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1.
Medicine (Baltimore) ; 98(51): e18303, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860979

RESUMO

RATIONALE: Aortoesophageal fistula (AEF) is the direct communication between the aorta and esophagus, which can cause fatal hemorrhage, and its incidence increased with the use of an esophageal stent (ES). PATIENT CONCERNS: A 79-year-old man was admitted due to hemodynamic shock with massive hematemesis caused by AEF 1 month after the implantation of an ES. DIAGNOSES: Computed tomography angiography visualized an AEF with an ulcer-like projection on the aortic arch where the ES was placed. Angiography of the aorta revealed extravasation of contrast media from the aortic arch into the stented esophagus, which confirmed the diagnosis. INTERVENTIONS: Thoracic endovascular aortic repair (TEVAR) was performed for massive hematemesis caused by ES-related, AEF but did not solve the underlying problem, leading to the second fatal hemorrhage. LESSONS: TEVAR for the unique treatment of ES-related AEF is feasible in certain cases but may lead to collapse after a specific period.


Assuntos
Doenças da Aorta/complicações , Fístula Esofágica/complicações , Hemorragia Gastrointestinal/etiologia , Implantação de Prótese/efeitos adversos , Stents/efeitos adversos , Fístula Vascular/complicações , Idoso , Doenças da Aorta/etiologia , Doenças da Aorta/cirurgia , Angiografia por Tomografia Computadorizada , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Evolução Fatal , Hemorragia Gastrointestinal/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Fístula Vascular/etiologia , Fístula Vascular/cirurgia
2.
J Vet Cardiol ; 24: 78-84, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31405558

RESUMO

This report describes a rare case of an aorto-cardiac fistula in a six-year-old French Warmblood mare presented with atrial fibrillation, decreased performance, ventral oedema, bounding arterial pulsation and pathological jugular venous pulse. A 2.7-cm-diameter fistula connected the right aortic sinus of Valsalva to the right atrium. Atrial fibrillation was likely due to volume overload of the right heart due to left-to-right shunting. The horse was treated by percutaneous transcatheter closure of the fistula delivered under general anaesthesia using a transarterial approach. The operation was initially successful, and clinical signs of congestive heart failure improved immediately. However, the device dislodged six days after procedure, and the general condition of the horse deteriorated quickly. A second closure attempt to deliver the occluder using a transvenous approach in the standing horse failed, and the horse was eventually euthanized. Procedural aspects and several possible risk factors for device dislodgement are discussed.


Assuntos
Átrios do Coração , Doenças dos Cavalos/cirurgia , Seio Aórtico , Fístula Vascular/veterinária , Animais , Fibrilação Atrial/etiologia , Fibrilação Atrial/veterinária , Cateterismo Cardíaco , Feminino , Cavalos , Fístula Vascular/complicações , Fístula Vascular/cirurgia
6.
Urologe A ; 58(6): 666-672, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-30997547

RESUMO

INTRODUCTION: Arterioureteral fistulas are rare, life-threatening, and difficult to diagnose. Risk factors are medical interventions in the lesser pelvis (general, urological, gynecological, and vascular surgery), radiation therapy of the lesser pelvis, permanent double J catheters, and previous vessel malformations. MATERIALS AND METHODS: We retrospectively evaluated all cases of arterioureteral fistulas registered over the last 10 years in the clinic's documentation system. For all cases, clinical symptoms, diagnostics, therapies as well as clinical outcome were evaluated. RESULTS: Four of the 5 patients were women. The most common initial symptom was a gross hematuria (4/5). All patients had a permanent double J catheter after extensive surgery of the lesser pelvis. In one case the initial diagnosis was done by retrograde ureterography, in 2 patients by provocative angiography and in the other 2 cases with a laparotomy due to cardiovascular problems. Three patients were treated by open surgery and 2 patients were treated by stenting of the iliac artery. One patient died, 2 patients had a permanent kidney fistula, and 2 patients continued treatment with a permanent double J catheter. CONCLUSION: Based on the more aggressive therapy regimens, we expect that the number of patients presenting with arterioureteral fistulas will continue to rise. The identification of these patients based on their risk profile is essential.


Assuntos
Hematúria/etiologia , Artéria Ilíaca , Stents , Fístula Urinária/terapia , Fístula Vascular/terapia , Idoso , Angiografia , Angioscopia , Cateteres , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Fístula Urinária/complicações , Fístula Vascular/complicações , Procedimentos Cirúrgicos Vasculares
7.
Vasc Endovascular Surg ; 53(6): 492-496, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31018831

RESUMO

Bronchial artery aneurysm (BAA) is a rare entity. Ruptured BAA can cause life-threatening hemorrhage. It is recommended that treatment should be initiated immediately after diagnosis. We present the case of a 56-year-old female with multiple BAAs and interstitial lung disease. Aortic computed tomography angiography demonstrated that the largest aneurysm at the right hilum was fed by right subclavian artery and right bronchial artery. A fistula between the pulmonary trunk and the aneurysm was also revealed. The patient underwent transcatheter embolization. Coils were placed in the feeding vessels instead of the aneurysms to avoid nontarget embolization of the pulmonary arteries through the fistula. The procedure achieved reduction in aneurysmal blood flow. The patient's cough resolved at 6-month follow-up.


