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1.
Rev. argent. cir ; 113(4): 487-491, dic. 2021. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1356960

ABSTRACT

RESUMEN Los pseudoaneurismas de la arteria humeral son infrecuentes, pero pueden asociarse a complicaciones de alta morbilidad como la isquemia de miembro superior. Comunicamos un caso de pseudoaneurisma humeral en el pliegue del codo, que se presentó como tumor pulsátil con leve disminución de la temperatura y parestesias en la mano homolateral de un año de evolución, debido a una punción arterial inadvertida durante la venopunción para extracción de sangre. Se trató con éxito mediante resección quirúrgica más reconstrucción vascular con bypass húmero-cubital y bypass húmero-radial ambos con vena safena. Se discuten las diversas opciones terapéuticas disponibles para los pseudoaneurismas humerales considerando las características anatómicas y la sintomatología del paciente.


ABSTRACT Brachial artery pseudoaneurysms are rare but can be associated with severe complications as ischemia of the upper extremity. We report a case of a brachial artery pseudoaneurysm in the crease of the elbow presenting as a pulsating mass with progressive growth over the past year. The ipsilateral hand was sightly cold and presented paresthesia. The lesion was due to inadvertent arterial puncture during venipuncture. The pseudoaneurysm was successfully treated with surgical resection and vascular reconstruction with a brachial to ulnar artery bypass and brachial to radial artery bypass with saphenous vein graft. The different therapeutic options available for brachial artery pseudoaneurysms are discussed, considering the anatomic characteristics and patients' symptoms.


Subject(s)
Humans , Female , Aged , Aneurysm, False/diagnosis , Ischemia , Paresthesia , Saphenous Vein , Therapeutics , Brachial Artery , Ulnar Artery , Phlebotomy , Upper Extremity , Iatrogenic Disease
2.
Rev. Assoc. Med. Bras. (1992) ; 67(8): 1093-1101, Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1346985

ABSTRACT

SUMMARY OBJECTIVE: Coronary artery bypass graft (CABG) surgery is a well-established treatment modality for patients with multivessel coronary artery disease (CAD). Syntax II Score has been established as novel scoring system with better prediction of postprocedural outcomes. This study aimed to investigate the prognostic value of SYNTAX II Score for predicting late saphenous vein graft (SVG) failure in patients undergoing isolated CABG. METHODS: The records of 1,875 consecutive patients who underwent isolated CABG with at least one SVG were investigated. Those who underwent coronary angiography and SVGs angiography at least 1 year after the CABG were included. Patients were divided into two groups based on the presence or absence of SVG failure. For each group, predictors of late SVG failure and subsequent clinical outcomes were analyzed. RESULTS: According to this study, the presence of hypertension, higher rates of repeat revascularization, and higher SYNTAX II Scores were found to be independent predictors of late SVG failure. In addition, the prognostic value of SYNTAX II Score was found to be significantly higher than anatomical SYNTAX Score in terms of predicting late SVG failure and major adverse cardiovascular and cerebrovascular event. CONCLUSIONS: There was a strong association between SYNTAX II Score and late SVG failure in patients undergoing isolated CABG.


Subject(s)
Humans , Saphenous Vein/surgery , Saphenous Vein/diagnostic imaging , Coronary Artery Disease/surgery , Coronary Artery Disease/diagnostic imaging , Vascular Patency , Coronary Artery Bypass/adverse effects , Treatment Outcome , Coronary Angiography
3.
Rev. bras. cir. cardiovasc ; 36(1): 106-111, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155800

ABSTRACT

Abstract The importance of the vasa vasorum and blood supply to the wall of human saphenous vein (hSV) used for coronary artery bypass grafting (CABG) is briefly discussed. This is in the context of the possible physical link of the vasa vasorum connecting with the lumen of hSV and the anti-ischaemic impact of this microvessel network in the hSV used for CABG.


