37 results on '"Marcelo Passos"'
Search Results
2. Radiological Profile of 18,430 Vascular Anomalies: Incidence and Demographic Distribution in an Adult Population
- Author
-
Portugal, Maria Fernanda C., Tachibana, Adriano, Rocha, Marcelo A., Naves, Érica A., Amaral, Lucas T.W., Camilo, Luana Perrone, Hallage, Bianca, Wolosker, Nelson, and Teivelis, Marcelo Passos
- Published
- 2023
- Full Text
- View/download PDF
3. Nationwide Cross-Sectional Epidemiological Analysis of 3,306 Lower Limb Peripheral Aneurysm Repairs in Brazilian Public Hospitals Between 2008 and 2019: Trends, Mortality and Costs
- Author
-
da Silva, Marcelo Fiorelli Alexandrino, Louzada, Andressa Cristina Sposato, Teivelis, Marcelo Passos, Junior, Edson Amaro, and Wolosker, Nelson
- Published
- 2022
- Full Text
- View/download PDF
4. Epidemiology of 869,220 varicose vein surgeries over 12 years in Brazil: trends, costs and mortality rate
- Author
-
Silva, Marcela Juliano, Louzada, Andressa Cristina Sposato, da Silva, Marcelo Fiorelli Alexandrino, Portugal, Maria Fernanda Cassino, Teivelis, Marcelo Passos, and Wolosker, Nelson
- Published
- 2022
- Full Text
- View/download PDF
5. Conventional Varicose Vein Surgery: Comparison between Single versus Staged Surgery Using Patient Reported Outcomes
- Author
-
Wolosker, Nelson, Teivelis, Marcelo Passos, de Almeida Mendes, Cynthia, Portugal, Maria Fernanda, Pinheiro, Lucas Lembrança, da Silva, Marcelo Fiorelli Alexandrino, Sakugawa, Lissa Severo, and Fioranelli, Alexandre
- Published
- 2022
- Full Text
- View/download PDF
6. Epidemiological Analysis of 37,424 Carotid Artery Stenosis Intervention Procedures During 11 Years in the Public Health System in Brazil: Stenting has Been More Common Than Endarterectomy
- Author
-
Wolosker, Nelson, Portugal, Maria Fernanda Cassino, da Silva, Marcelo Fiorelli Alexandrino, Massaud, Rodrigo, Amaro, Edson, Jr, Jerussalmy, Claudia, and Teivelis, Marcelo Passos
- Published
- 2021
- Full Text
- View/download PDF
7. Anxiety and Depression Scores in Patients Subjected to Arterial Revascularization for Critical Limb Ischemia
- Author
-
Fioranelli, Alexandre, Wolosker, Nelson, de Mello, Ricardo Abreu Feijó, Caffaro, Roberto Augusto, Leiderman, Dafne Braga Diamante, Portugal, Maria Fernanda Cassino, Mendes, Cynthia de Almeida, Pinheiro, Lucas Lembrança, and Teivelis, Marcelo Passos
- Published
- 2021
- Full Text
- View/download PDF
8. Inferior Vena Cava Filter in Cancer Patients: On Whom Should We Be Placing Them?
- Author
-
Teivelis, Marcelo Passos, Schettini, Isabela Hohlenwerger, Pignataro, Bruno Soriano, Zottele Bomfim, Guilherme Andre, Centofanti, Guilherme, Fonseca, Igor Yoshio Imagawa, Krutman, Mariana, Cavalcante, Rafael Noronha, Nishinari, Kenji, and Yazbek, Guilherme
- Published
- 2021
- Full Text
- View/download PDF
9. Lower Limb Revascularization for Peripheral Arterial Disease in 10,951 Procedures over 11 years in a Public Health System: A Descriptive Analysis of the Largest Brazilian City
- Author
-
Wolosker, Nelson, da Silva, Marcelo Fiorelli Alexandrino, Leiderman, Dafne Braga Diamante, Stabellini, Nickolas, Nogueira, Wellington Araujo, Szlejf, Claudia, Amaro Jr, Edson, and Teivelis, Marcelo Passos
- Published
- 2021
- Full Text
- View/download PDF
10. Epidemiological Analysis of Carotid Artery Stenosis Intervention during 10 years in the Public Health System in the Largest City in Brazil: Stenting Has Been More Common than Endarterectomy
- Author
-
Stabellini, Nickolas, Wolosker, Nelson, Leiderman, Dafne Braga Diamante, da Silva, Marcelo Fiorelli Alexandrino, Nogueira, Wellington Araujo, Amaro Jr, Edson, and Teivelis, Marcelo Passos
- Published
- 2020
- Full Text
- View/download PDF
11. Video-Assisted Thoracoscopic Sympathectomy for Facial Hyperhidrosis: The Influence of the Main Site of Complaint
- Author
-
Fukuda, Juliana Maria, Varella, Andrea Yasbek Monteiro, Teivelis, Marcelo Passos, de Campos, José Ribas Milanez, Kauffman, Paulo, Pinheiro, Lucas Lembrança, and Wolosker, Nelson
- Published
- 2018
- Full Text
- View/download PDF
12. Epidemiology of 869,220 varicose vein surgeries over 12 years in Brazil: trends, costs and mortality rate
- Author
-
Marcela Juliano Silva, Marcelo Fiorelli Alexandrino da Silva, Andressa Cristina Sposato Louzada, Maria Fernanda Cassino Portugal, Marcelo Passos Teivelis, and Nelson Wolosker
- Subjects
medicine.medical_specialty ,Population ,Veins ,Varicose Veins ,Epidemiology ,Varicose veins ,medicine ,Outpatient clinic ,Humans ,education ,education.field_of_study ,business.industry ,Mortality rate ,Public health ,General Medicine ,Surgical procedures ,Varicose vein surgery ,Treatment Outcome ,Emergency medicine ,Chronic Disease ,Surgery ,medicine.symptom ,business ,Cardiology and Cardiovascular Medicine ,Vascular Surgical Procedures ,Brazil - Abstract
2.Structured AbstractObjectivesto assess the total numbers of surgical procedures performed between 2008 and 2019 for the treatment of varicose veins in the Public Health System, which exclusively insures more than 160 million Brazilians, the distribution of surgeries over time, as well as its costs and mortality rates.Study designretrospective cross-sectional population-based studyMaterials and Methodspublic and open data referring to all surgeries to treat chronic venous disease between 2008 and 2019 were extracted from the database of the Brazilian Public Health System.ResultsIn total, 869,220 surgeries were performed to treat chronic venous disease in public hospitals and outpatient clinics in Brazil, with an average rate of 4.5 surgeries per 10,000 inhabitants per year. From 2015 on, we observed a slight downward trend in the total number of procedures. The total amount reimbursed by the government was US$ 232,775,518.11. A total of 49 deaths were registered following varicose vein surgery, corresponding to a mortality rate of 0.0056%.Conclusionsa total of 869,220 surgeries performed to treat chronic venous disease over twelve years, with an overall rate of 4.52 procedures per 10,000 inhabitants per year. The mortality rate was very low, 0.0056%.
