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1.
Ann R Coll Surg Engl ; 103(3): e94-e97, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645285

RESUMO

Behçet's disease is a rare disease characterised by recurrent oral ulcers, with systemic manifestations including genital ulcers, ocular disease, skin lesions, gastrointestinal disease, neurologic disease, vascular disease and arthritis. Most clinical manifestations of Behçet's disease are believed to be due to vasculitis. The heterogeneous clinical spectrum is influenced by sex, ethnicity and country of residence. Vascular manifestation in the form of isolated large brachial artery aneurysm is rare in children. Treatment involves aneurysmorrhaphy to avoid rupture or ischaemic sequelae in addition to lifelong medical management to control vasculitis.


Assuntos
Aneurisma/diagnóstico por imagem , Síndrome de Behçet/diagnóstico , Artéria Braquial/diagnóstico por imagem , Trombose/diagnóstico por imagem , Aneurisma/etiologia , Aneurisma/patologia , Aneurisma/cirurgia , Anticorpos Antinucleares/imunologia , Síndrome de Behçet/complicações , Síndrome de Behçet/imunologia , Síndrome de Behçet/patologia , Sedimentação Sanguínea , Artéria Braquial/patologia , Artéria Braquial/cirurgia , Proteína C-Reativa/imunologia , Pré-Escolar , Angiografia por Tomografia Computadorizada , Antígeno HLA-B51/imunologia , Humanos , Masculino , Veia Safena/transplante , Trombose/etiologia , Trombose/patologia , Trombose/cirurgia , Enxerto Vascular/métodos
2.
Dis Colon Rectum ; 64(1): e2-e5, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33306540

RESUMO

INTRODUCTION: Achieving a negative resection through a pelvic exenteration for a recurrent or an advanced pelvic malignancy offers the potential for cure. Exenterative surgical units have expanded the boundaries and redefined what constitutes resectable disease through improved surgical technique. In selected cases, contiguous tumor involvement of the aortoiliac axis requires en bloc resection and subsequent vessel reconstruction. However, vascular reconstruction can be challenging in a contaminated field during an extended radical resection. TECHNIQUE: The aim of this Technical Note is to describe a novel method in the management of patients with recurrent or advanced pelvic malignancy involving the aortoiliac axis by performing preemptive femoral-femoral arterial and venous crossover grafts, with adjunctive arteriovenous loop fistula formation before undergoing an extended radical pelvic resection 4 weeks later. RESULTS: Four patients have undergone preemptive femoral-femoral arterial and venous crossover grafts at our institution (median age = 60 y (range, 47-66 y); 2 women). There were no early complications, and all of the patients subsequently underwent extended radical pelvic resections for a pelvic malignancy. CONCLUSIONS: Preemptive vascular reconstruction before major pelvic surgery reduces the risk of graft infection because this method avoids the wounds being contaminated by GI or genitourinary organisms. Other advantages to this technique include a reduction in the overall operating time for the pelvic exenteration, a significant reduction in the ischemia time to the lower limbs, and ensuring that the grafts are patent before embarking on major intra-abdominal surgery.


Assuntos
Artéria Femoral/cirurgia , Veia Femoral/cirurgia , Artéria Ilíaca/cirurgia , Veia Ilíaca/cirurgia , Exenteração Pélvica , Neoplasias Pélvicas/cirurgia , Enxerto Vascular/métodos , Idoso , Aorta , Derivação Arteriovenosa Cirúrgica , Prótese Vascular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Pélvicas/patologia , Enxerto Vascular/instrumentação
3.
Cir. plást. ibero-latinoam ; 46(4): 471-474, oct.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198734

