RESUMO
AIM: The purpose of this paper is to evaluate the mid and long terms outcomes of open and endovascular surgical treatment, as well as multilayer stent, in patients affected by Renal Artery Aneurysm (RAA). PATIENTS AND METHODS: Twenty five patients with RAA (24 monolateral and 1 bilateral aneurysm, 26 aneurysms) were observed between 2000 and 2015: 4 were not treated due to the small size of the aneurysm (< 2.5 cm); out of the remaining, 16 underwent endovascular treatment, 2 were treated by open surgery consisting in aneurysmectomy and graft reconstruction and 5 (in 1 patient bilateral) were treated by ex vivo repair and autotransplantation. RESULTS: Out of the 22 patients treated for RAA, one patient operated upon open surgery presented an early thrombosis of a PTFE graft, followed by nephrectomy (4.7%); one patient underwent autotransplantation showed an ureteral kinking without functional consequences. In a follow-up ranging from 1 and 11 years (mean 5 years), no deaths were observed; all the renal arteries repaired were patents and 16 out of 21 patients had a significative reduction of systemic blood pressure. DISCUSSION: The choice of the best treatment is based on aneurysm's morphology according to Rundback's classification. The type I, involving the main renal artery, is always treated by endovascular approach; type II, involving renal artery bifurcations may be treated by open surgery or multilayer stents; type III (hilar or intraparenchymal aneurysms) needs only an open surgical treatment as autotransplantation. CONCLUSION: Based on our experience it seems that most of RAAs may be treated by endovascular technique. The ex vivo autotransplantation represents the first-line treatment in hilar and intraparenchymal aneurysms. Multilayer stents seem to have good outcome in the treatment of aneurysms involving arterial bifurcations. Mid and long term results, related to kidney preservation and to normalization of blood pressure, seems satisfying.
Assuntos
Aneurisma/cirurgia , Procedimentos Endovasculares , Artéria Renal/cirurgia , Stents , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos , Adulto JovemRESUMO
AIM: Mesoglycan, composed of natural glycosaminoglycans, is used for treatment in arterial and venous disease for its benefits on endothelial glicocalix. Little is known about mesoglycan impact on endothelial blood flow regulation. We sought to evaluate the effects of mesoglycan intermittently added to back-ground treatments on impairment of endothelial function in peripheral arterial disease (PAD) patients. METHODS: We studied the effects of a 2+2 months oral treatment with 50 mg b.i.d. of mesoglycan, intervalled by 2 months without mesoglycan, in 540 PAD patients on four occasions (visit 1: baseline, visit 2: 2 months, visit 3: 4 months and visit 4: 6 months). At these time visits we assessed brachial artery endothelial-dependent flow-mediated dilation (FMD), together with femoral intima-medial thickness (IMT), and walking distance (WD). RESULTS: There were significant changes in FMD (1.88%, CI 95%: 1.13, 2.63; P<0.001), IMT (-0.05 mm, CI 95%: -0.07,-0.02; P<0.001) and WD (38,9%, CI 95% 33.2, 44.8; P<0.001). The positive effects and benefit were maintained during the two-months interval without mesoglycan treatment. Significant changes in FMD were observed in a number of patient groups, stratified for risk factors (aging, sex, smoke, diabetes, dyslipidemia, hypertension). CONCLUSION: Two months cycles with mesoglycan improved endothelial function in PAD patients, with a parallel reduction of atherosclerotic damage and amelioration of clinical condition.
