Outcomes After Vascular Surgery Procedures in Patients with COVID-19 Infection: A National Multicenter Cohort Study (COVID-VAS).

OBJECTIVES: To analyze the outcome of vascular procedures performed in patients with COVID-19 infection during the 2020 pandemic. METHODS: This is a multicenter, prospective observational cohort study. We analyzed data from 75 patients with COVID-19 infection undergoing vascular surgery procedures in 17 hospitals across Spain and Andorra between March and May 2020. The primary end point was 30-day mortality. Clinical Trials registry number NCT04333693. RESULTS: The mean age was 70.9 (45-94) and 58 (77.0%) patients were male. Around 70.7% had postoperative complications, 36.0% of patients experienced respiratory failure, 22.7% acute renal failure, and 22.7% acute respiratory distress syndrome (ARDS). All-cause 30-days mortality rate was 37.3%. Multivariate analysis identified age >65 years (P = 0.009), American Society of Anesthesiologists (ASA) classification IV (P = 0.004), preoperative lymphocyte count <0.6 (×109/L) (P = 0.001) and lactate dehydrogenase (LDH) >500 (UI/L) (P = 0.004), need for invasive ventilation (P = 0.043), postoperative acute renal failure (P = 0.001), ARDS (P = 0.003) and major amputation (P = 0.009) as independent variables associated with mortality. Preoperative coma (P = 0.001), quick Sepsis Related Organ Failure Assessment (qSOFA) score ≥2 (P = 0.043), lymphocytes <0.6 (×109/L) (P = 0.019) leucocytes >11.5 (×109/L) (P = 0.007) and serum ferritin >1800 mg/dL (P = 0.004), bilateral lung infiltrates on thorax computed tomography (P = 0.025), and postoperative acute renal failure (P = 0.009) increased the risk of postoperative ARDS. qSOFA score ≥2 was the only risk factor associated with postoperative sepsis (P = 0.041). CONCLUSIONS: Patients with COVID-19 infection undergoing vascular surgery procedures showed poor 30-days survival. Age >65 years, preoperative lymphocytes <0.6 (x109/L) and LDH >500 (UI/L), and postoperative acute renal failure, ARDS and need for major amputation were identified as prognostic factors of 30-days mortality.

Acute iliac artery thrombosis and pulsatile femoral and popliteal veins in the same extremity: a case report.

Systemic venous pressure is elevated in right heart failure, and this elevation may be reflected in pulsatile venous flow when there is significant tricuspid regurgitation. The presence of this systolic reversed flow in the femoral and popliteal veins may result in major difficulties for diagnosis and treatment. We report the case of a patient with signs and symptoms of acute ischemia of the right lower limb with palpable pulse in the groin and popliteal fossa. Tricuspid regurgitation was suspected by clinical examination, and Doppler ultrasonographic examination of the extremity revealed pulsatile flow in the femoral and popliteal veins while the iliac arterial axis was occluded. A preoperative angiogram revealed an underlying iliac artery thrombosis, which was successfully treated.

Aortoenteric fistula arising as a complication of endovascular treatment of abdominal aortic aneurysm.

Estimates of the incidence of aortoenteric fistula as a sequela of surgery of the aorta range 1-2%. This complication is less common in patients who have had an aortic endograft implanted for aortoiliac aneurysm. We present three cases of aortoenteric fistula complicating endovascular treatment of abdominal aortic aneurysm (3/423 patients, 0.7% in our series).

Leiomiomatosis intravenosa con extensión cardíaca. Caso clínico y revisión de la bibliografía / Intravenous leiomyomatosis with extension into the heart. A case report and review of the literature

Introducción. La leiomiomatosis intravenosa (LIV) es un tumor poco frecuente que puede crecer a través devena cava inferior hasta extenderse a las cavidades cardíacas derechas. Es un tumor originado por las células de músculoliso y normalmente se encuentra confinado al sistema venoso pélvico. Se han descrito no más de 100 casos de LIV,de los cuales, tan sólo 30 presentaban afectación cardíaca. Aunque histológicamente es benigno, la afectación de las cavidadescardíacas derechas puede producir síntomas graves como síncopes y arritmias, y en algunos casos puede llegara producir la muerte súbita. Caso clínico. Mujer de 40 años con extensión cardíaca y que no presentaba síntomas previos.La extensión del tumor se producía tanto por ambas venas ilíacas internas como por la vena ovárica izquierda, algo quetan sólo se había descrito en otros dos casos anteriormente. La escisión quirúrgica se realizó en un único tiempo quirúrgicomediante circulación extracorpórea y abordaje abdominal y torácico. Conclusión. A pesar de ser un tumor poco frecuente,el retraso en la presentación de los síntomas (incluso 20 años) puede infravalorar su incidencia. Dado el gravecuadro clínico que puede provocar, su tratamiento es en todos los casos la extirpación quirúrgica, lo que supone un importantereto para el cirujano vascular. La escasa incidencia de la LIV y el tipo de extensión del tumor en este caso clínicolo hacen realmente excepcional

Introduction. Intravenous leiomyomatosis (IVL) is a rare tumour that may spread along the inferior venacava until it reaches the cavities on the right-hand side of the heart. It is a tumour that has its origins in smooth musclecells and is normally restricted to the pelvic venous system. No more than 100 cases of IVL have been reported, of whichonly 30 presented cardiac involvement. Although histologically it is benign, the involvement of the right cavities of theheart can give rise to severe symptoms such as syncopes and arrhythmias and in some cases it can even lead to suddendeath. Case report. A 40-year-old female with extension to the heart and who had no previous symptoms. The tumourspread along both the internal iliac veins and the left ovarian vein, something which had only previously been reportedin two other cases. Surgical excision was performed in a single session of surgery by means of a heart-lung bypass andusing an abdominal and thoracic approach. Conclusions. Despite being an infrequent tumour, its incidence may beunderestimated due to the fact that its symptoms often appear very late on in the course of the disease (up to 20 years).Given the severe clinical features that it may cause, its treatment always involves surgical removal, which is animportant challenge for the vascular surgeon. The low incidence of IVL and the type of extension of the tumour in thiscase make it truly exceptional

Aneurisma subclavio. Hallazgo casual y tratamiento endovascular / Subclavian aneurysm. A chance finding and endovascular treatment

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