Angiologia e Cirurgia Vascular最新文献

Introduction

In the event of aortoiliac occlusive disease when revascularization from the infrarenal aorta is contraindicated, the axillary‐femoral bypass surgery is the most common option, but it shows substantially inferior patency rates.

Material and methods

A retrospective analysis of six patients, submitted to surgery between 2003 and 2014, by the same surgical team, is presented.

Results

All six patients were male, their average age was 60.7 years (57‐64 years) and they had multiple cardiovascular disease risk factors: arterial hypertention, smoking and dyslipidemia.

At the time of the treatment, four patients had complaints of incapacitating intermitent claudication and two presented with critical limb ischaemia. All patients had contraindication to a revascularization procedure from the infrarenal aorta, particularly hostile abdomen, prosthetic infection and extensive calcification.

Surgical treatment consisted in supraceliac aorta ‐ bifemoral bypass in two patients and supraceliac aortic ‐ bifemoral interposition on another patient; on the other three cases the influx was obtained from the descending thoracic aorta.

The average follow‐up is 6 years (9‐1 years) and the grafts are functioning in excellent condition in 4 patients. One patient was lost to follow‐up and the other died a year after surgery.

Conclusion

atencyevascularization procedures from the supraceliac or the descending thoracic aorta are an alternative in cases in which direct revascularization is contraindicated, with favorable morbi‐mortality and long‐term patency rates.

Ischemic priapism is a persistent erection unrelated to sexual stimulation characterized by reduced or absent intracavernous blood flow. We present a clinical case of a 30 year old man with priapism with 48 hours of progression. He underwent surgical drainage of the corpora cavernosa, instillation of ephedrine, and creation of a cavernous‐spongeous shunt without improvement. On the duplex ultrasound there was no flow in the cavernous arteries, thrombosis of the cavernous veins and normal dorsal venous flow. He underwent Grayhack surgery with creation of cavernous‐femoral bypass with great saphenous vein bilaterally. He underwent a Grayhack surgery with creation of a bilateral cavernous‐femoral bypass with great saphenous vein. There was clinical improvement and resolution of the priapism. On the 7th post‐operative day, it was documented thrombosis of the bypasses and patent cavernous arteries and veins.

Post-traumatic pseudo-aneurysms of the femoral artery are a rare complication. They normally have iatrogenic causes and immediately appear. Less often, they appear at a later stage and are related with traumatisms, orthopaedic surgery, bone lesions, infections, etc.

This report presents a case of a patient with allergy to heparin, and pseudo-aneurysm of the superficial femoral artery and 1st portion of the popliteal artery secondary to remote trauma in an extremity with serious deformities as a sequel. We performed conventional surgery using a posterior approach, and obtained a satisfactory outcome and evolution.

Primary aortoesophgeal fistulas (AEF) are a rare but life-threatening condition because of substantial hemorrhage, requiring fast treatment to ensure patient survival. We report a case of a 69-year-old male with diagnosis of squamous cell carcinoma of the esophagus who suffered an episode of hematemesis and hemorrhagic shock. Gastrointestinal (GI) endoscopy revealed an ulcerated lesion with pulsatile hemorrhage. CT-scan confirmed the diagnosis of AEF. A stent-graft was placed in the descending aorta to control bleeding, and 2 days later an esophageal stent was deployed to reduce risk of aortic graft infection. The patient was discharged 13 days after admission and had no other episode of GI bleeding in a 6-month follow-up period. TEVAR may be used as a palliative or bridge treatment of AEF.

Introduction

Neurofibromatosis type1 (NF1), also known as Von Recklinghausen disease, is caused by an autosomal dominant abnormality in chromosome 17, responsible for the impaired production of neurofibromin. The presence of cafe‐au‐lait spots, neurofibromas and iris hamartomas are cardinal signs of the disease. The occurrence of a fatal or near‐fatal haemorrhage is reported in pleural, peritoneal, retroperitoneum, soft tissues of the trunk and extremities. The massive hemorrhage is caused by rupture of friable blood vessels as a consequence of impaired expression of neurofibromin in the arteries and veins. One of the most serious clinical consequences described in NF1 is the occurrence of severe haemorrhage and difficulty achieving hemostatic control.

Objectives

We report a case of spontaneous massive cervical hematoma and hemothorax as a result of venous rupture of innominate, subclavian and subclavian‐jugular veins junction in a NF1 patient.

Case report

A 51 year‐old woman with past history of neurofibromatosis type I and hypertension was admitted to the emergency department with an haemorrhagic shock in the clinical set of a sudden right shoulder pain and a expansive right cervical swelling. The CT angiography showed a massive hematoma, involving the right cervical, retropharyngeal‐prevertebral, right supraclavicular and the mediastinum regions, associated with an important right haemothorax.

Through a supraclavicular approach, it was performed hematoma drainage and identification of bleeding sources including: brachycephalic venous trunk, the subclavian vein and subclavian‐jugular confluence. It was required clavicle section to achieve haemorragic control and suture the ruptured venous trunks. A VATS was performed for haemothorax drainage and confirmed the absence of active bleeding.

A postoperative CT angiography confirmed the resolution of the right cervical hematoma and absence of contrast extravasation. Additionally it was found a saccular aneurysm of the right vertebral artery corrected later by embolization with coils.

Conclusion

NF1 is a genetic disorder that rarely can be associated with life‐threatening haemorrhage. The vasculopathy is an underestimated complication with limited recognition in NF1. The excessive vascular friability with spontaneous bleeding in NF1 is rare and can be fatal, requiring a timely diagnosis and prompt treatment.

Introduction

The rupture of an AAA is frequently fatal and accounts for nearly 1% of all deaths. Open surgical intervention is associated with high mortality, but EVAR (Endovascular Aneurysm Repair) is far from consensual owing to lack of level A evidence. Screening is cost effective in male patients over the age of 65 with a 44% reduction in AAA related mortality. This retrospective study had two endpoints, the first was the global assessment of care for both elective and urgent aneurysms in our institution. The second was raising awareness in local primary health care institutions for both the dismal prognosis of untreated AAA and the favorable prognosis of patients treated electively, using outcome data from our centre.

Methods

Data was extracted from the hospital database concerning urgent and elective repair of AAA from 2007 to 2014.

Results

Over the 8 year period, 155 elective aneurysm repairs were performed, 108 through open surgery and 47 through EVAR (with an increasing percentage with time). The early (30 days) mortality rate was 1.3%. We performed 51 aneurysm repairs for ruptured aneurysms (46 open surgery and 5 EVAR), with an intra‐operative mortality of 15.7% and early mortality of 47%. Concerning the geographic distribution of elective and urgent cases, we identified a tendency for assimetry in the distribution of elective and urgent repair of aneurysms. Unfortunately, due to lack of data concerning treatment of patients from our referral area in other centres and pre hospital mortality of ruptured aneurysms, no true incidence rates were possible to calculate.

Conclusions

The outcome of patients treated in our institution are comparable with data from literature We disclosed this data to all local primary health care institutions as well as the established recommendations for screening, with the final purpose of raising awareness for the active role they must have in the screening of AAA and treatment of this patients by controlling cardiovascular risk factors.

Introduction

Giant Cell Arteritis (GCA) is a systemic inflammatory vasculitis of unknown etiology that occurs in older persons and can result in a wide variety of clinical presentations. The disease most commonly affects the extracranial branches of the carotid artery but has also been shown to involve, in 10 to 15%, the upper extremity arteries, mostly the subclavian, axillary and proximal brachial arteries.

Clinical Case

A 80 year‐old woman with a prior history of hypertension and cerebrovascular disease presented with ischemic rest pain of both upper limbs, with evidence of distal digital cyanosis. Complaints began two months earlier and progressively worsened. Workup CT‐scan showed complete occlusion of both axillary and proximal branchial arteries and thickening of the wall of both subclavian arteries, aorta and common femoral arteries suggesting vasculitis.

Corticosteroid therapy was promptly commenced. No significant improvement was present after 5 days of treatment, so the patient underwent bilateral carotid‐brachial bypass. After surgery there was complete resolution of the complaints and radial pulse was present bilaterally. After 6 months, the patient remained asymptomatic and bypasses were permeable.

Conclusion

This paper aims to present the case of a patient with the inaugural diagnosis of GCA who presented with bilateral and simultaneous critical ischemia. This condition required the realization of a rare revascularization procedure.