Publications by authors named "Juliana Varino"

5 Publications

  • Page 1 of 1

[The Impact of Patient Transfer After Rupture of an Abdominal Aortic Aneurysm].

Rev Port Cir Cardiotorac Vasc 2019 Oct-Dec;26(4):273-277

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

Objective: determine whether patient transfer adversely affects the survival of ruptured abdominal aortic aneurysm (rAAA) patients after conventional surgery.

Methods: We performed a retrospective review of all patients undergoing attempted repair of an rAAA at a tertiary center, over January 2008 and December 2014. Patients were divided into those presenting directly to our center and those transferred from another hospital. The main outcome variable was 24-hour or 30-day mortality, with secondary variables including time to surgical treatment, length of intensive care unit stay and total length hospitalization.

Results: 78 patients (88% men) underwent attempted open repair of an rAAA during this period, 69% (54 cases) were transferred from another institution. Both groups were similar in terms of demographic characteristics, comorbidities and hemodynamic stability. The overall mortality rate was 51% at 30 days. Transferred patients took twice as long as direct patients to get to the operating room (median 7,9 vs. 3,9 horas, p < 0,05), Although the difference for surgery treatment, there was no difference in 24-hour and 30-day mortality between the transferred group and direct group (26% e 50% vs. 29% e 58%, p < 0,05). Mean intensive care unit stay (median, 12 vs. 4 dias, p = 0,04) and total hospitalization (median 11 vs. 4 dias, p = 0,04) were sustantially superior in the transferred group.

Conclusions: Transfer of patients with RAAA in this series results in a doubling of the time interval between initial patient presentation and arrival in the operating room. This, however, did not result in any disadvantage in the survival rate between the groups. The total length and resources consumption were higher in the transfer group. These results may be attributed to a pre-selection of patients (clinically stable) who are able to tolerate such a delay in surgical treatment, secondary to transfer.
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March 2020

[Aortic mural thrombus].

Rev Port Cir Cardiotorac Vasc 2019 Jan-Mar;26(1):19-26

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

Aortic mural thrombus is a rare clinical finding in the absence of aneurysm or atherosclerosis but an important source of noncardiogenic emboli with a difficult diagnosis and a high rate of complications, including high mortality. It appears to occur more frequently in young adults usually with underlying pro-thrombotic disorder. With the increasing use of high resolution imaging, the asymptomatic mural thrombus became an increasingly frequent finding, but its potential for embolization or the best treatment are still a matter of debate. The management of mural thrombus in non-atherosclerotic aorta represents a challenge because no guidelines are available, and should be individualized. The therapeutic approach should include the triple aspects of aortic mural thrombus: primary disease anticoagulation treatment, surgical thrombectomy to solve embolic complications and endovascular/classical surgery to exclude the thrombus from the aorta. Historically therapeutic anticoagulation was proposed as first-line therapy and surgical intervention was reserved for mobile thrombus, recurrent embolism and contraindication for anticoagulation. However, it is associated with a 25-50% embolic recurrence rate, thrombus persistence in 35% and secondary aortic surgery in up to 31% of the cases. Recent data suggest that endovascular coverage of the aortic thrombus, when feasible, appears to be an effective and safe procedure with a low recurrence and re-embolization rates. In this article we review the published literature concerning this topic.
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September 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

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