Pharmacomechanical thrombectomy with Angiojet in acute arterial occlusions: A prospective study among the results and outcomes.

OBJECTIVE: The main objective of this present paper was to evaluate the results and outcomes of patients with acute limb ischemia (ALI) submitted to pharmacomechanical thrombectomy (PMT) endovascular surgery with Angiojet, regarding the number of cycles/pumps. METHODS: Prospective, consecutive cohort study of ALI patients submitted to PMT endovascular intervention subdivided into two groups according to the number of cycles in the Angiojet technique: Group 1 higher than 150 cycles/second and Group 2 lesser than 150 cycles/second (cycles/s). RESULTS: Overall, 92 patients with ALI submitted to PMT were evaluated. Two groups of patients were identified: Group 1 higher than 150 cycles/s with 60 patients and Group 2 lesser than 150 cycles/s with 32 patients. The overall mortality rate (OMR) was 15.1% (13 patients) in total cohort within the first 30 days. Group 1 had a higher OMR than Group 2 (16.1% vs 9.3%, p = 0.007). There were 4 cases of hematuria (4.3%), all of them in Group 1. We have performed a Kaplan-Meier regarding limb salvage rates: Group 1 had 85% and Group 2 had 95.7% at 1057 days. P = 0.081. Among the factors evaluated, the following were related to overall mortality rate: PMT with higher >150 cycles/s (HR = 7.17, p = 0.007, CI: 1.38-8.89), COVID-19 infection (HR = 2.75, p = 0.010, CI = 1.73-5.97), and post-operative acute kidney injury (HR = 2.97, p < 0.001, CI = 1.32-8.13). Among the factors evaluated, the following was related to limb loss: post-operative acute kidney injury (HR = 4.41, p = 0.036, CI: 1.771-7.132), probably because patients experiencing limb loss have a higher incidence of acute renal insufficiency due to higher circulating myoglobin higher hemolysis from the increased Angiojet cycles inducing rhabdomyolysis. CONCLUSION: PMT with Angiojet is a safe and effective therapy in patients with ALI. However, patients receiving greater than 150 cycles/s were noted to have higher rates of acute kidney injury and mortality. This is likely reflective of increased thrombus burden and higher rates of hemolysis. Acute kidney injury, greater than 150 cycles/s, and COVID-19 infection were the variables with the strongest association to perioperative mortality.

The Importance of the Hypogastric Artery Preservation during Treatment for Aortoiliac Aneurysms: A Prospective Single-Center Study.

BACKGROUND: To determine the importance of the hypogastric artery for the outcomes of survival, endoleaks, reinterventions, buttock claudication (BC), and perioperative mortality rate (PMR) in patients with aortoiliac aneurysms (AIA) receiving endovascular or open surgical (OS) repair. METHODS: This was a prospective consecutive cohort study of patients with AIA who underwent endovascular treatment or OS repair during the period of 2010-2021. Endovascular repair was performed with use of aortoiliac endoprosthesis associated with internal iliac artery (IIA) coil embolization and/or with iliac branch endoprosthesis (IBE) in order to preserve the IIA. The AIA OS repairs were performed with the artery ligation in order to exclude the IIA, or in some cases, the exclusion of the IIA was performed with an endosuture in the proximal stump of the artery. Three groups were identified in the postprocedural period: group 0 (no hypogastric arteries (HAs) preserved), group 1 (1 hypogastric artery preserved), and group 2 (2 hypogastric arteries preserved). RESULTS: A total of 91 patients were submitted to OS or endovascular surgery. Regarding the HA patency, there were 17 patients in group 0, 45 patients in group 1, and 29 patients in group 2. There were 17 cases of bowel ischemia (BI) (94.1% in group 0, 5.9% in group 1, and no cases in group 2, P < 0.001) most of them in group 0, with statistical significance, 12 cases of BC (91.7% in group 0, 8.3% in group 1, and no cases in group 2, P < 0.001), most of them in group 0, with statistical significance. The perioperative mortality was 14.3%, 13 patients (9 patients - 52.9% group 0, 3 patients - 6.7% group 1, and 1 patient - 3.4% group 2, P < 0.001). The linear regression analysis for survival rates showed that BI [P = 0.026 to hazard ratio (HR) = 1.69], emergency aortoiliac repair (P < 0.001, HR = 8.86), and number of HAs (P < 0.001, HR = 5.46) in postoperative were related to poorer survival rates in both univariate and multivariate analysis. The linear regression analysis showed that the number of HAs (P < 0.001, HR = 3.61) in postoperative, emergency aortoiliac repair (P = 0.002, HR 3.233), and cardiac disease (P = 0.048, HR = 3.84) were related to BI. CONCLUSIONS: In conclusion, the number of HA is crucial for adequate and safe outcomes after abdominal aortic aneurysm (AAA) repair. The main factors related to death were BI, emergency aortoiliac repair, and the number of HAs preserved. Moreover, the main factors related to BI were the number of HAs in postoperative, emergency aortoiliac repair, and cardiac disease.

