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Thierstein L, Pereira-Macedo J, Duarte-Gamas L, Reis P, Myrcha P, Andrade JP, Rocha-Neves J. Polyvascular Disease Influences Long-Term Cardiovascular Morbidity in Carotid Endarterectomy. Ann Vasc Surg 2024; 102:236-243. [PMID: 37944897 DOI: 10.1016/j.avsg.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION/OBJECTIVE Carotid stenosis (CS) is an important cause of ischemic stroke. Secondary prevention lies in performing a carotid endarterectomy (CEA) procedure, the recommended treatment in most cases. When 2 or more vascular regions are simultaneously affected by atherosclerosis, mainly the carotid arteries, coronary arteries, or limb arteries, a multivessel disease polyvascular disease (PVD) is present. This study aims to assess the potential role of PVD as a long-term predictor of major adverse cardiovascular events (MACE) and all-cause mortality in patients submitted to CEA. METHODS From January 2012 to December 2021, patients submitted to CEA for carotid stenosis in a tertiary care and referral center were eligible from a prospective database. A posthoc survival analysis was performed using the Kaplan-Meier survival curve method. The primary outcome was the incidence of long-term MACE and all-cause mortality. Secondary outcomes included acute myocardial infarction (AMI), major adverse limb events (MALE), stroke, and acute heart failure (AHF). RESULTS A total of 207 patients were enrolled, with a median follow-up of 63 months. The mean age was 70.4 ± 8.9, and 163 (78.7%) were male. There were 65 (31.4%) patients that had 2 arterial vascular territories affected, and 29 (14.0%) patients had PVD in 3 arterial beds. On multivariable analysis, both MACE and all-cause mortality had as independent risk factors age (aHR 1.039, P = 0.003; aHR 1.041, P = 0.019), chronic kidney disease (aHR 2.524, P = 0.003; aHR 3.377, P < 0.001) and PVD2 (aHR 3.381, P < 0.001; aHR 2.665, P = 0.013). PVD1 was only associated with MACE as a statistically significant risk factor (aHR 2.531, 1.439-4.450, P < 0.001). CONCLUSIONS PVD in patients with cerebrovascular disease (CVD) was revealed to carry a 2-fold increased risk for all-cause mortality and MACE during long-term follow-up. PVD may be a simple yet valuable tool in predicting all-cause mortality, MACE, AMI, and MALE after CEA.
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Affiliation(s)
| | - Juliana Pereira-Macedo
- Department of surgery, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Pedro Reis
- Burn Unit-Department of Plastic Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Piotr Myrcha
- Faculty of Medicine, 1st Chair and Department of General and Vascular Surgery, Medical University of Warsaw, Warsaw, Poland; Department of General, Vascular and Oncological Surgery, Masovian Brodnowski Hospital, Warsaw, Poland
| | - José P Andrade
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Faculty of Medicine, CINTESIS@RISE, Department of Biomedicine - Unit of Anatomy, University of Porto, Portugal; Faculty of Medicine, Department of Biomedicine - Unit of Anatomy, University of Porto, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Faculty of Medicine, Department of Biomedicine - Unit of Anatomy, University of Porto, Portugal.
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Myrcha P, Pinheiro F, Rocha-Neves J, Myrcha J, Gloviczki P. The effect of the collateral cerebrovascular circulation on tolerance to carotid artery cross-clamping and on early outcome after carotid endarterectomy. J Vasc Surg 2024:S0741-5214(24)01078-4. [PMID: 38679219 DOI: 10.1016/j.jvs.2024.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/14/2024] [Accepted: 04/20/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The Circle of Willis (CoW) serves as the primary source of contralateral blood supply in patients who undergo carotid artery cross-clamping (CC) for carotid endarterectomy (CEA). It has been suggested that CoW's anatomy influences CEA outcomes. The aim of this study was to evaluate associations between the cerebral collateral circulation, a positive awake test for intraoperative neurologic deficit after carotid CC and postoperative adverse neurologic events. METHODS A systematic review was conducted searching MEDLINE, Cochrane and Web of Science databases for studies that assessed the cerebral circulation, including CoW variations, using neuroimaging techniques in patients who underwent carotid CC. For the metanalytical incidence, the statistical technique used was weight averaging. Otherwise, descriptive analysis was used due to the excessive heterogeneity of the studies. RESULTS Eight publications, seven cohort and one case-controlled study, involving 1313 patients who underwent carotid artery cross-clamping under LRA were included in the systematic review. The incidence of positive awake test in the cohort studies ranged from 4.4% to 19.7%. Carotid artery cross-clamping (CC) resulted in positive awake test in 5% to 91% of patients with alterations in the anterior portion and in 27% to 74% with alterations in the posterior portion of the Circle of Willis. A positive awake test in patients with contralateral carotid stenosis or occlusion ranged from 5.8% to 45.7%. Contralateral carotid stenosis >70% or occlusion were associated with a positive awake test (P <.001). Patients with incomplete CoW did not have statistically significant correlation with intraoperative neurological deficits after CC. Data were insufficient to evaluate the effect of the collateral circulation on early outcome after CEA. CONCLUSION In this systematic review, contralateral carotid artery stenosis or occlusion but not CoW abnormalities were associated with a positive awake test after carotid artery CC. Further research is needed to evaluate which specific CoW anomaly predicts neurologic deficit after CC and to confirm association between a positive awake test and clinical outcome after CEA.
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Affiliation(s)
- Piotr Myrcha
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland; Department of General, Vascular and Oncological Surgery, Masovian Brodnowski Hospital, 03-242 Warsaw, Poland.
| | | | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal; Department of Biomedicine- Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal.
| | - Jakub Myrcha
- Department of Vascular Surgery and Angiology, Bielanski Hospital, 01-809 Warsaw, Poland.
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Pereira-Macedo J, Freire B, Macedo-Oliveira C, Mendes J, Carvalho M, Rocha-Neves J, Fonseca S, Vinagreiro M, Lemos R, Silva N, Sampaio F. Hyperfunctioning papillary thyroid carcinoma - a case report and literature review. Acta Chir Belg 2024; 124:147-152. [PMID: 37133354 DOI: 10.1080/00015458.2023.2210699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/29/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Malignant hyperfunctioning thyroid nodules are rare and more likely to occur in follicular cancer types rather than papillary variants. The authors present a case of a papillary thyroid carcinoma associated with a hyperfunctioning nodule. METHODS A single adult patient submitted to total thyroidectomy with the presence of thyroid carcinoma within hyperfunctioning nodules was selected. Additionally, brief literature was conducted. RESULTS An asymptomatic 58-year-old male was subjected to routine blood analysis and a TSH level of <0.003 mIU/L was found. Ultrasonography revealed a 21 mm solid, hypoechoic, and heterogenous nodule with microcalcifications in the right lobe. A fine needle aspiration guided by ultrasound resulted in a follicular lesion of undetermined significance. A 99mTc thyroid scintigram was followed and identified a right-sided hyperfunctioning nodule. Another cytology was performed and a papillary thyroid carcinoma was derived as a result. The patient underwent a total thyroidectomy. Postoperative histology confirmed the diagnosis and a tumor-free margin with no vascular or capsular invasions. CONCLUSION Hyperfunctioning malignant nodules are a rare association, although a careful approach should be led since major clinical implications arise. Selective fine needle aspiration in all suspicious ≥1 cm nodules should be considered.
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Affiliation(s)
- Juliana Pereira-Macedo
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
- CINTESIS@RISE, University of Porto, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Bárbara Freire
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
| | - Carlos Macedo-Oliveira
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
| | - João Mendes
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
- Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - Márcia Carvalho
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
- Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar, Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Universidade do Porto, Porto, Portugal
- Department of Biomedicine - Unit of Anatomy, Universidade do Porto, Porto, Portugal
| | - Sofia Fonseca
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
| | - Margarida Vinagreiro
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
| | - Ricardo Lemos
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
| | - Nair Silva
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
| | - Francisco Sampaio
- Department of General Surgery, Hospitalar Centre of Médio-Ave, Vila Nova de Famalicão, Portugal
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Pereira-Macedo J, Duarte-Gamas L, Pereira-Neves A, de Andrade JJP, Rocha-Neves J. Short-term outcomes after selective shunt during carotid endarterectomy: a propensity score matching analysis. Neurocirugia (Astur : Engl Ed) 2024; 35:71-78. [PMID: 37696419 DOI: 10.1016/j.neucie.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Carotid cross-clamping during carotid endarterectomy might lead to intraoperative neurologic deficits, increasing stroke/death risk. If deficits are detected, carotid shunting has been recommended to reduce the risk of stroke. However, shunting may sustain a specific chance of embolic events and subsequently incurring harm. Current evidence is still questionable regarding its clear benefit. The aim is to determine whether a policy of selective shunt impacts the complication rate following an endarterectomy. MATERIAL AND METHODS From January 2013 to May 2021, all patients undergoing carotid endarterectomy under regional anesthesia with intraoperative neurologic alteration were retrieved. Patients submitted to selective shunt were compared to a non-shunt group. A 1:1 propensity score matching (PSM) was performed. Differences between the groups and clinical outcomes were calculated, resorting to univariate analysis. RESULTS Ninety-eight patients were selected, from which 23 were operated on using a shunt. After PSM, 22 non-shunt patients were compared to 22 matched shunted patients. Concerning demographics and comorbidities, both groups were comparable to pre and post-PSM, except for chronic heart failure, which was more prevalent in shunted patients (26.1%, P=0.036) in pre-PSM analysis. Regarding 30-day stroke and score Clavien-Dindo ≥2, no significant association was found (P=0.730, P=0.635 and P=0.942, P=0.472, correspondingly, for pre and post-PSM). CONCLUSIONS In this cohort, resorting to shunting did not demonstrate an advantage regarding 30-day stroke or a Clavien-Dindo ≥ 2 rates. Nevertheless, additional more extensive studies are mandatory to achieve precise results concerning the accurate utility of carotid shunting in this subset of patients under regional anesthesia.
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Affiliation(s)
- Juliana Pereira-Macedo
- Department of Surgery, Centro Hospitalar do Médio-Ave, Vila Nova de Famalicão, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - António Pereira-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Biomedicine - Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal
| | - José José Paulo de Andrade
- Department of Biomedicine - Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Biomedicine - Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal
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Duarte-Gamas L, Jácome F, Dias LR, Rocha-Neves J, Yeung KK, Baekgaard N, Dias-Neto M. Catheter-Directed Thrombolysis Protocols for Deep Venous Thrombosis of the Lower Extremities-A Systematic Review and Meta-analysis. Thromb Haemost 2024; 124:89-104. [PMID: 37279794 DOI: 10.1055/a-2106-3754] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To summarize characteristics, complications, and success rates of different catheter-directed thrombolysis (CDT) protocols for the treatment of lower extremity deep venous thrombosis (LE-DVT). METHODS A systematic review using electronic databases (MEDLINE, Scopus, and Web of Science) was performed to identify randomized controlled trials and observational studies related to LE-DVT treated with CDT. A random-effects model meta-analysis was performed to obtain the pooled proportions of early complications, postthrombotic syndrome (PTS), and venous patency. RESULTS Forty-six studies met the inclusion criteria reporting 49 protocols (n = 3,028 participants). In studies that addressed the thrombus location (n = 37), LE-DVT had iliofemoral involvement in 90 ± 23% of the cases. Only four series described CDT as the sole intervention for LE-DVT, while 47% received additional thrombectomy (manual, surgical, aspiration, or pharmacomechanical), and 89% used stenting.Definition of venogram success was highly variable, being the Venous Registry Index the most used method (n = 19). Among those, the minimal thrombolysis rate (<50% lysed thrombus) was 0 to 53%, partial thrombolysis (50-90% lysis) was 10 to 71%, and complete thrombolysis (90-100%) was 0 to 88%. Pooled outcomes were 8.7% (95% confidence interval [CI]: 6.6-10.7) for minor bleeding, 1.2% (95% CI: 0.8-1.7%) for major bleeding, 1.1% (95% CI: 0.6-1.6) for pulmonary embolism, and 0.6% (95% CI: 0.3-0.9) for death. Pooled incidences of PTS and of venous patency at up to 1 year of follow-up were 17.6% (95% CI: 11.8-23.4) and 77.5% (95% CI: 68.1-86.9), respectively. CONCLUSION Assessment of the evidence is hampered by the heterogeneity of protocols, which may be reflected in the variation of PTS rates. Despite this, CDT is a low-risk treatment for LE-DVT.
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Affiliation(s)
- Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, São João University Hospital Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Filipa Jácome
- Department of Angiology and Vascular Surgery, São João University Hospital Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lara Romana Dias
- Department of Angiology and Vascular Surgery, São João University Hospital Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, São João University Hospital Center, Porto, Portugal
- Biomedicine Department - Unit of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Kak K Yeung
- Department of Vascular Surgery, Amsterdam University Medical Centres, location VUmc, Amsterdam, The Netherlands
- Department of Physiology, Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Niels Baekgaard
- Department of Vascular Surgery, Rigshospitalet and Gentofte Hospital, Copenhagen, Denmark
| | - Marina Dias-Neto
- Department of Angiology and Vascular Surgery, São João University Hospital Center, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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Pereira-Macedo J, Silva AF, Duarte-Gamas L, Andrade JP, Sousa-Pinto B, Rocha-Neves J. Incidence of myocardial injury in patients submitted to carotid endarterectomy. VASA 2024; 53:13-27. [PMID: 37987782 DOI: 10.1024/0301-1526/a001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Myocardial injury following noncardiac surgery (MINS) is associated with higher mortality and major adverse cardiovascular event rates in the short- and long-term in patients undergoing carotid endarterectomy (CEA). However, its incidence is still unclear in this subset of patients. Therefore, this systematic review with meta-analysis aims to determine the incidence of MINS in patients undergoing CEA. Three electronic databases MEDLINE, Scopus, and Web of Science were used to search for studies assessing the occurrence of MINS in the postoperative setting of patients undergoing CEA. The incidence of MINS was pooled by random-effects meta-analysis, with sources of heterogeneity being explored by meta-regression and subgroup analysis (general anesthesia vs. regional anesthesia). Assessment of studies' quality was performed using National Heart, Lung, and Blood Institute Study Quality Assessment Tool, and Risk of Bias 2 tools. Twenty studies were included, with a total of 117,933 participants. Four of them were RCTs, while the remaining were cohort studies. All observational cohorts had an overall high risk of bias, except for Pereira Macedo et al. Three of them had repeated population, thus only data from the most recent one was considered. On the other hand, all RCT had an overall low risk of bias. In patients under regional anesthesia, the incidence of MINS in primary studies ranged between 2% and 15.3%, compared to 0-42.5% for general anesthesia. The meta-analytical incidence of MINS after CEA was of 6.3% [95% CI 2.0-10.6%], but severe heterogeneity was observed (I2=99.1%). MINS appears to be relatively common among patients undergoing CEA. The observed severe heterogeneity points to the need for further larger studies adopting consistent definitions of MINS and equivalent cut-off values.
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Affiliation(s)
- Juliana Pereira-Macedo
- Department of Surgery, Hospitalar Centre of Medio-Ave, Vila Nova de Famalicão, Portugal
- Department of Angiology and Vascular Surgery, University Hospitalar Centre of Sao Joao, Porto, Portugal
- Faculty of Medicine of University of Porto, Portugal
| | | | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, University Hospitalar Centre of Sao Joao, Porto, Portugal
| | - José Paulo Andrade
- Department of Biomedicine, Unity of Anatomy, Faculty of Medicine, University of Porto, Portugal
- CINTESIS@RISE - Centre for Health Technology and Services Research, Porto, Portugal
| | - Bernardo Sousa-Pinto
- CINTESIS@RISE - Centre for Health Technology and Services Research, Porto, Portugal
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, University Hospitalar Centre of Sao Joao, Porto, Portugal
- Department of Biomedicine, Unity of Anatomy, Faculty of Medicine, University of Porto, Portugal
- Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Portugal
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Quesado J, Dias L, Pereira-Macedo J, Duarte-Gamas L, Khairy A, Pinheiro M, Reis P, Andrade JP, Rocha-Neves J, Marreiros A. R2CHA2DS2-VA predicts the cardiovascular risk after carotid endarterectomy. Ann Vasc Surg 2023:S0890-5096(23)00116-4. [PMID: 36868457 DOI: 10.1016/j.avsg.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE R2CHA2DS2-VA score has been used to predict short and long-term outcomes in many cardiovascular diseases. This study aims to validate the R2CHA2DS2-VA score as a long-term major adverse cardiovascular events (MACE) predictor after CEA. Secondary outcomes were also assessed regarding the incidence of all-cause mortality, acute myocardial infarction (AMI), major adverse limb events (MALE), and acute heart failure (AHF). METHODS From January 2012 to December 2021, patients (n= 205) from a Portuguese tertiary care and referral center that underwent CEA with regional anesthesia (RA) for carotid stenosis were selected from a previously collected prospective database, and a post-hoc analysis was performed. Demographics and comorbidities were registered. Clinical adverse events were assessed 30-days after the procedure and in the subsequent long-term surveillance period. Statistical analysis was performed by the Kaplan-Meier method and Cox proportional hazards regression. RESULTS Of the patients enrolled, 78.5% were males with a mean age of 70.44 ± 8.9 years. Higher scores of R2CHA2DS2-VA were associated with long-term MACE (adjusted Hazard Ratio (aHR) 1.390; 95% Confidence Interval (CI) 1.173-1.647) and mortality (aHR 1.295; 95% CI 1.08-1.545) CONCLUSIONS: This study demonstrated the potential of the R2CHA2DS2-VA score to predict long-term outcomes such as AMI, AHF, MACE, and all-cause mortality in a population of patients submitted to carotid endarterectomy.
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Affiliation(s)
- João Quesado
- ICVS, Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
| | - Lara Dias
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Juliana Pereira-Macedo
- Department of surgery - Centro Hospitalar do Médio Ave; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Ahmed Khairy
- Faculty of Medicine-Assiut University-Assiut-Egypt
| | - Marina Pinheiro
- ICVS, Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal; REQUIMTE, University of Porto, Porto, Portugal; Public Health Unit - ACES Cávado III , Braga, Portugal
| | - Pedro Reis
- Burn Unit-Department of Plastic Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José P Andrade
- CINTESIS@RISE, Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Portugal; Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Portugal.
| | - Ana Marreiros
- Faculdade de Medicina e Ciências Biomédicas da Universidade do Algarve, Portugal, ABC, Algarve Biomedical Center, Faro, Portugal
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Myrcha P, Kozak M, Myrcha J, Ząbek M, Rocha-Neves J, Głowiński J, Hendiger W, Woźniak W, Taranta I. Clinical Characteristics and Predictors of Long-Term Prognosis of Acute Peripheral Arterial Ischemia Patients Treated Surgically. Int J Environ Res Public Health 2023; 20:3877. [PMID: 36900887 PMCID: PMC10001670 DOI: 10.3390/ijerph20053877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Acute peripheral arterial ischemia is a rapidly developing loss of perfusion, resulting in ischemic clinical manifestations. This study aimed to assess the incidence of cardiovascular mortality in patients with acute peripheral arterial ischemia and either atrial fibrillation (AF) or sinus rhythm (SR). METHODS This observational study involved patients with acute peripheral ischemia treated surgically. Patients were followed-up to assess cardiovascular mortality and its predictors. RESULTS The study group included 200 patients with acute peripheral arterial ischemia and either AF (n = 67) or SR (n = 133). No cardiovascular mortality differences between the AF and SR groups were observed. AF patients who died of cardiovascular causes had a higher prevalence of peripheral arterial disease (58.3% vs. 31.6%, p = 0.048) and hypercholesterolemia (31.2% vs. 5.3%, p = 0.028) than those who did not die of such causes. Patients with SR who died of cardiovascular causes more frequently had a GFR <60 mL/min/1.73 m2 (47.8% vs. 25.0%, p = 0.03) and were older than those with SR who did not die of such causes. The multivariable analysis shows that hyperlipidemia reduced the risk of cardiovascular mortality in patients with AF, whereas in patients with SR, an age of ≥75 years was the predisposing factor for such mortality. CONCLUSIONS Cardiovascular mortality of patients with acute ischemia did not differ between patients with AF and SR. Hyperlipidemia reduced the risk of cardiovascular mortality in patients with AF, whereas in patients with SR, an age of ≥75 years was a predisposing factor for such mortality.
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Affiliation(s)
- Piotr Myrcha
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
- Department of General, Vascular and Oncological Surgery, Masovian Brodnowski Hospital, 03-242 Warsaw, Poland
| | - Mariusz Kozak
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
- Department of General, Vascular and Oncological Surgery, Masovian Brodnowski Hospital, 03-242 Warsaw, Poland
| | - Jakub Myrcha
- Department of Vascular Surgery and Angiology, Bielanski Hospital, 01-809 Warsaw, Poland
| | - Mirosław Ząbek
- Department of Neurosurgery, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
- Department of Biomedicine—Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - Jerzy Głowiński
- Department of Vascular Surgery and Transplantalogy, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Włodzimierz Hendiger
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Witold Woźniak
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
- Department of General, Vascular and Oncological Surgery, Masovian Brodnowski Hospital, 03-242 Warsaw, Poland
| | - Izabela Taranta
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
- Department of General, Vascular and Oncological Surgery, Masovian Brodnowski Hospital, 03-242 Warsaw, Poland
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Vieira-Cardoso N, Pereira-Neves A, Fragão-Marques M, Duarte-Gamas L, Domingues-Monteiro D, Vidoedo J, Reis P, Teixeira J, Andrade JP, Rocha-Neves J. Red blood cell distribution width as a predictor of cardiovascular outcomes in extensive aortoiliac disease. J Cardiovasc Surg (Torino) 2023; 64:48-57. [PMID: 36168948 DOI: 10.23736/s0021-9509.22.12210-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aortoiliac peripheral artery disease may lead to disabling lower limb claudication or to lower limb chronic threatening ischemia, which is associated with increased short and long-term morbi-mortality. The red blood cell distribution width-coefficient of variation (RDW-CV) has been able to predict outcomes in other atherosclerotic diseases, such as myocardial infarction and stroke. The main objective of this study was to assess the predictive ability of perioperative RDW-CV in accurately predicting short and long-term major adverse cardiovascular events (MACE) and all-cause mortality in patients submitted to aortoiliac revascularization due to extensive aortoiliac atherosclerotic disease. METHODS From 2013 to 2020, patients who underwent aortoiliac revascularization due to severe aortoiliac disease were included in a prospective cohort. Blood samples were taken preoperatively and the patient's demographics, comorbidities, and postoperative outcomes were assessed. A multivariate Cox regression model was used to adjust for confounding and assess the independent effect of these prognostic factors on the outcomes. RESULTS The study group included 107 patients. Median follow-up was 57 (95% CI: 34.4-69.6) months. Preoperative RDW-CV was increased in thirty-eight patients (35.5%). Increased RDW-CV was associated with congestive heart failure - adjusted odds ratio of 5.043 (95% CI: 1.436-17.717, P=0.012). It could predict long-term occurrence of MACE (adjusted hazard ratio [aHR] 1.065, 95% CI: 1.014-1.118, P=0.011), all-cause mortality (aHR=1.069, 95% CI: 1.014-1.126, P=0.013), acute heart failure (AHF) (aHR=1.569, 95% CI: 1.179-2.088, P=0.002), and stroke (aHR=1.343, 95% CI: 1.044-1.727, P=0.022). CONCLUSIONS RDW is a widely available and low-cost marker that was able to independently predict long-term AHF, stroke, MACE, and all-cause mortality in patients with extensive aortoiliac disease submitted to revascularization. This biomarker could help assess which patients would likely benefit from stricter follow-up in the long-term.
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Affiliation(s)
| | | | | | | | | | | | - Pedro Reis
- University Hospital Centre of São João, Porto, Portugal
| | - José Teixeira
- University Hospital Centre of São João, Porto, Portugal
| | - José P Andrade
- Faculty of Medicine, University of Porto, Porto, Portugal
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10
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Pereira-Macedo J, Rocha-Neves J. FRAILTY - A prognosis index turned to a healthcare planner feature for vascular surgery and carotid revascularization. Port J Card Thorac Vasc Surg 2023; 29:15-16. [PMID: 36640282 DOI: 10.48729/pjctvs.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Juliana Pereira-Macedo
- Department of General Surgery, Hospital Centre of Médio Ave, Vila Nova de Famalicão, Portugal; CINTESIS@RISE, Faculty of Medicine, University of Porto, Portugal; Department of Angiology and Vascular Surgery, University Hospital Centre of São João, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, University Hospital Centre of São João, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Portugal
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11
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Gwilym BL, Pallmann P, Waldron CA, Thomas-Jones E, Milosevic S, Brookes-Howell L, Harris D, Massey I, Burton J, Stewart P, Samuel K, Jones S, Cox D, Clothier A, Edwards A, Twine CP, Bosanquet DC, Benson R, Birmpili P, Blair R, Bosanquet DC, Dattani N, Dovell G, Forsythe R, Gwilym BL, Hitchman L, Machin M, Nandhra S, Onida S, Preece R, Saratzis A, Shalhoub J, Singh A, Forget P, Gannon M, Celnik A, Duguid M, Campbell A, Duncan K, Renwick B, Moore J, Maresch M, Kamal D, Kabis M, Hatem M, Juszczak M, Dattani N, Travers H, Shalan A, Elsabbagh M, Rocha-Neves J, Pereira-Neves A, Teixeira J, Lyons O, Lim E, Hamdulay K, Makar R, Zaki S, Francis CT, Azer A, Ghatwary-Tantawy T, Elsayed K, Mittapalli D, Melvin R, Barakat H, Taylor J, Veal S, Hamid HKS, Baili E, Kastrisios G, Maltezos C, Maltezos K, Anastasiadou C, Pachi A, Skotsimara A, Saratzis A, Vijaynagar B, Lau S, Velineni R, Bright E, Montague-Johnstone E, Stewart K, King W, Karkos C, Mitka M, Papadimitriou C, Smith G, Chan E, Shalhoub J, Machin M, Agbeko AE, Amoako J, Vijay A, Roditis K, Papaioannou V, Antoniou A, Tsiantoula P, Bessias N, Papas T, Dovell G, Goodchild F, Nandhra S, Rammell J, Dawkins C, Lapolla P, Sapienza P, Brachini G, Mingoli A, Hussey K, Meldrum A, Dearie L, Nair M, Duncan A, Webb B, Klimach S, Hardy T, Guest F, Hopkins L, Contractor U, Clothier A, McBride O, Hallatt M, Forsythe R, Pang D, Tan LE, Altaf N, Wong J, Thurston B, Ash O, Popplewell M, Grewal A, Jones S, Wardle B, Twine C, Ambler G, Condie N, Lam K, Heigberg-Gibbons F, Saha P, Hayes T, Patel S, Black S, Musajee M, Choudhry A, Hammond E, Costanza M, Shaw P, Feghali A, Chawla A, Surowiec S, Encalada RZ, Benson R, Cadwallader C, Clayton P, Van Herzeele I, Geenens M, Vermeir L, Moreels N, Geers S, Jawien A, Arentewicz T, Kontopodis N, Lioudaki S, Tavlas E, Nyktari V, Oberhuber A, Ibrahim A, Neu J, Nierhoff T, Moulakakis K, Kakkos S, Nikolakopoulos K, Papadoulas S, D'Oria M, Lepidi S, Lowry D, Ooi S, Patterson B, Williams S, Elrefaey GH, Gaba KA, Williams GF, Rodriguez DU, Khashram M, Gormley S, Hart O, Suthers E, French S. Short-term risk prediction after major lower limb amputation: PERCEIVE study. Br J Surg 2022; 109:1300-1311. [PMID: 36065602 DOI: 10.1093/bjs/znac309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/06/2022] [Accepted: 07/31/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery. METHODS The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance. RESULTS Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679). CONCLUSION Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.
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Affiliation(s)
- Brenig L Gwilym
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | | | | | | | | | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Massey
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jo Burton
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Phillippa Stewart
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Sian Jones
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - David Cox
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - Annie Clothier
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Christopher P Twine
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - David C Bosanquet
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
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Pereira-Macedo J, Lopes-Fernandes B, Duarte-Gamas L, Pereira-Neves A, Mourão J, Khairy A, Andrade JP, Marreiros A, Rocha-Neves J. The Gupta Perioperative Risk for Myocardial Infarct or Cardiac Arrest (MICA) Calculator as an Intraoperative Neurologic Deficit Predictor in Carotid Endarterectomy. J Clin Med 2022; 11:jcm11216367. [PMID: 36362595 PMCID: PMC9653563 DOI: 10.3390/jcm11216367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Patients undergoing carotid endarterectomy (CEA) may experiment intraoperative neurologic deficits (IND) during carotid cross-clamping. This work aimed to assess the impact of the Gupta Perioperative Myocardial Infarct or Cardiac Arrest (MICA) risk calculator in the IND. Methods: From January 2012 to April 2021, patients undergoing CEA with regional anaesthesia for carotid stenosis with IND and consecutively control operated patients without IND were selected. A regressive predictive model was created, and a receiver operating characteristic (ROC) curve was applied for comparison. A multivariable dependence analysis was conducted using a classification and regression tree (CRT) algorithm. Results: A total of 97 out of 194 included patients developed IND. Obesity showed aOR = 4.01 (95% CI: 1.66–9.67) and MICA score aOR = 1.21 (1.03–1.43). Higher contralateral stenosis showed aOR = 1.29 (1.08–1.53). The AUROC curve was 0.656. The CRT algorithm differentiated obese patients with a MICA score ≥ 8. Regarding non-obese patients, the model identified the presence of contralateral stenosis ≥ 55% with a MICA ≥ 10. Conclusion: MICA score might play an additional role in stratifying patients for IND in CEA. Obesity was determined as the best discrimination factor, followed by a score ≥ 8. A higher ipsilateral stenosis degree is suggested to have a part in avoiding procedure-related IND. Larger studies might validate the benefit of MICA score regarding the risk of IND.
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Affiliation(s)
- Juliana Pereira-Macedo
- Department of General Surgery, Hospital Centre of Médio Ave, 4760-124 Vila Nova de Famalicão, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Department of Angiology and Vascular Surgery, University Hospital Centre of São João, 4200-319 Porto, Portugal
- Correspondence: ; Tel.: +351-914-585-045
| | - Beatriz Lopes-Fernandes
- Faculty of Medicine and Biomedical Sciences, University of Algarve, ABC, Algarve Biomedical Centre, 8005-139 Faro, Portugal
| | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, University Hospital Centre of São João, 4200-319 Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - António Pereira-Neves
- Department of Angiology and Vascular Surgery, University Hospital Centre of São João, 4200-319 Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Joana Mourão
- Department of Anesthesiology, University Hospital Centre of São João, 4200-319 Porto, Portugal
- Departament of Anesthesiology, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Ahmed Khairy
- Department of Vascular and Endovascular Surgery, Assiut University Hospital, Assiut University, Assiut 71515, Egypt
| | - José Paulo Andrade
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Ana Marreiros
- Faculty of Medicine and Biomedical Sciences, University of Algarve, ABC, Algarve Biomedical Centre, 8005-139 Faro, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, University Hospital Centre of São João, 4200-319 Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
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Pinheiro M, Rocha-Neves J. From bench to bedside: translating medicine from the lab to the clinic. Port J Card Thorac Vasc Surg 2022; 29:13-14. [PMID: 36197818 DOI: 10.48729/pjctvs.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Marina Pinheiro
- LAQV, REQUIMTE, Department of Chemistry, Faculdade de Farmácia, Universidade do Porto, Portugal; ICVS, Life and Health Sciences Research Institute, School of Medicine, University of Minho, Portugal; ARS Norte. ACES Cávado III. Public Health Unit. Barcelos, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Biomedicine - Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal
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14
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Pinheiro M, Carreira M, Rocha-Neves J. MANAGEMENT OF THE UPPER LIMB ARTERIOVENOUS MALFORMATIONS. Port J Card Thorac Vasc Surg 2022; 29:45-51. [PMID: 35471221 DOI: 10.48729/pjctvs.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Abstract
Arteriovenous malformations (AVMs) involving the upper limb constitute 10% of the total AVMs. In the upper limb, AVMs are more frequent in the hand than in the arm, being the hand one of the body's regions more frequently associated with AVMs, coming after the head and neck. The total prevalence of the upper limb AVMs remains unknown and there is currently no definitive consensus for the treatment of upper limb AVMs. The purpose of this study was to review the best evidence of the treatment for the upper limb AVMs and describe their clinical characteristics and diagnosis. The majority of patients with asymptomatic AVMs follows a conservative management. In the symptomatic patients, the treatment with surgery and or chemical embolization is beneficial. The amputation can be necessary in the case of life-threatening and massive AVMs, constituting the first step in patient's rehabilitation. Although the most common option for the management of symptomatic or functional AVMs is the embolo-sclerotherapy combined with surgery, different outcomes should be taken into account to plan the treatment, specially the presence of symptoms, bleeding and heart failure.
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Affiliation(s)
- Marina Pinheiro
- LAQV-REQUIMTE, Universidade do Porto, Porto, Portugal; CHUP, Centro Hospitalar Universitário do Porto, Porto; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | | | - João Rocha-Neves
- Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
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15
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Fragão-Marques M, Rocha-Neves J, Andrade JP. Response to the letter "Mean platelet volume may not predict restenosis after carotid endarterectomy" from Beyan C. and Beyan E. Ann Vasc Surg 2022; 83:e6-e7. [PMID: 35337928 DOI: 10.1016/j.avsg.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Mariana Fragão-Marques
- - Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; - Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal; - Cardiovascular R&D Unit, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - João Rocha-Neves
- - Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal; - Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - José P Andrade
- - Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; - Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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Jácome F, Nóbrega L, Pereira-Neves A, Duarte-Gamas L, Mourão J, Videira-Reis P, Dias-Neto M, Rocha-Neves J. Revised cardiac score index is a predictor of long-term outcomes after carotid endarterectomy. VASA 2022; 51:93-98. [DOI: 10.1024/0301-1526/a000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary: Background: Cardiac complications represent the main cause of mortality after non-cardiac surgery and the Revised Cardiac Risk Index (RCRI) was created to estimate the perioperative risk of these events. It considers history of ischaemic heart disease, congestive heart failure, diabetes requiring preoperative insulin, stroke or transient ischaemic attack and renal impairment. We aim to describe the accuracy of the RCRI for predicting perioperative major adverse cardiovascular events (MACE) - a composite of heart failure, ischemic events and all-cause death. Also, the authors aimed to review the score for better prediction of cardiovascular outcomes. Patients and methods: From January 2012 to January 2020, patients who underwent Carotid endarterectomy (CEA) with regional anaesthesia (RA) were selected. RCRI was calculated for each case. Estimated and reported cardiovascular complications were compared using multivariate logistic regression and cox proportional hazards. An alternative and optimized carotid-RCRI (CtRCRI) was obtained. Overall predictive accuracy was assessed and compared by measuring model discrimination. Adjustments for overfitting and evaluation of the new model were performed by bootstrap. Results: 186 patients were selected, of which 80% were male with a mean age of 70.0±9.05 years old. The median follow-up was 50 months, interquartile range 21–69 months. None of the scores were able to predict MACE in the perioperative period. Both were associated with 30-day Clavien-Dindo ≥2 (p=0.022 and p=0.041, respectively). Regarding long-term prognosis, both were able to predict MACE (RCRI: hazard ratio (HR) 3.54 (95% confidence interval [CI] 1.04–11.48) vs. CtRCRI: HR 2.08 (95%CI 1.08–3.98) and all-cause mortality (RCRI: HR 3.33, 95%CI 0.99–11.11 vs. CtRCRI: HR 1.57, 95%CI 1.14–7.04). Conclusions: RCRI and CtRCRI did not predict MACE in the perioperative period but are good predictors of 30-day complications (Clavien-Dindo ≥2). Both RCRI and CtRCRI have good prognostic value as predictors of long-term cardiovascular events.
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Affiliation(s)
- Filipa Jácome
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Leandro Nóbrega
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - António Pereira-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Joana Mourão
- Department of Anesthesiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Pedro Videira-Reis
- Burn Unit, Department of Plastic and Reconstructive Surgery, Centro Hospitalar São João, Porto, Portugal
| | - Marina Dias-Neto
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
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Fragão-Marques M, Teixeira F, Mancio J, Seixas N, Rocha-Neves J, Falcão-Pires I, Leite-Moreira A. Impact of oral anticoagulation therapy on postoperative atrial fibrillation outcomes: a systematic review and meta-analysis. Thromb J 2021; 19:89. [PMID: 34798896 PMCID: PMC8603521 DOI: 10.1186/s12959-021-00342-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/01/2021] [Indexed: 02/07/2023] Open
Abstract
Background Post-operative atrial fibrillation (POAF) is the most common complication after cardiac surgery. Recent studies had shown this phenomenon is no longer considered transitory and is associated with higher risk of thromboembolic events or death. The aim of this study was to systematically review and analyze previous studies comparing oral anticoagulation therapy with no anticoagulation, regarding these long-term outcomes. Methods PubMed/MEDLINE, EMBASE, Web of Science and Cochrane Database were systematically searched to identify the studies comparing the risk of stroke, or thromboembolic events or mortality of POAF patients who received anticoagulation compared with those who were not anticoagulated. Incidence of stroke, thromboembolic events and all-cause mortality were evaluated up to 10 years after surgery. Time-to-event outcomes were collected through hazard ratio (HR) along with their variance and the early endpoints using frequencies or odds ratio (OR). Random effect models were used to compute statistical combined measures and 95% confidence intervals (CI). Heterogeneity was evaluated through Q statistic-related measures of variance (Tau2, I2, Chi-squared test). Results Eight observational cohort studies were selected, including 15,335 patients (3492 on Oral Anticoagulants (OAC) vs 11,429 without OAC) that met the inclusion criteria for qualitative synthesis. Patients had a wide gender distribution (38.6–82.3%), each study with a mean age above 65 years (67.5–85). Vitamin K antagonists were commonly prescribed anticoagulants (74.3–100%). OAC was associated with a protective impact on all-cause mortality at a mean of 5.0 years of follow-up (HR is 0.85 [0.72–1.01]; p = 0.07; I2 = 48%). Thromboembolic events did not differ between the two treatment arms (HR 0.68 [0.40–1.15], p = 0.15). Conclusion Current literature suggests a possibly protective impact of OAC therapy for all-cause mortality in patients with new-onset atrial fibrillation after cardiac surgery. However, it does not appear to impact thromboembolism rate. Supplementary Information The online version contains supplementary material available at 10.1186/s12959-021-00342-2.
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Affiliation(s)
- Mariana Fragão-Marques
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, 4200, Porto, Portugal. .,São João University Hospital Center, Porto, Portugal. .,Faculty of Medicine of the University of Porto, Porto, Portugal.
| | | | - Jennifer Mancio
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, 4200, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Nair Seixas
- Vila Nova de Gaia Hospital Center, Vila Nova de Gaia, Portugal
| | - João Rocha-Neves
- São João University Hospital Center, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Inês Falcão-Pires
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, 4200, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, 4200, Porto, Portugal.,São João University Hospital Center, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
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Pereira-Neves A, Saramago S, Duarte-Gamas L, Domingues-Monteiro D, Fragão-Marques M, Marques-Vieira M, Andrade JP, Pais S, Rocha-Neves J. MEAN PLATELET VOLUME PREDICTS RESTENOSIS AFTER CAROTID ENDARTERECTOMY. Ann Vasc Surg 2021; 81:216-224. [PMID: 34748948 DOI: 10.1016/j.avsg.2021.08.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/17/2021] [Accepted: 08/31/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Carotid restenosis following carotid endarterectomy (CEA) has a cumulative risk at 5-years up to 32%, which may impact the well-being of patients following CEA. Haematological parameters in the standard complete blood cell count (CBC) are emerging as potential biomarkers, but their application in CEA is scarce. The primary aim of this study was to investigate haematological markers for restenosis following CEA. The secondary aim was to characterize clinical risk factors for restenosis. METHODS From January 2012 to January 2019, 151 patients who underwent CEA under regional anaesthesia due to carotid stenosis were selected from a prospectively maintained cohort database. Patients were included if a preoperative CBC was available in the two weeks preceding CEA. Multivariable analysis was performed alongside propensity score matching (PSM) analysis, using the preoperative CEA parameters, to reduce confounding factors between categories. RESULTS The study group comprised 28 patients who developed carotid restenosis. The remaining 123 patients without restenosis composed the control group. Mean age of the patients did not differ significantly between groups (70.25±8.05 vs. 70.32 ± 9.61 YO, p=0.973), neither did gender (male gender 89.3% vs. 78.9%, p=0.206). Regarding haematological parameters, only MPV remained statistically significant within multivariable analysis (1.855, aOR [1.174-2.931], p=0.008), a result supported by PSM analysis (2.072, aOR [1.036-4.147], p=0.042). CONCLUSION MPV was able to predict restenosis two years after CEA. Thus, MPV can be incorporated into score calculations to identify patients at greater risk of restenosis, who could benefit from specific monitoring during follow-up. While results are promising, more research is necessary to corroborate them.
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Affiliation(s)
- António Pereira-Neves
- Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - Sean Saramago
- Faculdade de Medicina e Ciências Biomédicas, Universidade do Algarve, Campus de Gambelas Ed. 2 - Piso 1, Gab. 1.6, 8005-139 Faro, Portugal.
| | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - Diogo Domingues-Monteiro
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - Mariana Fragão-Marques
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular R&D Unit, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - Mário Marques-Vieira
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Hospital de Braga, EPE, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - José P Andrade
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - Sandra Pais
- Faculdade de Medicina e Ciências Biomédicas, Universidade do Algarve, Campus de Gambelas Ed. 2 - Piso 1, Gab. 1.6, 8005-139 Faro, Portugal; Comprehensive Health Research Centre (CHRC), Lisboa, Campus de Gambelas Ed. 2 - Piso 1, Gab. 1.6, 8005-139 Faro, Portugal; Centro Internacional sobre o Envelhecimento, Campus de Gambelas Ed. 2 - Piso 1, Gab. 1.6, 8005-139 Faro, Portugal; ABC-RI, Algarve Biomedical Center Research Institute, Campus de Gambelas Ed. 2 - Piso 1, Gab. 1.6, 8005-139 Faro, Portugal.
| | - João Rocha-Neves
- Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
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Moreira R, Duarte-Gamas L, Pereira-Macedo J, Pereira-Neves A, Domingues-Monteiro D, Jácome F, Andrade JP, Marreiros A, Rocha-Neves J. Contralateral Carotid Stenosis is a Predictor of Long-term Adverse Events in Carotid Endarterectomy. Ann Vasc Surg 2021; 79:247-255. [PMID: 34699941 DOI: 10.1016/j.avsg.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
Contralateral carotid stenosis (clCS) has been described as a perioperative predictor of mortality after carotid endarterectomy (CEA). However, its predictive value on long-term cardiovascular events remains controversial. The study aims to assess the potential role of clCS as a long-term predictor of major adverse cardiovascular events (MACE) in patients who underwent CEA. From January 2012 to July 2020, patients undergoing CEA under regional anesthesia for carotid stenosis in a tertiary care and referral center were eligible from a prospective database, and a post hoc analysis was performed. The primary outcome consisted in the occurrence of long-term MACE. Secondary outcomes included all-cause mortality, stroke, myocardial infarction, acute heart failure, and major adverse limb events. A total of 192 patients were enrolled. With a median 50 months follow-up, chronic kidney disease (CKD) (mean survival time (MST) 51.7 vs. 103.3, p<0.010) and peripheral artery disease (PAD) (MST 75.1 vs. 90.3, p=0.001) were associated with decreased survival time. After propensity score matching (PSM), CKD (MST 49.1 vs. 106.0, p=0.001) and PAD (MST 75.7 vs. 94.0, p=0.001) maintained this association. On multivariate Cox regression analysis, contralateral stenosis was associated with higher MACE (hazard ratio (HR) = 2.035; 95% CI: 1.113-3.722, p=0.021 and all-cause mortality (HR = 2.564; 95% CI: 1.276-5,152 p=0.008). After PSM, only all-cause mortality (HR 2.323; 95% CI: 0.993-5.431, p=0.052) maintained a significant association with clCS. On multivariable analysis, clCS (aHR 2.367; 95% CI: 1.174-4.771, p=0.016), age (aHR 1.039, 95% CI: 1.008-1.070), CKD (aHR 2.803; 95% CI: 1.409-5.575, p=0.003) and PAD (aHR 3.225, 95% CI: 1.695-6.137, p<0.001) were independently associated with increased all-cause mortality. Contrary to MACE, clCS is a strong predictor of long-term all-cause mortality after CEA. However, MACE risk may compromise CEA benefits by other competitive events. Therefore, further studies are needed to establish the role of clCS on postoperative events and on patients' specific assessments in order to determine the best medical treatment and easy access to surgical intervention.
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Affiliation(s)
- Rita Moreira
- Faculdade de Medicina e Ciências Biomédicas da Universidade do Algarve, Portugal; ABC, Algarve Biomedical Center, Faro, Portugal.
| | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Juliana Pereira-Macedo
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - António Pereira-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Diogo Domingues-Monteiro
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Filipa Jácome
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - José P Andrade
- Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Ana Marreiros
- Faculdade de Medicina e Ciências Biomédicas da Universidade do Algarve, Portugal; ABC, Algarve Biomedical Center, Faro, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal
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20
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Nóbrega L, Pereira-Neves A, Duarte-Gamas L, Dias PP, Azevedo-Cerqueira A, Ribeiro H, Vidoedo J, Teixeira J, Rocha-Neves J. Outcome Analysis Using the Modified Frailty Index-5 in Patients With Complex Aortoiliac Disease. Ann Vasc Surg 2021; 79:153-161. [PMID: 34644633 DOI: 10.1016/j.avsg.2021.06.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Vascular surgery patients commonly have several comorbidities that cumulatively lead to a frailty status. The cumulative comorbidities disproportionately increase the risk of adverse events and are also associated with worsened long-term prognosis. In recent years, several tools have been elaborated with the objective of quantifying a patient's frailty. One of them is the modified frailty index-5 (mFI-5), a simplified and easy to use index. There is scarce data regarding its value as a prognostic factor in aortoiliac occlusive disease. The aim of this work is to validate mFI-5 as a potential postoperative prognostic indicator in this population. METHODS From January 2013 to January 2020, 109 patients who underwent elective revascularizations, either endovascular or open surgery, having Trans-Atlantic Inter-Society Consensus II type D aortoiliac lesions in a tertiary and a regional hospital were selected from a prospective vascular registry. Demographic data was collected including diabetes mellitus, chronic heart failure, chronic obstructive pulmonary disease, arterial hypertension requiring medication and functional status. The 30-d and subsequent long-term surveillance outcomes were also collected including major adverse cardiovascular events (MACE), major adverse limb events (MALE) and all-cause mortality were assessed in the 30-d post-procedure and in the subsequent long-term surveillance period. The mFI-5 was applied to this population to evaluate the prognostic impact of this frailty marker on mortality and morbidity. RESULTS In the long-term follow-up, mFI-5 was significantly associated with MACE (hazard ratio [HR] 2.469; 95% confidence interval [CI]: 1.267-4.811; P = .008) and all-cause mortality (HR 2.585; 95% CI: 1.270-5.260; P = .009). However, there was no significant association with 30-day outcomes. Along with the presence of chronic kidney disease, mFI-5 was the prognostic factor better able of predicting MACE. No prognostic value was found regarding short-term outcomes. CONCLUSION The mFI-5 index may have a role in predicting long term outcomes, namely MACE and all-cause mortality, in the subset of patients with extensive aortoiliac occlusive disease. Its ease of use can foster its application in risk stratification and contribute for the decision-making process.
