Anatomical and physiological changes in the venous system of lower limbs in pregnant women and findings associated with the symptomatology.

PURPOSE: Quantify the volume and diameter of veins in the lower limbs of primigravidae and associate the presence of venous signs and symptoms with the vascular measurements. METHODS: A cross-sectional study assessed 64 lower limbs of 32 healthy women of whom 16 were primigravidae between 22 and 36 weeks pregnant, and 16 nulligravidae. The women were submitted to physical assessment, air plethysmography and vascular ultrasound. The volumes and diameters of the main veins in the lower limbs were compared between pregnant and non-pregnant women. In the group of pregnant women, the attempt was also made to associate such measurements to the presence of vascular signs and symptoms. RESULTS: The average venous volume of the lower limbs (110.1 ± 30.2 and 94.7 ± 27.3 mL; p = 0.036), as well as the diameters of the common femoral (12.72 ± 2.27 and 10.14 ± 1.24 mm; p < 0.0001), saphenous (4.81 ± 1.15 and 3.55 ± 0.98 mm; p < 0.0001) and popliteal (6.87 ± 1.68 and 5.36 ± 1.07 mm; p < 0.0001) veins were, respectively, greater in the pregnant women compared with the control group. In pregnant women with venous stasis symptoms, a venous diameter of the saphenous vein compared to those without no symptoms (5.05 ± 1.19 and 4.09 ± 0.70 mm; p = 0.011) was noted. CONCLUSIONS: Anatomical and functional changes in the venous system during pregnancy were detected by the air plethysmography and the vascular ultrasound in primigravidae. In pregnant women, the presence of venous stasis symptoms found an anatomical and functional substrate detected in the differences in diameter of the saphenous vein.

Toracotomia esquerda como via de acesso para reoperaçöes de revascularizaçäo do miocárdio / Left thoracotomy in reoperations for miocardial revascularization

As reoperaçöes para revascularizaçäo do miocárdio têm se tornado cada vez mais frequentes. A via de acesso usual é uma segunda esternotomia mediana. Em certas situaçöes esta segunda incisäo poderá estar contra-indicada, sendo uma opçäo a toracotomia esquerda. Os autores relatam caso de paciente com duas deiscências prévias de esternotomia, necessitando de segunda revascularizaçäo miocárdica, reoperado por toracotomia esquerda, com anastomose de enxerto de safena entre a artéria subclávia esquerda e o ramo marginal da circunflexa. Fazem comentários acerca da técnica cirúrgica utilizada e das dificuldades observadas, concluindo ser esta uma boa via de acesso em casos selecionados.