Publications by authors named "Vladimir Vasconcelos"

11 Publications

  • Page 1 of 1

Effectiveness and safety of structured exercise vs. no exercise for asymptomatic aortic aneurysm: systematic review and meta-analysis.

J Vasc Bras 2020 May 8;19:e20190086. Epub 2020 May 8.

Universidade Federal de São Paulo - UNIFESP, Departamento de Medicina, São Paulo, SP, Brasil.

We conducted a systematic review to compare the effectiveness and safety of exercise versus no exercise for patients with asymptomatic aortic aneurysm. We followed the guidelines set out in the Cochrane systematic review handbook. We searched Medline, Embase, CENTRAL, LILACS, PeDRO, CINAHL, clinicaltrials.gov, ICTRP, and OpenGrey using the MeSH terms "aortic aneurysm" and "exercise". 1189 references were identified. Five clinical trials were included. No exercise-related deaths or aortic ruptures occurred in these trials. Exercise did not reduce the aneurysm expansion rate at 12 weeks to 12 months (mean difference [MD], -0.05; 95% confidence interval [CI], -0.13 to 0.03). Six weeks of preoperative exercise reduced severe renal and cardiac complications (risk ratio, 0.54; 95% CI, 0.31-0.93) and the length of intensive care unit stay (MD, -1.00; 95% CI, -1.26 to -0.74). Preoperative and postoperative forward walking reduced the length of hospital stay (MD, -0.69; 95% CI, -1.24 to -0.14). The evidence was graded as 'very low' level.
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http://dx.doi.org/10.1590/1677-5449.190086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202166PMC
May 2020

Treatments for unruptured intracranial aneurysms.

Cochrane Database Syst Rev 2021 May 10;5:CD013312. Epub 2021 May 10.

Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil.

Background: Unruptured intracranial aneurysms are relatively common lesions in the general population, with a prevalence of 3.2%, and are being diagnosed with greater frequency as non-invasive techniques for imaging of intracranial vessels have become increasingly available and used. If not treated, an intracranial aneurysm can be catastrophic. Morbidity and mortality in aneurysmal subarachnoid hemorrhage are substantial: in people with subarachnoid hemorrhage, 12% die immediately, more than 30% die within one month, 25% to 50% die within six months, and 30% of survivors remain dependent. However, most intracranial aneurysms do not bleed, and the best treatment approach is still a matter of debate.

Objectives: To assess the risks and benefits of interventions for people with unruptured intracranial aneurysms.

Search Methods: We searched CENTRAL (Cochrane Library 2020, Issue 5), MEDLINE Ovid, Embase Ovid, and Latin American and Caribbean Health Science Information database (LILACS). We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform from inception to 25 May 2020. There were no language restrictions. We contacted experts in the field to identify further studies and unpublished trials.

Selection Criteria: Unconfounded, truly randomized trials comparing conservative treatment versus interventional treatments (microsurgical clipping or endovascular coiling) and microsurgical clipping versus endovascular coiling for individuals with unruptured intracranial aneurysms.

Data Collection And Analysis: Two review authors independently selected trials for inclusion according to the above criteria, assessed trial quality and risk of bias, performed data extraction, and applied the GRADE approach to the evidence. We used an intention-to-treat analysis strategy.

Main Results: We included two trials in the review: one prospective randomized trial involving 80 participants that compared conservative treatment to endovascular coiling, and one randomized controlled trial involving 136 participants that compared microsurgical clipping to endovascular coiling for unruptured intracranial aneurysms. There was no difference in outcome events between conservative treatment and endovascular coiling groups. New perioperative neurological deficits were more common in participants treated surgically (16/65, 24.6%; 15.8% to 36.3%) versus 7/69 (10.1%; 5.0% to 19.5%); odds ratio (OR) 2.87 (95% confidence interval (CI) 1.02 to 8.93; P = 0.038). Hospitalization for more than five days was more common in surgical participants (30/65, 46.2%; 34.6% to 58.1%) versus 6/69 (8.7%; 4.0% to 17.7%); OR 8.85 (95% CI 3.22 to 28.59; P < 0.001). Clinical follow-up to one year showed 1/48 clipped versus 1/58 coiled participants had died, and 1/48 clipped versus 1/58 coiled participants had become disabled (modified Rankin Scale > 2). All the evidence is of very low quality.

Authors' Conclusions: There is currently insufficient good-quality evidence to support either conservative treatment or interventional treatments (microsurgical clipping or endovascular coiling) for individuals with unruptured intracranial aneurysms. Further randomized trials are required to establish if surgery is a better option than conservative management, and if so, which surgical approach is preferred for which patients. Future studies should include consideration of important characteristics such as participant age, gender, aneurysm size, aneurysm location (anterior circulation and posterior circulation), grade of ischemia (major stroke), and duration of hospitalizations.
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http://dx.doi.org/10.1002/14651858.CD013312.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8109849PMC
May 2021

Peripherally inserted central catheter versus central venous catheter for intravenous access: A protocol for systematic review and meta-analysis.

Medicine (Baltimore) 2020 Jul;99(30):e20352

Division of Vascular and Endovascular Surgery, Department of Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo-SP, Brazil.

Background: Since the first description of the central venous catheter (CVC) in 1952, it has been used for the rapid administration of drugs, chemotherapy, as a route for nutritional support, blood components, monitoring patients, or combinations of these. When CVC is used in the traditional routes (eg, subclavian, jugular, and femoral veins), the complication rates range up to 15% and are mainly due to mechanical dysfunction, infection, and thrombosis. The peripherally inserted central catheter (PICC) is an alternative option for CVC access. However, the clinical evidence for PICC compared to CVC is still under discussion. In this setting, this systematic review (SR) aims to assess the effects of PICC compared to CVC for intravenous access.

Methods: We will perform a comprehensive search for randomised controlled trials (RCTs), which compare PICC and traditional CVC for intravenous access. The search strategy will consider free text terms and controlled vocabulary (eg, MeSH and Entree) related to "peripherally inserted central venous catheter," "central venous access," "central venous catheter," "catheterisation, peripheral," "vascular access devices," "infusions, intravenous," "administration, intravenous," and "injections, intravenous." Searches will be carried out in these databases: MEDLINE (via PubMed), EMBASE (via Elsevier), Cochrane CENTRAL (via Wiley), IBECS, and LILACS (both via Virtual Health Library). We will consider catheter-related deep venous thrombosis and overall successful insertion rates as primary outcomes and haematoma, venous thromboembolism, reintervention derived from catheter dysfunction, catheter-related infections, and quality of life as secondary outcomes. Where results are not appropriate for a meta-analysis using RevMan 5 software (eg, if the data have considerable heterogeneity and are drawn from different comparisons), a descriptive analysis will be performed.

Results: Our SR will be conducted according to the Cochrane Handbook of Systematic Reviews of Interventions and the findings will be reported in compliance with PRISMA.

Conclusion: Our study will provide evidence for the effects of PICC versus CVC for venous access.

Ethics And Dissemination: This SR has obtained formal ethical approval and was prospectively registered in Open Science Framework. The findings of this SR will be disseminated through peer-reviewed publications or conference presentations. REGISTRATION:: osf.io/xvhzf.

Ethical Approval: 69003717.2.0000.5505.
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http://dx.doi.org/10.1097/MD.0000000000020352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386962PMC
July 2020

Internal iliac artery revascularisation versus internal iliac artery occlusion for endovascular treatment of aorto-iliac aneurysms.

Cochrane Database Syst Rev 2020 07 21;7:CD013168. Epub 2020 Jul 21.

Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil.

Background: Endovascular aortic aneurysm repair (EVAR) is used to treat aorto-iliac and isolated iliac aneurysms in selected patients, and prospective studies have shown advantages compared with open surgical repair, mainly in the first years of follow-up. Although this technique produces good results, anatomic issues (such as common iliac artery ectasia or an aneurysm that involves the iliac bifurcation) can make EVAR more complex and challenging and can lead to an inadequate distal seal zone for the stent-graft. Inadequate distal fixation in the common iliac arteries can lead to a type Ib endoleak. To avoid this complication, one of the most commonly used techniques is unilateral or bilateral internal iliac artery occlusion and extension of the iliac limb stent-graft to the external iliac arteries with or without embolisation of the internal iliac artery. However, this occlusion is not without harm and is associated with ischaemic complications in the pelvic territory such as buttock claudication, sexual dysfunction, ischaemic colitis, gluteal necrosis, and spinal cord injury. New endovascular devices and alternative techniques such as iliac branch devices and the sandwich technique have been described to maintain pelvic perfusion and decrease complications, achieving revascularisation of the internal iliac arteries in patients not suitable for an adequate seal zone in the common iliac arteries. These approaches may also preserve the quality of life of treated individuals and may decrease other serious complications including spinal cord ischaemia, ischaemic colitis, and gluteal necrosis, thereby decreasing the morbidity and mortality of EVAR.

