Prolonged cognitive effort impairs inhibitory control and causes significant mental fatigue after an endurance session with an auditive distractor in professional soccer players.

BACKGROUND: Throughout official soccer matches, the presence of cheer by the crowd could be considered a critical auditive distraction that could further impair the cognitive interference control system, multiple object tracking (MOT) skill, heart rate variability (HRV), and increase mental fatigue. As the resource is not immediately replenished, the impairment of the cognitive interference control system may be delayed following a soccer game. Then, evaluating the recovery time course of the cognitive interference control system, MOT skill, HRV, and mental fatigue after prolonged tasks combining physical, endurance, and cognitive effort are essential. PURPOSE: We aimed to analyze the acute effect of cognitive effort and auditive distractor with 24-h follow-up throughout a prolonged endurance session on inhibitory control, subjective mental fatigue, MOT skill, and HRV in professional soccer players. METHODS: Twenty professional male soccer players were recruited (23.56 ± 3.8 years, 78.1 ± 6.9 kg, 1.77 ± 0.06 m, and 12.5 ± 5.3% body fat). The sessions were performed in a randomized and counterbalanced crossover design, divided into four experimental conditions: endurance, endurance + MOT, endurance + MOT + AD, and endurance + AD. The soccer players completed the incongruent Stroop task utilizing an eye-tracker to assess cognitive effort. MOT task, subjective mental fatigue, and HRV were evaluated before the endurance training (60%Δ of maximal aerobic velocity during 40-min) and after 30-min and 24-h of recovery. These sessions were designed to investigate the acute effect of prolonged cognitive effort (repeated MOT throughout the endurance task) and AD (constant crowd noise and coach's voice each 15-40 s, totalizing = 80 voices) on inhibitory control, MOT skills, HRV, and subjective mental fatigue after a fixed endurance training session. RESULTS: There was no condition × time interaction for accuracy of inhibitory control (p > 0.05, ηp2 = 0.001). There was a significant condition × time interaction for inhibitory control response time (p < 0.05, ηp2 = 0.16). A higher response time of inhibitory control was found for the endurance + MOT + AD and endurance + MOT experimental sessions (p < 0.05). There was a significant condition × time interaction for subjective mental fatigue (p < 0.05, ηp2 = 0.46). A higher subjective mental fatigue was found for the endurance + MOT + AD and endurance + MOT experimental sessions (p < 0.05). There was no condition × time interaction for HRV (p > 0.05, ηp2 = 0.02). CONCLUSION: We concluded that cognitive effort throughout a prolonged endurance session impaired inhibitory control and increased mental fatigue without promoting greater MOT skill and HRV changes in professional soccer players.

Brain Stimulation Over the Motion-Sensitive Midtemporal Area Reduces Deleterious Effects of Mental Fatigue on Perceptual-Cognitive Skills in Basketball Players.

The objective of this study was to analyze the effect of anodal transcranial direct current stimulation (a-tDCS) over the motion-sensitive midtemporal area on perceptual-cognitive skills (visuomotor and basketball decision-making skills) in mentally fatigued basketball players. A total of 20 male basketball players were recruited. This was a randomized, double-blinded, and counterbalanced crossover study with two experimental conditions: a-tDCS and Sham. The participants completed the basketball decision-making task and visuomotor skill after performing a 60-min sport-based videogame task with anodal (i.e., a-tDCS) or placebo (Sham) stimulation over the motion-sensitive middle temporal area. Worse response time was observed in visuomotor skill for Sham than a-tDCS postexperiment (p < .05). There was no main condition effect for accuracy of visuomotor skill (p > .05). There was more impairment in accuracy and response time in basketball decision-making skills for the Sham condition than a-tDCS (p < .05). Notably, a-tDCS over the motion-sensitive middle temporal area removed the negative effects of mental fatigue on perceptual-cognitive skills.

Paclitaxel in real-life data is not associated with reduced survival but has limited benefit in preventing amputation.

BACKGROUND: Recent meta-analysis of randomized-controlled trials reported an increased risk of long-term mortality in patients treated with paclitaxel-coated devices (PCD) for femoropopliteal arteries (FP) lesions. However, real-life data on the subject is contradictory and data from CLTI patients is missing. The authors aim to evaluate the impact of PCD for the treatment of FP lesions on long-term mortality and amputation on a real-life cohort up to 5 years. METHODS: All patients treated for FP lesions with endovascular devices from January 2013 to December 2016 were included, irrespective of clinical presentation. Primary endpoint is overall survival. Secondary endpoints are freedom-from major amputation and amputation-free survival. Survival estimates were obtained using Kaplan-Meier plots and a multivariable model was constructed to correct for relevant baseline differences. RESULTS: From 2013 to 2016, 351 patients with FP lesions were treated, 250 with uncoated devices (nPCD) and 101 with PCD. Patients treated with nPCD were significantly older, more often female and with more severe degrees of ischemia. Median follow-up was 55(20-71) months. Overall survival and amputation-free survival were significantly higher in patients treated with PCD. Survival at one-year was 79% vs. 92%, at two-years 69% vs. 79% and at five-years 50% vs. 65% (P=0.02). AFS was 43% vs. 57% at 5-years (P=0.016). Freedom-from major amputation was similar between groups. After correction for relevant baseline differences on multivariable analysis, the survival advantage for patients treated with PCD was lost at 2 and 5 years. CONCLUSIONS: Our results do not confirm the findings of increased mortality associated with PCD. However, no improvement in amputation rate was found. For the time, our institutional data does not support withholding PCD to reduce mortality but suggests that the benefit in preventing amputation is not significant.

Effects of Different Types of Resistance Training and Detraining on Functional Capacity, Muscle Strength, and Power in Older Women: A Randomized Controlled Study.

ABSTRACT: Filho, MM, Venturini, GRdO, Moreira, OC, Leitão, L, Mira, PA, Castro, JB, Aidar, FJ, Novaes, JdS, Vianna, JM, and Caputo Ferreira, ME. Effects of different types of resistance training and detraining on functional capacity, muscle strength, and power in older women: A randomized controlled study. J Strength Cond Res 36(4): 984-990, 2022-Resistance training (RT) increases muscle strength, power, and functional capacity (FC) of older women. However, these benefits can be lost partially or totally with detraining. This study aimed to compare the effect of 20 weeks of different types of RT and 4 weeks of detraining on muscle strength, power, and FC in older women. Ninety-five older women were randomly divided into 4 experimental groups (strength endurance, power, absolute strength, and relative strength training) and 1 control group (CG). We assessed muscle strength (10RM test) and muscle power of the lower (countermovement jump) and upper limbs (medicine ball pitch). Functional capacity was assessed by the Senior Fitness Test, which comprises the following tests: 30-second arm curl, 30-second chair stand, back scratch, chair sit and reach, 8-foot up and go, and 6-minute walk. The experiment lasted 24 weeks (familiarization: 2 weeks; neural adaptation: 6 weeks; specific training: 12 weeks; and detraining: 4 weeks). Muscle strength, lower and upper limb power (all p < 0.05), 30-second arm curl, 30-second chair stand, 8-foot up and go, 6-minute walk (all p < 0.001), and lower limb flexibility (p = 0.002) improved in all experimental groups after training and CG showed no differences in any of these variables. After detraining, muscle strength, lower and upper limb power (p < 0.05 for all), and FC decreased in comparison to the end of RT (30-second arm curl, 30-second chair stand, 8-foot up and go, 6-minute walk, and lower limb flexibility, p < 0.05 for all). Although the FC of the subjects has been reduced after 4 weeks of detraining, it was maintained at higher levels in comparison to baseline. These results suggested that older women can be submitted to different types of RT to achieve improvements in general fitness.

Cystic Adventitial Disease of the Popliteal Vein, a Rare Cause of Lower Limb Deep Vein Thrombosis.

Introduction: Cystic adventitial disease (CAD) is characterised by the accumulation of gelatinous fluid within the adventitial layer of a blood vessel. Over 90% of CAD occurs in the arterial system. Venous CAD most commonly involves the iliofemoral rather than the popliteal segments. Report: This is the report of a 49 year old female patient with a previous right leg deep vein thrombosis (DVT). She presented to a vascular outpatient appointment with recurrent right lower extremity swelling. Venous duplex ultrasound showed an ectatic and incompetent right popliteal vein. Computed tomography (CT) venography showed focal ectasia of the right popliteal vein resulting from an eccentric low density cyst with a diameter of 15 mm. Under general anaesthesia, the patient was placed in the prone position. A lazy S incision was performed in the right popliteal fossa. The popliteal vein had an eccentrically thickened lateral bulge. After heparinisation, a longitudinal venotomy, endophlebectomy, and en bloc cyst removal were performed sequentially. Popliteal patch venoplasty was performed subsequently using the ipsilateral small saphenous vein. After six months, the patient remains on rivaroxaban. A follow up venous duplex ultrasound showed vein reflux through a standard calibre popliteal vein without evidence of cyst recurrence. Conclusion: Venous CAD is a rare disease and should be considered if previous DVT or symptoms mimicking DVT occur. Cyst resection and reconstruction with vein patch, venous or synthetic graft is the most commonly used strategy and has lower rates of cyst recurrence and need for re-operation.

