Reported pain at work is a risk factor for vascular surgery trainee burnout.

BACKGROUND: Work-related pain is a known risk factor for vascular surgeon burnout. It risks early attrition from our workforce and is a recognized threat to the specialty. Our study aimed to understand whether work-related pain similarly contributed to vascular surgery trainee well-being. METHODS: A confidential, voluntary survey was administered after the 2022 Vascular Surgery In-Service Examination to trainees in all Accreditation Council for Graduate Medical Education-accredited vascular surgery programs. Burnout was measured by a modified, abbreviated Maslach Burnout Inventory; pain after a full day of work was measured using a 10-point Likert scale and then dichotomized as "no to mild pain" (0-2) vs "moderate to severe pain" (3-9). Univariable analyses and multivariable regression assessed associations of pain with well-being indicators (eg, burnout, thoughts of attrition, and thoughts of career change). Pain management strategies were included as additional covariables in our study. RESULTS: We included 527 trainees who completed the survey (82.2% response rate); 38% reported moderate to severe pain after a full day of work, of whom 73.6% reported using ergonomic adjustments and 67.0% used over-the-counter medications. Significantly more women reported moderate to severe pain than men (44.3% vs 34.5%; P < .01). After adjusting for gender, training level, race/ethnicity, mistreatment, and dissatisfaction with operative autonomy, moderate-to-severe pain (odds ratio, 2.52; 95% confidence interval, 1.48-4.26) and using physiotherapy as pain management (odds ratio, 3.06; 95% confidence interval, 1.02-9.14) were risk factors for burnout. Moderate to severe pain was not a risk factor for thoughts of attrition or career change after adjustment. CONCLUSIONS: Physical pain is prevalent among vascular surgery trainees and represents a risk factor for trainee burnout. Programs should consider mitigating this occupational hazard by offering ergonomic education and adjuncts, such as posture awareness and microbreaks during surgery, early and throughout training.

Impact of COVID-19 on Dental Practices in El Salvador and Mexico: A Comprehensive Survey Analysis.

BACKGROUND AND OBJECTIVES: This study aimed to identify the relationship between prevention measures and protective barriers in dental practice in El Salvador and Mexico during the COVID-19 pandemic in 2020 and 2021. MATERIALS AND METHODS: A longitudinal study was conducted from June 2020 to December 2021, involving 1,719 dentists divided into four groups based on location and year. A 20-question survey in Spanish was utilized and validated with a Cronbach's alpha value of 0.84. RESULTS: The use of phone triage (OR = 1.3), thermometers (OR = 1.4), physical distancing (OR = 1.7), and face shields (OR = 2.6) was significantly associated with dental practice in both countries during the pandemic. CONCLUSIONS: During 2020 and 2021, dental care in El Salvador and Mexico was significantly linked to COVID-19 preventive measures. Phone triage, thermometers, distancing, and face shields positively correlated with dental services. National health agencies should promote the use of minimum preventive measures in dental care, preparing for potential reinfections or new pandemics from emerging virus variants.

Results of the North American Complex Abdominal Aortic Debranching (NACAAD) Registry.

BACKGROUND: Hybrid debranching repair of pararenal and thoracoabdominal aortic aneurysms was initially designed as a better alternative to standard open repair, addressing the limitations of endovascular repair involving the visceral aorta. We reviewed the collective outcomes of hybrid debranching repairs using extra-anatomic, open surgical debranching of the renal-mesenteric arteries, followed by endovascular aortic stenting. METHODS: Data from patients who underwent hybrid repair in 14 North American institutions during 10 years were retrospectively reviewed. Society of Vascular Surgery scores were used to assess comorbidity risk. Early and late outcomes, including mortality, morbidity, reintervention, and patency were analyzed. RESULTS: A total of 208 patients (118 male; mean age, 71±8 years old) were treated by hybrid repair with extraanatomic reconstruction of 657 renal and mesenteric arteries (mean 3.2 vessels/patient). Mean aneurysm diameter was 6.6±1.3 cm. Thoracoabdominal aortic aneurysms were identified in 163 (78%) patients and pararenal aneurysms in 45 (22%). A single-stage repair was performed in 92 (44%) patients. The iliac arteries were the most common source of inflow (n=132; 63%), and most (n=150; 72%) had 3 or more bypasses. There were 30 (14%) early deaths, ranging widely across sites (0%-21%). A Society of Vascular Surgery comorbidity score >15 was the primary predictor of early mortality (P<0.01), whereas mortality was 3% in a score ≤9. Early complications occurred in 140 (73%) patients and included respiratory complications in 45 patients (22%) and spinal cord ischemia in 22 (11%), of whom 10 (45%) fully recovered. At 5 years, survival was 61±5%, primary graft patency was 90±2%, and secondary patency was 93±2%. The most significant predictor of late mortality was renal insufficiency (P<0.0001). CONCLUSIONS: Mortality after hybrid repair and visceral debranching is highly variable by center, but strongly affected by preoperative comorbidities and the centers' experience with the technique. With excellent graft patency at 5 years, the outcomes of hybrid repair done at centers of excellence and in carefully selected patients may be comparable (or better) than traditional open or even totally endovascular approaches. However, in patients already considered as high-risk for surgery, it may not offer better outcomes.

