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1.
Zhongguo Gu Shang ; 33(12): 1142-7, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33369322

RESUMO

OBJECTIVE: To analyze the causes of vascular injury occurred in oblique lateral interbody fusion for treating lumbar degenerative diseases, and put forward preventive measures. METHODS: There were 235 patients analyzed from October 2014 to May 2017 in five hospitals, who were treated with oblique lateral interbody fusion with or without posterior pedicle screw fixation. There were 79 males and 156 females with an average age of (61.9±13.5) years old (ranged from 32 to 83 years). There were 7 cases of vascular injury, including 4 cases of segmental vessel injury, 1 case of left common iliac artery injury, 1 case of left common iliac veininjury and 1 case of ovarian vein injury. RESULTS: The follow up time ranged from 6 to 36 months, averagely (15.6±7.5) months. There was no pedicle screw loosen or fracture. The low back pain VAS decreased from preoperative 6.7±2.3 to 1.4±0.8 at the latest follow-up, which was statistically difference(t=7.21, P=0.033). The ODI decreased from preoperative (36.5±7.7)% to (9.4±3.6)% at the latest follow-up, which was statistically difference (t=8.11, P=0.025). CONCLUSION: Oblique lateral interbody fusion technique provides a new method for minimally invasive fusion of lumbar internal fixation. However, it has a risk of vascular injury. In order to effectively prevent the occurrence of vascular injury, the operative indications and careful and meticulous operation should be strictly grasped.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Lesões do Sistema Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/prevenção & controle , Lesões do Sistema Vascular/cirurgia
2.
Spine Deform ; 8(4): 637-646, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32170658

RESUMO

OBJECTIVES: We set out to determine the "safe zone" for anterior instrumentation in scoliosis surgery assessing the relationship of the great vessels to the spine. METHODS: A total of 34 children undergoing posterior idiopathic scoliosis surgery were included in the study between 2010 and 2016. The preoperative scans were assessed to identify the position of the great vessels relative to the spine from T4 to L4. A coordinate system was specifically designed to determine safe zones for device locations. The safe zone right (SZR) was defined as the angle formed between X-axis (0°) and a line connecting the origin and the edge of the aorta and the safe zone left (SZL), the angle between the edge of the aorta to 180°. RESULTS: The average age was 14 years, with 30 females (88.2%). Lenke classification, the most common curve was 1BN (20.6%), followed by 1AN, 3C- and 6CN (8.8% each). The Apex was T8 and T9 (29.4 and 23.5% respectively). 58% of the curves were right sided. The mean SZL was from 155.7° to 180° at the T4 level to 104.3°-180° at L4. The mean SZR was from 0 to 110.7° at T4 to 0-76.18° at L4. The side of the curves was correlated at p level with the SZL and SZR. There was a significant correlation in the following levels: from T4 to L2 in the SZL, and from T7 to L2 in the SZR. CONCLUSIONS: Between T4 and T11, the right side of the vertebrae is safe, and from T12 to L4 the safe zones are more lateral and smaller. In a right-sided scoliosis, the danger zone moves more posterolateral at every level. In a left-sided curve, the danger zone is more anteromedial. Knowledge of these safe zones should allow safer placement of anterior devices. LEVEL OF EVIDENCE: Level III.


Assuntos
Aorta/anatomia & histologia , Aorta/lesões , Complicações Intraoperatórias/prevenção & controle , Margens de Excisão , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Vértebras Torácicas/irrigação sanguínea , Vértebras Torácicas/cirurgia , Lesões do Sistema Vascular/prevenção & controle , Feminino , Humanos , Masculino , Segurança
3.
Arthroscopy ; 36(2): 492-498, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31901385

RESUMO

PURPOSE: We assessed the risk of injury to the popliteal neurovascular bundle (PNVB) while suturing the posterior horn of the lateral meniscus (PHLM). METHODS: We simulated all-inside suturing of the PHLM using magnetic resonance imaging of 60 knees. Lines were drawn from the medial and the lateral edges of the patellar tendon to the PHLM at increasing distances from the posterior cruciate ligament (PCL) to simulate suturing device trajectory. Distance from each line to the PNVB was measured (d). A similar analysis was performed using lines drawn from 1 cm medial and 1 cm lateral to the patellar tendon. We compared the average "d" at increasing distances from the PCL, between the different simulated portal entry points. We have also analyzed the association between different demographic characteristics and the shortest distance from the PVNB to the PHLM. RESULTS: Of 1200 measurements performed, the simulated suturing trajectory transected the PNVB 343 times (28.6%). At 0 mm from the PCL, the safest portal was the 1-cm lateral portal (P < .001), with an average "d" of 2.7 mm. At 3 mm, 6 mm, 9 mm, and 12 mm from the PCL, the safest portal was the 1-cm medial portal (P < .001), with average "d" of 3.8 mm, 6.9 mm, 10.1 mm, and 13.5 mm, respectively. Average distance between the PHLM and the PNVB was 7.8 mm. Shorter distance between the PHLM and the PNVB was associated with younger age and female sex (P = .014 and .001, respectively). CONCLUSIONS: All-inside suturing of the PHLM at 0 mm from the PCL is safer with a more lateral portal. Beyond 3 mm from the PCL, a more medial portal carries a lower risk to the PNVB. Young and female patients have a shorter distance between the PHLM and the PNVB, suggesting a greater risk for injury to the PNVB. Careful preoperative magnetic resonance imaging assessment may assist in safer portal selection when planning repair of the PHLM. CLINICAL RELEVANCE: This study describes a magnetic resonance imaging-based risk assessment for injury of the PVNB while suturing the PHLM. It allows the orthopaedic surgeon a better understanding of the anatomic relationship between the popliteal neurovascular bundle and the lateral meniscus and can assist in portal selection and safety.


