Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 265
Filtrar
1.
Tech Vasc Interv Radiol ; 22(4): 100635, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31864534

RESUMO

Vascular malformations are generally congenital benign lesions that have multiple variations in treatment algorithms. Surgery can be used as a single modality or as an adjunct in multimodal therapy to treat these lesions. Here we discuss surgical treatment of the major vascular malformations, including lymphatic, venous, and arteriovenous malformations. We explain some of the basic principles to resection of simple and complex lesions and adjunctive therapies. These adjunct therapies include chemotherapeutic injections, embolization, and laser therapy. Surgical resection of complex lesions should only be performed by an experienced vascular anomalies surgeon. A team approach is generally necessary to provide safe and effective treatment. While surgery for these complex lesions is an option, the most important principle to adhere to when treating any of these lesions is that the treatment should be no worse than the disease.


Assuntos
Anormalidades Linfáticas/cirurgia , Malformações Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares , Tomada de Decisão Clínica , Humanos , Anormalidades Linfáticas/diagnóstico por imagem , Anormalidades Linfáticas/fisiopatologia , Seleção de Pacientes , Fatores de Risco , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos
2.
Tech Vasc Interv Radiol ; 22(4): 100630, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31864535

RESUMO

Venous malformations are very commonly encountered in interventional radiologic practice. Indications for therapy are clearly defined based on the lesion's impact on patient's quality of life. Screening laboratory coagulation studies in patients with historical or lesion morphologic risk factors often reveal abnormal coagulation parameters consistent with localized intravascular coagulation or more severe coagulopathic states. These may require chronic or periprocedural medical management to avoid potentially life-threatening disseminated intravascular coagulation or other thromboembolic phenomena. Once a multidisciplinary decision to treat a venous malformation is made, one must decide between percutaneous and/or surgical techniques. Sclerotherapy with adjunctive stasis of efflux (STASE) techniques have become the mainstay of therapy for most venous malformations as they are well-tolerated and effective. STASE techniques work primarily by (i) the administration of sclerosant(s) exerting an inhibitory and/or endotheliocidal effect on venous malformation endothelium leading to thrombosis, involution, and fibrosis, and secondarily via adjunctive outflow occlusion using any combination of local compression, balloons, gelatin, coils, laser, radiofrequency, or adhesives to improve sclerosant penetration and dwell-time in the lesion. Adhesives alone can fill the lesion to facilitate surgical resection in some cases. Common sclerosants in modern practice include sodium tetradecyl sulfate, bleomycin, polidocanol, ethanol, and hypertonic saline. Most agents can be given directly in unmodified or "neat" form or can be mixed with a gas to form a sclerofoam or embolic such as gelatin to form a sclerogel. Choice and method of sclerosant delivery in each patient is based on the intraluminal lesion volume, architecture, vital structure proximity, agent toxicity, viscosity, and level of experience of the interventional radiologist with that particular agent. Multi-session STASE therapy usually reduces symptoms of chronic pain or mass with low risk of known complications of skin or nerve impairment, compartment syndrome, hemoglobinuria, deep venous thrombosis, or pulmonary phenomena.


Assuntos
Procedimentos Endovasculares , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Malformações Vasculares/terapia , Veias/anormalidades , Tomada de Decisão Clínica , Terapia Combinada , Procedimentos Endovasculares/efeitos adversos , Humanos , Seleção de Pacientes , Fatores de Risco , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia , Veias/diagnóstico por imagem , Veias/fisiopatologia
3.
J Med Vasc ; 44(5): 354-358, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474348

RESUMO

Bilateral absence of the superior vena cava (SVC) is an uncommon congenital vascular anomaly, mainly asymptomatic, usually undetected, and often associated with other cardiac anomalies. Though usually harmless and totally innocent, this vascular anomaly might complicate cardiovascular surgery, the insertion of a central venous catheter and the transvenous placement of a pacemaker. This SVC anomaly is still not well known, underdiagnosed and its incidence is much higher than described. A better understanding of this anomaly and its detection could play a key role in avoiding its potential complications. We are sharing a case of a female adult, with no medical history, who presented herself to the department of visceral surgery with a collateral venous circulation of the upper thorax, that was at first, mistaken for a portal hypertension syndrome, findings were pushed to finally conclude a bilateral absence of the SVC.


