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1.
Angiol Sosud Khir ; 26(3): 116-121, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063758

RESUMO

Presented herein is original experience in using a technique of arterialization in patients with critical lower limb ischaemia on the background of diffuse multilevel occlusive lesions of femoral, crural arteries and arteries of the foot in 214 patients. We used a new method of treatment by means of oxygenation of the sural group of muscles and the foot through the small saphenous vein and indirect communicating veins. This method does not require destruction of the valvular apparatus of the communicants themselves, promoting opening of previously not functioning ones, as well as appears to be a powerful stimulus for the development of collateral circulation of the extremity. Alterations introduced into the design characteristics of a valvulotome make it possible to avoid lateral injury of the venous wall in the area of confluence of tributaries, preventing incomplete resection of the valve. The method expands the boundaries of operability of patients with the absence of the receiving arterial bed of the calf and foot. It may be combined with arterial primary and repeat reconstructions in patients with depleted receiving channel of the calf as an effective additional path of outflow. It also makes it possible to lower the level of amputation in the developed necrosis of the distal part of the foot. Based on clinical laboratory and instrumental findings, the patients were diagnosed by the aetiological factor of the occlusive process and its extension, substantiating the indications for operative treatment with the use of one or another venous basin. Comparative assessment of reversion of arterial blood flow through the great saphenous vein, small saphenous vein, and posterior tibial vein, according to the findings of bioelectromagnetic diagnosis of reactivity of tissues demonstrated that the most effective method was that of arterialization thought the small saphenous vein. With the help of the questionnaire of quality of life in patients with performed arterialization of the calf and foot through the small saphenous vein for critical lower limb ischaemia we obtained 5-year remote results. Upon completion of this period, 87.3% of the limbs were saved and composite measures of the patients' quality of life proved to be high, ranging from 53 to 69 points.


Assuntos
Doenças Vasculares Periféricas , Qualidade de Vida , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/cirurgia , Perna (Membro) , Veia Safena
2.
Recenti Prog Med ; 111(9): 480-486, 2020 09.
Artigo em Italiano | MEDLINE | ID: mdl-32914775

RESUMO

At the end of March 2020, just over a month after the first ascertained case of CoViD-19 infection in Italy, the first reports of acute lesions of acro-ischemia appeared, especially in pre-adolescents and adolescents. These manifestations have been called in the course of these months in various ways, from "acro-ischemia acuta", "erythema pernio", "chilblains", up to characterize them more recently as "CoViD Toes". Clinical manifestations do not usually associate with other typical symptoms of Covid-19 and do not find a classical and defined serological antibody response (IgG and IgM). From a clinical point of view it is a localized and self-resolving problem of an interesting and relatively new pathogenetic model of disease in relation to a viral agent. Future studies must make us understand if there is in this specific condition a low viral load is not detectable by current methods and if this explains the inability to produce an adequate immune response for CoViD-19. It is important to determine whether the interferon immune response in some subjects can be the cause of both the low viremia and the endothelial damage so localized in the acral-site, as happens in other models of diseases (chilblain-lupus like). On the contrary, some authors believe that the acral lesions are attributable to chilblains caused by a series of favourable environmental conditions due to forced enclosure. We report the descriptive experience of 14 cases of acro-ischemia in children and adolescents observed in the territorial area of Ravenna and Rimini. The cases were subjected to the nasopharyngeal swab and to the search for antibodies with ELISA method for CoViD-19 both with negative results.


Assuntos
Infecções por Coronavirus/epidemiologia , Interferons/imunologia , Isquemia/epidemiologia , Estilo de Vida , Pneumonia Viral/epidemiologia , Adolescente , Pérnio/epidemiologia , Pérnio/etiologia , Pérnio/imunologia , Criança , Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Feminino , Humanos , Isquemia/etiologia , Isquemia/imunologia , Itália/epidemiologia , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Quarentena , Dedos do Pé
3.
J Med Vasc ; 45(5): 241-247, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862980

