Extrathoracic Aneurysms in Marfan Syndrome: A Systematic Review of the Literature.

BACKGROUND: Marfan syndrome (MS) most often shows as thoracic aortic aneurysm (TAA) or aortic dissection, but it may also involve other vascular territories. This study aimed to identify those extrathoracic vascular manifestations most frequently associated with MS. METHODS: A systematic review of the literature with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria was carried out. The following databases were included: MEDLINE, Embase, Web of Science, Cumulative Index of Nursing and Health Sciences Literature (CINHAL); Spanish database MEDESY Cochrane Central Register of Controlled Trials (CENTRAL). RESULTS: A total of 10,008 articles were identified, leaving 155 for the first stage of data analysis (total incidence of aneurysms) and 83 for the second (descriptive data analysis). Overall, 518 aneurysms were identified: 149 in the head and neck, 94 in the extremities, and 275 in the aortic, iliac, and visceral sectors. Mostly, they were simultaneously discovered during studies of the TAA. In the abdominal aorta, the presentation with rupture in 11 of 32 patients stands out. Resection and bypass were the most frequently used methods for repair in the treated cases. CONCLUSIONS: Although its frequency in the general population is unknown, this systematic review suggests that extrathoracic aneurysmal arterial involvement in the MS may be more frequent than expected. We believe screening for aneurysms in other vascular sectors may be advisable, especially in patients with MS and TAA.

Abdominal Aortic Rupture Secondary to Lymphoma Recurrence.

Neoplasias affecting the aorta are usually due to a variety of thoracic and abdominal tumors, which are more common than primary tumors of the aortic wall. Those tumors that can invade the abdominal aorta are usually sarcomas, which are able to mimic, both clinically and radiologically, an aortic disease such as an aneurysm or a dissection. There are few clinical scenarios where surgical resection and aortic repair needs to be performed, and indications have not still been clearly established in the literature. We describe the case of a patient with a periaortic lymphoma who presented an aortic rupture and was successfully treated with an urgent endovascular repair.

Evaluación in vitro de los dispositivos de energía para el sellado de colaterales de vena safena en cirugía de revascularización / In vitro model to assess energy devices for the sealing of saphenous vein collaterals in revascularization surgery

INTRODUCCIÓN: Los dispositivos de sellado por energía permiten la hemostasia de los vasos mediante su coagulación y transección de forma secuencial. OBJETIVOS: Comparar la eficacia in vitro de los principales dispositivos utilizados (electrocoagulación bipolar controlada por temperatura [EB] y bisturí armónico BA]) frente a la ligadura convencional en el sellado de colaterales de vena safena (VS) durante su preparación eventual para la cirugía de bypass. MATERIAL Y MÉTODOS: Estudio experimental in vitro de 25 fragmentos de VS extraída de donante cadáver o remanentes de cirugía de revascularización o amputación. En cada fragmento se realizó un sellado mediante ligadura con seda 3/0 (control) y otro con EB (n = 13) o BA (n = 12). Cada fragmento se incorporó a un circuito cerrado con flujo pulsátil y se aumentó progresivamente la presión hasta llegar a 300 mmHg (presión suprafisiológica) y, posteriormente, hasta provocar la rotura. Se registró el diámetro de las colaterales, la presión de estallido, el punto de fuga y el estudio histológico. RESULTADOS: La presión media de estallido fue ligeramente superior para la EB (788,9 ± 455 mmHg) que para el BA (602,5 ± 363,1 mmHg), aunque sin diferencias significativas (p = 0,268). En un solo caso (BA) se produjo el estallido en la zona de sellado a presiones inferiores a 300 mmHg. El punto de fuga para el BA ocurrió en la zona de sellado en todos los casos (12/12), mientras que para la EB se produjo en la zona de sellado en 8 de 13 fragmentos (p = 0,039). El estudio histológico no mostró diferencias entre ambos métodos. CONCLUSIONES: Los dispositivos de hemostasia por energía presentan una eficacia y seguridad no inferior al de la ligadura en el sellado de colaterales de VS. Dadas su rapidez y fácil manejo, pueden ser útiles en la preparación del injerto venoso durante la cirugía de revascularización. Aunque el EB mostró una mayor resistencia a la rotura al producirse el estallido a presiones suprafisiológicas, este hecho podría no tener relevancia clínica

INTRODUCTION: energy sealing devices achieve hemostasis of the blood vessels through sequential coagulation and transection. OBJECTIVES: to compare the efficacy of the main sealing devices used (Electrothermal Bipolar Tissue Sealing System [EB] and Harmonic Scalpel [HS]) versus conventional vessel ligation of saphenous vein (SV) collaterals. MATERIAL AND METHODS: experimental in vitro study of 25 fragments of SV extracted from cadaveric donor, from residual fragments obtained during amputation or lower limb revascularization procedures. Two venous colateral seals were made on each fragment, one by conventional ligation with 3/0 silk (control) and the other one by EB (n = 13) or HS (n = 12). Each venous fragment was then incorporated into a pulsatile flow circuit, and the pressure was progressively increased until 300 mmHg (supraphysiological pressure) was reached, and, later on, until sealing breakage occurred. Collateral vein diameter, burst pressure, and leakage points were recorded. A histological study was also performed for each energy sealing device. RESULTS: the mean burst pressure was slightly higher for EB (788,9 ±455 mmHg) than for HS (602,5 ± 363,1 mmHg), but without significant differences (p = 0,268). Only in one case (HS) the outbreak occurred in the sealing zone at pressures below 300 mmHg. The leakage point for HS was detected in the sealing zone in all cases (12/12). The leakage point for EB occurred in the sealing zone in 8 of 13 fragments (p = 0,039). The histological study showed no differences. CONCLUSIONS: Vessel sealing devices are as effective for the sealing of saphenous vein collaterals as conventional ligation. These devices may be useful due to their fast sealing time and easy handling during surgical venous graft preparation for lower limb revascularization. Although the EB showed greater strength, the outbreak occurred at supraphysiological pressure, so this fact may not have clinical relevance