Jornal Vascular Brasileiro最新文献

Background: The Endovascular Repair (EVAR) is the first-choice technique for Abdominal Aortic Aneurysm (AAA). Treatment success is dependent on favorable anatomy and an adequate sealing zone formed by a straight aortic neck (slightly angled). Endoprostheses implanted at critical aortic angles (above 75º) may result in unfavorable results such as fracture, migration, and type Ia endoleak. The technique for creating a proximal "Neoneck" consists of implanting the Palmaz stent in the proximal neck of the AAA, before placement of the endoprosthesis, allowing remodeling and rectification of the aortic neck.

Objectives: To describe the "Neoneck" technique and report the early results of three cases with rectification of the proximal neck angle using a Palmaz stent, enabling treatment in these cases with angulated necks.

Methods: We analyzed data collected from patients in whom Palmaz stents were placed, constructing a proximal Neoneck, during EVAR for infrarenal AAA with very tortuous proximal aortic neck, assessing anatomy, devices and perioperative results, including success rates, complications, mortality, and patency in the short and medium term.

Results: All patients presented satisfactory evolution with immediate technical success. There were no cases of migration, fracture, or type Ia endoleaks. There was evidence of aneurysmal sac reduction after six months. There were no complications related to surgical access or deaths.

Conclusions: In cases of angled aortic necks, when open AAA repair is not possible, in the absence of ideal devices or in urgent cases, prior rectification of the aortic neck deploying the Palmaz stent is feasible and effective. Long-term studies are still needed to validate the technique and assess safety.

Technical skill is one of the most important components of surgical competence and must be thoroughly learned and developed over the course of surgical residency. However, there are still few instruments for directly appraising and quantifying surgical skill and the majority of centers rely on the subjective observations of tutors. The objective of this study was to conduct a scoping review on the subject of instruments for appraisal of surgical skills available for assessment of vascular anastomosis performed by vascular surgery residents. A review was conducted using the following search terms: "educational measurement", "vascular surgery", and "internship and residency". The initial search results comprised 616 articles. After application of the eligibility criteria, just four studies were included in the review, only one of which was conducted in Brazil. Three of the studies used Objective Structured Assessment of Technical Skill (OSATS) to assess residents. However, all used separate and different supplementary checklists for evaluation of specific skills related to anastomoses. Appropriate appraisal and precise feedback during residency training are an extremely important part of residents' training. Systematic and objective feedback enables errors to be corrected and skills to be polished. Since there is no instrument for assessment of the surgical skills needed to perform anastomosis, after completion of the review a rating instrument was proposed focused on this important skill that vascular surgery residents must acquire. The instrument comprises a compilation of the instruments reviewed and includes a proposed checklist for use in real-world settings.

Background: Abdominal aortic aneurysm is defined as a focal and persistent dilatation of the abdominal portion of the aorta to a diameter ≥50% larger than the diameter of adjacent segments and involving all three layers of the vessel wall.

Objectives: To evaluate whether risk factors (diabetes mellitus, hypertension, dyslipidemia, smoking, and age) influence aneurysm expansion.

Methods: This is a retrospective observational study of a series of cases that included 299 patients treated from January 2007 to January 2020, separated into exposed and unexposed groups by risk factors. Student's t test was used to assess whether mean aneurysm diameters showed statistically relevant differences between groups. A multivariate regression analysis was also conducted with the same groups.

Results: Smokers had larger aneurysms than those who had never smoked (p=0.002) and than former smokers (p<0.01) and patients ≤65 years old had larger diameters compared to patients aged 66 to 75 years old (p=0.0226). There were no significant correlations with the other risk factors (diabetes mellitus, dyslipidemia, hypertension). Multivariate regression analysis confirmed the same result, but with a coefficient of determination of 0.0608. Furthermore, smokers, patients with hypertension, patients with dyslipidemia, and patients without diabetes had higher frequencies of much larger aneurysm diameters.

Conclusions: It was observed that age ≤65 years and current smoking were related to greater aneurysm diameter. In contrast, the same statistical relationship was not observed for hypertension, absence of diabetes, or dyslipidemia, since there was a greater frequency of discrepant values for these groups. Studies are needed with a more comprehensive analysis of determinants of aneurysm diameter.

Background: Despite considerable study, there is still no consensus defining the ideal compression regimen after ablation of the great saphenous vein with radio frequency or endolaser.

Objective: To identify the Brazilian Society of Angiology and Vascular Surgery members' current compression therapy practices after ablation of the great saphenous vein.

Methods: A multiple-choice electronic questionnaire on post-endovenous ablation compression was developed and made available on-line to Brazilian vascular surgeons for 60 days.

Results: A total of 430 responses were received, 362 (84.2%) of which were considered valid. Laser ablation was the predominant technique (73.5%) and the majority of procedures were conducted in hospitals or day hospitals. Ninety-four percent of the surgeons treated associated varicose veins in the same procedure, for which phlebectomy was the technique most employed. After ablation of the great saphenous vein, 99% of the surgeons applied compression immediately; 34.3% used 35 mmHg compression stockings, 26% preferred crepe bandages, and 12.4% opted for 20-30 mmHg compression stockings, with an average duration of 2.79 (±2 days). After this period, 88.4% used additional compression, with 20-30 mmHg compression stockings (80.9%) and an average duration of 39.3 (±24.0 days).

Conclusions: Compression therapy is widely employed after thermal ablation of the great saphenous vein. Practice immediately after ablation was divergent, but after the initial phase, the majority of surgeons prescribed additional compression, predominantly using 20-30 mmHg stockings.

Background: Stenosis resulting from neointimal hyperplasia remains a significant concern associated with dysfunction of arteriovenous fistulas (AVF).

Objectives: To investigate the safety and efficacy of paclitaxel drug-coated balloon (DCB) angioplasty for treating failing AVFs.

Methods: Investigators analyzed 58 hemodialysis patients treated with Ranger^TM DCBs from December 2022 to December 2023 across four centers. Lesions treated were de novo or restenotic and located in the juxta-anastomosis, cannulation zone, and outflow segment. Patients were evaluated through physical examinations and Duplex ultrasound at 1, 3, and 6 months. The primary efficacy endpoint was target lesion primary patency at 1, 3, and 6 months, and the primary safety endpoint was freedom from serious adverse events through 30 days post-procedure. Secondary endpoints were access circuit primary patency and technical and procedural success.

Results: Nine patients (16%) had thrombosed access at the initial presentation, and 31 (53%) presented with recurrent stenosis. The target lesion primary patency rate at 6 months was 85.7%, and the access circuit primary patency rate at 6 months was 67.5%. No serious adverse events, either local or systemic, were reported. Sex, age, stenosis location, type of lesion, presence of thrombosis, lesion recurrence, diabetes status, or whether post-ballooning dilation was performed did not significantly affect the 6-month target lesion primary patency.

Conclusions: DCB angioplasty was shown to be safe and effective for treating peripheral stenosis in vascular access.

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.