RESUMO

OBJECTIVE: The persistent sciatic artery (PSA) is a rare congenital anomaly with a high rate of aneurysm formation, occlusion and stenosis. It may lead to severe complications including thrombosis, distal embolisation, or aneurysm rupture. We reported herein our experience in the management of PSA and its complications, and discuss the therapeutic options. METHODS: Eight patients with 10 PSA were managed in our institutions between 1985 and 2017. An analysis was done for the clinical data, surgical technique, and results. RESULTS: The series included six women and two men. The median age of the patients was 66,5 years (37-80 years). Physical examination found a pulsatile gluteal mass in five patients, sciatic neuropathy in two cases. Four patients had an acute ischemia of the lower limb. Cowie's sign was described in only two patients (diminished or absent femoral pulse but presence of popliteal pulse). Digital subtraction angiography was performed in all patients, and was completed with a computed tomography angiography (CTA) with a diagnosis of PSA, associated with a symptomatic aneurysmal lesion in seven cases and with an occlusion in one case. The treatment was surgical in all cases: bipolar exclusion of the aneurysm and bypass between the iliac artery and the PSA distal to the aneurysm was performed in four cases, only proximal and distal ligation was done in 2 other cases. A Chopart amputation was necessary in 2 cases. CONCLUSION: We consider that the treatment of PSA is usually surgical in symptomatic cases. Surgical techniques depend on symptoms and classification describing anatomy of the PSA. However, future studies should compare the open versus the endovascular approach to optimize patient selection criteria and identify the most safe and effective strategy. In an asymptomatic patient, PSA does not require any intervention; continued follow-up is required because of the high incidence of aneurysmal formation and the risk of thromboembolic events.


Assuntos
Artérias/anormalidades , Isquemia/etiologia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/etiologia , Malformações Vasculares/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação , Artérias/diagnóstico por imagem , Artérias/cirurgia , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Ligadura , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/cirurgia , Fatores de Tempo , Resultado do Tratamento , Enxerto Vascular , Malformações Vasculares/diagnóstico por imagem
5.
Medicine (Baltimore) ; 99(29): e21340, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702932

RESUMO

RATIONALE: Circumcision like any other surgical procedure is not devoid of complications. Serious complications are rare and include iatrogenic hypospadias, glans ischemia/necrosis, and glans amputation, all of which require an emergent treatment. PATIENT CONCERNS: We report here a case of 6 months-old-boy with a superficial glans ischemia following circumcision. DIAGNOSIS: Physical examination revealed a severely cyanotic glans with the moderate edema of the dorsal penile skin. Plasma levels of D-dimer were 8.57 mg/L. Urine passage was unremarkable while color Doppler ultrasonography revealed a normal blood flow. INTERVENTIONS: The patient was successfully treated with subcutaneous injection of enoxaparin (low-molecular-weight heparin) and topical 2.5% dihydrotestosterone. OUTCOMES: The appearance of the glans penis on the 5th day was close to normal while the control levels of D-dimer dropped to the reference range. The patient was discharged from the hospital on the 6th day. At 6-month follow-up, the appearance of the glans penis was normal. LESSONS: Acute glans penis ischemia following circumcision is a rare complication. Its successful treatment with enoxaparin and topical dihydrotestosterone has not been previously reported in the literature.


Assuntos
Circuncisão Masculina/efeitos adversos , Di-Hidrotestosterona/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Isquemia/etiologia , Administração Tópica , Di-Hidrotestosterona/administração & dosagem , Humanos , Lactente , Isquemia/tratamento farmacológico , Masculino , Pênis/irrigação sanguínea
6.
Ann Vasc Surg ; 68: 88-92, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32589931

RESUMO

Heparin resistance is an uncommon phenomenon defined as the need for high-dose unfractionated heparin (UFH) of more than 35,000 IU/day to achieve the target activated partial-thromboplastin time ratio or the failure to achieve the desired activated clotting time after a full UFH dose. This rare phenomenon is being more commonly observed in Covid-19 patients in a hypercoagulable state. We describe a Covid-19 patient confirmed by reverse-transcriptase polymerase chain reaction assay, with acute limb ischemia, who developed heparin resistance. The patient was managed by the departments of vascular surgery, anesthesia and intensive care, and the Coagulation Service and Thrombosis Research from San Raffaele Scientific Institute, Milan, Italy.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Resistência a Medicamentos , Heparina/farmacologia , Isquemia/tratamento farmacológico , Extremidade Inferior/irrigação sanguínea , Pneumonia Viral/complicações , Doença Aguda , Idoso , Anticoagulantes/farmacologia , Coagulação Sanguínea/efeitos dos fármacos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Isquemia/sangue , Isquemia/etiologia , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Tomografia Computadorizada por Raios X
7.
Angiol Sosud Khir ; 26(2): 34-40, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32597883

