RESUMEN
Port-a-cath is widely used as a route for administration of drugs in hematology and oncology patients and, recently, has been adapted also for hemodialysis patients. Major complications include infection, thrombosis, arrhythmia, and embolization. The Pinch-off-syndrome (POS) means the clavicle and the first rib compress the long-term central venous catheter. The reported incidence rate ranges from 1.4% to 4.1%. This syndrome can be recognized on chest radiography by observing a thinning of the catheter lumen through the passage between the clavicle and the first rib. Catheter fracture is a rare but potentially life-threatening complication that must be recognized and treated promptly. Management of dislodged ports includes percutaneous transcatheter retrieval, open thoracotomy retrieval and oral anticoagulant therapy. Among these techniques, percutaneous transcatheter retrieval is an easy, safe and efficient method. We report the successful percutaneous endovascular retrieval of dislodged intracardiac catheter, separated from its port, in a 58 year-old male patient who presented with chest pain.
Asunto(s)
Cateterismo Venoso Central/efectos adversos , Dolor en el Pecho/diagnóstico por imagen , Dolor en el Pecho/etiología , Clavícula/diagnóstico por imagen , Diálisis Renal/efectos adversos , Costillas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
INTRODUCTION: Anastomotic pseudoaneurysm following renal transplantation is uncommon. Indications for repair, treatment options and outcomes remain controversial. REPORT: We present 6 renal transplant recipients with large anastomotic pseudoaneurysms. Five of the patients underwent open repair while one had a stent-grafting and delayed transplant nephrectomy for a ruptured pseudoaneurysm. A transplant nephrectomy was needed in all cases but one. Arterial reconstruction enabled limb salvage in all cases. One patient died of sepsis postoperatively. No patient presented late infection, failure of vascular reconstruction, nor pseudoaneurysm recurrence. CONCLUSIONS: Surgical excision of anastomotic pseudoaneurysms results in high rates of allograft loss. Less invasive techniques have a place in selected cases.
Asunto(s)
Aneurisma Falso/cirugía , Aneurisma Infectado/cirugía , Implantación de Prótesis Vascular , Arteria Ilíaca/cirugía , Trasplante de Riñón/efectos adversos , Nefrectomía , Arteria Renal/cirugía , Adulto , Anciano , Anastomosis Quirúrgica , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/microbiología , Aneurisma Falso/mortalidad , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/microbiología , Aneurisma Infectado/mortalidad , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/mortalidad , Femenino , Humanos , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/microbiología , Masculino , Persona de Mediana Edad , Nefrectomía/efectos adversos , Nefrectomía/mortalidad , Arteria Renal/diagnóstico por imagen , Arteria Renal/microbiología , Reoperación , Stents , Factores de Tiempo , Tomografía Computarizada por Rayos X , Trasplante Homólogo , Resultado del TratamientoRESUMEN
AIM: The aim of this study was to determine the clinical outcome of carotid endarterectomy in heart transplant recipients and morphologic features of atherosclerotic plaques removed during operation. METHODS: Between April 1993 and October 2001 5 heart transplant patients with symptomatic carotid stenosis >70% underwent carotid endarterectomy with regional anesthesia, including a staged bilateral procedure in one patient. Cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol were evaluated in each patient. The plaques ( n=6) underwent histologic analysis after carotid endarterectomy. Carotid artery duplex imaging was added to the routine postoperative evaluation. RESULTS: Carotid plaques resulted to be echolucent on B-mode ultrasound examination. Cholesterol, triglycerides and LDL-cholesterol levels were found to be increased, while HDL-cholesterol were decreased. All patients underwent successful carotid endarterectomy; there were no perioperative deaths, major neurologic or cardiac events. The mean length of stay was 2.2 days. The mean follow-up was 44 months. In 1 case, an asymptomatic restenosis >50% occurred 9 months later and, in 2 other cases, a contralateral mild stenosis was found 12 and 36 months later. One patient had a progressive contralateral stenosis, requiring operation 18 months later. High lipid content and heterogeneous cellular infiltration were observed, including macrophages, T-lymphocytes, neutrophils, and also eosinophils in the rapidly progressing plaque. CONCLUSIONS: Heart transplant patients receiving immunosuppression may successfully undergo carotid endarterectomy, without increased risk, but progression of atherosclerotic disease in the carotid arteries seems to continue, despite lipid-lowering regimen and antiplatelet therapy.
