Estudo comparativo entre tratamento endovascular e cirurgia convencional na correção eletiva de aneurisma de aorta abdominal: revisão bibliográfica

Abstract

O tratamento eletivo do aneurisma de aorta abdominal é recomendado pela alta morbiletalidade decorrente da eventual ruptura. O objetivo deste trabalho foi comparar o reparo endovascular eletivo com a cirurgia aberta e avaliar as mortalidades hospitalar e perioperatória, em 1 ano, por todas as causas e relacionadas ao aneurisma, a permanência hospitalar, as complicações, as taxas de sobrevida, conversão e reintervenção, a durabilidade do enxerto, o custo-benefício e a relação desses dados com o treinamento da equipe médica responsável pelo tratamento. Realizou-se uma revisão da literatura sobre reparo endovascular versus cirurgia convencional. Foram observados vantagem na sobrevivência perioperatória e menor estresse pós-cirúrgico; no entanto, os benefícios iniciais são perdidos por complicações e reintervenções tardias. Trabalhos baseados nas primeiras gerações de endopróteses superestimam as taxas de mortalidade em curto prazo, complicações e reintervenções. A durabilidade do enxerto, a real vantagem na sobrevida e o custo-benefício são incertos, e outros estudos são necessários para o seguimento em longo prazo.

Achados incidentais de aneurismas torácicos e abdominais

“…The prevalence of AAA was 0.6% for 10 A diagnosis of AAA was more frequent among male patients (71.4%), in agreement with the literature. [1][2][3][4][5][6][7][8][9]17,22,[30][31][32] The mean diameter of the AAAs was 4 cm (range: 3.1 cm to 6.9 cm), which is similar to two other Brazilian studies, which found mean diameters of 3.9 cm 9 and 3.5 cm. 16 Elective treatment of AAAs is recommended when their diameter reaches 5.5 cm.…”

“…[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].…”

“…16 Elective treatment of AAAs is recommended when their diameter reaches 5.5 cm. 4,11,13,32 One of the incidentally diagnosed AAAs had a diameter of 6.9 cm. We highlight this finding because it is estimated that the 5-year risk of rupture of aneurysms with diameters smaller than 5 cm is less than 5%, whereas diameters greater than 5 cm involve risk of 25 to 43%.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] According to the literature, they are most common in the aorta, followed by the iliac arteries and then the splenic artery. 7 They have multifactorial etiology (hereditary, traumatic, infectious, and/or inflammatory), but around 80% of aneurysms are associated with atherosclerotic degeneration of the artery wall.…”

“…They are often asymptomatic and may be detected incidentally or by screening programs. 3,4,14,15,29 Incidental diagnosis is an unexpected finding in a radiology examination conducted for some other reason and occurs in 5 to 20% of radiological examinations. 30,31 Incidental diagnosis of aneurysms has become more common because of the increase in life expectancy of populations and because of refinements to diagnostic methods and easier access to them.…”