Bloqueo BRILMA para extirpación de cartílago costal: caso clínico / BRILMA block for costal cartilage excision: case report

El bloqueo de las ramas laterales de los nervios intercostales en la línea axilar media (BRILMA) es un bloqueo ecoguiado interfascial para la analgesia en cirugía torácica y abdominal, y es una buena alternativa a las técnicas neuroaxiales. Presentamos el caso de una mujer de 49 años programada para reparación de estenosis idiopática subglótica, con extracción de cartílago costal de la décima costilla y traqueotomía. Tras la cirugía se realizó sin incidencias el bloqueo BRILMA unilateral con 20ml de ropivacaína al 0,2% a nivel de la 6.ª costilla. En el postoperatorio, la paciente refirió un máximo de dolor de 3/10. No requirió opioides tras el segundo día postoperatorio, aunque una incisión subcostal puede producir dolor de considerable intensidad. BRILMA es una técnica superficial, fácilmente reproducible en la mayoría de los pacientes. Mediante una sola punción se logra alcanzar analgesia efectiva en múltiples dermatomas, disminuyendo el riesgo de neumotórax y la toxicidad anestésica local

The block of the lateral branches of the intercostal nerves in the middle axillary line (BRILMA) is an interfascial ultrasound-guided block for analgesia in thoracic wall and upper abdominal surgery, presenting as an adequate alternative to neuraxial techniques. We present the case of a 49-year-old female scheduled for idiopathic subglottic stenosis repair with a costal cartilage graft from the 10th rib and tracheotomy. At the end of the surgery, unilateral ultrasound-guided BRILMA block with 20ml of ropivacaine 0.2% was performed at the level of the 6th rib, uneventfully. Postoperatively, the patient referred a maximum level of pain of 3/10. There was no opioid consumption after the 2nd postoperative day, although a subcostal incision may produce considerable pain. BRILMA is a superficial block, easily reproducible in most patients. It diminishes the number of punctures needed in the thoracic wall, as well as the risk for pneumothorax and local anesthetic toxicity

BRILMA block for costal cartilage excision: Case report. / Bloqueo BRILMA para extirpación de cartílago costal: caso clínico.

The block of the lateral branches of the intercostal nerves in the middle axillary line (BRILMA) is an interfascial ultrasound-guided block for analgesia in thoracic wall and upper abdominal surgery, presenting as an adequate alternative to neuraxial techniques. We present the case of a 49-year-old female scheduled for idiopathic subglottic stenosis repair with a costal cartilage graft from the 10th rib and tracheotomy. At the end of the surgery, unilateral ultrasound-guided BRILMA block with 20ml of ropivacaine 0.2% was performed at the level of the 6th rib, uneventfully. Postoperatively, the patient referred a maximum level of pain of 3/10. There was no opioid consumption after the 2nd postoperative day, although a subcostal incision may produce considerable pain. BRILMA is a superficial block, easily reproducible in most patients. It diminishes the number of punctures needed in the thoracic wall, as well as the risk for pneumothorax and local anesthetic toxicity.

¿Serán los nuevos bloqueos interfasciales de la pared torácica tan eficaces como el bloqueo paravertebral / Will the new thoracic fascial blocks be as effective as paravertebral block?

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Questions and answers on prostate multiparameter magnetic resonance imaging: Everything a urologist should know. / Preguntas y respuestas sobre resonancia magnética multiparamétrica prostática: todo lo que el urólogo debe conocer.

CONTEXT: For many years, the detection of prostate cancer (PC) and the management of its therapy have been based primarily on prostate-specific antigen, rectal examination and prostate biopsy. However, these parameters have known limitations. Multiparametric magnetic resonance imaging (mpMRI) for prostate cancer has undergone extensive development in recent years, providing morphological and functional information. The aim of this study is to present an updated review of the scope and limitations of prostatic mpMRI for PC, in the framework of a multidisciplinary vision. ACQUISITION OF EVIDENCE: We conducted a literature review (in PubMed) of articles referencing "mpMRI/staging/ PC/detection/active surveillance/therapy planning/post-therapy". We included 4 systematic reviews and other articles published in high impact-factor journals within the field of radiology and urology. SUMMARY OF THE EVIDENCE: MpMRI provides morphological and functional information concerning PC. This information is integrated into the Prostate Imaging Report and Date System, classifying the probability of clinically significant carcinoma on a scale from 1 to 5. The usefulness of mpMRI is currently being established for patients with high prostate-specific antigen levels and prior negative prostate biopsy; tumour staging in selected cases; assessment of patients who are candidates for active surveillance; the planning of focal treatments; and the assessment of tumour persistence and recurrence. CONCLUSIONS: MpMRI currently fills a relevant role in the diagnosis and therapeutic decision-making of PC. More widespread use of the technique requires a cost/benefit analysis.

