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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
Use of low-level laser therapy as an adjuvant therapy for phlebostatic lesions. 将低强度激光疗法作为咽喉病变的辅助疗法。
IF 0.8 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-07-08 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202301592
Lucas Dalvi Armond Rezende, Davi de Souza Catabriga, Alicia de Oliveira Pacheco, Aline de Oliveira Ramalho, Paula de Souza Silva Freitas

Low-intensity laser therapy (LILT) is commonly used as an adjuvant therapy for treating injuries. This integrative literature review was carried out in the MEDLINE, LILACS, CUMED, BDENF, SPORTDiscus, Dentistry & Oral Sciences Source, Academic Source and CINAHL databases. Among the inclusion criteria were: range from 2011 to 2021, in English, Portuguese and Spanish and any study, with the exception of preprints and books. The question was answered: "What is the effectiveness described in the literature of using low-intensity laser therapy (LILT) in the treatment of venous lesions?" The wavelength used in studies varied from 635 nm of red ray to 780 nm of infrared ray, generating healing improvement at any length. LBI presented itself as a low-cost and easy-to-apply adjuvant option, alleviating pain complaints and improving healing in patients with vasculogenic lesions.

低强度激光疗法(LILT)通常用作治疗损伤的辅助疗法。本综合文献综述是在 MEDLINE、LILACS、CUMED、BDENF、SPORTDiscus、Dentistry & Oral Sciences Source、Academic Source 和 CINAHL 数据库中进行的。纳入标准包括:时间范围从 2011 年至 2021 年,语言为英语、葡萄牙语和西班牙语,除预印本和书籍外的任何研究。问题解答"文献中描述的使用低强度激光疗法(LILT)治疗静脉病变的效果如何?"研究中使用的波长从 635 纳米的红外线到 780 纳米的红外线不等,任何波长的激光都能改善治疗效果。低强度激光治疗是一种低成本、易于应用的辅助治疗方法,可减轻脉管病变患者的疼痛症状,改善愈合情况。
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引用次数: 0
Comparison between vascular Doppler ultrasound and contrast exams in chronic peripheral arterial disease. 慢性外周动脉疾病中血管多普勒超声与造影剂检查的比较。
IF 0.8 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-07-08 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202301042
Alex Aparecido Cantador, Ana Terezinha Guillaumon

Background: Vascular Doppler ultrasound (DUS) has evolved over recent years because of improvements in the technology involved in the acquisition and processing of sound and image data. The method is an excellent option for use in diagnosis of peripheral arterial disease considering its availability, low cost, and absence of harmful effects. The breakdown of logistics supply chains caused by the COVID-19 pandemic caused worldwide shortages of iodinated contrast, highlighting the need to validate alternative diagnostic methods.

Objective: To use DUS for decision-making when choosing between by-pass and endovascular surgery for femoropopliteal arterial disease and compare the results to those of iodinated contrast exams.

Methods: We compared DUS with examinations using contrast for identification of stenoses/occlusions and indication of surgical treatment (by-pass vs. endovascular). In the first phase of the study the results were merely compared, DUS vs. angiotomography. Then, in the second phase, the vascular ultrasound results were used for screening between by-pass and endovascular treatment, comparing DUS with angiotomography in cases scheduled for by-pass and with arteriography in endovascular patients.

Results: In phase 1, the sensitivity of DUS compared to CT angiography was 100% for the SFA territory. When considering solely the choice of bypass vs. endovascular treatment, the results showed 100% agreement for phase 1 and 94% for phase 2.

Conclusion: Notwithstanding the sample size, the study fulfilled its objective of demonstrating the reliability of DUS for indicating the treatment choice between by-pass and endovascular surgery.

