Aun sin causar síntomas, un aneurisma aórtico puede ser muy peligroso, en . siguientes indicios de que el aneurisma aórtico se ha roto: • Dolor repentino e. Cohorte histórica de pacientes con diagnóstico de aneurisma de aorta abdominal aneurisma roto reparo abierto; Grupo 2, pacientes electivos reparo abierto;. Los hombres mayores de 65 años que han fumado en algún momento de la vida corren el riesgo más alto de tener un aneurisma aórtico.
|Published (Last):||1 December 2010|
|PDF File Size:||2.42 Mb|
|ePub File Size:||20.80 Mb|
|Price:||Free* [*Free Regsitration Required]|
BLA Responsabilidade geral pelo estudo: Entretanto, relatos da literatura mostram se tratar de evento normalmente autolimitado Pensando nisso, ElKassaby et al.
Habla con el doctor sobre el aneurisma aórtico abdominal –
Author contributions Conception and design: BLA Analysis and interpretation: Aortocaval fistulae are rare entities with a variety of etiologies and are very often associated with significant morbidity and mortality. It roo believed that increased tension in the walls of large aneurysms can cause an inflammatory reaction resulting in adhesion to the adjacent vein and culminating in erosion of the adherent layers and fistula formation.
Conventional surgical treatment has high mortality rates. Paradoxical pulmonary embolism and endoleaks are the most concerning complications linked with endovascular treatment.
Using a vascular occluder in combination with a bifurcated endograft is a good option for the treatment of an abdominal aortic aneurysm with aortocaval fistula.
Aneurisma de aorta abdominal roto e hiperostosis esquelética idiopática difusa | Angiología
Aortocaval fistulae are rare entities with a variety of etiologies and are associated with significant morbidity and mortality. The xortico majority are the result of erosion aorico rupture of an abdominal aorta aneurysm into the inferior vena cava. The objective of this article is to describe a case of aortocaval fistula in a patient with an abdominal aortic aneurysm that was managed with endovascular treatment using a vascular occluder combined with placement of a bifurcated endograft.
A year-old male patient who was a smoker with aneurismaa history of drinking and a preexisting infrarenal abdominal aortic aneurysm diagnosed 15 years previously, but not monitored regularly, was referred to the Endovascular Surgery Service at our institution for evaluation and possibly for treatment. He complained of an abdominal pulsating mass, associated with diffuse abdominal pains that were intermittent and had had onset a long time previously.
He also reported edema of the lower limbs over the previous 8 months, asthenia, and weight loss of 20 kg over the preceding 6 months.
Examination revealed a pulsating mass in the mesogastrium, with abdomen diffusely painful on palpation and a perceptible thrill in the left flank.
Abdominal color Doppler ultrasonography ansurisma an abdominal aortic aneurysm with a diameter of 9. High velocity flow was observed at the right posterolateral wall, suggestive of an arteriovenous fistula with a diameter of 5 mm, communicating between the aneurysm and the inferior vena cava.
Angiotomography of the aorta showed aneurysmal dilatation, fusiform at the infrarenal abdominal aorta, extending to the bifurcation of the common iliac arteries and measuring 9. The right cardiac chambers were also enlarged and there was pleural effusion with atelectasis of the lower pulmonary lobes, bilaterally.
Despite the presence of cardiac chamber dilatation seen on tomography, the echocardiogram showed discrete atrial enlargement and preserved cardiac function. The first step was bilateral dissection of the common aneurismq arteries and placement of 6Fr valved introducers bilaterally, under general anesthesia and with cardiopulmonary monitoring.
The common femoral veins were punctured and 5Fr valved introducers were placed bilaterally. A graduated Pigtail catheter was introduced into the abdominal aorta via the right arterial access and a cm Lunderquist guide wire was introduced via the left arterial access, to straighten the aortic anatomy.
Initial phlebography revealed strong collateral circulation, originating from the internal iliac veins, extrinsic compression of the distal segment of the inferior vena cava — by the adjacent aneurysm — and images compatible with an arteriovenous fistula in this topography Figure 3.
The fistula path was catheterized via the right venous access with a 5Fr JR diagnostic catheter and 0.
A 45cm 12Fr Flexor Check-Flo sheath Cook was positioned through the fistula orifice, via the right venous access. At this point a 21mm Figulla flex II vascular occluder Occlutech with two concentric discs was deployed, which successfully occluded the fistular communication between the aorta and the inferior vena cava Figure 4. The occluder size was chosen on the basis of the size of the fistula orifice, which had been measured on initial angiotomography and angiography, and was oversized in order to guarantee good apposition against the degenerated aorta wall, to prevent migration.
Final angiography showed that the aneurysm had been successfully repaired, the renal arteries were patent and there were no leaks, even when simultaneous injections via the arterial and venous accesses were applied Figure 5. The patient recovered well during the postoperative period and was discharged on the fifth day, in aneurizma clinical aorticco and with the lower limb edema in regression.
A control angiotomography at 30 days showed the endograft patent and no signs of zortico. It was also possible roro observe that the inferior vena aneuirsma was patent and the occluder was correctly positioned and with no evidence of secondary thrombosis Figure 6. It has been 1 year since treatment and unfortunately the patient refuses to attend any type of clinical follow-up or aodtico to imaging exams. Via telephone he states that he has no new complaints or related symptoms.
It is believed that increased tension against the aneurysm wall causes an inflammatory reaction and adhesion to the adjacent vein — generally the inferior vena cava — resulting in erosion of the walls and formation of the fistula.
On rare occasions paradoxical pulmonary embolism PPE may be caused by thrombi from the aneurysm entering venous circulation. In view of their severity, aortocaval fistulae should be treated as soon as they are diagnosed.
Endovascular techniques are attractive alternatives to conventional surgical treatment. A review of the literature published by Antoniou et al. First, manipulation of the aneurysm lumen could provoke displacement of thrombi and result in a PPE.
Additionally, treatment of the aneurysm without occlusion of the fistula could predispose to leakage, because of persistence of the fistula canal. A PPE is a rare event, but one that is associated with high morbidity and mortality. Other reports only describe conventional treatment of the aneurysm with an endograft, without use of filters, achieving successful occlusion of the aortocaval fistula without reporting paradoxical embolism.
When occluding the fistula canal prior to introduction xneurisma the endograft, we therefore manipulated the lumen of the aneurysm as little as possible to avoid displacement of thrombi, and consequently PPE. To address this, ElKassaby et al.
If the fistula had not been occluded and a leak had occurred during follow-up, a different strategy would have been needed to treat it, probably involving use of further high-value materials and the risk to the patient that an additional invasive procedure would involve.
Since alrtico materials needed for treatment in a single operation goto available, we judged this to be the safest option. Although this application was off-label, the occluder was a good fit to the arterial and venous walls, fulfilling its role without causing major technical difficulties during placement and release, since the fistular path had been catheterized in advance.
Vascular occluders have been used previously in patients with a narrow iliofemoral axis given percutaneous aortic valve implants, in whom creation of a fistular path between the vena cava and the aorta is an access option for larger diameter devices. However, in their reports these authors employed the occluder device as a remedial procedure in patients who had previously been treated with endografts or conventional surgery to repair abdominal aneurysms, but had exhibited persistent flow through the fistular orifice in follow-up.
Use of the vascular occluder in combination with a bifurcated endograft to treat this case of infrarenal abdominal aortic aneurysm with an aortocaval fistula was successful and immediate results were satisfactory. Further studies are needed to assess routine use of vascular occluders for treatment of aortocaval fistulae, including long-term follow-up.
As endovascular materials continue to evolve, new occluders or endoprostheses exclusively for venous applications may become the first choice for treatment of aortocaval fistulae. National Center for Biotechnology InformationU. Journal List J Vasc Bras v. Author information Article notes Copyright and License information Disclaimer.
Received Nov 23; Accepted Apr 3. Open in a separate xortico. Aneurisma abdominal com imagem de trombos murais ao ultrassom em modo B. Trajeto fistuloso cateterizado com cateter JR 5F pelo acesso venoso direito. Footnotes Fonte de financiamento: Aneurisma de aorta abdominal roto para veia cava inferior: Aortocaval fistula treated by aortic exclusion.
Aortocaval Fistula in ruptured aneurysms. Eur J Vasc Endovasc Surg. Angiologia e Cirurgia Vascular. Pre-operative diagnosis of an unusual complication of abdominal aortic aneurysm on multidetector computed tomography: Endovascular stent-graft repair of major abdominal arteriovenous fistula: Endovascular repair of Abdominal Aortic aneurysms with Aortocaval fistula.
Paradoxical pulmonary embolism aneurizma spontaneous Aortocaval Fistula. Endovascular exclusion of a large spontaneous aortocaval fistula in a patient with roho ruptured aortic aneurysm. Endovascular treatment of Aorto-caval fistula. Iliocaval fistula presenting with paradoxical pulmonary embolism combined with high-output heart failure successfully treated by endovascular stent-graft repair: J Korean Med Sci.
Conservative management of persistent aortocaval fistula after endovascular aortic repair. Total endovascular management of ruptured aortocaval fistula: Endovascular treatment of ruptured abdominal aortic aneurysm with aortocaval fistula based on aortic and inferior vena cava stent-graft placement.
Caval-aortic access to allow transcatheter aortic valve replacement in otherwise ineligible patients: J Am Coll Cardiol. How to perform transcaval access and closure for transcatheter aortic valve implantation.
Habla con el doctor sobre el aneurisma aórtico abdominal
Transcatheter closure of aortocaval fistula with the amplatzer duct occluder. Percutaneous closure of aortocaval fistula using the amplatzer muscular VSD occluder. Author information Copyright and License information Disclaimer. No conflicts of interest declared concerning the publication of this article. Contributed by Author contributions Conception and design: This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Aortocaval fistulae are rare entities with a variety of etiologies and are very often associated with significant morbidity and mortality.