RESUMO

AIM: The study was aimed at comparing the efficacy of implantation of autologous bone marrow cells with that of revascularizing osteotrephination in treatment of lower limb chronic critical ischaemia in patients with a poor distal vascular bed. PATIENTS AND METHOD: We analysed the results of comprehensive examination and treatment of a total of 60 patients presenting with lower limb chronic critical ischaemia due to atherosclerotic lesions of the femoropopliteal-tibial segment. According to the technology of treatment, the patients were divided into two statistically homogenous groups of 30 people each. Group One patients underwent standard revascularizing osteotrephination and Group Two patients in accordance with the original technique received intramuscular implantation of 40 ml of autologous bone marrow cells, with this volume distributed in 2-ml injections to 20 points of the muscles of the crus and femur along the internal and external surface. RESULTS: The use of the original technique of treatment made it possible to achieve the clinical status in the form of moderate or minimal improvement 6 months after bone marrow cells implantation in 29 (96.7%) patients and after 12 months in 28 (93.3%) patients, whereas after revascularizing osteotrephination in 25 (83.3%) and 20 (66.7%) patients, respectively. In the remote period after 12 months, the limb was saved in 28 (93.3%) and 26 (86.7%) patients in Group Two and Group One, respectively. The patients of the second group as compared with those of the first group after 12 months demonstrated a statistically significant increase in the physical health component by 19.8% and the mental health component by 9.8%. CONCLUSION: Implantation of autologous bone-marrow cells in chronic critical limb ischaemia is pathogenetically substantiated and makes it possible to optimize the results of treatment of patients.


Assuntos
Isquemia/etiologia , Doenças Vasculares Periféricas , Transplante de Medula Óssea , Humanos , Perna (Membro) , Extremidade Inferior , Transplante Autólogo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
8.
BMC Surg ; 20(1): 120, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503500

RESUMO

BACKGROUND: To explore the safety and effectiveness of a modified surgical technique which could shorten the time of renal ischemia in left renal cancer and Mayo level II to IV inferior vena cava (IVC) tumor thrombus. METHOD: We retrospectively analyzed the clinical data of 14 cases with left renal cell carcinoma (RCC) and Mayo level II to IV IVC tumor thrombus from February 2015 to July 2019. Preoperative imaging showed that there was no obvious sign of tumor thrombus invading the blood vessel wall. During the surgery, after the right renal artery, the right renal vein and the distal end of IVC were blocked, the balloon catheter was used and the tumor thrombus was removed completely from the IVC. The incision of IVC was closed by Satinsky clamp to make IVC partially blocked. Then the right renal artery and right renal vein were released. The incision of IVC was sutured continuously. At last, the Satinsky clamp and the blocking band at the distal end of the IVC were released. RESULT: There were 8 cases (57.1%) of Mayo level II, 3 cases (21.4%) of Mayo level III and 3 cases (21.4%) of Mayo level IV. The operation was successfully completed in all 14 patients. There were 2 cases (14.3%) operated by complete laparoscopic approach, 8 cases (57.1%) by open approach, and 4 patients (28.6%) by laparoscopic conversion to open approach. The occlusion time of right renal artery and vein (renal ischemia time) was 3 to 15 min, with an average of (6.8 ± 3.2) minutes. The mean time of IVC occlusion was (19.4 ± 4.9) min. Preoperative creatinine was 66 to 130 µmol/L, with an average of (96.6 ± 21.2) µmol/L. One week after operation, serum creatinine was 64 to 632 µmol/L, with an average of (132.4 ± 144.9) µmol/L. Among the 14 cases, 5 (42.9%) had early postoperative complications. Besides one of the 14 patients died in perioperative period, the median follow-up of other 13 cases was 10 months (range: 4-29 months). The 5 (35.7%) of the 14 cases were died of disease. CONCLUSION: This modified procedure was relatively safe and effective in shortening the time of renal ischemia in left RCC patients with Mayo II to IV IVC tumor thrombus.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Trombose/patologia , Idoso , Feminino , Humanos , Isquemia/etiologia , Rim/patologia , Neoplasias Renais/patologia , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Veias Renais , Estudos Retrospectivos , Trombectomia/métodos , Veia Cava Inferior/cirurgia , Trombose Venosa/patologia
11.
J Hand Surg Am ; 45(6): 518-522, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-228547

