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Objective: To evaluate the incidence of malfunction and colonization rates of fully implantable long-term catheters left unflushed during the COVID-19 pandemic; and to evaluate the average cost of transporting each patient to the hospital for flushing., Methods: During the COVID-19 pandemic, patients reduced the number of hospital visits and stopped flushing their catheters periodically with saline solution. After the pandemic stabilized in 2022, patients who completed chemotherapy treatment had their long-term catheters removed. We evaluated the catheters' function and colonization rates. To evaluate the incidence of malfunctions and the colonization rate of these catheters, we tested the flow and reflux during removal surgery, before removal, and by culturing their tips. These catheters were divided into two groups: a standard group, in which the last flushing occurred before 90 days, and another group, in which the last flushing occurred after 90 days. We analyzed the correlation between the time at which these catheters were closed, the incidence of malfunction, and the colonization rate of these catheters. To avoid confusion due to the reduced sample size, a second analysis was performed between the group of catheters that did not work and those that worked, evaluating the time they were closed and the catheter tip culture. We also analyzed the financial costs for each patient from home to the hospital., Results: Among the 66 patients included in the study, 28 spent >90 days without catheter flushing, and 38 spent <90 days. The incidence of infection occurred in two patients with >90 days of flushing and in three patients with <90 days of flushing. Catheter malfunction occurred in 4 patients in the group with >90 days without flushing and in 5 patients with <90 days of flushing. In the secondary analysis, the group with a functioning catheter (n=52) had a mean time of 152 days, whereas for the group with a non-functioning catheter (n=9), the mean time was 229 days (p=0.51). No differences were statistically significant. No correlation was found between the colonization rate of catheter in the group with a functioning or non-functioning catheter, as the group with a functioning catheter had three cases of positive catheter tip culture and the group with a non-functioning catheter had one case of positive catheter tip culture. The average cost for each patient to travel from home to the hospital was 39.01 reais (approximately 7.50 USD)., Conclusion: Among the patients followed up at our hospital during the COVID-19 pandemic, no statistically significant difference was observed in the function and colonization rate of long-term catheters between those who underwent flushing at intervals of <90 days and those with intervals of >90 days.

Background: The current study aimed to evaluate the distance between the right common iliac artery (RCIA) and lumbar vertebra in asymptomatic patients in order to determine whether such distance was statistically correlated with the left common iliac vein (LCIV) diameter (LCIVD) and to investigate if both measures were related to demographic characteristics and anthropometric data, such as sex, age, height, and body mass index (BMI)., Methods: In this descriptive and uncontrolled anatomic study, data from high-definition computed tomography (CT) angiography images of living kidney donors without a medical history of chronic venous insufficiency or past deep vein thrombosis (DVT) were analyzed. The RCIA crossed over the LCIV in 311 individuals, who were then included in this study. CT scans were reviewed to measure (1) the narrowest space between the RCIA and fifth lumbar vertebral body and (2) the LCIVD. Measures were subjected to normality tests and were divided according to the sex of the study population. Correlations of measures with age, BMI, and height were calculated., Results: Of the 311 patients analyzed, 66.6% (n = 207) were female. The mean lumbar vertebral body-iliac artery distance (LVBIAD) was 7.2 mm, whereas the mean LCIVD was 8.5 mm; both were higher in men (P < 0.001). The statistical analysis of LVBIAD and LCIVD distributions revealed no normality pattern (P < 0.05). The analysis of the correlation between them showed a weak statistically significant relationship with age. A linear regression model considering the normality percentile interval indicated a strong positive correlation between LVBIAD and LCIVD (R 2  = 0.884)., Conclusions: The LVBIAD was <5 mm and <3 mm in 25% and 5% of asymptomatic individuals, respectively. The LCIVD correlated with the space between the RCIA and lumbar vertebra. The distance between the RCIA and lumbar vertebra and the LCIVD were higher in male subjects and older patients, but did not correlate with BMI and height., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Worldwide, peripheral arterial disease (PAD) is a disorder with high morbidity, affecting more than 200 million people., Objectives: Our objective was to analyze surgical treatment for PAD provided on the Brazilian Public Healthcare System over 12 years using publicly available data., Methods: The study was conducted with analysis of data available on the Brazilian Health Ministry's database platform, assessing distributions of procedures and techniques over the years and their associated mortality and costs., Results: A total of 129,424 procedures were analyzed (performed either for claudication or critical ischemia, proportion unknown). The vast majority of procedures were endovascular (65.49%) and this disproportion exhibited a rising trend (p<0.001). There were 3,306 in-hospital deaths (mortality of 2.55%), with lower mortality in the endovascular group (1.2% vs. 5.0%, p=0.008). The overall governmental expenditure on these procedures was U$ 238,010,096.51, and endovascular procedures were on average significantly more expensive than open surgery (U$ 1,932.27 vs. U$ 1,517.32; p=0.016)., Conclusions: Lower limb revascularizations were performed on the Brazilian Public Healthcare System with gradually increasing frequency from 2008 to 2019. Endovascular procedures were vastly more common and were associated with lower in-hospital mortality rates, but higher procedure costs., Competing Interests: Conflicts of interest: No conflicts of interest declared concerning the publication of this article., (Copyright© 2022 The authors.)

