Jornal Vascular Brasileiro最新文献

英文中文

Prognostic factors for femoropopliteal vascular injuries: surgical decisions matter 股腘血管损伤的预后因素:手术决定至关重要

Q4 PERIPHERAL VASCULAR DISEASE

Jornal Vascular Brasileiro

Pub Date : 2023-01-01 DOI: 10.1590/1677-5449.202300502

Adenauer Marinho de Oliveira Góes Junior, Fernanda Beatriz Araújo de Albuquerque, Matheus Oliveira Feijó, Flávia Beatriz Araújo de Albuquerque, Luciana Roberta do Vale Corrêa, Mariseth Carvalho de Andrade

Abstract Background Lower limbs are frequently involved in vascular trauma, but it is still not clear which factors lead to unfavorable clinical outcomes. Objectives To determine the clinical profile of patients with femoropopliteal injuries, the trauma mechanisms, and treatment and identify which factors led to unfavorable outcomes. Methods A retrospective study based on the medical records of patients treated from 2017 to 2021. The following data were assessed: sex, age, distance to reach the hospital, trauma mechanism, hypovolemic shock, additional injuries, treatment of vascular injuries, whether fasciotomy was needed, inappropriate intraoperative decisions, and injury severity score. Need for surgical reintervention, amputation, and death were defined as unfavorable outcomes. Univariate, bivariate, and logistic regression analyses were conducted. Results The sample comprised 94 patients; 83% were men; mean age was 30.8 years; combined arterial and venous injuries prevailed (57.5%); and superficial femoral vessels were the most affected (61.7%). Penetrating mechanisms prevailed (80.9%). Arterial injuries were most frequently treated with venous graft (59.6%) and venous injuries underwent ligation (81.4%). In 15% of cases, inappropriate surgical decisions were detected; most often use of the ipsilateral great saphenous vein for arterial reconstruction. Unfavorable outcomes occurred in 44.7%: surgical reintervention was necessary in 21.3% and limb amputation in 25.5%, while 9.5% of the patients died. Conclusions These injuries mainly involved young men, victims of gunshot wounds. Superficial femoral vessels were the most injured; concomitant non-vascular trauma was frequent, mainly fractures. Inappropriate surgical decisions increased the need for reinterventions by 34 times. Need for fasciotomy, presence of fracture/dislocation, blunt trauma mechanism, and popliteal artery injury increased the risk of amputation.

背景下肢经常发生血管损伤，但目前尚不清楚是哪些因素导致了不良的临床结果。目的探讨股腘肌损伤患者的临床特点、创伤机制和治疗方法，并确定导致不良结果的因素。方法回顾性分析2017 ~ 2021年收治患者的病历资料。评估以下数据:性别、年龄、到达医院的距离、创伤机制、低血容量性休克、附加损伤、血管损伤的治疗、是否需要筋膜切开术、不适当的术中决策和损伤严重程度评分。需要手术再干预、截肢和死亡被定义为不良结果。进行了单因素、双因素和逻辑回归分析。结果本组94例患者;83%是男性;平均年龄30.8岁;动、静脉合并损伤占57.5%;以股浅血管为主(61.7%)。穿透机制占主导地位(80.9%)。静脉移植治疗动脉损伤最多(59.6%)，结扎治疗静脉损伤最多(81.4%)。在15%的病例中，发现了不适当的手术决定;最常使用同侧大隐静脉进行动脉重建。不良结局发生率为44.7%:21.3%的患者需要再次手术干预，25.5%的患者需要截肢，9.5%的患者死亡。结论这些损伤主要以年轻男性、枪伤受害者为主。股骨浅血管损伤最严重;同时发生非血管性损伤，以骨折为主。不恰当的手术决定使再干预的需求增加了34倍。需要进行筋膜切开术，存在骨折/脱位，钝性创伤机制和腘动脉损伤增加了截肢的风险。

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引用次数: 0

Prolonged Doppler US-guided pneumatic compression of a radial artery pseudoaneurysm after percutaneous coronary intervention: a simple and effective solution for a rare and challenging problem 经皮冠状动脉介入治疗后桡动脉假性动脉瘤的长时间多普勒超声引导气压压迫:一种简单有效的解决罕见且具有挑战性的问题的方法

Q4 PERIPHERAL VASCULAR DISEASE

Jornal Vascular Brasileiro

Pub Date : 2023-01-01 DOI: 10.1590/1677-5449.202102122

Marcos Danillo Oliveira, Pedro Perillo, Lélio Lemos Neto, Adriano Caixeta

Abstract Transradial access is associated with fewer access site-related complications, earlier patient mobilization, and greater postprocedural comfort. Pseudoaneurysms are an extremely rare complication after transradial procedures and the radial artery itself is the most atypical arterial site of occurrence. We report a case in which a non-surgical, non-invasive, simple, and effective solution (prolonged pneumatic compression) was used to manage a radial artery pseudoaneurysm, a very rare and challenging complication of transradial procedures.

