Paulo Eduardo Ocke Reis

Tratamento endovascular da síndrome de compressão da veia ilíaca (May-Thurner): relato de caso

May-Thurner Syndrome is an uncommon cause of venous symptoms and signs related to the left lower limb. It is characterized by compression of the left common iliac vein by the right common iliac artery and, when such anatomical change causes symptoms that may impair the patients’ quality of life, surgical treatment is indicated. This article addresses a case of May-Thurner syndrome in which we opted for endovascular treatment with satisfactory outcome, as well as a discussion about indications, nuances, and expected results. We concluded that endovascular treatment is effective in treating this syndrome, for it resolves the symptoms by recanalization of the venous system with little risks during the procedure and with short hospital stay.

Bone marrow stem cells and their role in angiogenesis

The degree of symptomatology of a patient with peripheral arterial disease dictates the kind of treatment. Despite the known therapies, some patients continue to have pain with ambulation, which affects their quality of life. The therapeutic implications of the angiogenic growth factors were identified by the pioneering studies of Folkman et al. 2 decades ago. Further investigations established the possibility of the use of formulations of recombinant angiogenic growth factors, with the objective of developing or increasing the network of collaterals in animal models of chronic myocardial or limb ischemia. Researches suggest that primitive stem cells with whole bone marrow possess greater functional plasticity, capable of contributing to regeneration of ischemic limb muscle and vascular endothelium by adult stem cells. Local autologous marrow stromal cells implantation induces a neovascular response resulting in a significant increase in blood flow to the ischemic limb. In this article we review the studies that have established how the implantation of bone marrow cells into ischemic limbs increases collateral vessel formation.

Surgical Treatment of Traumatic Injury of the Artery and Popliteal Vein -A Case Report

Popliteal artery injury is associated with high energy injury, including knee dislocation and complex tibial plateau fractures or supracondylar femur fractures. Delay in its diagnosis is the leading cause of amputation in this limb-threatening injury and the failure to revascularize within 6–8 hours results in an unacceptably high amputation rate.

Avanços nos materiais e no tratamento endovascular de oclusões arteriais crônicas totais: um relato de caso

Chronic arterial occlusions with great calcium component are usually a factor of limitation to endovascular treatment to the difficulty to transpose these lesions with guidewires and catheters commonly used. We reviewed the literature and described a case of endovascular treatment of a total occlusion of external iliac artery, where the use of new materials developed specifically to the treatment of such injuries was critical to the success of the case.

Blue toe syndrome

Os autores relatam o caso de sindrome do dedo azul em um homem que apresentou um quadro de isquemia bilateral dos pes e foi submetido ao reparo bem sucedido de um aneurisma da aorta abdominal e de estenose da arteria renal associada. A sindrome do dedo azul e caracterizada pela isquemia tecidual, secundaria a embolizacao de cristais de colesterol ou aterotrombose. A microembolizacao ocorre mais frequentemente em homens idosos que tem um aneurisma ou sao submetidos a um procedimento vascular invasivo.

Efficacy and safety of pharmacological interventions in metabolic syndrome: protocol for systematic review and network meta-analysis

Introduction: The prevalence of metabolic syndrome (MetS) and MetS-related stroke is set to increase dramatically in coming decades. MetS is a complex disease that includes endothelial dysfunction, insulin resistance, diabetes, hypertension, ectopic obesity, and dyslipidaemia and an increased risk of cardiovascular events.This study aims to fill this gap of research by conducting a Bayesian network meta-analysis to compare major drugs to treat MetS. Methods and analysis: We will search the PubMed, EMBASE, Cochrane Library, Web of Science, Embase, google scholar, clinical trials registry (ClinicalTrials. gov) for unpublished or undergoing research listed in registry platforms. Randomized controlled trials (RCTs) on the drug therapy of MetS with outcome measures including diagnostic criteria of MetS will be included. The quality of included RTCs will be evaluated according to the Cochrane Collaboration’s risk of bias tool. Traditional pairwise meta-analysis and Bayesian network meta-analysis will be conducted to compare the efficacies of antidiabetic drugs. Sensitivity analysis on the sample size of RCTs, meta-regression analysis on the follow-up periods, dosages and baselines of outcome measure, contradiction analysis between pairwise and network meta-analyses, and publication bias analysis, will be performed. Randomized controlled trials (RCTs) on the drug therapy of MetS with outcome measures criteria of MetS diagnostic will be included. The quality of included RTCs will be evaluated according to the Cochrane Collaboration’s risk of bias tool. Traditional pairwise meta-analysis and Bayesian network meta-analysis will be conducted to compare the efficacies of drugs. Sensitivity analysis on the sample size of RCTs, meta-regression analysis on the follow-up periods, dosages and baselines of outcome measure, contradiction analysis between pairwise and network meta-analyses, and publication bias analysis, will be performed. Ethics and dissemination Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. Trial registration number: PROSPERO (CRD42018083468). *Correspondence to: Leonardo Roever, MHS, Federal University of Uberlândia, Department of Clinical Research, Brazil, Email: leonardoroever@hotmail.com

