Anomalías congénitas de la vena cava inferior. El rol de la ...
Transcript of Anomalías congénitas de la vena cava inferior. El rol de la ...
1 0 4 AbrilJunio 2012
Dr. Alberto Emilio Morató López*Dr. Óscar Quiróz Castro**Dr. José Luis Ramírez Arias*
Anomalías congénitas de la vena cava inferior. El rol de la tomografía computada multidetector
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RESUMEN
Introducción. Las anoma/1&4"9+*0E*.(&4",$"/&"8$*&"9&8&".*;$'.+'" VW?2X" 4+*" '$4R/(&,+",$" /&" %$'4.4($*9.&" +" '$0'$4.M*"anormal de una de las venas $)L'.+*&'.&4"%'$9R'4+'&4@"7+*"'&'&4" <" 0$*$'&/)$*($" 4+*" U&//&O0+4".*9.,$*(&/$4"QR$"%R$,$*"(&)L.E*"%&4&'",$4&%$'9.L.,+4@"N&"(+)+0'&;1&"9+)%R(&,&")R/(.,$($9(+'"V:?H#X"$4"$/")E(+,+",$"$/$99.M*"%&'&"4R",.&0*M4(.9+@Objetivos."-$8.4&'"/&4"9&'&9
($'14(.9&4"&*&(M).9&4"<"$)L'.+/M0.9&4F"&41"9+)+"/&4".)%/.9&9.+*$4"9/1*.9&4"<"QR.'Y'0.9&4",$"/&4"&*+)&/1&4",$"/&"W?2"<",$)+4('&'"/&"R(./.,&,",$"/&":?H#"%&'&"4R"$8&/R&9.M*@Tipos de anomalía de la VCI.
N+4" %'.*9.%&/$4" 4+*P" &X" 8$*&"'$*&/" .OQR.$',&" '$('+&M'(.9&F" LX"
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iscusión. =/" ,.&0*M4(.9+"
,$"&*+)&/1&",$"/&"W?2"%$').($"&/")E,.9+"(+)&'"/&4"9+*4.,$'&ciones pertinentes de acuerdo 9+*"$/" (.%+" V)+,.\9&9.+*$4" $*"(E9*.9&4" QR.'Y'0.9&4F" $4(R,.+4"9+)%/$)$*(&'.+4F" %'$8$*9.M*",$" ('+)L+4.4" 8$*+4&F" $(9@X@"
N&":?H#",$)R$4('&" &,$9R&,&)$*($" $4(&4" &*+)&/1&4" &41"9+)+"U&//&O0+4"&4+9.&,+4"9+)+"8Z'.9$4" ,$" &]R$*($4" <[+" ('+)L+4.4@Conclusión."N&4"&*+)&/1&4"
9+*0E*.(&4",$"/&"W?2"(.$*$*".)%+'(&*($4".)%/.9&9.+*$4"9/1*.9&4"<"QR.'Y'0.9&4"<"%R$,$*"4$'")+(.vo de confusión en estudios de .)&0$*F"/+"QR$"U&9$"*$9$4&'.+"4R"9+*+9.).$*(+@"N&":?H#"U&",$)+4('&,+" 4$'" Y(./" <" $\9.$*($"%&'&",.&0*+4(.9&'"&*+)&/1&4",$"/&"W?2"<"%&'&"$8&/R&'"9+)%/.9&9.+*$4@
Palabras clave:" &*+)&/1&"9+*0E*.(&F" 8$*&" 9&8&" .*;$'.+'F"( +) + 0 ' & ; 1 & " 9 +)% R ( & , &")R/(.,$($9(+'F"('+)L+4.4"8$*+4&@
Continúa en la pág. 105
