IVAN BENADUCE CASELLA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
11 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 11
- Impact of the period of the day on all-cause mortality and major cardiovascular complications after arterial vascular surgeries(2023) ARTIOLI, Thiago; GUALANDRO, Danielle Menosi; CARDOZO, Francisco Akira Malta; ROJAS, Maria Carmen Escalante; CALDERARO, Daniela; YU, Pai Ching; CASELLA, Ivan Benaduce; LUCCIA, Nelson de; CARAMELLI, BrunoBackgroundConflicting results are reported about daytime variation on mortality and cardiac outcomes after non-cardiac surgeries. In this cohort study, we evaluate whether the period of the day in which surgeries are performed may influence all-cause mortality and cardiovascular outcomes in patients undergoing non-cardiac arterial vascular procedures. Methods1,267 patients who underwent non-cardiac arterial vascular surgeries between 2012 and 2018 were prospectively included in our cohort and categorized into two groups: morning (7 a.m. to 12 a.m., 79%) and afternoon/night (12:01 p.m. to 6:59 a.m. in the next day, 21%) surgeries. Primary endpoint was all-cause mortality within 30 days and one year. Secondary endpoints were the incidence of perioperative myocardial injury/infarction (PMI), and the incidence of major adverse cardiac events (MACE, including acute myocardial infarction, acute heart failure, arrhythmias, cardiovascular death) at hospital discharge. ResultsAfter adjusting for confounders in the multivariable Cox proportional regression, all-cause mortality rates at 30 days and one year were higher among those who underwent surgery in the afternoon/night (aHR 1.6 [95%CI 1.1-2.3], P = 0.015 and aHR 1.7 [95%CI 1.3-2.2], P < 0.001, respectively). Afternoon/night patients had higher incidence of PMI (aHR 1.4 [95%CI 1.1-1.7], P < 0.001). There was no significant difference in the incidence of MACE (aHR 1.3 [95%CI 0.9-1.7], P = 0.074). ConclusionsIn patients undergoing arterial vascular surgery, being operated in the afternoon/night was independently associated with increased all-cause mortality rates and incidence of perioperative myocardial injury/infarction.
conferenceObject Impact of the period of the day on mortality and major cardiovascular complications after vascular surgeries(2020) CARDOZO, F. A. M.; ARTIOLI, T.; CARAMELLI, B.; CALDERARO, D.; YU, P. C.; ROJAS, M. C. E.; CASELLA, I. B.; LUCCIA, N. De; GUALANDRO, D. M.- Combined Angioplasty Technique of the Carotid Territory and Supra-Aortic Trunk by Double Access (Cervical and Limbs) for Tandem Lesions(2020) RIBEIRO, Felipe S.; CASELLA, Ivan Benaduce; LEIDERMAN, Dafne Braga Diamante; PUECH-LEAO, Pedro; LUCCIA, Nelson DeBackground: The carotid stent angioplasty (CAS) has been the main option for patients with high cardiovascular risk and carotid stenosis. The common femoral artery is still the most used access site; however, the aortic arch manipulation is a critical moment for cerebral embolization. Carotid transcervical access should be considered as a good alternative access route for CAS. Tandem lesions combining supra-aortic trunks and ipsilateral carotid bulb critical stenosis pose a great challenge for the vascular surgeon. Methods: This is a retrospective descriptive study based on medical records of our institution. We report 2 cases of complex cerebral vascular insufficiency and discuss therapeutic options and strategies to protect the cerebrovascular territory avoiding microembolization, as well as demonstrate an alternative and safe total endovascular approach for those cases. Results: We describe the approach of 2 complex cerebral vascular insufficiency cases: case 1, a 63-year-old male with previous ischemic stroke, right internal carotid artery (ICA) occlusion, left ICA stenosis >70%, and critical stenosis of the origin of common carotid artery (CCA); case 2, a 68-year-old female with previous ischemic stroke, left ICA occlusion, brachiocephalic trunk critical stenosis, hypoplastic right vertebral artery, and aortobi-iliac chronic occlusion. In both cases reported here a challenging solution was chosen, little described in the literature, with cerebral filter protection as the first step. In addition, a literature review was performed to discuss the different approach options for tandem injuries of the supra-aortic trunk and carotid bulb. Conclusions: Our initial experience with total endovascular treatment of complex tandem lesions of the carotid territory and supra-aortic trunks show that transcervical access, coupled with distal protection filter device on the first step, is a safe and effective technique for preventing neurological events.
conferenceObject Predictors of acute heart failure after vascular surgery(2015) GUALANDRO, D. M.; MARCONDES-BRAGA, F. G.; YU, P. C.; CARDOZO, F. A. M.; LLOBET, G. B.; CALDERARO, D.; MELO, E. S.; CASELLA, I. B.; LUCCIA, N.; CARAMELLI, B.conferenceObject Long-term Results of Endovascular Treatment of Chronic Type B Aortic Dissection by Closure of the Primary Tear(2023) ESTENSSORO, Andre E. V.; PUECH-LEAO, Pedro; WAKASSA, Tais B.; CASELLA, Ivan Benaduce; DELUCCIA, Nelson- Atualização e enfoque em operações vasculares arteriais da II diretriz de avaliação perioperatória da Sociedade Brasileira de Cardiologia(2013) MARQUES, Andre Coelho; BELLEN, Bonno Van; CARAMELLI, Bruno; PRESTI, Calogero; PINHO, Claudio; CALDERARO, Daniela; GUALANDRO, Danielle Menosi; CARVALHO, Francine Correa de; CARMO, Gabriel Assis Lopes do; CASELLA, Ivan Benaduce; FORNARI, Luciana S.; VACANTI, Luciano Janussi; VIEIRA, Marcelo Luiz Campos; MONACHINI, Maristela C.; LUCCIA, Nelson de; YU, Pai Ching; FARSKY, Pedro Silvio; HEINISCH, Roberto Henrique; GUALANDRO, Sandra F. Menosi; MATHIAS JR., Wilson
- Carotid Plaque Morphology in Asymptomatic Patients with and without Metabolic Syndrome(2017) CURY, Marcus Vinicius Martins; PRESTI, Calogero; BONADIMAN, Suellen Stevam Timotheo; CASELLA, Ivan Benaduce; BENABOU, Joseph Elias; SILVA, Erasmo Simao da; LUCCIA, Nelson de; PUECH-LEAO, PedroBackground: The aim of this study was to determine the impact of metabolic syndrome (MetS) on the morphology of carotid plaques, as evaluated using duplex ultrasound (DUS) with computer-assisted analysis. Methods: In this cross-sectional observational study, we analyzed 148 carotid artery plaques in asymptomatic patients. Data were obtained via clinical and laboratory examinations, and DUS was performed by a single operator. All plaques were scanned in a longitudinal fashion, and the best segment was selected, recorded, and evaluated using dedicated software. The main software-based analyses included gray-scale median (GSM) measurements and carotid plaque morphology histograms. Results: MetS was identified in 51.8% of patients. Comparisons of patients with MetS and patients without MetS indicated that the former patients used more classes of antihypertensive drugs (2.49 vs. 1.93; P = 0.004) and were treated with statins for a longer period (71.08 vs. 49.17 months; P = 0.003). Most patients of both types exhibited moderate carotid artery stenosis ranging from 50% to 69% (n = 62; 37.3%), and MetS was not associated with an increased prevalence of severe carotid artery stenosis. The mean GSM was greater in the MetS group than in the non-MetS group (74.18 vs. 61.63; P = 0.012). The histogram analysis revealed that there were lower quantities of blood and fat (2.91 vs. 3.88; P = 0.006; 10.21 vs. 15.08; P = 0.004, respectively) and more fibrous tissue (19.93 vs. 14.55; P = 0.015) in the carotid plaques of patients with MetS than in the carotid plaques of patients without MetS. Conclusions: The present study demonstrated that MetS did not affect the stenosis grade or did it lead to unstable carotid plaques.
- Endovascular Therapy Provides Similar Results of Bypass Graft Surgery in the Treatment of Infrainguinal Multilevel Arterial Disease in Patients with Chronic Limb-Threatening Ischemia in All GLASS Stages(2020) CASELLA, Ivan Benaduce; SARTORI, Camila Holanda; FAUSTINO, Carolina Brito; MARIZ, Maria Paula Vieira; PRESTI, Calogero; PUECH-LEAO, Pedro; LUCCIA, Nelson DeBackground: Extensive infrainguinal arterial disease still pose a challenge for technical and clinical success of percutaneous angioplasty. The purpose of this study was to compare the results of concomitant femoropopliteal and infrapopliteal percutaneous angioplasty/stenting (PTA/S) with distal bypass graft surgery (BGS) in patients with chronic limb-threatening ischemia (CLTI). Method: In a single-center retrospective investigation between 2011 and 2017, 668 revascularization procedures for CLTI were reviewed. Concomitant femoropopliteal and infrapopliteal disease was identified in 153 CLTI patients, treated with BGS (48) using autogenous veins as substitute or PTA/S in a single procedure (105). A subgroup of patients with complex, extensive arterial lesions (GLASS stage III) received additional analysis. Primary outcomes were limb salvage and survival. Results: The mean follow-up time was 21.4 months. Patients treated with PTA/S were significantly older and with predominance of females, diabetes and chronic kidney disease. Smoking was more common in patients treated with BGS. The BGS group showed a 36-month survival rate of 73.4%, whereas the PTA/S group presented a survival of 61.3% in the same interval (P = 0.25). The 36-month cumulative limb salvage rate was 53.3 and 59.7% for BGS and PTA/S, respectively (P = 0.24). For GLASS stage III patients, 36-month limb salvage rates were 54.4% for the PTA/S group and 50.2% for the BGS group (P = 0.29). Multivariate analysis pointed poor runoff status (all endovascular patients) and diabetes (GLASS III endovascular patients) as risk factors for limb loss. Conclusion: PTA/S and BGS presented similar results of limb salvage and survival in the treatment of concomitant femoropopliteal and infrapopliteal arterial disease in patients with CLTI, even for patients with extensive and complex arterial disease.
- The similarities and differences among patients with abdominal aortic aneurysms referred to a tertiary hospital and found at necropsy(2015) SILVA, Erasmo S. da; GORNATI, Vitor C.; CASELLA, Ivan B.; AUN, Ricardo; ESTENSSORO, Andre E. V.; PUECH-LEAO, Pedro; LUCCIA, Nelson DeObjective: To analyze the characteristics of patients with abdominal aortic aneurysms referred to a tertiary center and to compare with individuals with abdominal aortic aneurysm found at necropsy. Methods: We have retrospectively analyzed the medical records of 556 patients with abdominal aortic aneurysm and 102 cases abdominal aortic aneurysm found at necropsy. Results: At univariated analysis, hypertension, tobacco use and maximum diameter were significant risk factors for symptomatic aneurysm, while diabetes tended to be a protective factor for rupture. By logistic regression analysis, the largest transverse diameter was the only one significantly associated with abdominal aortic aneurysm rupture (p<.0001, odds ratio 1.7, 95% confidence interval 1.481-1.951). Intact abdominal aortic aneurysm found at necropsy showed similarities with outpatients in relation to abdominal aortic aneurysm diameter and risk factors. Conclusion: Intact abdominal aortic aneurysm at necropsy and at outpatients setting showed similarities that confirmed that abdominal aortic aneurysm repair is less offered to women, and they died more frequently with intact abdominal aortic aneurysm from other causes.
- Prediction of major cardiac events after vascular surgery(2017) GUALANDRO, Danielle M.; PUELACHER, Christian; LURATIBUSE, Giovanna; LLOBET, Gisela B.; YU, Pai C.; CARDOZO, Francisco A.; GLARNER, Noemi; ZIMMERLI, Andres; ESPINOLA, Jaqueline; CORBIERE, Sydney; CALDERARO, Daniela; MARQUES, Andre C.; CASELLA, Ivan B.; LUCCIA, Nelson de; OLIVEIRA, Mucio T.; LAMPART, Andreas; BOLLIGER, Daniel; STEINER, Luzius; SEEBERGER, Manfred; KINDLER, Christoph; OSSWALD, Stefan; GURKE, Lorenz; CARAMELLI, Bruno; MUELLER, ChristianObjective: Predicting cardiac events is essential to provide patients with the best medical care and to assess the riskbenefit ratio of surgical procedures. The aim of our study was to evaluate the performance of the Revised Cardiac Risk Index (Lee) and the Vascular Study Group of New England Cardiac Risk Index (VSG) scores for the prediction of major cardiac events in unselected patients undergoing arterial surgery and to determine whether the inclusion of additional risk factors improved their accuracy. Methods: The study prospectively enrolled 954 consecutive patients undergoing arterial vascular surgery, and the Lee and VSG scores were calculated. Receiver operating characteristic curves for each cardiac risk score were constructed and the areas under the curve (AUCs) compared. Two logistic regression models were done to determine new variables related to the occurrence of major cardiac events (myocardial infarction, heart failure, arrhythmias, and cardiac arrest). Results: Cardiac events occurred in 120 (12.6%) patients. Both scores underestimated the rate of cardiac events across all risk strata. The VSG score had AUC of 0.63 (95% confidence interval [CI], 0.58-0.68), which was higher than the AUC of the Lee score (0.58; 95% CI, 0.52-0.63; P =.03). Addition of preoperative anemia significantly improved the accuracy of the Lee score to an AUC of 0.61 (95% CI, 0.58-0.67; P =.002) but not that of the VSG score. Conclusions: The Lee and VSG scores have low accuracy and underestimate the risk of major perioperative cardiac events in unselected patients undergoing vascular surgery. The Lee score's accuracy can be increased by adding preoperative anemia. Underestimation of major cardiac complications may lead to incorrect risk-benefit assessments regarding the planned operation.