Aortofemoral bypass to bridge end-stage renal disease patients with severe iliac calcification to kidney transplantation.

Patients undergoing hemodialysis have a lower survival rate than those who receive a kidney transplant. Mortality among hemodialysis patients is approximately 14.5% compared with 1.5% for transplant recipients. One of the exclusion criteria for renal transplant is severe iliac artery calcification. We performed an aortofemoral bypass in these patients to make them eligible for renal transplantation. Eleven patients were selected to receive an aortofemoral bypass. All had severe calcification of iliac arteries. Eight patients required a bypass from the thoracic aorta and two from the infrarenal level. Revascularization was successful in 10 patients. Patency was 100%. Surgery could not be performed in one owing to severe calcification of the femoral artery. One patient died owing to gastrointestinal bleeding. Two patients developed complications; one needed a splenectomy, and the other developed meningitis and paralytic ileus. To date, four patients have received transplants, and the viability of the transplanted kidney is good in all cases. Renal transplantation is the only method known to improve survival and quality of life for hemodialysis patients. We consider that if patients with severe iliac calcification are well informed of the morbidity and mortality risk of an aortic bypass, this intervention can be justified in this setting.

Role of temporary arterial shunt in the reimplantation of a traumatic above-elbow amputation.

Although the feasibility of reimplantation has increased greatly with the development of new surgical techniques, long-term functional prognosis is unpredictable. Injury to a major nerve is an important factor in long-term outcome, and prolonged ischemia time also has a negative effect. We present a 26-year-old woman whose right arm was sectioned above the elbow in an accident. The limb presented a complete section, with soft tissue loss of the humeral artery and vein, basilic vein, and cephalic vein. Median and radial nerve tissue was missing, and a supracondylar fracture with substantial loss of the humerus was also observed. During reimplantation surgery, a temporary arterial shunt reduced ischemia time. A venous and arterial bypass was performed, and the 12-month results were good.

Síndrome de Stewar-Treves / Stewart-Treves syndrome

El síndrome de Stewart-Treves es uno de los tumores vasculares más agresivos, siendo su diagnóstico muchas veces tardío. Se define como un tumor maligno de origen lingfático (linfangiosarcoma) que se origina en la extremidad superior afecta de linfedema crónico secundario a mastectomía por neoplasia de mama. Su incidencia del 0,5% de los pacientes con linfedema postmastectomía, apareciendo en una media de 9 años después del inicio del linfedema. Se caracteriza por la presencia de una o múltiples máculas de color rojizo o rojo-púrpura en el miembro superior que tienden a crecer y multiplicarse convirtiéndose en nódulos duros, con tendencia a la ulceración y hemorragias espontáneas. Cursan con metástasis precoces a nivel torácico. Creemos importante que los cirujanos vasculares conozcan esta enfermedad, siendo el diagnóstico precoz y el tratamiento multidisciplinar la única esperanza para estos pacientes

Stewart-Treves Síndrome is one of the most aggresive vascular neoplasm. Sometimes the diagnosis is late. This neoplasm is a lymphatic tumor (lymphangiosarcoma) which appears in an upper limb with chronic lymphedema postmastectomy, arising 9 years after the appearance of lymphedema´s symptoms. The clinical features are one or multiple rose or red-purple macular lesions in the upper limb. The natural evolution of the lesions are growing and becoming a hard nodule with tendency of ulceration and spontaneous hemorrhage. The thoracic metastasis is early. We think is important that the vascular surgeons recognize this pathology, being the early diagnosis and the multidisciplinary treatment the unique opportunity for these patients

Caso excepcional de thrombosis del Sistema venoso cava inferior / No disponible

Se trata de un caso excepcional de thrombosis que afectó todo el sistema venosos profundo de la extremidad y la vena cava inferior. Clínicamente se presentó como una flegmasía cerúlea dolens, manifestación grave de la enfermedad tromboembólica venosa (ETEV). Para l a valoración diagnóstica se realizó tomografía computerizada observándose trombosis de la vena cava inferior hasta su nivel hepático. El tratamiento fue contundente con fibirnolíticos y heparina de bajo peso molecular, presentando una buena evolución y ninguna complicación (AU)

This is an exceptional case of thrombosis that affected all extremity Deep venous system and inferior digging. Clinically appeared like a serious manifestation of the venous thrombosis-embolism disease (ETEV). For diagnosis evaluation was made a tomography being observed vein inferior digs until its liver level. Treatment was forceful with fibrionolitics and low molecular weight heparine, displaying a good evolution and no complication (AU)

