RESUMEN
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
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.
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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
In laparoscopic cholecystectomy (LC), the treatment of iatrogenic biliary tract injury has been given much attention. However, most accidental right hepatic artery (RHA) injuries are treated with simple clipping. The reason is that the RHA has difficulty in revascularization, and it is generally considered that RHA injury does not cause serious consequences. However, some studies suggest that some cases of RHA ligation can cause a series of pathological changes correlated to arterial ischemia, such as liver abscess, bile tumor, liver atrophy and anastomotic stenosis. Theoretically, RHA blood flow should be restored when possible, in order to avoid the complications of right hepatic ischemia. The present study involved two patients, including one male and one female patient. Both patients were admitted to the hospital with the diagnosis of chronic cholecystitis and gallbladder stone, and developed ischemia of the right half hepatic after accidental transection of the RHA. Both patients underwent continuous end-end anastomosis of the RHA with 6-0 Prolene suture. After the blood vessel anastomosis, the right half liver quickly recovered to its original bright red. No adverse complications were observed in follow-ups at three and six months after the operation. Laparoscopic repair of the RHA is technically feasible. Reconstruction of the RHA can prevent complications associated with right hepatic ischemia.
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Colecistectomía/efectos adversos , Cálculos Biliares/cirugía , Arteria Hepática/lesiones , Complicaciones Intraoperatorias/cirugía , Laparoscopía/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Lesiones del Sistema Vascular/etiología , Femenino , Arteria Hepática/cirugía , Humanos , Masculino , Persona de Mediana Edad , Lesiones del Sistema Vascular/diagnóstico , Lesiones del Sistema Vascular/cirugíaRESUMEN
PURPOSE: Peri-operative major arterial haemorrhage after revision total hip arthroplasty (RTHA) is an odd but limb- and life-threatening complication. In this retrospective analysis, we sought to determine the prevalence of such injuries requiring selective catheter embolization or bypass after RTHA and to evaluate the associated mortality rate. METHODS: Between 1995 and 2016, 2524 RTHAs were performed at a high-volume centre (1031 one-stage revisions, 1370 two-stage revisions and 123 resection arthroplasties). Throughout this period, nine patients presented with signs of persistent bleeding unaddressed during index surgery (9/2524; 0.35%), causing haemodynamic instability. All patients underwent angiographic exploration within the first 24 post-operative hours. Angiography evidenced four cases of bleeding pseudoaneurysms (three of them related to the common femoral artery and one to the medial circumflex femoral artery) and five cases of direct lacerations (one case in the inferior epigastric artery, one in the hypogastric artery, one in the external iliac artery, one in the popliteal artery and another in the superior gluteal artery). RESULTS: Six cases underwent selective percutaneous angiographic embolization with gelatin microspheres, obtaining immediate haemodynamic stabilization; whereas three cases required a further bypass surgery with synthetic graft. Of the former group, four patients had an uneventful evolution, while two died at a mean of 49 days after surgery due to multi-organ failure (MOF). Two cases of the bypass group died because of MOF at a mean of 22 days. Overall mortality rate was 44%. CONCLUSIONS: The overall risk of arterial injury associated with RTHA was low. However, recognition of such a complication is imperative since it was associated with a high mortality rate.
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Artroplastia de Reemplazo de Cadera/efectos adversos , Lesiones del Sistema Vascular/diagnóstico , Lesiones del Sistema Vascular/terapia , Anciano , Anciano de 80 o más Años , Angiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Reoperación , Estudios Retrospectivos , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/mortalidadRESUMEN
Hepatic artery dissection is an infrequent vascular complication that can arise after orthotopic liver transplant. Most patients with this complication are diagnosed during the intraoperative period or the first days after liver transplant, with an association shown with living-donor liver transplant. In this study, we discuss a rare case of an extrahepatic artery dissection that was successfully managed through surgical excision and arterial revascularization that was diagnosed 4 years after orthotopic liver transplant. Furthermore, we hypothesize on the potential causes of its occurrence.
