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Contains fulltext : 251517.pdf (Publisher’s version ) (Open Access) OBJECTIVE: International guidelines recommend supervised exercise therapy (SET) as primary treatment for all patients with intermittent claudication (IC), yet primary endovascular revascularisation (ER) might be more effective in patients with iliac artery obstruction. METHODS: This was a multicentre RCT including patients with IC caused by iliac artery stenosis or occlusion (NCT01385774). Patients were allocated randomly to SET or ER stratified for maximum walking distance (MWD) and concomitant SFA disease. Primary endpoints were MWD on a treadmill (3.2 km/h, 10% incline) and disease specific quality of life (VascuQol) after one year. Additional interventions during a mean follow up of 5.5 years were recorded. RESULTS: Between November 2010 and May 2015, 114 patients were allocated to SET, and 126 to ER. The trial was terminated prematurely after 240 patients were included. Compliance with SET was 57/114 (50%) after six months. Ten patients allocated to ER (8%) did not receive this intervention. One year follow up was complete for 90/114 (79%) SET patients and for 104/126 (83%) ER patients. The mean MWD improved from 187 to 561 m in SET patients and from 196 to 574 m in ER patients (p = .69). VascuQol sumscore improved from 4.24 to 5.58 in SET patients, and from 4.28 to 5.88 in ER patients (p = .048). Some 33/114 (29%) SET patients had an ER within one year, and 2/114 (2%) surgical revascularisation (SR). Some 10/126 (8%) ER patients had additional ER within one year and 10/126 (8%) SR. After a mean of 5.5 years, 49% of SET patients and 27% of ER patients underwent an additional intervention for IC. CONCLUSION: Taking into account the many limitations of the SUPER study, both a strategy of primary SET and primary ER improve MWD on a treadmill and disease specific Qol of patients with IC caused by an iliac artery obstruction. It seems reasonable to start with SET in these patients and accept a 30% failure rate, which, of course, must be discussed with the patient. Patients continue to have interventions beyond one year.

OBJECTIVE: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR).METHODS: This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests.RESULTS: The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38-50) mm and 68 (IQR 58-85) mm, respectively. Mortality was 1.3% (95% CI 0.7-2.4) after eIAA repair and 25.5% (95% CI 18.0-34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively).CONCLUSION: In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair.

Objective: To compare cost effectiveness of endovascular revascularisation (ER) and supervised exercise therapy (SET) as primary treatment for patients with intermittent claudication (IC) due to iliac artery obstruction. Methods: Cost utility analysis from a restricted societal perspective and time horizon of 12 months. Patients were included in a multicentre randomised controlled trial (SUPER study, NCT01385774, NTR2648) which compared effectiveness of ER and SET. Health status and health related quality of life (HRQOL) were measured using the Euroqol 5 dimensions 3 levels (EQ5D-3L) and VascuQol-25-NL. Incremental costs were determined per allocated treatment and use of healthcare during follow up. Effectiveness of treatment was determined in quality adjusted life years (QALYs). The difference between treatment groups was calculated by an incremental cost utility ratio (ICER). Results: Some 240 patients were included, and complete follow up was available for 206 patients (ER 111, SET 95). The mean costs for patients allocated to ER were €4 031 and €2 179 for SET, a mean difference of €1 852 (95% bias corrected and accelerated [bca] bootstrap confidence interval 1 185 – 2 646). The difference in QALYs during follow up was 0.09 (95% bcaCI 0.04 – 0.13) in favour of ER. The ICER per QALY was €20 805 (95% bcaCI 11 053 – 45 561). The difference in VascuQol sumscore was 0.64 (95% bcaCI 0.39 – 0.91), again in favour of ER. Conclusion: ER as a primary treatment, results in slightly better health outcome and higher QALYs and HRQOL during 12 months of follow up. Although these differences are statistically significant, clinical relevance must be discussed due to the small differences and relatively high cost of ER as primary treatment.

Background: To compare hospital outcomes of aortic aneurysm surgery, casemix correction for preoperative variables is essential. Most of these variables can be deduced from mortality risk prediction models. Our aim was to identify the optimal set of preoperative variables associated with mortality to establish a relevant and efficient casemix model.Methods: All patients prospectively registered between 2013 and 2016 in the Dutch Surgical Aneurysm Audit (DSAA) were included for the analysis. After multiple imputation for missing variables, predictors for mortality following univariable logistic regression were analyzed in a manual backward multivariable logistic regression model and compared with three standard mortality risk prediction models: Glasgow Aneurysm Score (GAS, mainly clinical parameters), Vascular Biochemical and Haematological Outcome Model (VBHOM, mainly laboratory parameters), and Dutch Aneurysm Score (DAS, both clinical and laboratory parameters). Discrimination and calibration were tested and considered good with a C-statistic > 0.8 and Hosmer-Lemeshow (H-L) P > 0.05.Results: There were 12,401 patients: 9,537 (76.9%) elective patients (EAAA), 913 (7.4%) acute symptomatic patients (SAAA), and 1,951 (15.7%) patients with acute rupture (RAAA). Overall postoperative mortality was 6.5%; 1.8% after EAAA surgery, 6.6% after SAAA, and 29.6% after RAAA surgery. The optimal set of independent variables associated with mortality was a mix of clinical and laboratory parameters: gender, age, pulmonary comorbidity, operative setting, creatinine, aneurysm size, hemoglobin, Glasgow coma scale, electrocardiography, and systolic blood pressure (C-statistic 0.871). External validation overall of VBHOM, DAS, and GAS revealed C-statistics of 0.836, 0.782, and 0.761, with an H-L of 0.028, 0.00, and 0.128, respectively.Conclusions: The optimal set of variables for casemix correction in the DSAA comprises both clinical and laboratory parameters, which can be collected easily from electronic patient files and will lead to an efficient casemix model.

