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1.
PLoS One ; 15(2): e0229444, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32101567

RESUMO

Clinical interpretation of arterial spin labeling (ASL) perfusion MRI in cerebrovascular disease remains challenging mainly because of the method's sensitivity to concomitant contributions from both intravascular and tissue compartments. While acquisition of multi-delay images can differentiate between the two contributions, the prolonged acquisition is prone to artifacts and not practical for clinical applications. Here, the utility of the spatial coefficient of variation (sCoV) of a single-delay ASL image as a marker of the intravascular contribution was evaluated by testing the hypothesis that sCoV can detect the effects of differences in label arrival times between ipsi- and contra-lateral hemispheres even in the absence of a hemispheric difference in CBF. Hemispheric lateralization values for sCoV and CBF were computed from ASL images acquired on 28 patients (age 73.9 ± 10.2 years, 8 women) with asymptomatic unilateral carotid occlusion. The results showed that sCoV lateralization predicted the occluded side with 96.4% sensitivity, missing only 1 patient. In contrast, the sensitivity of the CBF lateralization was 71.4%, with 8 patients showing no difference in CBF between hemispheres. The findings demonstrate the potential clinical utility of sCoV as a cerebrovascular correlate of large vessel disease. Using sCoV in tandem with CBF, vascular information can be obtained in image processing without the need for additional scan-time.


Assuntos
Arteriopatias Oclusivas/diagnóstico , Encéfalo/irrigação sanguínea , Doenças das Artérias Carótidas/diagnóstico , Circulação Cerebrovascular , Processamento de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Marcadores de Spin , Idoso , Feminino , Humanos , Masculino
2.
BMC Ophthalmol ; 19(1): 254, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842812

RESUMO

BACKGROUND: To investigate the surgical outcomes of strabismus related to iatrogenic occlusion of the ophthalmic artery and its branches from cosmetic facial filler injection. METHODS: A retrospective study was performed on 6 patients who underwent strabismus surgery among 23 patients who had suffered occlusion of the ophthalmic artery and its branches after cosmetic facial filler injection. Initial, preoperative and final ocular motility examinations, the type of surgery and surgical outcomes were evaluated. RESULTS: At initial presentation, visual acuity was no light perception in 5 patients and hand motion in one patient. Five out of 6 patients showed initial ophthalmoplegia. Among these 5 patients, eye motility fully recovered in 3 patients although sensory strabismus developed during follow-up, while the remaining 2 patients had persistent ocular motility limitations. Strabismus surgery was performed at 2.2 ± 1.5 years after iatrogenic ophthalmic artery occlusion. Preoperatively, 5 of the 6 patients showed exotropia, and one patient had esotropia. Vertical deviation was found in 3 out of 6 patients in addition to the horizontal deviation. Successful outcome was achieved only in the 4 patients without persistent ophthalmoplegia after 1.4 ± 1.0 years from surgery. The other two patients with persistent ocular motility limitations failed to achieve successful alignment after surgery, and one patient eventually underwent evisceration due to phthisis bulbi. CONCLUSIONS: In our study, surgical outcomes of strabismus caused by cosmetic facial filler injection were successful only in patients without persistent ophthalmoplegia at the time of surgery.


Assuntos
Arteriopatias Oclusivas/induzido quimicamente , Preenchedores Dérmicos/efeitos adversos , Músculos Oculomotores/cirurgia , Artéria Oftálmica/efeitos dos fármacos , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/cirurgia , Adulto , Arteriopatias Oclusivas/diagnóstico , Humanos , Doença Iatrogênica , Oftalmoplegia/induzido quimicamente , Estudos Retrospectivos , Ritidoplastia , Estrabismo/induzido quimicamente , Estrabismo/fisiopatologia , Resultado do Tratamento , Visão Binocular/fisiologia , Acuidade Visual/fisiologia , Adulto Jovem
3.
Expert Rev Cardiovasc Ther ; 17(11): 827-836, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31710251