Assuntos
Malformações Vasculares , Veia Cava Superior/anormalidades , Adulto , Circulação Colateral , Angiografia por Tomografia Computadorizada , Erros de Diagnóstico , Feminino , Humanos , Flebografia/métodos , Valor Preditivo dos Testes , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/fisiopatologia
4.
Medicine (Baltimore) ; 98(33): e16802, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415390

RESUMO

Impact of arterial stiffness on aortic morphology has not been well evaluated. We sought to investigate the association of brachial-ankle pulse wave velocity (baPWV) with aortic calcification and tortuosity.A total of 181 patients (65.4 ±â€Š10.4 years, males 59.7%) who underwent computed tomographic angiography and baPWV measurement within 1 month of study entry were retrospectively reviewed. Aortic calcification was quantified by the calcium scoring software system. Aortic tortuosity was defined as the length of the midline in the aorta divided by the length of linear line from the aortic root to the distal end of the thoraco-abdominal aorta. In simple correlation analyses, baPWV was correlated with aortic calcification (r = 0.36, P < .001) and tortuosity (r = 0.16, P = .030). However, these significances disappeared after controlling for confounders in multivariate analyses. Factors showing an independent association with aortic calcification were age (ß = 0.37, P < .001), hypertension (ß = 0.19, P = .003), diabetes mellitus (ß = 0.12, P = .045), smoking (ß = 0.17, P = .016), and estimated glomerular filtration rate (ß = -0.25, P = .002). Factors showing an independent association with aortic tortuosity were age (ß = 0.34, P < .001), body mass index (ß = -0.19, P = .018), and diabetes mellitus (ß = -0.21, P = .003).In conclusion, baPWV reflecting arterial stiffness was not associated with aortic calcification and tortuosity. Traditional cardiovascular risk factors were more influential to aortic geometry. Further studies with a larger sample size are needed to confirm our results.


Assuntos
Aorta/patologia , Artérias/anormalidades , Instabilidade Articular/fisiopatologia , Dermatopatias Genéticas/fisiopatologia , Calcificação Vascular/fisiopatologia , Malformações Vasculares/fisiopatologia , Rigidez Vascular/fisiologia , Idoso , Índice Tornozelo-Braço , Aorta/fisiopatologia , Artérias/patologia , Artérias/fisiopatologia , Índice de Massa Corporal , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Instabilidade Articular/patologia , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Estudos Retrospectivos , Dermatopatias Genéticas/patologia , Calcificação Vascular/patologia , Malformações Vasculares/patologia
5.
World J Pediatr Congenit Heart Surg ; 10(4): 464-468, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307306

RESUMO

OBJECTIVES: To review the outcomes of direct innominate artery cannulation for continuous cerebral perfusion used for repair of interrupted aortic arch (IAA) in a consecutive cohort of neonates regardless of weight. METHODS: Between September 1999 and April 2016, forty-four children with IAA (18 type A and 26 type B) underwent repair using continuous, hypothermic (18°C) low-flow cerebral perfusion via direct innominate artery cannulation. Associated cardiac lesions were truncus arteriosus (TA; 5), ventricular septal defect (VSD; 30), transposition of the great arteries (TGA; 1), unbalanced atrioventricular septal defect (1), double-inlet left ventricle (1), double-outlet right ventricle (3), and aortopulmonary window (APW; 5). Truncus arteriosus, single VSD, TGA, and APW were corrected while the other patients were palliated. RESULTS: Age at the time of surgery was 7 days (4-120 days) and weight 3.1 kg (2.1-5.8 kg). Selective cerebral perfusion was maintained in all patients. During the selective cerebral perfusion, perfusion flow rate was maintained at 30 mL/kg/min. Aortic cross-clamp time, low-flow, and total cardiopulmonary bypass time were 63 (40-116), 28 (17-41), and 108 (80-217) minutes, respectively. There were no deaths nor clinical evidence of neurological injury. Postoperative ventilation time, length of intensive care unit, and hospital stay were 3 (2-14), 5 (3-21), and 13 (6-27) days, respectively. Follow-up, complete at 84 months (24-221), revealed no late clinically evident neurologic sequelae nor innominate artery complications. CONCLUSIONS: Direct innominate arterial cannulation with continuous selective cerebral perfusion can be safely applied for repair of IAA even in low birth weight neonates. It is technically simple and associated with excellent clinical outcomes.