Does Social Media Use on Smartphones Influence Endurance, Power, and Swimming Performance in High-Level Swimmers?

Objective: This study aimed to investigate the repeated effect of social media on smartphones immediately before training sessions on inhibitory control (Stroop task), endurance (tethered swimming), countermovement jump (CMJ), and swimming performance (50, 100, and 400-m freestyle) in high-level female swimmers. Methods: It is a randomized and experimental investigation with parallel groups. Twenty-two participants underwent the eight weeks of the experiment. The swimmers (eight to twelve sessions per week with 15.9 ± 1.6 hours/week, and training experience of ~ 5.6 years) were randomized in two groups: control (CON, n = 11) and smartphone (SMA, n = 11). Immediately before each training session, the CON group watched videos about Olympic Games for 30-min. The SMA group used social network smartphone apps during 30-min. The inhibitory control, endurance, CMJ, and swimming performance were measured before and after the eight weeks of intervention. Results: No group x time interaction for 50-m freestyle (F(4, 18) = 1.04; p = .33; η2 = 0.09) and CMJ performance (F(4, 18) = 0.31; p = .58; η2 = 0.03) was found. Both experimental groups improved CMJ (F(2, 20) = 8.71; p = .01; η2 = 0.46). Only the CON group improved the 100-m (p = .02), 400-m freestyle (p = .01), and endurance performance (p = .01). The CON group improved the inhibitory control response (p = .01). Conclusion: It is concluded that the repeated effect of social media on smartphones immediately before swimming training sessions might reduce or nullify training gains on swimming and endurance performance.

Effects of smartphone use before resistance exercise on inhibitory control, heart rate variability, and countermovement jump.

BACKGROUND: The effect of MF induced by exposure time to social media smartphone apps on inhibitory control, heart rate variability (HRV), and high-intensity physical effort following a resistance exercise session might indicate whether strength and conditioning professionals should suggest avoiding smartphone usage before a resistance exercise session. AIM: The objective of this study was to analyze the effect of mental fatigue on inhibitory control, HRV, and countermovement jump (CMJ) in trained adults after resistance exercise. METHODS: A total of 16 trained males (21.4 ± 3.3 years) volunteered in this study. The participants performed resistance exercises with and without mental fatigue. The Stroop Task, countermovement jump, and heart rate variability were evaluated before and after the resistance exercise. The participants used smartphones in the mental fatigue condition, whereas the participants watched TV in the control condition. RESULTS: No condition × time interaction was found for the Stroop accuracy (p = 0.87), CMJ (p = 0.68), SDNN (p = 0.15), or pNN50 (p = 0.15) in the heart rate variability. An interaction was found for Stroop response time (p = 0.01) with a higher response time for the mental fatigue condition (p = 0.01). CONCLUSIONS: Mental fatigue impaired the inhibitory control performance after a resistance exercise session in trained adults.

Dissection Flap Fenestration with a Transjugular Intrahepatic Portosystemic Shunt Needle: An Adjuvant Technique in Endovascular Treatment of Post-Dissection Thoraco-Abdominal Aortic Aneurysms.

INTRODUCTION: In chronic aortic dissection complicated by aneurysmal degeneration, the absence of spontaneous tears between the true and false lumen at visceral artery level may limit treatment by fenestrated/branched endovascular aneurysm repair (F/BEVAR). The creation of new fenestrations may be required to allow access to the visceral vessels. TECHNIQUE: In this video, the endovascular treatment of a 70 year old white man with chronic type B aortic dissection complicated by Crawford type II thoraco-abdominal aortic aneurysmal degeneration is presented. The right renal artery had a false lumen origin without nearby visible re-entry tears. He underwent dissection flap fenestration at visceral vessel level using a transjugular intrahepatic portosystemic shunt (TIPS) needle and subsequent dilation with a high pressure balloon. A Zenith TX2 dissection endovascular graft was deployed proximally and extended distally with a Zenith dissection endovascular stent until the fenestration level was reached. In a second stage, a F/BEVAR was performed, with fenestration to the left renal artery and branches to right renal artery, superior mesenteric artery, and coeliac trunk. One year follow up computed tomography angiography showed visceral branch patency and a reduction of the aneurysm sac. DISCUSSION: The chronic dissection flap may be thick and fibrotic, creating a technical challenge for endovascular fenestration. The off label use of a TIPS needle in this procedure created a new fenestration at the desired level and allowed definitive post-dissection treatment of the thoraco-abdominal aneurysm.

