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1.
J Vasc Access ; 21(1): 105-109, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31328635

RESUMO

Non-maturation of arteriovenous fistulas is a frequent problem after dialysis access creation, especially in the forearm. The presence of accessory veins may play an important role in the non-maturing fistula. Several surgical and endovascular techniques are described to deal with this problem. We describe a new surgical technique in which we perform a rejoining of the arm veins to create a single large run-off vessel with greater diameter and flow for haemodialysis.


Assuntos
Braço/irrigação sanguínea , Derivação Arteriovenosa Cirúrgica/métodos , Diálise Renal , Veias/cirurgia , Adulto , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem
2.
Khirurgiia (Mosk) ; (12): 54-59, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825343

RESUMO

OBJECTIVE: To analyze the causes and develop methods for the treatment of extensive purulent processes after combined phlebectomy in patients with lower limb varicose veins. MATERIAL AND METHODS: The authors reported 3 cases of extensive phlegmon after phlebectomy for the period from 2014 to 2018. It is shown that comprehensive debridement of purulent-inflammatory lesion with application of additional methods including high-energy exposure by the air-plasma flow is essential for effective treatment of this complication. In addition, literature review showed only few observations of severe septic complications after traditional varicose vein surgery. RESULTS: Radical debridement of purulent wounds with wide excision of necrotic subcutaneous tissue and fascia, combination of standard surgical technique and plasma scalpel, as well as subsequent plasmodynamic staged wound repair in a therapeutic mode prevented severe purulent-inflammatory process, stopped systemic inflammatory syndrome and resulted fast wound healing. CONCLUSION: Active surgical approach combined with air-plasma technology was followed by high-quality correction of extensive suppurative process. Minimally invasive management of varicose disease with improvement of surgical techniques will minimize the likelihood of these complications.


Assuntos
Celulite (Flegmão)/cirurgia , Supuração/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Celulite (Flegmão)/etiologia , Desbridamento , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Supuração/etiologia , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento , Veias/cirurgia
3.
Angiol Sosud Khir ; 25(4): 116-122, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855208

RESUMO

The purpose of the study was to work out a Russian-made, simple-to-manufacture, safe, inexpensive and efficient device for performing endovasal laser obliteration (EVLO) of varicose veins, with the underlying principle of endoluminal distribution of the total laser energy into several flows. The development of this device was based on the principle of dividing the total laser radiation into two energy flows. One flow has a shape of circularly formed, continuous field of laser radiation of specified width within the angular range from 50 to 90°, which ensures the main energetic contribution to thermal impact on the vascular wall. The second energetic flow is formed in the part of the tip having a shape of a truncated cone, along the axis of the optical fibre within the angular range from 10 to 50°, which ensures additional thermal effect of radiation on the narrowing walls of the venous channel. Starting from 2016, EVLO with the use of the developed device was performed in a total of 50 patients with class C2-C3 varicose veins. The morphogenesis of the occurring restructuring of the venous wall was studied intraoperatively and in various time periods. Tissue specimens obtained intraoperatively demonstrated in the majority of cases complete or partial intimal detachment, swelling, disorganization of the middle membrane, adventitial loosening with thrombosis of the elements of the vasa vasorum in the majority of portions. The histological specimens harvested at 10 to 14 days were found to contain in the venous wall clear-cut distinct evidence of actively commensing connective-tissue proliferation. At 1 month of follow up the specimens of the veins treated with EVLO using the developed device showed the beginning of collagenisation of the wall, with finally fibrous restructuring and wall hyalinosis by month 3 after EVLO. The proposed device for EVLO of varicose veins makes it possible to act upon the venous wall simultaneously with two energy flows which excludes negative thermal action of excess energy of laser radiation on the vascular wall while using unidirectional radiation in the form of one or even two, but thin rings and, thus, dramatically decreasing reducing the risk for the development of complications. Implementation of the new device into the phlebological practice in Russia in conditions of complete import substitution has significant economic benefit.