背景:近年来,由于声音和图像数据的采集和处理技术不断进步,血管多普勒超声(DUS)也在不断发展。考虑到其可用性、低成本和无有害影响,该方法是诊断外周动脉疾病的绝佳选择。COVID-19 大流行导致物流供应链断裂,造成全球碘造影剂短缺,突出了验证替代诊断方法的必要性:目的:利用 DUS 对股骨头动脉疾病选择旁路手术还是血管内手术进行决策,并将其结果与碘造影剂检查结果进行比较:我们将 DUS 与使用造影剂的检查进行了比较,以确定狭窄/闭塞和手术治疗指征(旁路手术与血管内手术)。在研究的第一阶段,我们仅比较了 DUS 与血管造影的结果。然后,在第二阶段,血管超声结果被用于旁路治疗和血管内治疗之间的筛选,在计划进行旁路治疗的病例中比较 DUS 和血管造影,在血管内治疗患者中比较动脉造影:在第一阶段,与 CT 血管造影相比,DUS 对 SFA 区域的敏感性为 100%。如果仅考虑选择旁路治疗还是血管内治疗,结果显示第一阶段的一致性为100%,第二阶段为94%:结论:尽管样本量有限,但这项研究达到了其目的,即证明了 DUS 在显示旁路手术和血管内手术治疗选择方面的可靠性。
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引用次数: 0
Brazilian Angiology and Vascular Surgery Society Guidelines for the treatment of extracranial cerebrovascular disease. 巴西血管学和血管外科学会颅外脑血管疾病治疗指南。
IF 0.8 Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-05-31 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202300942
Arno von Buettner Ristow, Bernardo Massière, Guilherme Vieira Meirelles, Ivan Benaduce Casella, Marcia Maria Morales, Ricardo Cesar Rocha Moreira, Ricardo Jayme Procópio, Tércio Ferreira Oliveira, Walter Jr Boim de Araujo, Edwaldo Edner Joviliano, Júlio Cesar Peclat de Oliveira

Extracranial cerebrovascular disease has been the subject of intense research throughout the world, and is of paramount importance for vascular surgeons. This guideline, written by the Brazilian Society of Angiology and Vascular Surgery (SBACV), supersedes the 2015 guideline. Non-atherosclerotic carotid artery diseases were not included in this document. The purpose of this guideline is to bring together the most robust evidence in this area in order to help specialists in the treatment decision-making process. The AGREE II methodology and the European Society of Cardiology system were used for recommendations and levels of evidence. The recommendations were graded from I to III, and levels of evidence were classified as A, B, or C. This guideline is divided into 11 chapters dealing with the various aspects of extracranial cerebrovascular disease: diagnosis, treatments and complications, based on up-to-date knowledge and the recommendations proposed by SBACV.

颅外脑血管疾病一直是全世界深入研究的课题,对血管外科医生来说至关重要。本指南由巴西血管学和血管外科学会(SBACV)编写,取代了 2015 年指南。非动脉粥样硬化性颈动脉疾病未纳入本文件。本指南旨在汇集该领域最有力的证据,以帮助专科医生在治疗决策过程中进行决策。本指南采用 AGREE II 方法和欧洲心脏病学会系统进行推荐和证据分级。本指南分为 11 章,涉及颅外脑血管疾病的各个方面:诊断、治疗和并发症,以最新知识和 SBACV 提出的建议为基础。
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引用次数: 0
Brazilian Society of Angiology and Vascular Surgery 2023 guidelines on the diabetic foot. 巴西血管病学和血管外科学会 2023 年糖尿病足指南。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-05-17 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202300872
Eliud Garcia Duarte, Cicero Fidelis Lopes, Danilo Roberto Fadel Gaio, Jamil Victor de Oliveira Mariúba, Lorena de Oliveira Cerqueira, Marcos Antonio Bonacorso Manhanelli, Tulio Pinho Navarro, Aldemar Araújo Castro, Walter Jr Boim de Araujo, Hermelinda Pedrosa, Júnio Galli, Nelson de Luccia, Clayton de Paula, Fernando Reis, Milton Sérgio Bohatch, Tércio Ferreira de Oliveira, Amanda Fernandes Vidal da Silva, Júlio Cesar Peclat de Oliveira, Edwaldo Édner Joviliano

The diabetic foot interacts with anatomical, vascular, and neurological factors that challenge clinical practice. This study aimed to compile the primary scientific evidence based on a review of the main guidelines, in addition to articles published on the Embase, Lilacs, and PubMed platforms. The European Society of Cardiology system was used to develop recommendation classes and levels of evidence. The themes were divided into six chapters (Chapter 1 - Prevention of foot ulcers in people with diabetes; Chapter 2 - Pressure relief from foot ulcers in people with diabetes; Chapter 3 -Classifications of diabetic foot ulcers; Chapter 4 - Foot and peripheral artery disease; Chapter 5 - Infection and the diabetic foot; Chapter 6 - Charcot's neuroarthropathy). This version of the Diabetic Foot Guidelines presents essential recommendations for the prevention, diagnosis, treatment, and follow-up of patients with diabetic foot, offering an objective guide for medical practice.

