O aneurisma inflamatório da aorta abdominal caracteriza-se por dor lombar ou abdominal, perda de ... more O aneurisma inflamatório da aorta abdominal caracteriza-se por dor lombar ou abdominal, perda de peso e aumento da velocidade de sedimentação. Frequentemente o doente apresenta febre e leucocitose. Outros marcadores inflamatórios poderão estar aumentados como a PCR, os anticorpos-anti-nucleares e o IgG4. A tomografia computorizada é o exame de eleição, apresentando tipicamente o "sinal do manto". Os esteroides melhoram a sintomatologia, reduzindo a inflamação, mas não corrigem o aneurisma. A decisão, entre intervenção cirúrgica ou endovascular deve ser considerada de acordo com a experiencia do centro, os fatores de risco do doente, as características anatómicas do aneurisma e a presença de hidronefrose.
Introdução: O pé diabético é uma complicação da Diabetes Mellitus (DM) responsável por 250 amputa... more Introdução: O pé diabético é uma complicação da Diabetes Mellitus (DM) responsável por 250 amputações em 2015 em Portugal1,2. É uma consequência da vasculopatia, imunopatia e neuropatia3,4, sendo esta última o mecanismo mais importante da Neuroartropatia de Charcot (NC)5. A radiografia convencional permite uma primeira abordagem imagiológica, identificando os "6 D's": Dense subchondral bones; Degeneration; Destruction; Deformity; Debris, Dislocation6,7. Deste modo, pretende-se relacionar os dados imagiológicos da radiografia simples do pé com a clínica e a fisiopatologia da entidade "Pé Diabético", tendo como mote a descrição de um caso clínico. Caso clínico: Homem de 59 anos, com antecedentes de DM tipo 2 e amputação transmetatársica à direita recorreu ao Serviço de Urgência por dor, eritema e edema no pé e terço inferior da perna direita e úlcera plantar com exsudato purulento. Apresentava pulsos femorais e poplíteos. Pulsos distais ausentes. Foi internado ...
The presence of abdominal or back pain, weight loss and elevated erythrocyte sedimentation rate i... more The presence of abdominal or back pain, weight loss and elevated erythrocyte sedimentation rate is characteristic of the inflammatory abdominal aortic aneurysms. Low-grade fever is sometimes identified. Other inflammatory markers, such as white blood cell count, C reactive protein, anti-nuclear antibody and IgG4 levels can be elevated. Computed tomography is the exam of choice, showing characteristically the mantle sign. Steroids improve the symptomatology and reduce inflammation, but do not treat the aneurysm. The choice of interventions: open surgical repair or endovascular aneurysm repair can be considered according to the available expertise, patient risk factors, anatomic aneurysm criteria and presence of hydronephrosis.
Arteriovenous malformations are the least common vascular anomalies, but they can have a worst pr... more Arteriovenous malformations are the least common vascular anomalies, but they can have a worst prognosis when compared with other vascular anomalies. In this way, the authors present a case of young female with arteriovenous malformation on the left shoulder. The indication and the treatment options were discussed within national and international experts at the Conference of Vascular Anomalies in Lisbon in 2018. The authors shared their opinions and made a revision on this topic.
Introdução: Desde que o primeiro caso positivo de COVID-19 foi identificado a 2 de março em Lousa... more Introdução: Desde que o primeiro caso positivo de COVID-19 foi identificado a 2 de março em Lousada, uma região próxima à nossa área de influência, tivemos que readaptar a nossa actividade clínica. Objetivo: Descrever as alterações realizadas pelo nosso Serviço de Cirurgia Vascular de 13 de março a 14 de maio. Métodos: Recolhemos dados clínicos, da actividade cirúrgica, de internamento e da consulta, de 13 de março a 14 de maio e comparamos com o mesmo período do ano anterior. Também fizemos uma revisão dos documentos relacionados com a planificação da nossa actividade. Resultados: No pico do surto, dividimos a equipa de trabalho e incentivamos a segregação dos elementos para reduzir o risco de contaminação cruzada. O volume cirúrgico diminuiu 54,8% (de 31 casos para 14 casos) e a atividade cirúrgica de ambulatório foi cancelada. O volume de consultas presenciais diminuiu 86,4%: foram realizadas 73 consultas por telefone. No serviço de urgência, a principal diferença entre o perído ...
Catheter directed thrombolysis is a minimally invasive procedure that results in a significant re... more Catheter directed thrombolysis is a minimally invasive procedure that results in a significant reduction in venous obstruction after deep vein thrombosis. The technique implies the performance of phlebographies to monitor the thrombolysis progression. The objective of this paper is to describe the use of vascular ultrasound to follow the thrombus lysis and to adjust the catheter position according to the progression of the thrombolysis. This is the first case reported describing the application of ultrasound to monitor the thrombolysis. A 36-year woman was admitted ilio-femoral vein. The ipsilateral great saphenous vein was the percutaneous access to perform the anterograde thrombolysis. The procedure, including the control of thrombus lysis, as well as catheter progression was performed under ultrasound guidance. The thrombolysis took 52 hours. The patient has two years of follow-up without any complaint. The use of vascular ultrasound to monitor the thrombolysis has several theore...
Objective/Background: Peripheral artery disease (PAD) is an important manifestation of systemic a... more Objective/Background: Peripheral artery disease (PAD) is an important manifestation of systemic atherosclerosis. Obesity is a risk factor for atherosclerosis and for cardiovascular events. However, the relationship between obesity and PAD is unclear. We hypothesized that anthropometric measures of adiposity, in particularly of central obesity will be associated with PAD severity, in patients undergoing aorto-bifemoral bypass. Methods: A prospective observation study was conducted. From 2009 and 2012 a total of 46 males who underwent aorto-bifemoral bypass were enrolled prospectively. 17 with intermittent claudication (IC) and 29 with chronic limb threatening ischemia (CLTI). They were followed for 5 years. The anthropometric measures, weight, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and the seric levels of hemoglobin, triglycerides, and albumin were recorded. The mortality and cardiovascular events in following five years were also registered. Result...
A 42 years-old female presented with right inguinal swelling with one year of evolution. Magnetic... more A 42 years-old female presented with right inguinal swelling with one year of evolution. Magnetic resonance imaging was suggestive of inguinal endometriosis adherent to femoral vessels. Due to the rarity of this pathology (prevalence 0.3-0.6%), clinical suspicion is essential. Surgical excision is the treatment of choice.
Revista portuguesa de cirurgia cardio-toracica e vascular : orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular, 2020
Introduction Carotid endarterectomy confers maximum benefit if performed in the first 14 days aft... more Introduction Carotid endarterectomy confers maximum benefit if performed in the first 14 days after an acute, non-cardioembolic ischemic stroke/transient ischemic attack (TIA). Nevertheless, there is considerable interest in whether there is a role for starting double antiplatelet (DAPT) therapy in the very early time period after symptom onset. Materials and Methods The authors conducted an observational retrospective analysis of all consecutive patients submitted to carotid endarterectomy (CEA) between 2010 and 2020 due to carotid artery symptomatic stenosis. Patients were allocated to Group I (acetylsalicylic acid alone), II (clopidogrel alone) or III (DAPT) considering the anti-platelet treatment they received during the period between the index event and CEA. Outcomes were recurrent TIA or stroke during the pre-operative period. Results We analysed 104 patient, 78 males, with a mean age of 70 years old. In Group I, we had 72 patients with 9 (13%) recurrent events. Group II had ...
Traumatic injuries are very common, accounting for 2.6 million hospitalizations per year in the U... more Traumatic injuries are very common, accounting for 2.6 million hospitalizations per year in the United States. The incidence of arterial injuries following penetrating trauma of the limbs is about 10%. Vascular trauma occurs more often in the lower
Objective: We report a clinical case of a small-vessel vasculitis with ischemia of the left upper... more Objective: We report a clinical case of a small-vessel vasculitis with ischemia of the left upper limb. Case: A patient diagnosed with Wegener’s granulomatosis and involvement of the left axillary and brachial arteries. A left axillary-radial bypass with reversed left great saphenous vein was performed. Results: After a period of 36 months of follow-up the patient is asymptomatic with complete healing of the trophic lesions. Conclusion: Classic Wegener’s granulomatosis is a form of vasculitis that primarily involves the upper andyor lower respiratory tract and kidney. The amount of clinical symptoms is enormous and the diagnosis, arduous. In the literature there are only a few clinical cases referring to limb ischemia in a setting of Wegener’s granulomatosis. This is a unique case report of upper limb ischemia due to involvement of a medium–large size artery in a patient with Wegener’s granulomatosis. 2008 Published by European Association for Cardio-Thoracic Surgery. All rights res...
CLOVES syndrome is a rare, non-heritable sporadic overgrowth disorder. In the world 130-200 cases... more CLOVES syndrome is a rare, non-heritable sporadic overgrowth disorder. In the world 130-200 cases have been reported. This is the first case of CLOVES described in Portugal, which had been not been diagnosed for the last 36 years. With this paper, the authors look to highlight the clinical features of this syndrome so that it does not go unrecognized in daily practice. The authors also underline the efficacy and safety of sirolimus, and that this treatment should not be denied, even in adult patients.
Introduction Ultrasound examination of the lower extremity, regardless of the motive, can yield a... more Introduction Ultrasound examination of the lower extremity, regardless of the motive, can yield a considerable amount of data essential to the diagnosis of various diseases. Case Report We reported a clinical case of a woman, 50 years of age, who was sent to our vascular laboratory for arterial ultrasound examination of the lower extremities. She complained of coldness of the left foot associated with paresthesia and hypersensitivity of the middle third of the left lower leg for the past 3 years. During physical examination, there was a diminished, but palpable, posterior tibial artery pulse. The ultrasound performed revealed a tumor of the posterior tibial nerve, with 4 cm in longitudinal dimension and 2.7 cm of maximum diameter, typical of a neurofibroma or a schwannoma, with anterior deviation of the vascular structures. She was referred to a plastic surgeon and submitted to surgical resection of the nerve sheath tumor, with preservation of artery and venous flow. Histological an...
Introduction.-The purpose of our study was to evaluate the ultrasonographic characteristics of re... more Introduction.-The purpose of our study was to evaluate the ultrasonographic characteristics of recurrent carotid stenosis in patients submitted to carotid endarterectomy with patch angioplasty. Methods.-We performed carotid ultrasound examinations on patients who had undergone unilateral carotid endarterectomy between 2002 and 2009. Patients with bilateral and/or endovascular procedures were excluded. All ultrasound examinations were performed by the same registered vascular technologist. Results.-One hundred male and 25 female patients were studied. The average time between surgery and the ultrasound examination was 38.8 months (range, 3-99.2 months). Twenty-nine (23.2%) patients had recurrent carotid artery stenosis after unilateral endarterectomy. Of these, 17 patients were found to have recurrent carotid artery stenosis classifi ed as <50%; 7 patients had recurrent stenosis in the range of 50% and 69%, and 5 patients had >70% diameter-reducing lesions. Plaques associated with recurrent carotid stenosis were signifi cantly less echogenic, more acoustically homogenous, and had a smoother surface contour. Compared with the primary carotid stenosis (nonintervened side), plaques associated with recurrent carotid stenosis were more often hypoechoic (58.6% versus 8.1%), acoustically homogenous (69% versus 44.6%) and smoothsurfaced (93.1% versus 74.3%). Also, the longer the interval between surgery and the carotid sonographic examination, the more similar the ultrasonographic characteristics were between the two groups. Conclusions.-The different sonographic characteristics of primary carotid stenosis and recurrent stenosis after carotid endarterectomy in the same patients, are associated with different outcomes for the two conditions. There is a current clinical consensus that patients presenting with recurrent symptoms after carotid endarterectomy should be treated, but the best management for asymptomatic patients with recurrent carotid artery stenosis remains uncertain.
