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Antegrade access for infrainguinal endovascular intervention can be achieved through the common femoral artery (CFA) or superficial femoral artery (SFA). A few studies with small sample sizes have shown similar efficacy and safety for antegrade puncture of the CFA and SFA. In the present study, we analyzed the feasibility of SFA access and the occurrence of complications between SFA and CFA ipsilateral access in a broader cohort.In the present retrospective study, we analyzed data from 462 patients with peripheral arterial disease (PAD) who had undergone peripheral angioplasty from 2009 to 2016. The inclusion criteria were PAD at Rutherford stage 3 to 6 and use of an endovascular approach. Patients with coagulation disorders, those receiving anticoagulant therapy, cases with deployment of closure devices, cases with more than one access on the same limb, and patients with inadequate bed rest after the procedure were excluded. A systematic analysis of all patients' electronic medical records was performed to evaluate the demographic aspects and technical success and identify the possible complications associated with CFA and SFA access.Of the 462 patients, 290 had undergone SFA puncture and 172, CFA puncture. The demographic evaluation of both groups revealed no differences between the two groups, except that more patients with diabetes were in the CFA group and more patients with dyslipidemia and an advanced clinical presentation were in the SFA group. First puncture access was successful in 99.7% of the SFA group and 96.5% of the CFA group (P = .01). The hematoma rate in the SFA and CFA groups was 20.3% and 11%, respectively (P = .01). The incidence of major bleeding and clinically relevant nonmajor bleeding was not significantly different between the two groups (P = .215). Only three patients had developed a pseudoaneurysm, two of whom were in the SFA group. Female sex (odds ratio [OR], 2.572; 95% confidence interval [CI], 1.520-4.354; P .001] and older age (OR, 1.034; 95% CI, 1.009-1.059; P = .007) were associated with an increased hematoma rate.SFA access was associated with a higher overall rate of hematoma compared with CFA access. However, no significant difference was found in the incidence of major bleeding between the two access sites. Planned SFA access should be considered as an alternative to CFA access.

Background This study aimed to analyze the technical aspects and follow-up findings regarding patients with critical limb ischemia who underwent the kissing balloon technique (KBT). Methods Thirty patients (34 bifurcations) were enrolled in this retrospective analysis between September 2010 and February 2017. All patients were submitted to infrapopliteal intervention for critical limb ischemia. The KBT is the primary treatment in 3 situations: for cases with >70% stenosis of the main artery located less than 1 cm of the bifurcation, occlusion of one branch with greater than 50% stenosis of the contralateral branch, or greater than 50% bilateral stenosis. Stents were considered in cases of recoil greater than 30% or flow-limiting recoil and were used in 7 of the 34 bifurcations (20.5%). Results Primary patency at 30 days, 1 year, and 2 years was 100%, 68.1%, and 68.1, respectively. Limb salvage rates at 30 days, 1 year, and 2 years were 100%, 86.6%, and 65.0%, respectively. Wound healing rates at 30 days, 6 months, 1 year, and 2 years were 7.1%, 34.4%, 44.5%, and 68.7%, respectively. The bifurcations of the V-shape and T-shape groups were compared in terms of wound healing, primary patency, and limb salvage. No differences were observed in wound healing (P = 0.268), primary patency (P = 0.394), and limb salvage (P = 0.755). Conclusions The KBT is a feasible bifurcation approach for infrapopliteal angioplasties to maintain the patency of both branches after ballooning. The comparison between the anterior tibial artery and tibioperoneal trunk bifurcation and the peroneal artery and posterior tibial artery bifurcation revealed no difference in wound healing, primary patency, and limb salvage.

