Revista portuguesa de cirurgia cardio-torácica e vascular : órgão oficial da Sociedade Portuguesa de Cirurgia Cardio-Torácica e Vascular
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Rev Port Cir Cardiotorac Vasc · Jul 2017
Review Classical ArticleSurgical Treatment Options of Subclavian Artery Pseudoaneurysms: A Case Report and Litterature Review.
Subclavian artery pseudoaneurysms are rare and occur mostly as a consequence of an inadvertent arterial puncture during central venous catheterization, endovascular therapeutic procedures or after penetrating or blunt trauma. They usually have a late clinical presentation, with pain, swelling or other compressive symptoms. The optimal treatment in this situation is still a matter of debate. The authors describe a case of late presentation of subclavian artery pseudoaneurysm after transjugular hepatic biopsy and discuss the several options for treatment. ⋯ Subclavian artery pseudoaneurysms impose a major surgical challenge, especially when originating from the proximal third. Large pseudoaneurysms may rupture or produce signs and symptoms of compression. If intervention is considered necessary, several options are available: open surgical resection and vascular reconstruction, endovascular exclusion, stentgraft implantation or ultrasound-guided thrombin injection have all been described. The choice of procedure should be tailored to the patient, based on comorbidities, clinical presentation and anatomic characteristics. When compressive symptoms exist, an open approach is advised. However, because of their location, surgical exposure of the pseudoaneurysm may be technically difficult, requiring a sternotomy or a clavicular resection for adequate exposure. An endovascular approach demands an adequate landing zone and absence of severe tortuosity. When arteriovenous fistulae and enlargement of vertebral veins are verified, with subsequent increase in venous pressure, there is a risk of cervical radiculopathy (2-4%). This case report describes an uncommon presentation of subclavian pseudoaneurysm and exemplifies the complexity of their treatment.
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Rev Port Cir Cardiotorac Vasc · Jul 2017
Case ReportsFunctional Popliteal Artery Entrapment Syndrome.
Popliteal artery entrapment is an uncommon syndrome, caused by extrinsic compression of the popliteal artery by muscular or tendinous structures. It occurs mainly in young individuals, with no atherosclerostic risk factors, and a mean age of presentation of 20 to 40 years, and has higher prevalence in males (83% of patients). Clinical presentation depends on the degree of arterial lesion, the most common being intermittent claudication, with critical ischemia being frequent. Occasionally, it may present as acute ischaemia. ⋯ Continuous popliteal artery compression leads to its progressive fibrosis, which may cause thrombosis or post-stenotic aneurysmal dilation. Treatment should be performed as soon as possible as to avoid this course and the eventual necessity of interposition or bypass grafting. Futhermore, late intervention worsens the interposition/ bypass grafting prognosis5. In this sense, the possibility of this diagnosis should be considered in a young patient presenting with intermittent claudication. Diagnostic tests are often decisive for differential diagnosis and to establish the disease subtype and intervention strategy. In most patients, a culprit muscular or tendinous anomaly is detected before surgery, however, in some individuals, especially physically active ones, compression results from muscular hypertrophy.
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Rev Port Cir Cardiotorac Vasc · Jul 2017
Case ReportsUniportal VATS Lobectomy: Subxiphoid Approach.
Interest in uniportal video-assisted thoracic surgery (VATS) is rapidly growing worldwide because it represents the surgical approach to the lung with the least possible trauma and in recent years the subxiphoid approach has been used in the field of thoracic surgery as it is associated with lesser pain because there is no intercostal nerve damage and it provides excellent cosmetic outcomes. This technique was recently introduced for major pulmonary resections and even bilateral approaches in selected patients. ⋯ The subxiphoid approach is a variant of uniportal VATS approach without opening the intercostal space with its striking advantages in terms of pain control and cosmetics in selected patients. However, this technique has yet some limitations such as the control of major bleeding and the performance of a complete oncologic lymph node dissection related to its surgical complexity expected in emerging techniques. Further studies are necessary to certify the feasibility, safety and benefits of this approach.
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Rev Port Cir Cardiotorac Vasc · Jul 2017
Trifecta Bioprothesis for Aortic Valve Replacement: Our Experience.
Bioprosthesis are increasingly used for aortic valve replacement (AVR), as a result of increasing elderly patients, as well as, continuous improvements in durability and hemodynamic performance of pericardial prosthesis. The Trifecta aortic prosthesis is a latest-generation trileaflet stented pericardial valve designed for supra-annular placement in the aortic position. This study establishes the safety and early clinical and hemodynamic performance of the Trifecta valve. ⋯ The present systematic review demonstrated that AVR with this prosthesis provided excellent early safety and hemodynamic outcomes with acceptable mean gradients; nevertheless, their timing, pathological characteristics, and clinical presentation mandate continued follow-up.
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Rev Port Cir Cardiotorac Vasc · Jul 2017
Case ReportsReversal of Acute Spinal Cord Injury in the Immediate Post-Operative Period After Thoracoabdominal Aneurysm Repair with CSF Drainage.
Spinal cord injury after thoracoabdominal aortic aneurysm surgery is a devastating and unpredictable complication (1). With surgical manipulation, particularly with aortic clamping, cerebrospinal fluid (CSF) pressure may rise, and its pressure exceeds the spinal arterial pressure, spinal perfusion may be reduced, leading to neurological dysfunction. ⋯ CSF drainage has a therapeutic potential value of reducing its pressure, allowing an improvement of spinal perfusion pressure, therefore diminishing the risk of an ischemic and permanent lesion(2), thus it may have a role in preventing and/or treating acute paraplegia.