Isquemia pélvica aguda: uma complicação fatal após tratamento endovascular de aneurisma aorto‐ilíaco com prótese ramificada da ilíaca

Tratamento endovascular de aneurisma isolado bilateral de artéria ilíaca interna

“…There is a predominance among men (5:1) and the elderly. [2][3][4][5][6]20,21 Aneurysms can be classified as congenital or acquired and as saccular or fusiform (which are more frequent and are associated with atherosclerotic disease). Etiologic factors include traumas, vasculitis, pregnancy, infections, connective tissue diseases, and iatrogeny.…”

“…4 The majority of authors recommend preserving at least one internal iliac artery, thereby avoiding complications such as ischemia of the colon, ischemia of the spinal cord with paraplegia, gluteal necrosis, gluteal claudication, and erectile dysfunction. 2,5 The technique of excising and resecting these aneurysms is also associated with a high risk of bleeding and high rates of injuries to the ureter and adjacent structures, in addition to similar mortality (26.7%). Endoaneurysmorrhaphy is not recommended for bilateral iliac aneurysms, because of the high risk of gluteal necrosis, colitis, and paralysis.…”

“…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.…”

Tratamento endovascular do aneurisma aortoilíaco: relato do primeiro caso utilizando endoprótese brasileira com ramo ilíaco

“…10,11,19,20 The majority of significant complications described after implantation of these devices are related to acute occlusion of the iliac branch. While incidence is relatively low, there are reports of extremely serious and even fatal complications, 7 which underscores the need for multidisciplinary assessment, strict adherence to indications, and deployment of these devices by a trained medical team.…”

“…4,5 More severe complications such as medullary/mesenteric ischemia or gluteal necrosis are rare, but can occur in 1-3% of bilateral embolization cases. 6,7 Because of this, several different revascularization techniques have been designed to attempt to preserve pelvic circulation by maintaining flow through at least one of the internal iliac arteries, including revascularization with bypass, 8,9 placement of endoprostheses with iliac branches, 10,11 and techniques using endoprostheses in parallel, such as the sandwich technique described by Lobato. 12 Endoprostheses with iliac branches, known as iliac branch devices (IBD) were developed with the objective of enabling totally endovascular treatment of aortoiliac aneurysms, with exclusion of aneurysms and maintenance of anterograde flow into the internal iliac arteries.…”