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Guidelines on deep vein thrombosis of the Brazilian Society of Angiology and Vascular Surgery. 巴西血管病学和血管外科学会的深静脉血栓指南。
IF 0.8 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-09-03 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202301072
Marcone Lima Sobreira, Marcos Áreas Marques, Adilson Ferraz Paschoa, Alcides José Araújo Ribeiro, Ivan Benaduce Casella, Marcelo Calil Burihan, Marcelo Fernando Matielo, Rafael de Athayde Soares, Walter Junior Boin de Araujo, Edwaldo Edner Joviliano, Julio Cesar Peclat de Oliveira

Deep vein thrombosis is one of the main causes of inpatient and outpatient morbidity, both in medical and surgical patients, significantly impacting mortality statistics and requiring prompt diagnosis so that treatment can be initiated immediately. This document was prepared and reviewed by 11 specialists certified by the Brazilian Society of Angiology and Vascular Surgery, who searched the main databases for the best evidence on the diagnostic (physical examination, imaging) and therapeutic approaches (heparin, coumarins, direct oral anticoagulants, fibrinolytics) to the disease.

深静脉血栓是内科和外科住院病人和门诊病人发病的主要原因之一,严重影响死亡率统计,需要及时诊断,以便立即开始治疗。本文件由巴西血管病学和血管外科学会认证的 11 位专家编写和审阅,他们在主要数据库中搜索了有关该疾病的诊断(体格检查、影像学检查)和治疗方法(肝素、香豆素类、直接口服抗凝剂、纤维蛋白溶解剂)的最佳证据。
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引用次数: 0
Giacomini's vein - a report on the invaluable importance of an anomalous short saphenous vein. 贾科米尼静脉--关于异常短隐静脉的重要价值的报告。
IF 0.8 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202400242
Abdalla Ahmed Eldaw Elamin, Naveen Kumar, Vijay Paul Samuel, Kumar Megur Ramakrishna Bhat

Variations in the drainage (termination) and course of the lower limb veins are not uncommon. When dissecting the left lower limb of the adult male cadaver in the vascular case described herein, a unique kind of unilateral short saphenous vein (SSV) termination was observed. It was found that the SSV had normal origin and course in the dorsum of the foot and the back of the leg, respectively. Most often the SSV terminates in the popliteal vein at the popliteal fossa. In this case, it extended upward into the back of the thigh, passing behind the sciatic nerve and then deep to it and the biceps femoris, and finally ended in the veins of the thigh. The SSV did not penetrate any structures along its course to the end, so this unusual vein appears unlikely to be associated with SSV varicose veins. For general, plastic, cardiothoracic, and vascular surgeons, our case would be of significant value.

下肢静脉引流(终止)和走向的变化并不少见。在本文描述的血管病例中,解剖成年男性尸体的左下肢时,观察到一种独特的单侧短隐静脉(SSV)终止现象。研究发现,SSV 的正常起源和走向分别位于脚背和腿后部。大多数情况下,SSV 终止于腘窝处的腘静脉。在本病例中,它向上延伸至大腿后侧,经过坐骨神经后方,然后深入坐骨神经和股二头肌,最后止于大腿静脉。SSV 静脉沿其走向并未穿透任何结构,因此这条不寻常的静脉似乎与 SSV 静脉曲张无关。对于普外科、整形外科、心胸外科和血管外科医生来说,我们的病例具有重要价值。
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引用次数: 0
Popliteal artery pseudoaneurysm of spontaneous occurrence: a case report. 自发性腘动脉假性动脉瘤:病例报告。
IF 0.8 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-08-23 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202400212
Wallace Klein Schwengber, Claudia Carolina Schnorr, Guilherme Camargo Winckler, Ricardo Bocchese Paganella, Marco Aurélio Grudtner

Idiopathic popliteal artery pseudoaneurysms are exceedingly rare, posing significant diagnostic challenges due to their elusive etiology. This report presents the case of a 78-year-old female with no history of trauma or orthopedic procedures who was diagnosed with a large pulsatile mass in the right popliteal fossa. Arteriography confirmed a popliteal artery pseudoaneurysm. Despite extensive clinical evaluation, no causative factors were identified, suggesting an idiopathic diagnosis. The patient underwent open surgical repair using a posterior approach, during which the popliteal artery defect was closed using a bovine pericardium patch. Postoperative follow-up revealed proximal patch stenosis, necessitating angioplasty. This case underscores the need for comprehensive diagnostic evaluation of atypical pseudoaneurysm presentations and highlights the complexities involved in managing idiopathic cases, emphasizing the importance of postoperative follow-up to address potential complications.

