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1.
BMC Surg ; 20(1): 307, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33261613

RESUMO

BACKGROUND: Hemobilia occurs mainly due to iatrogenic factors such as impairment of the right hepatic or cystic artery, and/or common bile duct in hepatobiliary-pancreatic surgery. However, little or no cases with hemobilia from the intra-pancreatic remnant bile duct after bile duct resection (BDR) has been reported. Here, we report a case of massive hemobilia due to the perforation of psuedoaneurysm of the gastroduodenal artery (GDA) to the intra-pancreatic remnant bile duct after hepatectomy with BDR. CASE PRESENTATION: A 68-year-old male underwent extended right hepatectomy with BDR for gallbladder carcinoma. He presented with upper gastrointestinal bleeding 2 months after the initial surgery. Upper endoscopy identified a blood clot from the ampulla of Vater and simultaneous endoscopic balloon tamponade contributed to temporary hemostasis. Abdominal CT and angiography revealed a perforation of the psuedoaneurysm of the GDA to the intra-pancreatic remnant bile duct resulting in massive hemobilia. Subsequent selective embolization of the pseudoaneurysm with micro-coils could achieve complete hemostasis. He survived without any recurrence of cancer and bleeding. CONCLUSION: Hemobilia could occur in a patient with BDR due to perforation of the pseudoaneurysm derived from the GDA to the intra-pancreatic remnant bile duct. Endoscopic balloon tamponade was useful for a temporal hemostasis and a subsequent radiologic interventional approach.


Assuntos
Falso Aneurisma , Ductos Biliares/cirurgia , Hemobilia , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Hemobilia/etiologia , Hemobilia/cirurgia , Artéria Hepática/patologia , Humanos , Masculino
2.
BMC Surg ; 20(1): 266, 2020 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-33143659

RESUMO

BACKGROUND: The long-term complication rates of open repair and thoracic endovascular aortic repair (TEVAR) have not yet been determined. Therefore, this study aimed to compare the long-term outcomes and aortic reintervention rates between open repair and TEVAR in patients with descending thoracic aortic pathologies. METHODS: Between January 2002 and December 2017, 230 patients with descending thoracic aortic pathologies underwent surgery. Of these, 136 patients were included in this retrospective study: 45 patients (10, 2, and 33 with dissection, penetrating atherosclerotic ulcer, and pseudoaneurysm, respectively) underwent open repair and 91 patients (27, 1, and 63 with dissection, penetrating atherosclerotic ulcer, and pseudoaneurysm, respectively) underwent TEVAR. The primary end points were in-hospital mortality, and short-term complications. The secondary end points were long-term mortality and reintervention rates. Based on the propensity score matching (PSM), 35 patients who underwent open repair were matched to 35 patients who underwent TEVAR (ratio = 1:1). RESULTS: The mean follow-up period was 70.2 ± 51.9 months. Shorter intensive care unit and hospital stay were seen in the TEVAR group than in the open repair group before and after PSM (p < 0.001 and p < 0.001, respectively). However, in-hospital mortality, and spinal cord ischemia were not significantly different among the two groups (before PSM: p = 0.068 and p = 0.211, respectively; after PSM: p = 0.303 and p = 0.314, respectively). The cumulative all-cause death and aorta-related death showed no significant differences between the two groups (before PSM: p = 0.709 and p = 0.734, respectively; after PSM: p = 0.888 and p = 0.731, respectively). However, aortic reintervention rates were higher in the TEVAR group than in the open repair group before and after PSM (p = 0.006 and p = 0.013, respectively). CONCLUSION: The TEVAR group was superior in short-term recovery outcomes but had higher reintervention rates compared to the open repair group. However, there were no significant differences in long-term survival between the two groups.


Assuntos
Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Adulto , Idoso , Aneurisma Dissecante/cirurgia , Falso Aneurisma/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/cirurgia , Aterosclerose/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Implante de Prótese Vascular/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Úlcera/cirurgia
5.
Pan Afr Med J ; 36: 262, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33088391