Assuntos
Aorta Torácica/anormalidades , Cateterismo/métodos , Circulação Cerebrovascular/fisiologia , Recém-Nascido de Baixo Peso , Perfusão/métodos , Malformações Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Angiografia , Aorta Torácica/cirurgia , Feminino , Humanos , Recém-Nascido , Masculino , Resultado do Tratamento , Malformações Vasculares/fisiopatologia
6.
Optom Vis Sci ; 96(7): 531-535, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31274742

RESUMO

SIGNIFICANCE: Perifoveal exudative vascular anomalous complex (PEVAC) is a recently described macular entity, which can be confused with other well-known vascular lesions such as retinal angiomatous proliferation. Perifoveal exudative vascular anomalous complex is more common than previously believed and is usually unresponsive to anti-vascular endothelial growth factor treatment. Clinicians should be aware of this disorder. PURPOSE: The purpose of this study was to report a case of PEVAC using multimodal imaging in a Chinese patient with diabetes mellitus but without diabetic retinopathy, followed by a brief review of the relevant literature. CASE REPORT: A 53-year-old Chinese woman with a 7-year history of diabetes mellitus presented with complaints of a 1-month history of deterioration of visual acuity in her right eye. Complete ophthalmic examination, including fundus examination of the right eye, revealed an isolated lesion immediately temporal to the fovea, accompanied by small hemorrhages and small, hard intraretinal exudates. Fluorescein fundus angiography revealed a well-defined hyperfluorescent lesion in the early phase but with leakage in the late phase. Optical coherence tomography revealed an oval lesion with a hyperreflective wall and relatively dark lumen, intraretinal cystic spaces, and hard exudates. Two intravitreal injections of aflibercept resulted in reduced blood flow in the PEVAC lesion, but with more hemorrhaging and hard exudates and no improvement in visual acuity. CONCLUSIONS: Perifoveal exudative vascular anomalous complex is an isolated, perifoveal, aneurysmal abnormality. It can occur in healthy patients, in addition to those with diabetes mellitus without retinopathy. In contrast to similar macular vascular anomalies, PEVAC does not typically respond to anti-vascular endothelial growth factor therapy.


Assuntos
Diabetes Mellitus/diagnóstico , Doenças Retinianas/diagnóstico , Vasos Retinianos/anormalidades , Malformações Vasculares/diagnóstico , Inibidores da Angiogênese/uso terapêutico , Grupo com Ancestrais do Continente Asiático , Exsudatos e Transudatos , Feminino , Angiofluoresceinografia/métodos , Fóvea Central , Humanos , Injeções Intravítreas , Pessoa de Meia-Idade , Imagem Multimodal , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Doenças Retinianas/tratamento farmacológico , Doenças Retinianas/fisiopatologia , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Malformações Vasculares/tratamento farmacológico , Malformações Vasculares/fisiopatologia , Acuidade Visual/fisiologia
8.
Semin Ophthalmol ; 34(5): 353-358, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31165650

