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Wolosker N, Portela FSO, Louzada ACS, Galastri FL, Affonso BB, Nasser F. Robot-assisted endovascular treatment of hepatic artery aneurysm: A case report. Vascular 2024:17085381241246322. [PMID: 38597580 DOI: 10.1177/17085381241246322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Robot-assisted endovascular surgery has emerged as a new alternative to interventional procedures, with its application expanding to peripheral and visceral approaches. The objective of this paper is to describe a robot-assisted endovascular treatment in splanchnic arteries. METHODS A case report of an asymptomatic male patient with an incidental finding of a saccular aneurysm of the proper hepatic artery measuring 3.7 × 2.7 cm and distant 0.6 cm from the origin of the gastroduodenal artery. RESULTS Using a robot-assisted endovascular technique (CorPath GRX platform - Siemens), 2 guidewires were advanced in parallel: the first one was placed inside the aneurysm sac, while the second one was placed in the proper hepatic artery distal to the aneurysm; through the first guidewire, a balloon was advanced, positioned distally to the aneurysm, and through the second one, a microcatheter was advanced. Embolization of the aneurysm was performed with the use of coils and Onyx. Control exam performed 120 days after embolization revealed treated aneurysm and preserved distal arterial flow. CONCLUSION Using a robotic platform for navigation in splanchnic territory is safe and effective.
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Affiliation(s)
- Nelson Wolosker
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | - Breno Boueri Affonso
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Felipe Nasser
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Sakugawa LS, Portela FSO, Louzada ACS, Portugal MFC, Teivelis MP, Mendes CDA, Pinheiro LL, Silva MFAD, Fioranelli A, Wolosker N. Polidocanol-foam treatment of varicose veins: Quality-of-life impact compared to conventional surgery. Clinics (Sao Paulo) 2024; 79:100346. [PMID: 38574572 PMCID: PMC11004700 DOI: 10.1016/j.clinsp.2024.100346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/02/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Lower limb varicose veins are a prevalent disease associated with several available treatment options, including conventional surgery and polidocanol foam sclerotherapy. However, few studies have analyzed therapeutic modality outcomes based on Patient-Reported Outcome Measures (PROMs). This large sample-size study was designed to evaluate the outcomes of polidocanol foam sclerotherapy compared to conventional surgery based on an analysis of PROMs. METHODS This was a prospective, observational, and qualitative study of 205 patients who underwent varicose vein treatment with either polidocanol foam sclerotherapy (57 patients, 90 legs) or conventional surgery (148 patients, 236 legs). Patients were preoperatively assessed and re-evaluated 30 days after the procedure using the Venous Disease Severity Score (VCSS) and specific venous disease quality-of-life questionnaires (VEINES-QoL/Sym). RESULTS Both treatments significantly improved VCSS and VEINES results 30 days after the procedure (p < 0.05). However, surgery promoted greater improvements in VCSS (on average 4.02-points improvement, p < 0.001), VEINES-QoL (average 8-points improvement, p < 0.001), and VEINES-Sym (average 11.66 points improvement, p < 0.001) than did sclerotherapy. Postoperative pain and aesthetic concerns about the legs were the domains of the questionnaires in which the results varied the most between the treatment modalities, with worse results for sclerotherapy. CONCLUSION Both polidocanol foam sclerotherapy and conventional surgery positively impact patients' quality of life after 30 days, but the improvement is more significant for patients who undergo conventional surgery.
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Affiliation(s)
| | | | | | | | - Marcelo Passos Teivelis
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
| | | | - Lucas Lembrança Pinheiro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
| | | | | | - Nelson Wolosker
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
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Portela FSO, Louzada ACS, da Silva MFA, Teivelis MP, Kuzniec S, Wolosker N. Analysis of Lower Limb Amputations in Brazil's Public Health System over 13 Years. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00187-4. [PMID: 38395382 DOI: 10.1016/j.ejvs.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/30/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Understanding the causes of amputation is crucial for defining health policies that seek to avoid such an outcome, but only a few studies have investigated the epidemiology of patients submitted to amputations in developing countries. The objective of this study was to analyse all lower limb amputations performed in the public health system in Brazil over a 13 year period, evaluating trends in the number of cases, patient demographics, associated aetiologies, hospital length of stay, and in hospital mortality rate. METHODS This was a retrospective, population based analysis of all lower limb amputations performed in the Brazilian public health system between 1 January 2008 and 31 December 2020. Using a public database, all types of amputations were selected, defining the number of procedures, their main aetiologies, anatomical level of limb loss, demographic data, regional distribution, and other variables of interest. RESULTS A total of 633 455 amputations were performed between 2008 and 2020, mostly (55.6%) minor amputations, predominantly in males (67%). There was an upward trend in the number of amputations, determined mainly by the increase in major amputations (50.4% increase in the period). Elderly individuals have the highest rates of amputation. Diabetes mellitus (DM) is becoming the main primary diagnosis associated with amputations over the years. The highest in hospital mortality rate occurred after major amputations and was associated with peripheral arterial disease (PAD). CONCLUSION Amputation rates in Brazil show an upward trend. DM is becoming the most frequent associated primary diagnosis, although PAD is the diagnosis most associated with major amputations and in hospital death.