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Arteria Hepática/lesiones , Isquemia/etiología , Trasplante de Hígado/efectos adversos , Lesiones del Sistema Vascular/etiología , Adulto , Anastomosis Quirúrgica , Arteria Hepática/diagnóstico por imagen , Arteria Hepática/fisiopatología , Arteria Hepática/cirugía , Humanos , Isquemia/diagnóstico por imagen , Isquemia/fisiopatología , Isquemia/cirugía , Circulación Hepática , Masculino , Persona de Mediana Edad , Reoperación , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/fisiopatología , Lesiones del Sistema Vascular/cirugíaRESUMEN
Abstract Background and objectives Ultrasound-guided internal jugular vein catheterization is a common and generally safe procedure in the operating room. However, inadvertent puncture of a noncompressible artery such as the subclavian artery, though rare, may be associated with life-threatening sequelae, including hemomediastinum, hemothorax, and pseudoaneurysm. Case report We describe a case of the successful endovascular repair of right subclavian artery injury in a 75-year-old woman. Subclavian artery was injured secondary to ultrasound-guided right internal jugular vein catheterization under general anesthesia for orthopedic surgery. Conclusion Under general anesthesia several factors such as hypotension can mask the signs of subclavian artery injury. This case report indicates that clinicians should be aware of the complications of central venous catheterization and take prompt action.
Resumo Justificativa e objetivos A cateterização da veia jugular interna guiada por ultrassom é um procedimento comum e geralmente seguro em sala cirúrgica. No entanto, a punção inadvertida de uma artéria não compressível, como a artéria subclávia, embora rara, pode estar associada a sequelas e risco para vida, incluindo hemomediastino, hemotórax e pseudoaneurisma. Relato de caso Descrevemos um caso bem-sucedido da correção endovascular de lesão da artéria subclávia direita em uma paciente de 75 anos. A artéria subclávia foi lesionada após cateterização guiada por ultrassom da veia jugular interna direita sob anestesia geral para cirurgia ortopédica. Conclusão Sob anestesia geral, vários fatores, como a hipotensão, podem mascarar os sinais de lesão da artéria subclávia. Este relato de caso indica que os médicos devem estar cientes das complicações da cateterização venosa central e tomar medidas imediatas.
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Humanos , Femenino , Anciano , Arteria Subclavia/lesiones , Cateterismo Venoso Central/efectos adversos , Lesiones del Sistema Vascular/etiología , Procedimientos Endovasculares/métodos , Cateterismo Venoso Central/métodos , Ultrasonografía Intervencional/métodos , Procedimientos Ortopédicos/métodos , Venas Yugulares/diagnóstico por imagenRESUMEN
BACKGROUND AND OBJECTIVES: Ultrasound-guided internal jugular vein catheterization is a common and generally safe procedure in the operating room. However, inadvertent puncture of a noncompressible artery such as the subclavian artery, though rare, may be associated with life-threatening sequelae, including hemomediastinum, hemothorax, and pseudoaneurysm. CASE REPORT: We describe a case of the successful endovascular repair of right subclavian artery injury in a 75-year-old woman. Subclavian artery was injured secondary to ultrasound-guided right internal jugular vein catheterization under general anesthesia for orthopedic surgery. CONCLUSION: Under general anesthesia several factors such as hypotension can mask the signs of subclavian artery injury. This case report indicates that clinicians should be aware of the complications of central venous catheterization and take prompt action.
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Cateterismo Venoso Central/efectos adversos , Procedimientos Endovasculares/métodos , Arteria Subclavia/lesiones , Lesiones del Sistema Vascular/etiología , Anciano , Cateterismo Venoso Central/métodos , Femenino , Humanos , Venas Yugulares/diagnóstico por imagen , Procedimientos Ortopédicos/métodos , Ultrasonografía Intervencional/métodosRESUMEN
Excessive consumption of carbohydrate and fat increases the risk of cardiovascular disease. We sought to determine the potential ultrastructural alterations in large blood vessels induced by a high fat and fructose diet (HFD) in a rat model of prediabetes. Rats were either fed with HFD (model group) or a standard laboratory chow (control group) for 15 weeks before being sacrificed. The harvested thoracic aorta tissues were examined using transmission electron microscopy (TEM), and blood samples were assayed for biomarkers of pre-diabetes.TEM images showed that HFD induced profound pathological changes to the aortic wall layers, tunica intima and tunica media ultrastructures in the pre-diabetic rats as shown by apoptotic endothelial cells with pyknotic nuclei, damaged basal lamina, deteriorated smooth muscle cells that have irregular plasma membranes, shrunken nucleus with clumped nuclear chromatin, damaged mitochondria and few cytoplasmic lipid droplets and vacuoles. In addition, HFD significantly (p<0.05) decreased adiponectin and increased biomarkers of lipidemia, glycaemia, inflammation, oxidative stress, vascular injury such as soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion protein 1 (sVCAM-1), endothelin-1 (ET-1), and coagulation and thrombosis such as Von Willebrand factor (vWF), and plasminogen activator inhibitor-1 (PAI-1), compared to normal levels of these parameters in the control group. Thus, we demonstrated that feeding rats with a HFDisable to develop a pre-diabetic animal model that is useful to study the aortic ultrastructural alterations.
