1
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Tavares IR, Caffaro RA, Portugal MF, Ribeiro CM, da Silva VS, Krupa E, Nikolovski S, de Britto KF, Gomes Pereira Petisco AC, Miranda MC, Gomes de Souza Santos S, da Silva Dourado M, Siqueira PV, Siddiqui F, Fareed J, Ramacciotti E. Biomarkers Profile in Provoked Versus Unprovoked Deep Venous Thrombosis. Clin Appl Thromb Hemost 2024; 30:10760296241238211. [PMID: 38566607 PMCID: PMC10989034 DOI: 10.1177/10760296241238211] [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: 01/14/2024] [Revised: 02/12/2024] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), represents a substantial healthcare challenge. Provoked and unprovoked DVT cases carry distinct risks and treatment considerations. Recognizing the limitations of this classification, molecular markers may enhance diagnostic precision and guide anticoagulation therapy duration relying on patient history and risk factors. This preliminary, open-label, prospective cohort study was conducted including 15 patients (10 provoked DVT and 5 unprovoked DVT) and a control group of healthy plasmatic subjects. Plasma levels of 9 biomarkers were measured at diagnosis (baseline, day 0, and D0) and after 30 days (day 30-D30). Patient demographics, clinical data, and biomarker concentrations were analyzed. Serum concentrations of D-dimer, von Willebrand factor, C-reactive protein, and Anti-Xa were elevated in DVT groups at D0 compared to controls. No significant differences were observed between the provoked and unprovoked groups on the day of diagnosis and 30 days later. Over 30 days, the provoked group exhibited significant biomarker changes related to temporal assessment. No significant differences were noted in the biomarker profile between provoked and unprovoked DVT groups. This study is indicative of the concept of individualized thrombosis assessment and subsequent treatment for VTE. Larger cohorts are warranted to validate these findings and further define the most appropriate use of the molecular markers.
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Affiliation(s)
- Isabela Rodrigues Tavares
- Department of Vascular Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
- Dante Pazzanese Cardiology Institute, São Paulo, SP, Brazil
| | - Roberto Augusto Caffaro
- Department of Vascular Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
| | | | | | | | - Emily Krupa
- Pathology Department, Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
| | - Srdjan Nikolovski
- Pathology Department, Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
| | - Karen Falcão de Britto
- Department of Vascular Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
| | | | | | | | | | | | - Fakiha Siddiqui
- Pathology Department, Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
- Program in Health Sciences. UCAM - Universidad Católica San Antonio de Murcia, Guadalupe, Murcia, Spain
| | - Jawed Fareed
- Pathology Department, Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
| | - Eduardo Ramacciotti
- Science Valley Research Institute, Santo André, São Paulo, Brazil
- Pathology Department, Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
- Department of Cardiovascular Medicine, Hospital e Maternidade Christóvão da Gama, Grupo DASA, Santo André, São Paulo, Brazil
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2
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Carvalho de Oliveira CC, Agati LB, Ribeiro CM, Resende Aguiar VC, Caffaro RA, da Silva Santos M, Alves Fernandes RR, Alberto da Silva Magliano C, Tafur A, Spyropoulos AC, Lopes RD, Fareed J, Ramacciotti E. Cost-effectiveness analysis of extended thromboprophylaxis with rivaroxaban versus no prophylaxis in high-risk patients after hospitalisation for COVID-19: an economic modelling study. Lancet Reg Health Am 2023; 24:100543. [PMID: 37366432 PMCID: PMC10288203 DOI: 10.1016/j.lana.2023.100543] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
Background In patients at high risk of thromboembolism who were discharged after hospitalisation due to COVID-19, thromboprophylaxis with rivaroxaban 10 mg/day for 35 days significantly improved clinical outcomes, reducing thrombotic events compared with no post-discharge anticoagulation. The present study aimed to estimate the cost-effectiveness of this anticoagulation strategy. Methods Using the database of the MICHELLE trial, we developed a decision tree to estimate the cost-effectiveness of thromboprophylaxis with rivaroxaban 10 mg/day for 35 days versus no thromboprophylaxis in high-risk post-discharge patients for COVID-19 through an incremental cost-effectiveness analysis. Findings 318 patients in 14 centres in Brazil were enrolled in the primary MICHELLE trial. The mean age was 57.1 years (SD 15.2), 127 (40%) were women, 191 (60%) were men, and the mean body-mass index was 29.7 kg/m2 (SD 5.6). Rivaroxaban 10 mg per day orally for 35 days after discharge decreased the risk of events defined by the primary efficacy outcome by 67% (relative risk 0.33, 95% CI 0.12-0.90; p = 0.03). The mean cost for thromboprophylaxis with rivaroxaban was $53.37/patient, and no prophylaxis was $34.22/patient, with an incremental cost difference of $19.15. The effectiveness means obtained in the intervention group was 0.1457, while in the control group was 0.1421, determining an incremental QALY difference of 0.0036. The estimated incremental cost-effectiveness ratio (ICER) was $5385.52/QALY. Interpretation Extended treatment with Rivaroxaban as thromboprophylaxis after hospital discharge for high-risk patients with COVID-19 is a cost-effective treatment option. Funding Modest funding was provided by Science Valley Research Institute, São Paulo, Brazil.
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Affiliation(s)
- Caroline Cândida Carvalho de Oliveira
- Science Valley Research Institute, Santo André, São Paulo, Brazil
- Hospital e Maternidade Christóvão da Gama, Grupo DASA, Santo André, São Paulo, Brazil
- Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | | | - Valéria Cristina Resende Aguiar
- Science Valley Research Institute, Santo André, São Paulo, Brazil
- Hospital e Maternidade Christóvão da Gama, Grupo DASA, Santo André, São Paulo, Brazil
| | | | | | | | | | - Alfonso Tafur
- Northshore University Health System, Evanston, IL, USA
| | - Alex C Spyropoulos
- Zucker School of Medicine at Hofstra/Northwell and the Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Renato Delascio Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jawed Fareed
- Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
| | - Eduardo Ramacciotti
- Science Valley Research Institute, Santo André, São Paulo, Brazil
- Hospital e Maternidade Christóvão da Gama, Grupo DASA, Santo André, São Paulo, Brazil
- Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
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3
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Longo de Oliveira ALM, de Oliveira Pereira RF, Agati LB, Ribeiro CM, Kawamura Suguiura GY, Cioni CH, Bermudez M, Pirani MB, Caffaro RA, Castelli V, Resende Aguiar VC, Volpiani GG, Paschoa A, Scarlatelli Macedo AV, de Barros e Silva PGM, de Campos Guerra JC, Fareed J, Lopes RD, Ramacciotti E. Rivaroxaban Versus Enoxaparin for Thromboprophylaxis After major Gynecological Cancer Surgery: The VALERIA Trial : Venous thromboembolism prophyl Axis after gyneco Logical p Elvic cancer surgery with RIvaroxaban versus enox Aparin (VALERIA trial). Clin Appl Thromb Hemost 2022; 28:10760296221132556. [PMID: 36474344 PMCID: PMC9732794 DOI: 10.1177/10760296221132556] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 12/13/2022] Open
Abstract
Direct oral anticoagulants (DOACs) for venous thromboembolism (VTE) prevention after major gynecological cancer surgery might be an alternative to parenteral low-molecular-weight heparin (LMWH). Patients undergoing major gynecological cancer surgery were randomized at hospital discharge to receive rivaroxaban 10 mg once daily or enoxaparin 40 mg once daily for 30 days. The primary efficacy outcome was a combination of symptomatic VTE and VTE-related death or asymptomatic VTE at day 30. The primary safety outcome was the incidence of major or clinically relevant nonmajor bleeding. Two hundred and twenty-eight patients were enrolled and randomly assigned to receive rivaroxaban (n = 114)or enoxaparin (n = 114). The trial was stopped due to a lower-than-expected event rate. The primary efficacy outcome occurred in 3.51% of patients assigned to rivaroxaban and in 4.39% of patients assigned to enoxaparin (relative risk 0.80, 95% CI 0.22 to 2.90; p = 0.7344). Patients assigned to rivaroxaban had no primary bleeding event, and 3 patients (2.63%) in the enoxaparin group had a major or CRNM bleeding event (hazard ratio, 0.14; 95% CI, 0.007 to 2.73; P = 0.1963). In patients undergoing major gynecological cancer surgery, thromboprophylaxis with rivaroxaban 10 mg daily for 30 days had similar rates of thrombotic and bleeding events compared to parenteral enoxaparin 40 mg daily. While the power is limited due to not reaching the intended sample size, our results support the hypothesis that DOACs might be an attractive alternative strategy to LMWH to prevent VTE in this high-risk population.
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Affiliation(s)
| | | | | | | | | | | | - Marilsa Bermudez
- São Paulo State Public Women's Health Reference Center, São Paulo,
Brazil
| | | | | | - Valter Castelli
- Santa Casa de São Paulo School of Medical Sciences, São Paulo,
Brazil
| | | | - Giuliano Giova Volpiani
- Santa Casa de São Paulo School of Medical Sciences, São Paulo,
Brazil,Hospital e Maternidade Christóvão da Gama, Grupo DASA, Santo André,
SP, Brazil
| | | | | | | | | | - Jawed Fareed
- Hemostasis & Thrombosis Research Laboratories at Loyola
University Medical Center, Maywood, IL, USA
| | - Renato Delascio Lopes
- Duke Clinical Research Institute, Duke University School of
Medicine, Durham, NC, USA
| | - Eduardo Ramacciotti
- Science
Valley Research Institute, Santo André, São
Paulo, Brazil,Hospital e Maternidade Christóvão da Gama, Grupo DASA, Santo André,
SP, Brazil,Hemostasis & Thrombosis Research Laboratories at Loyola
University Medical Center, Maywood, IL, USA,Eduardo Ramacciotti, Science Valley
Research Institute, Santo André, São Paulo, Brazil.
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Ramacciotti E, Agati LB, Volpiani GG, Brito KF, Ribeiro CM, Aguiar VCR, Ramacciotti LS, Paganotti A, Pereira FM, Caffaro RA, Fioranelli A, Krakauer R, Rached HRS, Wolosker N, Anand SS, Eikelboom JW, Lopes RD. Rivaroxaban with Aspirin Versus Aspirin for Peripheral Arterial Disease and Intermittent Claudication. Rationale and Design of the COMPASS CLAUDICATION Trial. Clin Appl Thromb Hemost 2022; 28:10760296211073922. [PMID: 35043716 PMCID: PMC8796110 DOI: 10.1177/10760296211073922] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The COMPASS trial demonstrated that in patients with peripheral arterial disease, the combination of rivaroxaban and aspirin compared with aspirin reduces the risk of major adverse limb events, but it is not known whether this combination can also improve symptoms in patients with intermittent claudication. The primary objective of this study is to evaluate the effect of the combination on claudication distance. STUDY DESIGN Eighty-eight patients with intermittent claudication will be randomized to receive rivaroxaban 2.5 mg twice daily plus aspirin 100 mg once daily or aspirin 100 mg once daily for 24 weeks. The primary outcome is the change in claudication distance from the baseline to 24 weeks, measured by 6 min walking test and treadmill test. The primary safety outcome is the incidence of major bleeding and clinically relevant non-major bleeding according to the International Society on Thrombosis and Hemostasis criteria. SUMMARY The COMPASS CLAUDICATION trial will provide high-quality evidence regarding the effect of the combination of rivaroxaban and aspirin on claudication distance in patients with peripheral arterial disease.
