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1.
Ann Vasc Surg ; 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31629855

RESUMO

OBJECTIVE: The role of TEVAR in the treatment of chronic type B aortic dissection is controversial. Some advocate open surgery, based on the premise that all tears must be treated and others prefer branched endografts with the same premise. However, TEVAR, with closure of the primary tear in the thorax, has shown good results in some centers. This single-center cohort study was designed to contribute to the knowledge of the long term evolution (mean 4.8 years) of the patients submitted to endovascular closure of the proximal intimal tear. METHODS: 36 patients with asymptomatic chronic aortic dissection had a successful closure of the primary tear by TEVAR and were followed for a medium time of 57.2 months, RESULTS: In 75 % of the cases there was stabilization or decrease in the maximum diameter. 25 % had diameter increase in the thoracic or abdominal aorta and indication for one or more additional procedures. One patient refused a second procedure and died from rupture one month after the last evaluation; this was the only case of rupture in the series. One patient died of unrelated cause before having been submitted to a second procedure. 34 patients survived without diameter increase in the follow-up period. CONCLUSION: Chronic type B aortic dissections can be successfully treated by the coverage of the proximal tear with an endograft. Patients shall be followed carefully, and 25 % of them will require one or more additional procedures to achieve a good result.

2.
J Vasc Res ; 56(5): 255-266, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31533112

RESUMO

INTRODUCTION: In spite of the great relevance of abdominal aortic aneurysm, its etiopathogenesis is not fully understood. The biomechanical and histological study of the aortic wall may contribute to this elucidation. METHODS: Seventy-five male Wistar rats were divided into 4 groups: control (CG), smoker (SG), diabetic (DG), and diabetic + smoker (DSG). The SG and DSG rats were exposed to cigarette smoke for 30 min/day, 5 days a week. Diabetes was induced by the intravenous injection of streptozotocin. After 16 weeks, the abdominal aorta was collected for biomechanical, histological, and matrix metalloproteinase 2 (MMP-2) activity analyses. RESULTS: The valid biomechanical tests of 52 specimens were analyzed: 11 in the CG, 10 in the DG, 16 in the SG, and 15 in the DSG. The biomechanical analysis of the fragments showed no differences between the control, DG, SG, and DSG. Collagen deposition also did not present a significant difference between the studied groups. The total count of elastic fibers was higher in diabetic rats (DG and DSG) than in the SG. The inflammatory response observed in all experimental groups was significantly more intense than in the CG. Compared to the DSG, MMP-2 activity showed a significant decrease in the DG. CONCLUSIONS: Resistance and elasticity did not present a difference between the CG and the DG, SG, and DSG. Compared to the CG, the total count of elastic fibers, fragmentation of the elastic lamina, pericellular matrix deposition, and cell loss/substitution in the tunica media showed significant alterations in the aortic walls of the DG, SG, and DSG. MMP-2 activity was lower in the DG aorta than in the DSG aorta.

3.
Phlebology ; : 268355519850651, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31117882

RESUMO

OBJECTIVES: To compare the effectiveness of two foam sclerotherapy techniques of the great saphenous vein. METHODS: Fifty subjects with varicose veins, edema, and great saphenous vein incompetence (diameter 6-10 mm) were randomly categorized into two equal groups and were treated with different foam sclerotherapy techniques: A (usual ultrasound-guided) and B (catheter-directed with tumescence). Concomitant phlebectomy was performed in all patients. Patients were seen on days 7 and 28, and at six and 12 months. The primary outcomes were the full success rate of the treated great saphenous vein and the number of patients who required retreatment sessions performed at 28-day follow-up. The secondary-assisted outcomes were the full success rates of the treated great saphenous vein after the retreatment sessions at six- and 12-month follow-up. Secondary outcomes were changes in quality of life and side effects and complications of the intervention. In case of reflux, retreatment sessions were performed at 28 days and six months in both groups. RESULTS: Full success rate of the treated great saphenous vein was 36% in group A vs. 80% in group B ( p = 0.012) and the number of patients who required retreatment sessions were n = 14 in group A vs. n = 3 in group B at 28-day follow-up ( p = 0.002). Both were statistically significant. At six and 12 months, the success rates were not statistically significant between the groups. Complication rates were similar between the groups. Quality of life improved in both groups with statistical difference ( p < 0.001). CONCLUSIONS: Catheter-directed foam sclerotherapy with tumescence was better than usual ultrasound-guided foam sclerotherapy as it reached higher full success rate of the treated great saphenous vein and as a lower number of patients required retreatment sessions in the short-term. Both methods proved to be safe and improved the quality of life.