Assuntos
Imagem por Ressonância Magnética/métodos , Meniscos Tibiais/cirurgia , Artéria Poplítea/lesões , Ligamento Cruzado Posterior/cirurgia , Técnicas de Sutura/instrumentação , Suturas , Lesões do Menisco Tibial/cirurgia , Lesões do Sistema Vascular/prevenção & controle , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Meniscos Tibiais/diagnóstico por imagem , Pessoa de Meia-Idade , Ligamento Patelar/cirurgia , Artéria Poplítea/diagnóstico por imagem , Lesões do Menisco Tibial/diagnóstico , Lesões do Sistema Vascular/diagnóstico , Adulto Jovem
4.
Phytother Res ; 34(4): 836-845, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31793706

RESUMO

Hypertension is recognized to be associated with low-grade inflammation. Baicalin (BAI) is reported to possess various pharmacological including anti-inflammatory activities. This research explored the molecular mechanism by which BAI functions in human aortic endothelial cells (HAECs). HAECs were pretreated with BAI. Cell viability, apoptosis, and expressions of crucial proteins were respectively evaluated using cell counting kit-8 assay, flow cytometry, and western blot. Productions of cytokines were respectively assessed employing quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay. Cell transfection was utilized to alter miR-145 expression. The expressions of proteins participated in JNK and p38MAPK pathways were analyzed utilizing western blot. TNF-α inducement successfully evoked inflammatory injury in HAECs, exhibiting as prominently suppressed viability, while facilitated apoptosis and productions of cytokines. However, BAI pretreatment significantly ameliorated TNF-α-triggered inflammatory injuries. Besides, miR-145 expression was markedly inhibited by TNF-α inducement, while notably elevated by BAI pretreatment. Although miR-145 overexpression had no significant influence on apoptosis, miR-145 silence observably reversed BAI pretreatment-evoked protective influences on TNF-α-induced HAECs, as well as the inhibited impacts on the levels of key proteins involved in JNK and p38MAPK pathways. This investigation illustrated that BAI relieved TNF-α-triggered injuries through upregulating miR-145 via suppressing JNK and p38MAPK pathways.


Assuntos
Aorta/efeitos dos fármacos , Células Endoteliais/efeitos dos fármacos , Flavonoides/farmacologia , MicroRNAs/genética , Fator de Necrose Tumoral alfa/metabolismo , Aorta/lesões , Aorta/metabolismo , Aorta/patologia , Apoptose/efeitos dos fármacos , Apoptose/genética , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência Celular/genética , Células Cultivadas , Doença da Artéria Coronariana/genética , Doença da Artéria Coronariana/metabolismo , Doença da Artéria Coronariana/prevenção & controle , Células Endoteliais/metabolismo , Humanos , Inflamação/tratamento farmacológico , MicroRNAs/metabolismo , Ativação Transcricional/efeitos dos fármacos , Regulação para Cima/efeitos dos fármacos , Regulação para Cima/genética , Lesões do Sistema Vascular/genética , Lesões do Sistema Vascular/metabolismo , Lesões do Sistema Vascular/prevenção & controle , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo
5.
J Endovasc Ther ; 27(1): 102-108, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31724469

RESUMO

Purpose: To evaluate a new scoring balloon, the non-slip element (NSE) percutaneous transluminal angioplasty (PTA) balloon, in the treatment of femoropopliteal lesions by comparing angiographic dissection patterns to those of a conventional balloon. Methods: This retrospective, single-center study included 71 symptomatic patients (mean age 77.4±8.8 years; 33 men) with de novo femoropopliteal lesions <20 cm long treated with balloon angioplasty between January 2017 and May 2018. Thirty-four patients were treated with 3 inflations of an NSE balloon and 37 patients were treated with a conventional balloon. Results: Severe dissections were fewer (8.8% vs 29.7%, p=0.027) and the total dissection length was shorter (11.5±12.8 vs 35.7±24.1 mm, p=0.027) in the NSE group. The bailout stenting rate was also lower in the NSE group (17.6% vs 40.5%, p=0.035). There were no significant differences between the groups regarding lesion length (70.3±50.4 vs 77.8±56.6 mm, p=0.28), inflation time (294±162 vs 353±179 seconds, p=0.08), or inflation pressure (10.6±5.0 vs 11.3±5.3 atm, p=0.31). Conclusion: Three NSE balloon inflations may reduce severe dissections induced by balloon angioplasty in femoropopliteal lesions.


Assuntos
Angioplastia com Balão/instrumentação , Artéria Femoral/lesões , Doença Arterial Periférica/terapia , Artéria Poplítea/lesões , Dispositivos de Acesso Vascular , Lesões do Sistema Vascular/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Desenho de Equipamento , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Japão , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Stents , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/fisiopatologia
6.
Injury ; 51(2): 384-388, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31668355

RESUMO

BACKGROUND AND AIMS: Iatrogenic vascular injury associated with distal screw in the intramedullary nail for femoral trochanteric fracture is a rare but serious complication. This study aimed to investigate the positional relationship between distal screws and superficial (SFA), deep (DFA), and perforating femoral artery (PFA) using computed tomography (CT) angiography and to identify the risk factors of vascular injury. PATIENTS AND METHODS: Thirty-eight patients (11 patients who underwent osteosynthesis with proximal femoral intramedullary nail and 27 healthy people) who underwent CT angiography were included. The distance from the great trochanter tip and insertion angle from posterior condylar axis (reference line) of the distal screws were measured, and the presence rates and distances from the femur of each artery within the insertion angle were investigated. RESULTS: The distance from the great trochanter tip to the distal screw was 142.5 ±â€¯8.8 mm. The insertion angle from the reference line was 27.3°±15° The measurement points were set at 130, 140, and 150 mm distal from the great trochanter tip, and the assumed insertion angle as 27°±15° Within this angle, the presence rates and distances were 50.8%/34.2 ±â€¯7.0 mm (130 mm), 38.5%/34.3 ±â€¯6.0 mm (140 mm), 30.8%/33.4 ±â€¯6.0 mm (150 mm) in SFA; 12.3%/14.2 ±â€¯3.3 mm (130 mm), 3.1%/13.1 ±â€¯5.9 mm (140 mm), and 0% (150 mm) in DFA; and 0% (130-150 mm) in PFA. The presence rate of DFA increased at the posteromedial area in the thigh, and the distance from the femur became closer. CONCLUSION: Within the angle that distal screws were likely to be inserted, the risk of DFA injury was the highest. Therefore, anatomical reduction of the femoral neck anteversion should be performed so that the distal screw will be inserted towards the anteromedial area in the thigh, and great attention should be paid not to over-drill the medial femoral cortex.


