Predictors of retrieval and long-term mortality in patients treated with inferior vena cava filters.

OBJECTIVE: Inferior vena cava filters (VCFs) are a therapeutic resource for the treatment of patients with thromboembolic disease who have a contraindication to full-dose anticoagulation. In the present study, we report the retrieval rate and long-term mortality of patients receiving optional inferior VCFs and identify the predictors for retrieval and all-cause mortality during follow-up. METHODS: We conducted a retrospective cohort study of 739 consecutive recipients of optional inferior VCFs from January 2002 to December 2021 in two hospitals. Different clinical characteristics and procedure-related variables were included in the analysis. The all-cause mortality rate and retrieval rate and the predictive factors were evaluated using multivariate analysis. RESULTS: Of the 739 patients, 393 (53%) were women. The mean patient age was 69 ± 15 years. Of the patients, 67% presented with pulmonary thromboembolism and 43% with deep vein thrombosis (DVT). A contraindication to anticoagulation was present for nearly 90% of the patients, mainly (47%) related to the surgical procedure. In addition, 44% of the patients had active cancer. Follow-up data were available for 94% of the patients, with an average follow-up time of 6.08 ± 5.83 years. Long-term mortality was 53%. Cancer (odds ratio [OR], 3.60; 95% confidence interval [CI], 2.22-5.83), age (OR, 1.03; 95% CI, 1.08-1.42), and DVT (OR, 2.01; 95% CI, 1.08-1.42) were identified as independent predictors of mortality. The retrieval rate at follow-up was 33%. The predictors for retrieval included the indication of the filter related to a surgical procedure (OR, 4.85; 95% CI, 2.54-9.59), the absence of cancer (OR, 2.89; 95% CI, 1.45-5.75), and younger age (OR, 0.98; 95% CI, 0.97-0.99). CONCLUSIONS: High long-term mortality was observed. The predictors of mortality were cancer, older age, and DVT. One third of the filters implanted were retrieved. The predictors for retrieval were a contraindication to surgery-related anticoagulation, the absence of cancer, and younger age.

Complicaciones venosas centrales asociadas al aneurisma de aorta abdominal roto / Central Venous Complications Associated with Ruptured Abdominal Aortic Aneurysm

RESUMEN La ruptura del aneurisma de aorta abdominal (AAA) representa una verdadera emergencia quirúrgica. Asociada con dolor abdominal, hipotensión e incluso shock, exige una transferencia inmediata a una sala de operaciones adecuadamente equipada para tratar el aneurisma en forma efectiva y sin demora. Ocasionalmente puede manifestarse como resultado de su relación con estructuras adyacentes. Dos complicaciones venosas asociadas con el AAA roto son la fístula aortocava y la compresión de la vena cava inferior (VCI). Los autores informan casos particulares de fístula aortocava y compresión de VCI con trombosis venosa profunda (TVP) por AAA roto. Los cuatro pacientes fueron tratados mediante reparación endovascular. Además de discutir las circunstancias asociadas con las complicaciones venosas por AAA, los autores también discuten la estrategia de tratamiento adoptada y las posibles alternativas.

ABSTRACT Ruptured abdominal aortic aneurysms (rAAAs) represent a real surgical emergency. In the presence of abdominal pain, hypotension or even shock, patients require emergency transfer to an operating room adequately equipped to treat the aneurysm effectively and without delay. Occasionally, symptoms are the consequence of involvement of the adjacent structures, Aortocaval fistula and compression of the inferior vena cava (IVC) are venous complications associated with rAAAs. We report cases of aortocaval fistula and IVC compression with deep venous thrombosis (DVT) due to rAAA. The four patients underwent endovascular repair. The circumstances associated with the venous complications of rAAA, the treatment strategy used and the therapeutic options are described.

[Primary angioplasty in diabetic and non-diabetic patients with acute myocardial infarction: Predictors of mortality]. / Angioplastia primaria en diabéticos vs. no diabéticos con infarto agudo de miocardio: predictores de mortalidad.