4.
Ann Vasc Surg ; 60: 35-44, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30802572

RESUMO

BACKGROUND: Active cancer is found in approximately 20% of patients diagnosed with venous thromboembolism. This condition is more prevalent in patients with advanced and metastatic cancer and is the second largest cause of death among patients with active neoplasm. Many of them have contraindication for anticoagulation and needs an inferior vena cava filter to be implanted, but a large proportion of these patients have very low survival after filter implantation. Our aim was to verify whether the need for filter implantation represents an independent indicator of poor prognosis in oncological patients and to identify subgroups with a greater survival. METHODS: This study included a retrospective analysis of 247 oncologic patients with acute proximal venous thrombosis. We compared survival between 100 consecutive patients who needed vena cava filter (FILTER group) versus a control group of 147 patients in whom anticoagulation was possible (ANTICOAGULATION group). We verified survival, cause of death, filter's indications (clinical and surgical), and factors that might lead to worse prognosis. RESULTS: Risk of death was 8.83-fold higher in the FILTER group than that in the ANTICOAGULATION group, a greater risk than the presence of metastasis (OR: 2.47). Death was significantly more frequent in patients subjected to filter implantation because of clinical indications (93.2%) such as high risk of or recent bleeding and an adjusted risk of death of 2.24-fold higher in a multivariate analysis. CONCLUSIONS: The need to implant a vena cava filter in a patient with cancer is a marker that indicates patient's disease severity and worse prognosis. Survival was longer in the subgroup of patients who underwent filter implantation before oncologic surgery, probably because of a better status performance and less clinical complications.

5.
Ann Vasc Surg ; 54: 176-184, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30103051

RESUMO

BACKGROUND: Atherosclerosis and abdominal aortic aneurysms (AAAs) have several similar risk factors but different pathogenesis. Inflammation of the arteries is common to both. Central obesity can act as an endocrine organ through the secretion of inflammatory cytokines, and the perivascular fat has a local effect that could contribute to diseases of the abdominal aorta. Although the relation between central obesity and atherosclerosis occlusive arterial disease has been demonstrated, the correlation with AAA has conflicting results. The aim of this study was to analyze the correlation between central obesity and the presence of abdominal aortic diseases using computed tomography. METHODS: Six hundred thirty-nine consecutive patients classified into 3 groups (AAA, aortic atherosclerotic occlusive disease (AAOD), and without aortic disease [control group]) who underwent computed tomography had the aorta diameter, the visceral fat area (VFA), and the subcutaneous fat area (SFA) measured at the level of third and fourth lumbar vertebrae. RESULTS: VFA showed no difference between the groups. SFA was lower in atherosclerotic group (AAOD) than control (P < 0.01 in general and P < 0.04 in male). In AAA group, we found in men that the first tertile of aorta diameter had higher VFA than third tertile (P = 0.02). CONCLUSIONS: There was no difference in VFA between patients in AAA, AAOD, and without aortic disease groups. In men with aneurysm, there was an inverse relationship between VFA and aortic diameter. In AAOD, visceral to subcutaneous ratio is higher due to lower SFA.


