Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492006000400015
Jornal Vascular Brasileiro
Case Report

Tratamento endovascular do aneurisma da aorta abdominal em paciente com insuficiência renal crônica

Endovascular treatment of abdominal aortic aneurysm in a patient with chronic renal failure

Cleoni Pedron; Ana Carla M. Palis; Arno von Ristow; Alberto Vescovi; Bernardo Massière; José Mussa Cury Filho; Marcus Gress; Antonio Luiz de Medina

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Resumo

A insuficiência renal crônica não-dialítica é uma contra-indicação relativa ao tratamento endovascular dos aneurismas da aorta abdominal. O uso de contrastes alternativos, como o gadolínio, além de fornecer imagens de baixa qualidade, está relacionado à nefrotoxicidade. Relatamos um caso de tratamento endovascular de aneurisma da aorta abdominal guiado por eco-Doppler colorido. Um paciente masculino de 82 anos, com aneurisma da aorta abdominal de 55 mm de diâmetro e clearance de creatinina de 17 ml/min, recebeu implante de endoprótese aórtica modular bifurcada, utilizando este método de imagem associado à radioscopia. Não foi empregado contraste iodado. O resultado imediato e os controles de 1 e 6 meses revelam completa exclusão do aneurisma. A função renal permanece inalterada. Concluímos que o implante de endoprótese guiado por eco-Doppler colorido em pacientes com insuficiência renal crônica não terminal e com anatomia favorável é um método factível e seguro.

Palavras-chave

Tratamento endovascular, aneurisma aórtico abdominal, insuficiência renal, eco-Doppler colorido, duplex scan

Abstract

Non-dialytic chronic renal failure is a contraindication related to the endovascular treatment of abdominal aortic aneurysms. The use of alternative contrast agents, such as gadolinium, provides good-quality images and is associated with nephrotoxicity. We report a case of endovascular treatment of an abdominal aortic aneurysm guided by color-flow Doppler ultrasonography. An 82-year-old male patient, with abdominal aortic aneurysm (55 mm in diameter) and creatinine clearance of 17 ml/min, underwent implantation of modular bifurcated aortic stent-graft, using that imaging method associated with radioscopy. Iodinated contrast was not used. The immediate result and 1- and 6-month controls showed complete aneurysm exclusion. Renal function is still unaltered. We conclude that the stent-graft implantation guided by color-flow Doppler ultrasonography in patients with nonterminal chronic renal failure and with favorable anatomy is a feasible and safe method.

Keywords

Endovascular treatment, abdominal aortic aneurysm, renal failure, color-flow Doppler ultrasonography, duplex scan

References

Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg.. 1991;5:491-9.

Morcos SK. Contrast media-induced nephrotoxicity-questions and answers. Br J Radiol.. 1998;71:357-65.

McCullough PA, Wolyn R, Rocher LL, Levin RN, O'Neill WW. Acute renal failure after coronary intervention: incidence, risk factors and relationship to mortality. Am J Med.. 1997;103:368-75.

Moore RD, Steinberg EP, Powe NR. Nephrotoxicity of high osmolality versus low osmolality contrast media: randomized clinical trial. Radiology. 1992;182:649-55.

Spinosa DJ, Matsumoto AH, Angle JF, Hagspiel KD, McGraw JK, Ayers C. Renal insufficiency: usefulness of gadodiamide-enhanced renal angiography to supplement CO2-enhanced renal angiography for diagnosis and percutaneous treatment. Radiology. 1999;210:663-72.

Prince MR, Arnoldus C, Frisoli JK. Nephrotoxicity of high-dose gadolinium compared with iodinated contrast. J Magn Reson Imaging. 1996;6:162-6.

Silva NB, Becker AB, Silva OB. Avaliação do risco operatório em cirurgia de aorta. Aneurismas. 2000:67-78.

Shusterman N. Surgery in the patient with chronic renal failure. Perioperative medicine: the medical care of the surgical patient. 1994:309-17.

Silva NB, Bonamigo TP, Silva JH. Avaliação do risco cirúrgico de pacientes com aneurisma da aorta abdominal. Rev AMRIGS. 1989;33:305-10.

Lucas ML, Bonamigo TP, Weber EL, Lucchese FA. Combined carotid endarterectomy and coronary artery bypass grafting: Analysis of the results. Arq Bras Cardiol.. 2005;85:412-20.

Schenker MP, Solomon JA, Roberts DA. Gadolinium arteriography complicated by acute pancreatitis and acute renal failure. J Vasc Interv Radiol.. 2001;12:393.

Iezzi R, Cotroneo AR. Endovascular repair of abdominal aortic aneurysms: CTA evaluation of contraindications. Abdom Imaging.. 2006.

Browne TF, Hartley D, Purchas S, Rosenberg M, Van Schie G, Lawrence-Brown M. A fenestrated covered suprarenal aortic stent. Eur J Vasc Endovasc Surg.. 1999;18:445-9.

von Ristow A, Vescovi A, Pedron C. O tratamento de aneurisma da aorta abdominal justa-renal com endoprótese fenestrada reposicionável. Rev Angiol Cir Vasc.. 2005;1:78-80.

Puech-Leão P. Banding of the common iliac artery: an expedient in endoluminal correction of aortoiliac aneurysms. J Vasc Surg.. 2000;32:1232-4.

Lee WA, Berceli SA, Huber TS, Ozaki CK, Flynn TC, Seeger JM. Morbidity with retroperitoneal procedures during endovascular abdominal aortic aneurysm repair. J Vasc Surg.. 2003;38:459-63.

Morcos SK. Prevention of contrast media-induced nephrotoxicity after angiographic procedures. J Vasc Interv Radiol.. 2005;16:13-23.

Bown MJ, Norwood MG, Sayers RD. The management of abdominal aortic aneurysms in patients with concurrent renal impairment. Eur J Vasc Endovasc Surg.. 2005;30:1-11.

Amar AP, Larsen DW, Teitelbaum GP. Percutaneous carotid angioplasty and stenting with the use of gadolinium in lieu of iodinated contrast medium: technical case report and review of the literature. Neurosurgery. 2001;49:1262-5.

Prince MR, Arnoldus C, Frisoli JK. Nephrotoxicity of high-dose gadolinium compared with iodinated contrast. J Magn Reson Imaging.. 1996;6:162-6.

Ascher E, Marks NA, Schutzer RW, Hingorani AP. Duplex-assisted internal carotid artery balloon angioplasty and stent placement: a novel approach to minimize or eliminate the use of contrast material. J Vasc Surg.. 2005;41:409-15.

Ahmadi R, Ugurluoglu A, Schillinger M, Katzenschlager R, Sabeti S, Minar E. Duplex ultrasound-guided femoropopliteal angioplasty: initial and 12-month results from a case controlled study. J Endovasc Ther.. 2002;9:873-81.

Wolf YG, Johnson BL, Hill BB, Rubin GD, Fogarty TJ, Zarins CK. Duplex ultrasound scanning versus computed tomographic angiography for postoperative evaluation of endovascular abdominal aortic aneurysm repair. J Vasc Surg.. 2000;32:1142-8.

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