Portuguese journal of cardiac thoracic and vascular surgery最新文献

{"title":"A Timeline From Index Procedure To Complex Reinterventions For Thoracoabdominal Aortic Dissection.","authors":"Kevin Duh, Christopher Levy, Panagiotis Volteas, Stefanos Giannopoulos, George Koudounas, Dimitrios Virvilis","doi":"10.48729/pjctvs.434","DOIUrl":"10.48729/pjctvs.434","url":null,"abstract":"<p><p>The optimal management of acute type A aortic dissection (ATAAD) remains a controversial subject. While some surgeons opt for a hemiarch approach to minimize bypass and cross-clamping time, others prefer partial or total arch replacement to prevent the need for additional operations. The advent of hybrid approaches offers a variety of options to the aortic surgeon in treating ATAAD. Herein, we present a complex case of ATAAD requiring multistage reconstruction of the aortic arch and its branch vessels utilizing hybrid techniques. A 67-year-old man presented with chest pain and hypertension, leading to diagnosis of ATAAD. He initially underwent hemiarch replacement, which required multiple further interventions secondary to progressive thoracic aorta aneurysmal dilation, innominate artery dissection, and subclavian steal syndrome. A hybrid approach of open and endovascular techniques was utilized to treat the patient's pathology. ATAAD represents a challenging clinical entity in its acute, subacute, and long-term management. Currently, no consensus exists on ideal initial management of this disease. Nonetheless, new techniques such as fenestration of thoracic endografts can be utilized for the subsequent operations. Individualized care tailored to each case is the most effective management of this intricate disease.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"73-78"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Unusually Large Ascending Aortic Aneurysm.","authors":"Ana Margarida Silva, André Soeiro, Gonçalo Coutinho, David Prieto","doi":"10.48729/pjctvs.471","DOIUrl":"https://doi.org/10.48729/pjctvs.471","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"87-88"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Arteriovenous Malformation. An Uncommon Finding: A Case Report.","authors":"Fernando Téllez-Pallares, Miguel Jimenez-Yarza, Cynthia Sánchez-Rios, Sergio E Vázquez-Lara, Francisco Alberto Olvera-Yarza","doi":"10.48729/pjctvs.490","DOIUrl":"10.48729/pjctvs.490","url":null,"abstract":"<p><p>Vascular malformations (VMs) are dysplastic abnormalities of vascular channels, differing from vascular tumors by their slow growth. Arteriovenous malformations (AVMs) arise between weeks 4-10 of intrauterine life, with a prevalence of 1 in 100,000 among Caucasians. Common in the head, neck, and hands, AVMs may be asymptomatic or cause symptoms like pain, deformity, and disability. Treatments range from conservative management to amputation in severe cases. A 28-year-old male with finger trauma was found to have a vascular tumor, later diagnosed as an arteriovenous malformation, surgically removed and confirmed by histopathology. Angiography is the gold standard for diagnosing AVMs, though imaging and physical exams are often sufficient. Conservative management is preferred for minor symptoms, with surgery reserved for severe cases. Surgical intervention carries risks, especially for diffuse lesions. Treatment for hand AVMs is challenging, requiring specialized expertise due to the hand's complex anatomy.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"79-81"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact Of Open And Endovascular Caseload In Lower Limb Amputation In Portugal - An Analysis From 2000 To 2015.","authors":"Filipa Jácome, Alberto Freitas, Sérgio Sampaio, Marina Dias-Neto, Ricardo Castro-Ferreira","doi":"10.48729/pjctvs.437","DOIUrl":"10.48729/pjctvs.437","url":null,"abstract":"<p><strong>Objectives: </strong>Effective revascularization is the cornerstone of limb salvage in chronic limb threatening ischemia. In recent years, less invasive endovascular revascularization techniques have supplanted surgical bypass as the primary mode of revascularization. The real impact of this transition is being increasingly questioned. This study aims to evaluate the endovascular evolution, and how it impacted the amputation rates nationwide since de beginning of the century.</p><p><strong>Methods: </strong>Patients admitted to Portuguese public hospitals with peripheral arterial disease between 2000 and 2015 were selected. Of these, patients that underwent to limb revascularization and/ or limb amputation were evaluated. The information was obtained through the National Health Service administrative database. Three time periods (2000-2004, 2005-2009, 2010-2015) were considered to evaluate the evolution in amputation rates and type of revascularization.</p><p><strong>Results: </strong>The global number of revascularization episodes consistently increased along the 15 analyzed years. There were 25252 admissions for revascularization (55.1% open and 44.9% endovascular). The mean incidence of endovascular procedures significantly increased 5.8 times (p<0.01), and open surgery increased 1.3 times (p<0.01) when comparing the three time periods. 34633 limb amputations (65.3% major vs 34.7% minor) were realized along 15 years. The mean incidence of lower limb amputations increased by 1.5 times thanks to minor amputation, whose mean incidence increased two-fold while with the incidence of major amputations remained stable. Additionally, mean hospital mortality associated with revascularization episodes decreased from 10.6% to 8.2% (p<0.01), on 15-year follow-up.</p><p><strong>Conclusions: </strong>There was a significative increase in revascularization episodes over the 15 years, suggesting better access to health services and/or better diagnostic accuracy. Endovascular procedures were the most practiced. This was along with an increase in the minor limb amputation, a stabilization in major amputations incidence. This nationwide study adds to the increasing body of knowledge in the ever-pertinent discussion of revascularization types and their benefits.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"47-54"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professor Doutor António Braga The Founder of the Service, School and Attitude.","authors":"José F Teixeira","doi":"10.48729/pjctvs.493","DOIUrl":"https://doi.org/10.48729/pjctvs.493","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"15-19"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"President's Message.","authors":"Miguel Sousa Uva","doi":"10.48729/pjctvs.494","DOIUrl":"https://doi.org/10.48729/pjctvs.494","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancoast Tumors: 11-Year Single-Centre Experience.","authors":"Catarina Pereira Moita, Catarina Figueiredo, Zenito Cruz, Ana Rita Costa, João Maciel, João Santos Silva, João Eurico Reis, Paulo Calvinho","doi":"10.48729/pjctvs.438","DOIUrl":"10.48729/pjctvs.438","url":null,"abstract":"<p><strong>Introduction: </strong>Pancoast tumors encompass any tumor located on the lung apex, extending into structures in the thoracic inlet and, often, leading to the characteristic clinical syndrome. The main goal of this study is to analyze the response to multimodal treatment and outcome of patients with Pancoast tumors.</p><p><strong>Materials and methods: </strong>We performed a retrospective cohort single center study of patients with superior sulcus nonsmall cell lung carcinomas who underwent surgery between January of 2011 and February of 2022.</p><p><strong>Results: </strong>A total of ten patients were considered, 80,0% were male with a mean age of 53,6 (±6,6) years. At diagnosis, two tumors were stage II and eight were stage III. Histopathology revealed eight were adenocarcinomas and two were sarcomatoid carcinomas. All patients underwent neoadjuvant treatment before surgery. Nine patients received lung lobectomy, with en bloc resection comprising, predominantly, the chest wall (80,0%) and brachial plexus (30,0%). In one patient, surgery was aborted. Surgical histopathology showed free surgical margins were achieved in eight patients (80,0%). Two patients achieved full tumoral remission (ypT0N0, 22,2%), two tumors were stage I (22,2%), two were stage II (22,2%), two were stage III (22,2%) and one tumor was stage IV (11,1%). Mean disease-free survival was 83,9 (CI95% 42,1-125,8) months. 3-month disease-free survival rate was 88,9% and 1-year and 5-year disease-free survival rates were 63,5%. After the first-year follow-up, there was no evidence of disease progression. Mean overall survival was 115,7 (CI95% 89,3-142,1) months. At 3-month, 1-year and 5-years, overall survival was 88,9%.