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Background Diabetics are at 5-15 times greater risk of developing peripheral arterial disease (PAD) and few studies have compared risk factors and distribution and severity of arterial changes in diabetics compared with non-diabetics. Objectives To compare angiographic changes between diabetic and non-diabetic patients with advanced PAD and correlate them with risk factors. Methods A retrospective cross-sectional study was conducted of consecutive patients undergoing lower limb arteriography for PAD (Rutherford 3-6) using TASC II and Bollinger et al. angiographic scores. Exclusion criteria were upper limb angiographies, unclear images, incomplete laboratory test results, and previous arterial surgeries. Statistical analyses included chi-square tests, Fisher's test for discrete data, and Student’s t test for continuous data (significance level: p < 0.05). Results We studied 153 patients with a mean age of 67 years, 50.9% female and 58.2% diabetics. A total of 91 patients (59%) had trophic lesions (Rutherford 5 or 6) and 62 (41%) had resting pain or limiting claudication (Rutherford 3 and 4). Among diabetics, 81.7% were hypertensive, 29.4% had never smoked, and 14% had a history of acute myocardial infarction. According to the Bollinger et al. score, infra-popliteal arteries were more affected in diabetics, especially the anterior tibial artery (p = 0.005), while the superficial femoral artery was more affected in non-diabetics (p = 0.008). According to TASC II, the most severe angiographic changes in the femoral-popliteal segment occurred in non-diabetic patients (p = 0.019). Conclusions The most frequently affected sectors were the infra-popliteal sectors in diabetics and the femoral sector in non-diabetics.

Background Acute arterial occlusions (AAO) in limbs have been increasing in parallel with population longevity. Objective To assess risk factors, limb salvage rates, and survival of patients with AAO treated at a University Hospital. Methods Retrospective cohort study of consecutive patients. Outcomes included: patency, symptoms, comorbidities, Rutherford category, arteries occluded, postoperative complications, and 30-day limb salvage and mortality rates. Results Medical records were evaluated from 105 patients, predominantly males (65.7%), with ages ranging from 46 to 91 years. Etiology: thrombotic (54.3%), embolic (35.2%), and undefined (10.5%). About 2/3 of the patients were assessed as Rutherford category II or III. Associated symptoms: pain (97.1%), coldness (89.5%), pallor (64.7%), sensory loss (44.7%), paralysis (30.5%), anesthesia (21.9%), edema (21.9%), and cyanosis (15.2%). Associated comorbidities: hypertension (65.0%), smoking (59.0%), arrhythmias (26.6%), dyslipidemia (24.0%), and diabetes (23.8%). The distal superficial femoral-popliteal segment was the most affected (80%). Thromboembolectomy with a Fogarty catheter was performed in 73.3% of cases (81.0% of embolic cases, 71.9% of thrombotic cases, and 54.5% of cases with undefined etiology) and was the only treatment used in 41 cases (39.05%), among which there were 11 reocclusion, 20 amputations, and 14 deaths. Arterial reocclusion was more frequent in thrombosis cases (12.9%, p = 0.054). Within 30 days of treatment, total mortality was 14.6%, and 19.8% of cases underwent major amputation, which was less frequent among Rutherford Class I patients (p = 0.0179). Conclusion Treatment of AAO was primarily performed by thromboembolectomy with a Fogarty catheter, either alone or in combination with other treatments, achieving amputation and complication rates compatible with the best results in the literature and were progressively lower in less advanced Rutherford categories.

Made available in DSpace on 2021-07-14T10:38:54Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-06-16. Added 1 bitstream(s) on 2021-07-14T11:34:53Z : No. of bitstreams: 1 S1677-54492021000100613.pdf: 1908847 bytes, checksum: 37d087bee6e3b58419a51d6539da1c01 (MD5) Os aneurismas verdadeiros de artéria femoral profunda são extremamente raros, representando cerca de 0,5% do total dos aneurismas periféricos. Neste relato, descrevemos um paciente de 79 anos de idade, sexo masculino, com histórico de abordagem cirúrgica prévia convencional devido a aneurisma de aorta abdominal, que deu entrada no Serviço de Cirurgia Vascular do Hospital das Clínicas com quadro de claudicação intermitente de membros inferiores. Foi realizado eco-Doppler colorido arterial do membro inferior direito, que revelou doença arterial periférica femoro-poplítea e infrapatelar. A angiotomografia computadorizada identificou oclusão aortoilíaca e do enxerto bifurcado desde o segmento infrarrenal da aorta, além de aneurisma de artéria femoral profunda de 3,7 x 3,5 cm de diâmetro com 7 cm de extensão. Procedeu-se com a ressecção do aneurisma e revascularização da artéria femoral profunda por interposição de prótese de Dacron® e reimplante de artéria femoral superficial na prótese. Portanto, nos casos de aneurisma de artéria femoral profunda concomitante a doença arterial periférica, deve-se atentar para revascularização e perfusão adequada do membro inferior. Universidade Estadual Paulista “Júlio de Mesquita Filho”, Hospital das Clínicas da Faculdade de Medicina de Botucatu Universidade Estadual Paulista “Júlio de Mesquita Filho”, Hospital das Clínicas da Faculdade de Medicina de Botucatu

