Aneurisma de la aorta abdominal: controversias y tendencias en su diagnóstico y manejo
Palabras clave:
aneurisma de la aorta abdominal, técnicas de diagnóstico cardiovascular, procedimientos quirúrgicos vascularesResumen
Los aneurismas de aorta abdominal son una altera- ción frecuente en poblaciones con edad mayor de 65 años. Si se tiene en cuenta que la mayoría de los casos son asintomáticos, esta condición debería ser tamizada en todo paciente con factores de riesgo.
Su tratamiento se fundamenta en el riesgo de rup- tura y la mortalidad asociada. El abordaje qui- rúrgico está indicado siempre que el paciente presente síntomas o complicaciones asociadas (embolia distal, efecto compresivo en estructuras adyacentes) o cuando el diámetro del aneurisma supere los 5,5 cm. Las opciones de manejo con- sisten en un abordaje convencional (vía abierta) o en un abordaje intravascular. La decisión debe basarse en un proceso individualizado en el que se consideren las enfermedades concomitantes, las preferencias del paciente y la experiencia del equipo médico.
Con este objetivo, se revisará el conocimiento actual respecto al manejo de aneurismas menores de 5,5 cm de diámetro, y las nuevas tendencias en cuanto a terapias farmacológicas y a modificaciones del estilo de vida, que han probado ser protectoras.
El artículo incluye una revisión de la literatura y la presentación de un caso clínico.
Descargas
Los datos de descargas todavía no están disponibles.
Referencias bibliográficas
1. González Di-Fillipo A, Pestana-Tirado RA, Marzán-Esquivel AJ, Vengoechea-Hernández AF. Cirugía del aneurisma de la aorta abdominal: bases fisiológicas y monitoría. Experiencia en el Hos- pital Universitario de Cartagena. Revista Colombiana de Cirugía. 1999;14:152.
2. Zankl AR, Schumacher H, Krumsdorf U, Katus HA, Jahn L, Tiefenbacher CP. Pathology, natural history and treatment of ab- dominal aortic aneurysms. Clin Res Cardiol. 2007;96:140-51.
https://doi.org/10.1007/s00392-007-0472-5
3. Riambau V, Guerrero F, Montana X, Gilabert R. Abdominal aortic aneurysm and renovascular disease. Rev Esp Cardiol. 2007;60:639-54.
https://doi.org/10.1157/13107121
4. Lederle FA. Ultrasonographic screening for abdominal aortic aneurysms. Ann Intern Med. 2003;139:516-22.
https://doi.org/10.7326/0003-4819-139-6-200309160-00016
5. Valdes F, Sepúlveda N, Kramer A, Mertens R, Bergoeing M, Marine L, et al. Frequency of abdominal aortic aneurysms in adult population with known risk factors. Rev Med Chil. 2003;131:741-7.
6. Choksy SA, Wilmink AB, Quick CR. Ruptured abdominal aortic aneurysm in the Huntingdon district: A 10-year experience. Ann R Coll Surg Engl. 1999;81:27-31.
7. Blanchard JF, Armenian HK, Friesen PP. Risk factors for abdo- minal aortic aneurysm: Results of a case-control study. Am J Epidemiol. 2000;151:575-83.
https://doi.org/10.1093/oxfordjournals.aje.a010245
8. Brady AR, Thompson SG, Fowkes FG, Greenhalgh RM, Powell JT. Abdominal aortic aneurysm expansion: Risk factors and time intervals for surveillance. Circulation. 2004;110:16-21.
https://doi.org/10.1161/01.CIR.0000133279.07468.9F
9. Kent KC, Zwolak RM, Egorova NN, Riles TS, Manganaro A, Moskowitz AJ, et al. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg. 2010;52:539-48.
https://doi.org/10.1016/j.jvs.2010.05.090
10. Tang T, Wai-Leng C, Munday I, Gaunt M. Ruptured abdominal aortic aneurysm. Lancet. 2005;365:818.
https://doi.org/10.1016/S0140-6736(05)17993-8
11. Lindholt JS, Sorensen J, Sogaard R, Henneberg EW. Long-term benefit and cost-effectiveness analysis of screening for abdomi- nal aortic aneurysms from a randomized controlled trial. Br J Surg. 2010;97:826-34.
