RESUMO
OBJECTIVE: stroke etiology is ischemia in 85%, and in circa 25% of these, the source is the extracranial carotid. Recurrence is frequent and usually more severe. Carotid revascularization prevents new ischemic strokes. The sooner the treatment is undertaken, complete recovery chances are greater with less recurrences. But, historically, intervention in the acute setting was catastrophic. Objective: Identify determinants of success when carotid revascularization after a recent cerebral ischemic event is performed. MATERIALS AND METHODS: A cohort of 50 subjects underwent carotid revascularization after ischemic symptoms, within a period of 71 months. The currently diagnostic tools were used, and the symptoms stratified by the Rankin scale. The extension of the cerebral lesion and the source location the source of the event was analyzed. RESULTS: indications were based on the Rankin Scale (R0: 35.4%; R1: 45.8%; R2:18.8% and R3: zero), on the location of the source and the absence of ischemic areas greater than 15mm. An early surgical approach was adopted in all patients. Extreme care was applied to control arterial pressure. At discharge, no additional deficits were observed. CONCLUSIONS: carotid revascularization after ischemic events can be achieved without additional morbidity and no recurrences, using the most appropriate therapy in the shortest time, in patients with Rankin Scale up to 2, absence of intracranial hemorrhage and single or multiple ischemic intracerebral areas, with 15mm or less in their greater dimension.
Assuntos
Isquemia , Procedimentos Cirúrgicos Vasculares , Humanos , Pesquisa , Alta do PacienteRESUMO
ABSTRACT Objective: stroke etiology is ischemia in 85%, and in circa 25% of these, the source is the extracranial carotid. Recurrence is frequent and usually more severe. Carotid revascularization prevents new ischemic strokes. The sooner the treatment is undertaken, complete recovery chances are greater with less recurrences. But, historically, intervention in the acute setting was catastrophic. Objective: Identify determinants of success when carotid revascularization after a recent cerebral ischemic event is performed. Materials and Methods: A cohort of 50 subjects underwent carotid revascularization after ischemic symptoms, within a period of 71 months. The currently diagnostic tools were used, and the symptoms stratified by the Rankin scale. The extension of the cerebral lesion and the source location the source of the event was analyzed. Results: indications were based on the Rankin Scale (R0: 35.4%; R1: 45.8%; R2:18.8% and R3: zero), on the location of the source and the absence of ischemic areas greater than 15mm. An early surgical approach was adopted in all patients. Extreme care was applied to control arterial pressure. At discharge, no additional deficits were observed. Conclusions: carotid revascularization after ischemic events can be achieved without additional morbidity and no recurrences, using the most appropriate therapy in the shortest time, in patients with Rankin Scale up to 2, absence of intracranial hemorrhage and single or multiple ischemic intracerebral areas, with 15mm or less in their greater dimension.
RESUMO Introdução: isquemia é a etiologia do acidente vascular cerebral em 85% dos casos e em cerca de 25% destes, a fonte é a carótida extracraniana. Recorrência é frequente e usualmente mais grave que a inicial. A revascularização carotídea previne novos acidentes. Quanto mais cedo for realizado o tratamento, maiores as chances de recuperação e menor o risco de recorrência. Mas, historicamente, os resultados das intervenções precoces eram catastróficos. Objetivos: identificar determinantes de sucesso da revascularização carotídea após um evento isquêmico cerebral recente. Materiais e Métodos: uma coorte de 50 pacientes foi submetida à revascularização carotídea após sintomas isquêmicos, em um período de 71 meses. Foram empregados os métodos de investigação atuais e os sintomas estratificados pela Escala de Rankin. A extensão das lesões cerebrais e a fonte do evento foram estudados e analisados. Resultados: as indicações foram baseadas na escala de Rankin (R0: 35.4%; R1: 45.8%; R2: 18.8% e R3: zero), na localização da fonte e na ausência de áreas isquêmicas com menos de 15mm. Uma abordagem cirúrgica precoce foi empregada em todos os pacientes. Cuidados extremos com a pressão arterial foram aplicados. Na alta hospitalar, nenhum déficit adicional foi observado. Conclusões: a revascularização carotídea após eventos isquêmicos pode ser realizada sem morbidade adicional ou recorrências, empregando a terapêutica mais apropriada no período de tempo mais curto, em pacientes classificados como Rankin até 2, na ausência de hemorragia intracraniana e com áreas isquêmicas intracerebrais únicas ou múltiplas, com menos de 15mm em sua maior dimensão.
