Anai Espinelli S. Durazzo

University of São Paulo, San Paulo, São Paulo, Brazil

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Publications (6)6.78 Total impact

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    ABSTRACT: To describe bypass to perigeniculate vessels for limb salvage. Retrospective cohort study. Between 1995 and 2009, 47 bypass procedures to perigeniculate collateral arteries were performed in 46 patients (15 women, 31 men; median age, 68 years). All patients presented with critical ischaemia (tissue loss in 87.5%, rest pain in 12.5%). Mean ankle brachial index was 0.27 ± 0.17. The site of distal anastomosis was the descending genicular artery (DGA) in 23 bypasses (1 bilateral) and the medial sural artery (MSA) in 24. Proximal anastomosis was to the external iliac artery in 2 cases, common femoral artery in 23 cases, superficial femoral artery in 8 cases, deep femoral artery in 8 cases, above-knee poplitaeal artery in 2 cases, and previous graft in 4 cases. There were four deaths during the immediate postoperative period. Mean follow-up duration was 27 months. Ten patients required major amputation. Mean ankle brachial index post-operatively was 0.60 ± 0.21. At 3 years, primary patency was 74.7 ± 7%, secondary patency was 83.4 ± 8%, and the limb salvage and survival rates were 73.5 ± 7% and 77.4 ± 7%, respectively. Bypass to perigeniculate arteries is a viable treatment option for critical limb ischaemia in selected patients.
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 05/2011; 42(3):374-8. · 2.92 Impact Factor
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    ABSTRACT: We evaluated nonreversed vein grafts in above-knee bypasses for chronic critical limb ischemia in a retrospective study with intention-to-treat analysis in patients who underwent above-knee bypass grafting. During a 4-year period, 51 patients (men, 32; women, 19; mean age = 66 years) with 53 critically ischemic lower extremities underwent above-knee femoropopliteal bypass grafting. The follow-up evaluation consisted of clinical examination, assessment of the ankle-brachial systolic blood pressure index, and, whenever necessary, duplex scanning. Three (5.7%) deaths occurred within 30 days, two from myocardial infarction and one from an undetermined cause. The 2-year cumulative success rate was 82.5 +/- 9.6% for primary patency, 84.6 +/- 8.9% for secondary patency, 90.1 +/- 7.3% for tertiary patency, 86.9 +/- 7.6% for limb salvage, 77.7 +/- 8.4% for survival, 68.0 +/- 11.1% for composite patency, and 68.4 +/- 9.3% for amputation-free survival; the corresponding estimates for vein grafts alone were 86.6 +/- 9.2%, 88.9 +/- 8.6%, 89.0 +/- 8.5%, 88.1 +/- 8.1%, 81.1 +/- 9.1, 76.8 +/- 11.1%, and 72.6 +/- 10.2%. Three prosthetic grafts failed and were replaced with an arm vein graft. Nonreversed vein bypass grafts in above-knee revascularization of critically ischemic limbs are justified.
    Annals of Vascular Surgery 07/2008; 22(5):668-75. · 0.99 Impact Factor
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    ABSTRACT: Percutaneous transluminal angioplasty has been used with increasing frequency in the treatment of infrainguinal arterial occlusive disease. This meta-analysis aimed to assess the middle-term outcomes after crural angioplasty in patients with chronic critical limb ischemia and compare results with a meta-analysis of popliteal-to-distal vein bypass graft. Data were retrieved from 30 articles published from 1990 through 2006 (63% of articles published between 2000 and 2006). All studies used survival analysis, reported a 12-month cumulative rate of patency or limb salvage, and included at least 15 infrapopliteal angioplasties. The outcome measures were immediate technical success, primary and secondary patency, limb salvage, and patient survival. Data from life-tables, survival curves, and texts were used. The pooled estimate of success was 89.0% +/- 2.2% for immediate technical result. Results at 1 and 36 months were 77.4% +/- 4.1% and 48.6% +/- 8.0% for primary patency, 83.3% +/- 1.4% and 62.9% +/- 11.0% for secondary patency, 93.4% +/- 2.3% and 82.4% +/- 3.4% for limb salvage, and 98.3% +/- 0.7% and 68.4% +/- 5.5% for patient survival, respectively. Studies with >75% of the limbs with tissue loss fared worse than their respective comparative subgroup for technical success and patency but not for limb salvage or survival. No publication bias was detected. The technical success and subsequent durability of crural angioplasty are limited compared with bypass surgery, but the clinical benefit is acceptable because limb salvage rates are equivalent to bypass surgery. Further studies are necessary to determine the proper role of infrapopliteal angioplasty.
    Journal of Vascular Surgery 05/2008; 47(5):975-981. · 2.88 Impact Factor
