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1.
Vasc Endovascular Surg ; 54(3): 272-277, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31858897

RESUMO

INTRODUCTION: The optimal method of operative management of complex renal artery aneurysms (RAAs) involving distal branches (BRAAs) remains unclear. When more than 1 artery is involved within the BRAA, endovascular techniques are not advisable and an ex vivo approach is often preferred. In this study, we introduce an alternative surgical in situ technique to treat BRAAs. METHODS AND SURGICAL TECHNIQUE: Five aneurysms involving the main or second-order bifurcation of the renal artery (RA) were treated in 4 patients at our institute between November 2012 and January 2017. The treatment of the BRAAs was based on resection of the aneurysm wall and reconstruction with autologous Pantaloon vein graft (PVG): a "Y-shaped" bypass created on-bench with autogenous great saphenous vein. Sequential clamping/reperfusion of the kidney allows to reduce renal function impairment. RESULTS: No perioperative mortality or morbidity was observed, including none nephrectomy. In all the cases, aneurysms were treated with an in situ technique as previously planned. All the grafts were patent at the follow-up time (mean 64.1 ± 11.7 months). Renal function was preserved in all the cases. Vascularization of the renal parenchyma was satisfactory both on arterial echo Doppler and contrast-medium ultrasound in all the cases. Average cross-clamping times of the main RA and of a single branch RA were 15.8 ± 1.7 and 17.7 ± 4.6 minutes, respectively. Mean total operating time was 266.3 ± 18.9 minutes. CONCLUSION: The PVG with sequential clamping applied in the surgical treatment of BRAAs permits to reduce the ischemic effects to the renal parenchyma. To our knowledge, these are the first cases described in which BRAAs are treated with a PVG and our experience suggests that it is a feasible technique, with good long-term results and without severe adverse events recorded.


Assuntos
Aneurisma/cirurgia , Artéria Renal/cirurgia , Veia Safena/transplante , Enxerto Vascular/métodos , Idoso , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem , Artéria Renal/fisiopatologia , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
2.
Angiology ; 71(3): 263-273, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31867979

RESUMO

Saphenous vein grafts disease (SVGD) is a common complication after coronary artery bypass graft (CABG) and usually treated by percutaneous coronary intervention (PCI). In this prospective cohort study, we performed virtual histology-intravascular ultrasound to investigate whether plaque composition and morphological characteristics were associated with post-PCI major adverse cardiac events (MACEs) and slow/no-reflow in patients with SVGD. Patients (n = 90) were studied (76.7% men, mean age 64.9 ± 8.2 years and mean duration of SVG 8.0 ± 3.6 years). There were 77.8% lesions with a plaque burden of at least 70%; 18 MACE incidences accumulated in 14 patients over 12 months post-PCI and slow/no-reflow was observed in 12 patients. On adjusted multivariate analysis, lesion length (hazard ratio [HR] = 1.05; 95% confidence interval [CI]: 1.01-1.08]); age of CABG (HR = 1.51 [95% CI: 1.11-2.05], and absolute necrotic core (NC) area (HR = 8.04 [95% CI: 1.86-34.73]) were independently associated with MACEs. Factors independently associated with slow/no-reflow post-PCI were preprocedure systolic blood pressure (odds ratio [OR] = 0.98; 95% CI: 0.96-0.99) and absolute NC area (OR = 2.47 (95% CI: 1.14-5.36). A cutoff value of absolute NC area at ≥1.1 mm2 may serve as a significant risk predictor for no-reflow after SVG-PCI. Factors associated with MACEs and the slow/no-reflow phenomenon following PCI of the SVG can be used in risk assessment of SVG.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Oclusão de Enxerto Vascular/cirurgia , Intervenção Coronária Percutânea , Veia Safena/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sistema Cardiovascular/fisiopatologia , Feminino , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Placa Aterosclerótica/complicações , Placa Aterosclerótica/cirurgia , Medição de Risco , Fatores de Risco , Veia Safena/fisiopatologia , Stents/efeitos adversos , Ultrassonografia de Intervenção/efeitos adversos , Adulto Jovem
3.
Vasc Endovascular Surg ; 54(1): 47-50, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31581906