Arteritis de células gigantes / Giant cel arteritis

Las arteritis de células gigantes de la temporal y tipo Takayasu, son vasculitis primarias en las que el cuadro inflamatorio vascular es la lesión dominante sin causa mayor. La arteritis de la temporal de Horton afecta fundamentalmente a las ramas de la carótida externa y sobretodo a los ancianos. Son síntomas específicos: la claudicación mandibular, dificultad en la deglución o engrosamiento de la arteria temporal. En un 46% de los pacientes existe neuritis óptica con disminución de la agudeza visual. El diagnóstico positivo de la enfermedad debe hacerse por la biopsia de la arteria temporal. El tratamiento con prednisona es efectivo para conseguir la remisión de los síntomas, salvo los oculares. La arteritis de Takayasu afecta a la aorta y a los troncos supraórticos, y predomina en el sexo femenino. La hipertensión arterial, ausencia de pulsos y la presencia de soplos sistólicos cervicales son signos característicos de la enfermedad. La angiorresonancia magnética y/o la arteriografía son los métodos diagnósticos en estos pacientes, demostrando lesiones obliterantes en diversos troncos, acompañados de circulación colateral y de formación de aneurismas. El tratamiento médico habitual es con prednisona. Si ya se han desarrollado lesiones vasculares se deberá considerar el tratamiento quirúrgico

Temporal giant cell arteritis and Takayasu's arteritis are primary vasculitis in which the vascular inflammatory process is the dominant lesion without greater cause. Horton' s temporal arteritis fundamentally affects the branches of the externa I carotid artery and mainly in the elderly. The symptoms are specific: jaw claudication, difficulty in swallowing or the thickening of the temporal artery. In 46% of the patients there exists optic neuritis with vision 1055. The positive diagnostic of the disease must be made by temporal artery biopsy. Treatment with prednisone is effective in obtaining the remission of the symptoms, with the exception of the ocular ones. Takayasu's arteritis affects the aorta and the supra-aortic trunks, and predominates in the feminine sexo Hypertension, diminished or absent pulses and the presence of cervical systolic murmurs are characteristic signs of the disease. The magnetic resonance angiography (MRA) and/or the arteriography are the methods of diagnostic in these patients, demonstrating obliterant lesions in diverse trunks, accompanied by collateral circulation and the formation of aneurysms. The usual medical treatment is with prednisone. If vascular lesions have already developed then surgical treatment should be considered

Linfedema postmastectomía / Postmastectomy lymphedema

El linfedema postmastectomía es una complicación de la extirpación de la mama y territorios ganglionares. Su incidencia varía en función de la técnica empleada en la extirpación de la mama y de la aplicación o no de la radioterapia. Ante la presencia del mismo, desde las fases más iniciales, debe diagnosticarse correctamente, diferenciarlo de los edemas de otra etiología y tratarlo como tal. La linfografía isotópica y el eco-Doppler son métodos diagnósticos de elección para el estudio de las lesiones del sistema linfático y la posible afectación del sistema venoso, respectivamente. La linfografía y la flebografía convencionales quedan hoy en día relegadas como técnicas de recurso. El linfedema postmastectomía responde muy bien al tratamiento conservador: fundamentalmente a las Benzopironas (cumarina), vendaje y masaje de drenaje linfático manual. Sólo ante el fracaso del mismo o frente a eventuales complicaciones, -como la linfangitis-, es susceptible de tratamiento quirúrgico: anastomosis linfovenosas. Ante el linfefibredema postmastectomía, la técnica de resección o exéresis se impone como profilaxis de la degeneración neoplásica: linfangiosarcoma de Stewart-Treves

The postmastectomy lymphedema is a complication of breast removal and lymph nodule territory. Its incidence varies in accordance to the technique used in the removal of the breast and the application or not of radiotherapy. Faced with its presence, from the most initial stages, it must be correctly diagnosed, distinguished from oedemas of other etiologies and be treated as such. The isotope lymphography and the eco Doppler are chosen methods for the study of lymphatic system lesions and the possible affectation of the venal system respectively. The conventional lymphography and phlebography are nowadays relegated to being supplementary techniques. The postmastectomy lymphedema responds very well to conservative treatment: basically to the Benzopyrones (coumarins), bandages and massage of manual lymphatic drainage. Only if this fails or faced with eventual complications, - for example lymphangitis-, it is susceptible to surgery: lymphovenous anastomosis. In the case of postmastectomy fibrolymphedema, the resection technique or exeresis prevails as prophylaxis of the neoplastic degeneration: lymphangiosarcoma of STEWART-TREVES