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Affiliation(s)
- Eduardo Ramacciotti
- 600818Science Valley Research Institute, Santo André, São Paulo, Brazil.,Hospital e Maternidade Dr. Christóvão da Gama, DASA, São Paulo, SP, Brazil.,25815Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
| | | | - Giuliano Giova Volpiani
- 600818Science Valley Research Institute, Santo André, São Paulo, Brazil.,Hospital e Maternidade Dr. Christóvão da Gama, DASA, São Paulo, SP, Brazil.,67742Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | - Karen Falcão Brito
- 67742Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | | | | | | | - Alexia Paganotti
- 67742Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | | | | | - Alexandre Fioranelli
- 67742Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | - Rogério Krakauer
- Hospital e Maternidade Dr. Christóvão da Gama, DASA, São Paulo, SP, Brazil
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5
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Silveira FT, Razuk Filho Á, Saad PF, Saad KR, Telles GJP, Ravizzini PIC, Caffaro RA, Castelli Júnior V. Stent fractures in the superficial femoral artery: predisposing factors and their implications. J Vasc Bras 2022; 21:e20200014. [PMID: 36187216 PMCID: PMC9499724 DOI: 10.1590/1677-5449.202000142] [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: 03/03/2020] [Accepted: 09/23/2020] [Indexed: 11/22/2022] Open
Abstract
Abstract Background Fractures in stents implanted in the superficial femoral artery (SFA) are recognized complications of endovascular management of this arterial territory. Objectives The objective of this study was to determine the prevalence of fractures in stents implanted in the SFA and to identify predisposing factors for these fractures together with their impact on the patency of these devices. Methods The study included 39 patients (65.7±9.0 years) who previously underwent angioplasty for delivery of 56 stents into the SFA. During follow-up, which ranged from 7 to 46 months, variables were collected on the characteristics of the lesions treated and characteristics of the stents implanted. Two examiners independently analyzed digital radiographs for the presence of stent fractures and the patency of the devices. Results We found a 10.7% prevalence of fracture of implanted stents. Implantation of multiple stents was identified as a significant predisposing factor for fractures. We observed a marked tendency for fractures in female patients and in lesions treated with longer stents (> 150 mm). Stenosis exceeding 50% and occlusions were significantly more frequent in fractured stents. Conclusions This study suggests that implants longer than 150 mm and multiple stents are associated with higher device fracture rates. In cases with stent fractures, stenoses exceeding 50% and occlusions were significantly more frequent.
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Affiliation(s)
| | | | - Paulo Fernandes Saad
- Universidade Federal de São Paulo, Brasil; Universidade Federal do Vale do São Francisco, Brasil
| | - Karen Ruggeri Saad
- Universidade Federal de São Paulo, Brasil; Universidade Federal do Vale do São Francisco, Brasil
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6
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Mendes CDA, Wolosker N, Fioranelli A, Mello RAFD, Portugal MFC, Silva MFAD, Caffaro RA, Pinheiro LL, Teivelis MP. Anxiety and depression scores in patients subjected to aortic and iliac aneurysm repair procedures. Rev Assoc Med Bras (1992) 2021; 67:747-752. [PMID: 34550267 DOI: 10.1590/1806-9282.20210187] [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] [Received: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study examines the changes in anxiety and depression scores of 84 patients subjected to aortic or iliac aneurysm correction with no previous psychiatric history. METHODS Patients were referred to the evaluation using the Beck Anxiety and Depression Inventories no more than 3 days before surgery (i.e., preoperative [Pre-Op]), 30 days after revascularization (i.e., Early postoperative [PO]), and at least 6 months after revascularization (i.e., Late PO). RESULTS Mean anxiety scores declined from baseline at both the Early (mean difference: 2.75, p<0.001) and Late PO (mean difference: 2.74, p=0.001). The depression levels showed no significant variation in either evaluation (Early PO; mean difference: -0.84, p>0.05, Late PO: 0.87, p=0.05). A more severe degree of anxiety at baseline was related to better anxiety results both in the Early PO (p=0.041) and Late PO (p=0.008). An endovascular technique was related to the improvement in depression symptoms in the Early PO (p=0.01) but the worsening of the symptoms in the Late PO (p=0.033). CONCLUSIONS Patients subjected to aortoiliac aneurysm corrections have a higher incidence of anxiety and depressive symptoms. Anxiety symptoms, but not the depressive ones, improved considerably following the successful treatment. The formal psychiatric evaluation may be beneficial for patients with less improvement in the symptom.
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Affiliation(s)
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein - São Paulo (SP), Brazil.,Faculdade de Medicina da Universidade de São Paulo - São Paulo (SP), Brazil.,Faculdade Israelita de Ciências da Saúde Albert Einstein - São Paulo (SP), Brazil
| | - Alexandre Fioranelli
- Hospital Israelita Albert Einstein - São Paulo (SP), Brazil.,Faculdade de Ciências Médicas da Santa Casa de São Paulo - São Paulo (SP), Brazil
| | | | | | | | | | | | - Marcelo Passos Teivelis
- Hospital Israelita Albert Einstein - São Paulo (SP), Brazil.,Faculdade Israelita de Ciências da Saúde Albert Einstein - São Paulo (SP), Brazil
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Dos Santos VP, Pozzan G, Castelli V, Caffaro RA. Arteriosclerosis, atherosclerosis, arteriolosclerosis, and Monckeberg medial calcific sclerosis: what is the difference? J Vasc Bras 2021; 20:e20200211. [PMID: 34290756 PMCID: PMC8276643 DOI: 10.1590/1677-5449.200211] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/06/2020] [Accepted: 04/06/2021] [Indexed: 01/25/2023] Open
Abstract
Cardiovascular diseases are the main cause of death in contemporary times. Arteriosclerosis, atherosclerosis, arteriolosclerosis, and Monckeberg's arteriosclerosis are terms that are often used interchangeably, but they refer to different vascular pathologies. The objective of this study is to review the concepts of atherosclerosis, atherosclerosis, arteriosclerosis and Monckeberg medial calcific sclerosis (MMCS). The term arteriosclerosis is more generic, meaning the stiffening and consequent loss of elasticity of the arterial wall, and encompasses the other terms. Atherosclerosis is an inflammatory disease secondary to lesions in the intimal layer and whose main complication is acute and chronic obstruction of the arterial lumen. Arteriolosclerosis refers to thickening of arterioles, particularly in association with systemic arterial hypertension. MMCS refers to non-obstructive calcification in the internal elastic lamina or the tunica media of muscular arteries. Vascular calcifications, which include atherosclerotic lesions and MMCS, have been studied as a risk factor for cardiovascular morbidity and mortality.
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Affiliation(s)
| | - Geanete Pozzan
- Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, São Paulo, SP, Brasil
| | - Valter Castelli
- Faculdade de Ciências Médicas da Santa Casa de São Paulo - FCMSCSP, São Paulo, SP, Brasil
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8
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Qneibi D, Ramacciotti E, Macedo AS, Caffaro RA, Agati LB, Siddiqui F, Kouta A, Hoppensteadt D, Fareed J, Carter CA. Comparative Studies on the Anticoagulant Profile of Branded Enoxaparin and a New Biosimilar Version. Clin Appl Thromb Hemost 2021; 26:1076029620960820. [PMID: 32996340 PMCID: PMC7533927 DOI: 10.1177/1076029620960820] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Low molecular weight heparins (LMWH) represent depolymerized heparin prepared by various methods that exhibit differential, biochemical and pharmacological profiles. Enoxaparin is prepared by benzylation followed by alkaline depolymerization of porcine heparin. Upon the expiration of its patent, several biosimilar versions of enoxaparin have become available. Heparinox (Sodic enoxaparine; Cristália Produtos Químicos Farmacêuticos LTDA, Sao Paulo, Brazil) is a new biosimilar form of enoxaparin. We assessed the molecular weight and the biochemical profile of Heparinox and compared its properties to the original branded enoxaparin (Lovenox; Sanofi, Paris, France). Clotting profiles compared included activated clotting time, activated partial thromboplastin time (aPTT), and thrombin time (TT). Anti-protease assays included anti-factor Xa and anti-factor IIa activities. Thrombin generation was measured using a calibrated automated thrombogram and thrombokinetic profile included peak thrombin, lag time and area under the curve. USP potency was determined using commercially available assay kits. Molecular weight profiling was determined using high performance liquid chromatography. We determined that Heparinox and Lovenox were comparable in their molecular weight profile. Th anticoagulant profile of the branded and biosimilar version were also similar in the clot based aPTT and TT. Similarly, the anti-Xa and anti-IIa activities were comparable in the products. No differences were noted in the thrombin generation inhibitory profile of the branded and biosimilar versions of enoxaparin. Our studies suggest that Heparinox is bioequivalent to the original branded enoxaparin based upon in vitro tests however will require further in vivo studies in animal models and humans to determine their clinical bioequivalence.
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Affiliation(s)
- Dalia Qneibi
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Eduardo Ramacciotti
- Department of Pathology and Laboratory Medicines, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | | | | | | | - Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Ahmed Kouta
- Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA.,Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA.,Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Charles A Carter
- Department of Clinical Research, College of Pharmacy & Health Sciences, 2078Campbell University, Buies Creek, NC, USA
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9
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Park JH, Filho AR, Pires APM, Telles GJP, Esteves FP, Caffaro RA, Parrillo EF. Can we replace computed tomography angiography by contrast-enhanced ultrasound in the surveillance of patients submitted to aortoiliac aneurysm repair? Vascular 2021; 30:803-808. [PMID: 34144651 DOI: 10.1177/17085381211027440] [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: 11/17/2022]
Abstract
OBJECTIVES This study was designed for evaluation of CEUS (contrast-enhanced ultrasound) for the detection of endoleaks after EVAR (endovascular aortic aneurysms repair) as an alternative to CTA (computed tomography angiography), the gold standard in post-EVAR surveillance. METHODS Post-EVAR surveillance of patients who underwent CEUS and CTA was retrospectively analyzed to compare the accuracy of CEUS compared to CTA. For that, the following parameters were analyzed: the largest aneurysm diameter, type of endoleaks, and the time elapsed after EVAR using both surveillance tests. RESULTS The study involved 110 pairs of exams in patients with infrarenal aortoiliac or isolated iliac artery aneurysm, covering predominantly a male population (89%). The time elapsed after EVAR using CEUS or CTA exams were statistically similar, ranging from one to 58 months (mean 12.2) and one to 65 months (mean 9.7), respectively (p = 0.124). CEUS sensitivity was 75.5%, specificity 96.7%, false positives were 24.5%, and false negatives were 3.3%. The accuracy between the two exams was 87.3%. A secondary analysis, comparing CTA with CEUS as a reference standard, revealed CEUS sensitivity of 24.5%, higher than CTA for detecting endoleaks, with a concordance rate of true positive results of 75.5%. Among the endoleaks detected solely by CEUS (12 cases), one case was type Ia and eleven were type II, while those detected only by CTA (2 cases), one was type Ia and one type II. Additionally, a type II endoleak associated with type Ib, identified by CEUS, was seen as type II for CTA only. There was no difference between the pre-EVAR and the post-EVAR diameters of aortoiliac aneurysm (p = 0.058), both for CEUS and CTA. Computed tomography angiography, on the other hand, showed significant aneurysm diameter reduction compared to CEUS for isolated iliac artery aneurysms (p < 0.001). CONCLUSION Contrast-enhanced ultrasound was more effective than CTA in identifying and characterizing endoleaks in patients undergoing EVAR, especially type II endoleaks. The advantages include efficacy and, particularly, safety, and must be considered in EVAR surveillance protocols so that its use becomes widespread. We understand that CEUS, as a surveillance exam, considerably reduces risks to patients compared to CTA.
