Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492012000400007
Jornal Vascular Brasileiro
Artigo Original

Aneurisma da aorta abdominal infrarrenal: importância do rastreamento em hospitais do Sistema Único de Saúde na região metropolitana de Salvador - Bahia

Infrarenal abdominal aortic aneurysm: significance of screening in patients of public hospitals in the metropolitan region of Salvador - Bahia, Brazil

Aquiles Tadashi Ywata de Carvalho; Aleksandro de Jesus Santos; Carlos Alberto Pereira Gomes; Marcos Luis Martins; Vanessa Prado dos Santos; Roberto Pastor Rubeiz; Marcio Oliveira Queiroz; Roberto Augusto Caffaro

http://dx.doi.org/10.1590/S1677-54492012000400007 J Vasc Bras, vol.11, n4, p.289-300, 2012
PDF Português
PDF English
SciELO
Downloads: 21
Views: 4283

Resumo

INTRODUÇÃO: O aneurisma da aorta abdominal infrarrenal (AAA) representa doença vascular que merece constante atenção, tanto para os estudos de rastreamento como de aperfeiçoamento terapêutico. Sua importância clínica se baseia na alta taxa de mortalidade que ocorre com a sua ruptura, em contraste com a baixa taxa de mortalidade descrita com a correção cirúrgica eletiva em serviços especializados. Na região metropolitana de Salvador, não se encontram dados relativos à identificação desses indivíduos. Esse fato encorajou nosso estudo. OBJETIVOS: (1) determinar a prevalência do AAA infrarrenal nos pacientes com fatores de risco; (2) identificar esses fatores de risco; e (3) a população que deve ser rotineiramente rastreada. MÉTODOS: Em estudo de rastreamento do AAA realizado pelos Serviços de Cirurgia Vascular do Hospital Geral Roberto Santos (HGRS) e do Hospital Geral de Camaçari (HGC) de setembro de 2008 a outubro de 2009, foram selecionados 1350 indivíduos com 50 anos ou mais que apresentavam fatores de risco para o aneurisma da aorta. A triagem incluiu o preenchimento de protocolo e a realização de ultrassom doppler colorido. RESULTADOS: A prevalência do AAA infrarrenal nesta amostra foi 3,9%. Os fatores de risco mais frequentemente associados foram: média de idade de 72 anos, gênero masculino, tabagismo, antecedente de AAA e portadores de doença arterial oclusiva periférica, insuficiência coronariana e doença pulmonar obstrutiva crônica. O rastreamento do AAA deve ser considerado em homens com idade superior a 65 anos, principalmente quando presente um desses fatores de risco.

Palavras-chave

aneurisma da aorta abdominal, aneurisma aórtico, programas de rastreamento

Abstract

BACKGROUND: Infrarenal abdominal aortic aneurysm (AAA) is a vascular disease requiring continuous attention both in terms of screening and therapeutic improvement. Infrarenal AAA is a major condition because of its high mortality rate due to AAA rupture, as opposite to the low mortality rate related to elective surgical repair conducted in specialized facilities. In the metropolitan area of Salvador there are no data concerning the identification of patients with infrarenal AAA. Such lack of information prompted this study. OBJECTIVE: (1) to determine the prevalence of infrarenal AAA in patients with risk factors; (2) to identify risk factors; and (3) to determine whether the population at risk should be routinely screened. METHODS: In a study for AAA screening conducted by the Department of Vascular Surgery of Hospital Geral Roberto Santos and Hospital Geral de Camaçari from September 2008 to October 2009, 1,350 individuals aged 50 years or older with risk factors for aortic aneurysm were selected. Screening included completion of protocol and performance of color Doppler ultrasound. RESULTS: AAA prevalence in this sample was 3.9%. The most frequent risk factors associated with aneurysm were mean age of 72 years, male gender, smoking, and patients with peripheral obstructive arterial disease, coronary failure, and chronic obstructive lung disease. AAA screening should be considered in men aged over 65 years, mainly when one of these risk factors are present.

