Aneurismas de Aorta descendente
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Aneurismas de Aorta descendente
Clínica Vascular Zurbano
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Diámetro del saco > 2 veces el diámetro normal
de la aorta para el sexo y superficie corporal.
aneurismas de aorta descendente
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aneurismas de aorta descendente
Supervivencia:2 años: 24% - 28%
5 años: 7% - 19%
Mortalidad: 5 de cada 100.000 habitantes
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aneurismas de aorta descendente
etiología
enfermedad degenerativa de la media (79%)
disección crónica (7%)
ateromatosis (6’7%)
micóticos (1’1%)
aortitis (1’1%)
traumáticos
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aneurismas de aorta descendente
Enfermedad degenerativa de la media:
necrosis quística de la media
degeneración mixoide
aorta senil
síndrome de Marfan
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aneurismas de aorta descendente
fusiforme sacular
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aneurismas de aorta descendente
Síntomas:
dolor ronquera
disnea, tos paraparaseia/plejia
hemoptisis insf cardiaca aguda
disfagia y/o oclus. a.viscerales
hematemesis embolizaciones
ictericia
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aneurismas de aorta descendente
diagnóstico:
# Rx tórax
# RNM
# TAC
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aneurismas de aorta descendente
enfermedades asociadas:
0%
20%
40%
60%
80%
HTA
ECV
EPOC
HTA
C.Isquemica
IRC
ECV
EVP
EVV
EPOC
Fumador
Diabetes
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aneurismas de aorta descendente
tratamiento:
< 5 cm seguimiento
> 6 cm cirugía
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aneurismas de aorta descendente
indicaciones absolutas de cirugía:
ruptura
síntomas por compresión o erosión
diámetro > 60 mm en s. Marfan
diámetro > 65 mm en el resto de los pacientes
aumento del diámetro > 1 cm al año.
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aneurismas de aorta descendente
contraindicaciones de cirugía:
relativa: > 70 años
EPOC severo
cáncer con escasa supervivencia
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aneurismas de aorta descendente
Vía de abordaje
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aneurismas de aorta descendente
Disección y control
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aneurismas de aorta descendente
Apertura de saco
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aneurismas de aorta descendente
Sutura proximal
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aneurismas de aorta descendente
Implantación de
la prótesis
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aneurismas de aorta descendente
control
postoperatorio
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aneurismas de aorta descendente
resultados:
Mortalidad
intubación prolongada 33%
IRC 4% -40%
isquemia medular 4% - 27%
electiva 6% - 12%
urgente 20% - 22%
rotos > 50%
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aneurismas de aorta descendente
Es una patología muy grave que evoluciona
hacia la ruptura.
A partir de un determinado diámetro
el tratamiento es quirúrgico.
Debe ser realizado por equipos bien dotados
y entrenados.
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cirugía endovascular de aneurismas
aneurismas candidatos
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cirugía endovascular de aneurismas
aneurismas no candidatos
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cirugía endovascular de aneurismas
contraindicaciones morfológicas
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cirugía endovascular de aneurismas
Tipos de endoprótesis
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cirugía endovascular de aneurismas
Implantación ideal
de endoprótesis
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cirugía endovascular de aneurismas
implantación de endoprótesis
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cirugía endovascular de aneurismas
Colocación de la endoprótesis
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cirugía endovascular de aneurismas
control RNM de
prótesis implantada
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cirugía endovascular de aneurismas
stent
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cirugía endovascular de aneurismas
Integración del stent
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cirugía endovascular de aneurismas