Comparison of common carotid artery intima-media thickness between Brazilian Euro-descendants and Afro-descendants with atherosclerosis risk factors

OBJECTIVE: To compare common carotid intima-media thickness (IMT) between the two major Brazilian ethnic groups (those of African descent and those of European descent) among individuals with one or more risk factors for atherosclerotic disease. METHOD: Two hundred and six patients with one or more risk factors for atherosclerotic disease were evaluated in a cross-sectional study in which their clinical, ethnic and Demographic characteristics were collected. All patients underwent duplex ultrasound examination of their carotid vessels to obtain IMT measurements. RESULTS: One hundred and fifty-three patients (74.3%) had a carotid IMT greater than 1.0 mm at one or more point of measurement in at least one common carotid artery. There was a significant correlation between older age and mean carotid wall thickness (R=0.479 / P<0.01). Multivariate analysis identified male sex, arterial hypertension and older age as variables associated with increased IMT (P<0.05 for all variables). When IMT was compared between the two ethnic groups in this study, no significant differences were noted. Euro-descendants and Afro-descendants had similar IMT values, even when the groups were stratified by degree of IMT (normal vs. increased) and presence of stroke and/or transient ischemic attack (yes vs. no). CONCLUSIONS: The risk factors associated with increased common carotid artery IMT in Brazilian individuals are similar to those in previously described populations. No differences were observed between the two main Brazilian ethnic groups. Longitudinal studies are required for a better evaluation of the incidence, etiologic factors and evolution of carotid intimomedial thickening in this population.

A practical protocol to measure common carotid artery intima-media thickness

OBJECTIVE: To describe and test a practical protocol to measure common carotid intima-media thickness that uses the combined values of two longitudinal examination angles to increase sensitivity. METHOD: Between February and September 2005, 206 patients underwent duplex scan examination of carotid vessels, and the intima-media thickness of 407 common carotids were measured in three angles: transversal, longitudinal posterolateral, and anterolateral, with three intima-media thickness measurements for each near and far wall. In addition to numbers obtained from the three angles of measurement, a fourth visual perspective was obtained by combining the intima-media thickness results of posterolateral and anterolateral longitudinal views and considering the thickest wall measurement. RESULTS: Two hundred seventy (66.3 percent) carotid arteries had an intima-media thickness thicker than 1mm. The mean intima-media thickness values achieved by the different incidences were 1.26±0.6mm (transversal), 1.17±0.54mm (longitudinal anterolateral), and 1.18±0.58mm (longitudinal posterolateral). A significant difference in intima-media thickness measurement values was observed when the three angles of examination plus the combined positive results of both longitudinal angles were compared by ANOVA (P=0.005). The LSD Post-Hoc test determined that the combined longitudinal view results were similar to the transversal views (P=0.28) and had greater intima-media thickness means than isolated anterolateral or posterolateral longitudinal views (P=0.02 and 0.05, respectively). CONCLUSIONS: The protocol presented is a practical method for obtaining common carotid artery intima-media thickness measurements. The combined longitudinal posterolateral and anterolateral longitudinal views provide a more sensitive evaluation of the inner layers of the carotid walls than isolated longitudinal views.

Late results of catheter-directed recombinant tissue plasminogen activator fibrinolytic therapy of iliofemoral deep venous thrombosis

PURPOSE: To evaluate the efficacy of catheter-directed low-dose recombinant tissue-type plasminogen activator infusion in the treatment of iliofemoral deep venous thrombosis and prevention of post-thrombotic syndrome. METHOD: Eighteen patients (out of 260 evaluated) with acute iliofemoral deep venous thrombosis and no previous evidence of venous insufficiency were prospectively selected for thrombolytic therapy. Catheter-directed low-dose recombinant tissue-type plasminogen activator (1 mg/h) was infused into the thrombotic segments. RESULTS: Effective fibrinolysis was achieved in 14 of 18 cases, with correlation between effective fibrinolysis and major/complete resolution of acute signs and symptoms (P <.01). There were no episodes of major complications. Four patients presented with early rethrombosis (1 to 8 weeks). Individuals were followed for a period up to 131 weeks (average, 85.2). The incidence of clinical signs and symptoms of venous insufficiency and duplex-scan findings of valvular reflux was significantly lower in the patients in which lytic therapy succeeded and patency was kept, compared with patients experiencing acute therapeutic failure or rethrombosis (P <.01). CONCLUSIONS: Low-dose recombinant tissue-type plasminogen activator fibrinolytic therapy is safe and effective in the treatment of acute iliofemoral venous thrombosis. The late evolution as revealed clinically and by ultrasound was superior in patients for whom lytic therapy was effective.

OBJETIVOS: Avaliar a eficácia da infusão seletiva por cateter do ativador de plasminogênio tecidual recombinante em baixas doses no tratamento da trombose venosa iliacofemoral e na prevenção da síndrome pós-trombótica. MÉTODO: Dezoito pacientes (de 260 avaliados) portadores de trombose venosa profunda iliacofemoral sem evidência prévia de insuficiência venosa foram selecionados para terapia fibrinolítica e submetidos a infusão seletiva por cateter do ativador de plasminogênio tecidual recombinante na dose de 1mg/dl nos segmentos venosos trombóticos. RESULTADOS: Quatorze pacientes apresentaram fibrinólise efetiva; observamos correlação entre o grau de melhora clínica observado e a redução percentual do volume trombótico (P<.01). Não houve episódios de complicações graves. Quatro pacientes apresentaram retrombose precoce (1 a 8 semanas). Os pacientes foram seguidos por um período de até 131 semanas (média 85.2). A incidência de sinais e sintomas clínicos de insuficiência venosa e os achados ecográficos de refluxo valvular foram significativamente menores nos pacientes em que a terapia fibrinolítica foi efetiva e a perviedade mantida ao longo do período de seguimento, na comparação com os casos de falha aguda ou de retrombose precoce (P<.01). CONCLUSÕES: A terapia fibrinolítica da trombose venosa iliacofemoral com ativador de plasminogênio tecidual recombinante seletivo em baixas doses demonstrou-se eficaz e segura. A evolução clínica e ecográfica tardia foi superior nos pacientes em que a terapia lítica foi efetiva.

Doença arterial obstrutiva periférica: que atenção temos dispensado à abordagem clínica dos pacientes? / Peripheral obstructive arterial disease: what kind of clinical treatment are we recommending to our patients?

OBJETIVO: Avaliar como pacientes com doença arterial obstrutiva periférica têm sido tratados, em nosso meio, com relação aos fatores de risco e comorbidades. MÉTODO: Questionário sobre pesquisa e tratamento da dislipidemia, diabetes, exercício, uso de anti-plaquetários, tabagismo e hipertensão arterial no paciente com doença arterial obstrutiva periférica foi aplicado entre os médicos presentes na reunião mensal de março de 2004 da Sociedade Brasileira de Angiologia e Cirurgia Vascular - Regional São Paulo. RESULTADOS: Dos 102 questionários distribuídos, 75 foram respondidos (taxa de resposta de 73,5 por cento). Entre os consultados, 82 por cento pesquisam rotineiramente perfil lipídico e 20 por cento visam alvo de LDL-colesterol abaixo de 100 mg/dl; 94 por cento realizam pesquisa para diabetes melito; 97 por cento recomendam exercício; 79 por cento prescrevem aspirina; 97 por cento aconselham que os pacientes parem de fumar e 60 por cento se restringem ao aconselhamento isoladamente; 18 por cento não realizam a medida da pressão arterial durante a consulta e 19 por cento visam alvo pressórico de 130 x 80 mmHg. Considerando todas as avaliações em conjunto - intervenção no estilo de vida, no sentido de parar de fumar, orientação de exercícios, uso de anti-plaquetários, realização de pesquisa para diabetes melito, controle rigoroso da pressão arterial e lípides - observou-se que 7 por cento dos entrevistados seguem todas essas recomendações como uma rotina estabelecida. CONCLUSÃO: O presente estudo demonstrou que, em nosso meio, a pesquisa e o tratamento dos fatores de risco e comorbidades nos pacientes com doença arterial obstrutiva periférica estão sendo sub-realizados.

OBJECTIVE: The purpose of this survey was to evaluate how patients with peripheral obstructive arterial disease have been treated, concerning risk factors and comorbidities. METHOD: A questionnaire was applied to all physicians attending the monthly meeting of the Brazilian Society of Angiology and Vascular Surgery - São Paulo Section. Questions were asked about the following major risk factors: treatment of dyslipidemia, diabetes, exercise regimens, antiplatelet therapy, smoking and arterial hypertension. RESULTS: Of the 102 questionnaires, 75 were answered (response rate of 73.5 percent). Of these, 82 percent routinely measure cholesterol levels and 20 percent aim at an LDL cholesterol target below 100 mg/dl; 94 percent perform a screening for diabetes mellitus; 97 percent recommend patients to an exercise program; 79 percent prescribe aspirin; 97 percent recommend patients to quit smoking and 60 percent only do it by counseling; 18 percent do not measure blood pressure and 19 percent have a target pressure of 130 x 80 mmHg. Considering the recommendations as a whole - lifestyle intervention in order to quit smoking, aerobic exercise, prescription of antiplatelet therapy, screening for diabetes mellitus, rigorous control of blood pressure and lipids - it was observed that 7 percent of interviewees follow all of them as an established routine. CONCLUSION: The present study showed that patients with peripheral arterial disease are currently undertreated with regard to the screening and treatment of risk factors and comorbidities.