Safety of preoperative branch embolization in patients undergoing evar.

The purpose of this systematic review is to evaluate the safety of pre-endovascular abdominal aortic aneurysm repair (EVAR) embolization of aortic side branches - the inferior mesenteric artery and lumbar arteries. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. A search of MEDLINE and DIMENSION databases identified 9 studies published from 2011 to 2021 that satisfied the inclusion and exclusion criteria. These studies were analyzed to detect the incidence of embolization-related complications. A total of 482 patients underwent preoperative aortic side branch embolization, 30 (6.2%) of whom suffered some kind of minor complication. The only major complication observed was ischemic colitis in 4 (0.82%) patients, two (0.41%) of whom died after bowel resection surgery. Regarding these findings, aortic side branch embolization seems to be a safe procedure, with very low percentages of both minor and major complications.

O objetivo desta revisão sistemática foi avaliar a segurança da embolização de artéria mesentérica inferior (AMI) e artérias lombares (ALs) pré-correção endovascular de aneurisma da aorta abdominal. Foram realizadas pesquisas nas bases de dados MEDLINE e Dimensions. Foram encontrados 9 estudos publicados de 2011 a 2021 que atendiam aos critérios de inclusão e exclusão. Os estudos foram analisados ​​para definir a incidência de complicações relacionadas à embolização. No total, 482 pacientes foram submetidos a embolização de AMI e/ou ALs, dos quais 30 (6,2%) sofreram algum tipo de complicação menor. A única complicação importante observada foi colite isquêmica em 4 (0,82%) pacientes. Dois (0,41%) desses pacientes morreram após cirurgia de ressecção intestinal. Em relação a esses achados, a embolização de AMI e ALs parece ser um procedimento seguro, com um percentual muito baixo de complicações menores e importantes.

Safety of preoperative branch embolization in patients undergoing evar / Segurança da embolização pré-operatória do ramo em pacientes submetidos a evar

Abstract The purpose of this systematic review is to evaluate the safety of pre-endovascular abdominal aortic aneurysm repair (EVAR) embolization of aortic side branches - the inferior mesenteric artery and lumbar arteries. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. A search of MEDLINE and DIMENSION databases identified 9 studies published from 2011 to 2021 that satisfied the inclusion and exclusion criteria. These studies were analyzed to detect the incidence of embolization-related complications. A total of 482 patients underwent preoperative aortic side branch embolization, 30 (6.2%) of whom suffered some kind of minor complication. The only major complication observed was ischemic colitis in 4 (0.82%) patients, two (0.41%) of whom died after bowel resection surgery. Regarding these findings, aortic side branch embolization seems to be a safe procedure, with very low percentages of both minor and major complications.

Resumo O objetivo desta revisão sistemática foi avaliar a segurança da embolização de artéria mesentérica inferior (AMI) e artérias lombares (ALs) pré-correção endovascular de aneurisma da aorta abdominal. Foram realizadas pesquisas nas bases de dados MEDLINE e Dimensions. Foram encontrados 9 estudos publicados de 2011 a 2021 que atendiam aos critérios de inclusão e exclusão. Os estudos foram analisados ​​para definir a incidência de complicações relacionadas à embolização. No total, 482 pacientes foram submetidos a embolização de AMI e/ou ALs, dos quais 30 (6,2%) sofreram algum tipo de complicação menor. A única complicação importante observada foi colite isquêmica em 4 (0,82%) pacientes. Dois (0,41%) desses pacientes morreram após cirurgia de ressecção intestinal. Em relação a esses achados, a embolização de AMI e ALs parece ser um procedimento seguro, com um percentual muito baixo de complicações menores e importantes.

A rare cause of deep vein thrombosis: inferior vena cava agenesis.

