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1.
Ann Vasc Surg ; 50: 209-217, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29518510

RESUMO

BACKGROUND: The purpose of this study was to quantify and evaluate the expression response of miRNA-191 and miRNA-455-3p endovascular repair of abdominal aortic aneurysm (AAA) based in whole blood samples. METHODS: This report describes a prospective study of a single center of 30 patients with AAA who underwent endovascular repair. Blood samples were collected preoperatively and 6 months postoperatively. The differential expression of the miRNAs was performed by the real-time polymerase chain reaction method, after extraction of the RNA from the blood samples at the 2 moments. In addition, bioinformatic tools were used to determine pathophysiological pathways related to AAA. RESULTS: The miR-191 and miR-455-3p were overexpressed preoperatively. After 6 months postoperatively, miR-191 (median 0.98, IQR 0.5-2.1, P < 0.0001) and miR-455-3p (median 1.4, IQR 0.6-3.1, P = 0.0003) presented a significant reduction in their expressions. There was no correlation between the diameter of the aneurysm and the expression of the miRNAs studied. In addition, analysis of the influence of the various types of devices used for the endovascular treatment of AAA showed no significant differences in the expression of miR-191 and miR-455-3p. CONCLUSIONS: Exclusion of the aneurysmal sac after endovascular treatment induces a decrease in the expression of the studied miRNAs in whole blood samples, which suggests a possible use of them as biomarkers of therapeutic success.


Assuntos
Aneurisma da Aorta Abdominal/genética , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , MicroRNA Circulante/genética , Procedimentos Endovasculares , MicroRNAs/genética , Idoso , Aneurisma da Aorta Abdominal/sangue , Aneurisma da Aorta Abdominal/diagnóstico , Brasil , MicroRNA Circulante/sangue , Feminino , Marcadores Genéticos , Humanos , Masculino , MicroRNAs/sangue , Pessoa de Meia-Idade , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Fatores de Tempo , Resultado do Tratamento
2.
Ann Vasc Surg ; 50: 88-95, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29481941

RESUMO

BACKGROUND: The objective of this study was to evaluate the relationship between inflammatory markers, such as interleukin (IL)-1ß, IL-6, IL-8, IL-10, tumor necrosis factor α (TNF-α), transforming growth factor ß (TGF-ß), and highly sensitive C-reactive protein, and the development of arterial restenosis 6 months after femoropopliteal percutaneous transluminal angioplasty (PTA) with covered stent implantation. METHODS: We recruited 27 patients of a tertiary hospital in Brazil who were treated with covered stents for atherosclerotic peripheral arterial disease. Serum samples were collected before stent implantation, then 24 hr later, and 6 months after the procedure. RESULTS: At 6-month follow-up, 4 patients (15%) presented restenosis. IL1- ß, IL-6, IL-8, and TNF-α levels showed a statistically significant reduction after both 24 hr and 6 months compared with pretreatment levels (P < 0.01). There were increased levels of IL-10 and TGF-ß both 24 hr and 6 months after PTA and stenting compared with pretreatment levels (P < 0.01). None of the cytokines studied were correlated with restenosis. CONCLUSIONS: This study demonstrated a significant increase in anti-inflammatory TGF-ß and IL-10 and a decrease in proinflammatory cytokines IL-1ß, IL-6, IL-8, and TNF-α 6 months after the procedure, but no inflammatory marker was independently identified as a risk factor for in-stent restenosis.


Assuntos
Angioplastia com Balão/instrumentação , Artéria Femoral , Mediadores da Inflamação/sangue , Interleucinas/sangue , Doença Arterial Periférica/terapia , Artéria Poplítea , Stents , Adulto , Idoso , Angioplastia com Balão/efeitos adversos , Biomarcadores/sangue , Brasil , Constrição Patológica , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/sangue , Doença Arterial Periférica/diagnóstico por imagem , Artéria Poplítea/diagnóstico por imagem , Estudos Prospectivos , Desenho de Prótese , Recidiva , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Fator de Crescimento Transformador beta/sangue , Resultado do Tratamento , Fator de Necrose Tumoral alfa/sangue
3.
J Vasc Surg Venous Lymphat Disord ; 6(1): 83-89, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29126956