Kidney cancer focal cryoablation trend: does location or approach matter?

PURPOSE: We evaluated the current indications and surgical and survival outcomes for cryoablation (CA) using either a percutaneous (PCA) or a laparoscopic approach (LCA). We also investigated the ability of the PADUA score to predict the risk of complications and local recurrence. METHODS: A retrospective analysis was performed at two European tertiary referral centers. Parameters analyzed included size, location, approach, operative time, hospital stay, complications, and functional and oncologic outcomes. Univariate and multivariate analyses were performed. An ROC analysis was conducted to evaluate the accuracy of the PADUA score. RESULTS: Eighty patients were included. Mean tumor size was 2.6 cm. PCA was more often performed in posterior (95 vs. 60 %), inferior (72 vs. 32 %), and lateral (87 vs. 55 %) tumors. The global complication rate was 8.75 %, although proximity to the renal sinus resulted in a higher rate (30 vs. 4 %). Mean follow-up was 34 and 23 months for LCA and PCA, respectively. The 5-year recurrence-free survival was 76 and 90 % for LCA and PCA, respectively. Multivariate analysis showed that tumor involvement of the collecting system was predictive of recurrence. Under ROC analysis, PADUA score was a mild predictor for complications (AUC = 0.601) and a good predictor for recurrence (AUC = 0.723); PADUA ≥8 was identified as a cutoff for patients to a higher risk of recurrence. CONCLUSIONS: The percutaneous approach is confirmed to be the preferred CA technique for posterior and lateral tumors. CA in deeper renal lesions and tumors with PADUA score ≥8 might entail a higher risk of recurrence, and closer follow-up should be considered in these patients.

Pelvic MRI findings in relapsed prostate cancer after radical prostatectomy.

PURPOSE/OBJECTIVE: Little is known about the clinical impact of using multiparametric MRI to plan early salvage radiotherapy after radical prostatectomy. We aimed to evaluate the incidence and location of recurrence based on pelvic multiparametric MRI findings and to identify clinical variables predictive of positive imaging results. MATERIALS AND METHODS: We defined radiological criteria of local and lymph node malignancy and reviewed records and MRI studies of 70 patients with PSA recurrence after radical prostatectomy. We performed univariate and multivariate analysis to identify any association between clinical, pathological and treatment-related variables and imaging results. RESULTS: Multiparametric MRI was positive in 33/70 patients. We found local and lymph node recurrence in 27 patients and 7 patients, respectively, with a median PSA value of 0.38 ng/ml. We found no statistically significant differences between patients with positive and negative multiparametric MRI for any variable. Shorter PSADT was associated with positive lymph nodes (median PSADT: 5.12 vs 12.70 months; p: 0.017). CONCLUSIONS: Nearly half the patients had visible disease in multiparametric MRI despite low PSA. Positive lymph nodes incidence should be considered when planning salvage radiotherapy, particularly in patients with a short PSADT.

Aditivos y mezclas de anestésicos locales para bloqueos nerviosos periféricos / Local anesthetics mixtures and additives for peripheral nerve blocks

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Prospective study of ultrasound-guided percutaneous renal cryotherapy: case selection as an optimization factor for a technique.

