Jornal Vascular Brasileiro最新文献

Internal jugular phlebectasia is a non-tortuous abnormal dilation of the internal jugular vein that presents as a cervical mass with a saccular or fusiform aneurysmal appearance and is most common in male pediatric patients. Its etiologies include congenital, cervical trauma, tumors, and previous surgeries. The clinical picture is generally asymptomatic. In symptomatic cases, the most common complaint is pain in the affected cervical area. Diagnosis is established by visualization of the dilation when triggered by increased intrathoracic pressure during actions such as coughing or crying and is confirmed by imaging studies such as Doppler ultrasound and computed tomography. Therapeutic management is typically conservative, with surgical intervention reserved for cases with symptoms or complications.

This article presents three clinical cases of lower limb revascularization with closure of trophic defects using free gracilis flap transfer; two patients with Buerger's disease and one patient with type 2 diabetes mellitus. In these cases, we also describe and discuss direct or indirect evidence of indirect revascularization of ischemic tissues by means of the flap, as well as the advantages and limitations of the free gracilis muscle flap.

Variations in the renal vasculature and testicular artery are common within the human body. However, extra renal calyces and precaval renal arteries are uncommon. In the present case we report extra renal calyces of both kidneys, two right precaval renal arteries, and an abnormal right testicular artery. The kidneys and gonads develop from the intermediate mesoderm. The arteries supplying them bud from the dorsal aorta. This vascular plexus is arranged in a ladder-like manner due to the ascent of kidneys and descent of gonads. Any variation in the vascular supply of these structures must be interrelated, hence care has been taken to clarify the embryological aspect of these variations.

This article reports the case of a patient who developed bilateral compartment syndrome of the legs after use of intermittent pneumatic compression and compression stockings as prophylactic measures against venous thromboembolism in the perioperative period of plastic surgery. The patient was treated with fasciotomies, followed by uneventful recovery. A literature review is also presented covering diagnosis and treatment of lower limb compartment syndrome and the pathophysiological mechanisms of this clinical condition as a postoperative complication.

Exertional lower extremity pain due to arterial insufficiency is uncommon in the young. In this case report we present a 34-year-old, previously healthy male with sudden onset left lower limb pain upon walking for 50 meters. He was found to have a spontaneous dissection of his external iliac artery, which is a rare pathology. After successful open revascularization, he made an uneventful recovery.

Background: Polidocanol (POL) foam is widely used in sclerotherapy for the treatment of lower limb varicose veins and its properties are influenced by multiple variables, including preparation methods and room temperature.

Objectives: To compare the influence of temperature on the half-life and bubble diameter of 1% polidocanol foam using the Tessari and double syringe techniques.

Methods: The study employed 1% polidocanol foam prepared at room temperature and cooled to 4 °C, using two techniques: the Tessari technique and the double syringe technique. The foam half-life was recorded, defined as the time in seconds taken for half of the liquid volume to drain. Bubble diameter was analyzed with microscopy. Differences between groups were considered significant at p ≤ 0.05.

Results: Cooling significantly extended the half-life of the foam, especially when the double syringe technique was employed. The Tessari technique produced smaller bubbles under both temperature conditions.

Conclusions: Cooling the mixture of 1% polidocanol and room air increased half-life, irrespective of the preparation technique employed. Temperature had no effect on bubble diameter.

Background: COVID-19 is a predominantly respiratory disease, but it also has a strong association with thromboembolism, especially among hospitalized patients.

Objectives: To evaluate the prevalence of venous thromboembolism (VTE) and associated factors in patients with COVID-19 in a public hospital in the interior of South Brazil.

Methods: A retrospective, cross-sectional observational study was carried out by analyzing data from medical records. The VTE outcome was a composite of acute pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT). Associations were analyzed by logistic regression and bivariate analyses using Pearson's chi-square test.

Results: The sample comprised 964 patients. 56% were male and 44% female, with a mean age of 58.2 ± 15.1 years. 70% of patients were admitted to the ICU, 44.4% died, 97% required oxygen, and 63.7% required intubation. After adjusted analysis, the factors intubation (p=0.02) and prophylactic anticoagulation (p<0.001) were associated with VTE. The following variables were shown to be important risk factors for VTE: intubation (OR 2.3; 95% CI 1.1-4.8, p=0.020) and excess weight (OR 3.3; 95% CI 0.2-2.2, p=0.02), while prophylactic anticoagulation showed a small protective factor (OR 0.02; 95% CI 0.01-0.04, p<0.001).