Assuntos
Terapia a Laser/instrumentação , Varizes/cirurgia , Veias/cirurgia , Humanos , Varizes/patologia , Veias/patologia
4.
Plast Reconstr Surg ; 144(5): 751e-759e, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688749

RESUMO

BACKGROUND: The objective of this study was to compare the economic impact of complete decongestive therapy and lymphovenous bypass in the management of upper extremity lymphedema. METHODS: Economics were modeled for a patient with breast cancer-related lymphedema undergoing three different clinical pathways: (1) complete decongestive therapy alone; (2) lymphovenous bypass no longer requiring ongoing complete decongestive therapy; or (3) lymphovenous bypass requiring ongoing complete decongestive therapy. Activity-based cost analysis identified costs incurred with complete decongestive therapy and lymphovenous bypass. Costs were retrieved from supplier price lists, physician fee schedules, lymphedema therapists, and literature reviews. The net present value of all costs incurred for each clinical pathway were calculated. RESULTS: The estimated net present value of all costs for a patient with breast cancer-related lymphedema undergoing treatment were as follows: (1) complete decongestive therapy alone ($30,400); (2) lymphovenous bypass no longer requiring ongoing complete decongestive therapy ($15,000); or (3) lymphovenous bypass requiring ongoing complete decongestive therapy ($42,100). The expected net present value of all costs for lymphovenous bypass was $26,800, which was comparable to that of complete decongestive therapy alone. Sensitivity analysis demonstrated that the expected net present value of lymphovenous bypass was dependent on the patient's life expectancy, number of bypass anastomoses, and likelihood of discontinuing complete decongestive therapy. CONCLUSIONS: Lymphedema has substantial ongoing costs irrespective of the treatment modality. The cost of lymphovenous bypass appears comparable to that of complete decongestive therapy alone-the surgical costs of lymphovenous bypass are offset by the savings from discontinued ongoing therapy. Despite its limitations as a theoretical economic model, this study provides insight into the potential economic impact of lymphovenous bypass.


Assuntos
Linfedema Relacionado a Câncer de Mama/economia , Linfedema Relacionado a Câncer de Mama/cirurgia , Análise Custo-Benefício , Custos de Cuidados de Saúde , Excisão de Linfonodo/economia , Mastectomia/efeitos adversos , Anastomose Cirúrgica/economia , Anastomose Cirúrgica/métodos , Linfedema Relacionado a Câncer de Mama/fisiopatologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Canadá , Estudos de Coortes , Drenagem/economia , Drenagem/métodos , Feminino , Humanos , Excisão de Linfonodo/métodos , Vasos Linfáticos/cirurgia , Mastectomia/métodos , Estudos Prospectivos , Procedimentos Cirúrgicos Vasculares/economia , Procedimentos Cirúrgicos Vasculares/métodos , Veias/cirurgia
5.
Plast Reconstr Surg ; 144(5): 1214-1224, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688769

RESUMO

BACKGROUND: Lymphorrhea is probably the most appalling form of lymphedema and is difficult to treat. Intractable lymphorrhea is prone to infection because of skin breakdown. It is believed that supermicrosurgical lymphaticovenous anastomosis is unsuitable for treating such severe disease. Only a few lymphorrhea patients treated with lymphaticovenous anastomosis have been reported. Whether it can be used to treat lymphorrhea has remained inconclusive. METHODS: From September of 2015 to June of 2018, 105 patients underwent supermicrosurgical lymphaticovenous anastomosis (n = 746) in the authors' hospital. These patients are divided into the nonlymphorrhea group (three male and seven female patients) and the nonlymphedema group (lymphedema patients without lymphorrhea) (11 male and 84 female patients). Retrospective chart review with demographic data and intraoperative findings were recorded and analyzed. Post-lymphaticovenous anastomosis outcomes for lymphorrhea patients were also recorded. RESULTS: No significant differences were found in patient age, sex, or affected limbs between these two groups. As for intraoperative findings, no differences were found in the percentage of indocyanine green-enhanced lymphatic vessels (52.7 ± 41.1 percent versus 67.3 ± 36.7 percent; p = 0.227) or the pathologic changes of lymphatic vessels based on the normal, ectasis, contraction, and sclerosis type classification (2.2 ± 1.0 versus 2.1 ± 1.0; p = 0.893) between the lymphorrhea and nonlymphorrhea groups, respectively. The average follow-up period was 14.5 months (range, 3 to 31 months). Five lymphorrhea patients (50 percent) showed complete recovery without relapse; significant lymphorrhea reduction was found in three patients (30 percent), and two patients showed minimal improvements (20 percent). CONCLUSION: With comparable functional lymphatic vessels identified in lymphorrhea patients, supermicrosurgical lymphaticovenous anastomosis is a viable option for lymphorrhea treatment, with satisfactory results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Vasos Linfáticos/cirurgia , Linfedema/diagnóstico por imagem , Linfedema/cirurgia , Microcirurgia/métodos , Veias/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/métodos , China , Estudos de Coortes , Feminino , Hospitais Universitários , Humanos , Extremidade Inferior/cirurgia , Linfocintigrafia/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do Tratamento
6.
Angiol Sosud Khir ; 25(3): 129-134, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31503257

