RESUMEN
BACKGROUND: Blood donation is a safe process though reactions may still occur. We describe a rare vascular complication in a frequent donor, with improvements in the collection process aimed at avoiding future events. METHODS: A 63-year-old woman presented with local pain and an apparent collection in the left arm 8 days after donation. Duplex ultrasound identified a superficial liquid collection and signs of arteriovenous fistula (AVF) between the cubital vein and an arterial branch. A computed tomography (CT)-angio performed 1 day after ultrasound did not identify signs of AVF, followed by a new duplex which confirmed CT-angio findings. It was assumed that a traumatic AVF evolved with spontaneous thrombosis. In the early follow-up (18 days), a progressive regression of hematoma was observed without any sequelae. RESULTS: Investigation showed a faster whole blood bag collection time (3 min; normal: 5-9 min), and the processed packed red blood cell had a brighter red color than usual. The donor reported local bleeding after needle withdrawal, not observed in previous donations and a bruise forming on the same day. No arterial puncture (AP) was noticed by the collection staff during the procedure. The staff was retrained and actions were taken focusing on more active surveillance of late reactions, highlighting the importance of post-donation information by the donors, regardless of any adverse reaction observed, to detect late complications. CONCLUSION: We described an uncommon AP in a donor that was not identified, leading to an AVF that spontaneously thrombosed.
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Eliminación de Componentes Sanguíneos , Lesiones del Sistema Vascular , Femenino , Humanos , Persona de Mediana Edad , Donantes de Sangre , Donación de Sangre , PuncionesRESUMEN
INTRODUCTION: The incidence of vascular injury associated with knee arthroplasty is scarce, but, when they occur, the consequences are serious. OBJECTIVES: Describe the incidence of vascular lesions in our center and evaluate time to diagnosis, resolution and follow-up. MATERIALS AND METHODS: Retrospective cohort during the 2010-2019 period of primary arthroplasties and knee revision. The incidence of vascular lesions and their demographic characteristics were analyzed. Type of lesion, diagnostic method and treatment were recorded. It was evaluated in distant follow-up of pain and functionality. RESULTS: 7.940 primary total knee arthroplasty and revision surgeries were recorded, and a report of 7 emergency cases for vascular lesions was also recorded, with an incidence of 0.088%. 3 vascular lesions were caused by direct laceration of the popliteal artery, 1 case of thrombosis of the popliteal artery and 3 cases of pseudoaneurysmal lesion of the superior genicular artery. Three vascular lesions that occurred in primary arthroplasty were immediately repaired by a vascular surgeon. Pseudoaneurysm lesions and thrombosis were resolved by angiographic procedure. DISCUSSION: Vascular complications around the knee are rare. Time to diagnosis and treatment is essential. Digital angiography is a diagnostic and therapeutic tool. There are various repair techniques, whether it's embolization, cauterization, stenting or endoprosthesis; therefore, digital angiography is a safe method with a low complication rate. CONCLUSION: The incidence of vascular lesions in knee arthroplasty in our center is very low. The cases were diagnosed and resolved early, without registering subsequent complications with good functional results in distant follow-up.
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Aneurisma Falso , Artroplastia de Reemplazo de Rodilla , Arteria Poplítea , Lesiones del Sistema Vascular , Humanos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Masculino , Femenino , Estudios Retrospectivos , Anciano , Incidencia , Lesiones del Sistema Vascular/epidemiología , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/diagnóstico , Arteria Poplítea/lesiones , Arteria Poplítea/cirugía , Arteria Poplítea/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/epidemiología , Aneurisma Falso/diagnóstico , Persona de Mediana Edad , Reoperación/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Trombosis/etiología , Trombosis/epidemiología , Trombosis/diagnóstico , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Renin-angiotensin (Ang II)-aldosterone system (RAAS) is crucial for the cardiovascular risk associated with excessive ethanol consumption. Disturbs in mitochondria have been implicated in multiple cardiovascular diseases. However, if mitochondria dysfunction contributes to ethanol-induced vascular dysfunction is still unknown. We investigated whether ethanol leads to vascular dysfunction via RAAS activation, mitochondria dysfunction, and mitochondrial reactive oxygen species (mtROS). METHODS: Male C57/BL6J or mt-keima mice (6-8-weeks old) were treated with ethanol (20% vol./vol.) for 12 weeks with or without Losartan (10 mg/kg/day). RESULTS: Ethanol induced aortic hypercontractility in an endothelium-dependent manner. PGC1α (a marker of biogenesis), Mfn2, (an essential protein for mitochondria fusion), as well as Pink-1 and Parkin (markers of mitophagy), were reduced in aortas from ethanol-treated mice. Disturb in mitophagy flux was further confirmed in arteries from mt-keima mice. Additionally, ethanol increased mtROS and reduced SOD2 expression. Strikingly, losartan prevented vascular hypercontractility, mitochondrial dysfunction, mtROS, and restored SOD2 expression. Both MnTMPyP (SOD2 mimetic) and CCCP (a mitochondrial uncoupler) reverted ethanol-induced vascular dysfunction. Moreover, L-NAME (NOS inhibitor) and EUK 134 (superoxide dismutase/catalase mimetic) did not affect vascular response in ethanol group, suggesting that ethanol reduces aortic nitric oxide (NO) and H2O2 bioavailability. These responses were prevented by losartan. CONCLUSION: AT1 receptor modulates ethanol-induced vascular hypercontractility by promoting mitochondrial dysfunction, mtROS, and reduction of NO and H2O2 bioavailability. Our findings shed a new light in our understanding of ethanol-induced vascular toxicity and open perspectives of new therapeutic approaches for patients with disorder associated with abusive ethanol drinking.
