RESUMO
Arteriovenous fistula involving renal artery and inferior vena cava are rare. We report the case of a 47-year-old woman with a chronic arteriovenous fistula between right renal artery and inferior vena cava due to a penetrating trauma. Another finding was a vena cava aneurysm caused by the fistula. The patient was successfully treated with a covered stent in the renal artery. Diagnosis and postoperative control have been documented with CT scan. Endovascular techniques may be effective and minimally invasive option for treatment and renal preservation in renal-cava arteriovenous fistulae.
Assuntos
Fístula Arteriovenosa/terapia , Procedimentos Endovasculares , Artéria Renal/lesões , Veia Cava Inferior/lesões , Ferimentos Perfurantes/complicações , Aneurisma/etiologia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Dilatação Patológica , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologiaRESUMO
BACKGROUND: To describe the applicability and the performance of the treadmill test in elderly patients with peripheral arterial disease (PAD) and without PAD (non-PAD). PATIENTS AND METHODS: Fifty consecutive PAD and non-PAD elderly patients performed a progressive treadmill test. The proportion of patients who were unable to perform the test and the maximal walking distance were obtained. RESULTS: The proportion of patients who were unable to perform the treadmill test was similar between PAD (16.6 %) and non-PAD patients (12.5 %), P = .57. Maximal walking time for patients who performed the treadmill test was not different between PAD (232 +/- 218 s) and non-PAD patients (308 +/- 289 s), P = .37. CONCLUSIONS: The treadmill test is limited in almost 20 % of elderly patients with PAD and non-PAD. These results highlight the need for other forms of exercise stress tests in order to assess the peripheral limitation of patients with PAD.
Assuntos
Envelhecimento , Teste de Esforço , Tolerância ao Exercício , Claudicação Intermitente/diagnóstico , Doenças Vasculares Periféricas/diagnóstico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Humanos , Claudicação Intermitente/etiologia , Claudicação Intermitente/fisiopatologia , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/fisiopatologia , Valor Preditivo dos Testes , CaminhadaRESUMO
The objective of this study was to evaluate the existence of hemodynamic arterial flow correlation between preoperative duplex scanning (DS) and intraoperative direct outflow resistance (IDOR) measurements in ischemic lower limb revascularization. Sixty-eight ischemic lower limbs were submitted to preoperative DS. Anatomic and hemodynamic arterial characteristics of the outflow system were recorded, and the results were considered in the distal anastomosis placement site decision making. IDOR measurements were obtained at the same arterial segment, and Pearson's correlation coefficient test was performed to study the preoperative DS power in predicting the intraoperative outflow resistance. DS was technically satisfactory and helped define the distal anastomosis site in 93.2% of the cases (supragenicular popliteal artery, 19 [27.9%]; infragenicular popliteal artery, 10 [14.7%]; crural artery, 31 [57.4%]). A positive correlation could be found between preoperative DS and IDOR (0.450; p < .001). This correlation was particularly powerful in the crural artery (0.715; p < .001) when compared with the popliteal arterial segment (0.237; p = .192). Preoperative DS may help define the best distal arterial and outflow segment to be revascularized based on anatomic and hemodynamic parameters. There is a positive flow correlation between preoperative DS and IDOR that seems to be stronger in crural revascularization surgery.
Assuntos
Assistência Perioperatória , Circulação Renal , Cuidados Intraoperatórios , Cuidados Pré-Operatórios , Cuidados Pós-Operatórios , Implante de Prótese Vascular , Isquemia , Isquemia/cirurgia , Isquemia/fisiopatologia , Período Intraoperatório/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Resistência VascularRESUMO
INTRODUCTION: Thrombomodulin (TM) has been described as a marker of endothelial injury in atherosclerosis. The role of TM as a predictor of PAD severity is to be proven. The goal of the present study is to compare the level of plasmatic (TMp) in patients with intermittent claudication with patients with critical ischemia in the lower limbs. MATERIALS AND METHODS: TMp was measured using ELISA in the plasma of 41 patients with intermittent claudication degree 1 and in 40 patients presenting critical ischemia in the lower limbs degrees 2 and 3, according to TASC. The hypotheses of normality and homogeneity of the variance had been proven via Shapiro-Wilk and Levene tests, respectively. The comparison of the TMp between the groups was done using the t-Student test. RESULTS: No statistically significant difference was observed. The average levels of TMp for intermittent claudication were 5.2 ng/ml (0.78-13.61 ng/ml) and TMp for critical ischemia in the lower limbs were 6.34 (0.82-18.22 ng/ml) where p=0.265. CONCLUSION: TMp does not seem to be an appropriate marker for PAD severity.
Assuntos
Endotélio Vascular/patologia , Claudicação Intermitente/patologia , Isquemia/patologia , Trombomodulina/sangue , Idoso , Arteriopatias Oclusivas/patologia , Aterosclerose , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Reprodutibilidade dos Testes , Fatores de TempoRESUMO
The aim of this study was to assess the influence of anxiety and plasma catecholamines on the pharmaco-induced erection of psychogenic erectile dysfunction (ED) patients. A total of 23 patients with psychogenic ED aged from 19 to 43 y were submitted to: (1) anxiety evaluation by the Spielberger's State and Trait Anxiety Inventory-STAI; (2) intracavernous injection of PGE1 10 microg+phentolamine 1 mg with the response monitored by Rigiscan; (3) blood sampling from cavernous bodies and cubital vein for adrenaline and noradrenaline levels determination by high performance liquid chromatography. The whole procedure was done in a single clinical setting at the same day. We found no significant correlation between the erection rigidity and the cavernous or peripheral catecholamines or between erection rigidity and anxiety scores. Some patients showed rigid erections despite high anxiety scores or penile catecholamine levels while others, with incomplete erections, had much smaller levels. These results are suggestive of a more complex mechanism controlling the penile sympathetic responsiveness in psychogenic ED patients.