Introduction: Studying epidemiology of abdominal aortic aneurysms repairs is essential to prevent related deaths. Although outcomes are influenced by socioeconomic factors, there are no nationwide studies on these statistics in low-and-middle income countries. Therefore, we designed this study to evaluate abdominal aortic aneurysms repair rates, trends, costs, and in-hospital mortality in the Brazilian Public Health System, which exclusively insures over 160 million Brazilians., Material and Methods: Retrospective cross-sectional population-based analysis of publicly available data referring to all abdominal aortic aneurysm repairs performed between 2008 and 2019 in Brazilian public hospitals., Results: We observed a total of 13,506 abdominal aortic aneurysm repairs, of which 32% were emergency endovascular repairs, 20% emergency open repairs, 32% elective endovascular repairs and 16% elective open repairs. There has been a downward trend in total abdominal aortic aneurysms repairs and an increasing predominance of endovascular repair. Elective and endovascular repairs were significantly associated with lower in-hospital mortality. For ruptured abdominal aortic aneurysms, we observed mortality rates of 13.8% after endovascular repair and 52.1% after open repair. For intact abdominal aortic aneurysms, we observed mortalities of 3.8% after endovascular repair and 18.6% after open repair. Procedure and mortality rates varied significantly among the Brazilian regions., Conclusions: We observed a low and decreasing rate of abdominal aortic aneurysm repair. Most repairs were emergency and endovascular and there was an increasing predominance of endovascular repair. Endovascular and elective repairs were associated with lower mortality., (© 2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)

Background: Walking training (WT) improves walking capacity and reduces clinic blood pressure (BP) in patients with peripheral artery disease (PAD), but its effects on ambulatory BP remains unknown., Objective: To investigate the effect of 12 weeks of WT on ambulatory BP and its variability in patients with PAD., Methods: Thirty-five male patients with PAD and claudication symptoms were randomly allocated into two groups: control (n = 16, 30 min of stretching) and WT (n = 19, 15 bouts of 2 min of walking at the heart rate of leg pain threshold interspersed by 2 min of upright rest). Before and after 12 weeks, 24-hour ambulatory BP was assessed. Ambulatory BP variability indices assessed at both time points included the 24-hour standard deviation (SD24), the awake and asleep weighted standard deviation (SDdn), and the 24-hour average real variability (ARV24). Data were analyzed by mixed two-way ANOVAs, considering P<0.05 as significant., Results: After 12 weeks, neither group had significant changes in 24-hour, awake and sleep BPs. The WT decreased systolic and mean BP variabilities (Systolic BP - 13.3±2.8 vs 11.8±2.3, 12.1±2.84 vs 10.7±2.5 and 9.4±2.3 vs 8.8±2.2 mmHg); Mean BP - 11.0±1.7 vs 10.4±1.9, 10.1±1.6 vs 9.1±1.7 and 8.0.±1.7 vs 7.2±1.5 mmHg) for SD24, SDdn and ARV24, respectively). Neither group had significant changes in diastolic BP variabilities after 12 weeks., Conclusions: The WT does not change ambulatory BP levels but decreases ambulatory BP variability in patients with PAD. This improvement may have a favorable impact on the cardiovascular risk of patients with symptomatic PAD. (Arq Bras Cardiol. 2021; 116(5):898-905).