Assuntos
Parafusos Ósseos/efeitos adversos , Artéria Femoral/lesões , Fixação Intramedular de Fraturas/efeitos adversos , Lesões do Sistema Vascular/etiologia , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada/métodos , Feminino , Fraturas do Fêmur/cirurgia , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/cirurgia , Fixação Intramedular de Fraturas/instrumentação , Fraturas do Quadril/cirurgia , Humanos , Doença Iatrogênica/prevenção & controle , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/prevenção & controle
7.
Ann Vasc Surg ; 62: 191-194, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31449950

RESUMO

BACKGROUND: Percutaneous endovascular aortic repairs (pEVARs) are associated with access site complications. Two-device technique using 2 Perclose devices has been well established. Combined Perclose and Angioseal technique has been described as well. We sought to determine whether a hybrid Perclose and Angioseal closure technique would safely and effectively establish hemostasis in large-bore arteriotomies up to 20F. METHODS: Patients were identified as candidates for percutaneous access based on preoperative computed tomography findings, perioperative ultrasound of femoral vessels, or a combination of the 2 modalities. Prior to sheath insertion, 1 Perclose device was predeployed. At the end of pEVAR, device sheath and introducer were withdrawn over a 0.035″ wire, and partially deployed Perclose was fully deployed. The sheath and introducer were fully withdrawn and the arteriotomy was closed with a 6F Angioseal vascular closure device and completion deployment of the Perclose. Patients were followed at day 1 and day 30 and at least 1 year postintervention. RESULTS: A composite end point of complications was defined as an access site-related bleed or hematoma that required blood transfusion or an extended hospital stay, pseudoaneurysm, arteriovenous fistula, dissection, or retroperitoneal hematoma. The combined technique was initially successful in 44/45 arteriotomies (97.8%) in 24/25 patients (96.0%) with no conversions to cutdown. Sheath sizes ranged from 10F to 20F outer diameter (OD), with an average of 15.89F OD. The single-device failure was caused by a failure of the footplate to catch during deployment in the Angioseal with a 20F arteriotomy. Consequently, that was the only patient in which this closure was attempted for an arteriotomy larger than 19F. There were no early or late complications in this series. CONCLUSIONS: Large-bore arteriotomies may be safely and effectively closed using a hybrid percutaneous closure technique for sheaths up to 19F OD. Evaluation of this technique in closure of large-bore arteriotomies is ongoing and further investigation is needed to assess the value of this closure in 20F OD sheaths and above.


Assuntos
Doenças da Aorta/cirurgia , Cateterismo Periférico , Procedimentos Endovasculares , Hemorragia/prevenção & controle , Técnicas Hemostáticas/instrumentação , Dispositivos de Oclusão Vascular , Doenças da Aorta/diagnóstico por imagem , Transfusão de Sangue , Cateterismo Periférico/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Desenho de Equipamento , Hematoma/etiologia , Hematoma/prevenção & controle , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Humanos , Tempo de Internação , Punções , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/prevenção & controle
8.
Cardiovasc Res ; 116(3): 708-720, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31241138

RESUMO

AIMS: Adventitial vasa vasorum provides oxygen and nourishment to the vascular wall, but whether it regulates vascular disease remains unclear. We have previously shown that an increased expression of VEGF (vascular endothelial growth factor) is associated with macrophage infiltration. This study aims to determine whether adventitial fibroblast (AF)-derived VEGF increases the number of vasa vasorum contributing to neointima formation through macrophage recruitment. METHODS AND RESULTS: In rat balloon injury model, vasa vasorum count was increased particularly in the adventitia accompanied by cell proliferation and VEGF expression. Both endogenous and PKH26-labelled exogenous macrophages were mainly distributed in adventitia around vasa vasorum. Interestingly, perivascular delivery of Ranibizumab preferentially concentrated in adventitia resulted in a decrease of neointima formation with concurrent reduction of vasa vasorum count and macrophage infiltration. AFs with adenovirus-mediated VEGF over-expression delivered to the adventitia significantly enhanced these pathological changes after injury. In Tie2-cre/Rosa-LoxP-RFP mice, endothelial cells were increased in the adventitia after wire injury. By using multiphoton laser scanning microscopy, macrophage rolling, adhesion and transmigration were observed in vasa vasorum. Moreover, adoptive transfer of macrophages accelerated injury-induced neointima formation. VEGF-neutralizing antibody administration also attenuated wire injury-induced neointima formation and macrophage infiltration. In primary cultured AFs, exogenous VEGF increased VEGF expression and secretion in a time- and dose-dependent manner. AF-conditioned medium promoted endothelial cell angiogenesis, vascular cell adhesion molecule-1 expression and macrophage adhesion was blocked by VEGF-neutralizing antibody and VEGFR2 inhibitor ZM323881, which also inhibited activation of VEGFR2/ERK1/2 pathway. CONCLUSION: These results demonstrate that AF-derived VEGF plays a significant role in the increase of vasa vasorum count which is involved in macrophage recruitment and neointima formation.


