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1.
Medicine (Baltimore) ; 99(2): e18694, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914070

RESUMO

RATIONALE: Some patients with pulmonary arteriovenous malformation (PAVM) present with hypoxemia and life-threatening complications, including stroke and cerebral abscess. Catheter embolization is currently the preferred treatment for PAVM. However, previous studies have revealed that the incidence of PAVM recanalization is approximately 10% 5 to 7 years after embolization. In contrast, there are no studies where recanalization has occurred over 10 years after embolization. PATIENT CONCERNS: Herein, we report 2 cases diagnosed with cerebral embolism due to PAVM recanalization 13 years and 30 years after catheter treatment, in case I and II, respectively. DIAGNOSES: Both cases were diagnosed with PAVM recanalization on chest computed tomography (CT) examination performed after cerebral embolism development. Furthermore, pulmonary artery angiography revealed blood flow from the pulmonary artery to the vein in the PAVM, confirming PAVM recanalization. INTERVENTIONS: Coil re-embolization was performed for the all recanalized PAVM. OUTCOMES: All the target lesions were successfully re-embolized in both cases. However, in case I, the second recanalization of embolized PAVM was confirmed 1 year after coil re-embolization. Consequently, the third embolization was performed in case I. In contrast to case I, the patient in case II was followed up without recanalization for 2 years after embolization. LESSONS: We described the first 2 cases diagnosed with PAVM recanalization >10 years after the first catheter embolization. These cases suggest that patients with PAVMs should undergo life-long follow-up after catheter embolization.


Assuntos
Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/terapia , Embolização Terapêutica/métodos , Embolia Intracraniana/complicações , Embolia Intracraniana/terapia , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Idoso , Feminino , Humanos
2.
Nephrol. dial. transplant ; 34(10): 1746-1765, Oct. 2019.
Artigo em Inglês | BIGG | ID: biblio-1026220

RESUMO

There are three principle forms of vascular access available for the treatment of children with end stage kidney disease (ESKD) by haemodialysis: tunnelled catheters placed in a central vein (central venous lines, CVLs), arteriovenous fistulas (AVF), and arteriovenous grafts (AVG) using prosthetic orbiological material. Compared with the adult literature, there are few studies in children to provide evidence based guidelines for optimal vascular access type or its management and outcomes in children with ESKD.


Assuntos
Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/prevenção & controle , Fístula Arteriovenosa/terapia , Anastomose Arteriovenosa/fisiologia , Pressão Venosa Central/fisiologia
4.
Methodist Debakey Cardiovasc J ; 15(2): 152-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384380

RESUMO

Iatrogenic aortocaval fistula is an extremely rare pathologic condition that often results in clinically significant left-to-right extracardiac shunt. In slow-progressing cases, chronic right-sided heart failure can occur and, in some patients, may persist for years. We present a patient with a long-standing aortocaval fistula that was causing high-flow left-to-right shunting, tricuspid regurgitation, severe pulmonary hypertension, and right-side heart failure. After undergoing complete endoscopic isolation of the aortocaval fistula, the patient experienced dramatic clinical improvement and continued to have excellent imaging and clinical resolution after 2 years of follow-up.


Assuntos
Aorta/fisiopatologia , Fístula Arteriovenosa/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Insuficiência Cardíaca/etiologia , Hipertensão Pulmonar/etiologia , Doença Iatrogênica , Veia Cava Inferior/fisiopatologia , Aorta/diagnóstico por imagem , Aortografia/métodos , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/fisiopatologia , Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler em Cores , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Desenho de Prótese , Fluxo Sanguíneo Regional , Dispositivo para Oclusão Septal , Fatores de Tempo , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem
5.
Can Assoc Radiol J ; 70(3): 300-306, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31376886