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Losartán , Lesiones del Sistema Vascular , Humanos , Ratones , Masculino , Animales , Losartán/farmacología , Receptor de Angiotensina Tipo 1/metabolismo , Etanol/toxicidad , Peróxido de Hidrógeno/metabolismo , Especies Reactivas de Oxígeno/metabolismo , Mitocondrias/metabolismoRESUMEN
Los aneurismas asociados a las malformaciones arteriovenosas son lesiones vasculares que suelen encontrarse hasta en el 15 % de los pacientes que las presentan, lo que incrementa el riesgo global de hemorragia. Se presenta una paciente de 53 años de edad que sufrió un cuadro agudo de hemorragia subaracnoidea; en el estudio se evidenció la presencia de un aneurisma de comunicante anterior y malformación arteriovenosa distal de la arteria cerebral anterior izquierda, el cual requirió procedimiento quirúrgico debido al sangramiento. La evolución de la paciente fue satisfactoria y sin complicaciones.
Aneurysms associated with arteriovenous malformations are vascular lesions that are usually found in up to 15% of the patients who present them, which increases the overall risk of bleeding. We present a 53-year-old female patient who suffered from an acute subarachnoid hemorrhage; the study revealed the presence of an anterior communicating aneurysm and a distal arteriovenous malformation of the left anterior cerebral artery, which required surgical procedure due to bleeding. The evolution of the patient was satisfactory and without complications.
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Hemorragia Subaracnoidea , Aneurisma Intracraneal , Lesiones del Sistema VascularRESUMEN
BACKGROUND: One of the most serious complications of cholecystectomy is bile duct disruption, which can be associated with concomitant vascular injury in up to 3.4%. The incidence, demographic characteristics and treatment are underreported worldwide. OBJECTIVE: To determine the incidence of vascular lesions in patients with a diagnosis of bile duct disruption secondary to cholecystectomy from January 1, 2015 to December 31, 2019, confirmed by preoperative CT angiography or intraoperative findings. METHOD: Retrospective, observational and analytical study of a series of cases between 2015 and 2019. Where a total of 144 cases of bile duct disruption were found, 15 cases (10%) with concomitant vascular injury. RESULTS: The most frequent vascular injury was of the right hepatic artery in 13 patients (87%). The level of biliary disruption most frequently associated was Strasberg E3 and E4 in 5 patients (36%), respectively. The treatment of vascular injury was ligation of the injured vessel in 11 patients (73%). The treatment established for the repair of biliary disruption was the hepatic jejunum anastomosis in 14 patients (93%). CONCLUSIONS: The presence of injury at the level of the right hepatic artery is the most frequent and its ligation did not show a significant impact on biliodigestive reconstruction, as long as an adequate technique is performed (Hepp-Couinaud).
