Groin surgical site infection incidence in vascular surgery with intradermal suture versus metallic stapling skin closure: A study protocol for a pragmatic open-label parallel-group randomized clinical trial (VASC-INF trial).

BACKGROUND: Surgical site infection is 1 of the most frightening complications in vascular surgery due to its high morbimortality. The use of intradermal sutures for skin closure might be associated with a reduction in infections incidence. However, the data available in the literature is scarce and primarily built on low-evidence studies. To our knowledge, no multicenter clinical trial has been published to assess if the intradermal suture is associated with a lower surgical site infection incidence than metallic staples in patients who will undergo revascularization surgery requiring a femoral approach. METHODS: VASC-INF is a pragmatic, multicenter, multistate (Spain, Italy, and Greece), randomized, open-label, clinical trial assessing the surgical site infection incidence in patients undergoing revascularization surgery requiring a femoral approach. Patients will be randomized on a 1:1 ratio to intradermal suture closure (experimental group) or to metallic staples closure (control group).The primary outcome is the number (percentage) of patients with surgical site infection (superficial and/or deep) associated with a femoral approach up to 28 (±2) days after surgery. Among the secondary outcomes are the number (percentage) of patients with other surgical wound complications; the number (percentage) of patients with surgical site infections who develop sepsis; type of antibiotic therapy used; type of microorganisms' species isolated and to describe the surgical site infection risk factors. DISCUSSION: Intradermal suture closure may be beneficial in patients undergoing revascularization surgery requiring a femoral approach. Our working hypothesis is that intradermal suture closure reduces the incidence of surgical site infection respect to metallic staples closure.

Nuestra experiencia en el tratamiento urgente de la hemorragia renal / Our experience in emergency treatment of renal haemorrhage

INTRODUCCIÓN: Los casos de hemorragia renal que provocan un compromiso para la vida del paciente requieren de una cirugía urgente. Actualmente la cirugía endovascular es el tratamiento de primera elección. OBJETIVO: Revisar los pacientes con una hemorragia renal que fueron intervenidos de urgencia mediante una técnica endovascular en nuestro centro. Evaluar las causas de sangrado renal, el tratamiento realizado así como los resultados obtenidos. MATERIAL Y MÉTODOS: Realizamos un estudio retrospectivo de pacientes consecutivos con sangrado renal y que fueron tratados con una técnica endovascular entre junio del 2012 y junio del 2017 en el Hospital Universitari Joan XXIII (Tarragona). Se recogieron los datos demográficos (edad, sexo, comorbilidad) y otras variables relacionadas (mecanismo de la lesión, la estabilidad hemodinámica y si estaba en tratamiento anticoagulante). También se analizaron los hallazgos encontrados en la angio-TAC, el tiempo transcurrido entre el diagnóstico y la realización de la cirugía, la técnica endovascular y el material utilizado, la extensión de parénquima embolizado y los resultados obtenidos. RESULTADOS: Incluimos a 22 pacientes con una edad media de 63 años (19-85). Las causas de lesión fueron relacionadas con punción de una biopsia renal (n=7,31; 8%), sangrado de tumoraciones malignas renales (n=5; 22,7%), traumatismos (n=4; 18,2%), angiomiolipomas (n=2; 9,1%), sangrado espontáneo (n=2; 9,1%) y complicaciones quirúrgicas (n=2; 9,1%). En todos los casos la técnica endovascular realizada fue la embolización. El material utilizado fue: esferas (9,1%), coils (63,6%), esferas + coils (18,2%), esferas+oclusor (9,1%). En 17 de los casos (77,3%) se llevó a cabo una embolización selectiva y en 5 casos (22,7%) una embolización de todo el riñón. El éxito clínico y técnico fue del 100%. La mortalidad a los 30 días fue del 9,1%. CONCLUSIÓN: Creemos que el tratamiento endovascular es una técnica efectiva para el control del sangrado renal y permite, en la mayoría de casos, la preservación de gran parte de parénquima renal

