Aneurisma ilíaco associado a fístula arteriovenosa

Abstract

Rupture of aortoiliac aneurysms into the iliac vein or vena cava is an uncommon complication. Many signs and symptoms develop as a result of venous hypertension, which makes preoperative diagnosis difficult, such as leg edema, dyspnea, hematuria, signs of renal or cardiac insufficiency. Abdominal bruit, associated with pulsatile mass and abdominal pain, is the key for clinical diagnosis. Preoperative recognition of arteriovenous fistula is important for surgical planning. We report a case of right internal and common iliac artery aneurysm associated with fistula into the common iliac vein. Initial symptoms were right leg edema and dyspnea, which induced to the incorrect diagnosis of deep vein thrombosis.Keywords: Iliac aneurysm, arteriovenous fistula, ruptured aneurysm. RESUMOA ruptura dos aneurismas aorto-ilíacos para a veia ilíaca ou veia cava é uma complicação pouco comum. A hipertensão venosa leva a vários sinais e sintomas, o que dificulta o diagnóstico pré-operatório, tais como edema do membro inferior, dispnéia, hematúria, sinais de insuficiência renal ou cardíaca. Sopro abdominal é a chave do diagnóstico clínico, associado à massa pulsátil e dor abdominal. O reconhecimento da fístula arteriovenosa no pré-operatório é importante para o planejamento cirúrgico. Relatamos um caso de aneurisma da artéria ilíaca comum e interna direita associado a fístula para veia ilíaca comum, cursando, inicialmente, com edema do membro inferior direito e dispnéia, o que levou ao diagnóstico incorreto de trombose venosa profunda. Palavras-chave:Aneurisma ilíaco, fístula arteriovenosa, aneurisma roto.

Tratamento endovascular de fístula aortocaval pós-traumática tardia: relato de caso

“…Other typical signs of ACF are abdominal pain, pulsatile abdominal mass, abdominal bruit and acute dyspnea. 3,6 Signs of peripheral venous congestion, such as lower limb edema, deep vein thrombosis and pelvic venous hypertension with anuria, hematuria, edema or scrotal hematoma, have also been described 2,[4][5][6]8 . In large ACFs, clinical signs of pulmonary edema, central venous congestion, hepatomegaly and ascites may also be detected, in addition to echocardiographic findings of high-output CHF 3,4 .…”

“…In stable patients, Doppler ultrasound of the abdominal aorta may confirm the diagnosis. For surgical planning, the imaging study of choice is CT angiography of the abdominal, iliac and femoral arteries 1,3,8,15 . Some CT signs that suggest the presence of ACF are loss of fat tissue between the IVC and aorta, IVC early contrast enhancement (in the arterial phase) 8,15 (Figure 3) and the visualization of a fistula (Figures 1 and 2).…”

“…For surgical planning, the imaging study of choice is CT angiography of the abdominal, iliac and femoral arteries 1,3,8,15 . Some CT signs that suggest the presence of ACF are loss of fat tissue between the IVC and aorta, IVC early contrast enhancement (in the arterial phase) 8,15 (Figure 3) and the visualization of a fistula (Figures 1 and 2). Other signs are IVC dilatation, retrograde opacification of the renal veins during the arterial phase, poor renal enhancement, increase of kidney size and retroperitoneal and pelvic venous congestion 15 .…”

“…Studies in the literature confirm that, after vascular repair of the lesions, the clinical condition of patients with arteriovenous fistulas improves significantly, and their recovery is usually satisfactory2,8 .…”

“…The remaining 10% to 20% are sequelae of trauma. Secondary ACF and syphilitic and mycotic aneurysms have also been described, 7 as well as aneurysms associated with rare entities, such as Ehler Danlos and Marfan syndromes and Takayasu artheritis 3,5,6,8 .…”