RESUMO

La ferulización arterial es una modificación de la técnica de envoltura del sitio de aneurisma en aorta que se realiza en cirugía cardiotorácica. En microcirugía, modificamos la técnica sin envolver completamente el sitio de anastomosis cuando se presenta una angulación, sino solo ferulizándolo para disminuir la angulación de la anastomosis arterial causada por la turbulencia del paso del flujo sanguíneo y el alargamiento del pedículo empleando un injerto de vena como puente entre el vaso receptor y el pedículo del colgajo. Presentamos un caso de resección de carcinoma mandibular y reconstrucción con colgajo libre de tensor de fascia lata que a las 32 horas de la cirugía sufre sangrado profuso por avulsión de la microanastomosis arterial. Utilizamos 16 cm de vena safena para reconstruir el desgarro en el pedículo arterial y elongarlo, de cara a disminuir la tensión en la microanastomosis del vaso receptor y el pedículo del colgajo libre. Tras la microanastomosis se presenta angulación del pedículo y retardo de 10 segundos en el llenado capilar tras punción con aguja del colgajo libre. Reservamos 4 cm del injerto de vena para ferulizar el sitio de angulación de la microanastomosis arterial con el injerto de vena, observando disminución del ángulo de la microanastomosis y llenado capilar de 2 a 3 segundos, mejorando así la perfusión del colgajo libre


Arterial splinting is a modification of the aortic aneurysm site wrapping technique performed in cardiothoracic surgery. In microsurgery, we modify the technique without completely wrapping the anastomosis site when angulation occurs, but only splinting it to decrease angulation of the arterial anastomosis caused by turbulence in the passage of blood flow and lengthening of the pedicle using a vein graft such as bridge between the recipient vessel and the flap pedicle. We present a case of resection of mandibular carcinoma and reconstruction with fascia lata tensor free flap that, 32 hours after surgery, suffered profuse bleeding due to avulsion of the arterial microanastomosis. We used 16 cm of the saphenous vein to reconstruct the tear in the arterial pedicle and lengthen it in order to decrease the tension in the microanastomosis of the recipient vessel and the pedicle of the free flap. After microanastomosis, angulation of the pedicle occurs and noticed a 10-second delay in capillary filling after needle puncture of the free flap. We reserved 4 cm of the vein graft to splinting the angulation site of the arterial microanastomosis with the vein graft, achieving a decrease in the angle of the microanastomosis and a capillary filling of 2 to 3 seconds, thus improving the perfusion of the free flap


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Derivação Arteriovenosa Cirúrgica/métodos , Artérias/cirurgia , Microcirurgia/métodos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Aneurisma Aórtico/cirurgia , Veias/transplante , Enxerto Vascular/métodos , Retalhos de Tecido Biológico/cirurgia , Mandíbula/cirurgia
4.
Eur J Vasc Endovasc Surg ; 60(5): 721-729, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32807672

RESUMO

OBJECTIVE: Popliteal artery aneurysm (PAA) is the second most common arterial aneurysm. Vascunet is an international collaboration of vascular registries. The aim was to study treatment and outcomes. METHODS: This was a retrospective analysis of prospectively registered population based data. Fourteen countries contributed data (Australia, Denmark, Finland, France, Hungary, Iceland, Italy, Malta, New Zealand, Norway, Portugal, Serbia, Sweden, and Switzerland). RESULTS: During 2012-2018, data from 10 764 PAA repairs were included. Mean values with between countries ranges in parenthesis are given. The incidence was 10.4 cases/million inhabitants/year (2.4-19.3). The mean age was 71.3 years (66.8-75.3). Most patients, 93.3%, were men and 40.0% were active smokers. The operations were elective in 73.2% (60.0%-85.7%). The mean pre-operative PAA diameter was 32.1 mm (27.3-38.3 mm). Open surgery dominated in both elective (79.5%) and acute (83.2%) cases. A medial surgical approach was used in 77.7%, and posterior in 22.3%. Vein grafts were used in 63.8%. Of the emergency procedures, 91% (n = 2 169, 20.2% of all) were for acute thrombosis and 9% for rupture (n = 236, 2.2% of all). Thrombosis patients had larger aneurysms, mean diameter 35.5 mm, and 46.3% were active smokers. Early amputation and death were higher after acute presentation than after elective surgery (5.0% vs. 0.7%; 1.9% vs. 0.5%). This pattern remained one year after surgery (8.5% vs. 1.0%; 6.1% vs. 1.4%). Elective open compared with endovascular surgery had similar one year amputation rates (1.2% vs. 0.2%; p = .095) but superior patency (84.0% vs. 78.4%; p = .005). Veins had higher patency and lower amputation rates, at one year compared with synthetic grafts (86.8% vs. 72.3%; 1.8% vs. 5.2%; both p < .001). The posterior open approach had a lower amputation rate (0.0% vs. 1.6%, p = .009) than the medial approach. CONCLUSION: Patients presenting with acute ischaemia had high risk of amputation. The frequent use of endovascular repair and prosthetic grafts should be reconsidered based on these results.