El consumo excesivo de carbohidratos y grasas aumenta el riesgo de enfermedades cardiovasculares. Intentamos determinar las posibles alteraciones ultraestructurales en los grandes vasos sanguíneos, inducidas por una dieta alta en grasas y fructosa (HFD) en un modelo de rata de prediabetes. Las ratas se alimentaron con HFD (grupo modelo) o una comida de laboratorio estándar (grupo de control) durante 15 semanas antes de ser sacrificadas. Los tejidos de la aorta torácica recolectados se examinaron mediante microscopía electrónica de transmisión (TEM) y las muestras de sangre se analizaron para detectar biomarcadores de prediabetes. Las imágenes TEM mostraron que HFD indujo cambios patológicos profundos en las capas de la pared aórtica, túnica íntima y túnica media en la ratas pre-diabéticas como lo muestran las células endoteliales apoptóticas con núcleos picnóticos, lámina basal dañada, células musculares lisas deterioradas que tienen membranas plasmáticas irregulares, núcleo encogido con cromatina nuclear aglomerada, mitocondrias dañadas y pocas gotitas lipídicas citoplásmicas y vacuolas. Además, HFD presentó disminución significativa de adiponectina (p <0,05), y aumento de biomarcadores de lipidemia, glucemia, inflamación, estrés oxidativo, lesión vascular como la molécula de adhesión intercelular soluble 1 (sICAM-1), proteína de adhesión de células vasculares soluble 1 (sVCAM-1), endotelina 1 (ET-1), y la coagulación y la trombosis, como el factor de Von Willebrand (vWF), y el inhibidor del activador del plasminógeno-1 (PAI -1), en comparación con los niveles normales de estos parámetros en el grupo de control. Por tanto, la alimentación de ratas con HFD es capaz de desarrollar un modelo animal prediabético que es útil para estudiar las alteraciones ultraestructurales aórticas.
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Animales , Aorta Torácica/patología , Aorta Torácica/ultraestructura , Estado Prediabético/patología , Aorta/patología , Aorta/ultraestructura , Estado Prediabético/metabolismo , Grasas de la Dieta/efectos adversos , Ratas Sprague-Dawley , Microscopía Electrónica de Transmisión , Modelos Animales de Enfermedad , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/patología , FructosaRESUMEN
ABSTRACT Introduction: Laparoscopic donor nephrectomy (LDN) has become the standard of care and popular among most of the transplant centres across the globe. Objective of this video is to report different vascular injuries, their management during LDNs and propose risk reduction strategies. Patient and methods: This was a retrospective analysis of all the LDNs performed between January 2011 and March 2016. All donor nephrectomies were performed laparoscopically by transperitoneal route, under ideal operative conditions by expert laparoscopic surgeons and by novice surgeons. Results: 858 LDNs (left, n = 797; right, n = 61) were performed during the study period with 5 cases of vascular injuries. Mean (SD) donor age was 45.5 (± 10.76) years and the operative time was 165 (± 44.4) min. Of these five cases, two had renal vein injury, while the three others had renal artery, inferior vena cava and aortic injury (one each). Four injuries occurred during left LDN and only one during a right LDN. Vascular injuries were managed using the Rescue stitch or metallic clips as indicated. Risk reduction strategy was developed to avoid vascular injuries during LDN, which include - meticulous attention to port placement, addition of fourth port, complete dissection of upper pole and pedicle before clipping, and judicious use of ultrasonic diathermy. Conclusions: Careful evaluation of computed tomography angiography just before surgery will act like a global positioning system (GPS) for the operating surgeon. Rescue stitch is a saviour. Not to panic and being well versed with the risk reduction strategies of laparoscopy and rescue measures is of paramount importance.
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Humanos , Trasplante de Riñón/efectos adversos , Laparoscopía/efectos adversos , Lesiones del Sistema Vascular/etiología , Nefrectomía/efectos adversos , Estudios Retrospectivos , Donadores Vivos , Conducta de Reducción del Riesgo , Angiografía por Tomografía Computarizada , Persona de Mediana Edad , Nefrectomía/métodosRESUMEN
INTRODUCTION: Laparoscopic donor nephrectomy (LDN) has become the standard of care and popular among most of the transplant centres across the globe. Objective of this video is to report different vascular injuries, their management during LDNs and propose risk reduction strategies. PATIENT AND METHODS: This was a retrospective analysis of all the LDNs performed between January 2011 and March 2016. All donor nephrectomies were performed laparoscopically by transperitoneal route, under ideal operative conditions by expert laparoscopic surgeons and by novice surgeons. RESULTS: 858 LDNs (left, n = 797; right, n = 61) were performed during the study period with 5 cases of vascular injuries. Mean (SD) donor age was 45.5 (± 10.76) years and the operative time was 165 (± 44.4) min. Of these five cases, two had renal vein injury, while the three others had renal artery, inferior vena cava and aortic injury (one each). Four injuries occurred during left LDN and only one during a right LDN. Vascular injuries were managed using the Rescue stitch or metallic clips as indicated. Risk reduction strategy was developed to avoid vascular injuries during LDN, which include - meticulous attention to port placement, addition of fourth port, complete dissection of upper pole and pedicle before clipping, and judicious use of ultrasonic diathermy. CONCLUSIONS: Careful evaluation of computed tomography angiography just before surgery will act like a global positioning system (GPS) for the operating surgeon. Rescue stitch is a saviour. Not to panic and being well versed with the risk reduction strategies of laparoscopy and rescue measures is of paramount importance.