Background Aortic cross-clamping and balloon occlusion of the aorta could lead to damage to the aorta wall. Objective The aim of this study was to investigate changes to the aorta wall related to the method used to interrupt flow (clamping or balloon) in the different techniques available for aortic surgery. Methods Experiments were performed on 40 female pigs, weighing 25-30kg, which were randomly allocated to 4 study groups: S (n=10), no intervention (sham group); C (n=10), midline transperitoneal laparotomy for infrarenal abdominal aortic access with 60 min of cross-clamping; L (n=10), laparoscopic infrarenal abdominal aortic surgery with 60 min of cross-clamping; EV (n=10), remote proximal aortic control with transfemoral arterial insertion of aortic occlusion balloon catheter, inflated to provide continued aortic occlusion for 60min. After euthanasia, the aortas were removed and cross-sectioned to obtain histological specimens for light microscopic and morphometric analyses. The remaining longitudinal segments were stretched to rupture and mechanical parameters were determined. Results We observed a reduction in the yield point of the abdominal aorta, decrease in stiffness and in failure load in the aortic cross-clamping groups (C and L) compared with the EV group. Conclusions Aortic cross-clamping during open or laparoscopic surgery can affect the mechanical properties of the aorta leading to decrease in resistance of the aorta wall, without structural changes in aorta wall histology.

Resumo Contexto As oclusões arteriais agudas (OAA) de membros vêm crescendo paralelemente com a longevidade da população. Objetivos O objetivo deste estudo foi avaliar fatores de risco, salvamento de membros e sobrevida dos pacientes com OAA tratados em instituição universitária. Métodos Este é um estudo coorte retrospectivo de pacientes consecutivos. Os desfechos incluíram: sucesso técnico, sintomas, comorbidades, categoria Rutherford, artérias acometidas, complicações pós-operatórias, taxa de salvamento de membros em 30 dias e óbitos. Resultados Avaliou-se 105 prontuários, havendo predomínio do sexo masculino (65,7%) e idade entre 46 a 91 anos. As etiologias identificadas foram trombóticas (54,3%), embólicas (35,2%) e indefinidas (10,5%). Cerca de dois terços apresentavam-se nas Categorias II e III de Rutherford. Os sintomas associados encontrados foram dor (97,1%), esfriamento (89,5%), palidez (64,7%), parestesias (44,7%), paralisias (30,5%), anestesias (21,9%), edema (21,9%) e cianose (15,2%); e as comorbidades associadas observadas foram hipertensão (65,0%), tabagismo (59,0%), arritmias (26,6%), dislipidemias (24,0%) e diabetes (23,8%). O segmento femoral superficial-poplíteo-distal foi o mais acometido (80%). A tromboembolectomia com cateter Fogarty foi realizada em 73,3% dos casos (81,0% nas embolias, 71,9% nas tromboses e 54,5% nos indefinidos), sendo isoladamente em 41 pacientes (39,05%), nos quais ocorreram 11 reoclusões, 20 amputações e 14 óbitos. A reoclusão arterial foi mais frequente nas tromboses (12,9%; p = 0,054). Até 30 dias após tratamento, o óbito total foi de 14,6% e a amputação maior foi de 19,8%, sendo menos frequente na Classe I Rutherford (p = 0,0179). Conclusão O tratamento da OAA feito prioritariamente por meio de tromboembolectomia com cateter Fogarty, isolado e/ou associado, proporcionou taxas de amputação e complicações compatíveis com as apresentadas na literatura e progressivamente menores nas categorias Rutherford menos avançadas. Abstract Background Acute arterial occlusions (AAO) in limbs have been increasing in parallel with population longevity. Objective To assess risk factors, limb salvage rates, and survival of patients with AAO treated at a University Hospital. Methods Retrospective cohort study of consecutive patients. Outcomes included: patency, symptoms, comorbidities, Rutherford category, arteries occluded, postoperative complications, and 30-day limb salvage and mortality rates. Results Medical records were evaluated from 105 patients, predominantly males (65.7%), with ages ranging from 46 to 91 years. Etiology: thrombotic (54.3%), embolic (35.2%), and undefined (10.5%). About 2/3 of the patients were assessed as Rutherford category II or III. Associated symptoms: pain (97.1%), coldness (89.5%), pallor (64.7%), sensory loss (44.7%), paralysis (30.5%), anesthesia (21.9%), edema (21.9%), and cyanosis (15.2%). Associated comorbidities: hypertension (65.0%), smoking (59.0%), arrhythmias (26.6%), dyslipidemia (24.0%), and diabetes (23.8%). The distal superficial femoral-popliteal segment was the most affected (80%). Thromboembolectomy with a Fogarty catheter was performed in 73.3% of cases (81.0% of embolic cases, 71.9% of thrombotic cases, and 54.5% of cases with undefined etiology) and was the only treatment used in 41 cases (39.05%), among which there were 11 reocclusion, 20 amputations, and 14 deaths. Arterial reocclusion was more frequent in thrombosis cases (12.9%, p = 0.054). Within 30 days of treatment, total mortality was 14.6%, and 19.8% of cases underwent major amputation, which was less frequent among Rutherford Class I patients (p = 0.0179). Conclusion Treatment of AAO was primarily performed by thromboembolectomy with a Fogarty catheter, either alone or in combination with other treatments, achieving amputation and complication rates compatible with the best results in the literature and were progressively lower in less advanced Rutherford categories.

