Ayudando a la toma de decisiones en el diagnóstico, tratamiento y seguimiento de úlceras de etiología vascular mediante el empleo de una aplicación móvil / A mobile decision support system for diagnosis, treatment and follow-up of vascular ulcers

Introducción y objetivo: los sistemas de ayuda a la decisión médica (SADM) son sistemas computacionales que utilizan dispositivos inteligentes, lo que facilita el diagnóstico y el tratamiento de múltiples patologías, transformando la atención sanitaria en un sistema dinámico y de precisión. Las úlceras de etiología vascular representan un importante problema de salud que suponen un gran consumo de recursos. La transformación digital puede mejorarla calidad de los diagnósticos, de los tratamientos y de los seguimiento de los pacientes, mejorando la eficacia y la eficiencia de la asistencia sanitaria. El objetivo es desarrollar una aplicación móvil que facilite el diagnóstico y el tratamiento de úlceras de etiología vascular. Métodos: para desarrollar este SADM se elaboraron algoritmos para los diagnósticos y los tratamientos capaces de generar una respuesta correcta, guiando al usuario hacia un diagnóstico más probable o a la aplicación del tratamiento específico. En Android se empleó el entorno de programación Android Studio y el lenguaje de programación JAVA, y para el desarrollo en iOS se empleó XCode y el lenguaje de programación Swift. El diagnóstico de úlceras de etiología vascular incluye: úlcera neuropática, isquémica, neuroisquémica, venosa o flebostática, úlceramixta y úlcera hipertensiva o de Martorell. Resultados: UlcerAPP es visual e intuitiva. Orientará en el diagnóstico en respuesta a los algoritmos desarrollados. Además, podrá accederse al tratamiento específico de cada una de ellas. Incluirá recomendaciones de seguimiento y criterios de derivación. Conclusiones: UlcerAPP es un proyecto desarrollado para mejorar el manejo clínico de las úlceras en el entorno de la Atención Primaria y potenciar el conocimiento de la patología vascular y del tratamiento de las úlceras de dicha etiología. (AU)

Introduction and objective: decision support systems (DSS) are computer systems that use computer devicesor smartphones, facilitating the diagnosis and properly treatment of multiple pathologies, transforming healthcare into a dynamic, preventive and precision system. Vascular ulcers represent an important health problem, witha great consumption of resources. Digital transformation can improve the quality of diagnoses, treatments andpatient follow-up, and therefore improve the effectiveness and efficiency of healthcare. This paper aims to develop UlcerApp, a totally new mobile DSS for vascular ulcers management, which facilitates the diagnosis, treatment andmonitoring of ulcers of vascular etiology, in the primary health care. Methods: for achieving the main purpose of this research work, a decision algorithm will be developed and implemented by an Android (Android Studio- JAVA) and iOS (XCode- Switf ) mobile applications. Results: the App developed which implements the algorithms UlcerApp is capable of diagnose 6 kind of vascularulcers: neuropathic, ischemic, neuroischemic, venous ulcer, mixed ulcer and hypertensive or Martorell ulcer. UlcerAPP is a visual and intuitive application that will guide the user to correct diagnosis. After them, users will be able to access the specific treatment. It will include follow-up recommendations as well as referral criteria. Conclusions: UlcerAPP is a project developed to improve the clinical management of vascular ulcers in the primary health care, enhance knowledge of vascular pathology and treatment of ulcers of said etiology. (AU)

Results of endovascular treatment of venous anastomotic stenosis in prosthetic arteriovenous for hemodialysis PTFE grafts. Comparative analysis between patent and occluded grafts.

OBJECTIVE: To analyze the results of endovascular treatment of venous anastomotic stenosis (VAS) in humero-axillary arteriovenous grafts (HAG), comparing outcomes between patent and thrombosed HAG. MATERIAL AND METHODS: A retrospective cohort study was made of endovascular treated patients because of a VAS in a HAG between January 2009 and December 2019. Group A: Thrombosed HAG secondary to a VAS. Group B: Patent HAG with a VAS detected during follow-up. Technical success was defined as residual stenosis after treatment <30%, and clinical success as satisfactory immediate dialysis after surgery. After ET a biannual clinical and ultrasound follow-up was performed. STATISTICAL ANALYSIS: Survival analysis was performed for time-to-event data to assess patency. RESULTS: Group A: 55 patients. Group B: 22. There were no significative differences in demographic and anatomical factors between groups. Technical and clinical success were 100% in group B and 94.5% and 91% respectively in group A. Primary patency at 1, 6 and 12 months was: Group A: 81.8%, 22.4% y 15.7% respectively. Group B: 100%, 85.9%, 76,4% (p < 0.001). Secondary patency at 1, 6 and 12 months was: Group A: 85.2%, 45.8% y 31.3% respectively. Group B 100%, 95.3%, 95.2% (p < 0.001). Use of non-covered stents was associated with an increased risk of occlusion (HR 2.669 IC 95% 1.146-6.216, p = 0.010). CONCLUSION: A higher patency of EV performed on a patent HAG is expected. It is therefore advisable to develop surveillance programs that are capable to detect VAS before its occlusion.

