Acute Nonruptured Expansion of Extracranial Carotid Artery Aneurysm. An Infrequent Clinical Presentation.

The extracranial carotid artery aneurysms are a rare disease, representing a low percentage of peripheral aneurysms (0.4-4%). Their main symptoms are derived from cerebral events and local compression, with rupture being rare. We report the case of a 79-year-old woman who presented with a right Common Carotid Artery aneurysm with pain and local symptoms. The expansion of the aneurysm is documented with images and the surgical treatment consisting of bypass from Common Carotid artery to Internal Carotid artery with Dacron prosthesis and reimplantation of External Carotid artery is described and discussed. To the best of our knowledge, this is the first case of expansion directly documented in the literature.

Carotid Plaque Inflammation Assessed by 18F-FDG PET/CT and Lp-PLA2 Is Higher in Symptomatic Patients.

Carotid plaque inflammation assessed by 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels are higher in symptomatic patients. The aim of this study was to assess correlations between 18F-FDG uptake on PET scan of carotid artery plaques, plasma levels of Lp-PLA2, and cerebrovascular symptoms. The study included 45 consecutive patients (22 symptomatic, 23 asymptomatic) with >70% carotid stenosis. Patients were examined by hybrid PET/CT, and maximum standardized uptake values (SUVmax) were recorded. Blood samples were obtained, and plasma was stored at -80 °C for subsequent Lp-PLA2 analysis. Symptomatic and asymptomatic patients showed no significant difference in classical cardiovascular risk factors. Asymptomatic carotid stenosis patients more frequently had a history of coronary artery disease (P = .025) and peripheral artery disease (P = .012). The symptomatic group had higher 18F-FDG uptake in carotid plaques (P < .001), higher plasma Lp-PLA2 (P < .01), and higher high-sensitive C-reactive protein (P = .022). 2-Deoxy-2-[18F]fluoro-D-glucose uptake on PET/CT and plasma Lp-PLA2 show a statistically significant association with the symptomatic status of carotid plaques.

Self-administered versus interview-based questionnaires among patients with intermittent claudication: Do they give different results? A cross-sectional study / Questionários autoadministrados versus administrados por entrevistador para pacientes com claudicação intermitente: Os resultados são diferentes? Um estudo transversal

CONTEXT AND OBJECTIVE: Many clinical investigations use generic and/or specific questionnaires to obtain information about participants and patients. There is disagreement about whether the administration method can affect the results. The aim here was to determine whether, among patients with intermittent claudication (IC), there are differences in the Walking Impairment Questionnaire (WIQ) and European Quality of Life-5 Dimension (EQ-5D) scores with regard to: 1) the questionnaire administration method (self-administration versus face-to-face interview); and 2) the type of interviewer (vascular surgeon, VS, versus general practitioner, GP). DESIGN AND SETTING: Cross-sectional observational multicenter epidemiological study carried out within the Spanish National Health Service. METHODS: 1,641 evaluable patients with IC firstly completed the WIQ and EQ-5D questionnaires and then were interviewed by their doctor on the same day. Pearson correlations and Chi-square tests were used. RESULTS: There was a strong correlation (r > 0.800; P < 0.001) between the two methods of administering the WIQ and EQ-5D questionnaires, and between the VS and GP groups. Likewise, there was a high level of concordance (P > 0.05) between the different dimensions of the WIQ-distance and EQ-5D (self-administration versus face-to-face) in the VS and GP groups. CONCLUSION: There was no difference between the different methods of administering the WIQ and EQ-5D questionnaires, among the patients with IC. Similarly, the two types of interviewers (VS or GP) were equally valid. Therefore, it seems unnecessary to expend effort to administer these questionnaires by interview, in studies on IC.

