Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.313
Filtrar
1.
Rev Med Suisse ; 16(681): 331-333, 2020 Feb 12.
Artigo em Francês | MEDLINE | ID: mdl-32049457

RESUMO

Pancreatic arteriovenous malformations are rare conditions, mostly asymptomatic and increasingly diagnosed incidentally. Once symptomatic, patients can present with non specific abdominal pain, potentially life-threatening gastrointestinal bleeding, acute pancreatitis or portal hypertension. The aim of this article is to present the pathophysiology underlying this type of vascular malformation, to discuss its diagnostic modalities and the therapeutic options described to date in the literature.


Assuntos
Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/terapia , Pâncreas/patologia , Pâncreas/fisiopatologia , Doença Aguda , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/patologia , Hemorragia Gastrointestinal/complicações , Humanos , Hipertensão Portal/complicações , Pancreatite/complicações
2.
World Neurosurg ; 133: e121-e128, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476469

RESUMO

BACKGROUND: Primary intraventricular hemorrhage (PIVH) is rare, and causes, characteristics, and outcomes remain unknown in children. METHODS: We retrospectively analyzed the clinical characteristics of patients 1 month to 21 years of age who were admitted to the hospital with PIVH over a 7-year period. PIVH was defined as bleeding confined to the ventricular system without parenchymal or subarachnoid hemorrhage involvement. RESULTS: Of 18 included patients, 55.6% were female, and mean age was 13.8 ± 6.0 years. The most common presenting symptoms were headache (77.8%) and vomiting (33.3%). In 15 patients (83.3%), known etiologies were diagnosed, including arteriovenous malformations (66.7%), moyamoya disease (11.1%), and aneurysms (5.6%). Idiopathic PIVH was the diagnosis in 3 patients (16.7%). Surgery was performed in 15 patients (83.3%), and 3 patients (16.7%) received conservative treatment. Four patients (28.6%) had an unfavorable outcome at discharge, and 3 patients (16.7%) had an unfavorable outcome at the 3-month follow-up. Higher Graeb score was associated with an unfavorable outcome in both short-term and long-term follow-up. CONCLUSIONS: Arteriovenous malformations were diagnosed in most pediatric patients with PIVH. Specific surgical treatment of underlying etiologies should be required to increase clinical improvement. Children with a higher Graeb score at admission tended to have poor early and late outcomes.


Assuntos
Hemorragia Cerebral/epidemiologia , Ventrículos Cerebrais/irrigação sanguínea , Adolescente , Malformações Arteriovenosas/complicações , Dano Encefálico Crônico/etiologia , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/cirurgia , Criança , Pré-Escolar , Feminino , Cefaleia/etiologia , Humanos , Lactente , Recém-Nascido , Aneurisma Intracraniano/complicações , Masculino , Doença de Moyamoya/complicações , Estudos Retrospectivos , Resultado do Tratamento , Vômito/etiologia , Adulto Jovem
3.
Vasc Endovascular Surg ; 54(1): 75-79, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31506016

RESUMO

Brachial artery aneurysms and arteriovenous malformations (AVM) are limb-threatening vascular anomalies. This patient presented with a bilobed brachial artery aneurysm in the antecubital fossa proximally to an AVM arising from the dorsal interosseous and ulnar arteries that had been treated with endovascular embolization, leaving the hand solely supplied by the radial artery. The aneurysm continued to increase in size and imaging revealed concomitant thrombus. A femoral vein interposition graft was used to repair the aneurysm, and postoperatively, the patient retained full left arm function.


Assuntos
Aneurisma/cirurgia , Malformações Arteriovenosas/complicações , Artéria Braquial/cirurgia , Veia Femoral/transplante , Artéria Ulnar/anormalidades , Adolescente , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Embolização Terapêutica , Feminino , Humanos , Resultado do Tratamento , Artéria Ulnar/diagnóstico por imagem , Grau de Desobstrução Vascular
5.
BMJ Case Rep ; 12(7)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31296639

RESUMO

We report an unusual case of a dural arteriovenous fistula (dAVF) presenting as acute neck pain and quadripareis in a 55-year-old previously healthy man. Imaging was suspicious for cervicomedullary venous thrombosis and angiography failed to show evidence of arteriovenous malformation or dAVF. The patient was started on warfarin for a presumed cervicomedullary venous thrombosis and there was a significant clinical improvement. However, 3 weeks later, the symptoms recurred and repeat angiography revealed a dAVF fed by a posterior branch of the left middle meningeal artery draining into the posterior fossa vein. We postulated that warfarin caused recanalisation of the previously thrombosed venous pouch allowing for angiographic discovery and treatment of the dAVF. The dAVF was embolised with onyx resulting in the complete obliteration of the dAVF and symptomatic improvement. Although rare, some dAVF can be concealed or disappear on angiography due to thrombosis of the draining vein and warfarin can lead to recanalisation.


