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1.
Vasc Endovascular Surg ; 54(2): 165-168, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31707973

RESUMO

BACKGROUND: Pseudoaneurysm developing after repair of a patent ductus arteriosus (PDA) is uncommon, with only a handful of cases reported in the literature. While older literature cites infection, recent series suggest that formation of pseudoaneurysm off of a ligated PDA attributed to breakdown in the suture line. Thoracic endovascular aortic repair (TEVAR) for this rare pathology has been demonstrated in selected case reports. METHODS/RESULTS: A 61-year-old woman presented with enlarging left chest mass and shortness of breath. The patient reported a history of a PDA with 2 attempts at closure. At age 6, she had undergone an attempt at endovascular closure of the PDA; this subsequently resulted in right lower extremity limb ischemia with resultant below-knee amputation. At age 12, she underwent open thoracotomy with ligation of the PDA; at this procedure, she had injury to her recurrent laryngeal nerve, resulting in permanent hoarseness of voice. A computed tomography angiogram of the chest was obtained, which demonstrated a saccular 4.5 × 3.8 cm pseudoaneurysm in the region of the PDA with calcific wall changes. Recommendation was made to proceed with operative repair and she agreed. A TEVAR was performed using a commercially available stent graft. During the procedure, intravascular ultrasound was performed; however, the connection between the PDA pseudoaneurysm and the aorta was not visualized. She had an uncomplicated operative and postoperative course. Follow-up imaging showed complete thrombosis of the pseudoaneurysm. CONCLUSIONS: Pseudoaneurysm from previous PDA repair is a rare pathology. We present a unique case in which the patient had undergone attempts at both endovascular and open surgical repair. Open repair for PDA is still advocated; however, TEVAR appears to be a safe treatment in adults with this pathology following failed open closure.


Assuntos
Falso Aneurisma/cirurgia , Implante de Prótese Vascular , Permeabilidade do Canal Arterial/cirurgia , Procedimentos Endovasculares , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Permeabilidade do Canal Arterial/diagnóstico por imagem , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Ligadura/efeitos adversos , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
2.
World Neurosurg ; 133: 150-154, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31589986

RESUMO

BACKGROUND: Pseudoaneurysm after mechanical thrombectomy (MT) is rare but is one of the potential complications associated with endovascular procedures. There is limited information regarding its mechanism of formation and the potential risk of delayed bleeding. CASE DESCRIPTION: An 84-year-old woman was admitted to our institution with right hemiplegia and global aphasia. Magnetic resonance imaging and angiography revealed occlusion of the M2 segment of the left middle cerebral artery with subtle acute ischemic change in this territory. After initiating intravenous thrombolysis, MT was performed for persistent occlusion of the M2. Successful revascularization was finally achieved with a single pass of a Trevo XP 3 mm × 20 mm stent retriever; significant deviation of the vessel occurred during withdrawal of the stent retriever. Anticoagulation was initiated after confirming resolution of a small amount of postprocedural subarachnoid hemorrhage 1 day after the procedure. However, 4 days after the procedure, computed tomography and angiography revealed a massive sylvian hematoma with de novo formation of a small pseudoaneurysm at the site where the stent retriever was deployed. Open surgery revealed a small artery avulsion at this site. The lesion was closed by microsurgical suturing. CONCLUSIONS: Angiographic and intraoperative findings showed that the mechanism of formation of the pseudoaneurysm was small artery avulsion resulting from deviation of the vessel during withdrawal of the stent retriever. When performing MT in a tortuous distal vessel, the possibility of small artery avulsion should be kept in mind to both prevent and manage critical hemorrhagic complications.


Assuntos
Falso Aneurisma/etiologia , Isquemia Encefálica/terapia , Revascularização Cerebral/efeitos adversos , Trombectomia/efeitos adversos , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Microcirurgia , Procedimentos Neurocirúrgicos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Stents , Resultado do Tratamento
3.
Vasc Endovascular Surg ; 54(1): 80-84, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31533547

RESUMO

Brachial artery pseudoaneurysms (BAPs) are rare but could lead to complications of high morbidity. We report a case of a BAP presenting with hand ischemia and median nerve neuropathy nearly a decade after the inciting iatrogenic trauma, successfully treated with excision and direct repair. This report highlights that untreated pseudoaneurysms can be indolent and present late with both symptoms of embolization and local compression.


