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1.
Ann Vasc Surg ; 69: 451.e5-451.e10, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32615204

RESUMO

BACKGROUND: Acute aortic dissection rarely results in circumferential dissections of the aortic intima that may lead to intimo-intimal intussusception (IIS) with complete separation from the aortic wall. Circumferential dissection may then result in distal embolization of the involved intima and media, adding considerable complexity to the management of such cases. Despite the severity of this complication, the natural history of aortic disease following extensive intimal denuding and IIS is not well documented in the literature. Here we present a case with long-term follow-up of type B aortic dissection (TBAD) complicated by IIS and embolization of the intima into the distal aorta following thoracic endovascular aortic repair. METHODS: Medical records and imaging studies were retrospectively reviewed with the approval of the Institutional Review Board. A single patient underwent repair of a TBAD that was complicated by IIS, with follow-up for 6 years. Aortic recovery was monitored with serial computerized tomography scans. RESULTS: During endovascular stent deployment, the patient's dissection progressed circumferentially, leading to distal embolization of the intima and aortic occlusion. An open transabdominal aortic exploration was performed to extract the embolized intima. Despite this severe aortic structural disruption, the patient recovered well postoperatively and exhibited favorable aortic remodeling over long-term follow-up. The denuded aorta did not rupture or develop progressive worsening aneurysmal dilation and the diameter of the involved aortic segment remained stable during follow-up. CONCLUSIONS: Acute TBADs can progress to circumferential intimal separation and IIS when managed with endovascular stenting and balloon dilation. Continued endovascular management once IIS has occurred may lead to further intimal damage, resulting in distal embolization of the intima and aortic occlusion. Thus, IIS may require conversion to open repair. However, in the event that loss of the aortic intima does occur following IIS, it is possible for the denuded aorta to recover well and remain stable with favorable remodeling over long-term follow-up.


Assuntos
Aneurisma Dissecante/cirurgia , Angioplastia com Balão/efeitos adversos , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/efeitos adversos , Embolia/cirurgia , Lesões do Sistema Vascular/cirurgia , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Angioplastia com Balão/instrumentação , Aorta/diagnóstico por imagem , Aorta/lesões , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Embolia/diagnóstico por imagem , Embolia/etiologia , Humanos , Masculino , Stents , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
2.
J Card Surg ; 35(7): 1687-1689, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32400072

RESUMO

Device embolization is a rare major complication of atrial septal defect percutaneous closures which requires surgical management if noninvasive retrieval fails. We report a symptomatic delayed embolization of an Amplatzer septal occluder device into the left ventricle outflow tract tangled with the mitral valve, complicated with ventricular arrhythmias and cardiac tamponade during percutaneous retrieval attempt. Emergent surgical treatment was performed, requiring a combined approach through the right atrium and the aorta for surgical removal.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Remoção de Dispositivo/métodos , Embolia/etiologia , Embolia/cirurgia , Migração de Corpo Estranho/cirurgia , Ventrículos do Coração , Valva Mitral/cirurgia , Dispositivo para Oclusão Septal/efeitos adversos , Idoso , Aorta , Arritmias Cardíacas/etiologia , Tamponamento Cardíaco/etiologia , Feminino , Átrios do Coração , Humanos , Resultado do Tratamento
3.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 64(2): 130-133, mar.-abr. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-196242

RESUMO

La lesión vascular arterial asociada a la luxación anterior de hombro es una complicación rara, pero potencialmente devastadora, a menudo en el contexto de traumatismos de alta energía o heridas penetrantes. Se trata de una urgencia médica que puede llegar a comprometer la viabilidad y funcionalidad del miembro, incluso la vida del paciente si no es identificada precozmente y tratada de forma adecuada. Sin embargo, su diagnóstico puede ser difícil, pues precisa un alto índice de sospecha. La presencia de una trombosis de la arteria axilar con una luxación de hombro por un mecanismo de baja energía es extraordinariamente poco frecuente, especialmente cuando se presenta de forma subaguda con embolismo en la arteria radial