RESUMO

Surgical management of patients with tumour invasion of major veins by means of their resection and simultaneous reconstruction is an actively developing trend in modern surgery. The article describes a clinical case report concerning treatment of a patient presenting with disseminated neuroendocrine cancer of the pancreatic head and subjected to pancreatoduodenal resection with a complicated variant of mesenteric-portal reconstruction and the use of a graft made of porous polytetrafluoroethylene, followed by relapse-free survival of more than 5 years. In our case report, despite complexity of forming a proximal anastomosis, the findings of multislice computed tomography with 3D-reconstruction 4 months after the operation demonstrated uneven circular thickening of the graft's wall by 1-2 mm, which might be interpreted as neointimal hyperplasia. The maximum thickness amounted to 2 mm in the area of the distal anastomosis. Thus, the internal diameter of the graft varied from 8 to 9 mm. The minimum thickness was observed in the middle portion of the graft, amounting to 1 mm. The findings of computed tomography at 60 postoperative months demonstrated no evidence of the disease's progression, the portal system of the liver contrasted evenly, the mesenteric-portal graft fully patent, showing parietally a thin uneven low-density strip 1-2 mm thick (with the maximum thickness observed in the area of anastomoses and the minimum thickness in the centre of the graft). Thus, the obtained findings are suggestive of high efficacy, safety, and feasibility of using polytetrafluoroethylene grafts for reconstruction of major veins in clinical practice. More randomized studies are necessary to confirm our conclusions.


Assuntos
Invasividade Neoplásica , Politetrafluoretileno , Próteses e Implantes , Procedimentos Cirúrgicos Vasculares , Humanos , Hiperplasia , Sistema Porta , Veias/patologia , Veias/cirurgia
7.
Clin Nephrol ; 92(5): 233-236, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31496512

RESUMO

OBJECTIVE: To compare the functions and complications of forearm basilic vein transposition-arteriovenous fistula (BVT-AVF) created using the no-touch technique with that of conventional radiocephalic arteriovenous fistula (RC-AVF). MATERIALS AND METHODS: The no-touch technique was used to created basilic vein transposition-radial artery fistula in 22 patients. Another 30 patients received surgeries for RC-AVF. The fistula functions and complications were compared between these two groups. RESULTS: The two groups did not differ significantly in the incidence of postoperative bleeding, limb swelling, infection, steal syndrome, fistula thrombosis, fistula aneurysm, fistula flow, fistula maturation time, Kt/v, and fistula median survival. CONCLUSION: Forearm BVT-AVF created by the no-touch technique is a good alternative access for patients in whom the standard arteriovenous fistula cannot be established.


Assuntos
Derivação Arteriovenosa Cirúrgica , Antebraço/irrigação sanguínea , Artéria Radial/cirurgia , Veias/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Derivação Arteriovenosa Cirúrgica/estatística & dados numéricos , Humanos , Hemorragia Pós-Operatória/epidemiologia
8.
J Hand Surg Asian Pac Vol ; 24(3): 359-370, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31438795