RESUMO

OBJECTIVES: Cyanoacrylate glue is injected for incompetent great saphenous vein (GSV) treatment 5 cm distal to the saphenofemoral junction (SFJ). Although a few reports have investigated the postprocedural remnant stump length, none have focused on the factors affecting glue extension length and the consequent remnant stump length. METHODS: Seventy-nine patients undergoing cyanoacrylate closure using the VenaSeal system at our clinic between August 2018 and November 2018 were investigated. The GSV diameter was measured just before treatment in the supine position 3 cm distal to the SFJ. Cyanoacrylate glue was injected 5 cm distal to the SFJ. RESULTS: The mean glue extension length was 1.13 ± 1.12 cm. The GSV diameter and glue extension length exhibited a significant inversely proportional relationship (P < .001). More specifically, patients with a GSV diameter ≥0.7 cm had a longer remnant stump length than those with a smaller GSV diameter (P < .001). CONCLUSIONS: An increased GSV diameter is likely associated with a decreased glue extension length and, consequently, a longer remnant stump.


Assuntos
Cianoacrilatos/administração & dosagem , Veia Safena , Adesivos Teciduais/administração & dosagem , Varizes/terapia , Adulto , Cianoacrilatos/efeitos adversos , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção , Varizes/diagnóstico por imagem , Varizes/fisiopatologia
4.
J Card Surg ; 34(9): 821-828, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31299105

RESUMO

Coronary artery bypass grafting is a key cardiac surgery procedure and is the main treatment for patients with multivessel coronary artery disease. The most frequently used conduit for this procedure is the long saphenous vein (LSV). The technique of harvesting the LSV has evolved over the last 30 years from total open harvesting to endoscopic with minimal access technique. The most important determining factor for success in coronary artery surgery is the graft patency rate. The literature evidence behind each technique has been reported at different levels and there is an ongoing debate about which technique can provide optimum vein patency over the long term. This literature review aims to summarize the current evidence, the implications involved with the use of each technique for harvesting LSV and the patency rate at variable follow-up intervals.


Assuntos
Ponte de Artéria Coronária/métodos , Veia Safena/transplante , Coleta de Tecidos e Órgãos/métodos , Grau de Desobstrução Vascular , Doença da Artéria Coronariana/cirurgia , Humanos , Veia Safena/fisiopatologia
5.
Braz J Cardiovasc Surg ; 34(3): 297-304, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310468

RESUMO

OBJECTIVES: To investigate the association between clinical hematologic parameters and saphenous vein graft failure after on-pump coronary artery bypass surgery. METHODS: A total of 1950 consecutive patients underwent isolated on-pump coronary artery surgery between November 2010 and February 2013. Of these, 284 patients met our inclusion criteria; their preoperative clinical hematological parameters were retrospectively obtained for this cohort study. And of them, 109 patients underwent conventional coronary angiography after graft failure was revealed by coronary computed tomography angiography. The primary endpoint was to catch at least one saphenous vein graft stenosis or occlusion following the coronary angiogram. We then analyzed risk factors for graft failure. In sequential or T grafts, each segment was analyzed as a separate graft. RESULTS: In logistic regression analysis, older age, platelet distribution width, and diabetes mellitus were identified as independent predictors of saphenous vein graft failure (P<0.). In contrast, preserved ejection fraction value favored graft patency (P<0.001). CONCLUSION: Increased platelet distribution width is easily measurable and can be used as a simple and valuable marker in the prediction of saphenous vein graft failure.


Assuntos
Plaquetas/fisiologia , Ponte de Artéria Coronária/efeitos adversos , Veia Safena/transplante , Grau de Desobstrução Vascular/fisiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária/métodos , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/etiologia , Ecocardiografia , Feminino , Testes Hematológicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Valor Preditivo dos Testes , Curva ROC , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Veia Safena/fisiopatologia , Estatísticas não Paramétricas , Falha de Tratamento
6.
J Vasc Surg ; 69(6S): 126S-136S, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31159976