Assuntos
Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Angiografia Digital/métodos , Anticoagulantes/uso terapêutico , Malformações Arteriovenosas/terapia , Encéfalo/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/terapia , Dimetil Sulfóxido/uso terapêutico , Embolização Terapêutica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Polivinil/uso terapêutico , Varfarina/uso terapêutico
6.
BMJ Case Rep ; 12(7)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31270088

RESUMO

A 5-month-old girl with single ventricle, interrupted inferior vena cava and polysplenia syndrome palliated with bilateral Blalock-Taussig shunts developed severe cyanosis despite apparently increased pulmonary blood flow. Angiography revealed diffuse pulmonary arteriolar capillary dilatation and early pulmonary venous filling, suggesting the presence of pulmonary arteriovenous malformations. Abdominal angiography at 6 months demonstrated a large extrahepatic portosystemic shunt, which was percutaneously closed with a vascular plug. Kawashima operation was performed 2 weeks after portosystemic shunt closure. Although cyanosis improved temporarily, the patient suffered from deteriorating cyanosis at 9 months of age and underwent Fontan completion. Thereafter, her oxygen saturation gradually improved to 95% over the course of 3 weeks. Both the congenital extrahepatic portosystemic shunt and Kawashima operation contributed to the development of pulmonary arteriovenous malformations.


Assuntos
Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Síndrome de Heterotaxia/complicações , Síndrome de Heterotaxia/diagnóstico por imagem , /diagnóstico por imagem , Malformações Arteriovenosas/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Feminino , Síndrome de Heterotaxia/cirurgia , Humanos , Lactente , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Pulmão/cirurgia
7.
Medicine (Baltimore) ; 98(27): e16162, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277119

RESUMO

RATIONALE: The health vulnerability of certain populations such as children, the elderly and individuals with illnesses or physical disability can become significant in disasters. After the 2011 Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, significant health impacts on vulnerable populations were observed during early or mid-term phase of the disaster, presumably associated with the evacuation. However, there is limited information available on the health impacts owing to long-term evacuation after disaster among them. PATIENT CONCERNS: A 56-year-old physically challenged male with arteriovenous malformation on his right lower limb, diagnosed when he was 2 years' old, lived near the FDNPP. He and his family were forced to evacuate immediately after the accident. DIAGNOSIS: Three months after evacuation following the FDNPP accident, he developed a refractory foot ulcer associated with atrial fibrillation and congestive cardiac failure because of deterioration of arteriovenous malformation, presumably led by repeated evacuations. INTERVENTION: Although anticoagulation therapy and diuretic therapy improved his cardiac failure in the initial admission, he decided to only be treated with supportive care after revelation that his arteriovenous malformation was no longer eligible for aggressive intervention. OUTCOME: Three years after the long-term evacuation in temporary houses, the patient died of bleeding and infection of the ulcer. LESSONS: This case suggests that long-term evacuation for individuals with physical disability may lead to significant health impacts, and even premature death, through the deterioration of daily life activities due to physical and psychological burdens. This case presents a need for further research on ways that disasters impact the health of individuals with physical disabilities, and greater disaster preparation for the needs of populations with physical disabilities.


Assuntos
Malformações Arteriovenosas/complicações , Úlcera do Pé/complicações , Acidente Nuclear de Fukushima , Insuficiência Cardíaca/complicações , Pessoas com Deficiência/psicologia , Evolução Fatal , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Mortalidade Prematura , Populações Vulneráveis
8.
BMJ Case Rep ; 12(6)2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31248896

RESUMO

Atrial septal aneurysms have two mechanisms for cardioembolic events. One is the aneurysm itself can act as a nidus for thrombus formation in the left atrium. The aneurysm creates an area of low turbulence leading to haemostasis allowing fibrin-platelet adhesions to form. If the clot is on the left atrial wall, it may be dislodged by oscillations of the septum and travel into the systemic circulation. The second mechanism is via, an often comorbid, interatrial shunt such as a Patent Foramen Ovale or Atrial Septal Defect. We report a unique case where the associated right to left shunt leading to the cryptogenic stroke is a pulmonary arteriovenous malformation.


