Revisión sistemática de procedimientos quirúrgicos usados para tratar patología aórtica en México.

INTRODUCTION: In Mexico, there are no appropriate statistical data on aortic disease, which can be treated with medical management or open or endovascular surgical approach. OBJECTIVE: To carry out a systematic search and review of the literature in electronic databases with regard to invasive management of aortic pathology in Mexico. METHOD: A systematic search and narrative review of available literature was carried out using different electronic databases: PubMed, Imbiomed, Clinical Key, Bibliat, Scielo, Sage Journals and Sciencedirect, as well as with the Google Scholar search engine. RESULTS: Ninety articles were found, out of which only 53 met the inclusion criteria. Observational studies and case reports were selected, emphasizing on patient demographics, clinical results, and 30-day postoperative survival. CONCLUSION: An elevated rate of complications is reported for aortic pathologies due to underdiagnosis, which results in management being more complicated and prognosis unfavorable. The creation of a national aortic disease registry is crucial to standardization in the approach and optimization of results.

INTRODUCCIÓN: En México no se cuentan con estadísticas adecuadas acerca de la enfermedad aórtica, que puede ser tratada mediante manejo médico o cirugía abierta o endovascular. OBJETIVO: Identificar la literatura en bases de datos electrónicas relativa al manejo invasivo de la patología aórtica en México. MÉTODO: Se realizó búsqueda sistemática y revisión narrativa de la literatura disponible en diferentes bases de datos electrónicas: PubMed, Imbiomed, Clinical Key, Bibliat, Scielo, Sage Journals, Sciencedirect y con el motor de búsqueda de Google Académico. RESULTADOS: Se encontraron 90 artículos, de los cuales 50 reunían los criterios de inclusión. Fueron seleccionados estudios observacionales y reportes de casos, con énfasis en los datos demográficos de los pacientes, resultados clínicos y la supervivencia posoperatoria a 30 días. CONCLUSIÓN: Se reporta elevada tasa de complicaciones de las enfermedades aórticas debido al infradiagnóstico de estas, que deriva en manejo más complejo y pronóstico desfavorable. La creación de un registro nacional de patología aórtica es crucial para la estandarización en el abordaje y la optimación de los resultados.

[Acute aortic syndrome]. / Síndrome aórtico agudo.

Acute aortic syndrome embraces a group of heterogenous pathological entities involving the aortic wall with a common clinical profile. The current epidemiology, clinical presentation, diagnosis and treatment strategy are discussed in this review. Besides, the importance of multidisciplinary aortic teams, aortic centers and the implementation of an aortic code are emphasized.

Spanish Registry of Acute Aortic Syndrome (RESA). Changes in therapeutic management and lower mortality in acute aortic syndrome.

INTRODUCTION AND OBJECTIVES: The Spanish Registry of Acute Aortic Syndrome (RESA) was launched in 2005 to identify the characteristics of acute aortic syndrome (AAS) in Spain. The aim of this study was to analyze the differences in management and mortality in the 3 RESA iterations. METHODS: We analyzed data from patients with AAS prospectively included by 24 to 30 tertiary centers during the 3 iterations of the registry: RESA I (2005-2006), RESA-II (2012-2013), and RESA III (2018-2019). RESULTS: AAS was diagnosed in 1902 patients (74% men; age, 60.7±12.5 years): 1329 (69.9%) type A and 573 (30.1%) type B. Comparison of the 3 periods revealed that the use of computed tomography increased as the first diagnostic technique (77.1%, 77.9%, and 84.2%, respectively; P=.001). In type A, surgical management increased (79.6%, 78.7%, and 84.5%; P=.045) and overall mortality decreased (41.2%, 34.5%, and 31.2%; P=.002), due to a reduction in surgical mortality (33.4%, 25.1%, and 23.9%; P=.003). In type B, endovascular treatment increased (22.8%, 32.8%, and 38.7%; P=.006), while medical and surgical treatment decreased. Overall type B mortality also decreased (21.6%, 16.1%, and 12.0%; P=.005) in line with a reduction in mortality with medical (16.8%, 13.8%, and 8.8%, P=.030) and endovascular (27.0%, 18.0%, and 9.2%; P=.009) treatments. CONCLUSIONS: The iterations of RESA show a decrease in mortality from type A AAS, coinciding with an increase in surgical treatment and a reduction in surgical mortality. In type B, the use of endovascular treatment was associated with improved survival, allowing better management in patients with complications.

Aortic events in pregnant patients with Marfan syndrome. Lessons from a multicenter study.