Virtual reality promotes greater improvements than video-stimulation screen on perceptual-cognitive skills in young soccer athletes.

Background The literature has shown the positive effect of virtual reality (VR) in percepto-cognitive skills. However, the literature lacks findings about at what extent VR would be better than video. Purpose This study aimed to analyze the chronic effect of VR and video-stimulation screen training on passing decision-making, visual search behavior, and inhibitory control performance in young soccer athletes. Method A total of 26 young soccer players underwent an 8-week training protocol after being randomly assigned to the VR (n = 13) or video-screen (VID, n = 13) group. Passing decision-making, visual search behavior, and inhibitory control performance were measured before and after both interventions. Results A group x time interaction was found for decision-making performance (p < 0.01) and visual search behavior (p < 0.01). Both groups improved both decision-making performance (p < 0.01) and visual search behavior (p < 0.01); however, greater improvements were verified in VR (p < 0.01). Both VR and VID improved inhibitory control (p < 0.01), but no group interaction effect was observed (p > 0.05). Conclusion Our results suggest that VR leads to greater improvements in decision-making and visual search behavior in young soccer athletes than VID.

Effects of Mental Fatigue Induced by Social Media Use on Volleyball Decision-Making, Endurance, and Countermovement Jump Performance.

We studied the effects of repeated inducements of mental fatigue (MF) from using social media on smartphones immediately before training sessions by young male volleyball athletes, focusing specifically on their decision-making, endurance, and countermovement jump performance (CMJ). We pair-matched 24 participants according to their decision-making abilities and then, randomly assigned them to one of two 4-week block training groups: control (CON) and smartphone use (SMA). For a 30-minute period before each training session, the CON group watched TV and the SMA group used social media apps on smartphones. We found a significant group x time interaction effect for decision making (attack, p = 0.03; passing, p = 0.02) during training blocks. More specifically, only the CON group improved their decision making (attack, p = 0.03; passing, p = 0.02). Both groups significantly improved their CMJ performance (p = .01), with no significant group x time interaction effect for CMJ (p = 0.91). Neither group significantly improved their endurance (p = 0.56). We concluded that 30-minutes of repetitive social media app use on a smartphone immediately before 4-weeks of volleyball training sessions negatively affected decision-making in young male volleyball athletes.

The effect of smartphones and playing video games on decision-making in soccer players: A crossover and randomised study.

The objective of this study was to analyse the effect of the use of social networks in smartphones or playing video games on the passing decision-making performance in professional soccer athletes. Participants were 25 male professional soccer athletes (mean ± SD: age 23.4 ± 2.8 years). The participants performed three randomised conditions divided into three groups: control (CON), smartphone (SMA), and video game (VID). Before and after each experimental condition, the Stroop Task assessed the level of induced mental fatigue. Then, the athletes performed a simulated soccer match. A CANON® camera recorded the matches for further analysis on passing decision-making performance. A group effect was identified (p < .01) with impairment on passing decision-making performance for the SMA (p = .01, ES = 0.5) and VID (p = .01, ES = 0.5) conditions. We concluded that the use of social networks on smartphones and/or playing video games right before official soccer matches might impair the passing decision-making performance in professional soccer athletes.

Frequency of resistance training does not affect inhibitory control or improve strength in well-trained young adults.

The objective of the current study was to compare the effects of resistance training frequency on cognitive inhibitory control in young adults with previous experience in the modality. Male participants (N = 36) were randomly placed into one of three experimental groups. Participants performed resistance training 1 (F1), 2 (F2), and 3 (F3) times per week for 24 weeks. The three groups performed exercises of equal intensity, volume-load, and rest duration. Cognitive inhibitory control (via Stroop test) was tested 72 h before (pre-experiment) and 72 h after (post-experiment) the resistance training program. No time vs. group interaction effects were noted for accuracy (F(4, 29) = 3.57, p = 0.18) or response time (F(4, 29) = 2.61, p = 0.06) on the Stroop test. These results indicate that increased resistance training frequency, when volume-load is kept constant, does not appear to potentiate cognitive inhibitory control.

Effect of Dehydration on Passing Decision Making in Soccer Athletes.