ARTÍCULO DE REVISIÓN!"#$%&'(%')#(*+$+,-#'./0*1+'23425264378449:
9+*('&4($".*('&8$*+4+")R/(.;Z4.9+"&U+'&"4+*",$($9(&,&4"9+*")&<+'";'$9R$*9.&@^FDF_N&")&<+'1&",$"/&4"&*+)&/1&4"9+*0E*.(&4"4+*"&4.*(+
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$*"%'+9$,.).$*(+4",$"9&($($'.4)+"9&',1&9+F"9+/+9&9.M*",$"\/('+4",$"/&"W?2FGFa"%/&*$&9.M*",$"9.'R01&"9&',1&9&"<"'$%'$4$*(&*"R*"'.$40+"%+($*9.&/",$"9+)%/.9&9.M*",R'&*($"&9(+4"QR.'Y'0.9+4",$/"&L,+)$*F"%'.*9.%&/)$*($"$*"'$('+%$'.(+*$+"<"$*"%'+9$,.).$*(+4".*($'8$*9.+*.4(&4@BFb
Introducción=I.4($"R*"&)%/.+"$4%$9('+",$"&*+)&/1&4"9+*0E*.(&4"
,$" /&"8$*&"9&8&" .*;$'.+'" VW?2XBFc con una prevalencia 0$*$'&/" $4(.)&,&"$*('$" C@^>C@Dd"$*('$" /&" %+L/&9.M*"4&*&"<",$"U&4(&"cd"$*"%&9.$*($4"9+*"+('&4"&*+)&/1&4"9&',.+8&49R/&'$4@^Fe"=4(&4"&*+)&/1&4"4+*"9+*4.,$'&,&4"$*(.,&,$4"'&'&4`"4.*"$)L&'0+F"9+*"$/"&,8$*.).$*(+",$"/&"*R$8&"($9*+/+01&",$"(+)+0'&;1&"9+)%R(&,&")R/(.,$($9(+'"V:?H#X"<"&,QR.4.9.M*",$"$4(R,.+4"9+*")$,.+",$"
1 0 5AbrilJunio 2012
Viene de la pág. 104
ABSTRACT
Introduction." ?+*0$*.(&/"&*+)&/.$4"+;"(U$".*;$'.+'"8$*&"9&8&" V2W?X" &'$" (U$" '$4R/(" +;"persistence or abnormal re0'$44.+*"+;"+*$"+;"(U$"$)L'<+*.9"%'$9R'4+'" 8$.*4@":U$<"&'$"'&'$"&*,"R4R&//<"&'$".*9.,$*(&/"\*,.*04"(U&(")&<"0+"R**+(.9$,@"HR/(.,$($9(+'"9+)%R($,"(+)+0'&%U<"VH#?:X".4"(U$")$(U+,"+;"9U+.9$";+'",.&0*+4.4@Objectives. " -$8.$f" (U$"
&*&(+).9&/" &*," $)L'<+/+0.9&/"9U&'&9($'.4(.94F" &4"f$//" &4" (U$"9/.*.9&/"&*,"4R'0.9&/".)%/.9&(.+*4F"+;" 2W?" &*+)&/.$4" &*," %'+8$"(U$" R4$;R/*$44" +;" H#?:" .*"$8&/R&(.*0"(U$)@
Classification. :U$" )+4("9+))+* " 2W? " 9+*0$* . ( & /"&*+)&/.$4" &'$P " &X" '$('+&+'(.9"/$;(" '$*&/" 8$.*F" LX" 9.'9R)&+'(.9"/$; ( " '$*&/ " 8$.*F " 9X " ,+RL/$".*;'&'$*&/"2W?F",X"/$;(".*;'&'$*&/"2W?F"$X"9+*(.*R&(.+*"+;"2W?"f.(U"&O<0+4" +'" U$).&O<0+4" 8$.*F"&*,";X"&L4$*9$"+;"2W?@"=&9U"+;"(U$4$" &*+)&/.$4" U&4" ,.;;$'$*("g.*,4" +;" 9/.*.9&/" &*," 4R'0.9&/".)%/.9&(.+*4F" fU.9U" .*9/R,$"0'$&($'" '.4g" +;" ,$$%" 8$*+R4"(U'+)L+4.4" &*,[+'" 9U'+*.9"8$*+R4" .*4R;;.9.$*9<" &*," (U$"%+($*(.&/" '.4g" +;" 9+)%/.9&(.+*4".*"&L,+).*&/"+'"9U$4("4R'0$'.$4"&*," )&<" 9&R4$" ,.&0*+4(.9"$''+'4".*".)&0$"($4(4@Discussion. #.&0*+4.4"