Assuntos
Artéria Braquial/fisiopatologia , Artérias Carótidas/fisiopatologia , Endotélio Vascular/fisiopatologia , Glicosaminoglicanos/administração & dosagem , Doença Arterial Periférica/tratamento farmacológico , Vasodilatação/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Resultado do TratamentoAssuntos
Angioplastia/instrumentação , Aterosclerose/terapia , Fármacos Cardiovasculares/uso terapêutico , Obstrução da Artéria Renal/terapia , Stents , Angioplastia/efeitos adversos , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Fármacos Cardiovasculares/efeitos adversos , Humanos , Seleção de Pacientes , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/epidemiologia , Fatores de Risco , Resultado do TratamentoRESUMO
We studied the usefulness of preoperative resistance index to select patients who will benefit most from renal stenting. Sixty-two patients underwent renal stenting. All had chronic renal insufficiency with serum creatinine values ranging from 1.5 to 2.5 mg/dL and blood urea nitrogen between 80 and 107 mg/dL. All treated renal artery stenosis were >70%. Reduction in blood pressure in the early stages was observed in 39 (62.9%) patients; 31 (79.4%) patients returned to preoperative values within 12 months. A progressive reduction in creatinine values and blood urea nitrogen was reached in 43 (69.4%) patients, 12 (19.4%) patients remained unchanged, and the remaining 7 (11.2%) patients worsened. The best improvement in renal function was obtained in patients with a resistance index of ≤0.75 A preoperative resistance index up to 0.75 could be used as an indicator to predict which candidates will have improved renal function after stenting.
Assuntos
Procedimentos Endovasculares/instrumentação , Rim/fisiopatologia , Obstrução da Artéria Renal/terapia , Insuficiência Renal Crônica/fisiopatologia , Stents , Idoso , Biomarcadores/sangue , Pressão Sanguínea , Nitrogênio da Ureia Sanguínea , Creatinina/sangue , Progressão da Doença , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/fisiopatologia , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Resistência VascularRESUMO
AIM: Ischemic stroke represents a major health problem and it is an important cause of long-term disability. The aim of this study was to compare short-term and mid-term results of carotid endarterectomy and stenting. METHODS: During a three-year period, we enrolled 300 patients with carotid stenosis that fit with Stroke Prevention and Educational Awareness Diffusion (SPREAD) guidelines and we performed 150 carotid endarterectomy operations (CEA) and 150 carotid artery stenting procedures (CAS) with distal protection devices. All patients underwent preoperative and postoperative: neurological examination, ultrasound imaging, magnetic resonance imaging (MRI) and cognitive tests; moreover all patients were submitted to preoperative, intraoperative and postoperative Transcranial Doppler (TCD) monitoring, in order to detect microembolic signals (MES). RESULTS: Mortality was zero; two patients developed myocardial infarction in the CEA group during follow-up. The main post-operative results after endarterectomy versus CAS were respectively: neurological deficit: 1.3% vs. 3.3%, embolic lesions at postoperative MRI: 4% vs. 34% and worsening of cognitive tests: 4% vs. 25.3%. CONCLUSION: CEA seems to be the treatment of choice for carotid stenosis, due to its low rate of mortality and morbidity, especially in asymptomatic patients; CAS should be carried out only in particular subgroup of cases, such as: restenosis, previous neck surgery or radian therapy, anatomical high bifurcation or extended lesions. Ongoing multicenter randomized trials may give a definitive answer to this matter.
