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.
- 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.
- 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.
- Endovascular Treatment of Penetrating Injury to the Vertebral Artery by a Stab Wound: Case Report and Literature Review(2017) LEIDERMAN, Dafne Braga Diamante; ZERATI, Antonio Eduardo; WOLOSKER, Nelson; MELO, Henry Augusto Hoffmann; SILVA, Erasmo Simao da; LUCCIA, Nelson DeBackground: We describe a unique case of a patient with penetration of the cervical region by a stab wound, who required emergency care for the controlled removal of the knife and for vertebral artery trauma (VAT) treatment. Although rare, VAT causes high morbidity and mortality. Methods: A patient admitted for emergency care was diagnosed with traumatic complete section of the vertebral artery by a knife and underwent removal of the knife under radioscopic supervision and vertebral artery embolization with coils. Results: The knife was removed successfully, the bleeding was controlled, and the patient did not present any sequelae. Conclusions: In the authors' experience, a patient in an emergent state due to VAT can be treated effectively and quickly with proximal embolization.
- The Need for a Vena Cava Filter in Oncological Patients with Acute Venous Thrombosis: A Marker of a Worse Prognosis(2019) LEIDERMAN, Dafne Braga Diamante; ZERATI, Antonio Eduardo; MARIZ, Maria Paula Vieira; WOLOSKER, Nelson; PUECH-LEAO, Pedro; LUCCIA, Nelson DeBackground: Active cancer is found in approximately 20% of patients diagnosed with venous thromboembolism. This condition is more prevalent in patients with advanced and metastatic cancer and is the second largest cause of death among patients with active neoplasm. Many of them have contraindication for anticoagulation and needs an inferior vena cava filter to be implanted, but a large proportion of these patients have very low survival after filter implantation. Our aim was to verify whether the need for filter implantation represents an independent indicator of poor prognosis in oncological patients and to identify subgroups with a greater survival. Methods: This study included a retrospective analysis of 247 oncologic patients with acute proximal venous thrombosis. We compared survival between 100 consecutive patients who needed vena cava filter (FILTER group) versus a control group of 147 patients in whom anticoagulation was possible (ANTICOAGULATION group). We verified survival, cause of death, filter's indications (clinical and surgical), and factors that might lead to worse prognosis. Results: Risk of death was 8.83-fold higher in the FILTER group than that in the ANTICOAGULATION group, a greater risk than the presence of metastasis (OR: 2.47). Death was significantly more frequent in patients subjected to filter implantation because of clinical indications (93.2%) such as high risk of or recent bleeding and an adjusted risk of death of 2.24-fold higher in a multivariate analysis. Conclusions: The need to implant a vena cava filter in a patient with cancer is a marker that indicates patient's disease severity and worse prognosis. Survival was longer in the subgroup of patients who underwent filter implantation before oncologic surgery, probably because of a better status performance and less clinical complications.