Resultados obtenidos en el tratamiento de embolización endovascular de varices pélvicas / Treatment outcomes of pelvic varicose veins endovascular embolization

Introducción:el síndrome de congestión pélvica se presenta con un dolor de más de 6 meses de evolución, varices pélvicas e insuficiencia venosa pélvica. El diagnóstico diferencial incluye distintas patologías. Existen diferentes opciones terapéuticas, de las que la terapia endovascular con embolización es la más utilizada, la misma que ha sido significativamente más eficaz que la terapia quirúrgica.Objetivo:analizar la efectividad de la embolización endovascular de varices pélvicas.Materiales y métodos:estudio unicéntrico, observacional descriptivo y ambispectivo. Se han seguidi las recomendaciones STROBE para su redacción. Se incluyeron todos los pacientes a los que se les realizó una embolización de varices pélvicas que cumplían los criterios de inclusión. Se realizó un análisis de las variables cualitativas en forma de frecuencias absolutas y porcentajes y los datos cuantitativos mediante la media. Se describió el éxito terapéutico percibido por las pacientes, las complicaciones, la necesidad de reintervención y la supervivencia libre de reintervenciones.Resultados:se incluyeron 46 pacientes con una edad media de 32,54 años. 22 casos (47,82 %) tenían un peso adecuado, 29 (63,04 %) refirieron una clara mejoría sintomática después del procedimiento de embolización y en ninguno se presentaron complicaciones asociadas al procedimiento. Sin embargo, de este grupo de pacientes 11 tuvieron una intervención subsecuente asociada a las varices de miembros inferiores. El tiempo de supervivencia libre de nuevas embolizaciones fue de 54,37 meses, con un ES de 2,64 meses.Conclusiones:la embolización endovascular de varices pélvicas es una técnica efectiva y segura.(AU)

Introduction:pelvic congestion syndrome presents pain that lasts at least 6 months, pelvic varices and pelvic venous insufficiency. The differential diagnosis includes different pathologies. There are different therapeutic options, being endovascular therapy with embolization the most used, the same one that has been significantly more effective than surgical therapy.Objective:to analyze the effectiveness of endovascular embolization of pelvic varices.Materials and methods:single-center, descriptive and ambispective observational study. Following the STROBE recommendations for writing it. All patients who underwent embolization of pelvic varices who met the inclusion criteria were included. An analysis of the qualitative variables was showed like absolute frequencies and percentages; and quantitative data using the mean. The therapeutic success perceived by the patients, the complications, the need for reoperation, and reoperation-free survival are described.Results:46 patients with a mean age of 32.54 years were included, 22 cases (47.82 %) who had an adequate weight. In 29 cases (63.04 %) reported a clear symptomatic improvement after the embolization procedure, they were not complications associated with the procedure. However, of this group of patients, 11 had a subsequent intervention associated with varicose veins of the lower limbs. The survival time free of new embolizations was 54.37 months with a SE of 2.64 months.Conclusions:embolization is the most widely used treatment for pelvic varicose veins. In this review, symptomatic improvement was found in 63.04 % of the cases, being below the results reported in the bibliography where they report a therapeutic success of 75 % of the cases. Endovascular embolization of pelvic varices is an eective and safe technique for their treatment.(AU)

Resultados del tratamiento endovascular de la estenosis de la anastomosis venosa en las fístulas arteriovenosas protésicas para hemodiálisis de PTFE. Análisis comparativo entre fístulas permeables y trombosadas / Results of endovascular treatment of venous anastomotic stenosis in prosthetic arteriovenous for hemodialysis PTFE grafts. Comparative analysis between patent and occluded grafts