RESUMO

OBJECTIVE: The objective of this study was to analyze the effect of graduated compression stockings (GCS) on venous lower limb hemodynamics in healthy amateur runners. METHODS: Ten runners were evaluated during rest and after a 10-km run without and with knee-high GCS of 20 to 30 mm Hg. Air plethysmography evaluated venous filling index (VFI), ejection fraction, and residual volume fraction (RVF) in both limbs. Capillary lactate level and heart rate were also measured. RESULTS: Right VFI was 1.38 mL/s during rest, 1.98 mL/s without compression, and 1.32 mL/s with compression (P = .006). Left VFI was 1.35 mL/s during rest, 1.64 mL/s without compression, and 1.21 mL/s with compression (P = .006). In both limbs, ejection fraction was not different in the three situations. Right RVF was 22.35% during rest, 19.40% without compression, and 10.50% with compression (P = .006). Left RVF was similar in all situations. Capillary lactate level increased in runners without compression (P = .004) but kept stable in those wearing compression. The difference between after-run and before-run capillary lactate levels was similar in runners with and without compression. Rest, peak, and after-run heart rates were similar in runners with and without compression. CONCLUSIONS: Healthy amateur runners had associated hemodynamic improvements when wearing knee-high GCS of 20 to 30 mm Hg during a 10-km treadmill run. VFI dropped in both limbs and RVF dropped at least in the right limb. There was no positive effect on calf muscle pump; capillary lactate variation; or rest, peak, and after-run heart rates.


Assuntos
Hemodinâmica , Extremidade Inferior/irrigação sanguínea , Corrida , Meias de Compressão , Veias/fisiologia , Adulto , Desempenho Atlético , Biomarcadores/sangue , Velocidade do Fluxo Sanguíneo , Teste de Esforço , Feminino , Voluntários Saudáveis , Frequência Cardíaca , Humanos , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Pletismografia , Estudos Prospectivos , Fluxo Sanguíneo Regional , Fatores de Tempo
5.
Braz J Cardiovasc Surg ; 32(3): 215-224, 2017 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28832801

RESUMO

OBJECTIVE: Abdominal aortic aneurysm is an important cause of morbidity and mortality in the elderly. Currently, the only way to prevent rupture and death related to abdominal aortic aneurysms is through surgical intervention. Endovascular treatment is associated with less morbidity than conventional treatment. The formation of an aneurysm is a complex multifactorial process, involving destructive remodeling of the connective tissue around the affected segment of the aorta wall. MicroRNAs are small sequences of non-coding RNAs that control diverse cellular functions by promoting degradation or inhibition of translation of specific mRNAs. A profile aberrant expression of miRNAs has been linked to human diseases, including cardiovascular dysfunction.


Assuntos
Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/etiologia , Aneurisma da Aorta Abdominal/fisiopatologia , MicroRNAs/fisiologia , Aneurisma da Aorta Abdominal/terapia , Humanos , Ilustração Médica , Fatores de Risco , Fatores Sexuais
6.
Rev. bras. cir. cardiovasc ; 32(3): 215-224, May-June 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-897914

RESUMO

Abstract Objective: Abdominal aortic aneurysm is an important cause of morbidity and mortality in the elderly. Currently, the only way to prevent rupture and death related to abdominal aortic aneurysms is through surgical intervention. Endovascular treatment is associated with less morbidity than conventional treatment. The formation of an aneurysm is a complex multifactorial process, involving destructive remodeling of the connective tissue around the affected segment of the aorta wall. MicroRNAs are small sequences of non-coding RNAs that control diverse cellular functions by promoting degradation or inhibition of translation of specific mRNAs. A profile aberrant expression of miRNAs has been linked to human diseases, including cardiovascular dysfunction.

7.
J. vasc. bras ; 16(1): f:48-l:51, Jan.-Mar. 2017. ilus
Artigo em Português | LILACS | ID: biblio-841407

RESUMO

Resumo Relatamos o caso de uma menina de 12 anos que deu entrada na unidade de emergência com quadro de abdome agudo hemorrágico, massa abdominal pulsátil e instabilidade hemodinâmica. Confirmado o diagnóstico de aneurisma roto de artéria ilíaca direita, foi realizada correção cirúrgica de emergência por reparo aberto com reconstrução extra-anatômica, utilizando enxerto sintético de fino calibre, compatível com a anatomia. O tratamento foi bem-sucedido e a criança apresentou evolução favorável em curto prazo.