https://doi.org/10.1002/bjs.7001
12. Norman PE, Jamrozik K, Lawrence-Brown MM, Le MT, Spencer CA, Tuohy RJ, et al. Population based randomized controlled trial on impact of screening on mortality from abdominal aortic aneurysm. BMJ. 2004;329:1259.
https://doi.org/10.1136/bmj.329.7477.1259
13. Ashton HA, Buxton MJ, Day NE, Kim LG, Marteau TM, Scott RA, et al. The Multicentre Aneurysm Screening Study (MASS. into the effect of abdominal aortic aneurysm screening on mortality in men: A randomized controlled trial. Lancet. 2002;360:1531-9.
https://doi.org/10.1016/S0140-6736(02)11522-4
14. Greco G, Egorova NN, Gelijns AC, Moskowitz AJ, Manganaro AJ, Zwolak RM, et al. Development of a novel scoring tool for the identification of large =5 cm abdominal aortic aneurysms. Ann Surg. 2010;252:675-82.
https://doi.org/10.1097/SLA.0b013e3181f621c8
15. Scott RA, Bridgewater SG, Ashton HA. Randomized clinical trial of screening for abdominal aortic aneurysm in women. Br J Surg. 2002;89:283-5.
https://doi.org/10.1046/j.0007-1323.2001.02014.x
16. Mofidi R, Goldie VJ, Kelman J, Dawson AR, Murie JA, Chalmers RT. Influence of sex on expansion rate of abdominal aortic aneurysms. Br J Surg. 2007;94:310-4.
https://doi.org/10.1002/bjs.5573
17. Solberg S, Singh K, Wilsgaard T, Jacobsen BK. Increased growth rate of abdominal aortic aneurysms in women. The Tromso study. Eur J Vasc Endovasc Surg. 2005;29:145-9.
https://doi.org/10.1016/j.ejvs.2004.11.015
18. Silverstein MD, Pitts SR, Chaikof EL, Ballard DJ. Abdominal aortic aneurysm (AAA): Cost-effectiveness of screening, surveillance of intermediate-sized AAA, and management of symptomatic AAA. Proc (Bayl Univ Med Cent). 2005;18:345- 67.
https://doi.org/10.1080/08998280.2005.11928095
19. Manning BJ, Kristmundsson T, Sonesson B, Resch T. Abdo- minal aortic aneurysm diameter: A comparison of ultrasound measurements with those from standard and three-dimensional computed tomography reconstruction. J Vasc Surg. 2009;50:263- 8.
https://doi.org/10.1016/j.jvs.2009.02.243
20. Brown LC, Powell JT. Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants. Ann Surg. 1999;230:289-96.
https://doi.org/10.1097/00000658-199909000-00002
21. Hertzer NR, Mascha EJ, Karafa MT, O'Hara PJ, Krajewski LP, Beven EG. Open infrarenal abdominal aortic aneurysm repair: The Cleveland Clinic experience from 1989 to 1998. J Vasc Surg. 2002;35:1145-54.
https://doi.org/10.1067/mva.2002.123686
22. Ouriel K. The PIVOTAL study: A randomized comparison of endovascular repair versus surveillance in patients with smaller abdominal aortic aneurysms. J Vasc Surg. 2009;49:266-9.
https://doi.org/10.1016/j.jvs.2008.11.048
23. BrewsterDC,CronenwettJL,HallettJWJr,JohnstonKW,Krupski WC, Matsumura JS. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg. 2003;37:1106-17.
https://doi.org/10.1067/mva.2003.363
24. Thompson AR, Cooper JA, Ashton HA, Hafez H. Growth rates of small abdominal aortic aneurysms correlate with clinical events. Br J Surg. 2010;97:37-44.
https://doi.org/10.1002/bjs.6779
25. Goodney PP, Tavris D, Lucas FL, Gross T, Fisher ES, Finlayson SR. Causes of late mortality after endovascular and open surgical repair of infrarenal abdominal aortic aneurysms. J Vasc Surg. 2010;51:1340-7.
https://doi.org/10.1016/j.jvs.2010.01.054
26. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): Randomized controlled trial. Lancet. 2005;365:2179-86.
