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.

Quality of Life for Patients Receiving Elective Interventions for Abdominal Aortic Aneurysms.

Objectives: Information on the quality of life of patients operated on for abdominal aortic aneurysm (AAA) is scarce. The objective of this study was to analyse these patients' health-related quality of life (HRQoL). Materials and Methods: This was a cross-sectional observational study. Patients undergoing elective AAA surgery from January 2013 to December 2020 were included. The Spanish version of the SF-36 questionnaire was administered to participants one to sixty months after surgery. Results: During the study period, 178 patients underwent surgery for AAA, 109 (61.23%) had open abdominal aortic repair (AAR) and 69 (38.54%) had endovascular aneurysm repair (EVAR). Mortality before the month of surgery was higher among those treated by AAR than EVAR (2.7% and 1.45%, respectively), while late mortality was higher in the EVAR group than in the AAR group (11.5% and 2.7%, respectively). In the late postoperative period, 12.5% of patients who underwent AAR presented complications compared to 25% of those treated with EVAR. The questionnaire was administered to 151 patients (91 AAR and 60 EVAR patients). The AAR patients compared to the EVAR patients had significantly higher mean scores on the health scales of the SF-36 questionnaire in Physical Function (p = 0.001), Vitality (p = 0.003), General Health (p = 0.37), Social Function (p = 0.023) and Mental Health (p = 0.006). Scores on the Mental Summary Component were significantly higher in the AAR group (p = 0.026). Conclusions: The group of patients treated with AAR showed the highest average scores on the scales of the SF-36 questionnaire in Physical Function, Vitality, General Health and Mental Health. The worst result was found in the Social Function scale for EVAR patients and was related to a higher rate of late complications.

Association of Age and Surgical Technique with the Quality of Life of Male Patients Treated for Abdominal Aorta Aneurysms: A Cross-Sectional Study.

OBJECTIVES: The achievement of a good health-related quality of life (HRQoL) has become one of the primary objectives of medical-surgical interventions. The objective of this study is to determine the HRQoL of patients who underwent abdominal aortic aneurysm (AAA) surgery and to analyse the influence of age on HRQoL. MATERIALS AND METHODS: This is an observational cross-sectional study with 151 male patients who underwent an operation for AAAs between January 2013 and December 2020 in two hospital centres. HRQoL was assessed with the Spanish version of the 36-Item Short Form Survey (SF-36), starting in the month following the surgical intervention. Statistical analyses were performed using hypothesis tests and multivariate linear regression. RESULTS: The mean age of the patients was 73 years (SD: 7), and the mean interval between surgery and the interview was 37 months (SD: 27). The scores of the Physical Function (p = 0.001), Vitality (p = 0.016), Social Function (p = 0.014), and Mental Health (p = 0.007) dimensions of the SF-36 were significantly lower in the older age groups. In addition, the scores on the Physical Summary Component (p = 0.003) and the Mental Summary Component (p = 0.026) were significantly lower among individuals older than 70 years of age. The HRQoL in patients who underwent operations for AAAs was similar to that reported in the general population of Spain. Patients with an aorto-aortic shunt had better scores on the Physical Function (Beta: 10; p = 0.014) and Mental Health (Beta: 8.12; p = 0.040) dimensions than those who had an aorto-bi-iliac or bifemoral shunt, regardless of the age of the patients at operation. CONCLUSION: Among patients who underwent an operation for an AAA, there was a negative association between the age at operation and scores on the Physical Function, Vitality, Social Function, and Mental Health dimensions of the SF-36. The type of surgical technique influences the evolution of Physical Function and Mental Health scores, regardless of age.

Quality of Life of Patients Treated for Abdominal Aortic Aneurysm: Open Surgery and Endoprosthesis.