RESUMO

Introduction: An absent radial pulse prior to cardiac catheterization is an ominous finding as it portends the need for higher-risk arterial access. Solutions exist that can avoid the use of more hazardous access. Given the benefits of the radial artery access, it is essential to prevent radial artery occlusion, to diagnose acute occlusion at the time of hemostasis so it can be treated, and understand alternatives for access that exists in the lower forearms if the radial occlusion is recalcitrant. Ultrasound plays a significant role in safe access and procedural planning. It should be a skill embraced by all operators. Future devices will be improved for shallow vessel access. Better knowledge of access techniques and adjunctive therapies will work synergistically to improve outcomes in the years ahead.Areas covered: Literature review on forearm access is composed of small case series and underpowered trials but does provide a framework for evaluating the problem.Expert opinion: The objective of this paper is to give an approach to tackle forearm access when there appears to be no palpable radial pulse. Preservation of radial flow is paramount while alternative forearm means to vascular access may help avoid the need to access the femoral artery.


Assuntos
Arteriopatias Oclusivas/diagnóstico , Cateterismo Cardíaco/métodos , Artéria Radial , Artéria Femoral , Humanos
4.
Pediatr Cardiol ; 40(7): 1523-1529, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31375852

RESUMO

Acute femoral artery occlusion is common in pediatric patients following cardiac catheterization. A variety of means are utilized to assess lower extremity (LE) perfusion and arterial patency following cardiac catheterization including palpation of pulses, pulse oximetry, subjective assessment of lower extremity color and temperature, and ultrasound. We sought to evaluate the utility of Near-Infrared Spectroscopy (NIRS) to monitor LE perfusion in pediatric patients undergoing cardiac catheterization. INVOS pediatric sensors were placed on bilateral LE in all pediatric patients ≤ 40 kg undergoing cardiac catheterization. Data were recorded continuously from the start of the procedure until 4-6 h after completion of the procedure. NIRS readings were compared between the accessed versus non-accessed LE at baseline before start of case, time of vascular access, arterial sheath exchange when applicable, sheath withdrawal, and Safeguard application, deflation, and removal. 133 patients underwent 152 catheterizations with mean age 2.4 ± 2.3 years and mean weight 12.4 ± 13.2 kg. NIRS oximetry readings were significantly decreased in the LE with arterial access compared to non-accessed LE from time of sheath insertion until removal of the pressure assist device post procedure. A greater difference was noted in smaller patients. NIRS oximetry readings did not correlate with subjective assessment of lower extremity perfusion after arterial sheaths were removed. One patient had pulse loss 4 h post procedure with a decrease in oximetry readings noted at this point on review. Weight-based heparin protocol was initiated, and a gradual improvement in oximetry readings was noted over the next 5 h. Vascular ultrasound 12 h later showed no evidence of arterial thrombus. NIRS may be helpful in identifying patients who are risk for developing arterial thrombus post cardiac catheterization and for monitoring response to therapy; however, further study in these patients is warranted.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Extremidade Inferior/irrigação sanguínea , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Arteriopatias Oclusivas/diagnóstico , Encéfalo/irrigação sanguínea , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Oximetria/métodos , Trombose/etiologia , Trombose/prevenção & controle , Ultrassonografia Doppler
6.
J Stroke Cerebrovasc Dis ; 28(9): 2388-2397, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31320270

RESUMO

OBJECTIVE: Improve prehospital identification of acute ischemic stroke patients with large vessel occlusion (LVO) by using a trauma system-based emergency communication center (ECC) to guide the emergency medical service (EMS). METHODS: We trained 24 ECC paramedics in the Emergency Medical Stroke Assessment (EMSA). ECC-guided EMS in performance of the EMSA on patients with suspected stroke. During the second half of the study, we provided focused feedback to ECC after reviewing recorded ECC-EMS interactions. We compared the sensitivity, specificity, and area under the receiver operator characteristics curve (AUC) and 95% confidence interval of ECC-guided EMSA to the NIH Stroke Scale (NIHSS) for predicting a discharge diagnosis of LVO. RESULTS: We enrolled 569 patients from September 2016 through February 2018. Of 463 patients analyzed, 236 (51%) had a discharge diagnosis of stroke and 227 (49%) had a nonstroke diagnosis. There were 45 (19%) stroke patients with LVO. For predicting LVO, there was no significant difference between the EMSA AUC = .68 (.59-.77) and the NIHSS AUC = .73 (.65-.81). An EMSA score greater than or equal to 4 had sensitivity = 75.6 (60.5-87.1) and specificity = 62.4 (57.6-67.1) for LVO. During the first 9 months of the study, the EMSA AUC = .61 (.44-.77) compared to an AUC = .74 (.64-.84) during the second 9 months. CONCLUSIONS: ECC-guided prehospital EMSA is feasible, has similar ability to predict LVO compared to the NIHSS, and has sustained performance over time.