特发性腘动脉假性动脉瘤极为罕见,由于其病因难以捉摸,给诊断带来了极大的挑战。本报告介绍了一例 78 岁女性的病例,她没有外伤史或骨科手术史,被诊断为右腘窝大的搏动性肿块。动脉造影证实为腘动脉假性动脉瘤。尽管进行了广泛的临床评估,但没有发现致病因素,这表明诊断为特发性。患者接受了后路开放手术修补,术中使用牛心包补片缝合了腘动脉缺损。术后随访发现补片近端狭窄,需要进行血管成形术。该病例强调了对非典型假性动脉瘤进行全面诊断评估的必要性,并突出了处理特发性病例的复杂性,同时强调了术后随访对解决潜在并发症的重要性。
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引用次数: 0
Thromboprophylaxis in lower limb amputation surgery. 下肢截肢手术中的血栓预防。
IF 0.8 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-08-09 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202301442
Monique Magnavita Borba da Fonseca Cerqueira, Marcos Arêas Marques, Alcides José Araújo Ribeiro, Daniel Mendes-Pinto, Suzanna Maria Viana Sanches

Background: Lower limb amputation surgery is associated with a high risk of venous thromboembolism. There is evidence that pharmacological thromboprophylaxis is not widely prescribed to patients undergoing this type of procedure.

Objectives: To investigate the profile of the thromboprophylaxis practices of angiologists and vascular surgeons in Brazil during the perioperative period of lower limb amputation surgery and conduct a descriptive analysis of the findings.

Methods: This is a cross-sectional, descriptive study, with simple probabilistic sampling, carried out with angiologists and vascular surgeons working in Brazil. Data were collected through electronic questionnaires, from February to June 2023.

Results: There were 237 respondents, 58.6% of whom conduct thrombotic risk stratification. Of these, 86.3% use the Caprini score. Only 27% of participants stratify patients' bleeding risk. Low molecular weight heparin is the medication of choice for 85.7% of study participants, 78.9% of whom use a dosage of 40 IU per day. Around 46.8% use direct oral anticoagulants in addition to low molecular weight heparin and rivaroxaban is the drug they most often prescribe (94.6%). A little more than half (51.15%) routinely recommend pharmacological thromboprophylaxis until hospital discharge.

Conclusions: The study revealed the heterogeneous nature of conduct related to prescription of pharmacological thromboprophylaxis, highlighting the need for more studies to support prophylaxis decision-making in this patient population.

背景:下肢截肢手术具有很高的静脉血栓栓塞风险。有证据表明,接受此类手术的患者并未广泛使用药物预防血栓形成:调查巴西血管内科医生和血管外科医生在下肢截肢手术围手术期采取血栓预防措施的情况,并对调查结果进行描述性分析:这是一项横断面描述性研究,采用简单概率抽样法,对象是在巴西工作的血管内科医生和血管外科医生。数据通过电子问卷收集,时间为 2023 年 2 月至 6 月:共有 237 名受访者,其中 58.6% 的人进行了血栓风险分层。其中,86.3%的受访者使用卡普里尼评分。只有 27% 的受访者对患者的出血风险进行了分层。低分子量肝素是 85.7% 的研究参与者的首选药物,其中 78.9% 的参与者每天使用 40 IU 的剂量。除低分子量肝素外,约 46.8% 的人还使用直接口服抗凝剂,而利伐沙班是他们最常处方的药物(94.6%)。略多于半数的医生(51.15%)建议在出院前进行药物血栓预防:该研究揭示了药物血栓预防处方相关行为的异质性,强调需要更多的研究来支持这一患者群体的预防决策。
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引用次数: 0
There is no well-being without oral health: a case report of Lemierre's syndrome due to neglected odontogenic infection. 没有口腔健康就没有幸福:一例因被忽视的牙源性感染导致的莱米埃尔综合征报告。
IF 0.8 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-08-09 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202301622
Edward Davis, Ardeno Kristianto, Andrew Jackson Yang

