RESUMEN
Introducción El fingolimod es un agonista del receptor de esfingosina-1-fosfato utilizado para el tratamiento de la esclerosis múltiple (EM). Nuestro objetivo era evaluar los resultados del fingolimod en la calidad de vida de los pacientes con EM recurrente-remitente tras dos años de tratamiento en este estudio de la vida real. Pacientes y métodos Se trata de un estudio observacional prospectivo de dos años de duración realizado en Bulgaria en pacientes con EM recurrente-remitente tratados con fingolimod. Se evaluó la calidad de vida mediante la versión en búlgaro de la escala Multiple Sclerosis Quality of Life-54 (MSQoL-54). El criterio de valoración principal fue el cambio respecto al valor inicial en la puntuación en la MSQoL-54 tras dos años de tratamiento. Los criterios de valoración secundarios fueron el cambio respecto al valor inicial en la puntuación en la MSQoL-54 tras un año de tratamiento, además de la evaluación del nivel de depresión mediante la puntuación de la escala de puntuación de la depresión de Hamilton (HAM-D17). Resultados En el estudio se incluyó a 87 pacientes elegibles con una edad media de 38,7 ± 8,45 años. La mediana de la puntuación en la Expanded Disability Status Scale (EDSS) fue de 3,5 puntos. Se halló una mejora estadísticamente significativa en 10 subescalas en el mes 12 y en siete subescalas en el mes 24. La puntuación combinada de salud mental aumentó de 64 ± 16,69 puntos a 67,5 ± 15,94 puntos en el mes 24 (p = 0,012). La puntuación combinada de salud física aumentó de 61,7 ± 17,61 a 66,3 ± 16,7 (p = 0,001). El nivel de depresión medido por la HAM-D17 disminuyó considerablemente en el mes 12 y en el mes 24. La puntuación de la EDSS disminuyó o se mantuvo estable en más de la mitad de los pacientes (61,6%). Detectamos una mejor calidad de vida en los pacientes con una puntuación más baja en la EDSS. Conclusiones Las puntuaciones de calidad de vida y el nivel de depresión mejoraron ... (AU)
INTRODUCTION Fingolimod, a sphingosine-1-phosphate receptor agonist used for the treatment of multiple sclerosis (MS). Our goal was to assess the impact of fingolimod on quality of life in patients with relapsing-remitting multiple sclerosis (RRMS) after 2 years of treatment in this real-world study. PATIENTS AND METHODS This was a 2-year, prospective, observational study conducted in Bulgaria in RRMS patients treated with fingolimod. Quality of life was assessed using the Bulgarian-language version of the MSQoL-54 scale. The primary endpoint was the change from baseline in the MSQoL-54 score after 2 years of treatment. Secondary endpoints included the change from baseline in the MSQoL-54 score after one year of treatment, furthermore the assessment of depression level using the Hamilton D-17 score. RESULTS A total of 87 eligible patients were included in the study with a mean age of 38.7 ± 8.45 years. The median Expanded Disability Status Scale (EDSS) score was 3.5 points. We found statistically significant improvement in 10 subscales at month 12 and in seven subscales at month 24. The mental health composite score increased from 64.0 ± 16.69 points to 67.5 ± 15.94 points at month 24 (p = 0.012). The physical health composite score increased from 61.7 ± 17.61 to 66.3 ± 16.70 (p = 0.001). Depression level measured by the HAM-D17 decreased significantly by month 12 and month 24. The EDSS score decreased or remained stable in more than half of the patients (61.6%). We detected better quality of life in patients with a lower EDSS score. CONCLUSIONS Quality of life scores and the depression level are improved in RRMS patients treated with fingolimod over 2 years in real-life setting. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Esclerosis Múltiple/tratamiento farmacológico , Clorhidrato de Fingolimod/administración & dosificación , Clorhidrato de Fingolimod/uso terapéutico , Calidad de Vida , Depresión , Disfunciones Sexuales Fisiológicas , Trastornos del Movimiento , Bulgaria , Estudios ProspectivosRESUMEN
