«Ateroembolismo» paradójico en paciente con síndrome de Paget-Schroetter / Paradoxical «atheromatous embolism» in a patient with Paget-Schroetter syndrome

No disponible

Results of Infrainguinal Bypass in Acute Limb Ischaemia.

OBJECTIVE/BACKGROUND: To assess the outcomes of infrainguinal bypass performed for acute limb ischaemia, as well as the predictors of patency, mortality, and amputation. METHODS: This was a retrospective cohort study of patients undergoing infrainguinal bypass between 1998 and 2014. The cohort was stratified according to the indication for surgery into two groups: group A (acute limb ischaemia) and group B (chronic lower extremity ischaemia). Comparative analysis was performed on comorbidities, surgical technique, and outcomes, as well as prognostic factors in group A. RESULTS: In total, 702 bypasses were performed (group A, n = 107; group B, n = 595). Differences between groups were detected in age (65.9 vs. 70.9 years; p = .03), diabetes (16% vs. 49%; p < .01), renal insufficiency (6% vs. 13%; p = .05), stroke (7% vs. 14%; p = .04), and coronary artery disease (13% vs. 28%; p < .01). Patients with acute limb ischaemia more often required general anaesthesia (47% vs. 12%; p < .01) and a short bypass was more often performed (32% vs. 7%; p < .01). Median follow up was 23 and 24 months for groups A and B, respectively. No differences were found in patency rates at 1, 12, and 24 months between groups, but group B had a higher re-intervention rate during follow up. Primary patency in group A was 84%, 63%, and 58%, and in group B it was 88%, 62%, and 53% at 1, 12, and 24 months, respectively (p = .77). Assisted primary patency in group A was 85%, 72%, and 67%, and in group B it was 90%, 74%, and 66% at 1, 12, and 24 months, respectively (p = .61). Secondary patency in group A was 90%, 78%, and 75%, and in group B it was 94%, 80%, and 74% at 1, 12, and 24 months, respectively (p = .80). The freedom from re-intervention rate in group A was 91%, 74%, and 68%, and in group B it was 92%, 76%, and 71%, respectively (p = .04). Acute limb ischaemia was an independent risk factor for amputation (odds ratio [OR] 4.96, 95% confidence interval [CI] 1.74-14.09; p < .01) and mortality (OR 4.13, 95% CI 1.53-11.14; p = .01) at 30 days. In group A, female sex, prosthetic conduit, and need of distal thrombectomy were independently associated with worse patency rates. Poor intra-operative runoff was correlated with higher amputation rates. CONCLUSION: Among those undergoing infrainguinal bypass, patients who present with acute limb ischaemia constitute a subset showing higher early rates of amputation and death. In this subset of patients, worse outcomes may be expected for women, prosthetic conduits, need for distal thrombectomy, and patients with poor intra-operative runoff.

Evolución de la arteria ilíaca ectásica no tratada tras la reparación endovascular del aneurisma de aorta / Evolution of the untreated ectactic iliac artery after endovascular aortic aneurysm repair

OBJETIVOS: Determinar el crecimiento de la arteria ilíaca común (AIC) ectásica no tratada durante la reparación endovascular del aneurisma aórtico (EVAR), por existir zonas de anclaje proximales más favorables. MATERIAL Y MÉTODOS: Estudio de cohortes retrospectivo, incluyendo pacientes tratados por aneurisma de aorta abdominal de forma electiva, con un seguimiento de 5 años. Se estudiaron los casos con anclaje en AIC, registrando los diámetros máximos basales y a 1, 2, 3, 4 y 5 años en el segmento de AIC no tratado, excluyendo aquellos casos con anclaje en la arteria ilíaca externa. Se analizó la muestra en función de: A) Diámetro basal AIC: grupo 1 (G1) (n = 67): < 16 mm; grupo 2 (G2) (n = 23): ≥16 mm. B) Zona de anclaje: 2/3 proximales de AIC (n = 40); 1/3 distal (n = 50). RESULTADOS: Un total de 56 pacientes incluidos en el estudio, con 90 ilíacas analizadas. A) Los diámetros medios en G1 y G2 (basal, 3, 5 años) fueron: 12,8; 13,1; 13,3 vs. 18,0; 19,4; 20,3 mm, con un crecimiento 1,8 mm mayor a 5 años en G2 (p < 0,001). No se registraron fugas tipo IB durante el seguimiento. B) Existió una interacción significativa (p = 0,01) entre la localización del anclaje y el diámetro basal para el crecimiento ilíaco: en AIC ≥ 16 mm el anclaje en el tercio distal fue protector para crecimiento (p = 0,04). CONCLUSIONES: El crecimiento tras EVAR de la AIC no tratada es mayor en las AIC ectásicas. En estos casos, el anclaje en el tercio distal puede disminuir la tasa de crecimiento. No obstante, si el anclaje es más favorable en los 2/3 proximales de la AIC dicho crecimiento no se traduce en mayor número de complicaciones