+;" 2W?" &*+)&/.$4" &//+f4" (U$",+9(+'" (+" (&g$" (U$" %$'(.*$*("9+*4.,$'&(.+*4" L&4$," +*" (U$"
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Key words: " 9+*0$*. (& /"&*+)&/<F" .*;$'.+'" 8$*&" 9&8&F"mu l t i d e t e c t o r c ompu t ed (+)+0'&%U<F"8$*+R4"(U'+)L+4.4@
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'$%'$4$*(&"$/")E(+,+",$",.&0*M4(.9+",$"$/$99.M*"%&'&"$8&/R&'"/&4"&*+)&/1&4",$"/&"W?2",$L.,+"&"4R"&/(&"'$4+/R9.M*"$4%&9.&/"<"9&%&9.,&,")R/(.%/&*&'FD"&,$)Z4",$"QR$"%$').($",$($9(&'"<"$8&/R&'"9+)%/.9&9.+*$4".*U$'$*($4@3
Objetivosi" -$8.4&'"/&4"9&'&9($'14(.9&4"&*&(M).9&4"<"%+'":?H#"
,$"/+4",.;$'$*($4"(.%+4",$"&*+)&/1&"9+*0E*.(&",$"/&"W?2"U&9.$*,+"E*;&4.4"$*"$/"%'+9$4+"$)L'.+0E*.9+@
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Material y métodos7$" '$&/.OM" R*" $4(R,.+" R*.9E*('.9+F" ,$49'.%(.8+F" '$
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N&"8$*&"9&8&".*;$'.+'",$\*.(.8&"$4(Z"9+*;+')&,&"%+'"9R&('+" 4$0)$*(+4" QR$" 4+*F" $*" +',$*" 9$;&/+>9&R,&/P".*('&U$%Z(.9+F"4R%'&''$*&/F"'$*&/"$".*;'&''$*&/"V\0R'&"BX@=/",$4&''+//+"$)L'.+/M0.9+",$"/&"W?2"4$".*.9.&"9+*"/&"
&%&'.9.M*",$"/&"8$*&"8.($/.*&",$'$9U&"QR$"4$"R*$"&/"4$*+"8$*+4+")$,.&/" ,$'$9U+",$/" (RL+" 9&',1&9+" V\0R'&"cXF").4)&"QR$",&'Z"/R0&'"&"/&"%+'9.M*".*('&U$%Z(.9&",$"/&"W?2F"$*"(&*(+"QR$"/&4"8$*&4"8.($/.*&".OQR.$',&"<"R)L./.9&/$4"+'.0.*&'Z*"/+4"4.*R4+.,$4"U$%Z(.9+4"<"/&4"8$*&4"4R%'&U$%Z(.9&4@"N&"4$9R$*9.&",$"9&)L.+4"$)L'.+*&'.+4"4$"$4QR$)&(.O&"<",$49'.L$"$*"/&4"\0R'&4"B"&"b@
1 0 6 AbrilJunio 2012
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>" W$*&"'$*&/".OQR.$',&"'$('+&M'(.9&>" W$*&"'$*&/".OQR.$',&"9.'9R)&M'(.9&">" #+L/$"W?2".*;'&''$*&/">" W?2".*;'&''$*&/".OQR.$',&>" ?+*(.*R&9.M*",$"/&"W?2"9+*"/&"Z9.0+4"+"U$).Z9.0+4">" KR4$*9.&",$"W?2"
Vena vitelinaderecha
V. subcardinal
V. supracardinal
Ácigos Hemiácigos
