Combination of BeGraft and Solaris Stent Grafts for the Covered Endovascular Reconstruction of Aortic Bifurcation-BS-CERAB Technique.

Background: This study examines the impact of the use of the combination of BeGraft and Solaris stent grafts on the outcomes during the covered endovascular reconstruction of aortic bifurcation (BS-CERAB) technique and extension to the iliac arteries. Methods: Consecutive patients with aortoiliac occlusive disease who underwent endovascular treatment using BS-CERAB between January 2020 and December 2023 were included. Patient demographics, symptoms, lesion characteristics, and procedural and follow-up details were collected and analyzed. Perioperative complications and reinterventions were also identified. Results: A total of 42 patients met the inclusion criteria (32 men, 76.2%, median age 72 years, range 59-85). Indications for treatment were intermittent claudication (42.9%) and critical limb ischemia (57.1%). Procedure success was achieved in all cases. The median patient follow-up time was 14 months (1-36). One patient died at a 10-month follow-up due to lung cancer. The mean pre-operative ABI increased from 0.37 ± 0.19 before intervention to 0.71 ± 1.23 post-operatively at 12 months (p = 0.037). The estimated primary patency rates at 3, 6, and 12 months were 90.5%, 85.7%, and 81.0% and primary assisted patency rates were 90.5%, 90.5%, and 85.7%, respectively. Secondary patency was 95.2% at 3 and 6 months and 90.5% at a 12-month follow-up. Active cancer (p = 0.023, OR 2.12 95%CI 1.14-3.25) was a risk factor for restenosis. Conclusions: This mid-term experience shows that the CERAB technique using the combination of BeGraft and Solaris stents grafts, for the endovascular treatment of severe aortoiliac atherosclerotic disease, may allow an effective reconstruction of the aortic bifurcation and iliac arteries related to high-patency and lower-reintervention rates.

Quality and Readability of Spanish-Language Online Information for Aortic Aneurysm and Its Endovascular Treatment.

BACKGROUND: Aortic aneurysms represent a chronic degenerative disease with life-threatening implications. In order for patients to comprehend health related information, it must be written at a level that can be readily understood. STUDY DESIGN: In January 2023, we searched "aneurisma aorta" and "endoprótesis aorta" terms on Google, Yahoo and Microsoft/Bing. The 31th websites provided by each search engine were analyzed. Four readability measures were used to evaluate websites regarding aortic aneurysm and their endovascular treatment in Spanish language: Flesch Index, Flesch-Szigriszt Index, Fernández-Huerta Index and grading Inflesz scale. The quality on information was evaluated by the HONcode seal, the DISCERN instrument and the JAMA benchmark criteria. RESULTS: 180 websites containing the terms "aneurisma aorta" and "endoprótesis aorta" were analyzed. Among the websites retrieved, the mean Flesh index score (53.12 ± 6.09 and 47.48 ± 7.12, respectively; P = .019), the Flesch-Szigriszt index (56.39 ± 5.72 and 48.10 ± 8.33; P = .000), and the Fernández Huerta index (61.30 ± 5.59 and 53.19 ± 8.21; P = .000), corresponding to a "somewhat difficult" readability level. In addition, the Inflesz scale (2.62 ± .59 and 2.07 ± .61; P = .000) reported a "somewhat difficult" readability, higher for the websites regarding aortic aneurysm. The HONcode seal was only presented in websites regarding aortic aneurysm (16.7%), whereas none of the websites relating to aortic endoprostheses presented it (0%) (P = .000). Websites that presented the HONcode seal obtained higher DISCERN score (P = .000, 95% CI = 6.42-16.84) and JAMA score (P = .000, 95% CI = 3.44-11.32). CONCLUSION: Internet information on aortic aneurysms and aortic endoprostheses is too difficult to read for the general Spanish-speaking population and is lacking in quality.

Directional Atherectomy With Antirestenotic Therapy Versus PTA/Supera Stenting for Popliteal Artery Lesions: A Propensity-Matched Analysis.

