Jeannette Vergara G

Tratamiento endovascular del aneurisma de aorta torácica descendente

Background: The natural history of aneurysms ends in rupture and death. In 1990 the first endovascular exclusion of an aneurysm, using an endoluminal graft implanted through the femoral arteries was performed. More recently, the same procedure has been used for aneurysms of the thoracic aorta. Aim: To report our experience with endovascular treatment of thoracic aorta aneurysms. Material and methods: Analysis of 14 patients (nine male), aged 30 to 79 years, treated between May 2001 and August 2002. Results: The mean diameter of the aneurysms was 6.9 cm. The etiology was atherosclerotic in nine patients. The Excluder device (Goreâ) was preferentially used. There was no operative mortality or paraplegia. One patient had a transient leg monoparesis that reverted completely. No patient had type I endoleaks. Two patients had type II endoleaks on discharge, that sealed spontaneously. In a follow up, ranging from 2 to 17 months, one patient died of a bronchopneumonia and no aneurysm rupture has been detected. Conclusions: The short term results of endoluminal treatment of thoracic aorta aneurysms are excellent. This treatment is less invasive and has less complications than conventional surgery (Rev Med Chile 2003; 131: 617-22)

Tumor del cuerpo carotídeo: A propósito de 10 casos tratados

A fluid coupling includes a socket and a plug and is used to connect two fluid hoses, whereby the plug has a neck that can be inserted into the socket with an annular groove for engaging with a locking element. The locking element includes a push-button that can be activated in a radial manner from the exterior of the socket and from which two flexible fork arms protrude that engage into a hub of the socket and have diagonal ramp surfaces on the two opposing inner faces of the fork arms, whereby the diagonal ramp surfaces engage around the neck in the area of the annular groove around a part of the circumference of the neck. The annular groove is delimited by two opposing and diverging diagonal surfaces.

Transección traumática aguda de la aorta torácica: Tratamiento endovascular

Traumatic rupture of the aorta has a near 80% mortality. Most patients die on the site of the accident. Conventional surgical repair of these lesions has a high morbidity and mortality, generally associated to the severity of associated lesions. Over the last decade, endovascular treatment has become an effective therapeutic alternative. We report a 40 years old male, that suffered a traumatic rupture of the descending thoracic aorta in a car accident. A successful endovascular repair was performed, installing an endoprothesis on the site of the lesion, using a femoral artery approach. The patient had a good postoperative evolution and was discharged from the hospital once complete rehabilitation of his associated lesions was obtained (Rev Med Chile 2003; 131: 309-13).

Aneurisma roto de aorta torácica descendente: tratamiento endovascular

In 1991, a technique to exclude aortic aneurysms from circulation inserting an endoluminal graft through the femoral artery, was described. This procedure, usually used for elective abdominal aneurysms, can also be used in the thoracic aorta. We report a 41 years old male with a Marfan syndrome, presenting with a descending aorta aneurysm that ruptured to the mediastinum and pleural cavity. He was compensated hemodynamically and an endovascular stent-graft was deployed at the ruptured zone, through the femoral artery. The postoperative evolution of the patient was uneventful. This technique will allow a less invasive treatment of ruptured aortic aneurysms (Rev Med Chile 2001; 129: 1439-43)

Tratamiento endovascular del trauma de aorta descendente

Mortality of traumatic aortic lesions is over 80%. Agroup of those who survive, develop a chronic pseudo aneurism, usually asymptomatic, that isdetected during imaging studies. Since conventional surgical treatment of traumatic aorticlesions has a great mortality, endovascular treatment has been used as an alternative treatmentin the last decade.

Pseudoaneurisma traumático de troncos supra-aórticos: tratamiento endovascular. Casos clínicos

The traditional treatment of traumatic lesions of the aortic arch branches requires extended surgical exposures, not exempt of morbidity and mortality. Over the last decade, devices that allow a minimally invasive treatment, have been developed. The vessel can be repaired without direct exposure, using an endovascular procedure. We report three patients with traumatic pseudoaneurysms of the left subclavian, brachiocephalic and left common carotid arteries, respectively. All lesions were successfully repaired with the insertion of an endograft. Although long term results of these procedure are unknown, repair of a future stenosis or occlusion is less complicated than the treatment required by the original lesion. Endoluminal repair appears as a safe, efficient and less invasive treatment for these lesions. (Rev Med Chile 2002; 130: 1027-32)