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    ABSTRACT: Nous avons évalué les greffes veineuses non inversées dans les pontages fémoro-poplités hauts pour ischémie critique chronique de membre dans une étude rétrospective avec une analyse en intention de traiter des malades ayant eu un pontage fémoro-poplité haut. Au cours d'une période de quatre ans, 51 malades (hommes 32; femmes 19; âge moyen 66 ans) ayant 53 membres inférieurs en ischémie critique ont eu un pontage fémoro-poplité haut. Le bilan lors du suivi a consisté en un examen clinique, la mesure de l'indice de pression systolique cheville-bras et, chaque fois que nécessaire, une échographie-Doppler. Trois décès (5,7%) sont survenus dans les 30 jours, deux d'infarctus du myocarde et un de cause indéterminée. Le taux cumulé de succès à deux ans a été de 82,5 ± 9,6% pour la perméabilité primaire, 84,6 ± 8,9% pour la perméabilité secondaire, 90,1 ± 7,3% pour la perméabilité tertiaire, 86,9 ± 7,6% pour le sauvetage de membre, 77,7 ± 8,4% pour la survie, 68,0 ± 11,1% pour la perméabilité compose et 68,4 ± 9,3% pour la survie sans amputation. L'estimation correspondante pour les seules greffes veineuses a été de 86,6 ± 9,2%, 88,9 ± 8,6%, 89,0 ± 8,5%, 88,1 ± 8,1%, 81,1 ± 9,1, 76,8 ± 11,1% et 72,6 ± 10,2%. Trois greffons prothétiques se sont thrombosés et ont été remplacés par des veines du membre supérieur. Les pontages veineux non inversés sont justifiés dans les revascularisations fémoro-poplitées hautes pour ischémie critique.
    Annales De Chirurgie Vasculaire. 01/2008; 22(5):725-732.
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    ABSTRACT: Evaluamos los injertos de vena no invertida en los bypass suprageniculares para tratar la isquemia crítica de las extremidades en un estudio retrospectivo, con un análisis por intención de tratar, en pacientes sometidos a bypass protésico supragenicular. Durante un período de 4 años, 51 pacientes (32 hombres; 19 mujeres; media de edad = 66 años) con 53 extremidades inferiores con isquemia crítica fueron sometidos a bypass protésico femoropoplíteo supragenicular. La evaluación durante el seguimiento consistió en un examen clínico, evaluación del índice tobillo-brazo, y, cuando fue necesario, eco-Doppler. Se produjeron 3 fallecimientos (5,7%) en 30 días, dos por un infarto de miocardio y uno por causa indeterminada. El porcentaje de éxito acumulativo a los 2 años fue del 82,5 ± 9,6% para la permeabilidad primaria, del 84,6 ± 8,9% para la secundaria, del 90,1 ± 7,3% para la terciaria, del 86,9 ± 7,6% para el salvamento de la extremidad, del 77,7 ± 8,4% para la supervivencia, del 68,0 ± 11,1% para la permeabilidad compuesta, y del 68,4 ± 9,3% para la supervivencia sin amputación; las estimaciones correspondientes para los injertos venosos fueron del 86,6 ± 9,2%, 88,9 ± 8,6%, 89,0 ± 8,5%, 88,1 ± 8,1%, 81,1 ± 9,1, 76,8 ± 11,1%, y del 72,6 ± 10,2%. Tres implantes protésicos fallaron y fueron sustituidos por un injerto venoso del brazo. Están justificados los bypass con injertos de vena no invertida en la revascularización supragenicular de las extremidades con isquemia crítica.
    Anales de Cirugía Vascular. 01/2008; 22(5).
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    ABSTRACT: Objective: The purpose of this survey was to evaluate how patients with peripheral obstructive arterial disease have been treated, concerning risk factors and comorbidities. Method: A questionnaire was applied to all physicians attending the monthly meeting of the Brazilian Society of Angiology and Vascular Surgery - São Paulo Section. Questions were asked about the following major risk factors: treatment of dyslipidemia, diabetes, exercise regimens, antiplatelet therapy, smoking and arterial hypertension. Results: Of the 102 questionnaires, 75 were answered (response rate of 73.5%). Of these, 82% routinely measure cholesterol levels and 20% aim at an LDL cholesterol target below 100 mg/dl; 94% perform a screening for diabetes mellitus; 97% recommend patients to an exercise program; 79% prescribe aspirin; 97% recommend patients to quit smoking and 60% only do it by counseling; 18% do not measure blood pressure and 19% have a target pressure of 130 x 80 mmHg. Considering the recommendations as a whole - lifestyle intervention in order to quit smoking, aerobic exercise, prescription of antiplatelet therapy, screening for diabetes mellitus, rigorous control of blood pressure and lipids - it was observed that 7% of interviewees follow all of them as an established routine. Conclusion: The present study showed that patients with peripheral arterial disease are currently undertreated with regard to the screening and treatment of risk factors and comorbidities.
    Jornal Vascular Brasileiro 01/2005; 4(3).