INTRODUCTION AND OBJECTIVES: Pregnancy in women with Marfan syndrome (MS) is associated with an increased risk of aortic events. The clinical evidence on pregnant patients with MS is limited and there is no specific consensus on their optimal management. We report our multicenter experience. METHODS: From January 2004 to January 2020, 632 patients with MS underwent periodic monitoring in Marfan units. During this period, we identified all pregnant women with MS and analyzed the incidence of aortic events during pregnancy and puerperium. RESULTS: There were 133 pregnancies in 89 women with MS (8 women with prior aortic surgery). There were no maternal deaths, but 5 women had aortic events during the third trimester and puerperium (type A dissections in 2, type B dissection in 1, and significant [≥ 3mm] aortic growth in 2). The aortic event rate was 3.7%. Pregestational aortic diameter≥ 40mm showed a nonsignificant association with aortic events (P=.058). Fetal mortality was 3% and 37.6% of births were cesarean deliveries. CONCLUSIONS: Women with MS have an increased risk of aortic events during pregnancy, especially in the third trimester and postpartum period. Patients with MS and aortic diameters ≥40mm should be assessed in experienced centers for prophylactic aortic surgery before pregnancy. It is important to provide early diagnosis, prepregnancy study of the aorta, beta-blocker administration, and close monitoring during pregnancy, especially during the last trimester and postpartum.

A multicenter study of emergency endovascular repair of the thoracic aorta: indications and outcomes. / Estudio multicéntrico de la reparación endovascular urgente de la aorta torácica: indicaciones y resultados.

OBJECTIVE: Endovascular techniques have become an essential tool for the treatment of descending thoracic aortic disease (thoracic endovascular aneurysm repair [TEVAR]). The aim is to analyze the indications and outcomes of emergency TEVAR at national level in relation to elective surgery. STUDY DESIGN AND SCOPE: A retrospective multicenter registry of patients with descending thoracic aortic disease treated on an emergency basis using endovascular techniques between 2012-2016, in 11 clinical units. PATIENTS, INCLUSION CRITERIA: 1) Ruptured descending thoracic aortic aneurysms; 2) Blunt traumatic thoracic aortic injury; and 3) Complicated acute type B aortic dissections (TBADc). PRIMARY VARIABLES: Patient mortality, survival and reoperation rate. SECONDARY VARIABLES: Demographic data, cardiovascular risk factors, specific data by indication, technical resources and postoperative complications. RESULTS: A total of 135 urgent TEVARs were included (111 men, mean age 60.4 ± 16.3 years): 43 ruptured thoracic aortic aneurysms (31.9%), 54 type B dissections (40%) and 32 traumatic aortic injuries (23.7%), and other etiologies 4.4%. The overall mortality rate at 30 days was 18.5%, and proved higher in the ruptured descending thoracic aortic aneurysms group (27.9%). The mean actuarial survival rate was 67± 6% at 5 years. The postoperative stroke rate was 5.2%, and the paraplegia rate was 5.9%. Aortic reoperations proved necessary in 12 patients (9%). CONCLUSIONS: Emergency descending thoracic aortic diseases can be treated by endovascular techniques with optimal results and low morbidity and mortality - though the figures are slightly higher than in elective cases. This registry provides, for the first time, real information on the daily clinical practice of emergency TEVAR in Spain.

A multicenter study of emergency endovascular repair of the thoracic aorta: Indications and outcomes.

OBJECTIVE: Endovascular techniques have become an essential tool for the treatment of descending thoracic aortic disease (thoracic endovascular aneurysm repair [TEVAR]). The aim is to analyze the indications and outcomes of emergency TEVAR at national level in relation to elective surgery. STUDY DESIGN AND SCOPE: A retrospective multicenter registry of patients with descending thoracic aortic disease treated on an emergency basis using endovascular techniques between 2012-2016, in 11 clinical units. PATIENTS, INCLUSION CRITERIA: 1) Ruptured descending thoracic aortic aneurysms (RTAA); 2) Blunt traumatic thoracic aortic injury (TAI); and 3) Complicated acute type B aortic dissections (TBADc). PRIMARY VARIABLES: Patient mortality, survival and reoperation rate. SECONDARY VARIABLES: Demographic data, cardiovascular risk factors, specific data by indication, technical resources and postoperative complications. RESULTS: A total of 135 urgent TEVARs were included (111 men, mean age 60.4 ±â€¯16.3 years): 43 ruptured thoracic aortic aneurysms (31.9%), 54 type B dissections (40%) and 32 traumatic aortic injuries (23.7%), and other etiologies 4.4%. The overall mortality rate at 30 days was 18.5%, and proved higher in the RTAA group (27.9%). The mean actuarial survival rate was 67 ±â€¯6% at 5 years. The postoperative stroke rate was 5.2%, and the paraplegia rate was 5.9%. Aortic reoperations proved necessary in 12 patients (9%). CONCLUSIONS: Emergency descending thoracic aortic diseases can be treated by endovascular techniques with optimal results and low morbidity and mortality - though the figures are slightly higher than in elective cases. This registry provides, for the first time, real information on the daily clinical practice of emergency TEVAR in Spain.

