Browsing by Author "Almeida, R."
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- Aneurysmal Degeneration of the Brachial Artery after Vascular Access Creation: Surgical Treatment ResultsPublication . Teixeira, S.; Sá-Pinto, P.; Veiga, C.; Silva, I.; Almeida, R.True peripheral artery aneurysms proximal to a longstanding arteriovenous fistula is a well-recognized complication. Late aneurysmal degeneration is rare. This study analyzed the characteristics, therapeutic options, and outcomes of true donor brachial artery aneurysms (DBAA) after arteriovenous fistula (AVF) for hemodialysis. We retrospectively collected the data of patients with DBAA after AVF creation, surgically repaired between January 2001 and September 2015. We excluded patients with pseudoaneurysms, anastomotic aneurysms, and infected aneurysms. We recorded patient's demographics, type of access, aneurysm characteristics, symptoms, treatment, and follow-up. Ten patients were treated for aneurysmal degeneration of the brachial artery. Average aneurysm diameter was 37.5 mm. All cases had, at least, one previous distal AVF, ligated or thrombosed, at the time of diagnosis. The first access was created in mean 137 months before the diagnosis of DBAA. Nine patients had previous medical history of renal transplant and were under immunosuppressive therapy. All patients were symptomatic at the time of diagnosis. In all cases, the treatment was aneurysmectomy followed by interposition bypass. One patient developed a postoperative hematoma with the need of surgical drainage. At 50 months of follow-up, one patient was submitted to percutaneous angioplasty due to an anastomotic stenosis. No other complications occurred during the entire follow-up period (mean: 69 months). The pathogenesis underlying DBAA remains unclear. Increased blood flow after AVF creation, immunosuppressive therapy, and ligation/thrombosis of the AVF may contribute to aneurysm formation. Surgical treatment by aneurysmectomy and bypass, with autogenous conducts, is a safe and effective option.
- Arterio-arterial graft – an option for hemodialysis patients with exhaustion of venous patrimonyPublication . Castro, A.; Almeida, P.; Silva, F.; Rego, D.; Tavares, J.; Santos, J.; Silva, F.; Queirós, J.; Cabrita, A.; Almeida, R.Introduction: Vascular access (VA) for hemodialysis (HD) is the lifeline for End Stage Renal Disease (ESRD) patients. Long-term HD patients often have exhaustion of their venous patrimony for an autologous VA construction and, sometimes, even for a central venous catheter (CVC) placement. Case report: We describe the case of a 43-year-old woman with ESRD due to lupus nephritis, on maintenance HD since 2009. She also had secondary antiphospholipid syndrome and was chronically anticoagulated. Nevertheless, the patient had multiorgan thrombotic events (without sequelae) and several episodes of irreversible thrombosis of arteriovenous fistulas. Her HD course was also marked by multiple severe CVC infections, at diferente locations; a hemoperitoneum during cholecystectomy, and an immediate thrombosis of the renal artery of a kidney transplant. She was admitted to our hospital after an irreversible dysfunction of a right jugular CVC, with documentation of thrombosis of the superior and inferior vena cava. Exhaustion of the venous patrimony for HD was assumed and it was decided to make an arterio-arterial graft (AAG) of early cannulation. The first cannulation of the AAG was performed two days after surgical intervention, with no complications. The patient performed a twelve hour per week HD treatment with good efficiency. Conclusion: AAG is an alternative for HD patients who have exhausted all their venous patrimony and it can be considered prior to the placement of a CVC as their sole remaining vascular access.
- Associação de Arco Aórtico Cervical a Delecção 22q11 – Papel da RMN no DiagnósticoPublication . Almeida, R.; Álvares, S.; Fortuma, A.; Moreira, J.; Vieira, A.As anomalias do arco aórtico são relativamente comuns, ocorrendo em 0,5-3% da população, tendo recentemente sido reconhecidas como fazendo parte do espectro de anomalias cardiovasculares associadas à delecção do cromossoma 22q11. Actualmente a RMN surge como mais um método disponível para o seu diagnóstico, pois permite definir com precisão a anatomia vascular (nomeadamente da aorta) e as suas relações com a traqueia e esófago, obviando as limitações da ecocardiografia convencional de superfície e evitando algumas das desvantagens da angiografia convencional, nomeadamente o uso de radiação ionizante e de contraste iodado. Apresentam-se dois casos de arco aórtico cervical e CIV associados ao síndrome de DiGeorge (CATCH22 +), em cujos diagnósticos foram utilizadas a angiografia convencional e a angioressonância, respectivamente.Aortic arch anomalies are relatively common, occurring in 0.5-3% of the population. In recent years, they have been recognized as being among the cardiovascular malformations found in chromosome 22q11 deletion. MRI is now an alternative method of diagnosing aortic arch anomalies since it accurately defines aortic anatomy and its relation with the trachea and esophagus, with some advantages in comparison with echocardiography and conventional angiography. The authors present two cases of cervical aortic arch and VSD associated with DiGeorge syndrome (CATCH22 +), diagnosed by conventional angiography and magnetic resonance imaging, respectively.
