La educación científica cubana al servicio de la angiología y cirugía vascular / Cuban scientific education at the service of angiology and vascular surgery

En otro editorial ya se enunciaba la importancia de hacer el diagnóstico oportuno y el tratamiento adecuado de las enfermedades vasculares periféricas para apoyar su prevención en los pacientes que lo requirieran. También se alertaba sobre la necesidad, para el médico y la enfermera de la familia, de ejecutar acciones como las actividades docentes y el aporte de conocimientos adecuados acerca de estas enfermedades(AU)

Reversal of Lower-Extremity Intermittent Claudication and Rest Pain by Hydration.

BACKGROUND: Medical treatment of disabling intermittent claudication or critical limb-threatening ischemia causing rest pain often fails or has partial response. METHODS: In this pilot study, 36 patients (12 females) affected by disabling intermittent claudication or rest pain of the lower extremities were exposed to a daily 3-L water intake for up to 6 weeks. Cutaneous foot temperature, ankle/brachial index, time and distance of claudication, and pain intensity were recorded before and at the completion of the hydration period. RESULTS: Patients with a mean ± SE age of 71 ± 2 years (range, 40-86) had disabling claudication (less than 100 meters) for more than 5 months while 11% reported pain at rest. A 6-week water intake of more than 2,500 mL/24 hr was achieved in 35 of the 36 patients enrolled in the study. Increased water intake was associated with significant improvements in median ankle/brachial index (from 0.60 to 0.76; P < 0.0001) and skin temperature (first dorsal right toe, from 29.95°C to 30.0°C, P < 0.001). Time and distance to report claudication of supervised treadmill exercise improved from 1.25 to 6.25 min (P < 0.0001) and from 100 meters to 535 meters (P < 0.0001), respectively. CONCLUSIONS: This study suggests that hydration attained by daily water consumption of more than 2.5 L has a robust impact on reducing the symptoms of disabling claudication and rest pain caused by peripheral vascular disease.

Impacto de la medicina regenerativa en angiología. Experiencia cubana / Impact of the regenerative medicine in Angiology. Cuban experience

Introducción: La medicina regenerativa se apoya fundamentalmente en la terapia celular, en la administración de factores bioactivos, en la ingeniería de tejidos y en la terapia génica, integra todos estos procederes destinados a la promoción de la regeneración celular.Objetivo: Comunicar los principales resultados de la aplicación de la medicina regenerativa en Cuba en la especialidad de angiología.Métodos: Para la implantación celular se emplearon células mononucleares de la médula ósea y también las movilizadas con Filgrastim a la sangre periférica. Las plaquetas se usaron en forma de plasma rico en plaquetas o de lisado plaquetario. Se incluyeron los pacientes con diferentes enfermedades vasculares atendidos en instituciones del país en el período 2004-2015.Resultados: Con la terapia celular se obtuvo resultados favorables en pacientes con isquemia crítica de miembros inferiores, claudicación intermitente, tromboangeítis obliterante, pie diabético, síndrome posflebítico y linfedema de miembros inferiores. Con el uso de las plaquetas se obtuvieron resultados prometedores en pacientes claudicantes, con pie diabético y úlceras posflebíticas.Conclusiones: El balance realizado al finalizar el 2015 demuestra que el uso de la medicina regenerativa ha sido introducida en 14 de las 15 provincias cubanas. Se han beneficiados con la terapia celular 9 124 pacientes, de ellos 3 741 (41 por ciento) de la especialidad de angiología. Esta terapia resulta de menor costo que los procedimientos convencionales empleados en el tratamiento de las enfermedades vasculares periféricas; evita la amputación y el impacto social que esto representa se cuenta entre sus resultados más importantes(AU)

Introduction: Regenerative medicine is fundamentally based on cell therapy, administration of bioactive factors, tissue engineering and gene therapy and integrates all these procedures intended to promote cell regeneration.Objective: To present the main results of application of regenerative medicine in angiology in our country.Method: For cell implantation, mononuclear cells from the bone marrow and also those released with Filgrastim into the peripheral blood were used. Platelets were then used as platelet-rich plasma or platelet lysate. Patients with different vascular disorders, who had been treated in the 2004-2015 period in various domestic institutions, were included in this study.Results: The cell therapy yielded positive results in patients with critical lower limb ischemia, intermittent claudication, thromboangiitis obliterans, diabetic foot, postphlebitic syndrome, and lower limb lymphedema. The use of platelets showed promising results in patients with intermittent claudication, diabetic foot, and postphlebitic ulcers.Conclusions: The assessment made at the end of 2015 shows that regenerative medicine is implemented in 14 of the 15 Cuban provinces. A total number of 9 124 patients, 3 741 (41 percent) of whom are treated by the angiology specialty have benefited from cell therapy. This type of therapy is less costly than the conventional methods used in the treatment of peripheral vascular diseases, and avoidance of amputation and its social impact are the most significant outcomes of this therapy(AU)