Background: The costoclavicular space is a common site of thoracic outlet syndrome. When there is no anatomical alteration, the diagnosis of thoracic outlet syndrome is difficult. Several authors relate costoclavicular distance to symptoms of thoracic outlet syndrome; however, there is no standardized site for measurement of the costoclavicular distance. This study aimed to determine the standard costoclavicular distance at neurovascular bundle crossing points (near the subclavian vein [Measure V] and the subclavian artery/brachial plexus branches [Measure NA]) using high-resolution chest computed tomography (CT) scans and evaluate its variations with respect to age, sex, height, and body mass index., Methods: This prospective cross-sectional observational study analyzed 150 of 156 CT scans from consecutive adult patients (72 females and 78 males). Costoclavicular distance was measured at the subclavian vein and brachial plexus/subclavian artery sites, where narrowing of the costoclavicular distance could lead to symptoms of thoracic outlet syndrome. Costoclavicular distance was analyzed with respect to sex, laterality, age group (<50 and ≥50 years) and body mass index group (body mass index <25 and ≥25 kg/m 2 )., Results: Measures of V and NA were normally distributed. The measured costoclavicular distances were 1.23 cm (±0.40) and 1.24 cm (±0.47), respectively. Age (≥50 years) and body mass index (≥25 kg/m 2 ) increased the costoclavicular distance. Measurements V and NA below the fifth percentile indicated a narrowed costoclavicular distance and a greater chance of developing thoracic outlet syndrome. For young (<50 years) and eutrophic patients (body mass index <25 kg/m 2 ), these measurements were 0.46 and 0.44 cm, respectively; for young people and body mass index ≥25 kg/m 2 , they were 0.54 and 0.24 cm, respectively; for the elderly (≥50 years) and eutrophic, they were 0.57 and 0.48 cm, respectively; and for the elderly and body mass index ≥ 25 kg/m 2 , they were 0.83 and 0.73 cm, respectively. There was no significant difference between measurements V and NA regarding patient laterality, gender, and height., Conclusions: Standardization of costoclavicular distance measurements at neurovascular bundle crossing points (subclavian vein and brachial plexus/subclavian artery) is possible. It may aid the diagnosis and help direct the therapeutic indications for symptomatic patients with thoracic outlet syndrome., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: To date, no study has been performed analyzing changes in the vascular system comparing paired examinations of patients alive and after death with the use of cardiopulmonary bypass and computed tomography (CT) angiography., Materials and Methods: The aim of this study was to analyze in a large series (38 patients) the aorta and its branches by CT (without contrast) and CT angiography of patients still alive and after death comparing their diameters and length variations., Results: The variation between in vivo tomography and virtopsy methods was greater in the evaluation of distances between vascular segments than in the diameters; less than 30% of the distances evaluated in the entire study had acceptable variation between methods, regardless of the use of contrast scans. We observed better repeatability rates in the comparison between in vivo and postmortem contrast-enhanced examinations. Comparing the examinations of the still alive individuals with the contrast-enhanced tomography after death, we observed a higher concordance rate. The best variations between the methods were observed in the evaluation of the diameters in the contrast-enhanced examination of the ascending aorta, aortic arch, thoracic aorta, and thoracoabdominal transition., Conclusions: The measurements obtained in postmortem angiography images partially reflect the vascular anatomy of the main branches in the thoracoabdominal region in vivo. However, postmortem CT without contrast was not performed in the same comparison. We believe that adjustments to the contrast injection technique may eventually improve these results., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: Although the practice of physical exercise in patients with intermittent claudication (IC) is often encouraged, adherence is low. The difficulty in performing physical training may be related to the psychological characteristics of patients with claudication. To verify the association between anxiety and depression symptoms and barriers to physical exercise and walking capacity in patients with IC., Methods: One-hundred and thirteen patients with a clinical diagnosis of IC were included in the study. Patients underwent clinical evaluation by a vascular surgeon, answered the Beck Depression Inventory, and Beck Anxiety Inventory tests were applied by the psychologist. The patients performed the 6-minute test and reported their barriers to physical activity practice in a questionnaire., Results: Patients with signs of depression had a shorter pain-free walking distance (p=0.015) and total walking distance (p=0.035) compared to patients with no signs of depression. Pain-free walking distance (p=0.29) and total walking distance (p=0.07) were similar between patients with and without signs of anxiety. Patients with symptoms of moderate to severe depression reported more barriers to physical activity practice compared to patients without signs of depression., Conclusion: Symptoms of anxiety and depression are prevalent among patients with peripheral arterial occlusive disease (PAD). Depression symptoms are associated with personal barriers to exercise, while anxiety symptoms are not. The main barriers to physical activity among patients with IC are exercise-induced pain and the presence of other diseases.

The aim of the study was to verify the effects of creatine (Cr) supplementation on functional capacity (walking capacity; primary outcome) and calf muscle oxygen saturation (StO 2 ) (secondary outcome) in symptomatic peripheral arterial disease (PAD) patients. Twenty-nine patients, of both sexes, were randomized (1:1) in a double-blind manner for administration of placebo (PLA, n = 15) or creatine monohydrate (Cr, n = 14). The supplementation protocol consisted of 20 g/day for 1 week divided into four equal doses (loading phase), followed by single daily doses of 5 g in the subsequent 7 weeks (maintenance phase). Functional capacity (total walking distance) was assessed by the 6 min walk test, and calf muscle StO 2 was assessed through near infrared spectroscopy. The measurements were collected before and after loading and after the maintenance phase. The level of significance was p < 0.05. No significant differences were found for function capacity (total walking distance (PLA: pre 389 ± 123 m vs. post loading 413 ± 131 m vs. post maintenance 382 ± 99 m; Cr: pre 373 ± 149 m vs. post loading 390 ± 115 m vs. post maintenance 369 ± 115 m, p = 0.170) and the calf muscle StO 2 parameters ( p > 0.05). Short- and long-term Cr supplementation does not influence functional capacity and calf muscle StO 2 parameters in patients with symptomatic PAD.