OBJECTIVE: To evaluate the technical and oncological effectiveness of ultrasound-guided percutaneous renal cryotherapy (PRC) in a selected group of patients with renal cancer. MATERIAL AND METHODS: We conducted a prospective study of 28 patients with posterior-facing T1a renal tumors with middle and inferior external borders. All patients underwent ultrasound-guided PRC. Follow-up was conducted with computed tomography at 1 month and then every 6 months, with a good result defined as the total absence of contrast incorporation. We performed a descriptive and survival study using the Kaplan-Meier estimator. RESULTS: The 28 patients had a mean age (SD) of 68.3 (10.1) years, and the group underwent 28 procedures. The mean (SD) size of the tumors was 25.5 (7.5) mm, the mean nephrometry score was 1.41 (0.52) and the mean preoperative creatinine level was 133.5 (144.1) mmol/L. There were no intraoperative complications. In terms of postoperative complications, there was only 1 case (3.5%) of a skin lesion resulting from treating a tumor in a transplanted kidney (Clavien II). The median follow-up was 25 months, and the mean (SD) postoperative creatinine level was 135.5 (110.3) mmol/L. Two cases presented radiological recurrence (93% efficacy), with a mean time to recurrence of 12 and 19 months, respectively. There were no tumor-related deaths. CONCLUSIONS: Our series (the largest on PRC in our country to date) shows that, with an appropriate selection of tumors, PRC is a safe technique with minimal morbidity. Ultrasonography enables the controlled performance of the procedure and saves the patient from radiation and reduces costs.

Comentarios al artículo «Bloqueo paravertebral torácico, más bloqueo de nervios pectorales para mastectomía en un paciente con esclerosis lateral amiotrófica avanzada» / Comments to the article "Thoracic paravertebral block plus pectoral nerve block for mastectomy in a patient with advanced amyotrophic lateral sclerosis"

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Cloning, characterization and functional expression of Taenia solium 17 beta-hydroxysteroid dehydrogenase.

The 17ß-hydroxysteroid dehydrogenases (17ß-HSD) are key enzymes involved in the formation (reduction) and inactivation (oxidation) of sex steroids. Several types have been found in vertebrates including fish, as well as in invertebrates like Caenorhabditis elegans, Ciona intestinalis and Haliotis diversicolor supertexta. To date limited information is available about this enzyme in parasites. We showed previously that Taenia solium cysticerci are able to synthesize sex steroid hormones in vitro when precursors are provided in the culture medium. Here, we identified a T. solium 17ß-HSD through in silico blast searches in the T. solium genome database. This coding sequence was amplified by RT-PCR and cloned into the pcDNA 3.1(+) expression vector. The full length cDNA contains 957bp, corresponding to an open reading frame coding for 319 aa. The highest identity (84%) at the protein level was found with the Echinococcus multilocularis 17ß-HSD although significant similarities were also found with other invertebrate and vertebrate 17ß-HSD sequences. The T. solium Tsol-17ßHSD belongs to the short-chain dehydrogenase/reductase (SDR) protein superfamily. HEK293T cells transiently transfected with Tsol17ß-HSD induced expression of Tsol17ß-HSD that transformed 3H-androstenedione into testosterone. In contrast, 3H-estrone was not significantly transformed into estradiol. In conclusion, T. solium cysticerci express a 17ß-HSD that catalyzes the androgen reduction. The enzyme belongs to the short chain dehydrogenases/reductase family and shares motifs and activity with the type 3 enzyme of some other species.

Incidence and risk factors for incomplete HBV DNA suppression in HIV/HBV-co-infected patients initiating tenofovir-based therapy.

Suppression of hepatitis B virus (HBV)-DNA to undetectable levels is an important goal for HIV/HBV-co-infected patients receiving anti-HBV-active antiretroviral therapy (ART), and current guidelines recommend that this outcome should be reached by 1 year of treatment. However, the proportion of patients that fail to achieve an undetectable HBV DNA at this time point and its determinants remain unknown in clinical practice. The objective of this study was to determine the incidence and risk factors for incomplete HBV suppression following 1 year of tenofovir-based ART. We performed a cohort study among tenofovir-treated HIV/HBV-co-infected patients. Patients had HBV viraemia, initiated tenofovir-based ART and had HBV DNA measured at 1 year of therapy. The primary outcome was incomplete HBV suppression (HBV DNA ≥2.6 log IU/mL) at 1 year. Logistic regression determined odds ratio (ORs) of incomplete HBV suppression for risk factors of interest. Among 133 patients, 54% (95% CI, 46-63%) had incomplete HBV suppression at 1 year. Incomplete suppression was associated with higher baseline HBV DNA (OR, 1.46 per log IU/mL increase; 95% CI, 1.1-1.94) and detectable HIV viraemia at 1 year (OR, 2.52; 95% CI, 1.19-5.32). Among 66 patients with suppressed HIV RNA at 1 year, 28 (42%) failed to achieve an undetectable HBV DNA. Failure to suppress HBV DNA by 1 year occurred in a sizeable proportion of tenofovir-treated HIV/HBV-co-infected patients. Higher HBV DNA and detectable HIV viraemia were risk factors for incomplete HBV suppression.

Abordaje guiado por ultrasonidos de los nervios intercostales en la línea media axilar para cirugía de mama no reconstructiva y de la axila / Ultrasound-assisted approach to blocking the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery

Introducción. Recientemente se han descrito varios bloqueos nerviosos periféricos para el tratamiento del dolor en la cirugía de mama. El objetivo principal de nuestro estudio fue determinar la eficacia y seguridad del bloqueo ecoguiado de las ramas cutáneas anteriores y laterales de los nervios intercostales en la línea media axilar para cirugía no reconstructiva de mama y axila. Material y métodos. Estudio observacional prospectivo en 30 pacientes programadas para cirugía de mama no reconstructiva y axilar. Se realizó bloqueo de las ramas intercostales en la línea media axilar, guiado por ultrasonidos con levobupivacaína al 0,5% (3 ml en cada espacio intercostal). La eficacia clínica se evaluó en el periodo intraoperatorio mediante la respuesta hemodinámica al estímulo quirúrgico y la necesidad de opiáceos, y en el periodo postoperatorio mediante la valoración de la intensidad del dolor según escala verbal numérica y la necesidad de tratamiento de rescate. También se evaluó la calidad del sueño de la primera noche del postoperatorio, los eventos adversos acontecidos y la satisfacción de los pacientes y cirujanos con la técnica anestésica empleada. Resultados. El bloqueo de las ramas intercostales en la línea media axilar fue eficaz en la mayoría de los casos; solo 2 pacientes requirieron administración de opioides intraoperatorios y en un caso fue necesario rescate analgésico en el periodo postoperatorio. La duración de la analgesia postoperatoria fue de 19 ± 4 h. No se produjeron eventos adversos reseñables ni complicaciones. La satisfacción con respecto a la técnica elegida fue valorada como «muy buena» en todos los pacientes, y guiado por ultrasonidos. Conclusiones. El bloqueo de las ramas intercostales en la línea media axilar proporciona una adecuada analgesia intraoperatoria y postoperatoria para cirugía no reconstructiva de la mama y la axila. Es una técnica sencilla, reproducible en la mayoría de las pacientes de este estudio, con una ecoanatomía fácil de comprender, en la que mediante una punción única se puede ofrecer una adecuada analgesia, pudiendo ser una alternativa en estos casos a los bloqueos del neuroeje(AU)

Introduction. Several nerve blocks have recently been used for pain treatment in breast surgery. The main objective of our study was to determine the efficacy and safety of ultrasound-assisted blocking of the anterior and lateral cutaneous branches of the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery. Material and methods. A prospective observational study was conducted on 30 patients scheduled for non-reconstructive breast and axilla surgery. An intercostal branches block was performed in the mid-axillary line with 0,5% levobupivacaine (3 ml in each intercostal space). Clinical efficacy was assessed by standard intraoperative hemodynamic response to surgical stimulus and the need for opioids, and in the postoperative period, by assessing pain intensity as a verbal numerical scale and the need for rescue treatment. We also evaluated the quality of sleep the first night after surgery, any adverse events that occurred, and the satisfaction of patients and surgeons with the anesthetic technique. Results. The intercostal branches block in the mid-axillary line was effective in most cases, with only 2 patients requiring intraoperative opioids, and in one case analgesic rescue was necessary in the postoperative period. The duration of postoperative analgesia was 19 ± 4 h. There were no notable adverse events or complications. The satisfaction with the chosen technique was assessed as «very good» in all patients, and by 97% of the surgeons. Conclusions. Intercostal branches block in the mid-axillary line provides adequate intraoperative and postoperative analgesia for non-reconstructive breast and axilla surgery. It is a simple, reproducible technique in most patients of this study, with an easy to understand ultrasound anatomy, in which adequate analgesia could be provided through a single puncture, and may be an alternative to neuroaxial blocks(AU)

[Ultrasound-assisted approach to blocking the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery]. / Abordaje guiado por ultrasonidos de los nervios intercostales en la línea media axilar para cirugía de mama no reconstructiva y de la axila.

