ABSTRACT
JUSTIFICATIVA E OBJETIVOS: A expectativa de vida está aumentando no mundo. Mais idosos estão se submetendo a procedimentos endovasculares percutâneos, no entanto a ocorrênciade complicações vasculares na área de acesso pode afetar o prognóstico destes pacientes. O objetivo deste estudo foi comparar as taxas de complicações vasculares na área de acesso femoral em idosos submetidos à hemostasia, mecânica ou clássica da artériafemoral após procedimentos percutâneos. MÉTODO: Estudo prospectivo, aleatório, 1:1, que envolveu 110 pacientes recrutados entre novembro de 2009 e dezembrode 2010. Foram avaliadas as seguintes complicações vasculares: hematoma, equimose, fístula arteriovenosa, pseudoaneurisma, hematoma retroperitoneal e oclusão vascular periférica. P < 0,05 foi considerado estatisticamente significante. RESULTADOS: Considerando os grupos de compressão manual e mecânica respectivamente: a média de idade foi 69,6 ± 7,3 versus 67,8 ± 6,7 anos p = 0,2. As taxas de complicações vasculares maiores na fase hospitalar (0% versus 1,8%, p = 1,0) e no seguimento de sete dias (0% versus 1,8%, p = 0.5). No seguimento clínico de sete dias foi observado que a taxa total de complicações vasculares foi maior no grupo da compressão manual (64% versus 41,8%, p = 0.02) bem como a taxa de pacientes com complicações vasculares nessa técnica (48% versus 27,3%, p = 0,03). A taxa de complicações vasculares menores não foi diferente para os grupos nos dois períodos de observação. CONCLUSÃO: Não houve diferença nas taxas de complicações vasculares (maior ou menor) entre as técnicas hemostáticas. No seguimento de sete dias, a taxa total de complicações vasculares e de pacientes com estas complicações foi menor no uso da técnica mecânica.
BACKGROUND AND OBJECTIVES: Life expectancy is increasing worldwide. More elderly people are undergoing percutaneous endovascular procedures and the occurrence of vascular complications in the site access can adversely affect the patient's prognosis. This study to compare the rates of vascular complicationsin elderly patients submitted to mechanical or classical hemostasis of the femoral artery after percutaneous procedures. METHOD: A prospective, randomized, 1:1 study, which involved 110 patients, recruited between November/09 and December/10. The following vascular complications were assessed: hematoma, ecchymosis, arteriovenous fistula, pseudoaneurysm, retroperitoneal hematoma, peripheral vascular occlusion. Was considered to be statically significant p < 0.05. RESULTS: Considering manual and mechanical compression groups respectively: the mean age was 69.6 ± 7.3 v 67.8 ± 6.7 years, p = 0.2. The rates of major vascular complications were in the hospital phase (0% versus 1.8%, p = 1.0) and the seven days follow-up (0% versus 1.8%, p = 0.5). It was observed in the clinical follow-up after seven days that the total rate of vascular complications was higher in the manual compression group (64%versus 41.8%, p = 0.02), as was the rate of patients who suffered complications with this technique (48% versus 27.3%, p = 0.03).The rate of minor vascular complications was not different for the groups in the two periods of observation. CONCLUSION: There was no difference in the rates of vascular complications (major or minor) between the hemostatics techniques. At seven day follow-up the total rates of vascular complications and the number of patients with vascular complications were smaller in the mechanical technique.
Subject(s)
Humans , Male , Female , Aged , Aged , Hemostatic TechniquesABSTRACT
OBJECTIVE: Evaluation of inter and intraobserver reproducibility of by the visual method interpretation of cineangiogram in a clinically based context. METHODS: Five interventional cardiologists analyzed 11 segments of 8 coronary cineangiograms at a two month apart sessions. The percent luminal reduction by the lesions were analyzed by two different classifications: in one (A) the lesions were graded in 0 percent = absent, 1-50 percent = mild, 51 - 69 = moderate, and ü 70 percent = severe; the other classification (B) was a ichotomic one : <70 percent = nonsignificant and ü 70 percent=significant lesions. The agreement were measured by the kappa (k) index. RESULTS: Interobserver agreement was moderate for classification A (1st measurement, k = 0.36 ó 0.63, km = 0.49; 2nd measurement, k = 0.39-0.68, km = 0.52) and good for classification B (1st measurement, k = 0.55-0.73, km = 0.63; 2nd measurement, k = 0.37-0.82, km = 0.61). Intraobserver levels of agreement were k = 0.57-0.95 for classification A and 0.62-1.0 for classification B. CONCLUSION: The higher level of reproducibility obtained by adopting the dichotomous criteria usually considered for ischemic limits demonstrates that in the present clinical context, the reliability of the simple visual method is adequate for the identification of patients with clinically significant lesions and candidates for myocardial revascularization procedures.