Endoscopic surgery has proven to be beneficial to the patient with regard to reduction of hospital stay, postoperative pain and earlier return to daily activities. After its introduction, development of new instrumentation improved and facilitated endoscopic performance (Yohannes et al, 2002). Despite this development, laparoscopic procedures have been limited by fixed distances, restricted freedom of motion of the surgical instruments, impaired visualization and small working space (Sarle et al, 2004). With the introduction of surgical robotic systems an attempt was made to overcome these technical difficulties. Many conventional laparoscopic procedures have been duplicated with assistance of a surgical robotic system. Endoscopic cardiac procedures, that were not feasible before applying conventional laparoscopic techniques, are currently performed robotically-assisted. Several advantages of robotic surgery compared to conventional laparoscopy have been identified: additional degrees of freedom of motion, downscaling of movements, enhanced stability (both of visualization and surgical instrumentation), restoration of the eye-hand target axis, elimination of the fulcrum effect and improved ergonomics for the surgeon. These features are supposed to enhance surgical performance by improved accuracy, dexterity and visualization. Consequently, it can be expected that endoscopic surgical skills are more easily mastered and the learning curve is shortened. The learning curve can be defined as the amount of practice (in time or number of repetitions) necessary to achieve a consistency of a specified parameter. A time-action analysis, the time to complete a task, the number of actions required and the number of errors made, are parameters used to evaluate the learning curve for a specific task. In daily practice, other parameters viz. conversion rate, operating time, blood loss, morbidity and hospital stay are used to assess the learning curve for a specific procedure. Most advanced endoscopic procedures are characterized by a long learning curve. Learning curves are associated with prolonged operative times, increased patient morbidity and higher costs. These difficulties might delay further implementation of advanced endoscopic techniques. Although a surgical robotic system might impose as the ideal endoscopic instrument, most clinical studies have not shown benefit with regard to operative time compared to conventional endoscopy. The objective of this study is to systematically review the available literature to evaluate the impact of a surgical robotic system on the learning curve of endoscopic procedures compared to conventional endoscopy. O pe n A cc es s D at ab as e w w w .ite ch on lin e. co m

BACKGROUND: Colonic ischemia remains a severe complication after abdominal aortic aneurysm (AAA) repair and is associated with a high mortality. With open repair being one of the main risk factors of colonic ischemia, deciding between endovascular or open aneurysm repair should be based on tailor-made medicine. This study aims to identify high-risk patients of colonic ischemia, a risk that can be taken into account while deciding on AAA treatment strategy.METHODS: A nationwide population-based cohort study of 9,433 patients who underwent an AAA operation between 2014 and 2016 was conducted. Potential risk factors were determined by reviewing prior studies and univariate analysis. With logistic regression analysis, independent predictors of intestinal ischemia were established. These variables were used to form a prediction model.RESULTS: Intestinal ischemia occurred in 267 patients (2.8%). Occurrence of intestinal ischemia was seen significantly more in open repair versus endovascular aneurysm repair (7.6% vs. 0.9%; P < 0.001). This difference remained significant after stratification by urgency of the procedure, in both intact open (4.2% vs. 0.4%; P < 0.001) and ruptured open repair (15.0% vs. 6.2%); P < 0.001). Rupture of the AAA was the most important predictor of developing intestinal ischemia (odds ratio [OR], 5.9, 95% confidence interval [CI] 4.4-8.0), followed by having a suprarenal AAA (OR 3.4; CI 1.1-10.6). Associated procedural factors were open repair (OR 2.8; 95% CI 1.9-4.2), blood loss >1L (OR 3.6; 95% CI 1.7-7.5), and prolonged operating time (OR 2.0; 95% CI 1.4-2.8). Patient characteristics included having peripheral arterial disease (OR 2.4; 95% CI 1.3-4.4), female gender (OR 1.7; 95% CI 1.2-2.4), renal insufficiency (OR 1.7; 1.3-2.2), and pulmonary history (OR 1.6; 95% CI 1.2-2.2). Age CONCLUSIONS: One of the main risk factors is open repair. Several other risk factors can contribute to developing colonic ischemia after AAA repair. The proposed prediction model can be used to identify patients at high risk for developing colonic ischemia. With the current trend in AAA repair leaning toward open repair for better long-term results, our prediction model allows a better informed decision can be made in AAA treatment strategy.

Contains fulltext : 226469.pdf (Publisher’s version ) (Open Access) BACKGROUND: Long-term secondary aortic reinterventions (SARs) can be a sign of (lack of) effectiveness of abdominal aortic aneurysm (AAA) surgery. This study provides insight into the national number of SARs after primary AAA repair by endovascular aneurysm repair (EVAR) or by open surgical repair in the Netherlands. METHODS: Observational study included all patients undergoing SAR between 2016 and 2017, registered in the compulsory Dutch Surgical Aneurysm Audit (DSAA). The DSAA started in 2013, SARs are registered from 2016. Characteristics of SAR and postoperative outcomes (mortality/complications) were analyzed, stratified by urgency of SAR. Data of SARs were merged with data of their preceded primary AAA repair, registered in the DSAA after January 2013. In these patients undergoing SAR, treatment characteristics of the preceded primary AAA repair were additionally described, with focus on differences between stent grafts. RESULTS: Between 2016 and 2017, 691 patients underwent SAR, this concerned 9.3% of all AAA procedures (infrarenal/juxtarenal/suprarenal) in the Netherlands (77% elective/11% acute symptomatic/12% ruptured). Endoleak (60%) was the most frequent indication for SAR. SARs were performed with EVAR in 66%. Postoperative mortalities after SAR were 3.4%, 11%, and 29% in elective, acute symptomatic, and ruptured patients, respectively. In 26% (n = 181) of the patients undergoing SAR their primary AAA repair was performed after January 2013 and data of primary and SAR procedures could be merged. In 93% (n = 136), primary AAA repair was EVAR. Endografts primarily used were nitinol/polyester (62%), nitinol/polytetrafluoroethylene (8%), endovascular sealing (21%), and others (9%), compared with their national market share of 76% (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.38-0.71), 15% (OR, 0.50; CI, 0.29-0.89), 4.9% (OR, 5.04; CI, 3.44-7.38), and 4.1% (OR, 2.81; CI, 1.66-4.74), respectively. CONCLUSIONS: In the Netherlands, about one-tenth of the annual AAA procedures concerns an SAR. A quarter of this cohort had an SAR within 1-5 years after their primary AAA repair. Most SARs followed after primary EVAR procedures, in which an overrepresentation of endovascular sealing grafts was seen. Postoperative mortality after SAR is comparable with primary AAA repair.

