The role of Angiology and Vascular Surgery in the COVID-19 pandemic.

The New Coronavirus Epidemic (2019-nCoV), discovered in the city of Wuhan, China, in December 2019, presents mainly with pulmonary pneumonia that is preceded by fever, cough and myalgia. However, as the disease spread globally and the number of hospitalizations increased exponentially, it was noted that most serious patients hospitalized by COVID-19 have laboratory changes worthy of attention, such as lymphopenia, neutrophilia, increased time of prothrombin and increased levels of D-dimer. Due to these changes proving to be crucial for the mortality and morbidity rates in this subset of infected people, several studies focusing on the pathophysiology, mainly hematological, of the disease appear every day. Deepening these studies, several published works have shown SarsCoV-2 infection to the installation of a prothrombotic state in hospitalized patients, which leads to the potential occurrence of thrombotic or arterial events in this cohort. Thus, in order to understand how the departments of Angiology and Vascular Surgery are acting in the context of the COVID-19 pandemic, this work aims to gather studies that reveal from protocols applied in vascular services in the current situation, until to the role of vascular surgeons and angiologists in the clinical and surgical management of patients infected or not, as a way of helping and clarifying this specialty during the context of a pandemic due to the new coranavirus. For the selection of works, the following search criteria were used: "Coronavirus and venous thrombosis", "Coronavirus and thrombosis", "COVID-19 and venous thrombosis" and "COVID-19 Coronavirus and thrombosis".

A atuação da Angiologia e da Cirurgia Vascular na pandemia de COVID-19

A epidemia pelo novo Coronavirus (2019-nCoV), surgido na cidade de Wuhan, na China, em dezembro de 2019, quando sintomática, apresenta-se majoritariamente por um quadro de pneumonia pulmonar que é precedida por febre, tosse seca e mialgia. No entanto, conforme a doença se espalhou globalmente e o número de hospitalizações aumentaram de forma exponencial, notou-se que a maior parte dos pacientes graves internados por COVID-19 possuem alterações laboratoriais dignas de atenção, como linfopenia, neutrofilia, aumento do tempo de protrombina e elevação dos níveis de D-dímero. Devido tais mudanças se mostrarem cruciais para a taxa de mortalidade e morbidade nesse subgrupo de infectados, diversos trabalhos com enfoque na fisiopatologia, principalmente hematológica, da doença surgem a cada dia. Aprofundando em tais estudos, variados trabalhos publicados evidenciaram a infecção pelo Sars-CoV-2 à instalação de um estado pró-trombótico em pacientes hospitalizados graves, o que acarreta em potencial ocorrência de eventos trombóticos venosos ou arteriais nessa coorte. Assim, para entender como os Departamentos de Angiologia e Cirurgia Vascular estão atuando no contexto da pandemia de COVID-19, este estudo tem por objetivo reunir estudos que revelam desde protocolos aplicados nos serviços vasculares na atual conjuntura, até a atuação dos cirurgiões vasculares e angiologistas no manejo clínico e cirúrgico de pacientes infectados ou não, como forma de ajudar e esclarecer essa especialidade durante o contexto de pandemia pelo novo coronavírus. Para a seleção dos trabalhos foram utilizados os seguintes critérios de busca: "Coronavirus and venous thrombosis", "Coronavirus and thrombosis", "COVID-19 and venous thrombosis" e "COVID-19 Coronavirus and thrombosis".

The role of Angiology and Vascular Surgery in the COVID-19 pandemic

The New Coronavirus Epidemic (2019-nCoV), discovered in the city of Wuhan, China, in December 2019, presents mainly with pulmonary pneumonia that is preceded by fever, cough and myalgia. However, as the disease spread globally and the number of hospitalizations increased exponentially, it was noted that most serious patients hospitalized by COVID-19 have laboratory changes worthy of attention, such as lymphopenia, neutrophilia, increased time of prothrombin and increased levels of D-dimer. Due to these changes proving to be crucial for the mortality and morbidity rates in this subset of infected people, several studies focusing on the pathophysiology, mainly hematological, of the disease appear every day. Deepening these studies, several published works have shown SarsCoV-2 infection to the installation of a prothrombotic state in hospitalized patients, which leads to the potential occurrence of thrombotic or arterial events in this cohort. Thus, in order to understand how the departments of Angiology and Vascular Surgery are acting in the context of the COVID-19 pandemic, this work aims to gather studies that reveal from protocols applied in vascular services in the current situation, until to the role of vascular surgeons and angiologists in the clinical and surgical management of patients infected or not, as a way of helping and clarifying this specialty during the context of a pandemic due to the new coranavirus. For the selection of works, the following search criteria were used: "Coronavirus and venous thrombosis", "Coronavirus and thrombosis", "COVID-19 and venous thrombosis" and "COVID-19 Coronavirus and thrombosis".

