L. Del Río

Seudoaneurismas infecciosos en pacientes drogadictos: ligadura o revascularización

Resumen Introduccion La puncion arterial en drogadictos puede producir falsos aneurismas infecciosos (FAI) con riesgo de hemorragia, perdida de la extremidad o muerte. Pacientes y metodos Siete pacientes drogadictos con FAI fueron tratados en nuestro hospital entre 1990 y 1999. Una masa pulsatil con fistulizacion de liquido serosanguinolento fue la presentacion caracteristica. El estudio arteriografico distinguio entre absceso y seudoaneurisma, lo que ayudo a la localizacion anatomica de las lesiones. Una reconstruccion arterial, electiva (n = 3) o urgente (n = 4), se practico en todos los casos. Resultados El cultivo microbiano fue siempre positivo. Se utilizo un injerto venoso en 6 casos y se requirio una protesis de politetrafluoroetileno (PTFE) en un paciente con ausencia de venas utiles. Aunque el postoperatorio inmediato transcurrio con normalidad, la recidiva de infeccion y la hemorragia masiva obligaron a la ligadura arterial urgente en todos los pacientes. Tan solo fue necesaria una amputacion de brazo. No se registraron muertes. Conclusiones La reconstruccion arterial en pacientes drogadictos se acompana de numerosas complicaciones. La ligadura arterial con reseccion amplia de los tejidos es segura, bien tolerada y con aceptable morbilidad.

Transposición de la arteria vertebral (segmento V1) al tronco tirocervical

Summary Introduction. We describe a technique for reconstruction of the proximal segment of the vertebral artery. We transposed the vertebral artery to the thyrocervical trunk after ligating its branches. The stump was used for anastomosis. Patients and methods. We made a retrospective review of our experience from 1992 to 2001. This reconstruction had been done in five male patients with vertebrobasilar symptoms. Their average age was 64 years and they had diseased common carotid or ipsilateral internal carotid and/or contralateral internal carotid arteries. Surgical technique: during the first stage of the reconstruction, the contralateral internal carotid artery was operated on (n= 3). One month later, using an approach medial to the sternocleidomastoid muscle, with an oblique supraclavicular incision, we dissected between the common carotid artery and internal jugular vein to find the vagus nerve, thoracic duct and vertebral vein, which was ligated, observing the vertebral artery. The vertebral artery was sectioned below the lesion. Great care was taken not to damage the cervical sympathetic chain, vertebral nerve or inferior cervical sympathetic ganglion. The thyrocervical trunk arises lateral to the origin of the vertebral artery. We ligated its branches and the vertebral artery was anastomosed to the stump using partial subclavian clamping. Results. Five transpositions were done. One patient had a TIA immediately after the operation but recovered with no sequelae. During the follow-up period, 100% permeability was shown by echo-Doppler. Only one patient died, three years later, from ischaemic cardiopathy. Conclusion. We believe that transposition of the proximal segment of the vertebral artery to the thyrocervical trunk is not a very aggressive surgical operation, which needs no clamping of the main arterial trunks, therefore reducing the operating time and giving low morbi-mortality.