Hybrid treatment of aortic arch disease

Introduction: The management of thoracic aortic disease involving the ascending aorta, aortic arch and descending thoracic aorta are technically challenging and is an area in constant development and innovation. Objective: To analyze early and midterm results of hybrid treatment of arch aortic disease. Methods: Retrospective study of procedures performed from January 2010 to December 2012. The end points were the technical success, therapeutic success, morbidity and mortality, neurologic outcomes, the rate of endoleaks and reinterventions. Results: A total of 95 patients treated for thoracic aortic diseases in this period, 18 underwent hybrid treatment and entered in this study. The average ages were 62.3 years. The male was present in 66.7%. The technical and therapeutic success was 94.5% e 83.3%. The perioperative mortality rate of 11.1%. There is any death during one-year follow- up. The reoperation rates were 16.6% due 2 cases of endoleak Ia and one case of endoleak II. There is any occlusion of anatomic or extra anatomic bypass during follow up. Conclusion: In our study, the hybrid treatment of aortic arch disease proved to be a feasible alternative of conventional surgery. The therapeutic success rates and re- interventions obtained demonstrate the necessity of thorough clinical follow-up of these patients in a long time.Introdução: O manejo das doenças da aorta torácica que envolvem a aorta ascendente, arco aórtico e aorta torácica descendente constituem um desafio técnico e é uma área em constante desenvolvimento e inovação. Objetivo: Analisar os resultados iniciais e a médio prazo do tratamento híbrido das doenças do arco aórtico. Métodos: Estudo retrospectivo de procedimentos realizados no período de janeiro de 2010 a dezembro de 2012, em que foram analisados o sucesso técnico e terapêutico, a morbimortalidade, os desfechos neurológicos, a taxa de vazamentos e de reintervenções. Resultados: Em um total de 95 pacientes tratados por doenças da aorta torácica no período, 18 realizaram o tratamento híbrido e adentraram neste estudo. A idade média foi de 62,3 anos. O sexo masculino esteve presente em 66,7%. O sucesso técnico e terapêutico foi de 94,5% obe 83,3%, respectivamente. A mortalidade perioperatória foi de 11,1%. Não houve óbito durante o acompanhamento de 1 ano. A taxa de reintervenção foi de 16,6%, devido a 2 casos de endoleak tipo Ia e um caso de endoleak tipo 2. Não foi observada oclusão dos enxertos anatômicos ou extra-anatômicos durante o período de seguimento. Conclusão: O tratamento híbrido das doenças do arco aórtico demonstrou ser uma alternativa viável à cirurgia convencional. As taxas de sucesso terapêutico e de reintervenções demonstram a necessidade do seguimento clínico rigoroso desses pacientes a longo prazo.Universidade de São Paulo Faculdade de MedicinaInstituto Dante Pazzanese de Cardiologia Centro de Intervenções Endovascular Seção Médica de RadiologiaSecretaria da Saúde do Estado de São PauloInstituto Dante Pazzanese de Cardiologia Centro de Intervenções Seção Médica de Cirurgia VascularHospital SalvalusUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Endovascular treatment of abdominal aortic aneurysms with complex anatomy: preliminary results of the second generation stent graft with a dual-ring design

INTRODUÇÃO: O tratamento endovascular dos aneurismas da aorta abdominal tem revolucionado o tratamento dessa afecção, em decorrência das baixas taxas de morbidade e mortalidade. Apesar dos avanços tecnológicos ocorridos nas endopróteses, ainda existem limitações anatômicas para o emprego da técnica. Este estudo teve por objetivo avaliar os resultados imediatos do tratamento de pacientes portadores de aneurisma da aorta abdominal com anatomia complexa com uma endoprótese de segunda geração. MÉTODOS: Estudo observacional, prospectivo, não-randomizado, realizado em um único centro, em uma série de pacientes submetidos a tratamento endovascular de aneurismas da aorta abdominal infrarrenais complexos, com prótese com arcabouço metálico disposta em anéis (Anaconda - Vascutek, Terumo, Inchinnan, Escócia). Foram avaliados as características clínicas e angiográficas, o sucesso técnico, o sucesso terapêutico, a morbidade e a mortalidade, e a taxa de reintervenção perioperatória. RESULTADOS: Foram analisados, no período de fevereiro de 2010 a dezembro de 2011, 108 pacientes consecutivos portadores de aneurisma da aorta, dos quais 16 eram portadores de aneurisma da aorta abdominal com anatomia complexa tratados com a prótese Anaconda . A média de idade foi de 76 + 7 anos e 75% eram do sexo masculino. Houve sucesso técnico em 94% e êxito terapêutico em 75% dos casos. Ocorreu um óbito no pós-operatório. As complicações perioperatórias mais prevalentes foram sangramento da ferida operatória (2/16) e embolia periférica (2/16). Foram necessárias reintervenções em 12,5% dos pacientes durante o seguimento. CONCLUSÕES: Neste estudo, a segunda geração da endoprótese Anaconda foi efetiva e apresenta resultados imediatos satisfatórios no tratamento do aneurisma da aorta abdominal infrarrenal de anatomia complexa

Peripheral vascular insufficiency impairs functional capacity in patients with heart failure