Modelo de parkinson por lesão unilateral induzida pela 6-hidroxidopamina: análises comportamentais e imunohistoquímicas / Parkinson model for unilateral injury induced by 6-hydroxidopamine: behavioral and immunohistochemistry analysis

Introdução: A doença de Parkinson é uma doença neurodegenerativa crônica complexa que afeta o sistema dopaminérgico e atinge cercade 3% da população mundial acima de 50 anos. Clinicamente, a doença de Parkinson não é diagnosticada antes da manifestação dessasdifi culdades locomotoras, o que contribuiu para o diagnóstico tardio da doença e a dominância de modelos animais de estudos baseadosnessas características. Embora o uso de modelos animais seja limitado em diversos aspectos, devido às diferenças genéticas, anatômicase funcionais entre murinos e humanos, muito do nosso conhecimento a respeito da patofi siologia da doença é devido ao uso destasferramentas. Objetivos: Estabelecer modelo de estudo da doença de Parkinson, reprodutível e validado por testes comportamentais eimuno-histoquímicos. Método: O modelo murino de lesão unilateral induzida pela 6-hidroxidopamina (6-OHDA) foi realizado por meio decirurgia estereotáxica para administração intracranicana, no feixe medial do encéfalo anterior (MFB). A toxina foi infundida a uma taxade 1uL/min, e a cânula foi deixada no lugar por 3 min antes da retirada. Para limitar os danos nos neurônios noradrenérgicos, cloridratode desipramina (10 mg/kg, i.p) foram administrados 30 min antes da injeção de 6-OHDA. Os animais controles foram submetidos aomesmo procedimento estereotáxico, mas com solução salina...

Introduction: Parkinson's disease is a complex chronic neurodegenerative disease, damaging the dopaminergic system and affectingabout 3% of the world population over 50 years. Clinically, Parkinson's disease is not diagnosed prior to the manifestation of theselocomotor diffi culties, thus contributing to the late disease diagnosis and to the dominance of animal models of studies based on thesecharacteristics. Although the use of animal models is limited in several aspects due to genetic, anatomical and functional differencesbetween murine and human, much of our knowledge about the pathophysiology of the disease is due to the use of these tools.Objectives: To establish Parkinson's disease study models, reproducible and validated by behavioral and immunohistochemical tests.Method: The murine model of unilateral lesion induced by 6-hydroxydopamine (6-OHDA) was performed by stereotactic surgery forintracranial administration in the medial bundle of the forebrain (MFB). The toxin was infused at a rate of 1µL/ min, and the cannulawas left in place for 3 min prior to withdrawal...

Introducción: La enfermedad de Parkinson es una enfermedad neurodegenerativa crónica compleja que afecta al sistema dopaminérgicoy alcanza cerca del 3% de la población mundial por encima de 50 años. Clínicamente, la enfermedad de Parkinson no se diagnostica antesde la manifestación de esas difi cultades locomotoras, lo que contribuyó al diagnóstico tardío de la enfermedad y la dominación de modelosanimales de estudios basados en esas características. Aunque el uso de modelos animales es limitado en diversos aspectos, debido a las...