RESUMO

As coronavirus 2019 (COVID-19) continues to cause an immense burden on the global health care systems, it is crucial to understand the breadth of this disease process. Recent reports identified hypercoagulability in a subset of critically ill patients and extremity ischemia in an even smaller cohort. Because abnormal coagulation parameters and extremity ischemia have been shown to correlate with poor disease prognosis, understanding how to treat these patients is crucial. To better describe the identification and management of this phenomenon, we present 2 cases of critically ill patients with COVID-19 who developed fingertip ischemia while in the intensive care unit.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Dedos/irrigação sanguínea , Isquemia/tratamento farmacológico , Isquemia/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Adulto , Idoso , Betacoronavirus , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Terapia Combinada , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Estado Terminal/terapia , Progressão da Doença , Evolução Fatal , Feminino , Seguimentos , Humanos , Unidades de Terapia Intensiva , Isquemia/fisiopatologia , Masculino , Pandemias , Alta do Paciente , Doenças Vasculares Periféricas/diagnóstico , Doenças Vasculares Periféricas/tratamento farmacológico , Doenças Vasculares Periféricas/etiologia , Pneumonia Viral/terapia , Medição de Risco , Amostragem
12.
Invest Ophthalmol Vis Sci ; 61(5): 54, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32460316

RESUMO

Purpose: To evaluate the depth and pattern of retinal hemorrhage in acute central retinal vein occlusion (CRVO) and to correlate these with visual and anatomic outcomes. Methods: Retinal hemorrhages were evaluated with color fundus photography and fluorescein angiography at baseline and follow-up. Snellen visual acuity (VA), central foveal thickness (CFT), extent of retinal ischemia, and development of neovascularization were analyzed. Results: 108 eyes from 108 patients were evaluated. Mean age was 63.6 ± 16.1 years with a predilection for the right eye (73.1%). Average follow-up was 17.2 ± 19.2 months. Mean VA at baseline was 20/126 and 20/80 at final follow-up. Baseline (P = 0.005) and final VA (P = 0.02) in eyes with perivascular nerve fiber layer (NFL) hemorrhages were significantly worse than in eyes with deep hemorrhages alone. Baseline CFT was greater in the group with perivascular hemorrhages (826 ± 394 µm) compared to the group with deep hemorrhages alone (455 ± 273 µm, P < 0.001). The 10 disc areas of retinal ischemia was more common in patients with perivascular (80.0%) and peripapillary (31.3%) versus deep hemorrhages alone (16.1%, P < 0.001). Neovascularization of the iris was more common, although this differrence was not significant, in the groups with peripapillary (14.3%) and perivascular (2.0%) NFL versus deep hemorrhages alone (0.0%). Conclusions: NFL retinal hemorrhages at baseline correlate with more severe forms of CRVO, with greater macular edema, poorer visual outcomes, and greater risk of ischemia and neovascularization. This may be related to the organization of the retinal capillary plexus. The depth and pattern of distribution of retinal hemorrhages in CRVO may provide an easily identifiable early biomarker of CRVO prognosis.


