Signs of impending rupture in abdominal aortic and iliac artery aneurysms by computed tomography: Outcomes in 41 patients.

OBJECTIVES: This study aimed to determine the prevalence of signs of impending rupture (SIR) in asymptomatic patients with abdominal aortic and iliac artery aneurysms, and to evaluate whether these signs were associated with rupture in asymptomatic patients. METHODS: This was a retrospective study of patients with abdominal aortic and iliac artery aneurysms identified on computed tomography (CT) over a 10-year period in a single center. The CT scans were reviewed by two reviewers, and patients with SIR were assigned to one of three groups: (1) early symptomatic (ES), (2) late symptomatic (LS), and (3) always asymptomatic (AA). The four main SIR described in the literature were investigated: 1) crescent sign, 2) focal wall discontinuity of circumferential calcifications, 3) aortic bulges or blebs, and 4) aortic draping. RESULTS: From a total of 759 aortic and iliac aneurysm reports on 2226 CT scans, we identified 41 patients with at least one SIR, and a prevalence of 4.14% in asymptomatic patients. Focal wall discontinuity of circumferential calcifications was the most common sign, and it was present in 46.3% of these patients (19/41); among these, 26 were repaired (ES: 9, LS: 2, AA: 15). Eleven asymptomatic patients underwent follow-up CT. The aneurysm increased in size in 6 of the 11 (54.5%) patients, and three ruptured (all with discontinuity of calcifications), one of which had no increase in diameter. CONCLUSIONS: The presence of focal wall discontinuity of circumferential calcifications was the most common SIR. There was a prevalence of all signs in less than 5% of asymptomatic patients. In unrepaired patients, the signs could be observed on follow-up CT scans with an increase in aneurysm size, indicating that the presence of SIR alone in the absence of other clinical factors or aneurysm characteristics is an insufficient indication for surgery.

Signs of impending rupture in abdominal aortic and iliac artery aneurysms by computed tomography: Outcomes in 41 patients

OBJECTIVES: This study aimed to determine the prevalence of signs of impending rupture (SIR) in asymptomatic patients with abdominal aortic and iliac artery aneurysms, and to evaluate whether these signs were associated with rupture in asymptomatic patients. METHODS: This was a retrospective study of patients with abdominal aortic and iliac artery aneurysms identified on computed tomography (CT) over a 10-year period in a single center. The CT scans were reviewed by two reviewers, and patients with SIR were assigned to one of three groups: (1) early symptomatic (ES), (2) late symptomatic (LS), and (3) always asymptomatic (AA). The four main SIR described in the literature were investigated: 1) crescent sign, 2) focal wall discontinuity of circumferential calcifications, 3) aortic bulges or blebs, and 4) aortic draping. RESULTS: From a total of 759 aortic and iliac aneurysm reports on 2226 CT scans, we identified 41 patients with at least one SIR, and a prevalence of 4.14% in asymptomatic patients. Focal wall discontinuity of circumferential calcifications was the most common sign, and it was present in 46.3% of these patients (19/41); among these, 26 were repaired (ES: 9, LS: 2, AA: 15). Eleven asymptomatic patients underwent follow-up CT. The aneurysm increased in size in 6 of the 11 (54.5%) patients, and three ruptured (all with discontinuity of calcifications), one of which had no increase in diameter. CONCLUSIONS: The presence of focal wall discontinuity of circumferential calcifications was the most common SIR. There was a prevalence of all signs in less than 5% of asymptomatic patients. In unrepaired patients, the signs could be observed on follow-up CT scans with an increase in aneurysm size, indicating that the presence of SIR alone in the absence of other clinical factors or aneurysm characteristics is an insufficient indication for surgery.

Comparação dos achados ultrassonográficos de Doppler arterial com arteriografia intraoperária nos pacientes do programa de vigilância de revascularização dos membros inferiores / Comparison of ultrasonographic findings of arterial Doppler working intra arteriography in patients revascularization surveillance program of the lower limbs

A doença arterial periférica crônica é considerada uma forma de aterosclerose manifesta, caracterizando–se pela oclusão crônica e gradual dos segmentos arteriais dos membros, principalmente membros inferiores, determinando diferentes repercussões clínicas, desde o paciente assintomático, claudicação, dor isquêmica de repouso até lesões tróficas, comprometendo a viabilidade do membro. O tratamento compreende medidas clínicas, tratamento dos fatores de risco como hipertensão arterial, diabetes, dislipidemia e modificação de hábitos, como a interrupção do tabagismo, dieta adequada e exercícios supervisionados e enfim, o tratamento cirúrgico de revascularização, seja através de enxertos, derivações, ou por angioplastia

Comparação dos achados ultrasonográficos de Doppler arterial com arteriografia intraoperatória nos pacientes do programa de vigilância de revascularização dos membros inferiores / Comparison of ultrasound findings of Arterial doppler with intraoperative arteriography in patients in the surveillance program revascularization of the lower members

RESUMO A doença arterial periférica crônica é considerada uma forma de aterosclerose manifesta, caracterizando­se pela oclusão crônica e gradual dos segmentos arteriais dos membros, principalmente membros inferiores, determinando diferentes repercussões clínicas, desde o paciente assintomático, claudicação, dor isquêmica de repouso até lesões tróficas, comprometendo a viabilidade do membro. O tratamento compreende medidas clínicas, tratamento dos fatores de risco como hipertensão arterial, diabetes, dislipidemia e modificação de hábitos, como a interrupção do tabagismo, dieta adequada e exercícios supervisionados e enfim, o tratamento cirúrgico de revascularização, seja através de enxertos, derivações, ou por angioplastia. Neste estudo foram selecionados 10 pacientes no período de abril de 2012 a abril de 2015 do programa de acompanhamento das angioplastias realizadas no HSPM, pois tiveram alteração no Ultrassom Doppler Arterial (UDA) de membros inferiores após o procedimento inicial classificados em alto ou altíssimo para oclusão. Estes pacientes foram submetidos à nova arteriografia para subsequente angioplastia num total de 12 procedimentos cirúrgicos. Destes 58,33% dos casos avaliados obtiveram resultados concordantes entre o ultrassom doppler e a arteriografia perioperatória e 41,67% obtiveram resultados diferentes, porém mesmo os resultados diferentes mostraram que havia alteração com risco de oclusão embora não especificamente na mesma graduação de classificação, mostrando uma sensibilidade elevada. Reconhecemos que nossos resultados são limitados pelo estudo da natureza retrospectiva e relativamente baixo poder estatístico. No entanto, os resultados são interessantes e sugerem que o uso do UDA é de suma importância para avaliação pós operatória dos pacientes submetidos à angioplastia de membros inferiores, visto que possui correlação com a arteriografia perioperatória na indicação de nova angioplastia, sendo útil no manejo clínico dos pacientes após intervenção endovasculares das extremidades na doença arterial periférica, porém somente o doppler isoladamente, não deve ser utilizado como critério único para reabordagem, devendo ser a avaliação clínica de suma importância como a evolução da ferida, os 6 pulsos, ITB e a queixa do paciente, pois o UDA é um exame complementar e deve ser usado como tal. O ideal é associar o exame clínico com o UDA, visto que somente o exame clinico também pode não identificar estenoses importantes.