PURPOSE: This study examines the use and impact of directional atherectomy with antirestenotic therapy (DAART) versus angioplasty plus Supera stent implantation on the outcomes during endovascular treatment of popliteal lesions in clinical practice. METHODS: Overall 143 consecutive patients (mean age 75.0±12.2 years, 72% male), with isolated atherosclerotic disease of the popliteal artery who underwent endovascular treatment using DAART therapy or percutaneous transluminal angioplasty (PTA)/Supera stenting of the popliteal artery between January 2016 and December 2021 were identified from a retrospectively database. Patient and plaque characteristics were collected. A propensity-score matched, case-control analysis was conducted to balance covariates between the group of patients who underwent DAART and the one treated by PTA/Supera stenting. RESULTS: A total of 51 patients (35.7%) showed severe claudication and 92 (64.3%) critical limb ischemia. There was a trend toward longer treated lesions (90.4±81 vs 72.5±5.3 mm, p=0.089) and more chronic total occlusions (60.5% vs 46.8%, p=0.058) in the PTA/Supera stenting group, although not reaching statistically significance. Moderate-to-severe calcification was present in most lesions treated (75.8% of DAART group, 80.2% of PTA/Supera stenting group, and 78.3% of total cohort). Among the 53 case-matched pairs of patients treated with DAART or PTA/Supera stenting, there were no significant differences in short-term outcomes, including rate of technical success (96.2% vs 98.1%, p=0.232), procedural success (88.7% vs 90.1%, p=0.251), distal embolization (1.9% vs 1.9%, p=0.178), dissection (5.7% vs 1.9%, p=0.268), perforation (3.8% vs 5.6%, p=0.163), hospital discharge (1.2±0.1 vs 1.0±0.1, p=0.325), 30 day minor (28.3% vs 32.1%, p=0.264) or major amputation rates (7.5% vs 3.8%, p=0.107), and 30 day mortality (1.9% vs 1.9%, p=0.173). At 1 year, there was no difference in primary patency (73.6% vs 77.4%, p=0.233), primary assisted patency (81.3% vs 84.9%, p=0.167), secondary patency (86.8% vs 92.5%, p=0.094), ipsilateral minor (35.8% vs 39.6%, p=0.472) or major amputation (9.4% vs 7.5%, p=0.186), ankle brachial index improvement (0.32±0.12 vs 0.37±0.37, p=0.401), or mortality (5.7% vs 5.7%, p=0.121) rate between patients who underwent DAART or PTA/Supera stenting for popliteal lesions. CONCLUSION: Twelve-month results following DAART technique or PTA/Supera stenting of atherosclerotic lesions of the popliteal artery are not different, regardless of patient and plaque characteristics. CLINICAL IMPACT: The DAART technique for the treatment of popliteal artery atherosclerotic disease is presented as a "leave nothing behind" strategy with on-year clinical outcomes similar to ATP/Supera stenting.

Readability of patient educational materials in venous thrombosis: analysis of the 2021 ESVS guidelines and comparison with other medical societies information.

BACKGROUND: In order for patients to comprehend health related information, it must be written at a level that can be readily understood by the intended population. During 2021 the European Society for Vascular Surgery (ESVS) published a sub-section about information for patients into its Guidelines on the Management of Venous Thrombosis. METHODS: Nine readability measures were used to evaluate the patient educational material regarding venous thrombosis published by seven medical societies: ESVS, Society for Vascular Medicine (SVM), Society for Vascular Surgery (SVS), Vascular Society for Great Britain and Ireland (VS), Australia and New Zealand Society for Vascular Surgery (ANZSVS), Canadian Society for Vascular Surgery (CSVS) and American Heart Association (AHA). RESULTS: The mean reading grade level (RGL) for all the 58 recommendations was 10.61 (range 6.4-14.5) and the mean Flesch Reading Ease (FRE) was 56.10 (51.3-62.9), corresponding to a "fairly difficult" reading level. The mean RGL of the ESVS recommendations (11.45, 95% CI, 9.90-13.00) was significantly higher than the others. Post-hoc analysis determined a significant difference between the ESVS and the SVS (10.86, 95% CI, 9.84-11.91) recommendations (P=0.005). All the patient's education information published by the medical societies presented a RGL higher than recommended. The fifteen sub-sections of the information for patients included into the ESVS clinical guidelines presented a mean RGL above 9.5 points, revealing that no one (0%) was written at or below the recommended GRL. The mean FRE was 47.63 (28.2-61.6), corresponding to a "difficult" reading level. CONCLUSIONS: Venous thrombosis patient educational materials produced by leading medical societies have readability scores that are above the recommended levels. The innovative patient's information included into the ESVS venous thrombosis guidelines represents an important advance in the amelioration of the medical information for patients, but their readability should be improved to adapt the understanding to the general population.

