Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predict in-hospital mortality in symptomatic but unruptured abdominal aortic aneurysm patients.

BACKGROUND: Symptomatic but unruptured abdominal aortic aneurysm (AAA) is a potentially fatal disease since its etiopathogenesis, involving acute changes in the aortic wall, including inflammation, increasing the probability of impending rupture. The objective of the present study was to assess the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in patients undergoing urgent symptomatic AAA repair. METHODS: This was a retrospective study including 29 patients with symptomatic AAA repaired between 2011 and 2020. Both NLR and PLR were calculated on hospital admission prior to the intervention. The primary end point was in-hospital mortality, and the secondary end point included length of hospital stay and postoperative complications. RESULTS: In-hospital mortality rate was 10.3%. The discriminatory performance to predict the primary end point was very good both for PLR (area under the ROC curve [AUC]: 0.92 (95% confidence interval [CI]: 0.82-1.00; P=0.02) and NLR (AUC: 0.88 [95% CI: 0.75-1.00]; P=0.04). The best cutoff point to predict in-hospital mortality was 185 for PLR (100% sensitivity and 85% specificity) and 6.4 for NLR (100% sensitivity and 77% specificity). The most frequent postoperative complication was acute kidney failure (37.9%). Both elevated PLR as NLR were significantly associated with acute kidney failure and multiorgan failure in the immediate postoperative period (P<0.01). None of the two ratios was associated with length of hospital stay (P=NS). CONCLUSIONS: Both PLR and NLR are low-cost inflammatory markers widely available in every emergency department, with excellent performance to predict in-hospital mortality in patients undergoing symptomatic AAA repair. Patients with a PLR≥185 and/or an NLR≥6.4 could benefit from a "surveyed waiting conduct" improving the preoperative clinical condition prior to the intervention, or even considering endovascular repair.

Novel Common Femoral Artery Lesion Classification in Patients Undergoing Endovascular Revascularization.

PURPOSE: Common femoral artery (CFA) is a critical segment of the lower-limb arterial tree. We sought to propose an extensive classification in order to appraise a diagnostic and therapeutic approach. METHODS: A retrospective cohort of CFA lesions with endovascular therapy was evaluated. We appraised the extension, the degree of stenosis and the calcium burden. A new group "IV" included lesions that started at the external iliac artery or common iliac artery extending into the CFA and affecting its bifurcation. The primary outcome was the need for a retrograde bailout access after failed anterograde access and the procedural time. RESULTS: From 2012 to 2020, a total of 58 lower limbs in patients with CFA lesions were included. New proposed group IV compromised 36% of lesions. Additionally, procedural time was significantly longer in group IV lesions compared with the rest (76.9 ± 32.23 min vs 47.67 ± 17.93 min, p < 0.01), as was the requirement of retrograde bailout access (23.8 vs 2.6%, p = 0.03). Occlusive lesions were associated with longer procedural times and bailout retrograde access compared to stenotic lesions (74.7 ± 33.6 min vs 48.29 ± 16 min, p < 0.001 and 26.1 vs 0%, p = 0.006, respectively), as well as heavy calcification compared to mild or moderate calcification (73.18 ± 28.15 vs 51.86 ± 25.1, p = 0.06 and 29.4 vs 2.4%, p = 0.009, respectively). Secondary clinical outcomes and target lesion revascularization did not differ among groups. CONCLUSIONS: Our classification includes a new group of extensive and frequent lesions, which did not fit in previous classifications.

Symptomatic Iliofemoral and Iliocaval Venous Thrombosis in Patients With Cancer: Endovascular Treatment.

INTRODUCTION:: Proximal (iliocaval and iliofemoral) deep vein thrombosis (DVT) and pulmonary thromboembolism are the second cause of death in patients with cancer. MATERIAL AND METHODS:: A retrospective analysis was performed in 35 patients with cancer treated with endovascular therapy for proximal DVT. The primary objective was to evaluate the technical success of the procedure and the 30-day and long-term symptom improvement. RESULTS:: Thirty-five patients with a mean age of 57.7 years were treated. In 27 patients, DVT was due to tumor compression and/or invasion of the iliocaval venous axis, and in the remaining 8, it was secondary to their hypercoagulability state. The revascularization techniques used were manual catheter-directed aspiration of the thrombus plus angioplasty and stenting. Technical success was achieved in 33 patients. No complications occurred. Twenty-seven patients were followed up at 30 days posttreatment: 21 were free of postthrombotic syndrome, 4 (14.8%) had mild symptoms, and 2 (7.4%) had moderate symptoms. The mean long-term follow-up was 27.3 months, with a primary patency of 68.8% and assisted and secondary patency rates of 100%. CONCLUSION:: Endovascular revascularization in patients with cancer with extensive and symptomatic proximal DVT is safe and efficient, with a low rate of complications. We consider that this therapy should be offered to patients with cancer with an average or long life expectancy.

Endovascular treatment of paravisceral mycotic aneurysm: Chimmeny endovascular sealing the end of de road.

Open surgery is the elective treatment for mycotic aneurysms of the aorta. This surgery consists of resection of the aneurysm, debridement and revascularization with an in situ or extra-anatomic bypass. Even when surgery has been successful, the morbi-mortality is raised and the endovascular treatment has become an alternative for specific patients. When mycotic aneurysms involved the visceral arteries, more complex techniques are necessary such as fenestrated endovascular aortic repair or chimmeny endovascular aortic repair and the most frequent complications of this are endoleaks and oclussion the visceral arteries. We present a case of a pacient with a paravisceral abdominal mycotic aneurysms that was result with 2 chimney technique (in the right renal and superior mesenteric arteries) and a single Nellix EVAS (Endologix, Irvine, Calif) of 12 cm long without evidence of endoleaks in the follow-up.