INTRODUCTION: Fingolimod, a sphingosine-1-phosphate receptor agonist used for the treatment of multiple sclerosis (MS). Our goal was to assess the impact of fingolimod on quality of life in patients with relapsing-remitting multiple sclerosis (RRMS) after 2 years of treatment in this real-world study. PATIENTS AND METHODS: This was a 2-year, prospective, observational study conducted in Bulgaria in RRMS patients treated with fingolimod. Quality of life was assessed using the Bulgarian-language version of the MSQoL-54 scale. The primary endpoint was the change from baseline in the MSQoL-54 score after 2 years of treatment. Secondary endpoints included the change from baseline in the MSQoL-54 score after one year of treatment, furthermore the assessment of depression level using the Hamilton D-17 score. RESULTS: A total of 87 eligible patients were included in the study with a mean age of 38.7 ± 8.45 years. The median Expanded Disability Status Scale (EDSS) score was 3.5 points. We found statistically significant improvement in 10 subscales at month 12 and in seven subscales at month 24. The mental health composite score increased from 64.0 ± 16.69 points to 67.5 ± 15.94 points at month 24 (p = 0.012). The physical health composite score increased from 61.7 ± 17.61 to 66.3 ± 16.70 (p = 0.001). Depression level measured by the HAM-D17 decreased significantly by month 12 and month 24. The EDSS score decreased or remained stable in more than half of the patients (61.6%). We detected better quality of life in patients with a lower EDSS score. CONCLUSIONS: Quality of life scores and the depression level are improved in RRMS patients treated with fingolimod over 2 years in real-life setting.
TITLE: Eficacia en la vida real del fingolimod en pacientes con esclerosis múltiple en Bulgaria.Introducción. El fingolimod es un agonista del receptor de esfingosina-1-fosfato utilizado para el tratamiento de la esclerosis múltiple (EM). Nuestro objetivo era evaluar los resultados del fingolimod en la calidad de vida de los pacientes con EM recurrente-remitente tras dos años de tratamiento en este estudio de la vida real. Pacientes y métodos. Se trata de un estudio observacional prospectivo de dos años de duración realizado en Bulgaria en pacientes con EM recurrente-remitente tratados con fingolimod. Se evaluó la calidad de vida mediante la versión en búlgaro de la escala Multiple Sclerosis Quality of Life-54 (MSQoL-54). El criterio de valoración principal fue el cambio respecto al valor inicial en la puntuación en la MSQoL-54 tras dos años de tratamiento. Los criterios de valoración secundarios fueron el cambio respecto al valor inicial en la puntuación en la MSQoL-54 tras un año de tratamiento, además de la evaluación del nivel de depresión mediante la puntuación de la escala de puntuación de la depresión de Hamilton (HAM-D17). Resultados. En el estudio se incluyó a 87 pacientes elegibles con una edad media de 38,7 ± 8,45 años. La mediana de la puntuación en la Expanded Disability Status Scale (EDSS) fue de 3,5 puntos. Se halló una mejora estadísticamente significativa en 10 subescalas en el mes 12 y en siete subescalas en el mes 24. La puntuación combinada de salud mental aumentó de 64 ± 16,69 puntos a 67,5 ± 15,94 puntos en el mes 24 (p = 0,012). La puntuación combinada de salud física aumentó de 61,7 ± 17,61 a 66,3 ± 16,7 (p = 0,001). El nivel de depresión medido por la HAM-D17 disminuyó considerablemente en el mes 12 y en el mes 24. La puntuación de la EDSS disminuyó o se mantuvo estable en más de la mitad de los pacientes (61,6%). Detectamos una mejor calidad de vida en los pacientes con una puntuación más baja en la EDSS. Conclusiones. Las puntuaciones de calidad de vida y el nivel de depresión mejoraron en los pacientes con EM recurrente-remitente tratados con fingolimod durante dos años en un entorno real.