Enfermedades vasculares periféricas y niveles de calidad de vida en el municipio Diez de Octubre / Peripheral vascular diseases and levels of quality of life in 10 of October municipality

Objetivo: Determinar la prevalencia de las enfermedades vasculares periféricas y los niveles de calidad de vida en el municipio "Diez de Octubre".Métodos: Estudio descriptivo en una muestra aleatorizada (n= 200) de los 201 586 habitantes del municipio. El diagnóstico de las enfermedades vasculares periféricas se realizó por examen físico-vascular confirmado por estudios hemodinámico, ultrasonográfico, y ecográfico. Se aplicó el cuestionario de "Calidad de vida" SF-36 a los mayores de 18 años sin discapacidad mental.Resultados: La tasa de enfermedades vasculares periféricas fue de 66 por 100 000 habitantes debida a las flebopatías (59,5 por ciento), la macroangiopatia diabética (13,9 por ciento), la enfermedad arterial periférica (8,4 por ciento) y la cerebrovascular (6,4 por ciento). Los factores de riesgo más frecuentes fueron: obesidad (48,5 por ciento), hipertensión arterial (37,5 por ciento) y tabaquismo (33,5 por ciento). Hubo un incremento de enfermedades vasculares periféricas a partir de los 50 años con la presencia de dos o más enfermedades en el 37,3 por ciento. De las personas. En aquellas con enfermedad vascular se encontró una disminución (p < 0,05) en todas las escalas de la calidad de vida con un deterioro en la medida sumaria "salud física", la que se encontró asociada a su presencia (χ2 = 27,11; p = 0,001).Conclusiones: En el municipio Diez de Octubre, hay una elevada tasa de enfermedades vasculares periféricas con un deterioro importante en los niveles de calidad de vida de las personas que la padecen(AU)

Objective: To determine the prevalence of peripheral vascular diseases and the levels of quality of life in 10 of October municipality.Methods: A descriptive study was conducted on a random sample (n=200) from 201 586 inhabitants of the municipality. The diagnosis of peripheral vascular diseases was performed by physical-vascular examination confirmed by hemodynamic, ultrasound, and echo-Doppler studies. The "Quality of life" questionnaire SF-36 was applied to people older than 18 years without mental disabilities.Results: The rate of peripheral vascular disease was 66 per 100 000 inhabitants due to phlebopathies (59.5 percent), diabetic macroangiopathy (13.9 percent), peripheral arterial disease (8.4 percent) and cerebrovascular disease (6.4 percent). The most frequent risk factors were obesity (48.5 percent), hypertension (37.5 percent) and smoking (33.5 percent). There was an increase in peripheral vascular diseases after the age of 50 years with two or more types of diseases in 37.3 percent of the population. A decrease (p <0.05) in all the quality of life scales, with deterioration in the disease-related summary measure "physical health", was found in people with vascular disorders (χ2= 27.11; p= 0.001).Conclusions: In 10 of October municipality, there is a high rate of peripheral vascular diseases with a significant deterioration of the quality of life of people who suffer them(AU)

Accuracy of the Ankle-brachial Index in the Assessment of Arterial Perfusion of Heel Pressure Injuries.

BACKGROUND: The evaluation and treatment of heel pressure injuries are a significant and expensive sequela of the aging population. Although the workup of patients with lower extremity tissue loss usually involves an assessment of the arterial blood flow by means of noninvasive vascular testing, the results may be misleading in patients with heel pressure injuries when the ankle-brachial index (ABI) does not provide direct information about perfusion of the rearfoot. The objective of this retrospective, observational investigation was to determine if noninvasive vascular testing provides accurate and reliable results in patients with heel pressure injuries. MATERIALS AND METHODS: A retrospective chart review of 67 consecutive inpatients with 75 heel decubitus ulcerations was performed. RESULTS: At least 1 noncompressible ankle artery was observed in 35 (46.67%) of the 75 feet. When at least 1 compressible vessel was present, allowing for calculation of an ABI (n = 49 feet), it was based on the posterior tibial artery in 23 (46.94%) feet and on the anterior tibial artery in 26 (53.06%) feet. In total, of the 75 feet with heel pressure injuries that underwent noninvasive vascular testing, a compressible posterior tibial artery allowing for calculation of an ABI as a direct measure of heel perfusion was observed in only 23 (30.67%) feet. CONCLUSIONS: The results of this study suggest noninvasive vascular testing may be inaccurate and unreliable in the majority of patients with heel pressure injuries.

Cost-Effectiveness Analysis of the Use of a Prophylactic Antibiotic for Patients Undergoing Lower Limb Amputation due to Diabetes or Vascular Illness in Colombia.