Assuntos
Túnica Adventícia/metabolismo , Artérias Carótidas/metabolismo , Lesões das Artérias Carótidas/metabolismo , Artéria Femoral/metabolismo , Fibroblastos/metabolismo , Macrófagos/metabolismo , Neointima , Vasa Vasorum/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Lesões do Sistema Vascular/metabolismo , Transferência Adotiva , Túnica Adventícia/efeitos dos fármacos , Túnica Adventícia/patologia , Inibidores da Angiogênese/farmacologia , Animais , Artérias Carótidas/efeitos dos fármacos , Artérias Carótidas/patologia , Lesões das Artérias Carótidas/genética , Lesões das Artérias Carótidas/patologia , Lesões das Artérias Carótidas/prevenção & controle , Células Cultivadas , Modelos Animais de Doenças , Células Endoteliais/metabolismo , Células Endoteliais/patologia , Feminino , Artéria Femoral/efeitos dos fármacos , Artéria Femoral/patologia , Fibroblastos/efeitos dos fármacos , Fibroblastos/patologia , Macrófagos/efeitos dos fármacos , Macrófagos/patologia , Macrófagos/transplante , Masculino , Camundongos Endogâmicos C57BL , Comunicação Parácrina , Ratos Sprague-Dawley , Transdução de Sinais , Técnicas de Cultura de Tecidos , Vasa Vasorum/efeitos dos fármacos , Vasa Vasorum/patologia , Fator A de Crescimento do Endotélio Vascular/genética , Lesões do Sistema Vascular/genética , Lesões do Sistema Vascular/patologia , Lesões do Sistema Vascular/prevenção & controle
9.
Knee Surg Sports Traumatol Arthrosc ; 28(5): 1425-1435, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31119339

RESUMO

PURPOSE: (1) To analyse popliteal artery (PA) movement in a three-dimensional (3D) coordinate system in relation to knee flexion and high tibial osteotomy (HTO) techniques (lateral closed wedge HTO [LCHTO], uniplane medial open wedge HTO [UP-MOHTO], biplane medial open wedge HTO [BP-MOHTO]) and (2) to identify safe zones of the PA in each osteotomy plane. METHODS: Sixteen knees of patients who underwent magnetic resonance imaging with extension and 90° flexion were used to develop subject-specific 3D knee flexion models. Displacement of the PA during knee flexion was measured along the X- and Y-axis, as was the distance between the posterior tibial cortex and PA parallel to the Y-axis (d-PCA). Frontal plane safety index (FPSI) and maximal axial safe angles (MASA) of osteotomy, which represented safe zones for the osteotomy from the PA injury, were analysed. All measurements were performed along virtual osteotomy planes. Differences among the three osteotomy methods were analysed for each flexion angle using a linear mixed model. RESULTS: The average increments in d-PCA during knee flexion were 1.3 ± 2.3 mm in LCHTO (n.s.), 1.4 ± 1.2 mm in UP-MOHTO (P < 0.0001), and 1.7 ± 2.0 mm in BP-MOHTO (P = 0.015). The mean FPSIs in knee extension were 37.6 ± 5.9%, 46.4 ± 5.8%, and 45.1 ± 8.1% for LCHTO, UP-MOHTO, and BP-MOHTO, respectively. The mean MASA values in knee extension were 45.8° ± 4.4°, 37.3° ± 6.1°, and 38.9° ± 6.5° for LCHTO, UP-MOHTO, and BP-MOHTO, respectively. CONCLUSION: Although the PA moved posteriorly during knee flexion, the small (1.7 mm) increment thereof and inconsistent movements in subjects would not be of clinical relevance to PA safety during HTO. LEVEL OF EVIDENCE: Diagnostic study, Level II.


Assuntos
Osteoartrite do Joelho/cirurgia , Osteotomia/efeitos adversos , Osteotomia/métodos , Artéria Poplítea/lesões , Lesões do Sistema Vascular/prevenção & controle , Adulto , Simulação por Computador , Feminino , Humanos , Imageamento Tridimensional , Joelho/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Amplitude de Movimento Articular , Lesões do Sistema Vascular/etiologia , Adulto Jovem
10.
J Vasc Surg ; 71(1): 229-241, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31204215

RESUMO

OBJECTIVE: Intimal hyperplasia (IH) is the main cause of therapeutic failure after vascular and endovascular surgery. However, there is currently no targeted therapy for the treatment of IH. We recently reported that the inhibition of cyclic adenosine monophosphate response element (CRE) binding protein (CREB) activation is important in vein graft IH. We focused on a decoy oligodeoxynucleotide (ODN) therapeutic strategy for suppressing IH as a clinical application. The objective of this study was to confirm the therapeutic effect of a CRE decoy ODN in an animal model as a novel therapy for preventing intimal hyperplasia as the first step of the preclinical study of our strategy. METHODS: We designed two phosphorothioate CREs and two scramble decoy ODNs and screened them using a CREB transcription assay to check their ability to bind to a CRE sequence. We chose a CRE decoy ODN with high first-binding ability and transfected it into vascular smooth muscle cells (VSMCs) in vitro. Proliferation and migration were assessed using MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assays and modified Boyden chamber assays. We examined CRE activity using a luciferase reporter gene assay. We assessed the expression of messenger RNAs by quantitative real-time polymerase chain reaction. In a wire-injury mouse model (C57BL6, n = 6), CRE decoy ODN was transfected into the injured vessel wall using an ultrasound-sonoporation method in vivo. Mitogen-activated protein kinase-activated protein kinase 3 (MAPKAPK3) and four and a half LIM domains 5 (FHL5) expression of pregrafting vein remnants were assessed by immunohistologic analyses. RESULTS: Compared with scramble decoy ODN, the selected CRE decoy ODN could significantly decrease CRE activity (mean ± standard error of the mean: 0.20 ± 0.03 vs 1.00 ± 0.16, n = 6; P < .05) as shown by a luciferase reporter gene assay, VSMC proliferation (0.73 ± 0.04 vs 0.89 ± 0.02, n = 6; P < .05) and migration (96.4 ± 6.1 vs 311.4 ± 19.1 migrated VSMCs/well, n = 6; P < .05) after 24-hour transfection. The CRE decoy ODN significantly suppressed the formation of IH at injured vessel walls in an animal model, as analyzed by pathologic staining (0.20 ± 0.02 vs 0.56 ± 0.08, area of the intima/area of the artery vs the control after 21 days' transfection, n = 6; P < .05). Furthermore, MAPKAPK3 and FHL5, which are CREB activators, were significantly expressed in pregrafting vein remnants in diabetes mellitus patients. CONCLUSIONS: CREB-CRE signaling is an important mechanism of IH formation, and CRE decoy therapy can help preventing IH. This study is the first part of the preclinical study of our strategy.