Asunto(s)
Cardiomiopatías/cirugía , Estenosis Carotídea/cirugía , Endarterectomía Carotidea/métodos , Trasplante de Corazón , Anciano , Cardiomiopatías/complicaciones , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Ultrasonografía Doppler DúplexRESUMEN
BACKGROUND: Treatment of lymphoceles complicating vascular procedures is controversial. The purpose of this study was to evaluate the practicability, effectiveness and safety of conservative management on an outpatient basis. METHODS: Medical records were reviewed for 23 postoperative lymphoceles (in 18 patients) seen at our institution between 1986 and 1999. Diagnosis was made by physical examination and needle aspiration of fluid collection; bacterial cultures were obtained in all. Ultrasonography was performed in all patients, lymphoscintigraphy (99mTc HSA) in 11, angio-TC in 2 cases, MRI in 3 large lymphoceles. RESULTS: Twenty-one lymphoceles developed in the groin, 2 in the thigh and were mostly (72.2%) diagnosed after hospital discharge. Imaging techniques detected subcutaneous wound collection; in addition, lymphoscintigraphy showed lymphatic interruption and collateral pathways in patients with limb swelling. Outpatient management consisted of limited ambulation, limb elevation and pressure dressings; no serial aspirations were made. Resolution was obtained in all patients over a mean period of 21 days (range, 12 to 35). No patient required re-hospitalization or developed wound and/or graft infection. No recurrence was noted after a follow-up of all patients for 1 year. CONCLUSIONS: Outpatient treatment of lymphoceles following arterial reconstructive procedures can be performed safely. Significant advantages of this pathway include no re-hospitalization and cost reduction.
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Prótesis Vascular , Pierna/irrigación sanguínea , Linfocele/terapia , Complicaciones Posoperatorias , Adulto , Anciano , Anciano de 80 o más Años , Prótesis Vascular/efectos adversos , Femenino , Humanos , Linfocele/diagnóstico , Linfocele/diagnóstico por imagen , Linfocele/etiología , Linfocele/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Cintigrafía , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: To evaluate the feasibility and safety of surgical treatment of the superficial temporal artery aneurysms on an outpatient basis. METHODS: The records of 5 patients seen at our institution from 1983 to 1997 were reviewed retrospectively. Preoperative diagnosis was made by patient s history and physical examination, with no further evaluation. RESULTS: Outpatient ligation and excision of four aneurysms of distal branches of the superficial temporal artery (3 frontal, 1 parietal) and one involving its proximal portion was performed under local anesthesia. Supplementation with minimal intravenous sedation facilitated the treatment in an uncooperative child and in the patient affected with proximal STA aneurysm. All procedures were uneventful. Patients were discharged a few hours after surgical treatment. No patient required hospitalization following discharge. No recurrence was noted during follow-up periods of 2 to 16 years. CONCLUSIONS: Outpatient diagnosis and excision of aneurysm of the superficial temporal artery can be performed safely. Significant advantages of this pathway include no hospital admission and cost reduction.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Aneurisma Intracraneal/cirugía , Arterias Temporales , Adulto , Anciano , Niño , Femenino , Humanos , Ligadura , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: Infants undergoing cardiac surgery with prolonged cardio-pulmonary bypass are particularly exposed to the risk of acute renal failure for renal hypoxia due to low cardiac output. METHODS: To limit fluid overload deriving from oligo-anuria and low cardiac output we have recently adopted an early peritoneal dialysis protocol, positioning the peritoneal catheter during the intervention and performing early exchanges at first signs of inadequate diuretic response and/or "leaky capillary syndrome" with diffuse edema. From 1-1 to 31-12-1997 12 patients (8 males), of median age of 65.5 days (range 1-350 days) and median weight of 3463 g (range 2380-6550 g) were treated with peritoneal dialysis (automated exchanges of 10 ml/kg body weight of 1.5% glucose, dwell time 20 minutes). Cardiac pathologies included complex hearth malformations. Cardiopulmonary bypass lasted a mean of 202 minutes (range 102-372 minutes). The children were treated for a minimum of 1 to 42 peritoneal dialysis sessions. The infusional therapy included human albumin and fresh frozen plasma to substitute losses and furosemide at the dose of 4 mg/kg/day to reduce the "leaky capillary syndrome". RESULTS: The results were very satisfactory: only 3 children died in the first 30 days after surgery. Renal function was normal at the end of the observation in 8/12 cases, and 2 cases presented chronic renal failure. CONCLUSIONS: Since similar series report a mortality rate of 33-79%, it is suggested that early peritoneal dialysis may have positively influenced the final survival rate.