The aim of this study is to analyze the technical aspects and outcomes of the treatment of occlusion of the popliteal artery with the involvement of the trifurcation treated with a bypass (open) and endovascular (endo) approach.Overall, 108 consecutive procedures were enrolled retrospectively. Patients were evaluated in 2 groups: the endo group (65 patients) and the open group (43 patients). Primary outcome were MALE (major adverse limb events), amputation-free survival, and early mortality (until 30 days). Secondary outcome was overall survival in 3 years. Inclusion criteria were Rutherford 4 and 5 and occlusion of the popliteal artery with the involvement of trifurcation and, at least, 1 infrapopliteal artery of runoff.Technical success was achieved in 100% of patients in the open and 96.9% of patients in the endo group. Freedom from MALE was 73.5% and 68.5% for 1 and 3 years respectively for the endo group, and 84.3% and 77.2% respectively for the open group (P = 0.413). Considering the total number of major reinterventions executed until 3 years, the reinterventions was statistically more performed in the endo compared to the open group (P = 0.0459). Amputation-free survival for the endo group in 30 days, 1 year, and 3 years was 93.7%, 79.3%, and 66.0%, respectively, and the amputation-free survival for the open group was 88.4%, 77.4%, and 64.3% (P = 0.726). Early mortality was 9.3% for the open group and 1.5% for the endo group (P = 0.060). In 3 years, the overall survival was 75.1% in the open group and 84.3% in the endo group.In 3 years, follow-up endovascular treatment of occlusion of the popliteal artery with the involvement of the trifurcation has similar time freedom from MALE compared to open approach. Overall and amputation-free survival was not different between the groups besides more reinterventions in patients who underwent endovascular approach.

Resumo A infecção pelo coronavírus 2 causador da síndrome respiratória aguda grave (SARS-CoV-2) em humanos foi detectada pela primeira vez em Wuhan, na China, em 2019 e dispersada mundialmente ao longo de 2020. As diferentes manifestações clínicas, com amplo espectro de apresentação, desde infecções assintomáticas até formas graves que podem levar a óbito, são desafiadoras. Este trabalho objetiva descrever uma série de quatro casos de isquemia arterial aguda dos membros superiores em pacientes diagnosticados com COVID-19, os quais foram manejados clinicamente com anticoagulação, antiagregação plaquetária e uso de prostanoides. Dois pacientes receberam alta hospitalar com regressão e delimitação da área isquêmica, sem necessidade de intervenção cirúrgica, e dois pacientes faleceram em decorrência de complicações pulmonares. Uma adequada compreensão da fisiopatologia dessa doença pode favorecer um melhor manejo clínico de suas complicações.

Abstract. Background: The endovascular management of arterial injuries has resulted in reduced operating time, blood loss, hospital mortality, lower incidence of sepsis, and decrease in mortality rates. For penetrating trauma, however, the benefits of endovascular therapy are questionable. Patients and methods: Data were obtained by retrospective analysis of electronic medical records. All patients with vascular trauma seeking care at our institution from January 2010 to December 2015 were reviewed. A total of 223 vascular trauma patients were enrolled. Of these, 18 patients (8 %) were treated with endovascular techniques. The data related to clinical presentation, patient characteristics, technical aspects of the treatment, and follow-up were analysed. Results: The mean patient age was 35.4 ± 17.8 years, 94 % were male. The mean injury severity score was 10.4 ± 2.5. The most commonly observed trauma mechanism was a gunshot in 10 cases (55 %), followed by lesions provoked by arterial catheter misplacement in five cases (27 %), and stab wounds in three cases (16.6 %). The main injury site was the subclavian artery, accounting for eight cases (44 %), followed by the superficial femoral artery and the tibiofibular trunk in two cases, respectively (18 %). The anterior tibial, fibular artery, axillary, common carotid, superior mesenteric, and profunda femoris were each affected once. Arteriovenous fistula was detected in nine cases (50 %), pseudoaneurysms in nine cases (50 %), and short occlusion in two cases (11 %). The mean follow-up duration was 753 days. The primary patency rate was 92.3 and 61.5 % after one and two years, respectively. The survival rate was 94.4 % after one and two years. Infection of the stents or limb amputations were not identified at follow-up. Conclusions: The endovascular treatment of penetrating arterial injuries with covered stents is feasible. However, the criteria used to choose the best method must be individualized. Keywords: Trauma, endovascular, stent graft, gunshot, stab wound

Rubber projectiles are used as an alternative to metal bullets owing to their lower morbidity and mortality rate. There are few reports of vascular lesions of extremities caused by rubber projectiles in the literature. The authors report the case of a 37-year-old man who was the victim of a penetrating injury to the left thigh with a rubber projectile. He reported only pain at the site of the injury; pulses were decreased in the affected limb. After arteriography confirmed an injury to the superficial femoral artery, he underwent an arterial and venous femorofemoral bypass using a reversed contralateral saphenous vein. Keywords: Vascular trauma, Nonlethal projectile, Penetrating trauma