Arterial vascular injury associated with anterior dislocation of the shoulder is a rare but potentially devastating complication, often seen in the context of high-energy trauma or penetrating injury. It is a medical emergency that can compromise both the viability and functionality of the limb, as well as the patient's life if it is not identified early and treated properly. However, its diagnosis can be difficult, since it requires a high index of suspicion. The presence of an axillary artery thrombosis after shoulder dislocation resulting from low-energy trauma is extremely rare, even more so with subacute clinical presentation associated with embolism to the radial artery


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Artéria Axilar/lesões , Embolia/diagnóstico , Artéria Radial , Luxação do Ombro/complicações , Trombose/diagnóstico , Lesões do Sistema Vascular/diagnóstico , Artéria Axilar/diagnóstico por imagem , Artéria Axilar/cirurgia , Embolia/etiologia , Embolia/cirurgia , Artéria Radial/diagnóstico por imagem , Artéria Radial/cirurgia , Trombose/etiologia , Trombose/cirurgia , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/cirurgia
4.
Medicine (Baltimore) ; 99(11): e19354, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176057

RESUMO

RATIONALE: Leakage of bone cement is a common complication after percutaneous kyphoplasty. In rare cases, bone cement can leak into the venous system, which can be life threatening, especially when it causes an embolism in the heart. PATIENT CONCERNS: A 79-year-old female patient developed chest pain with chest tightness 3 weeks after the percutaneous kyphoplasty. DIAGNOSES: Initially, negative fluoroscopy results and elevated myocardial enzymes suggested that the patient's chest pain and chest tightness symptoms were manifestations of coronary heart disease. However, in the subsequent computed tomography (CT) examination, foreign bodies in the heart and pulmonary vessels were found. INTERVENTIONS: The patient underwent emergency surgery to remove the bone cement and repair the tricuspid valve. OUTCOMES: The postoperative course was uneventful and the patient was discharged on the 13th day after surgery. LESSONS: If a patient develops chest pain with chest tightness after percutaneous kyphoplasty, the clinicians must be vigilant and take into account the limited sensitivity of fluoroscopy and use chest computer tomography and echocardiogram as the first choice and thereby prevent serious consequences.


Assuntos
Cimentos para Ossos/efeitos adversos , Embolia/etiologia , Embolia/cirurgia , Corpos Estranhos/diagnóstico por imagem , Cifoplastia/efeitos adversos , Fraturas da Coluna Vertebral/cirurgia , Idoso , Cimentos para Ossos/uso terapêutico , Ecocardiografia/métodos , Embolia/diagnóstico por imagem , Feminino , Fluoroscopia/métodos , Seguimentos , Corpos Estranhos/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Cifoplastia/métodos , Vértebras Lombares/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
5.
Pediatr Blood Cancer ; 67(6): e28197, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32207557

RESUMO

Fibrin sheath formation around long-term indwelling central venous catheters is common and usually benign. Fibrin sheath can persist after catheter removal and rarely leads to complications. This is a report of three pediatric oncology patients that required cardiac surgery for cardiac embolization of a "ghost" catheter several years after catheter removal. One case required tricuspid valve replacement for complete tricuspid valve destruction and two had erosion through the atrial wall. The severity of these rare complications mandates follow-up of "ghost" catheters in pediatric oncology patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Procedimentos Cirúrgicos Cardíacos/métodos , Cateteres de Demora/efeitos adversos , Embolia/cirurgia , Átrios do Coração/cirurgia , Linfoma não Hodgkin/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adolescente , Criança , Embolia/etiologia , Embolia/patologia , Átrios do Coração/patologia , Humanos , Linfoma não Hodgkin/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Prognóstico
7.
AJNR Am J Neuroradiol ; 41(3): 464-468, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32029470