Abstract We describe the case of a 12-year-old girl who presented at the emergency department with hemorrhagic acute abdomen, an abdominal pulsating mass and hemodynamic instability. A diagnosis of ruptured right iliac artery aneurysm was confirmed and an emergency open repair procedure was performed with extra-anatomic reconstruction, using a small-caliber synthetic graft, compatible with her anatomy. The treatment was successful and the child was doing well at short-term follow-up.


Assuntos
Humanos , Feminino , Criança , Aneurisma Roto/cirurgia , Criança , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca , Abdome Agudo/complicações , Abdome Agudo/diagnóstico , Prótese Vascular
8.
Ann Vasc Surg ; 40: 285-293, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28163176

RESUMO

BACKGROUND: Analyze the effects of ischemic postconditioning on skeletal muscle injury and apoptosis produced by partial ischemia and reperfusion in rats. MATERIALS AND METHODS: An experimental study was designed using 70 Wistar rats divided in 3 groups: Sham; Control-submitted to ischemia and reperfusion; and Postconditioning-submitted to ischemia and reperfusion with ischemic postconditioning. Subgroups (n = 10) were divided by duration of ischemia (4, 5, or 6 hr). A partial ischemia model using aortic clamping was used. The postconditioning protocol consisted of 3 cycles of clamping the aorta for 1 min and releasing for another minute. Skeletal muscle injury was evaluated by measuring serum levels of releasing cytoplasmic enzymes: aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and total creatine phosphokinase (CPK). Lipid peroxidation was evaluated by muscular levels of malondialdehyde (MDA). Energetic cell storage was evaluated by muscular glycogen levels. Apoptosis was evaluated analyzing the expression of caspase 3 and protein B-cell lymphoma 2 (Bcl-2) by immunohistochemistry. RESULTS: AST levels in Sham group were 109.80 units/L, in Control subgroups were 4h 200.60 units/L/5h 392.30 units/L/6h 118.82 units/L, whereas in Postconditioning subgroups were: 4h 316.10 units/L/5h 268.40 units/L/6h 267.00 units/L. There was a 2-3-fold increase in Control and Postconditioning groups compared with Sham group (P = 0.003) There was no difference between groups with the same ischemic injury time. LDH, CPK, and MDA levels were similar in Sham, Control, and Postconditioning groups. Subgroups with the same ischemic injury time were also similar. Glycogen levels in Sham group were 0.629 mg%, in Control subgroups were 4h 0.323 mg%/5h 0.348 mg%/6h 0.183 mg%, whereas in Postconditioning subgroups were: 4h 0.443 mg%/5h 0.270 mg%/6h 0.324 mg%. Control and Postconditioning groups were decreased by half in relation with the Sham group (P = 0.002), with no difference between groups with the same ischemic injury time. For both caspase 3 and Bcl-2, the percentage of positive cells increased more than 2-fold in Control and Postconditioning groups when compared with Sham group (P < 0.001). The greater the ischemic injury time, the greater was the percent of positive cells (P < 0.0005), with no difference between subgroups with the same ischemic injury time. CONCLUSIONS: Ischemic postconditioning had neither protective effect on skeletal muscle injury nor avoided apoptosis induction in rats submitted to partial ischemia and reperfusion.


Assuntos
Aorta/cirurgia , Apoptose , Pós-Condicionamento Isquêmico/métodos , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/patologia , Traumatismo por Reperfusão/prevenção & controle , Animais , Aorta/fisiopatologia , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Caspase 3/metabolismo , Constrição , Creatina Quinase/sangue , Glicogênio/metabolismo , L-Lactato Desidrogenase/sangue , Peroxidação de Lipídeos , Masculino , Malondialdeído/metabolismo , Músculo Esquelético/metabolismo , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Ratos Wistar , Fluxo Sanguíneo Regional , Traumatismo por Reperfusão/sangue , Traumatismo por Reperfusão/patologia , Traumatismo por Reperfusão/fisiopatologia , Fatores de Tempo
9.
Phlebology ; 32(10): 670-678, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27928067

