Objectives This thesis aimed to explore psychological factors associated with walking behaviour in patients with Peripheral Arterial Disease, within the framework of Leventhal et al’s (1998) Common-sense Model of Self-regulation of Health and Illness. The objective was to identify psychological factors which could be modified to increase walking behaviour in these patients. Method A series of three studies were conducted to achieve these aims. The first study was an exploratory qualitative study, to explore the illness and treatment beliefs and walking behaviour of patients with intermittent claudication. The second study was a cross-sectional postal questionnaire to a cohort of patients with intermittent claudication, which tested the influence of the psychological factors identified in the qualitative study, in a larger sample. The final study was a randomised controlled trial of a brief psychological intervention designed to modify the illness and walking beliefs of patients with intermittent claudication, in order to increase walking behaviour. Results Beliefs about intermittent claudication, and beliefs about walking were both found to be associated with walking behaviour in the qualitative study. The results from the cross-sectional postal questionnaire confirmed this relationship – taken as a set, illness and walking beliefs accurately predicted adherence to minimum walking levels for 93.4% of the sample. The brief psychological intervention successfully modified illness and treatment beliefs and increased walking behaviour in patients newly diagnosed with intermittent claudication. Conclusion This thesis highlights the importance of illness and walking beliefs to the walking behaviour of patients with intermittent claudication. The thesis has added to the body of knowledge about intermittent claudication, and the findings of this thesis have implications for the treatment of patients with intermittent claudication within the health service. Theoretical and clinical implications of this research are discussed.

Bakgrund: Claudicatio Intermittens är vanligt förekommande hos äldre personer och ger upphov till fysiska och psykiska besvär såsom försämrad gångförmåga och sämre livskvalite. Fysisk aktivitet är en viktig fysioterapeutisk behandlingsmetod som har visat goda resultat för patientgruppen. Därför är det viktigt att sammanställa aktuell evidens för att öka och tillgängliggöra ny kunskap. Syfte: Att undersöka det vetenskapliga underlaget för fysisk aktivitet som behandling och dess effekt på gångförmåga och livskvalitet hos patienter med claudicatio intermittens. Metod: Studiens design var litteraturstudie. En litteratursökning efter randomiserade kontrollerade studier genomfördes i databasen PubMed. De utvalda studiernas kvalitet granskades enligt PEDro-skalan och tillförlitligheten av resultatet bedömdes utifrån ”Bedömning av den sammanvägda tillförlitligheten i systematiska översikter”. Resultat: Sex studier inkluderades i litteraturstudien. Bäst resultat gällande gångförmåga och livskvalitet fick grupperna som genomgick endovaskulär revaskularisering i kombination med en intervention som innehöll fysisk aktivitet. Samtliga studier fick hög kvalitet från granskningen enligt PEDro. Tillförlitligheten av det sammanvägda resultatet bedömdes enligt ”Bedömning av den sammanvägda tillförlitligheten i systematiska översikter” vara låg. Konklusion: Kombinationen av endovaskulär revaskularisering och fysisk aktivitet hade positiv effekt på utfallsmåttet gångförmåga och livskvalitét hos patienter med claudicatio intermittens, men ingen skillnad mellan olika sorters fysisk aktivitet framgick. Fler studier av hög kvalitet som jämför liknande interventioner behövs för att med hög tillförlitlighet kunna avgöra vilken behandling som ger bäst effekt. / Background: Intermittent claudication is common in the elderly population and causes physical and psychological problems such as impaired walking ability and poorer quality of life. Physical activity is an important physiotherapeutic method that has shown promising results for this population. Therefore, it is important to summarize current evidence in order to increase new knowledge and make it available. Purpose: The aim of this literature study was to examine the scientific evidence for physical activity as a treatment, and its effect on walking capacity and quality of life in patients with intermittent claudication  Method: The design of the study was literature study. A literature search for randomized controlled trials was conducted in the PubMed database. The quality of the included studies was examined by the PEDro scale, and the reliability of the results was assessed with ”Bedömning av den sammanvägda tillförlitligheten i systematiska översikter”. Result:  Six studies were included in the literature study. The best results regarding walking ability and quality of life were obtained by the groups that underwent endovascular revascularization in combination with an intervention that included physical activity. All studies received high quality according to PEDro. According to with ”Bedömning av den sammanvägda tillförlitligheten i systematiska översikter”, the reliability of the combined results was considered low. Conclusion: The combination of endovascular revascularization and physical activity had a positive effect on the outcome measures walking ability and quality of life in patients with intermittent claudication. No difference between different types of physical activity could be seen. More studies of high quality comparing similar interventions are needed to be able to determine, with high reliability, which treatment produces the best effect.