Vascular calcification progression in patients with end-stage chronic kidney disease.

BACKGROUND: Intima media thickness (IMT), vascular calcifications and ankle-brachial pressure index (ABPI) were shown to be independent predictors of mortality in end-stage renal disease (ESRD) patients. METHODS: Between January 2018 and March 2019, a physician-initiated, nonrandomized, prospective study was conducted. Carotid IMT, vascular calcifications analysis values and measurements of the ABPI, were made at baseline and after 1-year of follow-up. RESULTS: A total of 284 patients, 152 patients with dialysis (100 hemodialysis (HD) and 52 CAPD (continuous ambulatory peritoneal dialysis)) and 132 patients with stage 4 chronic kidney disease (control group), were included (55% male, 67 [29-88] years). The values of carotid IMT at baseline were higher in the HD group than in the CAPD group (1.10±0.08 mm vs. 0.08±0.04 mm, P=0.004). Adragao and Kauppila scores were higher in the HD group than in the CAPD group (2.56±2.10 vs. 1.08±2.02, P=0.009; and 7.40±6.86 vs. 4.44±5.26, P<0.001; respectively). These differences remained after 1-year of follow-up. Pathological ABPI after 1-year follow-up was more prevalent in the HD group than in the CAPD or control groups (32.0% vs. 19.4% vs. 7.7%, respectively, P=0.042). Multivariate regression analysis revealed that age, gender, dialysis type and LDLc were independent predictors for carotid IMT increase; age, dialysis type and smoking for vascular calcifications increase on Adragao Score; and dialysis type on Kauppila Score. Only the dialysis type was the independent predictor for all vascular calcifications markers. CONCLUSIONS: Dialysis, particularly HD, is an independent risk factor for cardiovascular calcification increase in ESRD patients.

Mönckeberg's Disease of the Lower Limb.

Vascular calcification represents a group of several pathological states of differing aetiologies. Mönckeberg medial sclerosis is considered to be more widespread in the lower abdominal region and lower limbs. We present a 59-years-old male patient presented right foot gangrene. At physical exploration, femoral and popliteal pulses were presented and the ankle-brachial pressure index was 0.45, and the toe-brachial index was 0.33. The patient underwent distal angioplasty of anterior and posterior tibial arteries and due to inaccurate evolution a transmetatarsal amputation was required. Mönckeberg's medial sclerosis is diagnosed with an ABI>1.1, however, questions have been raised about the validity and the role of ABI in diagnosis of Mönckeberg's medial sclerosis. Colour-doppler vascular ultrasound allow a non-invasive technique widely available to detect vascular calcification and to differentiation between Mönckeberg's medial sclerosis and the atherosclerosis-related lesions.

Endovascular Treatment of Venous Bypass Graft Pseudoaneurysm with the New Solaris Self-Expanding Covered Stent.

Nonanastomotic pseudoaneurysm formation after vascular reconstruction is a rarely encountered problem. Covered stent graft constitutes a minimal approach. To our knowledge, the present study constitutes the first case of implantation of Solaris stent graft in Europe. A 69-year-old man with severe cardiac dysfunction presented a pseudoaneurysm of a popliteal to popliteal artery reversed saphenous vein bypass graft. The patient was successfully treated by the percutaneous placement of a Solaris self-expanding covered stent. The postimplantation arteriogram demonstrated exclusion of the pseudoaneurysm, complete apposition of the stent, and adequate runoff. No complications occurred, and the patient was discharged from the hospital one day later receiving 75 mg of clopidogrel. Endovascular exclusion by covered stent deployment offers a safe, rapid, and minimally invasive alternative to open surgical resection in patients with lower limb venous graft pseudoaneurysm. The Solaris covered stent provides a new catheter-based device with adequate navigability and exceptional accurate delivery system.