ANTECEDENTES: Una de las complicaciones más serias de la colecistectomía es la disrupción de la vía biliar, la cual puede estar asociada con lesión vascular concomitante hasta en un 3.4%. Su incidencia, características demográficas y tratamiento son infrarreportados en todo el mundo. OBJETIVO: Conocer la incidencia de las lesiones vasculares en pacientes con diagnóstico de disrupción de la vía biliar secundaria a colecistectomía, del 1 de enero de 2015 al 31 de diciembre de 2019, confirmado por angiotomografía preoperatoria o por hallazgos transoperatorios. MÉTODO: Estudio retrospectivo, observacional y analítico de una serie de casos del 2015 al 2019. Encontrando 144 casos de disrupción de la vía biliar, 15 (10%) con lesión vascular concomitante. RESULTADOS: La lesión vascular más frecuente fue la de arteria hepática derecha, en 13 pacientes (87%). El nivel de disrupción biliar más habitualmente asociado fue Strasberg E3 y E4, en 5 pacientes (36%) cada uno. El tratamiento de la lesión vascular fue ligadura del vaso en 11 pacientes (73%). El tratamiento de la disrupción de vía biliar fue anastomosis hepático-yeyunal en 14 pacientes (93%). CONCLUSIONES: La presencia de lesión de la arteria hepática derecha es la más frecuente y su ligadura no tiene una repercusión significativa en la reconstrucción biliodigestiva, siempre y cuando se realice una técnica adecuada (Hepp-Couinaud).
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Colecistectomía Laparoscópica , Lesiones del Sistema Vascular , Humanos , Conductos Biliares/cirugía , Conductos Biliares/lesiones , Colecistectomía/efectos adversos , Colecistectomía Laparoscópica/efectos adversos , Incidencia , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: The Latin American military vascular trauma is virtually unknown. The aim of this study was to describe severe war vascular trauma during the last 20 years of the Colombian armed conflict, and to identify predictors of limb amputation. METHODS: Retrospective analysis of a follow-up cohort from 1999 to 2019 of patients with associated severe vascular injuries (ISS >15) in the Colombian armed conflict treated at the Hospital Militar Central. RESULTS: Out of 5948 patients, 243 had military vascular trauma with 430 vascular injuries. The most frequent trauma mechanisms were gunshot wounds (n = 153; 63%). The most common injured vessels were femoral. 24 (10%) patients required amputations. Mortality was 4.1%. Amputation was associated with arteriovenous lesions (RR 4.82, p = 0.025), compartment syndrome (RR 4.2, p = 0.007), arteriovenous femoropopliteal injuries (RR 3.5, p = 0.0026), multiple arterial injuries (RR 3.35, p = 0.0218), associated fractures (RR 3.1, p = 0.0032). CONCLUSIONS: Concomitant arteriovenous injuries in popliteal and femoropopliteal lesions, multiple arterial lesions, bone fractures, and compartment syndrome are associated with amputation in severe vascular injury.
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Traumatismo Múltiple , Lesiones del Sistema Vascular , Heridas por Arma de Fuego , Humanos , Lesiones del Sistema Vascular/epidemiología , Lesiones del Sistema Vascular/cirugía , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/epidemiología , Heridas por Arma de Fuego/cirugía , Estudios Retrospectivos , Colombia/epidemiología , Recuperación del Miembro , Conflictos Armados , Amputación Quirúrgica , Resultado del TratamientoRESUMEN
RESUMEN Introducción: Los modelos experimentales en animales proporcionan una valiosa información para comprender los procesos fisiopatológicos de las lesiones de los vasos sanguíneos y sus consecuencias. Objetivo: Analizar los cambios histológicos y morfométricos que se observaron en la aorta abdominal de las ratas Wistar sometidas a una dieta hiperglucídica. Métodos: Se formaron aleatoriamente dos grupos experimentales de 10 animales cada uno. El grupo control alimentado con dieta estándar para la especie, y el grupo experimental alimentado con dieta estándar más sacarosa al 35 %, como agua de bebida desde el destete hasta las 20 semanas de vida. El estudio se realizó en muestras de aorta fijadas y procesadas por la técnica clásica de inclusión en parafina y coloreadas con las técnicas de hematoxilina - eosina y Verhoeff. Se realizó la descripción de las capas de la pared arterial y la determinación de variables morfométricas en cada lámina histológica. Resultados: Las ratas Wistar pertenecientes al grupo experimental desarrollaron modificaciones incipientes en la pared arterial de la aorta abdominal, las cuales corresponden con la presencia de tumefacción en la célula endotelial y vacuolización en la célula muscular lisa vascular, así como marcada desorganización de las fibras elásticas y musculares de la capa media. Las variables morfométricas que mostraron diferencias significativas entre los grupos fueron el grosor de la túnica media y el cociente media/ lumen. Conclusiones: La pared media resultó ser la capa más afectada demostrándose el efecto nocivo de la dieta hiperglucídica en la pared arterial.
