Dr. GUILHERME YAZBEK CRM : 76.042
ATUAÇÃO NA ÁREA CLÍNICA E CIRURGICA:
Cirurgia Vascular;
Angiologia.
ATUAÇÃO PROFISSIONAL:
Hospital do Câncer A C Camargo - São Paulo;
Hospital Albert Einstein - São Paulo;
Hospital Sírio Libanês.
Hospital Nove de Julho;
Hospital Oswaldo Cruz
FORMAÇÃO ACADÊMICA
Faculdade de Medicina da Universidade de São Paulo 1992;
Residência Cirurgia Vascular – Faculdade de Medicina da Universidade de São Paulo 1997;
Doutorado pela Faculdade de Medicina da Universidade de São Paulo 2009.
TÍTULOS DE ESPECIALISTA
Cirurgia Vascular pela Faculdade de Medicina da Universidade de São Paulo;
Detalhado:
3.1. Atividades como Acadêmico de Medicina
3.1.1. Cursou a Faculdade de Medicina da Universidade de São Paulo, tendo obtido aprovação em todas as fases do curso de graduação, de
3.1.2. Exerceu Atividade de Instrumentador Cirúrgico no Hospital e Maternidade Leão XIII, diretamente ligado ao Dr. Amílcar Yazbek, de 1991 e 1992.
3.2. Cursos de Extensão Universitária
3.2.1. 5º CURSO CONTINUADO DE COLO-PROCTOLOGIA – MÓDULO I, promovido pela Faculdade de Medicina da Universidade de São Paulo,
3.2.2. VIII ASSEMBLÉIA CIRÚRGICA, promovido pelo Capítulo de São Paulo do Colégio Brasileiro de Cirurgiões,
3.2.3. X CURSO ANUAL DE CIRURGIA DE URGÊNCIA, promovido pelo Capítulo de São Paulo do Colégio Brasileiro de Cirurgiões,
3.2.4. MÓDULO IV DO SERVIÇO DE COLO-PROCTOLOGIA DO DEPARTAMENTO DE GASTROENTEROLOGIA DO
3.2.5. XXI CURSO DE ATUALIZAÇÃO
3.2.6. 7º CURSO CONTINUADO DE COLO-PROCTOLOGIA, promovido pela Faculdade de Medicina da Universidade de São Paulo,
3.2.7. XIII ENCONTRO PAULISTA DE
3.2.8. XXI CONGRESSO BRASILEIRO DE CIRURGIA, XI CONGRESSO LATINO-AMERICANO DE CIRURGIA,
3.2.9. XXXI CONGRESSO BRASILEIRO DE ANGIOLOGIA E
3.2.10. JORNADA “EVOLUÇÃO NATURAL DAS DOENÇAS VASCULARES - QUANDO OPERAR?”, promovida pelo Centro de Estudos e Pesquisas – CEPE, da Sociedade Beneficente de Senhoras do Hospital Sírio Libanês, realizada
3.1. Atividades como Acadêmico de Medicina
3.1.1. Cursou a Faculdade de Medicina da Universidade de São Paulo, tendo obtido aprovação em todas as fases do curso de graduação, de
3.1.2. Exerceu Atividade de Instrumentador Cirúrgico no Hospital e Maternidade Leão XIII, diretamente ligado ao Dr. Amílcar Yazbek, de 1991 e 1992.
3.2. Cursos de Extensão Universitária
3.2.1. 5º CURSO CONTINUADO DE COLO-PROCTOLOGIA – MÓDULO I, promovido pela Faculdade de Medicina da Universidade de São Paulo,
3.2.2. VIII ASSEMBLÉIA CIRÚRGICA, promovido pelo Capítulo de São Paulo do Colégio Brasileiro de Cirurgiões,
3.2.3. X CURSO ANUAL DE CIRURGIA DE URGÊNCIA, promovido pelo Capítulo de São Paulo do Colégio Brasileiro de Cirurgiões,
3.2.4. MÓDULO IV DO SERVIÇO DE COLO-PROCTOLOGIA DO DEPARTAMENTO DE GASTROENTEROLOGIA DO
3.2.5. XXI CURSO DE ATUALIZAÇÃO
3.2.6. 7º CURSO CONTINUADO DE COLO-PROCTOLOGIA, promovido pela Faculdade de Medicina da Universidade de São Paulo,
3.2.7. XIII ENCONTRO PAULISTA DE
3.2.8. XXI CONGRESSO BRASILEIRO DE CIRURGIA, XI CONGRESSO LATINO-AMERICANO DE CIRURGIA,
3.2.9. XXXI CONGRESSO BRASILEIRO DE ANGIOLOGIA E
3.2.10. JORNADA “EVOLUÇÃO NATURAL DAS DOENÇAS VASCULARES - QUANDO OPERAR?”, promovida pelo Centro de Estudos e Pesquisas – CEPE, da Sociedade Beneficente de Senhoras do Hospital Sírio Libanês, realizada
4. FORMAÇÃO E ESPECIALIZAÇÃO
4.1. Residência Médica
4.1.1. Em Cirurgia Geral
4.1.1.1. Cursou o Programa de RESIDÊNCIA MÉDICA, na Faculdade de Medicina da Universidade de São Paulo. Cumpriu o Programa de Residência Básica
1. Cirurgia Geral/Pronto Socorro Cirúrgico
2. Cirurgia Geral/Cirurgia Eletiva
3. Cirurgia Geral/Pronto Socorro Cirúrgico
4. Cirurgia Geral/Cirurgia Eletiva/SESI
5.
6. Cirurgia Pediátrica
7. Urologia
8. Técnica Cirúrgica
9. Cirurgia Plástica e Queimaduras
10. Anestesiologia
11. Cirurgia Experimental
12. Cirurgia Pulmonar
13. Cirurgia da Cabeça e Pescoço
14. Cirurgia do Aparelho Digestivo – Esôfago
15. Cirurgia do Aparelho Digestivo – Vias Biliares
16. Cirurgia do Aparelho Digestiva – Colon
4.1.2.
4.1.2.1. Cursou o Programa de RESIDÊNCIA MÉDICA, na Faculdade de Medicina da Universidade de São Paulo. Cumpriu o Programa de Residência especializada Pós-Básica
4.2. Títulos e Registros
4.2.1.
4.2.1.1. Registrado no Conselho Regional de Medicina do Estado de São Paulo a qualificação na especialidade de CIRURGIA GERAL na data de 21 de novembro de 2000 (registro nº. 16741/00).
4.2.2.
4.2.2.1. Registrado no Conselho Regional de Medicina do Estado de São Paulo a qualificação na especialidade de
4.2.2.2. Membro da Sociedade Brasileira de Angiologia e
4.3. Pós-Graduação
4.3.1. Doutorado
4.3.1.1. Defendeu a Tese de Doutorado em 29 de junho de 2009, intitulada ”Comparação dos resultados obtidos no tratamento da hiperidrose palmar pela simpatectomia torácica videotoracoscópica nos níveis de desnervação: T2 e T3”, tendo sido aprovado no Programa de Pós-Graduação
5. ATIVIDADES PROFISSIONAIS
5.1. Exerce a função de Cirurgião Vascular no Hospital do Câncer A. C. Camargo, no município de São Paulo, desde 1997.
5.2. Exerceu a função de Cirurgião Vascular no Hospital Regional Sul, da Secretaria de Estado da Saúde, tendo sido aprovado no concurso público de acordo com artigo 1°., Inciso I da lei 500/74, no período de 04/06/1998 a 08/12/1998. Exerceu atividade como cirurgião vascular no período de 28/04/1997 a 27/04/1998 de acordo com artigo 1°., Inciso I da lei 500/74, combinado com o artigo 1°., Inciso I, da LC 733,93.
5.3. Atua também como Médico Cirurgião credenciado nos hospitais, Albert Einstein, Sírio Libanês, São Luís, Santa Cruz e São Camilo - Ipiranga, no município de São Paulo.
