Migration and Surgical Retrieval of an Amplatzer Septal Occluder into Abdominal Aorta.

BACKGROUND: Structural heart defects, secondary to congenital malformations, have been commonly repaired by open cardiac surgery. Endovascular technology enables these repairs to be performed with fewer complications and better recovery. However, endovascular therapy can be associated with major complications as device dislocation or embolization. We present the case of migration of an Amplatzer occluder device into the abdominal aorta and its surgical retrieval. CLINICAL CASE: A 10-year-old child with ostium secundum-type interatrial communication underwent endovascular repair in our center. Cardiologists sorted out the atrial communication by endovascular deployment of an Amplatzer device. The 24-h ultrasound control study showed the loss of the occluder. An angio-CT scan showed the migration of the Amplatzer into the juxtarenal abdominal aorta. Initially, an endovascular rescue was attempted but was not effective. Our vascular team performed a median laparotomy, control of the abdominal aorta proximal to the renal arteries, and control of the renal arteries and the infrarenal aorta. We performed a transverse arteriotomy, and the material was removed. Subsequently, the arteriotomy was closed directly without any patch. Postoperative evolution was uneventful. COMMENTS: Most of the migrations and embolizations of the devices to close interatrial communications remain intracardiac. Although embolization of the abdominal aorta is only reported sporadically, it could cause a major vascular complication. Percutaneous retrieval of the device is currently recommended, with conventional surgery being the efficient treatment in case of endovascular failure or severe damage to the aorta.

Características clínicas y evolución intrahospitalaria de los pacientes con isquemia crítica de miembros inferiores: estudio ICEBERG / Clinical characteristics and in-hospital outcomes of patients with critical leg ischemia: ICEBERG Study

Fundamento y objetivos: La isquemia crítica de miembros inferiores (ICMI) es una urgencia médico-quirúrgica con una elevada morbimortalidad. Si bien su pronóstico ha mejorado durante los últimos años, no se dispone de datos en nuestro país sobre sus características clínicas, su tratamiento y su pronóstico intrahospitalario. Pacientes y método: Fueron incluidos 671 pacientes (81% varones, edad media 71,2 años) con ICMI de etiología aterosclerótica atendidos en 46 servicios de Cirugía Vascular.Resultados: La población incluida tenía una elevada prevalencia de factores de riesgo (72% hipertensos, 27% fumadores activos, 59% diabéticos) y de comorbilidad (25% enfermedad coronaria, 18% enfermedad cerebrovascular). Un 71% tenía un diagnóstico previo de enfermedad arterial periférica. Al ingreso, en un 71% se realizó algún tipo de revascularización, en un 5% amputación directa y en un 24% tratamiento conservador. Hubo 22 muertes y 49 pacientes fueron dados de alta con una amputación mayor. La presencia de gangrena fue el único factor asociado con la amputación durante el ingreso (odds ratio [OR] 2,45; intervalo de confianza del 95% [IC 95%] 1,22-4,92). La insuficiencia renal (OR 3,38; IC 95% 1,36-8,39) y la ICMI previa (OR 0,20; IC 95% 0,05-0,89) se asociaron con la mortalidad. Al alta hospitalaria, la prescripción de hipolipidemiantes fue del 59%, la de antihipertensivos del 70% y la de antiagregantes del 85%.Conclusiones: Los pacientes con ICMI atendidos en servicios de Cirugía Vascular españoles tienen una baja tasa inicial de amputaciones y de mortalidad. Sin embargo, y dado el alto riesgo cardiovascular de estos sujetos a medio plazo, se precisa mejorar la prescripción de los fármacos preventivos que reciben al alta (AU)

Background and objectives: Critical leg ischemia (CLI) is a medical emergency with a high morbidity and mortality. Although its prognosis has improved during the last years, there are no data on its clinical characteristics, treatment and in-hospital prognosis in our country.Patients and method: 671 patients (81% males, mean age 71.2 years) with atherosclerotic CLI, attended in 46 departments of vascular surgery were included in the study.Results: Participants had a high prevalence of cardiovascular risk factors (72% hypertensive, 27% current smokers, 59% diabetics) and comorbidity (25% coronary heart disease, 18% cerebrovascular disease). 71% had a previous diagnosis of peripheral arterial disease. Upon admission, 71% were referred for revascularization, 5% for direct amputation and 24% for conservative treatment. During hospitalization 22 patients died and 49 were discharged with a major amputation. On multivariate analysis, the only factor associated with the risk of amputation was gangrenous lesions (OR 2.45; IC95% 1.22-4.92). Factors associated with mortality were the presence of chronic renal failure (OR 3.38; IC95% 1.36-8.39) and previous CLI (OR 0.20; IC95% 0.05-0.89). At discharge, 59% received lipid lowering drugs, 70% blood-pressure lowering medications and 85% antiplatelet drugs. Conclusion: CLI patients attended in Spanish vascular surgery departments have a low amputation rate and a low hospital mortality. However, and due to their high cardiovascular risk, it is necessary to improve the prescription rate of evidence-based cardiovascular prevention therapies at discharge (AU)

[Clinical characteristics and in-hospital outcomes of patients with critical leg ischemia: ICEBERG Study]. / Características clínicas y evolución intrahospitalaria de los pacientes con isquemia crítica de miembros inferiores: estudio ICEBERG.

BACKGROUND AND OBJECTIVES: Critical leg ischemia (CLI) is a medical emergency with a high morbidity and mortality. Although its prognosis has improved during the last years, there are no data on its clinical characteristics, treatment and in-hospital prognosis in our country. PATIENTS AND METHOD: 671 patients (81% males, mean age 71.2 years) with atherosclerotic CLI, attended in 46 departments of vascular surgery were included in the study. RESULTS: Participants had a high prevalence of cardiovascular risk factors (72% hypertensive, 27% current smokers, 59% diabetics) and comorbidity (25% coronary heart disease, 18% cerebrovascular disease). 71% had a previous diagnosis of peripheral arterial disease. Upon admission, 71% were referred for revascularization, 5% for direct amputation and 24% for conservative treatment. During hospitalization 22 patients died and 49 were discharged with a major amputation. On multivariate analysis, the only factor associated with the risk of amputation was gangrenous lesions (OR 2.45; IC95% 1.22-4.92). Factors associated with mortality were the presence of chronic renal failure (OR 3.38; IC95% 1.36-8.39) and previous CLI (OR 0.20; IC95% 0.05-0.89). At discharge, 59% received lipid lowering drugs, 70% blood-pressure lowering medications and 85% antiplatelet drugs. CONCLUSION: CLI patients attended in Spanish vascular surgery departments have a low amputation rate and a low hospital mortality. However, and due to their high cardiovascular risk, it is necessary to improve the prescription rate of evidence-based cardiovascular prevention therapies at discharge.