Aortic polyaneurysmal disease: case report.

We report a 78-year-old man who presents progression of his aneurysmatic pathology with previous abdominal infrarenal aortic surgery 20 years later. The computed tomography (CT) scan showed proximal degeneration of the infrarenal aorta, left iliac aneurysm and a new descending thoracic aneurysm close to the aortic arch. The surgical treatment was staged in two times due to the evolution of the aneurysm measures. First, the thoracic and the infrarenal aneurysms were covered each one with endoprosthesis. Four years later the iliac disease was solved with a branched specific iliac endograft.

Usefulness of aneurysm sac angiography in therapeutic management of an endoleak after endovascular aneurysm repair.

Endoleak treatment after endovascular aneurysm repair (EVAR) can be difficult and complex. The key to success lies mostly in the accurate interpretation of imaging tests. We describe the case of a patient who was urgently operated on due to an episode of acute arterial ischemia in the left lower limb for stent-graft iliac limb thrombosis and a proximal type I endoleak. We highlight the importance of performing aneurysm sac angiography as part of an effective therapeutic strategy.

Duplex mapping of 2036 primary varicose veins.

OBJECTIVE: To produce a comprehensive anatomical and hemodynamic ultrasound scan mapping of the whole limb in patients with primary varicose veins (VVs). DESIGN: An analysis of venous duplex scans performed on patients referred for treatment of primary VVs. METHODS: A total of 2036 limbs were evaluated, looking for the origin of VVs in the saphenous systems and in the perforating vein (PV) systems, as well as for the presence of non-saphenous reflux. RESULTS: The sapheno-femoral junction (SFJ) of the great saphenous vein (GSV) was involved in 1330 limbs (65.3%). We have noted that finding reflux in the groin does not imply that it originates at that point necessarily, as reflux from the pelvis or abdominal wall can also cause primary VVs (SFJ reflux, 41.9% and competent SFJ with reflux from proximal veins, 35.4%). We also noted that analyzing only the presence of reflux in the SFJ of the GSV would miss 10.9% of limbs of reflux in the SFJ of the anterior accessory GSV. In 237 limbs (11.6%), reflux was observed in the popliteal fossa. In the PV system, we distinguished those PVs with retrograde flow that acted as an origin of the VVs, and other PVs that acted as re-entry points. Based on this difference, the location identified as the most frequent origin of VVs in the PV system was the thigh, specifically in the group of PVs of the medial thigh of the femoral canal, with 85 PVs with a total of 238 incompetent PVs identified. Pure non-saphenous reflux was observed in 162 limbs (8%). CONCLUSION: The assumption that the origin of VVs would be exclusively in the sapheno-femoral or sapheno-popliteal junction, is a mistaken attitude and a comprehensive duplex scan mapping is recommended.

Aneurisma toracoabdominal tipo IV: tratamiento mediante una prótesis multirrama y perfusión visceral continua / Type IV thoracoabdominal aneurysms: their treatment by means of a multibranched stent-graft and continuous visceral perfusion

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Pseudoaneurismas de la arteria glútea superior. A propósito de un caso y revisión de la bibliografía / Pseudoaneurysms of the superior gluteal artery. A case report and review of the literature

Introducción. Los aneurismas, verdaderos o falsos, de la arteria glútea superior e inferior son muy raros, y la mayoría se relaciona con traumatismos pélvicos o heridas penetrantes en la región glútea. Caso clínico. Varón de 70 años con una fístula persistente en la región glútea derecha de seis meses de evolución tras el drenaje de un absceso glúteo. La resonancia magnética informa de la existencia de un aneurisma de la arteria ilíaca interna derecha. Con este diagnóstico, es remitido a nuestro Servicio de Angiología y Cirugía Vascular donde, mediante una angiotomografía computarizada (angio-TC), se objetiva la presencia de un pseudoaneurisma dependiente de la arteria glútea superior derecha. Durante el estudio arteriográfico se decide realizar un tratamiento endovascular con embolización intraarterial selectiva de la arteria glútea superior, para conseguir la trombosis-exclusión del aneurisma. En la angio-TC de control de los tres meses se observa la trombosis del pseudoaneurisma y en la angio-TC de control a los nueve meses se constata una reducción de su tamaño. Conclusión. Se discute la incidencia, las formas de presentación y la estrategia quirúrgica de esta patología infrecuente y se revisa la bibliografía actual