OBJECTIVES: To determine the degree of long-term health-related quality of life (HRQoL) of patients undergoing surgery for abdominal aortic aneurysm (AAA) and to analyze the results according to the type of treatment, namely, open abdominal repair (OAR) or endoprosthesis (EVAR). PATIENTS AND METHODS: This was a prospective cross-sectional observational study. Patients receiving intervention for AAA between January 2013 and December 2020 were included. The Spanish version of the SF-36 questionnaire was used. A single survey was performed on all patients, and the time elapsed since the intervention was recorded. RESULTS: On all health scales and in the two groups of patients, the highest scores were recorded at six months postoperatively. At that time, the EVAR and OAR groups had similar values. Between 13 and 16 months postoperatively, EVAR patients presented a transient but significant decrease in their scores for physical function (p = 0.016), vitality (p = 0.035) and social function (p = 0.041). From that moment, there were progressive decreases in the scores of the two groups of patients on all the scales of the SF-36 questionnaire, although this trend was less pronounced in the OAR group. At 60 months after the intervention, the latter group showed significantly higher values than EVAR for physical function (p = 0.01), vitality (p = 0.032) and mental health (p = 0.029). Additionally, at 60 months after the intervention, the Sum of the psychological component (MCS) and Sum of the physical component (PCS) scores were significantly higher in the OAR group (p = 0.040 and p = 0.039, respectively). CONCLUSIONS: In the short term, patients treated for AAA by EVAR or OAR showed similar results on the SF-36 questionnaire. In the long term, patients treated by EVAR had lower scores on the physical function, vitality and mental health scales.

Efficacy and safety of intramuscular administration of allogeneic adipose tissue derived and expanded mesenchymal stromal cells in diabetic patients with critical limb ischemia with no possibility of revascularization: study protocol for a randomized controlled double-blind phase II clinical trial (The NOMA Trial).

BACKGROUND: Chronic lower limb ischemia develops earlier and more frequently in patients with type 2 diabetes mellitus. Diabetes remains the main cause of lower-extremity non-traumatic amputations. Current medical treatment, based on antiplatelet therapy and statins, has demonstrated deficient improvement of the disease. In recent years, research has shown that it is possible to improve tissue perfusion through therapeutic angiogenesis. Both in animal models and humans, it has been shown that cell therapy can induce therapeutic angiogenesis, making mesenchymal stromal cell-based therapy one of the most promising therapeutic alternatives. The aim of this study is to evaluate the feasibility, safety, and efficacy of cell therapy based on mesenchymal stromal cells derived from adipose tissue intramuscular administration to patients with type 2 diabetes mellitus with critical limb ischemia and without possibility of revascularization. METHODS: A multicenter, randomized double-blind, placebo-controlled trial has been designed. Ninety eligible patients will be randomly assigned at a ratio 1:1:1 to one of the following: control group (n = 30), low-cell dose treatment group (n = 30), and high-cell dose treatment group (n = 30). Treatment will be administered in a single-dose way and patients will be followed for 12 months. Primary outcome (safety) will be evaluated by measuring the rate of adverse events within the study period. Secondary outcomes (efficacy) will be measured by assessing clinical, analytical, and imaging-test parameters. Tertiary outcome (quality of life) will be evaluated with SF-12 and VascuQol-6 scales. DISCUSSION: Chronic lower limb ischemia has limited therapeutic options and constitutes a public health problem in both developed and underdeveloped countries. Given that the current treatment is not established in daily clinical practice, it is essential to provide evidence-based data that allow taking a step forward in its clinical development. Also, the multidisciplinary coordination exercise needed to develop this clinical trial protocol will undoubtfully be useful to conduct academic clinical trials in the field of cell therapy in the near future. TRIAL REGISTRATION: ClinicalTrials.gov NCT04466007 . Registered on January 07, 2020. All items from the World Health Organization Trial Registration Data Set are included within the body of the protocol.

Effectiveness and safety of 1470-nm diode laser fulguration in the management of diffuse venous malformations.

