Revisión sistemática de los resultados del trasplante renal en pacientes con cirugía abierta de revascularización aortoilíaca / Systematic review of the results of kidney transplantation in patients with aortoiliac revascularization surgery

Introducción: la enfermedad renal crónica (ERC) acelera el proceso de arterioesclerosis, lo que incrementa la prevalencia de enfermedad arterial periférica (EAP). El objetivo de esta revisión sistemática es evaluar los resultados del trasplante renal en pacientes sometidos a cirugía abierta de revascularización del sector aortoilíaco por arteriopatía crónica de las extremidades inferiores. Material y métodos: revisión sistemática según las recomendaciones QUOROM de artículos en PubMed y Cochrane, en español e inglés, que incluían pacientes con ERC y cirugía abierta de revascularización del sector aortoilíaco en el pasado o como indicación previa a un trasplante renal. Los artículos incluidos describían complicaciones inmediatas, supervivencia del injerto y supervivencia del paciente después del trasplante renal. Resultados: la búsqueda generó 253 artículos. Tras la revisión se seleccionaron 8 artículos que incluían 101 pacientes, de los que el 84,2 % fueron trasplantados. La incidencia de complicaciones tras la revascularización fue del 25,9 % y la incidencia de complicaciones tras el trasplante renal fue del 28,2 %. La mediana de seguimiento fue de 22 meses (rango: 6,7 a 71). La supervivencia del injerto renal fue del 80 % y la del paciente fue del 90,5 % al final del seguimiento. Conclusión: la coexistencia de enfermedad arterial y renal no debe considerarse un obstáculo para la realización de un trasplante renal. Los datos publicados hasta el momento muestran resultados satisfactorios en la supervivencia del injerto y del paciente.(AU)

Introduction: chronic kidney disease (CKD) increases and accelerates the arterial calcification process, increasing the prevalence of peripheral arterial disease in these patients. The aim of this systematic review is to evaluate the results of kidney transplantation in patients who have undergone open revascularization surgery in the aorto-iliac sector for chronic lower limb arteriopathy. Material and methods: systematic review, following QUORUM recommendations, of articles in PubMed and Cochrane, in English or Spanish, which include patients with CKD, who have undergone open revascularization surgery of the aorto-iliac sector in the past or as a prior indication to kidney transplantation. Articles included described immediate complications, graft survival and patient survival after kidney transplantation. Results: the search generated 253 articles and after the systematic review, 8 articles that included, 101 patients were selected, 84.2 % of whom were transplanted. Complications of revascularization surgery were 25.9 % and complications of kidney transplantation were 28.2 %. Median follow-up was 22 months (range: 6.7 to 71). Graft survival was 80 % and patient survival was 100 % at the end of follow-up. Conclusion: the coexistence of vascular and kidney disease should not be an obstacle to performing a kidney transplantation. Since the data published so far shows satisfactory results in graft and patient survival.(AU)

The CHIVA strategy applied to large-diameter saphenous veins.

BACKGROUND: CHIVA (Cure Conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire) is a conservative outpatient treatment strategy for chronic venous disease (CVD) that preserves the superficial venous system. A modified two-stage strategy is used in patients with a great saphenous vein (GSV) diameter ≥9 mm with the goal to decrease the risk of symptomatic superficial vein thrombosis (SVT), as the risk of complications is higher when first and second stage is performed simultaneously. METHODS: We conducted a retrospective observational study of 111 patients with CVD and a GVS diameter ≥9 mm treated with two possible stages of the CHIVA strategy, between January 2010 and December 2019. The goal of the first stage was to interrupt the main reflux escape point (incompetent saphenofemoral junction), thereby lowering the venous pressure and achieving a sufficient reduction in GSV diameter to enable, if necessary, a second stage that consists of disconnection of secondary reflux exit point (incompetent saphenous tributaries), with a lower risk of symptomatic SVT when patients do not show significant clinical improvement. Reductions in GSV diameter, postoperative complications and clinical improvement were analyzed. RESULTS: There were 60 men (54.1%) and 51 women (45.9%) with a mean age of 57±11.9 years. All patients undergone first surgical stage, and this interruption of the saphenofemoral junction was the single procedure in 77.5% of cases (86 patients). Mean follow-up time was 19.8 months. The second stage was performed in 25 patients (22.5%). Mean preoperative GSV diameter was 10.2±1.1 mm and this decreased to 7.1±1.5 mm after the first surgery (mean reduction, 3±1.5 mm, P<0.001). Six patients (5.4%) experienced recurrence due to recanalization of the reflux point and 16 patients (14.4%) developed SVT, which was symptomatic in 12 cases (10.8%). CONCLUSIONS: Interruption of the main reflux escape point as a single procedure in patients with a GSV diameter ≥9 mm led to a significant reduction in diameter and sufficient clinical improvement in almost 80% of cases.

Endovascular Occlusion of Iliocaval Confluence During Surgical Repair of Iliocaval Fistula due to Ruptured Abdominal Aortoiliac Aneurysm.

We describe the successful use of endovascular occlusion of the iliocaval confluence to prevent excessive bleeding during open repair of an iliocaval arteriovenous fistula due to a ruptured abdominal aortoiliac aneurysm. A 70-year-old man was admitted with chest pain, hemodynamic instability, acute pulmonary edema, and bilateral leg swelling. Computed tomography angiography (CTA) showed a ruptured AAIA with a large primary iliocaval fistula. Aortobifemoral bypass with a Dacron bifurcated prosthetic graft was performed with catheter balloon occlusion of the iliocaval confluence to prevent massive bleeding. Follow-up CTA showed no complications. Iliocaval fistula is a rare complication of AAIA that requires emergent surgery. Endovascular occlusion of iliac or inferior cava vein can control bleeding.

Prevalence of common origin of the innominate and left carotid artery or bovine arch configuration in patients with blunt aortic injury.

BACKGROUND: The common origin of the innominate and left carotid artery (CILCA) have been described as a risk factor for thoracic aortic diseases (dissections and aneurysms), but its relationship with traumatic pathology of the thoracic aorta is not so well known. The aim of the present study is to describe the prevalence of CILCA among patients admitted to the hospital for high-energy polytrauma with aortic injury (BTAI) compared with a control group. METHODS: Retrospective unicenter case-control study. Cases included all patients treated with BTAI between 1999-2020. The group of controls was patients admitted in our center for high-energy polytrauma between 2012-2017. Primary endpoint was to define the prevalence of CILCA among both groups and secondary endpoint was to measure the distance between brachiocephalic trunk (BCT) or left common carotid artery (LCCA) and left subclavian artery (LSA). Results were retrospectively reviewed by two investigators. RESULTS: Forty-nine patients in BTAI group and 248 patients in control group. With a good concordance between investigators, 21 patients with CILCA (42.9%) in the BTAI group versus 61 CILCA (24.6%) in the control group (P=0.009). The mean distance between BCT/LCCA and LSA among the cases with CILCA was 10.09 mm (SD=2.89) and 7.48 mm (SD=3.65) among cases with standard aortic arch (P=0.010). CONCLUSIONS: In the present study we found that CILCA configuration is more prevalent in patients with BTAI and the distance to left subclavian artery is longer.

Prevalence of Peripheral Arterial Disease and Associated Vascular Risk Factors in 65-Years-Old People of Northern Barcelona.

OBJECTIVE: To determine the prevalence and risk factors associated with peripheral arterial disease (PAD) in Northern Barcelona at 65 years of age. METHODS: A single-center, cross-sectional study, including males and females 65 years of age, health care cardholders of Barcelona Nord. PAD was defined as an ankle-brachial index (ABI) < 0.9. Attending subjects were evaluated for a history of common cardiovascular risk factors. A REGICOR score was obtained, as well as a physical examination and anthropometric measurements. RESULTS: From November 2017 to December 2018, 1174 subjects were included: 479 (40.8%) female and 695 (59.2%) male. Overall prevalence of PAD was 6.2% (95% CI: 4.8-7.6%), being 7.9% (95% CI: 5.9-9.9%) in males and 3.8% (95% CI: 2.1-5.5%) in females. An independent strong association was seen in male smokers and diabetes, with ORs pf 7.2 (95% CI: 2.8-18.6) and 1.8 (95% CI: 1.0-3.3), respectively, and in female smokers and hypertension, with ORs of 5.2 (95% CI: 1.6-17.3) and 3.3 (95% CI: 1.2-9.0). Male subjects presented with higher REGICOR scores (p < 0.001). CONCLUSION: Higher-risk groups are seen in male subjects with a history of smoking and diabetes and female smokers and arterial hypertension, becoming important subgroups for our primary healthcare centers and should be considered for ABI screening programs.