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Trasplante de Riñón/efectos adversos , Laparoscopía/efectos adversos , Nefrectomía/efectos adversos , Lesiones del Sistema Vascular/etiología , Angiografía por Tomografía Computarizada , Humanos , Donadores Vivos , Persona de Mediana Edad , Nefrectomía/métodos , Estudios Retrospectivos , Conducta de Reducción del RiesgoRESUMEN
INTRODUCTION:: Insertion of central catheters in peripheral vessels is a common procedure performed for a variety of indications, including parenteral nutrition. Hyperemesis gravidarum may require parenteral nutrition in exceptional situations. Although globally safe, insertion of peripherally inserted central catheters (PICCs) can lead to complications. CASE REPORT:: We describe a case of a pregnant woman who required parenteral nutrition and underwent an unsuccessful PICC insertion attempt resulting in arterial puncture, and who 34 days later presented with right upper limb paresthesia. A pseudoaneurysm with nerve compression was diagnosed and treated by open surgery, without maternal or fetal complications. CONCLUSION:: We recommend active surveillance ultrasound (e.g. in the first 24-48 h) of unsuccessful PICC insertion attempts, because late complications may occur and require invasive procedures for treatment.
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Arteria Braquial/lesiones , Neuropatías del Plexo Braquial/etiología , Cateterismo Periférico/efectos adversos , Hiperemesis Gravídica/terapia , Síndromes de Compresión Nerviosa/etiología , Nutrición Parenteral , Lesiones del Sistema Vascular/etiología , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Arteria Braquial/diagnóstico por imagen , Neuropatías del Plexo Braquial/diagnóstico , Neuropatías del Plexo Braquial/fisiopatología , Femenino , Humanos , Hiperemesis Gravídica/diagnóstico , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/fisiopatología , Embarazo , Recuperación de la Función , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler en Color , Ultrasonografía Prenatal/métodos , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/cirugía , Adulto JovenAsunto(s)
Procedimientos Endovasculares/métodos , Complicaciones Posoperatorias/terapia , Accidente Cerebrovascular/cirugía , Trombectomía/métodos , Edema Encefálico/epidemiología , Medios de Contraste/efectos adversos , Procedimientos Endovasculares/efectos adversos , Fiebre/epidemiología , Fiebre/terapia , Humanos , Hiperglucemia/epidemiología , Hiperglucemia/terapia , Hemorragias Intracraneales/epidemiología , Hemorragias Intracraneales/terapia , Enfermedades Renales/inducido químicamente , Enfermedades Renales/epidemiología , Enfermedades Renales/terapia , Cuidados Posoperatorios , Complicaciones Posoperatorias/epidemiología , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/terapia , Rehabilitación de Accidente Cerebrovascular , Trombectomía/efectos adversos , Lesiones del Sistema Vascular/epidemiología , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/terapiaRESUMEN
OBJECTIVE: to evaluate the epidemiological data of patients operated on due to vascular trauma at a referral hospital in Pará state, to determine the variables that increase the risk of death, and to make a comparative analysis with the results previously published by the same institution. METHODS: an analytical retrospective study was performed through data collection from patients operated due to vascular injuries, between March 2013 and March 2017. Demographic and epidemiological data, such as the mechanism and topography of the lesion, distance between the trauma site and the hospital, and type of treatment and complications, were analyzed. Multivariate analysis and logistic regression studies were performed, to evaluate significant dependence between some variables and death occurrence. RESULTS: two hundred and eighty eight patients with 430 lesions were studied; 92.7% were male, 49.7% were between 25 and 49 years old; 47.2% of all injuries were caused by firearm projectiles; 47.2% of the lesions were located in the upper limbs, 42.7% in the lower limbs, 8% in the cervical region, 3.1% in the thoracic region, and 0.7% in the abdominal region; 52.8% of the patients were hospitalized for seven days or less. Amputation was required in 6.9% of patients and there was mortality in 7.93% of the cases. CONCLUSION: distances greater than 200km were associated with prolonged hospitalization and greater probability of limb amputation. Significant correlation between death occurrence and arterial injury, vascular injury in the cervical region, and vascular injury in the thoracic region was found.