Assuntos
Aneurisma/cirurgia , Isquemia/cirurgia , Salvamento de Membro/estatística & dados numéricos , Artéria Poplítea/patologia , Trombose/cirurgia , Doença Aguda/epidemiologia , Doença Aguda/terapia , Idoso , Amputação/estatística & dados numéricos , Aneurisma/complicações , Aneurisma/epidemiologia , Aneurisma/patologia , Austrália/epidemiologia , Brasil/epidemiologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Europa (Continente)/epidemiologia , Feminino , Carga Global da Doença , Humanos , Incidência , Isquemia/epidemiologia , Isquemia/etiologia , Salvamento de Membro/efeitos adversos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Artéria Poplítea/cirurgia , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Trombose/epidemiologia , Trombose/etiologia , Resultado do Tratamento , Enxerto Vascular/efeitos adversos , Enxerto Vascular/métodos , Enxerto Vascular/estatística & dados numéricos , Grau de Desobstrução Vascular
5.
Medicine (Baltimore) ; 99(31): e21336, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756120

RESUMO

RATIONALE: Hepatic alveolar echinococcosis (HAE) presents a high pathogenicity and case fatality rate. The main treatment for HAE is surgical resection. Giant lesions in the liver and invasion of the pathogen into the retrohepatic inferior vena cava are usually associated with a poor prognosis when radical resection cannot be performed. PATIENT CONCERNS: A 56-year-old man who underwent hydatidectomy 7 years prior noted a recurrence of HAE. He was subsidized and admitted to our hospital for the purpose of surgical treatment. DIAGNOSIS: By computed tomography, angiography and three-dimensional (3D) computed tomography reconstruction images, multiple, giant HAE with 75% stenosis was confirmed. INTERVENTIONS: With the 3D visualization technique, we designed the surgical plan and performed radical resection of the lesions, including the invaded inferior vena cava, and maximized retention of normal liver tissue. The abdominal aorta of an organ donor was used for vascular allograft reconstruction. OUTCOMES: The patient recovered gradually after the operation. He was followed up for 3 months, and the reconstructed vein patency was good. LESSONS: The 3D visualization technique combined with a blood vessel allograft allowed us to expand indications for radical resection of extensive HAE.


Assuntos
Equinococose Hepática/cirurgia , Hepatectomia/métodos , Enxerto Vascular/métodos , Aloenxertos/transplante , Aorta Abdominal/cirurgia , Equinococose Hepática/diagnóstico por imagem , Humanos , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Veia Cava Inferior/cirurgia
6.
J Surg Res ; 253: 280-287, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32402853