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Affiliation(s)
| | | | | | | | | | - Nelson Wolosker
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
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Alexandrino da Silva MF, Oliveira Portela FS, Sposato Louzada AC, Teivelis MP, Amaro Junior E, Wolosker N. National Cross-Sectional Epidemiological Analysis of the Impact of Pandemic COVID-19 on Vascular Procedures in Public Health System: 521,069 Procedures Over 4 Years. Ann Vasc Surg 2024; 98:7-17. [PMID: 37717819 DOI: 10.1016/j.avsg.2023.07.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/09/2023] [Accepted: 07/19/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, there was a dramatic increase in healthcare demand. Resources were redirected to care patients with COVID-19. Therefore, surgical treatments were affected, including those of vascular diseases. There are no studies evaluating the whole impact of the COVID-19 pandemic, considering all types of vascular procedures, both elective and urgent, in a large country. The aim of the present study was to analyze the impact on all types of vascular procedures performed in Brazilian public hospitals during the COVID-19 pandemic. METHODS Cross-sectional population-based analysis of publicly available data referring to vascular procedures. Surgeries 2 years before the pandemic onset (2018-2019) and 2 years during pandemic (2020-2021) were included. RESULTS We observed a total of 521,069 procedures. Decrease was observed in elective abdominal aortic aneurysm repairs both open surgery (P = 0.001) and endovascular surgery (P < 0.001), emergency open abdominal repairs (P = 0.005), elective thoracic aortic aneurysm repairs (P = 0.007), elective open peripheral aneurysm repairs (P = 0.038), carotid endarterectomies (P < 0.001) and angioplasties (P = 0.001), open revascularizations for peripheral arterial disease (P < 0.001), surgical treatment of chronic venous disease (P < 0.001) and sympathectomies for hyperhidrosis (P < 0.001). However, there was an increase of lower limb amputations (P = 0.027) and vena cava filter placements (P = 0.005). There was a reduction of almost US$17 million in financial investments. CONCLUSIONS The reorganization of health systems led to a significant reduction in vascular procedures and decrease in financial investments. On the other hand, there was a significant increase in the number of lower limb amputations and vena cava filter placements.
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Affiliation(s)
- Marcelo Fiorelli Alexandrino da Silva
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Andressa Cristina Sposato Louzada
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Marcelo Passos Teivelis
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Edson Amaro Junior
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Nelson Wolosker
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Wolosker N, Louzada ACS, Portela FSO, da Silva MFA, Schettino GDPP, Corrêa LH, Juniordata EA, Teivelis MP. Proposed public policies to improve outcomes in vascular surgery: an experts' forum. Einstein (Sao Paulo) 2023; 21:eAE0241. [PMID: 37585883 PMCID: PMC10421605 DOI: 10.31744/einstein_journal/2023ae0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/18/2022] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE To evaluate outcomes of vascular surgeries and identify strategies to improve public vascular care. METHODS This was a descriptive, qualitative, and cross-sectional survey involving 30 specialists of the Hospital Israelita Albert Einstein via Zoom. The outcomes of vascular procedures performed in the Public Health System extracted through Big Data analysis were discussed, and 53 potential strategies to improve public vascular care to improve public vascular care. RESULTS There was a consensus on mandatory reporting of some key complications after complex arterial surgeries, such as stroke after carotid revascularization and amputations after lower limb revascularization. Participants agreed on the recommendation of screening for diabetic feet and infrarenal abdominal aortic aneurysms. The use of Telemedicine as a tool for patient follow-up, auditing of centers for major arterial surgeries, and the concentration of complex arterial surgeries in reference centers were also points of consensus, as well as the need to reduce the values of endovascular materials. Regarding venous surgery, it was suggested that there should be incentives for simultaneous treatment of both limbs in cases of varicose veins of the lower limbs, in addition to the promotion of ultrasound-guided foam sclerotherapy in the public system. CONCLUSION After discussing the data from the Brazilian Public System, proposals were defined for standardizing measures in population health care in the area of vascular surgery. Notification of complications of arterial surgeries is essential in identifying strategies to improve surgical outcomes. Screening of prevalent and/or morbid diseases allows early intervention and prevention of complications. Use of telemedicine in vascular follow-up allows optimizing the use of resources and reducing the burden on health services. Concentrating complex cases in reference hospitals leads to improved surgical outcomes.
