Adenauer Marinho de Oliveira Góes Junior

Tratamento endovascular de angiomiolipoma renal por embolização arterial seletiva

Relata-se um caso de um paciente com queixa principal de dor lombar a esquerda, portador de angiomiolipomas renais (AMLRs) bilaterais, com a lesao mais volumosa de 6,2 cm em seu maior diâmetro, submetido a tratamento endovascular por embolizacao arterial superseletiva com microesferas. Os AMLRs sao tumores benignos raros. A maioria e esporadica, enquanto uma minoria esta associada a Esclerose Tuberosa Complexa (ETC). Os AMLRs maiores do que 4 cm devem ser tratados devido ao maior risco de complicacoes, principalmente hemorragicas. A embolizacao arterial seletiva (EAS) e um tratamento efetivo e seguro para os AMLRs.

Idiopathic Lymphocele: A Possible Diagnosis for Infraclavicular Masses

Lymphoceles are usually related to trauma or surgery, and its spontaneous development is rare. The aim of this paper is to report an uncommon case of idiopathic lymphocele located on the right infraclavicular region, in a female patient with no previous local trauma or surgery and unremarkable medical history. The diagnose was suggested by the tomographic aspect of the lesion and confirmed by ultrasound-guided fluid aspiration and cytological analysis. The authors also provide a brief review of the most important thing diagnostic features and treatment options for this condition. For the practicing clinician, the most important is to achieve an accurate diagnose and to choose the proper therapeutic method according to each clinical scenario.

Tratamento de tromboembolismo pulmonar por aspiração percutânea do trombo: relato de caso

Massive pulmonary thromboembolism is an important cause of mortality. Its main cause of death is the failure of the right ventricle, due to the high resistance to its outflow, and the patient survival, on these cases, depends on prompt recanalization of the pulmonary arteries. Anticoagulation, use of thrombolytics and pulmonary embolectomy represent established therapeutic options to different clinical scenarios of pulmonary thromboembolism. Nowadays, Interventional Radiology represents an alternative to treat patients with massive pulmonary thromboembolism and contra-indications to thrombolytics, and is a less invasive option compared to embolectomy. The authors reported a case of a patient with massive pulmonary thromboembolismand contra-indication to thrombolysis, who was submitted to percutaneous clot aspiration of the pulmonary arteries, and discussed the main mechanisms of endovascular techniques of pulmonary thromboembolism treatment.

Associação entre aneurismas de aorta abdominal infrarrenal e doença renal policística autossômica dominante: relato de caso

A doenca renal policistica dominante e uma das doencas renais hereditarias mais comuns, podendo apresentar manifestacoes extrarrenais vasculares de importância clinica, como aneurismas intracranianos, aneurismas aorticos e disseccoes arteriais. Relatamos o caso de um paciente masculino, com 66 anos de idade, renal cronico nao-dialitico por doenca renal policistica dominante, com aneurisma de aorta abdominal infrarrenal assintomatico, diagnosticado por ultrassonografia de rotina e operado eletivamente com sucesso. A doenca renal policistica dominante e uma sindrome genetica, associada aos genes PDK1 e PDK2 no cromossomo 16. A expressao desses genes na parede dos vasos leva ao seu enfraquecimento, favorecendo a formacao de aneurismas. A producao de metaloproteinases pelos tubulos renais tambem estaria relacionada as doencas vasculares desses pacientes. Tais doencas se apresentam como importantes fatores de mortalidade precoce e morbidade dos portadores de doenca renal policistica dominante e, como usualmente sao assintomaticas, justifica-se o uso de propedeutica armada e tratamento precoce.

Hybrid treatment of arteriovenous fistula between popliteal vessels

The authors describe treatment of a patient who presented an arteriovenous fistula between the popliteal vessels more than 20 years after a gunshot wound. The patient underwent endovascular treatment using Viabahn (Gore  ) stent grafts, but, because of the large disparity in popliteal artery diameters proximal and distal of the fistula, the endovascular treatment was unsuccessful. The superficial femoral artery was then banded around the stent graft that was deployed previously. This improvised strategy allowed an open surgical approach to be performed far from the fistula site, reducing the risks of operating in a region with anatomic distortions and significant enlargement of the surrounding venous structures, which would certainly have increased the likelihood of iatrogenic injuries.

