Jornal Vascular Brasileiro
http://jvascbras.org/article/doi/10.1590/1677-5449.010317
Jornal Vascular Brasileiro
Case Report

Tratamento endovascular de fístula traumática de vasos subclávios: relato de caso

Endovascular treatment of traumatic subclavian arteriovenous fistula: case report

José Júlio Bechir Maués Filho, Heather Lynn Hauter

Downloads: 0
Views: 53

Resumo

policial masculino de 47 anos foi atendido em consultório com queixa de dispneia aos esforços, edema e dor importantes em braço direito. Relatou ferimento por arma de fogo infraclavicular direito 7 meses antes. Tomografia de tórax mostrou grande dilatação de veia subclávia, veias cervicais e de membro superior direito sem identificação da comunicação arteriovenosa. O paciente foi internado antes da data prevista para tratamento por piora clínica e foi submetido a implante de stent revestido Fluency 8x100 mm em artéria subclávia direita por técnica do varal. Angiografia de controle mostrou artéria subclávia pérvia e fechamento da fístula. Houve melhora dos sintomas em braço direito no primeiro dia após o procedimento. As lesões traumáticas da artéria subclávia são incomuns, porém podem evoluir com alto índice de morbimortalidade O trauma penetrante é o principal agente etiológico, e fístulas arteriovenosas devem ser pesquisadas durante o atendimento do paciente com lesões penetrantes em trajeto vascular.

Palavras-chave

fístula arteriovenosa; lesões do sistema vascular; ferimentos e lesões; procedimentos endovasculares.

Abstract

A 47-year-old male police officer presented at an outpatients consulting room complaining of exertional dyspnea and swelling and pain in the right arm. He had suffered a perforating gunshot wound of the right infraclavicular region 7 months previously. A chest tomography showed considerable dilatation of the subclavian and cervical veins and veins of the right upper limb, with no clear point of arteriovenous communication. His symptoms exacerbated and he was admitted to hospital before the date scheduled for treatment. He underwent endovascular treatment with an 8x100 mm Fluency covered stent that was placed in the right subclavian artery using the through-and-through technique. Control angiography showed that the fistulous defect had been completely sealed. There was significant relief of the symptoms on the first day after the operation. Traumatic lesions of the subclavian artery are rare, but can be associated with high morbidity and mortality rates. Penetrating trauma is the main cause and arteriovenous fistulas should be ruled out when evaluating penetrating injuries in vascular territories.

Keywords

arteriovenous fistula; vascular system injuries; wounds and injuries; endovascular procedures

References

1. Oliveira PP, Petrucci O, Vilarinho CA, Silveira LM, Vieira RW, Braile DM. Fístula traumática entre tronco braquiocefálico e veia braquiocefálica por arma de fogo. Arq Bras Cardiol. 2008;90(4):e21-3. http://dx.doi.org/10.1590/S0066-782X2008000400013. PMid:18516376.

2. Silva RM, Cury RC, Brito CJ. Fístulas arteriovenosas traumáticas. In: Brito CJ. Cirurgia vascular. 3 ed. Rio de Janeiro: Revinter; 2014. p. 1741-1757.

3. Martinez C, Maazoun Y, Durieux R, Defraigne J, Legrand V. Endovascular repair of left subclavian artery after gunshot wound: an alternative to surgical treatment. Acta Cardiol. 2012;67(5):609- 12. http://dx.doi.org/10.1080/AC.67.5.2174140. PMid:23252016.

4. Ostovan MA, Kojuri J, Dehghani P. Endovascular repair of traumatic dissection of the subclavian-axillary artery: Report of four cases. J Tehran Heart Cent. 2017;12(2):88-91. PMid:28828025.

5. Waller CJ, Cogbill TH, Kallies KJ, et al. Contemporary management of subclavian and axillary artery injuries – a western trauma association multicenter review. In: Proceedings of the 47th Annual Meeting of the Western Trauma Association; 2017; Snowbird, Utah. Whistler, British Columbia: Western Trauma Association. http://dx.doi.org/10.1097/TA.0000000000001645.

6. Rich NM, Spencer FC. Arteriovenous fistulas. In: Rich NM. Vascular Figura 3. Angiografia pos operatoria. trauma 2nd ed. Philadelphia: WB Sauders; 2009. p. 458-524.

7. Huang W, Villavicencio JL, Rich NM. Delayed treatment and late complications of a traumatic arteriovenous fistula. J Vasc Surg. 2005;4(41):715-7. http://dx.doi.org/10.1016/j.jvs.2005.01.049. PMid:15874939.

8. Weber CD, Kobbe P, Herren C, Mahnken AH, Hildebrand F, Pape HC. Endovascular management of a combined subclavian and vertebral artery injury in an unstable polytrauma patient: case report and literature review. Bull Emerg Trauma. 2017;5(1):53-7. PMID: 28246625.

9. Xenos ES, Freeman M, Stevens S, Cassada D, Pacanowski J, Goldman M. Covered stents for injuries of subclavian and axillary arteries. J Vasc Surg. 2003;38(3):451-4. http://dx.doi.org/10.1016/S0741-5214(03)00553-6. PMid:12947252.

10. Filis KA. Endovascular grafting as a complement to open surgery treatment for axillary and subclavian vascular injuries. South Med J. 2008;101(8):781-2. http://dx.doi.org/10.1097/SMJ.0b013e31817e6fc0. PMid:18622332.

11. Patel AV, Marin ML, Veith FJ, Kerr A, Sanchez LA. Endovascular graft repair of penetrating subclavian artery injuries. J Endovasc Surg. 1996;3(4):382-8. http://dx.doi.org/10.1583/1074-6218(1996)003<0382:EGROPS>2.0.CO;2. PMid:8959495.

12. Sarac M, Marjanovic I, Jevtic M, Misovic S, Zoranovic U, Rusovic S. Endovascular repair of a posttraumatic multiple femoral-femoral and popliteal-popliteal arteriovenous fistula with Viabahn and Excluder stent graft. Vojnosanit Pregl. 2011;68(7):616-20. http://dx.doi.org/10.2298/VSP1107616S. PMid:21899185.

13. Mo A. Endovascular repair of traumatic arteriovenous fistula between axillary artery and vein. Chin J Traumatol. 2014;17(2):112-4. PMid:24698582.

14. du Toit DF, Leith JG, Strauss DC, Blaszczyk M, Odendaal JV, Warren BL. Endovascular management of traumatic cervicothoracic arteriovenous fistula. Br J Surg. 2003;90(12):1516-21. http://dx.doi.org/10.1002/bjs.4343. PMid:14648730.

15. du Toit DF, Lambrechts AV, Stark H, Warren BL. Long-term results of stent graft treatment of subclavian artery injures: management of choice for stable patients? J Vasc Surg. 2008;47(4):739-43. http://dx.doi.org/10.1016/j.jvs.2007.11.009. PMid:18242938.

5cd1c20c0e88255e30632f8f jvb Articles

J Vasc Bras

Share this page
Page Sections