Endovenous laser ablation for saphenous veins and tributaries - the LEST technique.

Endovenous thermal ablation is now one of the most important techniques for treating chronic venous insufficiency. Technical refinements and technological innovations have made it possible to employ the method not only in the saphenous veins, but also to treat superficial veins such as varicose tributaries. We describe a technique for surgical treatment of varicose veins using endovenous laser thermal ablation employing multiple punctures and present the experience at our service with analysis of 601 cases operated using this technique. Thermoablative treatment of tributary veins with multiple puncture sites expands the applications for endolaser in treatment of lower limb varicose veins, providing, comprehensive, safe, and effective treatment.

Adventitial cystic disease of the radial artery.

Adventitial cystic disease (ACD) of the radial artery is a rare condition, with few cases described in the literature. We report the case of a 62-year-old white male with a history of diabetes, hypertension, and chronic kidney disease with indications for renal replacement therapy who was found to have a cystic lesion of the radial artery while undergoing surgical creation of an arteriovenous fistula. The surgical technique adopted was resection of the cystic segment and preservation of the radial artery. Fistula creation was completed successfully. Early diagnosis and appropriate treatment of ACD are effective, and can prevent complications and recurrence.

A doença cística adventicial (DCA) da artéria radial é uma condição rara, com poucos casos descritos na literatura. Relatamos o caso de um paciente do sexo masculino, 62 anos, branco, diabético, hipertenso, com insuficiência renal crônica e indicação para terapia substitutiva renal, em quem foi encontrada uma lesão cística da artéria radial durante operação para confecção de fistula arteriovenosa para hemodiálise. Após a dissecção da artéria radial, ficou evidenciado um importante envolvimento do vaso por uma formação cística. A técnica cirúrgica adotada foi a ressecção do segmento cístico comprometido e preservação da artéria radial. A confecção da fistula arteriovenosa foi realizada com sucesso. O diagnóstico precoce e o tratamento adequado da DCA mostram se eficientes e podem prevenir complicações e recidivas.

Agenesis of the internal carotid artery.

Agenesis of the internal carotid artery is a rare anomaly. It is usually asymptomatic because of the presence of anastomoses, but it can be associated with complications, especially when there is evidence of other anatomical abnormalities or severe atherosclerotic disease. We report the case of a 63-year-old female patient with hypertension and diabetes and a history of intracranial aneurysm clipping. Doppler ultrasonography and computed tomography angiography of the carotid and vertebral arteries showed unilateral agenesis of the left internal carotid artery. This report aims to highlight the importance of suspecting vascular malformations during investigation of neurological conditions. Internal carotid agenesis has a significant association with intracranial aneurysms and their early detection can spare the patient serious complications.

Abdominal collateral veins as an unconventional access site for hemodialysis after primary access failure.

INTRODUCTION: Vascular access dysfunction and the depletion of access pathways are complications associated with morbidity and mortality in dialysis patients. As described in the literature, catheter insertion through small collateral veins or recanalized cervical and thoracic veins is an attractive option. CASE DESCRIPTION: This article reports a case in which a collateral vein in the abdominal region was used as an access for hemodialysis. CONCLUSION: After multiple attempts with fistulas and catheters, the left abdominal wall collateral network proved to be a successful access site. Using unconventional veins can be an alternative in these patients.

Doença cística adventicial da artéria radial / Adventitial cystic disease of the radial artery

A doença cística adventicial (DCA) da artéria radial é uma condição rara, com poucos casos descritos na literatura. Relatamos o caso de um paciente do sexo masculino, 62 anos, branco, diabético, hipertenso, com insuficiência renal crônica e indicação para terapia substitutiva renal, em quem foi encontrada uma lesão cística da artéria radial durante operação para confecção de fistula arteriovenosa para hemodiálise. Após a dissecção da artéria radial, ficou evidenciado um importante envolvimento do vaso por uma formação cística. A técnica cirúrgica adotada foi a ressecção do segmento cístico comprometido e preservação da artéria radial. A confecção da fistula arteriovenosa foi realizada com sucesso. O diagnóstico precoce e o tratamento adequado da DCA mostram se eficientes e podem prevenir complicações e recidivas

Adventitial cystic disease (ACD) of the radial artery is a rare condition, with few cases described in the literature. We report the case of a 62-year-old white male with a history of diabetes, hypertension, and chronic kidney disease with indications for renal replacement therapy who was found to have a cystic lesion of the radial artery while undergoing surgical creation of an arteriovenous fistula. The surgical technique adopted was resection of the cystic segment and preservation of the radial artery. Fistula creation was completed successfully. Early diagnosis and appropriate treatment of ACD are effective, and can prevent complications and recurrence.

