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1.
J Surg Res ; 246: 145-152, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31580984

RESUMO

BACKGROUND: Agreement regarding indications for vena cava filter (VCF) utilization in trauma patients has been in flux since the filter's introduction. As VCF technology and practice guidelines have evolved, the use of VCF in trauma patients has changed. This study examines variation in VCF placement among trauma centers. MATERIALS AND METHODS: A retrospective study was performed using data from the National Trauma Data Bank (2005-2014). Trauma centers were grouped according to whether they placed VCFs during the study period (VCF+/VCF-). A multivariable probit regression model was fit to predict the number of VCFs used among the VCF+ centers (the expected [E] number of VCF per center). The ratio of observed VCF placement (O) to expected VCFs (O:E) was computed and rank ordered to compare interfacility practice variation. RESULTS: In total, 65,482 VCFs were placed by 448 centers. Twenty centers (4.3%) placed no VCFs. The greatest predictors of VCF placement were deep vein thrombosis, spinal cord paralysis, and major procedure. The strongest negative predictor of VCF placement was admission during the year 2014. Among the VCF+ centers, O:E varied by nearly 500%. One hundred fifty centers had an O:E greater than one. One hundred sixty-nine centers had an O:E less than one. CONCLUSIONS: Substantial variation in practice is present in VCF placement. This variation cannot be explained only by the characteristics of the patients treated at these centers but could be also due to conflicting guidelines, changing evidence, decreasing reimbursement rates, or the culture of trauma centers.


Assuntos
Utilização de Equipamentos e Suprimentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Filtros de Veia Cava/estatística & dados numéricos , Ferimentos e Lesões/terapia , Adolescente , Adulto , Bases de Dados Factuais/estatística & dados numéricos , Utilização de Equipamentos e Suprimentos/economia , Utilização de Equipamentos e Suprimentos/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Mecanismo de Reembolso/normas , Mecanismo de Reembolso/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Centros de Traumatologia/economia , Centros de Traumatologia/normas , Filtros de Veia Cava/economia , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle , Ferimentos e Lesões/complicações , Adulto Jovem
2.
Angiol Sosud Khir ; 25(4): 139-145, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855211

RESUMO

Using the 'Korona' cava filter in a total of 1345 oncological patients revealed regularity of a change in the shape of the inferior vena cava at the level of implantation. This made it feasible to determine one of the causes of long-term complications following implantation of other models of cava filters. The absence of clinically significant complications in the remote period after using this model of cava filter made it possible to implant it for a longer period, which is of special importance in oncological patients.


Assuntos
Embolia/prevenção & controle , Neoplasias/complicações , Filtros de Veia Cava , Veia Cava Inferior/cirurgia , Embolia/etiologia , Humanos , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle
3.
Angiol Sosud Khir ; 25(4): 181-187, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855216

RESUMO

BACKGROUND: Acute thrombosis in the system of the inferior vena cava is one of the most common vascular diseases and is of serious danger as a potential source of one of the most severe complications. In order to assess efficacy of open thrombectomy for embologenic iliofemoral venous thromboses we carried out comparison of the results of open thrombectomy and implantation of cava filters in a total of 119 patients presenting with iliofemoral thrombosis. PATIENTS AND METHODS: Open thrombectomy was performed in a total of 59 patients. Of these, 12 patients with segmental thromboses underwent radical thrombectomy and 47 patients with disseminated forms of thrombosis were subjected to partial thrombectomy with plication of the femoral vein. In 5 patients, the operation was supplemented with applying an arteriovenous fistula. Efficacy of operations was assessed with the help of ultrasonographic duplex angioscanning and regression of clinical manifestations. In the remote period, the degree of manifestations of post-thrombotic disease was assessed by means of the Villalta scale. RESULTS: After radical thrombectomy, patency of the iliofemoral segment was preserved in all patients during the whole follow-up period. In the group of patients with partial thrombectomy, 5 (9.5%) patients developed rethrombosis above the placation site at terms from 8 to 12 months. Four-year patency of the iliofemoral segment in this group of patients amounted to 81.5%. In patients with implanted cava filters, neither femoral vein nor iliac segment were patent completely. During the first year, thrombosis of cava filter developed in 9 cases; after 2 years, occlusion of the cava filter was diagnosed in 7 patients. In clinical assessment of the remote results with the use of the Villalta scale in patients after open thrombectomy the symptoms of post-traumatic disease were absent or weakly pronounced. After implantation of the cava filter all patients demonstrated the clinical course of post-traumatic disease, corresponding to 10-15 points. CONCLUSION: Open thrombectomy for iliofemoral embologenic thromboses performed at specialized departments is a radical method of preventing thromboembolic complications and promotes restoration or improvement of venous blood flow in the extremity.