RESUMO

BACKGROUND: The autologous vein remains the standard conduit for lower extremity and coronary artery bypass grafting despite a 30%-50% 5-y failure rate, primarily attributable to intimal hyperplasia (IH) that develops in the midterm period (3-24 mo) of graft maturation. Our group discovered that externally strengthening vein grafts by cross-linking the adventitial collagen with photochemical tissue passivation (PTP) mitigates IH in an arteriovenous model at 4 wk. We now investigate whether this effect is retained in the midterm period follow-up. METHODS: Six Hanford miniature pigs received bilateral carotid artery interposition vein grafts. In each animal, the external surface of one graft was treated with PTP before grafting, whereas the opposite side served as the untreated control. The grafts were harvested after 3 mo. Ultrasound evaluation of all vein grafts was performed at the time of grafting and harvest. The grafts were also evaluated histomorphometrically and immunohistologically for markers of IH. RESULTS: All vein grafts were patent at 3 mo except one graft in the PTP-treated group because of early technical failure. The control vein grafts had significantly greater IH than PTP-treated grafts at 3 mo, as evidenced by the intimal area (2.6 ± 1.0 mm2versus 1.4 ± 1.5 mm2, respectively, P = 0.045) and medial area (5.1 ± 1.9 mm2versus 2.7 ± 2.4 mm2, respectively, P = 0.048). The control grafts had an increased presence and proliferation of mural myofibroblasts with greater smooth muscle actin and proliferating cell nuclear antigen staining. CONCLUSIONS: PTP treatment to the external surface of the vein grafts decreases IH at 3 mo after arteriovenous grafting and may prevent future graft failure.


Assuntos
Artérias Carótidas/cirurgia , Neointima/prevenção & controle , Fotoquimioterapia/métodos , Veia Safena/transplante , Enxerto Vascular/métodos , Túnica Adventícia/efeitos dos fármacos , Túnica Adventícia/efeitos da radiação , Animais , Colágeno/química , Colágeno/efeitos dos fármacos , Colágeno/efeitos da radiação , Feminino , Corantes Fluorescentes/administração & dosagem , Luz , Neointima/diagnóstico , Neointima/etiologia , Neointima/patologia , Rosa Bengala/administração & dosagem , Veia Safena/diagnóstico por imagem , Veia Safena/patologia , Suínos , Porco Miniatura , Transplante Autólogo/efeitos adversos , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/patologia , Enxerto Vascular/efeitos adversos , Grau de Desobstrução Vascular
7.
J Card Surg ; 35(6): 1314-1321, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32353909

RESUMO

BACKGROUND: The saphenous vein remains the most frequently used conduit for coronary artery bypass grafting, despite reported unsatisfactory long-term patency rates. Understanding the pathophysiology of vein graft failure and attempting to improve its longevity has been a significant area of research for more than three decades. This article aims to review the current understanding of the pathophysiology and potential new intervention strategies. METHODS: A search of three databases: MEDLINE, Web of Science, and Cochrane Library, was undertaken for the terms "pathophysiology," "prevention," and "treatment" plus the term "vein graft failure." RESULTS: Saphenous graft failure is commonly the consequence of four different pathophysiological mechanisms, early acute thrombosis, vascular inflammation, intimal hyperplasia, and late accelerated atherosclerosis. Different methods have been proposed to inhibit or attenuate these pathological processes including modified surgical technique, topical pretreatment, external graft support, and postoperative pharmacological interventions. Once graft failure occurs, the available treatments are either surgical reintervention, angioplasty, or conservative medical management reserved for patients not eligible for either procedure. CONCLUSION: Despite the extensive amount of research performed, the pathophysiology of saphenous vein graft is still not completely understood. Surgical and pharmacological interventions have improved early patency and different strategies for prevention seem to offer some hope in improving long-term patency.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Oclusão de Enxerto Vascular/prevenção & controle , Oclusão de Enxerto Vascular/terapia , Disfunção Primária do Enxerto/prevenção & controle , Disfunção Primária do Enxerto/terapia , Veia Safena/transplante , Enxerto Vascular/métodos , Oclusão de Enxerto Vascular/etiologia , Humanos , Disfunção Primária do Enxerto/etiologia , Resultado do Tratamento , Grau de Desobstrução Vascular
8.
J Neuropathol Exp Neurol ; 79(6): 626-640, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32417932

