RESUMEN
Aortic injuries represent a rare but life-threatening complication of spinal surgery. Perforation of the aorta due to pedicle screw penetration or misplacement can lead to immediate bleeding with hemodynamic instability or to pseudoaneurysm development with delayed risk of rupture, which can occur weeks to months later. Recently, thoracic endovascular aortic repair (TEVAR) in aortic trauma has contributed to a reduction of both mortality and morbidity. The literature on this subject is reviewed.
Asunto(s)
Aorta Torácica/lesiones , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Fijación Interna de Fracturas/efectos adversos , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas/lesiones , Lesiones del Sistema Vascular/cirugía , Adulto , Aorta Torácica/cirugía , Tornillos Óseos/efectos adversos , Remoción de Dispositivos , Fijación Interna de Fracturas/instrumentación , Humanos , Masculino , Vértebras Torácicas/cirugía , Lesiones del Sistema Vascular/diagnóstico , Lesiones del Sistema Vascular/etiologíaRESUMEN
Central venous thrombosis may often arise following central venous cannulation for temporary haemodialysis access. Venous thrombosis may be clinically asymptomatic due to the presence of collateral circulation. However, if an arteriovenous (AV) fistula is prepared below the obstructed venous segment, then symptoms may occur. Central venous hypertension interferes with dialysis, compromises limb function and threatens its safety. Percutaneous treatment is mostly used. However, in some cases endovascular treatment may not be as easy and long term patency uncertain.We report our experience on 3 patients on chronic hemodialysis treatment presenting with a patent AV fistula and ipsilateral subclavian vein chronic fibrotic obstruction. They were treated by ipsilateral internal jugular to distal subclavian vein transposition. Two separate surgical incisions were performed to expose the subclavian vein distally to the occlusion and the jugular vein that was distally ligated and transposed. There was no mortality nor significant postoperative complications. Resolution of hypertensive symptoms was achieved within 3-4 weeks in all patients. The AV fistula was used for dialysis treatment starting from the first postoperative day. At follow-up (mean 13 months), there was no recurrence of upper limb venous hypertension.In patients with subclavian occlusion and ipsilateral low flow, patent AV fistula, jugular to distal subclavian vein transposition may prove useful in cases when percutaneous angioplasty is technically not feasible or long term patency is not expected.
Asunto(s)
Derivación Arteriovenosa Quirúrgica/efectos adversos , Cateterismo Venoso Central/efectos adversos , Presión Venosa Central , Descompresión Quirúrgica/métodos , Venas Yugulares/cirugía , Diálisis Renal , Vena Subclavia/cirugía , Trombosis Venosa Profunda de la Extremidad Superior/etiología , Anciano , Vena Axilar/cirugía , Circulación Colateral , Femenino , Fibrosis , Humanos , Venas Yugulares/diagnóstico por imagen , Venas Yugulares/fisiopatología , Masculino , Persona de Mediana Edad , Flebografía , Reoperación , Vena Subclavia/diagnóstico por imagen , Vena Subclavia/fisiopatología , Resultado del Tratamiento , Trombosis Venosa Profunda de la Extremidad Superior/diagnóstico por imagen , Trombosis Venosa Profunda de la Extremidad Superior/fisiopatologíaRESUMEN
The superficial femoral artery is the most frequently injured vessel in lower limb traumas. The traumatic agents responsible may be gunshot, blunt instrument and stab wounds. Preoperative angiography is often used to choose the most appropriate surgical approach for limb salvage. We report a case of a traumatic gunshot lesion of the superficial femoral artery surgically treated with a great saphenous vein bypass without preoperative angiography.
