Igor Schincariol Perozin

Tratamento endovascular de aneurisma de artéria poplítea

BACKGROUND: The most commonly occurring aneurysms in the periphery are those involving the popliteal artery. They comprise 70-80% of all such aneurysms. Conventional aneurysm repair consists of either opening the aneurysm sac and interposing a bypass graft or aneurysm ligation combined with bypass grafting. Endovascular treatment is an alternative to conventional repair. OBJECTIVE: To evaluate use of stent graft in the endovascular treatment of popliteal artery aneurysms. METHODS: We analyzed 17 male patients; of these, 11 were treated with endovascular stent graft, using Hemobahn and Viabahn stent grafts. RESULTS: One patient had pseudoaneurysm in the immediate postoperative period. Among late complications, one patient had distal endoleak after 7 months, and there was stent graft occlusion in another patient. The remaining nine patients had satisfactory Doppler ultrasonography control at 20 months, which resulted in a primary patency of 90% over mean follow-up time of 27 months. CONCLUSION: Endovascular repair of a popliteal artery aneurysm is feasible and has some advantages compared with the open treatment, such as shorter hospital stay and recovery.

Aneurisma de veia poplítea: relato de caso e revisão de literatura

Os aneurismas venosos sao entidades raras, porem com potencialidade de causar complicacoes tromboembolicas. Na maioria das vezes, sao encontrados incidentalmente, como achados de exame fisico ou de imagem. Os aneurismas sintomaticos de veia poplitea sao obrigatoriamente tratados por reparo cirurgico, devido ao alto risco de recorrencia de embolia pulmonar. A tecnica mais utilizada e a aneurismectomia tangencial com venorrafia lateral. Na impossibilidade de se empregar essa tecnica, faz-se a resseccao com reconstrucao venosa. Os autores relatam o caso de uma paciente com aneurisma de veia poplitea, cujo diâmetro era de 47 mm, submetido a aneurismectomia tangencial e venorrafia lateral, com sucesso.

Tratamento endovascular do aneurisma da aorta abdominal infrarrenal em pacientes com anatomia favorável para o procedimento: experiência inicial em um serviço universitário

BACKGROUND: Since its introduction in 1991, endovascular repair of infrarenal aortic aneurysms has become an attractive option to treat this disease. The evaluation of our initial results about safety and efficacy of this technique has led us to carry out this study. OBJECTIVES: To analyze perioperative mortality, late survival, reoperations, patency rates and the aneurysmal sac behavior in patients with favorable anatomy for this procedure. METHODS: A longitudinal, observational and retrospective study was conducted from October 2004 to January 2009, involving 41 patients with favorable anatomy for endovascular repair of infrarenal aortic aneurysm. The findings of diagnostic exams, the treatment and follow-up results were analyzed. RESULTS: Thirty-one (75.6%) bifurcated and 10 (24.5%) mono-iliac prosthesis of five different brands were successfully implanted. The average diameter of the fusiform aneurysms was 62 mm. Perioperative mortality rate was 4.8% and late survival was 90.2%. During the mean follow-up period of 30 months, two (4.8%) patients needed re-intervention, one for migration of the endoprosthesis and the other for type II endoleak. Two (4.8%) patients presented occlusion of an endograft branch. Eight (19.5%) endoleaks were diagnosed and there was no aneurysm rupture. CONCLUSION: Despite the small number of patients, the results seem to justify the performance of endovascular therapy in patients with favorable anatomy.

Necrose cutânea induzida por antagonistas da vitamina K

Oral anticoagulants acting via vitamin K antagonists have long been employed in the clinical practice. However, difficulties related to the management of treatment regimens and complications still persist. Among the complications, bleeding disorders are widely known, but others should also be taken into consideration, such as warfarin-induced skin necrosis. The pathophysiology of this rare but severe complication is still obscure, and its causes remain to be defined. Among possible causes, protein C and protein S deficiency, hypersensitivity reactions and VII factor deficiency are the most probable ones. There is an increased incidence of warfarin-induced skin necrosis among middle-aged women, usually affecting breasts and buttocks. The most important treatment measures are immediate discontinuation of the drug, use of unfractionated or low-molecular-weight heparin at therapeutic doses, use of vitamin K and, eventually, infusion of fresh-frozen plasma or recombinant activated protein C.

Pseudo-aneurisma de artéria tibial posterior pós-tratamento de fratura de perna com fixador externo: relato de caso e revisão da literatura

We describe a case of pseudoaneurysm in the posterior tibial artery following treatment for tibial and fibula fractures using external fixation (Ilizarov technique), as well as the techniques used for its treatment. Ultrasound-guided compression and ultrasound-guided thrombin injection were unsuccessfully performed. Definite treatment of pseudoaneurysm and arterial reconstruction was achieved through the traditional surgical treatment, using interposed graft of inverted homologous great saphenous vein. Indications, advantages and disadvantages of noninvasive treatment techniques (ultrasound-guided compression and ultrasound-guided thrombin injection) and the possible causes of their inability in obliterating the pseudoaneurysm are discussed. A literature review of pseudoaneurysms of the posterior tibial artery was also carried out, resulting in only one similar case out of 24 published cases.We describe a case of pseudoaneurysm in the posterior tibial artery following treatment for tibial and fibula fractures using external fixation (Ilizarov technique), as well as the techniques used for its treatment. Ultrasound-guided compression and ultrasound-guided thrombin injection were unsuccessfully performed. Definite treatment of pseudoaneurysm and arterial reconstruction was achieved through the traditional surgical treatment, using interposed graft of inverted homologous great saphenous vein. Indications, advantages and disadvantages of noninvasive treatment techniques (ultrasound-guided compression and ultrasound-guided thrombin injection) and the possible causes of their inability in obliterating the pseudoaneurysm are discussed. A literature review of pseudoaneurysms of the posterior tibial artery was also carried out, resulting in only one similar case out of 24 published cases.

Análise espectral segmentar no seguimento de pacientes revascularizados

BACKGROUND: Patients treated for peripheral arterial occlusive disease with lower limb revascularization (angioplasty or grafts) were followed up for a 2-year period after treatment with vascular ultrasound (segmental spectrum analysis, SSA). OBJECTIVE: To demonstrate that SSA can be used in the follow-up of patients treated for peripheral arterial occlusive disease. METHODS: The following SSA measurements were performed: peak systolic velocity (PSV), pulsatility index (PI), and flow velocity waveform (FVW). These measurements were performed and compared for each patient during the pre- and post-treatment periods (with 3-month intervals) for diagnosis of vascular patency. RESULTS: Measurements performed postoperatively in the arteries immediately distal to the treated segments showed a significant increase in PSV and PI, with a change of the FVW from a monophasic to a biphasic or triphasic configuration. PSV and PI increased, respectively, 92.26 and 98.2% (intervention in the aortoiliac segment), 112.83 and 62.39% (intervention in the femoral-popliteal segment), and 149.08 and 28.8% (in the popliteal-tibial segment). Such changes in flow velocity patterns occurred in all patients and remained almost unaltered during the period of patient follow up. When treatment failed (hemodynamically significant occlusion or stenosis), parameters fell to levels similar to those observed prior to treatment. If treatment failure was corrected by new revascularization (angioplasty or grafts), SSA parameters returned to patterns observed after initial treatment. CONCLUSION: SSA can be used in the follow-up of patients with lower limb revascularization due to peripheral arterial occlusive disease, demonstrating treatment patency and failure.