Tratamento cirúrgico de varizes de membros inferiores em paciente hemofílico: relato de caso / Surgical treatment of lower limb varicose veins in a hemophiliac patient: case report

Objetivo: Relatar uma situação rara na especialidade cirúrgica vascular, aparentemente ainda sem documentação de experiência semelhante e que consiste no tratamento cirúrgico de varizes de membros inferiores em paciente hemofílico e com sintomatologia venosa. Relato de caso: Procedimento cirúrgico realizado no Hospital Evangélico de Vila Velha, no setor de Cirurgia Vascular no ano de 2018, em paciente hemofílico e portador de veias varicosas primárias sintomáticas em membros inferiores. Realizado intervenção cirúrgica convencional com safenectomia bilateral e ressecção de varizes tronculares com infusão endovenosa de fator VIII no pré-operatório e nos 10 dias subsequentes. Necessitou de acompanhamento multidisciplinar incluindo hematologista e apresentou evolução satisfatória, sem intercorrências hemorrágicas. O paciente retornou no 14º de pós-operatório sem complicações. Concluímos que é perfeitamente possível a realização de cirurgia venosa de varizes com técnica convencional em paciente portador de doença hemofílica, bastando para isso a recomendada infusão de fator VIII.Descritores: Hemofilia A, Varizes, Procedimentos cirúrgicos vascularesAbstractObjective: To report a rare situation in the vascular surgical specialty, apparently still without documentation of similar experience, which consists in the surgical treatment of lower limb varicose veins in a hemophiliac patient with venous symptomatology. Case report: Surgical procedure performed at the Evangelical Hospital of Vila Velha, in the Vascular Surgery sector in 2018, in a hemophilic patient with symptomatic primary varicose veins in the lower limbs. Conventional surgical intervention was performed with bilateral saphenous vein resection and trunk varicose vein resection with intravenous factor VIII infusion preoperatively and in the 10 subsequent days. It was required multidisciplinary follow-up including hematologist and presented satisfactory evolution, without hemorrhagic complications. The patient returned in the 14th postoperative period without complications. It was concluded that to perform varicose vein surgery with conventional technique in a patient with hemophilic disease is perfectly possible with the recommended factor VIII infusion.Keywords: Hemophilia A, Varicose veins, Vascular surgery procedures

Case report: Acute cubital tunnel syndrome in a hemophiliac patient

A 24-year-old right-hand dominant male with severe Hemophilia A presented with acute elbow pain, associated paresthesias, and weakness in the ulnar nerve distribution after upper body weight lifting. In the week prior, he missed three doses of Factor VIII replacement. After no improvement with conservative measures, he was taken to the operating room urgently for decompression and was noted to have a perineural hematoma in the cubital tunnel. At final follow-up, the patient reported complete resolution of symptoms. Acute cubital tunnel syndrome in hemophiliac patients that does not respond to medical treatment is best treated with surgical decompression using minimal dissection to prevent hematoma formation, preserve perineural membranous tissue, and avoid destabilizing the nerve.