Browsing by Author "Almeida, Paulo"
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- Arteriovenous access banding revisitedPublication . Teixeira, Gabriela; Almeida, Paulo; Sousa, Clemente Neves; Teles, Paulo; De Sousa, Paulo; Loureiro, Luís; Teixeira, Sérgio; Rego, Duarte; Almeida, Rui; Norton de Matos, AntónioThe aim of this study is to validate the current applicability of arteriovenous access banding in high flow access (HFA) and/or haemodialysis access-induced distal ischaemia (HAIDI). This retrospective study was conducted at the GEV (Grupo de Estudos Vasculares) vascular access centre. The clinical records of consecutive patients undergoing banding for HAIDI and HFA symptoms, between June 2011 and January 2015, were reviewed until April 2015. All vascular access patients’ consultation records and surgical notes were reviewed. We analysed and compared patients’ age, gender, comorbidities, symptoms and intraoperative ultrasound control. We defined technical failure as recurrence of symptoms, requiring new banding. Excessive banding, access thrombosis, rupture and false aneurysm development were registered as complications. Primary clinical success was defined as improvement of symptoms or effective flow reduction after banding, with no need for reintervention. If one reintervention was necessary, we have defined it as secondary clinical success. Overall, 119 patients underwent banding: 64 (54%) with HAIDI and 55 (46%) with HFA. The HAIDI group was significantly older (65 ± 13 years compared with 56 ± 22 years, p = 0.001) and had significantly greater number of patients with diabetes (56% vs 24%, p = 0.004). Primary success was achieved in 85 patients (71.4%) and the secondary success rate was 84.9%. Older age (p = 0.016) and intraoperative ultrasound control (p = 0.012) were significantly associated with primary success. Our results do not corroborate the high incidence of thrombosis previously reported as associated with AV access banding and suggest that ultrasound control is crucial for preventing technical failure. The procedure was effective on both compared groups.
- Brachial-cephalic fistula recovered with drainage for the basilic vein: Case reportPublication . Sousa, Clemente Neves; Norton de Matos, António; Rocha, Ana; Almeida, Paulo; Xavier, EvaVascular access is essential for the implementation of hemodialysis (HD). The arteriovenous fistula (AVF) can be constructed in various locations using various veins. However, the quality of the veins will influence the construction site, as well as the functioning of the AVF. Careful analysis of the vascular network allows options for the development of new fistulas presentations. We present and discuss the case of a woman aged 69 years in HD in which a brachial-cephalic fistula with drainage to basilic vein was created, through rotation of the cephalic vein on the forearm level. This kind of access serves to prolong the time spent dialyzing through native fistulae, with their reduced complications and greater cost-effectiveness.
- Brachio-Brachial Arteriovenous Fistula Superficialization with Short Skip IncisionsPublication . Norton de Matos, António; Sousa, Clemente Neves; Almeida, Paulo; Queirós, José; Rego, Duarte; Teixeira, Gabriela; Loureiro, Luís; Teixeira, SérgioThe exhaustion of superficial venous patrimony or reduced diameter of superficial veins usually prevents patients from having an arteriovenous fistula created. In such cases, using deep vessels can be a more viable option as opposed to an arteriovenous graft. We describe a new approach for the brachio-brachial arteriovenous fistula creation technique. It consists of 3 small incisions, thus causing minimal surgical damage. We have found it to be better tolerated by the patients and well received by dialysis nurses. This procedure also allows improved access for cannulation and more available puncture sites.
- Efeitos das terapias de priming nas disfunções motoras e na excitabilidade cortical em sujeitos com AVC: revisão sistemáticaPublication . Santos, Hugo; Baleia, Isabel; Xavier, Adeline; Branco, Daniela; Leal, Joana; Almeida, PauloIntrodução: Aproximadamente 90% dos sujeitos com AVC ficam com algum tipo de limitação funcional. Têm surgido um conjunto de técnicas coadjuvantes no campo da reabilitação, tal como o priming, que consiste num processo inconsciente associado à aprendizagem, em que a exposição prévia a um estímulo altera a resposta a outro estímulo subsequente. Quando usado em conjunto com outra intervenção terapêutica, o priming pode resultar numa mudança de comportamento que parece coincidir com alterações nas redes neurais. Objetivos: Rever e analisar os ensaios clínicos randomizados (Randomized Controlled trial - RCT) que avaliam os efeitos do priming nas limitações motoras e na excitabilidade cortical de sujeitos com AVC. Material e Métodos: Realizou-se uma pesquisa bibliográfica em 3 bases de dados (Pubmed, PEDro e CENTRAL) e utilizada a metodologia de investigação - Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Foram incluídos estudos realizados em sujeitos que sofreram AVC, cuja intervenção usava explicitamente terapia priming. Resultados: Foram incluídos 14 estudos. 4 usaram estimulação magnética transcraniana, 3 usaram estimulação transcraniana por corrente contínua, 2 usaram imagética e observação da ação e 5 usaram priming baseado em movimento. Devido à heterogeneidade clínica e metodológica dos estudos, não foi possível a realização de meta-análise. Dos estudos incluídos, 10 mostraram que o priming associado à reabilitação teve melhorias significativas e 4 que não houve melhorias significativas entre os grupos. Conclusões: As terapias de priming, quando usadas em conjunto com outra intervenção terapêutica, parecem potencializar a reabilitação da função motora após o AVC. No futuro dever-se-ão realizar estudos experimentais com amostras maiores e padronizar a forma com se aplica cada uma das técnicas de priming.
- Outflow Rescue of Elbow-Blockade Forearm Arteriovenous Fistulas: Outcomes of Open Surgical TechniquesPublication . Mendes, Daniel; Almeida, Paulo; Sousa, Clemente Neves; Loureiro, Luís; Teixeira, Sérgio; Rego, Duarte; Norton-de-Matos, AntónioBackground Venous scarring at the elbow is a common problem that can cause early and late forearm arteriovenous fistula (AVF) dysfunction in hemodialysis patients. However, any effort to prolong the long-term patency of distal vascular accesses could benefit the patient's survival, maximizing the use of restricted venous patrimony. This study aims to report a single-center experience in the recovery of distal autologous AVF with venous outflow obstruction at the elbow using different surgical techniques. Methods Retrospective observational study of all patients treated at a single vascular access center from January 2011 to March 2022, with dysfunctional forearm AVFs presenting with outflow stenosis or occlusions at the elbow treated by open surgery, using 3 different surgical techniques. Demographics and clinically relevant data were collected. Evaluated endpoints included primary, assisted primary, and secondary patency rates at 1 and 2 years. Results Twenty-three patients with elbow-blocked outflow forearm AVFs have been treated with a mean age of 64 ± 15 years. The majority (96%) had a radiocephalic fistula. The median time from vascular access creation to intervention was 34.5 months (12–216 months). A total of 24 procedures have been performed using 3 different surgical techniques for bypassing the obstructed venous outflow at the elbow. Technical success was achieved in 96% of the surgically treated patients. Primary and secondary patency rates at 1 year were 67.4% and 89.4%, respectively, and 52.9% and 82.0% at 2 years, with a median follow-up of 19 months (6–92 months). Conclusions AVFs outflow stenosis or occlusions at the elbow not amenable to endovascular therapy could lead to vascular access abandonment. Our study demonstrates multiple surgical solutions to avoid this adverse outcome. Elbow venous outflow surgical reconstruction seems effective for distal vascular access preservation. Close surveillance is essential for timely endovascular treatment of newly developed stenosis at the venous drainage.
- Paulo AlmeidaPublication . Almeida, Paulo
- Pressão no ambulatório hospitalar: implementação de novos processosPublication . Duarte, Helena; Almeida, Paulo; Completo, Ana; Rouquinho, Marta; Alcobia, Armando
- Proposta de criação de curso de formação sobre a NP ISO 22320:2017Publication . Almeida, PauloEste projeto pretende responder à questão de partida que lhe deu origem – Como podemos melhorar a comunicação entre os atores envolvidos na gestão do incidente? Resulta da conjugação da experiência pessoal do autor onde, como instrutor na área da gestão de emergências e como bombeiro sapador se depara frequentemente com dificuldades de comunicação institucionais e interinstitucionais entre os diversos atores envolvidos na gestão de emergências e de um processo de pesquisa e exploração na busca de soluções que contribuam positivamente para a resolução da questão de partida. Se à primeira vista se considerou a tarefa de fácil execução, uma vez que existem Standards internacionais e nacionais relativos à gestão de emergências e a existência de plataformas que recebam um projeto deste tipo, a sua concretização evidenciou obstáculos que exigiram uma reflexão profunda acerca do que é o ato de ensinar online, do seu desenvolvimento até aos dias de hoje, bem como a testagem de uma metodologia que permitisse transmitir a “mensagem” de forma eficiente. Sendo a gestão de emergências um tema pouco trabalhado no ensino online de forma aberta e acessível a todos os interessados no processo, este estudo reveste-se de caráter exploratório. Não se pretende apresentar conclusões de carácter definitivo, pretende-se que o estudo seja visto como um contributo para futuros projetos de cursos online dedicados ao tema gestão de emergências. A dimensão e características do tema obriga a que neste trabalho se incluem assuntos relacionados com a história e do ensino à distância, um olhar histórico sobre o tema gestão de incidentes, a sua importância, leitura e interpretação de muitos documentos académicos, de diversos standards relativos ao tema gestão de emergências, conhecimentos de construção de ferramentas e metodologias, sem que com tal se esgotem todas as ramificações que um estudo desta natureza potencia.
- Radio-cephalic fistula recovered with drainage to forearm basilic veinPublication . Norton de Matos, António; Sousa, Clemente Neves; Almeida, Paulo; Teles, Paulo; Loureiro, Luís; Teixeira, Gabriela; Rego, Duarte; Teixeira, SérgioDysfunction problems with vascular access are a concern to patients and dialysis units. The vascular surgeon should analyse such dysfunction and perform a careful assessment of the vascular network in order to find new fistula layouts. We introduce and discuss the case of creation of a radio-cephalic fistula with outflow into the forearm basilic vein through rotation of the forearm basilic vein toward the cephalic vein in the forearm of an 88-year-old hemodialysis male patient. This technique enables extending fistula patency and improves cost efficiency.
- Radio‐cephalic fistula recovered with drainage to median basilic vein by straightening of the forearm cephalic vein: A case reportPublication . Costa, Luísa Lemos; Matos, António Norton; Almeida, Paulo; Teles, Paulo; Loureiro, Luís; Campos, Luís; Delgado, Elisabete; Oliveira, Debora; Campos, Tiago; Inácio, Marta; Fernandes, Filipa; Coutinho, Sara; Ventura, Ana; Pereira, Susana; Castro, Ana; Xavier, Eva; Sousa, Clemente NevesThe distal arteriovenous fistula (AVF) has less complications and better patency than the proximal fistula, when it works properly. The complications of outflow of the fistula are complex, and it is necessary to analyze all solutions to solve the problem. We introduce a novel approach to solve outflow problems of a radio-cephalic AVF by straightening of the forearm cephalic vein with drainage into the median basilic vein.