Assuntos
Angioplastia com Balão/instrumentação , Estenose das Carótidas/terapia , Endarterectomia das Carótidas , Stents , Acidente Vascular Cerebral/prevenção & controle , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/mortalidade , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/mortalidade , Estenose das Carótidas/psicologia , Estenose das Carótidas/cirurgia , Cognição , Imagem de Difusão por Ressonância Magnética , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/mortalidade , Humanos , Infarto do Miocárdio/etiologia , Exame Neurológico , Testes Neuropsicológicos , Seleção de Pacientes , Valor Preditivo dos Testes , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler TranscranianaAssuntos
Diagnóstico por Imagem/normas , Ultrassonografia/normas , Doenças Vasculares/diagnóstico , Índice Tornozelo-Braço , Circulação Sanguínea , Velocidade do Fluxo Sanguíneo , Monitorização Transcutânea dos Gases Sanguíneos , Prótese Vascular , Implante de Prótese Vascular , Vasos Sanguíneos/patologia , Espessura Intima-Media Carotídea , Constrição Patológica/diagnóstico , Impedância Elétrica , Teste de Esforço , Feminino , Genitália Feminina/irrigação sanguínea , Humanos , Impotência Vasculogênica/diagnóstico , Extremidade Inferior/anatomia & histologia , Extremidade Inferior/irrigação sanguínea , Linfedema/diagnóstico , Masculino , Nitroglicerina , Posicionamento do Paciente , Dor Pélvica/etiologia , Pênis/irrigação sanguínea , Fotopletismografia , Placa Aterosclerótica/patologia , Cuidados Pós-Operatórios , Cordão Espermático/irrigação sanguínea , Stents , Ultrassonografia/métodos , Extremidade Superior/anatomia & histologia , Extremidade Superior/irrigação sanguínea , Doenças Vasculares/terapia , Grau de Desobstrução Vascular , VasodilatadoresRESUMO
BACKGROUND: The true aneurysms of the infrapopliteal arteries are an unusual pathology with low incidence in the general population. They appear in the literature only as isolated case reports. True aneurysms of the infrapopliteal arteries represent a surgical problem, especially when a bifurcation is involved and when the distal vessels are affected by occlusive disease. CASE REPORT: A 67 year old man with an aneurysm which involved the tibioperoneal trunk and the origin of peroneal and posterior tibial arteries was surgical treated. At three months follow up, a duplex ultrasonography (DUS) control showed the bypass patency and the total exclusion of the aneurismal sac. DISCUSSION: Although the aneurysms of the infrapopliteal arteries are very uncommon and often asymptomatic, their associated vascular lesions and/or ischemic complications can lead to high risk of limb loss. When the aneurysm is large and/or symptomatic, the surgical treatment becomes mandatory. A conservative treatment and DUS follow up could be reserved to elderly patients and when the aneurysm is small and asymptomatic.
Assuntos
Aneurisma/cirurgia , Artéria Poplítea/cirurgia , Artérias da Tíbia/cirurgia , Idoso , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Implante de Prótese Vascular , Síndrome do Artelho Azul/etiologia , Humanos , Masculino , Artéria Poplítea/diagnóstico por imagem , Radiografia , Veia Safena/transplante , Artérias da Tíbia/diagnóstico por imagem , UltrassonografiaRESUMO
OBJECTIVES: To evaluate whether contrast ultrasonography can be used to distinguish asymptomatic from symptomatic carotid plaques and provide insight into underlying pathophysiological differences. DESIGN: Contrast carotid ultrasound was performed in both symptomatic and asymptomatic patients referred for carotid endarterectomy. MATERIALS AND METHODS: Of 77 consecutive patients referred for carotid artery evaluation, 64 underwent carotid endarterectomy for asymptomatic cerebrovascular disease and 9 underwent urgent surgery for acute neurological deficits with hemiparesis. The endarterectomy specimens were assessed immunohistologically. RESULTS: In all 9 patients undergoing urgent surgery, contrast ultrasonography showed the accumulation of diffuse microbubble contrast at the base of the carotid plaque. This pattern was observed only in 1/64 of the patients undergoing surgery for asymptomatic carotid disease. Immunohistologically staining of the endarterectomy specimens showed that the area of microbubble contrast at the base of the symptomatic plaques was associated with an increased number of small diameter (20-30 microm) microvessels staining for vascular endothelial growth factor (VEGF). CONCLUSIONS: Contrast carotid ultrasonography may allow the identification of microvessels with neoangiogenesis at the base of carotid plaques, and differentiate symptomatic from asymptomatic plaques.