It seems that dehydration may impair decision-making performance in athletes. PURPOSE: This study aimed to investigate the influence of dehydration on passing decision-making performance in soccer players. METHOD: Participants were 40 male soccer players (Mage = 22.3 ± 2.3 years) who agreed to participate in the study and were randomly assigned to the following conditions: control (CON), dehydration (DEH), and euhydration (EUH). The players played in 2 games of 90 min in duration (2 45-min halves) followed by 2 15-min halves (overtime) with and without proper hydration. The Game Performance Assessment Instrument (GPAI) was considered for the analysis of passing decision making. RESULTS: The GPAI analysis indicated effective reduction in the decision-making index in the DEH condition compared with the EUH and CON conditions, F(2, 38) = 31.4, p < .05, ES = 0.8. CONCLUSIONS: In conclusion, dehydration may be considered a mediating factor in the passing decision-making performance of male soccer athletes.

Circuit strength training improves muscle strength, functional performance and anthropometric indicators in sedentary elderly women.

BACKGROUND: This study aimed to investigate the effects of circuit strength training on the muscle strength, functional autonomy and anthropometric indicators of the elderly. METHODS: Were included 65 women divided in two groups: strength training (TG, N.=34) and control group (CG, N.=31). The strength-training group was subjected to a circuit shaped training program, three days per week, for a period of 12 weeks. In each training session, the circuit was repeated three times. In each circuit, all exercises were performed once, with 8 to 12 repetitions per exercise, with 30-second intervals between each exercise. RESULTS: TG showed significantly changes in body composition post 12 weeks, as decreases in body weight (Δ-1.5±1.8 kg) and BMI (Δ-0.57±0.74 kg/m²), and decreases in abdominal (Δ-3±1.61 cm), waist (Δ-1 ± 1.61 cm), hip (Δ-2.75±1.44 cm) and waist-hip ratio circumference (Δ-0.02±0.15 cm). For functional autonomy, TG showed increases post 12 weeks by 30-second chair stand (Δ 3.5±0.4 reps), six minute walk (Δ60.95±7.91 m), back scratch (Δ3.2±1.36 cm), and time up and go tests (Δ-1.62±0,15 s). TG also showed increases in muscle strength post 12 weeks in both leg press (Δ11±1.29 kg) and lat pulldown (Δ11±0.75 Kg). For CG, body composition, functional autonomy and muscle strength did not improved in any moment. CONCLUSIONS: Hence, circuit strength training provides significant improvements in muscle strength, functional performance and anthropometric indicators in sedentary elderly women.

Influence of Competitive-Anxiety on Heart Rate Variability in Swimmers.

The aim of this study was to analyze the relationship between competitive anxiety and heart rate variability (HRV) in swimming athletes. A total of 66 volunteers (41 male and 27 female) who swam the 400-m freestyle in the Brazilian Swimming Championships participated. Thirty minutes before the 400-m freestyle event, the athletes answered the Competitive Anxiety Inventory (CSAI-2R) questionnaire, then underwent anthropometric (body weight, height, and skinfold thickness) and HRV measurements. Then, at a second meeting, held 3 h after the 400-m freestyle event, the athletes returned to the evaluation room for HRV measurement (Polar® RS800cx, Kempele, Finland). Multiple linear regression was used to evaluate the relationship between competitive anxiety and HRV. The multiple linear regression was performed in three blocks (block 1: cognitive anxiety, block 2: somatic anxiety, and block 3: self-confidence), adopting the forward model. The results indicated a significant association between cognitive anxiety (p = 0.001) and HRV. An increased magnitude of the association was observed when somatic anxiety was inserted in the model (p = 0.001). In contrast, self-confidence showed, which was inserted in block 3, no relationship with HRV (p = 0.27). It was concluded that cognitive and somatic anxieties were associated with the HRV of swimmers. Athletes with a high magnitude of cognitive and/or somatic anxiety demonstrated more significant autonomic nervous system disturbance. Practically, psychological interventions are needed to improve anxiety states that are specific to perform well, and to improve HRV.

Scale development: ten main limitations and recommendations to improve future research practices.