RESUMO
OBJECTIVE: The bell-bottom technique is a widely used technique to treat aortoiliac aneurysms with preservation of the hypogastric arteries. The published data are scarce with conflicting results regarding the evolution. The aim of this study was to compare the outcomes of patients submitted to endovascular abdominal aortic aneurysm repair with standard technique (S-EVAR) versus bell-bottom technique. METHODS: This retrospective cohort study compared the outcomes of standard endovascular aneurysm repair (<16 mm iliac limbs) and bell-bottom technique (≥16 mm iliac limbs) in a tertiary vascular center between 2010 and 2015. The end points of this study were type IB endoleak, reintervention and 30-day mortality. The follow-up protocol included CT scans within 30 days of implantation and 12 months. Duplex ultrasound was performed yearly thereafter. RESULTS: Two hundred and three patients were treated with bell-bottom technique (n = 84, mean age 72.2 ± 8.9) and S-EVAR (n = 119, mean age 72.7 ± 8.4). The overall 30-day mortality was 1.9%, with no significant difference between groups. There was higher prevalence of coronary heart disease in the bell-bottom technique group compared to the S-EVAR group (41.6% vs. 18.4%, p < 0.01). One patient in the S-EVAR group (0.85%) and four patients in the bell-bottom technique (4.6%) developed type IB endoleak. The mean follow-up period was 35.2 ± 30.4 months. By Kaplan-Meier analysis, freedom from type IB endoleak in 80 months was 85.2% in the bell-bottom technique group and 98.7% in the S-EVAR group (p = 0.05). The freedom from reintervention in 80 months was 74.0% in the bell-bottom technique group and 94.1% in the S-EVAR group (p = 0.6). CONCLUSIONS: This study shows lower freedom from type IB endoleak in the bell-bottom group compared to the standard repair group. There is no significant difference in reoperation rate and 30-day mortality.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Fatores de Tempo , Resultado do TratamentoRESUMO
Complicações relacionadas ao acesso venoso cervicotorácico, como os pseudoaneurismas (PAs), podem ser devastadoras. Neste artigo, apresentamos dois casos semelhantes em que o avanço tecnológico impactou no diagnóstico, tratamento e resultados. Ambos pacientes apresentaram volumoso PA após a tentativa de punção venosa profunda. O primeiro caso, em 1993, diagnosticado por duplex scan , revelou grande PA oriundo da artéria subclávia direita. A artéria foi abordada por esternotomia mediana com extensão supraclavicular. O PA originava-se do tronco tireocervical, tratado com simples ligadura. No segundo caso, em 2017, angiotomografia revelou um PA originário da artéria vertebral, que foi tratado com técnica endovascular, mantendo a perviedade do vaso. Ambos evoluíram satisfatoriamente, apesar de abordagens bastante diferentes. A lesão vascular cervicotorácica representa um desafio propedêutico e terapêutico, com alto risco de ruptura. Os avanços tecnológicos diminuem os riscos de lesões vasculares com acesso cirúrgico difícil e devem estar entre as opções do cirurgião vascular
Complications such as pseudoaneurysms (PA) related to cervicothoracic venous access can be devastating. In this article, we present two similar cases in which technological advances impacted diagnosis, treatment, and results. Both patients developed massive PA after deep venous puncture attempts. The first case occurred in 1993 and was diagnosed by a duplex scan that revealed a large PA originating from the right subclavian artery. The artery was approached by median sternotomy with supraclavicular extension. The PA originated from the thyrocervical trunk and was treated with simple ligation. The second case was in 2017. Angiotomography revealed a PA originating in the vertebral artery, which was treated with endovascular techniques, maintaining vessel patency. Both patients progressed satisfactorily, despite quite different approaches. Cervicothoracic vascular lesions represent a diagnostic and therapeutic challenge, where the risk of rupture is high. Technological advances have reduced the risks involved in management of vascular injuries with difficult surgical access
