RESUMO
It has been assumed by some authors that patients with abdominal aortic aneurysms may be at increased risk of rupture after unrelated operations. From July 1986 to December 1989, 33 patients (29 men, 4 women) with a known abdominal aortic aneurysm underwent 45 operations. Twenty-eight patients had an infrarenal abdominal aortic aneurysm, and five patients had a thoracoabdominal aneurysm. The abdominal aortic aneurysm ranged in transverse diameter from 3.0 to 8.5 cm (average 5.6 cm). Twenty-seven patients underwent a single operation, and six patients had two or more (range of 1 to 6). Operations performed were abdominal (13); cardiothoracic (9); head/neck (2); other vascular (11); urologic (7); amputation (2); breast (1). General anesthesia was used in 29 procedures, spinal/epidural in 6, and regional/local in 10. One postoperative death occurred from cardiopulmonary failure. One patient died of a ruptured abdominal aortic aneurysm at 20 days after coronary artery bypass (1/33 patients [3%]; 1/45 operations [2%]). Fourteen patients had repair of their abdominal aortic aneurysm at a later date, an average of 18 weeks after operation. Four patients had abdominal aortic aneurysm considered too small to warrant resection (average 3.6 cm). Four patients were considered at excessive risk for elective repair. The five thoracoabdominal aneurysm were not repaired. Four patients are awaiting repair. During this same 40-month period, two other patients, not known to have an abdominal aortic aneurysm, died of a ruptured abdominal aortic aneurysm after another operative procedure, at 21 days and 77 days. All three ruptured abdominal aortic aneurysms were 5.0 cm or greater in transverse diameter.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Aneurisma Aórtico , Ruptura Aórtica/etiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Idoso , Aorta Abdominal , Aneurisma Aórtico/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Probabilidade , Estudos ProspectivosRESUMO
We have explored the effect of arterial hemodynamics on endothelial cell morphology and low-density lipoprotein metabolism in human saphenous vein segments harvested from tissue donors. An arterial pulsatile perfusion system was used to impose physiologic pressures and flows for 20 hours on saphenous vein and companion (control) femoral artery segments. A venous perfusion apparatus was also employed for the perfusion of a second (control) saphenous vein segment for the same period of time. Calculations of fluid shearing and wall tensile stresses were performed and related to induced changes in endothelial cell geometry and cytoskeletal actin organization and the incorporation, degradation, and localization of intact low-density lipoprotein within the vessel wall. Our results indicate that, compared with native arteries and veins, a 20-hour exposure of test saphenous veins to arterial hemodynamics induced (1) a significant increase in endothelial cell luminal surface area and perimeter independent of alignment with flow, (2) disassembly of the dense peripheral band of actin with a concomitant assembly of stress fibers, and (3) a two- to fourfold elevation in the undegraded low-density lipoprotein content, localized primarily within the subendothelial intima. Although the exact mechanisms underlying these results are uncertain, the focal accumulation of intramural low-density lipoprotein may be related to the loss of normal barrier function during endothelial cell enlargement, which is accompanied by transient cytoskeletal reorganization during the adaptation to arterial flow.
Assuntos
Actinas/metabolismo , Endotélio Vascular/patologia , Oclusão de Enxerto Vascular/metabolismo , Lipoproteínas LDL/metabolismo , Endotélio Vascular/metabolismo , Endotélio Vascular/fisiologia , Artéria Femoral/patologia , Artéria Femoral/fisiologia , Oclusão de Enxerto Vascular/fisiopatologia , Hemodinâmica , Humanos , Modelos Cardiovasculares , Perfusão/instrumentação , Veia Safena/patologia , Veia Safena/fisiologiaRESUMO
A case in which multiple cryopreserved allograft saphenous veins were used as vein grafts for a difficult mandible reconstruction with a free tissue transfer is reviewed. Use of allograft veins was recently reported for lower limb vascular reconstruction but not for free tissue transfers. Such grafts may represent a viable alternative to the use of autologous vein grafts and have the potential to decrease operating time and avoid necessary scars.
Assuntos
Criopreservação , Retalhos Cirúrgicos/métodos , Veias/transplante , Adulto , Feminino , Humanos , Infecções/cirurgia , Mandíbula/cirurgia , Prótese Mandibular/efeitos adversos , Reoperação , Transplante HomólogoRESUMO
True venous aneurysms are uncommon complications in patients undergoing hemodialysis through prosthetic grafts. We report the case of a large cephalic venous aneurysm that occurred proximal to a polytetrafluoroethylene hemodialysis fistula. The incidence, management, and possible cause of this unusual complication of prosthetic arteriovenous fistulas are reviewed.
Assuntos
Aneurisma/etiologia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Idoso , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Antebraço/irrigação sanguínea , Humanos , Falência Renal Crônica/terapia , Masculino , Politetrafluoretileno , Radiografia , Diálise RenalRESUMO
Inflammatory aneurysms of the abdominal aorta (IAAAs) have distinctive clinical and physical characteristics that separate them from typical atherosclerotic aneurysms. They were identified in 19 (7.2%) of 265 patients undergoing abdominal aortic aneurysm repair. Symptoms were present in 12 (63%) of 19, with one patient presenting with rupture, and multiple symptoms were present in six (32%). Intraoperatively, all aneurysms exhibited dense periaortic inflammation. Adjacent structures most frequently involved were the duodenum in 15 (79%) of 19 patients, the left renal vein in six (32%) of 19, and the ureter in five (26%) of 19. Seventeen (94%) of the 18 patients who underwent elective aneurysm resection survived. The involvement of retroperitoneal structures varied in number and severity, demonstrating that a wide spectrum of inflammation is present in IAAAs, making diagnosis and definition difficult.
Assuntos
Aneurisma Aórtico/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico , Feminino , Fibrose/complicações , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Obstrução Ureteral/etiologiaRESUMO
Hidradenitis suppurativa is a devastating disease of the apocrine sweat glands. The chronic form is characterized by a malodorous discharge from multiple draining sinuses embedded in dense fibrous tissue, and physical discomfort. The disease commonly affects the axillary, perineal, and perianal regions. A case of hidradenitis suppurativa of the mammary gland necessitating mastectomy is presented here to illustrate the severity of the disease at an uncommon site. As in other regions of the body, aggressive surgical intervention provides a chance for rapid recovery. The surgical treatment should be tailored to the severity of the disease.