Assuntos
Arteriopatias Oclusivas/diagnóstico , Isquemia Encefálica/diagnóstico , Competência Clínica , Sistemas de Comunicação entre Serviços de Emergência , Serviços Médicos de Emergência/métodos , Auxiliares de Emergência/educação , Capacitação em Serviço/métodos , Acidente Vascular Cerebral/diagnóstico , Idoso , Arteriopatias Oclusivas/fisiopatologia , Arteriopatias Oclusivas/psicologia , Arteriopatias Oclusivas/terapia , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/psicologia , Isquemia Encefálica/terapia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Fatores de Risco , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Acidente Vascular Cerebral/terapia , Tempo para o Tratamento
9.
J Invasive Cardiol ; 31(6): E160-E161, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31158817

RESUMO

A 60-year-old male presented with complaints of a non-healing wound on his right shin. Initial angiography showed a 100% occlusion of the right superficial femoral artery thought to be thrombotic in nature; he was treated with percutaneous transluminal angioplasty and stenting. Three weeks later, he presented with continuing symptoms of claudication. Angiography revealed stent fracture. Careful review of his prior angiogram was consistent with adventitial cystic disease of the popliteal artery as the cause of the popliteal artery occlusion. He was then referred for femoral-popliteal bypass.


Assuntos
Arteriopatias Oclusivas/diagnóstico , Cistos/diagnóstico , Artéria Poplítea/cirurgia , Stents/efeitos adversos , Angiografia , Arteriopatias Oclusivas/etiologia , Cistos/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagem , Falha de Prótese
10.
Future Cardiol ; 15(3): 169-173, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31148471

RESUMO

Radial artery access is associated with lower bleeding risks and higher patient satisfactions compared with femoral access. It is currently the preferred access for coronary catheterization and interventions, and increasingly used for peripheral and cranial vascular interventions. Herein, we present a patient who had a recent procedures included right transradial right vertebral artery and peripheral vascular interventions. She was admitted for abdominal aortic bifemoral artery bypass, and was complicated with ST elevation myocardial infarction that required immediate cardiac catheterization. Patient did not have palpable radial access and ultrasonography confirmed a total occlusion of right radial artery with thrombus. Although distal right radial artery - at the anatomical snuff box - was not palpable, artery was patent and could be accessed successfully with ultrasonography guidance.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Arteriopatias Oclusivas/complicações , Cateterismo Periférico/métodos , Intervenção Coronária Percutânea/métodos , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Angiografia , Arteriopatias Oclusivas/diagnóstico , Angiografia Coronária/métodos , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Radial
11.
Orthop Surg ; 11(3): 366-372, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31243922

RESUMO

Knee arthroplasty, including total knee arthroplasty (TKA) and unicondylar knee arthroplasty (UKA), is an effective procedure for patients with severe knee joint diseases. Arterial occlusion after knee arthroplasty is a rare but severe complication. However, there are few comprehensive reviews or analyses focusing on it. In this study, we presented a case of successful treatment of acute arterial occlusion of the popliteal artery after TKA by emergent balloon angioplasty, and conducted a review and analysis of published cases with this complication. After search and screening, 36 studies with 47 cases of arterial occlusion after knee arthroplasty in the past 35 years (1984-2018) were included. Among the 47 patients, there were 22 men and 25 women. The mean age was 68 years old. A total of 43 patients had primary TKA while 2 had revision surgery for TKA and 2 for UKA. For arterial occlusions, 66% presented symptoms in less than 1 day after knee surgery and 95% of the occlusion sites were around the popliteal artery. For treatment, 89% chose surgical treatment. Compared with conservative treatment, surgical treatment was more effective (P < 0.01). The patients who underwent surgical treatment less than 1 day after diagnosis had less sequelae (P < 0.05). For arterial occlusion after knee arthroplasty, we should pay attention to the perioperative risk factors and presentations, and diagnose and treat surgically at an early stage.