RESUMO

The clavicle fractures are frequent, vascular injuries associated with closed fractures of clavicle are rare. The pseudoaneurysms of the subclavian artery constitute an exceptional complication. We report a case of a 40-year-old who presented an expanding hematoma of the right side of the neck after a road traffic accident. Radiography of the right shoulder showed a midclavicular fracture. An arterial doppler of vessels showed a circulating hematoma in the contact of the right subclavian artery with a correct distality flow. Computed tomographic angiogram of the chest confirmed the diagnosis of a false aneurysm in the postvertebral portion of the right subclavian artery. The treatment was surgical and consisted of excision of the false aneurysm and a repair of the arterial injury by an arterial patch, the clavicle was fixed with a reconstruction plate and screws. Early intervention appears to be indicated due to the risk of thrombo-embolic complications. Endovascular repair appears to be the preferred treatment modalities, due to a lower rate of cardiopulmonary complications, but it is reserved for much selected cases.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Clavícula/lesões , Fraturas Fechadas/diagnóstico por imagem , Artéria Subclávia/lesões , Adulto , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Placas Ósseas , Parafusos Ósseos , Angiografia por Tomografia Computadorizada , Fraturas Fechadas/cirurgia , Humanos , Masculino , Radiografia , Ferimentos não Penetrantes/complicações
6.
J Oral Maxillofac Surg ; 78(11): 2008.e1-2008.e9, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32771443

RESUMO

A pseudoaneurysm (PA) is a collection of blood caused by an incomplete tear in the vessel wall. PA can be arterial or venous in origin. In the maxillofacial region, arterial PA can result from surgical interventions. Venous PAs in the maxillofacial region have never been described. A standardized protocol for management of post-traumatic PAs in the maxillofacial region would help clinicians make treatment decisions. On the basis of the available literature and our institutional experience, we present an algorithm for management of post-traumatic maxillofacial PAs. We also present patients from our institution who illustrate some of the management options in the algorithm.


Assuntos
Falso Aneurisma , Algoritmos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Humanos
9.
Medicine (Baltimore) ; 99(31): e21523, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756194

RESUMO

RATIONALE: An extremely rare spontaneous pseudoaneurysm (PSA) of the posterior tibial artery (PTA) in a middle-aged male patient was cured by open surgery effectively. PATIENT CONCERNS: A 53-year-old man presented with the increasing swollen left shank for 1 day, with intermittent pain, pulselessness and pallor. He denied the history of trauma, infection, and other diseases. DIAGNOSES: Physical examination, past medical history, ankle brachial index, ultrasonography, computed tomographic angiography (CTA), 3-dimensional reconstruction image of the popliteal artery and its branches and histological examination of intraluminal thrombus and clots helped us diagnose the patient as spontaneous PSA of PTA. INTERVENTIONS: Our patient underwent excision of PSA and repair operation of PSA. OUTCOMES: The patient recovered well at 2-year follow-up. LESSONS: This rare case provides valuable insights for tissue repair and vascular surgery. Therapeutic methods should be in accordance with the best interest of patient. Open surgery is the effective treatment for spontaneous PSA of PTA.


Assuntos
Falso Aneurisma/patologia , Artérias da Tíbia/patologia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Artérias da Tíbia/diagnóstico por imagem , Artérias da Tíbia/cirurgia
10.
Am J Cardiol ; 128: 161-162, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650913

RESUMO

We describe an 84-year-old man who presented with hemoptysis and acute blood loss anemia due to a pulmonary artery pseudoaneurysm (PAP). The etiology of his PAP was thought to be an abandoned epicardial defibrillator patch that was implanted at age 55. To our knowledge, PAP has never been reported as a possible complication of an abandoned epicardial defibrillator patch.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Desfibriladores Implantáveis , Corpos Estranhos/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Idoso de 80 Anos ou mais , Anemia/etiologia , Anemia/terapia , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Angiografia Digital , Transfusão de Sangue , Procedimentos Endovasculares , Corpos Estranhos/complicações , Hemoptise/etiologia , Hemoptise/cirurgia , Humanos , Masculino , Artéria Pulmonar/cirurgia , Tomografia Computadorizada por Raios X
11.
Ann Vasc Surg ; 69: 452.e1-452.e4, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32634556

RESUMO

INTRODUCTION: A narrow distal aorta (NDA) makes endovascular aortic repair (EVAR) challenging and prone to immediate and late complications. We describe a case of an abdominal aortic false aneurysm (AAFA) with an NDA and iliac occlusive disease that was treated by an iliac branch device (IBD) placed at the aortic bifurcation. CASE REPORT: A 76-year-old male patient suffering from severe bilateral calf claudication presented to our clinic. He had a history of ischemic heart disease, diabetes mellitus, and left colectomy for colon cancer. His workup revealed an AAFA with severe iliac occlusive disease. His aortic lumen and his aortic bifurcation were very narrow (10 mm) precluding a classic bifurcated EVAR. An open repair was not possible because of his multiple comorbidities. We successfully used an IBD by placing its Y configuration at the level of the aortic bifurcation, bridging the branch into one iliac artery with a balloon-expandable covered stent and extending the main component proximally up to the renal arteries with an aortic cuff. CONCLUSIONS: Bifurcated EVAR may not be suitable in patients with an NDA. Using an IBD at the level of the aortic bifurcation is feasible. This technique offers a total endovascular solution in high-risk patients for open repair.


