COVID-19-Related Aortic Thrombosis: A Report of Four Cases.

COVID-19 may predispose patients to an increased risk of thrombotic complications through various pathophysiological mechanisms. Most of the reports on a high incidence of thrombotic complications are in relation to deep vein thrombosis and pulmonary embolism, while the evidence about arterial thrombosis in patients with COVID-19 is limited. We describe 4 cases of aortic thrombosis and associated ischemic complications in patients with severe SARS-CoV-2 infection.

Lower Expression of Genes Involved in Protection against Oxidative Stress in Symptomatic Carotid Atherosclerosis.

BACKGROUND: Oxidative stress is increased in atherosclerosis, manifested both in blood and tissue (atherosclerotic plaque). We aim at describing the expression of a number of genes related to oxidative stress response in carotid atherosclerotic plaques and their relation to symptomatic state. METHODS: We have studied the messenger RNA expression levels for genes related to oxidative stress in a population of 44 patients undergoing carotid endarterectomy, according to the presence (24 patients) or absence (20 patients) of symptoms. Samples were homogenized, RNA was extracted, and gene expression was measured by quantitative reverse transcription polymerase chain reaction arrays. RESULTS: Data showed a decrease in expression of oxidative stress protective genes in symptomatic patients and increased expression of pro-oxidant genes. Asymptomatic patients maintain higher levels of expression of protective genes in the tissue. CONCLUSIONS: This study establishes a close relationship between symptoms and levels of expression of genes that protect against oxidative stress. We propose the existence of a mechanism that silences these genes, causing a more severe atherosclerotic disease state.

Ultrasound screening for abdominal aortic aneurysm in primary care. / Utilidad de la ecografía en el cribado del aneurisma de aorta abdominal en atención primaria.

INTRODUCTION: Abdominal aortic aneurysm (AAA) constitutes a pathology with high mortality. There is currently no screening program implemented in primary care in Spain. OBJECTIVES: To evaluate the usefulness of ultrasound in the detection of AAA in the at-risk population in primary care. Secondarily, to identify subjects whose vascular risk (VR) should be reclassified and to determine whether AAA is associated with the presence of carotid plaque and other risk factors. MATERIAL AND METHODS: Cross-sectional, descriptive, multicenter, national, descriptive study in primary care. SUBJECTS: A consecutive selection of hypertensive males aged between 65 and 75 who are either smokers or former smokers, or individuals over the age of 50 of both sexes with a family history of AAA. MEASUREMENTS: Diameter of abdominal aorta and iliac arteries; detection of abdominal aortic and carotid atherosclerotic plaque. VR was calculated at the beginning and after testing (SCORE). RESULTS: One hundred and fifty patients were analyzed (age: 68.3±5 years; 89.3% male). Baseline RV was high/very high in 55.3%. AAA was detected in 12 patients (8%; 95% CI: 4-12); aortic ectasia in 13 (8.7%); abdominal aortic plaque in 44% and carotid plaque in 62% of the participants. VR was reclassified in 50% of subjects. The detection of AAA or ectasia was associated with the presence of carotid plaque, current smoking and lipoprotein(a), p<0.01. CONCLUSIONS: The prevalence of AAA in patients with VR is high. Ultrasound in primary care allows detection of AAA and subclinical atherosclerosis and consequently reclassification of the VR, demonstrating its utility in screening for AAA in the at-risk population.

Endovascular management of splenic artery aneurysms.

Visceral aneurysms are rare clinical entities, being the most common in this group of pathology the aneurysms of the splenic artery. Its prevalence is estimated between 0.2 and 9.7%, according to different authors, however the introduction of imaging techniques to assess abdominal pathology have increased the incidental findings of these cases. Once diagnosed, treatment should be considered, when they are larger than 2 cm. in size. Conventional surgery in most cases, together with splenectomy and aneurysm resection is often required. Endovascular procedures emerge as a less aggressive and effective treatment option. Our institutional experience is presented in the treatment of 13 cases of splenic aneurysms, analyzing the profile of the patients, treatments performed and results obtained. This type of therapy and the current literature are also analysed.

Translation and adaptation to Spanish of Aberdeen varicose veins questionnaire.

