RESUMO
The New Coronavirus Epidemic (2019-nCoV), discovered in the city of Wuhan, China, in December 2019, presents mainly with pulmonary pneumonia that is preceded by fever, cough and myalgia. However, as the disease spread globally and the number of hospitalizations increased exponentially, it was noted that most serious patients hospitalized by COVID-19 have laboratory changes worthy of attention, such as lymphopenia, neutrophilia, increased time of prothrombin and increased levels of D-dimer. Due to these changes proving to be crucial for the mortality and morbidity rates in this subset of infected people, several studies focusing on the pathophysiology, mainly hematological, of the disease appear every day. Deepening these studies, several published works have shown SarsCoV-2 infection to the installation of a prothrombotic state in hospitalized patients, which leads to the potential occurrence of thrombotic or arterial events in this cohort. Thus, in order to understand how the departments of Angiology and Vascular Surgery are acting in the context of the COVID-19 pandemic, this work aims to gather studies that reveal from protocols applied in vascular services in the current situation, until to the role of vascular surgeons and angiologists in the clinical and surgical management of patients infected or not, as a way of helping and clarifying this specialty during the context of a pandemic due to the new coranavirus. For the selection of works, the following search criteria were used: "Coronavirus and venous thrombosis", "Coronavirus and thrombosis", "COVID-19 and venous thrombosis" and "COVID-19 Coronavirus and thrombosis".
Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pandemias , Pneumonia Viral/complicações , Embolia Pulmonar/virologia , Tromboembolia/virologia , Coagulação Sanguínea/fisiologia , COVID-19 , Protocolos Clínicos , Infecções por Coronavirus/fisiopatologia , Humanos , Pneumonia Viral/fisiopatologia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , SARS-CoV-2 , Tromboembolia/diagnóstico , Tromboembolia/terapia , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Vasculares/normasRESUMO
ABSTRACT The New Coronavirus Epidemic (2019-nCoV), discovered in the city of Wuhan, China, in December 2019, presents mainly with pulmonary pneumonia that is preceded by fever, cough and myalgia. However, as the disease spread globally and the number of hospitalizations increased exponentially, it was noted that most serious patients hospitalized by COVID-19 have laboratory changes worthy of attention, such as lymphopenia, neutrophilia, increased time of prothrombin and increased levels of D-dimer. Due to these changes proving to be crucial for the mortality and morbidity rates in this subset of infected people, several studies focusing on the pathophysiology, mainly hematological, of the disease appear every day. Deepening these studies, several published works have shown SarsCoV-2 infection to the installation of a prothrombotic state in hospitalized patients, which leads to the potential occurrence of thrombotic or arterial events in this cohort. Thus, in order to understand how the departments of Angiology and Vascular Surgery are acting in the context of the COVID-19 pandemic, this work aims to gather studies that reveal from protocols applied in vascular services in the current situation, until to the role of vascular surgeons and angiologists in the clinical and surgical management of patients infected or not, as a way of helping and clarifying this specialty during the context of a pandemic due to the new coranavirus. For the selection of works, the following search criteria were used: "Coronavirus and venous thrombosis", "Coronavirus and thrombosis", "COVID-19 and venous thrombosis" and "COVID-19 Coronavirus and thrombosis".