RESUMO

Purpose: To investigate the clinical characteristics of perifoveal exudative vascular anomalous complex (PEVAC) in Korean patients. Methods: This retrospective study included 8 eyes (8 patients) diagnosed with PEVAC. Demographic characteristics of the patients, fundus photography, optical coherence tomography (OCT), fluorescein angiography, and indocyanine-green angiography (ICGA) findings were analyzed. Available follow-up data were also reviewed. Results: The mean ± standard deviation age was 61.0 ± 11.0 years and mean logarithm of minimal angle of resolution (logMAR) best-corrected visual acuity was 0.15 ± 0.14. PEVAC was noted in 2 eyes with coincident age-related macular degeneration (AMD) and in the fellow eye of 1 eye with unilateral type 3 neovascularization. On fundus photography, PEVAC presented as a perifoveal isolated aneurysm associated with retinal exudation and hemorrhage. Well-defined hyperfluorescent lesions with leakage were noted on fluorescein angiography, but no leakage was observed on ICGA. Anti-vascular endothelial growth factor (VEGF) therapy was performed for 2 patients. However, there was no notable improvement after treatment. Conclusions: The clinical characteristics of PEVAC in Korean patients were similar to those reported in patients of other ethnicities. Further studies are needed to better understand the nature of this newly described clinical entity.


Assuntos
Fóvea Central/patologia , Doenças Retinianas , Vasos Retinianos/anormalidades , Malformações Vasculares , Adulto , Idoso , Exsudatos e Transudatos , Feminino , Humanos , Coreia (Geográfico) , Masculino , Pessoa de Meia-Idade , Doenças Retinianas/patologia , Doenças Retinianas/fisiopatologia , Neovascularização Retiniana/patologia , Neovascularização Retiniana/fisiopatologia , Estudos Retrospectivos , Malformações Vasculares/patologia , Malformações Vasculares/fisiopatologia , Acuidade Visual
9.
Cardiol Young ; 29(6): 835-836, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31198122

RESUMO

Aneurysms of the pulmonary arteries and trunk are rare entities. The Waterston shunt is a palliative procedure for children with cyanotic CHD due to obstruction of the pulmonary outflow. Described complications are distortion of the pulmonary artery and pulmonary arterial hypertension. We report a patient with a giant right pulmonary artery aneurysm in relation to a Waterston shunt.


Assuntos
Aneurisma/diagnóstico , Artéria Pulmonar , Circulação Pulmonar/fisiologia , Malformações Vasculares/diagnóstico , Adulto , Aneurisma/complicações , Aneurisma/fisiopatologia , Angiografia , Humanos , Masculino , Pressão Propulsora Pulmonar/fisiologia , Malformações Vasculares/complicações , Malformações Vasculares/fisiopatologia
10.
Ann Vasc Surg ; 60: 477.e11-477.e13, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200064

RESUMO

Congenital aortic arch anomalies are rare and may be associated with other congenital cardiovascular malformations. The authors report a rare case of anomaly in the aortic arch embryogenesis, presenting with a right aortic arch and an isolated innominate artery, associated with the subclavian steal phenomenon. This condition is discussed considering the Edwards hypothetical double embryonic arch and its clinical aspects.


Assuntos
Aorta Torácica/anormalidades , Tronco Braquiocefálico/anormalidades , Síndrome do Roubo Subclávio/etiologia , Malformações Vasculares/complicações , Adolescente , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/fisiopatologia , Feminino , Humanos , Síndrome do Roubo Subclávio/diagnóstico por imagem , Síndrome do Roubo Subclávio/fisiopatologia , Síndrome do Roubo Subclávio/terapia , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia , Malformações Vasculares/terapia
12.
Cir Pediatr ; 32(1): 28-33, 2019 Jan 21.
Artigo em Espanhol | MEDLINE | ID: mdl-30714698

