Jornal Vascular Brasileiro最新文献

Background: Vascular access (VA) is a critical component of hemodialysis (HD). Arteriovenous fistulas (AVFs) are associated with lower morbidity and mortality compared to central venous catheters (CVCs). However, VA practice varies across different healthcare systems.

Objectives: The aim of our study was to evaluate the trends, costs, and distribution of VA types used in North Macedonia over two decades.

Methods: This retrospective study reviewed VA procedures performed at the University Clinic of Nephrology in Skopje from 2002 to 2023, highlighting trends and financial implications. Data on AVFs, tunneled central catheters (TCCs), and temporary catheters were collected and analyzed. Preoperative Doppler ultrasound assessments and follow-up evaluations were used to monitor AVF maturation and CVC placement. The cost analysis was based on the Diagnostic-Related Group coding system.

Results: A total of 25 532 VA procedures were performed, including 5798 AVFs (83% of permanent VA), 1199 TCCs (17%), and 18 535 temporary CVCs. The number of AVFs steadily increased during the whole of the analyzed period, except in 2020 due to the COVID-19 pandemic. Temporary femoral vein catheterization accounted for 90% of CVCs. The financial burden of VA increased from 6.6% of the clinic's budget in 2018 to 9.3% in 2022, with a notable rise in CVC-related expenses.

Conclusions: In North Macedonia, use of temporary CVCs at dialysis initiation remains high. Increasing the number of preemptive AVFs and improving long-term VA planning are essential to optimize patient outcomes and reduce healthcare costs.

Fibromuscular dysplasia (FMD) is a disease of non-inflammatory vascular origin that occurs in medium-sized arteries. Its cause is still unknown. The disease mostly affects middle-aged Caucasian women and, in most cases, involves the renal artery. Disease involvement in the arteries of the upper and lower limbs is rare. We report a case of fibromuscular dysplasia of the medial layer of the brachial artery in an asymptomatic patient using Doppler Ultrasound.

Background: Contrast-induced nephropathy (CIN) is a complication of iodinated contrast media use that can lead to worsening of renal function, increased morbidity and mortality, and the need for renal replacement therapy.

Objectives: To evaluate the incidence of CIN after angioplasty and identify associated factors, including variations in creatinine, glomerular filtration rate (GFR), contrast volume, procedure time, and comorbidities.

Methods: Retrospective study of 305 patients undergoing angioplasty. Clinical and laboratory variables, including serum creatinine and GFR before and after the procedure, were analyzed. CIN was defined as an absolute increase in creatinine ≥ 0.3 mg/dL or a relative increase ≥ 50% within 48 hours. Logistic regression was applied to identify independent predictors.

Results: The incidence of CIN was 10.5% (n = 32/305). Patients with CIN showed a significant reduction in GFR (pre: 73.79 ± 22.5 vs. post: 34.32 ± 11.8 mL/min; p < 0.0001) and increased creatinine (pre: 1.12 ± 0.3 vs. post: 1.78 ± 0.6 mg/dL; p < 0.001). CIN was associated with stroke (p = 0.014), peripheral arterial occlusive disease (p = 0.007), diabetes mellitus (p = 0.002), chronic kidney disease (p = 0.005), and heart failure (p = 0.004). Multivariate analysis confirmed DM (OR = 2.45; 95% CI: 1.12-4.38; p = 0.022) as the main risk factor.

Conclusions: CIN occurred in 10.5% of patients, with DM, CKD, and HF being the main risk factors. These findings reinforce the importance of monitoring to reduce the impact of CIN and optimize clinical outcomes.

Inferior phrenic artery (IPA) pseudoaneurysms are highly uncommon and result from trauma, pancreatitis, or iatrogenic injury. However, rupture can lead to catastrophic hemothorax. The vessel's deep location and non-specific symptoms make early identification a difficult task. We report a case of a 22-year-old woman who was undergoing antitubercular therapy and presented with the onset of acute dyspnea after a five-month history of wheezing and hemoptysis. Computed tomography angiography revealed a pseudoaneurysm originating from the left IPA and a massive left hemothorax. This pseudoaneurysm sac and the descending branch of the IPA were successfully embolized with a glue: lipiodol mixture, followed by hemothorax evacuation. The patient is asymptomatic at 2-month follow-up. Endovascular embolization minimizes morbidity and enables rapid recovery when anatomy is favorable. This report emphasizes the importance of cross-sectional imaging in the early diagnosis and treatment planning of atypical hemothorax presentations.

Bullet embolism is a rare complication of gunshot wounds, but its incidence has increased due to the increasing number of wounds caused by low-velocity firearms in civilian settings. The increase in urban violence and widespread use of firearms with low-velocity projectiles have made diagnosis of ballistic embolism more common, so it is essential to recognize the risk factors for such events. Both treatment of the entry wound and removal of the ballistic embolism can be successfully performed by open, endovascular, or hybrid surgery, and the particularities of each case should be considered. We report the case of a 16-year-old male patient who presented with penetrating aortic trauma in addition to an intra-arterial firearm projectile in the right popliteal artery and underwent hybrid surgery to treat his injuries.