- Published
- 2022
13. Radiological Profile of 18,430 Vascular Anomalies: Incidence and Demographic Distribution in an Adult Population
- Author
-
Maria Fernanda C. Portugal, Adriano Tachibana, Marcelo A. Rocha, Érica A. Naves, Lucas T.W. Amaral, Luana Perrone Camilo, Bianca Hallage, Nelson Wolosker, and Marcelo Passos Teivelis
- Subjects
Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
14. Nationwide Cross-Sectional Epidemiological Analysis of 3,306 Lower Limb Peripheral Aneurysm Repairs in Brazilian Public Hospitals Between 2008 and 2019: Trends, Mortality and Costs
- Author
-
Marcelo Fiorelli Alexandrino da Silva, Andressa Cristina Sposato Louzada, Marcelo Passos Teivelis, Edson Amaro Junior, and Nelson Wolosker
- Subjects
Male ,Hospitals, Public ,Endovascular Procedures ,General Medicine ,Length of Stay ,Blood Vessel Prosthesis Implantation ,Cross-Sectional Studies ,Treatment Outcome ,Lower Extremity ,Elective Surgical Procedures ,Risk Factors ,Humans ,Surgery ,Hospital Mortality ,Cardiology and Cardiovascular Medicine ,Brazil ,Aged ,Aortic Aneurysm, Abdominal ,Retrospective Studies - Abstract
Although peripheral aneurysms can be limb- or life-threatening, the literature is scarce and there are only two large population-based epidemiological studies on peripheral aneurysm repair, comprising data from high-income countries only.This is a retrospective cross-sectional analysis on open and endovascular peripheral aneurysm repairs performed between 2008 and 2019 in the Brazilian Public Health System, which exclusively insures more than 160 million Brazilians.A total of 3,306 peripheral aneurysm repairs were observed. Most patients were elderly (57.74%) and male (72.66%), and patients treated with endovascular repair were older (P = 0.008). Most repairs were emergency (59.56%) and open (93.8%), and there was an overall downward trend in procedure rates. We observed a decreasing predominance of emergency open repair over elective open repair (P0.001), but open repairs prevailed over endovascular procedures, with no tendency to change this predominance. Mortality rates were 3.12% and 3.67% after elective and emergency open repair, respectively, with no difference, and 0 and 4.24% for elective and emergency endovascular repair, respectively. The government reimbursed an average of $1170.05 for open PA repair and $1802.01 for endovascular repair.We presented the largest series of the literature analyzing all 3,306 lower limb peripheral aneurysm repairs performed in public hospitals in a middle-income country. Procedure rates tended to decrease. Open repair predominated. Mortality rates ranged from 0 to 4%. Most procedures were emergency, but there was a relative increase of elective treatments over the years.
- Published
- 2022
15. Conventional varicose vein surgery: comparison between single versus staged surgery using Patient Reported Outcomes
- Author
-
Wolosker, Nelson, primary, Teivelis, Marcelo Passos, additional, de Almeida Mendes, Cynthia, additional, Portugal, Maria Fernanda, additional, Pinheiro, Lucas Lembrança, additional, da Silva, Marcelo Fiorelli Alexandrino, additional, Sakugawa, Lissa Severo, additional, and Fioranelli, Alexandre, additional
- Published
- 2021
- Full Text
- View/download PDF
16. Epidemiological Analysis of 37,424 Carotid Artery Stenosis Intervention Procedures During 11 Years in the Public Health System in Brazil: Stenting has Been More Common Than Endarterectomy
- Author
-
Maria Fernanda Cassino Portugal, Rodrigo Massaud, Edson Amaro, Claudia Szlejf Jerussalmy, Marcelo Fiorelli Alexandrino da Silva, Nelson Wolosker, and Marcelo Passos Teivelis
- Subjects
medicine.medical_specialty ,Time Factors ,Public Health Systems Research ,medicine.medical_treatment ,Cost-Benefit Analysis ,Population ,Carotid endarterectomy ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Cost Savings ,Angioplasty ,Carotid artery disease ,medicine ,Humans ,Carotid Stenosis ,Hospital Mortality ,Hospital Costs ,Practice Patterns, Physicians' ,education ,Stroke ,Cause of death ,Endarterectomy ,Retrospective Studies ,education.field_of_study ,Endarterectomy, Carotid ,business.industry ,Mortality rate ,Endovascular Procedures ,General Medicine ,medicine.disease ,Treatment Outcome ,Emergency medicine ,Surgery ,Stents ,Public Health ,Cardiology and Cardiovascular Medicine ,business ,Brazil - Abstract
Background Stroke is a leading cause of death worldwide, with carotid atherosclerosis accounting for 10–20% of cases. In Brazil, the Public Health System provides care for roughly two-thirds of the population. No studies, however, have analysed large–scale results of carotid bifurcation surgery in Brazil. Methods This study aimed to describe rates of carotid artery stenting (CAS) and carotid endarterectomy (CEA) performed between 2008 and 2019 in the country through web scraping of publicly available databases. Results Between 2008 and 2019, 37,424 carotid bifurcation revascularization procedures were performed, of which 22,578 were CAS (60.34%) and 14,846 (39.66%) were CEA. There were 620 in-hospital deaths (1.66%), 336 after CAS (1.48%) and 284 after CEA (1.92%) (P = 0.032). Governmental reimbursement was US$ 77,216,298.85 (79.31% of all reimbursement) for CAS procedures and US$ 20,143,009.63 (20.69%) for CEA procedures. The average cost per procedure for CAS (US$ 3,062.98) was higher than that for CEA (US$ 1,430.33) (P = 0.008). Conclusions In Brazil, the frequency of CAS largely surpassed that of CEA. In-hospital mortality rates of CAS were significantly lower than those of CEA, although both had mortality rates within the acceptable rates as dictated by literature. The cost of CAS, however, was significantly higher. This is a pioneering analysis of carotid artery disease management in Brazil that provides, for the first time, preliminary insight into the fact that the low adoption of CEA in the country is in opposition to countries where utilization rates are higher for CEA than for CAS.
