[Endovascular management of acute complications of type B aortic dissection]. / Manejo endovascular de las complicaciones agudas de la disección aórtica tipo B.

BACKGROUND: Type B aortic dissection is usually managed by intensive care medical therapy and surgery is reserved for treating the complications that can occur during the evolution of a case. AIM: To assess the endovascular management of acute complications of type B aortic dissection and the closure of the intimal defect and aortic false lumen. MATERIAL AND METHODS: Retrospective analysis of 8 consecutive patients aged 40 to 57 years (seven males) treated for acute complications in the initial episode of a type B aortic dissection between August 2006 and July 2008. RESULTS: Six/eight were known hypertensive patients. The indications for surgery were intractable pain in one, hypertension refractory to treatment in two and distal hypoperfusion in five. Five patients required covering of the left subclavian artery ostium, without need for surgical repair. One patient was subjected to renal angioplasty and stenting. Technical success was achieved in all cases, with complete closure of the proximal aortic tear and thoracic aortic false lumen, although 7 of patients had a persistent distal aortic false lumen. One case had a transient lower limb paraparesis. No patient died. CONCLUSIONS: Endovascular treatment is effective in closing the aortic tear as well as the thoracic aortic false lumen in aortic type B dissections with a low complication rate. Due to the high frequency of distal aortic false lumen persistence, it is not a definitive treatment for this condition but it is useful for the acute complications of the initial phase of type B aortic dissection.

[Popliteal artery entrampment: report of one case]. / Atrapamiento de la arteria poplítea: comunicación de un caso.

Popliteal artery entrampment is a rare condition, occurring in young subjects, that causes ischemia of the extremity. The anatomical background is the compression or occlussion of the popliteal artery caused by forced plantar or dorsal flexion. We report a 32 year-old sportsman who presented with gangrene of the right first toe and a history of three months of progressive claudication. The Ankle-Brachial index and pulse volume curve registries showed a severe ischemia below the knee. Angiography showed a medial deviation of the popliteal artery associated to stenosis and aneurysm formation. A CT scan of the contralateral artery was normal. The patient was operated using a posterior approach, performing a reverse saphenous vein bypass graft and excising the popliteal artery. The postoperative period was uneventful.

[Primary thrombophilia. Report of 93 cases and 12 asymptomatic relatives]. / Trombofilia primaria: detección y manifestación clínica en 105 casos.

BACKGROUND: Thrombophilia is defined as an altered hemostasis that predisposes to thrombosis. It can be primary when there is a family clustering of the disease or secondary, when it is associated to an acquired risk factor. AIM: To report clinical features in a series of patients with primary thrombophilia. MATERIAL AND METHODS: Review of clinical records of patients with thrombotic episodes that lead to the suspicions of primary thrombophilia. Analysis of asymptomatic adult close relatives of these patients. RESULTS: We report 93 subjects (56 females, age range 14-77 years) with repeated episodes of thrombosis and a family history of thrombosis and 12 asymptomatic close relatives. Seventy one percent had the first thrombotic episode before the age of 40 years, 62% had more than one thrombotic episode and 37% had a family history of thrombosis. Twenty four percent had protein C deficiency, 24% had antithrombin III deficiency, 18% had resistance to activated C protein by factor V Leiden, 10% had protein S deficiency, and 10% had the G20210 mutation of prothrombin gene. Among acquired defects studied simultaneously, 30% had lupus anticoagulant and 11% had hyperhomocysteinemia. Twenty four percent of cases had more than one thrombophilic risk factor. Among asymptomatic relatives, five had factor V Leiden, four had protein C deficiency and three had the G20210 mutation of prothrombin gene. CONCLUSIONS: Thrombophilia must be suspected in young subjects with thrombotic episodes and a family history. The type of coagulation defect will determine prognosis, and the type of treatment.

Hidatidosis cardíaca: dos casos clínicos que se presentaron con embolias a distancia / Cardiac hydatidosis: report of 2 clinical cases that present distant embolism

El quiste hidatídico en ubicación cardíaca, es poco habitual y generalmente produce un cuadro grave. Su frecuencia se estima en 0,02 al 2 por ciento de todas las hidatidosis por echinococcus granulosus. Se presentan dos casos clínicos. Caso 1. Escolar de 13 años portadora de un quiste único del septum interventricular. El cuadro clínico se inició con compromiso del sistema nervioso central a consecuencia de embolías cerebrales, producidas a partir de un quiste hidatídico cardíaco, fisurado. El examen físico acucioso orientó hacia el diagnóstico. La hipereosinofilia y los hallazgos ecocardiográficos fueron compatibles con quiste hidatídico, recientemente roto. La HAI fue (+) 1:800. El tratamiento quirúrgico resultó exitoso. El setudio de pieza operatoria determinó, quiste hidatídico, no fértil. Caso 2. Joven de 18 años, que ingresó por un cuadro brusco de paresia en extremidades inferiores. La aortografía mostró obstrucción en la aorta abdominal y la ecocardiografía un quiste roto en ventrículo izquierdo, el que se postuló, hidatídico. Se realizó intervención quirúrgica extrayéndose una hidátide hija, de 10 cm de diámetro de la aorta abdominal. Se trató con albendazol y anticoagulantes orales en espera de la cirugía cardíaca que finalmente no se realizó, por rechazo del paciente. Se enfatiza la ausencia de un cuadro clínico específico, que permita hacer el diagnóstico de hidatidosis cardíaca y la posibilidad de embolización a distancia como primera manifestación clínica