Aneurisma de artéria ilíaca interna roto: relato de caso

Abstract

ResumoAneurismas isolados da artéria ilíaca interna são raros, acometem 0,1% da população e correspondem a 1% dos aneurismas aorto-ilíacos. Na maioria das vezes, os pacientes são assintomáticos, mas podem apresentar dor abdominal, massa pulsátil no hipogástrio ou na fossa ilíaca, sintomas compressivos urinários, gastrointestinais ou neurológicos. Podem ocasionar quadro de abdome agudo, principalmente quando há ruptura. O diagnóstico precoce dos aneurismas isolados de artéria ilíaca interna é incomum, sendo identificados quando mais volumosos ou rotos, o que aumenta significativamente sua morbimortalidade e torna seu prognóstico mais reservado. Dessa forma, representam um desafio terapêutico. A ligadura cirúrgica tem sido o tratamento mais comum, entretanto a cirurgia endovascular tem mostrado bons resultados, inclusive nos aneurismas rotos. É relatado caso de aneurisma de artéria ilíaca interna isolado roto diagnosticado durante laparotomia para abordagem de abdome agudo. Palavras-chave:Aneurisma roto, artéria ilíaca, abdome agudo. AbstractIsolated internal iliac artery aneurysms are rare. They affect 0.1% of the population, and account for 1% of aortoiliac aneurysms. Patients are mostly asymptomatic, yet they can have abdominal pain, pulsatile mass in the hypogastrium or iliac fossa, or urinary, gastrointestinal or neurological compressive symptoms. Such aneurysms are likely to course with an acute abdomen, especially when ruptured. Early diagnosis of isolated internal iliac artery aneurysms is difficult, as they are more easily detected when larger or ruptured, which significantly raises their morbidity and mortality rate and determines a poor prognosis. Therefore, they are a therapeutic challenge. Surgical ligation has been the most common treatment; however, the endovascular approach has presented good outcomes, even in the event of ruptured aneurysms. A case of ruptured isolated iliac artery aneurysm diagnosed during a laparotomy (acute abdomen approach) is reported.Keywords: Ruptured aneurysm, iliac artery, acute abdomen. IntroduçãoO aneurisma isolado da artéria ilíaca interna é condição incomum, grave e de difícil diagnóstico. Acomete cerca de 0,1% da população em geral e corresponde a aproximadamente 1% dos aneurismas aorto-ilíacos [1][2][3] , sendo a artéria ilíaca comum a mais envolvida (85%), seguida da artéria ilíaca interna (10%) e artéria ilíaca externa (1%) 4 . Esse tipo de aneurisma é mais frequente em homens e idosos (média de 69 anos) [2][3][4] . Cerca de 50% são bilaterais 5 .Na maioria das vezes é assintomático, encontrando-se frequentemente roto nos quadros manifestos 6 . Quando sintomático, os sinais e sintomas dependem do tamanho, localização e relação com estruturas adjacentes. Relato de casoPaciente do sexo masculino, 67 anos, com quadro súbito de dor abdominal, referida em região lombar e em fossa ilíaca direita, associada à disúria e constipação

Achados incidentais de aneurismas torácicos e abdominais

“…24 The only case of internal iliac artery aneurysm detected in our sample also had a concomitant AAA. While the literature describes the combination of an aneurysm of the common iliac artery with an aneurysm of the infrarenal aorta as frequent, 20,23,24,33 the cases of common iliac aneurysm observed in this study both occurred in isolation.…”

“…None of these patients had an aneurysm with diameter greater than or equal to 6 cm, which is the cutoff beyond which surgical intervention is generally indicated. 1,8 Aneurysms of the common iliac artery are candidates for elective surgery when their diameters exceed 2.5 cm, 12,23,24 whereas repair of internal iliac aneurysms is indicated at any diameter. 20 Two aneurysms of the common iliac artery were found, one with a diameter of 3.0 cm and the other with a diameter of 2.6 cm.…”

“…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.…”

Tratamento endovascular de aneurisma isolado bilateral de artéria ilíaca interna

“…1 The internal iliac artery is involved in 10-30% of cases, and the aneurysm is bilateral in half of the cases. [2][3][4][5][6] The mortality rate in cases treated electively with open procedures is 10%. Mortality rises to 33-50% when the aneurysm ruptures.…”

“…9 Noninvasive imaging exams are often part of incidental diagnoses, but the gold standard is helical computed angiotomography. 2,3,8 The natural history of internal iliac artery aneurysms is still unclear, but several authors recommend repairing these aneurysms when diameter exceeds 3 cm, since the risk of rupture in such cases is 14-31%. Clinical management is reserved for asymptomatic patients with aneurysms smaller than 3 cm.…”