Tratamiento endovascular de la disección aórtica tipo B mediante endoprótesis

Background: Dissections that involve the ascending aorta are classified as type A, regardless of the site of the primary intimal tear, and all other dissections as type B. Type B dissections can have fatal ischemic and hemorrhagic complications. In the chronic state, dilatation and rupture can be mortal. Endovascular surgery is a therapeutic alternative, considering the high rate of complications of conventional surgery Aim: To report the results of endovascular treatment of type B aortic dissection. Material and methods: Report of 36 treated patients (30 males) aged 43 to 87 years, with a type B aortic dissection. Seventy eight percent were hypertensive and 39% smoked. The diagnosis was connrmed by CAT sean. Acute patients were treated for complications and chronic patients, for dilatation. In the operating room, an endoprothesis was placed through the femoral artery, to cover the tear. The tear was located and the lumens were differentiated using angiography and transesophageal echocardiography. Results: All procedures were successful. In 16 acute dissections the indications were malperfusion syndrome or unmanageable hypertension in seven patients and imminent rupture or persistent pain in nine. Twenty chronic patients were operated due to dilatation (mean 6 cm). One patient died due to cardiac failure. One patient had a transient paraparesia and two had pulmonary embolism. No patient died in a follow up period ranging from 2.5 to 74 months. Four patients required a new aortic endovascular procedure due to progressive dilatation or endoleak. Conclusion: Endovascular treatment of type B aortic dissection has good immediate andlong term results

Interrupción de la vena cava inferior mediante filtros de inserción percutánea: Indicaciones y resultados en 287 pacientes

Anticoagulation is the treatment of choice for deep veinthrombosis (DVT) and pulmonary embolism (PE). Occasionally this treatment is contraindicated orfails to prevent PE. In these patients, inferior vena caval (IVC) interruption is indicated and insertionof a filter is the most commonly performed procedure.

Tratamiento endovascular del síndrome de vena cava superior

Eight patients were treated, all of them with malignancies. Sixhad a benign obstruction due to the presence of a chemotherapy catheter located in the superiorvena cava, one had obstruction secondary to radiation therapy and one a tumor compression of thesuperior vena cava. Two patients underwent thrombolytic therapy. Angioplasty and stenting wasperformed in all patients. The chemotherapy catheter was removed to all patients and installedagain in one. One patient had a hemothorax secondary to a simultaneous needle lung biopsy undervideo thoracoscopy. No patient died in relation to the procedure. Congestive signs and symptomssubsided in all patients within 24 hours after the procedure. During follow up, only one patient hadsymptoms related to vena cava obstruction and three died due to their malignant tumor.

Tratamiento percutaneo de aneurismas aorto-ilíacos

Introduccion: La reparacion endovascular de aneurismas abdominales e iliacos requiere de la introduccion de dispositivos de alto calibre (> 16 F) mediante denudacion de arterias femorales. Mediante una variacion tecnica, el sistema de sutura arterial percutanea Prostar-XL® (Abbott, EEUU) permite el acceso arterial percutaneo evitando la denudacion. Objetivo: Analizar la experiencia inicial en el tratamiento percutaneo de aneurismas del territorio aorto-iliaco. Material y Metodo: Revision de las historias clinicas y base de datos de pacientes tratados con sutura arterial percutanea, entre octubre de 2003 y abril de 2008. Resultados: Tratamos 22 pacientes con esta tecnica (20 hombres y 2 mujeres). Dieciseis portadores de aneurisma aortico abdominal, 3 aneurismas iliacos, 2 reparaciones de endofuga y un aneurisma hipogastrico. La edad promedio fue 72,6 anos (rango 56-86). Se utilizo el sistema Prostar XL® para sutura percutanea en 37 arterias femorales. La anestesia mas utilizada fue peridural en el 50% de los pacientes. En 7 casos (31,8%) se efectuo la operacion exclusivamente con anestesia local. El diametro de los dispositivos de endoprotesis fue de 16 a 23 F. Se obtuvo exito tecnico en 34 cierres (92%). Tres arterias requirieron reparacion quirurgica tradicional. No hubo mortalidad operatoria. Durante el seguimiento (promedio 12,6 meses, rango 1-53) no se registraron falsos aneurismas femorales ni infeccion. Discusion: El cierre percutaneo en la reparacion endovascular de aneurismas aorto-iliacos es un procedimiento minimamente invasivo, seguro y efectivo, que permite eventualmente el uso de anestesia local.