Nine patients with intermittent claudication diagnosed at least 6 months before this investigation were evaluated to determine the effects of walking exercise on serum lactate accumulation (HLa, mmol⁻¹), ankle pressure index (API), total treadmill time (sec), and onset of leg pain (sec) in the most severely diseased limb. Subjects were evaluated via a functional walking tolerance test before participation in a thrice-weekly exercise program lasting 6 weeks. Post- treatment, the participants were re-evaluated on an identical walking test. Measurements of HLa accumulation and API were taken at rest and immediately following termination of the treadmill test. In the training sessions, body weight (kg), exercise heart rate (HR), systolic blood pressure (SBP), and distance traveled (m) were recorded daily. There were no significant changes (p<.05) after training in total time (mean increase = 23.7%) or time for onset of pain in the treadmill test (mean increase = 30.1%). Neither were there significant changes (p<.05) in API or HLa levels taken immediately after exercise, when pre- and post-training treadmill test data were compared. The weekly responses for exercise HR, and SBP, as well as body weight remained stable throughout. Mean distance walked by the subjects increased 203% (± 45%) across the 6 weeks. These data suggest that increases in total distance walked in an exercise program were apparently not related to HLa accumulation or API measurements in the working muscles, and that other mechanisms must be investigated in future studies to explain enhanced performance of such subjects. / Master of Science

A Estenose de Canal Lombar (ECL) é caracterizada pela redução do espaço de elementos neurais ou vasculares da coluna lombar. Os sintomas incluem dor e/ou parestesia em membros inferiores, região lombar, e glúteos e Claudicação Intermitente Neurogênica. O tratamento conservador é a escolha inicial para o manejo de pacientes com ECL, por isso é importante a identificação de diferentes estratégias para o tratamento conservador, e a compreensão das alterações em parâmetros funcionais que estes tratamentos geram. O presente estudo objetivou comparar os efeitos de 24 sessões de Fisioterapia Aquática (GFA) e de Fisioterapia Solo (GFS) nos parâmetros espaço-temporais de marcha, equilíbrio, nível de dor percebida, incapacidade, capacidade física funcional, medo de movimento e níveis de depressão em indivíduos com ECL. Para observação das diferenças entre os grupos e momentos foi realizado o teste de Equações de Estimativa Generalizada no software SPSS versão 20.0. Para todas as análises o índice de significância adotado foi de 95% (α=0,05). Os níveis de incapacidade, dor, e estados depressivos reduziram, bem como a velocidade de caminhada autosselecionada e o índice de reabilitação locomotora aumentaram após as intervenções sem diferenças entre os grupos. O GFA apresentou melhora dos parâmetros espaço-temporais de marcha em velocidade fixa, redução da ingesta de medicação analgésica, e redução da média semanal de dor mais cedo que o GFS. O GFS demonstrou maior melhora da mobilidade funcional indicando um melhor equilíbrio após a intervenção em comparação ao GFA. Tratamentos fisioterapêuticos estruturados com associação de exercícios de estabilização de tronco, alongamentos e terapia manual mostram-se eficazes para melhora da incapacidade, dor, depressão e parâmetros de marcha em indivíduos com Estenose da Canal Lombar, sendo o meio aquático potencializador da resposta analgésica e da melhora em parâmetros espaço temporais de marcha e o solo potencializador da melhora do equilíbrio. / Lumbar Spinal Stenosis (LSS) is characterized by a reduction in the space of vascular and neuronal elements of the spinal canal space. Symptoms include pain and/or paresthesia in lower limbs, lumbar region and buttocks, and Neurogenic Intermittent Claudication. Conservative treatments are the choice for initial management of patients with LSS, therefore it is important to identify different conservative treatments strategies and understanding of the changes in functional parameters that those treatments cause. The present study aimed to compare the effects of 24 physiotherapy sections of Aquatic Physiotherapy (GFA) and Ground Physiotherapy (GFS) in spatiotemporal gait parameters, balance, perceived level of pain, disability, functional exercise capacity, fear of movement, and clinical depression in individuals with LSS. Generalized Estimating Equations were made to observe the differences between groups and moments on SPSS software version 20.0. For all tests, the significance level was 95% (α = 0,05). Disability, pain and depressive symptoms reduced and selfselected walking speed and locomotor rehabilitation index increased after interventions with no differences between groups. GFA improve spatiotemporal gait parameter in fixed speed, reduced analgesic medication, and show an earlier reduction in weekly pain. GFS improve functional mobility indicating a better balance in comparison to GFA. Physiotherapeutic treatments structured with the association of stabilization exercises, stretching exercises and manual therapy are efficient in improving disability, pain, depression and gait parameters in Lumbar Spinal Stenosis patients, water environment potentiate analgesic and spatiotemporal improvements, and land potentiate balance improvements.

