Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492006000300013
Jornal Vascular Brasileiro
Case Report

Push and park: uma opção técnica no tratamento do ateroembolismo agudo dos membros inferiores

Push and park: a technical option for the management of acute lower limb atheroembolism

Bernardo Massière; Arno von Ristow; Cleoni Pedron; José Mussa Cury Filho; Marcus Gress; Alberto Vescovi; Fabrício Zucco

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Resumo

A aterotrombose é uma doença multissistêmica associada a elevada morbidade e mortalidade. A manipulação das artérias com fios-guia ou cateteres pode gerar trauma mecânico, com conseqüente deslocamento de material ateromatoso da parede vascular. Um paciente de 82 anos, no qual uma ponte fêmoro-poplítea distal com veia safena in situ havia sido realizada por nós há 10 anos, apresentou dor, palidez, hipotermia, diminuição da sensibilidade e força do pé direito 6 horas após coronariografia com acesso pela artéria femoral direita (classe 2b de Rutherford). Arteriografia diagnóstica evidenciou perviedade do enxerto, com múltiplas irregularidades em seu terço distal, compatíveis com material ateroembólico, além de pobreza extrema de circulação distal. Optamos pela revascularização do membro inferior direito em caráter de urgência, associando técnicas convencionais a métodos endovasculares. Empregando a técnica de push and park, cruzamos a lesão ateroembólica com fio-guia e tratamos todo o eixo arterial acometido com manobras de angioplastia. O paciente apresentou boa evolução, boa perfusão distal, adequado enchimento capilar, eliminação da dor e melhora acentuada imediata do déficit motor e sensitivo.

Palavras-chave

Angioplastia com balão, embolia de colesterol, membro inferior

Abstract

Atherothrombosis is a multisystemic disease associated with high morbidity and mortality rates. Management of arteries with guide-wires or catheters may cause mechanical trauma, with consequent detachment of atheromatous material from the vascular wall. An 82-year-old patient, in whom a distal femoropopliteal in situ saphenous vein graft bypass had been performed 10 years before, presented with pain, pallor, hypothermia, loss of sensibility and motor activity on the right lower limb 6 hours after coronary angiography from the femoral artery (Rutherford class 2b). Arteriography demonstrated bypass patency, with multiple irregularities in its distal third, compatible with atheroembolic material, and very poor distal circulation. We indicated lower limb revascularization on an emergency basis, by both conventional and endovascular techniques. Using the "push and park" technique, the atheroembolic obstruction was crossed by guide-wire and the whole affected arterial axis was treated by angioplasty. The patient progressed well, with good distal perfusion, adequate capillary refill, relief of pain and immediate recovery of sensory and motor function.

Keywords

Balloon angioplasty, cholesterol embolism, lower limb

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