RESUMO
We report a rare case of a tuberculous mycotic aortoiliac pseudoaneurysm treated with an endovascular procedure and follow-up of 36 months. The patient was a white 72-year-old man with pulmonary tuberculosis and a former smoker with hypertension, chronic renal failure, and dyslipidemia. A computed tomographic scan of the abdomen and pelvis revealed a left paravertebral cavity with fluid content and involvement of vertebrae L2-L4. After a surgical repair attempt, the patient was treated with the implant of a bifurcated endoprosthesis. Because it is unlikely that any center has extensive experience in the management of this rare manifestation of the disease, we reviewed the literature for similar cases.
Assuntos
Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/microbiologia , Falso Aneurisma/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/microbiologia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Procedimentos Endovasculares/métodos , Tuberculose Cardiovascular/diagnóstico , Idoso , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
Popliteal artery morphology changes while undergoing knee motion. A main flexion (i.e., the 'hinge point') and other flexions (termed 'accessory flexions') were described as a result of popliteal artery adaptation to knee flexion. Knee dynamics challenge the outcome of popliteal artery endovascular procedures. Complications such us stent fractures were reported despite rapidly improving technology. Understanding popliteal artery dynamics allows us to develop an endovascular technique that facilitates the avoidance of the difficulties of one of the most mobile arteries in the body. Here we report two cases with a novel stent implantation technique in the popliteal artery. The method includes diagnostic angiography, lesion angioplasty, and stenting using both extended and flexed knee in lateral view. The pressure gradients were measured with knee in extension and flexion before and after each step. A successful outcome was achieved in both cases. This method allows us: 1) to identify the flexions of the popliteal artery and its relationship with the lesions; 2) to detect those obstructions not visible with an extended knee; 3) to understand that the hinge point and accessory flexions can develop undesired and unexpected artery obstruction after a stent implantation only observed in knee flexion; and 4) to identify the morphological changes caused in the popliteal artery and its subsequent solution.