Made available in DSpace on 2020-12-12T02:41:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01. Added 1 bitstream(s) on 2021-07-15T15:26:12Z : No. of bitstreams: 1 S1677-54492020000100306.pdf: 3306771 bytes, checksum: 9b1f546b23a005a7f385041c2ef11bc2 (MD5) Background: Aortic cross-clamping and balloon occlusion of the aorta could lead to damage to the aorta wall. Objective: The aim of this study was to investigate changes to the aorta wall related to the method used to interrupt flow (clamping or balloon) in the different techniques available for aortic surgery. Methods: Experiments were performed on 40 female pigs, weighing 25-30kg, which were randomly allocated to 4 study groups: S (n=10), no intervention (sham group); C (n=10), midline transperitoneal laparotomy for infrarenal abdominal aortic access with 60 min of cross-clamping; L (n=10), laparoscopic infrarenal abdominal aortic surgery with 60 min of cross-clamping; EV (n=10), remote proximal aortic control with transfemoral arterial insertion of aortic occlusion balloon catheter, inflated to provide continued aortic occlusion for 60min. After euthanasia, the aortas were removed and cross-sectioned to obtain histological specimens for light microscopic and morphometric analyses. The remaining longitudinal segments were stretched to rupture and mechanical parameters were determined. Results: We observed a reduction in the yield point of the abdominal aorta, decrease in stiffness and in failure load in the aortic cross-clamping groups (C and L) compared with the EV group. Conclusions: Aortic cross-clamping during open or laparoscopic surgery can affect the mechanical properties of the aorta leading to decrease in resistance of the aorta wall, without structural changes in aorta wall histology. Universidade Estadual Paulista – UNESP Faculdade de Medicina de Botucatu Universidade Estadual Paulista – UNESP Faculdade de Medicina de Botucatu

Made available in DSpace on 2018-12-11T16:59:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-10-01. Added 1 bitstream(s) on 2019-10-09T18:30:06Z : No. of bitstreams: 1 S1677-54492015000400351.pdf: 1236080 bytes, checksum: e5ab6c28b9984a6c46c34a1a299c306c (MD5) Behçet’s disease is an inflammatory disease characterized by recurrent oral and genital ulcers, uveitis and skin lesions. Arterial involvement is rare, but when present aneurysmal degeneration is more common than occlusive disease. This report describes the clinical case of a female patient who had been receiving treatment for Behçet’s disease for twenty years before presenting with abdominal pain that progressed for 2 months before suddenly worsening significantly. A CT scan revealed a thoracoabdominal pseudoaneurysm. She was successfully treated with endovascular repair. Universidade Estadual Paulista – UNESP Department of Surgery and Orthopedics Universidade Estadual Paulista – UNESP Department of Surgery and Orthopedics

Made available in DSpace on 2016-04-01T18:42:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2014. Added 1 bitstream(s) on 2016-04-01T18:48:58Z : No. of bitstreams: 1 S1677-54492014000400318-en.pdf: 4640054 bytes, checksum: 1f6f134ac6653a7a40f82467057a2d61 (MD5). Added 1 bitstream(s) on 2016-04-01T18:48:58Z : No. of bitstreams: 2 S1677-54492014000400318-en.pdf: 4640054 bytes, checksum: 1f6f134ac6653a7a40f82467057a2d61 (MD5) S1677-54492014000400318-pt.pdf: 4665698 bytes, checksum: 3cc97d6402bbffe0d376b1ac1388caa5 (MD5) O tratamento endovascular para aneurisma de aorta abdominal (AAA) já está bastante difundido, sendo considerado como primeira escolha na maioria dos casos. Limitações no acesso pelas artérias ilíacas tortuosas, com estenoses, calibre pequeno ou doença oclusiva já foram contornadas com o uso de condutos, dissecção direta aortoilíaca, angioplastias, entre outros procedimentos. O objetivo deste desafio é mostrar as vantagens e limitações de cada alternativa, além de apresentar o resultado e as dificuldades com o endoconduíte. Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for abdominal aortic aneurysms (AAA). Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved. Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil

Giant aortic aneurysms (transverse diameter greater than 10.0 cm) are rare and open surgery is often the treatment of choice. We report an infrarenal saccular giant aortic aneurysm (measuring 25 cm in transverse diameter), which was treated with endovascular repair, with immediate technical success. No similar report of a giant infrarenal aortic aneurysm treated with an endovascular technique was found in the literature. High-risk patients could possibly benefit from the endovascular technique. Nevertheless, patient survival remains strongly influenced by comorbidities.