6. ATIVIDADES DIDÁTICAS I
I. PARTICIPAÇÕES
6.1. Na Faculdade de Medicina da Universidade de São Paulo
6.1.1. VIII CURSO DE BASES DA
6.1.2. TÉCNICAS
6.2. No Hospital do Câncer A. C. Camargo
6.2.1. EQUIPAMENTOS NECESSÁRIOS PARA A INSERÇÃO, no I Curso de Acessos Vasculares em Quimioterapia, no Hospital do Câncer A. C. Camargo,
6.2.2. TÉCNICA DE INSERÇÃO POR PUNÇÃO, no I Curso de Acessos Vasculares em Quimioterapia, no Hospital do Câncer A. C. Camargo,
6.2.3. TÉCNICA DE PASSAGEM DE INTRACATH, no Centro de Estudos do Hospital A. C. Camargo,
6.2.4. PUNÇÃO, no I Curso de Bases Técnicas da
6.2.5. BALÕES, no I Curso de Bases Técnicas da
6.2.6. INTRODUTORES, no I Curso de Bases Técnicas da
6.2.7. DISSECÇÃO, no I Curso de Bases Técnicas da
6.2.8. TÉCNICA DE INSERÇÃO DE CATETERES E SHUNTS POR PUNÇÃO, na I Jornada de Acessos Vasculares
6.2.9. EQUIPAMENTO E AMBIENTE CIRÚRGICO, na I Jornada de Acessos Vasculares
6.2.10. TÉCNICAS ENDOVASCULARES COMO ADJUVANTES À INSERÇÃO DE CATÉTERES, na I Jornada de Acessos Vasculares
6.2.11. TROMBOSE VENOSA PROFUNDA, no Centro de Reabilitação de Fisioterapia do Centro de Tratamento e Pesquisa do Hospital do Câncer A. C. Camargo,
6.2.12. EQUIPAMENTO E AMBIENTE CIRÚRGICO, na II Jornada de Acessos Vasculares
6.2.13. TÉCNICA DE INSERÇÃO DE CATETERES E SHUNTS POR PUNÇÃO, na II Jornada de Acessos Vasculares
6.2.14. TÉCNICAS ENDOVASCULARES COMO ADJUVANTES À INSERÇÃO DE CATÉTERES, na II Jornada de Acessos Vasculares
6.2.15. TÉCNICA DE INSERÇÃO DE CATETERES PARA QUIMIOTERAPIA, na III Jornada de Acessos Vasculares
6.2.16. RESULTADOS DO USO DOS ACESSOS VASCULARES PARA QUIMIOTERAPIA E TRANSPLANTE DE MEDULA ÓSSEA, na III Jornada de Acessos Vasculares
6.2.17. T.V.P. - TROMBOSE VENOSA PROFUNDA, no II Simpósio de Fisioterapia em Oncologia, no Hospital do Câncer A. C. Camargo,
6.2.18. ACESSOS VENOSOS EM ONCOLOGIA, no Curso de Pós-graduação Lato Sensu Especialização
6.2.19. ACESSOS VENOSOS EM ONCOLOGIA, para a 5° turma do Curso de Pós-Graduação Lato Sensu - Especialização
6.2.20. TROMBOSE VENOSA PROFUNDA
6.2.21. EXPERIÊNCIA COM CATETERES SEMI-IMPLANTÁVEIS, no Curso de Acessos Vasculares para Quimioterapia, no Hospital do Câncer A. C. Camargo,
6.2.22. INDICAÇÕES E TIPOS DE CATETERES, no Curso de Acessos Vasculares para Quimioterapia, no Hospital do Câncer A. C. Camargo,
6.3.
6.3.1. HEPARINIZAÇÃO, ANTIBIOTICOTERAPIA E DURABILIDADE DO CATETER, no Módulo II do Fórum de Acessos Vasculares em Quimioterapia, no Hospital Heliópolis,
6.3.2. NOVOS CATETERES DE USO CENTRAL, como palestrante na Mesa Redonda "VIAS DE ACESSO
6.4.
6.4.1. RECONSTRUÇÃO CAROTÍDEA
6.4.2. UTILIZAÇÃO DE CATETERES VENOSOS TOTALMENTE IMPLANTÁVEIS PELA VIA FEMORAL
6.4.3. RECONSTRUÇÕES VASCULARES
6.4.4. CATETERES TOTALMENTE IMPLANTÁVEIS PARA QUIMIOTERAPIA: EXPERIÊNCIA EM 500 CASOS, apresentado na Reunião Cientifica da Regional de São Paulo da Sociedade Brasileira de Angiologia e
6.4.5. ACESSOS CENTRAIS PARA HEMODIÁLISE, no Curso de Angiologia e
6.4.6. ACESSOS CENTRAIS PARA HEMODIÁLISE, no Curso de Angiologia e
6.4.7. CATÉTERES VALVULADOS TOTALMENTE IMPLANTÁVEIS (PORTS GROSHONG) PARA QUIMIOTERAPIA: EXPERIÊNCIA COM 350 DISPOSITIVOS, apresentado na Reunião Cientifica da Regional de São Paulo da Sociedade Brasileira de Angiologia e
6.4.8. CATÉTER RÉTIDO: UMA RARA COMPLICAÇÃO ASSOCIADA COM CATÉTERES TOTALMENTE IMPLANTÁVEIS, apresentado na Reunião Cientifica da Regional de São Paulo da Sociedade Brasileira de Angiologia e
6.5. Organizador, Coordenador de Cursos
6.5.1. Coordenador de Jornada
6.5.1.1. I JORNADA DE ACESSOS VASCULARES
6.5.1.2. III JORNADA DE ACESSOS VASCULARES PARA QUIMIOTERAPIA E HEMODIÁLISE, no Hospital do Câncer A. C. Camargo,
6.5.2. Organização de Cursos
6.5.2.1. I CURSO DE ACESSOS VASCULARES EM QUIMIOTERAPIA, no Hospital do Câncer A. C. Camargo,
6.5.2.2. I CURSO DE BASES TÉCNICAS DA
6.5.3. Comitê de Avaliação em Congressos
6.5.3.1. 11° CONGRESSO BRASILEIRO MULTIDISCIPLINAR E MULTIPROFISSIONAL EM DIABETES, membro da comissão de Temas Livres,
7. ATIVIDADES DIDÁTICAS II
II. ESTUDOS MULTICÊNTRICOS – PESQUISAS CIENTÍFICAS
7.1. EXECUÇÃO DO PROTOCOLO DE PESQUISA – intitulado "ESTUDO PILOTO, DUPLO-CEGO, PLACEBO-CONTROLADO, DA EFICÁCIA E SEGURANÇA DO BMS-207940, UM ANTAGONISTA SELETIVO DO RECEPTOR DA ENDOTELINA A,
III. PROGRAMAS DE EDUCAÇÃO MÉDICA CONTINUADA
7.2. PROGRAMA DE EDUCAÇÃO MÉDICA CONTINUADA DO
7.3. PROGRAMA DE EDUCAÇÃO MÉDICA CONTINUADA DO
7.4. PROGRAMA DE EDUCAÇÃO MÉDICA CONTINUADA DO
7.5. PROGRAMA DE EDUCAÇÃO MÉDICA CONTINUADA DA “SOCIETY FOR VASCULAR SURGERY”, tendo completado os requisitos a fim de receber créditos pela revisão de trabalho científico na revista “Journal of Vascular Surgery”, em janeiro de 2007.
7.6. PROGRAMA DE EDUCAÇÃO MÉDICA CONTINUADA DA “SOCIETY FOR VASCULAR SURGERY”, tendo completado os requisitos a fim de receber créditos pela revisão de trabalho científico na revista “Journal of Vascular Surgery”, em 18 de abril de 2008.