Subject(s)
Humans , Saphenous Vein , Vasa Vasorum , Coronary Artery Bypass , Femoral Vein
4.
Rev. guatemalteca cir ; 27(1): 3-9, 2021. tab
Article in Spanish | LILACS, LIGCSA | ID: biblio-1359836

ABSTRACT

Introducción: Actualmente se prefieren procedimientos mínimamente invasivos como las técnicas endovasculares para el tratamiento de la insuficiencia de vena safena mayor que pueden ser por ablación térmica, química o mecánica. Éstos tienen la ventaja de ser ambulatorios, presentar menos complicaciones postoperatorias, una rápida incorporación laboral y mejores resultados estéticos. El objetivo de este estudio es evaluar los resultados del tratamiento con radiofrecuencia versus crosectomía safenofemoral más oclusión endovascular distal. Material y Métodos: Estudio descriptivo prospectivo que incluyó a todos los pacientes con diagnóstico de insuficiencia de la vena safena mayor de enero 2017 a octubre 2019. La elección de la técnica a utilizar se hizo al azar. Resultados: El 77% correspondió al género femenino, con edad media 49 años, el estadío C:2 de la clasificación clíica CEAP fue la más frecuente (57%) y el shunt tipo 3 (63%). La ablación por radiofrecuencia se realizó con mayor frecuencia (83%). El dolor y parestesias (fueron las complicaciones más frecuentes en ambos grupos sin diferencias estadísticamente significativas (p = 0.1470). No hubo diferencias estadísticamente significativo entre las dos técnicas quirúrgicas realizadas en resultado estético (p = 0.4456), el retorno de actividades cotidianas (p = 0.992) ni las laborales (p = 0.901). Conclusiones: Tanto la ablación por radiofrecuencia de la vena safena mayor como la crosectomía safenofemoral más oclusión endovascular distal se consideran dos métodos seguros y efectivos para tratar insuficiencia de vena safena mayor; ya que los resultados finales fueron similares para ambas técnicas quirúrgicas.


Introduction: Minimally invasive endovascular procedures like thermal, chemical or mechanical ablation are currently preferred for the treatment of the great saphenous vein insufficiency, because have the advantage of being outpatient, with minimal postoperative complications, a faster incorporation to work and better aesthetic results. This study persuit to evaluate the results of radiofrequency treatment versus sapheno-femoral crosectomy plus distal endovascular occlusion. Methods: The study included all the patients with a diagnosis of great saphenous vein insufficiency from January 2017 to October 2019. The technic was chosen randomly. Results: 77% of patients was female , with a mean age of 49 , the C2 stage of the CEAP classification is present in 57% and the type 3 shunt in 63%. Radiofrequency ablation was performed in 83% of the cases. Pain and paresthesia were the most frequent complications, without statistically signification between both technics (p = 0.1470). The aesthetic result, the return to daily activities (p = 0.992) and to work (p = 0.901) had not statistically significant differences between the two surgical techniques. Conclusions: Both, radiofrequency ablation of the greater saphenous vein and sapheno-femoral crosectomy plus distal endovascular occlusion are considered safe and effective methods to treat great saphenous vein insufficiency because the final results were similar for both surgical techniques.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Saphenous Vein/surgery , Venous Insufficiency/surgery , Ablation Techniques/methods , Radiofrequency Ablation/methods , Pain/etiology , Minimally Invasive Surgical Procedures/methods
5.
Rev. bras. cir. cardiovasc ; 35(6): 964-969, Nov.-Dec. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143982

ABSTRACT

Abstract Perivascular adipose tissue (PVAT) is a source of factors affecting vasomotor tone with the potential to play a role in the performance of saphenous vein (SV) bypass grafts. As these factors have been described as having constrictor or relaxant effects, they may be considered either beneficial or detrimental. The close proximity of PVAT to the adventitia provides an environment whereby adipose tissue-derived factors may affect the vasa vasorum, a microvascular network providing the vessel wall with oxygen and nutrients. Since medial ischaemia promotes aspects of graft occlusion the involvement of the PVAT/vasa vasorum axis in vein graft patency should be considered.


Subject(s)
Saphenous Vein , Vasa Vasorum , Adipose Tissue , Femoral Vein
6.
Arq. bras. cardiol ; 115(3): 538-544, out. 2020. tab, graf
Article in English, Portuguese | SES-SP, LILACS, SES-SP | ID: biblio-1131322

ABSTRACT

Resumo Fundamento Os enxertos de veias safenas (EVS) são frequentemente usados em pacientes submetidos a cirurgia de revascularização do miocárdio (CRM). Objetivos Avaliar as relações entre índices aterogênicos e estenose de EVS. Métodos: No total, 534 pacientes (27,7% mulheres, com idade média de 65±8,4 anos) submetidos a CRM e angiografia coronariana eletiva foram incluídos no estudo. Pacientes com pelo menos uma estenose EVS ≥50% foram alocados ao grupo estenose EVS (+) (n=259) e pacientes sem estenose foram classificados como EVS (-) (n=275). O índice aterogênico plasmático (IAP) e o coeficiente aterogênico (CA) foram calculados a partir dos parâmetros lipídicos de rotina dos pacientes. A significância foi estabelecida no nível p<0,05. Resultados O número de pacientes com histórico de hipertensão (HT), diabetes mellitus (DM), acidente vascular cerebral e insuficiência cardíaca (IC) se mostrou significativamente maior no grupo EVS (+) do que no grupo EVS (-). O colesterol total, triglicerídeos e colesterol LDL mostraram-se significativamente mais altos e o colesterol HDL mostrou-se menor no grupo EVS (+) do que no grupo EVS (-). IAP (p<0,001) e CA (p<0,001) apresentaram-se significativamente mais altos no grupo EVS (+) do que no grupo EVS (-). A análise ROC mostra que tanto o IAP quanto o CA mostraram-se melhores que o colesterol HDL, colesterol LDL e colesterol não HDL na predição de estenose de EVS. Na análise multivariada, histórico de DM, HT, acidente vascular cerebral, IC, número de enxertos de safena, colesterol HDL, colesterol LDL, colesterol não HDL, IAP e CA foram fatores de risco independentes para estenose de EVS. Conclusão O IAP e o CA foram preditores independentes de estenose de EVS. Além disso, tanto o IAP quanto o CA têm melhor desempenho na predição de estenose de EVS do que o colesterol LDL, colesterol HDL e colesterol não HDL. (Arq Bras Cardiol. 2020; 115(3):538-544)


Abstract Background Saphenous vein grafts (SVG) are frequently used in patients that have undergone coronary artery bypass graft (CABG) surgery. Objectives: To evaluate the relationship between atherogenic indexes and SVG stenosis. Methods Altogether, 534 patients (27.7% women, mean age 65±8.4 years) that underwent CABG and elective coronary angiography were included in the study. Patients with at least one SVG stenosis ≥50% were allocated to the stenosis group SVG (+) (n=259) and patients without stenosis were categorized as SVG (-) (n=275). Atherogenic index of plasma (AIP) and atherogenic coefficient (AC) were calculated from the patients' routine lipid parameters. The level of significance was p<0.05. Results The number of patients with a history of hypertension (HT), diabetes mellitus (DM), stroke, and heart failure was significantly higher in the SVG (+) group than in the SVG (-) group. Total cholesterol, triglycerides, LDL-C were significantly higher and HDL-C was lower in the SVG (+) group than in the SVG (-) group. AIP (p<0.001) and AC (p<0.001) were significantly higher in the SVG (+) group than in the SVG (-) group. The receiver operating characteristic (ROC) analysis show that both AIP and AC were better than HDL-C, LDL-C and non-HDL-C at predicting SVG stenosis. In the multivariate analysis, history of DM, HT, stroke, heart failure (HF), number of saphenous grafts, HDL-C, LDL-C, non-HDL-C, AIP and AC were found to be independent risk factors for SVG stenosis. Conclusion AIP and AC were independent predictors of SVG stenosis. Moreover, both AIP and AC have better performance in predicting SVG stenosis than LDL-C, HDL-C and non-HDL-C. (Arq Bras Cardiol. 2020; 115(3):538-544)


Subject(s)
Humans , Male , Female , Aged , Coronary Artery Disease/surgery , Coronary Artery Disease/diagnostic imaging , Transplants , Saphenous Vein/diagnostic imaging , Coronary Artery Bypass , Coronary Angiography , Constriction, Pathologic , Middle Aged
8.
Rev. bras. cir. cardiovasc ; 35(5): 675-682, Sept.-Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137356

ABSTRACT

Abstract Objective: To elucidate the effect of diabetes mellitus (DM) on the atherosclerotic process in saphenous vein grafts by determining urotensin-II (U-II) levels in harvested saphenous veins of patients who underwent coronary artery bypass grafting (CABG). Methods: Coronary artery disease (CAD) patients who underwent CABG were divided into two groups: Group I (eight non-diabetic patients; CAD group) and Group II (13 patients; DM+CAD group). All patients underwent coronary angiography prior to surgery and Gensini score was used to determine the severity of coronary atherosclerosis. Saphenous vein samples were stained with hematoxylin-eosin and U-II, then damage score, H-Score, and vein layer thicknesses were calculated and statistically evaluated. Results: In light microscopic evaluation, significant difference was observed between the groups in terms of endothelial cells damage, internal elastic lamina degradation, and tunica media vascular smooth muscle cells (VSMCs) damage (P<0.001). U-II immunoreactivity was increased in tunica adventitia in the DM+CAD group (P=0.002). The increase in foam cells was directly proportional to the thickening of the subendothelial layer, and this increased U-II immunoreactivity. Gensini score was higher in the DM+CAD group than in the CAD group (P=0.002). Conclusion: Our results show that saphenous vein grafts are already atherosclerotic before they are grafted in CAD patients. This disease is more severe in diabetic CAD patients and these changes can be detected using U-II immunoreactivity.


Subject(s)
Humans , Male , Female , Urotensins , Coronary Artery Disease/surgery , Coronary Artery Disease/diagnostic imaging , Saphenous Vein/diagnostic imaging , Coronary Artery Bypass , Endothelial Cells
9.
Rev. bras. cir. cardiovasc ; 35(5): 757-763, Sept.-Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137320

ABSTRACT

Abstract It has been reported that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection induces endothelial inflammation, therefore facilitating the progression of endothelial and vascular dysfunction in coronavirus disease 2019 (COVID-19) patients. Coronary artery bypass grafting (CABG) involves mainly the use of the saphenous vein (SV) and internal mammary artery as graft material in the stenosed coronary arteries. Unfortunately, graft patency of the SV is low due to endothelial dysfunction and inflammation. We propose that SARS-CoV-2 might cause vascular inflammation, endothelial dysfunction, and thrombosis in coronary artery bypass graft vessels by binding angiotensin-converting enzyme 2 receptor. Therefore, in this Special Article, we consider the potential influence of COVID-19 on the patency rates of coronary artery bypass graft vessels, mainly with reference to the SV. Moreover, we discuss the technique of SV graft harvesting and the therapeutic potential of focusing on endothelial dysfunction, vascular inflammation, and thrombosis for protecting coronary artery bypass grafts in COVID-19 infected CABG patients.


Subject(s)
Humans , Vascular Patency , Coronary Artery Bypass , Coronavirus Infections/complications , Graft Occlusion, Vascular/virology , Saphenous Vein/surgery , Thrombosis/physiopathology , Endothelium, Vascular/physiopathology , Treatment Outcome , Betacoronavirus , Inflammation/physiopathology
11.
Säo Paulo med. j ; 138(2): 98-105, Mar.-Apr. 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1139675

ABSTRACT

ABSTRACT BACKGROUND: Diagnosis and treatment of small saphenous vein (SSV) insufficiency is of utmost importance for relieving chronic venous insufficiency symptoms. OBJECTIVES: To investigate the efficacy and safety of five different treatment approaches among patients with SSV insufficiency. DESIGN AND SETTING: Two-center retrospective clinical study, conducted at cardiovascular surgery clinics in a local training and research hospital and a state hospital. METHODS: A total of 282 extremities of 268 patients with SSV insufficiency alone who were treated for symptomatic varicose veins between January 2012 and January 2017 were included in the study. All extremities included in the study were divided into five groups as follows: high ligation + stripping; radiofrequency ablation (RFA); cyanoacrylate closure (CAC); and endovenous laser ablation (EVLA) at the wavelengths 980 nm and 1,470 nm. RESULTS: Although the recurrence rate at six months was similar among the treatment groups, we found significant differences in recurrence rates at one year, with lower rates in the CAC, RFA and 1,470 nm EVLA groups, compared with the other treatments (P = 0.005). No sural neuritis was observed in the CAC group. The pigmentation rate was higher in the two EVLA groups (980 nm and 1,470 nm). CONCLUSIONS: Our study results showed that although CAC, RFA and EVLA at 1,470 nm seemed to be effective methods for treating SSV insufficiency alone, CAC and RFA had better aesthetic results than EVLA at 1,470 nm. We consider that endovenous non-thermal techniques for treating SSV insufficiency may be preferable because of relatively low risk of nerve injury.


Subject(s)
Humans , Varicose Veins , Venous Insufficiency , Saphenous Vein , Retrospective Studies , Treatment Outcome
12.
Int. j. morphol ; 38(1): 182-185, Feb. 2020. graf
Article in Spanish | LILACS | ID: biblio-1056418

ABSTRACT

La proteína chaperona Calreticulina (CRT), ha sido identificada en retículo endoplásmico (RE) y últimamente en la matriz extracelular (MEC) de predentina y arterias, atribuyéndole diferentes funciones extracelulares entre las que destacan la adhesión celular, regulación de la MEC y prevención en la formación de trombos. El objetivo del estudio fue identificar la presencia de CRT en MEC de vena safena parva. Se extrajo una muestra de vena safena parva de un espécimen masculino y luego fue procesada por medios histológicos e inmunohistoquímicos para identificar su presencia. Mediante técnicas de inmunohistoquímica se pudo evidenciar la presencia de CRT en la MEC de la adventicia de vena safena parva. La presencia de CRT en MEC de safena parva orienta a que CRT tienen funciones de tipo extracelular en esta localización, pero es necesario realizar estudios más precisos para dilucidar sus principales funciones en la zona.


Calreticulin (CRT) protein, has been identified in the endoplasmic reticulum (ER) and lately in the extracellular matrix (ECM) of predentine and arteries. It is responsible for different extracellular functions, such as cell adhesion, ECM regulation, and the prevention of thrombosis. The aim was to identify the presence of CRT in ECM of small saphenous vein. A sample of small saphenous vein from a male specimen was extracted and then processed by histological and immunohistochemical assays to identify its presence. The presence of CRT in the ECM of the small saphenous vein was observed by immunohistochemical techniques. The presence of CRT in the small saphenous vein ECM, indicates that CRT have extracellular functions in this area, however, more precise studies are necessary to determine its main functions.


Subject(s)
Humans , Male , Middle Aged , Saphenous Vein/metabolism , Calreticulin/metabolism , Immunohistochemistry
13.
Rev. bras. cir. cardiovasc ; 35(1): 91-99, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092466

ABSTRACT

Abstract The saphenous vein is the most common conduit used in coronary artery bypass grafting (CABG) yet its failure rate is higher compared to arterial grafts. An improvement in saphenous vein graft performance is therefore a major priority in CABG. No-touch harvesting of the saphenous vein is one of the few interventions that has shown improved patency rates, comparable to that of the left internal thoracic artery. After more than two decades of no-touch research, this technique is now recognized as a Class IIa recommendation in the 2018 European Society of Cardiology and the European Association for Cardio-Thoracic Surgery guidelines on myocardial revascularization. In this review, we describe the structural alterations that occur in conventional versus no-touch saphenous vein grafts and how these changes affect graft patency. In addition, we discuss various strategies aimed at repairing saphenous vein grafts prepared at conventional CABG.


Subject(s)
Humans , Saphenous Vein , Mammary Arteries , Vascular Patency , Coronary Artery Bypass , Treatment Outcome
14.
Article in Chinese | WPRIM | ID: wpr-879228

ABSTRACT

External support stent is a potential means for restricting the deformation and reducing wall stress of the vein graft, thereby improving the long-term patency of the graft in coronary artery bypass surgery. However, there still lacks a theoretical reference for choosing the size of stent based on the diameter of graft. Taking the VEST (venous external support) stent currently used in the clinical practice as the object of study, we constructed three models of VEST stents with different diameters and coupled them respectively to a model of the great saphenous vein graft, and numerically simulated the expansion-contraction process of the vein graft under the constraint of the stents to quantitatively evaluate the influence of stent size on the radial deformation and wall stress of the vein graft. The results showed that while the stent with a small diameter had a high restrictive effect in comparison with larger stents, it led to more severe concentration of wall stress and sharper changes in radial deformation along the axis of the graft, which may have adverse influence on the graft. In order to solve the aforementioned problems, we ameliorated the design of the stent by means of changing the cross-sectional shape of the thick and thin alloy wires from circle into rectangle and square, respectively, while keeping the cross-sectional areas of alloy wires and stent topology unchanged. Further numerical simulations demonstrated that the ameliorated stent evidently reduced the degrees of wall stress concentration and abrupt changes in radial deformation, which may help improve the biomechanical environment of the graft while maintaining the restrictive role of the stent.


Subject(s)
Alloys , Coronary Artery Bypass , Saphenous Vein/surgery , Stents
16.
Rev. bras. cir. cardiovasc ; 34(5): 588-595, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042049

ABSTRACT

Abstract Objective: To evaluate the efficacy of triclosan-coated suture for the reduction of infection in saphenectomy wounds of patients undergoing coronary artery bypass graft (CABG) surgery. Methods: A total of 508 patients who underwent saphenectomy in CABG surgery were included in a prospective, randomized, double-blind trial from February/2011 to June/2014. Patients were randomized into the triclosan-coated suture group (n= 251) and the conventional non-antibiotic suture group (n=257). Demographic (gender and age), clinical (body mass index, diabetes, and use of analgesics), and intraoperative (cardiopulmonary bypass and cross-clamp times) variables and those related to the saphenectomy wound (pain, dehiscence, erythema, infection, necrosis, and hyperthermia) were measured and analyzed. Results: Of the 508 patients who underwent saphenectomy, 69.9% were males and 40.2% were diabetic. Thirty-three (6.5%) patients presented infection: 13 (5.3%) with triclosan and 20 (7.9%) with conventional suture (P=0.281). Among diabetic patients (n=204), triclosan suture was used in 45.1% with four cases of infection; conventional suture was used in 54.9% of them, with 11 cases of infection. Most patients (94.3%) underwent on-pump CABG. Wound pain was observed in 9.9% of patients with triclosan-coated suture and in 17.9% with conventional suture (P=0.011). Wound hyperthermia was found in 1.6% of patients with triclosan-coated suture and in 5.4% of those with conventional suture (P=0.028). Conclusion: Triclosan-coated suture shows lower infection rate in saphenectomy of patients undergoing CABG, although the differences were not statistically significant. Pain and wound hyperthermia were less frequent in patients with triclosan-coated sutures compared with conventional sutures.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Polyglactin 910/therapeutic use , Saphenous Vein/surgery , Surgical Wound Infection/prevention & control , Triclosan/therapeutic use , Coronary Artery Bypass/methods , Suture Techniques , Anti-Infective Agents, Local/therapeutic use , Pain, Postoperative/prevention & control , Time Factors , Body Mass Index , Coronary Artery Bypass/adverse effects , Double-Blind Method , Prospective Studies , Reproducibility of Results , Treatment Outcome , Statistics, Nonparametric , Diabetes Complications
17.
Rev. bras. cir. cardiovasc ; 34(5): 560-564, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042042

ABSTRACT

Abstract Introduction: Angiographically visible plaques in patent vein grafts are usually detected years after surgery. Our aim was to examine early plaque formation in vein grafts. Methods: Bypass angiography and intravascular ultrasonography (IVUS) examination were performed on 77 aortocoronary saphenous vein grafts (SVGs) implanted in 36 patients during the first 2 years after CABG. In each graft, a good quality 25 mm ultrasound image was analyzed. We measured: plaque area, lumen area, external elastic membrane (EEM) area, graft area and wall area. For the comparative assessment of SVGs, the index plaque area/EEM area was calculated. Data were analyzed for the following 4 time periods: I - 0-4 months (22 grafts), II - 5-8 months (23 grafts), III - 9-12 months (19 grafts) and IV - 13-16 months (13 grafts) after CABG. Student's t and Fisher-Snedecor tests were used for the purpose of statistical analysis in this retrospective study. Results: In period I, plaque formation (neointimal) was observed in 10 grafts (45%), with a mean plaque area of 1.59 mm., in 6 grafts (26%) in period II, with a mean plaque area of 1.03 mm. and in 15 grafts (71%) in period III, with a mean plaque area of 1.41 mm., and in all (100%) grafts in period IV, with mean plaque area of 2,3 mm.. Average index plaque area/EEM area in periods I, II, III and IV were 0.12, 0.08, 0.13 and 0.22. We have showed a significant plaque increase between periods II and IV(P=0.038). Conclusion: IVUS showed plaque in about 40% of venous grafts during the first year after CABG. Between 13-16 months plaque was visible in all studied grafts.


Subject(s)
Humans , Male , Female , Middle Aged , Saphenous Vein/transplantation , Coronary Artery Disease/etiology , Coronary Artery Disease/diagnostic imaging , Coronary Artery Bypass/adverse effects , Atherosclerosis/etiology , Atherosclerosis/diagnostic imaging , Time Factors , Retrospective Studies , Coronary Angiography/methods , Ultrasonography, Interventional/methods , Early Diagnosis
18.
Rev. bras. cir. cardiovasc ; 34(4): 480-483, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020495

ABSTRACT

Abstract The saphenous vein (SV) is the most commonly used conduit for coronary artery bypass surgery (CABG) and the second conduit of choice in Brazil and many other countries. The radial artery (RA) is suggested, by some, to be superior to SV grafts, although its use in the USA declined over a 10 year period. The patency of SV grafts (SVG) is improved when the vein is harvested with minimal trauma using the no-touch (NT) technique. This improved performance is due to the preservation of the outer pedicle surrounding the SV and reduction in vascular damage that occurs when using conventional techniques (CT) of harvesting. While the patency of NT SVGs has been shown superior to the RA at 36 months in one study, data from the RADIAL trial suggests the RA to be the superior conduit. When additional data using NT SVG is included in this trial the difference in risk of graft occlusion between the RA and SV grafts dissipates with there no longer being a significant difference in patency between conduits. The importance of preserving SV structure and the impact of NT harvesting on conduit choice for CABG patients are discussed in this short review.