BACKGROUND: Venous malformations (VMs) are the most frequent congenital vascular malformations. Pain and deformity are the main symptoms and usually progressive in untreated patients. Current therapeutic options are surgery (frequently partial resections with an uncomfortable postoperative period), sclerotherapy (often limited because of the need for high doses and the potential subsequent toxicity), and percutaneous intralesional laser treatment. The main objective of our study was to analyze efficiency and safety of 1470-nm diode laser treatment in the management of diffuse VMs. METHODS: We included patients treated between 2012 and 2018 whose quality of life was severely impaired. Data regarding laser settings, previous and subsequent D-dimer and fibrinogen blood levels, preprocedural and postprocedural assessment of pain by means of a visual analog scale, and reported complications were collected. RESULTS: Twenty-six procedures were performed in 17 patients (76% women); 59% were sporadic VMs, 70% had previously undergone other treatments, and 53% needed continuous analgesic treatment. The median pain reduction after the intervention, measured on the visual analog scale, was 5 points (P < .001). A significant decrease in the postoperative D-dimer values (P = .003) was observed in all patients. There were five postoperative complications in four patients, and none was life-threatening. CONCLUSIONS: The diode laser appears to be effective for treatment of diffuse VMs. It allows a reduction of the volume and symptoms of the malformation and is well tolerated by the patients. There is no currently described limitation in terms of dosage or number of procedures, making this a good alternative therapeutic option for these malformations.

The effects of allogenic stem cells in a murine model of hind limb diabetic ischemic tissue.

BACKGROUND: Diabetes is one of the major risk factors for peripheral arterial disease. In patients in whom surgery cannot be performed, cell therapy may be an alternative treatment. Since time is crucial for these patients, we propose the use of allogenic mesenchymal cells. METHODS: We obtained mesenchymal cells derived from the fat tissue of a healthy Sprague-Dawley rat. Previous diabetic induction with streptozotocin in 40 male Sprague-Dawley rats, ligation plus left iliac and femoral artery sections were performed as a previously described model of ischemia. After 10 days of follow-up, macroscopic and histo-pathological analysis was performed to evaluate angiogenic and inflammatory parameters in the repair of the injured limb. All samples were evaluated by the same blind researcher. Statistical analysis was performed using the SPSS v.11.5 program (P < 0.05). RESULTS: Seventy percent of the rats treated with streptozotocin met the criteria for diabetes. Macroscopically, cell-treated rats presented better general and lower ischemic clinical status, and histologically, a better trend towards angiogenesis, greater infiltration of type 2 macrophages and a shortening of the inflammatory process. However, only the inflammatory variables were statistically significant. No immunological reaction was observed with the use of allogeneic cells. DISCUSSION: The application of allogeneic ASCs in a hind limb ischemic model in diabetic animals shows no rejection reactions and a reduction in inflammatory parameters in favor of better repair of damaged tissue. These results are consistent with other lines of research in allogeneic cell therapy. This approach might be a safe, effective treatment option that makes it feasible to avoid the time involved in the process of isolation, expansion and production of the use of autologous cells.

Herida por arma de fuego y embolismo arterial periférico / Gun-shot wound and peripheral arterial embolism

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Evolución de endofugas tipo ii tras reparación endovascular de aneurismas aortoiliacos infrarrenales / Outcome of type ii endoleaks after endovascular infrarenal aortoiliac aneurysms repair

INTRODUCCIÓN: Las endofugas tipo II ocurren en el 10 y el 45% de los pacientes sometidos a reparación endovascular de aneurismas aortoiliacos infrarrenales. La mayoría son benignas y se resuelven espontáneamente, pero hay un porcentaje que persiste. Nuestro objetivo es describir el comportamiento de estas endofugas en nuestro centro: efecto sobre el saco y el paciente, y necesidad de tratamiento. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo. Entre febrero del 2009 y diciembre del 2013 se implantaron en nuestro centro 236 endoprótesis tipo Endurant II(R). Recogimos datos demográficos, factores de riesgo cardiovascular, anatomía de los aneurismas, eventos periprocedimiento, persistencia de la endofuga, efecto sobre el saco, tasa de reintervención y mortalidad. Se realizó un análisis actuarial mediante curvas de Kaplan Meyer. RESULTADOS: Observamos 47 endofugas tipo II (20,8%). El seguimiento medio fue de 16,94 meses, contabilizándose 12 pérdidas (25,5%). La endofuga desapareció en 21 pacientes (44,7%), en 16 casos en los primeros 6 meses (34,0%). El saco creció en 5 casos (10,6%), con rotura en uno de ellos y fallecimiento intraquirófano (2,1%). La supervivencia libre de crecimiento a 31 meses es del 70,6% y la supervivencia libre de rotura es a 44 meses del 75,1%. Cinco pacientes precisaron reintervención (10,6%): 2 por crecimiento sintomático del saco y 3 por complicaciones del dispositivo. Fallecieron 7 pacientes (en un caso en relación con el aneurisma): la supervivencia global a 58 meses es del 76,3%. CONCLUSIÓN: Las endofugas tipo II pueden condicionar crecimiento del saco aneurismástico con riesgo de rotura y fallecimiento. Deben realizarse un seguimiento estrecho y un planteamiento temprano de su tratamiento ante la persistencia y el crecimiento del saco