- Bone Mineral Density After Simultaneous Kidney–PancreasPublication . Pereira, S.; Pedroso, S.; Martins, L.; Santos, P.; Almeida, M.; Freitas, C.; Dias, L.; Dores, J.; Almeida, R.; Henriques, A.C.; Teixeira, M.ABSTRACT Bone disease and an high risk of fractures are major problems in transplantation. Among diabetic patients undergoing simultaneous kidney–pancreas (SKP) transplantation, there are few studies assessing long-term effects on bone mass. The aim of this study was to evaluate bone mineral density (BMD) over 4 years follow-up after SKP transplantation. Fifty-seven patients had 22.8 5.3 years of prior diabetes, 65% were female, and the overall mean age was 24.3 5.93 years. At the time of transplantation, the lumbar spine and femoral neck T-scores were 1.75 1.05 and 1.95 0.73, respectively; 28% of subjects had evidence of osteoporosis. One year after transplantation, 77.6% of patients displayed improved lumbar T-scores to 1.33 0.94 (.044) with stable femoral neck T-scores. Bone densitometry enhanced gradually through the 4 years follow-up: lumbar T-score to 1.04 0.67 (.004) and femoral neck T-score to 1.69 0.49 (.12). At year 4, no osteoporosis cases were detected but 86.7% of patients did not receive steroids in the immunosuppressive regimen. The graft function remained stable (serum creatinine, 1.2 mg/dL; fasting glucose, 87.7 mg/dL). During the follow-up, BMD improved more significantly at cortical sites. Our study reports a reduced prevalence of fractures (8.7%) compared with the literature, which could be related to a steroid-sparing protocol and/or aggressively treatment of osteoporosis.
- Combined Pancreas-Kidney Transplantation: A New Program in Portugal, Results From the First 12 CasesPublication . Martins, L.; Henriques, A.; Dias, L.; Ventura, A.; Seca, R.; Almeida, R.; Dores, J.; Bacelar, C.; Oliveira, F.; Lhamas, A.; Amil, M.; Rua, F.; Coelho, T.; Esteves, S.; Ribeiro, A.; Pereira, R.; Sarmento, A.; Teixeira, M.; Pereira, M.Transplant Proc. 2003 May;35(3):1107-8. Combined pancreas-kidney transplantation: a new program in Portugal, results from the first 12 cases. Martins L, Henriques A, Dias L, Ventura A, Seca R, Almeida R, Dores J, Bacelar C, Oliveira F, Lhamas A, Amil M, Rua F, Coelho T, Esteves S, Ribeiro A, Pereira R, Sarmento A, Teixeira M, Pereira M. Transplantation Department, Hospital Santo António, 4050, Porto, Portugal. lasalete@clix.pt PMID: 12947877 [PubMed - indexed for MEDLINE]
- Consentimento e discernimentoPublication . Almeida, R.O autor aborda questões relacionadas com a aplicação do estatuto do consentimento informado às crianças, apontando algumas condicionantes práticas e apelando à reflexão dos profissionais de saúde. ABSTRACT In this opinion paper, the author addresses aspects of the informed consent issues in children, describing some practical determinants and calling health professionals to a reflection.
- Custos do tratamento da doença arterial obstrutiva infra-poplítea (DAOIP) – análise de uma amostra aleatóriaPublication . Loureiro, L.; Machado, R.; Teixeira, S.; Pereira, C.; Vaz, C.; Loureiro, T.; Silveira, D.; Rego, D.; Ferreira, V.; Gonçalves, J.; Almeida, R.
