RESUMEN
Cystic adventitial disease is a rare form of non-atherosclerotic stenosis and one of the main causes of claudication in young and middle-aged men. Approximately 200 case reports are available in the literature to date. It is generally located in the popliteal artery, although it may be found in other arteries and even in veins. The aetiology is still unclear: most authors believe that the cyst may originate from a synovial ganglion close to the adjacent hip joint capsule. Patients affected by adventitial cystic degeneration are often young male non-smokers with intermittent calf claudication. The treatment of choice is surgical removal of the cyst or reconstruction with autologous vein or synthetic graft interposition. Percutaneous US-guided cystic aspiration is a recent easy and safe alternative method for treating the disease but may result in local recurrence. We report the case of a 51-year-old male patient with clinically intermittent claudication of the right leg. The arteriogram showed complete occlusion of the right proximal popliteal artery and no evidence of atherosclerotic disease in other vessels. The diagnosis was made at the time of surgery. Surgical exploration revealed a gelatinous material involving the popliteal artery. It was excised and evacuated and a segment of greater saphenous vein interposed. Ultrasound examination 12 months later showed graft patency and absence of local recurrence.
Asunto(s)
Arteriopatías Oclusivas/patología , Quistes/patología , Arteria Poplítea/patología , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/cirugía , Bioprótesis , Implantación de Prótesis Vascular , Constricción Patológica , Quistes/complicaciones , Quistes/diagnóstico , Quistes/cirugía , Humanos , Claudicación Intermitente/etiología , Masculino , Persona de Mediana Edad , Modelos Biológicos , Arteria Poplítea/cirugía , Vena Safena/cirugía , Membrana Sinovial/patologíaRESUMEN
The authors present a case of a brachial artery aneurysm in a patient with HIV infection. Aneurysms of unusual arteries, such as the common carotid, brachiocephalic, subclavian, superior mesenteric arteries and arteries of the upper extremity distal to the axillary artery, may be related to HIV infection. Chronic inflammatory infiltrate (plasma cells, B and T lymphocytes) around the vasa vasorum is noted in many reports. This condition may represent a "distinct clinicopathology entity". The best therapeutic option is operative repair. Reconstruction with autologous material is preferable since bacterial involvement of synthetic grafts is possible in individuals with an immunocompromised condition.
Asunto(s)
Aneurisma/diagnóstico , Aneurisma/cirugía , Arteria Braquial , Infecciones por VIH/cirugía , Adulto , Aneurisma/complicaciones , Aneurisma/patología , Arteria Braquial/patología , Arteria Braquial/cirugía , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Humanos , Resultado del TratamientoRESUMEN
Laparoscopic surgery decreases postoperative pain, shortens hospital stay, and returns patients to full functional status more quickly than open surgery in a variety of surgical procedures. This study was undertaken to evaluate laparoscopic techniques as applied to aortic surgery. Nine patients underwent elective hand-assisted laparoscopic surgery, 8 for obliterative disease and 1 for an aneurysm of the abdominal aorta. Five patients had a left aorto-femoral bypass, 3 patients an aorto-bifemoral bypass, and 1 patient an aorto-aortic bypass after aneurysmectomy. There were no laparotomic conversions and all procedures were completed with transperitoneal hand-assisted laparoscopic surgery. Mean aortic clamping time was 39 minutes and mean operative time 194 minutes. Mean blood loss was 500 ml and the mean postoperative hospital stay was 4.2 days without major complications. At control examinations all grafts were patent. Hand-assisted laparoscopic aortic surgery is feasible, safe, and effective. In selected cases it may be a valid surgical procedure in addition to conventional and endovascular surgery. The advantages observed in our patients were minimal tissue trauma, less postoperative pain and faster postoperative recovery.