Pseudoaneurisma da artéria glútea inferior após queda de bicicleta: relato de caso

Abstract

Resumo Pseudoaneurismas de artérias glúteas são raros, especialmente os que envolvem a artéria glútea inferior. Eles estão associados principalmente a traumas penetrantes, infecções ou fraturas de pelve. Em uma minoria de casos, são causados por traumas fechados, havendo somente seis casos relatados na literatura. Apresenta-se aqui um caso de pseudoaneurisma da artéria glútea inferior direita após queda de bicicleta, evoluindo com grande hematoma na região glútea ao exame clínico e queda hematimétrica significativa. A angiotomografia revelou um grande hematoma na região glútea, com extravasamento de contraste e formação de pseudoaneurisma no local. A angiografia revelou que a origem da lesão era na artéria glútea inferior direita. Foi realizada embolização dessa artéria com molas. Após esse procedimento, o paciente foi encaminhado para a unidade de terapia intensiva, de onde foi posteriormente transferido para outro hospital, com o sangramento controlado. Para esses casos, o tratamento endovascular é uma opção segura, rápida e efetiva.

Hybrid Management of a Pseudoaneurysm of the Inferior Gluteal Artery Following a Stab Wound

“…The inferior gluteal artery is the largest terminal branch of the anterior segment of the internal iliac artery. 2 Gluteal artery pseudoaneurysms are still uncommon. Fewer than 150 cases of pseudoaneurysms of the gluteal artery have been described in the literature to date.…”

“…5 These pseudoaneurysms might appear after penetrating wounds of the gluteal region and hip fractures or might be iatrogenic and appear after an injection, a bone marrow transplant, or a hip replacement. 1,2 The timeline for developing these pseudoaneurysms might range from a few weeks to a few years after the initial trauma. 6 The clinical presentation is polymorphic.…”

“…14 Compared to open repair, the embolization technique offers several advantages: it is a less complicated technique; it exposes the patient to lower risk of infection and hematoma, and lower risk of iatrogenic injuries to nerves or vessels; and it also allows the surgeon to avoid the retroperitoneal approach. 2 However, its efficacy is reduced in large aneurysms. 15 In the present case, emergency embolization successfully stopped the bleeding, avoiding potential permanent damage to the sciatic nerve by compression caused by the expanding gluteal hematoma.…”

“…Only a few cases have been described worldwide. 2 We present the case of a 30-year-old male, who presented to our emergency room one week after a stab wound in the left gluteal region causing a pseudoaneurysm of the left inferior gluteal artery with a sciatic compartment syndrome, that we treated by a hybrid approach.…”