Pseudoaneurisma de la arteria geniculada inferior medial tras reparación del ligamento del cruzado anterior.

Presentamos el caso de un varón de 24 años intervenido por una rotura crónica del ligamento cruzado anterior de rodilla izquierda. Se realizó una ligamentoplastia con técnica de cuatro fascículos con tendones ísquiotibiales. En el postoperatorio inmediato presentó un cuadro de hematoma en la zona de extracción de la plastia. Inicialmente se atribuyó a un sangrado muscular que se redujo con medidas médicas, el cuadro se repitió a los pocos días por lo que se decidió suspender el tratamiento con heparina de bajo peso molecular. Tras la mejoría se repite el hematoma, por lo que se realiza un angioTAC que muestra la presencia de un pseudoaneurisma de la arteria geniculada inferior medial. Ante la evolución tórpida del cuadro se decide la cirugía y se procede a ligar la arteria mencionada vaciándose el hematoma residual. El cuadro se resuelve sin incidencias, de modo que el paciente empieza su rehabilitación de modo habitual. Dada la infrecuencia de esta patología se revisa la bibliografía y su patogenia.We report the case of a 24 year old male with a chronic rupture of the anterior cruciate ligament in his left knee. We performed an anterior cruciate ligament reconstruction with four fascicles using the hamstrings tendon. In the immediate postoperative period, he presented a hematoma in the area of extraction plasty. Initially it was attributed to muscle bleeding and physical therapy (rest, ice and bandage) was prescribed. It reappeared few days later so it was decided to discontinue treatment with LMWH. Despite initial improvement, the haematoma reappeared so an angioCT Scan was performed showing medial inferior genicular artery pseudoaneurysm. The patient underwent a surgery for surgical wound exploration and ligation of the affected vessel. The patient improved and started the rehabilitation program as usual. Given the rarity of this disease and its pathogenesis literature is reviewed

Pseudoaneurisma de la arteria geniculada superior lateral secundaria a artroplastia de rodilla: Aportación de un caso

El pseudoaneurisma es una complicación infrecuente en la cirugía ortopédica de rodilla. Los pocos casos descritos generalmente están en relación con cirugía artroscópica. Presentamos un caso de pseudoaneurisma de la arteria geniculada superolateral secundario a artroplastia de rodilla en un varón de 69 años. El diagnóstico se realizó mediante arteriografía. Se trató con éxito mediante hemostasia y resección química.Pseudoaneurysm is an uncommon complication in knee orthopaedic surgery. There are few cases reported an most of them are secondary to arthroscopic techniques. We report a case of pseudoaneurysm of the superolateral genicular artery after knee arthroplasty in a 69-year-old-man. The diagnosis was made with arteriographay, and treatment was a successful hemostasia and surgical resection

Pseudoaneurismas femorales en fracturas de cadera. ¿Se puede evitar?

Aunque la aparición de un pseudoaneurisma femoral es infrecuente en el contexto del tratamiento de fracturas pertrocantéreas, debido a su extrema gravedad y a su posible implicación en las causas de mortali - dad, es necesario realizar un diagnóstico temprano y un tratamiento adecuado. Presentamos 3 casos en los que se produjo una lesión de la arteria femoral superficial, y 2 de la arteria femoral profunda, tratados los 3 casos con stents recubiertos. Conclusiones . Se debe tomar en consideración, recti fi car la aducción y rotación interna de la extremidad fracturada una vez colocado el implante, el uso de brocas cortas o con un tope para el momento del en - cerrojado distal, longitud adecuada de los tornillos, controlar el desplazamiento del trocánter menor, o una correcta colocación de los cerclajes femorales, para poder disminuir la incidencia de este tipo de lesiones.Although the appearance of a femoral pseudoaneurysm is uncommon in the context of treatment of trochanteric fractures, due to their extreme gravity and its possible involvement in the causes of death, it is ne - cessary for early diagnosis and appropriate treatment. We report 3 cases in which an injury occurred superficial femoral artery, and 2 of the deep femoral artery, 3 cases treated with stents. Conclusions. It should be taken into consideration, correct adduction and internal rotation of the fractured limb once fitted the implant, the use of short bits or a cap on the distal locking time, proper length screws, control the displacement of the lesser trochanter , or the correct placement of the femoral cerclage, to decrease the incidence of these injuries

Endovascular Therapy of Pseudoaneurysm and Arteriovenous Fistula in a Renal Graft

