ABSTRACT
OBJECTIVE: Prevention is the best treatment for cerebrovascular disease, which is why early diagnosis and the immediate treatment of carotid stenosis contribute significantly to reducing the incidence of stroke. Given its silent nature, 80% of stroke cases occur in asymptomatic individuals, emphasizing the importance of screening individuals with carotid stenosis and identifying high-risk groups for the disease. The aim of this study was to determine the prevalence and the most frequent risk factors for carotid stenosis. METHODS: A transversal study was conducted in the form of a stroke prevention campaign held on three nonconsecutive Saturdays. During the sessions, carotid stenosis diagnostic procedures were performed for 500 individuals aged 60 years or older who had systemic arterial hypertension and/or diabetes mellitus and/or coronary heart disease and/or a family history of stroke. RESULTS: The prevalence of carotid stenosis in the population studied was 7.4%, and the most frequent risk factors identified were mean age of 70 years, carotid bruit, peripheral obstructive arterial disease, coronary insufficiency and smoking. Independent predictive factors of carotid stenosis include the presence of carotid bruit or peripheral obstructive heart disease and/or coronary insufficiency. CONCLUSIONS: The population with peripheral obstructive heart disease and carotid bruit should undergo routine screening for carotid stenosis.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Carotid Stenosis/epidemiology , Age Distribution , Age Factors , Brazil/epidemiology , Carotid Stenosis/etiology , Carotid Stenosis , Epidemiologic MethodsABSTRACT
CONTEXTO: Quando se confecciona uma fístula arteriovenosa para hemodiálise (FAVH) autógena, é necessário que se aguarde a dilatação da veia em questão e o desenvolvimento de volume de fluxo mínimo, fenômeno chamado de maturação. Ainda hoje se discute qual o tempo necessário para ocorrer essa maturação. OBJETIVO: Avaliar a maturação de FAVH utilizando-se critérios ecográficos. MÉTODO: Entre maio de 2004 e 2005, 40 pacientes foram selecionados prospectivamente, sendo 23 homens (57,5%), com média de idade de 17,5±51,3 anos, com indicação de confecção de uma FAVH. Utilizou-se o aparelho Logic III® com transdutor de 10 MHz para a avaliação no pré-operatório e nos 7º, 14º, 21º e 28º dias de pós-operatório. Os critérios para a maturação após a cirurgia foram: veia com diâmetro médio maior que 4 mm e volume de fluxo maior que 400 mL/min. RESULTADOS: O diâmetro médio pré-operatório foi de 3,24±1,43 e 3,71±1,37 mm para fístulas de punho e de cotovelo, respectivamente. O diâmetro final foi de 5,01±0,87 mm para as FAVH de punho (p = 0,006) e de 6,15±1,16 mm para as FAVH de cotovelo (p = 0,95). O volume de fluxo no 7º dia pós-operatório foi de 493,63±257,49 mL/min e 976,33±332,90 mL/min para as FAVH de punho e cotovelo, respectivamente. Ao final do estudo, foi calculado o valor de 556,81±288,42 mL/min nas FAVH de punho (p < 0,05) e de 1031,62±614,812 mL/min nas FAVH de cotovelo. Baseados nos dois critérios, a maturação ocorreu em 57,1% das fístulas de punho e em 100% das fístulas de cotovelo após a 1ª semana. Após 4 semanas, 67,9% das fístulas de punho e 100 por cento das fístulas de cotovelo apresentaram maturação. CONCLUSÃO: A maioria das FAVH de cotovelo apresentou diâmetro e fluxo adequados para punção logo após a 1ª semana de pós-operatório. Para as FAVH de punho, houve melhora progressiva dos padrões de maturação com o passar das semanas, sugerindo que essas FAVH devem ser puncionadas preferencialmente após...
BACKGROUND: When a hemodialysis arteriovenous fistula (HAVF) is created, it is important to wait for venous dilatation and volume flow increase through the HAVF, a phenomenon called maturation. There is still some controversy as to the exact time required for this maturation to occur. OBJECTIVE: To evaluate the time required for HAVF maturation using ultrasound criteria. METHOD: From May 2004 through May 2005, 40 patients were prospectively selected. The sample was comprised of 23 men (57.5%), mean age of 51.3±17.5 years, with indication of HAVF creation. Logic III® ultrasound with 10 MHz transducer probe was used for pre- and postoperative evaluation 7, 14, 21 and 28 days after the procedure. Criteria for maturation after the procedure were vein diameter larger than 4 mm and volume flow larger than 400 mL/min. RESULTS: Preoperative mean diameter was 3.24±1.43 and 3.71±1.37 mm for fist and elbow fistula, respectively. Final diameter of the fist HAVF was 5.01±0.87 mm (p = 0.006) and 6.15±1.16 mm for the elbow HAVF (p = 0.95). Flow volume in the 7th postoperative day was 493.63±257.49 and 976.33±332.90 mL/min, respectively, for the fist and elbow HAVF. At the end of the study, the value of 556.81±288.42 mL/min was calculated for the fist HAVF (p < 0.05) and 1,031.62±614.812 mL/min for the elbow HAVF. Based on both cut-off values, maturation occurred in 57.1% of the fist fistula and in 100% of the elbow fistula after the first week. After 4 weeks, 67.9% of the fist HAVF and 100% of the elbow HAVF presented maturation. CONCLUSION: Most elbow HAVF showed adequate diameter and flow volume for puncture 1 week after the procedure. For the fist fistula, gradual maturation occurred throughout the weeks, suggesting that these HAVF should be punctured 4 weeks after the surgery.