Severe ischemic gastritis caused by chronic mesenteric ischemia.

Ischemic gastritis is a rare illness caused by localized or systemic vascular insufficiency. This condition is rarely seen in medical practice due to the vast arterial collateral blood supply to the stomach through the celiac trunk and superior mesenteric artery and also because other etiologies are much more frequent. The classic presentation of chronic ischemia is comprises the triad of postprandial pain, weight loss, and abdominal bruit. Intervention is indicated in symptomatic patients and endovascular treatment is an alternative to surgery in patients with high comorbidity that offers good results. We report a case of a 71-year-old female patient with severe ischemic gastritis with ulcers and bleeding caused by chronic mesenteric ischemia with occlusion of the celiac trunk and inferior mesenteric artery and critical stenosis of the superior mesenteric artery. The diagnosis was confirmed by imaging, and the patient underwent endovascular treatment. This is a rare condition that is difficult to diagnose and treat and a multidisciplinary team is needed for proper management.

Guidelines on vascular access for hemodialysis from the Brazilian Society of Angiology and Vascular Surgery.

Chronic kidney disease is a worldwide public health problem, and end-stage renal disease requires dialysis. Most patients requiring renal replacement therapy have to undergo hemodialysis. Therefore, vascular access is extremely important for the dialysis population, directly affecting the quality of life and the morbidity and mortality of this patient population. Since making, managing and salvaging of vascular accesses falls within the purview of the vascular surgeon, developing guideline to help specialists better manage vascular accesses for hemodialysis if of great importance. Thus, the objective of this guideline is to present a set of recommendations to guide decisions involved in the referral, evaluation, choice, surveillance and management of complications of vascular accesses for hemodialysis.

A doença renal crônica é um problema de saúde pública global e em seu estágio terminal está associada à necessidade de terapia dialítica. A grande maioria dos pacientes que necessitam realizar a terapia renal substitutiva, a fazem através da hemodiálise. Portanto, o acesso vascular é de extrema importância para a população dialítica, implicando diretamente na qualidade de vida e na morbimortalidade deste grupo de pacientes. Sendo a confecção, gerenciamento e resgate dos acessos vasculares uma das áreas de atuação do cirurgião vascular, é de grande importância a elaboração de uma diretriz que oriente o especialista no manejo mais adequado do acesso vascular para hemodiálise. Assim, o objetivo desta diretriz é apresentar um conjunto de recomendações para guiar as decisões na referenciação, avaliação, escolha, vigilância e gestão das complicações do acesso vascular para hemodiálise.

Traumatic arteriovenous fistula in the temporal region: a therapeutic challenge.

Arteriovenous fistulas can be congenital or traumatic, the former being more common and diagnosed in childhood, and the latter being rarer and diagnosed later in life. Both require interventional treatment, which may be endovascular, or surgical repair and each case must be studied individually. This article presents the case of a 46-year-old patient with an arteriovenous fistula (AVF) between the left temporal artery and its corresponding veins resulting from a blunt trauma to the parietal region during childhood. The diagnosis was confirmed by imaging examination and he underwent conventional surgical treatment with improvement of symptoms. The case calls attention to a rare condition, its diagnostic investigation, and therapeutic approaches. The incidence of traumatic arteriovenous fistulas is low. They can occur in a variety of ways and can cause symptoms, requiring treatment, which is sometimes challenging, resulting in improvement in the patient's quality of life.

The role of transillumination phleboscopy in the planning of cosmetic operations for varicose veins

Background: The cosmetic treatment of varicose veins is the main activity of most vascular surgeons in Brazil. In order to obtain satisfactory cosmetic results, careful planning of varicose vein operations is necessary. Objective: Marking (or "mapping") the varicose veins with indelible ink is an essential step in planning cosmetic surgeries for lower limb varicose veins. In the present study, the role of transcutaneous phleboscopy (TcPh) in planning varicose vein operations is evaluated. Methods: A series of 100 consecutive patients, all female, were evaluated with TcPH as part of their varicose vein operations planning. A total of 171 limbs with varicose veins (71 bilateral and 29 unilateral) were evaluated. The process of marking the varicose veins followed the same protocol in all cases. Firstly, the varicose veins were marked by inspection and palpation, with the patient standing, using an indelible black ink pen. Secondly, with the patients resting in supine and prone positions, the varicose veins detected with TcPh were marked again with red or blue ink. The marks made by the two methods were then compared. Results: In 41 patients, for a total of 80 limbs (46.8 percent), the marks were altered after use of TcPh. Reasons for such changes were: 1) identification of other varicose veins; 2) identification of reticular veins draining complex telangiectasias; and 3) changes in the position of the marks placed with the patient standing. Conclusions: TcPh has altered the planning of varicose vein surgeries in 46.8 percent of all limbs evaluated, especially when the patients had complex telangiectasias, associated with reticular varicose veins.

Contexto: O tratamento estético de varizes é a principal atividade da maioria dos cirurgiões vasculares do Brasil. Para se obter resultados estéticos satisfatórios, é necessário um planejamento adequado da cirurgia de varizes. Objetivo: A marcação (ou "mapeamento") das varizes com tinta indelével é uma etapa essencial do planejamento das cirurgias de varizes dos membros inferiores com finalidade estética. Neste estudo, é avaliado o papel da fleboscopia por transiluminação na marcação pré-operatória de varizes. Métodos: Uma série de 100 pacientes consecutivas, todas do sexo feminino, foram avaliadas através de fleboscopia por transiluminação, como parte do planejamento de suas operações de varizes. Do total de 171 membros com varizes, 71 pacientes tinham varizes bilaterais e 29 tinham varizes unilaterais. Em todos os casos, a marcação das varizes a serem operadas seguiu o mesmo protocolo. Na primeira etapa, as varizes foram marcadas de forma tradicional, por inspeção e palpação, com as pacientes de pé, usando canetas de tinta indelével de cor preta. Na segunda etapa, as pacientes assumiram a posição de decúbito e as varizes foram re-marcadas, com o auxílio da fleboscopia por transiluminação, com tinta de cor vermelha ou azul. Em seguida, foram comparadas as marcações pelos dois métodos. Resultados: Em 41 pacientes, totalizando 80 membros (46,8 por cento), foram alteradas as marcações depois da fleboscopia por transiluminação. Os motivos para as alterações foram: 1) identificação de novos trajetos varicosos; 2) identificação de veias de drenagem de telangiectasias complexas; e 3) mudanças no trajeto de varizes marcadas da forma tradicional. Conclusões: A fleboscopia por transiluminação alterou o planejamento da cirurgia de varizes em 46,8 por cento dos membros avaliados, especialmente quando as pacientes tinham telangiectasias complexas associadas a varizes reticulares.