Oral health profile status and treatment needs in the Salvadoran elderly population: a cross-sectional study.

INTRODUCTION: Older adults are a highly vulnerable group in their general health condition, including oral health that can be influenced by different factors, among them, changes in oral tissues inherent to the physiological processes of aging and by systemic condition. In El Salvador, it is a group that has received little attention at the public health level. OBJECTIVE: To determine the profile of the oral health status and treatment needs of the elderly population in El Salvador. MATERIALS AND METHODS: Secondary cross-sectional analysis of data from the last oral health survey in 471 Salvadorans aged 60 years and older. The variables under study were: sociodemographics, brushing frequency, oral hygiene according to simplified oral hygiene index (OHI-S), caries experience according to decayed, missing, and filled teeth index (DMFT) modified with international caries detection and assessment system (ICDAS) criteria, periodontal status through the community periodontal index of treatment needs (CPITN), edentulism and treatment needs. Statistical analysis was conducted using chi-square test, ANOVA, z-test and linear regression (p < 0.05). RESULTS: The older adults presented poor oral hygiene, low brushing frequency, high tooth loss with an average of 16 missing teeth while one third presented total edentulism. Most of the older adults were categorized as having "poor or very Poor" oral hygiene. Almost all respondents presented some degree of periodontal disease and required restorative intervention. CONCLUSION: The oral health status of elderly Salvadoran is poor. Furthermore, the development of public policies and specific oral health strategies aimed at this population is urgent.

Alteraciones sistémicas asociadas a Hipomineralización Molar Incisivo (HMI). Una revisión de literatura / Alterações sistêmicas associadas à Hipomineralização Molar Incisiva (HMI). Uma revisão da literatura / Systemic alterations associated with Incisor Molar Hypomineralization (HMI). A literature review

El estudio de hipomineralización en molares e incisivos fue descrito por primera vez en el año 1970, posteriormente en 2001 el término Hipomineralización Molar Incisivo (HMI) fue sugerido por la Academia Europea de Odontología Pediátrica (EAPD) para referirse a este como un defecto específico del desarrollo del esmalte; ya para el año 2003 se estandarizaron los criterios de diagnóstico clínico. La HMI es un defecto del esmalte dentario ampliamente estudiado, sin embargo, hasta la fecha los factores de riesgo no son concluyentes, pero se considera de origen sistémico y multifactorial. Las implicaciones sistémicas pueden acontecer en periodos específicos (pre, peri y posnatal) considerados periodos importantes y críticos en el desarrollo de la vida humana. Objetivo: aportar la mejor evidencia científica disponible sobre los factores sistémicos asociados a la Hipomineralización Molar Incisivo. Materiales y métodos: Se realizó una búsqueda sistematizada seleccionando estudios primarios en bases de datos electrónicas: Pub Med, biblioteca Cochrane e Hinari a través de la pregunta PICO. Resultados: 115 estudios fueron identificados a través de la búsqueda electrónica de estos solo 18 fueron elegibles según los criterios de inclusión. Conclusiones: Son múltiples los posibles factores sistémicos asociados con HMI, entre ellos resaltan complicaciones en el embarazo como: fiebres altas, hipertensión arterial, diabetes gestacional, procesos infecciosos, uso frecuente de antibióticos y desnutrición, así como parto prematuro, bajo peso al nacer y las enfermedades respiratorias, fiebre y otitis en los primeros años de vida del niño

O estudo da Hipomineralização nos molares e incisivos foi descrito pela primeira vez no ano de 1970, posteriormente no 2001 o termo Hipomineralização Molar Incisivo (HMI) foi sugerido pela Academia Europeia de Odontopediatria (EAPD) para se referir a este como um defeito específico do desenvolvimento do esmalte, já no ano 2003 se padronizaram os critérios de diagnóstico clínico. A HMI é um defeito do esmalte dentário amplamente estudado, no entanto até hoje os fatores de risco ainda não estão totalmente esclarecidos, mas se considera como de origem sistémico e multifatorial. As implicações sistémicas podem acontecer em períodos específicos (pre, peri e pós natal) que se consideram períodos importantes e críticos no desenvolvimento da vida humana. Objetivo: aportar a melhor evidencia científica disponível sobre os fatores sistémicos associados à Hipomineralização Molar Incisivo. Materiais e métodos: foi realizada uma busqueda sistematizada selecionando estudos primários em bases de dados eletrônicas: Pub Med, biblioteca Cochrane e Hinari a través da pergunta PICO. Resultados: 115 estudos foram identificados a través da busqueda eletrônica dos quais unicamente 18 foram elegíveis segundo os critérios de inclusão. Conclusões: São muitos os possíveis fatores sistémicos associados com HMI entre eles destacam complicações na gravidez como: febres altas, hipertensão arterial