Objective: We evaluated the frequency of significant left renal vein (LRV) compression, also called the nutcracker phenomenon (NCP), in a normal asymptomatic population., Methods: The present retrospective descriptive anatomic study analyzed the data from high-definition renal computed tomography (CT) angiography of living kidney donors. A total of 324 CT examinations were evaluated for signs of LRV compression, including the beak sign, aortomesenteric angle <41°, LRV diameter ratio ≥4.9, and beak angle ≥32°. The presence of pelvic varicose veins and the left gonadal vein in the proximal and mid-portion (considered dilated if >0.5 cm) were also evaluated. Anthropometric and laboratory (urine erythrocyte count) data were collected from the medical records. Statistical inference was calculated using Fisher's exact test and Student's t test., Results: The mean aortomesenteric angle was 53.1° in women and 58.7° in men (P = .044). The beak sign and beak angle were present in 15.3% and 9.8%, respectively, and both had a greater prevalence in the women (P = .01). An aortomesenteric angle <41° was identified in 30.5%, with a greater prevalence in women (P < .01). The diameter ratio was positive in 0.7% of the cases, with no difference between the sexes. A left gonadal vein >0.5 cm was more prevalent in women in both the proximal and the mid-portions (P < .01). Although analysis stratified by positive criteria (3 or 4) showed no difference between the sexes, a positive correlation was found with younger age (P < .01). The limitations included the absence of a nutcracker syndrome (NCS) population; the lack of a renocaval pressure gradient, because of the need for intervention; the absence of other types of imaging studies, such as duplex ultrasound scan; and the absence of female parity data., Conclusions: The NCP and NCS CT criteria were present with a high frequency in healthy individuals. Women and younger individuals showed a greater prevalence of compression findings in the aortomesenteric axis. Revision of the current NCP and NCS criteria with a distinct categorization between sex, age, and body mass index is recommended to better evaluate LRV compressive events., (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Case studies and reviews have shown that creatine supplementation can affect kidney function. The objective of this study is to verify the effects of 8 weeks of creatine supplementation on renal function (creatinine clearance: primary outcome) in patients with symptomatic peripheral arterial disease., Methods: Twenty-nine patients, of both genders, were randomized (1:1) in a double-blind manner for administration of Placebo (PLA; n = 15) or creatine monohydrate (Cr; n = 14). The supplementation protocol consisted of 20 g/day for 1 week divided into 4 equal doses (loading phase), followed by single daily doses of 5 g in the subsequent 7 weeks (maintenance phase). Before and after the supplementation period, markers of renal function, serum creatinine, creatinine excretion rate, and creatinine clearance were evaluated. The Generalized Estimation Equation Model was used for comparison between groups. The level of significance was P < 0.05., Results: No significant differences were found between groups before and after the intervention for serum creatinine (Cr: pre 1.00 ± 0.15 mL/dL vs. post 1.07 ± 0.16 mL/dL; PLA: pre 1.30 ± 0.53 mL/dL vs. post 1.36 ± 0.47 mL/dL, P = 0.590), creatinine excretion rate (Cr: pre 81.73 ± 43.80 mg/dL vs. post 102.92 ± 59.57 mg/dL; PLA: pre 74.37 ± 38.90 mg/dL vs. post 86.22 ± 39.94 mg/dL, P = 0.560), or creatinine clearance (Cr; pre 108 ± 59 mL/min/1.73 m 2 vs. post 117 ± 52 mL/min/1.73 m 2 ; PLA: pre 88 ± 49 mL/min/1.73 m 2 vs. post 82 ± 47 mL/min/1.73 m 2 , P = 0.366)., Conclusions: Eight weeks of creatine supplementation is safe and does not compromise the renal function of patients with peripheral arterial disease., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: To compare functional and cardiovascular variables of men and women with peripheral artery disease (PAD)., Methods: This observational, cross-sectional study included 67 women and 144 men (age 66 ± 9 and 67 ± 10 yr, respectively) with PAD. Patients were submitted to a clinical evaluation, 6-min walk test (6MWT) and cardiovascular evaluation, including blood pressure, arterial stiffness variables, and heart rate variability., Results: Women had lower claudication onset distance (P = .033) and 6MWT distance (P < .001), and similar percentage of the predicted 6MWT distance (P > .05). Women had higher pulse pressure (P = .002), augmentation index (P < .001), augmentation index corrected by 75 bpm (P < .001), and brachial and central systolic blood pressure (P = .041 and P = .029). Diastolic blood pressure, pulse wave velocity, and heart rate variability were similar between sexes (P > .05)., Conclusion: Although predicted 6MWT performance was similar between sexes, women had higher blood pressure and wave reflection variables compared with men. Interventions to reduce blood pressure and wave reflection should be emphasized in women with PAD.