Asunto(s)
Puente Cardiopulmonar/efectos adversos , Diálisis Peritoneal , Insuficiencia Renal/etiología , Insuficiencia Renal/terapia , Femenino , Humanos , Lactante , Recién Nacido , MasculinoRESUMEN
Cyclo-oxygenase-type-2 (COX-2) enzyme is fundamental for nephrogenesis, upregulated on fetal membranes and myometrium at parturition. Fetal COX-2 inhibition, due to maternal nimesulide assumption, can be responsible for neonatal chronic renal failure.
Asunto(s)
Inhibidores de la Ciclooxigenasa/efectos adversos , Fallo Renal Crónico/inducido químicamente , Trabajo de Parto Prematuro/prevención & control , Efectos Tardíos de la Exposición Prenatal , Sulfonamidas/efectos adversos , Adulto , Femenino , Humanos , Recién Nacido , EmbarazoRESUMEN
OBJECTIVE: The prognostic factors and treatment options for thoracic aortic intramural hematoma are controversial. The purpose of this study was to determine the most suitable treatment of this condition in very elderly patients. METHODS: In a review of the world literature, eight octogenarians with thoracic aortic intramural hematoma were found; to these the three cases reported here must be added. The descending thoracic aorta was involved in eight cases and the ascending/arch in three. RESULTS: In spite of patients' poor general conditions, the medical treatment group showed survival rates of 85.7% (descending) and 66.6% (ascending/arch), respectively. CONCLUSION: Extensive atherosclerotic changes of the aortic wall in the elderly, combined with control of hypertension, may probably prevent thoracic aortic intramural hematoma from progressing to dissection, with a favourable outcome. An earlier and more accurate preoperative diagnosis by modern diagnostic techniques, including spiral computed tomography (CT), as were performed in our own patients, will allow optimal treatment and increased patient survival.
Asunto(s)
Enfermedades de la Aorta/tratamiento farmacológico , Hematoma/tratamiento farmacológico , Nifedipino/uso terapéutico , Vasodilatadores/uso terapéutico , Anciano , Anciano de 80 o más Años , Analgésicos/uso terapéutico , Aorta Torácica , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/etiología , Aortografía , Arteriosclerosis/complicaciones , Quimioterapia Combinada , Femenino , Hematoma/diagnóstico por imagen , Hematoma/etiología , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Masculino , Nitroprusiato/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
Two lower limb amputees with infected contralateral axillofemoral prosthetic grafts received preserved human arteries after removal of the infected materials. Both grafts grew organisms (Enterococcus species, plus Staphylococcus species in one). Long length arterial conduits were fashioned from freshly harvested (in one patient) and cryopreserved (in another one) cadaveric iliac and femoral arteries. One arterial homograft had ABO-compatibility with the recipient. No immunosuppressive drugs were administered after repeat arterial reconstructions. After 12 and 15 months both grafts are still patent, without parietal changes at ultrasonography; the patients have a viable remaining lower extremity and are free of symptoms or re-infection.
