RESUMO
Background: When the ascending aorta and the femoral artery cannot be used for extracorporeal circulation, an emerging alternative is the use of axillary artery. Aim: To report the experience using the axillary artery for extracorporeal circulation. Patients and methods: Between November 1998 and May 2002, 22 patients (14 male) were operated with extracorporeal circulation, cannulating the axillary artery. Briefly, an incision is made below the middle third of the clavicle and a cut is made on major pectoris muscle. Minor pectoris muscle is retracted and axillary artery is exposed. It is cannulated directly or with the aid of a prosthesis. Results: Right axillary artery was used in 21 patients and in 20 it was cannulated with the aid of a prosthesis. Mean flow was 4.5 + 0.6 l/min. The most common indications were aortic dissection or aneurysms. The most common procedures done, were ascending aorta replacement in 8 cases and replacement of ascending aorta and aortic arch in 5. Thirty five percent of operations were emergencies and 32 percent were reoperations. In 15 patients (68 percent), a circulatory arrest was done. Of these, retrograde brain perfusion was used in 9, antegrade brain perfusion through the same axillary artery was used in 2 and mixed perfusion was used in 2. One patient had a complication related to the axillary cannulation. None had cerebrovascular accidents or thromboembolic complications. Two patients died in the postoperative period. Patients were followed up to 42 months after the procedure and no secondary complications of the cannulation were detected. Conclusions: When the ascending aorta and the femoral artery cannot be used, axillary artery is a good alternative for extracorporeal circulation
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Artéria Axilar , Circulação Extracorpórea/métodos , Cateterismo , Doenças Cardiovasculares , Aneurisma Aórtico/cirurgia , Coartação Aórtica/cirurgiaRESUMO
Traumatic rupture of the aorta has a near 80 percent mortality. Most patients die on the site of the accident. Conventional surgical repair of these lesions has a high morbidity and mortality, generally associated to the severity of associated lesions. Over the last decade, endovascular treatment has become an effective therapeutic alternative. We report a 40 years old male, that suffered a traumatic rupture of the descending thoracic aorta in a car accident. A successful endovascular repair was performed, installing an endoprothesis on the site of the lesion, using a femoral artery approach. The patient had a good postoperative evolution and was discharged from the hospital once complete rehabilitation of his associated lesions was obtained
Assuntos
Humanos , Masculino , Adulto , Aorta Torácica/lesões , Implante de Prótese Vascular/métodos , Ruptura Aórtica/cirurgia , Acidentes de Trânsito , Traumatismos Torácicos/cirurgia , Traumatismos Torácicos/complicaçõesRESUMO
Spontaneous dissection of the superior mesenteric artery is an unusual cause of mesenteric ischemia. Diagnosis can be based on findings of the helicoidal computed tomography or selective angiography of the superior mesenteric artery. We report two male patients, aged 47 and 50 years, who were admitted for abdominal pain. Isolated superior mesenteric artery dissection was confirmed by angiography. Both patients were treated with anticoagulation, conservative measures and recovered uneventfully
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Isquemia , Artéria Mesentérica Superior/fisiopatologia , Aortografia , Angiografia , TomografiaRESUMO
The traditional treatment of traumatic lesions of the aortic arch branches requires extended surgical exposures, not exempt of morbidity and mortality. Over the last decade, devices that allow a minimally invasive treatment, have been developed. The vessel can be repaired without direct exposure, using an endovascular procedure. We report three patients with traumatic pseudoaneurysms of the left subclavian, brachiocephalic and left common carotid arteries, respectively. All lesions were successfully repaired with the insertion of an endograft. Although long term results of these procedure are unknown, repair of a future stenosis or occlusion is less complicated than the treatment required by the original lesion. Endoluminal repair appears as a safe, efficient and less invasive treatment for these lesions
Assuntos
Humanos , Masculino , Adulto , Feminino , Idoso , Falso Aneurisma , Aorta Torácica/lesões , Implantação de Prótese/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