RESUMO

AIM OF THE STUDY: mTOR inhibitors are being used to treat complex vascular anomalies (VA) without response to conventional treatments. We report our results in pediatric patients treated with sirolimus. METHODS: Retrospective review of patients treated with sirolimus between 2014 and 2017, analyzing vascular anomaly type, treatment response and complications. Treatment protocol included patients with complex vascular anomalies, after signing the informed consent. The initial dose was 0.8 mg/m2/12 h, verifying plasmatic levels. Favorable response was defined both in clinical and radiological terms. MAIN RESULTS: Sirolimus was employed in nine patients, median age 14 months old (1 month-14 years), 66% girls. Five complex micro-cystic lymphatic malformations (LM), one multifocal lynphangioendotheliomatosis with thrombocytopenia, one kaposiform lymphangiomatosis, one lymphatic-venous malformation and one kaposiform hemangioendothelioma (KHE) were treated. Median treatment was 4 months (IQR 2-18 months). Resolution or improvement was objectified in four patients (44%). KHE patient presented complete resolution after two months of treatment. Two patients with micro-cystic LM and the one with lymphatic-venous malformation improved after a median treatment of three months. Two patients presented rebound effect after discontinuing treatment. Three patients had hypertransaminasemia and hypercholesterolemia without requiring medical treatment. CONCLUSION: Sirolimus presented mild effects for treatment of complex VA in our study, but was highly resolutive at KHE.


Assuntos
Sirolimo/uso terapêutico , Serina-Treonina Quinases TOR/antagonistas & inibidores , Malformações Vasculares/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Sirolimo/farmacologia , Resultado do Tratamento , Malformações Vasculares/fisiopatologia
13.
Biomech Model Mechanobiol ; 18(4): 883-896, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30652210

RESUMO

The superficial femoral artery (SFA) is a typical atherosclerosis-prone site. We aimed to explore whether the tortuosity of the SFA associates with the occurrence of atherosclerosis and investigate how vascular tortuosity influences the characteristics of blood flow. Ten patients diagnosed with atherosclerotic disease in their SFAs while free of systemic atherosclerosis risk factors were enrolled together with ten atherosclerosis-free patients. The tortuosity of each SFA was quantitatively evaluated by calculating the averaged curvature (AC), maximum curvature (MC) and fraction of high curvature (FC) based on the geometrical model reconstructed from medical images. Hemodynamic studies were performed using both geometrically simplified and anatomically realistic models of the SFA to systematically address the hemodynamic effects of vascular tortuosity. Morphological analyses revealed that all curvature indices of the SFA were significantly larger in patients with atherosclerosis than in atherosclerosis-free patients (AC [mm-1]: 0.034 ± 0.016 vs. 0.018 ± 0.006; MC [mm-1]: 0.055 ± 0.023 vs. 0.034 ± 0.008; FC [%]: 22.77 ± 10.22 vs. 11.39 ± 6.82; p < 0.001). Simulations of blood flows in the geometrically simplified SFAs showed that increasing vascular curvature caused a progressive increase in the area ratios of low wall shear stress (LWSA) and high oscillatory shear index (HOSA). Hemodynamic studies on the anatomically realistic SFAs further demonstrated that high-curvature SFAs (n = 10) had overall larger LWSA and HOSA compared with low-curvature SFAs (n = 10) (LWSA [%]: 4.13 ± 1.91 vs. 1.79 ± 1.13, p = 0.009; HOSA [%]: 4.95 ± 1.92 vs. 2.37 ± 1.51, p = 0.007). These results suggest that increased vascular tortuosity augments the severity and distribution of atherosclerosis-promoting flow disturbances in the SFA and may be an independent risk factor for atherosclerosis.


Assuntos
Artérias/anormalidades , Aterosclerose/fisiopatologia , Circulação Sanguínea/fisiologia , Artéria Femoral/fisiopatologia , Instabilidade Articular/fisiopatologia , Dermatopatias Genéticas/fisiopatologia , Malformações Vasculares/fisiopatologia , Adulto , Idoso , Artérias/fisiopatologia , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Cardiovasculares , Fatores de Risco
15.
Ann Vasc Surg ; 56: 351.e17-351.e20, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30342989