Objetivo: Analizar los resultados del tratamiento endovascular (TEV) de las estenosis en las anastomosis venosas (EAV) de las fístulas arteriovenosas protésicas (FAVp), comparando su utilidad al realizarse sobre FAVp permeables frente a trombosadas.Material y métodosEstudio retrospectivo de pacientes intervenidos mediante TEV por EAV de fístulas humeroaxilares realizadas entre enero de 2009 y diciembre de 2019 en nuestro centro. Grupo A: FAVp trombosada secundaria a EAV; Grupo B: FAVp permeable con EAV detectada en seguimiento. Se definió éxito técnico como estenosis residual ≤ 30% y éxito clínico como diálisis efectiva inmediata. Tras el TEV se realizó un seguimiento clínico y con eco-Doppler semestral. Estudio estadístico: se realizó un análisis de supervivencia mediante el método Kaplan Meier para el estudio de permeabilidades.ResultadosGrupo A: 55 pacientes. Grupo B: 22 pacientes. No existieron diferencias significativas en las características demográficas ni anatómicas entre grupos.El éxito técnico y clínico fueron del 100% en el grupo B frente a un 94,5% y 91%, respectivamente, en el grupo A.La permeabilidad primaria a 1, 6 y 12 meses en el Grupo A fue: 81,8%, 22,4% y 15,7%, respectivamente, frente al Grupo B: 100%, 85,9%, 76,4% (p<0,001). Permeabilidad secundaria a 1, 6 y 12 meses en el Grupo A fue 85,2%, 45,8% y 31,3%, respectivamente, frente al Grupo B 100%, 95,3%, 95,2% (p<0,001). El uso de stents no cubierto se asoció a un mayor riesgo de oclusión (HR 2,669 IC 95% 1,146-6,216, p=0,010).ConclusiónEs esperable una mayor permeabilidad del TEV realizado sobre una FAVp permeable, por lo que es recomendable elaborar programas de seguimiento que sean capaces de detectar la EAV previo a su trombosis. (AU)

Objective: To analyze the results of endovascular treatment of venous anastomotic stenosis (VAS) in humero-axillary arteriovenous grafts (HAG), comparing outcomes between patent and thrombosed HAG.Material and methodsA retrospective cohort study was made of endovascular treated patients because of a VAS in a HAG between January 2009 and December 2019. Group A: Thrombosed HAG secondary to a VAS. Group B: Patent HAG with a VAS detected during follow-up. Technical success was defined as residual stenosis after treatment <30%, and clinical success as satisfactory immediate dialysis after surgery. After ET a biannual clinical and ultrasound follow-up was performed. Statistical analysis: Survival analysis was performed for time-to-event data to assess patency.ResultsGroup A: 55 patients. Group B: 22. There were no significative differences in demographic and anatomical factors between groups.Technical and clinical success were 100% in Group B and 94.5% and 91% respectively in Group A.Primary patency at 1, 6 and 12 months was: Group A: 81.8%, 22.4% and 15.7% respectively. Group B: 100%, 85.9%, 76.4% (p<0.001). Secondary patency at 1, 6 and 12 months was: Group A: 85.2%, 45.8% and 31.3% respectively. Group B 100%, 95.3%, 95.2% (p<0.001). Use of non-covered stents was associated with an increased risk of occlusion (HR 2.669 95% CI 1.146–6.216, p=0.010).ConclusionA higher patency of EV performed on a patent HAG is expected. It is therefore advisable to develop surveillance programs that are capable to detect VAS before its occlusion. (AU)

Results of endovascular treatment of venous anastomotic stenosis in prosthetic arteriovenous for hemodialysis PTFE grafts. Comparative analysis between patent and occluded grafts. / Resultados del tratamiento endovascular de la estenosis de la anastomosis venosa en las fístulas arteriovenosas protésicas para hemodiálisis de PTFE. Análisis comparativo entre fístulas permeables y trombosadas.

OBJECTIVE: To analyze the results of endovascular treatment of venous anastomotic stenosis (VAS) in humero-axillary arteriovenous grafts (HAG), comparing outcomes between patent and thrombosed HAG. MATERIAL AND METHODS: A retrospective cohort study was made of endovascular treated patients because of a VAS in a HAG between January 2009 and December 2019. Group A: Thrombosed HAG secondary to a VAS. Group B: Patent HAG with a VAS detected during follow-up. Technical success was defined as residual stenosis after treatment <30%, and clinical success as satisfactory immediate dialysis after surgery. After ET a biannual clinical and ultrasound follow-up was performed. STATISTICAL ANALYSIS: Survival analysis was performed for time-to-event data to assess patency. RESULTS: Group A: 55 patients. Group B: 22. There were no significative differences in demographic and anatomical factors between groups. Technical and clinical success were 100% in Group B and 94.5% and 91% respectively in Group A. Primary patency at 1, 6 and 12 months was: Group A: 81.8%, 22.4% and 15.7% respectively. Group B: 100%, 85.9%, 76.4% (p<0.001). Secondary patency at 1, 6 and 12 months was: Group A: 85.2%, 45.8% and 31.3% respectively. Group B 100%, 95.3%, 95.2% (p<0.001). Use of non-covered stents was associated with an increased risk of occlusion (HR 2.669 95% CI 1.146-6.216, p=0.010). CONCLUSION: A higher patency of EV performed on a patent HAG is expected. It is therefore advisable to develop surveillance programs that are capable to detect VAS before its occlusion.

