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Biomedical subjects

A Dinis da Gama

Publications and source records attributed to A Dinis da Gama.

At least 19 recordsLinked to original sources
PubMed2004

Use of autologous superficial femoral artery in surgery for aortic prosthesis infection.

The surgical management of aortic prosthesis infection remains an enormous challenge for the vascular surgeon and a critical issue for the patient's well-being and life. Several techniques for its management have been devised and employed over the years, but none of them has been totally satisfactory. Thus new alternatives are needed. We present the clinical case of an infected aortic prosthesis in a 41-year-old man that was complicated by duodenal and ureteral erosion. The autologous superficial femoral artery was used successfully in the treatment of this most demanding situation.

Adult↗
PubMed2003

Use of external iliac artery in renal revascularization surgery: long-term angiographic assessment.

PURPOSE: The external iliac artery has physical characteristics, in particular, caliber and length, similar to those of the renal artery and would thus seem to be an ideal substitute for it. However, there are no studies in the literature designed to confirm this possibility. The present study was designed to demonstrate the feasibility of use of the external iliac artery as a substitute for the renal artery in surgical revascularization of renal artery fibrodysplasia and to assess the long-term biologic behavior of the external iliac artery so used. METHODS: Twelve patients (11 female, 1 male), ages 1 to 43 years (mean, 24.4 years), with severe hypertension underwent aortorenal bypass grafting with use of the external iliac artery to treat preocclusive stenotic lesions (n = 7), complete occlusion (n = 3), or aneurysm (n = 2) of the renal artery. It was considered unnecessary to reestablish circulation in the donor limb in 2 patients (young children), and transposition of the ipsilateral internal iliac artery was performed in 9 patients; in the remaining patient circulation was reestablished with insertion of an iliofemoral prosthesis. RESULTS: There were no operative deaths. In 1 patient nephrectomy was necessary because of occlusion of the graft as a consequence of technical complications. In 8 patients there was immediate normalization of blood pressure without aid of medication, and in the remaining 3 patients an antihypertensive drug was prescribed. Two patients were lost to follow-up; the other 9 were assessed with angiography at a mean of 8.8 years after the operation. All grafts were found to be in excellent condition, with no evidence of dilatation, kinking, twisting, anastomotic fibroplasia, or wall irregularities. CONCLUSION: On the basis of this experience, the external iliac artery is confirmed as a substitute for the renal artery, and the excellent long-term results would seem to make it particularly useful in young patients with long life expectancy, such as those with renal artery fibrodysplasia.

Adolescent↗
PubMed2002

A new approach for the surgical management of unilateral iliac artery occlusive disease: the iliofemoral crossover transposition.

Aortobifemoral bypass remains the standard therapy for aortoiliac occlusive disease. Extraanatomic revascularization has been considered as an acceptable alternative and provides reasonable long-term results. Because some of the causes for its failure are related to the prosthetic material used, a technique that uses autologous material and is applicable in patients with unilateral common iliac lesions was developed. Iliofemoral crossover transposition is a femorofemoral bypass procedure in which the external iliac artery is used as a graft. The procedure is easily performed and avoids the use of prosthetic materials, minimizing the risks of their related complications. Because its biologic behavior, including hemodynamic performance, has proven to be excellent, satisfactory long-term results can be anticipated.

Adult↗
PubMedDate not supplied

[Guidelines for the management of the abdominal aortic aneurysm: a comparison of the 1992 to the 2003 recommendations].

In this paper a comparison is made between the recommendations for the management of the abdominal aortic aneurysm in 1992, to the recommendations published in 2003, through different subcommittees of the Society for Vascular Surgery and American Association for Vascular Surgery. Substantive differences, in the format and content can be found, due to the enormous progress and technical achievements occurred during that period of time, the endovascular treatment becoming the most important and relevant but not yet regarded as valid alternative to the conventional surgical treatment, being indicated only in particular and well defined circumstances. But despite that fact, the spirit of the recommendations seems to be heavily influenced by the large transformations in the health care organisation and management area, occurred during that period of time, together with the powerful forces and interest moving around the medical act, a fact that allow us to conclude, according to the H E Sigerist's statement that "...changes in medical concepts are tightly connected to the culture as a whole, and are influenced by the changes of the ideas of each epoch".

Aortic Aneurysm, Abdominal↗
PubMedDate not supplied

[Revascularization surgery of an anuric solitary kidney using the left colic artery as a free graft].

The thrombotic occlusion of one renal artery may become completely asymptomatic, due to the functionality of the contralateral kidney. However, in rare circumstances, such is the case of individuals with a solitary kidney, a situation of anuria and acute renal failure may constitute the main presentation of the condition. The authors report the clinical case of a 43 year old male patient, with the previous diagnosis of an infrarenal aortic occlusion and a single left kidney, who developed a thrombotic occlusion of the renal artery, with anuria and acute renal failure. The patient underwent an emergency revascularization procedure, consisting in the implantation of a prosthetic bypass graft from the superceliac aorta to the renal artery, with immediate recovery of the diuresis and renal function. Seventeen months later as a consequence of an anastomotic hyperplasia, an occlusion of the bypass graft occurred, again with anuria and acute renal failure. The patient was reoperated on and due to the inadequacy of both saphenous veins to be used as the material of choice for the revascularization procedure, a redundant segment of the left colic artery (Riolan's arcade) was removed and used as an interposition graft, from the middle colic artery to the renal artery, followed by an immediate restoration of diuresis and renal function. The singular and recurrent character of this clinical condition and the utilization of an original, eventually unique and well succeeded revascularization procedure, prompted its presentation and divulgation.