Assuntos
AMP Cíclico/metabolismo , Músculo Liso Vascular/metabolismo , Miócitos de Músculo Liso/metabolismo , Neointima , Oligodesoxirribonucleotídeos/genética , Elementos de Resposta/genética , Lesões do Sistema Vascular/prevenção & controle , Animais , Proteína de Ligação a CREB/genética , Proteína de Ligação a CREB/metabolismo , Movimento Celular , Proliferação de Células , Células Cultivadas , Modelos Animais de Doenças , Humanos , Peptídeos e Proteínas de Sinalização Intracelular/genética , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Proteínas com Domínio LIM/genética , Proteínas com Domínio LIM/metabolismo , Masculino , Camundongos Endogâmicos C57BL , Músculo Liso Vascular/lesões , Músculo Liso Vascular/patologia , Miócitos de Músculo Liso/patologia , Oligodesoxirribonucleotídeos/metabolismo , Proteínas Serina-Treonina Quinases/genética , Proteínas Serina-Treonina Quinases/metabolismo , Fatores de Transcrição/genética , Fatores de Transcrição/metabolismo , Lesões do Sistema Vascular/genética , Lesões do Sistema Vascular/metabolismo , Lesões do Sistema Vascular/patologia
11.
J Foot Ankle Surg ; 59(1): 95-99, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882155

RESUMO

Recent evidence suggests that the use of suture button devices for ankle syndesmosis fixation is increasing. Multiple studies have shown some concern about damaging the greater saphenous neurovasculature with placement of the anchor point on the medial tibial cortex. We hypothesized that an all-inside button deployment technique would allow for a low risk to medial soft tissue structures. A total of 40 syndesmosis suture buttons were placed into 10 separate cadaveric lower limbs, using the newly developed technique. Four suture buttons were sequentially placed from distal to proximal in each limb within the zone of typical syndesmosis fixation, using fluoroscopic guidance. A medial incision was then performed to evaluate the relationship of the suture buttons to the medial soft tissue structures and the medial malleolus. Thirteen of 40 suture buttons (32.5%) were placed anterior, 7 (17.5%) posterior, and 20 (50%) with a portion of the button directly deep to the saphenous vein. Two of 40 buttons (5%) were placed within the tibial periosteum, and 38 (95%) were subfascial and directly superficial to the periosteum. Four of 40 (10%) limbs revealed a perforation in the saphenous vein from the guidepin. In conclusion, risks to the medial neurovascular structures exist with the medial deployment technique, but they appear to be mitigated compared with previous publications. The necessity of a medial incision to evaluate for soft tissue entrapment may not be necessary in all patients, as this technique appears to be safe, accurate, and reproducible.


Assuntos
Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Traumatismos dos Nervos Periféricos/prevenção & controle , Âncoras de Sutura , Técnicas de Sutura/efeitos adversos , Lesões do Sistema Vascular/prevenção & controle , Articulação do Tornozelo/irrigação sanguínea , Articulação do Tornozelo/inervação , Cadáver , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/etiologia , Lesões do Sistema Vascular/etiologia
12.
Injury ; 51(2): 452-456, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31882235

RESUMO

BACKGROUND: The incidence of arterial injury associated with femoral fractures is approximately 1%. Lateral sub-muscular plate fixation is gaining popularity for the management of distal femoral fractures. The objective of this study was to assess the iatrogenic risk to the superficial femoral artery (SFA) during Less Invasive Stabilisation System (LISS) plate fixation of distal femoral fractures by analysing the range of distances and angles between LISS plate screws and the drilling line to the SFA. MATERIALS AND METHODS: We identified all patients who underwent LISS plate fixation of distal femoral fractures between 2008 and 2018 in our level-1 trauma centre. Patients who underwent postoperative computed tomography for any reason were eligible for inclusion in the study. Twenty-five patients met the inclusion criteria. The sample comprised 10 male and 15 female patients with a mean age of 55 years. The most common fracture type was a supracondylar femur fracture (56%), followed by an intercondylar fracture (36%). A 13-hole LISS plate was the most common plate length used (44%). A consultant radiologist reviewed all scans to verify the visibility and marking of the SFA. RESULTS: The median distance between the screw tip and the SFA was 21 mm (range, 8-65 mm). There was a negative correlation between the LISS plate hole number and the trajectory of drilling (Pearson coefficient: -0.87, p < 0.001). Using a linear regression model, the SFA was more likely to be in the line of drilling when the 6th to 10th holes in the LISS plate were used. CONCLUSION: Extra care is needed when drilling into the LISS plate holes from the lateral to the medial direction in order to reduce the risk of iatrogenic injury to the SFA, especially in the high-risk plate zone where the artery can be close to the drilling line.


Assuntos
Artéria Femoral/lesões , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/instrumentação , Lesões do Sistema Vascular/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas/normas , Parafusos Ósseos/efeitos adversos , Feminino , Fraturas do Fêmur/classificação , Fraturas do Fêmur/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/normas , Estudos Retrospectivos , Tomógrafos Computadorizados , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/etiologia
13.
Clin Anat ; 33(4): 552-557, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31301242