V. cardinal posterior
Segmentos de la VCI
Intrahepático
Suprarrenal
Renal
Infrarrenal
Aorta
Conductos de Couvier Vena umbilical derecha Vena vitelina derecha
Bulbo arterial
Ventrículo primitivo
Aurícula primitiva
Senos venosos
Figura 1."7$0)$*(+4",$"/&"8$*&"9&8&".*;$'.+'
Figura 2."=/" (RL+"9&',1&9+@"N+4"9+*,R9(+4",$"?+R8.$'",$'$9U+4" ;+')&*" %&'($" ,$/" 4.4($)&"Z9.0+4@"=/" 4$*+" 8$*+4+".OQR.$',+"4$"U.%+('+\&"%&'&"9+*8$'(.'4$"$*"$/"4$*+"9+'+*&'.+@
Vena vitelinaderecha
V. subcardinal
V. cardinal posterior
Vena vitelinaderecha
V. subcardinal
V. cardinal posterior
Figura 3."K%&'.9.M*",$"/&4"8$*&4"9&',.*&/$4"%+4($'.+'$4"<",$"/&4"4RL9&',.*&/$4@"N&4"8$*&4"9&',.*&/$4",$4$)L+9&*"$*"/+4"9+*,R9(+4",$"?+R8.$'F"$I9$%(+"/&"4RL9&',.*&/",$'$9U&"QR$"4$"9+*$9(&"&"/&"8$*&"8.($/.*&",$'$9U&"QR$",'$*&",.'$9(&)$*($"$*"$/"4$*+"8$*+4+@
Figura 4." J+')&9.M*" ,$" &*&4(+)+4.4" ('&*48$'4&4" .*($'>4RL9&',.*&/"<"%+4($'+9&',.*&/>4RL9&',.*&/$4@"N&4"8$*&4"9&',.*&/$4",$4$)L+9&*"$*"/+4"9+*,R9(+4",$"?+R8.$'F"$I9$%(+"/&"4RL9&',.*&/",$'$9U&"QR$"4$"9+*$9(&"&"/&"8$*&"8.($/.*&",$'$9U&"QR$",'$*&",.'$9(&)$*($"$*"$/"4$*+"8$*+4+@
Vena renal izquierda retroaórtica=*"$4(&"&*+)&/1&"/&"8$*&"'$*&/".OQR.$',&"$4"Y*.9&"
<"(.$*$"('&<$9(+"'$('+&M'(.9+"V\0R'&"BCX@"7$",$L$"&"/&"%$'4.4($*9.&",$"/&"8$*&".*($'4R%'&9&',.*&/"9+*"'$0'$4.M*",$"/&".*($'4RL9&',.*&/@"7$",+9R)$*(M"R*&"%'$8&/$*9.&",$"U&4(&"^@ed@BFB^"6R$,$"$I.4(.'" 9+)%'$4.M*",$"$4(&"8$*&"&L$''&*($"$*('$"/&"&+'(&"<"/&"9+/R)*&"8$'($L'&/@"
1 0 7AbrilJunio 2012
3&"4.,+"'$9+*+9.,&"9+)+"R*";&9(+'"$(.+/M0.9+"%&'&"$/",$4&''+//+",$"8&'.9+9$/$F14"<"$*"9&4+4"4$8$'+4"%R$,$"9+*,.9.+*&'"R*"41*,'+)$",$"k9&49&*R$Ol"9+*"8Z'.9$4"%$'.R'$($'&/$4F"U$)&(R'.&F"8&'.9+9$/$"<"9+*0$4(.M*"8$*+4&"%E/8.9&".OQR.$',&@BFb"N&":?H#F"&,$)Z4",$",$($9(&'"/&"&*+)&/1&F")R$4('&"/+4"9&)L.+4"8&49R/&'$4",$"$4($"41*,'+)$"/+"QR$"&R*&,+"&"/&"9/1*.9&"%$').($"$4(&L/$9$'"$/",.&0*M4(.9+"V\0R'&"BCF".)Z0$*$4"B&"<"BLX@
