ANTONIO EDUARDO ZERATI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Analysis of the Correlation Between Central Obesity and Abdominal Aortic Diseases(2019) APOLONI, Rafael Correa; ZERATI, Antonio Eduardo; WOLOSKER, Nelson; SAES, Glauco Fernandes; WOLOSKER, Marina; CURADO, Taina; PUECH-LEAO, Pedro; LUCCIA, Nelson DeBackground: Atherosclerosis and abdominal aortic aneurysms (AAAs) have several similar risk factors but different pathogenesis. Inflammation of the arteries is common to both. Central obesity can act as an endocrine organ through the secretion of inflammatory cytokines, and the perivascular fat has a local effect that could contribute to diseases of the abdominal aorta. Although the relation between central obesity and atherosclerosis occlusive arterial disease has been demonstrated, the correlation with AAA has conflicting results. The aim of this study was to analyze the correlation between central obesity and the presence of abdominal aortic diseases using computed tomography. Methods: Six hundred thirty-nine consecutive patients classified into 3 groups (AAA, aortic atherosclerotic occlusive disease (AAOD), and without aortic disease [control group]) who underwent computed tomography had the aorta diameter, the visceral fat area (VFA), and the subcutaneous fat area (SFA) measured at the level of third and fourth lumbar vertebrae. Results: VFA showed no difference between the groups. SFA was lower in atherosclerotic group (AAOD) than control (P < 0.01 in general and P < 0.04 in male). In AAA group, we found in men that the first tertile of aorta diameter had higher VFA than third tertile (P = 0.02). Conclusions: There was no difference in VFA between patients in AAA, AAOD, and without aortic disease groups. In men with aneurysm, there was an inverse relationship between VFA and aortic diameter. In AAOD, visceral to subcutaneous ratio is higher due to lower SFA.
bookPart Tratamento minimamente invasivo da doença arterial periférica(2016) ZERATI, Antonio Eduardo; LUCCIA, Nelson de; WOLOSKER, Nelson- Impact of Endovascular Technique in Vascular Surgery Training at a Large University Hospital in Brazil(2011) PUECH-LEAO, Pedro; WOLOSKER, Nelson; ZERATI, Antonio E.; NASCIRNENTO, Luciano D.OBJECTIVES: The aim of this study was to determine the impact of endovascular surgery versus open vascular technique training in a Brazilian teaching service. DESIGN: Cross-sectional study. SETTING: Hospital das Clinicas-Faculty of Medicine University of Sao Paulo, a tertiary institutional hospital Brazil. PARTICIPANTS: We reviewed 1,040 arterial operations performed during 2 distinct time periods: January 1995 to December 1996, and January 2006 to December 2007. Based on the disease treated, the procedures were classified into the following 5 groups: abdominal aortic aneurysms (AAA), aorto-iliac obstructive disease (Al), obstructive disease of the femoropoplitealtibial segment (FP), carotid disease (C), and others (0). The operations were also divided into an endovascular surgery (ES) group and an open surgery (OS) group. We compared the number of open and endovascular procedures for each arterial disease group during both periods. RESULTS: During the 2006-2007 period, 654 patients were treated surgically, whereas over the 1995-1996 period, 386 arterial operations were performed. A. significant increase in endovascular procedures (p < 0.001) was found from the 1995-1996 period to the 2006-201)7 period (35 vs 351, respectively) in all groups, whereas open surgery showed a slight increase in the number of procedures in the AAA and 0 groups only. In the 1995-1996 period, OS was the primary surgical method for all groups, but in the 2006-2007 time frame, OS was performed more frequently than ES only in the AAA and 0 groups. Considering all vascular disease groups, OS was the technique used in 90.9% (351 of 386) of the operations during 1995-1996, whereas in 2006-2007, OS was performed in only 46.3% (303 of 654) of the procedures. CONCLUSIONS: The increase in the number of ES observed over the past decade has had little impact on OS procedures performed at our medical center, not bringing harm to open surgical training. (J Surg 68:19-23.
- En bloc vertebrectomy for the treatment of spinal lesions. Five years of experience in a single institution: a case series(2018) ARAUJO, Alex Oliveira de; NARAZAKI, Douglas Kenji; TEIXEIRA, William Gemio Jacobsen; GHILARDI, Cesar Salge; ARAUJO, Pedro Henrique Xavier Nabuco de; ZERATI, Antonio Eduardo; MARCON, Raphael Martus; CRISTANTE, Alexandre Fogaca; BARROS FILHO, Tarcisio Eloy Pessoa deOBJECTIVES: The objective of this study is to describe the experience of a Brazilian public university hospital regarding the treatment of metastatic or benign spine lesions with en bloc vertebrectomy of the thoracic and lumbar spines. METHODS: This study was a retrospective case series and included all medical records of patients with benign aggressive, primary malignant, or metastatic spine lesions who underwent en bloc vertebrectomy from 2010 to 2015. RESULTS: A total of 17 patients were included in the analysis. Most of them (71%) were indicated for surgery based on an oncologic resection for localized disease cure. Overall, 10 of the 17 patients (59%) underwent vertebrectomy via an isolated posterior approach using the technique described by Roy-Camille et al. and Tomita et al., while 7 patients (41%) underwent double approach surgeries. Of the 17 patients who underwent the en bloc resection, 8 are still alive and in the outpatient follow-up (47%), and almost all patients with metastatic lesions (8/9) died. The average survival time following the surgical procedure was 23.8 months. Considering the cases of metastatic lesions and the cases of localized disease (malignant or benign aggressive disease) separately, we observed an average survival time of 15 months and 47.6 months respectively. CONCLUSION: This study demonstrates and reinforces the reproducibility of the en bloc vertebrectomy technique described by Tomita et al.
- Cateteres venosos totalmente implantáveis: histórico, técnica de implante e complicações(2017) ZERATI, Antonio Eduardo; WOLOSKER, Nelson; LUCCIA, Nelson de; PUECH-LEÃO, PedroAbstract Access to the venous system is of vital importance for diagnosis and treatment of patients with the most varied range of clinical conditions, whether for taking blood samples or for infusion of solutions. In 1616, Harvey described the circulatory system on the basis of studies in animals and 4 decades later Sir Christopher Wren conducted the first intravenous infusions in living beings. Since then there has been constant evolution in access technique and infusion devices. Of particular note is the creation of long-term catheters in the 1970s, particularly totally implantable devices, which revolutionized cancer treatment, increasing both safety and comfort for oncology patients. The objectives of this article are to review historical data on vascular access and discuss the implantation technique and the main complications associated with procedures for placement and use of totally implantable venous access devices.
- Barriers and Levels of Physical Activity in Patients With Symptomatic Peripheral Artery Disease: Comparison Between Women and Men(2019) SOUSA, Adilson Santos Andrade de; CORREIA, Marilia A.; FARAH, Breno Quintella; SAES, Glauco; ZERATI, Antonio Eduardo; PUECH-LEAO, Pedro; WOLOSKER, Nelson; CUCATO, Gabriel G.; RITTI-DIAS, Raphael M.This cross-sectional study compared physical activity levels and barriers between 212 men and women with symptomatic peripheral artery disease. Physical activity was objectively measured by an accelerometer. Barriers to physical activity were obtained using a validated questionnaire. Women reported higher amounts of light physical activity (p <.001) and lower moderate-vigorous physical activity (p < .001) than men. Women more often reported barriers such as ""not having anyone to accompany"" (p = .006), ""lack of money"" (p = .018), ""fear of falling or worsening the disease"" (p = .010), ""lack of security"" (p = .015), ""not having places to sit when feeling leg pain"" (p = .021), and ""difficulty in getting to a place to practice physical activity"" (p = .015). In conclusion, women with symptomatic peripheral artery disease presented with lower amounts of moderate-vigorous activity and more barriers to activity than men. Strategies to minimize the barriers, including group actives and nonpainful exercises, are recommended for women with peripheral artery disease.
- Paraplegia of Lower Limbs Caused by a Segmental Thrombosis of the Descending Thoracic Aorta Reversed with Endovascular Treatmentd-A Case Report and Literature Review(2018) LEIDERMAN, Dafne Braga Diamante; WOLOSKER, Nelson; OLIVEIRA, Marcos Vieira de Melo; CARVALHO, Heitor Andrei Miranda de; BARAO, Felipe Trajano de Freitas; ZERATI, Antonio Eduardo; LUCCIA, Nelson De; PUECH-LEAO, PedroBackground: Transient paraplegia of the lower limbs is a rare condition and, when has a vascular etiology, is usually associated with thromboembolic events, aortic dissection, aortic aneurysms, or as a complication of the surgical correction of those diseases. There is no case reported of acute paraplegia caused by a segmental thrombotic subocclusion of the descending thoracic aorta. Case Report: We report a not yet described clinical situation of a young patient (51 years) admitted to the emergency care department for treatment of systemic arterial hypertension of difficult control with 4 antihypertensive medication classes. At the intensive care unit for treatment with intravenous antihypertensive medication, the patient evolved with acute paraplegia and a segmental thrombotic subocclusion of the descending thoracic aorta was diagnosed. He was submitted to endovascular treatment with total recovery of the deficits. Conclusions: The previously normal descending thoracic aorta may be a site of segmental thrombosis and may lead to paraplegia. Early endovascular treatment can reverse this type of situation.
- Epidemiology of Abdominal Aortic Aneurysm Repair in Brazil from 2008 to 2019 and Comprehensive Review of Nationwide Statistics Across the World(2022) LOUZADA, Andressa Cristina Sposato; SILVA, Marcelo Fiorelli Alexandrino da; PORTUGAL, Maria Fernanda Cassino; STABELLINI, Nickolas; ZERATI, Antonio Eduardo; AMARO, Edson; TEIVELIS, Marcelo Passos; WOLOSKER, NelsonIntroduction Studying epidemiology of abdominal aortic aneurysms repairs is essential to prevent related deaths. Although outcomes are influenced by socioeconomic factors, there are no nationwide studies on these statistics in low-and-middle income countries. Therefore, we designed this study to evaluate abdominal aortic aneurysms repair rates, trends, costs, and in-hospital mortality in the Brazilian Public Health System, which exclusively insures over 160 million Brazilians. Material and Methods Retrospective cross-sectional population-based analysis of publicly available data referring to all abdominal aortic aneurysm repairs performed between 2008 and 2019 in Brazilian public hospitals. Results We observed a total of 13,506 abdominal aortic aneurysm repairs, of which 32% were emergency endovascular repairs, 20% emergency open repairs, 32% elective endovascular repairs and 16% elective open repairs. There has been a downward trend in total abdominal aortic aneurysms repairs and an increasing predominance of endovascular repair. Elective and endovascular repairs were significantly associated with lower in-hospital mortality. For ruptured abdominal aortic aneurysms, we observed mortality rates of 13.8% after endovascular repair and 52.1% after open repair. For intact abdominal aortic aneurysms, we observed mortalities of 3.8% after endovascular repair and 18.6% after open repair. Procedure and mortality rates varied significantly among the Brazilian regions. Conclusions We observed a low and decreasing rate of abdominal aortic aneurysm repair. Most repairs were emergency and endovascular and there was an increasing predominance of endovascular repair. Endovascular and elective repairs were associated with lower mortality.
- Effect of Creatine Supplementation on Functional Capacity and Muscle Oxygen Saturation in Patients with Symptomatic Peripheral Arterial Disease: A Pilot Study of a Randomized, Double-Blind Placebo-Controlled Clinical Trial(2021) DOMINGUES, Wagner Jorge Ribeiro; RITTI-DIAS, Raphael Mendes; CUCATO, Gabriel Grizzo; WOLOSKER, Nelson; ZERATI, Antonio Eduardo; PUECH-LEAO, Pedro; COELHO, Daniel Boari; NUNHES, Pollyana Mayara; MOLITERNO, Andre Alberto; AVELAR, AdemarThe aim of the study was to verify the effects of creatine (Cr) supplementation on functional capacity (walking capacity; primary outcome) and calf muscle oxygen saturation (StO(2)) (secondary outcome) in symptomatic peripheral arterial disease (PAD) patients. Twenty-nine patients, of both sexes, were randomized (1:1) in a double-blind manner for administration of placebo (PLA, n = 15) or creatine monohydrate (Cr, n = 14). The supplementation protocol consisted of 20 g/day for 1 week divided into four equal doses (loading phase), followed by single daily doses of 5 g in the subsequent 7 weeks (maintenance phase). Functional capacity (total walking distance) was assessed by the 6 min walk test, and calf muscle StO(2) was assessed through near infrared spectroscopy. The measurements were collected before and after loading and after the maintenance phase. The level of significance was p < 0.05. No significant differences were found for function capacity (total walking distance (PLA: pre 389 +/- 123 m vs. post loading 413 +/- 131 m vs. post maintenance 382 +/- 99 m; Cr: pre 373 +/- 149 m vs. post loading 390 +/- 115 m vs. post maintenance 369 +/- 115 m, p = 0.170) and the calf muscle StO(2) parameters (p > 0.05). Short- and long-term Cr supplementation does not influence functional capacity and calf muscle StO(2) parameters in patients with symptomatic PAD.
- Imaging Signs of May-Thurner Syndrome in Asymptomatic Patients: Computed Tomography Angiography Analysis of Kidney Donors(2023) LOPES, Daniel F.; ZERATI, Antonio E.; LUCCIA, Nelson De; NAHAS, William C.; PUECH-LEAO, PedroBackground: The current study aimed to evaluate the distance between the right common iliac artery (RCIA) and lumbar vertebra in asymptomatic patients in order to determine whether such distance was statistically correlated with the left common iliac vein (LCIV) diameter (LCIVD) and to investigate if both measures were related to demographic characteristics and anthropometric data, such as sex, age, height, and body mass index (BMI).Methods: In this descriptive and uncontrolled anatomic study, data from high-definition computed tomography (CT) angiography images of living kidney donors without a medical history of chronic venous insufficiency or past deep vein thrombosis (DVT) were analyzed. The RCIA crossed over the LCIV in 311 individuals, who were then included in this study. CT scans were reviewed to measure (1) the narrowest space between the RCIA and fifth lumbar vertebral body and (2) the LCIVD. Measures were subjected to normality tests and were divided according to the sex of the study population. Correlations of measures with age, BMI, and height were calculated.Results: Of the 311 patients analyzed, 66.6% (n = 207) were female. The mean lumbar vertebral bodyeiliac artery distance (LVBIAD) was 7.2 mm, whereas the mean LCIVD was 8.5 mm; both were higher in men (P < 0.001). The statistical analysis of LVBIAD and LCIVD distributions revealed no normality pattern (P < 0.05). The analysis of the correlation between them showed a weak statistically significant relationship with age. A linear regression model considering the normality percentile interval indicated a strong positive correlation between LVBIAD and LCIVD (R2 = 0.884).Conclusions: The LVBIAD was <5 mm and <3 mm in 25% and 5% of asymptomatic individ-uals, respectively. The LCIVD correlated with the space between the RCIA and lumbar vertebra. The distance between the RCIA and lumbar vertebra and the LCIVD were higher in male sub-jects and older patients, but did not correlate with BMI and height.