Aneurisma simultáneo de aorta torácica y abdominal. Actitud terapéutica / Simultaneous aneurysm in the thoracic and abdominal aorta. Therapeutic attitudes

Objetivos. Se analizan las posibilidades terapéuticas y los resultados presentados en la bibliografía, y con estos datos, proponemos una orientación para abordar el tratamiento de aneurismas coexistentes de la aorta torácica descendente y la aorta abdominal. Desarrollo. Entre el 5 y el 12% de los pacientes con aneurisma de aorta abdominal (AAA) tiene a la vez aneurisma de aorta torácica descendente; por otro lado, entre el 13 y el 29% de los pacientes con aneurisma de aorta torácica descendente tiene AAA. La supervivencia a los tres y siete años de los pacientes a quienes no se tratan los aneurismas es del 32% y el 2%, en contraste con el 48% y el 12% en los pacientes a quienes se trata uno de los aneurismas, y con el 64% y el 34% a quienes se ha tratado de los dos aneurismas. Estos datos apoyan la necesidad de tratar ambas lesiones. Las opciones son tratarlos en uno o dos tiempos, mediante cirugía abierta convencional, cirugía endovascular o cirugía mixta. Conclusión. Recomendamos la cirugía simultánea de ambos aneurismas; por vía endovascular, si la anatomía lo permite, en pacientes de alto riesgo, y mixta en los pacientes en los que no está contraindicada la cirugía abierta del AAA y para facilitar la introducción de la endoprótesis

Aims. The therapeutic possibilities and outcomes reported in the literature are analysed, and these data are then used to put forward a series of guidelines for handling aneurysms that coexist in the descending thoracic aorta and the abdominal aorta. Development. Between 5 and 12% of patients with an abdominal aortic aneurysm (AAA) have, at the same time, an aneurysm of the descending thoracic aorta; moreover, between 13 and 29% of patients with aneurysm of the descending thoracic aorta also have an AAA. The survival rate of patients with aneurysms that are not treated is 32% and 2% at three and seven years, respectively, in contrast to 48% and 12% in the case of patients who receive therapy for one of the aneurysms, and 64% and 34% in those who undergo treatment for both aneurysms. These data clearly support the need to treat both lesions. The options available involve treating them in one or two stages, by means of conventional open surgery, endovascular surgery or mixed surgery. Conclusions. We recommend simultaneous surgery for both aneurysms using an endovascular approach (if the anatomy allows it) in high-risk patients and a mixed intervention in patients for whom open surgery to treat AAA is not prohibited and in order to facilitate the introduction of the stent

Brachial-jugular expanded PTFE grafts for dialysis.

The objective of this study was to analyze the long-term outcome of 51 patients with brachial-jugular grafts for dialysis. Age, presence of diabetic nephropathy, complications of the angio-access, and therapeutic methods of treating complications were analyzed. All surgical procedures were performed under local anesthesia in an ambulatory surgical setting. The duration of angio-access was analyzed using the life-table method. Our results showed that brachial-jugular grafts can be performed under local anesthesia and in an ambulatory surgical setting. This procedure can be an alternative to complex intrathoracic procedures, Dacron cuff catheters, or lower limb grafts, in cases of stenosis or occlusion of the subclavian vein.

[Proximal vein by-pass in the treatment of venous stenosis in expanded polytetrafluoroethylene prosthesis for hemodialysis]. / By-pass a vena proximal para el tratamiento de estenosis venosas en prótesis de politetrafluoroetileno expandido para hemodiálisis.