study was to review our experience with early and long-term outcomes of symptomatic patients trea... more study was to review our experience with early and long-term outcomes of symptomatic patients treated for intrastent carotid restenosis with carotid bypasses (CB). Methods: Data were retrospectively collected from a prospectively complied database on patients treated with CB in two high-volume Italian centers between 2008 and 2015, for symptomatic high-grade ISR after CAS. After stent removal, a great saphenous vein (GSV) was preferentially used as the graft; when a GSV was not available, a 6-mm polytetrafluoroethylene (PTFE) graft was implanted. Standard follow-up protocol in both centers included clinical examinations, duplex ultrasound scans (DUS), and computed tomography angiography at 1 month after surgery. In the absence of new clinical events, a routine DUS surveillance was scheduled at 3, 6, and 12 months and yearly thereafter. Measures considered for analysis were perioperative (30-day) and long-term follow-up of new ipsilateral cerebral events, neurologic events, and all causes of death, and needs for reintervention. In addition, peripheral nerve palsy, cervical hematoma, and other local complications after surgery were noted. Results: The study population comprised 12 patients (10 men and 2 women; mean age, 69.3 6 10.8 years). Mean time from index CAS to stent explantation and CB was 37.7 6 18.4 months. Surgical history of treated patients is reported in the Table. General anesthesia was performed in five cases (41.7%); all other procedures (58.3%) were performed under local anesthesia. Selective carotid shunts were required in two patients (17%). After stent removal, GSV grafts were used in seven cases (58.3%) and PTFE grafts in the other five cases (41.7%). Intraoperative neurologic complication rates were null. One patient, with ISR after post-CEA restenosis, presented with a transient dysphagia. At 30-day follow-up, no new neurologic complications, reinterventions, or deaths occurred. At mean follow-up of 46.2 6 22.7 months, three patients died (two of acute myocardial infarctions and one of lung cancer), in the absence of further neurologic events. At DUS examinations, all CB were patents without reinterventions. One patient treated by PTFE graft developed a nonhemodynamic restenosis. Conclusions: In our experience, CB offers satisfactory results in patients treated for symptomatic ISR, with an acceptable risk of cranial nerve injuries even in patients with prior carotid surgery.
Interactive cardiovascular and thoracic surgery, 2010
To review the experience of our institution in repairing isolated iliac artery aneurysm (isolated... more To review the experience of our institution in repairing isolated iliac artery aneurysm (isolated IAA) in the last six years. The medical records of patients who underwent isolated IAA repair were reviewed, to obtain information on patients' demographics, vascular risk factors, type of treatment and outcome. A total of 11 patients with 16 aneurysms, all men, with a mean age of 69.2+/-6.0 years were treated. The mean diameter was 3.7+/-1.0 cm (3.5+/-1.1 cm at elective repair; 5.7+/-2.9 cm on the emergency cases). The majority of aneurysms were at the common iliac artery and 27.3% of them were multiple. The diagnosis of multiple aneurysms was performed 10 years later, compared with the mean age of the diagnosis of single aneurysms, and this difference is statistically significant. Seven (63.6%) had elective operations, and one elective endovascular repair. Analysing the vascular risk factors, it was evident that hypertension was the most prevalent and the diagnosis of aneurysm was...
O aneurisma inflamatório da aorta abdominal caracteriza-se por dor lombar ou abdominal, perda de ... more O aneurisma inflamatório da aorta abdominal caracteriza-se por dor lombar ou abdominal, perda de peso e aumento da velocidade de sedimentação. Frequentemente o doente apresenta febre e leucocitose. Outros marcadores inflamatórios poderão estar aumentados como a PCR, os anticorpos-anti-nucleares e o IgG4. A tomografia computorizada é o exame de eleição, apresentando tipicamente o "sinal do manto". Os esteroides melhoram a sintomatologia, reduzindo a inflamação, mas não corrigem o aneurisma. A decisão, entre intervenção cirúrgica ou endovascular deve ser considerada de acordo com a experiencia do centro, os fatores de risco do doente, as características anatómicas do aneurisma e a presença de hidronefrose.
Introdução: O pé diabético é uma complicação da Diabetes Mellitus (DM) responsável por 250 amputa... more Introdução: O pé diabético é uma complicação da Diabetes Mellitus (DM) responsável por 250 amputações em 2015 em Portugal1,2. É uma consequência da vasculopatia, imunopatia e neuropatia3,4, sendo esta última o mecanismo mais importante da Neuroartropatia de Charcot (NC)5. A radiografia convencional permite uma primeira abordagem imagiológica, identificando os "6 D's": Dense subchondral bones; Degeneration; Destruction; Deformity; Debris, Dislocation6,7. Deste modo, pretende-se relacionar os dados imagiológicos da radiografia simples do pé com a clínica e a fisiopatologia da entidade "Pé Diabético", tendo como mote a descrição de um caso clínico. Caso clínico: Homem de 59 anos, com antecedentes de DM tipo 2 e amputação transmetatársica à direita recorreu ao Serviço de Urgência por dor, eritema e edema no pé e terço inferior da perna direita e úlcera plantar com exsudato purulento. Apresentava pulsos femorais e poplíteos. Pulsos distais ausentes. Foi internado ...
The presence of abdominal or back pain, weight loss and elevated erythrocyte sedimentation rate i... more The presence of abdominal or back pain, weight loss and elevated erythrocyte sedimentation rate is characteristic of the inflammatory abdominal aortic aneurysms. Low-grade fever is sometimes identified. Other inflammatory markers, such as white blood cell count, C reactive protein, anti-nuclear antibody and IgG4 levels can be elevated. Computed tomography is the exam of choice, showing characteristically the mantle sign. Steroids improve the symptomatology and reduce inflammation, but do not treat the aneurysm. The choice of interventions: open surgical repair or endovascular aneurysm repair can be considered according to the available expertise, patient risk factors, anatomic aneurysm criteria and presence of hydronephrosis.
Arteriovenous malformations are the least common vascular anomalies, but they can have a worst pr... more Arteriovenous malformations are the least common vascular anomalies, but they can have a worst prognosis when compared with other vascular anomalies. In this way, the authors present a case of young female with arteriovenous malformation on the left shoulder. The indication and the treatment options were discussed within national and international experts at the Conference of Vascular Anomalies in Lisbon in 2018. The authors shared their opinions and made a revision on this topic.
Introdução: Desde que o primeiro caso positivo de COVID-19 foi identificado a 2 de março em Lousa... more Introdução: Desde que o primeiro caso positivo de COVID-19 foi identificado a 2 de março em Lousada, uma região próxima à nossa área de influência, tivemos que readaptar a nossa actividade clínica. Objetivo: Descrever as alterações realizadas pelo nosso Serviço de Cirurgia Vascular de 13 de março a 14 de maio. Métodos: Recolhemos dados clínicos, da actividade cirúrgica, de internamento e da consulta, de 13 de março a 14 de maio e comparamos com o mesmo período do ano anterior. Também fizemos uma revisão dos documentos relacionados com a planificação da nossa actividade. Resultados: No pico do surto, dividimos a equipa de trabalho e incentivamos a segregação dos elementos para reduzir o risco de contaminação cruzada. O volume cirúrgico diminuiu 54,8% (de 31 casos para 14 casos) e a atividade cirúrgica de ambulatório foi cancelada. O volume de consultas presenciais diminuiu 86,4%: foram realizadas 73 consultas por telefone. No serviço de urgência, a principal diferença entre o perído ...
Catheter directed thrombolysis is a minimally invasive procedure that results in a significant re... more Catheter directed thrombolysis is a minimally invasive procedure that results in a significant reduction in venous obstruction after deep vein thrombosis. The technique implies the performance of phlebographies to monitor the thrombolysis progression. The objective of this paper is to describe the use of vascular ultrasound to follow the thrombus lysis and to adjust the catheter position according to the progression of the thrombolysis. This is the first case reported describing the application of ultrasound to monitor the thrombolysis. A 36-year woman was admitted ilio-femoral vein. The ipsilateral great saphenous vein was the percutaneous access to perform the anterograde thrombolysis. The procedure, including the control of thrombus lysis, as well as catheter progression was performed under ultrasound guidance. The thrombolysis took 52 hours. The patient has two years of follow-up without any complaint. The use of vascular ultrasound to monitor the thrombolysis has several theore...
Objective/Background: Peripheral artery disease (PAD) is an important manifestation of systemic a... more Objective/Background: Peripheral artery disease (PAD) is an important manifestation of systemic atherosclerosis. Obesity is a risk factor for atherosclerosis and for cardiovascular events. However, the relationship between obesity and PAD is unclear. We hypothesized that anthropometric measures of adiposity, in particularly of central obesity will be associated with PAD severity, in patients undergoing aorto-bifemoral bypass. Methods: A prospective observation study was conducted. From 2009 and 2012 a total of 46 males who underwent aorto-bifemoral bypass were enrolled prospectively. 17 with intermittent claudication (IC) and 29 with chronic limb threatening ischemia (CLTI). They were followed for 5 years. The anthropometric measures, weight, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and the seric levels of hemoglobin, triglycerides, and albumin were recorded. The mortality and cardiovascular events in following five years were also registered. Result...
A 42 years-old female presented with right inguinal swelling with one year of evolution. Magnetic... more A 42 years-old female presented with right inguinal swelling with one year of evolution. Magnetic resonance imaging was suggestive of inguinal endometriosis adherent to femoral vessels. Due to the rarity of this pathology (prevalence 0.3-0.6%), clinical suspicion is essential. Surgical excision is the treatment of choice.
