Un caso complejo de isquemia mesentérica crónica: Reporte de caso y revisión de la literatura / A complex case of chronic mesenteric ischemia: Case report and literature review

Introducción. La isquemia mesentérica crónica es una entidad infrecuente, con una prevalencia de 0,03 %, donde más del 90 % son debidas a enfermedad arterioesclerótica que compromete principalmente la arteria mesentérica superior. Sus síntomas son dolor abdominal crónico y pérdida de peso, asociado a alteraciones imagenológicas que hacen el diagnóstico. El tratamiento depende de las condiciones clínicas del paciente y el número de vasos comprometidos. Es claro que la enfermedad multivaso sintomática requiere revascularización. Caso clínico. Mujer de 67 años, fumadora activa con antecedentes de hipertensión arterial y dislipidemia, con cuadro de crisis hipertensiva tipo urgencia que requirió manejo en Unidad de Cuidados Intensivos. Se hizo diagnóstico de aneurisma toracoabdominal Crawford IV, oclusión aorto-ilíaca (TASC D) y oclusión crónica del tronco celíaco y la arteria mesentérica superior. Por los síntomas de isquemia mesentérica crónica fue llevada a tratamiento quirúrgico con baipás aorto-bifemoral más baipás retrógrado a la arteria mesentérica superior por vía abierta. Resultado. La paciente tuvo mejoría de la sintomatología y aumentó 13 % del peso al seguimiento a los 3 meses. Conclusión. La isquemia mesentérica crónica es una condición subdiagnosticada, marcador de riesgo cardiovascular, con alta carga de morbilidad y mortalidad, en la cual, con una identificación temprana se puede ofrecer una terapia de revascularización, sea por vía endovascular o abierta, con el fin de mejorar la calidad de vida y la ganancia de peso, y evitar la necrosis intestinal.

Introduction. Chronic mesenteric ischemia is a rare entity, with a prevalence of 0.03%, where more than 90% are due to arteriosclerotic disease that mainly affects the superior mesenteric artery. Its symptoms are chronic abdominal pain and weight loss, associated with imaging alterations that make the diagnosis. Treatment depends on the patient's clinical conditions and the number of vessels involved. It is clear that symptomatic multivessel disease requires revascularization. Clinical case. A 67-year-old woman, an active smoker with a history of high blood pressure and dyslipidemia, presented with an emergency-type hypertensive crisis that required management in the Intensive Care Unit. A diagnosis of Crawford IV thoracoabdominal aneurysm, aorto-iliac occlusion (TASC D), and chronic occlusion of the celiac trunk and superior mesenteric artery was made. Due to the symptoms of chronic mesenteric ischemia, she underwent surgical treatment with aorto-bifemoral bypass plus retrograde bypass to the superior mesenteric artery via an open approach. Result. The patient had improvement in symptoms and gained 13% weight at 3-month follow-up. Conclusion. Chronic mesenteric ischemia is an underdiagnosed condition, a marker of cardiovascular risk, with a high burden of morbidity and mortality, in which, with early identification, revascularization therapy can be offered, either endovascularly or open, in order to improve quality of life and weight gain, and avoiding intestinal necrosis.

Reanimación facial: experiencia mediante métodos estáticos y dinámicos / Facial reanimation: experience using static and dynamic methods

La parálisis facial periférica es una condición que impacta negativamente en la calidad de vida y psiquis de los pacientes. Se aborda como una afección relativamente frecuente, con diversas causas, con un manejo multidisciplinario para su tratamiento. Se presenta un estudio retrospectivo de cuatro pacientes femeninas que sufrieron parálisis facial periférica crónica, causada por cirugías previas. Se emplearon técnicas estáticas y dinámica para su tratamiento, incluyendo una nueva técnica estática no descrita anteriormente para parálisis faciales basada en el lifting de tercio medio de plano profundo. Se evaluó la satisfacción de los pacientes mediante el cuestionario FACE Q pre- y posoperatorio, mostrando resultados positivos en ambos grupos de tratamiento. Se destaca la importancia de la kinesiología motora en el proceso de rehabilitación. Demostramos la efi cacia de técnicas accesibles y de bajo costo, así como la introducción exitosa de técnicas más complejas, como la transferencia muscular con anastomosis nerviosa.

Peripheral facial paralysis is a condition that negatively impacts the quality of life and psyche of patients. It is addressed as a relatively frequent condition with various causes, managed through a multidisciplinary approach for its treatment. A retrospective study is presented involving four female patients who suff ered from chronic peripheral facial paralysis caused by previous surgeries. Both static and dynamic techniques were used for their treatment, including a new static technique not previously described for facial paralysis based on deep plane midface lifting. Patient satisfaction was evaluated using the FACE Q questionnaire pre- and post-operatively, showing positive results in both treatment groups. The importance of motor kinesiology in the rehabilitation process is highlighted. We demonstrate the effi cacy of accessible and low-cost techniques, as well as the successful introduction of more complex techniques, such as muscle transfer with nerve anastomosis.

Efectos adversos secundarios a Anfotericina B Liposomal

La anfotericina B liposomal se ha utilizado en reemplazo de la anfotericina B desoxicolato para disminuir sus efectos adversos asociados, especialmente la nefrotoxicidad. Presentamos el caso de un paciente masculino de 47 años, sin enfermedad cardíaca previa, con diagnóstico de leishmaniasis visceral, que presentó miocarditis, rabdomiólisis y polineuropatía periférica posterior al tratamiento con anfotericina B liposomal. Este caso resalta la importancia de considerar los efectos adversos tras la administración de anfotericina B liposomal.

Liposomal amphotericin B has been used to replace amphotericin B deoxycholate to reduce its associated adverse effects, especially nephrotoxicity. We present the case of a 47-year-old male patient without known previous heart disease with a diagnosis of visceral leishmaniasis, who presented myocarditis, rhabdomyolysis and peripheral polyneuropathy after starting treatment with liposomal amphotericin B. This case highlights the importance of other adverse effects to consider, such as cardiotoxicity, related to the administration of liposomal amphotericin B and other effects not previously reported such as peripheral polyneuropathy.

Síndrome de Leriche, Resolución Quirúrgica / Leriche Syndrome, Surgical Resolution

La enfermedad oclusiva aortoilíaca o el síndrome de Leriche, es una forma de enfermedad arterial periférica, en la que hay una oclusión de las arterias ilíacas de su bifurcación. La manifestación clínica es variable. La claudicación intermitente es la más común; Sin embargo, es una enfermedad generalmente subdiagnosticada debido a su cronicidad y al estilo de vida sedentario de los adultos mayores, que más la presentan. Para el diagnóstico, hay una variedad de opciones, que incluyen pruebas invasivas y no invasivas; La arteriografía es el método de elección. El tratamiento implica cambios en el estilo de vida combinado con el tratamiento conservador o quirúrgico, dependiendo de cada individuo.

Aortoiliac occlusive disease, or Leriche syndrome, is a form of peripheral arterial disease, in which there is an occlusion of the iliac arteries from their bifurcation. The clinical manifestation is variable. Intermittent claudication is the most common; However, it is a disease usually underdiagnosed due to its chronicity and the sedentary lifestyle of older adults, who present it most. For diagnosis, there is a range of options, including invasive and non-invasive tests; arteriography is the method of choice. Treatment involves changes in lifestyle combined with conservative or surgical treatment, depending on each individual

Vitaminas B1, B6, B12 y neuropatías periféricas: Consenso de expertos / Vitamins B1, B6, and B12 and peripheral neuropathies: International expert consensus

RESUMEN A partir de una revisión bibliográfica de la literatura se ha planeado y desarrollado un consenso de expertos internacionales sobre la utilización de las vitaminas B1, B6, B12 en sus déficits y en la neuropatía periférica que puede estar asociada a la misma, como tema que precia de esa aproximación aclaratoria para optimizar su manejo. Se plantearon varias cuestiones de discusión que se consideraron importantes y dignas de ser abordadas y aclaradas, conservando nueve de ellas para su discusión ulterior buscando el consenso en tres rondas consecutivas. Se han propuesto 41 recomendaciones sobre el manejo de estas condiciones, con unanimidad por parte de los participantes en el consenso. Con ellas se ha intentado aclarar puntos oscuros o controvertidos, facilitando la actitud del clínico ante ellos en la práctica médica actual.

ABSTRACT Based on a bibliographic review of the literature, a consensus of international experts has been carried out on the use of vitamins B1, B6, B12, in their deficiencies, and in the peripheral neuropathy that may be associated with them, to optimize the management of these conditions. Several questions considered important and worthy of being addressed and clarified were raised, retaining nine of them for further discussion to achieve consensus. Forty one recommendations on the management of these conditions have been proposed, with unanimity of the participants in the consensus. This has been an attempt to clarify controversial points, assisting the clinician's attitude in current medical practice.

Tumor maligno de la vaina nerviosa periférica: reporte de un caso / Malignant peripheral nerve sheath tumor, a case report

Resumen El tumor maligno de la vaina nerviosa periférica (TMVNP) es un sarcoma de alto grado de malignidad. Es poco frecuente, agresivo y generalmente se localiza en tronco y miembros inferiores. Se presenta mayormente en pacientes con neurofibormatosis tipo 1, aunque no siempre se encuentra esta asociación. Este tumorcomparte características histológicas e inmunohistoquímicas con el melanoma, lo que puede dificultar el diagnóstico. Presentamos el caso de un paciente con TMVNP, en el cual los hallazgos histológicos iniciales condujeron a un diagnósticoerróneode melanoma.

Abstract Malignant peripheral nerve sheath tumor (MPNST) is a high-grade sarcoma. It is rare, aggressive and generally located on the trunk and lower limbs. It occurs in a high percentage of patients with neurofibormatosis type 1, although this association is not always found. This tumor shares histological and immunohistochemical characteristics with melanoma, which can make diagnosis difficult. We present the case of a patient with MPNST, in whom the initial histological findings led to an erroneous diagnosis of melanoma.

Duplex ultrasound and pedal acceleration time as tools to evaluate foot perfusion: a literature review / Ultrassonografia dúplex e tempo de aceleração plantar como ferramentas para avaliar a perfusão do pé: uma revisão da literatura

Abstract Currently, the standard non-invasive test for diagnosing Peripheral Arterial Disease is the Ankle-Brachial Index. However, this test becomes unfeasible in a certain population. New evidence proposes the pedal acceleration time, an ultrasound index, as an alternative test. An integrative bibliographic review was carried out between June 3, 2022 and January 8, 2023, to investigate this new index as a tool to assess foot perfusion. Papers published in English, Portuguese, or Spanish between 2012 and 2022 were searched on PubMed, Google Scholar, and Scielo, using the keywords "Peripheral Arterial Disease" AND "Acceleration Time" AND (Pedal OR Plantar). Research that didn't assess foot perfusion using the methods of interest or did not present human data and also case series or reports were excluded. Seven out of the sixty-six articles identified in the searches were selected for the review, all of which had notable methodological limitations. Pedal acceleration time seems to be able to diagnose and stratify and may reflect prognosis.

Resumo Atualmente, o teste não invasivo padrão para diagnosticar a doença arterial periférica é o índice tornozelo-braquial, porém, em uma determinada população, este torna-se inviável. Novas evidências propõem o tempo de aceleração plantar, que é um índice ultrassonográfico, como alternativa. Para investigá-lo no contexto do estudo da perfusão do pé, uma revisão bibliográfica integrativa foi realizada entre 03/06/2022 e 08/01/2023. Artigos em inglês, português ou espanhol, publicados entre 2012 e 2022 foram pesquisados através das ferramentas PubMed, Google Scholar e SciELO, com as palavras-chave "Peripheral Arterial Disease" AND "Acceleration Time" AND (Pedal OR Plantar). Pesquisas que não avaliaram a perfusão do pé pelos métodos de interesse, sem dados em humanos e relatos ou séries de casos, foram excluídos. Dos 66 artigos, 7 foram selecionados; todos com notáveis limitações metodológicas. O tempo de aceleração plantar aparenta ser capaz de diagnosticar, estratificar e prognosticar os doentes.

Comparação entre ecografia vascular com Doppler e exames contrastados na doença arterial crônica periférica / Comparison between vascular Doppler ultrasound and contrast exams in chronic peripheral arterial disease

Resumo Contexto A ecografia vascular com Doppler (EVD) evoluiu nos últimos anos devido ao aprimoramento da tecnologia de aquisição e processamento da imagem. A disponibilidade do exame, o baixo custo e a ausência de efeitos deletérios de radiação e contraste tornam este método uma excelente opção no diagnóstico da doença arterial periférica. As quebras nas cadeias de suprimentos devido à pandemia de covid-19 levaram a uma escassez global de contraste iodado, reforçando a importância de validar abordagens alternativas. Objetivos Utilizar a EVD na decisão entre cirurgia aberta ou endovascular para doença arterial femoropoplítea e comparar os resultados com exames de contraste iodado. Métodos Comparamos EVD com exames contrastados (angiotomografia e arteriografia) em relação à localização de estenoses/oclusões e indicação do tratamento cirúrgico (by-pass vs. endovascular). Em uma primeira fase, os resultados foram apenas comparados entre EVD e angiotomografia. Numa segunda fase, os resultados da EVD foram usados na triagem entre by-pass vs. endovascular), sendo comparados com angiotomografia nos casos de cirurgia aberta e comparados com a arteriografia nos casos de tratamento endovascular. Resultados A sensibilidade da EVD em comparação com a angiotomografia na fase 1 foi de 100% para o território da artéria femoral superficial. Ao considerar apenas a indicação de by-pass versus endovascular, os resultados mostraram 100% de concordância para a Fase 1 e 94% para a Fase 2. Conclusões Com a ressalva do tamanho amostral, o estudo cumpriu seu objetivo de demonstrar a confiabilidade da EVD na indicação do tratamento cirúrgico entre aberto ou endovascular.

Abstract Background Vascular Doppler ultrasound (DUS) has evolved over recent years because of improvements in the technology involved in the acquisition and processing of sound and image data. The method is an excellent option for use in diagnosis of peripheral arterial disease considering its availability, low cost, and absence of harmful effects. The breakdown of logistics supply chains caused by the COVID-19 pandemic caused worldwide shortages of iodinated contrast, highlighting the need to validate alternative diagnostic methods. Objective To use DUS for decision-making when choosing between by-pass and endovascular surgery for femoropopliteal arterial disease and compare the results to those of iodinated contrast exams. Methods We compared DUS with examinations using contrast for identification of stenoses/occlusions and indication of surgical treatment (by-pass vs. endovascular). In the first phase of the study the results were merely compared, DUS vs. angiotomography. Then, in the second phase, the vascular ultrasound results were used for screening between by-pass and endovascular treatment, comparing DUS with angiotomography in cases scheduled for by-pass and with arteriography in endovascular patients. Results In phase 1, the sensitivity of DUS compared to CT angiography was 100% for the SFA territory. When considering solely the choice of bypass vs. endovascular treatment, the results showed 100% agreement for phase 1 and 94% for phase 2. Conclusion Notwithstanding the sample size, the study fulfilled its objective of demonstrating the reliability of DUS for indicating the treatment choice between by-pass and endovascular surgery.

Relação entre o índice de resistência vascular e o sucesso hemodinâmico de revascularizações distais dos membros inferiores / Vascular resistance index and the immediate hemodynamic success of lower limb distal artery revascularization

Resumo Contexto A cirurgia de revascularização é proposta para restaurar o fluxo sanguíneo para o pé nos casos de isquemia crítica (IC) devido a doença arterial obstrutiva periférica dos membros inferiores (MMII). O uso de ultrassonografia com Doppler (USD) vem despontando nos últimos anos como um método de grande valor para o planejamento cirúrgico dessa intervenção. Objetivos Avaliar a relação entre o índice de resistência (IR), mensurado por meio de USD, e o sucesso hemodinâmico imediato da cirurgia de revascularização dos MMII em pacientes com IC. Métodos O tipo de estudo empregado foi a coorte prospectiva, na qual foram avaliados 46 pacientes portadores de IC dos MMII submetidos à operação de revascularização infrainguinal por angioplastia ou em ponte de agosto de 2019 a fevereiro de 2022. Todos os pacientes foram submetidos à avaliação clínica vascular, à USD com medida do IR das artérias distais dos MMII, à arteriografia dos MMII e à aferição do índice tornozelo-braquial (ITB) no período pré-operatório. No pós-operatório imediato, todos os pacientes foram submetidos à nova aferição do ITB. Resultados Entre os 46 pacientes avaliados, 25 (54,3%) eram do sexo masculino. A idade variou de 32 a 89 anos (média de 67,83). Quanto ao sucesso hemodinâmico, avaliado pela comparação do ITB pré e pós-operatório, constatou-se que 31 (67,4%) pacientes apresentaram sucesso hemodinâmico após cirurgia de revascularização (aumento do ITB em 0,15 ou mais). Foi observada correlação positiva (p ≤ 0,05) entre o IR da artéria distal revascularizada do MMII e o sucesso hemodinâmico imediato avaliado pela aferição do ITB (IR menor e sucesso hemodinâmico). Conclusões Na presente pesquisa foi observada uma correlação positiva entre o índice de resistência arterial distal e o sucesso hemodinâmico nas revascularizações dos membros inferiores, avaliada através do índice tornozelobraquial, de forma que, quanto menor foi o IR, maior o sucesso hemodinâmico obtido.

Abstract Background Revascularization surgery is used to attempt to restore blood flow to the foot in patients with critical ischemia (CI) caused by peripheral arterial occlusive disease of the lower limbs (LL). Ultrasonography with Doppler (USD) SAH emerged in recent years as a highly valuable method for planning this surgical intervention. Objectives To evaluate the relationship between the resistance index (RI), measured with USD, and immediate hemodynamic success of LL revascularization surgery in patients with CI. Methods The study design was a prospective cohort assessing 46 patients with LL CLI who underwent operations to perform infrainguinal revascularization by angioplasty or bypass from August 2019 to February 2022. All patients underwent preoperative clinical vascular assessment with USD including measurement of the RI of distal LL arteries, LL arteriography, and measurement of the ankle-brachial index (ABI). All patients had their ABI measured again in the immediate postoperative period. Results Forty-six patients were assessed, 25 (54.3%) of whom were male. Age varied from 32 to 89 years (mean: 67.83). Hemodynamic success was assessed by comparison of preoperative and postoperative ABI, showing that hemodynamic success was achieved in 31 (67.4%) patients after revascularization surgery (ABI increased by 0.15 or more). A positive correlation (p ≤ 0.05) was observed between the RI of the distal revascularized LL artery and immediate hemodynamic success assessed by ABI (lower RI and hemodynamic success). Conclusions This study observed a positive correlation between the resistance index of the distal artery and immediate hemodynamic success of lower limb revascularizations, as assessed by the ankle-brachial index, so that the lower the RI the greater the hemodynamic success achieved.

Correlação entre o índice de resistência vascular e a arteriografia na avaliação do leito arterial distal na isquemia crítica dos membros inferiores / Correlation between the vascular resistance index and arteriography for assessment of the distal arterial bed in chronic limb threatening ischemia

Resumo Contexto Pacientes com isquemia crítica (IC) dos membros inferiores (MMII) precisam de arteriografia para o planejamento da cirurgia de revascularização. A ultrassonografia Doppler (UD) não é invasiva e, através da aferição do índice de resistência (IR), pode fornecer informações sobre as artérias distais. Objetivos Correlacionar a Classificação Angiográfica de Rutherford com o IR na avaliação do leito arterial distal dos MMII. Métodos Estudo transversal, realizado em hospital público terciário, com 120 pacientes portadores de IC dos MMII, entre setembro de 2019 a abril de 2022. Foi comparado o IR das artérias da perna passíveis de serem receptoras de revascularização com a imagem obtida através da arteriografia dessas artérias em acordo com a Classificação Angiográfica de leito distal de Rutherford. Resultados Foram avaliados 120 MMII em 120 pacientes com idade média de 68,6 anos. A amostra foi composta de 50,0% de pacientes do sexo masculino. Na amostra, 90,0% pacientes encontravam-se na classe cinco de Rutherford. Os valores do IR encontrados para as artérias de perna apresentaram uma correlação positiva, estatisticamente significativa, quando comparados com a Classificação de Rutherford (tibial anterior, p< 0,01; tibial posterior, p = 0,012 e fibular, p = 0,034 e artéria dorsal do pé, p < 0,001). Conclusões Neste estudo, os IRs das artérias da perna obtidos através da ultrassonografia Doppler apresentaram uma correlação positiva quando comparados à classificação de Rutherford. Em pacientes com isquemia crítica, esse índice pode ser útil na avaliação do leito arterial distal dos membros inferiores.

Abstract Background Patients with chronic limb threatening ischemia (CLTI) of the lower limbs (LL) undergo arteriography for revascularization surgery planning. Doppler ultrasound (DU) is non-invasive and can provide information about the distal arteries through measurement of the resistance index (RI). Objectives To correlate the Rutherford Angiographic Classification with the RI for assessment of the distal arterial bed of the LL. Methods A cross-sectional study, conducted at a public tertiary hospital with 120 patients with LL CLTI, from September 2019 to April 2022. The RI of arteries that were candidates for revascularization was compared with the images of the same arteries obtained using arteriography, using the Rutherford Angiographic Classification of the distal bed. Results A total of 120 LL were assessed in 120 patients with a mean age of 68.6 years. The sample was 50.0% male and 90.0% of the patients in the sample were classified as Rutherford category five. The RI values found for the arteries of the leg exhibited a statistically significant positive correlation with the Rutherford Classification (anterior tibial, p< 0.01; posterior tibial, p = 0.012 fibular, p = 0.034; and dorsalis pedis, p < 0.001). Conclusions In this study, RIs for the arteries of the leg measured using Doppler ultrasound exhibited a positive correlation with the Rutherford Classification. This index could be useful for assessment of the distal arterial bed of the lower limbs of patients with chronic limb threatening ischemia.

Prognostic relevance of female gender on mortality after peripheral artery disease revascularization / Relevancia pronóstica del género femenino en la mor talidad luego de la revascularización de la enfermedad arterial periférica

Abstract Introduction : Lower limb peripheral artery disease (PAD) presents high morbidity and mortality. Women represent a small subgroup in different studies, with scarce evidence regarding the prognosis of this gender on PAD. The aim of the present work was to determine the prognostic impact of female gender on lower limb PAD revascularization. Methods : This was a retrospective, single-center study, including patients undergoing symptomatic lower limb PAD revascularization. Results : Among a total of 309 patients included in the study, 109 belonged to the female gender (35%). Women were older and presented lower prevalence of cardiovascular risk factors compared with the male gender. All-cause mortality (22% vs. 12%, p = 0.02) and re-hospitalizations for chronic limb-threatening ischemia (18% vs. 10%, p = 0.04) rates were significantly higher in women. In a multivariate regression model, female gender was independently associated with all-cause mortality (OR 2.19 [95% CI: 1.06-4.51], p = 0.03). The time-to-event showed that women exhibited 93% more risk of suffering death than men, after adjusting for clinically relevant variables (HR 1.93 [95% CI: 1.04-3.56], p = 0.04). Discussion : Women with symptomatic PAD revascu larization presented worse prognosis than men in terms of all-cause mortality and re-hospitalizations for chronic limb-threatening ischemia rates. Therefore, it is essen tial to achieve an adequate control of cardiovascular risk factors, as well as to optimize medical treatment in female patients.

Resumen Introducción : La enfermedad arterial de miembros inferiores (EAMI) presenta elevada morbimortalidad. Las mujeres constituyen un subgrupo minoritario en distin tos estudios, con escasa evidencia acerca del pronóstico por género en EAMI. Nuestro objetivo fue determinar el impacto pronóstico del género femenino en la revascu larización de EAMI. Métodos : Estudio de cohorte retrospectivo y unicén trico, que incluyó pacientes con EAMI sintomática y revascularizada. Resultados : Se incluyeron 309 pacientes, de los cuales 109 (35%) eran mujeres. Las mujeres fueron más añosas y presentaron menor prevalencia de factores de riesgo cardiovascular en comparación a los hombres. Las tasas de mortalidad por todas las causas (22% vs. 12%, p = 0.02) y de hospitalizaciones por isquemia crítica (18% vs. 10%, p 0.04) fueron significativamente mayores en mujeres. En el modelo de regresión multivariado, el sexo femenino se asoció de forma independiente con mortalidad por todas las causas (OR 2.19 [IC 95%: 1.06-4.51], p = 0.03). En el análisis de tiempo al evento, las mujeres tuvieron 93% más riesgo de morir que los hombres, luego de ajustar por variables clínicamente relevantes (HR 1.93 [IC 95%: 1.04-3.56], p = 0.04). Discusión : Las mujeres con EAMI sintomática y re vascularizada presentaron un peor pronóstico en com paración a los hombres en términos de tasas de mor talidad por todas las causas y de hospitalizaciones por isquemia crítica de miembros inferiores. Por lo tanto, es fundamental lograr un adecuado control de factores de riesgo cardiovascular, como así también, optimizar el tratamiento médico en el género femenino.

Enfermedad arterial periférica en población trabajadora: factores de riesgo y estilo de vida

Introducción: La Enfermedad Arterial Periférica (EAP) es definida como la oclusión de las arterias de las extremidades, se reconoce como la tercera causa de morbilidad vascular aterosclerótica, después del infarto agudo de miocardio y el accidente cerebrovascular. Aunque las enfermedades cardiovasculares se han relacionado con la ocupación, la información sobre la relación entre el trabajo con la EAP es escasa. Objetivo: Identificar la prevalencia de EAP en población laboralmente activa y su relación con variables sociodemográficas, clínicas y estilo de vida. Metodología: Se realizó un estudio analítico de tipo transversal, en 203 sujetos de 40 años o más, laboralmente activos de Popayán. Tras la firma del consentimiento, se realizó una entrevista, y se registraron las variables sociodemográficas y clínicas. Para el tamizaje de EAP se evaluó el índice tobillo brazo (ITB). Los participantes se clasificaron en categorías basadas en el ITB de la siguiente manera: EAP ≤ 0,90; 0,91 a 0,99 normal; y no compresible > 1,40. Los datos fueron analizados con el programa SPSS versión 26.0, se aplicó la prueba de Kolmogorov-Smirnov como prueba de normalidad, la t Student para evaluar diferencias de medias entre los grupos de estudio y la prueba de Chi-cuadrado. Resultados y discusión: La prevalencia fue del 2,5 % para EAP, siendo el primer estudio reportado para población trabajadora en Colombia. La EAP fue más prevalente en empleados manuales (2,8 %) e ingresos bajos (30 %); además, fueron obesos y fumadores. El riesgo encontrado para edad fue OR 1,5; IC95 % 1,17 a 2,14, género OR 1,2; IC95 % 1,20 a 3,28 y DM2 OR 1,5; IC95 % 1,23 a 6,68. Conclusión: Se estableció por primera vez la prevalencia de EAP (2,5 %) en una población laboralmente activa de Popayán, siendo más prevalente en los individuos con ingresos bajos, expuestos a factores de riesgo cardiovascular y con antecedente familiar de DM2.

Introduction: The Peripheral Arterial Disease (PAD) is defined as the occlusion of the extremities' arteries, and it is known to be the third vascular atherosclerotic cause of death after acute myocardial infarction and brain stroke. Even though cardiovascular diseases had been linked to occupation, information about the relation between PAD and labor activity runs short. Objective: To identify the PAD prevalence in the working population and its relationship with sociodemographic, clinical and lifestyle variables. Methodology: A cross-sectional analytical study was conducted in 203 people of >40 years, actively working in the city of Popayán. After consent signing, interviews were completed to record such variables. PAD testing was evaluated through Ankle-Brachial Index (ABI). Participants were grouped into categories based on ABI as follows: PAD ≤0.90; normal 0.91 to 0.99; and non-compressible >1.40. Collected data was analyzed in SPSS version 26.0, applying Kolmogorov-Smirnov test as the normal; t Student test to evaluate mean differences between study groups and Chi-square. Results and discussion: PAD prevalence was 2.5 % being the very first report done for Colombia's working class. PAD was prevalent for manual-labor employees (2.8 %), low-income people (30 %), adding obesity and smoking to their profile. Age risk found was (OR 1.5; IC 95 % 1.17 to 2.14), by gender (OR 1.2; IC 95 % 1.20 to 3.28); DM2 (OR 1.5; IC 95 % 1.23 to 6.68). Conclusion: It was determined for the first time a prevalence of (2.5 °%) PAD for a population actively working in Popayán, being more frequent with individuals with low income, people exposed to higher cardiovascular risks, and for people with family DM2 records.

Clinical impact of the infrapatellar location in symptomatic peripheral arterial disease patients / Impacto clínico de la localización infrapatelar en pacientes con enfermedad arterial periférica sintomática

Abstract Background: Peripheral artery disease (PAD) frequently affects multiple segments of the limbs. Contradictory data have reported worse prognosis in aortoiliac lesions, nevertheless, diabetes and chronic limb ischemia frequently affects the infrapatellar territory. Our aim was to assess the impact of infrapatellar disease in cardiovascular outcomes. Methods: We performed a retrospective, observational cohort study at a university hospital in Argentina. Electronic health records were retrospectively reviewed including symptomatic PAD patients requiring revascularization. A multivariable regression model was performed to account for confounders. The primary endpoint was a composite of hospitalizations due to chronic limb threatening ischemia (CLTI) and major amputation events between infrapatellar and suprapatellar patients. Minor amputation events, all-cause death, myocardial infarction (MI), stroke, and major cardiovascular events (MACE) were secondary endpoints. Results: From January 2014 through July 2020, a total of 309 patients were included in the analysis. 151 patients had suprapatellar disease, and 158 had infrapatellar disease. The primary composite endpoint occurred in 35 patients (22.2%) in the infrapatellar patients and 18 patients (11.9%) in the suprapatellar patients (HR = 2.16; 95% confidence interval [CI] = [1.22-3.82]; p = 0.008). Both components of the primary outcomes occurred more frequently in infrapatellar patients. Minor amputation events were more prevalent in infrapatellar patients (HR = 5.09; 95% CI = [1.47-17.6]; p = 0.010). Death, MI, stroke, and MACE events were not different among groups (all p > 0.05). Conclusion: Infrapatellar disease was an independent factor for increased hospitalization of CLTI, major and minor amputations events, compared to suprapatellar disease in symptomatic revascularized PAD patients.

Resumen Objetivo: La enfermedad vascular periférica (EVP) afecta generalmente múltiples segmentos de los miembros. Existe información contradictoria con respecto al pronóstico de pacientes con enfermedad aortoilíaca, sin embargo, la diabetes y la enfermedad critica de miembros inferiores habitualmente afecta el territorio infrapatelar. Nuestro objetivo es determinar el impacto de la afectación infrapatelar en eventos cardiovasculares. Métodos: Estudio retrospectivo, observacional en un hospital universitario de Argentina. Se revisó la historia clínica electrónica de pacientes con EVP con requerimiento de revascularización. Se generó un modelo de regresión multivariado incluyendo variables clínicamente relevantes. El punto final primario fue un combinado de hospitalización por isquemia crítica y amputaciones mayores entre pacientes con afectación infrapatelar y suprapatelar. Amputaciones menores, muerte por todas las causas, infarto agudo de miocardio (IAM), accidente cerebrovascular (ACV) y un combinado de eventos cardiovasculares (MACE) fueron los puntos secundarios. Resultados: Se reclutó un total de 309 pacientes desde enero de 2014 hasta julio de 2020. 151 pacientes presentaron enfermedad suprapatelar y 158 infrapatelar. El punto final primario ocurrió en 35 pacientes (22.2%) en el grupo infrapatelar y en 18 pacientes (11.9%) en suprapatelares (HR 2.16; intervalo de confianza 95% [1.22-3.82]; p = 0.008). Ambos componentes ocurrieron con mayor frecuencia en pacientes con afectación infrapatelar. Los eventos de amputación menor fueron mas prevalentes en pacientes con afectación infrapatelar (HR 5.09; IC95% [1.47-17.6]; p = 0.010) La mortalidad por todas las causas, IAM, ACV y MACE no fueron diferentes entre los grupos (p > 0.05). Conclusión: La enfermedad infrapatelar fue un factor independiente para mayor riesgo de hospitalización por isquemia critica, amputación mayor y menor comparado con pacientes con afectación suprapatelar en EVP sintomática revascularizada.

Percepción de distancia central y periférica, en atletas del equipo nacional de tenis de mesa

El presente trabajo investiga sobre los estudios de percepción en atletas del equipo nacional de tenis de mesa. Tuvo como objetivo proponer ejercicios perceptivo-visuales para la mejora de la percepción de la distancia central y periférica en dicho equipo, a partir de la detección de las dificultades presentadas en el juego en los controles clasificatorios, 2019. La necesidad de realizar estudios que exploren la percepción de la distancia central y periférica en el ámbito de la psicología del deporte revela la importancia y actualidad del tema, por la contribución de este componente del sistema psicorregulador de las acciones motrices, al rendimiento de los atletas durante el proceso de entrenamiento y competencia. Se utilizaron métodos del nivel teórico como el análisis-síntesis y del nivel empírico la observación, la entrevista, la prueba de Vera y Saínz de la Torre para la determinación de la percepción de la distancia ajustada a las características específicas del tenis de mesa y el criterio de especialistas. Los principales resultados permitieron constatar un nivel inadecuado de desarrollo de la percepción de la distancia, en lo referente a los cálculos ópticos motriz, la visión central-periférica y los movimientos desequilibrados en los desplazamientos. Además, se aprecian dificultades en la coordinación y en las reacciones que afectan la precisión, potencia y colocación de los golpeos. Se elaboraron ejercicios perceptivo-visuales para la mejora de la percepción de la distancia central y periférica en el equipo nacional de tenis de mesa que fueron valoradas de muy adecuadas por los especialistas.

O presente trabalho investiga os estudos da percepção em atletas da seleção nacional de tênis de mesa. Teve como objetivo propor exercícios perceptivo-visuais para a melhoria da percepção da distância central e periférica nessa equipe, a partir da detecção das dificuldades apresentadas no jogo nos controles classificatórios de 2019. A necessidade de realizar estudos que explorem a percepção da distância central e periférica no campo da psicologia do esporte revela a importância e a atualidade do tema, devido à contribuição desse componente do sistema psicorregulatório das ações motoras para o desempenho dos atletas durante o processo de treinamento e competição. Foram utilizados métodos teóricos como análise-síntese e métodos empíricos como observação, entrevista, teste de Vera e Saínz de la Torre para a determinação da percepção da distância ajustada às características específicas do tênis de mesa e aos critérios dos especialistas. Os principais resultados mostraram um nível inadequado de desenvolvimento da percepção de distância, com relação a cálculos ópticos motores, visão centro-periférica e movimentos desequilibrados ao se movimentar. Além disso, há dificuldades na coordenação e nas reações que afetam a precisão, a potência e a colocação dos chutes. Exercícios perceptivo-visuais para a melhoria da percepção da distância central e periférica na equipe nacional de tênis de mesa foram elaborados e avaliados como muito adequados pelos especialistas.

This paper research perception studies in athletes from the national table tennis team. Its objective was to propose perceptual-visual exercises to improve the perception of central and peripheral distance in said team, based on the detection of the difficulties presented in the game in the qualifying controls, 2019. The need to carry out studies that explore the perception of central and peripheral distance in the field of sports psychology reveals the importance and topicality of the subject, due to the contribution of this component of the psychoregulatory system of motor actions, to the performance of athletes during the training and competition process. Theoretical level methods such as analysis-synthesis, as well as observation, interview and Vera and Saínz de la Torre test from the empirical level were used to determine the perception of distance adjusted to the specific characteristics of table tennis and tennis, also the specialist criteria method was used. The main results allowed to verify an inadequate level of development of the perception of distance, in relation to optical motor calculations, central-peripheral vision and unbalanced movements in displacements. In addition, there are difficulties in coordination and reactions that affect the precision, power and placement of the shots. Perceptual-visual exercises were developed to improve the perception of central and peripheral distance in the national table tennis team, which were valued as very adequate by specialists.

Factores asociados al éxito de la cirugía revascularizadora en diabéticos con isquemia crítica crónica de las extremidades / Factors associated with the success of revascularization surgery in diabetic patients with chronic critical limb ischemia

Introducción: La cirugía revascularizadora es una de las estrategias fundamentales para el tratamiento de la isquemia crítica crónica de los miembros inferiores. Objetivo: Identificar los factores asociados al éxito de la cirugía revascularizadora de los miembros inferiores en diabéticos con isquemia crítica crónica. Métodos: Se realizó un estudio descriptivo, prospectivo y de tipo cohorte en pacientes diabéticos sometidos a una cirugía revascularizadora, por presentar isquemia crítica crónica de la extremidad. Estos fueron seguidos durante seis meses en el Instituto Nacional de Angiología y Cirugía Vascular entre septiembre de 2019 y enero de 2021. La variable principal de salida resultó los factores pronosticadores del éxito de la cirugía, la cual se consideró exitosa cuando el paciente permaneció vivo y sin una amputación mayor. Resultados: Se incluyeron 50 pacientes con una edad promedio de 64 ± 10,21 años y un 24 por ciento de mujeres. El 88 por ciento fueron fumadores; y el 78 por ciento, hipertensos. La efectividad global de la cirugía resultó del 64 por ciento (IC al 95 por ciento 50 por ciento-78 por ciento). Solamente el sexo femenino, con una probabilidad de 0,053 y un Odds Ratio de 4,23; el antecedente de enfermedad cerebrovascular (p: 0,13 y OR: 6,98); y la infección (p: 0,18 y OR: 2,7) mostraron una tendencia a asociarse de forma estadísticamente significativa con el éxito de la cirugía. Conclusiones: El sexo femenino, el antecedente de enfermedad cerebrovascular y la presencia de infección fueron los principales candidatos para estudiarse como variables pronosticadoras del éxito de la cirugía revascularizadora(AU)

Introduction: Revascularizing surgery is one of the fundamental strategies for the treatment of chronic critical ischemia of the lower limbs. Objective: To identify the factors associated with the success of lower limb revascularization surgery in diabetics with chronic critical ischemia. Methods: A descriptive, prospective, cohort-type study was conducted in diabetic patients undergoing revascularization surgery due to chronic critical limb ischemia. The patients were followed for six months at the National Institute of Angiology and Vascular Surgery from September 2019 to January 2021. The primary endpoint variable was the predictor of the success of surgery, which was considered successful when the patient remained alive and without major amputations. Results: 50 patients with an average age of 64 ± 10.21 years and 24 percent women were included. 88 percent of the patients were smokers; and 78 percent hypertensive ones. The overall effectiveness of surgery was 64 percent (95 percent CI 50 percent-78 percent). Only the female sex, with a probability of 0.053 and an Odds Ratio of 4.23, history of cerebrovascular disease (p: 0.13 and OR: 6.98); and infection (p: 0.18 and OR: 2.7) showed a tendency to be statistically, significantly associated with the success of surgery. Conclusions: Female sex, history of cerebrovascular disease and presence of infection were the main candidates as prognostic variables of the success of revascularizing surgery(AU)

Intervención Psicofisiológica basada en la Teoría Polivagal para Manejo del Dolor Lumbar Crónico / Psychophysiological Intervention based on the Polyvagal Theory for the Management of Chronic Low Back Pain

Resumen El dolor lumbar crónico es un padecimiento común asociado a problemas físicos y afectivos. Recientemente, Dana (2019) sugirió un conjunto de estrategias psicológicas breves, basadas en los principios de la Teoría Polivagal, para el manejo del estrés, sin embargo, su uso no se ha aplicado en el campo del dolor. El presente estudio evaluó la eficacia de un plan de tratamiento en regulación autonómica del complejo vagal ventral para la disminución de la intensidad e interferencia del dolor, así como el efecto sobre la ansiedad, la depresión y catastrofización. Mediante un estudio pre experimental, con un muestreo no probabilístico, se utilizó un diseño de medidas repetidas para evaluar los efectos de un programa breve en pacientes con lumbalgia, sobre medidas psicométricas de dolor, ansiedad, depresión y catastrofización, así como la regulación fisiológica autonómica de la Frecuencia Cardiaca y la Temperatura Periférica. Los resultados revelaron una disminución significativa (p < .05) de la interferencia del dolor del estado anímico, el trabajo, la ansiedad, depresión y la catastrofización; así como un incremento en la temperatura periférica. Esto sugiere que el tratamiento fue eficaz para el manejo de problemas afectivos de estos pacientes, y consistente con los niveles de activación fisiológica propuestos por la Teoría Polivagal.

Abstract Chronic low back pain is a common chronic pain condition, associated with physical and emotional problems. Recently, Dana (2019) suggested a set of brief psychological strategies, based on the principles of the Polyvagal Theory, for stress management in people with chronic affective problems; however, no use has not been applied in the field of pain. The purpose of this study was to evaluate the efficacy of a treatment plan based on the autonomic regulation of the ventral vagal complex for the reduction of pain intensity, mood, behavioral and social interference, as well as the effect on anxiety, depression, and catastrophizing associated with pain. Through a pre-experimental study, with a non-probabilistic demonstration, a repeated measures design was obtained to evaluate the effects of a brief program in patients with low back pain, on validated psychometric measures of pain, anxiety, depression, and catastrophizing, as well as autonomic physiological regulation. Heart rate and peripheral temperature. Results revealed a significant (p < .05) decrease in pain interference from mood, work, anxiety, depression, and catastrophizing, as well as an increase in peripheral temperature. This suggests that the treatment was effective in managing the affective problems of these patients, and consistent with the levels of physiological activation proposed by the Polyvagal Theory on the affective state.

Características sociodemográficas y clínicas de pacientes con hipertensión arterial en un área de salud de Niquero / Sociodemographic and clinical characteristics of patients with hypertension in a health area of Niquero

Introducción: La hipertensión arterial es la enfermedad crónica de mayor morbilidad a escala mundial, la cual representa un problema de salud por su multicausalidad y sus consecuencias. Objetivo: Describir las principales características sociodemográficas y clínicas de pacientes con hipertensión arterial, pertenecientes a un área de salud de Niquero. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 370 pacientes con hipertensión arterial, quienes pertenecían al Consultorio Médico de la Familia No. 4 de Niquero, provincia de Granma, desde junio de 2021 hasta igual mes de 2022. Se estudiaron las variables edad, sexo, color de la piel, clasificación según cifras tensionales y evolución, así como estado del paciente y complicaciones. Resultados: Predominaron los grupos etarios de 40-59 (37,6 %) y 60-79 años (36,5 %), el sexo femenino (58,4 %), así como el color de la piel mestizo (55,9 %). Resultaron mayoría los pacientes con hipertensión arterial de grado II en fase 1 (44,3 %) y los parcialmente compensados (55,9 %). La enfermedad arterial periférica fue la principal complicación (21,1 %). Conclusiones: La descripción de las características sociodemográficas y clínicas de los pacientes con hipertensión arterial constituye un elemento a tener en cuenta para el adecuado control de los afectados en las áreas de salud.

Introduction: Hypertension is the chronic disease of more morbidity worldwide, which represents a health problem due to its multicausality and consequences. Objective: To describe the main sociodemographic and clinical characteristics of patients with hypertension, belonging to a health area of Niquero. Methods: An observational, descriptive and cross-sectional study of 370 patients with hypertension who belonged to the Family Doctor Office No. 4 of Niquero, Granma province, was carried out from June, 2021 to the same month in 2022. The variables age, sex, color of the skin, classification according to tension figures and evolution were studied, as well as patient state and complications. Results: There was a prevalence of the 40-59 (37.6 %) and 60-79 (36.5 %) age groups, female sex (58.4 %), as well as the mixed race color of the skin (55.9 %). The patients with grade II hypertension in phase 1 (44.3 %) and partially compensated (55.9 %) were the majority. Peripheral arterial disease was the main complication (21.1 %). Conclusions: The description of the sociodemographic and clinical characteristics of patients with hypertension constitutes an element to take into account for the appropriate control of those affected in the health areas.

Prevalencia de Neuropatía periférica de pequeñas fibras asociada a retinopatía en diabéticos tipo 2: Uso prueba biomédica por imagen termográfica

Introducción: La neuropatía periférica diabética de fibras delgadas (NPD-fd) son diagnosticadas por pruebas biomédicas vasomotoras cuyo fundamento es la alteración de la termorregulación de la piel. Objetivos: Calcular la prevalencia y los factores asociados a NPD-fd usando imagen termográfica (IT). Métodos: Se realizó un estudio observacional, transversal analítico en una unidad especializada en el ámbito de la atención primaria, en el que se avaluó pacientes con diabetes mellitus tipo 2 mediante pruebas neurológicas periféricas como la sensibilidad táctil y vibratoria para el diagnóstico de NPD de fibras gruesas (NPDfg) y la termorregulación pasiva por IT para la NPD-fd . Ésta última se realizó en la planta del pie utilizando una cámara termográfica en la consulta ambulatoria, evaluando 5 mediciones termográficas plantares por sujeto. Luego, la asociación entre diabéticos con y sin NPD-fd fue analizada respecto a género, edad, tiempo de enfermedad diabética, tipo de tratamiento diabético, hipertensión, retinopatía, nefropatía, dieta baja en carbohidratos, actividad física, síntoma dolor y IMC. Resultados: Se estudiaron 304 pacientes con diabetes mellitus tipo 2, una edad promedio de 65.07±11.39 años, en su mayoría de sexo masculino, encontrándose una NPD-fg en 14.8 %, NPD-fd en 27.3 % y ambas NPD en 34.9%. La asociación de la NPD-fd fue únicamente con el factor de la presencia de retinopatía (α=0,02, C= 0.18). Conclusiones: Se encontró una alta prevalencia de NPD-fd usando una imagen termográfica que estuvo asociado a la presencia de retinopatía.