BACKGROUND: The use of a prophylactic antibiotic in an amputation surgery is a key element for the successful recovery of the patient. We aim to determine, from the perspective of the Colombian health system, the cost-effectiveness of administering a prophylactic antibiotic among patients undergoing lower limb amputation due to diabetes or vascular illness in Colombia. METHODS: A decision tree was constructed to compare the use and nonuse of a prophylactic antibiotic. The probabilities of transition were obtained from studies identified from a systematic review of the clinical literature. The chosen health outcome was reduction in mortality due to prevention of infection. The costs were measured by expert consensus using the standard case methodology, and the resource valuation was carried out using national-level pricing manuals. Deterministic sensitivity, scenarios, and probabilistic analyses were conducted. RESULTS: In the base case, the use of a prophylactic antibiotic compared with nonuse was a dominant strategy. This result was consistent when considering different types of medications and when modifying most of the variables in the model. The use of a prophylactic antibiotic ceases to be dominant when the probability of infection is greater than 48%. CONCLUSIONS: The administration of a prophylactic antibiotic was a dominant strategy, which is a conclusion that holds in most cases examined; therefore, it is unlikely that the uncertainty around the estimation of costs and benefits change the results. We recommend creating policies oriented toward promoting the use of a prophylactic antibiotic during amputation surgery in Colombia.

Prevalencia de enfermedades vasculares periféricas en el municipio de Arroyo Naranjo / Prevalence of vascular peripheral diseases in Arroyo Naranjo municipality

Objetivo: Determinar la prevalencia de enfermedades vasculares periféricas en el municipio de Arroyo Naranjo según edad y sexo, su distribución en las personas detectadas enfermas y factores de riesgo asociados.Métodos: Se realizó un estudio descriptivo en una muestra aleatorizada (n= 200) de los 208 554 habitantes del municipio de Arroyo Naranjo. El diagnóstico de la enfermedad vascular periférica se realizó por examen físico–vascular confirmado por estudios hemodinámico, ultrasonográfico, y ecográfico. Los datos de interés se obtuvieron del interrogatorio.Resultados: Se halló una elevada frecuencia del sexo femenino (80,5 por ciento) y del grupo mayor de 60 años (33,5 por ciento). La tasa de enfermedades vasculares periféricas fue de 77,2 por 100 000 habitantes contribuyó a esta cifra las flebopatías. Se observó un predominio de la obesidad (45 por ciento), la hipertensión arterial (44,5 por ciento) y el tabaquismo (41 por ciento). Se encontró que el 47,8 por ciento de las personas enfermas tenían más de tres factores de riesgo. Las mujeres mayores de 50 años, a diferencia de los hombres, presentaban más enfermedad carotidea (80,8 por ciento) y macroangiopatía diabética (65,7 por ciento).Conclusiones: En el municipio de Arroyo Naranjo, hay una elevada tasa de enfermedades vasculares periféricas sobre todo en las mujeres mayores de 50 años, más aún cuando tienen tres o más factores de riesgo, lo que indica la importancia del diagnóstico precoz, ya que estas personas desconocían que estaban enfermas y que requerían de un tratamiento oportuno(AU)

Objective: To determine the prevalence of peripheral vascular diseases in Arroyo Naranjo municipality by sex and age, their distribution in the detected sick persons and the associated risk factors.Methods: A descriptive study was conducted in a randomized sample (n= 200) of 208 554 inhabitants of Arroyo Naranjo municipality. Peripheral vascular diseases were diagnosed through physical-vascular examination and confirmed with hemodynamic, ultrasonografic and echographic studies. Questioning of patients provided the necessary information.Results: There was high frequency of females (80.5 percent) and of the age group over 60 years (33.5 percent). The rate of peripheral vascular diseases was 77.2 per 100 000 inhabitants in which phlebopathies influence. Obesity (45,0 percent), arterial hypertension (44.5 percent) and smoking (41,0 percent) predominated. It was found that 47.8 percent of the sick persons had more than three risk factors. Unlike men, women older than 50 years were more affected by carotid disease (80.8 percent) and diabetic macroangiopathy (65.7 percent).Conclusions: In Arroyo Naranjo municipality, there is a high rate of peripheral vascular disease mainly in women older than 50 years, even more when they have three or more risk factors, which points to the importance of early diagnosis since these persons did not know that they were sick and required timely treatment (AU)

Prevalencia de las anomalías vasculares en niños menores de cinco años del municipio Cerro / Prevalence of vascular anomalies in children aged less than five years in Cerro municipality

