Tratamento endovascular de doença oclusiva venosa central com fístula arteriovenosa funcionante / Endovascular treatment of central vein occlusion in patients with functioning arteriovenous fistulas

Resumo Contexto A maior sobrevida dos doentes dialíticos somada à incapacidade de obtenção de órgãos suficientes para atender a demanda, bem como à dificuldade de acesso aos serviços de saúde, levou ao aumento da fila para transplante e ao prolongamento do tempo de utilização do acesso venoso central para hemodiálise. A etiologia mais comum de estenose de veia central é o acesso venoso central prolongado, pelas lesões intimais decorrentes da presença do cateter. Objetivos Avaliar resultados de angioplastia para tratamento de doença oclusiva venosa central com fístula arteriovenosa periférica funcionante. Métodos Estudo tipo coorte retrospectivo com revisão de prontuários de 47 doentes com lesões estenóticas ou oclusivas. A avaliação dos doentes foi realizada em 30 dias, 6 meses e 1 ano após a recanalização ou correção da estenose com ATP ou ATP/aplicação de stent. Resultados Lesões estenóticas foram encontradas em 25 doentes (53%), e oclusões, em 22 (47%) doentes. A angioplastia percutânea transluminal (ATP) com stent foi utilizada em 64% dos doentes, e angioplastia isolada com balão, em 36% deles. A análise de resultados clínicos mostrou elevada taxa de melhora clínica precoce (30 dias) em 82% dos doentes (intervalo de confiança [IC] 71-93%). Após 1 ano de seguimento, a taxa de perviedade primária foi de 57%, e a taxa de perviedade primária assistida foi de 72% (IC 57-84%). Conclusão O tratamento endovascular das estenoses ou oclusões de veia central sugere melhora clínica dos sintomas e taxas adequadas de perviedade no período de 1 ano, apesar da limitação no tamanho amostral.

Abstract Background The increased survival of dialysis patients and the inability to obtain sufficient organs to meet demand for transplantation, compounded by poor access to health services, have caused the transplant waiting lists to grow, extending the time spent using central venous accesses for hemodialysis. The most common etiology of central vein stenosis is prolonged central venous access, due to intimal injuries caused by the presence of the catheter. Objectives To assess the results of angioplasty to treat central vein occlusion in patients with functioning peripheral arteriovenous fistulas. Methods Retrospective cohort study with review of medical records from 47 patients with stenotic or occlusive lesions. Patients were assessed at 30 days, 6 months, and 1 year after recanalization or correction of stenosis with transluminal percutaneous angioplasty (TPA) or TPA/stenting. Results Stenotic lesions were detected in 25 patients (53%) and occlusions were found in 22 (47%) patients. TPA with stenting was used in 64% of patients and balloon angioplasty in isolation was used in 36%. Analysis of clinical results showed a high rate of early clinical improvement (30 days), seen in 82% of patients (confidence interval [CI] 71-93%). After 1 year of follow-up, the primary patency rate was 57% and the assisted primary patency rate was 72% (CI 57-84%). Conclusions Endovascular treatment of central vein stenosis or occlusions suggests clinical improvement of symptoms and adequate rates of patency at 1 year, notwithstanding the limited sample size.

Resultados en el corto y mediano plazo del tratamiento endovascular en la enfermedad arterial obstructiva infrapoplítea en pacientes con isquemia crítica de una extremidad / Short to midterm results after endovascular approach in critical limb isquemia in patients with below-the-knee arterial disease