RESUMO

Cerclage wiring of the humeral diaphysis entails particular danger to the radial nerve and the deep brachial artery. We sought to delineate safe zones for minimally invasive cerclage wiring of the humeral diaphysis, specifically in relation to the radial nerve and accompanying vasculature. Cerclage wires were percutaneously inserted into three groups of fresh-frozen cadaveric humeri. Group 1-proximal midshaft humerus at 30% of humeral height (n = 4); Group 2-midshaft spiral groove at 45% of humeral height (n = 4); and Group 3-distal midshaft humerus at 60% of humeral height (n = 4). Subsequently, an extensive surgical exploration of the arteries and nerves around the humerus was performed, noting any disturbance to the vessels or nerves and measuring the distance from the cerclage wire to the radial nerve. Neurovascular structures were injured in 75% of specimens when the cerclage wire was inserted at the level of the spiral groove. Both posterior structures, e.g. the radial nerve and the deep brachial artery, and medial structures, e.g., the median nerve and brachial artery, were incarcerated. Application of the cerclage at 30% or 60% of humeral height did not cause neurovascular injury. Minimally invasive application of the cerclage wire at the spiral groove, which is at 45% of humeral height, is likely to cause injury to neurovascular structures. Application of the cerclage at the proximal or distal midshaft humeral areas is associated with less risk of such injury. Clin. Anat. 33:552-557, 2020. © 2019 Wiley Periodicals, Inc.


Assuntos
Fios Ortopédicos , Diáfises/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Cadáver , Diáfises/irrigação sanguínea , Diáfises/inervação , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Traumatismos dos Nervos Periféricos/prevenção & controle , Lesões do Sistema Vascular/prevenção & controle
14.
Curr Med Sci ; 39(6): 920-928, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31845223

RESUMO

The aim of the present study was to observe the protective effects of α-lipoic acid (ALA) on vascular injury in rats with hyperuricemia (HUA). The ALA treatment groups (10, 30 and 90 mg/kg, respectively) were administered with ALA via gavage for 2 weeks. Subsequently, the levels of blood urea nitrogen (BUN), creatinine (CREA), uric acid (UA), total cholesterol (TC), high density lipoprotein-C (HDL-C) and low density lipoprotein-C (LDL-C) were measured; the activities of glutathione peroxidase (GSH-Px), catalase (CAT), malonaldehyde (MDA), superoxide dismutase (SOD) and xanthine oxidase (XOD) were also determined. The thoracic aorta of rats in each experimental group was observed under a light microscope; ultrastructural analysis was performed. SOD and CAT protein contents were investigated by Western blotting. The results revealed that: i) Compared with the model group, the levels of UA were decreased in the ALA groups and the levels of BUN, CREA, TC, and LDL-C decreased in the 30 and 90 mg/kg ALA groups (P<0.05); ii) compared with the model group, the activities of GSH-Px, SOD and XOD were increased and the levels of MDA were reduced in the 90 mg/kg ALA group (P<0.05); and iii) in the model and 10 mg/kg ALA groups, edema and shedding were observed in endothelial cells. Compared with the model and 10 mg/kg ALA groups, the 30 and 90 mg/kg ALA groups exhibited fewer swollen endothelial cells. In summary, the results of the present study indicated that HUA resulted in vascular oxidative stress injury and decreased the activity of antioxidative enzymes, which leads to endothelial cell damage and vascular lesions. ALA may serve as a therapeutic agent for the treatment of HUA-induced endothelial dysfunction.


Assuntos
Antioxidantes/administração & dosagem , Hiperuricemia/tratamento farmacológico , Ácido Tióctico/administração & dosagem , Lesões do Sistema Vascular/prevenção & controle , Animais , Antioxidantes/farmacologia , Nitrogênio da Ureia Sanguínea , Catalase/metabolismo , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Glutationa Peroxidase/metabolismo , Hiperuricemia/induzido quimicamente , Hiperuricemia/complicações , Masculino , Malondialdeído/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Ratos , Superóxido Dismutase/metabolismo , Ácido Tióctico/farmacologia
15.
Rev. bras. enferm ; 72(6): 1512-1518, Nov.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1042199

RESUMO

ABSTRACT Objective: to create, apply and analyze in clinical practice the effectiveness of a bundle to prevent peripheral vascular trauma to approach the peripheral venous puncture process. Method: action research with 435 adult participants in an emergency service from 2011 to 2013. Creation of the bundle for prevention of vascular trauma based on scientific evidence, ease of operation, observation and measurement with implantation through an educational intervention of the team of nursing. Effectiveness analyzed by descriptive and inferential statistics using chi-square. Consecutive sample with 95% confidence interval. Results: Five stages of the bundle were related to the catheter fixation, permanence and removal process. The incidence of vascular traumas due to vein punctures reduced by 46.41% after implantation of the bundle to prevent vascular trauma associated with emergency peripheral catheterization. Conclusion: The bundle in clinical practice reduced vascular traumas by venipuncture.


RESUMEN Objetivo: crear, aplicar y analizar en la práctica clínica la efectividad de un paquete para prevenir el traumatismo vascular periférico para abordar el proceso de punción venosa periférica. Método: investigación de acción con 435 participantes adultos en un servicio de emergencia de 2011 a 2013. Creación del paquete para la prevención de traumas vasculares basado en evidencia científica, facilidad de operación, observación y medición con implantación a través de una intervención educativa del equipo de enfermería. Efectividad analizada mediante estadística descriptiva e inferencial utilizando chi-cuadrado. Muestra consecutiva con intervalo de confianza del 95%. Resultados: Cinco etapas del paquete se relacionaron con la fijación del catéter, la permanencia y el proceso de extracción. La incidencia de traumas vasculares se redujo en un 46,41% después de la implantación del haz para prevenir traumatismos vasculares asociados con cateterismo. Conclusión: el paquete en la práctica clínica redujo los traumas vasculares por venopunción.