Guía de práctica clínica: Utilidad de los ultrasonidos en la creación y mantenimiento de los accesos arteriovenosos. Capítulo de Diagnóstico Vascular. Sociedad Española de Angiología y Cirugía Vascular / Clinical practice guide: utility of ultrasound in the creation and maintenance of arteriovenous access Vascular Diagnosis Chapter. Spanish Society of Angiology and Vascular Surgery

El acceso vascular en los pacientes en programa de hemodiálisis condiciona de forma significativa la calidad de las sesiones de diálisis, su morbimortalidad, complicaciones y necesidad de nuevos procedimientos a lo largo del tiempo, además de importantes implicaciones técnicas y económicas. Se trata de pacientes frágiles, muchas veces reintervenidos, que van a requerir un acceso vascular durante largos periodos de tiempo o para el resto de su vida, por lo que estamos ante una piedra angular que debemos tratar de la mejor forma posible. Y en este campo, los ultrasonidos ofrecen, más que en ninguna otra localización, una inestimable ayuda en todas las etapas del acceso vascular: desde su planificación, creación, seguimiento, o como herramienta intraoperatoria

Vascular access in patients on hemodialysis significantly affects the quality of life, morbidity, mortality, complications and the need for new procedures over time. In addition, they have important technical and economic implications. These are fragile patients, often with many reinterventions, who will require vascular access for long periods of time or for the rest of their lives, so we are facing a big health problem that we must treat in the best possible way. In this framework, ultrasounds offer, more than in any other location, an invaluable help in all stages of vascular disease: from planning the arteriovenous access, creation, follow-up or as intraoperative tool. This document tries to provide an update and help to clinical practice

Free skin micrografts with cyanoacrylate as outpatient treatment for venous leg ulcers.

OBJECTIVE: The present study describes an ambulatory, free skin micrograft technique with cyanoacrylate as a coadjuvant venous leg ulcer (VLU) healing strategy and its outcomes after one month. METHODS: This prospective study involved Comprehensive Classification System for Chronic Venous Disorders (CEAP) stage C6 patients with good granulation tissue and negative culture results, consecutively recruited in January 2017 in the Hospital Clinico San Carlos. A skin micrograft was harvested from the anterior surface of the patient's thigh with a 0.4cm punch (0.12cm2). The graft was adhered to the ulcer bed with cyanoacrylate. Anti-adherent dressing and double-layer bandaging was applied, with weekly replacements. Measurements were obtained of the surface of the VLU and graft progression (in cm2) using a photographic grid. RESULTS: A total of 12 VLUs in 12 patients were included, with a mean treated surface of 20.32±13.9cm2. A total of 18 grafts were placed and all were found to be viable after one week. Average graft growth was not noticeable after one week but was found to be 0.25±0.08cm2 after week two, 0.41±0.98cm2 after week three, and 0.70±0.15cm2 after week four (p<0.001). There were no complications in the donor zone. CONCLUSION: The findings of this study show that free skin micrografting with cyanoacrylate as outpatient treatment for VLUs was simple, rapid and without complication in this study, and may contribute to its wider application in clinical use.

Documento de Consenso SEMERGEN - CEFyL de la SEACV: Trombosis venosa superficial de miembros inferiores / Consensus document of SEMERGEN - CEFyL of the SEACV: super cial venous thrombosis of lower members in Primary Care

La trombosis venosa superficial (TVS) de miembros inferiores venía considerándose como una patología de naturaleza benigna con un curso clínico autolimitado. Actualmente se conoce que sus potenciales complicaciones pueden ser graves o incluso mortales, como la trombosis venosa profunda o el tromboembolismo pulmonar. Existen diferentes formas de presentación clínica, factores de riesgo y diferentes tratamientos para su abordaje, principalmente en Atención Primaria. Nuestro grupo de trabajo de vasculopatías de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN) ha elaborado esta actualización con la evidencia científica actual de forma conjunta con el Capílulo Español de Flebología y Linfología de la Sociedad Española de Angiología y Cirugía Vascular

