CONTEXTO: A Doença Venosa Crônica (DVC) dos membros inferiores apresenta uma alta prevalência, estando a cirurgia para cura das varizes dos membros inferiores entre as mais frequentemente realizadas pelos cirurgiões vasculares. Apesar disso, não foi estabelecido, na cidade de Recife e zona metropolitana, o perfil epidemiológico dos pacientes que são submetidos a essa modalidade terapêutica. OBJETIVOS: O objetivo deste trabalho foi avaliar o perfil epidemiológico dos pacientes suubmetidos à cirurgia para a cura das varizes dos membros inferiores. MATERIAL E MÉTODOS: Foram avaliados 201 pacientes submetidos ao tratamento cirúrgico de varizes dos membros inferiores, no Serviço de Cirurgia Vascular no Instituto de Medicina Integral Professor Fernando Figueira (IMIP), no período de agosto de 2006 a abril de 2007. Foram avaliados os seguintes parâmetros: sexo, idade, sedentarismo, sobrepeso e obesidade, e presença de ortostatismo prolongado durante atividade laboral. RESULTADOS: Do total de pacientes avaliados, 175 (87,1%) eram do sexo feminino e 26 (12,9%) do masculino. A faixa etária mais acometida foi a de 41 a 50 anos (32,3%), o sobrepeso estava presente em 38,8% dos pacientes, e a obesidade em 7,5% dos casos. O ortostatismo prolongado, durante a atividade laboral, estava presente em 82,1% dos pacientes avaliados. O grau de escolaridade mais comum, observado em 83,2% dos pacientes, foi de até oito anos de tempo de estudo. O sedentarismo foi encontrado em 69,2% dos pacientes. CONCLUSÃO: A maioria dos pacientes avaliados no presente estudo era do sexo feminino com idade maior que 40 anos, era sedentária e não apresentava sobrepeso ou obesidade, e desenvolvia atividades laborais com ortostatismo prolongado.

Bypass to the perigeniculate collateral arteries is an option for limb salvage. Lack of usual distal runoff or suitable, long lower limb vein for reconstruction are conditions that justify this option. Increased flow through collaterals, mainly nurtured by the perigeniculate arteries, is the rationale for this operation. Raised perfusion pressure, even though no pulsatile flow may be attained at the foot, may be enough to ensure healing of limb-threatening ischemic lesions.Initial attention to this possibility was brought to light by Barral et al. 1 The need to harvest arm veins because of the absence of lower limb veins and the use of the distal portion of the deep femoral as a donor artery, to reduce the need of vein, and due to incisions at the inguinal area from previous attempted revascularizations, are corollaries to explain technical aspects of these unusual reconstructions. 2 The present case illustrates these features. A 59-year-old woman presented with fifth toe gangrene, ischemic pain, and an anklebrachial index of 0.4. The patient had an occluded nonreversed saphenous vein bypass from the left common femoral to dorsalis pedis artery done 4 years earlier and a right transfemoral amputation.An arteriogram (A) showed extensive occlusion of the superficial femoral, popliteal, and major leg arteries. The dorsalis pedis was still patent, but this area had undergone a previous operation. No suitable lower limb vein was available because the homolateral vein had been used for the initial revascularization, and the other limb had a thigh amputation. A medial descending genicular artery was observed communicating with a large group of collaterals and was the foundation for the procedure that was performed.A basilic vein was harvested from right arm, and a nonreversed bridge from a distal zone of the profunda femoral up to the medial superior genicular artery was created. Relief of the ischemia was achieved, and ultimate healing of the foot was obtained after fifth toe amputation. The ankle-brachial index increased to 0.7. Control computed tomography angiography at the 6-month follow-up shows patency of the graft (Cover) and details of the proximal (B) and distal anastomosis (C), with collateral filling of leg arteries. REFERENCES 1. Latour B, Nourissat G, Duprey A, Berger L, Favre JP, Barral X. Bypass to the perigeniculate collateral arteries: mid-term results. Eur J Vasc Endovasc Surg 2008;35:473-9. 2. Brochado Neto FC, Albers M, Romiti M. The distal zone of the deep femoral artery as the inflow site in femorodistal bypass grafting. Eur J Vasc

OBJECTIVES:The aim of this study was to analyze silicone tubes with an internal diameter of 4 mm as a possible material for vascular prostheses.METHODS:Grafts were implanted into the infrarenal aortas of 33 rabbits. Fluoroscopic examinations were performed within 150 days after surgical implantation. Sample grafts were analyzed via electron microscopy to evaluate the eventual endothelialization of the prostheses.RESULTS:The patency rates of the prostheses were 87% (±6.7%) after 30 days, 73% (±9.3%) after 60 days and 48% (±12%) after 120 days. The material presented characteristics that support surgical implantation: good tolerance promoted by polyester tear reinforcement, ease of postoperative removal and a lack of pseudoaneurysms. However, intimal hyperplasia was a limiting factor for the patency rate.CONCLUSIONS:We concluded that polydimethylsiloxane has limited potential as an alternative material for small vascular prostheses.

Background: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD) of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. Objective: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. Material and Methods: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours). Results: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6%) of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. Conclusion: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

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