Geometric and hemodynamic analysis of fenestrated and multibranched aortic endografts.

OBJECTIVE: The objective of this study was to determine the influence of hemodynamic force on the development of type III endoleak and branch thrombosis after complex endovascular thoracoabdominal aortic aneurysm repair. METHODS: Patients with thoracoabdominal aortic aneurysm, within surgical range, treated with a fenestrated or branched endovascular aneurysm repair from 2014 to 2018 and with 3-month control computed tomography angiography were selected. Demographic variables, aneurysm anatomy, and endograft conformation were analyzed retrospectively from a prospective registry. The hemodynamic force was calculated using the mass and momentum conservation equations. RESULTS: Twenty-eight patients were included; the mean follow-up period was 24.7 ± 19.3 months. There were 102 abdominal vessels successfully catheterized (19 celiac arteries, 29 superior mesenteric arteries, 27 right renal arteries, 26 left renal arteries, and 1 polar renal artery). The rate of type III endoleak was 11.5% (n = 12); six cases were associated with branches that received two stents (P < .001). A higher rate of endoleak was observed with wider stents (8.50 ± 1.0 mm vs 7.17 ± 1.3 mm; P = .001) but not with longer stents (P = .530). All cases of type III endoleak affected visceral arteries (eight celiac arteries and four superior mesenteric arteries). The freedom from type III endoleak at 24 months was 86%. The rate of thrombosis was 5.9% (n = 6). A higher rate of thrombosis was observed in smaller vessels (5.00 ± 1.3 mm vs 7.16 ± 1.8 mm; P = .001), with higher stent oversizing (36.87% ± 23.6% vs 5.52% ± 15.0%; P < .001), and with a higher angle of curvature (124.33 ± 86.1 degrees vs 57.71 ± 27.9 degrees; P < .001). All cases of thrombosis were related to renal arteries (two left renal arteries, two right renal arteries, and two polar renal arteries). The freedom from thrombosis at 24 months was 92%. The area under the curve for the angle of curvature was 0.802 (95% confidence interval, 0.661-0.943; P = .013), and the cutoff point was established at 59.5 degrees (sensitivity, 100%; specificity, 60.4%). The receiver operating characteristic curve for the stent oversize showed an area under the curve of 0.903 (95% confidence interval, 0.821-0.984; P = .001), and the cutoff point was 14.5% (sensitivity, 100%; specificity, 77.1%). A higher hemodynamic force was associated with thrombosis (23.35 × 10-3 N ± 18.7 × 10-3 N vs 12.31 × 10-3 N ± 6.8 × 10-3 N; P = .001) but not with endoleak (P = .796). The freedom from endoleak and thrombosis at 24 months was 86% and 90%, respectively. CONCLUSIONS: Longer stents should be preferred to avoid type III endoleak. A higher angle of curvature leads to a higher hemodynamic force that results in a higher rate of thrombosis. Accordingly, we recommend maintaining the angle of curvature under 59.9 degrees. Small vessels and excessive stent oversizing entail a higher risk of thrombosis; as such, we advise a maximum stent oversize of 14.5%. Renal arteries are more susceptible to thrombosis, whereas visceral arteries are more prone to endoleak.

Nueva escala de predicción de mortalidad en los aneurismas de aorta abdominal rotos / New scale for predicting mortality in ruptured abdominal aortic aneurysms