OBJETIVO: avaliar dados epidemiológicos dos pacientes operados por trauma vascular em hospital de referência para traumatismos vasculares do Estado do Pará, determinar as variáveis que aumentam o risco de óbito e fazer uma análise comparativa com os resultados previamente publicados pela mesma instituição. MÉTODOS: estudo retrospectivo analítico realizado através da coleta de dados de pacientes operados por lesões vasculares, entre março de 2013 e março de 2017. Foram analisados dados demográficos e epidemiológicos, como o mecanismo e topografia da lesão, distância entre o local do trauma e o hospital, tipo de tratamento e complicações. Foi feito ainda o estudo de uma matriz de correlação com regressão logística entre as variáveis e a ocorrência de óbito. RESULTADOS: foram estudados 288 pacientes, com 430 lesões; 92,7% era do sexo masculino, 49,7% entre 25 e 49 anos de idade; 47,2% das lesões foi ocasionada por projéteis de arma de fogo; 47,2% das lesões situava-se nos membros superiores, 42,7% nos membros inferiores, 8% em região cervical, 3,1% torácicas e 0,7% abdominais; 52,8% dos pacientes teve hospitalização por sete dias ou menos. Amputação foi necessária em 6,9% e a mortalidade foi 7,93%. CONCLUSÃO: distâncias superiores a 200km foram associadas à internação prolongada e maior probabilidade de amputação de membros. Foi encontrada correlação significativa entre a ocorrência de óbito e o fato de haver lesão arterial, lesão vascular na topografia cervical e lesão vascular na topografia torácica.
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Arterias/lesiones , Lesiones del Sistema Vascular/mortalidad , Venas/lesiones , Adulto , Amputación Quirúrgica , Brasil/epidemiología , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Lesiones del Sistema Vascular/clasificación , Lesiones del Sistema Vascular/etiologíaRESUMEN
INTRODUCCIÓN: La luxación expuesta de rodilla es compleja, de incidencia baja con grandes secuelas funcionales. Existen escasos reportes de series en la literatura relativos a su manejo y resultados. OBJETIVO: El objetivo de este trabajo fue describir los resultados obtenidos de todos los pacientes con luxación expuesta de rodilla tratados durante las últimas dos décadas en nuestro hospital bajo un mismo estándar de tratamiento. MÉTODO: Estudio descriptivo retrospectivo en una serie quirúrgica de 11 pacientes con luxación expuesta de rodilla, tratados entre 1994 y 2015. Todos fueron estudiados y manejados según esquema estandarizado: Angiografía/ angioTC, aseo quirúrgico, fijador externo y reparación neurovascular en casos necesarios. Revisión de registros clínicos e imagenológicos consignando datos demográficos, lesiones concomitantes, número y tipo de cirugías, y complicaciones asociadas. Seguimiento promedio fue de 10,7 años con evaluación mediante encuesta funcionales SF-12/IKDC durante el mes de marzo de 2015. RESULTADOS: Diez pacientes eran hombres, 1 mujeres. Edad promedio al accidente 38,6 años. Mecanismo lesional de alta energía; como referencia la clasificación de Schenck, 1 lesión III-M, 4 tipo IV y los 6 restantes una tipo V. 4 lesiones vasculares (36.4%) y 7 lesiones neurológicas (63.6%). Tratamiento definitivo consistió en 4 reconstrucciones ligamentarias, 2 prótesis, 3 artrodesis y 2 amputaciones supracondíleas. Evaluaciones funcionales dieron como resultados un puntaje promedio de 37 y 48,5 para SF-12 físico y mental respectivamente, y de 44,1 para IKDC. CONCLUSIÓN: La luxación expuesta de rodilla es una lesión infrecuente, muy compleja, asociada a accidentes de alta energía, con complicaciones severas, lo que determina resultados funcionales relativamente malos. La estandarización permite sistematizar las distintas etapas de atención, racionalizar los recursos disponibles evitando la improvisación en momentos críticos, lo que podría incidir en la obtención de resultados.