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Affiliation(s)
- Jong Hun Park
- Department of Vascular and Endovascular Surgery, 37870Santa Casa de Sao Paulo Medical School, 485046Prevent Senior Health Operator, Bela Vista, São Paulo, Brazil
| | - Alvaro Razuk Filho
- Department of Vascular and Endovascular Surgery, 37870Santa Casa de Sao Paulo Medical School, 485046Prevent Senior Health Operator, Bela Vista, São Paulo, Brazil
| | - Ana Paula M Pires
- Department of Vascular and Endovascular Surgery, 37870Santa Casa de Sao Paulo Medical School, 485046Prevent Senior Health Operator, Bela Vista, São Paulo, Brazil
| | - Gustavo José P Telles
- Department of Vascular and Endovascular Surgery, 37870Santa Casa de Sao Paulo Medical School, 485046Prevent Senior Health Operator, Bela Vista, São Paulo, Brazil
| | - Fernando P Esteves
- Department of Vascular and Endovascular Surgery, 37870Santa Casa de Sao Paulo Medical School, 485046Prevent Senior Health Operator, Bela Vista, São Paulo, Brazil
| | - Roberto Augusto Caffaro
- Department of Vascular and Endovascular Surgery, 37870Santa Casa de Sao Paulo Medical School, 485046Prevent Senior Health Operator, Bela Vista, São Paulo, Brazil
| | - Eduardo F Parrillo
- Department of Vascular and Endovascular Surgery, 37870Santa Casa de Sao Paulo Medical School, 485046Prevent Senior Health Operator, Bela Vista, São Paulo, Brazil
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Biagioni RB, Lopes RD, Agati LB, Sacilotto R, Wolosker N, Sobreira ML, de Freitas Soares BL, Joviliano EE, Bernardi WH, Junior VC, Caffaro RA, Fioranelli A, Van Bellen B, Casella IB, Fidelis RJR, Flumignan RLG, Comerota AJ, Ramacciotti E. Rationale and design for the study Apixaban versus ClopidoGRel on a background of aspirin in patient undergoing InfraPoPliteal angioplasty for critical limb ischemia: AGRIPPA trial. Am Heart J 2020; 227:100-106. [PMID: 32730905 DOI: 10.1016/j.ahj.2020.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/10/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND New antithrombotic strategies that reduce primary thrombosis and restenosis might improve vascular outcomes in patients with peripheral artery disease (PAD) undergoing arterial angioplasty. The study objective is to evaluate the potential benefit of apixaban plus aspirin compared with standard of care dual antiplatelet therapy (DAPT) in reducing thrombotic restenosis and artery re-occlusion in patients undergoing endovascular infrapopliteal revascularization. STUDY DESIGN This multicenter, parallel-group, prospective, randomized, open-label, blinded-endpoint adjudication, proof-of-concept, exploratory trial aims to randomize 200 patients 72 hours after successful infrapopliteal angioplasty for critical limb ischemia (CLI). Patients will be randomly assigned in a 1:1 ratio to receive oral apixaban (2.5 mg twice daily) plus aspirin (100 mg once daily) for 12 months or clopidogrel (75 mg daily) for at least 3 months on a background of aspirin (100 mg once daily) for 12 months. The primary endpoint is the composite of target lesion revascularization (TLR), major amputation, or restenosis/occlusion (RAS) in addition to major adverse cardiovascular events - MACE (myocardial infarction, stroke or cardiovascular death) at 12 months. The primary safety endpoint is the composite of major bleeding or clinically relevant non-major bleeding at 12 months. SUMMARY This study will evaluate the efficacy and safety of apixaban 2.5 mg twice daily plus aspirin compared with DAPT (clopidogrel plus aspirin) in patients with CLI undergoing endovascular infrapopliteal revascularization and might prove the concept of an alternative antithrombotic regimen for these patients to be tested in a future large randomized clinical trial.
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Affiliation(s)
| | - Renato Delascio Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Nelson Wolosker
- Albert Einstein Hospital, São Paulo, Brazil; Hospital das Clínicas de São Paulo, São Paulo University, São Paulo, Brazil
| | | | | | - Edwaldo Edner Joviliano
- Hospital das Clínicas de Ribeirão Preto, São Paulo University Medical School (USP), Ribeirão Preto, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | - Eduardo Ramacciotti
- Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA; Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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11
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Ramacciotti E, Macedo AS, Biagioni RB, Caffaro RA, Lopes RD, Guerra JC, Orsi FA, Marques MA, Tafur AJ, Caprini JA, Nicolaides A, Carter CA, Filho CC, Fareed J. Evidence-Based Practical Guidance for the Antithrombotic Management in Patients With Coronavirus Disease (COVID-19) in 2020. Clin Appl Thromb Hemost 2020; 26:1076029620936350. [PMID: 32649232 PMCID: PMC7357049 DOI: 10.1177/1076029620936350] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This practical guidance, endorsed by the Brazilian Society of Thrombosis and Hemostasis and The Brazilian Society of Angiology and Vascular Surgery, the International Union of Angiology and the European Venous Forum, aims to provide physicians with clear guidance, based on current best evidence-based data, on clinical strategies to manage antithrombotic strategies in patients with coronavirus disease 2019.
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Affiliation(s)
- Eduardo Ramacciotti
- Hospital Christóvão da Gama, Grupo Leforte, Santo André, São Paulo, Brazil.,Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil.,Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
| | | | | | | | - Renato Delascio Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - João Carlos Guerra
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Centro de Hematologia de São Paulo, São Paulo, Brazil
| | | | - Marcos Areas Marques
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre and University of Nicosia Medical School, Nicosia, Cyprus
| | - Charles A Carter
- Department of Clinical Research, College of Pharmacy & Health Sciences, Campbell University, NC, USA
| | - Cyrillo Carvalheiro Filho
- Hospital Sirio-Libanês, São Paulo, Brazil.,Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Jawed Fareed
- Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
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12
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Ramacciotti E, Agati LB, Caffaro RA, Volpiani GG, Lopes RD, Comerota AJ, Fareed J. Direct Oral Anticoagulants and Cancer-Associated Thrombosis Management. Where Do We Stand in 2019? Clin Appl Thromb Hemost 2019; 25:1076029619856433. [PMID: 31234637 PMCID: PMC6714910 DOI: 10.1177/1076029619856433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 12/21/2022] Open
Abstract
Direct oral anticoagulants (DOACs) are now widely used for the management of venous thromboembolism (VTE) that now includes cancer-associated thrombosis. This review summarizes recent data on VTE prophylaxis and treatment, new challenges, guidelines, and updates as well as the current place for DOACs on the emerging cancer-associated VTE management landscape.
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Affiliation(s)
- Eduardo Ramacciotti
- 1 Hospital e Maternidade Dr. Christovão da Gama, Santo André, São Paulo, Brazil.,2 Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil.,3 Loyola University Medical Center, IL, USA
| | - Leandro B Agati
- 1 Hospital e Maternidade Dr. Christovão da Gama, Santo André, São Paulo, Brazil
| | | | - Giuliano G Volpiani
- 1 Hospital e Maternidade Dr. Christovão da Gama, Santo André, São Paulo, Brazil.,2 Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil
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13
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14
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Ramacciotti E, Ferreira U, Costa AJV, Raymundo SRO, Correa JA, Neto SG, Osvaldt AB, Agati L, Aguiar VCR, Davila R, Caltabiano TB, Magella FM, Volpiani GG, Castelli V, Caffaro RA, DalAcqua LZ, Matheus WE, Sato DY, Russeff GJDS, de Souza DG, Pazetto LE, de Lima TAM, Colnago EMDS, Fugii EY, Mussalem JS, Assao VT, Toffoletto O, Rodrigues DG, Afiune JB, Araujo GR. Efficacy and Safety of a Biosimilar Versus Branded Enoxaparin in the Prevention of Venous Thromboembolism Following Major Abdominal Surgery: A Randomized, Prospective, Single-Blinded, Multicenter Clinical Trial. Clin Appl Thromb Hemost 2018; 24:1208-1215. [PMID: 30021463 PMCID: PMC6714771 DOI: 10.1177/1076029618786583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Indexed: 11/16/2022] Open
Abstract
Several biosimilar versions of enoxaparin are already approved and in use globally. Analytical characterization can establish good quality control in manufacturing, but they may not assure similarity in clinical outcomes between biosimilar and branded enoxaparin. This study evaluated the efficacy and safety of biosimilar Cristália versus branded Sanofi enoxaparin in venous thromboembolism (VTE) prevention in patients undergoing major abdominal surgery at risk for VTE. In this randomized, prospective single-blind study, we compared Cristália enoxaparin (Ce), a biosimilar version, versus branded Sanofi enoxaparin (Se; at a dose of 40 mg subcutaneously per day postoperatively from 7 to 10 days) in 243 patients submitted to major abdominal surgery at risk for VTE for VTE prevention. The primary efficacy outcome was occurrence of VTE or death related to VTE. The principal safety outcomes were a combination of major bleeding and clinically relevant non-major bleeding. Bilateral duplex scanning of the legs was performed from days 10 to 14, and follow-ups were performed up to 60 days after surgery. The incidence of VTE was 4.9% in the Cristália group and 1.1% in the Sanofi group (absolute risk difference = 3.80%, 95% confidence interval [CI]: −1.4%-9.0%) yielding noninferiority since the 95% CI does not reach the prespecified value Δ = 20%. Clinically significant bleeding occurred in 9.9% in the Cristália group and in 5.5% in the Sanofi group (n.s. ). In conclusion, this study suggests that 40 mg once daily of Ce, a biosimilar enoxaparin, is as effective and safe as the branded Sanofi enoxaparin in the prophylaxis of VTE in patients submitted to major abdominal surgery at risk for VTE.
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Affiliation(s)
- Eduardo Ramacciotti
- 1 Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil.,2 Loyola University Medical Center, Maywood, IL, USA
| | - Ubirajara Ferreira
- 3 Oncological Urology Group-FCM-UNICAMP-Universidade Estadual de Campinas, São Paulo, Brazil
| | - Agenor José Vasconcelos Costa
- 4 Vascular Surgery Department, Hospital Estadual Mário Covas, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | | | - João Antônio Correa
- 6 Vascular Surgery, Hospital de Ensino da Faculdade de Medicina do ABC, São Paulo, Brazil
| | - Salvador Gullo Neto
- 7 Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Leandro Agati
- 1 Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil
| | | | - Ronaldo Davila
- 1 Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil.,9 Vascular Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Flávia Magalhães Magella
- 1 Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil
| | - Giuliano Giova Volpiani
- 1 Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil.,9 Vascular Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Valter Castelli
- 9 Vascular Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Lucas Zeponi DalAcqua
- 3 Oncological Urology Group-FCM-UNICAMP-Universidade Estadual de Campinas, São Paulo, Brazil
| | - Wagner Eduardo Matheus
- 3 Oncological Urology Group-FCM-UNICAMP-Universidade Estadual de Campinas, São Paulo, Brazil
| | - Debora Yuri Sato
- 5 Fundação Faculdade Regional de Medicina de São José do Rio Preto, São Paulo, Brazil
| | | | | | - Lucas Eduardo Pazetto
- 5 Fundação Faculdade Regional de Medicina de São José do Rio Preto, São Paulo, Brazil
| | | | | | - Eliane Yumii Fugii
- 6 Vascular Surgery, Hospital de Ensino da Faculdade de Medicina do ABC, São Paulo, Brazil
| | | | | | - Odaly Toffoletto
- 10 Cristália Produtos Químicos Farmacêuticos LTDA, São Paulo, Brazil
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Vitturi BK, Frias A, Sementilli R, Racy MDCJ, Caffaro RA, Pozzan G. Mycotic aneurysm with aortoduodenal fistula. Autops Case Rep 2017; 7:27-34. [PMID: 28740836 PMCID: PMC5507566 DOI: 10.4322/acr.2017.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 03/17/2017] [Accepted: 05/08/2017] [Indexed: 01/16/2023] Open
Abstract
Firstly described in the 19th century by Sir William Osler, the mycotic aneurysm (MA) is a rare entity characterized by an abnormal arterial dilation, which is potentially fatal, and is associated with the infection of the vascular wall. Elderly patients are mostly involved, especially when risk factors like chronic diseases, immunosuppression, neoplasia, and arterial manipulation are associated. The authors report the case of a young male patient diagnosed with an aortic aneurysm of infectious origin in the presence of repeated negative blood cultures. The diagnostic hypothesis was raised when the patient was hospitalized for an inguinal hernia surgery. The diagnosis was confirmed based on imaging findings consistent with mycotic aneurism. The patient was treated with an endovascular prosthesis associated with a long-lasting antibiotic therapy. Five months later, the patient attended the emergency unit presenting an upper digestive hemorrhage and shock, from which he died. The autopsy revealed a huge aneurysm of the abdominal aorta with an aortoduodenal fistula. The histological examination of the arterial wall revealed a marked inflammatory process, extensive destruction of the arterial wall, and the presence of Gram-positive bacteria. This case highlights the atypical presentation of a MA associated with an aortoduodenal fistula. Besides the early age of the patient, no primary arterial disease could be found, and no source of infection was detected.
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Affiliation(s)
| | - Amanda Frias
- Santa Casa de São Paulo, Faculdade de Ciências Médicas. São Paulo, SP, Brazil
| | - Raphael Sementilli
- Santa Casa de São Paulo, Faculdade de Ciências Médicas, Department of Pathology. São Paulo, SP, Brazil
| | | | - Roberto Augusto Caffaro
- Santa Casa de São Paulo, Faculdade de Ciências Médicas, Department of Vascular Surgery. São Paulo, SP, Brazil
| | - Geanete Pozzan
- Santa Casa de São Paulo, Faculdade de Ciências Médicas, Cardiovascular Pathology - Pathological Sciences. São Paulo, SP, Brazil
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16
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de Almeida Mendes C, de Arruda Martins A, Fukuda JM, Parente JBHF, Munia MAS, Fioranelli A, Teivelis MP, Varella AYM, Caffaro RA, Kuzniec S, Wolosker N. Randomized trial of radiofrequency ablation versus conventional surgery for superficial venous insufficiency: if you don't tell, they won't know. Clinics (Sao Paulo) 2016; 71:650-656. [PMID: 27982166 PMCID: PMC5108164 DOI: 10.6061/clinics/2016(11)06] [Citation(s) in RCA: 16] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/26/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES: This study compared radiofrequency ablation versus conventional surgery in patients who had not undergone previous treatment for bilateral great saphenous vein insufficiency, with each patient serving as his own control. METHOD: This was a randomized controlled trial that included 18 patients and was carried out between November 2013 and May 2015. Each of the lower limbs of each patient was randomly assigned to undergo either radiofrequency ablation or conventional surgery. Clinical features (hyperpigmentation, hematoma, aesthetics, pain, skin burn, nerve injury, and thrombophlebitis) were evaluated at one week, one month, and six months postoperatively. Hemodynamic assessments (presence of resection or occlusion of the great saphenous vein and recurrent reflux in the sapheno-femoral junction and in the great saphenous vein) were performed at one month, six months, and 12 months postoperatively. The independent observer (a physician not involved in the original operation), patient, and duplex ultrasonographer were not made aware of the treatment done in each case. Clinicaltrials.gov: NCT02588911. RESULTS: Among the clinical variables analyzed, only the aesthetic evaluation by the physicians was significant, with radiofrequency ablation being considered better than conventional surgery (average, 0.91 points higher: standard deviation: 0.31; 95% confidence interval: -1.51, -0.30; p=0.003). However, in our study, we observed primary success rates of 80% for radiofrequency ablation and 100% for conventional surgery. CONCLUSIONS: If the physician is not required to inform the patient as to the technique being performed, the patient will not be able to identify the technique based on the signs and symptoms. Our study revealed that both techniques led to high levels of patient satisfaction, but our results favor the choice of conventional surgery over radiofrequency ablation, as patients who underwent conventional surgery had better hemodynamic assessments.
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Affiliation(s)
- Cynthia de Almeida Mendes
- Hospital Israelita Albert Einstein, Division of Vascular and Endovascular Surgery, São Paulo/SP, Brazil
- Hospital Municipal Dr. Moysés Deutsch – M’Boi Mirim, São Paulo/SP, Brazil
| | - Alexandre de Arruda Martins
- Hospital Israelita Albert Einstein, Division of Vascular and Endovascular Surgery, São Paulo/SP, Brazil
- Hospital Municipal Dr. Moysés Deutsch – M’Boi Mirim, São Paulo/SP, Brazil
| | - Juliana Maria Fukuda
- Hospital Israelita Albert Einstein, Division of Vascular and Endovascular Surgery, São Paulo/SP, Brazil
- E-mail:
| | | | | | - Alexandre Fioranelli
- Hospital Israelita Albert Einstein, Division of Vascular and Endovascular Surgery, São Paulo/SP, Brazil
- Irmandade da Santa Casa de Misericórdia de São Paulo, Division of Vascular and Endovascular Surgery, São Paulo/SP, Brazil
| | - Marcelo Passos Teivelis
- Hospital Israelita Albert Einstein, Division of Vascular and Endovascular Surgery, São Paulo/SP, Brazil
| | | | - Roberto Augusto Caffaro
- Irmandade da Santa Casa de Misericórdia de São Paulo, Division of Vascular and Endovascular Surgery, São Paulo/SP, Brazil
| | - Sergio Kuzniec
- Hospital Israelita Albert Einstein, Division of Vascular and Endovascular Surgery, São Paulo/SP, Brazil
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein, Division of Vascular and Endovascular Surgery, São Paulo/SP, Brazil
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Telles GJP, Razuk Filho Á, Karakhanian WK, Saad PF, Saad KR, Park JH, Siqueira LCD, Caffaro RA. Dilatation of Common Iliac Arteries after Endovascular Infrarenal Abdominal Aortic Repair with Bell-Bottom Extension. Braz J Cardiovasc Surg 2016; 31:145-50. [PMID: 27556314 PMCID: PMC5062725 DOI: 10.5935/1678-9741.20160032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/21/2015] [Accepted: 03/28/2016] [Indexed: 11/20/2022] Open
Abstract
Objective Endovascular techniques to treat abdominal aortic aneurysms results in lower
morbidity and mortality rates. However, dilation of the common iliac
arteries prevents adequate distal sealing, which compromises the procedure
success. The aim of this study is report the long-term outcomes of patients
with abdominal aortic aneurysms associated with aneurysm of the common iliac
artery following endovascular repair using a bifurcated bell-bottom stent
graft. Methods This is a retrospective study that evaluated patients treated with bifurcated
bell-bottom extension stent grafts to repair an infrarenal abdominal aortic
aneurysm and who had at least one common iliac artery with dilatation >
1.5 cm for at least 12 months after the endovascular intervention. Results Thirty-eight patients with a mean age of 70.4±8.2 years were
included. Stent graft placement was followed by dilation of the common iliac
artery aneurysms in 35.3% of cases; endoleak and reoperation rates were
17.6% and 15.7%, respectively. Younger patients showed a higher rate of
artery diameter increase following the procedure. The average arterial
dilation was 16% in the first year, 29% in the second year, 57% in the third
year and 95% from the fourth year until the end of follow-up. Conclusion Repair of infrarenal abdominal aortic aneurysms with bifurcated bell-bottom
type stents when there is common iliac artery dilation is a good therapeutic
option to preserve hypogastric flow. The rate of endoleak was 17.6%, and
15.7% of cases required reoperation. Younger patients are more likely to
experience dilation of the common iliac artery after the procedure.
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Affiliation(s)
| | - Álvaro Razuk Filho
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Jong Hun Park
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil
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Gabriel SA, Antonangelo L, Capelozzi VL, Beteli CB, Camargo Júnior OD, Aquino JLBD, Caffaro RA. Hidrocortisona reduz as concentrações séricas dos biomarcadores inflamatórios séricos em pacientes submetidos a endarterectomia de carótida. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.0022] [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: 11/22/2022] Open
Abstract
ResumoContextoA hidrocortisona pode reduzir a concentração dos biomarcadores inflamatórios séricos e teciduais.ObjetivoAnalisar a atividade inflamatória da proteína C-reativa ultrassensível (PCR-US), do fator de necrose tumoral (FNT)-alfa e do fator de crescimento do endotélio vascular (FCEV) séricos e teciduais, mediante administração intraoperatória de hidrocortisona, após endarterectomia de artéria carótida (EAC).MétodoVinte e dois pacientes foram divididos em Grupo Controle (5 assintomáticos e 6 sintomáticos) – não foi administrada hidrocortisona – e Grupo 1 (4 assintomáticos e 7 sintomáticos) – foram administrados 500 mg intravenoso de hidrocortisona. O PCR-US, o FNT-alfa e o FCEV séricos foram dosados no pré-operatório e em 1 hora, 6 horas e 24 horas após a EAC. Na placa carotídea, mensuramos os níveis de FNT-alfa e FCEV.ResultadosO grupo 1 exibiu menor concentração sérica de FNT-alfa em 1 hora (p=0,031), 6 horas (p=0,015) e 24 horas (p=0,017) após a EAC, e menor concentração de FCEV em 1 hora (p=0,006) e 6 horas (p=0,005) após a EAC, em relação ao grupo controle. Os pacientes sintomáticos do grupo 1 exibiram menor concentração de FNT-alfa em 1 hora e 6 horas após a EAC, e menor concentração de FCEV em 1 hora após a EAC, em relação ao grupo controle. Não houve diferença estatística entre as concentrações teciduais de FNT-alfa e FCEV entre o grupo controle e o grupo 1.ConclusãoA hidrocortisona reduz as concentrações séricas pós-operatórias de FNT-alfa e FCEV, em especial nos sintomáticos; porém, não reduz os níveis teciduais destes biomarcadores.
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Gabriel SA, Antonangelo L, Capelozzi VL, Beteli CB, Camargo Júnior OD, Aquino JLBD, Caffaro RA. Hydrocortisone supresses inflammatory activity of metalloproteinase-8 in carotid plaque. Braz J Cardiovasc Surg 2015; 30:295-303. [PMID: 26313719 PMCID: PMC4541775 DOI: 10.5935/1678-9741.20150034] [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: 02/19/2014] [Accepted: 05/12/2015] [Indexed: 11/28/2022] Open
Abstract
Objective Matrix metalloproteinases are inflammatory biomarkers involved in carotid plaque
instability. Our objective was to analyze the inflammatory activity of plasma and
carotid plaque MMP-8 and MMP-9 after intravenous administration of
hydrocortisone. Methods The study included 22 patients with stenosis ≥ 70% in the carotid artery
(11 symptomatic and 11 asymptomatic) who underwent carotid endarterectomy. The
patients were divided into two groups: Control Group - hydrocortisone was not
administered, and Group 1 - 500 mg intravenous hydrocortisone was administered
during anesthetic induction. Plasma levels of MMP-8 and MMP-9 were measured
preoperatively (24 hours before carotid endarterectomy) and at 1 hour, 6 hours and
24 hours after carotid endarterectomy. In carotid plaque, tissue levels of MMP-8
and MMP-9 were measured. Results Group 1 showed increased serum levels of MMP- 8 (994.28 pg/ml and 408.54 pg/ml,
respectively; P=0.045) and MMP-9 (106,656.34 and 42,807.69
respectively; P=0.014) at 1 hour after carotid endarterectomy
compared to the control group. Symptomatic patients in Group 1 exhibited lower
tissue concentration of MMP-8 in comparison to the control group (143.89 pg/ml and
1317.36 respectively; P=0.003). There was a correlation between preoperative MMP-9
levels and tissue concentrations of MMP-8 (P=0.042) and MMP-9
(P=0.019) between symptomatic patients in the control
group. Conclusion Hydrocortisone reduces the concentration of MMP- 8 in carotid plaque, especially
in symptomatic patients. There was an association between systemic and tissue
inflammation.
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Affiliation(s)
| | - Leila Antonangelo
- Departamento de Citologia do Laboratório Central, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Vera Luiza Capelozzi
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
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Belczak CEQ, Godoy JMP, Seidel AC, Ramos RN, Belczak SQ, Caffaro RA. Influence of prevalent occupational position during working day on occupational lower limb edema. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.0079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: The lower limb edema observed in normal people at the end of their working days can vary in intensity and frequency depending on the predominant working positions required to perform different jobs.OBJECTIVES: To compare lower limb volumes of volunteers allocated to three study groups, depending on the predominant positions in which they work.METHODS: Volumetric assessments were conducted of both lower limbs of 51 people free from vascular disease, allocated to three groups of 17 individuals each by predominant working position: sitting, static standing or alternating between the two. Volumes were measured at the start and at the end of the working day and the differences in volumes were calculated for each group. Means and frequencies were compared using appropriate inferential statistics and correlation coefficients were calculated.RESULTS: The groups were homogenous in terms of sex distribution, age, skin color and BMI. The volumetric data from measurements taken before starting work revealed significant differences between all three groups. Volunteers who predominantly worked sitting down had largest volumes, followed by those who remained standing for long periods and then those who varied between these positions. The frequency of lower limb volume increase > 100 mL was significantly higher in the group of people who worked sitting down and maintained this position for long periods.CONCLUSIONS: Postural edema is more common among people who work sitting down for long periods, among whom it appears that there is a cumulative effect from the position, since they exhibit larger lower limb volumes at the start of the day.
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Abstract
Aneurysms of the subclavian-axillary segment are rare, but when diagnosed they must be treated. This article describes two cases of aneurysms of the upper extremities, one in a subclavian artery and the other in an axillary artery. The first case was a 71-year-old male with a pulsating supraclavicular bulge on the right and muscle weakness in the ipsilateral extremity. Duplex scanning and arteriography confirmed the diagnosis of aneurysm of the right subclavian artery and the patient underwent aneurysmectomy and end-to-end anastomosis. The second case was a 24-year-old female patient, with no history of comorbidities, who presented with a pulsating mass in the right axillary region and paresthesia of the ipsilateral extremity. Duplex scanning and arteriography confirmed an aneurysm in the right axillary artery, which was successfully treated with aneurysmectomy and end-to-end anastomosis. Pathology findings showed that the first case was an atherosclerotic aneurysm and the second was a congenital aneurysm.
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Santos VPD, Razuk Filho A, Castelli Junior V, Caffaro RA. Lower gastrointestinal bleeding as a result of fistula between the iliac artery and sigmoid colon in patient with advanced testicular cancer. Int Braz J Urol 2013; 39:747-50; discussion 751. [DOI: 10.1590/s1677-5538.ibju.2013.05.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 05/25/2013] [Indexed: 11/22/2022] Open
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Saad PF, Razuk A, Telles GJP, Park JH, Esteves FP, Caffaro RA. Trashepatic left gastric vein embolization in the treatment of recurrent hemorrhaging in patients with schistosomiasis previously submitted to non-derivative surgery. Arq Gastroenterol 2013; 49:238-44. [PMID: 23329216 DOI: 10.1590/s0004-28032012000400002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 09/11/2012] [Indexed: 12/20/2022]
Abstract
CONTEXT Non-derivative surgical techniques are the treatment of choice for the control of upper digestive tract hemorrhages after schistosomotic portal hypertension. However, recurrent hemorrhaging due to gastroesophagic varices is frequent. OBJECTIVE To evaluate the outcome of treatment based on embolization of the left gastric vein to control the reoccurrence of hemorrhages caused by gastroesophagic varices in patients with schistosomiasis previously submitted to non-derivative surgery. METHODS Rates of reoccurrence of hemorrhages and the qualitative and quantitative reduction of gastroesophagic varices in patients undergoing transhepatic embolization of the left gastric vein between December 1999 and January 2009 were studied based on medical charts and follow-up reports. RESULTS Seven patients with a mean age of 39.3 years underwent percutaneous transhepatic embolization of the left gastric vein. The mean time between azigoportal disconnections employed in combination with splenectomy and the percutaneous approach was 8.4 ± 7.3 years, and the number of episodes of digestive hemorrhaging ranged from 1 to 7 years. No episodes of reoccurrence of hemorrhaging were found during a follow-up period which ranged from 6 months to 7 years. Endoscopic postembolization studies revealed reductions in gastroesophagic varices in all patients compared to preembolization endoscopy. CONCLUSIONS Percutaneous transhepatic embolization of the left gastric vein in patients with schistosomiasis previously submitted to surgery resulted in a decrease in gastroesophagic varices and was shown to be effective in controlling hemorrhage reoccurrence.
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Abstract
OBJECTIVE The aim of this study was to investigate a possible relationship between obesity and decreased mobility of the talocrural joint and in turn chronic venous disease. SUBJECTS AND METHODS One hundred obese patients recruited at Hospital Santa Casa de Maringa, Parana were enrolled by order of arrival at the hospital in a randomized quantitative cross-sectional study. Inclusion criteria were patients with a body mass index above 30 kg/m(2) and the exclusion criteria were infectious conditions that would interfere with the assessment. Patients were graded according to the clinical, etiological, anatomical and pathophysiological classification. Talocrural goniometry was performed to assess the degree of mobility of the legs. The Kolmogorov-Smirnov normality test, Kruskal-Wallis test, Dunn's Multiple comparison test and analysis of variance were used for statistical analysis tests with an alpha error of 5% being considered acceptable. RESULTS The increase in body mass index is correlated to the reduction in joint mobility (Kruskal-Wallis test: p-value <0.0001) and increase in clinical, etiological, anatomical and pathophysiological classification is correlated to a decrease in joint mobility and the increase in age is associated with an increase in clinical, etiological, anatomical and pathophysiological classification (Kruskal-Wallis test: p-value <0.0001). CONCLUSION Obesity is associated with deterioration in joint mobility and worsening of chronic venous disease.
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Affiliation(s)
| | - José Maria Pereira de Godoy
- Department of Cardiology and Cardiovascular Surgery, Medicine School of São José do Rio Preto-FAMERP and CNPq (National Council for Research and Development), Brazil
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Carvalho ATYD, Santos ADJ, Gomes CAP, Martins ML, Santos VPD, Rubeiz RP, Queiroz MO, Caffaro RA. Aneurisma da aorta abdominal infrarrenal: importância do rastreamento em hospitais do Sistema Único de Saúde na região metropolitana de Salvador - Bahia. J Vasc Bras 2012. [DOI: 10.1590/s1677-54492012000400007] [Citation(s) in RCA: 3] [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] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O aneurisma da aorta abdominal infrarrenal (AAA) representa doença vascular que merece constante atenção, tanto para os estudos de rastreamento como de aperfeiçoamento terapêutico. Sua importância clínica se baseia na alta taxa de mortalidade que ocorre com a sua ruptura, em contraste com a baixa taxa de mortalidade descrita com a correção cirúrgica eletiva em serviços especializados. Na região metropolitana de Salvador, não se encontram dados relativos à identificação desses indivíduos. Esse fato encorajou nosso estudo. OBJETIVOS: (1) determinar a prevalência do AAA infrarrenal nos pacientes com fatores de risco; (2) identificar esses fatores de risco; e (3) a população que deve ser rotineiramente rastreada. MÉTODOS: Em estudo de rastreamento do AAA realizado pelos Serviços de Cirurgia Vascular do Hospital Geral Roberto Santos (HGRS) e do Hospital Geral de Camaçari (HGC) de setembro de 2008 a outubro de 2009, foram selecionados 1350 indivíduos com 50 anos ou mais que apresentavam fatores de risco para o aneurisma da aorta. A triagem incluiu o preenchimento de protocolo e a realização de ultrassom doppler colorido. RESULTADOS: A prevalência do AAA infrarrenal nesta amostra foi 3,9%. Os fatores de risco mais frequentemente associados foram: média de idade de 72 anos, gênero masculino, tabagismo, antecedente de AAA e portadores de doença arterial oclusiva periférica, insuficiência coronariana e doença pulmonar obstrutiva crônica. O rastreamento do AAA deve ser considerado em homens com idade superior a 65 anos, principalmente quando presente um desses fatores de risco.
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Ema Quilici Belczak C, Pereira De Godoy JM, Quilici Belzack S, Andréia De Moraes Silva M, Caffaro RA. Compression stockings have a synergistic effect with walking in the late afternoon to reduce edema of the lower limbs. INT ANGIOL 2012; 31:490-493. [PMID: 22990513] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The aim of this study was to evaluate whether an association of elastic stockings and walking for a short period in the late afternoon reduces leg edema. METHODS Volume changes of the legs of sixteen patients (32 limbs), who walked on a treadmill for 30 minutes using elastic compression stockings, were analyzed in a quantitative, cross-over randomized (in order of arrival at the clinic) study. They were submitted to volumetry using the water displacement technique and subsequently required to put on 20/30 made-to-measure compression stockings (Sigvaris). The patients walked on a treadmill for 30 minutes and after removing the stockings volumetry of the legs was again performed. Legs were assessed using the CEAP classification and divided into groups. Analysis of variance was used for statistical analysis with an alpha error of 5% being considered acceptable. RESULTS When participants walked wearing compression stockings, there was a reduction in leg volume. When the CEAP classification was evaluated, it was noted that there was a statistically significant difference for the CEAP C0, C1 and C2 categories of legs using stockings compared to those that did not use. CONCLUSION Compression stockings have a synergistic effect with walking in the late afternoon thus reducing edema of the lower limbs.