Asunto(s)
Esclerosis Múltiple Recurrente-Remitente , Esclerosis Múltiple , Humanos , Adulto , Persona de Mediana Edad , Clorhidrato de Fingolimod/uso terapéutico , Esclerosis Múltiple/tratamiento farmacológico , Bulgaria , Calidad de Vida , Estudios Prospectivos , Esclerosis Múltiple Recurrente-Remitente/tratamiento farmacológico , Inmunosupresores/uso terapéuticoRESUMEN
The study involves 70 patients for the period from 1990 till 2001. Male are 60 of them and female are 10 patients. A total of 77 surgical procedures were performed on these patients with highest number per year are 1990 and 2001. Results are as follows: patent reconstruction--47, graft thrombosis not requiring immediate amputation--18, graft thrombosis requiring immediate amputation--11, and death in one case. Fifty five patients had grafts to the bellow the knee popliteal artery, and 23 of them received grafts to a tibial or peroneal artery. The stage distribution of patients is as follows: stage II--5 patients, stage III--50 patients, and stage IV--22 patients. Rethrombosis rate increased with the higher stages of the disease. In six cases ipsilateral deep venous thrombosis was diagnosed by duplex ultrasound study. Synthetic grafts were used in 24 of patients, nine of them received composed grafts, and in 38 cases venous conduits were employed. Diabetes mellitus was a comorbid condition in 13 patients. Thirty one (40.26%) of the grafts thrombosed.
Asunto(s)
Arteriopatías Oclusivas/cirugía , Arterias , Rodilla/irrigación sanguínea , Anciano , Amputación Quirúrgica , Angiografía , Arteriopatías Oclusivas/diagnóstico por imagen , Arterias/cirugía , Arterias/trasplante , Prótesis Vascular , Enfermedad Crónica , Femenino , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/cirugía , Humanos , Recuperación del Miembro , Masculino , Persona de Mediana Edad , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/cirugía , Arteria Poplítea/trasplante , Estudios Retrospectivos , Arterias Tibiales/diagnóstico por imagen , Arterias Tibiales/cirugía , Arterias Tibiales/trasplante , Resultado del Tratamiento , Ultrasonografía , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/cirugíaRESUMEN
We operated 51 patients with chronic arterial occlusions of the bellow knee arteries in 2002 and 2003. Sixteen patients had foot lesions, and 8 of them had bones involved (most frequently--the toes). The rest had only skin and soft tissue involvement in the lesions. In most of the cases surgery (toe amputation or debridement) of those lesions was performed as a second stage procedure following the arterial reconstruction. The lesions of the skin and soft tissue are treated with wet to dry antiseptic dressings, and in three cases systemic antibiotic therapy was applied, because of clinical signs for severe infection. In cases of extensive necrotic lesions, they are debrided at the time of arterial surgery, in an effort to limit the risk of systemic sepsis and graft contamination.
Asunto(s)
Arteriopatías Oclusivas , Enfermedades del Pie/cirugía , Rodilla/irrigación sanguínea , Procedimientos de Cirugía Plástica , Anciano , Amputación Quirúrgica , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/cirugía , Desbridamiento , Femenino , Enfermedades del Pie/etiología , Enfermedades del Pie/patología , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Resultado del TratamientoRESUMEN
The abdominal aneurysm imposes prominent epidemiological impact due to its high incidence and life threatening complications. The first steps in endovascular treatment of abdominal aneurysms in Bulgaria are herein described. Five bifurcated and one straight stent-grafts were implanted in the ,,St.Ekaterina" University Hospital for the period from February till May 2004. Satisfactory therapeutic result was achieved in all cases. The continuing follow-up of the patients proved favorable tolerability. The good therapeutic response, lack of perioperative mortality, and low complication rate provide evidence that endovascular repair can have beneficial implication in patients with abdominal aneurysms and high operative risk.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/métodos , Adulto , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Bulgaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada Espiral , Resultado del TratamientoRESUMEN
We present a case of traumatic pseudoaneurysm of the anterior tibial artery in a 74-years-old male. The patient had history of a trauma on his left calf--a penetrating wound caused by a knife. The primary surgical treatment in a traumatological ward resulted in a good non-ischemic condition without signs of bleeding. Ten days after the operation a pulsating mass occurred at the treated place. An angiography was performed demonstrating pseudoaneurysm of the anterior tibial artery, followed by a revision of the lesion by a vascular surgeon (V.C.). A pseudoaneurysm and excessive coagula were found. The presence of a wound infection suggested ligature of the artery, without vascular reconstruction. Peroneal and posterior tibial arteries were patent. The final postoperative result was satisfactory, absence of significant ischemia of the left lower extremity, and healed operative incision.
