Lesões traumáticas de aorta em zona rural: série de casos com manifestações tardias e revisão dos aspectos terapêuticos / Traumatic aorta injuries in a rural area: late manifestations and review of therapeutic aspects

Resumo As lesões traumáticas da aorta (LTA) torácica estão associadas a altas taxas de morbimortalidade. São classificadas de acordo com a extensão do dano, e a angiotomografia computadorizada tem as maiores sensibilidade e especificidade para identificar o grau de lesão e potenciais lesões associadas. As estratégias terapêuticas para LTA são baseadas no tipo de lesão, na extensão e nas lesões associadas. Pode auxiliar na definição de conduta também o grau de estabilidade do paciente, podendo ser manejo cirúrgico convencional, endovascular (TEVAR) ou conservador em casos selecionados. Entre os pacientes com anatomia vascular adequada, a cirurgia endovascular está associada a melhor sobrevida e a menos riscos. O objetivo deste artigo foi descrever uma série de quatro casos acompanhados em serviço terciário, em um estado com poucos serviços de alta complexidade. A terapêutica endovascular foi empregada como método preferencial. Os pacientes apresentaram evolução favorável sem complicações até a alta e encontram-se em acompanhamento ambulatorial.

Abstract Traumatic thoracic aortic injuries (TTAI) are associated with high rates of morbidity and mortality. They are classified according to the extent of damage and computed tomography angiography has the highest sensitivity and specificity for identifying the degree of injury and potential associated lesions. Treatment strategies for TTAI are based on the type and extent of injury and associated lesions. The patient's degree of stability can also help to define the choice of treatment, which can be conventional or endovascular surgery (EVAR) or even conservative management in selected cases. Among patients with adequate vascular anatomy, endovascular surgery is associated with better survival and fewer risks. The objective of this article is to describe a series of four cases followed up at a tertiary service in a Brazilian state that has few centers that provide high complexity care. Endovascular therapy was employed as the preferred method. All four patients had favorable outcomes, with no complications up to discharge, and are currently in outpatient follow-up.

Three Extremely Rare Findings in the Same Patient: Harlequin Syndrome, Thyrocervical Trunk Aneurysm, and Systemic-Pulmonary Arterio-Arterial Fistula.

Harlequin syndrome is a rare autonomic disorder characterized by unilateral diminished sweating and flushing of the face in response to heat or exercise. Extrinsic ganglion compressions, most of the times by neoplasms, can induce the syndrome. During investigation of a 27-year-old woman presenting Harlequin syndrome with diminished sweating on the left side and flushing of the right half of her face, a left thyrocervical trunk aneurysm was detected by angio-magnetic resonance imaging. Thyrocervical trunk aneurysms are rare, and only a few cases have been reported. Treatment is advised due to possible rupture and airway compression by the resulting hematoma. Endovascular treatment was scheduled. Angiographies revealed bronchial arteries arising from a common trunk at the right thyrocervical trunk and the left bronchial artery was feeding an arterio-arterial fistula to the left pulmonary artery; the left thyrocervical trunk aneurysm was confirmed and an anomalous artery arising from the aneurysm converged to the left pulmonary artery arterio-arterial fistula; the fistula was also supplied by a branch of the left internal mammary artery. The young age and lack of clinical antecedents suggest a congenital etiology for this fistula. The treatment was postponed until cardiopulmonary repercussions of the arterio-arterial fistula could be assessed. Coil embolization of the aneurysm was performed in a second procedure. The fistula was not treated. The patient has been followed up for 12 months without complications.

Vascular injuries in the state of Pará, Brazil, 2011-2013 and their relation with demographic and clinical variables / Traumatismo vasculares no estado do Pará, Brasil, período de 2011 a 2013, e sua relação com variáveis clínicas e demográficas

BACKGROUND:Vascular traumas are associated with high morbidity rates.OBJECTIVE: To report the characteristics of vascular traumas in the Brazilian state of Pará, in trauma victims treated at the Hospital Metropolitano de Urgência e Emergência (HMUE), from 2011 to 2013.METHOD: This was a descriptive, cross-sectional, retrospective and quantitative study that analyzed data on sex, age group, geographical origin, time waiting for care, mechanism of trauma, clinical status, anatomic site of injury, prevalence of associated fractures, vascular structures injured, types of vascular injury, principal types of surgery, early postoperative outcomes, level of amputation, number of deaths, length of hospital stay and multidisciplinary care for 264 medical records.RESULTS: The majority of victims were male and the most common age group was from 16 to 30 years. The majority of cases were from towns other than the state capital, accounting for 169 cases (64.02%). The principal mechanism of injury was firearm wounding - 110 (41.67%) followed by cold weapon wounds - 65 (24.62%) and traffic accidents - 42 (15.91%). The segments of the body and the vascular structures most often injured were lower limbs - 120 (45.45%) and injuries to the popliteal and femoral arteries and veins. The most common clinical presentation at admission was hemorrhage - 154 (58.33%). The most common surgeries were ligatures of veins and arteries. There were 163 (61.74%) hospital discharges and 33 (12.5%) deaths.CONCLUSIONS: The greatest prevalence observed was related to traumas caused by urban violence. Victims were most frequently male, of working age and from towns other than the capital of the state of Pará.

CONTEXTO: Os traumatismos vasculares estão relacionados a altas taxas de morbidade. OBJETIVO: Caracterizar o traumatismo vascular no Estado do Pará, em vítimas atendidas no Hospital Metropolitano de Urgência e Emergência (HMUE), no período de 2011 a 2013. MÉTODO: Trata-se de um estudo descritivo, transversal, retrospectivo, quantitativo, que analisou: sexo, faixa etária, procedência, tempo de espera pelo atendimento, mecanismo de trauma, quadro clínico, região anatômica acometida, prevalência de fraturas associadas, estrutura vascular, tipos de lesão vascular, principais tipos de cirurgias, evolução do pós-operatório, nível de amputação, número de óbitos, tempo de internação e atendimento multiprofissional, dentre 264 prontuários.RESULTADOS: A maioria das vítimas foi do sexo masculino e a faixa etária mais acometida foi entre 16 a 30 anos. A maioria dos casos foi procedente de fora da capital, perfazendo 169 casos (64,02%). O principal mecanismo de lesão foi por arma de fogo - 110 (41,67%), seguido por arma branca - 65 (24,62%) e acidente de trânsito - 42 (15,91%). O segmento corporal e as estruturas vasculares mais acometidas foram os membros inferiores - 120 (45,45%), com lesões de artéria e veia poplítea e femoral. Durante a admissão, o quadro clínico mais frequente foi a hemorragia - 154 (58,33%). As ligaduras de veias e artérias foram as cirurgias mais frequentes. Houve 163 (61,74%) altas e 33 (12,5%) óbitos.CONCLUSÃO: A maior prevalência encontrada foi referente a traumas decorrentes da violência urbana, sendo também frequente o acometimento de indivíduos do sexo masculino, em idade produtiva e não procedentes da capital do Estado do Pará.