Endovascular Treatment of Symptomatic Renal Artery Aneurysm with Hostile Anatomy

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Therapeutic strategy in the chronic venous disease

Chronic venous disease (CVD) is a highly prevalent pathology that compromises patient’s quality of life, and has an important impact socioeconomically. Its treatment passes through the adoption of hygiene-dietetic measures, pharmacological therapy and elastic compression, as well as approaches that are able to ablate venous reflux and hypertension such as mechanical, thermic or chemical ablations. Due to the multiplicity of therapeutic approaches available nowadays, it is important to search for the more effective ones. The objective of this work is to establish a systematic clinical orientation for patients with chronic venous disease, taking into account the CEAP classification, the published results and the recommendations available, in a way to achieve clinical improvement and to answer patient’s expectations. English articles were searched in Medline in concern to the treatment of chronic venous disease. Articles cited by others contained in the initial research were also included. It was possible to understand that chronic venous disease treatment must be individualized and established according to the clinical state. Hygiene-dietetic measures must be adopted by all patients and the different compressions degrees adjusted to the CEAP classification. Pharmacological therapy induces symptomatic relieve and improves complications. All ablation techniques can be performed in an ambulatory setting. Thermal ablation is a promising treatment although there is lack of long term results for recurrence, whereas the chemical ablation, despite being the cheapest, is the mayor cause of pigmentation and recanalization. Mechanical approaches can be performed without general anesthesia and patients are able to return to work the day after the procedure

Endovascular correction of splenic artery aneurysm– case report

Splenic artery aneurysms, although they are the most common splanchnic aneurysms, they have a prevalence of only 0,01%. In this context the authors present a case report of a 41 years female patient with a splenic artery aneurysm of 20x29mm, treated by deployment of a covered self-expandable stent (Gore® Viabahn®). It is performed a literature review of the pathology in question, possible complications and made reference to the various treatment options, with particular emphasis on the new endovascular techniques

Treatment of Arterial Pathology in the Portuguese National Health Service - a Report of the Years 2009-2017

Introdução: A análise de bases de dados administrativas, consistindo em codificação hospitalar, é uma importante ferramenta para melhorar o conhecimento e a gestão de cuidados de saúde. Através destas, é possível avaliar tendências e proceder à monitorização e avaliação de resultados. Métodos: O presente relatório é resultante de um protocolo de colaboração entre a Sociedade Portuguesa de Angiologia e Cirurgia Vascular e a Escola Nacional de Saúde Pública, baseado na análise de dados resultantes da codificação hospitalar por Grupos de Diagnóstico Homogéneos da Administração Central do Sistema de Saúde. Tratou-se de um estudo observacional, retrospetivo e transversal. Apresenta as tendências verificadas nas admissões hospitalares e intervenções nos três grupos de patologia arterial mais expressivos da especialidade de Angiologia e Cirurgia Vascular em Portugal (aneurisma da aorta, doença arterial periférica e doença carotídea). Resultados: Foram analisados dados referentes aos episódios de internamento nos hospitais do SNS de Portugal continental entre 2009 e 2017. Observa-se que a grande maioria dos doentes tratados se encontram na faixa etária dos 65–84 anos e o sexo masculino é o que tem maior expressão. Nota-se uma significativa proporção de doentes tratados por patologia não eletiva. Os números de admissões aumentaram globalmente ao longo do tempo. Verifica-se, na globalidade, um progressivo aumento na utilização de técnicas endovasculares, sendo dominantes na maioria das áreas de intervenção. No entanto a cirurgia convencional permanece relevante como modalidade terapêutica sendo inclusivamente dominante no caso de patologia carotídea sintomática. Conclusão: A tendência de crescimento no número de doentes tratados, assim como a crescente utilização de terapêutica endovascular, tem importantes implicações na gestão do Serviço Nacional de Saúde e na programação da atividade dos Serviços. A utilização de dados administrativos tem importantes limitações na análise de resultados, na obtenção das características dos doentes e detalhes das intervenções, e representa apenas a realidade do Serviço Nacional de Saúde em Portugal Continental. Não obstante, a análise de resultados que tem na sua base informação de tipo administrativa, tem contribuído para melhorar o conhecimento das características da população e dos procedimentos realizados em diversas áreas clínicas permitindo, igualmente, apoiar tomadas de decisão a nível clínico e de governação da saúde.info:eu-repo/semantics/publishedVersio