Asunto(s)
Arteria Axilar/cirugía , Prótesis Vascular/efectos adversos , Enterococcus faecalis , Arteria Femoral/cirugía , Infecciones por Bacterias Gramnegativas/cirugía , Infecciones Relacionadas con Prótesis/cirugía , Infecciones Estafilocócicas/cirugía , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Trasplante HomólogoRESUMEN
Two unusual cases of iliac vein spontaneous rupture into the retroperitoneum are presented together with 18 cases reported by the literature. In one patient of ours, entrapment of clots in an IVC filter and proximal iliac vein involvement into the scar tissue surrounding the left limb of an aortoiliac bifurcation graft might have caused flow disturbances and subsequent predisposition to rupture of the thrombosed external iliac vein. Inflammatory parietal changes, including infiltration of macrophages, T and B lymphocytes producing elastin degradation by means of cytokines, may have led ultimately to vein disruption. Despite clinical features and CT scan findings, the physician's awareness of this disease remains the most important factor for the early treatment.
Asunto(s)
Hemoperitoneo/cirugía , Vena Ilíaca/cirugía , Trombosis/cirugía , Anciano , Implantación de Prótesis Vascular , Femenino , Hemoperitoneo/diagnóstico , Hemoperitoneo/etiología , Hemoperitoneo/patología , Humanos , Vena Ilíaca/patología , Masculino , Persona de Mediana Edad , Politetrafluoroetileno , Reoperación , Rotura Espontánea , Trombosis/diagnóstico , Trombosis/etiología , Trombosis/patología , Tomografía Computarizada por Rayos X , Filtros de Vena CavaRESUMEN
The progressive loss of renal function in children with chronic renal failure (CRF) has a negative influence on their nutritional status and statural growth. Supportive therapies with 1-25 dihydroxy-vitamin D3, recombinant erythropoietin and growth hormone have significantly improved the biochemical and clinical features but the success of these therapies is largely related to an appropriate diet, with adequate protein/caloric intakes. Children more than adults have minimal protein requirements to avoid malnutrition and growth impairment FAO/WHO and RDA recommendations save as guidelines for a correct diet in children with CRF. Following these allowances leads to a "normoproteic" diet, with a protein intake which is often half the unrestricted one in Western European countries, but which is still likely to be not enough to protect against renal deterioration. Indeed the European Study Group for Nutritional Treatment of CRF in children failed to show a significant effect of diet on the mean decline of glomerular filtration rate over two years.
Asunto(s)
Fallo Renal Crónico/dietoterapia , Adolescente , Niño , Fenómenos Fisiológicos Nutricionales Infantiles , Preescolar , Dieta con Restricción de Proteínas , Proteínas en la Dieta/administración & dosificación , Femenino , Humanos , Lactante , Fenómenos Fisiológicos Nutricionales del Lactante , Recién Nacido , MasculinoRESUMEN
BACKGROUND: Children's renal biopsy data were gathered for 3 consecutive years (1992-1994) by the Group of Renal Immunopathology of the Italian Society of Pediatric Nephrology, which opened a paediatric section of the Italian Registry of Renal Biopsies. MATERIALS: The Registry recorded the histological diagnosis and the clinical data at renal biopsy of 432 children < or = 15 years old (mean age 8.96 +/- 3.7 years). RESULTS: The most common glomerulonephritis (GN) at renal biopsy was idiopathic IgAGN (18.8%) and the most frequent secondary GN was Henoch-Schönlein purpura (HSP) nephritis (11.6%). Minimal-change disease (MCD) accounted for 11.6%, focal and segmental sclerosis (FSG) 8.5%, mesangial proliferative GN (MPGN) 9.5%, membranoproliferative GN 5.5%, and thin-membrane disease 5%. Lupus nephritis was diagnosed in 5% and Alport's GN in 3.9% of the cases. The annual incidence of primary GN in Italian children was 11.1 cases per million children population (p.m.c.p.), IgAN accounting for 3.1 cases, MCD 2.3, and HSP nephritis 1.9 cases p.m.c.p. respectively. Italian children underwent renal biopsy because of isolated microscopic haematuria in 19.3% of the cases, non-nephrotic proteinuria with or without microscopic haematuria in 31.2%, and nephrotic-range proteinuria in 34.2%, less frequently (15.3%) because of acute or chronic renal failure. Children with persistent isolated microscopic haematuria had most frequently IgAN (34.9%) or thin-membrane disease (25.3%), while those with non-nephrotic proteinuria had IgAN (30.4%) and HSP nephritis (23%). In cases with nephrotic proteinuria renal biopsy showed MCD in 34.5% of the cases, FSG in 16.9%, and MPGN in 12.2%. When renal biopsy was performed in chronic renal failure, chronic interstitial renal disease was detected in 62.5% of the cases. CONCLUSIONS: This National Registry provides data on the indications for performing renal biopsy in Italian children and on the frequency and annual incidence of histological lesions detected. IgAN, primary or related to HSP, was the most common nephritis in Italian children undergoing renal biopsy.