糖尿病足与解剖、血管和神经因素相互作用,给临床实践带来挑战。本研究旨在根据对主要指南的回顾,以及在 Embase、Lilacs 和 PubMed 平台上发表的文章,汇编主要科学证据。欧洲心脏病学会系统用于制定推荐类别和证据等级。主题分为六章(第1章--糖尿病足溃疡的预防;第2章--糖尿病足溃疡的压力缓解;第3章--糖尿病足溃疡的分类;第4章--足部与外周动脉疾病;第5章--感染与糖尿病足;第6章--夏科神经关节病)。这一版本的《糖尿病足指南》为糖尿病足患者的预防、诊断、治疗和随访提供了基本建议,为医疗实践提供了客观指导。
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引用次数: 0
Case report: persistent double dorsal aorta. 病例报告:持续性双背主动脉。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-05-10 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202301502
Paulo Henrique Alves Togni, Ernani Alves de Oliveira, Eduardo Milani Mora, Paulo Eduardo Borher Moreira, Bruno Previdelli Coghi, Guilherme Augusto Paro

Persistent double dorsal aorta is an extremely rare congenital anomaly, with only 13 cases published to date. The objective of this study is to present this embryological variant as observed in the abdominal aorta of a patient. The anatomical description was written up on the basis of a review of electronic medical records and imaging exams. The patient in this case was an elderly 79-year-old man who presented at emergency with pain at rest in the left lower limb. He was admitted and laboratory tests and imaging exams were ordered. The variation was an imaging finding observed on angiotomography, consisting of complete separation of the abdominal aorta into two portions - a ventral and a dorsal, with different calibers - at the level of the third lumbar vertebra. There was also an anomalous origin of the inferior mesenteric artery.

持续性双腹主动脉是一种极其罕见的先天性异常,迄今为止仅发表过 13 例。本研究旨在介绍在一名患者腹主动脉中观察到的这种胚胎变异。解剖学描述是在查阅电子病历和影像学检查的基础上撰写的。该病例的患者是一名 79 岁的老人,因左下肢静止时疼痛而急诊就诊。他被收治入院,并接受了实验室检查和影像学检查。在血管造影术中观察到腹主动脉完全分离成两部分--腹侧和背侧,口径不同。肠系膜下动脉的起源也不正常。
{"title":"Case report: persistent double dorsal aorta.","authors":"Paulo Henrique Alves Togni, Ernani Alves de Oliveira, Eduardo Milani Mora, Paulo Eduardo Borher Moreira, Bruno Previdelli Coghi, Guilherme Augusto Paro","doi":"10.1590/1677-5449.202301502","DOIUrl":"10.1590/1677-5449.202301502","url":null,"abstract":"<p><p>Persistent double dorsal aorta is an extremely rare congenital anomaly, with only 13 cases published to date. The objective of this study is to present this embryological variant as observed in the abdominal aorta of a patient. The anatomical description was written up on the basis of a review of electronic medical records and imaging exams. The patient in this case was an elderly 79-year-old man who presented at emergency with pain at rest in the left lower limb. He was admitted and laboratory tests and imaging exams were ordered. The variation was an imaging finding observed on angiotomography, consisting of complete separation of the abdominal aorta into two portions - a ventral and a dorsal, with different calibers - at the level of the third lumbar vertebra. There was also an anomalous origin of the inferior mesenteric artery.</p>","PeriodicalId":14814,"journal":{"name":"Jornal Vascular Brasileiro","volume":"23 ","pages":"e20230150"},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11129854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141156900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Superficial venous arterialization with the great saphenous vein in situ: a single-center experience. 原位大隐静脉浅静脉动脉化:单中心经验。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-03-25 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202300772
Karlene Thayane Barros da Silva, Marcos Antonio Bonacorso Manhanelli, José Francisco Moron Morad, Fábio Linardi, José Augusto Costa

Background: Arterialization of the dorsal venous arch of the foot is a technique indicated in cases of critical lower limb ischemia that do not have a distal bed that is adequate to enable conventional treatment such as revascularization, angioplasty, or clinical treatment.