Objectives: To assess the effects of internal iliac artery revascularisation versus internal iliac artery occlusion during endovascular repair of aorto-iliac aneurysms and isolated iliac aneurysms involving the iliac bifurcation.

Search Methods: The Cochrane Vascular Information Specialists searched the Cochrane Vascular Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 28 August 2019. The review authors searched Latin American Caribbean Health Sciences Literature (LILACS) and the Indice Bibliográfico Español de Ciencias de la Salud (IBECS) on 28 August 2019 and contacted specialists in the field and manufacturers to identify relevant studies.

Selection Criteria: We planned to include all randomised controlled trials (RCTs) that compared internal iliac artery revascularisation with internal iliac artery occlusion for patients undergoing endovascular treatment of aorto-iliac aneurysms and isolated iliac aneurysms involving the iliac bifurcation.

Data Collection And Analysis: Two review authors independently assessed identified studies for potential inclusion in the review. We used standard methodological procedures in accordance with the Cochrane Handbook for Systematic Review of Interventions.

Main Results: We identified no RCTs that met the inclusion criteria.

Authors' Conclusions: We found no RCTs that compared internal iliac artery revascularisation versus internal iliac artery occlusion for endovascular treatment of aorto-iliac aneurysms and isolated iliac aneurysms involving the iliac bifurcation. High-quality studies that evaluate the best strategy for managing endovascular repair of aorto-iliac aneurysms with inadequate distal seal zones in the common iliac artery are needed.
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http://dx.doi.org/10.1002/14651858.CD013168.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7389186PMC
July 2020

Angioplasty and stenting for below the knee ulcers in diabetic patients: protocol for a systematic review.

Syst Rev 2018 12 11;7(1):228. Epub 2018 Dec 11.

Division of Vascular and Endovascular Surgery, Department of Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Borges Lagoa 754, São Paulo, 04038-001, SP, Brazil.

Background: The worldwide incidence and prevalence of diabetes mellitus (DM) are increasing. DM has a high social and economic burden due to its complications and associated disorders. Peripheral arterial disease (PAD) is closely related to DM. More than 85% of patients with DM will develop PAD in their lifetime, and between 10 and 25% of patients with DM will have a foot ulcer. In such cases, it is important to determine for each patient whether it is necessary and feasible to revascularise the affected limb as well as the optimal technique. Percutaneous transluminal angioplasty (PTA) is designed to restore blood flow through the vessel lumen by various devices including balloons, drug-coated balloons, bare stents, drug-eluting stents and endovascular atherectomes. This systematic review aims to evaluate the effects of PTA in the treatment of lower limb arterial ulcers in diabetic patients.

Methods: We will search randomised controlled trials (RCTs) and quasi-RCTs in the following databases (e.g., MEDLINE via PubMed, EMBASE, Lilacs, Cochrane Central Register of Controlled Trials, Ibecs, CINAHL, AMED, World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov , and OpenGrey). Our search strategy will use the following free-text terms and controlled vocabulary (e.g., Emtree, MeSH) for 'foot ulcer', 'leg ulcer', 'diabetic foot', 'Peripheral Arterial Disease', 'Diabetes Complications', 'Peripheral Vascular Diseases', 'critical limb ischemia', 'below the knee ulcer', 'angioplasty', 'stents', 'stenting', and 'endovascular procedures'. There will be no limits on date or language of publication. Two authors will, independently, select studies and assess the data from them. Risks of bias (RoB) of included studies will be evaluated using the Cochrane's RoB tool. If possible, we will perform and report structured summaries of the included studies and meta-analyses. Results are not available as this is a protocol for a systematic review, and we are currently in the phase of building a sensitive search strategy.

Discussion: While there are several available endovascular techniques for revascularisation, it is unclear which technique has better outcomes for ulcers below the knee in diabetic patients. A systematic review is required to validate and demonstrate these techniques and their outcomes to allow an evidence-based clinical decision.

Systematic Review Registration: PROSPERO CRD42017065171.
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http://dx.doi.org/10.1186/s13643-018-0897-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6290534PMC
December 2018

Re: "Systematic Review and Meta-Analysis of Very Urgent Carotid Intervention for Symptomatic Carotid Disease".