The superficial venous thrombosis of the lower limbs was considered a pathology of a benign nature with a self-limiting clinical course. It is now known that its potential complications can be serious or even deadly, such as deep vein thrombosis or pulmonary thromboembolism. There are different forms of clinical presentation, risk factors and different treatments for its approach mainly in Primary Care. Our working group of vasculopathies of the Spanish Society of Primary Care Physicians (SEMERGEN) has developed this update with the current scientific evidence jointly with the Spanish Chapter of Phlebology and Lymphology of the Spanish Society of Angiology and Vascular Surgery

SEA-SEACV 2015: Guía para el diagnóstico y tratamiento del aneurisma de aorta abdominal / No disponible

No disponible

Recomendaciones de la guía para el diagnóstico y tratamiento del aneurisma de aorta abdominal / Guide recommendations for diagnosis and treatment of abdominal aortic aneurysm

No disponible

Recomendaciones de la guía para el diagnóstico y tratamiento del aneurisma de aorta abdominal / Guide recommendations for diagnosis and treatment of abdominal aortic aneurysm

No disponible

Comparison of popliteal artery aneurysm therapies.

OBJECTIVE: Surgical treatment of popliteal artery aneurysms (PAAs) has advanced over time. Constant development of new endovascular techniques has converted these into the most attractive methods available today. However, results for each endovascular procedure are still limited, and available data have emerged from studies examining only a small number of cases. The present retrospective review was designed to examine early and late results for PAA treatment and to identify possible factors associated with graft patency. METHODS: This was a retrospective review of all PAAs treated from January 1993 to December 2013. Symptomatic and asymptomatic PAAs >2 cm treated using open surgery or an endovascular procedure were included. Kaplan-Meier curves and the Breslow test were used to analyze data. RESULTS: A total of 171 aneurysms were treated in 142 men (mean age, 69.3 years); of these, 53.3% were asymptomatic and 18.7% presented as acute ischemia. Saphenous vein was used for bypass in 57.9% of the patients, expanded polytetrafluoroethylene (ePTFE) in 23.4%, and a stent graft in 18.7%. In the open surgical group, a popliteal-popliteal bypass was performed in 37.4% and a distal anastomosis to a tibial vessel was required in 14.4%. Good runoff (two to three vessels) was present in 69%. Perioperative mortality (30 days) was 1.8%. Of eight early occlusions recorded, five (2.9%) underwent reoperations. Major amputations were needed in five patients (all with previous acute ischemia). Median follow-up for the entire cohort was 49 months (range, 1-228 months). Primary and secondary patency rates at 24, 36, and 60 months were 76.3% and 89.5%, 73.4% and 87.4%, and 68.3% and 80.9%, respectively. Popliteal-popliteal bypasses showed better primary patency at 24 months when saphenous vein was used vs ePTFE (94.9% vs 79%; P = .04); however, similar patency rates were recorded for short ePTFE bypasses and stent grafts (79% vs 79.7%). On multivariate analysis, only poor runoff emerged as an independent factor for worse primary patency (hazard ratio, 3.5; 95% confidence interval, 1.7-7.2; P = .001). CONCLUSIONS: The open repair of PAA offers good long-term results, especially in asymptomatic patients, those undergoing elective surgery, and those showing good runoff. Given the also good midterm outcomes of endovascular treatment, this may be a feasible option in selected patients.

¿Está justificado el seguimiento ecográfico de las fístulas arteriovenosas protésicas húmero-axilares para hemodiálisis? / Is ultrasound follow-up necessary in humero-axillary prosthetic arteriovenous fistulas for haemodialysis?

Objetivo: Evaluar el impacto de una consulta específica de accesos vasculares (C-FAV) con seguimiento intensivo en la permeabilidad de las fístulas húmero-axilares. Pacientes y método: Estudio retrospectivo. Entre enero de 2005 y diciembre de 2009 se realizan 108 fístulas húmero-axilares. Desde junio de 2007 se establece una C-FAV. Se realiza eco-doppler preoperatorio y seguimiento posterior al mes de la intervención y, después, cada 3 meses. Resultados: Se analizan las permeabilidades de 57 fístulas húmero-axilares realizadas desde junio de 2007 hasta diciembre de 2009 (grupo C-FAV), comparándolas con 51 realizadas durante los 30 meses previos (grupo control). No se encontraron diferencias en la permeabilidad obtenida entre ambos grupos a 12 y 24 meses, con una permeabilidad secundaria a los 12 meses de 49% en el grupo C-FAV y 52% en el grupo control. El porcentaje de pacientes reintervenidos fue inferior en el grupo C-FAV (35%) que en el grupo control (67%), p = 0,002. La media de reintervenciones realizadas por paciente fue menor en C-FAV que en grupo control (0,49 vs. 1,18, p = 0,01). Los pacientes del grupo C-FAV presentaron un menor número de reintervenciones por obstrucción frente al grupo control (0,42 vs. 1,04, p = 0,01). Conclusiones: En nuestra experiencia, el seguimiento intensivo no ha mejorado la permeabilidad de las fístulas húmero-axilares, disminuyendo no obstante las reintervenciones por obstrucción. El seguimiento de estos accesos debe ser clínico basado en datos de hemodiálisis, quedando la valoración ecográfica para aquellos casos con sospecha de malfunción (AU)