- Published
- 2020
17. Anxiety and Depression Scores in Patients Subjected to Arterial Revascularization for Critical Limb Ischemia
- Author
-
Ricardo Abreu Feijó de Mello, Marcelo Passos Teivelis, Maria Fernanda Cassino Portugal, Lucas Lembrança Pinheiro, Roberto Augusto Caffaro, Nelson Wolosker, Dafne Braga Diamante Leiderman, Cynthia de Almeida Mendes, and Alexandre Fioranelli
- Subjects
Adult ,Male ,Time Factors ,medicine.medical_treatment ,Critical Illness ,030204 cardiovascular system & hematology ,Anxiety ,Risk Assessment ,Severity of Illness Index ,Amputation, Surgical ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Peripheral Arterial Disease ,0302 clinical medicine ,Psychiatric history ,Ischemia ,Risk Factors ,medicine ,Humans ,Prospective Studies ,Depression (differential diagnoses) ,Aged ,Gangrene ,Aged, 80 and over ,business.industry ,Depression ,Incidence (epidemiology) ,Incidence ,General Medicine ,Critical limb ischemia ,Perioperative ,Middle Aged ,medicine.disease ,Mental Health ,Treatment Outcome ,Amputation ,Anesthesia ,Surgery ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures ,Brazil - Abstract
This study aims to examine the changes in anxiety and depression scores in 138 patients with critical limb ischemia (rest pain or gangrene) who had no previous psychiatric history, at 30 days and 6 months after surgical revascularization.Patients were submitted to a questionnaire-based evaluation using the Beck Anxiety and Depression Inventories before surgery (no more than three days before surgery) ("Pre-Op"), 30 days after surgical revascularization ("Early PO") and at least 6 months after surgical revascularization ("Late PO"). The cut-off scores for depression were (1)10, no depression or minimal depression; (2) 10‒18, mild to moderate depression; (3) 19‒29, moderate to severe depression; and (4) 30‒63, severe depression. The cut-off scores for anxiety were (1)8, no anxiety or minimal anxiety; (2) 8‒15, mild anxiety; (3) 16‒25, moderate anxiety; and (4) 26‒63, severe anxiety.No perioperative mortality was observed 30 days after surgical revascularization. Thirty-nine (28.2%) patients underwent major (above-ankle) amputation within 30 days. Mean anxiety and depression scores, respectively, declined from 12.48 ± 9.74 (mean ± SD) and 16.92 ± 12.48 preoperatively to 4.89 ± 7.04 and 6.52 ± 9.36 postoperatively (P0.001, both). Anxiety and depression scores were not significantly affected by preoperative comorbidities (systemic arterial hypertension, diabetes mellitus, previous stroke, and smoking), affected arterial territory (aortoiliac, femoropopliteal, or infrapopliteal), or surgical technique (open surgery vs endovascular therapy). Only patients undergoing amputation within 30 days showed no improvement in depressive symptoms.Patients with critical limb ischemia have a high incidence of anxiety and depressive symptoms, which improve considerably after successful surgical revascularization. Major amputation was associated with a lack of improvement in depression scores. A formal psychiatric evaluation may be beneficial in patients who show no improvement in depressive symptoms.
- Published
- 2020
18. Lower Limb Revascularization for Peripheral Arterial Disease in 10,951 Procedures over 11 years in a Public Health System: A Descriptive Analysis of the Largest Brazilian City
- Author
-
Dafne Braga Diamante Leiderman, Marcelo Fiorelli Alexandrino da Silva, Nickolas Stabellini, Edson Amaro, Wellington Araujo Nogueira, Nelson Wolosker, Marcelo Passos Teivelis, and Claudia Szlejf
- Subjects
Male ,medicine.medical_specialty ,Financing, Government ,Time Factors ,Public Health Systems Research ,medicine.medical_treatment ,Critical Illness ,Disease ,030204 cardiovascular system & hematology ,Revascularization ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,Peripheral Arterial Disease ,0302 clinical medicine ,law ,Ischemia ,Urban Health Services ,Medicine ,Humans ,Hospital Mortality ,Aged ,Descriptive statistics ,business.industry ,Mortality rate ,Public health ,Endovascular Procedures ,General Medicine ,Perioperative ,Health Care Costs ,Intermittent Claudication ,Length of Stay ,Middle Aged ,Intensive care unit ,Intensive Care Units ,Treatment Outcome ,Lower Extremity ,Emergency medicine ,Surgery ,Residence ,Female ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures ,Brazil - Abstract
Background Worldwide, peripheral arterial disease (PAD) is a disease with high morbidity, affecting more than 200 million people. Our objective was to analyze the surgical treatment for PAD performed in the Unified Health System of the city of Sao Paulo during the last 11 years based on publicly available data. Methods The study was conducted with data analysis available on the TabNet platform, belonging to the DATASUS. Public data (government health system) from procedures performed in Sao Paulo between 2008 and 2018 were extracted. Sex, age, municipality of residence, operative technique, number of surgeries (total and per hospital), mortality during hospitalization, mean length of stay in the intensive care unit and amount paid by the government system were analyzed. Results A total of 10,951 procedures were analyzed (either for claudicants or critical ischemia—proportion unknown); 55.4% of the procedures were performed on males, and in 50.60%, the patient was older than 65 years. Approximately two-thirds of the patients undergoing these procedures had residential addresses in Sao Paulo. There were 363 in-hospital deaths (mortality of 3.31%). The hospital with the highest number of surgeries (n = 2,777) had lower in-hospital mortality (1.51%) than the other hospitals. A total of $20,655,272.70 was paid for all revascularizations. Conclusions Revascularization for PAD treatment has cost the government system more than $20 million over 11 years. Endovascular surgeries were performed more often than open surgeries and resulted in shorter hospital stays and lower perioperative mortality rates.
- Published
- 2020
19. Inferior Vena Cava Filter in Cancer Patients: On Whom Should We Be Placing Them?
- Author
-
Guilherme Centofanti, Rafael Cavalcante, Kenji Nishinari, Igor Yoshio Imagawa Fonseca, Guilherme Yazbek, Guilherme Andre Zottele Bomfim, Marcelo Passos Teivelis, Isabela Hohlenwerger Schettini, Mariana Krutman, and Bruno Soriano Pignataro
- Subjects
Adult ,Male ,medicine.medical_specialty ,Palliative care ,Time Factors ,Vena Cava Filters ,Clinical Decision-Making ,Inferior vena cava filter ,Context (language use) ,030204 cardiovascular system & hematology ,Risk Assessment ,030218 nuclear medicine & medical imaging ,Prosthesis Implantation ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Risk Factors ,Neoplasms ,medicine ,Humans ,Device Removal ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Standard treatment ,Patient Selection ,Contraindications, Drug ,Cancer ,Anticoagulants ,General Medicine ,Perioperative ,Venous Thromboembolism ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Filter (video) ,Female ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Background Standard treatment for venous thromboembolism is anticoagulation; vena cava filter placement is an alternative in special situations. We aimed to evaluate the outcomes in patients with cancer undergoing filter placement in a cancer center during a 10-year period and assess which preoperatory variables were associated with poorer survival. Methods Retrospective unicenter analysis during a 10-year period was carried out in patients with cancer who had undergone placement of vena cava filter. Early deaths were those that occurred less than 30 days after the filter placement or that occurred during the same hospital stay of the placement. Results About 250 patients were analyzed. About 51.6% were females; 77.2% had proximal lower limb deep vein thrombosis; 34.8% had contraindications to anticoagulation; 32.8% presented bleeding after the onset of anticoagulation; and 18.4% had the filter implanted because they were going to undergo surgery and could not be anticoagulated immediately after. About 51.2% of the filters were removable. However, only 2 had the filter removed. About 59.2% had metastatic disease at the time of filter placement. About 31.2% fulfilled criteria for early death. Of those, 34 patients were put in palliative care after filter insertion (median, 13.5 days). Body mass index >18 kg/m2, the absence of metastatic disease, and filter placement during the same anesthesia of another surgery (especially if elective and curative) were associated with a higher chance of survival. Conclusions Multidisciplinary evaluation (and possibly consideration for palliation) should take place before the decision to insert a vena cava filter in severe oncologic cases depending on overall status. Patients with a greater chance of survival at a 3 or 5 years interval seem to be those whose filters were placed in the perioperative context of other surgeries (specially elective and curative), who were not undernourished, and whose disease was not metastatic at that time. For patients who survived, an active investigation protocol for filter removal should be implemented.