RESUMO CONTEXTO E OBJETIVO: Muitas investigações clínicas usam questionários genéricos e/ou específicos para obter informações sobre os participantes e pacientes. Não se sabe se o modo de administração pode afetar os resultados. O objetivo foi determinar se, nos pacientes com claudicação intermitente (CI), existem diferenças nas pontuações do Walking Impairment Questionnaire (WIQ) e do European Quality of Life-5 Dimension (EQ-5D) no que diz respeito a: 1) a forma de administrar o questionário (autoadministrado versus entrevista presencial); e 2) o tipo de entrevistador: cirurgião vascular (CV) ou médico generalista (MG). TIPO DE ESTUDIO E LOCAL: Estudo epidemiológico observacional, transversal, multicêntrico realizado no Serviço Nacional de Saúde espanhol. METODO: 1.641 pacientes avaliáveis com CI completaram inicialmente o WIQ e questionários EQ-5, e depois, no mesmo dia, foram entrevistados pelo seu médico. Foram utilizados correlações de Pearson e testes de qui-quadrado. RESULTADOS: Houve forte correlação (r > 0,800; P < 0,001) entre os dois métodos de administração do WIQ e EQ-5D; e entre os grupos CV e MG. Também houve alto nível de concordância (P > 0,05) entre as diferentes dimensões do WIQ-distância e EQ-5D (autoadministrado versus entrevista presencial), nos grupos CV e MG. Conclusão: Em pacientes com CI, não há diferenças entre as diferentes formas de administrar os questionários WIQ e EQ-5D. Da mesma forma, os dois tipos de entrevistador (CV ou MG) foram igualmente válidos. Portanto, não parece necessário despender esforço para administrar esses questionários através de entrevista, em estudos de CI.

Self-administered versus interview-based questionnaires among patients with intermittent claudication: Do they give different results? A cross-sectional study.

CONTEXT AND OBJECTIVE: Many clinical investigations use generic and/or specific questionnaires to obtain information about participants and patients. There is disagreement about whether the administration method can affect the results. The aim here was to determine whether, among patients with intermittent claudication (IC), there are differences in the Walking Impairment Questionnaire (WIQ) and European Quality of Life-5 Dimension (EQ-5D) scores with regard to: 1) the questionnaire administration method (self-administration versus face-to-face interview); and 2) the type of interviewer (vascular surgeon, VS, versus general practitioner, GP). DESIGN AND SETTING: Cross-sectional observational multicenter epidemiological study carried out within the Spanish National Health Service. METHODS: 1,641 evaluable patients with IC firstly completed the WIQ and EQ-5D questionnaires and then were interviewed by their doctor on the same day. Pearson correlations and Chi-square tests were used. RESULTS: There was a strong correlation (r > 0.800; P < 0.001) between the two methods of administering the WIQ and EQ-5D questionnaires, and between the VS and GP groups. Likewise, there was a high level of concordance (P > 0.05) between the different dimensions of the WIQ-distance and EQ-5D (self-administration versus face-to-face) in the VS and GP groups. CONCLUSION: There was no difference between the different methods of administering the WIQ and EQ-5D questionnaires, among the patients with IC. Similarly, the two types of interviewers (VS or GP) were equally valid. Therefore, it seems unnecessary to expend effort to administer these questionnaires by interview, in studies on IC.

The role of foot collateral vessels on ulcer healing and limb salvage after successful endovascular and surgical distal procedures according to an angiosome model.

OBJECTIVES: Analyze the influence of the collateral distal vessels on ischemic ulcer healing and limb salvage after successful distal procedures, according to an angiosome model. METHODS: Retrospective analysis of 76 ischemic ulcers revascularized by surgical (n = 41) and endovascular (n = 35) distal procedures. All interventions were primary procedures with single outflow vessel that remained patent during follow-up. Ulcers were classified according to an angiography angiosome study as ''direct revascularization'' ([DR] n = 45), ''indirect revascularization'' ([IR] n = 31), and IR ''through collaterals'' ([IRc] n = 18). Healing rates and limb salvage were compared according to the type of revascularization. RESULTS: Ulcer healing rate at 12 months was higher in DR than in IR (92% vs 73%, P = .008) but similar to IRc (92% vs 85%). Limb salvage at 24 months was higher in DR than in IR (93% vs 72%, P = .02) but similar to IRc (93% vs 88%). CONCLUSION: Ulcer blood flow restoration through collateral vessels may give similar results to those obtained through its specific source artery.

Relationship between the plasma concentration of C-reactive protein and severity of peripheral arterial disease.

