Adequação da estratificação de risco e da profilaxia do tromboembolismo venoso em hospital universitário terciário / Adequacy of venous thromboembolism risk stratification and prophylaxis in a tertiary university hospital

Resumo Contexto O tromboembolismo venoso (TEV) é a terceira doença cardiovascular mais comum e a principal causa de óbito evitável em pacientes internados. Apesar de diretrizes bem estabelecidos na literatura, a profilaxia dessa afecção ainda é subutilizada. Estudos apontam taxa de adequação da profilaxia próxima de 50% mundialmente. Objetivos Avaliar a adequação da estratificação de risco e da prescrição de medidas de profilaxia do TEV em um hospital universitário terciário. Métodos Estudo transversal observacional realizado através da coleta de dados de prontuário. Foram incluídos pacientes adultos internados em diferentes especialidades e divididos em grupos cirúrgico e clínico. A estratificação de risco de TEV realizada pelos médicos assistentes foi comparada com a realizada pelos médicos pesquisadores, com base nas diretrizes recentes. A prescrição de medidas de profilaxia realizadas pelos médicos assistentes foi comparada com as recomendações das diretrizes, obtendo assim a taxa de adequação da profilaxia. Resultados Foram avaliados 400 pacientes, sendo 169 (42,3%) cirúrgicos e 231 (57,7%) clínicos. A taxa geral de adequação da estratificação foi de 50,8%. Nos grupos cirúrgico e clínico, as taxas de adequação foram respectivamente 39,1% e 59,3% (p < 0,0001). A taxa geral de adequação da profilaxia foi de 71,5%, enquanto no grupo cirúrgico foi de 78,1% e no grupo clínico de 66,7% (p = 0,0137). Conclusões A adequação da estratificação de risco para TEV foi baixa, demonstrando a pouca conscientização dos médicos assistentes sobre esse problema. No entanto, as taxas de adequação da prescrição de medidas de profilaxia estão superiores às de dados globais.

Abstract Background Venous thromboembolism is the third most common cardiovascular disease and the main cause of preventable death in hospitalized patients. Prophylaxis is still underused, despite well-established guidelines in the literature. Studies show a worldwide prophylaxis adequacy rate close to 50%. Objectives To assess the adequacy of risk stratification and prophylactic measures for venous thromboembolism in a tertiary university hospital. Methods A cross-sectional observational study was carried out, collecting data from medical records. Adult patients hospitalized by different specialties were enrolled and divided into surgical and clinical groups. The risk stratification of venous thromboembolism performed by the attending physicians was compared with stratification based on recent guidelines performed by the research physicians. Prophylaxis measures prescribed by the attending physicians were compared with guideline recommendations, thus obtaining the prophylaxis adequacy rate. Results 400 patients were analyzed, 169 (42.3%) surgical and 231 (57.7%) clinical. The overall stratification adequacy rate was 50.8%. Adequacy rates were 39.1% and 59.3% in the surgical and clinical groups respectively (P < 0.0001). The overall prophylaxis adequacy rate was 71.5%, with 78.1% in the surgical group and 66.7% in the clinical group (P=0.0137). Conclusions Risk stratification adequacy is low, demonstrating a low awareness among prescribing physicians of the need for adequate stratification for prescription of prophylaxis. However, the prophylaxis prescription adequacy rates are higher than those in global data.

Inpatient consultations with the vascular and endovascular surgery team at an academic tertiary hospital.

Background: Inpatient consultations are a fundamental component of practice in tertiary care centers. However, such consultations demand resources, generating a significant workload. Objectives: To investigate the profile of inpatient consultations requested by other specialties and provided by the Vascular and Endovascular Surgery team at an academic tertiary hospital. Methods: Prospective observational study. Results: From May 2017 to May 2018, 223 consultations were provided, representing 2.2% of the workload. Most consultations were requested by Oncology (16.6%), Hematology (9.9%), Nephrology (9.0%), and Cardiology (6.3%). The leading reasons for inpatient consultation were: need for vascular access (51.1%) and requests to evaluate a vascular disease (48.9%). Acute venous diseases accounted for 19.3% of consultations, chronic arterial diseases for 14.8%, acute arterial diseases for 7.2%, diabetic feet for 5.4%, and chronic venous diseases accounted for 2.2%. Surgical treatment was performed in 57.0%, either conventional (43.9%) or endovascular (13.0%). Almost all (98.2%) patients' issues were resolved. Conclusions: Inpatient consultations with the Vascular and Endovascular Surgery team in a tertiary academic hospital accounted for 2.2% of the team's entire workload. Most patients were elective and underwent low-complexity elective surgical procedures. There may be an opportunity to improve healthcare, redirecting these patients to the outpatient flow.

Introdução: Interconsultas são um componente fundamental da prática clínica em centros de atendimento terciários. No entanto, esse tipo de consulta requer recursos, resultando em uma alta carga de trabalho. Objetivo: Investigar o perfil das interconsultas solicitadas por outros departamentos e realizadas pela equipe de Cirurgia Vascular e Endovascular em um hospital universitário terciário. Métodos: Estudo observacional prospectivo. Resultados: De maio de 2017 a maio de 2018, foram realizadas 223 consultas, correspondendo a 2,2% da carga de trabalho. A maioria das consultas foram solicitadas pelos departamentos de Oncologia (16,6%), Hematologia (9,9%), Nefrologia (9,0%) e Cardiologia (6,3%). As principais razões das interconsultas foram a necessidade de acesso vascular (51,1%) e de avaliação de doenças vasculares (48,9%). As doenças venosas agudas corresponderam a 19,3% das avaliações; as doenças arteriais crônicas, a 14,8%; as doenças arteriais agudas, a 7,2%; o pé diabético, a 5,4%; e as doenças venosas crônicas corresponderam a 2,2%. Foi realizado tratamento cirúrgico em 57,0% dos casos, tanto convencional (43,9%) quanto endovascular (13,0%). Foram resolvidos os problemas de quase todos os pacientes (98,2%). Conclusão: As interconsultas realizadas pela equipe de Cirurgia Vascular e Endovascular em um hospital universitário terciário corresponderam a 2,2% da carga de trabalho total. A maioria dos pacientes eram eletivos e foram submetidos a procedimentos cirúrgicos eletivos de baixa complexidade. O redirecionamento desses pacientes para o atendimento ambulatorial poderia auxiliar na melhoria dos serviços de saúde.

Short-Term Outcomes of Transfemoral Carotid Artery Stenting and Carotid Endarterectomy in Symptomatic Patients: Data from a Multicentric Prospective Registry in Brazil.

BACKGROUND: Transfemoral carotid artery stenting (TF-CAS) and carotid endarterectomy (CEA) are alternative strategies for stroke prevention in patients with atherosclerotic carotid disease. Because their main objective is to prevent future ischemic events, regular reassessment of the outcomes is mandatory for providing the best therapy. The purpose of this study was to describe the practice and the outcomes of TF-CAS and CEA in symptomatic patients in public university hospitals in Brazil, using data from a prospective multicentric registry. METHODS: A prospective 8-year observational study of patients with symptomatic carotid artery atherosclerotic disease that underwent TF-CAS and CEA in 5 public university hospitals affiliated with the RHEUNI (Registry Project of Vascular Disease in the Public University Hospitals of São Paulo). All consecutive procedures were included. The indications for the procedures were determined by each surgeon's individual discretion, in accordance with a preoperative risk evaluation. The outcome measures were any 30-day follow-up death, stroke, myocardial infarction (MI), and their combined outcome (major adverse cardiovascular events [MACE]). The registration of the study was made at clinicaltrials.gov NCT02538276. RESULTS: From January 2012 through December 2019, 376 consecutive and symptomatic patients were included in the study records. There were 152 TF-CAS procedures (40.4%) and 224 CEA procedures (59.5%). All completed the 30-day follow-up period. Occurrence of death (TF-CAS: 0.66% × CEA: 0.66%, P = 0.99), stroke (TF-CAS: 4.61% × CEA: 4.46%, P = 0.99), and MI (TF-CAS: 0.66% × CEA: 0%, P = 0.403) were similar in both groups, without statistically significant differences. MACE rate did not differ in both groups (TF-CAS: 5.92% × CEA: 4.46%, P = 0.633). CONCLUSIONS: Data from a prospective registry of 5 Brazilian university hospitals showed that TF-CAS and CEA in symptomatic patients had similar 30-day perioperative rates of death, stroke, and MI and their combination.