Assuntos
Estenose das Carótidas/diagnóstico por imagem , Transtornos Cerebrovasculares/etiologia , Meios de Contraste , Microbolhas , Microvasos/diagnóstico por imagem , Neovascularização Patológica/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler de Pulso , Idoso , Estenose das Carótidas/complicações , Estenose das Carótidas/metabolismo , Estenose das Carótidas/cirurgia , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/metabolismo , Transtornos Cerebrovasculares/cirurgia , Endarterectomia das Carótidas , Feminino , Humanos , Imuno-Histoquímica , Masculino , Microvasos/química , Pessoa de Meia-Idade , Neovascularização Patológica/metabolismo , Neovascularização Patológica/cirurgia , Projetos Piloto , Valor Preditivo dos Testes , Regulação para Cima , Fator A de Crescimento do Endotélio Vascular/análiseRESUMO
Endovascular treatment of thoracic and thoraco-abdominal aortic aneurysm with celiac artery ostium coverage, seems to be safe according to the literature. We present a case in which the endograft deployement was achieved through a right common carotid artery access because four years before the patient was submitted to an axillo-bifemoral bypass with aortic graft removal and aortic stump ligature for infection. After endovascular repair the patient suffered from spinal cord ischemia, acute pancreatitis and spleen infarction. Probably, the new pancreatic event has been triggered by temporary visceral ischemia, acting on a pancreas damaged by a previous acute hemorrhagic pancreatitis.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Artéria Carótida Primitiva/cirurgia , Artéria Celíaca/cirurgia , Doença Aguda , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Celíaca/diagnóstico por imagem , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Pancreatite/etiologia , Isquemia do Cordão Espinal/etiologia , Infarto do Baço/etiologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
UNLABELLED: The aim of this study was to assess the prevalence and clinical relevance of microembolism in one hundred unselected patients submitted to 50 carotid endarterectomy (CEA) and 50 carotid stenting (CAS) procedures from January 2005 to January 2006 for hemodynamic lesions of the carotid bifurcation (> 70% stenosis). MATERIAL AND METHODS: High-resolution Colour-Flow Mapping (CFM), Transcranial Doppler (TCD), cerebral computed tomography (CT) or magnetic resonance (MR) and four psychometric tests (Mini mental state, Beck depression inventory, Zung anxiety inventory, SF-12) were carried out in the preoperative evaluation in all the patients. In the CEAs loco-regional anesthesia (100%), patch angioplasty (84%) and Pruitt- Inahara shunt (4%) were employed; in the CASs local anesthesia (100%), three different carotid stents (Precise-Cordis, Acculink-Guidant and Carotid Wallstent-Boston Scientific) and three temporary distal filter protection devices (Angioguard-Cordis, Accunet-Guidant, Filterwire-EZ- Boston Scientific), without pre-dilatation, were employed. TCD monitoring was used intra-operatively and 12 hours post-operatively to evaluate the presence and the number of microembolic events (ME's) and to investigate the efficiency of neuroprotective filter devices. The efficacy of the in situ opened filter was judged evaluating the decrease of mean blood velocity in ipsilateral middle cerebral artery and the reduction rate of microembolic events (number of microemboli detected during the entire procedure/number of microemboli detected during the filter positioning). Diffusion-weighted magnetic resonance imaging (DWI) of the brain was obtained within 24 to 48 hours after the procedures to detect new ischemic brain lesions. Psychometric tests were repeated at the discharge of the patient and after two months to evaluate cognitive faculties. RESULTS: During postoperative period (30 days) and follow-up, no procedure-related death and three regressive minor strokes occurred : 1 in CEA (2%) and 2 in CASs (4%) ; a cranial nerve lesion occurred in CEA (2%). TCD monitoring showed ME's (a mean of five events) in 37 CEAs (74%) and in 50 CASs (100%) (a mean of 60 ME's). In five patients submitted to CAS repeated microemboli occurred during one hour postoperative TCD control (10%). A 10-30% decrease of mean blood velocity basal value was recorded in the ipsilateral middle cerebral artery when the filter device was opened. A mean 70% reduction of ME's was obtained with a cerebral protection system deployed. Postoperative DWI detected new focal ischemic lesions in 24 patients [22 after CAS (44%) (a mean of 5 new ipsi and contra-lateral lesions) , and 2 after CEA (4%). Cognitive capability worsened in 20 patients [18 after CAS (36%) e 2 after CEA (4%)]. CONCLUSIONS: Mortality and morbidity rates of patients submitted to CAS are comparable to the results obtained by CEA. A great number of ME's are recorded by TCD during endovascular procedures, more than during open surgery. ME's due to CAS are reduced by filter protection devices, but the cognitive faculties in a great number of "asymptomatic" patients are decreased after CAS.
