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1.
Medicine (Baltimore) ; 100(6): e24570, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578554

RESUMO

RATIONALE: Intravenous pyogenic granuloma (IVPG) is a special type of pyogenic granuloma, and its preoperative diagnosis is difficult. We report a rare case of IVPG that develops in the lumen of the internal jugular vein (IJV). Here, we analyze the imaging characteristics of present case and summarize the imaging characteristics of previous reported cases. PATIENT CONCERNS: A 44-year-old man who presented with a growth in the IJV without any symptoms. DIAGNOSES: A diagnosis of IVPG was made, based on the pathological examination after surgery. INTERVENTIONS: The patient underwent surgery to excise the vein segment containing the neoplasm. OUTCOMES: The patient did not present with any complications in the postoperative follow-up period. LESSONS: For clinician, IVPG's preoperative diagnosis is difficult. Although histopathology remains the gold standard for diagnosis, the combination of multiple types of imaging examinations is necessary to rule out the differential diagnoses of IVPG.


Assuntos
Granuloma Piogênico/diagnóstico por imagem , Veias Jugulares/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Adulto , Granuloma Piogênico/patologia , Granuloma Piogênico/cirurgia , Humanos , Veias Jugulares/patologia , Veias Jugulares/cirurgia , Imagem por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X , Ultrassonografia , Doenças Vasculares/patologia , Doenças Vasculares/cirurgia
2.
Khirurgiia (Mosk) ; (1): 90-92, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395518

RESUMO

We report a complex reconstruction of arteriovenous fistula (AVF). Proximal stenosis of cephalic vein was followed by aneurysms of fistulous veins (distal segment of cephalic vein and median cubital vein) complicated by AVF thrombosis. Blood outflow from AVF was retrograde. One week after thrombosis, an aneurysm of median cubital vein containing dense clots was excised. We resected cephalic vein wall and repaired the vessel. Anastomosis with the brachial artery was created distal to the last anastomosis. Proximal cephalic vein repair was performed using resected aneurysm walls. After a year, AVF has been successfully used for hemodialysis.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Braquial/cirurgia , Diálise Renal , Doenças Vasculares/cirurgia , Veias/cirurgia , Aneurisma/etiologia , Aneurisma/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Artéria Braquial/diagnóstico por imagem , Humanos , Resultado do Tratamento , Doenças Vasculares/etiologia , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/métodos , Insuficiência Venosa/etiologia , Insuficiência Venosa/cirurgia , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
3.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431452

RESUMO

Lobular capillary haemangioma, also known as pyogenic granuloma, is a benign vascular tumour that usually originates in the skin and mucosal membrane. It sometimes derives from the lumen of a vein and the clinical presentations are various and non-specific. A 72-year-old woman complained of a sensation of pressure in her left neck for 1 month when cooking. Her left cephalic vein was enlarged with no signs of oedema, and cervical ultrasound revealed a space-occupying lesion in the left subclavian vein. Contrast-enhanced CT and MRI revealed an intravascular tumour. This tumour was removed with operation, and histopathological examination revealed intravascular capillary haemangioma. Intravascular lobular capillary haemangioma is a rare condition that occurs in the veins of the neck and upper extremities. Intravascular tumours could cause a unique symptom, such as neck discomfort associated with neck anteflexion.


Assuntos
Granuloma Piogênico/diagnóstico , Pescoço/irrigação sanguínea , Veia Subclávia/patologia , Doenças Vasculares/diagnóstico , Idoso , Implante de Prótese Vascular , Diagnóstico Diferencial , Feminino , Granuloma Piogênico/complicações , Granuloma Piogênico/patologia , Granuloma Piogênico/cirurgia , Humanos , Leiomiossarcoma/diagnóstico , Imagem por Ressonância Magnética , Pescoço/diagnóstico por imagem , Veia Subclávia/diagnóstico por imagem , Veia Subclávia/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia , Doenças Vasculares/complicações , Doenças Vasculares/patologia , Doenças Vasculares/cirurgia , Neoplasias Vasculares/diagnóstico
5.
Science ; 370(6513)2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33033191

RESUMO

Since the advent of the vascular anastomosis by Alexis Carrel in the early 20th century, the repair and replacement of blood vessels have been key to treating acute injuries, as well as chronic atherosclerotic disease. Arteries serve diverse mechanical and biological functions, such as conducting blood to tissues, interacting with the coagulation system, and modulating resistance to blood flow. Early approaches for arterial replacement used artificial materials, which were supplanted by polymer fabrics in recent decades. With recent advances in the engineering of connective tissues, including arteries, we are on the cusp of seeing engineered human arteries become mainstays of surgical therapy for vascular disease. Progress in our understanding of physiology, cell biology, and biomanufacturing over the past several decades has made these advances possible.


