Breno Boueri Affonso

Endovascular techniques and procedures, methods for removal of intravascular foreign bodies.

INTRODUCTION The incidence of intravascular embolization of venous catheters reported in the world medical literature corresponds to 1% of all the described complications. However, its mortality rate may vary between 24 to 60%. Catheter malfunction is the most likely signal of embolization, since patients are usually asymptomatic. OBJECTIVE To report the method of removing intravascular foreign bodies, catheters with the use of various endovascular techniques and procedures. METHODS This is a two-year retrospective study of 12 patients: seven women and five men. The average age was 29 years (ranging from two months to 65 years). RESULTS Technical performance was 100% successful. Ten port-a-caths, one intra-cath and one PICC were extracted. The most common sites for the lodging of one of the ends of the intravascular foreign bodies were the right atrium (41.6%) and the right ventricle (33.3%). In 100% of the cases, only one venous access was used for extraction of foreign bodies, and in 91.6% of the cases (11 catheters) the femoral access was used. The loop-snare was used in 10 cases (83.3%). The most common cause of intravascular foreign body insertion was a catheter fracture, which occurred in 66.6% of the cases (eight cases). One major complication, the atrial fibrillation, occurred (8.3%), which was related to the intravascular foreign body extraction. The mortality rate in 30 days was zero. CONCLUSION Percutaneous retrieval of intravascular foreign bodies is considered gold standard treatment because it is a minimally invasive, relatively simple, safe procedure, with low complication rates compared to conventional surgical treatment.

Safety, efficacy, and prognostic factors in endovascular treatment of pelvic congestion syndrome

To evaluate the safety and effectiveness of transcatheter embolization using coils for treatment of pelvic congestion syndrome (PCS) and to elucidate prognostic factors for clinical success.

Evaluation and management of symptomatic isolated spontaneous celiac trunk dissection

The purpose of this study is to describe 10 cases of symptomatic isolated spontaneous celiac trunk dissection (ISCTD) in order to evaluate the initial clinical presentation, diagnosis, treatment modalities and outcomes. A retrospective search was performed from 2009 to 2014 and 10 patients with ISCTD were included in the study. Patients with associated aortic and/or other visceral artery dissection were excluded. The following information was collected from each case: sex, age, associated risk factors, symptoms, diagnostic method, anatomic dissection pattern, treatment modality and outcome. Most patients were male (90%), with an average age of 44.8 years, and the most common symptom was abdominal pain (100%). Hypertension and vasculitis (polyarteritis nodosa) were the most frequent risk factors (40% and 30%, respectively). Diagnosis was made in all patients with computed tomography. Dissection was limited to the celiac trunk in three patients and extended to celiac branches in the other seven. Initial conservative treatment was attempted in every case and was successful in nine patients. In one case, initial conservative treatment was unsuccessful and arterial stenting with coil embolization of the false lumen was performed. After successful initial treatment, late progression of the dissection to aneurysmal dilatation was observed in two patients and it was decided to perform endovascular treatment. Mean follow-up was 19 months, ranging from 2 to 59 months. In conclusion, initial conservative treatment seems adequate for most patients with ISCTD. Long-term follow-up is mandatory, owing to the risk of later progression to aneurysm.

Safety and Feasibility of Same-Day Discharge of Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization with Drug-Eluting Beads in a Liver Transplantation Program

PURPOSE To evaluate the safety and feasibility of same-day discharge of patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization with the use of drug-eluting beads (DEBs) and elucidate the prognostic factors for hospital admission. MATERIALS AND METHODS A total of 266 DEB chemoembolization procedures in 154 consecutive patients listed for liver transplantation or identified for potential HCC downstaging were performed with the outpatient treatment protocol. Endpoints evaluated were admission to the hospital after the procedure for clinical reasons, readmission to the hospital within 1 month of the procedure, and procedure-related morbidity and mortality. In the evaluation of prognostic factors for admission, parameters of patients discharged the same day were compared with those of patients admitted overnight. RESULTS Same-day discharge was feasible in 238 cases (89.5%), and 28 (10.5%) needed overnight admission. The main reason for overnight admission was postprocedural abdominal pain (n = 23; 67.8%). The procedure-related complication rate was 2.6%, and there were no readmissions or deaths during the first 30 days after chemoembolization. Chemoembolization performed for downstaging and the use of more than one vial of embolic agent were associated with an increased need for overnight admission (P = .012 and P = .007, respectively). CONCLUSIONS Same-day discharge of patients with HCC treated with DEB chemoembolization in a liver transplantation program is safe and feasible, with low complication and admission rates. Treatment for HCC downstaging and the use of more than one vial of embolic agent were associated with an increased need for hospital admission.