INTRODUCTION: Several nerve blocks have recently been used for pain treatment in breast surgery. The main objective of our study was to determine the efficacy and safety of ultrasound-assisted blocking of the anterior and lateral cutaneous branches of the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery. MATERIAL AND METHODS: A prospective observational study was conducted on 30 patients scheduled for non-reconstructive breast and axilla surgery. An intercostal branches block was performed in the mid-axillary line with 0,5% levobupivacaine (3ml in each intercostal space). Clinical efficacy was assessed by standard intraoperative hemodynamic response to surgical stimulus and the need for opioids, and in the postoperative period, by assessing pain intensity as a verbal numerical scale and the need for rescue treatment. We also evaluated the quality of sleep the first night after surgery, any adverse events that occurred, and the satisfaction of patients and surgeons with the anesthetic technique. RESULTS: The intercostal branches block in the mid-axillary line was effective in most cases, with only 2 patients requiring intraoperative opioids, and in one case analgesic rescue was necessary in the postoperative period. The duration of postoperative analgesia was 19±4h. There were no notable adverse events or complications. The satisfaction with the chosen technique was assessed as "very good" in all patients, and by 97% of the surgeons. CONCLUSIONS: Intercostal branches block in the mid-axillary line provides adequate intraoperative and postoperative analgesia for non-reconstructive breast and axilla surgery. It is a simple, reproducible technique in most patients of this study, with an easy to understand ultrasound anatomy, in which adequate analgesia could be provided through a single puncture, and may be an alternative to neuroaxial blocks.

Abordaje ecoguiado de las ramas cutáneas de los nervios intercostales a nivel de la línea media axilar para cirugía no reconstructiva de mama / A new ultrasound-guided cutaneous intercostal branches nerves blocked for analgesia after no reconscturctive breast surgery

Introducción: La anestesia regional ecoguiada permite la descripción de nuevos abordajes y técnicas para el manejo anestésico-analgésico en cirugía de mama no reconstructiva. Material y métodos: Descripción, de un nuevo abordaje ecoguiado para analgesia en cirugía no reconstructiva de mama. Realizamos un abordaje en plano e introducimos la aguja de caudal a craneal en la línea media axilar, posicionando la punta de la aguja entre la fascia del músculo serrato anterior y la fascia del músculo intercostal externo. Resultados y discusión: El bloqueo de las ramas cutáneas de los nervios intercostales en la línea medio axilar (BRILMA) es un bloqueo de baja dificultad de ejecución, con una ecoanatomía fácil de comprender, reproducible en la mayoría de los pacientes, que puede ser realizado de manera segura asociado a sedación o con el paciente anestesiado. Permite el bloqueo de las ramas anteriores y laterales de los nervios intercostales entre 2º y 6º espacios intercostales, proporcionando analgesia en cirugía de mama no reconstructiva, incluido el complejo areola-pezón (AU)

Introduction: The regional anesthesia ecoguiada allows the description of new boardings and technologies for the managing anesthesic-analgesic in surgery of not reconstructive breast. Methods: We described a new ultrasound-guided cutaneous intercostal nerve branches blocked to provide analgesia for no reconstructive breast surgery. We introduce needle the in plane and placed the tip of the needle between the serratus anterior muscle and external intercostal muscle at the mid-axillary line. Results and discussion: The block cutaneous branches of the intercostal nerves (BRILMA) is a new nerve block technique that is easy to perform. This block is an intermediate nerve block technique. Although in principle, the technique is similar to that of the intercostals nerve block, its anatomy and indications are sufficiently distinct to deserve separate consideration, and have a significant clinical applicability for surgical anesthesia and post-operative pain management. It allows the blockade of the previous branches and wings of the intercostal nerves between 2 º and 6 º intercostal spaces, providing analgesia in surgery of not reconstructive breast, included the complex areola-nipple (AU)

Decidua mesenchymal stem cells migrated toward mammary tumors in vitro and in vivo affecting tumor growth and tumor development.