Introducción: las anomalías vasculares son motivo frecuente de consultas en la infancia; en Cuba se desconoce su prevalencia de las mismas, así como las conductas tomadas y las complicaciones que aparecen en la edad pediátrica.Objetivo: determinar la prevalencia de las anomalías vasculares en niños menores de cinco años del municipio Cerro.Métodos: estudio descriptivo exploratorio intencionado de corte transversal con técnica de muestreo aleatorio simple, en el período entre septiembre de 2013 a febrero de 2014. Se requirió una muestra de 312 niños de los 5 343 que conformaron el universo de estudio. La tasa de prevalencia se expresó por cada1 000 niños.Resultados: se identificaron tres pacientes del sexo femenino con antecedentes patológicos familiares y personales de hemangioma. Se encontró que la tasa de prevalencia fue de 9,6 × 1 000 niños. El cuero cabelludo fue el sitio más afectado con el 66,7 por ciento (n= 2). No se constataron complicaciones en ninguno de los casos. Solo una paciente recibió tratamiento con esteroides sistémicos (n= 1; 33,4 por ciento).Conclusión: la tasa de prevalencia encontrada (9,6 × 1 000) de las anomalías vasculares en niños menores de cinco años pertenecientes al municipio Cerro es similar a la registrada mundialmente. Su mayor frecuencia se encuentra en el sexo femenino(AU)

Introduction: vascular anomalies are frequent reason for going to the doctor's in children, but their prevalence, behaviors to be followed and the complications at pediatric ages barely known in Cuba.Objective: to determine the prevalence of vascular anomalies in children aged less than five years in Cerro municipality.Methods: intentional cross-sectional, exploratory and descriptive study performed with simple random sampling technique, in the period from September 2013 to February 2014. The final sample was 312 children out of a study universe of 5 343 ones. The prevalence rate was estimated per 1 000 children.Results: three female patients were found to have personal and family history of hemangioma, the prevalence rate was 9.6 per 1 000 children. The scalp was the most affected area with 66.7 percent (n= 2). No complications were observed. Just one patient was treated with systemic steroids (n= 1; 33.4 percent).Conclusions: the prevalence rate for vascular anomalies in children less than five years old was 9.6 per 1 000 children in Cerro municipality, which is similar to that reported worldwide. It is more frequent in females(AU)

Comportamiento del ácido úrico en una casuística general y en pacientes con enfermedad vascular periférica / Behaviour of the uric acid in the general casuistic and in patients with peripheral vascular disease

Objetivo: determinar el comportamiento del ácido úrico en una casuística general y en los pacientes con enfermedad vascular periférica y calcular la prevalencia de hiperuricemia. Métodos: estudio descriptivo en 464 pacientes que asistieron al Laboratorio de Bioquímica del Instituto de Angiología y Cirugía Vascular durante el mes de mayo de 2013, y en un grupo de 85 ingresados con enfermedad vascular periférica. El ácido úrico se cuantificó en todos con un juego de reactivo enzimático comercial. La hiperuricemia se determinó tomando como referencia los valores internacionales de 415,4 Ámol/L para hombres y 339 Ámol/L para las mujeres. Se calculó la prevalencia de hiperuricemia total y ajustada según sexo. Resultados: la concentración de ácido úrico en la muestra fue de 320,3 Ámol/L (IC: 310 a 330,6 Ámol/L, 95 por ciento); con diferencia entre hombres y mujeres (354,1 vs. 291,3 Ámol/L respectivamente, p= 3,74 x 10-9). Se encontró que los pacientes con macroangiopatía diabética mostraron valores elevados de ácido úrico (339,5 Ámol/L), sin diferencias significativas al compararlo con la casuística general. Se halló una prevalencia de hiperuricemia de 27,6 por ciento, de ella el 24,8 por ciento para el sexo masculino y el 30 por ciento para el femenino. Conclusiones: se llama a la reflexión sobre este parámetro, tiene una alta prevalencia y no debe ser indicado como rutina, ya que puede ser un biomarcador de enfermedades vasculares como lo es para la hipertensión arterial, función renal y gota(AU)

Objective: to determine the behaviour of the uric acid in a general casuistic and in the patients with vascular periphery disease and calculating the prevalence of hyper-uricaemia. Methods: a descriptive study in 464 patients assisted at aboratory of Biochemistry of the Institute of Angiology and Vascular Surgery during the month of may of 2013 and in the 85 patients with vascular periphery disease was analyzed. Uric acid quantified in alls with a commercial game of enzymatic reagent. The hyper-uricaemia determined itself when taking the following values into account: 415.4 Ámol/ L for man and 339.0 Ámol/L for woman. Was calculated the total prevalence of hyper-uricaemia and tight-fitting according to sex. Results: the concentration of uric acid in the sample was of 320.3 Ámol/L (95 percent CI: 310; 330,6) With difference between man and woman (354.1 vs. 29,3 Ámol/L, p= 3,74 x 10-9). The patients with diabetic macroangiopathy had high concentration of uric acid (339.5 Ámol/L) within significant difference with general casuistic. The prevalence of hyper-uricaemia was of the 27.6 percent; of her the 24.8 percent for the masculine sex and the 30.0 percent for the feminine. Conclusion: it is done called the reflection on this parameter, what has high prevalence, which must not be indicated like routine; since it can be a biomarker of vascular periphery disease as it is for the arterial hypertension, renal function and gout(AU)

