Charles Angotti Furtado de Medeiros

Comparison of endovenous treatment with an 810 nm laser versus conventional stripping of the great saphenous vein in patients with primary varicose veins.

Background Patients with varicose veins seek medical assistance for many reasons, including esthetic ones. The development of suitable and more flexible instruments, along with less invasive techniques, enables the establishment of new therapeutic procedures. Objective To compare endovenous great saphenous vein photocoagulation with an 810 nm diode laser and the conventional stripping operation in the same patient. Methods Twenty patients selected for operative treatment of primary great saphenous vein insufficiency on duplex scanning were assigned to a bilateral random comparison. In all cases, both techniques were performed, one on each lower limb. Clinically, evaluation was assessed on the seventh, thirtieth, and sixtieth postoperative days. Patients underwent examination with duplex ultrasonography and air plethysmography during the follow-up. Results Patients who received endovenous photocoagulation presented with the same pain but fewer swellings and less bruising than the stripping side. Most patients indicated that the limb operated on by laser received more benefits than the other. There was only one recanalization and no adverse effects. The venous filling time showed better hemodynamics in both techniques. Conclusion The endovenous great saphenous vein photocoagulation is safe and well tolerated and presents results comparable to those of conventional stripping.

Comparação entre o laser endovenoso e a fleboextração total da veia safena interna: resultados em médio prazo

OBJECTIVE: To compare endovenous diode laser photocoagulation and conventional stripping of the great saphenous vein. METHODS: A controlled and blind prospective study of 20 patients with symptomatic varicose veins and bilateral great saphenous vein insufficiency who underwent surgery between March 2002 and February 2004. For each case, both techniques were randomly performed, one at each side. The postoperative assessment consisted of questionnaires, physical examination and digital photography of all patients since the 7th postoperative day. Patients also underwent examination with duplex scan at the 30th postoperative day and air plethysmography 60 days after the surgery. This project was approved by the ethics committee, and the patients were included after signing the consent form. All data were submitted to statistical analysis using the software SPSS and SAS. RESULTS:: The endovenous laser technique presented similar pain, but less edema and less hematoma during the postoperative period. The index of esthetic improvement and satisfaction with the surgery was 100% for both techniques, but a minority of patients reported that the limb operated with the laser had better results. There was improvement in venous filling time in both groups, but with no significant difference. During the follow-up (average of 26 months), there was one case of mild and transient paresthesia at the conventional side and only one recanalization at the laser side. CONCLUSION: The endovenous photocoagulation for the treatment of the great saphenous vein in patients with lower limb varicose veins is safe and presents results comparable with the conventional stripping.

Ehlers-Danlos syndrome type IV and multiple aortic aneurysms : A case report

The aim of this randomized, placebo-controlled study was to evaluate the effect of local treatment with Essaven gel (EG) in comparison with placebo in 30 patients with superficial vein thrombosis (SVT). The 4-week study evaluated the average skin temperature and an analogue symptomatic score. Below-knee SVT was associated with large varicose veins. In patients treated with active EG the decrease in score and in the average, composite skin temperature was significantly larger than in the placebo and control groups. No intolerance was observed. The decrease in score and temperature in the placebo group was mainly due to skin manipulation and massage. In conclusion, treatment with EG in SVT improves symptoms and decreases skin temperature faster. This study confirms earlier observations on the effective use of EG in SVT.Beside atherosclerosis, aortic aneurysms can be part of the clinical spectrum of many systemic diseases, including infectious, inflammatory, genetic and, less often, congenital disorders. A 48- year-old white man presented with multiple large aneurysms of the aorta and its main branches. Medical history was unremarkable except for the presence of a softened abdominal mass since he was 28 years old. On the physical examination, an arterial murmur was heard over the left carotid artery and a palpable mass was noted in the whole right side of the abdomen. No skin or joint abnormalities were noted. Aortography, computed tomography, and magnetic resonance angiography showed multiple large aneurysms of the descending thoracic and abdominal aorta. Aneurysms of the innominate, left subclavian, and carotid arteries were also seen. This case resembles those previously reported, in which multiple aortic aneurysms were associated with abnormalities of the type III procollagen gene (COL3A1). Although the classic stigmas of the Ehlers-Danlos syndrome type IV were lacking, this genetic disease may be the cause of the multiple aneurysms in this patient.

Tratamento endovascular do trauma arterial dos membros

Treatment of arterial traumatic injuries is usually performed with conventional revascularization techniques. However, vascular injuries can increasingly be repaired efficiently through minimally invasive procedures. We report four cases of extremity arterial trauma treated by endovascular techniques in a reference center. All patients showed satisfactory development over a 15-month follow-up. We suggest that endovascular therapy is a promising alternative to surgery for selected patients with extremity arterial trauma.