INTRODUCTION: Open knee dislocation is a complex lesion of low incidence and large functional sequelae. There are few series reports in the literature regarding its management and outcomes. OBJECTIVE: Describe the results obtained from all patients with open knee dislocation treated during the last two decades in our hospital under the same treatment standard. METHOD: Retrospective descriptive study in a surgical series of 11 patients with open knee dislocation, treated between 1994 and 2015. All were studied and managed according to a standardized protocol: Angiography/angioCT, surgical debridement, external fixation and neurovascular repair in necessary cases. Review of clinical and imaging records, recording demographic data, concomitant injuries, number and type of surgeries and associated complications. Average follow-up was 10.7 years, with an evaluation through functional surveys SF-12/IKDC during March 2015. RESULTS: 10 patients were men, 1 woman. Average age at accident 38.6 years. High-energy trauma mechanism of injury; Schenk classification as reference, 1 lesion type III-M, 4 type IV and the remaining 6 type V. 4 vascular lesions (41.7%) and 7 neurological lesions (63.6%). Definitive treatment consisted in 4 ligamentous reconstructions, 2 prostheses, 3 arthrodesis and 3 supracondylar amputations. Functional evaluations showed an average score of 37 and 48.5 for SF-12 physical and mental respectively, and 44.1 for IKDC. CONCLUSION: Open knee dislocation is a rare, very complex, associated to high-energy trauma, with severe complications, which determines relatively poor functional outcomes. Standardization allows to systematize the different stages of attention and rationalize available resources avoiding improvisation at critical moments, which could affect the results.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Luxación de la Rodilla/cirugía , Arteria Poplítea/cirugía , Arteria Poplítea/lesiones , Encuestas y Cuestionarios , Estudios Retrospectivos , Estudios de Seguimiento , Resultado del Tratamiento , Recuperación de la Función , Luxación de la Rodilla/complicaciones , Lesiones del Sistema Vascular/cirugía , Lesiones del Sistema Vascular/etiología , Fracturas AbiertasRESUMEN
Popliteal artery trauma is uncommon but is associated with a high risk of limb loss depending on the scenario involving blunt or penetrating trauma as well as the severity and extent of injury that has occurred. In our setting there is a significant amount of gang and civilian warfare resulting in Vascular Trauma. There were 32 patients over a decade who sustained traumatic injury to the popliteal artery consisting of 30 males (94%) and 2 females with an age range 16-59 years with a mean of 32. There were 20 cases of penetrating trauma (63%) and 12 cases of blunt trauma (37%). Of the penetrating trauma, 18 were due to gunshot wounds (GSWs) (90%) and 2 stabs. The majority (7/12; 58%) of blunt trauma was due to falls, and 42% (5/12) secondary to motor vehicular accidents (MVAs). In terms of extent of injury, 21 of 32 patients (65%) sustained an isolated popliteal artery injury, whilst 6 (19%) had injury to both the popliteal artery and vein and another 5 (16%) had combined popliteal artery, vein and nerve injuries. There were 14 cases with associated orthopaedic injuries: 7 posterior knee dislocations, 1 fracture/dislocation of the knee, 2 femoral fractures, 2 tibial plateau fractures and 2 tibia/fibula fracture. Methods of repair included 14 reversed vein grafts, 16 polytetrafluoroethylene (PTFE) grafts and 2 primary. The overall amputation rate was 28% (9 patients). Of the penetrating trauma patients 25% required amputations composed of 5 GSWs, 33% of the blunt trauma patients required amputations. It was noted that factors associated with (but not statistically significant) poor outcomes included combined artery/vein injury, artery/vein/nerve injury, concomitant fracture/dislocation and delayed transfer to a Vascular Surgery Unit. The type of graft or repair did not affect outcome. The incidence of popliteal artery trauma was calculated at 2.46 per 100,000 population per year.