Eur J Vasc Endovasc Surg 2019 05 30;57(5):744. Epub 2018 Nov 30.

Department of Vascular Surgery, Federal University of São Paulo, São Paulo, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.ejvs.2018.10.033DOI Listing
May 2019

Immediate versus delayed treatment for recently symptomatic carotid artery stenosis.

Sao Paulo Med J 2016 Nov-Dec;134(6):557

Background:: The timing of surgery for recently symptomatic carotid artery stenosis remains controversial. Early cerebral revascularization may prevent a disabling or fatal ischemic recurrence, but it may also increase the risk of hemorrhagic transformation, or of dislodging a thrombus. This review examined the randomized controlled evidence that addressed whether the increased risk of recurrent events outweighed the increased benefit of an earlier intervention.

Objectives:: To assess the risks and benefits of performing very early cerebral revascularization (within two days) compared with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis.

Methods:: Search methods: We searched the Cochrane Stroke Group Trials Register in January 2016, the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, issue 1), MEDLINE (1948 to 26 January 2016), EMBASE (1974 to 26 January 2016), LILACS (1982 to 26 January 2016), and trial registers (from inception to 26 January 2016). We also handsearched conference proceedings and journals, and searched reference lists. There were no language restrictions. We contacted colleagues and pharmaceutical companies to identify further studies and unpublished trials Selection criteria: All completed, truly randomized trials (RCT) that compared very early cerebral revascularization (within two days) with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis.Data collection and analysis: We independently selected trials for inclusion according to the above criteria, assessed risk of bias for each trial, and performed data extraction. We utilized an intention-to-treat analysis strategy.

Main Results:: We identified one RCT that involved 40 participants, and addressed the timing of surgery for people with recently symptomatic carotid artery stenosis. It compared very early surgery with surgery performed after 14 days of the last symptomatic event. The overall quality of the evidence was very low, due to the small number of participants from only one trial, and missing outcome data. We found no statistically significant difference between the effects of very early or delayed surgery in reducing the combined risk of stroke and death within 30 days of surgery (risk ratio (RR) 3.32; confidence interval (CI) 0.38 to 29.23; very low-quality evidence), or the combined risk of perioperative death and stroke (RR 0.47; CI 0.14 to 1.58; very low-quality evidence). To date, no results are available to confirm the optimal timing for surgery.

Authors Conclusions:: There is currently no high-quality evidence available to support either very early or delayed cerebral revascularization after a recent ischemic stroke. Hence, further randomized trials to identify which patients should undergo very urgent revascularization are needed. Future studies should stratify participants by age group, sex, grade of ischemia, and degree of stenosis. Currently, there is one ongoing RCT that is examining the timing of cerebral revascularization.
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http://dx.doi.org/10.1590/1516-3180.20161346T2DOI Listing
October 2017

Immediate versus delayed treatment for recently symptomatic carotid artery stenosis.

Cochrane Database Syst Rev 2016 Sep 9;9:CD011401. Epub 2016 Sep 9.

Department of Vascular Surgery, Universidade Federal de São Paulo, Rua Borges Lagoa, 754, São Paulo, Brazil, 04038-001.

Background: The timing of surgery for recently symptomatic carotid artery stenosis remains controversial. Early cerebral revascularization may prevent a disabling or fatal ischemic recurrence, but it may also increase the risk of hemorrhagic transformation, or of dislodging a thrombus. This review examined the randomized controlled evidence that addressed whether the increased risk of recurrent events outweighed the increased benefit of an earlier intervention.

Objectives: To assess the risks and benefits of performing very early cerebral revascularization (within two days) compared with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis.

Search Methods: We searched the Cochrane Stroke Group Trials Register in January 2016, the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, Issue 1), MEDLINE (1948 to 26 January 2016), EMBASE (1974 to 26 January 2016), LILACS (1982 to 26 January 2016), and trial registers (from inception to 26 January 2016). We also handsearched conference proceedings and journals, and searched reference lists. There were no language restrictions. We contacted colleagues and pharmaceutical companies to identify further studies and unpublished trials.

Selection Criteria: All completed, truly randomized trials (RCT) that compared very early cerebral revascularization (within two days) with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis.

Data Collection And Analysis: We independently selected trials for inclusion according to the above criteria, assessed risk of bias for each trial, and performed data extraction. We utilized an intention-to-treat analysis strategy.