- Published
- 2020
20. Comparison between Saline Solution Containing Heparin versus Saline Solution in the Lock of Totally Implantable Catheters
- Author
-
Bruno Leonardo de Freitas Soares, Paulo Fernandes Saad, Mariana Krutman, Rafael Cavalcante, Guilherme Centofanti, Bruno Soriano Pignataro, Suellen Cristina Dias Emidio, Monica Aparecida Tomé Pereira, Karen Ruggeri Saad, Antonio Rafael de Oliveira Brito, Guilherme Yazbek, Kenji Nishinari, Guilherme Andre Zottele Bomfim, Marcelo Passos Teivelis, and Igor Yoshio Imagawa Fonseca
- Subjects
Adult ,Catheter Obstruction ,Male ,Catheterization, Central Venous ,medicine.medical_specialty ,medicine.medical_treatment ,Sodium Chloride ,03 medical and health sciences ,Catheters, Indwelling ,0302 clinical medicine ,Occlusion ,medicine ,Humans ,Outpatient clinic ,030212 general & internal medicine ,Infusions, Intravenous ,Saline ,Aged ,Retrospective Studies ,Aged, 80 and over ,Implantable Catheters ,Heparin ,business.industry ,Significant difference ,Reflux ,Anticoagulants ,Retrospective cohort study ,General Medicine ,Middle Aged ,Surgery ,030220 oncology & carcinogenesis ,Female ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background There are only 3 studies comparing the efficacy of 2 different types of lock used in totally implantable catheters regarding occlusion or reflux dysfunction. The present study contains the largest published casuistry (862 patients) and is the only one that analyzes 3 parameters: occlusion, reflux dysfunction, and flow dysfunction. Methods This was a retrospective study of patients operated at a large oncology center and followed up in the outpatient clinic between 2007 and 2015. The patients were divided into 2 groups according to the type of lock: the Hep group (heparine), whose lock was composed of saline solution 0.9% with heparin (100 IU/mL) and the SS group (saline solution), whose lock was composed of saline solution 0.9%. Results The Hep group was composed of 270 patients (31%) and the SS group of 592 patients (69%). Regarding occlusion, there were 8 cases in the Hep group (2.96%) and 8 in the SS group (1.35%; P = 0.11); in relation to reflux dysfunction, there were 8 cases in the Hep group (2.96%) and 8 in the SS group (1.35%; P = 0.11); in relation to flow dysfunction, there was 1 case in the Hep group (0.37%) and 4 cases in the SS group (0.68%; P = 1). Conclusions There was no statistically significant difference between the groups regarding occlusion, reflux dysfunction, and flow dysfunction.
- Published
- 2018
21. Video-Assisted Thoracoscopic Sympathectomy for Facial Hyperhidrosis: The Influence of the Main Site of Complaint
- Author
-
Lucas Lembrança Pinheiro, Andrea Yasbek Monteiro Varella, Juliana Maria Fukuda, Nelson Wolosker, José Ribas Milanez de Campos, Marcelo Passos Teivelis, and Paulo Kauffman
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,Side effect ,Sweating ,030204 cardiovascular system & hematology ,Thoracoscopic sympathectomy ,Young Adult ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Quality of life ,Refractory ,medicine ,Humans ,Hyperhidrosis ,Sympathectomy ,Child ,Aged ,Retrospective Studies ,Thoracic Surgery, Video-Assisted ,business.industry ,Medical record ,Compensatory hyperhidrosis ,Retrospective cohort study ,General Medicine ,Middle Aged ,Surgery ,Treatment Outcome ,Face ,Anesthesia ,Quality of Life ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction Facial hyperhidrosis (FH) may lead patients to a significantly impaired quality of life (QOL). Video-assisted thoracoscopic sympathectomy (VATS) is reserved for more severe cases refractory to common first-line agents. The aim of this study was to evaluate the efficacy of VATS for FH and to compare the results between patients with facial hyperhidrosis as main complaint (FHMC) and patients with facial hyperhidrosis as nonmain complaint (FHNMC). Methods This was a retrospective study based on medical chart analysis from March 2000 to January 2014: 40 patients with FHMC and 136 patients with FHNMC. Patients underwent VATS at the T2, T3, or T4 level, according to the main site of complaint. We assessed improvement in QOL, improvement in hyperhidrosis, and presence of complications and side effects, notably compensatory hyperhidrosis (CH). Results Patients with FHMC reported greater improvement in FH (97.1% versus 93.6%; P = 0.006) but had lower improvement in QOL (78.2% versus 92.7%; P = 0.024) compared to patients with FHNMC. For patients with FHNMC, any degree of improvement in FH was reported by 100%, almost 95%, and nearly 80% of the patients who underwent VATS at the T2, T3, and T4 level, respectively ( P = 0.039). Pain and CH were reported by more than 61% and 92% of the patients, respectively, with no statistical difference between both groups. Conclusions Patients with FHMC, despite the greater improvement in FH, experienced lower improvement in QOL compared to patients with FHNMC. CH was the most frequent side effect in both groups, affecting more than 92% of the patients.