Assuntos
Artérias , Prótese Vascular , Engenharia Tecidual/métodos , Doenças Vasculares/cirurgia , Técnicas de Cultura de Células , Humanos
7.
Plast Reconstr Surg ; 146(2): 227-237, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740566

RESUMO

BACKGROUND: Preoperative planning of microsurgical perforator free flaps continues to be a discussion topic among microsurgeons. The purpose of this study was to compare the ability of three methods of preoperative vascular mapping-hand-held Doppler imaging, color Doppler ultrasonography, and computed tomographic angiography-to detect perforators and their concordance with surgical findings. METHODS: A prospective study was performed to evaluate the sensitivity, specificity, and accuracy of hand-held Doppler imaging, color Doppler ultrasonography, and computed tomographic angiography to detect free flap perforators. Each patient undergoing a free flap reconstruction was studied preoperatively with the three methods, and the results were compared to the intraoperative findings. RESULTS: Fifty-three patients undergoing autologous tissue reconstruction were included. Most reconstructions (71.7 percent) were performed with anterolateral thigh flaps. The positive predictive value (color Doppler ultrasonography, 100 percent; computed tomographic angiography, 100 percent; hand-held Doppler imaging, 88.6 percent) and negative predictive value (color Doppler ultrasonography, 100 percent; computed tomographic angiography, 94.3 percent; hand-held Doppler imaging, 90.5 percent) rates were significantly different between methods. The high resolution of the color Doppler ultrasonography probe provided a direct vision of the vasculature arborization and efficiently detected vessels with diameters of less than 0.5 mm. The sensitivity, specificity, and accuracy of color Doppler ultrasonography were greater than those of both computed tomographic angiography and hand-held Doppler imaging. There was 100 percent concordance between color Doppler ultrasonography perforators and the surgical findings. CONCLUSIONS: Color Doppler ultrasonography provides a reproducible, harmless, and accurate way to visualize vascular anatomy. It has a high correlation with the surgical findings, signifying advantages over hand-held Doppler and computed tomographic angiography in sensitivity, specificity, and accuracy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Computadores de Mão , Retalho Perfurante/irrigação sanguínea , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ultrassonografia Doppler em Cores/métodos , Doenças Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Resultado do Tratamento , Doenças Vasculares/diagnóstico
8.
Vasc Endovascular Surg ; 54(8): 697-706, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32840176

RESUMO

OBJECTIVE: The global burden of surgical vascular disease is increasing and with it, the need for cost-effective, accessible prognostic biomarkers to aid optimization of peri-operative outcomes. The neutrophil-lymphocyte ratio (NLR) is emerging as a potential candidate biomarker for perioperative risk stratification. We therefore performed this systematic review and meta-analysis on the prognostic value of elevated preoperative NLR in vascular surgery. METHODS: We searched Embase (Ovid), Medline (Ovid), and the Cochrane Library database from inception to June 2019. Screening was performed, and included all peer-reviewed original research studies reporting preoperative NLR in adult emergent and elective vascular surgical patients. Studies were assessed for bias and quality of evidence using a standardized tool. Meta-analysis was performed by general linear (mixed-effects) modelling where possible, and otherwise a narrative review was conducted. Between-study heterogeneity was estimated using the Chi-squared statistic and explored qualitatively. RESULTS: Fourteen studies involving 5,652 patients were included. The overall methodological quality was good. Elevated preoperative NLR was associated with increased risk of long-term mortality (HR 1.40 [95%CI: 1.13-1.74], Chi-squared 60.3%, 7 studies, 3,637 people) and short-term mortality (OR: 3.08; 95%CI: 1.91-4.95), Chi-squared 66.59%, 4 studies, 945 people). Outcome measures used by fewer studies such as graft patency and amputation free survival were assessed via narrative review. CONCLUSIONS: NLR is a promising, readily obtainable, prognostic biomarker for mortality outcomes following vascular surgery. Heterogeneity in patient factors, severity of vascular disease, and type of vascular surgery performed renders direct comparison of outcomes from the current literature challenging. This systematic review supports further investigation for NLR measurement in pre-vascular surgical risk stratification. In particular, the establishment of a universally accepted NLR cut-off value is of importance in real-world implementation of this biomarker.


