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Vascular resistance index and the immediate hemodynamic success of lower limb distal artery revascularization. 血管阻力指数与下肢远端动脉再通术的即时血液动力学成功率。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-03-04 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202301192
Rebecca Paes de Andrade Souza Caldas, Esdras Marques Lins, Gabriela de Oliveira Buril, Fernanda Appolônio Rocha, Emmanuelle Tenório Albuquerque Godoi Berenguer de Barros E Silva, Larissa Barbosa de Andrade, Camilla Lins da Cunha Cavalcanti, Guilherme Barros Alves de Carvalho

Background: Revascularization surgery is used to attempt to restore blood flow to the foot in patients with critical ischemia (CI) caused by peripheral arterial occlusive disease of the lower limbs (LL). Ultrasonography with Doppler (USD) SAH emerged in recent years as a highly valuable method for planning this surgical intervention.

Objectives: To evaluate the relationship between the resistance index (RI), measured with USD, and immediate hemodynamic success of LL revascularization surgery in patients with CI.

Methods: The study design was a prospective cohort assessing 46 patients with LL CLI who underwent operations to perform infrainguinal revascularization by angioplasty or bypass from August 2019 to February 2022. All patients underwent preoperative clinical vascular assessment with USD including measurement of the RI of distal LL arteries, LL arteriography, and measurement of the ankle-brachial index (ABI). All patients had their ABI measured again in the immediate postoperative period.

Results: Forty-six patients were assessed, 25 (54.3%) of whom were male. Age varied from 32 to 89 years (mean: 67.83). Hemodynamic success was assessed by comparison of preoperative and postoperative ABI, showing that hemodynamic success was achieved in 31 (67.4%) patients after revascularization surgery (ABI increased by 0.15 or more). A positive correlation (p ≤ 0.05) was observed between the RI of the distal revascularized LL artery and immediate hemodynamic success assessed by ABI (lower RI and hemodynamic success).

Conclusions: This study observed a positive correlation between the resistance index of the distal artery and immediate hemodynamic success of lower limb revascularizations, as assessed by the ankle-brachial index, so that the lower the RI the greater the hemodynamic success achieved.

背景:下肢(LL)外周动脉闭塞性疾病导致严重缺血(CI)的患者可通过血管重建手术尝试恢复足部血流。近年来,超声多普勒(USD)SAH成为规划这种手术干预的一种非常有价值的方法:评估用多普勒超声测量的阻力指数(RI)与 CI 患者下肢血管再通手术的即时血液动力学成功率之间的关系:研究设计为前瞻性队列,评估自2019年8月至2022年2月期间接受血管成形术或搭桥术进行腹股沟下血运重建手术的46例LL CLI患者。所有患者都接受了USD术前临床血管评估,包括测量LL远端动脉的RI、LL动脉造影和测量踝肱指数(ABI)。所有患者都在术后立即再次测量了踝肱指数:46名患者接受了评估,其中25人(54.3%)为男性。年龄从 32 岁到 89 岁不等(平均:67.83 岁)。通过比较术前和术后的 ABI 来评估血流动力学成功与否,结果显示 31 例(67.4%)患者在接受血管再通手术后血流动力学成功(ABI 增加 0.15 或以上)。在血管再通远端 LL 动脉的 RI 与通过 ABI 评估的即时血液动力学成功率(RI 越低,血液动力学成功率越高)之间观察到了正相关性(P ≤ 0.05):本研究观察到远端动脉阻力指数与下肢血管再通的即时血流动力学成功率(以踝肱指数评估)之间存在正相关,因此阻力指数越低,获得的血流动力学成功率越高。
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引用次数: 0
The paradigm shift in treatment of severe venous thromboembolism. 严重静脉血栓栓塞症治疗模式的转变。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-03-04 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202300952
Fábio Henrique Rossi, Francisco José Osse, Patricia Ellen Thorpe

Pulmonary embolism (PE) is the third leading cause of cardiovascular death and the main cause of preventable in-hospital death in the world. The PERT® (Pulmonary Embolism Response Team) concept involves multidisciplinary diagnosis and immediate treatment. Deep venous thrombosis (DVT) is the initial cause of most cases of PE and is responsible for complications such as chronic thromboembolic recurrence, postthrombotic syndrome, and chronic thromboembolic pulmonary hypertension. An aggressive approach to severe cases of iliofemoral DVT similar to the PERT® system can not only reduce the immediate risk of PE and death but can also reduce later sequelae. New percutaneous techniques and mechanical thrombectomy devices for venous thromboembolism (VTE) have shown encouraging clinical results. We propose the development of an expanded concept of rapid response to VTE, which involves not only PE (PERT®) but also severe cases of DVT: the Venous Thromboembolism Response Team (VTERT®).

