22.17
Aneurisma III: Cuidados Interprofissionais
O manejo do aneurisma envolve terapia médica conservadora ou intervenção cirúrgica, dependendo do tamanho e dos sintomas do aneurisma. O manejo conser…
O tratamento do aneurisma envolve tratamento conservador para aneurismas pequenos e assintomáticos, geralmente com menos de 5,5 centímetros de diâmetro.
Inclui modificação de fatores de risco, como cessação do tabagismo, controle de condições como hiperlipidemia, hipertensão e diabetes e aumento gradual da atividade física.
O tamanho do aneurisma é monitorado regularmente por ultrassom ou tomografia computadorizada.
Pequenos aneurismas medindo 4,0-5,4 centímetros de diâmetro são monitorados a cada 6-12 meses, enquanto aneurismas da aorta abdominal menores que 4,0 centímetros são monitorados a cada 2-3 anos.
Para aneurismas assintomáticos maiores que 5,5 centímetros, recomenda-se um procedimento cirúrgico conhecido como reparo aberto do aneurisma.
Envolve uma incisão abdominal, remoção de trombo ou placa do segmento aórtico doente e sutura de um enxerto sintético nas extremidades proximal e distal do aneurisma.
A parede aórtica nativa é então suturada ao redor do enxerto.
Outro procedimento, o reparo endovascular de aneurisma, envolve a colocação de um enxerto aórtico sem sutura dentro do aneurisma da aorta abdominal usando um cateter de artéria femoral inserido através da artéria femoral.
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Q1: When is conservative treatment recommended for abdominal aortic aneurysms?
Conservative treatment is recommended for small, asymptomatic abdominal aortic aneurysms measuring less than 5.5 centimeters in diameter. This approach focuses on modifying risk factors such as tobacco cessation, managing hyperlipidemia, hypertension, and diabetes, and gradually increasing physical activity to prevent aneurysm growth and rupture.
Q2: What monitoring schedule is used for different sizes of abdominal aortic aneurysms?
Aneurysm monitoring frequency depends on size. Small aneurysms measuring 4.0 to 5.4 centimeters require ultrasound or CT scans every 6 to 12 months. Aneurysms smaller than 4.0 centimeters are monitored every 2 to 3 years. This surveillance helps detect expansion early, allowing timely intervention when necessary.
Q3: What are the key differences between open aneurysm repair and endovascular repair?
Open aneurysm repair involves a large abdominal incision where the surgeon removes thrombus or plaque and sutures a synthetic graft to the proximal and distal ends. Endovascular aneurysm repair is less invasive, placing a sutureless aortic graft inside the aneurysm via a femoral artery catheter, avoiding major abdominal surgery.
Q4: When is surgical repair recommended for asymptomatic aneurysms?
Surgical repair is advised for asymptomatic aneurysms measuring 5.5 centimeters or larger. At this size threshold, the rupture risk increases significantly, making intervention necessary. The choice between open aneurysm repair and endovascular repair depends on patient factors and anatomical considerations.
Q5: What is endoleak and why is it a concern after aneurysm repair?
Endoleak is the most common complication following abdominal aortic aneurysm repair, involving blood seeping back into the old aneurysm sac. It results from inadequate seal at graft ends, graft fabric tears, or leaks between overlapping segments. This complication can lead to continued aneurysm growth and potential rupture.
Q6: What other complications can occur after aneurysm repair besides endoleak?
Additional complications include aneurysm growth above or below the graft, aortic dissection, bleeding, aneurysm rupture, renal artery occlusion from stent migration, incisional hematoma, infection at the incision site, and graft thrombosis. Angiography is performed after repair to check for leaks and ensure graft patency.
Q7: How does surgical repair differ for iliac artery aneurysms versus saccular aneurysms?
Iliac artery aneurysm repair uses a bifurcated graft that replaces the entire affected segment. For saccular aneurysms, only the bulbous lesion is excised, and the artery is repaired using primary closure by suturing or applying an autogenous or synthetic patch graft. Both approaches aim to restore normal blood flow.