https://doi.org/10.1016/S0140-6736(05)66627-5
27. De Bruin JL, Baas AF, Buth J, Prinssen M, Verhoeven EL, Cuypers PW, et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2010;362:1881-9.
https://doi.org/10.1056/NEJMoa0909499
28. Lederle FA, Johnson GR, Wilson SE, Chute EP, Littooy FN, Bandyk D, et al. Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group. Ann Intern Med. 1997;126:441-9.
https://doi.org/10.7326/0003-4819-126-6-199703150-00004
29. The UK Small Aneurysm Trial. Mortality results for randomized controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet. 1998;352:1649-55.
https://doi.org/10.1016/S0140-6736(98)10137-X
30. Lederle FA, Wilson SE, Johnson GR, Reinke DB, Littooy FN, Acher CW, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002;346:1437-44.
https://doi.org/10.1056/NEJMoa012573
31. Cao P, De RP, Verzini F, Parlani G, Romano L, Cieri E. Comparison of Surveillance Versus Aortic Endografting for Small Aneurysm Repair (CAESAR): Results from a randomised trial. Eur J Vasc Endovasc Surg. 2010; Nov 22. [Epub ahead of print]
https://doi.org/10.1016/j.jvs.2010.11.058
32. Sadat U, Boyle JR, Walsh SR, Tang T, Varty K, Hayes PD. Endovascular Vs. open repair of acute abdominal aortic aneurysms -a systematic review and meta-analysis. J Vasc Surg. 2008;48:227-36.
https://doi.org/10.1016/j.jvs.2007.11.028
33. Mastracci TM, Garrido-Olivares L, Cina CS, Clase CM. Endovascular repair of ruptured abdominal aortic aneurysms: A systematic review and meta-analysis. J Vasc Surg. 2008;47:214-21.
https://doi.org/10.1016/j.jvs.2007.07.052
34. Rose DF, Davidson IR, Hinchliffe RJ, Whitaker SC, Gregson RH, MacSweeney ST, et al. Anatomical suitability of ruptured abdominal aortic aneurysms for endovascular repair. J Endovasc Ther. 2003;10:453-7.
https://doi.org/10.1177/152660280301000309
35. Reichart M, Geelkerken RH, Huisman AB, van Det RJ, de Smit P, Volker EP. Ruptured abdominal aortic aneurysm: Endovascular repair is feasible in 40% of patients. Eur J Vasc Endovasc Surg. 2003;26:479-86.
https://doi.org/10.1016/S1078-5884(03)00346-0
36. Lloyd GM, Bown MJ, Norwood MG, Deb R, Fishwick G, Bell PR, et al. Feasibility of preoperative computer tomography in patients with ruptured abdominal aortic aneurysm: A time-to- death study in patients without operation. J Vasc Surg. 2004;39:788-91.
https://doi.org/10.1016/j.jvs.2003.11.041
37. Golledge J, Norman PE. Pathophysiology of abdominal aortic aneurysm relevant to improvements in patients' management. Curr Opin Cardiol. 2009;24:532-8.
https://doi.org/10.1097/HCO.0b013e328330c2d3
38. Baxter BT, Terrin MC, Dalman RL. Medical management of small abdominal aortic aneurysms. Circulation. 2008;117:1883-9.
https://doi.org/10.1161/CIRCULATIONAHA.107.735274
39. Mosorin M, Juvonen J, Biancari F, Satta J, Surcel HM, Leinonen M, et al. Use of doxycycline to decrease the growth rate of ab- dominal aortic aneurysms: A randomized, double-blind, placebo- controlled pilot study. J Vasc Surg. 2001;34:606-10.
https://doi.org/10.1067/mva.2001.117891
40. Baxter BT, Pearce WH, Waltke EA, Littooy FN, Hallett JW Jr, Kent KC, et al. Prolonged administration of doxycycline in patients with small asymptomatic abdominal aortic aneurysms: report of a prospective (Phase II) multicenter study. J Vasc Surg. 2002;36:1-12.
https://doi.org/10.1067/mva.2002.125018
41. Veraldi GF, Tasselli S, de Manzani G, Cordiano C. Surgical treatment of abdominal aortic aneurysm with concomitant renal cell carcinoma: A single-centre experience with review of the literature. J Cardiovasc Surg (Torino). 2006;47:643-9.