Lemierre's syndrome is marked by presence of septic thrombophlebitis in the internal jugular vein. This case report describes a 57-year-old woman who presented with a progressively swelling neck with onset 1 day prior to admission. She had a history of untreated dental infection. Physical examination revealed slightly increased blood pressure, at 140/80 mmHg, and a painful, erythematous, warm swelling in the mid area of the neck. Ultrasound of the neck revealed occlusive intraluminal thrombus in the right internal jugular vein, a computed tomography (CT) scan with contrast showed that there was a blockage in the right jugular vein. The mainstay treatment for Lemierre's syndrome is antibiotics, while administration of anticoagulants remains controversial. The patient was treated conservatively, with administration of antibiotics and anticoagulant. Several days later the patient's condition had improved significantly, with less pain and reduced swelling.

勒米尔综合征的特征是颈内静脉出现化脓性血栓性静脉炎。本病例报告描述的是一名 57 岁女性,入院前一天出现颈部逐渐肿胀。她曾有未治疗的牙科感染病史。体格检查显示血压略有升高(140/80 mmHg),颈部中间区域出现疼痛、红斑、发热的肿胀。颈部超声波检查发现右颈内静脉有闭塞性腔内血栓,造影剂计算机断层扫描(CT)显示右颈静脉堵塞。莱米埃尔综合征的主要治疗方法是使用抗生素,而使用抗凝剂仍存在争议。患者接受了保守治疗,服用了抗生素和抗凝剂。几天后,患者的病情明显好转,疼痛减轻,肿胀减轻。
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引用次数: 0
Embolization of multiple splenic artery aneurysms in a patient with hypersplenism due to portal hypertension: a case report. 门静脉高压症脾功能亢进患者的多发性脾动脉瘤栓塞术:病例报告。
IF 0.8 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-08-09 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202301392
Lucas Victoy Guimarães Zengo, Maria Vitoria Bandeira Liebich, Larissa Rossi, Giuliana Rossato Biezus, Jeferson Freitas Toregeani, Jong Hun Park

Aneurysms of the splenic artery are the third most common type of intra-abdominal aneurysms and the most common type of visceral aneurysms. Portal hypertension is a significant risk factor for development of these aneurysms. We report the case of a white, female, 52-year-old patient with multiple splenic artery aneurysms and hypersplenism secondary to portal hypertension and cirrhosis. Abdominal angiotomography identified six splenic aneurysms. In this scenario, an endovascular intervention was scheduled to conduct embolization using controlled release coils and Onyx™ embolization agent. The three largest aneurysms were treated. Control angiographs showed good exclusion of the aneurysms. The endovascular technique therefore proved to be a good choice considering the patient's comorbidities and blood disorders. In this case, the procedure was successful. There were no immediate or long-term complications. The patient recovered well and is in clinical follow-up.

脾动脉瘤是第三种最常见的腹内动脉瘤,也是最常见的内脏动脉瘤。门静脉高压是这类动脉瘤发病的重要危险因素。我们报告了一例 52 岁的白人女性患者,她患有多发性脾动脉瘤和脾功能亢进,继发于门静脉高压症和肝硬化。腹部血管造影发现了六个脾动脉瘤。在这种情况下,安排了一次血管内介入治疗,使用控释线圈和Onyx™栓塞剂进行栓塞。三个最大的动脉瘤得到了治疗。对照血管造影显示动脉瘤排除良好。因此,考虑到患者的合并症和血液疾病,血管内技术被证明是一个不错的选择。在这个病例中,手术非常成功。没有出现即刻或长期并发症。患者恢复良好,目前正在接受临床随访。
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引用次数: 0
Ruptured carotid artery pseudoaneurysm following excision of a carotid body tumor: a rare complication managed successfully with surgery and literature review. 颈动脉体肿瘤切除术后颈动脉假性动脉瘤破裂:手术成功治愈的罕见并发症及文献综述。
IF 0.8 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-08-09 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202301702
Basil Babu, Divij Jayant, Arunanshu Behera, Cherring Tandup, Swapnesh Kumar Sahoo, Vipul Thakur