Resumen Objetivo: Mostrar los resultados en el corto y mediano plazo del tratamiento endovascular de angioplastia transluminal percutánea (ATP) con balón en pacientes en estado de isquemia crítica por enfermedad arterial obstructiva infrapoplítea. Materiales y Método: Estudio descriptivo, observacional, retrospectivo. Se incluyeron los pacientes hospitalizados entre 2009 y 2018 por isquemia crítica Fontaine III o IV sometidos a una ATP del territorio infrapoplíteo. Se observó como objetivos primarios la preservación de la extremidad afectada y la mortalidad posoperatoria a un año plazo, y como objetivos secundarios los procedimientos adicionales en pacientes con lesiones o necrosis distales, estadía hospitalaria, complicaciones posoperatorias y necesidad de reintervención. Resultados: Se incluyeron 42 pacientes con un promedio de edad de 66 años (46-82), con importantes comorbilidades. Un 83,3% ingresó en etapa Fontaine IV. En 16 casos se realizó una angioplastia percutánea en más de una arteria. No se colocó stents. Se presentaron complicaciones en 3 pacientes, 2 requirieron una amputación mayor y en otro se debió efectuar un nuevo procedimiento endovascular de rescate. La estadía hospitalaria promedio fue 22 días. No hubo mortalidad precoz posprocedimiento. La mortalidad global a un año fue 9,5%. A todos los pacientes en etapa Fontaine IV se les efectuó algún procedimiento adicional, a 31 una amputación menor, 3 cerraron sus lesiones por segunda intención y en otro se realizó un injerto dermo-epidérmico. De los 35 pacientes con seguimiento, 77% preservó su extremidad a un año. Conclusión: La reparación endovascular mediante una angioplastia percutánea en estos casos es un procedimiento seguro y tiene una alta tasa de preservación de la extremidad inicial a un año de seguimiento.

Aim: Show initial and midterms results of endovascular Percutaneous Transluminal Angioplasty (PTA) in critical limb isquemia (CLI) patients caused by below-the-knee arterial disease. Materials and Method: Observational, descriptive and retrospective study. 42 CLI patients admitted in our hospital from 2009 until 2018 with Fontaine III or IV treated by PTA in infrapopliteal arteries were analyzed, collecting demographic, clinical and surgical characteristics, additional procedures in Fontaine IV, hospital stay, postoperative complications, need of reintervention, limb preservation and mortality with one year follow-up after procedure. Results: 42 patients, average age 66 year-old (46-82), with significant comorbidities. Fontaine IV stage patients were 83.3%. In 16 cases more than one artery was intervened. No stent revascularization was performed. Complications occurred in 3 patients, 2 required major amputation and an urgent endovascular reintervention was required in another. Average hospital stay was 22 days with no post-operative mortality. One-year global mortality was 9.5 One-year follow-up in 35 patients shows that 77% preserved their limb. Conclusión: Percutaneous transluminal angioplasty procedure in this patients has a high rate of limb preservation in a one-year follow-up. There was no post-operative mortality.

The direct first pass aspiration technique in the treatment of acute ischemic stroke resulting from large vessel occlusions / Técnica de aspiração primária no tratamento do acidente vascular cerebral isquêmico por oclusões de grandes vasos

ABSTRACT Mechanical thrombectomy using stent retrievers is the standard treatment for acute ischemic stroke that results from large vessel occlusions. The direct aspiration first pass technique (ADAPT) has been proposed as an efficient, fast, and cost-effective thrombectomy strategy. The aim of this study was to assess the safety and efficacy of ADAPT. Methods Recanalization was assessed using the modified thrombolysis in cerebral infarction (mTICI) score. Neurological outcomes were assessed using the National Institutes of Health Stroke Scale and modified Rankin Scale. Results Fifteen patients were evaluated. The mTICI score was 2b-3 in 80%, and it was 3 in 60% of patients. No intracranial hemorrhage was seen. At three months, modified Rankin Scale scores ≤ 2 were observed in 60% of patients and the mortality rate was 13.3%. Conclusions The ADAPT appears to be a safe, effective, and fast recanalization strategy for treatment of acute ischemic stroke resulting from large vessel occlusions.

RESUMO A trombectomia mecânica com stent retrievers é o tratamento padrão ouro do acidente vascular cerebral isquêmico agudo (AVCi) por oclusão de grandes artérias. A técnica de aspiração primária (ADAPT) tem sido proposta como uma estratégia de trombectomia rápida e com boa custo-efetividade. O objetivo deste estudo foi avaliar a segurança e eficácia da técnica ADAPT. Métodos A recanalização foi avaliada utilizando a escala mTICI. Os desfechos neurológicos foram avaliados utilizando as escalas do NIHSS e mRS. Resultados Quinze pacientes foram avaliados. Foram obtidas taxas de mTICI = 2b-3 em 80% e TICI = 3 em 60% dos pacientes. Não ocorreram hemorragias intracranianas. Em 3 meses as taxas de mRS≤2 e mortalidade foram respectivamente 60% e 13.3%. Conclusão A técnica ADAPT parece ser uma estratégia de recanalização rápida, segura e efetiva para o tratamento do AVC por oclusão de grandes artérias.