RESUMO

Background: Chronic hand ischemia refers to progressive, non-acute ischemic symptoms such as cold intolerance, rest pain, ulceration, tissue necrosis, and digit loss and poses a significant challenge in management. Conservative treatment begins with medical optimization and pharmacologic therapy, but when symptoms persist, surgical intervention may be required. Various operations exist to improve circulation including sympathectomy, arterial bypass, or venous arterialization. The purpose of this study is to systematically review published outcomes and present our experience with each surgical technique. Methods: A systematic review of literature regarding surgical treatment of chronic hand ischemia published between 1990 and 2016 was conducted using PRISMA guidelines. A retrospective-review of surgical interventions for chronic hand ischemia from 2010 to 2016 was then conducted. Primary outcomes included improvement in pain, wound-healing, and development of new ulcerations. Results: The review included 38 eight studies, showing all three techniques were effective in treating chronic hand ischemia. Sympathectomy had the lowest rate of new ulcerations (0.8%); bypass had the highest rate of healing existing ulcerations (89%). Arterialization was associated with consistent pain improvement pain (100%) but more complications (30.8%). Our series included 18 patients with 21 affected hands, 18 sympathectomies, 6 ulnar artery bypasses, and 1 arterialization. Most hands had improvement of wounds (89.5%) and pain (78.9%). No patients developed new ulcerations, but one required secondary amputation. Conclusions: When conservative measures fail to improve chronic hand ischemia, surgical intervention is an effective last line treatment. An algorithmic approach can determine the best operation for patients with chronic hand ischemia.


Assuntos
Mãos/irrigação sanguínea , Isquemia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Estudos Retrospectivos , Simpatectomia , Resultado do Tratamento , Artéria Ulnar/cirurgia , Veias/cirurgia , Adulto Jovem
10.
Ulus Travma Acil Cerrahi Derg ; 25(4): 389-395, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31297775

RESUMO

BACKGROUND: The goal of this retrospective study was to clarify the effect of using temporary vascular shunt (TVS) as a previous intervention. METHODS: A total of 96 cases with war-related lower extremity arterial injury and surgically treated between October 2013 and March 2016 were included in the study. The patients were divided into two groups: those in which TVS was performed as a previous intervention on admission (TVS group, n=24) and those in which compression, tourniquet, and ligation/clampage were performed as a previous intervention on admission (non-TVS group, n=72). RESULTS: In comparing injury pattern, there was no difference between the two groups. In addition, mean hematocrit level, mean systolic blood pressure, the incidence of concomitant vein injury, nerve injury, soft tissue damage, and bone injury were similar in both groups. The overall amputation rate was 19%. There were a total of 18 amputations, with 1 (4%) in the TVS group and 17 (24%) in the non-TVS group. The difference on amputation rate was statistically significant. The mean values of the mangled extremity severity score (MESS) were 6.45 in the TVS group and 7.44 in the non-TVS group. The overall mean MESS was 7.1. The duration of ischemia (DoI) was 4.84+-1.84 h in the TVS group and 5.95+-1.92 h in the non-TVS group. These differences in MESS and DoI were statistically significant. CONCLUSION: We think that it may be beneficial for patients to consider a TVS to reduce DoI and gain time for surgical revascularization. As a result, the present study demonstrates that the use of TVS may successfully serve as a bridge between initial injury and definitive repair with a reduction in amputation rates.


Assuntos
Artérias/lesões , Traumatismos da Perna/cirurgia , Extremidade Inferior/irrigação sanguínea , Lesões do Sistema Vascular/cirurgia , Adulto , Idoso , Amputação/estatística & dados numéricos , Conflitos Armados , Artérias/diagnóstico por imagem , Artérias/cirurgia , Embolectomia com Balão , Angiografia por Tomografia Computadorizada , Constrição , Feminino , Humanos , Escala de Gravidade do Ferimento , Traumatismos da Perna/diagnóstico por imagem , Traumatismos da Perna/etiologia , Ligadura , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/lesões , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síria , Trombose/cirurgia , Fatores de Tempo , Resultado do Tratamento , Doenças Vasculares/complicações , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/diagnóstico por imagem , Veias/lesões , Veias/cirurgia , Adulto Jovem
11.
Zhonghua Er Ke Za Zhi ; 57(7): 526-531, 2019 Jul 02.
Artigo em Chinês | MEDLINE | ID: mdl-31269552

