Background: Whether they are defined as minor or major, lower limb amputations constitute a severe health problem, causing high rates of morbidity and mortality and considerable social impact. Different patient clinical characteristics appear to be related to different types of amputations. Objectives: To analyze risk factors present in patients who underwent lower limb amputations at a tertiary hospital. Methods: This was a retrospective, cross-sectional study of 109 patients who underwent lower limb amputations over a period of 31 months, analyzing gender, age, 15 clinical data and five laboratory parameters present at the time of admission. Data were treated with descriptive statistics and compared using Student' s t test for unpaired samples (for numerical variables), the Mann-Whitney test, or Fisher' s exact tests (for categorical variables). Results: There were 59 major and 50 minor amputations out of a total of 109 performed. The majority of patients were male (65%) and mean age was 65 years (range 39 to 93). Risk factors that were statistically (p < 0.05) more related to major amputations were advanced age, stroke, ischemia, sepsis, and low hemoglobin and hematocrit levels. Diabetes mellitus, neuropathy, and palpable distal pulses were factors more strongly associated with minor amputations. Conclusions: Lower limb amputations at different levels are related to different risk factors. Ischemia of greater severity and morbidity was associated with major amputations, while neuropathy and preserved perfusion were more often related to minor amputations.

O pseudoaneurisma de artéria mesentérica superior é uma doença rara, porém com alta taxa de ruptura e mortalidade. Sua etiologia geralmente é infecciosa e comumente o diagnóstico é feito por meio de achado nos exames de imagem. Historicamente, seu tratamento de eleição tem sido o reparo cirúrgico aberto; entretanto, é associado a inúmeras complicações e dificuldades técnicas. Relatamos um caso de pseudoaneurisma de artéria mesentérica superior em um paciente portador de abscesso hepático no qual, após resolução do processo infeccioso, foi empregado, com sucesso, um tratamento minimamente invasivo endovascular, com implante de micromolas e stent não-recoberto.

Background: Ultrasound-guided polidocanol foam sclerotherapy is used to treat patients with venous ulcers. It is a minimally invasive procedure and is simple to perform, but it has high relapse rates. Objectives: To report short to medium term results in patients with venous ulcers treated using ultrasound-guided polidocanol foam sclerotherapy. Methods: A sample of 19 patients who had been treated with ultrasound-guided polidocanol foam sclerotherapy between January 2013 and December 2014 were followed-up. Time taken for ulcers to heal, improvement of clinical symptoms, recanalization of treated veins, and relapse of symptoms and of venous ulcers were analyzed. Results: Fifteen of the patients analyzed were female (78.9%) and four were male (21.1%). Overall mean age was 53 years. Follow-up times ranged from 448 days to 1,276 days (mean of 791 days). The mean duration of active ulcers was 53 months. At postoperative follow-up assessments, total recanalization was observed in 15.7%, partial recanalization in 21%, and occlusion in 47.3% of the veins that had been treated. There was only one case of ulcer relapse. Analysis of mean Venous Clinical Severity Scores (VCSS) revealed a significant difference from before to after the procedure, with a variation of 11.2 (p < 0.01). Conclusions: Ultrasound-guided foam sclerotherapy has high rates of therapeutic success and achieves high rates of venous ulcer healing.

Background: Hybrid procedures for the treatment of complex thoracic aortic diseases (CTAD) require the revascularization of one or more supra-aortic arteries, followed by the deployment of one or more aortic endoprosthesis, with lower morbidity and mortality compared to conventional surgery.Objectives: To evaluate the technique and results of hybrid procedures for CTAD.Methods: During two years, 12 patients with CTAD underwent hybrid procedures, including aortic arch aneurysms and acute Stanford A and B aortic dissections. All patients had formal indications to invasive treatment, and inadequate proximal landing zone (less than 20 mm). Half were male and the mean age was 55.5 years (42 to 78). At least three cardiovascular risk factors were present in 75% of patients. The average follow-up was 10.9 months (2 to 25), with periodic consultations and CT scans. Results:The initial technical success was achieved in 10 patients. Bypasses of supra-aortic vessels were performed in a surgical environment and endovascular procedures in an interventional radiology facility. "Through-and-through" technique was used in six patients. INGRUND, JC ET AL -Hybrid procedures for complex thoracic aortic diseasesRev Bras Cir Cardiovasc 2010; 25(3): 303-310 procedures are linked to relevant incidence of paraplegia (6% to 11%) and cerebrovascular accident (3% to19%) [10].Although endovascular treatment of originated and confined lesions to the descending and abdominal aorta represent an important advance in medical practice, the repair of CTDA is difficult as a result of the necessity of surgical intervention in one or more supra-aortic trunks [11,12]. This approach is necessary in order to increase the zone of proximal anchor stent, while preserving the upper limbs and cerebral blood flow. In contrast, recent technological advances in making these devices allowed the treatment of lesions with complex anatomy, previously considered contraindicated for endovascular treatment [13]. The three-dimensional knowledge of anatomy and the involvement of its branches are crucial for the hybrid treatment planning, especially for the aortic arch. The open anatomical surgeries (in-situ) and extra-anatomic revascularization of the supra-aortic trunks provide a proximal segment of the aorta free from disease suitable for anchoring the stent.This study was conducted with the purpose of exposing the hybrid correction results of CTDA, in terms of immediate and medium-term results and its complications. METHODSIt is about longitudinal, retrospective and observational case series. From

embolization of giant uterine fibroids is a feasible procedure with acceptable clinical and radiological outcomes. It can be considered an option for patients who desire to preserve the uterus, and it may serve as adjuvant therapy for high-risk myomectomy.