Keywords

abdominal aortic aneurysm, aortic aneurysm, screening programs

Referências

Vincent WV. Combining Abdominal Aortic Aneurysmectomy with Gastrointestinal or Biliary Surgery. Am Surg.. 1988;54(5):290-6.

Burihan E, Baptista-Silva JCC. Aneurisma da aorta abdominal - como prevenir o evento fatal. Rev Soc Cardiol Est São Paulo.. 1999;6:833-9.

Puech-Leão P, Molnar LJ, Oliveira IR, Cerri GG. Prevalência de aneurismas da aorta abdominal - um programa de detecção em São Paulo. São Paulo Med J.. 2004;122(4):158-160.

Barros FS, Pontes SM, Taylos MASA. Rastreamento do aneurisma da aorta abdominal na população da cidade de Vitória (ES). J Vasc Bras.. 2005;4(1):59-65.

Carvalho FC, Brito VP, Tribulatto EC, Van Bellen B. Estudo prospectivo da morbi-mortalidade precoce e tardia da cirurgia do aneurisma da aorta abdominal. Arq Bras Cardiol.. 2005;84:292-6.

Breckwoldt WL, Mackey WC, O'Donnell TF. The economic implications of high risk abdominal aortic aneurysms. J Vasc Surg.. 1991;13:798-804.

Bengtsson H, Bergqvist D, Sternby NH. Increasing prevalence of abdominal aortic aneu rysms: a necropsy study. Eur J Surg.. 1992;158:19-23.

Law M. Screening for abdominal aortic aneurysms. Br Med Bull.. 1998;54(4):903-13.

Meirelles GV, Mantovani M, Braile DM, Araújo Filho JD, Araújo JD. Prevalência de dilatação da aorta abdominal em coronariopatas idosos. J Vasc Bras.. 2007;6(2):114-123.

Bickerstaff LK, Hollier LH, Van Peenem HJ. Abdominal aortic aneurysms: The changing natural history. J Vasc Surg.. 1984;1:6-12.

Yano OJ, Marin M, Hollier L. Patient selection for endovascular repair of aortoiliac aneurysms. Cardiovasc Surg.. 2000;8(5):340-9.

Thompson NM, Bell PR. Arterial aneurysms. Br Med J.. 2000;320:1193-6.

Basnyat PS, Biffin AH, Moseley LG, Hedges AR, Lewis MH. Mortality from ruptured abdominal aortic aneurysm in Wales. Br J Surg.. 1999;86(6):765-70.

Aun R, Saliture Neto FT, Lederman A, Waksman H. Tratamento endoluminal de aneurismas anastomóticos na aorta abdominal: relato de dois casos. J Vasc Bras.. 2006;5(1):371-81.

Simão ACP, Gonçalves ACA, Paulino MM, Oliveira RB, Polli CA, Fratezi AC. Estudo comparativo entre tratamento endovascular e cirurgia convencional na correção eletiva de aneurisma da aorta abdominal: revisão bibliográfica. J Vasc Bras. 2009;8(4):335-342.

Ashton HA, Buxton MJ, Day NE. The Multicentre aneurysm screening study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet.. 2002;360(9345):1531-9.

Morris GE, Hubbard CS, Quick CR. An abdominal aortic aneurysm screening programme for all males over the age of 50 years. Eur J Vasc Surg.. 1994;8:156-60.

Scott RA, Vardulaki KA, Walker NM, Day NE, Duffy SW, Asthon HA. The long-term benefits of a single scan for abdominal aortic aneurysm (AAA) at age 65. Eur J Vasc Endovasc Surg.. 2001;21:535‑40.

Bonamigo TP, Von Ristow A, Burihan E. História natural do aneurisma de aorta abdominal. Aneurismas. 1999:61-6.

