Isquemia arterial aguda trombótica de los miembros inferiores / Acute thrombotic arterial ischemia of the lower limbs

Introducción: La enfermedad arterial periférica es una de las afecciones más prevalentes. Resulta habitual su coexistencia con la enfermedad vascular en otras localizaciones. El diagnóstico precoz tiene importancia para mejorar la calidad de vida del paciente y reducir el riesgo de eventos secundarios mayores, como el infarto agudo de miocardio o el ictus. Objetivo: Caracterizar el comportamiento de la isquemia arterial aguda trombótica en miembros inferiores en pacientes que ingresaron en el Instituto Nacional de Angiología y Cirugía Vascular. Métodos: Se realizó un estudio observacional, descriptivo y retrospectivo, con el fin de determinar factores pronósticos en la evolución final del tratamiento quirúrgico de la isquemia arterial aguda trombótica en miembros inferiores, en pacientes que ingresaron en los servicios de Arteriología y Angiopatía Diabética del Instituto Nacional de Angiología y Cirugía Vascular durante un período de cuatro años. Resultados: El grupo de edades más afectado estuvo entre 40 y 59 años, con un predomino del sexo masculino. El hábito de fumar fue el factor de riesgo vascular más frecuente; y la amputación mayor, el procedimiento quirúrgico más empleado, por lo que el patrón oclusivo femoropoplíteo resultó el más prevalente. Conclusiones: Predominaron el sexo masculino, el hábito de fumar, la amputación mayor y el patrón oclusivo femoropoplíteo(AU)

Introduction: Peripheral arterial disease is one of the most prevalent conditions. Its coexistence with vascular disease in other locations is common. Early diagnosis is important to improve the patient's quality of life and reduce the risk of major secondary events, such as acute myocardial infarction or stroke. Objective: To characterize the behavior of acute thrombotic arterial ischemia in lower limbs in patients admitted to the National Institute of Angiology and Vascular Surgery. Methods: An observational, descriptive and retrospective study was conducted in order to determine prognostic factors in the final evolution of surgical treatment of acute thrombotic arterial ischemia in the lower limbs in patients admitted to the Arteriology and Diabetic Angiopathy services of the National Institute of Angiology and Vascular Surgery for a period of four years. Results: The most affected age group was the one of 40 to 59 years, with a predominance of males. Smoking was the most frequent vascular risk factor; and major amputation, the most used surgical procedure, so the femoropopliteal occlusive pattern was the most prevalent. Conclusions: Male sex, smoking habit, major amputation and femoropopliteal occlusive pattern predominated(AU)

Perfusión 2D por angiografía en oclusión arterial periférica. Método de evaluación inmediato posproceder / 2D perfusion by angiography in peripheral arterial occlusion. Post-procedural immediate evaluation method

La enfermedad arterial periférica se considera la mayor causa de hospitalización, con riesgo de amputación de la extremidad afectada y muerte debido a la enfermedad per se o sus complicaciones. Se reporta la experiencia del tratamiento a un paciente con macroangiopatía diabética, estenosis del 64 por ciento de la arteria ilíaca izquierda y afectación de los segmentos fémoro-poplíteos bilaterales, al cual, a través de un acceso percutáneo vía arteria braquial izquierda, se le realizó revascularización mediante la implantación de stent de cromo-cobalto liberado por balón catéter. El objetivo de este estudio fue describir la utilidad del 2D-ASD y su valor como herramienta para determinar el transproceder y la repercusión en el flujo sanguíneo de la revascularización realizada, y establecer un pronóstico funcional para el paciente. Se utilizó la angiografía por perfusión bidimensional como herramienta para evaluar el éxito técnico del proceder y la repercusión inmediata en la perfusión distal de la extremidad afecta, y describir la utilidad de la escala paramétrica de colores y las curvas de densidad en función del tiempo obtenidos en el estudio(AU)

Peripheral artery disease is considered the leading cause of hospitalization, with risk of amputation of the affected limb and death due to the disease per se or its complications. It is reported the experience of treatment in a patient with diabetic macroangiopathy, stenosis of 64 percent of the left iliac artery and involvement of the bilateral femoro-popliteal segments, to which, through a percutaneous access via the left brachial artery, revascularization was performed through the implantation of cobalt-chromium stent released by balloon catheter. The objective of this study was to describe the usefulness of 2D-ASD and its value as a tool to determine the trans-procedure and the impact on blood flow of the revascularization performed, and to establish a functional prognosis for the patient. Two-dimensional perfusion angiography was used as a tool to evaluate the technical success of the procedure and the immediate impact on distal perfusion of the affected limb, and to describe the usefulness of the parametric color scale and density curves as a function of the time obtained in the study(AU)

Perfusión 2D por angiografía en oclusión arterial periférica. Método de evaluación inmediato posproceder / 2D perfusion by angiography in peripheral arterial occlusion. Post-procedural immediate evaluation method

La enfermedad arterial periférica se considera la mayor causa de hospitalización, con riesgo de amputación de la extremidad afectada y muerte debido a la enfermedad per se o sus complicaciones. Se reporta la experiencia del tratamiento a un paciente con macroangiopatía diabética, estenosis del 64 por ciento de la arteria ilíaca izquierda y afectación de los segmentos fémoro-poplíteos bilaterales, al cual, a través de un acceso percutáneo vía arteria braquial izquierda, se le realizó revascularización mediante la implantación de stent de cromo-cobalto liberado por balón catéter. El objetivo de este estudio fue describir la utilidad del 2D-ASD y su valor como herramienta para determinar el transproceder y la repercusión en el flujo sanguíneo de la revascularización realizada, y establecer un pronóstico funcional para el paciente. Se utilizó la angiografía por perfusión bidimensional como herramienta para evaluar el éxito técnico del proceder y la repercusión inmediata en la perfusión distal de la extremidad afecta, y describir la utilidad de la escala paramétrica de colores y las curvas de densidad en función del tiempo obtenidos en el estudio(AU)

