Carotid artery endarterectomy : analysis of 100 consecutive cases

Os autores relatam sua experiência com as últimas 100 endarterectomias de carótida realizadas no HCPA de janeiro de 1993 a junho de 1997 sob anestesia geral e sem outro procedimento cirúrgico associado. Os pacientes foram avaliados quanto ao sexo, fatores de risco pré-operatórios, uso de remendo (patch) e derivação temporária (shunt), estenose hemodinâmica ou oclusão contralateral e complicações pós-operatórias imediatas. Foi utilizado o protocolo do Serviço de Cirurgia Vascular. O shunt foi indicado quando a mensuração da pressão retrógrada na carótida interna era 70%. Oitenta e dois casos apresentaram evento isquêmico ipsilateral prévio, e 18 eram assintomáticos. Utilizou-se patch em 13 e shunt em 15 pacientes. Vinte e um pacientes tinham DBPOC e 52 cardiopatia isquêmica, 32 eram diabéticos e 84 tinham HAS. No pós-operatório imediato 2 pacientes previamente sintomáticos (um acidente isquêmico transitório e um acidente vascular cerebral) desenvolveram AVC isquêmico ipsilateral. Para o controle da pressão arterial no pós-operatório, 27 pacientes necessitaram de nitroprussiato de sódio. Observou-se hematoma em 6 casos, cefaléia em 4, sem a presença de convulsões, e uma lesão de nervo periférico. Não ocorreu óbito nesta série. O índice de complicações neurológicas observado (2%), sem óbito, está dentro dos padrões internacionais e justificam o protocolo em uso.The outcome of 100 consecutive carotid endarterectomies performed in the HCPA, from january 1993 until june 1997 is analized. The patients were analyzed accordingly to sex, pre-operative risks, shunt and patch use, contralateral stenosis or occlusion and early post-operative complications. A predetermined protocol regarding shunt and patch use was established. The shunt was indicated when the retrograde pression in the lCA was lower than 50% of mean arterial pressure or < 40% without oscillations and the patch was indicated when the internaI carotid artery diameter was < 4 mm. Siexty two patients were males and 35females. Twenty three had bilateral hemodynamic stenosis or occlusion. An internaI shunt was used in 15 patients and patch in others 13. A total of 82 cases had an ischemic encephalic event (AIT or stroke) and 18 were asymptomatic. Twenty one patients had symptomatic pulmonary obstrutive disease, 52 patients had coronary symptoms, 32 had diabetes and 84 where receiving drugs to treat systemic hypertension. Two patients in the symptomatic group had postoperative stroke. To control postoperative hypertension 27 patients where treated with sodium nitroprussiate. Six hematomas and 4 severe headaches as part ofhyperperfusion syndrome where observed. One local nerve injury was detected. There was no obits in this group ofpatients. The lower index ofneurologic complications (2%) and the absence ofdeaths observed with our protocol are in accordance with international standards and justify its routine use

Superior mesenteric artery aneurysm

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Strategy to avoid vascular injuries in revision total hip arthroplasty with intrapelvic implants

Aims: Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components. Methods: Patients were defined as at risk to vascular injuries when components or cement migrated 5 mm or more beyond the ilioischial line in any of the pelvic incidences (anteroposterior and Judet view). In those patients, a serial investigation was initiated by a CT angiography, followed by a vascular surgeon evaluation. The investigation proceeded if necessary. The main goal was to assure a safe tissue plane between the hardware and the vessels. Results: In ten at-risk patients undergoing revision hip arthroplasty and submitted to our algorithm, six were recognized as being high risk to vascular injury during surgery. In those six high-risk patients, a preventive preoperative stent was implanted before the orthopaedic procedure. Four patients needed a second reinforcing stent to protect and to maintain the vessel anatomy deformed by the intrapelvic implants. Conclusion: The evaluation algorithm was useful to avoid blood vessels injury during revision total hip arthroplasty in high-risk patients

