Pseudoaneurismas em associacao com infeccao pelo virus da imunodeficiencia humana: relato de dois casos

Abstract

The authors describe the cases of two patients with pseudoaneurysms, discuss the difficulty in establishing diagnosis and treatment due to human immunodeficiency virus infection, and demonstrate the similarity with atherosclerotic saccular aneurysm of the abdominal aorta.Keywords: HIV; pseudoaneurysm; saccular aneurysm. ResumoOs autores descrevem os casos de dois pacientes que apresentaram pseudoaneurismas e ressaltam a dificuldade diagnóstica e terapêutica por apresentar associação com a infecção pelo vírus da imunodeficiência humana, e também demonstram a semelhança com aneurisma sacular aterosclerótico da aorta abdominal.Palavras-chave: HIV; pseudoaneurisma; aneurisma sacular. As the patient was obese, had previous abdominal surgery and her anatomy was favorable, the plan was to use an endovascular approach to place an aortic endoprosthesis for aneurysm repair.Right femoral dissection and left femoral puncture were used to place a 25 mm × 16 mm × 100 mm Powerlink R endoprosthesis (Endologix, Irvine, CA) using a 9F introducer sheath, and the aneurysm was immediately repaired. Post-operative progression was good, and the patient was discharged on the second day after operation. Ten days after the operation, she presented with left lower back pain, diarrheic stools, vomiting and paresthesia of left lower extremity. Physical examination detected femoral and distal pulses and no sign of hyperemia in the surgical wound; laboratory tests were normal. Two days after hospitalization, her general state deteriorated and she had abdominal and lower extremity pain. Physical examination found that the lower extremities were cold, and no pulses should be detected. Ultrasound scanning confirmed the clinical hypothesis of endoprosthesis occlusion. She underwent an urgent surgery for an axillobifemoral bypass and placement of an 8-mm Dacron prosthesis, and revascularization of the lower extremities was successful. After operation in the ICU, she was administered broad spectrum antibiotics (vancomycin 1 g, 12h/12h and meropenem 1 g, 8h/8h), but had refractory septic shock and died. Case 2A previously healthy 47-year-old male smoking patient was transferred from another hospital ward with a history of daily low fever for 20 days. Nine