EXTENSÃO PROXIMAL DE TROMBOSE AÓRTICA JUXTARENAL: UMA COMPLICAÇÃO SUBESTIMADA?
DOI:
https://doi.org/10.48750/acv.348Palavras-chave:
Doença oclusiva aorto-ilíaca, justa-renal, doença arterial renal, revascularizaçãoResumo
A trombose aórtica justa-renal pode complicar-se pela extensão proximal do trombo para a placa visceral. Neste artigo, apresentamos o caso clínico de um doente com queixas de claudicação intermitente incapacitante causada por trombose aórtica justa-renal com progressão proximal do trombo à região visceral e oclusão da artéria renal esquerda, embora mantendo a funcionalidade do rim através da circulação colateral. Este achado imagiológico implicou a alteração da estratégia cirúrgica habitual com necessidade de rotação visceral medial e clampagem aórtica supracelíaca. Concomitantemente, optou-se por revascularizar a artéria renal esquerda, enquanto se perfundia a artéria renal direita com lactato de Ringer. A cirurgia e o período pós-operatório decorreram sem complicações. A progressão visceral da trombose aórtica justa-renal é um evento pouco frequente, em 3 a 15% dos casos, mas que obriga a alterações na abordagem cirúrgica, com necessidade de clampagem proximal da aorta abdominal e ao uso de estratégias adjuvantes para minimizar as consequências da hipoperfusão renal e visceral.
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Referências
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10. Bax, L., Woittiez, A. J. J., Kouwenberg, H. J., Mali, W. P., Buskens, E., Beek, F. J., et al. (2009). Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial. Annals of internal medicine, 150(12), 840-848.
11. Wheatley K, Ives N, Gray R, Kalra PA, Moss JG, Baigent C, et al. (2009). Revascularization versus medical therapy for renal-artery stenosis. New England Journal of Medicine, 361(20), 1953-1962.
12. Bavry, A. A., Kapadia, S. R., Bhatt, D. L., Kumbhani, D. J. (2014). Renal artery revascularization: updated meta-analysis with the CORAL trial. JAMA internal medicine, 174(11), 1849-1851.
13. Dean, R. H., Englund, R., Dupont, W. D., Meacham, P. W., Plummer, W. D., Jr, Pierce, R., Ezell, C. (1985). Retrieval of renal function by revascularization. Study of preoperative outcome predictors. Annals of surgery, 202(3), 367–375.
14. Svensson, L. G., Crawford, E. S., Hess, K. R., Coselli, J. S., & Safi, H. J. (1992). Thoracoabdominal aortic aneurysms associated with celiac, superior mesenteric, and renal artery occlusive disease: methods and analysis of results in 271 patients. Journal of Vascular Surgery, 16(3), 378-390.
15. Allen, B. T., Anderson, C. B., Rubin, B. G., Flye, M. W., Baumann, D. S., Sicard, G. A. (1993). Preservation of renal function in juxtarenal and suprarenal abdominal aortic aneurysm repair. Journal of Vascular Surgery, 17(5), 948-959.
16. Svensson, L. G., Coselli, J. S., Safi, H. J., Hess, K. R., & Crawford, E. S. (1989). Appraisal of adjuncts to prevent acute renal failure after surgery on the thoracic or thoracoabdominal aorta. Journal of Vascular Surgery, 10(3), 230-239.
17. Coselli, J. S. (2010). Strategies for renal and visceral protection in thoracoabdominal aortic surgery. In https://core.ac.uk/download/pdf/82041469.pdf accessed in 31 August 2020.
18. Crutchley, T. A., Pearce, J. D., Craven, T. E., Edwards, M. S., Dean, R. H., Hansen, K. J. (2007). Branch renal artery repair with cold perfusion protection. Journal of Vascular Surgery, 46(3), 405-412.
19. Hirose, T., Sawabata, N., Abe, T., Hayata, Y., Hiraga, S., Nishikawa, H., Taniguchi, S. (2020). Protective Effects of Cold Ringer's Solution Perfusion in Abdominal Aortic Surgery Requiring Renal Artery Clamp. in vivo, 34(2), 739-744.
20. Tshomba, Y., Kahlberg, A., Melissano, G., Coppi, G., Marone, E., Ferrari, D., Chiesa, R. (2014). Comparison of renal perfusion solutions during thoracoabdominal aortic aneurysm repair. Journal of Vascular Surgery, 59(3), 623-633.
2. Starrett, R. W., & Stoney, R. J. (1974). Juxtarenal aortic occlusion. Surgery, 76(6), 890-897.
3. Madiba, T. E., & Robbs, J. V. (1993). Aortofemoral bypass in the presence of total juxtarenal aortic occlusion. European Journal of Vascular and Endovascular Surgery, 7(1), 77-81.
