1,721,012 research outputs found
Emergency endovascular repair of an acute aortocaval fistula with AAA: Case report and review of the literature
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Chronic venous insufficiency, edema and the permeability of the microvascular barrier
No full textMany hypotheses have been proposed to explain the clinical features and laboratory findings during chronic venous insufficiency (CVI). Edema is known to occur primarily as a result of the increase in venous pressure, accompanied by increased capillary permeability (PerM) and decreased blood colloid osmotic pressure as contributing factors. Nevertheless, there are many clinical and experimental observations which are not consistent with this accepted suggestion. Therefore, the diagnosis of edema is formulated, when edema has already occurred, i.e. only when the collection of the fluid exceeds a certain threshold and becomes clinically or instrumentally evident. The aim of this review was to clarify the pathophysiology of venous edema studying two fundamental processes: filtration and absorption that oversee the balance of intra- and extracellular fluids. In particular, we have described the alterations between filtration and absorption. The mechanisms involved in the CVI are several, starting from the structural rearrangement of the vascular endothelium up to the changes in intra and extracellular fluid. Evaluating the previous studies, we hypothesize that the venous edema is produced by the hydrostatic pressure prevailing on blood oncotic pressure, while the "intermediary" system or transduction system must be able to transform the physical stimulus induced by hypertension in a biochemical message promoting the cellular responses. Moreover, the chronic increase in shear stress, characteristic in CVI, prevails on calcium dependent mechanism, resulting in either hypertension, a mechanical stress, abolishes the Ca++ linked mechanism inducing a stable disassembly of adherens junction, or in the long run, the same mechanisms are unable to preserve the barrier integrity with a profound alteration of the vessel wall PerM, accompanied by leakage of macromolecules and blood cells. In conclusion, it is possible to assume that the essential sign in the venous chronic insufficiencies is not the edema, and then an excess of filtration, but the vessel wall permeation is the key factor to clarify the pathophysiological cascade and the clinical signs
Trattamento delle steno-ostruzioni della biforcazione aorto-iliaca mediante la tecnica "kissing-stents"
No full textRuolo della terapia immunosoppressiva nello sviluppo dell'aneurismosi delle fistole artero-venose per emodialisi in pazienti con trapianto renale
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Case report of a large cephalic vein aneurysm inducing heart failure in a renal transplant patient with radio-cephalic fistula for haemodialisys
No full textIntroduction: The autologous arteriovenous fistula (AVF) is considered the best vascular access for haemodialysis in patients with chronic kidney disease but in time can lead to several complications. Presentation of a case: Herein we describe a case of a large cephalic vein aneurysm causing heart failure in a renal transplant patient being treated with radio-cephalic AVF for haemodialysis. The patient was judged to be at very high risk for potential catastrophic rupture of the aneurysm and his cardiac function was deteriorating so a surgical resection was offered. Under general anesthesia, a longitudinal incision was performed on the volar side of the forearm and the anastomotic junction was ligated. The cephalic vein aneurysm was isolated and a total resection of the vein, up to the joint of the elbow, was carried out. A specimen was also submitted for histological and immunohistochemical analysis. Discussion: At present no clear indications pertaining to the need to close an AVF after kidney transplantation exist. Some authors recommend a closing of the fistula in patients with stable renal function to prevent the onset of complications, while others advise never to close the asymptomatic fistula in order to preserve vascular access for haemodialysis in case of graft failure. Conclusion: Based on our clinical experience, we suggest not ligating vascular access during the first year following transplantation with the exception of patients needing emergent closure. Otherwise, surgical closure to prevent the onset of complications could be considered a viable option in the following subset of patients: those who are 3 or more years from transplantation with good and stable renal function, those with a significant growth of venous aneurysms or have a high AVF flow rate or are young patients
trattamento endovascolare di aneurisma dell'aorta addominale rotto in vena cava inferiore
No full texttrattamento delle ostruzioni dell'arteria femorale superficiale mediante stents lunghi ad elevata flessibilità: risultati ad 1 anno
No full textEsperienza iniziale dell'e-ventus stent-graft nel trattamento endovascolare con IBD degli aneurismi aorto-iliaci
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