Professional Documents
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DIAGNSTICO E TRATAMENTO
Participantes:
Grupo de estudo:
Calgero Presti
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OBJETIVO:
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1. Introduo
2. Fatores de risco
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4. Mtodos diagnsticos
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com sintomas de claudicao intermitente, o ITB deve ser medido aps exerccio
no caso de um ITB normal em repouso.24
Ecodoppler Duplex29,30
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5. Tratamento
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Tratamento Farmacolgico
Metanlises distintas43,44 evidenciaram a superioridade do cilostazol versus
placebo em portadores de claudicao intermitente, tanto para a distncia inicial
de aparecimento dos sintomas quando para a distncia mxima percorrida. (A)
Terapia endovascular
Procedimentos endovasculares so indicados para pacientes com CI que
no responderam ao tratamento com exerccio ou com medicamentos, com
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Cirurgia Convencional
Com base nas evidncias avaliadas, a recomendao de cirurgia para
claudicao intermitente deve ser limitada para pacientes com estilo de vida
comprometido pela doena e quando a terapia endovascular contraindicada ou
apresentou falha teraputica10,25.
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Medicamentos
Agentes Antiplaquetrios aps revascularizao infrainguinal
Em pacientes sintomticos, submetidos a bypass infrainguinal, a terapia
antiplaquetria com aspirina contribui com um sensvel benefcio nos ndices de
perviedade.51(A).
Terapia endovascular
A reviso sistemtica de 22 estudos observacionais e um ensaio clnico
controlado, (totalizando 12.779 portadores de isquemia critica) observou que no
perodo de seis meses a um ano, o procedimento endovascular (maioria
angioplastia transluminal percutnea) ofereceu melhores resultados nos
desfechos mortalidade, taxas de amputao e sobrevida livre de amputao. Em
perodos maiores, no foi encontrada diferena entre a cirurgia e os
procedimentos endovasculares (Jones 2014)52 (A).
Segmento Aorto-ilaco
Metanlise publicada em 2011 avaliou a angioplastia percutnea no
tratamento de pacientes com leses iliacas (TASC C e D) e observou que os
desfechos a curto e longo prazos foram aceitveis, com melhora da perviedade
com uso de stent primrio53 (A).
Segmento Femoropopliteo
A angioplastia percutnea do segmento femoropoplteo sofreu enorme
avano tcnico nos ltimos anos com a evoluo e com o surgimento de novos
materiais endovasculares. Os fatores independentes diretamente relacionados
com a ocluso de uma angioplastia do segmento femoropoplteo so o tabagismo,
a extenso da leso e a condio do escoamento arterial.
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Vraux 2006 73 46 82 24 52 87 64
Casella 2010 76 48 96 24 64 68 85
Soderstrom 262 ? 60 - 75 48
2010 77
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Angioplastia Subintimal
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Cirurgia Convencional
Substitutos Arteriais
Revascularizaes com substitutos autlogos no convencionais (veias
superficiais de brao) no apresentam resultados equivalentes de perviedade aos
observados com a veia safena magna.90-92 Porm, so claramente superiores aos
substitutos sintticos nas revascularizaes infrageniculares.
Quando uma veia autloga no est disponvel, tanto dacron ou enxertos
de PTFE podem ser usados na cirurgia femoropopltea sem diferena significativa
na perviedade em 5 anos entre ambos (49,2% vs 38,4%)93 (B).
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