Comparação entre os métodos subjetivo e objetivo para avaliação da capacidade funcional durante tratamento clínico em pacientes com claudicação intermitente / Comparison between subjective and objective methods to assess functional capacity during clinical treatment in patients with intermittent claudication

OBJETIVO: Verificar se há relação entre a medida da capacidade funcional avaliada subjetiva e objetivamente em relação ao estado atual e após tratamento clínico em pacientes com claudicação intermitente. MÉTODOS: Foram recrutados 500 pacientes com claudicação intermitente. Todos realizaram exame clínico e foram submetidos a uma avaliação funcional por meio do método subjetivo (consulta clínica) e objetivo (teste de esteira). Adicionalmente, 50 pacientes foram selecionados para se avaliar o efeito do tratamento clínico, pelos métodos subjetivo e objetivo, em relação à capacidade funcional. RESULTADOS: Dos 500 pacientes selecionados, somente 60 (12,0%) apresentaram valores referidos e observados similares. Os demais pacientes, ou seja, 440 (88,0%) apresentaram valores relatados discordantes em relação àqueles obtidos no teste de esforço. Com relação ao efeito do tratamento clínico em relação à capacidade funcional, os resultados foram similares entre ambos os métodos (χ²=1,7; p=0,427). CONCLUSÃO: Apesar de o método subjetivo superestimar os valores de capacidade funcional, quando comparados ao método objetivo, não foram observadas diferenças significantes entre ambos os métodos, quando se analisou o efeito do tratamento clínico. Assim, o método subjetivo fornece informações similares em comparação à medida objetiva no acompanhamento do tratamento clínico de pacientes com claudicação intermitente.

OBJECTIVE: To analyze if there is any relation between functional capacity assessed by subjective and objective methods regarding the current state and after clinical treatment in patients with intermittent claudication. METHODS: A total of 500 patients with intermittent claudication were enrolled. All patients underwent clinical examination and a functional evaluation by subjective (clinical visit) and objective method (treadmill test). Additionally, 50 patients were selected to evaluate the effect of clinical treatment by subjective and objective methods in relation to functional capacity. RESULTS: Out of 500 patients, only 60 (12.0%) had similar results in both methods. The remaining, that is 440 patients (88.0%) had subject values in disagreement with stress test findings. Regarding the clinical effect of the treatment on the functional outcomes, results were similar in both methods (χ²=1.7; p=0.427). CONCLUSION: Although the subjective method overestimates the functional capacity when compared to the objective method, no significant differences were observed between both methods when analyzing the effect of clinical treatment. Thus, the subjective method provides similar information as compared with objective method, in monitoring the clinical treatment of patients with intermittent claudication.

Peripheral vascular disease in systemic lupus patients.

BACKGROUND: Systemic lupus erythematosus (SLE) is an independent risk factor for cardiovascular disease (CVD). Ankle-brachial index (ABI) is a measure of peripheral vascular disease (PVD), low values of which are associated with CVD. OBJECTIVES: Objectives were to identify the prevalence of PVD in SLE, to identify risk factors associated with PVD in SLE, and to determine whether SLE is an independent risk factor for PVD as assessed by ABI. METHODS: In a cross-sectional analysis of SLE subjects and control subjects, free of known CVD, SLE-related variables and cardiovascular risk factors were measured. Peripheral vascular disease was assessed using ABI. The prevalence of PVD (ABI ≤ 1.0) and comparisons of mean ABI, between SLE and control subjects, were examined. Systemic lupus erythematosus was examined as an independent risk for PVD in the cohort using propensity score matching. Logistic regression was performed to identify independent risk factors for PVD in SLE. RESULTS: Ankle-brachial index was lower in the 134 SLE subjects compared with 77 control subjects: 1.05 versus 1.09 (P = 0.003), and the prevalence of PVD was higher in SLE than in control subjects (33% vs 20%; P = 0.037). Systemic lupus erythematosus was not an independent risk for PVD. In the SLE subjects, the only significant risk factor for PVD was smoking. CONCLUSIONS: Ankle-brachial index, a marker of subclinical CVD, is an inexpensive and easy method in which to assess PVD. There was a 33% prevalence of PVD in SLE, which was independently associated with smoking. As PVD is a coronary artery disease risk equivalent, screening and diagnosis may change lipid management in preventive cardiovascular risk assessment in patients with SLE. The combination of SLE and a smoking history may identify individuals for whom checking an ABI makes particular sense.

