Outcomes After Vascular Surgery Procedures in Patients with COVID-19 Infection: A National Multicenter Cohort Study (COVID-VAS).

OBJECTIVES: To analyze the outcome of vascular procedures performed in patients with COVID-19 infection during the 2020 pandemic. METHODS: This is a multicenter, prospective observational cohort study. We analyzed data from 75 patients with COVID-19 infection undergoing vascular surgery procedures in 17 hospitals across Spain and Andorra between March and May 2020. The primary end point was 30-day mortality. Clinical Trials registry number NCT04333693. RESULTS: The mean age was 70.9 (45-94) and 58 (77.0%) patients were male. Around 70.7% had postoperative complications, 36.0% of patients experienced respiratory failure, 22.7% acute renal failure, and 22.7% acute respiratory distress syndrome (ARDS). All-cause 30-days mortality rate was 37.3%. Multivariate analysis identified age >65 years (P = 0.009), American Society of Anesthesiologists (ASA) classification IV (P = 0.004), preoperative lymphocyte count <0.6 (×109/L) (P = 0.001) and lactate dehydrogenase (LDH) >500 (UI/L) (P = 0.004), need for invasive ventilation (P = 0.043), postoperative acute renal failure (P = 0.001), ARDS (P = 0.003) and major amputation (P = 0.009) as independent variables associated with mortality. Preoperative coma (P = 0.001), quick Sepsis Related Organ Failure Assessment (qSOFA) score ≥2 (P = 0.043), lymphocytes <0.6 (×109/L) (P = 0.019) leucocytes >11.5 (×109/L) (P = 0.007) and serum ferritin >1800 mg/dL (P = 0.004), bilateral lung infiltrates on thorax computed tomography (P = 0.025), and postoperative acute renal failure (P = 0.009) increased the risk of postoperative ARDS. qSOFA score ≥2 was the only risk factor associated with postoperative sepsis (P = 0.041). CONCLUSIONS: Patients with COVID-19 infection undergoing vascular surgery procedures showed poor 30-days survival. Age >65 years, preoperative lymphocytes <0.6 (x109/L) and LDH >500 (UI/L), and postoperative acute renal failure, ARDS and need for major amputation were identified as prognostic factors of 30-days mortality.

Factores clínicos que influyen en la probabilidad diagnóstica pretest de trombosis venosa profunda en pacientes ambulatorios / Clinical factors that influence the pre-test diagnostic probability of deep vein thrombosis in out-patients

INTRODUCCIÓN: Los signos y síntomas de la trombosis venosa profunda (TVP) en las extremidades suelen ser inespecíficos y a menudo influidos por la comorbilidad del paciente. OBJETIVO: Análisis de variables clínicas de los pacientes con sospecha clínica de un primer episodio de TVP en Atención Primaria. MATERIAL Y MÉTODOS: Estudio observacional transversal y analítico de pacientes ambulatorios con sospecha de un primer episodio de TVP en extremidades inferiores. Se correlacionan los factores de riesgo y comorbilidades con la confirmación diagnóstica de TVP mediante ecografía-doppler. RESULTADOS: Se estudió a 116 pacientes, de los cuales en 22 (18,9%) se confirmó el diagnóstico. Las comorbilidades más frecuentes fueron la hipertensión, la hipercolesterolemia y la diabetes tipo 2. Solo la presencia de un diagnóstico alternativo probable y la inmovilización prolongada se asociaron con la exclusión o el diagnóstico final de TVP, respectivamente. Las enfermedades del aparato locomotor conllevaron una mayor probabilidad de falsa sospecha de TVP y el único signo clínico que se correlacionó con el diagnóstico fue la tumefacción de la extremidad afecta. CONCLUSIONES: En la práctica clínica, la tumefacción o el antecedente de parálisis de la extremidad nos ha de hacer sospechar firmemente una TVP. Sin embargo, la presencia de un posible diagnóstico alternativo prácticamente descartará dicha enfermedad

INTRODUCTION: Deep vein thrombosis (DVT) has unspecific signs and symptoms that are often influenced by the comorbidity of the patient. OBJECTIVE: To analyze the clinical features and the associated comorbidity of patients with symptoms compatible with a first DVT in a Primary Care setting. MATERIAL AND METHODS: Observational, cross-sectional and analytical study of patients with a first episode of suspected DVT. The risk factors and comorbidities are correlated with the DVT diagnostic confirmation by ultrasound. RESULTS: A total of 116 patients were included, of whom 22 had DVT (18,9%) confirmed by ultrasound. The most frequent associated comorbidities were hypertension, hypercholesterolemia, and type 2 diabetes mellitus. Only the presence of an alternative diagnosis more likely than DVT and the lower extremity immobilization were associated with the exclusion or confirmation of the diagnosis, respectively. Musculoskeletal diseases were correlated with a greater probability of a false suspicion of DVT. The only sign associated with the final diagnosis was the swelling of lower limbs. CONCLUSIONS: In clinical practice, swelling or a history of limb paralysis should lead to the suspicion of DVT. However, the presence of a possible alternative diagnosis could rule out this disease

Utilización de stents direccionadores de flujo en aneurismas viscerales / Use of flow-diverting stents in visceral aneurysms

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