Winston Bonetti Yoshida

São Paulo State University, San Paulo, São Paulo, Brazil

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Publications (116)53.77 Total impact

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    ABSTRACT: The sandwich technique is an endovascular off-the-shelf solution for patients with thoracoabdominal aortic aneurysms (TAAAs). In a sandwich configuration, the chimney stent runs in the middle of a space created by two or three aortic endografts. All patients with TAAAs who were treated with the sandwich technique were included in the study. Self-expanding Viabahn grafts (W. L. Gore and Associates Inc, Flagstaff, Ariz) were used as parallel grafts in the renal arteries and visceral vessels. Caudad-facing chimney grafts were used for the visceral arteries and cephalad-facing periscope grafts for the renal arteries. During the study period, 32 patients with TAAAs were treated with sandwich grafts. Indication for the procedure in 43% was an acute onset of symptoms, including two patients with a rupture and a retroperitoneal hematoma. Three patients required an additional debranching procedure. A total of 104 chimney grafts were implanted. Two patients died postoperatively because of the operation. Major adverse events were recorded in five patients, including one patient with persistent paraplegia and two with permanent renal failure requiring dialysis. The incidence of chimney graft occlusion was higher in patients with three or four parallel grafts than in those with two chimney grafts only. Patients with chronic dissections had a 12-times higher incidence of chimney graft occlusion than aneurysm patients. The number of patients with type I or III endoleaks was higher in the group with three or four parallel grafts. The sandwich technique is an off-the-shelf endovascular alternative to treat patients with TAAAs in an emergent setting. The combination of chimney grafts with a periscope configuration enables a rapid endovascular aneurysm exclusion with acceptable midterm results.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 03/2014; · 3.52 Impact Factor
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    Jornal Vascular Brasileiro 09/2013; 12(3):226-229.
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    Jornal Vascular Brasileiro 09/2013; 12(3):237-242.
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    ABSTRACT: Smoking is the most relevant environmental factor that affects the development of aortic aneurysm. Smokers have elevated levels of elastase activity in the arterial wall, which leads to weakening of the aorta. The aim of this study was to verify whether cigarette smoke exposure itself is capable of altering the aortic wall. Forty-eight Wistar rats were divided into 2-, 4-, and 6-month experimental periods and into 2 groups: smokers (submitted to smoke exposure at a rate of 40 cigarettes/day) and nonsmokers. At the end of the experimental periods, the aortas were removed and cross-sectioned to obtain histologic specimens for light microscopic and morphometric analyses. The remaining longitudinal segments were stretched to rupture and mechanical parameters were determined. A degenerative process (i.e., a reduction in elastic fibers, the loss of lamellar arrangement, and a reduction of smooth muscle cells) was observed, and this effect was proportional in intensity to the period of tobacco exposure. We observed a progressive reduction in the yield point of the thoracic aorta over time (P < 0.05). There was a decrease in stiffness (P < 0.05) and in failure load (P < 0.05) at 6 months in the abdominal aorta of rats in the smoking group. Chronic exposure to tobacco smoke can affect the mechanical properties of the aorta and can also provoke substantial structural changes of the arterial wall.
    Annals of Vascular Surgery 08/2013; 27(6):791-800. · 0.99 Impact Factor
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    Jornal Vascular Brasileiro 06/2013; 12(2):155-158.
