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Search Results: 1 - 10 of 949 matches for " mammary arteries. "
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Seguimento clínico a médio prazo com uso exclusivo de enxertos arteriais na revasculariza??o completa do miocárdio em pacientes com doen?a coronária triarterial
Lisboa, Luiz Augusto F.;Dallan, Luís Alberto O.;Puig, Luiz Boro;Abreu Filho, Carlos;Leca, Ricardo Cerquinho;Dallan, Luís Augusto P.;Oliveira, Sérgio Almeida de;
Revista Brasileira de Cirurgia Cardiovascular , 2004, DOI: 10.1590/S0102-76382004000100004
Abstract: objective: to evaluate the midterm benefits of exclusive use of arterial grafts in patients with triple vessel coronary arteriosclerotic disease who underwent complete myocardial revascularization. method: between july 1995 and july 1997, 137 consecutive patients with triple vessel coronary atherosclerotic disease underwent complete myocardial revascularization exclusively using arterial grafts. of these patients, 112 (81.7%) were male and the ages ranged from 36 to 78 years old (mean 56.5 years). three hundred and sixty-three arterial grafts were used to perform 442 coronary anastomoses; an average of 3.2 coronary anastomoses per patient. arterial grafts used were left internal thoracic artery (99.3%), right internal thoracic artery (56.2%), radial artery (94.9%), right gastroepiploic artery (13.9%) and inferior epigastric artery (0.7%). in 80 (58.4%) patients, arterial composite "y" grafts were constructed with the left internal thoracic artery and another arterial graft. results: no operative deaths occurred. four (2.9%) deaths occurred in the post-operative period and only one (0.7%) patient needed reoperation in the early follow-up. the 7 year actuarial survival was 94.0% and the event free probability (myocardial infarction, angioplasty, reoperation or death) was 87.0%. conclusions: good early and midterm clinical follow-ups can be achieved by exclusively using arterial grafts in the complete myocardial revascularization of patients with triple vessel coronary arteriosclerotic disease. a long-term follow-up will be necessary to show the influence of exclusive use of arterial grafts in the surgical treatment of coronary insufficiency.
REVASCULARIZACIóN MIOCáRDICA CON AMBAS ARTERIAS MAMARIAS INTERNAS, UN RETO PARA LOS CIRUJANOS CARDIOVASCULARES ACTUALES / Myocardial revascularization with both internal mammary arteries, a challenge for cardiovascular surgeons nowadays
Jean Luis Chao García,álvaro Lagomasino Hidalgo,Francisco Javier Vázquez Roque,Roger Mirabal Rodríguez
CorSalud , 2009,
Abstract: The left internal mammary artery is currently the most common graft in surgical myocardial revascularization. However, in spite of the works showing the effectiveness of the use of both mammary arteries, this technique remains a controversial topic in medical literature nowadays. Among the factors discouraging its use we have the good results of the myocardial revascularization with left internal mammary artery and with saphenous vein, a greater technicaldifficulty and a prolonged surgical time; as well as an increase in sternal complications. The advantages and disadvantages in the use of this procedure are discussed in this work, as well as the results presented by several authors. The surgical technique is also described.
Vasculariza??o arterial da glandula mamária em caprinos sem ra?a definida (Capra hircus, Linnaeus, 1758)
LUIZ, Carlos Rosemberg;MIGLINO, Maria Angelica;
Brazilian Journal of Veterinary Research and Animal Science , 2000, DOI: 10.1590/S1413-95962000000100001
Abstract: we studied the distribution and vascular disposition of arteries in the mammary gland of 30 adult, mixed-breed goats, which came from the states of ceará and minas gerais. in order to perform this study we analyzed schematic drawings taken from models, which were obtained through "latex neoprene 450" injection, followed by fixation in 10% aqueous solution and dissection. we noticed that the blood supply for each half of the mammary gland is carried out by the external pudendal artery and is complemented by connections to branches of the internal pudendal artery and internal thoracic artery. close to the mammary gland the external pudendal artery bends and sends out the superficial mammary branch. after that it is called a. mammaria until its bifurcation; it also sends out branches to mammary lymph nodes and ventral labium. when it penetrates the gland the cranial mammary artery divides itself, thus forming the cranial and medial mammary arteries, which send several branches throughout the mammary gland and to the skin that covers this region. the cranial mammary artery leaves the mammary gland and runs cranially along the ventral abdominal wall until it reaches the navel, yet as superficial caudal epigastric artery. we did not identify significant differences between the vascular disposition in both sides of the mammary gland. we reported the occurrence of anastomoses between the medial mammary arteries and their branches, and also took note of the type, site and frequency these occurred. our work was concluded with a comparative analysis confronting it to research of other authors, who studied the blood supply of the mammary gland in cattle.
Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patients
, Michel Pompeu Barros de Oliveira;Soares, Evelyn Figueira;Santos, Cecília Andrade;Figueiredo, Omar Jacobina;Lima, Renato Oliveira Albuquerque;Escobar, Rodrigo Renda;Rueda, Fábio Gon?alves de;Ferraz, Paulo Ernando;Lima, Ricardo Carvalho;
Revista Brasileira de Cirurgia Cardiovascular , 2011, DOI: 10.1590/S0102-76382011000200007
Abstract: background: mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. diabetes is a feared risk factor for mediastinitis and viewed with caution by cardiovascular surgeons. objective: to identify risk factors for mediastinitis in diabetics undergoing cabg surgery with use of unilateral ita in the division of cardiovascular surgery of pronto socorro cardiológico de pernambuco - procape. methods: retrospective study of 157 diabetics operated between may 2007 and april 2010. nine preoperative variables, five intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. univariate and multivariate logistic regression analyses were applied. results: the incidence of mediastinitis was 7% (n=11), with a lethality rate of 36.1% (n=4). variables associated with increased risk of mediastinitis were: use of pedicled ita (or 8.25, 95% ci 2.03 to 66.10, p=0.016), postoperative renal complications (or 5.10, 95% ci 1.03 to 25.62, p=0.049) and re-operation (or 7.45, 95% ci 1.24 to 42.17, p=0.023). in multivariate analysis using backward logistic regression, only one variable remained as independent risk factor: use of pedicled ita (or 7.64, 95% ci 1.95 to 61.6, p=0.048), in comparison to skeletonized ita. conclusions: we suggest that diabetics should be considered for strategies to minimize risk of infection. in diabetics that undergo unilateral ita, the problem seems to be related to how ita is harvested. diabetics should always be considered for use of skeletonized ita.
Diabéticos devem ter a artéria torácica interna esqueletizada? Avalia??o da perfus?o esternal por cintilografia
Santos Filho, Edmilson Cardoso dos;Moraes Neto, Fernando Ribeiro de;Silva, Ricardo Augusto Machado e;Moraes, Carlos Roberto Ribeiro de;
Revista Brasileira de Cirurgia Cardiovascular , 2009, DOI: 10.1590/S0102-76382009000200011
Abstract: objective: to assess, by scintillography, the effect of using bilateral internal thoracic arteries (bitas) - prepared by two different techniques - on the sternal perfusion. methods: 35 patients undergone coronary artery bypass grafting (cabg) were divided into two groups: group a (18) had both ita's dissected using skeletonization technique and group b (17) as pedicle preparation. there was no difference in the two groups relating gender, age and demographic characteristics. on the 7th postoperative day the patients underwent bone scintillography. the statistical analysis was performed using the student's t test with 95% significance. results: group a (skeletonized ita) showed higher perfusion (11.5%) of the sternum as a mean, than group b (pedicled ita) patients; however this was not statistically significant (p = 0.127). on the other hand, comparing the diabetic population, seven in each group, there was a marked 47.4% higher perfusion of the sternum in group a patients (skeletonized ita) comparing to group b (pedicled ita) and this difference reached statistical significance (p = 0.004). conclusion: 1- sternal perfusion is not affected significantly apart from the dissection technique used for both internal thoracic arteries in the general population when assessed by bone scintillography. 2 - in the diabetic subgroup, a significant preservation of the sternal perfusion was observed in patients undergone skeletonized dissection of the internal thoracic arteries. although these findings should be confirmed in a greater number of cases, diabetic patients should have the internal thoracic arteries dissected using skeletonization techinque.
