Tratamento endovascular da oclusão das artérias ilíacas

Abstract

A oclusão das artérias ilíacas é uma patologia freqüente. Várias opções cirúrgicas existem para o seu tratamento, como a ponte aorto-bifemoral, a ponte femoro-femoral cruzada, o implante de endoprótese e outros. A ponte aorto-bifemoral é considerada o tratamento com melhores resultados. O tratamento endovascular da oclusão das artérias apresenta alta taxa de sucesso e baixo índice de complicações. Realizamos este tratamento em 24 pacientes, com idade média de 61 anos, variando de 39 a 82 anos. A indicação foi claudicação intermitente em 19 pacientes e isquemia crítica em cinco. O fator de risco mais freqüente foi tabagismo em 19 pacientes. A taxa de sucesso técnico na ultrapassagem da lesão foi de 91,7% e a taxa de patência foi de 71% em um ano. Os bons resultados com o tratamento endovascular nas oclusões das artérias ilíacas, com baixas taxas de morbidade e mortalidade, sugerem a inclusão deste procedimento no arsenal terapêutico. Unitermos: Artérias ilíacas. Recanalização. Endoprótese. Endovascular treatment of iliac arteries occlusion.Occlusion of the iliac arteries is a common disease. Several surgical options are available to treat them, such as aorto-bifemoral bypass graft, cross femoro-femoral bypass, endoprosthesis implants and others. Aortobifemoral bypass graft is considered the treatment that provides the best results. Endovascular treatment for occlusion of the iliac arteries provides high success rates and low incidence of complications. Twenty-four patients, aged between 39 and 82 years (mean 61 years), were submitted to this treatment. Intermittent claudication and critical ischemia were the indications in 19 and 5 patients, respectively. The most common risk factor was smoking (19 patients). The technical success rate of iliac artery recanalization was 91.7% and the patency rate after one year was 71%. The good results achieved with percutaneous recanalization and stenting of occluded iliac arteries, which presents low morbidity and mortality rates, suggest that this procedure should be included among the therapeutic options for the treatment of iliac arteries occlusion.

Acute limb ischemia secondary to radiation-induced arteritis: case report

“…PTA associated with stent implantation is extremely effective in the treatment of iliac arterial stenosis of any etiology 14 . Patients usually have a good postoperative recovery, and clinical improvement is evident, as shown in this case and in the literature 12,14 .…”

“…Therefore, in the arterial involvement of the lower extremities, varying degrees of arterial insufficiency may occur, from exertion muscular ischemia (intermittent claudication) to rest pain and tissue loss 12 …”

“…Although other treatment options have been described (drug therapy, endarterectomy, extraanatomic bypass) 1,2 , PTA with stent implantation is increasingly becoming the treatment of choice in similar cases because of its low invasiveness and high success rates, as described in the literature 12,14 . PTA associated with stent implantation is extremely effective in the treatment of iliac arterial stenosis of any etiology 14 .…”

Midterm results of endovascular treatment of iliac artery lesions: analysis of 59 cases

“…1% 13 . Pedron et al 14 studied a series of 24 cases of iliac occlusion treated with angioplasty and found technical success rates of 91.7% and patency of 71% at 1 year 14 . Moreira et al 15 evaluated neointimal hyperplasia using intravascular ultrasound 8 months after the procedure in 30 patients that underwent angioplasty of the iliac arteries and stenting, and found that it was self-limited and did not lead to significant restenosis in any of the cases 15 .…”