Evolução no tratamento dos aneurismas da aorta torácica / Evolution and treatment of throracic aortic aneurysms

Os autores realizam uma revisão, de característica didática, das aortopatias, focalizando o histórico, o desenvolvimento do tratamento e os aspectos atuais de abordagem, utilizando a alta tecnologia das salas híbridas. Nos últimos anos, graças ao desenvolvimento das técnicas endovasculares, ocorreu uma verdadeira revolução no tratamento, especialmente para as patologias da aorta descendente, em que procedimentos eficientes foram aplicados com acentuada redução da morbimortalidade. A utilização de salas híbridas e tecnologia de moldes 3D, permitindo endoprótese customizadas, constituem-se em avanços significativos a serem utilizados nos próximos anos e que mudarão os paradigmas de uma subespecialidade

The authors performed a didactic review of aortic diseases, focusing on the historical aspects, the development of treatment, and aspects of the current approach using the latest technology of hybrid surgical rooms. In recent years, thanks to the development of endovascular techniques, there has been a real treatment revolution, especially for diseases of the descending aorta, with the application of efficient procedures, resulting in a significant reduction in morbidity and mortality. The use of hybrid technology rooms and computer 3-D reconstruction technology, enabling customized endoprostheses, are significant advances to be used in the coming years, and that will change the paradigms of a sub-specialty.

Tratamento endovascular de dissecção crônica toracoabdominal complicada com aneurisma torácico, mediante implante de endoprótese vascular / Endovascular treatment for chronic toracho-abdominal aortic dissection complicated with thoracic aneurysm, by the placement of an endovascular stent-graft

Our objective is to report a case of a patient with a descending thoracic aortic aneurysm and chronic aortic dissection, who was submitted to an endovascular treatment. A 68-year-old male with coronary artery disease and hypertension, with no history of trauma, diabetes or smoking. He had myocardial infarction ten years ago. Under general anesthesia, the left femoral artery was surgically exposed and the left braquial artery was catheterized with a "pigtail" catheter, under Seldinger technique. The proximal 46mm/0 and distal 34mm/0 stentgraft was placed just distal to the origen of the left subclavian artery. Control arteriography showed that the lesion was completely excluded. The patient was discharged seven days after the surgery, when a computed tomographic control, was performed showing a sustained aneurysm exclusion and a satisfactory endovascular position