Assuntos
Arteriopatias Oclusivas/etiologia , Artroplastia do Joelho , Osteoartrite do Joelho/cirurgia , Artéria Poplítea , Complicações Pós-Operatórias , Idoso , Angioplastia com Balão , Anticoagulantes/uso terapêutico , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/terapia , Terapia Combinada , Diagnóstico Precoce , Feminino , Heparina/uso terapêutico , Humanos , Artéria Poplítea/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia
13.
Pediatr Rheumatol Online J ; 17(1): 26, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138304

RESUMO

BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis in children. A delayed or missed diagnosis of pediatric EGPA is common, owing to the atypical clinical manifestation and limited recognition of this disorder. The vasculitis in EGPA typically involves small to medium size vessels. Extensive occlusion of arteries in the extremities was being extremely rare and has never been reported in children. CASE PRESENTATION: A 10-year and 10-month-old girl with recurrent wheezing and breathlessness during exercise, was initially diagnosed with asthma at the age of five years. Despite unexplained manifestations, including intermittent remarkably increased eosinophilia, uncontrolled allergic rhinitis, and recurrent petechia, from the onset of asthma through to its remission, the consideration of EGPA was completely ignored until the patient presented with aggravated petechia and severe ulceration of the lower extremities, associated with extensive stenosis and/or occlusion of the arteries of the shank and foot. Given her history of asthma, eosinophilia, allergic rhinitis, mononeuropathy, pulmonary infiltrates, and vasculitis confirmed by the skin biopsy, the diagnosis of EGPA was ultimately confirmed. Regrettably, the initial inappropriate and irrational use of corticosteroid failed to relieve the symptoms until more aggressive treatment with intravenous methylprednisolone was started. This was followed by methotrexate treatment, with tapering of prednisone, without relapse over a six-month follow-up. CONCLUSIONS: Pediatric rheumatologists should be alert to the possibility of EGPA in children with refractory asthma associated with unexplained manifestations, and should be aware of the thromboembolic complications as vascular sequelae of EGPA.


Assuntos
Arteriopatias Oclusivas/diagnóstico , Síndrome de Churg-Strauss/diagnóstico , Granulomatose com Poliangiite/diagnóstico , Arteriopatias Oclusivas/patologia , Criança , Síndrome de Churg-Strauss/complicações , Constrição Patológica , Diagnóstico Tardio , Eosinofilia/complicações , Eosinofilia/diagnóstico , Feminino , Pé/irrigação sanguínea , Granulomatose com Poliangiite/complicações , Humanos , Lactente , Perna (Membro)/irrigação sanguínea , Vasculite/patologia
14.
Ann Vasc Surg ; 59: 259-267, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31028851