7.7. PROGRAMA DE EDUCAÇÃO MÉDICA CONTINUADA DO
7.8. PROGRAMA DE EDUCAÇÃO MÉDICA, Society for Vascular Surgery, no ano de 2009.
8. COMPARECIMENTO A CONGRESSOS, SIMPÓSIOS E JORNADAS MÉDICAS
8.1. XI ENCONTRO DE ANGIOLOGIA E
8.2. CURSO CONTINUADO DE
8.3. CURSO CONTINUADO DE
8.4. II SIMPÓSIO BRASILEIRO DE FLEBOLOGIA DA SOCIEDADE BRASILEIRA DE ANGIOLOGIA E
8.5. XXXII CONGRESO BRASILEIRO DE ANGIOLOGIA E
8.6. XXXIII CONGRESSO BRASILEIRO DE ANGIOLOGIA E
8.7. SEMINÁRIO DE TELANGIECTASIAS COM LASER DIOLITE 532, promovido por Iriderm Corporation, em Campinas, março de 2000.
8.8. 1º WORKSHOP DE TUMORES VASCULARES – HEMANGIOMAS E LINFANGIOMAS, promovido pelo Centro de Tratamento e Pesquisa do Hospital do Câncer A. C. Camargo,
8.9. I ENCONTRO NACIONAL DE
8.10. XXXIV CONGRESSO BRASILEIRO DE ANGIOLOGIA E
8.11. I SIMPÓSIO INTERNACIONAL DE SIMPATECTOMIA TORÁCICA, promovido pelo Serviço de Cirurgia Torácica da Disciplina de Cirurgia Torácica e Cardiovascular da Faculdade de Medicina da Universidade de São Paulo,
8.12. CURSO PRÁTICO – CIRURGIA LAPAROSCÓPICA, realizado durante o GASTRÃO 2003
8.13. GASTRÃO 2003,
8.14. VIAS DE ACESSO
8.15. I JORNADA DE HIPERIDROSE – CLÍNICA DO SUOR, realizada
8.16. CURSO CONTINUADO DE
8.17. II ENCONTRO
8.18. VIAS DE ACESSO
8.19. CICE 2005 - II CONGRESSO INTERNACIONAL DE
8.20. 10° CONGRESSO BRASILEIRO MULTIDISCIPLINAR E MULTIPROFISSIONAL EM DIABETES, promovido pela ANAD (Associação Nacional de Assistência ao Diabético) e pela FENAD (Federação Nacional das associações e Entidades de Diabetes),
8.21. 36° CONGRESSO BRASILEIRO DE ANGIOLOGIA E
8.22. II JORNADA DE HIPERIDROSE – CLÍNICA DO SUOR, realizada
8.23. IV ENCONTRO
8.24. CICE 2006 - III CONGRESSO INTERNACIONAL DE
8.25. XX ENCONTRO DE ANGIOLOGIA E
8.26. Programa de lançamento do “CENTRO INTEGRADO DE CIRURGIA MINIMAMENTE INVASIVA – MÓDULO VASCULAR – HOSPITAL ISRAELITA ALBERT EINSTEIN”,
8.27. V ENCONTRO
8.28. 1st ENDOVASCULAR PANAMERICAN CONGRESS – VI SITE – 1st LATIN AMERICAN CONGRESS ON VENOUS DISEASE AND LASER THERAPY, no Rio de Janeiro, novembro de 2007.
8.29. CURSO PARA O APRENDIZADO DE TÉCNICAS ENDOVASCULARES 2008, promovido pelo Treinamento
8.30. I INTERNATIONAL SYMPOSIUM OF THROMBOSIS AND ANTICOAGULATION IN INTERNAL MEDICINE,
8.31. 35th ANNUAL VASCULAR AND ENDOVASCULAR ISSUES, TECHNIQUES AND HORIZONS (VEITHsympoiumTM),
8.32. CURSO DE ACESSOS VASCULARES PARA QUIMIOTERAPIA E TRANSPLANTE DE MEDULA ÓSSEA, promovido pelo Hospital do Câncer A. C. Camargo,
9. RESUMOS DE TRABALHOS PUBLICADOS
9.1. Nacionais
9.1.1. A UTILIDADE DA ARTERIOGRAFIA NA AVALIAÇÃO INICIAL DO PACIENTE COM CLAUDICAÇÃO INTERMITENTE.
9.1.2. VALOR PREDITIVO DO ÍNDICE TORNOZELO-BRAÇO NA EVOLUÇÃO DE PACIENTES COM CLAUDICAÇÃO INTERMITENTE. Ruben Rosoky;
9.1.3. RESULTADO DO TRATAMENTO CLÍNICO EM 614 PACIENTES PORTADORES DE CLAUDICAÇÃO INTERMITENTE.
9.1.4. AVALIAÇÃO OBJETIVA DE DISTÂNCIA PERCORRIDA POR PACIENTES COM CLAUDICAÇÃO INTERMITENTE.
9.1.5. COMPARAÇÃO ENTRE MEDIDAS SUBJETIVAS E OBJETIVAS DA DISTÂNCIA DE CLAUDICAÇÃO DURANTE TRATAMENTO CLÍNICO.
9.2. Internacionais
9.2.1. CAROTID RECONSTRUCTION IN PATIENTS OPERATED FOR MALIGNANT HEAD AND NECK NEOPLASIA.
9.2.2. VASCULAR RECONSTRUCTION IN LINBS ASSOCIATED WITH RESECTION OF TUMORS.
9.2.3. RESECTION OF RETROPERITONEAL SARCOMA WITH RECONSTRUCTION OF THE INFRA-RENAL AORTA AND VENA CAVA USING TEMPORARY BYPASSES: A CASE REPORT.