Assuntos
Veia Femoral/cirurgia , Veia Ilíaca/cirurgia , Embolia Pulmonar/prevenção & controle , Trombectomia/métodos , Trombose Venosa/cirurgia , Implante de Prótese Vascular , Humanos , Embolia Pulmonar/etiologia , Resultado do Tratamento , Filtros de Veia Cava , Trombose Venosa/complicações
4.
Medicine (Baltimore) ; 98(47): e17835, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764778

RESUMO

INTRODUCTION: An Inferior vena cava (IVC) filter is an intravascular filter that is implanted into the IVC to prevent pulmonary embolism in medical, surgical, and trauma patients. The insertion of an IVC filter is a relatively safe procedure, but rarely may be associated with symptomatic perforation of the IVC wall, particularly in the long term. PATIENT CONCERNS AND DIAGNOSIS: A 74-year-old-woman with a medical history of IVC filter insertion visited the emergency department complaining of abdominal pain. A computed tomography scan showed perforation of the IVC wall and penetration into the duodenum by one of the filter's struts. INTERVENTIONS: We performed a laparotomy to remove the IVC filter. OUTCOMES: Postoperatively, the patient was admitted to the general ward. On hospital day 12, she was discharged without any complications. We followed her up and computed tomography did not show any abnormal findings six months after discharge. LESSONS: There is currently no evidence testifying to the benefits of IVC filter removal. Detailed, evidence-based guidelines on the indications, timing and procedure for IVC filter removal are needed. Documenting cases of long-term complications of IVC filter s such as in this patient serve to accelerate the publication of updated guidelines and are aimed at improving outcomes of similar cases in the future.


Assuntos
Duodeno/lesões , Perfuração Intestinal/etiologia , Complicações Pós-Operatórias/etiologia , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/lesões , Idoso , Remoção de Dispositivo , Duodeno/cirurgia , Feminino , Humanos , Perfuração Intestinal/cirurgia , Complicações Pós-Operatórias/cirurgia , Veia Cava Inferior/cirurgia
5.
Zhonghua Yi Xue Za Zhi ; 99(43): 3403-3407, 2019 Nov 19.
Artigo em Chinês | MEDLINE | ID: mdl-31752467

RESUMO

Objective: To assess the technical success rate, stent patency, clinical efficacy and complications of stent placement for filter-related chronic occlusion of the inferior vena cava. Methods: A retrospective analysis was carried out for 12 patients with filter-related chronic occlusion of the inferior vena cava associated with severe post-thrombotic syndrome, who underwent stent placement after ineffective conservative therapy at Nanjing First Hospital from March 2016 to December 2018,9 males and 3 females, aged from 48 to 77 years, mean age 60 years, six had bilateral lower extremity symptoms and six had unilateral lower extremity symptoms.Technical success rate, stent patency, clinical efficacy and complications of stent placement were recorded. Clinical success was defined as relief of symptoms and a decrease in clinical, etiology, anatomy, and pathophysiology (CEAP) score for at least grade 1. Results: Stent placement in the unilateral or bilateral iliocaval occlusion was successful in 11 patients. The cause of technical failure in the single patient with failed stent placement was an inability to cross the occluded left iliacvein and the patient was treated with stent placement in the right iliocaval vein.There were 7 patients with inferior vena cava and unilateral iliocaval stent placement; 5 patients with inferior vena cava and bilateral iliocaval stent placement. Acute stent thrombosis occlusion occurred in 1 case after the operation, the blood flow recanalized after catheter-directed thrombolysis and re-stenting. All patients were followed up for 6 to 24 months, with an average of (13±6) months. During the follow-up period, CTV or venography of lower limbs showed that the blood flow in the stent was unobstructed. At the last follow-up, 12 patients were evaluated as clinically effective. Three patients had transient treatment of lateral lumbar pain during operation, which alleviated by themselves.No significant abdominal pain, severe hemorrhage, symptomatic pulmonary embolism and other complications related to treatment occurred in all patients during perioperative period and follow-up. Conclusion: Stent placement is safe and feasible in the treatment of filter-related chronic occlusion of the inferior vena cava, which can alleviate the clinical symptoms of severe post-thrombotic syndrome.