BACKGROUND AND AIMS: Diabetes mellitus is one of the major risk factors for coronary artery disease. The aim of this study was to evaluate in-hospital mortality and during follow-up of diabetic patients with acute myocardial infarction treated with primary angioplasty and to determine its predictors. MATERIALS AND METHODS: Eight hundred and sixty six patients were retrospectively enrolled from January 1993 to December 2013. A hundred patients with a diagnosis of diabetes were evaluated. The median follow-up was 121 months in 90% of the population. RESULTS: Of the 100 diabetic patients included (11.56%) 86% were male and 50% older than 70 years. Overall, 76% presented with a Killip-Kimball grade of 1 at admission and 16% presented with a Killip-Kimball 4. The most frequent location of myocardial infarction was anterior and 65% had 2 or more coronary vessel disease. In-hospital mortality was 15%. The only independent variable significantly associated was the Killip-Kimball at admission. Mortality during follow up was 35% and its independent predictors were: age, Killip-Kimball at admission and use of angiotensin-converting enzyme inhibitors Interestingly, in the non-diabetic group, Killip-kimball at admission failed to predict long-term mortality CONCLUSION: This group of diabetic patients was older, and with a higher prevalence of 2 or more vessel disease. Cardiogenic shock on admission was the only independent predictor of in-hospital death and along with age and angiotensin-converting enzyme inhibitor use, an independent predictor of mortality during long term follow-up.

Angioplastia primaria en el infarto agudo de miocardio: predictores de eventos en el seguimiento a largo plazo / Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction: Long-Term Predictors of Adverse Events

Introducción: El infarto agudo de miocardio (IAM) es una de las principales causas de muerte cardiovascular. Los tratamientos de reperfusión, aplicados dentro de las primeras horas del evento, han contribuido a disminuir significativamente esa mortalidad. No existen en nuestro país registros con seguimiento a largo plazo de pacientes con IAM tratados con angioplastia transluminal coronaria primaria (ATCP). Objetivos: Evaluar los resultados intrahospitalarios y el pronóstico alejado de pacientes sometidos a ATCP por IAM con supra-desnivel del segmento ST (IAMCST) y su relación con las principales variables clínicas y terapéuticas aplicadas en diferentes décadas (1993-2002 vs. 2003-2012). Material y métodos: Estudio observacional y retrospectivo de todos los pacientes con diagnóstico de IAMCST a los que se les realizó una ATCP en dos hospitales de comunidad entre los años 1993 y 2012. Resultados: Se incluyeron 851 pacientes ingresados consecutivamente entre los años 1993 y 2012. La edad promedio fue de 61 ± 12 años y la mediana de seguimiento fue de 7,8 años en el 85% de la población. La mortalidad intrahospitalaria total fue del 6% y del 1,6% excluidos los pacientes con shock al ingreso; las variables independientes asociadas fueron la edad (OR 1,06, IC 1,03-1,09; p < 0,001), el sexo femenino (OR 3,1, IC 1,5-6,2; p < 0,002), la diabetes mellitus (OR 3,9, IC 1,86-8; p < 0,001) y la enfermedad de tres vasos coronarios (OR 4,3, IC 2,1-8,6; p < 0,001); el flujo final TIMI 3 fue una variable predictora de menor mortalidad intrahospitalaria (OR 0,28, IC 0,08-0,11; p < 0,008). La mortalidad global en el seguimiento fue del 14,3% y los predictores independientes fueron la edad (OR 3,1, IC 1,8-5,5; p < 0,001), la diabetes mellitus (OR 2,3, IC 1,25-4,3; p < 0,007) y la clase C o D de la clasificación de Killip y Kimball (KK) al ingreso (OR 4, IC 1,7-9; p < 0,001); la utilización de stent se asoció con menor mortalidad global alejada (OR 0,35, IC 0,21-0,6; p < 0,001). Conclusiones: En este grupo de pacientes con IAMCST, la ATCP aplicada adecuadamente y una elevada tasa de seguimiento alejado permitió obtener resultados intrahospitalarios favorables que se mantienen en el largo plazo. La edad avanzada al momento del IAMCST, la diabetes mellitus, el sexo femenino y la presencia de lesiones significativas en más de un vaso epicárdico mayor fueron los predictores de mortalidad intrahospitalaria, mientras que los dos primeros (edad y diabetes mellitus) y el KK C o D fueron predictores independientes de mortalidad en el seguimiento. Los pacientes asistidos durante la segunda década mostraron una tendencia no significativa a menor mortalidad intrahospitalaria en comparación con los de la primera década.(AU)