Aim: To evaluate the impact of a specific vascular access (arteriovenous fistula) unit (AVF-U) and intensive follow-up controls on the patency of humero-axillary fistulas (Hax-AVF). Patients and method: Retrospective study. Between January 2005 and December 2009, 108 Hax-AVF were implanted. From June 2007 an AVF-U was established. A preoperative Doppler ultrasonography analysis was performed and a follow-up control carried out a month after the intervention and subsequently every 3 months. Results: An analysis was made of the patency of 57 Hax-AVF performed between June 2007 and December 2009 (AVF-U Group), in comparison to 51 interventions performed during the previous 30 months (Control Group). No differences in the patency achieved were found at 12 or 24 months, with a secondary permeability at 12 months of 49% in the AVF-U Group and 52% in the Control Group. The percentage of patients needing to be reoperated was lower in the AVF-U Group (35%) than in the Control Group (67%) (P=.02). The mean number of re-operations per patient was lower in the AVF-U Group than in the Control Group (0.49 vs 1.18; P=.01). The patients of the AVF-U Group underwent fewer reoperations for obstruction as compared to the Control Group (0.42 vs 1.04; P=.01). Conclusions: In our experience, the intensive follow-up controls did not improve the patency of the Hax-AVF, although reoperations due to obstruction did diminish. The follow-up of these fistulas should be clinically based on haemodialysis data, leaving ultrasound evaluation for those cases where AVF failure is suspected (AU)

Is ultrasound follow-up necessary in humero-axillary prosthetic arteriovenous fistulas for haemodialysis?

AIM: To evaluate through a specific trial on vascular access fistulas (T-VAF), the impact of intensive follow-up controls on the permeability of humero-axillary fistulas (Hax-AVF). PATIENTS AND METHOD: Retrospective study. Between January 2005 and December 2009, 108 Hax-AVF were implanted. From June 2007 a T-AVF was established. A preoperative duplex was performed and a follow-up control carried out a month after the intervention and subsequently every 3 months. RESULTS: An analysis was made of the permeability of 57 Hax-AVF carried out between June 2007 and December 2009 (T-AVF Group), in comparison to 51 interventions performed during the previous 30 months (Control Group). No differences in the permeability achieved were found at 12 and 24 months, with a secondary permeability at 12 months of 49% in the T-AVF Group and 52% in the Control Group. The percentage of patients needing to be re-operated was inferior in the T-AVF Group (35%) than in the Control Group (67%) p=0.02. The re-operation per patient average was lower in the T-AVF Group than in the Control Group (0.49 vs. 1.18 p=0.01). The patients of the TAVF Group underwent a lesser number of re-operations for obstruction as opposed to the Control Group (0.42 vs 1.04 p=0.01). CONCLUSIONS: In our experience, the intensive follow-up controls did not improve the permeability of the Hax-AVF, although re-operations due to obstruction did diminish. The follow-up of these access fistulas should be clinical based on hemodialysis data, leaving ultrasonographic evaluation for those cases where a malfunction is suspected.

Validación del eco-Doppler carotídeo como diagnóstico único de la estenosis carotídea extracraneal / Validation of Doppler ultrasound as the only diagnosis of extracranial carotid stenosis