RESUMO

PURPOSE: Arteriovenous fistulas and grafts, necessary for hemodialysis, may develop stenoses due to neointimal hyperplasia, which often require percutaneous transluminal angioplasty. Patient and lesion characteristics were evaluated prior to angioplasty and were correlated with 1- and 6-month outcomes. MATERIALS AND METHODS: This was an observational study of African American hemodialysis patients who presented for angioplasty of a dysfunctional fistula or graft. Clinical outcomes were ascertained from dialysis facilities 1 month and 6 months after angioplasty. One-month clinical success was defined as dialyzer blood flows of 450 mL/min without complications or interval shunt thrombosis, interventions, or loss of access, which was rarely achieved at 6 months. Logistic regression models were used to evaluate associations of clinical variables with outcomes. RESULTS: There were 150 stenoses treated during 99 procedures performed on 82 patients. The clinical success rate at one month was 67% with no complications as a result of the percutaneous transluminal angioplasty. Success at 1 month was positively associated with use of aspirin (P = .005) and with referral for high venous pressures (P = .004). Six-month data were available for 81 procedures, with 45.7% requiring repeat angioplasty and 12.3% suffering major complications (thrombectomy, revision surgery, or access abandonment). Major complications were seen predominantly in patients who were not receiving aspirin. CONCLUSIONS: Aspirin use and high venous pressure were associated with 1-month clinical success and fewer major complications at 6 months. Future work should investigate biologic mechanisms of action of aspirin and long-term effects of use to maintain vascular access.


Assuntos
Afro-Americanos/estatística & dados numéricos , Angioplastia/métodos , Fístula Arteriovenosa/terapia , Diálise Renal/efeitos adversos , Anti-Inflamatórios não Esteroides/administração & dosagem , Fístula Arteriovenosa/etiologia , Aspirina/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
6.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466976

RESUMO

We present a case of a high cardiac output (CO) arteriovenous fistula (AVF) with pulmonary hypertension (PH) post-double lung transplant presenting for AVF occlusion. The patient presented with a CO of 9.83 L/min, pulmonary artery pressures of 64/16, inferior vena cava dilatation and an AVF between the left common iliac artery and vein. Given her anaesthetic considerations, we elected to proceed with local anaesthesia and sedation. Trial balloon occlusion resulted in an increase in blood pressure and a headache that resolved with balloon deflation. Successful final occlusion with an endovascular stent was completed without adverse events. PH is a complex pathophysiology with the potential for catastrophic decompensation. Anaesthesiologists must consider a patient's comorbidities and the procedure to safely administer anaesthesia without complications.


Assuntos
Fístula Arteriovenosa/complicações , Insuficiência Cardíaca/etiologia , Transplante de Pulmão/efeitos adversos , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Adulto , Angiografia , Fístula Arteriovenosa/terapia , Oclusão com Balão/métodos , Débito Cardíaco/fisiologia , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/complicações , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Diálise Renal , Stents , Resultado do Tratamento
7.
World Neurosurg ; 130: e715-e721, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279921

RESUMO

BACKGROUND: Brain arteriovenous malformations (AVMs) are complex vascular lesions composed of abnormal arteries directly connected to veins without the typical intervening angioarchitecture. Rupture rates range from 2% to 4%, with that risk increasing to 4.5% per year for those presenting with hemorrhage. Mortality ranges from 12% to 66.7% after rupture, and up to 40% of survivors suffer from permanent neurologic sequelae. Treatment commonly includes a multimodality approach consisting of a combination of microsurgery, embolization, and radiosurgery. Typically, preoperative embolization is undertaken in a staged manner several days to weeks prior to microsurgical resection. METHODS: We describe a series of 5 pediatric patients harboring intracranial AVMs who underwent embolization and resection in the same anesthetic event, an approach that has not yet been described in the literature. RESULTS: Three patients presented symptomatically, whereas 2 AVMs were discovered incidentally, and average Spetzler-Martin grade was 1.6. Average anesthesia length was 580.8 minutes, and intraoperative angiography revealed complete resection in all cases. All patients were extubated at the end of the case and were discharged and followed up with a modified Rankin Scale score of 0. CONCLUSIONS: We describe a novel approach to treatment of pediatric intracranial AVMs that is shown to be safe and feasible. A single anesthesia event allows for aggressive preoperative embolization without increasing the risk of hemorrhage in the waiting period until resection. A single anesthesia event also prevents the patients from undergoing another intubation and anesthesia and decreases the risk associated with another anesthesia in a relatively short time frame.