Dupla artéria torácica esqueletizada versus convencional na revasculariza??o do miocárdio sem CEC em diabéticos
Milani, Rodrigo;Brofman, Paulo Roberto;Guimar?es, Maximiliano;Barboza, Laura;Tchaick, Rodrigo Mezzalira;Meister Filho, Hugo;Baggio, Thales;Maia, Francisco;
Revista Brasileira de Cirurgia Cardiovascular , 2008, DOI: 10.1590/S0102-76382008000300011
Abstract: objective: to evaluate the influence of the technique used in the dissection of thoracic arteries in the evolution of diabetic patients submitted to opcab. methods: seventy diabetic patients submitted to opcab using bilateral thoracic arteries were evaluated. in group a, thoracic arteries were dissected as a pedicle, while in group b they were skeletonized. results: the mean age of patients in group a was 52.14 ± 7.35 years old versus 55.71 ± 8.1 years for group b (p=0.057). in group a, six patients (17.1%) were insulin dependent against nine (25.7%) in group b (p = 0.561). the euroscore was 3.97 ± 2.49 for group a opposed to 4.14 ± 3.06 for group b (p = 0.879). the number of distal anastomoses in group a was 3 ± 0.77 versus 3.03 ± 0.89 in group b (p = 0.981). three patients (8.57%) from group a presented with mediastinitis. insulin dependence was the only significant risk factor (p=0.008) for mediastinitis. in this group the use of skeletonized internal thoracic arteries significantly decreased the incidence of mediastinitis (p = 0.044). conclusion: the incidence of mediastinitis was lower in the group for which mammary arteries were dissected using skeletonization. among insulin-dependent diabetics, 50% of the patients from the group in which the pedicled internal thoracic artery was utilized presented with mediastinitis; the utilization of skeletonized internal thoracic arteries significantly decreases the incidence of mediastinitis.
Aspectos técnicos na esqueletiza??o da artéria torácica interna com bisturi ultra-s?nico
Menezes, Alexandre Motta de;Vasconcelos, Frederico Pires de;Lima, Ricardo de Carvalho;Costa, Mário Gesteira;Escobar, Mozart Augusto Soares de;
Revista Brasileira de Cirurgia Cardiovascular , 2007, DOI: 10.1590/S0102-76382007000200009
Abstract: objective: to describe the technique and evaluate the immediate results of using an ultrasonic scalpel in the skeletonization of the internal thoracic artery for coronary artery bypass grafting surgery. methods: from january 2000 to october 2006, 188 patients were submitted to coronary artery bypass grafting with the internal thoracic artery skeletonized using an ultrasonic scalpel. seventy-one patients (37.8%) were women. the patients' ages varied from 28 to 81 years old. the entire internal thoracic artery was exposed opening the endothoracic fascia using scissors as close as possible to the arterial adventitia. an ultrasonic scalpel was used to transect and coagulate all the intercostal branches, thereby minimizing the use of metallic clips. results: the skeletonized internal thoracic arteries presented with excellent flow, obviating the need for intraluminal manipulation for vasodilatation. in the immediate postoperative period, two patients were found to have temporary left-sided diaphragmatic paralysis. there were no sternal wound infections in this series. the dissection can be performed in approximately 33 minutes however with more experience this time may be reduced. conclusion: this technique facilitates and shortens the internal thoracic artery skeletonization procedure and does not cause arterial spasms. cauterization of the collateral branches with an ultrasonic scalpel is efficient and the use of metallic clips is almost unnecessary. it is a procedure that is easy to reproduce and may be recommended as the first-choice technique for the dissection of the internal thoracic artery.
Cirurgia coronária com condutos arteriais múltiplos sem circula??o extracorpórea
Navia, Daniel;Vrancic, Mariano;Vaccarino, Guillermo;Piccinini, Fernando;Iparraguirre, Eduardo;Casas, Marcelo;Thierer, Jorge;
Revista Brasileira de Cirurgia Cardiovascular , 2005, DOI: 10.1590/S0102-76382005000100010
Abstract: objective: to analyze intra-hospital results in patients undergoing elective off-pump total arterial revascularization and identify morbidity and mortality predictors using this surgical strategy. method: from may 1999 to february 2004, 203 myocardial revascularization procedures with total arterial revascularization without cardiopulmonary bypass (off-pump) were carried out in patients with multivessel disease (three vessels 81.7 %, one vessel disease was excluded). we report pre-surgical variables and co-morbidities: average age 63.9 ± 9.13 years, men 182 (89.5%), hypertension 132 (65%), smokers 125 (61%), hypercholesterolemia 152 (74.8%), previous myocardial infarction (> 30 days) 73 (35%), moderate to severe ventricular dysfunction 31 (15%), redo five (2.5%). total arterial revascularization included t-grafts and sequential grafts with left internal mammary (100%), right internal mammary (56.6%) and radial (63%) arteries. the total number of distal anastomosis was 576 (mean of three grafts/patient), all carried out with external mechanical stabilizers. there were no proximal aortic anastomoses. conversion to on-pump surgery occurred in three (1.5%) patients; 90% of the patients was extubated in the operating room. the multiple logistic regression test was used for statistical analysis. results: the postoperative incidence of atrial fibrillation was 12.8% (26), oligoanuric renal failure 3% (six), dialysis 0.49% (one), postoperative myocardial infarction 1.47% (three), low cardiac output 4% (eight), redo for bleeding 1.47% (three), mediastinitis 1.47% (three), stroke 1.47% (three). intra-hospital mortality was 2.45% (five). the only independent 30 day morbidity predictor was age (p=0.033; or 1.04; ic 95%: 1-1.08). conclusion: off-pump myocardial revascularization with arterial conduits for multiple vessel disease is feasible with a low 30-day morbidity and mortality.
