Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.003315
Jornal Vascular Brasileiro
Case Report

Trauma inguinal penetrante com formação de fístula arteriovenosa e pseudoaneurisma: relato de caso

Acquired arteriovenous fistula and pseudoaneurysm secondary to penetrating inguinal trauma: a case report

Frederico Michelino de Oliveira; Ary Augusto Reis de Macedo; Adolfo Palhares Matheus Rodrigues; Jamil Jorge Abou Mourad; Ary Augusto de Castro Macedo; Lia Ormieres Costa; Paulo Eduardo Lucisano Bin

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Resumo

Resumo Os autores apresentam um relato de caso de vítima de acidente de trabalho com ferimento penetrante em região inguinal direita com peça metálica em espiral, que evoluiu com fístula arteriovenosa da artéria femoral profunda com a veia femoral profunda associado a pseudoaneurisma envolvendo essas estruturas e a veia femoral comum. As fístulas arteriovenosas ocorrem frequentemente após traumas e a associação com pseudoaneurisma é fato raro, devendo ser tratadas precocemente após seu diagnóstico. O ultrassom duplex é atualmente o exame mais utilizado para a avaliação inicial e a arteriografia, o padrão ouro para diagnóstico. No paciente em questão foi realizado tratamento convencional com abordagem cirúrgica direta, sutura arterial e ligaduras venosas. Entretanto, nos dias atuais a cirurgia endovascular e a compressão guiada por ultrassom são métodos terapêuticos que têm sido utilizados com sucesso. O paciente evoluiu sem intercorrência, recebendo alta para acompanhamento ambulatorial com preservação do membro.

Palavras-chave

fístula arteriovenosa, pseudoaneurisma, ferimentos penetrantes

Abstract

Abstract This article describes the case of a work accident victim with a penetrating wound to the right inguinal region caused by a metal spiral. The patient developed an arteriovenous fistula between the deep femoral artery and deep femoral vein, combined with a pseudoaneurysm surrounding these structures and the common femoral vein. Arteriovenous fistulas frequently occur after traumas, but the combination of fistula and pseudoaneurysm is rare. It is recommended that they be treated immediately after diagnosis. Duplex ultrasound is the most widely used method for initial assessment and arteriography is the gold standard for diagnosis of arteriovenous fistulas. Endovascular surgery has recently been used successfully in such cases. However, this patient was treated conventionally using a direct surgical approach, arterial suture and venous ligatures, and the limb was saved. The patient developed no complications and was discharged to outpatients follow-up.

Keywords

arteriovenous fistula, pseudoaneurysm, wounds, penetrating

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