Avanços nos materiais e no tratamento endovascular de oclusões arteriais crônicas totais: um relato de caso / Advances in materials and endovascular treatment of chronic total arterial occlusions: a case report

As oclusões arteriais crônicas totais com forte componente cálcico são ainda nos dias atuais, um fator muitas vezes limitante para o tratamento endovascular devido à dificuldade em transpor estas lesões com fios-guia e cateteres habitualmente utilizados. Revisamos a literatura e descrevemos um caso de tratamento endovascular de uma oclusão total de artéria ilíaca externa, onde o uso de novos materiais desenvolvidos especificamente para o tratamento deste tipo de lesão foi determinante para o sucesso do caso.

Chronic arterial occlusions with great calcium component are usually a factor of limitation to endovascular treatment to the difficulty to transpose these lesions with guidewires and catheters commonly used. We reviewed the literature and described a case of endovascular treatment of a total occlusion of external iliac artery, where the use of new materials developed specifically to the treatment of such injuries was critical to the success of the case.

The effect of femoral and popliteal percutaneous transluminal balloon angioplasty on patients' quality of life

CONTEXT AND OBJECTIVE: Peripheral arterial occlusive disease (PAOD) is a prevalent atherosclerotic disorder characterized by limb pain on exertion, limb loss and a high mortality rate. Because of its chronic nature, it often has a negative impact on patients' quality of life (QOL). This study aimed to assess QOL among patients with PAOD that was treated by endovascular intervention using femoral and popliteal percutaneous transluminal balloon angioplasty (PTBA). DESIGN AND SETTING: This study was local, prospective and longitudinal. It was carried at the Second Department of Internal Medicine of Charles University Hospital in Hradec Kralove, Czech Republic. METHODS: Thirty PAOD patients (20 male and 10 female) were treated by endovascular intervention using femoral and popliteal PTBA. The Czech version of the international generic European Quality of Life Questionnaire (EQ-5D) was applied. RESULTS: The statistical evaluation demonstrated that QOL presented highly significant statistical dependence on femoral and popliteal PTBA (p < 0.0001). CONCLUSION: The results showed that femoral and popliteal PTBA had a highly positive effect on the QOL of patients with PAOD.

CONTEXTO E OBJETIVO: Doença arterial oclusiva periférica (DAOP) é uma desordem aterosclerótica prevalente, caracterizada por dor esforço do membro, perda do membro e alta taxa de mortalidade. Devido à sua natureza crônica, freqüentemente tem impacto negativo na qualidade de vida (QV) dos pacientes. Este estudo objetivou avaliar a QV entre pacientes com DAOP tratada por intervenção endovascular usando angioplastia com balão transluminal femoral e poplítea (ABT). TIPO DE ESTUDO E LOCAL: Este estudo local, prospectivo e longitudinal foi realizado no Segundo Departamento de Medicina Interna do Charles University Hospital em Hradec Kralove, República Checa. MÉTODOS: 30 pacientes com DAOP (20 homens) foram tratados por intervenção endovascular usando ABT femoral e poplítea. A versão checa do Questionário Europeu de Qualidade de Vida (EQ-5D) foi aplicada. RESULTADOS: A avaliação estatística demonstrou que a QV apresentou dependência altamente significativa da ABT femoral e poplítea (p < 0,0001). CONCLUSÃO: Os resultados mostraram que a ABT femoral e poplítea teve efeito altamente positivo na QV dos pacientes com DAOP.

