RESUMO
Major abdominal arteriovenous fistula (AVF) is a rare clinical condition defined as an abnormal communication between the aorta or iliac arteries and the inferior vena cava or the iliac or renal veins. Penetrating trauma, including iatrogenic injuries, accounts for less than 20% of these AVFs. Endovascular techniques were useful in the management of vascular lesions. The authors report the case of a patient with high-output heart failure and high-flow AVF between the left external iliac artery and the left external iliac vein manifested 17 years after a gunshot wound. Endovascular approach was satisfactorily performed with the implantation of a septal occlusion device to interrupt abnormal vascular communication and preserve artery and vein patency. There were improvement of symptoms and control images showed arteriovenous communication closure.
Assuntos
Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/cirurgia , Corpos Estranhos/complicações , Hemodinâmica , Artéria Ilíaca/cirurgia , Veia Ilíaca/cirurgia , Adulto , Procedimentos Endovasculares , Humanos , Masculino , Ferimentos por Arma de Fogo/complicaçõesRESUMO
Free-floating thrombus in the deep venous system has a high potential to cause pulmonary embolization. It can also be found in patients with superficial venous thrombosis (SVT) that extends to a deep vein. There are still no defined criteria for treatments described in the literature, which range from anticoagulation and fibrinolytic treatments with vena cava filter implants, through open or endovascular thrombectomies, to more invasive procedures such as surgical interruption with ligation of the venous system. We present the case of a patient with extensive deep venous thrombosis affecting the iliofemoral-popliteal territory with a floating thrombus extending from the left common iliac vein to the inferior vena cava. Treatment was performed with fibrinolytic therapy delivered with a multiperforated catheter, supplemented with anticoagulation with heparin and daily control angiography. At the end of the treatment, a significant stenosis was identified in the left common iliac vein, and angioplasty was performed with stenting.
RESUMO
Resumo O trombo flutuante no sistema venoso profundo manifesta elevado potencial de embolização pulmonar. Pode também ser encontrado em pacientes com trombose venosa superficial (TVS) com extensão para uma veia profunda. Os tratamentos descritos na literatura, ainda sem critérios definidos, variam desde anticoagulação e tratamentos fibrinolíticos com implantes de filtros de veia cava, trombectomias abertas ou com dispositivos endovasculares até condutas mais invasivas como a interrupção cirúrgica com ligadura do sistema venoso. Apresentamos o caso de uma paciente com trombose venosa profunda extensa, acometendo o território ilíaco-fêmoro-poplíteo com um trombo flutuante estendendo-se da veia ilíaca comum esquerda até a veia cava inferior. O tratamento foi realizado com terapia fibrinolítica com um cateter multiperfurado, associado a anticoagulação com heparina e a controles angiográficos diários. Ao final do tratamento, foi identificada uma estenose significativa na veia ilíaca comum esquerda, sendo realizada angioplastia com implante de stent.
Abstract Free-floating thrombus in the deep venous system has a high potential to cause pulmonary embolization. It can also be found in patients with superficial venous thrombosis (SVT) that extends to a deep vein. There are still no defined criteria for treatments described in the literature, which range from anticoagulation and fibrinolytic treatments with vena cava filter implants, through open or endovascular thrombectomies, to more invasive procedures such as surgical interruption with ligation of the venous system. We present the case of a patient with extensive deep venous thrombosis affecting the iliofemoral-popliteal territory with a floating thrombus extending from the left common iliac vein to the inferior vena cava. Treatment was performed with fibrinolytic therapy delivered with a multiperforated catheter, supplemented with anticoagulation with heparin and daily control angiography. At the end of the treatment, a significant stenosis was identified in the left common iliac vein, and angioplasty was performed with stenting.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Trombose Venosa/terapia , Fibrinolíticos/uso terapêutico , Síndrome de May-Thurner/terapia , Veia Cava Inferior , Heparina/uso terapêutico , Stents , Terapia Trombolítica , Angioplastia , Extremidade Inferior , Veia IlíacaRESUMO
BACKGROUND: Placenta accreta is an important factor in maternal morbidity and mortality and is responsible for approximately 64% of emergency hysterectomy cases and about 2/3 of cases of puerperal bleeding. OBJECTIVES: To describe a series of cases of prophylactic uterine catheterization performed to prevent significant postpartum bleeding or during caesarean delivery in pregnant women with a previous diagnosis of accretion. METHODS: A retrospective analysis was conducted of medical records of cases of uterine artery catheterization performed during elective or emergency caesarean sections of patients at high risk of postpartum bleeding. RESULTS: The catheterization of uterine arteries procedure was performed in fourteen patients. Mean duration of surgery and hospital stay were 214.64 minutes (± 42.16) and 7 days, respectively. All patients underwent obstetric hysterectomy. No patient required embolization. There was no bleeding or need to revisit any patient and there were no complications related to puncture. There was one fetal death and no maternal deaths. CONCLUSIONS: In this study, prophylactic uterine artery catheterization with temporary occlusion of blood flow proved to be a safe technique with low fetal mortality, no maternal mortality, and a low rate of blood transfusion and can be considered an important and effective therapeutic strategy for reduction of maternal morbidity and mortality, especially in pregnant women with anomalous placental attachment. Furthermore, the possibility of uterine preservation with the use of this method is an excellent contribution to therapeutic management of this group of patients. However, randomized clinical trials are needed to evaluate the effectiveness of routine use of the technique.