Assuntos
Veia Cava Inferior , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular , Filtros de Veia Cava , Trombose Venosa
7.
J Radiol Case Rep ; 13(3): 19-27, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31565174

RESUMO

Spontaneous rupture of the inferior vena cava (IVC) is a rare entity. We report a case of a spontaneous IVC rupture associated with IVC filter thrombosis in a patient presenting with severe atraumatic back pain. Computed tomography (CT) identified a retroperitoneal hematoma and suggested IVC thrombosis. Magnetic resonance (MR) imaging confirmed the presence of IVC filter thrombosis and demonstrated a large defect in the infrarenal IVC, with the vessel lumen in free communication with the adjacent hematoma. The patient was managed conservatively and discharged in stable condition. MR imaging played an important role in characterizing the CT findings, which were unclear.


Assuntos
Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/etiologia , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/terapia , Tratamento Conservador , Hematoma/complicações , Hematoma/diagnóstico por imagem , Hematoma/terapia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/diagnóstico por imagem , Ruptura Espontânea/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
8.
Can Assoc Radiol J ; 70(4): 367-382, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31570169

RESUMO

Inferior vena cava filters are commonly encountered devices on diagnostic imaging that were highlighted in a 2010 Food and Drug Administration safety advisory regarding their complications from long-term implantation. The Predicting the Safety and Effectiveness of Inferior Vena Cava Filters (PRESERVE) trial is an ongoing after-market study investigating the safety and utility of commonly utilized filters in practice today. While most of these filters are safe, prompt recognition and management of any filter-associated complication is imperative to prevent or reduce the morbidity and mortality associated with them. This review is aimed at discussing the appropriate utilization and placement of inferior vena cava filters in addition to the recognition of filter-associated complications on cross-sectional imaging. An overview of the PRESRVE trial filters is also provided to understand each filter's propensity for specific complications.


Assuntos
Diagnóstico por Imagem , Hemorragia/etiologia , Filtros de Veia Cava , Veia Cava Inferior , Remoção de Dispositivo , Humanos , Vigilância de Produtos Comercializados , Desenho de Prótese , Filtros de Veia Cava/efeitos adversos
12.
Medicine (Baltimore) ; 98(31): e16645, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374036

RESUMO

RATIONALE: Abdominal aortic aneurysm is an extremely rare cause of deep vein thrombosis. Here we report an elderly gentleman who presented with deep vein thrombosis and was found to have concomitant abdominal aortic aneurysm upon ultrasonographic screening. It illustrates the possibility of such an aetiology, and the importance of screening for such aneurysms in a select patient population before heparinization. PATIENT CONCERNS: A 73-year-old Asian gentleman with underlying hypertension, hyperlipidaemia, chronic renal failure, and history of chronic smoking presented to the emergency department with acute left lower limb swelling of 1 day. On examination, the patient was tachycardic (110 beats/minute) and hypertensive (168/84 millimeters mercury (mmHg)). The entire left lower limb was swollen with notable pitting oedema, tenderness, and warmth; left calf swelling was measured to be 4 centimeters (cm). DIAGNOSES: The patient's Wells score of 4 placed him in the high-risk group for deep vein thrombosis. Serum D-dimer was subsequently found to be elevated at 926 nanograms/milliliter (ng/ml). Compression ultrasonography revealed a thrombus in the left deep femoral vein, confirming the diagnosis of deep vein thrombosis. The ultrasonographic evaluation was extended to the abdominal aorta due to the patient's high risk of abdominal aortic aneurysm, and a 7-cm aneurysm was indeed found. Further computed tomography and magnetic resonance imaging localized it to the infrarenal region, with left common iliac vein compression resulting in stagnant venous return. INTERVENTIONS: Emergency endovascular repair was performed with insertion of an inferior vena cava filter. OUTCOMES: The patient was subsequently monitored in the intensive care unit and uneventfully discharged after 2 weeks. LESSONS: Such clinical presentations of deep vein thrombosis are rare, but physicians are reminded to consider screening for abdominal aneurysms and other anatomical causes before heparinization in patients who seemingly do not have thromboembolic risk factors. This is especially so for the high risk group of male deep vein thrombosis patients aged 65-75 years with a history of smoking who have yet to be screened for abdominal aortic aneurysms, in line with United States Preventive Services Task Force recommendations.


