Takachi Moriya

Influence of high-heeled shoes on venous function in young women

BACKGROUND Walking with high-heeled shoes is a common cause of venous complaints such as pain, fatigue, and heavy-feeling legs. The aim of the study was to clarify the influence of high-heeled shoes on the venous return and test the hypothesis that women wearing different styles of high-heeled shoes present an impaired venous return when compared with their values when they are barefoot. METHODS Thirty asymptomatic women (mean age, 26.4 years) wearing appropriately sized shoes were evaluated by air plethysmography (APG), a test that measures changes in air volume on a cuff placed on the calf, while they performed orthostatic flexion and extension foot movements and altered standing up and lying down. The test was repeated in four situations: barefoot (0 cm), medium heels (3.5 cm), stiletto high heels (7 cm), and platform high heels (7 cm). The APG values of venous filling index (VFI), ejection fraction (EF), and residual volume fraction (RVF) were divided into four groups according to heel height and compared by repeated-measures analysis of variance. RESULTS RVF was increased in the groups wearing high heels (stiletto and platform) compared with the barefoot group (P < .05). RVF was increased in the medium-heel group (3.5 cm) compared with the barefoot group (P < .05), and despite the lack of statistical significance, the medium-heel group showed lower values of RVF compared with the two high-heel groups. The EF parameter followed the opposite tendency, showing higher values for the barefoot group compared with the other three groups (P < .05). Values for VFI were similar in the three situations evaluated. CONCLUSIONS High heels reduce muscle pump function, as demonstrated by reduced EF and increased RVF values. The continuous use of high heels tends to provoke venous hypertension in the lower limbs and may represent a causal factor of venous disease symptoms.

Inflammatory Markers and Restenosis in Peripheral Percutaneous Angioplasty With Intravascular Stenting: Current Concepts

In this article, we review the current status of inflammation linked to percutaneous transluminal angioplasty with stent implantation, especially as it relates to restenosis and its clinical implications. Common to multiple vascular diseases, including atherosclerosis, interventional restenosis is a localized inflammatory reaction. Activated smooth muscle cells respond to local inflammation and migrate from the media into the lumen of the vessel, where they proliferate and synthesize cytokines which they respond to in an autocrine manner, sustaining the progression of the lesion. The deleterious effects of proinflammatory cytokines, particularly immunomodulatory interleukins, on vascular pathophysiology and development of these maladaptive processes have been the subject of intense study. Matrix metalloproteinases and tissue inhibitors of metalloproteinases are important in many physiologic and pathologic processes and their expression is related with the classic cardiovascular risk factors as well as with inflammation. They seem to play a central role in atherosclerosis and restenosis. The primary use of drug-eluting stents has become routine clinical practice for coronary artery disease, but the use in peripheral arteries remains to be further studied, like that demonstrated in sirolimus-coated Cordis trials. New studies to understand this complex process in peripheral arteries are warranted.

A prospective study of venous hemodynamics and quality of live at least five years after varicose vein stripping

PURPOSE To assess venous hemodynamics and quality of life at lest five years after varicose vein stripping. METHODS We conducted a prospective study with 39 patients (63 limbs) with primary lower limbs varicose veins. Preoperatively, all patients were subjected to clinical evaluation, duplex ultrassound, air plethysmography (APG), and CIVIQ questionnaire of quality of life. By APG, venous filling index (VFI), ejection fraction (EF), and residual volume fraction (RVF) were determined. CIVIQ addresses four domains in course of 20 questions, including states of physical, social, and psychological well-being, and pain level. Varicose veins were treated by standard venous stripping. At least five years after surgery (77.9 ± 10.9 months), patients were reassessed and had clinical examination, duplex ultrasound, APG, and CIVIQ repeated. No late follow-up data was available for 24 patients. RESULTS Preoperative and late postoperative VFI levels were similar, whereas EF (P=0.05) and RVF (P=0.01), as hemodynamic variables, significantly improved following surgery. In the late postoperative period, overall CIVIQ scores were significantly lower (P=0.005), as were scores in all four domains: pain (P=0.001), physical (P=0.007), social (P=0.008), and psychological (P= 0.05). CONCLUSION In a small prospective cohort, improvements in venous hemodynamics and in quality of life of patients submitted to standard varicose veins stripping were maintained five years after the procedure.