Aortic dissection class 3: a little-known entity. Presentation of 4 cases. / Disección aórtica de clase 3: una entidad poco conocida. Presentación de 4 casos.

Aortic dissection (AD) is the most common acute condition of the aorta and has a high mortality. Therefore, it is a radiological emergency of vital importance. Currently, five subtypes are distinguished, among which AD class 3 -also known as limited or subtle AD- is the less recognised. This type of dissection is infrequent and needs to be acknowledged radiologically in order not to go unnoticed. Regarding its imaging features, this entity is characterized by a small focal bulging of the aortic wall outline and/or a limited round dilation at the region affected by the intimal tear. Recently, the low familiarity of the radiologist with this condition has been emphasized. With the aim of illustrating the main imaging findings of this entity and reviewing its most relevant aspects, we present four cases of AD class 3 diagnosed in our hospital.

Cardiac rehabilitation in a patient with DeBakey IIIb aortic disecction case report and literature review.

Aortic dissection is one of the three types of acute aortic syndromes, which has a determined mortality rate according to its type. Improvement in survival is possible through diagnostic and treatment advances. However, a great number of these patients frequently experience physical and mental disability after hospital discharge. Thus, we report a case of a woman with aortic dissection diagnosis, who joined a supervised physical training program and a brief review of evidence, demonstrating benefits and safety of cardiac rehabilitation in this pathology.

La disección aórtica es uno de los tres tipos de los síndromes aórticos agudos, que tienen una tasa de mortalidad determinada según su tipo. La mejora en la supervivencia es posible debido a los avances en el diagnóstico y el tratamiento. Sin embargo, un gran número de estos pacientes, con frecuencia experimentan discapacidad física y mental después del alta hospitalaria. Por lo tanto, se presenta el caso de una mujer con diagnóstico de Disección Aórtica, que se incorporó a un programa de entrenamiento físico supervisado, así como, una breve revisión de la evidencia, demostrando los beneficios y la seguridad de la rehabilitación cardíaca en pacientes con esta patología.

Compromiso de arteria renal en paciente con arteritis de Takayasu: reporte de caso y revisión de literatura

Introducción: La arteritis de Takayasu (TAK) es una enfermedad idiopática granulomatosa de grandes vasos que afecta predominantemente a la aorta, ramas arteriales principales y pulmonares. La prevalencia es mayor en adultos que en niños, con una incidencia de 1,1 por millón de personas. Su etiología sigue siendo poco conocida. Caso Clínico: Se presenta el caso de un paciente pediátrico con pérdida de la masa renal izquierda por disminución del calibre de arteria renal ipsilateral meses después del debut de la Arteritis de Takayasu como aneurisma de aorta abdominal. El paciente cumple criterios de TAK según clasificación EULAR/PRINTO/PReS basados en anomalía angiográfica, hipertensión arterial y elevación reactantes de fase aguda. La TAK presenta afectación sistémica y alteraciones cardiovasculares (75-85%), hipertensión en más del 80% de los casos, con estenosis de la arteria renal en casi el 50% de los pacientes. Conclusiones: El tratamiento general de la TAK está dirigido a controlar la inflamación vascular y prevenir el daño orgánico irreversible. A pesar de un diagnóstico temprano con tratamiento oportuno y agresivo el seguimiento en la enfermedad de Takayasu es imprescindible dado que la progresión de esta puede seguirse dando. Deben establecerse estrategias para asegurar la adherencia al seguimiento. (provided by Infomedic Intl.)

Introduction: Takayasu's arteritis (TAK) is an idiopathic granulomatous large vessel disease predominantly affecting the aorta, main arterial branches and pulmonary arteries. The prevalence is higher in adults than in children, with an incidence of 1.1 per million people. Its etiology remains poorly understood. Case Report: We present the case of a pediatric patient with loss of left renal mass due to decreased ipsilateral renal artery caliber months after the debut of Takayasu's arteritis as abdominal aortic aneurysm. The patient meets TAK criteria according to EULAR/PRINTO/PReS classification based on angiographic abnormality, arterial hypertension and elevated acute phase reactants. TAK presents systemic involvement and cardiovascular alterations (75-85%), hypertension in more than 80% of cases, with renal artery stenosis in almost 50% of patients. Conclusions: The general treatment of TAK is aimed at controlling vascular inflammation and preventing irreversible organ damage. Despite early diagnosis with timely and aggressive treatment, follow-up in Takayasu's disease is imperative as progression may still occur. Strategies should be established to ensure adherence to follow-up. (provided by Infomedic Intl.)