The outcomes of endovascular treatment of femoropopliteal atherosclerotic lesions have been improving recently. Although open repair is indicated for class D femoropopliteal lesions based on the TransAtlantic Inter-Society Consensus II (TASC II) document, in some cases, it is reasonable to use the endovascular approach for these lesions. The aim of this study was to retrospectively analyze the technical aspects and outcomes of treating TASC II D femoropopliteal disease with endovascular approaches.In total, 91 procedures between January 2011 and December 2016 were retrospectively analyzed. We collected data corresponding to the technical aspects and outcomes of treatment from an electronic database. Images and videos of all procedures were reviewed. Among the 91 procedures, 70 were for popliteal artery occlusions involving the trifurcation vessels, and 12 were for superficial femoral artery (SFA) occlusions of20 cm in length; 9 procedures for occlusions meeting both criteria were also performed. The χApproximately 44.4% of all patients were male. The mean age was 67.3 ± 20.7 years. Hypertension, diabetes, current smoker, kidney impairment, coronary disease, and cardiac insufficiency were identified in 92.3%, 66.6%, 21.7%, 7.6%, 25.6%, and 62.8% of the patients, respectively. All included patients had critical limb ischemia (11.5%, 84.6%, and 3.8% of cases corresponding to Rutherford categories 4, 5, and 6, respectively). Technical failure was observed in three patients (3.3%). The mean number of stents used was 0.7 ± 0.65 per patient. Primary patency at 30 days, 1 year, 2 years, and 3 years was 91%, 60.1%, 55.7%, and 50.6%, respectively. Limb salvage at 30 days, 1 year, 2 years, 3 years, and 4 years was 95.2%, 82.2%, 76.9%, 71.8%, and 63.7%, respectively. Reinterventions were necessary in 11.1% of the patients. Comparison of curves revealed significant differences in the 60-day primary patency for the SFA and popliteal groups (standard error, 10%; log-rank, P = .039). Analysis of the risk and technical factors affecting primary patency, limb salvage, and overall survival indicated that female sex was associated with poor survival (odds ratio, 8.942; 95% confidence interval, 1.105-72.36) and that the use of stents was associated with high rates of limb loss in the popliteal group (log-rank, P = .033).For endovascular treatment of TASC II D femoropopliteal lesions, primary patency was better in patients with popliteal artery occlusions involving the trifurcation vessels than in those with SFA occlusions20 cm in length. Female sex was associated with the risk of major amputations, and the use of stents in patients with popliteal occlusions was associated with major limb loss.

Objective The aim was to analyse the effect of the treatment of more than one infrapopliteal artery with respect to wound healing and limb salvage. Methods Seventy-eight patients were enrolled prospectively for 80 procedures (80 limbs) that were randomly divided into two groups: 40 in the single vessel (SV) group and 40 in the multiple vessel group (MV). All patients had tissue loss. The choice of the first artery to treat was based on an analysis of two factors: the ease of the required endovascular technique and the presence of adequate distal outflow. The randomisation point was after the first successful distal artery angioplasty. The primary endpoints were the wound healing rate and limb salvage. Results The mean age of the patients was 69.1 ± 4.3 years, and 56% were male. Concomitant treatment of the femoral and popliteal arteries was performed in 38.8% of patients. All demographic characteristics and technical aspects were statistically comparable for both groups. Successful recanalisation was achieved in 95.8%, 86.2%, 86.9%, and 92.5% for the tibio-fibular trunk, anterior tibial, posterior tibial, and fibular artery, respectively. In the MV group, a higher contrast volume (29 mL more; p = .049), longer procedure time (p = .01), and higher radiation exposure (p = .04) were noted. There was no difference in renal function between the groups either before or 30 days after the procedure (p = .165). The limb salvage rates after 1 and 3 years, respectively, were 75.9% and 67% for the SV group and 91.1% and 91.1% for the MV group (log rank p = .052). The wound healing rates after 1 and 3 years, respectively, were 33.6% and 70.9% for the SV and 63.9% and 78.4% for MV group (log rank p = .006). Wound healing was faster in MV (2.11 cm2/month) than SV group (0.62 cm2/month; p = .004). Conclusion Endovascular treatment of more than one artery was associated with better wound healing rates but not with better limb salvage.

Priapism, considered a medical emergency, is a relatively uncommon condition.1 Patients presenting with priapism require immediate intervention in an attempt to relieve those with ischemic priapism as promptly as possible. High flow priapism, the outcome of an exaggerated arterial flow into the cavernous artery, is not always an emergency and it can be at first treated only by observation.1,2 Both types of priapism can be distinguished by gas determination of the blood drawn from the cavernous bodies.3 We report on the case of a child with arterial priapism presenting with urinary retention, which led us to intervene by applying superselective arterial embolization.

