INTRODUCTION
S e v e ra l c o mp li c a ti o n s h a v e b e e n re p o rte d a s b e ing a sso c ia te d w ith the a c q ui re d i mmun o d e fi c i e n c y s y n d ro me (A IDS). In a d d itio n to Ka p o si’ s sa rc o ma , so me va sc ula r ma nife sta tio ns ha ve b e e n re p o rte d , suc h a s va sc ulitis,1 -4 a nd c uta ne o us va sc ula r tumo rs.5 So me re p o rts ha ve c a lle d a tte ntio n to the p o ssib ility tha t p a tie nts w ith A IDS w ill d e ve lo p p se ud o a ne urysms o f the la rg e a rte rie s.6 , 7
The o b je c tive o f the p re se nt re p o rt w a s to d e s c ri b e tw o p a ti e n ts w i th p se ud o a ne urysms o f the a b d o mina l a o rta a nd / o r ilia c a rte rie s a sso c ia te d w ith A IDS.
CASE REPORTS
Case 1
A 2 3 ye a r o ld b la c k ma le , a ma c hine o p e ra to r, c o mp la ine d o f b urning p a in tha t ha d la ste d fo r a p e rio d o f o ne ye a r o n his le ft fla nk, a t time s w ith c o lic , w hic h irra d ia te d to the e p ig a strium a nd me so g a strium. The sig ns a nd symp to ms ha d w o rse ne d d uring re c e n t mo n th s a n d s e v e re a rte ri a l hyp e rte nsio n w a s d ia g no se d o n the o c c a sio n
Case Report
Pse udoane urysms of large
arte rie s associate d with AIDS
Division of Vascular Surgery - Faculdade de Medicina de
Ribeirão Preto - Universidade de São Paulo, Ribeirão Preto, Brazil
Carlos Eli Piccinato Jesualdo Cherri Takachi Moriya Antônio Carlos Souza
ABSTRACT
Ba ck ground: Several vascular co mplicatio ns are kno wn to o ccur in asso ciatio n with the acquired immuno deficiency syndro me (AIDS) and recent publicatio ns have called attentio n to the develo pment o f pseudo aneurysms o f larg e arteries in patients with AIDS.
Ca se report: W e repo rt o n 2 patients with AIDS ag ed 2 3 and 3 1 years with pseudo aneurysms o f the abdo minal ao rta and co mmo n iliac arteries. After clinical and radio lo g ical evaluatio n by arterio g raphy and co mputed to mo g raphy, the patients were submitted to
aneurysmecto my, with the placement o f a patch o f dacro n in the first case and the interpo sitio n o f a rig ht ao rto -iliac and left femo ral pro sthesis in the seco nd. The seco nd patient develo ped new aneurysms o f the rig ht subclavian and left po pliteal arteries 2 mo nths after surg ery. Pro ximal lig atio n o f the rig ht subclavian artery was perfo rmed to treat the first aneurysm and resectio n and interpo sitio n o f a reversed sapheno us vein was carried o ut to treat the pseudo aneurysm o f the po pliteal artery. Histo patho lo g ical examinatio n o f the po pliteal artery revealed necro tizing arteritis.
o f his first me d ic a l visit, w ith institutio n o f tre a tme nt. The p a tie nt re p o rte d p ulmo na ry tub e rc ulo sis tre a te d o ne ye a r e a rlie r. He d e nie d a lc o ho lism, c ig a re tte smo king , fa mily histo ry o f a ne urysms, use o f inje c ta b le d rug s, se xua l p ro misc uity o r ho mo se xua lity. He re p o rte d p a rtia l a ma uro sis d ue to o p tic ne uritis 2 ye a rs e a rlie r.