Assuntos
Aorta/anatomia & histologia , Aneurisma da Aorta Abdominal/etiologia , Doenças da Aorta/etiologia , Aterosclerose/etiologia , Gordura Intra-Abdominal/anatomia & histologia , Obesidade Abdominal/complicações , Adiposidade , Idoso , Aorta/diagnóstico por imagem , Aorta/patologia , Doenças da Aorta/patologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Tomografia Computadorizada por Raios X
6.
Ann Vasc Surg ; 53: 44-52, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30053548

RESUMO

BACKGROUND: To characterize patients with internal carotid occlusion (ICO) with respect to demographic data, associated diseases, medical management, and risk factors and to compare these patients with those with nonsignificant stenosis (NSS; less than 50% stenosis). Secondary end points were new neurologic events, progression of contralateral degree of stenosis, cardiovascular symptoms, and death during follow-up. METHODS: Retrospective analysis was performed using data collected from clinical records and added to a prospective database. Missing data were obtained during phone interviews or requested medical appointments. RESULTS: From 2005 to 2013, 213 patients with ICO and 172 with NSS were studied (medium follow-up 37.81 months). Among the patients with ICO, a greater proportion were men, had a history of smoking, and presented with peripheral arterial disease and a lower creatinine clearance compared with those with NSS (P < 0.05). At the time of diagnosis, 76.1% of the patients with ICO were symptomatic compared with 35.5% of those with NSS (P = 0.000001). The patients in the ICO group exhibited significant progression of contralateral stenosis compared with those in the control group with progression on any side (15.0% vs. 2.3%, P = 0.00011). In addition, 18 patients in the ICO group (8.5%) exhibited new neurological symptoms compared with 13 (7.6%) in the NSS group (P = 0.41). When the ICO and NSS groups were combined, 10.8% of the initially symptomatic patients presented with new symptoms compared with 4.3% of those who were initially asymptomatic (P = 0.0218). The number of deaths was significantly higher among the patients in the ICO group (14.1% vs. 6.4%, P = 0.0150). CONCLUSIONS: Patients presenting with ICO have more risk factors and higher mortality by any cause. Initially, symptomatic patients will likely present with more neurological symptoms during follow-up, independent of carotid morphology, ICO, or NSS. Efforts must be made to identify those at risk before occlusion and to prevent secondary events and death.


Assuntos
Artéria Carótida Interna , Estenose das Carótidas/epidemiologia , Idoso , Brasil/epidemiologia , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/mortalidade , Estenose das Carótidas/terapia , Causas de Morte , Comorbidade , Progressão da Doença , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fumar/efeitos adversos , Fumar/epidemiologia
7.
Am Heart J ; 203: 67-73, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30041065

RESUMO

BACKGROUND: We aimed to directly compare preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentration for the prediction of major cardiac complications after non-cardiac surgery. METHODS: We measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in 1022 patients undergoing non-cardiac surgery. The primary endpoint was a composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days. We hypothesized that the type of surgery may impact on the predictive accuracy of hs-cTnI/T and stratified all analyses according to the type of surgery. RESULTS: Major cardiac complications occurred in 108 (11%) patients, 58/243 (24%) patients undergoing vascular surgery and 50/779 (6%, P < .001) patients undergoing non-vascular surgery. Using regulatory-approved 99th percentile cut-off concentrations, preoperative hs-cTnI elevations were less than one-fifth as common as preoperative hs-cTnT elevations (P < .001). Among patients undergoing vascular surgery, preoperative hs-cTnI concentrations, but not hs-cTnT, was an independent predictor of cardiac complications (adjusted odds ratio (aOR) 1.5, 95% confidence interval (95% CI) 1.0-2.1). The area under the receiver-operating characteristics curve (AUC) was 0.67 (95% CI, 0.59-0.75) for hs-cTnI versus 0.59 (95% CI 0.51-0.67, P = .012) for hs-cTnT. In contrast, among patients undergoing non-vascular surgery both preoperative hs-cTnI and hs-cTnT were independent predictors of the primary endpoint (aOR 1.6, 95% CI 1.3-2.0, and aOR 3.0, 95% CI 2.0-4.6, respectively) and showed higher predictive accuracy (AUC 0.77, 95% CI, 0.71-0.83, and 0.79, 95% CI 0.73-0.85, P = ns). CONCLUSIONS: Preoperative hs-cTnI and hs-cTnT concentrations predict major cardiac complications after non-vascular surgery, while, in patients undergoing vascular surgery, hs-cTnI may have better accuracy.