Inferior vena cava agenesis is a rare condition and is often misdiagnosed. This anomaly is asymptomatic in the majority of cases and is usually diagnosed during imaging tests carried out for other purposes. The most frequent manifestation is deep vein thrombosis (DVT) in lower limbs and anticoagulation therapy is the most frequent treatment option. Other techniques such as thrombolysis and venous bypass are also described. We report two cases diagnosed at our institution during the last year, both of which presented with an episode of DVT. We opted for indefinite anticoagulation therapy and both patients remain asymptomatic, after 1 year of surveillance in the first case and 6 months in the second, with no new episodes of DVT. Although it is not a life-threatening anomaly, it is important to make an appropriate diagnosis and provide treatment to improve the symptoms and quality of life of these patients.

A agenesia da veia cava inferior é uma condição rara e, muitas vezes, mal diagnosticada. Essa anomalia é, na maioria dos casos, assintomática, sendo geralmente diagnosticada durante exames de imagem realizados com outras finalidades. A manifestação mais comum é trombose venosa profunda (TVP) em membros inferiores, e a terapia anticoagulante é a opção de tratamento mais frequente, embora outras técnicas, como trombólise e derivações venosas, também tenham sido descritas. Relatamos dois casos diagnosticados na nossa Instituição no último ano, ambos com episódio de TVP. O tratamento consistiu em anticoagulação por tempo indeterminado e, após 1 ano de acompanhamento no primeiro caso e 6 meses no segundo, ambos os pacientes permanecem assintomáticos, sem novos episódios de TVP. Embora não seja uma anomalia com risco de vida, é importante realizar diagnóstico e tratamento adequados para melhorar os sintomas e a qualidade de vida desses pacientes.

Preoperative predictive factors for type II endoleak: Trying to define high-risk patients.

OBJECTIVE: Type 2 endoleaks (T2E) continue to be the "Achilles Heel" of endovascular aneurysm repair (EVAR). The aim of this study is to analyze preoperative factors of patients who underwent EVAR to define risk factors for T2E. METHODS: From January 2015 to June 2020, 140 of 191 patients who underwent EVAR in our institution meet inclusion criteria for this study. Postoperative image control were performed using duplex ultrasound or CT scan. All T2E detected during follow-up were confirmed by angio CT. Preoperative anatomic and clinical variables were analyzed for T2E using t-test, Mann-Whitney U test and Fisher exact test. ROC curves and the corresponding area under the curve (AUC) were used to describe the predictive accuracy for endoleak. RESULTS: T2E was detected in 16 patients (11.43%)0.12 of them (75%) were persistent and 10 (62.5%) provoked sac enlargement. Predictive factors for T2E were a greater IMA diameter (2.5 ± 0.5 vs. 3.3 ± 0.5, p < 0.001) and an increasing number of LA (4.8 ± 1.6 vs. 6.7 ± 1.4, p < 0.001). ROC curve analysis stablished thresholds of 3.5 mm for IMA diameter (sensitivity 77%, specificity 86%) and 5.5 for patent LA (sensitivity 88%, specificity 59%) as risk factor to develop T2E. CONCLUSIONS: Preoperative aortic side branches embolization to avoid T2E is not still standarised. We tried to define a group of high-risk patients for T2E. According to our findings, patients with a preoperative IMA> 3 mm and more than 5 patent LA should be considered for pre-EVAR embolization.

A rare cause of deep vein thrombosis: inferior vena cava agenesis / Agenesia da veia cava inferior: uma causa rara de trombose venosa profunda

Abstract Inferior vena cava agenesis is a rare condition and is often misdiagnosed. This anomaly is asymptomatic in the majority of cases and is usually diagnosed during imaging tests carried out for other purposes. The most frequent manifestation is deep vein thrombosis (DVT) in lower limbs and anticoagulation therapy is the most frequent treatment option. Other techniques such as thrombolysis and venous bypass are also described. We report two cases diagnosed at our institution during the last year, both of which presented with an episode of DVT. We opted for indefinite anticoagulation therapy and both patients remain asymptomatic, after 1 year of surveillance in the first case and 6 months in the second, with no new episodes of DVT. Although it is not a life-threatening anomaly, it is important to make an appropriate diagnosis and provide treatment to improve the symptoms and quality of life of these patients.

Resumo A agenesia da veia cava inferior é uma condição rara e, muitas vezes, mal diagnosticada. Essa anomalia é, na maioria dos casos, assintomática, sendo geralmente diagnosticada durante exames de imagem realizados com outras finalidades. A manifestação mais comum é trombose venosa profunda (TVP) em membros inferiores, e a terapia anticoagulante é a opção de tratamento mais frequente, embora outras técnicas, como trombólise e derivações venosas, também tenham sido descritas. Relatamos dois casos diagnosticados na nossa Instituição no último ano, ambos com episódio de TVP. O tratamento consistiu em anticoagulação por tempo indeterminado e, após 1 ano de acompanhamento no primeiro caso e 6 meses no segundo, ambos os pacientes permanecem assintomáticos, sem novos episódios de TVP. Embora não seja uma anomalia com risco de vida, é importante realizar diagnóstico e tratamento adequados para melhorar os sintomas e a qualidade de vida desses pacientes.

Uterine Leiomyomatosis With Intracardiac Extension: One-Stage Surgical Approach.

Intravenous leiomyomatosis is a rare benign vascular tumor. Intracardiac extension is infrequently but can lead into a threating-life situation. We report a 41-year-old woman who has undergone previous hysterectomy due to uterine myomatosis and now presents with a pelvic mass contacting the venous system through the right internal iliac vein and extending up to the right pulmonary artery. Surgical resection of the pelvic mass and intravenous tumor removal was successfully performed in a single-stage approach with cardiopulmonary bypass. Patient recovered satisfactorily, being asymptomatic at hospital discharge time. One-stage surgical approach needs a multidisciplinary surgical team and needs a longer operative time than two-stage approach. However it can be a safety treatment option for patients with good general condition. Furthermore cardiopulmonary bypass guarantees a safe procedure, avoiding renal and hepatic ischemia and potential embolizations into pulmonary circulation during mass or ilio cava venous sector manipulation.

Recurrent hematuria caused by nutcracker syndrome.

A 26-year-old woman presented to the emergency department complaining of left flank pain, and proteinuria and hematuria were detected during urinalysis. A renal ultrasound did not reveal any disorder, and after performing a computed tomography angiography scan, compression of the left renal vein between the superior mesenteric artery and the aorta was seen. This compression is known as Nutcracker syndrome. From among the different treatment options available, it was decided, with patient consensus, to use open surgical management, performing a transposition of the left renal vein to a more distal level in the inferior vena cava. The immediate postoperative care progressed without complications and the symptoms resolved; after 1 year of surveillance, the patient continues to be asymptomatic. Nutcracker syndrome is a rare phenomenon, with few cases described. There are different therapeutic options for the treatment of Nutcracker syndrome, such as open surgery, endovascular treatment, or conservative treatment; because of the low prevalence of this syndrome, there are no sufficiently large series at present or with the necessary long-term surveillance to decide on the most suitable treatment. Distal transposition of the left renal vein in the inferior cava vein has proved to offer good long-term results, and this option offers a higher chance of resolution without the need for as many postsurgery controls as would be required with endovascular treatment.

[Implications of the REACH registry for vascular surgery]. / Implicaciones del registro REACH para la cirugía vascular.

Because of the increase in life expectancy, peripheral artery disease (PAD) has become a major health problem. A study performed in Spain in persons aged more than 65 years old found an overall prevalence of PAD of 9.9%. The most important risk factors for PAD were smoking, diabetes mellitus, advanced age, hyperlipidemia and hypertension. Treatment includes smoking cessation, exercise, statins, platelet antiaggregants, cilostazol or hemorheologic agents, and revascularization techniques. Data from the Spanish arm of REACH indicate that the PAD subgroup shows the poorest control of blood pressure and cholesterol and that use of platelet antiaggregants and statins is lowest in these patients, indicating that therapeutic and preventive strategies are not being correctly applied.

Implicaciones del registro REACH para la cirugía vascular / Implications of the REACH registry for vascular surgery

El aumento de la expectativa de vida ha conducido a que la enfermedad arterial periférica (EAP) se haya constituido en un problema de salud. En un estudio realizado en España en mayores de 65 años se obtuvo una prevalencia global de la EAP del 9,9%. Los factores de riesgo mayores para la EAP son el consumo de tabaco, la diabetes mellitus, la edad avanzada, la hiperlipidemia y la hipertensión. El tratamiento incluye el abandono del tabaco, el ejercicio, las estatinas, los antiagregantes plaquetarios, el cilostazol o los hemorreológicos, y las técnicas de revascularización. Conforme a los datos del REACH España, los pacientes del subgrupo de EAP son los que tienen peor controlada la presión arterial y el colesterol, y en los que se usan menos los antiagregantes plaquetarios y las estatinas, por lo que se puede concluir que no se están aplicando correctamente las estrategias terapéuticas y preventivas (AU)

Because of the increase in life expectancy, peripheral artery disease (PAD) has become a major health problem. A study performed in Spain in persons aged more than 65 years old found an overall prevalence of PAD of 9.9%. The most important risk factors for PAD were smoking, diabetes mellitus, advanced age, hyperlipidemia and hypertension. Treatment includes smoking cessation, exercise, statins, platelet antiaggregants, cilostazol or hemorheologic agents, and revascularization techniques. Data from the Spanish arm of REACH indicate that the PAD subgroup shows the poorest control of blood pressure and cholesterol and that use of platelet antiaggregants and statins is lowest in these patients, indicating that therapeutic and preventive strategies are not being correctly applied (AU)

Estudio de prevalencia de isquemia crónica de miembros inferiores y de aneurisma de aorta abdominal en mayores de 65 años / A study of the prevalence of chronic ischaemia in the lower limbs and abdominal aortic aneurysms in persons over the age of 65

Introducción. El aumento de la expectativa de vida ha conducido a que patologías vasculares, especialmente prevalentes en el segmento de población con más edad, se hayan constituido en problemas de salud. Objetivo. Determinar la prevalencia de la isquemia crónica (IC) y de los aneurismas de aorta abdominal (AAA) infrarrenal en la población mayor de 65 años del Área Sanitaria V (Gijón) del Servicio de Salud del Principado de Asturias. Pacientes y métodos. Se diseña un estudio descriptivo transversal, incluyendo finalmente 232 pacientes, 114 hombres y 118 mujeres, seleccionados aleatoriamente a partir de los datos de la tarjeta sanitaria. Se les explora, se realiza un eco-Doppler de la aorta abdominal y se calcula el índice tobillo-brazo. Resultados. La prevalencia de la IC es del 9,9% y de un 2,6% para el AAA. Se desagregan los resultados por sexos y dos grupos de edad, de 65-74 años y mayores de 75. La prevalencia de la IC está seis puntos por encima en el grupo de los mayores de 75 años (13,4%) y la del AAA es más de siete veces superior (5,2%). Conclusión. La prevalencia es más elevada en los mayores de 75 años y los varones para la IC y el AAA, con diferencias estadísticamente significativas. Este estudio abre las puertas a un seguimiento de los integrantes de la muestra, que permita determinar la incidencia de las diversas patologías

Introduction. As life expectancy has increased, vascular pathologies, which are especially prevalent in the most elderly segment of the population, have become a health problem. Aim. To determine the prevalence of chronic ischaemia (CI) and infrarenal abdominal aortic aneurysms (AAA) in a population of persons over 65 years of age from Health Care District V (Gijón) of the Principality of Asturias Health Service. Patients and methods. A cross-sectional descriptive study was designed, which finally included 232 patients (114 males and 118 females) who were selected at random from the data contained in their health card. They were examined, submitted to a Doppler ultrasound scan of the abdominal aorta and their ankle-brachial index was calculated. Results. The prevalence of CI was found to be 9.9% and 2.6% for AAA. Results were broken down by sexes and two age groups: 65-74 years and over 75 years of age. The prevalence of CI was six points higher in the group of over 75s (13.4%) and that of AAA was seven times higher (5.2%). Conclusions. For CI and AAA, prevalence was higher in persons over 75 years old and males, with statistically significant differences. This study opens the way to a follow-up of the participants in the sample, which would allow us to determine the incidence of several different pathologies