Estudo da hemodinâmica venosa por meio da pletismografia a ar no pré e pós-operatório de varizes dos membros inferiores

Metodo:Foram estudados 63membros inferiores em 39 pacientes (35 mulheres e quatro homens), commedia de idade igual a 46,3 anos, operados no Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo, no periodo de janeiro de 2001 a dezembro de 2004.Osmembros inferiores foram classificados de acordo com a classificacao CEAP, em criterio clinico = C2 a C6 (C2 = 6, C3 = 32, C4 = 15, C5 = 7 e C6 = 3), criterio etiologico = Ep, criterio anatomico = As e criterio fisiopatologico = Pr. Os pacientes foram avaliados por exame clinico pre e pos-operatorio, mapeamento duplex pre-operatorio e pletismografia a ar pre e pos-operatoria.Background: Surgical treatment of primary varicose veins of the lower limbs might contribute to venous stasis relief by preventing evolution of the venous disease to worse severity stages. Objective: To study venous hemodynamic changes in patients with primary varicose veins of the lower limbs during the pre- and postoperative period using air plethysmography. Method: Sixty-three lower limbs of 39 patients (35 females and four males, mean age of 46.3 years) were evaluated. They were all operated at Hospital das Clinicas, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, between January 2001 and December 2004. Lower limbs were classified according to the CEAP classification: clinical criteria = C2 to C6 (C2 = 6, C3 = 32, C4 = 15, C5 = 7 and C6 = 3), etiologic criteria = Ep, anatomic criteria = As, and pathophysiological criteria = Pr. The patients were submitted to pre- and postoperative clinical examination, preoperative duplex scan and pre- and postoperative air plethysmography. Results: Improvement in venous hemodynamics was observed after surgery, confirmed by reduction in the venous filling index and residual volume fraction and increase in the ejection fraction in the lower limbs submitted to varicose vein surgery. Conclusion: Superficial varicose vein stripping contributed to venous stasis relief and provided appropriate treatment, preventing pathophysiological evolution of chronic venous disease independently of clinical severity.

Hidratação e equilíbrio ácido-base em pacientes cirúrgicos

Estudou-se a influencia da hidratacao em 30 pacientes submetidos a cirurgia de pequeno e grande porte. Os pacientes foram divididos em grupos de 5 conforme o porte cirurgico e o tipo de hidratacao: restricao hidrica, segundo o balanco diario e sobrecarga hidrossalina. As alteracoes mais relevantes do equilibrio acido base foram: pre-operatorio - alcalose respiratoria; pos-operatorio imediato - acidose respiratoria; 1o, 2o e 3o dias de pos-operatorio - alcalose respiratoria, metabolica ou mista. Os metodos de hidratacao com restricao hidrica ou segundo o balanco nao afetaram o equilibrio acido-base, enquanto que a sobrecarga hidrossalina reduziu de modo significativo a incidencia de alcalose metabolica no pos-operatorio.

Pseudoaneurysms of large arteries associated with AIDS

BACKGROUND Several vascular complications are known to occur in association with the acquired immunodeficiency syndrome (AIDS) and recent publications have called attention to the development of pseudoaneurysms of large arteries in patients with AIDS. CASE REPORT We report on 2 patients with AIDS aged 23 and 31 years with pseudoaneurysms of the abdominal aorta and common iliac arteries. After clinical and radiological evaluation by arteriography and computed tomography, the patients were submitted to aneurysmectomy, with the placement of a patch of dacron in the first case and the interposition of a right aorto-iliac and left femoral prosthesis in the second. The second patient developed new aneurysms of the right subclavian and left popliteal arteries 2 months after surgery. Proximal ligation of the right subclavian artery was performed to treat the first aneurysm and resection and interposition of a reversed saphenous vein was carried out to treat the pseudoaneurysm of the popliteal artery. Histopathological examination of the popliteal artery revealed necrotizing arteritis.