RESUMO

A persistent sciatic artery (PSA) is a rare congenital vascular anomaly that occurs in approximately 0.01 to 0.06% of the population. We encountered a patient with aneurysms in the common iliac-internal iliac artery continuous to an occluded right PSA. The patient was an 85-year-old male in whom intermittent claudication of the right lower limb appeared 3 months ago. The right ankle-brachial index (ABI) was 0.48. On contrast computed tomography, the right PSA was present and was occluded over the popliteal artery. The right superficial femoral artery was hypoplastic. Moreover, abdominal aortic (diameter: 42 mm) and right common-internal iliac (diameter: 46 mm) aneurysms continuous to the PSA were present. For the surgical procedure, endovascular aneurysm repair was selected. First, the right internal iliac artery was embolized, an aortouni-iliac stent graft was placed from the infrarenal aorta down to the left common iliac artery, and left common femoral-right deep femoral artery bypass was performed to achieve revascularization of the right lower limb. Postoperatively, the aneurysms were favorably excluded with stent grafts without endoleak. The right ABI markedly improved to 0.83, and claudication was resolved. There are few reports of iliac aneurysm with a concomitant PSA.


Assuntos
Artérias/anormalidades , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco/cirurgia , Extremidade Inferior/irrigação sanguínea , Malformações Vasculares/complicações , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Artérias/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Humanos , Aneurisma Ilíaco/complicações , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/fisiopatologia , Claudicação Intermitente/etiologia , Claudicação Intermitente/fisiopatologia , Isquemia/etiologia , Isquemia/fisiopatologia , Masculino , Stents , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia
16.
Cardiovasc Intervent Radiol ; 42(2): 213-219, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30374612

RESUMO

PURPOSE: To evaluate radiofrequency ablation (RFA) for closure of marginal veins in pediatric and adult patients with venous malformations. MATERIALS AND METHODS: Medical records, imaging and procedure details were retrospectively reviewed in patients who underwent RFA of the marginal vein in a 17-month period. Additional sclerotherapy (n = 19) and coil embolization of the marginal vein were performed (n = 2). RESULTS: A total of 23 marginal veins were treated in 20 patients. Mean age at treatment was 16 years ± 9.4 (1-37 years). Pre-procedural magnetic resonance imaging revealed thoracoabdominal marginal veins in 3 patients. A type I marginal vein (draining in the great saphenous vein below the popliteal vein) was identified in 1 and type IIa/IIb (draining in a median/lateral accessory saphenous vein) in 2/8 cases. Type III (draining into the profunda femoral vein) was detected in 8, and type IV (draining into gluteal veins) in 1. Mean diameter of the marginal veins was 13.2 mm ± 4 (7-20 mm). Patency was found in 1 during follow-up (22 months ± 9.8). Complete or partial occlusion was achieved in 94.5% of the veins. One patient showed signs of thrombophlebitis after the procedure, and another incomplete paresis of the peroneal nerve. CONCLUSION: RFA is effective as minimally invasive treatment of the marginal venous system. These veins should be treated early in life. Marginal veins with large diameter, residual tributaries and the intrafascial courses usually require adjunct coil embolization and sclerotherapy. LEVEL OF EVIDENCE: Case series, Level IV.


Assuntos
Ablação por Radiofrequência/métodos , Malformações Vasculares/terapia , Insuficiência Venosa/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Veia Femoral/fisiopatologia , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Veia Safena/fisiopatologia , Resultado do Tratamento , Malformações Vasculares/complicações , Malformações Vasculares/fisiopatologia , Grau de Desobstrução Vascular/fisiologia , Insuficiência Venosa/fisiopatologia , Adulto Jovem
17.
J Clin Res Pediatr Endocrinol ; 11(2): 207-210, 2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-30325337

RESUMO

Prostaglandin I2 (PGI2) causes hyperthyroidism, a critical complication in patients with pulmonary arterial hypertension (PAH). However, it remains unknown whether PGI2 may have unfavorable effects on thyroid function in children with congenital portosystemic venous shunt syndrome (CPSVS). We present a boy with CPSVS who developed PAH at seven years of age. During ongoing PGI2 therapy, he experienced thyrotoxicosis at 17 years of age. The literature review showed that the reported 12 patients with PAH (median 11 years of age) developed hyperthyroidism during between one and 11 years of PGI2 treatment. Only one patient survived the acute PAH crisis due to hyperthyroidism. These data provide evidence that prophylactic intervention for hyperthyroidism is indicated for children with CPSVS during PGI2 treatment.