RESUMO

BACKGROUND AND PURPOSE: Large intracranial vessel occlusion due to calcified emboli is a rare cause of major stroke. We assessed the prevalence, imaging appearance, the effectiveness of mechanical thrombectomy, and clinical outcome of patients with large-vessel occlusion due to calcified emboli. MATERIALS AND METHODS: We performed a retrospective analysis of clinical and procedural data of consecutive patients who underwent mechanical thrombectomy due to calcified emboli in 7 European stroke centers. RESULTS: We screened 2969 patients, and 40 patients matched the inclusion criteria, accounting for a prevalence of 1.3%. The mean maximal density of the thrombus was 327 HU (range, 150-1200 HU), and the mean thrombus length was 9.2 mm (range, 4-20 mm). Four patients had multiple calcified emboli, and 2 patients had an embolic event during an endovascular intervention. A modified TICI score of ≥2b was achieved in 57.5% (23/40), with minimal-to-no reperfusion (modified TICI 0-1) in 32.5% (13/40) and incomplete reperfusion (modified TICI 2a) in 10% (4/40). Excellent outcome (mRS 0-1) was achieved in only 20.6%, functional independence (mRS 0-2) in 26.5% and 90-day mortality was 55.9%. CONCLUSIONS: Acute ischemic stroke with large-vessel occlusion due to calcified emboli is a rare entity in patients undergoing thrombectomy, with considerably worse angiographic outcome and a higher mortality compared with patients with noncalcified thrombi. Good functional recovery at 3 months can still be achieved in about a quarter of patients.


Assuntos
Embolia/patologia , Embolia/cirurgia , Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/etiologia , Isquemia Encefálica/cirurgia , Calcinose/patologia , Calcinose/cirurgia , Embolia/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Reperfusão/métodos , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
10.
J Pak Med Assoc ; 69(10): 1557-1558, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31622317

RESUMO

Acute mesenteric ischaemia is a worrisome clinical condition with high mortality. We present a 90 years old male patient, known case of atrial flutter who developed acute mesenteric ischaemia. This was due to superior mesenteric artery embolus. He underwent successful superior mesenteric embolectomy and made a smooth recovery. He was symptom free and was discharged from hospital on 5th postoperative day on lifelong anticoagulants. Early diagnosis, adequate resuscitation and attention to finer technical details of superior mesenteric emboelctomy can save a life in selected patients.


Assuntos
Embolectomia/métodos , Embolia/cirurgia , Artéria Mesentérica Superior/cirurgia , Isquemia Mesentérica/cirurgia , Doença Aguda , Idoso de 80 Anos ou mais , Flutter Atrial/complicações , Embolia/etiologia , Humanos , Laparoscopia , Masculino , Isquemia Mesentérica/etiologia
11.
ACS Appl Mater Interfaces ; 11(40): 36324-36332, 2019 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-31556582

RESUMO

Here we report the efficacy of a nanoparticle-assisted high-intensity focused ultrasound (HIFU) treatment that selectively destroys blood clots while minimizing generation of microparticles, or microemboli, that can cause further complications postsurgery. Treatment of malignant blood clots (thrombi) and the resulting emboli are critical problems for numerous patients, and treatments addressing these conditions would benefit from advancements in noninvasive procedures such as HIFU. While recanalization of occlusive blood clots is currently addressed with surgical intervention that seeks to minimize formation of large emboli, there is a danger of microemboli (micrometer-size particles) that have been theorized to be responsible for the poor correlation between apparent surgical success and patient outcome. Here, the addition of phospholipid-coated hydrophobically modified silica nanoparticles (P@hMSNs) improved the efficacy of HIFU treatment by serving as cavitation nuclei for mechanical disruption of thrombi. This treatment was evaluated for the ability to clear the HIFU focal area of a thick and dense thrombus within 10 min. Moreover, it was found that the use of P@hMSN+HIFU treatment generated a significantly smaller microembolic load as compared to comparison techniques, including a HIFU + microbubble contrast agent, HIFU alone, and direct mechanical disruption. This reduction in the microembolic load can occur either with primary removal of the clot by P@hMSN+HIFU or by insonation of the clot fragments after mechanical thrombectomy. Lastly, this method was evaluated in a flow model, where nonocclusive model thrombi and model emboli were mechanically ablated within the focal area within 15 s. Together, these results represent a combination therapy capable of resolving thrombi and microembolisms resulting from thrombectomy through localized destruction of clotted material.