Infarto de miocardio con elevación del segmento ST inferior y anterior: ¿doble lesión culpable?

El dolor torácico es uno de los motivos de consulta más frecuente en un servicio de urgencia. Dentro de las hipótesis diagnósticas se deben descartar las patologías de mayor gravedad: el infarto al miocardio (IM), la disección aórtica, el tromboembolismo pulmonar y el neumotórax. El escenario más frecuente es el IM debido a un accidente de placa, pero existen casos en donde la disección aórtica puede verse acompañada de un déficit de perfusión coronaria (síndrome de malaperfusión) generando un IM. Su diagnóstico es difícil, con una mayor mortalidad y complejidad quirúrgica. Presentamos el caso de un hombre de 59 años que cursó con dolor torácico y electrocardiograma con elevación del segmento ST inferior y anterior, derivado a angioplastia primaria y que en el estudio angiográfico se identifica compromiso ostial de coronarias, se sospecha una disección aórtica, confirmándose por angiotomografía computada de aorta, donde se evidencia una disección de aorta ascendente con compromiso de ambos ostium coronarios que se trató quirúrgicamente.

Chest pain is one of the most frequent reasons for consultation in the emergency department. The most severe pathologies must be quickly ruled out within the diagnostic hypotheses: myocardial infarction (MI), aortic dissection, pulmonary thromboembolism, and pneumothorax. A frequent scenario is ST elevation MI due to a plaque accident. However, there are infrequent cases of aortic dissection associated with a deficit in coronary perfusion (malperfusion syndrome) that triggers a MI. The diagnosis of a double artery is difficult, with higher mortality and surgical complexity. We present the case of a 59-year-old man who presented chest pain and an electrocardiogram with inferior and anterior ST-segment elevation who was referred for primary angioplasty. The angiographic study confirmed the presence of a coronary ostium defect and suggested aortic dissection. Computed tomography angiography confirmed the diagnosis, showing the dissection of the ascending aorta with the compromise of both coronary ostia, which was subjected to surgical treatment.

Current hospital mortality, neurological deficit, and mid-term survival after surgery for acute type A aortic dissection in Argentina.

OBJECTIVE: To present the current in-hospital outcomes and mid-term survival of acute type A aortic dissection (AAAD) surgery performed by a group of dedicated high-volume thoracic aortic surgeons in a University Hospital in Argentina. METHODS: A retrospective analysis of prospectively collected data over a 6-year period (2011-2016) was performed on a consecutive series of 53 adult patients who underwent emergency cardiac surgery for AAAD in the Buenos Aires University Hospital in Argentina. RESULTS: A mean of 8.8 AAAD repairs were performed yearly during the 6-year period. In-hospital mortality was 17%, and was statistically equivalent to the expected operative mortality rate of 21% (EuroSCORE II) (observed-to-expected mortality ratio 0.81; p=0.620). New neurological deficit appeared postoperatively in 6% of cases, and the observed major postoperative morbidity rate was 42%. All-cause death cumulative survival probability was 0.711 (SE 0.074), with a mean follow-up period of 49.2 (SE 5.0) months. Cumulative survival probability for in-hospital survivors was 0.903 (SE 0.053), with a mean follow-up period of 62.5 (SE 3.6) months. CONCLUSION: Although the present results do not reach international standards, AAAD surgery in our institution was associated with an acceptable mortality risk and satisfactory mid-term survival compared with previous local studies. In addition to in-hospital mortality, the incidence of new permanent neurological deficit after surgery must be considered the most devastating complication to avoid. Patient-focused care in referral aortic centers with surgery performed by specialized teams should be encouraged in order to improve surgical outcomes in acute aortic dissection surgery in Argentina.

[Evaluation of the characteristics of aortic dissection by computed angio-tomography in the Mexican population]. / Evaluación de las características de la disección aórtica en la población mexicana mediante angiotomografía computarizada.