Assuntos
Anestesia Geral/métodos , Fístula Arteriovenosa/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Malformações Arteriovenosas Intracranianas/terapia , Adolescente , Fístula Arteriovenosa/diagnóstico por imagem , Criança , Terapia Combinada/métodos , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Masculino , Estudos Retrospectivos , Resultado do Tratamento
8.
World Neurosurg ; 131: 1-5, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31356978

RESUMO

BACKGROUND: Distal catheterization in the ophthalmic artery beyond the origin of the central retinal artery has been attempted to avoid visual complications in cases of transarterial embolization (TAE). Although avoiding visual complications is important, extraocular complications have been rarely reported and discussed. Here, we report a case of an intraorbital arteriovenous fistula (AVF) presenting with impaired extraocular movement after a provocation test and discuss the potential risks associated with TAE at the third segment of the ophthalmic artery. CASE DESCRIPTION: A 53-year-old man was referred to our hospital for a newly diagnosed vascular lesion on the left optic chiasm. A left internal carotid angiogram revealed an intraorbital AVF fed by distal branches of the left ophthalmic artery taking a recurrent course toward the proximal ophthalmic artery, and the anterior branches of the inferior lateral trunk draining into the tortuous basal vein of Rosenthal with a varix. Neither the cavernous sinus nor the superior ophthalmic vein was opacified as draining routes of this lesion. A provocation test was done for diagnostic and therapeutic purposes at the third segment of the ophthalmic artery. During the test, the patient developed a transient impaired adduction of the left eye without any visual field deficit; therefore, TAE was avoided. The patient made an uneventful recovery and was recommended a transcranial transvenous embolization for a radical treatment. CONCLUSIONS: In intraorbital hypervascular lesions, occlusion of the third segment of the ophthalmic artery is associated with a potential risk of extraocular complications.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Músculos Oculomotores/irrigação sanguínea , Artéria Oftálmica/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Embolização Terapêutica/métodos , Humanos , Malformações Arteriovenosas Intracranianas/terapia , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/prevenção & controle , Músculos Oculomotores/fisiopatologia
9.
Indian J Med Res ; 149(3): 376-383, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31249203

RESUMO

Background & objectives: : The pathophysiological mechanisms involved in distal pressure changes following arteriovenous fistula (AVF) creation in patients with end-stage renal disease (ESRD) are not completely understood. This study was aimed to assess digital pressure changes post-AVF creation and to identify the factors that might influence these changes in ESRD patients. Methods: : In this prospective study, 41 patients with ESRD underwent AVF creation. Basal digital pressure (BDP), digital brachial index (DBI), calcium, phosphorus and blood urea levels were assessed preoperatively. BDP, DBI, vein and artery diameters, and AVF blood flow were also evaluated at one and two month(s) post-AVF creation. Results: : Mean BDP significantly decreased from 131.64±25.86 mmHg (baseline) to 93.15±32.14 and 94.53±32.90 mmHg at one and two months post-AVF creation, respectively (P <0.001). Mean DBI significantly decreased one month post-AVF creation versus baseline (0.70±0.18 vs. 0.89±0.17 mm, P <0.001) and remained similar at two versus one month(s) postoperatively (0.70±0.23 vs. 0.70±0.18 mm). At both postoperative timepoints, no correlation between DBI decrease and increased artery and vein diameters or fistula blood flow was observed. Mean DBI difference between patients with previous ipsilateral access versus those without was not significant from pre to one month postoperatively. No correlation was observed between baseline phosphorus, calcium and blood urea nitrogen and DBI changes. Interpretation & conclusions: : Our findings suggest that decrease in distal pressure following AVF creation may not be influenced by the arterial remodelling degree, vein diameter or fistula flow. In uraemic patients, those with low calcium and/or increased phosphorus, no association between these parameters and DBI changes could be observed.