Made available in DSpace on 2018-12-11T17:10:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-10-01. Added 1 bitstream(s) on 2021-07-15T15:21:47Z : No. of bitstreams: 1 S1677-54492016000400312.pdf: 4576429 bytes, checksum: 6a8a2db599a6d6da436365fda673a084 (MD5) Infections at the sites of surgery involving synthetic prostheses are challenging to treat. We present a case of a patient with multiple comorbidities who had undergone an aortobifemoral bypass 6 years previously and then re-intervention at the femoral anastomoses for restenosis 5 years previously. The patient presented with acute left inguinal pain and swelling and was diagnosed with a ruptured femoral pseudoaneurysm and hemodynamic instability. A repair was conducted by interposition of a silver-coated Dacron graft in the emergency room, and a large abdominal incisional hernia was repaired with synthetic mesh during the same intervention. After surgery, the patient remained intubated in intensive care for a long period. Meanwhile, she presented dehiscence of sutures and a left inguinal purulent fistula that was in contact with the vascular prosthesis. Conservative treatment was chosen, with debridement of wounds and vacuum therapy. The patient improved and the wounds healed. This could be an important tool in similar cases. Universidade Estadual Paulista ‘Júlio de Mesquita Filho’ – UNESP Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia Universidade Estadual Paulista ‘Júlio de Mesquita Filho’ – UNESP Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia

Made available in DSpace on 2014-10-01T13:08:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-09-01Bitstream added on 2014-10-01T14:03:08Z : No. of bitstreams: 1 S1677-54492013000300230.pdf: 687548 bytes, checksum: ed12dca3fb83777baad3783aa1309784 (MD5) Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia

Made available in DSpace on 2014-10-01T13:08:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-06-01Bitstream added on 2014-10-01T14:03:08Z : No. of bitstreams: 1 S1677-54492013000200155.pdf: 930381 bytes, checksum: 88fa45dd817b1d4b890e423ae7db6ff4 (MD5) Universidade Estadual Paulista Faculdade de Medicina de Botucatu Department of Surgery and Orthopedics Angiovalle Universidade Estadual Paulista Faculdade de Medicina de Botucatu Universidade Estadual Paulista Faculdade de Medicina de Botucatu Department of Surgery and Orthopedics Universidade Estadual Paulista Faculdade de Medicina de Botucatu

infarction and heart failure. Important warning signs of thrombotic occlusions include postprandial abdominal pains and food intolerance. Superior mesenteric artery (SMA) showing acute occlusion related to iatrogenic causes have received little attention in the literature and those that have been described are generally related to prior endovascular procedures3-5. In this article we describe a case of acute occlusion of the superior mesenteric artery after conventional surgery to treat intestinal cancer by total colectomy. The occlusion was successfully resolved by endovascular surgery.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:29Z No. of bitstreams: 1 S1677-54492013000100007.pdf: 3352231 bytes, checksum: 1730857606a620c747e560c9530810cc (MD5) Made available in DSpace on 2013-08-22T18:43:29Z (GMT). No. of bitstreams: 1 S1677-54492013000100007.pdf: 3352231 bytes, checksum: 1730857606a620c747e560c9530810cc (MD5) Previous issue date: 2013-03-01 Made available in DSpace on 2013-09-30T18:16:25Z (GMT). No. of bitstreams: 2 S1677-54492013000100007.pdf: 3352231 bytes, checksum: 1730857606a620c747e560c9530810cc (MD5) S1677-54492013000100007.pdf.txt: 16086 bytes, checksum: f39853e4c6808a53b37a2356bca60495 (MD5) Previous issue date: 2013-03-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:44Z No. of bitstreams: 2 S1677-54492013000100007.pdf: 3352231 bytes, checksum: 1730857606a620c747e560c9530810cc (MD5) S1677-54492013000100007.pdf.txt: 16086 bytes, checksum: f39853e4c6808a53b37a2356bca60495 (MD5) Made available in DSpace on 2014-05-20T13:32:44Z (GMT). No. of bitstreams: 2 S1677-54492013000100007.pdf: 3352231 bytes, checksum: 1730857606a620c747e560c9530810cc (MD5) S1677-54492013000100007.pdf.txt: 16086 bytes, checksum: f39853e4c6808a53b37a2356bca60495 (MD5) Previous issue date: 2013-03-01 Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia Universidade Estadual Paulista Faculdade de Medicina de Botucatu Hospital Augusta Angiovalle Hospital de Clínicas Antônio Alfonso Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia Universidade Estadual Paulista Faculdade de Medicina de Botucatu

