Preservação das artérias hipogástricas com endoprótese ramificada no tratamento endovascular de aneurismas aorto-ilíacos.

 

Emanuel Dias*, Gonçalo Alves** Leonor Vasconcelos***, Aragão de Morais****, João Albuquerque Castro*****, Luís Mota Capitão ******

Hospital de Santa Marta, EPE Serviço de Angiologia e Cirurgia Vascular (Director: Dr.L. Mota Capitão)

* 5ºAno do Internato Médico em Angiologia e Cirurgia Vascular

** 3ºAno do Internato Médico em Angiologia Cirurgia Vascular

***Assistente Hospitalar de Angiologia e Cirurgia Vascular

****Assist Hospitalar Grad. de Angiologia e Cirurgia Vascular

***** Chefe de Serviço de Angiologia e Cirurgia Vascular

***** Chefe de Serviço de Angiologia e Cirurgia Vascular

 

RESUMO

Introdução: Os doentes com indicação para tratamento endovascular de aneurismas da aorta abdominal (EVAR) apresentam frequentemente artérias ilíacas comuns ectasiadas ou aneurismáticas, o que impossibilita a sua utilização como zona de encoragem distal da endoprótese. Em cerca de 15 a 30% dos casos pode existir necessidade de oclusão/embolização de uma ou de ambas as hipogástricas, com extensão da endoprótese para a artéria ilíaca externa. Isto tem sido associado a casos de claudicação glútea, isquémia intestinal, deficits neurológicos, e de disfunção vesical, intestinal e eréctil. O uso de endopróteses com ramo para a artéria hipogástrica apresenta-se como uma recente inovação que permite a preservação desta artéria e evitar estas complicações.

Caso clínico: Homem de 63 anos, com antecedentes de cirurgia aórtica com interposição protésica aorto-aórtica em 2008 por aneurisma da aorta abdominal (AAA) infra-renal, admitido para tratamento endovascular de aneurisma das artérias ilíaca comum e hipogástrica direitas, com 3,3 cm de maior diâmetro. O doente foi submetido a colocação por via femoral de endoprótese Zenith® ramificada para bifurcação ilíaca com preservação da artéria hipogástrica.

Conclusões: A utilização de endopróteses ramificadas para a bifurcação ilíaca durante a correcção endovascular de aneurismas aorto-ilíacos para ser uma forma segura e pouco complexa de garantir a preservação das artérias hipogástricas e minimizar as complicações associadas à sua oclusão.

Palavras-Chave: Aneurisma da aorta, Tratamento endovascular, Endoprótese ramificada ilíaca

 

The Zenith iliac bifurcation Device (IBD) for preservation of the internal iliac arteries during endovascular repair of aortic-iliac aneurysms.

ABSTRACT

Introduction: A significant portion of patients presenting for endovascular aneurysm repair of the abdominal aorta (EVAR) have aneurysmatic or ectasied common iliac arteries, raising distal anchorage issues. In these cases, it may be necessary occlusion / embolization of one or both hipo gastric arteries with extension of the endoprothesis to the external iliac artery. This procedure has been associated to gluteal claudication, intestinal ischemia, vesical and intestinal disfunction, neurologic deficits and impotence. The use of branched endoprothesis with preservation of the hypgastric artery is a recente innovation to reduce such complications.

Clinical case: A 63 year-old male, previously submitted to an open repair of an abdominal aortic aneurysm with an aorto-aortic prothesis, was admitted for endovascular treatment of an aneurysm of the right common and internal iliac arteries with 3,3cm. A Zenith® branched endoprothesis with a branch to the iliac bifurcation was deployed via right femoral access, thus assuring preservation of the hypogastric artery.

Conclusion: Hypogastric preservation necessity during EVAR in aorto-iliac aneurysms may be achieved in a secure and simple way through the placement of endoprothesis to the iliac bifurcation.

Key Words: Aortic aneurysms, Endovascular treatment, Iliac branch device |

 

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