Objectives: The purpose of this study is to present the result of arterialization of the venous arch of the foot in 16 patients who underwent treatment with this technique.

Methods: This is a cross-sectional retrospective descriptive analytical study based on a review of the medical records of 16 patients who underwent arterialization of the dorsal venous arch of the foot for limb salvage from January 2016 to January 2021.

Results: Four (25%) of the 16 patients who underwent arterialization of the venous arch of the foot underwent a major amputation during the same hospital stay and one patient (6.25%) had a major amputation within 6 months. The other 11 patients (68.75%) had their limbs preserved, with 10 undergoing minor amputations (toes and forefoot) and one patient having no additional procedures.

Conclusions: We conclude that the technique of arterialization of the dorsal venous arch of the foot should be considered in selected cases. It is a valid alternative for limb salvage when conventional treatment is impossible.

背景:足背静脉弓动脉化是一项适用于下肢严重缺血病例的技术,这些病例的远端静脉床不足以进行血管重建、血管成形术或临床治疗等常规治疗:本研究的目的是介绍 16 名接受该技术治疗的患者足弓静脉动脉化的结果:这是一项横断面回顾性描述性分析研究,基于对2016年1月至2021年1月期间接受足背静脉弓动脉化治疗以挽救肢体的16名患者的病历回顾:在接受足背静脉弓动脉化手术的16名患者中,有4名患者(25%)在住院期间接受了大截肢手术,1名患者(6.25%)在6个月内接受了大截肢手术。其他 11 名患者(68.75%)保留了肢体,其中 10 名患者进行了轻微截肢(脚趾和前脚),一名患者没有进行其他手术:我们的结论是,在选定的病例中应考虑足背静脉弓动脉化技术。结论:我们得出结论,足背静脉弓动脉化技术应在特定病例中加以考虑,这是在无法进行常规治疗的情况下挽救肢体的有效选择。
{"title":"Superficial venous arterialization with the great saphenous vein <i>in situ</i>: a single-center experience.","authors":"Karlene Thayane Barros da Silva, Marcos Antonio Bonacorso Manhanelli, José Francisco Moron Morad, Fábio Linardi, José Augusto Costa","doi":"10.1590/1677-5449.202300772","DOIUrl":"10.1590/1677-5449.202300772","url":null,"abstract":"<p><strong>Background: </strong>Arterialization of the dorsal venous arch of the foot is a technique indicated in cases of critical lower limb ischemia that do not have a distal bed that is adequate to enable conventional treatment such as revascularization, angioplasty, or clinical treatment.</p><p><strong>Objectives: </strong>The purpose of this study is to present the result of arterialization of the venous arch of the foot in 16 patients who underwent treatment with this technique.</p><p><strong>Methods: </strong>This is a cross-sectional retrospective descriptive analytical study based on a review of the medical records of 16 patients who underwent arterialization of the dorsal venous arch of the foot for limb salvage from January 2016 to January 2021.</p><p><strong>Results: </strong>Four (25%) of the 16 patients who underwent arterialization of the venous arch of the foot underwent a major amputation during the same hospital stay and one patient (6.25%) had a major amputation within 6 months. The other 11 patients (68.75%) had their limbs preserved, with 10 undergoing minor amputations (toes and forefoot) and one patient having no additional procedures.</p><p><strong>Conclusions: </strong>We conclude that the technique of arterialization of the dorsal venous arch of the foot should be considered in selected cases. It is a valid alternative for limb salvage when conventional treatment is impossible.</p>","PeriodicalId":14814,"journal":{"name":"Jornal Vascular Brasileiro","volume":"23 ","pages":"e20230077"},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140335744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Duplex ultrasound and pedal acceleration time as tools to evaluate foot perfusion: a literature review. 双工超声和踏板加速时间作为评估足部灌注的工具:文献综述。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-03-25 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202300172
Drako de Amorim Souza, Pedro Victor Freitas Medrado, Vinícius Alves Santos, Carolline Xavier de Aguiar, Guilherme Souza Silva, Lucas Pereira Pintos de Sousa, Yasmin Bione Diniz Amando, Paulo Fernandes Saad