ABSTRACT Introduction: experimental animal models provide valuable information to understand the physiological and pathological processes of blood vessel injuries and their consequences. Objective: to analyze the histological and morphometric changes observed in the abdominal aorta of Wistar rats subjected to a hyperglycemic diet. Methods: two experimental groups of 10 animals each were randomly formed. The control group was fed with a standard diet for this species, and the experimental group was fed with a standard diet plus 35% sucrose, as drinking water from weaning to 20 weeks of life. The study was performed on aortic samples fixed and processed by the classic paraffin embedding technique and stained with the hematoxylin-eosin and Verhoeff techniques. The description of the layers of the arterial wall and the determination of morphometric variables in each histological slide were made. Results: the Wistar rats belonging to the experimental group developed incipient changes in the arterial wall of the abdominal aorta, which correspond to the presence of endothelial cell swelling and vacuolation in the vascular smooth muscle cell, as well as marked disorganization of the muscle and elastic fibers of the middle layer. The morphometric variables that showed significant differences between the groups were the thickness of the tunica media and the media/lumen ratio. Conclusions: the middle wall turned out to be the most affected layer, demonstrating the harmful effect of the hyperglycemic diet on the arterial wall.
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Enfermedades Cardiovasculares , Ratas Wistar , Dieta Baja en Carbohidratos , Lesiones del Sistema VascularRESUMEN
Resumen Introducción: Las lesiones de grandes vasos del tórax por traumatismo torácico (TTLGV) son un grupo heterogéneo de lesiones con alta morbimortalidad que constituyen un 0,3-10% de los hallazgos en el traumatismo torácico (TT). Objetivos: Describir características, tratamientos y variables asociadas a mortalidad en pacientes hospitalizados con TTLGV. Material y Métodos: Estudio analítico-observacional. Período enero-1981 y diciembre-2020. Revisión de protocolos de TT prospectivos y fichas clínicas. Se clasificaron los TTLGV según American Association for the Surgery of Trauma (AAST), se calcularon índices de gravedad del traumatismo: Injury Severity Score (ISS), Revised Trauma Score Triage (RTS-T) y Trauma Injury Severity Score (TRISS). Se realizó análisis univariado y multivariado con cálculo de Odds Ratio (OR) para variables asociadas a mortalidad. Se usó SPSS25®, con pruebas UMann Whitney y chi-cuadrado, según corresponda. Resultados: de un total 4.577 TT, 97 (2,1%) cumplieron criterios de inclusión. Hombres: 81 (91,8%), edad promedio: 32,3 ± 14,8 años. TT penetrante: 65 (67,0%). Lesión de arterias axilo-subclavias en 39 (40,2%) y aorta torácica en 31 (32,0%) fueron las más frecuentes. Fueron AAST 5-6: 39 (40,2%). Tratamiento invasivo: 87 (89,7%), de éstos, en 20 (20,6%) reparación endovascular, 14 (14,4%) de aorta torácica. Cirugía abierta en 67 (69,1%). Mortalidad en 13 (13,4%), fueron variables independientes asociadas a mortalidad el shock al ingreso (OR 6,34) e ISS > 25 (OR 6,03). Conclusión: En nuestra serie, los TTLGV fueron más frecuentemente de vasos axilo-subclavios y aorta torácica. El tratamiento fue principalmente invasivo, siendo la cirugía abierta el más frecuente. Se identificaron variables asociadas a mortalidad.
Background: Thoracic great vessel injuries in thoracic trauma (TTGVI) are a heterogeneous group of injuries with high morbimortality that constituting 0.3-10% of the findings in thoracic trauma (TT). Aim: To describe characteristics, treatments and variables associated with mortality in hospitalized patients with TTGVI. Methods: Observational-analytical study. Period January-1981 and December-2020. Review of prospective TT protocols and clinical records. TTGVI were classified according to American Association for the Surgery of Trauma (AAST), trauma severity index were calculated: Injury Severity Score (ISS), Revised Trauma Score Triage (RTS-T) and Trauma Injury Severity Score (TRISS). Univariate and multi- variate analysis was performed with calculation of Odds Ratio (OR) for variables associated with mortality. SPSS25® was used, with U Mann Whitney and chi-squared tests, as appropriate. Results: From a total of 4.577 TT in the period, 97 (2.1%) met the inclusion criteria. Males: 81 (91.8%), mean age: 32.3 ± 14.8 years. Penetrating TT: 65 (67.0%). Axillary-subclavian artery lesions in 39 (40.2%) and thoracic aorta in 31 (32.0%) were more frequent. AAST 5-6: 39 (40.2%). Invasive treatment: 87 (89.7%), of these, in 20 (20.6%) endovascular repair, 14 (14.4%) of thoracic aorta. Open surgery in 67 (69.1%). Mortality in 13 (13.4%), shock on admission was independently associated with mortality (OR 6.34) and ISS > 25 (OR 6.03). Conclusión: In our series, TTGVI were more frequent in axillary-subclavian vessels and thoracic aorta. Treatment was mainly invasive, with open surgery being the most frequent. Variables associated with mortality were identified.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/terapia , Cirugía Torácica/métodos , Venas/lesiones , Radiografía Torácica/métodos , Lesiones del Sistema Vascular , Procedimientos EndovascularesRESUMEN