OBJECTIVE: To review aortic dissection (AD) in the Mexican population. METHOD: A retrospective study was conducted using 434 medical records of patients with aortic angio-tomography between November 2014 and October 2015. A sample was obtained of 32 patients with a first time diagnosis of AD. An analysis was performed of the dissections according to gender, age group, Stanford/De Bakey classification, and mortality rate 6 months after diagnosis. Statistical analysis was performed by obtaining the Chi squared index for the independent variables of gender, Marfan syndrome, systemic arterial hypertension, as well as calcified atheromatous disease in association with dissection subtypes, re-entry sites, and hypo-perfusion signs. RESULTS: The patients included 65.6% males with a mean age of 54.5 years, and 34.4% females with mean age of 42.5 years. The most common dissection subtype was B/3. Mortality rate at 6 months was 18.7%. There was a significant association, with a marginal P in patients with Marfan syndrome and Stanford subtypes of AD (P=.0506). There was a significant association in patients with abdominal aortic aneurysm, when compared with Stanford subtypes of AD (P=.047104). CONCLUSIONS: AD is an emergency in which diagnosis and timely management are essential to improve prognosis. In the sample presented here, a significant association was found in patients with a history of Marfan syndrome and abdominal aneurysms with dissections according to the Stanford classification. The rest of the independent variables did not show any significant association, probably related to the size of the sample.

Type A chronic aortic dissection with obesity and preeclampsia. / Disección aórtica crónica tipo A en un paciente con obesidad mórbida y preeclampsia.

Aortic dissection is a potentially lethal disease whose incidence in pregnant women can be up to 100 times that of the remaining adult population. In most cases, it presents as typical chest pain. We report the case of a 37yo obese woman diagnosed with chronic type A aortic dissection documented by a radiological finding 10 months after delivery.

Disección aórtica: verdadero valor diagnóstico de la radiografía de tórax / Aortic dissection: True diagnostic value of thorax X-ray

Resumen Objetivo: Evaluar la capacidad diagnóstica de los signos radiológicos y su aplicabilidad para el diagnóstico de disección aórtica (DA). Establecer un valor de corte para el ensanchamiento mediastínico izquierdo en la DA y determinar su sensibilidad (S) y especificidad (E). Método: Se incluyeron 39 pacientes a los que se realizó angiotomografía de aorta torácica por sospecha clínica de DA, en un instituto cardiovascular de alta complejidad, del 1 de agosto de 2018 al 1 de febrero de 2019. Se realizaron radiografías de tórax de frente a todos los pacientes. Resultados: el 72% de los pacientes eran hombres. El promedio de edad fue de 63 años. La hipertensión arterial fue el factor de riesgo cardiovascular más común. El 43% de los pacientes tuvieron DA, el 76% fueron de tipo B. La media del ancho mediastínico máximo mostró una diferencia de 1,5 cm entre los pacientes con DA y sin DA. En cambio, la diferencia fue de 2 cm para el ancho mediastínico izquierdo. El ensanchamiento mediastínico máximo y del mediastino izquierdo fueron signos estadísticamente significativos; este último con muy buena capacidad diagnóstica (área bajo la curva: 0,84). Se calculó un punto de corte para el ancho mediastínico izquierdo de 5,39 cm (S: 82%; E: 77%). El ensanchamiento del botón aórtico, aorta ascendente/descendente o asimetría entre ambas también fueron signos estadísticamente significativos. Conclusiones: Los signos radiológicos para el diagnóstico de DA fueron validados. Se calculó un punto de corte para el ancho mediastínico izquierdo de 5,39 cm, con buena capacidad diagnóstica.

Abstract Objective: To evaluate the diagnostic capacity of the radiological signs for aortic dissection (AD) and their applicability for the diagnosis, as well as to establish a cut-off value for left mediastinal width in AD and determine its sensitivity (S) and specificity (E). Method: From a high complexity cardiovascular institute, 39 patients were selected and chest X-rays were performed from August 1, 2018 to February 1, 2019. Selection criteria involved those who underwent computed tomography angiography of thoracic aorta for clinical suspicion of AD. Results: Within the sample, 72% were men (mean 63 years old), with hypertension as a most common risk factor. 43% of the patient had AD, 76% were type B. The mean maximum mediastinal width showed a difference of 1.5 cm between patients with AD and those without it. In contrast, the difference was 2 cm for the left mediastinal width. Maximum mediastinal width and left mediastinal width were statistically significant signs. Left mediastinal width presented good diagnostic capacity (area under the curve: 0.84). Cut-off point of 5.39 cm for the left mediastinal width was calculated (S: 82%; E: 77%). Finally, widening of the aortic knob, ascending/descending aorta or asymmetry between both showed to be statistically significant signs. Conclusions: Radiological signs for the diagnosis of AD was validated. Also, a cut-off point for the left mediastinal width of 5.39 cm was found with a very good diagnostic capacity.

