the investigations at the CHULN could give rise to new recommendations

The thoracic aorta has been the subject of several studies carried out by Ryan Gouveia e Melo and he explains the motivations himself to Just News: “The thoracic aorta, namely the descending segment, is difficult to study because of its location, and there were several questions we wanted to ask. see the answer. The studies were gradually generated, following the conclusions of the previous surveys.

“First, we started by trying to understand the incidence and prevalence of thoracic aortic aneurysm. Through a follow-up study, we concluded that one of the ways we could identify these patients was to assess research data from patients with aneurysms in other locations. Recently, we have also turned our attention to aortic dissections,” he explains.

Although there are already a few studies that pointed to a link between abdominal and thoracic aortic aneurysms, “the information has been scattered, so the initial work was a systematic review with meta-analysis of these studies, and it was soon realized that there was a much higher prevalence than initially suspected.

In view of the clinical dynamics, “it was intuitive to request a whole body scan when assisting a patient with an aneurysm, although there is no clear recommendation in this regard”, reinforces -he.

Ryan Gouveia and Melo

The interaction between Cardiology and Vascular Surgery, in this context, has brought “synergies, uniting general perspectives on cardiovascular diseases and risk factors, with more specific knowledge of the vascular field”.

This knowledge, combined with the application of data aggregation methods, allows us to synthesize the evidence available in the literature. In this way, “we obtain robust results, which make it possible to draw more global conclusions on a given problem and to be in a register of symbiosis between what are the questions of those who are in the field and the use of a methodology based on global questions”.

“A disease that goes, naturally, more and more unnoticed”

By aggregating existing clinical evidence, it was concluded, in a study published in the Journal of the American Heart Association in 2020, that “1 in 5 patients with an abdominal aortic aneurysm also have a thoracic aortic aneurysm , which is a very large number. pertinent”.

If the diagnosis of abdominal aortic aneurysm is often made “thanks to the performance of ultrasound to control other pathologies, such as prostate diseases, in case of thoracic aortic aneurysm (in particular the segment descending), its location requires that its assessment be carried out only by CAT angiography or magnetic resonance angiography, it is therefore a disease which naturally goes unnoticed”.

These results open the way to new investigations, first of all, to understand whether it is wise to have a systematic screening of patients presenting with an aneurysm of the abdominal aorta to an aneurysm of the thoracic aorta, and if this prevalence is clinically relevant or not, depending on the patient’s size of aneurysms”. In summary, he explains:

“For the moment, we have been able to answer in a more synthetic way that the prevalence is important. As for the need for treatment and the validity of testing, that is an area of ​​future interest.” Simultaneously, they identified that women are twice as likely to have this type of aneurysm as men.

It is a fact that Ryan Gouveia e Melo admits that should be studied, since other investigations have already shown that “the behavior of aneurysmal disease in women is slightly different, being less prevalent, but more aggressive, systemic and with poorer results. , both in the treatment and in the risk of rupture”.

However, “as in the cardiovascular field, this group ends up being understudied, which means that the conclusions drawn from the studies are not fully extrapolable to women”.

Production of clinically relevant articles

Daniel Caldeira, cardiologist at CHULN, considers that these conclusions “will, at the very least, lead to the equation of new studies, because there are questions such as the clinical relevance and the size of the aneurysms, which require reflection on the possibility to monitor, at least opportunistically, this type of aneurysm”.

Naturally, “this action must be supported by studies that support the rules that underlie the screening process”.

In statements to just newspraises Ryan Gouveia e Melo: “He was a very productive intern, both from the point of view of formulating ideas and executing them, with quality and speed, which generated the production of a sequence of clinically relevant.”

Daniel Caldeira: “There are issues that require reflection on the possibility of monitoring, at least opportunistically, this type of aneurysm”

These studies have been published in journals and presented at conferences, in the form of e-posters or oral communications. The future vascular surgeon has also carried out clinical studies with CHULN patients, which have also been presented at national and international congresses.

Ryan Gouveia e Melo is completing his internship in the specialty and is doing his doctorate, whose thesis focuses on the field of epidemiology of thoracic aortic diseases, under the supervision of Luís Mendes Pedro, director of the vascular surgery department, and co-edited by Daniel Caldeira.

Daniel Caldeira values ​​the interest of “a future surgeon for a subject which is not, at least initially, necessarily surgical” and underlines that “the volume of production demonstrates the capacity to identify the questions which require answers with a scientific basis”. for this one being treated.” treats the largest artery in the human body – the aorta.”

“The development of scientific activity has a positive impact on clinical activity”

For Luís Mendes Pedro, director of the Vascular Surgery Department of the CHULN, “it is crucial that interns develop a significant scientific activity and change must be made in this direction”.

According to him, “typically, the asymmetry is great, and if there are interns with a higher or average scientific activity, others only develop it in a residual way, because what is most valued is the activity related to the treatment of patients, from a clinical point of view”.

Ryan Gouveia e Melo, Luís Mendes Pedro and Daniel Caldeira

He recognizes, however, that “the ability to develop projects during internships is increasingly valued at the global level”, with countries that allow interns to suspend their training, or even that it is even an obligation for them to invest in scientific activity.

“This is an important element, because it allows the development of characteristics that will have a positive impact on the treatment of patients, so that, in general, the development of scientific activity has a positive impact on clinical activity. “.

In this context, Ryan Gouveia e Melo deserves recognition for “the important scientific activity developed, which has provided new information on the epidemiology of diseases of the thoracic aorta”.

The report can be read in the latest issue of the magazine heart and vesselsedited by just news.