Tratamiento híbrido en isquemia mesentérica aguda / Hybrid treatment in acute mesenteric ischaemia

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Reparación endovascular de seudoaneurisma en aorta infrarrenal / Endovascular treatment of infrarenal aortic pseudoaneurysm

No disponible

Tratamiento endovascular del síndrome de vena cava superior / Endovascular treatment of superior vena cava syndrome

No disponible

Tratamiento endovascular de aneurismas micóticos en aorta torácica / Endovascular treatment of mycotic thoracic aortic

No disponible

Complicaciones vasculares asociadas a la cirugía de columna lumbar / Vascular complications associated with lumbar spinal surgery

Hoy en día han surgido técnicas poco invasivas para tratamiento de lesiones de columna; sin embargo, la cirugía abierta todavía es requerida en muchos casos. Las lesiones vasculares ocurridas durante la cirugía de columna lumbar; si bien son infrecuentes, revisten gran importancia por su potencial gravedad. Las manifestaciones clínicas de las mismas varían desde un shock hemorrágico agudo precisando tratamiento urgente para salvar la vida del paciente, hasta lesiones de evolución insidiosa e incluso asintomáticas, que permitirían estudiar la mejor alternativa terapéutica. Presentamos cuatro casos que representan este abanico de posibilidades y que enfatizan la importancia de llevar a cabo una técnica quirúrgica minuciosa durante las intervenciones de la columna lumbar y la necesidad de una alta sospecha clínica, imprescindible para el diagnóstico temprano de estas complicaciones vasculares, a la vez que se comentan las alternativas terapéuticas disponibles en la actualidad (AU)

Although there are currently less invasive techniques available for the treatment of spinal injuries, open surgery is still required in many cases. Vascular injuries occurring during lumbar spine surgery, although uncommon, are of great importance due to their potential gravity. Clinical manifestations vary from an acute hemorrhagic shock that needs urgent treatment to save the patient's life, to insidious injuries or an asymptomatic evolution, and should be studied to choose the best therapeutic alternative. Four cases are reported that represent this range of possibilities and emphasize the importance of a careful surgical technique during lumbar spine interventions, and the need for high clinical suspicion, essential for the early diagnosis of these vascular complications. The current therapeutic options are also discussed (AU)

[Vascular complications associated with lumbar spinal surgery]. / Complicaciones vasculares asociadas a la cirugía de columna lumbar.

Although there are currently less invasive techniques available for the treatment of spinal injuries, open surgery is still required in many cases. Vascular injuries occurring during lumbar spine surgery, although uncommon, are of great importance due to their potential gravity. Clinical manifestations vary from an acute hemorrhagic shock that needs urgent treatment to save the patient's life, to insidious injuries or an asymptomatic evolution, and should be studied to choose the best therapeutic alternative. Four cases are reported that represent this range of possibilities and emphasize the importance of a careful surgical technique during lumbar spine interventions, and the need for high clinical suspicion, essential for the early diagnosis of these vascular complications. The current therapeutic options are also discussed.

Endofugas tipo 2 en una población tratada con endoprótesis Gore(R) Excluder: incidencia, persistencia y crecimiento del saco aneurismático / Type 2 endoleaks in a population treated with a Gore (R) Excluder endoprosthesis: incidence, persistence and aneurysmal sac growth

INTRODUCCIÓN: La endofuga tipo 2 (EF2) es la complicación más frecuente tras EVAR, con una tasa de crecimiento del saco variable y un tratamiento de resultados poco efectivos. Se pretende analizar la incidencia de EF2, su persistencia y evolución en una población homogénea, buscando variables predictoras de crecimiento del saco. MATERIAL Y MÉTODOS: Setenta EF2 (32,2%) detectadas en 217 EVAR aortoilíacos tratados con GORE(R) Excluder entre 2003 y 2011. Seguimiento clínico y con angiotomografía computarizada (media 32,5 meses). Análisis univariante de datos recogidos de forma prospectiva. Función de supervivencia de Kaplan-Meier y regresión de Cox. RESULTADOS: Un 90% de varones con edad media 75,5 ± 8 años y diámetro aórtico 59,6 ± 10 mm. El vaso aferente más frecuente fue una arteria lumbar (n = 42), con un 30% de endofugas complejas (n = 21). Veinticinco endofugas fueron transitorias (35,7%) y 45 persistentes, grupo este último con mayor número de mujeres (p = 0,044) y de colaterales aferentes al saco (1,5 ± 0,7 vs. 1,2 ± 0,4, p = 0,022). Crecimiento > 5 mm en un 38,6% de casos (mediana 8,5 mm, rango 5-24); once se trataron con embolización (éxito 63,6%). Las endofugas complejas no incrementaron el riesgo. El único predictor independiente de crecimiento en la regresión de Cox fue la edad (HR 2,71 IC 95% 1,01-7,19 p = 0,046). CONCLUSIONES: Las EF2 constituyen una complicación frecuente y sin factores predictores sólidos que permitan estratificar el riesgo de crecimiento del saco, por lo que es necesario un seguimiento exhaustivo

