RESUMO
Cerebral revascularization, using extra-anatomic bypass grafts of autologous saphenous vein, was performed in three patients to prevent or to compensate for ischemic effects of emergency ligation of a carotid artery. These ligations were required after spontaneous disruption of common carotid arteries in patients with previous irradiation and radical head and neck surgery. External-carotid-to-external-carotid cross-over (submandibular) bypass graft was performed once, and ipsilateral axillointernal carotid bypass grafts twice. The role of infection in carotid artery rupture, the unpredictable nature and different mechanisms of cerebral malfunctions after carotid ligation, technical details of extra-anatomic bypass grafts, and anatomic considerations in the prevention of recurrent infection and bleeding are discussed. A planned approach of cerebral revascularization at the time of ligation appears to be preferable to a fortuitous outcome. Neurological disability and death from cerebral ischemia can be prevented by using extraanatomic bypass vein grafts.
Assuntos
Encéfalo/irrigação sanguínea , Artérias Carótidas/cirurgia , Veia Safena/transplante , Artérias Carótidas/anatomia & histologia , Humanos , Ataque Isquêmico Transitório/etiologia , Ligadura , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/efeitos adversos , Complicações Pós-Operatórias , Radioterapia/efeitos adversos , Ruptura Espontânea , Infecção da Ferida Cirúrgica/etiologia , Transplante AutólogoRESUMO
Pathological fibrinolysis due to pseudoaneurysms was observed in a patient 4 years after aortobifemoral bypass graft. The patient presented with a pulsatile abdominal mass and ischemic changes in the legs. Excessive bleeding from venipuncture sites prompted coagulation screening, which disclosed rapid clot lysis, fibrin split products, and low fibrinogen suggestive of pathological fibrinolysis. Therapy with epsilon amino caproic acid (EACA, Amicar) controlled the coagulopathy, permitting angiography and operation. Resection of the pseudoaneurysms resulted in resolution of the abnormal fibrinolysis. Normally, there is a balance between coagulation and fibrinolysis protecting against excessive bleeding or clotting. Clot itself is a powerful stimulus for the activation of the fibrinolytic system, although many other factors have been shown to initiate and sustain the process. Fibrinolysis is pathological when the process becomes excessive or inappropriate. Plasminogen is activated to plasmin which digests fibrin. Both plasmin and fibrin split products inhibit polymerization of fibrin monomers (which is the final step in the coagulation cascade in the formation of a stable clot), resulting in an unstable clot which is rapidly lysed. To our knowledge such a coagulopathy has not been reported to be a complication of pseudoaneurysms.
Assuntos
Aneurisma/complicações , Aneurisma Aórtico/complicações , Transtornos da Coagulação Sanguínea/etiologia , Fibrinólise , Ácido Aminocaproico , Aneurisma/cirurgia , Aorta Abdominal/cirurgia , Aneurisma Aórtico/cirurgia , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Testes de Coagulação Sanguínea , Artéria Femoral/cirurgia , Produtos de Degradação da Fibrina e do Fibrinogênio , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Twelve patients with bilateral symptomatic lesions of internal carotid arteries have had bilateral carotid endarterectomy at single operations without complications. These were patients up to age 80 who had prior mycardial infarction, stroke with recovery, and hemispheric and nonhemispheric episodes. Neurologist's clearance and three- or four-vessel intracranial-extracranial angiography preceded all operations, which were performed with the patient under general anesthesia. Stump pressure measurements were the principal guideline of adequacy of collateral flow and predictor of safe outcome. The safety of this concept of bilateral operations during one anesthesia can eliminate uncertainties of sequence and timing, obviate delay and indecision, and avoid the hazards of a second anesthetic-operative experience.
Assuntos
Arteriopatias Oclusivas/cirurgia , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Endarterectomia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Complicações Pós-OperatóriasRESUMO
A search for desiccation tolerant grasses in India revealed nine grass species (in the genera Eragrostiella, Oropetium and Tripogon) whose ability to recover from airdryness had not previously been reported. Dry leaves of these species recover uninjured within 24 h of plants receiving water. Desiccation tolerance limits were 0%-11% RH (at 28°C). Some species were relatively tall and vigorous and may be useful for grazing purposes in arid areas.
