Thirty-three vascular residency programs among 13 countries joining forces to improve surgical education in times of COVID-19: A survey-based assessment.

BACKGROUND: Academic interaction with mentors has almost become minimal due to the current pandemic of COVID-19. The objective of this study is to introduce how a group of vascular surgery residencies joined forces to improve surgical education in times of COVID-19. METHODS: On May 2020, a group of Hispanic American vascular residency programs created webinar sessions of arterial and venous clinical cases among vascular residents across Latin America and Europe. Participants were surveyed via email. Questions were about the perceived quality and utility of the webinars; answers were stratified into negative (disagree), neutral, and positive (agree). RESULTS: There have been 60 sessions and 118 clinical cases presented. The survey was answered by 106 participants, 82 males (78.8%) and 24 women (23.0%). Fifty-four (51.9%) were board-certified vascular surgeons, 49 (47.1%) vascular surgery residents, and 2 (1.9%) general surgery residents. Mean age of the participants was 41.5 years (range: 25-74 years). Mean years of vascular surgery practice or experience were 11.2 years (range: 0-45 years). The residency programs involved in this project were from 13 different countries. Most answers received were positive for both perceived quality and utility of the webinars. CONCLUSION: Globalization and technology provide an opportunity for international education, with the goal of building well-rounded and academic vascular surgeons. This group is just the beginning of a large collaborative group among Hispanic American countries, hoping that more residency programs will join, with the aim of breaking borders in the education of vascular surgery.

Infección de prótesis aórtica abdominal convencional: resultados del tratamiento mediante resección y revascularización extraanatómica / Aortic graft infection: outcomes of graft excision and extra anatomic revascularization

Introducción: la infección de prótesis después de cirugía abierta de aorta abdominal es infrecuente (0,7-3 %) y potencialmente mortal. El manejo clásico ha sido mediante revascularización extraanatómica y retiro del material protésico, y actualmente existen alternativas de reparación in situ. La mortalidad perioperatoria global es entre 4 y 40 % dependiendo de la serie y del tipo de reparación. Objetivos: reportar nuestra experiencia con revascularización extraanatómica y resección de la prótesis infectada. Metodología: estudio retrospectivo entre 1977 y 2020. Se incluyeron solo pacientes con infección de prótesis tratados mediante resección y reconstrucción extraanatómica. Se consideraron variables demográficas, comorbilidades, presentación clínica y agente microbiano. Como resultado primario utilizamos mortalidad posoperatoria y para resultados secundarios: reoperaciones, complicaciones precoces y tardías, amputación mayor, permeabilidad y sobrevida alejada. Se realizaron estadísticas descriptivas y asociaciones dicotómicas con chi-cuadrado. Resultados: dieciséis pacientes, todos masculinos. Edad promedio 69,2 años (55-82). Tiempo promedio de cirugía a infección de 27,8 meses (1-84). Fue más frecuente la infección en pacientes intervenidos por aneurisma roto que por otras causas (p < 0,05). Once pacientes (68,8 %) presentaban fiebre, 6 (37,5 %) debutaron con dolor abdominal o lumbar, 5 (31,3 %) con signos inflamatorios cutáneos (región inguinal o lumbar). Doce pacientes (75 %) presentaron comunicación aortoduodenal: 6 fístulas y 6 erosiones. Tres pacientes (18,8 %) debutaron con isquemia de miembros inferiores. Siete pacientes (43,8 %) presentaron complicaciones posoperatorias mayores y 2 pacientes fallecieron en el posoperatorio (12,5 %). La sobrevida actuarial al año y a 5 años fue de 86,7 % y 64,3 % respectivamente. Las permeabilidades primaria y secundaria de la reconstrucción extraanatómica a 5 años fue 77,8 % y 100 %, respectivamente...(AU)

Introduction: aortic graft infection (AGI) after aortic open repair is an unusual (0.7-3 %) and potentially lethal complication. Standard treatment has been excision of infected graft and extra anatomic bypass, although currently there are in situ repair techniques. Global perioperative mortality is 4-40 % according to the series and the repair technique. Objectives: to report our experience with extra anatomic revascularization and excision of infected graft in AGI. Methodology: retrospective study between 1977 and 2020. Were included patients with AGI treated with extra anatomic revascularization and excision of infected graft only. Demographics, morbidities, clinical presentation and microbiological agents were considered. Primary outcome was postoperative mortality. Secondary outcomes were reinterventions, postoperative complications, major amputations, bypass patency and long-term survival. Descriptive statistics were performed and dycotomical asociations were established with chi-squared test. Results: sixteen patients, all male. Average age 69.2 years (55-82). Average time to infection from surgery was 27.8 months (1-84). AGI was more frequent in patients with ruptured aortic aneurysm (p < 0.05). Eleven patients (68.8 %) had fever, 6 (37.5 %) consulted with abdominal or lumbar pain, 5 (31.3 %) had inflammatory changes of local skin. Twelve patients (75 %) had aortoduodenal communications. Three patients (18.8 %) had lower limb ischemia. Seven patients (43.8 %) presented postoperative complications and 2 patients expired (12.5 %). Actuarial one-year and five-year survival were 86.7 % and 64.3 %, respectively. Five-year primary and secondary patency of the axillofemoral bypass were 77.8 % and 100 %, respectively. Conclusions: AGI is a serious condition, which treatment carries significant morbidity and mortality. Axillofemoral bypass grafting and infected graft excision currently is a safe alternative of treatment.

Reconstrucción combinada de extremidad inferior mediante colgajo libre anastomosado a bypass vascular. Caso clínico / Combined lower limb reconstruction with free tissue transfer anastomosed to a vascular bypass. Case report

Presentamos un caso de reconstrucción de extremidad inferior combinando revascularización arterial y un colgajo libre en un paciente de 72 años con enfermedad arterial oclusiva y defecto de cobertura con exposición ósea, mediante vascularización poplítea-pedia con bypass de safena y cobertura con colgajo libre de músculo recto abdominal. Debido a la ausencia de vasos receptores adecuados utilizamos el bypass como fuente de irrigación arterial y un injerto venoso entre la vena epigástrica donante y la vena poplítea como drenaje del colgajo. En pacientes que requieren reconstrucción extensa de partes blandas con enfermedad arterial oclusiva concomitante, el tratamiento combinado con revascularización quirúrgica y cobertura con colgajo libre está asociado a una alta tasa de salvamento de la extremidad y excelentes resultados funcionales. El colgajo libre de recto abdominal provee una adecuada cobertura y relleno de defectos tridimensionales, además de presentar ventajas en cuanto al tiempo de disección y el tamaño del pedículo. En casos de vasos receptores inadecuados, es posible utilizar el bypass como fuente arterial y un injerto venoso de drenaje a un vaso proximal

We present a case of lower extremity reconstruction combining bypass revascularization and free flap for soft tissue coverage in a 72-year-old diabetic man with lower extremity arterial occlusive disease and wide soft tissue defect with bone exposure, who was treated with a popliteal-pedal vein saphenous bypass and a free rectus abdominis muscle flap. The bypass was used as the arterial inflow to the flap and an interposition saphenous vein graft to the popliteal vein as the outflow vessel, due the absence of appropriate local venous receptor vessels. In patients with concomitant occlusive arterial disease, combined treatment with surgical revascularization and free flap coverage is associated with a high rate of limb salvage and excellent functional outcomes. The free rectus abdominis flap provides adequate coverage and filling of the defect, as well as advantages in terms of dissection time and donor vessel diameter. In cases of inadequate recipient vessels, it is possible to use the bypass conduit as an arterial inflow and another venous graft for outflow to a proximal vessel

Transección traumática aguda de la aorta torácica: tratamiento endovascular / Endovascular treatment of acute traumatic rupture of the thoracic aorta: report of 1 case

Traumatic rupture of the aorta has a near 80 percent mortality. Most patients die on the site of the accident. Conventional surgical repair of these lesions has a high morbidity and mortality, generally associated to the severity of associated lesions. Over the last decade, endovascular treatment has become an effective therapeutic alternative. We report a 40 years old male, that suffered a traumatic rupture of the descending thoracic aorta in a car accident. A successful endovascular repair was performed, installing an endoprothesis on the site of the lesion, using a femoral artery approach. The patient had a good postoperative evolution and was discharged from the hospital once complete rehabilitation of his associated lesions was obtained

Isquemia mesentérica aguda por disección espontánea y aislada de la arteria mesentérica superior / Mesenteric ischemia caused by a spontaneous and isolated dissection of the superior mesenteric artery

Spontaneous dissection of the superior mesenteric artery is an unusual cause of mesenteric ischemia. Diagnosis can be based on findings of the helicoidal computed tomography or selective angiography of the superior mesenteric artery. We report two male patients, aged 47 and 50 years, who were admitted for abdominal pain. Isolated superior mesenteric artery dissection was confirmed by angiography. Both patients were treated with anticoagulation, conservative measures and recovered uneventfully

Pseudoaneurisma traumático de troncos supra-aórticos: tratamiento endovascular: casos clínicos / Endovascular treatment of traumatic pseudoaneurysms of aortic arch branches: report of3 cases

The traditional treatment of traumatic lesions of the aortic arch branches requires extended surgical exposures, not exempt of morbidity and mortality. Over the last decade, devices that allow a minimally invasive treatment, have been developed. The vessel can be repaired without direct exposure, using an endovascular procedure. We report three patients with traumatic pseudoaneurysms of the left subclavian, brachiocephalic and left common carotid arteries, respectively. All lesions were successfully repaired with the insertion of an endograft. Although long term results of these procedure are unknown, repair of a future stenosis or occlusion is less complicated than the treatment required by the original lesion. Endoluminal repair appears as a safe, efficient and less invasive treatment for these lesions

Aneurisma roto de aorta torácica descendente: tratamiento endovascular / Endovascular treatment of a ruptured thoracic aorta aneurysm

In 1991, a technique to exclude aortic aneurysms from circulation inserting an endoluminal graft through the femoral artery, was described. This procedure, usually used for elective abdominal aneurysms, can also be used in the thoracic aorta. We report a 41 years old male with a Marfan syndrome, presenting with a descending aorta aneurysm that ruptured to the mediastinum and pleural cavity. He was compensated hemodynamically and an endovascular stent-graft was deployed at the ruptured zone, through the femoral artery. The postoperative evolution of the patient was uneventful. This technique will allow a less invasive treatment of ruptured aortic aneurysms

Terapia endovascular en el síndrome de vena cava superior: caso clínico / Endovascular treatment of superior vena cava syndrome: report of 1 case

The treatment of superior vena cava syndrome is usually oriented to the underlying cause, that can be too slow in emergency cases. We report a 49 years old woman with a multiple myeloma that was admitted due to a superior vena cava syndrome caused by a central venous catheter used for chemotherapy for 20 weeks. She was successfully treated with thrombolysis, angioplasty and stent placement. The patient died 7 months later due to the underlying disease. Long term catheters are the responsible for 20 to 30 percent of superior vena cava syndromes. Endovascular treatment of the syndrome is successful in 60 to 100 percent of cases with a symptomatic relapse in 4 to 45 percent of patients