INTRODUCTION: Type 2 endoleaks (T2E) are the most common finding after endovascular aortic repair (EVAR), with a variable sac growth rate and a treatment with unpromising results. The aim of this study is to analyze the incidence of T2E and their evolution in a homogeneous population, seeking predictors for sac growth. MATERIAL AND METHODS: A total of 70 T2E (32.2%) were detected in 217 aorto-iliac EVAR treated with a GORE(R) Excluder endograft from 2003 to 2011. They were systematically followed-up with contrast enhanced tomography (mean 32.5 months). Univariate analysis of prospectively collected data; Kaplan-Meier survival functions and multivariate Cox regression. RESULTS: 90% of patients with T2E were males, with a mean age 75.8 ± 8 years, and mean aortic diameter 59.5 ± 10 mm. The most common persistent collateral vessel was a lumbar artery (n = 42), with 30% of complex T2E (n = 21). The endoleaks were transient in 25 cases (35.7%), and 45 persisted for more than 6 months, the latter with a higher percentage of women (p = 0 .044), and total number of afferent vessels (1.5 ± 0.7 vs. 1.2 ± 0.4, p = 0 .022). Sac growth over 5 mm was observed in 38.6% of cases (median 8.5 mm, rank 5-24), with eleven of those treated with trans-arterial or trans-lumbar embolization (63.6% success). Complex endoleaks did not show a higher risk profile. Age was the only independent risk factor in the Cox regression analysis (HR 2.71, 95% CI; 1.01-7.19 p = 0 .046). Conclusions : T2E are a frequent complication, with no solid predictive factors for stratifying sac growth risk, thus needing close surveillance

Exclusión de pseudoaneurismas de la aorta infrarrenal utilizando extensores aórticos / Exclusion of infrarenal aorta pseudoaneurysms using aortic extensions

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Erosión vertebral en aneurismas de aorta abdominal como causa de dolor lumbar crónico. Serie de 5 casos / Vertebral erosions in abdominal aortic aneurysms as a cause of chronic low back pain. A series of 5 cases

El dolor lumbar crónico es una causa habitual de consulta médica y se relaciona en muchas ocasiones con la enfermedad vertebral degenerativa. A pesar de ello no debemos olvidar otras enfermedades incluso en aquellos casos en los que las pruebas de imagen preliminares sugieran cambios degenerativos crónicos en la columna lumbar, y la posible presencia de un aneurisma de aorta abdominal con una rotura contenida debe ser descartada por sus implicaciones pronósticas y terapéuticas. Presentamos 5 casos de dolor lumbar crónico asociado a lesiones líticas graves del cuerpo vertebral debido a rotura crónica contenida de un aneurisma de aorta abdominal (AU)

Chronic low back bain is a common cause of medical consultation, and is often associated with degenerative vetebral disease. Despite this, we must not forget other diseases even in those cases where the imaging tests may suggest chronic degenerative changes in the lumbar spine, including the possible presence of an abdominal aortic aneurysm with a contained rupture must be ruled out due to its prognostic and therapeutic implications. We present 5 cases of chronic low back pain associated with serious lytic lesions in the vertebral body due to chronic rupture of an abdominal aortic aneurysm (AU)

Aneurismas aórticos yuxtarrenales rotos / No disponible

No disponible

[Vertebral erosions in abdominal aortic aneurysms as a cause of chronic low back pain. A series of 5 cases]. / Erosión vertebral en aneurismas de aorta abdominal como causa de dolor lumbar crónico. Serie de 5 casos.

Chronic low back bain is a common cause of medical consultation, and is often associated with degenerative vetebral disease. Despite this, we must not forget other diseases even in those cases where the imaging tests may suggest chronic degenerative changes in the lumbar spine, including the possible presence of an abdominal aortic aneurysm with a contained rupture must be ruled out due to its prognostic and therapeutic implications. We present 5 cases of chronic low back pain associated with serious lytic lesions in the vertebral body due to chronic rupture of an abdominal aortic aneurysm.

Experiencia preliminar con cirugía híbrida en el tratamiento de los aneurismas toracoabdominales / Initial experience with hybrid surgery in the treatment of thoracoabdominal aneurysms

Introducción. La cirugía convencional de los aneurismas toracoabdominales (ATA) todavía conlleva una elevada morbimortalidad, por lo que han surgido alternativas: endoprotesis con ramas y tratamiento híbrido. Objetivo. Se presenta la experiencia preliminar con tratamiento híbrido en ATA extensos. Material y métodos. Entre octubre de 2006 y septiembre de 2009 se trataron 5 pacientes con ATA extensos mediante cirugía híbrida, cuyas historias clínicas fueron retrospectivamente examinadas. Un caso se presentó con rotura, y fue el único tratado de manera urgente. Sólo dos procedimientos se realizaron durante una única intervención. En todos, excepto uno, se realizó revascularización renovisceral completa. La arteria subclavia izquierda fue ocluida intencionadamente en dos ocasiones, sin revascularización. Siempre se empleó un sistema de drenaje de líquido cefalorraquídeo. Para el seguimiento se empleó tomografía computarizada en el primer mes, a los 6 y 12 meses y anualmente. Resultados. La mortalidad inmediata fue nula. Ningún paciente presentó paraplejia. Dos pacientes sufrieron complicaciones respiratorias. En dos casos se registró un incremento de creatinina Ý 0,5 mg/dl, con recuperación. La permeabilidad inmediata fue del 100 %, sin endofugas en el primer control. El seguimiento oscila entre 4,9 y 37,4 meses (mediana 26,5 meses); se registraron dos exitus: hemorragia intracraneal a los 31 meses y sepsis a los 37,4 meses. Este último caso tenía una endofuga tipo I distal a los 6 meses, que no fue tratada. Conclusión. Los resultados del tratamiento híbrido en ATA extensos aparentan ser prometedores, aunque todavía no hay evidencia de que disminuya la morbimortalidad y cuál será su papel futuro (AU)

Introduction. Given that open repair of thoracoabdominal aortic aneurysms (TAA) is stillassociated with high mortality and morbidity, alternative techniques have arisen: branchedendografts and hybrid procedures (debranching plus endoprosthesis).Objective. To report our preliminary experience with hybrid procedures for extensive TAA.Materials and methods. Medical records of 5 patients with extensive TAA treated by abdominaldebranching plus endoprosthesis from October 2006 to September 2009 were retrospectivelyreviewed. Elective procedures were performed in all but one with rupture. Only in two patientswas treatment performed during a single intervention. Total debranching was performed in allcases but one. The subclavian artery was occluded without revascularisation in two patients.A cerebrospinal drainage was employed in all cases. Follow-up was assessed by computedtomography during the fi rst month, at 6, 12 months and annually thereafter.Results. There was no immediate mortality. No patient suffered paraplegia. Respiratorycomplications appeared in two patients, and worsening of renal function (creatinine increase¡Ý 0.5 mg/dl) appeared in other two cases, both with recovery. Immediate patency rate was100 %, without endoleaks during the fi rst assessment. Follow-up ranges from 4.9 to 37.4 months(median 26.5). Two patients died (intracerebral haemorrhage at 31 months and sepsis at37.4 months). The latter also developed a distal type I endoleak at 6 months, which was nottreated.Conclusion. Results of hybrid treatment for extensive TAA seem to be promising, although thereis still not enough evidence to demonstrate that it decreases mortality and morbidity, or whatwill be its role in the future(AU)

¿Está justificado el cribado de aneurisma de aorta abdominal en pacientes con hernia inguinal? Estudio de prevalencia en la Comunidad Asturiana / Is abdominal aortic aneurysm screening justified in patients suffering from inguinal hernia? A prevalence study in the Asturian Community

Introducción. La importancia de la detección precoz de los aneurismas de aorta abdominal (AAA) como mediode reducir la elevada morbimortalidad asociada a su rotura, se encuentra ampliamente reconocida, especialmente engrupos de riesgo. Objetivo. Determinar si la hernia inguinal (HI) debe considerarse un factor de riesgo para el desarrollode un AAA. Sujetos y métodos. Se diseñó un estudio de casos y controles, prospectivo y muticéntrico en la comunidadasturiana. Se comparó 291 pacientes que iban a ser intervenidos por HI con 459 controles, obtenidos de la misma población(varones de 50 o más años de edad). La definición de AAA fue la de un diámetro máximo mayor o igual a 30 mm medidoscon ecografía. Se evaluó la asociación entre HI y AAA. Resultados. Se realizó un total de 750 ecografías abdominales,obteniéndose una prevalencia similar de AAA en ambos grupos: 3,8% en el grupo de pacientes con HI y 3,5% enel grupo control. Conclusiones. De acuerdo con los resultados, no podemos confirmar una asociación positiva entre AAAy HI; por lo tanto, con los datos presentes, no se puede justificar el cribado selectivo de pacientes con HI para la detecciónprecoz de AAA

Introduction. Early detection of abdominal aortic aneurysms is broadly accepted as a prominent issue toreduce the high morbimortality rates results from ruptured AAAs, especially in high-risk population. Aim. To estimatewhether inguinal hernia (IH) must be considered as a risk factor for the development of an abdominal aortic aneurysm(AAA). Subjects and methods. A multi centric, prospective case-control study was designed. 291 patients suffering fromIH expecting surgical repair were compared with 459 controls. We seek to evaluate the association between AAA and IH.AAA is defined by a maximum aortic diameter of 30 mm or more measured by ultrasonography. All male aged 50-yearsoldor older subjects were recruited from a single population. Results. An overall 750 abdominal duplex-scans wereperformed. We found a similar prevalence of AAA in both groups: 3.8 % for the hernia group and 3.5 % for the controls.Conclusion. According to the results, we can not confirm a positive association between AAA and IH. Thus, present datado not support selective screening in patients with IH for an early AAA detection

Documento base sobre el tratamiento de la estenosis carotídea con stent / Core document about the treatment of carotid stenosis with stenting

Introducción. El tratamiento quirúrgico de la estenosis carotídea ha suscitado, desde sus inicios, gran número de estudios internacionales, que cuestionaban su indicación, beneficios, etc.; pero, cuando las cosas parecían en calma, las nuevas tecnologías endovasculares vuelven a introducir el dilema, hasta plantear el tratamiento endovascular como una alternativa a la endarterectomía. Objetivo. Presentar el estado actual del conocimiento para que sirva de punto de partida a futuras guías en el diagnóstico y tratamiento de esta patología lesional. Desarrollo. Se comentan las distintas exploraciones diagnósticas, desde la ecografía Doppler, la tomografía axial computarizada y la angiotomografía, la resonancia magnética y la angiorresonancia, la angiografía de los troncos supraaórticos, discutiendo sus ventajas e inconvenientes para el diagnóstico. La indicación del stenting carotídeo se evalúa teniendo en cuenta el riesgo anatómico para la endarterectomía, los riesgos de alto riesgo médico para la cirugía y los riesgos de tipo técnico para la endarterectomía. También se comentan las contraindicaciones del stenting. Se describen de forma bastante extensa y precisa las distintas técnicas actuales de angioplastia y stenting, comentando los accesos, los tipos de materiales para cada una de ellas, capítulo este muy completo. Los sistemas de protección cerebral también se describen comenzando por la oclusión distal hasta los sistemas de flujo inverso hacia un shunt arteriovenoso. Se describen las complicaciones inmediatas (trombosis, embolismo cerebral, disección, hemorragia, vasoespasmo, etc.), así como las complicaciones tardías, destacando la reestenosis y las maneras de prevenirla. Conclusión. El documento base es el punto de partida a raíz de los acontecimientos y conocimientos actuales para poder contar en el futuro con más evidencias que conviertan este documento en una auténtica guía

Introduction. From its early days, the surgical treatment of carotid stenosis has given rise to a large number of international studies that have questioned its indication, benefits, and so forth; yet, when things seemed to have calmed down, the new endovascular technologies have revived the dilemma, to the point where endovascular treatment is proposed as an alternative to endarterectomy. Aim. To outline the present state of the art as a starting point for future guidelines in the diagnosis and treatment of this lesional pathology. Development. The article considers the different diagnostic examinations, from Doppler ultrasound, computerised axial tomography and tomography angiography, magnetic resonance imaging and MR angiography, to angiography of the supra-aortic trunks; at the same time, their advantages and disadvantages for use in diagnosis are also discussed. The indication for carotid stenting is assessed taking into account the anatomical risk involved in endarterectomies, the high medical risk for surgery and the risks of a technical nature deriving from endarterectomies. The contraindications of stenting are also discussed. The different angioplasty and stenting techniques that are currently used are described at length in this comprehensive chapter, with detailed information about accesses and the types of materials for each kind of procedure. Cerebral protection systems are also described, these ranging from distal occlusion to systems of reverse flow towards an arteriovenous shunt. Immediate complications (thrombosis, cerebral embolism, dissection, haemorrhage, vasospasm, etc.) are described, as are late complications, with special attention given to restenosis and ways of preventing it. Conclusions. The core document is the starting point based on current knowledge and events that will allow us to use more evidence to make this document a real guide in the future

Thrombosed aneurysm of the infrarenal vena cava: diagnosis and treatment.

Aneurysms of the inferior vena cava are rare. Usually they are diagnosed incidentally or due to the patient having suffered thromboembolic complications. We report one case of a patient admitted due to deep vein thrombosis of his left lower limb in whom a thrombosed mass of the infrarenal vena cava and of both proximal common iliac veins was detected by duplex, CT scan and MRI. The additional information obtained by the phlebography showed abundant collateral circulation via ascending lumbar veins, suggesting gradual occlusion rather than sudden thrombosis. Guided biopsy was not contemplated and the patient underwent surgery with a diagnosis of thrombosis of the infrarenal vena cava due to suspected malignancy versus aneurysm. Intraoperative anatomopathological examination revealed no evidence of malignancy and partial resection with infrarenal vena cava ligation was performed. After six months the patient remains well under oral anticoagulation. On the basis of the literature and taking into account this case, the management of aneurysms of the inferior vena cava when they have already suffered thrombosis should include open surgery which allows us to make the diagnosis with certainty and treatment of the patient.

Operative results and death predictors for nonruptured abdominal aortic aneurysms in the elderly.

Elective repair of abdominal aortic aneurysms (AAA) in the elderly has conventionally been associated with higher mortality rates than in younger patients, although some authors do not agree with this view. The aim of this study is to look into current results of surgical treatment in elderly patients with nonruptured AAA and to define those factors associated with an increased mortality. Over a period of 2 years (1995-1996), 183 patients aged 75 or older were operated on for nonruptured AAA in 21 hospitals. Their medical records were reviewed and those factors that could be related to death were analyzed. Those variables with statistical significance through univariate analysis were entered into a multivariate logistic regression model to predict mortality. The results showed that surgery for nonruptured AAA in the elderly has a greater mortality rate than that in younger patients, but it is not so great as to deny surgical correction to prevent rupture in selected cases, especially if they are unsuitable for endovascular repair. These patients must first undergo thorough cardiac and renal function evaluation. Selective screening must be considered, so earlier detection and treatment in younger patients can be performed.

Knitted dacron grafts used for abdominal aortic reconstruction: sizing references.

This study was undertaken to analyze immediate and mid-term knitted Dacron graft dilation and to establish which parameters should be taken as a reference when aortic graft dilation is evaluated. A Dacron knitted microvel double velour vascular graft (Hemashield Gold) was implanted in 30 patients with aneurysmal (19 cases, 63%) or occlusive (11 cases, 37%) aortic disease. The stems of bifurcated prostheses (27 patients, 90%) and tube grafts (3 patients, 10%) were measured. The package sizing (labelled size) was compared with the external diameter measured intraoperatively with a slide caliper, prior to implantation and after complete clamp release. Additional measurements were obtained by ultrasound 1 and 6 months after implantation, and in 16 cases (53% of the patients) ultrasound and computed tomography (CT) were performed at the end of the first year. The means of the measurements were compared using Student's t test for matched pairs. The statistical significance level was set at p values < 0.05. There was a statistically significant difference between the package sizing (15.3 +/- 1.1 mm) and the external diameter measured prior to implantation (18.7 +/- 1.3 mm); and with the external diameter following implantation (19.6 +/- 1.4 mm), (p < 0.01). External diameters measured prior to grafting and following implantation (after complete clamp release), when compared with the manufacturer's size, showed a mean increase in graft diameter of 3.4 mm (22%) and 4.3 mm (28%), respectively. There were no statistical differences between the external diameter measured after clamp release (19.6 +/- 1.4 mm) and the size determined by ultrasound 4 weeks (19.3 +/- 1.2 mm) and 6 months (19.8 +/- 1.5 mm) following surgery (p values 0.11 and 0.56, respectively). Considering size after clamp release as a reference (19.6 +/- 1.4 mm), an almost significant (p = 0.08) increase in the diameter (0.7 +/- 1.5 mm) was obtained at the end of the first year when the measurement was performed with ultrasound. However, when the measurement was performed by CT at the end of the first year, the differences (0.9 +/- 1.6 mm) revealed statistical relevance (p = 0.04). There was no statistically significant difference between the sizes obtained by ultrasound (20.3 +/- 2.1 mm) and by CT (20.5 +/- 2.2 mm) at the end of the first year (p values 0.07). The package sizing is not a reliable parameter for choosing the size of knitted Dacron grafts. Immediate increase in diameter noted in Dacron grafts is caused by discrepancies between the package sizing and the measured diameter after clamp release during implantation, and by an initial adaptation of the textile structure. This must be taken into account for an accurate investigation of the immediate graft dilation rate, and if further follow-up is contemplated, a measurement to be taken as a reference should be performed by ultrasound or CT in the immediate postoperative period.

Factors increasing the mortality rate for patients with ruptured abdominal aortic aneurysms.

The objective of this report was to analyze the current surgical results of operative treatment in patients suffering ruptured AAA (abdominal aortic aneurysms) and to define those independent predictive factors for mortality. During a period of 2 years, from January 1996 to December 1997, 144 patients operated on for ruptured AAA in 10 hospitals were included in a multicenter retrospective study. Among the collected variables concerning each patient, those with potential relation to surgical mortality were studied: gender, age, diabetes, hypertension, cardiopathy, pulmonary obstructive disease, preoperative renal dysfunction, symptomatic cerebrovascular disease, peripheral vascular disease, hematocrit on admission, preoperative hypotension < 80 mmHg, loss of consciousness, cardiac arrest, aortic aneurysm location (infrarenal versus non-infrarenal), iliac involvement, aneurysm size, type of rupture, left renal vein ligature, ligature of a patent inferior mesenteric artery, place of aortic cross-clamping, type of grafting, exclusion of both hypogastric arteries, venous technical complications, associated surgery, use of cell saver, intraoperative blood loss, and postoperative complications (renal failure, sepsis, coagulopathy, cardiac complications, pulmonary complications, colon ischemia, prosthetic graft complications, and need for reoperation). Those variables with statistical significance in the univariate analysis were introduced into a multivariate logistic regression model to determine the independent predictors of death. From our results we concluded that surgery for ruptured abdominal aortic aneurysms continues to have an excessively high mortality rate. Even though some preoperative variables could be identified as predictors of mortality, an absolute mortality risk has not yet been determined and the decision to negate surgery should be individualized rather than taken on that basis only. Early diagnosis and treatment of symptomatic aneurysms would improve mortality figures and selective screening should be contemplated.

[Use of specific immunotherapy in the Basic Health Area of Campiña Sur (Moguer-Huelva)]. / Utilización de inmunoterapia específica en la Zona Básica de Salud Campiña Sur (Moguer-Huelva).

OBJECTIVE: To analyse the appropriateness of specific immunotherapy treatment (IT) to indications based on scientific evidence. DESIGN: Cross-sectional, descriptive study. SETTING: Primary care in a health district of about 12,000 inhabitants. PATIENTS: 166 patients for whom IT was prescribed in the period between January 1998 and June 1999 were included. The full evaluation covered 65 patients whose allergy report was available in their clinical records. MEASUREMENTS AND RESULTS: IT prescription was considered adequate in patients with single sensitivity to respiratory allergy or anaphylaxis to insect poison, in whom well-standardised single-component "vaccines" were used. IT was only used adequately in 36.4% of cases (71.4% in asthma, 46.1% in naso-bronchial allergy, and 18.7% in rhinitis). The high prescription of accompanying medication should be highlighted: oral H1 anti-histamines (81.8%), inhaled steroids for asthma (42.4%) and nasal steroids for rhinitis (72.4%). CONCLUSIONS: Use of IT in our health district is poorly suited to the indications based on contrasted scientific evidence. Clinical practice guidelines must be agreed at all care levels so as to improve the quality of care for all allergy patients.