Introducción. En los últimos años ha crecido el interés por indicar la endarterectomía carotídea basada en eco-Doppler, por lo que es imprescindible la validación continuada de los laboratorios hemodinámicos de los servicios de Cirugía Vascular. Objetivos. Presentar la concordancia del eco-Doppler frente a una prueba de referencia en los pacientes remitidos a nuestro laboratorio. Identificar el grupo de pacientes en los que la exactitud del eco-Doppler podría emplearse como prueba de diagnóstico único preoperatoria. Pacientes y métodos. Se estudian 47 pacientes (94 carótidas) con sospecha de enfermedad carotídea significativa en pacientes remitidos a nuestro laboratorio. En todos se realiza prueba de referencia de control (arteriografía: 78,7%; angiorresonancia: 21,3%). Resultados. Se ha obtenido en el total de la serie un coeficiente kappa de 0,89 dúplex-prueba de referencia. Se detectaron 10 oclusiones, que se confirmaron con pruebas de referencia. Las curvas COR (serie global) para la velocidad sistólica (VS), velocidad diastólica (VD) y ratio VS carótida interna/común (VSI/VSC) presentaron las áreas 92,7, 93,4 y 90,5%, respectivamente. Se han establecido como puntos de corte de estenosis grave los siguientes: VS: 275 cm/s (sensibilidad: 93,3%; especificidad: 88,9%); VD: 90 cm/s (sensibilidad: 90%; especificidad: 94,4%) y ratio VSI/VSC: 3,5 (sensibilidad: 90%; especificidad: 85,2%). La validez del eco-Doppler mejora cuando se excluyen los pacientes con estenosis grave u oclusión contralateral (COR VS: 97,2%; VD: 97,7%; ratio VSI/VSC: 92,5%). En el diagnóstico de estenosis grave con contralateral levemoderada, el valor kappa ha sido 0,95. Conclusiones. El dúplex carotídeo es una prueba fiable y válida en el diagnóstico de la estenosis carotídea extracraneal. Puede utilizarse como diagnóstico preoperatorio único cuando el eje carotídeo contralateral no presente enfermedad grave y el estudio sea de buena calidad

Introduction. In recent years there has been growing interest to indicate Doppler ultrasound-based carotid endarterectomy, which thus makes continual validation by the haemodynamic laboratories in Vascular Surgery services essential. Aims. Our aim was to present a comparison of DU versus a reference test in patients referred to our laboratory. We also sought to identify the group of patients that allowed the precision of Doppler ultrasound to be used as a single preoperative diagnostic test. Patients and methods.We studied a sample of 47 patients (94 carotids) who were referred to our laboratory with suspected significant carotid diseases. A control reference test was carried out in all of them (arteriography: 78.7%; MR angiography: 21.3%). Results. A duplex-reference test kappa coefficient of 0.89 was obtained for the whole series. Ten occlusions were detected, which were confirmed with reference tests. The ROC curves (overall series) for the systolic velocity (SV), diastolic velocity (DV) and the internal/common carotid SV ratio (ISV/ CSV) presented areas of 92.7, 93.4 and 90.5%, respectively. The following cut-off points for severe stenosis were established: SV: 275 cm/s (sensitivity: 93.3%; specificity: 88.9%); DV: 90 cm/s (sensitivity: 90%; specificity: 94.4%) and the ISV/CSV ratio: 3.5 (sensitivity: 90%; specificity: 85.2%). The validity of Doppler ultrasound is improved when patients with severe stenosis or contralateral occlusion are excluded (ROC SV: 97.2%; DV: 97.7%; ISV/CSV ratio: 92.5%). In the diagnosis of severe stenosis with mild-moderate contralateral stenosis, the kappa value was 0.95. Conclusions. Carotid duplex is a reliable, valid test for diagnosing extracranial carotid stenosis. It can be used as a single preoperative diagnosis when the contralateral carotid axis does not present any serious disease and the study is of sufficiently high quality

Papel de los polimorfismos del promotor del gen de la interleucina-10 en la génesis de los aneurismas de la aorta abdominal / Role of polymorphisms in the interleukin-10 gene promoter in the development of an abdominal aortic aneurysm

Introducción. La interleucina-10 (IL-10) es una citocina antiinflamatoria que se ha implicado en la patogenia de los aneurismas de la aorta abdominal (AAA). Se han descrito variaciones en el promotor de su gen que pueden condicionar su producción, y alterar el equilibrio entre citocinas pro y antiinflamatorias. Objetivo. Estudiar el genotipo de los microsatélites y polimorfismos del promotor de la IL-10 para valorar las posibles predisposiciones genéticas en la población española portadora de un AAA. Sujetos y métodos. Se realizó el tipado de los microsatélites asociados (IL-10R e IL-10G) y de las tres posiciones polimórficas (-1082, -819, -592) del promotor de la IL-10 en un grupo de 72 pacientes con un AAA, y se comparó con una muestra control de 349 sujetos sanos. Resultados. Microsatélites asociados: no se encontraron diferencias significativas al analizar el patrón fenotípico de los microsatélites IL-10G e IL-10R entre los pacientes con un AAA y el grupo control. Polimorfismos puntuales: no se encontraron diferencias significativas al analizar los diferentes haplotipos del promotor del gen de la IL-10 entre los pacientes con un AAA y el grupo control. Conclusiones. A la vista de nuestros resultados, en la población española no existe una relación entre ninguno de los diferentes alelos de los microsatélites IL-10R e IL-10G asociados al promotor de la IL-10 y la presencia de un AAA en dicha población. Tampoco existe una relación entre los diferentes haplotipos del promotor de la IL-10 y esta enfermedad en nuestro medio

