Does early repair of small abdominal aortic aneurysms (AAAs) lead to faster aneurysm sac regression or less secondary intervention? Computed tomography scans and reconstructions from M2S of all patients undergoing endovascular AAA repair at our institution from 1996 to 2006 were retrospectively reviewed. A small aneurysm is defined as an aneurysm sac to renal diameter ratio of less than 2. There were 374 patients with endovascular AAA repair that had complete imaging studies. There were 75 patients (20%) with small AAAs; of those, 19 patients (25.3%) had endoleak compared with 108 patients (36.1%) with a large aneurysm ( P = .1). Over a mean follow-up time of 42 months (range, 1-109), 11 small AAAs (14.7%) had secondary interventions compared with 58 (19.4%) of the large AAAs (P = .41). Small AAAs at 5 years had a 2.5% volume sac regression but a 3.0% increase in diameter. Those with a large aneurysm had a slight increase in sac volume and diameter at 1 month (3.3%, 1.4%) and then steadily decreased to -13.4% and -8.8% at 5 years. Patients with Endologix (Endologix Inc., Irvine, Calif) devices have the most regression when compared with patients with AneuRx (Medtronic Inc., Minneapolis, Minn) and Talent (Medtronic Inc., Minneapolis, Minn) devices. Early endovascular intervention in small AAAs does not result in faster aneurysm sac regression or secondary intervention. Aneurysm sac regression is significantly affected by endoleak, aneurysm size, and device used.

OBJETIVO: Tratamento endovascular - angioplastia carotídea com stent (ACS) - tem se mostrado como opção atual no tratamento da estenose da artéria carótida em pacientes considerados de alto risco para endarterectomia de carótida (ECA). Este trabalho reporta a experiência do Instituto de Cirurgia Vascular e Endovascular (ICVE) de São Paulo nos casos de ACS em pacientes de alto risco. MATERIAL E MÉTODO: Foi realizado um estudo retrospectivo descritivo baseado na análise dos prontuários de 113 pacientes (84 homens e 29 mulheres) submetidos a 130 procedimentos de ACS pelo ICVE, no período de março de 2000 a junho de 2004. A idade média dos pacientes foi de 74 anos (variando de 51 a 86 anos). Os pacientes assintomáticos (55%) apresentavam estenose > 75%, enquanto nos sintomáticos (45%) as lesões encontradas foram > 70%. Foi indicado ACS nos seguintes pacientes: alto risco para ECA (45%), reestenose pós-ECA (15%), estenose carotídea severa bilateral (14%), oclusão da carótida contralateral (12%), bifurcação alta (no nível ou acima da segunda vértebra cervical) (6%), estenose pós-radioterapia (5%) e pescoço hostil (3%). As lesões encontradas localizavam-se na bifurcação carotídea (46%), carótida interna (32%), origem da artéria carótida comum (9%), tronco braquiocefálico (8%) e artéria carótida comum (5%). RESULTADO: Foi observado um total de sete eventos neurológicos (cinco casos de acidente vascular encefálico e dois pacientes que apresentaram ataque isquêmico transitório). A taxa de óbito foi de 0%. A taxa total de complicações (acidente vascular encefálico, acidente isquêmico transitório, óbito) foi de 5,3%. CONCLUSÃO: ACS demonstrou ser um procedimento com baixa taxa de complicações, sendo uma opção segura e eficaz nos pacientes de alto risco para ECA.

No abstract

Angiolymphoid Hyperplasia with Eosinophilia (ALHE) is a benign vascular proliferative disorder with uncertain etiology and pathogenesis. The aim of this paper is to report a case of ALHE in the temporal artery and discuss the general aspects of this pathology. A 29-year-old female black patient sought the Vascular Surgery Outpatient Service, complaining of bulging in the right temporal region, associated with pain and local discomfort. Physical examination revealed pulsatile bulging in the right temporal region measuring approximately 2.5 × 1.5 cm. Nuclear Magnetic Resonance showed an expansive fusiform lesion in the superficial soft parts of the right temporal region, measuring 2.9 cm in the longest longitudinal axis. Surgical excision proved to be the best therapeutic option for the patient in this case. Histopathological sections showed the proliferation of vessels of different sizes, covered by swollen endothelium, prominent inflammatory infiltrate composed of lymphocytes, plasma cells, eosinophils, and scarce histiocytes. Immunohistochemical analysis of the lesion showed positivity for CD31, corroborating the diagnosis of ALHE.