INTRODUCTION: Heart failure (HF) is a complex syndrome in which effort limitation is associated with deterioration of peripheral musculature. Improving survival rates among these patients have led to the appearance of cases in which other pathologies are associated with HF, such as peripheral vascular insufficiency (PVI). The combination of these two pathologies is common, with significant repercussions for affected patients.OBJECTIVE: To compare functional limitations and quality of life between patients with HF in isolation or HF + PVI.METHOD: Twelve patients with HF+PVI were paired to 12 patients with HF in isolation. All had ejection fraction <40%. The following were conducted: 6 minute walk test (6MWT), chair test (CT), step test (ST), one repetition maximum test (1RM) and quality of life questionnaire.RESULTS: The results for the 6MWT (311±27 vs. 447±29), ST (49±3 vs. 81±10) and CT (17±1 vs. 21±1) were lower in the HF+PVI group than in the HF group (p<0.05). The HF+PVI group exhibited a reduction in the number of steps taken from the first to the second minute of the ST, in relation to the HF group. The HF group exhibited better HR recovery than the HF+PVI group (50±4 vs. 26±3; p<0.05). No differences were found in results for the Borg scale, the peripheral muscle strength test (1RM) or the questionnaires (p>0.05).CONCLUSIONS: The study participants who had mixed disease exhibited a greater degree of functional impairment than the group with HF, without reporting worsened quality of life

Effects of electrocautery to provoke endovascular thermal injury Efeitos do eletrocautério para provocar lesão térmica endovascular

PURPOSE: To investigate the effects of a new electrocautery device to provoke endovascular venous thermal injury. METHODS: An experimental endovascular electrocautery was placed inside eight ex-vivo bovine saphenous veins models. Each one was divided in eight segments and progressive intensities of electric energy liberated. The macroscopic and microscopic effects were analyzed. RESULTS: Forty bovine saphenous veins segments were studied. The higher the electric energy applied the greater the nuclear picnosis and more intense the cytoplasmatic shrinkage and electrocoagulation effects. CONCLUSION: The experimental endovascular electrocautery device demonstrated to be both capable of inducing the destruction of the intimal layers of the studied vein model and provoke endovascular thermal injury.<br>OBJETIVO: Investigar os efeitos de um modelo experimental de eletrocautério em provocar lesão venosa térmica endovascular. MÉTODOS: O eletrocautério endovascular foi colocado dentro de oito modelos experimentais de veia safena bovina. Cada uma foi dividida em oito segmentos e intensidades progressivas de energia elétrica liberada. Os efeitos macroscópicos e microscópicos foram analisados. RESULTADOS: Foram estudados quarenta segmentos de veia safena bovina. Quanto maior a energia elétrica aplicada pelo eletrocauterizador endovascular maiores foram as alteraçoes de picnose nuclear e mais intensa a retração citoplasmática observada. CONCLUSÃO: O eletrocautério endovascular experimental demonstrou ser capaz de induzir a destruição da camada íntima e provocar lesão térmica endovascular

Open vs. endovascular repair of abdominal aortic aneurysm: a comparative analysis

Context:Abdominal aortic aneurysm (AAA) is a condition that is usually asymptomatic, but potentially fatal, and has a prevalence in men over 60 years old ranging from 4.3% to 8%. There are two treatment options available: open surgery (OS) and endovascular treatment (ET).Objective:To compare the results of repairs conducted using these two treatment methods from 2008 to 2013 in a tertiary hospital.Methods:A retrospective analysis comparing 119 patients treated with OS and 219 patients who underwent ET for AAA repair.Results:The ET group was older (71.3 vs. 68.2 years; p<0.001) and had a higher rate of coronary disease (44.7% vs. 27.7%; p=0.002) and a lower ejection fraction (57.6% vs. 64.3%; p<0.001); in turn, the OS group had more chronic obstructive pulmonary disease (16.0% vs. 5.9%; p=0.004) and a smaller proximal infrarenal neck (15.5 mm vs. 23.0 mm; p<0.001). However, there was no difference in ASA classification (American Society of Anesthesiology) (p=0.36). The ET group had less intraoperative bleeding (171 mL vs. 729 mL; p<0.001) and required fewer blood transfusions (11.9% vs. 73.1% p<0.001), and spent shorter stays in both ICU (2.4 vs. 3.5 days; p=0.002) and hospital (5.8 vs. 10.3 days; p<0.001). Thirty-day mortality was similar (OS 5.0% vs. ET 4.1%; p=0.78) and there was also no difference in postoperative complications. The average cost of ET was higher (R$34,277.76 vs. R$4,778.60; p<0.001).Conclusions:Rates of morbidity and mortality were similar, although ET was associated with less bleeding, fewer transfusions and shorter hospital stays, but was more expensive

Relationships between severity of signs and symptoms and quality of life in patients with chronic venous disease

BACKGROUND: Chronic venous disease (CVD) is progressive and has a high prevalence in the economically active population. Its impact on the quality of life of affected individuals is poorly understood. OBJECTIVE: To test for correlations between the CEAP classification of CVD severity and CVD symptoms and quality of life of affected individuals. METHODS: We investigated 91 lower limbs in 59 patients with CVD (CEAP C1- C6). Patients were assessed with a Visual Analogue Pain Scale (VAPS), the Venous Clinical Severity Score (VCSS) and the SF-36 quality-of-life questionnaire. Spearman correlation coefficients were calculated. RESULTS: There were positive correlations between the CEAP classification and scores for VAPS (0.815, p <0.000), VCSS (0.937, p <0.000), and SF-36 in the dimensions Physical Functioning: -0.791, p <0.000; Role Physical: -0.839; p <0.000; Bodily Pain: -0.684; General Health: -0.617, p <0.000; Role Emotional: -0.691, p <0.000). There was no correlation with Vitality: -0.003, p=0.979; Role Social: -0.188, p=0.740 or Mental Health: -0.085, p=0.421. CONCLUSIONS: There were positive correlations between CEAP and both VAPS and VCSS. Chronic Venous Insufficiency progressively affects quality of life (SF-36). Physical and emotional aspects are more severe at later stages of CVD. Vitality, Mental Health and Role Social can be negatively impacted from the early stages of the disease