Jornal Vascular Brasileiro最新文献

Varicose veins are a common disease worldwide, mainly affecting adults, and are estimated to be the 7th most common reason for physician referral in the USA. There is no ideal technique for treatment of varicose veins. Several techniques have emerged in recent years: the most widely used are thermal techniques such as laser and radio frequency and non-thermal techniques such as chemical and mechanochemical ablation (MOCA). MOCA employs a combination of physical damage to the vessel with infusion of a sclerosant fluid with the objective of improving the effects and avoiding disadvantages of thermal ablation such as pain and nerve injuries. The aim of this study will be to evaluate the effects of MOCA for treatment of superficial varicose veins in the lower limbs. We will search randomized controlled trials of MOCA for treatment of varicose veins. The search strategy will include free text terms and controlled vocabulary terms (e.g. Emtree, MeSH) for 'varicose veins', 'varices', 'ablation', 'mechanical ablation', 'chemical ablation', and 'mechanochemical ablation'. We will search at least the following databases: Medline (via Pubmed), Embase, Cochrane Central Register of Controlled Trials, Lilacs, Ibecs, WHO Clinical Trials Platform, and Clinicaltrials.com. The risks of bias will be evaluated with the Cochrane tool. We will report structured summaries of the included studies and conduct meta-analyses if possible. Development of new treatments such as MOCA must be encouraged and validation by systematic reviews is required to demonstrate their effects and support better clinical treatment decisions.

Background: The COVID-19 pandemic affected health resources in Brazil, as priority was given to providing care to those infected. As a result, patients with other pathologies suffered delays in treatment, especially those waiting for elective surgical treatments, such as sympathectomy for hyperhidrosis.

Objectives: To analyze the number of thoracic sympathectomies performed to treat hyperhidrosis on the Brazilian Unified Health System (SUS), their mortality, demographics, length of hospital stay, and associated costs in the periods before, during, and after the peak of the COVID-19 pandemic.

Methods: This is a retrospective cross-sectional study that analyzed the number of video-assisted thoracic sympathectomies performed on the SUS in the 2 years prior to the pandemic (2018 and 2019), the 2 years of peak pandemic (2020 and 2021), and the 2 years after (2022 and 2023). Data on regional distribution, profile of patients, hospitalization, and associated mortality were also analyzed. Figures were extracted from the SUS Department of Informatics (DATASUS) database.

Results: The number of sympathectomies performed in Brazil during 2020 and 2021 was 60% lower than the number recorded in 2018 and 2019, followed by a 30% smaller than expected increase in 2022 and 2023. Half of these procedures were conducted in the Southeast region of the country. The profile of patients was predominantly young women. Hospitalization time, costs, and mortality were stable over the years.

Conclusions: The volume of sympathectomies for treatment of hyperhidrosis in the SUS was severely affected by the COVID-19 pandemic and remains in slow recovery. The regional distribution, demographic profile, hospitalization data, and mortality rate remained stable.

Background: Injuries to the retrohepatic vena cava are associated with high mortality rates and vascular control must be obtained prior to exposure. Various treatment techniques have been described, including triple hepatic vascular exclusion, atriocaval shunt, and endovascular and hybrid strategies.

Objectives: To determine which of these is associated with the lowest mortality rate.

Methods: A systematic literature review was conducted, guided by the Cochrane Handbook and PRISMA guidelines. The PUBMED, LILACS, Embase, Web of science, and Scopus databases were searched and Ryyan software was employed to manage the studies identified.

Results: Sixteen studies were selected, reporting 96 cases, in 49 of which the patients were treated with triple hepatic exclusion, in 38 with an atriocaval shunt, and in 9 with endovascular or hybrid techniques, with the third of these groups being statistically less frequent (p < 0.0001). The mortality rate was 53.8%, with no statistically significant differences between any of the techniques studied (p = 0.9085).

Conclusions: Injuries to the retrohepatic vena cava had similar mortality rates regardless of the technique employed for treatment.

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.