Irvine CD, Shaw E, Poskitt KR, Whyman MR, Earnshaw JJ, Heather BP. A comparison of the mortality rate after elective repair of aortic aneurysms detected either by screening or incidentally. Eur J Vasc Endovasc Surg.. 2000;20:374-8.

Bonamigo TP, Siqueira I. Screening for abdominal aortic aneurysms. Rev Assoc Med Bras.. 2003;41:43-6.

Singh K, Bonaa KH, Solberg S, Jacobsen BK, Bjork L. Intra and interobserver variability in ultrasound measurements of abdominal aortic diameter. The tromso study. Eur J Vasc Endovasc Surg. 1998;15:497-504.

Beiguelman B. Curso prático de bioestatística. 1996.

Hosmer DW, Lemeshow S. Applied Logistic Regression. 2000.

Lindholt JS, Juul S, Fasting H, Henneberg EW. Hospital costs and benefits of screening for abdominal aortic aneurysms. Results from a randomized population screening trial. Eur J Vasc Surg.. 2002;23:55-60.

Lilienfeld DE, Gurdenson PD, Sprafka JM, Vargas C. Epidemiology of aortic aneurysms: mortality trends in the United Stated 1951‑1981. Atherosclerosis.. 1987;7:637-43.

Leopold GR, Goldberg LE, Berstein EF. Ultrasonic detection an evaluation of AAA. Surgery. 1971;72:939-45.

Bonamigo TP. Aneurisma da aorta abdominal: rastreamento, tratamento e seguimento (tese). 1996.

Molnar LJ, Langer B, Serro-Azul J, Wanjgarten M, Cerri GC, Lucarelli CL. Prevalência do aneurisma intra-abdominal em idosos. Rev Assoc Med Bras.. 1995;41:43-6.

Lucarotti ME, Shaw E, Heather BP. Distribution of aortic diameter in a screened male population. Br J Surg.. 1992;79:641-2.

Silva ES, Dói A, Hanaoka BY, Takeda FR, Ikeda MH. Prevalência de aneurisma e outras anormalidades do diâmetro da aorta infra-renal detectadas em necrópsia. J Vasc Bras.. 2002;1(2):89-96.

Vardulaki KA, Walker NM, Day NE, Duffy SW, Ashton HA, Scott RA. Quantifying the risks of hypertension, age, sex and smoking in patients with abdominal aortic aneurysm. Br J Surg.. 2000;87:195‑200.

Carvalho ATY, Santos VP, Razuk A. Fatores de Morbi-mortalidade na Cirurgia Eletiva do Aneurisma da Aorta Abdominal Infra-renal: Experiência de 134 Casos. J Vasc Bras.. 2008;7(3):214‑224.

Collin J, Araújo L, Walton J, Lindsell D. Oxford screening programme for abdominal aortic aneurysm in men aged 65 to 74 years. Lancet.. 1988;2(8611):613-5.

Marston WA, Alquist R, Johnson G, Meyer AA. Misdiagnosis of ruptured abdominal aortic aneurysms. J Vasc Surg.. 1992;16:17-22.

Becker M, Bonamigo TP, Faccini FP. Avaliação da mortalidade cirúrgica em aneurismas infra-renais da aorta abdominal. J Vasc Bras.. 2002;1(1):15-21.

Bengtsson H, Ekberg O, Aspelin P, Kallero S, Bergqvisk D. Ultrasound screening of the abdominal aorta in patients with intermittent claudication. Eur J Vasc Surg.. 1989;3:497-502.

Barba A, Estallo L, Rodríguez L, Gimena S, Monux G. Prevalence of infrarenal abdominal aortic aneurysms in patients suffering of chronic limb ischaemia. Gac Med Bilbao.. 2001;98:33-42.

Darling RC, Messina GR, Brewster DC, Ottinger LW. Autopsy study of unoperated aortic aneurysms. The case for early resection. Circulation.. 1977;56(3 Suppl):II161-4.

Mello FMC. Aneurisma da aorta abdominal: avaliação ultra-sonográfica em homens acima de 50 anos [dissertação]. 2003.