A 31 year old male Caucasian received a renal cadaveric allograft. Reconstruction of an inferior polar artery was corrected pre-implantation. Delayed graft function occurred leading to dialysis support for one month. Graft biopsies(days 7, 15) showed acute tubular necrosis(ATN) and no rejection. Serial ultrasound (US), performed on average weekly, were compatible with ATN. On day 31, Doppler US and a CAT scan suggested for the first time a pseudoaneurysm adjacent to the implantation of the graft artery on the external iliac artery. For clinical and technical reasons, arteriography was only performed on day 67, when serum creatinine was 3.3 mg/dl. It showed a large pseudoaneurysm with an arteriovenous fistula to the right common iliac vein. Compression of the right external iliac artery was clear. In an attempt to close the arteriovenous fistula, the communication with the pseudoaneurysm was embolised with gelfoam and metallic coils with partial success. One week later, by right femoral approach a covered wallstent was placed immediately below the origin of the graft artery.Subsequent Doppler US and arteriography con-firmed closure of the communication with thepseudoaneurysm and of the arteriovenous fistula. The calibre of the right external iliac artery was then normal. By month 18, serum creatinine is stable at 2.1 mg/dl. We can only speculate on the origin of thepseudoaneurysm and of the AV fistula, whichwere not evident until one month post-transplantation. Backtable surgery was performed on thepolar not the main graft artery. Invasive angiography was irreplaceable in this unusual clinical situation

Parálisis del plexo braquial por pseudoaneurisma de la arteria axilar tras luxación de hombro

Las lesiones del plexo braquial y de las arterias subclavia y axilar son complicaciones poco frecuentes, pero importantes, de los traumatismos dé la cintura escapular. Las lesiones neurovasculares son más frecuentes en heridas penetrantes, pero son raras en traumatismos cerrados. Cuando la sintomatología neurológica se desarrolla insidiosamente, días o semanas después del traumatismo, hay que pensar en una lesión vascular. Presentamos un caso de parálisis del plexo braquial tardía, en un paciente varón de 39 años, que sufrió una luxación gleno-humeral anterior diez días antes. La angiografía mostró un pseudoaneurisma de la arteria axilar y el electromiograma confirmó la parálisis del plexo braquial. El tratamiento consistió en la reparación del defecto vascular. Al año de la intervención la evolución tanto clínica, como electrofisiológica fue satisfactoria, aunque no completa.Injuries to the brachial plexus and subclavian and axillary arteries are uncommon and serious complications of shoulder girdle trauma, due to the close anatomical relationship between them. Neurovascular injuries are most frequent in penetrant lesions, but are are after a closed trauma. When neurological symptoms develop insidiously, some days to weeks after trauma, that should lead to the suspicion of a vascular injury. We report a delayed brachial plexus paralysis in a 39 years old male, who sustained an anterior dislocation of the shoulder ten days before. The DIVAS showed a pseudoaneurysm of the axillary artery and the EMG confirmed the brachial plexus palsy. Treatment consisted in surgical release repair of the vascular defect. One year follow-up show good clinical result

Delayed epistaxis secondary to intracavernous pseudoaneurysm of internal carotid artery

Post-traumatic pseudoaneurysm of the internal carotid artery is a very rare but potentially fatal cause of epistaxis. Early diagnosis is essential for an adequate management of this entity. The authors present a case of pseudoaneurysm of the internal carotid artery that developed massive epistaxis six months after skull base trauma.Pseudoaneurisma traumático da artéria carótida interna é uma causa rara de epistaxe, porém potencialmente fatal. O diagnóstico precoce é essencial para um adequado manejo da patologia. Os autores relatam um caso de pseudoaneurisma da carótida interna que se apresentou como epistaxe maciça após seis meses de trauma craniano prévio.Hospital do Servidor Público do Estado de São Paulo Serviço de Otorrinolaringologia/Cabeça e PescoçoUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Pseudoaneurisma crónico del ventrículo izquierdo de etiología indeterminada

Pseudoaneurysms occur as a rare complication of the myocardial infarction, of which hemorrhagic process is contained by adherences of the visceral or parietal pericardium - or of both - preventing the development of cardiac tamponade. We report the case of a 55-year-old patient, with a chronic left ventricular pseudoaneurysm of undetermined etiology, who was submitted to a conservative treatment.Los pseudoaneurismas ocurren como rara complicación del infarto de miocardio, tras rotura miocárdica, con detención del proceso hemorrágico por las adherencias del pericardio visceral, parietal - o de ambos -, impidiendo el desarrollo de taponamiento cardiaco. Relatamos el caso de un paciente de 55 años, con pseudoaneurisma crónico del ventrículo izquierdo de etiología indefinida, de larga evolución, que se sometió a tratamiento conservador.Os pseudoaneurismas ocorrem como rara complicação do infarto do miocárdio, após rotura miocárdica, cujo processo hemorrágico é contido por aderências do pericárdio visceral, parietal - ou de ambos -, impedindo o desenvolvimento de tamponamento cardíaco. Relatamos o caso de um paciente de 55 anos, com pseudoaneurisma crônico do ventrículo esquerdo de etiologia indefinida, de longa evolução, que foi submetido a tratamento conservador.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Hospital São PauloUNIFESP, EPM, Hospital São PauloSciEL

