Correção cirúrgica de pseudoaneurismas e fístula arteriovenosa complexa entre vasos poplíteos

Abstract

Resumo A fístula arteriovenosa (FAV) é uma comunicação anormal e permanente entre uma artéria e uma veia devido a traumas penetrantes e lesões iatrogênicas. O trauma penetrante na parede arterial pode levar à formação de pseudoaneurismas (PSA) e, se houver lesão venosa concomitante, à formação de uma FAV. Os autores apresentam o caso de um paciente portador de FAV complexa de vasos poplíteos associada a pseudoaneurisma de artéria poplítea, sugeridos a partir de exames clínicos e exames de imagem, e tratados por cirurgia convencional devido à indisponibilidade de um stent graft com diâmetro apropriado, além de a cirurgia endovascular não estar disponível no serviço em que o paciente foi operado.

Correção cirúrgica de fístula carotídeo-jugular traumática

“…3,4 However, venous grafts may undergo late dilation, especially in younger patients, as in the case presented here, demanding careful follow-up. 2,3 The great saphenous vein can be used, with low rates of thrombosis and infection, but this requires an additional incision in the lower limb, with consequent increase in the duration of surgery. 2,8 Considering the benefits of an autologous graft, and since the external jugular vein was already dilated, with thickening of the wall (because of pressurization by the AVF), the surgical team decided to use it, avoiding the need for additional incisions and reducing the duration of the operation.…”

“…However, the conventional technique was chosen instead of an endovascular approach because of the risks of late complications and the lack of studies investigating its long-term efficacy, since the patient was very young. 2 Furthermore, endovascular repair would also have needed long-term postoperative antiplatelet treatment to avoid thromboembolic complications and occlusion of the stent and also follow-up with regular imaging exams, which would have made adhesion to treatment less likely, especially since the patient was in a situation of socioeconomic vulnerability. 4,19…”

“…Some arterial injuries are complicated by the development of arteriovenous fistulas (AVFs), which occur as abnormal communications between arteries and veins caused by iatrogenic or traumatic injuries. 1,2 A penetrating trauma can lead to formation of pseudoaneurysms (PSA) and, if there are also venous injuries, to formation of an AVF. 2,3 If left untreated, depending on their site and size, these vascular injuries can cause complications such as congestive heart failure, cerebral ischemia, thromboembolism, or bleeding.…”

“…1,2 A penetrating trauma can lead to formation of pseudoaneurysms (PSA) and, if there are also venous injuries, to formation of an AVF. 2,3 If left untreated, depending on their site and size, these vascular injuries can cause complications such as congestive heart failure, cerebral ischemia, thromboembolism, or bleeding. 3,4 The first observations of AVFs were made by Hunter in 1757 and published in 1764.…”