A New Technique for Superselective Catheterization of Arteries: Preshaping of a Micro-Guide Wire into a Shepherd's Hook Form

OBJECTIVE: We wanted to introduce a new technique for superselective catheterization of arteries with preshaping of a micro-guide wire into a shepherd's hook form, and this is useful for superselection of small arteries branching at an acute angle from a large parent artery for the treatment of tumors and hemorrhages. MATERIALS AND METHODS: We developed a superselective catheterization technique by using preshaping of a micro-guide wire into a shepherd's hook form. We encountered six patients in our practice for whom we failed to catheterize the small tumor-feeding arteries that branched at an acute angle from wide parent arteries during chemoembolization of hepatocellular carcinoma; the parent arteries were the right inferior phrenic artery (n = 4) and the left gastric artery (n = 1) from the celiac axis with celiac stenosis due to compression by the median arcuate ligament and the proper hepatic artery from the gastroduodenal artery (n = 1) in a patient who had celiac axis occlusion with collateral circulation via the pancreaticoduodenal arcade from the superior mesenteric artery. In these consecutive six patients, we tested the usefulness of this new technique with employing preshaping of a micro-guide wire into a shepherd's hook form for superselective catheterization of targeted vessels. RESULTS: The target arteries were successfully catheterized and satisfactory transcatheter arterial chemoembolization was performed in all six patients. There were no significant complications such as arterial dissection. CONCLUSION: We developed a technique that is effective for superselection of vessels with preshaping of micro-guide wire into a shepherd's hook form, and we successfully applied it during chemoembolization of hepatocellular carcinoma. This technique can be useful for superselection of small arteries that branch from a large parent artery at acute angles for the treatment of tumors and hemorrhages.

Stent Placement for Chronic Iliac Arterial Occlusive Disease: the Results of 10 Years Experience in a Single Institution

OBJECTIVE: We wanted to retrospectively evaluate the long-term therapeutic results of iliac arterial stent placement that was done in a single institution for 10 years. MATERIALS AND METHODS: From May 1994 to April 2004, 206 patients who underwent iliac arterial stent placement (mean age; 64+/-8.8) were followed up for evaluating the long term stent patency. Combined or subsequent bypass surgery was performed in 72 patients. The follow up period ranged from one month to 120 months (mean; 31+/-25.2 months). The factors that were analyzed for their effect on the patency of stents were age, the stent type and diameter, the lesion site, lesion shape, lesion length, the Society of Cardiovascular and Interventinal Radiology criteria, the total run off scores, the Fontaine stage and the cardiovascular risk factors (diabetes mellitus, hypertension and smoking). Follow-up included angiography and/or CT angiography, color Doppler sonography and clinical evaluation with the ankle-brachial index. RESULTS: Two hundred and eighty-four stents were placed in 249 limbs of 203 patients. The technical success rate was 98% (203/206). The primary patency rates of the stents at 3, 5, 7 and 10 year were 87%, 83%, 61% and 49%, respectively. One hundred seventy-seven patients maintained the primary stent patency until the final follow up and 26 patients showed stenosis or obstruction during the follow up. Secondary intervention was performed in thirteen patients. Lesions in the external iliac artery (EIA) or lesions in both the common iliac artery (CIA) and EIA were a poor prognostic factor for stent patency. The run off score and stent diameter also showed statistically significant influence on stent patency. The overall complication rate was 6%. CONCLUSION: Iliac arterial stent placement is a safe treatment with favorable long term patency. Lesions in the EIA or lesions in both the EIA and CIA, poor run off vessels and a stent having the same or a larger diameter than 10 mm were the poor prognostic factors for long term stent patency.

Oclusión aórtica aguda: una grave emergencia vascular de difícil manejo / Acute abdominal aorta occlusion: difficult management of a serious vascular emergency