INTRODUCTION: Renal haemorrhage is a potentially life-threatening event requiring emergency surgery. Endovascular therapy is currently the first-line treatment option. OBJECTIVS: Review patients with renal haemorrhage who required emergency endovascular therapy at our center. Evaluate the causes of the bleeding, the treatment performed and the clinical outcomes. MATERIAL AND METHODS: We performed a retrospective analysis of consecutive patients with renal bleeding who underwent endovascular therapy from June 2012 to June 2017 at Hospital Universitari Joan XXIII (Tarragona, Spain). Demographic data (age, gender and comorbidity) and other related variables were collected (mechanism of injury, haemodynamic stability and anticoagulant therapy). We also studied the CT angiography findings, time from diagnosis to surgery, endovascular technique and materials used, extent of tissue embolised and outcomes. RESULTS: Twenty-two (22) patients were included with a mean age of 63 (range 19-85). The aetiology of injuries included: renal biopsy (n=7, 31.8%), bleeding from malignant kidney tumour (n=5, 22.7%), trauma (n=4, 18.2%), angiomyolipoma (n=2, 9.1%), spontaneous bleeding (n=2, 9.1%) and surgical complications (n=2, 9.1%). The endovascular therapy technique was embolisation in all cases. The following materials were used: spheres (9.1%); coils (63.6%); spheres + coils (18.2%); and spheres + plug (9.1%). In 17 cases (77.3%), selective embolisation was performed and in five cases (22.7%), embolisation of the whole kidney. Clinical and technical success rates of 100% were recorded. The 30-day mortality rate was 9.1%. CONCLUSION: We believe that endovascular therapy is an effective modality for the management of renal bleeding which, in many cases, enables a large part of the renal tissue to be preserved

Our experience in emergency treatment of renal haemorrhage. / Nuestra experiencia en el tratamiento urgente de la hemorragia renal.

INTRODUCTION: Renal haemorrhage is a potentially life-threatening event requiring emergency surgery. Endovascular therapy is currently the first-line treatment option. OBJECTIVES: Review patients with renal haemorrhage who required emergency endovascular therapy at our center. Evaluate the causes of the bleeding, the treatment performed and the clinical outcomes. MATERIAL AND METHODS: We performed a retrospective analysis of consecutive patients with renal bleeding who underwent endovascular therapy from June 2012 to June 2017 at Hospital Universitari Joan XXIII (Tarragona, Spain). Demographic data (age, gender and comorbidity) and other related variables were collected (mechanism of injury, haemodynamic stability and anticoagulant therapy). We also studied the CT angiography findings, time from diagnosis to surgery, endovascular technique and materials used, extent of tissue embolised and outcomes. RESULTS: Twenty-two (22) patients were included with a mean age of 63 (range 19-85). The aetiology of injuries included: renal biopsy (n=7, 31.8%), bleeding from malignant kidney tumour (n=5, 22.7%), trauma (n=4, 18.2%), angiomyolipoma (n=2, 9.1%), spontaneous bleeding (n=2, 9.1%) and surgical complications (n=2, 9.1%). The endovascular therapy technique was embolisation in all cases. The following materials were used: spheres (9.1%); coils (63.6%); spheres + coils (18.2%); and spheres + plug (9.1%). In 17 cases (77.3%), selective embolisation was performed and in five cases (22.7%), embolisation of the whole kidney. Clinical and technical success rates of 100% were recorded. The 30-day mortality rate was 9.1%. CONCLUSION: We believe that endovascular therapy is an effective modality for the management of renal bleeding which, in many cases, enables a large part of the renal tissue to be preserved.