IntroductionPerforator veins (PVs) play an important role in the development of chronic venous insufficiency and ulceration. Procedures to eliminate incompetence and reflux in PV may include open surgery, subfascial endoscopic surgery, intravenous ablation techniques and sclerotherapy. With the aim of filling the evidence gap, this is a protocol for a systematic review that will assess the effects of any form of intervention for the treatment of pathologic PVs of the lower limbs in patients with chronic venous disease.Methods and analysisSystematic searches will be carried out in MEDLINE, EMBASE, Cochrane CENTRAL, IBECS and LILACS databases at a minimum without date or language restrictions for relevant randomised controlled trials (RCTs) and quasi-RCTs (trials in which the method of allocation is not truly random). In addition, a search will also be carried out in the WHO International Clinical Trials Registry Platform, in the clinical trial registries of ClinicalTrials.gov and in the grey literature source OpenGrey.eu. The RCT and quasi-RCT comparison techniques isolated or in combination for treating PVs will be considered. Three review authors will independently perform data extraction and quality assessments of data from included studies, and any disagreements will be resolved by discussion. The primary outcomes will be wound healing and pain. Secondary outcomes will include oedema, adverse events, recurrence or recanalisation, quality of life and economic aspects. The Cochrane handbook will be used for guidance. If the results are not appropriate for a meta-analysis in RevManV.5 software (eg, if the data have considerable heterogeneity and are drawn from different comparisons), a descriptive analysis will be performed.Ethics and disseminationEthics committee approval is not necessary. We intend to update the public registry used in this review, report any important protocol amendments and publish the results in a widely accessible journal.PROSPERO registration numberCRD42018092974

Resumo Contexto Os cateteres venosos centrais para hemodiálise (CVCH) de curta permanência (CCP) e cateteres tunelizáveis de longa permanência (CTLP) são fundamentais para a terapia hemodialítica. Entretanto, há escassa casuística nacional acerca da incidência de complicações desses dois tipos de cateteres. Objetivos Analisar as complicações e tempo de duração de CVCHs em centro de hemodiálise de hospital de ensino. Métodos Foi feito um estudo unicêntrico, longitudinal e retrospectivo de 115 pacientes consecutivos submetidos a implante de cateteres para hemodiálise (67 CCP e 48 CTLP) em um período de 2 anos, com análise de sobrevida geral, perviedade, perda do acesso e incidência de complicações. Resultados Sessenta por cento eram do sexo masculino e a média de idade foi de 62 anos. O principal sítio de punção foi a veia jugular interna direita. Hipertensão arterial sistêmica estava presente em 95% dos casos. A mediana de permanência do cateter foi de 50 dias (CCP) versus 112 dias (CTLP; p < 0,0001). Não houve diferença na sobrevida global. Infecção relacionada ao cateter apresentou maior incidência nos CCP, sendo Staphylococcus sp. o microrganismo mais encontrado. A taxa de infecção por 1.000 dias foi maior nos CCP em relação aos CTLP (16,7 eventos/1.000 dias versus 7,0 eventos/1.000 dias, respectivamente). Baixa renda foi o único fator relacionado a maior incidência de infecção. Conclusões O tempo de permanência dos CTLP foi significativamente maior que os CCP, porém ainda assim abaixo dos valores relatados na literatura e sem impacto na sobrevida global. Baixa renda foi um fator associado a infecção de cateter.

RESUMOIntrodução: Os aneurismas de artérias ilíacas (AAI) isolados são condições raras, ocorrendo em somente 1% dos aneurismas periféricos. O tratamento endovascular é atualmente a opção de escolha à cirurgia aberta, porém ainda é sujeito a complicações no intra e pós-procedimento. Relato: Sexo masculino, 77 anos, hipertenso, portador de AAI comuns simultâneos foi submetido à correção endovascular através de implante de extensões ilíacas de endopróteses de aorta abdominal e embolização da artéria ilíaca interna esquerda. Após 50 dias houve trombose de todo o segmento ilíaco esquerdo e embolização distal. Realizada fibrinólise intra-arterial (sem sucesso), implante de stents auto expansíveis no segmento ilíaco esquerdo e trombectomia através de acesso femoral superficial. O paciente manteve-se assintomático, sem sequelas neurológicas, com pulso distal presente após um ano de acompanhamento. Conclusão: O tratamento endovascular dos AAI e a correção de suas complicações através de técnicas híbridas são opções factíveis, com bons resultados a curto e médio prazo.Palavras-chave: Aneurisma ilíaco, Angiografia digital, Implante de prótese vascular.ABSTRACT Introduction: Isolated iliac arteries aneurysms (IAA) are rare conditions, occurring in only 1% of all peripheral aneurysms. Endovascular treatment is currently the preferred method compared to open surgery, but  it is still prone to intra- and post-procedure complications. Case report: Male, 77 years, hypertension, with simultaneous common isolated IAA, underwent endovascular repair through implantation of two iliac extensions of abdominal aortic stent graft, and coil embolization of the left internal iliac artery. After 50 days thrombosis of the entire left iliac segment and distal embolization was observed. Intra-arterial fibrinolysis was performed (unsuccessfully), followed by implantation of self-expanding stents in the left iliac segment and thrombectomy through superficial femoral access. The patient remained asymptomatic without neurological sequelae, with palpable distal pulses after one year of follow-up. Conclusion: Endovascular treatment of IAA and treatment of its complications through hybrid techniques are feasible options, with good results in the short and medium-term.Keywords: Iliac aneurysm, Digital subtraction angiography, Blood vessel prosthesis implantation