Os aneurismas do segmento subclávio-axilar são de ocorrência rara e, uma vez diagnosticados, devem ser tratados. Neste trabalho, relatamos dois casos de aneurismas de membros superiores, sendo um da artéria subclávia e outro da artéria axilar. No primeiro caso, o paciente de 71 anos, sexo masculino, apresentava abaulamento pulsátil supraclavicular direito associado à fraqueza muscular no membro ipsilateral. Foram realizados duplex scan e arteriografia, que confirmaram o diagnóstico de aneurisma da artéria subclávia direita, sendo o paciente submetido à aneurismectomia com anastomose término-terminal. No segundo caso, uma paciente de 24 anos, do sexo feminino, sem antecedentes mórbidos ou comorbidades, apresentava queixa de massa pulsátil na região axilar direita associada à parestesia no membro ipsilateral. O duplex scan e a arteriografia confirmaram o aneurisma da artéria axilar direita, que foi tratado com aneurismectomia e anastomose término-terminal com sucesso. O diagnóstico anátomo-clínico foi de aneurisma aterosclerótico no primeiro caso e, no segundo caso, de aneurisma congênito.

Aneurysms of the subclavian-axillary segment are rare, but when diagnosed they must be treated. This article describes two cases of aneurysms of the upper extremities, one in a subclavian artery and the other in an axillary artery. The first case was a 71-year-old male with a pulsating supraclavicular bulge on the right and muscle weakness in the ipsilateral extremity. Duplex scanning and arteriography confirmed the diagnosis of aneurysm of the right subclavian artery and the patient underwent aneurysmectomy and end-to-end anastomosis. The second case was a 24-year-old female patient, with no history of comorbidities, who presented with a pulsating mass in the right axillary region and paresthesia of the ipsilateral extremity. Duplex scanning and arteriography confirmed an aneurysm in the right axillary artery, which was successfully treated with aneurysmectomy and end-to-end anastomosis. Pathology findings showed that the first case was an atherosclerotic aneurysm and the second was a congenital aneurysm.

Fistula between arteries and the gastrointestinal tract are a rare cause of gastrointestinal bleeding, but potentially fatal. The recognition and early treatment can modify the patient prognosis. We report a case of a patient with previous surgery for seminoma of cryptorchidic testicle, with massive lower gastrointestinal bleeding. We performed the diagnosis and surgical treatment of the fistula between left external iliac artery and sigmoid colon. The patient was successfully treated by external iliac artery ligation and left colectomy.

OBJETIVO: Avaliar as características demográficas e de imagens da trombose endoluminal em uma série de pacientes submetidos a tratamento endovascular do aneurisma de aorta abdominal (TEAAA). MÉTODOS: Avaliamos as características de imagem que permitiram o diagnóstico da trombose endoluminal em uma série de 30 pacientes submetidos ao TEAAA, com seguimento de 5 a 29 meses, através de exames de tomografia computadorizada multidetectores (TCMD) de 64 canais. RESULTADOS: Foram diagnosticados dez casos de trombose luminal (33,3%), sendo que em três pacientes a trombose foi total de um ramo ilíaco. CONCLUSÃO: A TCMD permitiu o diagnóstico de diferentes tipos de trombose endoluminal em pacientes submetidos ao TEAAA. O uso desta modalidade diagnóstica minimamente invasiva deverá ser encorajado na prática clínica.

OBJECTIVE: Evaluate the imaging findings of thrombosis in a series of patients submitted to endovascular repair of aortic abdominal aneurysm. METHODS: MDCT images of 30 patients submitted to endovascular repair of aortic abdominal aneurysm were obtained by a 64 slice scanner, 5 to 29 months after the endovascular treatment. RESULTS: Thrombosis was diagnosed in 10 patients (33.3%), and in three patients thrombosis was total in an iliac branch. CONCLUSION: MDCT allowed diagnosis of different types of endoluminal thrombosis in patients submitted to endovascular repair of aortic abdominal aneurysm. Utilization of this minimally invasive diagnostic technique should be encouraged in clinical practice.

OBJECTIVE: The purpose of this study was to improve the use of 64-channel multidetector computed tomography using lower doses of ionizing radiation during follow-up procedures in a series of patients with endovascular aortic aneurysm repair. METHODS: Thirty patients receiving 5 to 29 months of follow-up after endovascular aortic aneurysm repair were analyzed using a 64-channel multidetector computed tomography device by an exam that included pre-and postcontrast with both arterial and venous phases. Leak presence and type were classified based on the exam phase. RESULTS: Endoleaks were identified in 8/30 of cases; the endoleaks in 3/8 of these cases were not visible in the arterial phases of the exams. CONCLUSION: The authors conclude that multidetector computed tomography with pre-contrast and venous phases should be a part of the ongoing follow-up of patients undergoing endovascular aortic aneurysm repair. The arterial phase can be excluded when the aneurism is stable or regresses. These findings permit a lower radiation dose without jeopardizing the correct diagnosis of an endoleak.