The study of Hypomineralization in molars and incisors was described for the first time in the year 1970. Later in 2001, the term Molar Incisor Hypomineralization (MIH) was suggested by the European Academy of Paediatric Dentistry (EAPD) to refer to this as a specific enamel development defect, and in 2003, the clinical diagnostic criteria were standardized. MIH is a widely studied tooth enamel defect; however, to date, the risk factors are not conclusive but, it is considered of systemic and multifactorial origin. The systemic implications can occur in specific periods (pre, peri, and postnatal) considered important and critical periods of the development of human life. Objective: to provide the best available scientific evidence on the systemic factors associated with molar incisor Hypomineralization. Methodology: A systematized search was varied out selecting primary studies in electronic database: Pub Med, Cochrane and Hinari library, through the PICO question. Results: 115 studied were identified through the electronic search. Of these, only 18 were found eligible according to the inclusion criteria. Conclusions: There are multiple possible systemic factors associated with MIH. Among them, certain complications in pregnancy stand out, such as: Hugh fevers, arterial hypertension, gestational diabetes, infectious processes, frequent use of antibiotics and malnutrition, as well as premature delivery, low birth weight, and respiratory diseases, fever and otitis in the first years of the child's life

Repercusiones estéticas, funcionales, psicológicas y económicas de iatrogenia en el tratamiento de la avulsión dental. Relato de caso / Implicações estéticas, funcionais, psicológicas e econômicas da iatrogênia no tratamento da avulsão dentária. Relatório de caso / Aesthetic, functional, psychological, and economic repercussions of iatrogenesis in the treatment of dental avulsion. Case report

Introducción: La avulsión dental es el desalojo completo del diente fuera del alvéolo con consecuencias estéticas, funcionales, psicológicas y económicas. La Asociación Internacional de Trauma Dental establece que entre las acciones para favorecer el pronóstico está el reimplante inmediato. Objetivo: Evaluar el impacto en la calidad de vida en un paciente de 9 años de edad ante un caso probable de iatrogenia al tratar la avulsión dental. Presentación de Caso: Paciente masculino de 9 años que sufrió avulsión de 11 por golpe directo contra columpio en la escuela; madre informa que fue trasladado de inmediato a clínica privada, el diente no fue reimplantado, indicándose como tratamiento una prótesis parcial fija. Dos semanas posteriores se presentó a las Clínicas de Posgrado de la Facultad de Odontología Universidad de El Salvador, se evaluó integralmente, se priorizó el impacto psicológico a consecuencia de la pérdida del diente, como tratamiento empático de urgencia se utilizó la corona del diente avulsionado, fijándolo con férula de alambre-resina por palatino, generando al finalizar evidente satisfacción en el paciente. Conclusiones: El índice de perfil de impacto en salud oral confirmó un impacto importante en la calidad de vida del niño a consecuencia de la pérdida de un diente anterior. El abordaje incorrecto generó la pérdida irreparable del incisivo central superior permanente, con repercusiones en la calidad de vida del paciente

Introdução: A avulsão dentária é o deslocamento com saída total do dente do interior do seu alvéolo com consequências estéticas, funcionais, psicológicas e econômicas. A Associação Internacional de Trauma Dental estabelece que uma das ações favoráveis ao prognóstico é o reimplante imediato. Objetivo: Avaliar o impacto na qualidade de vida de um paciente de 9 anos com provável caso de iatrogenia no tratamento de avulsão dentária. Relato de caso: Paciente do sexo masculino, 9 anos de idade, apresentou avulsão do dente 11, por impacto direto contra um balanço infantil na escola, a mãe relatou que foi imediatamente transferido para uma clínica particular, o dente não foi reimplantado, indicando uma Prótese parcial fixa como tratamento. Após duas semanas compareceu às Clínicas da Pós-Graduação da Faculdade de Odontologia da Universidade de El Salvador, foi avaliado integralmente, o impacto psicológico foi priorizado como resultado da perda do dente, como tratamento empático de urgência. foi utilizado o dente avulsionado fixando-o com esplintagem de resina-fio pela superfície palatina, gerando no final evidente satisfação do paciente. Conclusões: O índice de perfil de impacto na saúde bucal confirmou um impacto significativo na qualidade de vida da criança como resultado da perda de um dente anterior. A abordagem incorreta gerou a perda irreparável do incisivo central superior permanente, com repercussões na qualidade de vida do paciente

Introduction: dental avulsion is the complete removal of the tooth out of the socket with aesthetic, functional, psychological, and economic consequences. The International Association of Dental Traumatology establishes that among the actions to favor the prognosis is the immediate reimplantation. Objective: To assess the impact on quality of life in a 9-year-old patient with a probable case of iatrogenesis when treating dental avulsion. Case Presentation: 9-year-old male patient who suffered a 11 avulsion from a direct hit against the swing at school; the mother reports that he was immediately transferred to a private clinic. The tooth was not reimplanted, indicating a fixed partial prosthesis as treatment. Two weeks later, he was presented to the Postgraduate Clinics of the Faculty of Dentistry at the University of El Salvador. He was comprehensively evaluated, and the psychological impact as a result of tooth loss was prioritized. As emergency empathic treatment the crown of the avulsed tooth was used, fixing it with a palatal wire-resin splint, generating evident satisfaction in the patient at the end. Conclusions: Child-Oral index in Daily Performances confirmed an important impact on the quality of life the child as a consequence of the loss of an anterior tooth. The incorrect approach generated the irreparable loss of the permanent upper central incisor, with repercussions on the quality of life the patient

