The Potential Relation Between polytetrafluoroethylene Grafts after Open Reconstructions for Abdominal Aortic Aneurysm and Perigraft Seromas.

BACKGROUND: The presence of sac enlargement after abdominal aortic aneurysm (AAA) open repair, a condition usually called perigraft seroma (PGS), nearly always has a benign behavior. Some theories implicated for PGS formation include coagulation abnormalities, fibroblast inhibition, low-grade infection, or improper graft handling. METHODS: This is a retrospective study including patients treated for AAA in 2 academic vascular surgery departments from 2007 to 2014, where 1 center preferably used polytetrafluoroethylene (PTFE) grafts whereas the preference of other center was mostly Dacron graft. The definition of PGS was conceived as a fluid collection around the graft on CT scan imaging with a radiodensity ≤25 Hounsfield units, reaching at least 30 mm in diameter and beyond the third postoperative month. Analysis was performed between patients with and without PGS. RESULTS: Seventy-eight patients met the inclusion criteria: 42 received Dacron and 36 PTFE grafts. Twenty-three (29.5%) patients accomplished the PGS diagnosis. Having a PTFE graft was the strongest factor for PGS formation on multivariate analysis. The medium seroma size was 42 mm (range, 30-90.6 mm) and the mean time from AAA repair to PGS detection was 26 months (range, 4-106 months). Three patients of the 23 with PGS required surgical repair, all of them were successfully treated: 2 by endovascular means and the remaining with explantation and Dacron reconstruction. CONCLUSIONS: PGS formation is not an unusual complication after open reconstructions for AAA treatment. This is especially true for PTFE grafts, and thus, closer follow-up is warranted if using this material. Treatment is clearly needed when symptoms appear; however, preventive strategies with either endovascular relining or reopen reconstructions require an individual approach counterbalancing benefits versus risk of the procedures.

Adapting Vascular Surgery Practice to the Current COVID-19 Era at a Tertiary Academic Center in Madrid.

BACKGROUND: The epidemic potential of coronavirus infection is now a reality. Since the first case detected in late 2019 in China, a fast worldwide expansion confirms it. The vascular patient is at a higher risk of developing a severe form of the disease because of its nature associating several comorbid states, and thus, some vascular surgery communities from many countries have tried to stratify patients into those requiring care during these uncertain times. METHODS: This is an observational study describing the current daily vascular surgery practice at one tertiary academic hospital in Madrid region, Spain-one of the most affected regions worldwide due to the COVID-19 outbreak. We analyzed our surgical practice since March 14th when the lockdown was declared up to date, May 14th (2 months). Procedural surgical practice, organizational issues, early outcomes, and all the troubles encountered during this new situation are described. RESULTS: Our department is composed of 10 vascular surgeons and 4 trainees. Surgical practice has been reduced to only urgent care, totaling 50 repairs on 45 patients during the period. Five surgeries were performed on 3 COVID-19-positive patients. Sixty percent were due to critical limb ischemia, 45% of them performed by complete endovascular approach, whereas less than 10% of repairs were aorta related. We were allocated to use a total of 5 surgical rooms in different locations, none our usual, as it was converted into an ICU room while performing 50% of those repairs with unusual nursery staff. CONCLUSIONS: The COVID-19 outbreak has dramatically changed our organization and practice in favor of urgent or semiurgent surgical care alone. The lack of in-hospital/ICU beds and changing nursery staff changed the whole availability organization at our hospital and was a key factor in surgical decision-making in some cases.

Symptomatic Aortic Bare-Metal Stent Fracture after PETTICOAT Technique for Complicated Type B Aortic Dissection.

BACKGROUND: Aortic bare-metal stent rupture is an exceptional complication, associated with high risk of aorta rupture and death. We describe a successful endovascular approach for a symptomatic aortic bare-metal stent fracture after the provisional extension to induce complete attachment (PETTICOAT) technique. METHODS: A 53-year-old man with a complicated type B aortic dissection (visceral malperfusion) was treated with thoracic endovascular aortic repair (TEVAR) and "PETTICOAT" technique. The 1-, 6-, and 12-month follow-up scans showed progressive aortic remodeling. After 15 months from the initial procedure, the patient was admitted to the emergency department with severe thoracic pain and two syncopal episodes. Urgent angio-computed tomography (CT) showed bare-metal stent rupture and aortic dilatation to 45 mm at the site of stent fracture. RESULTS: He was urgently treated with TEVAR to cover the entire length of the bare-metal stent under local anesthesia and motor-evoked potential (MEP) monitoring. If signs of medullary ischemia are observed in the MEP register, a carotid-subclavian bypass was planned. At 12 months of follow-up, the patient remains asymptomatic. CT scan at 1 month and 12 months showed no signs of endoleak and aortic remodeling to 40 mm. CONCLUSIONS: Although unusual, this case demonstrates the possibility of material fatigue/failure and highlights the need of close imaging follow-up after TEVAR for treatment of aortic diseases.