Comparison between subjective and objective methods to assess functional capacity during clinical treatment in patients with intermittent claudication.

OBJECTIVE: To analyze if there is any relation between functional capacity assessed by subjective and objective methods regarding the current state and after clinical treatment in patients with intermittent claudication. METHODS: A total of 500 patients with intermittent claudication were enrolled. All patients underwent clinical examination and a functional evaluation by subjective (clinical visit) and objective method (treadmill test). Additionally, 50 patients were selected to evaluate the effect of clinical treatment by subjective and objective methods in relation to functional capacity. RESULTS: Out of 500 patients, only 60 (12.0%) had similar results in both methods. The remaining, that is 440 patients (88.0%) had subject values in disagreement with stress test findings. Regarding the clinical effect of the treatment on the functional outcomes, results were similar in both methods (χ²=1.7; p=0.427). CONCLUSION: Although the subjective method overestimates the functional capacity when compared to the objective method, no significant differences were observed between both methods when analyzing the effect of clinical treatment. Thus, the subjective method provides similar information as compared with objective method, in monitoring the clinical treatment of patients with intermittent claudication.

Prognostic value of endothelial function in patients with atherosclerosis: systematic review.

Analysis of flow-mediated vasodilation (FMV) of the brachial artery by use of ultrasound allows assessing endothelial function, and provides pathophysiological, diagnostic and prognostic information. This systematic review was aimed at assessing the literature level of evidence of the predictive capacity of endothelial function, measured through brachial artery FMV by use of ultrasound, regarding cardiovascular events in individuals with atherosclerosis. The MEDLINE, SCIELO and LILACS databases were searched, and prospective cohort studies on human beings about the prognostic value of endothelial function, measured by use of brachial artery FMV in individuals with peripheral or coronary atherosclerosis, were selected. Studies with clear methodological biases were excluded. The final selection consisted of 15 studies. Of the 13 studies that on univariate analysis showed statistical significance of the FMV method to predict cardiovascular events, 12 showed independent predictive capacity on multivariate analysis. None of the studies reviewed described the incremental predictive value of FMV to the traditional predictive models, such as the Framingham score. Results of three studies have suggested that the method adds prognostic value to isolated markers such as ankle-brachial index (ABI), diabetes, and high-sensitivity C-reactive protein (hsCRP). In conclusion, brachial artery FMV predicts cardiovascular risk, but its incremental predictive value to clinical prognostic models has not been established. In addition, solid evidence supporting its use in routine clinical practice to predict cardiovascular risk still lacks.

Valor prognóstico da função endotelial em portadores de aterosclerose: revisão sistemática / Prognostic value of endothelial function in patients with atherosclerosis: systematic review

A Vasodilatação Mediada por Fluxo (VMF) da artéria braquial, por meio da ultrassonografia, é um método de avaliação da função endotelial que pode oferecer informações fisiopatológicas, diagnósticas e prognósticas. A realização dessa revisão sistemática objetivou avaliar o nível de evidência na literatura a respeito da capacidade preditora da função endotelial, medida pela VMF da artéria braquial, por meio da ultrassonografia, quanto a eventos cardiovasculares, em indivíduos portadores de aterosclerose. Foram realizadas buscas nas bases de dados MEDLINE, SCIELO e LILACS e selecionados estudos de coorte prospectivos, em seres humanos, que analisaram o valor prognóstico da função endotelial medida pela VMF da artéria braquial, em populações portadoras de doença aterosclerótica, periférica ou coronariana. Trabalhos com evidentes vieses metodológicos foram excluídos. A seleção final constituiu-se de 15 estudos. Dos 13 estudos que, na análise univariada, mostraram significância estatística do método da VMF na predição de eventos cardiovasculares, 12 deles demonstraram sua capacidade preditora independente, em análise multivariada. Em nenhum dos trabalhos foi descrito valor prognóstico incremental em relação a modelos preditores tradicionais, como escore de Framingham. Resultados de três trabalhos sugerem que o método agrega valor prognóstico a marcadores isolados como: Índice Tornozelo-Braquial (ITB), diabetes e Proteína C Reativa (PCR) de alta sensibilidade. Em conclusão, a VMF da artéria braquial prediz risco cardiovascular, porém não é estabelecido seu valor preditor incremental a modelos prognósticos clínicos, não havendo, até o momento, evidências sólidas que amparem seu uso na rotina clínica para predição de risco cardiovascular.