Mesenchymal stem cells (MSCs) have affinity to tumor sites where they home, affecting their biology and growth. Previously, we have isolated mesenchymal cells from the decidua of the human placenta named as decidua-derived MSCs (DMSCs). The aims of the present study were to investigate the migration capacity of DMSCs in vitro, and in vivo in a preclinical model of mammary tumors induced by N-nitroso-N-methylurea (NMU). Additionally, we assessed the safety of DMSC administration in vivo and their effect on tumor growth. In vitro studies showed that DMSCs significantly migrate toward both, healthy human breast tissue and breast adenocarcinoma. Nevertheless, the effect on DMSC migration was significantly higher in the presence of tumor tissue. DMSCs also significantly migrated in vitro in the presence of NMU-mammary tumor homogenate when compared with control media alone. In vivo studies showed both migration and engraftment of DMSCs into NMU-induced tumors. Interestingly, DMSCs showed an inhibitory effect on the growth of primary tumors and in the development of new tumors. DMSCs did not affect the growth of secondary tumors, although secondary tumors appeared 2 weeks later, and the number of secondary tumors was lower in the DMSC-treated rats as compared with vehicle-treated rats. To our knowledge, this is the first report showing placental MSCs effect on tumor growth. In conclusion, DMSCs could serve as a therapeutic agent themselves and as a cellular vehicle of anticancer drugs.

Bloqueo de las ramas cutáneas laterales y anteriores de los nervios intercostales para analgesia de mama / Analgesic combined lateral and anterior cutaneous branches of the intercostal nerves ultrasound block in ambulatory breast surgery

Introducción: proporcionar una buena analgesia postoperatoria en los procedimientos quirúrgicos no reconstructivos sobre la mama es una de las claves del éxito de los programas de cirugía ambulatoria y ello es posible incorporando a nuestra estrategia multimodal bloqueos de nervios periféricos eco guiados. Material y métodos: estudio observacional descriptivo en el que se evaluó de forma prospectiva a 44 mujeres programadas para cirugía de mama. El mismo investigador realizo un bloqueo de las ramas cutáneas laterales (BRCL)de los nervios intercostales, en todos los casos cuando la lesión a extirpar se localizó en la región del complejo areola-pezón, se asocio también el bloqueo de las ramas cutaneas anteriores de los nervios intercostales (BRCA). En todos los casos se le practico una RM tras la realización del bloqueo para observar la distribución y la extensión del anestesico local por la pared torácica. El estudio (..) (AU)

Introduction: Provide good postoperative analgesia in the non reconstructive surgical procedures on the breast is one of the keys to success in outpatient programs and this is possible by incorporating peripheral ultrasounds blocks multimodal approach. Patients and methods: Descriptive observational study which prospectively evaluated 44 women scheduled for breast surgery. In all of them the same researcher conducted a blockade of the lateral cutaneous branches(BRCL) of the intercostals nerves and when to remove the lesion was located from the complex areola-nipple to the sternum was also associated block of the anterior cutaneous branches (BRCA). All women also underwent an MRI after the blockade to observe the distribution and extent of local anesthetic through the chest wall. The extension study was completed with the (..) (AU)

[Endovascular treatment of stenosis of the renal artery in transplanted kidney]. / Tratamiento endovascular de la estenosis de la arteria renal en el riñón trasplantado.

INTRODUCTION: The incidence of renal artery stenosis in the transplanted kidney (TRAS) varies between 2 and 23%, being the most frequent vascular complication following renal trasplantation. The delay in diagnosis and treatment can lead to functional graft loss. Percutaneous trasluminal angioplasty with stent (PTAS) is the treatment of choice to restore kidney perfusion. MATERIALS AND METHODS: Retrospective review of renal transplant casuistic in our institution between September 2005 and August 2009. Were included patients with greater than 70% TRAS and impaired graft function, treated with PTAS. Follow-up at 3, 12 and 36 months was done with creatinine, glomerular filtration rate (GFR) and Doppler ultrasonography (DUS). Technical success was defined as correct stent placement associated with decreased flow, and clinical success as improve renal function during follow-up. RESULTS: Incidence of TRAS was 7.3% (22/298), 60% PTAS subsidiary. 100% technical success and 84.6% clinical success, 15.4% without changes in renal function. 84% decreases flow rate greater than 70% by DUS, and 26% up to 60%. Wave changes from type III to type II were recorded in 69% and to type I in 33%. CONCLUSIONS: The PTAS is a safe and effective procedure for the treatment of selected TRAS patients, as it preserves vascular permeability in short and medium term, ensuring the functionality of the graft. DUS is the method of choice for diagnosis and monitoring TRAS.