Jornal Vascular Brasileiro最新文献

Background: Varicose disease is a common pathology among the population, with an incidence of about 38%. In Brazil, it affects 45% of women and 30% of men. Currently, endovenous thermal ablation (EVTA) of the saphenous vein is the method of choice in the treatment of varicose veins. As a minimally invasive procedure that promotes quick recovery and does not require hospitalization, it can be performed on an outpatient basis.

Objectives: To evaluate the safety and cost-benefit of outpatient varicose vein treatment in a clinic compared to the same procedure performed in a hospital environment.

Methods: A uncontrolled retrospective transversal study of case series evaluated a random group of 50 patients undergoing EVTA for the treatment of varicose disease by the same group of vascular surgeons. Twenty-five underwent the procedure in a tertiary hospital environment and 25 on an outpatient basis. The average costs of room fees and materials from both groups were analyzed and statistically compared with the Student's t-test. Intraoperative and postoperative complications were assessed.

Results: The average hospital cost of the procedure was R$ 1391.99 (± 280.8) in the hospital and R$ 1593.40 (± 99.53) in the clinic. The Student's t-test showed a significant difference with p=0.02. No patient had complications either intraoperatively or postoperatively.

Conclusions: Outpatient surgery, despite having a statistically higher cost than hospital surgery in Brazil, is safe and has a positive cost-benefit for the patient.

Plantar vein thrombosis is a vascular disease that affects the medial and/or lateral plantar veins. Its clinical manifestations are generally non-specific. However, it usually presents with pain in the plantar region, edema, and difficulty walking. The disease predominantly affects middle-aged females and is idiopathic in the majority of cases. The most commonly associated risk factors are recent surgical procedures, cancer, use of oral contraceptives, local trauma, and genetic disorders, such as hereditary thrombophilia. The gold standard diagnostic test is vascular ultrasound, evaluating venous compressibility. We report a case of venous thrombosis of the lateral plantar vein diagnosed with vascular ultrasound.

Background: The treatment of thoracoabdominal aortic aneurysms (TAA) has advanced. Understanding the pathophysiology and surgical approaches to this disease is essential for best therapeutic performance.

Objectives: We aimed to improve previously described methods for creating thoracoabdominal aortic aneurysms in a porcine animal model, reducing surgical procedure time and specimen mortality.

Methods: A total of 18 swine underwent a surgical procedure to create a TAA. An autologous peritoneal patch was used to create the aneurysm in 2 animals, and a bovine pericardial patch was used in the other 16. The animals were followed up postoperatively, and the aneurysm sac was reexamined after 4 weeks. The animals that did not die in the post-operative period were euthanized according to institutional recommendations.

Results: All of the animals underwent laparotomy with retroperitoneal access. Two received an autologous peritoneal patch and 16 received a bovine pericardial patch. Three animals underwent single suprarenal clamping, while 15 underwent sequential clamping. There were no differences in operative time (p=0.207) or total clamping time (p=0.276) between groups. There was a higher mortality rate after 4 weeks in animals that received single clamping (100%) than sequential clamping (26.7%) (p=0.0017).

Conclusions: The experimental model of TAA using a bovine pericardial patch and a sequential clamping technique provided a stable and reliable platform that remains stable and patent for up to 4 weeks. This model can be extremely valuable for assessing new endovascular therapy options in living organisms.

Indications for surgical repair of saccular abdominal aortic aneurysms lack satisfactory evidence, and the risk of rupture has been questioned. We conducted a systematic review assessing surgical outcomes following repair of this condition. Eight studies were included, totaling 540 patients. Endovascular repair was the most common approach. Complications occurred in 18.99% of the patients, and unfavorable surgical outcomes occurred in 3.15%, of which cardiac and pulmonary comorbidities were the most frequent. Aneurysms with smaller diameters presented fewer complications and unfavorable surgical outcomes than those with larger diameters. The ideal threshold for repair remains uncertain. Although diameter is an important indicator, other factors should be considered. These aneurysms should be treated electively at earlier stages due to their uncertain rupture risk and the higher prevalence of complications at larger diameters. Further research is needed to establish clear treatment guidelines for this condition.

Background: Knowledge of the vascular anatomy of the liver and other abdominal organs helps surgeons improve preoperative planning, achieve greater surgical success, prevent complications, and reduce morbidity and mortality.

Objectives: To report the prevalence of anatomical variation in the proper hepatic artery and portal vein observed through computed tomography.

Methods: This retrospective study was based on 500 3-phase abdominal computed tomography scans. Variations in arterial anatomy were classified according to the Michels system (1966), while those in regarding portal vein anatomy were classified according to the Cheng system (1996).

Results: A total of 31.2% of the cases showed variations in arterial vascularization, the most prevalent being type V (8.2%). No participants were identified with type X, and 0.4% could not be classified. A total of 21.8% showed variation in venous vascularization, with type IV being the most prevalent (8%).

Conclusions: Medical knowledge of these variations and their prevalence is fundamental for the correct surgical management of upper abdomen pathologies and lower rates of postoperative complications. Variations not classified by previous trials should be categorized according to their clinical importance, and new studies should clarify national population patterns to reduce mortality rates from surgical procedures that involve these vessels.

Totally implantable venous access devices (TIVADs) are commonly used for prolonged intravenous treatment, particularly in oncology. Although removal is typically a straightforward procedure at the end of treatment, it can occasionally be complicated by adhesion of the distal end of the catheter to the intravascular wall. This rare complication is often associated with factors such as prolonged catheter dwell time, use of polyurethane material, and younger age at insertion. The technique used for removal depends largely on the degree of adhesion. We report the case of a 60-year-old woman with a TIVAD in place for 12 years for chemotherapy for breast cancer. Removal was challenging due to distal adhesion of the catheter but was ultimately successful following careful dissection and traction.

We report an exceptional case of a large right persistent proatlantal artery (PPPA), defined as a "mixed" type, because it originated as in Type 2 from the external carotid artery and courses as in Type1, i.e. over the vertebral artery groove of the posterior arch of C1, entering the skull via the foramen magnum, without passing through the transverse foramen of any of the cervical vertebra. This "mixed" PPPA was associated first with an azygos anterior cerebral artery and second with a left common carotid artery arising from the brachiocephalic trunk. The right occipital artery arose from the PPPA. In addition, an aneurysm arose from the kinked right cervical internal carotid artery. This case illustrated an association not reported previously, making treatment of the concomitant aneurysm challenging. Moreover, understanding of persistent carotid-vertebral anastomosis is essential to enable evaluation and management before performing endovascular treatment, especially in cases of basilar thrombectomy and for posterior circulation strokes.