经桡骨通路与更少的通路部位相关并发症、更早的患者活动和更大的术后舒适度有关。假性动脉瘤是经桡动脉手术后极为罕见的并发症，而桡动脉本身是最不典型的动脉发生部位。我们报告一例非手术，无创，简单，有效的解决方案(延长气动压缩)被用来处理桡动脉假性动脉瘤，一个非常罕见的和具有挑战性的并发症经桡动脉手术。

引用次数: 0

Neurofibromatosis type 1, fibromuscular dysplasia, and ischemic stroke: an association lost in time? A case report. 1型神经纤维瘤病、纤维肌肉发育不良和缺血性中风:一种随时间消失的关联?一份病例报告。

Q4 PERIPHERAL VASCULAR DISEASE

Jornal Vascular Brasileiro

Pub Date : 2023-01-01 DOI: 10.1590/1677-5449.202201182

Igor Oliveira da Fonseca, Gustavo José Luvizutto, Isaac Pantaleão Souza, André Petean Trindade, Carlos Clayton Macedo de Freitas, Rodrigo Bazan, Gabriel Pinheiro Modolo

Neurofibromatosis Type 1 (NF1) is a rare cause of ischemic stroke (IS) in the general population. We report a case of a young patient with NF1 in whom IS was caused by fibromuscular dysplasia. An angiographic study demonstrated occlusion in the right internal carotid artery (ICA), just after its origin, and the left ICA, just before the intracranial portion, and brain magnetic resonance imaging showed the limits of an area of brain infarction in the right frontoparietal region. Despite these concomitant neuroimaging findings, this association is rare, and it is difficult to establish the contribution to the outcome made by each of these diseases, which treatment is the best to implement, or what prognosis is.

1型神经纤维瘤病(NF1)是一个罕见的原因缺血性中风(is)在一般人群。我们报告一例年轻的NF1患者，其中IS是由纤维肌肉发育不良引起的。血管造影显示右侧颈内动脉(ICA)闭塞，位于其起源后方，左侧颈内动脉(ICA)闭塞，位于颅内部分之前，脑磁共振成像显示右侧额顶区脑梗死区域的界限。尽管有这些伴随的神经影像学发现，但这种关联是罕见的，并且很难确定每种疾病对结果的贡献，哪种治疗方法最好，或者预后如何。

引用次数: 0

Comparative study of angiographic changes in diabetic and non-diabetic patients with peripheral arterial disease. 糖尿病与非糖尿病外周动脉病变患者血管造影改变的比较研究。

Q4 PERIPHERAL VASCULAR DISEASE

Jornal Vascular Brasileiro

Pub Date : 2023-01-01 DOI: 10.1590/1677-5449.202000531

Giovanni Ortale Trainotti, Jamil Victor Mariúba, Matheus Bertanha, Marcone Lima Sobreira, Ricardo de Alvarenga Yoshida, Rodrigo Gibin Jaldin, Paula Angeleli Bueno de Camargo, Winston Bonetti Yoshida

Background: Diabetics are at 5-15 times greater risk of developing peripheral arterial disease (PAD) and few studies have compared risk factors and distribution and severity of arterial changes in diabetics compared with non-diabetics.

Objectives: To compare angiographic changes between diabetic and non-diabetic patients with advanced PAD and correlate them with risk factors.

Methods: A retrospective cross-sectional study was conducted of consecutive patients undergoing lower limb arteriography for PAD (Rutherford 3-6) using TASC II and Bollinger et al. angiographic scores. Exclusion criteria were upper limb angiographies, unclear images, incomplete laboratory test results, and previous arterial surgeries. Statistical analyses included chi-square tests, Fisher's test for discrete data, and Student's t test for continuous data (significance level: p < 0.05).

