Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.20140041
Jornal Vascular Brasileiro
Original Article

Surgical treatment of chronic aortoiliac occlusion

Tratamento cirúrgico da oclusão crônica aorto-ilíaca

Márcio Luís Lucas; Lúcia Deibler; Nilon Erling Jr.; Eduardo Lichtenfels; Newton Aerts

http://dx.doi.org/10.1590/1677-5449.20140041 J Vasc Bras, vol.14, n1, p.29-36, 2015
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Abstract

BACKGROUND: Chronic aortoiliac occlusion (CAIO) is a significant cause of lower limb ischemia and is often found in young patients who smoke. OBJECTIVE: To review recent results achieved treating CAIO patients with open surgery. METHODS: From November 2011 to April 2014, 21 patients with CAIO were treated at the Santa Casa de Misericórdia, Porto Alegre, Brazil. Demographic data, comorbidities, clinical presentation and surgical results were analyzed. RESULTS: Eleven women and ten men were treated with direct aortic bypass (DAB; n=18) or with extra-anatomic bypass (EAD; n=3). Mean age was 53.7 ± 7.3 years (range: 43-79 years) and all patients smoked. Thirteen patients (62%) had critical ischemia. Six of the patients treated with DAB (33.4%) also required additional revascularization (3 renal and 3 femoropopliteal procedures). Perioperative mortality was zero. Four patients (22.2%) suffered transitory renal dysfunction, but only one patient (5.6%) required hemodialysis. Median follow-up time was 17 months (range: 2-29 months) and there was just one late death, from ischemic heart disease, 7 months after the surgery on the abdominal aorta. CONCLUSIONS: Aortic reconstruction is a safe method for treating patients with CAIO, with low perioperative morbidity and mortality rates.

Keywords

abdominal aorta, thrombosis, surgical procedures

Resumo

CONTEXTO: A oclusão crônica aorto-ilíaca (OCAI) é uma importante causa de isquemia dos membros inferiores e é frequentemente encontrada em pacientes jovens e tabagistas. OBJETIVO: Revisar os resultados recentes da cirurgia aberta em pacientes com OCAI. MÉTODOS: Entre novembro de 2011 e abril de 2014, 21 pacientes com OCAI foram tratados na Santa Casa de Misericórdia de Porto Alegre. Foram analisados dados demográficos, comorbidades, apresentação clínica e resultados cirúrgicos. RESULTADOS: Onze mulheres e dez homens foram tratados com derivação aórtica direta (DAD; n=18) ou com derivação extra-anatômica (DEA; n=3). A média de idade foi 53,7 ± 7,3 anos (variação 43-79 anos), sendo todos os pacientes tabagistas. Treze pacientes (62%) apresentavam isquemia crítica. Dos pacientes submetidos à DAD, seis (33,4%) necessitaram de revascularização associada (3 renais e 3 fêmoro-poplíteas). A mortalidade perioperatória foi nula. Quatro pacientes (22,2%) desenvolveram disfunção renal transitória, mas apenas um paciente (5,6%) necessitou de hemodiálise. O tempo mediano de seguimento foi de 17 meses (variação 2-29 meses), havendo apenas um óbito tardio, por cardiopatia isquêmica, sete meses após a cirurgia da aorta abdominal. CONCLUSÃO: A reconstrução aórtica é um método seguro para o tratamento de pacientes com OCAI, com baixas taxas de morbidade e mortalidade perioperatórias.

Palavras-chave

aorta abdominal, trombose, procedimentos cirúrgicos

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