Assuntos
Infarto do Miocárdio/sangue , Complicações Pós-Operatórias/sangue , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Troponina I/sangue , Troponina T/sangue , Idoso , Biomarcadores/sangue , Brasil/epidemiologia , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Feminino , Seguimentos , Humanos , Imunoensaio , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Imagem de Perfusão do Miocárdio , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Suíça/epidemiologia , Fatores de Tempo
9.
J Vasc Surg ; 68(6): 1782-1787, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29914831

RESUMO

OBJECTIVE: The increasing use of computed tomography (CT) angiography has led to more frequent diagnoses of celiac artery compression (CAC) by the median arcuate ligament (MAL). The signs of CAC by the MAL have been described as stenosis and a hook or J appearance on sagittal views. The importance of the "hook signal," however, has not been documented by studies of the normal anatomy of the celiac axis. METHODS: CT angiography images of 344 completely asymptomatic, live kidney donors (without history of chronic abdominal pain or weight loss) were reviewed. The angle of emergence (AE) of the celiac axis from the aorta and the angle of upward or downward shifting of the celiac axis before its first branch (fold angle [FA]) were measured. Weight, height, and body mass index were obtained from our electronic database, and correlations with the angles measured were tested. The occurrence of stenosis >50% at the origins of the celiac axis was also determined in the sample. RESULTS: Measurements were possible in 321 cases. The celiac axis was found to leave the aorta at an angle of <90 degrees in all patients (AE range, 7-83 degrees) and <45 degrees in 292 (90%) patients. The FA ranged from 66 to 208 degrees. Before the first branch, the celiac trunk shifted upward in 306 (95%) patients, remained straight in just one of them, and shifted downward in 14 (4%). The AE was positively correlated with weight in women. The FA was negatively correlated with weight in men and women. Body mass index was positively correlated with AE and negatively correlated with FA in both men and women. In 11 cases (3.4%), stenosis >50% was found at the origin of the celiac axis. In only two patients, the celiac axis had an upward slope after the stenosis, which could be interpreted as a hook shape. CONCLUSIONS: The normal anatomy of the celiac axis, when seen on CT angiography images, demonstrates that it exits the aorta downward and then shifts upward. This hook or J shape should not be interpreted as resulting from external compression. CAC by the MAL occurs in 3.42% of the normal asymptomatic population; a hook or J shape is not visible in most cases in that subgroup.


Assuntos
Aortografia/métodos , Artéria Celíaca/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Síndrome do Ligamento Arqueado Mediano/diagnóstico por imagem , Adulto , Idoso , Brasil/epidemiologia , Constrição Patológica , Feminino , Humanos , Masculino , Síndrome do Ligamento Arqueado Mediano/epidemiologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Adulto Jovem
10.
Ann Vasc Surg ; 50: 300.e5-300.e10, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29518516