Assuntos
Aneurisma da Aorta Abdominal/complicações , Trombose Venosa/etiologia , Idoso , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Endovasculares/métodos , Humanos , Masculino , Filtros de Veia Cava
14.
AJR Am J Roentgenol ; 213(4): 768-777, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31361526

RESUMO

OBJECTIVE. Inferior vena cava (IVC) filters are commonly used in patients who are at risk for life-threatening pulmonary embolism. After the introduction of permanent devices, numerous retrievable and convertible designs became available. Inaccurate identification can lead to confusion in options for filter retrieval and anticoagulation. CONCLUSION. This article highlights device designs of retrievable and convertible IVC filters to assist interpretation of diagnostic studies.


Assuntos
Embolia Pulmonar/prevenção & controle , Radiologistas , Filtros de Veia Cava , Remoção de Dispositivo , Humanos , Desenho de Prótese
15.
AJR Am J Roentgenol ; 213(4): 762-767, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31361531

RESUMO

OBJECTIVE. Inferior vena cava (IVC) filters are commonly used in patients at risk for life-threatening pulmonary embolism. Since the Mobin-Uddin filter was introduced in 1967, numerous other IVC filters have been developed. Given the plethora of IVC filter types, inaccurate identification of a filter on radiographic examination can lead to confusion in the options for filter retrieval and anticoagulation. CONCLUSION. This article highlights permanent IVC designs to assist the interpretation of diagnostic studies. Accurate identification of indwelling IVC filters could have a dramatic effect on patient management regarding anticoagulant use and possibility for IVC filter retrieval and removal. Identification of filter type, filter position, presence or absence of thrombosis, filter tilt, and filter fracture should be included in interpretive reports.


Assuntos
Embolia Pulmonar/prevenção & controle , Radiologistas , Filtros de Veia Cava , Humanos , Desenho de Prótese
16.
N Engl J Med ; 381(4): 328-337, 2019 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-31259488

RESUMO

BACKGROUND: Whether early placement of an inferior vena cava filter reduces the risk of pulmonary embolism or death in severely injured patients who have a contraindication to prophylactic anticoagulation is not known. METHODS: In this multicenter, randomized, controlled trial, we assigned 240 severely injured patients (Injury Severity Score >15 [scores range from 0 to 75, with higher scores indicating more severe injury]) who had a contraindication to anticoagulant agents to have a vena cava filter placed within the first 72 hours after admission for the injury or to have no filter placed. The primary end point was a composite of symptomatic pulmonary embolism or death from any cause at 90 days after enrollment; a secondary end point was symptomatic pulmonary embolism between day 8 and day 90 in the subgroup of patients who survived at least 7 days and did not receive prophylactic anticoagulation within 7 days after injury. All patients underwent ultrasonography of the legs at 2 weeks; patients also underwent mandatory computed tomographic pulmonary angiography when prespecified criteria were met. RESULTS: The median age of the patients was 39 years, and the median Injury Severity Score was 27. Early placement of a vena cava filter did not result in a significantly lower incidence of symptomatic pulmonary embolism or death than no placement of a filter (13.9% in the vena cava filter group and 14.4% in the control group; hazard ratio, 0.99; 95% confidence interval [CI], 0.51 to 1.94; P = 0.98). Among the 46 patients in the vena cava filter group and the 34 patients in the control group who did not receive prophylactic anticoagulation within 7 days after injury, pulmonary embolism developed in none of those in the vena cava filter group and in 5 (14.7%) in the control group, including 1 patient who died (relative risk of pulmonary embolism, 0; 95% CI, 0.00 to 0.55). An entrapped thrombus was found in the filter in 6 patients. CONCLUSIONS: Early prophylactic placement of a vena cava filter after major trauma did not result in a lower incidence of symptomatic pulmonary embolism or death at 90 days than no placement of a filter. (Funded by the Medical Research Foundation of Royal Perth Hospital and others; Australian New Zealand Clinical Trials Registry number, ACTRN12614000963628.).


Assuntos
Embolia Pulmonar/prevenção & controle , Filtros de Veia Cava , Ferimentos e Lesões/terapia , Adulto , Angiografia por Tomografia Computadorizada , Humanos , Incidência , Escala de Gravidade do Ferimento , Estimativa de Kaplan-Meier , Perna (Membro)/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/mortalidade , Risco , Falha de Tratamento , Ultrassonografia , Trombose Venosa/diagnóstico por imagem , Ferimentos e Lesões/mortalidade
17.
Br J Radiol ; 92(1100): 20190051, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31204842