Assuntos
Hemorragia Retiniana/etiologia , Oclusão da Veia Retiniana/complicações , Doença Aguda , Idoso , Correlação de Dados , Feminino , Fóvea Central/patologia , Humanos , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica , Fibras Nervosas/patologia , Hemorragia Retiniana/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença
14.
J Hand Surg Am ; 45(6): 518-522, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32387155

RESUMO

As coronavirus 2019 (COVID-19) continues to cause an immense burden on the global health care systems, it is crucial to understand the breadth of this disease process. Recent reports identified hypercoagulability in a subset of critically ill patients and extremity ischemia in an even smaller cohort. Because abnormal coagulation parameters and extremity ischemia have been shown to correlate with poor disease prognosis, understanding how to treat these patients is crucial. To better describe the identification and management of this phenomenon, we present 2 cases of critically ill patients with COVID-19 who developed fingertip ischemia while in the intensive care unit.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Dedos/irrigação sanguínea , Isquemia/tratamento farmacológico , Isquemia/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Adulto , Idoso , Betacoronavirus , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Terapia Combinada , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Estado Terminal/terapia , Progressão da Doença , Evolução Fatal , Feminino , Seguimentos , Humanos , Unidades de Terapia Intensiva , Isquemia/fisiopatologia , Masculino , Pandemias , Alta do Paciente , Doenças Vasculares Periféricas/diagnóstico , Doenças Vasculares Periféricas/tratamento farmacológico , Doenças Vasculares Periféricas/etiologia , Pneumonia Viral/terapia , Medição de Risco , Amostragem
15.
Zhonghua Yan Ke Za Zhi ; 56(4): 246-249, 2020 Apr 11.
Artigo em Chinês | MEDLINE | ID: mdl-32306615

RESUMO

Retinal vein occlusion (RVO) is the consequence of obstruction of retinal vein system caused by a variety of etiologies. Its ocular complications include macular edema, retinal ischemia and neovascular glaucoma. Although many drugs for management of RVO are available, some doctors do not fully understand the exact purpose of each treatment. This article starts from the etiology evaluation of RVO, emphasizing that, besides systemic etiology and risk factor management, the treatment of RVO should focus on the three major complications at the same time, rather than just dealing with macular edema. Meanwhile, a regular follow-up for observing the changes of the degree of retinal ischemia is important for whole course management. Anti-vascular endothelial growth factor therapy, the first-line treatment option of RVO, can not only reduce macular edema, but also prevent the complications caused by retinal ischemia and create opportunities for further laser photocoagulation. Laser photocoagulation has an irreplaceable value in the comprehensive treatment of ischemic RVO. Glucocorticoid intraocular implants should not be used alone in the treatment of macular edema secondary to RVO. (Chin J Ophthalmol, 2020, 56:246-249).


Assuntos
Oclusão da Veia Retiniana/terapia , Inibidores da Angiogênese/uso terapêutico , Glaucoma/etiologia , Humanos , Isquemia/etiologia , Fotocoagulação , Edema Macular/etiologia , Oclusão da Veia Retiniana/complicações , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
16.
Plast Reconstr Surg ; 145(5): 1302-1312, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332556

RESUMO

BACKGROUND: Limb salvage techniques using free tissue transfer in patients with chronic wounds caused by longstanding osteomyelitis, diabetes, and peripheral vascular disease are technically challenging. The longitudinal slit arteriotomy end-to-side anastomosis is the authors' preferred technique because it is the least invasive arteriotomy and is especially important for diseased recipient arteries. The authors reviewed highly comorbid patients who underwent free tissue transfer with this technique to understand the success rates, overall outcomes, and long-term limb salvage rates. METHODS: A retrospective review was performed to analyze outcomes of free tissue transfer using longitudinal slit arteriotomy end-to-side anastomosis between 2012 and 2018 performed by the senior surgeon (K.K.E.). RESULTS: One hundred fifteen free flaps were identified. Patients were, on average, 55.9 years old, with a body mass index of 29.2 kg/m. Comorbidities included osteomyelitis (83.5 percent), hypertension (60.9 percent), tobacco use (46.1 percent), diabetes (44.3 percent), peripheral vascular disease (44.3 percent), hypercoagulability (35.7 percent), and arterial calcifications (17.4 percent). Overall flap success was 93.0 percent; 27.8 percent required reoperation perioperatively because of complications. On univariate analysis, diabetes mellitus, hypertension, and hypercoagulability were significantly associated with eventual amputation (p < 0.05). Multivariate analysis showed that intraoperative thrombosis and take back was independently associated with flap failure. There was an overall limb salvage rate of 83.5 percent, and of those salvaged, 92.7 percent were ambulating without a prosthesis at a mean follow-up of 1.53 years. CONCLUSIONS: This is the largest series of longitudinal slit arteriotomy end-to-side anastomosis for patients undergoing free tissue transfer for limb-threatening defects in the compromised host. Overall flap success, limb salvage rates, and functional outcomes are high using this technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Artérias/cirurgia , Retalhos de Tecido Biológico/transplante , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Salvamento de Membro/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/estatística & dados numéricos , Doença Crônica/terapia , Estado Terminal/terapia , Pé Diabético/complicações , Pé Diabético/epidemiologia , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Perna (Membro)/cirurgia , Salvamento de Membro/efeitos adversos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/epidemiologia , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fumar/efeitos adversos , Fumar/epidemiologia , Resultado do Tratamento , Adulto Jovem
17.
Angiol Sosud Khir ; 26(1): 121-128, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32240146

