Percorrer por autor "Teixeira, Sérgio"
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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.
- 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.
- 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.
- Pedagogical Innovation in Higher Education and Active Learning Methodologies - A Case StudyPublication . Carvalho, Andreia; Teixeira, Sérgio; Olim, Leonilde; Campanella, Sancha; Costa, TeresaPurpose – The aim of this study is to obtain a broader knowledge of innovative pedagogical practices in higher education, by analysing the particular case of the Higher Institute of Administration and Languages (ISAL). The literature review reveals a gap in this scientific field, and filling this gap is as imperative as the need to articulate higher education with the Students’ Profile by the End of Compulsory Schooling. Design/methodology/approach – This research adopts a qualitative methodological approach, in order to analyse the students and teachers’ perceptions of the active learning methodologies implemented at ISAL. Data were collected from a closed-ended questionnaire, aimed at a population composed of students and teachers. Findings – The literature review reveals a gap in this scientific field, particularly in Portugal. Filling this gap is as imperative as the need to articulate higher education with the Students’ Profile by the End of Compulsory Schooling. Practical implications – With the adoption of this methodological approach, this research intends to verify not only whether the innovative pedagogical practices addressed in the literature review are implemented in this institution, but also to identify obstacles to their implementation. With regard to the results, several pedagogical innovation practices are already implemented, even though some limitations to their implementation are identified. Originality/value – This research allows identifying indicators that are essential to outline an intervention plan in the pedagogical practices implemented at ISAL or other higher education institutions and contributes to assessing the current state of pedagogical practices in higher education.
- 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.
- Radiocephalic Fistula Recovery Using the Brachial Vein and Forearm Basilic Vein: A Case Series and Literature ReviewPublication . Norton de Matos, António; Sousa, Clemente Neves; Almeida, Paulo; Teles, Paulo; Rego, Duarte; Teixeira, Gabriela; Loureiro, Luís; Teixeira, Sérgio; Antunes, InêsVascular access dysfunction is a serious problem in dialysis units. Some patients have complex dysfunctions that are difficult to resolve. In this article, we report the case a of two patients with radiocephalic arteriovenous fistulae (RC-AVF) who had stenosis/occlusion of the forearm median vein and where we used the basilic vein of the forearm as a solution. We reviewed the use of this surgical solution in RC-AVF. Two male patients on hemodialysis exhibited stenosis/occlusion of the forearm median vein. The forearm basilic vein was isolated and rotated toward the forearm median vein in order to solve RC-AVF problems. One patient had fistula thrombosis 5 months after the procedure, while for the other patient, the fistula continues to work without problems. Literature describes only a few cases using the forearm basilic vein or the brachial vein for fistula recovery. This procedure increased the patency of fistulas. This approach has been proven to be a good solution for solving outflow problems using the superficial or deep veins, increasing fistula patency and avoiding the need to place a central venous catheter and all the related complications.
- Ruptured arteriovenous fistula pseudoaneurysm treatment by balloon‐assisted direct percutaneous thrombin injectionPublication . Loureiro, Luís; Mendes, Daniel; Sousa, Clemente Neves; Almeida, Paulo; Norton de Matos, António; Teles, Paulo; Rego, Duarte; Teixeira, Gabriela; Teixeira, Sérgio; Antunes, Inês; Costa, Luísa Lemos