Morphological aspects of mural thrombi deposition residual lumen route in infrarenal abdominal aorta aneurisms

PURPOSE To assess the most frequent deposition site of mural thrombi in infrarenal abdominal aorta aneurisms, as well as the route of the residual lumen. METHODS Assessment of CT scan images from 100 patients presenting asymptomatic abdominal aorta aneurism, and followed at HC-FMRP-USP. RESULTS In 53% of the cases the mural thrombus was deposited on the anterior wall; from these, in 22%, the residual lumen described a predominantly right sided route; in 22%, a left sided route; on the mid line in 5%; and crossing over the mid line in 1%. In 23%, the deposition of thrombi was concentric. In 11% it occurred on the posterior wall; from these, in 5%, the route of the residual anterior lumen was predominantly right sided; in 5%, left sided; and crossed over the mid line in 1%. In 13% complex morphological deposition patterns were found. CONCLUSION Mural thrombi formation was predominantly found on the anterior wall of the aneurismatic mass, with the route of the residual lumen projecting towards the posterior wall.

Correlation between the hemodynamic gain obtained after operation of primary varicose veins and chronic venous disease classification

CONTEXT Previous studies have demonstrated improvement of venous hemodynamics after surgical treatment of primary varicose veins of the lower extremities using air plethysmography (APG). PURPOSE To correlate the venous hemodynamics obtained by APG with the CEAP classification after surgical treatment of primary varicose veins. METHODS We studied 63 limbs of 39 patients (35 women and 4 men) aged on average 46.3 years, operated upon at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, during the period from January 2001 to December 2004. The 63 limbs were divided into the three following groups according to CEAP classification: group C2 + C3 (38 limbs), group C4 (15 limbs) and group C5 + C6 (10 limbs). The patients were evaluated clinically before and 30 to 40 days after surgery by preoperative duplex ultrasonography and pre- and postoperative APG. RESULTS There was an apparent hemodynamic improvement after surgical treatment of the varicose veins in the two groups of lower severity, but the improvement was significant in the most severe group based on venous filling index. CONCLUSION Surgical treatment was beneficial for all three groups, but the greatest hemodynamic gain was observed in the group of highest clinical severity (group C5 + C6).

Influência da altura do salto de sapatos na função venosa da mulher jovem

Background: The influence of shoe heel height on venous function is still a controversial subject in the international literature. The importance of ergonomics for quality of life is a universally accepted factor, and situations that impair it, such as prolonged permanence in the supine position, shoe quality and workplace conditions may interfere with the individual’s health.

Endovascular treatment of endotension with dacron stent graft reinforcement and femorofemoral crossover bypass: therapeutic challenge

A 54 year-old man with an asymptomatic 5.9 cm AAA was treated with an Excluder® 26 mm/14.5 mm/16 cm endoprosthesis (Gore, USA). Initial aortic morphology showed a proximal neck of 2.0 cm of extension by 23 mm of diameter. The common iliac arteries measured 13 mm in right diameter and 12 mm in left diameter. No endoleak was detected immediately after the procedure. One month after the procedure, computed tomography (CT) scan showed maintenance of aneurysmal diameters without evidence of endoleak (Figure 1). After one year, follow-up duplex ultrasound and CT scan showed no endoleak, but a small growth of the aneurysmal sac to 6.2 cm was observed (Figure 2). Aortography with selective visceral and hypogastric arteries showed no endoleak (Figure 3). We decided to observe the outcome of the condition with a second CT scan within six months. The patient only returned after one year, when CT scan found the aneurysmal diameter had increased to 7.5 cm, but without evidence of endoleak. The case was interpreted as endotension, and intervention was considered. Since the patient presented class II heart failure, poorly controlled cardiac arrhythmia and a previous left pneumonectomy for a neoplasm, an endovascular approach was chosen.