- Published
- 2018
22. Epidemiological Analysis of Carotid Artery Stenosis Intervention during 10 years in the Public Health System in the Largest City in Brazil: Stenting Has Been More Common than Endarterectomy
- Author
-
Nickolas Stabellini, Edson Amaro, Marcelo Fiorelli Alexandrino da Silva, Marcelo Passos Teivelis, Nelson Wolosker, Wellington Araujo Nogueira, and Dafne Braga Diamante Leiderman
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,medicine.medical_treatment ,Population ,Carotid endarterectomy ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Epidemiology ,Medicine ,Humans ,Carotid Stenosis ,Hospital Mortality ,Hospital Costs ,education ,Stroke ,Reimbursement ,Endarterectomy ,Cause of death ,Retrospective Studies ,education.field_of_study ,Endarterectomy, Carotid ,business.industry ,Public health ,Endovascular Procedures ,General Medicine ,medicine.disease ,Treatment Outcome ,Emergency medicine ,Surgery ,Female ,Stents ,Public Health ,Cardiology and Cardiovascular Medicine ,business ,Brazil - Abstract
Background Stroke is the second leading cause of death worldwide with approximately 5.7 million cases/year, and carotid atherosclerosis accounts for 10 to 20% of cases. Methods In Brazil, the Unified Health System (Sistema Unico de Saude [SUS]) is a tax-funded public health care system that provides care for roughly half the population. Sao Paulo is the eighth largest city in the world with an estimated population of over 12 million people, of whom more than 5 million rely solely on SUS. This study aimed to describe rates of carotid artery stenting (CAS) and carotid endarterectomy (CEA) performed between 2008 and 2017 in the city of Sao Paulo through web scraping of publicly available databases. Results Three thousand seven hundred and four carotid revascularization procedures were performed between 2008 and 2017, of which 2,432 were CAS (65.7%). Rates of CAS ranged from 59.9% in 2016 to 86% in 2011. There were 57 in-hospital deaths (1.54%), 34 after CAS (1.4%; 34/2,432) and 23 after CEA (1.81%; 23/1,272) (P = 0.562). SUS reimbursements were US $7,862,017.09 (81.44% of all reimbursements) for 2,432 CAS procedures and US $1,792,324.06 (18.56%) for 1,272 CEA procedures. Average SUS reimbursement for CAS (US $3,232.73) was more than double than that for CEA (US $1,409.05). Conclusions In a city whose population exceeds that of some European countries, costs of CAS and CEA to the public health care system totaled more than US$ 9 million over 10 years. Epidemiologically, CAS was performed more commonly than CEA with no difference in in-hospital mortality between CAS and CEA, but reimbursements were 2.29 times higher for CAS. The low adoption of CEA in Sao Paulo is in contrast to countries where utilization rates are higher for CEA than for CAS.
- Published
- 2019
23. Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm Results in Higher Hospital Expenses than Open Surgical Repair: Evidence from a Tertiary Hospital in Brazil
- Author
-
Nelson Wolosker, Marcelo Bellini Dalio, Daniel Tavares Malheiro, Marcio Hampe, and Marcelo Passos Teivelis
- Subjects
Adult ,medicine.medical_specialty ,Time Factors ,Cost-Benefit Analysis ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Patient Readmission ,Endovascular aneurysm repair ,Tertiary Care Centers ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Aortic aneurysm ,Postoperative Complications ,0302 clinical medicine ,Cost Savings ,medicine ,Humans ,030212 general & internal medicine ,Hospital Costs ,Aged ,Retrospective Studies ,Aged, 80 and over ,Surgical repair ,business.industry ,Endovascular Procedures ,Retrospective cohort study ,General Medicine ,Length of Stay ,Middle Aged ,medicine.disease ,Abdominal aortic aneurysm ,Blood Vessel Prosthesis ,Surgery ,Perioperative death ,Treatment Outcome ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Lower mortality ,Brazil ,Aortic Aneurysm, Abdominal ,Abdominal surgery - Abstract
Endovascular aneurysm repair (EVAR) has become the preferred approach for the treatment of infrarenal abdominal aortic aneurysm (IRAAA) in detriment of open surgical repair (OSR). EVAR results in lower mortality rates within 30 days, but rates tend to be the same after longer periods. Moreover, reduced use of hospital resources with EVAR does not necessarily offset the costs of the endoprosthesis. We aimed, in this study, to estimate hospital expenses after OSR or EVAR, including early and late readmissions.Retrospective analysis of hospital expenses (2005-2012) with elective IRAAA surgeries performed in a tertiary hospital, including 127 patients divided into 2 groups, EVAR (n = 102) and OSR (n = 25).One perioperative death occurred in each group. EVAR interventions lasted 145 vs. 210 min of OSR (P 0.001). Among OSR patients, 68% required packed red blood cells. Among EVAR patients, this proportion was 7.8% (P 0.001). Median hospitalization time differed significantly for EVAR (4 days) and OSR (8 days; P 0.001, intervals EVAR: 1-17 days, OSR: 2-442 days). The median and mean expenses with EVAR were US $53,080.95 and US $56,289.49, respectively. The median and mean expenses with OSR were US $37,116.04 and US $68,788.54, respectively. Early readmissions reached 11.2%. None of the OSR patients required late reinterventions, but 10 (9.9%) EVAR patients did, one of whom died.EVAR resulted in higher expenses with the exclusion of one outlier. Late reinterventions, with elevated costs, were only required by EVAR patients. Thus, when patients are eligible to undergo either intervention, OSR seems to have lower costs and better long-term results.
- Published
- 2016
24. Carbon dioxide Is a Cost-effective Contrast Medium to Guide Revascularization of TASC A and TASC B Femoropopliteal Occlusive Disease
- Author
-
Nelson Wolosker, Marcelo Passos Teivelis, Kenji Nishinari, Helio Halpern, Sergio Kuzniec, Alexandre de Arruda Martins, Mariana Krutman, and Cynthia de Almeida Mendes
- Subjects
Adult ,Male ,medicine.medical_specialty ,Cost-Benefit Analysis ,Concordance ,medicine.medical_treatment ,Contrast Media ,Renal function ,Constriction, Pathologic ,Radiography, Interventional ,Revascularization ,Nephrotoxicity ,Peripheral Arterial Disease ,Predictive Value of Tests ,Angioplasty ,medicine ,Humans ,Ankle Brachial Index ,Popliteal Artery ,Prospective Studies ,Contraindication ,Aged ,Aged, 80 and over ,business.industry ,Endovascular Procedures ,Health Care Costs ,General Medicine ,Gold standard (test) ,Carbon Dioxide ,Middle Aged ,Surgery ,Femoral Artery ,Contrast medium ,Treatment Outcome ,Feasibility Studies ,Female ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Brazil ,Glomerular Filtration Rate - Abstract
Background Iodine contrast medium (ICM) is considered gold standard in endovascular revascularization procedures. However, nephrotoxicity and hypersensitivity to ICM are causes that limit its indiscriminate use. Carbon dioxide (CO 2 ) contrast angiography has been used as an alternative in patients with formal contraindication to ICM. However, no studies to the present date have compared in a randomized and prospective way, outcomes of revascularization procedures performed with either ICM or CO 2 in patients eligible for use of both contrasts. Methods Between April 2012 and April 2013, 35 patients with peripheral arterial disease with arterial lesions classified as Trans-Atlantic Inter-Society Consensus A or B (identified on preoperative angio computed tomography scan) and adequate runoff underwent femoropopliteal revascularization by endovascular technique in a prospective, randomized, and controlled study. Patients were randomized into 2 groups: CO 2 group and ICM group, according to the contrast media selected of the procedure. We evaluated the following outcomes in both groups: feasibility of the procedures, complications, surgical outcomes (ankle-brachial index [ABI]), glomerular filtration rate using the Cockcroft–Gault formula, relationship between the volume of injected iodine and postoperative creatinine clearance, quality of the angiographic images obtained with CO 2 , costs of the endovascular materials, and finally, cost of contrast agents. Results We were able to perform the proposed procedures in all patients treated in this series (ICM group and CO 2 ). There were no CO 2 -related complications. No procedures required conversion to open surgery. Clinical results were satisfactory, with regression of ischemia and increased levels of ABI in both groups. Variations in creatinine clearance levels showed a numerical increase in the CO 2 group and a decrease in ICM group, however, with no statistically significant difference between the delta clearance in each group. All CO 2 arteriograms of the supragenicular arteries were graded as good or fair by both observers with high interobserver image quality concordance. There was no statistical difference between endovascular material costs between the groups, but the contrast cost was significantly lower in CO 2 group ( P Conclusions The use of CO 2 in patients with no restriction for ICM is an alternative that does not limit the feasibility of the procedures. Similar outcomes were observed with CO 2 when compared with the gold standard contrast (ICM) regarding quality of images produced, with no associated changes in creatinine clearance or hypersensitivity reactions and also allows a reduction in contrast-related costs in angioplasty procedures.