Assuntos
Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Evolução Fatal , Feminino , Septos Cardíacos/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Veias Pulmonares/diagnóstico por imagem
11.
BMC Surg ; 19(1): 70, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248400

RESUMO

BACKGROUND: Jejunal diverticula are the rarest of all small bowel diverticula. Most patients with jejunal diverticula are asymptomatic. Major complications include diverticulitis, gastrointestinal hemorrhage, intestinal obstruction and perforation. The hemorrhage has been attributed to diverticulitis with ulceration, diverticulosis associated with trauma and irritation disorder. However, only six cases reported the arteriovenous malformations within jejunal diverticulosis to be the cause of hemorrhage. CASE PRESENTATION: We present a case of arteriovenous malformations within jejunal diverticulosis in a 68-year-old male presented with lower gastrointestinal bleeding. After admission and stabilization, upper and lower endoscopies were performed without demonstrating the bleeding site. They only revealed clotted and red blood throughout the colon. Technetium-labeled red blood cell bleeding scan, endoscopic capsule, and selective angiography were performed to localize the site of bleeding without significant findings. As the clinical status of the patient deteriorated, exploratory laparotomy was performed urgently. Extensive jejunal saccular pouches were found 10 cm distal to duodenojejunal junction extending 1.6 m distally. Segmental resection was performed with side to side primary anastomosis. Microscopic examination of the specimen revealed many diverticula. He was followed up 2 years after that without complications. CONCLUSION: We report yet the seventh case jejunal diverticulosis with the presence of angiodysplasia, in hope of expanding the knowledge of a rare occurrence and increasing the demand for further research about the etiology, clinical impact and treatment of such anomalies coexistence. This case also highlights the importance of considering the diagnosis of AVMs within jejunal diverticulosis in the presence of uncontrollable blood loss in the pre- or intra- operatively diagnosed jejunal diverticulosis and the urgent need for surgical intervention. In addition, the diagnostic tests should be performed close to the bleeding episode.


Assuntos
Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico , Divertículo/complicações , Divertículo/diagnóstico , Doenças do Jejuno/complicações , Doenças do Jejuno/diagnóstico , Idoso , Malformações Arteriovenosas/cirurgia , Divertículo/cirurgia , Hemorragia Gastrointestinal/etiologia , Humanos , Doenças do Jejuno/cirurgia , Laparotomia , Masculino
13.
Urology ; 130: 211-212, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31051167

RESUMO

We describe a rare case of a large renal arteriovenous malformation in a patient with von Willebrand disease. Initial attempts at technically challenging embolization failed requiring a nephrectomy. Extra-intestinal vascular malformations are rare in von Willebrand disease. However, there is more recent evidence of von Willebrand factor's regulatory role in angiogenesis and vascular malformations.


Assuntos
Anormalidades Múltiplas/cirurgia , Malformações Arteriovenosas/complicações , Artéria Renal/anormalidades , Veias Renais/anormalidades , Doenças de von Willebrand/complicações , Malformações Arteriovenosas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Renal/cirurgia , Veias Renais/cirurgia , Doenças de von Willebrand/cirurgia
14.
JAMA ; 321(13): 1295-1303, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30938800

RESUMO

Importance: Although spontaneous intraparenchymal hemorrhage (IPH) accounts for less than 20% of cases of stroke, it continues to be associated with the highest mortality of all forms of stroke and substantial morbidity rates. Observations: Early identification and management of IPH is crucial. Blood pressure control, reversal of associated coagulopathy, care in a dedicated stroke unit, and identification of secondary etiologies are essential to optimizing outcomes. Surgical management of hydrocephalus and space occupying hemorrhage in the posterior fossa are accepted forms of treatment. Modern advances in minimally invasive surgical management of primary, supratentorial IPH are being explored in randomized trials. Hemorrhagic arteriovenous malformations and cavernous malformations are surgically excised if accessible, while hemorrhagic dural arteriovenous fistulas and distal/mycotic aneurysms are often managed with embolization if feasible. Conclusions and Relevance: IPH remains a considerable source of neurological morbidity and mortality. Rapid identification, medical management, and neurosurgical management, when indicated, are essential to facilitate recovery. There is ongoing evaluation of minimally invasive approaches for evacuation of primary IPH and evolution of surgical and endovascular techniques in the management of lesions leading to secondary IPH.