OBJECTIVE: The purpose of the study is to translate the Aberdeen Varicose Vein Questionnaire (AVVQ) into Spanish and evaluate the feasibility and reliability of the Spanish-translated AVVQ in patients with chronic venous disease. METHODS: Reliability was assessed by test and retest of the Spanish translated AVVQ in a sample of 77 patients. The questionnaires were answered within a 2-week interval. RESULTS: There was a 100% test and retest response. The AVVQ showed 6.5% of missing responses. Cronbach's alpha was 0.71 indicating an adequate level of internal consistency. Spearman's rho showed a significant strong association between test and retest scores (rho = 0.84, p < 0.0001). CONCLUSIONS: The Spanish-translated AVVQ is a reliable tool in our daily clinical practice in order to measure the impact of venous disease in the quality of life.

Treatment of Thoracic Outlet Syndrome Complications Assisted with a Cerebral Embolism Protection Device.

We report a case of a stroke and upper limb ischemia in a 27-year-old female secondary to a right cervical rib and retrograde thromboembolization. Follow-up showed complete patency of the vessels after thrombectomy and internal carotid artery stenting followed by transbrachial embolectomy performed with a cerebral protection device. The cervical rib was surgically removed to prevent additional events.

[Ecodoppler evaluation on the progress of atherosclerotic disease in patients undergoing contralateral carotid endarterectomy]. / Avaliação por ecodoppler da progressão da doença aterosclerótica em pacientes com endarterectomia carotídea contralateral.

PURPOSE: The clinical utility of monitoring by Doppler ultrasound patients undergoing carotid endarterectomy is not clearly established. Our goal is to evaluate by echo-Doppler the progress of contralateral stenosis in a real environment, in order to assess its usefulness. MATERIAL AND METHODS: Retrospective study with Doppler ultrasound monitoring in patients undergoing carotid endarterectomy for a period of 3 years. We included cases with Doppler echography before and at least one post-surgery. We excluded patients with contralateral thrombosis, contralateral stenosis, established surgical indication or prior carotid surgery. Analysis was performed using Kaplan-Meier curves to estimate the rate of patients free of progression and / or surgery, as well as an analysis of risk factors for progression of contralateral stenosis. RESULTS: We included 119 patients (41.2% symptomatic) age 68.3 +/- 8.41 years. The follow-up was 40.5 +/- 23.2 months, with a mean of 2.64 +/- 1.58 scans per patient. The likelihood of progression of contralateral carotid stenosis was estimated at 91, 86, 81 and 79% at one, two, three and four years respectively. The only significant risk factor for progression was the presence of moderate or greater contralateral stenosis (30% or more) at the time of surgery. CONCLUSIONS: The evolution of the contralateral carotid atherosclerosis is relatively common. The degree of stenosis correlates with early progression, the study by echo-Doppler plays an important role in monitoring these patients.

Unilateral Proptosis (Exophthalmos) Caused by Axillary-Subclavian Venous Thrombosis in a Patient with Upper Extremity Arteriovenous Dialysis Fistula.

Arterialization of orbital veins is most often due to dural arteriovenous malformations of the cavernous sinus area. We report an unusual case of unilateral proptosis (exophthalmos) caused by arterialized retrograde venous flow in the external jugular vein and cavernous sinus in a patient with an upper extremity hemodialysis fistula and ipsilateral acute central venous thrombosis. The patient's symptoms improved after surgical closure of the hemodialysis fistula.

Endovascular therapy of ascending thoracic aorta.

We describe the endovascular treatment given to a patient who, after surgery on the ascending thoracic aorta due to acute type A dissection (Bentall's procedure), developed a pseudoaneurysm 12 cm in diameter of the ascending aorta at the brachiocephalic trunk. Firstly, an extra-anatomical carotid-carotid bypass was performed, which was followed by endovascular treatment, excluding the aortic arch from the origin of both coronary arteries to the origin of the left common carotid artery, occluding the brachiocephalic trunk. For accurate placement of the endoprosthesis, the device was released after cardiac arrest with adenosine.

Mortality in patients undergoing open aortoiliac surgery: prognostic value of troponin T in the immediate postoperative period.