Contains fulltext : 226467.pdf (Publisher’s version ) (Closed access) OBJECTIVE: Composite measures may better objectify hospital performance than individual outcome measures (IOM). Textbook outcome (TO) is an outcome measure achieved for an individual patient when all undesirable outcomes are absent. The aim of this study was to assess TO as an additional outcome measure to evaluate quality of care in symptomatic patients treated by carotid endarterectomy (CEA). METHODS: All symptomatic patients treated by CEA in 2018, registered in the Dutch Audit for Carotid Interventions, were included. TO was defined as a composite of the absence of 30 day mortality, neurological events (any stroke or transient ischaemic attack [TIA]), cranial nerve deficit, haemorrhage, 30 day readmission, prolonged length of stay (LOS; > 5 days) and any other surgical complication. Multivariable logistic regression was used to identify covariables associated with achieving TO, which were used for casemix adjustment for hospital comparison. For each hospital, an observed vs. expected number of events ratio (O/E ratio) was calculated and plotted in a funnel plot with 95% control limits. RESULTS: In total, 70.7% of patients had a desired outcome within 30 days after CEA and therefore achieved TO. Prolonged LOS was the most common parameter (85%) and mortality the least common (1.1%) for not achieving TO. Covariates associated with achieving TO were younger age, the absence of pulmonary comorbidity, higher haemoglobin levels, and TIA as index event. In the case mix adjusted funnel plot, the O/E ratios between hospitals ranged between 0.63 and 1.27, with two hospitals revealing a statistically significantly lower rate of TO (with O/E ratios of 0.63 and 0.66). CONCLUSION: In the Netherlands, most patients treated by CEA achieve TO. Variation between hospitals in achieving TO might imply differences in performance. TO may be used as an additive to the pre-existing IOM, especially in surgical care with low baseline risk such as CEA.

Contains fulltext : 226470.pdf (Publisher’s version ) (Closed access) OBJECTIVE: Mycotic aneurysms of the abdominal aorta (MAAA) can be treated by open repair (OR) or endovascular aneurysm repair (EVAR). This nationwide study provides an overview of the situation of MAAA treatment in The Netherlands in 2016. METHODS: A retrospective cohort study was conducted with all centers that registered aortic abdominal aneurysms in the Dutch Surgical Aneurysm Audit in 2016. Questionnaires on 1-year outcomes were sent to all centers that treated patients with MAAA. The primary aim was to determine 30-day and 1-year mortality and morbidity of OR- and EVAR-treated patients. Morbidity was determined by the need for reoperations and the number of readmissions to the hospital. RESULTS: Twenty-six MAAA were detected in the Dutch Surgical Aneurysm Audit database of 2016, resulting in an incidence of 0.7% of all registered abdominal aortic aneurysms. The 30-day mortality for OR and EVAR treated patients was 1 in 13 and 0 in 13, respectively. Major and minor reinterventions within 30 days were needed for two (one OR and one EVAR) and two (one OR and one EVAR) patients, respectively. Two patients (15.4%) in the OR group and one patient (7.7%) in the EVAR group were readmitted to hospital within 30 days. In total, 1-year outcomes of 23 patients were available. In the OR group, one patient (9.1%) died in the first postoperative year. There was one major reintervention (removal of endoprosthesis and spiralvein reconstruction) in the EVAR group. Two patients (18.2%) treated with OR and two (16.7%) treated with EVAR required a minor reintervention. In both groups, four patients (OR, 36.4%; EVAR, 33.3%) were readmitted to hospital within 1 year postoperatively. CONCLUSIONS: Both OR- and EVAR-treated patients show acceptable clinical outcomes after 30 days and at the 1-year follow-up. Depending on the clinical course of the patient, EVAR may be considered in the management of this disease.

Contains fulltext : 229914.pdf (Publisher’s version ) (Open Access) BACKGROUND: While several observational studies suggested a lower postoperative mortality after minimal invasive endovascular aneurysm repair (EVAR) in patients with a ruptured abdominal aortic aneurysm (RAAA) compared to conventional open surgical repair (OSR), landmark randomized controlled trials have not been able to prove the superiority of EVAR over OSR. Randomized controlled trials contain a selected, homogeneous population, influencing external validity. Observational studies are biased and adjustment of confounders can be incomplete. Instrumental variable (IV) analysis (pseudorandomization) may help to answer the question if patients with an RAAA have lower postoperative mortality when undergoing EVAR compared to OSR. METHODS: This is an observational study including all patients with an RAAA, registered in the Dutch Surgical Aneurysm Audit between 2013 and 2017. The risk difference (RD) in postoperative mortality (30 days/in-hospital) between patients undergoing EVAR and OSR was estimated, in which adjustment for confounding was performed in 3 ways: linear model adjusted for observed confounders, propensity score model (multivariable logistic regression analysis), and IV analysis (two-stage least square regression), adjusting for observed and unobserved confounders, with the variation in percentage of EVAR per hospital as the IV instrument. RESULTS: 2419 patients with an RAAA (1489 OSR and 930 EVAR) were included. Unadjusted postoperative mortality was 34.9% after OSR and 22.6% after EVAR (RD 12.3%, 95% CI 8.5-16%). The RD adjusted for observed confounders using linear regression analysis and propensity score analysis was, respectively, 12.3% (95% CI 9.6-16.7%) and 13.2% (95%CI 9.3-17.1%) in favor of EVAR. Using IV analysis, adjusting for observed and unobserved confounders, RD was 8.9% (95% CI -1.1-18.9%) in favor of EVAR. CONCLUSIONS: Adjusting for observed confounders, patients with an RAAA undergoing EVAR had a significant better survival than OSR in a consecutive large cohort. Adjustment for unobserved confounders resulted in a clinical relevant RD. An "EVAR preference strategy" in patients with an RAAA could result in lower postoperative mortality.

BACKGROUND: Previous studies have suggested that sigmoidectomy with primary anastomosis is superior to Hartmann's procedure. The likelihood of stoma reversal after primary anastomosis has been reported to be higher and reversal seems to be associated with lower morbidity and mortality. Although promising, results from these previous studies remain uncertain because of potential selection bias. Therefore, this study aimed to assess outcomes after Hartmann's procedure versus sigmoidectomy with primary anastomosis, with or without defunctioning ileostomy, for perforated diverticulitis with purulent or faecal peritonitis (Hinchey III or IV disease) in a randomised trial. METHODS: A multicentre, randomised, open-label, superiority trial was done in eight academic hospitals and 34 teaching hospitals in Belgium, Italy, and the Netherlands. Patients aged between 18 and 85 years who presented with clinical signs of general peritonitis and suspected perforated diverticulitis were eligible for inclusion if plain abdominal radiography or CT scan showed diffuse free air or fluid. Patients with Hinchey I or II diverticulitis were not eligible for inclusion. Patients were allocated (1:1) to Hartmann's procedure or sigmoidectomy with primary anastomosis, with or without defunctioning ileostomy. Patients were enrolled by the surgeon or surgical resident involved, and secure online randomisation software was used in the operating room or by the trial coordinator on the phone. Random and concealed block sizes of two, four, or six were used, and randomisation was stratified by age (

Objectives: Failure to rescue (FTR) is a composite quality indicator, defined as the proportion of deceased patients following major complications. The aims of this study were to compare FTR with mortality for hospital comparisons in abdominal aortic aneurysm (AAA) surgery in The Netherlands and investigate hospital volume and associated factors.Methods: Patients prospectively registered between 2013 and 2015 in the Dutch Surgical Aneurysm Audit (DSAA) were analysed. FTR was analysed for AAA patients and subgroups elective (EAAA) and acute (AAAA; symptomatic or ruptured) aneurysms. Variables and hospital volume were analysed by uni- and multivariable regression analysis. Adjusted hospital comparisons for mortality, major complications, and FTR were presented in funnel plots. Isomortality lines were constructed when presenting FTR and major complication rates.Results: A total of 9258 patients were analysed in 61 hospitals: 7149 EAAA patients (77.2%) and 2109 AAAA patients (22.8%). There were 2785 (30.1%) patients with complications (unadjusted range 5-65% per hospital): 2161 (77.6%) with major and 624 (28.4%) patients with minor complications. Overall mortality was 6.6% (adjusted range 0-16% per hospital) and FTR was 28.4% (n = 613) (adjusted range 0-60% per hospital). Glasgow Coma Scale, age, pulse, creatinine, electrocardiography, and operative setting were independently associated with FTR. Hospital volume was not associated with FTR. In AAAA patients hospital volume was significantly associated with a lower adjusted major complication and mortality rate (OR 0.62, 95% CI 0.49-0.78; and 0.64, 95% CI 0.48-0.87). Four hospitals had a significant lower adjusted FTR with different major complication rates on different isomortality lines.Conclusions: There was more variation in FTR than in mortality between hospitals. FTR identified the same best performing hospitals as for mortality and therefore was of limited additional value in measuring quality of care for AAA surgery. FTR can be used for internal quality improvement with major complications in funnel plots and diagrams with isomortality lines. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

Background: The Dutch Audit for Carotid Interventions (DACI) registers all patients undergoing interventions for carotid artery stenosis in the Netherlands. This study describes the design of the DACI and results of patients with a symptomatic stenosis undergoing carotid endarterectomy (CEA). It aimed to evaluate variation between hospitals in process of care and (adjusted) outcomes, as well as predictors of major stroke/death after CEA.Methods: All patients with a symptomatic stenosis, who underwent CEA and were registered in the DACI between 2014 and 2016 were included in this cohort. Descriptive analyses of patient characteristics, process of care, and outcomes were performed. Casemix adjusted hospital procedural outcomes as (30 day/in hospital) mortality, stroke/death, and major stroke/death, were compared with the national mean. A multivariable logistic regression model (backward elimination at p > 0.10) was used to identify predictors of major stroke/death.Results: A total of 6459 patients, registered by 52 hospitals, were included. The majority (4,832, 75%) were treated Conclusion: CEA in The Netherlands is associated with an overall low mortality and (major) stroke/death rate. Whereas the indicator time to intervention varied between hospitals, mortality and (major) stroke/death were not significantly distinctive enough to identify worse practices and therefore were unsuitable for hospital comparison in the Dutch setting. Additionally, predictors of major stroke/death at population level could be identified. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

SummaryEndoluminal techniques such as laser therapy, radiofrequency therapy and sclerotherapy are increasingly replacing classic stripping for the treatment of incompetent saphenous veins. Interim results of the ongoing international, multicentre BRITTIV study to investigate the effectiveness and tolerability of the minimally invasive bipolar radiofrequency-induced thermal therapy (RFITT) are presented. Patients, methods: A flexible bipolar RFITT applicator is passed under ultrasound control into the affected vein of patients with varicosis of the great saphenous vein (GSV) or small saphenous vein (SSV). The vein is occluded by impedance-controlled release of radiofrequency energy as the RFITT applicator is slowly and smoothly withdrawn. The effectivness and tolerability of RFITT is checked over a one-year period by regular follow-ups. Results: To date a total of 345 saphenous veins (90% GSV, 10% SSV) in 271 patients (average age 50 years, 63% women, mean CEAP score 2.8) have been treated with RFITT in eight European hospitals. 72% of patients underwent general anaesthesia (18% spinal, 11% local) and tumescent anaesthesia was also used in 83% of the veins (mean length 45 cm). The average application time was 1.4 s/cm with a mean power output of 24 Watt. At the interim analysis after an average follow-up of 103 days, 90% of 335 treated veins were occluded. Differential analysis showed that partial (P) and complete (C) recurrences occurred significantly less often when longer application times had been used, whereby complete recurrences showed a greater reduction in frequency than partial. The total recurrence rate with an application time < 1 s/cm was 22% (P = 10%, C = 12%); with an application time between 1.0 and 1.4 s/cm it had already fallen to 9% (P = 6%, C = 3%) and with a time greater than 1.4 s/cm it was only 4% (P = 3%, C = 1%). According to subjective pain assessment on a visual analogue scale (VAS) of 0 to 10 (corresponding to no pain up to the strongest conceivable pain), by the first day after treatment already 74% of those questioned had only slight remaining pain or none at all (VAS 0–2). This generally low subjective pain sensation continued to fall at subsequent followups and at the 6-month follow-up, 99% of patients reported a VAS score of 0. Nearly all patients (99%) were satisfied with the treatment and would recommend it to others. Conclusions: With the same power output, even a minor increase in the application time to more than 1.4 s/cm can markedly reduce recurrence rate. In summary, the ongoing BRITTIV study illustrates the potential of RFITT for use in phlebology as it combines a spatially-defined obliteration of incompetent saphenous veins with overall moderate side effects and impressive results.