OBJECTIVE: To investigate the prediction ability of vascular injury biomarkers for haemodialysis requirement in patients with severe leptospirosis. METHODS: Prospective study with severe leptospirosis patients hospitalised in Fortaleza, Brazil. Blood samples were collected hospital admission to quantify vascular injury biomarkers: syndecan-1, ICAM-1, VCAM-1, angiopoietin-2 and FGF-23. Two groups were evaluated according to haemodialysis requirement during hospital stay. RESULTS: Twenty-seven patients were included, with a mean age of 39 ± 18 years. 88.9% were males. 53.8% needed haemodialysis and presented higher levels on hospital admission of syndecan-1 (572 [300-811] vs. 263 [106-421] ng/ml; p = 0.03), angiopoietin-2 (1.52 [0.72-2.72] vs. 0.63 [0.4-1.38] ng/ml; p = 0.01), and FGF-23 (291 [56-2031] vs. 10 [10-806] pg/ml; p = 0.021). Syndecan-1 showed significant correlation with creatinine (r = 0.546; p = 0.05) and total bilirubin levels (r = 0.534; p = 0.013) on hospital admission. Angiopoietin-2 showed significant correlation with creatinine levels (r = 0.513; p = 0.009) on hospital admission and with number of haemodialysis sessions (r = 0.406; p = 0.049). No significant correlation was found with FGF-23. Regarding prognostic performance, combined syndecan-1 and angiopoietin-2 levels had a better ability to predict haemodialysis need in patients with severe leptospirosis (AUC-ROC = 0.744 [95% CI: 0.545-0.943] p = 0.035). CONCLUSION: Syndecan-1 and angiopoietin-2 were associated with haemodialysis need in patients with severe leptospirosis and may be useful to improve therapeutic approach and reduce mortality.
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Leptospirosis , Lesiones del Sistema Vascular , Enfermedad de Weil , Adulto , Angiopoyetina 2/uso terapéutico , Biomarcadores , Creatinina/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Diálisis Renal , Sindecano-1/uso terapéutico , Lesiones del Sistema Vascular/complicaciones , Enfermedad de Weil/complicaciones , Adulto JovenRESUMEN
Objetivo: apresentar um caso de lesão vascular em paciente idoso tratado pela técnica da escleroterapia. Relato do caso: paciente masculino, 67 anos, vítima de acidente vascular cerebral, buscou atendimento odontológico por apresentar raízes residuais. Durante o exame físico foi identificada lesão exofítica, de coloração violácea, base séssil, com aproximadamente dois centímetros, localizada em comissura labial esquerda. Para confirmar a origem da alteração foi realizada manobra semiotécnica (diascopia) que revelou tratar-se de lesão vascular. Por ser o paciente idoso, hipertenso, com histórico de acidente vascular cerebral, foi feita a opção por tratamento conservador, sendo realizada a escleroterapia com oleato de monoetanolamina 5%, numa única sessão. No retorno de sete dias, foi observada regressão parcial da lesão e com 30 dias a região se mostrou completamente cicatrizada, sem vestígios da alteração. O oleato de monoetanolamina provoca uma reação inflamatória estéril, aguda, dose-dependente, no endotélio vascular e nos tecidos extravasculares que resulta em fibrose e obliteração dos vasos sanguíneos, induzindo a regressão das lesões. Conclusão: Com base no caso apresentado e nos registros da literatura é possível afirmar que a escleroterapia é uma alternativa terapêutica minimamente invasiva, eficaz, de baixo custo e com resultado estético favorável no tratamento de lesões vasculares orais... (AU)
Objective: to present a case of vascular injury in an elderly patient treated by the sclerotherapy technique. Case report: male patient, 67 years old, victim of a stroke, sought dental care due to residual dental roots. During the physical examination, an exophytic lesion, violet in color, sessile base, approximately two centimeters, located in the left labial commissure, was identified. Diascopy was performed to confirm the origin of the alteration, which revealed that it was a vascular le sion. As the patient was elderly, hypertensive, with a history of stroke, conservative treatment was chosen, with sclerotherapy with 5% mon oethanolamine oleate in a single session. On return after seven days, partial regression of the lesion was observed and, after 30 days, the region was completely healed, with no traces of the alteration. Mon oethanolamine oleate causes a sterile, acute, dose-dependent inflam matory reaction in the vascular endothelium and extravascular tissues that results in fibrosis and obliteration of blood vessels, inducing re gression of the lesions. Conclusion: Based on the case presented and on the literature records, it is possible to affirm that sclerotherapy is a minimally invasive, effective, low-cost therapeutic alternative with a favorable aesthetic result in the treatment of oral vascular lesions... (AU)