RESUMO

BACKGROUND: Functional popliteal artery entrapment syndrome (FPAES) results from hypertrophied gastrocnemius, soleus, and/or plantaris muscles, without an identifiable anatomic abnormality. Historically, FPAES has been managed with surgical myotomy or myomectomy. Herein, we review the literature to evaluate the results of surgery along with a newer treatment (botulinum toxin A injection) for this rare form of claudication. METHODS: A literature search in PubMed, Cochrane, and Ovid for studies reporting incidence and management of FPAES yielded 3391 publications; 2804 articles were excluded based on initially established exclusion criteria. Ultimately, data were extracted from six articles, from which the number of patients, demographic information, preoperative workup, surgical treatment details, follow-up imaging, and results of treatment were obtained. RESULTS: A total of 133 patients were studied. Mean age was 26 years; 57% were female, and noninvasive testing revealed bilateral findings in 39%. Treatment involved surgical myotomy/myomectomy (98; five studies) and botulinum toxin injection (35; two studies). Adjunctive vascular reconstruction was performed in eight of the surgical cases. Patients with FPAES who underwent surgical management were evaluated subjectively for symptomatic improvement, and some patients had duplex ultrasounds in follow-up averaging 25.6 months. Three of 98 patients (3%) had recurrent symptoms, and seven (7%) underwent revision surgical procedures. Complications in the surgical management group included seroma/hematoma (4%, 4/98) and infection (2%, 2/98). For the botulinum toxin treatment group, improvement of symptoms was achieved in 66% of patients at an average follow-up time of ten months. Most patients treated with botulinum toxin did not undergo imaging in follow-up. No complications were reported. CONCLUSIONS: This review suggests FPAES may be treated successfully with surgical myotomy/myomectomy plus adjunctive vascular reconstruction if necessary. Botulinum toxin A injection may be useful as a diagnostic and therapeutic measure for FPAES.


Assuntos
Inibidores da Liberação da Acetilcolina/administração & dosagem , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/terapia , Toxinas Botulínicas Tipo A/administração & dosagem , Miotomia/métodos , Artéria Poplítea , Inibidores da Liberação da Acetilcolina/efeitos adversos , Adolescente , Adulto , Idoso , Arteriopatias Oclusivas/fisiopatologia , Toxinas Botulínicas Tipo A/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miotomia/efeitos adversos , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Valor Preditivo dos Testes , Recidiva , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
15.
Circulation ; 139(18): e891-e908, 2019 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-30913893

RESUMO

Myocardial infarction in the absence of obstructive coronary artery disease is found in ≈5% to 6% of all patients with acute infarction who are referred for coronary angiography. There are a variety of causes that can result in this clinical condition. As such, it is important that patients are appropriately diagnosed and an evaluation to uncover the correct cause is performed so that, when possible, specific therapies to treat the underlying cause can be prescribed. This statement provides a formal and updated definition for the broadly labelled term MINOCA (incorporating the definition of acute myocardial infarction from the newly released "Fourth Universal Definition of Myocardial Infarction") and provides a clinically useful framework and algorithms for the diagnostic evaluation and management of patients with myocardial infarction in the absence of obstructive coronary artery disease.


Assuntos
Algoritmos , Arteriopatias Oclusivas , Doença da Artéria Coronariana , Infarto do Miocárdio , American Heart Association , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/patologia , Arteriopatias Oclusivas/terapia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/terapia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/patologia , Infarto do Miocárdio/terapia , Estados Unidos
17.
Korean J Radiol ; 20(3): 459-468, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30799577

RESUMO

OBJECTIVE: To investigate whether diagnostic performance of contrast-enhanced ultrasound (CEUS) could be improved with modified criteria to diagnose significant hepatic artery occlusion (HAO) and to determine the role of CEUS in patients with a tardus-parvus hepatic artery (HA) pattern on Doppler US. MATERIALS AND METHODS: Among 2679 adult liver transplantations performed over 7 years, HAO was suspected in 288 recipients, based on Doppler ultrasound. Among them, 130 patients underwent CEUS. After excluding two technical failures, 128 CEUS images were retrospectively reviewed to search for abnormal findings, such as no HA enhancement, abnormal HA enhancement (delayed, faint, and discontinuous enhancement), and perfusion defect in the liver parenchyma. The performance CEUS abnormalities were assessed in the patients overall and in subgroups based on Doppler ultrasound abnormality (group A, no flow; group B, tardus-parvus pattern) and were compared based on the area under the receiver operating characteristic curve (AUC). RESULTS: HAO were diagnosed in 41 patients by surgery, angiography, or follow-up abnormality. By using the conventional criterion (no HA enhancement) to diagnose HAO in patients overall, the sensitivity, specificity, and AUC were 58.5%, 100%, and 0.793, respectively. Modified criteria for HAO (no HA enhancement, abnormal enhancement, or parenchymal perfusion defect) showed statistically significantly increased sensitivity (97.6%, 40/41) and AUC (0.959) (p < 0.001), although the specificity (95.4%, 83/87) was slightly decreased. The sensitivity and specificity of the modified criteria in Groups A and B were 97.1% (33/34) and 95.7% (22/23), and 100% (7/7) and 95.3% (61/64), respectively. CONCLUSION: Modified criteria could improve diagnostic performance of CEUS for HAO, particularly by increasing sensitivity. CEUS could be useful for diagnosing HAO even in patients with a tardus-parvus HA pattern on Doppler US, using modified criteria.


