Tratamento endovascular de aneurismas da aorta em pacientes com doença de Behçet: relato de dois casos

Abstract

A doença de Behçet, uma vasculite sistêmica de causa desconhecida, pode ser causa de doença aneurismática da aorta em alguns portadores dessa patologia. Nós apresentamos nossa experiência com dois casos de aneurismas aórticos em pacientes com doença de Behçet submetidos à terapêutica endovascular, descrevendo seus respectivos seguimentos. A terapêutica atual, a patofisiologia e os critérios diagnósticos vigentes foram revisados. Concluímos que a técnica endovascular é uma excelente opção terapêutica para certos pacientes com doença de Behçet e que esta deve ser acompanhada de tratamento imunossupressivo adequado.

Tratamento endovascular da doença de Behçet: relato de caso

“…For these reasons it should be the option of choice in the majority of cases, particularly when surgical risk is high. 5,7,8,10,15 In a study of 912 patients with BD, 20 aneurysms in 16 patients were treated with endovascular techniques. In counterpoint, eight aneurysms in seven patients were treated with repair by conventional surgery.…”

“…Three or more points are needed to define a patient as a case of BD. 5 Studies are still being conducted in attempts to uncover the pathogenesis of this disease, which remains obscure and the subject of speculation. 1,6 Notwithstanding, a relationship with the HLA-B5 gene has been demonstrated in many patients.…”

Correção endovascular de pseudoaneurisma toracoabdominal em paciente com Doença de Behçet

“…21 Immunohistochemical studies confirm the presence of complement and immunoglobulins in the tunica media and tunica intima of arteries. 10 Occlusion of the vasa vasorum and/or intramural hematoma are considered the most important factors in this type of aortic condition. 22 The pseudoaneurysm in the case described here was possibly formed by the rupture of a small, localized, saccular aneurysm, with contained blood leakage.…”

“…As endovascular surgery has developed, it has become the preferred choice for surgical treatment of arterial aneurysms, including those related to BD. 2,10,24 However, there is not yet consensus in the literature on this indication. The presence of significant symptoms that did not undergo remission with clinical treatment and the risk of rupture were determinant factors in prescribing emergency treatment.…”

“…1 In around 8% of cases there is arterial involvement, in which aneurysmal degeneration is more common than occlusive disease. 2,3 Aneurysms have been reported in several arterial locations, such as the aortic arch and pulmonary artery, 4 celiac trunk, 5,6 superior mesenteric artery, 7 carotid arteries, 8 brachiocephalic trunk, 9 abdominal aorta, [10][11][12] iliac artery, 13 deep femoral artery 14 and popliteal artery. 15 There are few descriptions of aneurysms involving the thoracoabdominal segment of the aorta, 11,13,16 or of aortic pseudoaneurysms.…”