INTRODUÇÃO: O tratamento híbrido das lesões complexas da aorta torácica (LCAT) requer a revascularização de uma ou mais artérias supra-aórticas, seguida do implante de endoprótese, com morbidade e mortalidade presumidamente mais baixas que a cirurgia convencional. OBJETIVOS: Avaliar a técnica e resultados do tratamento híbrido das LCAT. MÉTODOS: Durante dois anos, 12 pacientes com LCAT foram submetidos a procedimentos híbridos, incluindo aneurismas do arco aórtico e dissecções aórticas agudas Stanford A e B. Todos possuíam indicação de tratamento invasivo, além de zona de ancoragem proximal inadequada (menor que 20 mm). Metade era do sexo masculino e a média de idade de 55,5 anos (42 a 78). Pelo menos três fatores de risco cardiovascular estavam presentes em 75% dos pacientes. A média de seguimento foi de 10,9 meses (2 a 25), com acompanhamento clínico e tomográfico. RESULTADOS: O sucesso técnico inicial foi alcançado em 10 pacientes. Todas as derivações dos vasos supra-aórticos foram realizadas em ambiente cirúrgico e os procedimentos endovasculares em sala de radiologia vascular. A "técnica do varal" foi empregada em seis casos. Dois óbitos ocorreram nos primeiros 30 dias do procedimento. Nenhuma migração da endoprótese foi observada. Nenhum paciente apresentou paraplegia, acidente vascular cerebral, insuficiência renal, hemorragia ou coagulopatia, conversão cirúrgica eletiva ou de emergência. CONCLUSÃO: O tratamento híbrido das LCAT é viável, especialmente em pacientes de alto risco. Uma adequada integração das técnicas cirúrgica e endovascular, além do acompanhamento clínico e radiológico adequado, tornam esta técnica uma ótima opção à cirurgia convencional. BACKGROUND: Hybrid procedures for the treatment of complex thoracic aortic diseases (CTAD) require the revascularization of one or more supra-aortic arteries, followed by the deployment of one or more aortic endoprosthesis, with lower morbidity and mortality compared to conventional surgery. OBJECTIVES: To evaluate the technique and results of hybrid procedures for CTAD. METHODS: During two years, 12 patients with CTAD underwent hybrid procedures, including aortic arch aneurysms and acute Stanford A and B aortic dissections. All patients had formal indications to invasive treatment, and inadequate proximal landing zone (less than 20 mm). Half were male and the mean age was 55.5 years (42 to 78). At least three cardiovascular risk factors were present in 75% of patients. The average follow-up was 10.9 months (2 to 25), with periodic consultations and CT scans. RESULTS: The initial technical success was achieved in 10 patients. Bypasses of supra-aortic vessels were performed in a surgical environment and endovascular procedures in an interventional radiology facility. "Through-and-through" technique was used in six patients. Two deaths occurred in the first 30 days after the procedure. No endoprosthesis migration was observed. No patient had paraplegia, stroke, renal failure, bleeding or coagulopathy, elective or emergency surgical conversion. CONCLUSION: Hybrid treatment of CTAD is feasible, especially in high risk patients. Proper integration of surgical and endovascular techniques, in addition to clinical and radiological surveillance, makes this technique a great alternative to conventional surgery.

O acesso totalmente percutâneo para o implante de endopróteses aórticas, através da preclose technique, é possível mesmo quando utilizadas bainhas introdutoras de elevado perfil. Relatamos sete casos de tratamento endovascular de doenças da aorta, todos realizados de modo percutâneo, e discutimos os principais aspectos desta técnica.