Efeitos do treinamento aeróbico e combinado na distância percorrida sem dor e na qualidade de vida relacionada à saúde em pacientes com doença arterial periférica : um ensaio clínico randomizado

Background: Decreased walking ability in patients with peripheral arterial disease is often a clinical problem and limits the quality of life and daily activities of these subjects. physical exercise is important in this scenario, as it improves both the daily walking distance and the ability to withstand intermittent claudication related to the limitations of the peripheral disease. Objectives: Our aim was to compare the effects of two types of exercise training (aerobic training and aerobic training combined with resistance exercises) on pain-free walking distance (PFWD) and health-related quality of life (HRQoL) in a sample composed of patients with peripheral artery disease (PAD). Methods: Twenty patients with claudication symptoms were randomized to either aerobic control (AC) N= 9, or combined training (CT) N= 8, (24 sixty-minute sessions, twice a week). The total walking distance until onset of pain due to claudication was assessed using the 6-minute walk test and HRQoL was measured using the WHOQOL-bref questionnaire (general and specific domains) at baseline and after training. We used generalized estimating equations (GEE) to assess the differences between groups for the PFWD and HRQoL domains, testing the main group and time effects and their respective interaction effects. P values < 0.05 were considered statistically significant. Results: Seventeen patients (mean age 63±9 years; 53% male) completed the study. Both groups experienced improvement in claudication, as reflected by a significant increase in PFWD: AC, 149 m to 299 m (P<0.001); CT, 156 m to 253 m (P<0.001). HRQoL domains also improved similarly in both groups (physical capacity, psychological aspects, and self-reported quality of life; P=0.001, P=0.003, and P=0.011 respectively). Conclusions: Both aerobic and combined training similarly improved PFWD and HRQoL in PAD patients. There are no advantages in adding strength training to conventional aerobic training. This study does not support the conclusion that combined training is a good strategy for these patients when compared with classic training.Contexto: A diminuição da capacidade de marcha em pacientes com doença arterial periférica é frequentemente um problema clínico e limita a qualidade de vida e as atividades diárias desses indivíduos. O exercício físico é importante nesse cenário, pois melhora tanto a distância caminhada diária quanto a capacidade de suportar a claudicação intermitente relacionada às limitações da doença periférica. Objetivos: Comparar os efeitos do treinamento aeróbico (TA) e do treinamento aeróbico combinado com exercícios de resistência (TC) na distância percorrida livre de dor (DPLD) e na qualidade de vida relacionada à saúde (QVRS) em pacientes com doença arterial periférica (DAP). Métodos: Vinte pacientes com sintomas de claudicação foram randomizados para TA ou TC. Os treinamentos foram realizados em 24 sessões, duas vezes por semana. A DPLD foi avaliada por meio do teste de caminhada de 6 minutos, e a QVRS foi medida pelo instrumento da avaliação de qualidade de vida da Organização Mundial da Saúde (WHOQOL-BREF), no início e após o treinamento. Para avaliar as diferenças entre os grupos para DPLD e os domínios da QVRS, foi utilizado o modelo de equações de estimativa generalizada, testando os efeitos principais do grupo e tempo, bem como os respectivos efeitos de interação. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Dezessete pacientes (idade média: 63±9 anos; 53% do sexo masculino) completaram o estudo. Ambos os grupos apresentaram melhora na claudicação, refletida por um aumento significativo na DPLD: grupo controle aeróbico - de 149 m para 299 m (P < 0,001); grupo de treinamento combinado - de 156 m para 253 m (P < 0,001). Os domínios da QVRS também melhoraram de forma semelhante em ambos os grupos (capacidade física, aspectos psicológicos e qualidade de vida autorreferida; P = 0,001, P = 0,003 e P = 0,011, respectivamente). Conclusões: Ambos os treinamentos melhoraram de forma semelhante a DPLD e a QVRS em pacientes com DAP. Não há vantagens em associar o treinamento de força ao treinamento aeróbico convencional. O estudo não permite concluir que o TC é uma boa estratégia para esses pacientes quando comparado ao treinamento clássico

