IVAN BENADUCE CASELLA

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina

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  • article 13 Citação(ões) na Scopus
    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 de
    OBJECTIVE: 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.
  • article 11 Citação(ões) na Scopus
    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, Pedro
    OBJECTIVE: 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 0 Citação(ões) na Scopus
    Profile of patients diagnosed with acute venous thromboembolism in routine practice according to age and renal function: RE-COVERY DVT/PE study
    (2021) AGENO, Walter; CASELLA, Ivan B.; CHEE, Kok Han; SCHELLONG, Sebastian; SCHULMAN, Sam; SINGER, Daniel E.; DESCH, Marc; TANG, Wenbo; VOCCIA, Isabelle; ZINT, Kristina; GOLDHABER, Samuel Z.
    In randomized clinical trials (RCTs) of nonvitamin K antagonist oral anticoagulants (NOACs) for acute venous thromboembolism (VTE), similar to 12-13% of patients were elderly and similar to 26% had mild-to-moderate renal impairment. Observational studies are not restricted by the selection and treatment criteria of RCTs. In this ancillary analysis of the RE-COVERY DVT/PE global observational study, we aimed to describe patient characteristics, comorbidities, and anticoagulant therapy for subgroups of age (< or >= 75 years) and renal impairment (creatinine clearance [CrCl; estimated with Cockcroft-Gault formula] < 30 [severe], 30 to < 50 [moderate], 50 to < 80 [mild], >= 80 [normal] mL/min). Of 6095 eligible patients, 25.3% were aged >= 75 years; 38.2% (1605/4203 with CrCl values) had mild-to-moderate renal impairment. Comorbidities were more common in older patients (73.9% aged >= 75 vs. 58.1% < 75 years) and in those with mild or moderate versus no renal impairment (75.9%, 80.9%, and 59.3%, respectively). At hospital discharge or 14 days after diagnosis (whichever was later), most patients (53.7% and 55.1%, respectively) in both age groups received NOACs; 20.8% and 23.4%, respectively, received vitamin K antagonists, 19.0% and 21.8% parenteral therapy, 2.3% and 3.8% other anticoagulant treatments. Use of NOACs decreased with worsening renal impairment (none 58.5%, moderate 49.6%, severe 25.7%) and, in younger versus older patients with moderate renal impairment (33.1% vs. 56.1%). In routine practice, there are more elderly and renally impaired patients with VTE than represented in RCTs. Decreasing renal function, but not older age, was associated with less NOAC use. Clinical Trial Registration:. Unique identifier: NCT02596230. Graphic abstract Decreasing renal function, particularly in the subgroup with CrCl < 30 mL/min, but not older age, was associated with less use of nonvitamin K antagonist oral anticoagulants (NOACs). Nevertheless, more than half of the older patients with moderate renal impairment received a NOAC as their oral anticoagulant.
  • article 0 Citação(ões) na Scopus
    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, Bruno
    BackgroundConflicting 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.
  • article 0 Citação(ões) na Scopus
    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 De
    Background: 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.
  • article 6 Citação(ões) na Scopus
    Generic versus branded enoxaparin in prophylaxis and treatment of vein thrombosis
    (2015) CASELLA, Ivan Benaduce; PUECH-LEAO, Pedro
    Objectives: to compare the biological efficacy of generic enoxaparin (Heptron (TM)) versus branded Sanofi-Aventis enoxaparin for prophylaxis and treatment of lower-extremity deep venous thrombosis (DVT) in a prospective, randomized, openlabel study. Methods: patients with diagnosed lower-extremity DVT (therapeutic branch, n=57) and patients requiring venous thromboembolism (VTE) prophylaxis after arterial vascular surgery or major lower-extremity amputations (prophylactic branch, n=57) were randomized to receive generic or branded enoxaparin for up to seven days. Enoxaparin activity was measured by estimating blood anti-factor Xa levels at the peak plasma concentration. As secondary outcomes, development or progression of VTE events, major adverse events and major bleeding events were considered for efficacy and safety comparisons. Results: DVT therapy: twenty-five patients received generic enoxaparin while 32 received branded enoxaparin (subcutaneous, 1 mg/kg BID). Mean percentages of anti-factor Xa levels within the target ranges were 62 +/- 35.4% and 67.5 +/- 24.7%, respectively (p=.035 for non-inferiority). No patient presented DVT progression, clinically detectable pulmonary embolism, or major bleeding events in any subgroup. DVT prophylaxis: Thirty patients received generic enoxaparin and 27 received branded enoxaparin (subcutaneous, 40 mg/day). Mean percentages of anti- factor Xa levels within the target ranges were 77.9 +/- 30.9% and 77.8 +/- 32.9%, respectively (p = .009 for non-inferiority). There were no cases of VTE or major bleeding events in any subgroup. Conclusion: generic and branded enoxaparins exhibited similar in vivo responses as measured by the anti-factor Xa activity, as well as similar clinical efficacy and safety outcomes.
  • article 0 Citação(ões) na Scopus
    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
  • article 3 Citação(ões) na Scopus
    Sinus Bradycardia Persisting for 9 Days after Carotid Angioplasty and Stenting
    (2012) KRUTMAN, Mariana; CALDERARO, Daniela; CASELLA, Ivan Benaduce; CARAMELLI, Bruno; WOLOSKER, Nelson; PUECH-LEAO, Pedro
  • article 5 Citação(ões) na Scopus
    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, Pedro
    Background: 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.
  • article 16 Citação(ões) na Scopus
    Rationale and design for the study Apixaban versus ClopidoGRel on a background of aspirin in patient undergoing InfraPoPliteal angioplasty for critical limb ischemia: AGRIPPA trial
    (2020) BIAGIONI, Rodrigo Bruno; LOPES, Renato Delascio; AGATI, Leandro Barile; SACILOTTO, Roberto; WOLOSKER, Nelson; SOBREIRA, Marcone Lima; SOARES, Bruno Leonardo de Freitas; JOVILIANO, Edwaldo Edner; BERNARDI, Walkiria Hueb; CASTELLI JUNIOR, Valter; CAFFARO, Roberto Augusto; FIORANELLI, Alexandre; BELLEN, Bonno Van; CASELLA, Ivan Benaduce; FIDELIS, Ronald Jose Ribeiro; FLUMIGNAN, Ronald Luiz Gomes; COMEROTA, Anthony James; RAMACCIOTTI, Eduardo
    Background New antithrombotic strategies that reduce primary thrombosis and restenosis might improve vascular outcomes in patients with peripheral artery disease (PAD) undergoing arterial angioplasty. The study objective is to evaluate the potential benefit of apixaban plus aspirin compared with standard of care dual antiplatelet therapy (DAPT) in reducing thrombotic restenosis and artery re-occlusion in patients undergoing endovascular infrapopliteal revascularization. Study design This multicenter, parallel-group, prospective, randomized, open-label, blinded-endpoint adjudication, proof-of-concept, exploratory trial aims to randomize 200 patients 72 hours after successful infrapopliteal angioplasty for critical limb ischemia (CLI). Patients will be randomly assigned in a 1:1 ratio to receive oral apixaban (2.5mg twice daily) plus aspirin (100 mg once daily) for 12months or clopidogrel (75 mg daily) for at least 3 months on a background of aspirin (100 mg once daily) for 12months. The primary endpoint is the composite of target lesion revascularization (TLR), major amputation, or restenosis/occlusion (RAS) in addition to major adverse cardiovascular events - MACE (myocardial infarction, stroke or cardiovascular death) at 12 months. The primary safety endpoint is the composite of major bleeding or clinically relevant non-major bleeding at 12 months. Summary This study will evaluate the efficacy and safety of apixaban 2.5 mg twice daily plus aspirin compared with DAPT (clopidogrel plus aspirin) in patients with CLI undergoing endovascular infrapopliteal revascularization and might prove the concept of an alternative antithrombotic regimen for these patients to be tested in a future large randomized clinical trial.