Tratamento endovascular com endoprótese aórtica para aneurisma de artéria subclávia secundário à fístula arteriovenosa axilo-axilar traumática tardia
Endovascular treatment with aortic endoprostheses for subclavian artery aneurysm secondary to late traumatic axillary-axillary arteriovenous fistula
Vinicius Tadeu Ramos da Silva Grillo; Rodrigo Gibin Jaldin; Felipe Damascena Rosa; Mariana Thais Silva Secondo; Rafael Elias Farres Pimenta; Matheus Bertanha; Marcone Lima Sobreira; Winston Bonetti Yoshida
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Abstract
Traumatic arteriovenous fistulas (AVFs) involving the axillary and subclavian vessels are uncommon and account for 5 to 10% of all arterial traumas. The complex anatomy of this region makes treatment of this segment challenging. In this therapeutic challenge, we describe the case of a 73-year-old man, referred for progressive edema and ulceration involving the right upper limb and with a history of gunshot wound to the right infraclavicular region about 50 years previously. Angiotomography was performed and an axillary-axillary AVF was found, associated with tortuosity and aneurysmatic dilation of the subclavian artery downstream. He underwent endovascular intervention and a conical (monoiliac) 26 × 14 × 90 mm Braile® endoprosthesis was used in the aneurysmatic subclavian artery, posterior to the exit of the right vertebral artery and a 16 × 16 × 95mm Excluder® monoiliac endoprosthesis was placed overlapping the first prosthesis, showing a satisfactory result. Therefore, the possibility of successfully using aortic endoprostheses in an unusual and exceptional situation is described.
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References
1 Mo A. Endovascular repair of traumatic arteriovenous fistula between axillary artery and vein. Chin J Traumatol. 2014;17(2):112-4. PMid:24698582.
2 Maués JJB Fo, Hauter HL. Tratamento endovascular de fístula traumática de vasos subclávios: relato de caso. J Vasc Bras. 2018;17(3):248-51.
3 Cohen JE, Rajz G, Gomori JM, et al. Urgent endovascular stent-graft placement for traumatic penetrating subclavian artery injuries. J Neurol Sci. 2008;272(1-2):151-7.
4 Castelli P, Caronno R, Piffaretti G, et al. Endovascular repair of traumatic injuries of the subclavian and axillary arteries. Injury. 2005;36(6):778-82.
5 Branco BC, DuBose JJ. Endovascular solutions for the management of penetrating trauma: an update on REBOA and axillo-subclavian injuries. Eur J Trauma Emerg Surg. 2016;42(6):687-94.
6 Jaldin RG, Bertanha M, Sobreira ML, et al. pseudoaneurisma da artéria subclávia próximo à origem da artéria vertebral após punção inadvertida: Tratamento endovascular ou cirurgia aberta? J Vasc Bras. 2013;12(3):237-42.
7 Oliveira PPM, Petrucci O, Vilarinho KADS, Silveira LM, Vieira RW, Braile DM. Fístula traumática entre tronco braquiocefálico e veia braquiocefálica por arma de fogo. Arq Bras Cardiol. 2008;90(4):21-3.
8 Santos EP Jr, Batista RRA, Felici FM, Correia VE, Oliveira MB, Alves RF. Endovascular correction of a traumatic internal iliac arteriovenous fistula with a covered stent. J Vasc Bras. 2014;13(1):48-52.
9 Pilan BF, Oliveira AM, Siqueira DED, Guillaumon AT. Tratamento de fístula arteriovenosa adquirida com repercussões hemodinâmicas graves: desafio terapêutico. J Vasc Bras. 2014;13(1):34-8.
10 Medeiros CAF, Landim RM, Castro AN, et al. Condutas no trauma penetrante da artéria axilar. J Vasc Bras. 2003;2(3):225-8.
11 Ramacciotti E, Gerardi VA Fo, Fagundes DJ. Endovascular de Fístulas Artériovenosas. Acta Cir Bras. 1999;14(1):47-51.
12 Medeiros CAF, Hatsumura TC, Gusmão DR, Freire LMD, Rocha EF, Guillaumon AT. Tratamento endovascular do trauma arterial dos membros. J Vasc Bras. 2008;7(1):56-61.