Assuntos
Falso Aneurisma/cirurgia , Angioplastia com Balão/instrumentação , Aneurisma da Aorta Abdominal/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Artéria Ilíaca/cirurgia , Stents , Idoso , Falso Aneurisma/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Arteriopatias Oclusivas/diagnóstico por imagem , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino , Desenho de Prótese , Resultado do Tratamento
13.
J Card Surg ; 35(8): 2103-2105, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652642

RESUMO

A 59-year-old man with acute mitral regurgitation due to papillary muscle rupture after myocardial infarction was admitted to our hospital. He underwent emergent mitral valve replacement with a mechanical valve by median sternotomy. Although postoperative echocardiography showed no sign of a ventricular aneurysm, echocardiography performed 5 weeks after the surgery showed enlarging left ventricular pseudoaneurysm of the inferior to the posterior cardiac wall. He underwent dacron patch closure of the orifice by fifth intercostal left thoracotomy. The postoperative course was uneventful and he was discharged on postoperative day 10. The patient was successfully treated for two life-threatening complications occurring subsequently after myocardial infarction.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Cardíaco/cirurgia , Ruptura Cardíaca Pós-Infarto/cirurgia , Implante de Prótese de Valva Cardíaca , Ventrículos do Coração/cirurgia , Valva Mitral/cirurgia , Infarto do Miocárdio/complicações , Músculos Papilares , Complicações Pós-Operatórias , Toracotomia/métodos , Falso Aneurisma/etiologia , Aneurisma Cardíaco/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
14.
J Card Surg ; 35(8): 2070-2072, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652682

RESUMO

OBJECTIVE: Highlight our management of a Pasteurella Multiocida-infected descending thoracic aorta mycotic pseudoaneurysm. METHODS: Report a case of a canine bite resulting in a P. Multiocida descending thoracic aorta mycotic pseudoaneurysm. RESULTS: We present a 61-year-old gentleman who was initially seen in an emergency department after a canine bite. He was admitted and treated with a course of IV antibiotics for P. Multiocida bacteremia and discharged. Three weeks after discharge, he continued to feel generalized malaise and work-up was significant for a descending thoracic aorta mycotic pseudoaneurysm. The patient underwent a low left posterior lateral thoracotomy and femoral-femoral cardiopulmonary bypass for complete pseudoaneurysm resection and aortic replacement with a 24-mm Gelweave graft. Given purulence and gross infection, we planned for a staged approach, with a secondary washout and omental flap for biologic coverage of the graft. The patient did well clinically and was discharged at 14 days to rehabilitation with 6-week intravenous course of antibiotics. CONCLUSIONS: The patient's clinical course with subsequent follow-up suggest that complete resection of the mycotic pseudoaneurysm, followed by omental flap coverage is a viable strategy to manage mycotic aortic infections with virulent organisms.


Assuntos
Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Aneurisma Infectado/etiologia , Aneurisma Infectado/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/cirurgia , Bacteriemia/etiologia , Mordeduras e Picadas/complicações , Infecções por Pasteurella/etiologia , Infecções por Pasteurella/cirurgia , Pasteurella multocida , Animais , Implante de Prótese Vascular/métodos , Ponte Cardiopulmonar , Cães , Humanos , Masculino , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Toracotomia/métodos
15.
Int J Cardiovasc Imaging ; 36(11): 2105-2106, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32686029

RESUMO

A patient with Takayasu arteritis who underwent CABG using a saphenous vein graft (SVG) experienced ventricular fibrillation due to total SVG occlusion. A drug-eluting stent was implanted; however, follow-up CAG demonstrated an advanced expansion of peri-stent contrast staining. Coronary computed tomography angiography revealed contrast media extending around the SVG. An intravascular ultrasound indicated a worsening stent malapposition and a significant positive remodeling.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Coronário/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Stents Farmacológicos , Oclusão de Enxerto Vascular/terapia , Imagem Multimodal , Intervenção Coronária Percutânea/instrumentação , Veia Safena/transplante , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Angiografia por Tomografia Computadorizada , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/etiologia , Angiografia Coronária , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Humanos , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Valor Preditivo dos Testes , Veia Safena/diagnóstico por imagem , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico , Resultado do Tratamento , Ultrassonografia de Intervenção , Remodelação Vascular
16.
Vasc Endovascular Surg ; 54(8): 741-746, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32729388