- Published
- 2014
25. Long-term Results of the Use of Oxybutynin for the Treatment of Axillary Hyperhidrosis
- Author
-
Marcelo Passos Teivelis, Rafael Pessanha de Paula, Pedro Puech-Leão, Mariana Krutman, Nelson Wolosker, José Ribas Milanez de Campos, and Paulo Kauffman
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,medicine.medical_treatment ,Sweating ,QUALIDADE DE VIDA ,Muscarinic Antagonists ,Drug Administration Schedule ,Young Adult ,Patient satisfaction ,Quality of life ,medicine ,Humans ,Hyperhidrosis ,Young adult ,Child ,Oxybutynin ,Aged ,Retrospective Studies ,Dose-Response Relationship, Drug ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,Surgery ,Clinical trial ,Treatment Outcome ,Sympathectomy ,Patient Satisfaction ,Child, Preschool ,Anesthesia ,Axilla ,Mandelic Acids ,Patient Compliance ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,medicine.drug - Abstract
Background Axillary hyperhidrosis (AH) is a common disease, with a significant impact on quality of life (QOL). Good short-term results are reported with oxybutynin, but longer follow-up data are lacking. We evaluated its effectiveness in a large series of patients who were not surgically treated and who had at least 6 months of follow-up. Methods From September 2007 to September 2013, 431 consecutive patients were enrolled in “pharmacological first” protocol for treatment of AH with oxybutynin. Thirty-four patients were lost to follow-up, and data are available for 397 patients treated for at least 6 weeks. Data at the start of the protocol, 6 weeks after beginning treatment, and at final visit were analyzed. Results One hundred fourteen patients (28.7%) did not improve and were referred for surgery (sympathectomy). Eight patients (2.01%) presented significant side effects (e.g. dry mouth) and discontinued therapy. Twenty-six patients (9.4%) preferred surgery over pharmacologic treatment. Sixty-two patients have not yet been under treatment for 6 months. The 181 patients with more than 6 months of follow-up (median: 17 months, range: 6–72) were analyzed as follows: 82.9% of patients presented moderate or great improvement in AH and 89% of patients presented improvement in other sites of hyperhidrosis after a median of 17 months. Conclusions In patients with good initial response to oxybutynin, >80% presented moderate or great improvement in axillary and in other sites of excessive sweating. Results were particularly better in women and those who presented better QOL after 6 weeks.
- Published
- 2014
26. Quality of Life before Hyperhidrosis Treatment as a Predictive Factor for Oxybutynin Treatment Outcomes in Palmar and Axillary Hyperhidrosis
- Author
-
Marcelo Passos Teivelis, Taiz Pereira Dozono de Almeida Campbell, Paulo Kauffman, Pedro Puech-Leão, José Ribas Milanez de Campos, Mariana Krutman, and Nelson Wolosker
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Treatment outcome ,Sweating ,Muscarinic Antagonists ,Thoracoscopic sympathectomy ,Axillary hyperhidrosis ,Young Adult ,Quality of life ,Surveys and Questionnaires ,Humans ,Hyperhidrosis ,Medicine ,Child ,Oxybutynin ,Adverse effect ,Retrospective Studies ,TORACOSCOPIA ,business.industry ,General Medicine ,Middle Aged ,humanities ,Predictive factor ,Treatment Outcome ,Child, Preschool ,Quality of Life ,Physical therapy ,Mandelic Acids ,Female ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background Studies have suggested that quality of life (QOL) evaluation before video-assisted thoracoscopic sympathectomy for patients with hyperhidrosis may serve as a predictive factor for positive postoperative outcomes. Our study aims to analyze if this tendency is also observed in patients treated with oxybutynin for palmar and axillary hyperhidrosis. Methods Five hundred sixty-five patients who submitted to a protocol treatment with oxybutynin were retrospectively analyzed between January 2007 and January 2012 and were divided into 2 groups according to QOL assessment before treatment. The groups consisted of 176 patients with “poor” and 389 patients with “very poor” QOL evaluation before oxybutynin treatment. Outcomes involving improvements in QOL and clinical progression of hyperhidrosis were evaluated using a validated clinical questionnaire that was specifically designed to assess satisfaction in patients with excessive sweating. Results Improvements in hyperhidrosis after oxybutynin were observed in 65.5% of patients with very poor pretreatment QOL scores and in 75% of patients with poor pretreatment QOL scores, and the only adverse event associated with oxybutynin treatment was dry mouth, which was observed with greater intensity in patients with very poor initial QOL evaluation. Conclusion Improvements in hyperhidrosis after oxybutynin treatment were similar in both groups, suggesting that QOL before treatment is not a predictive factor for clinical outcomes, contrasting with surgical results that disclose significantly better results in patients with initially poorer QOL analysis.