RESUMO

Objective: To investigate the effect of the endoscopic selective varices devascularization (ESVD) for the esophageal gastric varices bleeding (EGVB) in children. Methods: The clinical data of the patients diagnosed with EGVB and treated with ESVD from January 2018 to March 2018 were retrospectively analyzed. The effects, safety and complications of ESVD were evaluated. Results: There were five patients (including 2 males and 3 females, age ranged from 4 to 7 years) in the study. No rebleeding was found at the first follow-up on one week post operation. Three patients were treated with the endo-therapy at the twice follow-up (3 months after surgery): 2 patients had ESVD again and 1 patient had resection under endoscopy due to stenosis caused by surgical scar. After the second procedure, there was no rebleeding but one patient had abdominal pain caused by mesenteric thrombosis, cured with low molecular weight heparin. Conclusion: The ESVD for EGVB is safe and effective, but the long-term curative effect should be further studied.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Esôfago/cirurgia , Hemorragia Gastrointestinal/cirurgia , Veias/cirurgia , Criança , Pré-Escolar , Endoscopia , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/cirurgia , Esôfago/irrigação sanguínea , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
12.
Int J Surg ; 68: 117-125, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31271930

RESUMO

PURPOSE: To evaluate current views on comparing delayed ligature of the dorsal venous complex (D-DVC) with standard ligature of the dorsal venous complex (S-DVC) for safety, urinary control and oncological outcomes during laparoscopic radical prostatectomy. METHODS: A comprehensive searching of PubMed, Web of science, Embase and the Cochrane Library was made and then we performed a meta-analysis, including all randomized controlled trials (RCTs) and retrospective studies, to evaluate the two different techniques. RESULTS: Two RCTs and six retrospective studies containing 1822 cases (222 cases from RCTs and 1600 cases from retrospective studies) were identified. Although D-DVC was related to more blood loss (WMD: 7.30 mL; 95% CI, 2.43 to 12.16; p = 0.003), the blood transfusion rate between the two groups showed no significant difference (OR = 1.93; 95% CI, 0.55 to 6.73; p = 0.31), and patients in the D-DVC group could benefit from a shorter operative time (WMD: -30.83 min; 95% CI, -53.32 to -8.35; p = 0.007). Positive apical margin events were significantly less in the D-DVC group (OR = 0.39; 95% CI, 0.22 to 0.71; p = 0.002). As for urinary control, there were no differences in continence rates after 3 months (OR = 1.64; 95% CI, 0.98 to 2.73; p = 0.06) and 12 months (OR = 1.00; 95% CI, 0.63 to 1.57; p = 0.99) of follow-up. However, there was a significantly higher continence rate after 6 months of follow-up in the D-DVC group (OR = 1.46; 95% CI, 1.02 to 2.11; p = 0.04). CONCLUSIONS: Standard and delayed approaches to DVC are equally safe and result in similar urinary control. The delayed approach could decrease the positive apical margin rate. However, further large-scale prospective studies are needed to investigate and compare the prognosis and long-term functional outcomes between the two approaches.


Assuntos
Laparoscopia/métodos , Ligadura/métodos , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Veias/cirurgia
14.
Ann Vasc Surg ; 60: 211-220, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200038

RESUMO

BACKGROUND: The purpose of the study was to compare the access patency rates of forearm loop arteriovenous grafts (AVGs) using deep veins and superficial veins for venous outflow. METHODS: The medical records of patients on dialysis were retrospectively reviewed to identify the individual risk factors and the outcomes of forearm loop AVGs according to their outflow types. RESULTS: Overall, 170 cases were enrolled in this study. Of these, 103 cases (60.6%) used deep veins for outflow. Most patients using deep vein outflow had their venous anastomosis above the elbow (P = 0.000). Patients with venous anastomosis above the elbow were more likely to be female (P = 0.049) and have a lower albumin level (P = 0.025). The primary patency rates for superficial vein outflow and deep view outflow were 35.5% and 29.4% at 12 months and 18.9% and 4.9% at 24 months, respectively. There was a statistically significant difference between the two groups (P = 0.013). The assisted primary patency rates for superficial venous outflow and deep vein outflow were 85.5% and 79.5% at 12 months and 73.2% and 59.6% at 24 months, respectively (P = 0.139). Primary and assisted primary patency rates did not differ according to the crossing of the elbow. CONCLUSIONS: The primary patency rate of AVGs using deep veins for outflow was inferior to AVGs using superficial veins. But the assisted primary patency rate showed no difference. The use of a deep vein for outflow in the forearm loop AVG is a safe strategy for patients with exhausted superficial veins.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Antebraço/irrigação sanguínea , Veias/cirurgia , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/terapia , Humanos , Masculino , Diálise Renal , Retratamento , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
15.
Khirurgiia (Mosk) ; (5): 88-93, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169826

