This study aimed to investigate the natural course of the contralateral carotid artery atherosclerotic disease after patients were treated with carotid endarterectomy (CEA). Identifying the incidence of the development of a new contralateral carotid artery lesion and its association with potential clinical risk factors constitutes our end points.

Advent of antiretroviral therapy has increased survival of patients with human immunodeficiency virus (HIV) infections, with the result that some of these patients now develop degenerative diseases, such as atherosclerotic aneurysms.Degenerative thoracoabdominal aortic aneurysm is rare in HIV patients.In this report, a 63-year-old male patient with HIV submitted to open repair of thoracoabdominal aortic aneurysm.The patient did not suffer any type of complication in the perioperative period and remained well in a 28-month follow-up period.In summary, open repair still remains a good alternative for aortic complex aneurysms even in HIV patients.

PURPOSE:To evaluated the role of oxidative stress on aging process in patients submitted to carotid endarterectomy.METHODS:Twenty patients were divided into two groups: older group (≥ 70 years old); and the younger group (< 70 years old). We evaluated the reactive oxygen species (ROS) concentration, nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase, superoxide dismutase (SOD) and catalase (CAT) activities as so as nitrite levels in fragments of carotid arteries harvested during carotid endarterectomy for treatment of high grade carotid stenosis.RESULTS:We observed a higher levels of ROS and NADPH oxidase activity in the older group (p<0.05). Furthermore, the nitrite concentration was lower in the older group (14.55 ± 5.61 x 10-3 versus 26.42 ± 8.14 x 10-3 µM; p=0.0123). However, the activities of antioxidant enzymes (CAT and SOD) were similar in both the groups.CONCLUSIONS:: Arterial aging is associated with increased concentrations of oxygen species and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity as so as nitrite reduction in human carotid artery specimens. Maybe therapies that block NADPH oxidase activity and enhance nitrite stores would be a good strategy to reduce the effect of oxidative stress in arterial aging.

We report a case of a ruptured aneurysm of the celiac trunk in a 32-year-old, male patient with Behçet Disease (BD). Aneurysm resection was performed and the patient is well during a follow up of 32 months. To our knowledge, this is the first reported case of a ruptured celiac trunk aneurysm successfully treated in a patient with BD. RESUMO Relatamos o caso de um aneurisma roto do tronco celíaco em um paciente de 32 anos, do sexo masculino, portador de Doença de Behçet (DB). A ressecção do aneurisma foi realizada e o paciente está bem, com acompanhamento de 32 meses. Até onde sabemos, este é o primeiro caso relatado de um aneurisma do tronco celíaco roto tratado com sucesso em um paciente com DB.

Introduction:Oxidative stress seems to be a role in the atherosclerosis process, but research in human beings is scarce.Objective:To evaluate the role of oxidative stress on human aortas of patients submitted to surgical treatment for advanced aortoiliac occlusive disease.Methods:Twenty-six patients were divided into three groups: control group (n=10) formed by cadaveric organ donors; severe aortoiliac stenosis group (patients with severe aortoiliac stenosis; n=9); and total aortoiliac occlusion group (patients with chronic total aortoiliac occlusion; n=7). We evaluated the reactive oxygen species concentration, nicotinamide adenine dinucleotide phosphate-oxidase, superoxide dismutase and catalase activities as well as nitrite levels in samples of aortas harvested during aortofemoral bypass for treatment of advanced aortoiliac occlusive disease.Results:We observed a higher level of reactive oxygen species in total aortoiliac occlusion group (48.3±9.56 pmol/mg protein) when compared to severe aortoiliac stenosis (33.5±7.4 pmol/mg protein) and control (4.91±0.8 pmol/mg protein) groups (P<0.05). Nicotinamide adenine dinucleotide phosphate oxidase activity was also higher in total aortoiliac occlusion group when compared to the control group (3.81±1.7 versus 1.05±0.31 µmol/min.mg protein; P<0.05). Furthermore, superoxide dismutase and catalase activities were significantly higher in the severe aortoiliac stenosis and total aortoiliac occlusion groups when compared to the control cases (P<0.05). Nitrite concentration was smaller in the severe aortoiliac stenosis group in comparing to the other groups.Conclusion:Our results indicated an increase of reactive oxygen species levels and nicotinamide adenine dinucleotide phosphate-oxidase activity in human aortic samples of patients with advanced aortoiliac occlusive disease. The increase of antioxidant enzymes activities may be due to a compensative phenomenon to reactive oxygen species production mediated by nicotinamide adenine dinucleotide phosphate oxidase. This preliminary study offers us a more comprehensive knowledge about the role of oxidative stress in advanced aortoiliac occlusive disease in human beings.