RESUMO

BACKGROUND: The optimal strategy for revascularization in infrainguinal chronic limb-threatening ischemia (CLTI) remains debatable. Comparative trials are scarce, and daily decisions are often made using anecdotal or low-quality evidence. METHODS: We searched multiple databases through May 7, 2017, for prospective studies with at least 1-year follow-up that evaluated patient-relevant outcomes of infrainguinal revascularization procedures in adults with CLTI. Independent pairs of reviewers selected articles and extracted data. Random-effects meta-analysis was used to pool outcomes across studies. RESULTS: We included 44 studies that enrolled 8602 patients. Periprocedural outcomes (mortality, amputation, major adverse cardiac events) were similar across treatment modalities. Overall, patients with infrapopliteal disease had higher patency rates of great saphenous vein graft at 1 and 2 years (primary: 87%, 78%; secondary: 94%, 87%, respectively) compared with all other interventions. Prosthetic bypass outcomes were notably inferior to vein bypass in terms of amputation and patency outcomes, especially for below knee targets at 2 years and beyond. Drug-eluting stents demonstrated improved patency over bare-metal stents in infrapopliteal arteries (primary patency: 73% vs 50% at 1 year), and was at least comparable to balloon angioplasty (66% primary patency). Survival, major amputation, and amputation-free survival at 2 years were broadly similar between endovascular interventions and vein bypass, with prosthetic bypass having higher rates of limb loss. Overall, the included studies were at moderate to high risk of bias and the quality of evidence was low. CONCLUSIONS: There are major limitations in the current state of evidence guiding treatment decisions in CLTI, particularly for severe anatomic patterns of disease treated via endovascular means. Periprocedural (30-day) mortality, amputation, and major adverse cardiac events are broadly similar across modalities. Patency rates are highest for saphenous vein bypass, whereas both patency and limb salvage are markedly inferior for prosthetic grafting to below the knee targets. Among endovascular interventions, percutaneous transluminal angioplasty and drug-eluting stents appear comparable for focal infrapopliteal disease, although no studies included long segment tibial lesions. Heterogeneity in patient risk, severity of limb threat, and anatomy treated renders direct comparison of outcomes from the current literature challenging. Future studies should incorporate both limb severity and anatomic staging to best guide clinical decision making in CLTI.


Assuntos
Implante de Prótese Vascular , Procedimentos Endovasculares , Isquemia/terapia , Doença Arterial Periférica/terapia , Veia Safena/transplante , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Isquemia/diagnóstico , Isquemia/mortalidade , Isquemia/fisiopatologia , Salvamento de Membro , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Intervalo Livre de Progressão , Medição de Risco , Fatores de Risco , Veia Safena/fisiopatologia , Stents , Fatores de Tempo , Grau de Desobstrução Vascular
8.
J Vasc Access ; 20(6): 782-785, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31006336

RESUMO

We devised a method that enables blood removal/return by creating a fistula between the skin and the great saphenous vein to insert the dialysis needle sheath in the femoral vein under ultrasonography guidance with respect to each dialysis. We report the principles, methods, and cases. A skin-great saphenous vein fistula is created under local anesthesia. It is used for blood removal/return during maintenance hemodialysis performed immediately after creating the fistula. Ten limbs of 10 patients (three men and seven women; mean age, 77.6 ± 4.8 years; dialysis history, 9.9 ± 13.0 years), where skin-great saphenous vein fistulas were created in our hospital between May 2017 and June 2018, were included. In all the cases, an arteriovenous fistula or arteriovenous graft was difficult to create because of the general condition and/or vascular fitness of the patients. During or after the fistula-creating surgery, no serious complications were found. No complications such as blood removal failure, infection, or hemorrhage were found during the follow-up period. The primary patency rates by the Kaplan-Meier method were 100% at 3 months and 67.5% at 6 months. This method is considered a valuable substitute method for cases with difficulty in creating a vascular access.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Diálise Renal , Veia Safena/cirurgia , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Feminino , Humanos , Masculino , Fluxo Sanguíneo Regional , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular
9.
Ann Vasc Surg ; 59: 231-236, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009711