Introduction: Acute myocardial infarction (AMI) is one of the leading causes of cardiovascular death. Reperfusion treatments performed within the first hours have contributed to produce a significant reduction in mortality. In our country, there are no long-term follow-up registries of AMI patients treated with primary percutaneous coronary intervention (PCI). Objectives: The aim of this study is to evaluate the in-hospital results and long-term outcome of ST-segment elevation AMI (STEMI) patients undergoing primary PCI and their correlation with the main clinical and therapeutic variables applied in different decades (1993-2002 vs. 2003-2012). Methods: We performed an observational and retrospective study of all STEMI patients undergoing primary PCI in two community hospitals between 1993 and 2012. Results: The study included 851 patients consecutively admitted between 1993 and 2012. Mean age was 61 ± 12 years and median follow-up was 7.8 years in 85% of the population. In-hospital mortality was 6% and 1.6% when patients with shock at admission were excluded. It was independently associated with age (OR 1.06, CI 1.03-1.09; p < 0.001), female sex (OR 3.1, CI 1.5-6.2; p < 0.002), diabetes mellitus (OR 3.9, CI 1.86-8; p < 0.001) and three-vessel disease (OR 4.3, CI 2.1-8.6; p < 0.001). Conversely, final TIMI grade 3 flow predicted lower in-hospital mortality (OR 0.28, CI 0.08-0.11; p < 0.008). During follow-up, overall mortality was 14.3% and the independent predictors were age (OR 3.1, CI 1.8-5.5; p < 0.001), diabetes mellitus (OR 2.3, CI 1.25-4.3; p < 0.007) and Killip and Kimball (KK) class C or D at admission (OR 4, CI 1.7-9; p < 0.001); stent implant was associated with lower overall long-term mortality (OR 0.35, CI 0.21-0.6; p < 0.001). Conclusions: In this group of STEMI patients, the adequate use of primary PCI and the high rate of patients at long-term follow-up allowed the collection of favorable in-hospital and long-term results. Advanced age at the moment of STEMI, diabetes mellitus, female sex and multiple vessel disease were predictors of in-hospital mortality, while age, diabetes mellitus and KK class C or D were independent predictors of mortality during follow-up. Patients treated during the second decade showed a non-significant trend towards reduced in-hospital mortality compared with those of the first decade.(AU)

Angioplastia primaria en el infarto agudo de miocardio: predictores de eventos en el seguimiento a largo plazo / Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction: Long-Term Predictors of Adverse Events

Introducción: El infarto agudo de miocardio (IAM) es una de las principales causas de muerte cardiovascular. Los tratamientos de reperfusión, aplicados dentro de las primeras horas del evento, han contribuido a disminuir significativamente esa mortalidad. No existen en nuestro país registros con seguimiento a largo plazo de pacientes con IAM tratados con angioplastia transluminal coronaria primaria (ATCP). Objetivos: Evaluar los resultados intrahospitalarios y el pronóstico alejado de pacientes sometidos a ATCP por IAM con supra-desnivel del segmento ST (IAMCST) y su relación con las principales variables clínicas y terapéuticas aplicadas en diferentes décadas (1993-2002 vs. 2003-2012). Material y métodos: Estudio observacional y retrospectivo de todos los pacientes con diagnóstico de IAMCST a los que se les realizó una ATCP en dos hospitales de comunidad entre los años 1993 y 2012. Resultados: Se incluyeron 851 pacientes ingresados consecutivamente entre los años 1993 y 2012. La edad promedio fue de 61 ± 12 años y la mediana de seguimiento fue de 7,8 años en el 85% de la población. La mortalidad intrahospitalaria total fue del 6% y del 1,6% excluidos los pacientes con shock al ingreso; las variables independientes asociadas fueron la edad (OR 1,06, IC 1,03-1,09; p < 0,001), el sexo femenino (OR 3,1, IC 1,5-6,2; p < 0,002), la diabetes mellitus (OR 3,9, IC 1,86-8; p < 0,001) y la enfermedad de tres vasos coronarios (OR 4,3, IC 2,1-8,6; p < 0,001); el flujo final TIMI 3 fue una variable predictora de menor mortalidad intrahospitalaria (OR 0,28, IC 0,08-0,11; p < 0,008). La mortalidad global en el seguimiento fue del 14,3% y los predictores independientes fueron la edad (OR 3,1, IC 1,8-5,5; p < 0,001), la diabetes mellitus (OR 2,3, IC 1,25-4,3; p < 0,007) y la clase C o D de la clasificación de Killip y Kimball (KK) al ingreso (OR 4, IC 1,7-9; p < 0,001); la utilización de stent se asoció con menor mortalidad global alejada (OR 0,35, IC 0,21-0,6; p < 0,001). Conclusiones: En este grupo de pacientes con IAMCST, la ATCP aplicada adecuadamente y una elevada tasa de seguimiento alejado permitió obtener resultados intrahospitalarios favorables que se mantienen en el largo plazo. La edad avanzada al momento del IAMCST, la diabetes mellitus, el sexo femenino y la presencia de lesiones significativas en más de un vaso epicárdico mayor fueron los predictores de mortalidad intrahospitalaria, mientras que los dos primeros (edad y diabetes mellitus) y el KK C o D fueron predictores independientes de mortalidad en el seguimiento. Los pacientes asistidos durante la segunda década mostraron una tendencia no significativa a menor mortalidad intrahospitalaria en comparación con los de la primera década.