Compara??o do efeito da nimodipina e da papaverina como vasodilatadores sobre o fluxo na artéria torácica interna esquerda
Santos Junior, Edhino;Cividanes, Gil Vicente Lico;Marchiori, Rosangela Cristina;Souto, Francisco de Andrade;
Revista Brasileira de Cirurgia Cardiovascular , 2006, DOI: 10.1590/S0102-76382006000400010
Abstract: objective: to compare the flow of the left internal thoracic artery under a local pharmacological effect caused by the topical action on the arterial pedicle and the intraluminal effect of a calcium channel blocker with a control group using papaverine. methods: over a period from july to november 2004, a prospective study was performed involving 73 patients who were submitted to coronary artery bypass surgery utilizing the left internal thoracic artery as one of a group of grafts. a comparative analysis of the flow was made when using two different pharmacological agents. the patients were randomized to receive either nimodipine or papaverine as vasodilators. two types of flow were determined: the flow at time 1 representing the period of topical action of the drug on the arterial pedicle (extraluminal) and the flow at time 2 representing the intraluminal action of the drug. a comparison of the means of the two types of flow between the two groups of pharmacological agents was carried out using the non-parametric mann-whitney test. results: there is no evidence that the mean flow using the two pharmacological agents is different at time 1 (p = 0.534) or at time 2 (p = 0.063). conclusions: there is no evidence that the mean flow varies due to the topical action of one or other drug or that the mean flow is different due to the intraluminal action, proving that nimodipine as a locally acting vasodilator is similar to papaverine.
Clinical significance of intramammary arterial calcifications in diabetic women
Milo?evi? Zorica,Bjeki? Jelica,Radulovi? Stanko,Goldner Branislav
Vojnosanitetski Pregled , 2004, DOI: 10.2298/vsp0402163m
Abstract: Background. It is well known that intramammary arterial calcifications diagnosed by mammography as a part of generalized diabetic macroangiopathy may be an indirect sign of diabetes mellitus. Hence, the aim of this study was to determine the incidence of intramammary arterial calcifications, the patient’s age when the calcifications occur, as well as to observe the influence of diabetic polineuropathy, type, and the duration of diabetes on the onset of calcifications, in comparison with nondiabetic women. Methods. Mammographic findings of 113 diabetic female patients (21 with type 1 diabetes and 92 with type 2), as well as of 208 nondiabetic women (the control group) were analyzed in the prospective study. The data about the type of diabetes, its duration, and polineuropathy were obtained using the questionnaire. Statistical differences were determined by Mann-Whitney test. Results. Intramammary arterial calcifications were identified in 33.3% of the women with type 1 diabetes, in 40.2% with type 2, and in 8.2% of the women from the control group, respectively. The differences comparing the women with type 1, as well as type 2 diabetes and the controls were statistically significant (p=0.0001). Women with intramammary arterial calcifications and type 1 diabetes were younger comparing to the control group (median age 52 years, comparing to 67 years of age, p=0.001), while there was no statistically significant difference in age between the women with calcifications and type 2 diabetes (61 years of age) in relation to the control group (p=0.176). The incidence of polineuropathy in diabetic women was higher in the group with intramammary arterial calcifications (52.3%) in comparison to the group without calcifications (26.1%), (p=0.005). The association between intramammary arterial calcifications and the duration of diabetes was not found. Conclusion. The obtained results supported the theory that intramammary arterial calcifications, detected by mammography could serve as markers of co-existing diabetes mellitus and therefore should be specified in radiologic report in case of their early development.
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