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
PDF
SciELO
Downloads: 0
Views: 1016

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

References

Dillavou ED, Muluk SC, Rhee RY. Does hostile neck anatomy preclude successful endovascular aortic aneurysm repair?. J Vasc Surg. 2003;38:657-63.

Mendonça CT, Moreira RCR, Timi JRR. Comparação entre os tratamentos aberto e endovascular dos aneurismas da aorta abdominal em pacientes de alto risco cirúrgico. J Vasc Bras. 2005;4:232-42.

Lin PH, Madsen K, Bush RL, Lumsden AB. Iliorenal artery bypass grafting to facilitate endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2003;38:183-5.

Kotsis T, Scharrer-Pamler R, Kapfer X. Treatment of thoracoabdominal aortic aneurysms with a combined endovascular and surgical approach. Int Angiol. 2003;22:125-33.

Flye MW, Choi ET, Sanchez LA. Retrograde visceral vessel revascularization followed by endovascular aneurysm exclusion as an alternative to open surgical repair of thoracoabdominal aortic aneurysm. J Vasc Surg. 2004;39:454-8.

Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5:491-9.

Chuter TA, Parodi JC, Lawrence-Brown M. Management of abdominal aortic aneurysm: a decade of progress. J Endovasc Ther. 2004;11(^s2):II82-95.

Veith FJ, Baum RA, Ohki T. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg. 2002;35:1029-35.

Linsen MA, Vos AW, Diks J, Rauwerda JA, Wisselink W. Fenestrated and branched endografts: assessment of proximal aortic neck fixation. J Endovasc Ther. 2005;12:647-53.

Greenberg RK, Haulon S, O'Neill S, Lyden S, Ouriel K. Primary endovascular repair of juxtarenal aneurysms with fenestrated endovascular grafting. Eur J Vasc Endovasc Surg. 2004;27:484-91.

Greenberg RK, Haulon S, Lyden SP. Endovascular management of juxtarenal aneurysms with fenestrated endovascular grafting. J Vasc Surg. 2004;39:279-87.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddfdbbf0e8825a62b4ce1d9 jvb Articles
Links & Downloads
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections