Study of the correlation between intravenous pressure measurements in the cavo-iliac system and Intravascular ultrasound findings in the diagnosis of May-Thurner Syndrome in patients with advanced chronic venous insufficiency of the lower limbs

Introdução: A Insuficiência Venosa Crônica (IVC) é responsável pela grande maioria dos sintomas vasculares que acometem os membros inferiores, podendo levar a graves sintomas. A Síndrome de compressão Venosa Cavo-ilíaca (SCVCI) é cada vez mais reconhecida como importante causa da IVC e os métodos de imagem utilizados para o seu diagnóstico fornecem informações anatômicas, mas não trazem informações fisiológicas claras. A importância diagnóstica dos Gradientes pressóricos venosos Cavo-ilíacos precisa ser mais bem estudada e esses ainda não foram comparados ao método padrão-ouro atualmente disponível, o Ultrassom Intravascular (UI). Esse estudo tem como objetivo avaliar a correlação entre as medidas de Pressão intravenosa (PI) e Gradientes pressóricos (GP) e a presença de obstrução venosa significativa no Sistema Cavo-Ilíaco (SCI) estabelecida pelo UI, para o diagnóstico da SCVCI em pacientes portadores de IVC avançada dos membros inferiores. Método: Foram incluídos 50 pacientes com IVC avançada (Classificação CEAP 3 ou superior) de, ao menos, um dos membros inferiores, sem melhora após um ano de tratamento clínico, totalizando 100 membros inferiores. Todos os pacientes foram submetidos, prospectivamente, aos exames de Ultrassom Vascular com Doppler Colorido (UVDC), Angiotomografia Computadorizada Helicoidal (ACTH), Flebografia Multiplanar Ascendente (FMA), Medidas de pressão intravenosa e Ultrassom Intravascular (UI). Os membros inferiores estudados foram divididos em dois grupos: Grupo 1 com obstrução = 50% ao UI. A correlação entre os gradientes e demais variáveis quantitativas foi realizada utilizando o Coeficiente de Spearman. As Curvas ROC foram utilizadas para avaliar qual o melhor desempenho entre os gradientes, na discriminação do grau de obstrução. O desempenho diagnóstico isolado dos GP em comparação com o UI foi avaliado por meio das medidas de Sensibilidade, Especificidade, Valor Preditivo Positivo, Valor Preditivo Negativo e Acurácia. A concordância dos exames com o UI foi realizada por meio do Kappa e do teste de McNemar. A Análise de Regressão Logística foi utilizada para avaliar a contribuição dos GP com a Flebografia, na identificação de pacientes com obstrução significativa. Foram utilizados os programas R (Versão 3.1.0) e SPSS (Versão 2.0). Valores de p-50% ao UI.Introduction: Chronic venous insufficiency (CVI) is responsible for most of the vascular symptoms affecting the lower limbs, and can lead to severe complications. Iliac vein compression syndrome (IVCS) is increasingly recognized as an important cause of CVI. The imaging methods used for its diagnosis provide anatomical information but not clear physiological information. The diagnostic importance of the cavo-iliac vein pressure gradients (VPG) requires further study, and they have not yet been compared with the currently available gold standard, the Intravascular ultrasound (IVUS). The aim of this study was to evaluate the correlations between intravenous pressure (IP) and VPG, and the presence of significant IVUS-diagnosed venous obstruction in the cavo-iliac system, for assessment of IVCS in patients with advanced CVI of the lower limbs. Method: The study included 100 lower limbs of 50 patients with advanced CVI (Clinical-Etiology-Anatomy-Pathophysiology - CEAP classification 3 or higher), without symptoms improvement after one year of clinical treatment. All patients prospectively underwent Color Doppler vascular Ultrasound (CDVU), Helical Computed Tomography Angiography (HCTA), Multiplane Ascending Phlebography (MAP), IP measurements, and IVUS. The studied limbs were divided into Group 1 with obstruction =50% by IVUS. Spearman\'s correlation coefficient was used to compare gradients and other quantitative variables. Receiver operating characteristic (ROC) curves were used to evaluate the best performance among the gradients for determination of the degree of obstruction. Isolated diagnostic performance of PGs was compared with the IVUS for Sensitivity, Specificity, Positive predictive value, Negative predictive value, and Accuracy. The agreement between the evaluation methods and IVUS was determined using the Kappa statistic and McNemar\'s test. Logistic regression analysis was used to evaluate the contribution of PG to the MAP in identifying patients with significant obstruction. R (Version 3.1.0) and SPSS (Version 2.0) were used for statistical analysis. Values of p-50% by IVUS

Study of the correlation between intravenous pressure measurements in the cavo-iliac system and Intravascular ultrasound findings in the diagnosis of May-Thurner Syndrome in patients with advanced chronic venous insufficiency of the lower limbs

Introdução: A Insuficiência Venosa Crônica (IVC) é responsável pela grande maioria dos sintomas vasculares que acometem os membros inferiores, podendo levar a graves sintomas. A Síndrome de compressão Venosa Cavo-ilíaca (SCVCI) é cada vez mais reconhecida como importante causa da IVC e os métodos de imagem utilizados para o seu diagnóstico fornecem informações anatômicas, mas não trazem informações fisiológicas claras. A importância diagnóstica dos Gradientes pressóricos venosos Cavo-ilíacos precisa ser mais bem estudada e esses ainda não foram comparados ao método padrão-ouro atualmente disponível, o Ultrassom Intravascular (UI). Esse estudo tem como objetivo avaliar a correlação entre as medidas de Pressão intravenosa (PI) e Gradientes pressóricos (GP) e a presença de obstrução venosa significativa no Sistema Cavo-Ilíaco (SCI) estabelecida pelo UI, para o diagnóstico da SCVCI em pacientes portadores de IVC avançada dos membros inferiores. Método: Foram incluídos 50 pacientes com IVC avançada (Classificação CEAP 3 ou superior) de, ao menos, um dos membros inferiores, sem melhora após um ano de tratamento clínico, totalizando 100 membros inferiores. Todos os pacientes foram submetidos, prospectivamente, aos exames de Ultrassom Vascular com Doppler Colorido (UVDC), Angiotomografia Computadorizada Helicoidal (ACTH), Flebografia Multiplanar Ascendente (FMA), Medidas de pressão intravenosa e Ultrassom Intravascular (UI). Os membros inferiores estudados foram divididos em dois grupos: Grupo 1 com obstrução = 50% ao UI. A correlação entre os gradientes e demais variáveis quantitativas foi realizada utilizando o Coeficiente de Spearman. As Curvas ROC foram utilizadas para avaliar qual o melhor desempenho entre os gradientes, na discriminação do grau de obstrução. O desempenho diagnóstico isolado dos GP em comparação com o UI foi avaliado por meio das medidas de Sensibilidade, Especificidade, Valor Preditivo Positivo, Valor Preditivo Negativo e Acurácia. A concordância dos exames com o UI foi realizada por meio do Kappa e do teste de McNemar. A Análise de Regressão Logística foi utilizada para avaliar a contribuição dos GP com a Flebografia, na identificação de pacientes com obstrução significativa. Foram utilizados os programas R (Versão 3.1.0) e SPSS (Versão 2.0). Valores de p-50% ao UI.Introduction: Chronic venous insufficiency (CVI) is responsible for most of the vascular symptoms affecting the lower limbs, and can lead to severe complications. Iliac vein compression syndrome (IVCS) is increasingly recognized as an important cause of CVI. The imaging methods used for its diagnosis provide anatomical information but not clear physiological information. The diagnostic importance of the cavo-iliac vein pressure gradients (VPG) requires further study, and they have not yet been compared with the currently available gold standard, the Intravascular ultrasound (IVUS). The aim of this study was to evaluate the correlations between intravenous pressure (IP) and VPG, and the presence of significant IVUS-diagnosed venous obstruction in the cavo-iliac system, for assessment of IVCS in patients with advanced CVI of the lower limbs. Method: The study included 100 lower limbs of 50 patients with advanced CVI (Clinical-Etiology-Anatomy-Pathophysiology - CEAP classification 3 or higher), without symptoms improvement after one year of clinical treatment. All patients prospectively underwent Color Doppler vascular Ultrasound (CDVU), Helical Computed Tomography Angiography (HCTA), Multiplane Ascending Phlebography (MAP), IP measurements, and IVUS. The studied limbs were divided into Group 1 with obstruction =50% by IVUS. Spearman\'s correlation coefficient was used to compare gradients and other quantitative variables. Receiver operating characteristic (ROC) curves were used to evaluate the best performance among the gradients for determination of the degree of obstruction. Isolated diagnostic performance of PGs was compared with the IVUS for Sensitivity, Specificity, Positive predictive value, Negative predictive value, and Accuracy. The agreement between the evaluation methods and IVUS was determined using the Kappa statistic and McNemar\'s test. Logistic regression analysis was used to evaluate the contribution of PG to the MAP in identifying patients with significant obstruction. R (Version 3.1.0) and SPSS (Version 2.0) were used for statistical analysis. Values of p-50% by IVUS