9.2.4. IDIOPATHIC ANEURYSM OF THE INFERIOR VENA CAVA ASSOCIATED WITH RETROPERITONEAL GANGLIONEUROMA: A CASE REPORT.
9.2.5. CATETERES VENOSOS TOTALMENTE IMPLANTÁVEIS PARA QUIMIOTERAPIA: EXPERIÊNCIA EM 415 PACIENTES.
9.2.6. CATETERES SEMI-IMPLANTÁVEIS
10. TRABALHOS APRESENTADOS
10.1. PSEUDOANEURISMAS COMO COMPLICAÇÃO APÓS PROCEDIMENTOS ARTERIAIS INVASIVOS, no XXI Congresso Brasileiro de Cirurgia, IX Congresso Latino-Americano de Cirurgia,
10.2. ISQUEMIA ARTERIAL COMO AOMPLICAÇÃO APÓS PROCEDIMENTOS ARTERIAIS INVASIVOS, no XXI Congresso Brasileiro de Cirurgia, IX Congresso Latino-Americano de Cirurgia,
10.3. ISQUEMIA ARTERIAL COMO COMPLICAÇÃO APÓS PROCEDIMENTOS ARTERIAIS INVASIVOS, XXXI Congresso Brasileiro de Angiologia e
10.4. PSEUDOANEURISMAS COMO COMPLICAÇÃO APÓS PROCEDIMENTOS ARTERIAIS INVASIVOS, no XXXI Congresso Brasileiro de Angiologia e
10.5. A UTILIDADE DA ARTERIOGRAFIA NA AVALIAÇÃO INICIAL DO PACIENTE COM CLAUDICAÇÃO INTERMITENTE, no XXXII Congresso Brasileiro de Angiologia e
10.6. RESULTADO DO TRATAMENTO CLÍNICO EM 614 PACIENTES PORTADORES DE CLAUDICAÇÃO INTERMITENTE, no XXXII Congresso Brasileiro de Angiologia e
10.7. VIA DE ACESSO ALTERNATIVA PARA ANGIOPLASTIA ASSOCIADA À AMPUTAÇÃO TRANSTIBIAL: APRESENTAÇÃO DE UM CASO, no XXXII Congresso Brasileiro de Angiologia e
10.8. VALOR PREDITIVO DO ÍNDICE TORNOZELO-BRAÇO NA EVOLUÇÃO DE PACIENTES COM CLAUDICAÇÃO INTERMITENTE, no XXXII Congresso Brasileiro de Angiologia e
10.9. RECONSTRUÇÕES VASCULARES
10.10. RECONSTRUÇÕES VASCULARES
10.11. CATETERES PARCIALMENTE IMPLANTÁVEIS NO TRATAMENTO DE TRANSPLANTE DE MEDULA, no XXXIV Congresso Brasileiro de Angiologia e
10.12. CATETERES PARCIALMENTE IMPLANTÁVEIS NO TRATAMENTO QUIMIOTERÁPICO DE TUMORES SÓLIDOS, no XXXIV Congresso Brasileiro de Angiologia e
10.13. TROMBOSE VENOSA (TVP) ASSOCIADA A CATETERES DEFINITIVOS PARA TRATAMENTO DE PACIENTES ONCOLÓGICOS, no XXXIV Congresso Brasileiro de Angiologia e
10.14. CATETERES TOTALMENTE IMPLANTÁVEIS PARA O TRATAMENTO DE PACIENTES COM TUMORES SÓLIDOS, no XXXIV Congresso Brasileiro de Angiologia e
10.15. RECONTRUÇÕES CAROTÍDEAS
10.16. HIPERIDROSE PALMAR – QUAL MELHOR NÍVEL DE RESSECÇÃO T2 OU T3?,
10.17. ANÁLISE DA EVOLUÇÃO TEMPORAL DA HIPERIDROSE PLANTAR APÓS A SIMPATECTOMIA POR VÍDEO, no 36° Congresso Brasileiro de Angiologia e
10.18. TRATAMENTO DA HIPERIDROSE AXILAR PELA SIMPATECTOMIA TORÁCICA VÍDEO-ASSISTIDA: ANÁLISE DE 276 CASOS, no 36° Congresso Brasileiro de Angiologia e
11. TRABALHOS APRESENTADOS
11.1. COMPARAÇÃO ENTRE MEDIDAS SUBJETIVAS E OBJETIVAS DA DISTÂNCIA DE CLAUDICAÇÃO DURANTE TRATAMENTO CLÍNICO, no XXXI Congresso Brasileiro de Angiologia e
11.2. AVALIAÇÃO OBJETIVA DE DISTÂNCIA PERCORRIDA POR PACIENTES COM CLAUDICAÇÃO INTERMITENTE, no XXXI Congresso Brasileiro de Angiologia e
11.3. USO DE TÉCNICAS ENDOVASCULARES NA COLOCAÇÃO DE SHUNT TOTALMENTE IMPLANTÁVEL PELA VEIA JUGULAR EXTERNA, no XXXI Congresso Brasileiro de Angiologia e
11.4. VALORIZAÇÃO DAS MEDIDAS DE DISTÂNCIA DE CLAUDICAÇÃO INTERMITENTES REFERIDAS PELOS PACIENTES. UM MÉTODO DE AVALIAÇÃO ADEQUADO?, no XXXIV Congresso Brasileiro de Angiologia e
11.5. O USO DA COMPRESSÃO ELÁSTICA NO TRATAMENTO DO EDEMA DE MEMBRO INFERIOR NA FASE AGUDA DA TROMBOSE VENOSA PROFUNDA, no XXXIV Congresso Brasileiro de Angiologia e
11.6. TRATAMENTO DA HIPERIDROSE PALMAR PELA SIMPATECTOMIA VIDEOTORACOSCÓPICA: COMPARAÇÃO DE DUAS TÉCNICAS (T2 OU T3), no 36° Congresso Brasileiro de Angiologia e
11.7. COMPARAÇÃO DOS RESULTADOS DA SIMPATECTOMIA VIDEOTORACOSCÓPICA PARA TRATAMENTO DA HIPERIDROSE PALMAR NOS NÍVEIS: T3 E T4, no 36° Congresso Brasileiro de Angiologia e
12. TRABALHOS PUBLICADOS COMO RESUMO
12.1. EXPERIÊNCIA COM 228 CASOS SUBMETIDOS À COLOCAÇÃO DE SHUNT IMPLANTÁVEL PARA QUIMIOTERAPIA NO HOSPITAL DO CÂNCER A. C. CAMARGO. Yazbek, G.; Fritela, S.; Nishinari, K.; Malavolta, L.C.; Wolosker, N. Revista
12.2. USO DE TÉCNICAS ENDOVASCULARES NA COLOCAÇÃO DE SHUNT TOTALMENTE IMPLNATÁVEL PELA VEIA JUGULAR EXTERNA. Yazbek, G.; Nishinari, K.; Malavolta, L.C.; Kuzniec, S.; Wolosker, N. Revista
12.3. O USO DA COMPRESSÃO ELÁSTICA NO TRATAMENTO DO EDEMA DE MEMBRO INFERIOR NA FASE AGUDA DA TROMBOSE VENOSA PROFUNDA. Yazbek,G.; Nishinari,K.; Nishimoto, I.N.; Malavolta,L.; Wolosker,N. Revista
12.4. VALORIZAÇÃO DAS MEDIDAS DE DISTÂNCIA DE CLAUDICAÇÃO INTERMITENTE REFERIDAS PELOS PACIENTES. UM MÉTODO DE AVALIAÇÃO ADEQUADO? Yazbek,G.; Rosoky, R.A.; Nishimoto,I.N.; Wolosker,N.; Puech-Leão, P. Revista
12.5. RECONSTRUÇÃO CAROTÍDEA
12.6. RECONSTRUÇÕES VASCULARES
12.7. CATETERES PARCIALMENTE IMPLANTÁVEIS NO TRATAMENTO DE TRANSPLANTE DE MEDULA. Malavolta, L.C.; Nishinari, K.; Yazbek, G.; Zerati, A.; Langer, M.; Wolosker,N. Revista
12.8. CATETERES PARCIALMENTE IMPLANTÁVEIS NO TRATAMENTO QUIMIOTERÁPICO DE TUMORES SÓLIDOS. Zerati, A.; Malavolta, L.C.; Nishinari, K.; Yazbek, G.; Langer, M.; Wolosker, N. Revista
12.9. TROMBOSE VENOSA (TVP) ASSOCIADA A CATETERES DEFINITIVOS PARA TRATAMENTO DE PACIENTES ONCOLÓGICOS. Malavolta, L.C.; Nishinari, K.; Yazbek, G.; Zerati, A.; Langer, M.; Wolosker,N. Revista
12.10. CATETERES TOTALMENTE IMPLANTÁVEIS PARA O TRATAMENTO DE PACIENTES COM TUMORES SÓLIDOS. Zerati, A; Malavolta LM.; Nishinari, K.; Yazbek, G.; Langer, M.; Wolosker, N. Revista
12.11. TRATAMENTO DA HIPERIDROSE AXILAR PELA SIMPATECTOMIA TORÁCICA VÍDEO-ASSISTIDA: ANÁLISE DE 276 CASOS. Kauffman P, Wolosker N, Munia MA, Kuzniec S, Yazbek G, de Campos JRM, Puech-Leão P. Jornal Vascular Brasileiro, vol 4 n° 3 – Supl.1, pág S27, 2005.
12.12. TRATAMENTO DA HIPERIDROSE PALMAR PELA SIMPATECTOMIA VIDEOTORACOSCÓPICA: COMPARAÇÃO DE DUAS TÉCNICAS (T2 OU T3). Yazbek G, Wolosker N, Munia MA, Kauffman P, de Campos JRM, Puech-Leão P. Jornal Vascular Brasileiro, vol 4 n° 3 – Supl.1, pág S27, 2005.
12.13. COMPARAÇÃO DOS RESULTADOS DA SIMPATECTOMIA VIDEOTORACOSCÓPICA PARA TRATAMENTO DA HIPERIDROSE PALMAR NOS NÍVEIS: T3 E T4. Yazbek G, Ishy A, Wolosker N, de Campos JRM, Kauffman P, Puech-Leão P. Jornal Vascular Brasileiro, vol 4 n° 3 – Supl.1, pág S75, 2005.