Assuntos
Aneurisma/terapia , Artérias Brônquicas , Embolização Terapêutica , Procedimentos Endovasculares , Doenças Pulmonares Intersticiais/complicações , Artéria Pulmonar , Fístula do Sistema Respiratório/terapia , Fístula Vascular/terapia , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Artérias Brônquicas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Fístula do Sistema Respiratório/complicações , Fístula do Sistema Respiratório/diagnóstico por imagem , Resultado do Tratamento , Fístula Vascular/complicações , Fístula Vascular/diagnóstico por imagem
8.
Am J Emerg Med ; 37(7): 1394.e3-1394.e4, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31003830

RESUMO

A 58-year-old woman presented with gum bleeding, hematuria, and cutaneous ecchymoses. Left hip replacement had been performed five years prior. The overall findings of our work-up were consistent with ongoing DIC triggered by the presence of an arterio-venous left femoral fistula. The patient was treated successfully with fresh frozen plasma, the fistula was surgically repaired and a stent was placed. On the second day, bleeding had resolved and laboratory values reverted to normal. This uncommon scenario is reminiscent of the Kasabach-Merritt syndrome and well illustrates that patients with an arterio-venous fistula can sometimes present with atypical features. The Kasabach-Merritt syndrome is reported in pediatric and adult patients with giant hemangiomas and angiosarcomas. Adult cases are described also in association with hematomas and large vascular aneurysms. The underlying pathophysiology is the sequestration and consumption of platelets and clotting factors with uncontrolled formation of microthrombi within the vascular lesion. DIC and a microangiopathic hemolytic anemia can subsequently develop. Mechanistic pathways of the Kasabach-Merritt syndrome in the context of a vascular fistula are shared with the more common causes of the syndrome. We speculate that the endothelial dysfunction and injury caused by the flow shear were the pivotal triggers of the aberrant trapping of platelets, the consumptive coagulopathy, and the formation of microthrombi within the fistula. Mortality rate can be as high as up to 40%. The Kasabach-Merritt syndrome could represent the only clinical feature of an otherwise occult vascular fistula. Emergency physicians should be aware of this condition.


Assuntos
Coagulação Intravascular Disseminada/diagnóstico , Síndrome de Kasabach-Merritt/diagnóstico , Fístula Vascular/diagnóstico , Angiografia , Coagulação Intravascular Disseminada/etiologia , Feminino , Humanos , Síndrome de Kasabach-Merritt/etiologia , Pessoa de Meia-Idade , Fístula Vascular/complicações , Fístula Vascular/cirurgia
11.
Future Cardiol ; 15(2): 85-88, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30848672

RESUMO

We present a 33-year-old man with atypical chest pain and with no significant past medical history. The patient was finally diagnosed as a case of huge fistula from the left main coronary artery to the right atrium, a very rare condition with challenging diagnostic and therapeutic approaches. The majority of cases of coronary artery fistula are small, asymptomatic and clinically undetectable; they frequently do not cause any complications and can spontaneously resolve. However, larger fistulas are frequently three times the size of a typical caliber of a coronary artery and may or may not cause symptoms or complications.


Assuntos
Dor no Peito/etiologia , Aneurisma Coronário/complicações , Vasos Coronários , Dispneia/etiologia , Átrios do Coração , Esforço Físico , Fístula Vascular/complicações , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Dor no Peito/diagnóstico , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/cirurgia , Angiografia Coronária , Dispneia/diagnóstico , Ecocardiografia Transesofagiana , Cardiopatias/complicações , Cardiopatias/diagnóstico , Cardiopatias/cirurgia , Humanos , Masculino , Índice de Gravidade de Doença , Fístula Vascular/diagnóstico , Fístula Vascular/cirurgia
12.
Clin J Gastroenterol ; 12(4): 341-346, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30706429

RESUMO

We report a 74-year-old male patient with compensated cirrhosis after hepatic C virus eradication. After the patient underwent hepatectomy for hepatocellular carcinoma, multiple lung and lymph node metastases were detected by computed tomography. Computed tomography also revealed a portosystemic shunt from the superior mesenteric vein to the right testicular vein. He was administered lenvatinib (12 mg). Five days after the initiation of lenvatinib, he developed grade 3 hepatic encephalopathy, and his ammonia level increased. Lenvatinib was stopped, with improvement of the encephalopathy and decrease in ammonia level. When lenvatinib was restarted, grade 2 encephalopathy recurred which then improved upon stopping the drug. We thought that the encephalopathy was due to the portosystemic shunt, and occlusion of the shunt was performed. The day after shunt occlusion, lenvatinib (8 mg) was restarted, and the lenvatinib dose was increased to 12 mg at 2 days after shunt occlusion. Subsequently, the ammonia level remained stable and the patient remained alert and conscious. Lenvatinib was continued until the time of this report (40 days after shunt occlusion), and after 1 month of lenvatinib therapy, the computed tomography verified absence of the portosystemic shunt and stable disease of hepatocellular carcinoma.