Asunto(s)
Aneurisma Falso , Arterias Tibiales/cirugía , Anciano , Aneurisma Falso/diagnóstico , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Angiografía , Humanos , Masculino , Procedimientos Quirúrgicos Operativos/efectos adversos , Resultado del Tratamiento , Heridas Punzantes/cirugíaRESUMEN
The surgical technique of the arterial reconstructions to the leg vessels is of critical importance for the outcome of those delicate procedures. The anatomic surgical exposures to the potentially target leg arteries are described. Infrapopliteal reconstructions are performed when popliteal artery is unsuitable for a distal anastomosis. Posterior tibial artery is exposed through a medial approach as an extension of the bellow knee popliteal artery exposure. Anterior tibial artery is accessible through the medial approach only in its ostial section, distal segments of it can be exposed using antero-lateral approach between tibia and fibula. Peroneal artery can also be exposed using medial approach in its proximal third, and for distal exposure resection of the fibula is required. All patients receive venous antibiotic, and Heparin 100 IU/kg or the corresponding doses low-molecular Heparin. All patients with thrombosed by-passes within 30 days undergo reoperation. Suggested is treatment of skin and soft tissue foot lesions. "Failing graft" should be diagnosed and treated properly, since assisted primary patency is higher than secondary patency. Intraoperative fluoroscopy has the potential to provide valuable information before, during and at completion of the procedure. Mortality is mainly due to myocardial infarction.
Asunto(s)
Arteriopatías Oclusivas/cirugía , Arteria Poplítea/cirugía , Arterias Tibiales/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Anticoagulantes/uso terapéutico , Arteriopatías Oclusivas/sangre , HumanosRESUMEN
Restoration of blood flow to severely ischemic limbs may produce compartment and revascularization syndrome. It may require fasciotomies to be performed to decompress leg compartments. In cases when the skin edges are not close to each other skin grafting is a method of choice to close the defect without functional muscular and nerve deficit.
Asunto(s)
Isquemia/cirugía , Pierna/irrigación sanguínea , Arteria Poplítea/cirugía , Complicaciones Posoperatorias/etiología , Arterias Tibiales/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Anciano , Síndromes Compartimentales/etiología , Fasciotomía , Humanos , Pierna/cirugía , Microcirculación , Persona de Mediana Edad , Daño por Reperfusión/etiología , Trasplante de Piel , Colgajos Quirúrgicos , Resultado del TratamientoRESUMEN
Endovascular grafts are transluminally implanted vascular devices that combine a vascular stent with a "prosthetic cover" and are designed for use as a less invasive treatment of vascular disease. Indications include aneurysms, arteviovenous fistulas, dissections, traumatic vascular lesions, and vascular occlusions. High risk patients with severe co morbidities are candidates for endoluminal grafting. Specific complications peculiar to stent-grafts have been described. Early and midterm results demonstrate that endovascular grafting is a safe and promising treatment modality. Concurrent comparative studies, randomized trials and registries will be needed to evaluate long-term efficacy of those devices.
Asunto(s)
Stents , Procedimientos Quirúrgicos Vasculares/instrumentación , Aneurisma/diagnóstico por imagen , Aneurisma/cirugía , Animales , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/cirugía , Prótesis Vascular , Implantación de Prótesis Vascular , Humanos , Radiografía , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
UNLABELLED: The stroke is one of the major causes for death and invalidization in the modern society. In about 30% of the cases the stroke is attributed to stenosis of a supraaortic vessel. In the last few years the percutaneous angioplasty and stenting is an alternative method of the classical surgical treatment--the carotid thrombendarterectomy. Crucial moment in the evolution of the method is the introduction in the practice of the systems for distal embolic protection of the brain and the routine implantation of stents with new design. One of the main conditions for successful and noncomplicated stenting is the respect of a strict procedural protocol. In the article we present the results of 17 cases with angioplasty and stenting of supraaortic vessels performed in our Clinic in the period 07.02.2001-01.07.2001. The immediate success rate is 100%. No major complications (stroke, myocardial infarction and death) were registered. In the midterm follow-up there were no thrombosis and restenosis of the implanted stents. We present four interesting case reports: 1. One stage stenting of right coronary artery and right internal carotid artery, 2. Stenting of a subocclusive right internal carotid stenosis with balloonexpandable stent and 3. Stenting of a vertebral artery as the unique brain supplying vessel and 4. Stenting of subocclusive aortoostial lesion of the brachiocephalic trunk in a patient with totally occluded contralateral internal carotid artery. CONCLUSIONS: Stenting of supraaortic vessels is a safe and reliable method when performed by experienced operator and when are applied the ultimate methods of cerebral protection and the new stent designs. The carotid stenting is a reliable alternative of the surgery and gains more and more popularity.
