Aspectos cirúrgicos dos aneurismas isolados das artérias ilíacas

Abstract

203 ResumoObjetivo: Discorrer sobre os aspectos clínicos e o tratamento cirúrgico de uma série de casos de aneurismas isolados das artérias ilíacas.Métodos: Foram analisados retrospectivamente os dados protocolados e os prontuários de 12 pacientes com diagnóstico de aneurisma isolado das artérias ilíacas, operados no Departamento de Cirurgia da Santa Casa de São Paulo, no período de novembro de 1999 a fevereiro de 2003.Resultados: A freqüência do aneurisma isolado das artérias ilíacas foi de 1,5% dos aneurismas abdominais operados no período do estudo. A faixa etária variou entre 56 e 80 anos, 33% dos doentes apresentavam aneurisma bilateral, e os diâmetros dos aneurismas variaram entre 2,0 e 8,5 cm. Em 83% dos casos, os pacientes encontravam-se sintomáticos no momento do tratamento. Em nenhum dos casos o aneurisma se encontrava roto. A via de acesso utilizada nos aneurismas unilaterais foi a extraperitoneal homolateral à dilatação e, nos aneurismas bilaterais, a transperitoneal, longitudinal ou transversa. Não dissecamos o segmento posterior das artérias ilíacas para clampeamento, para evitar a ocorrência de lesão venosa intra-operatória. Não observamos mortalidade no período peroperatório. Em todos os casos, preservamos pelo menos uma artéria ilíaca interna.Conclusão: A via de acesso para os aneurismas isolados das artéri-as ilíacas deve ser individualizada. A preservação de pelo menos uma artéria ilíaca interna constitui uma regra a ser observada, bem como deve-se evitar a dissecção circunferencial das artérias ilíacas no intraoperatório.Palavras-chave: Aneurisma, artéria ilíaca, isolado, tratamento, cirurgia. AbstractObjective: To discuss clinical aspects and surgical treatment of a series of cases of isolated iliac artery aneurysms.Methods: Protocol data and medical charts of 12 patients with diagnosis of isolated iliac artery aneurysm were retrospectively analyzed. The patients underwent surgery at the Department of Surgery of Santa Casa de São Paulo, from November 1999 to February 2003.Results: Frequency of isolated iliac artery aneurysm was 1.5% of abdominal aneurysms who underwent surgery in the period under investigation. Age group ranged between 56-80 years, 33% of patients presented bilateral aneurysm, and aneurysm diameters ranged between 2.0-8.5 cm. In 83% of cases, the patients were symptomatic during treatment. Aneurysms were not ruptured in any case. Extraperitoneal approach ipsilateral to the dilatation was used in unilateral aneurysms, and transperitoneal approach, longitudinal or transverse, in bilateral aneurysms. We did not dissect the posterior segment of the iliac arteries for clamping, in order to avoid intraoperative venous lesion. There were no deaths during the surgery. In all cases, we preserved at least one internal iliac artery.Conclusion: Approach to isolated iliac artery aneurysms should be chosen on an individual basis. Preserving at least one internal iliac artery is a rule to be observed. Circumferential dissection of iliac arteries during the surgery should be avoided.

Achados incidentais de aneurismas torácicos e abdominais

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]22,23,[30][31][32] While the 60.6% of the sample were CTs of female patients, there was a predominance (although not a statistically significant difference) of diagnoses among males [15 (60%) men and 10 (40%) women].…”

“…9,11,12,23 Smaller dilations were classified as ectasias. Dilations detected in other arteries were classified according to descriptions in the literature.…”

“…2,9,10,22 The majority of studies define an infrarenal AAA as a dilation with a cross-sectional diameter greater than or equal to 3 cm. 9,11,12,19,20,23 Elective treatment is recommended for an AAA when its diameter reaches 5.5 cm or when there is an increase of at least 5 mm in1 year, because of the increased risk of rupture and the potential lethality.…”

“…Elective repair is indicated for aneurysms that are symptomatic and/or for those that are larger than 2.5 cm. 9,12,23,24 Aneurysms of the internal iliac artery should be treated irrespective of diameter. 20 Aneurysms of the splenic artery are the third most common intra-abdominal aneurysms and the most common visceral aneurysms (46 to 60%); they are more common among women (75 to 87%) aged 50 to 79 years.…”

Aneurisma ilíaco associado a fístula arteriovenosa

“…In a recent review of 12 cases of independent iliac aneurysms, Carvalho et al reported that 83% had unspecific abdominal pain. 14 The classical diagnostic triad of aneurysm associated with AVF is abdominal pain, pulsatile mass and abdominal murmur. Abdominal murmur is the most common sign, but it can be missing due to presence of thrombi in the aneurysmal sac next to the fistula.…”