Real Time Stratigraphy (RTS) is a novel development of a widely used basin and field scale correlation algorithm (INPEFA) that detects stratigraphic discontinuities and trends by distinguishing these from orbitally forced climatic changes in stratigraphic data. This allows for the development of a high resolution correlation. Well placement in heterogeneous carbonates where rock quality is defined by variations in rock and pore textures and not mineralogy can be challenging. This often relies on the use of multiple LWD tools or techniques that require the use of cuttings with significant delay in decision making and cost efficiency.

Thermal hydraulic design and thermal stress calculations were conducted for a water-cooled solid target irradiated by a MW-class proton beam for a spallation neutron source. Plate type and rod bundle type targets were examined. The thickness of the plate and the diameter of the rod were determined based on the maximum and the wall surface temperature. The thermal stress distributions were calculated by a finite element method (FEM). The neutronics performance of the target is roughly proportional to its average density. The averaged densities of the designed targets were calculated for tungsten plates, tantalum–clad tungsten plates, tungsten rods sheathed by tantalum and Zircaloy and they were compared with mercury density. It was shown that the averaged density was highest for the tungsten plates and was high for the tantalum cladding tungsten plates, the tungsten rods sheathed by tantalum and Zircaloy in order. They were higher than or equal to that of mercury for the 1–2 MW proton beams. Tungsten target without the cladding or the sheath is not practical due to corrosion by water under irradiation condition. Therefore, the tantalum cladding tungsten plate already made successfully by HIP and the sheathed tungsten rod are the candidate of high performance solid targets. The decay heat of each target was calculated. It was low enough low compared to that of ISIS for the target without tantalum but was about four times as high as that of ISIS when the thickness of the tantalum cladding was 0.5 mm. Heat removal methods of the decay heat with tantalum were examined. It was shown that a special cooling system was required for the target exchange when tantalum was used for the target. It was concluded that the tungsten rod target sheathed with stainless steel or Zircaloy was the most reliable from the safety considerations and had similar neutronics performance to that of mercury.

A solid target is expected to give higher neutron intensity than a liquid target of mercury at a spallation neutron source with a power of around 1 MW. We have studied the neutronic performance of a target-moderator-reflector assembly with a tungsten solid target. It is found that the neutron intensities from moderators were higher in the solid target system than in the mercury liquid target. However, the tungsten target required cladding to prevent tungsten from the corrosion of cooling water. A tungsten target with tantalum cladding has been already developed although tantalum has high decay heat. Therefore, we estimated the decay heat of the target and found that the decay heat of 0.5 mm thick tantalum was still high. We need a thinner tantalum or new cladding materials. It was revealed that adoption of a thinner tantalum or new cladding material such as chrome nitride reduced the decay heat effectively.

Background: Considerable training is necessary to master laparoscopic suturing and knot-tying. Robotic systems are assumed to facilitate these skills and shorten the learning curve. The effect of laparoscopic experience and robotic assistance on the learning curve of vascular anastomoses was studied. Methods: A laparoscopically experienced surgeon and a laparoscopically inexperienced surgeon made alternating laparoscopic vascular anastomoses and robot-assisted laparoscopic vascular anastomoses using a Zeus-Aesop surgical robotic system with various prosthetic conduits and suture materials in a laparoscopic training box. Results: Neither laparoscopic method influenced the quality score or leakage rate, but with laparoscopic experience, significantly fewer failures were made. Suturing and knot-tying were faster with laparoscopic experience both with and without the robotic system, and fewer stitch actions and knot actions were performed. The learning curves of both surgeons were not improved by the robotic system. Conclusions: Experience is the most important factor in the performance of laparoscopic vascular anastomoses. The robotic system was not helpful in shortening the learning curve

Background: The objective of this study was to compare the efficiency of manual and robotically assisted laparoscopic surgery. Methods: To evaluate the surgical efficiency in a set of basic endoscopic movements, 20 medical students without any surgical experience were selected to perform at random a set of laparoscopic tasks either manually or robotic assisted (Zeus). This task consisted of dropping beads into receptacles, running a 25-cm rope, capping a hypodermic needle, suturing, and performing a laparoscopic cholecystectomy on a cadaver liver of a pig. A quantitative time–action analysis was performed to evaluate the efficacy and skill performance in terms of time and the number of actions. Results: The dropping beads exercise and the laparoscopic cholecystectomy required more time when performed with robotic assistance, as compared with manual performance (respectively, median, 78.5 s; range, 63 – 122 s vs median, 144.5 s; range, 100 – 169 s; p

Objectives:To investigate the effectiveness of bipolar radiofrequency-induced thermal therapy (RFITT) in a multicentre non-randomized study.Methods:Some 672 incompetent saphenous veins (85% great saphenous varicose vein, 15% short saphenous vein) in 462 patients (56.5% CEAP [clinical, aetiological, anatomical and pathological elements] class 3 or worse) were treated in eight European centres. Patients were assessed between 180 and 360 days postoperatively. Occlusion rates were determined by duplex ultrasound and compared with the power used for treatment, pull back rate and experience of the operating surgeon.Results:Complete occlusion rates of 98.4% were achieved when treatments were performed by an experienced operator (more than 20 cases), when the maximum power setting on the RFITT generator was between 18 and 20 Wand the applicator was withdrawn at a rate slower than 1.5 second/cmConclusions:RFITT is efficacious, well tolerated by patients and has a low incidence of procedure-related post-operative c...