Introduction. Aneurysms, either true or false, of the superior and inferior gluteal artery are very rare and most of the cases that are seen are related to traumatic injury to the pelvis or stab wounds in the gluteal region. Case report. A 70-year-old male who had had a persistent fistula in the right-hand gluteal region for six months following the drainage of a gluteal abscess. Magnetic resonance imaging showed the existence of an aneurysm in the right internal iliac artery. With this diagnosis, the patient was referred to our Angiology and Vascular Surgery Service, where a pseudoaneurysm was detected in the right superior gluteal artery by means of computerised tomographic angiography (CT-angiography). During the arteriographic study it was decided that endovascular treatment with selective intraarterial embolisation of the superior gluteal artery should be carried out in order to achieve thrombosis-exclusion of the aneurysm. Thrombosis of the pseudoaneurysm was observed in the follow-up CT-angiography carried out at three months and the follow-up CT-angiography study performed at nine months showed that it had got smaller. Conclusions. The incidence, presenting symptoms and surgical strategy of this infrequent pathology are discussed and the current literature on the subject is reviewed

Insuficiencia venosa superficial de miembros inferiores. ¿Cuál es el punto de fuga? / Superficial venous insufficiency in the lower limbs. Where is the leakage point?

La causa más frecuente de varices es el reflujo en el confluente safenofemoral, pero no es la única. La correcta identificación preoperatoria de los puntos de fuga (PF) parece básica a la hora de plantear una correcta indicación quirúrgica. Objetivo. Identificar los diferentes PF en los pacientes enviados por varices primarias no evolucionadas. Pacientes y métodos. Durante el año 2003 se realizó un eco-Doppler (ED) venoso a todos los pacientes incluidos en el estudio. La exploración se llevó a cabo en bipedestación, sobre la extremidad de mayor relevancia clínica, mediante las maniobras de compresión-relajación, Valsalva y Paraná. Los resultados se almacenaron en una base de datos informática y en una cartografía hemodinámica. Resultados. Se objetivó reflujo safeno en 95 pacientes y no safeno en 5. El flujo retrógrado afectó a la safena interna en 87 pacientes y en 12 a la externa. Sólo el 71% de los flujos retrógrados de la interna fueron ostiales puros, presentando 30 pacientes un PF diferente a los cayados de safena, ya fuese aislado o asociado a éste. Conclusión. En un porcentaje no despreciable de pacientes el PF no se sitúa en los cayados safenianos, o existe más de uno, por lo que la cirugía no guiada por ED podría conllevar un inadecuado tratamiento y contribuir a la elevación de la tasa de recidivas

The origin of varicose veins most often lies in the backflow that occurs in the saphenofemoral junction, but it is not the only cause. Correct preoperative identification of the leakage points (LP) is essential when it comes to designing the right surgical approach. AIMS. The aim of this study was to identify the different LP in patients referred because of undeveloped primary varicose veins. PATIENTS AND METHODS. Throughout the year 2003 all the patients included in the study were submitted to venous Doppler ultrasound recording (DU). The examination (of the clinically more affected limb) was performed while patients were standing, using the compression-relaxation, Valsalva and Paraná manoeuvres. Results were saved in a computer database and in a blood map. RESULTS. Saphenous backflow was observed in 95 patients and in 5 of them it was non-saphenous. Backflow affected the great saphenous vein in 87 patients and in 12 of them it involved the small saphenous vein. Only 71% of the backflows in the great saphenous vein were purely ostial, and 30 patients presented an LP other than the saphenous arches, some being isolated while others were associated to it. CONCLUSIONS. In a fairly important number of patients, the LP is not situated in the saphenous arches, or there are more than one, and therefore surgery that is not guided by DU could lead to unsuitable treatment and contribute to an increase in the rates of relapses