RESUMO

BACKGROUND: Transient paraplegia of the lower limbs is a rare condition and, when has a vascular etiology, is usually associated with thromboembolic events, aortic dissection, aortic aneurysms, or as a complication of the surgical correction of those diseases. There is no case reported of acute paraplegia caused by a segmental thrombotic subocclusion of the descending thoracic aorta. CASE REPORT: We report a not yet described clinical situation of a young patient (51 years) admitted to the emergency care department for treatment of systemic arterial hypertension of difficult control with 4 antihypertensive medication classes. At the intensive care unit for treatment with intravenous antihypertensive medication, the patient evolved with acute paraplegia and a segmental thrombotic subocclusion of the descending thoracic aorta was diagnosed. He was submitted to endovascular treatment with total recovery of the deficits. CONCLUSIONS: The previously normal descending thoracic aorta may be a site of segmental thrombosis and may lead to paraplegia. Early endovascular treatment can reverse this type of situation.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Extremidade Inferior/inervação , Paraplegia/etiologia , Trombose/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Aortografia/métodos , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/diagnóstico , Paraplegia/fisiopatologia , Recuperação de Função Fisiológica , Trombose/complicações , Trombose/diagnóstico por imagem , Trombose/fisiopatologia , Resultado do Tratamento
11.
Innov Surg Sci ; 3(3): 225-234, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31579786

RESUMO

The endovascular technique has led to a revolution in the care of patients with vascular disease; however, acquiring and maintaining proficiency over a broad spectrum of procedures is challenging. Three-dimensional (3D) printing technology allows the production of models that can be used for endovascular training. This article aims to explain the process and technologies available to produce vascular models for endovascular training, using 3D printing technology. The data are based on the group experience and a review of the literature. Different 3D printing methods are compared, describing their advantages, disadvantages and potential roles in surgical training. The process of 3D printing a vascular model based on an imaging examination consists of the following steps: image acquisition, image post-processing, 3D printing and printed model post-processing. The entire process can take a week. Prospective studies have shown that 3D printing can improve surgical planning, especially in complex endovascular procedures, and allows the production of efficient simulators for endovascular training, improving residents' surgical performance and self-confidence.

12.
J Vasc Surg ; 66(6): 1826-1835.e1, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28807383

RESUMO

OBJECTIVE: Predicting cardiac events is essential to provide patients with the best medical care and to assess the risk-benefit ratio of surgical procedures. The aim of our study was to evaluate the performance of the Revised Cardiac Risk Index (Lee) and the Vascular Study Group of New England Cardiac Risk Index (VSG) scores for the prediction of major cardiac events in unselected patients undergoing arterial surgery and to determine whether the inclusion of additional risk factors improved their accuracy. METHODS: The study prospectively enrolled 954 consecutive patients undergoing arterial vascular surgery, and the Lee and VSG scores were calculated. Receiver operating characteristic curves for each cardiac risk score were constructed and the areas under the curve (AUCs) compared. Two logistic regression models were done to determine new variables related to the occurrence of major cardiac events (myocardial infarction, heart failure, arrhythmias, and cardiac arrest). RESULTS: Cardiac events occurred in 120 (12.6%) patients. Both scores underestimated the rate of cardiac events across all risk strata. The VSG score had AUC of 0.63 (95% confidence interval [CI], 0.58-0.68), which was higher than the AUC of the Lee score (0.58; 95% CI, 0.52-0.63; P = .03). Addition of preoperative anemia significantly improved the accuracy of the Lee score to an AUC of 0.61 (95% CI, 0.58-0.67; P = .002) but not that of the VSG score. CONCLUSIONS: The Lee and VSG scores have low accuracy and underestimate the risk of major perioperative cardiac events in unselected patients undergoing vascular surgery. The Lee score's accuracy can be increased by adding preoperative anemia. Underestimation of major cardiac complications may lead to incorrect risk-benefit assessments regarding the planned operation.


