Neoplasia colorrectal: tratamiento de la obstrucción con endoprótesis metálicas autoexpandibles / Colorectal neoplasm: treatment of obstructing with expandable metal stents

Background: Expandable metal stents can be used as a palliative or pre surgical method to decompress obstructing colonic carcinomas. Aim: To assess the effectiveness of these stents in the treatment of obstructive colonic carcinoma. Patients and methods: Expandable metal stents were placed in nine patients with the diagnosis of colorectal carcinoma and with clinical and radiographic signs of intestinal obstruction. Stents were placed under fluoroscopic guidance in nine patients and with endoscopic help in 2. The indications were palliative treatment in 7 and pre surgical decompression in 2 patients. Results: Stent placement was successful in all patients. One patient presented a self limited rectal bleeding after the procedure. Obstruction was relieved in less than 24 hours after the procedure. Conclusion: Expandable metal stent placement is an effective means of relieving intestinal obstruction caused by colorectal carcinoma

Recanalización percutánea de oclusiones crónicas de arterias ilíacas con instalación primaria de stent / Percutaneous revascularization of chronic iliac artery occlusions and primary stent placement

Background: Percutaneous transluminal angioplasty is a well established treatment method for aorto iliac stenoses. However its success is limited in arterial occlusions and vascular stent placement can improve the results. Aim: To assess the effectiveness of percutaneous revascularization with stent placement in patients with chronic iliac artery occlusions. Patients and methods: twenty six patients (18 male) aged 47 to 82 years, with iliac artery occlusions lasting six or more weeks were treated. Fourteen had involvement of common iliac artery, five had involvement of external iliac artery and seven of both. The occluded segment length ranged from 3.5 to 12 cm. According to the Society of Cardiovascular Surgery/International Society for Cardiovascular Surgery classification, 22 patients had category 1 claudication, 10 were in category 2, 12 in category 3 and two in category 4. Results: A technical success was obtained in 23 patients and clinical success in 21. After the intervention, the anklearm index improved from 0.49 ñ 0.12 to 0.88 ñ 0.18 (p < 0.001). Permeability after 12 months of follow up was 81 percent and after 36 months, 65 percent. Four patients had complications; one had a vascular perforation, two had an acute occlusion and one had an asymptomatic distal embolization. All these were solved using endovascular techniques. Conclusions: Percutaneous revascularization with stent placement is a valid alternative to surgery in selected patients with chronic iliac artery occlusion

Tratamiento del aneurisma aórtico abdominal por vía endovascular: experiencia inicial / Endovascular treatment of abdominal aortic aneurysm: initial experience

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

Anglioplastía transluminal percutánea (ATP) y endoprótesis en el tratamiento de estenosis venosas centrales y periféricas, de fístulas arteriovenosas para hemodiálisis crónica / Percutaneous transluminal angioplasty and endoprosthesis in the treatment of the central and peripheral venous stenoses of arteriovenous fistula for chronic hemodialysis

We studied retrospectively 48 patients with arteriovenous fistulae stenoses, that were followed during 24 months. When the fistulography disclosed an stenosis, a percutaneous thrombolysis was done. These procedures were repeated as needed. Twenty four patients had a peripheral vein stenoses, 20 had subclavian vein stenosis and 4 had both veins compromissed. All were dilated with percutaneous transluminal angioplasty. Five stents were installed in the subclavian vein and five in peripheral veins. Two patients required thrombolysis. The procedure was succeful in 96 percent of peripheral lesions and 92 percent of central lesions. There was regression of superior limb edema in 16 of 20 patients. Five patients had an subclavian treated veins remained patent. The use of percutaneous transluminal angioplasty and intravascular stents, maintains long term arteriovenous fistulae permeability and has similar results to surgical procedures

Rol diagnóstico de la combinación tomografía computada - angiografía en lesiones traumáticas de la aorta torácica / Diagnostic role of the combination of computed tomography and angiography in traumatic injury of thoracic aorta

Aim: To assess tha diagnostic value of the combination of computed tomography and angiography in aptients with blunt thoracic trauma and suspicion of aortic injury. Patients and methods: restrospective analysis of six patients, aged 22 to 72 years old, with traumatic thoracic aorta injury secondary to severe trauma, specially car accidents, seen between 1985 and 1994. Results: an early diagnosis was done in 3 patients. One patient, in whom diagnosis was delayed, died before surgery. In 3 cases, CAT scan showed indirect evidence of aortic rupture, consisting in alterations of aortic outline. In other 3 patients, it showed hemomediastinum, associated to a left hemothorax in one case. Angiography confirmed the diagnosis, localized and characterized yhe injury in all patients. Conclusions: the delay in the diagnosis of aortic injury may be fatal. The combination of CAT scan and angiography has a high sensitivity and specificity to localize and characterize lesions of the aorta or its branches or associated organs, essential step for surgical planning. CAT scan restrict the use of angiography, avoiding false negative studies, but cannot be used as the sole diagnostic procedure