Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492006000100004
Jornal Vascular Brasileiro
Artigo Original

Estenose carotídea acima de 70% em pacientes no pré-operatório de cirurgia da aorta abdominal: freqüência e fatores de risco

Frequency and risk factors for carotid stenosis above 70% in patients undergoing abdominal aortic surgery

André Ventura Ferreira; Vanessa Prado dos Santos; Roberto Augusto Caffaro

http://dx.doi.org/10.1590/S1677-54492006000100004 J Vasc Bras, vol.5, n1, p.17-22, 2006
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Resumo

OBJETIVO: Analisar a freqüência e os fatores de risco associados à estenose carotídea acima de 70% em pacientes que serão submetidos a cirurgias de aorta abdominal. MATERIAL E MÉTODO: Foram analisados 94 pacientes que realizaram ultra-som Doppler de carótidas no pré-operatório de cirurgias de aorta abdominal entre janeiro de 2000 e janeiro de 2003, pela disciplina de Cirurgia Vascular da Santa Casa de São Paulo. RESULTADOS: Sessenta e sete pacientes (71%) eram homens. Dentre os 94 pacientes, 42 (44,6%) tinham doença oclusiva aorto-ilíaca, e 52 (53,4%), aneurismas da aorta abdominal (AAA). A análise dos dados mostrou uma prevalência de estenose de carótidas acima de 70% em 8,33% dos pacientes com AAA e em 13,51% dos pacientes com doença oclusiva aorto-ilíaca, diferença esta sem significância estatística (P = 0,5). Nos pacientes que apresentavam antecedente de isquemia cerebral - acidente vascular cerebral (AVC) ou ataque isquêmico transitório (AIT) -, houve uma prevalência estatisticamente maior de estenose carotídea entre 70 e 99%. Outros fatores de risco para aterosclerose, como sexo masculino, diabetes, hipertensão arterial e tabagismo, não foram preditivos da presença de estenose carotídea acima de 70%. CONCLUSÃO: A freqüência de estenose da carótida acima de 70% em pacientes no pré-operatório de cirurgia de aorta foi de 9,57%, e a presença de antecedente de AVC ou AIT na história foi preditiva de estenose acima de 70% neste grupo de pacientes.

Palavras-chave

Estenose da carótida, cirurgia da aorta, aterosclerose, aneurismas da aorta abdominal, doença aterosclerótica oclusiva aorto-ilíaca

Abstract

OBJECTIVE: To analyze the frequency and risk factors of carotid stenosis above 70% in patients undergoing abdominal aortic reconstruction. MATERIAL AND METHOD: Ninety-four patients who underwent Doppler ultrasound preoperative screening for abdominal aortic surgery between January 2000 and January 2003 were analyzed by the Vascular Surgery Unit of the Santa Casa of São Paulo (Faculty of Medical Sciences). RESULTS: Sixty-seven (71%) patients were male. Of the 94 patients, 42 (44.6%) had aortoiliac occlusive disease and 52 (53.4%) had abdominal aortic aneurysm. The data analysis showed a prevalence of carotid stenosis above 70% in 8.33% of patients with abdominal aortic aneurysms and 13.51% in patients with aortoiliac occlusive disease, a difference without statistical significance (P = 0.5). The previous history of cerebral ischemic symptoms (stroke and transitory ischemic attack) was predictive of the presence of a 70-99% carotid stenosis. Other risk factors for atherosclerosis, such as being male, having diabetes, hypertension and smoking history, were not predictive of the presence of a carotid stenosis above 70%. CONCLUSION: The frequency of carotid stenosis above 70% in patients undergoing abdominal aortic surgery is 9.57% and the presence of transitory ischemic attack or stroke in medical history was predictive of stenosis above 70% in this group of patients.

Keywords

Carotid stenosis, aortic surgery, atherosclerosis, abdominal aortic aneurysms, atherosclerotic aortoiliac occlusive disease

Referências

Cahan MA, Killewich LA, Kolodner L. The prevalence of carotid artery stenosis in patients undergoing aortic reconstruction. Am J Surg. 1999;178(3):194-6.

Kallikazaros IE, Tsioufis CP, Stefanadis CI, Pitsavos CE, Toutouzas PK. Closed relation between carotid and ascending aortic atherosclerosis in cardiac patients. Circulation. 2000;102:III263-8.

Axelrod DA, Diwan A, Stanley JC. Cost of routine screening for carotid and lower extremity occlusive disease in patients with abdominal aortic aneurysms. J Vasc Surg. 2002;35(4):754-8.

Bower TC, Merrell SW, Cherry KJ Jr. Advanced carotid disease in patients requiring aortic reconstruction. Am J Surg. 1993;166(2):146-51.

Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325(7):445-53.

Eastcott HH, Pickering GW, Rob CG. Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia. Lancet. 1954;267(6846):994-6.

Autret A, Pourcelot L, Saudeau D, Marchal C, Bertrand P, de Boisvilliers S. Stroke risk in patients with carotid stenosis. Lancet. 1987;1(8538):888-90.

Marek J, Mills JL, Harvich J, Cui H, Fujitani RM. Utility of routine carotid duplex screening in patients who have claudication. J Vasc Surg. 1996;24(4):572-7.

Cheng SW, Wu LL, Lau H, Ting AC, Wong J. Prevalence of significant carotid stenosis in Chinese patients with peripheral and coronary artery disease. Aust N Z J Surg. 1999;69(1):44-7.

Deville C, Kerdi S, Madonna F, de la Renaudiere DF, Labrousse L. Infrarenal abdominal aortic aneurysm repair: detection and treatment of associated carotid and coronary lesions. Ann Vasc Surg.. 1997;11(5):467-72.

Kang SS, Littooy FN, Gupta SR. Higher prevalence of abdominal aortic aneurysms in patients with carotid stenosis but without diabetes. Surgery. 1999;126(4):687-91.

Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273(18):1421-8.

Bechtel JF, Bartels C, Hopstein S, Horsch S. Carotid endarterectomy prior to major abdominal aortic surgery. J Cardiovasc Surg. 2000;41(2):269-73.

Cheung RT, Eliasziw M, Meldrum HE, Fox AJ, Barnett HJ. Risk, types, and severity of intracranial hemorrhage in patients with symptomatic carotid artery stenosis. Stroke. 2003;34(8):1847-51.

Macchi C, Lova RM, Miniati B. Is the percentage of stenosis of the internal carotid artery a reliable measure of the risk of ischemic stroke?: A morphometric study by duplex ultrasound of aortic arch branches in 500 normal adults. J Cardiovasc Surg. 2002;43(1):71-6.

Fukuda I, Gomi S, Watanabe K, Seita J. Carotid and aortic screening for coronary artery bypass grafting. Ann Thorac Surg. 2000;70(6):2034-9.

Kuukasjarvi P, Kaira P, Riekkinen H, Salenius JP. Carotid stenosis and abdominal aortic aneurysm at the follow-up examination in patients treated for acute extremity ischaemia. J Cardiovasc Surg (Torino). 2000;41(2):275-9.

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