RESUMEN
OBJECTIVE: The aim of this study was to report the clinical presentation and treatment outcomes of patients treated for IAAD with and without abdominal aortic aneurysm (AAA) in a single academic institution in South America. MATERIALS AND METHODS: A retrospective review of all patients with IAAD with or without concomitant AAA between January 2002 and December 2023 from a single academic hospital was performed. RESULTS: Eighteen patients with IAAD were diagnosed of whom 13 (72.2%) were males. Median age was 63 years (range: 43-88 years). Sixteen (88.8%) patients presented with symptoms, and in two (11.1%) asymptomatic patients IAAD was an incidental finding. Ten (55.5%) patients had concomitant abdominal aortic aneurysm (AAA), with a median size of the aneurysm of 49.5 mm (range: 44-66 mm). No statistical differences in baseline characteristics were seen between patients with concomitant IAAD and AAA and patients with only IAAD. Seven (38.8%) patients presented chronic dissection, and 11 (61.1%) patients had acute dissection. Five (27.7%) patients were treated conservatively with blood pressure, pain control, and antiplatelets; endovascular surgery was performed in eight (44.4%) patients and open surgery in five (27.7%) patients. The complication rate was 22.2% (n = 4), and the mortality rate was 0%. Median follow-up was 36 months (range: 6-240 months). Complete remodeling was seen in all patients except two patients who underwent conservative treatment. Of those, one had partial remodeling, and the other no changed. CONCLUSION: Isolated aortic dissection of the abdominal aorta is an uncommon condition, with acceptable different treatment strategies, from conservative to invasive treatments. Sometimes IAAD can concur with AAA, and when so, invasive treatment might be considered. More studies describing the natural history of AAA and its association with IAAD are warranted, as well as further research reporting long-term outcomes on aortic remodeling after different treatment modalities.
Asunto(s)
Aneurisma de la Aorta Abdominal , Disección Aórtica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Humanos , Masculino , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/mortalidad , Femenino , Anciano , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Disección Aórtica/mortalidad , Disección Aórtica/complicaciones , Disección Aórtica/terapia , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto , Anciano de 80 o más Años , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Factores de Tiempo , Factores de Riesgo , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Tratamiento Conservador , Complicaciones Posoperatorias/etiología , Disección Aórtica AbdominalRESUMEN
BACKGROUND: Spontaneous isolated celiac artery dissection (SICAD) is uncommon, with very few series reported in the literature. The present study aims to describe the clinical characteristics and treatment outcomes of patients with SICAD treated at a single Chilean institution over 20 years. METHODS: A retrospective review of all patients from a single academic hospital with SICAD diagnosed between January 2003 and March 2023 was performed. Conservative treatment included antiplatelets, anticoagulation, or both. The normal size of a celiac artery in our population was 7.9 ± 0.79 mm in females and 8.3 ± 1.08 mm in males. We defined a celiac artery with a diameter equal to or more than 12.5 mm as an aneurysmal celiac artery. RESULTS: The cohort included 27 patients; 77.8% (n = 21) were males. The median age was 51.0 years (range: 38-84 years). Fourteen (51.8%) patients presented with aneurysmal dilatation. Fourteen (51.8%) patients were treated with antiplatelets, 6 (22.2%) patients with anticoagulation, and 7 (25.9%) with anticoagulation and antiplatelets. One patient was treated with endovascular therapy due to a pseudoaneurysm of the celiac artery detected 10 days after conservative treatment with antiplatelets. The median length of hospital stay was 5 days (range: 2-14 days). Complete remodeling was seen in 6 (22.2%) patients, partial remodeling in 10 (37.0%) patients, and no change was seen in 8 (26.9%) patients. Three (11.5%) patients were lost to follow-up. There were no significant differences between treatments and remodeling outcomes (P = 0.729). The median celiac artery diameter of patients with aneurysmal dilatation was 13.5 mm (range: 12.5-20.5 mm). Systemic arterial hypertension was found more commonly in patients who presented with aneurysmal dilatation than in patients without (87.5% vs. 12.5%, respectively, P = 0.016). Mean follow-up was 41.5 months and median follow-up was 16 months (range: 6-204 months). CONCLUSIONS: Most patients with SICAD can be treated conservatively with excellent outcomes. Hypertension was more commonly found in patients with SICAD and aneurysmal dilatation.