Asunto(s)
Angioplastia Coronaria con Balón/efectos adversos , Angioplastia de Balón/efectos adversos , Estenosis Carotídea/terapia , Prevención Primaria/instrumentación , Stents , Adulto , Angioplastia de Balón/métodos , Angioplastia Coronaria con Balón/métodos , Tronco Braquiocefálico/diagnóstico por imagen , Arteria Carótida Interna/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Vasos Coronarios , Femenino , Estudios de Seguimiento , Humanos , Embolia Intracraneal/prevención & control , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Arteria Vertebral/diagnóstico por imagenRESUMEN
Percutaneous peripheral and coronary interventions as well as surgical procedures can be complicated by dissections and traumatic lesions of peripheral arteries. Posttraumatic peripheral dissections can be threatening for the extremities and often their management might be a challenge. Open surgery requires wide exposure and dissection of posttraumatic tissues. Endovascular techniques using selfexpandable stents gains popularity because of high efficiency, safety and good results. This technique is associated with decreased trauma, no requirements for anesthesia, short hospital stay. We present two cases of posttraumatic iliac dissections treated with self expandable stents.
Asunto(s)
Angioplastia de Balón/efectos adversos , Disección Aórtica/terapia , Stents , Anciano , Disección Aórtica/diagnóstico por imagen , Angioplastia de Balón/métodos , Implantación de Prótesis Vascular , Femenino , Humanos , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/patología , Masculino , Persona de Mediana Edad , Radiografía , Resultado del TratamientoRESUMEN
Congenital vascular malformations present a difficult therapeutic challenge. Phlebectasias are abnormally large veins found supra or/and subfascially most often involving lower extremities. There might be a communication with the arterial system or not. Asymptomatic and mildly symptomatic lesions do not require treatment. Absolute indications for treatment include hemorrhage, secondary ischemic complications, and congestive heart failure from arteriovenous shunting. Relative indications include pain, functional impairment, and cosmetic deformity, including limb asymmetry associated with extremity lesions. We present a surgical approach indicated for symptomatic patients for whom supportive measures do not provide relief of symptoms. It includes total excision of the involved skin and underlying fatty tissue with the abnormal vessels. A special device for obtaining a split skin graft is used and autotransplantation is performed.
Asunto(s)
Malformaciones Arteriovenosas/cirugía , Extremidad Inferior/irrigación sanguínea , Adulto , Estudios de Seguimiento , Humanos , Masculino , Factores de Tiempo , Resultado del TratamientoRESUMEN
Although not very often diagnosed, the acute and chronic mesenterial ischemia is advancing and life threatening condition. When associated with multivascular pathology compromising the perfusion and causing multiple organ failure the choice of treatment is a challenge. In such cases the radical surgical treatment is associated with high morbidity and mortality. In recent years endovascular methods of treatment (angioplasty and stenting) are gaining popularity in the treatment of these patients. We report a case of chronic mesenteric ischemia that caused abdominal angina and weight loss in a 63-year-old man with renovasal hypertension, renal insufficiency and peripheral vascular disease. Angiographic study revealed multivascular pathology including total occlusion of the superior mesenteric artery, 90% stenosis of the celiac trunk, bilateral high grade renal stenoses and obstructive pathology of both iliac arteries. One stage successful endovascular treatment was performed in the three vascular territories. In the Celiac trunk, left renal artery and right common iliac artery were implanted stents. A double right renal artery was treated successfully with kissing balloon. A clinical follow-up demonstrated success with no recurrence of abdominal pain, body weight gain, better control of the hypertension and improvement of the renal function. This is the first reported case of one stage endovascular treatment of a visceral artery, bilateral renal arteries and iliac artery. This case report illustrates the value of endovascular treatment in a patient with atherosclerotic narrowing of multiple abdominal visceral arteries.
