Treatment of Multiple Arterial Aneurysms in Patient with Polyaneurysmal Disease: Case Report

Abstract

Polyneurysmal dystrophy is defined as the clinical entity characterized by the presence of multiple arterial lesions in different sections of the arterial tree in a simultaneous or sequential manner, excluding uniquely bilateral and multilobulated aneurysms [1, 2]. The incidence of multiple aneurysms in the United States is 0.01% [3] to 3.9% [4]. These aneurysms are caused by: atherosclerosis [4, 5], changes in elastic fibers (ectasic medial dystrophy) [6], Polyarteritis Nodosa, Takayasu's arteritis, Behçet's disease, Marfan's syndrome, trauma and infection [7]. We performed a search on the PubMed and Bireme databases, where we found 17 articles from 1963 to 2017. This work is a case report. A 79-year-old male, a former smoker, hypertensive. He was undergoing colored arterial Doppler ultrasonography that revealed fusiform aneurysms in popliteal arteries (AAP) and femoral arteries (AAF) bilaterally. A Computed tomography angiography (CTA) showed Abdominal Aortic Aneurysm (AAA) type IV (Crawford) of 4.5 cm in diameter, iliac arteries and common femoral arteries enlarged. Fifteen days before the starting of studies of this case, the patient presented fungal lesion in right foot evolving with critical ischemia. We opted for conventional surgery. A femoral-pedal bypass with ex-vivo saphenous vein without valves, in the right lower limb, with the exclusion of AAF and AAP, was also performed, in addition to amputation of the 5th right toe. The colored arterial Doppler ultrasonography of the RLL at the 30th day after the surgery evidenced exclusion of AAF, patent bypass, AAP with low flow and thrombi in it. Forty days after the surgery in RLL, he evolved with pain, pallor and hypothermia in Left Lower Limb (LLL). A colored arterial Doppler ultrasonography of the LLL revealed acute occlusion of the left popliteal artery and a Left Femoral Artery Aneurysm. We have performed a femoral-pedal bypass in Left Lower Limb, with exclusion of AAF and left AAP. About 3 (three) months after the last surgery, the patient evolved well, with peripheral pulses preserved. But during preparation for the correction of the thoracic aneurysm the patient developed mesenteric thrombosis due to the mural thrombi of the abdominal aortic aneurysm; he was submitted to exploratory laparotomy and resection of 70 cm of small intestine. During waiting for customized endoprosthesis to treat abdominal aortic aneurysm, the patient had passed away. We cannot waste time in the treatment of this disease, and it is extremely difficult to predict which of the aneurysms needs to be treated first.