Asunto(s)
Disección Aórtica , Procedimientos Endovasculares , Hipertensión , Masculino , Femenino , Humanos , Persona de Mediana Edad , Arteria Celíaca/diagnóstico por imagen , Resultado del Tratamiento , Procedimientos Endovasculares/efectos adversos , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/terapia , Anticoagulantes/uso terapéutico , Estudios RetrospectivosRESUMEN
Background: Cervicocranial arterial dissection (CIAD) is an important cause of stroke. Aim: To describe the clinical and imaging characteristics of patients with CIAD. Material and Methods: An anonymous registry was made including all patients admitted to a private hospital with a diagnosis of CIAD. Patients were subdivided as having an anterior or posterior circulation dissection (ACD or PCD, respectively). Results: Fifty-seven patients aged 40 ± 8 years (60% women) were included in the study, 39 with PCD and 18 with ACD. Cervical pain was the most common symptom. CIAD was diagnosed with no clinical or imaging signs of stroke in 49% of patients. Fifty one percent of patients had focal neurological deficits and 72% had a NIH stroke score below five. No significant differences between patients with ACD or PCD were found. Fifty patients received antiplatelet therapy (simple or dual), seven patients were anticoagulated and 13 were subjected to stenting due to progression of stenosis with hemodynamic involvement or bilateral dissection with scarce collaterals. The lesion was located in V3 segment in 27 patients and cervical segment of the internal carotid in 16 cases. A favorable Modified Rankin Scale (0-2) was achieved in 85.9%, with a trend towards achieving better functional prognosis in PCD. Conclusions: Due to the greater availability of non-invasive imaging methods, 50% of these patients with CIAD did not have a stroke. Thus, an earlier and more timely management is feasible.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Accidente Cerebrovascular/etiología , Disección Aórtica/complicaciones , Disección Aórtica/terapia , Pronóstico , StentsRESUMEN
BACKGROUND: Cervicocranial arterial dissection (CIAD) is an important cause of stroke. AIM: To describe the clinical and imaging characteristics of patients with CIAD. MATERIAL AND METHODS: An anonymous registry was made including all patients admitted to a private hospital with a diagnosis of CIAD. Patients were subdivided as having an anterior or posterior circulation dissection (ACD or PCD, respectively). RESULTS: Fifty-seven patients aged 40 ± 8 years (60% women) were included in the study, 39 with PCD and 18 with ACD. Cervical pain was the most common symptom. CIAD was diagnosed with no clinical or imaging signs of stroke in 49% of patients. Fifty one percent of patients had focal neurological deficits and 72% had a NIH stroke score below five. No significant differences between patients with ACD or PCD were found. Fifty patients received antiplatelet therapy (simple or dual), seven patients were anticoagulated and 13 were subjected to stenting due to progression of stenosis with hemodynamic involvement or bilateral dissection with scarce collaterals. The lesion was located in V3 segment in 27 patients and cervical segment of the internal carotid in 16 cases. A favorable Modified Rankin Scale (0-2) was achieved in 85.9%, with a trend towards achieving better functional prognosis in PCD. CONCLUSIONS: Due to the greater availability of non-invasive imaging methods, 50% of these patients with CIAD did not have a stroke. Thus, an earlier and more timely management is feasible.