Aneurismas poplíteos. Evolución y factores pronósticos en la trombosis del saco / Popliteal aneurysms. Their course and prognostic factors in thrombosis of the sac

Objetivos. Conocer la evolución de aneurismas poplíteos tratados quirúrgicamente y evaluar factores pronósticos en la trombosis del saco. Pacientes y métodos. Desde mayo de 1993 hasta junio del año 2005, 43 pacientes presentaron 64 aneurismas poplíteos (diámetro medio: 2,8 cm; intervalo: 1,2-8 cm); de ellos, 19 (29%) han recibido tratamiento médico (compensación tras trombosis), dos (3%) aneurismectomía más injerto terminoterminal vía posterior, 22 (34%) exclusión por ligadura más bypass poplíteo-poplíteo y, por último, 21 (32%) exclusión y bypass femoropoplíteo. Hemos realizado un estudio descriptivo transversal en los 43 aneurismas tratados mediante exclusión y bypass (67%). Mediante eco-Doppler de control se evaluó: diámetro, presencia de flujo o trombosis del aneurisma y permeabilidad del bypass. Se analizó, mediante regresión de Cox, si existía asociación estadísticamente significativa entre la trombosis postoperatoria del saco aneurismático y los siguientes factores: diámetro preoperatorio del aneurisma, edad, factores de riesgo cardiovascular, comorbilidad, tipo de tratamiento, run-off, permeabilidad del bypass y presencia de aneurisma contralateral o de aorta. Resultados. De 43 aneurismas intervenidos, se pudieron evaluar 25 (56%). Se detectó flujo Doppler intraaneurismático en cuatro casos (16%); de éstos, hubo crecimiento del saco en tres (12%), y en uno (4%) disminuyó. De los 21 casos (84%) con trombosis completa del saco, se detectó su crecimiento en dos (8%), y en los 19 restantes (76%) disminuyó. El control clínico medio fue de 65 meses (intervalo: 1-128 meses). No se detectaron roturas ni síntomas compresivos. El tipo de cirugía resultó ser el único factor estadísticamente significativo (p = 0,04). Conclusiones. La reparación quirúrgica no garantiza la trombosis del aneurisma. El bypass poplíteo-poplíteo muestra mayores garantías en la trombosis del saco aneurismático

Aims. To determine how surgically treated popliteal aneurysms progressed and to evaluate the prognostic factors for thrombosis of the aneurysmal sac. Patients and methods. Between May 1993 and June 2005, 43 patients presented with 64 popliteal aneurysms (mean diameter: 2.8 cm; interval: 1.2-8 cm), of which 19 (29%) received medical treatment (compensation following thrombosis), two (3%) underwent an aneurysmectomy plus an end-to-end graft inserted using a posterior approach, 22 (34%) were treated with exclusion by ligation plus popliteal-popliteal bypass and, lastly, 21 (32%) underwent exclusion and femoral-popliteal bypass. We conducted a cross-sectional descriptive study in the 43 aneurysms treated by means of exclusion and bypass (67%). A control Doppler ultrasound recording was used to evaluate diameter, presence of flow or thrombosis of the aneurysm and patency of the bypass. Cox regression was used to analyse whether there was a statistically significant association between post-operative thrombosis of the aneurysmal sac and the following factors: pre-operative diameter of the aneurysm, age, cardiovascular risk factors, comorbidity, type of treatment, run-off, patency of the bypass and the presence of a contralateral or aortic aneurysm. Results. Of the 43 aneurysms that were treated with surgery, we were able to evaluate 25 (56%). Intra-aneurysmal Doppler flow was detected in four cases (16%); of these, the sac was seen to have grown in three (12%) and it had diminished in one (4%). Of the 21 cases (84%) with complete thrombosis of the sac, growth was detected in two of them (8%) and it had diminished in the remaining 19 (76%). Mean clinical monitoring time was 65 months (interval: 1-128 months). No ruptures or symptoms of compression were detected. Findings showed that type of surgery is the only statistically significant factor (p = 0.04). Conclusions. Surgical repair does not guarantee thrombosis of the aneurysm. A popliteal-popliteal bypass offers a higher degree of safety in thrombosis of the aneurysmal sac

Agenesia de la vena cava inferior en pacientes adultos jóvenes con trombosis venosa profunda ilíaca / Agenesia of inferior vena cava in young adults with iliac deep vein thrombosis

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