Objetivo: presentar un caso de lesión vascular en un paciente de edad avanzada, tratado mediante la técnica de escleroterapia. Reporte de caso: paciente masculino, 67 años, víctima de un derrame cerebral, buscó atención odontológica por raíces dentarias residuales. Durante el examen físico se identificó una lesión exofítica, de color violeta, de base sésil, de aproximadamente dos centímetros, ubicada en la comisura labial izquierda. Se realizó diascopia para confirmar el origen de la alteración, que reveló que se trataba de una lesión vascular. Como el paciente era anciano, hipertenso, con antecedentes de ictus, se optó por tratamiento conservador, con escleroterapia con oleato de monoetanolamina al 5% en una sola sesión. Al regreso a los siete días se observó una regresión parcial de la lesión y, a los 30 días, la región estaba completamente curada, sin rastros de la alteración. El oleato de monoetanolamina provoca una reacción inflamatoria estéril, aguda y dependiente de la dosis en el endotelio vascular y los tejidos extravasculares que produce fibrosis y obliteración de los vasos sanguíneos, lo que induce la regresión de las lesiones. Conclusión: Con base en el caso presentado y en los registros de la literatura, es posible afirmar que la escleroterapia es una alternativa terapéutica mínimamente invasiva, efectiva, de bajo costo y con resultado estético favorable en el tratamiento de las lesiones vasculares orales... (AU)
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Humanos , Masculino , Anciano , Escleroterapia , Atención Odontológica , Malformaciones Vasculares , Hemangioma , Boca/patología , Vasos Sanguíneos , Lesiones del Sistema Vascular , Tratamiento ConservadorRESUMEN
OBJECTIVE: Although the current guidelines for the management of blunt traumatic aortic injury (BTAI) have recommended intervention for grade 2 injuries or higher, a national trend has occurred for aggressive endovascular treatment of low-grade BTAIs. Little is known about the natural history of grade 1 and 2 injuries treated nonoperatively. We hypothesized that most of these low-grade injuries would remain stable with nonoperative management. METHODS: We performed a review of BTAIs at a large referral level 1 trauma center from 2004 to 2020. The injuries were graded using a standard 1 to 4 scale. The outcomes of the nonoperative and thoracic endovascular aortic repair (TEVAR) management strategies were compared, including post-trauma morbidity, mortality, reinterventions, and lesion stability. RESULTS: A total of 176 patients with BTAIs and sufficient imaging studies and follow-up data available were identified during the study period, including 36 with grade 1, 24 with grade 2, 115 with grade 3, and 1 with a grade 4 injury. Of these 176 patients, 112 had undergone TEVAR and 64 had been treated nonoperatively. Most of the patients (90.2%) who had undergone TEVAR had had grade 3 injuries. Nonoperative management was performed for 97.2% of the grade 1 injuries and 62.5% of the grade 2 injuries. Endovascular reintervention after TEVAR was rare (2.7%). The rates of post-trauma morbidity within 30 days (stroke, 3.6% vs 3.1%; myocardial infarction/arrhythmia, 8.9% vs 1.6%; respiratory failure, 31.2% vs 28.1%; acute kidney injury, 9.8% vs 12.5%; urinary tract infection, 2.7% vs 4.8%; gastrointestinal bleeding, 3.6% vs 0.0%; pulmonary embolism, 10.9% vs 4.5%) and 1-year mortality after discharge (1.8% vs 3.1%) were comparable between the operative and nonoperative groups. The median follow-up was 1501 days (interquartile range [IQR], 475.6-2804 days) for the TEVAR group and 1170.5 days (IQR, 317-2173 days) for the nonoperative group. No lesion progression had occurred in the patients with low-grade (grade 1-2) injuries managed nonoperatively. Resolution of grade 1 and 2 injury had occurred in 20% of the patients at 30 days, which had improved to 44% at long-term follow-up. Fourteen patients with grade 3 injuries (12.2% of the grade 3 injuries in our series) were also observed and did not require future intervention. These patients had generally had smaller pseudoaneurysms with minimal periaortic hematoma. None of these 14 patients had experienced progression or rupture during follow-up (median, 454.5 days; IQR, 81-1199 days) using computed tomography. CONCLUSIONS: Nonoperative management of low-grade BTAIs did not result in long-term aortic complications or the need for reintervention. We found that grade 3 injuries with smaller pseudoaneurysms and minimal periaortic hematoma can be safely observed if the patients can be appropriately followed up. Thus, the indications for treatment of select grade 3 injuries merit further consideration.