Asunto(s)
Angioscopía/métodos , Arteriopatías Oclusivas/cirugía , Arteria Celíaca/cirugía , Arteria Ilíaca/cirugía , Arteria Renal/cirugía , Angiografía , Arteriopatías Oclusivas/diagnóstico por imagen , Arteria Celíaca/diagnóstico por imagen , Humanos , Arteria Ilíaca/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Arteria Renal/diagnóstico por imagen , Obstrucción de la Arteria Renal/diagnóstico por imagen , Obstrucción de la Arteria Renal/cirugía , Stents , Resultado del TratamientoRESUMEN
Retroperitoneal tumors engaging large vessels require vascular reconstruction when surgically removed. We present a case of retroperitoneal rhabdomiosarcoma in a child, which required inferior vena cava (IVC) grafting, creating a new bifurcation of IVC, and an A-V fistula between greater saphenous vein and femoral artery as well as grafting of right common iliac artery.
Asunto(s)
Derivación Arteriovenosa Quirúrgica , Prótesis Vascular , Neoplasias Retroperitoneales/cirugía , Rabdomiosarcoma Embrionario/cirugía , Vena Cava Inferior/trasplante , Niño , Arteria Femoral/cirugía , Humanos , Procedimientos de Cirugía Plástica/métodos , Neoplasias Retroperitoneales/irrigación sanguínea , Rabdomiosarcoma Embrionario/irrigación sanguínea , Vena Safena/cirugíaRESUMEN
Aorto-caval fistula is a rare complication of infrarenal abdominal aortic aneurysm /AAA/, and it occurs when the aneurysm ruptures into inferior vena cava. Literature indicates that such a communication is present in less than 2% of the elective AAA resections and in 3%-6.97% of the cases of AAA ruptures. From 1986 and 2000 in the University Hospital "St. Ekaterina" 207 elective AAA cases and 43 ruptured AAA cases underwent surgery. In 2 cases (4.65% of the ruptured AAA) we encountered aorto-caval communication. We report a patient with infrarenal AAA having significant oedema of lower extremities bilaterally, treated in another hospital for iron deficiency anemia and vegetative disorders. Patient presented for consultation and abdominal Echo showed AAA. The angiogram performed demonstrated aorto-caval fistula. At surgery bifurcated graft was implanted successfully. This is the first case of diagnosed prior to surgery aorto-caval fistula followed by successful surgery reported in Bulgaria.
Asunto(s)
Aneurisma de la Aorta Abdominal/complicaciones , Rotura de la Aorta/complicaciones , Fístula Arteriovenosa/etiología , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Rotura de la Aorta/diagnóstico por imagen , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/cirugía , Implantación de Prótesis Vascular , Bulgaria , Femenino , Humanos , Persona de Mediana Edad , Radiografía , Vena Cava InferiorRESUMEN
Renal artery hypoplasia is a relatively rare condition in childhood causing renovascular hypertension. We present a case of hypoplasia of the proximal two thirds of the right renal artery, and almost normal distal third of the renal artery as well as normal parenchymal branches managed with hypogastric autoarterial conduit. We discuss conduit options and technical considerations when dealing with this delicate condition in paediatric population.
Asunto(s)
Hipertensión Renovascular/cirugía , Adolescente , Anastomosis Quirúrgica/métodos , Humanos , Hipertensión Renovascular/etiología , Masculino , Radiografía , Obstrucción de la Arteria Renal/diagnóstico por imagen , Obstrucción de la Arteria Renal/etiología , Obstrucción de la Arteria Renal/patología , Obstrucción de la Arteria Renal/cirugíaRESUMEN
Aorto-enteric fistula (AEF) is a very rare entity. Any direct or indirect communication between the arterial tree and the intestine represents a life threatening situation. Major symptom is gastro-intestinal bleeding with varying longevity and gravity. Preoperative diagnosis is difficult and this is why higher level of suspicion is necessary. Presence of Abdominal Aortic Aneurysm (AAA) or aorto-iliac grafts makes the diagnosis more likely. AEF are: primary, predominantly a complication of ruptured AAA, and secondary, after aorto-iliac reconstruction. The most frequent location of AEF is the end part of tue duodenum. In the group of secundary AEF the paraprosthetic type represents the most frequent morphological findings. Preoperative confirmation of an AEF however proved difficult despite the improvement in endoscopic and imaging technology. Diagnostic modality of choice is enhanced computed tomography. Management is surgical only. The choice of surgical repair is still controversial. Every effort must be made to prevent its occurrence by separating bowel and artery at the first aortic operation. Our experience in diagnosis and treatment of AEF is based on 3 cases with aorto-duodenal fistulas. Pathogenesis, clinical features and therapeutic aspects are presented and discussed.