Assuntos
Hemorragia Cerebral/terapia , Procedimentos Cirúrgicos Minimamente Invasivos , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/cirurgia , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/reabilitação , Técnicas Hemostáticas , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Acidente Vascular Cerebral
15.
J Am Coll Cardiol ; 73(14): 1769-1778, 2019 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-30975293

RESUMO

BACKGROUND: Angiotensin II receptor activation may result in angiogenesis, and ultimately arteriovenous malformations (AVM), through transforming growth factor (TGF)-ß and angiopoietin-2 pathway activation. OBJECTIVES: The goal of this study was to determine whether angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) were associated with lower risk of major gastrointestinal bleeds (GIB) and AVM-related GIBs in continuous-flow left ventricular assist device (CF-LVAD) patients. METHODS: The authors reviewed HeartMate II CF-LVAD recipients between January 2009 and July 2016. Major GIBs were endoscopically confirmed requiring ≥2 U of packed red blood cells or resulting in death. ACE inhibitor/ARB dose was abstracted from medical records. ACE inhibitor/ARB exposure status was landmarked at 30 days post-operatively to avoid immortal time bias. Fine and Gray hazard models assessed the impact of ACE inhibitor/ARB therapy on major GIB and AVM-related GIB, whereas standard Cox regression assessed the impact on mortality, adjusting for baseline variables. RESULTS: One-hundred and eleven patients were included with a mean 2.1 ± 1.4 years follow-up. Patients who received an ACE inhibitor/ARB within 30 days post-operatively had a 57% reduction in the risk of major GIB (adjusted hazard ratio [aHR]: 0.43; 95% confidence interval [CI]: 0.19 to 0.97; p = 0.042) and a 63% reduction in the risk of AVM-related GIB (aHR: 0.37; 95% CI: 0.16 to 0.84; p = 0.017). When the mean daily post-operative lisinopril-equivalent ACE inhibitor/ARB dose was >5 mg, the risk of major GIB decreased in a dose-threshold manner (aHR: 0.28; 95% CI: 0.09 to 0.85; p = 0.025). CONCLUSIONS: ACE inhibitor/ARB therapy is associated with a protective effect of developing GIBs in CF-LVAD patients, with a dose threshold of >5 mg of daily lisinopril equivalence, possibly due to prevention of AVM formation.


Assuntos
Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Malformações Arteriovenosas/prevenção & controle , Hemorragia Gastrointestinal , Coração Auxiliar , Antagonistas de Receptores de Angiotensina/farmacocinética , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/farmacocinética , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/metabolismo , Disponibilidade Biológica , Transfusão de Sangue/estatística & dados numéricos , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/prevenção & controle , Hemorragia Gastrointestinal/terapia , Coração Auxiliar/efeitos adversos , Coração Auxiliar/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Receptores de Angiotensina/metabolismo , Estudos Retrospectivos , Risco Ajustado/métodos , Análise de Sobrevida , Estados Unidos/epidemiologia
16.
Actas Dermosifiliogr ; 110(7): 526-532, 2019 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30975431

RESUMO

Osler-Weber-Rendu syndrome, also known as hereditary hemorrhagic telangiectasia, is a rare autosomal dominant disorder with an estimated worldwide prevalence of 1 case per 10,000 population. Its clinical manifestations are the result of arteriovenous malformations characterized by telangiectases that can affect the skin, mucous membranes, and solid organs and cause life-threatening conditions, such as liver disease, systemic emboli, and heart failure. Timely diagnosis is thus essential in order to prevent disease-related complications and offer genetic counseling to families. We review the clinical features of Osler-Weber-Rendu syndrome with a focus on mucocutaneous manifestations and their treatment.


Assuntos
Telangiectasia Hemorrágica Hereditária/complicações , Malformações Arteriovenosas/complicações , Epistaxe/etiologia , Gastroenteropatias/etiologia , Humanos , Malformações Arteriovenosas Intracranianas/etiologia , Hepatopatias/etiologia , Pneumopatias/etiologia , Dermatopatias Vasculares/etiologia , Telangiectasia Hemorrágica Hereditária/diagnóstico , Telangiectasia Hemorrágica Hereditária/genética , Telangiectasia Hemorrágica Hereditária/terapia
17.
BMC Surg ; 19(1): 35, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953554

RESUMO

BACKGROUND: Arteriovenous malformations (AVMs) are rare congenital vascular lesions associated with early quiescence, late expansion, and, ultimately, infiltration and destruction of local soft tissue and bone. The extremities are a common location. Incidence of bony involvement by AVM has been reported as high as 31%. However, there are few reports on management of pathologic fracture associated with AVM. Teriparatide is a recombinant parathyroid hormone (PTH) analogue consisting of the 1-34 fragment of PTH. Recently, some reports have shown the ability of teriparatide to improve fracture healing. Here, we present a case of pathologic femoral shaft fracture associated with large AVMs that was treated successfully by external fixation and teriparatide. CASE PRESENTATION: A 68-year-old Japanese woman, previously diagnosed as having large AVMs, sustained a right femoral shaft fracture due to a fall. At the time of admission, she presented with massive swelling and venous varicosities of the right thigh. Plain radiography of the right thigh revealed femoral shaft fracture with bony erosion and calcification of soft tissue. We planned closed reduction and intramedullary nailing with a unilateral external fixator following embolization of the feeding artery. However, closed reduction using the fracture table was difficult. When we attempted open reduction, massive bleeding (1000 mL) after incision of subcutaneous tissue occurred. Finally, we carefully applied a Taylor Spatial Frame. Fracture displacement was corrected successfully and bony union was obtained with administration of teriparatide 15 months after the initial surgery. The patient is able to walk using 1 cane. CONCLUSION: We present the first report of pathologic fracture associated with large AVMs that achieved bony union using a 3-dimensional external fixator and teriparatide.


