Made available in DSpace on 2014-06-11T19:26:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-18Bitstream added on 2014-06-13T20:34:48Z : No. of bitstreams: 1 brandao_gms_me_botfm.pdf: 1478164 bytes, checksum: 2a2a85c3df30f48b27dadc4c51f20e91 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Universidade Estadual Paulista (UNESP) / A trombose venosa profunda (TVP) dos membros inferiores é doença grave, potencialmente fatal e pode levar à síndrome pós-trombótica (SPT). A SPT é doença crônica, com consideráveis conseqüências socioeconômicas para os pacientes serviços de saúde. Sua fisiopatologia relaciona-se com o surgimento de hipertensão venosa, que ocorre devido à incompetência valvular e a obstrução da veia pelo trombo residual. Assim, é importante conhecer o processo de recanalização das veias trombosadas para melhor compreensão das seqüelas da TVP. Avaliar e quantificar o processo inicial de recanalização das veias dos membros inferiores após um episódio de TVP aguda pelo mapeamento dúplex em cores (MDC). Estudou-se pelo MDC 12 pacientes na fase aguda (até 10 dias), no 1°, 3º e 6º mês após o episódio agudo de TVP. Os pacientes foram mantidos com terapia anticoagulante adequada por 6 meses e orientados a usar meias de compressão elástica. Para avaliar e quantificar a recanalização foram utilizados o escore trombótico (ET) e a variação percentual do diâmetro venoso na máxima compressibilidade em relação a sua ausência (Δ%Øvmax/Øvsem). O ET foi verificado em 18 segmentos venosos (veias ilíaca externa; femoral comum; femoral profunda; femoral ao nível da junção e a 10 cm da prega inguinal; poplítea supra patelar e cavo; fibulares; tibiais posteriores; gastrocnêmias; soleares; veia safena magna ao nível da crossa, terço proximal, médio e distal; veia safena parva ao nível da crossa, terço proximal e médio). Segmentos venosos patentes tiveram ET de zero. A TVP foi considerada parcialmente oclusiva quando o segmento venoso foi não compressível com um sinal Doppler presente (ET = 1). Considerou-se a TVP totalmente oclusiva quando o segmento venoso foi não compressível e o sinal Doppler não foi encontrado (ET = 2). Para cada membro foi calculado o ET total... / The deep vein thrombosis (DVT) of the lower limbs is a serious, potentially fatal disease and it can lead to the post-thrombotic syndrome (PTS). The PTS is a chronic disease, with considerable social and economical consequences for the patients and health services. His physiopathology is connected with the appearance of vein high blood pressure that takes place due to the valval incompetence and the obstruction of the vein for the residual thrombus. So, it is important to know the process of recanalization of the thrombosed veins for better understanding of the sequels of the DVT. The objective of this study was to evaluate and quantify the early recanalization of the vein of the lower limbs after acute DVT by duplex ultrasound scanning (DUS). Twelve elegible patients were examined by DUS at acute phase (less than 10 days), 1°, 3º and 6º months after the first episode of DVT. All patients were treated initially with unfractionated heparin or low-molecular-weightheparin followed by oral anticoagulation for 6 months and strongly encouraged to use compression stockings. To evaluate and quantify the recanalization of the veins were used the thrombus escore (TS) and the percentage variation of the vein diameter during the maximal compressibility regarding his absence (PVVDMA). The thrombus score (TS) assigned to 18 vein segments: external iliac vein; common femoral vein; deep femoral vein; confluence of femoral and deep femoral vein; femoral vein 10 cm at the inguinal ligament; popliteal vein suprapatellar; popliteal vein fossa; fibular veins; posterior tibial veins; gastrocnemius veins; soleal veins; sapheno-femoral junction; grate saphenous... (Complete abstract click electronic access below)

Resumo: A trombose venosa profunda (TVP) dos membros inferiores é doença grave, potencialmente fatal e pode levar à síndrome pós-trombótica (SPT). A SPT é doença crônica, com consideráveis conseqüências socioeconômicas para os pacientes serviços de saúde. Sua fisiopatologia relaciona-se com o surgimento de hipertensão venosa, que ocorre devido à incompetência valvular e a obstrução da veia pelo trombo residual. Assim, é importante conhecer o processo de recanalização das veias trombosadas para melhor compreensão das seqüelas da TVP. Avaliar e quantificar o processo inicial de recanalização das veias dos membros inferiores após um episódio de TVP aguda pelo mapeamento dúplex em cores (MDC). Estudou-se pelo MDC 12 pacientes na fase aguda (até 10 dias), no 1°, 3º e 6º mês após o episódio agudo de TVP. Os pacientes foram mantidos com terapia anticoagulante adequada por 6 meses e orientados a usar meias de compressão elástica. Para avaliar e quantificar a recanalização foram utilizados o escore trombótico (ET) e a variação percentual do diâmetro venoso na máxima compressibilidade em relação a sua ausência (Δ%Øvmax/Øvsem). O ET foi verificado em 18 segmentos venosos (veias ilíaca externa; femoral comum; femoral profunda; femoral ao nível da junção e a 10 cm da prega inguinal; poplítea supra patelar e cavo; fibulares; tibiais posteriores; gastrocnêmias; soleares; veia safena magna ao nível da crossa, terço proximal, médio e distal; veia safena parva ao nível da crossa, terço proximal e médio). Segmentos venosos patentes tiveram ET de zero. A TVP foi considerada parcialmente oclusiva quando o segmento venoso foi não compressível com um sinal Doppler presente (ET = 1). Considerou-se a TVP totalmente oclusiva quando o segmento venoso foi não compressível e o sinal Doppler não foi encontrado (ET = 2). Para cada membro foi calculado o ET total... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The deep vein thrombosis (DVT) of the lower limbs is a serious, potentially fatal disease and it can lead to the post-thrombotic syndrome (PTS). The PTS is a chronic disease, with considerable social and economical consequences for the patients and health services. His physiopathology is connected with the appearance of vein high blood pressure that takes place due to the valval incompetence and the obstruction of the vein for the residual thrombus. So, it is important to know the process of recanalization of the thrombosed veins for better understanding of the sequels of the DVT. The objective of this study was to evaluate and quantify the early recanalization of the vein of the lower limbs after acute DVT by duplex ultrasound scanning (DUS). Twelve elegible patients were examined by DUS at acute phase (less than 10 days), 1°, 3º and 6º months after the first episode of DVT. All patients were treated initially with unfractionated heparin or low-molecular-weightheparin followed by oral anticoagulation for 6 months and strongly encouraged to use compression stockings. To evaluate and quantify the recanalization of the veins were used the thrombus escore (TS) and the percentage variation of the vein diameter during the maximal compressibility regarding his absence (PVVDMA). The thrombus score (TS) assigned to 18 vein segments: external iliac vein; common femoral vein; deep femoral vein; confluence of femoral and deep femoral vein; femoral vein 10 cm at the inguinal ligament; popliteal vein suprapatellar; popliteal vein fossa; fibular veins; posterior tibial veins; gastrocnemius veins; soleal veins; sapheno-femoral junction; grate saphenous... (Complete abstract click electronic access below) / Orientador: Hamilton Almeida Rollo / Coorientador: Marcone Lima Sobreira / Banca: José Bitu Moreno / Banca: Regina Moura / Mestre

Objectives: Pelvic vein incompetence (PVI) has been suggested as a cause for chronic pelvic pain. The overall objective of this thesis is to determine how PVI affects women, identify suitable methods of diagnosis and provide evidence regarding its association with chronic pelvic pain. This thesis will also evaluate the evidence behind its treatment. Methods: Four observation studies were completed during this thesis. A characterisation study encompassing 120 participants was performed to determine symptoms commonly experienced by women with PVI. Two observation studies analysed the ability of trans-vaginal ultrasound to detect PVI and compared its accuracy with reflux venography; considered the reference standard. A further 70 participants were recruited in a case-control study to determine the prevalence of PVI in women with and without chronic pelvic pain. A randomised control trial treating women with PVI and pelvic pain was also designed. Results: Women with PVI had an increased frequency of CPP when compared with healthy controls or women with varicose veins. This pain was associated with the menstrual cycle and intercourse. It was also found to frequently radiate into the upper thighs. Trans-vaginal ultrasound was shown to have a sensitivity and positive predictive value of 100% and 95% respectively when compared with reflux venography. The frequency of PVI in women with chronic pelvic pain was found to be 47% compared with 25% in women with no history of CPP (p < 0.001). Conclusion: The results of this thesis suggest PVI to be a possible cause of CPP in women and likely to be under-diagnosed. It can be identified by trans-vaginal ultrasound although the degree of accuracy is still yet to be determined. PVI merits further research and attention from clinicians and researchers. The proposed randomised control trial is needed both to further understanding of the role of PVI in CPP and to assess the efficacy of an under-researched treatment approach currently used in practice.

Introduction Bypass surgery for infrainguinal disease is indicated when a patient presents with chronic (disabling claudication or chronic limb-threatening ischaemia) or acute ischemia. Duplex ultrasound surveillance can be used in the follow-up period to detect grafts in risk of failure. If detected before occlusion occurs an intervention can prolong patency. Aim The purpose of this study was to evaluate the outcome of the procedure, whether there are factors associated with no improvement, and to elucidate the value of routine ultrasound surveillance. Methods Patients who underwent lower extremity bypass surgery at Falu hospital between 2010 and 2020 were identified from the national registry Swedvasc. Clinical outcome was based on change in the Rutherford classification. Duplex ultrasound measured peak systolic velocities. A significant stenosis was defined as a 2-3.5-fold increase in ratio of adjacent velocities in the bypass. For a non-significant stenosis, the ratio had to be increased but by less than 2 times. Results 114 patients underwent bypass surgery. Mean age was 70 years. Postoperative surveillance was carried out for 78 patients. Of these, 40 (51.3%) presented with an abnormality and further 30 of them (75%) received further intervention. There was a correlation between cardiac risk and outcome at the 30-day follow-up. For the majority of the not-surveilled, a major adverse event occurred within 1 year. Conclusions Bypass surgery was beneficial for the majority. Cardiac risk was a negative predictor for outcome. Most patients attending the surveillance benefited from early detection of risk of graft failure. To improve its value and efficacy, guidelines are needed within the clinic.