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    ABSTRACT: BACKGROUND: Venous ulcers account for 70% of chronic leg ulcers and affect about 2-7% of the population, causing much socioeconomic impact and reducing patients' quality of life. In this study we aimed to describe the clinical features of venous ulcers and sociodemographic characteristics of patients with ulcers due to chronic venous disease (CVD). METHODS: This cross-sectional, observational study was conducted at the Vascular Surgery Service, Universidade Federal de Sergipe, in northeastern Brazil. The study included a consecutive series of 154 patients with active venous ulcers (CEAP C6) in the lower limb due to CVD. Sociodemographic characteristics (age, gender, race, monthly income, education, occupation, and caregiver) and clinical data (affected limb, ulcer site, etiopathogenesis, recurrence, and time elapsed since the first episode of ulcer) were collected. A possible correlation of time elapsed since the first episode of ulcer and number of recurrences with primary or secondary etiology was analyzed by Mann-Whitney U-test. RESULTS: Of the 154 patients analyzed, 79% were female, 94% were ethnically black or brown, 90% had a monthly income less than or equal to minimum wage, 47% were illiterate, 35% had not completed elementary school, 50% had informal jobs, 19.5% were retired, and 18.2% received sick pay from the social security system. The mean age was 53.7 years. Both limbs were affected similarly, and venous ulcers were located predominantly on the medial aspect of the leg (84%). The median time elapsed since the first episode of ulcer was 36 months, being significantly higher in patients with venous ulcers of secondary etiology (P < 0.0003). The prevalence of recurrence was also significantly higher in patients with venous ulcers of secondary etiology (P < 0.001). According to CEAP classification, 65% of ulcers were primary (Ep), 94.1% demonstrated reflux involving the superficial system (As), 92% had incompetent perforators (Ap), 35% demonstrated reflux involving the deep system (Ad), and all ulcers showed reflux without obstruction (Pr). CONCLUSIONS: Venous ulcers were more prevalent among low-income patients, especially chronic, recurrent ulcers of primary etiology. This finding highlights the need for improvements in patient care and surgical treatment in most cases aimed at ulcer healing and reduced recurrence. Better care would improve patients' quality of life and reduce social security expenditures.
    Annals of Vascular Surgery 03/2013; · 0.99 Impact Factor
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    Jornal Vascular Brasileiro 03/2013; 12(1):34-39.
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    Winston Bonetti Yoshida
    Jornal Vascular Brasileiro 03/2013; 12(1):1-2.
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    ABSTRACT: BACKGROUND: In the past 10 years, new anticoagulants (NACs) have been studied for venous thromboembolism (VTE) prophylaxis. OBJECTIVE: To evaluate the risk/benefit profile of NACs versus enoxaparin for VTE prophylaxis in major orthopedic surgery. METHODS: A systematic review of double-blind randomized phase III studies was performed. The search strategy was run from 2000 to 2011 in the main medical electronic databases in any language. Independent extraction of articles was performed by 2 authors using predefined data fields, including study quality indicators. RESULTS: Fifteen published clinical trials evaluating fondaparinux, rivaroxaban, dabigatran, and apixaban were included. Primary efficacy (any deep vein thrombosis [DVT], nonfatal pulmonary embolism, or all-cause mortality) favored fondaparinux (relative risk [RR] 0.50; 95% CI, 0.39, 0.63) and rivaroxaban (RR, 0.50; 95% CI, 0.34, 0.73) over enoxaparin, although significant heterogeneity was observed in both series. The primary efficacy of dabigatran at 220 mg, apixaban, and bemiparin were similar, with RRs of 1.02 (95% CI, 0.86, 1.20), 0.63 (95% CI, 0.39, 1.01), and 0.87 (95% CI, 0.65, 1.17), respectively. The primary efficacy of dabigatran at 150 mg (RR, 1.20; 95% CI, 1.03, 1.41), was inferior to enoxaparin. The incidence of proximal DVT favored apixaban (RR, 0.45; 95% CI, 0.27, 0.75) only. Rivaroxaban (RR, 0.45; 95% CI, 0.27, 0,77) and apixaban (RR, 0.38; 95% CI, 0.16, 0.90) produced significantly lower frequencies of symptomatic DVT. The incidence of major VTE favored rivaroxaban (RR, 0.44; 95% CI, 0.25, 0.81), only. Bleeding risk was similar for all NACs, except fondaparinux (RR, 1.27; 95% CI, 1.04, 1.55), which exhibited a significantly higher any-bleeding risk compared with enoxaparin, and apixaban (RR, 0.88; 95% CI, 0.79, 0.99), which was associated with a reduced risk of any bleeding. Alanine amino transferase was significantly lower with 220 mg of dabigatran, (RR, 0.67; 95% CI, 0.79, 0.99) than with enoxaparin. CONCLUSIONS: NACs can be considered alternatives to conventional thromboprophylaxis regimens in patients undergoing elective major orthopedic surgery, depending on clinical characteristics and cost-effectiveness. The knowledge of some differences concerning efficacy or safety profile, pointed out in this systematic review, along with the respective limitations, may be useful in clinical practice.
    Annals of Vascular Surgery 01/2013; · 0.99 Impact Factor
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    Jornal Vascular Brasileiro 01/2013; 12(3):230-233.
  • Jornal Vascular Brasileiro 01/2013;
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    Jornal Vascular Brasileiro 01/2013; 12(2):1-4.
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    Winston Bonetti Yoshida
    Jornal Vascular Brasileiro 12/2012; 11(4):255-255.
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    Winston Bonetti Yoshida
    Jornal Vascular Brasileiro 09/2012; 11(3):173-174.
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    ABSTRACT: Superficial nerve injuries are very common during varicose vein surgery. In contrast, deep nerve injuries are rare and reported especially when surgery involves the small saphenous vein (SSV). The deep motor nerves most commonly injured are the tibial nerve and the peroneal nerve, which are directly or indirectly affected by extrinsic compression, stretching, or healing process involvement. In this report, two cases of common fibular nerve injury after SSV stripping are described, including treatment used and patient outcomes. Nerve damage mechanisms, anatomy, and prevention strategies are also discussed. In conclusion, fibular nerve damage may occur during SSV stripping. Preventive measures include careful preoperative ultrasonographic investigation of the anatomy of the vein, determining location of the saphenopopliteal joint, and careful dissection far from fibular nerve and restricted to the popliteal fossa.
    Annals of Vascular Surgery 07/2012; 26(5):729.e11-5. · 0.99 Impact Factor
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    ABSTRACT: Perforation of inferior vena cava (IVC) by filter struts ranges from 9% to 24%, and clinical sequelae and complications are unpredictable. The aim of this article was to report an unusual case of late complication of IVC filter that caused an IVC wall perforation and penetration of the filter's hooks in the aorta, which was treated by endovascular procedure. Molding strut tip by balloon angioplasty, its accommodation with a bare stent, and its coverage and protection with an endoprosthesis is probably the first technique reported so far in this situation.
    Annals of Vascular Surgery 06/2012; 26(6):859.e9-12. · 0.99 Impact Factor
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    ABSTRACT: Isolated iliac artery aneurysms are rare in the general population (0.03%) and represent 2% of all abdominal aneurysms, and the association with Marfan syndrome is even rarer. We report a Marfan syndrome case with an isolated common iliac artery aneurysm treated by using a modified "stent-graft sandwich" technique, with preservation of the internal iliac artery perfusion. The modified "stent-graft sandwich" technique involves building an appropriate proximal neck just in the common iliac artery for fittingly housing two new stent-grafts inside, both deployed simultaneously and each one going to both distal iliac arteries (internal and external).
    Annals of Vascular Surgery 02/2012; 26(3):419.e7-9. · 0.99 Impact Factor
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    ABSTRACT: Síndrome do desfiladeiro torácico – ressecção de costela cervical por videotoracoscopia Thoracic outlet syndrome – cervical rib resection through videothoracoscopic surgery Resumo A base do tratamento cirúrgico da Síndrome do Desfiladeiro Torácico (SDT) é a ressecção da primeira costela Abstract The basis of Thoracic Outlet Syndrome (TOS) surgical treatment is the first rib resection and may be associated with scalenectomy or cervical rib resection. The latter is traditionally done through a supraclavicular or axillary access, which is the most technically challenging. It can also be achieved through parascapular access. Although technically attractive and associated with less invasiveness and increased security, with excellent aesthetic results, the first thoracic rib resection via video-assisted transaxillary surgery or videothoracoscopic technique is seldom reported in the literature, and no reference was found on cervical rib resection through this technique. In this article, we introduced this innovation successfully performed for surgical cervical rib resection in two patients.
    Jornal Vascular Brasileiro 01/2012; 11(3):219-225.
