ABSTRACT
O tratamento endovascular das doenças da aorta torácica progrediu muito rapidamente nos últimos anos, principalmente nas lesões da aorta descendente e que possuem uma zona adequada de fixação proximal e distal. Hoje em dia as endopróteses disponíveis no mercado nacional permitem tratar aneurismas da aorta torácica descendente, dissecção da aorta do tipo B, hematomas e úlceras de aorta, e lesões traumáticas. O objetivo deste artigo é analisar os estudos recentes publicados e avaliar os resultados encorajadores do tratamento de casos desafiadores como as dissecções de aorta do tipo B e lesões traumáticas da aorta. Além disso, avaliamos os resultados iniciais da nova geração de endopróteses desenvolvidas para o tratamento e aneurismas tóraco-abdominais e justa-renais. Com esta ampla revisão esperamos expandir a população de pacientes que podem ser tratados por este método. Devido a condições de emergências, doenças associadas, muitos pacientes não têm opções cirúrgicas e com resultados apresentados com o tratamento endovascular das dissecções do tipo B e lesão traumática da aorta; a cirurgia endovascular passa a ser a primeira opção no tratamento destas doenças.
Treatment of thoracic aortic lesions using endografts has rapidly progressed.Clinical trials are underway evaluating stent graft use in a variety of applications. Endovascular repair can successfully treat challenging aortic indications such as type B dissection, traumatic injury and transection.The goal of this paper is to analyze the recent results of endovascular repair. Investigators are working to improve upon encouraging initial experiences and determine the degree to which endovascular repair can successfully treat challenging aortic diseases.We also analyze the next-generation endovascular systems that are designed to treat thoraco-abdominal aneurysms and para-renal aneurysms.The effort of this paper is to expand the population of patients that can be treated. Due to emergent conditions, comorbid concerns, high risk for surgery, and difficult anatomies, many patients have insufficient options for treating their life-threatening aortic diseases. For those patients with type B aortic dissections and traumatic aortic rupturel...
Subject(s)
Humans , Aortic Aneurysm/surgery , Aortic Aneurysm/diagnosis , Aorta, Thoracic/injuries , Aortic Rupture/therapyABSTRACT
El aneurisma paraanastomótico es el que ocurre luego de una reconstrucción quirúrgica previa, en este caso en la aorta, el cual debe de ser reparado en cuanto se diagnostica. Presentamos el caso de un paciente con antecedente de reparo quirúrgico de aneurisma de aorta abdominal infrarenal, un año siete meses atrás. El paciente ingresa con un cuadro urgente de rotura de aneurisma aórtico paraanastomótico en la aorta remanente infrarenal adyacente a la anastomosis aórtica proximal. El paciente fue tratado con intervención endovascular mediante la aplicación de dos stent-graft aórticos, tubulares, uno con sistema de fijación transrenal, y el segundo telescopado entre el primero y el injerto tubular antiguo. Se obtuvo completa exclusión angiográfica del aneurisma roto y mejoría clínica inmediata con desaparición del dolor. Fue dado de alta al cuarto día post intervención. En el seguimiento a los 45 días con control tomográfico se demuestra exclusión completa del aneurisma roto y reducción significativa del hematoma retroperitoneal con los stent grafts in situ y buena permeabilidad de las arterias renales. En los casos de aneurisma aórtico paraanastomótico electivo o roto el tratamiento endovascular con stent-graft es factible y exitoso; presenta menos morbimortalidad y debe considerarse como de primera elección.
The paraanastomotic aneurysm is the one that occurs after aortic reconstructive surgery and needs to be repaired at the time of diagnosis. We present the case of a patient with a previous infrarenal aortic aneurysm surgical repair 19 months back. The patient is admitted with an urgent case of ruptured paraanastomotic aortic aneurysm in the infrarenal remanent aorta next to the proximal aortic anastomosis. The patient underwent succesful endovascular intervention by placement of two aortic tube stent grafts, the first with a transrenal fixation system and the second one overlapped between the first stent graft and the previous Dacron tubular graft. Complete angiographic aortic aneurysm exclusion was obtained and we observed immediate clinical improvement with no pain. He was released from the hospital at the 4th day post endovascular repair. During the follow-up 45 days later the CT Scan showed complete exclusion of the aneurysm, reduction of the retroperitoneal haematoma, stent grafts in situ and bilateral renal artery patency. In elective or emergency paraanastomotic aortic aneurysms the endovascular stent-graft repair is feasible and successful; has lower perioperative morbidity and mortality and must be considered as the first line approach.
Subject(s)
Humans , Male , Aged , Aortic Rupture , Aortic Rupture/therapyABSTRACT
Se presenta el caso de un joven de 22 años, herido de bala en región toracoabdominal, con orificio de entrada en el precordio. Entre las lesiones producidas se destacó la efracción aórtica de magnitud y el taponamiento natural que se produjo en la transcavidad de los epiplones, lo que permitió su resolución exitosa, remedando lo que ocurre en las heridas cardíacas con el taponamiento pericárdico
Subject(s)
Aortic Rupture/surgery , Aortic Rupture/diagnosis , Aortic Rupture/therapy , Wounds, Gunshot , EmergenciesABSTRACT
Traumatic rupture of the thoracic aorta is a life threatening situation, and may be secondary to several mechanisms; mainly penetrating or iatrogenic lesions and blunt trauma. Although penetrating mechanisms predominate, the number of patients with aortic disruption due to blunt trauma has continued to increase.This paper shows an overview focusing on the pathogenesis, diagnosis, timing and type of treatment regarding traumatic injuries of the thoracic aorta; it also reports the experience of one single center that deals with these lesions.The major difficulty in the evaluation data on blunt aortic injury is that retrospective reviews often group together patients with all types of aortic lesions, comparing outcomes for injuries in different locations, with diverse methods of repair and different surgeons and/or institutions.
Subject(s)
Humans , Male , Adult , Aorta, Thoracic/injuries , Aorta, Thoracic/pathology , Wounds and Injuries/diagnosis , Aortic Rupture/surgery , Aortic Rupture/diagnosis , Aortic Rupture/therapy , Retrospective Studies , TomographyABSTRACT
We report a case in which a ruptured aneurysm of the sinus of Valsalva opening into the right atrium was successfully closed transcutaneously by an Amplatzer duct occluder.
Subject(s)
Adult , Aortic Rupture/therapy , Balloon Occlusion/instrumentation , Heart Atria , Cardiac Catheterization , Humans , Male , Prostheses and Implants , Sinus of ValsalvaSubject(s)
Humans , Female , Pregnancy , Aortic Rupture/surgery , Aortic Rupture/diagnosis , Aortic Rupture/therapy , CatheterizationABSTRACT
A 35 year-old man with aneurysm of the noncoronary sinus of Valsalva ruptured into the right atrium, detected by echodopplercardiogram and submitted to surgical correction is reported. The authors discuss peculiar aspects of this disease, with emphasis to the echodopplercardiographic diagnosis