ABSTRACT
Debido al aumento del uso de endoprótesis complejas, que requieren canalización de arterias viscerales, se expone el uso de un catéter deflectable para su realización. Este catéter se utilizaría a través de los accesos femorales, lo que evita el uso de un acceso en la extremidad superior, así como las posibles complicaciones existentes de dicho acceso. Asimismo, se reduce el tiempo quirúrgico y la exposición a la radiación ionizante.(AU)
Given the increase in the use of complex endoprostheses, which require cannulation of visceral arteries, the use of a deflectable catheter for performing these is described. This catheter would be used through the femoral accesses, avoiding the use of an access in the upper extremity, thus avoiding the possible complications of said access, as well as reducing the surgical time and exposure to ionizing radiation.(AU)
Subject(s)
Humans , Catheters , Prostheses and Implants , Femoral Artery , Operative Time , Aortic Aneurysm, Abdominal/surgery , Catheterization, Peripheral , Radiation Exposure , Cardiovascular System , Lymphatic Vessels , Blood Vessels , Lymphatic SystemABSTRACT
BACKGROUND: Due to population aging and the spread of endovascular techniques for aortic diseases, there has been an increase in older population intervened. Objectively assessing patient's global status becomes mandatory in advanced ages, as impaired functional status and frailty are associated with higher postoperative mortality rates. The aim of this paper is to evaluate the impact of a systematic geriatric preoperative assessment on the outcomes of aortic interventions. METHODS: All patients above 60 years old with surgical indication for aortic disease between September 2016 and May 2019 underwent a standardized geriatric assessment. It analyzed physiological reserve, frailty, and life expectancy. An algorithm was created for its application before intervention indication. Variables registered were patient's data, type of aortic disease, type of intervention, geriatric assessment result, mortality and follow-up time. A bivariate analysis was performed. RESULTS: One hundred forty-four patients were included. Geriatric report was unfavorable for intervention in 6.25% (N.=9). From these, 88% (N.=8) were finally rejected for intervention. In those undergoing aortic intervention (N.=127) there was a 7% mortality rate (N.=9) and in the no-intervention group (N.=17) mortality rate raised up to 35% (N.=6). No aortic-related mortality was reported. A relevant association between an unfavorable geriatric report and mortality was found "OR 0.036 (CI 0.0082-0.155)." A protective relationship between any aortic intervention and mortality was found, with OR 0.139 (CI 0.043-0.447). CONCLUSIONS: Geriatric assessment is a valid tool to estimate life expectancy and patient's physiological status. An unfavorable report correlates with short-term non-aortic mortality independently of undergoing intervention. This has a high clinical relevance, and it highlights its practical applicability to improve aortic surgery indication's quality and optimize resource investment.