Background: The objective of this study was to analyze the association between cardiac autonomic modulation and arterial stiffness in patients with peripheral artery disease (PAD)., Methods: This cross-sectional study included one hundred fourteen patients with symptomatic PAD (67.5% men; 65 ± 7 years; body mass index: 26.8 ± 4.5 kg/m 2 ). Heart rate variability (HRV) was measured within time (standard deviation of all RR intervals [beat to beat heart interval] [SDNN], root mean square of the successive differences between adjacent normal RR intervals [RMSSD], and the proportion of successive RR intervals that differed by more than 50 msec [pNN50]) and frequency (low frequency [LF] and high frequency [HF]) domains. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Crude and adjusted linear regression analyses examined the relationship between HRV and cfPWV., Results: Nonsignificant crude associations were identified among cfPWV and RMSSD (P = 0.181), SDNN (P = 0.105), pNN50 (P = 0.087), LF (P = 0.376), HF (P = 0.175), and LF/HF ratio (P = 0.426). After adjustments for age, sex, smoking, body mass index, ankle-brachial index, and use of beta-blockers, significant associations were identified among cfPWV and RMSSD (P = 0.037), SDNN (P = 0.049), and pNN50 (P = 0.049)., Conclusions: Cardiac autonomic modulation was significantly associated with arterial stiffness in patients with PAD after adjustment for confounding factors. This relationship may contribute to the enhanced cardiovascular disease risk for PAD patients and provides a target for strategies to improve patient clinical outcomes., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: The aim of the study was to analyze the relationship between gait speed and measurements of physical function in patients with symptomatic peripheral artery disease (PAD)., Methods: One hundred sixty-nine patients (age 66.6±9.4 years) with symptomatic PAD were recruited. Usual and fast gait speeds were assessed with a 4-meter walk test. Objective (balance, sit-to-stand, handrip strength, and six-minute walk test) and subjective (WIQ - Walking Impairment Questionnaire and WELCH - Walking Estimated-Limitation Calculated by History) measurements of physical function were obtained. Crude and adjusted linear regression analyses were used to confirm significant associations., Results: Usual and fast gait speeds were significantly correlated with all objective and subjective physical function variables examined (r<0.55, p<0.05). In the multivariate model, usual gait speed was associated with six-minute walking distance (β=0.001, p<0.001), sit-to-stand test score (β=-0.005, p=0.012), and WIQ stairs score (β=0.002, p=0.006) adjusted by age, ankle brachial index, body mass index, and gender. Fast gait speed was associated with six-minute walking distance (β=0.002, p<0.001), WIQ stairs score (β=0.003, p=0.010), and WELCH total score (β=0.004, p=0.026) adjusted by age, ankle brachial index, body mass index, and gender., Conclusion: Usual and fast gait speeds assessed with the 4-meter test were moderately associated with objective and subjective measurements of physical function in symptomatic PAD patients.

Background: Active cancer is found in approximately 20% of patients diagnosed with venous thromboembolism. This condition is more prevalent in patients with advanced and metastatic cancer and is the second largest cause of death among patients with active neoplasm. Many of them have contraindication for anticoagulation and needs an inferior vena cava filter to be implanted, but a large proportion of these patients have very low survival after filter implantation. Our aim was to verify whether the need for filter implantation represents an independent indicator of poor prognosis in oncological patients and to identify subgroups with a greater survival., Methods: This study included a retrospective analysis of 247 oncologic patients with acute proximal venous thrombosis. We compared survival between 100 consecutive patients who needed vena cava filter (FILTER group) versus a control group of 147 patients in whom anticoagulation was possible (ANTICOAGULATION group). We verified survival, cause of death, filter's indications (clinical and surgical), and factors that might lead to worse prognosis., Results: Risk of death was 8.83-fold higher in the FILTER group than that in the ANTICOAGULATION group, a greater risk than the presence of metastasis (OR: 2.47). Death was significantly more frequent in patients subjected to filter implantation because of clinical indications (93.2%) such as high risk of or recent bleeding and an adjusted risk of death of 2.24-fold higher in a multivariate analysis., Conclusions: The need to implant a vena cava filter in a patient with cancer is a marker that indicates patient's disease severity and worse prognosis. Survival was longer in the subgroup of patients who underwent filter implantation before oncologic surgery, probably because of a better status performance and less clinical complications., (Copyright © 2019 Elsevier Inc. All rights reserved.)

This cross-sectional study compared physical activity levels and barriers between 212 men and women with symptomatic peripheral artery disease. Physical activity was objectively measured by an accelerometer. Barriers to physical activity were obtained using a validated questionnaire. Women reported higher amounts of light physical activity ( p  < .001) and lower moderate-vigorous physical activity ( p  < .001) than men. Women more often reported barriers such as "not having anyone to accompany" ( p  = .006), "lack of money" ( p  = .018), "fear of falling or worsening the disease" ( p  = .010), "lack of security" ( p  = .015), "not having places to sit when feeling leg pain" ( p  = .021), and "difficulty in getting to a place to practice physical activity" ( p  = .015). In conclusion, women with symptomatic peripheral artery disease presented with lower amounts of moderate-vigorous activity and more barriers to activity than men. Strategies to minimize the barriers, including group actives and nonpainful exercises, are recommended for women with peripheral artery disease.