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Figura 6."K('+\&",$"/&4"8$*&4"9&',.*&/$4"%+4($'.+'$4"9+*"$I('$)+4")Z4"9&R,&/$4@"=/"]Rh+"8$*+4+"4$",.'.0$"U&9.&"/&4"8$*&4"4R%'&9&',.*&/$4"<"4RL9&',.*&/$4"&"('&8E4",$"/&4"&*&4(+)+4.4@
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Figura 8."?+*;+')&9.M*",$/"4$0)$*(+".*;'&''$*&/",$"/&"W?2@"-$4R/(&" ,$" /&" 9+&/$49$*9.&" $*('$" /&" 8$*&" 4R%'&9&',.*&/" <"4RL9&',.*&/",$'$9U&4@
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&+'(&@" N&" 8$*&" ,$" ('&<$9(+" %+4($'.+'" $4" 9&R,&/" &" /&"%'$&M'(.9&"V\0R'&"BBF" .)Z0$*$4"c&>c,X@"7R"+'.0$*"4$"debe a la persistencia de las venas intersubcardinal <"/&".*($'4R%'&9&',.*&/@BFB^"7$"9&/9R/&"R*&"%'$8&/$*9.&",$" c@e" &" a@Gd@1" 7R" .,$*(.\9&9.M*" $4" '$/$8&*($" %&'&"/&"%/&*$&9.M*"QR.'Y'0.9&",$"*$;'$9(+)1&@BD"N&":?H#F"$*"%&'(.9R/&'"$*";&4$4"&'($'.&/"<"8$*+4&F"$4"&/(&)$*($"efectiva para elaborar el mapeo vascular renal e iden(.\9&'" 8&'.&*($4@B_"#$" .0R&/")&*$'&"%R$,$"&4+9.&'4$"
1 0 8 AbrilJunio 2012
,$"&*+)&/1&",$"/&"8$*&"'$*&/".OQR.$',&"<"/&"%'$4$*9.&",$"8Z'.9$4"%E/8.9&4@Ba@":&)L.E*"4$",+9R)$*(M"QR$"$4($"(.%+" ,$" &*+)&/1&" $4" 9&R4&" ;'$9R$*($" ,$" 8&'.9+9$/$"'$9.,.8&*($@BGFBb
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).*&/@"N&"W?2".OQR.$',&"4$"R*$"&"/&"8$*&"'$*&/".%4./&($'&/"<",$4$)L+9&"$*"/&"W?2",$'$9U&"4R%'&''$*&/BFc"V\0R'&"BcF".)Z0$*$4"^&>^,X@"N&"$8.,$*9.&".*,.9&"R*&"%'$8&/$*9.&",$"C@D"&"^d@13"7$"+'.0.*&"%+'"/&"%$'4.4($*9.&",$"&)L&4"8$*&4"4R%'&9&',.*&/$4@"6R$,$"9+*;R*,.'4$F"$*"$4(R,.+4",$".)&0$*"4$99.+*&/F"9+*"&,$*+%&(1&4"%&'&&M'(.9&4F"$4%$9.&/)$*($"4."$/"'$;+'O&).$*(+"%+49+*('&4($".*('&8$*+4+"$4"%+L'$"%+'"'&O+*$4"(E9*.9&4"+"('+)L+4.4@cCFcB En caso ,$".*,.9&9.M*",$"\/('+",$"/&"W?2"4$"'$QR$'.'Z""9+/+9&9.M*",$",+L/$"\/('+F"R*+"$*"9&,&"W?2@GFcc
Vena vitelinaderecha
V. subcardinal
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Ácigos Hemiácigos
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1 0 9AbrilJunio 2012
Figura 11."W$*&"'$*&/".OQR.$',&"9.'9R)&M'(.9&@
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Figura 12."#+L/$"8$*&"9&8&".*;$'.+'@