INTRODUCTION: Type II endoleaks occur in 10-45% of patients undergoing endovascular infrarenal aortoiliac aneurysms repair. Most of them are benign and resolve spontaneously, but there is a percentage that persists. The behaviour of these endoleaks in this centre is described, including the effect on aneurysm sac, on the patient, and reinterventions. MATERIAL AND METHODS: A retrospective review was conducted on 236 Endurant II(R) stent grafts implanted between February 2009 and December 2013. A record was made of the demographic data, cardiovascular risk factors, anatomy of aneurysms, peri-procedural events, persistent endoleak, effect on the sac, reintervention rate, and mortality. Actuarial analysis was performed using Kaplan Meyer curves. RESULTS: A total of 47 type II endoleaks (20.8%) were observed. Mean follow-up was 16.94 months, with 12 cases lost (25.5%). The endoleak disappeared in 21 patients (44.7%), and in 16 cases within the first 6 months (34.0%). The sac grew in 5 cases (10.6%), with one rupture and death in the operating room (2.1%). Freedom from growth at 31 months was 70.6%, and freedom from rupture at 44 months was 75.1%. Reintervention (10.6%) was required in 5 patients: 2 symptomatic growth of sac, and 3 device related complications. There were 7 deaths (in one case due to an aneurysm): overall survival at 58 months was 76.3%. CONCLUSION: Type II endoleaks may lead to aneurysm sac growth with risk of rupture and death. Persistent endoleaks with sac enlargement should be closely monitored in order that they can be treated early

Endovascular treatment of posttraumatic pseudoaneurysm of the common carotid artery.

Carotid artery injuries with pseudoaneurysm are uncommon but associated with central neurologic dysfunction. We present a case of posttraumatic pseudoaneurysm of the right common carotid artery treated by implantation of a covered stent. A 44-year-old woman with multiple injuries after fall from height presents a small dissection flap of the right common carotid artery (RCCA) on the initial computed tomography angiography (CTA). Fifteen days later a 10 mm pseudoaneurysm is observed on control CTA. We decided endovascular treatment. Through right femoral access with a long introducer sheath placed in the innominate artery, we implanted a covered stent Advanta V12 9 × 38 mm in the RCCA. The patient was discharged from the hospital with antiplatelet therapy without any neurological dysfunction and complete exclusion of the pseudoaneurysm. Use of covered stents has emerged as a safe and effective alternative to surgical repair of carotid injuries.

Experimental model for coadjuvant treatment with mesenchymal stem cells for aortic aneurysm.

