RESUMEN
Congenital aortic aneurysms are a rare, life-threatening disorder that present complex treatment challenges. The authors describe a congenital thoracic aortic aneurysm treated by endovascular means with stent-assisted coil deployment. Because of rapid in utero aneurysm growth and cardiac dysfunction, a 2.6-kg male was delivered expeditiously by Cesarean section at 35(2)/(7) weeks' gestation. On day of life 1, bilateral femoral arterial access was used to deliver a balloon-expandable stent across the wide-necked aneurysm. Microcoil embolization of the aneurysm via a prepositioned microcatheter was then performed. The child had an uncomplicated hospital course and is asymptomatic 5 months later, with complete aneurysm thrombosis.
Asunto(s)
Aneurisma de la Aorta Torácica/terapia , Procedimientos Endovasculares , Aneurisma de la Aorta Torácica/congénito , Aneurisma de la Aorta Torácica/diagnóstico , Aortografía/métodos , Cesárea , Embolización Terapéutica , Procedimientos Endovasculares/instrumentación , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Imagen por Resonancia Magnética , Masculino , Embarazo , Radiografía Intervencional , Stents , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía Doppler en Color , Ultrasonografía Prenatal/métodos , Adulto JovenRESUMEN
The present report describes the intentional retrieval of six Viabil stent-grafts from the biliary system. The six stent-grafts were successfully removed from five patients with a mean time from placement to retrieval of 38 days. Successful retrieval was independent of underlying disease etiology and included strictures associated with benign disease, malignant disease, disease of unknown etiology, and stent-graft misplacement. There were no complications resulting from stent-graft retrieval. Intentional removal of Viabil stent-grafts is technically feasible. Further study is necessary to establish its potential role in the management of biliary disease.
Asunto(s)
Enfermedades de las Vías Biliares/terapia , Prótesis Vascular , Remoción de Dispositivos/métodos , Stents , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , PolitetrafluoroetilenoRESUMEN
An effective transcervical method for fluoroscopically guided fallopian tube occlusion has long been sought for female sterilization. The Essure permanent birth control device was approved by the Food and Drug Administration in November 2002 and is currently indicated for hysteroscopic placement. In a series of eight patients, bilateral Essure microcoils were placed with fluoroscopic guidance in seven patients for a success rate of 87.5%. One patient described peri- and postprocedure pelvic pain, otherwise no complications were identified. All patients returned to normal activities within 24 hours. Fluoroscopically guided transcervical tubal sterilization with the Essure microcoil device (Conceptus, San Carlos, CA) is a viable outpatient procedure.
Asunto(s)
Fluoroscopía , Histeroscopía , Esterilización Tubaria/instrumentación , Adulto , Femenino , Humanos , Esterilización Tubaria/efectos adversos , Esterilización Tubaria/métodos , Resultado del TratamientoRESUMEN
Vascular thoracic outlet syndrome generally affects young, active, otherwise healthy patients. The diagnosis is suspected by clinical presentation, and can be confirmed with angiography or venography. Conservative management has been associated with significant morbidity and long-term residual disability. We have used a multimodal treatment protocol that includes thrombolysis, anticoagulation, surgical decompression, and interventional procedures. Catheter-directed recombinant tissue-type plasminogen activator and intravenous heparin infusion are instituted at the time of diagnosis to promote recanalization and prevent propagation of thrombus. Surgical decompression of the thoracic outlet can be readily achieved by first rib resection during the same hospitalization. Postoperative venograms are obtained in all patients. Residual stenoses can be managed with angioplasty alone in some patients but more commonly require stent placement. We believe thrombolysis, anticoagulation, surgical decompression, and percutaneous interventions act synergistically to improve results of therapy in patients with vascular thoracic outlet syndrome.