Off-label use of Proglide percutaneous closure device in iatrogenic arterial catheterizations: Our experience.

INTRODUCTION: Incidental arterial puncture is one of the main complications associated with central venous catheter placement. Manual compression to achieve hemostasis in subclavian and carotid artery punctures is often ineffective because of the anatomical arterial position. Accidental cannulation has traditionally been treated with open surgery or endovascular treatment, but such procedures are not exempt from complications. OBJECTIVES: Report our experience with ultrasound-guided off-label use of Perclose ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA) in patients with iatrogenic arterial cannulation. METHODS: Six unstable patients with accidental arterial catheterization during placement of a central venous catheter: five of them in the subclavian artery and one in the right common carotid artery. Ultrasound-guided percutaneous closure was performed at bedside using a Perclose ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA). RESULTS: All patients underwent duplex ultrasound 6, 12, 24, and 48 h postprocedure, and no complications associated with percutaneous closure (embolism, ischemia, stenosis, or arterial occlusion, bleeding, pseudoaneurysm, etc.) were described. CONCLUSIONS: Accidental artery puncture during central venous catheterization is an uncommon situation but can be effectively managed by using percutaneous vascular closure device. It is a reliable alternative that should be considered as a first-line approach before endovascular or open surgery, specially in patients with unstable conditions in which it is possible to be performed without transfer to an operation room.

Aneurisma de aorta abdominal y cáncer colorrectal sincrónico. ¿Cambios en el tratamiento? / Abdominal aorta aneurysm and synchronous colorectal cancer. Changes in treatment?

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Mycotic Abdominal Aortic Aneurysm Secondary to Septic Embolism of a Thoracic Aorta Graft Infection.

Mycotic aneurysms account for 1% of abdominal aortic aneurysms. There are very few cases published that describe the formation of mycotic aneurysms after septic embolism due to graft infection. We present the first case to our knowledge to be described in the literature of a mycotic aneurysm caused by septic embolism derived from a thoracic aorta graft infection, treated with conventional surgery leading to a successful outcome and evolution.

Similitudes y discrepancias en las características clinicopatológicas de feocromocitomas y paragangliomas / Clinical and pathological similarities and differences between pheochromocytomas and paragangliomas

Objetivo: Comparar características clínicas, principalmente adrenérgicas, de los feocromocitomas (FC), paragangliomas simpáticos (PGLS) y parasimpáticos (PGLPS).Pacientes y método: Se incluyó en el estudio a 34 pacientes diagnosticados y tratados consecutivamente de FC (20), PGLS (9) y PGLPS (5), con una edad media de 44 (rango, 17-74) años. Se comparó formas de presentación, manifestaciones clínicas, producción hormonal, características patológicas y resultados tras el tratamiento. Resultados: Los pacientes fueron atendidos por múltiples servicios. Los FC se diagnosticaron predominantemente por clínica adrenérgica (65%); los PGLS, por clínica adrenérgica (44%) y por efecto compresivo (45%), y los PGLPS, por efecto masa (100%). Sin embargo, cuando se evaluó de forma dirigida la clínica adrenérgica, el 80% de los FC, el 66,7% de los PGLS y el 40% de los PGLPS la habían manifestado. Presentaron secreción hormonal el 82,4% de los FC y el 100% de los PGLS. No se realizó estudio bioquímico en 3 FC, 5 PGLS y en ningún PGLPS. El tamaño tumoral (en mm) de los FC fue significativamente mayor que los PGLS y PGLPS (59 ± 28, 39 ±16 y 34 ± 26). Tras la extirpación del tumor, 17pacientes con FC, 7 con PGS y 4 con PGLPS quedaron libres de enfermedad, en 1 con PGLPS, éste persiste parcialmente, 1 PGLS recidivó y 5 pacientes murieron (3 con FC y 2 con PGLS).Conclusiones: En nuestro estudio observamos que se diagnostica por clínica adrenérgica los FC (65%) y los PGLS (44%), y además los PGLPS también presentaron clínica compatible con producción de catecolaminasen el interrogatorio dirigido en un 40%. Queremos reseñar el alto porcentaje de manifestaciones adrenérgicas en el grupo de tumores extra adrenales, que no se suele estudiarlos en este sentido, por tanto creemos que deben ser manejados como una misma entidad nosológica por una unidad de referencia (AU)