Background: Atherosclerosis and abdominal aortic aneurysms (AAAs) have several similar risk factors but different pathogenesis. Inflammation of the arteries is common to both. Central obesity can act as an endocrine organ through the secretion of inflammatory cytokines, and the perivascular fat has a local effect that could contribute to diseases of the abdominal aorta. Although the relation between central obesity and atherosclerosis occlusive arterial disease has been demonstrated, the correlation with AAA has conflicting results. The aim of this study was to analyze the correlation between central obesity and the presence of abdominal aortic diseases using computed tomography., Methods: Six hundred thirty-nine consecutive patients classified into 3 groups (AAA, aortic atherosclerotic occlusive disease (AAOD), and without aortic disease [control group]) who underwent computed tomography had the aorta diameter, the visceral fat area (VFA), and the subcutaneous fat area (SFA) measured at the level of third and fourth lumbar vertebrae., Results: VFA showed no difference between the groups. SFA was lower in atherosclerotic group (AAOD) than control (P < 0.01 in general and P < 0.04 in male). In AAA group, we found in men that the first tertile of aorta diameter had higher VFA than third tertile (P = 0.02)., Conclusions: There was no difference in VFA between patients in AAA, AAOD, and without aortic disease groups. In men with aneurysm, there was an inverse relationship between VFA and aortic diameter. In AAOD, visceral to subcutaneous ratio is higher due to lower SFA., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: The increasing use of computed tomography (CT) angiography has led to more frequent diagnoses of celiac artery compression (CAC) by the median arcuate ligament (MAL). The signs of CAC by the MAL have been described as stenosis and a hook or J appearance on sagittal views. The importance of the "hook signal," however, has not been documented by studies of the normal anatomy of the celiac axis., Methods: CT angiography images of 344 completely asymptomatic, live kidney donors (without history of chronic abdominal pain or weight loss) were reviewed. The angle of emergence (AE) of the celiac axis from the aorta and the angle of upward or downward shifting of the celiac axis before its first branch (fold angle [FA]) were measured. Weight, height, and body mass index were obtained from our electronic database, and correlations with the angles measured were tested. The occurrence of stenosis >50% at the origins of the celiac axis was also determined in the sample., Results: Measurements were possible in 321 cases. The celiac axis was found to leave the aorta at an angle of <90 degrees in all patients (AE range, 7-83 degrees) and <45 degrees in 292 (90%) patients. The FA ranged from 66 to 208 degrees. Before the first branch, the celiac trunk shifted upward in 306 (95%) patients, remained straight in just one of them, and shifted downward in 14 (4%). The AE was positively correlated with weight in women. The FA was negatively correlated with weight in men and women. Body mass index was positively correlated with AE and negatively correlated with FA in both men and women. In 11 cases (3.4%), stenosis >50% was found at the origin of the celiac axis. In only two patients, the celiac axis had an upward slope after the stenosis, which could be interpreted as a hook shape., Conclusions: The normal anatomy of the celiac axis, when seen on CT angiography images, demonstrates that it exits the aorta downward and then shifts upward. This hook or J shape should not be interpreted as resulting from external compression. CAC by the MAL occurs in 3.42% of the normal asymptomatic population; a hook or J shape is not visible in most cases in that subgroup., (Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Edoxaban, a direct factor Xa inhibitor (FXa), is the fourth direct oral anticoagulant (DOAC) approved for clinical use in the treatment of venous thromboembolism (VTE) in Latin America, following global approvals for this indication. Edoxaban features some particular characteristics when compared to the previously approved DOACs. This review summarizes the main properties of edoxaban, the outcomes results of its pivotal global clinical trials and the peculiar clinical features of this compound. This practical guide aims to help Latin America clinicians understand edoxaban, its proper indication and its use for the appropriate patients with VTE.

Background: Impaired microcirculation is associated with poor walking capacity in symptomatic peripheral artery disease (PAD) patients during treadmill test; however, this test does not simulate the efforts of daily walking of these patients. Thus, the aim of the study was to describe the microcirculation responses during a 6-minute walk test (6MWT) and to analyze the relationship between microcirculation indicators and walking impairment in symptomatic PAD patients., Methods: Thirty-four patients were included (mean age = 67.6 ± 11.2 years). Their clinical characteristics were collected, and they performed a 6MWT, in which the initial claudication distance (ICD) and total walking distance (TWD) were recorded. During and after the 6MWT, calf muscle oxygen saturation (StO 2 ) parameters were monitored continuously to measure microcirculation behavior. The association between calf muscle StO 2 parameters and walking impairment were analyzed by Pearson or Spearman correlations., Results: Walking impairment was not associated with any StO 2 parameters during exercise. In contrast, after 6MWT, recovery time of StO 2 (r = -0.472, P = 0.008) and recovery time to maximal StO 2 (r = -0.402, P = 0.019) were negatively correlated with ICD. Furthermore, the distance walked under claudication symptoms (ΔTWD-ICD) was positively correlated with recovery time to maximal StO 2 (r = 0.347, P = 0.048)., Conclusions: In symptomatic PAD patients, shorter ICD values during a 6MWT are associated with a delayed recovery in calf muscle StO 2 after exercise. Calf muscle StO 2 parameters decrease subtly during 6MWT, suggesting that the degree of ischemia in the calf muscle during ground walking, simulating efforts of the daily walking, is relatively low., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The management of long-term central venous catheter (LTCVC) infections by multidrug-resistant (MDR) bacteria in cancer patient is a challenge. The objectives of this study were to analyze outcomes in cancer patients with LTCVC-associated infection, identify risks for unfavorable outcomes, and determine the impact of MDR bacteria and antibiotic lock therapy (ALT) in managing such infections. We evaluated all LTCVC-associated infections treated between January 2009 and December 2016. Infections were reported in accordance with international guidelines for catheter-related infections. The outcome measures were 30-day mortality and treatment failure. We analyzed risk factors by Cox forward-stepwise regression. We identified 296 LTCVC-associated infections; 212 (71.6%) were classified as bloodstream infections (BSIs). The most common agent was Staphylococcus aureus Forty-six (21.7%) infections were due to MDR Gram-negative bacteria. ALT was used in 62 (29.2%) patients, with a 75.9% success rate. Risk factors identified for failure of the initial treatment were having a high sequential organ failure assessment (SOFA) score at diagnosis of infection and being in palliative care; introduction of ALT at the start of treatment was identified as a protective factor. Risk factors identified for 30-day mortality after LTCVC-associated infection were a high SOFA score at diagnosis, infection with MDR bacteria, and palliative care; introduction of ALT at the start of treatment, hematological malignancies, and adherence to an institutional protocol for the management of LTCVC-associated infection were identified as protective factors. Despite the high incidence of infection with MDR bacteria, ALT improves the outcome of LTCVC-associated infection in cancer patients., (Copyright © 2018 American Society for Microbiology.)