RESUMO
Venous thromboembolism (VTE) is a common disease with high rates of morbidity and mortality and is considered the number one cause of avoidable mortality among hospitalized patients. Although VTE incidence is extremely high in all countries and there is ample evidence that thromboprophylaxis inexpensively reduces the rate of thromboembolic complications in both clinical and surgical patients, a great deal of doubt remains with respect to patient safety with this type of intervention and in relation to the ideal thromboprophylaxis methods. Countless studies and evidence-based recommendations confirm the efficacy of prophylaxis for prevention of VTE and/or patient deaths, but it remains underutilized to this day. This article presents a wide-ranging review of existing prophylaxis methods up to the present, from guidelines and national and international studies of thromboprophylaxis.
RESUMO
Malformations of inferior vena cava (IVC) as agenesis are a rare congenital anomaly and cause of deep venous thrombosis (DVT) of lower limbs and should be investigated in young patients of unknown aetiology. Treatment with mechanical thrombectomy and thrombolysis can be considered in certain cases of DVT, promoting rapid clot removal, and has also been shown to be an effective treatment in acute DVT. We present a case of acute lower limb DVT associated with IVC agenesis in which Alteplase thrombolysis was used and thrombus aspiration with catheter bilaterally, with subsequent angioplasty of the common and external iliac, obtaining satisfactory results.
Assuntos
Trombectomia/métodos , Terapia Trombolítica/métodos , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/cirurgia , Doença Aguda , Adulto , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Flebografia , Resultado do Tratamento , Ultrassonografia Doppler , Veia Cava Inferior/anormalidades , Trombose Venosa/diagnóstico por imagemRESUMO
Haemosuccus pancreaticus (HP) is an uncommon cause of upper gastrointestinal (GI) bleeding, most often intermittent, making it difficult to diagnose, becoming fatal. It usually occurs in patients with chronic pancreatitis and is caused by the rupture of a visceral aneurysm within the main pancreatic duct. The association between pseudoaneurysm formation and pancreatitis is well established. Pseudoaneurysm occurs in 3.5%-10% of pancreatitis cases and its rupture is a rare but life-threatening complication of chronic pancreatitis occurring in 6%-8% of patients with pseudocysts and corresponds to less than 1% of cases of GI bleeding.Its diagnosis is challenging, given the intermittent nature of bleeding. Angiographic therapy is considered the first-choice treatment, especially in patients who are stable haemodynamically. We present a case of embolisation of inferior pancreaticoduodenal branches with polyvinyl alcohol microparticles in the treatment of HP.
Assuntos
Falso Aneurisma/diagnóstico por imagem , Embolização Terapêutica , Hemorragia Gastrointestinal/diagnóstico por imagem , Artéria Mesentérica Superior/diagnóstico por imagem , Pâncreas/irrigação sanguínea , Pancreatopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Dor Abdominal/diagnóstico por imagem , Adulto , Falso Aneurisma/fisiopatologia , Falso Aneurisma/terapia , Angiografia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Melena , Artéria Mesentérica Superior/fisiopatologia , Pâncreas/diagnóstico por imagem , Pancreatopatias/fisiopatologia , Pancreatopatias/terapia , Álcool de Polivinil/administração & dosagem , Resultado do TratamentoRESUMO
A placenta acreta é um importante causa de morbimortalidade materna, sendo responsável por aproximadamente 64% dos casos de histerectomia de urgência e em torno de 2/3 dos casos de sangramento puerperal. Objetivos Descrever uma série de casos de cateterização uterina profilática para evitar sangramento significativo no pós-parto ou durante parto cesárea em gestantes com diagnóstico prévio de acretismo. Métodos Foi realizada uma análise retrospectiva de prontuários dos casos de cateterização da artéria uterina durante cesarianas eletivas ou de urgência em pacientes com alto risco de sangramento puerperal. Resultados O procedimento foi realizado em 14 pacientes. O tempo médio do procedimento cirúrgico e da internação foi de 214,64 minutos (± 42,16) e 7 dias, respectivamente. Todas as pacientes foram submetidas a histerectomia por indicação obstétrica. Nenhuma paciente necessitou de embolização. Não houve sangramento ou necessidade de reabordagem em nenhuma paciente e nenhuma complicação relacionada à punção. Houve apenas um caso de morte fetal e nenhuma morte materna. Conclusões Neste estudo, a cateterização profilática de artérias uterinas com oclusão temporária do fluxo sanguíneo demonstrou ser uma técnica segura, pois apresentou baixa mortalidade fetal, baixa necessidade de hemotransfusão, e nenhuma morte materna. Portanto, pode ser considerada uma estratégia terapêutica importante e eficaz para a diminuição da morbimortalidade materna, especialmente em gestantes com implantação placentária anômala. Além disso, a possibilidade de preservação uterina com o uso do método traz excelente contribuição na terapêutica nesse grupo de pacientes. Entretanto, são necessários ensaios clínicos randomizados para avaliar a eficácia do uso rotineiro da técnica