Assuntos
Falso Aneurisma/etiologia , Artéria Braquial/lesões , Doença Iatrogênica , Isquemia/etiologia , Flebotomia/efeitos adversos , Extremidade Superior/irrigação sanguínea , Lesões do Sistema Vascular/etiologia , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/fisiopatologia , Falso Aneurisma/cirurgia , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Artéria Braquial/cirurgia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Isquemia/cirurgia , Masculino , Neuropatia Mediana/etiologia , Fluxo Sanguíneo Regional , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/fisiopatologia , Lesões do Sistema Vascular/cirurgia
4.
Rev. cuba. angiol. cir. vasc ; 20(2): e391, jul.-dic. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1003861

RESUMO

Introducción: Los aneurismas arteriales son poco frecuentes en edad pediátrica, sin embargo; se observa un incremento en la incidencia de pseudoaneurismas a partir de traumatismos vasculares, sobre todo, por la aplicación de procederes invasivos. También se observan en procesos infecciosos y tumorales adyacentes, que acaban por lesionar la pared arterial. La mayoría suelen ser asintomáticos, o se presentan como una masa pulsátil que se asientan sobre la zona de la arteria afectada. Objetivo: Demostrar la importancia del diagnóstico temprano de los pseudoaneurismas para el tratamiento quirúrgico oportuno y evitar complicaciones posteriores. Presentación del caso: se discute un caso de una paciente de dos años de edad con un trauma vascular iatrogénico en la extremidad inferior derecha, que se manifestó como una tumoración pulsátil. Se realizó eco-doppler y angiografía, con lo que se diagnosticó un aneurisma de la arteria femoral derecha. Se realizó una exéresis y reconstrucción vascular con buena evolución. Conclusiones: El diagnóstico rápido de estas entidades vasculares evita que se presenten complicaciones posteriores y aseguran una evolución rápida y satisfactoria de los pacientes que las padecen(AU)


Introduction: Arterial aneurysms are rare in the pediatric ages. However, it is observed an increasement of the incidence of pseudoaneurysms caused by vascular traumas, mainly due to the use of invasive procedures. It is also present in infectious and tumour processes that end up injuring the arterial wall. Most of them are asymptomatic or are presented as a pulsatile mass that sets up over the affected artery's zone. Objective: To show the importance of early diagnosis of pseudo-aneurysms. Case presentation: It is presented the case of a two years old patient with a iatrogenic vascular trauma in the right lower limb that manifested in the way of a pulsatile tumor. Through an eco-Doppler and an angiography, an aneurysm of the right femoral artery was diagnosed, which led to an excision and a vascular reconstruction with good evolution. Conclusions: Early diagnosis of these vascular entities allows its timely surgical treatment, avoids the appearance of further complications and assures a prompt and satisfactorily evolution of the patients(AU)


Assuntos
Humanos , Feminino , Pré-Escolar , Falso Aneurisma/cirurgia , Falso Aneurisma/diagnóstico , Artéria Femoral , Angiografia por Tomografia Computadorizada/métodos
5.
Medicine (Baltimore) ; 98(48): e17789, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770196

RESUMO

INTRODUCTION: Riolan arch thickening is usually caused by the occlusion of the superior mesenteric artery (SMA), inferior mesenteric artery, or abdominal aortic artery, by colon cancer, or by ulcerative colitis in the active phase. PATIENT CONCERNS: A 61-years-old female was admitted due to left lower abdominal pain, nausea, and vomiting for more than 4 days. She had received an endovascular covered stent-graft exclusion due to abdominal aortic aneurysm 18 months earlier. Computed tomographic angiography (CTA) showed a local rupture of 1 of the branch artery of the SMA, and a pseudoaneurysm was formed around it. It was feared that performing Riolan atrial arch pseudoaneurysm embolization may cause ischemia of the inferior mesenteric artery (IMA) and could lead to avascular necrosis of the descending colon and sigmoid colon, intestinal perforation, and peritonitis. DIAGNOSIS: Riolan arch collateral circulation associated with pseudoaneurysm hemorrhage after endovascular covered stent-graft treatment of an abdominal aortic aneurysm. INTERVENTIONS: Riolan arterial arch pseudoaneurysm embolization was performed near the distal end. OUTCOMES: The symptoms, signs, and biochemistry returned to normal. CONCLUSION: Riolan arch collateral circulation can be caused by pseudoaneurysm hemorrhage after endovascular covered stent-graft treatment of an abdominal aortic aneurysm.