Total Abdominal Aortic Stent Graft Occlusion

We report a case involving an acute chronic endovascular abdominal aortic stent graft occlusion in which percutaneous angioplasty was performed via bilateral trans femoral approach. This case emphasized that endograft occlusion treatment after endovascular aortic aneurysm repair (EVAR) is feasible.

Advances in Vascular and Endovascular Surgery in 2016

Citation: Reis PEO, Roever L. Advances in Vascular and Endovascular Surgery in 2016. J Vasc Endovasc Surg. 2017, 2:1. We mainly refer to advances in concept, notwithstanding the advances of technique and materials. Historically the endovascular procedures had a great advance since the 90s, mainly related to the development and improvement of techniques for treatment in all levels of the thoracoabdominal aortic aneurisms. From then on, there was a worldwide explosion in the dissemination of knowledge with a solid basis for updating the concepts, new techniques such as embolization or endovenous therapies besides new materials. We will make a brief summary of some highlights in 2016.

Thrombectomy and angioplasty as treatment for acute superior vena cava syndrome

Superior vena cava syndrome (SVCS), a disease caused by obstruction of the venous blood influx, because of benign etiology, from the upper body into the right atrium, is becoming more frequent, with growing use of central catheters. The present study is a case report of such acute SVCS managed successfully with an endovascular approach. A 53-year-old male patient, who had received a central venous catheter into the right jugular vein for chemotherapy, revealed an extensive thrombus formation in the veins and was diagnosed of grade 2 SVCS. He was subjected to local thrombolysis therapy followed by mechanical thrombectomy with adjunctive catheter-guided aspiration and a stent being placed through balloon angioplasty. The patient revealed a complete relief of symptoms, excellent signs of clinical improvement, and no signs of recurrence till date, 6 months posttherapy. This case supports the feasibility, safety, and efficacy of endovascular thrombectomy and angioplasty to treat SVCS.

An Update on Cellular Treatments for Angiogenesis in Ischemic Limbs

In addition to clinical treatments, regular exercise, or smoking cessation among patients who have symptomatic peripheral arterial disease (PAD) or critical limb ischemia (CLI), the conventional or endovascular surgical revascularization can improve the state and the evolution of PAD or CLI, and obtain positive results for relief of critical symptoms or for limb salvage [1]. Despite the fact that surgical revascularization for ischemia of lower limbs can avoid amputation, this treatment does not necessarily lead to an efficient limb blood supply or mobility without pain, nor to independence of the patient [1-4]. When progression of atherosclerosis is not interrupted by the used treatments, graft failure or thrombosis may require additional interventional procedures [1-5]. Some patients can reach the disease stage in which the local circulatory system contains arteries of small caliber, with circulation maintained by an extensive network of collateral vessels that cannot provide an adequate supply of blood to tissues. The local anatomy, limited percutaneous access, reduction of autologous vein graft options for revascularization, as well as serious disease of the distal vascular bed, minimize the potential benefits of revascularization procedures or their feasibility. In this context, there is a class of patients in a pre-amputation stage with advanced CLI of the lower limbs that are not candidates for surgery. Besides poor survival rates, prognosis with respect to limb preservation in CLI patients remains also poor, particularly in no-option CLI patients, where 6-month major amputation rates have been reported to range from 10% to 40% [1-5].