A 47-year-old male presented with a right-sided Shamblin type 2 carotid body tumor measuring 5*5 cm. After preoperative embolization, a sub adventitial resection of the tumor was done. He was discharged after postoperative day 5 and presented again to emergency 10 days later with a bleeding pseudoaneurysm at the surgical site causing dysphagia and dyspnea. He was taken for emergency exploration of the surgical wound and, intraoperatively, it was observed that the proximal ends of the internal carotid artery and external carotid artery close to the bifurcation were forming a pseudoaneurysm, 1 cm distal to the common carotid artery. The external carotid artery was ligated and a common carotid to internal carotid artery bypass was done with a reversed saphenous vein graft. He recovered well in the postoperative period and was discharged on day 7. Pseudoaneurysm formation following carotid body tumor resection is extremely rare and has only been reported thrice in the literature.

一名 47 岁的男性患有右侧香卜林 2 型颈动脉体瘤,大小为 5*5 厘米。术前栓塞后,对肿瘤进行了临床下切除。术后第 5 天出院,10 天后因手术部位假性动脉瘤出血导致吞咽困难和呼吸困难再次急诊就诊。他被送往急诊检查手术伤口,术中观察到颈内动脉和颈外动脉靠近分叉处的近端在颈总动脉远端 1 厘米处形成假性动脉瘤。他结扎了颈外动脉,并用反向大隐静脉移植物做了颈总动脉到颈内动脉的搭桥手术。患者术后恢复良好,于第 7 天出院。颈动脉体肿瘤切除术后假性动脉瘤的形成极为罕见,文献中仅报道过三次。
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引用次数: 0
Case report: persistent bilateral complete sciatic artery associated with aneurysmal degeneration. 病例报告:持续性双侧完全坐骨动脉伴有动脉瘤变性。
IF 0.8 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-08-09 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202301512
Paulo Henrique Alves Togni, André Luís Santos Vaz Leite, Marcela Prando Sampaio, Beatriz Camargo Castro, Henrique Tomaz Rodrigues, Guilherme Augusto Paro

Persistent sciatic artery is a rare congenital anomaly, with few cases described in the literature. This study presents a case of this embryological variation observed in a patient's lower limb circulatory system. The anatomical description is based on a review of medical records and imaging exams. This case report describes a 63-year-old female patient admitted to the emergency department complaining of severe pain in the right lower limb, with a cold, pale extremity and ecchymosis on the dorsum of the foot. Duplex ultrasound showed no detectable flow in the anterior tibial and fibular arteries and a tardus parvus pattern in the posterior tibial artery. The patient developed loss of movement and fixed cyanosis in the right foot and was referred for urgent thromboembolectomy. However, adequate reperfusion was not seen after the procedure. Angiotomography was performed on the first postoperative day, showing bilateral persistence of the sciatic artery, with aneurysmal degeneration, partially thrombosed, and no opacification of the arterial system downstream of the aneurysm. By the third postoperative day, the patient had developed areas of dry necrosis in the limb, with no perfusion to the ankle, and underwent transfemoral amputation. Despite being a rare condition, it is of great clinical importance because of the high complication rates.

持续性坐骨动脉是一种罕见的先天性异常,文献中描述的病例很少。本研究介绍了一例在患者下肢循环系统中观察到的这种胚胎变异。解剖学描述基于对医疗记录和成像检查的回顾。本病例报告描述了一名 63 岁的女性患者因右下肢剧烈疼痛、四肢冰冷、苍白和足背瘀斑而被送入急诊科。双反射超声显示,胫前动脉和腓动脉未发现血流,胫后动脉呈迟缓旁流型。患者右脚出现活动障碍和固定性紫绀,被紧急转诊进行血栓栓塞切除术。然而,术后未见充分再灌注。术后第一天进行了血管造影,显示坐骨神经动脉双侧持续存在,动脉瘤变性,部分血栓形成,动脉瘤下游的动脉系统未见不通畅。术后第三天,患者肢体出现干性坏死区域,踝关节无灌注,接受了经股截肢手术。尽管这种情况非常罕见,但由于并发症发生率高,因此在临床上具有非常重要的意义。
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引用次数: 0
Left ventricle pedunculated thrombi risks and outcomes: a case report and literature review. 左心室梗阻性血栓的风险和结果:病例报告和文献综述。
IF 0.8 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-08-09 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202301242
Ahmed Ali Ali, Eman Elsayed Sakr