- Endovascular Abdominal Aneurysm Repair in Women: What are the Differences Between the Genders?Publication . Machado, R.; Teixeira, G.; Oliveira, P.; Loureiro, L.; Pereira, C.; Almeida, R.Introduction: Abdominal aortic aneurysm has a lower incidence in the female population, but a higher complication rate. It was been hypothesized that some anatomical differences of abdominal aortic aneurysm in women could be responsible for that. We proposed to analyze our data to understand the differences in the clinical and anatomical characteristics and the outcomes of patients undergoing endovascular aneurysm repair, according to gender. Methods: A retrospective analysis of patients undergoing endovascular aneurysm repair between 2001-2013 was performed. Patients were divided according gender and evaluated regarding age, atherosclerotic risk factors, aneurysm anatomic features, endograft type, anesthesic risk classification, length of stay, reinterventions and mortality. Two statistical studies were performed, first comparing women and men (Group A) and a second one comparing women and men, adjusted by age (Group B). Results: Of the 171 patients, only 5.8% (n=10) were females. Women were older (P<0.05) and the number of women with no atherosclerotic risk factor was significantly higher. The comparison adjusted by age revealed women with statistically less smoking history, less cerebrovascular disease and ischemic heart disease. Women had a trend to more complex anatomy, with more iliac intern artery aneurysms, larger aneurysm diameter and neck angulations statistically more elevated. No other variables were statistically different between age groups, neither reintervention nor mortality rates. Conclusion: Our study showed a clear difference in the clinical characteristics of women. The female population was statistically older, and when compared with men adjusted by age, had less atherosclerotic risk factors and less target organ disease. Women showed a more complex anatomy but with the same outcomes.
- Endovascular Treatment of Aortic Aneurysms and Blood Transfusion. What do We Need?Publication . Machado, R.; Loureiro, L.; Antunes, I.; Coutinho, J.; Almeida, R.INTRODUCTION: Comparatively to open repair, endovascular aneurysm repair has reduced transfusion rates but thereâs no recommendation about number of red blood cells units to be crossmatched preoperatively. Our aim is contribute to the analysis of red blood cells units needs in endovascular and hybrid aortic aneurysm repair and developing a protocol for maximum surgical blood orders schedule. MATERIAL AND METHODS: We retrospectively analyzed our prospective database of elective endovascular aneurysm repair from 2001 to 2012. We analyzed patients' age, gender, ASA classification, maximum surgical blood orders schedule, red blood cells units transfused and timings, types of endoprosthesis, red blood cells units consumption/endoprosthesis' type ratio, crossmatch to transfusion ratio, conversion to open repair, hemoglobin concentrations before surgery and discharge. RESULTS: We selected 187 patients, 90% men, mean age 73.1, ASA mode III. The endoprosthesis were aorto-bi-iliac in 71%, aorto-uni-iliac in 23% and thoracic in 6%. Of these, 72,6% of the patients did not require blood transfusion. We transfused 171 red blood cells units. Crossmatch to transfusion ratio was 10.1 until 2010 and 7.3 after. The ratio of red blood cells units consumption/endoprosthesis in the first 24 hours was 0.21 red blood cells units/aorto-bi-iliac, 0.46 red blood cells units/aorto-uni-iliac, 0.8 red blood cells units/thoracic, 1.3 red blood cells units/hybrid-thoracic and 2 red blood cells units/hybrid-aorto-bi-iliac. A statistical correlation was observed between red blood cells units transfused postoperatively and type of endoprosthesis (p < 0.001) and between ASA classification and red blood cells units transfused after 24 hours (p < 0.01). DISCUSSION: Guidelines from the British Society of Haematology are based on a crossmatch to transfusion ratio of 2:1. Our crossmatch to transfusion ratio was 10.1 until 2010 and 7.3 from 2011 to 2012. CONCLUSION: These results changed our policy of maximum surgical blood orders schedule for endovascular aneurysm repair. We now type and screen aorto-bi-iliac and aorto-uni-iliac. We crossmatch two red blood cells units for thoracic, three red blood cells units for hybrid thoracic and four red blood cells units for hybrid abdominal procedures. This may lead to financial savings, improved efficiency and reduce workload in hematology department.
- Endovascular Treatment of Isolated Chronic Abdominal Aortic DissectionPublication . Machado, R.; Rego, D.; Loureiro, L.; Almeida, R.Isolated acute abdominal aortic dissection is a relatively rare event. Its natural history is not fully understood and its optimal treatment is not established. Open surgery represents the most described treatment but endovascular intervention has had increasing application. Isolated chronic abdominal aortic dissection is even less described in the literature. We describe three patients with isolated chronic abdominal aortic dissection who underwent endovascular treatment in our institution. Mean age at presentation was 82 years. Indication for surgical intervention was aneurismal degeneration. Mean aortic diameter at presentation was 46.7 mm. There was no perioperative mortality or reinterventions. Mean follow-up was 5.3 years (2-12 years). Late reintervention was needed in one patient, eight years after initial surgery, due to type 1 endoleak. According to our experience, endovascular intervention represents an effective and durable treatment option in isolated chronic abdominal aortic dissection. However, long-term follow-up is mandatory. Furthermore, larger studies are still needed to understand this disease and its adequate treatment.
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