OBJECTIVES: To analyze angiotomographic parameters of juxtarenal aneurysms to assess the applicability of an endograft model to patients and to create in vitro and in vivo models to assess the new endograft. METHODS: A total of 49 patients with juxtarenal aneurysms were submitted to angiotomographic evaluation, and parameters such as the aortic diameter, the length of the neck, and the angulations of the celiac trunk, superior mesenteric artery and renal arteries; the distances between them; and anatomic variations were analyzed. Based on these parameters, an endograft model was developed and tested in a newly created in vitro model of juxtarenal aneurysm. An experimental model of juxtarenal aneurysm was then established in six pigs weighing 50-60 kg to assess the new endograft model. RESULTS: The angiotomographic parameters of juxtarenal aneurysm measured in this study were similar to those reported in the literature and allowed the development of an endograft based on the hourglass concept, which was applicable to 85.8% of the patients. The in vitro model of juxtarenal aneurysm evidenced good radiopacity and functionality and permitted adjustments in the new device and technical improvements in the procedures for treating these aneurysms. In addition, the porcine model of juxtarenal aneurysm was successfully created in all six animals using a bovine pericardial patch, and use of the new endograft in three pilot procedures evidenced its feasibility. CONCLUSIONS: The Hourglass endograft was rendered applicable to treatment of the majority of patients with juxtarenal aneurysms simply by changing its diameter. Moreover, the new in vitro and in vivo models were shown to be effective for assessing both the presented endograft and experiments assessing the endovascular treatment of juxtarenal aneurysms.

This systematic review focuses on the 30-day mortality associated with open surgery and fenestrated endografts for short-necked (<15 mm) juxtarenal abdominal aortic aneurysms. A search for studies published in English and indexed in the PubMed and Medline electronic databases from 2002 to 2012 was performed, using “juxtarenal abdominal aortic aneurysm” and “treatment” as the main keywords. Among the 110 potentially relevant studies that were initially identified, eight were in accordance with the inclusion criteria in the analysis. Similar outcomes for open and endovascular repair were observed for 30-day mortality. No differences were observed regarding the secondary outcomes (duration of surgery, hospital stay, postoperative renal dysfunction and late mortality), except that the late mortality rate was significantly higher for the patients treated with open repair after a median follow-up of 24 months. Fenestrated endografting is a viable alternative to conventional surgery in juxtarenal abdominal aortic aneurysms with a proximal neck <15 mm.

A dor pélvica crônica é um problema subdiagnosticado e relativamente comum nas mulheres. Alguns autores evidenciaram prevalência de até 15% entre mulheres de 18 a 50 anos, com repercussões sobre a qualidade de vida e sobre a economia. Dentre as causas de dor pélvica crônica, destaca-se a síndrome de congestão venosa pélvica, com quadro clínico caracterizado por diversos graus de dor, disúria, hematúria, dismenorréia, dispareunia e congestão vulvar, que pode ser acompanhado de varizes vulvares, descrito em 1949 por Taylor. Relatamos o caso de uma paciente portadora de dor pélvica crônica, na qual se diagnosticou o pinçamento da veia renal esquerda entre a aorta e a artéria mesentérica superior, com conseqüente quadro de hipertensão do plexo gonadal esquerdo, varizes pélvicas e sintomas de congestão pélvica. O tratamento realizado constou de embolização das varizes pélvicas, por método minimamente invasivo endovascular, com sucesso técnico e resolução dos sintomas em menos de 24 h.

Chronic pelvic pain is a problem at the same time common and underdiagnosed in women. Some literature reports show an incidence of up to 15% in women aged between 18-50 years, with impact over quality of life and economy. Among the causes of chronic pelvic pain, pelvic congestion syndrome stands out, characterized by pain, dysuria, hematuria, dysmenorrhea, dyspareunia and vulvar congestion, often accompanied by vulvar varices, described in 1949 by Taylor. We herein report a case of a patient with chronic pelvic pain in whom we diagnosed a nutcracker syndrome, characterized by stenosis of the left renal vein between the superior mesenteric artery and the aorta, with consequent status of left gonadal plexus hypertension, pelvic varices and symptoms of pelvic congestion. The treatment was varicose pelvic veins embolization, through a minimally invasive endovascular approach, with immediate technical and clinical success in less than 24 hours.