Asunto(s)
Enfermedades Renales/epidemiología , Riñón/patología , Adolescente , Biopsia , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Italia , Masculino , Sistema de RegistrosRESUMEN
A case of acute iliofemoral artery thrombosis occurring 32 years after radiation therapy is reported. Radiological and MRI findings are described; the patient was successfully treated by intra-arterial thrombolysis and PTA-stent.
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Arteria Femoral , Arteria Ilíaca , Isquemia/etiología , Pierna/irrigación sanguínea , Traumatismos por Radiación , Radioterapia/efectos adversos , Terapia Trombolítica , Trombosis/terapia , Enfermedad Aguda , Anciano , Angiografía , Angioplastia de Balón , Arteria Femoral/diagnóstico por imagen , Humanos , Arteria Ilíaca/diagnóstico por imagen , Masculino , Stents , Trombosis/diagnóstico por imagen , Trombosis/etiología , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Blunt arterial injuries secondary to bone fractures are frequently associated with nerve, vein and soft tissue lesions. A delayed diagnosis or treatment is the main cause of high amputation rate. Thirty-four patients presenting acute arterial occlusion (15 cases), false aneurysms (13 cases) or AVFs (6 cases) of the extremity were identified between 1983 and 1995. To repair injured arteries, ligation (3 cases), patch angioplasty (6 cases), autogenous vein (15 patients) or PTFE (4 cases) interposition or bypass grafting were made. Percutaneous embolization by coils was performed in 3 AVFs of small limb arteries. Associated venous lesions were treated in 9 patients. External fixation of long bone fractures was made in 29 patients, before vascular reconstruction, to prevent further injury during orthopedic stabilization. Fasciotomies were made in 6 patients to treat compartmental hypertension. Early reexplorations were necessary to correct technical defects in 4 patients. Hyperbaric oxygen therapy was applied in 7 patients to control bacterial contamination and improve wound healing. Primary (2 cases) or secondary (3 cases) amputations were carried out in unsalvageable limbs. Nerve or extensive muscle damage caused poor functional outcome in 4 patients. A multidisciplinary diagnostic and management strategy is required to improve limb and patient survival.
Asunto(s)
Arterias/lesiones , Fracturas Óseas/complicaciones , Heridas no Penetrantes/complicaciones , Adolescente , Adulto , Anciano , Angiografía , Niño , Femenino , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/terapia , Humanos , Masculino , Persona de Mediana Edad , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/terapiaRESUMEN
In order to evaluate the incidence, the diagnostic modalities and significance of blisters of the abdominal aortic aneurysm wall, in a retrospective review, 14 patients (2.6%) having these lesions were identified between 1983 and 1995. At preoperative examination, aortography had less accuracy (1 case = 20%) than CT scan (3 cases = 27.2%) or MRI angiography (6 cases = 85.7%) to detect blisters; others were discovered intraoperatively in the remaining four patients. Most blisters were located on the anterior or antero-lateral wall of aneurysms; its area ranged from 0.8 to 2.6 cm2. One patient with a suspected blister diagnosed at aortography, during chest physiotherapy for his COPD, presented sudden abdominal pain: at urgent laparotomy, an acute contained rupture of a large blister, without extraluminal blood loss, was found. All patients underwent aneurysm repair, with no postoperative deaths. Occurrence of rupture in one patient clearly indicates the natural course of aortic blisters. MRI angiography may accurately detect these lesions; surgical treatment is necessary for preventing imminent rupture.