Main Results: We identified one RCT that involved 40 participants, and addressed the timing of surgery for people with recently symptomatic carotid artery stenosis. It compared very early surgery with surgery performed after 14 days of the last symptomatic event. The overall quality of the evidence was very low, due to the small number of participants from only one trial, and missing outcome data. We found no statistically significant difference between the effects of very early or delayed surgery in reducing the combined risk of stroke and death within 30 days of surgery (risk ratio (RR) 3.32; confidence interval (CI) 0.38 to 29.23; very low-quality evidence), or the combined risk of perioperative death and stroke (RR 0.47; CI 0.14 to 1.58; very low-quality evidence). To date, no results are available to confirm the optimal timing for surgery.

Authors' Conclusions: There is currently no high-quality evidence available to support either very early or delayed cerebral revascularization after a recent ischemic stroke. Hence, further randomized trials to identify which patients should undergo very urgent revascularization are needed. Future studies should stratify participants by age group, sex, grade of ischemia, and degree of stenosis. Currently, there is one ongoing RCT that is examining the timing of cerebral revascularization.
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http://dx.doi.org/10.1002/14651858.CD011401.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457772PMC
September 2016

Long-segment thoracoabdominal aortic coarctation in a child with Down syndrome.

J Vasc Surg Cases 2015 Jun 19;1(2):171-173. Epub 2015 Jun 19.

Department of Vascular Surgery, Federal University of São Paulo, São Paulo, SP, Brazil.

Midaortic syndrome is a rare vascular anomaly characterized by coarctation of the descending thoracic and abdominal aorta. Down syndrome is associated with multiple congenital cardiac malformations but is rarely associated with developmental vascular anomalies. Midaortic syndrome may result in severe renovascular hypertension that requires early intervention to prevent life-threatening complications. We report a child with Down syndrome who presented with occlusion of the aorta and was treated with aortic bypass. More than 4 years after the procedure, the patient's renal function remains normal, and there is no evidence of recurrent hypertension. Long-term follow-up is important to assess the benefits of surgical repair.
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http://dx.doi.org/10.1016/j.jvsc.2015.04.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6849921PMC
June 2015

Cardiac metastasis of melanoma presenting as acute aortic occlusion.

J Thromb Thrombolysis 2013 Nov;36(4):536-8

Department of Vascular Surgery, Federal University of São Paulo, Rua Borges Lagoa, 754, São Paulo, SP, 04038-001, Brazil,

Cardiac diseases are the most common cause of acute arterial emboli, however, cardiac tumors are not as frequent. Cardiac metastases from melanoma are usually silent, and rarely cause symptoms. Only a few reports are found in the literature of metastatic melanoma, causing arterial emboli. Here, we report a case of a cardiac metastasis of melanoma cancer that presented preoperative as arterial emboli. The gross appearance of the emboli already suggested the presence of a cardiac tumor. In selected patients who have a solitary intracardiac melanoma, surgical resection can provide relief from clinical symptoms and minimize potential cardiac sequelae of the tumor.
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http://dx.doi.org/10.1007/s11239-013-0912-1DOI Listing
November 2013

Kidney weight and volume among living donors in Brazil.

Sao Paulo Med J 2007 Jul;125(4):223-5

Department of Surgery, Hospital do Rim e Hipertensão, Universidade Federal de São Paulo, São Paulo, Brazil.

Context And Objective: The present study was performed to measure kidney weight and volume among living donors of both sexes in Brazil.

Design And Setting: This was a cross-sectional survey carried out between December 2001 and August 2004.

Methods: Kidney transplantations from 219 living donors were analyzed for this study. The kidneys were weighed in grams on a single-pan digital balance just after drainage of the perfusion fluid and removal of the perirenal fat. The kidney volume was determined in milliliters by water displacement.

Results: The mean age at nephroureterectomy was 44 +/- 9.5. The donor organs came from the left side in 172 cases and from the right side in 47 cases. The weights and volumes of the right and left kidneys were, respectively, 169.83 +/- 29.91 g and 157.38 +/- 31.84 ml; and 173.00 +/- 33.52 g and 160.34 +/- 34.40 ml. The differences between the sides were not significant.

Conclusions: According to the present study, kidney weight cannot be the only factor determining the side on which nephroureterectomy is performed, because of the lack of statistical significance between the two sides. On average, females donate lower nephron doses than males do, which could in some transplants result in allograft damage.
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http://dx.doi.org/10.1590/s1516-31802007000400006DOI Listing
July 2007
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