Asunto(s)
Disección Aórtica , Accidente Cerebrovascular , Adulto , Disección Aórtica/complicaciones , Disección Aórtica/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Stents , Accidente Cerebrovascular/etiologíaRESUMEN
BACKGROUND Cocaine abuse is a globally recognized problem with great socioeconomic and health impacts on society. We report a case of dissection of vertebral arteries and right renal artery after cocaine abuse that clinically presented as atypical headache and hypertension. CASE REPORT A 36-year-old male sought emergency care due to cervical pain after cocaine abuse. The pain was located to the right cervical side with irradiation to the homolateral temporal region. He had no previous comorbidities, except for cocaine abuse on a weekly basis. Angiotomography showed alterations compatible with recent arterial dissection of the right vertebral artery, confirmed on angioresonance. The patient received double anti-aggregation and antihypertensive drugs and was discharged. He was readmitted 5 days later due to hypertensive crisis and mild abdominal pain. Abdominal ultrasound with a Doppler of renal arteries showed signs right renal artery stenosis. Magnetic resonance angiography confirmed dissection of the same vessel. The patient underwent arteriography with stent implantation in the right renal artery. During outpatient follow-up, he progressed with gradual reduction of antihypertensive drugs. CONCLUSIONS There is only 1 case report correlating renal artery dissection with cocaine use and none with concomitant presentation of dissection in the vertebral and renal arterial beds. The scarcity of reports is a consequence of many problems. Therefore, young patients presenting with new-onset hypertension or abdominal pain and cocaine abuse history should raise suspicion for renal artery dissection.
Asunto(s)
Disección Aórtica/inducido químicamente , Cocaína/efectos adversos , Hipertensión Renovascular/inducido químicamente , Disección de la Arteria Vertebral/inducido químicamente , Adulto , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/terapia , Angiografía por Tomografía Computarizada , Humanos , Hipertensión Renovascular/diagnóstico por imagen , Hipertensión Renovascular/terapia , Angiografía por Resonancia Magnética , Masculino , Arteria Renal/diagnóstico por imagen , Stents Metálicos Autoexpandibles , Disección de la Arteria Vertebral/diagnóstico por imagen , Disección de la Arteria Vertebral/terapiaRESUMEN
Abstract Aortic dissection (AD) has been recognized to be associated with an inflammatory process. Clinical observations demonstrated that patients with AD had an elevated interleukin (IL)-6 level in comparison to hypertensive or healthy controls. Adverse events such as acute lung injury, postimplantation syndrome, and death are associated with an elevated IL-6 level. Thus, circulating IL-6 could be a reliable biomarker for the diagnosis of AD and for the eveluation of the therapeutic outcomes and the prognosis of AD patients. Therapeutic interventions aiming at attenuating the inflammatory status by IL-6 neutralization could effectively decrease the IL-6 level and thus reverse the progression of the disorder of AD patient. Endovascular aortic repair can effectively control the inflammatory cytokines. Selective antegrade cerebral perfusion with deep hypothermic circulatory arrest during aortic arch replacement shows better neuroprotectve effect with an improved IL-6 level of the cerebrospinal fluid. These results facilitate the understanding of the etiology of AD and guide the directions for the treatment of acute AD in the future. More effective therapeutic agents developed based on the theories of IL-6 signaling involved in the mechasims of AD are anticipated.
Asunto(s)
Humanos , Aneurisma de la Aorta/metabolismo , Interleucina-6/análisis , Disección Aórtica/metabolismo , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/terapia , Pronóstico , Valores de Referencia , Factores de Tiempo , Valor Predictivo de las Pruebas , Citocinas/análisis , Disección Aórtica/diagnóstico , Disección Aórtica/terapiaRESUMEN
OBJECTIVE: This study aimed to address the shortcomings of previous clinical trials that were inadequate to prove the superiority of thoracic endovascular aortic repair (TEVAR) in managing type B aortic dissection (TBAD) over open surgery (OS) or best medical treatment (BMT). The comparative effectiveness of these three treatments was analyzed using data of the National Inpatient Sample, a large U.S. database including patients from 4378 hospitals. METHODS: Adult patients diagnosed with a primary or secondary TBAD in the years 2005 to 2012 were included for analysis. Patients who had aortic aneurysm or received cardioplegia, valve repair, or operations on vessels of the heart were excluded. A three-category propensity score was created by using a multinomial logistic regression model, a three-way matching algorithm for 1:1:1 matching was applied, and a parallel outcome comparison between the three matched treatment groups was performed. RESULTS: Of a total of 54,971 patients included in the study, we matched 17,211 into three equal-size treatment groups (OS, 5755; TEVAR, 5695; BMT, 5761). No significant difference in the 22 baseline covariates was found in the matched cohort. We found TEVAR to have a much lower mortality rate than OS (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.46-0.79) or BMT (OR, 0.62; 95% CI, 0.47-0.83). Mortality rates between OS and BMT were similar (OR, 0.97; 95% CI, 0.74-1.27). We also found TEVAR to have a lower complication rate, shorter hospitalization, and lower medical cost compared with OS. CONCLUSIONS: TEVAR is superior to BMT or OS for treatment of TBAD in terms of mortality, complications, and cost.