Assuntos
Fístula Arteriovenosa/terapia , Falência Renal Crônica/terapia , Diálise Renal , Adulto , Idoso , Fístula Arteriovenosa/fisiopatologia , Feminino , Hemodinâmica , Humanos , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pressão , Estudos Prospectivos , Resultado do Tratamento , Veias/fisiopatologia
10.
Radiol Med ; 124(10): 973-988, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31209790

RESUMO

Pulmonary arteriovenous malformations (PAVMs) or fistulas are rare direct pathological connections between pulmonary arterial and venous circulation. Most of PAVMs are congenital and closely associated with hereditary hemorrhagic telangiectasia, but acquired PAVMs have also been described in the literature. Diagnosis of PAVMs is a priority for clinicians, in order to prevent potentially fatal events such as cerebrovascular stroke, systemic septic embolization, hemoptysis and hemothorax. In this scenario, the radiologist plays a key role in both diagnostic and therapeutic workups of PAVMs: Chest X-ray, computed tomography and magnetic resonance are effective tools for PAVMs identification and confirmation of the suspected diagnosis. Furthermore, imaging modalities provide most of the elements for PAVMs classification according to their angioarchitecture (simple and complex) and help the clinicians in establishing which lesion requires prompt treatment and which one will benefit of imaging follow-up alone. Endovascular management of PAVMs has grown up as the first-line treatment in respect of surgery during last decades, showing lower risk of intra- and post-procedural complications and offering a wide number of treatment options and materials, ensuring effective management in virtually any clinical situation; interventional treatment aims to exclude PAVMs from pulmonary circulation, and specific technique and embolic agents should be selected according to pre-treatment imaging, in order to obtain the best procedural outcome. This paper proposes a review of the clinical and radiological features that a radiologist needs to know for PAVMs diagnosis and proper management, also showing an overview of the most common endovascular treatment strategies and embolization materials.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Radiografia Intervencionista , Diagnóstico Diferencial , Humanos , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem
11.
J Neurointerv Surg ; 11(10): 1040-1044, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31147436

RESUMO

BACKGROUND AND PURPOSE: Liquid embolic agents (LEAs) are the determinant tool for successful embolization of cranial arteriovenous shunts. There are few currently available LEAs. The aim of the study was to summarize our initial experience with a recently introduced non-adhesive ethylene vinyl alcohol (EVOH) copolymer based LEA (Menox 18) in the endovascular treatment of cerebral arteriovenous malformations. METHODS: From April 2018 to November 2018, 24 patients harboring cerebral arteriovenous malformations underwent endovascular embolization with Menox 18. Clinical features, angiographic results, procedural details, complications, and follow-up details were prospectively collected and retrospectively analyzed. RESULTS: Curative embolization in one endovascular session was achieved in 14/24 (58.3%) of the treated patients. Partial embolization was achieved in 10 patients (42.6%) in whom staged treatment with radiosurgery or microsurgical resection was planned. No mortality was recorded in our series. Clinical complications after embolization occurred in 1/24 (4.66%) patients. No technical complications were noted CONCLUSIONS: Our pilot study suggests that the Menox embolization system offers similar technical and clinical results in comparison with the other currently available LEAs. Further studies with larger cohorts and long term follow-up data are needed to fully evaluate its efficacy.


Assuntos
Fístula Arteriovenosa/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Malformações Arteriovenosas Intracranianas/terapia , Polivinil/administração & dosagem , Adolescente , Adulto , Idoso , Fístula Arteriovenosa/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
Vasc Endovascular Surg ; 53(6): 501-506, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31159685

RESUMO

Inferior vena cava (IVC) filters are important devices for patients who are at high risk for developing thrombi and pulmonary embolism but have conditions that preclude the use of pharmacologic anticoagulants. IVC filter retrieval has become an important quality initiative backed by Food and Drug Administration guidelines for prompt removal after the filter is no longer indicated. Filter retrieval is a common procedure that usually has very few complications. However, when the filter is tilted or embedded in the caval wall, advanced techniques of retrieval may be necessary. These techniques have a higher rate of success but also a higher risk of complications such as injury to the IVC. Here, we describe a case of IVC filter retrieval resulting in formation of an arteriovenous fistula between the right renal artery and IVC and subsequent successful repair of this fistula using a vascular plug.


