â) was preferentially used. There was no operative mortality or paraplegia. One patient had a transient leg monoparesis that reverted completely. No patient had type I endoleaks. Two patients had type II endoleaks on discharge, that sealed spontaneously. In a follow up, ranging from 2 to 17 months, one patient died of a bronchopneumonia and no aneurysm rupture has been detected. Conclusions: The short term results of endoluminal treatment of thoracic aorta aneurysms are excellent. This treatment is less invasive and has less complications than conventional surgery (Rev Méd Chile 2003; 131: 617-22)]]>
Endovascular surgery allows effective exclusion of AAA avoiding progressive enlargement and/or rupture and is a good alternative to open repair. Close and frequent postoperative follow up is mandatory.
Background: Dissections that involve the ascending aorta are classified as type A, regardless of the site of the primary intimal tear, and all other dissections as (Rev Méd Chile 2008; 136: 1431-8).
Surgical treatment of thoracoabdominal aneurysms is a big technical challenge with a high rate of complications and mortality. It requires a large exposure and transient interruption of vital organ perfusion during its repair. Endovascular repair is a less invasive alternative available over the last decade. We report four male patients aged 44 to 76 years, with thoracic aortic aneurysms and involvement of visceral aorta, treated with a two stage procedure. During the first stage, a retrograde revascularization of the superior mesenteric and renal arteries from the infrarenal aorta was done, associated in two cases to a concomitant repair of an infrarenal aortic aneurysm. In the second stage, an endovascular graft was placed through the femoral artery, from the segment proximal to the aneurysm to the infrarenal aorta, above the origin of the visceral artery reconstructions, excluding the aneurysm from circulation. In one patient, both stages were concomitant and in three the second stage was delayed. One patient presented a postoperative bleeding that required reintervention without adverse consequences. No patient died, presented paraplegia or deterioration of renal function. After follow up of 6 to 20 months, there is no evidence of aneurysm growth or complications derived from the procedure.
Esophageal squamous cell carcinoma can spread locally to neighboring organs in the mediastinum. When it invades the aorta, the patient may develop an aorto esophageal fistula (AEF),puc.cl E l cáncer escamoso es la segunda causa de neoplasia de esófago 1,2 . Cuando el diagnóstico es tardío el pronóstico es malo, con sobrevida reportada entre 5 y 20% a largo plazo 1 . El síntoma principal es la disfagia con baja de peso secundaria, y en 12-17% de los casos puede coexistir un cáncer oro-faríngeo. En los pacientes que no son candidatos a cirugía con intención curativa, el tratamiento preferido es la quimioradioterapia (QRT), siendo el principal objetivo aliviar la disfagia cuando está presente y mejorar la calidad de vida 3 .Dependiendo de la localización, el tumor puede comprometer localmente otras estructuras en el mediastino. El compromiso aórtico es particularmente grave pues la presencia de una fístula aorto-esofágica (FAE) es de alta letalidad. Presentamos el caso de un paciente con cáncer epidermoide de esófago de tercio medio etapa IV, que durante el tratamiento paliativo con QRT evoluciona con FAE exitosamente tratada con una prótesis endovascular.
Caso clínicoPaciente varón de 62 años de edad con antecedente de tabaquismo (20 paquetes/año) que consultó por disfagia y baja de peso. Endoscopia digestiva alta (EDA) demostró un tumor estenosante del esófago a 30 cm de la arcada dentaria. Biopsia confirmó un carcinoma escamoso moderadamente diferenciado. El estudio de etapificación con tomografía axial computada (TAC) mostró una lesión infiltrante en tercio medio del esófago de 9 cm de largo, desde el cayado aórtico hasta el nivel de las venas pulmonares derechas; en su aspecto posterior se apreciaba que rodeaba y aparentemente infiltraba la aorta en más de un 50% de su circunferencia. Presentaba además un nódulo pulmonar de 1 x 0,5 cm en el lóbulo superior derecho y un nódulo hepático de 3 cm en el lóbulo caudado, compatibles con localizaciones secundarias (T4NxM1). Considerando que el paciente tenía un cáncer metastásico, recibió tratamiento paliativo para alivio de su disfagia con
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