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Affiliation(s)
- C Ema Quilici Belczak
- School of São Jose do Rio Preto-FAMERP-Brazil, São José do Rio Preto, São Paulo, Brazil
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Park JH, Razuk A, Saad PF, Telles GJP, Karakhanian WK, Fioranelli A, Rodrigues AC, Volpiani GG, Campos P, Yamada RM, Castelli V, Caffaro RA. Carotid stenosis: what is the high-risk population? Clinics (Sao Paulo) 2012; 67:865-70. [PMID: 22948451 PMCID: PMC3416889 DOI: 10.6061/clinics/2012(08)02] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 03/23/2012] [Accepted: 04/01/2012] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Prevention is the best treatment for cerebrovascular disease, which is why early diagnosis and the immediate treatment of carotid stenosis contribute significantly to reducing the incidence of stroke. Given its silent nature, 80% of stroke cases occur in asymptomatic individuals, emphasizing the importance of screening individuals with carotid stenosis and identifying high-risk groups for the disease. The aim of this study was to determine the prevalence and the most frequent risk factors for carotid stenosis. METHODS A transversal study was conducted in the form of a stroke prevention campaign held on three nonconsecutive Saturdays. During the sessions, carotid stenosis diagnostic procedures were performed for 500 individuals aged 60 years or older who had systemic arterial hypertension and/or diabetes mellitus and/or coronary heart disease and/or a family history of stroke. RESULTS The prevalence of carotid stenosis in the population studied was 7.4%, and the most frequent risk factors identified were mean age of 70 years, carotid bruit, peripheral obstructive arterial disease, coronary insufficiency and smoking. Independent predictive factors of carotid stenosis include the presence of carotid bruit or peripheral obstructive arterial disease [corrected] and/or coronary insufficiency. CONCLUSIONS The population with peripheral obstructive arterial disease [corrected] and/or coronary insufficiency and carotid bruit should undergo routine screening for carotid stenosis.
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Affiliation(s)
- Jong Hun Park
- Federal University of São Francisco Valley (UNIVASF), Petrolina, PE, Brazil
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Belczak CEQ, Godoy JMPD, Cruz Junior AF, Caffaro RA. Lymphoscintigraphic changes after harvesting of the saphenous vein for coronary artery bypass graft. Braz J Cardiovasc Surg 2012; 26:488-9. [PMID: 22086590 DOI: 10.5935/1678-9741.20110028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 08/01/2011] [Indexed: 11/20/2022] Open
Abstract
Bridged incisions do not eliminate lesions to the lymphatic vessels and so the identification of risk factors associated to lymphatic lesions is important.
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Affiliation(s)
- Cleusa Ema Quilici Belczak
- Course Post Graduation Lato-Sensu of Lymphovenous Rehabilitation, Medicine School of São José do Rio Preto, São José do Rio Preto, SP, Brazil
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Fioranelli A, Razuk Filho Á, Castelli Júnior V, Pereira de Godoy JM, Karakhanian WK, Caffaro RA. Predictive risk of mortality in the endovascular approach of Stanford type B complicated aortic dissection. INT ANGIOL 2012; 31:304. [PMID: 22634988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Carvalho ATYD, Silva GSA, Pereira MCSB, Santos ADJ, Majdalane VC, Santos VPD, Rubeiz RP, Caffaro RA. Tratamento endovascular da coarctação da aorta: relato de caso. J Vasc Bras 2012. [DOI: 10.1590/s1677-54492012000100010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A coarctação da aorta é uma malformação cardiovascular congênita de elevada prevalência. É caracterizada por um estreitamento da aorta torácica, geralmente logo abaixo da artéria subclávia esquerda. É mais frequente no sexo masculino na razão de 2 a 3:1. O quadro clínico habitualmente é composto por hipertensão arterial em membros superiores e diminuição de pulsos em membros inferiores. Tradicionalmente, o tratamento proposto é cirúrgico, mas a técnica endovascular vem sendo descrita com bons resultados. Relatamos um caso de um paciente do sexo masculino, 24 anos, quadro clínico de claudicação dos membros inferiores e hipertensão arterial sistêmica difícil de controlar há sete anos, com diagnóstico de coarctação da aorta sem outras malformações associadas. O tratamento endovascular foi realizado através de angioplastia da coarctação e implante de endoprótese vascular.
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Carvalho ATYD, Pereira MCSB, Santos ADJ, Galon GDF, Ferreira Filho AU, Cambuí VD, Rubeiz RP, Caffaro RA. Impacto dos marcadores socioeconômicos na gravidade do linfedema das extremidades inferiores. J Vasc Bras 2011. [DOI: 10.1590/s1677-54492011000400007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
No Brasil, a incidência do linfedema é pouco conhecida e poucas são as documentações científicas reportando a associação do linfedema com os fatores sociais e econômicos na nossa região. O objetivo do estudo foi analisar o impacto dos marcadores socioeconômicos na gravidade do linfedema das extremidades inferiores conforme a classificação de Mowlem, na região metropolitana de Salvador (BA). Dos 324 pacientes estudados, 200 (62%) eram do gênero feminino. A idade variou entre 14 e 69 anos, com mediana de 48 anos. Analisando comparativamente as variáveis: gravidade do linfedema versus grau de escolaridade e gravidade versus renda familiar, observou-se que 93,8% dos pacientes classificados como Mowlem III estavam incluídos no grupo dos pacientes sem escolaridade e/ou com renda familiar de até três salários-mínimos. Não houve registro de doença avançada em pacientes com renda familiar acima de sete salários-mínimos e/ou com terceiro grau completo.
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Siqueira GLG, Hueb W, Contreira R, Nogueron MA, Cancio DM, Caffaro RA. Infecção de corrente sanguínea relacionada a cateter venoso central (ICSRC) em enfermarias: estudo prospectivo comparativo entre veia subclávia e veia jugular interna. J Vasc Bras 2011. [DOI: 10.1590/s1677-54492011000300005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXTO: Hemocultura positiva associada a cateter venoso central tem sido estudada em unidades de terapia intensiva (UTI), mas ainda é controverso se o acesso jugular tem maior incidência de complicações infecciosas que o acesso na veia subclávia. OBJETIVO: Comparar índice de infecção entre os acessos na jugular interna e os na veia subclávia em pacientes internados nas enfermarias de cirurgia. MÉTODOS: Estudo prospectivo, descritivo e comparativo com 114 cateteres em 96 pacientes admitidos nas enfermarias de cirurgia de um Hospital Quaternário, tendo como variáveis o local de inserção, número de lumens, tempo de uso, comparando-os com o índice de complicações infecciosas. RESULTADOS: O índice de infecção foi de 9,64% (11 cateteres), sem significância estatística quando comparados o número de lumens (mono versus duplo) e infecção (p=0,274); também sem significância estatística a comparação entre o tempo de uso (>14 dias) e infecção (p=0,156). Comparando os acessos jugular e subclávia, encontramos significância estatística tendo infecção em 17,2% na subclávia e 1,8% na jugular, com p=0,005. Índice de Hemocultura positivo associado a cateter venoso central foi maior no acesso subclávia quando comparado com jugular interna, com OR 11,2, IC95% (1,4-90,9; p=0,023). CONCLUSÕES: O acesso venoso central na jugular interna tem menor risco de infecção se comparado com subclávia em enfermarias.
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Fioranelli A, Razuk Filho Á, Castelli Júnior V, Karakhanian W, Godoy JMPD, Caffaro RA. Mortality within the endovascular treatment in Stanford type B aortic dissections. Braz J Cardiovasc Surg 2011; 26:250-7. [DOI: 10.1590/s0102-76382011000200016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 05/01/2011] [Indexed: 11/22/2022] Open
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Belczak CEQ, de Godoy JMP, Cruz AF, Tyszca AL, Neto HJG, Caffaro RA. Lymphoscintigraphic findings: delayed oedema after great saphenous vein harvesting. Phlebology 2011; 26:185-90. [DOI: 10.1258/phleb.2010.010071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective The aim of this study was to identify lymphoscintigraphic changes associated with lower-extremity oedema after the harvesting of the saphenous vein using a series of short Q2 incisions for coronary bypass. Method Forty-four patients (32 males and 12 females) with a mean age of 62.7 ± 7.8 (47–75 years old) were evaluated in a retrospective, quantitative, cross-sectional study from June 2007 to January 2008, three to 188 months (mean: 46 months) after the surgical procedure. Assessment was by water displacement volumetry and lymphoscintigraphy of the lower limbs. Results expressed as means with standard deviations were compared employing the Student's t-test and the chi-square or Fisher's exact tests were used to compare data expressed as frequencies. An alpha error of 5% was considered acceptable ( P ≤ 0.05). Results The presence of dermal backflow, as identified by lymphoscintigraphy with an accumulation of radiotracer in the thoracic duct and popliteal lymph nodes was significantly greater on the operated side. Conclusion There was a significant association between dermal backflow and delayed oedema.
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Affiliation(s)
- C E Q Belczak
- Lymphovenous Rehabilitation of the Medicine, School, São Jose do Rio Preto (FAMERP), Brazil
| | - J M P de Godoy
- Department Cardiology and Cardiovascular Surgery of the Medicine, School, São José do Rio Preto (FAMERP) and CNPq (National Council for Research and Development), Brazil
| | - A F Cruz
- Diagnosis Nucleus of Maringá, Brazil
| | | | - H J G Neto
- Medical Sciences School of Santa Casa de São Paulo (FCMSCSP), Brazil
| | - R A Caffaro
- Medical Sciences School of Santa Casa de São Paulo (FCMSCSP), Brazil
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Neser RA, Caffaro RA. Invagination stripping with ultrasound-guided perivenous tumescence: an original method of great saphenous vein stripping. Dermatol Surg 2011; 37:349-52. [PMID: 21342313 DOI: 10.1111/j.1524-4725.2011.01885.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although minimally invasive treatment of the great saphenous vein (GSV) is now preferred over stripping, in some cases, stripping is still necessary. However, stripping, as an invasive method of treatment, promotes significant bleeding and trauma to the saphenous vein track. OBJECTIVE To describe an original method of GSV stripping, reducing bleeding during procedure. METHODS AND MATERIALS Seventeen patients underwent stripping of 29 GSVs using tumescent infusion in the saphenous compartment guided by ultrasound, similar to the tumescent anesthesia used in laser ablation during treatment of saphenous vein insufficiency. RESULTS Less bleeding and shorter recovery time was observed than in conventional GSV stripping. CONCLUSION GSV stripping using tumescent ultrasound-guided technique promotes less bleeding than conventional stripping and should be always performed when GSV stripping is considered. The authors have indicated no significant interest with commercial supporters.
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Affiliation(s)
- Rogério Abdo Neser
- Department of Vascular Surgery, College of Medical Sciences of Santa Casa of São Paulo, São Paulo, Brazil.
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Bastos RDM, Razuk Filho A, Blasbalg R, Caffaro RA, Karakhanian WK, Esteves FP, Romualdo AP, Rocha AJD. [Stent thrombosis in aortic aneurysm: evaluation by multidetector CT]. Rev Assoc Med Bras (1992) 2011; 57:31-34. [PMID: 21390456] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 11/07/2010] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE Evaluate the imaging findings of thrombosis in a series of patients submitted to endovascular repair of aortic abdominal aneurysm. METHODS MDCT images of 30 patients submitted to endovascular repair of aortic abdominal aneurysm were obtained by a 64 slice scanner, 5 to 29 months after the endovascular treatment. RESULTS Thrombosis was diagnosed in 10 patients (33.3%), and in three patients thrombosis was total in an iliac branch. CONCLUSION MDCT allowed diagnosis of different types of endoluminal thrombosis in patients submitted to endovascular repair of aortic abdominal aneurysm. Utilization of this minimally invasive diagnostic technique should be encouraged in clinical practice.