BACKGROUND: Patients undergoing open aortoiliac surgery constitute a high-risk subgroup. The aim of this study was to evaluate the relationship between postoperative troponin T (TnT) elevation with the associated postoperative mortality, and mean hospital stay. METHODS: This was a prospective observational study of consecutive patients who underwent open aortoiliac surgery during 2006. TnT levels in the first 72 hours after the operation, immediate mortality, postoperative care unit stay, and total postoperative hospital stay were recorded. Statistical analyses were performed with the program SPSS 14.0; the chi-square test (or the Fisher's exact test) was used for qualitative variables and the Mann-Whitney test for quantitative variables. RESULTS: Of the 65 patients included in the study, postoperative TnT was elevated in 14 (21.5%) patients. No significant differences were found in age, sex, hypertension, dyslipidemia, smoking, diabetes mellitus, ischemic heart disease, heart failure, bronchopathy, or renal failure between groups. Mortality in patients with elevated TnT levels was significantly higher (42% compared with 3.92%; relative risk 10.93 +/- 0.76; p = 0.001). Likewise, their mean postoperative intensive care unit stay was significantly greater (23.21 +/- 6.96 days compared to 2.86 +/- 1.96; p < 0.001). This finding resulted in a significantly longer postoperative hospital stay (32.57 +/- 25.38 days compared with 12.47 +/- 2.21). CONCLUSION: TnT level in the immediate postoperative period is a highly relevant indicator of prognosis in patients undergoing major vascular surgery.

Venous thromboembolism in very elderly patients: findings from a prospective registry (RIETE).

BACKGROUND AND OBJECTIVES: Elderly patients with venous thromboembolism (VTE) have an increased rate of bleeding complications on therapeutic doses of anticoagulant therapy. DESIGN AND METHODS: Using data in RIETE, an international registry of consecutive patients with objectively confirmed, symptomatic acute VTE, we analyzed the clinical characteristics and outcome within 90 days of therapy of all enrolled patients aged > or = 80 years old. RESULTS: Of the 13,011 patients with VTE enrolled in RIETE up tp September 2005, 2890 (22%) were aged > or = 80 years old. During the study period 99 patients (3.4%) aged > or = 80 years, and 212 aged < 80 years (2.1%) had major bleeding events (odds ratio: 1.7; 95% CI: 1.3-2.1). Fatal bleeding occurred in 0.8% and 0.4%, respectively (odds ratio: 2.0; 95% CI: 1.2-3.4). The incidence of recurrent VTE was 2.1% and 2.8%. However, 3.7% of patients > or = 80 years and 1.1% < 80 years died of pulmonary embolism (PE) (odds ratio: 3.6; 95% CI: 2.7-4.7). On multivariate analysis, patients > or = 80 years with symptomatic PE, heart failure, long-term therapy with low-molecular-weight heparin (LMWH) or a vena cava filter had an increased risk of recurrent VTE. Those with recent bleeding, abnormal renal function, use of corticosteroids or long-term therapy with LMWH had an increased risk of major bleeding. INTERPRETATION AND CONCLUSIONS: In patients aged > or = 80 years old the 3.4% incidence of major bleeding exceeded the 2.1% incidence of VTE recurrences. However, the 3.7% incidence of fatal PE outweighed the 0.8% of fatal bleeding. Thus, there seems to be more reason to be concerned about fatal PE than about bleeding in elderly patients with VTE.

[Identifying clinical risk factors in recurrent idiopathic deep venous thrombosis]. / Identificación de factores de riesgo clínicos en la trombosis venosa profunda idiopática recurrente.