Inpatient consultations with the vascular and endovascular surgery team at an academic tertiary hospital / Interconsultas realizadas pela equipe de cirurgia vascular e endovascular em um hospital universitário terciário

ABSTRACT Background Inpatient consultations are a fundamental component of practice in tertiary care centers. However, such consultations demand resources, generating a significant workload. Objectives To investigate the profile of inpatient consultations requested by other specialties and provided by the Vascular and Endovascular Surgery team at an academic tertiary hospital. Methods Prospective observational study. Results From May 2017 to May 2018, 223 consultations were provided, representing 2.2% of the workload. Most consultations were requested by Oncology (16.6%), Hematology (9.9%), Nephrology (9.0%), and Cardiology (6.3%). The leading reasons for inpatient consultation were: need for vascular access (51.1%) and requests to evaluate a vascular disease (48.9%). Acute venous diseases accounted for 19.3% of consultations, chronic arterial diseases for 14.8%, acute arterial diseases for 7.2%, diabetic feet for 5.4%, and chronic venous diseases accounted for 2.2%. Surgical treatment was performed in 57.0%, either conventional (43.9%) or endovascular (13.0%). Almost all (98.2%) patients' issues were resolved. Conclusions Inpatient consultations with the Vascular and Endovascular Surgery team in a tertiary academic hospital accounted for 2.2% of the team's entire workload. Most patients were elective and underwent low-complexity elective surgical procedures. There may be an opportunity to improve healthcare, redirecting these patients to the outpatient flow.

RESUMO Introdução Interconsultas são um componente fundamental da prática clínica em centros de atendimento terciários. No entanto, esse tipo de consulta requer recursos, resultando em uma alta carga de trabalho. Objetivo Investigar o perfil das interconsultas solicitadas por outros departamentos e realizadas pela equipe de Cirurgia Vascular e Endovascular em um hospital universitário terciário. Métodos Estudo observacional prospectivo. Resultados De maio de 2017 a maio de 2018, foram realizadas 223 consultas, correspondendo a 2,2% da carga de trabalho. A maioria das consultas foram solicitadas pelos departamentos de Oncologia (16,6%), Hematologia (9,9%), Nefrologia (9,0%) e Cardiologia (6,3%). As principais razões das interconsultas foram a necessidade de acesso vascular (51,1%) e de avaliação de doenças vasculares (48,9%). As doenças venosas agudas corresponderam a 19,3% das avaliações; as doenças arteriais crônicas, a 14,8%; as doenças arteriais agudas, a 7,2%; o pé diabético, a 5,4%; e as doenças venosas crônicas corresponderam a 2,2%. Foi realizado tratamento cirúrgico em 57,0% dos casos, tanto convencional (43,9%) quanto endovascular (13,0%). Foram resolvidos os problemas de quase todos os pacientes (98,2%). Conclusão As interconsultas realizadas pela equipe de Cirurgia Vascular e Endovascular em um hospital universitário terciário corresponderam a 2,2% da carga de trabalho total. A maioria dos pacientes eram eletivos e foram submetidos a procedimentos cirúrgicos eletivos de baixa complexidade. O redirecionamento desses pacientes para o atendimento ambulatorial poderia auxiliar na melhoria dos serviços de saúde.

Expression of MicroRNA-1281, C-Reactive Protein, and Renal Function in Individuals with Abdominal Aortic Aneurysm and their Clinical Correlation after Endovascular Repair.

INTRODUCTION: The treatment of infrarenal aortic aneurysms has changed in the last three decades. Endovascular aneurysm repair (EVAR) has become the primary treatment option in anatomically suitable patients with infrarenal aortic aneurysms. However, there is no serum biomarker to be used in EVAR follow-up. METHODS: This is a prospective single-centre study of 30 consecutive patients with abdominal aortic aneurysm (AAA) who underwent EVAR. Serum dosages of micro ribonucleic acid 1281 (miRNA-1281), creatinine, total cholesterol, triglycerides, and C-reactive protein (CRP) were evaluated and angiotomographic evaluations were performed preoperatively and six months after the intervention. RESULTS: There was a hyperexpression of miRNA-1281 in patients with AAA and a significant reduction of it after EVAR, from 1.66-fold before EVAR to 0.27 after the procedure (P<0.0001). MiRNA-1281 expression was not influenced by renal function (creatinine: 1.14±0.29, P=0.68), total cholesterol (179.9±59.9, P=0.22), or CRP (1.17±3.5; P=0.48). There is correlation between AAA size and CRP serum levels, however there was no statically significant reduction of CRP after EVAR. DISCUSSION: MiRNA-1281 expression may be influenced by cholesterol, triglycerides levels, and renal function. We found no difference in these markers before and six months after EVAR. However, miRNA-1281 presents a significant reduction in patients with no follow-up complications. We hypothesize that miRNA-1281 expression may be related to aortic wall stress or flow changes. CONCLUSION: MiRNA-1281 may contribute as a possible marker of EVAR follow-up.

Surgical treatment of cervical rib-associated arterial thoracic outlet syndrome.

The arterial form of thoracic outlet syndrome is rare and is associated with anatomic anomalies, generally a cervical rib. It has a varied range of manifestations. The aim of this article is to describe two cases with different clinical presentations: microembolization and aneurysm. A cervical rib was present in both cases. Diagnosis was made on the basis of history, physical examination, postural maneuvers, and X-rays. Computed tomography angiography provided the anatomic detail necessary to plan surgery. Surgical treatment was performed via supraclavicular access, successfully, in both cases.

Contemporary Management of Arterial Thoracic Outlet Syndrome.

BACKGROUND: Arterial thoracic outlet syndrome (aTOS) is characterized by compression of the subclavian artery as it exits the thoracic girdle. Chronic and repetitive compression leads to several degrees of arterial wall damage. The treatment is varied and depends on the presentation severity. This study aimed to describe the contemporary experience in managing arterial thoracic outlet syndrome at a large tertiary hospital. METHODS: We conducted a single-institution retrospective review of aTOS cases from January 2009 to January 2020. Demographic data, clinical presentation, medical images, operative notes, and outcomes were assessed. RESULTS: Thirteen aTOS cases were identified. The mean age was 43 ± 10 years, and 11 (85%) were women. Both sides were equally affected: right (7 cases, 54%) and left (6 cases, 46%). The most common clinical presentation was arm claudication (7 cases, 54%). Other presentations were: acute arm ischemia, pulsatile neck mass and distal embolization. Cervical ribs were identified by plain X-rays in most cases. All patients were submitted to surgical decompression through the supraclavicular approach. Patients with early disease stages were not submitted to arterial reconstruction and were followed with duplex scan. Arterial reconstruction was done in advanced disease stages (5 cases, 38%): end-to-end anastomosis, interposition graft, and bypass graft. The mean follow-up duration was 32,6 ± 25 months. In all patients, the subclavian artery/graft was patent, and the vascular symptoms were entirely resolved. There were no deaths or amputations. CONCLUSIONS: Arterial thoracic outlet syndrome has a varied clinical presentation. Cervical ribs are the most common anatomic abnormalities. The diagnosis was based on history, physical examination, and imaging exams. Surgery consisted of supraclavicular decompression, arterial resection, and vascular reconstruction, according to the disease stage. The outcomes were excellent.

Transcervical Access for Endograft Exclusion of a Postendarterectomy Carotid Pseudoaneurysm in a Patient With Type III Aortic Arch.

Postendarterectomy carotid pseudoaneurysms are infrequent. The endovascular treatment is less invasive, with a minor risk of complications. However, the presence of a highly angulated aortic arch (type III) is a challenge, since the navigation of endovascular devices is not favorable. Through transcervical access, it is possible to deliver the devices directly into the carotid artery. We herein present a case of a postendarterectomy carotid pseudoaneurysm in a patient with type III aortic arch that was successfully treated with transcervical endograft exclusion.

Endovascular repair of a ruptured abdominal aortic aneurysm after endovascular aneurysm repair due type IB endoleak associated with a late fistula between the abdominal aorta and a retroaortic left renal vein.

A ruptured abdominal aortic aneurysm after endovascular aneurysm repair with an arteriovenous fistula between the aneurysm sac and a retroaortic left renal vein is an extremely rare complication. This case describes an 81-year-old man who developed an aorto-left renal vein fistula owing to a type IB endoleak 2 years after endovascular aneurysm exclusion. The leak was repaired with a left endograft limb extension. Endovascular techniques are attractive and feasible alternatives and can play an essential role in reinterventions. This report is the first of an aorto-left renal vein fistula owing a type IB endoleak after an endovascular aneurysm repair.

Expression in Whole Blood Samples of miRNA-191 and miRNA-455-3p in Patients with AAA and Their Relationship to Clinical Outcomes after Endovascular Repair.

BACKGROUND: The purpose of this study was to quantify and evaluate the expression response of miRNA-191 and miRNA-455-3p endovascular repair of abdominal aortic aneurysm (AAA) based in whole blood samples. METHODS: This report describes a prospective study of a single center of 30 patients with AAA who underwent endovascular repair. Blood samples were collected preoperatively and 6 months postoperatively. The differential expression of the miRNAs was performed by the real-time polymerase chain reaction method, after extraction of the RNA from the blood samples at the 2 moments. In addition, bioinformatic tools were used to determine pathophysiological pathways related to AAA. RESULTS: The miR-191 and miR-455-3p were overexpressed preoperatively. After 6 months postoperatively, miR-191 (median 0.98, IQR 0.5-2.1, P < 0.0001) and miR-455-3p (median 1.4, IQR 0.6-3.1, P = 0.0003) presented a significant reduction in their expressions. There was no correlation between the diameter of the aneurysm and the expression of the miRNAs studied. In addition, analysis of the influence of the various types of devices used for the endovascular treatment of AAA showed no significant differences in the expression of miR-191 and miR-455-3p. CONCLUSIONS: Exclusion of the aneurysmal sac after endovascular treatment induces a decrease in the expression of the studied miRNAs in whole blood samples, which suggests a possible use of them as biomarkers of therapeutic success.

The Role of Interleukins and Inflammatory Markers in the Early Restenosis of Covered Stents in the Femoropopliteal Arterial Segment.

BACKGROUND: The objective of this study was to evaluate the relationship between inflammatory markers, such as interleukin (IL)-1ß, IL-6, IL-8, IL-10, tumor necrosis factor α (TNF-α), transforming growth factor ß (TGF-ß), and highly sensitive C-reactive protein, and the development of arterial restenosis 6 months after femoropopliteal percutaneous transluminal angioplasty (PTA) with covered stent implantation. METHODS: We recruited 27 patients of a tertiary hospital in Brazil who were treated with covered stents for atherosclerotic peripheral arterial disease. Serum samples were collected before stent implantation, then 24 hr later, and 6 months after the procedure. RESULTS: At 6-month follow-up, 4 patients (15%) presented restenosis. IL1- ß, IL-6, IL-8, and TNF-α levels showed a statistically significant reduction after both 24 hr and 6 months compared with pretreatment levels (P < 0.01). There were increased levels of IL-10 and TGF-ß both 24 hr and 6 months after PTA and stenting compared with pretreatment levels (P < 0.01). None of the cytokines studied were correlated with restenosis. CONCLUSIONS: This study demonstrated a significant increase in anti-inflammatory TGF-ß and IL-10 and a decrease in proinflammatory cytokines IL-1ß, IL-6, IL-8, and TNF-α 6 months after the procedure, but no inflammatory marker was independently identified as a risk factor for in-stent restenosis.