Conclusions: The results demonstrate how COVID-19, together with several other associated factors, especially intubation, excess weight, and use of anticoagulants, may be related to thromboembolism as risk factors and protective factors. Prophylactic anticoagulation, in particular, was a protective factor.

We report the case of a 38-year-old man with a traumatic arteriovenous fistula between the left common femoral artery and vein, resulting from a gunshot wound sustained 20 years earlier. He began presenting symptoms, including a venous stasis ulcer and cardiac dysfunction, 4 years ago. Computed tomography revealed the presence of a fistula and downstream dilation of the iliac vessels and inferior vena cava, the latter measuring up to 37.5 mm. Given the patient's complex vascular anatomy and overall good clinical condition, an open surgical approach was selected, resulting in excellent outcomes. Due to the risk of deep vein thrombosis and pulmonary thromboembolism, placement of an inferior vena cava filter and initiation of long-term anticoagulation were also performed. Surgery proved to be the definitive treatment, resolving both heart failure and ulcer, and restoring the patient's quality of life. The open approach was an excellent treatment option, considering the patient's young age, anatomical distortion, and the unavailability of adequate endovascular materials.

Background: Thoraco-abdominal endovascular aortic repair [(T)EVAR] of thoracic (TEVAR) and abdominal aorta (EVAR) has surpassed open surgical repair for thoraco-abdominal aortic diseases.

Objectives: We describe the long-term outcomes of 101 (T)EVAR patients treated over the last eleven years.

Methods: A retrospective analysis of 101 consecutive (T)EVAR patients was performed. The primary endpoints were in-hospital and 30-day outcomes, while the secondary endpoints were long-term outcomes and re-intervention rates.

Results: Out of 101 patients, EVAR and TEVAR were performed in 40 (39.6%) and 61 (60.3%) patients, respectively. Mean age was 58.04 ± 15.7 years. Technical success rates were 100% and 95% in the EVAR and TEVAR groups, respectively. Intraoperative endoleak was observed in 17 patients. Major perioperative complications (n=16) included retrograde aortic dissection (n=1), stent graft migration (n=2), paraparesis (n=1), device system entrapment in iliac vessels (n=1), acute renal failure (n=2), acute limb ischemia (n=3), and aorto-enteric fistula (n=2). The 30-day mortality rate was 7.9% (8 patients). Kaplan Meyer survival estimates at 1 and 5 years were 79% (95% CI 66.0-87.0, SE 0.053%) and 71% (95%CI 56.0- 81.0, SE 0.065%) for TEVAR and 84% (95% CI 67.0-92.0, SE 0.061%) and 69% (95%CI 46.0-83.0, SE 0.094%) for EVAR, respectively. Diabetes and smoking were associated with increased all-cause mortality in EVAR (p=0.018) and TEVAR (p=0.045) cases, respectively, following Cox regression analysis.

Conclusions: We observed favorable short- and long-term outcomes in 101 (T)EVAR patients, proving its safety and long-term efficacy for management of thoracoabdominal aortic disease.

Background: Patients with acute renal failure requiring hemodialysis should be treated using temporary hemodialysis catheters due to the urgency and potential reversibility of the condition. To date, 3 studies in North America have suggested a higher risk of catheter-related issues in COVID-19 patients needing hemodialysis.

Objectives: This study examines the functionality and complications of temporary hemodialysis access in COVID-19 patients at a Brazilian hospital during the coronavirus outbreak of 2020.

Methods: A retrospective analysis was conducted at a COVID-19 referral center from May to July 2020. During this period, the Vascular Surgery team implanted temporary hemodialysis catheters in 107 patients. These patients were monitored, and their demographic and clinical characteristics were analyzed to identify any that correlated with catheter malfunction.

Results: Of the 107 patients studied, 22 (20.6%) had catheter-related complications. Eighteen (16.8%) had catheter malfunctions, while 4 (3.7%) developed infections. Five patients had unfavorable clinical status and did not undergo catheter replacement. Catheter tip thrombosis was the cause of the malfunction in 13 of the patients with malfunctions. The analysis revealed that the only variables correlated with higher risk of malfunction were the need for orotracheal intubation (p = 0.009), deep vein thrombosis (p = 0.01), and a history of a previous catheter use (p = 0.002).

Conclusions: The rate of temporary dysfunction of the high-flow catheter in patients with COVID-19 in this sample was similar to the rate described in the literature for patients without this disease.