Assuntos
Linfócitos , Neutrófilos , Doenças Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Doenças Vasculares/sangue , Doenças Vasculares/diagnóstico , Doenças Vasculares/mortalidade , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
11.
Ann Vasc Surg ; 68: 522-526, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32479881

RESUMO

BACKGROUND: Patients requiring vascular surgery have turned in older subjects with several comorbidities with frailty problems and increased vulnerability. Treating this kind of patients has become an important challenge both for vascular surgeons and for dedicated nurses, as these patients are more susceptible to postoperative complications and during discharge. The aim of this review is to analyze the role of vascular nurse in vascular surgery activities. METHODS: For this study, Medline, ScienceDirect, and Scopus databases were searched. The following keywords were used: nursing and vascular surgery, nursing and vascular disease, nursing and vascular procedure, and care and vascular patient. RESULTS: From the search strategy, the following areas were identified as relevant and analyzed in detail: vascular disease related to vascular surgery, the definition of vascular nursing, the role of vascular nursing in implementing clinical pathways in vascular surgery procedures, nursing postoperative care in vascular surgery, frailty assessment in vascular patient, nursing in phlebology and wound care, and the management of vascular access. CONCLUSIONS: Vascular nursing is a discipline that is able to provide comprehensive and optimal care, better postoperative outcomes, and coordinated, standardized, and cost-effective clinical pathways for patients managed in the area of vascular surgery.


Assuntos
Enfermagem Cardiovascular/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Assistência Perioperatória , Doenças Vasculares/enfermagem , Doenças Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/organização & administração , Humanos , Papel do Profissional de Enfermagem , Equipe de Assistência ao Paciente/organização & administração , Papel do Médico , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Resultado do Tratamento , Doenças Vasculares/diagnóstico , Procedimentos Cirúrgicos Vasculares/efeitos adversos
12.
J Ayub Med Coll Abbottabad ; 32(2): 155-159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32583985

RESUMO

Background: We aim to share our experience of the efficacy of Distal Revascularization and Interval Ligation (DRIL) in alleviating ischemic symptoms of dialysis access induced steal syndrome (DAISS) while preserving the original access. Methods: In this multicentre study, all consecutive patients with DAISS undergoing DRIL over a period of 3 years were included. Results: A total of 25 DRILs were included. Mean age was 37.8±SD 7.8 years and 52% (n=13) were females. Out of 25 patients; 88% (n=22) had more than one of the following ischemic symptoms: coolness (96%), pain (88%), paresthesia (80%), and discoloration (44%). Significant improvement following DRIL was noted in paraesthesia (86%, p-value 0.00), pain (85%, P value 0.00), coolness (83%, p-value 0.00). There was significant improvement in distal blood flow following DRIL, reflected by increase in the Aggregate Peak Systolic Velocities (PSV) in forearm vessels (PSV aggregate pre-op 39cm/s: PSV aggregate post-op 58 cm/s; p-value 0.01). The cumulative patency of DRIL graft was 96% at 3 months, 84% at 6 months and 76% at 1 year. Conclusion: Distal Revascularization and Interval Ligation significantly improves circulation to the distal limb and reduce ischemic symptoms thus making it a procedure of choice for treatment of DAISS.


Assuntos
Isquemia , Ligadura/métodos , Diálise Renal/efeitos adversos , Doenças Vasculares , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Feminino , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Vasculares/etiologia , Doenças Vasculares/cirurgia
13.
Ann Vasc Surg ; 67: 1-5, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32505678

RESUMO

BACKGROUND: The epidemic potential of coronavirus infection is now a reality. Since the first case detected in late 2019 in China, a fast worldwide expansion confirms it. The vascular patient is at a higher risk of developing a severe form of the disease because of its nature associating several comorbid states, and thus, some vascular surgery communities from many countries have tried to stratify patients into those requiring care during these uncertain times. METHODS: This is an observational study describing the current daily vascular surgery practice at one tertiary academic hospital in Madrid region, Spain-one of the most affected regions worldwide due to the COVID-19 outbreak. We analyzed our surgical practice since March 14th when the lockdown was declared up to date, May 14th (2 months). Procedural surgical practice, organizational issues, early outcomes, and all the troubles encountered during this new situation are described. RESULTS: Our department is composed of 10 vascular surgeons and 4 trainees. Surgical practice has been reduced to only urgent care, totaling 50 repairs on 45 patients during the period. Five surgeries were performed on 3 COVID-19-positive patients. Sixty percent were due to critical limb ischemia, 45% of them performed by complete endovascular approach, whereas less than 10% of repairs were aorta related. We were allocated to use a total of 5 surgical rooms in different locations, none our usual, as it was converted into an ICU room while performing 50% of those repairs with unusual nursery staff. CONCLUSIONS: The COVID-19 outbreak has dramatically changed our organization and practice in favor of urgent or semiurgent surgical care alone. The lack of in-hospital/ICU beds and changing nursery staff changed the whole availability organization at our hospital and was a key factor in surgical decision-making in some cases.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pandemias , Pneumonia Viral/complicações , Especialidades Cirúrgicas/estatística & dados numéricos , Doenças Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/organização & administração , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , Espanha/epidemiologia , Doenças Vasculares/complicações
14.
Eur J Vasc Endovasc Surg ; 60(1): 127-134, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32499169