Assuntos
Malformações Arteriovenosas/cirurgia , Conservadores da Densidade Óssea/uso terapêutico , Fraturas do Fêmur/terapia , Fixação de Fratura/métodos , Fraturas Espontâneas/terapia , Teriparatida/uso terapêutico , Idoso , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Diáfises/irrigação sanguínea , Diáfises/diagnóstico por imagem , Diáfises/efeitos dos fármacos , Diáfises/cirurgia , Fixadores Externos , Feminino , Artéria Femoral , Fraturas do Fêmur/complicações , Fraturas do Fêmur/diagnóstico por imagem , Fêmur/irrigação sanguínea , Fêmur/diagnóstico por imagem , Fêmur/efeitos dos fármacos , Fêmur/cirurgia , Fixação de Fratura/instrumentação , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Humanos
18.
World Neurosurg ; 127: e1255-e1261, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30986580

RESUMO

BACKGROUND: Advances in acute and long-term poststroke care have resulted in improved survival and functional outcomes for patients who have suffered large vessel ischemic strokes. For years, tissue plasminogen activator was the mainstay of treatment for acute stroke. Its use was previously limited to patients without known comorbid intracranial vascular pathology because of concern for bleeding risk. More recently, however, the use of tissue plasminogen activator in select patients with vascular anomalies has increased and is now largely thought to be safe. With the safety and efficacy of mechanical thrombectomy now proven for large vessel occlusions (LVOs), similar investigation is needed to assess procedural safety in patients with concomitant arteriovenous (AV) malformations or fistulae. METHODS: We reviewed patients treated for LVOs at our institution and those of our collaborators and identified 6 patients who were treated for LVO with either known or incidentally identified concomitant AV malformations or dural AV fistulae. RESULTS: We present a case series of 6 patients with nonaneurysmal intracranial vascular lesions who underwent mechanical thrombectomy for LVO without complications related to these lesions. CONCLUSIONS: Although limited by small size, our series adds to the literature evidence that mechanical thrombectomy for LVO can safely be performed with concomitant dural AV fistulae and AV malformations.


Assuntos
Fístula Arteriovenosa/cirurgia , Malformações Arteriovenosas/cirurgia , Isquemia Encefálica/cirurgia , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fístula Arteriovenosa/complicações , Malformações Arteriovenosas/complicações , Isquemia Encefálica/complicações , Feminino , Humanos , Masculino , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
20.
Am J Case Rep ; 20: 314-317, 2019 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-30852581

RESUMO

BACKGROUND Congenital renal vascular anomalies have been classified into 3 categories: cirsoid, angiomatous, and aneurysmal. These classifications are based on the size, location, and number of vessels involved. Aneurysmal malformations, such as the one reported here, have a single (and dilated) feeding and draining vessel. The prevalence of renal AVMs is estimated at less than 0.04%, making them rare causes of secondary hypertension. CASE REPORT A 29-year-old white woman was seen in the hypertension clinic as a referral from high-risk obstetric clinic for management of hypertension (HTN). A secondary hypertension workup with Doppler waveforms of the renal arteries revealed prominent diastolic flow in the left compared to the right. For confirmation, an MRA was done, which showed a large left renal upper-pole arteriovenous malformation (AVM) with associated vascular shunting and early opacification of the left renal vein. This congenital AVM was identified as the cause of her hypertension. Angiography and coil embolization were performed. The patient's BP normalized within a few days and she was taken off her antihypertensive medications. CONCLUSIONS This case illustrates that a careful review of duplex waveforms beyond just peak velocity and ratios is important to identify uncommon pathologies. This is important, as renal AVMs respond well to embolization, with resolution of hypertension in 59% of patients treated.


Assuntos
Malformações Arteriovenosas/complicações , Hipertensão Renovascular/etiologia , Hipertensão Renovascular/terapia , Artéria Renal/anormalidades , Veias Renais/anormalidades , Adulto , Feminino , Humanos , Hipertensão Renovascular/diagnóstico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA