Jornal Vascular Brasileiro最新文献

The radial artery most often arises from the brachial artery in the cubital fossa, lying deep to the brachioradialis in the upper part and superficial in the lower part. Recently, the radial artery has increasingly been used for coronary procedures. However, the radial artery is observed to vary in origin, course, and branching pattern. Precise knowledge of these parameters is essential for successful outcomes. Considering the immense clinical significance associated with this artery, this study was conducted. The aim is to expound the details of the radial artery and to highlight the associated implications, serving as a ready reference for vascular surgeons. The study was conducted using various databases and various terms related to the radial artery were used to search the literature. The literature reveals that the radial artery varies in origin, course, and branching pattern and information on these parameters will help vascular surgeons to carry out various procedures with minimum complications.

Carotid web is a rare and poorly understood condition associated with cryptogenic and recurrent acute ischemic stroke in young patients without atherosclerotic risk factors. We describe the case of a 58-year-old female patient with hypertension and dyslipidemia who had recurrent ischemic strokes for 5 years. Presence of carotid web was suggested by Doppler ultrasonography and confirmed by digital subtraction angiography. The patient underwent endarterectomy and, due to satisfactory internal carotid reflux, it was decided not to use a temporary vascular shunt. Endarterectomy and arteriorrhaphy with a bovine pericardium patch were performed. Although carotid web can be seen with imaging exams, detection can be challenging and it can mimic other conditions, such as arterial dissection, non-calcified atherosclerotic plaque, and intraluminal thrombus. The ease with which it can go unnoticed or misdiagnosed highlights the need to understand this disease.

The association between COVID-19 and coagulation disorders has been discussed since the onset of the pandemic. Four years into the pandemic, it is crucial to organize the findings and evidence accumulated thus far. The objective of this study was to review and synthesize the available scientific evidence regarding the relationship between COVID-19 and development of venous thromboembolism (VTE). A rapid systematic review was conducted by searching two electronic databases, selecting systematic review articles that assessed the association between COVID-19 and development of VTE, such as deep vein thrombosis (DVT) or pulmonary embolism (PE). The studies indicated that hospitalized COVID-19 patients are at greater risk of developing VTE, especially those admitted to intensive care units (ICUs). Elevated D-dimer levels and male gender were also associated with increased risks.

Subacute traumatic arterial pseudoaneurysms involving the infragenicular arteries are rarely discussed in the literature because they tend to be asymptomatic or manifest clinically subtle symptoms even at late stages. We describe the case of a 25-year-old patient with a perforation injury to the lower limb from a shard of glass, who, after two weeks, developed pain and swelling in the limb, which suggested deep vein thrombosis. Venous Doppler ultrasound ruled out thrombosis but revealed heterogeneous echogenicity in the anterior wall of the middle third of the anterior tibial artery with internal flow, suggesting a pseudoaneurysm. We opted for conventional surgical treatment and, after proximal and distal control of the artery, drainage of the local hematoma and primary suturing of the lesion were performed. Pseudoaneurysm of the infrapatellar arteries, although rare, is a challenging clinical entity that requires early diagnosis.

Background: Peripheral artery disease, which occurs due to lower limb artery disorders, is associated with high cardiovascular mortality rates. Studies show that supervised exercise is an effective option for controlling symptoms.

Objective: This study identified exercise types and complementary therapies used for vascular rehabilitation in people with peripheral artery disease and discusses the best recommendations in the literature.

Methods: This integrative literature review is based on studies published in the last 5 years. The search was performed in the following databases: PubMed, SciELO, LILACS (BVS), and Cochrane. In addition to supervised exercise, the interventions in the clinical trials included other approaches that contributed to patient rehabilitation. Duplicate articles, articles whose full text was unavailable, and those whose title or abstract indicated they were unrelated to the topic were excluded.

Results: Nine articles were included in the analysis. The results indicate that supervised exercise is the gold standard treatment method. However, therapies such as blood flow restriction, heat therapy, hydrotherapy, and resistance training can help improve treatment adherence, and their complementary effects benefit cardiovascular and physical function.

Conclusions: In patients with peripheral artery disease, exercise-based rehabilitation is fundamental. However, resistance training with blood flow restriction can optimize muscle strength, while heat therapy and hydrotherapy can act as adjuvants to exercise.

Background: Pedal acceleration time (PAT) is a novel indicator of peripheral arterial disease in the lower limbs. Elevated PAT values are associated with worse limb ischemia. Arterial stiffness indexes are another class of indicators recently studied in patients with chronic limb-threatening ischemia (CLTI). The correlation between PAT and arterial stiffness has not yet been established.

Objectives: To analyze correlations between PAT and arterial stiffness indexes in patients with CLTI.

Methods: A cross-sectional analysis was conducted of patients with CLTI from August to December of 2022. The PAT measurements were performed using a vascular ultrasound machine and stiffness indexes were measured using a brachial artery oscillometry unit. An analysis was conducted of the correlations between central blood pressure, peripheral blood pressure, arterial stiffness, and PAT.

Results: A total of 55 patients were analyzed, of whom 23 were women and 83.6% had diabetes. Mean PAT was 166.6 ms; mean pulse wave velocity (PWV) was 11.8 m/s, and the mean augmentation index corrected for a heart rate of 75 beats per minute (AIx@75) was 29.8%. There were positive correlations between PAT and PWV (Spearman r = 0.69; p < 0.001) and between PAT and AIx@75 (Spearman r = 0.59, p < 0.001) and an inverse relationship with the ankle/brachial index (Spearman r = -0.79; p < 0.001).

Conclusions: There is a correlation between arterial stiffness indexes and PAT in patients with CLTI. These indicators are important for quantification of limb ischemia.

Background: Early recognition of peripheral tissue perfusion deficits can minimize secondary complications of peripheral arterial disease in individuals with diabetes.

Objectives: To compare parameters of peripheral tissue perfusion in the leg at rest and during and after progressive effort between non-diabetics and individuals with type 2 diabetes and normal ankle brachial index values, as well as to evaluate the factors associated with peripheral tissue perfusion in the leg in individuals with type 2 diabetes during progressive effort.

Methods: This cross-sectional study included 31 individuals with type 2 diabetes and 31 non-diabetics. Anthropometric measurements and physical activity levels were assessed in all individuals. Peripheral tissue perfusion was analyzed using near-infrared spectroscopy during an arterial occlusion maneuver and the Incremental Shuttle Walking Test.

Results: During progressive effort, the tissue oxygen saturation level was lower in the type 2 diabetes group (type 2 diabetes, 58.74 [56.27-61.74] than the non-diabetic group, 62.15 [59.09-66.49]; p = 0.005). There were significant correlations between tissue oxygen saturation during progressive effort and physical activity level (p < 0.0001; r = -0.681), total body fat percentage (p = 0.001; r = 0.590), segmental body fat percentage (p < 0.0001; r = 0.616), total skeletal muscle mass (p < 0.0001; r = -0.628), and segmental skeletal muscle mass (p = 0.001; r = -0.592).

Conclusions: Individuals with type 2 diabetes and normal ankle-brachial index values had worse tissue perfusion during progressive effort than non-diabetics, and there was an association between perfusion, physical activity level, and body composition in the type 2 diabetes group.

Anticholinergics have been shown to enhance quality of life and reduce sweat in patients with hyperhidrosis. However, it remains unclear whether topical application specifically exerts local or systemic effects. This study's primary aim is to assess topical oxybutynin's impact on axillary hyperhidrosis. Twenty patients will be randomized into three groups. Group A will receive 2.5 mg of oral oxybutynin from day 1 to day 35 (on a variable frequency regimen). Group B will be administered a topical placebo for 35 days and Group C will receive a 10% oxybutynin topical spray, to be used twice daily for 35 days. The primary efficacy outcome will be the evaluation of the effectiveness of topical oxybutynin spray in treating hyperhidrosis. The TODAY trial will generate high-quality evidence on the effects of topical oxybutynin, assessing whether its impact is local or systemic in patients with axillary hyperhidrosis.

Telemedicine encompasses various activities leveraging technology for remote health care. Surgical teleproctoring is described in the literature and has been used by some medical specialties for real-time and remote intraoperative guidance. However, there is still limited evidence on its use for the implantation of aortic endoprostheses. Technological progress and the advancement of telemedicine encourage surgical telementoring, especially in circumstances where in-person proctorship is not feasible, such as in remote areas, during pandemics and wars, and in settings lacking financial resources. In this context, we present the successful application of easily available and low-cost online teleproctoring of real-time aortic endoprosthesis implantation, addressing aortic diseases in a country experiencing social isolation due to the ongoing pandemic and war.