ResumoAneurismas primários da veia ilíaca são extremamente raros e podem complicar com trombose, embolia pulmonar ou ruptura. Acredita-se que existam apenas 14 casos descritos na literatura. Neste artigo, descrevemos um caso de um jovem de 25 anos, que apresentava edema e cianose do membro inferior esquerdo. A ecografia vascular revelou uma massa cística em fossa ilíaca esquerda. A angiotomografia confirmou o diagnóstico de um aneurisma da veia ilíaca externa esquerda de 3,8 cm, no maior diâmetro. O paciente foi submetido ao tratamento cirúrgico através da ressecção do aneurisma seguida de venorrafia longitudinal. Teve boa evolução pós-operatória, com um seguimento clínico de 44 meses. Houve uma melhora do edema no membro inferior esquerdo, sem complicações tardias.

Primary external iliac vein aneurysms are rare and can be complicated by thrombosis, pulmonary embolism, or rupture. To date, there are only 14 cases reported in the literature. In this paper we report a case of a 25-year-old man who presented with left lower limb edema and cyanosis. Vascular ultrasonography revealed a cystic tumor in the left iliac fossa. Computed tomography angiography confirmed that the finding was an external iliac vein aneurysm, measuring 3.8 cm at its largest diameter. The patient underwent surgical treatment with resection followed by longitudinal venorrhaphy, with no complications. After the procedure left limb symptoms improved. The patient has exhibited no late complications over 44 months of follow-up.

PURPOSE: To evaluated the effects of L-arginine (a NO donor) and L-NAME (Nw-nitro-L-arginine methyl ester -a NOS inhibitor) on ischemia-reperfusion in rat livers.METHODS: One hundred fifty two male Wistar rats were divided into four groups: control (simulated surgery); hepatic IR; pretreatment with L-arginine plus hepatic IR; and L-NAME plus hepatic IR. The hepatocellular damage was evaluated at the first, third and seventh days after the procedures through the alanine-aminotransferase (ALT) and aspartate-aminotransaminase (AST) levels, as well as histopathological features: vascular congestion (VC); steatosis (STE); necrosis (NEC); and inflammatory infiltration (INF). The mortality rate was also evaluated.RESULTS: The pretreatment with L-NAME significantly worsened the AST levels after hepatic IR (p<0.05) at first day and L-arginine demonstrated an attenuating effect on ALT levels at seventh day (p<0.05). Furthermore, the administration of L-arginine was able to reduce the VC and STE in the seventh day after hepatic IR (p<0.05). The analysis of the mortality rates did not demonstrate any difference between the groups. Nevertheless, there was not effect of L-arginine and L-NAME on the mortality of the animals.CONCLUSION: L-arginine/NO pathway has a role in the hepatic IR because the pretreatment with L-arginine partially had attenuated the hepatocellular damage induced by hepatic IR in rats.