Assuntos
Anti-Hipertensivos/efeitos adversos , Epoprostenol/efeitos adversos , Hipertensão Pulmonar/tratamento farmacológico , Tireotoxicose/induzido quimicamente , Tireotoxicose/patologia , Malformações Vasculares/fisiopatologia , Humanos , Hipertensão Pulmonar/patologia , Recém-Nascido , Masculino , Prognóstico
18.
Heart Vessels ; 34(4): 650-657, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30315495

RESUMO

A persistent left superior vena cava (PLSVC) is a congenital venous abnormality and is usually asymptomatic and does not cause hemodynamic disturbances. Therefore, it is difficult to identify it by routine examinations in clinical practice. This study aimed to elucidate the electrocardiographic characteristics for the prediction of a PLSVC. Twelve patients (9 males, 56.2 ± 18.3 years) who were diagnosed with a PLSVC were enrolled. The electrocardiographic parameters, including the P-wave duration, axis, and morphology of the P waves, were automatically measured and compared to 150 controls (77 males, 57.3 ± 14.6 years). There were no significant differences in the P-wave duration. Negative or positive/negative P waves in lead III predicted a PLSVC with a sensitivity of 100% and specificity of 81%. The P-wave axis in PLSVC exhibited a significant leftward deviation as compared to the controls (14.8 ± 21.1 vs. 54.0 ± 17.4°, p < 0.001). A receiver operating characteristic curve analysis of the P-wave axis for predicting a PLSVC exhibited an area under curve of 0.93 [CI 95% (0.87-0.98), p < 0.001), and identified a P-wave axis of less than 37.5° to have a 92% sensitivity and 83% specificity in predicting a PLSVC. A negative or positive/negative P-wave morphology in lead III was a useful finding for suggesting the presence of a PLSVC.


Assuntos
Eletrocardiografia , Malformações Vasculares/fisiopatologia , Veia Cava Superior/anormalidades , Pressão Venosa Central , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Malformações Vasculares/diagnóstico , Veia Cava Superior/diagnóstico por imagem
19.
Radiologia ; 61(1): 4-15, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30292467

RESUMO

Vascular malformations and tumors, also known as "vascular anomalies", comprise an extensive variety of lesions involving all parts of the body. Knowledge of their classification and imaging characteristics is paramount. Whereas hemangiomas are benign vascular tumors, characterized by cellular proliferation and hyperplasia; vascular malformations are not real tumors and characteristically exhibit normal endothelial turnover. Vascular malformations are classified according to the predominant vascular channel as arterial, capillary, venous, lymphatic, or mixed. Ultrasound and MRI are the main imaging modalities used in the diagnosis and classification of the vascular anomalies. In this series of two articles we review the classification of vascular anomalies, describe the role of imaging, summarize their distinctive histopathogenic, clinical and imaging features, and discuss the treatment options. On the first article we discuss the high-flow lesions, whereas the slow-flow lesions will be reviewed on the second. Complex syndromes with associated vascular tumors and malformations will be also presented.


Assuntos
Neoplasias de Tecidos Moles/classificação , Neoplasias de Tecidos Moles/diagnóstico por imagem , Malformações Vasculares/classificação , Malformações Vasculares/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Fluxo Sanguíneo Regional , Neoplasias de Tecidos Moles/fisiopatologia , Neoplasias de Tecidos Moles/terapia , Ultrassonografia Doppler , Malformações Vasculares/fisiopatologia , Malformações Vasculares/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA