ABSTRACT
A doença cística adventicial da artéria poplítea é uma doença pouco frequente, que deve ser considerada no diagnóstico diferencial de pacientes jovens com claudicação intermitente e sem fatores de risco para doença arterial periférica aterosclerótica. Apresentamos um caso de claudicação intermitente de membros inferiores em paciente masculino de 51 anos no qual essa doença foi diagnosticada. Foi submetido a ressecção do segmento de artéria comprometido e interposição de safena autóloga ipsilateral. Discutimos alternativas diagnósticas e terapêuticas
Adventitial cystic disease of the popliteal artery is an uncommon pathology that should be considered in differential diagnostic of younger patients with intermittent claudication and without risk factors for peripheral atherosclerotic arterial disease. We report the case of a 51 year-old male patient presenting with lower-limb intermittent claudication in whom this pathology was diagnosed and who was treated with segmental arterial resection and autologous saphenous vein interposition. We also discuss diagnostic and therapeutic alternatives
Subject(s)
Humans , Male , Middle Aged , Popliteal Artery/diagnostic imaging , Lower Extremity , Angiography/methods , Magnetic Resonance Spectroscopy/methods , Echocardiography, Doppler/methods , Cysts , Ankle Brachial Index/methods , Vascular Grafting/methods , Intermittent Claudication/therapyABSTRACT
RESUMO Objetivo: avaliar, através de dopplerfluxometria, de venografia, de histologia e de evolução clínica, o uso de enxertos tubulares de biopolímero de cana-de-açúcar (BP) na reconstrução de veias femorais em cães. Métodos: oito cães adultos foram submetidos à reconstrução de veia femoral, à esquerda com enxerto tubular de BP e à direita com veia autóloga. No período pós-operatório, os animais foram submetidos à avaliação clínica e dopplerfluxometria das veias femorais. Após 360 dias, os cães foram reoperados e submetidos à flebografia das veias femorais com contraste iodado. Os segmentos das veias femorais contendo os enxertos foram retirados e enviados para avaliação histopatológica. Resultados: os cães não apresentaram hemorragia, hematoma, infecção da ferida operatória ou edema dos membros operados. Um animal apresentou dilatação venosa superficial na região inguinal esquerda. A flebografia realizada 360 dias após a primeira cirurgia demonstrou que três (37,5%) enxertos de BP e sete (87,5%) do grupo controle (C) estavam pérvios. Na avaliação histopatológica foi encontrada uma reação inflamatória com neutrófilos e linfócitos na superfície externa de ambos os grupos. Na camada íntima de revestimento dos enxertos e na camada externa nos dois grupos, foi encontrada fibrose. Conclusão: com base nos resultados obtidos com o modelo experimental utilizado, conclui-se que a BP apresenta potencial para ser utilizado como enxerto tubular para revascularização venosa, porém novas pesquisas precisam ser realizadas para confirmar a sua eficácia na revascularização de veias de médio e grande calibre, o que poderia permitir o seu uso na prática clínica.
ABSTRACT Objective: to evaluate, through Doppler flowmetry, venography, histology and clinical evolution, the use of sugarcane biopolymer (BP) tubular grafts in the reconstruction of femoral veins in dogs. Methods: we submitted eight adult dogs to femoral vein reconstruction, on the left with BP tubular graft and on the right with autologous vein. In the postoperative period, the animals underwent clinical evaluation and femoral vein Doppler flowmetry. After 360 days, we reoperated the dogs and submitted them to femoral vein phlebography with iodinated contrast. We removed the segments of the femoral veins containing the grafts and sent them for histopathological evaluation. Results: the dogs did not present hemorrhage, hematoma, surgical wound infection or operated limb edema. One animal had superficial venous dilatation in the left inguinal region. Phlebography performed 360 days after the first surgery showed that three (37.5%) BP grafts and seven (87.5%) grafts from the control group (C) were patent. In the histopathological evaluation, we found an inflammatory reaction, with neutrophils and lymphocytes on the external surface of both groups. In the intimal layer of the grafts and in the outer layer in the two groups, we observed fibrosis. Conclusion: based on the results obtained with the experimental model used, BP presents potential to be used as a tubular graft for venous revascularization. However, new research must be performed to confirm its efficacy in the revascularization of medium and large diameter veins, which could allow its use in clinical practice.