RESUMO

Objective Analyse venous haemodynamics in healthy primigravidae during pregnancy and in the postpartum. Methods Cohort with primigravidae evaluated in the three trimesters of pregnancy and postpartum. Duplex evaluated venous diameters and reflux; air plethysmography evaluated venous filling index, ejection fraction, residual volume fraction and outflow fraction in both limbs. Results During pregnancy, diameters increased in bilateral common femoral and right infravalvar great saphenous, but returned to first trimester values after delivery. Reflux developed in one woman (5%) in the second trimester and in two more women (15%) in the third trimester. No reflux was detected in postpartum. Bilateral venous filling index was higher during pregnancy. Bilateral ejection fraction and residual volume fraction did not change. Bilateral outflow fraction increased progressively. The right limb outflow fraction in left lateral decubitus was similar. All changes returned to first trimester values after delivery. Conclusions Healthy primigravidae presented changes in lower limbs' veins during pregnancy: diameters in bilateral common femoral and infravalvar great saphenous veins increased; new reflux was developed in 15% of women, but there was no venous hypertension. Calf muscular pump function did not change. All changes returned to first trimester values after delivery.


Assuntos
Veia Femoral/fisiologia , Número de Gestações/fisiologia , Hemodinâmica/fisiologia , Período Pós-Parto/fisiologia , Gravidez/fisiologia , Veia Safena/fisiologia , Feminino , Humanos , Estudos Prospectivos , Adulto Jovem
10.
J Vasc Surg ; 65(1): 119-127, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27667150

RESUMO

OBJECTIVE: The purpose of this study was to investigate the roles of the kallikrein-kinin system and matrix metalloproteinases (MMPs) in the development of arterial restenosis attributable to intimal hyperplasia in the femoropopliteal arteries. METHODS: This report describes a single-center prospective study of 27 patients with peripheral artery disease who required percutaneous transluminal angioplasty and stenting of the femoropopliteal segment using covered stent grafts. The blood concentrations of total and kininogen fractions were evaluated using immunoenzymatic methods. Plasma kallikrein was evaluated by the colorimetric method. Tissue kallikrein was evaluated by the spectrophotometric method. The activity of kininase II was measured by fluorometric analysis. Quantification of MMPs was performed by zymography, and tissue inhibitors of metalloproteinases were measured by enzyme-linked immunosorbent assay. RESULTS: Four (15%) of the treated patients developed restenosis at the 6-month follow-up evaluation. These patients had significantly lower levels of high-molecular-weight kininogens (24 hours; P < .05) and low-molecular-weight kininogens (before, P < .05; 24 hours, P < .01; 6 months, P < .05) and lower levels of tissue inhibitor of metalloproteinases-2 (6 months; P < .05) than the patients without restenosis. The activity levels of plasma and tissue kallikrein, kininase II, and MMPs did not differ significantly between the patients with and without restenosis. CONCLUSIONS: This study demonstrates an involvement of the kallikrein-kinin system in in-stent restenosis, although we could not confirm the participation of metalloproteinases in the restenosis process.


Assuntos
Angioplastia com Balão/instrumentação , Artéria Femoral , Calicreínas/sangue , Cininogênio de Alto Peso Molecular/sangue , Cininogênio de Baixo Peso Molecular/sangue , Metaloproteinases da Matriz/sangue , Neointima , Doença Arterial Periférica/terapia , Artéria Poplítea , Stents , Inibidores Teciduais de Metaloproteinases/sangue , Adulto , Idoso , Angioplastia com Balão/efeitos adversos , Biomarcadores/sangue , Brasil , Constrição Patológica , Feminino , Humanos , Hiperplasia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/sangue , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/enzimologia , Estudos Prospectivos , Desenho de Prótese , Recidiva , Fatores de Tempo , Resultado do Tratamento
13.
J. vasc. bras ; 15(4): 287-292, Oct.-Dec. 2016. graf
Artigo em Inglês | LILACS | ID: biblio-841391

RESUMO

Abstract Air plethysmography is a non-invasive test that can quantify venous reflux and obstruction by measuring volume changes in the leg. Its findings correlate with clinical and hemodynamic measures. It can quantitatively assess several components of venous hemodynamics: valvular reflux, calf muscle pump function, and venous obstruction. Although clinical uses of air plethysmography have been validated, it is used almost exclusively for medical research. Air plethysmography can be used to assess chronic venous disease, to evaluate improvement after venous surgery, to diagnose acute and past episodes of deep venous thrombosis, to evaluate compression stocking therapy, to study the physiological implications of high-heeled shoes in healthy women, and even to evaluate the probability of ulcer healing.