Assuntos
Embolia/cirurgia , Ablação por Ultrassom Focalizado de Alta Intensidade , Interações Hidrofóbicas e Hidrofílicas , Nanopartículas/química , Fosfolipídeos/química , Dióxido de Silício/química , Trombectomia , Trombose/cirurgia , Animais , Bovinos , Nanopartículas/ultraestrutura
13.
J Pak Med Assoc ; 69(8): 1216-1218, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31431784

RESUMO

Peripartum cardiomyopathy (PPCM) is a condition of unknown etiology that presents as heart failure due to left ventricular systolic dysfunction in the last of month of pregnancy and up to six months after giving birth. PPCM predisposes towards thrombo-embolism and an acute limb ischaemia can be a manifestation of this disease. We present a case of a 23-year-old lady presenting an acute lower limb ischaemia four months post-partum. Doppler ultrasound showed bilateral femoral emboli and cardiac ECHO showed a 24% ejection fraction. Amputation was performed on both limbs, below her right knee and above her left knee. The patient was started on heart failure medication and her symptoms improved with diuretic therapy, confirming the diagnoses of PPCM. It is important to recognise acute limb ischaemia as a rare manifestation of PPCM, as a timely diagnosis and effective treatment of the disease can improve the prognosis. We believe this is the first case to be reported in medical literature from Pakistan of a patient presenting PPCM with bilateral acute limb ischaemia and gangrene.


Assuntos
Cardiomiopatias/complicações , Embolia/etiologia , Artéria Femoral/diagnóstico por imagem , Gangrena/etiologia , Isquemia/etiologia , Transtornos Puerperais/diagnóstico por imagem , Amputação , Cardiomiopatias/diagnóstico por imagem , Ecocardiografia , Embolectomia , Embolia/diagnóstico por imagem , Embolia/cirurgia , Feminino , Gangrena/cirurgia , Humanos , Isquemia/diagnóstico por imagem , Extremidade Inferior , Volume Sistólico , Falha de Tratamento , Ultrassonografia Doppler , Adulto Jovem
15.
Angiol. (Barcelona) ; 71(4): 167-169, jul.-ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-190301

RESUMO

Las variaciones anatómicas en la vascularización arterial renal son altamente prevalentes y su conocimiento es de especial interés clínico. Nuestro objetivo es describir una variante anatómica de las arterias renales poco conocida en la literatura actual


The anatomical variations in renal arterial vascularization are highly prevalent and their knowledge is of special clinical interest. Our aim is to describe an anatomical variant of the renal arteries little known in current literatura


Assuntos
Humanos , Feminino , Idoso , Embolia/diagnóstico por imagem , Embolia/cirurgia , Artéria Renal/anormalidades , Artéria Renal/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Nefropatias/cirurgia
16.
Vasc Endovascular Surg ; 53(7): 606-608, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31272303

RESUMO

Hydrophilic polymer coatings are now widely applied to catheters and other intravascular devices used in neurovascular, cardiovascular, and peripheral vascular procedures. Emboli consisting of these materials have been previously identified in biopsies and autopsies following pulmonary infarction, stroke, gangrene, or death. We report a case involving a nonhealing foot ulcer that appeared following cardiac catheterization, stenting, and automatic implanted cardiac defibrillator (AICD) implantation in a patient without other evidence of significant peripheral artery disease. An 85-year-old woman with chronic atrial fibrillation, aortic valve stenosis, and coronary artery disease underwent coronary stenting and AICD implantation for ventricular tachycardia and syncope. She developed a toe ulcer shortly thereafter, which did not respond to standard treatment. A histological examination following amputation of the toe found amorphous basophilic material in capillaries adjacent to the edge of the ulcer, which was similar to material associated with hydrophilic polymer coatings. Ischemia and infarcts following endovascular procedures should not be presumed to result from thrombus or vascular disease, even if intravascular devices appear intact or properly placed after the procedure. To help establish the incidence of ischemia caused by hydrophilic polymer device coatings, if excision of ischemic or infarcted tissue after endovascular procedures using coated devices becomes necessary, the tissue should be evaluated microscopically. Surgeons should also consider the tolerance of distal organs to infarct or ischemia when selecting coated intravascular devices.