Endovascular treatment of visceral artery aneurysms and pseudoaneurysms with stent-graft: Analysis of immediate and long-term results

The aim of this study is to analyze the safety and efficacy of stent-graft endovascular treatment for visceral artery aneurysms and pseudoaneurysms. METHODS: Multicentric retrospective series of patients with visceral aneurysms and pseudoaneurysms treated by means of stent graft. The following variables were analyzed: Age, sex, type of lesion (aneurysms/pseudoaneurysms), localization, rate of success, intraprocedural and long term complication rate (SIR classification). Follow-up was performed under clinical and radiological assessment. RESULTS: Twenty-five patients (16 men), with a mean age of 59 (range 27-79), were treated. The indication was aneurysm in 19 patients and pseudoaneurysms in 6. The localizations were: splenic artery (12), hepatic artery (5), renal artery (4), celiac trunk (3) and gastroduodenal artery (1). Successful treatment rate was 96% (24/25 patients). Intraprocedural complication rate was 12% (4% major; 8% minor). Complete occlusion was demonstrated during follow up (mean 33 months, range 6-72) in the 24 patients with technical success. Two stent migrations (2/24; 8%) and 4stent thrombosis (4/24; 16%) were detected. Mortality rate was 0%. CONCLUSION: In our study, stent-graft endovascular treatment of visceral aneurysmns and pseudoaneurysms has demonstrated to be safe and is effective in the long-term in both elective and emergent cases, with a high rate of successful treatment and a low complication rate

Thoracic aortic aneurysm. Natural history, diagnosis and management

Indexación: Web of Science; Scielo.Los aneurismas corresponden a una dilatación arterial localizada que es producida por una debilidad de la pared; se clasifican en verdaderos y falsos. La incidencia es de aproximadamente 6 - 10 casos por 100.000 habitantes al año y los aneurismas de la aorta ascendente son los más frecuentes dentro del grupo de los aneurismas de la aorta torácica (AAT). Habitualmente se generan como resultado de una necrosis quística de la media que suele estar asociada a otras patologías. Los aneurismas suelen pesquisarse de manera incidental mediante exámenes imagenológicos solicitados por diferentes motivos. Su historia natural no está completamente clarificada, pero en términos generales los AAT tienen un crecimiento promedio de 0,1 cm por año. La angiografía por tomografía computada o por resonancia magnética, son los exámenes de elección para el diagnóstico. Para aquellos pacientes con aneurismas pequeños que no requieren cirugía, las medidas orientadas a la reducción del riesgo de ateroesclerosis son el pilar del tratamiento. Para los aneurismas de la aorta ascendente que cumplan con los requisitos, requieran de revascularización coronaria o reemplazo valvular, se recomienda el tratamiento quirúrgico. En relación a los aneurismas del cayado aórtico las opciones terapéuticas son tres: cirugía, terapia endovascular y terapia combinada. Para los aneurismas de la aorta descendente la terapia endovascular se perfila como la más eficiente. Los pacientes sin indicación de tratamiento quirúrgico o endovascular deben ser controlados de manera seriada con estudios imagenológicos.Aneurysms are defined as a localized dilatation caused by a weakness in the arterial wall. and may be classified as true or false aneurysm. The incidence is estimated to be 6-10 cases per 100,000 patient years. Aneurysms of the ascending aorta are the most common within the group of thoracic aortic aneurysms (TAA). These often result from cystic medial degeneration, which tends to be associated with other pathologic entities. Aneurysms are diagnosed most commonly on imaging studies performed for an unrelated indication. Although its natural history remains unclear, it is known that current average growth is about 0.1 cm per year. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are the preferred imaging tests to detect aortic aneurysms. Measures aimed to reduce atherosclerosis risk are the main treatment objective for patients with smaller aneurysms that do not require surgery. When ascending aortic aneurysms meet the size criteria or coronary revascularization and aortic valvular replacement are necessary, surgical treatment it's recommended. For aortic arch aneurysms, there are three therapeutic alternatives: surgery, endovascular therapy and combined therapy. For descending aortic aneurysms, endovascular therapy is the preferred procedure. Patients with no indication for surgical or endovascular therapy, should be followed up with serial imaging studies.http://ref.scielo.org/62pjw

Tratamento endovascular do trauma arterial.

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Departamento de Clínica Cirúrgica, Curso de Medicina, Florianópolis, 200