Assuntos
Arteriopatias Oclusivas/diagnóstico , Artéria Hepática/diagnóstico por imagem , Transplante de Fígado , Ultrassonografia Doppler , Adulto , Idoso , Angiografia , Arteriopatias Oclusivas/diagnóstico por imagem , Meios de Contraste/química , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
18.
Ann Thorac Surg ; 108(2): e107-e109, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30684481

RESUMO

We report a case of a newborn infant who experienced circulatory collapse caused by a calcified lesion occluding the main pulmonary artery (PA). The baby was full-term at birth at a normal birth weight. Cyanosis was noted immediately after birth. Echocardiography revealed a main PA occlusion caused by a calcified lesion. Bradycardia and circulatory failure occurred at postnatal day 4, and an urgent surgical resection was successfully performed. Idiopathic calcification causing both PA obstruction and circulatory collapse is rare. Our report indicates that PA calcification can cause hemodynamic instability requiring early surgical intervention.


Assuntos
Arteriopatias Oclusivas/complicações , Artéria Pulmonar , Choque/etiologia , Calcificação Vascular/complicações , Procedimentos Cirúrgicos Vasculares/métodos , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/cirurgia , Ecocardiografia , Feminino , Humanos , Recém-Nascido , Choque/diagnóstico , Choque/cirurgia , Tomografia Computadorizada por Raios X , Calcificação Vascular/diagnóstico , Calcificação Vascular/cirurgia
19.
Pediatr Transplant ; 23(2): e13352, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30623995

RESUMO

BACKGROUND: Intracranial and pulmonary vascular anomalies are well-known complications and causes of mortality in AGS; however, visceral artery anomalies are less commonly recognized. Herein, we present a retrospective analysis of our experience with pediatric LDLT that focuses on the current problems with and treatments for visceral artery anomalies in AGS after LDLT. METHODS: Between May 2001 and December 2017, 294 LDLTs were performed for 285 pediatric recipients. Of these, 13 LDLTs (4.4%) for 12 AGS patients were performed. We classified the visceral artery anomalies into aneurysms and stenosis. RESULTS: The overall incidence of visceral aneurysm was 2 of 12 recipients (16.7%) and included a SMA aneurysm in one patient and an IPDA aneurysm with a subsequent SPA aneurysm in one patient; the ages of the diagnosis of visceral aneurysm were 16.3, 21.1, and 21.7 y, respectively. An endovascular treatment was performed for a progressive IPDA saccular aneurysm (12.0 × 14.5 × 15.0 mm). The overall incidence of visceral artery stenosis was 7 of 12 recipients (58.3%) and the median age at the diagnosis of visceral artery stenosis was 15.5 y (range 1.7-22.9 y). All 3 AGS patients with RA stenosis suffered from renal dysfunction (eGFR of 51, 78, and 51 mL/min/1.73m2 ). CONCLUSION: The morbidity of visceral artery anomalies is not negligible. The performance of periodic imaging examinations is necessary, even for infants, because it is difficult to detect visceral vascular anomalies in the infant stage.


Assuntos
Síndrome de Alagille/cirurgia , Aneurisma/etiologia , Arteriopatias Oclusivas/etiologia , Sistema Digestório/irrigação sanguínea , Transplante de Fígado , Complicações Pós-Operatórias , Adolescente , Aneurisma/diagnóstico , Aneurisma/epidemiologia , Aneurisma/terapia , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/epidemiologia , Arteriopatias Oclusivas/terapia , Criança , Pré-Escolar , Procedimentos Endovasculares , Feminino , Seguimentos , Humanos , Incidência , Lactente , Doadores Vivos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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