Endovascular Treatment of Descending Thoracic Aortic Pathology: Results of the Regis-TEVAR Study.

BACKGROUND: Endovascular techniques have become an essential tool for treatment of thoracic aortic pathology. The objective of this study was to analyze indications and results of thoracic endovascular aortic repair (TEVAR) in vascular surgery units, through a retrospective and multicentric national registry called Regis-TEVAR. METHODS: From 2012 to 2016, a total of 287 patients from 11 vascular surgery units, treated urgently and electively, were recruited consecutively. The primary variables analyzed are mortality, survival, and reintervention rate. The following indications for TEVAR were also analyzed: aortic dissections, thoracic aneurysms, traumatisms, and intramural hematomas or penetrating ulcers, as well as results and postoperative complications in accordance with each indication. RESULTS: Of the 287 TEVAR performed (239 men, mean age 64.1 ± 14.1 years), 155 were because of aortic aneurysm (54%), 90 because of type B aortic dissection (31.4%), 36 because of traumatic aortic rupture (12.5%), and 6 because of penetrating ulcers or intramural hematomas (2.1%). Overall mortality at 30 days was 11.5% (18.5% in urgent and 5.3% in elective), being higher in dissections (13.3%). The median actuarial survival was 73% at 4 years. The stroke rate was 3.1%, and the rate of spinal cord ischemia was 4.9%. Aortic reoperations were necessary in 23 patients (8.1%). CONCLUSIONS: This registry provides complete and reliable information on real clinical practice of TEVAR in Spain, with results similar to international series of open surgery. In accordance with these data, TEVAR can be performed with acceptable morbidity and mortality and with low rates of postoperative complications.

Recurrent hematuria caused by nutcracker syndrome.

A 26-year-old woman presented to the emergency department complaining of left flank pain, and proteinuria and hematuria were detected during urinalysis. A renal ultrasound did not reveal any disorder, and after performing a computed tomography angiography scan, compression of the left renal vein between the superior mesenteric artery and the aorta was seen. This compression is known as Nutcracker syndrome. From among the different treatment options available, it was decided, with patient consensus, to use open surgical management, performing a transposition of the left renal vein to a more distal level in the inferior vena cava. The immediate postoperative care progressed without complications and the symptoms resolved; after 1 year of surveillance, the patient continues to be asymptomatic. Nutcracker syndrome is a rare phenomenon, with few cases described. There are different therapeutic options for the treatment of Nutcracker syndrome, such as open surgery, endovascular treatment, or conservative treatment; because of the low prevalence of this syndrome, there are no sufficiently large series at present or with the necessary long-term surveillance to decide on the most suitable treatment. Distal transposition of the left renal vein in the inferior cava vein has proved to offer good long-term results, and this option offers a higher chance of resolution without the need for as many postsurgery controls as would be required with endovascular treatment.

Estudio de prevalencia de isquemia crónica de miembros inferiores y de aneurisma de aorta abdominal en mayores de 65 años / A study of the prevalence of chronic ischaemia in the lower limbs and abdominal aortic aneurysms in persons over the age of 65

Introducción. El aumento de la expectativa de vida ha conducido a que patologías vasculares, especialmente prevalentes en el segmento de población con más edad, se hayan constituido en problemas de salud. Objetivo. Determinar la prevalencia de la isquemia crónica (IC) y de los aneurismas de aorta abdominal (AAA) infrarrenal en la población mayor de 65 años del Área Sanitaria V (Gijón) del Servicio de Salud del Principado de Asturias. Pacientes y métodos. Se diseña un estudio descriptivo transversal, incluyendo finalmente 232 pacientes, 114 hombres y 118 mujeres, seleccionados aleatoriamente a partir de los datos de la tarjeta sanitaria. Se les explora, se realiza un eco-Doppler de la aorta abdominal y se calcula el índice tobillo-brazo. Resultados. La prevalencia de la IC es del 9,9% y de un 2,6% para el AAA. Se desagregan los resultados por sexos y dos grupos de edad, de 65-74 años y mayores de 75. La prevalencia de la IC está seis puntos por encima en el grupo de los mayores de 75 años (13,4%) y la del AAA es más de siete veces superior (5,2%). Conclusión. La prevalencia es más elevada en los mayores de 75 años y los varones para la IC y el AAA, con diferencias estadísticamente significativas. Este estudio abre las puertas a un seguimiento de los integrantes de la muestra, que permita determinar la incidencia de las diversas patologías

Introduction. As life expectancy has increased, vascular pathologies, which are especially prevalent in the most elderly segment of the population, have become a health problem. Aim. To determine the prevalence of chronic ischaemia (CI) and infrarenal abdominal aortic aneurysms (AAA) in a population of persons over 65 years of age from Health Care District V (Gijón) of the Principality of Asturias Health Service. Patients and methods. A cross-sectional descriptive study was designed, which finally included 232 patients (114 males and 118 females) who were selected at random from the data contained in their health card. They were examined, submitted to a Doppler ultrasound scan of the abdominal aorta and their ankle-brachial index was calculated. Results. The prevalence of CI was found to be 9.9% and 2.6% for AAA. Results were broken down by sexes and two age groups: 65-74 years and over 75 years of age. The prevalence of CI was six points higher in the group of over 75s (13.4%) and that of AAA was seven times higher (5.2%). Conclusions. For CI and AAA, prevalence was higher in persons over 75 years old and males, with statistically significant differences. This study opens the way to a follow-up of the participants in the sample, which would allow us to determine the incidence of several different pathologies