UNLABELLED: Many factors are possibly involved in the inflammatory process which causes the degeneration of the arterial wall in the formation of Abdominal Aortic Aneurysms. During the last years different experimental models have been published to treat this fault of the arterial walls. Parallel the clinical treatment has evolved. With this work we have tried to develop an animal model basing on the clinical current treatment. Finally, we propose a treatment based on mesenchymal cells to disable local immune response, preventing excessive fibrosis, apoptosis, and inducing intrinsic cellular progenitors. OBJECTIVE: To present a reproducible superior animal model of experimentation, intending to show that mesenchymal stem cells inserted in the sac of an artificial aneurysm are able to survive, so that they can be made accountable for a subsequent beneficial effect upon this condition. METHODS: Six Landrace-White pigs, weighing around 25Kg. We generate 2 aneurysms of abdominal aorta (2x1cm) with Dacron's patches. Later we treat the aneurysms endoscopic with a covered endograft. Finally, in one of the aneurysmal sac we introduce 1cc fibrin sealant and in another 1 cc of fibrin sealant with 10 million MSC. Animals were sacrificed at 24 hs and 1, 3, 5, 7 and 9 weeks. Samples of aneurysms were processed histologically (H&E and Masson). The injected cells were located by immunofluorescence (GFP market). RESULTS: The surgical technique is reproducible and similar to those conducted in common clinical practice. Histological cross-section samples of cases treated with MSC and analyzed by a blind researcher present a lower inflammation reaction, or with longer evolution time than in controls. Immunofluorescence studies have detected cells marked with GFP up to three weeks after treatment. CONCLUSION: This reproducible animal model is similar to common clinical treatment. MSC can stand alive at least for three weeks since their implantation within an aneurysm sac. This may improve the results of conventional endovascular treatment by the stabilization of the aneurysmal sac.

Aneurisma arterioesclerótico de la carótida interna extracraneal / Arteriosclerotic aneurysm of the extracranial internal carotid artery

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Dosis de radiación recibida por el paciente durante el tratamiento endovascular de los aneurismas de aorta abdominal / The radiation dose received by patients during endovascular treatment of abdominal aortic aneurysms

Introducción. Las técnicas endovasculares se utilizan cada vez con mayor frecuencia en el tratamiento de los aneurismas de aorta abdominal (AAA), para lo que es necesario emplear mayores dosis de radiación en los pacientes, tanto en el diagnóstico como en el procedimiento y su seguimiento posterior, que en el tratamiento quirúrgico convencional. Es imprescindible delimitar los niveles de referencia de dosis de radiación necesarios para la ejecución del procedimiento. Objetivo. Cuantificar la dosis total que reciben los pacientes sometidos a esta modalidad de tratamiento. Pacientes y métodos. Se analiza de forma observacional-prospectiva a 46 pacientes con AAA tratados mediante abordaje endovascular en el año 2004, de los cuales 27 reciben un montaje aortomonoilíaco y 19 bifurcado. Resultados. Se obtiene una dosis de radiación total de 48,62 mSv el primer año; esta dosis no difiere entre los pacientes a los que se les coloca una endoprótesis aortomonoilíaca o una bifurcada. Conclusiones. La dosis obtenida no produce un efecto nocivo apreciable el primer año en lo que respecta a efectos deterministas de la dosis empleada. La mayor parte de la dosis recibida se debe a los estudios con tomografía axial computarizada. La resonancia magnética puede jugar un papel muy importante para la reducción de la dosis necesaria en el futuro

Introduction. It is becoming increasingly more frequent to treat abdominal aortic aneurysms (AAA) using endovascular techniques and as a result the doses of radiation patients receive, both in the diagnosis and intervention as well as in the ensuing follow-up, are higher than in conventional surgical treatment. It is essential to define the reference radiation dosage levels that are needed to perform the operation. Aim. To quantify the total dose received by patients submitted to this kind of treatment. Patients and methods. An observational-prospective study was conducted to analyse 46 patients with AAA who were treated using an endovascular approach in the year 2004; aortomonoiliac devices were utilised in 27 cases and 19 received bifurcated stents. Results. A total radiation dose of 48.62 mSv was obtained in the first year; patients received the same dose regardless of whether an aortomonoiliac or a bifurcated stent had been placed. Conclusions. The dose obtained does not give rise to any appreciable adverse effects in the first year as far as dosage-determined effects are concerned. The greater part of the dose received by patients is due to the computerised axial tomography scans that are carried out. Magnetic resonance imaging can play an important role in reducing the doses that are required in the future

Tratamiento endovascular de fístula arteriovenosa y falso aneurisma poplíteos postraumáticos. Presentación de un caso / Endovascular treatment of post-traumatic popliteal arteriovenous fistula and false aneurysm. A case report