Objective: To compare the clinical features, mainly adrenergic manifestations, in patients with pheochromocytoma (PCT), sympathetic paraganglioma (SPGL) and parasympathetic paraganglioma (PSPGL).Patients and method: Thirty-four patients consecutively diagnosed and treated for PCT (n = 20), SPGL (n = 9) and PSPGL (n = 5) were included in the present study. The mean age was 44 years (range, 17-74). The forms of presentation, clinical manifestations, results of diagnostic tests, pathological characteristics, and postsurgery outcomes were analyzed. Results: The patients were treated in different medical units in our hospital. Diagnosis of PCT was mainly based on adrenergic symptoms (65%), SPGL on adrenergic symptoms (44%) and compressive symptoms (65%) and PSPGL on the basis of the tumor mass effect (100%). However, exhaustive analysis of adrenergic manifestations revealed that 80%, 66.7% and 40% of patients with PCT,SPGL and PSPGL respectively had adrenergic manifestations. Eighty-two percent of patients with PCT and 100% of those with SPGL showed increased urinaryexcretion of catecholamines and their metabolites. Biochemical studies were not performed in three patients with PCT and five with SPGL and were performed in all patients with PSPGL. The mean tumoral size (in mm) was significantly higher in PCT than in SPGL and PSPGL (59 ± 28, 39 ± 16 and 34 ± 26). After surgery, 17 patients with PCT, seven with PGS and four with PSPGL were considered cured, one patient showed partially persistent PSPGL, one patient with SPGL relapsed, and five patients died (three with PCT and two with SPGL).Conclusions: In the present study, 65% of PCT and 44% of SPGL were diagnosed on the basis of adrenergic symptoms, while 40% of PSPGL also showed symptoms compatible with catecholamine production. We highlight the high percentage of adrenergic manifestations in the group of extra-adrenal tumors, which are not usually investigated in this context. Therefore, we believe that PCT, SPGL and PSPGL should be considered as the same nosological entity in different locations and should be managed in referral units (AU)

Análisis crítico del tratamiento fibrinolítico en la trombosis del bypass femoropoplíteo / A critical analysis of fibrinolytic treatment in femoral-popliteal bypass thrombosis

Objetivo. Evaluar el resultado de la terapia fibrinolítica en el tratamiento de la trombosis del injerto femoropoplíteo. Pacientes y métodos. Desde enero de 1998 a diciembre de 2005 se han tratado 50 casos de trombosis de bypass femoropoplíteo con fibrinólisis local con urocinasa. La muestra se compone de 30 pacientes con edad media de 67,7 años, portadores de bypass a primera (16%) o tercera porción (84%), con material protésico (88%) o vena (12%). La trombosis sucedió en el primer año de control clínico en el 73% de los casos. Presentaron una isquemia grado I y IIa (escala de Rutherford) el 58%. Se trató del primer episodio de trombosis en el 66% de la muestra. El tiempo de evolución de la isquemia fue menor de 14 días en el 58% de los casos. Resultados. La eficacia técnica fue del 80%. Se identificó lesión causante de la trombosis en el 90% de los casos, tratándose con terapia endovascular (69,4%) o cirugía (19,4%). La permeabilidad y el salvamento de extremidad al año fueron del 26,8 y 50,6%, respectivamente, y a los dos años del 22,3 y 47,2%, respectivamente. Los injertos que se fibrinolisaron por primera vez presentaron mayor permeabilidad (p = 0,008) y mayor salvamento de extremidad (p = 0,006), que los injertos que ya se habían tratado previamente. Conclusiones. La terapia trombolítica es una técnica útil para restablecer la permeabilidad de los injertos femoropoplíteos; no obstante, los resultados obtenidos en la segunda y tercera fibrinólisis de un mismo bypass hacen replantear la necesidad de un tratamiento alternativo

Aim. To evaluate the results of fibrinolytic therapy in the treatment of femoral-popliteal graft thrombosis. Patients and methods. Between January 1998 and December 2005, 50 cases of femoral-popliteal bypass thrombosis were treated by local fibrinolysis using urokinase. The sample consisted of 30 patients with a mean age of 67.7 years who had received a bypass made of either prosthetic material (88%) or vein (12%) in the first (16%) or third portion (84%). Thrombosis occurred during the first year of clinical monitoring in 73% of cases. Grade I and IIa ischaemia (Rutherford scale) was present in 58% of them. It was the first episode of thrombosis for 66% of the sample. Progression time of the ischaemia was 14 days or less in 58% of cases. Results. Technical efficiency was 80%. The lesions causing the thrombosis were found in 90% of cases and were treated with endovascular therapy (69.4%) or surgery (19.4%). Patency and limb salvage at one year were 26.8 and 50.6%, respectively, and at two years the figures were 22.3 and 47.2%, respectively. The grafts submitted to fibrinolysis for the first time offered greater patency (p = 0.008) and higher limb salvage rates (p = 0.006) than grafts that had been treated previously. Conclusions. Thrombolysis therapy is a useful technique for restoring the patency of femoral-popliteal grafts; yet, the outcomes of second and third-time fibrinolysis of the same bypass make it necessary to consider an alternative treatment