INTRODUCCIÓN: Conocer la utilidad de las escalas de riesgo de mortalidad para el tratamiento endovascular de los pacientes con aneurisma de aorta abdominal roto. Diseñar una escala de riesgo específica. MÉTODOS: Estudio retrospectivo de 61 pacientes intervenidos mediante reparación endovascular de aneurisma de aorta abdominal roto entre 2009 y 2014. Se recogieron variables preoperatorias y de mortalidad intrahospitalaria, así como las escalas Hardman, GAS, Vancouver y ERAS. RESULTADOS: La mortalidad intrahospitalaria fue del 45,9%. El estudio univariante obtuvo como factores pronósticos la edad, el sexo varón, la hipertensión arterial, el hábito tabáquico, la enfermedad pulmonar obstructiva crónica, la tensión arterial sistólica < 90 mmHg, la frecuencia cardiaca y la pérdida de conciencia. Tras la realización del análisis multivariante, la variables significativas fueron la edad (p = 0,021), la presión arterial sistólica (p = 0,004) y la frecuencia cardiaca (p = 0,050). Las escalas GAS (76,79 ± 9,88 vs. 90,43 ± 14,76; p = 0,001), Vancouver (4,41 ± 0,62 vs. 4,83 ± 0,55; p = 0,007) y ERAS (0,06 ± 0,24 vs. 0,86 ± 0,76; p = 0,001) resultaron estadísticamente diferentes en los pacientes fallecidos. La escala resultante de la siguiente fórmula: 0,083 + 0,158 (si edad > 80 años) + 0,701 (si tensión arterial< 80 mmHg) + 0,598 (si frecuencia cardiaca< 70 lat/min) obtuvo un área bajo la curva de 0,95. CONCLUSIONES: Edad, presión sistólica y frecuencia cardiaca constituyen factores predictores de mortalidad intrahospitalaria de los pacientes con aneurisma de aorta abdominal roto tratados mediante exclusión endovascular. La aplicación de la escala propuesta en el presente estudio, en combinación con las escalas GAS, Vancouver y ERAS, permite conocer los pacientes que no se beneficiarían de tratamiento endovascular

INTRODUCTION: To determine the usefulness of mortality risk scores for the endovascular treatment of ruptured abdominal aortic aneurysms. METHODS: Retrospective study of 61 patients undergoing endovascular repair between 2009 and 2014. Preoperative variables and in-hospital mortality were collected. The Hardman, GAS, Vancouver and ERAS scales were calculated. RESULTS: In-hospital mortality was 45.9%. The univariate predictors obtained were age, male sex, hypertension, smoking, chronic obstructive pulmonary disease, systolic blood pressure < 90 mmHg, heart rate and loss of consciousness. After completing the multivariate analysis, significant variables were age (P=.021), systolic blood pressure < 90 mmHg (P = .004) and heart rate (P = .050). The GAS (76.79 ± 9.88 vs. 90.43 ± 14.76, P=.001), Vancouver (4.41 ± 0.62 vs. 4.83 ± 0.55, P =.007) and ERAS scales (0.06 ± 0.24 vs. 0.86 ± 0.76, P = .001) were statistically different between the groups. The scale resulting from the following formula: 0.083 + 0.158 (if age > 80 years) + 0.701 (if systolic blood pressure < 80 mmHg) + 0.598 (if heart rate < 70 beats/min); obtained an area under the curve of 0.95. CONCLUSIONS: Age, systolic pressure and heart rate, are predictors of hospital mortality of patients treated with endovascular repair of ruptured abdominal aortic aneurysms. Applying the scale proposed in this study, in combination with GAS, Vancouver and ERAS scales, allows the detection of patients who would not benefit from endovascular treatment

New scale for predicting mortality in ruptured abdominal aortic aneurysms. / Nueva escala de predicción de mortalidad en los aneurismas de aorta abdominal rotos.

INTRODUCTION: To determine the usefulness of mortality risk scores for the endovascular treatment of ruptured abdominal aortic aneurysms. METHODS: Retrospective study of 61 patients undergoing endovascular repair between 2009 and 2014. Preoperative variables and in-hospital mortality were collected. The Hardman, GAS, Vancouver and ERAS scales were calculated. RESULTS: In-hospital mortality was 45.9%. The univariate predictors obtained were age, male sex, hypertension, smoking, chronic obstructive pulmonary disease, systolic blood pressure <90mmHg, heart rate and loss of consciousness. After completing the multivariate analysis, significant variables were age (P=.021), systolic blood pressure <90mmHg (P=.004) and heart rate (P=.050). The GAS (76.79±9.88 vs. 90.43±14.76, P=.001), Vancouver (4.41±0.62 vs. 4.83±0.55, P=.007) and ERAS scales (0.06±0.24 vs. 0.86±0.76, P=.001) were statistically different between the groups. The scale resulting from the following formula: 0.083+0.158 (if age>80 years)+0.701 (if systolic blood pressure<80mmHg)+0.598 (if heart rate<70 beats/min); obtained an area under the curve of 0.95. CONCLUSIONS: Age, systolic pressure and heart rate, are predictors of hospital mortality of patients treated with endovascular repair of ruptured abdominal aortic aneurysms. Applying the scale proposed in this study, in combination with GAS, Vancouver and ERAS scales, allows the detection of patients who would not benefit from endovascular treatment.