Cronenwett JL, Sargent SK, Wall MH. Variables that affect the expansion rate and outcome of small abdominal aortic aneurysms. J Vasc Surg.. 1990;11:260-9.

Singh K, Bonaa KH, Jacobsen BK, Bjork L, Solberg S. Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study. Am J Epidemiology.. 2001;154(3):236-244.

Powell J, Greenhalgh RM. Cellular, enzymatic and genetic factors in the pathogenesis of abdominal aortic aneurysms. J Vasc Surg.. 1989;9:297-304.

Porter JM, Taylor LM, Harris EJ. Nonatherosclerotic vascular disease. Vascular Surgery: 3rd ed. 1991:97-130.

Read RC, Cannon DJ. Are abdominal aneurysms atherosclerotic in origin. J Cardiovasc Surg.. 1984;22:489.

Ruby ST, Whittemore AD, Couch NP. Coronary artery disease in patients requiring abdominal aortic aneurysms repair. Ann Surg.. 1985;201:758-762.

Hollier LH, Taylor LM, Ochsner J. Recommended indications for operative treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery. J Vasc Surg.. 1992;15(6):1046-56.

Bengtsson H, Ekberg O, Aspelin P, Takolander R, Bergqvisk D. Abdominal aortic dilatation in patients operated on for carotid artery stenosis: Acta Chir Scand. 441-.

Anacleto G, Nobrega L, Goncalves A. Aneurisma de aorta abdominal: analise de 200 casos. Rev Angiol Cir Vasc.. 2001;10(2).

Pleumeekers HJ, Hoes AW, Van der Does E. Aneurysms of the abdominal aortic in the older adults: the Rotterdam study. Am J Epidemiol.. 1995;142:1291-9.

Simoni G, Gianotti A, Ardia A. Screening study of abdominal aortic aneurysm in a general population: lipid pa-rameters. Cardiovasc Surg.. 1996;4:445-8.

Naydeck BL, Sutton-Tyrell K, Schiller KD. Prevalence and risk factors for abdominal aortic aneurysm in older adults with and without isolated hypertension. Am J Cardiol.. 1999;83:759-64.

Collin J, Walton J. Is abdominal aortic aneurysm a familial disease?. Br Med J.. 1989;299:493.

Ouriel K, Green RM, Donayre C. An evaluation of new methods of expressing aortic aneurysm size: Relationship to rupture. J Vasc Surg.. 1992;15:12-20.

White JV, Haas K, Phillips S, Comerota AJ. Adventitial elastolysis is a primary event in aneurysm formation. J Vasc Surg.. 1993;17:371-81.

Brophy CM, Reilly JM, Smith GJW, Tilson MD. The role of inflamation in nonspecific ab dominal aortic aneurysm disease. Ann Vasc Surg.. 1991;5:299.

Johnston KW. Multicenter prospective study of nonruptured abdominal aortic aneurysm. Part II. Variables predicting morbidity and mortality. J Vasc Surg.. 1989;9(3):437-47.

MacSweeney ST, O'Meara MO, Alexander C, Powell JT, Greenhalgh RM. High prevalence of unsuspected abdominal aortic aneuriysm in patients with confirmed symptomatic peripheral or cerebral arterial disease. Br J Surg.. 1993;80:582-4.

Hirose H, Ozsvath KJ, Xia S, Tilson MD. Molecular cloning of complementary DNA for additional member of the family of aortic aneurysm antigenic proteins. J Vasc Surg.. 1997;26:313-8.

Boll AP, Verbeek AL, Van de Lisdonk EH, Van der Vliet JA. High prevalence of abdominal aortic aneurysm in a primary care screening program. BR J Surg.. 1998;85:1090-4.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddd25650e88253f3e1da3eb jvb Articles
1677-7301 (Eletrônico)
J Vasc Bras ©2024 Todos os direitos reservados.

J Vasc Bras

Share this page
Page Sections