Assuntos
Humanos , Feminino , Idoso , Artéria Vertebral , Falso Aneurisma/terapia , Procedimentos Endovasculares , Artéria Subclávia , Cateterismo Venoso Central/métodos , Angiografia/métodos , Stents , Resultado do Tratamento , Ecocardiografia Doppler em Cores/métodos , Esternotomia/métodos , HematomaRESUMO
Complications such as pseudoaneurysms (PA) related to cervicothoracic venous access can be devastating. In this article, we present two similar cases in which technological advances impacted diagnosis, treatment, and results. Both patients developed massive PA after deep venous puncture attempts. The first case occurred in 1993 and was diagnosed by a duplex scan that revealed a large PA originating from the right subclavian artery. The artery was approached by median sternotomy with supraclavicular extension. The PA originated from the thyrocervical trunk and was treated with simple ligation. The second case was in 2017. Angiotomography revealed a PA originating in the vertebral artery, which was treated with endovascular techniques, maintaining vessel patency. Both patients progressed satisfactorily, despite quite different approaches. Cervicothoracic vascular lesions represent a diagnostic and therapeutic challenge, where the risk of rupture is high. Technological advances have reduced the risks involved in management of vascular injuries with difficult surgical access.
RESUMO
ABSTRACT About 20% of patients with abdominal aortic aneurysms have associated iliac aneurysms. Distal sealing during the endovascular treatment of aortic-iliac aneurysms is a challenge that has led to the emergence of several technical options to achieve this goal over the years. Internal iliac artery embolization is associated with the risk of ischemic complications, such as gluteal necrosis, lower limb neurological deficit, colonic ischemia, impotence and gluteal claudication. This article summarizes the technical options for endovascular treatment of aortoiliac aneurysms with different approaches to preserving the patency of internal iliac arteries.
RESUMO Cerca de 20% dos pacientes com aneurismas de aorta abdominal apresentam aneurismas ilíacos associados. A obtenção do selamento distal, durante o tratamento endovascular dos aneurismas aortoilíacos, constitui-se em um desafio que suscitou, ao longo dos anos, o surgimento de diversas opções técnicas para alcançar esse objetivo. A embolização da artéria ilíaca interna é associada ao risco de desenvolvimento de complicações isquêmicas, tais como: necrose glútea, déficit neurológico dos membros inferiores, isquemia colônica, impotência e claudicação glútea. Esse artigo resume as opções técnicas de tratamento endovascular dos aneurismas aortoilíacos com diferentes formas de abordagem de preservação da perviedade das artérias ilíacas internas.
Assuntos
Humanos , Masculino , Feminino , Aneurisma Ilíaco/terapia , Aneurisma da Aorta Abdominal/terapia , Implante de Prótese Vascular , Procedimentos Endovasculares , Stents , Resultado do Tratamento , Artéria IlíacaRESUMO
About 20% of patients with abdominal aortic aneurysms have associated iliac aneurysms. Distal sealing during the endovascular treatment of aortic-iliac aneurysms is a challenge that has led to the emergence of several technical options to achieve this goal over the years. Internal iliac artery embolization is associated with the risk of ischemic complications, such as gluteal necrosis, lower limb neurological deficit, colonic ischemia, impotence and gluteal claudication. This article summarizes the technical options for endovascular treatment of aortoiliac aneurysms with different approaches to preserving the patency of internal iliac arteries.
Assuntos
Aneurisma da Aorta Abdominal/terapia , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Ilíaco/terapia , Feminino , Humanos , Artéria Ilíaca , Masculino , Stents , Resultado do TratamentoRESUMO
We evaluated the outcome of the retrograde endovascular hypogastric artery preservation (REHAP) technique for the treatment of complex aortoiliac aneurysms (AIAs). Perioperative and long-term outcomes were assessed for 12 patients (mean age 77 years, range 64-86 years) who underwent elective endovascular AIA repair via aortouniiliac endografting and REHAP between January 2004 and January 2011. Preoperative images obtained by computed tomography were used for planning. Postoperative images were obtained one and six months after surgery, and once a year thereafter. Technical success was achieved in all cases. No patients exhibited endoleak related to the endoprosthesis, occlusion of implanted components, hip and/or buttock claudication, or colon or spinal cord ischemia during follow-up. This hybrid procedure illustrates the potential of REHAP in the treatment of AIA cases.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Artéria Ilíaca/cirurgia , Pelve/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Procedimentos Cirúrgicos Eletivos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJETIVO: Avaliar o resultado do implante de filtro em veia cava inferior empregando angiografia digital por subtração com dioxide de carbono (CO2) como meio de contraste. MÉTODOS: No período de abril de 2010 a fevereiro de 2011, sete pacientes foram submetidos ao implante de filtro na veia cava inferior, utilizando-se CO2 como meio de contraste em subtração digital. Os pacientes apresentaram como critério de inclusão trombose venosa profunda no setor ilíaco-femoral e contraindicação à anticoagulação. RESULTADOS: Foi obtido sucesso técnico em todos os casos, com adequada visualização da veia cava e veias renais, não havendo complicações relacionadas ao uso do CO2 ou ao procedimento. CONCLUSÃO: O implante de filtro de veia cava utilizando o CO2 como meio de contraste é segura e efetiva em pacientes portadores de alergia ao contraste iodado ou com insuficiência renal não dialítica.
OBJECTIVE: To assess the use of digital subtraction with carbon dioxide (CO2 ) for vena cava filter implant. METHODS: From April (2)010 to February (2)011, seven patients underwent inferior vena cava filter placement with digital subtraction angiography with the use of CO2 as contrast media. All patients had iliac and femoral deep venous thrombosis and contraindications for anticoagulation. RESULTS: Technical success was achieved in all cases. Inferior vena cava e renal veins were identified in all cases. There were no evidences of complications related to the use of CO2 during or after the procedure. CONCLUSION: The placement of inferior vena cava filter with CO2 and digital subtraction angiography is safe and effective with good results in patients with renal insufficiency and allergy to iodine.
Assuntos
Humanos , Angiografia Digital/métodos , Dióxido de Carbono , Trombose Venosa/diagnóstico , Filtros de Veia CavaRESUMO
CONTEXTO: A relação entre trombose venosa profunda e trombofilia tem sido pouco estudada em indivíduos portadores de compressão da veia ilíaca comum esquerda, conhecida clinicamente como síndrome de May-Thurner. OBJETIVO: Avaliar a prevalência de marcadores de trombofilia nos pacientes portadores de síndrome de May-Thurner e trombose de veia ilíaca comum esquerda. MÉTODOS: Entre março de 1999 e dezembro de 2008, 20 pacientes com síndrome de May-Thurner e trombose de veia ilíaca comum esquerda foram avaliados retrospectivamente quanto à presença de marcadores de trombofilia. RESULTADOS: Foi detectada a associação entre síndrome de May-Thurner e marcadores de trombofilia em 8 pacientes (40 por cento). CONCLUSÃO: A presença de marcadores de trombofilia em pacientes com trombose de veia ilíaca comum esquerda e síndrome de May-Thurner é frequente, porém não difere da prevalência encontrada em pacientes portadores de trombose venosa profunda sem a síndrome associada.
BACKGROUND: The relationship between deep venous thrombosis and thrombophilia has been little studied in patients with left common iliac vein compression, clinically known as May-Thurner syndrome. OBJECTIVE: To evaluate the prevalence of thrombophilia markers in patients with May-Thurner syndrome and left common iliac vein thrombosis. METHODS: From March 1999 to December 2008, 20 patients with May-Thurner syndrome and left common iliac vein thrombosis were retrospectively investigated for the presence of thrombophilia markers. RESULTS: The association between May-Thurner syndrome and thrombophilia markers was found in 8 patients (40 percent). CONCLUSION: There is a high prevalence of thrombophilia markers in patients with May-Thurner syndrome and left common iliac vein thrombosis. The prevalence, however, is not different from that found in patients with deep venous thrombosis without May-Thurner syndrome.