BACKGROUND: Chronic aortoiliac occlusion (CAIO) is a significant cause of lower limb ischemia and is often found in young patients who smoke. OBJECTIVE: To review recent results achieved treating CAIO patients with open surgery. METHODS: From November 2011 to April 2014, 21 patients with CAIO were treated at the Santa Casa de Misericórdia, Porto Alegre, Brazil. Demographic data, comorbidities, clinical presentation and surgical results were analyzed. RESULTS: Eleven women and ten men were treated with direct aortic bypass (DAB; n=18) or with extra-anatomic bypass (EAD; n=3). Mean age was 53.7 ± 7.3 years (range: 43-79 years) and all patients smoked. Thirteen patients (62%) had critical ischemia. Six of the patients treated with DAB (33.4%) also required additional revascularization (3 renal and 3 femoropopliteal procedures). Perioperative mortality was zero. Four patients (22.2%) suffered transitory renal dysfunction, but only one patient (5.6%) required hemodialysis. Median follow-up time was 17 months (range: 2-29 months) and there was just one late death, from ischemic heart disease, 7 months after the surgery on the abdominal aorta. CONCLUSIONS: Aortic reconstruction is a safe method for treating patients with CAIO, with low perioperative morbidity and mortality rates.

A 42-year-old man presented with acute abdominal pain. He was normotensive and had no history of smoking, diabetes, surgeries, or trauma, but had hypertension controlled with one drug. There was no family history of vascular disease. The physical examination revealed hypersensibility in the lower abdomen, without any palpable mass. Femoral and distal pulses were normal. Ultrasound imaging revealed ectasia of the right common iliac artery (RCIA) and wall hematoma but no free fluid in the abdominal cavity. Computed tomography angiography (CTA) showed a slightly dilated RCIA and dissection from the RCIA to the distal abdominal aorta (retrograde dissection; A/Cover). The patient was placed under general anesthesia, and a transperitoneal approach was initiated. An extensive hematoma and inflammatory reaction were seen next to the anterior wall of the aorta and the RCIA. The site of the RCIA dissection was the iliac bifurcation extending to the distal abdominal aorta. The arterial wall was extremely thin and fragile and was reconstructed using a bifurcated polytetrafluoroethylene graft (B). Histology revealed myxoid degeneration and fragmentation of the elastic fibers of the RCIA. Control CTA imaging on postoperative day 6 did not reveal any problems (C), and the patient was discharged on postoperative day 7 without complications. At 50 days postoperatively, the patient was doing well. Spontaneous and retrograde dissection of the iliac artery is rare. Some etiologic factors are connective tissue disorders, fibromuscular dysplasia, trauma, atheromatous ulcer, and medial degeneration.1Honjo O. Yamada Y. Kuroko Y. Kushida Y. Une D. Hioki K. Spontaneous dissection and rupture of common iliac artery in a patient with fibromuscular dysplasia: a case report and review of the literature on iliac artery dissections secondary to fibromuscular dysplasia.J Vasc Surg. 2004; 40: 1032-1036Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 2Uchino A. Satoh Y. Ohno M. Spontaneous retrograde dissection of the right common iliac artery: a case report.Radiat Med. 1988; 6: 117-119PubMed Google Scholar, 3Barker S.G. Burnand K.G. Retrograde iliac artery dissection in Marfan's syndrome A case report.J Cardiovasc Surg (Torino). 1989; 30: 953-954PubMed Google Scholar Our patient met no diagnostic criteria for Marfan syndrome and had no history of trauma, angiographic evidence of fibromuscular dysplasia, or aortoiliac calcifications to develop an atheromatous ulcer, but he had a histologic diagnosis of myxoid degeneration of the media. Isolate iliac dissection may be asymptomatic or may cause abdominal and groin pain or lower limb ischemia, defined as sudden intermittent claudication or lower limb pain at rest.1Honjo O. Yamada Y. Kuroko Y. Kushida Y. Une D. Hioki K. Spontaneous dissection and rupture of common iliac artery in a patient with fibromuscular dysplasia: a case report and review of the literature on iliac artery dissections secondary to fibromuscular dysplasia.J Vasc Surg. 2004; 40: 1032-1036Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 2Uchino A. Satoh Y. Ohno M. Spontaneous retrograde dissection of the right common iliac artery: a case report.Radiat Med. 1988; 6: 117-119PubMed Google Scholar Prompt diagnosis and treatment of the iliac dissection avoids complications such as progression of the dissection, iliac occlusion, and rupture.1Honjo O. Yamada Y. Kuroko Y. Kushida Y. Une D. Hioki K. Spontaneous dissection and rupture of common iliac artery in a patient with fibromuscular dysplasia: a case report and review of the literature on iliac artery dissections secondary to fibromuscular dysplasia.J Vasc Surg. 2004; 40: 1032-1036Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar Some patients may receive conservative treatment.2Uchino A. Satoh Y. Ohno M. Spontaneous retrograde dissection of the right common iliac artery: a case report.Radiat Med. 1988; 6: 117-119PubMed Google Scholar There is no standardized technique to treat retrograde iliac dissections, but open surgery may be performed with resection of the dissected artery and prosthetic graft insertion.1Honjo O. Yamada Y. Kuroko Y. Kushida Y. Une D. Hioki K. Spontaneous dissection and rupture of common iliac artery in a patient with fibromuscular dysplasia: a case report and review of the literature on iliac artery dissections secondary to fibromuscular dysplasia.J Vasc Surg. 2004; 40: 1032-1036Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 3Barker S.G. Burnand K.G. Retrograde iliac artery dissection in Marfan's syndrome A case report.J Cardiovasc Surg (Torino). 1989; 30: 953-954PubMed Google Scholar Endovascular techniques might also be useful in similar cases.

