Persistent sciatic artery aneurysm. A case reportWe report the case of a 71 years old female patient, who had a partially thrombosed true aneurysm in a persistent sciatic artery (PSA), treated in the Surgery Department of Hospital Dr. Eduardo Pereira of Valparaíso. The sciatic artery arises from the umbilical artery and during early embryological state is the main blood supply of the lower limbs. Later, the superfi cial femoral artery appears with the subsequent progressive involution of the sciatic artery. PSA is a rare congenital vascular anomaly that occurs when sciatic artery fails to regress during fetal development. This is associated with superfi cial femoral artery hipoplasia and the PSA becomes the dominant arterial infl ow to the lower limb. This anatomic abnormality may be bilateral and can remain asymptomatic for many years, however, it has been described aneurysmal degeneration, like in this case, symptoms of sciatic nerve compression, aneurysm thrombosis and distal embolization.Key words: Persistent sciatic artery, aneurysm, surgical treatment. ResumenSe reporta el caso de una paciente de 71 años, que presenta un aneurisma verdadero, parcialmente trombosado, en una Arteria Ciática Persistente (ACP), tratada en el Servicio de Cirugía del Hospital Dr. Eduardo Pereira de Valparaíso. La arteria ciática se origina en la arteria umbilical y durante las primeras fases embriológicas es el principal aporte sanguíneo de la extremidad inferior. Posteriormente aparece la arteria femoral superfi cial y se produce la progresiva involución de la arteria ciática. La ACP constituye una rara anomalía y ocurre por la falta de desarrollo de la arteria femoral superfi cial. La ACP se origina en el adulto en la arteria hipogástrica, transcurre hacia la región glútea a través de la escotadura ciática y sigue hacia distal por la parte posterior del muslo continuándose después con la arteria poplítea. Se acompaña de un variable menor desarrollo del eje arterial anterior de la arteria ilíaca externa y femoral superfi cial. Esta anomalía anatómica puede ser bilateral y puede permanecer asintomática durante muchos años, sin embargo, se ha descrito la degeneración aneurismática, como en este caso, y síntomas por compresión del nervio ciático, trombosis del aneurisma y embolización distal.Palabras clave: Arteria ciática persistente, aneurisma, tratamiento quirúrgico.
Endovascular repair of abdominal aortic aneuriysms. Experience in 28 patientsBackground: Endovascular repair of aortic aneurysms is less invasive than the traditional surgical approach. Aim: To evaluate the early and mid-term results of aorto-iliac aneurysm endovascular repair. Material and Methods: Analysis of 28 patients aged 59 to 86 years (22 males), subjected to an endovascular repair of aorto-iliac aneurysms between 2007 and 2012. Results: The follow up period of patients ranged from 1 to 65 months. A tri-modular bifurcated prosthesis was installed in 25 patients. A bi-modular bifurcated prosthesis was installed in one patient, an aorto uni iliac prosthesis was installed in one patient; in other patient, a straight endoprosthesis was installed after an abdominal visceral disconnection. In cases of associated iliac aneurysms, unilateral iliac embolization was carried out in seven patients and bilateral embolization in one patient. In one case, the sealing of the hypogastric artery was achieved leaning the prosthetic branch on the hypogastric artery ostium. One patient died 31 days after the operation due to multiple organ failure. One patient died 24 months after surgery due to a gallbladder cancer and other patient died 36 months after surgery due to a rectal cancer. The long-term follow-up showed the presence of type 2 endo-leaks in two patients. The aneurysm decreased in size in 83% of patients after 2 years of follow-up. In five patients, a non-progressive laminar parietal thrombosis inside the endoprosthesis, was observed in the immediate postoperative period. It was initially treated with oral anticoagulants. Conclusions: Endovascular repair of aorto-iliac aneurysms is safe and effective in patients with appropriate anatomical conditions, if a skilled surgical team is available.
Paciente de sexo femenino de 46 años con cuadro de 1 año de evolución de dolor lumbar irradiado a extremidad inferior derecha, que fue estudiada en el policlínico de neurocirugía con resonancia nuclear magnética de columna que demostró hernia al nú-cleo pulposo L4-L5 derecha. Debido a esto se realizó disectomía lumbar sin reportar complicaciones intraoperatorias. A las 6 h del postoperatorio cursa con dolor abdominal intenso, vómitos e hipotensión que respondió a volemización, se realizó angioTC que mostró pseudoaneurisma y fístula arteriovenosa de arteria ilíaca común izquierda (Figuras 1 y 2). Se realizó angiografía que confirmó hallazgos y se procedió a la colocación de stent cubierto Fluency Plus de BARD de 10 mm x 60 mm (Figura 3). La paciente evolucionó favorablemente siendo dada de alta al día siguiente. Tras 5 meses de la cirugía la paciente no ha presentado complicaciones, con angioTC de control que mostró stent in situ (Figura 4). Este tipo de lesiones son de baja frecuencia reportándose en 1 a 5 casos por cada diez mil disectomías 1,2 . Se deben sospechar ante la presencia de dolor abdominal, sangrado inexplicable en el espacio intervertebral e hipotensión durante o posterior a la disectomía lumbar 3 . Figura 1. Corte transversal de AngioTAC que muestra pseudoaneurisma de arteria iliaca común izquierda con comunicación hacia la vena ilíaca común ipsilateral, destaca la presencia de medio de contraste ambas venas ilíacas. Además se aprecian cambios postquirúrgicos en vértebra lumbar.
complex arteriovenous malformation of the neck Background: Arteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system and forming arterial, venous and capillary nests. case report: We report a female consulting for the first time at the age of 15 for an AVM located in the left posterior region of the neck. The patient was operated at that time, performing an extensive excision of the lesion and covering the defect with a skin flap. The lesion relapsed three years later. Vascular imaging revealed the malformation with afferent arteries from the subclavian, vertebral and left occipital arteries and a great posterior cervical nest that drained through a great anomalous vein to the subclavian vein. A surgical ligation of all the anomalous branches of the subclavian vein was performed, to perform a local excision in a second intervention. The patient got pregnant, delaying the intervention and had a normal delivery at the age of 19. At 21 years of age, she consulted again due to a great growth of her AVM, with repeated bleeding episodes, requiring transfusions. The patient was treated with embolization of the nest and the afferent arteries. Finally at 23 years of age, the lesion was excised again and the defect was covered with a skin flap. The patient had a good postoperative evolution.
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