Reparación endovascular de la aorta torácica, resultados a largo plazo / Endovascular repair of the thoracic aorta, long-term results

Resumen Introducción: Las diversas patologías de la aorta torácica descendente, representan una implícita amenaza para la vida, y son potencialmente tratables mediante reparación endovascular. Objetivo: Evaluar los resultados de la reparación endovascular de la aorta torácia descendente (TEVAR). Material y Método: Estudio observacional, retrospectivo y descriptivo, donde se analiza TEVAR, en un período de 10 años (2009 al 2019), en el Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Se realizó TEVAR en 31 pacientes, sexo masculino 74,2%, femenino 25,8%, edad promedio 67,8 años (rango 53-85), patologías asociadas: hipertensión arterial sistémica (77,4%), tabaquismo (67,7%) y dislipidemia (38,7%), las indicaciones para TEVAR fueron: el aneurisma de la aorta descendente (51,61%), la disección tipo B crónica complicada (29,03%), y la disección tipo B aguda complicada (19,35%), relacionado al procedimiento se evidenció: morbilidad cardiovascular (12,9%) y morbilidad neurológica (6,45%), complicaciones relacionadas a la endoprótesis (29,03%), incidencia de endofugas (19,35%), estancia hospitalaria promedio de 5,2 días (rango 3 a 17), seguimiento promedio de 47,3 meses (9-108), éxito técnico primario (100%), tasa de reintervención: 3,22%, tasa de supervivencia a 1, 3, 5 años del 96,77%, 93,54 y 90,32% respectivamente, no hubo mortalidad menor a 30 días. Discusión: La evidencia demuestra que TEVAR puede realizarse en forma segura y efectiva, cumpliendo estrictos criterios clínicos y condiciones anatómicas, representando la modalidad de elección para la reparación de las lesiones de la aorta descendente. Conclusión: Los resultados demuestran que TEVAR, representa una excelente estrategia terapeutica, menos invasiva, con baja morbilidad y mortalidad asociada.

Introduction: The pathological injuries of the descending thoracic aorta, represent an implicit threat to life, and are potentially treatable by endovascular repair. Aim: To evaluate the results of endovascular repair of the descending thoracic aorta (TEVAR) in the medium and long term. Material and Method: Observational, retrospective and descriptive study, where TEVAR is analyzed, over a period of 10 years (2009 to 2019), at the Dr. Eduardo Pereira Hospital in Valparaíso, Chile. Results: TEVAR was performed in 31 patients, male sex 74.2%, average age 67.8 years (range 53-85), symptomatic 64.5%, associated pathologies: systemic arterial hypertension (77.4%), smoking (67.7%) and dyslipidemia (38.7%), indications for endovascular repair were descending aortic aneurysm (51.61%), complicated Stanford type B chronic aortic dissection (29.03%), and complicated Stanford type B acute aortic dissection (19.35%), neurological morbidity (6.45%), cardiovascular morbidity (12.9%), complications related to the stent (29.03%), where endoleaks predominate (19.35%), average hospital stay of 5.2 days (range 3 to 17), average followup of 47.3 months (9-108), primary technical success (100%), survival rate at 1, 3, 5 years of 96.77%, 93.54 and 90.32% respectively, there was no mortality less than 30 days or reoperation. Discussion: the evidence shows that TEVAR can be performed safely and effectively, meeting strict clinical criteria and anatomical conditions, which represents the modality of choice for the repair of lesions in the descending aorta. Conclusion: The results show that TEVAR represents an excellent therapeutic strategy, less invasive, with low associated morbidity and mortality.

Implantación endovascular urgente de stent en disección aórtica aguda tipo III de DeBakey / Emergency endovascular stent graft implantation for acute traumatic DeBakey type III aortic dissection

RESUMEN El tratamiento de las enfermedades de la aorta torácica con la implantación percutánea de stent se viene realizando desde su aplicación, por primera vez, a principios del siglo XX. Se presenta un paciente de 79 años de edad que fue llevado a urgencias con intenso dolor de espalda posterior a un accidente automovilístico, a quien se le realizó tomografía computarizada y se le diagnosticó una disección aórtica tipo III de DeBakey. Se le implantó un stent endovascular autoexpandible de nitinol (Talent Stent Graft, Medtronic) en la aorta descendente, donde comenzaba el segmento disecado. Este procedimiento es un método eficaz para prevenir la isquemia de órganos y la ruptura vascular en las enfermedades traumáticas de la aorta. Es menos invasivo, tiene menos complicaciones que el tratamiento quirúrgico, y es efectivo para restituir el flujo sanguíneo de forma rápida y segura.