Subject(s)
Humans , Saphenous Vein/transplantation , Coronary Artery Disease/surgery , Coronary Artery Bypass/methods , Radial Artery/transplantation , Vascular Patency , Brazil , Meta-Analysis as Topic , Treatment Failure
19.
Rev. bras. cir. cardiovasc ; 34(3): 297-304, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013476

ABSTRACT

Abstract Objectives: To investigate the association between clinical hematologic parameters and saphenous vein graft failure after on-pump coronary artery bypass surgery. Methods: A total of 1950 consecutive patients underwent isolated on-pump coronary artery surgery between November 2010 and February 2013. Of these, 284 patients met our inclusion criteria; their preoperative clinical hematological parameters were retrospectively obtained for this cohort study. And of them, 109 patients underwent conventional coronary angiography after graft failure was revealed by coronary computed tomography angiography. The primary endpoint was to catch at least one saphenous vein graft stenosis or occlusion following the coronary angiogram. We then analyzed risk factors for graft failure. In sequential or T grafts, each segment was analyzed as a separate graft. Results: In logistic regression analysis, older age, platelet distribution width, and diabetes mellitus were identified as independent predictors of saphenous vein graft failure (P<0.). In contrast, preserved ejection fraction value favored graft patency (P<0.001). Conclusion: Increased platelet distribution width is easily measurable and can be used as a simple and valuable marker in the prediction of saphenous vein graft failure.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Saphenous Vein/transplantation , Blood Platelets/physiology , Vascular Patency/physiology , Coronary Artery Bypass/adverse effects , Platelet Count , Reference Values , Saphenous Vein/physiopathology , Coronary Artery Disease/etiology , Echocardiography , Logistic Models , Coronary Artery Bypass/methods , Predictive Value of Tests , Retrospective Studies , Risk Factors , ROC Curve , Age Factors , Coronary Angiography/methods , Treatment Failure , Statistics, Nonparametric , Hematologic Tests
20.
Rev. bras. cir. cardiovasc ; 34(3): 290-296, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013469

ABSTRACT

Abstract Objective: In this study, we aimed to examine the effects of amitriptyline, fluoxetine, tranylcypromine and venlafaxine on saphenous vein grafts in coronary artery bypass graft surgeries. Methods: 59 patients (40 males and 19 females; mean age 65.1 years, distribution: 45-84 years) who had coronary artery bypass graft surgery between February 2014 and May 2016 were included in the study. After the saphenous vein grafts with intact and denuded endothelium were precontracted with 3×10-6M phenylephrine, amitriptyline, fluoxetine and tranylcypromine were cumulatively added to isolated organ baths in the range of 10-11-3x10-5M, while venlafaxine was added in the range of 10-9-3×10-5M. Then, the antidepressant-induced relaxation responses were recorded isometrically. Results: While the relaxation response of amitriptyline at -6.42 (Log M) was 74.6%, the response at -6.32 (Log M) was 75.5%. While the relaxation response at -6.46 (Log M) of fluoxetine was 68.02%, the response at -6.02 (Log M) was 72.12%. While the relaxation response of tranylcypromine at -7.53 (Log M) was 61.13%, the response at -7.23 (Log M) was 65.53%. While the relaxation response of venlafaxine at -6.21 (Log M) was 29.98%, the response at -5.90 (Log M) was 32.96%. Conclusion: The maximum relaxation at minimum and maximum therapeutic concentrations was obtained with amitriptyline, fluoxetine and tranylcypromine, and the minimum relaxation was obtained with venlafaxine. The relaxation responses were independent of the endothelium.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Saphenous Vein/drug effects , Saphenous Vein/transplantation , Tranylcypromine/pharmacology , Fluoxetine/pharmacology , Amitriptyline/pharmacology , Antidepressive Agents/pharmacology , Reference Values , Vasodilation/drug effects , Endothelium, Vascular/drug effects , Coronary Artery Bypass/methods , Analysis of Variance , Transplants/drug effects , Venlafaxine Hydrochloride/pharmacology , Muscle, Smooth, Vascular/drug effects
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