Background: Transient paraplegia of the lower limbs is a rare condition and, when has a vascular etiology, is usually associated with thromboembolic events, aortic dissection, aortic aneurysms, or as a complication of the surgical correction of those diseases. There is no case reported of acute paraplegia caused by a segmental thrombotic subocclusion of the descending thoracic aorta., Case Report: We report a not yet described clinical situation of a young patient (51 years) admitted to the emergency care department for treatment of systemic arterial hypertension of difficult control with 4 antihypertensive medication classes. At the intensive care unit for treatment with intravenous antihypertensive medication, the patient evolved with acute paraplegia and a segmental thrombotic subocclusion of the descending thoracic aorta was diagnosed. He was submitted to endovascular treatment with total recovery of the deficits., Conclusions: The previously normal descending thoracic aorta may be a site of segmental thrombosis and may lead to paraplegia. Early endovascular treatment can reverse this type of situation., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: The objective of this study is to describe the experience of a Brazilian public university hospital regarding the treatment of metastatic or benign spine lesions with en bloc vertebrectomy of the thoracic and lumbar spines., Methods: This study was a retrospective case series and included all medical records of patients with benign aggressive, primary malignant, or metastatic spine lesions who underwent en bloc vertebrectomy from 2010 to 2015., Results: A total of 17 patients were included in the analysis. Most of them (71%) were indicated for surgery based on an oncologic resection for localized disease cure. Overall, 10 of the 17 patients (59%) underwent vertebrectomy via an isolated posterior approach using the technique described by Roy-Camille et al. and Tomita et al., while 7 patients (41%) underwent double approach surgeries. Of the 17 patients who underwent the en bloc resection, 8 are still alive and in the outpatient follow-up (47%), and almost all patients with metastatic lesions (8/9) died. The average survival time following the surgical procedure was 23.8 months. Considering the cases of metastatic lesions and the cases of localized disease (malignant or benign aggressive disease) separately, we observed an average survival time of 15 months and 47.6 months respectively., Conclusion: This study demonstrates and reinforces the reproducibility of the en bloc vertebrectomy technique described by Tomita et al.

Background: We describe a unique case of a patient with penetration of the cervical region by a stab wound, who required emergency care for the controlled removal of the knife and for vertebral artery trauma (VAT) treatment. Although rare, VAT causes high morbidity and mortality., Methods: A patient admitted for emergency care was diagnosed with traumatic complete section of the vertebral artery by a knife and underwent removal of the knife under radioscopic supervision and vertebral artery embolization with coils., Results: The knife was removed successfully, the bleeding was controlled, and the patient did not present any sequelae., Conclusions: In the authors' experience, a patient in an emergent state due to VAT can be treated effectively and quickly with proximal embolization., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Leiomyosarcoma (LMS) of inferior vena cava (IVC) is a rare neoplasm affecting approximately 1/100,000 people. The prognosis is poor and potential curative intent occurs through challenging operations, such as vena cava resection, occasionally multivisceral when required, and vascular reconstruction. There are few retrospective series regarding this retroperitoneal neoplasm, and the aim of the present study was to discuss the experience at the São Paulo Cancer Institute and Clinics Hospital of University of São Paulo Medical School, São Paulo, Brazil. The current study is a retrospective review of 7 patients treated in the two tertiary hospitals between 2005 and 2013. Oncological and operative aspects were discussed, primarily regarding surgical aspects highlighting en bloc resection, vascular reconstruction, and the overall survival and recurrence rates. All the patients were treated with radical intent, 4 of whom underwent multivisceral resection, with the kidney being the most resected organ. The location of the IVC tumor was described using Kulaylat's description and the median tumor size was 10 cm. Vascular reconstruction was necessary in 4 patients. The overall survival rate at 3 and 5 years was 100, and 25%, respectively. The disease-free survival rate at 3 and 5 years was 57 and 20%, respectively. In conclusion, IVC LMS is a rare and severe retroperitoneal neoplasm, with multivisceral resections remaining a surgical challenge. The treatment requires numerous experienced surgeons and the impact of microscopic free margins remains unclear. Vascular reconstruction depends on several aspects regarding primarily the topography of the tumor.

