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

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

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

Ultrasound-guided central venous catheterization - "Syringe-Free" approach / Cateterização venosa central guiada por ultrassom - abordagem "Syringe-Free"

Abstract Background and objectives: Central venous catheterization of the internal jugular vein is a commonly performed invasive procedure associated with a significant morbidity and even mortality. Ultrasound-guided methods have shown to improve significantly the success of the technique and are recommended by various scientific societies, including the American Society of Anesthesiologists. The aim of this report is to describe an innovative ultrasound-guided central line placement of the internal jugular vein. Technique: The authors describe an innovative ultrasound-guided central line placement of the internal jugular vein based on an oblique approach - the "Syringe-Free" approach. This technique allows immediate progression of the guide wire in the venous lumen, while maintaining a real-time continuous ultrasound image. Conclusions: The described method adds to the traditional oblique technique the possibility of achieving a continuous real-time ultrasound-guided venipuncture and a guide wire insertion that does not need removing the probe from the puncture field, while having a single operator performing the whole procedure.

Resumo Justificativa e objetivos: A cateterização venosa central da veia jugular interna é um procedimento invasivo feito frequentemente e associado a morbilidade significativa e até mesmo mortalidade. Os métodos guiados por ultrassonografia têm demonstrado uma melhoria do sucesso desse procedimento e são recomendados por várias sociedades científicas, incluindo a American Society of Anesthesiologists. O objetivo deste artigo é descrever uma abordagem inovadora de cateterização venosa central guiada por ultrassonografia no nível da veia jugular interna. Técnica: Os autores descrevem técnica ecoguiada inovadora de cateterização venosa central da veia jugular interna, baseada numa abordagem oblíqua - a abordagem Syringe-Free. Essa técnica permite uma progressão imediata do fio-guia ao longo do lúmen venoso e manter uma visualização ecográfica em tempo real e contínua. Conclusões: A técnica descrita acrescenta à técnica oblíqua tradicional a possibilidade de, com um único operador, conseguir uma punção venosa central com visualização ecográfica contínua e em tempo real associada à inserção do fio-guia sem necessidade de afastamento do transdutor de ultrassonografia do campo de punção.

Peso cardíaco em chagásicos crônicos com ninhos de Trypanosoma cruzi na veia central da supra-renal / Cardiac Weight in Patients with Chronic Chagas Disease with Trypanosoma Cruzi Nests in the Central Vein of the Adrenal Glands

PURPOSE--Comparative analysis of cardiac weight (CW) in patients with chronic Chagas disease, with or without parasitism by Trypanosoma cruzi in the central vein of the adrenal gland (CVAG). METHODS--The CW has been studied in 96 necropsied individuals with chronic Chagas disease. Among them, 48 of them had Trypanosoma cruzi nests on the wall of the CVAG and the other 48 patients did not have nests in the CVAG. Later, this sample was paired for sex, age and anatomo-clinical form, resulting in 60 patients. Among these patients, 30 of them had Trypanosoma cruzi nests on the walls of the CVAG and the other 30 did not have. RESULTS--The CW of Chagas patients which had nests of T. cruzi in the CVAG, was 484.8 +/- 146.0g, while in the ones that did not have the nests on the walls of the CVAG, the CW weight was 415.8 +/- 125.3g. This difference was statistically significant. In the first group it had a prevail of congestive heart failure. Subsequently to the pairing for sex, age and anatomo-clinical form, the CW was respectively 464.3 +/- 146.2g and 436.0 +/- 108.9g. This difference was not statistically significant. CONCLUSION--These data suggest that the parasitism in the central vein of the adrenal gland, combined with other possible events intrinsic to the chronic Chagas disease patients' hearts, carries a supporting role in the increasing of the cardiac weight and in the congestive cardiac insufficiency.