A Estenose de Canal Lombar (ECL) é caracterizada pela redução do espaço de elementos neurais ou vasculares da coluna lombar. Os sintomas incluem dor e/ou parestesia em membros inferiores, região lombar, e glúteos e Claudicação Intermitente Neurogênica. O tratamento conservador é a escolha inicial para o manejo de pacientes com ECL, por isso é importante a identificação de diferentes estratégias para o tratamento conservador, e a compreensão das alterações em parâmetros funcionais que estes tratamentos geram. O presente estudo objetivou comparar os efeitos de 24 sessões de Fisioterapia Aquática (GFA) e de Fisioterapia Solo (GFS) nos parâmetros espaço-temporais de marcha, equilíbrio, nível de dor percebida, incapacidade, capacidade física funcional, medo de movimento e níveis de depressão em indivíduos com ECL. Para observação das diferenças entre os grupos e momentos foi realizado o teste de Equações de Estimativa Generalizada no software SPSS versão 20.0. Para todas as análises o índice de significância adotado foi de 95% (α=0,05). Os níveis de incapacidade, dor, e estados depressivos reduziram, bem como a velocidade de caminhada autosselecionada e o índice de reabilitação locomotora aumentaram após as intervenções sem diferenças entre os grupos. O GFA apresentou melhora dos parâmetros espaço-temporais de marcha em velocidade fixa, redução da ingesta de medicação analgésica, e redução da média semanal de dor mais cedo que o GFS. O GFS demonstrou maior melhora da mobilidade funcional indicando um melhor equilíbrio após a intervenção em comparação ao GFA. Tratamentos fisioterapêuticos estruturados com associação de exercícios de estabilização de tronco, alongamentos e terapia manual mostram-se eficazes para melhora da incapacidade, dor, depressão e parâmetros de marcha em indivíduos com Estenose da Canal Lombar, sendo o meio aquático potencializador da resposta analgésica e da melhora em parâmetros espaço temporais de marcha e o solo potencializador da melhora do equilíbrio. / Lumbar Spinal Stenosis (LSS) is characterized by a reduction in the space of vascular and neuronal elements of the spinal canal space. Symptoms include pain and/or paresthesia in lower limbs, lumbar region and buttocks, and Neurogenic Intermittent Claudication. Conservative treatments are the choice for initial management of patients with LSS, therefore it is important to identify different conservative treatments strategies and understanding of the changes in functional parameters that those treatments cause. The present study aimed to compare the effects of 24 physiotherapy sections of Aquatic Physiotherapy (GFA) and Ground Physiotherapy (GFS) in spatiotemporal gait parameters, balance, perceived level of pain, disability, functional exercise capacity, fear of movement, and clinical depression in individuals with LSS. Generalized Estimating Equations were made to observe the differences between groups and moments on SPSS software version 20.0. For all tests, the significance level was 95% (α = 0,05). Disability, pain and depressive symptoms reduced and selfselected walking speed and locomotor rehabilitation index increased after interventions with no differences between groups. GFA improve spatiotemporal gait parameter in fixed speed, reduced analgesic medication, and show an earlier reduction in weekly pain. GFS improve functional mobility indicating a better balance in comparison to GFA. Physiotherapeutic treatments structured with the association of stabilization exercises, stretching exercises and manual therapy are efficient in improving disability, pain, depression and gait parameters in Lumbar Spinal Stenosis patients, water environment potentiate analgesic and spatiotemporal improvements, and land potentiate balance improvements.

A Estenose de Canal Lombar (ECL) é caracterizada pela redução do espaço de elementos neurais ou vasculares da coluna lombar. Os sintomas incluem dor e/ou parestesia em membros inferiores, região lombar, e glúteos e Claudicação Intermitente Neurogênica. O tratamento conservador é a escolha inicial para o manejo de pacientes com ECL, por isso é importante a identificação de diferentes estratégias para o tratamento conservador, e a compreensão das alterações em parâmetros funcionais que estes tratamentos geram. O presente estudo objetivou comparar os efeitos de 24 sessões de Fisioterapia Aquática (GFA) e de Fisioterapia Solo (GFS) nos parâmetros espaço-temporais de marcha, equilíbrio, nível de dor percebida, incapacidade, capacidade física funcional, medo de movimento e níveis de depressão em indivíduos com ECL. Para observação das diferenças entre os grupos e momentos foi realizado o teste de Equações de Estimativa Generalizada no software SPSS versão 20.0. Para todas as análises o índice de significância adotado foi de 95% (α=0,05). Os níveis de incapacidade, dor, e estados depressivos reduziram, bem como a velocidade de caminhada autosselecionada e o índice de reabilitação locomotora aumentaram após as intervenções sem diferenças entre os grupos. O GFA apresentou melhora dos parâmetros espaço-temporais de marcha em velocidade fixa, redução da ingesta de medicação analgésica, e redução da média semanal de dor mais cedo que o GFS. O GFS demonstrou maior melhora da mobilidade funcional indicando um melhor equilíbrio após a intervenção em comparação ao GFA. Tratamentos fisioterapêuticos estruturados com associação de exercícios de estabilização de tronco, alongamentos e terapia manual mostram-se eficazes para melhora da incapacidade, dor, depressão e parâmetros de marcha em indivíduos com Estenose da Canal Lombar, sendo o meio aquático potencializador da resposta analgésica e da melhora em parâmetros espaço temporais de marcha e o solo potencializador da melhora do equilíbrio. / Lumbar Spinal Stenosis (LSS) is characterized by a reduction in the space of vascular and neuronal elements of the spinal canal space. Symptoms include pain and/or paresthesia in lower limbs, lumbar region and buttocks, and Neurogenic Intermittent Claudication. Conservative treatments are the choice for initial management of patients with LSS, therefore it is important to identify different conservative treatments strategies and understanding of the changes in functional parameters that those treatments cause. The present study aimed to compare the effects of 24 physiotherapy sections of Aquatic Physiotherapy (GFA) and Ground Physiotherapy (GFS) in spatiotemporal gait parameters, balance, perceived level of pain, disability, functional exercise capacity, fear of movement, and clinical depression in individuals with LSS. Generalized Estimating Equations were made to observe the differences between groups and moments on SPSS software version 20.0. For all tests, the significance level was 95% (α = 0,05). Disability, pain and depressive symptoms reduced and selfselected walking speed and locomotor rehabilitation index increased after interventions with no differences between groups. GFA improve spatiotemporal gait parameter in fixed speed, reduced analgesic medication, and show an earlier reduction in weekly pain. GFS improve functional mobility indicating a better balance in comparison to GFA. Physiotherapeutic treatments structured with the association of stabilization exercises, stretching exercises and manual therapy are efficient in improving disability, pain, depression and gait parameters in Lumbar Spinal Stenosis patients, water environment potentiate analgesic and spatiotemporal improvements, and land potentiate balance improvements.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-19T18:55:06Z No. of bitstreams: 1 Adilson Santos Andrade de Sousa.pdf: 1247821 bytes, checksum: 9a8380bf13484c105223476f4ae7b8b5 (MD5) / Made available in DSpace on 2018-07-19T18:55:06Z (GMT). No. of bitstreams: 1 Adilson Santos Andrade de Sousa.pdf: 1247821 bytes, checksum: 9a8380bf13484c105223476f4ae7b8b5 (MD5) Previous issue date: 2018-04-29 / Patients with peripheral arterial disease have low levels of physical activity and high cardiovascular risk. Although peripheral arterial disease has a similar prevalence between men and women, studies have shown that the consequences of the disease are extremely different between the sexes. Studies show that women have lower functional capacity and lower levels of physical activity than men. However, the sexes are different from the barriers to the practice of physical activity and cardiovascular health indicators have not yet been studied. Objective: To compare the barriers to the practice of physical activity, cardiovascular function and arterial rigidity among men and women with peripheral arterial disease. Material and Method: this is a descriptive epidemiological study. The study included 267 patients with peripheral arterial disease and symptoms of intermittent claudication divided into two studies, 102 patients in the first study and 167 patients in the second study. The patients were submitted to the evaluation of physical activity level and barriers to the practice of physical activity, as well as cardiovascular health indicators (auscultatory arterial pressure, autonomic cardiovascular modulation, and arterial stiffness). Results: Women had a higher rate of increase by 34% compared to men who presented 29%, women had a rate of increase corrected by 75 beats per minute 31%, men had 25%. Women with peripheral arterial disease had lower levels of physical activity with moderate and vigorous intensity and reported more frequently than the following barriers to physical activity: lack of companionship to practice physical activity, fear of physical activity aggravate the disease, no place to sit when pain is felt and no place to practice physical activity. Conclusion: Regarding the cardiovascular variables, women present higher reflected wave indicators than men, as well as presented more barriers to physical activity compared to men. / Pacientes com doença arterial periférica apresentam baixos níveis de atividade física e elevado risco cardiovascular. Embora a doença arterial periférica tenha prevalência similar entre homens e mulheres, estudos têm mostrado que as consequências da doença são extremamente diferentes entre os sexos. Estudos mostram que as mulheres apresentam menor capacidade funcional e menores níveis de atividade física do que os homens. Porém, o quanto os sexos são diferentes às barreiras para a prática de atividade física e os indicadores de saúde cardiovascular ainda não foram estudados. Objetivo: Comparar as barreiras para a prática de atividade física, função cardiovascular e rigidez arterial entre homens e mulheres com doença arterial periférica. Material e Método: trata-se de um estudo epidemiológico descritivo. Fizeram parte do estudo 267 pacientes com doença arterial periférica e sintomas de claudicação intermitente divididos em dois estudos, no primeiro estudo foram 102 pacientes e no segundo estudo 167 pacientes. Os pacientes foram submetidos à avaliação do nível de atividade física e das barreiras para a prática de atividade física, bem como dos indicadores da saúde cardiovascular (pressão arterial auscultatória, modulação autonômica cardiovascular, e rigidez arterial).Resultados: As mulheres apresentaram maior índice de aumento 34% em comparação aos homens que apresentaram 29%, as mulheres apresentaram um índice de aumento corrigido por 75 batimentos por minuto 31%, os homens apresentaram 25%. As mulheres com doença arterial periférica apresentaram menores níveis de atividade física com intensidade moderada e vigorosa e reportam mais frequentemente que as seguintes barreiras para a prática de atividade físca: falta de companhia para a prática de atividade física, medo da atividade física agravar a doença, não ter lugar para sentar quando sente dor e não ter lugar para a prática de atividade física. Conclusão: Com relação às variáveis cardiovasculares as mulheres apresentam maiores indicadores de onda refletida do que os homens, bem como apresentaram mais barreiras para a prática de atividade física em comparação aos homens.

Popliteal artery entrapment syndrome has been reported to be a rare disease typically found in athletic and otherwise healthy young adults. It manifests as a temporary lower limb pain that occurs in connection with physical exercise. It is caused by an anatomic anomaly, usually anaberrant head of the gastrocnemius muscle that compresses the popliteal artery on the backside of the knee joint. The popliteal artery is the main vessel supplying blood to the lower part of the leg and the condition, if left untreated, can lead to serious complications such as thrombosis or aneurysm. If detected in time and surgically corrected patients can expect full recovery within weeks.The purpose of this study was to examine a group of healthy asymptomatic individuals (n=50)using ultrasound and a series of provocation to see if there was a possibility of entrapment. A secondary objective was to find which maneuvers during the ultrasound would provide the best results. They were subjected to ultrasound examinations at rest, during plantar flexion without resistance, against a light resistance and against substantial resistance.The results showed that most of the test subjects could temporarily constrict blood flow greatly although ultrasound imagery alone was not enough to confirm diagnosis. It seems that detected occlusion of the artery in conjunction with other diagnostic data such as AnkleBrachial Index and symptomatology can be useful both in confirming or ruling out PAESwithout the use of more expensive and invasive methods.

Tyrimo objektas. 27–90 metų asmenys, sergantys pirmojo ir antrojo tipo diabetu ir periferinių arterijų liga, gydyti Vilniaus universiteto kraujagyslių chirurgijos centre Vilniaus miesto universitetinėje ligoninėje 1997–2011 m. Tyrimo tikslas. Nustatyti Vilniaus universiteto kraujagyslių chirurgijos centre Vilniaus miesto universitetinėje ligoninėje gydytų pacientų, sergančių diabetu, periferinių arterijų ligos ypatumus, PAL padarinius ir PAL padarinių rizikos veiksnius. Tyrimo medžiaga ir metodai. Išanalizuotos 925 pacientų, sergančių 1 ir 2 tipo diabetu ir 1997–2011 metais gydytų Vilniaus universiteto kraujagyslių chirurgijos centre Vilniaus miesto universitetinėje ligoninėje nuo periferinių arterijų ligos istorijos. Statistinė analizė atlikta SPSS 19.0 for Windows programų paketu. Pasirinktas statistinio reikšmingumo lygmuo &#945;=0,05. Rezultatai. Ištyrėme 387 moterų ir 538 vyrų, duomenis. Vidutinis tiriamųjų amžius buvo 67,99±9,47 metų. 95,6 proc. tiriamųjų sirgo 2 tipo diabetu. Vidutinė sirgimo diabetu trukmė buvo 12,95±9,91 metų. Diabetinę angiopatiją turėjo 47,8 proc. tiriamųjų, nefropatiją – 34,9 proc., retinopatiją – 14,6 proc., polineuropatiją – 33,7 proc.. Statistiškai reikšmingai dažniau nefropatija, retinopatija ir polineuropatija buvo nustatyta pacientams, sergantiems 1 tipo diabetu. Pacientai dažniausiai sirgo širdies ir kraujagyslių sistemos ligomis. 21,2 proc. tiriamųjų jau buvo patyrę galūnių amputacijas. Vidutinė hospitalizacijos trukmė buvo 17,3±10,80... [toliau žr. visą tekstą] / Object of the research. 27–90 years old patients having the type 1 and type 2 diabetes mellitus and peripheral artery disease, who were treated at the Vilnius University Vascular Surgery Center in the Vilnius town University Hospital in the year 1997–2011. The aim of our research was. To analyse aspects of peripheral artery disease in patients with diabetes mellitus, who were cured at Vilnius University Vascular Surgery Center in the Vilnius town University Hospital as well as to determine the consequenses of PAD and the risk factors PAD. Material and methods of the research. 925 cases of the type 1 and type 2 diabetes mellitus were explored at the Vilnius University Vascular Surgery center in the Vilnius town University hospital in the year 1997–2011, who received treatment for the peripheral artery disease. The statistic survey has been done using the program pack SPSS 19.0 for Windows. Statistic importance level &#945;=0.05. Results. Data about 378 women and 538 men have been explored. An average age of all the patients was 67.99±9.47 years. 95.6% of patients had the type 2 diabetes mellitus. An average duration of having disease was 12.95±9.91 years, 47.8% of cases had diabetic angiopathy, 34.9% of patients had nephropaty, 14.6% of cases had retinopathy, 33.7% of all the cases had polyneuropathy. According to the statistic importance rates retinopathy, nephropathy, polyneuropathy are more often among patients with the type 1 diabetes mellitus. Cardiovascular diseases were... [to full text]

Apesar dos grandes avanços na medicina perioperatória, as operações vasculares ainda estão associadas a elevada morbi-mortalidade. A fisiopatologia dos eventos perioperatórios é complexa, envolvendo a instabilização de placas ateroscleróticas, o que não é contemplado nos algoritmos para estratificação de risco cardíaco perioperatório. Acreditamos que a identificação de características relacionadas à instabilização de placas incipientes, como alterações na reatividade vascular e maior atividade inflamatória, pode melhorar a acurácia da estimativa de risco e a análise do comportamento perioperatório destas características pode elucidar importantes mecanismos fisiopatológicos. Estudamos 100 pacientes com indicação de operação vascular e aferimos por meio de ultrassom-Doppler de artéria braquial, a hiperemia reativa (HR), marcador de função microvascular, e a dilatação mediada pelo fluxo (DMF), marcador de função endotelial, antes e após a operação. Analisamos também os níveis de proteina-C reativa ultra-sensível (PCR-us). A operação foi realizada em 96 pacientes e 27 deles apresentaram algum evento até o 30º dia pós-operatório: 4 óbitos cardíacos, 5 infartos agudos do miocárdio, 2 acidentes vasculares cerebrais isquêmicos, 2 elevações isoladas de troponina, 1 embolia de pulmão, 2 reoperações e 11 óbitos não cardíacos. Detectamos disfunção endotelial em 70% dos pacientes, mas não observamos nenhum padrão característico de comportamento perioperatório da DMF, ou associação significativa entre a mesma e os eventos. Observamos significativo aumento da PCR-us após a intervenção cirúrgica (0,5mg/dL x 3,01mg/dL, P=0,001), mas sem associação com eventos. Identificamos forte associação entre disfunção microvascular, representada pela menor velocidade de fluxo na artéria braquial durante a hiperemia reativa, e eventos: 81 cm/s + 20 x 95 cm/s + 28 ( P= 0,02). Concluímos que a identificação de disfunção microvascular no pré-operatório pode estratificar o risco de complicações perioperatórias e que embora não tenhamos observado piora da vasodilatação mediada pelo fluxo, não podemos afastar que haja piora da função endotelial no perioperatório. O aumento de PCR-us denota grande diátese inflamatória, que pode estar relacionada à disfunção endotelial. / Despite great advances in perioperative care, major vascular surgeries are still related to high morbidity and mortality. The pathophysiology of perioperative cardiac events is complex and comprehends atherosclerotic plaque instability, witch is not contemplated in the current algorithms for cardiac risk estimation. We hypothesized that the identification of characteristics related to predisposition for plaque instability, such as abnormalities in the vascular reactivity, is very promising and the characterization of this parameter`s behavior in the perioperative setting contributes to the better understanding of event\'s pathophysiology. We prospectively studied a cohort of 100 patients, candidates for elective major vascular surgery and assessed, by Doppler ultrasound in the brachial artery, reactive hyperemia(RH), a marker of microvascular function, and flow mediated dilation(FMD), a marker of endothelial function, before and after surgery. We also obtained C-reactive protein-high sensitive assay (CRP-hs) before and after surgery. Ninety six patients were submitted to the planned vascular surgery and 27 patients had an event up to the 30º postoperative day. We observed 4 cardiac deaths, 5 acute myocardial infarctions, 2 isolated troponin elevations, 2 ischemic strokes, 1 pulmonary embolism, 2 reoperations and 11 noncardiac deaths. Results: although there was no significant difference in the preoperative FMD between patients with and without events: 4.83% + 6.81 x 5.88% + 6.00 (p= .457), respectively, low RH response, measured as lower peak flow velocity in RH, was associated to events: 81 cm/s + 20 x 95 cm/s + 28 (p=0,02). There was no significant difference in the preoperative CRP-hs between groups (median: 0.51mg/dL (IQR 2.12) x 0.41mg/dL (IQR 0.59), p= .234). There was no significant difference between FMD before and after surgery but we detected an almost 6-fold increase in CRP-hs after surgery: 0.50mg/dL x 3.01mg/dL (p < .001), respectively. Our study demonstrated that microvascular dysfunction is closely related to perioperative events after major vascular surgery and is a better marker of perioperative risk than endothelial dysfunction, in specific conditions.