Background: Over the years and the evolution of technology, social networks have become widely accessible and play an important role in interpersonal relationships. Currently, the use of these platforms to disseminate health information ranging from diagnosis to treatments and medical procedures is increasing. In this sense, this study aimed to verify the importance of using social networks in attracting new patients to the office.

Objectives: This study aimed to verify the impact of using social networks on attracting new patients in a medical office of angiology and vascular surgery.

Methods: The study was carried out in a private vascular surgery office, with a sample of 604 patients. Data was collected from January 2022 to December 2023 through an electronic registration, filled out by the secretary at the office.

Results: From the total of 604 patients, 77% were female and 23% male. Of the total number of patients, 41% found out about the office through advertisements made on social media. This generated a positive impact of 38% on the practice's revenue in the period analyzed.

Conclusions: Analysis of the results indicated that the office's presence on social media contributed positively to attracting new patients, as well as increasing revenue. Digital marketing is a trend that will only grow with the spread of the internet and including social networks in the dissemination of health information generates benefits for both parties: doctor and patient.

Background: Although the overall volume of Brazilian scientific research has increased over the past decades, for years there has been a noticeable lack of prestige attributed to national publications in favor of foreign journals. This dynamic has limited their influence and the development of Brazilian lines of research.

Objectives: To analyze the references used by the Brazilian Vascular Journal (BVJ), in relation to its own journal of origin, in order to identify the representativeness and relevance of national journals.

Methods: A cross-sectional observational study was carried out, examining 13,633 bibliographic references cited in 582 articles from the BVJ, published between 2016 and 2024 and indexed in PubMed. The references were extracted and organized in a Microsoft Excel^® spreadsheet, in which the origin of each citation was verified, with an emphasis on identifying which were Brazilian and/or from the BVJ, in addition to searching for self-citations by the first author.

Results: A total of 1,300 (9.5%) citations of articles from Brazilian journals were identified in the BVJ. The BVJ was the most frequently cited national journal, with 613 references (4.5%). It was observed that 189 (32%) of the articles analyzed did not include any national reference. The percentage of self-citations was 8%, showing a downward trend over time.

Conclusions: The low number of citations is consistent with what has been previously described in the national literature, which has warned of the same issue for 30 years. The decreasing percentage of self-citations may suggest greater diversity of sources used over the years. These findings highlight a culture of disregard for national journals, which hinders original research and compromises the development of research lines focused on the Brazilian population.

Giant hepatic hemangiomas are benign vascular lesions that may cause abdominal pain, compression of adjacent structures, bleeding, and thrombotic complications. Management of symptomatic cases is challenging, especially for larger lesions. This systematic review and meta-analysis evaluated the efficacy and safety of endovascular treatment through transarterial embolization, focusing on the embolization agents employed, reductions in tumor diameter, and associated complications. The results showed significant reductions in mean hemangioma diameter, with low rates of severe complications. This treatment emerges as a promising minimally invasive option for symptomatic or unresectable cases.

Renal revascularization in patients with a solitary functioning kidney and a suprarenal abdominal aortic aneurysm (AAA) is a surgical challenge due to the risk of renal ischemia and postoperative renal dysfunction. We present a unique case in which a 69-year-old male with a solitary left kidney and suprarenal AAA was managed successfully with a preemptive splenic artery-to-left renal artery transposition (splenorenal bypass) followed by aneurysmorrhaphy. This approach preserved renal function and avoided ischemic insult during aortic reconstruction. At 2 years of follow-up, the patient maintains stable renal parameters and the reconstruction is patent, underscoring the utility of splenorenal bypass as a viable alternative in anatomically constrained and high-risk scenarios.

Endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs) is a less invasive alternative, with reduced mortality and morbidity compared to open repair. However, reports on the results of this procedure in Brazil are scarce. This article reports the first institutional experience with endovascular treatment of TAAAs using branched and fenestrated endografts. Four patients with TAAA were included in this report. The devices used were custom-made by Braile, tailored to each patient's anatomy based on computed tomography (CT) imaging. A total of 10 visceral branches were required to maintain the patency of the visceral arteries. CT follow-up was performed 2 months after the procedure. All implants were successfully completed. The fenestration/branch interfaces were secured with covered, balloon-expandable, and self-expanding peripheral stents in 8 of the 10 target branches. The remaining 2 branches were preserved with openings and free flow. Post-procedural angiography demonstrated correct positioning of the endografts and stents in the visceral arteries, with patency maintained in 9 of the 10 target branches. Among the complications, one selective catheterization of the celiac trunk was not possible at the first attempt. However, there was no mesenteric ischemia, and a peripheral stent was successfully implanted in the celiac trunk in a second procedure. All patients had a complication-free recovery. Follow-up CT demonstrated complete aneurysm exclusion with no leaks and visceral perfusion was maintained in 7 of the 8 target branches. It was concluded that endovascular treatment of TAAA with custom-made endografts is feasible and may become a treatment of choice for patients with challenging anatomical lesions.