Radiation Exposure in Endovascular Surgery According to Complexity: Protocol for a Prospective Observational Study.

In the past decades, we have witnessed tremendous developments in endovascular surgery. Nowadays, highly complex procedures are performed by minimally invasive means. A key point is equipment improvement. Modern C-arms provide advanced imaging capabilities, facilitating endovascular navigation with an adequate open surgical environment. Nevertheless, radiation exposure remains an issue of concern. This study aims to analyze radiation used during endovascular procedures according to complexity, comparing a mobile X-ray system with a hybrid room (fixed X-ray system). This is an observational and prospective study based on a cohort of non-randomized patients treated by endovascular procedures in a Vascular Surgery department using two imaging systems. The study is planned for a 3-year duration with a recruitment period of 30 months (beginning 20 July 2021) and a 1-month follow-up period for each patient. This is the first prospective study designed to describe the radiation dose according to the complexity of the procedure. Another strength of this study is that radiologic variables are obtained directly from the C-arm and no additional measurements are required for feasibility benefit. The results from this study will help us determine the level of radiation in different endovascular procedures, in view of their complexity.

Role of Botulinum Toxin in Pectoralis Minor Syndrome.

BACKGROUND: Thoracic outlet syndrome (TOS) causes neurogenic symptoms in 95% of the cases due to neurovascular bundle compression. The treatment goal is the decompression of the neurovascular structures. In the last decade, non-surgical treatments have been evaluated as a treatment option for spastic syndromes and thoracic outlet syndrome. In this study we report the use of botulinum toxin (BTX-A) injection as a diagnostic tool to identify the pectoral minor syndrome, and as a less aggressive treatment-option. METHODS: An observational cohort study of patients with neurogenic thoracic outlet syndrome who underwent sonographically guided chemodenervation of pectoral minor muscle with botulinum toxin. Follow-up includes clinical evaluation at one month, 3 months and 6 months after the procedure. Clinical evaluation was made with clinical questionnaire. In case of patients with partial improvement of the symptoms, a second infiltration of BTX-A was performed. The categorical variables were shown as percentages, and the continuous variables as mean and standard deviation (SD). For the comparison of categorical variables, the Fisher's exact test was used. Statistical analysis was performed using the SPSS version 20.0 program. We consider P <0.05 to be statistically significant. RESULTS: A total of twenty-six patients were diagnosed with thoracic outlet syndrome in this period, and 20 accomplished the inclusion criteria. 7 patients were excluded (1 due to neoplasia, 2 did not sign the informed consent, 1 due to neoplasia, 2 did not sign the informed consent, 1 was lost during the follow-up and 3 due to anomalies of the first rib secondary to fractures and cervical rib and 1 was lost during the follow-up), therefore a sample of 13 patients aged between 24 and 55 years was obtained. The most common type of procedure performed was the single injection of 50 IU of botulinum toxin. 4 patients were infiltrated in 2 occasions due to partial improvement in symptoms at 1month follow-up. Clinical stability was found at three months and at 6 months follow-up. CONCLUSION: The ultrasound-guided botulinum injection of the pectoralis minor muscles provides symptoms relief in patients with pectoral minor syndrome, and could be considered a safe tool in the diagnosis of the pectoralis minor syndrome within the spectrum of thoracic operculum syndrome.

Comparación entre amputaciones menores primarias respecto a amputaciones menores con revascularización previa en patología del pie diabético / Comparison between primary minor amputations and minor amputations with previous revascularization in diabetic foot pathology

INTRODUCCIÓN: la realización de amputaciones menores primarias en pacientes diabéticos es una práctica aún frecuente en servicios de cirugía vascular. El objetivo de este estudio es comparar la evolución de las amputaciones menores primarias respecto a las realizadas con revascularización previa, considerando la presencia o no de angiosoma directo que revascularice la zona del muñón que vamos a crear. MATERIAL Y MÉTODOS: se realizó un estudio observacional y comparativo sobre la población de pacientes diabéticos que requerían amputaciones menores de miembros inferiores ingresados en nuestro servicio durante el periodo comprendido entre enero y diciembre de 2018. La revascularización previa (o no) a la amputación menor se decidía con base en estudios hemodinámicos y posibilidades según pruebas de imagen. La muestra se dividió en cuatro grupos tomando en cuenta la necesidad-posibilidad de revascularización previa a la amputación menor y la presencia de vascularización basada en angiosoma directo o indirecto a la zona del muñón que íbamos a crear. Se valoró en cada grupo la tasa de amputaciones mayores, la tasa de curación de las amputaciones menores y la mortalidad. Consideramos significativa p < 0,05. RESULTADOS: se reclutaron 106 pacientes de enero a diciembre de 2018. Las tasas de curación de los muñones de amputación en los cuatro grupos no presentaron diferencias estadísticamente significativas (p = 0,085). Los pacientes no revascularizados mostraron una tasa de pérdida de extremidad más alta que el grupo previamente revascularizado, con una diferencia estadísticamente significativa entre los grupos (p = 0,002). CONCLUSIONES: la tasa de pérdida de extremidad es mayor en los pacientes que no son sometidos a cirugía de revascularización previa a la amputación menor, así como en los pacientes cuya vascularización depende de angiosomas indirectos al muñón creado

INTRODUCTION: the performance of primary minor amputations in diabetic patients is a frequent practice in vascular surgery services. The aim of this study is to compare the evolution of minor primary amputations, with those performed with previous revascularization, considering the presence or not of a direct angiosome that revascularizes the stump area that we are going to create. MATERIAL AND METHODS: an observational and comparative study was performed on diabetic patients who required minor lower limb amputations admitted to our department during the period from January to December 2018. The revascularization prior, or not, to minor amputation, was decided based on hemodynamic studies and possibilities according to imaging tests. Patients were divided into 4 groups considering the need-possibility of revascularization prior to minor amputation, and vascularization based on direct or indirect angiosome to the area of the stump that we were going to create. The rate of major amputations, the healing rate of minor amputations, and mortality were assessed in each group. We consider significant p < 0.05. RESULTS: 106 patients were recruited, from January to December 2018. The healing rate of the amputation stumps in the four groups did not show statistically significant differences (p = 0.085). Non-revascularized patients showed a higher rate of limb loss respect the previously revascularized group, with a statistically significant difference between the groups (p = 0.002). CONCLUSIONS: the rate of limb loss is higher in patients who do not undergo revascularization surgery prior to minor amputation, as well as in patients whose vascularization depends on indirect angiosomes to the created stump

Infection of arteriovenous fistula for hemodialysis: An uncommon etiology / Infección de fístula arteriovenosa protésica para hemodiálisis de causa inusual

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Manejo de pseudoaneurisma de arteria cervical transversa / Management of transverse cervical artery pseudoaneurysm

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