Tuberculosis pulmonar cavitaria una presentación inusual en pediatría / Cavitary pulmonary tuberculosis an unusual presentation in pediatrics

Se presenta el caso de una paciente femenina de 5 años quien fue ingresada en el Hospital Nacional Benjamín Bloom, por presentar tos y fiebre persistente de 3 semanas, previo al ingreso en el centro hospitalario, la paciente curso con gastroenteritis aguda por lo que en el Hospital Nacional Zacamil, se sospechó fiebre tifoidea sin embargo al continuar febril y con tos fue transferida al hospital, durante el ingreso hospitalario se realizó el estudio para confirmar enfermedad tuberculosa presentando: prueba mantoux positiva (13 milimetros), radiografía de tórax con cavitación apical izquierda, baciloscopias positivas (16 puntos de los criterios de Stegen y Toledo), también se realizó una tomografía axial torácica computarizada que mostro lesión cavitada a nivel del lóbulo superior izquierdo segmento apical posterior de paredes gruesas tabicadas. Iniciando tratamiento con 4 fármacos antituberculosos (isoniacida, rifampicina, pirazinamida y etambutol), y posterior al egreso hospitalario el paciente continuo con el tratamiento durante 6 meses y presentando evolución clínica satisfactoria

We present the case of a 5-year-old female patient who was admitted to the Benjamin Bloom National Hospital, due to a 3-week persistent cough and fever, prior to admission to the hospital, the patient had acute gastroenteritis, so in the Hospital Nacional Zacamil, typhoid fever was suspected, however, as she continued to febrile and with a cough, she was transferred to the hospital, during hospital admission a study was carried out to confirm tuberculosis disease, presenting: positive mantoux test (13 millimeters), chest x-ray with left apical cavitation , positive smear microscopy (16 points of the Stegen and Toledo criteria), a computed thoracic axial tomography was also performed, which showed a cavitated lesion at the level of the upper left lobe posterior apical segment with thick septate walls. Starting treatment with 4 anti-tuberculosis drugs (isoniazid, rifampicin, pyrazinamide and ethambutol), and after hospital discharge the patient continued with the treatment for 6 months and presenting satisfactory clinical evolution

Síndrome inflamatorio multisistémico en niños asociado a infección por SARS-CoV-2 / Multisystemic inflammatory syndrome in children associated with SARS-CoV-2 infection

El siguiente reporte de caso describe la presentación del síndrome inflamatorio multisistémico asociado a la infección por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2 por sus siglas en inglés) en niños, que inicialmente se comparó con el síndrome mucocutáneo linfonodular, mejor conocido como enfermedad de Kawasaki clásica. Sin embargo, existen marcadas diferencias entre ambos síndromes, como se observará en el desarrollo del caso clínico, el cual cursa con un importante compromiso pulmonar, desarrollando un síndrome de distress respiratorio agudo pediátrico y posteriormente secuelas cardiovasculares que determinan el desenlace desfavorable. En este caso, la paciente desarrolló las manifestaciones de gravedad al sexto día de enfermedad y se inició cuidados intensivos oportunos con soporte aminérgico, ventilación con maniobras de protección alveolar e inicio temprano de inmunoglobulinas, lo que permitió el destete progresivo de todas las medidas instauradas. Así como se obtuvieron aciertos en el manejo intensivo, otros aspectos de la terapéutica se van dejando de lado con el mayor conocimiento de esta entidad y su reconocimiento temprano

The following case report describes the presentation of the multisystemic inflammatory syndrome associated with infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children, which was initially compared with lymphonodular mucocutaneous syndrome, better known as classic Kawasaki disease. However, there are marked differences between both syndromes, as will be observed in the development of the clinical case, which presents with significant pulmonary involvement, developing a pediatric acute respiratory distress syndrome and later cardiovascular sequelae that determine the unfavorable outcome. In this case, the patient developed the manifestations of severity on the sixth day of the disease and timely intensive care with aminergic support, ventilation with alveolar protection maneuvers and early initiation of immunoglobulins was started, which allowed progressive weaning of all the measures established. As well as successes were obtained in the intensive management, other aspects of the therapy are being put aside with the greater knowledge of this entity and its early recognition

Recomendaciones para la atención odontológica según riesgo de infección por COVID-19 / Recommendations for dental care according to the risk of infection by COVID-19