12.14. ANÁLISE DA EVOLUÇÃO TEMPORAL DA HIPERIDROSE PLANTAR APÓS A SIMPATECTOMIA POR VÍDEO. Wolosker N, Yazbek G, de Campos JRM, Kauffman P, Ishy A, Puech-Leão P. Jornal Vascular Brasileiro, vol 4 n° 3 – Supl.1, pág S170, 2005.
13. ARTIGOS PUBLICADOS EM REVISTAS
13.1. Nacionais
13.1.1. UTILIZAÇÃO DOS CATETERES DE HICKMAN
O transplante autólogo de medula óssea é realizado com os cateteres semi implatáveis para coleta de células tronco para restaurar a hematopoiese após a mieloablação quimioterápica. Estudaram-se prospectivamente os resultados obtidos com a colocação e utilização desses cateteres. Material e Métodos: Foram implantados 49 cateteres para transplante autólogo de medula óssea preferencialmente sob anestesia geral e utilizando-se a veia jugular interna direita. O cateter apresentava perfil específico (13,5 Fr) para a coleta de células tronco e infusão de drogas e hemoderivados. Foram avaliadas as complicações precoces, as tardias e a evolução. Resultados: A duração média dos cateteres foi de 82 dias. Entre as complicações precoces observamos dois hematomas de trajeto e uma bacteremia primária. Entre as complicações tardias, observamos 24 complicações infecciosas (0,74/1000 dias de uso de cateter). Foram retirados 38 cateteres, 21 relacionados às complicações e 17 por final de tratamento. Seis pacientes foram à óbito com o cateter funcionante e cinco pacientes ainda faziam uso do cateter. Conclusão: os cateteres semi implantáveis são essenciais para a realização do transplante autólogo de medula óssea e podem ser utilizados por um longo período, entretanto não são isentos de complicações, que sendo conhecidas podem ser evitadas e tratadas para a melhoria dos resultados obtidos.
13.1.2. CATÉTERES VENOSOS TOTALMENTE IMPLANTÁVEIS PARA QUIMIOTERAPIA: EXPERIÊNCIA EM 415 PACIENTES.
Os dispositivos totalmente implantáveis vem sendo cada vez mais utilizados para tratamento quimioterápico de pacientes oncológicos, porém poucos são os estudos em nosso meio que analisam os resultados obtidos com o implante e utilização desses cateteres.
Material e Métodos: Foram colocados 430 cateteres totalmente implantáveis em 415 pacientes a serem submetidos a regime de quimioterapia preferencialmente utilizando-se a veia jugular externa direita. Foram avaliadas as complicações precoces, as tardias e a evolução até a retirada do dispositivo, morte ou fim de tratamento.
Resultados: A análise prospectiva mostrou uma duração média dos cateteres de 290 dias. Não observou-se nenhuma complicação em 340 pacientes. Entre as complicações precoces observamos 11 hematomas de trajeto, 10 arritmias, 6 tromboflebite de coto distal de veia jugular externa e uma infecção de bolsa de subcutâneo. Entre as complicações tardias, observamos 38 complicações infecciosas (0,3/1000 dias de uso de cateter), 10 obstruções (0,08/1000 dias de uso de catete) e 13 tromboses venosas profundas (0,11/1000 dias de uso de cateter). Foram retirados 77 cateteres, 29 relacionados às complicações e 48 por final de tratamento. 172 pacientes foram a óbito com o cateter estava funcionante e 181 pacientes ainda faziam uso do cateter.
Conclusão: As baixas taxas de complicação obtidas nesse estudo que implicaram em perda do cateter confirmam a segurança e conveniência do uso dos acessos totalmente implantáveis em pacientes em regime prolongado de quimioterapia.
13.2. Nacionais (MEDLINE)
13.2.1. ISQUEMIA ARTERIAL AGUDA DE MEMBROS COMO COMPLICAÇÃO APÓS PROCEDIMENTOS ARTERIAIS INVASIVOS EM CARDIOLOGIA,
13.2.2. CAROTID RECONSTRUCTION IN PATIENTS OPERATED FOR MALIGNANT HEAD AND NECK NEOPLASIA. Nishinari K, Wolosker N, Yazbek G, Malavolta LC, Zerati AE, Kowalski LP. Sao Paulo Med J. 2002 Sep 2;120(5):137-40.
Patients with malignant head and neck neoplasia may present simultaneous involvement of large vessels due to the growth of the tumoral mass. The therapeutic options are chemotherapy, radiotherapy, surgery or combined treatments. Objective: To analyse the result of surgical treatment with carotid reconstruction in patients with advanced malignant head and neck neoplasia. Design: Prospective. Participants: Eleven patients operated because of advanced malignant head and neck neoplasia that was involving the internal and/or common carotid artery. Main measurements: By means of clinicalexamination, outpatient follow-up and duplex scanning, we analyzed the patency of carotid grafts, vascular and non-vascular complications, desease recurrence and survival of the patients. Results: Six patients (54.5%) does not present any type of complication represented by an occlusion of the carotid graft with a cerebrovascular stroke in one hemisphere. Non-vascular complications occurred in five patients (45.5%). During the follow-up, eight patients died (72.7%), of whom seven had pulmonary and hepatic metastases (at an average of 9 months after the operation). Seven of these patiens presents functioning grafts. The three patients still alive have no tumor recurrence and their grafts are functioning (an average of 9 months has passed since the operation). Conclusions: Patients with advanced malignant head and neck neoplasia involving the carotid artery that are treated surgically present a prognosis with reservations. When the internal and/or common carotid artery is resected en-bloc with the tumor, arterial reconstruction must be performed. The long saphenous vein is a suitable vascular substitute. Key words: Head and neck neoplasms. Carotid arteries. Neck neoplasms. Neoplasia. Carotid artery diseases. Carotid. Artery. Vascular. Resection. Arterial. Grafting.
13.3. Internacionais
13.3.1. RESECTION OF RETROPERITONEAL SARCOMA WITH RECONSTRUCTION OF THE INFRA-RENAL AORTA AND VENA CAVA USING TEMPORARY BYPASSES.
Retroperitoneal sarcomas are rare tumors characterized by the absence of specific symptoms, wich is why their diagnosis is delayed and becomes possible only when they are already bulky. Surgical resection is the main form of treatment and reconstructions of large abdominal vessels concomitant to neoplasm resection are sometimes necessary. We report a case of resection of a retroperitoneal sarcoma with a non-described surgical technique: repair of the infra-renal aorta and vena cava, in which we utilized temporary bypasses to reduce the time of ischemia and of retroperitoneal bleeding. Retroperitoneal sarcomas are rather rare tumors that comprise up to 15% of all soft tissue sarcomas. They are characterized by the absence of specific symptoms, wich is why their diagnosis is delayed and becomes possible only when they are already bulky. Surgical resection is the main form of treatment of retroperitoneal sarcomas since characteristically they do not respond to radiotherapy and/or chemotheraphy, especially the low malignancy grade tumors. The outcome of the treatment then rests mainly upon the possibility of complete resection and of the degree of the malignancy. In some cases, in order to achieve complete en bloc resection, withdrawal of the tumor is required with replacement of the large abdominal vessels, in which the vascular cross-clamping time is not foreseeable with possible local or systemic significant consequences. We herein report a case of resection of a retroperitoneal sarcoma with a non-described surgical technique: repair of the infra-renal aorta and vena cava, in which we utilized temporary bypasses to reduce the time of ischemia and of retroperitoneal bleeding.
13.4. Internacionais (ISI)
13.4.1. IDIOPATHIC ANEURYSM OF THE INFERIOR VENA CAVA ASSOCIATED WITH RETROPERITONEAL GANGLIONEUROMA: A CASE REPORT.
Venous aneurysms are less common than arterial aneurysms in clinical practice, and the occurrence of isolated cases is a topic for publication. Idiopathic aneurysms of the inferior vena cava are very rare, and their origin is unknown. With regard to their shape, they can be saccular, fusiform or diverticular. Many aneurysms are asymptomatic, with the diagnosis being established from radiological findings. Others are diagnosed after complications occur, with the most common of these being thrombosis of aneurysms that are associated with severe symptomatology in lower limbs. Other dramatic complications are pulmonary embolism, cerebral embolism, rupture and genital bleeding. Because of the rarity of this pathology and consequent absence of standardization in the treatment, the conduct must be adapted to fit each case. Ganglioneuromas are infrequent benign tumors that are preferentially located in the mediastinum and retroperitoneum. Most of them do not have endocrine activity and the clinical manifestations are related to the growth of the mass, which leads to compressive symptoms. Diagnosis of the mass is achieved via computerized tomography or nuclear magnetic resonance, and histological diagnosis may be obtained via biopsy puncture. The treatment of ganglioneuromas is eminently surgical. We describe a novel case of a patient with idiopathic aneurysm of the inferior vena cava associated with retroperitoneal ganglioneuroma. The diagnosis of these pathologies was obtained from the symptoms related to the growth of the tumor. The diagnosis of ganglioneuroma was made after biopsy of the mass and the diagnosis of the aneurysm of the vena cava was made from the findings of computerized tomography. The patient underwent combined surgical treatment, with resection of the tumor and the aneurysm, and the short-term results were excellent.
13.4.2. VASCULAR RECONSTRUCTIONS IN LIMBS ASSOCIATED TO RESECTION OF TUMORS.
BACKGROUND: Patients with tumors of the extremities submitted to surgical treatment may present involvement of major vessels. Major arteries must be reconstructed for limb salvage. Major veins may be reconstructed. The objective of this study is to analyze the result of surgical treatment of tumors associated to vascular reconstructions of the extremities. METHODS: Seventeen patients with tumors involving major vessels of the extremities submitted to vascular reconstructions, were followed up prospectively. Arterial and venous reconstructions were performed in nine patients, an arterial reconstruction was performed in six patients and a venous reconstruction was performed in two patients. The vascular substitutes utilized were: greater saphenous vein (19), expanded polytetrafluorethylene prosthesis (5) and Dacron prosthesis (2). RESULTS: Vascular complications occurred in seven patients: one rupture of the arterial graft, three occlusions of the venous graft and lymphedema in five patients. Non vascular complications were detected in ten patients: pulmonary metastases (7), local recurrence (2), neurological deficit (2), infection of the surgical wound (2), partial necrosis of the flap (1) and enteric fistula (1). Six patients with pulmonary metastases died. One patient was submitted to transfemoral amputation. CONCLUSIONS: Major arterial and venous reconstructions associated to resection of limb neoplasm are safe procedures. Venous revascularization should be performed with an autologous substitute.
13.4.3. VASCULAR RECONSTRUCTIONS IN LIMBS WITH MALIGNANT TUMORS. Nishinari K, Wolosker N, Yazbek G, Zerati AE, Nishimoto IN, Penna V, Lopes A. Vasc Endovascular Surg. 2004 Sep-Oct;38(5):423-9.
BACKGROUND: Patients with tumors in limbs who undergo surgical treatment may present involvement of major vessels. Major arteries must be reconstructed for limb salvage. Major veins may be reconstructed to avoid the onset of venous hypertension. The objective of this study is to analyze the results from surgical treatment of malignant tumors associated with vascular reconstruction in limbs. METHODS: A prospective follow-up was made of twenty patients with malignant tumors involving major vessels in limbs, who underwent vascular reconstruction. Arterial and venous reconstructions were performed in eleven patients, arterial reconstruction in seven patients and venous reconstruction in two patients. The vascular substitutes utilized were: greater saphenous vein (21), expanded polytetrafluoroethylene prosthesis (5) and Dacron prosthesis (5).RESULTS: Vascular complications occurred in nine patients: one rupture of the arterial graft, four occlusions of the venous graft and worsening of previous edema in five patients. Non-vascular complications occurred in six patients: infection (2), neurological deficit (2), partial necrosis of the flap (1) and enteric fistula (1). Four patients presented local recurrence, and one of them underwent transfemoral amputation. Seven patients presented pulmonary metastases, of whom four died. CONCLUSIONS: Arterial revascularization in association with the resection of limb neoplasm is a safe procedure with a low rate of complications. Venous revascularization should be performed using an autologous substitute.
13.4.4. TOTALLY IMPLANTABLE VENOUS CATHETERS FOR CHEMOTHERAPY: EXPERIENCE IN 500 PATIENTS. Wolosker N, Yazbek G, Nishinari K, Malavolta LC, Munia MA, Langer M, Zerati AE. S Paulo Med J. 2004;122(4):147-151.
CONTEXT: Totally implantable devices are increasingly being utilized for chemotherapy treatment of oncological patients, although few studies have been done in our environment to analyze the results obtained from the implantation and utilization of such catheters.
OBJECTIVE: To study the results obtained from the implantation of totally implantable catheters in patients submitted to chemotherapy.
TYPE OF STUDY: Prospective.
SETTING: Hospital do Câncer A. C. Camargo, São Paulo, Brazil.
METHODS: 519 totally implantable catheters were placed in 500 patients submitted to chemotherapy, with preference to the use of the right external jugular vein. There were evaluated the early and late-stage complications and patient evolution until removal of the device, death or the end of the treatment.
RESULTS: The prospective analysis showed an average duration of 353 days for the catheters. There were 427 (82.2%) catheters with no complications. Among the early complications observed, there were 15 pathway hematomas, 8 of thrombophlebitis of the distal stump of the external jugular vein and one case of pocket infection. Among the late-stage complications observed, there were 43 infectious complications (0.23/1000 days of catheter use), 11 obstructions (0.06/1000 days of catheter use) and 14 cases of deep vein thrombosis (0.07/1000 days of catheter use). Hundred and one catheters were removed: 35 due to complications and 66 upon terminating the treatment. 240 patients died while the catheter was functioning and 178 patients are still making use of the catheter.
CONCLUSION: The low rate of complications obtained in this study confirms the safety and convenience of the use of totally implantable accesses in patients undergoing prolonged chemotherapy regimes.
13.4.5. TOTALLY IMPLANTABLE FEMORAL VEIN CATHETERS IN CANCER PATIENTS.
INTRODUCTION: Totally implantable devices are increasingly being utilized for chemotherapy treatment of oncological patients. When it is impossible to implant the reservoir on the anterior wall of the thorax, or when there is an obstruction of the superior vena cava system, alternative access routes must be sought. Of these, the femoral vein is the most utilized. Few studies have been performed to analyse the results obtained from the implantation and utilization of such catheters in the femoral vein. The goal of this work was to prospectively study the results obtained from the implantation of 20 TIC in femoral veins in a large-sized cancer hospital with its own dedicated vascular clinical team. MATERIAL AND METHODS: Twenty femoral TIC were inserted in 20 patients out of a group of 560 cancer patients submitted to TIC implantation for chemotherapy. Evaluations were made of the early and late-stage complications and patient evolution until removal of the device, death or the end of the treatment. RESULTS: The prospective analysis showed a mean duration of 215 days for the catheters. There were 16 patients with no complications. There were no early complications. Among the late complications, three were infections, representing 0.69/1000 days of catheter use, and one was a deep vein thrombosis (0.23/1000 days of catheter use). One catheter was removed due to primary bacteremia and one due to subcutaneous pocket infection. Fourteen patients died while the catheter was functioning and four patients are still making use of the catheter. CONCLUSION: The low rate of complications implying catheter loss in this study confirms the safety and convenience of the use of femoral TIC in patients who cannot be submitted to implantation in the superior vena cava system.
13.4.6. PALMAR HYPERHIDROSIS - WHICH IS THE BEST LEVEL OF DENERVATION USING VIDEO-ASSISTED THORACOSCOPIC SYMPATHECTOMY: T2 OR T3 GANGLION? Yazbek G, Wolosker N, de Campos JR, Kauffman P, Ishy A, Puech-Leão P. J Vasc Surg. 2005 Aug;42(2):281-5.