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1 1 0 AbrilJunio 2012
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Interrupción de la VCI con continuación en la ácigos o hemiácigos3&<"R*&" ;&//&" $*" /&" ;+')&9.M*" ,$" /&" &*&4(+)+4.4"
4RL9&',.*&/>U$%Z(.9&"<"4RL4$9R$*($)$*($"$I.4($"&('+\&",$"/&"8$*&"4RL9&',.*&/"VW?2"4R%'&''$*&/",$'$9U&X@"N&"W?2".*;'&''$*&/"4$"9+*(.*Y&"9+*"/&"Z9.0+4""VU$).Z9.0+4"4."$4"W?2".OQR.$',&X"<"4$"&4+9.&"9+*"/&"8$*&"'$*&/".OQR.$',&"'$('+&M'tica en todos los casosBFcFe"V\0R'&"BeF".)Z0$*$4"D&>D,X@"=4")R<"'&'&F"%$'+"9+)Y*"$*"&*+)&/1&4",$/"situs"&L,+).*&/F"%'.*9.%&/)$*($"$*"&QR$//&4"QR$"9R'4&*"9+*"%+/.$4%/$*.&"V4+*")R<"'&'&4"/&4"QR$"9R'4&*"9+*"&4%/$*.&X"<"0$*$'&/)$*($"4$"/+9&/.O&"&"/&",$'$9U&"9+*"9+*(.*R&9.M*"9+*"/&"Z9.0+4@4"N&"Z9.0+4"+"U$).Z9.0+4"&0'&*,&,&4"%R$,$*"4$'"9+*;R*,.,&4"9+*"&,$*+%&(1&4"<"0$*$'&'",$49+*9.$'(+"&/"+L4$'8&'"%'+).$*9.&",$"$4(+4"8&4+4"$*"$4(R,.+4",$"(M'&IF"<&"4$&*"'&,.+0'&\&4"+":?H#@eFB^"=I.4($".)%/.9&9.M*"%&'&"/&"%/&*$&9.M*",$"9.'R01&"9&',1&9&"<"'$%'$4$*(&"R*"'.$40+"QR.'Y'0.9+"$/$8&,+"%&'&"(+'&9+(+)1&@BFce
Ausencia de la VCI infrarrenal=*"/+4"$4(R,.+4",$":?H#"*+"4$".,$*(.\9&"R*&"$4('R9
(R'&"8&49R/&'"QR$"%R$,&",$\*.'4$"9+)+"W?2".*;'&''$*&/F"
Imagen 4."HRh$'",$"_b"&p+4@"=*"/&":?H#"4$"$8.,$*9.&"QR$"/&"W?2"$4(Z"&"/&".OQR.$',&",$"/&"&+'(&"V&X`"4$"R*$"&"/&"8$*&"'$*&/".OQR.$',&"<"9'RO&"/&"/1*$&")$,.&F"&*($'.+'"&"/&"&+'(&"VLX"<"4$"9+*(.*R&"9+*"/&"W?2".*('&U$%Z(.9&@"-$9+*4('R99.M*"9+'+*&/"H26F"H6-F"QR$",$)R$4('&",$")&*$'&"9/&'&"/&"&*+)&/1&"V9X@
Figura 13."W?2".*;$'.+'".OQR.$',&@
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1 1 1AbrilJunio 2012
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Imagen 5.":?H#",$"&L,+)$*";$)$*.*+",$"De"&p+4@"7$"+L4$'8&"8$*&"'$*&/".OQR.$',&"'$('+&M'(.9&"V&F"]$9U&XF"/&"8$*&"Z9.0+4"$4"%'+).*$*($"hR*(+"&"/&"&+'(&"$*"$/"$4%&9.+"'$('+9'R'&/"VLF"9"<",F"]$9U&4X""<"&R4$*9.&",$"W?2".*('&U$%Z(.9&"VLF"]$9U&",.49+*(.*R&X@"N&4"8$*&4"4R%'&U$%Z(.9&4",'$*&*",.'$9(&)$*($"$*"/&"&R'19R/&",$'$9U&"V9F"]$9U&",.49+*(.*R&X@"N&"Z9.0+4"4.0R$"4R"('&<$9(+"U&L.(R&/",$4$)L+9&*,+"$*"/&"8$*&"9&8&"4R%$'.+'"V,F"]$9U&X@