El SARS-CoV-2 es el séptimo betacoronavirus que infecta a la especie humana. Este se caracteriza por una alta transmisibilidad y relativa baja letalidad. La enfermedad se manifiesta, en la mayor parte de la población, de forma leve y aumenta la probabilidad de severidad y letalidad en adultos mayores de 65 años, con enfermedades crónicas no trasmisibles previas como diabetes, hipertensión arterial, enfermedades respiratorias y obesidad. En este artículo de revisión se presentan parámetros con base en la evidencia científica, que guíen al odontólogo en la toma de decisiones, para la atención odontológica y limitar el riesgo de infección cruzada en el marco del estado actual de pandemia por COVID-19. La llamada o video llamada constituye la primera elección para realizar el triaje, previo a asignar una cita, ya que permite clasificar el riesgo de infección por COVID-19 de un paciente y establecer el nivel de prioridad de tratamiento. El algoritmo para la toma de decisiones en clínicas odontológicas durante el período de emergencia por COVID-19, debe constituirse en una recomendación que los odontólogos que atienden pacientes pongan en práctica. Por cuanto, permite clasificar el riesgo de infección y letalidad del paciente, definiendo los tratamientos en electivos, de urgencia o emergencia. Palabras clave: infecciones por coronavirus, Clínicas Odontológicas, Contención de riesgos biológicos, Toma de decisiones, pandemia

SARS-CoV-2 is the seventh betacoronavirus to infect the human species. It is characterized by high transmissibility and relatively low lethality. The disease manifests itself, in most of the population, in a mild way and increases the probability of severity and fatality in adults over 65 years of age, with previous non-communicable chronic diseases such as diabetes, high blood pressure, respiratory diseases and obesity. This review article presents parameters based on scientific evidence, which guide the dentist in decision-making, for dental care and limit the risk of cross infection in the context of the current state of the COVID-19 pandemic. The call or video call is the first choice for triage, prior to assigning an appointment, since it allows classifying the risk of infection by COVID-19 of a patient and establishing the level of priority of treatment. The algorithm for decision-making in dental clinics during the emergency period due to COVID-19 should become a recommendation that dentists who care for patients put into practice. Because, it allows classifying the risk of infection and lethality of the patient, defining the treatments as elective, urgent or emergency. Keywords: coronavirus infections, Dental Clinics, Containment of biological risks, Decision making, pandemic

Emergencias frecuentes en Odontología / FREQUENT EMERGENCIES IN DENTISTRY

La Organización Mundial de la Salud (OMS), el pasado 11 de marzo de 2020 emitió alerta mundial debido a la propagación del SARS-CoV-2, un virus altamente contagioso que se presentó por primera vez en diciembre de 2019 en Hubei, Wuhan, República Popular de China. Con el propósito de proteger la salud de la población, el gobierno de El Salvador implementó "Medidas Extraordinarias de Prevención y Contención para declarar al territorio Nacional como zona sujeta a Control Sanitario, con el fin de Contener la Pandemia de COVID-19". El Órgano Ejecutivo en el Ramo de Salud anunció dichas medidas el 21 de marzo de 2020 a través del decreto No.12, lo que indica la suspensión de las consultas odontológicas privadas y públicas que no sean emergencia1,2. En el Decreto Ejecutivo No. 12, Artículo 3, literal h2, se hace mención a las excepciones y casos de emergencias y otros relacionados estrictamente con la salud. El decreto custodia por la vida e integridad de la población y en todo su contenido expresa el cuido de las poblaciones vulnerables y que ameritan seguimiento a necesidades prioritarias en salud; tal es el caso de las Emergencias en Odontología, las cuales si no son atendidas de forma oportuna pueden derivar en complicaciones sistémicas en detrimento del sistema inmunológico aumentando el riesgo de letalidad de las personas, independientemente al grupo etario al que pertenezca. En concordancia con el decreto ejecutivo, la Junta de Vigilancia de la Profesión Odontológica (JVPO) a través del Consejo Superior de Salud Pública (CSSP), emite un comunicado de prensa el 24 de marzo en el cual hace una aclaración a los profesionales de la odontología y al público en general, indicando que durante la cuarentena domiciliar se podrán realizar procedimeintos odontológicos exclusivamente de emergencias3.

Premature atherosclerotic peripheral artery disease: An underrecognized and undertreated disorder with a rising global prevalence.

Premature atherosclerotic peripheral artery disease (PAD) of the lower extremities is characterized by disease diagnosis before the age of 50 years. The global prevalence of premature PAD has increased, and the disease is often underdiagnosed given heterogenous patient symptoms. Traditional cardiovascular risk factors like smoking, diabetes, hypertension, and hyperlipidemia as well as non-traditional risk factors like elevated lipoprotein(a), family history of PAD, hypercoagulability, and systemic inflammation are associated with premature PAD. Patients with premature PAD tend to have an aggressive vascular disease process, a high burden of cardiovascular risk factors, and other concomitant atherosclerotic vascular diseases like coronary artery disease. Prevention of cardiovascular events, improvement of symptoms and functional status, and prevention of adverse limb events are the main goals of patient management. In this review, we discuss the epidemiology, risk factors, clinical evaluation, and management of patients with premature PAD.

Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms.

Thoracic aortic diseases, including disease of the descending thoracic aorta (DTA), are significant causes of death in the United States. Open repair of the DTA is a physiologically impactful operation with relatively high rates of mortality, paraplegia, and renal failure. Thoracic endovascular aortic repair (TEVAR) has revolutionized treatment of the DTA and has largely supplanted open repair because of lower morbidity and mortality. These Society for Vascular Surgery Practice Guidelines are applicable to the use of TEVAR for descending thoracic aortic aneurysm (TAA) as well as for other rarer pathologic processes of the DTA. Management of aortic dissections and traumatic injuries will be discussed in separate Society for Vascular Surgery documents. In general, there is a lack of high-quality evidence across all TAA diseases, highlighting the need for better comparative effectiveness research. Yet, large single-center experiences, administrative databases, and meta-analyses have consistently reported beneficial effects of TEVAR over open repair, especially in the setting of rupture. Many of the strongest recommendations from this guideline focus on imaging before, during, or after TEVAR and include the following: In patients considered at high risk for symptomatic TAA or acute aortic syndrome, we recommend urgent imaging, usually computed tomography angiography (CTA) because of its speed and ease of use for preoperative planning. Level of recommendation: Grade 1 (Strong), Quality of Evidence: B (Moderate). If TEVAR is being considered, we recommend fine-cut (≤0.25 mm) CTA of the entire aorta as well as of the iliac and femoral arteries. CTA of the head and neck is also needed to determine the anatomy of the vertebral arteries. Level of recommendation: Grade 1 (Strong), Quality of Evidence: A (High). We recommend routine use of three-dimensional centerline reconstruction software for accurate case planning and execution in TEVAR. Level of recommendation: Grade 1 (Strong), Quality of Evidence: B (Moderate). We recommend contrast-enhanced computed tomography scanning at 1 month and 12 months after TEVAR and then yearly for life, with consideration of more frequent imaging if an endoleak or other abnormality of concern is detected at 1 month. Level of recommendation: Grade 1 (Strong), Quality of Evidence: B (Moderate). Finally, based on our review, in patients who could undergo either technique (within the criteria of the device's instructions for use), we recommend TEVAR as the preferred approach to treat elective DTA aneurysms, given its reduced morbidity and length of stay as well as short-term mortality. Level of recommendation: Grade 1 (Strong), Quality of Evidence: A (High). Given the benefits of TEVAR, treatment using a minimally invasive approach is largely based on anatomic eligibility rather than on patient-specific factors, as is the case in open TAA repair. Thus, for isolated lesions of the DTA, TEVAR should be the primary method of repair in both the elective and emergent setting based on improved short-term and midterm mortality as well as decreased morbidity.

Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms

Thoracic aortic diseases, including disease of the descending thoracic aorta (DTA), are significant causes of death in the United States. Open repair of DTA is a physiologically impactful operation with relatively high rates of mortality, paraplegia, and renal failure. Thoracic endovascular aneurysm repair (TEVAR) has revolutionized the treatment of DTA, and has largely supplanted open repair due to lower morbidity and mortality. These Society for Vascular Surgery (SVS) Practice Guidelines are applicable to the use of TEVAR for descending thoracic aortic aneurysm (TAA) as well as other rarer pathologies of the DTA. Many of the strongest recommendations from the present guideline focus on imaging either prior to, during or after TEVAR.

Perioperative Outcomes for Abdominal Aortic Aneurysm Repair Based on Aneurysm Diameter.

BACKGROUND: Guidelines from the Society for Vascular Surgery recommend elective repair in asymptomatic patients with an abdominal aortic aneurysm (AAA) only if their diameter is greater than or equal to 5.5 cm, yet smaller ones are routinely repaired. This study aims to evaluate perioperative outcomes based on aneurysm size at the time of repair. METHODS: Male patients who underwent elective endovascular aneurysm repair (EVAR) or open abdominal aneurysm repair (OAAR) repair of an infrarenal AAA were abstracted from 2011 to 2015 Targeted National Surgical Quality Improvement Program (NSQIP) database. Patients with symptoms or with aneurysmal extension into the visceral or iliac vessels were excluded. Outcomes of open versus endovascular repair were reported, with multivariate analyses to identify factors associated with the decision to repair AAA ≤5.4 cm. RESULTS: A total of 2115 (90.9%) patients underwent EVAR, while 213 (9.1%) underwent OAAR. The mean diameter in patients who underwent OAAR was 6.1 cm (interquartile range [IQR]: 5.2-6.1 cm) versus 5.7 cm (IQR: 5.2-6.0 cm) for EVAR. However, in 42.5% of EVAR and 32.8% of OAAR patients, the diameter of the AAA was 5.4 cm or less. The group undergoing repair of AAA ≤5.4 cm was younger compared to the larger AAA group (71.9 vs 73.9 years; P < .0001). Patients older than 80 years were less likely to have a repair of AAA measuring ≤5.4 cm (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.30-0.65). Additionally, patients who underwent EVAR were more likely to have AAA measuring ≤5.4 cm repaired compared to those who underwent OAAR (OR = 1.62, 95% CI = 1.19-2.21). There were no differences in perioperative morbidity or mortality between the groups. CONCLUSION: There were no differences in perioperative outcomes after AAA repair, independent of aneurysm diameter. We found a higher likelihood of repairing AAA ≤5.4 cm in younger patients who were more likely to have been repaired with EVAR. Patients older than 80 years were less likely to undergo small AAA repair.