Analysis of flow-mediated vasodilation (FMV) of the brachial artery by use of ultrasound allows assessing endothelial function, and provides pathophysiological, diagnostic and prognostic information. This systematic review was aimed at assessing the literature level of evidence of the predictive capacity of endothelial function, measured through brachial artery FMV by use of ultrasound, regarding cardiovascular events in individuals with atherosclerosis. The MEDLINE, SCIELO and LILACS databases were searched, and prospective cohort studies on human beings about the prognostic value of endothelial function, measured by use of brachial artery FMV in individuals with peripheral or coronary atherosclerosis, were selected. Studies with clear methodological biases were excluded. The final selection consisted of 15 studies. Of the 13 studies that on univariate analysis showed statistical significance of the FMV method to predict cardiovascular events, 12 showed independent predictive capacity on multivariate analysis. None of the studies reviewed described the incremental predictive value of FMV to the traditional predictive models, such as the Framingham score. Results of three studies have suggested that the method adds prognostic value to isolated markers such as ankle-brachial index (ABI), diabetes, and high-sensitivity C-reactive protein (hsCRP). In conclusion, brachial artery FMV predicts cardiovascular risk, but its incremental predictive value to clinical prognostic models has not been established. In addition, solid evidence supporting its use in routine clinical practice to predict cardiovascular risk still lacks.

Asistencia primaria y especializada en pacientes con insuficiencia arterial aguda / Specialized and primary care in patients with acute arterial insufficiency

Se efectuó un estudio descriptivo y observacional de los pacientes con insuficiencia arterial aguda de las extremidades, ingresados en el Servicio de Angiología del Hospital Clinicoquirúrgico Docente Dr Ambrosio Grillo Portuondo de Santiago de Cuba, desde enero del 2008 hasta abril del 2011, con vistas a observar la evolución de estos en cuanto a un diagnóstico precoz y tratamiento oportuno. Todos los integrantes de la serie presentaron los síntomas clásicos de la afección; sin embargo, a la mayoría no se le realizó el examen de los pulsos arteriales en la atención primaria de salud y a pesar de que más de 50 % de estos fue atendido en las 4 primeras horas de iniciado el cuadro clínico, el mayor número recibió asistencia especializada de 9 a 24 horas después de manifestarlo. De igual manera, primaron el grupo etario de 61 y más años, la procedencia urbana, la ateroesclerosis obliterante (sola o unida a otras enfermedades) como la entidad clínica más asociada y la cirugía revascularizadora como proceder inicial. Un importante porcentaje de aquellos que fueron intervenidos antes de las 8 horas salvó la extremidad, pero los que recibieron tratamiento quirúrgico pasadas las 24 horas del inicio agudo fueron amputados(AU)

A descriptive and observational study was carried out in patients with acute arterial insufficiency of the limbs, admitted to the Angiology Department of Dr Ambrosio Grillo Portuondo Clinical Surgical Teaching Hospital of Santiago de Cuba, from January 2008 to April 2011, with the purpose of monitoring their progress as for an early diagnosis and treatment. All the members of the series had the classic symptoms of the condition, but the majority did not undergo the examination of arterial pulses in the primary health care, and although more than 50% of them were treated at the first 4 hours after the onset of symptoms, most of them received specialized care between 9 and 24 hours of its manifestation. Similarly, age group of 61 years and over, urban origin, obliterating atherosclerosis (alone or combined with other diseases) prevailed as the clinical entity most associated and surgical revascularization as an initial procedure. A significant percentage of those who were operated before 8 hours saved the limb, but those that were operated after 24 hours of acute onset were amputees(AU)

Distances walked in the six-minute walk test: suggestion of defining characteristic for the nursing diagnosis Ineffective Peripheral Tissue Perfusion.

Distances walked in walking tests are important functional markers, although they are not accepted as defining characteristics of Ineffective Peripheral Tissue Perfusion. The aims of this study were to verify the distances participants with and without this nursing diagnosis walked in the six-minute walk test and if these measures may be considered defining characteristics of this phenomenon. Participants with (group A; n=65) and without (group B; n=17) this nursing diagnosis were evaluated regarding physical examination, vascular function and functional capacity. Participants of group A seemed to have worse vascular function and functional capacity compared with those of group B. Pain-free travelled distance was predictive of the nursing diagnosis. These results are important for the refinement of this diagnosis. In conclusion, this study provides evidences that the distances walked in the six-minute walk test may be considered defining characteristics of Ineffective Peripheral Tissue Perfusion.

Tratamento endovascular na síndrome de May-Thurner: relato de caso e revisão da literatura / Endovascular treatment of May-Thurner syndrome: case report and literature review

A síndrome de May-Thurner consiste na compressão extrínseca da veia ilíaca comum esquerda pela artéria ilíaca comum direita, podendo ocasionar trombose venosa profunda e graus variados de insuficiência venosa crônica. O objetivo deste relato de caso é demonstrar os diversos aspectos relacionados ao diagnóstico e conduta em uma pacientes portadora da sindrome de May-Thurner, com diagnóstico inicial pela ultrassonografia abdominal com Doppler e submetida à angioplastia com implante de stent, com resultados satisfatórios.

Índice tornozelo-braquial em pacientes de alto risco cardiovacular / Ankle brachial index in patients at high cardiovascular risk

Fundamentos: A doença arterial obstrutiva periférica (DAOP) é forte marcador de doenças cardiovasculares, havendo associação entre a DAOP e outras manifestações ateroscleróticas, entre elas a doença arterial coronariana (DAC). Objetivo: Analisar a presença da DAOP em pacientes submetidos ao cateterismo cardíaco, utilizando o índice tornozelo-braquial (ITB) e sua relação com a DAC. Métodos: Elaborou-se formulário de avaliação clínica, sendo os pesquisadores treinados para realizar a medida do ITB de forma padronizada. Para a realização da medida foi utilizado o aparelho Doppler Vascular Portátil (DV610, MEDMEGA) e o esfigmomanômetro (Diasyst). Resultados: Em relação aos fatores de risco cardiovascular associados ao ITB anormal não houve diferença estatisticamente significativa; porém ao se analisar quanto à classificação do grau da lesão coronariana através do cateterismo cardíaco, houve diferença significativa (p<0,05) quando comparado o ITB anormal com lesão denominada grave. Conclusão: O ITB pode ser uma ferramenta eficaz de triagem da aterosclerose difusa principalemnte em pacientes de alto risco, pois houve associação significativa (>70%) entre a DAOP e a DAC através do cateterismo cardíaco.

Distances walked in the six-minute walk test: suggestion of defining characteristic for the nursing diagnosis Ineffective Peripheral Tissue Perfusion / Distâncias percorridas no teste de caminhada de seis minutos: proposta de característica definidora para o diagnóstico de enfermagem Perfusão Tissular Periférica Ineficaz / Distancias recorridas en la prueba de caminata de los seis minutos: propuesta de característica definitoria para el diagnóstico de enfermería Perfusión Tisular Periférica Inefectiva

Distances walked in walking tests are important functional markers, although they are not accepted as defining characteristics of Ineffective Peripheral Tissue Perfusion. The aims of this study were to verify the distances participants with and without this nursing diagnosis walked in the six-minute walk test and if these measures may be considered defining characteristics of this phenomenon. Participants with (group A; n=65) and without (group B; n=17) this nursing diagnosis were evaluated regarding physical examination, vascular function and functional capacity. Participants of group A seemed to have worse vascular function and functional capacity compared with those of group B. Pain-free travelled distance was predictive of the nursing diagnosis. These results are important for the refinement of this diagnosis. In conclusion, this study provides evidences that the distances walked in the six-minute walk test may be considered defining characteristics of Ineffective Peripheral Tissue Perfusion.

Distâncias percorridas em testes de marcha são importantes marcadores funcionais, porém, não são aceitos como características definidoras de Perfusão Tissular Periférica Ineficaz. Os objetivos foram verificar as distâncias percorridas no teste de caminhada de seis minutos, por participantes com e sem esse diagnóstico de enfermagem, e se tais medidas podem ser consideradas características definidoras desse fenômeno. A amostra foi composta por sujeitos com (grupo A, n=65) e sem (grupo B, n=17) Perfusão Tissular Periférica Ineficaz, avaliados quanto ao exame físico, à função vascular periférica e à capacidade funcional. Os participantes do grupo A apresentaram pior função vascular e capacidade funcional do que os do grupo B. Verificou-se que a distância percorrida livre de dor foi preditiva para a ocorrência do diagnóstico de enfermagem. Os resultados deste estudo são importantes para o refinamento desse diagnóstico. Conclui-se que as distâncias percorridas no teste de caminhada de seis minutos podem ser características definidoras de Perfusão Tissular Periférica Ineficaz.

Las distancias en pruebas de marcha son importantes marcadores funcionales, pero no son aceptados como características de definición de la Perfusión Tisular Periférica Inefectiva. Los objetivos fueron determinar las distancias recorridas en la prueba de caminata de los seis minutos por los participantes con e sin el diagnóstico de enfermería y si esas medidas se pueden considerar características de definición de este fenómeno. Los participantes con (grupo A, n=65) y sin (grupo B, n=17) el diagnóstico fueron evaluados mediante examen físico, función vascular periférica y capacidad funcional. Los participantes del grupo A ha presentado peor función vascular y desempeño en la prueba de marcha do que aquellos del grupo B. La distancia recorrida libre de dolor fue predictiva del diagnóstico de enfermería. Los resultados de este estudio pueden contribuir para el refinamiento de este diagnóstico. Las distancias recorridas en la prueba de marcha se pueden considerar características de definición de este diagnóstico.