PURPOSE: This study compares early results of video-assisted thoracoscopic sympathectomy (VTS) at the thoracic T2 versus T3 ganglion denervation levels for the treatment of palmar hyperhidrosis (PH). METHODS: Sixty patients with PH were prospectively randomized for VTS at the thoracic T2 or T3 ganglion denervation levels. The patients underwent postoperative evaluation on three occasions: before surgery, and 1 and 6 months after the operation. Endpoints included the absence of PH, the presence, location, and severity of compensatory hyperhidrosis (CH), and a quality-of-life assessment. RESULTS: Fifty-nine of 60 patients reported complete resolution of PH after surgery. One failure occurred in the T3 group. CH was observed in 26 patients (86.66%) in the T2 group and in 27 patients (90%) in the T3 group at 1 month. At 6 months, 30 of 30 patients in the T2 group and 29 of
13.4.7. VENA CAVA FILTERS IN CANCER PATIENTS: EXPERIENCE WITH 50 PATIENTS. Zerati AE, Wolosker N, Yazbek G, Langer M, Nishinari K. Clinics. 2005 Oct;60(5):361-6.
OBJECTIVE: To study the immediate and late results obtained from the implantation of vena cava filters in cancer patients with deep vein thrombosis concomitant with neoplasia.
METHODS: This was a retrospective evaluation of 50 patients with an association of cancer and deep venous thrombosis who underwent interruption of the inferior vena cava and the insertion of permanent vena cava filters. The indications for the procedure, filter implantation technique, early and late complications related to the operation, and the clinical evolution were evaluated.
RESULTS: The most frequent indication for filter implantation was the contraindication for full anticoagulant treatment (80%). The femoral vein was the preferred access route (86% of the patients). There were no complications related to the surgical procedure. During the follow-up, the following complications were observed: 1 episode of nonfatal pulmonary thromboembolism, 2 cases of occlusion of the inferior vena cava, and 1 case of thrombus retained in the device. Twenty patients (40%) died due to progression of the neoplasm.
CONCLUSIONS: Interruption of the inferior cava vein using an endoluminal filter is a procedure with a low rate of complications. It is a safe and efficient measure for preventing pulmonary embolism in cancer patients who have deep vein thrombosis of the lower limbs.
13.4.8. ARTERIAL RECONSTRUCTIONS ASSOCIATED WITH THE RESECTION OF MALIGNANT TUMORS.
Objectives: patients with malignant tumors affecting the vascular bundle submitted to surgical treatment and concomitant vascular reconstruction is not a frequent condition. The published samples include venous and arterial reconstructions or contain small number of patients. This study compares the results in the treatment of patients who underwent resection of malignant neoplasia with concomitant arterial reconstructions in three different regions: Neck (N), Extremities (E) and Abdomen (A).
Methods: Thirty-eight patients submitted to 40 arterial reconstructions were prospectively followed up with an average of 24 months. Endpoints included primary patency of the reconstructions, vascular complications and survival.
Results: There were five graft complications: three occlusions, one occlusion of branch and one rupture (two in the N group, two in the E and one in the A). There were two amputations of limbs unrelated to failure of vascular reconstruction. Twenty patients died because the primary disease. The statistical analysis showed no differences in primary patency between the groups (P< .6921). There was a worse prognosis for the Neck group (P< .0089).
Conclusions: The primary patency of the arterial reconstructions is good and there is no statistical difference between the groups, but patients with neck neoplasia present a worse prognosis.
13.4.9. VENOUS RECONSTRUCTIONS IN LOWER LIMBS ASSOCIATED WITH RESECTION OF MALIGNANCIES.
BACKGROUND: Patients with tumors in limbs who undergo surgical treatment may present involvement of major vessels. Major arteries are always reconstructed for limb salvage. Major veins may be reconstructed to avoid the onset of venous hypertension. The objective of this study was to analyze the results from lower limb venous reconstructions associated with the resection of malignant tumors.
METHODS: A prospective follow-up was made of fourteen patients with malignant tumors involving major veins in lower limbs. Venous concomitant to arterial reconstructions was performed in twelve patients and venous reconstruction in two patients. The venous substitutes utilized were: greater saphenous vein (9), expanded polytetrafluoroethylene prosthesis (3) and Dacron prosthesis (2).
RESULTS: Vascular complications occurred in six patients: three occlusions of the venous graft after 2, 3 and 8 months, edema in six patients and one rupture of the arterial graft. Nonvascular complications occurred in five patients: partial necrosis of the flap (2), infection (1), neurological deficit (1) and enteric fistula (1). Two patients presented local recurrence and one of them underwent transfemoral amputation. Seven patients presented pulmonary metastases, of whom six died.
CONCLUSIONS: Lower limb venous reconstruction associated with tumor resection should be performed. The saphenous vein is an adequate substitute.
13.4.10. EVALUATION OF PLANTAR HYPERHIDROSIS IN PATIENTS UNDERGOING VIDEO-ASSISTED THORACOSCOPIC SYMPATHECTOMY.
Sympathectomy is the treatment of choice for primary hyperhidrosis. A curious fact of difficult anatomic-physiologic explanation observed in cases of Video-assisted thoracoscopic sympathectomy (VATS) for the treatment of palmar hyperidrosis is the improvement in Plantar hyperidrosis (PLH). Nevertheless, current reports on VATS rarely describe the effect on PLH or just give us superficial data.
The aim of this study was to prospectively investigate howcome surgery affects PLH in patients with palmo-plantar hyperidrosis during a period of one year.
Methods: From May 2003 to January 2004, 70 patients with combined PH and PLH underwent VATS in the levels T2, T3 or T4 ganglion level. (47 women and 23 men, at a mean age of 23 years);
Results: During the immediate postoperative period, all the patients denied episodes of PH. Two patients (2,8%) suffered continued PH. Compensatory Hyperhidrosis (CH) was observed in 58 (90,6%) patients after one year in different degrees. Only 13 (20,3%) suffered severe
There was a great initial improvement (50%) in PLH followed by a progressive regression of that improvement (23,4%) after one year. Absence of improvement increased progressively (from 17,1% to 37,5%) and Low improvement rates remained stable (32,9 to 39,1%). Of the 24 patients with no improvement after one year, 6 patients graded plantar sweating worse.
Conclusion: Patients submitted to VATS for treatment of palmo-plantar hyperidrosis present a good initial improvement in PLH that reduces after the period of 1 year in smaller levels.
13.4.11. ABDOMINAL AORTIC PSEUDOANEURYSM ASSOCIATED WITH A METASTATIC GERM CELL TUMOR: A RARE COMPLICATION.
The first description of en bloc resection of malignant neoplasia involving the abdominal aorta along with its reconstruction, was published by Crawford and DeBakey in 1956. Since then, few studies have been published, and most of the aortic reconstructions have been associated with retroperitoneal tumors originating from germinative cells. On rare occasions, these tumors cause erosion of the aorta, with the formation of a pseudoaneurysm and only two cases have been described.
We describe the case of a patient with primary testicular cancer, presenting retroperitoneal recurrence with formation of a pseudoaneurysm requiring surgical treatment.
13.4.12. IS SYMPATHECTOMY AT T4 LEVEL BETTER THAN AT T3 LEVEL FOR TREATING PALMAR HYPERHIDROSIS? Wolosker N, Yazbek G, Ishy A, de Campos JR, Kauffman P, Puech-Leão P. J Laparoendosc Adv Surg Tech A. 2008 Feb;18(1):102-6.
