Monitoring the practice of vascular surgery: findings from a national registry (1996-2011).

BACKGROUND: The goal of this article is to present for the first time to the international community the detailed findings and outcomes of the Spanish Vascular Registry (SVR) after 16 years of experience. METHODS: We examined the nationwide registry promoted by the Spanish Society of Angiology and Vascular Surgery (1996-2011). The changes in vascular surgical activity in Spain during the period of study were examined. We evaluated the number of services, medical specialists, consultations, admissions, and operations that occurred in Spain. We also assessed the trends in therapeutic activity and the medical and social impact of vascular pathology. RESULTS: A mean of 60 centers (range = 32-83) participated in the SVR (79.3 % of the total). In the last year of the study period, 94.3 % centers (100 % of teaching centers) participated. The mean number of activities per hospital per year was 5,298 consultations, 2,625 vascular explorations, 630 hospital admissions (61 % elective and 31 % emergency), and 742 surgical procedures. A total of 29,289 carotid stenosis procedures had been registered over 16 years. Both carotid endarterectomy (CEA) and carotid artery stenting (CAS) procedures have increased in frequency over time. In 2011, CAS constituted 19.3 % of all carotid procedures. A total of 31,703 abdominal aortic aneurysm (AAA) operations were registered during the study period. Surgery for ruptured AAA remained stable over time. Since its appearance in the year 2000, endovascular treatment (EVAR) increased steadily over time. Currently, EVAR represents about half of all AAA surgery (50.2 %). The total rate of in-hospital operative deaths was 1.1 %, but in-hospital mortality for open arterial surgery was 4 %. Mortality has decreased of late. CONCLUSIONS: The SVR has enabled us to understand the development and implementation of vascular surgery throughout Spain and to note the increased healthcare activity and the better overall results obtained as a consequence.

Estudio mediante linfogammagrafía isotópica del edema postquirúrgico tras cirugía del sector fémoro-poplíteo / Lymphoscintigraphy study of oedema after femoropopliteal segment surgery

Introducción: El edema postcirugía del sector femoropoplíteo es una complicación frecuente, no relacionada con la gravedad de los síntomas previos ni con los cambios en la PA distal posterior. El objetivo del estudio es evaluar si el edema observado en los pacientes intervenidos de bypass femoropoplíteo es de causa linfática, y la posible influencia del tipo de prótesis utilizada y del tipo de intervención. Pacientes y métodos: Estudio analítico observacional de casos control con 30 pacientes intervenidos de bypass femoropoplíteo. Se ha realizado linfogammagrafía isotópica del sistema linfático superficial y profundo de ambas extremidades en todos los pacientes seleccionados para el estudio. Resultados: Se utilizó vena safena en 19 pacientes y PTFE en 11. Quince pacientes fueron controles (sin edema) y 15 casos (con edema). Tipo de cirugía: 9 reconstrucciones a primera porción de poplítea (1.a p.p.), 18 a tercera porción de poplítea (3.a p.p.) y 3 a ramas distales. Hallazgos gammagráficos: en las 30 exploraciones se observó asimetría del drenaje linfático entre las 2 extremidades, excepto en 1 caso (que no presentó edema). En 5 no había drenaje linfático (uno desarrolló edema). Se compararon casos con controles y pacientes con injerto autólogo y sintético, así como derivaciones por encima y por debajo de la rodilla. La única significación estadística que se obtuvo fue que estos últimos desarrollaron edema con mayor frecuencia que los practicados proximalmente a la rodilla. Conclusión: Por tanto los hallazgos linfogammagráficos no apuntan al daño linfático como causa del edema postcirugía femoropoplítea. Tampoco el material utilizado parece tener influencia. Las derivaciones infrageniculares sufren más edema que las suprageniculares (AU)

Introduction: Post-surgical oedema of the femoropopliteal segment is a frequent complication, unrelated to the severity of the previous symptoms or changes in subsequent distal arterial pressure. The aim of the study is to assess whether the oedema present in femoropopliteal bypass patients is of lymphatic origin, and the possible influence of the prosthesis and the type of intervention used. Patients and methods: An analytical, observational and case-control study of 30 patients who had a femoropopliteal bypass. Isotopic lymphoscintigraphy of the superficial and deep lymphatic system was performed on both limbs in all patients selected for the study. Results: The saphenous vein was used in 19 patients and PTFE in 11. The patients were divided into controls, 15 without oedema, and cases, 15 with oedema. Surgery technique: 9 reconstructions of the popliteal portion (1st p.p.), 18 third popliteal portion (3rd p.p.), and 3 distal branches. Scintigraphy findings: Asymmetric lymphatic drainage between the 2 limbs was observed in the all 30 examinations, except 1 case (which did not have oedema). There was no lymphatic drainage in 5 cases (one developed oedema). Cases with controls and patients with an autologous or synthetic graft, as well as shunts above and below the knee, were compared. The only statistical difference obtained was that the latter developed oedema more often than those performed close to the knee. Conclusions: Therefore, the scintigraphy findings did not point to lymphatic damage as a cause of post-femoropopliteal surgery oedema. The material used did not appear to influence this. The below-knee shunts suffered more oedema than those above the knee (AU)

[Lymphoscintigraphy study of oedema after femoropopliteal segment surgery]. / Estudio mediante linfogammagrafía isotópica del edema postquirúrgico tras cirugía del sector fémoro-poplíteo.

INTRODUCTION: Post-surgical oedema of the femoropopliteal segment is a frequent complication, unrelated to the severity of the previous symptoms or changes in subsequent distal arterial pressure. The aim of the study is to assess whether the oedema present in femoropopliteal bypass patients is of lymphatic origin, and the possible influence of the prosthesis and the type of intervention used. PATIENTS AND METHODS: An analytical, observational and case-control study of 30 patients who had a femoropopliteal bypass. Isotopic lymphoscintigraphy of the superficial and deep lymphatic system was performed on both limbs in all patients selected for the study. RESULTS: The saphenous vein was used in 19 patients and PTFE in 11. The patients were divided into controls, 15 without oedema, and cases, 15 with oedema. Surgery technique: 9 reconstructions of the popliteal portion (1st p.p.), 18 third popliteal portion (3rd p.p.), and 3 distal branches. Scintigraphy findings: Asymmetric lymphatic drainage between the 2 limbs was observed in the all 30 examinations, except 1 case (which did not have oedema). There was no lymphatic drainage in 5 cases (one developed oedema). Cases with controls and patients with an autologous or synthetic graft, as well as shunts above and below the knee, were compared. The only statistical difference obtained was that the latter developed oedema more often than those performed close to the knee. CONCLUSIONS: Therefore, the scintigraphy findings did not point to lymphatic damage as a cause of post-femoropopliteal surgery oedema. The material used did not appear to influence this. The below-knee shunts suffered more oedema than those above the knee.