Results: We studied 153 patients with a mean age of 67 years, 50.9% female and 58.2% diabetics. A total of 91 patients (59%) had trophic lesions (Rutherford 5 or 6) and 62 (41%) had resting pain or limiting claudication (Rutherford 3 and 4). Among diabetics, 81.7% were hypertensive, 29.4% had never smoked, and 14% had a history of acute myocardial infarction. According to the Bollinger et al. score, infra-popliteal arteries were more affected in diabetics, especially the anterior tibial artery (p = 0.005), while the superficial femoral artery was more affected in non-diabetics (p = 0.008). According to TASC II, the most severe angiographic changes in the femoral-popliteal segment occurred in non-diabetic patients (p = 0.019).

Conclusions: The most frequently affected sectors were the infra-popliteal sectors in diabetics and the femoral sector in non-diabetics.

背景:糖尿病患者发生外周动脉疾病(PAD)的风险是非糖尿病患者的5-15倍，很少有研究比较糖尿病患者与非糖尿病患者动脉病变的危险因素、分布和严重程度。目的:比较糖尿病和非糖尿病晚期PAD患者的血管造影变化及其与危险因素的相关性。方法:采用TASC II和Bollinger等血管造影评分对连续接受下肢动脉造影的PAD患者进行回顾性横断面研究(Rutherford 3-6)。排除标准为上肢血管造影，图像不清，实验室检查结果不完整，既往动脉手术。统计分析采用卡方检验，离散数据采用Fisher检验，连续数据采用Student t检验(显著性水平:p < 0.05)。结果:153例患者，平均年龄67岁，女性50.9%，糖尿病患者58.2%。共有91例(59%)患者有营养损害(Rutherford 5或6)，62例(41%)患者有静息性疼痛或局限性跛行(Rutherford 3和4)。糖尿病患者中，81.7%患有高血压，29.4%从未吸烟，14%有急性心肌梗死史。根据Bollinger等人的评分，糖尿病患者腘下动脉受影响更大，尤其是胫骨前动脉(p = 0.005)，而非糖尿病患者股浅动脉受影响更大(p = 0.008)。根据TASC II，最严重的股腘段血管造影改变发生在非糖尿病患者(p = 0.019)。结论:糖尿病患者最常见的病变部位为腘下区，非糖尿病患者最常见的病变部位为股动脉。

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引用次数: 1

Atividades Profissionais Confiáveis (APCs) para os programas de residência em cirurgia vascular 血管外科住院医师计划的可靠专业活动(APCs)

Q4 PERIPHERAL VASCULAR DISEASE

Jornal Vascular Brasileiro

Pub Date : 2023-01-01 DOI: 10.1590/1677-5449.202300751

Marcos Aurélio Perciano Borges, Ricardo André Viana Barros, Alcides José Araújo Ribeiro, Vanessa Dalva Guimarães Campos

引用次数: 0

Prevalence of rare visceral aneurysms on 92,833 CAT scans (2005-2021) 2005-2021年92,833份ct扫描中罕见内脏动脉瘤的患病率

Q4 PERIPHERAL VASCULAR DISEASE

Jornal Vascular Brasileiro

Pub Date : 2023-01-01 DOI: 10.1590/1677-5449.202300742

Sergio Quilici Belczak, Nathalia Almeida Cardoso da Silva, Matheus Toledo Nora, Paula Ribeiro do Prado Chadud, Luciana Helena Benetti, Camila de Freitas Corrêa, Adriano Tchibana, Ricardo Aun

Abstract Background Studies on the prevalence of rare visceral aneurysms are still scarce and the few studies that have focused on these aneurysms present prevalence rates in groups of patients with visceral aneurysms, but little is known about their prevalence in the general population. Objectives To assess the prevalence of rare visceral aneurysms on CAT scans performed for diagnosis and follow-up of patients with other vascular pathologies. Methods This cross-sectional study began by accessing all reports from CAT scans performed between January 2005 and July 2021 at a private hospital of excellence located in the city of São Paulo. A software program for pre-indexed reports was used to search the Radiological Information System (RIS) database to identify reports of patients with intra-abdominal aneurysms. Results CAT scan reports from 92,883 patients were accessed. Of these, 2,597 (2.795%) showed intra-abdominal aneurysms, 937 (1.063%) of which were visceral, including 158 (0.171%) rare visceral aneurysms, which were more frequent among male patients and in the following segments: celiac trunk (0.098%), superior mesenteric (0.033%), left gastric (0.010%), pancreatic-duodenal (0.009%), and gastroduodenal arteries (0.005%) and the pancreatic arch (0.004%). Lower prevalence was found in other segments. Additional findings revealed concomitance of rare visceral aneurysms with other intra-abdominal aneurysms ranging from 11.11% to 66.67%. Conclusions The prevalence of rare visceral aneurysms in a large population undergoing CAT scan was 0.171%, with greater involvement in male patients.

背景关于罕见内脏动脉瘤患病率的研究仍然很少，少数研究集中在这些动脉瘤的患者群体中，但对其在一般人群中的患病率知之甚少。目的探讨罕见内脏动脉瘤的ct扫描诊断及其他血管病变患者的随访情况。方法:本横断面研究首先访问了2005年1月至2021年7月在圣保罗市一家优秀私立医院进行的所有CAT扫描报告。使用预索引报告的软件程序搜索放射信息系统(RIS)数据库，以识别腹内动脉瘤患者的报告。结果共获取92,883例患者的CAT扫描报告。其中腹内动脉瘤2597例(2.795%)，内脏动脉瘤937例(1.063%)，其中罕见内脏动脉瘤158例(0.171%)，男性多见于乳糜干(0.098%)、肠系膜上(0.033%)、左胃(0.010%)、胰-十二指肠(0.009%)、胃十二指肠动脉(0.005%)和胰弓(0.004%)。其他人群的患病率较低。其他研究结果显示，罕见的内脏动脉瘤与其他腹内动脉瘤合并的发生率为11.11%至66.67%。结论:在接受CAT扫描的大量人群中，罕见的内脏动脉瘤的患病率为0.171%，男性患者的患病率更高。

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引用次数: 0

The emotional impact on patients of venous thromboembolism. 情绪对静脉血栓栓塞患者的影响。

Q4 PERIPHERAL VASCULAR DISEASE

Jornal Vascular Brasileiro

Pub Date : 2023-01-01 DOI: 10.1590/1677-5449.202201511

Alcides José Araújo Ribeiro, Marcos Arêas Marques

引用次数: 0

Squamous cell carcinoma on an arteriovenous fistula scar: case report. 鳞状细胞癌伴动静脉瘘瘢痕1例。

Q4 PERIPHERAL VASCULAR DISEASE

Jornal Vascular Brasileiro

Pub Date : 2023-01-01 DOI: 10.1590/1677-5449.202200622

Vinicius Tadeu Ramos da Silva Grillo, Pedro Luciano Mellucci, Marina Moraes Lopes Soares, Nathalia Dias Sertorio, Rodrigo Gibin Jaldin, Marcone Lima Sobreira, Eloisa Bueno Pires de Campos, Matheus Bertanha

The main type of access used for hemodialysis is the arteriovenous fistula (AVF) because it offers superior patency and lower complication rates when compared to other hemodialysis accesses. We report the case of a 69-year-old female patient with chronic kidney disease on dialysis secondary to hypertensive nephrosclerosis with a radiocephalic AVF in the left upper limb created 9 years previously. Two years previously, she had undergone a kidney transplant and was taking immunosuppressants. A crusted lesion developed on her left forearm with onset 3 months before presentation and she underwent an excisional biopsy that revealed a well-differentiated and superficially invasive squamous cell carcinoma, with lateral and deep surgical margins free from neoplasia. At 1-year follow-up, the patient showed no signs of neoplastic recurrence.

用于血液透析的主要通道类型是动静脉瘘(AVF)，因为与其他血液透析通道相比，它具有优越的通畅性和较低的并发症发生率。我们报告一例69岁女性慢性肾脏疾病透析继发于高血压肾硬化，并在左上肢放射性头部AVF 9年前创建。两年前，她接受了肾脏移植手术，并服用了免疫抑制剂。患者左前臂出现结痂病变，发病时间为就诊前3个月，患者行切除活检，结果为分化良好、浅表浸润的鳞状细胞癌，手术边缘外侧和深部未见瘤变。随访1年，患者无肿瘤复发迹象。

引用次数: 1

Dunbar syndrome - case report. 邓巴综合征病例报告。

Q4 PERIPHERAL VASCULAR DISEASE

Jornal Vascular Brasileiro

Pub Date : 2023-01-01 DOI: 10.1590/1677-5449.202300301

Sarah Maria Lemos de Campos, Rafael Prado Pessoa, João Paulo de Araújo Pelegrini, Henrique Fernandes Silveira, Maria Fernanda Lopes Diniz, Maria Passos Bianchini, Leonardo Soares Lopes, Marcus Eduardo Valadares Meireles Martins da Costa

