Justificación y diseño del estudio multicéntrico prospectivo de cohortes para evaluar los resultados del cierre percutáneo en procedimientos de reparación aórtica endovascular. Registro SPAIN / Justification and design of the prospective multicentre cohort study to evaluate the results of percutaneous closure in endovascular aortic repair procedures. SPAIN Registry

Introducción: el cierre percutáneo es una herramienta esencial en el tratamiento endovascular actual. Los procedimientos de patología aórtica precisan abordajes arteriales de gran calibre a nivel inguinal, lo que conlleva mayor posibilidad de complicaciones en el cierre. Es por esto que actualmente continúan conviviendo la técnica quirúrgica abierta y el abordaje percutáneo, siendo también así en el territorio nacional, con resultados a día de hoy no cuantificados. La literatura actual aporta buenos resultados para la técnica de presutura en patología aórtica, sin embargo aún existen dudas respecto a determinados factores de riesgo como la obesidad, calcificación severa o arterias de pequeño calibre. Tampoco existen suficientes datos que estudien cómo afecta este procedimiento a la calidad de vida, lo cual es un punto esencial, especialmente en pacientes mayores. Dado que un alto porcentaje de los pacientes que se someten a estas intervenciones son ancianos con patologías concomitantes (los llamados pacientes frágiles), minimizar la agresión quirúrgica y mejorar su calidad de vida inmediata post-procedimiento puede ser determinante. Objetivos: primarios: estimar la tasa de éxito técnico del procedimiento de cierre percutáneo en intervenciones aórticas, estimación del impacto en la calidad de vida así como encontrar posibles diferencias en la morbimortalidad a 30 días en relación a la puntuación de cada paciente en la escala de fragilidad modificada; secundarios: evaluar el tiempo de presutura, tiempo de hemostasia, complicaciones derivadas del cierre, estancia hospitalaria y el dolor posoperatorio. Material y métodos: el Registro SPAIN es un estudio multicéntrico prospectivo de pacientes sometidos a procedimientos percutáneos sobre la aorta y sus ramas con dispositivos ≥ 10 French (F), en el que serán recogidas variables relacionadas con el cierre de sus accesos inguinales. El periodo de seguimiento será de 30 días...(AU)

Introduction: percutaneous closure is an essential tool in current endovascular treatment. Aortic pathology procedures require large-caliber arterial approaches, leading to a greater possibility of closure complications. For this reason, nowadays, both open surgical and the preclose technique coexist in almost every center worldwide, as it does in Spain with no contrasted results. The current literature provides good results for the pre-closing technique in aortic pathology, however there are still doubts regarding certain risk factors such as obesity, severe calcification or small-caliber arteries. There is not enough data to study how this procedure affects quality of life, an essential point, especially in older patients. Minimizing surgical aggression and improving their immediate post-procedure quality of life can be decisive because most of the patients are elderly with concomitant pathologies (fragile patients). Objetives: primary objectives: to estimate the technical success rate of the percutaneous closure procedure in aortic interventions, estimate the impact on quality of life and find possible differences in morbidity and mortality at 30 days in relation to the score of each patient on the frailty scale; secondary objectives: To evaluate the pre-suture time, hemostasis time, complications derived from closure, hospital stay and post-operative pain. Material and methods: the SPAIN Registry is a prospective multicenter study of patients undergoing percutaneous procedures on the aorta and its branches with ≥ 10 French (F) devices. Variables related to the closure of their inguinal access will be collected. The follow-up period will be 30 days. The duration of the recruitment period will be one year initially. Participants must certify that they have performed the closure of at least 10 large caliber percutaneous approaches (≥ 10 F) in national units of the specialties of Angiology and Vascular Surgery and Cardiology...(AU)

Persistent sciatic artery.

Persistent sciatic artery (PSA) is a very uncommon congenital malformation. Its incidence is estimated to be 0.025-0.04%. If it is accompanied by hypoplasia of the femoral artery system, its presence is essential for perfusion of the limbs. The usual form of presentation is as an aneurysm (25-58%) and/or its complications (thrombosis, distal remobilization, local compression). A 66-year-old woman presented with a painful mass of several months' progression. After performing angio-computed tomography, a fusiform aneurysmal dilation was observed in the left gluteal mass dependent on the left obturator artery, which was identified as the left lower gluteal artery. For this reason, we decided to perform therapeutic embolization. During the angiogram, a left aneurysmal PSA with distal thrombosis was observed. In view of these findings, a bypass from the superficial femoral artery to the tibioperoneal trunk was performed, with a contralateral inverted saphenous vein. The PSA was subsequently embolized with an occluder (AGA Medical IZASA, Plymouth, MN). The patient was discharged after checking complete exclusion of the aneurysm by ultrasound, with distal pulses during follow-up. Combined treatment using embolization, before surgical revascularization of the limb, markedly decreases the morbidity and mortality by avoiding the pelvic approach by the posterior route.

Tratamiento endovascular de aneurismas toracoabdominales con previa revascularización visceral / Endovascular treatment of thoracoabdominal aneurysms with prior visceral revascularisation

Introducción. La terapéutica endovascular ha revolucionado la actuación frente a aneurismas aórticos; sin embargo, su uso en aneurismas de aorta toracoabdominal (AATA) está limitado al englobar las arterias viscerales. Con el fin de solventar esta problemática e intentando mejorar la elevada morbimortalidad de la cirugía abierta convencional, proponemos una técnica híbrida con revascularización multivisceral retrógrada previa a la colocación de endoprótesis toracoabdominal. Casos clínicos. Caso 1: varón de 73 años con AATA tipo II según la clasificación de Crawford; se realizan bypass protésico iliorrenohepático, iliomesentérica superior e iliorrenal izquierdo y posterior colocación de endoprótesis desde la aorta torácica descendente hasta la aorta infrarrenal, sin incidencias posquirúrgicas y con un seguimiento de diez meses mediante angiotomografía. Caso 2: varón de 74 años con AATA tipo II según clasificación de Crawford; se practica bypass aortoaórtico infrarrenal y, desde éste, bypass protésico a mesentérica superior y a hepática común previa a exclusión endovascular de AATA hasta nivel suprarrenal; postoperatorio inmediato sin complicaciones, con buena angiotomografía de control; aparición de absceso peripancreático a los dos meses, que precisó tratamiento quirúrgico, sin nuevas incidencias tras nueve meses de seguimiento. Conclusión. El tratamiento híbrido de los AATA presenta resultados esperanzadores frente a la cirugía abierta; la ausencia de clampaje aórtico y apertura torácica parece reducir las complicaciones cardiopulmonares, renales y neurológicas, y es una opción válida especialmente para aquellos pacientes que por su elevada comorbilidad no son subsidiarios de cirugía convencional

Introduction. Endovascular therapeutic procedures have revolutionised the treatment of aortic aneurysms; yet, their use in thoracoabdominal aortic aneurysms (TAAA) is limited because the visceral arteries are involved. In an attempt to resolve this issue and to improve the high morbidity and mortality rates of conventional open surgery, we propose a hybrid technique involving retrograde multivisceral revascularisation prior to the placement of the thoracoabdominal stent. Case reports. Case 1: a 73-year-old male with type II TAAA according to the Crawford classification; a hepato-iliorenal, superior iliomesenteric and left iliorenal bypass graft was performed and a stent was implanted from the descending thoracic aorta to the infrarenal aorta, with no post-surgical incidences and with a 10-month follow-up by means of tomography angiography. Case 2: a 74-year-old male with type II TAAA according to the Crawford classification; an infrarenal aorto-aortic bypass was carried out and, from this, a bypass graft was created to the superior mesenteric and to the common hepatic arteries prior to endovascular exclusion of the TAAA as far as the suprarenal level; immediate post-operative period was free of complications, good control tomography angiography; appearance of a peripancreatic abscess at two months, which required surgical treatment; no new incidences after nine months’ follow-up. Conclusions. Hybrid treatment of TAAAs offers promising results with respect to open surgery; the absence of aortic clamping and the need to open the thorax seem to reduce cardiopulmonary, renal and neurological complications and it is an option that is especially valid for patients who are not amenable to conventional surgery due to their high rates of comorbidity