In 1991, a technique to exclude aortic aneurysms from circulation inserting an endoluminal graft through the femoral artery, was described. This procedure, usually used for elective abdominal aneurysms, can also be used in the thoracic aorta. We report a 41 years old male with a Marfan syndrome, presenting with a descending aorta aneurysm that ruptured to the mediastinum and pleural cavity. He was compensated hemodynamically and an endovascular stent-graft was deployed at the ruptured zone, through the femoral artery. The postoperative evolution of the patient was uneventful. This technique will allow a less invasive treatment of ruptured aortic aneurysms
Assuntos
Humanos , Masculino , Aneurisma Roto , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Síndrome de Marfan/complicaçõesRESUMO
The treatment of superior vena cava syndrome is usually oriented to the underlying cause, that can be too slow in emergency cases. We report a 49 years old woman with a multiple myeloma that was admitted due to a superior vena cava syndrome caused by a central venous catheter used for chemotherapy for 20 weeks. She was successfully treated with thrombolysis, angioplasty and stent placement. The patient died 7 months later due to the underlying disease. Long term catheters are the responsible for 20 to 30 percent of superior vena cava syndromes. Endovascular treatment of the syndrome is successful in 60 to 100 percent of cases with a symptomatic relapse in 4 to 45 percent of patients
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cateterismo Venoso Central/efeitos adversos , Síndrome da Veia Cava Superior/terapia , Mieloma Múltiplo/complicações , Síndrome da Veia Cava Superior/etiologiaRESUMO
Background: Endarterectomy is the treatment of choice for internal carotid artery critical stenosis. Some authors have proposed that the use of regional anesthesia has advantages over general anesthesia. Aim: To report our initial experience with carotid endarterectomy under regional anesthesia. Patients and methods: Between 1998 and 1999, patients with critical carotid artery stenosis, asymptomatic or with transient and recovered symptoms, were selected. A C2, C3, C4 root deep cervical block and superficial block was performed, using a mixture of lidocaine and bupivacaine. A carotid endarterectomy with patch and without routine shunt insertion, with standard and neurological monitoring, was performed. Results: During the study period, 94 carotid endarterectomies were done, 22 under regional anesthesia in 21 patients (12 male, age range 58-90 years old). Ninety five percent had hypertension, 52 percent smoked and 38 percent had renal dysfunction. One patient was converted to general anesthesia. Seventeen patients were discharged within 48 hours of the procedure and the rest, within 72 hours. There was no mortality or complications. Conclusions: Endarterectomy under regional anesthesia is less invasive, has excellent results and is well accepted by patients
Assuntos
Humanos , Doença das Coronárias/cirurgia , Anestesia por Condução/métodos , Endarterectomia das Carótidas/métodos , Diabetes Mellitus/complicações , Hiperlipidemias/complicações , Hipertensão/complicaçõesRESUMO
Death due to rupture of and abdominal aortic or iliac aneurysm, is their most frequent complication. We report two male patients, both over seventy years old, who presented with unexplained unilateral ilio-femoral deep vein thrombosis. During diagnostic work up an aortic and iliac aneurysm, compressing the deep venous system with secondary thrombosis, was found. In both patients a prophylactic inferior vena caval filter was inserted and standard elective surgery was then performed. No perioperative complications occurred and both patients remain asymptomatic during follow up. Deep vein thrombosis due to compression by an abdominal aortic and iliac aneurysm is infrequent. It must be ruled out together with intrabdominal cancer, in the elderly patient presenting with unexplained deep vein thrombosis
Assuntos
Humanos , Masculino , Idoso , Trombose Venosa/etiologia , Aneurisma da Aorta Abdominal/complicações , Complicações Pós-Operatórias , Aneurisma Roto , Trombose Venosa/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico , Diagnóstico Clínico , Tomografia Computadorizada de EmissãoRESUMO
The popliteal vein aneurysm is a rare condition that can lead to local symptoms, thrombosis and pulmonary embolism. We report the case of a 67 years old, otherwise healthy white male, who presented to us with localised swelling and pain in the left popliteal fossa. Duplex ultrasound and venography were obtained, confirming the diagnosis of popliteal vein aneurysm. The patient underwent tangential aneurysmectomy and lateral venorrhaphy, recovery was uneventful remaining asymptomatic. The reconstruction was demonstrated patent on a duplex scan. The popliteal vein aneurysm is a potentially fatal condition for which surgical treatment is recommended