BackgroundSignificant morbidity and mortality are related to conventional aortic replacement surgery. Endovascular debranching techniques, fenestrated or branched endografts are time consuming and costly.ObjectiveWe alternatively propose to use endovascular approach with parallel grafts for debranching of aortic arch.MethodsUnder general anesthesia, 12 F sheaths were inserted in the femoral, axillary and common carotid arteries for vascular accesses. ViaBahn grafts 10 – 15 cm in length were placed into the aortic arch from right common carotid, left common carotid and left axillary arteries, until the tip of each graft reached into the ascending aorta. Through one femoral artery, the aortic stent –graft was positioned and delivered. Soon after, the parallel grafts were sequentially delivered. Self-spanding WallstentsR were used for parallel grafts reinforcement. Ballooning was routinely used for parallel grafts and rarely for aortic graft.ResultsThis technique was used in 2 cases. The first one was a lady with 72 years old, with an aortic retrograde dissection from left subclavian artery and involving remaining arch branches. Through right common carotid artery a stent-graft was placed in the ascending aorta and through the left common carotid artery a ViaBahn was inserted parallel to the former. A thoracic endograft then covered all the aortic arch dissection extending into the ascending aorta close to the sinu –tubular junction. The second case was a 82 year old male patient with a 7 cm aortic arch aneurysm. Through both common carotid arteries ViaBahn grafts were introduced and positioned into the ascending aorta. Soon after, the deployment of the thoracic stent graft covered all parallel grafts of the aortic arch, excluding the aneurysm. Both cases did not have neurologic or cardiac complications and were discharged 10 days after the procedure.ConclusionsThis technique may be a good minimal invasive off-the-shelf technical option for aortic arch ‘‘debranching’’. More data and further improvements are required before this promising technique can be widely advocated.

Introduction So far the only endovascular option to treat patients with thoraco abdominal aortic aneurysms is the deployment of branched grafts. We describe a technique consisting of the deployment of standard off-the- shelf grafts to treat urgent cases. Material and Methods The sandwich technique consists of the deployment of ViaBahn chimney grafts in combination with standard thoracic and abdominal aortic stent grafts. The chimney grafts are deployed using a transbrachial and transaxillary access. These coaxial grafts are placed inside the thoracic tube graft. After deployment of the infrarenal bifurcated abdominal graft a bridging stent-a short tube graft is positioned inside the thoracic graft further stabilizing the chimney grafts. Results 5 patients with symptomatic thoraco abdominal aneurysms were treated. There was one Type I endoleak that resolved after 2 months. In all patients 3 stentgrafts had to be used When possible all visceral and renal branches were revascularized. A total number of 17 arteries were reconnected with covered branches. During follow up we lost one target vessel the right renal artery. Conclusion The sandwich technique in combination with chimney grafts permits a total endovascular exclusion of thoraco abdominal aortic aneurysms. In all cases off-the shelf products and grafts could be used. The number of patients treated so far is still too small to draw further more robust conclusions with regard to long term performance and durability.

Made available in DSpace on 2013-09-27T14:54:08Z (GMT). No. of bitstreams: 1 WOS000274602800034.pdf: 836972 bytes, checksum: 7730db96d9fdd748de0eb210036aab07 (MD5) Previous issue date: 2010-02-01 Made available in DSpace on 2013-09-30T18:16:41Z (GMT). No. of bitstreams: 1 WOS000274602800034.pdf: 836972 bytes, checksum: 7730db96d9fdd748de0eb210036aab07 (MD5) Previous issue date: 2010-02-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:50Z No. of bitstreams: 1 WOS000274602800034.pdf: 836972 bytes, checksum: 7730db96d9fdd748de0eb210036aab07 (MD5) Made available in DSpace on 2014-05-20T13:32:50Z (GMT). No. of bitstreams: 1 WOS000274602800034.pdf: 836972 bytes, checksum: 7730db96d9fdd748de0eb210036aab07 (MD5) Previous issue date: 2010-02-01 Background: Limitations of endovascular thoracic aneurym treatment include small, tortuous, or severely calcified iliac Back, arteries. We present our experience with a total laparoscopic access to deploy thoracic endografts.Methods. A total laparoscopic left retrocolic approach was used in all cases. A Dacron conduit was laparoscopically sutured to either the iliac artery or to the aorta directly. The endograft was inserted through this conduit. After graft deployment, the Dacron prosthesis was tunneled to the groin and anastomosed with the femoral artery.Results. The laparoscopic procedure could successfully be performed in 11 patients. In six cases, the aorta was used as all access and in five patients, the iliac arteries were preferred. In one of these cases, the right iliac artery, was used for deployment of the endograft. After successful aorto- or ileo-femoral bypass grafting, all patients had an improvement of their ankle brachial index postoperatively. The mean operative time was almost four hours, including laparoscopy, laparoscopic anastomosis, endograft deployment, and femoral artery anastomosis or profundaplasty.Conclusion: Totally laparoscopic assisted graft implantation in aorta or iliac arteries provides a safe and effective access for the endovascular delivery system. However, further evaluation and long follow-up are necessary to ensure the potential advantages of this technique. It is a less invasive option to overcome access-related problems with thoracic endograft deployment, giving the patient the advantage of a totally minimal invasive procedure. (J Vasc Surg 2010;51:504-8.) São Paulo State Univ, Botucatu Sch Med, Dept Surg & Orthoped, São Paulo, Brazil Augusta Hosp, Dept Vasc Surg & Endovasc Therapy, D-40472 Dusseldorf, Germany São Paulo State Univ, Botucatu Sch Med, Dept Surg & Orthoped, São Paulo, Brazil