RESUMO Objetivo: criar e aplicar um bundle na prática clínica e analisar sua efetividade para prevenção de trauma vascular periférico para abordagem do processo de punção venosa periférica. Método: pesquisa-ação com 435 participantes adultos num serviço de urgência, no período de 2011 a 2013. Criação do bundle para prevenção de trauma vascular baseada em evidências científicas, com facilidade de operacionalização, observação, mensuração e implantação por meio de uma intervenção educativa da equipe de enfermagem. Efetividade analisada por estatística descritiva e inferencial, usando o qui-quadrado. Amostra consecutiva com intervalo de confiança de 95%. Resultados: foram realizadas cinco etapas do bundle relacionadas ao processo de fixação, permanência e remoção do cateter. Houve redução de 46,41% na incidência de traumas vasculares após a implantação do bundle para prevenção de trauma vascular associado ao cateterismo periférico em urgência. Conclusão: o bundle, na prática clínica, reduziu a ocorrência de traumas vasculares decorrentes de punção venosa.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Cateterismo Periférico/métodos , Flebotomia/efeitos adversos , Serviço Hospitalar de Emergência , Lesões do Sistema Vascular/prevenção & controle , Pacotes de Assistência ao Paciente/métodos , Avaliação em Enfermagem/métodos , Cateterismo Periférico/efeitos adversos , Distribuição de Qui-Quadrado , Intervalos de Confiança , Emergências , Pessoa de Meia-Idade
16.
Clin Orthop Relat Res ; 477(12): 2761-2768, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31764348

RESUMO

BACKGROUND: Fixation of clavicle shaft fractures with a plate and screws can endanger the neurovascular structures if proper care is not taken. Although prior studies have looked at the risk of clavicular plates and screws (for example, length and positions) to vulnerable neurovascular structures (such as the subclavian vein, subclavian artery, and brachial plexus) in the supine position, no studies to our knowledge have compared these distances in the beach chair position. QUESTIONS/PURPOSES: (1) In superior and anteroinferior plating of midclavicle fractures, which screw tips in a typical clavicular plating approach place the neurovascular structures at risk of injury? (2) How does patient positioning (supine or beach chair) affect the distance between the screws and the neurovascular structures? METHODS: The clavicles of 15 fresh-frozen cadavers were dissected. A hypothetical fracture line was marked at the midpoint of each clavicle. A precontoured six-hole 3.5-mm reconstruction locking compression plate was applied to the superior surface of the clavicle by using the fracture line to position the center of the plate. The direction of the drill bits and screws through screw holes that offer the greater risk of injury to the neurovascular structures were identified, and were defined as the risky screw holes, and the distances from the screw tips to the neurovascular structures were measured according to a standard protocol with a Vernier caliper in both supine and beach chair positions. Anteroinferior plating was also assessed following the same steps. The different distances from the screw tips to the neurovascular structures in the supine position were compared with the distances in the beach chair position using an unpaired t-test. RESULTS: The risky screw holes were the first medial and second medial screw holes. The relative distance ratios compared with the entire clavicular length for the distances from the sternoclavicular joint to the first medial and second medial screw holes were 0.46 and 0.36 in superior plating and 0.47 and 0.37 in anteroinferior plating, respectively. The riskiest screw hole for both superior and anteroinferior plates was the second medial screw hole in both the supine and beach chair positions (supine superior plating: 8.2 mm ± 3.1 mm [minimum: 1.1 mm]; beach chair anteroinferior plating: 7.6 mm ± 4.2 mm [minimum: 1.1 mm]). Patient positioning affected the distances between the riskiest screw tip and the nearest neurovascular structures, whereas in superior plating, changing from the supine position to the beach chair position increased this distance by 1.4 mm (95% CI -2.8 to -0.1; supine 8.2 ± 3.1 mm, beach chair 9.6 ± 2.1 mm; p = 0.037); by contrast, in anteroinferior plating, changing from the beach chair position to the supine position increased this distance by 5.4 mm (95% CI 3.6 to 7.4; beach chair 7.6 ± 4.2 mm, supine 13.0 ± 3.2 mm; p < 0.001). CONCLUSIONS: The second medial screw hole places the neurovascular structures at the most risk, particularly with superior plating in the supine position and anteroinferior plating in the beach chair position. CLINICAL RELEVANCE: The surgeon should be careful while making the first medial and second medial screw holes. Superior plating is safer to perform in the beach chair position, while anteroinferior plating is more safely performed in the supine position.


Assuntos
Placas Ósseas/efeitos adversos , Clavícula/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Posicionamento do Paciente/métodos , Traumatismos dos Nervos Periféricos/prevenção & controle , Lesões do Sistema Vascular/prevenção & controle , Idoso , Parafusos Ósseos/efeitos adversos , Plexo Braquial/lesões , Cadáver , Clavícula/lesões , Feminino , Humanos , Masculino , Traumatismos dos Nervos Periféricos/etiologia , Fatores de Risco , Lesões do Sistema Vascular/etiologia
17.
Foot (Edinb) ; 41: 19-23, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31675596

RESUMO

INTRODUCTION: First tarsometatarsal (TMT) joint fusion is routinely used for arthritis and deformities. Common fixation methods include a locking plate construct, cross-screws, or combinations of the two. Cross screws have proven effective for union and stability; however, there is a potential for harm to nearby neurovascular structures due to the nature of percutaneous insertion technique. This study assessed risk of damage to the superficial peroneal nerve with percutaneous TMT fusion. METHODS: Nine fresh-frozen cadaver specimens were included. A medial incision in the internervous plane was made for TMT joint preparation. Two crossed percutaneous wires followed by 4.0 cc screws were placed in the dorsal aspect of the proximal aspect of first metatarsal and in the medial cuneiform. Both were 10-15 mm from the TMT joint line. The dorsal aspect of the foot was dissected and examined for neurovascular interruptions, particularly branches of the superficial peroneal nerve. RESULTS: Results showed a mean distance of 4.33 mm from the proximal pin to the medial branch of the superficial peroneal nerve. The distal pin had a mean distance of 6.44 mm from the medial branch, with one pin 9 mm from the lateral branch. One incident of direct injury to the neurovascular bundle was observed. CONCLUSION: Preparing the joint from the medial side using a percutaneous approach is less invasive, but presents a relative risk for neuritis. Care should be taken during insertion of the percutaneous screw after TMT joint preparation for fusion. LEVEL OF EVIDENCE: Level V, cadaver study.