RESUMO

AIM: The purpose of the study was to examine overall survival and the incidence of major adverse cardiovascular events, as well as economic expenditures for treatment of patients with occlusion of the femoropopliteal-tibial segment and critical ischaemia in low competence of the outflow channel, with a poor prognosis for endovascular or open revascularization of lower-limb arteries. PATIENTS AND METHODS: We studied the results of treating a total of 68 patients with lower-limb critical ischaemia and low parameters of the outflow channel competence. Primary arterial reconstruction was performed in 48 cases. At various terms after revascularization due to thrombosis of the reconstruction zone and the development of gangrene, amputation of the lower limb was performed: at 3 to 11 (n=25) and at 12 to 24 (n=25) months. Primary amputation of the lower limb was performed in 20 patients. The endpoints of the study included overall survival, the incidence of major adverse cardiovascular events, and economic expenditures for the in-hospital treatment. The average duration of follow-up amounted to 2 years. RESULTS: The obtained findings demonstrated that in patients with lower-limb critical ischaemia and low parameters of the outflow channel competence, redo arterial reconstructions and amputation within 11 months, as well as a high level of surgical risk were associated with a low overall survival rate and the development of major adverse cardiovascular events in the remote period. Secondary surgical interventions on the major vessels significantly increased the cost of treatment.


Assuntos
Salvamento de Membro , Doença Arterial Periférica/cirurgia , Amputação , Humanos , Isquemia/etiologia , Extremidade Inferior , Estudos Retrospectivos , Fatores de Risco , Grau de Desobstrução Vascular
19.
Rev. chil. cardiol ; 39(1): 24-33, abr. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1115446

RESUMO

INTRODUCCIÓN: Los ratones SR-B1 KO/ApoER6 1h/h que son alimentados con una dieta rica en grasas saturadas, desarrollan enfermedad coronaria aterosclerótica severa, complicaciones isquémicas e insuficiencia cardíaca, con alta mortalidad. Los estudios con este modelo se han enfocado fundamentalmente en la enfermedad coronaria y menos en el remodelado cardíaco. El OBJETIVO del trabajo ha sido caracterizar el remodelado miocárdico, evaluar la evolución temporal de la función ventricular izquierda y la sobrevida asociada a enfermedad cardíaca por ateromatosis. MÉTODO: Ratones homocigotos SR-B1 KO/ApoER6 1h/h fueron alimentados por 8 semanas con dieta aterogénica o dieta normal y se comparó la sobrevida en ambos grupos. A las 4 semanas se realizó un ecocardiograma bidimensional. En los ratones eutanasiados se evaluó en la pared cardíaca fibrosis miocárdica y tamaño de los cardiomiocitos por morfometría, apoptosis con técnica de TUNEL e infiltración por células inflamatorias mononucleares (ED1) por inmunohistoquímica. RESULTADOS: En el grupo que recibió dieta aterogénica la sobrevida se redujo en 46,7% (p < 0.001), debido a muerte súbita y a falla cardíaca progresiva. En este grupo, a las 4 semanas se observó dilatación de cavidades izquierdas y disminución de la fracción de eyección del ventrículo izquierdo en comparación con el grupo control (79,3 ± 1,3% vs 66 ± 3,7%, p<0,01). También se observó aumento de la masa cardíaca relativa de 2.1 veces (p<0,001) y del peso pulmonar relativo en 80% (p<0,001), sin cambios en las dimensiones de los cardiomiocitos. En el miocardio de los ratones que recibieron dieta aterogénica hubo un aumento de la fibrosis cardíaca de 7.9 veces (p < 0.01) y del número de cardiomiocitos apoptóticos en 55.9 veces (p < 0.01), junto a un aumento del número de células inflamatorias mononucleares ED1. CONCLUSIONES: En el modelo de falla cardíaca severa de etiología isquémica con alta mortalidad en el ratón homocigoto SR-B1 KO/ApoER6 1h/h sometido a una dieta aterogénica, con falla cardíaca izquierda por disfunción sistólica, el remodelado patológico del miocardio está dado fundamentalmente por apoptosis y fibrosis. También se observa un aumento discreto de macrófagos en la pared cardíaca. Es posible que el edema parietal también pueda ser un mecanismo de remodelado relevante en este modelo.