Asunto(s)
Aneurisma de la Aorta Torácica/terapia , Disección Aórtica/terapia , Adulto , Anciano , Anciano de 80 o más Años , Disección Aórtica/clasificación , Disección Aórtica/tratamiento farmacológico , Disección Aórtica/cirugía , Aneurisma de la Aorta Torácica/clasificación , Aneurisma de la Aorta Torácica/tratamiento farmacológico , Aneurisma de la Aorta Torácica/cirugía , Procedimientos Endovasculares , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Procedimientos Quirúrgicos VascularesRESUMEN
Aortic dissection (AD) has been recognized to be associated with an inflammatory process. Clinical observations demonstrated that patients with AD had an elevated interleukin (IL)-6 level in comparison to hypertensive or healthy controls. Adverse events such as acute lung injury, postimplantation syndrome, and death are associated with an elevated IL-6 level. Thus, circulating IL-6 could be a reliable biomarker for the diagnosis of AD and for the eveluation of the therapeutic outcomes and the prognosis of AD patients. Therapeutic interventions aiming at attenuating the inflammatory status by IL-6 neutralization could effectively decrease the IL-6 level and thus reverse the progression of the disorder of AD patient. Endovascular aortic repair can effectively control the inflammatory cytokines. Selective antegrade cerebral perfusion with deep hypothermic circulatory arrest during aortic arch replacement shows better neuroprotectve effect with an improved IL-6 level of the cerebrospinal fluid. These results facilitate the understanding of the etiology of AD and guide the directions for the treatment of acute AD in the future. More effective therapeutic agents developed based on the theories of IL-6 signaling involved in the mechasims of AD are anticipated.
Asunto(s)
Aneurisma de la Aorta/metabolismo , Disección Aórtica/metabolismo , Interleucina-6/análisis , Disección Aórtica/diagnóstico , Disección Aórtica/terapia , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/terapia , Citocinas/análisis , Humanos , Valor Predictivo de las Pruebas , Pronóstico , Valores de Referencia , Factores de TiempoRESUMEN
We report the case of a 32 year old male with recurrent colic abdominal pain due to superior mesenteric artery (SMA) and celiac trunk dissection, which resolved after placing 3 stents in SMA. The patient presented atypical clinical signs and symptoms, which made the diagnosis difficult. Clinical presentation, diagnostic methods and treatment options are discussed. We started with conservative management with pain medication, anticoagulation, antihypertensive drugs and image control, but on the seventh day, after restarting oral ingestion, he presented with abdominal angina, after which we proceeded to endovascular treatment with successful results and with an uneventfully 2 year follow up.