Assuntos
Artrodese/efeitos adversos , Artrodese/métodos , Ossos do Metatarso/cirurgia , Ossos do Tarso/cirurgia , Idoso , Idoso de 80 Anos ou mais , Parafusos Ósseos , Cadáver , Feminino , Articulações do Pé/irrigação sanguínea , Articulações do Pé/inervação , Articulações do Pé/cirurgia , Humanos , Masculino , Ossos do Metatarso/irrigação sanguínea , Ossos do Metatarso/inervação , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Nervo Fibular/anatomia & histologia , Ossos do Tarso/irrigação sanguínea , Ossos do Tarso/inervação , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/prevenção & controle
18.
J Oleo Sci ; 68(12): 1241-1249, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31735744

RESUMO

Nicotine has been linked to the development of abdominal aortic aneurysms. Isoflavones, a group of polyphenolic compounds, reportedly exhibit antioxidant and anti-inflammatory properties and facilitate cardiovascular protection. However, the effects of isoflavone on nicotine-induced abdominal aortic aneurysms have not yet been elucidated. The objective of the current study was to evaluate the inhibitory effect of isoflavone on nicotine-induced weakening of the aortic wall in mouse models. Nicotine reportedly increases the occurrence of abdominal aortic aneurysms by activating endothelin-1 (ET-1), angiotensinogen and the angiotensin II type 1 (AT1) receptor, leading to an increase in neutrophil elastase, oxidative stress, and matrix metalloproteinase (MMP)-2 expression, which causes vascular wall weakness and damage. Immunohistological analyses have indicated that isoflavone significantly inhibits the activation of ET-1, angiotensinogen and the AT1 receptor in nicotine-administered mice. Additionally, isoflavone suppressed elastic fiber destruction and decreased areas positive for MMP-2, neutrophil elastase, and malondialdehyde in the vascular wall of nicotine-administered mice. Considered together, these findings suggest that isoflavone shows potential for preventing vascular wall injury induced by nicotine administration, and that food containing isoflavone may protect against abdominal aortic aneurysms.


Assuntos
Aorta/efeitos dos fármacos , Isoflavonas/uso terapêutico , Estresse Oxidativo/efeitos dos fármacos , Lesões do Sistema Vascular/prevenção & controle , Administração Oral , Animais , Antígenos CD/metabolismo , Antígenos de Diferenciação Mielomonocítica/metabolismo , Aorta/patologia , Colágeno/metabolismo , Elastina/metabolismo , Isoflavonas/administração & dosagem , Elastase de Leucócito/metabolismo , Masculino , Malondialdeído/metabolismo , Metaloproteinase 2 da Matriz/metabolismo , Camundongos Endogâmicos C57BL , Nicotina , Receptor de Endotelina A/metabolismo , Receptores de Angiotensina/metabolismo , Lesões do Sistema Vascular/induzido quimicamente
19.
J Bone Joint Surg Am ; 101(21): 1961-1964, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31596820

RESUMO

BACKGROUND: Injury to femoral arterial vessels is a risk with internal fixation of the hip. Understanding the anatomy of proximate vessels, particularly medial vessels not directly visualized, may reduce intraoperative and postoperative complications. METHODS: We analyzed 47 patients (29 men and 18 women) using a computed tomographic (CT) angiogram of the lower limbs. The mean age of our patients was 69 years (range, 46 to 88 years). The distance from the tip of the greater trochanter to the profunda femoris and its perforators within 5 mm of the medial femoral shaft was measured along the length of the expected placement of typical dynamic hip screw constructs and other proximal femoral fracture fixation methods. RESULTS: All patients were found to have 2 perforator vessels within 5 mm of the medial femoral shaft along the line of dynamic hip screw insertion (up to 200 mm from the tip of the greater trochanter). The first perforator was found at a mean distance of 112.6 mm (median, 110 mm) in women and at 123.4 mm (median, 122 mm) in men (p = 0.0066) from the tip of the greater trochanter. The second perforator appeared at a mean distance of 159.7 mm (median, 159 mm) in women and 178.9 mm (median, 180 mm) in men (p = 0.0028) from the tip of the greater trochanter. CONCLUSIONS: Surgeons should be aware of the presence of 2 arteries within 5 mm of the medial femoral shaft during femoral internal fixation procedures. We suggest avoiding the overdrilling of the medial cortex and the insertion of overlong screws along the femoral shaft from 110 to 120 mm in women and 120 to 130 mm in men (as measured from the tip of the greater trochanter) to prevent vascular injury during proximal femoral fracture fixation. CLINICAL RELEVANCE: This article can assist orthopaedic surgeons in planning for procedures involving internal fixation of the hip and may reduce vascular complications from such procedures.


Assuntos
Artéria Femoral/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Lesões do Sistema Vascular/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
20.
Rev Bras Enferm ; 72(6): 1512-1518, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644738

RESUMO

OBJECTIVE: to create, apply and analyze in clinical practice the effectiveness of a bundle to prevent peripheral vascular trauma to approach the peripheral venous puncture process. METHOD: action research with 435 adult participants in an emergency service from 2011 to 2013. Creation of the bundle for prevention of vascular trauma based on scientific evidence, ease of operation, observation and measurement with implantation through an educational intervention of the team of nursing. Effectiveness analyzed by descriptive and inferential statistics using chi-square. Consecutive sample with 95% confidence interval. RESULTS: Five stages of the bundle were related to the catheter fixation, permanence and removal process. The incidence of vascular traumas due to vein punctures reduced by 46.41% after implantation of the bundle to prevent vascular trauma associated with emergency peripheral catheterization. CONCLUSION: The bundle in clinical practice reduced vascular traumas by venipuncture.


Assuntos
Cateterismo Periférico/métodos , Serviço Hospitalar de Emergência , Avaliação em Enfermagem/métodos , Pacotes de Assistência ao Paciente/métodos , Flebotomia/efeitos adversos , Lesões do Sistema Vascular/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/efeitos adversos , Distribuição de Qui-Quadrado , Intervalos de Confiança , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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