*.9+"9+)+"(&/`"*+"+L4(&*($F"&Y*"*+"$I.4($"R*&*.).,&,",$"9'.($'.+4"%&'&",$\*.'"4R4"9&R4&4@^FBc"?/1*.9&)$*($"4$" &4+9.&" 9+*")&<+'" '.$40+" ,$" ('+)L+4.4" 8$*+4&"%'+;R*,&"$*"%&9.$*($4"hM8$*$4"9+*".*4R\9.$*9.&"8$*+4&"9'M*.9&@cD"Las colaterales prominentes pueden 4$'" 9+*;R*,.,&4" 9+*" /$4.+*$4" '$('+%$'.(+*$&/$4" <[+"%&'&$4%.*&/$4@^FBCFBc=*"9&4+",$" ('+)L+4.4",$"8$*&4" ./1&9&4",$'$9U&4"
%R$,$"4$)$h&'"&%$*,.9.(.4"%+'"R/('&4+*.,+"%'+%.9.&*,+"$''+'",.&0*M4(.9+@7"7$" '$%+'(M"R*"9&4+"9+*"U$)&(+QR$4.&@c_"#$" .0R&/")&*$'&" '$%'$4$*(&" R*" ;&9(+'" ,$"'.$40+" QR.'Y'0.9+F" %'.*9.%&/)$*($" $*" 9.'R01&" %E/8.9&"<&"QR$"4$"&4+9.&"9+*"9+)%/.9&9.+*$4"U$)+''Z0.9&4".*('&+%$'&(+'.&4@27
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//&O0+4" .*9.,$*(&/$4" $*" $4(R,.+4" ,$":?H#"QR$F" 4.*"$)L&'0+F" %R$,$*" %&4&'" ,$4&%$'9.L.,&4@"7$" U&" ,$)+4('&,+"QR$"/&4"&*+)&/1&4",$"/&"W?2"%R$,$*"($*$'"R*&" '$%$'9R4.M*" U$)+,.*Z).9&" <" $*" 9+*4$9R$*9.&"representar factores predisponientes para varias enti,&,$4"%&(+/M0.9&4F"9+)+"$/"8&'.9+9$/$"<"$/"41*,'+)$",$"9&49&*R$O"9+*,.9.+*&,+"%+'"/&""8$*&"'$*&/".OQR.$',&"'$('+&M'(.9&"+"9.'9R)&+'(.9&`"$4"%+'"$//+"QR$"9+*4.,$'&)+4"%$'(.*$*($"QR$F"$*"(+,+"%&9.$*($")&49R/.*+"$*"$/" QR$" 4$" ,+9R)$*($")$,.&*($":?H#"$4($" (.%+" ,$"&*+)&/1&F",$L$"'$&/.O&'4$"R*"$4(R,.+",$"R/('&4+*.,+"#+%%/$'" ($4(.9R/&'"%R$4"U&<"$8.,$*9.&",$"QR$"$*" /&")&<+'1&",$"$4(+4"%&9.$*($4"$I.4($",.;$'$*($4"0'&,+4",$"8&'.9+9$/$@33K4.).4)+F" $*" %&9.$*($4" 9+*" ('+)L+4.4" 8$*+4&"
profunda de miembros inferiores con indicación de \/('+",$"8$*&"9&8&".*;$'.+'F"/&",R%/.9&9.M*".*;'&''$*&/",$"/&"W?2"'$QR$'.'Z",+L/$"\/('+"%&'&"9+*('&''$4(&'"$/"'.$40+",$"$)L+/.4)+`"W?2".OQR.$',&"$4"9+*('&.*,.9&9.M*"%&'&"9+/+9&9.M*",$"\/('+"('&*4<R0R/&'@"=*"$4(&4"4.(R&9.+*$4" /&" :?H#" ,$)R$4('&" ,$")&*$'&" 9/&'&"(&*(+"/&",R%/.9&9.M*"9+)+"/&"%+4.9.M*".OQR.$',&",$"/&"W?2@"J.*&/)$*($F"$*"%&9.$*($4"9+*"&R4$*9.&",$"W?2",$L$'1&*" 9+*4.,$'&'4$")$,.,&4" ,$" %'$8$*9.M*" ,$"
