Medicações referentes às complicações após correção de aneurisma da aorta abdominal endovascular

Abstract

150KONING, GG ET AL -Medication in relation to complications after endovascular abdominal aortic aneurysm repair Braz J Cardiovasc Surg 2006; 21(2): 149-154 INTRODUCTIONCo-morbidity is common in patients with abdominal aortic aneurysms (AAA) [1]. The majority of AAA-patients have manifestations of cardiovascular disease such as myocardial infarction, stroke or hypertension, as well as pulmonary problems [2][3][4]. These co-morbidities require several medication-controlled treatments at the same time. The importance of medication in the prevention of secondary events is well known [5], but there is a risk of side effects or interaction of drugs in patients undergoing endovascular aneurysm repair (EVAR).The reported incidence of complications after EVAR varies from 20% to 75% [6]. This morbidity is considerable and requires further investigation [6]. While in the earlier series complications could be attributed to suboptimal device construction, present stent-graft and delivery systems have improved and are fairly standardised [7]. With the use of improved equipment, the patient and doctor related risk factors for failure or complications are becoming more important determinants [6,8,9]. These factors have not been very well defined at the present time [6]. Various conditions may be expected to influence the occurrence of complications such as the learning curve, and anatomic characteristics of the aneurysm [10,11]. Also patient factors such as age, ASA-class and medication may influence the occurrence of complications and prolong hospital stay [2,6].Until now, no research has been carried out on the influence of medication side effects or interactions on the occurrence of complications in AAA-patients with endovascular aneurysm repair. METHOD SubjectsPatients with endovascular abdominal aneurysm repair (EVAR) or attempted EVAR between April 1999 and November 2003 in two vascular surgical centres were included in the study. Experienced surgeons and interventional radiologists jointly performed implantation of stent-grafts. When necessary, adjuvant procedures such as the placement of extension devices of iliac limbs, coil embolisation of side branches, endarterectomy or patchplasty of the common femoral artery were performed to obtain a satisfactory result. All patients were placed in the intensive care unit for monitoring during the first 4-20 hours after EVAR. On the first post-operative day, patients started with acetylsalicyl-acid (ASA) at a dosage of 80-100 mg per day as a standard medication. The follow-up protocol included contrast-enhanced CT-scanning on the first postoperative day and at 6, 12, 18, 24 months and annually thereafter. Data assessmentTreatment results were assessed by clinical examination 151Overall, 41 patients (59%) experienced one or more complications (N=67) of which 24 were device-related and 43 non-device-related complications (Table 2). Most complications were in the early post-operative period. There were 20 endoleaks (29%) of which 8 were type I (11%), 4 endoleaks type II (6%), 4...

Morbi-Mortalidade Em Cirurgia De Correção De Aneurisma De Aorta Em Um Hospital Público De Fortaleza-Ce: Estudo Retrospectivo

“…Novero 4 descreve a etiologia dos aneurismas como de origem degenerativa em aproximadamente 80% dos pacientes, com risco de ruptura e morte em um ano de acompanhamento. A dissecção aórtica é referida em estudos como a afecção mais temida e duas vezes mais frequente do que a ruptura da aorta, sendo esta um dos fatores de risco para a ruptura de um aneurisma, tal como o diâmetro maior que 5 cm, evolução no crescimento do aneurisma, tabagismo, doença pulmonar obstrutiva crônica, hipertensão arterial sistêmica, insuficiência renal crônica e doenças degenerativas da aorta 5,6 . A correção cirúrgica do aneurisma é realizada quando seu diâmetro atinge ou ultrapassa 5,5 cm para homens e 5,0 cm para mulheres ou quando ocorre expansão do diâmetro transverso > 5 cm em um ano.…”