OBJECTIVE: To determine whether the increase in plasma levels of C-Reactive Protein (CRP), a non-specific reactant in the acute-phase of systemic inflammation, is associated with clinical severity of peripheral arterial disease (PAD). METHODS AND RESULTS: This is a cross-sectional study at a referral hospital center of institutional practice in Madrid, Spain. A stratified random sampling was done over a population of 3370 patients with symptomatic PAD from the outpatient vascular laboratory database in 2007 in the order of their clinical severity: the first group of patients with mild chronological clinical severity who did not require surgical revascularization, the second group consisted of patients with moderate clinical severity who had only undergone only one surgical revascularization procedure and the third group consisted of patients who were severely affected and had undergone two or more surgical revascularization procedures of the lower extremities in different areas or needed late re-interventions. The Neyman affixation was used to calculate the sample size with a fixed relative error of 0.1. A homogeneity analysis between groups and a unifactorial analysis of comparison of medians for CRP was done. The groups were homogeneous for age, smoking status, Arterial Hypertension HTA, diabetes mellitus, dyslipemia, homocysteinemia and specific markers of inflammation. In the unifactorial analysis of multiple comparisons of medians according to Scheffé, it was observed that the median values of CRP plasma levels were increased in association with higher clinical severity of PAD (3.81 mg/L [2.14-5.48] vs. 8.33 [4.38-9.19] vs. 12.83 [9.5-14.16]; p < 0.05) as a unique factor of tested ones. CONCLUSION: Plasma levels of CRP are associated with not only the presence of atherosclerosis but also with its chronological clinical severity.

[Repair of secondary aortoenteric fistulas. A systematic review]. / Reparación de las fístulas aortoentéricas secundarias. Revisión sistemática.

We performed a systematic review of the literature on the diagnosis and treatment of secondary aortoenteric fistulas (AEF). A MEDLINE search was performed of articles published in English or Spanish between January 1991 and August 2006. Diagnostic methods, treatment modalities and the results of surgical treatment were analyzed. The most frequent first aortic surgery associated with AEF was repair of abdominal aortic aneurysm (54.31%). The most common form of presentation was gastrointestinal bleeding. Repair through in situ prosthetic replacement had the lowest early mortality rates (8-13.3%) compared with graft excision and extraanatomic revascularization (18.2-44%). AEF is a serious entity and diagnosis requires a high index of suspicion based on clinical findings and indirect data from imaging techniques (computed tomography). The most appropriate therapeutic option continues to be controversial.

Reparación de las fístulas aortoentéricas secundarias. Revisión sistemática / Repair of secondary aortoenteric fistulas. A systematic review

El objetivo fue realizar una revisión sistemática de la literatura disponible sobre el diagnóstico y el tratamiento de las fístulas aortoentéricas secundarias (FAEs). Se realiza una selección de artículos publicados en lengua inglesa y castellana, entre enero de 1991 y agosto de 2006, mediante una búsqueda sistemática en MEDLINE. Se analizan métodos diagnósticos, modalidades y resultados del tratamiento quirúrgico. La primera cirugía aórtica más frecuentemente asociada a las FAEs fue la reparación de aneurisma de aorta abdominal (54,31%). La presentación más común fue la hemorragia digestiva. La reparación mediante sustitución in situ de la prótesis aportó las menores tasas de mortalidad precoz (8-13,3%) frente a la retirada y revascularización extraanatómica (18,2-44%). La FAEs es una entidad grave, cuyo diagnóstico precisa un alto grado de sospecha según la clínica y datos indirectos de las técnicas de imagen (tomografía computarizada). Cuál es la opción terapéutica más adecuada continúa siendo un tema controvertido (AU)

We performed a systematic review of the literature on the diagnosis and treatment of secondary aortoenteric fistulas (AEF). A MEDLINE search was performed of articles published in English or Spanish between January 1991 and August 2006. Diagnostic methods, treatment modalities and the results of surgical treatment were analyzed. The most frequent first aortic surgery associated with AEF was repair of abdominal aortic aneurysm (54.31%). The most common form of presentation was gastrointestinal bleeding. Repair through in situ prosthetic replacement had the lowest early mortality rates (8-13.3%) compared with graft excision and extraanatomic revascularization (18.2-44%). AEF is a serious entity and diagnosis requires a high index of suspicion based on clinical findings and indirect data from imaging techniques (computed tomography). The most appropriate therapeutic option continues to be controversial (AU)