RESUMO

Modern data on the prevalence and pathophysiology of lower limb varicose disease are presented. The results of studies of modern approaches to the surgical correction of this state are demonstrated. Conclusions about the unresolved number of problems.


Assuntos
Extremidade Inferior/cirurgia , Varizes/cirurgia , Veias/cirurgia , Humanos , Prevalência , Federação Russa/epidemiologia , Varizes/epidemiologia , Varizes/fisiopatologia
17.
Biomed Res Int ; 2019: 7934328, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30984784

RESUMO

Varicocele, a vascular event, is associated with infertility due to testicular damage that causes abnormal spermatogenesis in males. The goal of this study is to ascertain the diagnostic significance of scrotal color Doppler ultrasonography (CDUS) by measuring peak systolic value (PSV) and resistive index (RI) of the arteries supplying blood to the testis and their association with semen quality attributes. Sixty prospective patients (age: 20-50 years) undergoing microsurgical varicocelectomy at a teaching hospital were included in the study. Semen parameters and CDUS were recorded and testicular blood flow was determined as PSV and RI of subcapsular artery and intraparenchymal artery of the testes. Nonparametric statistics was applied to test the correlation/association of the semen quality with the PSV, RI, and other variables. Results revealed a significant negative correlation (r = -0.28; p < 0.05) between progressive motility of spermatozoa and resistive index of the intraparenchymal arterial blood flow. Furthermore, it was noticed that the progressive motility of spermatozoa was tended to be negatively correlated (r = -0.236) with resistive index of subcapsular arterial blood flow. In conclusion, this study has revealed that progressive motility of sperms has correlation with the intraparenchymal blood flow of testes. The progressive motility of sperms could be correlated with RI of testicular blood flow. The apparent lack of association between diameter of varicocele vein and semen quality signifies the need of investigating some other factors that may be involved in pathogenicity of varicocele. The diagnostic value of CDUS may be carefully interpreted and clinically correlated in assessment of severity of varicocele.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Infertilidade Masculina/sangue , Testículo/irrigação sanguínea , Varicocele/sangue , Adulto , Hemodinâmica , Humanos , Infertilidade Masculina/patologia , Infertilidade Masculina/cirurgia , Masculino , Microcirurgia , Pessoa de Meia-Idade , Paquistão , Sêmen/metabolismo , Análise do Sêmen , Motilidade Espermática/fisiologia , Espermatogênese/fisiologia , Testículo/patologia , Testículo/cirurgia , Varicocele/patologia , Varicocele/cirurgia , Veias/patologia , Veias/cirurgia , Adulto Jovem
18.
J Vasc Access ; 20(1_suppl): 65-70, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31032726

RESUMO

Obtaining adequate and precise anatomical information is mandatory to prevent vascular access-related complications in dialysis patients. For this purpose, we underwent Doppler ultrasound, vascular access angiogram, and plain computer-assisted tomography scan of the arm with vascular access. With the use of computer graphics software, the anatomical structure of the vascular access can be visualized three dimensionally which is shared among the staffs for precise and better recognition. Furthermore, created object is applicable for virtual reality and/or augmented reality presentation that provides useful means for education and practical procedures in the management of vascular access.


