Salim Abdon Haber Jeha

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.

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.

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.

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.

Stent Graft-in-Stent Graft as a Rescue Technique for Endovascular Treatment of Giant Extracranial Internal Carotid Aneurysm

Endovascular treatment of a giant extracranial internal carotid aneurysm by a stent graft implantation was unsuccessful due to a high flow leak directly through the stent grafts coating. The problem was solved deploying a second stent graft inside the previously implanted one resulting in complete exclusion of the aneurysmal sac and patent carotid lumen preservation. The review of the literature did not provide a case using this endovascular strategy. Follow-up for more than 12 months, using CT angiography, showed confirmed aneurysmal exclusion and carotid patency and no clinical complications have been detected.

Selective vesical artery embolization for treatment of gross hematuria due to actinic cystitis

This article describes the case of a 46-year-old female patient who had been treated with radiotherapy for cervical cancer. She developed actinic cystitis with frequent episodes of severe hematuria. She required repeated catheterization to manage urinary retention, blood transfusions and hospital admissions. Conservative measures and attempts to achieve hemostasis by cystoscopy were unsuccessful at controlling bleeding. The patient therefore underwent endovascular treatment with superselective embolization of the vesical arteries and other vascular pedicles found to be linked with the bleeding. The procedure was successful and the patient has been in follow-up for 9 months with no need for further blood transfusions or admission to hospital. According to a review of the literature, use of this technique has not previously been described in Brazil.

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.