Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492006000100007
Jornal Vascular Brasileiro
Original Article

Aneurismas toracoabdominais rotos

Ruptured thoracoabdominal aneurysms

Eduardo Faccini Rocha; Aline Meira Martins; Lucas Marcelo Dias Freire; Daniel Razi Gusmão; Ana Terezinha Guillaumon

http://dx.doi.org/10.1590/S1677-54492006000100007 J Vasc Bras, vol.5, n1, p.37-41, 2006
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Resumo

OBJETIVO: Avaliar os dados pré, intra e pós-operatórios dos aneurismas toracoabdominais rotos operados no Hospital de Clínicas da Universidade Estadual de Campinas. MÉTODOS: Estudo retrospectivo de cinco pacientes submetidos à correção de aneurisma toracoabdominal roto no Hospital de Clínicas da Universidade Estadual de Campinas, entre setembro de 2000 e abril de 2004. Todos os pacientes apresentavam aneurisma toracoabdominal tipo IV roto, sendo que quatro estavam estáveis hemodinamicamente. Três pacientes foram operados com o simples pinçamento da aorta supracelíaca e infusão de soro fisiológico a 4 ºC nas artérias renais; um paciente evoluiu para óbito no intra-operatório antes da abertura do aneurisma; e um paciente foi operado utilizando-se perfusão de sangue oxigenado nas artérias viscerais. RESULTADOS: Dos cinco pacientes operados, dois foram a óbito (40%). Um deles apresentava instabilidade hemodinâmica e faleceu no intra-operatório; o outro faleceu no 26º dia pós-operatório com insuficiência de múltiplos órgãos. Todos os três sobreviventes evoluíram bem, sem seqüelas. Entre os pacientes que chegaram ao centro cirúrgico estáveis hemodinamicamente, a mortalidade foi de 25%. CONCLUSÕES: Pacientes com aneurisma toracoabdominal tipo IV roto, com estabilidade hemodinâmica, alcançam resultados cirúrgicos satisfatórios, semelhantes aos aneurismas rotos infra-renais.

Palavras-chave

Aneurisma toracoabdominal, aneurisma roto

Abstract

OBJECTIVE: To evaluate the pre-, intra- and postoperative data of ruptured thoracoabdominal aneurysms operated at Hospital de Clínicas da Universidade Estadual de Campinas. METHODS: A retrospective study of five patients submitted to repair of ruptured thoracoabdominal aneurysm at Hospital de Clínicas da Universidade Estadual de Campinas from September 2000 to April 2004. All patients presented a ruptured type IV thoracoabdominal aneurysm, and four of them were hemodynamically stable. Three patients were operated by the simple supraceliac aortic clamping and saline solution infusion at 4 ºC in the renal arteries; one patient died during the surgery before the aneurysm was opened; and one patient was operated by perfusion of oxygenated blood in the visceral arteries. RESULTS: Of the five patients operated, two died (40%). One of them presented hemodynamic instability and died during the surgery; the other patient died on the 26th postoperative day due to multiple organ failure. All three surviving patients progressed well, with no sequelae. Among patients who were taken to the operating room hemodynamically stable, the mortality rate was 25%. CONCLUSIONS: Patients with ruptured type IV thoracoabdominal aneurysm, hemodynamically stable, achieved satisfactory surgical results, similar to infrarenal ruptured aneurysms.

Keywords

Thoracoabdominal aneurysm, ruptured aneurysm

References

Bradbury AW, Bulstrode NW, Gilling-Smith G, Stansby G, Mansfield AO, Wolfe JH. Repair of ruptured thoracoabdominal aortic aneurysm is worthwhile in selected cases. Eur J Vasc Endovasc Surg. 1999;17:160-5.

Lewis ME, Ranasinghe AM, Revell MP, Bonser RS. Surgical repair of ruptured thoracic and thoracoabdominal aortic aneurysms. Br J Surg. 2002;89:442-5.

Cowan JA Jr, Dimick JB, Wainess RM, Henke PK, Stanley JC, Upchurch GR Jr. Ruptured thoracoabdominal aortic aneurysm treatment in the United States: 1988 to 1998. J Vasc Surg. 2003;38:319-22.

LeMaire SA, Rice DC, Schmittling ZC, Coselli JS. Emergency surgery for thoracoabdominal aortic aneurysms with acute presentation. J Vasc Surg. 2002;35:1171-8.

Rocha EF, Luccas GC, Baldini Neto L. Aneurisma tóraco-abdominal inflamatório. J Vasc Br. 2005;4:301-6.

Rocha EF, Guillaumon AT, Antunes N, Vieira RW. Aneurisma toracoabdominal roto: modificação do circuito de perfusão visceral. Rev Bras Cir Cardiovasc. 2004;19:413-6.

Mastroroberto P, Chello M. Emergency thoracoabdominal aortic repair: clinical outcome. J Thorac Cardiovasc Surg. 1999;118:477-81.

Cota AM, Omer AA, Jaipersad AS, Wilson NV. Elective versus ruptured abdominal aortic aneurysm repair: a 1-year cost-effectiveness analysis. Ann Vasc Surg. 2005;19:858-61.

Girardi LN, Krieger KH, Altorki NK, Mack CA, Lee LY, Isom OW. Ruptured descending and thoracoabdominal aortic aneurysms. Ann Thorac Surg. 2002;74:1066-70.

Schepens MA, Defauw JJ, Hamerlijnck RP, De Geest R, Vermeulen FE. Surgical treatment of thoracoabdominal aortic aneurysms by simple crossclamping: Risk factors and late results. J Thorac Cardiovasc Surg. 1994;107:134-42.

Cambria RP, Davison JK, Zannetti S, L'Italien G, Atamian S. Thoracoabdominal aneurysm repair: perspectives over a decade with the clamp-and-sew technique. Ann Surg. 1997;226:294-303.

Anacleto A, Anacleto JC. Aneurismas da aorta torácica e toracoabdominal. Cirurgia vascular: cirurgia endovascular, angiologia. 2002:439-59.

Santos VP, Ignácio MR, da Silveira DR, Caffaro RA. Aneurisma toracoabdominal roto: relato de um caso com o uso de anel rígido sulcado de Delrin intraluminal na anastomose proximal. J Vasc Br. 2004;3:383-6.

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