PURPOSE: We compared the results from a video-assisted thoracoscopic sympathectomy (VTS) at the T4 denervation level with those from a VTS at the T3 level for the treatment of palmar hyperhydrosis (PH). METHODS: Seventy patients with PH were prospectively followed for VTS at the T3 or T4 denervation levels for 6 months. The end points of this study were: absence of PH, compensatory hyperhydrosis (CH), and quality-of-life assessment. RESULTS: Sixty-seven patients reported a complete resolution of PH after surgery. One failure occurred in the T3 group and
13.4.13. TWENTY MONTHS OF EVOLUTION FOLLOWING SYMPATHECTOMY ON PATIENTS WITH PALMAR HYPERHIDROSIS: SYMPATHECTOMY AT THE T3 LEVEL IS BETTER THAN AT THE T2 LEVEL.
OBJECTIVE: To compare two surgical techniques (denervation levels) for sympathectomy using video-assisted thoracoscopy to treat palmar hyperhidrosis in the long-term. METHODS: From May 2003 to June 2006, 60 patients with palmar hyperhidrosis were prospectively randomized for video-assisted thoracoscopic sympathectomy at the T2 or T3 ganglion level. They were followed for a mean of 20 months and were evaluated regarding their degree of improvement of palmar hyperhidrosis, incidence and severity of compensatory hyperhidrosis and its evolution over time, and quality of life. RESULTS: Fifty-nine cases presented resolution of the palmar hyperhidrosis. One case of therapeutic failure occurred in the T3 group. Most of the patients presented an improvement in palmar hyperhidrosis, without any difference between the groups. Twenty months later, all patients in both groups presented some degree of compensatory hyperhidrosis but with less severity in the T3 group (p = 0.007). Compensatory hyperhidrosis developed in most patients during the first month after the operation, with incidence and severity that remained stable over time. An improvement in quality of life was seen starting from the first postoperative evaluation but without any difference between the groups. This improvement was maintained until the end of the follow-up. CONCLUSION: Both techniques were effective for treating palmar hyperhidrosis. The most frequent complication was compensatory hyperhidrosis, which presented stable incidence and severity over the study period. Sympathectomy at the T3 level presented compensatory hyperhidrosis with less severity. Nevertheless, the improvement in quality of life was similar between the groups.
13.4.14. QUALITY OF LIFE BEFORE SURGERY IS A PREDICTIVE FACTOR FOR SATISFACTION AMONG PATIENTS UNDERGOING SYMPATHECTOMY TO TREAT HYPERHIDROSIS. Wolosker N, Yazbek G, Ribas Milanez de Campos J, Munia MA, Kauffman P, Jatene FB, Puech-Leão P. J Vasc Surg. 2010. [IN PRESS]
PURPOSE: The objective of this study was to evaluate the postoperative quality of life (QOL) experienced among a group of 1167 patients who underwent video-assisted thoracoscopic sympathectomy (VATS) to treat primary hyperhidrosis, as compared with the presurgical QOL. METHODS: Between February 2002 and June 2007, 1167 patients who had undergone VATS were surveyed. The majority had presented with palmar hyperhidrosis (794 patients; 68%), while 340 (29%) had presented with axillary hyperhidrosis. Based on data obtained from the QOL protocol applied to all of the patients preoperatively, the patients were divided into two groups according to the level of their QOL: group 1 consisted of 312 patients (27%) with poor QOL and group 2 of 855 patients (73%) with very poor QOL. The same protocol was applied postoperatively, and five different levels of satisfaction were obtained. The same parameters were evaluated for both the palmar and the axillary hyperhidrosis subgroups. RESULTS: The patients with very poor QOL had much better results in terms of improvement in QOL than did those with poor QOL (P < .05). The same result was observed for both the palmar and axillary hyperhidrosis subgroups (P < .05). CONCLUSION: The worse the preoperative QOL among patients undergoing sympathectomy to treat primary hyperhidrosis is, the better the postoperative improvement in QOL will be.
13.4.15. COMPARISON OF PAIN SEVERITY FOLLOWING VIDEO-ASSISTED THORACOSCOPIC SYMPATHECTOMY: ELECTRIC VERSUS HARMONIC SCALPELS.
The aim of this study was to compare the severity of pain over a 30-day period in a group of 1515 patients who underwent video-assisted thoracoscopic sympathectomy (VATS) to treat primary hyperhidrosis, among whom 929 were treated using electric scalpels and 586 using harmonic scalpels. From February 2000 to June 2008, 1515 patients scheduled for VATS were prospectively surveyed. They were divided into two groups according to whether electric or harmonic scalpels would be used. The patients filled out a protocol at every visit according to their subjective perception of pain, evaluating it on a scale from 0 to 10, such that 0 represented no pain and 10, maximum pain. The severity was recorded as null when the score was 0; slight, 1-4; moderate, 5-7; or severe, 8-10. The results from the evaluations were compared between the two groups. Only 152 patients did not present postoperative pain. No significant association was found between the type of scalpel used and the severity of the pain. There was no difference between harmonic and electric scalpel use in the levels of thoracic pain during the first 30 days after VATS. Keywords: Thoracic pain; Sympathectomy; Postoperative period; Hyperhidrosis.
13.4.16. TOTALLY IMPLANTABLE PORTS CONNECTED TO VALVED CATHETERS FOR CHEMOTHERAPY: EXPERIENCE FROM 350 GROSHONG DEVICES. Nishinari K, Wolosker N, Bernardi CV, Yazbek G. J Vasc Access. 2010. [IN PRESS]
Purpose: There are few studies regarding the use of totally implantable valved ports for chemotherapy. The objective of this study was to analyze the results obtained from consecutive implantation of 350 devices. Methods: Adult patients submitted to port insertion in veins of the superior vena cava system over a 17-month period (July 2006 to December 2007) were considered. The device used was composed of a titanium and silicone rubber port (Dome PortTM; Bard Inc,
13.4.17. RETAINED CATHETER: A RARE COMPLICATION ASSOCIATED WITH TOTALLY IMPLANTABLE VENOUS PORTS. Nishinari K, Bernardi CV, Wolosker N, Yazbek G. J Vasc Access. 2010. [IN PRESS]
Totally implantable venous ports are the main access for chemotherapy. The complications associated with these devices occur most frequently over the course of their use. We report two cases of a complication that had only been described in patients with partially implantable catheters for hemodialysis: retention of a catheter fragment within a vessel during port removal. Both patients underwent adjuvant chemotherapy through the port and even after indication of catheter removal because at the end of treatment, they remained with the devices for long periods of time (7 and 8 yrs, respectively). Due to adherence of the catheters along their intravascular portions, complete removal was impossible. The catheters were sectioned and ligated close to the site where it entered the access vein. After 1 yr of follow-up, both patients were asymptomatic and imaging examinations showed the retained catheters. We believe that an implantable port should be removed after appropriate oncological follow-up.
13.4.18. COVERED STENT TREATMENT FOR AN ANEURYSM OF A SAPHENOUS VEIN GRAFT TO THE COMMON CAROTID ARTERY. Nishinari K, Wolosker N, Yazbek G, Bernardi CV. Annals of Vascular Surgery. 2010. [IN PRESS]
13.5. Internacionais (MEDLINE)
13.5.1. ENDOVASCULAR TECHNIQUES FOR PLACEMENT OF LONG-TERM CHEMOTHERAPY CATHETERS. Yazbek G, Zerati AE, Malavolta LC, Nishinari K, Wolosker N. Rev Hosp Clin Fac Med Sao Paulo. 2003 Jul-Aug;58(4):215-8.
14. AUTOR DE CAPÍTULO DE LIVRO
14.1. CATETERES ENDOVENOSOS
14.2. CATETERES ENDOVENOSOS
14. 3. EQUIPAMENTOS NECESSÁRIOS PARA INSERÇÃO DE CATETERES,
14. 4. TÉCNICA DE INSERÇÃO POR DISSECÇÃO,
14. 5. TÉCNICAS DE INSERÇÃO POR PUNÇÃO,
15. PRÊMIOS
15.1. HIPERIDROSE PALMAR – QUAL MELHOR NÍVEL DE RESSECÇÃO T2 OU T3?,
16. PARTICIPAÇÃO
16.1. Membro do Conselho Médico Editorial da Revista Vascular In, desde 2003.