http://hdl.handle.net/11422/25220 Thu, 30 Jul 2026 03:55:55 GMT 2026-07-30T03:55:55Z http://hdl.handle.net/11422/29573 Title: Fístula de membros inferiores como alternativa à exaustão de acessos vasculares superiores: relato de caso e revisão de literatura Author(s)/Inventor(s): Dellagnelo, Gabriel Vieira Advisor: Pinto, Luiza Máximo Cunha Abstract: End-stage chronic kidney disease presents significant therapeutic and social challenges. Vascular access for hemodialysis, its most common modality, stands as a central issue. Arteriovenous fistulas are the current access of choice for most patients, preferably created in the upper limbs. However, these options may become exhausted over the course of treatment. This case report aims to demonstrate the use of a lower-extremity arteriovenous fistula as a viable and durable access alternative in this setting, along with a brief associated literature review. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Sun, 30 Nov 2025 00:00:00 GMT http://hdl.handle.net/11422/29573 2025-11-30T00:00:00Z http://hdl.handle.net/11422/29559 Title: Hemangioendotelioma epitelioide com ressecção vascular em membro inferior: relato de caso cirúrgico com revisão da literatura Author(s)/Inventor(s): Bonfá, Natália Deoclecio Advisor: Pinto, Luiza Máximo Cunha Abstract: Epithelioid hemangioendothelioma (EHE) is an ultra-rare vascular sarcoma of endothelial origin, characterized by heterogeneous clinical behavior that can range from an indolent course to aggressive evolution with metastatic potential. This report presents a primary case of EHE located in the left femoral neurovascular bundle in a symptomatic patient. Complementary imaging studies demonstrated a solid, well-defined lesion, tightly adherent to the femoral artery, vein, and nerve in the left lower limb of a 59-year-old female patient. Diagnostic confirmation was initially obtained by incisional biopsy with histopathological and immunohistochemical analysis. Conservative treatment was rendered unfeasible by symptom progression. En bloc resection of the lesion was then performed, with joint removal of the femoral artery, vein, and nerve, followed by arterial reconstruction using an autologous reversed great saphenous vein graft from the contralateral limb. The patient had a satisfactory immediate postoperative course, later developing deep venous thrombosis treated with full-dose anticoagulation. Longitudinal follow-up in the 6 months after the surgical approach demonstrated full return to daily activities. The case highlights the role of the integration between imaging methods, histological analysis, and individualized surgical planning for the appropriate management of EHE in larger vascular structures. Early diagnosis and timely surgical intervention can preserve limb function and reduce the risk of serious consequences, including amputation and other vascular complications. The rarity of this pathology and the lack of data in the medical literature justify the relevance of this case report. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Sun, 30 Nov 2025 00:00:00 GMT http://hdl.handle.net/11422/29559 2025-11-30T00:00:00Z http://hdl.handle.net/11422/26140 Title: Hipertensão refratária em paciente com aorta em recife de coral: um relato de caso Author(s)/Inventor(s): Menezes, Rubens Thadeu Mangilli de Advisor: Silva, Luciana Moura Farjoun da Abstract: Introduction: Coral reef aorta (ARC) is a relatively uncommon vascular pathology, with the formation of coarse atherosclerotic plaques and irregular calcification that grow towards the lumen of the aorta and cause stenosis with a reduction in the overall caliber of the vessel, which may have repercussions hemodynamics. Case Report: Patient female, 73 years old, with hypertensive encephalopathy refractory to sodium nitroprusside and nitroglycerin in full doses. Presents a history of previous lameness, without trophic lesions, monitored by the clinical cardiology team. Presents only reduced bilateral femoral pulses. There is an upper and lower blood pressure discrepancy, without neurological changes. The aorto-iliac tomography angiography showed diffuse atherosclerotic disease of irregular calcified plaques, with a diffusely reduced caliber of the aorta throughout its entire length, presenting two points of significant stenosis - with a presumed diagnosis of coral-like aorta as the trigger for renovascular hypertension. She had undergone balloon angioplasty of the descending thoracic aorta and had a self-expanding stent placed; Angioplasty of the abdominal aorta was then performed with a balloon and balloon-expanding stent implantation. She was discharged on the eighth postoperative day, with controlled SBP below 140mmHg and outpatient follow-up. Conclusion: Coral reef aorta is an uncommon pathology, which can present life-threatening symptoms, is still underdiagnosed and requires further studies. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Mon, 01 Jan 2024 00:00:00 GMT http://hdl.handle.net/11422/26140 2024-01-01T00:00:00Z http://hdl.handle.net/11422/26139 Title: Paraganglioma de carótida direita: tratamento cirúrgico de Glomus carotídeo em Hospital Público Universitário do Rio de Janeiro Author(s)/Inventor(s): Knoploch, Brunno Bastos Advisor: Silva, Luciana Moura Farjoun da Abstract: Paragangliomas are rare neuroendocrine tumors that originate from extra-adrenal autonomic paraganglia, small structures mainly composed of neuroendocrine cells derived from the embryonic neural crest, with the ability to secrete catecholamines. Most paragangliomas of parasympathetic origin are located in the neck and skull base, along the branches of the glossopharyngeal and vagus nerves. They most commonly arise from the carotid body, less frequently from jugulotympanic and vagal paraganglia, and rarely from laryngeal paraganglia. Carotid body paragangliomas account for 0.5-0.6% of head and neck tumors and approximately 60% of cervical paragangliomas. These tumors are typically asymptomatic and grow indolently but may progress to larger, symptomatic, and potentially secreting lesions. In this case report, we present a male patient with a painless cervical bulge on the right side. During the diagnostic workup, a neck AngioCT revealed a 5.5 x 4.3 x 1.0 cm mass at the carotid bulb, followed by a urinary catecholamine assessment. The typical location of this rare neoplasm, the carotid bulb, is a critical area that requires detailed preoperative planning with imaging studies, obviating the need for biopsy. However, in this case, a biopsy was performed before the patient was referred to the UFRJ service. The tumor is highly vascularized, and catecholamine assessment is essential to prevent complications from adrenergic release during surgery. In this case, the catecholamine test was negative. The patient underwent resection of the cervical mass, requiring permanent ligation of the external carotid artery. In surgical planning, it is crucial for the team and the patient to be fully informed about the complexity of the procedure, especially the possibility of sacrificing the carotid artery and its branches. The development of a detailed surgical plan should include strategies for cervical revascularization to ensure adequate perfusion and minimize risks. However, in some cases, revascularization may be unnecessary if appropriate tests confirm the competence of the circle of Willis, ensuring effective cerebral circulation. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Mon, 01 Jan 2024 00:00:00 GMT http://hdl.handle.net/11422/26139 2024-01-01T00:00:00Z