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:26Z No. of bitstreams: 1 S1677-54492008000200005.pdf: 195062 bytes, checksum: 032201f4b915bf41cfa96985bb38d081 (MD5) Made available in DSpace on 2013-08-22T18:43:26Z (GMT). No. of bitstreams: 1 S1677-54492008000200005.pdf: 195062 bytes, checksum: 032201f4b915bf41cfa96985bb38d081 (MD5) Previous issue date: 2008-06-01 Made available in DSpace on 2013-09-30T19:31:03Z (GMT). No. of bitstreams: 2 S1677-54492008000200005.pdf: 195062 bytes, checksum: 032201f4b915bf41cfa96985bb38d081 (MD5) S1677-54492008000200005.pdf.txt: 36629 bytes, checksum: 5f14e9231dcdcb8725c4b89ee8914de5 (MD5) Previous issue date: 2008-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:28Z No. of bitstreams: 2 S1677-54492008000200005.pdf: 195062 bytes, checksum: 032201f4b915bf41cfa96985bb38d081 (MD5) S1677-54492008000200005.pdf.txt: 36629 bytes, checksum: 5f14e9231dcdcb8725c4b89ee8914de5 (MD5) Made available in DSpace on 2014-05-20T13:32:28Z (GMT). No. of bitstreams: 2 S1677-54492008000200005.pdf: 195062 bytes, checksum: 032201f4b915bf41cfa96985bb38d081 (MD5) S1677-54492008000200005.pdf.txt: 36629 bytes, checksum: 5f14e9231dcdcb8725c4b89ee8914de5 (MD5) Previous issue date: 2008-06-01 CONTEXTO: Os fatores de risco para doença aterosclerótica, que influenciam na evolução natural dessa doença, estão bem estabelecidos, assim como o benefício do programa de exercícios para pacientes claudicantes. Entretanto, faltam informações sobre a relação entres limitações clínicas e fatores de risco, com desempenho do programa de caminhadas e suas implicações na evolução e mortalidade destes pacientes. OBJETIVO: Comparar, ao longo do tempo, a distância de claudicação e sobrevida de pacientes claudicantes em ambulatório específico, com ou sem limitação para exercícios. MÉTODOS: Foi feito um estudo tipo coorte retrospectivo de 185 pacientes e 469 retornos correspondentes, no período de 1999 a 2005, avaliando-se dados demográficos, distância média de claudicação (CI) e óbito. Os dados foram analisados nos programas Epi Info, versão 3.2, e SAS, versão 8.2. RESULTADOS: A idade média foi de 60,9±11,1 anos, sendo 61,1% do sexo masculino e 38,9% do sexo feminino. Oitenta e sete por cento eram brancos, e 13%, não-brancos. Os fatores de risco associados foram: hipertensão (69,7%), tabagismo (44,3%), dislipidemia (32,4%) e diabetes (28,6%). Nos claudicantes para menos de 500 m, a CI inicial em esteira foi de 154,0±107,6 m, e a CI final, de 199,8±120,5 m. Cerca de 45% dos pacientes tinham alguma limitação clínica para realizar o programa de exercícios preconizado, como: angina (26,0%), acidente vascular cerebral (4,3%), artropatia (3,8%), amputação menor ou maior com prótese (2,1%) ou doença pulmonar obstrutiva crônica (1,6%). Cerca de 11,4% dos pacientes tinham infarto do miocárdio prévio, e 5,4% deles usavam cardiotônico. O tempo de seguimento médio foi de 16,0±14,4 meses. A distância média de CI referida pelos pacientes aumentou 100% (de 418,47 m para 817,74 m) ao longo de 2 anos, nos grupos não-limitante (p < 0,001) e não-tabagista (p < 0,001). A sobrevida dos claudicantes foi significativamente menor no grupo com limitação. A análise de regressão logística mostrou que a limitação para realização de exercícios, isoladamente, influenciou significativamente na mortalidade (p < 0,001). CONCLUSÃO: A realização correta e regular dos exercícios e o abandono do fumo melhoram a distância de claudicação, além de reduzir a mortalidade nesses casos, seja por meio de efeitos positivos próprios do exercício, seja por meio de controle dos fatores de risco e de seus efeitos adversos. BACKGROUND: Risk factors for atherosclerotic disease acting on natural history are well established, as well as the benefits of physical training in the treatment of intermittent claudication (IC). However, current data do not provide enough information about the relationship between clinical limitations and risk factors and the performance of physical training and its implications on the evolution and mortality of these patients. OBJECTIVE: To compare the claudication distance and survival of patients with IC throughout time in a specific outpatient setting, with or without limitation for exercises. METHODS: A retrospective cohort study was performed to review the protocols of 185 patients and 469 returns, from 1999 to 2005, evaluating demographic data, average claudication distance and death. The data were analyzed using the software Epi-Info, version 3.2, and SAS, version 8.2. RESULTS: Mean age was 60.9±11.1 years; 61.1% were males and 38.9% were females; 87% were Caucasians and 13% were non-Caucasians. Associated risk factors were hypertension (69.7%), smoking (44.3%), dyslipidemia (32.4%), and diabetes (28.6%). For the patients with claudicating distance lower than 500 m, mean initial distance was 154.0±107.6 m and final distance was 199.8±120.5 m. About 45% of the patients had some clinical limitation to perform the prescribed exercise program, such as angina (26.0%), stroke (4.3%), osteoarthrosis (3.8%), previous minor or major amputation (2.1%), or chronic obstructive pulmonary disease (1.6%). About 11.4% of the patients had previous myocardial infarction, and 5.4% of them were using cardiotonic drugs. Mean follow-up time was 16.0±14.4 months. Mean claudication distance increased 100% (418.47 to 817.74 m) throughout 2 years in the group without limitation (p < 0.001) and in nonsmokers (p < 0.001). Survival rate of patients with IC was significantly reduced in the group with limitation for exercises. Logistic regression analysis showed that limitation to exercises was the single factor significantly influencing mortality (p < 0.001). CONCLUSION: Proper and regular exercises and quitting smoking improve claudication distance and reduce mortality rates of these patients, whether by the positive effects of exercises or by controlling risk factors and their adverse effects. Universidade Estadual Paulista Faculdade de Medicina de Botucatu Universidade Estadual Paulista Faculdade de Medicina de Botucatu