Peripheral artery disease is considered the leading cause of hospitalization, with risk of amputation of the affected limb and death due to the disease per se or its complications. It is reported the experience of treatment in a patient with diabetic macroangiopathy, stenosis of 64 precent of the left iliac artery and involvement of the bilateral femoro-popliteal segments, to which, through a percutaneous access via the left brachial artery, revascularization was performed through the implantation of cobalt-chromium stent released by balloon catheter. The objective of this study was to describe the usefulness of 2D-ASD and its value as a tool to determine the trans-procedure and the impact on blood flow of the revascularization performed, and to establish a functional prognosis for the patient. Two-dimensional perfusion angiography was used as a tool to evaluate the technical success of the procedure and the immediate impact on distal perfusion of the affected limb, and to describe the usefulness of the parametric color scale and density curves as a function of the time obtained in the study(AU)

Caracterización clínica, hemodinámica y ecográfica de pacientes diabéticos con enfermedad arterial crónica en miembros inferiores / Clinical, hemodynamic and echographic characterization of diabetic patients with arterial chronic disease in lower limbs

Introducción: La diabetes mellitus es la enfermedad crónica considerada como una de las mayores emergencias sanitarias del siglo XXI en el mundo, que puede desencadenar algunas complicaciones y problemas graves para la salud. Objetivo: Caracterizar a pacientes diabéticos con enfermedad arterial crónica en miembros inferiores según variables clínicas, hemodinámicas y ecográficas. Métodos: Se realizó un estudio observacional, descriptivo y transversal de los 178 pacientes diabéticos con diagnóstico clínico de enfermedad arterial crónica en miembros inferiores, quienes fueron atendidos en el Servicio de Imagenología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba desde enero de 2017 hasta diciembre de 2019, a los cuales se les realizó examen hemodinámico mediante el índice tobillo-brazo y ecografía Doppler arterial. Resultados: En la investigación primaron los adultos mayores (41,6 %) del sexo femenino (54,0 %), la claudicación intermitente como principal síntoma (57,3 %), el sector femoropoplíteo (34,8 %) según la topografía exacta de las lesiones, así como la estenosis significativa (53,9 %) y la enfermedad arterial periférica moderada (58,3 %). Conclusiones: La mayoría de los pacientes presentó una estenosis significativa detectada por ecografía Doppler, en correspondencia con el diagnóstico de enfermedad arterial periférica moderada por el índice tobillo-brazo. La ecografía Doppler también aportó la topografía exacta de las lesiones.

Introduction: The diabetes mellitus is the chronic disease considered as one of the highest sanitary emergencies in the XXI century in the world that can trigger some complications and serious health problems. Objective: To characterize diabetic patients with arterial chronic disease in lower limbs according to clinical, hemodynamic and ultrasound variables. Methods: An observational, descriptive and cross-sectional study of the 178 diabetic patients with clinical diagnosis of arterial chronic disease in lower limbs was carried out, who were assisted in the Imaging Service of Dr. Juan Bruno Zayas Alfonso General Hospital in Santiago de Cuba from January, 2017 to December, 2019, to whom hemodynamic exam by means of the ankle-brachial index and arterial Doppler ultrasound was carried out. Results: In the investigation there was a prevalence of the elderly (41.6 %) from the female sex (54.0 %), the intermittent abandonment as main symptom (57.3 %), the femoropopliteal sector (34.8 %) according to the exact topography of the lesions, as well as the significant stenosis (53.9 %) and the moderate peripheral arterial disease (58.3 %). Conclusions: Most of the patients presented a significant stenosis according to Doppler ultrasound, in correspondence with the diagnosis of moderated peripheral arterial disease by the ankle-brachial index. The Doppler ultrasound also contributed the exact topography of the lesions.

Doença arterial obstrutiva periférica em pacientes com insuficiência renal crônica dialítica na região de Toledo - Paraná: prevalência e fatores de risco / Peripheral arterial disease in patients with dialytic chronic renal failure in the region of Toledo - Paraná: prevalence and risk factors

Introdução: a doença arterial obstrutiva periférica (DAOP) tem alta prevalência na população em geral e está associada a elevado risco de eventos cardiovasculares. O índice tornozelo-braquial (ITB), é um exame simples e não invasivo, com alta sensibilidade e especificidade no diagnóstico de DAOP. A patologia pode estar associada a diversos fatores de risco, entre eles a doença renal crônica terminal. Contudo, os dados que avaliam sua prevalência e fatores de risco na população de doentes renais crônicos são escassos. Objetivos: Determinar a prevalência e os fatores de risco da doença arterial obstrutiva periférica em pacientes com insuficiência renal crônica dialítica. Metodologia: trata-se de um estudo transversal, que analisou 117 pacientes com doença renal dialítica. Foram avaliados através de um questionário para identificação dos fatores de risco e submetidos ao teste do ITB, sendo considerado diagnóstico de DAOP quando ITB <0,9. Resultados: o presente estudo evidenciou uma prevalência de DAOP em 11% dos pacientes, sendo 10 classificados como DAOP leve e 3 como moderada. Não foram encontrados pacientes com DAOP severa. Entretanto, 54 pacientes (46,2%) apresentaram rigidez de parede vascular. Assim, foi possível verificar que 67 (57,3%) pacientes apresentaram o ITB alterado. Conclusão: a alta prevalência de DAOP em pacientes com doença renal crônica dialíticafoi análoga ao encontrado por outros autores. É importante ressaltar que pacientes com ITB > 1,3 podem gerar resultados falsos-negativos no diagnóstico de DAOP. Devido a isso, a prevalência pode estar subestimada, o que sugere que o ITB nesses pacientes deve ser avaliado com mais atenção.

Background: peripheral arterial disease (PAD) has a high prevalence in the general population and is associated with a high risk of cardiovascular events. The ankle-brachial index (ABI) is a simple noninvasive exam with high sensitivity and specificity in the diagnosis of PAD. Pathology may be associated with several risk factors, including terminal chronic kidney disease. However, data assessing their prevalence and risk factors in the chronic kidney disease population are scarce. Objectives: to determine the prevalence and risk factors of peripheral arterial disease in patients with dialytic chronic renal failure. Methods: this is a cross-sectional study that analyzed 117 patients with dialytic kidney disease. They were evaluated through a questionnaire to identify risk factors and were submitted to the ABI test, being considered a diagnosis of PAD when ABI <0.9. Results: the present study showed a prevalence of PAD in 11% of the patients, 10 classified as mild and 3 as moderate. No patients with severe PAD were found. However, 54 patients (46.2%) had vascular wall stiffness. Thus, it was possible to verify that 67 (57.3%) patients presented altered ABI. Conclusion: the high prevalence of PAD in patients with dialytic chronic kidney disease was similar to that found by other authors. It is important to highlight that patients with ABI> 1.3 may generate false negative results in the diagnosis of PAD. Because of this, the prevalence may be underestimated, suggesting that ABI in these patients should be evaluated more carefully.

Angioplastia simple de arteria tibial posterior en paciente diabético para el salvamento de la extremidad / Posterior tibial artery simple angioplasty in diabetic patient for limb salvage

Introducción: La diabetes mellitus constituye un factor de riesgo distintivo en la enfermedad arterial periférica. Esta produce típicamente la afectación de los vasos infrageniculares, asociada con mayor predisposición a ulceración y amputación que en pacientes no diabéticos. Debido al desenlace sombrío de estos pacientes es necesario revascularizar con el fin de salvar la extremidad. Objetivo: Presentar un caso en el que se utilizó la angioplastia simple de la arteria tibial posterior para salvar la extremidad de un paciente diabético. Presentación del caso: Se presenta un caso con diagnóstico de pie diabético isquémico infectado en la extremidad inferior izquierda. Al examen físico se constató lesión isquémica infectada en el quinto y cuarto dedos con extensión al dorso y planta del pie, y patrón esteno-oclusivo distal. Se detectó disminución de los índices de presiones distales. En la arteriografía se apreció oclusión de las arterias tibial anterior y peronea desde su origen, y lesiones esteno-oclusivas en la tibial posterior en el tercio inferior de la pierna. Se realizó angioplastia transluminal percutánea de la tibial posterior y el paciente recuperó pulso en tibial posterior con mejoría hemodinámica. Evolucionó satisfactoriamente y egresó con tratamiento médico. A los cinco meses de operado mantenía su pulso tibial posterior presente y la lesión cicatrizada. Conclusiones: La angioplastia simple de una de las arterias de la pierna puede resultar beneficiosa para la cicatrización de lesiones en el pie, aun siendo estas extensas(AU)

Introduction: Diabetes mellitus is a distinctive risk factor in peripheral artery disease. This typically produces the involvement of the infragenicular vessels, associated with a greater predisposition to ulceration and amputation than in non-diabetic patients. Due to the bleak outcome of these patients it is necessary to revascularize in order to save the limb. Objective: To present a case in which simple angioplasty of the posterior tibial artery was used to save the limb of a diabetic patient. Case Presentation: It is presented a case with a diagnosis of infected ischemic diabetic foot in the left lower extremity. On physical examination, infected ischemic lesion was found in the fifth and fourth toes with extension to the back and soles of the foot, and distal steno-occlusive pattern. Decreases in distal pressure indices were detected. Arteriography showed occlusion of the anterior tibial and peroneal arteries from their origin, and steno-occlusive lesions in the posterior tibial in the lower third of the leg. Percutaneous transluminal angioplasty of the posterior tibial was performed and the patient recovered pulse in the posterior tibial with hemodynamic improvement. The patient progressed satisfactorily and was discharged with medical treatment. Five months after surgery, the kept posterior tibial pulse present and the injury healed. Conclusions: Simple angioplasty of one of the arteries of the leg can be beneficial for the healing of foot injuries, even if these are extensive(AU)

Correlación clínico ecográfica de la enfermedad arterial periférica de miembros inferiores en diabéticos tipo 2 / Clinical ultrasound correlation of peripheral arterial disease of the lower limbs in type 2 diabetics

Introducción: La enfermedad arterial periférica en pacientes ateroscleróticos diabéticos suele subdiagnosticarse, ya que la mayoría de la población afectada está asintomática. Objetivo: Correlacionar los signos clínicos y ultrasonográficos de la enfermedad arterial periférica de los miembros inferiores en los pacientes ateroscleróticos diabéticos. Métodos: Se hizo un estudio descriptivo y prospectivo en una muestra aleatoria de 209 pacientes diabéticos con enfermedad arterial periférica, según clasificación de Leriche-Fontaine. A estos se les realizó ecografía Doppler. El estudio estadístico se practicó mediante la aplicación del coeficiente de Kappa. Resultados: La enfermedad arterial periférica predominó en el sexo masculino con 60 años y más. En el 26,32 por ciento del miembro inferior izquierdo en tibial posterior se corroboró ausencia de pulso. Según cuadro clínico, por clasificación de Leriche-Fontaine, la más alta incidencia se encontró en el estadio IIb con 33,97 por ciento, seguido por el estadio II con 20,54 por ciento; y por clasificación ecográfica hubo una reducción del diámetro significativo en la pierna izquierda en arterias distales, con un coeficiente de Kappa de 0,927. Conclusiones: Existió una fuerte correlación clínico ecográfica en cuanto al grado de estenosis en la enfermedad arterial periférica de los pacientes diabéticos estudiados(AU)

Introduction: Peripheral arterial disease in diabetic atherosclerotic patients is usually underdiagnosed, since the majority of the affected population is asymptomatic. Objective: Correlate the clinical and ultrasonographic signs of peripheral arterial disease of the lower limbs in diabetic atherosclerotic patients. Methods: A descriptive and prospective study was conducted in a random sample of 209 diabetic patients with peripheral arterial disease, according to the Leriche-Fontaine classification. These underwent Doppler ultrasound. The statistical study was performed by applying the Kappa coefficient. Results: Peripheral arterial disease predominated in males aged 60 years and over. In 26.32 percent of the left lower limb in the posterior tibial, the absence of pulse was confirmed. According to the clinical picture, by Leriche-Fontaine classification, the highest incidence was found in stage IIb with 33.97 percent, followed by stage II with 20.54 percent; and by ultrasound classification there was a significant reduction in diameter in the left leg in distal arteries, with a Kappa coefficient of 0.927. Conclusions: There was a strong clinical ultrasound correlation regarding the degree of stenosis in peripheral arterial disease of the diabetic patients studied(AU)

Diagnostic thresholds for absolute systolic toe pressure and toe-brachial index in diabetic foot screening

INTRODUCTION@#Identifying peripheral arterial disease (PAD) during diabetic foot screening (DFS) is crucial in reducing the risk of diabetic foot ulcerations and lower limb amputations. Screening assessments commonly used include absolute systolic toe pressure (ASTP) and toe-brachial index (TBI). There is a lack of research defining the threshold values of both assessment methods. We aimed to compare the accuracy of ASTP and TBI and establish optimal threshold values of ASTP and TBI with reference to the internationally accepted ankle-brachial pressure index (ABPI) screening test, for a multiethnic diabetic population in Singapore.@*METHODS@#A retrospective, observational study of DFS results from January 2017 to December 2017 was conducted. Receiver operating characteristic analysis was conducted for ASTP and TBI using the internationally accepted ABPI cut-off value of ≤0.9 to indicate PAD.@*RESULTS@#A total of 1,454 patients with mean (standard deviation) age of 63.1 (12.4) years old were included. There were 50.8% men and 49.2% women, comprising 69.7% Chinese, 13.5% Indian, 10.1% Malay and 6.7% other ethnicities. Areas under the curve for ASTP and TBI were 0.89 (95% confidence interval [Cl] 0.85-0.94) and 0.94 (95% Cl 0.90-0.98), respectively, and the difference was statistically significant (P<0.001). Derived optimal threshold values to indicate ABPI≤0.9 for ASTP and TBI were <95.5mmHg (specificity 0.86, sensitivity 0.84) and <0.7 (specificity 0.89, sensitivity 0.95), respectively.@*CONCLUSION@#ASTP or TBI may be used to detect ABPI-determined PAD in DFS. The optimal threshold values derived from a multiethnic Asian diabetic population were <95.5mmHg for ASTP and <0.7 for TBI.

Two-year clinical outcomes following lower limb endovascular revascularisation for chronic limb-threatening ischaemia at a tertiary Asian vascular centre in Singapore

INTRODUCTION@#Percutaneous transluminal angioplasty (PTA) is commonly used to treat patients with chronic limb-threatening ischaemia (CLTI). This study aimed to examine the mortality and functional outcomes of patients with CLTI who predominantly had diabetes mellitus in a multi-ethnic Asian population in Singapore.@*METHODS@#Patients with CLTI who underwent PTA between January 2015 and March 2017 at the Vascular Unit at Singapore General Hospital, Singapore, were studied. Primary outcome measures were 30-day unplanned readmission, two-year major lower extremity amputation (LEA), mortality rates, and ambulation status at one, six and 12 months.@*RESULTS@#A total of 221 procedures were performed on 207 patients, of whom 184 (88.9%) were diabetics. The one-, six- and 12-month mortality rate was 7.7%, 16.4% and 21.7%, respectively. The two-year LEA rate was 30.0%. At six and 12 months, only 96 (46.4%) and 93 (44.9%) patients were ambulant, respectively. Multivariate analysis revealed that preoperative ambulatory status, haemoglobin, Wound Ischaemia and foot Infection (WIfI) score, and end-stage renal failure (ESRF) were independent predictors of one-year ambulatory status. Predictors of mortality at one, six and 12 months were ESRF, preoperative albumin level, impaired functional status and employment status.@*CONCLUSION@#PTA for CLTI was associated with low one-year mortality and two-year LEA rates but did not significantly improve ambulation status. ESRF and hypoalbuminaemia were independent predictors of mortality. ESRF/CKD and WIfI score were independent predictors of loss of ambulation at six months and one year. We need better risk stratification for patients with CLTI to decide between initial revascularisation and an immediate LEA policy.

Mid- and long-term outcomes and prognostic factors of drug-coated balloon angioplasty for treatment of femoropopliteal long lesions / 中华外科杂志

Objective: To examine the effective and safe outcomes of drug-coated balloon (DCB) angioplasty for the treatment of femoropopliteal long lesions in mid-term and long-term follow-up. Methods: The clinical data of 114 patients with symptomatic (Rutherford 2 to 6) femoropopliteal long lesions who underwent angioplasty with DCB between June 2016 and May 2021 at Department of Vascular Surgery,Beijing Tsinghua Changgung Hospital were retrospectively analyzed. A total of 75 males and 39 females were enrolled, aged (71.9±8.4)years (range: 49 to 89 years). Among 138 lesions in 114 patients, there were 111 de nove lesions (80.4%, 111/138). Total occlusions were recanalized in 116 limbs (84.1%, 116/138). The lesion length was (280.9±78.7)mm (range: 150 to 520 mm). DCB angioplasty combined with debulking devices was used in 59 lesions (42.8%, 59/138).The bail-out stent implantation was performed in 27 limbs (19.6%, 27/138). The Kaplan-Meier method was used to evaluate cumulative primary patency rate, freedom from the clinically driven target lesion revascularization (CD-TLR) rate and accumulate survival rate. Univariate and multivariate analyses with Cox proportional hazards models were performed to determine the significant prognostic factors for primary patency. Results: DCB angioplasty was completed in 114 patients. The technical success rate was 98.2%(112/114). The mean follow-up time was 18 months (range: 3 to 54 months).The results showed that primary patency rates at 12, 24 and 36 months postoperatively were 87.5%, 75.2% and 55.1%, respectively. Freedom from CD-TLR rate at 12, 24 and 36 months postoperatively were 92.4%, 81.8% and 68.7%, respectively. Accumulate survival rate at 12, 24 and 36 months postoperatively were 96.2%, 94.0% and 80.2%. Multivariate Cox's regression analyses showed that chronic limb-threatening ischemia(CLTI) (HR=2.629, 95%CI:1.519 to 4.547, P<0.01) and hyperlipidemia (HR=2.228, 95%CI: 1.004 to 4.948, P=0.026) were independent prognosis factors for primary patency in DCB treatment of femoropopliteal long lesions. Conclusions: DCB provided favorable outcomes for the treatment of femoropopliteal long lesions. CLTI and hyperlipidemia are independent prognosis factors for restenosis after DCB angioplasty.

Impacto da COVID-19 no perfil cirúrgico dos pacientes de cirurgia vascular em serviço de referência em Curitiba / Impact of COVID-19 on the surgical profile of vascular surgery patients at a tertiary hospital in Curitiba, Brazil

Resumo Contexto Na pandemia de covid-19, os serviços de saúde diminuíram os atendimentos e procedimentos eletivos. Pacientes de cirurgia vascular são grupo de risco para adquirir formas graves da infecção, ao mesmo tempo que são suscetíveis a apresentar complicações de suas doenças de base caso não tenham acompanhamento rotineiro. Dessa forma, faz-se necessário entender os impactos e as consequências diretas e indiretas da pandemia com relação aos pacientes vasculares. Objetivos Avaliar o impacto de 1 ano de pandemia em um serviço de Cirurgia Vascular, assim como a mudança do perfil de cirurgias no mesmo período. Métodos Foi feita a análise de prontuários de pacientes submetidos a cirurgias eletivas e de urgência entre 2019 e 2021. Em conjunto, foi realizada uma revisão de literatura com as palavras-chave "cirurgia vascular", "covid-19" e "amputações". Os dados foram analisados com o programa computacional Stata/SE v.14.1 (StataCorpLP, EUA). Resultados Foram identificadas 1.043 cirurgias no período de estudo, sendo 51,6% pré-pandemia e 48,4% durante a pandemia. Observou-se redução no número de cirurgias eletivas e aumento no número de amputações de membros inferiores e desbridamentos cirúrgicos. Foi possível observar também aumento de pacientes com doença arterial obstrutiva periférica com classificação de Rutherford avançada, assim como de casos de pé diabético. Conclusões A diminuição dos atendimentos eletivos e o receio dos pacientes em procurar os serviços de saúde durante o período da pandemia são os prováveis motivos que justificam o aumento da gravidade dos quadros dos pacientes, com maior necessidade de amputação de membros inferiores, desbridamento cirúrgico e mudanças no perfil de cirurgia do serviço.

Abstract Background During the COVID-19 pandemic, healthcare services reduced the number of elective procedures performed. Vascular surgery patients are a group at risk of contracting severe forms of the infection, but are also susceptible to complications of their underlying diseases if they do not receive routine care. It is therefore necessary to understand the direct and indirect impacts and consequences of the pandemic on vascular patients. Objectives To assess the impact of 1 year of the pandemic on a vascular surgery service and changes to the profile of surgeries during the same period. Methods An analysis was conducted of the medical records of patients who underwent elective and emergency surgery from 2019 to 2021. A review of the literature was also conducted, using the search terms "vascular surgery", "COVID-19", and "amputations". Data were analyzed with Stata/SE v.14.1 (StataCorpLP, United States). Results A total of 1,043 surgeries were identified during the study period, 51.6% conducted pre-pandemic and 48.4% performed during the pandemic. There was a reduction in the number of elective surgeries and an increase in the number of lower limb amputations and surgical debridements. Increases were also observed in the proportion of patients with peripheral arterial occlusive disease with advanced Rutherford classifications and in the number of cases of diabetic foot. Conclusions The reduction in elective care and patients' reluctance to seek health services during the pandemic are the probable causes of increased severity of patient status, with greater need for lower limb amputation and surgical debridement and changes to the profile of the surgery performed at the service.

Fatores associados a anormalidades na cintilografia de perfusão miocárdica de pacientes diabéticos / Factors associated with abnormalities on myocardial perfusion scintigraphy in diabetic patients

O diabetes melito é o maior fator de risco para doença arterial coronariana. Além da longa duração de diabetes, outros fatores, como presença de doença arterial periférica e tabagismo são fortes preditores para anormalidades na cintilografia de perfusão do miocárdio. O objetivo deste estudo foi avaliar o impacto dos fatores de risco de pacientes diabéticos nos resultados da cintilografia de perfusão do miocárdio e comparar com os resultados de pacientes não diabéticos em uma clínica de medicina nuclear. Foi realizado um estudo transversal retrospectivo por meio da análise de prontuários de pacientes que realizaram cintilografia miocárdica no período de 2010 a 2019. Foram avaliados 34.736 prontuários. Analisando a fase de estresse da cintilografia de perfusão do miocárdio, os portadores de diabetes melito precisaram receber estímulo farmacológico duas vezes mais que os não diabéticos para sua realização. Também foram avaliados fatores que tivessem impacto negativo no resultado da cintilografia de perfusão do miocárdio, e foi visto que o diabetes melito (33,6%), a insulinoterapia (18,1%), a hipertensão arterial sistêmica (69,9%), a dislipidemia (53%), o sedentarismo (83,1%), o uso de estresse farmacológico (50,6%), a dor torácica típica (8,5%) e a angina limitante durante o teste (1,7%) estiveram associados significativamente (p<0,001) a anormalidades neste exame. (AU)

Diabetes mellitus (DM) is the greatest risk factor for coronary artery disease. In addition to a long duration of diabetes, the presence of peripheral arterial disease and smoking are strong predictors of abnormalities on myocardial perfusion scintigraphy (MPS). This study aimed to assess the impact of risk factors in diabetic patients on MPS results and compare them with those of non-diabetic patients in a nuclear medicine clinic. A retrospective cross-sectional study was performed through the analysis of the medical records of patients who underwent MPS in 2010­2019. A total of 34,736 medical records were evaluated. Analyzing the stress phase of MPS, DM patients required two-fold more pharmacological stimulation than non-diabetic patients for MPS. Factors that negatively impact the MPS results were also evaluated, and DM (33.6%), insulin therapy (18.1%), systemic arterial hypertension (69.9%), dyslipidemia (53%), sedentary lifestyle (83.1%), use of pharmacological stress (50.6%), typical chest pain (8.5%), and limiting angina during the test (1.7%) were significantly associated (p < 0.001) with test abnormalities. (AU)

Epidemiological analysis of lower limb revascularization for peripheral arterial disease over 12 years on the public healthcare system in Brazil / Análise epidemiológica da revascularização de membros inferiores para doença arterial periférica em 12 anos no sistema público de saúde do Brasil

Abstract Background Worldwide, peripheral arterial disease (PAD) is a disorder with high morbidity, affecting more than 200 million people. Objectives Our objective was to analyze surgical treatment for PAD provided on the Brazilian Public Healthcare System over 12 years using publicly available data. Methods The study was conducted with analysis of data available on the Brazilian Health Ministry's database platform, assessing distributions of procedures and techniques over the years and their associated mortality and costs. Results A total of 129,424 procedures were analyzed (performed either for claudication or critical ischemia, proportion unknown). The vast majority of procedures were endovascular (65.49%) and this disproportion exhibited a rising trend (p<0.001). There were 3,306 in-hospital deaths (mortality of 2.55%), with lower mortality in the endovascular group (1.2% vs. 5.0%, p=0.008). The overall governmental expenditure on these procedures was U$ 238,010,096.51, and endovascular procedures were on average significantly more expensive than open surgery (U$ 1,932.27 vs. U$ 1,517.32; p=0.016). Conclusions Lower limb revascularizations were performed on the Brazilian Public Healthcare System with gradually increasing frequency from 2008 to 2019. Endovascular procedures were vastly more common and were associated with lower in-hospital mortality rates, but higher procedure costs.

Resumo Contexto A doença arterial periférica (DAP) é uma doença com alta morbidade global, afetando mais de 200 milhões de pessoas. Objetivos Neste estudo, analisamos o tratamento cirúrgico para DAP no sistema público de saúde do Brasil no período de 12 anos, com base em dados publicamente disponíveis. Métodos O estudo foi conduzido a partir da análise de dados disponíveis na plataforma do Departamento de Informática do Sistema Único de Saúde (DATASUS), do Ministério da Saúde, avaliando a distribuição da técnica cirúrgica utilizada, a mortalidade e o custo ao longo dos anos. Resultados Um total de 129.424 procedimentos foram analisados (para claudicantes e isquemia crítica, em proporção desconhecida). A maiora dos procedimentos foi via endovascular (65,49%), com tendência de aumento nessa desproporção (p < 0,001). Houve 3.306 mortes intra-hospitalares (mortalidade de 2,55%) com menor mortalidade no grupo endovascular (1,2% vs. 5,0%; p = 0,008). O investimento governamental total para esses procedimentos foi de US$ 238.010.096,51, e os procedimentos endovasculares foram significativamente mais caros que a cirurgia aberta convencional (US$ 1.932,27 vs. US$ 1.517,32; p = 0,016). Conclusões No sistema público de saúde brasileiro, as revascularizações de membros inferiores ocorreram com frequência crescente entre 2008 e 2019. Os procedimentos endovasculares foram mais comuns e relacionados a menor mortalidade intra-hospitalar, mas a maiores custos.

Qualidade de vida e índices de rigidez arterial em pacientes com isquemia crônica ameaçadora ao membro / Quality of life and arterial stiffness indices in patients with chronic limb-threatening ischemia

Introdução: Os fatores associados ao comprometimento da qualidade de vida em pacientes com isquemia crônica ameaçadora ao membro não estão bem estabelecidos. Objetivo: Verificar se existe associação entre a qualidade de vida e os índices de rigidez arterial, velocidade de onda de pulso (VOP) e o índice de aumentação normalizado para a frequência cardíaca de 75 bpm (AIx@75). Métodos: Trata-se de um estudo transversal, observacional, com a participação de 17 pacientes (65,65 ±11,79 anos) com isquemia crônica ameaçadora ao membro definida pela classificação de Rutherford 4, 5 e 6, e com o índice tornozelo-braço (ITB) < 0,80. A avaliação dos parâmetros vasculares e os índices de rigidez arterial foram realizadas com o aparelho Mobil-O-Graph ® que gera a onda de pulso aórtica a partir da oscilometria da artéria braquial. A qualidade de vida foi avaliada pelo questionário Vascular quality of life questionaire (VascuQoL-6), versão curta, desenvolvido especificamente para avaliar pacientes com comprometimento circulatório, arterial ou venoso. Resultados: Os valores do ITB e do escore de qualidade de vida foram 0,48 ± 0,14 e 15,88 ± 1,03; respectivamente. Dos 17 pacientes, 12 apresentavam hipertensão arterial sistólica e dezesseis apresentaram a VOP maior que 10 m/s. Não foram observadas correlações entre o escore de qualidade de vida com o AIx@75 (p=0,54 e r=0,16), a VOP (p=0,332 e r=0,248) e o ITB (p=0,707 e r=0,098). Conclusão: O presente estudo demonstrou que pacientes com isquemia crônica ameaçadora ao membro apresentam comprometimento importante da qualidade de vida sem associação com os índices de rigidez arterial e ITB.