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Bastos RDM, Filho AR, Blasbalg R, Caffaro RA, Karakhanian W, Esteves FP, Romualdo AP, Rocha AJD. Trombose na endoprótese do aneurisma da aorta: avaliação por TC multidetector. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1590/s0104-42302011000100012] [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: 11/22/2022] Open
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Bastos RM, Razuk Filho A, Blasbalg R, Caffaro RA, Karakhanian WK, Rocha AJ. A multidetector tomography protocol for follow-up of endovascular aortic aneurysm repair. Clinics (Sao Paulo) 2011; 66:2025-9. [PMID: 22189725 PMCID: PMC3226595 DOI: 10.1590/s1807-59322011001200005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 08/18/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The purpose of this study was to improve the use of 64-channel multidetector computed tomography using lower doses of ionizing radiation during follow-up procedures in a series of patients with endovascular aortic aneurysm repair. METHODS Thirty patients receiving 5 to 29 months of follow-up after endovascular aortic aneurysm repair were analyzed using a 64-channel multidetector computed tomography device by an exam that included pre-and postcontrast with both arterial and venous phases. Leak presence and type were classified based on the exam phase. RESULTS Endoleaks were identified in 8/30 of cases; the endoleaks in 3/8 of these cases were not visible in the arterial phases of the exams. CONCLUSION The authors conclude that multidetector computed tomography with pre-contrast and venous phases should be a part of the ongoing follow-up of patients undergoing endovascular aortic aneurysm repair. The arterial phase can be excluded when the aneurism is stable or regresses. These findings permit a lower radiation dose without jeopardizing the correct diagnosis of an endoleak.
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Nakamura F, Silva RA, dos Santos VP, Razuk Filho A, Caffaro RA. [Preoperative embolization of abdominal paraganglioma: case report]. Rev Col Bras Cir 2010; 37:159-61. [PMID: 20549108 DOI: 10.1590/s0100-69912010000200015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Accepted: 07/25/2006] [Indexed: 11/22/2022] Open
Abstract
Paragangliomas is a pheochromocytoma of extra adrenal localization. The case report is a male, 55 years old who presented symptoms of adrenergic hyperstimulation associated to an abdominal mass diagnosed as paraganglioma by a biopsy. Because of its size, localization and vascularization, an aortography with embolization of the nutrient branches of the tumor was done pre-operatively. Four days later, a surgical ressection was performed, and the tumor was adhered to the duodenum, infra-renal aorta and inferior vena cava. We believe that an angiographic study pre-operatively with embolization makes possible an analysis of the anastomosis and arterial supplement, making the ressecability of the tumor safer, although it seems the surgical intervention should have been done earlier.
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Affiliation(s)
- Fernando Nakamura
- Departamento de Cirurgia, Faculdade Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP.
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Marques CG, Fioranelli A, Telles GP, Saad P, Razuk Filho A, Karakhanian VK, Castelli Junior V, Caffaro RA. Fístula aortoesofágica após correção endovascular da dissecção de aorta torácica tipo B de Stanford. J Vasc Bras 2010. [DOI: 10.1590/s1677-54492010000100009] [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: 11/22/2022] Open
Abstract
A correção endovascular da dissecção de aorta tipo B tem se mostrado como uma nova alternativa para reduzir o trauma cirúrgico. No entanto, as complicações de médio e longo prazo, tais como a fístula aortoesofágica, são ainda pouco conhecidas e pouco relatadas. O objetivo deste trabalho é descrever três casos de fístula aortoesofágica após o tratamento endovascular de 23 casos de dissecção de aorta descendente conduzidos pela equipe de Cirurgia Vascular da Santa Casa de São Paulo em um estudo retrospectivo. Esses pacientes apresentavam características em comum, como dissecção crônica, pós-operatório imediato sem intercorrências, necessidade de reintervenções, oclusão de troncos arteriais como a artéria subclávia, mesentérica, tronco celíaco, e, ainda, uma rápida evolução para o óbito após os primeiros sinais de fístula. Portanto, embora raramente descrita na literatura, a ocorrência de fístula aortoesofágica é uma complicação de causa até o momento indefinida do tratamento endovascular da dissecção de aorta descendente que merece atenção, dada sua recorrência e evolução fatal.
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Novaes GS, Razuk Filho Á, Pozzan G, Reis A, Fioranelli A, Castelli Jr. V, Karakhanian WK, Caffaro RA. Técnica para quantificação e qualificação de material coletado em filtros de proteção cerebral. J Vasc Bras 2009. [DOI: 10.1590/s1677-54492009000400005] [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: 11/21/2022] Open
Abstract
Contexto: A qualidade e a quantidade de partículas coletadas em filtros de proteção cerebral (FPC) durante angioplastia transluminal percutânea com stent (ATPS) podem esclarecer a importância desses dispositivos no tratamento de estenoses carotídeas. Objetivos: Analisar o conteúdo retido por FPC em pacientes submetidos a ATPS de artéria carótida interna com nova técnica de análise qualiquantitativa. Métodos: O material coletado em 10 FPC durante ATPS da bifurcação da carótida em pacientes com alto risco cirúrgico foi submetido a análise microscópica qualiquantitativa. Fotografias digitais das lâminas com material corado com hematoxilina e eosina foram analisadas com o programa Axio Vision LE Release 4.1, que calculou a área das partículas em micrômetros/metro quadrado (µm²). Resultados: O exame histopatológico evidenciou material em 100% dos filtros consistindo predominantemente de restos hemáticos, cristais de colesterol e cálcio. A área média de fragmentos coletados foi expressiva (1.570.310 µm²), e houve ampla variância desses valores. Conclusões: Os FPC coletam quantidade importante de fragmentos de placas de ateroma, e a grande variância nas quantidades de material coletado pode estar associada com a gravidade da lesão, motivo pelo qual se tornam relevantes estudos que utilizem técnica padronizada para a quantificação desses fragmentos e para a compreensão de seu real significado clínico.
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Affiliation(s)
| | | | - Geanete Pozzan
- Faculdade de Ciências Médicas da Santa Casa de São Paulo
| | - Andrea Reis
- Faculdade de Ciências Médicas da Santa Casa de São Paulo
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Belczak CEQ, Tyszka AL, Godoy JMPD, Ramos RN, Belczak SQ, Caffaro RA. Clinical complications of limb undergone harvesting of great saphenous vein for coronary artery bypass grafting using bridge technique. Braz J Cardiovasc Surg 2009; 24:68-72. [PMID: 19504022 DOI: 10.1590/s0102-76382009000100013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Accepted: 01/31/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess clinical complications of limbs undergone harvesting of the great saphenous vein for venous coronary artery bypass graft surgery using bridge technique. METHODS Fourty-four patients who had undergone CABG using the great saphenous vein harvested by the bridge technique over more than 3 months ago were randomly selected. The exclusion criteria were the harvesting of both saphenous veins, prior saphenectomy of the contralateral limb, edema caused by a systemic etiology, such as heart, renal, thyroid or hepatic diseases and venous insufficiency of the lower limbs as characterized by swollen varicose veins both with and without trophic changes. The age, gender, diabetes, time of surgery and occurrence of complications, such as edema, paresthesia, infection, lymphorrhea, erysipelas and deep venous thrombosis, were assessed. The assessment was clinic and diagnosis of the diabetes was performed by the preoperative exams. The chi-square, Fisher and Student's t tests were used for statistical analysis with an alpha error of 5%. RESULTS The time between surgery and assessment ranged between 3 and 187 months with a mean of 47.3+/-42.5 months. Infections of the saphenous harvest site were detected in 25% of the cases, edema in 52.3%, paresthesia in 29.5%, erysipelas in 9.1%, lymphorrhea in 4.5% and deep venous thrombosis in 2.3%. There was no association between diabetes and complications. CONCLUSION The saphenous vein harvesting using bridge technique for coronary artery bypass grafting does not eliminate clinical complications, such as paresthesia, infection and edema of the saphenous vein harvesting site.
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Villela ALC, Guedes LGS, Paschoa VVA, David AB, Tenório TM, Lamego Junior HP, Guedes Neto HJ, Caffaro RA. Perfil epidemiológico de 58 portadores de síndrome de Klippel-Trénaunay-Weber acompanhados no Ambulatório da Santa Casa de São Paulo. J Vasc Bras 2009. [DOI: 10.1590/s1677-54492009000300006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
CONTEXTO: A síndrome de Klippel-Trénaunay-Weber é uma doença rara sobre a qual encontramos poucos artigos na literatura (geralmente relatos de casos esporádicos relacionados a complicações). OBJETIVO: Avaliar o perfil epidemiológico dos portadores da referida síndrome. MÉTODOS: Foram copilados dados dos prontuários de 58 pacientes acompanhados no ambulatório de doenças linfáticas e angiodisplasias da disciplina de Cirurgia Vascular da Faculdade de Ciências Médicas da Santa Casa de São Paulo. RESULTADOS: A distribuição foi igual entre homens e mulheres (30 homens e 28 mulheres). A idade média dos pacientes em tratamento foi de 12,8 anos. Na maioria dos casos, a doença foi diagnosticada na infância, sendo a mancha em vinho do porto o primeiro sinal notado pela família, no nascimento ou primeiro ano de vida. O sintoma mais referido foi a dor, normalmente relacionada aos sintomas de estase venosa, sendo o sintoma considerado debilitante. Pela classificação CEAP, encontramos as crianças nas classes C0 e C1 e a maioria dos adultos nas classes avançadas. Foi diagnosticada a presença de fístulas arteriovenosas em 8,5% dos casos. Apenas 6,8% referiram história familiar. CONCLUSÃO: A síndrome de Klippel-Trénaunay e a síndrome de Parkes Weber são apresentações diferentes de uma única enfermidade e podem ser estudadas conjuntamente como síndrome de Klippel-Trénaunay-Weber. O melhor momento para reconhecer os portadores e poder amenizar a progressão de insuficiência venosa, hipertrofia óssea e tecidos moles é a infância. O tratamento compressivo deve ser indicado a todos os portadores com o intuito de diminuir a evolução da doença venosa periférica.
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Belczak CEQ, de Godoy JMP, Ramos RN, de Oliveira MA, Belczak SQ, Caffaro RA. Is the wearing of elastic stockings for half a day as effective as wearing them for the entire day? Br J Dermatol 2009; 162:42-5. [PMID: 19785617 DOI: 10.1111/j.1365-2133.2009.09396.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background There is good evidence for the use of compression for some clinical indications but little is known about dosimetry in compression. Objective The aim of this work was to evaluate whether or not the use of compression stockings during part of the day would help in the reduction of evening oedema in patients with clinical, epidemiological, anatomical and physiopathological (CEAP) classifications C0 and C1. Methods The effects of elastic compression stockings on volumetric variations during the working day were evaluated for the legs of two men and 18 women (40 legs). The inclusion criterion was classification as C0 (10 legs) or C1 (30 legs) according to the CEAP criteria. Participants used three-quarter-length elastic compression stockings (20-30 mmHg) on three consecutive days for the entire day or only for the morning or they did not use the stockings at all. Volumetry using the water displacement technique was performed in the morning and in the evening. When the patients wore the stockings only during the morning, volumetry was also performed at 13:00 h. Results Significant increases in volume were observed for both legs when stockings were not used compared with the use of stockings in the morning only. After removing the stockings, both legs had significant increases in volume in the afternoon. However, use for half the day was better than not using the stockings at all. Conclusions The use of elastic compression stockings can reduce volumetric variations during working hours, with the use of stockings for the entire day being better than for just half the day.