Asunto(s)
Dolor Abdominal/etiología , Disección Aórtica/diagnóstico , Arteria Celíaca , Tratamiento Conservador , Arteria Mesentérica Superior , Adulto , Disección Aórtica/complicaciones , Disección Aórtica/terapia , Terapia Combinada , Procedimientos Endovasculares , Humanos , MasculinoAsunto(s)
Angioplastia Coronaria con Balón/efectos adversos , Disección Aórtica/terapia , Aneurisma Coronario/etiología , Intervención Coronaria Percutánea/efectos adversos , Stents , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/etiología , Aneurisma Coronario/diagnóstico por imagen , Aneurisma Coronario/terapia , Angiografía Coronaria , Femenino , Humanos , Enfermedad Iatrogénica , Masculino , Persona de Mediana EdadAsunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Aneurisma Coronario/etiología , Angioplastia Coronaria con Balón/efectos adversos , Stents , Intervención Coronaria Percutánea/efectos adversos , Disección Aórtica/terapia , Aneurisma Coronario/terapia , Aneurisma Coronario/diagnóstico por imagen , Angiografía Coronaria , Enfermedad Iatrogénica , Disección Aórtica/etiología , Disección Aórtica/diagnóstico por imagenRESUMEN
Reportamos el caso de un paciente varón de 32 años con dolor abdominal recurrente tipo cólico a causa de disección de arteria mesentérica superior (AMS) y tronco celíaco, el cual se resolvió luego de la colocación de 3 stents en AMS. El paciente presentó una clínica atípica lo cual dificultó el diagnóstico. Discutimos la clínica, métodos diagnósticos y alternativas de tratamiento. Iniciamos con un manejo conservador con analgesia, anticoagulación plena, antihipertensivo y control de imágenes, pero al séptimo día luego de reiniciar la vía oral, presenta angina abdominal, por lo cual procedimos a tratamiento endovascular con resultado exitoso y buena evolución, sin eventos, a un seguimiento de 2 años
We report the case of a 32 year old male with recurrent colic abdominal pain due to superior mesenteric artery (SMA) and celiac trunk dissection, which resolved after placing 3 stents in SMA. The patient presented atypical clinical signs and symptoms, which made the diagnosis difficult. Clinical presentation, diagnostic methods and treatment options are discussed. We started with conservative management with pain medication, anticoagulation, antihypertensive drugs and image control, but on the seventh day, after restarting oral ingestion, he presented with abdominal angina, after which we proceeded to endovascular treatment with successful results and with an uneventfully 2 year follow up
Asunto(s)
Adulto , Humanos , Masculino , Dolor Abdominal/etiología , Arteria Celíaca , Arteria Mesentérica Superior , Tratamiento Conservador , Disección Aórtica/diagnóstico , Terapia Combinada , Procedimientos Endovasculares , Disección Aórtica/complicaciones , Disección Aórtica/terapiaRESUMEN
It is inexorable that a proportion of patients with systemic arterial hypertension will develop a hypertensive crisis at some point in their lives. The hypertensive crises can be divided in hypertensive patients with emergency or hypertensive emergency, according to the presence or absence of acute end-organ damage. In this review, we discuss the cardiovascular hypertensive emergencies, including acute coronary syndrome, congestive heart failure, aortic dissection and sympathomimetic hypertensive crises (those caused by cocaine use included). Each is presented in a unique way, although some patients with hypertensive emergency report non-specific symptoms. Treatment includes multiple medications for quick and effective action with security to reduce blood pressure, protect the function of organs remaining, relieve symptoms, minimize the risk of complications and improve patient outcomes.
Inevitablemente, una proporción de pacientes con hipertensión arterial sistémica desarrollará crisis hipertensiva en algún momento de su vida. Las crisis hipertensivas pueden dividirse en hipertensos con emergencia o urgencia hipertensiva, según la presencia o ausencia de daño agudo en órganos blanco. En esta revisión discutimos la emergencia cardiovascular hipertensiva, la cual incluye el síndrome coronario agudo, la disección aórtica, la insuficiencia cardiaca congestiva y las crisis hipertensivas simpaticomiméticas (de estas, también mencionaremos aquellas causadas por el consumo de cocaína). Cada una de estas crisis se presenta de una manera única, aunque algunos pacientes con emergencia hipertensiva reportan síntomas inespecíficos. El tratamiento incluye varios medicamentos de acción rápida y eficaces con seguridad para reducir la presión arterial, proteger la función de órganos restantes, aliviar los síntomas, minimizar el riesgo de complicaciones y mejorar los resultados del paciente.