Acute Kidney Injury↗
PubMedDate not supplied

[Use of autologous superficial femoral artery in surgery for aortic prosthesis infection].

The surgical management of the aortic prosthesis infection still remains an enormous challenge for the vascular surgeon and a critical issue for the patient's integrity and life. Several techniques for its management have been devised and employed, along the years, but none of them revealed itself as totally satisfactory. This stimulates the creation of new alternatives. We present the clinical case of an infected aortic prosthesis in a 41 year old man, complicated by duodenal and ureteral erosion, in whom the autologous superficial femoral artery was employed successfully in the treatment of this most demanding situation.

Adult↗
PubMedDate not supplied

[Rupture of an abdominal aortic aneurysm with concomitant aorto-caval fistula].

Aorto-caval fistulas are one of the most uncommon complications of infrarenal aortic aneurysms and have a high pre and perioperative mortality rates. Its prompt diagnosis and early treatment may be helpful in lowering the surgical morbidity and mortality. One successfully treated case of a ruptured aortic aneurysm with concomitant aorto-caval fistula is reported, discussing the clinical presentation, the diagnosis and the details of the surgical techniques employed.

Aged↗
PubMedDate not supplied

[Isolated obstructive lesions of the cervical common carotid: clinical and surgical aspects].

Isolated lesions of the extra-thoracic common carotid arteries are unusual in clinical practice. Contrarily to the well known lesions of carotid bifurcation, its natural history is poorly understood and indications for surgical management are not well defined. In this paper, seven patients with isolated lesions of the common carotid arteries are reported, being two symptomatic (TIA's). Patients underwent successful surgical management. The main features of clinical presentation, diagnosis and surgical management are presented and discussed

Aged↗
PubMedDate not supplied

[Surgical management of Takayasu's arteritis with extensive vascular involvement and bilateral renal artery stenosis].

Proximal renal artery stenosis, in association with stenoses and/or aneurysms of aorta and its branches, suggests a Takayasu's disease and is an important, treatable cause of hypertension in young people. A 29-year-old black woman presents with systodiastolic hypertension and suprasternal and abdominal bruits. An aortography disclosed multiple aneurysms and stenosis of the aorta and its main branches, and bilateral stenosis of renal arteries. The patient underwent an unusual and well-succeeded surgical procedure consisting in the creation of a "ventral aorta", a bypass from the ascending aorta down to the aortic bifurcation, and revascularization of both kidneys. Takayasu's disease frequently courses with extensive involvement of vasculature and bilateral renal stenosis. Renovascular hypertension is a major complication, contributing to the high mortality of this disease. Renal revascularization plays an important role in the modification of the natural history of Takayasu's disease and is essential for long-term survival and prevention of ischaemic renal failure.

Adult↗
PubMedDate not supplied

[Grawitz tumor with invasion of the inferior vena cava and right atrium: surgical management with a multidisciplinary team].

In this paper, the clinical condition of a 56 year old male patient is reported, with the diagnosis of renal cell carcinoma, complicated by a tumoral thrombus, extended from the renal vein into the vena cava and right atrium, who underwent surgical treatment. The operation consisted in the radical nephrectomy associated to the vena caval thrombectomy, under extracorporeal circulation, utilizing a multidisciplinary team composed by urologists, vascular and cardio-thoracic surgeons. The main features related to the diagnosis and surgical management of this case are described and discussed, according to data taken from the most recent publications of the literature on the subject.

Carcinoma, Renal Cell↗
PubMedDate not supplied

[Mycotic rupture of the reno-external iliac artery anastomosi following kidney transplantation].

Two clinical cases of an unusual complication of the renal transplantation are reported, consisting in the infection of the arterial wall by fungi of the species Candida Albicans and Aspergillus, which caused acute ruptures of the external iliac artery and hypovolemic shock. The main features of the pathogenesis of the infection, its diagnosis, management and prevention are subjected to analysis and discussion.

Adult↗
PubMedDate not supplied

[Lower limbs revascularization originated in the descending thoracic aorta].

The revascularization of the lower limbs through a bypass graft from the descending thoracic aorta is one of the most uncommon surgical procedures within the scope of the so-called "extra-anatomic revascularization". It is an highly selective procedure in terms of indications and is regarded as an effective hemodynamic alternative, with acceptable long-lasting results. Two patients who underwent successfully the operation are reported, followed by a discussion on the technical aspects, indications, complications and early and late results of the procedure.

Aorta, Thoracic↗
PubMedDate not supplied

[The use of superficial femoral veins in reconstructive surgery of aortic prosthesis infection (Clagett's operation)].

Prosthetic aortic infection still represents an enormous challenge to the possibilities of contemporary reconstructive vascular surgery, particularly in terms of diagnosis and surgical management, and is accompanied by high mortality and morbidity rates. Several surgical methods have been devised and employed, including the extra-anatomic bypasses and the in "situ" revascularization. The later uses either antibiotic bounded prosthesis, or biologic homologous conduits, including cryopreserved allografts or autologous arteries and veins. The authors report the clinical condition of a 73 years old male with an infected aortic prosthesis, who underwent the complete removal of the infected graft, followed by an interposition of a venous autograft composed by two superficial femoral veins, removed from both thighs (Clagett's operation). The procedure was extremely well succeeded and the patient was discharged one month later. Reviewed one year later he was found in good condition and free of symptoms.

Aged↗