Background: Abdominal aortic aneurysms (AAA) are rare in

CONTEXTO: A presença de aneurisma da aorta abdominal (AAA) é rara em pacientes jovens. OBJETIVO: Avaliar os resultados da cirurgia do AAA em pacientes com idade < 50 anos. MÉTODOS: De junho de 1979 a janeiro de 2008, 946 pacientes foram operados eletivamente do AAA infrarrenal pelo primeiro autor. Desses, 13 pacientes (1,4%) tinham idade < 50 anos no momento da cirurgia. Foram analisadas as características demográficas e cirúrgicas bem como os resultados precoces e tardios da cirurgia nesses pacientes. RESULTADOS: A média de idade foi 46±3,4 anos (variando de 43 a 50 anos), sendo a maioria homens (76,9%), hipertensos (76,9%) e tabagistas (61,5%). Não ocorreu nenhum óbito perioperatório, e a morbidade cirúrgica atingiu dois pacientes (15,4%) (um paciente com infecção respiratória e outro com angina instável). O seguimento mediano foi de 85,5 meses, ocorrendo dois óbitos devido a cardiopatia isquêmica em um paciente e acidente vascular cerebral em outro, durante o seguimento. CONCLUSÃO: A cirurgia do AAA é um procedimento seguro com bons resultados a longo prazo, pois, em nosso estudo, apresentou mortalidade perioperatória nula e boa sobrevida a longo prazo.

We report a case of lower limb critical ischemia associated with chemotherapy with gemcitabine. This report presents a case of a 68-year-old man who underwent pancreatoduodenectomy due to pancreas tumor. One month later, the patient was submitted to four chemotherapy sessions with gemcitabine for 1 month. In addition, 30 days later he developed symptoms of peripheral arterial obstructive disease, and critical ischemia of the right lower limb 2 weeks later. An imaging study showed diffuse arterial disease associated with femoropopliteal occlusion and poor distal bed. The patient was submitted to a revascularization procedure, which was unsuccessful due to local conditions, resulting in above-knee amputation.