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Affiliation(s)
- Nelson Wolosker
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | | | | | | | - Lucas Hernandes Corrêa
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Edson Amaro Juniordata
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Marcelo Passos Teivelis
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Portela FSO, Megale AB, Souza KP, Portugal MFC, Gilberto GM, de Almeida Mendes C, Wolosker N. Percutaneous Embolization for Management of a Recurrent Popliteal Artery Aneurysm after Failure of Conventional Treatment. J Vasc Interv Radiol 2023; 34:319-322. [PMID: 36423814 DOI: 10.1016/j.jvir.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/13/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Felipe Soares Oliveira Portela
- Hospital Israelita Albert Einstein , Avenida Albert Einstein, 627, bloco A1, sala 423, Morumbi, São Paulo, SP, 05652-900, Brazil.
| | - Adalberto Batalha Megale
- Hospital Israelita Albert Einstein , Avenida Albert Einstein, 627, bloco A1, sala 423, Morumbi, São Paulo, SP, 05652-900, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP 05652-000, Brazil
| | - Kauê Polizel Souza
- Hospital Israelita Albert Einstein , Avenida Albert Einstein, 627, bloco A1, sala 423, Morumbi, São Paulo, SP, 05652-900, Brazil
| | - Maria Fernanda Cassino Portugal
- Hospital Israelita Albert Einstein , Avenida Albert Einstein, 627, bloco A1, sala 423, Morumbi, São Paulo, SP, 05652-900, Brazil
| | - Guilherme Moratti Gilberto
- Hospital Israelita Albert Einstein , Avenida Albert Einstein, 627, bloco A1, sala 423, Morumbi, São Paulo, SP, 05652-900, Brazil
| | - Cynthia de Almeida Mendes
- Hospital Israelita Albert Einstein , Avenida Albert Einstein, 627, bloco A1, sala 423, Morumbi, São Paulo, SP, 05652-900, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP 05652-000, Brazil
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein , Avenida Albert Einstein, 627, bloco A1, sala 423, Morumbi, São Paulo, SP, 05652-900, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP 05652-000, Brazil; Faculdade de Medicina da Universidade de São Paulo-USP, Av. Dr. Arnaldo, 455-Cerqueira César, São Paulo, SP 01246-903, Brazil
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Tasca Okamoto GF, Oliveira Portela FS, Alexandrino da Silva MF, Cassino Portugal MF, Wolosker N, de Cássia Ribeiro de Souza R, Teivelis MP, de Almeida Mendes C. Intraoperative evaluation of tunneled dialysis catheter mobility and function with arm movement. J Vasc Surg Venous Lymphat Disord 2021; 10:146-151. [PMID: 34634517 DOI: 10.1016/j.jvsv.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The main objectives of the present study were to analyze the right internal jugular vein tunneled dialysis catheter (TDC) tip displacements, functional changes, pathway deformities, and angulations associated with different arm positions. METHODS We prospectively studied 21 patients who had undergone TDC implantation for hemodialysis via the right internal jugular vein at a single center from February to September 2020. After implantation, a baseline resting fluoroscopy image was taken, and three movement-mimicking images of the ipsilateral arm were obtained for comparison, with the arm in maximum abduction, maximum flexion, and maximum adduction. Device function was analyzed for each movement-mimicking position and correlated with catheter tip displacement, catheter deformity, and catheter pathway angulation. RESULTS TDC pathway deformity occurred in 16 patients (69.5%). Deformities were more frequent in the movement-mimicking positions than in to the control resting baseline images (P = .004). The different arm positions did not lead to significant tip displacement (either horizontal or vertical; P > .05), nor did they result in significant pathway angulation between the subcutaneous and intravenous regions (P = .114). However, in the maximum abduction position, a positive relationship was present between the catheter pathway angle and impairment of catheter function (P = .028). CONCLUSIONS Catheter deformity was more frequent and more severe with maximum adduction and flexion of the arm. Although no significant changes were observed in the tip of the catheter with the movements, a positive relationship was found between the catheter pathway angle and impairment of catheter function with the arm in the maximum abduction position.
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Affiliation(s)
| | | | | | | | - Nelson Wolosker
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, São Paulo, Brazil
| | | | - Marcelo Passos Teivelis
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, São Paulo, Brazil
| | - Cynthia de Almeida Mendes
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, São Paulo, Brazil
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