The scale development process is critical to building knowledge in human and social sciences. The present paper aimed (a) to provide a systematic review of the published literature regarding current practices of the scale development process, (b) to assess the main limitations reported by the authors in these processes, and (c) to provide a set of recommendations for best practices in future scale development research. Papers were selected in September 2015, with the search terms "scale development" and "limitations" from three databases: Scopus, PsycINFO, and Web of Science, with no time restriction. We evaluated 105 studies published between 1976 and 2015. The analysis considered the three basic steps in scale development: item generation, theoretical analysis, and psychometric analysis. The study identified ten main types of limitation in these practices reported in the literature: sample characteristic limitations, methodological limitations, psychometric limitations, qualitative research limitations, missing data, social desirability bias, item limitations, brevity of the scale, difficulty controlling all variables, and lack of manual instructions. Considering these results, various studies analyzed in this review clearly identified methodological weaknesses in the scale development process (e.g., smaller sample sizes in psychometric analysis), but only a few researchers recognized and recorded these limitations. We hope that a systematic knowledge of the difficulties usually reported in scale development will help future researchers to recognize their own limitations and especially to make the most appropriate choices among different conceptions and methodological strategies.

Scale development: ten main limitations and recommendations to improve future research practices

Abstract The scale development process is critical to building knowledge in human and social sciences. The present paper aimed (a) to provide a systematic review of the published literature regarding current practices of the scale development process, (b) to assess the main limitations reported by the authors in these processes, and (c) to provide a set of recommendations for best practices in future scale development research. Papers were selected in September 2015, with the search terms “scale development” and “limitations” from three databases: Scopus, PsycINFO, and Web of Science, with no time restriction. We evaluated 105 studies published between 1976 and 2015. The analysis considered the three basic steps in scale development: item generation, theoretical analysis, and psychometric analysis. The study identified ten main types of limitation in these practices reported in the literature: sample characteristic limitations, methodological limitations, psychometric limitations, qualitative research limitations, missing data, social desirability bias, item limitations, brevity of the scale, difficulty controlling all variables, and lack of manual instructions. Considering these results, various studies analyzed in this review clearly identified methodological weaknesses in the scale development process (e.g., smaller sample sizes in psychometric analysis), but only a few researchers recognized and recorded these limitations. We hope that a systematic knowledge of the difficulties usually reported in scale development will help future researchers to recognize their own limitations and especially to make the most appropriate choices among different conceptions and methodological strategies.

Psychometric evaluation of the Sociocultural Attitudes Towards Appearance Questionnaire-3 among Brazilian young adults.

The objective was evaluating the psychometric properties of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3) among Brazilian young adults of both genders. The sample was composed by 506 undergraduate students (295 females and 211 males), aged between 17 and 29 years old. Exploratory and confirmatory factor analyses were used for construct validity (N = 506). Correlations between the SATAQ-3 scores and those of the Tripartite Influence Scale (TIS) and Body Shape Questionnaire (BSQ) were used for convergent validity. Reliability was assessed through internal consistency (α) and reproducibility (test-retest) through comparison of the means obtained at two different time points and through intra-class correlation. The scale presented a factor structure composed of five factors, replicated in the confirmatory factor analysis with satisfactory values for the measurements of adjustment to the model. Correlations with the BSQ and TIS scores were rho = .52 and rho = -.35, respectively. Cronbach's alpha coefficients were satisfactory, and their stability was demonstrated. Brazilian SATAQ-3 had good validity and reproducibility, being indicated for use in samples of Brazilian youths.

[Reconstructive surgery of the large intrathoracic veins, four case reports]. / Cirurgia Reconstrutiva das Grandes Veias Intratorácicas, a Propósito de Quatro Casos Clínicos.

The resection and reconstruction of the large venous vessels of the chest is a procedure intended to treat the symptoms of venous hypertension caused by the Superior Vena Cava Syndrome and to allow resection of mediastinal tumors that invade the superior vena cava (SVC) and the left and right innominate veins. We report four clinical cases of mediastinal tumors involving the large intrathoracic venous vessels, submitted to surgery between 2010 and 2013. In all cases our purpose was to completely resect the tumor. We intended to evaluate the surgical results in terms of improvement of symptoms, complications of the procedures, permeability of the bypasses in the short and medium term and mortality rates. We used ringed ePTFE grafts to perform the following vascular reconstructions: - Y configuration bypass from the left subclavian vein and the left internal jugular vein to the left inominate vein; - two bypasses from the top of the left innominate vein to the right atrial appendage; - bypass from the left innominate vein to the right atrial appendage and a bypass from the right innominate vein to the SVC. All patients were discharged, and all the bypasses were patent at discharge and after 30 days . There were two cases of late thrombosis, but patients remained asymptomatic. Our series shows the feasibility of these technically complex surgeries, which are an excellent example of the benefits of multidisciplinary collaboration between vascular and thoracic surgeons.