Assuntos
Epinefrina/sangue , Disfunção Erétil/sangue , Disfunção Erétil/psicologia , Norepinefrina/sangue , Ereção Peniana , Disfunções Sexuais Psicogênicas/sangue , Disfunções Sexuais Psicogênicas/psicologia , Antagonistas Adrenérgicos alfa/administração & dosagem , Adulto , Alprostadil/administração & dosagem , Ansiedade , Combinação de Medicamentos , Disfunção Erétil/fisiopatologia , Humanos , Injeções , Masculino , Ereção Peniana/efeitos dos fármacos , Fentolamina/administração & dosagem , Disfunções Sexuais Psicogênicas/fisiopatologia , Vasodilatadores/administração & dosagemRESUMO
Treatment of arterial traumatic intimal lesions is controversial due to its unknown natural history. Current therapeutical options include arterial reconstruction and clinical observation. The idea of using stents to correct intimal flaps is based on their use to correct dissections, flaps, and arterial irregularities after angioplasty. We report the successful treatment of a traumatic intimal flap of the superficial femoral artery, caused by gunshot trauma, with a Palmaz stent in the acute period. One year after the operation, a duplex scan revealed normal flow in the artery and complete exclusion of the intimal flap; distal pulses were palpable, and the patient was completely asymptomatic.
Assuntos
Artéria Femoral/lesões , Stents , Túnica Íntima/lesões , Ferimentos por Arma de Fogo/terapia , Adulto , Humanos , MasculinoRESUMO
PURPOSE: To describe endovascular repair of a large aneurysm of the innominate artery in a patient with episodes of transient cerebral ischemia. CASE REPORT: A 44-year-old man with a history of transient hemiparesis and aphasia demonstrated a large mass in the upper right hemithorax on chest radiography. Systolic brachial pressure in the right arm was 100 mm Hg versus 130 mm Hg in the left. Imaging disclosed a large 12-mm-diameter aneurysm involving the brachiocephalic trunk 1 cm above its origin and the first portion of the right subclavian artery, which was occluded after the dilated segment. The aneurysm was treated with a tapered endograft made from polyester graft attached to a Palmaz stent inserted via a carotid artery arteriotomy. The distal end of the graft was anastomosed to the common carotid artery. Completion angiography showed exclusion of the aneurysm, which has been confirmed by imaging at 21 months. After 2 years, the patient is free from neurological symptoms and has a strong carotid pulse; no arm claudication developed. CONCLUSIONS: Endovascular correction of innominate artery aneurysms is feasible whenever there is an adequate proximal neck for attachment. In these cases, thoracotomy may be avoided.
Assuntos
Aneurisma/cirurgia , Tronco Braquiocefálico/cirurgia , Procedimentos Cirúrgicos Vasculares , Adulto , Anastomose Cirúrgica , Aneurisma/complicações , Artéria Carótida Primitiva/cirurgia , Humanos , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/cirurgia , MasculinoRESUMO
Simultaneous repair of abdominal aortic aneurysm and treatment of cholelithiasis by the transperitoneal approach is controversial because of the risk of prosthesis infection. We report two patients who underwent a successful combined procedure using a retroperitoneal approach for the aortic aneurysm repair and a laparoscopic approach to the cholecystectomy. This combined approach reduces the risk of infection of the aortic prosthesis and is associated with a rapid return of normal peristalsis.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Colecistectomia Laparoscópica , Colelitíase/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/complicações , Implante de Prótese Vascular , Colelitíase/complicações , Humanos , Masculino , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
PURPOSE: Congenital venous malformations of the lower limbs represent a particular challenge for the vascular surgeon. Persistence of fetal veins is a rare malformation, and the most common is the persistence of the lateral marginal vein usually observed in patients with Klippel-Trenaunnay Syndrome. The persistence of this embryonic vein as an isolated venous malformation without the other characteristics of the Klippel-Trenaunnay Syndrome has not yet been reported. This paper describes two cases. METHODS: Two patients, a 17-year-old male patient and a 16-year-old female, have had since their birth a large venous trunk in the lateral aspect of the right leg and thigh. The limbs underwent duplex scanning and phlebography. The surgical removal of the lateral marginal vein was performed. RESULTS: Surgical treatment resulted in very good functional and aesthetic results. Follow-up at 26 months showed no evidence of varicose vein recurrence. CONCLUSIONS: To achieve good results, surgical intervention may be indicated in cases of orthopedic deformity, hemorrhage, symptomatic, and unaesthetic lesions.
Assuntos
Síndrome de Klippel-Trenaunay-Weber/cirurgia , Perna (Membro)/irrigação sanguínea , Veias/anormalidades , Adolescente , Feminino , Seguimentos , Humanos , Perna (Membro)/cirurgia , Masculino , Flebografia , Veias/cirurgiaRESUMO
Dilatation of the common iliac arteries is one of the most frequent causes for exclusion of patients in a series of endovascular correction of abdominal aortic aneurysms (AAAs). In this article we describe the banding technique we use to constrict the large iliac arteries. Four patients underwent endovascular treatment for AAAs with bifurcated grafts. Five of the eight common iliac arteries were 16 to 20 mm in diameter and were constricted around the endoprosthesis by banding with two cotton tapes through a retroperitoneal access. An angioplasty balloon was used as a counterresistance inside the graft. Completion angiogram and postoperative computed tomographic scans showed no endoleak in all cases. No complications occurred in the follow-up (3-10 months). Banding of the common iliac artery is an efficient procedure for endoluminal correction of AAAs when the diameter of the common iliac arteries is greater than 16 mm and less than 20 mm.