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Affiliation(s)
- C E Q Belczak
- Santa Casa School of Medical Sciences, Sao Paulo, Brazil
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Belczak CEQ, Godoy JMPD, Ramos RN, Tyszka AL, Belczak SQ, Caffaro RA. Edema de membro inferior secundário a exérese de veia safena magna para utilização como enxerto na revascularização do miocárdio. J Vasc Bras 2009. [DOI: 10.1590/s1677-54492009005000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXTO: A revascularização do miocárdio utilizando-se a veia safena magna ainda é procedimento cirúrgico bastante realizado na atualidade. O edema que surge no membro inferior operado causa grande desconforto e necessita ser melhor estudado. OBJETIVOS: Caracterizar o edema de membro inferior secundário a exérese da veia safena magna pela técnica de incisões escalonadas para sua utilização como enxerto venoso na revascularização do miocárdio. MÉTODOS: Foram selecionados aleatoriamente 44 indivíduos submetidos a exérese de veia safena magna para revascularização miocárdica há mais de 3 meses. Excluíram-se fatores que pudessem interferir na formação de edema dos membros inferiores. Foram avaliados por volumetria e perimetria maleolares ambos os membros inferiores. Considerou-se como presença de edema significativo a diferença de volume maior que 50 mL e maior de 2 cm em relação ao membro não-operado. Para a análise estatística foram empregados o teste do qui-quadrado, teste exato de Fisher, teste t de Student e o teste de McNemar. O nível de significância adotado foi de 5% (a = 0,05). RESULTADOS: Encontraram-se diferenças estatisticamente significativas (p < 0.05) entre os membros operados e os não-operados, sendo 56,8% com volume maior que 50 mL e 31,9% com perímetro maleolar maior que 2 cm. Não se encontrou associação entre a presença do edema e características da amostra ou da cirurgia e de intercorrências clínicas perioperatórias ou tardias. CONCLUSÕES: Pacientes submetidos a ressecções de veia safena magna para sua utilização como ponte coronariana poderão apresentar edema no membro associado.
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Belczak CEQ, de Godoy JMP, Ramos RN, de Oliveira MA, Belczak SQ, Caffaro RA. Rate of occupational leg swelling is greater in the morning than in the afternoon. Phlebology 2009; 24:21-5. [DOI: 10.1258/phleb.2008.008042] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to investigate the rate of occupational leg swelling depending on the time period of the working day. Volumetric variations of the legs of 70 hospital employees, enrolled in three groups, were evaluated. Group I: 35 morning shift workers; Group II: 35 afternoon shift workers; and Group III: 15 individuals randomly selected from Groups I and II, who were evaluated on the day they worked 12 hours consecutively. Volumetry was performed before and after each shift for both legs of the participants in Groups I and II. For Group III volumetry was performed early in the morning, at noon and in the evening. For statistical analysis, the Student's t-test and Mann-Whitney test were used with an alpha error of 5% being considered acceptable ( P value < 0.05). Significant increases in volume were recorded for the limbs in all three groups ( P value < 0.001). On comparing Groups I and II, the accumulation of fluids was significantly higher in the morning than in the afternoon ( P value < 0.003). Asymptomatic workers may present with oedema of the legs during their work with the rate of oedema being different for morning and afternoon shifts. The possibility of wearing compression stockings should be considered for this type of work.
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Affiliation(s)
- C E Q Belczak
- Santa Casa Medicine School in Sao Paulo (FCMSCSP), Professor of the Lymphovenous Rehabilitation Post-graduation Course of the Medicine School in Sao Jose do Rio Preto (FAMERP)
| | - J M P de Godoy
- Livre Docente, Medicine School of São Jose do Rio Preto (FAMERP) and CNPq Researcher
| | - R N Ramos
- João Belczak Vascular Centre, Maringá, Paraná
| | | | - S Q Belczak
- Fourth-year resident in Vascular Surgery, Hospital das Clínicas, University of São Paulo (USP)
| | - R A Caffaro
- Vascular Surgery Section, Medicine School of the Santa Casa of São Paulo (FCMSCSP), Brazil
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Santos VPD, Caffaro RA, Pozzan G, Saieg MA, Castelli Júnior V. Comparative histological study of atherosclerotic lesions and microvascular changes in amputated lower limbs of diabetic and non-diabetic patients. ACTA ACUST UNITED AC 2008; 52:1115-23. [DOI: 10.1590/s0004-27302008000700007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Accepted: 08/19/2008] [Indexed: 11/22/2022]
Abstract
OBJETIVE: To perform a comparative analysis of atherosclerotic lesions and capillaries changes in diabetic and nondiabetic patients. METHODS: Leg arteries and skin of 57 amputated lower limbs of diabetic (47.3%) and nondiabetic patients were histologically examined. The percentage of arterial stenosis of infrapopliteal arteries and the histological classification of atherosclerotic lesions were determined. Capillary thickening was classified into four categories. RESULTS: Diabetic group showed more than 75% stenosis in 57% (vs. 56% in nondiabetic) of the anterior tibial; 78% (vs. 68%) of the posterior tibial; 58% (vs. 50%) of the peroneal leg arteries. Diabetic and nondiabetic patients have predominance of type VI atherosclerotic lesions. The comparison of both groups showed no significant differences in atherosclerotic lesions. Diabetic patients had significantly more PAS positive capillary thickening (63% vs. 23%). CONCLUSIONS: There were no differences in histological characteristics of atherosclerosis between the two groups. Capillary thickening has been more observed in diabetics.
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Belczak CEQ, Godoy JMPD, Ramos RN, Oliveira MAD, Belczak SQ, Caffaro RA. Influência do turno laboral na formação de edema dos membros inferiores em indivíduos normais. J Vasc Bras 2008. [DOI: 10.1590/s1677-54492008000300007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
CONTEXTO: A presença de edema vespertino nos membros inferiores de indivíduos normais, após jornada habitual de trabalho, foi demonstrada na literatura nacional e internacional. O ritmo de formação e o acúmulo desse edema variam de acordo com os distintos turnos laborais. OBJETIVO: O edema de membros inferiores tem sido descrito após jornadas habituais de trabalho e representa uma queixa freqüente na prática vascular. O objetivo deste estudo foi avaliar a evolução do edema em indivíduos normais durante os distintos turnos laborais. MÉTODO: Foram feitas avaliações volumétricas de ambos os membros inferiores em 20 profissionais da área da saúde do Hospital e Maternidade São Marcos de Maringá, no Paraná. A escolha dos participantes foi por ordem de chegada, e as volumetrias foram feitas por técnica de deslocamento de água às 7, 13 e 19 h. Para análise estatística foi utilizado o teste t de Student, considerando erro alfa de 5%. RESULTADO: Dos 20 participantes, 19 eram do sexo feminino e 1 do masculino, sem evidência de doença venosa nos membros inferiores e pertencentes a C0 e C1 da classificação CEAP (C = clínica, E = etiologia, A = segmento anatômico, P = fisiopatologia). As idades dos participantes variaram entre 20 e 53 anos. Detectou-se aumento significativo de volume nos membros inferiores entre os distintos períodos avaliados, com p = 0,0001 e 0,0001, respectivamente. A maior variação ocorreu no período da manhã, com média ± desvio padrão de 107,2±63,5 mL, enquanto que à tarde, a variação foi de 44,5±35,4 mL. CONCLUSÃO: O edema é uma constante durante atividades laborais, mesmo em pessoas sem doença venosa manifesta e sofre influência do turno laboral ao qual o trabalhador se encontra exposto.
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Carvalho ATYD, Santos VPD, Razuk Filho Á, Karakhaian W, Guedes Neto HJ, Castelli Jr. V, Caffaro RA. Fatores de morbimortalidade na cirurgia eletiva do aneurisma da aorta abdominal infra-renal: experiência de 134 casos. J Vasc Bras 2008. [DOI: 10.1590/s1677-54492008000300006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
CONTEXTO: O tratamento cirúrgico convencional do aneurisma da aorta abdominal (AAA) infra-renal pode resultar em complicações graves. A fim de otimizar os resultados na evolução do tratamento, é importante que sejam identificados os pacientes predispostos a determinadas complicações e instituídas condutas preventivas. OBJETIVOS: Avaliar a taxa de mortalidade operatória precoce, analisar as complicações pós-operatórias e identificar os fatores de risco relacionados com a morbimortalidade. MÉTODO: Foram analisados 134 pacientes com AAA infra-renal submetidos a correção cirúrgica eletiva no período de fevereiro de 2001 a dezembro de 2005. RESULTADOS: A taxa de mortalidade foi de 5,2%, sendo secundária principalmente a infarto agudo de miocárdio (IAM) e isquemia mesentérica. As complicações cardíacas foram as mais freqüentes, seguidas das pulmonares e renais. A presença de diabetes melito (DM), insuficiência cardíaca congestiva (ICC), insuficiência coronariana (ICO) e cintilografia miocárdica positiva para isquemia estiveram associadas às complicações cardíacas. A idade avançada, a doença pulmonar obstrutiva crônica (DPOC) e a capacidade vital forçada reduzida aumentaram os riscos de atelectasia e pneumonia. História de nefropatia, tempo de pinçamento aórtico prolongado e níveis de uréia elevados aumentaram os riscos de insuficiência respiratória aguda (IRA). A isquemia dos membros inferiores esteve associada ao tabagismo e à idade avançada, e a maior taxa de mortalidade, à presença de coronariopatia, tempos prolongados de pinçamento aórtico e de cirurgia. CONCLUSÃO: A taxa de morbimortalidade esteve compatível com a literatura nacional e internacional, sendo secundária às complicações cardíacas, respiratórias e renais. Os fatores de risco identificados no pré e transoperatório estiveram relacionados com essas complicações.
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Abstract
CONTEXTO: O presente estudo avalia a mobilidade da articulação talocrural nos seis estágios clínicos da classificação CEAP (clínica, etiológica, anatômica e patofisiológica do International Consensus Committee Reporting Standards on Venous Disease) para doença venosa utilizando a goniometria, e detecta redução da mobilidade articular nos estágios mais avançados da doença, C5 e C6 (úlcera cicatrizada ou ativa). OBJETIVO: Investigar a existência de uma relação entre a severidade clínica da doença venosa crônica dos membros inferiores e a diminuição do grau de mobilidade da articulação talocrural. MÉTODO: Selecionaram-se aleatoriamente 120 membros pertencentes a 88 pacientes brancas, que foram separados com base em sua apresentação clínica de acordo com a categoria C da classificação CEAP, sendo distribuídos em 6 grupos pertencentes às categorias de C0-C1 (grupo controle) até C6, com 20 membros cada um e médias de idade próximas para cada grupo. O grau de mobilidade do tornozelo foi acessado por goniometria de apoio plantar em posição de decúbito supino. RESULTADOS: Os grupos C de CEAP apresentam diferença significativa em relação ao grau de mobilidade da articulação talocrural medida por goniometria (p < 0,001). C6 difere significativamente dos demais grupos (p < 0,05); C5 difere significativamente de C6, C3, C2 e C0-C1 (p < 0,05), mas não apresenta diferença significativa do grupo C4; C4 difere significativamente do grupo C6 (p < 0,05) e não difere dos demais grupos; C0-C1, C2 e C3 não apresentam diferença significativa entre si e em relação a C4, e diferem dos grupos C5 e C6 (p < 0,05). O nível de significância utilizado para os testes foi de 5%. CONCLUSÃO: Existe relação entre a severidade clínica da insuficiência venosa crônica dos membros inferiores e a diminuição do grau de mobilidade da articulação talocrural, e ela se faz mais evidente na presença de úlcera venosa ativa ou cicatrizada.
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