Leonardo Ghizoni Bez

Bio: Leonardo Ghizoni Bez is an academic researcher. The author has contributed to research in topics: Pseudoaneurysm & Femoral artery. The author has an hindex of 4, co-authored 12 publications receiving 27 citations.

Experiência inicial com o uso de adesivo tissular contendo trombina para tratamento do pseudo-aneurisma femoral

Abstract: O pseudo-aneurisma (PSA) apos cateterizacao femoral tem sido diagnosticado com regularidade em servicos com grande movimento de intervencoes percutâneas, com incidencia variando de 0,05 a 6%. PSA femorais pequenos podem ser acompanhados ate a resolucao espontânea. As opcoes de tratamento sao: compressao guiada por ultra-som, injecao de trombina para trombose do PSA e tratamento cirurgico. A injecao percutânea de trombina tem a vantagem de ser um procedimento indolor e rapido. Podem ser utilizados trombina isolada ou preparados contendo trombina associada a fibrinogenio e fatores de coagulacao. A experiencia inicial dos autores de cinco casos tratados com injecao de adesivo tissular contendo trombina mostrou resultado satisfatorio em quatro; um caso necessitou tratamento cirurgico. Nao houve sucesso com uso isolado de trombina humana, porem, ocorreu trombose imediata apos injecao de preparado de trombina associada a fibrinogenio/fator XIII. Neste artigo, sao discutidas as opcoes de tratamento dos PSA femorais e a tecnica do uso de trombina percutânea.

Safety and efficacy of the EPIC™ nitinol vascular stent system for the treatment of lesions located in the superficial femoral artery: prospective and multicentric trial.

Abstract: Background The aim of this study was to evaluate the short and mid-term safety and efficacy of the EPIC™ nitinol vascular stent system for the treatment of lesions located in the superficial femoral artery (SFA). Methods From October 2010 to June 2012, 83 subjects were enrolled in a prospective, multicenter, non-randomized study designed to demonstrate that the EPIC nitinol vascular stent system for SFA lesions is non-inferior to the published patency rates found in literature. Inclusion criteria were stenosis or occlusion of the SFA or SFA and proximal popliteal artery, with total length from 4 to 11 cm and amenable for treatment with a single stent, in patients with a score from 2 to 5 on Rutherford classification. The primary endpoint was primary patency rate at 12 months as determined by Duplex ultrasound. The secondary endpoints evaluated were: initial arteriographic success, primary patency rate at 6 months, major adverse event rate at one year and technical success. Follow-up with a complete clinical and physical exam, including ABI and Duplex ultrasound was performed at 6 and 12 months. Results Most patients (56.6%) were men and the mean age was 68.59 (33.1-99.15) years. 25.3% of the total population had intermittent claudication and 73.5% presented with critical limb ischemia. Most lesions were total occlusions (75.9%) and the mean lesion length was 71.16 mm. Contralateral femoral access was performed in 26.5%cases, and ipsilateral femoral approach was used for the remaining 73.5% patients. Technical and arteriographic success was obtained in all 83 (100.00%) patients. Duplex controlled primary patency rate at 6 and 12 months was 95.8% and 76.1%, respectively. The freedom from target lesion revascularization rate was 98.7% and 92.6% at 6 and 12 months, respectively. No stent fractures were observed in this study. Major adverse event rate at 1 year (clinically driven TLR, major amputation, and all-cause mortality) was 15.7%: two target lesion revascularizations (2.4%), one major amputation (1.2%) and ten deaths not related to the procedure (12%). Conclusions In conclusion, this study demonstrates the safety and efficacy of the EPIC™ Nitinol Vascular Stent System for the treatment of SFA lesions.

Aneurisma ilíaco associado a fístula arteriovenosa

Abstract: A ruptura dos aneurismas aorto-iliacos para a veia iliaca ou veia cava e uma complicacao pouco comum. A hipertensao venosa leva a varios sinais e sintomas, o que dificulta o diagnostico pre-operatorio, tais como edema do membro inferior, dispneia, hematuria, sinais de insuficiencia renal ou cardiaca. Sopro abdominal e a chave do diagnostico clinico, associado a massa pulsatil e dor abdominal. O reconhecimento da fistula arteriovenosa no pre-operatorio e importante para o planejamento cirurgico. Relatamos um caso de aneurisma da arteria iliaca comum e interna direita associado a fistula para veia iliaca comum, cursando, inicialmente, com edema do membro inferior direito e dispneia, o que levou ao diagnostico incorreto de trombose venosa profunda.

Persistência da artéria isquiática: relato de caso

Abstract: A persistencia da arteria isquiatica e uma anomalia congenita rara do sistema circulatorio, sendo descritos poucos casos na literatura e nao existindo, assim, consenso sobre metodos diagnosticos e de tratamento. Os autores apresentam o caso de um paciente masculino, de 59 anos de idade, com historia de dor tipo "claudicacao intermitente" progressiva em panturrilha direita, associada a uma massa pulsatil em fossa poplitea e ausencia de pulsos distais. A angiotomografia da aorta abdominal e dos membros inferiores revelou persistencia da arteria isquiatica a direita, sendo realizada, ainda, angiografia com subtracao digital seletiva da arteria isquiatica para o planejamento cirurgico. O paciente foi submetido a ponte femoro-fibular com veia safena magna ipsolateral reversa e ligadura da arteria isquiatica na pelve, por acesso retroperitoneal.

Resultados do tratamento do refluxo de veias safenas com endolaser 1.470 nm e correlação com o grau de insuficiência venosa

Abstract: Resumo Contexto Pacientes com doenca venosa cronica avancada sao mais propensos a exigir outros procedimentos para recidiva de veias varicosas. Ainda nao esta estabelecido se a gravidade da insuficiencia venosa e um fator que influencia a taxa de oclusao de veias safenas tratadas por endolaser. Objetivos Analisar a taxa de oclusao dos segmentos venosos tratados com endolaser e correlacionar com o Venous Clinical Severity Score (VCSS) e a classificacao Clinica-Etiologica-Anatomica-Patologica (CEAP) dos pacientes. Metodos Analise retrospectiva de coorte de pacientes operados com endolaser 1.470 nm entre novembro/2012 a marco/2020. Foram realizadas estatistica descritiva e curva de sobrevida de Kaplan-Meier com regressao de Cox para grupos de VCSS e CEAP. Resultados Foram analisados 170 pacientes e 180 segmentos venosos; a idade media foi de 44,3 ± 9,2, sendo a maioria do sexo feminino (71%). A densidade de energia media utilizada na veia safena magna foi 49,2 ± 8,3 J/cm. As principais complicacoes foram dor no trajeto da safena (12,2%) e parestesias apos 6 meses (17,2%). Nao houve diferenca na taxa de oclusao venosa entre grupos com VCSS ≤ 7 e VCSS > 7 (p = 0,067). O grupo de pacientes com CEAP agrupada C4-C5-C6 teve taxa de oclusao menor em relacao ao grupo C2-C3 [hazard ratio (HR) = 3,22; intervalo de confianca (IC) 1,85, 5,61; p = 0,001]. Conclusoes As taxas de oclusao de segmentos venosos tratados com endolaser foram menores na presenca de classificacoes CEAP avancadas. Nesses pacientes, provavelmente deve-se despender mais energia para o tratamento eficaz das safenas.

Nitinol Stents in the Femoropopliteal Artery: A Mechanical Perspective on Material, Design, and Performance.

Abstract: Endovascular stenting has matured into a commonly used treatment for peripheral arterial disease (PAD) due to its minimally invasive nature and associated reductions in short-term morbidity and mortality. The mechanical properties of the superelastic Nitinol alloy have played a major role in the explosion of peripheral artery stenting, with modern stents demonstrating reasonable resilience and durability. Yet in the superficial femoral and popliteal arteries, even the newest generation Nitinol stents continue to demonstrate clinical outcomes that leave significant room for improvement. Restenosis and progression of native arterial disease often lead to recurrence of symptoms and reinterventions that increase morbidity and health care expenditures. One of the main factors thought to be associated with stent failure in the femoropopliteal artery (FPA) is the unique and highly dynamic mechanical environment of the lower limb. Clinical and experimental data demonstrate that the FPA undergoes significant deformations with limb flexion. It is hypothesized that the inability of many existing stent designs to conform to these deformations likely plays a role in reconstruction failure, as repetitive movements of the leg and thigh combine with mechanical mismatch between the artery and the stent and result in mechanical damage to both the artery and the stent. In this review we will identify challenges and provide a mechanical perspective of FPA stenting, and then discuss current research directions with promise to provide a better understanding of Nitinol, specific features of stent design, and improved characterization of the biomechanical environment of the FPA to facilitate development of better stents for patients with PAD.

Superficial Femoral Artery Intervention: Creating an Algorithmic Approach for the Use of Old and Novel (Endovascular) Technologies.

Abstract: Femoropopliteal (FP) disease is a common presentation of peripheral arterial disease (PAD), and a challenging anatomic region for durable treatment. Surgical bypass has historically been the primary therapeutic modality, but has been supplanted in the last decade by endovascular therapy, even with the most complex presentation of disease. Endovascular therapy has the advantage of a more favorable and rapid recovery, while preserving future treatment options. Endovascular management of FP disease, initially with “Plain Old” balloon angioplasty (POBA) has yielded over the years to bare metal stents (BMS), and more recently, to technologies seeking to limit BMS use due to difficult-to-treat patterns of in-stent restenosis (ISR). Despite a myriad number of endovascular devices and strategies, the approach to FP intervention lends itself to an algorithmic schema largely predicated on lesion length, severity of calcification, recanalization method, and clinical goals based upon individual patient status. In addition, treatment costs are a growing consideration in device selection. These criteria can be summarized into what we have termed as a “CADENCE” approach to treatment, an acronym representing the following factors: Clinical scenario, Anatomy, Device performance specifications, Experience/Ease, Novelty, Cost, and Evidence-base (Fig. 1). While the individual components of the CADENCE strategy are not always hierarchical, they combine to give a framework for reasonable interventional strategies for a given patient presentation and lesion appearance. Since there is a notable lack of prospective data for FP interventions, most notably with regard to direct device comparisons, actual practice is often experiential, and further data to guide optimal patient care are needed.

Nitinol Self-Expanding Stents for the Superficial Femoral Artery.

Abstract: The superficial femoral artery is a complex artery subject to a unique set of biomechanical loading conditions in its course through the leg. Plain balloon angioplasty and balloon-expandable stents had unacceptably high rates of restenosis, necessitating target vessel revascularization. Nitinol alloy is well suited to provide the strength and flexibility needed of stents to withstand the external forces posed by the environment of the superficial femoral artery. Advances in stent technology with the addition of a slow-releasing antiproliferative agent and changes in scaffold design have shown promise in reducing the rates of stent fracture and in-stent restenosis.