Assuntos
Artérias/diagnóstico por imagem , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Angiografia por Tomografia Computadorizada , Imagem Tridimensional , Modelagem Computacional Específica para o Paciente , Ultrassonografia Doppler , Ultrassonografia de Intervenção/métodos , Extremidade Superior/irrigação sanguínea , Veias/diagnóstico por imagem , Realidade Virtual , Artérias/fisiopatologia , Artérias/cirurgia , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/cirurgia , Humanos , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador , Diálise Renal , Software , Cirurgia Assistida por Computador , Grau de Desobstrução Vascular , Veias/fisiopatologia , Veias/cirurgia
19.
J Vasc Access ; 20(1_suppl): 71-75, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31032728

RESUMO

INTRODUCTION: The number of elderly hemodialysis patients continues to grow. The aim of this study was to investigate differences in elderly high flow access patients compared with middle-aged and young patients. METHODS: We performed a retrospective study to determine the characteristics of elderly patients (aged >60 years) following blood flow suppression procedures. Preoperative and postoperative data from 177 patients who underwent blood flow suppression procedures and 73 patients who underwent procedures for run-off vein ligation and subcutaneous fixation of the superficial artery were compared. RESULTS: A high proportion of young (aged 20-40 years) and middle-aged (aged 41-60 years) patients met the criteria for blood flow suppression procedures (flow volume 1500 mL/min, flow volume/cardiac output 35%), whereas a high proportion of elderly patients did not. Moreover, heart strain could evidently be caused even with low flow volume. In elderly patients, a tricuspid regurgitation pressure gradient and right heart strain were observed more frequently. CONCLUSION: Elderly patients who underwent blood flow suppression procedures or subcutaneous fixation of the superficial artery exhibited lower flow volume, and the effects of high flow access in elderly patients depend on the nature of vascular changes. Ultimately, the underlying conditions and hemodynamics of each patient must be determined on an individual basis.


Assuntos
Artérias/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Débito Cardíaco Elevado/etiologia , Hemodinâmica , Diálise Renal , Extremidade Superior/irrigação sanguínea , Veias/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artérias/diagnóstico por imagem , Artérias/fisiopatologia , Velocidade do Fluxo Sanguíneo , Débito Cardíaco Elevado/diagnóstico , Débito Cardíaco Elevado/fisiopatologia , Débito Cardíaco Elevado/cirurgia , Feminino , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Ultrassonografia Doppler , Veias/diagnóstico por imagem , Veias/fisiopatologia , Adulto Jovem
20.
Biomed Eng Online ; 18(1): 50, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023303

RESUMO

BACKGROUND: Blood flow condition may have influence upon the hydraulic conductivity of venous graft (Lp,vein) in an arterial bypass, then affecting the accumulation of low-density lipoproteins (LDLs) within the graft wall. To probe this possibility, we first measured in vitro the filtration rates of swine lateral saphenous vein segments under different flow rates, and the correlation of Lp,vein with wall shear stress (WSS) was then obtained. RESULTS: The experimental results showed that when WSS was very low, Lp,vein would increase drastically with WSS from 1.16 ± 0.15 × 10-11 m/s Pa at 0 dyn/cm2 to 2.17 ± 0.20 × 10-11 m/s Pa at 0.7 dyn/cm2, then became constant of approximately 2.33 × 10-11 m/s Pa as the WSS increased further. Based on the experimental results, we assumed three different cases of Lp,vein and numerically simulated the LDLs transport in an arterial bypass model with venous graft. Case A: Lp,vein = 2.33 × 10-11 m/s Pa; Case B: Lp,vein = 1.16 × 10-11 m/s Pa (static condition with WSS of 0); Case C: Lp,vein was shear dependent. The simulation showed that the deposition/accumulation of LDLs within the venous graft wall in Case A was greatly enhanced when compared with that in Case B. However, the LDL accumulation in the graft wall was similar for Case A and Case C. CONCLUSIONS: Our study, therefore, indicates that when the venous graft was implanted as a bypass graft, the Lp,vein might remain nearly constant along its whole length except for very few areas where the value of WSS was extremely low (less than 0.7 dyn/cm2) and the effects of Lp,vein modulated by blood flow on LDL transport may be neglected.


Assuntos
Artérias/cirurgia , Hidrodinâmica , Lipoproteínas LDL/metabolismo , Enxerto Vascular , Veias/cirurgia , Animais , Modelos Biológicos , Transporte Proteico , Estresse Mecânico , Suínos
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