Subject(s)
Animals , Male , Female , Dogs , Bioprosthesis , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/methods , Femoral Vein/transplantation , Vascular Grafting/methods , Transplantation, Autologous/methods , Biopolymers/therapeutic use , Random Allocation , Laser-Doppler Flowmetry , Blood Vessel Prosthesis Implantation/instrumentation , Plastic Surgery Procedures/methods , Models, Animal , Saccharum , Femoral Vein/pathologyABSTRACT
OBJECTIVES: To analyze the histological changes observed in venous grafts subjected to arterial blood flow as a function of the duration of the postoperative period to optimize their use in free flap reconstructions. METHOD: Twenty-five rats (7 females and 18 males) underwent surgery. Surgeries were performed on one animal per week. Five weeks after the first surgery, the same five animals were subjected to an additional surgery to assess the presence or absence of blood flow through the vascular loop, and samples were collected for histological analysis. This cycle was performed five times. RESULTS: Of the rats euthanized four to five weeks after the first surgery, no blood flow was observed through the graft in 80% of the cases. In the group euthanized three weeks after the first surgery, no blood flow was observed in 20% of the cases. In the groups euthanized one to two weeks after the first surgery, blood flow through the vascular loop was observed in all animals. Moreover, intimal proliferation tended to increase with the duration of the postoperative period. Two weeks after surgery, intimal proliferation increased slightly, whereas strong intimal proliferation was observed in all rats evaluated five weeks after surgery. CONCLUSION: Intimal proliferation was the most significant change noted in venous grafts as a function of the duration of the postoperative period and was directly correlated with graft occlusion. In cases in which vascular loops are required during free flap reconstruction, both procedures should preferably be performed during the same surgery.
Subject(s)
Animals , Male , Female , Carotid Arteries/physiopathology , Carotid Arteries/surgery , Jugular Veins/physiopathology , Jugular Veins/transplantation , No-Reflow Phenomenon/diagnosis , Regional Blood Flow/physiology , Vascular Grafting/methods , Anastomosis, Surgical , Carotid Arteries/pathology , Fibrosis , Jugular Veins/pathology , Microsurgery/methods , Neovascularization, Physiologic , Postoperative Period , Rats, Wistar , Reproducibility of Results , Time Factors , Treatment Outcome , Vascular Grafting/adverse effectsABSTRACT
ABSTRACT Seton for treatment of perianal fistula can be of the cutting or a loose type. We adopted a simple technique for tighten the seton by applying a necktie shape tie on the vascular loop, hence it can be used for drainage on the beginning, and for cutting purpose later on. In this retrospective study we report our experience on this seton tie method. Material and methods: Patients operated for perianal fistula between 2012 and 2014 were reviewed. Results: Of 63 patients operated, 23 (35%) had a necktie-tie seton. There were 15 (65%) men. Age 34.1 ± 10.6. Six (26%) had a recurrent fistula, 2 (9%) with loose seton in place. The external opening: anterior four (17%), lateral fifteen (65%), posterior three (13%), one patient (4%) had two opening. The internal opening was identified: posterior seventeen (74%), anterior four (17%) and right posterior two (8%). Nineteen (82%) had a trans-sphenteric tract, four (17%) females had an anterior location. Operative time was 32 min (range 22-55). The seton was tightened 4 times (range 2-5) with 2 weeks interval. Healing was achieved in 7 weeks (range 5-11). In 24 months (range 12-35) follow-up, no reported anal incontinence. Recurrence was observed in one patient (4%). Conclusion: The necktie tightening of the vascular loop seton is a simple, safe, easily performed and may simplify the seton management of perianal fistulae.
RESUMO Setons para o tratamento de fístula perianal podem ser do tipo de corte ou do tipo frouxo. Adotamos uma técnica simples para apertar o seton, pela aplicação, na alça vascular, de uma laçada em forma de nó de gravata. Desse modo, inicialmente a laçada pode ser utilizada para drenagem e, subsequentemente, para as finalidades de corte. Neste estudo retrospectivo, relatamos nossa experiência com este método de aplicação da laçada do Seton em nó de gravata. Material e métodos: Foram revisados pacientes operados para fístula perianal entre 2012-2014. Resultados: Dos 63 pacientes operados, 23 (35%) receberam um Seton em nó de gravata. Desse total, 15 (65%) eram homens, com média de idade de 34,1 ± 10,6 anos. Seis (26%) tiveram fístula recorrente, e dois (9%) tiveram afrouxamento do seton in loco. Foram identificadas aberturas externas: anteriores, quatro (17%); laterais, 15 (65%); posteriores, três (13%); e duas aberturas em um paciente (4%). Também foram identificadas aberturas internas: posteriores, 17 (74%); anteriores, quatro (17%); e posteriores direitas, duas (8%). Em 19 (82%) havia um trato trans-esfinctérico, e quatro pacientes mulheres (17%) tiveram localização anterior. O tempo de cirurgia foi de 32 minutos (variação, 22-55). O seton foi apertado 4 vezes (variação, 2-5) a intervalos de 2 semanas. A cicatrização ocorreu em sete semanas (variação, 5-11). Ao longo dos 24 meses (variação, 12-35) de seguimento dos pacientes, não houve relato de incontinência anal. Houve recorrência em um paciente (4%). Conclusão: O aperto do Seton em alça vascular pela técnica do nó de gravata é método simples, seguro, de fácil realização e que pode simplificar o tratamento de fístulas perianais com Seton.
