Robotic endovascular peripheral arterial interventions: a proposal of a new learning model.

Objective: This study tests a suitable model for training robot-assisted peripheral vascular interventions and examines the learning curves of endovascular surgeons with different levels of previous experience and main focus of work, analyzing procedure time, fluoroscopy time, use of contrast, and radiation emission.

Methods: Sixteen endovascular surgeons with different previous experience and training performed nine manual and 18 robotic angioplasties using the CorPath GRX platform on a 3D-printed life-size immersed infragenicular arterial phantom.

Results: All participants considered the model reliable.

Robotic cardiac surgery for removal of iliac venous stent embolized in the right cardiac chambers: a case report.

A 42-year-old female patient with a surgical history of iliac venous angioplasty with stenting developed dyspnea on exertion 9 months later. Chest computed tomography angiography revealed a fractured vascular stent in the right cardiac chamber. Doppler echocardiography confirmed that the stent was anchored by the tricuspid valve, causing mild obstruction of the right ventricular filling.

Preoperative evaluation profile of patients undergoing arterial vascular surgery in a tertiary hospital.

Background: Patients with peripheral arterial disease have an increased risk of developing cardiovascular complications in the postoperative period of arterial surgeries known as Major Adverse Cardiac Events (MACE), which includes acute myocardial infarction, heart failure, malignant arrhythmias, and stroke. The preoperative evaluation aims to reduce mortality and the risk of MACE. However, there is no standardized approach to performing them.

Dynamic computed tomography angiography for noninvasive diagnosis of bow Hunter's syndrome: a case report.

The focus of this case report is to technically describe a noninvasive diagnostic evaluation of bow Hunter's syndrome using a dynamic computed tomography angiography protocol and discuss its advantages. In addition, we aimed to exemplify the quality of the study by presenting images of a 3D-printed model generated to help plan the surgical treatment for the patient. The dynamic computed tomography angiography protocol consisted of a first image acquisition with the patient in the anatomic position of the head and neck.

Retrospective analysis of 1,203 cases of referral to a quaternary vascular surgery outpatient clinic within the Unified Health System, São Paulo, Brazil.

Objective: Through a retrospective analysis of 1,203 cases of referral from primary healthcare units to a specialized quaternary vascular surgical service, the findings of this study revealed a high proportion of inappropriate referrals, which may represent a substantial subutilization of this highly complex service. Consequently, in this study, we aimed to evaluate 1,203 cases of referral to a quaternary vascular surgical service, in São Paulo, Brazil, over a 6-year period, to assess the appropriate need for referral; in addition to the prevalence of surgical indications.

Methods: In this retrospective analysis, we reviewed the institutional records of participants referred from Basic Healthcare Units to a vascular surgical service inside the Brazilian Unified Health System, between May 2015 and December 2020.

Editor's Choice - Analysis of Lower Limb Amputations in Brazil's Public Health System over 13 Years.

Objective: Understanding the causes of amputation is crucial for defining health policies that seek to avoid such an outcome, but only a few studies have investigated the epidemiology of patients submitted to amputations in developing countries. The objective of this study was to analyse all lower limb amputations performed in the public health system in Brazil over a 13 year period, evaluating trends in the number of cases, patient demographics, associated aetiologies, hospital length of stay, and in hospital mortality rate.

Methods: This was a retrospective, population based analysis of all lower limb amputations performed in the Brazilian public health system between 1 January 2008 and 31 December 2020.

National Cross-Sectional Epidemiological Analysis of the Impact of Pandemic COVID-19 on Vascular Procedures in Public Health System: 521,069 Procedures Over 4 Years.

Background: During the COVID-19 pandemic, there was a dramatic increase in healthcare demand. Resources were redirected to care patients with COVID-19. Therefore, surgical treatments were affected, including those of vascular diseases.

Shared decision-making and specific informed consent in patients with aortic aneurysms.

Objective: To analyze the refusal rate of elective aortic aneurysm surgery in asymptomatic patients after the presentation of a detailed informed consent form followed by a meeting where patient and their families can analyze each item.

Methods: We conducted a retrospective analysis of 49 patients who had aneurysms and were offered surgical treatment between June 2017 and February 2019. The patients were divided into two groups: the Rejected Surgery Group, which was composed of patients who refused the proposed surgical treatment, and the Accepted Surgery Group, comprising patients who accepted the proposed surgeries and subsequently underwent them.

Proposed public policies to improve outcomes in vascular surgery: an experts' forum.

Objective: To evaluate outcomes of vascular surgeries and identify strategies to improve public vascular care.

Methods: This was a descriptive, qualitative, and cross-sectional survey involving 30 specialists of the Hospital Israelita Albert Einstein via Zoom. The outcomes of vascular procedures performed in the Public Health System extracted through Big Data analysis were discussed, and 53 potential strategies to improve public vascular care to improve public vascular care.

Epidemiology of the use of inferior vena cava filters in Brazil between 2008 and 2019.

Objectives: The primary objective was to study the totality of inferior vena cava filter placements and their temporal and geographic distribution in the Brazilian Public Health System, which insures more than 160 million Brazilians. The secondary objective was to analyze in-hospital mortality after filter placement and deaths due to pulmonary embolism.

Methods: Public and open data on in-hospital mortality due to pulmonary embolism and on rates of inferior vena cava filters placement, its associated diagnosis, and in-hospital mortality in Brazilian public hospitals between January 2008 and December 2019 were extracted from Ministry of Health databases.

Radiological Profile of 18,430 Vascular Anomalies: Incidence and Demographic Distribution in an Adult Population.

Background: Most studies on focusing on the prevalence of vascular anomalies are either aimed to determine the individual occurrence of a specific type among known bearers of abnormalities or propose an estimation of prevalence for the general population by extrapolating from the paediatric population. In this scenario, we intended to assess the profile of vascular anomalies in a group of patients subjected to imaging studies, throughout a long period of time, to evaluate the frequency of abnormal findings in a consecutive, nonselected population.

Methods: This is a retrospective review of 996,569 computed tomography and magnetic resonance studies between 2009 and 2019.

The impact of the institutional abdominoperineal resections volume on short-term outcomes and expenses: a nationwide study.

Background: The aim of this study was to evaluate the influence of the institutional volume of abdominoperineal resections (APR) on the short-term outcomes and costs in the Brazilian Public Health system.

Methods: This population-based study evaluated the number of APRs by institutions performed in the Brazilian Public Health system from January/2010 to July/2022. Data were extracted from a public domain from the Brazilian Public Health system.

Varicose Vein Stripping in 66,577 patients in 11 years in public hospitals in São Paulo.

Objectives: The aim of this study was to evaluate the epidemiology of varicose vein stripping in Brazil's largest city, São Paulo.

Methods: Open and anonymous data regarding varicose vein surgeries between 2008 and 2018 were evaluated from the TabNet platform of the Municipal Health Secretary of São Paulo, Brazil.

Results: Most patients were female and adults.

Evaluation of laparoscopic skills in medical students.

Objective: To evaluate the laparoscopic skills of medical students and identify personal characteristics in terms of greater easiness in performing laparoscopic surgical procedures.

Methods: This study included medical students in the 6th semester of a Medical School in Brazil who answered 10 questions concerning their habits and characteristics. A laparoscopic platform and an abdominal synthetic model were used to assess surgical skills comprising the three following surgical steps: to pass the needle through the trocar and to place it in the laparoscopic needle holder, to perform a laparoscopic simple stitch in synthetic liver parenchyma and, to perform a laparoscopic surgical knot.

Epidemiological analysis of lower limb revascularization for peripheral arterial disease over 12 years on the public healthcare system in Brazil.

Background: Worldwide, peripheral arterial disease (PAD) is a disorder with high morbidity, affecting more than 200 million people.

Objectives: Our objective was to analyze surgical treatment for PAD provided on the Brazilian Public Healthcare System over 12 years using publicly available data.

Methods: The study was conducted with analysis of data available on the Brazilian Health Ministry's database platform, assessing distributions of procedures and techniques over the years and their associated mortality and costs.

Population-based analysis of the epidemiology of the surgical correction of hyperhidrosis in 1,216 patients over 11 years: a cross-sectional study.

Background: Endoscopic thoracic sympathectomy is the definitive surgical treatment for hyperhidrosis and a nationwide study has suggested that cultural and socioeconomic factors play a role in the numbers of operations performed. Thus, there is a need to evaluate local data in order to understand the local epidemiology and trends in hyperhidrosis treatment.

Objective: To study the epidemiology of sympathectomy for treating hyperhidrosis in São Paulo, the largest city in Brazil.

Surgical repair of abdominal aortic aneurysms on the public health system in the largest city in Brazil: a descriptive analysis of in-hospital data on 2693 procedures over 10 years.

Background: From 1990 to 2015, mortality from aortic aneurysms increased 16.8% in Brazil. São Paulo is the largest city in Brazil and about 5 million people depend on the public health system there.

Cross-Sectional Analysis of 180,595 Lower Limb Amputations in the State of Sao Paulo Over 12 Years.

Background: Lower limb amputations represent a high social, economic and health burden. Most of them are preventable and reflect areas for improvement in health care, making it essential to know their epidemiology.

Materials And Methods: This is a retrospective population-based cross-sectional analysis on all lower limb amputations performed in public hospitals in Sao Paulo between 2009 and 2020, the most populous Brazilian state, with 46 million inhabitants.

Epidemiological Analysis of 12 Years of Open Thoracoabdominal Aortic Aneurysm Repair in the Brazilian Public Health System.

Introduction: Although endovascular correction is a promising perspective, the gold-standard treatment for thoracoabdominal aortic aneurisms and type-B dissections with visceral involvement remains open surgery, particularly due to its well-established long-term durability. This study aims to describe and evaluate public data from patients treated for thoracoabdominal aortic aneurism in the Brazilian public health system in a 12-year interval.

Methods: Data from procedures performed between 2008 and 2019 were extracted from the national public database (Departamento de Informática do Sistema Único de Saúde, or DATASUS) using web scraping techniques.

Temporal trends in vena cava filter implantation in public health system inpatients: an 11-year analysis of the largest city in Brazil.

Background: Vena cava filter implantation is considered a simple procedure, which can lead to overuse and over-indication. It is nevertheless associated with short and long-term complications.

Objectives: The goals of this study were to evaluate rates of vena cava filter implantation conducted by Brazil's Unified Public Health System, analyzing in-hospital mortality and migration of patients from other cities seeking medical attention in São Paulo.

Initial experience with Duplex scan combined with contrast-enhanced ultrasound for follow-up of endovascular abdominal aortic aneurysm repair.

Background: Microbubble contrast enhanced ultrasound (CEUS) is an accurate diagnostic method for follow-up after endovascular abdominal aortic aneurysm repair (EVAR) that has been well-established in international studies. However, there are no Brazilian studies that focus on this follow-up method.

Objectives: The objective of this study was to report initial experience with CEUS at a tertiary hospital, comparing the findings of CEUS with those of conventional Doppler ultrasound (DUS), with the aim of determining whether addition of contrast to the standard ultrasonographic control protocol resulted in different findings.

Epidemiological analysis of 556 procedures of open thoracoabdominal aortic aneurysm repair in the Public Health System in the largest Brazilian city.

Objective: Despite the development of endovascular procedures, open repair remains the gold standard for the treatment of aortic thoracoabdominal aneurysms and some type B dissections, with well-established good outcomes and long-term durability at high-volume centers. The present study described and analyzed public data from patients treated in the public system in a 12-year interval, in a city where more than 5 million inhabitants depend on the Public Health System.

Methods: Public data from procedures performed between 2008 and 2019 were extracted using web scraping techniques.

Nationwide Cross-Sectional Epidemiological Analysis of 3,306 Lower Limb Peripheral Aneurysm Repairs in Brazilian Public Hospitals Between 2008 and 2019: Trends, Mortality and Costs.

Background: Although peripheral aneurysms can be limb- or life-threatening, the literature is scarce and there are only two large population-based epidemiological studies on peripheral aneurysm repair, comprising data from high-income countries only.

Methods: This is a retrospective cross-sectional analysis on open and endovascular peripheral aneurysm repairs performed between 2008 and 2019 in the Brazilian Public Health System, which exclusively insures more than 160 million Brazilians.

Results: A total of 3,306 peripheral aneurysm repairs were observed.

Minimally invasive swine spine surgery training: technical aspects, benefits, and anatomical limitations.

Objective: To describe the technical specificities and feasibility of simulation of minimally invasive spine surgery in live pigs, as well as similarities and differences in comparison to surgery in humans.

Methods: A total of 22 Large White class swine models, weighing between 60 and 80kg, were submitted to surgical simulations, performed during theoretical-practical courses for training surgical techniques (microsurgical and endoscopic lumbar decompression; percutaneous pedicular instrumentation; lateral access to the thoracic spine, and anterior and retroperitoneal to the lumbar spine, and management of complications) by 86 spine surgeons. For each surgical technique, porcine anatomy (similarities and differences in relation to human anatomy), access route, and dimensions of the instruments and implants used were evaluated.