Results of Palliative Stenting in Malignant Superior Vena Cava Syndrome Analyzing Self-Expanding Stainless Steel and Nitinol Venous Bare Metal Stents.

PURPOSE: The purpose was to analyze the technical, clinical, and survival outcomes of our patients with malignant superior cava vein syndrome (SVCS) treated with endovascular approach and analyze the efficacy of different stent types used. MATERIAL AND METHODS: It is an observational, retrospective, single-center study. From 2006 to 2023, 42 patients (32 male, 10 female, mean age 62 years, age range, 41-87 years) underwent percutaneous stent placement for malignant SVCS. One stainless steel stent (Wallstent) and 2 venous nitinol stent type (Sinus-XL, Venovo) were used. Follow-up mean was 276 days. RESULTS: A total of 53 stents were deployed. Clinical success was 97.6% in less 24 hours. Technical success was achieved in 97.6%. No complications were found except 1 patient died during the procedure due to stent migration and atrial dissociation (2.3%). Overall intraprocedural stent migration rate was 11.9% (18.8% stainless steel stent, 9.6% nitinol stent, p>0.05). Overall survival rates were 87.8%, 41.99%, and 34.12%, and overall primary patency rates were 100%, 93.3%, 91.6% at 1, 6, and 12 months, respectively. CONCLUSIONS: Endovascular treatment is a safe and effective therapeutic option for SVCS with high technical and clinical success rates and low complication and recurrence rates. CLINICAL IMPACT: The malignant superior cava vein syndrome is a rare clinical entity treated classically with radiation and chemotherapy with a slower response, or surgical bypass, which is an aggressive surgical technique. Endovascular treatment offers a low-invasive technique with quick clinical resolution and good permeability results. However, further studies are lacking to deal with procedure technical characteristics, stent type used, technical complications, and medium- and long-term patency studies. This study aims to evaluate all these items, analysing self-expanding stainless steel and nitinol venous bare metal stents, and add value to endovascular treatment, confirming the good results of this technique.

Osteomielitis de pie diabético: ¿es posible un manejo conservador? / Diabetic foot osteomyelitis: Is conservative treatment possible?

INTRODUCCIÓN: El objetivo de este estudio consiste en determinar el porcentaje de úlceras complicadas con osteomielitis en pacientes diabéticos que se resuelven con tratamiento conservador. Y también, analizar las principales características clínicas y microbiológicas de los episodios, e identificar posibles factores predictivos de una mala evolución del tratamiento conservador. MÉTODOS: Estudio prospectivo observacional entre 2007 y 2009 en pacientes atendidos en una unidad ambulatoria de pie diabético. Para ser incluido en el estudio, se requería un cultivo de hueso a través de biopsia percutánea. RESULTADOS: Se evaluaron 81 episodios de osteomielitis en 64 pacientes diabéticos. Staphylococcus aureus (28/81) y Staphylococcus plasmocoagulasa negativo (22/81) fueron los principales microorganismos aislados. Dentro del grupo de gramnegativos (34/81), las bacterias gramnegativas no fermentadoras constituyeron el microorganismo más frecuentemente aislado (14/81). El porcentaje de curación fue del 73%. En el análisis multivariado, solo el tamaño de la úlcera mayor de 2 cm se asoció de forma significativa al fracaso del tratamiento conservador. El tratamiento antibiótico guiado en función del cultivo óseo se relacionó con un mejor pronóstico. CONCLUSIÓN: La evaluación precoz, así como la optimización del tratamiento antibiótico tras la toma de cultivos, permite el manejo con éxito de forma conservadora en un elevado porcentaje de pacientes con osteomielitis. Se debería considerar el tratamiento empírico frente a bacterias gramnegativas no fermentadoras en determinados casos, dada la elevada frecuencia de aislamiento en nuestro medio

INTRODUCTION: The aim of the present study is to determine the proportion of foot ulcers, complicated by osteomyelitis in diabetic patients, that heal without amputation. Furthermore, an attempt is made to analyze the main clinical and microbiological characteristics of episodes, and to identify potential predictive factors leading to the failure of conservative treatment. METHODS: A prospective observational study was carried out between 2007 and 2009 on diabetic patients with a foot lesion and attending a diabetic foot clinic. A percutaneous bone biopsy was required to be included in the study. RESULTS: A total of 81 episodes of diabetic foot osteomyelitis in 64 patients were evaluated. Staphylococcus aureus (28/81) and coagulase negative Staphylococcus (22/81) were the most frequent organisms isolated. Among the gramnegative group (34/81), non-fermenting gram negative bacteria were the most prevalent organisms isolated (14/81). Conservative treatment was successful in 73% of episodes. After a logistic regression analysis using the most significant prognostic variables, only lesion size greater than 2 cm independently predicted failure of conservative treatment. Culture guided antibiotic treatment was associated with a better prognosis. CONCLUSIÓN: Conservative treatment, including culture-guided antibiotics, is successful without amputation in a large proportion of diabetic patients with diabetic foot osteomyelitis. Considering empiric therapy directed at non-fermenting gramnegative bacteria could be advisable in some cases, because they are frequently isolated in our setting

[Diabetic foot osteomyelitis: is conservative treatment possible?]. / Osteomielitis de pie diabético: ¿es posible un manejo conservador?

INTRODUCTION: The aim of the present study is to determine the proportion of foot ulcers, complicated by osteomyelitis in diabetic patients, that heal without amputation. Furthermore, an attempt is made to analyze the main clinical and microbiological characteristics of episodes, and to identify potential predictive factors leading to the failure of conservative treatment. METHODS: A prospective observational study was carried out between 2007 and 2009 on diabetic patients with a foot lesion and attending a diabetic foot clinic. A percutaneous bone biopsy was required to be included in the study. RESULTS: A total of 81 episodes of diabetic foot osteomyelitis in 64 patients were evaluated. Staphylococcus aureus (28/81) and coagulase negative Staphylococcus (22/81) were the most frequent organisms isolated. Among the gramnegative group (34/81), non-fermenting gram negative bacteria were the most prevalent organisms isolated (14/81). Conservative treatment was successful in 73% of episodes. After a logistic regression analysis using the most significant prognostic variables, only lesion size greater than 2cm independently predicted failure of conservative treatment. Culture guided antibiotic treatment was associated with a better prognosis. CONCLUSION: Conservative treatment, including culture-guided antibiotics, is successful without amputation in a large proportion of diabetic patients with diabetic foot osteomyelitis. Considering empiric therapy directed at non-fermenting gramnegative bacteria could be advisable in some cases, because they are frequently isolated in our setting.