Resumo A pletismografia a ar é um método não invasivo que pode quantificar refluxo e obstrução venosa medindo alterações no volume das pernas. Seus achados se correlacionam com parâmetros clínicos e hemodinâmicos. Ela pode fornecer informações quantitativas dos diferentes componentes da hemodinâmica venosa: refluxo valvular, função de bomba muscular da panturrilha e obstrução venosa. Apesar de ter seu uso clínico validado, a pletismografia a ar é usada quase que exclusivamente para pesquisa. Ela pode ser usada para avaliar a doença venosa crônica, mensurar o ganho hemodinâmico após cirurgia venosa, diagnosticar trombose venosa profunda atual ou prévia, avaliar os efeitos da elastocompressão, estudar as implicações fisiológicas do uso de salto alto em mulheres e também avaliar a probabilidade de cura de uma úlcera venosa.


Assuntos
Humanos , Feminino , Úlcera Cutânea/patologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/patologia , Doença Crônica , Pletismografia/classificação
14.
JMIR Res Protoc ; 5(4): e226, 2016 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-27881360

RESUMO

BACKGROUND: Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are alternative strategies for stroke prevention in patients with atherosclerotic carotid disease. CEA has been considered the first-line treatment for carotid stenosis worldwide, and the safety and efficacy of CAS compared to CEA remains in question. OBJECTIVE: The purpose of this study is to compare the practice and outcomes of CAS and CEA in a real-world setting within public university hospitals in Brazil. METHODS: This study will be a prospective 5-year analysis of treatment for atherosclerotic carotid stenosis with CEA and CAS performed at 5 centers affiliated with the Vascular Study Group at public university hospitals in Brazil. The indications for the procedures will be determined by each surgeon's individual discretion, in accordance with preoperative risk evaluation. The primary outcome measures will be (1) any in-hospital stroke or death, and (2) any per-procedural stroke, death, or myocardial infarction (MI). Patients undergoing CEA in conjunction with cardiac surgery will be excluded from the study. Multivariate logistic regression will be performed to identify predictors of stroke or death in patients undergoing CEA and CAS. All tests of significance will be performed at the .05 level. This study was approved by the Committee of Ethics in Research at the University Hospital of Ribeirao Preto Medical School, and in all other participating institutions linked to National Research System and National Board of Health in Brazil (Process 15695/2011). RESULTS: This study is currently in the recruitment phase, and the final patient is expected to be enrolled by the end of 2018. We hope to recruit approximately 800 patients to the study. Analyses will focus on primary end points for patients that are allocated to each treatment group. During the per-procedural period, the occurrence of the primary end point components (stroke, MI, or death) for CAS and CEA will be analyzed for symptomatic or asymptomatic subjects. CONCLUSIONS: The analyses of the primary endpoints (and all others variables of the study) are expected to be published in 2019 in a peer reviewed journal, and results will be presented at scientific meetings, with summary results published online. This study will obtain new data related to the quality of treatment for carotid disease in Brazil at the primary training centers of future vascular surgeons, but the initial data that will be obtained and published (with the outcomes and complications) are restricted to the first 30 days postprocedure. This time restriction limits the comparison of the results that relate to the main goal of treatment, which is to decrease the risk of stroke over 5 years. The purpose of the study group is to continue the monitoring of patient records, and evaluate the follow-up data in the 5 years following the initial evaluation. This study protocol will contribute very significantly to improving the care of patients with carotid disease, in addition to qualifying the level of assistance provided in public university hospitals in the state of São Paulo, Brazil. TRIAL REGISTRATION: Clinicaltrials.gov NCT02538276; https://www.clinicaltrials.gov/ct2/show/NCT02538276 (Archived by WebCite at http://www.webcitation.org/6m7APnFLD).

15.
J. vasc. bras ; 15(3): 245-249, jul.-set. 2016. graf
Artigo em Português | LILACS | ID: lil-797956

RESUMO

Resumo A doença cística da adventícia é uma entidade rara que acomete principalmente a artéria poplítea. A ocorrência em veias é muito rara, e sua etiologia é desconhecida. Clinicamente, apresenta-se como isquemia, trombose ou dor a depender do território acometido. Apresentamos o caso de um paciente masculino jovem referindo nódulo no braço esquerdo. A angiorressonância magnética do membro mostrou lesão cística em contato com a veia basílica, com conteúdo homogêneo e sem realce pós-contraste. Foi realizada ressecção da lesão em bloco com o segmento venoso envolvido. O estudo anatomopatológico foi sugestivo de cisto de adventícia de veia basílica.