Introducción: La oclusión aguda de la aorta abdominal es un evento poco frecuente pero que constituye una real emergencia vascular, siendo potencialmente catastrófica, desde el punto de vista de la morbilidad y mortalidad, si ésta no es tratada precozmente y en forma agresiva desde el punto de vista quirúrgico. En nuestro medio sólo existen dos publicaciones con sólo ocho casos en total en un lapso de cuatro años, motivo por el cual en este reporte se describen dos casos operados en nuestro servicio. Material y Método: Se trata de dos casos clínicos que presentaron oclusión aguda de la aorta abdominal de tipo trombótica secundaria a enfermedad ateroesclerótica, en que ambos requirieron de revasculación aórtica. El primero, aórtica simple acompañado de trombectomía de la aorta proximal y el segundo revascularización aórtica compleja. Resultados: El primer caso, sobrevive y no presenta complicaciones. El segundo caso, fallece a los 18 días del postoperatorio debido a un accidente vascular hemorrágico. Discusión: La oclusión aórtica aguda es una emergencia vascular poco frecuente cuyas causas son principalmente por embolía y enfermedad ateroesclerótica subyacente. Afecta de preferencia a pacientes en edad avanzada y su diagnóstico debe ser sospechado por la clínica, ya que se caracteriza por signos de isquemia aguda de ambas extremidades inferiores. Sin embargo, hay un grupo de pacientes cuya sintomatología, hace difícil plantear el diagnóstico ya que puede simular un cuadro neurológico, una insuficiencia renal o un abdomen agudo quirúrgico por isquemia intestinal. El diagnóstico puede ser confirmado por la Tomografía Computarizada, pero es fundamental la Angiografía, a fin de definir su localización y la extensión de la oclusión para poder planear en buena forma el tratamiento quirúrgico, el cual debe ser precoz y agresivo cuando se requiere una revascularización. Aún así la morbimortalidad sigue siendo alta. Como conclusión, creemos que la precocidad en el diagnóstico y el tratamiento quirúrgico agresivo de revascularización en los casos de trombosis secundaria a enfermedad ateromatosa es la mejor opción de sobrevida para este tipo de pacientes.

Vascular endothelial growth factor-induced angiogenic gene therapy in patients with peripheral artery disease

This phase 1 clinical trial tested the safety of intramuscular gene transfer by using naked plasmid DNA encoding the gene for VEGF, and analyzed the potential therapeutic benefits in patients with severe peripheral arterial disease (PAD). This study was an open-labeled, dose- escalating, single-center trial on nine male patients with severe debilitating PAD who had not responded to conventional therapy. Seven had Buerger's disease and two had arteriosclerosis obliterans. Plasmid DNA (pCK) containing human VEGF165 was given by eight intramuscular injections in and around the area in need of new blood vessels. The study evaluated three escalating total doses (2, 4, and 8 mg of pCK- VEGF165), with half of each total dose given four weeks apart. The follow-up duration was nine months. The gene injections were well tolerated without significant side effects or laboratory abnormalities related to gene transfer. Three patients showed transient edema in their extremities. Ischemic pain of the affected limb was relieved or improved markedly in six of seven patients. Ischemic ulcers healed or improved in four of six patients. The mean ankle-brachial index (ABI) improved significantly. Six of nine patients showed an increase in collateral vessels around the injection sites demonstrated by digital subtraction angiography. However, there was no relationship between the degree of ABI improvement and the dose given. Mean plasma levels of VEGF did not increase significantly. In conclusion, intramuscular injections of pCK- VEGF165 can be performed safely to induce therapeutic angiogenesis in patients with severe PAD.

A Newly Designed Nitinol Stent: Early Clinical Experience in the Treatment of Iliac Artery Stenoses and Occlusions

OBJECTIVE: To investigate the effectiveness of the newly designed Niti-S stent in the management of iliac arterial stenoses and occlusions. MATERIALS AND METHODS: Stenoses (n=25) or occlusions (n=5) in the iliac arteries of 25 patients (30 limbs) were treated. The site of the lesions was the common (n=15) or external (n=11) iliac artery, or both (n=4). Eight limbs were treated for diffuse disease, six for highly eccentric lesion, five for occlusive lesion, and 11 for failed angioplasty. RESULTS: In all patients, technical success was achieved without major complications. One death, not procedure-related, occurred within 30 days. Ankle-brachial indexes improved from 0.63 +/- 0.30 to 0.99 +/- 0.21, and ischemic symptoms showed improvement in 22 patients (88%). Fontaine classifications before stenting, namely IIa(n=3), IIb(n=16), III(n=2), and IV(n=4) improved to I(n=17), IIa(n=5), and IV(n=3). Follow-up over a 27 (mean, 19.8 +/- 8)-month period showed that cumulative patency rates were 95.8% at 1 year and 86.2% at 2 and 3 years. No significant decrease in the mean ankle-brachial index was observed. CONCLUSION: The Niti-S stent appears to be a safe and effective device for the treatment of iliac stenoses and occlusions. These preliminary results require confirmation with a larger series.