RESUMO

Choroid plexus (CP) may aid brain development and repair by secreting growth factors and neurotrophins for CSF streaming to ventricular and subventricular zones. Disrupted ventricular/subventricular zone progenitors and stem cells lead to CNS maldevelopment. Exploring models, we organ cultured the CP and transplanted fresh CP into a lateral ventricle of postnatal hydrocephalic (hyHTx) and nonhydrocephalic (nHTx) rats. After 60 days in vitro, the cultured choroid ependyma formed spherical rings with beating cilia. Cultured CP expressed endocytotic caveolin 1 and apical aquaporin 1 and absorbed horseradish peroxidase from medium. Transthyretin secretory protein was secreted by organ-cultured CP into medium throughout 60 days in vitro. Fresh CP, surviving at 1 week after lateral ventricle implantation of nHTx or hyHTx did not block CSF flow. Avascular 1-week transplants in vivo expressed caveolin 1, aquaporin 1, and transthyretin, indicating that grafted CP may secrete trophic proteins but not CSF. Our findings encourage further exploration on CP organ culture and grafting for translational strategies. Because transplanted CP, though not producing CSF, may secrete beneficial molecules for developing brain injured by hydrocephalus, we propose that upon CP removal in hydrocephalus surgery, the fractionated tissue could be transplanted back (ventricular autograft).


Assuntos
Plexo Corióideo , Hidrocefalia/cirurgia , Ventrículos Laterais/cirurgia , Enxerto Vascular/métodos , Animais , Modelos Animais de Doenças , Técnicas de Cultura de Órgãos , Ratos , Resultado do Tratamento
9.
Transplant Proc ; 52(6): 1802-1806, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32448668

RESUMO

BACKGROUND: Portal vein (PV) reconstruction is an important surgical skill for living donor liver transplantation (LDLT), especially for patients with portal vein thrombosis (PVT). However, this technique remains a critical problem in LDLT because of technical demands and requirements for appropriate venous graft harvesting. This study aimed to evaluate the surgical procedure used for PV reconstruction and outcomes in LDLT recipients with PVT. METHODS: Between March 2002 and December 2018, 128 adult LDLTs were performed. Fourteen recipients (10.8%) had PVT at the time of LDLT, classified as grade I in 2, grade II in 5, grade III in 6, and grade IV in 1, according to the Yerdel classification. We retrospectively analyzed the surgical procedure and postoperative complications associated with PV reconstruction of recipients with PVT. RESULTS: Surgical treatments for 14 recipients with PVT were as follows: thrombectomies in 2 recipients, replacement of interpositional venous grafts using the internal jugular vein (IJV) in 3 recipients and the external iliac vein (EIV) in 6 recipients, mesoportal jump grafts using the IJV in 1 recipient and the IJV + EIV in 1 recipient, and renoportal anastomosis using the EIV in 1 recipient. Among interpositional venous grafts, 5 venous grafts (IJV: 2, EIV: 3) passed the dorsal side of the pancreas without using the jump graft. Postoperative complications associated with PV anastomosis occurred in 1 of 14 (7.1%) recipients, who developed anastomosis bleeding caused by coagulation disorders at 27 days after LDLT, without any strictures of PV anastomoses. The overall survival rate at 5 years posttransplant was not statistically different between recipients with and without PVT (50.0% vs 65.0%, P = .163). CONCLUSION: Our techniques of PV reconstruction, using the appropriate venous grafts and route, are feasible, resulting in a prognosis comparable to that of recipients without PVT.


Assuntos
Hepatopatias/cirurgia , Transplante de Fígado/métodos , Veia Porta/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Enxerto Vascular/métodos , Trombose Venosa/cirurgia , Adulto , Anastomose Cirúrgica , Estudos de Viabilidade , Feminino , Humanos , Veia Ilíaca/transplante , Veias Jugulares/transplante , Hepatopatias/complicações , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Trombectomia/métodos , Coleta de Tecidos e Órgãos/métodos , Resultado do Tratamento , Trombose Venosa/complicações , Adulto Jovem
10.
J Cardiothorac Surg ; 15(1): 97, 2020 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-32410655