Assuntos
Falso Aneurisma/etiologia , Aneurisma da Aorta Abdominal/cirurgia , Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/etiologia , Falso Aneurisma/cirurgia , Implante de Prótese Vascular/efeitos adversos , Embolização Terapêutica/métodos , Feminino , Humanos , Artéria Mesentérica Inferior/cirurgia , Artéria Mesentérica Superior/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Hemorragia Pós-Operatória/cirurgia , Stents/efeitos adversos
6.
Medicine (Baltimore) ; 98(29): e16486, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335713

RESUMO

RATIONALE: Esophageal foreign body is a commonly seen in China. However, pseudoaneurysm of the aortic arch caused by ingestion of fish bones is a rare, life-threatening condition. PATIENT CONCERNS: A 71-year-old male was admitted to the Ear, Nose, and Throat department with a 4-day history of chest pain after eating fish. DIAGNOSES: After taking out the fish bone by rigid endoscopy, magnetic resonance imaging and computerized tomography angiography (CTA) scans revealed the presence of an aortic arch pseudoaneurysm, which was likely caused by the fish bone. INTERVENTIONS: A successful endovascular graft exclusion surgery was performed to block the aorta ulcer. OUTCOMES: The patient recovered and was discharged 20 days after hospitalization. The patient was healthy and had no fever or chest pain 4 months after discharge from the hospital. LESSONS: Esophageal foreign bodies may lead to life-threatening impairment of the aorta or other big arteries. When esophageal foreign bodies puncture the esophageal wall, especially in the second stenosis of the esophagus, an enhanced-contrast computed tomography scan or a CTA scan may be necessary to exclude any potential impairment of the arteries.


Assuntos
Falso Aneurisma/etiologia , Aorta Torácica , Doenças da Aorta/etiologia , Esôfago/lesões , Corpos Estranhos/complicações , Alimentos Marinhos/efeitos adversos , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Animais , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Osso e Ossos , Esofagoscopia , Esôfago/diagnóstico por imagem , Esôfago/cirurgia , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X
7.
BMJ Case Rep ; 12(7)2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31350231

RESUMO

The oral anticoagulant warfarin is a vitamin K antagonist and is considered the first line anticoagulant in valvular atrial fibrillation. However prothrombin time should be closely monitored, drug interactions checked and compliance regarding diet ensured when the patient is on warfarin therapy. Anaemia should be looked for, evaluated for the cause and corrected since it is an independent predictor of bleeding and thrombotic episodes during warfarin therapy for atrial fibrillation We present an interesting case of anaemia which developed during warfarin therapy for atrial fibrillation. The patient was on amiodarone and was consuming leafy vegetables resulting in frequent raise in prothrombin time during which time she developed bleeding into the right femoral pseudoaneurysm which had developed following catheterisation for thrombectomy. Surgical correction of pseudoaneurysm was done, comedication was changed and diet compliance ensured which resulted in the subsequent maintenance of prothrombin time in the therapeutic range and steady haemoglobin levels.


