Protocolo diagnóstico y terapéutico de los aneurismas de la aorta torácica / Diagnostic and therapeutic protocol for thoracic aortic aneurysms

Los aneurismas de la aorta torácica presentan una incidencia de 6-10/100 000 habitantes. Esta incidencia está enaumento debido al envejecimiento de la población y a la mayor realización de pruebas de imagen.Generalmente son asintomáticos y su historia natural tiende al crecimiento del aneurisma. A mayor tamaño, másprobabilidad de rotura (con elevada mortalidad). El diagnóstico precoz es difícil (debido a que los pacientes suelenser asintomáticos) y suele ser incidental (por ejemplo, al realizar un TC por otros motivos).El seguimiento de los aneurismas pequeños y el tratamiento quirúrgico programado tienen como objetivo pre-venir la rotura del aneurisma. El tratamiento endovascular, cada vez más perfeccionado, es eficaz y seguro, ya quereduce la morbimortalidad respecto del tratamiento quirúrgico abierto y es el de elección en los aneurismas dela aorta torácica descendente.El presente protocolo se centra fundamentalmente en los aneurismas de la aorta torácica descendente y abdo-minotorácica. Aquellos que afectan a la aorta torácica ascendente y al arco aórtico están dentro del campo de lacirugía cardiaca.(AU)

Thoracic aortic aneurysms have an incidence of 6-10/100,000 inhabitants. Its incidence is increasing due to theaging of the population and the increased performance of imaging tests.They are generally asymptomatic and their natural history tends towards the growth of the aneurysm. The largerthe size, the greater the probability of rupture (with high mortality). Early diagnosis is difficult (since patients aregenerally asymptomatic) and is usually incidental (e.g. a CT for other reasons).Monitoring small aneurysms and scheduled surgical treatment are aimed at preventing the aneurysm from ruptur-ing. Endovascular treatment, which is increasingly being perfected, is effective and safe by reducing morbidity andmortality compared to open surgical treatment, which is the choice for aneurysms of the descending thoracic aorta.This protocol is mainly focused on aneurysms of the descending thoracic aorta and thoraco-abdominal. Those thataffect the ascending thoracic aorta and aortic arch are within the field of cardiac surgery.(AU)

Los anticoagulantes orales directos en el tratamiento de la enfermedad tromboembólica venosa asociada a cáncer. Evidencias y recomendaciones / Direct oral anticoagulants in the treatment of venous thromboembolic disease associated with cancer. Evidence and recommendations

Revisión en PubMed y Medline hasta el 31 de marzo de 2021 buscando la evidencia disponible sobre el tratamiento de la enfermedad tromboembólica venosa (ETV) con anticoagulantes orales directos (AOD) en pacientes con cáncer. Se incluyen 15 ensayos aleatorios y controlados, 26 revisiones sistemáticas y metaanálisis y 6 guías de práctica clínica.En pacientes con cáncer, los AOD como tratamiento (inicial y a largo plazo) de la ETV son una opción eficaz y segura frente a las heparinas de bajo peso molecular (HBPM). El riesgo de ETV recurrente es menor con AOD, sin que aumente significativamente el riesgo de hemorragia mayor. En comparación con la HBPM, el riesgo de hemorragia no es mayor, pero desde un punto de vista clínicamente relevante es superior. El mayor riesgo de hemorragia en pacientes tratados con AOD parece estar relacionado con un exceso de hemorragia digestiva alta. Además del cáncer gastrointestinal, otras características de alto riesgo asociadas a las complicaciones hemorrágicas son el cáncer urotelial, las interacciones medicamentosas y el uso de medicamentos contra el cáncer asociados con la toxicidad gastrointestinal.Por todo ello, los AOD deben usarse con precaución en pacientes con cáncer y alto riesgo de hemorragia. Las preferencias individuales son otro aspecto relevante al indicar AOD.(AU)

A review (PubMed/Medline) is carried out until March 31, 2021, looking for the available evidence on the treatment of venous thromboembolic disease (VTE) with direct oral anticoagulants (DOA) in cancer patients. It includes 15 randomized and controlled trials, 26 systematic reviews and meta-analyzes, and 6 clinical practice guidelines.In cancer patients, DOAs as treatment (initial and long-term) of VTE are an effective and safe option compared to low-molecular-weight heparins (LMWH). The risk of recurrent VTE is lower with DOA, without significantly increasing the risk of major bleeding. Compared with LMWH, the risk of non-major but clinically relevant bleeding is higher. The increased risk of bleeding in patients treated with DOA appears to be related to excess upper gastrointestinal bleeding. In addition to gastrointestinal cancer, other high-risk characteristics associated with bleeding complications are urothelial cancer, drug interactions, and the use of anticancer drugs associated with gastrointestinal toxicity.Therefore, DOAs should be used with caution in cancer patients and high risk of bleeding. Individual preferences are another relevant aspect when indicating DOA.(AU)

Transcaval Access to the Abdominal Aorta: indications of Interest to Surgeons and a Comprehensive Literature Review.

We performed a review of the literature (until August 01, 2019) on the occasion of the first transcaval approach for transcatheter aortic valve implantation in our hospital. This review focuses mainly on the indications of this alternative access route to the aorta. It may be useful for vascular surgeons in selected cases, such as the treatment of endoleaks after endovascular aneurysm repair and thoracic endovascular aneurysm repair. We describe historical aspects of transcaval access to the aorta, experimental studies, available case series and outcomes. Finally, we summarize the most significant technical aspects of this little-known access.

Transcaval access to the abdominal aorta: indications of interest to surgeons and a comprehensive literature review

Abstract We performed a review of the literature (until August 01, 2019) on the occasion of the first transcaval approach for transcatheter aortic valve implantation in our hospital. This review focuses mainly on the indications of this alternative access route to the aorta. It may be useful for vascular surgeons in selected cases, such as the treatment of endoleaks after endovascular aneurysm repair and thoracic endovascular aneurysm repair. We describe historical aspects of transcaval access to the aorta, experimental studies, available case series and outcomes. Finally, we summarize the most significant technical aspects of this little-known access.

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.