Asunto(s)
Amputación Quirúrgica/estadística & datos numéricos , Traumatismos de la Pierna/fisiopatología , Recuperación del Miembro/métodos , Arteria Poplítea/lesiones , Lesiones del Sistema Vascular/cirugía , Heridas no Penetrantes/fisiopatología , Heridas Penetrantes/fisiopatología , Adolescente , Adulto , Femenino , Hospitales de Enseñanza , Humanos , Traumatismos de la Pierna/complicaciones , Traumatismos de la Pierna/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Trinidad y Tobago/epidemiología , Procedimientos Quirúrgicos Vasculares/métodos , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/fisiopatología , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/cirugía , Heridas Penetrantes/complicaciones , Heridas Penetrantes/cirugía , Adulto JovenRESUMEN
RESUMO Objetivo: avaliar dados epidemiológicos dos pacientes operados por trauma vascular em hospital de referência para traumatismos vasculares do Estado do Pará, determinar as variáveis que aumentam o risco de óbito e fazer uma análise comparativa com os resultados previamente publicados pela mesma instituição. Métodos: estudo retrospectivo analítico realizado através da coleta de dados de pacientes operados por lesões vasculares, entre março de 2013 e março de 2017. Foram analisados dados demográficos e epidemiológicos, como o mecanismo e topografia da lesão, distância entre o local do trauma e o hospital, tipo de tratamento e complicações. Foi feito ainda o estudo de uma matriz de correlação com regressão logística entre as variáveis e a ocorrência de óbito. Resultados: foram estudados 288 pacientes, com 430 lesões; 92,7% era do sexo masculino, 49,7% entre 25 e 49 anos de idade; 47,2% das lesões foi ocasionada por projéteis de arma de fogo; 47,2% das lesões situava-se nos membros superiores, 42,7% nos membros inferiores, 8% em região cervical, 3,1% torácicas e 0,7% abdominais; 52,8% dos pacientes teve hospitalização por sete dias ou menos. Amputação foi necessária em 6,9% e a mortalidade foi 7,93%. Conclusão: distâncias superiores a 200km foram associadas à internação prolongada e maior probabilidade de amputação de membros. Foi encontrada correlação significativa entre a ocorrência de óbito e o fato de haver lesão arterial, lesão vascular na topografia cervical e lesão vascular na topografia torácica.
ABSTRACT Objective: to evaluate the epidemiological data of patients operated on due to vascular trauma at a referral hospital in Pará state, to determine the variables that increase the risk of death, and to make a comparative analysis with the results previously published by the same institution. Methods: an analytical retrospective study was performed through data collection from patients operated due to vascular injuries, between March 2013 and March 2017. Demographic and epidemiological data, such as the mechanism and topography of the lesion, distance between the trauma site and the hospital, and type of treatment and complications, were analyzed. Multivariate analysis and logistic regression studies were performed, to evaluate significant dependence between some variables and death occurrence. Results: two hundred and eighty eight patients with 430 lesions were studied; 92.7% were male, 49.7% were between 25 and 49 years old; 47.2% of all injuries were caused by firearm projectiles; 47.2% of the lesions were located in the upper limbs, 42.7% in the lower limbs, 8% in the cervical region, 3.1% in the thoracic region, and 0.7% in the abdominal region; 52.8% of the patients were hospitalized for seven days or less. Amputation was required in 6.9% of patients and there was mortality in 7.93% of the cases. Conclusion: distances greater than 200km were associated with prolonged hospitalization and greater probability of limb amputation. Significant correlation between death occurrence and arterial injury, vascular injury in the cervical region, and vascular injury in the thoracic region was found.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Arterias/lesiones , Venas/lesiones , Lesiones del Sistema Vascular/mortalidad , Brasil/epidemiología , Incidencia , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Lesiones del Sistema Vascular/clasificación , Lesiones del Sistema Vascular/etiología , Accesibilidad a los Servicios de Salud , Amputación Quirúrgica , Persona de Mediana EdadRESUMEN
Vascular injury in accidental punctures may occur in large abdominal vessels, it is known that 76% of injuries occur during the development of pneumoperitoneum. The aim of this video is to demonstrate two cases of vascular injury occurring during access in laparoscopic urologic surgery. The first case presents a 60-year old female patient with a 3cm tumor in the superior pole of the right kidney who underwent a laparoscopic partial nephrectomy. After the Verres needle insertion, output of blood was verified. During the evaluation of the cavity, a significant hematoma in the inferior vena cava was noticed. After the dissection, a lesion in the inferior vena cava was identified and controlled with a prolene suture, the estimated bloos loss was 300ml. The second case presents a 42-year old female live donor patient who had her right kidney selected to laparoscopic live donor nephrectomy. After the insertion of the first trocar, during the introduction of the 10mm scope, an active bleeding from the mesentery was noticed. The right colon was dissected and an inferior vena cava perforation was identified; a prolene suture was used to control the bleeding, the estimated blood loss was 200mL, in both cases the patients had no previous abdominal surgery. Urologists must be aware of this uncommon, serious, and potentially lethal complication. Once recognized and in the hands of experienced surgeons, some lesions may be repaired laparoscopically. Whenever in doubt, the best alternative is the immediate conversion to open surgery to minimize morbidity and mortality.
