Manejo de pseudoaneurismas asociados a tratamientos endovasculares en tercer nivel de atención
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Palabras clave
Aneurisma Falso, Trombina, Procedimientos Quirúrgicos Vasculares
Resumen
Introducción: los pseudoaneurismas se producen cuando se lesiona la pared de un vaso sanguíneo y la sangre que se filtra se acumula en el tejido circundante, con una prevalencia del 0.5 al 2%. Su etiología se asocia principalmente a punción arterial, tamaño de aguja e introductor, uso de ultrasonido (US), duración o complejidad del procedimiento, así como al uso de anticoagulación y de dispositivos de cierre. Entre los factores de riesgo se incluyen edad ≥ 75 años, sexo mujer, enfermedad renal crónica, hipertensión arterial sistémica, diabetes mellitus tipo 2, arritmia cardíaca, presencia de tejidos infectados y múltiples intentos de punción.
Objetivo: analizar protocolos de manejo de pseudoaneurismas secundarios a procedimientos endovasculares en una unidad de tercer nivel de atención del occidente de México.
Material y métodos: estudio transversal analítico con componente longitudinal. Se evaluaron expedientes electrónicos y reportes de US con diagnóstico de pseudoaneurisma en pacientes sometidos a procedimientos endovasculares, del 1 de enero al 31 de diciembre de 2022. Se consideró estadísticamente significativo un valor p ≤ 0.05.
Resultados: se evaluaron 48 pacientes: Grupo 1 (tratamiento conservador, n = 27) y Grupo 2 (invasivo, n = 21). Grupo 2 frente a Grupo 1: edad promedio (62.67 ± 16.93 frente a 66.48 ± 11; p = 0.018). Tipo de procedimiento: cateterismo cardíaco, angioplastia periférica e implantación de válvula aórtica percutánea; tiempo (días) solicitud de valoración (158 ± 34.4 frente a 6.86 ± 1.32; p = 0.032); acceso femoral (62% frente a 52%; p = 0.125); tamaño del saco ≥ 3 cm (81% frente a 22%; p = 0.001).
Conclusiones: 56% se resolvió con manejo conservador y 44% requirió tratamiento invasivo.
Referencias
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