O n o n e o f h i s re turn v i s i ts f o r re e va lua tio n, a p ulsa tile , e xp a nsive 5 x 5 c m tumo r ma s s , w ith n o murmur, w a s
p a lp a te d in the e p ig a strium, w ith a ll d ista l p ulse s p a lp a b le a nd symme tric a l. A rte ria l p re ssure w a s 1 9 0 x 1 6 0 mmHg a nd he a rt ra te 9 2 b p m.
Und e r the se c o nd itio ns, the p a tie nt w a s re fe rre d to the Divisio n o f Va sc ula r Surg e ry a nd A ng io lo g y o f the Fa c ulty o f M e d ic ine o f Rib e irã o Pre to , Unive rsity o f Sã o Pa ulo (FM RP-USP). The p a tie nt w a s a d mitte d fo r e va lua tio n, w ith a d ia g no sis o f a b d o mina l a o rtic a ne urysm. Arte rio g ra p hy re ve a le d tw o sa c c ula r a b d o mina l a o rtic a ne urysms, o ne o f the m sup ra re na l o n the le ft, a nd the o the r infra re na l, a s w e ll a s o c c lusio n o f the le ft re na l a rte ry (Fig . 1 ). Se ro lo g ic te sts fo r syp hilis, he p a titis D a nd C ha g a s’ d ise a se w e re ne g a tive . HIV infe c tio n w a s d ia g no se d b y a n immuno e nz yma tic te st (ELISA ) a nd b y la te x p a rtic le a g g lutina tio n. The re sults o f the se se ro lo g y te sts b e c a me kno w n a fte r surg ic a l tre a tme nt. La p a ro to my re ve a le d a n a o rtic p se ud o a ne urysm b e tw e e n the le ft re na l a rte ry a nd the sup e rio r me se nte ric a rte ry. The p a tie nt w a s sub mitte d to a ne urysme c to my o f the a b d o mina l a o rta a nd the a rte ry w a s c lo se d w ith a d a c ro n p a tc h. C ulture o f the thro mb i o b ta ine d fro m the a ne urysm w a s ne g a tive . N o b io p sy o f the a b d o mina l a rte ry w a s o b ta ine d .
The p a tie nt e vo lve d w e ll d uring the imme d ia te p o sto p e ra tive p e rio d . A fte r d isc ha rg e fro m the ho sp ita l, he w a s fo und to c o ntinue to ha ve a rte ria l hyp e rte nsio n d e sp ite the use o f va rio us hyp o te nsive d rug s. The c o nd itio n w a s d e fine d a s re no va sc ula r hyp e rte nsio n a nd the p a tie nt w a s sub mitte d to le ft ne p hre c to my thre e mo nths a fte r the first surg e ry. The kid ne y p re se nte d hy a line a rte rio ne p hro sc le ro sis a nd se c o nd a ry re na l a tro p hy. The p a tie nt ha d a re la tive ly g o o d c o urse a nd ha s b e e n fo llo w e d up a t the infe c tio us d ise a se s o utp a tie nt c linic fo r 4 9 mo nths (up to N o ve mb e r 1 9 9 8 ) fo r the c o ntro l o f the b a sa l d ise a se (A IDS).
Case 2
A 3 1 -ye a r-o ld mula tto ma le , a ma c hine
Figure 1 - Abdominal aortogram of case 1, showing a saccular aneurysm (pseudoaneurysm) of the ab-dominal aorta and occlusion of the left renal artery.