Asunto(s)
Arteria Femoral/lesiones , Arteria Femoral/cirugía , Heridas por Arma de Fuego/cirugía , Adulto , Angiografía , Humanos , MasculinoRESUMEN
The purpose of this study was to compare magnetic resonance angiography with duplex ultrasound for defining anatomical features relevant to performing lower limb revascularisation. From June 2003 to June 2004, 30 consecutive patients with chronic lower limb ischaemia underwent magnetic resonance angiography and duplex ultrasound investigations before undergoing lower limb revascularisation procedures. The mean age was 72 years (range: 45-93). Indications for the procedure included resting pain (6 cases), ischaemic ulcer (8 cases), and gangrene (16 cases). We compared magnetic resonance angiography and duplex ultrasonography findings and the differences in the aorto-iliac, femoro-popliteal and infrapoliteal segments were noted. Magnetic resonance angiography and duplex ultrasound findings agreed in 13/15 cases (86%) in the aorto-iliac segment, in 14/17 (82%) in the femoro-popliteal segment, and in 8/11 (74%) in the infrapopliteal segment. In all, duplex ultrasound agreed with intraoperative findings in 97% of cases while magnetic resonance angiography agreed in 81%. These data show that magnetic resonance angiography is less accurate than duplex ultrasound in the infrapopliteal segment. Adeguate training is necessary before duplex ultrasound can be used as the only preoperative imaging procedure.
Asunto(s)
Angioplastia de Balón , Implantación de Prótesis Vascular , Gangrena/diagnóstico , Gangrena/terapia , Isquemia/diagnóstico , Isquemia/terapia , Úlcera de la Pierna/diagnóstico , Úlcera de la Pierna/terapia , Pierna/irrigación sanguínea , Angiografía por Resonancia Magnética , Ultrasonografía Doppler Dúplex , Anciano , Anciano de 80 o más Años , Prótesis Vascular , Enfermedad Crónica , Interpretación Estadística de Datos , Femenino , Gangrena/diagnóstico por imagen , Gangrena/cirugía , Humanos , Isquemia/diagnóstico por imagen , Isquemia/cirugía , Pierna/diagnóstico por imagen , Pierna/cirugía , Úlcera de la Pierna/diagnóstico por imagen , Úlcera de la Pierna/cirugía , Recuperación del Miembro , Masculino , Persona de Mediana Edad , Politetrafluoroetileno , Cuidados Preoperatorios , Factores de RiesgoRESUMEN
The retroperitoneal approach for the treatment of thoracoabdominal type IV and infrarenal aortic aneurysms is an accepted alternative to thoraco-phrenolaparotomy. The purpose of this retrospective study was to report our experience and results in terms of respiratory and renal complications. From January 1997 to December 2003, 48 patients (36 with thoracoabdominal type IV and 12 with infrarenal aortic aneurysms) were treated by a retroperitoneal extrapleural approach in intercostal space X or XI. We performed 40 aorto-aortic and 8 aorto-basilar reconstructions. The perioperative mortality was 2%. Postoperative respiratory insufficiency was 8%, and postoperative renal insufficiency 12%. Permanent dialysis was necessary in 4% of cases. The survival rates were 98%, 89.4% and 58.7 at 1, 5 and 7 years, respectively. Retroperitoneal extrapleural access with a partial phrenotomy results in a significantly reduced incidence of postoperative respiratory complications.
Asunto(s)
Aneurisma de la Aorta/cirugía , Espacio Retroperitoneal/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Anciano , Arteria Basilar/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversosRESUMEN
The purpose of this study was to assess which modalities offered the best timing in the treatment of abdominal aortic aneurysms associated with other abdominal surgical diseases. From January 1984 to December 2002, 372 patients underwent surgery for abdominal aortic aneurysms, 350 men (94%) and 22 women (6%), mean age 72 years. Of these 10% were operated on urgently. The traditional open technique was used in 307 patients, and the endovascular method in the remaining 65 cases. In 40 patients (11%) we observed other associated abdominal diseases which were treated during the same operation in 34 cases (85%). We had three deaths in the 34 cases treated in the same operation (9%). In the remaining cases no perioperative mortality was registered. There were no cases of prosthesis infection. The mean hospital stay was 9 days. Simultaneous treatment appears, on the one hand, to carry an increased operative risk and increased mortality and, on the other, to present the advantage of having to perform only one surgical procedure. The advent of the endovascular method allows us to postpone the treatment of the associated disease without increasing the technical difficulty of the second operation.