肺栓塞(PE)是心血管疾病死亡的第三大原因,也是世界上可预防的院内死亡的主要原因。PERT®(肺栓塞应对小组)的理念包括多学科诊断和即时治疗。深静脉血栓(DVT)是大多数肺栓塞病例的最初病因,也是慢性血栓栓塞复发、血栓后综合征和慢性血栓栓塞性肺动脉高压等并发症的罪魁祸首。对严重的髂股深层血栓病例采取类似于 PERT® 系统的积极治疗方法,不仅能降低 PE 的即刻风险和死亡风险,还能减少日后的后遗症。治疗静脉血栓栓塞症(VTE)的新经皮技术和机械血栓切除装置已显示出令人鼓舞的临床效果。我们建议制定一个扩大的 VTE 快速反应概念,不仅包括 PE(PERT®),还包括严重的深静脉血栓形成病例:静脉血栓栓塞反应小组(VTERT®)。
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引用次数: 0
Safety of preoperative branch embolization in patients undergoing evar. 对接受 evar 手术的患者进行术前分支栓塞的安全性。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-02-23 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202201372
Luis Ángel Suárez González, Iñigo Lozano Martínez-Luengas, Pablo Del Canto Peruyera, Manuel Javier Vallina-Victorero Vazquez

The purpose of this systematic review is to evaluate the safety of pre-endovascular abdominal aortic aneurysm repair (EVAR) embolization of aortic side branches - the inferior mesenteric artery and lumbar arteries. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. A search of MEDLINE and DIMENSION databases identified 9 studies published from 2011 to 2021 that satisfied the inclusion and exclusion criteria. These studies were analyzed to detect the incidence of embolization-related complications. A total of 482 patients underwent preoperative aortic side branch embolization, 30 (6.2%) of whom suffered some kind of minor complication. The only major complication observed was ischemic colitis in 4 (0.82%) patients, two (0.41%) of whom died after bowel resection surgery. Regarding these findings, aortic side branch embolization seems to be a safe procedure, with very low percentages of both minor and major complications.

本系统综述旨在评估主动脉侧支--肠系膜下动脉和腰动脉--在血管内腹主动脉瘤修补术(EVAR)前栓塞的安全性。研究遵循《系统综述和元分析首选报告项目》指南。通过检索 MEDLINE 和 DIMENSION 数据库,发现了 9 项发表于 2011 年至 2021 年、符合纳入和排除标准的研究。对这些研究进行了分析,以检测栓塞相关并发症的发生率。共有482名患者在术前接受了主动脉侧支栓塞治疗,其中30人(6.2%)出现了某种轻微并发症。唯一观察到的主要并发症是缺血性结肠炎,有 4 名患者(0.82%)发生了这种并发症,其中 2 人(0.41%)在肠切除手术后死亡。从这些发现来看,主动脉侧支栓塞似乎是一种安全的手术,轻微和严重并发症的发生率都很低。
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引用次数: 0
Open revascularization for chronic mesenteric ischemia in the endovascular era: a quaternary-center experience and management algorithm. 血管内治疗时代的慢性肠系膜缺血开放性血管重建术:四级中心的经验和管理算法。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-02-12 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202301482
Bruno Pagnin Schmid, Vinícius Adorno Gonçalves, Lucas Marcelo Dias Freire, Felipe Nasser, Fábio Hüsemann Menezes

Background: Chronic mesenteric ischemia (CMI) is a debilitating disease with a heavy burden on quality of life. Stenting of the superior mesenteric artery (SMA) is the first option for treatment, but there is a lack of consensus defining precise indications for open revascularization (OR).

Objectives: To describe a series of 4 patients with CMI treated with OR and to present an algorithm for the management of this condition.

Methods: Three patients presented with typical intestinal angina and weight loss. One patient was subjected to prophylactic revascularization during open abdominal aortic aneurysm repair. Surgical techniques included: 1) Bypass from the infrarenal aorta to the SMA; 2) Bypass from an aorto-bifemoral polyester graft to the SMA; 3) Bypass from the right iliac artery to the SMA; 4) Bypass from the right graft limb of an aorto-biiliac polyester graft to the median colic artery at Riolan's arcade. PTFE was used in all surgeries. All grafts were placed in a retrograde configuration, tunneled under the left renal vein, making a smooth C-loop. A treatment algorithm was constructed based on the institution's experience and a review of recent literature.

Results: All patients demonstrated resolution of symptoms and recovery of body weight. All grafts are patent after mean follow-up of two years.

Conclusions: Open revascularization using the C-loop configuration is a valuable technique for CMI and may be considered in selected cases. The algorithm constructed may help decision planning in other quaternary centers.

背景:慢性肠系膜缺血(CMI)是一种使人衰弱的疾病,对生活质量造成沉重负担。肠系膜上动脉(SMA)支架植入术是治疗的首选方案,但对于开放性血管重建术(OR)的确切适应症还缺乏共识:目的:描述4例接受开放性肠系膜上动脉再通术治疗的肠系膜上动脉硬化症(CMI)患者的系列病例,并介绍该病症的治疗方法:方法:三名患者出现典型的肠绞痛和体重减轻。一名患者在开腹主动脉瘤修补术中接受了预防性血管再通手术。手术技术包括1)从肾下主动脉到 SMA 的分流术;2)从主动脉-双股聚酯移植物到 SMA 的分流术;3)从右侧髂动脉到 SMA 的分流术;4)从主动脉-双髂聚酯移植物的右侧移植物肢到 Riolan's arcade 的正中结肠动脉的分流术。所有手术均使用聚四氟乙烯。所有移植物均以逆行方式放置,在左肾静脉下穿行,形成一个平滑的C形环。根据该机构的经验和对近期文献的回顾,制定了一套治疗算法:结果:所有患者的症状都得到了缓解,体重也得到了恢复。平均随访两年后,所有移植物均保持通畅:结论:使用 C 环结构进行开放性血管再通是治疗 CMI 的一项重要技术,可在选定病例中加以考虑。所构建的算法可能有助于其他四级中心的决策规划。
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引用次数: 0
A rare case of multiple visceral vascular variations around the kidneys: morphological and clinical aspects. 肾脏周围多发性内脏血管变异的罕见病例:形态学和临床方面。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-02-12 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202301202
Dibakar Borthakur, Mohammed Ahmed Ansari, Neerja Rani, Rajesh Kumar, Monica Baxla

Knowledge of the anatomical variations of the visceral branches of the abdominal aorta is important information for planning any surgeries in the region. We present here a rare constellation of variations of visceral vessels around the kidneys with a brief review of the recent literature. On the right side, an accessory renal artery was observed originating just distal to the main renal artery. The middle suprarenal artery was absent on the right side and there were two inferior suprarenal arteries originating from a branch of the main right renal artery. On the left side, the testicular artery had an arched course anterior to the left renal vein mimicking an unusual variety of nutcracker phenomenon. The right kidney was drained by two renal veins into the inferior vena cava. Knowledge of the coexistence of such complex anatomical variations might be helpful for clinicians during diagnostic and therapeutic procedures.

了解腹主动脉内脏分支的解剖变异是计划该区域任何手术的重要信息。我们在此介绍一种罕见的肾脏周围内脏血管变异组合,并对近期文献进行简要回顾。在右侧,我们观察到一条附属肾动脉,起源于主肾动脉的远端。右侧没有肾上中动脉,有两条肾上下动脉,源自右肾主动脉的分支。在左侧,睾丸动脉在左肾静脉前方呈弧形走向,模仿了一种不同寻常的胡桃钳现象。右肾由两条肾静脉排入下腔静脉。了解这种复杂的解剖变异的共存情况可能对临床医生的诊断和治疗过程有所帮助。
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引用次数: 0
Sexual dysfunction after open abdominal aortic aneurysm repair: 16 years' experience in a quaternary center and literature review. 开腹主动脉瘤修补术后的性功能障碍:一家四级中心的 16 年经验和文献综述。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-02-05 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202301352
Bruno Pagnin Schmid, Marcelo Vezzi Muce, Rodrigo Gonzalez Bocos, Fábio Hüsemann Menezes

Background: Open abdominal aortic aneurysm (AAA) repair can lead to sexual dysfunction (SD) in men.

Objectives: To determine the prevalence of SD following open AAA repair, explore whether surgical techniques for aortic reconstruction can have a differential impact on the occurrence of SD, and summarize current knowledge in this field.

Methods: Retrospective review of 100 patients submitted to open AAA repair between 1995 and 2010 in a quaternary center. Sexual dysfunction was assessed according to questions from the modified International Index of Erectile Function (IIEF), considering the condition before surgical repair and 3 months after surgery. The chi-square test, Fisher's exact test, and Student's t test were used for statistical analyses.

Results: 100 patients were included (mean age = 66.4 years old). Normal sexual activity, no sexual activity, erectile dysfunction, and retrograde ejaculation with preserved erectile function were found in 36%, 21%, 18%, and 24% of patients, respectively. The group of patients with no sexual activity was older (mean age = 72.3 years old vs 64.5 years old, p < 0.001). Erectile dysfunction prevalence was higher in patients submitted to an aorto-bifemoral bypass (p = 0.032). Retrograde ejaculation was more frequent in patients submitted to an aorto-aortic bypass (p = 0.007).

Conclusions: Sexual function is a frequent condition intimately associated with the aortic reconstruction technique. The literature review found contradictory results regarding whether the endovascular approach is protective compared with open repair, but clearly demonstrated the importance of techniques targeting preservation of the internal iliac artery and the superior hypogastric plexus.

背景:开放性腹主动脉瘤(AAA)修补术可导致男性性功能障碍(SD):确定开放性AAA修复术后SD的发生率,探讨主动脉重建手术技术是否会对SD的发生产生不同影响,并总结该领域的现有知识:方法:回顾性分析一家四级医疗中心 1995 年至 2010 年间接受开放式 AAA 修补术的 100 名患者。根据改良的国际勃起功能指数(IIEF)中的问题对性功能障碍进行评估,考虑手术修复前和术后3个月的情况。统计分析采用卡方检验、费雪精确检验和学生 t 检验:结果:共纳入 100 名患者(平均年龄 = 66.4 岁)。正常性活动、无性活动、勃起功能障碍和逆行射精但勃起功能保留的患者分别占 36%、21%、18% 和 24%。没有性活动的患者年龄更大(平均年龄 = 72.3 岁 vs 64.5 岁,P < 0.001)。主动脉-双股动脉搭桥术患者的勃起功能障碍发生率更高(P = 0.032)。接受主动脉搭桥术的患者逆行射精的发生率更高(p = 0.007):结论:性功能是与主动脉重建技术密切相关的常见疾病。文献综述发现,与开放式修复相比,血管内方法是否具有保护作用,结果相互矛盾,但清楚地表明了以保留髂内动脉和胃下上神经丛为目标的技术的重要性。
{"title":"Sexual dysfunction after open abdominal aortic aneurysm repair: 16 years' experience in a quaternary center and literature review.","authors":"Bruno Pagnin Schmid, Marcelo Vezzi Muce, Rodrigo Gonzalez Bocos, Fábio Hüsemann Menezes","doi":"10.1590/1677-5449.202301352","DOIUrl":"10.1590/1677-5449.202301352","url":null,"abstract":"<p><strong>Background: </strong>Open abdominal aortic aneurysm (AAA) repair can lead to sexual dysfunction (SD) in men.</p><p><strong>Objectives: </strong>To determine the prevalence of SD following open AAA repair, explore whether surgical techniques for aortic reconstruction can have a differential impact on the occurrence of SD, and summarize current knowledge in this field.</p><p><strong>Methods: </strong>Retrospective review of 100 patients submitted to open AAA repair between 1995 and 2010 in a quaternary center. Sexual dysfunction was assessed according to questions from the modified International Index of Erectile Function (IIEF), considering the condition before surgical repair and 3 months after surgery. The chi-square test, Fisher's exact test, and Student's <i>t</i> test were used for statistical analyses.</p><p><strong>Results: </strong>100 patients were included (mean age = 66.4 years old). Normal sexual activity, no sexual activity, erectile dysfunction, and retrograde ejaculation with preserved erectile function were found in 36%, 21%, 18%, and 24% of patients, respectively. The group of patients with no sexual activity was older (mean age = 72.3 years old <i>vs</i> 64.5 years old, p < 0.001). Erectile dysfunction prevalence was higher in patients submitted to an aorto-bifemoral bypass (p = 0.032). Retrograde ejaculation was more frequent in patients submitted to an aorto-aortic bypass (p = 0.007).</p><p><strong>Conclusions: </strong>Sexual function is a frequent condition intimately associated with the aortic reconstruction technique. The literature review found contradictory results regarding whether the endovascular approach is protective compared with open repair, but clearly demonstrated the importance of techniques targeting preservation of the internal iliac artery and the superior hypogastric plexus.</p>","PeriodicalId":14814,"journal":{"name":"Jornal Vascular Brasileiro","volume":"23 ","pages":"e20230135"},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10903787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140021706","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
Correlation between the vascular resistance index and arteriography for assessment of the distal arterial bed in chronic limb threatening ischemia. 血管阻力指数与动脉造影术在评估慢性肢体威胁性缺血远端动脉床方面的相关性。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-02-05 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202300712
Gabriela de Oliveira Buril, Esdras Marques Lins, Emmanuelle Tenório Albuquerque Godoi Berenguer de Barros E Silva, Fernanda Appolônio da Rocha, Juliana Cavalcanti de Siqueira Charamba, Rebecca Paes de Andrade Souza Caldas, Isadora Ísis Fernandes Vieira, Paloma Karine Araújo da Silva

Background: Patients with chronic limb threatening ischemia (CLTI) of the lower limbs (LL) undergo arteriography for revascularization surgery planning. Doppler ultrasound (DU) is non-invasive and can provide information about the distal arteries through measurement of the resistance index (RI).

Objectives: To correlate the Rutherford Angiographic Classification with the RI for assessment of the distal arterial bed of the LL.

Methods: A cross-sectional study, conducted at a public tertiary hospital with 120 patients with LL CLTI, from September 2019 to April 2022. The RI of arteries that were candidates for revascularization was compared with the images of the same arteries obtained using arteriography, using the Rutherford Angiographic Classification of the distal bed.

Results: A total of 120 LL were assessed in 120 patients with a mean age of 68.6 years. The sample was 50.0% male and 90.0% of the patients in the sample were classified as Rutherford category five. The RI values found for the arteries of the leg exhibited a statistically significant positive correlation with the Rutherford Classification (anterior tibial, p< 0.01; posterior tibial, p = 0.012 fibular, p = 0.034; and dorsalis pedis, p < 0.001).

Conclusions: In this study, RIs for the arteries of the leg measured using Doppler ultrasound exhibited a positive correlation with the Rutherford Classification. This index could be useful for assessment of the distal arterial bed of the lower limbs of patients with chronic limb threatening ischemia.

背景:下肢(LL)慢性肢体缺血(CLTI)患者需要接受动脉造影检查,以制定血管重建手术计划。多普勒超声(DU)是一种无创检查,可通过测量阻力指数(RI)提供有关远端动脉的信息:将卢瑟福血管造影分类与 RI 相关联,以评估 LL 远端动脉床:一项横断面研究,于2019年9月至2022年4月在一家公立三甲医院进行,共收治120名LL CLTI患者。采用卢瑟福远端动脉床血管造影分类法,将作为血管重建候选者的动脉的 RI 与使用动脉造影术获得的相同动脉的图像进行比较:共对 120 名患者的 120 条 LL 进行了评估,这些患者的平均年龄为 68.6 岁。样本中男性占 50.0%,90.0% 的患者被划分为卢瑟福五类。腿部动脉的 RI 值与卢瑟福分类有显著的统计学正相关(胫骨前动脉,p< 0.01;胫骨后动脉,p = 0.012 腓骨动脉,p = 0.034;足背动脉,p < 0.001):在这项研究中,使用多普勒超声测量的腿部动脉RI与卢瑟福分类法呈正相关。该指数可用于评估慢性肢体威胁性缺血患者的下肢远端动脉床。
{"title":"Correlation between the vascular resistance index and arteriography for assessment of the distal arterial bed in chronic limb threatening ischemia.","authors":"Gabriela de Oliveira Buril, Esdras Marques Lins, Emmanuelle Tenório Albuquerque Godoi Berenguer de Barros E Silva, Fernanda Appolônio da Rocha, Juliana Cavalcanti de Siqueira Charamba, Rebecca Paes de Andrade Souza Caldas, Isadora Ísis Fernandes Vieira, Paloma Karine Araújo da Silva","doi":"10.1590/1677-5449.202300712","DOIUrl":"10.1590/1677-5449.202300712","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic limb threatening ischemia (CLTI) of the lower limbs (LL) undergo arteriography for revascularization surgery planning. Doppler ultrasound (DU) is non-invasive and can provide information about the distal arteries through measurement of the resistance index (RI).</p><p><strong>Objectives: </strong>To correlate the Rutherford Angiographic Classification with the RI for assessment of the distal arterial bed of the LL.</p><p><strong>Methods: </strong>A cross-sectional study, conducted at a public tertiary hospital with 120 patients with LL CLTI, from September 2019 to April 2022. The RI of arteries that were candidates for revascularization was compared with the images of the same arteries obtained using arteriography, using the Rutherford Angiographic Classification of the distal bed.</p><p><strong>Results: </strong>A total of 120 LL were assessed in 120 patients with a mean age of 68.6 years. The sample was 50.0% male and 90.0% of the patients in the sample were classified as Rutherford category five. The RI values found for the arteries of the leg exhibited a statistically significant positive correlation with the Rutherford Classification (anterior tibial, p< 0.01; posterior tibial, p = 0.012 fibular, p = 0.034; and dorsalis pedis, p < 0.001).</p><p><strong>Conclusions: </strong>In this study, RIs for the arteries of the leg measured using Doppler ultrasound exhibited a positive correlation with the Rutherford Classification. This index could be useful for assessment of the distal arterial bed of the lower limbs of patients with chronic limb threatening ischemia.</p>","PeriodicalId":14814,"journal":{"name":"Jornal Vascular Brasileiro","volume":"23 ","pages":"e20230071"},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10903956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140021783","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
Short term outcomes of carotid surgery: the real-world experience of a single teaching center. 颈动脉手术的短期疗效:一个教学中心的实际经验。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-02-05 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202300332
Tércio Ferreira Oliveira, Carlos Diego Ribeiro Centellas, Marcelo Bellini Dalio, Edwaldo Edner Joviliano

Background: Surgical treatment of symptomatic extracranial carotid stenosis is well established for preventing neurological events and should adhere to optimal quality standards. However, there is growing concern as to whether results of controlled trials are replicable in real-world settings.

Objectives: To assess a symptomatic carotid stenosis population that underwent surgery and its short-term outcomes in a real-world context at a professional training center.

Methods: Observational study using data collected from medical records from January 2012 to January 2023. Patients undergoing operations for other carotid diseases and with concomitant heart surgery were excluded.

Results: A total of 70 patients undergoing angioplasty or carotid endarterectomy were included. Population subsets undergoing angioplasty or endarterectomy were similar. Differences in anesthetic modality and a longer operative time in the carotid endarterectomy subgroup were statistically significant. There were 4 cases of stroke, only 3 of which (2 minor and 1 major) were related to the index lesion. Thus, the rate of major operation-related stroke was 1.43% and the rate of any lesion-related stroke was 4.29%. There was 1 case of AMI in the angioplasty group and there were no deaths in the sample. The overall rate of major adverse cardiovascular events was 5.71%. There were no statistical differences between the endarterectomy and angioplasty groups regarding the main outcomes.

Conclusions: The rates of outcomes of ischemic stroke, acute myocardial infarction, death, and major adverse cardiovascular events at this center are in line with the rates reported by randomized controlled trials, demonstrating the feasibility of carotid surgery in centers with teaching programs.

背景:对有症状的颅外颈动脉狭窄进行手术治疗可有效预防神经系统事件的发生,且应符合最佳质量标准。然而,人们越来越关注对照试验的结果是否可以在现实环境中复制:评估在专业培训中心接受手术的无症状颈动脉狭窄患者及其短期疗效:观察性研究使用从 2012 年 1 月至 2023 年 1 月的医疗记录中收集的数据。结果:共有70名患者接受了血管狭窄手术:共纳入70名接受血管成形术或颈动脉内膜剥脱术的患者。接受血管成形术或颈动脉内膜切除术的人群子集相似。在颈动脉内膜切除术亚组中,麻醉方式的差异和手术时间的延长具有统计学意义。共有 4 例中风,其中只有 3 例(2 例轻微中风,1 例严重中风)与指标病变有关。因此,与大手术相关的中风发生率为 1.43%,与任何病变相关的中风发生率为 4.29%。血管成形术组有 1 例急性心肌梗死,样本中没有死亡病例。主要不良心血管事件的总发生率为 5.71%。在主要结果方面,动脉内膜切除术组和血管成形术组之间没有统计学差异:结论:该中心的缺血性中风、急性心肌梗死、死亡和主要不良心血管事件的发生率与随机对照试验报告的发生率一致,表明在有教学计划的中心进行颈动脉手术是可行的。
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引用次数: 0
Superficial ulnar artery diagnosed by vascular ultrasound: case report. 通过血管超声诊断尺骨浅动脉:病例报告。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-02-05 eCollection Date: 2024-01-01 DOI: 10.1590/1677-5449.202300852
Mariana Jordão França, Luciana Akemi Takahashi, Graciliano José França, Luiz Fernando Tosi Ferreira

The largest branch of the terminal division of the brachial artery is the ulnar artery, which arises after the cubital fossa. This artery usually has a deep path in the muscles of the anterior forearm and is responsible for vascularization of the superficial and deep musculature on the ulnar side of the forearm and hypothenar area of the hand. We report an anatomical variant diagnosed by Doppler ultrasound in which the ulnar artery had a superficial position in the forearm. Occurrence of a superficial ulnar artery is rare, but it is an important fact for clinicians, surgeons, and nursing professionals.

肱动脉末端分支的最大分支是尺动脉,发源于肘窝之后。该动脉通常在前臂前部肌肉的深层有一条路径,负责前臂尺侧和手掌下部浅层和深层肌肉组织的血管扩张。我们报告了通过多普勒超声诊断出的一种解剖变异,其中尺动脉在前臂的位置较浅。尺动脉表浅虽然罕见,但对于临床医生、外科医生和护理专业人员来说却是一个重要的事实。
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引用次数: 0
Occurrence of depression and assessment of functional capacity in patients with vascular diseases admitted to a Vascular Surgery Service. 血管外科住院病人的抑郁发生率和功能能力评估。
Q4 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-12-18 eCollection Date: 2023-01-01 DOI: 10.1590/1677-5449.202300821
José Aderval Aragão, Osmar Max Gonçalves Neves, Iapunira Catarina Sant'Anna Aragão, Felipe Matheus Sant'Anna Aragão, Bárbara Costa Lourenço, Luciano Conceição Porto, Pedro Henrique Adário Marassi, Francisco Prado Reis

Background: Vascular diseases are associated with significant sequelae and clinical repercussions for the lives of affected patients, which are more serious among the elderly. The consequences of vascular disease, such as limb loss, chronic pain, prolonged hospitalization, and polypharmacy, reduce these patients' autonomy and independence, influencing their wellbeing and quality of life.

Objectives: To determine the prevalence of depression and assess functional capacity in patients with vascular diseases admitted to a Vascular Surgery Service.

Methods: This is a descriptive, cross-sectional study, carried out at the Vascular Surgery Service of a tertiary hospital with a non-random sample of patients selected consecutively. The geriatric depression scale short form (GDS-15) was used to assess depression and the Katz scale was used for functional assessment.

Results: The prevalence of depression in these patients was 60.6%. Associations were observed between depression and consultation with a family doctor in the last 12 months, alcoholism, claudication, diabetes, and individuals who had had an amputation. Individuals' Katz index functional capacity scores were significantly associated with sociodemographic variables, conditions related to vascular disease, and hospitalization.

Conclusions: There was a high prevalence of depression in patients with vascular diseases admitted to a vascular surgery service and important reductions in functional capacity in some groups, such as individuals with low educational levels, those who had chronic pain in the lower limbs, patients with diabetes, and those who had had an amputation.

背景:血管疾病会给患者的生活带来严重的后遗症和临床影响,在老年人中更为严重。血管疾病的后遗症,如肢体缺失、慢性疼痛、长期住院和多种药物治疗,降低了这些患者的自主性和独立性,影响了他们的福祉和生活质量:方法:这是一项描述性横断面调查:这是一项描述性横断面研究,在一家三级医院的血管外科服务处进行,连续选取非随机样本的患者。老年抑郁量表简表(GDS-15)用于评估抑郁情况,卡茨量表用于功能评估:结果:这些患者的抑郁症患病率为 60.6%。抑郁症与过去 12 个月内咨询过家庭医生、酗酒、跛行、糖尿病和截肢之间存在关联。个人的卡茨指数功能能力得分与社会人口学变量、血管疾病相关情况和住院治疗有显著关联:结论:在血管外科住院的血管疾病患者中,抑郁症的发病率很高,而在某些群体中,如教育水平低、下肢长期疼痛、糖尿病患者和截肢者,其功能能力会明显下降。
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引用次数: 0
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Jornal Vascular Brasileiro
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