CONTEXTO: Desde sua introdução, em 1991, o reparo endovascular do aneurisma da aorta abdominal infrarrenal tem se tornado uma alternativa atraente para o tratamento dessa doença. Avaliar nossos resultados iniciais quanto à segurança e eficácia dessa técnica nos levou à realização deste estudo. OBJETIVOS: Analisar a mortalidade perioperatória, a sobrevida tardia, as reoperações, as taxas de perviedade e o comportamento do saco aneurismático em pacientes com anatomia favorável para a realização do procedimento. MÉTODOS: Trata-se de um estudo longitudinal, observacional e retrospectivo realizado entre outubro de 2004 e janeiro de 2009 com 41 pacientes que foram submetidos à correção endovascular do aneurisma de aorta abdominal infrarrenal por apresentarem anatomia favorável para o procedimento. Foram analisados os achados dos exames diagnósticos, o tratamento e o seguimento em todos os pacientes. RESULTADOS: Foram implantadas, com sucesso, 31 (75,6%) próteses bifurcadas e 10 (24,5%) monoilíacas, de 5 diferentes marcas. O diâmetro médio dos aneurismas fusiformes era de 62 mm. A mortalidade perioperatória foi de 4,8% e a sobrevida tardia, 90,2%. Durante o acompanhamento médio de 30 meses, 2 (4,8%) pacientes necessitaram de reintervenção, um por migração da endoprótese e outro por vazamento tipo II. Dois (4,8%) pacientes apresentaram oclusão de ramo da prótese. Oito (19,5%) vazamentos foram diagnosticados e não houve nenhuma rotura dos aneurismas. CONCLUSÃO: Apesar do pequeno número de pacientes, os resultados observados parecem justificar a realização do procedimento endovascular nos pacientes com anatomia favorável.
Horseshoe kidney is one of the most common urologic anomalies, present in about 0.12% of patients with abdominal aortic aneurysm. Conventional surgical repair is associated with technical difficulties that probably increase morbidity and mortality but can be avoided with endovascular treatment. We report the case of a 64-year-old patient presenting with horseshoe kidney and abdominal aortic aneurysm and successfully treated with endovascular repair.Keywords: abdominal aortic aneurysm; congenital abnormalities; blood vessel prosthesis implantation. ResumoO rim em ferradura é uma das anomalias urológicas congênitas mais comuns e está presente em cerca de 0,12% dos pacientes com aneurisma de aorta abdominal. O reparo cirúrgico convencional está associado a dificuldades técnicas que provavelmente aumentam a morbidade e a mortalidade, mas que podem ser evitadas com o tratamento endovascular. Relatamos um caso de um paciente de 64 anos com rim em ferradura e aneurisma de aorta abdominal, que foi submetido ao reparo endovascular do aneurisma com sucesso.Palavras-chave: aneurisma de aorta abdominal; anormalidades congênitas; implante de prótese vascular.
Objective To assess urethral vascularization in healthy young women, using colour Doppler ultrasonography. Subjects and methods Eleven healthy young women volunteers (mean age 33.6 years, range 24±46) with no pelvic¯oor disorders and no history of incontinence were assessed. The subjects underwent colour Doppler ultrasonography using a 4±7 MHz convex broadband transducer. Translabial sagittal scans of the urethra were taken when the subjects had a full bladder, both during the oestrogenic and progestogenic phases. The colour Doppler ultrasonography parameters were optimized to detect slow¯ows in the anterior and posterior distal, middle and proximal urethra. A rank-sum nonparametric test was used to assess differences between the resistive indices. Results The statistical evaluation showed a signi®cant difference in the resistive index only in the anterior urethra, between the distal and middle plus proximal urethra, in both the progestogenic (P=0.002) and oestrogenic (P=0.0127) phases. Conclusions This study con®rmed that the vascularization of the urethra plays an important role in the`seal' effect, which is considered one of the most important factors in urethral closure. There was a signi®cantly greater resistive index in the anterior proximal urethra than in the middle and distal urethra. These ®ndings suggest that the seal effect is related to the existence of a rich venous urethral vascularization, involved in the mechanism of urethral closure. Colour Doppler ultrasonography of the urethra seems to be feasible and useful for understanding the mechanism of the vascular component in female continence.
Study design: Prospective study. Objectives: To evaluate the feasibility of color ultrasound imaging of the urethra in association with UPP to diagnose intrinsic sphincter de®ciency (ISD). Setting: Italy. Methods: We studied a group of 13 normal female volunteers (mean age 29 years) during the estrogenic phase and a group of 15 patients (mean age 63.9 years) with ISD. All patients and normal volunteers underwent color ultrasound imaging using a 4 ± 7 MHz convex broad band transducer. Translabial sagittal scans of the urethra were obtained. The color ultrasound parameters were optimized for detection of parenchymal slow¯ows. A subjective score of the degree of vascularization along the entire urethra was established as follows: (a) minimal or absent (1), (b) poor (2), (c) moderate (3), (d) good (4). Statistical analysis, using the nonparametric Mann-Whitney rank sum test, was carried out to determine di erences of ultrasound scores between volunteers and patients. Results: The statistical evaluation showed that the di erences between the ultrasound scores in the two groups was statistically signi®cant (P50.001). Conclusion: We a rm that color ultrasound imaging of the urethra seems to be feasible and useful in association with UPP in the diagnosis of ISD even if this echographic investigation needs further observations.
Complications arising from use of the Amplatzer © device to correct endovascular conditions such as atrial septal defect have been described with increasingly frequency. We report on a case in which this device was used to correct an atrial septal defect, but 6 months later migrated to the abdominal aorta bifurcation. Removal of the foreign body was accomplished by conventional surgery after an endovascular attempt had failed.Keywords: endovascular procedures; abdominal aorta; embolism. ResumoCom o uso crescente do dispositivo Amplatzer para diversos procedimentos endovasculares, dentre os quais a comunicação interatrial, complicações decorrentes de seu uso vêm sendo descritas. Relatamos um caso em que o dispositivo foi empregado para correção de comunicação interatrial e, seis meses depois, migrou para a bifurcação da aorta abdominal. A retirada do corpo estranho foi realizada por cirurgia convencional, após insucesso de tentativa por via endovascular.Palavras-chave: procedimentos endovasculares; aorta abdominal; embolia.
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