Agenesia de artéria carótida interna / Agenesis of the internal carotid artery

A agenesia de carótida interna é uma anomalia rara. Na maioria dos casos, é assintomática devido às anastomoses que podem estar presentes, mas pode estar associada a complicações, principalmente quando evidenciada a presença de outras alterações anatômicas ou doença aterosclerótica grave. Relatamos o caso de uma paciente feminina de 63 anos, hipertensa e diabética, com história de cirurgia prévia para clipagem de aneurisma cerebral. Na investigação através de eco-Doppler e angiotomografia de carótidas e vertebrais, foi evidenciada agenesia unilateral da artéria carótida interna esquerda. Este relato objetiva chamar atenção para a importância de se suspeitar de malformações vasculares durante a investigação de quadros neurológicos. A agenesia de carótida interna tem uma importante associação com aneurismas intracerebrais, e é possível poupar o paciente de graves complicações quando estes são identificados a tempo

Agenesis of the internal carotid artery is a rare anomaly. It is usually asymptomatic because of the presence of anastomoses, but it can be associated with complications, especially when there is evidence of other anatomical abnormalities or severe atherosclerotic disease. We report the case of a 63-year-old female patient with hypertension and diabetes and a history of intracranial aneurysm clipping. Doppler ultrasonography and computed tomography angiography of the carotid and vertebral arteries showed unilateral agenesis of the left internal carotid artery. Thisreport aims to highlight the importance of suspecting vascular malformations during investigation of neurological conditions. Internal carotid agenesis has a significant association with intracranial aneurysms and their early detection can spare the patient serious complications

Fístula arteriovenosa após termoablação com laser endovenoso 1470 nm: relato de caso / Arteriovenous fistula after endovenous laser ablation with 1470 nm laser: case report

Resumo O tratamento tradicional da insuficiência da veia safena magna (VSM) inclui a ligadura alta na junção safeno-femoral combinada com a fleboextração. No entanto, a morbidade associada à insatisfação do paciente com esse tratamento tem conduzido ao desenvolvimento de técnicas alternativas, e a termoablação com laser endovenoso (EVLT) tornou-se uma alternativa minimamente invasiva à cirurgia. A formação de fístula arteriovenosa (FAV) durante o EVLT é extremamente rara. Neste estudo, relatamos um caso de identificação ecográfica de FAV entre um segmento da veia safena acessória lateral e a artéria femoral superficial. Optou-se inicialmente pela realização de duas tentativas de compressão com transdutor linear, sem sucesso, e alternativamente o procedimento cirúrgico foi realizado sem intercorrência e com resolução da FAV. Esse relato de caso evidencia a importância do seguimento de vigilância ecográfica após o EVLT tanto para o controle da efetividade do método como para o diagnóstico e tratamento precoce de suas complicações.

Abstract Traditional treatment for great saphenous vein (GSV) insufficiency includes high ligation of the saphenofemoral junction and subsequent stripping of the GSV. However, the considerable morbidity and patient dissatisfaction associated with surgical treatment led to development of alternative techniques and intravenous laser treatment (EVLT) has emerged as a minimally invasive alternative to surgery. Formation of arteriovenous fistulas (AVF) during EVLT is extremely rare. In this study we report a case of AVF between a segment of the lateral accessory saphenous vein and the superficial femoral artery that was identified by ultrasound. Initially, two attempts were made at compression with a linear-array transducer without success, then alternatively surgery was performed without complications, leading to resolution of the AVF. This case report highlights the importance of ultrasound follow-up after EVLT, both for monitoring the effectiveness of the method and for diagnosis and early treatment of its complications.