RESUMO
Since the discovery of penicillin, the incidence of tertiary syphilis dramatically has decreased. However, cases of cardiovascular complications of syphilis still are present. Ascending aortic aneurysms are some of the most devastating complications. Nonetheless, syphilitic aortitis (SA) can appear and should be suspected in patients with syphilis and aortic aneurysm. We report a case of a 57-year-old patient with a large ascending aortic aneurysm with cartilage and rib erosion. The purpose of this article is to discuss the particular surgical aspects of this unusual case.
Assuntos
Aorta/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Sífilis Cardiovascular/complicações , Sífilis/complicações , Parede Torácica , Aorta/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Implante de Prótese Vascular , Ponte Cardiopulmonar , Ecocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Fraturas das Costelas/diagnóstico por imagem , Sorodiagnóstico da Sífilis , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Descending thoracic aortic aneurysm rupture is a life-threatening disease associated with high rates of morbidity and mortality. Treatment in these cases is a surgical emergency. Less invasive therapies for the treatment of this pathology have been developed over time. For descending thoracic aneurysm rupture, endovascular stent grafting is less invasive, life-saving, and a unique alternative to open repair. However, this approach is subject to anatomical and logistic limitations. The purpose of the present study is to report a case of an emergency endovascular repair for a ruptured thoracic aortic aneurysm in a patient with peripheral arterial disease, and to discuss some important issues related to this approach. Severe calcifications were discovered in this patient on both iliac arteries, and the remaining circulated lumen was less than 2 to 3 mm. Unfortunately, only catheter insertion into the left iliac artery for angiography was able to determine the development of a dissection in the arterial wall. We decided to dilate both iliac arteries with partial stabilization of the dissection on the right iliac artery which allowed us to successfully continue the endovascular procedure. After 24 hours, the patient experienced right limb ischemia, and revascularization of the affected limb was achieved by performing a right axillofemoral bypass.