tratamento De Fístula Arteriovenosa Adquirida Com Repercussões Hemodinâmicas Graves: Desafio

A 34-year-old female patient with severe heart failure and pulmonary hypertension was diagnosed late with a high-output acquired arteriovenous fistula between the right common iliac vein and artery. The most probable cause was an iatrogenic vascular injury inflicted during a prior laparoscopic cholecystectomy. Treatment was conducted by placement of an endoprosthesis in the common iliac artery, achieving total exclusion of the fistula and complete remission of symptoms. Considering the options available for treating this type of lesion, endovascular techniques are becoming ever more effective and are now the option of first-choice for management of this pathology.A 34-year-old female patient with severe heart failure and pulmonary hypertension was diagnosed late with a high-output acquired arteriovenous fistula between the right common iliac vein and artery. The most probable cause was an iatrogenic vascular injur1313438sem informaçãosem informaçãoPinto, D.M., Bez, L.G., Dias, J.O., Lopes, C.S., Mandi, A., Iliac aneurysm associated with arteriovenous fistula (2007) J Vasc Bras., 6 (3), pp. 299-302Davis, P., Gloviczki, P., Cherry, K., Aorto-caval and ilio-iliac arteriovenous fistulae (1998) Am J Surg., 176, pp. 115-118. , http://dx.doi.org/10.1016/S0002-9610(98)00166-4Queiroz, A.B., Mulatti, G.C., Aun, R., Valentim, L.A., Puech-Leão, P., Endovascular repair of a traumatic arteriovenous fistula involving the iliac bifurcation using an iliac branch device (2012) J Vasc Surg., 55 (5), pp. 1474-1476. , http://dx.doi.org/10.1016/j.jvs.2011.12.006, May, Epub 2012 Jan 24Kuehnl, A., Zimmermann, A., Pongratz, J., Eckstein, H.H., Young girl presenting with heart failure 5 years after laparoscopic appendectomy. Case report of an ilio-iliac AV fistula (2010) Eur J Vasc Endovasc Surg., 40 (1), pp. 107-109. , http://dx.doi.org/10.1016/j.ejvs.2010.02.013, JulSexton, J.A., Ricotta, J.J., Endovascular approaches to arteriovenous fistula (2011) Adv Surg., 45, pp. 83-100. , http://dx.doi.org/10.1016/j.yasu.2011.03.011Weng, C.F., Wei, J., Lee, Y.T., High-output Heart Failure Resulting from an Obscure Traumatic Arteriovenous Fistula (2008) J Chin Med Assoc, 71 (8), pp. 428-430. , http://dx.doi.org/10.1016/S1726-4901(08)70096-0Wang, E.A., Lee, M.H., Wang, M.C., Lee, H.Y., Iatrogenic left iliac-caval fistula: Imaging and endovascular treatment (2004) AJR Am J Roentgenol., 183 (4), pp. 1032-1034. , http://dx.doi.org/10.2214/ajr.183.4.1831032, OctChaudry, M., Flinn, W.R., Kim, K., Neschis, D.G., Traumatic arteriovenous fistula 52 years after injury (2010) J Vasc Surg., 51 (5), pp. 1265-1267. , http://dx.doi.org/10.1016/j.jvs.2009.11.080, May, Epub 2010 Mar 29Brewster, D., Cambria, R., Moncure, A., Aortocaval and iliac arteriovenous fistulas: Recognition and treatment (1991) J Vasc Surg, 13, pp. 253-264. , http://dx.doi.org/10.1016/0741-5214(91)90218-J, discussion 264-5Cronin, B., Kane, J., Lee, W., Shriki, J., Weaver, F.A., Repair of a high-flow iliac arteriovenous fistula using a thoracic endograft (2009) J Vasc Surg., 49 (3), pp. 767-770. , http://dx.doi.org/10.1016/j.jvs.2008.10.062, Mar, Epub 2009 Jan 14Yared, K., Baggish, A.L., Wood, M.J., High-output heart failure resulting from a remote traumatic arteriovenous fistula (2009) Can J Cardiol., 25 (4). , http://dx.doi.org/10.1016/S0828-282X(09)70083-2, AprParodi, J., Barone, H., Transluminal treatment of abdominal aortic aneurysms and peripheral arteriovenous fistulas (1992) Proceedings of the 19th Annual Montefiore Medical Center Symposium on Current Critical Problems and New Techniques in Vascular Surgery, , In: 1992New York. New YorkSanchez, L., Veith, F., Ohki, T., Early experience with the Corvita endoluminal graft for the treatment of arterial injuries (1999) Ann Vasc Surg, 13, pp. 151-157. , http://dx.doi.org/10.1007/s100169900233Marin, M., Veith, F., Panetta, T., Transluminally placed endovascular stented graft repair for arterial trauma (1994) J Vasc Surg, 20, pp. 466-472. , http://dx.doi.org/10.1016/0741-5214(94)90147-3McCarter, D., Johnstone, R., McInnes, G., Reid, D., Pollock, J., Reid, A., Iliacarteriovenous fistula following lumbar disc surgery treated by percutaneousendoluminal stent grafting (1996) Br J Surg, 83, pp. 796-797. , http://dx.doi.org/10.1002/bjs.1800830622Zajko, A., Little, A., Steed, D., Curtiss, E., Endovascular stent-graft repair of common iliac artery-to-inferior vena cava fistula (1995) J Vasc Intervent Radiol, 6, pp. 803-806. , http://dx.doi.org/10.1016/S1051-0443(95)71190-3McLaughlin, V.V., McGoon, M.D., Pulmonary arterial hypertension (2006) Circulation, 114 (13), pp. 1417-1431. , http://dx.doi.org/10.1161/CIRCULATIONAHA.104.50354

Estudo Comparativo Entre Ultrassonografia Duplex E Angiotomografia No Acompanhamento Pós-operatório Da Correção Endovascular De Aneurismas Do Eixo Aortoilíaco

To compare duplex ultrasound and computed tomography (CT) angiography in terms of their performance in detecting endoleaks, as well as in determining the diameter of the aneurysm sac, in the postoperative follow-up of endovascular abdominal aortic aneurysm repair. Materials and Methods: This was a prospective study involving 30 patients who had undergone endovascular repair of infrarenal aortoiliac aneurysms. Duplex ultrasound and CT angiography were performed simultaneously by independent radiologists. Measurements of the aneurysm sac diameter were assessed, and the presence or absence of endoleaks was determined. Results: The average diameter of the aneurysm sac, as determined by duplex ultrasound and CT angiography was 6.09 ± 1.95 and 6.27 ± 2.16 cm, respectively. Pearson’s correlation coefficient showing a statistically significant correlation (R = 0.88; p < 0.01). Comparing the duplex ultrasound and CT angiography results regarding the detection of endoleaks, we found that the former had a negative predictive value of 92.59% and a specificity of 96.15%. Conclusion: Our results show that there is little variation between the two methods evaluated, and that the choice between the two would have no significant effect on clinical management. Duplex ultrasound could replace CT angiography in the postoperative follow-up of endovascular aneurysm repair of the infrarenal aorta, because it is a low-cost procedure without the potential clinical complications related to the use of iodinated contrast and exposure to radiation. © Colégio Brasileiro de Radiologia e Diagnóstico por Imagem.49422923