Bridge Graft to a Small Distal Artery after Fistula Ligation for Angioaccess-Induced Ischemia: Report of Two Cases

Angioaccess-induced ischemia is an infrequent but cumbersome problem, because both limb ischemia correction and access salvage should be undertaken during the same procedure. This paper reports two cases that we successfully managed with a bridge graft to a small distal artery after fistula ligation.

Impact of screening on thrombophilia for patients with venous thrombosis

AIM

The epidemiologic importance of thrombophilia on venous thromboembolism (VTE) has been extensively studied. We tried to identify the variables that point to the positive test results for thrombophilia and the impact of these results on clinical decisions.

METHODS

Thrombophilia screening was applied to 84 consecutive patients with VTE. After test results, two independent observers evaluated, in a case by case basis, the indication of a change on prophylaxis or special attention, in order to modify the period of anticoagulant intake or have a higher medical surveillance before risk situations or for the extension of the research to the first degree relatives.

RESULTS

Thrombophilia was found in 41.66% (35/84), and in 32.12% (27/84) it involved a genetic cause. The factor V Leiden was found in 15.47%, followed by the natural anticoagulant dysfunction (11.9%). There was no significative difference of thrombophilia frequency between ages, nor a difference of age in the onset of the first thrombotic event between thrombophilic and non-thrombophilic patients. There was a higher prevalence of thrombophilia in patients with superficial thrombophlebitis of spontaneous onset and in cases of recurrence. The change on prophylaxis resulted in 7.14% (6/84) and special attention in 40.47% (34/84).

CONCLUSIONS

Spontaneous superficial thrombophlebitis, occurrence of VTE related to non surgical causes, and recurrence, were the main findings which suggested thrombophilia. The change of prophylaxis was applied to a small percentage of patients. The special attention for risk situations and the extension of the primary prophylaxis to the asymptomatic family members seems to be the best indication for the laboratory research on thrombophilia.

[Use of the combination of a nitrofurazone derivative with polyethylene glycols in the prevention of the formation of peritoneal adhesions - experimental study]

The authors studied the effectiveness of the association of Nitrofurazone derivates with Polyethylene glycol (NPG) on peritoneal adhesions prevention. Despite the fact of constitutional characteristics may elicit or not the formation of adhesions and bands, they concluded that, although the drugs have not demonstrated the capacity of avoiding such phenomena, they could block this process at a fibrinous stage, which is relatively safe concerning the possibility of intestinal obstruction.