RESUMO
INTRODUCTION: May-Thurner syndrome has been recognized as a cause of chronic venous insufficiency and a trigger for venous thromboembolism. There is no consensus about the definition, diagnosis, and therapeutic approach. We are aiming to describe its characteristics and a scoping literature review. METHODS: A retrospective review of patients with May-Thurner syndrome from March 2010 to May 2018 and scoping literature review were made. RESULTS: Seven patients were identified. All patients were female with a median age of 36 (20-60) years. The median time from the first symptom to diagnosis was 3.41 (0.01-9) years. The primary clinical presentation was post-thrombotic syndrome (4 patients). Six patients had at least one risk factor for deep venous thrombosis. All patients underwent angioplasty with stent; patients with acute deep venous thrombosis, furthermore mechanic thrombectomy with or without catheter-directed thrombolysis were done. There were three complications (one patient, lymphedema, and two venous stent thrombosis). Scoping review results were descriptively summarized. CONCLUSION: May-Thurner syndrome has a varied spectrum of clinical presentation, and clinical awareness is paramount for diagnosis. Its principal complication is the post-thrombotic syndrome, which is associated with high morbidity. There is no consensus on the antithrombotic treatment approach.
Assuntos
Angioplastia , Síndrome de May-Thurner/terapia , Síndrome Pós-Trombótica/terapia , Trombectomia , Terapia Trombolítica , Trombose Venosa/terapia , Adulto , Angioplastia/efeitos adversos , Angioplastia/instrumentação , Feminino , Humanos , Masculino , Síndrome de May-Thurner/complicações , Síndrome de May-Thurner/diagnóstico por imagem , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/diagnóstico , Síndrome Pós-Trombótica/etiologia , Recidiva , Estudos Retrospectivos , Stents , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Adulto JovemRESUMO
We report an adult female patient with Takayasu arteritis (TA) receiving conventional medical treatment and anti-TNF therapy, which developed progressive thoracic and abdominal aortic aneurysms. She developed imminent rupture of the thoracic aneurysm and an endovascular stent-graft (EVSG) was emergency implanted and a year after this procedure the abdominal aneurysm increased in size requiring reoperation and placement of another EVSG. Both procedures had a very good outcome. This case shows the effectivity and security of multiple EVSG implantations in multiple aortic aneurisms in patients with TA.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Stents , Arterite de Takayasu/complicações , Arterite de Takayasu/tratamento farmacológico , Adulto , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/etiologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/etiologia , Aortografia/métodos , Produtos Biológicos/uso terapêutico , Feminino , Humanos , Reoperação , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/imunologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
BACKGROUND: Popliteal arterial injuries carry a high risk of amputation. The currently available literature from both civilian and military experiences is characterized by a wide variation of recommendations for surgical management. We questioned how these recommendations have been applied in our practice. Therefore, we aimed to identify predictors of amputation after popliteal arterial injury. METHODS: We conducted an observational study of 175 patients with popliteal arterial injuries who underwent surgical treatment from 1992 to 2006 at a level I trauma center in Cali, Colombia. Information on demographic characteristics, clinical information, and surgical management was collected from clinical records. The outcome measure was amputation within 30 days following the first surgical intervention. RESULTS: The amputation rate was 17.1%. A multivariable logistic regression model indicates that blunt mechanism (odds ratio [OR] 4.79, 95% confidence interval [CI] 1.49-15.42), signs of ischemia (OR 5.29, 95% CI 1.48-18.91), ligation of the popliteal vein of the compromised limb during surgical exploration (OR 3.83, 95% CI 1.20-12.18), and the development of arterial thrombosis (OR 56.51, 95% CI 12.36-258) were found to be independent predictors of amputation. Fractures, popliteal venous injuries, prolonged time between injury and surgery, fasciotomies, and graft arterial repair were not statistically significant predictors of amputation. CONCLUSIONS: Emphasis on the early assessment and prompt identification of signs of ischemia after popliteal arterial injury continue to be the most important factor for reducing the risk of amputation, especially in blunt trauma. Vascular trauma teams must emphasize the need for the specialized management of popliteal veins. Clinical research is needed in order to identify means of decreasing arterial thrombosis after popliteal repair.
RESUMO
BACKGROUND: The incidence of abdominal aortic aneurysms has increased. Its predisposing factors are smoking, high blood pressure and dislipidemia. Progressive aneurysmal enlargement may lead to its rupture, which is associated to a mortality rate above 80 per cent. AIM: To assess the prevalence of abdominal aortic aneurysms in Chilean subjects with cardiovascular risk factors. SUBJECTS AND METHODS: Through announcements in open media we invited individuals aged over 60 years, who smoked, had hypertension and/or had occlusive arterial disease, to participate in a study that included medical history and physical examination. An aortic ultrasound was performed in all subjects in whom the aorta was not palpable or there was a suspicion of dilatation. Aortic diameter over 3 cm was considered aneurysmal. RESULTS: Three hundred fifty six subjects aged 67.1 +/- 6.7 years, (73.9 per cent males), were evaluated. The study group included 62 per cent hypertensives, 39 per cent with abnormal lipids and 46 per cent smokers. Known coronary heart disease or peripheral arterial diseases were present in 14 per cent and 10 per cent, respectively. Ultrasound was required in 159 subjects. Aneurysms were detected in 21 persons (5.9 per cent), 7.6 per cent in males and 1.1 per cent in females. The mean transverse diameter of the aneurysm was 4.1 cm (3-7.5). Aneurysm was found in 2.3 per cent of subjects younger than 65 years and 8.3 per cent of subjects aged over 65 years. CONCLUSIONS: In this sample the prevalence of abdominal aortic aneurysms was 5.9 per cent, affecting predominantly males, with a notorious increase with advanced age.