IGOR RAFAEL SINCOS
Projetos de Pesquisa
Unidades Organizacionais
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
13 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 13
- Endovascular treatment of peripheral arterial injury with covered stents: an experimental study in pigs(2011) BELCZAK, Sergio; SILVA, Erasmo Simao da; AUN, Ricardo; SINCOS, Igor Rafael; BELON, Alessandro Rodrigo; CASELLA, Ivan Benaduce; GORNATI, Vitor; FIGUEIREDO, Luiz Francisco Poli deOBJECTIVE: To evaluate the feasibility of using endovascular repair to treat penetrating arterial injuries with covered stents. Feasibility was examined according to the circumferential extent of the injury. INTRODUCTION: Surgical trauma often increases the risk of major morbidity and mortality associated with vascular injury, and endovascular repair has many advantages in such situations. METHODS: Twenty white male domestic pigs weighing 28-38 kg with controlled vascular injuries were divided into four equal groups according to the circumferential extent of their vascular lesion (i.e., no lesion, lesion <50%, lesion >50%, and complete lesion). The left common carotid artery was dissected with proximal and distal control, and this procedure was followed by controlled sectioning of the arterial wall. Local manual compression was applied for 10 min and was followed by endovascular repair with the placement of a 5x50 mm VIABHAN (TM) covered stent using the femoral approach. We also monitored additional variables, such as the duration of the procedures (the mean was 56.3 +/- 19.1 min), ultrasound parameters (e.g., maximum arterial diameter, peak systolic and diastolic velocity, and resistance index), arteriography findings, and fluctuations in vital signs (e.g., cardiac output, arterial pressure, and central venous pressure). RESULTS: The experimental procedure was found to be feasible and reproducible. Repairs were successful in all animals in the control (no lesion) and <50% lesion groups. Success was also achieved in four out of five pigs in the >50% group and in one pig in the complete lesion group. DISCUSSION: The endovascular repair of an arterial injury is possible, but success depends on the circumferential extent of the arterial lesion. The present experimental model, which involved endovascular techniques, highlighted important factors that must be considered in future studies involving similar animals and materials.
- Endovascular and open repair for blunt aortic injury, treated in one clinical institution in Brazil. A case series(2011) SINCOS, Igor Rafael; AUN, Ricardo; BELCZAK, Sergio Quilici; NASCIMENTO, Luciano Dias; NETTO, Boulanger Mioto; CASELLA, Ivan; SILVA, Erasmo Simao da; PUECH-LEAO, PedroOBJECTIVE: The objective of this retrospective study is to analyze and compare the results of conventional surgical repair and endovascular treatment of blunt aortic injury over the past 8 years. METHODS: Twenty-eight patients (25 male; mean age, 35 years) were treated for blunt aortic injury between April 2001 and March 2009 in a university hospital in Brazil. Twenty-six patients were included in the study: five were treated with operative repair (OR) and 21 with endovascular treatment (TEVAR). Two patients were excluded from analysis: one was managed conservatively, and one was treated with endovascular treatment for chronic dissection related to aortic trauma. RESULTS: Mean age was lower in the OR group than in the endovascular treatment group (17.8 vs. 38 years, P = .003). There was one death in the OR group and four deaths in the endovascular treatment group. Mean follow-up for the overall group was 33.6 months, with 48.7 months (range 8-83 months) for the OR group, and 29.8 months (range 2-91 months) for the TEVAR group. Mean time elapsed from injury to repair was 23.4 hours (range 8-48 h, median 20 h) for the OR group and 30.3 hours (range 2-240 h, median 18 h) for the TEVAR group (P = .374). The duration of surgery was shorter in the endovascular treatment group (142 versus 237 minutes; P = .005). There were no significant differences with respect to the number of postoperative days requiring mechanical ventilation, duration of ICU stay or duration of hospital stay. CONCLUSION: In this retrospective analysis, endovascular treatment was a safe method for repair of blunt aortic trauma, with immediate and midterm results that were comparable to those results obtained with operative repair. No complications from the stent graft were identified during follow-up. Nevertheless, long-term follow-up is necessary to confirm the effectiveness of this treatment.
article 19 Citação(ões) na Scopus Impact of Stent-Graft Oversizing on the Thoracic Aorta: Experimental Study in a Porcine Model(2011) SINCOS, Igor Rafael; AUN, Ricardo; SILVA, Erasmo Simao da; BELCZAK, Sergio; HIGUCHI, Maria de Lourdes; GORNATI, Vitor Cervantes; GIGGLIO, Pedro Nogueira; BAPTISTA, Anna Paula Weinhardt; FIGUEIREDO, Luiz Francisco Poli dePurpose: To analyze in an experimental animal model the effect of 4 different levels of stents-graft oversizing on non-atherosclerotic aortas such as those found in young individuals who undergo stent-graft repair for traumatic aortic injuries. Methods: The diameter of the porcine thoracic aorta is similar to the aorta of young adults (18-20 mm), so 25 pigs were randomized into 5 groups: 1 control (without stent-graft) and 4 oversizing groups (A: 10%-19%, B: 20%-29%, C: 30%-39%, and D: >40%). Two types of biomechanical tests were performed on all aortas 4 weeks after endoprosthesis deployment. Results: The results of the detachment test, which analyzed the strength necessary to remove the stent-graft from the aorta, were similar in the 4 groups (A: 42 N, B: 41 N, C: 46 N, and D: 46 N). However, 2 aortas ruptured during the tests (groups C and D). The second test was performed in 3 aortic segments. Maximum shear strength, maximum stress, and maximum tension supported by the aortic wall had a negative and linear correlation with oversizing. There were significant differences in all 4 groups when compared with the control group. Strain, which reflects the elastic properties of the aortic wall, was very similar in all 4 groups, but a great difference was found when compared with the control group (p<0.0001). Conclusion: The study showed an important subacute change in the biomechanical properties of the aortic wall after implantation of an oversized endoprosthesis. This weakness of the aortic wall was confirmed by 2 ruptures during the detachment test. These results partially explain the interaction of stent-grafts with non-atherosclerotic thoracic aortas and may serve as a basis for further studies and the development of specific material to be used in vascular trauma and young patients. J Endovasc Ther. 2011; 18: 576-584conferenceObject DUPLEX SCAN AND HISTOLOGIC ASSESSMENT OF ACUTE RENAL INJURY IN A KIDNEY-KIDNEY CROSSTALK SWINE EXPERIMENTAL MODEL(2018) SINCOS, Anna; MAZZEO, Angela; SINCOS, Igor; COELHO NETO, Felipe; WOLOSKER, Nelson; LEITE, Katia; PENIDO, Vitoria; KAUFMANN, OskarconferenceObject Effects of Saphenous and Perforating Vein Radiofrequency Ablation in Ulcer Healing: Midterm Results of a Randomized Controlled Trial (VUERT)(2018) SINCOS, Igor Rafael; PUGGINA, Juliana; CAMPOS, Walter; BAPTISTA-SINCOS, Anna Paula W.; PORTA, Rina Maria Pereira; LUCCIA, Nelson De; PUECH-LEAO, Pedro; SILVA, Erasmo Simao da- A randomized clinical trial of the effects of saphenous and perforating veins radiofrequency ablation on venous ulcer healing (VUERT trial)(2021) PUGGINA, Juliana; SINCOS, Igor Rafael; CAMPOS JR., Walter; PORTA, Rina Maria P.; SANTOS, Jorgete Barreto dos; LUCCIA, Nelson De; PUECH-LEAO, Pedro; COLLARES, Felipe Birchal; SILVA, Erasmo Simao daObjectives To investigate whether radiofrequency endovenous ablation (RFA) of saphenous and perforating veins increases venous leg ulcer (VLU) healing rates and prevents ulcer recurrence. Method This prospective, open-label, randomized, controlled, single-center trial recruited 56 patients with VLU divided into: compression alone (CR, N = 29) and RFA plus compression (RF, N = 27). Primary endpoints were ulcer recurrence rate at 12 months; and ulcer healing rates at 6, 12, and 24 weeks. Secondary endpoints were ulcer healing velocity; and Venous Clinical Severity Score (VCSS). Results Recurrence was lower in the RF group (p < .001), as well as mean VCSS after treatment (p = .001). There were no significant between-group differences in healing rates. Healing velocity was faster in the RF group (p = 0.049). In the RF group, 2 participants had type 1 endovenous heat-induced thrombosis (EHIT). Conclusions RFA plus compression is an excellent treatment for VLU because of its safety, effectiveness, and impact on ulcer recurrence reduction and clinical outcome. Registration:Clinicaltrials.gov, NCT03293836, clinicaltrials.gov.
conferenceObject Prospective Randomized Trial Comparing Radiofrequency Ablation and Complete Stripping of Saphenous Vein in Patients With Mild to Moderate Chronic Venous Disease With a 3-Year Follow-up(2018) SINCOS, Igor Rafael; BAPTISTA-SINCOS, Anna Paula W.; COELHO, Felipe; LABROPOULOS, Nicos; PUGGINA, Juliana; BELCZAK, Sergio; CARDOSO, Mirian Goncalves; AUN, Ricardo- Correção endovascular de aneurisma de aorta abdominal e artéria ilíaca comum esquerda em paciente com hemofilia C grave(2012) BELCZAK, Sergio Quilici; SINCOS, Igor Rafael; AUN, Ricardo; MIOTO NETO, Boulanger; LOBATO, Manoel; SALITURE, Fernando; LEDERMAIN, AlexFactor XI deficiency, also known as hemophilia C, is a rare hereditary blood disease that manifests with persistent bleeding after surgery, trauma, menorrhagia, and dental extractions. This article reports an endovascular repair of a patient diagnosed with an aortic and left common iliac aneurysm, with severe factor XI deficiency (factor XI activity below 20%). The procedure was successfully performed with management of the coagulation disorder by preoperative and postoperative infusion of plasma and laboratory control of the coagulation.
- Veno-active drugs for chronic venous disease: A randomized, double-blind, placebo-controlled parallel-design trial(2014) BELCZAK, Sergio Q.; SINCOS, Igor R.; CAMPOS, Walter; BESERRA, Julio; NERING, Gilberto; AUN, RicardoIntroduction:Our current understanding of the pathophysiology of chronic venous disease (CVD) suggests that veno-active drugs (VAD) can provide effective symptom relief. Few studies have conducted head-to-head comparisons of VAD and placebo while also assessing objective measures (such as water plethysmography findings and tibiotarsal joint range of motion) and patient-reported quality of life outcomes. Objectives:To compare the effects of different VAD on limb volume reduction, tibiotarsal range of motion, and quality of life. Methods:136 patients with CVD (CEAP grades 2-5) were randomly allocated into four groups to receive micronized diosmin+hesperidin, aminaphthone, coumarin+troxerutin, or placebo (starch). Patients were administered a questionnaire consisting of a quality of life (QoL) measure designed specifically for persons with CVD, and underwent tibiotarsal joint angle measurement and water plethysmography of the lower extremity before and 30 days after pharmacological intervention. Assessors were blind to the treatment groups. Results:Nine patients dropped out of the trial. Data collected from the 127 remaining patients was considered for statistical analysis. There were no differences in tibiotarsal joint range of motion. Volume reductions 100 mL were more frequent in the diosmin+hesperidin group than in any other group. QoL scores were best in the aminaphthone group, and between-group differences were found on individual analysis of questionnaire items. Conclusions:Use of VAD was associated with significant improvements in QoL as compared with placebo. VAD may be effective for providing symptom relief in patients with CVD.
bookPart Úlceras de membros inferiores(2017) SINCOS, Igor Rafael; SINCOS, Anna Paula Weinhardt Baptista; RIBEIRO, Fabrício Carlos