Aneurismas Toracoabdominais Rotos [ruptured Thoracoabdominal Aneurysms]

Objective: To evaluate the pre-, intra- and postoperative data of ruptured thoracoabdominal aneurysms operated at Hospital de Clínicas da Universidade Estadual de Campinas. Methods: A retrospective study of five patients submitted to repair of ruptured thoracoabdominal aneurysm at Hospital de Clínicas da Universidade Estadual de Campinas from September 2000 to April 2004. All patients presented a ruptured type IV thoracoabdominal aneurysm, and four of them were hemodynamically stable. Three patients were operated by the simple supraceliac aortic clamping and saline solution infusion at 4°C in the renal arteries; one patient died during the surgery before the aneurysm was opened; and one patient was operated by perfusion of oxygenated blood in the visceral arteries. Results: Of the five patients operated, two died (40%). One of them presented hemodynamic instability and died during the surgery; the other patient died on the 26 th postoperative day due to multiple organ failure. All three surviving patients progressed well, with no sequelae. Among patients who were taken to the operating room hemodynamically stable, the mortality rate was 25%. Conclusions: Patients with ruptured type IV thoracoabdominal aneurysm, hemodynamically stable, achieved satisfactory surgical results, similar to infrarenal ruptured aneurysms. Copyright © 2006 by Sociedade Brasileira de Angiologia e de Cirurgia Vascular.513741Bradbury, A.W., Bulstrode, N.W., Gilling-Smith, G., Stansby, G., Mansfield, A.O., Wolfe, J.H., Repair of ruptured thoracoabdominal aortic aneurysm is worthwhile in selected cases (1999) Eur J Vasc Endovasc Surg, 17, pp. 160-165Lewis, M.E., Ranasinghe, A.M., Revell, M.P., Bonser, R.S., Surgical repair of ruptured thoracic and thoracoabdominal aortic aneurysms (2002) Br J Surg, 89, pp. 442-445Cowan Jr., J.A., Dimick, J.B., Wainess, R.M., Henke, P.K., Stanley, J.C., Upchurch Jr., G.R., Ruptured thoracoabdominal aortic aneurysm treatment in the United States: 1988 to 1998 (2003) J Vasc Surg, 38, pp. 319-322LeMaire, S.A., Rice, D.C., Schmittling, Z.C., Coselli, J.S., Emergency surgery for thoracoabdominal aortic aneurysms with acute presentation (2002) J Vasc Surg, 35, pp. 1171-1178Rocha, E.F., Luccas, G.C., Baldini Neto, L., Aneurisma tóracoabdominal inflamatório (2005) J Vasc Br, 4, pp. 301-306Rocha, E.F., Guillaumon, A.T., Antunes, N., Vieira, R.W., Aneurisma toracoabdominal roto: Modificação do circuito de perfusão visceral (2004) Rev Bras Cir Cardiovasc, 19, pp. 413-416Mastroroberto, P., Chello, M., Emergency thoracoabdominal aortic repair: Clinical outcome (1999) J Thorac Cardiovasc Surg, 118, pp. 477-481Cota, A.M., Omer, A.A., Jaipersad, A.S., Wilson, N.V., Elective versus ruptured abdominal aortic aneurysm repair: A 1-year cost-effectiveness analysis (2005) Ann Vasc Surg, 19, pp. 858-861Girardi, L.N., Krieger, K.H., Altorki, N.K., Mack, C.A., Lee, L.Y., Isom, O.W., Ruptured descending and thoracoabdominal aortic aneurysms (2002) Ann Thorac Surg, 74, pp. 1066-1070Schepens, M.A., Defauw, J.J., Hamerlijnck, R.P., De Geest, R., Vermeulen, F.E., Surgical treatment of thoracoabdominal aortic aneurysms by simple crossclamping. Risk factors and late results (1994) J Thorac Cardiovasc Surg, 107, pp. 134-142Cambria, R.P., Davison, J.K., Zannetti, S., L'Italien, G., Atamian, S., Thoracoabdominal aneurysm repair: Perspectives over a decade with the clamp-and-sew technique (1997) Ann Surg, 226, pp. 294-303Anacleto, A., Anacleto, J.C., Aneurismas da aorta torácica e toracoabdominal (2002) Cirurgia Vascular: Cirurgia Endovascular, Angiologia, pp. 439-459. , Brito CJ. Rio de Janeiro: RevinterSantos, V.P., Ignácio, M.R., Da Silveira, D.R., Caffaro, R.A., Aneurisma toracoabdominal roto: Relato de um caso com o uso de anel rígido sulcado de Delrin intraluminal na anastomose proximal (2004) J Vasc Br, 3, pp. 383-38

