Leiomiosarcoma intraluminal de vena femoral común / Intraluminal leiomyosarcoma of the common femoral vein

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[Incidence of contrast induced nephropathy in patients who underwent an aortic endovascular repair]. / Incidência De Nefropatia Induzida Por Contraste Em Pacientes Operados De Reparação Aórtica endovascular.

INTRODUCTION: Intravascular iodinated contrasts are essencial in endovascular therapy. One of their major inconveniences is contrast-induced nephropathy (CIN), which has been associated with an increase in complications and prolonged hospital stay. AIM: To analyze the incidence of CIN in patients undergoing endovascular aneurysm repair (EVAR) in our hospital. MATERIAL AND METHODS: A retrospective study including patients (n=129) treated with EVAR between January 2014 - September 2015. Information was gathered concerning age, history of diabetes, hypertension, pre-existing chronic kidney disease and previous treatment with diuretics or metformin. We analyzed serum levels of urea, creatinine, sodium, potassium and glomerular filtrate (GF), at baseline, at 24hours, peak levels during post-operative period and before discharge. The amount of intravascular contrast and periprocedureral hydration were correlated to creatinine and GF to determine their effect on CIN. RESULTS: Of 129 patients, 11 (8.53%) developed CIN. A significant difference was found between preoperative and postoperative levels of urea and sodium, both p<0.001.Volume of contrast was the only variable that presented a statistically significant association with increase of creatinine levels in postoperative period (p=0.032). Worsening of glomerular filtrate showed a statistically significant association with preoperative levels of urea (p=0.036) and GF (p= 0.019). Fluid-therapy before or after exposure to contrast did not show any influence on the outcome. CONCLUSIONS: The incidence of CIN depends mainly on baseline GF and amount of contrast, and it is barely associated with hydration during the perioperative period. Since there is no specific treatment for CIN, the best practice is its prevention.

Aneurysmal degeneration of brachial artery in kidney transplant receptors after arteriovenous fistula ligation.

OBJECTIVES: True brachial artery aneurysms are. Recent case reports have suggested aneurysmal degeneration of brachial artery in kidney transplant receptors after arteriovenous fistula (AVF) ligation. We present a study on the evolution of the brachial artery in this context in our center. MATERIAL AND METHODS: This is a descriptive study in kidney transplant receptors in whom AVF was ligated between 2008 and 2015. Patients with AVF in both upper limbs were excluded. Diameters of axillary artery, brachial artery in middle portion and its bifurcation, as well as brachial artery flow were measured using Dupplex ultrasound in AVF and contralateral limb. Both groups were compared using the Student t-test for paired samples. RESULTS: 20 patients were included in the study and had a mean age of 59.35 ± 2.49 years. The median time of use of AVF for hemodialysis was 729 days (range 120-6117) and the median time in which AVF was patent was 2261 days (range 791-7091). Mean diameters (in mm) of axillary artery, brachial in middle portion and bifurcation were respectively 9.33 ± 1.07, 7.5 ± 0.61 and 5.81 ± 0.43 in AVF arm and 5.6 ± 2.8, 4.4 ± 0.1, 4.9 ± 0.15 in control limb, finding statistically significant differences (p <0.01) in brachial and axillary arteries. 5 patients (25%) developed aneurysm, 2 of which (10%) underwent surgery and 3 are on follow up. CONCLUSION: True incidence of brachial artery aneurysm in kidney receptors following AVF ligation is high. Careful follow up with physical examination and dupplex scanning are needed to find this complication.