ABSTRACT
Introdução: Dispositivos externos compressivos após a punção radial para cateterismo cardíaco e intervenção coronária percutânea visam à hemostasia, ao conforto para o paciente e à segurança. O estudo objetivou avaliar pacientes submetidos a procedimentos coronários invasivos por via radial, nos quais se utilizou um curativo compressivo e de baixo custo, desenvolvido no serviço, avaliando a segurança dele e a ocorrência de complicações. Métodos: Indivíduos submetidos à coronariografia e à intervenção coronária percutânea, avaliados no momento de retirada do curativo compressivo e após 7 dias, por meio de questionário abrangendo comorbidades, quadro clínico, tempo do procedimento e de compressão, avaliação física de hematoma e dor, e Doppler vascular sonoro para avaliação de oclusão da artéria radial. Resultados: Foram avaliados 144 pacientes, sendo 138 com seguimento em 7 dias. Os eventos não diferiram entre procedimentos diagnósticos e terapêuticos. Na avaliação imediata à retirada do curativo, revelou-se incidência de 4,2% de oclusão da artéria radial, com dor referida em 23,6% dos pacientes, graduada em 2,9±1,7 pela Escala Visual Analógica (intensidade de zero a dez) e sem sangramentos graves. Hematoma ocorreu em um paciente (0,9%), com classificação III pelo critério EASY. Na avaliação de 7 dias, a incidência de oclusão da artéria radial foi de 2,2%, a dor foi referida em 11,1% da amostra (intensidade 1,8±0,8), e o hematoma foi evidenciado em 3,5%. Conclusão: O curativo compressivo mostrou-se um procedimento seguro, com baixa taxa de complicações e baixa taxa de dor local nos pacientes submetidos a procedimentos coronários invasivos pela via radial.
Background: External compressive devices after radial puncture for cardiac catheterization and percutaneous coronary intervention aim at hemostasis, patient comfort, and safety. The objective of the study was to evaluate patients undergoing invasive coronary procedures by radial approach, in which a low-cost compressive dressing developed at the service was used, assessing its safety and the occurrence of complications. Methods: Patients undergoing coronary angiography and percutaneous coronary intervention, evaluated at the time of removal of compressive dressing and after 7 days, by means of a questionnaire addressing comorbidities, clinical picture, procedure and compression time, physical assessment of hematoma and pain, and a vascular Doppler ultrasound to evaluate radial artery occlusion. Results: A total of 144 patients were evaluated, 138 of whom were followed up within 7 days. Events did not differ among diagnostic and therapeutic procedures. In the immediate evaluation after removal of dressing, an incidence of 4.2% of radial artery occlusion was observed, with pain reported by 23.6% of patients, graded at 2.9±1.7 points in the Visual Analogue Scale (intensity of zero to ten), and no major bleeding. Hematoma occurred in one patient (0.9%), classified as type III according to the EASY criteria. In the 7-day evaluation, the incidence of radial artery occlusion was 2.2%, pain was reported in 11.1% of sample (intensity 1.8±0.8), and hematoma was evident in 3.5%. Conclusion: The compressive dressing proved to be a safe procedure, with a low rate of complications and a low rate of local pain in patients undergoing invasive coronary procedures via radial approach.
ABSTRACT
OBJECTIVE: This study aimed to analyze the results of hysterosonography performed prior to in vitro fertilization (IVF) and to correlate anomalous findings with hysteroscopy. METHODS: Findings from 197 hysterosonograms of patients examined in an assisted reproduction clinic between January 2012 and August 2014 were included. Enrollment criteria: patients in preparation for IVF not recently submitted to uterine examination through hysterosalpingography or hysteroscopy referred to hysterosonography. Uterine cavity evaluation was considered anomalous when one or more of the following were found: polyps, submucous myomas, uterine synechiae, Müllerian duct anomalies. Individuals with cavity abnormalities that might interfere with IVF results were referred to hysteroscopy. RESULTS: Normal test results were seen in 170/197 of the cases (86.3%). Eighteen of the 197 cases (9.1%) were suspected for polyps, two (1%) for submucous myoma, six (3.5%) for synechiae, and one (0.5%) for Müllerian duct anomalies. Sixteen of the patients diagnosed with abnormalities underwent hysteroscopy to confirm or treat the suspected pathology. In only two cases there was no agreement between tests: one patient suspected for synechiae and another for polyps were not confirmed; another individual suspected for polyps was found to have focal endometrial thickening in hysteroscopy. The positive predictive value (PPV) in our study was 93.7%. CONCLUSION: In most cases, the diagnoses obtained by hysterosonography showed normal uterine cavities. The most common anomalous findings were polyps, followed by synechiae, submucous myoma, and Müllerian duct anomalies. Hysterosonography is a good option for evaluating the uterus and offers a high positive predictive value, while hysteroscopy stands as the gold standard.
