Publications by authors named "André Marinho"

9 Publications

  • Page 1 of 1

Vascular training does matter in the outcomes of saphenous high ligation and stripping.

J Vasc Surg Venous Lymphat Disord 2019 09 5;7(5):732-738. Epub 2019 May 5.

Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar São João, Porto, Portugal; Centro de Investigação e Tecnologia de Informação em Sistemas de Saúde (CINTESIS) e Departamento de Ciências da Informação e da Decisão em Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.

Objective: Varicose vein (VV) surgery is frequently performed by surgeons without formal vascular training. We aimed to compare the outcomes of the procedure based on the background of the surgeon.

Methods: All patients registered with VV surgery between 2004 and 2016 in Portuguese public hospitals were included in the study. Intrahospital outcomes were assessed from this administrative database. A random multicenter sample of 315 patients submitted to saphenous high ligation and stripping (175 patients from six vascular surgery departments and 140 patients from five general surgery divisions) were further queried over the phone, whereby additional nonregistered outcomes were evaluated: preoperative venous ultrasound, impact on quality of life by the 14-item Chronic Venous Insufficiency Quality of Life Questionnaire, visual analogue scale evaluation (score of 1 to 5) of the aesthetic results and general satisfaction, work absence days, and time to return to physical activities.

Results: In 13 years, there were 153,382 patients submitted to VV surgery. Of these, 49% were operated on by general surgeons and 40% by vascular surgeons; in 11%, it was not possible to identify the specialty performing the operation. Twenty-three deaths were registered (no differences between groups). In the general surgery group, 14% of patients were hospitalized for more than one night compared with 3% in the vascular group (P < .001). Reintervention rate during the period analyzed was significantly higher in the general surgery group (13.5% vs 8.2%; P < .001). Rate of outpatient surgery was higher in the vascular surgery group (60% vs 36%; P < .001). Phone query revealed similar overall satisfaction and improvement in quality of life in both groups (4.2 vs 4.0 [P = .275] and 35% vs 36% [P = .745], respectively). However, patients operated on by general surgeons reported worse surgical scars (2.8 vs 2.1; P = .007), higher number of residual VVs (2.4 vs 1.7; P = .006), and higher number of days absent from work (40 vs 27 days; P = .005) and took longer to resume physical activities (60 vs 41 days; P = .001).

Conclusions: Despite that the majority of VV surgery in Portugal is executed by general surgeons, this study highlights important advantages when it is performed by surgeons with vascular training.
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http://dx.doi.org/10.1016/j.jvsv.2019.01.060DOI Listing
September 2019

Analysis of the efficiency of an emergency network for the treatment of multiple burn victims.

Rev Col Bras Cir 2019 18;46(2):e2115. Epub 2019 Apr 18.

Harvard Medical School, Program in Global Surgery and Social Change, Boston, Massachusetts, Estados Unidos da América.

Objective: to evaluate the effectiveness of the adopted strategy and the care quality for pediatric trauma in the survival of patients attended after a disaster in a city in the interior of Minas Gerais state, compared to the expected results of studies on infant mortality in major burns.

Methods: retrospective observational analysis of ten patients who were burned and transferred to a trauma reference center. We used the modified R-Baux score to estimate the expected mortality. We compared the expected mortality predicted by R-Baux score and the actual mortality determined from one-ratio test. We also compared time of post-trauma admission with mortality and burned body surface area with mortality.

Results: mean R-Baux score was 75.2, which means an expected mortality of 5% among major burn patients. However, in this study, mortality in the group of children with large burned body surface area was of 60%, p=0.001, a rate far beyond that expected in literature.

Conclusion: despite the innumerable variables, we consider the hypothesis of the pediatric trauma care infrastructure being inferior than the one needed in the state. This study suggests a greater incentive for public policies concerning pediatric trauma care, prepared referral center, well-established transfer agreements, and optimization of catastrophe plans, in order to reduce morbimortality of patients who survive the first hour after trauma.
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http://dx.doi.org/10.1590/0100-6991e-20192115DOI Listing
June 2019

[Aneurysmal disease - a multifocal pathology with regard to a clinical case.]

Rev Port Cir Cardiotorac Vasc 2018 Jul-Dec;25(3-4):141-144

Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário de Coimbra, Portugal.

Introduction: True para-anastomotic aneurysms are a rare complication of arterial surgery.

Objective: This paper aims to describe the clinical case of a 73 years-old patient, with history of a left above-the- -knee amputation due to an occluded popliteal aneurysm, admitted for surgical treatment of a contralateral popliteal aneurysm.