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Aneurisma Falso , Procedimientos Endovasculares , Traumatismos Torácicos , Lesiones del Sistema Vascular , Heridas no Penetrantes , Aneurisma Falso/cirugía , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/lesiones , Aorta Torácica/cirugía , Procedimientos Endovasculares/efectos adversos , Hematoma , Humanos , Estudios Retrospectivos , Traumatismos Torácicos/diagnóstico por imagen , Traumatismos Torácicos/cirugía , Factores de Tiempo , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/cirugía , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/cirugíaRESUMEN
Lower-extremity arterial disease is a major health problem with increasing prevalence, often leading to non-traumatic amputation, disability and mortality. The molecular mechanisms underpinning abnormal vascular wall remodeling are not fully understood. We hypothesized on the existence of a vascular tissue memory that may be transmitted through soluble signaling messengers, transferred from humans to healthy recipient animals, and consequently drive the recapitulation of arterial wall thickening and other vascular pathologies. We examined the effects of the intralesional infiltration for 6 days of arteriosclerotic popliteal artery-derived homogenates (100 µg of protein) into rats' full-thickness wounds granulation tissue. Animals infiltrated with normal saline solution or healthy brachial arterial tissue homogenate obtained from traumatic amputation served as controls. The significant thickening of arteriolar walls was the constant outcome in two independent experiments for animals receiving arteriosclerotic tissue homogenates. This material induced other vascular morphological changes including an endothelial cell phenotypic reprogramming that mirrored the donor's vascular histopathology. The immunohistochemical expression pattern of relevant vascular markers appeared to match between the human tissue and the corresponding recipient rats. These changes occurred within days of administration, and with no cross-species limitation. The identification of these "vascular disease drivers" may pave novel research avenues for atherosclerosis pathobiology.
Asunto(s)
Arteriosclerosis/metabolismo , Tejido de Granulación/metabolismo , Arteria Poplítea/lesiones , Proteínas/administración & dosificación , Lesiones del Sistema Vascular/inducido químicamente , Anciano , Animales , Arteriosclerosis/patología , Modelos Animales de Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ratas , Lesiones del Sistema Vascular/patologíaAsunto(s)
Animales , Gatos , Perros , Bazo/anomalías , Tromboembolia/veterinaria , Enfermedades de los Gatos/diagnóstico por imagen , Ultrasonografía Doppler/veterinaria , Enfermedades de los Perros/diagnóstico por imagen , Lesiones del Sistema Vascular/veterinaria , Tejido Parenquimatoso/anomalías , UltrasonidoRESUMEN
OBJECTIVES: To propose a contemporary management strategy for venous injury during anterior lumbar spinal exposure that incorporates endovascular treatment. METHODS: Vein injuries suffered by patients treated in a single practice were reviewed. A treatment algorithm based on these experiences was formulated. RESULTS: Between 2015 and 2018, 914 patients received anterior access procedures for indicated lumbar interbody fusions. Of these patients, 15 (1.6%) suffered minor vascular injuries treated with manual pressure or suture repair. Four (0.4%) patients undergoing anterior lumbar spine surgery suffered major venous injuries, all of whom received the indicated spinal hardware following endovascular rescue. Primary repair was attempted in three patients before endovascular control and not at all in one. Vascular access was obtained via the bilateral femoral veins in 2 patients, unilateral femoral in one, and bilateral femoral plus right internal jugular vein in one. Stent choice included both uncovered (5, 63%) and covered stents (3, 38%). Deep venous thrombosis occurred in 2 patient's post-treatment. 1 DVT was encountered in the setting of a covered stent and 1 uncovered stent thrombosis was treated with catheter-directed lysis 4 weeks post-operatively. Ultimately, 3 patients were therapeutically anticoagulated. Mean follow-up is 13 months (range 1-36) with duplex ultrasounds available at 6 months or later in 3 of 4 patients. There is no evidence of post-thrombotic syndrome in the 2 patients that developed DVT's or in-stent stenosis in the 3 patients with available follow-up imaging. CONCLUSIONS: Endovascular techniques are important adjuncts when controlling large-volume hemorrhage associated with venous tears during anterior spinal exposure. Adequate direct compression allowing occlusion balloon inflation are key steps to reduce blood loss. Covered and uncovered stents are both appropriate choices to treat injuries. Patients must be anticoagulated post-operatively and surveilled for the sequelae of venous insufficiency. With expedient hemostasis, the indicated spinal surgery may be safely completed.