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Affiliation(s)
- Leandro Nóbrega
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - António Pereira-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Pedro Paz Dias
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Ana Azevedo-Cerqueira
- Unidade de Saúde Familiar Odisseia, Agrupamento de Centros de Saúde Grande Porto III, Porto, Portugal
| | - Hugo Ribeiro
- Unidade de Saúde Familiar Barão Do Corvo, Agrupamento de Centros de Saúde de Gaia, Porto, Portugal; Equipa Comunitária de Suporte Em Cuidados Paliativos de Vila Nova de Gaia, Porto, Portugal
| | - José Vidoedo
- Department of Angiology and Vascular Surgery, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - José Teixeira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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21
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Duarte-Gamas L, Pereira-Neves A, Sousa J, Sousa-Pinto B, Rocha-Neves J. The Diagnostic Accuracy of Intra-Operative Near Infrared Spectroscopy in Carotid Artery Endarterectomy Under Regional Anaesthesia: Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2021; 62:522-531. [PMID: 34284934 DOI: 10.1016/j.ejvs.2021.05.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/16/2021] [Accepted: 05/29/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Intra-operative near infrared spectroscopy (NIRS) is a non-invasive tool used to monitor regional cerebral oxygen saturation during carotid endarterectomy (CEA), for which accuracy remains unclear. Therefore, this systematic review and meta-analysis aimed to determine the diagnostic accuracy of NIRS in patients undergoing CEA under regional anaesthesia (RA). DATA SOURCES MEDLINE, Scopus, and Web of Science were searched for studies that compared NIRS with the "awake test" in patients undergoing CEA under RA. REVIEW METHODS Bivariable random effects meta-analysis was performed to determine the diagnostic accuracy of NIRS to detect cerebral ischaemia. Meta-regression was performed to explore causes of heterogeneity. Meta-analysis of proportions was also performed to determine the accuracy of NIRS in predicting 30 day stroke. Study quality was evaluated using the QUADAS-2 criteria. RESULTS Eleven primary studies were included, assessing 1 237 participants. The meta-analysis obtained a partial area under the summary receiver operating characteristic curve for diagnosing brain ischaemia of 0.646, with a summary sensitivity of 72.0% (95% confidence interval [CI] 58.1 - 82.7; I2 = 48.6%) and a specificity of 84.1% (95% CI 78.5-88.4; I2 = 48.6%). In meta-regression analysis, the frequency of hypertension (p = .011) and patients with symptomatic carotid stenosis (p = .031) were significant effect modifiers. Higher frequency of arterial hypertension (z score = -2.15; p = .032) and diabetes (z score = -2.12; p = .034) were associated with lower summary sensitivity, while a higher frequency of symptomatic carotid stenosis (z score = 2.11; p = .035) was associated with higher summary sensitivity. Point estimate sensitivity and specificity for predicting 30 day stroke occurrence were 41% (95% CI 19.5 - 66.6; I2 = 0%) and 81.4% (95% CI 74.4 - 86.9, I2 = 65.6%), respectively. CONCLUSION The results of this study suggest that NIRS as a cerebral monitoring technique does not have sufficiently high sensitivity or specificity to be used alone in the neurological monitoring of patients undergoing CEA under RA.
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Affiliation(s)
- Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - António Pereira-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Department of Biomedicine - Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Joel Sousa
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Bernardo Sousa-Pinto
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal; MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Department of Biomedicine - Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Jácome F, Ribeiro M, Rocha-Neves J, Figueiredo-Braga S. MORTALITY SCORES IN SURGICAL CORRECTION OF ABDOMINAL AORTIC ANEURYSM IN RUPTURE. Port J Card Thorac Vasc Surg 2021; 28:39-44. [PMID: 33834653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Ruptured abdominal aortic aneurysm's treatment relies on the emergent surgery, considering preoperative prognosis. There are several scores that estimate perioperative mortality of ruptured abdominal aortic aneurysm, however, the accuracy of such algorithms in some populations remains unknown. OBJECTIVE Compare the prognostic validity of the Weingarten score with the Glasgow Aneurysm Score and the Vancouver Scoring System. Validation of three prognostic ruptured abdominal aortic aneurysms tools for the Portuguese population. MATERIAL AND METHODS A retrospective analysis of consecutive patients with ruptured abdominal aortic aneurysm surgically treated, in a peripheral and in a referral hospital between 2012 and 2016 was performed. The 30-day mortality discriminative power was analysed using each score. RESULTS 120 patients were included. The mean Glasgow Aneurysm Score was 98.53 ± 19.57, the Vancouver Scoring System was 3.64 ± 1.43. The Weingarten score classified 51 (43.2%) patients as stable and 67 (56.8%) as unstable. The three scores demonstrated some predictive value concerning mortality, although Glasgow Aneurysm Score demonstrated the highest area under the ROC curve (0.74) and the best discriminatory capacity for cut-off points with higher specificity. Neither of the scores demonstrated clinically useful predictive value. CONCLUSIONS The Weingarten score did not present as a superior prediction model of preoperative mortality in ruptured abdominal aortic aneurysm. None of the scores, even when optimized for a higher specificity, could select which patients will not benefit from surgical intervention. The Glasgow Aneurysm Score was validated for the Portuguese population.
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Affiliation(s)
- Filipa Jácome
- Centro Hospitalar Universitário de São João, EPE, Portugal
| | - Marta Ribeiro
- Escola de Medicina - Universidade do Minho, Portugal
| | - João Rocha-Neves
- Centro Hospitalar Universitário de São João, EPE; Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal
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Pereira-Neves A, Fragão-Marques M, Rocha-Neves J, Gamas L, Oliveira-Pinto J, Cerqueira A, Andrade J, Fernando-Teixeira J. THE IMPACT OF NEUTROPHIL-TOLYMPHOCYTE RATIO AND PLATELETTO- LYMPHOCYTE RATIO IN CAROTID ARTERY DISEASE. Port J Card Thorac Vasc Surg 2021; 28:45-51. [PMID: 33834652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Inflammation is a common underlying feature of atherosclerosis. Several inflammatory biomarkers have been reported to have prognostic value, in several areas, including in vascular surgery. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) may permit to identify patients at greater risk for cerebrovascular events, tailor patient management, improve preoperative status and possibly develop target anti-atherosclerotic therapy. However, studies reporting usefulness of these hematological biomarkers in the context of carotid artery disease are still scarce. The aim of this study was to review the literature concerning the prognostic ability of NLR and PLR in the subpopulation of vascular patients with carotid artery disease. METHODS A Medline search was performed in order to identify publications focused on the physiopathology of NLR and PLR and their impact in the management of patients with carotid artery disease. RESULTS The study identified 18 articles with a total of 5339 patients. NLR is associated with carotid intima-media thickness, carotid plaques, carotid stenosis, symptomatic stenosis and intra-stent restenosis after carotid artery stenting and cognitive dysfunction after carotid endarterectomy. PLR is associated with carotid stenosis, symptomatic stenosis and predicts post-operative outcomes after carotid artery revascularization, including post-operative stroke, acute coronary syndrome and all-cause mortality. CONCLUSIONS The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have the ability to predict sub-clinic atherosclerosis, atherosclerosis progression in carotid artery disease and propensity for carotid stenosis to become symptomatic along with morbidity following CEA and carotid stenting. Consequently, these parameters may be considered to tailored therapy and improve patient management.
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Affiliation(s)
- António Pereira-Neves
- Department of Biomedicine - Unit of Anatomy and Department of Surgery and Physiology
| | - Mariana Fragão-Marques
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto; Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - João Rocha-Neves
- Department of Biomedicine - Unit of Anatomy and Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto
| | - Luís Gamas
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto
| | - José Oliveira-Pinto
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Alfredo Cerqueira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto
| | - José Andrade
- Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal
| | - José Fernando-Teixeira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
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Pereira-Neves A, Rocha-Neves J, Fragão-Marques M, Duarte-Gamas L, Jácome F, Coelho A, Cerqueira A, Andrade JP, Mansilha A. Red blood cell distribution width is associated with hypoperfusion in carotid endarterectomy under regional anesthesia. Surgery 2021; 169:1536-1543. [PMID: 33610341 DOI: 10.1016/j.surg.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND A subset of patients submitted to carotid endarterectomy under regional anesthesia develop intraoperative neurologic deficit during carotid artery crossclamping related to critical cerebral perfusion, which may be owing to low flow or embolic phenomena. This subgroup is deemed prone to worse outcomes, which highlights its clinical relevance. The main aim of this study was to identify clinical and hematological predictors for intraoperative neurologic deficit. The secondary aim was to evaluate the perioperative prognostic value of postcarotid artery crossclamping manifestations of cerebral ischemia. METHODS Between January 2012 to January 2020, patients submitted to carotid endarterectomy under regional anesthesia in a tertiary referral center who presented intraoperative neurologic deficit were prospectively and consecutively included. This group constituted 8% of the total carotid endarterectomy performed in the center during this timeframe. The control group of patients was the subsequent patient submitted to carotid endarterectomy without intraoperative neurologic deficit in a 1:1 ratio. Blood samples were collected before surgery (<2 weeks). Propensity score matching was used to identify well-matched pairs of patients. RESULTS A total of 180 patients were included, with 90 (50% of the cohort and 8% of total carotid endarterectomies) presenting intraoperative neurologic deficit associated to clamping. Mean age was 71.4 ± 9.27 years in the study group and 68.8 ± 8.36 years in the control group. The clinical variables presenting significance after multivariate analysis include: age (adjusted odds ratio: 1.04, 5-95% confidence interval, [1.003-1.078]; P = .034), obesity (adjusted odds ratio: 3.537 [1.445-8.658]; P = .006), lower ipsilateral carotid stenosis grade (adjusted odds ratio: 0.725 [0.525-0.997]; P = .049), and higher contralateral carotid stenosis grade (adjusted odds ratio: 1.266 [1.057-1.516]; P = .010). Red cell distribution width coefficient of variation demonstrated statistical significance in predicting intraoperative neurologic deficit with an adjusted odds ratio of 1.394 (1.076-1.805); P = .012. The 30-day stroke rate was significantly higher in the intraoperative neurologic deficit group, with an adjusted odds ratio of 5.13 (5-95% confidence interval [1.058-24.87]; P = .042) after propensity score matching. Postoperative complications (Clavien-Dindo ≥2) were also associated with intraoperative neurologic deficit (after propensity score matching adjusted odds ratio of 2.748 [5-95% confidence interval, 0.976-7.741]; P = .051). CONCLUSION In this study, increased red cell distribution width coefficient of variation demonstrated value to predict intraoperative neurologic deficit. Additionally, age, obesity, a lower degree of ipsilateral carotid stenosis, and a higher degree of contralateral carotid stenosis also demonstrated ability to predict intraoperative neurologic deficit. Moreover, intraoperative neurologic deficit was an independent risk factor for 30-day stroke and postoperative complications Clavien-Dindo ≥2.
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Affiliation(s)
- António Pereira-Neves
- Department of Biomedicine-Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal.
| | - João Rocha-Neves
- Department of Biomedicine-Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Mariana Fragão-Marques
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular R & D Unit, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Filipa Jácome
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Andreia Coelho
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal
| | - Alfredo Cerqueira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José P Andrade
- Department of Biomedicine-Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Armando Mansilha
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
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Rocha-Neves J, Pereira-Macedo J, Ferreira A, Dias-Neto M, Andrade JP, Mansilha AA. Impact of intraoperative neurologic deficits in carotid endarterectomy under regional anesthesia. SCAND CARDIOVASC J 2021; 55:180-186. [PMID: 33487041 DOI: 10.1080/14017431.2021.1874509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Patients undergoing carotid endarterectomy (CEA) may experiment neurologic deficits during the carotid cross-clamping due to secondary cerebral hypoperfusion. An associated risk of postoperative stroke incidence is also well established. This work aimed to assess the postoperative adverse events related to neurologic deficits in the awake test after clamping and to determine its predictive factors. Methods. From January 2012 to January 2018, 79 patients from a referral hospital that underwent CEA with regional anesthesia for carotid stenosis and manifested neurologic deficits were gathered. Consecutively selected controls (n = 85) were submitted to the same procedure without developing neurological changes. Postoperative complications such as stroke, myocardial infarction, all-cause death, and Clavien-Dindo classification were assessed 30 days after the procedure. Univariate and binary logistic regressions were performed for data assessment. Results. Patients with clamping associated neurologic deficits were significantly more obese than the control group (aOR = 9.30; 95% CI: 2.57-33.69; p = .01). Lower degree of ipsilateral stenosis and higher degree of contralateral stenosis were independently related to clamping intolerance (aOR = 0.70; 95% CI: 0.49-0.99; p = .047 and aOR = 1.30; 95% CI: 1.06-1.50; p = .009, respectively). Neurologic deficits were a main 30-day stroke predictor (aOR = 4.30; 95% CI: 1.10-16.71; p = .035). Conclusions. Neurologic deficits during carotid clamping are a predictor of perioperative stroke. Body mass index > 30 kg/m2, a lower degree of ipsilateral stenosis, and a higher degree of contralateral stenosis are independent predictors of neurologic deficits and, therefore, might play a role in the prevention of procedure-related stroke.
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Affiliation(s)
- João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Biomedicine - Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Juliana Pereira-Macedo
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - André Ferreira
- Department of Biomedicine - Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Marina Dias-Neto
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Cardiovascular R&D Unit, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - José P Andrade
- Department of Biomedicine - Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Armando A Mansilha
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Cardiovascular R&D Unit, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Mendes-Andrade I, Dias-Neto M, Rocha-Neves J, Mansilha A. The Burden of Post-Thrombotic Syndrome in a Long-Term Retrospective Cohort in Northern Portugal. ACTA MEDICA PORT 2021; 34:35-43. [PMID: 33159722 DOI: 10.20344/amp.13567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/25/2020] [Accepted: 03/23/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Post-thrombotic syndrome is a frequent and disabling complication of deep venous thrombosis. Its incidence is not described in the Portuguese population. The objective of this study is to report the incidence and severity of post-thrombotic syndrome after the initial episode of deep venous thrombosis. MATERIAL AND METHODS This is an observational, unicentric, retrospective cohort of patients who had a first episode of deep venous thrombosis in the lower limb, documented with duplex ultrasound (n = 101). The modified Villalta score was applied by phone interview for the diagnosis and staging of post-thrombotic syndrome. The quality of life of patients was measured with the modified CIVIQ 14 classification. RESULTS Median follow-up time was six years (interquartile range 1). Severe post-thrombotic syndrome was present in 27% of patients and moderate in 33%. Performing physical activity at the time of the interview was associated with lower incidence of post-thrombotic syndrome (relative risk 0.489; 95% confidence interval = 0.320 - 0.748). Body weight gain after deep venous thrombosis (relative risk 2.188; 95% confidence interval 1.137 - 4.210) and lower education levels (relative risk 2.005; 95% confidence interval 1.297 - 3.098) were associated positively with post-thrombotic syndrome. Quality of life was 90 ± 17 vs 64 ± 18 vs 43 ± 15 in patients without postthrombotic syndrome, with moderate post-thrombotic syndrome and with severe post-thrombotic syndrome, respectively (p < 0.001). DISCUSSION The long-term incidence of post-thrombotic syndrome in a cohort of patients from Northern Portugal is higher than in other studies and correlates with worse adjusted CIVIQ-14 scores. CONCLUSION Large studies of prospective nature could provide more definitive evidence.
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Affiliation(s)
- Inês Mendes-Andrade
- Faculty of Medicine. University of Porto. Porto; Department of Physical Medicine and Rehabilitation. Centro de Medicina de Reabilitação de Alcoitão. Cascais. Portugal
| | - Marina Dias-Neto
- Faculdade de Medicina. Universidade do Porto. Porto. Cardiovascular Research & Development Unit. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery. São João Hospital. Porto. Unit of Anatomy. Department of Biomedicine. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Armando Mansilha
- Department of Surgery and Physiology. Faculdade de Medicina. Universidade do Porto. Porto. Cardiovascular Research & Development Unit. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
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Pereira-Neves A, Gouveia R, Dias-Neto M, Duarte-Gamas L, Rocha-Neves J, Teixeira J. Covered Endovascular Repair of Innominate Artery Bifurcation After Thoracic Blunt Trauma. Vasc Endovascular Surg 2020; 55:405-409. [PMID: 33252013 DOI: 10.1177/1538574420976478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Innominate artery (IA) injury is a rare entity with most patients dying before reaching the hospital. While open surgery remains the standard treatment, the endovascular approach is attractive as it may reduce perioperative morbidity and mortality. We report a case of IA blunt injury extending to the subclavian artery with pseudoaneurysm formation successfully treated with covered stenting of IA and its bifurcation. A 49-year-old male was admitted after suffering multiple trauma due to a high energy impact motorcycle crash. In the emergency room, the patient was hypotensive with a Glasgow coma score of 15. On physical examination, he had right peri-orbital ecchymosis, left otorrhagia and an open patella fracture. The computed tomographic angiography (CTA) revealed enlargement of the mediastinum and a 29 mm pseudoaneurysm involving the right brachiocephalic trunk and its bifurcation. Under general anesthesia, a covered balloon-expandable stent (CBES) was then placed in the IA followed by kissing stent of its bifurcation with an additional 2 covered balloon-expandable stents. Final subtraction angiography demonstrated complete pseudoaneurysm exclusion and stent patency without additional complications. No neurologic deficits or other intervention-related complications were found in the postoperative period. At 10 months follow-up, the patient remained asymptomatic and with palpable distal pulses. Endovascular management of IA injury may provide a good alternative to open surgery with low perioperative morbidity and mortality.
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Affiliation(s)
- António Pereira-Neves
- Department of Biomedicine-Unit of Anatomy, 26705Faculty of Medicine, University of Porto, Portugal.,Department of Surgery and Physiology, 26705Faculty of Medicine, University of Porto, Portugal.,Department of Angiology and Vascular Surgery, 26706Centro Hospitalar Universitário São João, EPE, Porto, Portugal
| | - Ricardo Gouveia
- Department of Surgery and Physiology, 26705Faculty of Medicine, University of Porto, Portugal.,Department of Angiology and Vascular Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Marina Dias-Neto
- Department of Surgery and Physiology, 26705Faculty of Medicine, University of Porto, Portugal.,Department of Angiology and Vascular Surgery, 26706Centro Hospitalar Universitário São João, EPE, Porto, Portugal.,Cardiovascular R&D Unit, 26705Faculdade de Medicina da Universidade Do Porto, Portugal
| | - Luís Duarte-Gamas
- Department of Surgery and Physiology, 26705Faculty of Medicine, University of Porto, Portugal.,Department of Angiology and Vascular Surgery, 26706Centro Hospitalar Universitário São João, EPE, Porto, Portugal
| | - João Rocha-Neves
- Department of Biomedicine-Unit of Anatomy, 26705Faculty of Medicine, University of Porto, Portugal.,Department of Surgery and Physiology, 26705Faculty of Medicine, University of Porto, Portugal.,Department of Angiology and Vascular Surgery, 26706Centro Hospitalar Universitário São João, EPE, Porto, Portugal
| | - José Teixeira
- Department of Angiology and Vascular Surgery, 26706Centro Hospitalar Universitário São João, EPE, Porto, Portugal
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Sousa J, Rocha-Neves J, Oliveira-Pinto J, Mansilha A. Myocardial injury after non-cardiac surgery (MINS) in EVAR patients: a retrospective single-centered study. J Cardiovasc Surg (Torino) 2020; 62:130-135. [PMID: 32885923 DOI: 10.23736/s0021-9509.20.11205-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Myocardial injury after non-cardiac surgery (MINS) stands for myocardial injury due to ischemia that occurs during or within 30-days after non-cardiac surgery. Although MINS is known to be independently associated with 30-day mortality after intervention, little is described about the impact of MINS after vascular procedures, particularly after endovascular aneurysm repair (EVAR). METHODS This is an observational, retrospective, single-centered study. All patients underwent elective standard EVAR between January 2008 and June 2017, and them with at least one postoperative measurement of troponin I in the first 48 h after surgery, were retrospectively included. MINS was defined as the value exceeding the 99th percentile of a normal reference population with a coefficient of variation <10%. Primary outcomes include the prevalence of MINS in this subset of EVAR patients, as well as its impact in mid-term all-cause mortality. As secondary aim, the preoperative predictors of MINS were also assessed. RESULTS One-hundred and thirty-six patients with postoperative troponin measurements were included (95.6% male; mean age 75.51years). MINS was diagnosed in 16.2% (N.=22) of the patients, and in 86.4% of the cases (N.=19) it was completely asymptomatic. Heart failure (31.8% vs. 10.5%, P=0.016), ASA Score ≥3 (95.5% vs. 67.5%, P=0.004), pre-operative (P=0.036) and postoperative (P=0.04) hemoglobin concentrations ≤12 g/dL were found to be significantly associated with MINS. Regarding remaining baseline characteristics, anesthesia and femoral access, no further differences were observed. Survival at 1, 3 and 5 years was 92% (95% CI: 4.6-6.9, standard error [SE] 0.023), 81% (95% CI: 5.6-7.6, SE=0.034) and 71% (95% CI: 6.9-8.7, SE=0.04), with two deaths reported at 30 days follow-up. MINS was found to be significantly associated with increased mid-term all-cause mortality after EVAR at 24 months follow-up (84.2±3.4% vs. 63.6±10.3%, P=0.001), with a 2.12-fold risk increase of death. CONCLUSIONS MINS is a common complication after EVAR and negatively impacts the mid-term prognosis of such interventions. In the majority of cases, it is asymptomatic and, therefore, not detectable unless routine postoperative troponin measurements are performed.
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Affiliation(s)
- Joel Sousa
- Department of Angiology and Vascular Surgery, CHU de S. João, Porto, Portugal - .,Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal -
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, CHU de S. João, Porto, Portugal.,Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Oliveira-Pinto
- Department of Angiology and Vascular Surgery, CHU de S. João, Porto, Portugal.,Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Armando Mansilha
- Department of Angiology and Vascular Surgery, CHU de S. João, Porto, Portugal.,Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
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Pereira-Macedo J, Machado N, Pereira-Neves A, Ferreira V, Oliveira-Pinto J, Dias-Neto M, Rocha-Neves J, Teixeira J, Andrade J. Myocardial injury after aortoiliac revascularization for extensive disease: A survival analysis. Turk Gogus Kalp Damar Cerrahisi Derg 2020; 28:426-434. [PMID: 32953204 PMCID: PMC7493606 DOI: 10.5606/tgkdc.dergisi.2020.20100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/23/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study aims to evaluate the incidence of myocardial injury after non-cardiac surgery for an extensive disease pattern (TASC II type D) and to examine its prognostic value. METHODS This prospective study included a total of 66 consecutive patients (62 males, 4 females; mean age 62.5±8.2 years) who underwent elective revascularization for aortoiliac TASC II type D lesions in the tertiary setting between January 2013 and March 2019. The patients were scheduled for revascularization either by open surgery or endovascular approach. Cardiac troponins were routinely measured in the postoperative period. Myocardial injury after non-cardiac surgery was defined as the elevation of cardiac troponin for at least one value above the 99th percentile upper reference limit. Myocardial infarction, acute heart failure, stroke, major adverse cardiovascular events, major adverse limb events, and all-cause mortality were assessed both postoperatively and during follow-up. RESULTS The incidence of myocardial injury after non-cardiac surgery was 25.8%. In the multivariate analysis, chronic heart failure was found to be a significant risk factor for myocardial injury after non-cardiac surgery (odds ratio: 10.3; 95% confidence interval 1.00-106.8, p=0.018). At 12 months after revascularization, the diagnosis of myocardial injury after non-cardiac surgery was significantly associated with myocardial infarction, stroke, major adverse cardiovascular events, major adverse limb events, and all-cause mortality. At 12 months after revascularization, the diagnosis of myocardial injury after non-cardiac surgery was significantly associated with myocardial infarction (log-rank p=0.002), stroke (log-rank p=0.007), major adverse cardiovascular events (log-rank p=0.000), major adverse limb events (log-rank p=0.007), and all-causemortality (log-rank p=0.000). CONCLUSION Our study results suggest that myocardial injury after non-cardiac surgery plays a role as a predictor of significant cardiovascular comorbidities and mortality after complex aortoiliac revascularization. The presence of chronic heart failure is also associated with a higher incidence of myocardial injury after aortoiliac TASC II type D revascularization. Therefore, preemptive strategies should be adopted to identify and treat these patients.
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Affiliation(s)
- Juliana Pereira-Macedo
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Neuza Machado
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - António Pereira-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Vítor Ferreira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - José Oliveira-Pinto
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marina Dias-Neto
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Teixeira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Andrade
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
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Pereira-Neves A, Rocha-Neves J, Duarte-Gamas L, Cerqueira A, Gouveia R. Complex Aortoiliac Pelvic And Visceral Revascularization. Rev Port Cir Cardiotorac Vasc 2020; 27:231-233. [PMID: 33068517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Indexed: 06/11/2023]
Abstract
Aortoiliac occlusive disease (AIOD) remains an area of debate concerning open and endovascular treatment options. A case of a 63-year old female is reported, with previous known vascular intermittent claudication, that presented in the emergency room with acute ischemia of the right lower limb with 24-hours of evolution. The computer tomographic angiography unveiled occlusion of the superior mesenteric artery, occlusion of left common iliac artery (CIA), subocclusive stenosis of right CIA, occlusion of distal runoffs vessels in the right lower limb and diffuse aorto-iliac disease. The first approach was to place the patient under catheter directed thrombolysis (48h) which led to right pedal pulse recovery but the occlusion of left CIA remained. The patient was then electively submitted to Covered Endovascular Repair of Aortic Bifurcation (CERAB) with chimney to inferior mesenteric artery and with an additional bailout left iliac sandwich due to dissection. Distal pulses are still present after 18 months of follow-up. Endovascular techniques provide a low morbimortality option with similar symptomatic improvement, challenging open surgery as the standard of care even in complex AIOD.
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Affiliation(s)
- António Pereira-Neves
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário São João, EPE, Porto, Portugal
| | - João Rocha-Neves
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário São João, EPE, Porto, Portugal
| | - Luís Duarte-Gamas
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário São João, EPE, Porto, Portugal
| | - Alfredo Cerqueira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário São João, EPE, Porto, Portugal
| | - Ricardo Gouveia
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Vila Nova de Gaia/ Espinho, Vila Nova de Gaia, Portugal
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Carreira M, Duarte-Gamas L, Rocha-Neves J, Andrade JP, Fernando-Teixeira J. Management of The Carotid Artery Stenosis in Asymptomatic Patients. Rev Port Cir Cardiotorac Vasc 2020; 27:159-166. [PMID: 33068504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND An asymptomatic carotid stenosis (CS) is defined as a stable atherosclerotic luminal narrowing in patients with no history of ipsilateral cerebral or ocular ischemic events in the past six months. The bifurcation of the common carotid artery makes this area vulnerable to atherosclerosis due to the features of haemodynamic flow. The exact prevalence of asymptomatic patients with CS remains unknown and opinions on the treatment of these patients are controversial. OBJECTIVE The authors aimed to review the evidence on the management of the asymptomatic CS and describe its clinical characteristics, diagnosis and treatment management. METHODS A comprehensive review of the literature was carried out to collate data from relevant studies concerning patients with extracranial moderate to severe asymptomatic carotid stenosis. The data used was identified by a search using PubMed and Google Scholar with the keywords / MESH terms "carotid stenosis", in combination with the term "asymptomatic". For this study, the authors focused on publications in the past two decades, using English publications. RESULTS A few studies have addressed the prevalence, natural course and/or prognostic impact of asymptomatic CS in patients under medical treatment or undergoing vascular surgery procedures. The prevalence of asymptomatic CS ranged from 0.3% to 4.5% in women and 0.5% to 5.7% in men - The risk of stroke/TIA in these patients was reported between 2% to 5% annually with a downward trend across time to 0.5% with current best medical therapy. CONCLUSION A great proportion of patients with asymptomatic CS should be submitted to conservative management with best medical therapy. However, selective surgical management should be considered if high risk features are present.
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Affiliation(s)
- Mariana Carreira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Biomedicine - Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal
| | - José Paulo Andrade
- Department of Biomedicine - Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal
| | - José Fernando-Teixeira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
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Pereira-Neves A, Rocha-Neves J, Dias-Neto M, Cerqueira A, Fernando-Teixeira J. The impact of COVID-19 pandemic in the management of a Vascular Surgery Department. Rev Port Cir Cardiotorac Vasc 2020; 27:73-74. [PMID: 32707609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Indexed: 06/11/2023]
Affiliation(s)
- António Pereira-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Oporto, Portugal; Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Oporto, Oporto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Oporto, Oporto, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Oporto, Portugal; Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Oporto, Oporto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Oporto, Oporto, Portugal
| | - Marina Dias-Neto
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Oporto, Portugal; Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Oporto, Oporto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Oporto, Oporto, Portugal
| | - Alfredo Cerqueira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Oporto, Portugal; Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Oporto, Oporto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Oporto, Oporto, Portugal
| | - José Fernando-Teixeira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Oporto, Portugal; Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Oporto, Oporto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Oporto, Oporto, Portugal
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Rocha-Neves J, Ferreira A, Pereira-Neves A, Ferreira-Castro J, Macedo J, Pinto A, Sousa J, Dias-Neto M, Teixeira J. The Peripheral Artery Questionnaire Validation Of The Portuguese Version. Rev Port Cir Cardiotorac Vasc 2020; 27:23-31. [PMID: 32239822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Indexed: 06/11/2023]
Abstract
Peripheral Arterial Disease (PAD) is a prevalent condition that predisposes the patients to major cardiovascular events. The majority of patients are asymptomatic, however PAD has a great impact in the patients' lifestyle due to its chronic nature. The Peripheral Arterial Questionnaire (PAQ) is a validated tool to quantify the patients' subjective experience of the disease. The aim of this work is to validate the Portuguese version of PAQ. A retrospective study of 59 patients with aortoiliac disease Trans-Atlantic Inter Society Consensus (TASC) type D from two centers in Portugal was conducted. Only 36 patients were able to answer the PAQ and two Portuguese validated questionnaires - a disease-specific (Walk Impairment Questionnaire - WIQ) and a generic one (EuroQol 5 dimensions - 5 level EQ5D-5L). Con- vergent validity of the PAQ was evaluated by correlating the extracted PAQ subscales and Summary score with the WIQ subscales and summary score, as with EQ5D-5L Summary score and EQ5D-5L index by calculating the covariance. The Portuguese version of the peripheral artery questionnaire presented a Cronbach's α for the Summary scale of 0.913. Mean inter-item correlation for the Physical Function domain was 0.471, 0.551 for the Perceived Disability, and 0.464 for Treat- ment Satisfaction. In summary, the Portuguese version of PAQ demonstrated a good level of discrimination between patients with or without symptomatic PAD and its severity and was sensitive to the presence of risk-factors relevant for PAD.
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Affiliation(s)
- João Rocha-Neves
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto; Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal; Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Portugal
| | - André Ferreira
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Portugal
| | - António Pereira-Neves
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto; Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal; Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Portugal
| | - João Ferreira-Castro
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto; Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal; Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Portugal
| | - Juliana Macedo
- Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal
| | - Ana Pinto
- Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal
| | - Joel Sousa
- Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal; Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Portugal
| | - Marina Dias-Neto
- Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal; Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Portugal
| | - José Teixeira
- Department of Angiology and Vascular Surgery, São João Hospital Center, Porto, Portugal
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Rocha-Neves J, Ferreira A, Sousa J, Pereira-Neves A, Vidoedo J, Alves H, Teixeira J, Azevedo A. Endovascular Approach Versus Aortobifemoral Bypass Grafting: Outcomes in Extensive Aortoiliac Occlusive Disease. Vasc Endovascular Surg 2019; 54:102-110. [DOI: 10.1177/1538574419888815] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: Compare technical, clinical, and economic outcomes between endovascular and open approaches in patients with type D aortoiliac occlusive disease according to the TransAtlantic Inter-Society Consensus. Methods: Patients undergoing revascularization for type D aortoiliac lesions, either endovascular or open surgery approach, from 2 Portuguese institutions between January 2011 and October 2017 were included. The surgical technique was left to the surgeon discretion. Patients with common femoral artery affection, both obstructive and aneurysmatic, were excluded. Results: Twenty-seven patients underwent aortobifemoral bypass and 32 patients were submitted to endovascular repair. The patients undergoing endovascular procedure were more likely to present with chronic heart failure ( P = .001) and chronic kidney disease ( P = .022) and less likely to have a history of smoking ( P = .05). The mean follow-up period was 67.84 (95% confidence interval = 61.85-73.83) months. The open surgery approach resulted in a higher technical success ( P = .001); however, limb salvage and patency rates were not different between groups. Endovascular approach was associated with a shorter length-of-stay, both inpatient (6 vs 9 days; P = .041) and patients admitted in the intensive care unit (0 vs 3.81 days; P = .001) as well as lower hospital expenses (US$9281 vs US$23 038; P = .001) with a similar procedure cost (US$2316 vs US$1173; P = .6). No differences were found in the postsurgical quality of life. Conclusion: Endovascular approach is, at least, clinically equivalent to open surgery approach and is more cost-efficient. The “endovascular-first” approach should be considered for type D occlusive aortoiliac lesions.
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Affiliation(s)
- João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Department of Biomedicine—Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - André Ferreira
- Department of Biomedicine—Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Joel Sousa
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - António Pereira-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Department of Biomedicine—Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - José Vidoedo
- Unit of Angiology and Vascular Surgery, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Hélio Alves
- Department of Biomedicine—Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - José Teixeira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - Ana Azevedo
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto (ISPUP), Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Centro de Epidemiologia Hospitalar, Centro Hospitalar de São João, EPE, Porto, Portugal
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Alves-Ferreira J, Rocha-Neves J, Dias-Neto M, Braga SF. Poor long-term outcomes after carotid endarterectomy: a retrospective analysis of two portuguese centers. SCAND CARDIOVASC J 2019; 53:266-273. [PMID: 31251084 DOI: 10.1080/14017431.2019.1638518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objetives. Carotid endarterectomy (CEA) is an established treatment for carotid stenosis (CS). However, this procedure is not risk-free and it is insufficient to control disseminated atherosclerosis. Our aim was to determine long-term cardiovascular morbidity and mortality after CEA and identify associated risk predictors. Design. Consecutive cohorts of CEAs performed between 2010 and 2018 in two Portuguese hospitals were retrospectively analysed. The major end-points were acute myocardial infarction (AMI), stroke, all-cause death and major adverse cardiovascular events (MACE). Results. 248 patients (mean age 69 years; 79% male) were enrolled in the study. 24% had postoperative complications. At 52 months median follow-up, 9 ± 2.0% (mean ± standard error) of patients experienced an acute myocardial infarction (AMI), 12 ± 2.4% a stroke and 26 ± 3.2% a MACE. All-cause mortality rate was 21 ± 3.0%. Multivariate analysis identified coronary artery disease (CAD) as significant predictor of AMI (p < .001; Hazard Ratio (HR):9.628; 95% Confidence Interval (95%CI):2.805-33.046), whereas no statistically significant risk factor of stroke was found. Predictors of death included left sided CS (p = .042; HR:1.886; 95%CI:1.024-3.475), chronic kidney disease (CKD) (p = .007; HR:2.352; 95%CI:1.266-4.372) and anticoagulant medication (p = .015; HR:2.107; 95%CI:1.216-6.026), while statin use was significantly protective (p = .049; HR:0.482; 95%CI:0.233-0.998). Concerning MACE, male gender (p = .040; HR:1.709; 95%CI:1.025-2.849), tobacco use (p = .004; HR:2.181; 95%CI:1.277-3.726), CAD (p = .002; HR:2.235; 95%CI:1.340-3.727) and CKD (p < .001; HR:3.029; 95%CI:1.745-5.258) were risk predictors. Conclusions. Patients continue to have high rates of AMI, MACE and death after CEA. Prior CAD is a risk factor for future AMI, whereas CKD is a significant predictor of MACE and death. Aggressive best medical treatment and risk factors modification should be advised in all patients with systemic atherosclerosis.
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Affiliation(s)
| | - João Rocha-Neves
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto , Porto , Portugal.,Department of Physiology and Surgery - Cardiovascular Research Unit, Faculty of Medicine, University of Porto , Porto , Portugal.,Department of Angiology and Vascular Surgery, São João Hospital Center , Porto , Portugal
| | - Marina Dias-Neto
- Department of Physiology and Surgery - Cardiovascular Research Unit, Faculty of Medicine, University of Porto , Porto , Portugal.,Department of Angiology and Vascular Surgery, São João Hospital Center , Porto , Portugal
| | - Sandrina F Braga
- Department of Angiology and Vascular Surgery, Senhora de Oliveira Hospital Center , Guimarães , Portugal
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Poleri I, Dias-Neto M, Rocha-Neves J, Sampaio S. Type B Aortic Dissection - A Single Center Series. Rev Port Cir Cardiotorac Vasc 2019; 26:131-137. [PMID: 31476814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Type B aortic dissection (TBAD) is associated with high morbidity and mortality. The DISSECT classification aims to reunite clinical and anatomical characteristics of interest to clinicians involved in its management. This paper aims to characterize a cohort of patients admitted for type B aortic dissection in a tertiary institution. METHODS This is a retrospective study that included all patients admitted to the hospital due to TBAD from 2006 to 2016. The computerized tomographic angiography that enabled the TBAD diagnosis were reevaluated using DISSECT classification. RESULTS Thirty-two patients were included in this case series. As to DISSECT classification, 79.3% were acute (Duration), 66% had a primary Intimal tear location in aortic arch, the maximum aortic diameter was 44±13mm (Size), 60% extended from aortic arch to abdomen or iliac arteries (Segmental Extent), 28% presented with Complications, and 28% had partial Thrombosis of false lumen. Six patients underwent intervention during the follow-up period. At 12 months, overall survival was 75.4%±8.3% and survival free of aorta-related mortality was 87.0±6.1%. Survival free of aortic dilatation was 82.6±9.5%. In univariate analysis, the presence of complications and chronic kidney disease associated with increased overall and aorta-related mortality rates. Hypertension was associated with aortic dilatation. CONCLUSIONS The outcomes after TBAD in a Portuguese center are reported. All interventions in TBAD were performed due to complications. The presence of complications and chronic kidney disease was associated with overall mortality and aorta-related mortality and hypertension with aortic dilatation. DISSECT classification was possible to apply in all patients.
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Affiliation(s)
| | - Marina Dias-Neto
- Faculty of Medicine, University of Porto, Portugal; Department of Angiology and Vascular Surgery, São João Hospital, Porto, Portugal
| | - João Rocha-Neves
- Faculty of Medicine, University of Porto, Portugal; Department of Angiology and Vascular Surgery, São João Hospital, Porto, Portugal; Department of Biomedicine - Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Sérgio Sampaio
- Faculty of Medicine, University of Porto, Portugal; Department of Angiology and Vascular Surgery, São João Hospital, Porto, Portugal
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Oliveira-Pinto J, Sousa J, Rocha-Neves J, Silva E, Riambau V, Teixeira J. Endovascular Solutions for Thoracic Aortic Aneurysms with Challenging Anatomies. Rev Port Cir Cardiotorac Vasc 2017; 24:113. [PMID: 29701346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The suitability of the proximal and distal landing zones remains one of the main limitations to thoracic endovascular aortic repair. The advent of custom-made scalloped stent grafts widened the endovascular options in some challenging anatomies. METHODS The authors present three cases of thoracic aortic aneurysm (TAA), with three different hostile anatomies, successfully treated with custom-made scalloped stent grafts. RESULTS Case1: Male patient, 47 years old, no relevant medical history. Angio-CT revealed a 54mm post- traumatic TAA, extending distally from the origin of the left subclavian artery. Inadequate sealing in Ishimaru zone 2 was evident. The patient was sequentially treated by means of a carotid-subclavian bypass followed by TEVAR with proximal scallop to the left common carotid artery. Proper proximal sealing was obtained. Case2: Male patient, 76 years old, diagnosed with a 65mm diameter TAA, involving the origin of the left subclavian artery. Presence of a bovine trunk, and inadequate landing zone distally to it, were noted. The patient was sequentially treated by means of a carotid-subclavian bypass followed by TEVAR with proximal scallop to the bovine trunk. Proper sealing in Ishimaru zone 2 was granted. Case3: Male patient, 77 years old, multiple comorbidities. Angio-CT revealed a 59,3mm saccular aneurysm of the distal thoracic descending aorta, extending proximally from the origin of the celiac trunk. Good collateralization was observed after celiac trunk occlusion test. Proper distal seal was obtained by means of selective embolization of the celiac trunk followed by TEVAR with distal scallop to the superior mesenteric artery. All procedures were uneventful, with no reported endoleaks, birdbeaks, migrations or re- interventions. There are no reported complications at 1-year follow-up. CONCLUSION Custom-made scalloped thoracic stentgrafts are an accessible, reproducible and safe therapeutic option when dealing with hostile descending thoracic anatomies, and should be considered as a minimally-invasive effective solution in selected cases.
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Affiliation(s)
| | | | | | | | - Vincent Riambau
- Department of Vascular Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
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Rocha-Neves J, Ferreria A, Sousa J, Dias-Neto M, Gamas L, Vilaça I, Teixeira J. Amniotic Membrane in the Treatment of Varicose Ulcers: a Center Experience. Rev Port Cir Cardiotorac Vasc 2017; 24:147. [PMID: 29701378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Amniotic membrane (AM) is an option as a cover in varicose leg ulcers, promoting epithelization. Anti-inflammatory and analgesic proprieties are described, as well as high levels of growth factors and angiogenesis. The costs are inferior to surgical plasty. The aim of this work is to describe the results of AM in the treatment of varicous leg ulcers in a group of patients refractory to the best medical treatment. METHODS A pilot prospective trial was conducted. Thirteen patients were selected for the treatment with AM from an outpatient clinic. The inclusion criteria included: ulcer area inferior to 100 cm2, ulcer size variation inferior to 30% in the last month, duration superior to 2 years and refractory to best medical treatment including compressive therapy. The exclusion criteria were ABI>0,8m active infection, bone exposure, severe myopathy of the low limb and acute decompensation of systemic chronic disease. The first five cases were applied on the enfermary (mean stay 3 days), the last 8 patients were applied in the outpatient clinic. After the treatment behavioral reinforcement was made. RESULTS The mean sample age was 56 YO (50-71), 70% were female, 30% were diabetic, and post-thrombotic syndrome was present in 54% (7), only one patient was an active smoker. After 2 years a recurrence was observed in 23% (3) cases. CONCLUSION AM is effective in the treatment of varicose ulcers unresponsive to best medical treatment.
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Affiliation(s)
- J Rocha-Neves
- Faculdade de medicina da universidade do Porto - Departamento de biomedicina - Unidade de Anatomia, Portugal
| | - André Ferreria
- Faculdade de medicina da universidade do Porto - Departamento de biomedicina - Unidade de Anatomia, Portugal
| | - Joel Sousa
- Centro Hospitalar São João, EPE - serviço de Angiologia e Cirurgia Vascular, Portugal
| | - Marina Dias-Neto
- Faculdade de medicina da universidade do Porto - Departamento de Cirurgia e Fisiologia, Portugal
| | - Luis Gamas
- Centro Hospitalar São João, EPE - serviço de Angiologia e Cirurgia Vascular, Portugal
| | - Isabel Vilaça
- Centro Hospitalar São João, EPE - serviço de Angiologia e Cirurgia Vascular, Portugal
| | - José Teixeira
- Centro Hospitalar São João, EPE - serviço de Angiologia e Cirurgia Vascular, Portugal
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Rocha-Neves J, Casal-Moura M, Oliveira-Pinto J, Braga S, Teixeira J, Mansilha A. IP121. Early Carotid Endarterectomy After Intravenous Thrombolysis: Systematic Review of Evidence. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.03.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rocha-Neves J, Casal-Moura M, Capoccia L, Oliveira-Pinto J, Mansilha A, Teixeira J. IP127. Urgent Carotid Endarterectomy in Symptomatic Carotid Stenosis: A Systematic Review and Meta-analysis. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.03.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vieira M, Ferreira A, Machado L, Almeida P, Rocha-Neves J, Ramos J, Sampaio S, Silva E, Paz Dias P, Teixeira J. [Early type I Endoleak after Endovascular Management of an Aorto-esophageal Fistula]. Rev Port Cir Cardiotorac Vasc 2015; 22:47-51. [PMID: 27912233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Presentation of a clinical case of an aorto-esophageal fistula secondary to thoracic aorta pseudoaneurysm, complicated by early type Ia endoleak after endovascular repair. CLINICAL CASE A 64 years old male patient, with a history of arterial hypertension, smoking, alcohol abuse and ischemic heart disease with previous coronary revascularization was observed because of chest pain and abundant hematemesis, with Angio-CT revealing a 77mm pseudoaneurysm of the descending thoracic aorta, close to the left subclavian artery, with mass effect on the esophagus and trachea and signs of fistulization. He was proposed to endovascular repair with sealing in zone 2 of the aortic arch after building a left carotid-subclavian bypass. In the first 24 hours there were two episodes of massive hematemesis, with new Angio-CT revealing a early distal migration of the prosthesis, conditioning a type Ia endoleak. A carotid-carotid right-left bypass with left carotid ligation was performed and a new endoprosthesis was implanted in the origin of the brachycephalic trunk (zone 1). The final angiography showed aneurysm exclusion with permeability of the supra-aortic trunks. Later contrasted esophageal examination and endoscopy revealed an ulcer of the posterior left lateral wall with clot suggestive of fistula, and an esophageal prosthesis was successfully implanted. It held seven days of antibiotic therapy with ceftriaxone and metronidazole with no evidence of mediastinal infection and with aneurysm exclusion in the CT follow-up. CONCLUSION The recognized biomechanical and anatomical complexity of the aneurysmatic thoracic aorta represents a considerable challenge to the endovascular treatment of aorto-esophageal fistulas, especially in aneurysmatic sealing of the aortic arch, with significant rates of type Ia and III endoleaks.
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Affiliation(s)
- Mário Vieira
- Serviço de Angiologia e Cirurgia Vascular do Centro Hospital de São João, Porto, Portugal
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Rocha-Neves J, Macedo C, Vieira M, Santos J, Silva E, Teixeira J. [Occlusion of Peripheral Bypass - Changing of an Institutional Paradigm]. Rev Port Cir Cardiotorac Vasc 2014; 21:179-181. [PMID: 27866403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Indexed: 06/06/2023]
Abstract
The vast majority of renovascular hypertension is treated nowadays resorting to endovascular procedures (angioplasty/stenting). We report a case of malignant hypertension derived from bilateral ostial renal artery occlusion with unfit anatomy for endovascular correction. The patient maintained assymptomatic with controlled arterial tension at the thirteenth yeah of follow-up, due to a splenorenal bypass. A review of the literature and this surgery indications is discussed.
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Affiliation(s)
- João Rocha-Neves
- Serviço de Angiologia e Cirurgia Vascular do Hospital de S. João, Serviço de Radiologia do Hospital Geral de Santo António, Unidade de Medicina Geral e Familiar (ULS) do Alto Minho e Departamento de Anatomia da Faculdade de Medicina da Universidade do Porto, Portugal
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Rocha-Neves J, Ramos J, Vieira M, Neto M, Albuquerque RR, Da Gama AD, Teixeira JF. [Joint recomendations for clinical priority in arterial surgery from Portuguese Society of Cardiothoracic and Vascular Surgery and Portuguese Society of Cardiology]. Rev Port Cir Cardiotorac Vasc 2014; 21:115-119. [PMID: 26182455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There is a gap in international guidelines for acceptable wait times for cardiovascular surgery. Most patients benefit from surgery as fast as possible after the establishment of an indication. However due to extrinsic factors a continuous and cost-effective response is not feasible to all of them. Priority criteria for surgery after the indication is heterogeneous. The physician/surgeon is responsible for the surgical prioritization upon experience-based criteria. The prioritization is accepted by the hospitals most of the times, but incorrections are verified in excess and defect. There is a press in need for evidence-based prioritization criteria in cardiac and vascular surgery that maintains an adequate waiting time with maximum benefit. Surgical waiting times superior to what is clinically reasonable affects not only the patient but also the health system by indirect costs (morbidity, absence from work). The objective is to establish recommendations in extra-carotid disease, abdominal aortic disease, peripheral artery disease and vascular access construction. A review from the data is made to define an appropriate balance between the surgical scheduling and the prevention of pre an perioperatory adverse events.
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