Results: A bypass between the right distal superficial femoral artery (SFA) and the distal popliteal artery was performed using autologous vein. Two years after the index surgery, aneurysmatic degeneration of the native artery was found on ultrasound, with 1.7 cm at the proximal anastomosis, and 1.4 cm distally. We kept surveillance, however, 12 years after surgery, he had a proximal true para-anastomotic aneurysm of the SFA with 4.8 cm. So, resection with interposition of a prosthetic graft between the native artery and the venous conduit of the previous bypass was performed. At this time the popliteal artery at the distal anastomosis had, approximately, 1.8 cm, so we chose to remain vigilant. Seventeen years after surgery, it measured 3.2 cm, in computed tomographic angiography. Therefore, total aneurysmectomy was performed and, due to redundancy of the previous bypass venous conduit caused by progressive dilation restricted to the distal popliteal artery, we did a termino-terminal reanastomosis to the normal sized popliteal artery. After 20 months, he is asymptomatic, with distal pulses present, without clinical nor radiological signs of aneurysmal degeneration.

Discussion And Conclusion: This work aims to highlight the relevance of the follow up, not only on a clinical basis but also radiological, since we are dealing with a diffuse pathology that can appear in any arterial segment without symptoms.
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July 2019

[Brachial artery aneurysm - a rare cause of acute ischemia].

Rev Port Cir Cardiotorac Vasc 2018 Jan-Jun;25(1-2):105-106

Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário de Coimbra, Portugal.

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July 2019

True Brachial Artery Aneurysm in a Patient with Vascular Access for Haemodialysis and Kidney Graft.

Rev Port Cir Cardiotorac Vasc 2017 Jul-Dec;24(3-4):184

Serviço de Angiologia e Cirurgia Vascular do Centro Hospitalar e Universitário de Coimbra, Portugal.

Introduction: True brachial artery aneurysms are rare and some of them have been described as a late complication in patients with vascular access for haemodialysis and kidney graft. The purpose of this paper is to present a clinical case of a patient with a true brachial artery aneurysm and its following treatment.

Methods: This case concerns a caucasian male patient with 43 years old who had vesicoureteral reflux at 7 years old, and subsequent end-stage renal disease, and started on haemodialysis at the age of twelve. The patient had homolateral radial and brachiocephalic arteriovenous fistulas (AVF), two sequential kidney grafts and was under immunosuppressant therapy for several years. As part of the medical history he also had bilateral amaurosis, Hepatitis B and C and was submitted to total parathyroidectomy and a following auto-transplant. In the latest years the patient presented with several aneurysms related to the vascular access. After the finding of an anastomotic false aneurysm and venous aneurysms complicating the AVF, the patient had removal of the aneurysms and ligation of the AVF. Later, he was diagnosed, in different times, with two true brachial artery aneurysms. At the time of the diagnosis of the first true aneurysm, the patient presented with local pain and occasional paraesthesias relative to compression symptoms. At physical examination the patient had a brachial pulsatile mass and a palpable radial pulse. The Doppler ultrasound exam revealed a true brachial artery aneurysm with 4,5 cm diameter. After two years, the patient was once again diagnosed with a true brachial artery aneurysm with 3,1 cm diameter. At this time the patient was asymptomatic and had palpable brachial mass and radial pulse.

Results: At the time of the diagnosis of the first true brachial aneurysm the patient was submitted to partial aneurysmectomy and brachiobrachial graft with PTFE 8. The patency of the graft persisted until the diagnosis of the second aneurysm. After two years, the patient was submitted to partial aneurysmectomy and axilobrachial graft with PTFE 8. During the follow-up period, the patient remained asymptomatic, had palpable radial pulse and the Doppler ultrasound exam confirmed the patency of the graft.

Conclusion: The surveillance of patients with long duration AVF and kidney grafts might be advantageous in the early detection of arterial aneurysms. The surgical treatment in this group of patients is a first treatment option that is associated to a low morbidity.
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May 2019

Abdominal Aortic Aneurysm in Women: Retrospective Analysis of the Cases that Undergo Surgical Repair.

Rev Port Cir Cardiotorac Vasc 2017 Jul-Dec;24(3-4):150

CHUC, Portugal.

Introduction: The prevalence of infra-renal aortic abdominal aneurysms (AAA) is about 3 to 4 times higher in men, with a recommendation I 1a for screening men > 65y. Althoug women only represente 20% of the total AAAs they have a significant higher rupture rate - threefold higher - and a worse outcome after ruptured AAA repair. Screening is not consensual but can be recommended for women > 65y who have smoked or have a family history of AAA. Against screening is the fact that the AAA in women have not only a lower incidence but also a late presentation (>80y) but references have been made to the fact that smoking became popular more than 30 years after than men and so the effects just now can start to be seen.

Methods: A retrospective review was made to all women with an infra- renal AAA who undergo a surgical treatment, elective or urgent, in the past 7 years (January 2010 - August 2017) in our hospital. Information was obtained through the clinical process. It was made an evaluation of the demographic information and anatomic features.

Results: 15 cases were reviewed, 4 elective and 11 ruptured surgical repairs. The mean age was 74 and only 4 women were more than 80 years old, with a minium age of 57. More than half the patients were previously diagnosis with hypertension but only 30% had high cholesterol. Only one was a known smoker. None had a diagnosis of cardiac disease. One had a sintomatic cerebrovascular disease. Within the elective cases, all open repair, the intra-hospitalar mortality was zero with a mean stay of 7,5 days. The ruptured cases, 1 endovascular, had a perioperative mortality of 50% The mean aortic diametre at rupture was less than 6 cm.

Conclusion: Data supports the evidence of the morbidity of a ruptured AAA and the high intra-hospitalar mortality in women. Early detection and elective repair should be considered. Sex-specific research is needed to provide the best medical treatment.
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May 2019

[Cystic adventitial disease of the popliteal artery].

Rev Port Cir Cardiotorac Vasc 2016 Jul-Dec;23(3-4):171-173

Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário de Coimbra, Portugal.

Although rare, popliteal artery cystic adventitial disease (CAD) is one of the most common non-atheromatous causes of intermittent claudication. This work aims to describe the clinical case of a 50 years old male patient with symptomatic popliteal artery CAD, presenting with calf intermittent claudication for long distances on flat but 50m in ascending plane, which affected his life quality. On examination he presented with normal coloration and temperature of the lower extremities, with distal pulses present at rest. By flexing the right knee, he lost distal pulses. On ultrasound was found a cystic formation surrounding the right popliteal artery, so a MRI was done and confirmed the presence of an adventitial cystic surrounding about 50% of the artery at the popliteal fossa with 31x13x17mm. He underwent surgery with a posterior approach followed by cyst removal, preservating the media of the artery, and ligation of a ductus that seemed to extent from the articular capsule. At the fourth post-operative day he was discharged and remained without symptoms nor recurrence during the follow up. The CAD usually affects the popliteal artery (85%). It's more common in men with 35-40 years and the prevalence is estimated at 1/1200 claudicants. The symptoms are caused, usually, by extrinsic compression of the artery. Ultrasound, today, is the first line exam, and might be complemented with others to confirm the diagnosis and plan the treatment. The surgical treatment may vary from drainage to segmental arterial resection in case of significant degeneration. The prognostic is usually favorable.
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December 2016

Popliteal artery aneurysm surgical repair: Retrospective unicenter analysis.

Rev Port Cir Cardiotorac Vasc 2015 Jul-Sep;22(3):161-166

Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar e Universitário de Coimbra, Portugal.

Background: Popliteal artery aneurysm (PAA) thromboembolic complications may result in limb loss. We review our experience reporting outcomes in terms of complications and early and long-term patency rates.

Methods: From 2004 to 2013, 116 PAA required surgical repair at Coimbra Hospital and Universitary Centre, Portugal. Outcomes were analyzed using Kaplan-Meier method with log-rank tests, X2, and Cox proportional hazards models.

Results: A total of 116 PAAs with a mean diameter of 3.3 cm (1.5 to 10 cm) were followed. 40% limbs were asymptomatic and 27% presented with acute ischemia. 97% underwent medial bypass procedure (venous in 66%). Early mortality was 0.9% (1/116). 30-day and five-year cumulative limb salvage was 94.0% and 87%, respectively. There was no limb loss in asymptomatic patients and 1-3 Rutherford chronic ischemia. 62% early amputations were performed in acute ischemia, half of them with functioning bypass. 30-day primary and secondary patency rates were 91% and 97% respectively, higher with GSVs (96% and 99%) than PTFE (58% and 95%, P < .05; Fig 1). The 5-year primary and secondary patency rates were 68.1% and 73,5%, respectively, higher with GSVs (83% and 87%) than PTFE (37% and 43%, P < .05). Two recurrent PAAs (1,7%) required reintervention. Predictors for both amputation and loss of primary patency were PTFE bypass (p =0,002), and emergent surgery (p = 0,005). Acute ischemia was also predictor for amputation (p = 0,026), but not for loss of primary patency.

Conclusions: Results of surgery on asymptomatic PAAs are good - significantly better than those from symptomatic PAAs. The results are similarly good in claudicants. The risks of early and late amputation were higher with prosthetic grafts and in an emergent settings.
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July 2015

[Dysphagia lusoria - a clinical report].

Rev Port Cir Cardiotorac Vasc 2013 Jul-Sep;20(3):163-5

Serviço de Angiologia e Cirurgia Vascular do Centro Hospitalar e Universitário de Coimbra, Portugal.

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June 2015
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