Category: Vascular Surgery
To describe the case of a young female patient, affected by Systemic Lupus Erythematous, hospitalized for severe SARS-CoV-2 infection pneumonia and presenting a treatment-resistant acute upper limb ischemia.Two days after hospital admission, the patient suffered sudden right upper limb pain associated with mild functional impairment. At physical examination, radial and ulnar pulses were absent, and no flow signal was detected at duplex ultrasound scan. Therefore, an acute limb ischemia diagnoses was posed.
Arterial tumor embolization is a rare but often catastrophic complication of lung resection for malignancy. This case describes tumor embolization to the abdominal aorta in a patient with metastatic sarcoma. After partial pneumonectomy he developed acute kidney injury, bilateral lower limb ischemia and spinal cord ischemia. Computed tomography angiogram demonstrated complete occlusion of the paravisceral aorta. Perfusion was restored with open thromboembolectomies of the abdominal aorta, superior mesenteric artery and bilateral lower limbs.
Open surgical repair has historically been the standard of care in the management of thoracoabdominal aortic aneurysms (TAAA). First described in 2001, endovascular TAAA repair is less invasive and may be offered to patients who would previously not have been candidates for open repair due to underlying comorbidities.1, 2 Recent studies comparing open and endovascular repair for complex aneurysm have revealed similar outcomes in regard to perioperative mortality, permanent dialysis, cerebrovascular accident (CVA), and permanent paraplegia.
Peripheral artery disease (PAD) affects more than 200 million people and the burden of PAD is increasing due to a rise in known risk factors such as increased age and diabetes mellitus (1, 2). Patients with PAD present with a variety of symptoms with chronic limb threatening ischemia (CLTI) being the most severe form. It is estimated that the prevalence of CLTI in patients with PAD is between 3 and 10% (3, 4). These patients have a risk of undergoing a major amputation within 1 year of nearly 30% (5).
Stroke (cerebrovascular accident) figures among CVDs as the second leading cause of death worldwide, responding for approximately 5.7 million cases per year, which represent 10% of global mortality (1), as well as the third leading cause of disability globally (2). In Brazil, stroke is currently the second leading cause of death and impairing symptoms (3). In 10 to 20% of cases, strokes are secondary to carotid atherosclerosis (4), hence the relevance of analysing carotid bifurcation operative procedures as a sensible preventative measure for cerebral ischemic diseases.