Abstract Cystic adventitial disease is a rare entity that most often involves the popliteal artery. It rarely occurs in veins. Its etiology is unknown. Clinically, it presents with ischemia, thrombosis or pain, depending on the vessel affected. Here we present the case of a young male with a nodule in the left arm. Magnetic resonance angiography showed a cystic lesion in contact with the basilic vein, with homogenous content without post-contrast enhancement. The lesion was resected en bloc together with the venous segment involved. The results of microscopic analysis were suggestive of basilic vein cystic adventitial disease.


Assuntos
Humanos , Masculino , Adulto , Cisto Epidérmico/diagnóstico por imagem , Artéria Poplítea/anatomia & histologia , Artéria Poplítea/diagnóstico por imagem
17.
J Vasc Bras ; 15(4): 287-292, 2016 Oct-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29930606

RESUMO

Air plethysmography is a non-invasive test that can quantify venous reflux and obstruction by measuring volume changes in the leg. Its findings correlate with clinical and hemodynamic measures. It can quantitatively assess several components of venous hemodynamics: valvular reflux, calf muscle pump function, and venous obstruction. Although clinical uses of air plethysmography have been validated, it is used almost exclusively for medical research. Air plethysmography can be used to assess chronic venous disease, to evaluate improvement after venous surgery, to diagnose acute and past episodes of deep venous thrombosis, to evaluate compression stocking therapy, to study the physiological implications of high-heeled shoes in healthy women, and even to evaluate the probability of ulcer healing.

18.
J. vasc. bras ; 14(4): 297-304, out.-dez. 2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-767701

RESUMO

Aneurismas de artéria poplítea (AAPs) correspondem a 70,00% dos aneurismas periféricos. A indicação cirúrgica é para aneurismas com diâmetros maiores que 2,0 cm ou sintomáticos. O tratamento é feito por técnicas cirúrgicas convencionais ou endovasculares. Esta última tem ganho muitos adeptos, mas ainda não há consenso estabelecido sobre sua indicação. Objetivo Apresentar a experiência da Divisão de Cirurgia Vascular e Endovascular do Hospital das Clínicas de Ribeirão Preto da Universidade de São Paulo no tratamento dos AAPs. Método Foram revisados casos de reparo convencional e endovascular de AAPs tratados nos últimos cinco anos, avaliando dados demográficos, comorbidades, indicação cirúrgica, complicações pré e pós-operatórias precoces e tardias, tempo de internação e de perviedade em até um ano. Resultados Foram realizadas no período dez cirurgias endovasculares (CE) e 21 cirurgias abertas (CA). O grupo CE teve maior frequência de comorbidades. Houve maior frequência de pacientes sintomáticos no grupo CA (85,00%) do que no grupo CE (40,00%). O Grupo CE apresentou menor número de complicações clínicas e cirúrgicas. A idade entre os grupos e o tempo de internação de cada grupo não apresentaram diferença estatística. A perviedade primária em um ano no Grupo CE foi de 80,00%, enquanto no Grupo CA foi de 75,00%. Conclusão O tratamento endovascular para AAPs apresenta bons resultados, em termos de perviedade com taxas de complicações aceitáveis, em pacientes com risco cirúrgico elevado e anatomia favorável, justificando, assim, a necessidade de mais estudos controlados para modificar a posição da técnica endovascular como uma terapia alternativa para casos selecionados.


Popliteal artery aneurysms (PAAs) account for 70% of peripheral aneurysms. Surgery is indicated for aneurysms that have diameters greater than 2.0 cm or are symptomatic. Repair can be achieved by conventional surgical techniques or using endovascular methods, which are becoming increasingly popular, but for which there is not yet a consensus on indications. Objective To describe the experience of treating PAAs at the vascular and endovascular surgery department of the Hospital das Clínicas de Ribeirão Preto, affiliated to the Universidade de São Paulo (Brazil). Method A review was conducted of cases of conventional and endovascular repair of PAAs over the last 5 years, analyzing demographic data, comorbidities, surgical indications, preoperative and early and late postoperative complications, length of hospital stay and patency, during follow-up of up to 1 year. Results During the period analyzed, ten endovascular surgeries (ES) and 21 open surgeries (OS) were performed. The ES group exhibited a higher frequency of comorbidities. There was a higher frequency of symptomatic patients in the OS group (85%) than in the ES group (40%). The ES group exhibited a lower number of clinical and surgical complications. There were no statistical differences between the groups in terms of age or length of hospital stay. Primary patency at 1 year was 80% in the ES group and 75% in the OS group. Conclusions Endovascular treatment for PAAs offers good results in terms of patency, with acceptable complication rates, in patients with high surgical risk and favorable anatomy. Controlled studies are therefore warranted to validate the endovascular technique and afford it the status of an alternative procedure for use in selected cases.