o p e ra to r, w a s re fe rre d to FMRP-USP w ith a c o mp la int o f p a in o f the ilia c fo ssa e , e sp e c ia lly o n the le ft, irra d ia ting to the le ft thig h fo r the p re c e d ing 3 mo nths. The p a in a me li o ra te d w i th re s t. He re p o rte d a w o rse ning o f symp to ms d uring the la st mo nth. He ha d a histo ry o f c ig a re tte smo king , use o f intra ve no us d rug s, g o no rrhe a a nd se xua l p ro misc uity. He d e nie d a fa mily histo ry o f a ne urysms. A rte ria l p re ssure w a s 1 3 0 x 8 0 mmHg a nd he a rt ra te 8 8 b p m. La b o ra to ry w o rk-up re ve a le d he p a titis B a nd HIV infe c tio n b y the immuno e nz yma tic te st (ELISA) a nd b y la te x p a rtic le a g g lutina tio n. A p ulsa tile , e xp a nsive 1 0 x 1 0 c m ma ss w a s p a lp a b le in the le ft ilia c fo ssa , w ith systo lic fre mitus a nd murmur, a nd a 5 x 5 c m ma ss w ith the sa me c ha ra c te ristic s a s the p re vio us o ne w a s p a lp a b le in the rig ht ilia c fo ssa . C o mp ute d to mo g ra p h y re v e a le d p se ud o a ne urysms o f the ilia c a rte rie s, a n a b d o mina l a o rtic p se ud o a ne urysm c lo se to the le ft re na l a rte ry, sp le e n c ysts a nd / o r a b s c e s s e s a n d re tro p e ri to n e a l a n d me s e n te ri c a d e n o me g a ly ( Fi g . 2 ) . Ao rto g ra p hy re ve a le d a n a b d o mina l a o rtic p se ud o a ne urysm c lo se to the le ft re na l a rte ry a nd 2 e no rmo us p se ud o a ne urysms o f the c o mmo n ilia c a rte rie s (Fig . 3 ).
Th e p a ti e n t w a s s ub mi tte d to e xp lo ra to ry la p a ro to my in A p ril 1 9 9 7 a nd a sa c c ula r p se ud o a ne urysm me a suring 4 c m in d ia me te r, w ith a 1 . 5 c m ne c k w a s d e te c te d o n the a nte rio r w a ll o f the juxta re na l a o rta , in a d d itio n to tw o p se ud o a ne urysms o f the c o mmo n ilia c a rte rie s, o ne o n the rig ht me a suring 8 c m in d ia me te r, a nd o ne o n the le ft me a suring 1 0 c m. A b ifurc a te rig ht a o rto -ilia c a nd a le ft c o mmo n fe mo ra l d a c ro n p ro sthe sis w e re inse rte d . Thro mb us c ulture s w e re n e g a ti v e a n d h i s to p a th o lo g i c a l e xa mina tio n o f p re a o rtic lymp ha tic g a ng lia sho w e d re a c tio na l hyp e rp la sia a c c o mp a nie d b y g ra nulo ma to us infla mma tio n. Z ie hl-N e e lse n a nd G M S sta ining d id no t re ve a l the p re se nc e o f fung i.
The p a tie nt e vo lve d w e ll d uring the
Figure 3 - Abdominal aortogram of case 2, showing an enormous pseudoaneurysm of the left common iliac artery.
p o sto p e ra tive p e rio d b ut 2 mo nths la te r p re se nte d a p ulsa tile ma ss in the rig ht sup ra c la vic ula r fo ssa . Ang io g ra p hy re ve a le d a n a ne urysm o f the p ro xima l third o f the sub c la via n a rte ry. The p a tie nt re p o rte d lo c a l p a in tha t irra d ia te d to the up p e r limb .
W e o p te d fo r p ro xima l lig a tio n o f the sub c la via n a rte ry to re lie ve the p a inful symp to ms. The p a in imp ro ve d a nd the p a tie nt w a s d isc ha rg e d fro m the ho sp ita l. Thre e mo n th s la te r h e d e v e lo p e d a p se ud o a ne urysm o f the p o p lite a l a rte ry. A n e nd -to -e nd re ve rse d sa p he no us ve in g ra ft w a s c a rrie d o ut to tre a t the p se ud o a ne urysm o f the p o p lite a l a rte ry. Histo p a tho lo g ic a l e xa mina tio n o f the p o p lite a l a rte ry re ve a le d d e s truc ti o n o f th e a rte ri a l w a ll a n d he mo rrha g ic ne c ro sis a lso re a c hing the a d v e n titia , c h a ra c te riz in g n o n s p e c ific ne c ro tiz ing a rte ritis.
a o rtic a ne urysm. N o p o st-mo rte m stud y ha s b e e n d o ne .
