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
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.
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Rev Port Cir Cardiotorac Vasc · Jul 2017
Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting Surgery.
Postoperative atrial fibrillation (PoAF) is the most common arrhythmia following cardiac surgery, which increase the patient's morbidity and mortality. ⋯ PoAF incidence after CABG surgery was 18%. Older age, lower CC values and larger left atrial diameter were settled as PoAF independent predictors. Additionally, the occurrence of this arrhythmia was independently associated with lower long-term survival, after CABG surgery.
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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
Arterial Vascular Complications in Peripheral Venoarterial Extracorporeal Membrane Oxygenation Support.
Extracorporeal membrane oxygenation (ECMO) has been evolved as a life-saving measure for patients requiring emergent support of respiratory and cardiac function.The femoral artery is the standard site for vascular access when initiating adult venoarterial (VA) ECMO.Cannulation-related complications are a known source of morbidity and it has been speculated that patients undergoing ECMO via femoral arterial cannulation are more likely to develop peripheral vascular complications (up to 70%). In patients with severe peripheral arterial disease (PAD) these risks are even higher and its presence may be considered a relative contraindication for femoral artery cannulation. ⋯ Cannulation of femoral vessels remains associated with considerable rates of vascular events (28.6%).PAD and ischemic cardiopathy are associated with vascular complications in this form of cannulation.Physical examination and the assessment of ankle-brachial índex before ECMO implantation is therefore recommended.Improved efforts at preventing these complications need to be developed to avoid additional morbidity in an already critical patient population.