Dunbar syndrome or celiac artery compression syndrome is an infrequently described clinical condition with poorly defined diagnostic criteria and an obscure pathophysiology. It is usually associated with an extrinsic compression upon the celiac axis near its takeoff from the aorta by fibrous diaphragmatic bands or sympathetic neural fibers. The authors report the case of a 70-year-old male patient presenting with nausea, epigastric pain, and weight loss. An aortography showed a compression of the celiac trunk. A preliminary attempt at percutaneous transluminal angioplasty and stenting proved unsuccessful. The patient became asymptomatic and his clinical condition improved after surgical release of the celiac trunk by partial section of the arcuate ligament of the diaphragm and with resection of the neural, fibrotic, and lymphatic tissues surrounding the aortic and visceral vessels. The purpose of this report is to discuss the indications and the therapeutic options of this syndrome.
OBJETIVO: Desenvolver um novo modelo experimental de pseudoaneurisma sacular de artéria ilíaca comum com o uso de remendo de pericárdio bovino em suínos. MÉTODO: Foram utilizados dois suínos da raça Landrace, com peso de 30 kg e do sexo feminino. Os animais foram submetidos a anestesia geral e a laparotomia com acesso extraperitoneal da aorta infra-renal e artérias ilíacas. Após heparinização sistêmica e pinçamento, foram efetuadas arteriotomia longitudinal e sutura do pericárdio bovino em formato de bolsa previamente confeccionada. Os animais permaneceram confinados por 3 semanas e então foram submetidos a arteriografia para avaliação da perviedade do aneurisma e, posteriormente, sacrificados. RESULTADO: Os animais sobreviveram ao experimento e apresentaram aneurismas pérvios no momento do sacrifício. Não houve ocorrência de ruptura de aneurismas. CONCLUSÃO: O modelo proposto é viável e tem potencial para ser utilizado no estudo e desenvolvimento de novas próteses endovasculares.
OBJETIVO: Avaliar os efeitos da homocisteinemia induzida na artéria ilíaca de suínos. MATERIAL E MÉTODO: Realizou-se estudo experimental comparativo em dois grupos homogêneos de sete suínos da raça Macau, com peso entre 20 e 30 kg durante 30 dias. Os animais foram divididos em dois grupos, sendo um deles alimentado com metionina adicionada à dieta por um período de 4 semanas. Foram colhidas amostras de sangue para a dosagem de colesterol, triglicerídeos, HDL e homocisteína. Os animais foram submetidos à arteriografia para avaliação da perviedade das artérias ilíacas e, posteriormente, sacrificados. As artérias ilíacas foram enviadas para análise histológica. RESULTADOS: Os animais sobreviveram ao experimento, e não houve alterações significativas nos níveis de colesterol total, triglicerídeos e HDL nos dois grupos. O exame microscópico do grupo-controle não apresentou alterações patológicas e foi semelhante em todas as preparações examinadas. No grupo da dieta com metionina, as placas eram formadas por macrófagos espumosos, mas não foram observadas células musculares lisas, cristais de colesterol ou células inflamatórias. A túnica média apresentava-se com lâmina elástica interna íntegra. No grupo-controle, não houve alteração nos níveis de homocisteína durante o experimento. No grupo-metionina, houve aumento dos níveis séricos da homocisteína, com valor médio de 59,80 µmol/l após 30 dias de dieta rica em metionina. CONCLUSÃO: A homocisteinemia induzida pela metionina causa aterogênese nas artérias ilíacas de suínos.
França LHG, Pereira AH, Perini SC. Self-expandable nitinol stent placement in homocysteinemic porcine aorta. Clinics. 2008;63:229-36. PURPOSE:To compare aortic intimal thickening of normal and hyperhomocysteinemic pigs (induced with a methionine-rich diet) following placement of a self-expanding nitinol stent. METHODS: Eighteen Macau pigs were used. They were older than eight weeks in age and had an average weight of 30 kg. Pigs were randomly divided into two groups. The first, Group C (control), was fed a regular diet, and the second group, Group M, was fed a methionine-rich diet for 30 days to induce hyperhomocysteinemia. The self-expandable nitinol stents were 25mm in length and 8 mm in diameter after expansion. Blood samples were collected to measure total cholesterol, triglycerides, HDL and homocysteine concentrations. All animals were subjected to angiography. Thirty days after the procedure, the animals were sacrificed, and the abdominal aorta was removed for histological and digital morphometry analysis. RESULTS: Under microscopic evaluation, the intima was significantly thicker in Group C than in Group M. When groups were compared by digital morphometric analysis, intimal thickening of the vessel wall was higher in Group C than in Group M. There was no significant change in total cholesterol, triglycerides or HDL concentrations in either group. In group C the levels of plasma homocysteine ranged from 14,40 to 16,73µmol/l; in Group M, plasma homocysteine levels ranged from 17.47 to 59.80 µmol/l after 30 days of a methionine-rich diet. CONCLUSION: Compared to normal pigs, less intimal hyperplasia was observed in the abdominal aortas of hyperhomocysteinemic pigs thirty days after the insertion of a self-expandable nitinol stent.
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