Abstract
Resumo Os autores apresentam um relato de caso de vítima de acidente de trabalho com ferimento penetrante em região inguinal direita com peça metálica em espiral, que evoluiu com fístula arteriovenosa da artéria femoral profunda com a veia femoral profunda associado a pseudoaneurisma envolvendo essas estruturas e a veia femoral comum. As fístulas arteriovenosas ocorrem frequentemente após traumas e a associação com pseudoaneurisma é fato raro, devendo ser tratadas precocemente após seu diagnóstico. O ultrassom duplex é atualmente o exame mais utilizado para a avaliação inicial e a arteriografia, o padrão ouro para diagnóstico. No paciente em questão foi realizado tratamento convencional com abordagem cirúrgica direta, sutura arterial e ligaduras venosas. Entretanto, nos dias atuais a cirurgia endovascular e a compressão guiada por ultrassom são métodos terapêuticos que têm sido utilizados com sucesso. O paciente evoluiu sem intercorrência, recebendo alta para acompanhamento ambulatorial com preservação do membro.
Highlights
Trauma is the number one cause of death among people up to 44 years of age and the third greatest cause of death in the population in general, according to studies conducted in the 1980s and 1990s.1 Traumas cause vascular injuries in 3% of the population.[2]
Pseudoaneurysms and arteriovenous fistulas (AVFs) are among the complications caused by vascular traumatisms and are associated with high rates of morbidity and mortality.[3]
Pseudoaneurysms are defined as widening of an artery caused by partial rupture of layers of the walls of blood vessels, with hematoma contained within periarterial tissues.[4]
Summary
Trauma is the number one cause of death among people up to 44 years of age and the third greatest cause of death in the population in general, according to studies conducted in the 1980s and 1990s.1 Traumas cause vascular injuries in 3% of the population.[2]. During a physical examination conducted the day after the operation, a thrill was detected in the right inguinal region, prompting further examination with ultrasonography and digital arteriography, which revealed an AVF between the deep femoral artery and the deep femoral vein, associated with a pseudoaneurysm encompassing these structures and the common femoral vein (Figure 3). Four days after the initial operation, the patient underwent a second surgical intervention to correct these vascular injuries. This surgical procedure began with an oblique incision at the base of the right thigh, opening the femoral sheath to expose the structures and confirm the damage seen on arteriography. The patient did not suffer from any complications related to the limb that had suffered the arteriovenous fistula and pseudoaneurysm
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