spinal cord deficits was 3.7%, 2 patients with paraplegia and 1 patient with paraparesis. None had bladder or rectum dysfunction. Neo-intercostal arteries were clogged in 12 patients within follow-up period and formed pseudoaneurysm in 2 patients with Marfan syndrome. The mean survival time in this group was 54.22 ± 3.03 months (95% confidence interval 44.37-59.90 months) with survival rate of 92.37% after 1 year, 89.02% after 2 years, and 85.54% after 5 years. All patients were free from spinal cord deficits. CONCLUSIONS: Intercostal artery reconstruction is an effective technique for spinal cord protection in patients with the thoracoabdominal aortic repair. It can achieve favorable results and avoid spinal cord deficits with long-term follow-up.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Cirúrgicos Reconstrutivos , Isquemia do Cordão Espinal/prevenção & controle , Medula Espinal/irrigação sanguínea , Artérias Torácicas/cirurgia , Adulto , Anastomose Cirúrgica , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/fisiopatologia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Paraparesia/etiologia , Paraparesia/prevenção & controle , Paraplegia/etiologia , Paraplegia/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Fatores de Risco , Isquemia do Cordão Espinal/diagnóstico , Isquemia do Cordão Espinal/etiologia , Isquemia do Cordão Espinal/mortalidade , Isquemia do Cordão Espinal/fisiopatologia , Artérias Torácicas/diagnóstico por imagem , Artérias Torácicas/fisiopatologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
J Korean Med Sci ; 31(4): 641-3, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27051252

RESUMO

Delayed hemothorax after blunt torso injury is rare, but might be associated with significant morbidity and mortality. We present a case of delayed hemothorax bleeding from phrenic artery injury in a 24-year-old woman. The patient suffered from multiple rib fractures on the right side, a right hemopneumothorax, thoracic vertebral injury and a pelvic bone fracture after a fall from a fourth floor window. Delayed hemothorax associated with phrenic artery bleeding, caused by a stab injury from a fractured rib segment, was treated successfully by a minimally invasive thoracoscopic surgery. Here, we have shown that fracture of a lower rib or ribs might be accompanied by delayed massive hemothorax that can be rapidly identified and promptly managed by thoracoscopic means.


Assuntos
Hemotórax/complicações , Fraturas das Costelas/diagnóstico , Acidentes por Quedas , Feminino , Hemotórax/cirurgia , Humanos , Fraturas das Costelas/complicações , Artérias Torácicas/diagnóstico por imagem , Fatores de Tempo , Adulto Jovem
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