DISCUSSION
Sinc e the p ub lic a tio n o f the first c a se o f a rup ture d a nd Sa lmo ne lla8- infe c te d a b d o mina l a o rtic a ne urysm, o the r re p o rts re la ting a ne ury sms to A IDS ha ve b e e n p ub lishe d .6 , 7 , 9 The se a ne ury sms ma inly d e ve lo p in yo ung HIV-infe c te d p a tie nts w ith no sig ns o f a the ro sc le ro tic d ise a se , tra uma tic injury o r a ny o the r kno w n p a tho g e nic fa c to r. The tw o p a tie nts re p o rte d he re w e re yo ung (2 3 a nd 3 1 ye a rs o ld , re sp e c tive ly) a nd d id n o t p re s e n t c li n i c a l ma n i f e s ta ti o n s o r a ng io g ra p hic a lte ra tio ns sug g e stive o f a th e ro s c le ro s i s . A ls o , n e i th e r p a ti e n t p re se nte d se p tic e mia o r e nd o c a rd itis. The first p a tie nt re p o rte d tre a tme nt fo r p ulmo na ry tub e rc ulo sis o ne ye a r e a rlie r. Ao rtic thro mb us c ulture d id no t le a d to the iso la tio n o f b a c te ria l a g e nts in e ithe r p a tie nt.
Sa lmo ne lla is kno w n to p o se a hig h ri s k, p e r s e , fo r th e d e v e lo p me n t o f a b d o mina l a o rtic infe c tio n in p a tie nts a g e d o v e r 5 0 y e a rs .1 0 Jo h a n s e n a n d D e v i n re p o rte d my c o ti c a o rti c a n e ur y s ms i n immuno d e p re sse d p a tie nts.1 1 O n the o the r ha nd , tub e rc ulo us myc o tic a ne urysms o f b o th fe mo ra l a rte rie s ha ve b e e n d e te c te d a fte r va c c ina tio n w ith C a lme tte -G ué rin b a c illus in p a ti e n ts s ub mi tte d to i mmun o th e ra p y, sug g e sting tha t va sc ula r tissue c a n p re se nt a n infla mma to ry re sp o nse to infe c tio n.1 2
De sp ite the p ub lic a tio n o f c a se s o f infe c te d a the ro sc le ro tic a ne urysm,8 , 1 3 mo st HIV-infe c te d p a tie nts p ro b a b ly d e ve lo p ne c ro tiz ing va sc ulitis o f the va sc ula r w a ll fo llo w e d b y the fo rma tio n o f fa lse a ne urysms, a s w a s the c a se fo r the p re se nt p a tie nts.9
In a re vie w o f 1 4 c a se s o f a rte ritis in p a tie nts w ith AIDS, C a la b re se e t a l d e sc rib e d se ve ra l p a tho lo g ic a l a lte ra tio ns.1 4 Five c a se s w e re d e fi n e d a s h a v i n g a n g i o g e n i c immuno p ro life ra tive a sp e c ts w hic h the a uth o rs a ttri b ute d to a uto i mmun e
me c ha nisms. The re ma ining o ne s p re se nte d a re a s o f inte nse ne c ro tiz ing va sc ulitis w ith the fo rma tio n o f a ne urysms a ttrib uta b le to lo c a l infe c tio n o f the ve sse l w a ll o r to intra lumina l thro mb o sis. N e c ro tiz ing a rte ritis w a s c ha ra c te riz e d in the histo p a tho lo g ic a l stud y o f the p o p lite a l a rte ry in the se c o nd c a se .
