RESUMO
Fatigue is a material-based phenomenon playing a significant role in the mechanical behavior of components and structures. Although fatigue has been well studied for traditional materials, such as metals, its underlying mechanisms are not thoroughly understood in novel applications such as the case of textiles used as patches to close the arteriotomy in carotid endarterectomy. The latter is a type of vascular surgery for the treatment of carotid artery disease in which after an arteriotomy and removal of atherosclerotic plaque closure is made with a patch sutured on the artery. Completion of the operation signals the initiation of complex mechanical and hemodynamic phenomena. Fatigue performance of the patch eventually determines the successful outcome of carotid endarterectomy. In this study, we evaluate with a two-fold approach the mechanics of patch angioplasty in carotid endarterectomy. First, an analytical model for the fatigue behavior of textiles is developed, considering the microstructure and geometry of the fabric. Then, the surgical procedure is simulated and a finite element analysis of the endarterectomized and patched carotid artery is employed. Stress fields are calculated, while deformation at the site of patch angioplasty indicates a potential cause for the formation of aneurismal degeneration after the surgery. Such analysis can provide a better understanding in the establishment of follow-up protocols.
Assuntos
Doenças das Artérias Carótidas , Endarterectomia das Carótidas , Angioplastia , Artérias Carótidas/cirurgia , Humanos , TêxteisAssuntos
Isquemia Encefálica/tratamento farmacológico , Resistência a Medicamentos , Inibidores da Agregação Plaquetária/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Testes de Função Plaquetária , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Resultado do TratamentoAssuntos
Doenças das Artérias Carótidas/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Hematoma/cirurgia , Técnicas Hemostáticas/instrumentação , Infecções Cutâneas Estafilocócicas/etiologia , Telas Cirúrgicas , Infecção da Ferida Cirúrgica/etiologia , Idoso , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Masculino , Infecções Cutâneas Estafilocócicas/diagnóstico , Infecções Cutâneas Estafilocócicas/microbiologia , Infecções Cutâneas Estafilocócicas/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/terapia , Idoso de 80 Anos ou mais , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Implante de Prótese Vascular , Humanos , Masculino , Tomografia Computadorizada por Raios XAssuntos
Aneurisma/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Artéria Hepática/cirurgia , Aneurisma/diagnóstico por imagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Artéria Hepática/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Stents , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Aneurisma/diagnóstico por imagem , Veia Poplítea , Adulto , Feminino , Humanos , UltrassonografiaAssuntos
Acidentes de Trânsito , Falso Aneurisma/cirurgia , Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Procedimentos Endovasculares , Adulto , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Lesões das Artérias Carótidas/diagnóstico , Lesões das Artérias Carótidas/etiologia , Artéria Carótida Interna/diagnóstico por imagem , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Inibidores da Agregação Plaquetária/uso terapêutico , Desenho de Prótese , Stents , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Insuficiência Venosa/terapia , Doença Crônica , Humanos , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Insuficiência Venosa/diagnóstico , Insuficiência Venosa/epidemiologia , Insuficiência Venosa/fisiopatologia , Insuficiência Venosa/cirurgiaAssuntos
Anticoagulantes/uso terapêutico , Benzimidazóis/uso terapêutico , Morfolinas/uso terapêutico , Pirazóis/uso terapêutico , Piridinas/uso terapêutico , Piridonas/uso terapêutico , Prevenção Secundária , Tiazóis/uso terapêutico , Tiofenos/uso terapêutico , Tromboembolia Venosa/tratamento farmacológico , beta-Alanina/análogos & derivados , HumanosRESUMO
AIM: Venous training in Europe is lacking a formal curriculum among various specialties related to management of venous diseases. We conducted a survey in order to have a snapshot on the actual education and training level among physicians practicing currently venous surgery and phlebology in Europe. METHODS: From April 7, 2014 to June 11, 2014 a survey was carried out using the Survey Monkey system, including 11 main questions covering all the domains of training and education in venous surgery and phlebology. The questionnaire was sent to all physicians included in the current mailing list of the European Venous Forum (EVF) and the Mediterranean League of Angiology and Vascular Surgery. Two questions were particularly addressed to those physicians who had attended the EVF hands-on workshop (HOW) at least once. RESULTS: The response rate was 24% (97/400) and 51.5% of them were practicing in a hospital service. Most responders were vascular surgeons (67.7%), followed by angiologists (19.4%). Only half of the responders felt as being competent to manage the whole spectrum of venous diseases successfully after completion of their training, while a few were able to perform endovenous ablations and even less more advanced venous interventions. Formal training in Duplex ultrasound was undertaken only in 55.2%. The majority suggested that a venous training program should be a separate part of their specialty rotation and should be organized at a national or European level, or even by a specific scientific society. Over 95% of those physicians who already participated in the EVF HOW considered the knowledge they acquired there as useful for their practice. CONCLUSION: There is currently an important need for more specialized venous training for all physicians involved in the diagnosis and management of venous diseases. Therefore all local, national and international initiatives should be encouraged to improve education in this field.