Hybrid treatment of arteriovenous fistula between popliteal vessels

Os autores descrevem o tratamento de um paciente portador de fístula arteriovenosa entre vasos poplíteos com mais de 20 anos de evolução, após ferimento por projétil de arma de fogo. O paciente foi submetido a tratamento endovascular pelo implante de stents revestidos Viabahn (Gore^®), porém o mesmo não foi bem sucedido devido à diferença de diâmetro entre a artéria poplítea proximal e a distal à fístula. A artéria femoral superficial foi submetida à cerclagem com fios de sutura ao redor do stentgraft previamente implantado. Esse recurso de improvisação permitiu uma abordagem distante do sítio da fístula, diminuindo os riscos do acesso cirúrgico em uma região com distorções anatômicas e vasos sanguíneos ectasiados, o que certamente acarretaria maior risco de lesões iatrogênicas.

Immediate graft histological assay, post pig's liver transplantation

PURPOSE: To describe the vascular and tissue histopathological changes in seven sequential experimental liver transplantations in pigs. METHODS: Fourteen female pigs, Sus domesticus species, with body mass between 5 and 8 kg were utilized. After the end of all anastomoses of the graft implantation in the receptor, the animal was monitored for 30 minutes, and at its end one of the biopsies was collected for histological analysis. The histological criteria utilized were: lytic hepatocyte necrosis, density of septal and portal inflammatory infiltrated, sinusoidal congestion and hemorrhage. The analysis was performed separately for the portal region in zone 1, 2 and 3. RESULTS: Among the structural changes undergone by the graft, those with greater frequency and intensity were vascular congestion and steatosis, which stood out in transplantations 5, 6 and 7. CONCLUSIONS: The technique demonstrated vascular alterations represented by vasocongestion, edema and minimum inflammatory reaction. In relation to the parenchyma, was observed macrovacuolar pan-acinar steatosis, focal lytic and occasional hemorrhages, beyond the accumulation of hemosiderin in Kuppfer's cells.