RESUMO
O aneurisma arterial induzido por uso de muleta é um evento raro, e a associação com aneurismas venosos não está descrita na literatura. Relatamos o caso de uma paciente que, após o uso prolongado dessa órtese, apresentou quadro de isquemia aguda de membro superior secundária à trombose de um aneurisma da artéria braquial, associado ao achado incidental de aneurismas da veia braquial. Embora a principal causa de oclusão arterial aguda de membro superior seja a embolização de fonte cardíaca, deve-se considerar a possibilidade de embolização arterioarterial por aneurismas provocados pelo uso prolongado de muletas. Os aneurismas venosos também devem ser suspeitados, uma vez que podem ser sede de trombos e fonte de êmbolos pulmonares
Crutch-induced arterial aneurysm is a rare event and there are no descriptions in the literature of cases with concomitant venous aneurysms. We report the case of a patient who, after prolonged crutch use, presented with acute ischemia of the upper limb secondary to brachial artery aneurysm thrombosis, associated with the incidental finding of brachial vein aneurysms. Although the main cause of acute upper limb occlusion is embolization of cardiac origin, consideration should be given to the possibility of arterio-arterial embolization due to an aneurysm induced by prolonged use of crutches. Venous aneurysms should also be suspected since they can be sites of thrombosis, and a source of pulmonary embolism
Assuntos
Humanos , Feminino , Idoso , Aneurisma/cirurgia , Artéria Braquial/lesões , Muletas , Embolectomia com Balão/métodos , Isquemia , Aparelhos Ortopédicos/efeitos adversos , Trombose , Ultrassonografia Doppler/métodos , Extremidade Superior , Lesões do Sistema Vascular/complicações , Lesões do Sistema Vascular/diagnósticoRESUMO
Autogenous arteriovenous fistula (AVF) is the first choice for hemodialysis access in renal failure with uremia. However, AVF cannot be performed in some patients due to small and narrow veins in the forearm. In this study, a Fogarty catheter was used to establish autogenous radiocephalic hemodialysis access in patients with small caliber cephalic veins, and the patency rate and complications of this method were observed. Sixty-seven patients with uremia were divided into a treatment group (40 cases, caliber of cephalic veins<2.5 mm) and a control group (27 cases, caliber of cephalic veins≥2.5 mm). According to ultrasound results, the treatment group received AVF after expansion with a Fogarty catheter, and the control group received traditional AVF. The fistula patency rate and complications were observed during follow-up. All patients were followed up for an average period of 18 months (range=3-36 months). AVF was successfully used in 58 patients for hemodialysis, with primary access failure in 9 cases (5 cases in the treatment group and 4 cases in the control group) due to early thrombosis. The primary and secondary patency rates 12 months after surgery in the treatment group were 64 and 72%, respectively, and those in the control group were 60 and 76%, respectively. Patients with small caliber cephalic veins can be treated with radiocephalic fistula after the caliber of cephalic veins is expanded to more than 2.5 mm with a Fogarty catheter. The long-term patency rate awaits observation in a longer follow-up period.