MicroRNAs and Current Concepts on the Pathogenesis of Abdominal Aortic Aneurysm.

OBJECTIVE: Abdominal aortic aneurysm is an important cause of morbidity and mortality in the elderly. Currently, the only way to prevent rupture and death related to abdominal aortic aneurysms is through surgical intervention. Endovascular treatment is associated with less morbidity than conventional treatment. The formation of an aneurysm is a complex multifactorial process, involving destructive remodeling of the connective tissue around the affected segment of the aorta wall. MicroRNAs are small sequences of non-coding RNAs that control diverse cellular functions by promoting degradation or inhibition of translation of specific mRNAs. A profile aberrant expression of miRNAs has been linked to human diseases, including cardiovascular dysfunction.

Micrornas and current concepts on the pathogenesis of abdominal aortic aneurysm

Abstract Objective: Abdominal aortic aneurysm is an important cause of morbidity and mortality in the elderly. Currently, the only way to prevent rupture and death related to abdominal aortic aneurysms is through surgical intervention. Endovascular treatment is associated with less morbidity than conventional treatment. The formation of an aneurysm is a complex multifactorial process, involving destructive remodeling of the connective tissue around the affected segment of the aorta wall. MicroRNAs are small sequences of non-coding RNAs that control diverse cellular functions by promoting degradation or inhibition of translation of specific mRNAs. A profile aberrant expression of miRNAs has been linked to human diseases, including cardiovascular dysfunction.

Effects of Postconditioning on Skeletal Muscle Injury and Apoptosis Induced by Partial Ischemia and Reperfusion in Rats.

BACKGROUND: Analyze the effects of ischemic postconditioning on skeletal muscle injury and apoptosis produced by partial ischemia and reperfusion in rats. MATERIALS AND METHODS: An experimental study was designed using 70 Wistar rats divided in 3 groups: Sham; Control-submitted to ischemia and reperfusion; and Postconditioning-submitted to ischemia and reperfusion with ischemic postconditioning. Subgroups (n = 10) were divided by duration of ischemia (4, 5, or 6 hr). A partial ischemia model using aortic clamping was used. The postconditioning protocol consisted of 3 cycles of clamping the aorta for 1 min and releasing for another minute. Skeletal muscle injury was evaluated by measuring serum levels of releasing cytoplasmic enzymes: aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and total creatine phosphokinase (CPK). Lipid peroxidation was evaluated by muscular levels of malondialdehyde (MDA). Energetic cell storage was evaluated by muscular glycogen levels. Apoptosis was evaluated analyzing the expression of caspase 3 and protein B-cell lymphoma 2 (Bcl-2) by immunohistochemistry. RESULTS: AST levels in Sham group were 109.80 units/L, in Control subgroups were 4h 200.60 units/L/5h 392.30 units/L/6h 118.82 units/L, whereas in Postconditioning subgroups were: 4h 316.10 units/L/5h 268.40 units/L/6h 267.00 units/L. There was a 2-3-fold increase in Control and Postconditioning groups compared with Sham group (P = 0.003) There was no difference between groups with the same ischemic injury time. LDH, CPK, and MDA levels were similar in Sham, Control, and Postconditioning groups. Subgroups with the same ischemic injury time were also similar. Glycogen levels in Sham group were 0.629 mg%, in Control subgroups were 4h 0.323 mg%/5h 0.348 mg%/6h 0.183 mg%, whereas in Postconditioning subgroups were: 4h 0.443 mg%/5h 0.270 mg%/6h 0.324 mg%. Control and Postconditioning groups were decreased by half in relation with the Sham group (P = 0.002), with no difference between groups with the same ischemic injury time. For both caspase 3 and Bcl-2, the percentage of positive cells increased more than 2-fold in Control and Postconditioning groups when compared with Sham group (P < 0.001). The greater the ischemic injury time, the greater was the percent of positive cells (P < 0.0005), with no difference between subgroups with the same ischemic injury time. CONCLUSIONS: Ischemic postconditioning had neither protective effect on skeletal muscle injury nor avoided apoptosis induction in rats submitted to partial ischemia and reperfusion.