A correção endovascular da dissecção de aorta tipo B tem se mostrado como uma nova alternativa para reduzir o trauma cirúrgico. No entanto, as complicações de médio e longo prazo, tais como a fístula aortoesofágica, são ainda pouco conhecidas e pouco relatadas. O objetivo deste trabalho é descrever três casos de fístula aortoesofágica após o tratamento endovascular de 23 casos de dissecção de aorta descendente conduzidos pela equipe de Cirurgia Vascular da Santa Casa de São Paulo em um estudo retrospectivo. Esses pacientes apresentavam características em comum, como dissecção crônica, pós-operatório imediato sem intercorrências, necessidade de reintervenções, oclusão de troncos arteriais como a artéria subclávia, mesentérica, tronco celíaco, e, ainda, uma rápida evolução para o óbito após os primeiros sinais de fístula. Portanto, embora raramente descrita na literatura, a ocorrência de fístula aortoesofágica é uma complicação de causa até o momento indefinida do tratamento endovascular da dissecção de aorta descendente que merece atenção, dada sua recorrência e evolução fatal.

Endoluminal stent-graft for type B aortic dissection is a new alternative to reduce surgical trauma. However, medium- and long-term complications are still little known and poorly reported, such as the aortic-esophageal fistula. The objective of this study is to describe three cases of aortic-esophageal fistula after the endovascular treatment of 23 cases of descending aortic dissection conducted by the vascular surgery team of Santa Casa de São Paulo in a retrospective study. These patients presented some common characteristics: chronic dissection, successful early outcome, need of reinterventions, occlusion of arterial trunks such as subclavian artery, mesenteric artery, celiac trunk, and finally, a fast fatal course after the first fistula-related symptoms. Therefore, despite rarely described in the literature, aortic-esophageal fistula is a complication of the endovascular treatment of descending aortic dissection which demands attention due to its unpredictability, recurrence, and fatal outcome.

OBJETIVO: Analisar fatores prognósticos relacionados com a letalidade dos doentes com aneurisma de aorta abdominal roto. MÉTODO: Foram analisados, retrospectivamente, 72 doentes portadores de aneurisma de aorta abdominal roto, operados no período de 1976 a 2000 pela disciplina de Cirurgia Vascular da Santa Casa de São Paulo. RESULTADOS: A análise descritiva dos dados mostra média de idade de 67,93 anos, com desvio padrão de 11,58 anos, sendo 32% do sexo feminino e 68% do sexo masculino. Do total, 28% tinham história prévia de aneurisma e 72% desconheciam a doença. A pressão arterial sistólica na admissão foi de 96,53 mmHg. A dor esteve presente em 100% dos doentes, assim como massa abdominal pulsátil. O local de rompimento do aneurisma foi em 93% dos casos para o retroperitônio, 4% para o duodeno e 2% para peritônio livre. CONCLUSÃO: Os fatores prognósticos relacionados à letalidade que se mostraram com significância estatística foram: idade, pressão arterial admissional, diurese intra-operatória, volume infundido e creatinina admissional.

OBJECTIVE: To analyze the prognostic factors related to the mortality of ruptured abdominal aortic aneurysm. METHOD: Seventy-two patients who suffered ruptured abdominal aortic aneurysm and were operated in the period between 1976 and 2000 by the Vascular Surgery Unit of the Santa Casa de São Paulo - School of Medical Sciences were retrospectively analyzed. RESULTS: The descriptive analysis of the data shows a mean age of 67.93 years, with a standard deviation of 11.58, 32% female and 68% male. Of the total number, 28% had a previous history of aneurysm and 72% were not aware of the disease. Mean systolic blood pressure during hospital admission was 96.53 mmHg. Pain was present in 100% of the patients, as well as throbbing abdominal mass. In 93% of the cases the location of the aneurysm rupture was the retroperitoneum, 4% in the duodenum, and 2% in the free peritoneum. CONCLUSION: The prognostic factors related to mortality and morbidity that demonstrated statistical significance were: age, initial blood pressure at hospital admission, diuresis during surgery, volume infused, and creatinine levels.