Currently, the standard non-invasive test for diagnosing Peripheral Arterial Disease is the Ankle-Brachial Index. However, this test becomes unfeasible in a certain population. New evidence proposes the pedal acceleration time, an ultrasound index, as an alternative test. An integrative bibliographic review was carried out between June 3, 2022 and January 8, 2023, to investigate this new index as a tool to assess foot perfusion. Papers published in English, Portuguese, or Spanish between 2012 and 2022 were searched on PubMed, Google Scholar, and Scielo, using the keywords "Peripheral Arterial Disease" AND "Acceleration Time" AND (Pedal OR Plantar). Research that didn't assess foot perfusion using the methods of interest or did not present human data and also case series or reports were excluded. Seven out of the sixty-six articles identified in the searches were selected for the review, all of which had notable methodological limitations. Pedal acceleration time seems to be able to diagnose and stratify and may reflect prognosis.

目前,诊断外周动脉疾病的标准无创检测方法是踝肱指数。然而,在某些人群中,这种检测方法变得不可行。新的证据表明,超声波指数踏板加速时间可作为替代检测方法。我们在 2022 年 6 月 3 日至 2023 年 1 月 8 日期间进行了一次综合文献综述,以研究这种作为足部灌注评估工具的新指数。在PubMed、Google Scholar和Scielo网站上,使用关键词 "外周动脉疾病 "和 "加速时间 "以及(踏板或足底)对2012年至2022年期间用英语、葡萄牙语或西班牙语发表的论文进行了检索。未使用相关方法评估足部灌注或未提供人体数据的研究,以及病例系列或报告均被排除在外。在搜索到的 66 篇文章中,有 7 篇被选中进行综述,这些文章在方法上都有明显的局限性。踏板加速时间似乎能够进行诊断和分层,并可能反映预后。
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引用次数: 0
Multiple variation of right renal and gonadal vascularization: report of two cases. 右肾和性腺血管的多重变异:两个病例的报告。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-03-25 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202300442
Marcelo Calil Burihan, Silvio Antonio Garbelotti, Paulo Laino Cândido, Rodrigo Barbosa de Souza, Osvaldo Pelozo, Aluisio Andrade, Marco Antonio De Angelis

We present two cases of multiple anatomical variations of the renal and gonadal vessels. The first case presented duplication of the renal vein and the presence of an accessory renal artery. However, the most interesting fact, in this case, was that the right gonadal vein emptied into the inferior right renal vein instead of ending in the inferior vena cava as would typically be the case. In the second case, we also found an accessory renal artery and the right gonadal vein emptied at the exact junction between the right renal vein and the inferior vena cava. Clinicians and surgeons should be familiar with anatomical variations to provide an accurate diagnosis during preoperative studies and to avoid surprises in abdominal surgical procedures.

我们介绍了两例肾血管和性腺血管的多重解剖变异。第一个病例出现了肾静脉的重复和附属肾动脉的存在。然而,在这个病例中,最有趣的事实是右侧性腺静脉排入右肾下静脉,而不是像通常情况下那样止于下腔静脉。在第二个病例中,我们还发现了一条附属肾动脉,右性腺静脉正好在右肾静脉和下腔静脉的交界处排空。临床医生和外科医生应熟悉解剖变异,以便在术前检查中提供准确诊断,避免腹部手术过程中出现意外。
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引用次数: 0
Lipectomy as an alternative for superficialization of autologous AVF in obese patients: experience of a referral center in Amazon. 脂肪切除术作为肥胖患者自体动静脉瘘浅表化的替代方法:亚马逊一家转诊中心的经验。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-03-25 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202300542
José Maciel Caldas Dos Reis, Flávio Roberto Cavalleiro de Macêdo Ribeiro, Glauco Dos Santos Melo, Humberto Balbi Reale, Mariseth Carvalho de Andrade

Background: The preferred vascular access for hemodialysis is a native arteriovenous fistula (AVF) because it offers the best results in the short and long terms, lower morbidity and mortality, and has additional advantages in relation to central venous catheters or arteriovenous grafts. However, obesity can present an additional challenge because of the barrier of subcutaneous cellular tissue covering the surface of the vein to be punctured.

Objectives: The authors review their experience with excision of subcutaneous tissue (lipectomy) overlying upper arm cephalic vein arteriovenous fistulas in obese patients.

Methods: Consecutive vascular access patients undergoing lipectomy for cannulation with difficult access because of vein depth were reviewed. Cephalic vein depth was measured by ultrasound in all cases.

Results: Twenty-two patients were reviewed (15 men and 7 women), with a mean body mass index of 34.0 kg/m2 (range: 28-40 kg/m2). Mean age was 58.4 years. The mean preoperative vein depth of 7.9 mm (range: 7.0-10.0 mm) was reduced to 4.7 mm (range: 3.0-6.0 mm) (P 0.01). The mean follow-up period for patients was 13.2 months. Four patients were lost to follow-up and four died during the period due to causes unrelated to vascular access.

Conclusions: Obesity should not be a limiting factor to creation of a native AVF, since lipectomy is a relatively simple option for superficialization, enabling functioning native and deep arteriovenous fistulas in obese patients.

背景:血液透析的首选血管通路是原发性动静脉瘘(AVF),因为它在短期和长期内都能达到最佳效果,发病率和死亡率较低,而且与中心静脉导管或动静脉移植相比还有其他优势。然而,肥胖会带来额外的挑战,因为要穿刺的静脉表面有皮下细胞组织的屏障:作者回顾了肥胖患者上臂头静脉动静脉瘘皮下组织切除术(lipectomy)的经验:作者回顾了因静脉深度而难以进入的血管通路患者接受皮下组织切除术进行插管的情况。所有病例的头静脉深度均通过超声波测量:22名患者(15名男性和7名女性)的平均体重指数为34.0 kg/m2(范围:28-40 kg/m2)。平均年龄为 58.4 岁。术前平均静脉深度为 7.9 毫米(范围:7.0-10.0 毫米),术后降至 4.7 毫米(范围:3.0-6.0 毫米)(P 0.01)。患者的平均随访时间为 13.2 个月。四名患者失去了随访机会,四名患者在随访期间因与血管通路无关的原因死亡:结论:肥胖不应成为创建原生动静脉瘘的限制因素,因为脂肪切除术是一种相对简单的浅表化选择,可使肥胖患者的原生和深层动静脉瘘正常运作。
{"title":"Lipectomy as an alternative for superficialization of autologous AVF in obese patients: experience of a referral center in Amazon.","authors":"José Maciel Caldas Dos Reis, Flávio Roberto Cavalleiro de Macêdo Ribeiro, Glauco Dos Santos Melo, Humberto Balbi Reale, Mariseth Carvalho de Andrade","doi":"10.1590/1677-5449.202300542","DOIUrl":"10.1590/1677-5449.202300542","url":null,"abstract":"<p><strong>Background: </strong>The preferred vascular access for hemodialysis is a native arteriovenous fistula (AVF) because it offers the best results in the short and long terms, lower morbidity and mortality, and has additional advantages in relation to central venous catheters or arteriovenous grafts. However, obesity can present an additional challenge because of the barrier of subcutaneous cellular tissue covering the surface of the vein to be punctured.</p><p><strong>Objectives: </strong>The authors review their experience with excision of subcutaneous tissue (lipectomy) overlying upper arm cephalic vein arteriovenous fistulas in obese patients.</p><p><strong>Methods: </strong>Consecutive vascular access patients undergoing lipectomy for cannulation with difficult access because of vein depth were reviewed. Cephalic vein depth was measured by ultrasound in all cases.</p><p><strong>Results: </strong>Twenty-two patients were reviewed (15 men and 7 women), with a mean body mass index of 34.0 kg/m<sup>2</sup> (range: 28-40 kg/m<sup>2</sup>). Mean age was 58.4 years. The mean preoperative vein depth of 7.9 mm (range: 7.0-10.0 mm) was reduced to 4.7 mm (range: 3.0-6.0 mm) (<i>P</i> 0.01). The mean follow-up period for patients was 13.2 months. Four patients were lost to follow-up and four died during the period due to causes unrelated to vascular access.</p><p><strong>Conclusions: </strong>Obesity should not be a limiting factor to creation of a native AVF, since lipectomy is a relatively simple option for superficialization, enabling functioning native and deep arteriovenous fistulas in obese patients.</p>","PeriodicalId":14814,"journal":{"name":"Jornal Vascular Brasileiro","volume":"23 ","pages":"e20230054"},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140335742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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