Acesso venoso trans-hepático percutâneo para hemodiálise: uma alternativa para pacientes portadores de insuficiência renal crônica

BACKGROUND: Percutaneous transhepatic venous access is an option for hemodialysis patients who have exhausted all traditional sites of venous access. OBJECTIVES: To present a small sample regarding the possibility and the functionality of transhepatic implantation of long-term catheters for hemodialysis in patients with no other possible access routes. METHODS: Retrospective observational analysis was made of the charts of six patients in which nine tunneled dialysis catheters were implanted by the percutaneous transhepatic route. Transhepatic catheters were placed in the absence of an available peripheral venous site. Patients were monitored to evaluate technical success, the complication rate, the infection rate and the duration of catheter patency. RESULTS: Four men and two women aged 31 to 85 years (mean age: 55 years). Technical success was 100%. The mean duration of catheter function was 300.5 days (range: 2 to 814 days). Means of primary and secondary patency were 179.60 and 328.33 days, respectively. The catheter thrombosis rate was 0.05 per 100 catheter-days as the infection rate. There were three early complications (within the first 30 days of catheter implantation): two catheter displacement and one infection. Two late complications were observed: one thrombosis and one migration. Three patients (50%) needed to have their catheters changed. The 30-day mortality rate was 33% but with no relation to the procedure. CONCLUSION: It may be suggested that this technique is safe, however transhepatic hemodialysis catheters may be used in patients with no other options for deep venous access for hemodialysis, albeit as a last resort access route.

Tratamento endovascular de pseudoaneurisma de artéria mesentérica superior: relato de caso

Pseudoaneurysm of the superior mesenteric artery is a rare disease, however it is associated to a high incidence of rupture and mortality. The etiology is usually infectious and the diagnosis is commonly made by means of occasional imaging. Historically, the treatment of choice has been open surgical repair; however it is associated to numerous complications and technical difficulties. We reported a case of a pseudoaneurysm of superior mesenteric artery in a patient with liver abscess who, after resolution of infection, underwent successfully a minimally invasive endovascular approach, with deployment of microcoils and bare stent.

Endovascular Stenting of Brachial Artery Occlusion in Critical Hand Ischemia

Critical upper limb ischemia caused by atherosclerosis is uncommon. Endovascular treatment, with angioplasty or stenting, has been successfully performed for subclavian and below the elbow diseases; however, theres a lack of report regarding the treatment of brachial artery disease causing critical hand ischemia. In this article, we describe the treatment of a brachial artery occlusion with endovascular stenting in a patient with chronic upper limb ischemia.

Minimally invasive treatment of hepatic adenoma in special cases

ABSTRACT Hepatocellular adenoma is a rare benign tumor that was increasingly diagnosed in the 1980s and 1990s. This increase has been attributed to the widespread use of oral hormonal contraceptives and the broader availability and advances of radiological tests. We report two cases of patients with large hepatic adenomas who were subjected to minimally invasive treatment using arterial embolization. One case underwent elective embolization due to the presence of multiple adenomas and recent bleeding in one of the nodules. The second case was a victim of blunt abdominal trauma with rupture of a hepatic adenoma and clinical signs of hemodynamic shock secondary to intra-abdominal hemorrhage, which required urgent treatment. The development of minimally invasive locoregional treatments, such as arterial embolization, introduced novel approaches for the treatment of individuals with hepatic adenoma. The mortality rate of emergency resection of ruptured hepatic adenomas varies from 5 to 10%, but this rate decreases to 1% when resection is elective. Arterial embolization of hepatic adenomas in the presence of bleeding is a subject of debate. This observation suggests a role for transarterial embolization in the treatment of ruptured and non-ruptured adenomas, which might reduce the indication for surgery in selected cases and decrease morbidity and mortality. Magnetic resonance imaging showed a reduction of the embolized lesions and significant avascular component 30 days after treatment in the two cases in this report. No novel lesions were observed, and a reduction in the embolized lesions was demonstrated upon radiological assessment at a 12-month follow-up examination.

Importance of angiographic study in preoperative planning of conjoined twins: case report.

The occurrence of conjoined twins is rare. Its actual prevalence is unknown, but it is estimated to range from 1:50,000 to 1:200,000 with a higher level of incidence in Southwest Asia and Africa where an occurrence of 1:14,000 to 1:25,000 is observed, with a female predominance ratio of 3:1. Its etiology is unknown, but an incomplete division of the zygote between 13th and 15th days after fertilization probably occurs. About 40% to 60% of the conjoined twins are born alive, [...]

Dissecção espontânea do tronco celíaco: qual a melhor abordagem terapêutica?

A disseccao espontânea das arterias viscerais e um evento relativamente raro. Dor abdominal subita no epigastrio e o sintoma mais frequentemente manifestado pelos pacientes. O avanco das tecnicas de exames de imagem possibilitou o diagnostico deste evento com maior facilidade, aumentando a incidencia das disseccoes das arterias viscerais. O tratamento clinico conservador, a revascularizacao cirurgica, e a terapia endovascular sao as tres possiveis opcoes terapeuticas. Neste artigo, relatamos os casos de dois pacientes com disseccao espontânea do tronco celiaco conduzidos de formas diversas, de acordo com a apresentacao clinica e exames de imagem, alem de realizar uma revisao bibliografica sobre esta doenca.