OBJECTIVE: To show the long-term results of 97 politetraflouroethylene dialysis grafts submitted to a graft by-pass to treat graft-vein stenosis. MATERIALS AND METHODS: Venous stenoses were studied and diagnosed by means of fistulography in cases with fistula dysfunction or during surgery for graft thrombectomy. Both early and late complication rates were studied, as well as primary and secondary patency rates. RESULTS: Number of cases, 97. Mean age, 58 years (7-79). Diabetic nephropathy: 19.5%. Types of grafts in which stenoses developed: straight forearms 13; loop forearm 9; 6 mm upper arm 36; 6-8 mm upper arm 34; brachio-jugular 4; femoro-femoral 1. Overall follow-up time: 2,427 graft-months. Mean follow-up time: 21 +/- 5 months. Late complication rate: 0.30 episodes per graft-year of follow-up. Re-stenosis rate: 0.12 graft-year of follow-up. Primary cumulative patency rate: 70%, 62%, 51%, 45% at one, two, three and four years, respectively. Secondary cumulative patency rate: 87%, 79%, 74% and 71% at one, two, three and four years, respectively (p < 0.0016). No differences were observed between secondary patency observed after by-pass to treat dysfunction or thrombosis (p = 0.09259). DISCUSSION: In our experience, by-pass to proximal vein is associated with good results both at short and long term, probably because the intimal hyperplasia area is excluded and because by-pass is performed on an already dilated vein. The procedure can be performed under local anesthesia and in an outpatient basis between dialysis, with little discomfort for the patient.

By-pass a vena proximal para el tratamiento de estenosis venosas en prótesis de politetrafluoroetileno expandido para hemodiálisis / By-pass to proximal vein for treatment of venous stenoses in politetrafluorethylene grafts for haemodialysis

Objetivo. Mostrar los resultados a largo plazo de 97 by-pass a vena proximal para tratar estenosis protésis-vena periféricas de prótesis de politetrafluoroetileno (PTFE) para hemodiálisis.Material y métodos. Las estenosis venosas fueron estudiadas y diagnosticadas con fistulografía en casos de disfunción de la fístula o durante el procedimiento de trombectomía de las prótesis. Se estudiaron la tasa de complicaciones precoces y tardías, así como las curvas de permeabilidad primaria y secundaria.Resultados. Número de casos: 97. Edad media: 58 (7-79). Nefropatía diabética: 19,5 por ciento. Tipos de prótesis en las que se desarrollaron las estenosis: 13 rectas de antebrazo, 9 antebrazo curvas, 36 brazo 6 mm, 34 brazo 6-8 mm, 4 humeroyugulares y 1 femorofemoral. Tiempo global de seguimiento: 2.427 meses. Tiempo medio de seguimiento: 21ñ 5 meses. Tasa de complicaciones totales: 0,30 episodios prótesis/año de seguimiento. Tasa de reestenosis: 0,12 prótesis/año de seguimiento. Curva actuarial de permeabilidad primaria: 70 por ciento, 62 por ciento, 51 por ciento, 45 por ciento al primer, segundo, tercer y cuarto año, respectivamente. Curva actuarial de permeabilidad secundaria: 87 por ciento, 79 por ciento, 74 por ciento y 71 por ciento al primer, segundo, tercer y cuarto año, respectivamente (p < 0,0016). No hubo diferencia en la curva de función secundaria si el by-pass fue realizado por malfunción o trombosis. Conclusiones. En nuestra experiencia el by-pass a vena proximal tiene buenos resultados a corto y largo plazo probablemente por excluir la zona de hiperplasia intimal y por realizar el by-pass sobre vena dilatada. El tratamiento puede ser realizado bajo anestesia local, en régimen ambulatorio y en período interdiálisis con mínimas molestias para los pacientes (AU)

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Peroneal arteriovenous fistula as a complication of above-knee femoropopliteal polytetrafluorethylene graft thrombectomy with the Fogarty catheter.

The Fogarty catheter is an invaluable tool in the surgical practice of a vascular surgeon. Arteriovenous fistula is an unusual but potentially dangerous complication of its use. We present the case of a man who suffered a peroneal arteriovenous fistula as a result of an above-knee femoropopliteal polytetrafluorethylene graft thrombectomy. As the fistula compromised the viability of the extremity, surgical correction was warranted. It was performed without further complications to the patient. The few cases reported in the literature are reviewed. We conclude that this complication should be repaired as soon as it is detected.