Re c e nt histo p a tho lo g ic a l stud ie s ha ve re ve a le d le sio n, re g e ne ra tio n a nd a c tiva tio n o f the a o rtic e nd o the lium in HIV-infe c te d p a tie nts w ho d ie d o f o the r c a use s, ind ic a ting a mo re a c tive ro le o f the virus in the p a th o g e n e s i s a n d p ro g re s s i o n o f th e d ise a se .1 5
Ra d io lo g ic a l e xa mina tio n (c o mp ute d to mo g ra p h y o r a rte ri o g ra p h y ) us ua lly c ha ra c te riz e s the a ne urysms o f the se p a tie nts a s b e i n g o f th e s a c c ula r ty p e o r p s e ud o a ne ury s ms . In the tw o p a tie nts re p o rte d he re , the a ne urysms w e re fo und to b e sa c c ula r o r p se ud o a ne ury sms d uring p re o p e ra tive e va lua tio n a nd c o nfirme d a s p se ud o a ne urysms d uring the tra nso p e ra tive p e rio d .
S urg i c a l tre a tme n t o f a n e ur y s ms c o nsid e re d to b e myc o tic id e a lly c o nsists o f the e xc isio n o f the e ntire infe c te d tissue , inc lud ing a ll the va sc ula r tissue invo lve d , w ith re sto ra tio n o f va sc ula r c o ntinuity b y e xtra -a n-a to mic -a l re c o nstruc tio n.1 6 -1 8 Ho w e ve r, the re a re re p o rts in the lite ra ture o f g o o d re sults o b ta ine d w ith in situ p la c e me nt o f a d a c ro n p ro sthe sis in a n a o rtic p o sitio n inste a d o f a n e xtra -a na to mic b yp a ss.1 9 -2 1 The la tte r p ro c e d ure w a s a d o p te d he re sinc e ne ithe r p a tie nt sho w e d lo c a l sig ns o f p urule nt se c re tio n d uring la p a ro to my a nd thro mb us c ulture w a s ne g a tive . A ntib io tic tre a tme nt w ith c e fo tria xo ne w a s ma inta ine d in b o th p a tie nts fo r o ne w e e k a nd d isc o ntinue d a fte r d isc ha rg e fro m the ho sp ita l.
S o me e th i c a l a s p e c ts s h o uld b e c o nsid e re d in the surg ic a l tre a tme nt o f HIV-infe c te d p a tie nts. Sho uld re sto ra tive va sc ula r s urg e r y f o r th e c o rre c ti o n o f a rte ri a l a ne urysms b e ind ic a te d fo r p a tie nts w ith a le tha l d ise a se ? Sinc e the se a re usua lly yo ung p a tie nts (2 3 a nd 3 1 ye a rs o f a g e in the p re se nt c a se ), w ith b e tte r c urre nt p e rsp e c tive s o f surviva l a nd p ro b a b le re c o ve ry a nd o f a re turn to the ir p ro fe ssio na l a c tivitie s, o ur te a m o p te d fo r surg ic a l tre a tme nt. This e thic a l q ue stio n w a s a lso a na lyz e d b y Dup o nt e t a l. in 1 9 8 9 a nd tho se inve stig a to rs a lso o p te d fo r inte rve ntio n w he n the y p ub lishe d the first c a se o f a b d o mina l a o rtic a ne urysm in a p a tie nt w ith A IDS.8
It is c le a r tha t b o th in g e ne ra l surg e ry a nd in va sc ula r surg e ry the surg ic a l te a m sho uld d o ub le its p re c a utio ns in vie w o f the risk o f c o nta mina tio n o f te a m me mb e rs (d o ub le g lo ve s, c a p s, ma sks, p ro te c tive g la s s e s , e tc . ) d uri n g th e i n tra - a n d p o sto p e ra tive p e rio d .