Assuntos
Artérias/cirurgia , Técnicas de Apoio para a Decisão , Cardiopatias/etiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Área Sob a Curva , Brasil , Distribuição de Qui-Quadrado , Feminino , Cardiopatias/diagnóstico , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Sistema de Registros , Medição de Risco , Fatores de Risco , Suíça , Resultado do Tratamento
13.
Ann Vasc Surg ; 45: 267.e1-267.e5, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28689948

RESUMO

BACKGROUND: We describe a unique case of a patient with penetration of the cervical region by a stab wound, who required emergency care for the controlled removal of the knife and for vertebral artery trauma (VAT) treatment. Although rare, VAT causes high morbidity and mortality. METHODS: A patient admitted for emergency care was diagnosed with traumatic complete section of the vertebral artery by a knife and underwent removal of the knife under radioscopic supervision and vertebral artery embolization with coils. RESULTS: The knife was removed successfully, the bleeding was controlled, and the patient did not present any sequelae. CONCLUSIONS: In the authors' experience, a patient in an emergent state due to VAT can be treated effectively and quickly with proximal embolization.


Assuntos
Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Lesões do Sistema Vascular/cirurgia , Artéria Vertebral/cirurgia , Ferimentos Perfurantes/cirurgia , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/lesões , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/etiologia
14.
Ann Vasc Surg ; 41: 294-299, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28242407

RESUMO

BACKGROUND: The status of the left arm, the need of revascularization, and the occurrence of type II endoleakes from de left subclavian artery (LSA) after intention LSA coverage for thoracic aortic aneurysm endovascular repair need to be better understood. This systematic review was developed for contributing with such issue. METHODS: Systematic literature review of studies published from January 2000 through December 2015 identified 7 studies comprising 201 patients submitted to elective endovascular repair for thoracic aortic aneurysms requiring intentional LSA coverage. Outcomes of interest included left-arm complications (ischemia, symptoms of claudication, and subclavian steal syndrome [SSS]) requiring postoperative revascularization of LSA, as well as endoleaks from the subclavian artery requiring postoperative embolization of LSA. RESULTS: Left-arm complication rate was 4.5% (9 patients), requiring postoperative revascularization of LSA in 1 case (0.5%) of SSS. Type II endoleaks from the subclavian artery requiring postoperative embolization of LSA were reported in 2 cases (1.0%). CONCLUSIONS: Low-quality evidence suggests very low rates of arm complications with need of LSA revascularization and of type II endoleaks requiring embolization in elective endovascular treatment of thoracic aortic aneurysms with intentional coverage of LSA without prophylactic revascularization of LSA.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Endoleak/cirurgia , Procedimentos Endovasculares/efeitos adversos , Isquemia/cirurgia , Artéria Subclávia/cirurgia , Síndrome do Roubo Subclávio/cirurgia , Extremidade Superior/irrigação sanguínea , Aneurisma da Aorta Torácica/fisiopatologia , Endoleak/etiologia , Endoleak/fisiopatologia , Humanos , Isquemia/etiologia , Isquemia/fisiopatologia , Fluxo Sanguíneo Regional , Reoperação , Fatores de Risco , Síndrome do Roubo Subclávio/etiologia , Síndrome do Roubo Subclávio/fisiopatologia , Resultado do Tratamento
16.
Ann Vasc Surg ; 39: 285.e17-285.e21, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27666805

RESUMO

BACKGROUND: Aortic lesions are uncommon complications in spine surgery, but potentially fatal, because they can cause massive bleeding and hemodynamic instability. We report the endovascular treatment of late aortic erosive lesion by pedicle screw without screw removal. METHODS: A breast cancer patient had a pathological fracture on T10, with spinal cord compression, and a pseudoaneurysm of the aorta in contact with an anterolateral pedicle screw. Endovascular surgery corrected the aortic lesion and allowed decompression, a week later, by posterior arthrodesis (T7-L1), with screw maintenance. RESULTS: There was no contrast leakage at thorax angiotomography in 2 years, and she died of meningeal carcinomatosis. CONCLUSION: Screw maintenance was safe in the endovascular treatment of aortic lesion by erosion.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Parafusos Ósseos , Neoplasias da Mama/secundário , Procedimentos Endovasculares , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Vértebras Torácicas/cirurgia , Lesões do Sistema Vascular/cirurgia , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Aortografia/métodos , Neoplasias da Mama/terapia , Angiografia por Tomografia Computadorizada , Evolução Fatal , Feminino , Humanos , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
17.
Ann Vasc Surg ; 39: 173-181, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27522984