Introduction: Acute myocardial infarction (AMI) is one of the leading causes of cardiovascular death. Reperfusion treatments performed within the first hours have contributed to produce a significant reduction in mortality. In our country, there are no long-term follow-up registries of AMI patients treated with primary percutaneous coronary intervention (PCI). Objectives: The aim of this study is to evaluate the in-hospital results and long-term outcome of ST-segment elevation AMI (STEMI) patients undergoing primary PCI and their correlation with the main clinical and therapeutic variables applied in different decades (1993-2002 vs. 2003-2012). Methods: We performed an observational and retrospective study of all STEMI patients undergoing primary PCI in two community hospitals between 1993 and 2012. Results: The study included 851 patients consecutively admitted between 1993 and 2012. Mean age was 61 ± 12 years and median follow-up was 7.8 years in 85% of the population. In-hospital mortality was 6% and 1.6% when patients with shock at admission were excluded. It was independently associated with age (OR 1.06, CI 1.03-1.09; p < 0.001), female sex (OR 3.1, CI 1.5-6.2; p < 0.002), diabetes mellitus (OR 3.9, CI 1.86-8; p < 0.001) and three-vessel disease (OR 4.3, CI 2.1-8.6; p < 0.001). Conversely, final TIMI grade 3 flow predicted lower in-hospital mortality (OR 0.28, CI 0.08-0.11; p < 0.008). During follow-up, overall mortality was 14.3% and the independent predictors were age (OR 3.1, CI 1.8-5.5; p < 0.001), diabetes mellitus (OR 2.3, CI 1.25-4.3; p < 0.007) and Killip and Kimball (KK) class C or D at admission (OR 4, CI 1.7-9; p < 0.001); stent implant was associated with lower overall long-term mortality (OR 0.35, CI 0.21-0.6; p < 0.001). Conclusions: In this group of STEMI patients, the adequate use of primary PCI and the high rate of patients at long-term follow-up allowed the collection of favorable in-hospital and long-term results. Advanced age at the moment of STEMI, diabetes mellitus, female sex and multiple vessel disease were predictors of in-hospital mortality, while age, diabetes mellitus and KK class C or D were independent predictors of mortality during follow-up. Patients treated during the second decade showed a non-significant trend towards reduced in-hospital mortality compared with those of the first decade.

Pseudo dislodgement of a stent due to crumpling of a coronary artery: a hitherto unreported complication of the "accordion effect".

The "accordion effect" is a mechanical remodeling of the arterial wall produced by endoluminal introduction of stiff guidewires, leading to vessel wall shortening and development of multiple eccentric constrictions. This phenomenon is unresponsive to vasodilators and may lead to unnecessary stenting of the pseudo-lesions. It must be suspected with the development of multiple lesions and when a tortuous artery assumes a linear shape after advancing distally a stiff wire. In the situation of a complete occlusion of the artery the diagnosis may be challenging. Stenting in this scenario can be demanding because of the difficulty to appropriately size the length of the stent to the true lesion. We present a case of an unrecognized accordion phenomenon in an occluded coronary artery with a long dissection treated with two stents that after retrieving the wire were insufficient to cover the whole dissection.

