Jornal Vascular Brasileiro最新文献

Aneurysms of arteries of the hand are rarely encountered. Literature reports such aneurysms in the distal ulnar artery, the palmar artery, and the digital arteries. Most are false aneurysms involving trauma-induced defects of the vessel wall. True aneurysms with intact intimal, medial, and adventitial layers of the arterial wall are more unusual. In this case report, we present a 77-year-old previously healthy lady who was diagnosed with a true aneurysm of a common digital artery when she presented with a pulsatile lump over her left palm.

Lower limb peripheral artery disease (PAD) is highly prevalent. Current guidelines recommend duplex ultrasound (DUS) with spectral analysis for diagnosis. This systematic review and meta-analysis assessed the diagnostic accuracy of DUS in symptomatic PAD patients. We searched electronic databases for studies comparing DUS and arteriography. Arteries were analyzed individually and grouped into segments (aorto-common femoral, femoropopliteal, below the knee, and the entire lower limb). The meta-analysis estimated sensitivity, specificity, likelihood, and diagnostic odds ratios (DOR). Fifteen studies were included, analyzing 9,067 arteries. DUS accuracy for symptomatic PAD was 0.86 (95% CI 0.81-0.90) for sensitivity and 0.95 (95% CI 0.78-0.97) for specificity. The best results were observed for the femoropopliteal segment: sensitivity 0.86 (95% CI 0.80-0.90), specificity 0.95 (95% CI 0.93-0.97). The poorest performance was observed for the below-the-knee segment: sensitivity 0.78 (95% CI 0.60-0.89), specificity 0.92 (95% CI 0.78-0.97). Most studies had high and unclear risk of bias. There is significant heterogeneity in results, with a limited number of primary studies for each arterial segment, especially for the below-the-knee segment.

The COVID-19 pandemic affected millions of people worldwide. In addition to respiratory impairment, this viral infection can also provoke gastrointestinal symptoms caused by vascular disorders, such as portal-splenic-mesenteric venous thrombosis (PSMVT). This systematic review aimed to investigate the profile of patients who developed PSMVT concomitant with or after viral infection and its predominant outcomes. The database searches returned 214 articles. Of these, 40 case reports were included in the review, presenting a total of 41 cases of PSMVT addressed. Males were more prevalent (n=27; 65.85%), mean age was 51.54 years, and 19.57% had a previous history of endocrine diseases. Statistically significant relationships (p<0.05) were found between patient death and tachypnea at hospital admission (p=0.043) and between patient death and age (p=0.019). It was therefore possible to identify the main profiles and risk factors for PSMVT development and mortality of COVID-19 infected patients.

Lipedema, historically underrecognized, has recently gained attention due to advancements in research and growing public awareness. The Brazilian Consensus Statement on Lipedema, developed by the Brazilian Society of Angiology and Vascular Surgery, aims to establish clear recommendations for the diagnosis, treatment, and management of lipedema. Using the Delphi methodology, experts elaborated 90 statements about lipedema, which were then evaluated by a panel of 113 professionals. The statements were analyzed using SurveyMonkey, with a 75% agreement threshold required for their inclusion in the consensus statement. Most statements achieved significant consensus, with only 9 topics requiring further investigation. This consensus statement highlights the complexity of lipedema, the effectiveness of conservative treatment over surgery, the need for multidisciplinary approaches, and the importance of awareness to reduce underdiagnosis and stigma. It also underscores the ongoing need for research to develop more effective management strategies.

Lipedema is characterized by abnormal fat deposition in areas such as the arms, hips, buttocks, and thighs, sparing the hands and feet. Symptoms include pain, bruising, edema, and subcutaneous nodules, which resist traditional interventions such as diet and exercise. Despite increasing recognition, comprehensive understanding, including pathophysiological, clinical, and therapeutic aspects, has not been fully achieved. This review aims to fill gaps in knowledge of this field, to support more informed management of lipedema. This narrative review provides a deeper understanding of lipedema treatment, addressing pathophysiology and therapeutic options. The data reveal advances in knowledge, especially regarding conservative and surgical treatments, focusing on improving quality of life. However, scientific evidence supporting the safety and efficacy of various treatments is lacking. Additional research is needed to ensure safety and to enhance efficacy of management of this complex condition.

Intervention studies require all participants to originate from the same population, with random allocation to intervention groups to ensure comparability. Randomization is crucial for minimizing confounding factors, allowing differences in outcomes to be attributed to the intervention. Simple randomization performs well for large samples (>100 per group), but smaller samples may require block or stratified randomization to balance group sizes and covariates. When randomization isn't feasible, quasi-randomized methods (e.g., based on dates or enrollment order) can help but must compensate with multivariate adjustments. Moreover, blinding and allocation concealment enhance internal validity and reproducibility. Allocation concealment (e.g., sealed envelopes) prevents bias during participant assignment while blinding mitigates detection and performance biases. Precise methodological descriptions in clinical trial registrations and publications enhance study reliability and reproducibility, highlighting the importance of rigorous planning and transparent reporting in intervention research. This article reviews the key concepts of randomization, blinding, and allocation concealment in interventional studies.

Pulmonary arteriovenous malformations (PAVM) are characterized by abnormal pulmonary vessels forming arteriovenous shunts that compromise oxygenation of the blood, causing hypoxemia, and predispose to infections and cerebral ischemia. The patient in this case was a 38-year-old male who presented with tachypnea and dyspnea, cyanosis of extremities, and significant digital clubbing. The patient had structural epilepsy secondary to neurosurgery for a cerebral abscess during childhood. Arterial blood gas analysis showed significant hypoxemia (PaO₂ = 46.2; SaO₂ = 77%; PaO₂/FiO₂ = 70) and a chest computed tomography showed PAVM in the apical segments of the right upper and lower lobes, with ectatic and tortuous vascular structures following an intraparenchymal path, communicating with the pulmonary artery and veins. After confirmation of the PAVM, it was concluded that elevated pulmonary resistance was contributing to refractive hypoxemia and hypercapnia. Gradual reduction of the ventilation parameters, primarily controlled pressure and positive end-expiratory pressure, and consequent reduction of the arteriovenous shunt, resulted in progressive improvement of oxygenation and respiratory mechanics. The vascular surgery team's assessment was that treatment with embolization was warranted.

Colorectal cancer is one of the most prevalent malignant neoplasms in Brazil. Hepatectomy for resection of liver metastases plays an essential role in increasing disease-free survival, with the possibility of cure. The feasibility of liver resection depends on factors related to the remaining liver after surgery. In this article, a case is reported on the hepatic metastasectomy approach in a 47-year-old female patient, with colon adenocarcinoma who underwent vascular reconstruction in the same surgical procedure. The intrahepatic mass was transposition of the gastroduodenal artery through the anastomosis of the gastroduodenal artery and the right hepatic artery in a continuous suture, without complications. It is concluded that vascular anastomosis in hepatectomies for colon adenocarcinoma metastases is a complex procedure that requires skill and experience from the surgeon. The success rate is high, but it is important to be aware of the risk factors for complications. The most current data suggest that vascular reconstruction does not alter overall disease-free survival, but further studies are needed.

Venous aneurysms are uncommon and can involve the entire venous system and occur at any age. The presence of these aneurysmal formations at the level of the saphenous vein junction is rarely reported, given the small number of cases described in the literature. We report the case of a 41-year-old patient with an aneurysm in the saphenofemoral junction of the right great saphenous vein, discovered incidentally during a consultation for varicose veins of the right lower limb.