The role of Angiology and Vascular Surgery in the COVID-19 pandemic / A atuação da Angiologia e da Cirurgia Vascular na pandemia de COVID-19

ABSTRACT The New Coronavirus Epidemic (2019-nCoV), discovered in the city of Wuhan, China, in December 2019, presents mainly with pulmonary pneumonia that is preceded by fever, cough and myalgia. However, as the disease spread globally and the number of hospitalizations increased exponentially, it was noted that most serious patients hospitalized by COVID-19 have laboratory changes worthy of attention, such as lymphopenia, neutrophilia, increased time of prothrombin and increased levels of D-dimer. Due to these changes proving to be crucial for the mortality and morbidity rates in this subset of infected people, several studies focusing on the pathophysiology, mainly hematological, of the disease appear every day. Deepening these studies, several published works have shown SarsCoV-2 infection to the installation of a prothrombotic state in hospitalized patients, which leads to the potential occurrence of thrombotic or arterial events in this cohort. Thus, in order to understand how the departments of Angiology and Vascular Surgery are acting in the context of the COVID-19 pandemic, this work aims to gather studies that reveal from protocols applied in vascular services in the current situation, until to the role of vascular surgeons and angiologists in the clinical and surgical management of patients infected or not, as a way of helping and clarifying this specialty during the context of a pandemic due to the new coranavirus. For the selection of works, the following search criteria were used: "Coronavirus and venous thrombosis", "Coronavirus and thrombosis", "COVID-19 and venous thrombosis" and "COVID-19 Coronavirus and thrombosis".

RESUMO A epidemia pelo novo Coronavirus (2019-nCoV), surgido na cidade de Wuhan, na China, em dezembro de 2019, quando sintomática, apresenta-se majoritariamente por um quadro de pneumonia pulmonar que é precedida por febre, tosse seca e mialgia. No entanto, conforme a doença se espalhou globalmente e o número de hospitalizações aumentaram de forma exponencial, notou-se que a maior parte dos pacientes graves internados por COVID-19 possuem alterações laboratoriais dignas de atenção, como linfopenia, neutrofilia, aumento do tempo de protrombina e elevação dos níveis de D-dímero. Devido tais mudanças se mostrarem cruciais para a taxa de mortalidade e morbidade nesse subgrupo de infectados, diversos trabalhos com enfoque na fisiopatologia, principalmente hematológica, da doença surgem a cada dia. Aprofundando em tais estudos, variados trabalhos publicados evidenciaram a infecção pelo Sars-CoV-2 à instalação de um estado pró-trombótico em pacientes hospitalizados graves, o que acarreta em potencial ocorrência de eventos trombóticos venosos ou arteriais nessa coorte. Assim, para entender como os Departamentos de Angiologia e Cirurgia Vascular estão atuando no contexto da pandemia de COVID-19, este estudo tem por objetivo reunir estudos que revelam desde protocolos aplicados nos serviços vasculares na atual conjuntura, até a atuação dos cirurgiões vasculares e angiologistas no manejo clínico e cirúrgico de pacientes infectados ou não, como forma de ajudar e esclarecer essa especialidade durante o contexto de pandemia pelo novo coronavírus. Para a seleção dos trabalhos foram utilizados os seguintes critérios de busca: "Coronavirus and venous thrombosis", "Coronavirus and thrombosis", "COVID-19 and venous thrombosis" e "COVID-19 Coronavirus and thrombosis".

Endovascular treatment of acute gastrointestinal bleeding from a large splenic artery pseudoaneurysm: case report and literature review / Tratamento endovascular da hemorragia digestiva aguda por volumoso pseudoaneurisma esplênico: relato de caso e revisão da literatura

O pseudoaneurisma da artéria esplênica é uma entidade rara, com pouco mais de 150 casos descritos na literatura. A pancreatite é a etiologia mais comum, seguida do trauma. Em contraposição ao aneurisma verdadeiro, esse pseudoaneurisma é frequentemente sintomático, com risco de ruptura de 47% e mortalidade de 90%, quando não tratado. Descrevemos o caso de uma paciente de 48 anos que apresentou hemorragia gastrointestinal associada a pancreatite crônica agudizada. Durante investigação, a endoscopia evidenciou sinais de sangramento recente, e a angiorressonância de abdome observou volumoso pseudoaneurisma da artéria esplênica. Foi submetida a tratamento endovascular com embolização com micromolas, não apresentando novos episódios de sangramento. Atualmente, o tratamento endovascular é efetivo com baixa morbimortalidade e taxas de sucesso de 79-100%, sendo uma técnica viável para pacientes com processo inflamatório abdominal em franca atividade. Realizamos uma revisão das técnicas endovasculares e agentes embolizantes usados para o tratamento dessa patologia

Pseudoaneurysm of the splenic artery is a rare entity, with little more than 150 cases described in the literature. Pancreatitis is the most common etiology, followed by trauma. In contrast with true aneurysms, pseudoaneurysms are frequently symptomatic, with a 47% risk of rupture and 90% mortality if left untreated. We describe the case of a 48-year-old female patient who suffered a gastrointestinal hemorrhage associated with acute-on-chronic pancreatitis. During workup, endoscopy revealed signs of recent bleeding and magnetic resonance angiography of the abdomen showed a large pseudoaneurysm of the splenic artery. The patient underwent endovascular treatment with microcoil embolization and no further bleeding episodes occurred. Endovascular treatment is now an effective option with low morbidity and mortality and success rates in the range of 79-100%, making it a viable technique for patients with active abdominal inflammation. We conducted a review of endovascular techniques and embolization agents used to treat this pathology