Assuntos
Fístula Arteriovenosa/etiologia , Remoção de Dispositivo/efeitos adversos , Implantação de Prótese/instrumentação , Artéria Renal/lesões , Lesões do Sistema Vascular/etiologia , Filtros de Veia Cava , Veia Cava Inferior/lesões , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Feminino , Humanos , Pessoa de Meia-Idade , Flebografia/métodos , Artéria Renal/diagnóstico por imagem , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/terapia , Veia Cava Inferior/diagnóstico por imagem
13.
Diagn Interv Radiol ; 25(3): 219-224, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31063141

RESUMO

PURPOSE: We aimed to study the technical and clinical outcome of urgent transcatheter arterial embolization (TAE) for postoperative arterial complications after pelvic or hip surgery, and to accumulate additional experience about the role of embolization for these injuries. METHODS: Patients who received TAE procedure for arterial complications after pelvic or hip surgery between September 1st, 2002 and December 1st, 2014 were screened on medical records and included in the analysis. Angiographic findings included active contrast agent extravasation, pseudoaneurysm formation, arteriovenous fistula, and other suspicious signs such as sighting of coarse margin or distortion of vessels. Embolic agents consisted of coils, gelatin sponge, and polyvinyl alcohol. Technical success was defined as complete occlusion of targeted artery through angiography, and clinical success as sustained resolution of symptoms. RESULTS: A total of 22 patients (15 males, 19-76 years old) were enrolled. Prior to TAE, 12 patients developed hemorrhagic shock and the remaining 10 patients had hemorrhage-related pain, hematoma, or anemia. Contrast agent extravasation occurred in 12 cases, pseudoaneurysm formation in 5 cases, and other suspicious signs in 5 cases. Injury occurred in the internal iliac artery stem in 6 cases, inferior gluteal artery in 6 cases and superior gluteal artery in 6 cases. Multiple vascular lesions appeared in 5 cases. After TAE, technical success occurred in 22 patients and clinical success in 21 patients (95.5%). A 36-year-old woman died of irreversible multiple organ failure; no other severe procedure-related complications were recorded. CONCLUSION: TAE is safe and effective for postoperative arterial complications after pelvic or hip surgery.


Assuntos
Embolização Terapêutica/métodos , Quadril/cirurgia , Pelve/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Angiografia/métodos , Artérias/lesões , Fístula Arteriovenosa/terapia , Nádegas/irrigação sanguínea , Extravasamento de Materiais Terapêuticos e Diagnósticos , Feminino , Hemorragia/terapia , Humanos , Artéria Ilíaca/lesões , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia , Resultado do Tratamento , Adulto Jovem
14.
G Ital Nefrol ; 36(2)2019 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-30983175

RESUMO

Native arteriovenous fistula is the preferred vascular access because of it does not usually cause infections and seems to be closely related with prolonged patient survival, compared to prosthetic grafts and central venous catheters; it also is cost effective. Venous stenosis is one of the main causes of AVF failure. It is caused by a number of upstream and downstream events. The former group comprises hemodynamic and surgical stressors, inflammatory stimuli and uraemia, while downstream events involve the proliferation of smooth muscle cells and myofibroblasts and the development of neo-intimal hyperplasia. Percutaneous transluminal angioplasty is the gold standard for arteriovenous fistula stenosis. It allows the visualization of the whole vascular circuit and the immediate use of the vascular access for the next dialysis session. Ultrasound-guided percutaneous endovascular angioplasty is a feasible and safe alternative to conventional fluoroscopic technique: it is equally effective in treating arteriovenous fistula stenosis, but it presents the advantage of not using contrast media or ionizing radiation. The aim of this review is to report the latest evidence on cellular and molecular mechanisms that contribute to the development of neo-intimal hyperplasia, as well as the current and future therapeutic perspectives, especially concerning the use of anti-proliferative drugs, and the efficacy of the ultrasound-guided angioplasty in restoring and maintaining the vascular access patency over time.


Assuntos
Angioplastia/métodos , Fístula Arteriovenosa/terapia , Ultrassonografia de Intervenção , Angioplastia com Balão/métodos , Constrição Patológica/terapia , Stents Farmacológicos , Humanos , Hiperplasia/etiologia , Miócitos de Músculo Liso/patologia , Complicações Pós-Operatórias/terapia , Diálise Renal/efeitos adversos , Stents , Túnica Íntima/patologia
16.
J Stroke Cerebrovasc Dis ; 28(7): e100-e101, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31006519