Endovascular Management Of Extremity Arterial Trauma

Treatment of arterial traumatic injuries is usually performed with conventional revascularization techniques. However, vascular injuries can increasingly be repaired efficiently through minimally invasive procedures. We report four cases of extremity arterial trauma treated by endovascular techniques in a reference center. All patients showed satisfactory development over a 15-month follow-up. We suggest that endovascular therapy is a promising alternative to surgery for selected patients with extremity arterial trauma.715661Deguara, J., Ali, T., Modarai, B., Burnand, K.G., Upper limb ischemia: 20 years experience from a single center (2005) Vascular, 13, pp. 84-91Huynh, T.T., Pham, M., Griffin, L.W., Management of distal femoral and popliteal arterial injuries: An update (2006) Am J Surg, 192, pp. 773-778Peck, M.A., Rasmussen, T.E., Management of blunt peripheral arterial injury (2006) Perspect Vasc Surg Endovasc Ther, 18, pp. 159-173Vasdekis, S.N., Kakisis, J.D., Lazaris, A.M., Panayiotides, J.G., Angeli, A.A., Karkaletsis, K.G., Common femoral artery injury secondary to tennis ball strike (2006) J Vasc Surg, 44, pp. 1350-1352Starnes, B.W., Arthurs, Z.M., Endovascular management of vascular trauma (2006) Perspect Vasc Surg Endovasc Ther, 18, pp. 114-129Criado, E., Marston, W.A., Ligush, J., Mauro, M.A., Keagy, B.A., Endovascular repair of peripheral aneurysms, pseudoaneurysms and arteriovenous fistulas (1997) Ann Vasc Surg, 11, pp. 253-263du Toit, D.F., Strauss, D.C., Blaszczyk, M., de Villiers, R., Warren, B.L., Endovascular treatment of penetrating thoracic outlet arterial injuries (2000) Eur J Vasc Endovasc Surg, 19, pp. 489-495du Toit, D.F., Leith, J.G., Strauss, D.C., Blaszczyk, M., Odendaal, J.V., Warren, B.L., Endovascular management of traumatic cervicothoracic arteriovenous fistula (2003) Br J Surg, 90, pp. 1516-1521Kember, P.G., Wood, R.F., Gaines, P.A., Endovascular management of a non-penetrating traumatic axillary artery occlusion (1997) Eur J Vasc Endovasc Surg, 14, pp. 227-228Mattox KL, Hirshberg A. Traumatismo vascular. In: Haimovici H, editor. Cirurgia vascular. Rio de Janeiro: Di-Livros2000. p. 480-96Strauss, D.C., du Toit, D.F., Warren, B.L., Endovascular repair of occluded subclavian arteries following penetrating trauma (2001) J Endovasc Ther, 8, pp. 529-533Kuzniec, S., Traumatismos vasculares (2002) Cirurgia vascular, pp. 706-720. , Brito CJ, editor, Rio de Janeiro: Revinter;Aun, R., Leão, P.P., Tratamento dos ferimentos vasculares por métodos endovasculares (2002) Cirurgia vascular, pp. 721-727. , Brito CJ, editor, Rio de Janeiro: Revinter;Lönn, L., Delle, M., Karlström, L., Risberg, B., Should blunt arterial trauma to the extremities be treated with endovascular techniques? (2005) J Trauma, 59, pp. 1224-1227Alvarez-Tostado, J., Tulsyan, N., Butler, B., Rizzo, A., Endovascular management of acute critical ischemia secondary to blunt tibial artery injury (2006) J Vasc Surg, 44, pp. 1101-1103Johnson SF, Johnson SB, Strodel WE, Barker DE, Kearney PA. Brachial plexus injury: association with subclavian and axillary vascular trauma. J Trauma. 1991;31:1546-50. J Vasc Bras. 2008;7(1):62-