42. Hafez KS, El Fettouh HA, Novick AC, Ouriel K. Management of synchronous renal neoplasm and abdominal aortic aneurysm. J Vasc Surg. 2000;32:1102-10.
https://doi.org/10.1067/mva.2000.111539
43. Grego F, Lepidi S, Bassi P, Tavolini IM, Noventa F, Pagano F, et al. Simultaneous surgical treatment of abdominal aortic aneurysm and carcinoma of the bladder. J Vasc Surg. 2003;37:607-14
https://doi.org/10.1067/mva.2003.26
2. Zankl AR, Schumacher H, Krumsdorf U, Katus HA, Jahn L, Tiefenbacher CP. Pathology, natural history and treatment of ab- dominal aortic aneurysms. Clin Res Cardiol. 2007;96:140-51.
https://doi.org/10.1007/s00392-007-0472-5
3. Riambau V, Guerrero F, Montana X, Gilabert R. Abdominal aortic aneurysm and renovascular disease. Rev Esp Cardiol. 2007;60:639-54.
https://doi.org/10.1157/13107121
4. Lederle FA. Ultrasonographic screening for abdominal aortic aneurysms. Ann Intern Med. 2003;139:516-22.
https://doi.org/10.7326/0003-4819-139-6-200309160-00016
5. Valdes F, Sepúlveda N, Kramer A, Mertens R, Bergoeing M, Marine L, et al. Frequency of abdominal aortic aneurysms in adult population with known risk factors. Rev Med Chil. 2003;131:741-7.
6. Choksy SA, Wilmink AB, Quick CR. Ruptured abdominal aortic aneurysm in the Huntingdon district: A 10-year experience. Ann R Coll Surg Engl. 1999;81:27-31.
7. Blanchard JF, Armenian HK, Friesen PP. Risk factors for abdo- minal aortic aneurysm: Results of a case-control study. Am J Epidemiol. 2000;151:575-83.
https://doi.org/10.1093/oxfordjournals.aje.a010245
8. Brady AR, Thompson SG, Fowkes FG, Greenhalgh RM, Powell JT. Abdominal aortic aneurysm expansion: Risk factors and time intervals for surveillance. Circulation. 2004;110:16-21.
https://doi.org/10.1161/01.CIR.0000133279.07468.9F
9. Kent KC, Zwolak RM, Egorova NN, Riles TS, Manganaro A, Moskowitz AJ, et al. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg. 2010;52:539-48.
https://doi.org/10.1016/j.jvs.2010.05.090
10. Tang T, Wai-Leng C, Munday I, Gaunt M. Ruptured abdominal aortic aneurysm. Lancet. 2005;365:818.
https://doi.org/10.1016/S0140-6736(05)17993-8
11. Lindholt JS, Sorensen J, Sogaard R, Henneberg EW. Long-term benefit and cost-effectiveness analysis of screening for abdomi- nal aortic aneurysms from a randomized controlled trial. Br J Surg. 2010;97:826-34.
https://doi.org/10.1002/bjs.7001
12. Norman PE, Jamrozik K, Lawrence-Brown MM, Le MT, Spencer CA, Tuohy RJ, et al. Population based randomized controlled trial on impact of screening on mortality from abdominal aortic aneurysm. BMJ. 2004;329:1259.
https://doi.org/10.1136/bmj.329.7477.1259
13. Ashton HA, Buxton MJ, Day NE, Kim LG, Marteau TM, Scott RA, et al. The Multicentre Aneurysm Screening Study (MASS. into the effect of abdominal aortic aneurysm screening on mortality in men: A randomized controlled trial. Lancet. 2002;360:1531-9.
https://doi.org/10.1016/S0140-6736(02)11522-4
14. Greco G, Egorova NN, Gelijns AC, Moskowitz AJ, Manganaro AJ, Zwolak RM, et al. Development of a novel scoring tool for the identification of large =5 cm abdominal aortic aneurysms. Ann Surg. 2010;252:675-82.
https://doi.org/10.1097/SLA.0b013e3181f621c8
15. Scott RA, Bridgewater SG, Ashton HA. Randomized clinical trial of screening for abdominal aortic aneurysm in women. Br J Surg. 2002;89:283-5.
