Angiologia e Cirurgia Vascular最新文献

Coronary‐subclavian steal syndrome is a clinical entity that consists in the ocurrence of reverse blood flow in the internal mamary artery in patients who underwent coronary revascularization using this artery as conduit, due to severe proximal stenosis or occlusion of the subclavian artery. Considered to be a rare syndrome, it's existence is becoming more significant thanks to the common use of the internal mamary artery in coronary revascularization, causing cardiac ischemia and, more rarely, acute myocardial infarction. We reporte the case of a pacient who underwent coronary revascularization with the internal mamary artery, presented with recurrent thoracic pain, who was diagnosed with coronary‐subclavian steal syndrome. The subclavian stenosis was treated with angioplasty and stenting, with complete remission of symptoms.

Endovascular aneurysm repair (EVAR) is indicated in high-risk patients for conventional surgery, with anatomic conditions for endoprosthesis implantation. Low morbidity, mortality and physiological aggressiveness have been expanding the indications for its use. Still, EVAR is questionable in younger patients, with a low surgical risk and a prolonged life expectancy. Abdominal aortic aneurysms (AAA) are rare in human immunodeficiency virus (HIV) infected patients in western countries and have singular characteristics: an unknown etiology, multiple arterial involvement, poor open surgery results and risk of infection transmission to surgeons. For these reasons EVAR opened new therapeutic perspectives in this group of patients. We present our experience with two HIV patients in whom an AAA was diagnosed, one with a 10 cm diameter treated by EVAR, excluded with an aorto-uni-iliac endoprosthesis, other followed regularly, describing their features and therapeutic results. The reported cases allow us to speculate on the importance of anti-retroviral and endovascular treatments reducing the inflammatory process on the arterial wall, with a consequent delay in aneurysm growth and even its regression, which reinforces the possible relevance of EVAR as a first line treatment for this particular pathology.

Background

Introduction: Raynaud's phenomenon (RP) is a well-defined clinical syndrome. Systemic sclerosis (SSc) is the most frequent associated disease to RP (96%). The aim of this study was to assess the differences between primary RP (PRP) and secondary RP (SRP) regarding macrovascular disease parameters, endothelial dysfunction and angiogenesis biomarkers.

Materials and methods

Flow-mediated dilatation (FMD), endothelin-1 (ET-1), asymmetric dimethylarginine (ADMA) vascular endothelial growth factor (VEGF), endoglin and endostatin were analyzed in a cohort study of 32 PRP patients and 77 SRP all with SSc. 38 of the SRP SSc-associated patients had severe digital ulcer (DU).

Results

Patients with PRP had significantly longer history of RP compared to SRP SSc-sssociated patients (p = 0.028).

FMD was significantly lower in SRP patients 10.85 ± 11.0% (p < 0.001), more evidenced in SRP SSc-associated DU patients 5.34 ± 7.49 (p < 0.001). ET-1 plasma levels were significantly increased in both PRP 7.53 (0.16–11.73) and SRP patients 11.85 (7.42–17.23) (p < 0.001). Significant increased serum levels of ADMA 0.52 (0.45–0.63) μmol/L (p < 0.001) and endoglin 3.01 (1.46–7.02) mg/ml (p < 0.001) were found in the SRP SSc-associated group with DU. VEGF was significantly decreased in the DU group 245.06 (158.68–347.33) pg/ml compared to PRP 438.50 (269.26-854.00) pg/ml and SRP naïve–DU patients 290 (166.71–361.78) pg/ml patients (p < 0.001). No significant differences were found between groups regarding endostatin (p = 0.118).

Comparing PRP and SRP SSc-associated patients without DU no statistically significant difference regarding FMD, ET-1, ADMA, VEGF, plasma levels were observed.

Conclusion

Overproduction of ET-1 and VEGF is present in PRP patients. Macrovascular disease and an impaired response to shear stress are more characteristic of SRP with a grater expression in patients with peripheral ischemic lesions.