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    ABSTRACT: Significant morbidity and mortality are related to conventional aortic replacement surgery. Endovascular debranching techniques, fenestrated or branched endografts are time consuming and costly. We alternatively propose to use endovascular approach with parallel grafts for debranching of aortic arch. Under general anesthesia, 12 F sheaths were inserted in the femoral, axillary and common carotid arteries for vascular accesses. ViaBahn grafts 10 - 15 cm in length were placed into the aortic arch from right common carotid, left common carotid and left axillary arteries, until the tip of each graft reached into the ascending aorta. Through one femoral artery, the aortic stent -graft was positioned and delivered. Soon after, the parallel grafts were sequentially delivered. Self-spanding Wallstents(R) were used for parallel grafts reinforcement. Ballooning was routinely used for parallel grafts and rarely for aortic graft. This technique was used in 2 cases. The first one was a lady with 72 years old, with an aortic retrograde dissection from left subclavian artery and involving remaining arch branches. Through right common carotid artery a stent-graft was placed in the ascending aorta and through the left common carotid artery a ViaBahn was inserted parallel to the former. A thoracic endograft then covered all the aortic arch dissection extending into the ascending aorta close to the sinu -tubular junction. The second case was a 82 year old male patient with a 7 cm aortic arch aneurysm. Through both common carotid arteries ViaBahn grafts were introduced and positioned into the ascending aorta. Soon after, the deployment of the thoracic stent graft covered all parallel grafts of the aortic arch, excluding the aneurysm. Both cases did not have neurologic or cardiac complications and were discharged 10 days after the procedure. This technique may be a good minimal invasive off-the-shelf technical option for aortic arch ''debranching''. More data and further improvements are required before this promising technique can be widely advocated.
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 07/2011; 42(5):627-30. · 2.92 Impact Factor
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    ABSTRACT: After about 50 years of experience with heparin and vitamin K antagonists (VKA), research and clinical studies of new anticoagulants have recently evolved . Although traditional anticoagulants have proven to be clinically useful, they have important limitations in terms of laboratory control, complications, side effects and interactions with medications and food. .Unfractionated heparin interacts with plasma proteins and the vascular wall, may trigger thrombocytopenia, can only be administered parenterally, requires control by the laboratory test of partial thromboplastin time, may cause osteoporosis and alopecia when used for long periods and it is produced from biological sources. VKA have the advantage of being administered orally, but the control (made by the international normalized ratio) can be difficult in some cases, since they have delayed onset of action and metabolism and a narrow therapeutic window. They also interact with foods and with a large number of medications, can cause skin necrosis in patients with antithrombin and protein C and S deficiencies and may induce fetal changes when prescribed in pregnancy. In the 1980´s the low-molecular-weight heparins were developed and proved to be an evolution over unfractionated heparin, because of their greater bio-availability, fixed dose per body weight, no need for laboratory control, subcutaneous administration, lower risk of heparin-induced thrombocytopenia, and efficacy and safety similar to unfractionated heparin. Over the last decade, a series of new anticoagulants have appeared in the market and shown promising results in several situations of venous thromboembolism prophylaxis and treatment. In the present review, the new low-molecular-weight heparins, ultra-low molecular weight heparin, pentasaccharides and the new direct inhibitors of factor Xa and factor IIa.are addressed.
    Jornal Vascular Brasileiro 06/2011; 10(2):145-153.

Publication Stats

228 Citations
53.77 Total Impact Points

Institutions

  • 1988–2014
    • São Paulo State University
      • • Department of Surgery and Orthopaedics
      • • Faculdade de Medicina de Botucatu
      • • Department of Veterinary Surgery and Anesthesiology
      San Paulo, São Paulo, Brazil
  • 2010–2012
    • Vascular and Endovascular Surgery Institute of São Paulo
      San Paulo, São Paulo, Brazil
    • Faculdade de Medicina de Marília
      Marília, São Paulo, Brazil
  • 2006–2010
    • Fatec Botucatu
      Botucatu, São Paulo, Brazil
  • 2003
    • Instituto de Moléstias Cardiovasculares
      Rio Preto, São Paulo, Brazil