Antonio Luiz de Medina

Closure of Carotid Artery Puncture Site With a Percutaneous Device

The surgical treatment of traumatic neck injuries in patients with hostile anatomy is associated with higher risk of complications, due to the technical challenge and associated clinical conditions. The use of a percutaneous closure device for removal of a 7.5 Fr sheath, nonintentionally implanted into the carotid artery, is reported. The right common carotid sheath was removed after introducing a 0.035-inch guidewire; the Angioseal 8 Fr device was then introduced over the wire, successfully sealing the puncture site. Duplex scan control showed patency of the carotids, sealing of the puncture, and adequate flow in the jugular vein and carotid arteries. This maneuver allowed the safe placement of a percutaneous arterial device (Angioseal) to close the puncture site.

Tratamento endovascular do aneurisma da aorta abdominal em paciente com insuficiência renal crônica

Abstract Non-dialytic chronic renal failure is a contraindication related tothe endovascular treatment of abdominal aortic aneurysms. The useof alternative contrast agents, such as gadolinium, provides good-quality images and is associated with nephrotoxicity. We report a caseof endovascular treatment of an abdominal aortic aneurysm guidedby color-flow Doppler ultrasonography. An 82-year-old male patient,with abdominal aortic aneurysm (55 mm in diameter) and creatinineclearance of 17 ml/min, underwent implantation of modular bifurcatedaortic stent-graft, using that imaging method associated withradioscopy. Iodinated contrast was not used. The immediate resultand 1- and 6-month controls showed complete aneurysm exclusion.Renal function is still unaltered. We conclude that the stent-graftimplantation guided by color-flow Doppler ultrasonography inpatients with nonterminal chronic renal failure and with favorableanatomy is a feasible and safe method.Keywords: Endovascular treatment, abdominal aortic aneurysm,renal failure, color-flow Doppler ultrasonography, duplex scan.

Implante de filtro de veia cava com uso de dióxido de carbono como meio de contraste: série de casos

OBJECTIVE: To assess the use of digital subtraction with carbon dioxide (CO2 ) for vena cava filter implant. METHODS: From April 2010 to February 2011, seven patients underwent inferior vena cava filter placement with digital subtraction angiography with the use of CO2 as contrast media. All patients had iliac and femoral deep venous thrombosis and contraindications for anticoagulation. RESULTS: Technical success was achieved in all cases. Inferior vena cava e renal veins were identified in all cases. There were no evidences of complications related to the use of CO2 during or after the procedure. CONCLUSION: The placement of inferior vena cava filter with CO2 and digital subtraction angiography is safe and effective with good results in patients with renal insufficiency and allergy to iodine.

Angioplastia subintimal sem o uso de stent em paciente diabético portador de lesão complexa no pé

Diabetic patients presenting with both peripheral vascular disease and complex soft-tissue defects are often treated by primary amputation. We report the case of a 66-year-old female patient with multiple comorbid conditions. She presented left foot plantar abscess and TASC C superficial femoral lesion. Endovascular revascularization of the left lower limb was performed employing the subintimal angioplasty technique, without stenting or endografting. This combined approach of lower limb revascularization associated with intensive care in diabetic foot wounds should always be considered before amputation. We recommend subintimal angioplasty as an option for high-risk patients with complex limb wounds.

Cierre mediante dispositivo percutáneo de perforación accidental de la arteria carótida

El tratamiento quirurgico de las lesiones traumaticas del cuello en los pacientes con una anatomia dificil esta asociado con un riesgo elevado de complicaciones debido al desafio tecnico y a los procesos clinicos asociados. Se describe el uso de un dispositivo de cierre percutaneo para la retirada de un introductor 7,5 Fr, implantado de forma inadvertida en la arteria carotida. El introductor situado en la carotida comun derecha se retiro tras introducir una guia de 0,035 pulgadas; posteriormente se introdujo el dispositivo Angioseal 8 Fr sobre la guia sellando de forma satisfactoria la zona perforada. Un eco-Doppler de control mostro la permeabilidad de las carotidas, el sellado de la perforacion, y el flujo adecuado en la vena yugular y las arterias carotidas. Esta maniobra permitio colocar de forma segura un dispositivo arterial percutaneo (Angioseal) para cerrar el lugar perforado.