Endovascular embolization of a muscular symptomatic arteriovenous malformation with Glubran 2 acrylic glue.

OBJECTIVE: Few cases of muscle arteriovenous malformations have been reported in literature to date. CASE REPORT: We report the case of a 32-year-old man presenting a muscle arteriovenous malformation involving the vastus lateralis muscle with recurrent episodes of pain. The patient was treated by transcatheter embolization with Glubran 2 acrylic glue. There were no periprocedural or subsequent clinical complications, the glue resulted in successful selective occlusion and the patient showed resolution of symptoms at the six-months follow-up. CONCLUSIONS: Endovascular therapy has been shown to be beneficial in patients with high surgical risks and is the treatment of choice for arteriovenous malformation lesions that extend beyond the deep fascia and involve muscle, tendon, and bone. Glubran 2 constitutes a useful tool to attempt embolization of the muscle arteriovenous malformation nidus, with easier handling and promising results.

Calidad de la información disponible en internet sobre el aneurisma de aorta y su tratamiento endovascular / The quality of information available on the internet about aortic aneurysm and its endovascular treatment

Introducción y objetivos. Evaluar legibilidad, accesibilidad, utilidad y fiabilidad de la información existente en internet sobre el aneurisma de aorta y su tratamiento endovascular, para comprobar su función como vehículo de información comprensible que capacite al paciente para participar en decisiones respecto a su enfermedad. Métodos. En noviembre de 2010 se recopiló información en internet sobre los términos «aneurisma aorta» y «endoprótesis de aorta» empleando los buscadores más extendidos: Google, Yahoo y MSN/Bing. Se analizaron las primeras 30 páginas ofrecidas por cada uno. Para calcular la legibilidad de los textos, se empleó el programa informático Inflesz y el instrumento LIDA como método validado de evaluación de páginas web relacionadas con la salud sobre accesibilidad, utilidad y fiabilidad. Resultados. Los índices de correlación Word (48,3±11,42; 50,11±9,33; p=0,87), Flesch-Szigriszt (52,69±8,86; 49,31±7,24; p=0,87), Fernández-Huerta (58,05±8,5; 54,44±7,19; p=0,82) y Gunning-Fog (22,03±2,05; 23,86±1,59; p=0,83) y el grado de la escala Inflesz (2,39±0,7; 2,08±0,64; p=0,28) de las páginas web sobre «aneurisma de aorta» y «endoprótesis de aorta», respectivamente, reflejaron una legibilidad «algo difícil». Los valores de accesibilidad (82,28±14,14; 77,77±12,64; p=0,98), utilidad (72,28±16,67; 72,28±26,61; p=0,08), fiabilidad (46,17±28,69; 56,38±16,17; p=0,06) y valoración total LIDA (70,22±16,85; 72,15±14,93; p=0,52) resultaron «moderados». Conclusiones. La información disponible en internet sobre el aneurisma de aorta y su terapéutica mediante implantación de endoprótesis presenta deficiencias en cuanto a accesibilidad, utilidad y fiabilidad, con la dificultad añadida de una complicada legibilidad. Creemos que los índices de legibilidad deber ser utilizados en la elaboración o la mejora de las páginas web sobre conocimientos médicos cardiovasculares (AU)