RESUMO A epidemia pelo novo Coronavirus (2019-nCoV), surgido na cidade de Wuhan, na China, em dezembro de 2019, quando sintomática, apresenta-se majoritariamente por um quadro de pneumonia pulmonar que é precedida por febre, tosse seca e mialgia. No entanto, conforme a doença se espalhou globalmente e o número de hospitalizações aumentaram de forma exponencial, notou-se que a maior parte dos pacientes graves internados por COVID-19 possuem alterações laboratoriais dignas de atenção, como linfopenia, neutrofilia, aumento do tempo de protrombina e elevação dos níveis de D-dímero. Devido tais mudanças se mostrarem cruciais para a taxa de mortalidade e morbidade nesse subgrupo de infectados, diversos trabalhos com enfoque na fisiopatologia, principalmente hematológica, da doença surgem a cada dia. Aprofundando em tais estudos, variados trabalhos publicados evidenciaram a infecção pelo Sars-CoV-2 à instalação de um estado pró-trombótico em pacientes hospitalizados graves, o que acarreta em potencial ocorrência de eventos trombóticos venosos ou arteriais nessa coorte. Assim, para entender como os Departamentos de Angiologia e Cirurgia Vascular estão atuando no contexto da pandemia de COVID-19, este estudo tem por objetivo reunir estudos que revelam desde protocolos aplicados nos serviços vasculares na atual conjuntura, até a atuação dos cirurgiões vasculares e angiologistas no manejo clínico e cirúrgico de pacientes infectados ou não, como forma de ajudar e esclarecer essa especialidade durante o contexto de pandemia pelo novo coronavírus. Para a seleção dos trabalhos foram utilizados os seguintes critérios de busca: "Coronavirus and venous thrombosis", "Coronavirus and thrombosis", "COVID-19 and venous thrombosis" e "COVID-19 Coronavirus and thrombosis".
Assuntos
Humanos , Pneumonia Viral/complicações , Embolia Pulmonar/virologia , Tromboembolia/virologia , Infecções por Coronavirus/complicações , Pandemias , Betacoronavirus , Pneumonia Viral/fisiopatologia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Tromboembolia/terapia , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Vasculares/normas , Coagulação Sanguínea/fisiologia , Protocolos Clínicos , Infecções por Coronavirus/fisiopatologia , SARS-CoV-2 , COVID-19RESUMO
Carotid-cavernous fistulas (CCFs) are an uncommon pathology in current neurosurgical practice. Furthermore, they generally present a challenge to the neurosurgeon because of both their deep location and the major neurovascular structures that surround them. CCFs consist of a vascular anomaly in which blood flows from meningeal branches of the internal and external carotid arteries, or directly from the internal carotid artery, into the venous circulation around and in the cavernous sinus. Twelve patients with direct and indirect/dural CCFs who underwent examination and treatment between July 2003 and February 2006 are reported here. All patients of this retrospective evaluation were symptomatic at the time of diagnosis, which was confirmed by cerebral angiography. The patients were treated by endovascular approaches and the CCFs were occluded. From our evaluation, we concluded that the endovascular procedure is safe, effective and minimally invasive in patients with CCF.
Assuntos
Artéria Carótida Interna/cirurgia , Fístula Carótido-Cavernosa/cirurgia , Seio Cavernoso/cirurgia , Embolização Terapêutica/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Adesivos/normas , Adesivos/uso terapêutico , Adolescente , Adulto , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/patologia , Fístula Carótido-Cavernosa/diagnóstico por imagem , Fístula Carótido-Cavernosa/patologia , Cateterismo/efeitos adversos , Cateterismo/métodos , Cateterismo/normas , Seio Cavernoso/diagnóstico por imagem , Seio Cavernoso/patologia , Angiografia Cerebral , Diagnóstico por Imagem , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Complicações Pós-Operatórias , Próteses e Implantes/normas , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/normasAssuntos
Aorta Torácica/cirurgia , Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Doença Aguda , Dissecção Aórtica/classificação , Aorta Abdominal/cirurgia , Aneurisma Aórtico/classificação , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Brasil , Doença Crônica , Humanos , Procedimentos Cirúrgicos Vasculares/normasRESUMO
OBJECTIVE: To analyze our experience in the surgical correction of transposition of the great arteries associated with aortic arch obstruction. METHOD: From January 1998 to December 2005 we performed 223 arterial switch operations for transposition of the great arteries; 21 (9.4%) patients had associated aortic arch obstruction. Aortic arch anatomy showed: localized aortic coarctation (n=10) and coarctation with hypoplastic aortic arch (n=6) and interrupted aortic arch (n=5). Ventricular septal defect was present in 19 (90.5%) patients. Size discrepancy between the aorta and pulmonary artery and complex coronary artery anatomy were common findings. Surgical correction was performed in either one (14) or two stages (7). Aortic arch reconstruction was achieved either by resection and extended anastomoses (13) or by relocation of the ascending aorta (8). RESULTS: Hospital mortality was 23.8% (n=5); with only one death (11.1%) among the last nine patients. Reoperations in the immediate post-operative period included: bleeding (5), residual ventricular septal defect and unrecognized coarctation (1) or residual stenosis of the aortic arch (1). There were two late deaths caused by fungal infections and reoperation for severe aortic regurgitation. Three patients underwent procedures to relieve right ventricular outflow tract obstruction. Two patients have slight to moderate aortic regurgitation. CONCLUSION: The surgical treatment of transposition of the great arteries with aortic arch obstruction is complex with high morbidity. Our present choice is one-stage treatment for all patients without using homologous or heterologous tissue for aortic arch reconstruction. We recommend resection and extended anastomoses for localized coarctation and relocation of the ascending aorta for hypoplastic or interrupted aortic arch.
Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Arteriopatias Oclusivas/cirurgia , Comunicação Interventricular/cirurgia , Transposição dos Grandes Vasos/cirurgia , Doenças da Aorta/complicações , Doenças da Aorta/mortalidade , Arteriopatias Oclusivas/complicações , Arteriopatias Oclusivas/mortalidade , Brasil/epidemiologia , Feminino , Seguimentos , Comunicação Interventricular/mortalidade , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias/mortalidade , Reoperação , Taxa de Sobrevida , Transposição dos Grandes Vasos/complicações , Transposição dos Grandes Vasos/mortalidade , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Vasculares/normasRESUMO
OBJECT: The aim of this study was to analyze cerebellar cavernous malformations (CMs) with respect to epidemiological, clinical, radiological, and therapeutic aspects. METHODS: Between 1984 and 2004, 100 patients were surgically treated for intracranial CMs at the Division of Neurosurgery of Federal University of Sao Paulo. The authors reviewed the records of 10 patients whose lesions were located in the cerebellum. There were four male and six female patients (ratio 1:1.5) whose ages ranged from 14 to 45 years (mean age 33 years). Clinical presentation was sudden or acute in all cases, and neuroimaging examinations performed in all patients demonstrated signs of bleeding. The mean size of the malformations was 4.6 cm, and in all but one patient the lesions were totally removed without complications. After a mean follow-up period of 70 months, all patients were considered to be in good or excellent clinical condition. CONCLUSIONS: Cerebellar CMs should be analyzed separately from other posterior fossa CMs. These lesions can reach large sizes and cause massive hemorrhages, resulting in acute or sudden presentation. Surgery is a safe and effective option that provides a curative treatment when a complete removal is achieved.
Assuntos
Neoplasias Cerebelares/cirurgia , Cerebelo/cirurgia , Veias Cerebrais/cirurgia , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Doença Aguda/terapia , Adolescente , Adulto , Distribuição por Idade , Neoplasias Cerebelares/diagnóstico , Neoplasias Cerebelares/fisiopatologia , Cerebelo/irrigação sanguínea , Cerebelo/fisiopatologia , Veias Cerebrais/anormalidades , Veias Cerebrais/patologia , Fossa Craniana Posterior/anatomia & histologia , Fossa Craniana Posterior/cirurgia , Diagnóstico por Imagem/normas , Progressão da Doença , Feminino , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico , Hemangioma Cavernoso do Sistema Nervoso Central/fisiopatologia , Humanos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/prevenção & controle , Hemorragias Intracranianas/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/normas , Estudos Retrospectivos , Distribuição por Sexo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/normasRESUMO
Cultures were made of the distal ends of 101 venous catheters removed from the same number of patients recently operated on for vascular disorders, and 7.9 per cent of the cultures were positive. The most frequently found germ was negative coagulase staphylococcus (4.9%). In these patients, 5.9 per cent of hemocultures were positive, the most frequent germ being positive coagulase staphylococcus (1.9%). There was no coincidence between the patients with positive hemocultures and those with positive cultures of the distal ends of the removed venous catheters. There were no infective or non-infective complications. Also, there no reports of early or late infection of the vascular prosthesis implanted on the patients operated on up to now.