BACKGROUND AND OBJECTIVE: Oral anticoagulant therapy for more than 6 months in patients with an episode of idiopathic thromboembolic disease is controversial. The objective was to determine predictive clinical signs that identify patients at increased risk of thromboembolic recurrence after stopping anticoagulant therapy for 6 months after an episode of idiopathic deep vein thrombosis (DVT). PATIENTS AND METHODS: A prospective study which included 306 consecutive patients with a first episode of idiopathic DVT from June 2012 to June 2014. Predictor variables of recurrent thromboembolic disease and episodes of recurrence during follow-up of the patients (28.42 months) were collected. We performed a multivariate analysis to analyze possible predictors (P<.20) and an analysis of Kaplan-Meier to establish mean recurrence-free survival. RESULTS: We identified 91 episodes of residual vein thrombosis on follow-up of the patients (37.5% men and 20.3% women) (OR 1.84; 95% CI 1.25-2.71). In the Cox regression analysis stratified by gender, variables showed significant presence of hyperechoic thrombus (P=.001) in males, and persistence of residual thrombus in women (P=.046). The mean recurrence-free survival was shorter in both groups. CONCLUSIONS: The presence of echogenic thrombus in men and the existence of residual DVT in women were 2 clinical signs associated with increased risk of thromboembolic recurrence after stopping anticoagulant therapy for 6 months after an episode of idiopathic DVT in our study.

Femoral pseudoaneurysms post-cardiac catheterization surgically treated: evolution and prognosis.

OBJECTIVES: To analyze the postoperative complications of patients who have undergone surgical repair of femoral pseudoaneurysm after cardiac catheterization. DESIGN: Prospective study. MATERIALS: Cardiovascular risk factors, related to surgery and cardiac catheterization were collected prospectively in 79 patients from 2003 to 2006 in Valladolid University Hospital. The indications of surgery included necrosis of adjacent soft tissue, rapid growth, infection, bleeding, hemodynamic instability or failure of the percutaneous treatment (US-guided compression and US-guided percutaneous thrombin injection). METHODS: Patient and management related predictors for 30-day outcome were analyzed. RESULTS: Fifty-six patients (56/79, 71%) experienced some type of postoperative complication, the most frequent being the need for a transfusion. Infection (15/79, 19%) and dehiscence of the surgical wound (10/79, 12.7%) were the other two most common complications. The mortality related to the intervention was 3.8% (3/79). The mean hospital stay was 32.5 days (+/-28.4 days). Significant risk factors in logistic regression model were gender (P=0.023, OR=9.66), 70 years old (P=0.049, OR=0.15) and the concurrent use of anticoagulation or antiplatelet therapy after the cardiac catheterization (P=0.005, OR=0.03). CONCLUSION: Patients who undergo surgical treatment of femoral pseudoaneurysm post-cardiac catheterization experience a high postoperative morbidity and hospital stay. Factors such as female gender, age over 70 years and treatment with anticoagulants or antiplatelets increase the postoperative morbidity. A seasonal influence was appreciated, with a higher frequency during the summer period.

Tratamiento endovascular de las arterias distales del miembro inferior / Endovascular treatment of distal lower limb arteries / Tratamento endovascular das artérias distais do membro inferior

La angioplastía es un procedimiento que se ha introducido en el tratamiento de las lesiones oclusivas de los miembros inferiores con resultados prometedores. No obstante, son importantes los nuevos aportes de datos sobre los resultados obtenidos, teniendo en cuenta la falta de homogeneidad de los pacientes tratados afectados por diferentes procesos obstructivos arteriales, tratados en diferentes situaciones clínicas y con una muy variada extensión de las lesiones. Se realiza un análisis de 239 casos incluidos en un estudio prospectivo con el objetivo de analizar los resultados en relación a los diversos factores que afectan a los pacientes. Se analizan los resultados y se valoran los mismos.

A angioplastia é um procedimento que foi introduzido no tratamento das lesões oclusivas dos membros inferiores com resultados prometedores. Entretanto, são importantes as novas contribuições de dados sobre os resultados obtidos, levando em consideração a falta de homogeneidade dos pacientes tratados afetados por diferentes processos obstrutivos arteriais, tratados em diferentes situações clínicas e com uma muito variada extensão das lesões. Realiza-se uma análise de 239 casos incluídos em um estudo prospectivo com o objetivo de analisar os resultados com relação aos diversos fatores que afetam os pacientes. Analisam-se os resultados e se valorizam os mesmos.

Angioplasty is a procedure that has been introduced with promising results in the treatment of occlusive lesions of the lower limbs. However, it is necessary further input of data on the results obtained taking into account the lack of homogeneity of patients suffering from obstructive arterial different processes, treated in different clinical situations and with a very wide extent of the injury. An analysis of 239 cases in a prospective study to analyze the results in relation to the various factors that affect patients. The results are analyzed and valued the same.