Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492007000200015
Jornal Vascular Brasileiro
Case Report

Aneurisma de aorta abdominal justa-renal: correção endovascular combinada com derivação ilíaco-renal direita para criar colo proximal adequado

Juxtarenal abdominal aortic aneurysm: combined endovascular and open repair with right iliorenal bypass to create adequate proximal neck

Matheus Bredarioli; Marcelo Bellini Dalio; Cleber Aparecido Pita Bezerra; Carlos Eli Piccinato; Jesualdo Cherri

http://dx.doi.org/10.1590/S1677-54492007000200015 J Vasc Bras, vol.6, n2, p.182-185, 2007
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Resumo

Homem de 78 anos de idade, portador de múltiplas morbidades clínicas deu entrada na emergência com um aneurisma de aorta abdominal justa-renal em condições hemodinâmicas estáveis. A tomografia computadorizada caracterizou aneurisma de 6 cm de diâmetro, e a distância do colo proximal do aneurisma era de 5 mm em relação à artéria renal direita e 28 mm à esquerda. Em virtude das condições clínicas do paciente, optou-se pelo reparo endovascular, mas previamente fez-se uma derivação ilíaco-renal direita com enxerto de politetrafluoretileno, via retroperitoneal para se criar um colo proximal adequado. Após quatro dias, o aneurisma de aorta abdominal foi corrigido colocando-se uma endoprótese Excluder® sem intercorrências. O seguimento pós-operatório evidenciou boa perfusão do rim esquerdo e ausência de migração ou endoleak da endoprótese. Este caso ilustra a combinação de técnicas para tornar possível o reparo de aneurisma de aorta abdominal justa-renal em pacientes de alto risco cirúrgico e anatomia desfavorável.

Palavras-chave

Aneurisma da aorta abdominal, cirurgia, prótese vascular, endovascular, artéria renal

Abstract

A 78-year-old man with a juxtarenal abdominal aortic aneurysm and several comorbid conditions was admitted at the emergency room in hemodynamically stable conditions. Computed tomography revealed an aneurysm measuring 6 cm in diameter beginning 28 mm below the left renal artery and 5 mm below the right renal artery. Because of the patient's clinical status, a bypass from the right iliac artery to the right renal artery was performed through a retroperitoneal approach using a polytetrafluoroethylene vascular graft. Four days later, an endovascular aneurysm repair was successfully performed using an Excluder® stent-graft. Postoperative follow-up showed good left renal perfusion and no migration or endoleak. This case illustrates the effectiveness of combining open and endovascular techniques to repair juxtarenal abdominal aortic aneurysm in high-risk patients with unfavorable anatomy.

Keywords

Abdominal aortic aneurysm, surgery, vascular graft, endovascular, renal artery

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