RESUMO

Pulmonary arteriovenous fistula (PAVF), a vessel malformation connecting the pulmonary circulation to the systemic circulation while bypassing the pulmonary capillaries, can cause paradoxical cerebral infarction. It is often associated with hereditary hemorrhagic telangiectasia (HHT), a genetic disease characterized by multiple dermal, mucosal, and visceral telangiectasia causing recurrent bleeding. Paradoxical cerebral embolism caused by PAVF without HHT is rare. Here, we report a patient with isolated PAVF who experienced an ischemic stroke caused by a paradoxical embolism from deep venous thrombosis; the patient was successfully treated with recombinant tissue plasminogen activator. She presented with a decrease in arterial oxygen saturation to 91%, and lung disease was suspected. A PAVF was subsequently found in the right S6 region using contrast computed tomography. Interventional radiologists successfully occluded the shunt using 6 microcoils. PAVF should be considered when determining the pathogenesis of cerebral ischemia in patients with hypoxia, which can be the only symptom of PAVF.


Assuntos
Fístula Arteriovenosa/complicações , Embolia Paradoxal/tratamento farmacológico , Fibrinolíticos/administração & dosagem , Embolia Intracraniana/tratamento farmacológico , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , Trombose Venosa/complicações , Idoso de 80 Anos ou mais , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Imagem de Difusão por Ressonância Magnética , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/etiologia , Embolização Terapêutica/instrumentação , Inibidores do Fator Xa/uso terapêutico , Feminino , Humanos , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/diagnóstico por imagem , Angiografia por Ressonância Magnética , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Piridinas/uso terapêutico , Proteínas Recombinantes/administração & dosagem , Tiazóis/uso terapêutico , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
17.
Med Sci Monit ; 25: 2727-2734, 2019 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-30980711

RESUMO

BACKGROUND Arteriovenous fistulas (AVFs) are used to provide vascular access for hemodialysis in patients with end-stage renal failure. However, stenosis and thrombosis can compromise long-term AVF patency. The objective of this study was to evaluate catheter thrombolysis with percutaneous transluminal angioplasty (PTA), using a trans-brachial approach, for acutely thrombosed AVFs. MATERIAL AND METHODS This retrospective study examined 30 cases of AVF thrombosis treated between January 1, 2015 and January 1, 2017. All patients received transcatheter thrombolysis with PTA using a trans-brachial approach. AVF patency was assessed after 6 months. RESULTS Thrombolysis with PTA was performed at 2 to 72 h after diagnosis of AVF occlusion due to acute thrombosis, and AVF patency was restored in all patients. After 6 months, the primary and secondary patency rates were 76.7% and 93.3%, respectively. For type I stenosis, primary patency was achieved in 10 of 16 patients (62.5%) and secondary patency was achieved in 14 of 16 patients (87.5%). For type II stenosis, primary patency was achieved in 13 of 14 patients (92.9%) and secondary patency was achieved in 14 of 14 patients (100%). Comparing type I and II stenosis, a significant difference was detected in the rates of primary patency (odds ratio=0.909, 95% confidence interval 0.754-1.096, P=0.049), but not secondary patency (P=0.178), after 6 months. CONCLUSIONS Our study provides preliminary evidence that catheter-directed thrombolysis with PTA using a trans-brachial approach can achieve high patency rates when used to treat acutely thrombosed AVFs.


Assuntos
Angioplastia/métodos , Fístula Arteriovenosa/terapia , Trombose/terapia , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica , Feminino , Oclusão de Enxerto Vascular/cirurgia , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal , Estudos Retrospectivos , Terapia Trombolítica/métodos , Resultado do Tratamento , Grau de Desobstrução Vascular
18.
World Neurosurg ; 127: 126-130, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30965172

RESUMO

BACKGROUND: A 26-year-old man was admitted with complaints of progressive depressive mood and general fatigue. Magnetic resonance imaging revealed diffuse enhanced lesions in the neurohypophyseal, pineal, and paraventricular regions and ventricular wall. CASE DESCRIPTION: Endoscopic biopsy confirmed the presence of germ cell tumor, and chemoradiation therapy (CRT) was then performed. Most of the tumors disappeared after CRT except for the right paraventricular lesion. Follow-up magnetic resonance imaging performed 14 months after CRT showed enlargement of this residual lesion. In addition to tumor growth, coexistent flow void signals within the tumor increased. Angiographically, this vascular lesion mimicked arteriovenous malformation, which was mainly fed by the lenticulostriate artery and drained into the internal cerebral vein. Transarterial embolization was performed, resulting in effective flow reduction. Subsequently, the tumor was resected without complications. It was histopathologically diagnosed as a mature teratoma with an arteriovenous fistula (AVF). Arterial components were observed to directly connect to venous components within the tumor without any intermediate nidal components. CONCLUSIONS: To the best of our knowledge, this is the first reported case of an intracranial germ cell tumor coexistent with a growing AVF. AVF developed within a CRT-refractory teratomatous component, which was successfully treated with embolization followed by surgical resection.


