Resumo
A aterotrombose é uma doença multissistêmica associada a elevada morbidade e mortalidade. A manipulação das artérias com fios-guia ou cateteres pode gerar trauma mecânico, com conseqüente deslocamento de material ateromatoso da parede vascular. Um paciente de 82 anos, no qual uma ponte fêmoro-poplítea distal com veia safena in situ havia sido realizada por nós há 10 anos, apresentou dor, palidez, hipotermia, diminuição da sensibilidade e força do pé direito 6 horas após coronariografia com acesso pela artéria femoral direita (classe 2b de Rutherford). Arteriografia diagnóstica evidenciou perviedade do enxerto, com múltiplas irregularidades em seu terço distal, compatíveis com material ateroembólico, além de pobreza extrema de circulação distal. Optamos pela revascularização do membro inferior direito em caráter de urgência, associando técnicas convencionais a métodos endovasculares. Empregando a técnica de push and park, cruzamos a lesão ateroembólica com fio-guia e tratamos todo o eixo arterial acometido com manobras de angioplastia. O paciente apresentou boa evolução, boa perfusão distal, adequado enchimento capilar, eliminação da dor e melhora acentuada imediata do déficit motor e sensitivo.
Palavras-chave
Angioplastia com balão, embolia de colesterol, membro inferior
Abstract
Atherothrombosis is a multisystemic disease associated with high morbidity and mortality rates. Management of arteries with guide-wires or catheters may cause mechanical trauma, with consequent detachment of atheromatous material from the vascular wall. An 82-year-old patient, in whom a distal femoropopliteal in situ saphenous vein graft bypass had been performed 10 years before, presented with pain, pallor, hypothermia, loss of sensibility and motor activity on the right lower limb 6 hours after coronary angiography from the femoral artery (Rutherford class 2b). Arteriography demonstrated bypass patency, with multiple irregularities in its distal third, compatible with atheroembolic material, and very poor distal circulation. We indicated lower limb revascularization on an emergency basis, by both conventional and endovascular techniques. Using the "push and park" technique, the atheroembolic obstruction was crossed by guide-wire and the whole affected arterial axis was treated by angioplasty. The patient progressed well, with good distal perfusion, adequate capillary refill, relief of pain and immediate recovery of sensory and motor function.
Keywords
Balloon angioplasty, cholesterol embolism, lower limb
References
von Ristow A. Oclusão arterial aguda. Ars Curandi.. 1984;17:96-112.
Rousseau H, Perreault P, Otal P. Thrombus aspiration devices. Radiology of peripheral vascular diseases. 1999:435-9.
Higginson A, Alaeddin F, Fishwick G, Bolia A. Push and park: an alternative strategy for management of embolic complication during balloon angioplasty. Eur J Vasc Endovasc Surg.. 2001;21:279-82.
Parodi JC. Treatment of blue toe syndrome with intra-arterial injections of prostaglandin E1. The ischemic extremity. 1995:325-31.
Keeley EC, Grines CL. Scraping of aortic debris by coronary guiding catheters: a prospective evaluation of 1000 cases. J Am Coll Cardiol.. 1998;32:1861-5.
Drost H, Buis B, Haan D, Hillers JA. Cholesterol embolism as a complication of left heart catheterisation: Report of seven cases. Br Heart J.. 1984;52:339-42.
Colt HG, Begg RJ, Saporito JJ, Cooper WM, Shapiro AP. Cholesterol emboli after cardiac catheterization: eight cases and a review of the literature. Medicine (Baltimore). 1988;67:389-400.
Fukumoto Y, Tsutsui H, Tsuchihashi M, Masumoto A, Takeshita A. The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study. J Am Coll Cardiol.. 2003;42:211-6.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email