[Non-iatrogenic trauma of the brachial artery]. / Traumatismos não iatrogénicos da artéria braquial.

Brachial artery trauma are treated quite frequently in the emergency units. Between January 1987 and December 1990 we studied prospectively 50 patients with brachial artery trauma at the Hospital das Clinicas, of University of Sao Paulo. The patients mean age ranged from 2 to 64 years. Males were predominant with 46 patients. Most of them were white (66%). Penetrating injuries were the most frequent. Most of these injuries were caused by gunshot wounds or stabing. Absence of distal palpable pulses was the predominant finding among the clinical features (94%). 74% of the patients do not present important ischemia. The right side was more affected (34 patients). 14 patients had concomitant nerve injury. 35 patients (70%) were submitted to arterial reconstruction with saphenous vein. 12 patients (24%) had end-to-end vascular anastomoses. 3 patients (6%) were submitted to brachial artery ligation. 2 patients underwent simultaneous median nerve repair. In 3 patients we used fasciotomy. 6 patients developed arterial occlusion following vascular reconstruction and in one of them it was necessary to perform amputation. 2 patients had wound infection with saphenous vein repair disruption. Both were treated with brachial artery ligation and one underwent amputation. One patient died on the post operative period owing to associated lesions. Limb preservation was achieved in 47 patients (94%). 33 (70.2%) had no neurological deficit and 14 (29.7%) had some degree of neurological deficit. None of the patients had venous hypertension at the time of discharge.

[Assessment of arterial occlusive disease with Duplex sonography. Prospective study]. / Avaliação da doença oclusiva das artérias renais com Triplex Scan. Estudo prospectivo.

Occlusive disease involving the renal arteries represent a major cause of curable hypertension and improvement of renal dysfunction. Angiography is still the major diagnostic procedure. Isotopic methods with Captopril and split-function studies have shown high incidence of false-positive and false-negative results. Colour flow Duplex-Scan renders possible the visualization of the aorta and renal arteries, is noninvasive and combines morphologic and hemodynamic evaluation. To assess its efficacy in the diagnosis of renal artery occlusive disease, a prospective blind study was undertaken in 24 patients, 48 renal arteries, 15 women and 9 men, with mean age of 44 years. Scans of the aorta and renal arteries at the origin, along its extension and at the renal hilum were obtained using and ATL Ultrmark 9 with 3.0 MHZ probe Velocity measurements were obtained at the aorta and along the renal arteries. Criteria for a positive examination were: focal acceleration with a reduction of the flow velocity at the hilum. Absence of flow in a properly visualized renal artery was considered as occlusion. All patients had digital subtraction arteriography. In 1 patient the non-invasive examination was inadequate. In the remain 23 patients the exam was considered adequate. False-positives were 4.8%; false-negatives 8.7%. Sensitivity, specificity and accuracy were respectively 91.7%, and 95.7% and 93.5%. These results suggest that non-invasive assessment of renal artery occlusive disease is feasible and accurate when compared to angiography, thus providing a useful tool for screening hypertensive patients.

[Endovascular surgery: recanalization technics and stent(s)]. / Cirurgia endovascular: técnicas de recanalização e stent(s).

Endovascular surgery has experimented a great development in the last years owing to the technologic advances in fields as mechanical and Laser recanalization technics, low profile catheters, Stents and diagnostic image. In a review work we discuss the role of this therapeutic modality in the treatment of vascular disease. To the vascular surgeon it becomes essential to be prepared to perform this procedures; to the general practitioner it becomes important to know about endovascular surgery potentialities. We discuss historical and technical aspects as also two important and polemic subjects in endovascular interventions: recanalization technics and stents. The authors personal experience, which is the first in Portugal in the fields of laser recanalization technics and stents placements, has been presented in several meetings and here is illustrated with one of our cases.

[Neodymium--Yag laser in the recanalization of arterial occlusions]. / Neodymium--Yag Laser na recanalização das oclusões arteriais.

Failure of the guide-wire to recanalize some arterial total occlusion does not preclude balloon angioplasty. Nowadays there are recanalization devices such as the mechanical atherectomy and Lasers. The following report describes the successful use of the Nd: YG Laser in the recanalization of a common iliac artery total occlusion in a patient with claudication, rendering possible balloon angioplasty and a Palmaz Stent implantation, which is the first case performed in our country.

[The role of stents in endovascular surgery]. / O stent na cirurgia endovascular.

Stent appears as the most recent and revolutionary acquisition in Endovascular Surgery. It represents the percutaneous permanent placement of a Vascular prosthesis. We discuss its background and evolution, the several types as well as some of its characteristics as biocompatibility, trombogenicity and biomechanics. We also describe practical aspects concerning the placement procedure. It is also discussed the present day prespectives and the future.

[Carotid artery surgery in extracranial occlusive disease and cerebral ischemia. Early and late results]. / Cirurgia carotídea na doença oclusiva extracraneana e isquemia cerebral. Resultados precoces e tardios.

Carotid artery surgery became an established procedure for the treatment of cerebrovascular insufficiency associated with carotid artery stenosis and for the prevention of Stroke. 180 patients were consecutively treated because of occlusive disease of the carotid arteries: 152 (84%) had TIA's or reversible deficits, 11 (6.1%) had strokes with partial recovery, 16 (8.8%) asymptomatic carotid disease and 1 patient (0.5%) had global cerebral ischemia. The severity of occlusive disease was assessed by ECHO-DOPPLER, with or without colour mapping and by angiography: 21 had minimal lesions (less than 20%), 58 stenosis between 21-75%, 92 stenosis between 76-99% and 7 had complete occlusion of the carotid artery; 2 patients had aneurysmal disease 196 operations were performed; early mortality (less than 30 days) was 2.2% (4/180) and neurological morbidity 1.6% (3/180), the operative risk being 3.8%. Longterm results were assessed during a follow-up period extending to 132 months and were assessed by life-table analysis. Survival was 52.5%, 79.3% of the patients were fully asymptomatic during the follow-up but 89.2% were stroke-free, the incidence of stroke being 0.97%/year. These results compare favorably with data available from the natural history and confirm the efficacy of carotid artery reconstructive surgery for the prevention of stroke.

Intravascular ultrasound evaluation of iliac stents one year following laser-assisted angioplasty.

With the proliferation of sophisticated endovascular interventions, the need for more definitive assessment of preprocedural and postprocedural pathology and long-term outcome is acute. A new technique, intravascular ultrasound imaging, was used to provide a 1-year evaluation of iliac artery stents in a patient whose renal insufficiency contraindicated protocol-mandated arteriography. The sonogram provided adequate visualization of the functional status of the stents through cross-sectional measurements and the intimal response to the devices. This represents the first use of intravascular ultrasound imaging for long-term evaluation of iliac stents.