Background The aim of this study was to evaluate the short and mid-term safety and efficacy of the EPIC™ nitinol vascular stent system for the treatment of lesions located in the superficial femoral artery (SFA). Methods From October 2010 to June 2012, 83 subjects were enrolled in a prospective, multicenter, non-randomized study designed to demonstrate that the EPIC nitinol vascular stent system for SFA lesions is non-inferior to the published patency rates found in literature. Inclusion criteria were stenosis or occlusion of the SFA or SFA and proximal popliteal artery, with total length from 4 to 11 cm and amenable for treatment with a single stent, in patients with a score from 2 to 5 on Rutherford classification. The primary endpoint was primary patency rate at 12 months as determined by Duplex ultrasound. The secondary endpoints evaluated were: initial arteriographic success, primary patency rate at 6 months, major adverse event rate at one year and technical success. Follow-up with a complete clinical and physical exam, including ABI and Duplex ultrasound was performed at 6 and 12 months. Results Most patients (56.6%) were men and the mean age was 68.59 (33.1-99.15) years. 25.3% of the total population had intermittent claudication and 73.5% presented with critical limb ischemia. Most lesions were total occlusions (75.9%) and the mean lesion length was 71.16 mm. Contralateral femoral access was performed in 26.5%cases, and ipsilateral femoral approach was used for the remaining 73.5% patients. Technical and arteriographic success was obtained in all 83 (100.00%) patients. Duplex controlled primary patency rate at 6 and 12 months was 95.8% and 76.1%, respectively. The freedom from target lesion revascularization rate was 98.7% and 92.6% at 6 and 12 months, respectively. No stent fractures were observed in this study. Major adverse event rate at 1 year (clinically driven TLR, major amputation, and all-cause mortality) was 15.7%: two target lesion revascularizations (2.4%), one major amputation (1.2%) and ten deaths not related to the procedure (12%). Conclusions In conclusion, this study demonstrates the safety and efficacy of the EPIC™ Nitinol Vascular Stent System for the treatment of SFA lesions.

O tratamento endovascular dos aneurismas aórticos torácicos tem se desenvolvido consideravelmente nos últimos anos. No entanto, complicações tardias desta nova modalidade terapêutica apenas agora estão sendo observadas e analisadas. Fístulas aorto-esofágicas são complicações raras do tratamento endovascular dos aneurismas aórticos, sendo encontrados poucos relatos na literatura. O presente caso reporta um paciente com aneurisma aórtico torácico tratado há 4 anos e complicado com fratura da endoprótese. Após nova intervenção endovascular, foi observada extrusão da antiga endoprótese através do esôfago com formação de fístula. Apesar do tratamento realizado, o paciente evoluiu a óbito 9 dias após por hemorragia digestiva maciça. Aspectos técnicos e revisão de literatura são discutidos. The endovascular treatment of thoracic aortic aneurysms has undergone considerable development over the past years. However, late complications of this new therapeutic modality have only recently been observed and analyzed. Aortoesophageal fistulas are rare complications of the endovascular treatment of aortic aneurysms, and there are few reports in the literature. We report a case of a patient with thoracic aortic aneurysm treated 4 years ago and with complications due to stent-graft fracture. After a new endovascular intervention, there was extrusion of the old graft through the esophagus with fistula formation. Despite the treatment, the patient died 9 days later due to massive digestive hemorrhage. Technical aspects and review of the literature are discussed.

O uso de cateteres venosos centrais em pacientes hemofílicos é muito freqüente, devido às próprias características terapêuticas da doença. As complicações desses procedimentos, tais como pseudo-aneurisma, geralmente são mais graves nesses pacientes. A correção cirúrgica do pseudo-aneurisma que acomete a artéria subclávia constitui um dos maiores desafios da cirurgia vascular. Em pacientes hemofílicos, à dificuldade habitual de exposição cirúrgica somam-se os problemas de alteração no processo normal de coagulação. Como alternativa ao tratamento cirúrgico convencional, a utilização de técnicas endovasculares constitui uma solução segura e com bons resultados.

The occurrence of vascular trauma due to a range of causes has increased considerably. In this setting, endovascular repair has arisen as a new and less invasive approach. We report the case of three patients with lesions of below-knee vessels that were treated by endovascular procedures.