AVALIAÇÃO DA FORÇA DE EXPANSÃO DE PROTÓTIPOS STENTS ARTERIAIS

Objective: Several metal stents have been developed in the last years. There are great&nbsp; differences concerning their mechanical properties. Aiming at evaluating the performance of the prototype stents, a device and a procedure to obtain curves of Expansion Power (F) X Relative Strain (ε) of these stents were developed.Materials and Methods: Three different stents were chosen to undergo compression analysis: the Talent stent, the X stent prototype, and the Z stent prototype. To determine the F X ε curves of the stents, the Force X Displacement curves of each stent were obtained with the compression device and, based on these figures, the resulting deformation was calculated.Results: The force level presented by the Talent stent was the highest (4.35 N for ε = 0.30) and the X stent prototype presented the lowest force level (0.19 N for ε = 0.30).Conclusions: The results presented show that a reformulation of mechanical characteristics of the X stent prototype is necessary for a more satisfactory performance. The main factors which make the force level presented by this prototype to be so low are its geometric configuration and the diameter of the thread used in its construction.Objetivos: Vários stents de metal foram desenvolvidos nos últimos anos. Há grandes diferenças entre as propriedades mecânicas dos mesmos. Buscando-se avaliar o desempenho de stents protótipos, foram desenvolvidos um equipamento e um procedimento para obtenção de curvas Força de Expansão (F) X Deformação Relativa (ε) dos mesmos.Materiais e Métodos: Três stents diferentes foram escolhidos para proceder a uma análise de compressão: o stent da Talent, o X stent protótipo e o Z stent protótipo. Para determinar as curvas de F X ε dos stents, obteve-se, primeiramente, a curva Força X Deslocamento dos mesmos com o auxílio do dispositivo de compressão construído e, a partir destes valores, calculou-se a deformação resultante.Resultados: O nível de forças apresentado pelo stent da Talent foi o maior (4,35 N para um ε = 0,30) e o X stent protótipo foi o que apresentou o menor nível de forças (0,19 N para um ε = 0,30).Conclusões: Os resultados apresentados mostram que uma reformulação nas características mecânicas do X stent protótipo é necessária para uma ação mais satisfatória do mesmo. Os principais fatores que levam a força de expansão apresentada por este protótipo a ser tão baixa são a sua configuração geométrica e o diâmetro do fio utilizado em sua construção

Aerobic exercise and telomere length in patients with systolic heart failure : protocol study for a randomized controlled trial

Background: Heart failure (HF) with reduced ejection fraction (HFrEF) is a syndrome that leads to fatigue and reduced functional capacity due to disease-related pathophysiological mechanisms. Aerobic exercise (AERO) plays a key role in improving HF outcomes, such as an increase in peak oxygen uptake (VO2peak). In addition, HF promotes cell senescence, which involves reducing telomere length. Several studies have shown that patients with a worse prognosis (i.e., reduced VO2 peak) also have shorter telomeres. However, the effects of AERO on telomere length in patients with HFrEF are still unknown. In an attempt to fill this gap, we designed a study to determine the effects of 16 weeks of aerobic training (32 sessions) on telomere length in HFrEF patients. Methods: In this single-center randomized controlled trial, men and women between 50 and 80 years old will be allocated into two different groups: a moderate-intensity aerobic training and a control grouTelomere length, functional capacity, echocardiographic variables, endothelial function, and walking ability will be assessed before and after the 16-week intervention period. Discussion: Understanding the role of physical exercise in biological aging in HFrEF patients is relevant. Due to cell senescence, these individuals have shown a shorter telomere length. AERO can delay biological aging according to a balance in oxidative stress through antioxidant action. Positive telomere length results are expected for the aerobic training group