RESUMO

BACKGROUND: The procedure aims to show our results with a novel nontumescent, nonthermal technique to treat varicose veins. The V-block occlusion stent is a minimally invasive device for treating reflux of the great saphenous vein (GSV). It is an office-based procedure that does not require tumescence anesthesia. The V-block stent is a self-expandable device that functions as a vein occluder and blood clot trap. Once the V-block is in place, further treatment of the saphenous vein such as ultrasound-guided sclerotherapy can be performed. The V-block device is intended to eliminate the possibility of forwarding passage of clot and sclerosant (embolization) to the deep and pulmonary circulations. METHODS: Patients were treated in an outpatient setting with the V-block occluding device. Follow-up was performed using duplex ultrasound to assess occlusion of the saphenous vein as well as the Aberdeen Varicose Vein Questionnaire and Venous Severity Scoring to determine changes in quality of life after the procedure. Patients were followed up at 1 week, 1 month, and 3 months after V-block placement. Duplex scanning was performed to confirm GSV occlusion at all follow-up visits. After deployment of the occlusion stent, a maximum of 2% polidocanol foam was injected with a double barrel syringe which simultaneously evacuated blood from the greater saphenous vein. Follow-up assessment for safety included evaluation of potential complications, device migration, and potential injury at the deployment site. RESULTS: Fifty-one symptomatic subjects with documented GSV reflux were enrolled in the study. Complete occlusion of the GSV was achieved in 98% of the patients during the 7-day postprocedural visit. There was no injury at the deployment site. No migration of the V-block device was observed. No deep vein thrombosis or any other complication was recorded. One patient of the 50 patients and 51 procedures experienced an adverse event, phlebitis that resolved under conservative therapy within 4 days with no residual effect. There was a significant improvement in the Aberdeen Vein quality of life measurements and the pain scores. After 3 years, 18 patients were willing to undergo a duplex follow-up examination. The occlusion rate after 3 years was 77.8. There were no device-related complications after this period. CONCLUSIONS: The study demonstrated a good safety and performance profile without any major adverse events. The primary end point of vein occlusion and obliteration was met.


Assuntos
Procedimentos Endovasculares/instrumentação , Polidocanol/administração & dosagem , Veia Safena , Soluções Esclerosantes/administração & dosagem , Escleroterapia/instrumentação , Stents , Varizes/terapia , Idoso , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polidocanol/efeitos adversos , Desenho de Prótese , Qualidade de Vida , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Ultrassonografia de Intervenção , Varizes/diagnóstico por imagem , Varizes/fisiopatologia
10.
Eur J Vasc Endovasc Surg ; 57(4): 570-577, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30898493

RESUMO

OBJECTIVES: Reflux assessment with ultrasound (U/S) is usually qualitative. Quantitative measurements of superficial venous insufficiency (SVI) include the venous arterial flow index (VAFI), recirculation index (RCI), venous filling index (VFI), and the postural diameter change (PDC) of the saphenous trunk. The aim was to investigate their relationship. MATERIALS AND METHODS: This was an observational study performed on patients with varicose veins and hospital employees. Four haemodynamic parameters were measured in 21 legs from 16 subjects. Legs were divided into no reflux (n = 7) and reflux (n = 14). The VAFI is the U/S ratio of common femoral vein volume flow divided by the common femoral artery volume flow, performed supine. The RCI is the U/S ratio of reflux volume over antegrade volume within the saphenous trunk after calf compression, standing. The VFI is the rate of calf volume increase on dependency measured in mL/s, using air plethysmography. The PDC is the percentage reduction of the saphenous trunk diameter from standing to lying, using U/S. RESULTS: The clinical part of the CEAP classification was: C0 = 3, C1 = 4, C2 = 5, C3 = 1, C4a = 1, C4b = 6, C5 = 1. All four tests demonstrated significant differences between the two groups with minimal overlap (Mann Whitney U test): VAFI (p = .028), RCI (p < .0005), VFI (p = .001), and PDC (p = .014). Furthermore, significant correlations were observed with the tests: VAFI vs. RCI (r = .532, p = .015), VFI (r = .489, p = .025) and PDC (r = -.474, p = .030); RCI vs. VFI (r = .446, p = .043) and PDC (r = -.527, p = .014). CONCLUSIONS: Superficial venous drainage insufficiency should not be confined to an U/S assessment of the presence of reflux, which is qualitative. Quantitative data may be provided using the VAFI, RCI, VFI, and PDC. Understanding why there are significant correlations among these parameters and the preferred objective reference test requires further work.


Assuntos
Hemodinâmica , Pletismografia , Veia Safena/diagnóstico por imagem , Ultrassonografia/métodos , Varizes/diagnóstico por imagem , Insuficiência Venosa/diagnóstico por imagem , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Veia Safena/fisiopatologia , Índice de Gravidade de Doença , Varizes/fisiopatologia , Insuficiência Venosa/fisiopatologia
13.
Ann Vasc Surg ; 57: 276.e5-276.e8, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30731231

RESUMO

It has long been reported that cryogenic allografts have suboptimal mid- and long-term patencies and consequently are only used in the absence of autologous vein, predominantly in lower extremity limb salvage situations. As such, we felt that our recent experience with an upper extremity bypass for limb salvage using a cryogenic saphenous vein allograft, which aneurysmally degenerated after one month and required multiple endovascular rescues, serves to re-emphasize such concerns and the importance of continuous postoperative surveillance.


Assuntos
Bioprótese , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares , Doença Arterial Periférica/cirurgia , Falha de Prótese , Veia Safena/transplante , Extremidade Superior/irrigação sanguínea , Aloenxertos , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Fluxo Sanguíneo Regional , Terapia de Salvação , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Stents , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Grau de Desobstrução Vascular
14.
Ann Vasc Surg ; 57: 275.e1-275.e4, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30711505

RESUMO

We report a case of saphenous vein bypass aneurysm and arteriovenous fistula in a 65-year-old man, 20 years after an in situ vein bypass for occlusive disease. He was found to have patent venous branches which kept the bypass open despite distal anastomotic occlusion. The saphenous vein was successfully excised without distal revascularization due to sufficient native arterial flow. This is the first reported case of aneurysmal degeneration of an in situ vein conduit with occluded distal anastomosis and patent venous side branches. Ultrasound surveillance is warranted for all bypass procedures, and early endovascular or open revisions can prevent late complications.


Assuntos
Aneurisma/etiologia , Arteriopatias Oclusivas/cirurgia , Fístula Arteriovenosa/etiologia , Veia Safena/cirurgia , Enxerto Vascular/efeitos adversos , Idoso , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Aneurisma/cirurgia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/fisiopatologia , Fístula Arteriovenosa/cirurgia , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Flebografia/métodos , Fluxo Sanguíneo Regional , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
15.
BMJ Open ; 9(1): e024813, 2019 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-30705242

RESUMO

INTRODUCTION: Endovenous ablations are the new standard procedures for treatment of great saphenous vein reflux including endovenous laser ablation (EVLA), radio frequency ablation (RFA), endovenous steam ablation (EVSA), mechanochemical ablation (MOCA), cyanoacrylate injection and ultrasound-guided foam sclerotherapy (UGFS). EVLA and RFA have demonstrated similar anatomical success for short-term outcome, but results are controversial for longer term (≥5 years). Additional evidences from randomised controlled trials have been published. This study is, therefore, conducted to, directly and indirectly, compare outcomes among all procedures stratifying by short-term and long-term follow-up. METHODS AND ANALYSIS: Medline and Scopus will be searched from 2000 to September 2018 with predefined search strategy. Interventions of interest are open surgery (ie, saphenofemoral or high ligation (HL) with stripping) and endovenous ablations (ie, EVLA, RFA, EVSA, MOCA, cyanoacrylate injection and UGFS). The primary outcome is anatomical success. Two independent reviewers will select studies, extract data and assess risk of bias. Disagreement will be adjudicated by the third party. Outcomes will be directly pooled if there are at least three studies in that comparison. A fixed-effect model will be used unless heterogeneity is present, in which case a random-effect model will be applied. Sources of heterogeneity will be explored using meta-regression analysis, and sub-group analysis will be done accordingly. Publication bias will be assessed using Egger's test and funnel plot. A network meta-analysis will be applied to indirect compare all interventions including RFA, EVLA, EVLA with HL, UGFS, UGFS with HL and HL with stripping. Probability of being best intervention will be estimated and ranked. Inconsistency assumption will be checked using a design-by-treatment interaction model. ETHICS AND DISSEMINATION: Ethical approval is not required for systematic review and network meta-analysis. The study will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42018096794.


Assuntos
Veia Safena/cirurgia , Varizes/terapia , Insuficiência Venosa/terapia , Ablação por Cateter , Cianoacrilatos/administração & dosagem , Procedimentos Endovasculares , Humanos , Terapia a Laser , Meta-Análise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Projetos de Pesquisa , Veia Safena/fisiopatologia , Escleroterapia , Revisão Sistemática como Assunto , Fatores de Tempo , Resultado do Tratamento
16.
Ann Vasc Surg ; 58: 302-308, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30769060

