ABSTRACT
INTRODUCTION: The aortobifemoral bypass (AFB) is one of the best options to revascularize patients with Aortoiliac Occlusive Disease (AIOD). The impact of this procedure in sexual function (SF) is unpredictable, with 0 to 80% of the patients reporting sexual dysfunction (SD) after surgery. The aim of this study was to evaluate SD after AFB and to assess the importance of patent hypogastric arteries before the procedure. METHODS: The study includes only male population submitted to AFB due to AIOD from between January 2013 and March 2016 in Centro Hospital São João (CHSJ). Patients with major amputations after the surgery or dead were excluded. The development of SD was evaluated by phone call. The quality of life before and after the procedure was evaluated by a standardized index score questionnaire (15D). Pre-operative patency of hypogastric arteries was appraised by assessing the patients imaging file. The arteries with direct anterograde flow were considered patent. RESULTS: Of a total of 53 patients, 40 were included in the study - 37% reported worsening, 26% improved and 37% didn't notice any change in SF after surgery. Exclusion causes were intrahospital death (5.7%), natural cause death (9.4%) and major amputation (11.3%). If at least one of the hypogastric arteries was patent before surgery, 51.1% described worsening in SF compared to only 7.1% in the group with no sustained anterograde flow to the hypogastric arteries (p<0.001). The majority of the group (92.1%), wasn't warned of the possibility of SD after surgery, being that 26.3% of these would have refused the procedure if they knew. CONCLUSION: SD is a prevalent and often overlooked complication after open aortoiliac revascularization and it remains a major taboo in the surgeon/patient relation. The existence of at least one hypogastric artery with preserved anterograde flow before surgery can strongly predict a higher risk of SD after surgery.
Introdução: O bypass aortobifemoral (BABF) é uma das melhores opções para revascularizar doentes com patologia aorto-ilíaca oclusiva. O impacto deste procedimento na função sexual é particularmente imprevisível, com 0 a 80% dos doentes a relatar deterioração após a cirurgia. Este trabalho tem como objectivo determinar a evolução da função sexual após BABF e avaliar a importância da permeabilidade pré-operatória das artérias hipogástricas. Métodos: No estudo estão incluídos apenas os doentes do sexo masculino que realizaram BABF por patologia aorto-ilíaca oclusiva entre Janeiro de 2013 e Março de 2016 no Centro Hospitalar São João (CHSJ). Foram excluídos os doentes submetidos a amputação major após a cirurgia. A evolução da função sexual foi avaliada por contacto telefónico. A evolução da qualidade de vida, antes e após a cirurgia, foi avaliada por um questionário padronizado (15D). A permeabilidade pré-operatória das artérias hipogástricas foi avaliada por consulta do processo clínico. Foram consideradas patentes as artérias com fluxo anterógrado directo. Resultados: Foram incluídos no estudo 40 doentes de um total de 53 37% reportaram agravamento, 26% melhoria e 37% não referiram qualquer alteração da função sexual após a cirurgia. As causas de exclusão foram morte intra-hospitalar (5,7%), morte de causas naturais (9,4%) e amputação major (11,3%). Dos doentes que apresentavam no mínimo uma artéria hipogástrica permeável antes da cirurgia, 57,1% agravou a função sexual, em comparação com apenas 7,1% dos doentes em que nenhuma hipogástrica apresentava fluxo anterógrado preservado (p<0,001). A maior parte dos doentes (92,1%) não foi alertado para o facto da sua função sexual poder deteriorar-se após a cirurgia, sendo que 26,3% teria recusado o procedimento caso tivessem obtido essa informação. Conclusão: A disfunção sexual após a cirurgia de revascularização aorto-ilíaca permanece um tema tabu na relação entre o doente e o cirurgião vascular. A existência de pelo menos uma artéria hipogástrica com fluxo anterógrado preservado antes da cirurgia poderá antever um risco significativamente maior de agravamento da disfunção sexual após o procedimento.
ABSTRACT
OBJECTIVES: Estimate the frequency and risk factors of restenosis after carotid endarterectomy, contralateral carotid disease development, neurologic symptoms (ipsi or contralateral) and new endarterectomy (ipsi or contralateral) in patients who underwent previously endarterectomy. METHODS: Retrospective single center analysis of the electronic clinical data and of duplex ultrasound results of 293 consecutive patients who underwent carotid endarterectomy between 2002 and 2008. The study included risk factors, procedure and patient's characteristics. All outcomes, since time-dependent, were estimated by the Kaplan-Meier method. The association between outcomes and risk factors was evaluated with the Log Rang test. RESULTS: The proportion of patients with restenosis/occlusion during follow up was 16% (EP=0,04), at 8,5 years. The rate of patients with restenosis was much higher in patients that underwent direct closure when compared to all other (16% Vs 2% at 3,4 years; P=0,02). At 9 years, 26% (EP=0,05) of the patients without previous contralateral internal carotid artery stenosis showed progression of the disease. CONCLUSION: Findings during duplex ultrasound follow up in patients who underwent carotid endarterectomy reach a somewhat unexpected high frequency. However, most of these changes do not mean hemodynamic or clinical significance. Direct arterial closure was associated with higher restenosis frequency. The disease progression in contralateral side occurred in a considerable proportion of cases, in particular in those patients who had already hemodynamically significant stenosis. These findings emphasize the potential benefits of duplex ultrasound follow up in patients who undergo carotid endarterectomy.
ABSTRACT
The aim of this study was to report the initial experience with eversion carotid endarterectomy technique at our department. We undertook a retrospective analysis of prospectively collected data on all carotid endarterectomies performed since January 2004 to March 2006. A comparison between both groups - eversion endarterectomy (EE) and conventional endarterectomy (CE) - was done using a statistical software package. A total of 150 consecutive carotid endarterectomies were performed, 26 (17 %) of them being done using EE. Median age for all patients was 69 [52 - 89] years old with a clear male predominance (n=119; 79,3%). Cardiovascular risk factors were distributed as follows: hypertension, 126 (84%); diabetes, 40 (26,7%); dyslipidaemia, 105 (70%); tobacco smoking, 44 (29,3%). There were proportionately more patients on the EE group submitted to simultaneous CABG (30,8 % vs. 8,8 %; p=0,043) and asymptomatic for previous neurological events (53,9 %vs. 27,3%; p=0,05). There was one case of cervical haematoma reported for the EE technique. Neither neurological morbidity nor deaths were reported within this group. In the CE group the mortality was 0,8 % (1 patient) and the neurological morbidity (either stroke or TIA) was 2,4 % (3 patients). The overall stroke and death rate combining both groups was 2,7 %. Outcome differences between EE and CE patients were nonsignificant, even on multivariate analysis. Eversion carotid endarterectomy is a safe procedure that might be considered as a valid option to conventional endarterectomy.