O aneurisma de artéria poplítea é relativamente raro, porém representa cerca de 85% de todos os aneurismas arteriais periféricos. Apresenta-se geralmente com um quadro de complicação isquêmica e elevado risco de perda do membro acometido. Em função disso, preconiza-se seu tratamento eletivo, atualmente realizado com resultados satisfatórios pela técnica endovascular. Relatamos nossa experiência com a utilização do stent de nitinol auto-expansível revestido com PTFEe - Fluency (Bard, Alemanha), reforçado internamente com o stent de nitinol auto-expansível Zilver (Cook, EUA) no tratamento de um aneurisma de artéria poplítea.

Popliteal artery aneurysm is relatively rare, but represents around 85% of all peripheral arterial aneurysms. It is usually presented with ischemic complication and high risk of limb loss. For that reason, its elective treatment is indicated and currently carried through with satisfactory results using endovascular techniques. We describe our experience with the use of an ePTFE-covered nitinol self-expandable stent graft - Fluency (Bard, Germany), reinforced internally with the nitinol self-expandable Zilver stent (Cook, USA) for the treatment of a popliteal artery aneurism.

Relatamos aqui um caso singular de complicação isquêmica, e também traumática, referente ao uso de dois novos dispositivos para utilização endovascular, ambos no mesmo paciente. Um é um dispositivo hemostático para selamento de punção (Angio-Seal®; - St. Jude Medical) e o outro, um cateter para trombectomia rotacional aspirativa percutânea (Rotarex®; - Straub Medical). Discutimos a indicação destes dispositivos em pacientes gravemente enfermos, com quadro de instabilidade hemodinâmica ou em estado de hipercoagulabilidade, associado à doença aterosclerótica femoral, por seu elevado potencial de complicações.

We describe a singular case of both ischemic and traumatic complication, referring to use of new devices used for endovascular approach, in the same patient. One is a hemostatic closure device (Angio-Seal®; - St. Jude Medical) and the other is a catheter for percutaneous rotational and aspiration thrombectomy (Rotarex®; - Straub Medical). We discuss indication to use these devices in severely ill patients, with hemodynamic instability, or in a state of hypercoagulability, associated with femoral atherosclerotic disease, due to its high potential of complications.

OBJETIVOS: Descrever a técnica de recanalização endovascular da artéria femoral superficial e fazer uma análise retrospectiva dos 3 primeiros anos da técnica. MÉTODOS: Análise retrospectiva dos pacientes tratados entre 2001 e 2004, visando obter as taxas de perviedade das recanalizações. A amostra considerada neste estudo consta de 79 artérias femorais superficiais recanalizadas em 61 pacientes, nos quais foram utilizados exclusivamente a técnica descrita e o mesmo modelo de stent de nitinol auto-expansível (Zilver, COOK). RESULTADOS: Dos 61 pacientes, 8% possuíam isquemia crítica de membro inferior e 92% apresentavam claudicação incapacitante refratária ao tratamento clínico. A melhora clínica foi observada e referida pelos pacientes numa relação direta à perviedade das recanalizações. A análise estatística demonstrou taxas acumuladas de perviedade primária assistida de 98, 91 e 84% em 12, 24 e 37 meses, respectivamente. As taxas de perviedade, entendida como fluxo continuado nas recanalizações, foram de 96, 93 e 93% em 12, 24 e 37 meses, respectivamente. CONCLUSÕES: Consideramos a técnica da recanalização da artéria femoral superficial um método ao mesmo tempo pouco invasivo, com reduzidas complicações e de consideráveis taxas de sucesso anatômico e perviedade, que, em conjunto, são capazes de proporcionar satisfação e qualidade de vida aos pacientes portadores de doença arterial obstrutiva periférica.

OBJECTIVES: To describe the endovascular recanalization technique of the superficial femoral artery and perform a 3-year retrospective analysis of the technique. METHODS: Retrospective analysis of the patients treated between 2001 and 2004, with the aim of obtaining the patency rates of the recanalizations. The sample consisted of 79 recanalized superficial femoral arteries in 61 patients, exclusively using the described technique and the same nitinol self-expanding stent model (Zilver, COOK). RESULTS: Of the 61 patients, 8% had critical lower limb ischemia and 92% had incapacitating claudication refractory to the clinical treatment. Clinical improvement was observed and reported by the patients in a direct correlation with the recanalization patency. The statistical analysis showed accumulated assisted primary patency rates of 98, 91 and 84% in 12, 24 and 37 months, respectively. The patency rates, considered as the continuous flow in the treated area, were 96, 93 and 93% in 12, 24 and 37 months, respectively. CONCLUSIONS: We consider the recanalization technique of the superficial femoral artery a less invasive method, with few complications and considerable anatomic success and patency rates, which are able of promoting satisfaction and quality of life to patients with peripheral obstructive arterial disease.