Revista portuguesa de cirurgia cardio-toracica e vascular : orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular, 2020
Introduction Carotid endarterectomy confers maximum benefit if performed in the first 14 days aft... more Introduction Carotid endarterectomy confers maximum benefit if performed in the first 14 days after an acute, non-cardioembolic ischemic stroke/transient ischemic attack (TIA). Nevertheless, there is considerable interest in whether there is a role for starting double antiplatelet (DAPT) therapy in the very early time period after symptom onset. Materials and Methods The authors conducted an observational retrospective analysis of all consecutive patients submitted to carotid endarterectomy (CEA) between 2010 and 2020 due to carotid artery symptomatic stenosis. Patients were allocated to Group I (acetylsalicylic acid alone), II (clopidogrel alone) or III (DAPT) considering the anti-platelet treatment they received during the period between the index event and CEA. Outcomes were recurrent TIA or stroke during the pre-operative period. Results We analysed 104 patient, 78 males, with a mean age of 70 years old. In Group I, we had 72 patients with 9 (13%) recurrent events. Group II had ...
Traumatic injuries are very common, accounting for 2.6 million hospitalizations per year in the U... more Traumatic injuries are very common, accounting for 2.6 million hospitalizations per year in the United States. The incidence of arterial injuries following penetrating trauma of the limbs is about 10%. Vascular trauma occurs more often in the lower
Objective: We report a clinical case of a small-vessel vasculitis with ischemia of the left upper... more Objective: We report a clinical case of a small-vessel vasculitis with ischemia of the left upper limb. Case: A patient diagnosed with Wegener’s granulomatosis and involvement of the left axillary and brachial arteries. A left axillary-radial bypass with reversed left great saphenous vein was performed. Results: After a period of 36 months of follow-up the patient is asymptomatic with complete healing of the trophic lesions. Conclusion: Classic Wegener’s granulomatosis is a form of vasculitis that primarily involves the upper andyor lower respiratory tract and kidney. The amount of clinical symptoms is enormous and the diagnosis, arduous. In the literature there are only a few clinical cases referring to limb ischemia in a setting of Wegener’s granulomatosis. This is a unique case report of upper limb ischemia due to involvement of a medium–large size artery in a patient with Wegener’s granulomatosis. 2008 Published by European Association for Cardio-Thoracic Surgery. All rights res...
CLOVES syndrome is a rare, non-heritable sporadic overgrowth disorder. In the world 130-200 cases... more CLOVES syndrome is a rare, non-heritable sporadic overgrowth disorder. In the world 130-200 cases have been reported. This is the first case of CLOVES described in Portugal, which had been not been diagnosed for the last 36 years. With this paper, the authors look to highlight the clinical features of this syndrome so that it does not go unrecognized in daily practice. The authors also underline the efficacy and safety of sirolimus, and that this treatment should not be denied, even in adult patients.
Introduction Ultrasound examination of the lower extremity, regardless of the motive, can yield a... more Introduction Ultrasound examination of the lower extremity, regardless of the motive, can yield a considerable amount of data essential to the diagnosis of various diseases. Case Report We reported a clinical case of a woman, 50 years of age, who was sent to our vascular laboratory for arterial ultrasound examination of the lower extremities. She complained of coldness of the left foot associated with paresthesia and hypersensitivity of the middle third of the left lower leg for the past 3 years. During physical examination, there was a diminished, but palpable, posterior tibial artery pulse. The ultrasound performed revealed a tumor of the posterior tibial nerve, with 4 cm in longitudinal dimension and 2.7 cm of maximum diameter, typical of a neurofibroma or a schwannoma, with anterior deviation of the vascular structures. She was referred to a plastic surgeon and submitted to surgical resection of the nerve sheath tumor, with preservation of artery and venous flow. Histological an...