RESUMO

BACKGROUND: The aim of this study is to compare 2 groups of patients treated for great saphenous vein (GSV) reflux with open surgical saphenofemoral ligation (SFL) and endovenous laser ablation (EVLA). METHODS: Consecutive patients with primary unilateral GSV reflux undergoing EVLA treatment since 2014 were enrolled, and another series of patients treated with SFL was considered. The patients were stratified according to treatment and the results were compared using the propensity score (1:1). The covariables were age, gender, body mass index, CEAP (Clinical class, Etiology, Anatomy and Pathophysiology) staging, and GSV and saphenofemoral junction diameters. Primary outcomes were GSV occlusion or recurrent groin varicose veins at 1 year after treatment. Secondary outcomes included vein thrombosis, hyperpigmentation, paresthesia, postoperative pain, analgesic requirement, and ecchymosis assessed at discharge and CEAP stage and quality of life (QoL) assessment 1 month after surgery. RESULTS: A total of 123 patients were included in the study: 59 were treated with EVLA and 64 with SFL. At 12 months, we observed 10 recurrent groin varicose veins after SFL (15.6%) and 6 GSV recanalization after EVLA (10.2%, P = 0.369). Extra-saphenous recurrent varicose veins were observed in 36 patients (29.3%): 20 in the open group (31.2%) and 16 in EVLA group (27.1%, P = 0.615). After matching procedure 74 patients were analyzed (37 patients by group), logistic regression model showed that the risk of outcome was not associated with the surgical treatment (odds ratio 1.76, 95% confidence interval 0.52-6.01). CONCLUSIONS: Both techniques to treat saphenous impairment have demonstrated to be safe, with good results in terms of efficacy and symptomatic improvement at follow-up. EVLA with 1,470 nm seems to have lower rates of recurrence and good perceived QoL. Tumescent anesthesia is a good option with good results and may be extended to open surgical ligation.


Assuntos
Anestesia Local , Procedimentos Endovasculares/instrumentação , Veia Femoral/cirurgia , Terapia a Laser/instrumentação , Lasers Semicondutores/uso terapêutico , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Anestesia Local/efeitos adversos , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Terapia a Laser/efeitos adversos , Lasers Semicondutores/efeitos adversos , Ligadura , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Qualidade de Vida , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
17.
ABC., imagem cardiovasc ; 32(1): 14-18, jan.-mar. 2019. ilus, tab, graf
Artigo em Português | LILACS | ID: biblio-969861

RESUMO

A correta identificação dos pontos de refluxo no estudo das varizes primárias dos membros inferiores é importante na abordagem terapêutica desses pacientes. Objetivo: Avaliar a associação entre a insuficiência de veias perfurantes anteriores do joelho e a insuficiência de veia safena magna em pacientes com varizes primárias de membros inferiores. Métodos: Foram avaliados 886 pacientes, correspondendo a 1.772 membros inferiores, em pacientes acima de 18 anos, de ambos os sexos, submetidos ao mapeamento venoso superficial pela ecografia vascular. Resultados: Os pacientes apresentaram idade média de 46,1 ± 14,5 anos, sendo 81,7% do sexo feminino. A insuficiência de veia safena magna foi encontrada em 38,8% dos casos. A insuficiência da perfurante anterior do joelho foi encontrada em 146 membros inferiores (8,2%), com diâmetro médio de 1,7 ± 0,15 mm, sendo predominante a localização infrapatelar (86,4%). A tributária anterior da veia safena magna originou o refluxo na perna em 34%, com relação direta desta tributária com a perfurante anterior do joelho em 79,4%. Observou-se associação entre a presença de perfurante anterior do joelho e insuficiência de veia safena magna (p = 0,0001) e sexo masculino (p = 0,001). Conclusão: Houve associação entre insuficiência de perfurante anterior do joelho e insuficiência de veia safena magna em pacientes com varizes primárias dos membros inferiores submetidos à ecografia vascular, sendo que a correta identificação desta perfurante pode ser importante na abordagem terapêutica desses pacientes


The accurate identification of reflux points in the study of primary varicose veins of the lower limbs is important in the therapeutic approach of these patients. Objective: To evaluate the association between insufficiency of the anterior perforator vein of the knee and great saphenous vein insufficiency in patients with primary varicose veins of the lower limbs. Methods: The study included 886 patients, corresponding to 1,772 lower limbs, in patients older than 18, of both sexes, undergoing superficial venous mapping using vascular ultrasound. Results: The mean age of the patients was 46.1 ± 14.5 and 81.7% were females. Great saphenous vein insufficiency was found in 38.8% of the cases. Insufficiency of the anterior perforator vein of the knee was found in 146 lower limbs (8.2%), with a mean diameter of 1.7 ± 0.15 mm, prevailing in the infrapatellar area (86.4%). The anterior tributary vein of the great saphenous vein originated leg reflux in 34%, with a direct relation of this tributary vein with the anterior perforator vein of the knee in 79.4%. An association between the presence of anterior perforator vein of the knee and great saphenous vein insufficiency (p = 0.0001) and male gender (p = 0.001). Conclusion: There was an association between insufficiency of the anterior perforator vein of the knee and great saphenous vein insufficiency in patients with primary varicose veins of the lower limbs at vascular ultrasound, and the accurate identification of this perforator vein may be important in the therapeutic approach of these patients


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Veia Safena/fisiopatologia , Varizes/diagnóstico por imagem , Insuficiência Venosa/cirurgia , Extremidade Inferior/cirurgia , Diagnóstico por Imagem/métodos , Fatores Sexuais , Doença Crônica , Prevalência , Estudos Transversais , Ultrassonografia/métodos
18.
Phlebology ; 34(1): 17-24, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29514566

RESUMO

BACKGROUND: In physiology, velocity of the deep venous compartment is higher than the one in the saphenous compartment which is higher than the one in the tributaries. Considering that velocity variation is associated with changes in the pressure gradient, aim of the present study is to assess changes in venous kinetics in case of superficial chronic venous disease, so to provide further clues in venous drainage direction determination. METHODS: Venous ultrasound scanning was performed on 40 lower limbs of 28 chronic venous disease patients (C2-6Ep,As,Pr). Velocities were measured in three different venous segments: great saphenous vein at 2 cm above the origin of the incompetent tributary (Group-A). great saphenous vein at 2 cm below the origin of tributary (Group-B). tributary at 2 cm from its origin from the great saphenous vein (Group-C.). RESULTS: Diastolic time average velocity was higher in group-C (-21.3 ± 8.5 cm/s) than in group-A (-15.7 ± 5.2 cm/s; p = .0001) and group-B (-11.1 ± 2.9 cm/s; p = .0001), thus indicating an inversion of the physiological velocity gradient in chronic venous disease patients. DISCUSSION: Chronic venous disease presents a subverted velocity gradient. These data introduce objective hemodynamics data, paving the way for further investigation in venous drainage direction determination.


Assuntos
Veia Femoral , Veia Safena , Ultrassonografia Doppler Dupla , Varizes , Insuficiência Venosa , Adolescente , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Doença Crônica , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
19.
Asian Cardiovasc Thorac Ann ; 27(2): 121-123, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29719982

RESUMO

A saphenous vein graft chronic total occlusion intervention is uncommonly performed, partly due to the high risk of distal embolization. We described a strategy in which after successful wiring of a saphenous vein graft chronic total occlusion, balloon dilatation was performed to create a blind sac within the lesion, followed by aspiration thrombectomy to remove all the dislodged debris. Thereafter, balloon dilatation and stenting were safely performed in the distal occluded segment, to achieve complete recanalization.


Assuntos
Angioplastia Coronária com Balão , Ponte de Artéria Coronária/efeitos adversos , Oclusão de Enxerto Vascular/cirurgia , Veia Safena/transplante , Trombectomia , Trombose/cirurgia , Angioplastia Coronária com Balão/instrumentação , Angiografia Coronária , Stents Farmacológicos , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular
20.
Phlebology ; 34(2): 88-97, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29726741

RESUMO

OBJECTIVES: To investigate the haemodynamic causes of skin changes in limbs with primary varicose veins, which were assessed with air plethysmography. METHODS: Five hundred seventeen consecutive patients with axial reflux in the great saphenous vein (varicose vein group) and 248 normal subjects (normal group) were investigated. Varicose vein group patients were divided into two groups according to whether they did (C4-6) or did not (C2-3) have skin changes. Several parameters obtained using air plethysmography were compared among the normal group, C2-3 and C4-6 patients. RESULTS: Although there was no significant difference in the regurgitation index to quantify venous reflux in C2-3 and C4-6 patients, the maximum arterial inflow rate increased (normal group < C2-3 < C4-6), even in limbs with a small amount of venous reflux. CONCLUSIONS: This study suggests that it is not essential to increase the venous reflux rate in skin change development; rather, it is based on various pathophysiological conditions that increase the arterial inflow rate.


Assuntos
Veia Safena , Pele , Varizes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veia Safena/fisiologia , Veia Safena/fisiopatologia , Pele/patologia , Pele/fisiopatologia , Varizes/patologia , Varizes/fisiopatologia
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