OBJECTIVE: To assess the enlargement of ectatic common iliac arteries (CIA) which are not covered during endovascular aortic aneurysm repair (EVAR) due to the existence of more favorable proximal sealing zones. MATERIAL AND METHODS: Patients who underwent elective EVAR, with a 5 year follow up were included in a retrospective cohort study. Only cases with distal sealing zones in CIA were studied, recording a maximum basal diameter at the non-covered segment of CIA, and at 1, 2, 3, 4 and 5 years. Cases with distal sealing on external iliac artery were excluded. The sample was analyzed according to: A) CIA baseline diameter: group 1 (G1) (n = 67): < 16 mm; group 2 (G2) (n = 23): ≥16 mm. B) Sealing zone: proximal two thirds of CIA (n = 40); distal third (n = 50). RESULTS: A total of 56 patients were included in the study, with 90 CIA analyzed. A) Mean diameters in G1 and G2 (baseline, 3, 5 years) were: 12.8, 13.1, 13.3 versus 18.0, 19.4, 20.3 mm, respectively, with a 1.8 mm greater enlargement for G2 (P<.001) at 5 years. No type IB endoleaks were registered during follow up. B) A significant interaction was observed (P=.01) between the distal sealing zone and basal diameter for iliac enlargement: in CIA ≥16 mm distal sealing in the distal third of the CIA was protective for iliac enlargement (P=.04). CONCLUSIONS: Iliac enlargement in non-treated segments of CIA after EVAR is greater in ectatic arteries. In these cases, distal sealing on the distal third of the CIA can decrease enlargement rate. However, if a more favorable zone for sealing exists proximally, the enlargement of the ectatic CIA does not result in a higher rate of complications

Efectos del bosentán sobre la función vascular e inflamación de pacientes diabéticos con enfermedad vascular periférica / Bosentan effects on vascular function and inflammation in diabetic patients with peripheral vascular disease

INTRODUCCIÓN: La endotelina-1 (ET-1) interviene en la regulación del tono vasomotor y remodelado vascular y en la disfunción endotelial. El bloqueante de ET-1, bosentán, podría tener un efecto beneficioso en la enfermedad arterial. OBJETIVO: Analizar la expresión de ET-1, óxido nítrico (NO) e interleucinas 6 y 10 (IL-6, IL-10), en diabéticos con arteriopatía periférica y en controles no diabéticos. Analizar el efecto de bosentán en la expresión de mediadores inflamatorios y en la liberación de NO. PACIENTES: Un total de 3 grupos de sujetos; G1: controles no diabéticos (n = 15), G2: diabéticos con claudicación (n = 15), G3: diabéticos con lesiones tróficas (n = 15). MATERIAL Y MÉTODOS: Análisis de expresión plasmática de ET-1 mediante dot-blot, de concentraciones plasmáticas de IL-6 e IL-10 (kits de ELISA). Capacidad de liberar NO mediante kit de nitratos+nitritos. RESULTADOS: Se observa un aumento de los niveles de ET-1 (G1: 172,9; G2: 277,1; G3: 367,3; p < 0,05, unidades arbitrarias) y un descenso de IL-6 en las formas más avanzadas de la enfermedad (G1: 45,8; G2: 16,4; G3: 9,8; p < 0,05 pg/ml). Bosentán elevó los niveles de IL-6 en el grupo de lesiones tróficas hasta igualarla con el grupo control. Se observó una reducción significativa de la capacidad de liberar NO por los leucocitos en G3 (G1: 16,7; G3: 12; p < 0,05 μmol/L). Este efecto se revirtió significativamente en presencia de bosentán. CONCLUSIONES: Los niveles elevados de ET-1 podrían influir en la progresión de la EAP. En la arteriopatía avanzada parece existir un descenso de la actividad inflamatoria (disminución de IL-6), lo que podría disminuir la vasodilatación (reducción de NO). Bosentán tiene un efecto antagonista sobre estos efectos, fundamentalmente en los estadios más avanzados de la enfermedad

INTRODUCTION: Endothelin-1 (ET-1) is involved in the regulation of vasomotor tone, vascular remodeling, and endothelial dysfunction. The ET-1 blocker, osentan, could have a beneficial effect on vascular disease. OBJECTIVE: To analyze the expression of ET-1, nitric oxide (NO), and interleukins 6 and 10 (IL-6, IL-10), in diabetics with peripheral arterial disease (PAD) and non-diabetic controls. To analyze the effects of bosentan on the expression of inflammatory mediators and the release of NO. PATIENTS: G1: non-diabetic controls (n = 15), G2: diabetic patients with claudication (n = 15), G3: diabetics patients with trophic lesions (n = 15). MATERIAL AND METHODS: Analysis of plasma ET-1 expression by dot-blot, plasma concentrations of IL-6 and IL-10 (ELISA kits). Ability to release NO by nitrate + nitrite kit. RESULTS: Increased levels of ET-1 (G1: 172.9; G2: 277.1; G3: 367.3, P<.05, arbitrary units) and a decrease in IL-6 (G1: 45.8; G2: 16.4; G3: 9.8; P<.05 pg/ml) are observed in the most advanced forms of disease. Bosentan increased levels of IL-6 in the group of trophic lesions when compared with the control group. A significant reduction in the ability of NO release by leukocytes in G3 (G1: 16.7; G3: 12; P<.05 μmol/L) was observed. This effect was significantly reversed in the presence of bosentan. CONCLUSIONS: Elevated levels of ET-1 may influence the progression of PAD. In advanced artery disease, there appears to be a reduction in inflammatory activity (decrease IL-6), which could reduce the vasodilation (NO reduction). Bosentan has an antagonistic effect on these effects, mainly in the more advanced stages of the disease