The clinical importance of air plethysmography in the assessment of chronic venous disease / Importância clínica da pletismografia a ar na avaliação da doença venosa crônica

Abstract Air plethysmography is a non-invasive test that can quantify venous reflux and obstruction by measuring volume changes in the leg. Its findings correlate with clinical and hemodynamic measures. It can quantitatively assess several components of venous hemodynamics: valvular reflux, calf muscle pump function, and venous obstruction. Although clinical uses of air plethysmography have been validated, it is used almost exclusively for medical research. Air plethysmography can be used to assess chronic venous disease, to evaluate improvement after venous surgery, to diagnose acute and past episodes of deep venous thrombosis, to evaluate compression stocking therapy, to study the physiological implications of high-heeled shoes in healthy women, and even to evaluate the probability of ulcer healing.

Resumo A pletismografia a ar é um método não invasivo que pode quantificar refluxo e obstrução venosa medindo alterações no volume das pernas. Seus achados se correlacionam com parâmetros clínicos e hemodinâmicos. Ela pode fornecer informações quantitativas dos diferentes componentes da hemodinâmica venosa: refluxo valvular, função de bomba muscular da panturrilha e obstrução venosa. Apesar de ter seu uso clínico validado, a pletismografia a ar é usada quase que exclusivamente para pesquisa. Ela pode ser usada para avaliar a doença venosa crônica, mensurar o ganho hemodinâmico após cirurgia venosa, diagnosticar trombose venosa profunda atual ou prévia, avaliar os efeitos da elastocompressão, estudar as implicações fisiológicas do uso de salto alto em mulheres e também avaliar a probabilidade de cura de uma úlcera venosa.

The clinical importance of air plethysmography in the assessment of chronic venous disease.

Air plethysmography is a non-invasive test that can quantify venous reflux and obstruction by measuring volume changes in the leg. Its findings correlate with clinical and hemodynamic measures. It can quantitatively assess several components of venous hemodynamics: valvular reflux, calf muscle pump function, and venous obstruction. Although clinical uses of air plethysmography have been validated, it is used almost exclusively for medical research. Air plethysmography can be used to assess chronic venous disease, to evaluate improvement after venous surgery, to diagnose acute and past episodes of deep venous thrombosis, to evaluate compression stocking therapy, to study the physiological implications of high-heeled shoes in healthy women, and even to evaluate the probability of ulcer healing.

A pletismografia a ar é um método não invasivo que pode quantificar refluxo e obstrução venosa medindo alterações no volume das pernas. Seus achados se correlacionam com parâmetros clínicos e hemodinâmicos. Ela pode fornecer informações quantitativas dos diferentes componentes da hemodinâmica venosa: refluxo valvular, função de bomba muscular da panturrilha e obstrução venosa. Apesar de ter seu uso clínico validado, a pletismografia a ar é usada quase que exclusivamente para pesquisa. Ela pode ser usada para avaliar a doença venosa crônica, mensurar o ganho hemodinâmico após cirurgia venosa, diagnosticar trombose venosa profunda atual ou prévia, avaliar os efeitos da elastocompressão, estudar as implicações fisiológicas do uso de salto alto em mulheres e também avaliar a probabilidade de cura de uma úlcera venosa.

