ABSTRACT
Relata-se um caso de uma paciente de 50 anos, dislipidêmica, tabagista e hipertensa, que se queixava de claudicação intermitente progressiva há seis anos (durante primeira consulta ao deambular 100 metros). Ao exame clínico inicial, apresentava-se hipertensa (PA: 150 x 70 mmHg) e baixa amplitude de pulso nas artérias femorais, já em uso de quatro classes diferentes de anti-hipertensivos. Durante investigação diagnóstica, detectou-se, na angioressonância, estenose de 75% do lumen da aorta, 5 cm abaixo das artérias renais. Foi submetida à aortoplastia com stent, com satisfatória evolução clínica e normalização dos níveis pressóricos. Dessa forma, com as características clínicas descritas e com o tratamento utilizado para esta paciente, ilustramos um caso de coarctação atípica da aorta abdominal infrarrenal, patologia rara e com mecanismo fisiopatológico pouco compreendido. Destaca-se a importância do diagnóstico precoce e do tratamento adequado dessa síndrome.
We report a case of a 50 years-old patient, with dyslipidemia, that smokes and has hypertension, who complained of progressive intermittent claudication six years ago (during the first visit when walking 100 meters). The initial clinical examination revealed hypertension (BP: 150 x 70 mmHg) and low pulse width in femoral arteries, already in use in four different classes of antihypertensive drugs. During diagnostic investigation was detected in magnetic resonance angiography, 75% stenosis of the aorta lumen 5 cm below the renal arteries. She underwent angioplasty with a stent, a good outcome and normal blood pressure. Thus, with the clinical characteristics and the treatment used for this patient, we illustrate a case of atypical coarctation of the aorta abdominal below-renal, rare disease with poorly understood pathophysiological mechanism. We emphasize the importance of early diagnosis and appropriate treatment of this syndrome.
Subject(s)
Humans , Female , Middle Aged , Aortic Coarctation , Dyslipidemias , HypertensionABSTRACT
A 51-year-old man was referred to us because of upper extremity hypertension and vascular claudication of the lower extremities. He underwent extraanatomic ascending aorta-abdominal aorta bypass with vascular graft under a median sternotomy and a midline laparotomy incision without cardiopulmonary bypass. The postoperative course was uneventful. Upper extremity hypertension and vascular claudication were completely resolved. Although the patient has done well in the three years since his operation, we continue to observe him closely. The etiology of atypical coarctation may be related to Takayasu arteritis because of the angiographic findings and positive specific alleles such as HLA-B5201 and DRB1 1502.
ABSTRACT
A 81-year old woman had hypertensive heart failure. She had a history of intermittent claudication for 5 years. Her ankle brachial pressure index (ABI) was 0.53 on the right and 0.58 on the left side. Coarctation of the descending aorta with severe calcification was found by a whole body CT. After medical therapy for heart failure, axillo-bifemoral artery bypass using an 8 mm ringed expanded polytetrafluoroethylene (ePTFE) graft was performed. Postoperatively, ABI improved to 0.83 on the right and 0.87 on the left side. The patient is doing well without any signs of heart failure or intermittent claudication. Although it is a palliative operation, axillo-bifemoral artery bypass is an effective and less-invasive procedure and appropriate for elderly patients.
ABSTRACT
Takayasu's arteritis is occlusive disease of aorta, its main branches, and pulmonary artery. Its clinical manifestations are quite variable, but comes from mainly stenotic or aneurysmal change of the vascular wall. We experienced two cases of unusual presentations of Takayasu's arteritis, one with thorcoabdominal aortic aneurysm (Crawford type III) and the other with atypical coarctation of descending aorta. Surgical procedures were graft replacement of thoracoabdominal aortic aneurysm with implantation of inferior mesenteric artery supplying almost all abdominal vicera to the graft, and graft bypass of the coarctation. They survived postoperatively with improved clinical symptoms.
Subject(s)
Aneurysm , Aorta , Aorta, Thoracic , Aortic Aneurysm , Aortic Aneurysm, Thoracic , Mesenteric Artery, Inferior , Pulmonary Artery , Takayasu Arteritis , TransplantsABSTRACT
A 37-year-old female was admitted to our hospital because of haemoptysis. She had undergone descending thoracic aorta-abdominal aorta bypass grafting 11 years previously. Then the diagnosis was atypical coarctation due to aortitis syndrome. No follow up had been continued. Angiogram and CTscan disclosed a false aneurysm at the anastomotic site of the descending thoracic aorta, which was ruptured into the left lung. An emergency operation was performed. A new extra-anatomical ascending aorta abdominal aorta bypass was constructed using 16mm Dacron prosthesis, and three permanent clamps were employed for thromboexclusion of the descending aorta, previous bypass graft and the ruptured aneurysm. At present, three years after the operation, she is leading normal life with medication of hypotensive drugs. Pathogenesis, surgical approach and long-term postoperative care were discussed.