Correção endovascular do aneurisma de artéria poplítea bilateral

The first report of a successful endovascular repair of a popliteal artery aneurysm was described in 1994. Since then, few series with not many cases have been published. Next, the authors describe two cases of successful endovascular repair of bilateral popliteal artery aneurysm.

Cirurgia de varizes: história e evolução

Since great saphenous vein stripping is a well established surgery, the use of a minimally invasive method to obtain the same effects indicates that short and medium-term benefits should prevail over expected risks. However, because it is a very common disease in the world population, there is great concern about this subject by government health institutions and correlated scientific societies. Therefore, the arguments about new treatment modalities must be well based, including to gain acceptance by the general public.To effectively evaluate new devices, there must be well designed clinical studies with groups and controls. All projects about this matter must be submitted to the appreciation of an ethics committee at the institution where the research will be carried out for previous approval.

Femoral/axillary volume flow ratio as a new index for the assessment of iliac atherosclerosis.

OBJECTIVE To measure the arterial volume flow (VF) with duplex scan, calculate femoral/axillary VF ratio, and discuss its applicability as a new index for the hemodynamic significance of an aorto-iliac occlusive lesion. METHODS Several measures of VF were obtained consecutively with duplex scan in both common femoral and axillary arteries of healthy volunteers with no signs of atherosclerosis and patients with documented evidence of occlusive aorto-iliac disease with segmental pressure measurement. Then the patient group was sent to complimentary evaluation for a second confirmatory examination. RESULTS There were a total of 635 measures of VF performed in 10 healthy volunteers and 8 patients with severe iliac stenoses or occlusion, 2 of then with bilateral disease. When comparing normal participants and patients with severe iliac stenoses or occlusion, there was statistical significant difference between these 2 groups (P < .01 Mann-Whitney). Similar result was found when comparing patient with diseased limbs with their own contralateral normal side (P < .05 Wilcoxon). And measuring the VF only during the systolic phase was a much more sensitive parameter for differentiating the normal from the diseased. Besides that a good correlation between proximal thigh pressure index and femoral/axillary systolic flow ratio was found in the patient group (P < .01 Spearman correlation). CONCLUSION The femoral/axillary VF ratio is useful in assessing the hemodynamic significance of aorto-iliac disease, and the systolic femoral-axillary ratio may also be useful as a follow-up tool.Objective: To measure the arterial volume flow (VF) with duplex scan, calculate femoral/axillary VF ratio, and discuss its applicability as a new index for the hemodynamic significance of an aorto-iliac occlusive lesion. Methods: Several measures of VF were obtained consecutively with duplex scan in both common femoral and axillary arteries of healthy volunteers with no signs of atherosclerosis and patients with documented evidence of occlusive aorto-iliac disease with segmental pressure measurement. Then the patient group was sent to complimentary evaluation for a second confirmatory examination. Results: There were a total of 635 measures of VF performed in 10 healthy volunteers and 8 patients with severe iliac stenoses or occlusion, 2 of then with bilateral disease. When comparing normal participants and patients with severe iliac stenoses or occlusion, there was statistical significant difference between these 2 groups (P < .01 Mann-Whitney). Similar result was found when comparing patient with diseased limbs with their own contralateral normal side (P < .05 Wilcoxon). And measuring the VF only during the systolic phase was a much more sensitive parameter for differentiating the normal from the diseased. Besides that a good correlation between proximal thigh pressure index and femoral/axillary systolic flow ratio was found in the patient group (P < .01 Spearman correlation). Conclusion: The femoral/axillary VF ratio is useful in assessing the hemodynamic significance of aorto-iliac disease, and the systolic femoral axillary ratio may also be useful as a follow-up tool.

Tratamento endovascular da estenose da artéria renal em rim único

CONTEXTO: O tratamento endovascular da doenca renal hipertensiva, em doentes com rim unico, consequente a estenose de arteria renal, mostrou ser efetivo na prevencao da falencia do orgao, sua funcao e controle da hipertensao. Quando indicado apos avaliacao criteriosa, tanto bioquimica como por imagens e sinais do doente, o tratamento endovascular apresenta beneficios clinicos de forma efetiva e pouco invasiva. OBJETIVO: Estudar a doenca hipertensiva renovascular e avaliar a eficacia do tratamento endovascular no controle da hipertensao arterial sistemica e da insuficiencia renal secundarias a estenose da arteria renal e como medida de prevencao de falencia renal em doentes com rim unico funcionante. METODO: Estudo realizado com protocolo de atendimento previamente elaborado, no Centro de Referencia de Alta Complexidade em Cirurgia Endovascular do Hospital de Clinicas da Universidade de Campinas, de abril de 1997 a junho de 2005, em 10 doentes com diagnostico de estenose da arteria renal em rim unico funcionante, submetidos ao tratamento endovascular. Foi avaliada a melhora da hipertensao e funcao renal atraves de seguimento clinico e laboratorial com medidas de pressao arterial, dosagens sericas de ureia, creatinina e clearance. Exames pelo eco-color-Doppler foram realizados no pos-operatorio de 30 dias, 3 meses, 6 meses e anualmente; no caso de haver alguma duvida na obtencao de imagens ou sinais, foi realizada a aortografia e arteriografia seletiva renal. Nesta casuistica, 90% dos doentes apresentavam hipertensao arterial, 70% eram tabagistas, 40%, hiperlipidemicos, 30% apresentavam doenca oclusiva cerebral extracraniana, 60%, obstrucao arterial cronica nos membros inferiores, e 20%, diabetes melito. RESULTADOS: O sucesso inicial foi de 100%. O seguimento medio foi de 40 meses. Houve controle da pressao arterial em 90%, diminuicao significativa dos niveis de ureia e creatinina apos procedimento e piora do quadro de hipertensao em 10%. CONCLUSAO: O tratamento endovascular da estenose da arteria renal e uma tecnica que apresenta beneficios clinicos no controle da hipertensao arterial, preserva a funcao renal e desacelera a progressao da insuficiencia renal cronica de origem renovascular, porem sem melhora desta.

Tratamento combinado da cirurgia de varizes com a escleroterapia de telangiectasias dos membros inferiores no mesmo ato

OBJETIVOS: A escleroterapia por metodo quimico e o tratamento mais tradicional para eliminar as telangiectasias. Ha varias decadas, e realizada em consultorio, mas com alto indice de abandono devido ao seu carater prolongado, doloroso e, por isso, pouco eficaz. Uma grande proporcao destes pacientes apresenta tambem insuficiencia de tributarias, ou seja, veias varicosas com indicacao de fleboextracao e que serao submetidas a cirurgia. O objetivo deste trabalho e descrever a opcao de tratamento combinado da cirurgia de varizes com a escleroterapia das telangiectasias no mesmo ato. METODOS: De janeiro de 1998 a marco de 2002, 213 pacientes (426 membros inferiores) foram submetidos ao tratamento das telangiectasias por meio de injecao de glicose hipertonica durante a cirurgia de varizes. RESULTADOS: Mais de 90% dos pacientes relataram altos indices de satisfacao estetica. A escleroterapia complementar foi necessaria em 165 pacientes, para atingir plena satisfacao estetica durante o seguimento. Nao foram constatados casos de tromboflebites superficiais, nem de trombose venosa profunda. Tambem nao houve relatos de complicacoes graves. Em 10% dos casos, foram necessarias pequenas drenagens de microtrombos residuais. O indice de manchas hipercromicas nao ultrapassou 3%. Apenas um paciente desenvolveu uma pequena ulcera no dorso do pe (0,2%), que cicatrizou espontaneamente. CONCLUSOES: O tratamento combinado da cirurgia de varizes com a escleroterapia das telangiectasias dos membros inferiores e uma alternativa para os pacientes que desejam um resultado mais rapido e indolor. As sessoes multiplas com injecao de glicose hipertonica sao uma opcao segura e eficaz.

Ehlers-Danlos Syndrome Type IV and Multiple Aortic Aneurysms

The aim of this randomized, placebo-controlled study was to evaluate the effect of local treatment with Essaven gel (EG) in comparison with placebo in 30 patients with superficial vein thrombosis (SVT). The 4-week study evaluated the average skin temperature and an analogue symptomatic score. Below-knee SVT was associated with large varicose veins. In patients treated with active EG the decrease in score and in the average, composite skin temperature was significantly larger than in the placebo and control groups. No intolerance was observed. The decrease in score and temperature in the placebo group was mainly due to skin manipulation and massage. In conclusion, treatment with EG in SVT improves symptoms and decreases skin temperature faster. This study confirms earlier observations on the effective use of EG in SVT.Beside atherosclerosis, aortic aneurysms can be part of the clinical spectrum of many systemic diseases, including infectious, inflammatory, genetic and, less often, congenital disorders. A 48- year-old white man presented with multiple large aneurysms of the aorta and its main branches. Medical history was unremarkable except for the presence of a softened abdominal mass since he was 28 years old. On the physical examination, an arterial murmur was heard over the left carotid artery and a palpable mass was noted in the whole right side of the abdomen. No skin or joint abnormalities were noted. Aortography, computed tomography, and magnetic resonance angiography showed multiple large aneurysms of the descending thoracic and abdominal aorta. Aneurysms of the innominate, left subclavian, and carotid arteries were also seen. This case resembles those previously reported, in which multiple aortic aneurysms were associated with abnormalities of the type III procollagen gene (COL3A1). Although the classic stigmas of the Ehlers-Danlos syndrome type IV were lacking, this genetic disease may be the cause of the multiple aneurysms in this patient.