Jornal Vascular Brasileiro最新文献

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.

Prediction of the development of post-thrombotic syndrome (PTS) among patients with deep venous thrombosis (DVT) is currently based on clinical characteristics alone; no reliable biomarkers are available. Coagulation Factor XIII A chain (F13A1) of the clotting cascade stabilizes the thrombus; myeloperoxidase (MPO) interacts with the endothelium; and Fms-related tyrosine kinase 4 (FLT4), also known as Vascular Endothelial Growth Factor Receptor-3, encodes a vascular endothelium-derived growth factor receptor that participates in angiogenesis. In this study, MPO, FLT4, and F13A1 gene expression was evaluated to identify novel biomarkers of PTS. This study evaluated nine patients allocated to three different groups. The control group included three healthy patients (group I); the second group included three patients with DVT without PTS (group II); and the third group included three patients with PTS (group III). Expression of MPO, FLT4, and F13A1 was evaluated in all three groups. A decrease in FLT4 expression was observed in group II (ΔCt -2.71; gene expression 0.03, p=0.11) and a significant decrease was observed in group III (ΔCt -2.44; gene expression 0.01, p=0.05). A nonsignificant difference in MPO gene expression was found among the three groups. There was a notable and progressive increase in F13A1 expression in group III (ΔCt 6.54; gene expression 3.5, p=0.02). Despite the low sampling rate in the present study, the decreased FLT4 expression and increased of F13A1 expression may represent biomarkers of PTS in group III.

Background: During the COVID-19 pandemic, there was a substantial increase in the number of severely ill hospitalized patients, which coincided with a corresponding increase in the consumption of medical supplies, including vascular devices. In this context, vascular surgeons perceived an absolute increase in complications associated with their use.

Objectives: To calculate the rate of severe complications requiring surgical vascular intervention following vascular device implantation during the COVID-19 pandemic.

Methods: A retrospective cohort was conducted to investigate complications associated with vascular devices, such as central venous catheters (CVC), arterial lines, peripherally inserted central catheters (PICCs), totally implantable venous catheters, and semi-implantable venous catheters. The exposed population was defined based on the number of vascular devices used during the pandemic period, identified using the WPDHOSP materials management software. A total of 1,708 consultations with the vascular surgery team were analyzed using Medview medical record software. Patient records were evaluated, selecting those requiring vascular intervention.

Results: Out of a total of 16,988 vascular devices used, 25 patients needed surgical or endovascular vascular interventions. This corresponds to a severe complication rate of 0.14%. The complications found were intravascular foreign body, active bleeding, pseudoaneurysm, unintentional arterial implantation, expanding cervical hematoma, acute limb ischemia, and arteriovenous fistula. Patients underwent vascular procedures such as foreign body removal, arterial repair, arterial embolization, endovascular stenting, arterial thrombectomy, and arteriovenous fistula repair.

Conclusions: The severe complication rate is consistent with incidences found in the pre-pandemic literature.

Background: Endovascular aneurysm repair (EVAR) is now considered the preferred treatment modality in most abdominal aortic aneurysm (AAA) patients.

Objectives: The objective of this study was to quantify and evaluate MMP-2, MMP-9, TIMP-1, and TIMP-2 expression response to EVAR based on serum assays at 6-month follow-up.

Methods: 47 patients with AAA who underwent EVAR and ten people with no comorbidities were recruited for the study. Plasma levels of MMPs and TIMPs were assayed by ELISA preoperatively and after 6 months in the group submitted to EVAR and only once in the control group. Demographic profiles, clinical follow-up data, and imaging exams with angiotomography performed preoperatively and after 6 months were collected.

Results: Forty-seven patients with AAA were treated with EVAR. 87.2% of these patients were male and 68.08% were smokers. There were no deaths in the first 30 days. Ten patients (21.27%) had an endoleak during the 6-month postoperative period. Higher MMP and TIMP levels were observed in the AAA patients compared with patients in the control group, although without statistical significance. After EVAR, there were increases in MMP and TIMP levels both in the group with endoleaks and in the group without endoleaks (p<0.05). The variables related to demographic and anatomical data and types of devices used by the patients did not show statistical significance, except for a significant reduction in aneurysmal sac diameter (p<0.05).

Conclusions: None of the markers assessed showed any association with endoleak status. However, the concentrations of MMPs and TIMPs in circulation increased in all patients after EVAR. Collectively, these findings suggest that the markers assessed have little potential to influence current post-EVAR monitoring practices.

An aneurysm of the anterior tibial artery is always a challenge because it does not provoke symptoms and when a pulsating mass is detected, the aneurysm diameter is already enlarged and there is a greater likelihood of rupture or thrombosis. We report the case of a healthy, 53-year-old, female patient diagnosed with an aneurysm of the anterior tibial artery at the transition to the dorsalis pedis artery, which was identified during ultrasonography performed to investigate plantar fasciitis. The aneurysm was treated by coil embolization and there were no complications.

Background: Heart rate variability (HRV) parameters are an important indicator of cardiovascular health. While it has been well established that aerobic exercise improves HRV, the effects of resistance training on HRV remain less explored.

Objectives: To compare the impact of a resistance training routine on HRV parameters in physically active young adults.

Methods: This observational study included 24 participants, 12 who underwent resistance training and a control group of 12 who underwent moderate-intensity exercise. HRV was assessed during a 15-minute resting period in the supine position with a Polar RS800CX heart rate monitor. The analysis encompassed time-domain metrics (root mean square of successive differences between adjacent normal R-R intervals [RMSSD] and the standard deviation of normal-to-normal R-R intervals [SDNN]), frequency-domain metrics (high-frequency and low-frequency indices, both expressed in normalized units, and the low-frequency/ high-frequency ratio), and non-linear metrics (SD of the Poincaré plot width [SD1] and the SD of the Poincaré plot length [SD2]). HRV parameters were processed in Kubios HRV. Statistical analysis included unpaired t-tests, with significance set at p < 0.05.

Results: The resistance-trained group demonstrated significantly higher RMSSD (75.3 [SD, 28.5] ms) and SDNN (65.8 [SD, 23.1] ms) values than the untrained group (RMSSD: 37.5 [SD, 19.6] ms; SDNN: 40.2 [SD, 14.2] ms; p < 0.01). SD1 and SD2 were also significantly higher in the resistance training group than the control group, reflecting greater parasympathetic activity.

Conclusions: Long-term resistance training was associated with improved parasympathetic modulation, indicating potential cardiovascular benefits and enhanced autonomic function.

Horseshoe kidney (HSK) is a rare congenital malformation of the kidney with reported prevalence between 1 in 600 and 1 in 400. A typical HSK has two lower poles fused across the midline in front of the abdominal aorta just below the origin of the inferior mesenteric artery. Very rarely, the upper poles may fuse resulting in a reverse HSK. It is more common in males than in females, but no definite racial or genetic predilection has been established. The HSK is frequently associated with other congenital anomalies, the most common being vascular anomalies. This report describes HSK in a 73-year-old male cadaver, with triple renal arteries and aberrant right testicular artery originating from the ipsilateral renal artery and bilateral extra-renal calyces. Although rare in occurrence, a surgeon must bear in mind that such a combination of anomalies may pose technical difficulties during open or laparoscopic abdominal surgeries.

Background: The carotid bifurcation is known for its anatomical variations, involving structures that can be assessed by ultrasound examination. Knowledge of unusual anatomy is crucial in surgical procedures, directly influencing their outcomes.

Objectives: To assess whether fourth-year medical students with prior training are capable of performing ultrasound examinations to compare the height of the carotid bifurcation between men and women.

Methods: 602 carotid bifurcations from 301 participants were identified by ultrasound examinations conducted by medical students after prior training by a professional qualified in vascular ultrasound. After each examination, the results were verified by a specialist physician. Gender, age, and bilateral measurement of the distance between the carotid bifurcation and the ear lobe were compared.

Results: The students' measurements differed from the specialist physician's measurements by more than 0.2 cm in just 8 examinations. On the right side, the average height of the carotid bifurcation relative to the earlobe was 5.9 cm, compared to 5.8 cm on the left side, for the whole sample. The distance on the right side was significantly shorter among the women, with an average of 5.6 cm, compared to 6.3 cm among the men (p<0.0001). The distance on the left side was also significantly shorter in women, with an average of 5.4 cm, compared to 6.2 cm among the men (p<0.0001). The difference between sides was not statistically significant between the sexes.

Conclusions: After training, medical students demonstrate high accuracy in the technique of measuring the carotid bifurcation height using vascular ultrasound. Men showed a tendency for the bifurcations to be located farther from the earlobe compared to women.

Background: Few studies have described the prevalence of peripheral arterial disease (PAD) in the diabetic population of Brazil.

Objectives: To evaluate the prevalence of PAD and its association with the presence of claudication and to compare risk factors for atherosclerosis between subjects with and without PAD.

Methods: An analytical, observational, prospective, cross-sectional study was conducted with 150 volunteers with type 2 Diabetes Mellitus (T2DM) treated at a university endocrinology outpatient clinic (Federal University of Paraná, Curitiba, Brazil) and assessed using the ankle-brachial index (ABI) and the Edinburgh Claudication Questionnaire.

Results: ABI was evaluated in 143 volunteers (7 did not meet the inclusion criteria). Six individuals had an ABI > 1.4. Excluding these cases and adopting an ABI ≤ 0.9 to identify PAD, the prevalence of PAD was 14.6% (20 of 137), 15.8% in men (6 of 38), and 14.1% in women (14 of 99). We identified twenty-five participants with borderline ABI (18.2%). Claudication was present in 25% of subjects with PAD; however, only 15% had typical claudication. A significant association with the presence of typical claudication was observed only when ABI values were stratified above or below 1.0 (p = 0.04, Fisher's exact test). Participants with PAD were older (median difference: 5.5 years, 95% CI 3.0 to 9.0, p < 0.001) and tended to have a longer duration of DM and higher BMI.

Conclusions: The prevalence of PAD in T2DM volunteers with no prior screening was 14.6% and 75% were asymptomatic.

Within the spectrum of abdominal aortic aneurysm, various complications can arise, including the development of an arteriovenous fistula connecting this major vessel to the infrarenal inferior vena cava. This report presents the case of a 70-year-old man with sudden, intense abdominal pain and syncope, found intraoperatively to have an aortocaval fistula due to a ruptured abdominal aortic aneurysm. The patient underwent emergency care, including fistula closure and placement of a Dacron aortobifemoral graft. Aortocaval fistula is a rare complication of aortic aneurysmal disease, with clinical manifestations varying depending on disease progression, leading to high morbidity and mortality both before and after surgical or interventional treatment.