Introduction.-The purpose of our study was to evaluate the ultrasonographic characteristics of re... more Introduction.-The purpose of our study was to evaluate the ultrasonographic characteristics of recurrent carotid stenosis in patients submitted to carotid endarterectomy with patch angioplasty. Methods.-We performed carotid ultrasound examinations on patients who had undergone unilateral carotid endarterectomy between 2002 and 2009. Patients with bilateral and/or endovascular procedures were excluded. All ultrasound examinations were performed by the same registered vascular technologist. Results.-One hundred male and 25 female patients were studied. The average time between surgery and the ultrasound examination was 38.8 months (range, 3-99.2 months). Twenty-nine (23.2%) patients had recurrent carotid artery stenosis after unilateral endarterectomy. Of these, 17 patients were found to have recurrent carotid artery stenosis classifi ed as <50%; 7 patients had recurrent stenosis in the range of 50% and 69%, and 5 patients had >70% diameter-reducing lesions. Plaques associated with recurrent carotid stenosis were signifi cantly less echogenic, more acoustically homogenous, and had a smoother surface contour. Compared with the primary carotid stenosis (nonintervened side), plaques associated with recurrent carotid stenosis were more often hypoechoic (58.6% versus 8.1%), acoustically homogenous (69% versus 44.6%) and smoothsurfaced (93.1% versus 74.3%). Also, the longer the interval between surgery and the carotid sonographic examination, the more similar the ultrasonographic characteristics were between the two groups. Conclusions.-The different sonographic characteristics of primary carotid stenosis and recurrent stenosis after carotid endarterectomy in the same patients, are associated with different outcomes for the two conditions. There is a current clinical consensus that patients presenting with recurrent symptoms after carotid endarterectomy should be treated, but the best management for asymptomatic patients with recurrent carotid artery stenosis remains uncertain.
study was to review our experience with early and long-term outcomes of symptomatic patients trea... more study was to review our experience with early and long-term outcomes of symptomatic patients treated for intrastent carotid restenosis with carotid bypasses (CB). Methods: Data were retrospectively collected from a prospectively complied database on patients treated with CB in two high-volume Italian centers between 2008 and 2015, for symptomatic high-grade ISR after CAS. After stent removal, a great saphenous vein (GSV) was preferentially used as the graft; when a GSV was not available, a 6-mm polytetrafluoroethylene (PTFE) graft was implanted. Standard follow-up protocol in both centers included clinical examinations, duplex ultrasound scans (DUS), and computed tomography angiography at 1 month after surgery. In the absence of new clinical events, a routine DUS surveillance was scheduled at 3, 6, and 12 months and yearly thereafter. Measures considered for analysis were perioperative (30-day) and long-term follow-up of new ipsilateral cerebral events, neurologic events, and all causes of death, and needs for reintervention. In addition, peripheral nerve palsy, cervical hematoma, and other local complications after surgery were noted. Results: The study population comprised 12 patients (10 men and 2 women; mean age, 69.3 6 10.8 years). Mean time from index CAS to stent explantation and CB was 37.7 6 18.4 months. Surgical history of treated patients is reported in the Table. General anesthesia was performed in five cases (41.7%); all other procedures (58.3%) were performed under local anesthesia. Selective carotid shunts were required in two patients (17%). After stent removal, GSV grafts were used in seven cases (58.3%) and PTFE grafts in the other five cases (41.7%). Intraoperative neurologic complication rates were null. One patient, with ISR after post-CEA restenosis, presented with a transient dysphagia. At 30-day follow-up, no new neurologic complications, reinterventions, or deaths occurred. At mean follow-up of 46.2 6 22.7 months, three patients died (two of acute myocardial infarctions and one of lung cancer), in the absence of further neurologic events. At DUS examinations, all CB were patents without reinterventions. One patient treated by PTFE graft developed a nonhemodynamic restenosis. Conclusions: In our experience, CB offers satisfactory results in patients treated for symptomatic ISR, with an acceptable risk of cranial nerve injuries even in patients with prior carotid surgery.
Interactive cardiovascular and thoracic surgery, 2010
To review the experience of our institution in repairing isolated iliac artery aneurysm (isolated... more To review the experience of our institution in repairing isolated iliac artery aneurysm (isolated IAA) in the last six years. The medical records of patients who underwent isolated IAA repair were reviewed, to obtain information on patients' demographics, vascular risk factors, type of treatment and outcome. A total of 11 patients with 16 aneurysms, all men, with a mean age of 69.2+/-6.0 years were treated. The mean diameter was 3.7+/-1.0 cm (3.5+/-1.1 cm at elective repair; 5.7+/-2.9 cm on the emergency cases). The majority of aneurysms were at the common iliac artery and 27.3% of them were multiple. The diagnosis of multiple aneurysms was performed 10 years later, compared with the mean age of the diagnosis of single aneurysms, and this difference is statistically significant. Seven (63.6%) had elective operations, and one elective endovascular repair. Analysing the vascular risk factors, it was evident that hypertension was the most prevalent and the diagnosis of aneurysm was...
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