Tratamiento endovascular versus tratamiento quirúrgico de la enfermedad estenótico-oclusiva arterial ilíaca. Análisis costo-beneficio / Endovascular treatment versus surgical treatment of the disease stenotic-occlusive iliac artery: analysis cost-benefit

En esta comunicación intentamos establecer un análisis de la relación costo/beneficio de la Cirugía Convencional vs. los Procedimientos Endovasculares sobre Vasos Ilíacos, dado que esta última alternativa de tratamiento a demostrado tener la misma efectividad a 5 años que la cirugía. Durante los últimos 4 años, 129 procedimientos endovasculares han sido realizados sobre Arterias Ilíacas, en los Hospitales Español y Gutiérrez de La Plata. Los vasos tratados fueron: Arteria Ilíaca común en el 52 por ciento, Arteria Ilíaca Externa en el 44 por ciento, Arteria Ilíaca Interna 4 por ciento de los casos. Las comparaciones de ambos tratamientos (quirúgico vs. endovascular) se realizan en la siguiente tabla...

Recanalización percutánea de oclusiones crónicas de arterias ilíacas con instalación primaria de stent / Percutaneous revascularization of chronic iliac artery occlusions and primary stent placement

Background: Percutaneous transluminal angioplasty is a well established treatment method for aorto iliac stenoses. However its success is limited in arterial occlusions and vascular stent placement can improve the results. Aim: To assess the effectiveness of percutaneous revascularization with stent placement in patients with chronic iliac artery occlusions. Patients and methods: twenty six patients (18 male) aged 47 to 82 years, with iliac artery occlusions lasting six or more weeks were treated. Fourteen had involvement of common iliac artery, five had involvement of external iliac artery and seven of both. The occluded segment length ranged from 3.5 to 12 cm. According to the Society of Cardiovascular Surgery/International Society for Cardiovascular Surgery classification, 22 patients had category 1 claudication, 10 were in category 2, 12 in category 3 and two in category 4. Results: A technical success was obtained in 23 patients and clinical success in 21. After the intervention, the anklearm index improved from 0.49 ñ 0.12 to 0.88 ñ 0.18 (p < 0.001). Permeability after 12 months of follow up was 81 percent and after 36 months, 65 percent. Four patients had complications; one had a vascular perforation, two had an acute occlusion and one had an asymptomatic distal embolization. All these were solved using endovascular techniques. Conclusions: Percutaneous revascularization with stent placement is a valid alternative to surgery in selected patients with chronic iliac artery occlusion

Insuficiencia Arterial Crónica. Análisis Epidemiológico en el Servicio de Angiología y Cirugía Vascular, 1995-1996 / Chronic arterial failure. Epidemiologic analysis at the Service of Angiology and Vascular Surgery, 1995-1996

