SciELO - Scientific Electronic Library Online

 
vol.57 número4Estudo histológico comparativo das cartilagens alares nasais em pacientes com fissura labial unilateralOsteodistrofia Hereditária de Albright: relato das manifestações bucais de um caso índice de autoresíndice de assuntospesquisa de artigos
Home Pagelista alfabética de periódicos  

Revista do Hospital das Clínicas

versão impressa ISSN 0041-8781

Resumo

AGUIAR, Eduardo Toledo de; LEDERMAN, Alex; SITRANGULO JUNIOR, Cid José  e  PUECH-LEAO, Pedro. Aortofemoral thromboendarterectomy. Rev. Hosp. Clin. [online]. 2002, vol.57, n.4, pp. 147-160. ISSN 0041-8781.  http://dx.doi.org/10.1590/S0041-87812002000400005.

PURPOSE: To study whether endarterectomy is feasible in all patients with aortofemoral atherosclerotic obstruction, considering early and late results. METHODS: A clinical, prospective, and descriptive study carried out in a university hospital. Inclusion criteria were atherosclerotic aortofemoral obstructive disease, clinical status compatible with major surgery, and absence of prior restorative procedure. Exclusion criteria were aneurysm, inflammatory arterial disease, and prior restorative procedure found during surgery. Eighty patients entered the protocol, but 9 were excluded (11.2%). Seventy-one patients, mean age of 57.3 years, underwent endarterectomy. Operative indications were intermittent claudication and critical ischemia. A ring-stripper endarterectomy technique was employed in all patients. Results were related to age, gender, symptoms, presence of diabetes mellitus, extension of endarterectomy, and extent of obstructive disease. Chi square or Fisher exact tests were used when appropriate, and the Wilkoxon (Gehan) test was used to compare survival curves. RESULTS: Sixty-eight (100%) endarterectomies were patent at discharge. The mortality rate was 4.2%. The amputation rate (4.3%) was higher in diabetic patients and when there was associated femoropopliteal obstruction. The 5-year survival rate was 83.3%, and late deaths were mostly cardiovascular. Diabetes mellitus, age above 65 years, and associated femoropopliteal obstruction lowered the survival rate. The 5-year patency rate was 87.0%. Critical ischemia and less extensive endarterectomies were associated with a lower patency rate. There were no anastomotic aneurysms or deep infections. CONCLUSIONS: Aortofemoral thromboendarterectomy is feasible in 90% of patients, early mortality rate is low, diabetic patients and those with associated femoropopliteal obstructive disease have a higher mortality rate, amputation rate is low, late deaths are mostly cardiovascular, and late patency rate is high, and even higher in the intermittent claudication group.

Palavras-chave : Aorta; Iliac artery; Endarterectomy; Atherosclerosis; Arterial reconstructive surgery.

        · resumo em Português     · texto em Inglês     · pdf em Inglês