RESUMO

BACKGROUND: The aim of this study was to determine the impact of metabolic syndrome (MetS) on the morphology of carotid plaques, as evaluated using duplex ultrasound (DUS) with computer-assisted analysis. METHODS: In this cross-sectional observational study, we analyzed 148 carotid artery plaques in asymptomatic patients. Data were obtained via clinical and laboratory examinations, and DUS was performed by a single operator. All plaques were scanned in a longitudinal fashion, and the best segment was selected, recorded, and evaluated using dedicated software. The main software-based analyses included gray-scale median (GSM) measurements and carotid plaque morphology histograms. RESULTS: MetS was identified in 51.8% of patients. Comparisons of patients with MetS and patients without MetS indicated that the former patients used more classes of antihypertensive drugs (2.49 vs. 1.93; P = 0.004) and were treated with statins for a longer period (71.08 vs. 49.17 months; P = 0.003). Most patients of both types exhibited moderate carotid artery stenosis ranging from 50% to 69% (n = 62; 37.3%), and MetS was not associated with an increased prevalence of severe carotid artery stenosis. The mean GSM was greater in the MetS group than in the non-MetS group (74.18 vs. 61.63; P = 0.012). The histogram analysis revealed that there were lower quantities of blood and fat (2.91 vs. 3.88; P = 0.006; 10.21 vs. 15.08; P = 0.004, respectively) and more fibrous tissue (19.93 vs. 14.55; P = 0.015) in the carotid plaques of patients with MetS than in the carotid plaques of patients without MetS. CONCLUSIONS: The present study demonstrated that MetS did not affect the stenosis grade or did it lead to unstable carotid plaques.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Síndrome Metabólica/complicações , Placa Aterosclerótica , Ultrassonografia Doppler Dupla , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Artérias Carótidas/patologia , Estenose das Carótidas/complicações , Estenose das Carótidas/patologia , Estudos Transversais , Feminino , Fibrose , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Ruptura Espontânea , Índice de Gravidade de Doença , Software
18.
J Vasc Surg Venous Lymphat Disord ; 4(2): 200-5, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26993868

RESUMO

OBJECTIVE: The aim of this study was to investigate the risk factors for complications of totally implantable catheters in a referral cancer center. METHODS: This was a retrospective study of prospectively collected data of all consecutive cancer patients undergoing port placement, with a primary outcome of interest of major complication and subanalysis of the types of complications. RESULTS: We studied 1255 nonvalved implanted port catheters inserted in 1230 patients, for a combined total of 469,882 catheter-days of use. Venous puncture was ultrasound (US)-guided in 1049 cases (84%). Inadvertent arterial puncture occurred in 14 cases (1.1%) and was more frequent in procedures not guided by US (P = .045). Among the outpatients, 90 (9%) developed infection, and 75 (29%) of the hospitalized patients (P < .001) developed infections. Infection was diagnosed in 131 catheters (13%) implanted through the internal jugular vein (IJV), 23 catheters (14%) implanted in the subclavian vein (SCV), 1 catheter (5%) implanted in the external jugular vein, and 10 catheters (31%) implanted in the femoral vein (P = .044). In the multivariate analysis, only the hospitalization regimen maintained statistical significance, with hospitalization presenting as a risk factor for infection (P < .001). Regarding the introduction site, ambulatory patients in whom the femoral vein was the site of access had more infections than the others (28.6% vs 9.4% of the IJV, 4.8% of the SCV, and 4.8% of the external jugular vein; P = .019), which did not occur among the hospitalized patients (33.3% vs 26.5% of IJV and 39.5% of the SCV; P = .218). CONCLUSIONS: Not using US is a risk factor for iatrogenic arterial puncture. Port implantation in hospitalized patients and the use of femoral access are risk factors for infection.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Veias Jugulares , Masculino , Pessoa de Meia-Idade , Neoplasias , Pacientes , Estudos Retrospectivos , Risco , Fatores de Risco , Veia Subclávia , Adulto Jovem
19.
Int J Angiol ; 25(1): 39-43, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26900310