Introduction: The factors associated with impaired quality of life in patients with chronic limb-threatening ischemia are not well established. Objective: Check whether there is an association between quality of life and arterial stiffness indexes, pulse wave velocity (PWV) and the augmentation index corrected to 75 beats per minute heart rate (AIx@75). Methods: This is a cross-sectional, observational study, with the participation of 17 patients (65.65 ± 11.79 years) with chronic limb-threatening ischemia defined by the Rutherford classification 4, 5 and 6, and with the ankle-arm index (ABI) < 0.80. The evaluation of vascular parameters and arterial stiffness indeces was performed with the MobilO-Graph ® device that generates the aortic pulse wave from the brachial artery oscillometry. Quality of life was assessed using the questionnaire Vascular quality of life questionaire (VascuQoL-6), short version, developed specifically to evaluate patients with circulatory, arterial or venous involvement. Results: The values of the ITB and the quality of life score were 0.48 ± 0.14 and 15.88 ± 1.03; respectively. Of the 17 patients, 12 had systolic arterial hypertension and sixteen had PWV greater than 10 m / s. No correlations were observed between the quality of life score with AIx @ 75 (p = 0.54 and r = 0.16), PWV (p = 0.332 and r = 0.248) and ABI (p = 0.707 and r = 0.098). Conclusion: The present study demonstrated that patients with chronic limb-threatening ischemia present significant impairment of quality of life without association with arterial stiffness and ABI.

Doença arterial obstrutiva periférica: um estudo comparativo entre revascularizações abertas e endovasculares realizadas em caráter de urgência no sistema público de saúde do Brasil entre 2010 e 2020 / Peripheral artery disease: a comparison of urgent open and endovascular revascularizations on the public health system in Brazil, from 2010 to 2020

RESUMO Contexto A doença arterial obstrutiva periférica apresenta alta prevalência, sendo associada a elevado risco de eventos cardiovasculares. A intervenção cirúrgica ou endovascular faz-se necessária na isquemia crítica do membro. Objetivos Avaliar a distribuição de realização de revascularizações abertas e endovasculares nas diferentes regiões do Brasil, analisando os custos para o sistema de saúde e a mortalidade relacionada a esses procedimentos. Métodos Foi realizado um estudo epidemiológico observacional transversal descritivo para avaliar as cirurgias abertas e endovasculares realizadas no sistema público de saúde do Brasil entre 2010 e 2020. Os dados foram coletados através do Departamento de Informática do SUS (Datasus). Resultados No período analisado, foram registradas 83.218 internações para realização de cirurgias abertas e endovasculares, com um custo total de R$ 333.989.523,17. Houve predominância das internações para os procedimentos percutâneos (56.132) em relação aos cirúrgicos convencionais (27.086). As Regiões Sudeste e Sul concentraram a maior parte do total de procedimentos realizados no país (83%), enquanto a Região Norte foi a que apresentou a menor taxa de internação. Observou-se uma tendência decrescente para os procedimentos abertos, e uma tendência crescente para os endovasculares. A média de permanência hospitalar foi menor nos procedimentos endovasculares (5,3 dias) em relação aos abertos (10,2 dias). Além disso, notou-se uma maior taxa de mortalidade hospitalar relacionada à revascularização aberta em relação à endovascular (5,24% versus 1,56%). Conclusões As técnicas endovasculares consistiram em uma abordagem dominante no tratamento cirúrgico da isquemia crítica, apresentando menor taxa de mortalidade hospitalar e menor tempo de internação quando comparada às cirurgias abertas.

ABSTRACT Background Peripheral artery disease (PAD) has high prevalence and is associated with high risk of cardiovascular events. Surgical or endovascular intervention is necessary in chronic limb-threatening ischemia. Objectives To evaluate the distribution of open and endovascular revascularizations in different regions of Brazil, analyzing the health system costs and mortality related to these procedures. Methods A descriptive, cross-sectional, observational, epidemiological study was carried out to evaluate open and endovascular surgeries performed on the SUS public healthcare system in Brazil, from 2010 to 2020. Data were collected from the SUS Department of Informatics (Datasus). Results Over the period analyzed, 83,218 admissions for open and endovascular surgeries were registered, with a total cost of R$ 333,989,523.17. There were more hospital admissions for percutaneous procedures (56,132) than for conventional surgery (27,086). Most of the procedures (83%) were performed in the country's Southeast and South regions, while the North region had the lowest number of procedures. Over the period evaluated, there was a decreasing trend for open procedures and an increasing trend for endovascular procedures. The average hospital stay was shorter for endovascular procedures (5.3 days) than for open surgery (10.2 days). The analysis of mortality related to these procedures revealed a higher rate of in-hospital mortality associated with open revascularization than with endovascular (5.24% vs. 1.56%). Conclusions Endovascular techniques constituted the primary approach for revascularization treatment in critical limb-threatening ischemia, with a lower in-hospital mortality rate and shorter hospital stay when compared to open surgeries.

Pesquisa de enfermedad arterial periférica asintomática en pacientes con diabetes mellitus tipo 2 / Screening for asymptomatic peripheral artery disease in patients with type 2 diabetes mellitus

Introducción: La diabetes mellitus modifica la historia natural de la aterosclerosis. Por ello, la repercusión de este proceso en los diferentes lechos vasculares constituye la principal causa de morbimortalidad en estos pacientes. Objetivos: Determinar la frecuencia de enfermedad arterial periférica asintomática en personas con diabetes mellitus tipo 2, su relación con otras variables clínicas de la diabetes y las complicaciones de la enfermedad. Métodos: Se realizó un estudio descriptivo transversal en el policlínico Cerro con un total de 100 pacientes diabéticos tipo 2 en edades comprendidas entre 40 y 70 años en el período de un año (2019), sin diagnóstico previo de enfermedad arterial periférica ni lesiones en los pies. Se examinaron los pulsos periféricos de miembros inferiores y se calculó el índice de presiones tobillo-brazo. Resultados: Se identificaron 36 pacientes con índices bajos, lo que fue consistente con una enfermedad arterial periférica asintomática (36 por ciento). El tabaquismo se relacionó de forma significativa con la presencia de índices bajos (p = 0,02), pero no hubo diferencias significativas con respecto a la edad, el sexo, el color de la piel, el tiempo de evolución de la diabetes, el consumo de bebidas alcohólicas, la actividad física, la hipertensión arterial y la obesidad. La mayoría de los pacientes tuvo una afectación ligera en cuanto a la severidad. Conclusiones: La enfermedad arterial periférica asintomática es una complicación frecuente en las personas con diabetes de tipo 2(AU)

