The First Latin American Consensus on Superficial and Perforating Venous Mapping.

With the aim of obtaining a map which is useful as a diagnostic tool and therapeutical orientation, complementing the written report of duplex ultrasound venous study, Latin-American Scientific Societies of Phlebology, Vascular Surgery and Vascular Imaging were invited to participate, through their regional representatives, to the First Consensus of Superficial and Perforating Venous Mapping. A consensus process using a modified Delphi method was carried out. An International Working Group was formed, which developed a Prototype of the Venous Mapping that worked as a starting point for consensus, and was presented in a first virtual meeting of 54 experts (societies' representatives) when the methodology was explained. For the consensus process, two rounds of self-administrated questionnaires with feedback were used. In the first questionnaire a 100% consensus was obtained in the 15 statements (an agreement range of 85.2% to 100%) In the analysis of qualitative data, three categories according to the actions to implement were identified - actions which involved no action, minor changes and major changes. This analysis was used to build the second questionnaire, which reached a consensus in its six statements (agreement range of 87.1% to 98.1%). A final consensus on every field proposed was established with the approval of all the experts consulted and it was presented at a third online meeting. The document of the superficial and perforating venous mapping reached by consensus is presented hereafter.

Tratamento cirúrgico da isquemia cerebral devida a lesão arterial extracraniana / Surgical treatment of cerebral ischemia due to extracranial arterial injury

Introduction: Carotid surgery in daily clinical practice is different from planned clinical trials mainly when indications for surgery are considered. Nevertheless results should be close to those published in the trials. The objective was to study etiology, localization, symptoms and early results of carotid surgery performed in a tertiary care private hospital in São Paulo, Brasil. Materials and methods: Retrospective study of 86 operations performed on 69 patients. Most of them were men (65,2%), hypertensive (73.9%) and current smokers (73.9%); 28 (40.5%) had diabetes, 44,9% had coronary artery disease and 50,7% had peripheral artery occlusive disease. Associated procedures performed were coronary artery bypass, femoro-tibial bypass, cholecystectomy, and hysterectomy and hip surgery. Results: Etiology was atherosclerotic occlusive disease (96,5%), Takayasu's arteritis (1.1%) and aneurysm of extracranial internal carotid artery (2.3%). Bilateral occlusive carotid disease (contralateral occlusion or stenosis above 50%) was found in 35 patients (53.6%) and 3 (3.4%) had total occlusion of common carotid artery. Most carotid lesions were related to cerebral ischemic symptoms (67,4%). Operations performed were 80 carotid bifurcation endarterectomies, one thrombectomy and patch closure of carotid bifurcation (Takayasu's disease), one carotid aneurysm resection and replacement with Dacron graft and three ring-stripping endarterectomy of common carotid artery. The results of carotid surgery were one death ­ 1.1% (caused by miocardial infarction after carotid endarterectomy associated to femoro-tibial bypass), four strokes ­ 4.6%; total complication rate: 5.6%. Three patients with postoperative stroke recovered before 30 days and the post-operative complication rate after 30 days were reduced to 2.3% Conclusion: Although different indications and surgical techniques the carotid surgery results are similar to those of multicentric trials.

Introdução: a cirurgia da carótida na prática diária é diferente daquela planejada nos ensaios clínicos principalmente quando indicações cirúrgicas são consideradas. Contudo os resultados devem ser próximos daqueles publicados nos grandes ensaios. Objetivo: estudar etiologia e localização das lesões, os sintomas, operação realizada e seu resultado imediato numa série de doentes operados pela mesma equipe em Hospital terciário privado de São Paulo. Material e métodos: estudo clínico, retrospectivo e descritivo baseado na revisão dos prontuários. A casuística compõe-se de 69 doentes submetidos a 86 operações. Eram 45 (65,2%) homens e 24 (34,8%) mulheres com idades variando de 29 a 84 anis (média: 66,6 ± 9,0). Resultado: a etiologia da lesão que desencadeou a indicação cirúrgica variou. Nas 86 operações realizadas a aterosclerose foi a mais freqüente: 83 casos (96,5%). Houve um caso de arterite de Takayasu (1,1%) e dois casos de aneurisma (2,3%). A localização das lesões também foi variada. A mais freqüente foi a placa de ateroma na bifurcação carotídea (80 casos ­ 93,0%). Houve três casos de oclusão total aterosclerótica da carótida comum (duas do lado direito e uma do esquerdo) ­ 3,5%. Os aneurismas eram ambos fusiformes, localizados ao nível das origens da carótida interna direita e da carótida comum direita. Houve um óbito (1,1%) e quatro eventos neurológicos (4,6%) sendo que apenas um deixou seqüela. O total de complicação mais óbito foi 5,8%. Considerando óbito mais sequela a cifra é 2,3%. Conclusão: o resultado da cirurgia da carótida na prática clínica é bastante próximo dos resultados apresentados nos ensaios multicêntricos.