INTRODUCTION:Traumatic rupture of the thoracic aorta (TRTA) is a life-threatening condition usually caused by deceleration mechanism following vehicle accidents.OBJECTIVE:To report our experience with the conventional surgical treatment of TRTA and its long-term results.PATIENTS AND METHODS:We reviewed five patients assisted in our Service between 1990 to 2006. Four of them underwent the conventional surgical treatment and the remaining patient was submitted to an endovascular approach, by other surgeon due to high-risk comorbidities. We evaluated the perioperative morbity and mortality, as well as the long-term results.RESULTS:All the four cases were male, aged between 21 and 54 years old. Three patients were victims of vehicle accidents and one patient reported a fall from a stair. Two patients were operated on in the acute fase of TRTA (5 and 17 days) and another two patients had delayed treatment (4 months and 10 years later). No death or permanent neurologic deficits were noticed. One patient had temporary parestesias of lower limbs with complete recover in three weeks. The follow-up duration was one to 16 years; no deaths, reinterventions or other complications were observed.CONCLUSION:Although the small number of patients of the present series, we would like to stress the quality of long-term results of the surgical management of TRTA, undertaken in young patients, with a long-life expectancy.

Nas cirurgias vasculares periféricas, as cefalosporinas têm seu uso consagrado como agente antimicrobiano profilático de escolha. Recentemente, observamos uma mudança nos padrões de colonização, prevalência de patógenos e suscetibilidade geral aos antimicrobianos. Os patógenos multirresistentes vêm se tornando cada vez mais freqüentes nas infecções de ferida cirúrgica vascular, demonstrando variações regionais e locais quanto à suscetibilidade aos antimicrobianos profiláticos utilizados na rotina cirúrgica. Os dados e a literatura disponível até o momento demonstram que não existe evidência suficiente para uma mudança na rotina profilática perioperatória. Entretanto, devemos levar em consideração os padrões regionais e institucionais de prevalência de patógenos resistentes e padrões de suscetibilidade aos antimicrobianos para estabelecer guias e orientações específicas para a utilização de antimicrobianos profiláticos alternativos.

Este estudo tem por objetivo relatar um caso de isquemia crítica de membro inferior associada a quimioterapia com gemcitabina. O relato descreve o caso de um paciente de 68 anos submetido a duodenopancreatectomia devido a tumor no pâncreas. Um mês depois da operação, o paciente realizou quatro sessões de quimioterapia com gemcitabina, durante um mês. Após 30 dias, o paciente desenvolveu sintomas de doença arterial obstrutiva periférica, e duas semanas depois, isquemia crítica do membro inferior direito. O exame por imagem demonstrou doença arterial difusa associada à oclusão femoropoplítea com reenchimento distal precário. O paciente foi submetido a uma tentativa de revascularização que, devido às condições locais, foi malsucedida, resultando na amputação do membro no nível da coxa.

INTRODUCTION:Stenosis of the renal artery is frequent in patients with atherosclerotic aortic disease.OBJECTIVE:To evaluate the surgical results of renal revascularization concomitant to the abdominal aortic aneurysm (AAA) repair.PATIENTS AND METHODS:Between April 1986 and August 2006, 783 patients were submitted to the infrarenal AAA elective repair by the first author. Of these, 24 patients (3%) were submitted to concomitant renal revascularization to the AAA repair. We analysed the demographics, surgical data and the survival through the long term results.RESULTS:Sixteen patients were male (66,7%), with average age of 69,4 + 6,4 years (range, 54 to 78 years), with the majority hypertensive (62,5%) and smokers (54,2%). Nine patients (37,5%) had previous renal insufficiency (creatinine levels > 2mg/dL). Surgical indication was due to aortic aneurismatic disease in all cases. The renal procedures were unilateral in 18 patients (75%) and bilateral in 6 (25%). Occurred two deaths (8,3%) and morbidity of 25% (6/24). The mean of survival time was 53 +/- months and the estimated 5 year survival was 41,7%.CONCLUSION:In our study, renal revascularization concomitant to AAA repair revealed acceptable mortality (8,3%), despite the high risk of our patients (previous renal dysfunction). Furthermore, the long term survival in our patients was comparable to that of patients with renal insufficiency submitted to AAA repair.