La reparación mediante TEVAR de disecciones agudas de aorta promueve su remodelación a largo plazo en los segmentos stentados comparados con segmentos no tratados de la aorta / TEVAR of acute aortic dissections promotes long-term remodelling across the stented segment compared to untreated segments of the aorta

Objetivo: Evaluar el efecto anatómico a largo plazo de la reparación endovascular de la aorta torácica (TEVAR) en disecciones tipo B complicadas en comparación con segmentos no tratados de la aorta. Material y métodos: Entre enero de 2008 y septiembre de 2015, 18 pacientes con disección de aorta complicada tipo B se trataron mediante TEVAR con al menos un año de seguimiento en imágenes. Se realizaron angio-TC a los 3, 6, 12 meses y anualmente (media 25,25 ± 22,9 meses) a partir de entonces y se compararon con las angio-TC preoperatorias. Se registraron las medidas de mayor diámetro de la aorta, de la luz verdadera y de la luz falsa (LF) a nivel del segmento stentado, así como en segmentos no tratados de la aorta torácica y de la aorta abdominal supracelíaca. El análisis estadístico se realizó con un análisis de la varianza de efecto mixto para medidas repetidas. Resultados: La edad media fue de 57,67 años y un 88,9% eran hombres. La indicación de TEVAR fue: 5,6% síndrome de malperfusión, 27,8% hipertensión refractaria, 11,1% diámetro > 40mm, 50% dolor persistente y 5,6% hematoma periaórtico. El mayor diámetro de la aorta permaneció estable durante el seguimiento (p = 0,230), el diámetro de la luz verdadera en el segmento tratado aumentó (p = 0,005), y el diámetro de la LF disminuyó (p = 0,020). La trombosis completa de la LF se consiguió mediante la liberación de coils en aquellos casos con permeabilidad de LF y aumento del mayor diámetro de la aorta durante el seguimiento. Conclusiones: El tratamiento mediante TEVAR de disecciones agudas de aorta promueve la remodelación a largo plazo de los segmentos tratados en detrimento del diámetro de la LF en comparación con segmentos no tratados de la aorta. El uso de coils asocia trombosis a largo plazo de la LF y la estabilización del diámetro aórtico (AU)

Objective: To evaluate the long-term anatomical effect of thoracic endovascular aortic repair (TEVAR) in acute type B aortic dissection in comparison with untreated segments of the aorta. Material and methods. A total of 18 patients with complicated type B aortic dissection were treated with TEVAR between January 2008 and September 2015, and had over one-year follow-up imaging. Computed tomography angiograms obtained at 3, 6, and 12 months and long-term (mean 25.25 ± 22.9 months) were compared with baseline scans. The largest diameters of the stented thoracic aorta, stented true lumen, and stented false lumen (FL) were recorded at each time point, as well as the values in the unstented distal thoracic aorta and the abdominal aorta (supracoeliac). Changes over time were evaluated by a mixed effect analysis of variance model of repeated measurements. Results: The mean age of the patients was 57.67 years, and 88.9% were male. Indications for TEVAR were: 5.6% malperfusion, 27.8% refractory hypertension, 11.1% diameter > 40 mm, 50% persistent pain, and 5.6% peri-aortic haematoma. The maximum diameter of the stented thoracic aorta was stable (P = .230), the diameter of the stented true lumen increased (P = .005), and the diameter of the stented FL decreased (P = .020). Complete FL obliteration was achieved more significantly by liberating coils in those cases with residual patency of the FL and an increase in aortic diameter during follow-up. Conclusions: TEVAR of acute aortic dissection promotes long-term remodelling across the stented segment, with a significant long-term decrease of false lumen diameter compared to untreated segments of the aorta. The use of coils is significantly associated with long-term obliteration of the FL and stabilisation of aortic diameter (AU)

Results of superficial fermoral artery stenting in patients with chronic steno-occlusive disease

Objective: To analyse clinical outcome after failure of endovascular stenting of the superficial femoral artery (SFA) in patients with steno-occlusive lesions. Material: A prospective study including patients with atherosclerotic disease treated between January 2007 and December 2013 with self-expansible stents in the superficial femoral artery (n=194). Excluded patients with steno-occlusive lesions affecting also iliac arteries. Methods: Analyzed the demographic and hemodynamic characteristics before and after the procedure, and their clinical consequences on the limb. The following variables were taken into consideration: gender, clinical state (Leriche - La Fontaine Classification), location of lesion (TASC - II Classification), Ankle - Brachial Index (ABI) in preoperative and postoperative period, number of stents deployed and runoff (preoperative angiography). We identified failure of the procedure considering clinical worsening, ABI and dupplex techniques during follow up. Kaplan-Meier curves and multivariate survival analysis were applied on variables analyzed. Results: The mean time of follow up was 22,7 months, ranging between 1 and 84 months after SFA stenting. Mean period free of reintervention or thrombosis was 8,2 months, ranging between 1 day and 52 months after stenting. Limb salvage rate was up to 46,6%, in clinical state III and IV groups. Amputation rate was 5,67% of total patients. Although 50% of these patients had a clinical state III or IV, global patency rates reached up to 46,6% in these groups. A statistically significant difference on the outcome of stenting was found in the increased postoperative ankle-brachial index (p<0,01), runoff (p = 0,03) and number of stents (p<0,01). Conclusions: Failure of stenting in AFS was not associated with significant clinical deterioration, despite most patients with failure of primary endovascular treatment required secondary surgical procedures. The low incidence of thrombosis and reduced amputation rate suggest that these procedures are effective with acceptable patency rates and limb salvage

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Embolización de venas hipogástricas como tratamiento de síndrome de congestión Pélvica / Hypogastric vein embolisation as treatment in pelvic congestion syndrome

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