Fina lly, it ma y b e e xp e c te d tha t, w ith the inc re a se in the numb e r o f A IDS p a tie nts in the p o p ula tio n a nd the ir e xte nd e d life e x p e c ta nc y, the inc id e nc e o f a ne ury sms a mo ng the se p a tie nts w ill inc re a se o ve r the ne xt fe w ye a rs.7 , 8
3. Mannik M. Experimental mo dels fo r immune co mplex mediated vascular inflammatio n. Acta Med Scand 1987;715(Suppl):145-55. 4. S c h w a rt z N D , S o YT, H o l l a n d e r H , Al l e n s S , Fye KH . Eo sino p hylic vasc ulitis le ad ing to am auro sis fugax in a p atie nt with ac q uire d im m uno d e fic ie nc y synd ro m e . Arc h Inte rn Me d 1986;146:2059- 60.
5. Fe rguso n LJ, Fe ll G, Buxto n B, Ro yle SP. Myc o tic c e rvic al c aro tid ane urysm . Br J Surg 1984;71:245-8.
6. Me stre s CA, Nino t S, De d ac y AM, Caste l MT, Iranzo P, Azo n A, Pe ra M, Mule t J. AIDS and s alm o ne lla- infe c te d ab d o m inal ao rtic ane urysm . Aust NZ J Surg1990;60:225-6.
7. Sinzo b aham vya N, Kalangu K, Häm e l- Kalino ws ki W. Arte rial a n e u rys m s a s s o c ia te d with im m u n o d e fic ie n c y viru s ( HIV) infe c tio n. Ac ta Chir Be l 1989;89:185-8.
8. Dup o nt JR, Bo navita JA, Digio vanni RS, Sp e c to r HB, Ne ls o n S C. Ac q u i re d i m m u n o d e fi c i e n c y s yn d ro m e a n d m yc o t i c ab d o m inal ao rtic ane urys m s : a ne w c halle nge ? Re p o rt o f a c ase . J Vasc Surg 1989;10:254-7.
9. Marks C, Kisko v S. Patte rn o f arte rial ane urysm s in ac q uire d im m uno d e fic ie nc y d ise ase . Wo rld J Surg 1995; 19:127-32. 10. Co he n PS, O ’Brie n TF, Sc ho e nb aum SC, Me d e iro s AA. The risk
o f e nd o the lial infe c tio n in ad ults with salm o ne lla b ac te re m ia. Ann Inte rn Me d 1978;89:931-2.
11. Jo h an s e n K, De vin J. Myc o tic ao rtic an e u rys m s . Arc h Su rg 1983;118:583- 8.
12. Bo rne t P, Pujad e B, Lac aie F. Tub e rc ulo us ane urys m o f the fe m o ral arte ry: a co m plicatio n o f Calm è tte -Gue rin b acilli vaccine im m uno the rap y: a c ase re p o rt. J Vasc Surg 1989;10:688-9. 13. Go uny P, Valve rd e A, Vinc e nt D, Fad e l E, Te no t B, Tric o t JF,
Ro ze nb aum W, Nassaum e O . Hum an im m uno d e fic ie nc y virus and infe c te d ane urysm o f the ab d o m inal ao rta: re p o rt o f thre e c ase s. Ann Vasc Surg 1992;6:239-43.
14. Calab re se LH, Este r M, Ye n-Lie b e rm an B. Syste m ic vasc ulitis in asso c iatio n with hum an im m uno d e fic ie nc y virus infe c tio n. Arthritis Rhe um 1989;32:569-72.
15. Zie ts C, Ho tz B, Stürzl M, Rauc h E, Re nning R, Lö hrs V. Ao rtic e nd o the lium in HIV-1 infe c tio n. Chro nic injury, ac tivatio n and inc re ase d le uko c yte ad he re nc e . Am J Patho l 1996;149:1887-97. 16. Ba i rd RN . M yc o t i c a o rt i c a n e u rys m s . Eu r J Va s c S u rg
1989;3:95- 8.