RESUMO

OBJECTIVE: This study aimed to evaluate the protocol adopted during the emergency phase of the COVID-19 pandemic to maintain elective activity in a vascular surgery unit while minimising the risk of contamination to both patients and physicians, and the impact of this activity on the intensive care (IC) resources. METHODS: The activity of a vascular surgery unit was analysed from 8 March to 8 April 2020. Surgical activity was maintained only for acute or elective procedures obeying priority criteria. The preventive screening protocol consisted of nasopharyngeal swabs (NPS) for all patients and physicians with symptoms and for unprotected contact infected cases, and serological physician evaluations every 15 days. Patients treated in the acute setting were considered theoretically infected and the necessary protective devices were used. The number of patients and the possible infection of physicians were evaluated. The number and type of interventions and the need for post-operative IC during this period were compared with those in the same periods in 2018 and 2019. RESULTS: One hundred and fifty-one interventions were performed, of which 34 (23%) were acute/emergency. The total number of interventions was similar to those performed in the same periods in 2019 and 2018: 150 (33, of which 22% acute/emergency) and 117 (29, 25% acute/emergency), respectively. IC was necessary after 6% (17% in 2019 and 20% in 2018) of elective operations and 33% (11) of acute/emergency interventions. None of the patients treated electively were diagnosed with COVID-19 infection during hospitalisation. Of the 34 patients treated in acute/emergency interventions, five (15%) were diagnosed with COVID-19 infection. It was necessary to screen 14 (47%) vascular surgeons with NPS after contact with infected colleagues, but none for unprotected contact with patients; all were found to be negative on NPS and serological evaluation. CONCLUSION: A dedicated protocol allowed maintenance of regular elective vascular surgery activity during the emergency phase of the COVID-19 pandemic, with no contamination of patients or physicians and minimal need for IC resources.


Assuntos
Infecções por Coronavirus , Procedimentos Cirúrgicos Eletivos , Serviço Hospitalar de Emergência , Controle de Infecções , Pandemias , Pneumonia Viral , Doenças Vasculares , Procedimentos Cirúrgicos Vasculares , Adulto , Betacoronavirus/isolamento & purificação , Protocolos Clínicos , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Procedimentos Clínicos/tendências , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Doenças Vasculares/epidemiologia , Doenças Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos
16.
J Med Vasc ; 45(3): 114-124, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32402425

RESUMO

BACKGROUND: The precise epidemiological evaluation of amputations is difficult. It is a serious public health and economic problem with a high death rate. The proportion of amputees with pre-amputation vascular status remains unknown. The main objective of our study was to evaluate the proportion of patients with lower limb amputation who had a pre-procedural vascular assessment. The secondary objectives were to evaluate the risk of amputation at the admission of these patients, estimate the incidence of amputations in Martinique, and to collect epidemiological data on this category of patients. MATERIAL AND METHODS: We conducted an epidemiological, retrospective, and observational study, over the year 2018 between January 01 and December 31, including all adults' patients who underwent an amputation of the lower limb at the university hospital center of Martinique. RESULTS: Among the 170 included patients, 79 (46%) patients had a major lower limb amputation. The incidence of amputations in 2018 was estimated at 48.9/100,000 inhabitants. The vascular assessment was performed for 110 (65%) patients. For the other 60 (35%) patients who did not have a vascular assessment, 53 (88%) had a severe infection. This assessment was significantly related to the amputation level: a vascular assessment was performed in 97 (70%) patients with below the knee amputation versus 13 (41%) patients with above the knee amputation (P<0.01). The WIfI classification system found a high risk of amputation for 152 (89%) of patients but also a benefit of revascularization ranked high for 138 (81%) of them. The origin of amputation was limb ischemia for 125 (68%) patients. CONCLUSION: A significant number of patients who underwent lower limb amputation did not have a pre-procedural vascular assessment. Many improvements in the health care are therefore to be implemented. The upcoming M@diCICAT project in Martinique will contribute in the improvement of patient management. The incidence of amputation in Martinique is considered high compared to other countries (French national incidence in 2003=24.8/100,000 inhabitants), and it seems to have remained stable since 2008. Our population is considered to be at high risk of amputation by the SVS-WIfI classification. This score seems adapted to anticipate the evolution of these patients and could be useful in daily practice.


Assuntos
Amputação/tendências , Amputados , Técnicas de Diagnóstico Cardiovascular/tendências , Hospitais Universitários , Extremidade Inferior/cirurgia , Doenças Vasculares/diagnóstico , Doenças Vasculares/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Admissão do Paciente , Valor Preditivo dos Testes , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Doenças Vasculares/epidemiologia
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