Placenta accreta is an important factor in maternal morbidity and mortality and is responsible for approximately 64% of emergency hysterectomy cases and about 2/3 of cases of puerperal bleeding. Objectives To describe a series of cases of prophylactic uterine catheterization performed to prevent significant postpartum bleeding or during caesarean delivery in pregnant women with a previous diagnosis of accretion. Methods A retrospective analysis was conducted of medical records of cases of uterine artery catheterization performed during elective or emergency caesarean sections of patients at high risk of postpartum bleeding. Results The catheterization of uterine arteries procedure was performed in fourteen patients. Mean duration of surgery and hospital stay were 214.64 minutes (± 42.16) and 7 days, respectively. All patients underwent obstetric hysterectomy. No patient required embolization. There was no bleeding or need to revisit any patient and there were no complications related to puncture. There was one fetal death and no maternal deaths. Conclusions In this study, prophylactic uterine artery catheterization with temporary occlusion of blood flow proved to be a safe technique with low fetal mortality, no maternal mortality, and a low rate of blood transfusion and can be considered an important and effective therapeutic strategy for reduction of maternal morbidity and mortality, especially in pregnant women with anomalous placental attachment. Furthermore, the possibility of uterine preservation with the use of this method is an excellent contribution to therapeutic management of this group of patients. However, randomized clinical trials are needed to evaluate the effectiveness of routine use of the technique
Assuntos
Humanos , Feminino , Adulto , Cateterismo , Artéria Uterina , Hemorragia Pós-Parto/terapia , Placenta Acreta , Complicações na Gravidez , Útero , Espectroscopia de Ressonância Magnética/métodos , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia/métodos , Embolização Terapêutica/métodos , Entorno do Parto , Histerectomia/métodosRESUMO
O tromboembolismo venoso (TEV) é uma doença frequente e de alta morbimortalidade, sendo considerada a maior causa evitável de mortalidade em pacientes hospitalizados. Apesar da incidência altíssima de TEV em todos os países e das evidências de que a tromboprofilaxia reduz as complicações tromboembólicas em pacientes clínicos e cirúrgicos, e a custo baixo, persistem grandes dúvidas quanto à segurança desse tipo de intervenção nos pacientes e quanto à tromboprofilaxia ideal. Inúmeros estudos e recomendações baseadas em evidências comprovam a eficácia da profilaxia na prevenção do TEV e/ou da morte dos pacientes, mas ainda hoje ela é subutilizada. Neste artigo, apresentamos uma ampla revisão dos métodos de profilaxia existentes até os dias atuais, publicados em diretrizes e estudos nacionais e internacionais sobre tromboprofilaxia
Venous thromboembolism (VTE) is a common disease with high rates of morbidity and mortality and is considered the number one cause of avoidable mortality among hospitalized patients. Although VTE incidence is extremely high in all countries and there is ample evidence that thromboprophylaxis inexpensively reduces the rate of thromboembolic complications in both clinical and surgical patients, a great deal of doubt remains with respect to patient safety with this type of intervention and in relation to the ideal thromboprophylaxis methods. Countless studies and evidence-based recommendations confirm the efficacy of prophylaxis for prevention of VTE and/or patient deaths, but it remains underutilized to this day. This article presents a wide-ranging review of existing prophylaxis methods up to the present, from guidelines and national and international studies of thromboprophylaxis
Assuntos
Humanos , Masculino , Feminino , Prevenção de Doenças , Tromboembolia Venosa/prevenção & controle , Pacientes Internados , Embolia Pulmonar/terapia , Fatores de Risco , Guias de Prática Clínica como Assunto/normas , Enoxaparina/uso terapêutico , Extremidade Inferior , Inibidores do Fator Xa/uso terapêutico , Rivaroxabana/uso terapêutico , Dabigatrana/uso terapêutico , Hemorragia/complicações , Anticoagulantes/uso terapêuticoRESUMO
Pancreatic haemangiomas are benign vascular tumours very rare in adults. Twenty-two cases are described in the literature. The symptoms are non-specific, and therefore rarely clinically suspected, and the vast majority are incidental findings in imaging tests such as ultrasound, CT, angiography or MRI. They appear on CT as a cystic lesion with contrast enhancement in the arterial phase. We present the case of a 36-year-old male patient with no history of disease, referred with lumbar pain and suspected renal calculus after tomography showing hypervascular enhancement in the pancreatic body and infiltrative lesion (possible neuroendocrine neoplasia) on MRI and biliopancreatic echoendoscopy. He was submitted to laparotomy with subtotal pancreatectomy and splenectomy and satisfactory evolution.