Dunbar syndrome is diagnosed by excluding other possible causes of abdominal pains. Surgical treatment comprises complete dissection of the ligament and the surrounding nerve ganglion. This report describes the case of a previously healthy 45-year-old male patient who presented with epigastric abdominal pain irradiating to the back and weakness. Initially, abdominal computed tomography was ordered, showing arteriopathy of the celiac trunk and mesenteric artery with stenosis. The patient underwent surgical treatment because of the refractory pain, but findings were nonspecific. It was necessary to continue workup with serial angiotomography to follow the case. After around 6 months, thickening of the arcuate ligament was found, with compression of the proximal third of the celiac trunk and 80% stenosis. The patient therefore underwent laparoscopy to relieve celiac trunk compression, with satisfactory postoperative recovery.

邓巴综合征是通过排除其他可能的腹痛原因来诊断的。手术治疗包括完全剥离韧带和周围的神经神经节。本报告描述了一个先前健康的45岁男性患者，他表现为上腹部疼痛照射到背部和虚弱。最初，腹部计算机断层扫描显示腹腔干动脉病变和肠系膜动脉狭窄。由于难治性疼痛，患者接受了手术治疗，但结果是非特异性的。有必要继续进行连续血管断层扫描以跟踪该病例。约6个月后，发现弓形韧带增厚，乳糜干近三分之一受压，80%狭窄。因此，患者接受腹腔镜手术以缓解腹腔干压迫，术后恢复满意。

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引用次数: 0

Double-edged sword effect of platelets in COVID-19. 血小板在COVID-19中的双刃剑效应。

Q4 PERIPHERAL VASCULAR DISEASE

Jornal Vascular Brasileiro

Pub Date : 2023-01-01 DOI: 10.1590/1677-5449.202201012

Zohreh Jadali

1 Tehran University of Medical Sciences, School of Public Health, Department of Immunology, Tehran, Iran. Financial support: None. Conflicts of interest: No conflicts of interest declared concerning the publication of this article. Dear Editor, With interest we read the article by Sobreira et al. about the thromboembolic complications of COVID-19 vaccines.1 This study has important implications, but no mention is made regarding these complications in COVID-19 patients. It is therefore necessary to discuss this topic and possible pathogenic mechanisms. Coagulopathy is a common feature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its incidence increases in severe cases.2 The mechanisms of thrombotic events are multifactorial and platelets play a major role in this phenomenon. Beyond hemostasis and thrombosis, platelets are also capable of sensing and responding to invading pathogen and immune signals.3 Virusplatelet interactions may serve as part of the immune response or of viral counterdefense strategies. Platelets can interact with and respond to viruses via different mechanisms including phagocytosis and production of antiviral molecules. Conversely, they can also shelter several viruses and increase their transport ability throughout the circulation. Virus-mediated activation of platelets may also activate release of various pro-inflammatory mediators which lead to development of virus-induced immunopathology.4 Both positive and negative effects depend on the interaction between viral proteins and host cell receptors. Interactions can occur directly via various immune receptors in platelets or indirectly through plasma proteins. Platelets also express angiotensinconverting enzyme 2 (ACE2) which serves as the primary receptor for SARS-CoV-2 and facilitates virus entry into host cells.5 COVID-19 thrombotic complications may be the result of direct or indirect impacts of viral infection. SARS-CoV-2 can directly activate ACE2 and potentiates platelet activation. Moreover, the SARS-CoV-2 spike protein enhances the potential of thrombosis and recombinant human ACE-2 protein can suppress virus-induced platelet activation. The virus can also directly induce platelet releasing coagulation factors and inflammatory cytokines and increases formation of leukocyte-platelet aggregates. Platelets may also be activated indirectly, through sensing of an inflammatory microenvironment and subsequent dysfunction of vascular endothelium, which are induced by viral infection. The inflammatory milieu may cause uncontrolled platelet activation which consecutively may lead to pathophysiological effector activities. Moreover, immune complex containing viral particles may impact on the platelet hyperactivity in COVID19 patients.6 Altogether, platelets may be affected by SARSCoV-2. Therefore, understanding of the underlying mechanisms can be beneficial in promoting assessment and treatment of COVID-19 patients.

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