Abstract: SR-B1 KO/ApoER6 1h/h mice fed a high saturated fat diet develop severe coronary atheromatosis, and cardiac failure with a high mortality rate. Cardiac remodeling under these conditions has not been well studied. AIM: To evaluate the time course of left ventricular function, cardiac remodeling and survival associated to the administration of an atherogenic diet. METHOD: Homozygote SR-B1 KO/ApoER6 1h/h mice received an atherogenic diet for 8 weeks. Mice receiving a normal diet served as controls. Survival rate, myocardial fibrosis, cardiomyocyte size, apoptosis and infiltration by inflammatory or mononuclear cells were compared between groups. A TUNEL technique was used to evaluate apoptosis. RESULTS: A 46.7% survival reduction compared to controls was observed in the experimental group (p<0.01), due to left ventricular and atrial dilatation associated to a decrease in ejection fraction (79,3 ± 1,3% vs 66 ± 3,7%, p<0,01, respectively). Also, an increased cardiac weight, 2.6 times greater was observed in the experimental group, compared to controls. Mice receiving the atherogenic diet showed an 80% increased lung weight. There was no evident change in cardiomyocytes, but there was more (7.9 times) cardiac fibrosis (p<0.01) and 55.9 times more apoptotic cells. (p<0.01), along with a greater number of inflammatory cells and ED1 mononuclear cells. CONCLUSION: Mice receiving an atherogenic diet develop heart failure and reduced survival rate. This is associated with cardiac remodeling with underlying apoptosis an ventricular wall fibrosis. It is posible that wall edema might contribute to the observed cardiac remodeling.


Assuntos
Animais , Camundongos , Remodelação Ventricular , Dieta Aterogênica , Insuficiência Cardíaca/etiologia , Hiperlipidemias/patologia , Isquemia/etiologia , Fibrose , Análise de Sobrevida , Função Ventricular Esquerda , Apoptose , Camundongos Knockout , Disfunção Ventricular , Modelos Animais de Doenças , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/patologia , Isquemia/fisiopatologia , Isquemia/mortalidade , Isquemia/patologia
20.
Ann Vasc Surg ; 67: 567.e9-567.e12, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32209415

RESUMO

Ocular ischemic syndrome is a rare complication of carotid arterial disease that can lead to irreversible vision loss. The disease is related to ocular hypoperfusion secondary to carotid stenosis. Carotid endarterectomy (CEA) has been proven to reduce the risk of embolic stroke in specific patient populations; however, the role of CEA in the treatment of ocular ischemic syndrome or other flow-related symptoms is less well defined. We present a case of ocular ischemic syndrome successfully treated with carotid endarterectomy, and summarize the current literature regarding management of ocular ischemic syndrome.


Assuntos
Cegueira/etiologia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Olho/irrigação sanguínea , Isquemia/etiologia , Idoso de 80 Anos ou mais , Cegueira/diagnóstico , Cegueira/fisiopatologia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Humanos , Isquemia/diagnóstico , Isquemia/fisiopatologia , Masculino , Recuperação de Função Fisiológica , Fluxo Sanguíneo Regional , Resultado do Tratamento , Visão Ocular
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