4. Reilly, L. M., Sauer, L., Weinstein, E. S., Ehrenfeld, W. K., Goldstone, J., Stoney, R. J. (1990). Infrarenal aortic occlusion: does it threaten renal perfusion or function?. Journal of Vascular Surgery, 11(2), 216-225.
5. Erskine, J. M., Gerbode, F. L., French, S. 3., & Hood, R. M. (1959). Surgical Treatment of Thrombotic Occlusion of Aorta and Iliac Arteries: The Leriche Syndrome. AMA archives of surgery, 79(1), 85-93.
6. Rob, C. G. (1960). Chronic occlusive disease of the aorta and iliac arteries (treatment and results). J. Cardiovasc. Surg., 1, 57.
7. Yune, H. Y., Klatte, E. C. (1976). Collateral circulation to an ischemic kidney. Radiology, 119(3), 539-546.
8. a Gama, A. D., Nunes, J. S., & Pedro, L. M. (2003). Revascularization surgery of an anuric solitary kidney using the left colic artery as a free graft. Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular, 10(3), 141.
9. Hirsch, A. T., Haskal, Z. J., Hertzer, N. R., Bakal, C. W., Creager, M. A., Halperin, J. L., Rosenfield, K. A. (2006). ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic) a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery,* Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines. Circulation, 113(11), e463-e654.
10. Bax, L., Woittiez, A. J. J., Kouwenberg, H. J., Mali, W. P., Buskens, E., Beek, F. J., et al. (2009). Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial. Annals of internal medicine, 150(12), 840-848.
11. Wheatley K, Ives N, Gray R, Kalra PA, Moss JG, Baigent C, et al. (2009). Revascularization versus medical therapy for renal-artery stenosis. New England Journal of Medicine, 361(20), 1953-1962.
12. Bavry, A. A., Kapadia, S. R., Bhatt, D. L., Kumbhani, D. J. (2014). Renal artery revascularization: updated meta-analysis with the CORAL trial. JAMA internal medicine, 174(11), 1849-1851.
13. Dean, R. H., Englund, R., Dupont, W. D., Meacham, P. W., Plummer, W. D., Jr, Pierce, R., Ezell, C. (1985). Retrieval of renal function by revascularization. Study of preoperative outcome predictors. Annals of surgery, 202(3), 367–375.
14. Svensson, L. G., Crawford, E. S., Hess, K. R., Coselli, J. S., & Safi, H. J. (1992). Thoracoabdominal aortic aneurysms associated with celiac, superior mesenteric, and renal artery occlusive disease: methods and analysis of results in 271 patients. Journal of Vascular Surgery, 16(3), 378-390.
15. Allen, B. T., Anderson, C. B., Rubin, B. G., Flye, M. W., Baumann, D. S., Sicard, G. A. (1993). Preservation of renal function in juxtarenal and suprarenal abdominal aortic aneurysm repair. Journal of Vascular Surgery, 17(5), 948-959.
16. Svensson, L. G., Coselli, J. S., Safi, H. J., Hess, K. R., & Crawford, E. S. (1989). Appraisal of adjuncts to prevent acute renal failure after surgery on the thoracic or thoracoabdominal aorta. Journal of Vascular Surgery, 10(3), 230-239.
17. Coselli, J. S. (2010). Strategies for renal and visceral protection in thoracoabdominal aortic surgery. In https://core.ac.uk/download/pdf/82041469.pdf accessed in 31 August 2020.
18. Crutchley, T. A., Pearce, J. D., Craven, T. E., Edwards, M. S., Dean, R. H., Hansen, K. J. (2007). Branch renal artery repair with cold perfusion protection. Journal of Vascular Surgery, 46(3), 405-412.
19. Hirose, T., Sawabata, N., Abe, T., Hayata, Y., Hiraga, S., Nishikawa, H., Taniguchi, S. (2020). Protective Effects of Cold Ringer's Solution Perfusion in Abdominal Aortic Surgery Requiring Renal Artery Clamp. in vivo, 34(2), 739-744.
20. Tshomba, Y., Kahlberg, A., Melissano, G., Coppi, G., Marone, E., Ferrari, D., Chiesa, R. (2014). Comparison of renal perfusion solutions during thoracoabdominal aortic aneurysm repair. Journal of Vascular Surgery, 59(3), 623-633.
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Publicado
2021-03-05
Como Citar
1.
Henriques M, Ministro A, Silva E, Pinto V, Rato J, Mendes Pedro L. EXTENSÃO PROXIMAL DE TROMBOSE AÓRTICA JUXTARENAL: UMA COMPLICAÇÃO SUBESTIMADA?. Angiol Cir Vasc [Internet]. 5 de Março de 2021 [citado 24 de Novembro de 2024];16(4):314-7. Disponível em: https://acvjournal.com/index.php/acv/article/view/348
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