RESUMO

BACKGROUND: There has been an increasing number of children with congenital heart disease that undergo primary or second systemic-pulmonary shunt, while there are few reports on the second systemic-pulmonary shunt. Therefore, this study summarizes the experience of second systemic-pulmonary shunt for congenital heart disease in our hospital. METHODS AND RESULTS: Sixty-five children with congenital heart disease who underwent systemic-pulmonary shunt for the second time in our hospital were analyzed. At the early stage after the operation, cyanosis improved and SpO2 significantly increased. One patient died in hospital (1.54%) and the causes of death were aggravated atrioventricular regurgitation, low cardiac output syndrome, and liver failure. Early complications occurred in 18 patients (27.7%). All the children were rechecked in our hospital every 3-6 months and the McGoon index significantly increased. CONCLUSION: Systemic-pulmonary artery shunt can promote pulmonary vascular development, improve cyanosis symptoms, and increase the chance of radical treatment in children with pulmonary vascular dysplasia.


Assuntos
Cardiopatias Congênitas/cirurgia , Hipóxia/etiologia , Artéria Pulmonar/cirurgia , Reoperação/métodos , Artéria Subclávia/cirurgia , Enxerto Vascular/métodos , Adolescente , Anastomose Cirúrgica , Criança , Pré-Escolar , Feminino , Seguimentos , Cardiopatias Congênitas/complicações , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento
11.
Ann R Coll Surg Engl ; 102(6): e141-e144, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32326731

RESUMO

Deep vein thrombosis is a common clinical condition, with well-known risk factors. An unusual case of venous leiomyoma manifesting as a deep vein thrombosis in the left femoral vein of a 55-year-old man was managed successfully at our institution with anticoagulation, en-bloc excision and reconstruction of the femoral vein with spiral vein graft.


Assuntos
Veia Femoral/transplante , Leiomioma/diagnóstico , Neoplasias Vasculares/diagnóstico , Trombose Venosa/terapia , Anticoagulantes/uso terapêutico , Veia Femoral/diagnóstico por imagem , Veia Femoral/patologia , Humanos , Canal Inguinal , Leiomioma/complicações , Leiomioma/patologia , Leiomioma/cirurgia , Masculino , Pessoa de Meia-Idade , Músculo Liso Vascular/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Enxerto Vascular/métodos , Neoplasias Vasculares/complicações , Neoplasias Vasculares/patologia , Neoplasias Vasculares/cirurgia , Trombose Venosa/etiologia
12.
Am J Case Rep ; 21: e922153, 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32253368

RESUMO

BACKGROUND Aortoenteric fistula is a dreadful and uncommon complication after abdominal aortic aneurysm repair. Continuous friction against the intestine and the aortic graft along with local inflammation is thought to be the major cause of aortoenteric fistula formation, although it is unexpected to have fistula formation with a thrombosed aortic graft. CASE REPORT Here, we report a case of an aortoenteric fistula between a thrombosed aortoiliac bypass graft and the duodenum in a 75-year-old male patient who presented with a 2-month history of melena. In this case, the aortoduodenal fistula was repaired with excision of the aortic graft, proximal and distal oversewing of the aorta, omental flap coverage, pyloric exclusion and loop gastrojejunostomy creation. CONCLUSIONS An aortoenteric fistula can form through a thrombosed graft. Since this is not an expected route of fistula formation, there may be a delay in identification.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Fístula Intestinal/etiologia , Trombose/etiologia , Fístula Vascular/etiologia , Enxerto Vascular/métodos , Idoso , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/cirurgia , Masculino , Melena , Trombose/diagnóstico por imagem , Trombose/cirurgia , Tomografia Computadorizada por Raios X , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia
13.
World Neurosurg ; 139: 208-214, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32251811