ResumoContexto: O tratamento cirúrgico da reestenose carotídea apresenta alta taxa de lesão neurológica. Contrariamente, o tratamento endovascular da doença obstrutiva carotídea extracraniana tem se tornado mais factível e gradualmente menores taxas de risco cirúrgico vêm sendo reportadas, tornando-se uma opção em situações especiais, e provavelmente poderá ser considerado o tratamento padrão para reestenose carotídea. Objetivos: Avaliar a aplicabilidade, a segurança e a eficácia da angioplastia com o uso do stent (ACS) no tratamento da reestenose carotídea (REC) no intraoperatório e no pós-operatório recente (<30 dias). Métodos: Análise retrospectiva dos pacientes portadores de reestenose carotídea submetidos à angioplastia com stent no período de março 2000 a junho de 2004. Resultados: Foram analisados 19 pacientes com reestenose carotídea. Quatorze pacientes (74%) eram do sexo masculino, com média de idade de 74 anos. Quinze (79%) eram assintomáticos com estenose >80%, enquanto quatro (21%) eram sintomáticos com estenose >70%. Apenas em um paciente não foi utilizado sistema de proteção cerebral. O sucesso técnico foi obtido em todos os casos. Não houve morte ou acidente vascular encefálico no intra ou no pós-operatório recente (30 dias). Conclusão: O tratamento endovascular da reestenose carotídea mostrou-se uma abordagem factível e segura em curto prazo.Palavras-chave: Doenças das artérias carótidas; angioplastia com balão; estenose das carótidas. AbstractContext: The surgical treatment of carotid artery restenosis presents a high risk of nerve injury. On the contrary, endovascular treatment for extracranial carotid artery obstructive disease has become more feasible. Gradually, lower rates of surgical risk have been reported, which makes the treatment a good option in special situations. It may be considered as the standard treatment for carotid artery restenosis. Objective: To evaluate the applicability, safety, and efficacy of the angioplasty with the use of a stent (Carotid Artery Stenting -CAS) for the treatment of carotid artery restenosis, in the intraoperative and early (<30 days) postoperative period. Methods: Retrospective analysis of patients with carotid artery restenosis who have undergone stenting angioplasty from March 2000 to June 2004. Results: Nineteen patients with carotid artery restenosis were analyzed. Fourteen (74%) patients were male, with a mean age of 74 years. Fifteen (79%) patients were asymptomatic, with stenosis >80%, whereas 4 (21%) were symptomatic with stenosis >70%. In only one patient a cerebral protection system was not used. Technical success was achieved in all cases. There was no death or stroke in the intraoperative or the early postoperative period (30 days). Conclusion: Endovascular treatment of carotid artery restenosis seems to be a feasible and safe approach in the short term.

6-month group. Overall, fatal and nonfatal VTE during and after treatment occurred in 8% of those receiving 3 months of anticoagulation (n ϭ 31) and in 8% of those receiving 6 months anticoagulation (n ϭ 29; P ϭ .80; 95% confidence interval [CI] difference, -3.1% to 4.7%). No patients in either group had a fatal hemorrhage during treatment, but there were eight major hemorrhages in those treated for 6 months and none in those treated for 3 months (P ϭ .008; 95% CI, -3.5% to -0.7%). Adverse events occurred in 8% of the patients receiving 3 months of anticoagulation (n ϭ 31) and in 9% of the patients receiving 6 months of anticoagulation (n ϭ 35; P ϭ .79, 95% CI -4.9% to 3.2%).Comment: The data with regard to the hard end points in this study-death from VTE or major hemorrhage-are likely reliable. The data with respect to recurrence, extension, or failure to resolve VTE are likely highly unreliable because they were derived from review forms completed by clinicians at each individual site, without specific requirements for imaging during follow-up. Indeed, the idea that the DVT resolved in Ͼ95% of the patients treated with oral anticoagulation is completely disparate with regard to the findings of serial imaging studies in patients with DVT. The authors also provide no information about possible postphlebitic syndrome in their patients. Follow-up is too short for such an analysis. Overall, the study indicates no difference in death from VTE with 3 or 6 months of anticoagulation in a patient with VTE and unidentified risk factors. The data are not sufficient to conclude that there is no difference in recurrence of VTE with the two treatment paradigms. Heritability of Platelet Responsiveness to Aspirin in ActivationPathways Directly and Indirectly Related to Cyclooxygenase-1 Faraday N, Yanek LR, Mathias R, et al. Circulation 2007;115:2490-6.Conclusion: There is a genetic basis to variability in residual platelet function after aspirin exposure.Summary: It is known that the inability of aspirin to suppress platelet function can be associated with future risk of myocardial infarction, stroke, and cardiovascular death. The authors sought to determine if there was genetic variation that could be linked to insufficient aspirin responsiveness.Aspirin responsiveness was assessed in 1880 asymptomatic patients. The mean age was 44 Ϯ 13 years, and 58% were women. Patients were recruited from 309 white and 208 black families with premature coronary heart disease. Platelet function was determined ex vivo before and after ingestion of aspirin (81 mg/d for 2 weeks). Platelet function was determined with a panel of tests assessing platelet activation in pathways indirectly and directly related to cyclooxygenase-1 (COX-1). Multivariable regression analysis was also used to determine the proportion of phenotypic variance related to coronary heart disease risk factor covariates.Arachidonic acid-induced thromboxane B 2 production was inhibited by Ͼ99% with aspirin (P Ͻ .0001). Platelet activation by pathways indirectly related to COX-1...