Introduction and objectives. To evaluate the readability, accessibility, usability, and reliability of information available on the Internet in the Spanish language about aortic aneurysm and its endovascular treatment, and to determine whether this information source provides comprehensible material that will enable patients to participate in decisions regarding their condition. Methods. In November 2010, information from the Internet was compiled by entering the terms “aneurisma aorta” (aortic aneurysm) and “endoprótesis aorta” (aortic endoprosthesis) in the most widely used search engines: Google, Yahoo, and MSN/Bing. The first 30 pages provided by each search engine were analyzed. The Inflesz software was used to calculate the readability of the information retrieved and the LIDA instrument, a validated tool to evaluate the quality of health-related Web sites, was used to assess accessibility, usability, and reliability. Results. The results for Web pages containing the terms aneurisma aorta and endoprótesis aorta indicated that the readability of the material retrieved was “somewhat difficult” based on the Flesch index within Microsoft Word (48.3±11.42 and 50.11±9.33, respectively; P=.87), Flesch-Szigriszt index (52.69±8.86, 49.31±7.24; P=.87), Fernández-Huerta index (58.05±8.5, 54.44±7.19; P=.82), and Gunning-Fog index (22.03±2.05, 23.86±1.59; P=.83), as well as the Inflesz grading scale (2.39±0.7, 2.08±0.64; P=.28). The LIDA values for accessibility (82.28±14.14, 77.77±12.64; P=.98), usability (72.28±16.67, 72.28±26.61; P=.08), and reliability (46.17±28.69, 56.38±16.17; P=.06) and the total score (70.22±16.85, 72.15±14.93; P=.52), yielded an evaluation of “moderate”. Conclusions. The Internet information on aortic aneurysms and its endovascular treatment with aortic endoprostheses was deficient with regard to accessibility, usability, and reliability, and had the added difficultly of complicated readability. Our results suggest that readability indexes should be incorporated in the creation and improvement of Web sites providing medical information related to cardiovascular disease (AU)

[The quality of information available on the internet about aortic aneurysm and its endovascular treatment]. / Calidad de la información disponible en internet sobre el aneurisma de aorta y su tratamiento endovascular.

INTRODUCTION AND OBJECTIVES: To evaluate the readability, accessibility, usability, and reliability of information available on the Internet in the Spanish language about aortic aneurysm and its endovascular treatment, and to determine whether this information source provides comprehensible material that will enable patients to participate in decisions regarding their condition. METHODS: In November 2010, information from the Internet was compiled by entering the terms "aneurisma aorta" (aortic aneurysm) and "endoprótesis aorta" (aortic endoprosthesis) in the most widely used search engines: Google, Yahoo, and MSN/Bing. The first 30 pages provided by each search engine were analyzed. The Inflesz software was used to calculate the readability of the information retrieved and the LIDA instrument, a validated tool to evaluate the quality of health-related Web sites, was used to assess accessibility, usability, and reliability. RESULTS: The results for Web pages containing the terms aneurisma aorta and endoprótesis aorta indicated that the readability of the material retrieved was "somewhat difficult" based on the Flesch index within Microsoft Word (48.3 ± 11.42 and 50.11 ± 9.33, respectively; P = .87), Flesch-Szigriszt index (52.69 ± 8.86, 49.31 ± 7.24; P = .87), Fernández-Huerta index (58.05 ± 8.5, 54.44 ± 7.19; P=.82), and Gunning-Fog index (22.03 ± 2.05, 23.86±1.59; P=.83), as well as the Inflesz grading scale (2.39 ± 0.7, 2.08 ± 0.64; P=.28). The LIDA values for accessibility (82.28 ± 14.14, 77.77 ± 12.64; P=.98), usability (72.28 ± 16.67, 72.28 ± 26.61; P=.08), and reliability (46.17 ± 28.69, 56.38 ± 16.17; P=.06) and the total score (70.22 ± 16.85, 72.15 ± 14.93; P=.52), yielded an evaluation of "moderate". CONCLUSIONS: The Internet information on aortic aneurysms and its endovascular treatment with aortic endoprostheses was deficient with regard to accessibility, usability, and reliability, and had the added difficultly of complicated readability. Our results suggest that readability indexes should be incorporated in the creation and improvement of Web sites providing medical information related to cardiovascular disease.

Subclavian venous aneurysm: endovascular treatment.

Few cases of venous aneurysm involving the subclavian vein have been reported in the literature to date, and all were treated conservatively or with surgical excision. The present report describes a 73-year-old woman with a pulmonary thromboembolism that likely originated from a large right subclavian vein aneurysm that was treated by percutaneous endovascular means. The technique involved placement of a self-expanding stent in the parent vein across the aneurysm, followed by filling of the lumen of the aneurysm with coils through a microcatheter. The patient has remained symptom-free at 18-month follow-up.