Resultado imediato do tratamento endovascular com stents paralelos do aneurisma roto justarrenal
Immediate outcome of endovascular treatment of ruptured juxtarenal aneurysm with parallel stents
Claudia Guimarães Agle; César Amorim Pacheco Neves; Flávia Dórea Carneiro Abbehusen; Tainã Lemos Andrade; Filinto Marques de Cerqueira Neto; Dejean Sampaio Amorim Filho
Rupture of an abdominal aortic aneurysm is an event with a high mortality rate and treatment is a medical emergency. Endovascular treatment of these aneurysms has become established as a minimally invasive alternative to classical open surgery and is now the first-choice option. However, 20 to 50% of patients with abdominal aortic aneurysms do not have anatomy favorable for endovascular treatment because of a short aneurysm neck or because visceral branches are involved by the aneurysm. We report the case of a 70-year-old patient who underwent endovascular repair of a ruptured juxtarenal aneurysm with deployment of parallel stents in the renal arteries (in a chimney technique). Clinical data and details of the procedure are reported. Technical success was achieved and there were no postoperative complications.
1 Badger SA, Harkin DW, Blair PH, Ellis PK, Kee F, Forster R. Endovascular repair or open repair for ruptured abdominal aortic aneurysm: a Cochrane systematic review. BMJ Open. 2016;6(2):e008391.
2 Magliano CA, Senna K, Santos M. Diretriz brasileira para o tratamento do aneurisma de aorta abdominal. CONITEC. 2017;240:1-55.
3 Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG, EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet. 2004;364(9437):843-8.
4 EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet. 2005;365(9478):2187-92.
5 Prinssen M, Verhoeven EL, Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351(16):1607-18.
6 Lederle FA, Freischlag JA, Kyriakides TC, et al. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. N Engl J Med. 2012;367(21):1988-97.
7 Aburahma AF, Campbell JE, Mousa AY, et al. Clinical outcomes for hostile versus favorable aortic neck anatomy in endovascular aortic aneurysm repair using modular devices. J Vasc Surg. 2011;54(1):13-21.
8 Faruqi RM, Chuter TA, Reilly LM, et al. Endovascular repair of abdominal aortic aneurysm using a pararenal fenestrated stent-graft. J Endovasc Surg. 1999;6(4):354-8.
9 Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2-77.e2.
10 Hofmeister S, Thomas MB, Paulisin J, Mouawad NJ. Endovascular management of ruptured abdominal aortic aneurysms and acute aortic dissections. Vasa. 2019;48(1):35-46.
11 Mureebe L, Egorova N, Giacovelli JK, Gelijns A, Kent KC, McKinsey JF. National trends in the repair of ruptured abdominal aortic aneurysms. J Vasc Surg. 2008;48(5):1101-7.
12 Powell JT, Sweeting MJ, Thompson MM, et al. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ. 2014;348:f7661.
13 Kayssi A, DeBord Smith A, Roche-Nagle G, Nguyen LL. Health-related quality-of-life outcomes after open versus endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2015;62(2):491-8.
14 Böckler D, Holden A, Krievins D, et al. Extended use of endovascular aneurysm sealing for ruptured abdominal aortic aneurysms. Semin Vasc Surg. 2016;29(3):106-13.
15 Karthikesalingam A, Holt PJ, Vidal-Diez A, et al. Predicting aortic complications after endovascular aneurysm repair. Br J Surg. 2013;100(10):1302-11.
16 Lobato AC, Camacho-Lobato L. A new technique to enhance endovascular thoracoabdominal aortic aneurysm therapy--the sandwich procedure. Semin Vasc Surg. 2012;25(3):153-60.
17 Hu Z, Li Y, Peng R, et al. Multibranched stent-grafts for the treatment of thoracoabdominal aortic aneurysms: a systematic review and meta-analysis. J Endovasc Ther. 2016;23(4):626-33.
18 Kansagra K, Kang J, Taon MC, et al. Advanced endografting techniques: snorkels, chimneys, periscopes, fenestrations, and branched endografts. Cardiovasc Diagn Ther. 2018;8(Suppl 1);S175-83.
19 Stenson KM, De Bruin JL, Holt PJ, Loftus IM, Thompson MM. Extended use of endovascular aneurysm sealing: chimneys for juxtarenal aneurysms. Semin Vasc Surg. 2016;29(3):120-5.