Assuntos
Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Embolia Intracraniana/etiologia , Complicações Pós-Operatórias , Stents , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão , Velocidade do Fluxo Sanguíneo , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Estenose das Carótidas/patologia , Transtornos Cognitivos/etiologia , Diagnóstico por Imagem , Feminino , Filtração , Seguimentos , Humanos , Isquemia/etiologia , Isquemia/patologia , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Testes Neuropsicológicos , Acidente Vascular Cerebral/etiologiaRESUMO
AIM: Isolated iliac artery aneurysm is a rare pathology that is often asymptomatic for long periods; this late diagnosis exposes patients to a high risk of death following aneurysm rupture. The aim of this study was to establish the most suitable diagnostic approach, the correct indications for treatment, and the most appropriate tactics and surgical technique. METHODS: Twenty-eight patients were observed over 13 years. Aneurysmal involvement was unilateral in 22 cases and bilateral in the remaining 6 patients. Preoperative diagnostic tests included eco-colour Doppler (ECD) and angio-CT in all cases, with angio-MR and angiography as more selective procedures. Seventeen patients underwent conventional open surgery with prosthetic replacement of the aneurysmatic tract, 7 patients were treated using endovascular exclusion, and lastly 4 were monitored over time. RESULTS: There was no perioperative mortality for either treatment. During the postoperative period following conventional open surgery, complications included one case of severe respiratory failure, one microembolism of the lower limb, and 2 periprosthetic hematoma. During the follow-up, we observed one pseudo-aneurysm, 3 cases of retrograde ejaculation and one patient with erectile dysfunction after traditional surgery; there was one minor endoleak after endovascular exclusion. CONCLUSIONS: Our experience suggests that ECD is a useful method for arriving at an early diagnosis, while angio-CT imaging is essential for a correct preoperative study. Aneurysms with a diameter equal or greater than 3 cm or that present annual increases in excess of 5 mm represent a correct indication for treatment. Conventional open surgery is the treatment of choice for young patients in good general conditions. Endovascular exclusion is indicated when the patient's clinical conditions contraindicate open surgery and the morphology of the aneurysmal arterial district allows the endoprosthesis to be safely implanted.
Assuntos
Aneurisma Ilíaco/diagnóstico , Aneurisma Ilíaco/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Implante de Prótese Vascular , Feminino , Seguimentos , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/fisiopatologia , Artéria Ilíaca/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/efeitos adversosRESUMO
BACKGROUND: The aim of this study is to evaluate diagnostic methods, indications and surgical technique in SEPS procedure and to analyze short term results. METHODS: Eighteen patients affected by chronic venous insufficiency (CVI) have been analyzed. According to NAVS (North American Vascular Society) classification three patients were included in class 6 (C6), 3 (C5), 6 (C4), 2 (C3) and 4 (C2). From 2 to 5 selective subfascial endoscopic ligation of perforator veins, especially I and II Cockett perforator veins' were performed. In 7 cases, total stripping of the great (6) or less (1) saphenous vein was associated with SEPS procedure. After the operation, an elastic bandage of the lower limbs was performed and a medical treatment with LMVH was started. RESULTS: In 6 patients of the C2 and C3 groups, neither recurrence or pathological reflux were observed at clinical examination and at color duplex. In 12 patients of C4, C5 and C6 groups a reduction of the perimalleolar oedema was observed. In the last 3 patients, with leg ulceration, a resolution of the lesion in 2 cases, and a reduction in diameter in the last one, were observed. CONCLUSIONS: SEPS is particularly advised in those patients belonging to C5 and C6 groups, especially in presence of leg ulceration. This operations is suggested also in patients with CVI and incontinence of perforator veins detected by at color duplex. This diagnostic investigation seems to be adequate in the diagnosis of CVI and in the mapping of perforator veins of the leg.