RESUMO

BACKGROUND: The superficial temporal artery to middle cerebral artery (MCA) end-to-side anastomosis is the most commonly used direct extracranial-intracranial bypasses type for Moyamoya disease (MMD). In progressive MMD without suitable scalp arteries, other bypass constructs may need to be considered to augment blood flow. CASE DESCRIPTION: We present the exceptional case of a 48-year-old woman with progressive MMD and repeated transient ischemic attacks originating from the right hemisphere despite previous bilateral bypasses. We used the descending branch of the lateral circumflex femoral artery as an interposition graft for an occipital artery to M4 MCA bypass with 2 end-to-side anastomoses to augment blood flow. The ipsilateral occipital artery had already formed bilateral transdural collaterals; the goal was to preserve its supply while using the artery as a donor for an interposition graft. Access to the Sylvian fissure was limited because of the previous superficial temporal artery to MCA bypass with an extensive superficial collateral network necessitating preservation. The posterior aspect of the Sylvian fissure was targeted to revascularize the posterior frontal and parietal region using an interposition graft matching the vessel size of a distal MCA vessel segment. Surgery was technically successful, without complications, and the patient recovered without new neurologic deficits. The bypass graft was patent on postoperative computed tomographic angiography and transcranioplasty ultrasound. CONCLUSIONS: This case illustrates the need for creative bypass constructs in progressive MMD patients with multiple prior surgeries. Two surgical goals are paramount: flow augmentation with preservation of the existing collateral network to avoid complications and new deficits.


Assuntos
Revascularização Cerebral/métodos , Artéria Femoral/transplante , Artéria Cerebral Média/cirurgia , Doença de Moyamoya/cirurgia , Enxerto Vascular/métodos , Artéria Carótida Externa/cirurgia , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Doença de Moyamoya/diagnóstico por imagem , Imagem de Perfusão , Tomografia Computadorizada por Raios X
15.
Anticancer Res ; 40(2): 1049-1053, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014952

RESUMO

BACKGROUND/AIM: Retroperitoneal sarcomas represent very aggressive malignancies with high capacity of invading the surrounding vital structures. CASE REPORT: We present the case of a 46-year-old patient who had been initially diagnosed with a large retroperitoneal mass 18 months ago. At that moment the mass was resected en bloc with the inferior cava vein, which was reconstructed using a cadaveric graft, the histopathological studies demonstrating the presence of a leiomyosarcoma. One year later she was diagnosed with recurrent disease invading the abdominal aorta and a liver metastasis. This time the recurrence was resected en bloc with the abdominal aorta, which was reconstructed by placing a cadaveric graft; atypical liver resection was also performed. The postoperative course was uneventful. CONCLUSION: Extended vascular resections and cadaveric graft reconstructions might be needed in order to achieve a good local control of the disease in patients with retroperitoneal sarcomas.


Assuntos
Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/cirurgia , Cadáver , Leiomiossarcoma/complicações , Neoplasias Retroperitoneais/complicações , Enxerto Vascular , Feminino , Humanos , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/cirurgia , Pessoa de Meia-Idade , Recidiva , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/cirurgia , Resultado do Tratamento , Enxerto Vascular/métodos
16.
Vascular ; 28(3): 321-324, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32013771

RESUMO

OBJECTIVES: Scarring from prior bypass surgery and irradiation may compromise revascularization options in critical ischemia due to underlying occlusive disease. Occlusive disease of the axillo-brachial artery is particularly difficult to revascularize under such hostile conditions. METHOD: We present a case of a 58-year-old woman presenting with a painful, pulseless, and cool left upper extremity. The patient had a known history of left upper extremity occlusive disease which was managed by subclavian-axillary artery stenting with re-occlusion and subsequent extra-anatomic left carotid-to-proximal brachial artery prosthetic bypass, which was complicated by stroke. The patient had a history of left mastectomy, axillary node dissection, and external beam radiation therapy. When considering revascularization options, the combination of post-radiation changes and scarring of the conventional operative zones for revascularization posed a high risk for complications. We describe a novel approach for such revascularization, where the inflow source was the terminal brachiocephalic artery, outflow to the upper left brachial artery, with anatomic intrathoracic-to-axillary tunneling through the thoracic outlet after verifying the lack of dynamic extrinsic compression at that level. RESULT: The procedure resulted in resolution of the symptoms and the patient continued to do well 2 years later. CONCLUSION: This case shows that anatomic tunneling through the thoracic outlet can be a viable option for upper extremity revascularization when hostile conditions preclude other anatomic tunneling routes or extra-anatomic options.


