ABSTRACT
Objective: To perform an analysis of the costs of treatment of varicose ulcers by radical surgery of varices and the use of Unna boot. Methods: Fifteen outpatients were selected to receive treatment of varicose ulcers with radical surgery and Unna boot. The total cost of treatment was calculated (hospitalization, surgery, dressings, and outpatient?s follow-up visits) and compared to the cost of clinical follow-up with daily simple dressing changes. Results: The proposed treatment was on average 55.71% more economical than the management with daily dressings (approximately US$452.32 versus US$1,021.39). Conclusion: Radical varicose vein surgery associated with the useof the Unna boot proved meaningly less expensive for the public health system than clinical follow-up with daily dressings.
Objetivo: Realizar uma análise de custo do tratamento da úlcera varicosa mediante cirurgia radical de varizes e uso de bota de Unna. Métodos: quinze pacientes foram selecionados ambulatorialmente para receber o tratamento da úlcera varicosa com cirurgia radical de varizes e bota de Unna, sendo o custo total do tratamento contabilizado (internação, cirurgia, curativos e retornos ambulatoriais) e comparado ao custo do acompanhamento clínico com curativos simples trocados diariamente. Resultados: O tratamento proposto foi em média 55,71% mais econômico que o manejo com curativos diários (R$ 717,84 x R$ 1.620,95 ou aproximadamente US$ 452.32 x US$ 1,021.39). Conclusão: O emprego da cirurgia radical de varizes associado ao uso de bota de Unna provou-se expressivamente menos dispendioso para a saúde pública do que o acompanhamento clínico com curativos diários.
Subject(s)
Public Health , Varicose Ulcer/surgery , Varicose Ulcer/economicsABSTRACT
OBJECTIVE: To evaluate the feasibility of using endovascular repair to treat penetrating arterial injuries with covered stents. Feasibility was examined according to the circumferential extent of the injury. INTRODUCTION: Surgical trauma often increases the risk of major morbidity and mortality associated with vascular injury, and endovascular repair has many advantages in such situations. METHODS: Twenty white male domestic pigs weighing 28-38 kg with controlled vascular injuries were divided into four equal groups according to the circumferential extent of their vascular lesion (i.e., no lesion, lesion <50 percent, lesion >50 percent, and complete lesion). The left common carotid artery was dissected with proximal and distal control, and this procedure was followed by controlled sectioning of the arterial wall. Local manual compression was applied for 10 min and was followed by endovascular repair with the placement of a 5x50 mm VIABHAN TM covered stent using the femoral approach. We also monitored additional variables, such as the duration of the procedures (the mean was 56.3 ± 19.1 min), ultrasound parameters (e.g., maximum arterial diameter, peak systolic and diastolic velocity, and resistance index), arteriography findings, and fluctuations in vital signs (e.g., cardiac output, arterial pressure, and central venous pressure). RESULTS: The experimental procedure was found to be feasible and reproducible. Repairs were successful in all animals in the control (no lesion) and <50 percent lesion groups. Success was also achieved in four out of five pigs in the >50 percent group and in one pig in the complete lesion group. DISCUSSION: The endovascular repair of an arterial injury is possible, but success depends on the circumferential extent of the arterial lesion. The present experimental model, which involved endovascular techniques, highlighted important factors that must be considered in future studies involving similar animals and materials.