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:25Z No. of bitstreams: 1 S1677-54492007000300014.pdf: 105634 bytes, checksum: 16cc06060e81e6adb1d5adb1e030f7eb (MD5) Made available in DSpace on 2013-08-22T18:43:25Z (GMT). No. of bitstreams: 1 S1677-54492007000300014.pdf: 105634 bytes, checksum: 16cc06060e81e6adb1d5adb1e030f7eb (MD5) Previous issue date: 2007-09-01 Made available in DSpace on 2013-09-30T19:31:03Z (GMT). No. of bitstreams: 2 S1677-54492007000300014.pdf: 105634 bytes, checksum: 16cc06060e81e6adb1d5adb1e030f7eb (MD5) S1677-54492007000300014.pdf.txt: 17811 bytes, checksum: dc07006538bf0898a10f7f8a7b36cdd7 (MD5) Previous issue date: 2007-09-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:22Z No. of bitstreams: 2 S1677-54492007000300014.pdf: 105634 bytes, checksum: 16cc06060e81e6adb1d5adb1e030f7eb (MD5) S1677-54492007000300014.pdf.txt: 17811 bytes, checksum: dc07006538bf0898a10f7f8a7b36cdd7 (MD5) Made available in DSpace on 2014-05-20T13:32:22Z (GMT). No. of bitstreams: 2 S1677-54492007000300014.pdf: 105634 bytes, checksum: 16cc06060e81e6adb1d5adb1e030f7eb (MD5) S1677-54492007000300014.pdf.txt: 17811 bytes, checksum: dc07006538bf0898a10f7f8a7b36cdd7 (MD5) Previous issue date: 2007-09-01 RESUMO A fístula arteriovenosa com bom fluxo sangüíneo é de fundamental importância para os pacientes portadores de insuficiência renal crônica em tratamento hemodialítico. Uma das complicações da fístula arteriovenosa é a síndrome do roubo, mas esta é de ocorrência incomum, e o seu tratamento está diretamente indicado quando há sintomas manifestos. Vários métodos foram propostos para sua correção nos membros superiores, sendo considerada a revascularização distal com ligadura arterial o procedimento de escolha. Neste relato de caso inédito, descreve-se o tratamento da síndrome do roubo de uma fístula arteriovenosa realizada em membro inferior, tratada com sucesso por meio da mesma técnica indicada para os membros superiores. Arteriovenous fistula with adequate blood flow is extremely important for patients with chronic renal insufficiency undergoing hemodialysis. Steal syndrome is a complication of arteriovenous fistula, but it is rare and its treatment is directly indicated when there are associated symptoms. Although many treatments have been proposed for its repair in the upper limbs, distal revascularization and interval ligation is currently the treatment of choice. This original case report describes the treatment of steal syndrome secondary to arteriovenous fistula in the lower limb, which was successfully treated using the same procedure described for the upper limbs. Universidade Estadual Paulista Faculdade de Medicina de Botucatu Serviço de Cirurgia Vascular Universidade Estadual Paulista Faculdade de Medicina de Botucatu Serviço de Cirurgia Vascular

