Chronic infrarenal aortic occlusion: predictors of surgical outcome in patients undergoing aortobifemoral bypass reconstruction.

AIM: Chronic infrarenal aortic occlusion is relatively infrequent. Aortobifemoral bypass has been the traditional treatment. The aim of this study is to evaluate the prognostic factors related to long-term survival and patency rates of chronic infrarenal aortic occlusion after aortobifemoral bypass. METHODS: From January 1984 to December 2004, we performed consecutively 278 aortobifemoral for aortoiliac occlusive disease. Of these, 67 (24%) patients, 62 men (92.5%), presented with ischemia due to aortic occlusion. The log-Rank test was used to determine predictors of long-term survival and graft patency in a univariate analysis. With a model of proportional-hazards Cox regression the independent prognostic factors of long-term survival were determined. RESULTS: The postoperative mortality was 8.9%. The estimated cumulative long-term survival for aortic occlusion patients was 56% and 38% at 10 and 20 years, respectively. The estimated cumulative primary patency was 79% at 10 years and 40% at 20 years. The 20-year limb survival rate was 86%. There was no statistical difference in long-term survival and graft patency between TASCIC-D and IRAO. Previous coronary disease (P=0.008) and postoperative complications (P=0.017) significantly decreased the survival of patients. Both variables retained significance on multivariable analysis. The presence of chronic renal failure significantly decreased the patency of the aortobifemoral bypass (P=0.013). CONCLUSION: Aortobifemoral bypass for chronic infrarenal aortic occlusion has an excellent primary patency rate with reasonable morbi-mortality. The presence of concomitant coronary disease and postoperative complications are prognostic factors of long-term survival.

Aneurisma de la arteria renal: análisis de un caso / Renal artery aneurysm: a case analysis

Introducción. Los aneurismas de arteria renal (AAR) son poco frecuentes, y se precisa su cribado en mujeres hipertensas y jóvenes, grupo de población donde su incidencia es más alta. Presentamos un caso de una paciente tratada quirúrgicamente con éxito. Caso clínico. Mujer de 49 años con antecedentes de fibromialgia y tuberculosis pleural y pulmonar. En el transcurso de un estudio de protocolo por hipertensión arterial, con exploración física y pruebas complementarias generales normales, se evidenció en la angiografía venosa una imagen sugestiva de aneurisma sacular bilobulado en la trifurcación de arteria renal derecha, que se confirmó con arteriografía renal. Mediante TC abdominal se objetivó un diámetro de 1,5 cm, que en controles posteriores aumentó, y alcanzó 2,2 cm en los últimos 6 meses, por lo que se indicó reparación quirúrgica. Durante la intervención se identificaron dos aneurismas en la trifurcación de la arteria. Se realizó ex situ resección de los dos aneurismas, y reconstrucción arterial con injerto de safena autóloga invertida (tiempo de isquemia fría de 100 minutos). El postoperatorio cursó favorablemente. En la actualidad la paciente está asintomática y sin ninguna complicación. Conclusión. Cuando se objetiva un AAR que requiere tratamiento quirúrgico, la reconstrucción arterial ex vivo es una alternativa válida y recomendable (AU)

[Morbidity and mortality of carotid endarterectomy]. / Morbilidad y mortalidad en la endarterectomía carotídea.

In order to investigate the peroperative complications in carotid surgery, a cohort of 64 patients operated of carotid endarterectomy (EC) were evaluated. A total 78 EC were performed, 56 unilateral (EC-U) and 11 bilateral (EC-B). All the cases were managed in a similar manner regarding surgical technique, monitoring, anesthetic management and pre and postoperative care. A temporary shunt was inserted in 6 cases. The hospital mortality has been 0. We registered the following postoperative complications: arterial hypertension in 23.1 of EC-U and 18.2% of EC-B, cervical hematoma in 5.3% (EC-U) and 13.6% (EC-B), TIA in 5.3% (EC-U) and 4.5% (EC-B), stroke 1.7% (EC-U) and 4.5% (EC-B), vocal cord injury in 3.5% of EC-U and chest pain with angina in 1.7% of EC-U. A review of the mortality and morbidity in carotid surgery is done.