External iliac pseudoaneurysm secondary to medial wall penetration of an acetabular screw: a rare cause of total hip arthroplasty failure 15 years after implantation.

Vascular injury as a result of total hip arthroplasty (THA) represents an uncommon complication. Although these injuries typically present acutely, delayed presentation has been reported. In this case, a 70-year-old female presented with groin pain and medial thigh numbness 15 years after a left THA. After initially being misdiagnosed, repeat imaging revealed a large external iliac pseudoaneurysm as a result of a transacetabular screw penetrating the medial acetabular wall. The patient underwent staged endovascular exclusion of the pseudoaneurysm, percutaneous drainage, and revision THA. She had resolution of her symptoms. To our knowledge, this is the only reported case of a late vascular injury related to an aseptic THA with well-fixed components. Staged treatment with endovascular exclusion and revision THA is a viable approach.

Surveillance Recommendations after Thoracic Endovascular Aortic Repair Should Be Based on Initial Indication for Repair.

BACKGROUND: Current surveillance recommendations after thoracic endovascular aortic repair (TEVAR) include contrast-enhanced computed tomography (CT) scans at 1-, 2-, 6-, and 12-month intervals, with annual scans thereafter. Patient compliance with such schedules remains inconsistent for all etiologies of aortic disease. It remains unclear which boundaries prevent compliance and whether compliance is associated with improved aorta-specific outcomes. METHODS: A retrospective analysis was performed of a multicenter health-care system's electronic medical records to include all patients who underwent TEVAR from July 1, 2011 to April 1, 2016. Patients were assigned a compliance score of 0 through 4 based on the number of images received at the recommended time intervals. Whether patients underwent any postoperative imaging within 1 year of discharge was also recorded. Patients who died within 12 months of discharge were excluded. Aorta-specific complications included postoperative sac expansion, rupture, or need for additional aortic intervention. RESULTS: A total of 262 patients were included; of whom, 203 (77.5%) received at least one postoperative contrast-enhanced CT scan. Race, insurance status, and distance to hospital were not associated with 12-month compliance or compliance score (all P > 0.05). Regarding 12-month compliance, 76.2% of aneurysm patients, 81.6% of dissection patients, 72.2% of transection patients, and 72.2% of penetrating aortic ulcer patients underwent at least 1 CT scan within the first year (all P > 0.05). There were no differences in compliance score based on indication for repair. The overall aorta-related complication rate was 34.7%. TEVAR for dissection was associated with increased long-term aorta-specific complications (49.5%, P < 0.05 when compared with other indications). CONCLUSIONS: In this large, multihospital analysis of TEVAR outcomes, there was no difference in compliance among patients undergoing TEVAR for major indications, but patients with dissection who required TEVAR had a significant difference in aorta-specific complication rates. TEVAR for dissection should be subject to stricter surveillance guidelines than TEVAR for other indications.

Prevalencia de caries dental y necesidades de tratamiento según ICDAS y CPO en escolares de El Salvador / Dental cavity and treatment needs prevalence according to ICDAS and DMF in schools of El Salvador / Prevalência de cáries dentárias e necessidade de tratamento de acordo com ICDAS e CPO nas escolas de El Salvador / Prévalence des caries dentaires et des besoins de soins chez les écoliers du Salvador selon l'ICDAS et le CAO

Resumen Objetivo: Comparar la prevalencia de caries dental y necesidades de tratamiento según criterios International Caries Detection and Assessment System (ICDAS) y CPO-D, en niños de 7-8 años de Centros Escolares públicos rurales pertenecientes a 16 municipios de El Salvador. Materiales y métodos: El diseño corresponde a una investigación epidemiológica descriptiva transversal realizada a partir de las historias clínicas de 420 escolares de 7 - 8 años de zonas rurales de El Salvador; el diagnóstico de caries se estableció con base en criterios ICDAS. Las variables analizadas fueron: prevalencia de caries y necesidades de tratamientos. El CPO-D/ceo-d se estableció excluyendo las fases precavitacionales de la enfermedad, se empleó T de Student para probar las diferencias de las medias entre índices y la Prueba de Levene para evaluar la igualdad de las varianzas. La significación estadística fue fijada en p <0,05. Resultados: Según ICDAS, cada niño presentó un promedio de 9.52 dientes afectados por caries y 6.24 según CPO. La diferencia encontrada entre índices es significativa en dientes permanentes y en primarios (p<0,05). Los diagnósticos según criterios ICDAS, generaron 4,269 necesidades de tratamientos curativos y 4,475 preventivos; mientras que con CPO, 2,997 tratamientos curativos y ningún preventivo. Conclusiones: ICDAS reflejó una mayor afectación por caries al considerar los estadios precavitacionales; por tanto, permite establecer una diversidad de tratamientos preventivos y de limitación del daño, que, en su mayoría, no es posible indicar con CPO.