Assuntos
Antineoplásicos/efeitos adversos , Carcinoma Hepatocelular/tratamento farmacológico , Encefalopatia Hepática/induzido quimicamente , Neoplasias Hepáticas/tratamento farmacológico , Compostos de Fenilureia/efeitos adversos , Quinolinas/efeitos adversos , Fístula Vascular/terapia , Idoso , Antineoplásicos/uso terapêutico , Embolização Terapêutica/métodos , Encefalopatia Hepática/etiologia , Humanos , Masculino , Veias Mesentéricas/diagnóstico por imagem , Compostos de Fenilureia/uso terapêutico , Quinolinas/uso terapêutico , Testículo/irrigação sanguínea , Tomografia Computadorizada por Raios X , Fístula Vascular/complicações , Fístula Vascular/diagnóstico por imagem
15.
Turk Kardiyol Dern Ars ; 47(1): 60-62, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30628903

RESUMO

Aorto-atrial fistula is a rare anomaly of the heart that may be the result of congenital or acquired conditions, such as bacterial endocarditis, paravalvular abscess, aortic dissection, or a complication of cardiac surgery. A 50-year-old female patient presented at the clinic with the complaint of dyspnea and abdominal distention due to ascites. On admission, her functional capacity was New York Heart Association (NYHA) class III. A physical examination revealed a systolic murmur, which was best audible in the right parasternal side, ascites, and hepatomegaly. An aorto-right atrial fistula was detected using transthoracic echocardiography and confirmed with transesophageal echocardiography and aortography. The patient had a history of previous cardiac surgery, anticoagulant use, and heart failure; therefore, percutaneous intervention was preferred to surgery as a result of the high surgical risk. A successful closure of the fistula was performed with an Amplatzer Duct Occluder II device. The patient demonstrated a dramatic response to the treatment, resulting in a decrease in the ascites and halving of her diuretic dose within 1 week. Her functional capacity improved to NYHA class II, and right atrial pressure decreased to 8 mmHg after a month.


Assuntos
Átrios do Coração , Cardiopatias , Insuficiência Cardíaca/etiologia , Fístula Vascular , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Átrios do Coração/cirurgia , Cardiopatias/complicações , Cardiopatias/diagnóstico por imagem , Cardiopatias/fisiopatologia , Cardiopatias/cirurgia , Humanos , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Fístula Vascular/complicações , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/fisiopatologia , Fístula Vascular/cirurgia
17.
Interact Cardiovasc Thorac Surg ; 28(3): 483-484, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30124870

RESUMO

This study aimed to report the case of a patient diagnosed with pulmonary sequestration accompanied by an intermittent haematemesis as the initial and life-threatening symptom. Emergent surgical intervention finally confirmed a rare direct fistula formation between the arterial blood supply of pulmonary sequestration and the oesophagus, which led to intermittent upper gastrointestinal haemorrhage. To our knowledge, this is the first case reported with this kind of fistula formation.


Assuntos
Sequestro Broncopulmonar/complicações , Fístula Esofágica/complicações , Hematemese/etiologia , Fístula Vascular/complicações , Sequestro Broncopulmonar/diagnóstico , Sequestro Broncopulmonar/cirurgia , Fístula Esofágica/diagnóstico , Fístula Esofágica/cirurgia , Esôfago/diagnóstico por imagem , Esôfago/cirurgia , Hematemese/diagnóstico , Hematemese/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonectomia , Tomografia Computadorizada por Raios X , Fístula Vascular/diagnóstico , Fístula Vascular/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos
18.
Kyobu Geka ; 71(13): 1122-1124, 2018 12.
Artigo em Japonês | MEDLINE | ID: mdl-30587755

RESUMO

We report a case of a ruptured coronary artery aneurysm associated with coronary artery fistula. A 63-year-old man was suffering from cardiac tamponade due to a ruptured coronary artery aneurysm. An emergency operation was performed to repair the aneurysm. Under cardiopulmonary bypass, all inlet and outlet vessels were sutured and closed. The patient recovered uneventfully. A postoperative coronary computed tomography(CT) angiogram showed extinction of the aneurysm.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma Coronário/cirurgia , Doença da Artéria Coronariana/cirurgia , Fístula Vascular/cirurgia , Aneurisma Roto/complicações , Tamponamento Cardíaco/etiologia , Aneurisma Coronário/complicações , Doença da Artéria Coronariana/complicações , Vasos Coronários , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Vascular/complicações
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