Assuntos
Humanos , Masculino , Idoso , Aneurisma/reabilitação , Aneurisma/terapia , Aneurisma , Artéria Poplítea/cirurgia , Artéria Poplítea , Procedimentos Endovasculares/reabilitação , Angiografia , Comorbidade , Fatores de Risco , Tomografia
19.
Ann Transplant ; 20: 698-706, 2015 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-26596354

RESUMO

BACKGROUND: The endovascular approach has shown high initial technical success rates, good patency rates, and minimal complications in treating transplant renal artery stenosis (TRAS). The objective of this study was to describe our experience with an endovascular approach to TRAS. MATERIAL AND METHODS: We performed a retrospective single-institutional review of all kidney transplant procedures performed at our institution from September 2009 to September 2014. All consecutive cases of TRAS were included. RESULTS: From a total of 183 kidney transplantations, 16 patients had TRAS. Mean time from transplantation to TRAS diagnosis was 201.8 days. Stenoses or hemodynamic significant kinkings were located at the anastomosis (7), proximal (5) and middle (4) portions of the transplant artery. All patients were treated with angioplasty and primary balloon-expanding stenting. Early technical success was 93.75% and local complication rate was 12.5%. No deaths occurred. Mean serum creatinine level dropped from 3.87 mg/dL to 2.91 mg/dL after 24 hours; 1.85 mg/dL after one month; and 1.67 mg/dL after three months (P<0.05). Mean estimated glomerular filtration rate increased from 31.60 mL/min to 39.53 mL/min after 24 hours; 50.92 mL/min after one month; and 55.05 mL/min after three months (P<0.05). Doppler ultrasound criteria normalized after the procedure. Number of classes of antihypertensive drugs was not different before and after the procedure (P=0.38). Mean follow-up time was 9.75 months. One patient had a restenosis and required surgical intervention to restore graft function. CONCLUSIONS: The endovascular approach to TRAS with primary balloon-expanding stenting was safe and had a high rate of technical success. It was effective for restore and maintain the renal function in transplant kidney grafts with a low rate of restenosis.


Assuntos
Angioplastia com Balão/métodos , Transplante de Rim/efeitos adversos , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/terapia , Grau de Desobstrução Vascular/fisiologia , Adulto , Idoso , Brasil , Estudos de Coortes , Creatinina/sangue , Feminino , Seguimentos , Taxa de Filtração Glomerular , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Testes de Função Renal , Transplante de Rim/métodos , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Obstrução da Artéria Renal/diagnóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do Tratamento
20.
Ann Vasc Surg ; 29(8): 1659.e21-5, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26303271

RESUMO

Penetrating aortic ulcer (PAU) is an atherosclerotic lesion with ulceration that penetrates the internal elastic lamina of the aortic wall. PAUs are classified as a category of acute aortic syndrome and have a reported rupture rate of up to 38%. To our knowledge, there is no prior published report of a PAU causing an aortogastric fistula. With the goal of raising awareness of this potentially catastrophic complication, we present herein a case of a PAU that ruptured into the gastric fundus, resulting in massive bleeding. The diagnosis was confirmed by computed tomography angiography, and thoracic endovascular aortic repair was used to control bleeding. Unfortunately, the patient did not survive the severe hypovolemic shock.


Assuntos
Doenças da Aorta/complicações , Aterosclerose/complicações , Fístula Gástrica/diagnóstico , Fístula Gástrica/etiologia , Fístula Vascular/diagnóstico , Fístula Vascular/etiologia , Idoso , Doenças da Aorta/diagnóstico , Doenças da Aorta/cirurgia , Aterosclerose/diagnóstico , Aterosclerose/cirurgia , Fístula Gástrica/cirurgia , Humanos , Masculino , Fístula Vascular/cirurgia
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