Contaminação de água subterrânea por substâncias de limpeza da neve em estradas: o caso do sector de Nave de Santo António – Covão do Curral (Serra da Estrela, Centro de Portugal)

Num momento em que a gestão sustentável dos recursos hídricos se assume como uma das maiores preocupações à escala mundial, as regiões de montanha têm vindo a ser reconhecidas como Reservatórios de Água (PROGRAMA UNESCO IHP-VI). O facto de muitas destas áreas se localizarem a altitudes elevadas e serem recortadas por rodovias obriga a frequentes operações de limpeza de neve, especialmente no inverno. A aplicação de substâncias químicas como cloreto de sódio e cloreto de cálcio na promoção da fusão do gelo e na limpeza da neve das estradas constitui um problema ambiental de elevado interesse científico, social e económico. Devido às suas características geológicas, geomorfológicas e climáticas, a Serra da Estrela é considerada estratégica para a gestão da água em Portugal. No presente trabalho apresentam-se alguns resultados hidrogeoquímicos que indicam que a utilização dos referidos sais na limpeza do gelo e da neve das rodovias contribui para a contaminação dos recursos hídricos

Comparison between CDC and WHO BMI z-score and their relation with metabolic risk markers in Northern Portuguese obese adolescents

Growth-curves are an important tool for evaluating the anthropometric development in pediatrics. The different growth-curves available are based in different populations, what leads to different cut-offs. Pediatric obesity tracks into adulthood and is associated with increased cardiovascular risk. The accurate assessment of a child nutritional status using growth-curves can indicate individuals that are either obese or in risk of becoming obese, allowing an early intervention. Moreover, the association between the data obtained from growth-curves with specific metabolic risk factors further highlights the importance of these charts. This study aimed to evaluate the associations between body mass index z-score (BMIzsc), determined using the growth-curves from the Centre for Disease Control and Prevention (CDC) and from the World Health Organization (WHO), with cardiovascular risk factors, represented here by metabolic syndrome (MS) and insulin resistance (IR) related parameters. The study involved 246 obese adolescents (10-18 years, 122 females). MS was defined according to the International Diabetes Federation. IR was considered for HOMA-IR greater than 2.5

Tratamento Endovascular do Aneurisma da Aorta Abdominal por Via Percutânea e Anestesia Local – One Day Surgery

To evaluate the results of the abdominal aortic aneurism endovascular treatment (EVAR), percutaneously and with local anesthesia, according to the concept of one day surgery. MATERIAL AND METHODS: Unicentric, retrospective analysis of patients with aorto-iliac aneurysmal disease, consecutively treated by EVAR with percutaneous access trough the Preclose technique (pEVAR), according to the outpatient criteria, with one overnight stay in the hospital. The technical success, exclusion of the aneurysmal sac, endoleak, re-intervention and mortality were evaluated. RESULTS: Twenty consecutive patients (all male; mean age 74.65 years) were treated by EVAR with percutaneous access and local anesthesia, from which 95% (19) presented with abdominal aortic aneurysm and 5% (1) common iliac aneurysm. All implants were sucessfully performed, with an initial endoleak rate of 10% (2), determined by one type 1a endoleak successfully corrected intra-operatively and one type 2a endoleak diagnosed in the first imaging control, which sealed spontaneously on the second control. Initial technical success for percutaneous closure was 97.5%, with one case reported of femoral pseudo-aneurism, posteriorly treated by percutaneous thrombin injection. Median length of stay was one day [1-10], with a mean follow-up of 11.4 months [1-36]. Both the re-intervention and mortality rate are 0% for the selected period. CONCLUSION: Our one day surgery model for the outpatient treatment of abdominal aortic aneurysm by the pEVAR technique is innovative, safe and effective, as long as the selection criteria are respected.info:eu-repo/semantics/publishedVersio