https://doi.org/10.1046/j.0007-1323.2001.02014.x
16. Mofidi R, Goldie VJ, Kelman J, Dawson AR, Murie JA, Chalmers RT. Influence of sex on expansion rate of abdominal aortic aneurysms. Br J Surg. 2007;94:310-4.
https://doi.org/10.1002/bjs.5573
17. Solberg S, Singh K, Wilsgaard T, Jacobsen BK. Increased growth rate of abdominal aortic aneurysms in women. The Tromso study. Eur J Vasc Endovasc Surg. 2005;29:145-9.
https://doi.org/10.1016/j.ejvs.2004.11.015
18. Silverstein MD, Pitts SR, Chaikof EL, Ballard DJ. Abdominal aortic aneurysm (AAA): Cost-effectiveness of screening, surveillance of intermediate-sized AAA, and management of symptomatic AAA. Proc (Bayl Univ Med Cent). 2005;18:345- 67.
https://doi.org/10.1080/08998280.2005.11928095
19. Manning BJ, Kristmundsson T, Sonesson B, Resch T. Abdo- minal aortic aneurysm diameter: A comparison of ultrasound measurements with those from standard and three-dimensional computed tomography reconstruction. J Vasc Surg. 2009;50:263- 8.
https://doi.org/10.1016/j.jvs.2009.02.243
20. Brown LC, Powell JT. Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants. Ann Surg. 1999;230:289-96.
https://doi.org/10.1097/00000658-199909000-00002
21. Hertzer NR, Mascha EJ, Karafa MT, O'Hara PJ, Krajewski LP, Beven EG. Open infrarenal abdominal aortic aneurysm repair: The Cleveland Clinic experience from 1989 to 1998. J Vasc Surg. 2002;35:1145-54.
https://doi.org/10.1067/mva.2002.123686
22. Ouriel K. The PIVOTAL study: A randomized comparison of endovascular repair versus surveillance in patients with smaller abdominal aortic aneurysms. J Vasc Surg. 2009;49:266-9.
https://doi.org/10.1016/j.jvs.2008.11.048
23. BrewsterDC,CronenwettJL,HallettJWJr,JohnstonKW,Krupski WC, Matsumura JS. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg. 2003;37:1106-17.
https://doi.org/10.1067/mva.2003.363
24. Thompson AR, Cooper JA, Ashton HA, Hafez H. Growth rates of small abdominal aortic aneurysms correlate with clinical events. Br J Surg. 2010;97:37-44.
https://doi.org/10.1002/bjs.6779
25. Goodney PP, Tavris D, Lucas FL, Gross T, Fisher ES, Finlayson SR. Causes of late mortality after endovascular and open surgical repair of infrarenal abdominal aortic aneurysms. J Vasc Surg. 2010;51:1340-7.
https://doi.org/10.1016/j.jvs.2010.01.054
26. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): Randomized controlled trial. Lancet. 2005;365:2179-86.
https://doi.org/10.1016/S0140-6736(05)66627-5
27. De Bruin JL, Baas AF, Buth J, Prinssen M, Verhoeven EL, Cuypers PW, et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2010;362:1881-9.
https://doi.org/10.1056/NEJMoa0909499
28. Lederle FA, Johnson GR, Wilson SE, Chute EP, Littooy FN, Bandyk D, et al. Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group. Ann Intern Med. 1997;126:441-9.
https://doi.org/10.7326/0003-4819-126-6-199703150-00004
29. The UK Small Aneurysm Trial. Mortality results for randomized controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet. 1998;352:1649-55.
https://doi.org/10.1016/S0140-6736(98)10137-X
30. Lederle FA, Wilson SE, Johnson GR, Reinke DB, Littooy FN, Acher CW, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002;346:1437-44.
https://doi.org/10.1056/NEJMoa012573
31. Cao P, De RP, Verzini F, Parlani G, Romano L, Cieri E. Comparison of Surveillance Versus Aortic Endografting for Small Aneurysm Repair (CAESAR): Results from a randomised trial. Eur J Vasc Endovasc Surg. 2010; Nov 22. [Epub ahead of print]
https://doi.org/10.1016/j.jvs.2010.11.058
32. Sadat U, Boyle JR, Walsh SR, Tang T, Varty K, Hayes PD. Endovascular Vs. open repair of acute abdominal aortic aneurysms -a systematic review and meta-analysis. J Vasc Surg. 2008;48:227-36.
https://doi.org/10.1016/j.jvs.2007.11.028
33. Mastracci TM, Garrido-Olivares L, Cina CS, Clase CM. Endovascular repair of ruptured abdominal aortic aneurysms: A systematic review and meta-analysis. J Vasc Surg. 2008;47:214-21.
https://doi.org/10.1016/j.jvs.2007.07.052
34. Rose DF, Davidson IR, Hinchliffe RJ, Whitaker SC, Gregson RH, MacSweeney ST, et al. Anatomical suitability of ruptured abdominal aortic aneurysms for endovascular repair. J Endovasc Ther. 2003;10:453-7.
https://doi.org/10.1177/152660280301000309
35. Reichart M, Geelkerken RH, Huisman AB, van Det RJ, de Smit P, Volker EP. Ruptured abdominal aortic aneurysm: Endovascular repair is feasible in 40% of patients. Eur J Vasc Endovasc Surg. 2003;26:479-86.
https://doi.org/10.1016/S1078-5884(03)00346-0
36. Lloyd GM, Bown MJ, Norwood MG, Deb R, Fishwick G, Bell PR, et al. Feasibility of preoperative computer tomography in patients with ruptured abdominal aortic aneurysm: A time-to- death study in patients without operation. J Vasc Surg. 2004;39:788-91.
https://doi.org/10.1016/j.jvs.2003.11.041
37. Golledge J, Norman PE. Pathophysiology of abdominal aortic aneurysm relevant to improvements in patients' management. Curr Opin Cardiol. 2009;24:532-8.
https://doi.org/10.1097/HCO.0b013e328330c2d3
38. Baxter BT, Terrin MC, Dalman RL. Medical management of small abdominal aortic aneurysms. Circulation. 2008;117:1883-9.
https://doi.org/10.1161/CIRCULATIONAHA.107.735274
39. Mosorin M, Juvonen J, Biancari F, Satta J, Surcel HM, Leinonen M, et al. Use of doxycycline to decrease the growth rate of ab- dominal aortic aneurysms: A randomized, double-blind, placebo- controlled pilot study. J Vasc Surg. 2001;34:606-10.
https://doi.org/10.1067/mva.2001.117891
40. Baxter BT, Pearce WH, Waltke EA, Littooy FN, Hallett JW Jr, Kent KC, et al. Prolonged administration of doxycycline in patients with small asymptomatic abdominal aortic aneurysms: report of a prospective (Phase II) multicenter study. J Vasc Surg. 2002;36:1-12.
https://doi.org/10.1067/mva.2002.125018
41. Veraldi GF, Tasselli S, de Manzani G, Cordiano C. Surgical treatment of abdominal aortic aneurysm with concomitant renal cell carcinoma: A single-centre experience with review of the literature. J Cardiovasc Surg (Torino). 2006;47:643-9.
42. Hafez KS, El Fettouh HA, Novick AC, Ouriel K. Management of synchronous renal neoplasm and abdominal aortic aneurysm. J Vasc Surg. 2000;32:1102-10.
https://doi.org/10.1067/mva.2000.111539
43. Grego F, Lepidi S, Bassi P, Tavolini IM, Noventa F, Pagano F, et al. Simultaneous surgical treatment of abdominal aortic aneurysm and carcinoma of the bladder. J Vasc Surg. 2003;37:607-14
https://doi.org/10.1067/mva.2003.26
Descargas
Publicado
2010-10-01
Cómo citar
(1)
Ramírez, J.; Pozo, M. E. Aneurisma De La Aorta Abdominal: Controversias Y Tendencias En Su diagnóstico Y Manejo. Rev Colomb Cir 2010, 25, 323-331.
Número
Sección
Presentación de Caso
Licencia
Todos los textos incluidos en la Revista Colombiana de Cirugía están protegidos por derechos de autor. Las opiniones expresadas en los artículos firmados son las de los autores y no coinciden necesariamente con las de los directores o los editores de la Revista Colombiana de Cirugía. Las sugerencias diagnósticas o terapéuticas como elección de productos, dosificación y métodos de empleo corresponden a la experiencia y al criterio de los autores.
Métricas
.jpg)