ABSTRACT The applications of thoracic aorta pathologies with a stent graft percutaneously have been performed for the first time since the beginning of the 20th century. Computed tomography was performed on a 79-year-old patient who was brought to the emergency room due to an in-vehicle traffic accident with severe back pain, and DeBakey type III aortic dissection was determined. An endovascular self-expanding nitinol stent (Talent Stent Graft, Medtronic) was implanted in the descending aorta where the dissected segment begins. Stent graft implantation is an effective method in preventing organ ischemia and rupture in traumatic aortic pathologies. This procedure is less invasive and has less complication than surgical approach. It is effective in providing blood flow quickly and safely.

Cardiac rehabilitation in a patient with DeBakey IIIb aortic disecction case report and literature review / Rehabilitación cardiaca en paciente con disección aortica DeBakey IIIb reporte de caso y revisión de la literatura

Abstract Aortic dissection is one of the three types of acute aortic syndromes, which has a determined mortality rate according to its type. Improvement in survival is possible through diagnostic and treatment advances. However, a great number of these patients frequently experience physical and mental disability after hospital discharge. Thus, we report a case of a woman with aortic dissection diagnosis, who joined a supervised physical training program and a brief review of evidence, demonstrating benefits and safety of cardiac rehabilitation in this pathology.

Resumen La disección aórtica es uno de los tres tipos de los síndromes aórticos agudos, que tienen una tasa de mortalidad determinada según su tipo. La mejora en la supervivencia es posible debido a los avances en el diagnóstico y el tratamiento. Sin embargo, un gran número de estos pacientes, con frecuencia experimentan discapacidad física y mental después del alta hospitalaria. Por lo tanto, se presenta el caso de una mujer con diagnóstico de Disección Aórtica, que se incorporó a un programa de entrenamiento físico supervisado, así como, una breve revisión de la evidencia, demostrando los beneficios y la seguridad de la rehabilitación cardíaca en pacientes con esta patología.

Aortic Dissection Stanford B. A case report / Disección Aórtica Stanford B. Un Reporte de Caso / Dissecção da aorta Stanford B. Um relato de caso

ABSTRACT Introduction: chest pain is a common presentation in the emergency department environment. Although most cases of chest pain that present in the emergency department are eventually diagnosed as non-cardiovascular aetiology, it is important to exclude acute life-threatening conditions such as acute myocardial infarction, pulmonary embolism, visceral perforation and aortic dissection. This publication aims to show the importance of CT Angiography in the diagnosis of this disease and to review the updated bibliography. Case presentation: 45-year-old male patient with onset of chest pain and arterial hypertension, on CT angiography. Discussion: a type B aortic dissection was performed according to Stanford and type III according to the DeBakey classification, the patient was stabilized, cared for by a cardiologist, and referred to a tertiary hospital. Aortic dissection is a disease to consider in young patients who complain of sudden chest pain, hypertension, mainly if the D-dimer is altered; Conclusions: aortic dissection is a disease with a high risk of mortality that must be treated early; the most important radiological study in the diagnosis is CT angiography, the most common clinical presentation is atypical chest pain.

RESUMEN Introducción: el dolor de pecho es una presentación común en el entorno del departamento de emergencias. Si bien la mayoría de los casos de dolor torácico que se presentan en el servicio de urgencias finalmente se diagnostican como de etiología no cardiovascular, es importante excluir afecciones agudas que pongan en peligro la vida, como infarto agudo de miocardio, embolia pulmonar, perforación visceral y disección aórtica. Esta publicación tiene como objetivo mostrar la importancia de Angio TAC en el diagnóstico de esta enfermedad y revisar la bibliografía actualizada. Presentación de caso: paciente masculino de 45 años con inicio de dolor torácico e hipertensión arterial, en el angio TC. Discusión: se realizó una disección aórtica tipo B según Stanford y tipo III según clasificación DeBakey, el paciente fue estabilizado, atendido por un cardiólogo, y derivado a un hospital terciario. La disección aórtica es una enfermedad a tener en cuenta en pacientes jóvenes que se quejan de dolor torácico brusco, hipertensión arterial, principalmente si el dímero D está alterado; Conclusiones: la disección aórtica es una enfermedad de alto riesgo de mortalidad que debe tratarse temprano; el estudio radiológico más importante en el diagnóstico es el Angio TAC, la presentación clínica más común es el dolor torácico atípico.

RESUMO Introdução: a dor torácica é uma apresentação comum no ambiente de pronto-socorro. Embora a maioria dos casos de dor no peito que se apresentam no departamento de emergência sejam eventualmente diagnosticados como de etiologia não cardiovascular, é importante excluir condições agudas de risco de vida, como infarto agudo do miocárdio, embolia pulmonar, perfuração visceral e dissecção aórtica. Esta publicação tem como objetivo mostrar a importância da angiotomografia no diagnóstico desta doença e revisar a bibliografia atualizada. Apresentação do caso: Paciente do sexo masculino, 45 anos, com quadro de dor torácica e hipertensão arterial, à angiotomografia. Discussão: foi realizada dissecção aórtica tipo B de acordo com Stanford e tipo III de acordo com a classificação de DeBakey, o paciente foi estabilizado, atendido por cardiologista e encaminhado para hospital terciário. A dissecção da aorta é uma doença a ser considerada em pacientes jovens que se queixam de dor torácica súbita, hipertensão, principalmente se o dímero D estiver alterado; Conclusões: a dissecção aórtica é uma doença de alto risco de mortalidade que deve ser tratada precocemente; o estudo radiológico mais importante para o diagnóstico é a angiotomografia, a apresentação clínica mais comum é a dor torácica atípica.

Hypoxic hepatitis in an extensive aortic disecction: case report / Hepatitis hipóxica en una disección aórtica extensa: reporte de caso

Hypoxic hepatitis is an uncommon cause of hepatic damage characterized by a centrolobular necrosis. Its pathophysiology remains unclear. Aortic dissection is a rare but frequently catastrophic event. It is caused by an aortic intimal tear with propagation of a false channel in the media. Depending on the site and extension, it can cause hypoperfusion of any organ leading to cellular ischemia and necrosis. We are presenting a case of hypoxic hepatitis in a patient with an extensive aortic dissection who present to the emergency department.

La hepatitis hipóxica es una causa poco frecuente de daño hepático caracterizada por una necrosis centrolobular. Su fisiopatología sigue siendo poco clara. La disección aórtica es un evento raro pero con frecuencia catastrófico. Dependiendo del sitio y la extensión, puede causar hipoperfusión de cualquier órgano lo que conduce a una isquemia celular y necrosis. Nosotros presentamos un caso de hepatitis hipóxica en un paciente con disección aórtica extensa que se presenta al servicio de emergencia.

Características de los pacientes con disección aórtica aguda en Villa Clara: Estudio multicéntrico / Characteristics of patients with acute aortic dissection in Villa Clara: Multicentric study

RESUMEN Introducción: La disección aórtica aguda es considerada como una de las enfermedades cardiovasculares más catastróficas que ocurren en el ser humano, tiene una alta mortalidad que obliga a un diagnóstico y tratamiento precoces. Objetivo: Describir las características de los pacientes con disección aórtica atendidos en 4 instituciones hospitalarias de la provincia de Villa Clara. Método: Se realizó un estudio observacional, descriptivo, de corte transversal, multicéntrico, en 25 pacientes que fueron atendidos con el diagnóstico de disección aórtica en el período comprendido entre enero de 2012 y diciembre de 2017, en 4 centros hospitalarios de nivel secundario de la provincia de Villa Clara, Cuba. Resultados: La media de la edad de los pacientes fue 60,48 ± 13,99 años, 21 fueron del sexo masculino lo que representó el 84,0%. Según la clasificación de Stanford, predominó el tipo A, en 17 pacientes (68,0%). El síntoma más referido fue el dolor torácico anterior y el taponamiento cardíaco fue la complicación más frecuente (28,0%). Conclusiones: Las características de los pacientes con disección aórtica en Villa Clara fueron similares a lo que acontece en el ámbito nacional e internacional, con una elevada mortalidad y una mayor incidencia en hombres, hipertensos y mayores de 65 años de edad. El dolor torácico fue el síntoma cardinal y el taponamiento cardíaco la complicación más temida. La disección aórtica requiere un alto nivel de sospecha por parte del médico para un diagnóstico y un tratamiento tempranos.

ABSTRACT Introduction: Acute aortic dissection is considered one of the most tragic cardiovascular diseases that occur in humans; with high mortality which requires early diagnosis and treatment. Objective: To describe the characteristics of patients with aortic dissection treated in 4 hospital institutions in the province of Villa Clara. Method: An observational, descriptive, cross-sectional, multicenter study was conducted in 25 patients who were treated under the diagnosis of aortic dissection in the period between January 2012 and December 2017, in 4 secondary-level hospital centers in Villa Clara province, Cuba. Results: The mean age of the patients was 60.48 ± 13.99 years, 21 were male, which represented 84.0%. According to the Stanford classification, type A predominated in 17 patients (68.0%). The most common symptom was anterior chest pain while the most frequent complication was cardiac tamponade (28.0%). Conclusions: The characteristics of patients with aortic dissection in the Villa Clara setting manifested in a similar way to those in the national and international sphere. A high level of suspicion is required by the doctor to achieve a timely diagnosis and treatment.