Asunto(s)
Pérdida de Sangre Quirúrgica/prevención & control , Procedimientos Endovasculares , Técnicas Hemostáticas , Vena Ilíaca/lesiones , Vértebras Lumbares/cirugía , Fusión Vertebral/efectos adversos , Lesiones del Sistema Vascular/terapia , Adulto , Anticoagulantes/uso terapéutico , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Femenino , Técnicas Hemostáticas/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Síndrome Postrombótico/tratamiento farmacológico , Síndrome Postrombótico/etiología , Stents , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico , Lesiones del Sistema Vascular/etiología , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/etiología , Adulto JovenRESUMEN
BACKGROUND: The inferior vena cava is the most frequently injured vascular structure in penetrating abdominal trauma. We aimed to review inferior vena cava injury cases treated at a limited resources facility and to discuss the surgical management for such injures. METHODS: This was a retrospective study of patients with inferior vena cava injuries who were treated at a single center between January 2011 and January 2020. Data pertaining to the following were assessed: demographic parameters, hypovolemic shock at admission, the distance that the patient had to be transported to reach the hospital, affected anatomical segment, treatment, concomitant injuries, complications, and mortality. Non-parametric data were analyzed using Fisher's exact, Chi-square, Mann-Whitney, or Kruskal-Wallis test, as applicable. The Student's t-test was used to assess parametric data. Moreover, multiple logistic regression analyses (including data of possible death-related variables) were performed. Statistical significance was set at P <0.05. RESULTS: Among 114 patients with inferior vena cava injuries, 90.4% were male, and the majority were aged 20-29 years. Penetrating injuries accounted for 98.2% of the injuries, and the infrarenal segment was affected in 52.7% of the patients. Suturing was perfomed in 69.5% and cava ligation in 29.5% of the patients, and 1 patient with retrohepatic vena cava injury was managed non-operatively. The overall mortality was 52.6% with no case of compartment syndrome in the limbs. A total of 7.9% of the patients died during surgery. CONCLUSION: The inferior vena cava is often injured by penetrating mechanisms, and the most frequently affected segment was the infrarenal segment. A higher probability of death was not associated with injury to a specific anatomical segment. Additionally, cava ligation was not related to an increased probability of compartment syndrome in the leg; therefore, prophylactic fasciotomy was not supported.
Asunto(s)
Traumatismos Abdominales/cirugía , Lesiones del Sistema Vascular/cirugía , Vena Cava Inferior/lesiones , Heridas Penetrantes/cirugía , Traumatismos Abdominales/mortalidad , Adolescente , Adulto , Brasil , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Lesiones del Sistema Vascular/mortalidad , Heridas Penetrantes/mortalidadRESUMEN
Resumo O tamanduá-bandeira é um mamífero encontrado na América Central e na América do Sul. Esse animal possui garras que podem chegar a 6,5 cm de comprimento, utilizadas para escavar formigueiros e obter alimento, além de servir para sua defesa. Relatamos o caso de paciente masculino de 52 anos, com histórico de epilepsia, que foi levado desacordado ao pronto-socorro, devido a lesões no seu braço direito causadas por um tamanduá. Frente à suspeita de trauma vascular, o paciente foi submetido a exploração cirúrgica, que evidenciou uma lesão combinada de vasos braquiais, submetida a reparo. Apresentou boa evolução do quadro, recebendo alta hospitalar no segundo dia de pós-operatório e, no seguimento ambulatorial, evoluiu sem sequelas neurológicas ou vasculares.
Abstract The giant anteater is a mammal found in Central and South America. These animals have claws that can reach 6.5 centimeters in length, which they use to dig anthills to obtain food and for defense. We report the case of a 52-year-old male patient with a history of epilepsy who was taken unconscious to the emergency room due to injuries to his right arm caused by an anteater. He underwent surgical exploration to investigate suspected vascular trauma, revealing a combined (arterial and venous) injury of the brachial vessels, which were repaired. He recovered well and was discharged on the second postoperative day. During outpatient follow-up he continued to improve, with no neurological or vascular sequelae.