Asunto(s)
Síndrome Coronario Agudo/etiología , Aneurisma de la Aorta/etiología , Disección Aórtica/etiología , Insuficiencia Cardíaca/etiología , Hipertensión/complicaciones , Infarto del Miocardio/etiología , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/terapia , Enfermedad Aguda , Disección Aórtica/diagnóstico , Disección Aórtica/terapia , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/terapia , Progresión de la Enfermedad , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Humanos , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapiaRESUMEN
The purpose of this study is to describe 10 cases of symptomatic isolated spontaneous celiac trunk dissection (ISCTD) in order to evaluate the initial clinical presentation, diagnosis, treatment modalities and outcomes. A retrospective search was performed from 2009 to 2014 and 10 patients with ISCTD were included in the study. Patients with associated aortic and/or other visceral artery dissection were excluded. The following information was collected from each case: sex, age, associated risk factors, symptoms, diagnostic method, anatomic dissection pattern, treatment modality and outcome. Most patients were male (90%), with an average age of 44.8 years, and the most common symptom was abdominal pain (100%). Hypertension and vasculitis (polyarteritis nodosa) were the most frequent risk factors (40% and 30%, respectively). Diagnosis was made in all patients with computed tomography. Dissection was limited to the celiac trunk in three patients and extended to celiac branches in the other seven. Initial conservative treatment was attempted in every case and was successful in nine patients. In one case, initial conservative treatment was unsuccessful and arterial stenting with coil embolization of the false lumen was performed. After successful initial treatment, late progression of the dissection to aneurysmal dilatation was observed in two patients and it was decided to perform endovascular treatment. Mean follow-up was 19 months, ranging from 2 to 59 months. In conclusion, initial conservative treatment seems adequate for most patients with ISCTD. Long-term follow-up is mandatory, owing to the risk of later progression to aneurysm.
Asunto(s)
Anticoagulantes/uso terapéutico , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/terapia , Arteria Celíaca/diagnóstico por imagen , Embolización Terapéutica , Procedimientos Endovasculares , Inhibidores de Agregación Plaquetaria/uso terapéutico , Tomografía Computarizada por Rayos X , Dolor Abdominal/etiología , Adulto , Disección Aórtica/complicaciones , Anticoagulantes/efectos adversos , Enfermedades Asintomáticas , Progresión de la Enfermedad , Embolización Terapéutica/efectos adversos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/efectos adversos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Stents , Factores de Tiempo , Resultado del Tratamiento , Vómitos/etiologíaRESUMEN
Introduction: Spontaneous dissection of the superior mesenteric artery (AMS) is a infrecuent pathology, representing the main frequency of isolated peripheral artery dissection, it is more common in males and occurs in the fifth decade of life. Materials and Methods: Retrospective cases analysis of patients with spontaneous dissection of AMS that were handled in our hospital, in last two years. Results: Two patients were diagnosed in this period, both active smoking and hypertensive pathology, appearing with severe abdominal and back pain. The diagnosis was made by CT angiogram of the abdomen and pelvis; establishing medical management of hypertension and standard heparin anticoagulation. Both patients had dissections at new imaging controls and one patient required exploratory laparotomy with bowel resection and intestinal anastomosis. Patients recovered satisfactorily and are in control. Conclusions: Spontaneous dissection of the SMA is a rare disease with uncertain evolution, it may occur in middle age of life, associated with smoking and hypertension. The suspected diagnosis is clinical and can be confirmed by CT angiography. Initial management remains conservative and occasionally is surgical.
Introducción: La Disección espontánea de la arteria mesentérica superior (AMS) es una patología infrecuente, representando la primera frecuencia de disección de arteria periférica aislada, ocurre más en varones en la quinta década de la vida. Material y Método: Casos en los últimos 2 años revisados en forma retrospectiva. Resultados: Dos pacientes fueron diagnosticados en este período, presentándose ambos por dolor abdominal y lumbar de gran intensidad al Servicio de Urgencia del hospital; ambos tabáquicos activos y con hipertensión arterial (HTA). El diagnóstico fue realizado por angioTC de abdomen y pelvis, instaurándose manejo médico de HTA y anticoagulación con heparina estándar. Los 2 pacientes presentaron nuevas disecciones en los controles imagenológicos y un paciente requirió laparotomía exploradora con resección intestinal y anastomosis por isquemia intestinal. Los pacientes evolucionaron satisfactoriamente y se encuentran en control. Conclusiones: La disección espontánea de la AMS es una enfermedad poco frecuente de evolución incierta, que ocurre en la edad media de la vida, asociada a tabaquismo e HTA, la sospecha es clínica y el diagnóstico por imágenes. El manejo inicial sigue siendo médico y ocasionalmente es quirúrgico.
Asunto(s)
Humanos , Masculino , Adulto , Femenino , Persona de Mediana Edad , Disección Aórtica , Disección Aórtica/terapia , Arteria Mesentérica Superior , Angiografía , Rotura Espontánea , Tomografía Computarizada por Rayos XRESUMEN
Dissecting aneurysms located in peripheral regions of the cerebellar arteries are rare, and few cases have been described in the literature. Surgical treatment of these lesions may become difficult due to its relatively inaccessible location. Thus, the approach of these aneurysms through endovascular therapy may be an alternative treatment. We described a case of ruptured dissecting aneurysm located in the distal portion of the superior cerebellar artery, which was treated with endovascular embolization. We also discuss the results of endovascular therapy for this type of injury...
Aneurismas dissecantes localizados em regiões periféricas das artérias cerebelares são de ocorrência incomum e poucos casos têm sido descritos na literatura. O tratamento cirúrgico dessas lesões pode se tornar difícil por causa de sua localização relativamente inacessível. Assim, a abordagem desses aneurismas por terapia endovascular pode ser um método alternativo de tratamento. Descrevemos um caso de aneurisma dissecante roto localizado na porção distal da artéria cerebelar superior que foi tratado com embolização endovascular. Discutimos, também, os resultados da terapia endovascular para esse tipo de lesão...
Asunto(s)
Humanos , Femenino , Adulto , Disección Aórtica/terapia , Embolización Terapéutica , Arteria Cerebral Posterior , Hemorragia SubaracnoideaRESUMEN
El tratamiento de endoprótesis endovascular para la disección aórtica aparece con buenos resultados a mediano tiempo. Las posteriores indicaciones, por ejemplo, tanto la disección del arco aórtico como las disecciones aórticas agudas no complicadas se encuentran bajo estudio.
O tratamento de endoprótese endovascular para a dissecção aórtica aparece com bons resultados a médio prazo. As posteriores indicações, por exemplo, tanto a dissecção do arco aórtico quanto as dissecções aórticas agudas não complicadas se encontram sob estudo.
Endovascular stent-graft therapy for aortic dissection is emerging with good midterm results. Further indications, i.e. aortic arch dissection and uncomplicated acute aortic dissections, are under evaluation.
Asunto(s)
Humanos , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/terapia , Implantación de Prótesis Vascular/métodos , Stents , Disección Aórtica/cirugía , Disección Aórtica/terapia , Resultado del Tratamiento , Rotura de la Aorta/cirugíaRESUMEN
PURPOSE: To describe the clinical and angiographic results of endovascular therapy for traumatic injuries of the extracranial carotid artery. MATERIALS AND METHODS: The clinical and angiographic features of 36 traumatic injuries of the carotid artery during a 12-year period were reviewed. There were 35 male patients (97.2%) and 1 female patient (2.8%) with an average age of 28.8 years (range 13-60 years). Of the 36 lesions of the carotid artery, 29 (80.6%) were the result of gunshot injury, and 7 (19.4%) were secondary to stab wounds. In 24 (66.7%) instances, the injury resulted in a pseudoaneurysm; in 7 (19.4%), in an arteriovenous fistula (AVF); in 4 (11.1%), in a dissection; and in 1 (2.8%), in inactive bleeding. All patients were treated with an endovascular approach using different techniques (balloon occlusion, embolization, or stent deployment). RESULTS: Endovascular therapy resulted in documented lesion occlusion in 34 (94.4%) patients. Two patients declined any follow-up postprocedural imaging; however, they have remained asymptomatic. Clinical improvement was documented in 35 (97.2%) patients, and there was one procedure-related complication with fatal consequences. CONCLUSIONS: In this series, endovascular techniques were an effective method of treatment. It was possible to use different endovascular reconstructive techniques or parent artery occlusion depending on the degree of vessel damage, with resolution of clinical symptoms and avoidance of surgery in most cases.