Subject(s)
Humans , Male , Female , Rectal Fistula/surgery , Vascular Grafting/methods , Ligation/methods , Retrospective Studies , Treatment OutcomeABSTRACT
AbstractObjective:This study aimed to show the effects of intra-operative diltiazem infusion on flow in arterial and venous grafts in coronary artery bypass graft surgery.Methods:Hundred fourty patients with a total of 361 grafts [205 (57%) arterial and 156 (43%) venous] underwent isolated coronary surgery. All the grafts were measured by intraoperative transit time flow meter intra-operatively. Group A (n=70) consisted of patients who received diltiazem infusion (dose of 2.5 microgram/kg/min), and Group B (n=70) didn't receive diltiazem infusion.Results:Mean graft flow values of left internal mammary artery were 53 ml/min in Group A and 40 ml/min in Group B (P<0.001). Pulsatility index (PI) values of left internal mammary artery for Group A and Group B were 2.6 and 3.0 respectively (P<0.001). No statistically significant difference was found between venous graft parameters.Conclusion:We recommend an effect of diltiazem infusion in increasing graft flows in coronary artery bypass graft operations.
ResumoObjetivo:Este estudo teve como objetivo mostrar os efeitos da infusão de diltiazem intraoperatória no fluxo arterial e enxertos venosos em cirurgia de revascularização do miocárdio.Métodos:Cento e quarenta pacientes com um total de 361 enxertos [205 (57%) arteriais e 156 (43%) venosos] passaram por uma cirurgia coronária isolada. Todos os enxertos foram medidos pelo medidor de fluxo de tempo de trânsito intraoperatório. Grupo A (n=70), formado por pacientes que receberam infusão de diltiazem (dose de 2,5 micrograma/kg/min), e Grupo B (n=70), por aqueles que não receberam infusão de diltiazem.Resultados:Os valores médios de fluxo de enxerto de artéria mamária interna esquerda foram 53 ml/min no grupo A e 40 ml/min no Grupo B (P<0,001). Valores do índice de pulsatilidade da artéria mamária interna esquerda para o Grupo A e do Grupo B foram de 2,6 e 3,0, respectivamente (P<0,001). Não houve diferença estatisticamente significativa entre os parâmetros do enxerto venoso.Conclusão:Sugerimos um efeito da infusão de diltiazem em aumentar os fluxos de enxerto em operações de bypass de artéria coronária.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Antihypertensive Agents/pharmacology , Coronary Artery Bypass/methods , Coronary Circulation/drug effects , Diltiazem/pharmacology , Infusions, Intra-Arterial/methods , Intraoperative Care/methods , Myocardial Reperfusion , Vascular Grafting/methods , Antihypertensive Agents/administration & dosage , Diltiazem/administration & dosage , Flowmeters , Internal Mammary-Coronary Artery Anastomosis , Mammary Arteries/surgery , Predictive Value of Tests , Treatment OutcomeABSTRACT
PURPOSE: The failure of small-caliber vascular grafts still means a serious problem. Concerning the early postoperative complications we aimed to investigate the hemostaseological and hemorheological aspects of this issue in a canine model. METHODS: In the Control group only anesthesia was induced. In the Grafted group under general anesthesia a 3.5-cm segment was resected unilaterally from the femoral artery and replaced with a PTFE graft (diameter: 3 mm). On the 1st-3rd-5th-7th and 14th postoperative days the skin temperature of both hind limbs was measured, and blood sampling occurred for hematological, hemostaseological and hemorheological tests. RESULTS: The skin temperature of the operated versus intact limbs did not differ. In the Grafted group leukocyte count was elevated by the 1st postoperative day, while platelet count increased over the entire follow-up period. Fibrinogen concentration rose on the 1st-5th days, activated partial thromboplastin time increased on the 3rd-7th days. Erythrocyte aggregation was enhanced significantly on the 1st-5th days. In specimens taken on the 14th day, histologically we found matured thrombus narrowing the graft lumen. CONCLUSIONS: Small-caliber PTFE graft implantation into the femoral artery caused significant changes in several hemostaseological and hemorheological parameters. However, better clarifying the factors leading to early thrombosis of these grafts needs further studies. .