Abstract Objective: To compare the prevalence of dental cavity and treatment needs according to International Cavity Detection and Assessment System (ICDAS) and DMF, in 7-8 years old children of rural public school centers belonging to 16 municipal towns of El Salvador. Materials and methods: The design corresponds to a transversal descriptive epidemiological investigation made from clinical histories of 7-8 year- old schoolchildren in rural areas of El Salvador; the diagnosis of dental cavities was established based on ICDAS criteria. The variables analyzed were: caries prevalence and treatment needs. The DMF-T/ dmf-t was established, excluding the precavitation phases of the disease, Student's T was used to test the differences of the means between indexes and the Levene test to evaluate the equality of the variances. The statistical significance was set at p <0.05. Results: According to ICDAS, each child presented an average of 9.52 teeth affected by caries and, according to DMF, 6.24. The difference found between indexes is significant in permanent teeth and in primary teeth (p<0,05). Diagnoses according to ICDAS criteria, generated 4269 needs for curative treatments and 4475 preventive ones; while with DMF, 2997 curative treatments and no preventive ones. Conclusions: ICDAS reflected a higher affectation by dental cavities when considering the precavitation stages; therefore, it allows establishing a diversity of preventive treatments and damage limitation; which, mostly, it is not possible to indicate with DMF.

Resumo Objetivo: Comparar a prevalência de cáries dentárias e necessidade de tratamento de acordo com os critérios do International Caries Detection and Assessment System (ICDAS) e da CPO, em criabas de 7 a 8 años de escolas públicas em áreas rurais pertencentes a 16 municipios de El Salvador. Materiais e métodos: O projeto corresponde a uma investigação epidemiológica descritiva transversal, realizada a partir da história clínicas de 420 alunos de 7 a 8 anos de áreas rurais de El Salvador. O diagnóstico de cárie foi estabelecido com base nos critérios do ICDAS. As variáveis analisadas foram: a prevalencia de cárie e a necessidade de tratamento. O CPO-D/ceo-d foi estabelecido excluindo as fases pré-cavitacionais da doença. Utilizou- se o teste t de student para comparar as médias dos índices e o teste de levene teste de Levene para a igualdade de variançias. A significancia estatística foi definida em p <0,05. Resultados: De acordo com o ICDAS, cada criaba apresentou em média de 9,52 dentes afetados por cáries e 6,24 de acordo com CPO. A diferen9a encontrada entre os índices é significativa nos dentes definitivos e nos primeiros dentes (p<0,05). Os diagnósticos, de acordo com os critérios do ICDAS, criaram 4269 necessidades para tratamentos curativos e 4475 preventivos; mas com os de CPO, apenas 2997 tratamentos curativos e nenhum preventivo. Conclusões: O ICDAS demostrou maior quantidade de dentes afetados por cárie ao considerar as etapas pré-cavitacionais; no entanto, permite estabelecer uma diversidade de tratamentos preventivos e de limitação de danos que, na maior parte das vezes, náo é possível estabelecer com CPO.

Résumé Objectif: Comparer la prévalence des caries dentaires et des besoins de soins selon les criteres du International Caries Detection and Assessment System (ICDAS) et du CAO-D, chez les enfants de 7 a 8 ans de centres scolaires publiques ruraux de 16 municipalités du Salvador. Matériels et méthodes: L'étude est épidémiologique, transversale et descriptive. Elle a été réalisée à partir de l'histoire clinique de 420 écoliers de 7 a 8 ans, de zones rurales du Salvador. Le diagnostic de caries a été établi sur la base des critères ICDAS. Les variables analysées sont la prévalence de caries et les besoins de soins. Le CAO-D / ceo-d a été établi en excluant les stades pré-cavitaires de la maladie. Le test de Student a été utilisé pour comparer les moyennes obtenues pour les indices et le test de Levene pour évaluer l'égalité des variances. La signification statistique a été fixée à p <0,05. Résultats: Selon l'ICDAS, chaque enfant présentait en moyenne 9,52 dents cariées; et selon le CAO 6,24. La différence entre les indices est significative pour les dents permanentes et les primaires (p <0,05). Les diagnostics selon les criteres ICDAS, ont permis d'identifier 4269 besoins de soins curatifs et 4475 préventifs; avec le CAO, 2997 soins curatifs et aucun soins préventif. Conclusions: L'ICDAS a permis de détecter plus d'affectations par caries en raison de sa prise en compte des stades pré-cavitaires; il permet donc d'établir une grande diversité de soins préventifs pour limiter les dommages, ce qui est généralement impossible avec le CAO.