Angiologia e Cirurgia Vascular最新文献

The authors present a successful clinical report of endovascular exclusion of a common iliac aneurysm and surgical revascularization of the internal iliac artery (IIA).

Case report of an 80‐year‐old man, previously submitted to endovascular repair of an aortoiliac aneurysm. Seven years after this intervention, the follow‐up angiographic computerized tomography showed progression of the right common iliac artery aneurysm to the iliac bifurcation and occlusion of the contralateral IIA.

The patient was submitted to a hybrid endovascular and surgical procedure, through right IIA interruption, external iliac artery – IIA bypass graft with prosthesis and endovascular repair of the right common iliac artery aneurysm.

The procedure was successful and, as the post‐surgical period, free of any complication. The patient was discharged at the fourth day after surgery and, till this date, remains asymptomatic and with imagiologic evidence of iliac aneurysm exclusion, with no endoleak, and EIA – IIA bypass patency.

In the treatment of the complex aorto‐iliac aneurysms, the hybrid technique is an alternative associated to a high rate of imagiologic and clinical success, with a lower rate of complications.

The true aneurysms of the superficial femoral artery are extremely rare and, in the majority of cases, they are associated to arterial aneurysms in other territories. The rarity of this pathology is responsible for the absence of prospective randomized clinical trials, so the gold standard therapy for this kind of aneurysms remains open surgery procedures.

A 58‐year‐old male, previously submitted to right lower limb bypass surgery for obstructive atherosclerotic arterial disease, presented with an acute painless and pulsatile mass in his left thigh, which had appeared 24 hours earlier. The arterial doppler ultrasonography and angio CT showed rupture of a true aneurysm of the superficial femoral artery, with 42 mm of diameter and associated haematoma with 90 x 60 mm of diameter, with no evidence of other aneurysms.

The patient was submitted to aneurysm resection, superficial femoral artery interposition with prosthesis and haematoma drainage.

The intervention and follow‐up were intercurrences free. The microbiology was negative and the anatomopathological report confirmed degenerative aneurysm of the superficial femoral artery.

Chronic venous disease (CVD) it's the most frequent vascular pathology, with an estimated prevalence in western countries of 40% in females and 17% in males. The human and financial resources necessary to provide treatment to such a ubiquitous disease is massive. Therefore, it is imperative to know the consequences of CVD and to highlight the benefits of its surgical treatment. In contrast to other vascular surgeries, the outcomes to assess in varicose veins surgery are less well defined. It is so vital to define a concrete set of international validated outcomes to compare the national results with the international literature. Besides, varicose vein surgery in Portugal has the particularity of being performed by both vascular and general surgeons. The selected outcomes will be important to confront the results of this procedure between the two specialties.

The article proposes the creation of a varicose veins surgery evaluation protocol in Portugal. A literature revision of the main negative aspects of CVD and a systematization of the advantages of its surgical treatment will also be performed.

Introduction

Renal artery aneurysms and arteriovenous fistulae are rare, generally asymptomatic, whose clinical manifestations can be varied. Renal artery pseudoaneurysms are usually associated with previous trauma and are more likely to rupture. The indication for treatment of these lesions is not consensual, as well as the method to be used.

Material and Methods

In this study the authors have made a retrospective analysis of patients with the diagnosis of renal artery pseudoaneurysm treated in the institution in the period between 2011 and 2015, including clinical presentation, diagnosis, treatment and result.

Results

Six patients were treated, four male and two female, with an average age of 59 years. The inaugural clinical manifestation was macroscopic haematuria in four patients, hemodynamic instability in a patient and decrease of the hemoglobin value in another patient. In all patients, the diagnosis was made by Computed Tomography (CT) and confirmed by angiography, which was therapeutic in the same act.

Conclusion/Discussion

In all cases there was a recent history of a urological procedure, renal artery pseudoaneurysms may be considered iatrogenic lesions. With the rising number of urological interventions similar to those described in this study, it is expected a rising incidence of lesions of the renal artery or its branches, particularly pseudoaneurysms.

As it includes in most cases small intra‐parenchymal vessels, conventional surgery has few therapeutic alternatives and usually consists in nephrectomy. The endovascular treatment is the only one that can minimize the loss of kidney tissue, embolization is the preferred method. All our cases were successfully treated as clinically proven and on CT control. So in our experience, endovascular treatment was an effective method of treatment of these lesions.

Splenic artery aneurysms are the most common of all visceral artery aneurysms, with a risk of rupture up to 10%. Most patients present asymptomatically and its elective treatment is recommended for diameters> 2.5 cm. Once treated exclusively by open surgery through aneurysm resection with or without arterial reconstruction, with or without splenectomy associated, nowadays endovascular repair has become increasingly used, by embolization with coils or stenting of the splenic artery. Comparative studies report overlapping efficacy, with lower perioperative morbidity and mortality, but higher rate of late complications. Splenic infarction and abscess is one of them, and the goal of our study was to study and describe this complication.

Introduction

Takayasu's arteritis is a chronic, rare and idiopathic inflammatory disease, which affects the aorta, its main branches, the pulmonary and coronary arteries. The visceral artery most frequently involved is the renal artery, which may lead to renovascular hypertension.

Case report

A 58‐year old woman, with previous history of Takayasu's arteritis and systemic arterial hypertension refractory to treatment. The patient was submitted to aorto‐visceral angiography, showing a right renal artery stenosis, superior to 70% of the estimated diameter, then being submitted to renal artery transluminal angioplasty.

The procedure was technically well‐succeeded and there were no complications related to it. The patient was discharged from hospital in the following day, asymptomatic and presenting arterial blood pressure values within the normal range, with no need for antihypertensive drugs, maintaining this clinical picture at 10 months of follow‐up.

Conclusion

Angioplasty of Takayasu's arteritis induced renal artery stenosis is a safe, effective and low invasive procedure, related to a low complication rate, reasons why this is actually considered the method of choice in the treatment of this pathology.

Introduction

A systemic inflamatory response is common after EVAR. Its clinical impact is unknown, and although is it usually well tolerated, there is concern it might be associated with increased morbidity and mortality in high risk patients. This study aims to evaluate the occurrence of the post-implantation syndrome (PIS) in patients undergoing EVAR, its characteristics and clinical significance.

Methods

This study is a retrospective observational analysis of patients undergoing elective EVAR between November 2012 and November 2014. PIS was defined by fever (>38 °C) and leukocytosis (>12,000 μL⁻¹), excluding infectious complications. We evaluated the epidemiological characteristics of the patient, aneurysm and procedure characteristics and their relationship with development of PIS.

Results

Fifty-two patients were included, and 21.2% were diagnosed with PIS. The ePTFE grafts were not associated with the occurrence of the syndrome, in contrast with polyester stent grafts (0% vs. 28.2%, p = 0.031). The age and gender of patients, the diameter of the aneurysm, duration and radiation dose and the configuration of the stent graft (aorto-bi-iliac, aorto-uni-iliac or fenestrated) were not associated with PIS. There was no statistically significant difference in the occurrence of major cardiovascular events during hospitalization in both groups.

Conclusion

The inflammatory syndrome after EVAR occurs in a significant percentage of patients (21%). Stent grafts constructed by polyester are a significant risk factor. Despite the exuberant inflammatory response, it was not associated with increased occurrence of cardiovascular events, and it is usually benign, well tolerated and self-limiting.