Subject(s)
Animals , Dogs , Blood Coagulation/physiology , Erythrocyte Aggregation/physiology , Femoral Artery/transplantation , Models, Animal , Polytetrafluoroethylene/therapeutic use , Vascular Grafting/methods , Anastomosis, Surgical , Blood Cell Count , Blood Vessel Prosthesis , Fibrinogen/analysis , Partial Thromboplastin Time , Postoperative Complications , Postoperative Period , Prothrombin Time , Time Factors , Treatment OutcomeABSTRACT
This study evaluated the outcomes of off-pump coronary artery bypass surgery (OPCAB) with severe left ventricular dysfunction using composite bilateral internal thoracic artery grafting. From January 2001 to December 2008, 1,842 patients underwent primary isolated OPCAB with composite bilateral internal thoracic artery grafting. A total of 131 of these patients were diagnosed with a severely depressed preoperative left ventricle ejection fraction (LVEF) (0.6). The early mortality for patients with severe LVEF was 2.3%. The 3-yr and 7-yr survival rate for patients with severe LV dysfunction was 86.0% and 82.8%, respectively. Multivariate analysis showed that severe LV dysfunction EF increased the risk of all-cause death (P=0.012; hazard ratio [HR],2.14; 95% confidence interval [CI],1.19-3.88) and the risk of cardiac-related death (P=0.008; HR,3.38; 95% CI, 1.37-8.341). The study identified positive surgical outcomes of OPCAB, although severe LVEF was associated with two-fold increase in mortality risk compared with patients who had normal LVEF.
Subject(s)
Female , Humans , Male , Middle Aged , Coronary Artery Bypass, Off-Pump/methods , Heart , Mammary Arteries/transplantation , Retrospective Studies , Stroke Volume , Survival Rate , Treatment Outcome , Vascular Grafting/methods , Ventricular Dysfunction, Left/mortality , Ventricular Function, LeftABSTRACT
A angiotomografia por multidetectores de coronárias constitui um método preciso para avaliação dos enxertos venosos e arteriais pós-revascularização coronariana e vem substituindo em parte o cateterismo, o qual é um método invasivo e de maior custo. Este ensaio iconográfico tem como objetivo a demonstração anatômica dos enxertos mais comumente utilizados, como diferenciar enxertos venosos e arteriais e como localizá-los. Os exames foram realizados em aparelhos de tomografia computadorizada multislice de 64 fileiras de detectores, com apneia, frequência cardíaca controlada e protocolos adequados com posterior reconstruções MPR, MIP e 3D, de acordo com o eletrocardiograma. A localização dos enxertos e anastomoses em tomografias computadorizadas direcionadas para as artérias coronárias e para o tórax pode dificultar a análise do exame pelo radiologista não familiarizado, sendo que o conhecimento das técnicas cirúrgicas utilizadas e dos possíveis trajetos das pontes de safena e enxertos arteriais ajuda na análise de ambos os exames, evitando também erros diagnósticos.
Multidetector coronary computed tomography angiography is a precise method for evaluating post-coronary revascularization arterial and venous bypass grafts, and is somehow superseding coronary catheterization that is an invasive and more expensive technique. The present iconographic essay is aimed at anatomically demonstrating the bypass grafts most frequently utilized, how to differentiate between arterial and venous grafts and how to find them. The studies were performed in 64-row multidetector computed tomography equipment, with breath hold, controlled heart rate and appropriate protocols with later MPR, MIP and 3D reconstructions according to electrocardiogram. The localization of the bypass grafts and anastomoses at computed tomography studies focused on chest and coronary arteries may represent a difficulty in the images analysis by the radiologist who is not familiar with the matter, so the knowledge of the surgical techniques adopted and possible courses of the saphenous bypass grafts and arterial grafts can aid in the analysis of both studies, avoiding diagnostic errors.