Infecções em cateteres venosos centrais de longa permanência: revisão da literatura

Long-term venous catheters are widely used in patients with needs of venous access for prolonged periods. The infection related to these catheters remains a challenge in clinical practice. We reviewed the literature about infection epidemiology and treatment related to catheters. Staphylococcus aureus is the most common isolated bacteria. Tunneled catheters present higher infection rates than implanted ports. Treatment may consist in the use of locks, systemic antibiotics, and even catheter removal, depending on the kind of infection, the isolated microorganism, and the patients clinical conditions. Catheter salvation should be tried whenever possible.

Oclusão duodenal após cirurgia da aorta abdominal: relato de caso

Abstract Most articles on duodenal obstruction following aortic surgeryreportdatarelativetorepairsof aneurysmaldisease,notatheroscleroticdisease.However,duodenalobstructionisanuncommoncomplication,occurring in less than 1% of patients. We report a case of a patientsubmittedtoaortobifemoralbypassreconstructionwhohadduodenalobstruction as postoperative complication. The patient was treatedwith surgical intervention and omental patching for retroperitonealsynthesis. Literature review indicates that most cases respond well tothe conservative treatment, and surgical conduct is usually onlyrequiredwhenadherencesarecausingtheobstructionorwhenclinicaltreatment is not satisfactory after 2 weeks. Keywords: Occlusion, duodenum, surgery, aorta. Introducao A incidencia de complicacoes gastrointestinais aposcirurgia de aorta varia de 6,6 a 21%. Essas complica-coes sao associadas a risco aumentado de morbidade emortalidadeeincluemmaisfrequentementeileoparali-tico,hemorragiadigestivaalta,enterocolitepor

Correção cirúrgica de pseudoaneurismas e fístula arteriovenosa complexa entre vasos poplíteos

Abstract An arteriovenous fistula (AVF) is an abnormal and permanent communication between an artery and a vein caused by penetrating traumas or iatrogenic injuries. A penetrating trauma to the endothelial wall can lead to formation of pseudoaneurysms (PSA) and to formation of an AVF. Here, the authors present the case of a patient with a complex AVF of popliteal vessels, associated with popliteal artery pseudoaneurysm, suggested by clinical features and imaging exams, and treated with conventional surgery due to unavailability of a stent graft with appropriate diameter and because endovascular surgery isn’t provided at the service where this patient was operated.

Esternotomia parcial para tratamento de lesão iatrogênica do tronco braquiocefálico durante traqueostomia

: The median thoracotomy is an access incision made longitudinally through the sternum and variants can be subdivided into total vertical and partial upper or partial lower vertical incisions. In surgical practice, using a partial median sternotomy is an alternative option that causes less surgical aggression. The brachiocephalic artery is one of the thoracic vessels most often affected in traumas and it can be accessed via a median sternotomy. This report describes use of an upper partial sternotomy to provide access in a case of traumatic iatrogenic injury of the brachiocephalic trunk.Abstract The median thoracotomy is an access incision made longitudinally through the sternum and variants can be subdivided into total vertical and partial upper or partial lower vertical incisions. In surgical practice, using a partial median sternotomy is an alternative option that causes less surgical aggression. The brachiocephalic artery is one of the thoracic vessels most often affected in traumas and it can be accessed via a median sternotomy. This report describes use of an upper partial sternotomy to provide access in a case of traumatic iatrogenic injury of the brachiocephalic trunk.

Embolização arterial superseletiva para tratamento de angiomiolipoma em paciente com rim único

Resumo Os autores relatam o caso de uma paciente jovem previamente submetida a nefrectomia direita por apresentar angiomiolipomas renais (AMLRs) e portadora de dois volumosos angiomiolipomas no rim esquerdo remanescente. A paciente foi encaminhada pelo urologista para tratamento endovascular. Realizou-se embolização superseletiva de um dos tumores, localizado no polo renal inferior e em situação subcapsular; apesar de várias tentativas, não foi obtido um cateterismo seletivo suficiente para embolizar o segundo angiomiolipoma (localizado no polo renal superior) sem que um volume considerável de parênquima renal adjacente sofresse isquemia. O procedimento e a recuperação da paciente transcorreram sem complicações. A paciente recebeu alta no primeiro pós-operatório e vem sendo acompanhada ambulatorialmente há 9 meses sem intercorrências. É feita uma breve revisão sobre indicações, aspectos técnicos e complicações do tratamento endovascular dos AMLRs, além de serem discutidas vantagens dessa técnica quando comparada à ressecção cirúrgica dos tumores.