¿Cómo influye la cirugía endovascular en el diámetro del cuello aórtico? / How does endovascular surgery affect the diameter of the aortic neck?

Introducción. La variación del diámetro del cuello aórtico proximal (CAP) de un aneurisma de aorta abdominal(AAA) tras cirugía endovascular (CEV) está sujeta a controversia. Objetivos. Valorar los cambios en el diámetro delCAP tras la CEV y comparar grupos de pacientes según presenten diferentes grados de dilatación del CAP. Pacientes ymétodos. Estudio observacional de casos y controles entre enero 1999 a diciembre de 2006. Un total de 75 pacientes conAAA arterioscleróticos y asintomáticos tratados mediante CEV han sido intervenidos en nuestro servicio; hemos excluidopacientes yuxta/suprarrenales, sintomáticos, fisurados e inflamatorios. Hemos recogido variables como factores deriesgo cardiovascular y comorbilidad, así como variables relacionadas con la morfología del AAA y el tipo de endoprótesisusada, antes de la CEV y en el último control postoperatorio. Los pacientes con dilatación del CAP han sido agrupadossegún ésta sea menor o mayor del 15% (‘de riesgo’). Resultados. En 59 pacientes (72%) hubo dilatación del CAPdespués de un tiempo de seguimiento medio de 24 meses; en el 34% esta dilatación era ‘de riesgo’. En estos pacientes,el tiempo se seguimiento era mayor que en el resto de la muestra, siendo esta diferencia estadísticamente significativa(p < 0,05). Conclusión. En el 72% de los pacientes con AAA tratados mediante CEV se produce dilatación del CAP;en un tercio de éstos la dilatación es mayor al 15%, y ello no se relaciona con una mayor tasa de complicaciones. El tiempode seguimiento tras la cirugía es una variable relacionada con esta dilatación

Introduction. The variation in the diameter of the proximal aortic neck (PAN) of an abdominal aortic aneurysm(AAA) following endovascular surgery (EVS) is a matter of some controversy. Aims. To assess the changes in thediameter of the PAN after EVS and to compare groups of patients with different degrees of PAN dilatation. Patients andmethods. We conducted an observation-based study of cases and controls between January 1999 and December 2006. Atotal of 75 patients with asymptomatic, arteriosclerotic AAA treated by means of EVS underwent surgery in ourdepartment; juxta/suprarenal, symptomatic, fissured and inflammatory patients were excluded. Data were collected onvariables such as cardiovascular risk factors and comorbidity, as well as variables related to the morphology of the AAAand the type of stent used, both before the EVS and in the last post-operative control visit. Patients with PAN dilatationwere divided into groups according to whether the dilatation was below or above 15% (‘high risk’). Results. PANdilatation was observed in 59 patients (72%) after a mean follow-up time of 24 months; this dilatation was classified as‘high risk’ in 34% of cases. In these patients the follow-up time was longer than in the rest of the sample, and thedifference was statistically significant (p < 0.05). Conclusions. PAN dilatation occurred in 72% of the patients with AAAtreated by means of EVS; in a third of them, the dilatation was greater than 15%, and this was not related to a higherrate of complications. The follow-up time after surgery is a variable that is related with this dilatation

Non-cardiac arterial disease in Catalonia: patient profiles and quality of clinical records by characteristics of the Vascular Surgery Unit.

AIM: Non-cardiac arterial disease (NCAD) is a frequent cause of hospital admission. The aim of this study was to investigate differences in patient profiles and clinical records as a function of the size of the Vascular Surgery Unit (VSU). METHODS: Retrospective observational study. Stratified cluster sampling and selection of patients hospitalized for NCAD. ANALYSIS: 1) description of patient profiles, quality of clinical records, and VSU [availability of diagnostic (DR) and therapeutic (TR) resources, and of written protocols (WP)]; 2) association between these variables and size of VSU. RESULTS: The sample consisted of 14 hospitals, 6 with a VSU of 15 or fewer beds (VSU < or = 15B) and 8 with >15 beds (VSU >15B). The mean number of DRs, TRs and WPs was 9, 2.8 and 2 in VSUs < or = 15B, and 11.5, 6.5 and 3.3 in VSUs >15B. The proportion of patients older than 70, female, with ischemic disease, or with coexisting diabetes was significantly higher in VSUs < or = 15B (67%, 31%, 95% and 57%, respectively) than in VSUs >15B (58%, 22%, 69% and 48%). Comorbid conditions and treatment during admission and at discharge were documented significantly less frequently in the clinical records in VSUs < or = 15B. Risk factors were under-reported in the clinical records of both types of VSU. CONCLUSION: Patient profiles and the quality of clinical records vary by size of VSU. Under-reporting of risk factors may hinder the implementation of prevention and treatment measures.