Assuntos
Anemia/etiologia , Falso Aneurisma/etiologia , Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Spinacia oleracea/efeitos adversos , Vitamina K/antagonistas & inibidores , Varfarina/efeitos adversos , Falso Aneurisma/fisiopatologia , Falso Aneurisma/cirurgia , Cateterismo Cardíaco , Aconselhamento Diretivo , Feminino , Humanos , Pessoa de Meia-Idade , Tempo de Protrombina , Spinacia oleracea/química , Resultado do Tratamento , Vitamina K/sangue , Vitamina K/uso terapêutico
9.
Medicine (Baltimore) ; 98(28): e16442, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305471

RESUMO

RATIONALE: Visceral arterial pseudoaneurysms are rare but important vascular entities because of their inclination to cause life-threatening hemorrhage. They were commonly reported to be associated with trauma, infection, inflammatory disease, or occurred as postoperative complication. To date, there has been no published report of a superior mesenteric artery (SMA) branch pseudoaneurysm rupture mimicking acute pancreatitis in a patient with acute type B aortic dissection. PATIENT CONCERNS: The patient's medical history, clinical information, imaging findings including follow-up computed tomography angiography (CTA), and treatment are reported. A 51-year-old male presenting with epigastric pain and fever was found to have an enlarged pancreatic head and obscure fatty space around it on abdominal nonenhanced CT. He has medical history of anaphylactoid purpura and uncontrolled hypertension. His serum lipase and amylase were both within normal limits. Thoracoabdominal CTA following a sudden blood pressure drop attributed to the accurate diagnosis. DIAGNOSES: He was diagnosed with acute type B aortic dissection involving SMA and retroperitoneal hemorrhage secondary to SMA branch pseudoaneurysm rupture. INTERVENTIONS: The patient was successfully treated by thoracic endovascular aortic repair without additional branch intervention. OUTCOMES: Follow-up CTA at 3 months later demonstrated that the endoprothesis is well positioned with no endoleaks, and SMA branch pseudoaneurysm disappeared. LESSONS: We report a rare and complicated case presenting with SMA branch pseudoaneurysm rupture and acute type B aortic dissection. CTA is vital in the diagnosis of such vessel pathology. We must inspect carefully to ensure that no small lesions are missed.


Assuntos
Aneurisma Dissecante/diagnóstico , Falso Aneurisma/diagnóstico , Aneurisma Roto/diagnóstico , Aneurisma Aórtico/diagnóstico , Artéria Mesentérica Superior , Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Falso Aneurisma/complicações , Falso Aneurisma/cirurgia , Aneurisma Roto/complicações , Aneurisma Roto/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Pancreatite/diagnóstico
11.
Intern Med ; 58(13): 1901-1905, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31257277

RESUMO

We report a case with the simultaneous occurrence of pseudo-aneurysm of the left ventricle and ventricular septal rupture, which was successfully surgically repaired. A 77-year-old woman with a history of aortic valve replacement and coronary bypass graft presented to our clinic due to chest pain. She was diagnosed with anterior ST-segment elevation myocardial infarction (STEMI) based on an electrocardiogram. Echocardiography revealed pseudo-aneurysm of the left ventricle and ventricular septal rupture. Coronary angiography revealed 99% stenosis with delayed contrast filling in the mid left anterior descending artery. Surgical repair with a bovine pericardium patch was performed, and the postoperative course was uneventful.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/cirurgia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Ruptura do Septo Ventricular/cirurgia , Idoso , Falso Aneurisma/etiologia , Animais , Bovinos , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Feminino , Aneurisma Cardíaco/etiologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Resultado do Tratamento , Ruptura do Septo Ventricular/etiologia
12.
Int Heart J ; 60(4): 998-1002, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257334

RESUMO

Ventricular pseudoaneurysm (PSA) is a rare, yet life-threatening complication of myocardial infarction, cardiac surgery, and transcatheter valve replacement. Although conventional surgery is the preferred treatment strategy, transcatheter closure has emerged as an effective alternative in selected candidates. In this report, we describe successful transcatheter closure of two unique cases of ventricular pseudoaneurysm (PSA): first, a complex post-myocardial infarction left ventricular PSA (LVPSA) with multi-communications, and second, a case of post-traumatic right ventricular PSA (RVPSA) following blunt chest injury caused by domestic violence.