A 42-year-old male with ischemic cardiomyopathy presented with acute bilateral femoral artery embolization. After management with embolectomy and fasciotomy in both femoral arteries, transthoracic echocardiography revealed two pedunculated highly mobile left ventricle (LV) thrombi. Given the procedural risk, anticoagulation therapy was recommended over surgery. However, the bleeding risk impeded the continuation of anticoagulation, which increased the thrombus size. Multiorgan failure and disseminated intravascular coagulopathy followed and the patient died. We also systematically reviewed the PubMed and Scopus databases for pedunculated LV thrombi cases and retrieved 74 and 63 reports respectively. Of these, 37 relevant reports (45 cases) plus 11 reports from the manual search were included for data extraction, a total of 56 cases besides our case. Based on the etiologies and risks, LV thrombi are predictable and preventable, especially after ischemic events. A clear diagnostic algorithm and vigilant follow-up are needed as well as multidisciplinary management once a diagnosis is confirmed.

一名患有缺血性心肌病的42岁男性出现急性双侧股动脉栓塞。在对双侧股动脉进行栓子切除术和筋膜切开术后,经胸超声心动图检查发现左心室(LV)有两个梗阻性高流动性血栓。考虑到手术风险,建议采用抗凝治疗而不是手术。然而,出血风险阻碍了抗凝治疗的继续,导致血栓增大。患者随后出现多器官功能衰竭和弥散性血管内凝血病,最终不治身亡。我们还系统地查阅了 PubMed 和 Scopus 数据库中的左心室有蒂血栓病例,分别检索到 74 篇和 63 篇报道。其中,37篇相关报道(45例)加上人工检索的11篇报道被纳入数据提取,除我们的病例外,共有56例。根据病因和风险,左心室血栓是可以预测和预防的,尤其是在缺血性事件后。一旦确诊,需要明确的诊断算法和警惕的随访以及多学科管理。
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引用次数: 0
Catastrophic thrombotic events with partial bilateral amputation of legs and fingers in a 12-year-old girl with COVID-19 in Brazil: case report. 病例报告:巴西一名患有 COVID-19 的 12 岁女孩因严重血栓事件导致双腿和手指部分截肢。
IF 0.8 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-08-09 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202301752
Giselly Rosa Modesto Pereira, André Ricardo Araújo da Silva, Claudia Escórcio Gurgel do Amaral Pitanga, Jocemir Ronaldo Lugon

The first case of COVID-19 was detected in Dec 2019, in China. The disease shortly evolved into a pandemic and imposed an unparalleled health and social burden on mankind. Severe forms of COVID-19 mainly affect adults, especially the elderly and those with comorbidities. We report a severe case of COVID-19 in a previously healthy 12-year-old female who was admitted to the emergency room on May 26, 2020, with fever, abdominal pain, vomiting, and diarrhea. During the hospital stay, she tested positive for SARS-CoV-2 and developed multiple organ failure and catastrophic thrombotic events resulting in bilateral amputation of legs and fingers. She was discharged from the hospital for outpatient follow-up after 107 days. By the time this report was written, the patient was undergoing prosthesis prescription and training and regaining her independence to walk.

2019 年 12 月,中国发现首例 COVID-19 病例。该疾病很快演变成大流行病,给人类带来了巨大的健康和社会负担。严重型 COVID-19 主要影响成年人,尤其是老年人和合并症患者。我们报告了一例严重的COVID-19病例,患者是一名原本健康的12岁女性,于2020年5月26日因发烧、腹痛、呕吐和腹泻被送入急诊室。住院期间,她的 SARS-CoV-2 检测呈阳性,并出现多器官衰竭和灾难性血栓事件,导致双腿和手指截肢。107 天后,她出院接受门诊随访。撰写本报告时,患者正在接受假肢处方和训练,恢复了独立行走能力。
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引用次数: 0
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Jornal Vascular Brasileiro
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