Assuntos
Angioscopia/métodos , Insuficiência Venosa/diagnóstico , Insuficiência Venosa/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
BACKGROUND: To evaluate the possibility to perform carotid surgery without angiography. METHODS: From January 1994 to June 1998, 514 patients with carotid obstructive disease were operated upon, 225 of them (43.8%) without previous angiography; 55 out of 68 (80.8%) during the last six months. Eighty-one (36.0%) had lateralizing symptoms, 50 aspecific ones (22.2%) and 94 were asymptomatic (41.8%). All patients were investigated by color-coded duplex sonography (CDS) of the arteries at the neck and by transcranial Doppler (TCD) and computed tomography (CT). One hundred eighty-eight patients were operated upon under local anaesthesia and 37 under general anesthesia; 204 had a carotid endartereotomy (90.7%) with patch angioplasty in 154 (75.5%), and 21 required a bypass graft (9.3%). In 26 patients (11.5%) an indwelling shunt was needed. RESULTS: Findings at surgery were consistent with CDS for plaque composition, ulcerations and degree of stenosis. There were no early deaths. Neurologic or ocular deficits occurred in 2 cases (0.9%). No strokes were observed in follow-up from 6 to 34 months. CONCLUSIONS: Carotid endarterectomy can be done without angiography in selected cases provided CDS plus TCD are of high quality. Under such conditions it can be considered a safer way to deal with carotid obstructive disease.
Assuntos
Artérias Carótidas/diagnóstico por imagem , Endarterectomia das Carótidas/métodos , Idoso , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler Dupla , Ultrassonografia Doppler TranscranianaAssuntos
Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Doenças do Sistema Digestório/complicações , Doenças do Sistema Digestório/cirurgia , Aneurisma Roto/complicações , Aneurisma Roto/cirurgia , Feminino , Doenças da Vesícula Biliar/complicações , Doenças da Vesícula Biliar/cirurgia , Gastroenteropatias/complicações , Gastroenteropatias/cirurgia , Hérnia Inguinal/complicações , Hérnia Inguinal/cirurgia , Humanos , Nefropatias/complicações , Nefropatias/cirurgia , Hepatopatias/complicações , Hepatopatias/cirurgia , Masculino , Pancreatopatias/complicações , Pancreatopatias/cirurgia , Esplenopatias/complicações , Esplenopatias/cirurgia , Fatores de Tempo , Doenças da Bexiga Urinária/complicações , Doenças da Bexiga Urinária/cirurgiaAssuntos
Implante de Prótese Vascular/efeitos adversos , Edema/terapia , Artéria Femoral/cirurgia , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Complicações Pós-Operatórias/terapia , Artérias da Tíbia/cirurgia , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Estado Terminal , Edema/etiologia , Fibrinolíticos/uso terapêutico , Heparina/uso terapêutico , Humanos , Extratos Vegetais/uso terapêuticoRESUMO
From July 1991 to March 1995, 178 patients who underwent 198 carotid surgical repairs were investigated preoperatively, intraoperatively, and postoperatively by transcranial Doppler sonography (TCD). Preoperative TCD evaluation showed stenosis of the middle cerebral artery (MCA) in 4 patients (2.2%), siphon stenosis in 3 (1.6%), incomplete circle of Willis in 23 (12.9%), a decrease of mean blood flow velocity more than 70% of the basal value during digital common carotid compression in 31 (17.9%), and a critical reduction of vasomotor reactivity (no significant increase of mean blood flow velocity in the MCA during breath-holding test) in 34 (19.1%). Nine patients (5%) had surgery without preoperative angiography. In those patients the indication for surgery was based on color Doppler imaging and TCD investigations. Ninety surgical procedures were carried out under general anesthesia and 188 under locoregional anesthesia. In 37 surgeries (31.7%) a shunt was inserted. The use of a shunt was based on a decrease of mean blood flow velocity in the MCA below 50% of the basal value under general anesthesia or loss of consciousness combined with a decrease of mean blood flow velocity in the MCA higher than 70% of the basal value when locoregional anesthesia was employed. Intraoperative TCD monitoring showed a decrease of mean blood flow velocity in the MCA due to shunt malfunction in (8.3%) of 36 surgeries, turbulence of blood flow during declamping in 79 procedures (39.8%), and microembolic events in 10 patients (5%) that were related to one transient and one permanent neurological deficit. Another permanent deficit occurred in a patient without TCD signs. After surgery, TCD reliably detected an early asymptomatic occlusion of the carotid artery, hyperperfusion syndrome in 12 (6.0%), and an increase of vasomotor reactivity in 10 (29.4%) of 34 surgeries.