RESUMO
This is the sixth report in the English literature of survival following repair of a supraceliac aortic traumatic aneurysm secondary to penetrating injury. Symptoms, (12 months after a stab wound of the flank), led to discovery of an aneurysm 15 cm in diameter, originating from the left side of the supraceliac aorta. Repair was accomplished with a temporary thoracoabdominal bypass shunt graft of woven Dacron.
Assuntos
Aneurisma Aórtico/cirurgia , Prótese Vascular , Adulto , Aorta Abdominal/lesões , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/etiologia , Humanos , Masculino , Métodos , Polietilenotereftalatos , UltrassonografiaRESUMO
A rationale is presented for extra-anatomic carotid cross-over bypass to maintain or restore blood flow to the internal carotid artery distal to sites of disruption and ligation of a common carotid artery. Anatomic evidence indicates that the attachment of the carotid sheath to the hyoid bone is a barrier to spread of infection cephalad to that level. A patient with infected and disrupted right common carotid artery associated with an esophageal fistula was treated by double ligation of the artery. Contralateral hemiplegia 48 hours later forced consideration of cerebral revascularization. Left carotid angiography demonstrated patent cerebral vessels on the right, with retrograde filling of the right internal carotid artery to the bifurcation. These findings were interpreted as consistent with technical feasibility of external carotid to external carotid cross-over vein bypass in a suprahyoid location, avoiding reconstruction in an infected area and resulting in prompt recovery of function.
Assuntos
Encéfalo/irrigação sanguínea , Artérias Carótidas/cirurgia , Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Circulação Cerebrovascular , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Radiografia , Veia Safena/transplante , Transplante AutólogoAssuntos
Arteriosclerose/cirurgia , Artéria Femoral/cirurgia , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Artéria Poplítea/cirurgia , Veias/transplante , Idoso , Amputação Cirúrgica , Angiografia , Arteriosclerose/diagnóstico por imagem , Seguimentos , Humanos , Isquemia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Veia Safena , Transplante AutólogoAssuntos
Síndromes do Arco Aórtico , Tronco Braquiocefálico/diagnóstico por imagem , Adolescente , Adulto , Idoso , Síndromes do Arco Aórtico/diagnóstico por imagem , Síndromes do Arco Aórtico/cirurgia , Prótese Vascular , Tronco Braquiocefálico/cirurgia , Artéria Carótida Externa/diagnóstico por imagem , Artéria Carótida Externa/cirurgia , Criança , Endarterectomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgiaAssuntos
Arteriopatias Oclusivas/fisiopatologia , Hemodinâmica , Rim/irrigação sanguínea , Doenças da Aorta/complicações , Aortografia , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Arteriosclerose/complicações , Determinação da Pressão Arterial , Débito Cardíaco , Feminino , Humanos , Artéria Ilíaca , Pessoa de Meia-Idade , UrografiaAssuntos
Arteriopatias Oclusivas/cirurgia , Artéria Femoral/cirurgia , Artéria Poplítea/cirurgia , Veias/transplante , Idoso , Angiografia , Aorta Abdominal , Aneurisma Aórtico/complicações , Aneurisma Aórtico/cirurgia , Arteriopatias Oclusivas/etiologia , Arteriosclerose Obliterante/complicações , Arteriosclerose Obliterante/cirurgia , Prótese Vascular , Artéria Femoral/diagnóstico por imagem , Gangrena/etiologia , Gangrena/cirurgia , Humanos , Artéria Ilíaca , Úlcera da Perna/etiologia , Masculino , Pessoa de Meia-Idade , Polietilenotereftalatos , Veia Safena , Transplante AutólogoAssuntos
Arteriopatias Oclusivas/cirurgia , Artéria Ilíaca/cirurgia , Adulto , Idoso , Angiografia , Aorta/cirurgia , Arteriosclerose/complicações , Prótese Vascular , Dilatação , Endarterectomia , Artéria Femoral/cirurgia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Métodos , Pessoa de Meia-Idade , Artéria Poplítea/cirurgia , Fluxo Sanguíneo Regional , Artéria Renal/cirurgiaAssuntos
Doenças da Aorta/complicações , Arteriopatias Oclusivas/complicações , Artéria Femoral , Enteropatias/etiologia , Angiografia , Aorta Abdominal , Doenças da Aorta/cirurgia , Aortografia , Arteriosclerose/cirurgia , Angiopatias Diabéticas , Hemodinâmica , Humanos , Artéria Ilíaca/cirurgia , Masculino , Artérias Mesentéricas , Oclusão Vascular Mesentérica/complicações , Pessoa de Meia-Idade , Necrose , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/diagnóstico , Cuidados Pré-Operatórios , Fluxo Sanguíneo RegionalRESUMO
The outstanding angiographic features of small intestinal intussusception are: (a) abrupt disappearance of mesenteric vessels at the neck of the intussusception with crowding of the vasa recta; (b) appearance of long collateral channels at the neck of intussusception; (c) angulation and retraction of major intestinal branches; (d) reversal of the course and angulation of the invaginated mesenteric vessels; (e) overlapping of the mesentery vessels by branches of the intussuscipiens; (f) abrupt change in the appearance of the vasa rectae of the distended intussuscipiens and the distal nondistended small intestines.
Assuntos
Íleo , Intussuscepção/diagnóstico por imagem , Adulto , Angiografia , Humanos , Íleo/irrigação sanguínea , Íleo/diagnóstico por imagem , Intussuscepção/patologia , MasculinoRESUMO
A patient was seen with symptomatic, rapidly expanding aneurysms that developed in both carotid arteries 4 years after bilateral radiation to the neck, left combined mandibular resection, and radical neck dissection. The presenting symptoms were pain and transient ischemic attacks of cerebrovascular insufficiency. The aneurysms were treated uneventfully be resection and vein-graft replacement at 15-day intervals. Microscopy demonstrated typical radiation changes. Effects of radiation on arteries are reviewed.
Assuntos
Aneurisma/etiologia , Doenças das Artérias Carótidas/etiologia , Radioterapia/efeitos adversos , Aneurisma/cirurgia , Prótese Vascular , Carcinoma de Células Escamosas/radioterapia , Artérias Carótidas/patologia , Artérias Carótidas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Tonsilares/radioterapiaRESUMO
During 1968-1973, 122 patients with 126 arterial injuries were treated. In 94 instances (90 patients), these injuries involved extremities. Systolic blood pressure was below 90 mm Hg upon admission in 55.6% of all patients and 37.7% of those with injuries to arteries of the extremities. The decision for operative exploration and repair of arteries of extremities was based largely on clinical grounds (shock, loss of pulse). Preoperative arteriography was needed infrequently, while operative angiography was nearly routine. Although several cases of late revascularization or traumatic thrombosis of renal artery have been reported, hypertension complicates the postoperative period, and early, aggressive approach is essential. Mortality was 10.6%, from aortic injuries. There were no deaths among patients with arterial injuries distal to inguinal ligament or thoracic outlet. The amputation rate from reconstruction failure was 1.1%, none occurring in the last 3 years of the series. The high patency rate and lack of evidence of pulmonary embolization suggest that associated venous injuries be repaired routinely. Arterial injuries represent ideal lesions (normal arterial wall with excellent run-in and run-off). Prompt treatment of shock and early, proper management of patients' mechanical disruptions will salvage many lives and most limbs.
Assuntos
Artérias/lesões , Adolescente , Adulto , Amputação Cirúrgica , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Choque Hemorrágico/etiologia , Fatores de Tempo , Transplante Autólogo , Veias/transplante , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico por imagem , Ferimentos e Lesões/cirurgiaRESUMO
The management of 23 patients with traumatic pseudoaneurysms is presented. A pulsatile mass associated with pain was the usual presentation. Hypertension and hypovolemic shock from rupture are uncommon presentations but potential hazards of this lesion. Twenty-one pseudoaaeurysms were treated surgically. Resection with end-to-end anastomosis (eight patients), with graft replacement (one patient), with lateral repair (seven patients) was done. Hypothermia with circulatory arrest and external Dacron shunt were used to prevent visceral ischemia during high aortic occlusion. There were no mortalities or significant postoperative complications.