Assuntos
Falso Aneurisma/cirurgia , Cateterismo Cardíaco/métodos , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração , Infarto do Miocárdio/complicações , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Idoso , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Violência Doméstica , Ecocardiografia , Feminino , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/etiologia , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Traumatismos Torácicos/diagnóstico , Ferimentos não Penetrantes/diagnóstico
13.
Ann R Coll Surg Engl ; 101(7): e154-e156, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31155912

RESUMO

Infected pseudoaneurysms are a vascular emergency, necessitating urgent surgical management. Owing to the infected field, a synthetic graft may be inappropriate in patients for whom autografting is impossible. Ligation of the artery is the usual management, often leading to amputation. We report a case of cadaveric allografting of the common femoral artery in a patient with a traumatic, infected pseudoaneurysm, who was taking immunosuppressive therapy for a liver transplant. The patient was followed up with ultrasound at 12 months and was found to have a significant graft stenosis, which was treated successfully with angioplasty. At 18 months, the patient remained well. This case describes the successful implantation of a cadaveric allograft into a patient with an infected pseudoaneurysm, negating the for need primary ligation.


Assuntos
Falso Aneurisma/cirurgia , Veia Femoral/transplante , Flebotomia/efeitos adversos , Infecções Estafilocócicas/cirurgia , Enxerto Vascular/métodos , Adulto , Aloenxertos/transplante , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Falso Aneurisma/microbiologia , Cadáver , Angiografia por Tomografia Computadorizada , Artéria Femoral/cirurgia , Veia Femoral/diagnóstico por imagem , Veia Femoral/lesões , Veia Femoral/microbiologia , Virilha , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento
14.
World Neurosurg ; 129: 130-132, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31154100

RESUMO

BACKGROUND: Indications for reconstruction of the common carotid artery (CCA) include trauma, iatrogenic injury, neoplastic growth (such as invasive neck carcinomas), postoperative infection, and cervical carotid aneurysm. Although various techniques and conduits have been described, the clinical scenario may preclude the use of the most commonly used grafts. We describe a case using a superficial femoral artery (SFA) interposition graft to repair the CCA and review the available literature, highlighting the feasibility of this technique for carotid artery reconstruction. CASE DESCRIPTION: A patient aged 51 years presented with a ruptured mycotic CCA pseudoaneurysm that developed in the setting of a pharyngeal-carotid fistula. Because of the presence of a pharyngeal-carotid fistula and active infection within the vessel wall, endovascular treatment of the pseudoaneurysm was not feasible, and open surgical correction was required to repair the fistulous connection. Furthermore, owing to the extensive soft tissue infection, the use of a synthetic or venous autograft conduit for repair of the artery was contraindicated. Therefore, we harvested a segment of the SFA and used it as an interposition graft to reconstruct the diseased CCA, achieving an excellent anatomic and clinical result. CONCLUSIONS: This case highlights the feasibility of using an SFA interposition graft for short-segment CCA reconstruction, which can provide significant utility in the setting of a hostile operative field due to prior infection or radiation.


Assuntos
Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/cirurgia , Artéria Femoral/transplante , Enxerto Vascular/métodos , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Lesões das Artérias Carótidas/etiologia , Quimiorradioterapia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/complicações , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia
15.
Khirurgiia (Mosk) ; (5): 68-70, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169822

RESUMO

The patient 58-year-old with nodular goiter grade 2 was hospitalized to the surgical clinic. Thyroidectomy was performed. Postoperative period was complicated by hiccups and pulsation in the right half of the neck. According to angiography and CT data, there were a hematoma within thyroid bed and arteriovenous fistula between superior thyroid artery and right facial vein. Surgical repair of the fistula and false aneurysm drainage were carried out. This case report demonstrates a rare complication of thyroidectomy - arteriovenous fistula between superior thyroid artery and facial vein followed by pulsatile false aneurysm.