Introducción. La fístula arteriovenosa (FAV) postraumática que afecta a los vasos poplíteos es una patología de incidencia escasa cuyo tratamiento hasta ahora ha sido quirúrgico; no obstante, también se puede lograr la oclusión de la fístula mediante la implantación de un stent recubierto intraarterial, con reducción extraordinaria tanto del tiempo quirúrgico como de la estancia hospitalaria del paciente. Caso clínico. Varón de 29 años con una FAV en la segunda porción de poplítea derecha, así como falso aneurisma de dos años de evolución provocados por traumatismo por arma blanca. Tras el estudio preoperatorio correspondiente que incluía eco-Doppler y arteriografía, se decidió tratamiento mediante técnica endovascular, que consistió en la implantación de un stent recubierto en la arteria poplítea, con lo que se consiguió al mismo tiempo la oclusión de la fístula y de la comunicación con el falso aneurisma. El tiempo quirúrgico fue de 60 minutos, no se requirió transfusión sanguínea y se dio de alta al paciente en el quinto día de postoperatorio. El eco-Doppler realizado a los 90 días de la intervención muestra la arteria y la vena poplíteas permeables con ausencia de comunicación entre ellas, así como trombosis del falso aneurisma. Conclusión. Las técnicas endovasculares constituyen una alternativa a la cirugía en casos de FAV postraumáticas que afectan a vasos de calibre grande y mediano

Introduction. Post-traumatic arteriovenous fistula (AVF) involving the popliteal vessels is a pathology with a poor incidence being open surgery its treatment of choice. Nowadays however the total occlusion of the fistula can also be achieved by means of the implantation of a covered stent-graft, which implies an important reduction of both surgical time and hospital stay. Case report. A 29-year old man who had a stab wound in the right popliteal fossa two years earlier was admitted with a popliteal AVF involving the middle popliteal segment along with a false aneurysm. After echo-Doppler examination and arteriography the patient was assessed for endovascular treatment that consisted in the implantation of a covered stent-graft thus achieving the occlusion of both the fistula and the false aneurysm. The procedure lasted 60 minutes, blood transfusion was not required and the patient was discharged on the 5th postoperative day. 90 days after operation an echo-Doppler examination was performed that showed patency of both artery and vein, absence of fistula and thrombosis of the false aneurysm. Conclusion. Endovascular techniques are an alternative to open surgery in the treatment of post-traumatic AVF involving large or middle size vessels

Reparación endovascular de fístula arteriovenosa femoral bilateral tras cateterismo / Endovascular repair of bilateral arteriovenous femoral fistula following catheterization

Introducción. El aumento del número de cateterismos cardíacos para el diagnóstico y el tratamiento de la patología cardíaca se ha acompañado de un incremento en la incidencia de complicaciones vasculares. Las fístulas arteriovenosas tras cateterismo tienen una incidencia escasa (1%). Caso clínico. Varón de 64 años con antecedentes de tabaquismo, dislipemia, hipertensión arterial, broncopatía crónica y cardiopatía isquémica crónica que precisó revascularización quirúrgica hace 18 años y angioplastia con implantación de dos stents hace un año. Fue remitido a nuestro servicio por claudicación intermitente a cortas distancias en el miembro inferior izquierdo de aparición brusca tras realización de cateterismo de control. El estudio arteriográfico demostró la presencia de una oclusión segmentaria de la arteria ilíaca externa izquierda y sendas fístulas arteriovenosas en ambos sectores femorales. El paciente fue intervenido de dichos hallazgos mediante técnica endovascular sin complicaciones perioperatorias. Conclusiones. Se distinguen tres tipos de factores de riesgo en el desarrollo de las fístulas arteriovenosas tras cateterismo: relacionados con el paciente, con el procedimiento y la anticoagulación en relación con éste. La reparación endovascular supone un procedimiento menos agresivo que la cirugía convencional en pacientes seleccionados, que ofrece excelentes resultados a corto y medio plazo

