Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202000281
Jornal Vascular Brasileiro
Therapeutic Challenge

Tratamento endovascular de urgência do aneurisma justarrenal utilizando técnica de stents em paralelo

Urgent endovascular treatment of juxtarenal aneurysm using a parallel grafts technique

Fábio Augusto Cypreste Oliveira; Bruno Campos Coelho; Marina Balestra; Juliana Caetano Barreto Cypreste Oliveira; Maria Cunha Ribeiro Amorelli; Davi Douglas Heckmann; Carlos Eduardo de Sousa Amorelli; Fábio Lemos Campedelli

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Resumo

O aneurisma da aorta abdominal pode representar um desafio terapêutico em várias condições anatômicas, tornando complexo o seu tratamento endovascular. O aneurisma de aorta abdominal justarrenal (AAA-JR) é definido pela ausência de uma zona proximal de fixação no segmento infrarrenal, e, dessa forma, técnicas são utilizadas para obter um colo adequado para a fixação das endopróteses sem promover a oclusão das artérias renais e dos ramos viscerais. As técnicas de stents em paralelo, fenestração em bancada, customização pela indústria e utilização de endoprótese ramificada de prateleira são utilizadas nos aneurismas abdominais com colo proximal inadequado, porém cada técnica apresenta indicação, limitação e riscos. Neste desafio terapêutico, apresenta-se um caso de tratamento endovascular de urgência de um AAA-JR com a técnica de stents em paralelo com boa evolução a médio prazo e discute-se suas opções terapêuticas.

Palavras-chave

aneurisma da aorta abdominal, procedimentos endovasculares, stents

Abstract

Abdominal aortic aneurysms can constitute a therapeutic challenge in several anatomical scenarios, making endovascular treatment more complex. A juxtarenal abdominal aortic aneurysm (JR-AAA) is defined by the absence of a proximal landing zone in the infrarenal segment and, therefore, techniques must be used to obtain an adequate neck for fixing the endoprostheses without provoking occlusion of renal arteries and visceral branches. The parallel grafts technique, physician-modified stent-graft, industry customized endoprostheses, and off-the-shelf branched endoprosthesis are techniques used in abdominal aneurysms with inadequate proximal neck, but each technique has its indications, limitations, and risks. In this therapeutic challenge, we present a case of urgent endovascular treatment of a JR-AAA using a parallel grafts technique, with good medium-term results, and discuss the therapeutic options.

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Submitted date:
07/01/2019

Accepted date:
07/03/2020

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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