Asunto(s)
Enfermedades de la Aorta/diagnóstico , Fístula/diagnóstico , Fístula Intestinal/diagnóstico , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/cirugía , Enfermedades de la Aorta/cirugía , Enfermedades Duodenales/diagnóstico , Enfermedades Duodenales/etiología , Enfermedades Duodenales/cirugía , Femenino , Fístula/etiología , Fístula/cirugía , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/patología , Hemorragia Gastrointestinal/cirugía , Humanos , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/patología , Complicaciones Posoperatorias/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Carotid body tumors are rare, with a tendency of slow but progressive growth, giving rise to external compression and/or involvement of the carotid arteries, craniofacial nerves and other neighbouring structures. They are adequately vascularized, with surgery being the treatment of choice. Localization and vascularity require comprehensive understanding of the anatomy, and most likely, vascular surgeons with carotid experience and neurosurgeons would make the best teams. In certain cases the participation of craniofacial surgeon is likewise needed. Over the period 1989 through 1999, in the Department of Vascular Surgery, six patients presenting carotid body tumor are treated. There is not a single case with bilateral involvement, and all have negative family history for carotid body tumor. Two of them are subjected to explorative surgery elsewhere. Two patients only are asymptomatic. In 3 patients CT of the neck, and in one--MRI are used as diagnostic modalities. Five patients undergo carotid artery ultrasonography, and three--angiography. Internal carotid clamping is necessitated in one case only, undergoing explorative surgery at another hospital and presenting a big tumor, stage III (Shamblin). Postoperatively, the patients complain of slight deviation of the tongue and slurred speech. The check-up carotid ultrasound shows hemodynamically relevant stenosis of the internal carotid artery, 1 cm distally to the carotid bifurcation, without flow into the external carotid being detected. On follow-up, all patients are alive and free of local recurrences or metastases.
Asunto(s)
Tumor del Cuerpo Carotídeo/diagnóstico , Tumor del Cuerpo Carotídeo/cirugía , Adulto , Angiografía , Trastornos de la Articulación/complicaciones , Arteria Carótida Interna , Tumor del Cuerpo Carotídeo/irrigación sanguínea , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
We discuss vascular surgical problems in 59 kidney transplantations using alive donors. From April 96 till May 99 we harvested 59 kidneys from relatives (44 women and 15 men), mean age 54.33 years. Those kidneys were transplanted to 37 men (mean age 55.71 years), and 22 women (mean age 36.85 years). Preoperative dialysis was performed for a period of 5.015 years (mean). Thirty eight of the kidneys are right, and 21 of them are left. Six kidneys have two renal veins (10.16%), and 5 of them have two renal arteries (8.47%). We prefer end-to-end anastomosis between the donor renal artery and the recipient hypogastric artery. It ensures best regional hemodynamics, long-term patency and best positioning of the kidney avoiding vascular compression. The venous anastomosis is performed end-to-side to the iliac vein of the recipient. In 7 cases of short renal artery of the donor kidney greater saphenous vein is used as arterial conduit to ensure tension-free anastomoses. Only 1 patient (1.74%) of 59 cases (71 venous anastomoses) suffered thrombosis of the iliac vein, which caused kidney rupture. We had 5 cases of postoperative bleeding (8.47%), three of them were from the kidney hilus, and two from exposure sites. After reexploration all of them have normal function. Vascular anomalies and/or vascular disease do not preclude the procedure. Atraumatic harvesting of the kidney is critical.