Assuntos
Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico por imagem , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Embrionárias de Células Germinativas/complicações , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Adulto , Fístula Arteriovenosa/terapia , Neoplasias Encefálicas/terapia , Quimiorradioterapia/métodos , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/terapia , Procedimentos Neurocirúrgicos/métodos
19.
Med. clín (Ed. impr.) ; 152(7): 274-280, abr. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183547

RESUMO

La telangiectasia hemorrágica hereditaria es una enfermedad minoritaria con herencia autosómica dominante que ocasiona un crecimiento vascular anómalo de forma sistémica. El abordaje y seguimiento de estos pacientes debería hacerse desde unidades multidisciplinares. Su diagnóstico es clínico según los criterios de Curaçao. Las telangiectasias en la mucosa nasal ocasionan epistaxis recurrentes, principal síntoma de esta enfermedad y de difícil control. Los 3 patrones de afectación hepática, comunicaciones entre arteria hepática y venas suprahepáticas, entre arteria hepática y vena porta o entre vena porta y venas suprahepáticas pueden causar insuficiencia cardiaca por hiperaflujo, hipertensión portal o encefalopatía hepática, respectivamente. Estos tipos de afectación vascular se pueden establecer mediante tomografía computarizada. Se debe realizar un cribado de fístulas arteriovenosas pulmonares a todos los pacientes mediante una ecocardiografía con contraste. Nuestro principal objetivo es realizar una revisión del manejo de las epistaxis, afectación hepática y pulmonar del paciente adulto con telangiectasia hemorrágica hereditaria


Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant inherited Rare Disease that causes a systemic anomalous vascular overgrowth. The approach and follow-up of these patients should be from multidisciplinary units. Its diagnosis is carried out according to Curaçao clinical Criteria. Telangiectasia in the nasal mucosa cause recurrent epistaxis, the main symptom of HHT and difficult to control. The three types of hepatic shunting, hepatic artery to hepatic vein, hepatic artery to portal vein or to portal vein to hepatic vein, can cause high-output heart failure, portal hypertension or porto-systemic encephalopathy, respectively. These types of vascular involvement can be established using computerised tomography. Pulmonary arteriovenous fistula should be screened for all HHT patients by contrast echocardiography. The main objective is to review the management of epistaxis, liver and lung involvement of the adult patient with HHT


Assuntos
Humanos , Adulto , Telangiectasia Hemorrágica Hereditária/terapia , Epistaxe/terapia , Fístula do Sistema Respiratório/terapia , Fístula Arteriovenosa/terapia , Telangiectasia Hemorrágica Hereditária/complicações , Epistaxe/etiologia , Fístula do Sistema Respiratório/etiologia , Fístula Arteriovenosa/etiologia
20.
World Neurosurg ; 126: e1242-e1245, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30878741

RESUMO

OBJECTIVE: We sought to report transarterial Onyx embolization of residual brain arteriovenous malformation (AVM) after surgical resection. METHODS: From January 2017 to January 2019, 7 patients with residual AVM after surgery were treated by transarterial Onyx embolization. Demographics, angioarchitectural characteristics, complications, and results were retrospectively reviewed. RESULTS: All patients presented initially with a ruptured AVM. Residual AVM was found on control angiograms within 1 month after surgery. All residual AVMs were cured by transarterial Onyx embolization. One patients experienced feeding artery perforation without adding new neurologic deficits. CONCLUSIONS: Complete obliteration of residual AVMs can be obtained by salvage transarterial Onyx embolization.


Assuntos
Fístula Arteriovenosa/terapia , Dimetil Sulfóxido/uso terapêutico , Embolização Terapêutica/métodos , Malformações Arteriovenosas Intracranianas/terapia , Polivinil/uso terapêutico , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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