Cirurgia aberta e endovascular no tratamento de aneurisma de artéria poplítea: experiência de cinco anos do HCRP-FMRP-USP / Open versus endovascular surgery for treatment of popliteal artery aneurysms: 5 years’ experience at the HCRP-FMRP-USP

Aneurismas de artéria poplítea (AAPs) correspondem a 70,00% dos aneurismas periféricos. A indicação cirúrgica é para aneurismas com diâmetros maiores que 2,0 cm ou sintomáticos. O tratamento é feito por técnicas cirúrgicas convencionais ou endovasculares. Esta última tem ganho muitos adeptos, mas ainda não há consenso estabelecido sobre sua indicação. Objetivo Apresentar a experiência da Divisão de Cirurgia Vascular e Endovascular do Hospital das Clínicas de Ribeirão Preto da Universidade de São Paulo no tratamento dos AAPs. Método Foram revisados casos de reparo convencional e endovascular de AAPs tratados nos últimos cinco anos, avaliando dados demográficos, comorbidades, indicação cirúrgica, complicações pré e pós-operatórias precoces e tardias, tempo de internação e de perviedade em até um ano. Resultados Foram realizadas no período dez cirurgias endovasculares (CE) e 21 cirurgias abertas (CA). O grupo CE teve maior frequência de comorbidades. Houve maior frequência de pacientes sintomáticos no grupo CA (85,00%) do que no grupo CE (40,00%). O Grupo CE apresentou menor número de complicações clínicas e cirúrgicas. A idade entre os grupos e o tempo de internação de cada grupo não apresentaram diferença estatística. A perviedade primária em um ano no Grupo CE foi de 80,00%, enquanto no Grupo CA foi de 75,00%. Conclusão O tratamento endovascular para AAPs apresenta bons resultados, em termos de perviedade com taxas de complicações aceitáveis, em pacientes com risco cirúrgico elevado e anatomia favorável, justificando, assim, a necessidade de mais estudos controlados para modificar a posição da técnica endovascular como uma terapia alternativa para casos selecionados.

Popliteal artery aneurysms (PAAs) account for 70% of peripheral aneurysms. Surgery is indicated for aneurysms that have diameters greater than 2.0 cm or are symptomatic. Repair can be achieved by conventional surgical techniques or using endovascular methods, which are becoming increasingly popular, but for which there is not yet a consensus on indications. Objective To describe the experience of treating PAAs at the vascular and endovascular surgery department of the Hospital das Clínicas de Ribeirão Preto, affiliated to the Universidade de São Paulo (Brazil). Method A review was conducted of cases of conventional and endovascular repair of PAAs over the last 5 years, analyzing demographic data, comorbidities, surgical indications, preoperative and early and late postoperative complications, length of hospital stay and patency, during follow-up of up to 1 year. Results During the period analyzed, ten endovascular surgeries (ES) and 21 open surgeries (OS) were performed. The ES group exhibited a higher frequency of comorbidities. There was a higher frequency of symptomatic patients in the OS group (85%) than in the ES group (40%). The ES group exhibited a lower number of clinical and surgical complications. There were no statistical differences between the groups in terms of age or length of hospital stay. Primary patency at 1 year was 80% in the ES group and 75% in the OS group. Conclusions Endovascular treatment for PAAs offers good results in terms of patency, with acceptable complication rates, in patients with high surgical risk and favorable anatomy. Controlled studies are therefore warranted to validate the endovascular technique and afford it the status of an alternative procedure for use in selected cases.

Aortogastric Fistula Due to a Penetrating Atherosclerotic Aortic Ulcer.

Penetrating aortic ulcer (PAU) is an atherosclerotic lesion with ulceration that penetrates the internal elastic lamina of the aortic wall. PAUs are classified as a category of acute aortic syndrome and have a reported rupture rate of up to 38%. To our knowledge, there is no prior published report of a PAU causing an aortogastric fistula. With the goal of raising awareness of this potentially catastrophic complication, we present herein a case of a PAU that ruptured into the gastric fundus, resulting in massive bleeding. The diagnosis was confirmed by computed tomography angiography, and thoracic endovascular aortic repair was used to control bleeding. Unfortunately, the patient did not survive the severe hypovolemic shock.