CONTEXTO: A insuficiência venosa crônica (IVC) em suas formas mais graves, com ulceração e lesões inflamatórias, associa-se a um tratamento cirúrgico convencional de difícil execução. A escleroterapia de veias tronculares com espuma de polidocanol é considerada uma alternativa terapêutica com resultados satisfatórios. OBJETIVO: Relatar os resultados da escleroterapia com espuma de polidocanol no tratamento de pacientes com IVC de membros inferiores com úlcera ativa. MÉTODOS: Em um período de 48 meses, 71 pacientes (76 membros) foram submetidos à escleroterapia de veias tronculares com espuma de polidocanol a 3% guiada por ultrassom. O seguimento pós-procedimento foi feito por meio de questionário clínico, exame físico e ultrassom Doppler, realizados em sete dias, um e seis meses e, a partir de então, semestralmente. Analisou-se tempo de cicatrização da úlcera, melhora de sintomas clínicos, recanalização, recidiva dos sintomas e complicações. RESULTADOS: O sexo feminino correspondeu a 61% dos casos, e a idade variou de 25 a 85 anos (média de 59 anos). O tempo médio de acompanhamento foi de 460 dias. O refluxo do sistema venoso profundo foi observado em 53,4% dos membros. A cicatrização das úlceras ocorreu em 84,2% dos casos, com um tempo médio de cicatrização de 37 dias. A recanalização ocorreu em 31,5%, porém a recidiva de sintomas, com ressurgimento de úlcera, foi de 11,8%. CONCLUSÃO: A esclerose com espuma é efetiva e apresenta altas taxas de cicatrização de úlceras, com baixos índices de complicações, em pacientes com IVC grave. BACKGROUND: Chronic Venous Insufficiency (CVI) in its most severe forms, with ulceration and inflammatory lesions, is associated with a conventional surgical treatment of difficult execution. Polidocanol foam sclerotherapy of saphenous veins is considered an alternative therapy with satisfactory results. OBJECTIVE: To report the results of polidocanol foam sclerotherapy in the treatment of patients with lower limb CVI with active ulcer. METHODS: Over a period of 48 months, 71 patients (76 limbs) underwent 3% polidocanol foam ultrasound-guided sclerotherapy of saphenous vein. Follow-up was performed by means of clinical questionnaire, physical examination and Doppler ultrasound, in seven days, one and six months, and every six months thereafter. We analyzed time to ulcer healing, improvement of clinical symptoms, recanalization, recurrence of symptoms and complications. RESULTS: Females accounted for 61% of cases, and the age ranged from 25 to 85 years (mean 59 years). The mean follow-up was 460 days. Reflux of the deep venous system was observed in 53% of the limbs. Ulcer healing occurred in 84,2% of cases, with a mean healing time of 37 days. Recanalization occurred in 31,5%, but recurrence of symptoms, with recurrence of ulcer, was 11,8%. CONCLUSION: Foam sclerotherapy is effective and presents high rates of ulcer healing, with low rates of complications, in patients with severe CVI.

CONTEXTO: O trauma vascular na população pediátrica apresenta-se como um desafio único, frente à sua incidência relativamente baixa, mesmo em centros médicos de referência. Devido à fragilidade dos tecidos, ao reduzido tamanho dos vasos e à sua baixa incidência, manifesta-se com taxas significativas de morbidade e mortalidade. OBJETIVO: Descrever e analisar os casos de trauma vascular em pacientes pediátricos admitidos em hospital terciário. MÉTODOS: Por meio de estudo retrospectivo, analisaram-se os casos de trauma vascular em pacientes menores de 18 anos, admitidos de janeiro de 2000 a julho de 2010, levando-se em conta dados demográficos, mecanismos de lesão, traumas associados, tratamentos empregados e complicações. RESULTADOS: Foram estudados 242 pacientes com trauma vascular, sendo 37 (15,2%) pertencentes à população pediátrica. A média de idade foi de 12,5 anos, sendo 81% dos participantes da pesquisa do sexo masculino. Entre os mecanismos de lesão, o trauma penetrante foi o mais comum (57%), seguido do contuso (38%) e do iatrogênico (5%). Das técnicas cirúrgicas empregadas, o enxerto arterial com veia autóloga foi o procedimento mais comum (13 casos). Houve um caso de amputação primária (infrapatelar) e quatro amputações no período pós-operatório precoce (três transfemorais e uma transtársica). Dos 11 pacientes admitidos com lesão de artéria poplítea, a taxa de amputação transfemoral pós-operatória foi de 27,3%. Houve apenas um óbito devido a trauma iatrogênico em lactente hemofílico. CONCLUSÕES: O trauma vascular pediátrico envolve vários desafios técnicos, como o vasoespasmo e o calibre dos vasos. As altas taxas de amputações observadas em pacientes com lesões de artéria poplítea, apesar das tentativas de revascularização, reforçam a gravidade desse tipo de trauma. BACKGROUND: Vascular trauma in the pediatric population is a unique challenge, mainly due to its relatively low incidence, even in high complexity medical centers. Due to the fragility of the tissues, the small size of vessels and low incidence, it manifests with significant rates of morbidity and mortality. OBJECTIVE: To describe and analyze the cases of vascular trauma in pediatric patients admitted to a tertiary hospital. METHODS: Through retrospective study we analyzed the cases of vascular trauma in patients younger than 18 years, admitted from January 2000 to July 2010, taking into account demographic data, mechanisms of injury, associated injuries, treatment techniques and complications. RESULTS: During the studied period, 242 patients were admitted with vascular trauma, 37 (15.2%) belonging to the pediatric population. The average age was 12.5 years, and 81% of the research participants were male. Related to the mechanisms of injury, penetrating trauma was the most common (57%), followed by blunt (38%) and iatrogenic (5%). Among the surgical techniques employed, arterial bypass with autologous vein was the most common (13 cases). There was a case of primary major amputation (below the knee) and four amputations in the early postoperative period (three transfemoral and one transtarsic). For the 11 patients admitted with popliteal artery injury, the rate of postoperative transfemoral amputation was 27.3%. There was only one death due to an iatrogenic trauma in a hemophilic lactant. CONCLUSIONS: Vascular trauma in pediatric patients involves several technical challenges, such as vasospasm and vessel diameter. The high rates of amputation in patients with popliteal artery injuries, despite attempts of revascularization, reinforce the seriousness of this type of trauma.