- Published
- 2014
27. Comparison between Saline Solution Containing Heparin versus Saline Solution in the Lock of Totally Implantable Catheters
- Author
-
Brito, Antonio Rafael de Oliveira, primary, Nishinari, Kenji, additional, Saad, Paulo Fernandes, additional, Saad, Karen Ruggeri, additional, Pereira, Monica Aparecida Tomé, additional, Emídio, Suellen Cristina Dias, additional, Yazbek, Guilherme, additional, Bomfim, Guilherme Andre Zottele, additional, Cavalcante, Rafael Noronha, additional, Krutman, Mariana, additional, Teivelis, Marcelo Passos, additional, Pignataro, Bruno Soriano, additional, Fonseca, Igor Yoshio Imagawa, additional, Centofanti, Guilherme, additional, and Soares, Bruno Leonardo Freitas, additional
- Published
- 2018
- Full Text
- View/download PDF
28. Videothoracoscopic Sympathectomy Results after Oxybutynin Chloride Treatment Failure
- Author
-
Paulo Kauffman, Pedro Puech-Leão, Lucas Lembrança, Nelson Wolosker, Marcelo Passos Teivelis, and José Ribas Milanez de Campos
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,medicine.medical_treatment ,Sweating ,Muscarinic Antagonists ,030204 cardiovascular system & hematology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Oxybutynin Chloride ,Quality of life ,Surveys and Questionnaires ,Medicine ,Humans ,Hyperhidrosis ,Treatment Failure ,Sympathectomy ,Retrospective Studies ,business.industry ,Thoracic Surgery, Video-Assisted ,Incidence (epidemiology) ,Compensatory hyperhidrosis ,Retrospective cohort study ,General Medicine ,Surgery ,Anesthesia ,Quality of Life ,Mandelic Acids ,Observational study ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Brazil - Abstract
Background Videothoracoscopy sympathectomy (VATS) is the only definitive treatment for primary hyperhidrosis (HH). Since 2007, in our institution, patients with HH were initially treated with oxybutynin chloride to avoid VATS and reduce compensatory hyperhidrosis incidence with good results. The aim of this study was to analyze the surgical response of patients suffering from essential hyperhidrosis after failure of oxybutynin chloride treatment. Methods This was an observational retrospective study that included 737 patients who were diagnosed with palmar or axillary hyperhidrosis and received VATS from January 2007 to January 2014. Patients were selected for 2 different groups: The post-oxybutynin surgery group consisted of 167 patients that were initially treated with oxybutynin chloride for 6 weeks and then received VATS after drug treatment failure. The primary surgery group consisted of a historic control group of 570 patients who were referred directly to surgical treatment. We evaluated the degree of improvement in symptoms 30 days after surgery and quality of life before and after the surgical treatment. Results All patients showed poor or very poor quality of life before surgery. Most patients showed a response between moderate and high after surgical treatment. However, those in primary surgery group responded better (95.1% vs. 98.2%). In the quality of life after surgery, most of the patients reported improvement, and the primary surgery group had better improvement (92.2% vs. 95.1%). Conclusions VATS showed good results in patients with palmar or axillary hyperhidrosis regarding surgical response and improvement on quality of life even when the previous oxybutynin chloride treatment failed.
- Published
- 2016
29. Carbon Dioxide as Contrast Medium to Guide Endovascular Aortic Aneurysm Repair
- Author
-
Cynthia de Almeida Mendes, Sergio Kuzniec, Nelson Wolosker, Alexandre de Arruda Martins, Marcelo Passos Teivelis, and Andrea Yasbek Monteiro Varella
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Computed Tomography Angiography ,medicine.medical_treatment ,Iohexol ,Operative Time ,Contrast Media ,030204 cardiovascular system & hematology ,Radiography, Interventional ,Endovascular aneurysm repair ,Aortography ,03 medical and health sciences ,Aortic aneurysm ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,medicine.artery ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Contraindication ,reproductive and urinary physiology ,Computed tomography angiography ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,General Medicine ,Carbon Dioxide ,Middle Aged ,medicine.disease ,Internal iliac artery ,Surgery ,Contrast medium ,Treatment Outcome ,embryonic structures ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Brazil ,Abdominal surgery ,Aortic Aneurysm, Abdominal - Abstract
Background Iodine contrast medium (ICM) is considered to be gold standard in endovascular procedures, but its nephrotoxicity and hypersensitivity limit the widespread use. Carbon dioxide (CO 2 ) is considered as an alternative for endovascular procedures in patients with contraindication to ICM. However, no studies have compared the outcomes of endovascular aneurysm repair (EVAR) performed with ICM or CO 2 among patients with no contraindication to ICM. Methods From May 2012 to April 2014, 36 patients with abdominal aortic aneurysms underwent EVAR in a prospective, randomized, and controlled study. Patients were randomized into 2 groups, CO 2 or ICM group. Results We were able to perform the proposed procedures in all patients in this study. There were no conversions to open surgery and no CO 2 -related complications. Endovascular material costs, duration of surgery, and time of fluoroscopy were similar between groups, and the cost of the contrast media was smaller in the CO 2 group than in the ICM group. Among CO 2 group procedures, 62.5% of the patients needed ICM complementary use. Conclusions The use of CO 2 as a contrast medium for EVAR is an alternative in patients with no restriction for ICM, with similar outcomes when compared to ICM, regarding duration of surgery, duration of fluoroscopy, and endovascular material costs. Using CO 2 , there were no changes in creatinine clearance and no risk of hypersensitivity reactions; moreover, there was a reduction in contrast-related costs for EVAR procedures. However, in our study, additional use of ICM to visualize the internal iliac artery was needed in most procedures.
- Published
- 2016
30. Videothoracoscopic Sympathectomy Results after Oxybutynin Chloride Treatment Failure
- Author
-
Lembrança, Lucas, primary, Wolosker, Nelson, additional, de Campos, José Ribas Milanez, additional, Kauffman, Paulo, additional, Teivelis, Marcelo Passos, additional, and Puech-Leão, Pedro, additional
- Published
- 2017
- Full Text
- View/download PDF
31. Carbon Dioxide as Contrast Medium to Guide Endovascular Aortic Aneurysm Repair
- Author
-
de Almeida Mendes, Cynthia, primary, de Arruda Martins, Alexandre, additional, Teivelis, Marcelo Passos, additional, Kuzniec, Sergio, additional, Varella, Andrea Yasbek Monteiro, additional, and Wolosker, Nelson, additional
- Published
- 2017
- Full Text
- View/download PDF
32. Treatment of Abdominal Aortic Aneurysms in Cancer Patients
- Author
-
Guilherme Yazbek, Rafael Cavalcante, Bruno Soriano Pignataro, Mariana Krutman, Kenji Nishinari, Guilherme André Zottelle Bomfim, Marcelo Passos Teivelis, Nelson Wolosker, and Igor Yoshio Imagawa Fonseca
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,030230 surgery ,Endovascular aneurysm repair ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Aneurysm ,Prostate ,medicine.artery ,Neoplasms ,Medicine ,Humans ,Cause of death ,Aged ,Retrospective Studies ,Surgical repair ,Aged, 80 and over ,business.industry ,Abdominal aorta ,Endovascular Procedures ,Cancer ,Retrospective cohort study ,General Medicine ,Length of Stay ,Middle Aged ,medicine.disease ,Surgery ,Survival Rate ,medicine.anatomical_structure ,Treatment Outcome ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal - Abstract
Background The aim of this study was to analyze the outcomes of oncologic patients with associated aneurysm of the abdominal aorta (AAA), treated at a specialized cancer (Ca) hospital more than a 10-year period. Methods This was a retrospective study, and the data were obtained from our institution's prospective database. Between September 2003 and 2013, a total of 36 consecutive patients with AAA in association with Ca underwent surgical repair. Of these, 9 patients were excluded because the Ca treatment was performed at another service. Most of the patients were male (22) and the most frequent form of neoplasia was prostate Ca. Surgery for AAA repair was performed after the Ca treatment in 19 cases, before Ca treatment in 7 cases and concomitantly in 1 case. The intraoperative characteristics, treatment technique used, complications, patients' clinical evolution, and survival outcomes were analyzed. Results Endovascular aneurysm repair (EVAR) was used in 19 cases (70.4%) and conventional open repair (OR) in 8 cases (29.6%). Surgical treatment was uneventful in 19 cases, however, when present, postoperative complications occurred more frequently with EVAR (36.84% vs. 12.5%). There were no cases of death related to the aneurysm surgery. Most of the patients in both groups were alive at the end of the study. The probability of survival in our study was 65.8% at 3 years and 53% at 5 years, with no statistically significant difference between the EVAR and OR groups. The main cause of death was progression of the neoplastic disease. Conclusions Patients who present Ca in association with AAA benefit from surgical treatment of both conditions, simultaneously or not. In these cases, it is important for the treatment to be individualized, and the disease of greater severity should be treated first. The endovascular and conventional open techniques were shown to be equivalent.
- Published
- 2015
33. Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm Results in Higher Hospital Expenses than Open Surgical Repair: Evidence from a Tertiary Hospital in Brazil
- Author
-
Teivelis, Marcelo Passos, primary, Malheiro, Daniel Tavares, additional, Hampe, Marcio, additional, Dalio, Marcelo Bellini, additional, and Wolosker, Nelson, additional
- Published
- 2016
- Full Text
- View/download PDF
34. Treatment of Abdominal Aortic Aneurysms in Cancer Patients
- Author
-
Yazbek, Guilherme, primary, Nishinari, Kenji, additional, Krutman, Mariana, additional, Wolosker, Nelson, additional, Zottelle Bomfim, Guilherme André, additional, Pignataro, Bruno Soriano, additional, Fonseca, Igor Yoshio Imagawa, additional, Cavalcante, Rafael Noronha, additional, and Teivelis, Marcelo Passos, additional
- Published
- 2016
- Full Text
- View/download PDF
35. Successful Image-Guided Percutaneous Embolization of a Ruptured Abdominal Aortic Aneurysm Sac due to Type II Endoleak after Endovascular Repair
- Author
-
Wolosker, Nelson, primary, Varella, Andrea Yasbek Monteiro, additional, Teivelis, Marcelo Passos, additional, Mendes, Cynthia de Almeida, additional, Garcia, Rodrigo Gobbo, additional, and Pfeferman, Elcio, additional
- Published
- 2015
- Full Text
- View/download PDF
36. Long-term Results of the Use of Oxybutynin for the Treatment of Axillary Hyperhidrosis
- Author
-
Wolosker, Nelson, primary, Teivelis, Marcelo Passos, additional, Krutman, Mariana, additional, de Paula, Rafael Pessanha, additional, Kauffman, Paulo, additional, de Campos, José Ribas M., additional, and Puech-Leão, Pedro, additional
- Published
- 2014
- Full Text
- View/download PDF
37. Carbon dioxide is a cost-effective contrast medium to guide revascularization of TASC A and TASC B femoropopliteal occlusive disease.
- Author
-
de Almeida Mendes C, de Arruda Martins A, Teivelis MP, Kuzniec S, Nishinari K, Krutman M, Halpern H, and Wolosker N
- Subjects
- Adult, Aged, Aged, 80 and over, Ankle Brachial Index, Brazil, Carbon Dioxide adverse effects, Constriction, Pathologic, Contrast Media adverse effects, Endovascular Procedures adverse effects, Feasibility Studies, Female, Femoral Artery physiopathology, Glomerular Filtration Rate drug effects, Humans, Male, Middle Aged, Peripheral Arterial Disease diagnostic imaging, Peripheral Arterial Disease physiopathology, Popliteal Artery physiopathology, Predictive Value of Tests, Prospective Studies, Radiography, Interventional adverse effects, Tomography, X-Ray Computed, Treatment Outcome, Carbon Dioxide economics, Contrast Media economics, Cost-Benefit Analysis, Endovascular Procedures economics, Femoral Artery diagnostic imaging, Health Care Costs, Peripheral Arterial Disease economics, Peripheral Arterial Disease therapy, Popliteal Artery diagnostic imaging, Radiography, Interventional economics
- Abstract
Background: Iodine contrast medium (ICM) is considered gold standard in endovascular revascularization procedures. However, nephrotoxicity and hypersensitivity to ICM are causes that limit its indiscriminate use. Carbon dioxide (CO2) contrast angiography has been used as an alternative in patients with formal contraindication to ICM. However, no studies to the present date have compared in a randomized and prospective way, outcomes of revascularization procedures performed with either ICM or CO2 in patients eligible for use of both contrasts., Methods: Between April 2012 and April 2013, 35 patients with peripheral arterial disease with arterial lesions classified as Trans-Atlantic Inter-Society Consensus A or B (identified on preoperative angio computed tomography scan) and adequate runoff underwent femoropopliteal revascularization by endovascular technique in a prospective, randomized, and controlled study. Patients were randomized into 2 groups: CO2 group and ICM group, according to the contrast media selected of the procedure. We evaluated the following outcomes in both groups: feasibility of the procedures, complications, surgical outcomes (ankle-brachial index [ABI]), glomerular filtration rate using the Cockcroft-Gault formula, relationship between the volume of injected iodine and postoperative creatinine clearance, quality of the angiographic images obtained with CO2, costs of the endovascular materials, and finally, cost of contrast agents., Results: We were able to perform the proposed procedures in all patients treated in this series (ICM group and CO2). There were no CO2-related complications. No procedures required conversion to open surgery. Clinical results were satisfactory, with regression of ischemia and increased levels of ABI in both groups. Variations in creatinine clearance levels showed a numerical increase in the CO2 group and a decrease in ICM group, however, with no statistically significant difference between the delta clearance in each group. All CO2 arteriograms of the supragenicular arteries were graded as good or fair by both observers with high interobserver image quality concordance. There was no statistical difference between endovascular material costs between the groups, but the contrast cost was significantly lower in CO2 group (P < 0.001)., Conclusions: The use of CO2 in patients with no restriction for ICM is an alternative that does not limit the feasibility of the procedures. Similar outcomes were observed with CO2 when compared with the gold standard contrast (ICM) regarding quality of images produced, with no associated changes in creatinine clearance or hypersensitivity reactions and also allows a reduction in contrast-related costs in angioplasty procedures., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.