Browsing by Author "Machado, R."
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- 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 Internal Iliac Artery Aneurysms: Single Center ExperiencePublication . Machado, R.; Rego, D.; Oliveira, P.; Almeida, Rui.Objective: Internal iliac artery aneurysms (IIAA) are rare, representing only 0.3% of aortoiliac aneurysms. Its treatment with open surgery is complex and associated with high morbidity and mortality, which led to increasing application of endovascular solutions. In this study, we aimed to evaluate outcomes of endovascular aneurysm repair (EVAR) of IIAA in one institution. Methods: We retrospectively reviewed all cases of IIAA treated with endovascular techniques between 2003 and 2014. Endpoints were morbidity, mortality, freedom from pelvic ischemic symptoms (buttock claudication, ischemic colitis, and spinal cord injury), and need for reintervention. Results: There were 16 patients, 13 males and 3 females, with mean age of 75.1±7 years. A total of 20 IIAA (4 cases were bilateral), with mean diameter of 37.9 mm, were treated. EVAR was performed in 13 (81.3%) patients, with associated internal iliac artery's outflow occlusion in 2. Iliac branch device was used in one patient. Two patients underwent endovascular IIAA embolization alone. One patient underwent percutaneous, transgluteal, IIAA embolization. IIAA flow preservation in at least one internal iliac artery was possible in 9 (56.3%) patients. Early mortality was 7% (1 case). Early morbidity was 18.8%. Pelvic ischemic complications occurred in 1 (7%) patient with buttock claudication. Late reintervention was needed in 3 patients, none of them for IIAA related complications. Conclusion: Endovascular treatment of IIAA is technically feasible and durable. Although overall morbidity is relatively high, major complications are infrequent and perioperative mortality is low. internal iliac artery flow preservation is technically challenging and, in a significant number of cases, not possible at all.
- 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.
- Fístula Coronária: Causa Rara de Sopro CardíacoPublication . Diamantino, C.; Machado, R.; Anjos, R.; Ferreira, R.; Martins, F.As fístulas coronárias congénitas são raras, representando cerca de 0,2% a 0,4% das anomalias cardíacas congénitas. Na maioria dos casos são anomalias assintomáticas, condicionando a existência de um sopro cardíaco contínuo, que constitui o principal motivo de estudo do doente. Descreve-se o caso clínico de uma criança de 16 meses, assintomática, referenciada à consulta de cardiologia por um sopro contínuo e cujo ecocardiograma revelou fístula coronária direita de alto débito para a aurícula direita e comunicação interauricular multifenestrada, condicionando dilatação das cavidades direitas. Foi realizado com sucesso o encerramento electivo, por via percutânea, da fístula coronária. Este caso demonstra claramente a importância de um exame clínico cuidadoso, que permitiu o diagnóstico, e a possibilidade de tratamento por cateterismo, seguro e eficaz. Coronary arterial fi stula is a rare congenital cardiac anomaly. It accounts for 0.2%-0.4% of all congenital cardiac anomalies. The majority of the patients is asymptomatic and is referred because of a murmur. We describe the case of a 16 month year old girl, asymptomatic, with a continuous murmur. Echocardiographic study revealed a signifi cant right coronary arterial fi stula draining to the right atrium, a fenestrated atrial septal defect and enlarged right atrium and ventricle. The patient underwent percutaneous closure of the fistula.
- Infecções Respiratórias por Influenza: Reflexões para a ausência de um diagnósticoPublication . Machado, R.; Brito, M. J.; Loureiro, V.; Ferreira, G.RESUMO Introdução: O vírus influenza afecta anualmente 10 a 40% das crianças e destas 0,5 a 1% vão necessitar de internamento. Ao averiguar a prevalência desta infecção no internamento do Hospital Dona Estefânia, entre Janeiro de 2004 e Junho de 2006, constatámos a existência de apenas nove casos diagnosticados. Objectivos: Determinar as causas da escassez do número de diagnósticos de infecções pelo vírus influenza. Materiais e Métodos: Para alcançar o objectivo deste estudo foram consideradas as seguintes hipóteses: 1) baixa incidência de gripe sazonal no período considerado 2) insuficiência do número de pedidos para pesquisa do vírus pelo corpo clínico 3) baixa identificação por procedimentos técnicos incorrectos. Foram analisados os pedidos de pesquisa de vírus respiratórios e realizado um inquérito ao corpo clínico e enfermagem sobre os procedimentos técnicos de diagnóstico. Os dados foram completados através de consulta de processos clínicos. O diagnóstico laboratorial foi realizado por técnica de imunofluorescência indirecta (Kit VRK®, Bartels). Resultados: Após exclusão de várias hipóteses identificámos procedimentos técnicos incorrectos na metodologia do diagnóstico utilizada, condicionando uma baixa taxa de identificação vírus respiratórios - 23% (276 resultados positivos em 1231 amostras). Comentários: O diagnóstico da gripe contribui para o controle da morbilidade e mortalidade desta infecção. Para que este processo seja efectivo é essencial que os profissionais de saúde sigam rigorosamente os procedimentos que conduzem a um correcto diagnóstico da doença. O insuficiente número de casos detectados no nosso estudo proporcionou-nos uma reflexão sobre a metodologia empregue para que, futuramente, se possa maximizar o número de diagnósticos de infecções respiratórias pelo vírus influenza.
- Influência no fluxo sanguíneo do ângulo da anastomose latero-terminal da pontagem femoro-femoral cruzada – estudo in vivo humanoPublication . Loureiro, L.; Machado, R.; Vaz, C.; Loureiro, T.; Silveira, D.; Teixeira, S.; Rego, D.; Ferreira, V.; Gonçalves, J.; Almeida, R.
- Institutional Impact of EVAR's Incorporation in the Treatment of Abdominal Aortic Aneurysm: a 12 Years' Experience AnalysisPublication . Machado, R.; Antunes, I.; Oliveira, P.; Pereira, C.; Almeida, R.Introduction: Endovascular aneurysm repair (EVAR) was introduced as a less aggressive treatment of abdominal aortic aneurysms (AAA) for patients ineligible for open repair (OR). Objective: To analyze EVAR's incorporation impact in the treatment of infra-renal abdominal aortic aneurysms in our institution. Methods: A retrospective study of the patients with diagnostic of infra-renal AAA treated between December 2001 and December 2013 was performed. The choice between EVAR and OR was based on surgeon's experience, considering patient clinical risk and aneurysm's anatomical features. Patients treated by EVAR and by OR were analyzed. In each group, patient's and aneurysm's characteristics, surgical and anesthesia times, cost, transfusion rate, intraoperative complications, hospital stay, mortality and re-intervention rates and survival curves were evaluated. Results: The mean age, all forms of heart disease and chronic renal failure were more common in EVAR group. Blood transfusion, surgical and anesthesia times and mean hospital stay were higher for OR. Intraoperative complications rate was higher for endovascular aneurysm repair, overall during hospitalization complication rate was higher for open repair. The average cost in endovascular aneurysm repair was 1448.3€ higher. Re-interventions rates within 30 days and late re-intervention were 4.1% and 11.7% for endovascular aneurysm repair versus 13.7% and 10.6% for open repair. Conclusions: Two different groups were treated by two different techniques. The individualized treatment choice allows to achieve a mortality of 2.7%. Age ≥80 years influences survival curve in OR group and ASA ≥IV in EVAR group. We believe EVAR's incorporation improved the results of OR itself. Patients with more comorbidities were treated by endovascular aneurysm repair, decreasing those excluded from treatment. Late reinterventions were similar for both techniques.
- Is Age a Determinant Factor in EVAR as a Predictor of Outcomes or in the Selection Procedure? Our ExperiencePublication . Machado, R.; Teixeira, G.; Oliveira, P.; Loureiro, L.; Pereira, C.; Almeida, R.Introduction: Endovascular aneurysm repair (EVAR) is the therapy of choice in high risk patients with abdominal aortic aneurysm. The good results described are leading to the broadening of clinical indications to younger patients. However, reintervention rates seem higher and even with successful treatment sometimes there is growth of the aneurysm sac and rupture, meaning a failure of the therapeutic goal. This study proposes to analyse the impact of age in patients' selection and post-EVAR results. Methods: The clinical records of consecutive patients undergoing endovascular aneurysm repair, between 2001 and 2013, were retrospectively reviewed. Patients were divided according to age groups (<70, 70-80 and >80 years). Gender, body mass index, aneurysm anatomic features, neck characteristics, iliac morphology, surgical indication, endograft type, anesthesic risk classification, length of stay, reinterventions and mortality were analysed and compared. Results: The study included 171 patients, 161 (94.1%) men, and mean age 74.1±8.9 years. The age group under 70 had 32% of the patients. Only three characteristics were found different among age groups: 1) body mass index was higher in younger patients, with a considerable trend toward significance (P=0.06); 2) surgical indication, in the younger group, surgeon's and the patient's option were more proeminent (P<0.05); 3) erectile dysfunction was higher in elderly group (P<0.05). No other clinical and anatomical characteristics or final outcomes were found statisticaly different among age groups. Conclusion: The absence of statistically differences in mortality and reinterventions among age groups suggests that age by itself is not a relevant factor in endovascular aneurysm repair. Indeed, the three characteristics different in younger (obesity, sexual function and patient's choice) favor endovascular aneurysm repair.