CONTEXTO: Durante um período da vida embrionária, a veia ciática é a principal coletora do membro inferior. Na embriogênese vascular, há diferenciação dos angioblastos em um plexo vascular primitivo, com posterior remodelagem e expansão. Consequentemente, durante esse processo, podem ocorrer anomalias. Quando ocorre persistência da veia ciática, esta pode se comunicar com a veia safena parva ou com a veia poplítea durante seu percurso, anastomosando-se com a veia perfurante superior e com a veia circunflexa medial do fêmur. OBJETIVO: Relatar o caso da persistência bilateral de veia ciática nos membros inferiores, comparando à literatura. MÉTODOS: Foram dissecados 32 membros inferiores de 16 cadáveres formolizados no Laboratório de Anatomia pela Disciplina de Anatomia Topográfica da Faculdade de Medicina da Universidade de Santo Amaro (Unisa), durante 2006 e 2007, observando-se em 2 membros inferiores de um único cadáver, a presença de veia ciática. RESULTADOS: No membro inferior esquerdo de um cadáver que apresentou a anomalia bilateralmente, a veia media 37 cm, tinha origem na região da veia poplítea, acompanhava o nervo ciático, perfurava o músculo adutor magno e desembocava na veia femoral profunda. No membro inferior direito, ela media 36 cm, originava-se recebendo as veias do compartimento tibial anterior, acompanhava o nervo ciático, perfurava o músculo adutor magno e desembocava na veia ilíaca interna. CONCLUSÃO: As variações anatômicas do sistema venoso do membro inferior são as mais prevalentes. A persistência da veia ciática pode causar insuficiência venosa crônica no membro inferior e, dessa forma, deve ser investigada para uma melhor conduta clínica ou cirúrgica. BACKGROUND: During a period of the embryonic life, the sciatic vein is the main lower limb collector. In vascular embryogenesis, there is a differentiation of the angioblasts in a primitive vascular plexus, with posterior remodeling and expansion. Consequently, anomalies may occur during this process. When there is persistence of the sciatic vein, it may communicate with the small saphenous vein or with the popliteal vein during its route, being anastomosed to the superior perforating vein and to the medial circumflex femoral vein. OBJECTIVE: To report a case of bilateral persistent sciatic vein on the lower limbs in comparison to the literature. METHODS: Thirty-two lower limbs from 16 corpses preserved in formaldehyde were dissected at the Laboratory of Anatomy of the discipline of Topographic Anatomy of the Medical School of Universidade Santo Amaro (Unisa), during 2006 and 2007, and the sciatic vein was observed in 2 lower limbs of one single corpse. RESULTS: On the left lower limb of a corpse that presented bilateral anomaly, the vein had 37 cm, emerging on the popliteal vein, accompanying the sciatic nerve, perforating the long adductor muscle and leading into the deep femoral vein. On the right lower limb, it measured 36 cm, emerged receiving the veins of the anterior tibial compartment, accompanied the sciatic nerve, perforated the long adductor muscle and led into the internal iliac vein. CONCLUSION: The anatomical variations of the lower limb venous system are the most common ones. The persistent sciatic vein may cause chronic venous failure in the lower limbs and, in this manner, must be investigated aiming at a better clinical or surgical management.

Hybrid procedures for the treatment of complex thoracic aortic diseases (CTAD) require the revascularization of one or more supra-aortic arteries, followed by the deployment of one or more aortic endoprosthesis, with lower morbidity and mortality compared to conventional surgery.To evaluate the technique and results of hybrid procedures for CTAD.During two years, 12 patients with CTAD underwent hybrid procedures, including aortic arch aneurysms and acute Stanford A and B aortic dissections. All patients had formal indications to invasive treatment, and inadequate proximal landing zone (less than 20 mm). Half were male and the mean age was 55.5 years (42 to 78). At least three cardiovascular risk factors were present in 75% of patients. The average follow-up was 10.9 months (2 to 25), with periodic consultations and CT scans.The initial technical success was achieved in 10 patients. Bypasses of supra-aortic vessels were performed in a surgical environment and endovascular procedures in an interventional radiology facility. "Through-and-through" technique was used in six patients. Two deaths occurred in the first 30 days after the procedure. No endoprosthesis migration was observed. No patient had paraplegia, stroke, renal failure, bleeding or coagulopathy, elective or emergency surgical conversion.Hybrid treatment of CTAD is feasible, especially in high risk patients. Proper integration of surgical and endovascular techniques, in addition to clinical and radiological surveillance, makes this technique a great alternative to conventional surgery.

Contexto: A terapia endovascular tem avançado muito como tratamento para a doença arterial oclusiva infrainguinal, principalmente com o desenvolvimento dos materiais e dos stents autoexpansíveis de nitinol. Objetivo: Avaliar os resultados e os fatores determinantes da angioplastia fêmoro-poplítea em pacientes portadores de isquemia de membros inferiores. Métodos: Foram tratados, através de angioplastia com ou sem stent, 114 pacientes, e acompanhados por um período médio de 12 meses. A média de idade foi de 66 anos; 53% eram do sexo feminino; 23,7% eram portadores de claudicação incapacitante; 8,8%, de dor isquêmica de repouso; e 67,5%, de lesão trófica. As lesões foram classificadas segundo o TransAtlantic Inter-Society Consensus II em A (53%), B (34%), C (5%) e D (9%). Resultados: A análise angiográfica do leito distal mostrou uma média de 1,4±1,0 artérias infrapoplíteas pérvias. O sucesso inicial foi de 97%. No seguimento de 1, 6, 12 e 24 meses, a perviedade primária foi de 94, 78, 48 e 31%, e a primária assistida, de 94, 84, 73 e 61%, respectivamente (p = 0,005). O leito distal pobre e a presença de diabetes melito foram associados a uma menor perviedade primária (p = 0,01), enquanto a extensão da lesão não influenciou os resultados. As taxas de salvamento de membro em 6, 12 e 24 meses foram de 95, 90 e 90%, respectivamente. Conclusões: A extensão das lesões tratadas não foi um fator determinante em nossa casuística para o menor sucesso da angioplastia, o que pode sugerir que as indicações para o tratamento endovascular possam ser ampliadas para pacientes com lesões TransAtlantic Inter-Society Consensus II C/D. Background: Endovascular techniques have undergone major advances with regard to the treatment of infrainguinal arterial occlusive disease, mainly as a result of development of new devices and self-expanding nitinol stents. Objective: To evaluate the results and determinant factors of femoropopliteal angioplasty in patients with critical lower limb ischemia. Methods: During the study, 114 patients were submitted to angioplasty or stenting and followed during an average of 12 months. Mean age was 66 years, and 53% were female; 23.7% presented disabling claudication, 8.8% ischemic rest pain and 67.5% tissue loss. Lesions were classified as A (53%), B (34%), C (5%) and D (9%) according to the TransAtlantic Inter-Society Consensus II. Results: Angiographic run-off analysis showed an average of 1.4±1.0 patent infrapopliteal artery. Initial success rate was 97%. At 1, 6, 12 and 24 months of the follow-up period, primary patencies of 94, 78, 48 and 31%, and assisted primary patencies of 94, 84, 73 and 61% were achieved (p = 0.005). Poor run-off and diabetes mellitus were directly associated with lower primary patency rates (p = 0.01), while angiographic severity of the lesions did not influence results. Limb salvage rates calculated at 6, 12 and 24 months were 95, 90 and 90%, respectively. Conclusions: Lesion length was not a determinant factor of lower success rates for angioplasty or stenting, which may suggest that indications for endovascular treatment can be extended to patients with TransAtlantic Inter-Society Consensus II C/D lesions.