ABSTRACT
Introducción: La estenosis grave de la arteria carótida es una causa importante de accidente vascular encefálico(AVE) y evento isquémico transitorio (TIA) (10-20 por ciento). La endarterectomía carotídea extracraneana (ECE) ha demostrado ser efectiva en reducir este riesgo en pacientes seleccionados, sintomáticos y asintomáticos. Objetivo: Presentar los resultados de una serie de pacientes sometidos a ECE. Métodos: Serie de 135 ECE en 121 sujetos (84 hombres y 37 mujeres), con mediana de 72,2 +/- 7,7 años, tratados con ECE en el Servicio de Cirugía Vascular del Hospital Dipreca entre enero de 1998 y diciembre de 2004. La operación consistió en endarterectomía carotídea (común e interna) luego de realizar arteriotomía longitudinal amplia y endarterectomía carotídea externa por eversión. En la mayoría de los casos se utilizó shunt y bloqueo anestésico cervical profundo y superficial; en todos se fijó la placa distal y arteriorráfia con parche. Se utilizó estadística descriptiva y se calculó porcentajes, medianas, promedios, desviaciones estándar y supervivencia. Resultados: El déficit neurológico central homolateral postoperatorio fue de 1,5 por ciento. La morbilidad general fue de 12,6 por ciento. No hubo mortalidad perioperatoria. Se obtuvo un 94 por ciento de seguimiento. La causa de muerte más frecuente fue la de origen cardíaco (74 por ciento) y hubo un 4,7 por ciento de eventos neurológicos tardíos (TIA o AVE). La supervivencia libre de re estenosis fue de 92 por ciento. Conclusión: La ECE sigue siendo una alternativa de tratamiento en nuestro Hospital con baja morbimortalidad en sujetos seleccionados con estenosis carotídea sintomática y asintomática.
Background: Critical carotid artery stenosis is an important cause of stroke (CVA) and transient ischemic attack (TIA). Extra cranial endarterectomy (ECE) has proven effective in reducing the risk of these complications in selected patients, both symptomatic and asymptomatic. Aim: To report the results of ECE at Dipreca Hospital in Santiago, Chile. Methods: From January 1998 to December 2004, 135 ECE procedures were performed in 121 patients (84 males and 37 females). Mean age was 72.2 years (SD 7.7). ECE consisted of common and external carotid artery endarterectomy with eversion. In most cases, superficial and deep anesthetic blockade and shunts were utilized. A patch and fixation of distal plaque were performed in all. Results are presented with standard statistics methods. Results: Homolateral postoperative neurologic deficit was observed in 1.5 percent. All cause morbidity was 12.6 percent. There was no perioperative mortality. Follow up data was obtained for 94 percent of patients. Seventy-four percent of late deaths were due to cardiac events and 4.7 percent of patients developed late neurologic events (CVA or TIA). Restenosis free survival was 92 percent. Conclusion: ECE is a safe procedure for patients with both symptomatic and asymptomatic carotid artery stenosis.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Carotid Artery, External/surgery , Endarterectomy, Carotid/adverse effects , Carotid Stenosis/surgery , Carotid Artery, Common/surgery , Cause of Death , Chile/epidemiology , Endarterectomy, Carotid/mortality , Follow-Up Studies , Coronary Restenosis/epidemiology , Survival RateABSTRACT
Background: Thirty day mortality of current surgical treatment of abdominal aortic aneurysm is 0.7 to 5 percent. Coronary artery disease is the main risk factor in this elderly population. An alternative procedure based on the transfemoral deployment of self expandable prostheses to exclude the aneurysm, avoids a laparotomy and major surgical trauma, reducing the risks of the conventional operation. Aim: To report our experience on endovascular repair of abdominal aortic aneurysms. Patients and methods: Nine consecutive patients aged 66 to 82 years old, possible candidates for the procedure, were studied. Results: Only four patients fulfilled the requirements for the procedure, which was technically successful in three. One patient was converted to an open surgical repair. Patients were discharged 72-96 hours after graft implantation. The postoperative CAT scan confirmed total exclusion of the aneurysm by the endovascular graft. All nine patients are alive at the time of this report. Conclusions: Given certain anatomical conditions, endovascular treatment of abdominal aortic aneurysms is an attractive alternative for high risk patients
Subject(s)
Humans , Male , Female , Middle Aged , Blood Vessel Prosthesis , Aortic Aneurysm, Abdominal/surgery , Angiography , Aortic Aneurysm, Abdominal , Clinical Evolution , Blood Vessel Prosthesis Implantation , Patient SelectionABSTRACT
Se presenta una serie prospectiva de 75 pacientes portadores de cáncer de colon derecho operados en el Hospital Clínico de la Universidad de Chile. Se analizan las variables que pueden estar relacionadas con la mortalidad operatoria concluyendo que la indicación de urgencia o cirugía electiva, la preparación de colon y el tipo de cirugía efectuado se asocian significativamente con la tasa de mortalidad observada