Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492012000300013
Jornal Vascular Brasileiro
Case Report

Dissecção espontânea da aorta abdominal infrarrenal

Spontaneous dissection of the infrarenal aorta

Otacílio de Camargo Junior; Antonio Cláudio Guedes Chrispim; Claudio Roberto Cabrini Simões; Márcia Fayad Marcondes; Guilherme Camargo Gonçalves de Abreu; Guilherme Vieira Meirelles; Kelly Cristina de Moraes; Marcio Villar de Freitas; Marivan Pedra Araújo; Gustavo Braga Murta

Downloads: 0
Views: 135

Resumo

A rotura da camada íntima que marca o início da dissecção aórtica se origina na maioria dos casos na aorta torácica, sendo rara a dissecção espontânea da aorta abdominal infra-renal. As três principais causas são: iatrogênica, traumática ou espontânea. A dor abdominal e a isquemia de membros são os sintomas mais comuns e um número significativo de pacientes e´ assintomatico. O diagnóstico tem sido feito através de métodos de imagem como ultrassonografia, tomografia computadorizada, ressonância nuclear magnética e angiografia aliados ao alto índice de suspeição. Relatamos os casos de duas pacientes que apresentaram dissecção de aorta abdominal infrarrenal com quadro de dor abdominal súbita, sem sinais de irritação peritoneal com pulsos presentes e simétricos ao exame físico que deram entrada no pronto socorro do Hospital e Maternidade Celso Pierro da PUC Campinas e que foram tratadas pela equipe de Cirurgia Vascular. As duas pacientes no momento do exame apresentavam-se hipertensas e ao ultrassom apresentavam alteração da conformidade da aorta abdominal que foram tratada s cirurgicamente. Uma paciente foi tratada cirurgicamente submetida a endarterectomia da placa dissecada da aorta abdominal infrarrenal de 2,2 cm de diâmetro e 2,0 cm de extensão. A outra paciente foi submetida a revascularização da aorta abdominal bi-iliaca com prótese de Dacron 16 × 8 mm por apresentar disseccao da aorta abdominal distal. As duas pacientes apresentaram boa evolução pos-operatoria tendo alta hospitalar em bom estado geral.

Palavras-chave

dissecção, aorta abdominal, atherosclerosis

Abstract

The rupture of the intimal layer marks the beginning of the aortic dissection, which usually happens in the thoracic aorta. The spontaneous dissection of the infrarenal aorta is rare. The main causes are: iatrogenic, traumatic and spontaneous. Abdominal pain and limb ischemia are the commonest symptoms, and some patients are asymptomatics. The diagnosis is made by ultrasound, computed tomography, nuclear magnetic resonance and angiography, with a high suspicious index. We describe two cases of spontaneous rupture of the infrarenal aorta that were treated surgically. We report two cases of patients who were admitted to the emergency room of Celso Pierro Hospital with infrarenal abdominal aortic dissection and were treated by the vascular surgery group. They have presented sudden abdominal pain, no signs of peritoneal irritation and pulses were presents and simmetrics in physical examination The two patients during the examination were hypertensive and the ultrasound showed abnormal compliance of the abdominal aorta who were treated surgically. One patient was treated surgically with dissected plaque endarterectomy of infrarenal abdominal aorta of 2.2 cm in diameter and 2.0 cm in length. The other patient underwent revascularization of the abdominal aorta with bi-iliac Dacron graft 16 × 8 mm due to distal abdominal aortic dissection. Both patients had good postoperative evolution and they were discharged in good general condition.

Keywords

dissection, aorta, abdominal, atherosclerosis

References

Anacleto A, Anacleto JC. Dissecção aórtica. Doenças vasculares periféricas. 2002:1173-214.

Barros Junior N, Amorim JE, Perez MCJ, Miranda Junior F. Spontaneous infrarenal abdominal aortic dissection: case report and literature review. J Vasc Bras. 2004;3(4):379-82.

Mózes G, Gloviczki P, Park WM, Schultz HL, Andrews JC. Spontaneous dissection of infrarenal abdominal aorta. Semin Vasc Surg. 2002;15(2):128-36.

Porcellini M, Mainenti P, Bracale U. Endograft repair of spontaneous infrarenal abdominal aortic dissection. J Vasc Surg. 2005;41(1).

Borioni R, Garofalo M, De Paulis R, Nardi P, Scaffa R, Chiarello L. Abdominal Aortic dissections: anatomic and clinical features and therapeutic options. Tex Heart Inst J. 2005;32(1):70-3.

Farber A, Wagner WH, Cossman DV. Isolated dissection of abdominal aorta: clinical presentation and therapeutic options. J Vasc Surg. 2002;36(2):205-10.

Trimarchi S, Tsai T, Eagle KA. Acute abdominal aortic dissection: insight from the International Registry of Acute Aortic Dissection (IRAD). J Vasc Surg. 2007;46(5):913-9.

Mantelas M, Antonitsis P, Kaitzis D, Hatzibaloglou A, Moros I. Spontaneous isolated dissection of the abdominal aorta: single-center experience. Interact Cardiovasc Thorac Surg. 2009;8(4):398‑401.

Farber A, Lauterbach SR, Wagner WH. Spontaneous infrarenal abdominal aortic dissection presenting as claudication: case report and review of the literature. Ann Vasc Surg. 2004;18(1):4-10.

Green GR, Kron IL. Aortic dissection. Cardiac surgery in the adult. 2003:1095-122.

Kibria SM, Leveson SH, Homer-Vanniasinkam S. Spontaneous dissection of abdominal aorta. J R Coll Surg Edinb. 2000;45(6):408-10.

Berthet JP, Marty-Ané CH, Veerapen R, Picard E, Mary H, Alric P. Dissection of abdominal aorta in blunt trauma: endovascular or conventional surgical management?. J Vasc Surg. 2003;38(5):997‑1003.

Giudice R, Frezzoti A, Scoccianti M. Intravascular ultrasound-guided stenting for chronic abdominal aortic dissection. J Endovasc Ther. 2002;9(6):926-31.

5ddd30240e8825fb6e1da3e9 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections