Angiologia e Cirurgia Vascular最新文献

The utilization of totally implantable venous access port systems has been growing, along with its importance, given that it's a frequently used technique to face the increasing occurrence of tumors. Given so, it's important to understand its complications and how to approach them.

The most frequent technique is the percutaneous catheterization. This technique is used to gain access to the central venous circulation and has become increasingly important in Oncology, as a way to infuse chemotherapy.

One of the many possible complications, and one that can lead to severe consequences, is the arterial lesion.

In our clinical case, we will analyze the arterial complications associated with this technique, and highlight the different therapeutics. Our case consists of a 42 year‐old woman, with a mediastinal lymphoma, who was submitted to a totally implantable venous catheter access port, in the femoral vein, that complicated into a transfixive lesion of the femoral artery.

Although the introduction of these catheters in the femoral vein occurs rarely, this case is interesting given that this kind of lesion has a good probability of occurring in other vascular territories.

The internal iliac artery aneurysm is a rare clinical entity, which constitutes a diagnostic and therapeutic challenge, manifested by a high percentage of mortality cases when rupture occurs.

The authors present a 75 year‐old male previously submitted to infra‐renal aorto‐iliac aneurysm partial resection and interposition of a bifurcated aorto‐bifemoral graft. At 9 years follow‐up a 4,5 cm asymptomatic hypogastric aneurysm was diagnosed. Hypogastric embolization complemented with the implantation of an iliac stent‐graft was the treatment of choice, proving to be a safe and effective treatment modality

The revascularization of the lower limbs from the thoracic aorta, although feasible, is an unusual choice. The authors describe the clinical case of a patient with chronic aortic type B dissection, severe aortic stenosis, coarctation of the aorta at the isthmus, and occlusion of the left external iliac artery. He underwent simultaneous aortic valve replacement and construction of a bypass from the ascending thoracic aorta to both femoral common arteries. The patient was discharged at the 13th postoperative day, and is now being followed. This is a rare and complex procedure possible due to multidisciplinary collaboration between vascular surgeons and cardiothoracic surgeons.

Introduction/Objectives

Surgical site infection (SSI) in vascular surgery is a complication that may lead not only to healing problems, but also limb loss and risk of death. The incidence of surgical site infection at the groin after vascular procedures ranges among 3% to 44%. The aim of this study is to review the incidence of groin infection in our department and the degree of correlation between infection, known risk factors and preventing measures.

Methods

Retrospective review of consecutive arterial vascular surgeries in a university central hospital during one year. Patients undergoing groin incisions were studied according to baseline demographics, clinical characteristics, active infection, previous inguinal access, antithrombotic therapy, indication for intervention, prophylactic antibiotic use, type of intervention and type of graft used. Wound site infections over a 30-day period were registered and graded based on Szilagyi classification. On patients with documented groin infection, the presentation timing, modality of treatment (surgical and non-surgical) and time of healing were recorded. Data were analyzed by using SPSS 18.0 version software.

Results

From January to December 2013, 1266 vascular surgeries were performed. Of these, 782 were arterial vascular procedures, 279 by inguinal approach, with a total of 358 groin incisions. Our base population included 241 patients (31 patients with more than one procedure in a year). Total infection rate was 4.7% (17/358 groin incisions). All Szilagyi I (n = 4) resolved with antibiotic only; three of the ten Szilagyi II infections needed drainage/debridement at operation room; the other Szilagyi II resolved with antibiotic and wound care. All Szilagyi III infections (n = 3) were treated with bypass removal, and in two patients an in situ revascularization was performed. These two patients died from sepsis. Identification of the infecting agent was possible in 9 patients, with the most common isolated agent being Pseudomonas. Hypertension was significantly associated with a higher risk of SSI (p = 0.033).

Discussion/Conclusions

In our department, the infection rate of the inguinal approach equals the best international standards described. These results may be the outcome of a carefully planned strategy of infection control. Arising from the fact that groin SSI is a low incidence event, correlations between suspected risk factors and this infection are hard to establish. Longer follow-ups would be useful for identification of all groin infections.

The authors describe a rare case report of a septic embolism to a lower limb, a mycotic superior mesenteric artery aneurysm and a hemorrhagic stroke derived from a large mobile vegetation in an ascending aortic graft.

Infected ascending aortic grafts should be handled with a high level of suspicion, always bearing in mind that the survival of these patients depends largely on their physiological reserve, fast diagnosis and prompt medical or/and mainly used surgical treatment.

Review of the literature and clinical features of the pathology in question are also described and discussed.

The coexistence of an infra-renal abdominal aortic aneurysm (AAA) and a congenital pelvic kidney (CPK) is rare and there are only a few cases reported in literature, mostly treated by conventional open surgery. We present the first report of hybrid surgery as a successful and less invasive treatment for this association. A 75 year-old patient was referred to our department with a 5.7 cm diameter AAA and an ectopic right CPK vascularized by one artery, originated from the anterior wall of the aneurysm in the distal aorta. Treatment consisted in an ilio-renal bypass with autologous saphenous vein by a retroperitoneal approach, followed by the aneurysm endovascular aneurysm repair (EVAR) with an aorto-uni-iliac stent-graft, occlusion of left common iliac artery and ePTFE femoro-femoral crossover bypass. This procedure was simpler and less aggressive than a conventional surgery, with only 6 minutes of renal ischemia, which allowed preservation of the renal function and a faster recovery of the patient.

The authors present a case report of 72 years‐old male patient, who had two isolated saccular abdominal aneurysms, one aneurysm of the left common iliac artery of 3 cm of diameter involving the iliac bifurcation, corrected by endovascular embolization with multiple coils of the ipsilateral internal iliac artery with subsequent placement of a iliac extension of an Endurant II stent‐graft (Medtronic Inc, Minneapolis, Minn) and an abdominal aortic aneurysm of 3.8 cm, managed by the placement of an Endurant II tubular stent‐graft.

A literature review is performed on the level of evidence of the treatment of saccular aneurysms and made reference of the possible complications resulting from the exclusion of iliac artery aneurysms, especially in relation to the internal iliac artery embolization.