Introduction: The majority of cases of stenosis or occlusion of central veins are the result of central catheters, arteriovenous fistulas, neoplasms or traumas and these conditions can cause severe cases of venous hypertension or reduce the flow through fistulas. The objective of this study is to analyze the results of central venous angioplasties conducted at our hospital. Methodology: We conducted a retrospective and descriptive study to analyze the results of central venous angioplasties conducted from 2010 to 2012 at a university hospital run by the Universidade Estadual de Londrina, Brazil. We calculated primary and secondary success rates and analyzed whether or not stents were used and complications occurred during a 6-month follow-up period. Results: A total of 25 central venous angioplasties were conducted. Twenty-four (96%) of these were because of catheter-related intimal hyperplasia and one was to treat the effects of compression by a tumor. Fifteen (60%) angioplasties were to correct stenosis and ten (40%) were because of occlusions, with a one-hundred percent success rate for all stenosis-related procedures. However, none of the cases of occlusion could be treated endovascularly. Patency during the 6-months follow-up period was 80% after reinterventions. Conclusions: Despite good results observed after primary interventions for stenoses, it must be accepted that all current treatment options for chronic occlusive venous disease will, sooner or later, lead to restenosis or occlusion. Venous occlusions constitute a challenge demanding the development of new techniques and new materials. Prevention is paramount, through avoidance of central catheterization and early creation of arteriovenous fistulas.

Background: There is little information available on follow-up of abdominal aortic aneurysm patients treated with endovascular repair using vascular ultrasonography in Brazil or on how it compares with the results of angiotomography. Since ultrasonography is an examination that is risk-free, inexpensive and widely available, it is a very attractive method. In this study we attempted to evaluate the sensitivity and specificity of vascular ultrasonography for follow-up of these patients by comparing the method with angiotomography. Materials and methods: We conducted a prospective study from June 2012 to May 2013. We examined patients followed-up at the endovascular surgery clinic run by the University Hospital of Londrina after endovascular repair of abdominal aortic aneurysms. All patients underwent angiotomography for follow-up and were also examined using simple abdominal X-rays and vascular ultrasonography. Results: A total of 30 patients were analyzed, with a mean age of 73 years and a mean aneurysm diameter of 6 cm. Four endoleaks were detected. Vascular ultrasonography achieved sensitivity of 75% and specificity of 96% for classification of these endoleaks, in comparison with angiotomography. Conclusions: Vascular ultrasonography is an excellent primary method for evaluation and post-surgical follow-up of patients treated with endovascular repair of abdominal aorta aneurysms. However, when ultrasonography detects problems or is difficult to accomplish, it should be supplemented with a more specific investigation for diagnostic confirmation.

Post-thrombotic syndrome (PTS) is a late complication that does not have a cure yet, with a prevalence estimated between 20 to 75%, associated with previous deep vein thrombosis event. Although the Villalta score (VS) is the gold-standard clinical tool for diagnostic and prognostic evaluation of PTS, there are currently no VS intra-rater agreement established and no validation studies for VS’ application into Brazilian Portuguese. We sought to translate and validate VS reliability systematically; and, secondarily, to compare the ultrasound findings with the severity of PTS.We systematically translated the original VS into Brazilian Portuguese (BP). Fifty participants who underwent two outpatient visits were evaluated using the translated VS. We assessed its intra-rater and inter-rater agreement and compared BP VS versus CEAP clinical component (CEAP C), and the clinical PTS severity versus the duplex ultrasound (DUS) findings. The study and its report followed the Guidelines for Reporting Reliability and Agreement Studies.The intra-rater evaluation of VS grades had a simple Kappa coefficient of 0.73, and the simple Kappa coefficient inter-rater for VS grades was 0.67. When VS was compared to CEAP C, it established a remarkably high correlation over 0.9. There was difference among VS values compared to DUS initial deep vein thrombosis territory, with femoropopliteal showing higher values than distal veins. Higher VS values were correlated to DUS venous recanalization and reflux.There was a substantial inter-rater and intra-rater agreement when the BP VS was applied; and when compared to CEAP C, VS showed a high correlation. When VS grading was compared to DUS characteristics, there were significant statistical and clinical correlation, with presence of reflux and recanalization showing higher VS values. This external VS validation also changes the clinical practice allowing the VS use in a different population and establishes the VS intra-rater agreement.

The authors describe the cases of two patients with pseudoaneurysms, discuss the difficulty in establishing diagnosis and treatment due to human immunodeficiency virus infection, and demonstrate the similarity with atherosclerotic saccular aneurysm of the abdominal aorta.Keywords: HIV; pseudoaneurysm; saccular aneurysm. ResumoOs autores descrevem os casos de dois pacientes que apresentaram pseudoaneurismas e ressaltam a dificuldade diagnóstica e terapêutica por apresentar associação com a infecção pelo vírus da imunodeficiência humana, e também demonstram a semelhança com aneurisma sacular aterosclerótico da aorta abdominal.Palavras-chave: HIV; pseudoaneurisma; aneurisma sacular. As the patient was obese, had previous abdominal surgery and her anatomy was favorable, the plan was to use an endovascular approach to place an aortic endoprosthesis for aneurysm repair.Right femoral dissection and left femoral puncture were used to place a 25 mm × 16 mm × 100 mm Powerlink R endoprosthesis (Endologix, Irvine, CA) using a 9F introducer sheath, and the aneurysm was immediately repaired. Post-operative progression was good, and the patient was discharged on the second day after operation. Ten days after the operation, she presented with left lower back pain, diarrheic stools, vomiting and paresthesia of left lower extremity. Physical examination detected femoral and distal pulses and no sign of hyperemia in the surgical wound; laboratory tests were normal. Two days after hospitalization, her general state deteriorated and she had abdominal and lower extremity pain. Physical examination found that the lower extremities were cold, and no pulses should be detected. Ultrasound scanning confirmed the clinical hypothesis of endoprosthesis occlusion. She underwent an urgent surgery for an axillobifemoral bypass and placement of an 8-mm Dacron prosthesis, and revascularization of the lower extremities was successful. After operation in the ICU, she was administered broad spectrum antibiotics (vancomycin 1 g, 12h/12h and meropenem 1 g, 8h/8h), but had refractory septic shock and died. Case 2A previously healthy 47-year-old male smoking patient was transferred from another hospital ward with a history of daily low fever for 20 days. Nine

BACKGROUND: Peripheral arterial disease (PAD) is characterized by progressive narrowing of the arterial lumen, resulting from atherosclerotic plaques. Treatment for PAD aims to control atherosclerosis and improve blood flow. Use of antiplatelet agents and anticoagulants has played important roles in helping to prevent occlusions and stenosis. OBJECTIVE: To evaluate the evidence from Cochrane systematic reviews regarding the accuracy, effectiveness and safety of use of anticoagulants and antiplatelets in lower-limb revascularization, in patients with peripheral arterial disease. METHODS: Systematic reviews found through searches in the Cochrane Library were included. Two authors evaluated whether the reviews found were in line with the inclusion criteria for this investigation. A qualitative synthesis of their findings was presented. RESULTS: Three systematic Cochrane reviews were included. Patients who underwent prosthetic bypass surgery probably presented greater benefit from use of antiplatelets, and patients who underwent vein revascularization probably presented greater benefit from use of anticoagulants. Patients who received endovascular treatment benefited from both antiplatelet and anticoagulant treatment. However, the reliability of the results found was impaired because at the time when these reviews were published, there was no mandatory assessment using the GRADE criteria. CONCLUSION: Despite the evidence found, it is necessary for these reviews to be updated in order to evaluate the degree of certainty of the results found.