RESUMEN
Although peripheral arterial embolism is a common vascular disease, abdominal aortic saddle embolism (ASE) is rare. However, ASE is considered to be quite severe. A rapid and accurate diagnosis followed by timely and appropriate medical intervention is the key to minimize the risk of severe complications and reduce the risk of mortality. We report the case of an 84-year-old female patient who was diagnosed with acute ASE. She was successfully treated using thrombolytic therapy through a bilateral femoral arterial puncture catheter. Our report aims at raising awareness of this potentially fatal disease, highlighting the importance of rapid diagnosis and timely treatment, and exploring the possibility of endovascular treatment for ASE in the future.
Asunto(s)
Embolia , Fibrinolíticos , Anciano de 80 o más Años , Catéteres , Femenino , Humanos , Punciones , Terapia TrombolíticaRESUMEN
BACKGROUND: Combination treatment with percutaneous endovenous intervention (PEVI) and anticoagulation has been proposed for treating lower-extremity proximal deep vein thrombosis (DVT). We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of PEVI plus anticoagulation versus anticoagulation alone in patients with lower-extremity proximal DVT. METHODS: We systematically searched PubMed, Embase, and the Cochrane Library from inception to May 2016. All RCTs comparing clinical outcomes between additional PEVI and anticoagulation alone were included. The main end points were postthrombotic syndrome (PTS) and major bleeding complications. Secondary outcomes included the iliofemoral patency rate, venous obstruction, and recurrent DVT. We assessed pooled data using a random-effects model. RESULTS: Four RCTs were included. PEVI plus standard anticoagulation compared with anticoagulation alone was associated with a lower rate of PTS (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.18-0.63), significantly higher iliofemoral patency rate at 6 months and 12 months (OR 8.49, 95% CI 1.32-54.60), a lower rate of venous obstruction (OR 0.42, 95% CI 0.20-0.924), and a lower rate of recurrent DVT (OR 0.42, 95% CI 0.20-0.92). However, more major bleeding episodes occurred in the group with catheter-directed thrombolysis (Peto OR 5.86, 95% CI 1.76-19.48). CONCLUSIONS: PEVI plus anticoagulation reduced the occurrence of PTS, recurrent DVT, and venous obstruction. Another advantage is an increased patency rate at 6 and 12 months. The disadvantage is an increased occurrence of major bleeding events.
Asunto(s)
Anticoagulantes/uso terapéutico , Procedimientos Endovasculares/métodos , Trombosis de la Vena/terapia , Anticoagulantes/efectos adversos , Coagulación Sanguínea/efectos de los fármacos , Terapia Combinada , Procedimientos Endovasculares/efectos adversos , Femenino , Hemorragia/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Síndrome Postrombótico/etiología , Recurrencia , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción Vascular/efectos de los fármacos , Trombosis de la Vena/sangre , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/fisiopatologíaRESUMEN
<p><b>OBJECTIVE</b>To investigate the application of the retroperitoneal approach in aortic surgery.</p><p><b>METHODS</b>We collected and analyzed data of 7 patients in Macau who presented with aortic diseases from 2007 to 2008 and were treated with aorta repair through retroperitoneal approach. Demographic features as well as intraoperative and postoperative data were analyzed. One case of thoracoabdominal aneurysm and 4 cases of abdominal aneurysm received artificial graft, among which hybrid iliac artery reconstruction with Zenith stent covering the ostium of the left subclavian artery was performed in 2 cases of infrarenal abdominal aneurysm. Aortic-iliac artery bypass was performed in 2 cases of aortoiliac occlusion.</p><p><b>RESULTS</b>No operative or early postoperative death was observed. No perioperative intestinal adhesion or ureteral obstruction was found. One case reported delayed paraplegia and graft infection as postoperative complications. The complications were partially removed 3 months later after rehabilitation.</p><p><b>CONCLUSION</b>Retroperitoneal approach is a safe and feasible technique, which associated with a low incidence of postoperative pulmonary complications.</p>
Asunto(s)
Anciano , Humanos , Aorta , Cirugía General , Revascularización Miocárdica , Métodos , Cavidad Peritoneal , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares , MétodosRESUMEN
OBJECTIVE: To describe a hybrid endovascular procedure for aorta repair with different kinds of bypass followed by concomitant placement of stent graft in the aorta. METHODS: From June 2007 to May 2008, 5 consecutive patients who presented with aortic aneurysm or dissection were treated with a new hybrid aorta repair technique. Complete surgical rerouting of supra-aortic vessels was simultaneously created by endovascular repair of aortic arch aneurysm with stent graft. Hybrid left carotid-subclavian bypass with stent graft deployment covering the ostium of the left subclavian artery was performed in a Debakey type III aortic dissection case. The supra-aortic branch was revascularized in 2 cases from ascending aorta to bilateral common carotid arteries using a 16-8 mm bifurcated graft, then total aortic arch and descending artery was occluded with stent-graft. The left carotid artery to the left subclavian artery bypass was created in 1 case, followed by stent-graft deployment. Two cases of infrarenal abdominal aortic aneurysm underwent left external iliac artery to left internal iliac artery bypass by a retroperineal route, then hybrid procedure was performed with bifurcated stent-graft. All stent grafts were deployed via a retrograde femoral artery approach in 5 patients. RESULTS: Technical success with complete aneurysmal exclusion was achieved in all patients. There was no incidence of endoleak. During a follow-up period of 2 to 10 months, documented perioperative neurologic events did not occur in all patients. One patient suffered from adult respiratory distress syndrome. After received tracheostomy, he recovered later. There was one death resulting from a postoperative myocardial infarction. CONCLUSION: Hybrid arch repair provides an alternative therapy to patients otherwise considered prohibitively high risk for traditional open arch and thoracoabdominal aorta repair.