Assuntos
Falso Aneurisma/cirurgia , Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Externa/cirurgia , Bócio Nodular/cirurgia , Tireoidectomia/efeitos adversos , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Angiografia , Fístula Arteriovenosa/etiologia , Lesões das Artérias Carótidas/diagnóstico , Lesões das Artérias Carótidas/etiologia , Face/irrigação sanguínea , Humanos , Pessoa de Meia-Idade , Glândula Tireoide/irrigação sanguínea , Glândula Tireoide/cirurgia
16.
J Card Surg ; 34(7): 620-623, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31212364

RESUMO

Heart Teams are increasingly confronted with decision-making in anatomically and clinically complex surgical candidates. Herein, we discuss the versatility of the endoaortic occlusion device (Intraclude; Edwards Lifesciences Inc) for the management of a various array of complex primary and reoperative cardiac cases. Three clinical scenarios are illustrated (ascending aortic pseudoaneurysm, mitral valve surgery after previous CABG, extensive thoracic aortic surgery with continuous visceral perfusion), suggesting the effectiveness of the patient-specific strategy to minimize operative morbidity. Evolution of surgical techniques needs to be considered in decision-making among alternative treatment strategies.


Assuntos
Falso Aneurisma/cirurgia , Aorta , Aneurisma Aórtico/cirurgia , Oclusão com Balão/instrumentação , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias/cirurgia , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte de Artéria Coronária , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
17.
Tex Heart Inst J ; 46(2): 143-146, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31236083

RESUMO

A 63-year-old woman was incidentally found to have a thoracic aortic aneurysm. We performed hybrid repair involving aortic arch debranching and endovascular stent-graft placement. Four months later, an asymptomatic pseudoaneurysm had formed at the aortic conduit-brachiocephalic artery anastomosis. To exclude the pseudoaneurysm, we deployed a Covered CP Stent across the anastomosis through a surgically created right axillary artery conduit. We discuss the patient's case and our choice of treatment.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Tronco Braquiocefálico/cirurgia , Materiais Revestidos Biocompatíveis , Procedimentos Endovasculares/métodos , Stents , Falso Aneurisma/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , Aortografia , Tronco Braquiocefálico/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Pessoa de Meia-Idade , Desenho de Prótese
18.
Tex Heart Inst J ; 46(2): 147-150, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31236084

RESUMO

Pseudoaneurysms of the mitral-aortic intervalvular fibrosa are rare complications that can develop after mitral or aortic valve surgery, endocarditis, or Takayasu arteritis. The optimal timing of surgery to avoid potentially life-threatening complications of pseudoaneurysms has not been established, and watchful waiting has been adopted in specific situations. We describe the case of a 50-year-old man in whom a pseudoaneurysm of the mitral-aortic intervalvular fibrosa developed after aortic root replacement with a homograft. After 13 years of watchful waiting, reoperation was deemed necessary because the pseudoaneurysm had grown to 48 mm and the aortic regurgitation caused by the degenerated homograft had become severe. This case highlights the need for increased awareness of mitral-aortic intervalvular fibrosa pseudoaneurysms and their management.


Assuntos
Falso Aneurisma/cirurgia , Aorta Torácica/cirurgia , Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Aneurisma Cardíaco/cirurgia , Valva Mitral/cirurgia , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Aorta Torácica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Imagem Tridimensional , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reoperação , Tomografia Computadorizada por Raios X
20.
World Neurosurg ; 128: 314-319, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31125771

RESUMO

BACKGROUND: Direct extracranial to intracranial (EC-IC) bypass is a valuable treatment option for symptomatic occlusive cerebrovascular disease and complex intracranial aneurysms. Aneurysm formation at or near the anastomotic site is a rarely reported phenomenon, and the pathophysiology and appropriate management of such de novo aneurysms are not clear. CASE DESCRIPTION: Here we present the case of a superficial temporal to middle cerebral artery (STA-MCA) anastomosis that was complicated by aneurysm formation at the anastomotic site. This was treated with microsurgical clipping with preservation of the bypass. Pathologic analysis of the lesion was consistent with a pseudoaneurysm. We provide a literature review of this phenomenon, which is most often associated with low-flow STA-MCA bypasses, including review of the pathologic findings associated with it. CONCLUSION: Pseudoaneurysm formation at the site of an EC-IC bypass is a rare phenomenon that should be recognized and treated to prevent further growth and rupture.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/cirurgia , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/cirurgia , Artéria Cerebral Média/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Artérias Temporais/cirurgia , Adulto , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Revascularização Cerebral/métodos , Feminino , Humanos
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