Submitted by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-02-19T13:03:29Z No. of bitstreams: 5 denio.pdf: 1745055 bytes, checksum: 531bb76e60dd34c17e7c27620ce5b5c0 (MD5) license_url: 52 bytes, checksum: 3d480ae6c91e310daba2020f8787d6f9 (MD5) license_text: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) license.txt: 2110 bytes, checksum: b4c884761e4c6c296ab2179d378436d4 (MD5) Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-02-20T10:55:25Z (GMT) No. of bitstreams: 5 denio.pdf: 1745055 bytes, checksum: 531bb76e60dd34c17e7c27620ce5b5c0 (MD5) license_url: 52 bytes, checksum: 3d480ae6c91e310daba2020f8787d6f9 (MD5) license_text: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) license.txt: 2110 bytes, checksum: b4c884761e4c6c296ab2179d378436d4 (MD5) Made available in DSpace on 2015-02-20T10:55:25Z (GMT). No. of bitstreams: 5 denio.pdf: 1745055 bytes, checksum: 531bb76e60dd34c17e7c27620ce5b5c0 (MD5) license_url: 52 bytes, checksum: 3d480ae6c91e310daba2020f8787d6f9 (MD5) license_text: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) license.txt: 2110 bytes, checksum: b4c884761e4c6c296ab2179d378436d4 (MD5) Previous issue date: 2013-02-21 Funda??o de Amparo ? Pesquisa do estado de Minas Gerais (FAPEMIG) Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico (CNPq) Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (Capes) Neste trabalho, foi realizado o desenvolvimento de um imunosensor para detec??o de anticorpos anti-Leishmania infantum. O princ?pio de transdu??o foi a Resson?ncia de Pl?smons de Superf?cie (SPR) e o sensor foi produzido atrav?s da imobiliza??o covalente de ant?genos sol?veis de Leishmania infantum sobre Monocamada Auto-Organizada (SAM) do ?cido 11-Mercaptoundecan?ico (11-MUA) ativado pela mistura contendo 100,0 mmol.L-1 de 1-etil-3-(3-dimetilaminopropil) carbodiimida (EDC) e 150 mmol.L-1 de N-hidroxisuccinimida (NHS). Atrav?s das t?cnicas de Voltametria C?clica e Redu??o Dessortiva por Voltametria de Pulso Diferencial o processo de forma??o da SAM foi otimizado. Sob condi??es otimizadas, 1,0 mmol.L-1 da solu??o etan?lica de 11-MUA e 24 horas foram suficientes para a forma??o de uma SAM est?vel sobre a superf?cie de ouro. Para obten??o de informa??es complementares da SAM, foram realizados c?lculos da Cobertura de Superf?cie, Constante Diel?trica e Espessura do tiol adsorvido no substrato de ouro. Ap?s esta etapa, a adi??o de ant?genos sol?veis de L. infantum sobre a SAM foi acompanhada por SPR. As t?cnicas de Voltametria C?clica e Espectroscopia de Imped?ncia Eletroqu?mica foram usadas para caracterizar a imobiliza??o do ant?geno. Ap?s constru??o do imunosensor, foram adicionados em sua superf?cie soros caninos positivos para Leishmaniose Visceral, evidenciando varia??o significativa no ?ngulo de SPR, mostrando excelente sensibilidade da t?cnica para detec??o da intera??o ant?geno-anticorpo. Por outro lado, a adi??o dos soros negativos n?o foi acompanhada com resposta significativa, concluindo-se tamb?m que o imunosensor apresentou boa especificidade contra anticorpos anti-L. infatum. Portanto, neste trabalho foi desenvolvido com sucesso um sensor empregando SPR para detec??o em tempo real de anticorpos anti-L. infatum, apresentando grande perspectiva como sistema de sensoriamento da Leishmaniose Visceral em ?reas end?micas. Disserta??o (Mestrado) ? Programa de P?s-Gradua??o em Qu?mica, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2012. ABSTRACT In this work, the development of an immunosensor for detection of anti-Leishmania infantum antibodies was performed. The principle of transduction used was the Surface Plasmon Resonance (SPR) and the sensor was constructed by covalent immobilization of soluble antigens of Leishmania infantum on self-assembled monolayers (SAMs) of 11-mercaptoundecanoic acid (11-MUA) which was activated by the mixture 100.0 mmol.L-1 1-ethyl-3 (3-dimethylaminopropyl) carbodiimide (EDC) and 150 mmol.L-1 N-hidroxisuccinimide (NHS). Cyclic Voltammetry and Dessortive Reduction by Differential Pulse Voltammetry techniques were employed in monitoring of SAM formation. Under optimized conditions, 1.0 mmol.L-1 of the 11-MUA in ethanolic solution and 24 hours were sufficient for the formation of a stable SAM on the gold surface. To obtain further information about the SAM, the Surface Coverage, Dielectric Constant and Thickness of the thiol film adsorbed on gold substrate were performed. After this step, the addition of soluble antigens?of L.?infantum?on the?SAM?was monitored?by SPR. Cyclic Voltammetry and Electrochemical Impedance Spectroscopy techniques were employed in characterization of antigen immobilization. After construction of immunosensor, positive canine serum for Visceral Leishmaniasis were added on its surface showing significant variation in the SPR angle, indicating excellent sensitivity of the technique for?antigen-antibody interaction detection. On the other hand, the addition of negative serum was not accompanied with a significant response, demonstrating that the immunosensor shows excellent specificity against anti-L infantum antibodies. Therefore, this work shows a successfully development of a SPR sensor for anti-L. infatum antibodies detection in real time, showing a great perspective as a sensing system of Visceral Leishmaniasis in endemic regions.

The traditional surgical treatment of an incompetent great saphenous vein (GSV) and small saphenous vein (SSV) is challenged by endovenous techniques. Bipolar radio frequency induced thermo therapy (RFITT) is a new endovenous treatment, which occludes the vein by using the venous wall as a conductor. Linear endovenous energy densitiy (LEED) describes the amount of energy used for vein closure. Material/methods From March 2007 till April 2009, two cohorts (23 W and 20 W) were compared, respectively 280 and 178 patients. GSV and SSV were separately analyzed. Follow-up was performed at 3 weeks and 1 year post-operatively with duplex ultrasound, to assess vein closure and perioperative complaints. A visual analog scale (VAS) pain score (range 0–10) was documented. For patients operated after October 2008 follow-up was performed at least 6 months after surgery. Results 528 GSV and 76 SSV were treated. For the GSV a significant difference in LEED 40.8 17.1 in the 20 W cohort was found, resulting in higher occlusion rates 90.6% compared to 82.7% after 3 weeks. Follow-up of 1 year in the 20 W cohort showed 88.7% occlusion. Multivariate analysis showed that pullback speed (OR 3.7, CI 1.1–12.4) and CEAP classification (OR 3.1, CI 1.7–5.6) were significant predictors for vein occlusion. Despite a higher LEED, post-operative complaints were not significantly worse. Conclusion RFITT is a safe and effective method to treat incompetent saphenous veins. Slower pullback speed with higher LEED results in higher closure rates without causing more pain.