RESUMO

The incidence of common carotid artery occlusion (CCAO) is approximately 3% in patients who undergo angiography for symptomatic cerebrovascular disease; however, few studies have reported on management of this condition. The objective of this article was to analyze risk factors, therapeutic options, and clinical benefits of surgical treatment at a hospital in the city of São Paulo, Brazil. Data were collected from medical records of 40 patients with CCAO who were treated from June 2002 to October 2013. Results were analyzed retrospectively. Most of the patients were men (63.0%), who were significantly younger than women. Most of the participants had hypertension (90.0%), and more than half had a history of smoking (52.5%). The mean number of coexisting comorbidities/risk factors was 2.9 ± 1.0. Half of our sample had ipsilateral patent internal and external carotid artery, and 32.5% presented with an occluded internal carotid artery and a patent external artery. Patients with both an internal and an external occluded carotid artery (12.5%) were significantly older. Contralateral arteriosclerosis was observed in 65% of the patients, mainly represented by 50 to 90% stenosis. Most patients were symptomatic (67.5%), and hemiparesis was the most common symptom (55.0%) found. Most (77.5%) of the patients underwent the medical treatment; one out of three endovascular approaches failed. During the mean follow-up of 55 ± 43 months (range, 2-136 months), 17.5% of the patients died within 4 days after surgical repair and after along 123 months of clinical follow-up. Coexisting comorbidities/risk factors were significantly associated with fatal outcomes, such as acute myocardial infarction. This study provides scientific evidences on treatment and outcomes of CCAO.

20.
Vascular ; 24(1): 59-63, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25687720

RESUMO

OBJECTIVE: The objective of this study was to analyze the roles of demographic, clinical, and laboratory factors on the progression of atherosclerotic stenosis in carotid bifurcation. It was based on prospective information from records entered on a specific application form for follow-up outpatients at a tertiary university service. METHODS: Consecutive symptomatic and asymptomatic patients (n = 210) who had undergone more than one carotid duplex scan but no surgical intervention were selected for the analysis. The patients were divided into two groups: patients whose duplex scans did not show bilateral progression of carotid stenosis and patients with carotid stenosis progression of <50%, 50%-69%, or >70%. Clinical and demographic parameters were compared between groups. RESULTS: Group II levels of plasma urea (51.6 ± 27.8 mg/dl) and fibrinogen (493.2 ± 113.3 mg/dl) were higher than the Group I levels (43.0 ± 14.9 mg/dl and 441.3 ± 106.7 mg/dl, respectively) with statistical significance (p urea = 0.013 and p fibrinogen = 0.018). Paradoxically, the mean body mass index was higher in Group I (26.4 ± 4.6 kg/m(2)) than in Group II (24.6 ± 3.9 kg/m(2); p = 0.02). CONCLUSIONS: Traditional risk factors for the development of atherosclerosis in a carotid bifurcation are important but not unique. Metabolic and inflammatory factors can contribute to disease progression.


Assuntos
Aterosclerose/epidemiologia , Estenose das Carótidas/epidemiologia , Idoso , Assistência Ambulatorial , Doenças Assintomáticas , Aterosclerose/sangue , Aterosclerose/diagnóstico por imagem , Biomarcadores/sangue , Brasil/epidemiologia , Estenose das Carótidas/sangue , Estenose das Carótidas/diagnóstico por imagem , Comorbidade , Progressão da Doença , Feminino , Hospitais Universitários , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Centros de Atenção Terciária , Fatores de Tempo , Ultrassonografia Doppler em Cores
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