Duplicated inferior vena cava is a rare anomaly, and thrombosis in one or both segments is even less frequent. We present a case of deep venous thrombosis of the left lower limb involving the popliteal, femoral, and iliac veins as well as the left segment of the duplicated vena cava and nutcracker syndrome. After catheter-directed thrombolysis complemented by mechanical thrombolysis, the compromised veins had complete revascularization; the nutcracker syndrome was treated with stent placement, followed by the use of anticoagulants. There was technical success and complete recovery of the patient.

Made available in DSpace on 2016-04-01T18:42:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2014. Added 1 bitstream(s) on 2016-04-01T18:48:57Z : No. of bitstreams: 1 S1677-54492014000300235-en.pdf: 3535584 bytes, checksum: fe5b5f29841df8e1c94b1203dc69a36c (MD5). Added 1 bitstream(s) on 2016-04-01T18:48:57Z : No. of bitstreams: 2 S1677-54492014000300235-en.pdf: 3535584 bytes, checksum: fe5b5f29841df8e1c94b1203dc69a36c (MD5) S1677-54492014000300235-pt.pdf: 3588122 bytes, checksum: 608308201df80b1059962c0017d83267 (MD5) O tratamento endovascular de aneurismas de aorta abdominal (AAA), envolvendo a saída das artérias renais e viscerais, constitui ainda um importante desafio. Diversas técnicas foram desenvolvidas ao longo do tempo para contornar as dificuldades oferecidas por esta situação, destacando-se as endopróteses fenestradas ou ramificadas, as técnicas envolvendo próteses paralelas, como Chaminé, Periscópio e Sanduíche, e, mais recentemente, a utilização da modulação de fluxo por stent multicamadas Multilayer. Apresentamos um caso de AAA sacular complexo justarrenal e com alto risco cirúrgico pela avaliação cardiológica e por apresentar via aérea difícil, em decorrência de laringectomia total por antecedente de neoplasia de laringe. Devido à facilidade técnica do uso do Multilayer, à presença de doença obstrutiva crônica aorto-ilíaca, à estenose ostial renal e ao diâmetro limitado da aorta suprarrenal, descartaram-se as opções envolvendo endopróteses fenestradas/ramificadas ou técnicas envolvendo próteses paralelas, pela necessidade de diversos acessos para a execução. Diante do dilema imposto, apresentamos este caso como desafio terapêutico e com uma opção de tratamento bem sucedida, em curto prazo. Endovascular aortic aneurysm repair (EVAR) involving renal and visceral arteries remains a great challenge. Several techniques have been developed over the time to treat juxtarenal, pararenal and thoracoabdominal aneurysms, highlighting the fenestrated and branched endografts, parallel prostheses as Chimney, Periscope and Sandwich Techniques and the use of flow modulation by multilayer stent. We report a case of saccular juxtarenal aortic aneurysm with high surgical risk for complex airway access due to a history of radical laryngectomy for laryngeal neoplasm. Due to chronic aorto-iliac obstructive disease, ostial stenosis of renal artery and limited diameter of the suprarenal aorta, we discarded options involving fenestrated/branched endografts and involving parallel prostheses techniques. We present this case as a therapeutic challenge and a successful treatment option in the short-term evaluation. Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Cirurgia e Ortopedia, Botucatu, SP, Brasil

Spontaneous isolated dissection of iliac arteries is very rare, with few reports in the literature. Medical, surgical, and endovascular treatment modalities have all been used to manage iliac artery dissections. We report a case of symptomatic, isolated, spontaneous dissection of the common iliac and external iliac arteries. Both dissections were successfully treated by separate percutaneous stent-graft placement, preserving hypogastric artery flow. This technique is interesting because it provides adequate sealing of proximal and distal dissection sites while preserving hypogastric artery and pelvic flow.

Universidade Estadual Paulista, Departamento de Cirurgia e Ortopedia, Faculdade de Medicina de Botucatu, Botucatu