Jornal Vascular Brasileiro最新文献

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.

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.