Assuntos
Materiais Revestidos Biocompatíveis/efeitos adversos , Embolia/etiologia , Úlcera do Pé/etiologia , Migração de Corpo Estranho/etiologia , Isquemia/etiologia , Polímeros/efeitos adversos , Dedos do Pé/irrigação sanguínea , Idoso de 80 Anos ou mais , Amputação , Angiografia , Biópsia , Embolia/diagnóstico por imagem , Embolia/cirurgia , Feminino , Úlcera do Pé/diagnóstico por imagem , Úlcera do Pé/fisiopatologia , Úlcera do Pé/cirurgia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Interações Hidrofóbicas e Hidrofílicas , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Isquemia/cirurgia , Fluxo Sanguíneo Regional , Dedos do Pé/cirurgia , Resultado do Tratamento
17.
Cardiol Young ; 29(6): 842-844, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169093

RESUMO

We describe two cases of spontaneous embolisation and successful retrieval of ceramic-coated patent arterial duct devices. In both, the device embolised to the descending aorta in the absence of pulmonary hypertension and despite optimum placement. We have discussed possible mechanisms for embolisation in these patients and suggested alternative methods for device retrieval. Based on this limited experience, we conclude that for tubular ducts, ceramic-coated devices should be oversized to form a tighter waist or alternate devices may be considered.


Assuntos
Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/cirurgia , Cateterismo Cardíaco/métodos , Cerâmica , Remoção de Dispositivo/métodos , Embolia/cirurgia , Dispositivo para Oclusão Septal/efeitos adversos , Doenças da Aorta/diagnóstico , Doenças da Aorta/etiologia , Aortografia , Materiais Revestidos Biocompatíveis , Permeabilidade do Canal Arterial/cirurgia , Embolia/diagnóstico , Feminino , Humanos , Lactente , Falha de Prótese
20.
J Vasc Surg ; 69(4): 1174-1179, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30777685

RESUMO

OBJECTIVE: The primary objective was to evaluate the safety of transfer, type of procedure, and factors associated with limb salvage in patients with acute limb ischemia (ALI) treated at a quaternary referral center. METHODS: A retrospective review of all patients with ALI secondary to thrombotic or embolic occlusion at a quaternary referral hospital from 2013 to 2016 was conducted. Patients were transferred from throughout Washington and Alaska by ambulance, helicopter, or fixed-wing modes of transportation. Demographics, transport and operative timing, Rutherford classification, level of occlusion, procedural information, and fasciotomy characteristics were reviewed. Outcomes measured included limb salvage rates, discharge disposition, and mortality. RESULTS: One hundred twelve patients with ALI were identified, with 82% due to thrombosis and 18% due to arterial embolization. Fifty-seven percent of patients were transferred from a referring hospital with low mean transfer times (1.9 hours for embolic, 2.7 hours for thrombotic). Although the initial operative strategy varied according to the etiology, with 50% of thrombotic occlusions treated with endovascular therapies and 80% of embolic occlusions treated with open thrombectomy, the rates of limb salvage did not vary based on operative approach (92% endovascular first, 90% open first). Further, limb salvage rates were identical between transferred and nontransferred patients (77%). Limb salvage was successful in 91% of patients with Rutherford class 1 and 2 disease, but only 8% in patients with Rutherford class 3 disease. In-hospital and 30-day mortality rates were not different based on ischemic etiology (5%), although patients with Rutherford class 3 disease had significantly higher mortality rates (15%) compared with patients with class 1 (6%), class 2a (6%), and class 2b (2%) disease. Fasciotomy was performed in 29% of patients, with 59% of fasciotomy wounds closed primarily. Predictors of amputation include multiple attempts at limb salvage, higher Rutherford class, multilevel occlusion, more proximal levels of occlusion, and nonviable muscle seen after fasciotomy, with ischemic times trending toward higher amputation rates without statistical significance. There was no difference in discharge disposition based on ischemic etiology. CONCLUSIONS: The modern treatment of patients with ALI is effective, with high rates of limb salvage and low mortality regardless of transfer status, etiology, or initial operation performed. In situations where compartment syndrome is unclear, fasciotomy should not be withheld because it provides valuable predictive information regarding limb salvage.


Assuntos
Resgate Aéreo , Embolia/cirurgia , Procedimentos Endovasculares , Isquemia/cirurgia , Salvamento de Membro , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Trombectomia , Trombose/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Amputação , Embolia/diagnóstico por imagem , Embolia/mortalidade , Embolia/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Fasciotomia , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/mortalidade , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Trombose/diagnóstico por imagem , Trombose/mortalidade , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
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