[Percutaneous closure of a mitral paraprosthetic leak with an Amplatzer® device]. / Tratamiento endovascular de una fuga paraprotésica mitral con dispositivo amplatzer®

Mitral paraprosthetic leaks are present in 5 to 17% of patients who receive valve replacement surgery. Overall, the defects are single, most of them are located in the postero-medial region of the annulus, and only one third produce a severe reflux. Percutaneous closure by endovascular surgery is a valid therapeutic alternative in patients at high risk for re-operation. The approach depends on the location, size, morphology and relationships or neighboring defects. The procedure must be performed by professionals with experience in the treatment of structural heart disease and in the management of these closure devices. Guidance with three dimensional transesophageal echocardiography is considered essential. A case of a mitral paraprosthetic leak that was closed with an Amplatzer® device introduced percutaneously from the femoral vein is here presented.

Tratamiento endovascular de una fuga paraprotésica mitral con dispositivo Amplatzer« / Percutaneous closure of a mitral paraprosthetic leak with an Amplatzer« device

El leak o fuga paraprotésica mitral se presenta entre el 5 y el 17% de los pacientes tratados con cirugía de reemplazo valvular. En general, los defectos son únicos, la mayoría se encuentran localizados en la región postero-medial del anillo valvular y solo la tercera parte produce reflujo de grado grave. El cierre percutáneo por vía endovascular es una alternativa terapéutica válida en pacientes con elevado riesgo para re-operación. La estrategia de abordaje depende de la localización, tamaño, morfología y relaciones adyacentes del o los defectos. El procedimiento debe ser realizado por profesionales con experiencia en el tratamiento de cardiopatías estructurales y en el manejo de estos dispositivos de cierre, y se considera imprescindible la utilización de un ecocardiograma transesofágico tridimensional. Se presenta el caso de un paciente con una fuga paraprotésica valvular mitral que fue cerrada con un dispositivo Amplatzer « introducido en forma percutánea desde la vena femoral.(AU)

Mitral paraprosthetic leaks are present in 5 to 17% of patients who receive valve replacement surgery. Overall, the defects are single, most of them are located in the postero-medial region of the annulus, and only one third produce a severe reflux. Percutaneous closure by endovascular surgery is a valid therapeutic alternative in patients at high risk for re-operation. The approach depends on the location, size, morphology and relationships or neighboring defects. The procedure must be performed by professionals with experience in the treatment of structural heart disease and in the management of these closure devices. Guidance with three dimensional transesophageal echocardiography is considered essential. A case of a mitral paraprosthetic leak that was closed with an Amplatzer « device introduced percutaneously from the femoral vein is here presented.(AU)

Tratamiento endovascular de una fuga paraprotésica mitral con dispositivo Amplatzer® / Percutaneous closure of a mitral paraprosthetic leak with an Amplatzer® device

El leak o fuga paraprotésica mitral se presenta entre el 5 y el 17% de los pacientes tratados con cirugía de reemplazo valvular. En general, los defectos son únicos, la mayoría se encuentran localizados en la región postero-medial del anillo valvular y solo la tercera parte produce reflujo de grado grave. El cierre percutáneo por vía endovascular es una alternativa terapéutica válida en pacientes con elevado riesgo para re-operación. La estrategia de abordaje depende de la localización, tamaño, morfología y relaciones adyacentes del o los defectos. El procedimiento debe ser realizado por profesionales con experiencia en el tratamiento de cardiopatías estructurales y en el manejo de estos dispositivos de cierre, y se considera imprescindible la utilización de un ecocardiograma transesofágico tridimensional. Se presenta el caso de un paciente con una fuga paraprotésica valvular mitral que fue cerrada con un dispositivo Amplatzer ® introducido en forma percutánea desde la vena femoral.

Mitral paraprosthetic leaks are present in 5 to 17% of patients who receive valve replacement surgery. Overall, the defects are single, most of them are located in the postero-medial region of the annulus, and only one third produce a severe reflux. Percutaneous closure by endovascular surgery is a valid therapeutic alternative in patients at high risk for re-operation. The approach depends on the location, size, morphology and relationships or neighboring defects. The procedure must be performed by professionals with experience in the treatment of structural heart disease and in the management of these closure devices. Guidance with three dimensional transesophageal echocardiography is considered essential. A case of a mitral paraprosthetic leak that was closed with an Amplatzer ® device introduced percutaneously from the femoral vein is here presented.