Angiologia e Cirurgia Vascular最新文献

Introduction

The constant advances in Angiology and Vascular Surgery specialty has brought to us a great variety in the training during the residency. The main purpose of this study was to show the distinct trends in training during Angiology and Vascular Surgery residency over time, particularly in the field of surgical exposure and scientific activity.

Methods

After identifying the physicians who completed the Angiology and Vascular Surgery residency between January 2001 and March 2014 in the institution, a retrospective analysis was performed and all data collected from the final curriculum was reviewed. The results were obtained using the Spearman correlation coefficient.

Results

From 2001 to 2014, 13 subjects concluded Angiology and Vascular Surgery residency in the Institution, with a mean age 35 ± 5.7 and 4 subjects (31%) were female. The average exposure to surgical procedures was 2518 ± 310, which 2026 ± 291 were vascular procedures. The mean of scientific presentations as first author was 9.7 ± 5.7 and the mean of publications as first author was 4.5 ± 5.9. Although surgical exposure has remained approximately constant, there was a marked variability in the proportion of endovascular procedures. It was observed a marked correlation between the number of endovascular procedures and time (rho = 0.869, p < 0.001). There was no correlation between the number of endovascular procedures in respect to age or gender. Regarding scientific activity, variability was also large, there has also been an association between time and number of publications (rho = 0.879, p < 0.001) and presentations (rho = 0.753, p < 0.001). In a similar way, no correlation was found between the scientific activity and age or gender.

Conclusion

In overall the surgical exposure during the residency has remained stable; there was an evolution of the proportion of endovascular procedures, a growing concern with the scientific activity; also the gender or age did not affect surgical exposure and adoption of new technical or scientific activity.

Introduction

The lower limb sarcomas represent the most common location of tumors of the connective tissue and no other treatment proved to be better than surgery. The objective of this paper is to present a case of leiomyosarcoma located in the left thigh of a 59 year old woman.

Case report

The authors describe the case of a 59 year old woman, asymptomatic until January 2013, when a swelling, painless and progressive growth in the left thigh has been identified. No signs of neuro‐vascular compromise. A mass with 10 cm diameter, adhering to the deep planes, without pulsatility, has been identified through physical examination. She had no palpable lymphadenopathy and pulses were present and symmetrical. MRI revealed a solid lesion in intermuscular plane designed along the vascular‐nervous pedicle. The incisional biopsy confirmed a leiomyosarcoma. Together with the Plastic Surgery service a wide resection of leiomyosarcoma was performed followed by reconstruction of the SFA and the FV with interposition of the contralateral great saphenous vein in femoro‐femoral position. The procedure was held without significant complications.

Discussion and conclusion

Leiomyosarcomas are malignant and locally aggressive, therefore the extended resection (no touch no see) has been proved to be the best therapeutic option, as a multidisciplinary approach in order to achieve the cure with functional preservation of the member even with radical resections becomes indispensable.

Contrast-induced acute kidney injury is the third leading cause of intrahospital acute kidney disease, accounting for 11% of all cases. It is associated with a worse prognosis on the short- and long-term, as well as with extended hospital stay and increase in health-care costs. As the number of diagnostic and interventional angiographies and computerized tomography increases in clinical practice and higher doses of contrast media are administered to sicker and older patients, contrast-induced acute kidney injury is an increasing problem. Contrast-induced acute kidney injury is a unique form of acute kidney injury in that its risk factors are known and its timing predictable. This makes room for the implementation of prophylactic measures in patients at risk.

Several articles were searched in nephrology journals (“American Journal of Kidney Disease”, “Journal of the American Society of Nephrology”, “Clinical Journal of the American Society of Nephrology”, “Kidney International” and “Nephrology Dialysis Transplantation”) for a global view on contrast-induced acute kidney injury and prophylactic strategies. Subsequently, individual searches were made on MEDLINE^® database for randomized controlled trials and meta-analyses on each prophylactic strategy encountered.

Several approaches to contrast-induced acute kidney injury prevention have been reported, of which vigorous hydration and the use of non-ionic contrast media are the most important. The administration of oral N-acetylcysteine is also a popular strategy in virtue of its favorable risk/benefit profile. Statins have also been reported as protective against contrast-induced acute kidney injury. The authors review the disease and studied prophylactic interventions, presenting a practical approach to the prevention of contrast-induced acute kidney injury.

The authors describe the case of an inferior vena duplication with azygos vein drainage diagnosed during diagnostic venography, prior to filter introduction.

In a 69 years old medical inpatient woman with hemorrhagic stroke, a left popliteal‐femoro‐iliac DVT was diagnosed on the 20th day of admission. She was referred for vena cava filter placement. We performed a diagnostic venography with access from the right internal jugular vein. It has been possible to observe an inferior vena cava duplication with an anomalous posterior heart drainage. We placed an inferior vena cava filter in suprarrenal position, accessing the right common femoral vein.

Duplication of vena cava is rare with a prevalence of 0.2‐3%. Its approach in the context of placing a filter becomes an unusual challenge.