Tratamento endovascular nos aneurismas verdadeiros e na dissecção aórtica do tipo B: fase intra-hospitalar, seguimento de médio prazo e uma reflexão sobre seleção de pacientes

• Autor(a) principal: Alves, Claudia Maria Rodrigues [UNIFESP]
• Data de Publicação: 2009
• Outros Autores: Fonseca, José Honório de Almeida Palma da [UNIFESP], Souza, José Augusto Marcondes de [UNIFESP], Kim, Hyung Chun [UNIFESP], Esher, Guilherme [UNIFESP], Buffolo, Enio [UNIFESP]
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1590/S2179-83972009000100010; http://repositorio.unifesp.br/handle/11600/4747
• topic: Aortic aneurysm; Stents; Aorta, thoracic; Blood vessel prosthesis implantation; Aneurisma aórtico; Contenedores; Aorta torácica; Implante de prótese vascular

BACKGROUND: Endovascular treatment of thoracic aortic diseases is a well established procedure although late results and differences among demographic groups are unknown. METHOD: From December/1996 to December/2004, 92 patients with true aneurysms or penetrating ulcers (G1) and 130 patients with type B dissection or intramural hematoma (G2) were submitted to primary or complementary endovascular treatment. Clinical success was defined as sustained technical success without death or surgical conversion. Late failure was defined as death of any cause, surgical conversion or re-intervention. RESULTS: G1 mean age was 65 ± 11 years and 56 ± 11 years in G2 (P < 0.0001). A high frequency of previous stroke was observed in G1 (8.7% vs. 0; P = 0.0007). Clinical success was observed in 71% in G1 and 84% in G2 (P = 0.02) with higher in-hospital death rates in G1 (14% vs. 4.6%; P = 0.01). Neurologic complications were similar (6.5% vs. 3%, respectively; P = 0.32), with a mild prevalence of paraplegia in G1 (3.2% vs. 0.8%; P = 0.3). Late failure rates of 60% were observed in G1 and 43% in G2 (P = 0.09) at 33 ± 27 months of follow-up. CONCLUSIONS: Endovascular treatment in patients with true aneurysms may be slightly inferior to those achieved in patients with type B dissection. This might be due to demographic differences between groups and technical difficulties related to aortic anatomy. The knowledge and understanding of these peculiarities enables better patient selection for the procedure resulting in decreased mortality rates.