Assuntos
Artéria Braquial/cirurgia , Tronco Braquiocefálico/cirurgia , Isquemia/cirurgia , Veia Safena/transplante , Esternotomia , Extremidade Superior/irrigação sanguínea , Enxerto Vascular/métodos , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/fisiopatologia , Estado Terminal , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Resultado do Tratamento , Grau de Desobstrução Vascular
18.
J Pak Med Assoc ; 70(Suppl 1)(2): S106-S109, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31981347

RESUMO

Blunt aortic injury is associated with significant mortality. A large number of patients lose their lives before reaching the hospital, those who survive half die within a day. Isthmus is the commonest site of aortic injury. Aortic injury is usually associated with other injuries of the body hence a multidisciplinary approach is required. For aortic transection the treatment options have evolved from proximal and distal aortic cross clamping and repair with distal perfusion technique using shunt or partial heart bypass (extracorporeal circulation) to endovascular stenting depending upon the available facilities andexpertise. Distal perfusion technique helps in avoiding paraplegia. We present our institutional experience of polytrauma associated with blunt aortic injuries managed with open surgical repair with distal perfusion using cardiopulmonary bypass.


Assuntos
Aorta/lesões , Ponte Cardiopulmonar/métodos , Traumatismo Múltiplo/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/cirurgia , Acidentes de Trânsito , Lesão Renal Aguda/epidemiologia , Adolescente , Adulto , Aorta/cirurgia , Circulação Extracorpórea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Paraplegia/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Respiração Artificial , Estudos Retrospectivos , Sepse/epidemiologia , Trombocitopenia/epidemiologia , Enxerto Vascular/métodos , Lesões do Sistema Vascular/complicações , Adulto Jovem
19.
Vasc Endovascular Surg ; 54(3): 272-277, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31858897

RESUMO

INTRODUCTION: The optimal method of operative management of complex renal artery aneurysms (RAAs) involving distal branches (BRAAs) remains unclear. When more than 1 artery is involved within the BRAA, endovascular techniques are not advisable and an ex vivo approach is often preferred. In this study, we introduce an alternative surgical in situ technique to treat BRAAs. METHODS AND SURGICAL TECHNIQUE: Five aneurysms involving the main or second-order bifurcation of the renal artery (RA) were treated in 4 patients at our institute between November 2012 and January 2017. The treatment of the BRAAs was based on resection of the aneurysm wall and reconstruction with autologous Pantaloon vein graft (PVG): a "Y-shaped" bypass created on-bench with autogenous great saphenous vein. Sequential clamping/reperfusion of the kidney allows to reduce renal function impairment. RESULTS: No perioperative mortality or morbidity was observed, including none nephrectomy. In all the cases, aneurysms were treated with an in situ technique as previously planned. All the grafts were patent at the follow-up time (mean 64.1 ± 11.7 months). Renal function was preserved in all the cases. Vascularization of the renal parenchyma was satisfactory both on arterial echo Doppler and contrast-medium ultrasound in all the cases. Average cross-clamping times of the main RA and of a single branch RA were 15.8 ± 1.7 and 17.7 ± 4.6 minutes, respectively. Mean total operating time was 266.3 ± 18.9 minutes. CONCLUSION: The PVG with sequential clamping applied in the surgical treatment of BRAAs permits to reduce the ischemic effects to the renal parenchyma. To our knowledge, these are the first cases described in which BRAAs are treated with a PVG and our experience suggests that it is a feasible technique, with good long-term results and without severe adverse events recorded.


Assuntos
Aneurisma/cirurgia , Artéria Renal/cirurgia , Veia Safena/transplante , Enxerto Vascular/métodos , Idoso , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem , Artéria Renal/fisiopatologia , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
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