INTRODUCTION. The anti-inflammatory cytokine interleukin-10 (IL-10) has been implicated in the pathogenesis of the abdominal aortic aneurysm (AAA). Changes in the promoter region of the IL-10 gene have been found to condition its production, altering the balance between pro- and anti-inflammatory cytokines. AIM. Associated microsatellites and polymorphisms in the IL-10 promoter were typed in an attempt to identify a possible genetic predisposition for AAA in the Spanish population. SUBJECTS AND METHODS. Associated microsatellites (IL-10R and IL-10G) and the three polymorphic loci (-1082, -819, -592) of the IL-10 promoter were determined in 72 patients with AAA and compared with those established in 349 healthy control subjects. RESULTS. No significant differences were observed between the AAA and control group in the phenotypic patterns shown by the microsatellites IL-10G and IL-10R nor in the different haplotypes of the IL-10 gene promoter. CONCLUSIONS. Our findings suggest no relationship between the different alleles of the IL-10R and IL-10G microsatellites and AAA in the Spanish population. We were also unable to detect a clear association between the different IL-10 promoter haplotypes and this disease

Fibrodisplasia del tronco tibioperoneo. A propósito de un caso / Arterial fibrodysplasia of tibioperoneal trunk. A case report

Se presenta el caso de un varón de 43 años con un cuadro de isquemia aguda producida por la trombosis de un aneurisma del tronco tibioperoneo secundario a una fibrodisplasia. Se realiza una revisión de la literatura, se discute la metodología diagnóstica y se revisan las diferentes opciones terapéuticas (AU)

¿Es útil el empleo del autotransfusor en la cirugía aortoilíaca por enfermedad oclusiva? / Use of autotransfusion device in aortoiliac reconstruction because occlusive disease. Is it worthwile?

Objetivo: El objetivo del presente estudio es determinar si el empleo de dispositivos de autotransfusión es útil en las reconstrucciones del sector aortoilíaeo por patología oclusiva. Material y métodos: Se analizó de forma retrospectiva el empleo del autotransfusor en 227 procedimientos electivos primarios realizados sobre la aorta por patología oclusiva del sector aortoilíaeo. Se valoraron los factores de riesgo, valores hematológicos preoperatorios, volumen reinfundido por el autotransfusor y administración de sangre homóloga. Se realizó, además, una valoración del coste económico derivado del uso de AT.Resultados: De los 227 procedimientos, 201 fueron bypasses aortobifemorales y 26 aortofemorales. El uso del autotransfusor se asoció a una disminución en la cantidad de unidades de sangre homóloga administrada en los pacientes intervenidos de bypass aortobifemoral (1,7 frente a 3 unidades, p<0,01). Sin embargo, esto no ocurrió en las revascularizaciones unilaterales (1 frente a 1,2 unidades -N.S.). Asimismo, el mímero de pacientes en los que la cirugía se realizó sin necesidad de transfusión homóloga durante todo el ingreso fue mayor cuando se empleó el autotransfusor, (41 por ciento frente a 24 por ciento, p<0,05). Esta diferencia fue significativa en los pacientes intervenidos de un bypass aortobifemoral (41 por cientofrente a 17 por ciento, p<0,05) pero no para la cirugía aortofemoral (40 por ciento frente a 47 por ciento, p NS).El coste del dispositivo de autotransfusión se justificó con recuperaciones superiores a 440 ml de sangre. Siguiendo este criterio, el autotransfusor resultó rentable desde un punto de vista de costes en el 36 por ciento de los pacientes (37 por ciento en los aortobifemorales y 20 por ciento en los aortofemorales). El uso de autotransfusor supone en nuestro medio un coste aproximado adicional de unas 3.000 ptas. por paciente en el caso de un bypass aortobifemoral y de 19.000 ptas. en un bypass aortofemoral. Conclusiones El empleo rutinario del autotransfusor está justificado en el bypass aortobifemoral por patología oclusiva. Reduce cl consumo de sangre, con un discreto aumento de costes. En la cirugía unilateral, cl empleo rutinario del autotransfusor no está justificado, no reduce el consumo de sangre de banco y no es coste-efectivo. (AU)