Se realizó un estudio retrospectivo de los expedientes clínicos de 74 pacientes egresados del Servicio de Angiología y Cirugía Vascular del Hospital "Vladimir Ilich Lenín", todos con el diagnóstico de insuficiencia arterial crónica en miembros inferiores, en el período comprendido de agosto de 1995-agosto 1996. Esta entidad es la responsable de la ocupación del 5 al 10 por ciento de las camas del Servicio, de ahí el importante papel que desempeña la enfermera en el servicio. Entre los objetivos que motivaron el estudio estuvieron: contribuir a la elevación del nivel científico-técnico del personal de Enfermería en el manejo y cuidado de los pacientes con enfermedades vasculares, además de identificar el comportamiento de esta enfermedad y su importancia en relación con la Epidemiología; determinar las causas más frecuentes que originan esta enfermedad y sus manifestaciones e identificar el tratamiento más empleado. De la casuística estudiada se analizaron las diferentes variables: edad y sexo, zona de residencia, factores de riesgo, etiología, la clínica presentada, el tratamiento que recibieron, las complicaciones más frecuentes, el promedio de estadía y el resultado obtenido al egreso. Se utilizó el método porcentual. La mayor incidencia se mostró para las edades de 61-70 años con 28,38 por ciento y el sexo masculino fue el más afectado con 81,08 por ciento. En la zona urbana se detectó el 91,90 por ciento de pacientes con esta enfermedad. El factor de riesgo prevalenciente fue el tabaquismo con 51,35 por ciento; la arteriosclerosis obliterante es la causa más frecuente con 68,92 por ciento. La clínica predominante es la claudicación con 55,45 por ciento. El tratamiento médico fue el más empleado en el 56,76 por ciento, con sólo el 8,10 por ciento de complicaciones. El promedio de estadía fue de 26 días y el 95,95 por ciento de los pacientes egresaron en la categoría de mejorado

Angioplastia percutánea transluminal. Experiencia en el Hospital Español / Transluminal percutaneous angioplasty. Experience of the ®Hospital Español¼

El propósito del presente trabajo, es el de revisar la experiencia obtenida en un Servicio de Cirugía Vascular en un grupo de enfermos con lesiones vasculares oclusivas, que fueron tratadas con técnicas de dilatación vascular, describir los protocolos empleados para ello, y analizar los resultados. De 1988 a 1996 se trataron con angioplastia 20 lesiones en 19 enfermos. Se les dividió en dos Grupos. Grupo A, 15 con lesiones de miembros inferiores. Y Grupo b, cinco con fístulas A/V para Hemodiálisis disfuncionales, colocadas en los miembros torácicos. Tres enfermos fueron del sexo femenino y seis masculino. Las indicaciones para efectuar la angioplastia. Para el grupo A: Claudicación intermitente en cuatro e isquemia crítica en 10. En el Grupo B había disyunción de fístula A/V en todos los casos. Los territorios anatómicos involucrados fueron Aorto-iliaco en ocho, femoro-poplíteo-tibial en seis y miembros torácicos. En cinco de los enfermos del grupo A hubo éxito inicial en el 87 por ciento de los casos y salvamento de extremidad en el 83 por ciento de los casos, en un caso se efectuó redilatación de la arteria iliaca y colocación de endoprótesis seis meses después de efectuada la angioplastia inicial. En el grupo B había disyunción de fístula en tres casos durante un tiempo promedio de 3.5 años. Conclusión. Los procedimientos vasculares pueden realizarse con éxito en enfermos con lesioens vasculares cortas localizadas preferentemente en el territorio aorto-iliaco. En la actualidad, se recomienda a los grupos que practican cirugía vascular capacitarse en los procedimientos endovasculares y realizarlos de manera independiente o con otros especialistas

Rabdomiólise e síndrome metabólica mionefropática secundárias à oclusäo arterial aguda / Rhabdomyolysis and metabolic myonephropathic syndrome associated to acute arterial occlusion

Os autores apresentam uma revisäo da literatura recente sobre a síndrome metabólica mionefropática associada à oclusäo arterial aguda, que inclui sua epidemiologia, aspectos clínicos, diagnóstico e tratamento. Trata-se de um tema ainda pouco divulgado em nosso meio, apesar de sua grande morbimortalidade, sendo, muitas vezes, subdiagnosticado pela freqüente associaçäo com outras doenças cardiovasculares.

Angioplastia transluminal percutanea: uma alternativa eficaz no tratamento da arteriopatia periferica obstrutiva / Percutaneous transluminal angioplasty: effective alternative in the treatment of the peripheric vascular obstructive disease

Atualmente, pacientes portadores de patologia obstrutiva vascular dos membros inferiores podem ser tratados atraves de procedimentos percutaneos sem recorrer as classicas cirurgias de reconstrucao vascular. Desta maneira contribui-se para o desenvolvimento de uma modalidade conhecida como Radiologia Intervencionista...