Background: We analyze the effects of graduated compression stoking (GCS) on walking capacity and oxygen saturation in intermittent claudication (IC) patients., Methods: Eighteen patients with IC performed the 6-minute walking test in 2 conditions in random order: GCS or placebo sock. Onset claudication distance and total walking distance were obtained. The calf muscle oxygen saturation was continuously monitored before, during, and after 6-minute walk test. Comparisons of the walking capacity and StO 2 parameters between GCS and placebo conditions were analyzed by Wilcoxon rank-sum test., Results: The onset claudication distance (GCS: 120 ± 99 meters vs. placebo: 150 ± 126 meters; P = 0.798) and total walking distance (GCS: 330 ± 108 meters vs. placebo: 324 ± 60 meters; P = 0.130) were similar between conditions. There were no differences in StO 2 parameters between conditions (P > 0.05)., Conclusions: GCS does not decrease walking performance and calf muscle oxygenation saturation during 6-minute walk test in patients with IC., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Competing Interests: Conflito de interesse: Os autores declararam não haver conflitos de interesse que precisam ser informados.

Background: Aortic lesions are uncommon complications in spine surgery, but potentially fatal, because they can cause massive bleeding and hemodynamic instability. We report the endovascular treatment of late aortic erosive lesion by pedicle screw without screw removal., Methods: A breast cancer patient had a pathological fracture on T10, with spinal cord compression, and a pseudoaneurysm of the aorta in contact with an anterolateral pedicle screw. Endovascular surgery corrected the aortic lesion and allowed decompression, a week later, by posterior arthrodesis (T7-L1), with screw maintenance., Results: There was no contrast leakage at thorax angiotomography in 2 years, and she died of meningeal carcinomatosis., Conclusion: Screw maintenance was safe in the endovascular treatment of aortic lesion by erosion., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to investigate the risk factors for complications of totally implantable catheters in a referral cancer center., Methods: This was a retrospective study of prospectively collected data of all consecutive cancer patients undergoing port placement, with a primary outcome of interest of major complication and subanalysis of the types of complications., Results: We studied 1255 nonvalved implanted port catheters inserted in 1230 patients, for a combined total of 469,882 catheter-days of use. Venous puncture was ultrasound (US)-guided in 1049 cases (84%). Inadvertent arterial puncture occurred in 14 cases (1.1%) and was more frequent in procedures not guided by US (P = .045). Among the outpatients, 90 (9%) developed infection, and 75 (29%) of the hospitalized patients (P < .001) developed infections. Infection was diagnosed in 131 catheters (13%) implanted through the internal jugular vein (IJV), 23 catheters (14%) implanted in the subclavian vein (SCV), 1 catheter (5%) implanted in the external jugular vein, and 10 catheters (31%) implanted in the femoral vein (P = .044). In the multivariate analysis, only the hospitalization regimen maintained statistical significance, with hospitalization presenting as a risk factor for infection (P < .001). Regarding the introduction site, ambulatory patients in whom the femoral vein was the site of access had more infections than the others (28.6% vs 9.4% of the IJV, 4.8% of the SCV, and 4.8% of the external jugular vein; P = .019), which did not occur among the hospitalized patients (33.3% vs 26.5% of IJV and 39.5% of the SCV; P = .218)., Conclusions: Not using US is a risk factor for iatrogenic arterial puncture. Port implantation in hospitalized patients and the use of femoral access are risk factors for infection., (Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: Of this study were to evaluate the functional independence of patients with intermittent claudication and to verify its association with sociodemographic and clinical variables, walking ability and physical activity level., Method: This was a descriptive, exploratory, cross-sectional study with a quantitative approach. Fifty participants (66.4 years; 68% male) were recruited from Claudication Unit of a tertiary hospital. Functional Independence Measure were used to evaluate functional incapacity; the Baltimore Activity Scale, to estimate the physical activity level and the Walking Impairement Questionnaire, the walking ability., Results: Participants had complete functional independence (124.8 + 2.0), low levels of physical activity (4.2 + 2.0), and impairment of walking ability; the worst performance was found in walking velocity domain (21.2 + 16.4). The functional independence score was associated with physical activity (r=0,402) and walking ability scores (distance, r=0,485; speed, r=0,463; stairs, r=0,337)., Conclusion: In conclusion, the level of functionality is associated with functional capacity in these patients.