17. Mund th ED, Darling RC, Alvarad o RH, Buc ke y MJ, Linto n RR, Auste n WG. Surgic al m anage m e nt o f m yc o tic ane urysm s and th e c o m p lic a tio n s o f in fe c tio n in va s c u la r re c o n s tru c tive surge ry. Am J Surg 1969;117:460-70.
18. Pic c inato CE, Che rri J, Mo riya T. Ane urism a m ic ó tic o d a ao rta ab d o m inal. Re v Paul Me d 1990;108:52-6.
19. Bitse ff HL, Ed ward s WH, Mulhe rin JL, Kaise r AB. Infe c te d ao rtic ane urysm s. So uth Me d J 1987;80:309-12.
20. Hard y JD, Tim m ins HH. Ab d o m inal ao rtic ane urys m s p e c ial p ro b le m s. Ann Surg 1971;173:945-65.
21. Jarre t F, Darling RC, Mund t ED, Auste n WG. Exp e rie nc e with i n fe c t e d a n e u rys m s o f t h e a b d o m i n a l a o rt a . Arc h S u rg 1975;110:1281- 6.
REFERENCES
1. Jac o b so n MA, Mills J. Se rio us c yto m e galo virus d ise ase in the ac q uire d im m uno d e fic ie nc y synd ro m e (AIDS). Ann Inte rn Me d 1988;108:332- 3.
Sour ces of Fund ing : N o t d e c la re d
Conflict of inter est: N o t d e c la re d
La st r eceiv ed : 1 Fe b rua ry 1 9 9 9
Accep ted : 3 Fe b rua ry 1 9 9 9
Ad d ress for corresp ond ence:
C a rlo s Eli Pic c ina to
Av. Ba nd e ira nte s, 3 9 0 0 - De to . d e C irurg ia - 9 º a nd a r Rib e irã o Pre to / SP - Bra sil - C EP 1 4 0 4 8 -9 0 0
E-ma il: c e p ic c in@ fmrp . usp . b r
RESUMO
Contex to: São co nhecidas várias co mplicaçõ es vasculares asso ciadas à Síndro me de Imuno deficiência Adquirida (AIDS). Publicaçõ es recentes chamam à atenção so bre o desenvo lvimento de aneurismas em g randes artérias em pacientes aidético s.
Rela to de Ca so: N este relato são apresentado s do is caso s de pacientes (2 3 e 3 1 ano s de idade) po rtado res de AIDS co m pseudo aneurismas da ao rta abdo minal e artérias ilíacas co muns. Apó s a avaliação clínica e radio ló g ica (arterio g rafia e to mo g rafia co mputado rizadas), fo ram o perado s e submetido s à aneurismecto mia co m co lo cação de selo de dacro n no primeiro caso e interpo sição de pró tese ao rto -ilíaca direito e femo ral esquerdo no seg undo . Este último desenvo lveu no vo s aneurismas de subclávia direita e po plítea esquerda, do is meses apó s a o peração , o ptando -se pela lig adura pro ximal do seu co lo para tratar o primeiro e ressecção e interpo sição de veia safena interna invertida para tratar o pseudo -aneurisma de artéria po plítea. O estudo histo pato ló g ico da artéria po plítea revelo u arterite necro tizante.
Ca r los Eli Piccina to - Pro fe sso r A sso c ia d o , Divisã o d e C irurg ia Va sc ula r e A ng io lo g ia d o De p a rta me nto d e C irurg ia , O rto p e d ia e Tra uma to lo g ia d a FM RP-USP
Jesua ld o Cher r i - Pro fe sso r Do uto r, Divisã o d e C irurg ia Va sc ula r e A ng io lo g ia d o De p a rta me nto d e C irurg ia , O rto p e d ia e Tra uma to lo g ia d a FM RP-USP
Ta k a chi M oriy a - Pro fe sso r Do uto r, Divisã o d e C irurg ia Va sc ula r e A ng io lo g ia d o De p a rta me nto d e C irurg ia , O rto p e d ia e Tra uma to lo g ia d a FM RP-USP