RESUMO

BACKGROUND: Pseudoaneurysms that develop after surgical repair of a patent ductus arteriosus (PDA) are more likely to rupture, but open surgery including a repeat thoracotomy would be highly invasive. We report 2 cases of thoracic endovascular aortic repair (TEVAR) for such pseudoaneurysms. METHODS/RESULTS: A 59-year-old woman who underwent PDA surgical ligation at 13 years of age presented with sudden hemoptysis. She was diagnosed with a ruptured distorted pseudoaneurysm sized 26 mm; emergency TEVAR was performed. A 23-year-old woman with a history of Down syndrome, endocardial cushion defect, and PDA underwent 2 thoracotomy surgeries including PDA ligation. During a medical checkup, an abnormal shadow was detected on chest radiography. She was diagnosed with a 15-mm pseudoaneurysm after PDA surgical repair; TEVAR was performed. In both cases, the postoperative course was uneventful. CONCLUSIONS: To the best of our knowledge, this is the first report of emergency TEVAR for ruptured pseudoaneurysms after PDA ligation. Thoracic endovascular aortic repair is an important therapeutic option for such cases as it eliminates the need for repeat thoracotomy.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Permeabilidade do Canal Arterial/cirurgia , Procedimentos Endovasculares , Lesões do Sistema Vascular/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , Stents , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Adulto Jovem
17.
Acta Neurochir (Wien) ; 162(11): 2725-2729, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32720013

RESUMO

The clinical manifestations of coronavirus disease 2019 (COVID-19) are non-specific and multi-inflammatory. They vary from mild to severe manifestations that can be life-threatening. The association of SARS-CoV-2 infection and pseudoaneurysm formation or rupture of an already existing aneurysm is still unexplored. Several mechanisms may be involved, including the direct destruction to the artery by the viral infection or through the release of the inflammatory cytokines. We are presenting a case of a 13-year-old girl with a ruptured cerebral pseudoaneurysm of the left middle cerebral artery (M2 segment) with severe intracerebral hemorrhage as the earliest manifestation of COVID-19 infection.


Assuntos
Falso Aneurisma/etiologia , Aneurisma Roto/etiologia , Hemorragia Cerebral/etiologia , Infecções por Coronavirus/complicações , Artéria Cerebral Média , Pneumonia Viral/complicações , Adolescente , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Angiografia Digital , Ascite/etiologia , Betacoronavirus , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Angiografia Cerebral , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Angiografia por Tomografia Computadorizada , Coronavirus , Infecções por Coronavirus/diagnóstico , Craniotomia , Progressão da Doença , Feminino , Hepatomegalia/etiologia , Humanos , Nefropatias/etiologia , Pandemias , Pneumonia Viral/diagnóstico , Infarto do Baço/etiologia , Tomografia Computadorizada por Raios X
18.
Asian Cardiovasc Thorac Ann ; 28(5): 279-281, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32483974

RESUMO

Mycobacterium tuberculosis is a very rare cause of extracranial carotid artery pseudoaneurysm. A 39-year-old man presented with a rapidly increasing neck mass and hoarseness of voice for 15 days. He was on antitubercular treatment for pulmonary tuberculosis. Computed tomography angiography showed a large pseudoaneurysm of the right common carotid artery. Emergency surgery was performed to excise the pseudoaneurysm sac and repair the artery with a Dacron graft. Postoperative angiography showed normal flow in the carotids and cerebral circulation. Histology of the excised tissue was consistent with a tubercular etiology of the pseudoaneurysm.


Assuntos
Falso Aneurisma/microbiologia , Aneurisma Infectado/microbiologia , Doenças das Artérias Carótidas/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/microbiologia , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Antituberculosos/uso terapêutico , Implante de Prótese Vascular , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Humanos , Masculino , Resultado do Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico
20.
World Neurosurg ; 141: 72, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32492541

RESUMO

The natural history of unruptured dissections of the intracranial vertebral artery (VA) is not well delineated. The dissected VA may heal spontaneously or may be associated with ischemic events. The literature on medical management for intracranial VA dissections is also limited. Some patients may develop pseudoaneurysms that can rupture and cause subarachnoid hemorrhage, which is associated with high morbidity and mortality rates. The authors present a challenging case of bilateral VA dissections associated with left VA pseudoaneurysm that was initially managed medically.1-3 Imaging follow-up demonstrated rapid progression with flow-limiting dissection and increase in pseudoaneurysm size. The decision making of the case and procedural nuances are discussed in this video case report (Video 1).


Assuntos
Falso Aneurisma/cirurgia , Procedimentos Endovasculares/métodos , Procedimentos Neurocirúrgicos/métodos , Dissecação da Artéria Vertebral/cirurgia , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/diagnóstico por imagem , Gravação em Vídeo
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