Introduction: Small fibers diabetic peripheral neuropathy (DPN-sf) are diagnosed by biomedical vasomotor tests whose foundation is altered skin thermoregulation. Objectives: To estimate the prevalence and factors associated with DPN-sf using thermographic imaging (TI). Methods: An observational, cross-sectional, analytical study was performed in a specialized unit in the primary care setting, in which patients with type 2 diabetes mellitus were assessed by peripheral neurological tests such as tactile and vibratory sensitivity for the diagnosis of large fibers peripheral neuropathy (DPN-lf) and passive thermoregulation by TI for DPN-sf .The latter was performed on the sole using a thermographic camera in the outpatient clinic, evaluating 5 plantar thermographic measurements per subject. Then, the association between diabetics with and without DPN-sf was analyzed concerning gender, age, time of diabetic disease, type of diabetic treatment, hypertension, retinopathy, nephropathy, low carbohydrate diet, physical activity, pain symptom, and BMI. Results: 304 patients with type 2 diabetes mellitus were studied, mean age of 65.07±11.39 years, mostly male, finding DPN-lf in 14.8 %, DPN-sf in 27.3 %, and both NPD in 34.9%. The association of DPN-sf was only with the factor of the presence of retinopathy (α=0.02, C= 0.18). Conclusions: We found a high prevalence of DPN-sf using thermographic imaging that was associated with the presence of retinopathy.

Bacterial cellulose biomaterials for the treatment of lower limb ulcers / Biomateriais de celulose bacteriana para o tratamento de úlceras de membros inferiores

ABSTRACT Chronic ulcers of the lower limbs are common and recurrent, especially in the elderly population, they are disabling injuries that generate a great socioeconomic burden. This scenario encourages the development of new, low-cost therapeutic alternatives. The present study aims to describe the use of bacterial cellulose in the treatment of lower limb ulcers. This is an integrative literature review, carried out in the PubMed and Science Direct databases by associating the descriptors, with the inclusion criteria being clinical studies in the last 5 years, available in full in English, Portuguese and Spanish. Five clinical trials were analyzed and the main therapeutic effects obtained in the experimental groups that used bacterial cellulose dressings were a reduction in the area of the wounds, one of the studies showed a reduction of 44.18cm2 in the area of the wound, the initial lesions measured on average 89.46cm2 and at the end of the follow-up, they had an average of 45.28cm2, since the reduction in pain and the decrease in the number of exchanges were advantages described in all groups that used the BS. It is concluded that BC dressings are an alternative for the treatment of lower limb ulcers, their use also reduces operational costs related to the treatment of ulcers.

RESUMO As úlceras crônicas de membros inferiores são comuns e recorrentes principalmente na população idosa, são lesões incapacitantes e que geram grande ônus socioeconômico. Tal cenário incentiva o desenvolvimento de novas alternativas terapêuticas e de baixo custo. O presente estudo tem como objetivo descrever o uso da celulose bacteriana no tratamento de úlceras de membros inferiores. Trata-se de uma revisão integrativa da literatura, realizada nas bases de dados PubMed e Science Direct por meio da associação dos descritores, tendo como critério de inclusão estudos clínicos nos últimos 5 anos, disponíveis na integra em inglês, português e espanhol. Cinco ensaios clínicos foram analisados e os principais efeitos terapêuticos obtidos nos grupos experimentais que utilizaram os curativos de celulose bacteriana foram redução da área das feridas, um dos estudos apontou uma redução de 44,18cm2 da área da ferida, as lesões iniciais mediam em média 89,46cm2 e ao término do acompanhamento apresentaram uma média de 45,28cm2, já a redução da dor e diminuição do número de trocas foram vantagens descritas em todos os grupos que utilizaram a CB. Conclui-se que os curativos de CB são uma alternativa para o tratamento das úlceras de MMII, sua utilização reduz também os custos operacionais relacionados ao tratamento de úlceras.

Correlação das medidas ultrassonográficas, tomográficas e intraoperatórias da veia safena interna utilizada como enxerto arterial / Correlations between ultrasound, tomographic, and intraoperative measurements of the great saphenous vein used as an arterial graft

Resumo Contexto A veia safena interna é a principal veia superficial do membro inferior, sendo também a mais utilizada para cirurgias de enxerto arterial para revascularização de membros inferiores. O conhecimento prévio da qualidade da veia pode orientar a mudança da estratégia terapêutica, evitando cirurgias fadadas ao insucesso. Observou- se, com frequência, a discrepância entre achados intraoperatórios e exames de imagem. Objetivos Avaliar e comparar o calibre da veia safena interna através de dois métodos de imagem [ultrassonografia (USG) dúplex e angiotomografia computadorizada (angio TC)] e do padrão-ouro (medida no intraoperatório). Métodos Tratou-se de estudo prospectivo observacional. Os dados coletados foram obtidos dos procedimentos médicos de rotina realizados pela equipe de Cirurgia Vascular. Resultados Foram avaliados 41 pacientes, seguidos clinicamente por 12 meses, sendo 27 (65,8%) do sexo masculino, com média de idade de 65,37 anos. Dezenove (46,3%) pacientes foram submetidos a enxerto fêmoro-poplíteo, e 22 (53,7%) a enxertos distais. Os diâmetros da veia safena foram em média 16,4% menores na TC e 33,8% menores na USG, quando medidos em decúbito dorsal no pré-operatório, comparados ao diâmetro externo após dilatação hidrostática no intraoperatório. Não houve diferença estatística das medidas da cirurgia quando se comparou sexo, peso e altura. Conclusões A avaliação do calibre da veia safena foi subestimada pelos exames de USG e TC pré-operatórias com o paciente em decúbito dorsal, em relação à medida intraoperatória. Em pacientes em programação de enxerto para revascularização, a escolha do conduto deve levar esse dado em consideração para que não ocorra exclusão precipitada do uso da veia safena no planejamento.

Abstract Background The great saphenous vein is the major superficial vein of the lower limb, and also the most often used as arterial graft material for lower limb revascularization. Prior knowledge of the quality of the vein can guide choice of therapeutic strategy, avoiding surgery that is doomed to failure. Discrepancies between intraoperative findings of the quality of the great saphenous vein and imaging tests are also frequently observed. Objectives To evaluate the diameter of the great saphenous vein using two imaging methods (Duplex Ultrasound and Computed Tomography) and the gold-standard (intraoperative direct measurement of the vein), comparing the results. Methods Prospective, observational study of data obtained during routine medical procedures performed by the Vascular Surgery team. Results 41 patients were evaluated, with a 12-month follow-up. 27 (65.85%) were male and mean age was 65.37 years. 19 (46.34%) patients had femoropopliteal grafts and 22 (53.66%) had distal grafts. Preoperative saphenous vein internal diameters measured with the patient supine were on average 16.4% smaller on CT and 33.8% smaller on US than the external diameters measured after intraoperative hydrostatic dilatation. There were no statistical differences in measurements when sex, weight, and height were considered. Conclusions Saphenous vein diameters were underestimated by preoperative US and CT scans when compared to intraoperative measurements. Thus, in patients undergoing graft planning for revascularization, the choice of conduit should take this data into consideration, so that use of the saphenous vein is not ruled out unnecessarily during planning.