Objective: The objective of this systematic review is to evaluate the results of clinical studies on laparoscopic surgery for aorto-iliac disease. Methods: A systematic review of the literature from 1966 to September 2006 on laparoscopic and robotic vascular surgery was performed. Only patient series containing more than 5 cases were included. Operative, clamping and anastomosis times, conversion, mortality and morbidity and hospital stay were evaluated. Results: Thirty studies were identified. These were all descriptive and included 9 comparative studies. Operative times varied widely, the shortest being for hand-assisted procedures (2.5-4 hours) and the longest for totally laparoscopic procedures (4-6.5 hours). Clamping times were all < 1 hour in hand-assisted procedures while in other techniques clamping times from 1-2.5 hours were seen. The conversion rate varied from

Background Robotic technology may facilitate laparoscopic aortic reconstruction. We present our early clinical experience with laparoscopic aortobifemoral bypass, aided by two different robotic surgical systems. Methods Between February 2002 and April 2004, we performed eight robot-assisted laparoscopic aorto-bifemoral bypasses for aortoiliac occlusive disease. All patients were male; median age was 55 years (range: 36–64). Dissection was performed laparoscopically and the robotic system was used to construct the aortic anastomosis. Results A robot-assisted anastomosis was successfully performed in seven patients. Median operative time was 405 min (range: 260–589), with a median clamp-time of 111 min (range: 85–205). Median blood loss was 900 ml (range: 200–5800). Median anastomosis time was 74 min (range 40–110). In two patients conversion was necessary, one due to bleeding of an earlier clipped lumbar artery after completion of the anastomosis, the other because of difficulties with the laparoscopic exposure of the aorta. On post-operative day 3 one patient died unexpectedly as a result of a massive myocardial infarction. Median hospital stay was 7.5 days (range: 3–57). Conclusion Our initial experience with robotic assisted laparoscopic surgery (RALS) shows it is a feasible technique for aortoiliac bypass surgery. However, laparoscopic aortoiliac surgery demands considerable experience and operative times need to be reduced before this technique can be widely implemented.

Background. Robot-assisted surgery is thought to facilitate complex laparoscopic movements, enhancing advanced laparoscopic procedures. Objective. To evaluate the benefit of robotic assistance for laparoscopic vascular surgery. Design. Experimental study using prosthetic conduits in a laparoscopic training box. Methods. Two surgeons each performed 40 laparoscopic vascular anastomoses alternating with and without robotic assistance. A Zeus-Aesop surgical Robotic system™ with 3-D visualisation was used. Each surgeon made 40 anastomoses in total, using different prostheses (5 mm PTFE and 16 mm Dacron) and suture material (Prolene and PTFE). A time-action analysis was performed to evaluate surgical performance. Primary efficacy parameters were quality and leakage of the anastomosis, total time and total number of actions. Results. Equal quality scores and anastomotic leakage were achieved with both techniques. Robotic assistance resulted in significant longer suture and knot tying time and significant more actions were needed compared to the manual laparoscopic procedures. Significant more failures occurred during the robot-assisted procedures. Conclusion. In this study, robotic (Zeus-Aesop) assistance did not improve the laparoscopic performance of the surgeon whilst making vascular anastomoses.

BACKGROUND: The efficacy of conventional laparoscopic cholecystectomy (CLC) was compared with robot-assisted laparoscopic cholecystectomy (RLC). Surgical trainees performed the LC to avoid the surgeon's experience bias. METHODS: Two surgical trainees performed 10 CLCs and 10 RLCs at random with a Zeus-Aesop Surgical Robotic System. The primary efficacy parameters were the total time and the number of actions involved in the procedure. The secondary parameters were setup and dissection times, and the number of grasping and dissection actions. Surgical complications were evaluated. RESULTS: For CLC and RLC, respectively, the total times were 95.4 +/- 28 min and 123.5 +/- 33.3 min and the total actions were 420 +/- 176.3 and 363.5 +/- 158.2. For CLC, the times required for setup (21 +/- 10.4 min) and dissection (50.2 +/- 17.7 min) were less than for RLC (33.8 +/- 11.3 min and 72 +/- 24.3 min, respectively). The numbers of grasping and dissection actions were not significantly different: 41.4 +/- 26.5 and 378 +/- 173.7, respectively, for CLC versus 48.9 +/- 27 and 314.6 +/- 141.9, respectively, for RLC. CONCLUSION: Although feasible, RLC requires significantly more time than CLC because of slower performed actions

Recently introduced robot-assisted laparoscopic surgery (RALS) facilitates endoscopic surgical manipulation and thereby reduces the learning curve for (advanced) laparoscopic surgery. We present our learning curve with RALS for aortobifemoral bypass grafting as a treatment for aortoiliac occlusive disease. Between February 2002 and May 2005, 17 patients were treated in our institution with robot-assisted laparoscopic aorto-bifemoral bypasses. Dissection was performed laparoscopically and the robot was used to make the aortic anastomosis. Operative time, clamping time, and anastomosis time, as well as blood loss and hospital stay, were used as parameters to evaluate the results and to compare the first eight (group 1) and the last nine patients (group2). Total median operative, clamping, and anastomosis times were 365 min (range: 225–589 min), 86 min (range: 25–205 min), and 41 min (range: 22–110 min), respectively. Total median blood loss was 1,000 ml (range: 100–5,800 ml). Median hospital stay was 4 days (range: 3–57 days). In this series 16/18 anastomoses were completed with the use of the robotic system. Three patients were converted (two in group 1, one in group 2), and one patient died postoperatively (group 1). Median clamping and anastomosis times were significantly different between groups 1 and 2 (111 min [range: 85–205 min] versus 57.5 min [range: 25–130 min], p

Recognition of the significance, the lateral correlation and the erosional magnitude of lithofacies boundaries in wells as well as in outcrops is an important but elusive aspect of highresolution sequence stratigraphic analysis.

The rapid development in sequence stratigraphy duririg the last decade has contributed in an important way to hydrocarbon exploration, development and production. The main innovative aspect which has been introduced since the application of sequence stratigraphic concepts in petroleum geology, was the departure from a more lithostratigraphic approach to an onderstanding of geological relationships within a time-related stratigraphic framework.

O orientador do trabalho n?o mencionado na lista da Folha de Aprova??o. Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2018-12-21T18:55:49Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) glayton_andrade_souza.pdf: 2463638 bytes, checksum: f189fa983448744adf7f9128c61c565b (MD5) Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2019-01-28T14:13:26Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) glayton_andrade_souza.pdf: 2463638 bytes, checksum: f189fa983448744adf7f9128c61c565b (MD5) Made available in DSpace on 2019-01-28T14:13:26Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) glayton_andrade_souza.pdf: 2463638 bytes, checksum: f189fa983448744adf7f9128c61c565b (MD5) Previous issue date: 2018 Atualmente existem novas subst?ncias psicoativas (NPS) destacando-se, a classe dos NBOMes (2,5-Dimetoxi-N-(2-metoxibenzil)feniletilaminas), que possui diversos compostos com pequenas varia??es qu?micas estruturais, principalmente, pela adi??o de um halog?nio ao anel benz?nico. Os halog?nios mais adicionados s?o o bromo, cloro e iodo, os quais s?o conhecidos pelas siglas 25B-NBOMe, 25C-NBOMe e 25I-NBOMe, respectivamente. Os NBOMes est?o entre as drogas sint?ticas psicoativas emergentes encontradas em selos com padr?o de uso recreativo. Anteriormente, a ?nica droga encontrada em selos era o ?cido lis?rgico, mais conhecida pela sua sigla LSD. A identifica??o preliminar desses compostos ? de extrema import?ncia na ?rea forense, em especial, para lavratura de auto de pris?o em flagrante delito. No entanto, ainda n?o ? utilizado nenhum m?todo para identifica??o preliminar dos NBOMes pela per?cia criminal, havendo apenas o m?todo preliminar para o LSD e os m?todos de identifica??o definitiva para NBOMes, os quais, em geral, s?o realizados por LC-MS e CG-MS. Neste contexto, os m?todos eletroanal?ticos podem ser uma alternativa de an?lise simples, r?pida e de baixo custo para identifica??o dos NBOMes. O presente trabalho apresenta, pela primeira vez, o comportamento eletroqu?mico desses compostos e seus similares no eletrodo de diamante dopado com boro (BDD), bem como a detec??o e identifica??o preliminar dessa classe de drogas em selos por voltametria c?clica (VC) e de onda quadrada (VOQ). O LSD, os NBOMes e um composto similar, o 2C-B, foram investigados por voltametria c?clica em tamp?o acetato e Britton-Robinson (pH 2 a 12). As melhores condi??es foram obtidas em tamp?o acetato 0,1 mol L-1 (pH 4) com 10 % de metanol, onde foi observado picos de oxida??o no BDD para todos os analitos, sendo proposto um mecanismo para os processos eletroqu?micos dos NBOMes. Os par?metros da VOQ foram otimizados com a amplitude de pulso de 70 mV e a frequ?ncia de 80 S-1. Nessas condi??es, foi poss?vel identificar os NBOMes seletivamente do LSD, obtendo um baixo DPR (< 1,0%) para 10 an?lises de todos os compostos, al?m de uma ampla faixa linear (de pelos menos 3 ordens de magnitude) com baixo limite de detec??o (< 0,28 ?g/mL). Amostras de 12 selos apreendidas com diferentes NBOMes e drogas similares foram avaliadas pelo m?todo proposto, sendo os resultados comparados e confirmados pelo m?todo definitivo. Portanto, o m?todo proposto apresenta um grande potencial para identifica??o preliminar dos NBOMEs em selos. Disserta??o (Mestrado) ? Programa de P?s-Gradua??o em Qu?mica, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2018. Nowadays, new psychoactive substances (NPS) are rising to notoriety, specially the NBOMes (2,5-dimethoxy-N-(2-methoxybenzyl)phenethylamine) class, that contains several compounds with small structural chemical variations, mainly due to the addition of a halogen to the benzene ring. Bromine, chlorine and iodine are the most commonly added halogens, known by the symbols 25B-NBOMe, 25C-NBOMe e 25I-NBOMe, respectively. The NBOMes are present within the emerging synthetic psychoactive drugs found within tabs of blotter paper for recreational purposes. Previously, the only drug found in such tabs was the lysergic acid, known as LSD. The preliminary identification of these compounds is of extreme importance for forensics, namely, for imprisonment decrees of in flagrante delicto. However, no method is yet used in the preliminary identification of NBOMes by criminal forensics, being used only the preliminary method for LSD and the definitive identification methods for NBOMes, which, in general, are carried out by LC-MS e CG-MS. In this context, electroanalytical methods can be an alternative for simple, quick and low-cost analysis for the identification of NBOMes. This paper presents, for the first time, the electrochemical behaviour of these compounds and similars in the boron-doped diamond electrodes (BDD), as well as the detection and preliminary identification of this class of drugs in tabs of blotter paper by cyclic and squarewave voltammetry (CV and SWV, respectively). LSD, NBOMes and a similar compound, the 2C-B, where investigated by cyclic voltammetry on acetate buffer and Britton-Robinson (pH 2 to 12). The best conditions were obtained on acetate buffer 0,1 mol L-1 (pH 4) with 10% of methanol, on which were observed peaks of oxidation on the BDD for all analytes, being suggested a mechanism for the electrochemical processes of the NBOMes. The SWV parameters were optimized with the pulse amplitude of 70 mV and the frequency of 80 S-1. Such conditions allowed the identification of the NBOMes distinctively from the LSD, obtaining a low RSD (< 1,0%) for ten analysis of all compounds, besides a wide linear track (of at least three orders of magnitude) with a low level of detection (< 0,28 ?g/mL). Samples of 12 tabs seized with different NBOMes and similar drugs were evaluated by the proposed method and had the results compared and verified by the definitive method. Therefore, the proposed method presents a great potential for the preliminary identification of the NBOMes in blotter paper tabs.