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Laparoscopía/efectos adversos , Nefrectomía/efectos adversos , Lesiones del Sistema Vascular/etiología , Vena Cava Inferior/lesiones , Adulto , Pérdida de Sangre Quirúrgica , Femenino , Humanos , Persona de Mediana Edad , Polipropilenos/uso terapéutico , Lesiones del Sistema Vascular/cirugíaRESUMEN
BACKGROUND: Aortic lesions are uncommon complications in spine surgery, but potentially fatal, because they can cause massive bleeding and hemodynamic instability. We report the endovascular treatment of late aortic erosive lesion by pedicle screw without screw removal. METHODS: A breast cancer patient had a pathological fracture on T10, with spinal cord compression, and a pseudoaneurysm of the aorta in contact with an anterolateral pedicle screw. Endovascular surgery corrected the aortic lesion and allowed decompression, a week later, by posterior arthrodesis (T7-L1), with screw maintenance. RESULTS: There was no contrast leakage at thorax angiotomography in 2 years, and she died of meningeal carcinomatosis. CONCLUSION: Screw maintenance was safe in the endovascular treatment of aortic lesion by erosion.
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Aneurisma Falso/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular , Tornillos Óseos , Neoplasias de la Mama/secundario , Procedimientos Endovasculares , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentación , Vértebras Torácicas/cirugía , Lesiones del Sistema Vascular/cirugía , Anciano , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/etiología , Aortografía/métodos , Neoplasias de la Mama/terapia , Angiografía por Tomografía Computarizada , Resultado Fatal , Femenino , Humanos , Vértebras Torácicas/diagnóstico por imagen , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiologíaRESUMEN
Complications of transseptal puncture are significant and potentially life threatening. Aortic perforation is one of these complications and it needs to be repaired immediately. We report the case of a 48-year-old female with a history of rheumatic mitral valve disease. She underwent three previous mitral valve replacements. Her last echocardiogram reported an anterolateral leak in the mitral prosthesis. Catheterization was performed. During the procedure, when attempting to perform transseptal puncture, catheterization was complicated by a forcefully puncture of the aortic root by the Brockenbrough needle followed by an immediately advancement of an 8-Fr Mullins sheath. We decided to leave the 8-Fr sheath in the aortic root recognizing the danger of removing the sheath and finally we advanced a 6/4 mm Amplatzer ductal occluder (ADO I) through the Mullins sheath and under fluoroscopy and TEE guidance we achieved a successful deployment of the device and closure of the perforation. Subsequently, the paravalvular leak was closed with an Amplatzer Vascular Plug (AVP III 10/5 mm). There are only three cases of a similar technique for the same injury in which the authors describe successful closing of aortic perforation with percutaneous closure devices. Our case is the first described during a mitral paravalvular leak closure. It is also the first to describe a different technique of leaving the Mullins sheath in the aortic root and advancing the Amplatzer device through it to achieve successful closure of the aortic perforation. We preferred the percutaneous closure over open-heart repair. © 2015 Wiley Periodicals, Inc.
Asunto(s)
Aorta/lesiones , Tabique Interatrial , Cateterismo Cardíaco/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Enfermedad Iatrogénica , Válvula Mitral/cirugía , Falla de Prótesis , Cardiopatía Reumática/cirugía , Dispositivo Oclusor Septal , Lesiones del Sistema Vascular/terapia , Aorta/diagnóstico por imagen , Aortografía , Tabique Interatrial/diagnóstico por imagen , Ecocardiografía Doppler en Color , Ecocardiografía Tridimensional , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Diseño de Prótesis , Punciones , Cardiopatía Reumática/diagnóstico por imagen , Cardiopatía Reumática/fisiopatología , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiologíaRESUMEN
AIM: To report experience with liver resection in a select group of patients with postoperative biliary stricture associated with vascular injury. METHODS: From a prospective database of patients treated for benign biliary strictures at our hospital, cases that underwent liver resections were reviewed. All cases were referred after one or more attempts to repair bile duct injuries following cholecystectomy (open or laparoscopic). Liver resection was indicated in patients with Strasberg E3/E4 (hilar stricture) bile duct lesions associated with vascular damage (arterial and/or portal), ipsilateral liver atrophy/abscess, recurrent attacks of cholangitis, and failure of previous hepaticojejunostomy. RESULTS: Of 148 patients treated for benign biliary strictures, nine (6.1%) underwent liver resection; eight women and one man with a mean age of 38.6 years. Six patients had previously been submitted to open cholecystectomy and three to laparoscopic surgery. The mean number of surgical procedures before definitive treatment was 2.4. All patients had Strasberg E3/E4 injuries, and vascular injury was present in all cases. Eight patients underwent right hepatectomy and one underwent left lateral sectionectomy without mortality. Mean time of follow up was 69.1 mo and after long-term follow up, eight patients are asymptomatic. CONCLUSION: Liver resection is a good therapeutic option for patients with complex postoperative biliary stricture and vascular injury presenting with liver atrophy/abscess in which previous hepaticojejunostomy has failed.