Left subclavian artery stenting: an option for the treatment of the coronary-subclavian steal syndrome

Introduction: The subclavian steal syndrome is characterized by the vertebral artery flow inversion, due to a stenotic lesion in the origin of the subclavian artery. The Coronary-subclavian Steal Syndrome is a variation of the Subclavian Steal Syndrome and is characterized by inversion of flow in the Internal Thracic artery that has been used as conduct in a myocardial revascularization. Its diagnosis must be suspected in patients with difference in pulse and arterial pressure in the upper limbs, that present with angina pectoris and that have done a myocardial revascularization. Its treatment must be a surgical bypass or a transluminal angioplasty. Objective: The objective is to show the left subclavian artery stenting as a safe and effective method to treat the coronary-subclavian steal syndrome. Methods: Historical prospective, non-randomized trial, through revision of the hospital records of the patients treated with the stenting of the left subclavian artery, from January 2006 to September 2012. Results: In the mentioned period, 4.291 miocardial revascularizations were performed with the use of the left mammary artery, and 16 patients were identified to have the Coronary-subclavian steal syndrome. All of them were submitted to endovascular treatment. The success rate was 100%; two patients experienced minor complications; none of them presented with major complications. Eleven of the 16 patients had ultrassonographic documentation of patent stent for at least one year; two patients lost follow up and other two died. Conclusion: The stenting of the left subclavian artery is a good option for the treatment of the Coronary-subclavian Steal Syndrome, with high level of technical and clinical success

Embolization by micro navigation for treatment of persistent type 2 Endoleaks after endovascular abdominal aortic aneurysm repair

Background:Endovascular repair has become established as a safe and effective method for treatment of abdominal aortic aneurysms. One major complication of this treatment is leakage, or endoleaks, of which type 2 leaks are the most common.Objective:To conduct a brief review of the literature and evaluate the safety and effectiveness of embolization by micronavigation for treatment of type 2 endoleaks.Method:A review of medical records from patients who underwent endovascular repair of abdominal aortic aneurysms identified 5 patients with persistent type 2 endoleaks. These patients were submitted to embolization by micronavigation.Results:In all cases, angiographic success was achieved and control CT scans showed absence of type 2 leaks and aneurysm sacs that had reduced in size after the procedure.Conclusion:Treatment of type 2 endoleaks using embolization by micronavigation is an effective and safe method and should be considered as a treatment option for this complication after endovascular repair of abdominal aortic aneurysms

Tratamento endovascular de aneurisma de aorta abdominal com fístula aorto-cava utilizando oclusor vascular concomitante a endoprótese bifurcada: relato de caso

Resumo As fístulas aorto-cava são entidades raras e de etiologia variada, estando frequentemente associadas a significativa morbimortalidade. Acredita-se que o aumento da tensão da parede nos grandes aneurismas resulte em reação inflamatória e aderência à veia adjacente, culminando na erosão das camadas aderidas e na formação da fístula. O tratamento cirúrgico convencional tem altas taxas de mortalidade. Embolia pulmonar paradoxal e o vazamento são complicações temidas do tratamento endovascular. O uso de oclusor vascular associado a endoprótese bifurcada é boa opção no tratamento do aneurisma de aorta abdominal com fístula aorto-cava

Angiossarcoma mimetizando endoleak tardio pós-reparo endovascular de aneurisma de aorta infrarrenal: relato de caso

Resumo Em todo paciente submetido a reparo endovascular do aneurisma de aorta abdominal (REVA) que se apresente subitamente com quadro de dor abdominal ou sinais de choque, a hipótese de endoleak ou vazamento, com expansão do aneurisma e ruptura deve ser aventada. Apresentamos o caso de um paciente em pós-operatório de REVA que apresentou uma neoplasia de duodeno mimetizando um endoleak

Angiosarcoma mimicking a late endoleak following endovascular aneurysm repair: case report

<p></p><p>Abstract Whenever a patient who has undergone endovascular repair of an abdominal aortic aneurysm (EVAR) presents with sudden onset abdominal pains or signs of shock, the hypothesis of endoleak with aneurysm expansion and rupture should be considered. We present the case of an EVAR patient in whom a tumor of the duodenum mimicked an endoleak during the postoperative period.</p><p></p