RESUMO

OBJECTIVE: To review inferior vena cava (IVC) filter retrieval practice at our institution, the Royal London Hospital, and measure changes following a quality improvement intervention. IVC filters are a preventive treatment for pulmonary embolism when anticoagulation is ineffective/contraindicated. Unless permanent filtration is required, all filters should undergo attempted retrieval within manufacturer's recommendations with a success rate of ≥80 %. METHODS: Retrospective audit of filters inserted between 2011 and 2014, followed by a quality improvement intervention and a second audit between 2015 and 2017. Clinical-radiological data were analysed using the Picture Archiving and Communication System and electronic patient records. RESULTS: During the first audit, filter retrieval was attempted in 92% of cases, of which 82% underwent the procedure within manufacturer's recommendations and 86% were successful. During the second audit, an improvement across indicators was seen. Retrieval increased by 3% and was attempted in 95% of cases (92% of which were within manufacturer's guidelines). Rate of retrievals within manufacturer's guidelines increased by 10%. Filter retrieval success rate increased by 11% - to 97%. CONCLUSIONS: IVC filter retrieval practice at a single institution can be improved by implementing a simple audit intervention. ADVANCES IN KNOWLEDGE: Filter retrieval practice has clinical and medicolegal implications. A simple quality intervention can substantially improve overall practice.


Assuntos
Remoção de Dispositivo/métodos , Auditoria Médica/métodos , Embolia Pulmonar/prevenção & controle , Melhoria de Qualidade/estatística & dados numéricos , Filtros de Veia Cava , Adulto , Feminino , Humanos , Londres , Masculino , Estudos Retrospectivos
18.
Medicine (Baltimore) ; 98(23): e15874, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169692

RESUMO

RATIONALE: Pulmonary artery sarcomas (PAS) are easily misdiagnosed as thromboembolic disease of pulmonary arteries, because of rarity and presenting with nonspecific signs, symptoms, or imaging findings. PATIENT CONCERNS: A 26-year-old man was admitted to the department of invasive technology with fever and dyspnea. Blood tests showed inflammatory activity, a slight increase of D-dimer and Fibrin Degradation Product. A chest enhanced computed tomography (CT) scanning revealed multiple filling defects occurred in the main trunk of both pulmonary arteries and branches of the left pulmonary artery DIAGNOSES:: It was initially diagnosed with pulmonary embolism (PE) and deep vein thrombosis (DVT), but was eventually diagnosed with pulmonary artery sarcoma that was confirmed by biopsy. INTERVENTIONS: The transcatheter thrombolysis therapy, inferior vena cava filter implantation, and operation were performed. OUTCOMES: The Organized mass was removed by the operation and was pathologically diagnosed as pulmonary artery sarcoma, the patient received postoperative chemotherapy according to the recommendation of oncology department. LESSONS: Coagulation markers have been reported to differentiate PAS from PE, but this case suggested that PAS can be associated with DVT and abnormal coagulation-fibrinolysis system.


Assuntos
Artéria Pulmonar/patologia , Sarcoma/diagnóstico , Neoplasias Vasculares/diagnóstico , Trombose Venosa/diagnóstico , Adulto , Erros de Diagnóstico , Humanos , Masculino , Trombólise Mecânica , Artéria Pulmonar/cirurgia , Sarcoma/patologia , Sarcoma/cirurgia , Tomografia Computadorizada por Raios X , Neoplasias Vasculares/patologia , Neoplasias Vasculares/cirurgia , Filtros de Veia Cava , Trombose Venosa/terapia
20.
Vasc Endovascular Surg ; 53(6): 501-506, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31159685

RESUMO

Inferior vena cava (IVC) filters are important devices for patients who are at high risk for developing thrombi and pulmonary embolism but have conditions that preclude the use of pharmacologic anticoagulants. IVC filter retrieval has become an important quality initiative backed by Food and Drug Administration guidelines for prompt removal after the filter is no longer indicated. Filter retrieval is a common procedure that usually has very few complications. However, when the filter is tilted or embedded in the caval wall, advanced techniques of retrieval may be necessary. These techniques have a higher rate of success but also a higher risk of complications such as injury to the IVC. Here, we describe a case of IVC filter retrieval resulting in formation of an arteriovenous fistula between the right renal artery and IVC and subsequent successful repair of this fistula using a vascular plug.


Assuntos
Fístula Arteriovenosa/etiologia , Remoção de Dispositivo/efeitos adversos , Implantação de Prótese/instrumentação , Artéria Renal/lesões , Lesões do Sistema Vascular/etiologia , Filtros de Veia Cava , Veia Cava Inferior/lesões , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Feminino , Humanos , Pessoa de Meia-Idade , Flebografia/métodos , Artéria Renal/diagnóstico por imagem , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/terapia , Veia Cava Inferior/diagnóstico por imagem
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