</p><p><strong>Conclusion: </strong>Although considering the small sample of patients, the survival of Pancoast tumors in our institution exhibits a positive outcome, when compared to current literature, Significant improvements have been reported recently, in understanding the nature of Pancoast tumors, emphasizing the importance of a multidisciplinary approach but still, further research is required.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"39-46"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored Perioperative Medicine For Frail Patients Undergoing Vascular Surgery: A Narrative Review.","authors":"Bernardo Miguel, Sarah Oliveira, João Valente Jorge, Patrícia Conde, Ângela Alves","doi":"10.48729/pjctvs.442","DOIUrl":"10.48729/pjctvs.442","url":null,"abstract":"<p><p>Frailty is a concept that is emerging as an important tool in the preoperative assessment of patients. The incidence of frailty in vascular surgery patients is high and is expected to increase concomitantly with the aging of the population. The identification of these patients and their optimization in the perioperative period can lead to an improvement in their outcomes with a reduction in morbidity and mortality. In this narrative review we address the concept of frailty applied to vascular surgery patients as well as assessment tools for its evaluation. This review focus not only on the most utilized evaluation tools but also on the most recent and specific frailty evaluation instruments that are suitable for vascular surgery patients. Furthermore, we review patient optimization strategies to improve perioperative outcomes.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"65-72"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surviving By A Thread Of Life For 20 Years.","authors":"Vidur Bansal, Vinay Upadhyay, Ruchit Patel, Chirag Doshi","doi":"10.48729/pjctvs.476","DOIUrl":"https://doi.org/10.48729/pjctvs.476","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"89"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High And Intermediate-High Risk Pulmonary Embolism Management: A 5-Year Intensive Care Unit Casuistic Review.","authors":"Inês Mendonça, Sara Teixeira, Ana Rita Ferreira, José Artur Paiva","doi":"10.48729/pjctvs.415","DOIUrl":"10.48729/pjctvs.415","url":null,"abstract":"<p><strong>Background and objectives: </strong>The optimal management of high-risk and intermediate-high-risk Pulmonary Embolism (PE) is a matter of ongoing debate. This paper aims to assess the short and long-term clinical outcomes associated with different treatment approaches for high-risk and intermediate-high-risk PE within an Intensive Care Unit (ICU) and identify potential areas for improvement.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients admitted to an ICU with high and intermediate-high-risk PE between January 2018 and December 2023. The therapeutic approach and clinical outcomes were evaluated: ICU and 28-days survival, ICU and hospital length of stay, major hemorrhagic complications and direct and indirect signs of pulmonary hypertension (PHT). Demographic, comorbid state and severity at admission data were also collected (sex, age, Charlson Comorbidity and APACHE II scores).</p><p><strong>Results: </strong>64 patients were included: 32 high-risk PE (including 18 in cardiac arrest) [Groups 1-5] and 32 intermediate-high-risk PE [Group 6a-c]. Treatment approaches varied: Group 1 - High-risk PE treated with systemic thrombolysis (ST) (n=18); Group 2 - High-risk PE treated with Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) plus ST (n=6); Group 3 - High-risk PE treated with VA-ECMO alone (n=5); Group 4 - High-risk PE treated with catheter-direct-therapy (n=1); Group 5 - Heparin only (n=2). Group 1 demonstrated an ICU and 28-day survival of 83.0%, while Groups 2 and 3 exhibited survival rates of 66.67% and 60.0%, respectively. There were 10 major bleeding complications in Group 1 and 2. For intermediate-high-risk PE, heparin alone was used in 90%; ICU and 28-day survival rate was 97%. Three patients exhibited signs of PHT during follow-up.</p><p><strong>Conclusion: </strong>This paper provides insights for the decision-making process involved in managing high and intermedi- ate-high-risk PE drawing from a 5-year retrospective cohort study conducted at an ECMO center and literature review. Fur- ther research is needed to identify the specific subgroup within the intermediate-high-risk PE that would benefit from more advanced treatment modalities for both short and long-term outcomes.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"21-31"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}