Introduction: Diabetes mellitus modifies the natural history of atherosclerosis. Therefore, the impact of this process on the different vascular beds is the main cause of morbidity and mortality in these patients. Objectives: Determine the frequency of asymptomatic peripheral artery disease in people with type 2 diabetes mellitus, its relationship with other clinical variables of diabetes and complications of the disease. Methods: A cross-sectional descriptive study was conducted at Cerro polyclinic with a total of 100 type 2 diabetic patients aged between 40 and 70 years in a period of one year (2019), without prior diagnosis of peripheral arterial disease or foot injuries. Peripheral pulses of the lower limbs were examined and the ankle-brachial pressure index was calculated. Results: 36 patients with low rates were identified, which was consistent with asymptomatic peripheral arterial disease (36 percent). Smoking habit was significantly related to the presence of low rates (p = 0.02), but there were no significant differences with respect to age, sex, skin color, time of evolution of diabetes, consumption of alcoholic beverages, physical activity, high blood pressure and obesity. Most patients had a slight affectation regarding severity. Conclusions: Asymptomatic peripheral artery disease is a common complication in people with type 2 diabetes(AU)

Estudio Descriptivo: Frecuencia y factores de riesgo de la enfermedad arterial periférica en pacientes con Diabetes Mellitus II del Hospital José Carrasco Arteaga, Cuenca / Descriptive Study: Frequency and risk factors of peripheral arterial disease in patients with type II Diabetes Mellitus of Hospital José Carrasco Arteaga, Cuenca

INTRODUCCIÓN: La enfermedad arterial periférica (EAP) es más frecuente en pacientes conDiabetes Mellitus tipo 2 (DM2) que en la población general, convirtiéndolos en un grupo de alto riesgo de morbimortalidad. El objetivo del presente estudio fue determinar la frecuencia de EAP, mediante la medición del ITB y la frecuencia de sus factores de riesgo en los pacientes con Diabetes Mellitus tipo 2 del Hospital José Carrasco Arteaga. MATERIALES Y MÉTODOS: Estudio descriptivo, de corte transversal, con una muestra aleatoria simple de pacientes con diagnóstico de DM2 que acudieron a consulta externa del Hospital José Carrasco Arteaga, Cuenca-Ecuador, en el año 2017 (315 pacientes).Se aplicó una entrevista a los pacientes con datos sobre las características sociodemográficas y ciertos antecedentes médicos de importancia para el estudio; se determinó el ITB; se valoraron los exámenes complementarios de laboratorio realizados en los seis meses previos al estudio. Finalmente, se describieron frecuencias y porcentajes de cada una de las variables, se utilizó el programa IBM SPSS versión 22. RESULTADOS: Del total de pacientes se observó un promedio de edad de 62.9 años, con predominio del sexo femenino. Se determinó que la frecuencia de EAP en los pacientes con DM2 fue del 35.30%. LA EAP fue más frecuente en: el grupo de edad mayor a 50 años (38.8%), el sexo masculino (43.9%), en el grupo de pacientes con tiempo de evolución de la DM2 ≥ a 5 años (35.5%), en los pacientes con tabaquismo (38.4%), en los pacientes con niveles elevados de hemoglobina glicosilada (HbA1c ≥7%) (40.6%), los pacientes con hipertrigliceridemia, en los pacientes con LDL elevado y en hombres con HDL por debajo de valores normales. CONCLUSIÓN: Podemos concluir que la frecuencia de enfermedad arterial periférica en los pacientes con Diabetes Mellitus tipo 2, en el Hospital José Carrasco Arteaga, utilizando el índice tobillo brazo como método diagnóstico fue del 35.30%.(au)

BACKGROUND: Peripheral arterial disease (PAD) is more common in patients with type 2 Diabetes Mellitus (DM2) than in the general population, making them a high-risk group for morbidity and mortality. The aim of this study was to determine the frequency of peripheral arterial disease, by measuring ankle-brachial index, and the frequency of its risks factors in patients with type 2 Diabetes Mellitus at Hospital José Carrasco Arteaga. METHODOS: descriptive, cross-sectional study, with a simply randomized sample of patients diagnosed with Type 2 Diabetes Mellitus, who attended the outpatient clinic of Hospital José Carrasco Arteaga, Cuenca - Ecuador, in 2017 ( 315 patients). An interview was applied to the patients, to collect data on sociodemographic characteristics and certain important medical history; ankle-brachial index was determined; complementary laboratory tests made six months prior to the study were evaluated. Finally, frequencies and percentages of each variable were described; we used IMB SPSS version 22 software. RESULTS: Of the total number of patients, the average age was 62.9 years, with a predominance of the female sex. The frequency of PAD in patients with DM2 was 35.30%. PAD was more frequent in: age group over 50 years (38.8%), male sex (43.9%), disease evolution time ≥ 5 years (35.5%), in smoking patients(38.4%), in patients with elevated glycosylated hemoglobin levels (HbA1c ≥7%)(40.6%),in patients with hypertriglyceridemia, in patients with elevated LDL and in men with low HDL values. CONCLUSION: we can conclude that the peripheral arterial disease frequency in patients with type 2 Diabetes Mellitus, at Hospital José Carrasco Arteaga, using the ankle-brachial index as a diagnostic method was 35.50%.(au)