INTRODUCTION. The increasing number of cardiac catheterizations for diagnosis and/or treatment of coronary disease has raised the incidence of vascular complications. This incidence is not high in case of postcatheterization arteriovenous fistulae (1%). CASE REPORT. A 64 year-old man with the following clinical backgrounds: cigarette-smoker, dyslipemia, arterial hypertension, chronic bronchopathy and chronic ischemic cardiopathy, underwent coronary revascularisation 18 years ago; two coronary stent grafts were placed one year ago. He was referred to our department because of sudden onset of short distance intermittent claudication immediately after a diagnostic cardiac catheterization. Arteriography showed a left external iliac artery short occlusion and a bilateral femoral arteriovenous fistula. The patient underwent repair of these lesions by using endovascular techniques without complications. CONCLUSIONS. There are three risk factors for the development of postcatheterization arteriovenous fistulae: those related to the patient, the procedure and the anticoagulation. In selected patients, endovascular repair is less aggressive than open surgery and offers excellent short- and medium-term results

Experiencia en nuestro centro en el tratamiento de aneurismas de la aorta infrarrenal rotos mediante prótesis endovasculares / Experience in the treatment of ruptured infrarenal aortic aneurysms by means of endovascular grafts in our centre

Introducción. La morbimortalidad perioperatoria asociada a la cirugía por la rotura de un aneurisma de la aorta abdominal (AAA) se ha venido manteniendo constante en las últimas décadas, alrededor del 50-70%. Con el desarrollo de las técnicas endovasculares disponemos de una alternativa terapéutica a la cirugía abierta que podría tener éxito para disminuir el número de complicaciones a corto plazo. Pacientes y métodos. Presentamos una serie de 16 pacientes intervenidos entre enero del 2001 y agosto del 2005 por rotura de un AAA. Se emplearon endoprótesis aortomonoilíacas y bifurcadas asociadas a diversos procedimientos como embolización del saco aneurismático o implantación de stents entre la hipogástrica y la ilíaca externa. Resultados. La mortalidad perioperatoria fue del 12,5%. Durante los primeros 30 días hubo cinco reintervenciones (31%), dos Friedrich, dos revisiones por sangrado inguinal y un bypass axilobifemoral. En el 37% de los casos se asoció la implantación de stents recubiertos entre la arteria ilíaca externa e hipogástrica. En el 31% de los casos se embolizó el saco aneurismático con Ethiblock®. En un caso hubo que realizar una interposición de un segmento de dacron en la arteria femoral común por desgarro durante la introducción de la endoprótesis. En los primeros 30 días postoperatorios se produjeron diez complicaciones sistémicas graves en cinco pacientes, incluidos un infarto agudo de miocardio, dos íleos prolongados, dos casos de insuficiencia respiratoria aguda, tres casos de insuficiencia renal aguda, y un caso de colitis isquémica que requirió una hemicolectomía. Conclusiones. El uso de técnicas endovasculares en el tratamiento de AAA rotos nos permite reducir la mortalidad a corto plazo a causa de éstos en pacientes seleccionados (AU)

INTRODUCTION. The rate of perioperative morbidity and mortality associated to surgery for rupture of an abdominal aortic aneurysm (AAA) has remained more or less constant over recent decades, with a value of around 50-70%. The development of endovascular techniques has provided us with an alternative to open surgery that could be successful in lowering the number of short-term complications. PATIENTS AND METHODS. We report on a series of 16 patients submitted to surgery between January 2001 and August 2005 to treat an AAA. Aortomonoiliac and bifurcated stents were employed in association with different procedures such aneurysmal sac embolisation or the placement of stents between the hypogastric and external iliac arteries. RESULTS. Perioperative mortality rate was 12.5%. During the first 30 days there were five reinterventions (31%), two Friedrich, two revisions due to inguinal bleeding and one axillobifemoral bypass. In 37% of cases placement of covered stent-grafts between the external iliac and hypogastric arteries was associated to the treatment. In 31% of cases the aneurysmal sac was embolised with Ethiblock®. In one case a segment of dacron had to be inserted in the common femoral artery due to a laceration that occurred during placement of the stent. In the first 30 days of the post-operative period ten severe systemic complications occurred in five patients. These included one acute myocardial infarction, two prolonged ileus, two cases of acute respiratory failure, three cases of acute renal failure, and one case of ischaemic colitis that required a hemicolectomy. CONCLUSIONS. The use of endovascular techniques in the treatment of ruptured AAA makes it possible to reduce the short-term mortality rates from this condition in selected patients (AU)