Assuntos
Artérias Cerebrais/diagnóstico por imagem , Endarterectomia das Carótidas , Ultrassonografia Doppler Transcraniana , Anestesia por Condução , Anestesia Geral , Apneia/fisiopatologia , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Derivação Arteriovenosa Cirúrgica , Velocidade do Fluxo Sanguíneo , Artéria Carótida Primitiva/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/etiologia , Angiografia Cerebral , Doenças Arteriais Cerebrais/diagnóstico por imagem , Doenças Arteriais Cerebrais/cirurgia , Circulação Cerebrovascular , Círculo Arterial do Cérebro/diagnóstico por imagem , Círculo Arterial do Cérebro/cirurgia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/cirurgia , Hemorreologia , Humanos , Embolia e Trombose Intracraniana/diagnóstico por imagem , Embolia e Trombose Intracraniana/etiologia , Ataque Isquêmico Transitório/diagnóstico por imagem , Ataque Isquêmico Transitório/cirurgia , Monitorização Intraoperatória , Exame Neurológico , Cuidados Pós-Operatórios , Reprodutibilidade dos Testes , Ultrassonografia Doppler em Cores , Sistema Vasomotor/diagnóstico por imagem , Sistema Vasomotor/fisiopatologiaAssuntos
Prótese Vascular/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/cirurgia , Feminino , Artéria Femoral/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Polietilenotereftalatos , Politetrafluoretileno , Infecções Relacionadas à Prótese/terapia , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
A total of 236 femoropopliteal below the knee and 64 femorotibial bypasses were carried out for critical ischaemia of the lower limbs using various prosthetic materials. These were evaluated in order to assess the patency of composite grafts (29 cases) compared with autogenous saphenous veins (189) and polytetrafluoroethylene (PTFE) (82). The composite graft was made by anastomosing a segment of autogenous vein in the distal position and joining it by an end-to-end oblique anastomosis to a PTFE prosthesis in the proximal position. These grafts were employed when an adequate autogenous vein could not be used for the entire length of the bypass. The graft-graft anastomosis was never placed near the knee-joint and if the PTFE segment had to cross the knee, it was always of the externally supported type. There were no early occlusions in the composite grafts. A total of 257 grafts were available for assessment at a mean of 4 years (range 6 months to 15 years). The patency for autologous saphenous vein was: 81.2% (121/142 femoropopliteal and 13/23 femorotibial). The patency for PTFE was 67.1% (41/58 femoropopliteal and 4/9 femorotibial) and for composite grafts was 76% (10/11 femoropopliteal and 9/14 femorotibial). There was no significant difference in patency between the autologous saphenous vein and the composite grafts, both in the femoropopliteal and femorotibial positions. Both were significantly better than PTFE grafts. Composite grafts are the best alternative when an autologous saphenous vein is not available.