1 1 2 AbrilJunio 2012
('+)L+4.4"8$*+4&"%'.*9.%&/)$*($"4."U&<"+('+4";&9(+'$4",$"'.$40+"&0'$0&,+4@N&":?H#F" 0'&9.&4" &" 4R" &/(&" '$4+/R9.M*" $4%&9.&/F"
9&%&9.,&,",$"&*Z/.4.4")R/(.%/&*&'" <" /&" R(./.O&9.M*" ,$")$,.+" ,$" 9+*('&4($" .*('&8&49R/&'F" %$').($" $8&/R&'" <",$)+4('&'"&,$9R&,&)$*($"/&4"&*+)&/1&4"9+*0E*.(&4",$" /&"W?2" <" ,.4(.*0R.'/&4" ,$"&,$*+%&(1&4F" /$4.+*$4"R"+('&4"%+4.L./.,&,$4"QR$" .)%/.QR$*"$''+'@ 6+'" ('&(&'4$",$"R*"$4(R,.+",$"9&)%+",$"$I%/+'&9.M*"&)%/.+"%$').($"$8&/R&'"9+)%/.9&9.+*$4"<"U&//&O0+4"&4+9.&,+4"9+)+"%R$,$"4$'"/&",./&(&9.M*"8&'.9+4&",$"8$*&4"&]R$*($4"+"('+)L+4.4"8$*+4&@
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Figura 15."KR4$*9.&",$"/&"W?2".*;'&''$*&/@
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4+*"U&//&O0+4" .*9.,$*(&/$4" $*":?H#`" 4.*" $)L&'0+F"(.$*$*".)%+'(&*($4".)%/.9&9.+*$4"9/1*.9&4"<"QR.'Y'0.9&4"<"%R$,$*",&'"%.$"&" 9+*;R4.+*$4"$*" /+4"$4(R,.+4",$".)&0$*"%+'"/+"QR$"$4"*$9$4&'.+"9+*+9$'/&4@"=/"$4(R,.+",$"/&"$)L'.+0E*$4.4"&<R,&"&"9+*+9$'"4R4")$9&*.4)+4",$";+')&9.M*@N&":?H#"9+*"9+*('&4($".*('&8&49R/&'"U&",$)+4('&,+"
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ReferenciasB@" n&*,%&/"3F"7U&')&"-F"q&)&*0&((."7F"
7'.8&4(&8&"#AF"W&4U.4U("7@"2)&0.*":U$"2*;$'.+'"W$*&"?&8&P"K"-+&,"N$44":'&8$/$,`"-&,.+0'&%U.94"cCCa`caP__br_ab@
c@" s&44" t=F" -$,f.*$"H#F" n'&)$'" NKF"3R<*U"6:F"3&''.4"t3@"7%$9('R)"+;"9+*0$*.(&/" &*+)&/.$4"+;" (U$" .*;$'.+'" 8$*&"9&8&P"9'+44>4$9(.+*&/".)&0.*0"\*,.*04@"-&,.+0'&%U.94"cCCC`cCP_^b>_Dc@
^@" JR/9U$'"K7F":R'*$'"HK@"KL,+).*&/")&*.;$4(&(.+*4"+;"4.(R4"&*+)&/.$4".*"&,R/(4@"-&,.+0'&%U.94"cCCc`ccPBe^b>BeD_@
e@" q&<$'"qF"NRL+4U.(O"tF"3$'(O"HF"o.44.*"-F":U&/$'"HF"NRL$(4g<"KF"$("&/@"?+*0$*.(&/"K*+)&/.$4"+;"(U$"2*;$'.+'"W$*&"?&8&"-$8$&/$,"+*"?:".*"6&(.$*(4"f.(U"#$$%"W$.*":U'+)L+4.4`"Kt-"cCC^`BaCPGcbrG^c@
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