Asunto(s)
Aorta Abdominal/patología , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/patología , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/patología , Anciano , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/etiología , Rotura de la Aorta/cirugía , Aortografía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
A variety of anatomical abnormalities may product an external compression of the popliteal artery, resulting in a thrombotic occlusion. Between 1983 and 1995, 9 patients presented a popliteal artery entrapment syndrome, bilateral in two cases. Ultrasonography, Angio-CT scan and MRI showed the abnormal structures and position of the popliteal artery on popliteal fossa. Arteriography detected an arterial compression in 6 limbs and occlusion in 4 limbs as well as an associated popliteal aneurysm in one patient and distal embolism in four. The abnormal medial head of the gastrocnemius muscle was resected in 8 limbs, while fibrous membranes were resected in 3 limbs. Autogenous vein replacement was performed in 4 cases of popliteal artery occlusion and following resection of a popliteal artery aneurysm in one case. All patients recovered. In the followup period, the occlusion of the arterial reconstruction occurred after 28 months in one patient, with a mild claudication. Noninvasive vascular imaging techniques may allow early diagnosis and management of PAES, avoiding popliteal arterial wall lesions and its occlusion, with a better outcome.
Asunto(s)
Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/cirugía , Arteria Poplítea , Adolescente , Adulto , Aneurisma/diagnóstico , Aneurisma/etiología , Aneurisma/cirugía , Angiografía , Arteriopatías Oclusivas/etiología , Estudios de Seguimiento , Humanos , Claudicación Intermitente/etiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Músculo Esquelético/anomalías , Síndrome , Factores de TiempoRESUMEN
To evaluate the treatment of late sequelae of penetrating arterial injuries associated with civilian firearms, such as false aneurysms and arteriovenous fistulas (AV-Fs) of the extremities, a retrospective clinical study was carried out. Whenever diagnosis or operative management is delayed because of local fibrosis or morphological and structural vessel changes, primary repair is not feasible and segmental resection is required. Twenty-four patients presenting late false aneurysms (14) and AV-Fs (11) of the extremities, caused by firearms (6 rifle wounds, and 18 pistol wounds), were identified between 1983 and 1995. Twenty-three patients were submitted to resection of pseudoaneurysms (13) or AV-Fs (8), while arterial patch angioplasty was applied in two patients. The venous lesions were repaired by an interposition graft (7) or lateral venorraphy (3). Saphenous vein (15) or PTFE (6) grafts were placed in injured arteries. Percutaneous embolization by coils was performed in two patients. Twenty-three out of 24 patients (95.8%) recovered; one patient (4.1%), affected by aneurysmal AV-Fs of a lower limb dating from 12 years, with enlarged and weakened artery, bled to death. No limb loss occurred. A better evaluation of minimal vascular injuries is required to avoid late sequelae of civilian firearms lesions, with significant blood loss, which need segmental excision of the injured vessels.
Asunto(s)
Aneurisma/cirugía , Arterias/lesiones , Fístula Arteriovenosa/cirugía , Extremidades/irrigación sanguínea , Heridas por Arma de Fuego/cirugía , Adolescente , Adulto , Aneurisma/diagnóstico por imagen , Aneurisma/etiología , Angiografía , Brazo/irrigación sanguínea , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/etiología , Prótesis Vascular , Embolización Terapéutica , Femenino , Humanos , Pierna/irrigación sanguínea , Masculino , Persona de Mediana Edad , Politetrafluoroetileno , Vena Safena/trasplante , Factores de Tiempo , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico por imagenRESUMEN
Among complications of vascular access operations, symptomatic steal syndrome is uncommon, but may lead to ischemia of the hand. Between 1983 and 1995, 5 patients with hemodialysis fistulas presented rest pain of finger necrosis with a wrist-brachial index of 0.56 (range 0.35 to 0.63) improving to 0.96 (range 0.72 to 1.05) after digital pressure of the fistula. Ligation of distal radial artery was performed in 3 patients with side-to-end radiocephalic fistula, while basilic vein was distally ligated in a case of side-to-side brachiobasilic fistula. A vein "banding" procedure reduce fistula flow and improved distal perfusion in one patient, while a true venous aneurysm of the cephalic vein was treated by excision and replacement with a tapered PTFE graft. Hemodynamic assessment is required during surgical correction, but it may also be useful in pre- and intra-operative evaluation of patients undergoing therapeutical AVFs to prevent arterial insufficiency of the hand.