Total Luminal Volume Predicts Risk after Endovascular Aneurysm Repair

Objective: Large aneurysm diameter represents a well known predictor of late complications after endovascular aneurysm repair (EVAR). However, the role of the thrombus free lumen inside the abdominal aortic aneurysm (AAA) sac is not clear. It was hypothesised that greater luminal volume represents a relevant risk factor for late complications after EVAR. Methods: A retrospective cohort analysis was performed including all patients undergoing EVAR from 2005 to 2016 at a tertiary referral institution. Pre-operative AAA lumen volume was measured in centre lumen line reconstructions and patients were stratified into quartiles according to luminal volume. The primary endpoint was freedom from AAA related complications. Secondary endpoints were freedom from neck events (type 1A endoleak, migration >5 mm or any pre-emptive neck related intervention), iliac related events (type 1B endoleak or pre-emptive iliac related intervention), and overall survival. Results: Four hundred and four patients were included: 101 in the first quartile (Q1; <61 cm3). Patients with higher luminal volumes had wider, shorter, and more angulated proximal necks. There were more ruptured AAAs, more aorto-uni-iliac implanted devices and patients outside neck instructions for use in the 4th quartile. Five year freedom from AAA related complications was 79%, 66%, 58% and 56%, respectively (p = .007). At five years, freedom from neck related events was 86%, 84%, 73%, and 71%, respectively, for the four groups (p = .009), and freedom from iliac related events was 96%, 91%, 88%, and 88%, respectively (p = .335). On multivariable analysis, luminal volume was an independent predictor of late complications (Q4 vs. Q1 - hazard ratio: 1.91, 95% confidence interval 1.01-3.6, p = .046). Overall survival at five years was not affected by lumen volume (p = .75). Conclusion: AAA luminal volume represents an important risk factor for AAA related complications. This information may be considered when deciding tailoring surveillance protocols after EVAR. However, larger studies are needed to validate this hypothesis.info:eu-repo/semantics/publishedVersio

Body fat percentage is a major determinant of total bilirubin independently of UGT1A1*28 polymorphism in young obese

OBJECTIVES: Bilirubin has potential antioxidant and anti-inflammatory properties. The UGT1A1*28 polymorphism (TA repeats in the promoter region) is a major determinant of bilirubin levels and recent evidence suggests that raised adiposity may also be a contributing factor. We aimed to study the interaction between UGT1A1 polymorphism, hematological and anthropometric variables with total bilirubin levels in young individuals. METHODS: 350 obese (mean age of 11.6 years; 52% females) and 79 controls (mean age of 10.5 years; 59% females) were included. Total bilirubin and C-reactive protein (CRP) plasma levels, hemogram, anthropometric data and UGT1A1 polymorphism were determined. In a subgroup of 74 obese and 40 controls body composition was analyzed by dual-energy X-ray absorptiometry. RESULTS: The UGT1A1 genotype frequencies were 49.9%, 42.7% and 7.5% for 6/6, 6/7 and 7/7 genotypes, respectively. Patients with 7/7 genotype presented the highest total bilirubin levels, followed by 6/7 and 6/6 genotypes. Compared to controls, obese patients presented higher erythrocyte count, hematocrit, hemoglobin and CRP levels, but no differences in bilirubin or in UGT1A1 genotype distribution. Body fat percentage was inversely correlated with bilirubin in obese patients but not in controls. This inverse association was observed either in 6/7 or 6/6 genotype obese patients. UGT1A1 polymorphism and body fat percentage were the main factors affecting bilirubin levels within obese patients (linear regression analysis). CONCLUSION: In obese children and adolescents, body fat composition and UGT1A1 polymorphism are independent determinants of total bilirubin levels. Obese individuals with 6/6 UGT1A1 genotype and higher body fat mass may benefit from a closer clinical follow-up.This work was funded by FEDER funds through the Operational Competitiveness Programme – COMPETE and by National Funds through FCT – Fundação para a Ciência e a Tecnologia under the project FCOMP-01-0124-FEDER-028613 (PTDC/DTP-DES/0393/2012). A PhD grant was attributed to H. Nascimento by FCT (SFRH/BD/48060/2008). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript